“I don't have a very romantic answer: my comfort zone is the gut.
To each his own theme".
Pablo Stringa knows that minutes are not too many and he gets to the point.
He is a young veterinarian from La Plata.
A Conicet researcher who is seeing the fruits of the very specific field he decided to dedicate himself to:
intestine transplantation in animals
, a topic that led him to a very human finding.
Thanks to him, the number of intestine donations promises to grow in the coming years.
Until now it was understood that the intestines "suitable" for transplantation should come from deceased subjects, of course, but with the quality of having active cardiac activity.
He looks like a nonsense but he is not.
In any case, Stringa proved that this is not the case.
The explanation for this apparent contradiction is that "from the moment there is cerebral or encephalic death, the person is considered to have died, even though the body is 'plugged in' in intensive care and seems alive, that is, even though
there is breathing and the heart is beating
, ”the vet clarified.
Ever since the first intestine transplant was performed in the 1960s, the world has lived convinced that only those organs with an active blood supply (that is, “plugged in”) were suitable for use in transplants.
Stringa's years of work consisted of proving that
could also be transplanted (if only a few minutes had passed since death), which promises to broaden the spectrum of potential donors.
Pablo Stringa, Conicet research veterinarian who is dedicated to intestinal transplantation in animals.
Photo: Conicet / Rayelén Baridón
It is no small matter, considering that intestine transplantation is especially cumbersome: "It is one of the most complex, due to the qualities of the organ and the
that is required between donor and recipient."
The icing on the cake is Emma, a Spanish baby who is evolving favorably these days, eight months after the intestine transplant "in asystole", the medical concept that summarizes the idea of cardiorespiratory arrest, which she had to go through.
The expectation of adding the intestine to the organs capable of being used in asystole is great.
“Last year, in Spain, 42% of the transplanted organs were obtained from patients in these conditions”, that is to say that they were not “plugged in”, in the sense of being artificially maintained with cardiac activity.
Emma, the Spanish baby who underwent an intestinal transplant in asystole, thanks to the research of the Argentine Pablo Stringa.
Photo: TwinClick Communication CONICET
It's a few minutes, maybe
no more than five
that will open as a window now.
A patient who dies of cardiac arrest, for example, could be consolidated as a donor.
Since Emma was operated on, two babies have already received transplants of this type in the same Spanish institution as her: the La Paz University Hospital in Madrid.
The entire case has just been published in the
American Journal of Transplantation
The collaboration with Spain has its explanation: in addition to working in the Transplant Laboratory of the Faculty of Medical Sciences of the UNLP, Stringa did the preclinical study at the Institute of Immunological and Physiopathological Studies (IIFP, CONICET-UNLP).
It was with rats, first, and with pigs, later.
But the clinical part, with humans, was in charge of doctors from that Spanish hospital, always in collaboration with the veterinarian.
At the head of the team was Francisco Hernández Oliveros, head of the Pediatric Transplant Section of that hospital.
“Paco is one of those guys who is really 'touched' by what he does,” Stringa said modestly.
"No, no... I'm more of the pick and shovel," he evaluated between laughs.
It is difficult to estimate to what extent the supply of donors will increase, partly because intestine transplantation is an underdeveloped practice.
“It's like the chicken and egg riddle.
It is a transplant that is rarely requested, but it is also carried out in few places, ”he remarked.
Baby Emma and the Spanish doctors who carried out the first bowel transplant in asystole.
"In Argentina, intestine transplants have been done since 2000. Except for countries like Argentina or Chile, if you need an intestine transplant in other parts of Latin America, it will be difficult for you," he said.
The difficulties of intestine transplantation
“On the one hand, the intestine is difficult in itself due to its anatomical characteristics.
If I measure 1.75 meters and I need a transplant, neither a person of 2.20 nor one of 1.40 can donate to me.
It has to be someone
to me in their physical characteristics, ”Stringa described.
In addition, “it is a complex organ from the immunological point of view.
It has a lymphocyte load (
N. de la R.: white blood cells
) set sail, added to what is the microflora”.
In other words, “there are many more chances of
rejecting an intestine
than a kidney.
Achieving immunological tolerance is really very complex”.
As he said, “having such an immune load, you have to find a balance.
If the receiver is stronger than the organ, it rejects it.
And if the organ is stronger, a condition called 'graft-versus-host disease' is generated.
The organ begins to attack its receptor.”
Just like if the person had an autoimmune disease, he compared.
Study rats, save babies
Why so many transplanted babies?
Although many adults require intestine transplants "due to having had an accident in which they lost a lot of intestinal mass, or due to a tumor, for example", many of the diseases linked to this organ (of which it is usually said that it is "the second brain”) are diagnosed in newborns.
For example, if like Emma they are born with a failure that
prevents them from absorbing the necessary nutrients
to meet the minimum requirements of growth.
Ivana Ivanoff Marinoff, Rodrigo Papa Gobbi, Natalia Lausada, Pablo Stringa, Claudio Ledesma, Leandro Vecchio Dezillo and Martín Rumbo, from the Institute of Immunological and Pathophysiological Studies (IIFP, CONICET-UNLP).
Credits: CONICET Photography/Rayelén Baridón
“It was 2016 when with Paco we wrote this as a project.
In 2022, a baby could be operated on.
The satisfaction is enormous, ”he noted.
“Luckily I got to meet Emma.
And I communicate often with her parents.
The world of research is always very much within four walls.
He is a hermit.
But our work group seeks a rather transnational medicine.
It is an enormous satisfaction, ”she emphasized.
“I wanted to breathe the problem from the other side.
In a laboratory with tubes and rats everything is very light.
But when I travel to Madrid to work, I stay with the patients and their families in a residential home, ”she said.
Then he concluded: “When one internalizes with this world... well, it is tense, or rather, sensitive.
These are very critical situations.
You live with life and death all the time.”
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