1
|
Generating an Artificial Intestine for the Treatment of Short Bowel Syndrome. Gastroenterol Clin North Am 2019; 48:585-605. [PMID: 31668185 DOI: 10.1016/j.gtc.2019.08.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/21/2023]
Abstract
Intestinal failure is defined as the inability to maintain fluid, nutrition, energy, and micronutrient balance that leads to the inability to gain or maintain weight, resulting in malnutrition and dehydration. Causes of intestinal failure include short bowel syndrome (ie, the physical loss of intestinal surface area and severe intestinal dysmotility). For patients with intestinal failure who fail to achieve enteral autonomy through intestinal rehabilitation programs, the current treatment options are expensive and associated with severe complications. Therefore, the need persists for next-generation therapies, including cell-based therapy, to increase intestinal regeneration, and development of the tissue-engineered small intestine.
Collapse
|
2
|
Ladd MR, Costello CM, Gosztyla C, Werts AD, Johnson B, Fulton WB, Martin LY, Redfield EJ, Crawford B, Panaparambil R, Sodhi CP, March JC, Hackam DJ. Development of Intestinal Scaffolds that Mimic Native Mammalian Intestinal Tissue. Tissue Eng Part A 2019; 25:1225-1241. [PMID: 30652526 PMCID: PMC6760185 DOI: 10.1089/ten.tea.2018.0239] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Accepted: 12/05/2018] [Indexed: 12/27/2022] Open
Abstract
IMPACT STATEMENT This study is significant because it demonstrates an attempt to design a scaffold specifically for small intestine using a novel fabrication method, resulting in an architecture that resembles intestinal villi. In addition, we use the versatile polymer poly(glycerol sebacate) (PGS) for artificial intestine, which has tunable mechanical and degradation properties that can be harnessed for further fine-tuning of scaffold design. Moreover, the utilization of PGS allows for future development of growth factor and drug delivery from the scaffolds to promote artificial intestine formation.
Collapse
Affiliation(s)
- Mitchell R. Ladd
- Department of Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Cait M. Costello
- Department of Biological and Environmental Engineering, Cornell University, Ithaca, New York
| | - Carolyn Gosztyla
- Department of Surgery, Walter Reed National Military Medical Center, Bethesda, Maryland
| | - Adam D. Werts
- Department of Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Blake Johnson
- Department of Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - William B. Fulton
- Department of Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Laura Y. Martin
- Department of Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Elizabeth J. Redfield
- Department of Biological and Environmental Engineering, Cornell University, Ithaca, New York
| | - Bryan Crawford
- Department of Materials Science and Engineering, Johns Hopkins University, Baltimore, Maryland
| | - Rohan Panaparambil
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, Maryland
| | - Chhinder P. Sodhi
- Department of Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - John C. March
- Department of Biological and Environmental Engineering, Cornell University, Ithaca, New York
| | - David J. Hackam
- Department of Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland
| |
Collapse
|
3
|
Lauro A, Lacaille F. Short bowel syndrome in children and adults: from rehabilitation to transplantation. Expert Rev Gastroenterol Hepatol 2019; 13:55-70. [PMID: 30791840 DOI: 10.1080/17474124.2019.1541736] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Short bowel syndrome (SBS) is a dramatic clinical condition in both children and adults; the residual bowel length is not sufficient to avoid intestinal failure, with subsequent malnutrition and growth retardation, and intravenous support is required to provide the nutrients normally coming from the intestine. Apart from the primary disease, the medical status can be worsened by complications of intestinal failure: if there are irreversible, the prognosis is poor unless a successful intestinal rehabilitation is achieved. Areas covered: The rescue of the remnant small bowel requires a multidisciplinary expertise to achieve digestive autonomy. The use of intestinal trophic factors has shown encouraging results in improving the intestinal adaptation process. Whenever the residual bowel length is inadequate, in a well-selected population weaning parenteral nutrition (PN) off could be attempted by surgery through lengthening procedures. A further subset of patients, with total and irreversible intestinal failure and severe complications on PN, may have an indication to intestinal transplantation. This procedure is still affected by poor long-term results. Expert commentary: Novel approaches developed through a multidisciplinary team work, such as manipulation of microbiota or tissue bioengineering, should be added to current therapies to treat successfully SBS.
