Her cystic fibrosis was threatening her life, and her case spurred a debate on how to allocate donor organs. Lungs and other organs for transplant are scarce.
But what if there were another way? What if you could grow a custom-made organ in a lab?
It sounds incredible. But just a three-hour drive from the Philadelphia hospital where Sarah got her transplant, another little girl is benefiting from just that sort of technology. Two years ago, Angela Irizarry of Lewisburg, Pa., needed a crucial blood vessel. Researchers built her one in a laboratory, using cells from her own bone marrow. Today the 5-year-old sings, dances and dreams of becoming a firefighter - and a doctor.
Growing lungs and other organs for transplant is still in the future, but scientists are working toward that goal. In North Carolina, a 3-D printer builds prototype kidneys. In several labs, scientists study how to build on the internal scaffolding of hearts, lungs, livers and kidneys of people and pigs to make custom-made implants.
Here's the dream scenario: A patient donates cells, either from a biopsy or maybe just a blood draw. A lab uses them, or cells made from them, to seed onto a scaffold that's shaped like the organ he needs. Then, says Dr. Harald Ott of Massachusetts General Hospital, "we can regenerate an organ that will not be rejected (and can be) grown on demand and transplanted surgically, similar to a donor organ."
That won't happen anytime soon for solid organs like lungs or livers. But as Angela Irizarry's case shows, simpler body parts are already being put into patients as researchers explore the possibilities of the field.
Just a few weeks ago, a girl in Peoria, Ill., got an experimental windpipe that used a synthetic scaffold covered in stem cells from her own bone marrow. More than a dozen patients have had similar operations.
Dozens of people are thriving with experimental bladders made from their own cells, as are more than a dozen who have urethras made from their own bladder tissue. A Swedish girl who got a vein made with her marrow cells to bypass a liver vein blockage in 2011 is still doing well, her surgeon says.
In some cases the idea has even become standard practice. Surgeons can use a patient's own cells, processed in a lab, to repair cartilage in the knee. Burn victims are treated with lab-grown skin.
In 2011, it was Angela Irizarry's turn to wade into the field of tissue engineering.
Angela was born in 2007 with a heart that had only one functional pumping chamber, a potentially lethal condition that leaves the body short of oxygen. Standard treatment involves a series of operations, the last of which implants a blood vessel near the heart to connect a vein to an artery, which effectively rearranges the organ's plumbing.
Yale University surgeons told Angela's parents they could try to create that conduit with bone marrow cells. It had already worked for a series of patients in Japan, but Angela would be the first participant in an American study.
"There was a risk," recalled Angela's mother, Claudia Irizarry. But she and her husband liked the idea that the implant would grow along with Angela, so that it wouldn't have to be replaced later.
So, over 12 hours one day, doctors took bone marrow from Angela and extracted certain cells, seeded them onto a 5-inch-long biodegradable tube, incubated them for two hours, and then implanted the graft into Angela to grow into a blood vessel.
It's been almost two years and Angela is doing well, her mother says. Before the surgery she couldn't run or play without getting tired and turning blue from lack of oxygen, she said. Now, "she is able to have a normal play day."
This seed-and-scaffold approach to creating a body part is not as simple as seeding a lawn. In fact, the researchers in charge of Angela's study had been putting the lab-made blood vessels into people for nearly a decade in Japan before they realized that they were completely wrong in their understanding of what was happening inside the body.
"We'd always assumed we were making blood vessels from the cells we were seeding onto the graft," said Dr. Christopher Breuer, now at Nationwide Children's Hospital in Columbus, Ohio. But then studies in mice showed that in fact, the building blocks were cells that migrated in from other blood vessels. The seeded cells actually died off quickly. "We in essence found out we had done the right thing for the wrong reasons," Breuer said.
Other kinds of implants have also shown that the seeded cells can act as beacons that summon cells from the recipient's body, said William Wagner, director of the McGowan Institute for Regenerative Medicine at the University of Pittsburgh. Sometimes that works out fine, but other times it can lead to scarring or inflammation instead, he said. Controlling what happens when an engineered implant interacts with the body is a key challenge, he said.
So far, the lab-grown parts implanted in people have involved fairly simple structures - basically sheets, tubes and hollow containers, notes Anthony Atala of Wake Forest University whose lab also has made scaffolds for noses and ears. Solid internal organs like livers, hearts and kidneys are far more complex to make.
His pioneering lab at Wake Forest is using a 3-D printer to make miniature prototype kidneys, some as small as a half dollar, and other structures for research. Instead of depositing ink, the printer puts down a gel-like biodegradable scaffold plus a mixture of cells to build a kidney layer by layer. Atala expects it will take many years before printed organs find their way into patients.
Another organ-building strategy used by Atala and maybe half a dozen other labs starts with an organ, washes its cells off the inert scaffolding that holds cells together, and then plants that scaffolding with new cells.
"It's almost like taking an apartment building, moving everybody out ... and then really trying to repopulate that apartment building with different cells," says Dr. John LaMattina of the University of Maryland School of Medicine. He's using the approach to build livers. It's the repopulating part that's the most challenging, he adds.
