Chapter 36 - Intestinal Regeneration: The Stem Cell Approach

Abstract

The ultimate goal of therapies for intestinal failure is to replace the structure and function of the absent region of the intestine. Intestinal failure is the inability to independently maintain nutrition via enteral absorption and has many causes, including genetic and metabolic abnormalities. Short bowel syndrome (SBS) is one form of intestinal failure caused by the anatomical loss of intestinal length. While patients with SBS are able to survive with intravenous nutrition, quality of life is poor, and morbidity is high. Liver failure and sepsis are the most common morbidities. Intestine and multivisceral transplantation have salvaged many children but also come at a high human and financial cost. With complications from necessary immunosuppression and significant graft failure rates, alternative therapies are needed. Recent advances in intestinal stem cell (ISC) and developmental biology have led to the identification and analysis of multiple putative ISCs and progenitor cells. Concurrent growth in the fields of material bioengineering and cell biology has augmented the growth of the field of tissue engineering. By replicating and manipulating the normal developmental and regenerative processes, it has been possible to grow tissue-engineered intestine. Further study to refine the processes and generate larger quantities of engineered tissue will be necessary in order to employ tissue-engineered intestine as a viable future strategy for intestinal replacement in patients with intestinal failure.