Esophageal Preservation in Five Male Patients After Endoscopic Inner-Layer Circumferential Resection in the Setting of Superficial Cancer: A Regenerative Medicine Approach with a Biologic Scaffold

被引:124
作者
Badylak, Stephen F. [1 ,2 ]
Hoppo, Toshitaka [3 ]
Nieponice, Alejandro [1 ,2 ,4 ]
Gilbert, Thomas W. [1 ,2 ]
Davison, Jon M. [5 ]
Jobe, Blair A. [1 ,3 ]
机构
[1] Univ Pittsburgh, McGowan Inst Regenerat Med, Pittsburgh, PA 15219 USA
[2] Univ Pittsburgh, Dept Surg, Pittsburgh, PA 15219 USA
[3] Univ Pittsburgh, Dept Cardiothorac Surg, Pittsburgh, PA 15219 USA
[4] Univ Favaloro, Dept Surg, Buenos Aires, DF, Argentina
[5] Univ Pittsburgh, Dept Pathol, Pittsburgh, PA 15219 USA
关键词
SMALL-INTESTINAL SUBMUCOSA; HIGH-GRADE DYSPLASIA; EXTRACELLULAR-MATRIX SCAFFOLD; BARRETTS-ESOPHAGUS; MUCOSAL RESECTION; DOG-MODEL; MACROPHAGE PHENOTYPE; IMMUNE-RESPONSE; TUMOR INVASION; CANINE MODEL;
D O I
10.1089/ten.tea.2010.0739
中图分类号
Q813 [细胞工程];
学科分类号
摘要
As a result of injury caused by chronic gastroesophageal reflux, Barrett's esophagus with high-grade dysplasia and esophageal adenocarcinoma are rapidly increasing problems in the United States. The current standard of care involves esophagectomy, a procedure associated with a high morbidity, a negative impact on long term quality of life, and amortality rate of 1-6 percent. An entirely endoscopic technique for circumferential, long segment en bloc removal of the mucosa and submucosa with subsequent placement of a biologic scaffold material that promotes a constructive remodeling response and minimizes stricture is described herein. The results of this approach are reported for five patients with 4-24-month follow-up. Restoration of normal mature, K4+/K14+, squamous epithelium, and return to a normal diet without significant dysphagia is reported for all patients. Two of five patients show a small focus of recurrent Barrett's esophagus at the gastroesophageal junction, but the entire length and circumference of the reconstituted esophageal mucosa remains free of disease. This experience provides evidence that a regenerative medicine approach may, for the first time, enable aggressive endoscopic resection of early stage neoplasia without the need for esophagectomy and its associated complications.
引用
收藏
页码:1643 / 1650
页数:8
相关论文
共 49 条
[1]   H+ pump-dependent changes in membrane voltage are an early mechanism necessary and sufficient to induce Xenopus tail regeneration [J].
Adams, Dany S. ;
Masi, Alessio ;
Levin, Michael .
DEVELOPMENT, 2007, 134 (07) :1323-1335
[2]   Xenogeneic extracellular matrix grafts elicit a Th2-restricted immune response [J].
Allman, AJ ;
McPherson, TB ;
Badylak, SF ;
Merrill, LC ;
Kallakury, B ;
Sheehan, C ;
Raeder, RH ;
Metzger, DW .
TRANSPLANTATION, 2001, 71 (11) :1631-1640
[3]   Resorbable bioscaffold for esophageal repair in a dog model [J].
Badylak, S ;
Meurling, S ;
Chen, M ;
Spievack, A ;
Simmons-Byrd, A .
JOURNAL OF PEDIATRIC SURGERY, 2000, 35 (07) :1097-1103
[4]   THE USE OF XENOGENEIC SMALL-INTESTINAL SUBMUCOSA AS A BIOMATERIAL FOR ACHILLES-TENDON REPAIR IN A DOG-MODEL [J].
BADYLAK, SF ;
TULLIUS, R ;
KOKINI, K ;
SHELBOURNE, KD ;
KLOOTWYK, T ;
VOYTIK, SL ;
KRAINE, MR ;
SIMMONS, C .
JOURNAL OF BIOMEDICAL MATERIALS RESEARCH, 1995, 29 (08) :977-985
[5]   Esophageal reconstruction with ECM and muscle tissue in a dog model [J].
Badylak, SF ;
Vorp, DA ;
Spievack, AR ;
Simmons-Byrd, A ;
Hanke, J ;
Freytes, DO ;
Thapa, A ;
Gilbert, TW ;
Nieponice, A .
JOURNAL OF SURGICAL RESEARCH, 2005, 128 (01) :87-97
[6]   Immune response to biologic scaffold materials [J].
Badylak, Stephen E. ;
Gilbert, Thomas W. .
SEMINARS IN IMMUNOLOGY, 2008, 20 (02) :109-116
[7]   Macrophage Phenotype as a Determinant of Biologic Scaffold Remodeling [J].
Badylak, Stephen F. ;
Valentin, Jolene E. ;
Ravindra, Anjani K. ;
McCabe, George P. ;
Stewart-Akers, Ann M. .
TISSUE ENGINEERING PART A, 2008, 14 (11) :1835-1842
[8]  
Balbani Aracy Pereira Silveira, 2004, Rev. Assoc. Med. Bras., V50, P433, DOI 10.1590/S0104-42302004000400036
[9]   Chemoattraction of Progenitor Cells by Remodeling Extracellular Matrix Scaffolds [J].
Beattie, Allison J. ;
Gilbert, Thomas W. ;
Guyot, Juan Pablo ;
Yates, Adolph J. ;
Badylak, Stephen F. .
TISSUE ENGINEERING PART A, 2009, 15 (05) :1119-1125
[10]   Macrophage phenotype and remodeling outcomes in response to biologic scaffolds with and without a cellular component [J].
Brown, Bryan N. ;
Valentin, Jolene E. ;
Stewart-Akers, Ann M. ;
McCabe, George P. ;
Badylak, Stephen F. .
BIOMATERIALS, 2009, 30 (08) :1482-1491