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Ludwig EK, Abraham N, Schaaf CR, McKinney CA, Freund J, Stewart AS, Veerasammy BA, Thomas M, Cardona DM, Garman K, Barbas AS, Sudan DL, Gonzalez LM. Comparison of the effects of normothermic machine perfusion and cold storage preservation on porcine intestinal allograft regenerative potential and viability. Am J Transplant 2024; 24:564-576. [PMID: 37918482 PMCID: PMC11082874 DOI: 10.1016/j.ajt.2023.10.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 10/27/2023] [Accepted: 10/28/2023] [Indexed: 11/04/2023]
Abstract
Intestinal transplantation (IT) is the final treatment option for intestinal failure. Static cold storage (CS) is the standard preservation method used for intestinal allografts. However, CS and subsequent transplantation induce ischemia-reperfusion injury (IRI). Severe IRI impairs epithelial barrier function, including loss of intestinal stem cells (ISC), critical to epithelial regeneration. Normothermic machine perfusion (NMP) preservation of kidney and liver allografts minimizes CS-associated IRI; however, it has not been used clinically for IT. We hypothesized that intestine NMP would induce less epithelial injury and better protect the intestine's regenerative ability when compared with CS. Full-length porcine jejunum and ileum were procured, stored at 4 °C, or perfused at 34 °C for 6 hours (T6), and transplanted. Histology was assessed following procurement (T0), T6, and 1 hour after reperfusion. Real-time quantitative reverse transcription polymerase chain reaction, immunofluorescence, and crypt culture measured ISC viability and proliferative potential. A greater number of NMP-preserved intestine recipients survived posttransplant, which correlated with significantly decreased tissue injury following 1-hour reperfusion in NMP compared with CS samples. Additionally, ISC gene expression, spheroid area, and cellular proliferation were significantly increased in NMP-T6 compared with CS-T6 intestine. NMP appears to reduce IRI and improve graft regeneration with improved ISC viability and proliferation.
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Affiliation(s)
- Elsa K Ludwig
- Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, North Carolina, USA
| | - Nader Abraham
- Department of Surgery, Duke University School of Medicine, Durham, North Carolina, USA
| | - Cecilia R Schaaf
- Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, North Carolina, USA
| | - Caroline A McKinney
- Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, North Carolina, USA
| | - John Freund
- Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, North Carolina, USA
| | - Amy S Stewart
- Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, North Carolina, USA
| | - Brittany A Veerasammy
- Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, North Carolina, USA
| | - Mallory Thomas
- Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, North Carolina, USA
| | - Diana M Cardona
- Department of Pathology, Duke University School of Medicine, Durham, North Carolina, USA
| | - Katherine Garman
- Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA
| | - Andrew S Barbas
- Department of Surgery, Duke University School of Medicine, Durham, North Carolina, USA
| | - Debra L Sudan
- Department of Surgery, Duke University School of Medicine, Durham, North Carolina, USA.
| | - Liara M Gonzalez
- Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, North Carolina, USA.
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2
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Xie LW, Cai S, Lu HY, Tang FL, Zhu RQ, Tian Y, Li M. Microbiota-derived I3A protects the intestine against radiation injury by activating AhR/IL-10/Wnt signaling and enhancing the abundance of probiotics. Gut Microbes 2024; 16:2347722. [PMID: 38706205 PMCID: PMC11086037 DOI: 10.1080/19490976.2024.2347722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2023] [Accepted: 04/22/2024] [Indexed: 05/07/2024] Open
Abstract
The intestine is prone to radiation damage in patients undergoing radiotherapy for pelvic tumors. However, there are currently no effective drugs available for the prevention or treatment of radiation-induced enteropathy (RIE). In this study, we aimed at investigating the impact of indole-3-carboxaldehyde (I3A) derived from the intestinal microbiota on RIE. Intestinal organoids were isolated and cultivated for screening radioprotective tryptophan metabolites. A RIE model was established using 13 Gy whole-abdominal irradiation in male C57BL/6J mice. After oral administration of I3A, its radioprotective ability was assessed through the observation of survival rates, clinical scores, and pathological analysis. Intestinal stem cell survival and changes in the intestinal barrier were observed through immunofluorescence and immunohistochemistry. Subsequently, the radioprotective mechanisms of I3A was investigated through 16S rRNA and transcriptome sequencing, respectively. Finally, human colon cancer cells and organoids were cultured to assess the influence of I3A on tumor radiotherapy. I3A exhibited the most potent radioprotective effect on intestinal organoids. Oral administration of I3A treatment significantly increased the survival rate in irradiated mice, improved clinical and histological scores, mitigated mucosal damage, enhanced the proliferation and differentiation of Lgr5+ intestinal stem cells, and maintained intestinal barrier integrity. Furthermore, I3A enhanced the abundance of probiotics, and activated the AhR/IL-10/Wnt signaling pathway to promote intestinal epithelial proliferation. As a crucial tryptophan metabolite, I3A promotes intestinal epithelial cell proliferation through the AhR/IL-10/Wnt signaling pathway and upregulates the abundance of probiotics to treat RIE. Microbiota-derived I3A demonstrates potential clinical application value for the treatment of RIE.
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Affiliation(s)
- Li-Wei Xie
- Suzhou Key Laboratory for Radiation Oncology, Department of Radiotherapy and Oncology, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Shang Cai
- Suzhou Key Laboratory for Radiation Oncology, Department of Radiotherapy and Oncology, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Hai-Yan Lu
- Suzhou Key Laboratory for Radiation Oncology, Department of Radiotherapy and Oncology, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Feng-Ling Tang
- Suzhou Key Laboratory for Radiation Oncology, Department of Radiotherapy and Oncology, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Rui-Qiu Zhu
- Suzhou Key Laboratory for Radiation Oncology, Department of Radiotherapy and Oncology, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Ye Tian
- Suzhou Key Laboratory for Radiation Oncology, Department of Radiotherapy and Oncology, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Ming Li
- State Key Laboratory of Radiation Medicine and Protection, School of Radiation Medicine and Protection, Medical College of Soochow University; Collaborative Innovation Center of Radiation Medicine of Jiangsu Higher Education Institutions, Soochow University, Suzhou, China
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3
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Dasyam AK, Borhani AA, Tirukkovalur NV, Cruz RJ. Intestinal and Multivisceral Transplantation: Complications. Radiol Clin North Am 2023; 61:871-887. [PMID: 37495294 DOI: 10.1016/j.rcl.2023.04.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/28/2023]
Abstract
Advancements in immunosuppression protocols, surgical techniques, and postoperative care in the last few decades have improved outcomes of intestinal transplant patients. Normal immediate postoperative imaging appearance can simulate pathology. Intestinal transplant recipients are prone for several postoperative complications due to the complex surgical technique, which involves multiple anastomoses, and immunogenic nature of the allograft intestine. Imaging plays a crucial role in detection of several major complications including infectious, immunologic, vascular, gastrointestinal, pancreaticobiliary, genitourinary, and neoplastic complications. The awareness of the posttransplant anatomy and normal imaging appearances helps radiologists anticipate and accurately detect posttransplant complications.
