It is estimated that every year 6% of newborns in the world, approximately 8 million children, suffer from a congenital defect. When a fetus shows signs of difficulty during pregnancy, doctors are faced with a daunting task: finding out what’s wrong and how to intervene without putting the pregnancy at risk. Despite genetic and imaging tests, it is difficult to intervene. Now, however, revolutionary research seems to have managed to overcome these limitations: a team of scientists has been able to recreate, outside the maternal womb, some organoids, that is, groups of cells that imitate tissues and organs, in all respects, and which allow us to study how they react to treatments and therapies.
The results, published on Nature Medicinepave the way for a series of unprecedented discoveries on the cause and progression of malformations and the possibility, for the first time, of “accessing the fetus without touching it”, he underlined Mattia Gerlibiologist at University College London, expert in stem cells and co-author of the study.
An unprecedented approach
For the first time, scientists, including some researchers from the Bambino Gesù Pediatric Hospital, the Telethon Institute of Genetics and Medicine of Pozzuoli, the Polytechnic of Milan, the University of Naples Federico II and the Southern High School of Naples , have obtained the organoids by exploiting the progenitor cells present in the amniotic fluid, also known as multipotent stem cells: they are cells that have already taken the first steps towards specialization and have been “cultivated” to obtain replicas of the kidneys, small intestine and lungs of the fetus.
The cells were taken from 12 ongoing pregnancies, between the 16th and 34th week of gestation. It is a fundamental step, because, until now, the creation of an organoid had never occurred with living fetuses, since a biopsy was necessary.
No risk to the fetus
To date, amniotic fluid is already extracted for routine checks in order to check for the presence of possible anomalies and, since organoids only take four to six weeks to grow, the new technique should allow us to have the necessary time to carry out tests and treatments before giving birth. Organoids can be used to evaluate various therapeutic possibilities and to monitor the progress of treatments without disturbing the fetus. The team, in particular, followed the progress of treatment in fetuses affected by congenital diaphragmatic hernia, a birth defect that compresses the lungs and prevents them from developing properly. By comparing the organoids obtained from amniotic fluid cells, taken before and after the treatment, by inflating a balloon in the trachea of the fetus, an improvement in the condition of the organoids themselves was observed, deducing that the treatment was working.
The limitations to overcome
Now the hope is that organoids could, one day, provide information about how congenital conditions progress and be used to personalize treatment for individual fetuses. The applications for evaluating current therapies and developing new drugs are also promising, as is the prospect of being able to intervene in the presence of preterm pregnancies so as to guarantee the survival of the unborn child. To date, not all organs can be replicated with this technique: only the epithelial tissue of the kidneys, small intestine and lungs has been successfully cultured. Furthermore, it may not be possible to use this new method to model organs that do not shed cells into the amniotic fluid, such as the brain or heart. Despite this, once this approach reaches clinical application, organoids obtained through amniocentesis could be a fundamental tool in the screening planned for pregnant women.