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J Thorac Cardiovasc Surg 2003;126:537-544
© 2003 The American Association for Thoracic Surgery

General thoracic surgery

Tissue-engineered esophagus: experimental substitution by onlay patch or interposition

^a Departments of Department of Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, Mass, USA
^b Department of Pathology, Massachusetts General Hospital and Harvard Medical School, Boston, Mass, USA
^c Cardiovascular Research Center, Massachusetts General Hospital, Boston, Mass USA

Received for publication June 17, 2002; revisions received August 19, 2002; revisions received August 28, 2002; accepted for publication September 12, 2002.

^* Address for reprints: Joseph P. Vacanti, MD, Department of Pediatric Surgery, Massachusetts General Hospital, Warren 1157, 55 Fruit St, Boston, MA 02114, USA
jvacanti{at}partners.org

OBJECTIVES: We proposed to fabricate a tissue-engineered esophagus and to use it for replacement of the abdominal esophagus.

METHODS: Esophagus organoid units, mesenchymal cores surrounded by epithelial cells, were isolated from neonatal or adult rats and paratopically transplanted on biodegradable polymer tubes, which were implanted in syngeneic hosts. Four weeks later, the tissue-engineered esophagus was either harvested or anastomosed as an onlay patch or total interposition graft. Green Fluorescent Protein labeling by means of viral infection of the organoid units was performed before implantation. Histology and immunohistochemical detection of the antigen -actin smooth muscle were performed.

RESULTS: Tissue-engineered esophagus grows in sufficient quantity for interposition grafting. Histology reveals a complete esophageal wall, including mucosa, submucosa, and muscularis propria, which was confirmed by means of immunohistochemical staining for -actin smooth muscle. Tissue-engineered esophagus architecture was maintained after interposition or use as a patch, and animals gained weight on a normal diet. Green Fluorescent Protein–labeled tissue-engineered esophagus preserved its fluorescent label, proving the donor origin of the tissue-engineered esophagus.

CONCLUSIONS: Tissue-engineered esophagus resembles the native esophagus and maintains normal histology in anastomosis, with implications for therapy of long-segment esophageal tissue loss caused by congenital absence, surgical excision, or trauma.

Key Words: 8

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