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Affiliation(s)
- Anil K Dasyam
- Department of Radiology, University of Pittsburgh School of Medicine, 200 Lothrop Street, Pittsburgh, PA 15216, USA.
| | - Amir A Borhani
- Department of Radiology, Northwestern University Feinberg School of Medicine, 676 North Street Claire Street, Suite 800, Chicago, IL 60611, USA
| | - Nikhil V Tirukkovalur
- Kamineni Academy of Medical Science and Research Centre, LB Nagar, Hyderabad, TG 500068, India
| | - Ruy J Cruz
- Intestinal Rehabilitation and Multivisceral Transplant Program, Starzl Transplant Institute
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4
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Qi D, Shi W, Black AR, Kuss MA, Pang X, He Y, Liu B, Duan B. Repair and regeneration of small intestine: A review of current engineering approaches. Biomaterials 2020; 240:119832. [PMID: 32113114 DOI: 10.1016/j.biomaterials.2020.119832] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Revised: 01/21/2020] [Accepted: 01/25/2020] [Indexed: 02/06/2023]
Abstract
The small intestine (SI) is difficult to regenerate or reconstruct due to its complex structure and functions. Recent developments in stem cell research, advanced engineering technologies, and regenerative medicine strategies bring new hope of solving clinical problems of the SI. This review will first summarize the structure, function, development, cell types, and matrix components of the SI. Then, the major cell sources for SI regeneration are introduced, and state-of-the-art biofabrication technologies for generating engineered SI tissues or models are overviewed. Furthermore, in vitro models and in vivo transplantation, based on intestinal organoids and tissue engineering, are highlighted. Finally, current challenges and future perspectives are discussed to help direct future applications for SI repair and regeneration.
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Affiliation(s)
- Dianjun Qi
- Department of General Practice, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning, China; Mary & Dick Holland Regenerative Medicine Program, University of Nebraska Medical Center, Omaha, NE, USA; Division of Cardiology, Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE, USA
| | - Wen Shi
- Mary & Dick Holland Regenerative Medicine Program, University of Nebraska Medical Center, Omaha, NE, USA; Division of Cardiology, Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE, USA
| | - Adrian R Black
- Eppley Institute for Research in Cancer and Allied Diseases, University of Nebraska Medical Center, Omaha, NE, USA
| | - Mitchell A Kuss
- Mary & Dick Holland Regenerative Medicine Program, University of Nebraska Medical Center, Omaha, NE, USA; Division of Cardiology, Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE, USA
| | - Xining Pang
- Department of General Practice, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning, China; Department of Academician Expert Workstation and Liaoning Province Human Amniotic Membrane Dressings Stem Cells and Regenerative Medicine Engineering Research Center, Shenyang Amnion Biological Engineering Technology Research and Development Center Co., Ltd, Shenyang, Liaoning, China
| | - Yini He
- Department of General Practice, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning, China
| | - Bing Liu
- Department of Anorectal Surgery, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning, China
| | - Bin Duan
- Mary & Dick Holland Regenerative Medicine Program, University of Nebraska Medical Center, Omaha, NE, USA; Division of Cardiology, Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE, USA; Department of Surgery, University of Nebraska Medical Center, Omaha, NE, USA; Department of Mechanical and Materials Engineering, University of Nebraska-Lincoln, Lincoln, NE, USA.
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5
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Stobutzki N, Schlickeiser S, Streitz M, Stanko K, Truong KL, Akyuez L, Vogt K, Appelt C, Pascher A, Blau O, Gerlach UA, Sawitzki B. Long-Term Signs of T Cell and Myeloid Cell Activation After Intestinal Transplantation With Cellular Rejections Contributing to Further Increase of CD16 + Cell Subsets. Front Immunol 2019; 10:866. [PMID: 31134051 PMCID: PMC6514047 DOI: 10.3389/fimmu.2019.00866] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Accepted: 04/04/2019] [Indexed: 02/06/2023] Open
Abstract
The intestine mediates a delicate balance between tolerogenic and inflammatory immune responses. The continuous pathogen encounter might also augment immune cell responses contributing to complications observed upon intestinal transplantation (ITx). We thus hypothesized that ITx patients show persistent signs of immune cell activation affecting both the adaptive and innate immune cell compartment. Information on the impact of intestinal grafts on immune cell composition, however, especially in the long-term is sparse. We here assessed activated and differentiated adaptive and innate immune subsets according to time, previous experience of cellular or antibody-mediated rejections or type of transplant after ITx applying multi-parametric flow cytometry, gene expression, serum cytokine and chemokine profiling. ITx patients showed an increase in CD16 expressing monocytes and myeloid dendritic cells (DCs) compared to healthy controls. This was even detectable in patients who were transplanted more than 10 years ago. Also, conventional CD4+ and CD8+ T cells showed persistent signs of activation counterbalanced by increased activated CCR4+ regulatory T cells. Patients with previous cellular rejections had even higher proportions of CD16+ monocytes and DCs, whereas transplanting higher donor mass with multi-visceral grafts was associated with increased T cell activation. The persistent inflammation and innate immune cell activation might contribute to unsatisfactory results after ITx.
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Affiliation(s)
- Nadja Stobutzki
- Institute for Medical Immunology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | - Stephan Schlickeiser
- Institute for Medical Immunology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany.,Berlin-Brandenburg Center for Regenerative Therapies, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | - Mathias Streitz
- Institute for Medical Immunology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | - Katarina Stanko
- Institute for Medical Immunology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | - Kim-Long Truong
- Institute for Medical Immunology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | - Levent Akyuez
- Institute for Medical Immunology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany.,Berlin-Brandenburg Center for Regenerative Therapies, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | - Katrin Vogt
- Institute for Medical Immunology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | - Christine Appelt
- Institute for Medical Immunology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | - Andreas Pascher
- Department of Surgery, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | - Olga Blau
- Department for Hematology, Oncology and Tumor Immunology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | - Undine A Gerlach
- Department of Surgery, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | - Birgit Sawitzki
- Institute for Medical Immunology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany.,Berlin-Brandenburg Center for Regenerative Therapies, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
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6
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Urban P, Rabajdová M, Feterik Š, Bódy G, Granda T, Mareková M, Veselá J. Evaluation of molecular changes of distal organs after small bowel transplantation. Physiol Res 2018; 67:591-599. [PMID: 29750876 DOI: 10.33549/physiolres.933701] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
The ischemia and reperfusion of a jejunal graft during transplantation triggers the stress of endoplasmic reticulum thus inducing the synthesis of pro-inflammatory cytokines. Spreading of these signals stimulate immunological reactions in distal tissues, i.e. lung, liver and spleen. The aim of this study was to detect the molecular changes in liver and spleen induced by transplanted jejunal graft with one or six hours of reperfusion (group Tx1 and Tx6). Analysis of gene expression changes of inflammatory mediators (TNF-alpha, IL-10) and specific chaperones (Gadd153, Grp78) derived from endoplasmic reticulum (ER) was done and compared to control group. The qRT-PCR method was used for amplification of the specific genes. The levels of corresponding proteins were detected by Western blot with immunodetection. Protein TNF-alpha was in liver tissue significantly overexpressed in the experimental group Tx1 by 48 % (p<0.001). In the group Tx6 we found decreased levels of the same protein to the level of controls. However, the protein concentrations of TNF-alpha in spleen showed increased levels in group Tx1 by 31 % (p<0.001) but even higher levels in the group Tx6 by 115 % (p<0.001) in comparing to controls. Our data demonstrated that the spleen is more sensitive to post-transplantation inflammation than liver, with consequent stress of ER potentially inducing apoptosis and failure of basic functions of lymphoid tissue.
