A 10-year-old British boy has become the first child to undergo a windpipe transplant with an organ crafted from his own stem cells.

It is hoped that using the boy’s own tissue in the nine-hour operation at Great Ormond Street Hospital will cut the risk of rejection.

The world’s first tissue-engineered windpipe transplant was done in Spain in 2008 but with a shorter graft.

Doctors say the boy is doing well and breathing normally.

He has a rare condition called Long Segment Congenital Tracheal Stenosis, in which patients are born with an extremely narrow airway.

At birth his airway was just one millimetre across.

Doctors had previously operated to expand his airway but in November last year he suffered complications from erosion of a metal stent in his windpipe or trachea.

In order to build him a new airway, doctors took a donor trachea, stripped it down to the collagen scaffolding, and then injected stem cells taken from his bone marrow.

The organ was then implanted in the boy and over the next month, doctors expect the stem cells to transform into specialised cells which form the inside and outside of the trachea.

Pioneering

Two years ago, Claudia Castillo, a 30-year-old mother of two, became the first person to receive a transplant organ created from stem cells.

She received a new section of trachea after her own had been damaged by tuberculosis.

The latest operation is a significant advance on that pioneering work, as it is the first time a whole tissue engineered windpipe has been transplanted.

Claudia Castillo became the first person to have a tissue-engineered organ transplant

Also in Ms Castillo’s case, doctors grew the new tissue from her stem cells in the laboratory.

But in the UK operation, the donor windpipe was treated with a cocktail of chemicals designed to prompt the stem cells to grow into new tissue once inside the body.

Professor Martin Birchall, head of translational regenerative medicine at University College London, who was part of the team behind the operation, said it was a “real milestone”.

“It is the first time a child has received stem cell organ treatment, and it’s the longest airway that has ever been replaced.

“I think the technique will allow not just highly specialised hospitals to carry out stem cell organ transplants.”

He said more clinical trials were needed to prove the technique worked but that the team was also thinking about transplanting other organs, such as the oesophagus.

Professor Anthony Hollander, ARC professor of rheumatology and tissue engineering at the University of Bristol, said: “The advantage of the new approach is that it can be performed quickly and cheaply and so if successful it could be made available to large numbers of patients at relatively low cost.”

But he said the technique was more unpredictable than that done in the laboratory because there is less control of the type of stem cells being used and a very short time between seeding the cells onto the scaffold and implantation.

Stem cell pioneer Professor Paolo Macchiarini, from Careggi University Hospital in Florence was involved in both the Spanish and UK transplants.

He had also carried out the stem cell procedure on a 53-year-old Italian woman.

Deep brain stimulation is a promising therapy for epilepsy, US researchers from Stanford University have said.

In a clinical trial, 110 people had electrodes implanted in their brains and their seizures were monitored.

Forty-one per cent of patients showed a reduction in seizures after 13 months while 56% experienced a reduction after two years.

The patients all suffered from regular epileptic seizures and had failed to respond to drug treatment.

Deep brain stimulation (DBS) is a surgical treatment involving the implantation of a medical device called a brain pacemaker, which sends electrical impulses to specific parts of the brain.

In the group of patients who received brain stimulation, researchers noted a 41% reduction in seizures compared to a 14.5% decline in seizures in a control group. This group did not receive stimulation.

Invasive therapy

Epilepsy is a common neurological disorder which is characterised by recurrent seizures. These seizures can cause temporary loss of consciousness, convulsions, confusion or disturbances in sensations.

According to the World Health Organization, epilepsy affects 50 million people worldwide.

Previous studies indicate that one third of those with epilepsy do not respond to anti-epileptic drugs.

Dr Robert Fisher, director of the Epilepsy Centre at Stanford University and lead author of the study, said electrical deep brain stimulation does reduce seizure frequency in patients.

But he cautioned: “DBS therapy is invasive and serious complications can occur. Additional clinical knowledge would help to determine the best candidates for DBS therapy.”

