Author:
Eiji Kobayashi Department of Kidney Regenerative Medicine, Industry-Academia Collaborative Department, The Jikei University School of Medicine, Tokyo, Japan

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Abstract

Small intestinal transplantation has emerged as an essential treatment for intestinal failure, but its relatively high graft rejection rate and mortality rate when compared to those of other transplanted organs has led to difficulties in post-transplantation treatment management. The recently-developed technique of creating organoids from somatic stem cells has created a challenging opportunity to develop a treatment that involves the creation of a substitute small intestine using autologous cells instead of transplanting another individual's small intestines. The remaining partial large intestine is then used as a segmental graft, and autologous small intestinal organoid transplantation is conducted on its epithelium in order to create a pedunculated hybrid graft. This is a new surgical technique for interposing with the original ileocecal region. The hybrid large intestine acquires both the lymphatic vessels that are involved in nutrient absorption and the original peristaltic function of the large intestine.

This lecture touches upon the history of the development of organoid medicine, after which an introduction is provided of the revolutionary surgical technique in which a functional small intestine is created by regenerating autologous cells.

The content here was introduced in a special lecture (online) at the 29th Congress of the Experimental Surgical Session of the Hungarian Surgical Society (Host: Dr. Norbert Nemeth, 9/9/2022, Budapest).

  • 1.

    Pironi L, Steiger E, Joly F, Jeppesen PB, Wanten G, Sasdelli AS, et al. Characteristics of adult patients with chronic intestinal failure due to short bowel syndrome: an international multicenter survey. Clin Nutr ESPEN 2021 Oct; 45: 43341. https://doi.org/10.1016/j.clnesp.2021.07.004. Epub 2021 Jul 28.

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  • 2.

    Kobayashi E. Organ fabrication: progress and hurdles to overcome. Current Transplantation Reports https://doi.org/10.1007/s40472-022-00372-3.

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  • 3.

    Caleb I, Erlitz L, Telek V, Vecsernyés M, Sétáló G Jr, Hardi P, et al. Characterizing autophagy in the cold ischemic injury of small bowel grafts: evidence from Rat Jejunum. Metabolites 2021 Jun 17; 11(6): 396. https://doi.org/10.3390/metabo11060396.

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  • 4.

    Kobayashi E, Enosawa S. Liver bud transplantation in rats. Magy Seb 2018 Dec; 71(4): 1639. https://doi.org/10.1556/1046.71.2018.4.3.

  • 5.

    Yanagi Y, Nakayama K, Taguchi T, Enosawa S, Tamura T, Yoshimaru K, et al. In vivo and ex vivo methods of growing a liver bud through tissue connection. Sci Rep 2017 Oct 26; 7(1): 14085. https://doi.org/10.1038/s41598-017-14542-2.

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  • 6.

    Kawai Y, Tohyama S, Arai K, Tamura T, Soma Y, Fukuda K, et al. Scaffold-free tubular engineered heart tissue from human induced pluripotent stem cells using bio-3D printing technology in vivo. Front Cardiovasc Med 2022 Jan 20; 8: 806215. https://doi.org/10.3389/fcvm.2021.806215. eCollection 2021.

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  • 7.

    Saito Y, Matsumoto N, Yamanaka S, Yokoo T, Kobayashi E. Beneficial impact of interspecies chimeric renal organoids against a xenogeneic immune response. Front Immunol 2022 Feb 15; 13: 848433. https://doi.org/10.3389/fimmu.2022.848433. eCollection 2022.

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  • 8.

    Sugimoto S, Kobayashi E, Fujii M, Ohta Y, Arai K, Matano M, et al. An organoid-based organ-repurposing approach to treat short bowel syndrome. Nature 2021 Apr; 592(7852): 99104. https://doi.org/10.1038/s41586-021-03247-2. Epub 2021 Feb 24.

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    Takebe T, Sekine K, Enomura M, Koike H, Kimura M, Ogaeri T, et al. Vascularized and functional human liver from an iPSC-derived organ bud transplant. Nature 2013 Jul 25; 499(7459): 4814. https://doi.org/10.1038/nature12271. Epub 2013 Jul 3.

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  • 14.

    Takasato M, Er PX, Chiu HS, Maier B, Baillie GJ, Ferguson C, et al. Kidney organoids from human iPS cells contain multiple lineages and model human nephrogenesis. Nature 2015 Oct 22; 526(7574): 5648. https://doi.org/10.1038/nature15695. Epub 2015 Oct 7.

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  • 15.

    Wu H, Uchimura K, Donnelly EL, Kirita Y, Morris SA, Humphreys BD. Comparative analysis and refinement of human PSC-derived kidney organoid differentiation with single-cell transcriptomics. Cell Stem Cell 2018 Dec 6; 23(6): 86981.e8. https://doi.org/10.1016/j.stem.2018.10.010. Epub 2018 Nov 15.

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  • 16.

    Combes AN, Zappia L, Er PX, Oshlack A, Little MH. Single-cell analysis reveals congruence between kidney organoids and human fetal kidney. Genome Med 2019 Jan 23; 11(1): 3. https://doi.org/10.1186/s13073-019-0615-0.

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  • 17.

    Fernandes MA, Usatin D, Allen IE, Rhee S, Vu L. Improved enteral tolerance following step procedure: systematic literature review and meta-analysis. Pediatr Surg Int 2016 Oct; 32(10): 9216. https://doi.org/10.1007/s00383-016-3927-9. Epub 2016 Jul 26.

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  • 18.

    Sasaki H, Iwai S, Yokoo T, Kobayashi E. Transplantation of vulnerable renal organoids by use of a novel laparoscopic device in pigs. Transpl Direct 2021 Oct 22; 7(11): e777. https://doi.org/10.1097/TXD.0000000000001206. eCollection 2021 Nov.

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