One goal of that process is humanizing pig organs for transplant, by replacing their cells with human ones.
"I believe the future is ... a pig matrix covered with your own cells," says Doris Taylor of the Texas Heart Institute in Houston. She reported creating a rudimentary beating rat heart in 2008 with the cell-replacement technique and is now applying it to a variety of organs.
Ott's lab and the Yale lab of Laura Niklason have used the cell-replacement process to make rat lungs that worked temporarily in those rodents. Now they're thinking bigger, working with pig and human lung scaffolds in the lab. A human lung scaffold, Niklason notes, feels like a handful of Jell-O.
Cell replacement has also worked for kidneys. Ott recently reported that lab-made kidneys in rats didn't perform as well as regular kidneys. But, he said, just a "good enough organ" could get somebody off dialysis. He has just started testing the approach with transplants in pigs.
Ott is also working to grow human cells on human and pig heart scaffolds for study in the laboratory.
There are plenty of challenges with this organ-building approach. One is getting the right cells to build the organ. Cells from the patient's own organ might not be available or usable. So Niklason and others are exploring genetic reprogramming so that, say, blood or skin cells could be turned into appropriate cells for organ-growing.
Others look to stem cells from bone marrow or body fat that could be nudged into becoming the right kinds of cells for particular organs. In the near term, organs might instead be built with donor cells stored in a lab, and the organ recipient would still need anti-rejection drugs.
How long until doctors start testing solid organs in people? Ott hopes to see human studies on some lab-grown organ in five to 10 years. Wagner calls that very optimistic and thinks 15 to 20 years is more realistic. Niklason also forecasts two decades for the first human study of a lung that will work long-term.
But LaMattina figures five to 10 years might be about right for human studies of his specialty, the liver.
"I'm an optimist," he adds. "You have to be an optimist in this job."
--- Michael Rubinkam in Lewisburg, Pa., and Allen Breed in Winston-Salem, N.C., contributed to this story.
SAN ANTONIO (AP) -- Manu Ginobili had 24 points and 10 assists in a surprise start to spark the San Antonio Spurs to a 114-104 victory over the Miami Heat in Game 5 of the NBA Finals on Sunday night, pushing the Spurs one victory away from their fifth championship.
Danny Green scored 24 points and broke Ray Allen's finals record for 3s in a series with 25. Tony Parker had 26 points for San Antonio.
LeBron James scored 25 points on 8-for-22 shooting for the Heat and Dwyane Wade had 25 points and 10 assists. But the Heat missed 21 of their first 29 shots to fall behind by 17 points in the second quarter of another uninspired performance.
Game 6 of the best-of-seven series is Tuesday night in Miami.
Whirling through the defense like the Manu of old, Ginobili shrugged off a postseason full of disappointment to deliver a performance that the Spurs have never needed more desperately. He hit 8 of 14 shots and had his highest points total since June 4, 2012.
Tim Duncan had 13 points and 11 rebounds, Green was 6 for 10 from 3-point range, and Parker gutted through 36 minutes on that tender right hamstring. Kawhi Leonard had 16 points and eight rebounds, and the San Antonio shot 60 percent to overcome 19 turnovers.
Allen scored 21 points and Chris Bosh had 16 points and six rebounds for the Heat, who were stunned by a vintage Ginobili performance early and never really recovered.
Miami missed 21 of its first 29 shots and Green hit three straight 3s in the middle of the second quarter to tie Allen's record of 22. The Spurs led 47-30 on Duncan's two free throws before the Heat finally showed some fight.
A 12-0 run got them back within striking distance at 47-42 and the Heat surged out of the halftime gates to cut San Antonio's lead to 61-59 in the first 1:17 of the third.
San Antonio pushed right back, getting a jumper from Parker, a 3-pointer from Green that broke Allen's record and a lefty layup from Ginobili to get a little breathing room.
Ginobili closed the third with a twisting, off-balance, left-handed runner and a right-handed drive to the bucket to bring cheers of "Manu! Manu!" from the delirious crowd.
Nowhere to be found in the first four games, and for most of these playoffs, Ginobili had his fingerprints all over the opening of Game 5. He hit a step-back jumper, had two pretty assists on a backdoor cut from Green and a thunderous dunk from Duncan and knocked down two free throws for an early 9-4 lead.
Ginobili's 3-pointer from the wing made it 15-10, bringing the nervous crowd to its feet. The awakening was a welcome sign for the Spurs, who desperately missed their playmaking daredevil.
The Heat reclaimed momentum in Game 4 thanks to a shuffle of the starting lineup by coach Erik Spoelstra, who moved sharp-shooter Mike Miller into the starting lineup in Udonis Haslem's place, giving Miami a smaller lineup that spaced the floor better and gave James and Wade room to operate.
Spurs coach Gregg Popovich made a move to match that on Sunday night, putting the struggling Ginobili in for center Tiago Splitter. Ginobili was averaging 7.5 points in the first four games and shooting 34 percent. In the final year of his deal, the soon-to-be 36-year-old was asked about retirement on Saturday.
The crowd roared for Ginobili when he was introduced last, with one banner reading "We still Gino-believe!"