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Affiliation(s)
- P Urban
- Department of Medical and Clinical Biochemistry, Faculty of Medicine, Pavol Jozef Šafárik University in Košice, Slovak Republic, Department of Histology and Embryology, Faculty of Medicine, Pavol Jozef Šafárik University in Košice, Košice, Slovak Republic.
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7
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Abstract
The gut microbiota is mainly composed of a diverse population of commensal bacterial species and plays a pivotal role in the maintenance of intestinal homeostasis, immune modulation and metabolism. The influence of the gut microbiota on solid organ transplantation has recently been recognized. In fact, several studies indicated that acute and chronic allograft rejection in small bowel transplantation (SBT) is closely associated with the alterations in microbial patterns in the gut. In this review, we focused on the recent findings regarding alterations in the microbiota following SBTand the potential roles of these alterations in the development of acute and chronic allograft rejection. We also reviewed important advances with respect to the interplays between the microbiota and host immune systems in SBT. Furthermore, we explored the potential of the gut microbiota as a microbial marker and/or therapeutic target for the predication and intervention of allograft rejection and chronic dysfunction. Given that current research on the gut microbiota has become increasingly sophisticated and comprehensive, large cohort studies employing metagenomic analysis and multivariate linkage should be designed for the characterization of host-microbe interaction and causality between microbiota alterations and clinical outcomes in SBT. The findings are expected to provide valuable insights into the role of gut microbiota in the development of allograft rejection and other transplant-related complications and introduce novel therapeutic targets and treatment approaches in clinical practice.
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8
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Trecartin A, Grikscheit T. Tissue Engineering Functional Gastrointestinal Regions: The Importance of Stem and Progenitor Cells. Cold Spring Harb Perspect Med 2017; 7:cshperspect.a025700. [PMID: 28320829 DOI: 10.1101/cshperspect.a025700] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
The intestine shows extraordinary regenerative potential that might be harnessed to alleviate numerous morbid and lethal human diseases. The intestinal stem cells regenerate the epithelium every 5 days throughout an individual's lifetime. Understanding stem-cell signaling affords power to influence the niche environment for growing intestine. The manifold approaches to tissue engineering may be organized by variations of three basic components required for the transplantation and growth of stem/progenitor cells: (1) cell delivery materials or scaffolds; (2) donor cells including adult stem cells, induced pluripotent stem cells, and in vitro expansion of isolated or cocultured epithelial, smooth muscle, myofibroblasts, or nerve cells; and (3) environmental modulators or biopharmaceuticals. Tissue engineering has been applied to the regeneration of every major region of the gastrointestinal tract from esophagus to colon, with scientists around the world aiming to carry these techniques into human therapy.
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Affiliation(s)
- Andrew Trecartin
- Department of Pediatric Surgery, Children's Hospital Los Angeles, Los Angeles, California 90027
| | - Tracy Grikscheit
- Department of Pediatric Surgery, Children's Hospital Los Angeles, Los Angeles, California 90027
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9
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Calvo Pulido J, Manrique Municio M, Loinaz Segurola C, Justo Alonso I, Caso Maestro O, García-Sesma A, Cambra Molero F, San-Juan Garrido R, Abradelo de Usera M, Marcacuzco Quinto A, Moreno González E, Jiménez Romero C. Aortic Graft Mycotic Pseudoaneurysm as a Severe Complication After Multivisceral Transplantation: A Case Report. Transplant Proc 2016; 48:539-42. [PMID: 27109996 DOI: 10.1016/j.transproceed.2015.10.083] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2015] [Accepted: 10/21/2015] [Indexed: 11/15/2022]
Abstract
BACKGROUND Surgical complications in multivisceral transplantation (MVT) are frequent and always severe. Those related to technical issues are relevant as they have implications not only on the graft but also on patient survival. The aim of this study was to review our case-based data and experience with 5 MVT performed since December 2004. CASE REPORT A 38 year-old woman presented with ultra-short bowel syndrome due to massive ischemia also affecting the celiac trunk. She also had moderate to severe hepatitis/steatosis with some degree of fibrosis on liver biopsy, due to long-term home parenteral nutrition (HPN). An MVT was carried out in September 2010 including the liver, stomach, pancreatoduodenal complex with the spleen, and small bowel. The postoperative course was complicated by a leak from the pyloromiotomy, requiring reoperation on postoperative day 13. She also had central line catheter infection and renal impairment, requiring renal replacement therapy, and was discharged on postoperative day 150. Fifteen days later she was hospitalized because of severe abdominal pain associated with an abdominal mass. Computed tomography showed an aortic donor graft pseudoaneurysm, so we decided to operate on the patient. A complete resection of the pseudoaneurysm using an interposed polytetrafluoroethylene graft was performed. Six months after the MVT, the patient died due to sepsis, despite a functional graft and complete digestive autonomy. CONCLUSIONS Although this complication is rare, surgical complications in MVT are severe and may seriously impair graft and patient survival.
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Affiliation(s)
- J Calvo Pulido
- Department of Transplant Surgery, University Hospital 12 de Octubre, Madrid, Spain.
| | - M Manrique Municio
- Department of Transplant Surgery, University Hospital 12 de Octubre, Madrid, Spain
| | - C Loinaz Segurola
- Department of Transplant Surgery, University Hospital 12 de Octubre, Madrid, Spain
| | - I Justo Alonso
- Department of Transplant Surgery, University Hospital 12 de Octubre, Madrid, Spain
| | - O Caso Maestro
- Department of Transplant Surgery, University Hospital 12 de Octubre, Madrid, Spain
| | - A García-Sesma
- Department of Transplant Surgery, University Hospital 12 de Octubre, Madrid, Spain
| | - F Cambra Molero
- Department of Transplant Surgery, University Hospital 12 de Octubre, Madrid, Spain
| | - R San-Juan Garrido
- Unit of Infectious Diseases, University Hospital 12 de Octubre, Madrid, Spain
| | - M Abradelo de Usera
- Department of Transplant Surgery, University Hospital 12 de Octubre, Madrid, Spain
| | - A Marcacuzco Quinto
- Department of Transplant Surgery, University Hospital 12 de Octubre, Madrid, Spain
| | - E Moreno González
- Department of Transplant Surgery, University Hospital 12 de Octubre, Madrid, Spain
| | - C Jiménez Romero
- Department of Transplant Surgery, University Hospital 12 de Octubre, Madrid, Spain
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10
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Wengerter BC, Emre G, Park JY, Geibel J. Three-dimensional Printing in the Intestine. Clin Gastroenterol Hepatol 2016; 14:1081-5. [PMID: 27189913 DOI: 10.1016/j.cgh.2016.05.008] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2015] [Revised: 05/02/2016] [Accepted: 05/04/2016] [Indexed: 02/07/2023]
Abstract
Intestinal transplantation remains a life-saving option for patients with severe intestinal failure. With the advent of advanced tissue engineering techniques, great strides have been made toward manufacturing replacement tissues and organs, including the intestine, which aim to avoid transplant-related complications. The current paradigm is to seed a biocompatible support material (scaffold) with a desired cell population to generate viable replacement tissue. Although this technique has now been extended by the three-dimensional (3D) printing of geometrically complex scaffolds, the overall approach is hindered by relatively slow turnover and negative effects of residual scaffold material, which affects final clinical outcome. Methods recently developed for scaffold-free 3D bioprinting may overcome such obstacles and should allow for rapid manufacture and deployment of "bioprinted organs." Much work remains before 3D bioprinted tissues can enter clinical use. In this brief review we examine the present state and future perspectives of this nascent technology before full clinical implementation.
