April 8, 2016

expert reaction to case study of reconstruction of oesophageal tissue in a patient in the USA

Regeneration of tissues and organs following injury or other events is a complex task. A case study has been published in The Lancet journal which reports the use of a non-biological scaffold to bridge a gap in the oesophagus of a 24 year old man, which was then able to support regeneration of tissues and restoration of structure and function.

Prof. John Hunt, Head of Unit of Clinical Engineering, University of Liverpool, said:

“This is another very exciting case study for the use of decellularised degradable biological material with or without cells and with or without nondegradable materials intended to be explanted.

“Strictly speaking it may be correct to say this is the first oesophageal reconstruction using this approach. However this kind of human decellularised skin material has been used in man successfully for decades, it has been used for “tubular structures” like esophageal reconstruction as far back as 2006. Most commonly it used in hernia repairs and other smooth muscle reconstructions and repairs.

“This doesn’t reduce the value of the clinical breakthrough as a treatment for the oesophagus which is fantastic and extremely exciting. What it should be tempered with and what should be noted in this success is the science, the materials and the technology are well established and this approach was well supported in theory and existing clinical evidence for the use of stents, allograft and pluripotent cells as medical therapies. It is as the authors say a complex procedure, but globally clinicians are switched on and are embracing these kinds of approaches as they will provide improved patient outcomes both in terms of patient satisfaction and dare we say happiness (that’s not trivial where health is concerned) as well as life time savings to the healthcare provider.

“What currently holds these approaches back is the cost and the time required beforehand to prepare a tissue engineered structure with cells. Regenerative medicine using tissue engineering is a complex procedure, using materials that will be removed in combination with pluripotent cells and degradable materials will become much more common. We are tackling the so called “off the shelf” approaches and at that stage these treatments will become more widely available as well as more cost effective.

“In summary, It’s very exciting, but not completely new as an approach or some kind of eureka moment; we’ve been working as a community towards exactly these treatments for decades. Every success is celebrated globally by everyone in our field.”

‘In-vivo oesophageal regeneration in a human being by use of a non-biological scaffold and extracellular matrix’ by Dua et al. published in The Lancet on Friday 8th March. 

Declared interests

Prof. John Hunt: I have no known conflicts of interest with the group.