Simon Wigglesworth, deputy chief executive at UK charity Epilepsy Action, said: “We have been hopeful for some time that deep brain stimulation may be a treatment option for some people with epilepsy.

“This study is exciting news and could be an important development in the treatment of epilepsy in the 30% of people whose seizures don’t respond to traditional drug therapies.”

The research is published online in the journal Epilepsia.

Impotence is a strong predictor of heart attack and death among high-risk patients, German researchers have said.

The study of 1,519 men who already had cardiovascular disease found those who were also impotent had twice the risk of a heart attack or death as the rest.

The University of Saarland report, published in the journal Circulation, suggests men with impotence should be checked for cardiovascular disease.

Some experts want doctors to ask about impotence in over-40s health checks.

Impotence is linked to inadequate blood flow in the penile arteries.

These are much smaller than coronary arteries.

So for some men, a persistent failure to get an erection might be an early sign that his arteries are narrowing.

The study followed men from 13 countries who already had cardiovascular disease. It monitored whether they went on to have heart attacks or strokes.

The participants were also asked about their erectile dysfunction at the start, after two years and after five years.

Powerful predictor

As well as being twice as likely to die or have a heart attack, those with impotence were also 10% more likely to have a stroke and 20% more likely to be hospitalised for heart failure, after adjusting for factors like age and smoking.

Lead author Michael Böhm said men who take medication to treat impotence should also be checked for cardiovascular disease, but this does not always happen.

“The medication works and the patient doesn’t show up anymore,” Mr Böhm said.

“These men are being treated for the erectile dysfunction, but not the underlying cardiovascular disease. A whole segment of men is being placed at risk.”

The study confirms previous research that has linked impotence and cardiovascular disease. It has been welcomed by British experts.

Unrecognised

Richard Hobbs, professor of general practice at the University of Birmingham, said doctors were already aware of the link, but said the findings of this study added weight to the case for screening of men with impotence for the co-existence of vascular disease.

Professor Mike Kirby, a doctor who specialises in erectile dysfunction and cardiovascular risk, thinks doctors should be more pro-active still.

As well as checking impotent patients for cardiovascular risks, he wants doctors to start screening for impotence.

“This provides very good evidence to support a campaign to persuade doctors to ask about erectile dysfunction as part of routine cardiovascular assessment,” said Professor Kirby.

He said men who were impotent often did not raise it with their doctors because they were embarrassed and were not aware of the wider health implications.

‘National disgrace’

Dr Geoff Hackett, a consultant urologist at the Good Hope Hospital in Sutton Coldfield, said it was a “national disgrace” that medicals for over-40s did not include questions about impotence.

He said that when GPs were trying to assess whether a patient is at risk of heart disease, they asked about smoking and family history. But impotence is a more significant risk factor for cardiovascular disease than smoking.

“A GP might be thought negligent not to ask about smoking, yet they routinely fail to ask about impotence.” he said.

A Department of Health spokesperson said: “Some reports do suggest a link between erectile dysfunction and heart disease, and the Department of Health will keep new and emerging evidence under review in relation to the content of the NHS Health Check programme.”

The NHS Health Check programme offers five-yearly medicals to 40 to 74-year-olds with the aim of preventing heart disease, stroke, diabetes and chronic kidney disease.

They started being rolled out in 2009.

Two key treatments do not halt diabetes in people with early signs of the disease, a large study has found.

Researchers said the results showed the only way to ensure future health in people at high risk of diabetes was exercise and a healthy diet.

Trials in more than 9,000 people also found no reduction in future heart problems in people prescribed two drug treatments compared with dummy pills.

Diabetes UK said 7m people in the UK were at risk of developing diabetes.

Everyone taking part in the study, published in the New England Journal of Medicine, had been diagnosed with what doctors call “impaired glucose tolerance”.

It effectively means that people have high blood sugar and their bodies are starting to not respond to insulin as well as they should.

