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Endoscopic transplantation in oesophageal ulceration
The late transplantation pioneer, Norman Shumway, MD, was fond of saying, “The future of transplantation is xenotransplantation. And, it always will be.” Tissue engineering, the in vitro creation of functional replacement tissues, has been proposed as a way to replace lost or damaged tissues due to acute or chronic disease for nearly 20 years.1 Despite the tremendous interest, there are a few tissue-engineered constructs that have gained considerable acceptance in clinical use, although progress is being made. Ohki et al2, demonstrate recent progress of the potential application of tissue engineering in endoscopy.
The complexity of organs and the lack of knowledge of how these organs are patterned in their development have made tissue engineering of solid organs like the liver difficult.3 In the case of the liver, the construct must have two separate vascular inflows, a single vascular outflow and a separate biliary drainage system. This also necessitates a particular polarity in the organisation of hepatocytes. Thus, despite the desire and need to replace liver allografts as a treatment for end-stage liver disease, there is no solution in sight. Because of the complexity of many solid organs, tissue engineering has turned to relatively simpler structures like bone, cartilage and skin, and it is likely that the first clinically successful tissue engineered construct will be one of these tissues.
In the study by Ohki et al2, the authors are not engineering an entire oesophagus, but rather are attempting a simpler task. Their goal is the restoration of the protective stratified epithelium after endoscopic submucosal dissection using cultured sheets of cells harvested from the buccal mucosa. They report short-term survival of these grafts with improved healing or the areas of …
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