Biomedical Engineering Reference
In-Depth Information
6
Small intestinal submucosa and other
decellularized matrix biomaterials for tissue repair
M . H I L E S and J . H O D D E , Cook Biotech Incorporated, USA
Abstract: Extracellular matrix (ECM) is an essential component of every
tissue in our bodies, but it has been relatively misunderstood for decades.
More recently, knowledge regarding the role of the ECM in biology and in
medicine has been significantly expanded, and its study has greatly added to
the world of regenerative medicine in a real and practical sense. This chapter
seeks to address the concepts of in situ tissue engineering through the
provision of an ECM as a scaffold for regrowth of functional tissue. Whether
harvesting and decellularizing an ECM from a tissue source or building it de
novo, the many variables encountered in tissue processing affect the
physicochemical aspects of the ECM material, the results achieved after in
vivo implantation, and the resulting clinical utility of the implants made from
such materials. Furthermore, even the most robust ECM materials are
affected by procedural and patient-related variables that together affect
clinical outcomes for tissue reconstructions with ECM. Advanced
biomaterials that consist, either wholly or partially, of ECMs can form the
basis for many therapeutic modalities, but clinical medicine must play a role
in defining the procedures and the patients that will best benefit from these
materials in the future.
Key words: decellularized materials, extracellular matrix, crosslinking,
biologic grafts, matrix signals, clinical lessons.
6.1 Introduction
In the whole hierarchy of cells, tissues, organs, systems, and organisms, the roles
of the scaffolds and signals of the traditional tissue engineering triad (Fig. 6.1)
are lost, or at least obscured. Cells are `nesters', meaning that they tailor their
environment to suit their needs and often the needs of other cells around them or
that are likely coming to visit (more on this later). The cells plus this `nest'
become the true basis for tissues, and conversely, harvesting tissues and remov-
ing the cells become the basis for the extracellular matrix-based materials that
are the focus of this chapter. Herein, we will take a more in-depth look at the
extracellular matrix (ECM), but not so much from the point of view of the
molecular biologist. We will instead look at the ECM from the point of view of a
biomedical or tissue engineer seeking to use it as a building block for medically
useful constructs.
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