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Woman speaks after pioneering voice box transplant
By Admin (from 22/04/2011 @ 08:00:12, in en - Science and Society, read 2156 times)

Just 13 days after receiving a pioneering larynx transplant, a Californian woman was able to speak her first words in a decade. Her own larynx was permanently damaged by an operation 11 years ago.

The first combined larynx and thyroid transplant was performed in 1998, but in the latest operation Brenda Charett Jensen of Modesto, California, received a section of trachea too. The feat, which took 18 hours, was performed last October at the Medical Center of the University of California, Davis, but announced only yesterday.

The transplant also works far better than the first because more of the donated organs' nerves have been plugged into the 52-year-old woman's own nervous system. This enables her to move muscles that control speaking by moving the vocal cords, and others that will eventually allow her to swallow again, once she relearns how to do it.

"It is a miracle," says Jensen. "I'm talking, talking, talking, which just amazes my family and friends." The sound of her voice is her own, rather than that of the donor.

Her own voice again

Jensen lost her speech 11 years ago through complications during surgery that blocked her airway. The blockage stopped her larynx working, so for years she has communicated with a handheld voice synthesiser. That operation also left her breathing dependent on a tracheotomy – a tube inserted into her windpipe. With the new trachea, the hope is that she should also be able to breathe normally and dispense with the tracheotomy.

One of the reasons that Jensen was chosen was that she was already on immunosuppressive drugs because of a previous kidney-pancreas transplant, reducing the risk of organ rejection.

Led by surgeon Gregory Farwell, the team transplanted the larynx, thyroid and trachea of a woman who died in an accident . The thyroid has to be transplanted too, because it supplies blood to the larynx.

Farwell and his colleagues plumbed numerous blood vessels from the donated organs into Jensen's own, and also reconnected five major nerves to maximise her control over the muscle tissue that came with the transplant.

"The first larynx transplant only reconnected three nerves," says Martin Birchall of University College London, who served as chief scientific adviser to the team, specialising in reconnection of the nerves. "Here, we've done five nerves with the intention of restoring much more laryngeal function than the original, and eventually getting rid of the tracheotomy."

Rapid progress

Birchall said that although the man who received the original larynx transplant at the Cleveland Research Clinic in Ohio in 1998 is doing well and has recovered some speech, he still has a tracheotomy. His vocal cords have never moved, whereas Jensen's were moving in just a fortnight. "We've already seen much quicker progress in speech," says Birchall.

The breakthrough is the latest to exploit rapid improvements in microsurgical techniques since the first face transplant in 2005. The increasingly ambitious use of more complex transplants including muscles, nerves and bones has also highlighted the greater functionality that this allows the recipient.

Birchall believes that recipients will benefit even more if their own stem cells are extracted and used to coat donated organs chemically stripped of all donor cells. Because all that's then left of the donated organ is a "scaffold" of the protein collagen, it can be covered with the recipient's own cells and transplanted into their body with no fear of rejection.

In 2008, Birchall was part of a team that demonstrated this can be done by performing the world's first trachea transplant.

Complex challenge

Birchall told New Scientist that such an approach would be possible with the larynx, but unlike the trachea – which is simply a tube – a recoated larynx would also have to include artificially constructed muscles and blood vessels because of its much more complex function.

"It's much more complex than the trachea, but we do have ways to address these things," says Birchall. "Regenerative medicine using stem cells is now moving at a furious pace, and the airways and plumbing systems are at the forefront," he says.

Hear and see her voice here.

Source: NewScientist

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