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Affiliation(s)
- Brian C Wengerter
- Department of Surgery, Yale University School of Medicine, New Haven, Connecticut
| | - Gulus Emre
- Department of Surgery, Yale University School of Medicine, New Haven, Connecticut
| | - Jea Young Park
- Department of Surgery, Yale University School of Medicine, New Haven, Connecticut
| | - John Geibel
- Department of Surgery, Yale University School of Medicine, New Haven, Connecticut.
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Abstract
Despite recent therapeutic advances, patients with Crohn's disease (CD) continue to experience high recurrence with cumulative structural damage and ultimate loss of nutritional autonomy. With short bowel syndrome, strictures, and enteric fistulae being the underlying pathology, CD is the second common indication for home parenteral nutrition (HPN). With development of intestinal failure, nutritional management including HPN is required as a rescue therapy. Unfortunately, some patients do not escape the HPN-associated complications. Therefore, the concept of gut rehabilitation has evolved as part of the algorithmic management of these patients, with transplantation being the ultimate life-saving therapy. With type 2 intestinal failure, comprehensive rehabilitative measures including nutritional care, pharmacologic manipulation, autologous reconstruction, and bowel lengthening is often successful, particularly in patients with quiescent disease. With type 3 intestinal failure, transplantation is the only life-saving treatment for patients with HPN failure and intractable disease. With CD being the second common indication for transplantation in adults, survival outcome continues to improve because of surgical innovation, novel immunosuppression, and better postoperative care. Despite being a rescue therapy, the procedure has achieved survival rates similar to other solid organs, and comparable to those who continue to receive HPN therapy. With similar technical, immunologic, and infectious complications, survival is similar in the CD and non-CD recipients. Full nutritional autonomy is achievable in most survivors with better quality of life and long-term cost-effectiveness. CD recurrence is rare with no impact on graft function. Further progress is anticipated with new insights into the pathogenesis of CD and mechanisms of transplant tolerance.
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12
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Silva JT, San-Juan R, Fernández-Caamaño B, Prieto-Bozano G, Fernández-Ruiz M, Lumbreras C, Calvo-Pulido J, Jiménez-Romero C, Resino-Foz E, López-Medrano F, Lopez-Santamaria M, Maria Aguado J. Infectious Complications Following Small Bowel Transplantation. Am J Transplant 2016; 16:951-9. [PMID: 26560685 DOI: 10.1111/ajt.13535] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2015] [Revised: 09/08/2015] [Accepted: 09/09/2015] [Indexed: 01/25/2023]
Abstract
Microbiological spectrum and outcome of infectious complications following small bowel transplantation (SBT) have not been thoroughly characterized. We performed a retrospective analysis of all patients undergoing SBT from 2004 to 2013 in Spain. Sixty-nine patients underwent a total of 87 SBT procedures (65 pediatric, 22 adult). The median follow-up was 867 days. Overall, 81 transplant patients (93.1%) developed 263 episodes of infection (incidence rate: 2.81 episodes per 1000 transplant-days), with no significant differences between adult and pediatric populations. Most infections were bacterial (47.5%). Despite universal prophylaxis, 22 transplant patients (25.3%) developed cytomegalovirus disease, mainly in the form of enteritis. Specifically, 54 episodes of opportunistic infection (OI) occurred in 35 transplant patients. Infection was the major cause of mortality (17 of 24 deaths). Multivariate analysis identified retransplantation (hazard ratio [HR]: 2.21; 95% confidence interval [CI]: 1.02-4.80; p = 0.046) and posttransplant renal replacement therapy (RRT; HR: 4.19; 95% CI: 1.40-12.60; p = 0.011) as risk factors for OI. RRT was also a risk factor for invasive fungal disease (IFD; HR: 24.90; 95% CI: 5.35-115.91; p < 0.001). In conclusion, infection is the most frequent complication and the leading cause of death following SBT. Posttransplant RRT and retransplantation identify those recipients at high risk for developing OI and IFD.
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Affiliation(s)
- J T Silva
- Unit of Infectious Diseases, University Hospital "12 de Octubre," Instituto de Investigación Hospital "12 de Octubre," Department of Medicine, Universidad Complutense, Madrid, Spain
| | - R San-Juan
- Unit of Infectious Diseases, University Hospital "12 de Octubre," Instituto de Investigación Hospital "12 de Octubre," Department of Medicine, Universidad Complutense, Madrid, Spain
| | - B Fernández-Caamaño
- Department of Pediatric Gastroenterology, University Hospital "La Paz," Department of Medicine, Universidad Autónoma, Madrid, Spain
| | - G Prieto-Bozano
- Department of Pediatric Gastroenterology, University Hospital "La Paz," Department of Medicine, Universidad Autónoma, Madrid, Spain
| | - M Fernández-Ruiz
- Unit of Infectious Diseases, University Hospital "12 de Octubre," Instituto de Investigación Hospital "12 de Octubre," Department of Medicine, Universidad Complutense, Madrid, Spain
| | - C Lumbreras
- Unit of Infectious Diseases, University Hospital "12 de Octubre," Instituto de Investigación Hospital "12 de Octubre," Department of Medicine, Universidad Complutense, Madrid, Spain
| | - J Calvo-Pulido
- Department of General and Digestive Surgery and Abdominal Organ Transplantation, University Hospital "12 de Octubre," Madrid, Spain
| | - C Jiménez-Romero
- Department of General and Digestive Surgery and Abdominal Organ Transplantation, University Hospital "12 de Octubre," Madrid, Spain
| | - E Resino-Foz
- Unit of Infectious Diseases, University Hospital "12 de Octubre," Instituto de Investigación Hospital "12 de Octubre," Department of Medicine, Universidad Complutense, Madrid, Spain
| | - F López-Medrano
- Unit of Infectious Diseases, University Hospital "12 de Octubre," Instituto de Investigación Hospital "12 de Octubre," Department of Medicine, Universidad Complutense, Madrid, Spain
| | - M Lopez-Santamaria
- Department of Pediatric Surgery, University Hospital "La Paz," Department of Medicine, Universidad Autónoma, Madrid, Spain
| | - J Maria Aguado
- Unit of Infectious Diseases, University Hospital "12 de Octubre," Instituto de Investigación Hospital "12 de Octubre," Department of Medicine, Universidad Complutense, Madrid, Spain
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13
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Matthé S, Pirenne J, Knops N. Energy expenditure and growth failure after intestinal transplantation: A case report. Pediatr Transplant 2016; 20:162-7. [PMID: 26667223 DOI: 10.1111/petr.12643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/28/2015] [Indexed: 11/26/2022]
Abstract
We present a 12-yr-old boy who received a combined liver-pancreas small bowel transplantation at the age of two. The post-operative period was complicated by wound closure problems resulting in a large asymptomatic abdominal wall defect. Further follow-up was uneventful, with the exception of new onset growth failure not explained by extensive routine investigations. An indirect calorimetry was performed. The resting energy expenditure (REE) was significantly increased (126% of predicted), demanding a daily caloric intake of 123 kcal/kg body weight (normal for age: 80 kcal/kg). In the absence of classic reasons for increased REE, a thermal camera revealed increased dermal heat loss at the abdominal wall defect (estimated surplus in energy loss of at least 29 kcal/day: 10.4% of the elevated REE). In addition, we found lower total lung capacity due to impaired abdominal breathing. In the exploration of growth failure in children after (ITx), increased REE must be taken into account. Indirect calorimetry can serve as a valuable diagnostic tool for evaluating individual energy requirements and nutritional support. In this child, exaggerated heat loss through an aberrant abdominal wall could be a potential important contributor to the patient's increased energy requirements.
