Four teenage girls born with Mayer-Rokitansky-Küster-Hauser syndrome, a condition that causes the underdevelopment or complete absence of the vagina, cervix and uterus, have successfully received vaginas grown from their own cells. The vaginal development, implantation and incorporation were reported on April 10 in The Lancet by researchers from the Wake Forest Baptist Medical Center.
The lab-grown vaginas began as vulvar tissue samples. These samples, taken from the female patients when they were between the ages of 13 and 18, were incubated for four weeks and then layered onto a cellular scaffold. In an interview with The News-Letter, Kathryn Tifft, a lecturer in the Biology Department at Hopkins, described the use of a cellular scaffold.
“The scaffold provides the structure that gives the organ physical shape and ... may provide physical cues that help the cells to act appropriately,” Tifft said.
One face of the vaginal scaffold used by the Wake Forest researchers included cells that would become vaginal epithelial cells; the other face supported cells that would become vaginal muscle tissue. By working with a team of surgeons from the Federico Gomez Children’s Hospital of Mexico, the Wake Forest researchers were able to ensure that the scaffolds were individually sized for each patient.
Once the cell-scaffold constructs were properly formed, the researchers developed them in a bioreactor, an incubation device that maintains the same conditions as the human body. After about a week, the Wake Forest researchers handed the lab-grown vaginas back to the surgeons for implantation. The implantations, which involved the careful forging of connections between vaginal and uterine tissues, occurred between 2005 and 2008. The researchers closely monitored the structure and function of the vaginas before publishing the results this April.
According to the published results, the patients could menstruate and have sexual intercourse six months after surgery. Amazingly, the sexual experiences were not only pain-free, but reportedly involved normal levels of sexual arousal, satisfaction and orgasm. This demonstrates that the lab-grown vaginas were properly connected to the nervous system. Vaginal innervation allows for physical changes to the female genitalia upon sexual arousal. In the absence of these changes, particularly if vaginal lubrication is not increased, sex can be painful for the female.
Currently, patients suffering from Mayer-Rokitansky-Kuster-Hauser Syndrome can either undergo tissue dilation or reconstructive surgery, Dilation of existing tissue is only possible in mild cases of the condition, as it relies on the existence of vaginal tissue. Several underdeveloped vaginas or the complete absence of vaginal tissue necessitates reconstructive surgery. This procedure involves tissue grafts from other body parts, usually the intestine or parts of the skin. Although this reconstructive surgery uses the patient’s own cells, it has a high risk of complication. According to Tifft, this increased risk is not surprising.
“Different cell types act very differently, so cells from the skin or organ are unlikely to function exactly like normal vaginal cells. Organs grown using cells from the same organ that is being made are more likely to be able to function properly than cells from a different tissue,” Tifft said.
This new procedure is a welcome alternative to tissue dilation and reconstructive surgery. The lab-grown vaginas are developed until the structural cells can recruit other cells in vivo to fully form the organ. This ensures the incorporation of localized cells, lowering the risk of complications. Furthermore, the scaffold, which is the only part of the implanted structure foreign to the patient’s body, degrades months after the surgery. This leaves the patients’ own cells to form the muscles and epithelial cells of the vagina.
“The cells will secrete molecules to create a scaffold of extracellular matrix molecules that are naturally found in these organs,” Tifft said. Essentially, this means the cultured cells replace the degraded scaffold.
The four lab-grown vaginas that were successfully grown and implanted represent a huge advance for both genitalia-related surgery and reconstructive medicine as a whole. Lab-grown sexual organs can help alleviate genitalia problems related to trauma and cancer and serve as a useful for people seeking sex-reassignment surgery. Moreover, these amazing tissues demonstrate that lab-engineered organs can grow inside the human body to fully functioning capacity.
