In-vivo oesophageal regeneration in a human being by use of a non-biological scaff old and extracellular matrix

9 July 2016

Background
Tissue-engineered extracellular matrix populated with autologous pluripotent cells can result in de-novo organogenesis, but the technique is complex, not widely available, and has not yet been used to repair large oesophageal defects in human beings. We aimed to use readily available stents and extracellular matrix to regeneratethe oesophagus in vivo in a human being to re-establish swallowing function.
Methods
In a patient aged 24 years, we endoscopically placed a readily available, fully covered, self-expanding, metal stent (diameter 18 mm, length 120 mm) to bridge a 5 cm full-thickness oesophageal segment destroyed by a mediastinal abscess and leading to direct communication between the hypopharynx and the mediastinum.
A commercially available extracellular matrix was used to cover the stent and was sprayed with autologous plateletrichplasma adhesive gel. The sternocleidomastoid muscle was placed over the matrix. After 4 weeks, stent removal was needed due to stent migration, and was replaced with three stents telescopically aligned to improve anchoring.
The stents were removed after 3⋅5 years and the oesophagus was assessed by endoscopy, biopsy, endoscopic ultrasonography, and high-resolution impedance manometry.
Findings
After stent removal we saw full-thickness regeneration of the oesophagus with stratifi ed squamous epithelium, a normal fi ve-layer wall, and peristaltic motility with bolus transit. 4 years after stent removal, the patient was eating a normal diet and maintaining a steady weight.
Interpretation
Maintenance of the structural morphology of the oesophagus with off -the-shelf non-biological scaff old and stimulation of regeneration with commercially available extracellular matrix led to de-novo structural and functional regeneration of the oesophagus.

Division of Gastroenterology and Hepatology, Department of Medicine (Prof K S Dua MD, Prof W J Hogan MD) and Division of Cardiothoracic Surgery, Department of Surgery (Prof M Gasparri MD), Medical College of Wisconsin, Milwaukee, WI, USA; and Division of Gastroenterology
and Hepatology, Northwestern University, Evanston, IL, USA (A A Aadam MD)

Published Online April 8, 2016 http://dx.doi.org/10.1016/S0140-6736(15)01036-3

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