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Affiliation(s)
| | - Jacques Pirenne
- Department of Transplantation Surgery, UZ Leuven, Leuven, Belgium
| | - Noël Knops
- Department of Pediatric Nephrology and Solid Organ Transplantation, UZ Leuven, Leuven, Belgium
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14
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Goldschmidt ML, Kocoshis SA, Tiao GM, Alonso MH, Nathan JD. Limited surgical resection for graft salvage following recovery from complicated exfoliative rejection in pediatric intestinal recipients. Pediatr Transplant 2015; 19:E170-6. [PMID: 26230722 PMCID: PMC6361159 DOI: 10.1111/petr.12563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/16/2015] [Indexed: 11/30/2022]
Abstract
Complications of ER contribute significantly to morbidity and mortality following intestinal transplantation. The surgical management of three pediatric patients who experienced complications of late ER after composite LSB transplantation is described, highlighting the potential for allograft salvage after limited surgical resection. A retrospective case series was compiled. Data collected included time to ER from transplant, medical management of ER, complications, and surgical management of ER complications. All patients had undergone composite LSB transplantation between one and two yr of age. Time to ER after transplantation was 9.5-26.5 months. ER complications included ileal allograft stricture, intramural hematoma with perforation of jejunal allograft, and massive GI hemorrhage secondary to focal ulceration and pseudopolyp formation. With evidence of mucosal regeneration, all three patients underwent limited segmental allograft resection. Two patients continue to maintain satisfactory allograft function 39-44 months following operation. The third patient retained adequate allograft function until he developed PTLD, subsequently dying from disseminated Adenovirus infection 51 months after resection. Severe disruption of intestinal allograft integrity in ER can lend itself to medically refractory complications. Prompt recognition and surgical correction of complications can play a crucial role in allograft salvage and patient survival after ER.
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Affiliation(s)
- Monique L. Goldschmidt
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
| | - Samuel A. Kocoshis
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
| | - Gregory M. Tiao
- Division of Pediatric General and Thoracic Surgery, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA,,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Maria H. Alonso
- Division of Pediatric General and Thoracic Surgery, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA,,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Jaimie D. Nathan
- Division of Pediatric General and Thoracic Surgery, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA,,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
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15
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Roskott AM, Groen H, Rings EHHM, Haveman JW, Ploeg RJ, Serlie MJ, Wanten G, Krabbe PFM, Dijkstra G. Cost-effectiveness of intestinal transplantation for adult patients with intestinal failure: a simulation study. Am J Clin Nutr 2015; 101:79-86. [PMID: 25527753 DOI: 10.3945/ajcn.114.083303] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Home parenteral nutrition (HPN) and intestinal transplantation (ITx) are the 2 treatment options for irreversible intestinal failure (IF). OBJECTIVE This study simulated the disease course of irreversible IF and both of these treatments--HPN and ITx--to estimate the cost-effectiveness of ITx. DESIGN We simulated IF treatment in adults as a discrete event model with variables derived from the Dutch Registry of Intestinal Failure and Intestinal Transplantation, the Intestinal Transplant Registry, hospital records, the literature, and expert opinions. Simulated patients were enrolled at a rate of 40/mo for 10 y. The maximum follow-up was 40 y. Survival was simulated as a probabilistic function. ITx was offered to 10% of patients with <12 mo of remaining life expectancy with HPN if they did not undergo ITx. Costs were calculated according to Dutch guidelines, with discounting. We evaluated the cost-effectiveness of ITx by comparing models conducted with and without ITx and by calculating the cost difference per life-year gained [incremental cost-effectiveness ratio (ICER)]. RESULTS The average survival was 14.6 y without ITx and 14.9 y with ITx. HPN costs were €13,276 for treatment introduction, followed by €77,652 annually. The costs of ITx were ∼€73,000 during the first year and then €13,000 annually. The ICER was €19,529 per life-year gained. CONCLUSION Our simulations show that ITx slightly improves survival of patients with IF in comparison with HPN at an additional cost of €19,529 per life-year gained.
