Small intestinal submucosa

=Small Intestinal Submucosa (SIS)=

Small intestinal submucosa (SIS) is a common, non-immunogenic material used in several clinical applications. Some uses under investigation include a scaffold for intervertebral disc regeneration. Unlike other scaffold materials, the SIS–extracellular matrix (SIS-ECM) scaffold is replaced by well-organized host tissues, including differentiated skeletal muscle. [cite journal|author=Stephen Badylak|title=Morphologic Study of Small Intestinal Submucosa as a Body Wall Repair Device|journal=Journal of Surgical Research|volume=103|issue= 2|month=April|year=2002|pages=190–202|doi=10.1006/jsre.2001.6349]

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 [Badylak SF, Lantz GC, Coffey A, Geddes LA. Small intestinal submucosa as a large diameter vascular graft in the dog. J Surg Res. 1989 Jul;47(1):74-80.] . SIS has been published for use in over 20 applications in humans including: multiple types of hernia repair [Oelschlager BK, Pellegrini CA, Hunter J, Soper N, Brunt M, Sheppard B, Jobe B, Polissar N, Mitsumori L, Nelson J, Swanstrom L. Biologic prosthesis reduces recurrence after laparoscopic paraesophageal hernia repair: a multicenter, prospective, randomized trial. Ann Surg. 2006 Oct;244(4):481-90.] [Helton WS, Fisichella PM, Berger R, Horgan S, Espat NJ, Abcarian H. Short-term outcomes with small intestinal submucosa for ventral abdominal hernia. Arch Surg. 2005 Jun;140(6):549-60; discussion 560-2.] [Franklin ME Jr, Treviño JM, Portillo G, Vela I, Glass JL, González JJ. 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. 2008 Sep;22(9):1941] [Ansaloni L, Catena F, D'Alessandro L.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. 2003;74 Suppl 2:10-4.] , dermal wound healing [Mostow EN, Haraway GD, Dalsing M, Hodde JP, King D; OASIS Venus Ulcer Study Group. Effectiveness of an extracellular matrix graft (OASIS Wound Matrix) in the treatment of chronic leg ulcers: a randomized clinical trial. J Vasc Surg. 2005 May;41(5):837-43.] [Niezgoda JA, Van Gils CC, Frykberg RG, Hodde JP. Randomized clinical trial comparing OASIS Wound Matrix to Regranex Gel for diabetic ulcers. Adv Skin Wound Care. 2006 Mar;19(2):64.] , dural repair [Bejjani GK, Zabramski J; Durasis Study Group. Safety and efficacy of the porcine small intestinal submucosa dural substitute: results of a prospective multicenter study and literature review. J Neurosurg. 2007 Jun;106(6):1028-33.] , anal fistula closure [Champagne BJ, O'Connor LM, Ferguson M, Orangio GR, Schertzer ME, Armstrong DN. Efficacy of anal fistula plug in closure of cryptoglandular fistulas: long-term follow-up. Dis Colon Rectum. 2006 Dec;49(12):1817-21.] , stress urinary incontinence treatment [Wiedemann A, Otto M. Small intestinal submucosa for pubourethral sling suspension for the treatment of stress incontinence: first histopathological results in humans. J Urol. 2004 Jul;172(1):215-8.] , pelvic organ prolapse repair [Chaliha C, Khalid U, Campagna L, Digesu GA, Ajay B, Khullar V. SIS graft for anterior vaginal wall prolapse repair--a case-controlled study. Int Urogynecol J Pelvic Floor Dysfunct. 2006 Sep;17(5):492-7.] , and Peyronie’s disease treatment [Knoll LD. Use of small intestinal submucosa graft for the surgical management of Peyronie's disease. J Urol. 2007 Dec;178(6):2474-8; discussion 2478.] . 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.

ee also

*Tissue engineering

References