Small intestinal submucosa

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Small intestinal submucosa (SIS) is submucosal tissue in the small intestines of vertebrates.

SIS is harvested (typically from pigs) for transplanted structural material in several clinical applications, typically biologic meshes. They have low immunogenicity. Some uses under investigation include a scaffold for intervertebral disc regeneration. Unlike other scaffold materials, the resorbable SIS extracellular matrix (SIS-ECM) scaffold is replaced by well-organized host tissues, including differentiated skeletal muscle.[1]

[edit] Expanded Description

Small intestinal submucosa (SIS) is a naturally derived biomaterial isolated from the small intestine of pigs. After removal of the mucosal, serosal, and muscular layers of the intestine, a strong, collagenous matrix remains. Through treatments for disinfection, cell removal, and sterilization, SIS can be made into a medically useful material suitable for many clinical applications.

In its native role, the submucosa of the small intestine provides mechanical strength to the intestine, preventing it from rupturing when a big meal is eaten. Consisting primarily of a strong extracellular matrix, the submucosa contains collagens, proteoglycans such as heparin, glycosaminoglycans such as heparin and hyaluronan, glycoproteins such as fibronectin, and growth factors such as FGF-2. Cells are mainly present to maintain the matrix, or in the abundant vasculature present to carry away the nutrients digested in the intestine. This rich environment is necessary to maintain the strength while supporting the rapid cell turnover of the mucosal layer. The strong yet biochemically rich and diverse extracellular matrix of the submucosa makes it an excellent choice for a naturally derived biomaterial.

Well documented in the scientific and medical literature (over 600 publications as of August 2008), SIS has been investigated as a biomaterial graft since 1989[2]. SIS has been published for use in over 20 applications in humans including: multiple types of hernia repair[3][4][5][6][7], dural repair[8], anal fistula closure[9], stress urinary incontinence treatment[10], pelvic organ prolapse repair[11], and Peyronie’s disease treatment[12]. There are over 150 medical publications (as of August 2008) describing SIS use in a wide variety of human use clinical situations. SIS has widespread potential for use in surgical repair due to its inherent strength and complex composition. In addition, SIS can be formed into many shapes and sizes, including large sheets, tubes, cylinders, and cones. This makes it suitable for many surgical applications.


SIS is a naturally derived, extracellular matrix based biomaterial. Easy to source and process, SIS also provides a rich environment that signals the body to repair itself. SIS provides the temporary strength or filling necessary for the immediate repair, but also signals the surrounding tissue to grow into and around it, gradually replacing the SIS with native tissue that has the necessary properties to continue the repair. Ultimately, this leads to a functional, long-lasting repair without the presence of a permanent foreign body that can cause problems years later. The use of SIS or biomaterials like SIS represents the future of medicine working with the body’s own repair mechanisms instead of simple patching.


[edit] See also

[edit] References

  1. ^ Badylak S, Kokini K, Tullius B, Simmons-Byrd A, Morff R (April 2002). "Morphologic study of small intestinal submucosa as a body wall repair device". J. Surg. Res. 103 (2): 190–202. doi:10.1006/jsre.2001.6349. PMID 11922734. http://linkinghub.elsevier.com/retrieve/pii/S0022480401963498. 
  2. ^ Badylak SF, Lantz GC, Coffey A, Geddes LA (July 1989). "Small intestinal submucosa as a large diameter vascular graft in the dog" ([dead link]). J. Surg. Res. 47 (1): 74–80. doi:10.1016/0022-4804(89)90050-4. PMID 2739401. http://linkinghub.elsevier.com/retrieve/pii/0022-4804(89)90050-4. 
  3. ^ Oelschlager BK, Pellegrini CA, Hunter J, et al. (October 2006). "Biologic prosthesis reduces recurrence after laparoscopic paraesophageal hernia repair: a multicenter, prospective, randomized trial". Ann. Surg. 244 (4): 481–90. doi:10.1097/01.sla.0000237759.42831.03. PMC 1856552. PMID 16998356. http://meta.wkhealth.com/pt/pt-core/template-journal/lwwgateway/media/landingpage.htm?issn=0003-4932&volume=244&issue=4&spage=481. 
  4. ^ Helton WS, Fisichella PM, Berger R, Horgan S, Espat NJ, Abcarian H (June 2005). "Short-term outcomes with small intestinal submucosa for ventral abdominal hernia". Arch Surg 140 (6): 549–60; discussion 560–2. doi:10.1001/archsurg.140.6.549. PMID 15967902. http://archsurg.ama-assn.org/cgi/pmidlookup?view=long&pmid=15967902. 
  5. ^ Franklin ME, Treviño JM, Portillo G, Vela I, Glass JL, González JJ (September 2008). "The use of porcine small intestinal submucosa as a prosthetic material for laparoscopic hernia repair in infected and potentially contaminated fields: long-term follow-up". Surg Endosc 22 (9): 1941–6. doi:10.1007/s00464-008-0005-y. PMID 18594919. 
  6. ^ Ansaloni L, Catena F, D'Alessandro L (2003). "Prospective randomized, double-blind, controlled trial comparing Lichtenstein's repair of inguinal hernia with polypropylene mesh versus Surgisis gold soft tissue graft: preliminary results". Acta Biomed 74 (Suppl 2): 10–4. PMID 15055026. 
  7. ^ Magee G, Ovington LG (March 2006). "Clinical trial report stirs debate". Adv Skin Wound Care 19 (2): 64; author reply 64, 67. doi:10.1097/00129334-200603000-00001. PMID 16557046. http://meta.wkhealth.com/pt/pt-core/template-journal/lwwgateway/media/landingpage.htm?issn=1527-7941&volume=19&issue=2&spage=64. 
  8. ^ Bejjani GK, Zabramski J (June 2007). "Safety and efficacy of the porcine small intestinal submucosa dural substitute: results of a prospective multicenter study and literature review". J. Neurosurg. 106 (6): 1028–33. doi:10.3171/jns.2007.106.6.1028. PMID 17564175. http://thejns.org/doi/abs/10.3171/jns.2007.106.6.1028?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%3dncbi.nlm.nih.gov. 
  9. ^ Champagne BJ, O'Connor LM, Ferguson M, Orangio GR, Schertzer ME, Armstrong DN (December 2006). "Efficacy of anal fistula plug in closure of cryptoglandular fistulas: long-term follow-up". Dis. Colon Rectum 49 (12): 1817–21. doi:10.1007/s10350-006-0755-3. PMID 17082891. 
  10. ^ Wiedemann A, Otto M (July 2004). "Small intestinal submucosa for pubourethral sling suspension for the treatment of stress incontinence: first histopathological results in humans". J. Urol. 172 (1): 215–8. doi:10.1097/01.ju.0000132148.56211.af. PMID 15201777. http://linkinghub.elsevier.com/retrieve/pii/S0022-5347(05)61855-1. 
  11. ^ Chaliha C, Khalid U, Campagna L, Digesu GA, Ajay B, Khullar V (September 2006). "SIS graft for anterior vaginal wall prolapse repair—a case-controlled study". Int Urogynecol J Pelvic Floor Dysfunct 17 (5): 492–7. doi:10.1007/s00192-005-0053-y. PMID 16733627. 
  12. ^ Knoll LD (December 2007). "Use of small intestinal submucosa graft for the surgical management of Peyronie's disease". J. Urol. 178 (6): 2474–8; discussion 2478. doi:10.1016/j.juro.2007.08.044. PMID 17976656. http://linkinghub.elsevier.com/retrieve/pii/S0022-5347(07)02050-2. 
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