In-vivo oesophageal regeneration in a human being by use of a non-biological scaffold and extracellular matrix. Lancet 2016 Jul 02;388(10039):55-61
Date
04/14/2016Pubmed ID
27068836DOI
10.1016/S0140-6736(15)01036-3Scopus ID
2-s2.0-84963614903 (requires institutional sign-in at Scopus site) 54 CitationsAbstract
BACKGROUND: Tissue-engineered extracellular matrix populated with autologous pluripotent cells can result in de-novo organogenesis, but the technique is complex, not widely available, and has not yet been used to repair large oesophageal defects in human beings. We aimed to use readily available stents and extracellular matrix to regenerate the oesophagus in vivo in a human being to re-establish swallowing function.
METHODS: In a patient aged 24 years, we endoscopically placed a readily available, fully covered, self-expanding, metal stent (diameter 18 mm, length 120 mm) to bridge a 5 cm full-thickness oesophageal segment destroyed by a mediastinal abscess and leading to direct communication between the hypopharynx and the mediastinum. A commercially available extracellular matrix was used to cover the stent and was sprayed with autologous platelet-rich plasma adhesive gel. The sternocleidomastoid muscle was placed over the matrix. After 4 weeks, stent removal was needed due to stent migration, and was replaced with three stents telescopically aligned to improve anchoring. The stents were removed after 3ยท5 years and the oesophagus was assessed by endoscopy, biopsy, endoscopic ultrasonography, and high-resolution impedance manometry.
FINDINGS: After stent removal we saw full-thickness regeneration of the oesophagus with stratified squamous epithelium, a normal five-layer wall, and peristaltic motility with bolus transit. 4 years after stent removal, the patient was eating a normal diet and maintaining a steady weight.
INTERPRETATION: Maintenance of the structural morphology of the oesophagus with off-the-shelf non-biological scaffold and stimulation of regeneration with commercially available extracellular matrix led to de-novo structural and functional regeneration of the oesophagus.
FUNDING: None.
Author List
Dua KS, Hogan WJ, Aadam AA, Gasparri MAuthors
Kulwinder S. Dua MD Professor in the Medicine department at Medical College of WisconsinMario G. Gasparri MD Professor in the Surgery department at Medical College of Wisconsin
MESH terms used to index this publication - Major topics in bold
AbscessBone Plates
Cervical Vertebrae
Device Removal
Endoscopy
Esophageal Diseases
Esophagus
Extracellular Matrix
Guided Tissue Regeneration
Humans
Male
Manometry
Mediastinal Diseases
Pharyngeal Diseases
Spinal Diseases
Spinal Fractures
Stents
Tissue Scaffolds
Young Adult
