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New approaches to increase intestinal length: Methods used for intestinal
regeneration and bioengineering
#MMPMID27011901
Shirafkan A
; Montalbano M
; McGuire J
; Rastellini C
; Cicalese L
World J Transplant
2016[Mar]; 6
(1
): 1-9
PMID27011901
show ga
Inadequate absorptive surface area poses a great challenge to the patients
suffering a variety of intestinal diseases causing short bowel syndrome. To date,
these patients are managed with total parenteral nutrition or intestinal
transplantation. However, these carry significant morbidity and mortality.
Currently, by emergence of tissue engineering, anticipations to utilize an
alternative method to increase the intestinal absorptive surface area are
increasing. In this paper, we will review the improvements made over time in
attempting elongating the intestine with surgical techniques as well as using
intestinal bioengineering. Performing sequential intestinal lengthening was the
preliminary method applied in humans. However, these methods did not reach
widespread use and has limited outcome. Subsequent experimental methods were
developed utilizing scaffolds to regenerate intestinal tissue and organoids unit
from the intestinal epithelium. Stem cells also have been studied and applied in
all types of tissue engineering. Biomaterials were utilized as a structural
support for naive cells to produce bio-engineered tissue that can achieve a
near-normal anatomical structure. A promising novel approach is the elongation of
the intestine with an acellular biologic scaffold to generate a neo-formed
intestinal tissue that showed, for the first time, evidence of absorption in
vivo. In the large intestine, studies are more focused on regeneration and
engineering of sphincters and will be briefly reviewed. From the review of the
existing literature, it can be concluded that significant progress has been
achieved in these experimental methods but that these now need to be fully
translated into a pre-clinical and clinical experimentation to become a future
viable therapeutic option.
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