PEORIA — A pioneer in regenerative medicine traveled from Sweden to the Children’s Hospital of Illinois in Peoria last month to create a new trachea for a 2-year-old girl.
Born in South Korea without a trachea in 2010, Hannah Warren had been unable to breathe, eat, drink or swallow on her own. To keep her alive, doctors in Seoul reconfigured her esophagus so that a breathing tube could go down it from her mouth to her lungs, creating an airway for her to breathe. The esophagus normally runs behind the windpipe and carries food to the stomach. The doctors closed off her stomach from her esophagus so the acid wouldn’t get into her lungs, and she was fed by a feeding tube that was inserted directly into her stomach.
When Hannah was a month old, Lindsay Sohn, a Korean-born nurse, suggested that Mark Holterman, a pediatric surgeon at the Children’s Hospital of Illinois who was traveling on a business trip in Seoul, meet the infant who was expected to die soon. Holterman was intrigued by Hannah’s case and began to think of an appropriate way to help her. On a subsequent visit, Holterman met Hannah’s parents — Darryl, a Canadian man, and Lee Young-mi, a Korean women — and offered to do what he could to find a solution for their infant.
Through the Internet, the couple and Holterman learned about the field of regenerative medicine and hoped that this would be the answer to Hannah’s dilemma. After doing further research on regenerative medicine, they learned of Paolo Macchiarini, a professor of regenerative surgery at the Karolinska Institute in Stockholm, Sweden, who had built new tracheas out of stem cells and biological scaffolds, and implanted them into adult patients.
“We did about 14 transfers before in adults using stem cells and biological scaffolds,” said Macchiarini. “There are some that are doing well. Some patients died because of complications and/or because of prior arrangements in which the patients had cancer.”
Although Macchiarini had never regenerated and implanted a trachea in a child, he offered to help Hannah.
“It is the first time I’ve done a transfer on a child,” said Macchiarini.
Hannah’s parents could not afford the surgery, so Holterman arranged to have the procedure at the Children’s Hospital of Illinois, a Roman Catholic hospital that is part of OSF Saint Francis Medical Center. The hospital considers the operation that would have cost the family hundreds of thousands of dollars as part of its mission to provide charity care, but also views it as a way to champion a type of stem-cell therapy that doesn’t involve human embryos. The Catholic church opposes using stem cells derived from human embryos in research or treatment.
Macchiarini was unsure if Hannah’s surgery would be successful.
“There are so many complications and unexpected events that can occur, so I was quite uncertain about the final outcome,” said Macchiarini.
Prior to the surgery, Macchiarini extracted stem cells from Hannah’s bone marrow with a special needle inserted into her hip bone. The stem cells were seeded in a lab onto a plastic scaffold, where it took less than a week for them to multiply and create a new trachea.
During the course of nine hours, Macchiarini successfully implanted Hannah’s new trachea.
“We implanted a new bioartificial trachea comprised of a plastic nanofiber scaffold that was seeded with bone marrow cells,” said Holterman. “The cell seeding allows for the trachea to incorporate new blood vessels supply and begin differentiation into tracheal type cells. We connected the two ends of her swallowing tube (esophagus) together.”
According to Holterman, it will take Hannah three months to recover from the surgery. Hannah is wearing a “trach,” a tracheostomy tube that was inserted from the surface of her neck directly into the windpipe and connected to a ventilator, to help her breathe.
Currently, Hannah is being treated for an infection that resulted from the surgery.
“(Hannah is) complicated by a leak from her swallowing tube surgical connection, and this has caused an infection that she is recovering from,” said Holterman.
Hannah’s parents said their daughter is quickly recovering from her surgery.
“Hannah has made tremendous progress since her surgery,” said Darryl and Lee Young-mi Warren in an email statement. “Of course there were some anticipated complications, but each one was recognized quickly and dealt with effectively. She’s getting back to the ‘old’ Hannah we remember, admire and love. She’s tough as nails and an inspiration.”
As a result of the surgery, Hannah is now able to smell and taste.
“She can now smell and taste,” said the Warrens in an email statement. “She loves experimenting with new foods, but right now lollipops are her favorite. With time, she’ll be able to swallow and eat and drink like normal.”
According to Holterman, Hannah will probably need another trachea surgery in five years.
“She will grow, the windpipe may not be big enough for her as an adult,” said Holterman. “Also, we hope to connect her voice box to her new trachea one day to allow her to speak.”
If Hannah needs an additional trachea surgery, her parents would like to return to the Children’s Hospital of Illinois for the procedure.
“Our experience (at the Children’s Hospital of Illinois) has been outstanding,” said the Warrens in an email statement. “We have received the highest level of care and support. When we first entered Hannah’s new hospital room at OSF PICU, we knew this was the place Hannah and her family needed and deserved to be. All staff have been very professional, supportive and friendly. We are blessed to be in such an incredible place with equally incredible people.”
Hannah’s parents think their daughter will “be able to live a long, healthy and normal life.”
“Hannah has multiple miracles notched on her young belt and she’s just getting started,” said the Warrens in an email statement. “She will never be just ‘normal.’ She’s extraordinary in every way.
“She is breathing well with her new trachea and trach, and there’s real hope that once her trachea can be attached ‘normally’ with her larynx and voice box, she’ll be able to breathe normally without the trach, and she’ll be able to talk.”
The stem-cell technique that Macchiarini used to create Hannah’s trachea has been used to create other body parts, and holds promise for treating other birth defects and childhood diseases. Similar methods have been used to grow bladders and urethras. Last year a girl in Sweden got a lab-made vein using her own stem cells and a cadaver vein.
Scientists hope to eventually use the stem-cell technique to create solid organs, including kidneys and livers.
If you would like to help provide world-class medical care to children like Hannah, please call the Children’s Hospital of Illinois Foundation at (309) 566-5666.