Sometimes called pre-diabetes, it is thought that the condition is a stage in the development of full-blown type 2 diabetes, and can be associated with obesity.

It is thought that in the UK, around 17% of 35-65 year olds have impaired glucose tolerance.

Medical intervention

In the trial, researchers in the US and UK looked at whether using a drug that lowers blood pressure or a drug which lowers blood sugar could be used to stop diabetes developing in these high-risk patients.

But the results, from patients in 40 countries, found no great difference in how many people went on to get diabetes when prescribed either drug compared with a dummy pill.

Neither did the drugs prevent future heart attacks and strokes, which are dangerous complications of the condition.

In the blood-sugar lowering drug part of the study around a third of people went on to develop diabetes within five years whether they were taking the real medicine or dummy medicine.

Professor Rury Holman, director of the Diabetes Trials Unit at the University of Oxford, said the treatments were proven to be effective once someone had diabetes but there was an “urgent need” for drugs to prevent the disease and its complications developing in the first place in those at high risk.

He said: “The most successful treatment for someone at high risk of diabetes is diet and exercise.”

‘Dramatic difference’

Co-author Professor John McMurray from the University of Glasgow agreed that the results reinforced the importance of lifestyle changes in preventing diabetes.

“Losing as little as 5% of body weight has been shown to make a dramatic difference in other studies.”

Dr Victoria King, research manager at Diabetes UK, said: “Unfortunately there is unlikely to be a quick and easy route to prevent type 2 diabetes and a healthy balanced lifestyle with a good diet and physical activity levels are the best preventative methods.”

But she added some drugs may be of benefit in these patients and the latest study would help doctors prescribe the most appropriate option.

Professor Alan Maryon-Davis, president, UK Faculty of Public Health, said: “A huge number of people are in this ‘nearly diabetes’ category without realising it.

“We need to rapidly expand the national healthcheck programme, with many more community dietitians and exercise advisors ready to offer help.”

Successful treatment for gum disease cuts the risk of pregnant women giving birth early, US research suggests.

The preliminary research showed those whose gum disease was not treated successfully were three times more likely to give birth before 35 weeks.

The study of 160 women was presented to the annual conference of the American Association for Dental Research.

UK experts said the finding was “controversial” but advised pregnant women to take care of teeth and gums.

Doctors have previously established that severe gum infections cause an increase in the production of prostaglandin and tumour necrosis factor, chemicals which induce labour, to be produced.

The study by researchers at the University of Pennsylvania enrolled women who were between six and 20 weeks’ pregnant.

All of the volunteers had gum disease. These women were given treatment, which was successful in one third of the cases.

The researchers found a “strong and significant association” between successful treatment and full-term births.

Those whose treatment did not work were “significantly more likely” to give birth before 35 weeks.

‘Controversial area’

UK experts warned that this was a small study and further research was needed.

Professor Iain Chapple, from Birmingham Dental School, said this was a “controversial area”, and that while some previous studies had shown an association between gum disease and early births, others had shown no association.

He said the results “could reflect behavioural differences in the successfully treated group versus the unsuccessfully treated group” such as “poorer diets, smoking status, alcohol intake and many other issues”.

But Dr Nigel Carter, chief executive of the British Dental Health Foundation, said: “This paper adds to the growing evidence around links between gum disease and pre-term babies.

“It is further strong evidence that pregnant women should take care of their periodontal health and receive appropriate treatment during their pregnancy to reduce as far as possible their chance of a pre-term birth.”

‘Only one clue’

This advice was echoed by the pregnancy research charity Tommy’s.

Its consultant midwife, Annette Briley, said: “Women in the UK do get free dental care during pregnancy and for a year after the baby’s birth.

“It is therefore good to go to the dentist early in pregnancy and ensure that your mouth, teeth and gums are as healthy as they can be.

“However, the causes of preterm birth are multifactorial and many women with no periodontal disease may still have their babies early, this is only one clue to one cause.”