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Affiliation(s)
- Anne Margot Roskott
- From the Departments of Gastroenterology and Hepatology (AMR and GD), Surgery (AMR, JWH, and RJP), Epidemiology (HG and PFMK), and Pediatrics (EHHMR), University of Groningen, University Medical Center Groningen, Groningen, The Netherlands; the Department of Endocrinology and Metabolism, University of Amsterdam, Academic Medical Center, Amsterdam, The Netherlands (MJS); and the Department of Gastroenterology and Hepatology, University of Nijmegen, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands (GW)
| | - Henk Groen
- From the Departments of Gastroenterology and Hepatology (AMR and GD), Surgery (AMR, JWH, and RJP), Epidemiology (HG and PFMK), and Pediatrics (EHHMR), University of Groningen, University Medical Center Groningen, Groningen, The Netherlands; the Department of Endocrinology and Metabolism, University of Amsterdam, Academic Medical Center, Amsterdam, The Netherlands (MJS); and the Department of Gastroenterology and Hepatology, University of Nijmegen, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands (GW)
| | - Edmond H H M Rings
- From the Departments of Gastroenterology and Hepatology (AMR and GD), Surgery (AMR, JWH, and RJP), Epidemiology (HG and PFMK), and Pediatrics (EHHMR), University of Groningen, University Medical Center Groningen, Groningen, The Netherlands; the Department of Endocrinology and Metabolism, University of Amsterdam, Academic Medical Center, Amsterdam, The Netherlands (MJS); and the Department of Gastroenterology and Hepatology, University of Nijmegen, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands (GW)
| | - Jan Willem Haveman
- From the Departments of Gastroenterology and Hepatology (AMR and GD), Surgery (AMR, JWH, and RJP), Epidemiology (HG and PFMK), and Pediatrics (EHHMR), University of Groningen, University Medical Center Groningen, Groningen, The Netherlands; the Department of Endocrinology and Metabolism, University of Amsterdam, Academic Medical Center, Amsterdam, The Netherlands (MJS); and the Department of Gastroenterology and Hepatology, University of Nijmegen, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands (GW)
| | - Rutger J Ploeg
- From the Departments of Gastroenterology and Hepatology (AMR and GD), Surgery (AMR, JWH, and RJP), Epidemiology (HG and PFMK), and Pediatrics (EHHMR), University of Groningen, University Medical Center Groningen, Groningen, The Netherlands; the Department of Endocrinology and Metabolism, University of Amsterdam, Academic Medical Center, Amsterdam, The Netherlands (MJS); and the Department of Gastroenterology and Hepatology, University of Nijmegen, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands (GW)
| | - Mireille J Serlie
- From the Departments of Gastroenterology and Hepatology (AMR and GD), Surgery (AMR, JWH, and RJP), Epidemiology (HG and PFMK), and Pediatrics (EHHMR), University of Groningen, University Medical Center Groningen, Groningen, The Netherlands; the Department of Endocrinology and Metabolism, University of Amsterdam, Academic Medical Center, Amsterdam, The Netherlands (MJS); and the Department of Gastroenterology and Hepatology, University of Nijmegen, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands (GW)
| | - Geert Wanten
- From the Departments of Gastroenterology and Hepatology (AMR and GD), Surgery (AMR, JWH, and RJP), Epidemiology (HG and PFMK), and Pediatrics (EHHMR), University of Groningen, University Medical Center Groningen, Groningen, The Netherlands; the Department of Endocrinology and Metabolism, University of Amsterdam, Academic Medical Center, Amsterdam, The Netherlands (MJS); and the Department of Gastroenterology and Hepatology, University of Nijmegen, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands (GW)
| | - Paul F M Krabbe
- From the Departments of Gastroenterology and Hepatology (AMR and GD), Surgery (AMR, JWH, and RJP), Epidemiology (HG and PFMK), and Pediatrics (EHHMR), University of Groningen, University Medical Center Groningen, Groningen, The Netherlands; the Department of Endocrinology and Metabolism, University of Amsterdam, Academic Medical Center, Amsterdam, The Netherlands (MJS); and the Department of Gastroenterology and Hepatology, University of Nijmegen, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands (GW)
| | - Gerard Dijkstra
- From the Departments of Gastroenterology and Hepatology (AMR and GD), Surgery (AMR, JWH, and RJP), Epidemiology (HG and PFMK), and Pediatrics (EHHMR), University of Groningen, University Medical Center Groningen, Groningen, The Netherlands; the Department of Endocrinology and Metabolism, University of Amsterdam, Academic Medical Center, Amsterdam, The Netherlands (MJS); and the Department of Gastroenterology and Hepatology, University of Nijmegen, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands (GW)
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16
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Zambernardi A, Chiodetti A, Meier D, Cabanne A, Nachman F, Solar H, Rumbo C, Gondolesi GE, Rumbo M. Immunosuppressive therapies after intestinal transplant modulate the expression of Th1 signature genes during acute cellular rejection. Implications in the search for rejection biomarkers. Clin Transplant 2014; 28:1365-71. [DOI: 10.1111/ctr.12464] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/05/2014] [Indexed: 12/24/2022]
Affiliation(s)
- Agustina Zambernardi
- Laboratorio de Investigaciones del Sistema Inmune (LISIN); Facultad de Cs. Exactas; Universidad Nacional de La Plata; La Plata Argentina
- Instituto de Transplante Multiorgánico; Fundación Favaloro; Buenos Aires Argentina
| | - Ana Chiodetti
- Laboratorio de Investigaciones del Sistema Inmune (LISIN); Facultad de Cs. Exactas; Universidad Nacional de La Plata; La Plata Argentina
| | - Dominik Meier
- Instituto de Transplante Multiorgánico; Fundación Favaloro; Buenos Aires Argentina
| | - Ana Cabanne
- Instituto de Transplante Multiorgánico; Fundación Favaloro; Buenos Aires Argentina
| | - Fabio Nachman
- Instituto de Transplante Multiorgánico; Fundación Favaloro; Buenos Aires Argentina
| | - Héctor Solar
- Instituto de Transplante Multiorgánico; Fundación Favaloro; Buenos Aires Argentina
| | - Carolina Rumbo
- Instituto de Transplante Multiorgánico; Fundación Favaloro; Buenos Aires Argentina
| | - Gabriel E. Gondolesi
- Instituto de Transplante Multiorgánico; Fundación Favaloro; Buenos Aires Argentina
| | - Martin Rumbo
- Laboratorio de Investigaciones del Sistema Inmune (LISIN); Facultad de Cs. Exactas; Universidad Nacional de La Plata; La Plata Argentina
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17
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Cieślar-Pobuda A, Wiechec E. Research on liver regeneration as an answer to the shortage of donors for liver transplantation. Hepatol Res 2014; 44:944-6. [PMID: 25224133 DOI: 10.1111/hepr.12265] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Affiliation(s)
- Artur Cieślar-Pobuda
- Department of Clinical & Experimental Medicine (IKE), Division of Cell Biology, Integrative Regenerative Medicine Center (IGEN), Linköping University, Linkoping, Sweden; Biosystems Group, Institute of Automatic Control, Silesian University of Technology, Gliwice, Poland
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18
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Ting MJ, Chen Y, Chang SC. Factors affecting the duration of mechanical ventilation in patients after intestinal transplantation: preliminary results. ACTA ACUST UNITED AC 2013; 51:108-11. [PMID: 24148738 DOI: 10.1016/j.aat.2013.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2012] [Revised: 06/03/2013] [Accepted: 06/06/2013] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Intestinal transplantation (ITx) is a definitive therapy for patients with intestinal failure. However, postoperative respiratory care in such patients remains a clinical challenge. In this study, we investigated the factors affecting the duration of mechanical ventilation in patients who underwent ITx. METHODS In this observational study, eight patients who underwent ITx between 2007 and 2013 were studied. They were divided into two groups, with Group E including three patients who could be successfully extubated within 72 hours and Group V including the remaining five, who could not be extubated. The differences in demographical and clinical data between the two groups were evaluated. RESULTS The surgery success rate, patient survival rate, and graft survival rate were 100%, 88%, and 75%, respectively. Compared with Group E, postoperative bleeding was significantly higher in Group V (700 ± 420.7 mL vs. 50.0 ± 2.0 mL, p = 0.021). In addition, postoperative respiratory complications including pleural effusion and pneumonia (p = 0.017 and p = 0.0714, respectively) were prone to occur in Group V. Other variables including demographic parameters and clinical data showed no significant differences between the two groups. It was not unexpected that the duration of ventilator use and the length of intensive care unit stay were significantly shorter in Group E. CONCLUSION Postoperative blood loss and postoperative respiratory complications might be the factors responsible for delayed extubation in ITx patients. Because the study had few examinees, further studies with a larger population are needed to verify these issues.
