Re: Regenerative tissue - Notan?

[Guest guest]

Barb wrote:

>

> I have been reading some articles and viewing some TV segments lately

> on regenerative tissue research and repairing esophageal cancer with

> this tissue. ... Last year Dr. Jobe at UPMC removed and replaced part

> of an esophagus with this new technique.

>

Let me start this by saying that your intestines are a lot like your

esophagus. They have the same kind of muscles. They have peristalsis.

When a part of them is used to replace your esophagus that part becomes

just an inactive tube. The peristalsis no longer functions and there are

problems with scarring where it is joined to the stomach and the

remaining top of the esophagus. Even so, this is a life saving procedure

for esophageal cancer. Growing an esophagus to use may be better because

the tissue in it is better suited to the acid and other reflux problems

that do happen to everybody to some extent. There will still be the

problem of scarring at the connections and while some reinnervation will

take place I think it will be a long time before perfect reinnervation

is possible, so lack of peristalsis is probably a problem. Today if you

had an esophagectomy you would likely have a gastric pull-up. They turn

the stomach into a tube and connect it to the what is left of the

esophagus in the neck. There is no LES after that. With a replacement

esophagus it could be connected to the stomach where the LES should be.

This would be a major remaking of the LES and it is unlikely that it

would act normally. To put the new esophagus in you still have to take

the old one out, so you still need an esophagectomy to do that. The

replacement esophagus may make the surgery a little easier but it will

not make that job an easy one. It will still be a major surgery and

somewhat risky. It will still take a long time to recover from. The good

news is that because the stomach won't have to be turned into a tube it

should function better than after a gastric pull-up.

When tissue is produced in a lab like that it can be considered

processed. Processed cells tend to have epigenetic changes. These kind

of changes may or may not be a problem. If they are a problem they may

not show up for years after the surgery. This is a problem with

processing stem cell to use in treatments too. The epigenetic changes

may cause the tissues they treat to have problems, such as cancer. Once

they start doing the surgery for achalasia it may take some time to find

the best way to join the new esophagus to the stomach and remake the

LES. There may be other learning curve issues with the surgery too. Do

you want to be one of first for your doctor? Do you want to have it done

in the early years of the surgery and then find out that there are

long-term problems, like cancer. Well I doubt you will have to worry

about that anytime soon. Even if somebody did one of these surgeries for

achalasia today it would still be years before most patients could get

one. There will have to be studies and it will be experimental so your

insurance won't pay for it if you get one.

So, that was about growing an esophagus for esophageal replacement and

also a little about stem cells. Much of what there is to read about

things actually being done is not those kind of things though. They tend

to be about making a patch to cover where a tumor was removed or to

reinforce where where the gastric tube joins the esophagus after an

esophagectomy. Much of what is being done is just with smaller parts of

the esophagus. Getting from doing those kind of things to fixing

achalasia is a big step, maybe many big steps.

Just my impressions. I could be wrong. It would be nice if I was wrong

and the fix was soon but I doubt it will be.

notan

[Guest guest]

Notan,

I always find your replies very interesting and informative. Thank you for

providing your research.

I find the intestines and esophagus remarkable. My son had a volvulus (twisted

intestines) about 14 years ago, after his surgery he had no peristalsis, but

after his recovery the peristalsis returned. When we have Achalasia we lose the

peristalsis in our esophagus and rarely, very rarely (if ever)does any of this

movement return in the " e. " Both of these " rare " illnesses occurred in my

immediate family and my father passed away from cancer of the " e. " These three

illnesses have made me research endlessly and puzzled about this complicated and

mystery machine we call our bodies.

Barb C.

> >

> > I have been reading some articles and viewing some TV segments lately

> > on regenerative tissue research and repairing esophageal cancer with

> > this tissue. ... Last year Dr. Jobe at UPMC removed and replaced part

> > of an esophagus with this new technique.

> >

>

> Let me start this by saying that your intestines are a lot like your

> esophagus. They have the same kind of muscles. They have peristalsis.

> When a part of them is used to replace your esophagus that part becomes

> just an inactive tube. The peristalsis no longer functions and there are

> problems with scarring where it is joined to the stomach and the

> remaining top of the esophagus. Even so, this is a life saving procedure

> for esophageal cancer. Growing an esophagus to use may be better because

> the tissue in it is better suited to the acid and other reflux problems

> that do happen to everybody to some extent. There will still be the

> problem of scarring at the connections and while some reinnervation will

> take place I think it will be a long time before perfect reinnervation

> is possible, so lack of peristalsis is probably a problem. Today if you

> had an esophagectomy you would likely have a gastric pull-up. They turn

> the stomach into a tube and connect it to the what is left of the

> esophagus in the neck. There is no LES after that. With a replacement

> esophagus it could be connected to the stomach where the LES should be.

> This would be a major remaking of the LES and it is unlikely that it

> would act normally. To put the new esophagus in you still have to take

> the old one out, so you still need an esophagectomy to do that. The

> replacement esophagus may make the surgery a little easier but it will

> not make that job an easy one. It will still be a major surgery and

> somewhat risky. It will still take a long time to recover from. The good

> news is that because the stomach won't have to be turned into a tube it

> should function better than after a gastric pull-up.

>

> When tissue is produced in a lab like that it can be considered

> processed. Processed cells tend to have epigenetic changes. These kind

> of changes may or may not be a problem. If they are a problem they may

> not show up for years after the surgery. This is a problem with

> processing stem cell to use in treatments too. The epigenetic changes

> may cause the tissues they treat to have problems, such as cancer. Once

> they start doing the surgery for achalasia it may take some time to find

> the best way to join the new esophagus to the stomach and remake the

> LES. There may be other learning curve issues with the surgery too. Do

> you want to be one of first for your doctor? Do you want to have it done

> in the early years of the surgery and then find out that there are

> long-term problems, like cancer. Well I doubt you will have to worry

> about that anytime soon. Even if somebody did one of these surgeries for

> achalasia today it would still be years before most patients could get

> one. There will have to be studies and it will be experimental so your

> insurance won't pay for it if you get one.

>

> So, that was about growing an esophagus for esophageal replacement and

> also a little about stem cells. Much of what there is to read about

> things actually being done is not those kind of things though. They tend

> to be about making a patch to cover where a tumor was removed or to

> reinforce where where the gastric tube joins the esophagus after an

> esophagectomy. Much of what is being done is just with smaller parts of

> the esophagus. Getting from doing those kind of things to fixing

> achalasia is a big step, maybe many big steps.

>

> Just my impressions. I could be wrong. It would be nice if I was wrong

> and the fix was soon but I doubt it will be.

>

> notan

>

>

>

>