Grikscheit1

Grikscheit1 - Short Bowel Syndrome x and Stem Cell...

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Short Bowel Syndrome x and Stem Cell Solutions Tracy Grikscheit, MD Childrens Hospital Los Angeles Saban Research Institute USC Keck School of Medicine
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NEC Gastroschisis Atresia Trauma Volvulus
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Short Bowel Syndrome: costly and morbid 30%, 5 year mortality rate • Morbidity rate much higher • US costs $1000/day or more • Progression to Liver or Liver/Small Bowel transplant -- low donor supply and excessive morbidity/mortality (1yr graft/patient survival 65/77%)
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Ruiz et al. Current Status of Transplantation of the Small Intestine. T ransplantation 2007
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Options for Absent tissue: Substitution Not enough tissue “Rob Peter to pay Paul” Man-made Multiple operations Foreign body
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WHAT IS TISSUE ENGINEERING?
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What is NOT Tissue Engineering? Wound healing Tissue ingrowth Cellular persistence Cell death Adaptation Transplantation
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Polymer Fabrication
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The problem of blood supply 40-200um distance for oxygen diffusion: 5mm of tissue requires a complex vascular network
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Transplantation of an Engineered Pulmonary Artery 4 y.o. female with a single right ventricle, pulmonary atresia, s/ p PA angioplasty, and Fontan procedure - with occlusion of right intermediate pulmonary artery. Shin ` oka, Imai, Ikada. N.Engl. J. Med., Vol. 344, No. 7, Feb. 15, 2001:pp. 532-533.
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Organoid Unit Isolation Organoid Units On Polymer Intestine biopsy Engineered Intestine Tissue engineered graft
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Background and Hypothesis • Death results from overwhelming post- splenectomy sepsis (OPSS) in greater than half of all cases. (Br J Surg 1989;76:1074-81) • Splenosis from implanted fragments occurs with an intial necrosis to a rudimentary connective tissue structure with hypocellularity and a loss of lymphoid elements. (Br J Surg 1991;78:270-278) • Could Tissue-Engineered spleen avoid necrotic loss prior to regeneration?
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• Sharp dissection to 2 mm • Enzymatic digestion • Purification with
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Grikscheit1 - Short Bowel Syndrome x and Stem Cell...

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