Written by Wirtschaftsjournal / Fahlenkamp.
Every year in Germany there are approximately 40,000 surgical interventions to correct urethral stenosis. Tissue replacement using autologous cell transplantation could provide an alternative to conventional treatments. Prof. Dr. Dirk Fahlenkamp, Head of Department Urology at the Zeisigwald Clinics at Bethanien, Chemnitz, explains the procedure in an interview with the Wirtschaftsjournal.
Wirtschaftsjournal: What does the term autologous cell transplantation mean?
Prof. Dirk Fahlenkamp: The urologist Dr. med. Gouya Ram-Liebig was the first person in the world to develop this procedure for reconstructing the urethra. Previously the only way to treat tissue defects in the urethra had been by transplanting mucous membranes from the mouth. To do this the requisite quantity of tissue had to be taken from the patient in advance of the transplant procedure. Thanks to this new technique it is now possible to manufacture the tissue in the laboratory from a sample which is a quarter of the size of a one cent piece.
WJ: How are the transplant grafts manufactured?
Prof. Fahlenkamp: The company MukoCell GmbH in Dresden manufactures the first ever tissue engineering1 product which is called MukoCell®. In this form of manufactured tissue cell engineering, a few living cells are enough to start the procedure of growing tissue from them. Under this procedure, the cells which are removed from the patient during a biopsy are isolated, expanded and cultivated on the surface of a biological carrier. The tissue then grows within 21 days in highly standardized sterile clean room laboratory conditions until it has reached the specific size required in each case. The tissue graft for the patient is then packed in a sterile container and sent to the clinic where it will be used.
WJ: How is a tissue graft manufactured in a laboratory different from a conventional tissue graft?
Prof. Fahlenkamp: Autologous tissue grafts are easily adaptable in size and form; they are resistant to urine and mechanically stable. This is due to the biological carrier substance which gives the tissue greater elasticity. This is transplanted with the mucous membranes from the mouth and is broken down in the body in four to eight weeks. Additionally, the transplant graft bonds with the surrounding tissue a short while after transplantation, and develops into a fully functioning urethra. This procedure has already been successfully performed on 15 patients in Chemnitz. Across the Federal Republic as a whole, over 50 patients have already been treated with MukoCell at specialist centers.
WJ: What are the benefits of this new technology for patients?
Prof. Fahlenkamp: Autologous transplantation, that is the transplantation of living cells, is an alternative to traditional forms of transplant in that the tissue removal is a procedure which is mostly pain-free and free of complications. Previously, sections of mucous membrane up to 20 centimeters in length, depending on the size of the defect in the urethra, had to be removed from the mouth in a surgical operation under anesthetic. The large surgical wound was very slow to heal. Complications, such as pain, sensory disorders, scars, difficulties in speaking, eating and drinking were all associated with the removal of large sections of mucous membranes from the mouth. Now all that is a required is for a sample of tissue the size of a grain of rice to be taken. This can be done as an outpatient operation under local anesthetic, meaning there is no need for surgery. The complications described above do not arise. This method also has a very low relapse rate. It is estimated that between 5,000 and 10,000 patients per year could benefit in this way from an autologous tissue transplant.
WJ: Are there any other indications of what else this procedure could be used for?
Prof. Fahlenkamp: It is quite possible to think of other uses for this technique in urology. Bladder defects, for example, could be another indication for this treatment. This would, however, require production of an elastic form of tissue, which has so far presented a great challenge to research.
1 Tissue engineering (including the construction or growth of tissue) is the umbrella term for the manufacture of biological tissue from the cultivation of cells in order to either replace or regenerate diseased tissue in a patient. To do this, cells are taken from the donor organism and these are multiplied in the laboratory. Finally they are re-transplanted into the recipient.
Interview: Stefanie Rudolph, Wirtschaftjournal in Sachsen, 12/57.