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Affiliation(s)
- Man-Ju Ting
- Institute of Emergency and Critical Care Medicine, National Yang-Ming University, Taipei, Taiwan; Department of Chest Medicine, Far Eastern Memorial Hospital, Taipei, Taiwan
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19
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Sun G, Shan J, Li Y, Feng L, Zhou Y, Guo Y, Tong Y, Xia M. Adoptive infusion of tolerance dendritic cells prolongs survival of small intestine allografts in rats: systematic review and meta-analysis. J Evid Based Med 2013; 6:185-96. [PMID: 24325375 DOI: 10.1111/jebm.12050] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2013] [Accepted: 07/23/2013] [Indexed: 02/05/2023]
Abstract
BACKGROUND Postoperative infections and rejection are the main limiting factors of small intestine allograft survival. In this study, we performed a systematic review and meta-analysis to review rat small intestine allograft survival following infusion of tolerance dendritic cells (Tol-DCs) induced by different methods. METHODS Relevant publications were searched from PubMed database and EMbase database. Meta-analysis was performed using RevMan 5.0 software. We chose allograft survival, mixed leukocyte reaction, Th1/Th2 differentiation, Treg induction, and cytotoxic T lymphocyte activity as the outcomes by which to examine possible mechanisms that promote survival. RESULTS Eleven suitable articles were identified and assessed. Tol-DCs induced by four methods all prolonged allograft survival. The difference in survival time between the Tol-DC group and the control group was indicated by SMD as follows: drug intervention (SMD = 3.02, 95% CI 1.16 to 4.88, P = 0.001), gene modification (SMD = 2.43, 95% CI 1.77 to 3.10, P < 0.00001), imDC (SMD = 1.76, 95% CI 0.90 to 2.62, P < 0.0001), cytokine induction (SMD = 1.68, 95% CI 0.40 to 2.96, P = 0.01). Tol-DCs were also synergistic with immunosuppressive drugs or costimulation inhibitors, but no immune tolerance was observed. A single-dose intravenous injection of 5×10(6) to 6×10(6) Tol-DCs showed the highest allograft survival. Possible mechanisms included donor-specific T-cell hyporesponsiveness and Th2 differentiation. CONCLUSIONS Our results demonstrated that Tol-DCs induced by four methods prolong rat small intestine allograft survival. Intravenous infusion of 5×10(6) to 6×10(6) Tol-DCs was the optimum dose in rat small intestine transplantation. Immunosuppressive or costimulatory blockade was synergistic with Tol-DC on graft survival. Additional high-quality studies with larger sample sizes are needed to better investigate small intestinal graft longer term survival.
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Affiliation(s)
- Guixiang Sun
- Key Laboratory of Transplant Engineering and Immunology of Health Ministry of China, West China Hospital, Sichuan University, Chengdu, Sichuan, China
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20
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Yagi H, Soto-Gutierrez A, Kitagawa Y. Whole-organ re-engineering: a regenerative medicine approach to digestive organ replacement. Surg Today 2013; 43:587-94. [PMID: 23184357 PMCID: PMC3682788 DOI: 10.1007/s00595-012-0396-1] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2012] [Accepted: 06/28/2012] [Indexed: 12/12/2022]
Abstract
Recovery from end-stage organ failure presents a challenge for the medical community, considering the limitations of extracorporeal assist devices and the shortage of donors when organ replacement is needed. There is a need for new methods to promote recovery from organ failure and regenerative medicine is an option that should be considered. Recent progress in the field of tissue engineering has opened avenues for potential clinical applications, including the use of microfluidic devices for diagnostic purposes, and bioreactors or cell/tissue-based therapies for transplantation. Early attempts to engineer tissues produced thin, planar constructs; however, recent approaches using synthetic scaffolds and decellularized tissue have achieved a more complex level of tissue organization in organs such as the urinary bladder and trachea, with some success in clinical trials. In this context, the concept of decellularization technology has been applied to produce whole organ-derived scaffolds by removing cellular content while retaining all the necessary vascular and structural cues of the native organ. In this review, we focus on organ decellularization as a new regenerative medicine approach for whole organs, which may be applied in the field of digestive surgery.
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Affiliation(s)
- Hiroshi Yagi
- Department of Surgery, School of Medicine, Keio University, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan
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21
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Timpone JG, Girlanda R, Rudolph L, Fishbein TM. Infections in Intestinal and Multivisceral Transplant Recipients. Infect Dis Clin North Am 2013; 27:359-77. [DOI: 10.1016/j.idc.2013.02.012] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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22
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Song P, Song W, Liu X, Jin C, Xie H, Zhou L, Tuo B, Zheng S. Function and expression of cystic fibrosis transmembrane conductance regulator after small intestinal transplantation in mice. PLoS One 2013; 8:e62536. [PMID: 23626828 PMCID: PMC3633864 DOI: 10.1371/journal.pone.0062536] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2012] [Accepted: 03/22/2013] [Indexed: 01/14/2023] Open
Abstract
The secretion function of intestinal graft is one of the most important factors for successful intestinal transplantation. Cystic fibrosis transmembrane conductance regulator (CFTR) mediates HCO3- and Cl- secretions in intestinal epithelial cells. In this study, we made investigation on the expression and function of CFTR in an experimental model of murine small intestinal transplantation. Heterotopic intestinal transplantations were performed in syngeneic mice. The mRNA and protein expressions of CFTR were analyzed by real time PCR and western blot. Murine intestinal mucosal HCO3- and Cl- secretions were examined in vitro in Ussing chambers by the pH stat and short circuit current (Isc) techniques. The results showed that forskolin, an activator of CFTR, stimulated jejunal mucosal epithelial HCO3- and Cl- secretions in mice, but forskolin-stimulated HCO3- and Cl- secretions in donor and recipient jejunal mucosae of mice after heterotopic jejunal transplantation were markedly decreased, compared with controls (P<0.001). The mRNA and protein expression levels of CFTR in donor and recipient jejunal mucosae of mice were also markedly lower than those in controls (P<0.001), and the mRNA and protein expression levels of tumor necrosis factor α (TNFα) were markedly increased in donor jejunal mucosae of mice (P<0.001), compared with controls. Further experiments showed that TNFα down-regulated the expression of CFTR mRNA in murine jejunal mucosa. In conclusion, after intestinal transplantation, the function of CFTR was impaired, and its mRNA and protein expressions were down-regulated, which may be induced by TNFα.