Wade had endured a similarly quiet start to these finals before erupting for 32 points and six steals in Miami's Game 4 victory that evened the series. That carried over to the opening quarter of Game 5, when Wade's assertive play helped Miami withstand Ginobili's initial haymaker.
Wade's trademark euro-step on the break and two free throws kept the game tight and James hit a 3-pointer to tie it at 17 with under 5 minutes to play in the period.
The two teams entered Game 5 riding a pendulum of momentum that was swinging wildly back and forth over the previous three games. A classic, air-tight Game 1 victory by the Spurs gave way to three blowouts - Miami by 19 in Game 1, San Antonio by 36 in Game 3 and the Heat by 16 in Game 4.
The volatility made it difficult for either team to feel like it had a grip on expectations heading into the pivotal Game 5, but the Heat did appear to finally assert themselves with a dominant performance from their three All-Stars on Thursday night.
James, Wade and Bosh broke out of a series-long malaise to combine for 85 points, 30 rebounds and 10 steals, finally finding a way to get to the rim against the paint-clogging Spurs defense.
But for a team as talented and experienced as they are, these Heat have shown a maddening inconsistency over the last month. The team that won 27 straight during the regular season came into the game having going 11 straight games without winning two in a row.
There was so much more riding on this game for the Spurs than the Heat, who reclaimed homecourt advantage with their decisive victory in Game 4. Under the current 2-3-2 format that was adopted in 1985, no visiting team has won both Games 6 and 7 on the road in the finals.
And the Spurs played with more urgency from the start.
Now the Heat's backs are against the wall one more time. And it was Ginobili who put them there.
MIAMI (AP) -- Maybe the St. Louis Cardinals were looking ahead to the Chicago Cubs.
In a matchup of worst versus first, NL Central leader St. Louis mustered only five hits Sunday and lost to the woeful Miami Marlins. 7-2.
The Cardinals dropped two of three games in Miami - the first series they've lost since April 26-28 against Pittsburgh. They went 5-4 on a three-city trip and open a homestand Monday against the traditional rival Cubs.
The Marlins climbed above .300 at 21-47, still baseball's worst record.
"We didn't see it," St. Louis manager Mike Matheny said. "The team we saw is hitting the ball and making good pitches."
The Cardinals didn't do enough of either. Tyler Lyons (2-3), making his fifth major league start, lost for the third time in a row after winning his first two decisions.
Lyons gave up six runs in 5 1-3 innings.
"I made some mistakes with guys on base," the rookie said.
The Cardinals, who have the lowest ERA in the majors, gave up 19 runs in the series. Meanwhile, they managed just three hits and one run against Ricky Nolasco, who pitched seven innings.
St. Louis scored a run in the ninth and loaded the bases with two out, but Steve Cishek came to strike out pinch-hitter Matt Holliday looking to end the game.
Matheny liked the comeback bid.
"These guys have always shown that - they don't give up," Matheny said. "They keep coming. That will pay off in the long run."
Aside from the ninth inning, the Cardinals did little. All of their hits were singles, and with Holliday and NL batting leader Yadier Molina out of the starting lineup and given a day to rest, St. Louis went down in order in five of the first six innings.
Carlos Beltran finished 0 for 4 to end the longest active hitting streak in the majors at 14 games. Matt Carpenter was also hitless and went 7 for 38 (.184) on the trip.
Jon Jay and Matt Adams drove in St. Louis' runs. Right fielder Giancarlo Stanton made a leaping catch at the fence to rob Adams of an RBI and an extra-base hit in the seventh.
"With that lineup, probably among the top three in the league, you just have to stay focused," Nolasco said. "You can't lose concentration and leave balls over the middle, because they're just going to start crushing you. I was able to get away with some balls that they hit hard, and we had great defense at the same time, so it worked out."
A bout of wildness against the bottom of the order cost Lyons in the fourth inning. He hit Jeff Mathis, who was batting .128, and then Nolasco walked for the first time this year to load the bases. Juan Pierre followed with a two-out, two-run single for a 4-1 Miami lead.
Placido Polanco had three hits starting for the first time in five games after being sidelined by back stiffness. His two-out, two-run double in the fifth made it 6-1.
The abundance of offense was a refreshing change for Nolasco (4-7), who has endured the worst run support of any pitcher with at least 14 starts. Luxuriating in an early lead, he retired 11 in a row during one stretch.
"It helps a ton," he said. "It just changes everything and the way you pitch and your approach."
Pierre drove in two runs and had two hits to extend his hitting streak to 12 games, while Justin Ruggiano added a two-RBI single. The Marlins have won eight of the past 14 games, their best stretch this season.
"To get a win against such a great team and a great lineup, and to play as well as we did, that's a great day for all of us," Marlins manager Mike Redmond said.
NOTES: Miami 1B Logan Morrison (back) took grounders before the game but sat out for the third day in a row. ... Lyons' six strikeouts were a career high. ... The crowd of 18,468 was the largest of the homestand. ... David Freese had one hit, but his lifetime average against the Marlins fell to .462 (18 for 39).