King’s College Hospital

UK first in heart failure operation.

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Sevket Gocer,
Sevket Gocer, right, was the first patient in the UK

A pioneering operation to improve the function of failing hearts while they are still beating has taken place in the UK for the first time.

Patients with heart failure struggle to pump blood around the body and mild exercise can leave them breathless.

Surgeons used a form of “cardiac sewing” to remove scar tissue and reduce the size of the heart so it pumps more efficiently.

The operation took place at King’s College Hospital in London.

One common cause of heart failure is when the arteries which nourish the organ become blocked, leading to a heart attack. Heart muscle dies and is replaced by hard scar tissue which does not beat.

Over time, the scar tissue can stretch so chambers of the heart become larger, meaning the organ has more blood to force out with each heartbeat.

The overall effect is a weaker heart, less able to do its job, transforming simple day-to-day tasks like climbing stairs into extreme exertions.

In the operation, surgeons used a wire with anchors at both ends to pierce two sections of heart muscle. When the wire was tightened, the walls of the heart were “remodelled”.

Before and after surgery
Scar tissue, in grey, is “sewn out”

The scar tissue was effectively removed and the volume of one of the chambers of the heart was reduced by a quarter.

Sevket Gocer, 58 and from Bromley in south-east London, was the first patient to be treated in the UK. His heart function is said to have “improved significantly” after the operation.

A similar procedure used to be performed by opening up the chest and stopping the heart, but it was a very risky operation and fell out of medical practice.

Surgeons hope the less invasive operation, which can be performed while the heart is still pumping, will be a better option for patients.

Mr Olaf Wendler, a professor of cardiac surgery at King’s College Hospital, told the BBC: “In the technique we have now used for the first time in the UK, one does not need to stop the heart, one does not even necessarily need to place the patient on a heart-lung machine.

“It’s a less traumatic and less invasive type of procedure.”

He said the operation was being tested in a trial at hospitals across Europe and that the procedure could make a difference to patients’ lives.

He said: “[If successful] it’s bringing them on to an exercise level where they’re able to look after themselves properly including going to do the shopping and having a social life.”

Prof Jeremy Pearson, associate medical director at the British Heart Foundation, said: “The results of this trial will determine if this experimental procedure is safe.

“If the trial is successful, there will be further use of the technology as surgeons gain expertise in the technique. As more people are treated with this procedure, it will become fully clear whether it will have a real benefit for patients.”

Tiny stem-cell livers grown in laboratory.

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Tiny functioning human livers have been grown from stem cells in the laboratory by scientists in Japan.

They said they were “gobsmacked” when liver buds, the earliest stage of the organ’s development, formed spontaneously.

stem cell

The team, reporting their findings in Nature, hope that transplanting thousands of liver buds could reverse liver failure.

Experts welcomed the findings, describing them as “exciting”.

Scientists around the world are trying to grow organs in the lab to overcome a shortage of organ donors.

Some patients already have bladders made from their own cells, but dense solid organs such as the liver and kidneys are much harder to produce.

Grow your own

The team at the Yokohama City University were reproducing the earliest stages of liver development – similar to that in an embryo.

They had mixed three types of cells – two types of stem cells and material taken from the umbilical cord.

 “Start Quote

The promise of an off-the-shelf-liver seems much closer than one could hope even a year ago”

Dr Dusko IlicKing’s College London

Unexpectedly, the cells began to organise themselves and appeared to curl up to form a liver bud.

These buds were transplanted into mice, where they hooked themselves up with the blood supply and began to function as little livers.

The transplants increased the lifespan of mice with liver failure.

Prof Takanori Takebe said: “We just simply mixed three cell types and found that they unexpectedly self-organise to form a three-dimensional liver bud – this is a rudimentary liver.

“And finally we proved that liver bud transplantation could offer therapeutic potential against liver failure.”

He told the BBC that he was “completely gobsmacked” and “absolutely surprised” when he first witnessed the buds forming.

Treatment hope

Analysis

This is a significant advance for the field of regenerative medicine.

It might seem like science fiction but there are already people walking around today with organs made from stem cells.

A major breakthrough came in 2006 when bladders made from patients’ own cells were implanted. Grown windpipes have also been transplanted.

In regenerative medicine there are four levels of complexity: flat structures such as skin; tubessuch as blood vessels; hollow organs such as the bladder; and solid organs such as the kidney, heart and liver.

The last group is the most difficult as they are complex organs containing many types of tissue.

This is a new approach to growing solid organs and is yet another window on what could be the future of organ transplants.

It is thought that other organs such as the pancreas, kidneys and even the lungs could be developed in the same way. However, turning this into a treatment is still a distant prospect.

The buds are 4-5mm in length but the researchers say they would need to develop buds that are much smaller and could be injected into the blood.

The buds would not grow to be a whole new liver, but would embed themselves in the failing one and restore it.

Dr Varuna Aluvihare, a liver transplant physician at King’s College Hospital in London, told BBC News: “This a great piece of work and as a proof of concept, very interesting.

“The real highlight is that such simple mixtures of cells can differentiate and organise themselves into highly complex tissue structures that function well in an animal model.”

He said the liver was very damaged in chronic liver disease so there were still questions about where the buds were transplanted and how they would function.

The risk of a tumour developing after the transplant would also need to be assessed.

Dr Dusko Ilic, a stem cell scientist at King’s College London, said: “The strategy is very promising, and represents a huge step forward.

“Although the promise of an off-the-shelf-liver seems much closer than one could hope even a year ago, the paper is only a proof of concept. There is much unknown and it will take years before it could be applied in regenerative medicine.”

Prof Chris Mason, the chair of regenerative medicine at University College London, said there might be more immediate benefits for drug testing.

New medicines can be toxic to the human liver in a way which does not show up in animal tests. He said using liver buds might be a better was to test for toxicity.

Source: BBC