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Affiliation(s)
- Penghong Song
- Key Laboratory of Combined Multi-organ Transplantation of Ministry of Public Health, First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Wenfeng Song
- Key Laboratory of Combined Multi-organ Transplantation of Ministry of Public Health, First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Xiaosun Liu
- Department of Surgery, First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Changhai Jin
- Key Laboratory of Combined Multi-organ Transplantation of Ministry of Public Health, First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Haiyang Xie
- Key Laboratory of Combined Multi-organ Transplantation of Ministry of Public Health, First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Lin Zhou
- Key Laboratory of Combined Multi-organ Transplantation of Ministry of Public Health, First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Biguang Tuo
- Department of Gastroenterology, Affiliated Hospital of Zunyi Medical College, Zunyi, China
| | - Shusen Zheng
- Key Laboratory of Combined Multi-organ Transplantation of Ministry of Public Health, First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
- * E-mail:
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23
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Spurrier RG, Grikscheit TC. Tissue engineering the small intestine. Clin Gastroenterol Hepatol 2013; 11:354-8. [PMID: 23380001 DOI: 10.1016/j.cgh.2013.01.028] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2013] [Accepted: 01/30/2013] [Indexed: 02/07/2023]
Abstract
Short bowel syndrome (SBS) results from the loss of a highly specialized organ, the small intestine. SBS and its current treatments are associated with high morbidity and mortality. Production of tissue-engineered small intestine (TESI) from the patient's own cells could restore normal intestinal function via autologous transplantation. Improved understanding of intestinal stem cells and their niche have been coupled with advances in tissue engineering techniques. Originally described by Vacanti et al of Massachusetts General Hospital, TESI has been produced by in vivo implantation of organoid units. Organoid units are multicellular clusters of epithelium and mesenchyme that may be harvested from native intestine. These clusters are loaded onto a scaffold and implanted into the host omentum. The scaffold provides physical support that permits angiogenesis and vasculogenesis of the developing tissue. After a period of 4 weeks, histologic analyses confirm the similarity of TESI to native intestine. TESI contains a differentiated epithelium, mesenchyme, blood vessels, muscle, and nerve components. To date, similar experiments have proved successful in rat, mouse, and pig models. Additional experiments have shown clinical improvement and rescue of SBS rats after implantation of TESI. In comparison with the group that underwent massive enterectomy alone, rats that had surgical anastomosis of TESI to their shortened intestine showed improvement in postoperative weight gain and serum B12 values. Recently, organoid units have been harvested from human intestinal samples and successfully grown into TESI by using an immunodeficient mouse host. Current TESI production yields approximately 3 times the number of cells initially implanted, but improvements in the scaffold and blood supply are being developed in efforts to increase TESI size. Exciting new techniques in stem cell biology and directed cellular differentiation may generate additional sources of autologous intestinal tissue for direct translation to human therapy.
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Affiliation(s)
- Ryan G Spurrier
- Division of Pediatric Surgery, Children's Hospital Los Angeles, Keck School of Medicine of the University of Southern California, Los Angeles, California, USA
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24
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Garg M, Jones RM, Mirza D, Wang BZ, Fink MA, Starkey G, Vaughan RB, Testro AG. Australia's first liver-intestinal transplant. Med J Aust 2013; 197:463-5. [PMID: 23072244 DOI: 10.5694/mja12.10605] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Mayur Garg
- Liver Transplant Unit, Austin Health, Melbourne, VIC, Australia
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25
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Zambernardi A, Gondolesi G, Cabanne A, Martinez MI, Solar H, Rumbo M, Rumbo C. Serum albumin level during intestinal exfoliative rejection: a potential predictor of graft recovery and patient outcome. Clin Transplant 2013; 27:E137-42. [DOI: 10.1111/ctr.12078] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/30/2012] [Indexed: 11/30/2022]
Affiliation(s)
| | - Gabriel Gondolesi
- Instituto de Transplante Multiorgánico; Fundación Favaloro; Buenos Aires; Argentina
| | - Ana Cabanne
- Instituto de Transplante Multiorgánico; Fundación Favaloro; Buenos Aires; Argentina
| | - María I. Martinez
- Instituto de Transplante Multiorgánico; Fundación Favaloro; Buenos Aires; Argentina
| | - Héctor Solar
- Instituto de Transplante Multiorgánico; Fundación Favaloro; Buenos Aires; Argentina
| | - Martín Rumbo
- Laboratorio de Investigaciones del Sistema Inmune (LISIN); Facultad de Cs. Exactas; Universidad Nacional de La Plata; La Plata; Argentina
| | - Carolina Rumbo
- Instituto de Transplante Multiorgánico; Fundación Favaloro; Buenos Aires; Argentina
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Abstract
Adaptation is an important compensatory response to environmental cues resulting in enhanced survival. In the gut, the abrupt loss of intestinal length is characterized by increased rates of enterocyte proliferation and apoptosis and culminates in adaptive villus and crypt growth. In the development of an academic pediatric surgical career, adaptation is also an important compensatory response to survive the ever changing research, clinical, and economic environment. The ability to adapt in both situations is critical for patients and a legacy of pediatric surgical contributions to advance our knowledge of multiple conditions and diseases.
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Donor-derived bone marrow transfusion produces mixed chimerism and promotes a Th2 shift in Th1/Th2 balance in rat heterotopic small bowel transplantation. Dig Liver Dis 2012; 44:988-94. [PMID: 22954489 DOI: 10.1016/j.dld.2012.08.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2012] [Revised: 07/13/2012] [Accepted: 08/05/2012] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND AIM In this study, we investigated immunomodulatory effects of donor-derived bone marrow transfusion in rat heterotopic small bowel transplantation. METHODS Rat heterotopic segmental small bowel transplantation models (male Brown Norway to female Lewis) were established. The recipients were randomly divided into control group (pute small bowel transplantation), tacrolimus group (small bowel transplantation plus oral tacrolimus) and small bowel transplantation plus oral tacrolimus and intraportal infusion of donor-derived bone marrow cells group. We investigated the survival time, graft pathologic injuries and rejection grade by haematoxylin-eosin staining, serum IL-2 and IL-10 detection by enzyme labelled immunosorbent assay after small bowel transplantation. The recipients mixed chimerism were observed by detecting sex-determining region of Y chromosome gene in blood, liver, spleen and intestine by using real-time polymerase chain reaction and fluorescence in situ hybridization. RESULTS Bone marrow cells group showed a superior survival than the other groups, accompanied by milder pathologic injuries and lower rejection grade, decreasing serum IL-2 and increasing serum IL-10. The recipient chimerism rate in blood, liver, spleen and intestine in bone marrow cells group was significantly higher than the other groups. CONCLUSION Transfusion of donor-derived bone marrow cells via portal vein induces mixed chimerism in rats after small bowel transplantation, which may promote a Th2 shift in Th1/Th2 balance and facilitate the induction of immune tolerance.
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Strasser SI. Another achievement in organ transplantation in Australia - yet much still needs to be done. Med J Aust 2012; 197:429-30. [PMID: 23072226 DOI: 10.5694/mja12.11431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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29
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Howell JC, Wells JM. Generating intestinal tissue from stem cells: potential for research and therapy. Regen Med 2012; 6:743-55. [PMID: 22050526 DOI: 10.2217/rme.11.90] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Intestinal resection and malformations in adult and pediatric patients result in devastating consequences. Unfortunately, allogeneic transplantation of intestinal tissue into patients has not been met with the same measure of success as the transplantation of other organs. Attempts to engineer intestinal tissue in vitro include disaggregation of adult rat intestine into subunits called organoids, harvesting native adult stem cells from mouse intestine and spontaneous generation of intestinal tissue from embryoid bodies. Recently, by utilizing principles gained from the study of developmental biology, human pluripotent stem cells have been demonstrated to be capable of directed differentiation into intestinal tissue in vitro. Pluripotent stem cells offer a unique and promising means to generate intestinal tissue for the purposes of modeling intestinal disease, understanding embryonic development and providing a source of material for therapeutic transplantation.
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Affiliation(s)
- Jonathan C Howell
- Division of Endocrinology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229-3039, USA
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