Collapse
Affiliation(s)
- Augusto Lauro
- a Emergency Surgery Department , St. Orsola University Hospital , Bologna , Italy
| | - Florence Lacaille
- b Gastroenterology Hepatology Nutrition Unit , Hôpital Necker-Enfants Malades , Paris , France
| |
Collapse
|
4
|
Ladd MR, Martin LY, Werts A, Costello C, Sodhi CP, Fulton WB, March JC, Hackam DJ. The Development of Newborn Porcine Models for Evaluation of Tissue-Engineered Small Intestine. Tissue Eng Part C Methods 2018; 24:331-345. [PMID: 29638197 PMCID: PMC5998831 DOI: 10.1089/ten.tec.2018.0040] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Accepted: 03/19/2018] [Indexed: 12/17/2022] Open
Abstract
Short bowel syndrome (SBS) is a major cause of morbidity and mortality in the pediatric population, for which treatment options are limited. To develop novel approaches for the treatment of SBS, we now focus on the development of a tissue-engineered intestine (also known as an "artificial intestine"), in which intestinal stem cells are cultured onto an absorbable bioscaffold, followed by implantation into the host. To enhance the translational potential of these preclinical studies, we have developed three clinically relevant models in neonatal piglets, which approximate the size of the human infant and were evaluated after implantation and establishment of intestinal continuity over the long term. The models included (1) a staged, multioperation approach; (2) a single operation with a de-functionalized loop of small intestine; and (3) a single operation with an intestinal bypass. The first model had complications related to multiple operations in a short time period, including surgical site infections and wound hernias. The second model avoided wound complications, but was associated with high ostomy output, local skin breakdown, and systemic dehydration with associated electrolyte imbalances. The third model was the most effective, although resulted in stoma prolapse. In summary, we have now developed and evaluated three operative methods for the long-term evaluation of the artificial intestine in the piglet, and conclude that a single operation with a de-functionalized loop of small intestine may be an optimal approach for evaluation over the long term.
Collapse
Affiliation(s)
- Mitchell R. Ladd
- Division of Pediatric Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Laura Y. Martin
- Division of Pediatric Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Adam Werts
- Division of Pediatric Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Cait Costello
- Department of Biomedical Engineering, Cornell University, Ithaca, New York
| | - Chhinder P. Sodhi
- Division of Pediatric Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - William B. Fulton
- Division of Pediatric Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - John C. March
- Department of Biomedical Engineering, Cornell University, Ithaca, New York
| | - David J. Hackam
- Division of Pediatric Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| |
Collapse
|
5
|
Cromeens BP, Wang Y, Liu Y, Johnson J, Besner GE. Critical intestinal cells originate from the host in enteroid-derived tissue-engineered intestine. J Surg Res 2018; 223:155-164. [PMID: 29433868 DOI: 10.1016/j.jss.2017.11.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2017] [Revised: 09/25/2017] [Accepted: 11/03/2017] [Indexed: 12/24/2022]
Abstract
BACKGROUND Enteroid-derived tissue-engineered intestine (TEI) contains intestinal subepithelial myofibroblasts (ISEMFs) and smooth muscle cells (SMCs). However, these cell types are not present in the donor enteroids. We sought to determine the origin of these cell types and to quantify their importance in TEI development. MATERIALS AND METHODS Crypts from pan-EGFP or LGR5-EGFP mice were used for enteroid culture and subsequent implantation for the production of TEI. TEI from pan-EGFP enteroids was labeled for smooth muscle alpha actin (SMA) to identify ISEMFs and SMCs and green fluorescent protein (GFP) to identify cells from pan-EGFP enteroids. Fluorescence in situ hybridization (FISH) for the Y chromosome was applied to TEI from male LGR5-EGFP enteroids implanted into female nonobese diabetic/severe combined immunodeficiency mice. To identify chemotactic effects of intestinal epithelium on ISEMFs, a Boyden chamber assay was performed. RESULTS Immunofluorescence of TEI from pan-EGFP enteroids revealed GFP-positive epithelium with surrounding SMA positivity and no colocalization of the two. FISH of TEI from male LGR5-EGFP enteroids implanted into female nonobese diabetic/severe combined immunodeficiency mice revealed that only the epithelium was Y chromosome positive. Chemotactic assays demonstrated increased ISEMF migration in the presence of enteroids (983 ± 133) compared to that in the presence of either Matrigel alone (357 ± 36) or media alone (339 ± 24; P ≤ 0.05). CONCLUSIONS Lack of GFP/SMA colocalization suggests that ISEMFs and SMCs are derived from host animals. This was confirmed by FISH which identified only epithelial cells as being male. All other cell types originated from host animals. The mechanism by which these cells are recruited is unknown; however, Boyden chamber assays indicate a direct chemotactic effect of intestinal epithelium on ISEMFs.
