Diagnosing congenital disorders before birth and creating in the lab new organs that can be transplanted into infants without the risk of rejection. The future challenges to regenerative medicine are lying right at the doorstop of the Great Ormond Street Hospital, London, where Paolo De Coppi – a member of the Aspen Italian Talent Abroad group – is the head of pediatric surgery. His team has already performed cell-based, tissue engineered tracheal replacement in a child. In the near future, he is planning to correct congenital disorders at birth using the cells of the fetus extracted during amniocentesis.
Today the problem of rejection during transplants is being solved by creating organs in the lab. How did you reach this conclusion?
Regenerative medicine reconstructs organs with cells extract from the patient; it is therefore a bridge between transplant surgery and medicine. Years of study have led us to the operating theater: we have already performed tracheal transplants in younger patient.
Generally, when an organ is transplanted from a donor, it is perceived by the receiving body as extraneous. Instead, we took our patients’ own stem cells, expanded them and were able to construct a trachea in the lab that was not rejected. Practically speaking, we had to take an organ from someone who died, remove all the donor’s cells and plant those of the receiver. The challenge of the future is to engineer more complex organs; the liver for example, the lungs or the heart.
You performed surgery on infants. How do you create an organ for someone just born?
My research is concerned with congenital deformities, especially those diagnosed before birth. When we discover that the fetus is missing a muscle, the diaphragm for example, the next step is to engineer one using the stem cells of the fetus. We can intervene at birth because pregnancy gives us time to prepare. These disorders are diagnosed at around the twentieth week, before the sixth month. Recently, we were able to demonstrate that amniotic stem cells can take on the characteristics of fetal cells without any manipulation. In the near future, we hope to be able to correct congenital deformities at birth using fetal stem cells extracted during amniocentesis.
Are there studies being done in this area in Italy as well?
There is considerable excellence in regenerative medicine and stem cell research, even though the climate is not favorable. Personally, I am still working with the University of Padua – where I got my degree – and opened a small lab in the university. I often go over from London to encourage these efforts, and I hope that the area of regenerative medicine will be successful.
However, the unsolved problem in Italy is how to attract talent from abroad. It’s useless to bring back Italians who have chosen to leave; what we need is young researchers from other countries. This can be done by making a career in Italy as competitive as any in England and Germany. The key, once again, is to create incentives to merit. Our country has so many strong points; now we need to create conditions where talent, partly attracted perhaps by the beauty here, are motivated to move here and do research.
