Esophageal regeneration without tissue engineering
Researchers from the University of Wisconsin College of Medicine, working under the guidance of Professor Kulwinder Dua, successfully performed an unprecedented operation to restore a 5-centimeter esophageal defect using metal stents and an extracellular matrix.
A 24-year-old patient was admitted to the clinic with a ruptured esophagus, the cause of which was a mediastinal abscess that developed as a complication of one of the injuries received earlier in a car accident and caused partial paralysis. Despite several surgical operations, doctors were unable to repair the defect, as it was too large and affected the entire thickness of the esophageal wall.
The esophagus is a hollow muscular tube connecting the oral cavity with the stomach and providing the movement of food and fluid. In some cases, the removal of a tumor or the elimination of traumatic injuries requires the removal of the esophagus or its fragment, after which the removed area is usually replaced by a fragment of the intestine. However, in this case, such a procedure was impossible due to the size of the defect and the poor health of the patient.
The authors decided to get out of the situation with the help of a technique tested on dogs, but never before applied to humans. Using an endoscope, they inserted a metal stent with a diameter of 18 mm and a length of 120 mm into the defect zone. After that, the entire area of the defect was covered with a commercially available extracellular matrix preparation made from donor skin, over which an adhesive gel based on the patient's blood plasma was sprayed, containing a large number of platelets and growth factors that not only stimulate cell growth, but also attract stem cells to the damaged area. The patient's sternocleidomastoid muscle passing along the lateral surface of the neck was fixed on top of the extracellular matrix and adhesive gel. 4 weeks after the operation, due to the migration of the stent, it had to be removed and replaced with 3 stents placed according to the telescopic principle for better fixation in the tissue.
Initially, the stents were planned to be removed 12 weeks after implantation, but the patient refused surgery for fear of developing narrowing or damage to the esophagus. As a result, the stents were removed only after 3.5 years, and an ultrasound examination conducted a year later revealed foci of fibrosis (scarring) and regeneration of all five layers of the esophageal wall. At the same time, swallowing tests demonstrated a complete restoration of swallowing function. However, due to the long delay in the removal of stents at the request of the patient, the authors find it difficult to draw conclusions about the duration of the recovery period.
According to the researchers, despite the excellent results, it is still very early to talk about the widespread introduction of this method into clinical practice. To do this, it is necessary to conduct additional studies on large animals and clinical studies of phase 1 and 2. They also note that the advantage of the described approach is that it implies the use of commercially available materials approved for clinical practice without the use of complex tissue engineering methods.
The article Kulwinder S Dua et al. In-vivo oesophageal regeneration in a human being by use of a non-biological scaffold and extracellular matrix is published in The Lancet.
Evgeniya Ryabtseva
Portal "Eternal youth" http://vechnayamolodost.ru based on EurekAlert materials!: The Lancet: US doctors report reconstructing new esophagus tissue in a critically ill patient.
11.04.2016