By Stephen Brown
Rome - An Italian doctor has reconstructed vaginas for two women born with a rare congenital deformation, using their own cells to build vaginal tissue in the lab for the first time.
Dr Cinzia Marchese of Rome's Policlinico Umberto I hospital, giving details of the operations on Wednesday, said a 28-year-old woman who underwent the first such operation a year ago now has a healthy vagina.
"She has got married and is living a normal life," said Marchese, whose study has been published in the journal Human Reproduction.
The second operation was carried out on a 17-year-old girl on Tuesday and the first signs are that the cells taken by biopsy from the area where her vagina should grow and provide mucosal tissue.
Mucosal tissue is found inside the vagina, the mouth and elsewhere in the body and has important attributes distinct from ordinary skin.
The two women had a condition called Mayer-Von Rokitansky-Kuster-Hauser Syndrome, or MRKHS for short, which affects an estimated one in 4 000 to 5 000 female infants.
Girls with the syndrome are born with no vagina. The patient often has a normal uterus, ovaries and external secondary sexual organs such as breasts, but cannot have sexual intercourse or give birth.
"Usually the syndrome is diagnosed when they are young and they try to have sexual intercourse for the first time and it hurts," said Marchese.
Often embarrassed to talk about it with their parents when they are young, MRKHS sufferers often "live the rest of their lives with no normal sexual life, even though they are normal women with normal feelings", she said.
So far, surgeons have been able to correct the condition by reconstructing a vagina out of grafted skin or from intestinal tissue, but the surgery is highly invasive, lengthy and painful. And it takes a long time to grow a normal mucosal wall.
Such women, if they have healthy ovaries, have been able to achieve pregnancy by artificial insemination but would then need a surrogate mother to carry the fertilised eggs and give birth.
"What we do is to take a little biopsy of 0.5cm from the place the vagina should be, " Marchese said. They used an enzyme to break down the tissue and then let the immature cells, called stem cells, generate new, mucosal tissue on their own.
It took about 15 days to get a thick enough layer to transplant into the patients, Marchese said.
Marchese, a 47-year-old professor of clinical pathology and biotechnology, studied the use of stem cells to build sheets of skin in vitro to provide skin grafts for burn victims at Harvard Medical School with the technique's pioneer, Howard Green.
"When I came back to Italy I modified this technique for mucosal vagina tissue," she said, adding that its success could be good news for women with cancer and other vaginal complaints.