Collapse
Affiliation(s)
- Barrett P Cromeens
- Department of General Pediatric Surgery, Nationwide Children's Hospital, Columbus, Ohio
| | - Yijie Wang
- Department of General Pediatric Surgery, Nationwide Children's Hospital, Columbus, Ohio
| | - Yanchun Liu
- Department of General Pediatric Surgery, Nationwide Children's Hospital, Columbus, Ohio
| | | | - Gail E Besner
- Department of General Pediatric Surgery, Nationwide Children's Hospital, Columbus, Ohio.
| |
Collapse
|
6
|
Singh A, Lee D, Sopko N, Matsui H, Sabnekar P, Liu X, Elisseeff J, Schoenberg MP, Pienta K, Bivalacqua TJ. Biomanufacturing Seamless Tubular and Hollow Collagen Scaffolds with Unique Design Features and Biomechanical Properties. Adv Healthc Mater 2017; 6. [PMID: 28135047 DOI: 10.1002/adhm.201601136] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2016] [Revised: 12/19/2016] [Indexed: 01/14/2023]
Abstract
A versatile process to develop designer collagen scaffolds for hollow and tubular tissue engineering applications is presented. This process creates seamless and biomechanically tunable scaffolds ranging from ureter-like microsized tubings to structures with highly customized lumens that resemble intestinal villi, fluid bladders, and alveolar sacs that together with stem cells can potentially be used in preclinical and clinical settings.
Collapse
Affiliation(s)
- Anirudha Singh
- Department of Urology; The James Buchanan Brady Urological Institute; The Johns Hopkins School of Medicine; Baltimore MD 21287 USA
- Department of Chemical and Biomolecular Engineering; Johns Hopkins University; Baltimore MD 21218 USA
- Translational Tissue Engineering Center; Johns Hopkins University; Baltimore MD 21231 USA
| | - David Lee
- Translational Tissue Engineering Center; Johns Hopkins University; Baltimore MD 21231 USA
| | - Nikolai Sopko
- Department of Urology; The James Buchanan Brady Urological Institute; The Johns Hopkins School of Medicine; Baltimore MD 21287 USA
| | - Hotaka Matsui
- Department of Urology; The James Buchanan Brady Urological Institute; The Johns Hopkins School of Medicine; Baltimore MD 21287 USA
| | - Praveena Sabnekar
- Department of Urology; The James Buchanan Brady Urological Institute; The Johns Hopkins School of Medicine; Baltimore MD 21287 USA
| | - Xiaopu Liu
- Department of Urology; The James Buchanan Brady Urological Institute; The Johns Hopkins School of Medicine; Baltimore MD 21287 USA
| | - Jennifer Elisseeff
- Translational Tissue Engineering Center; Johns Hopkins University; Baltimore MD 21231 USA
| | - Mark P. Schoenberg
- Department of Urology; Albert Einstein College of Medicine; Bronx NY 10467 USA
| | - Kenneth Pienta
- Department of Urology; The James Buchanan Brady Urological Institute; The Johns Hopkins School of Medicine; Baltimore MD 21287 USA
- Department of Surgery and Oncology; Johns Hopkins Medical Institutions and Sidney Kimmel Comprehensive Cancer Center (SKCC); Baltimore MD 21287 USA
| | - Trinity J. Bivalacqua
- Department of Urology; The James Buchanan Brady Urological Institute; The Johns Hopkins School of Medicine; Baltimore MD 21287 USA
- Department of Surgery and Oncology; Johns Hopkins Medical Institutions and Sidney Kimmel Comprehensive Cancer Center (SKCC); Baltimore MD 21287 USA
| |
Collapse
|
7
|
Mayer O, Kerner JA. Management of short bowel syndrome in postoperative very low birth weight infants. Semin Fetal Neonatal Med 2017; 22:49-56. [PMID: 27576105 DOI: 10.1016/j.siny.2016.08.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Short bowel syndrome is a potentially devastating morbidity for the very low birth weight infant and family with a high risk for mortality. Prevention of injury to the intestine is the ideal, but, if and when the problem arises, it is important to have a systematic approach to manage nutrition, use pharmaceutical strategies and tools to maximize the outcome potential. Safely maximizing parenteral nutrition support by providing adequate macronutrients and micronutrients while minimizing its hepatotoxic effects is the initial postoperative strategy. As the infant stabilizes and starts to recover from that initial injury and/or surgery, a slow and closely monitored enteral nutrition approach should be initiated. Enteral feeds can be complemented with medications and supplements emerging as valuable clinical tools. Engaging a multidisciplinary team of neonatologists, gastroenterologists, pharmacists, skilled clinical nutrition support staff including registered dietitians and nutrition support nurses will facilitate optimizing each and every infant's long term result. Promoting intestinal rehabilitation and adaptation through evidence-based practice where it is found, and ongoing pursuit of research in this rare and devastating disease, is paramount in achieving optimal outcomes.
Collapse
Affiliation(s)
- Olivia Mayer
- Lucile Packard Children's Hospital Stanford, Palo Alto, CA, USA.
| | - John A Kerner
- Lucile Packard Children's Hospital Stanford, Palo Alto, CA, USA; Stanford University Medical Center, Stanford, CA, USA
| |
Collapse
|