Joshua D Rouch1, Nhan Huynh1, Andrew Scott1, Elvin Chiang1, Benjamin M Wu2, Shant Shekherdimian1, James C Y Dunn3. 1. Department of Surgery, Division of Pediatric Surgery, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, 90095, USA. 2. School of Engineering, Department of Bioengineering, University of California, Los Angeles, Los Angeles, CA, 90095, USA. 3. Department of Surgery, Division of Pediatric Surgery, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, 90095, USA; School of Engineering, Department of Bioengineering, University of California, Los Angeles, Los Angeles, CA, 90095, USA. Electronic address: jdunn@mednet.ucla.edu.
Abstract
INTRODUCTION: Techniques of distraction enterogenesis have been explored to provide increased intestinal length to treat short bowel syndrome (SBS). Self-expanding, polycaprolactone (PCL) springs have been shown to lengthen bowel in small animal models. Their feasibility in larger animal models is a critical step before clinical use. METHODS: Juvenile mini-Yucatan pigs underwent jejunal isolation or blind ending Roux-en-y jejunojejunostomy with insertion of either a PCL spring or a sham PCL tube. Extrapolated from our spring characteristics in rodents, proportional increases in spring constant and size were made for porcine intestine. RESULTS: Jejunal segments with 7mm springs with k between 9 and 15N/m demonstrated significantly increased lengthening in isolated segment and Roux-en-y models. Complications were noted in only two animals, both using high spring constant k>17N/m. Histologically, lengthened segments in the isolated and Roux models demonstrated significantly increased muscularis thickness and crypt depth. Restoration of lengthened, isolated segments back into continuity was technically feasible after 6weeks. CONCLUSION: Self-expanding, endoluminal PCL springs, which exert up to 0.6N force, safely achieve significant intestinal lengthening in a translatable, large-animal model. These spring characteristics may provide a scalable model for the treatment of SBS in children. Copyright Â
INTRODUCTION: Techniques of distraction enterogenesis have been explored to provide increased intestinal length to treat short bowel syndrome (SBS). Self-expanding, polycaprolactone (PCL) springs have been shown to lengthen bowel in small animal models. Their feasibility in larger animal models is a critical step before clinical use. METHODS: Juvenile mini-Yucatan pigs underwent jejunal isolation or blind ending Roux-en-y jejunojejunostomy with insertion of either a PCL spring or a sham PCL tube. Extrapolated from our spring characteristics in rodents, proportional increases in spring constant and size were made for porcine intestine. RESULTS: Jejunal segments with 7mm springs with k between 9 and 15N/m demonstrated significantly increased lengthening in isolated segment and Roux-en-y models. Complications were noted in only two animals, both using high spring constant k>17N/m. Histologically, lengthened segments in the isolated and Roux models demonstrated significantly increased muscularis thickness and crypt depth. Restoration of lengthened, isolated segments back into continuity was technically feasible after 6weeks. CONCLUSION: Self-expanding, endoluminal PCL springs, which exert up to 0.6N force, safely achieve significant intestinal lengthening in a translatable, large-animal model. These spring characteristics may provide a scalable model for the treatment of SBS in children. Copyright Â
Authors: Katherine I Portelli; Jun-Beom Park; Jordan S Taylor; Anne-Laure Thomas; Matthias Stelzner; Martin G Martin; James C Y Dunn Journal: J Pediatr Surg Date: 2020-06-30 Impact factor: 2.545
Authors: Holly M Poling; David Wu; Nicole Brown; Michael Baker; Taylor A Hausfeld; Nhan Huynh; Samuel Chaffron; James C Y Dunn; Simon P Hogan; James M Wells; Michael A Helmrath; Maxime M Mahe Journal: Nat Biomed Eng Date: 2018-06-04 Impact factor: 29.234
Authors: Talha A Rafeeqi; Anne-Laure Thomas; Fereshteh Salimi-Jazi; Modupeola Diyaolu; James C Y Dunn Journal: PLoS One Date: 2022-09-15 Impact factor: 3.752
Authors: Nhan Huynh; Genia Dubrovsky; Joshua D Rouch; Andrew Scott; Elvin Chiang; Tommy Nguyen; Benjamin M Wu; Shant Shekherdimian; Thomas M Krummel; James C Y Dunn Journal: PLoS One Date: 2018-07-12 Impact factor: 3.240