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Presenter: Nhan, Huynh, Los Angeles, United States
Authors: Nhan Huynh, Genia Dubrovsky, Joshua Rouch, Andrew Scott, Matthias Stelzner, Shant Shekherdimian, James Dunn
Nhan Huynh1,3, Genia Dubrovsky1, Joshua D. Rouch1, Andrew Scott1, Matthias Stelzner2, Shant Shekherdimian1, James CY Dunn1,2,3.
1Division of Pediatric Surgery, Department of Surgery, University of California, Los Angeles, Los Angeles, CA, United States; 2Division of General Surgery, Department of Surgery, University of California, Los Angeles, Los Angeles, CA, United States; 3Division of Pediatric Surgery, Stanford University, Stanford, CA, United States
Introduction: Distraction enterogenesis has been investigated as a novel treatment for short bowel syndrome (SBS). With variable intestinal sizes, it is critical to determine safe, translatable spring characteristics in different sized animal models prior to clinical use. Nitinol springs have been shown to lengthen intestines in rats and pigs. Here we show spring-mediated intestinal lengthening is scalable and feasible in a murine model.
Methods: A 10 mm nitinol spring was compressed to 3 mm and placed in a 5 mm intestinal segment isolated from continuity in mice. A non-compressed spring placed in a similar fashion served as a control. Spring parameters were proportionally extrapolated from previous spring parameters to accommodate the smaller size of murine intestines[1,2]. After 2 to 3 weeks, the intestinal segments were examined for size and histology.
Results: Experimental group with spring constants, k=0.2-1.4 N/m, showed intestinal lengthening from 5.0±0.6 to 9.5±0.8 mm (p<0.0001) (Figure), whereas control segments lengthened from 5.4±0.5 mm to 6.4±0.9 mm (p<0.02). Diameter increased similarly in both groups. Isolated segment perforation was noted when k≥0.8 N/m. Histologically, lengthened segments had increased muscularis thickness and crypt depth in comparison to normal intestine.
Conclusion: Nitinol springs with k≤0.4 N/m can safely yield nearly 2-fold distraction enterogenesis in length and diameter in a scalable mouse model. Not only does this study derive the safe ranges and translatable spring characteristics in a scalable murine model for patients with SBS, it also demonstrates the feasibility of spring-mediated intestinal lengthening in a mouse, which can be used to study underlying mechanisms in the future.
Sun West Company.
[1] Sullins VF, Wagner JP, Walthers CM, Chiang EK, Lee SL, Wu BM, Dunn JC. Function of mechanically lengthened jejunum after restoration into continuity. J Pediatr Surg 2014; 49, 971-975.
[2] Rouch JD, Huynh N, Scott A, Chiang E, Wu BM, Shekherdimian S, Dunn JC. Scalability of an endoluminal spring for distraction enterogenesis. J Pediatr Surg 2016. Advance online publication. DOI: 10.1016/j.jpedsurg.2016.09.023.
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