Nat. Rev. Gastroenterol. Hepatol. doi: /nrgastro

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Nat. Rev. Gastroenterol. Hepatol. doi:10.1038/nrgastro.2017.76 Figure 4 Use of extracellular matrix bioscaffolds in gastrointestinal tissue repair and regeneration Figure 4 | Use of extracellular matrix bioscaffolds in gastrointestinal tissue repair and regeneration. The major organs of the gastrointestinal (GI) tract include the oesophagus, stomach, duodenum, jejunum, colon, ileum, rectum and anus. Extracellular matrix (ECM) bioscaffolds have been evaluated for their ability to facilitate the constructive and functional regeneration of tissues of the GI tract, including the oesophageal and colonic mucosa. GERD, which can lead to Barrett oesophagus (dysplasia) and can progress to oesophageal adenocarcinoma (OAC), is a common cause of oesophageal injury. Using a regenerative medicine approach, the mucosal and submucosal layers of the oesophagus are resected. A tubular ECM bioscaffold is implanted at the resection site directly onto the remaining muscle layer. ECM-derived signalling molecules that are released by the degradation of the implanted ECM bioscaffold induce a fundamental transition in the host healing response from the classical inflammatory and scarring response towards a restorative programme of tissue formation through the recruitment and differentiation of endogenous stem cells, the activation of an anti-inflammatory macrophage host response, angiogenesis and the deposition of new ECM components. Similarly, ECM hydrogels can be used to facilitate a constructive healing response in GI tissues, particularly inflammatory conditions such as IBD. The topical application of an ECM hydrogel on ulcerative colonic tissue can modulate the tissue microenvironment towards an anti-inflammatory state. The enema-delivered ECM hydrogel adheres to the colonic mucosa and promotes a rapid and marked reduction in local pro-inflammatory cytokine secretion from macrophages, and facilitates the restoration of a normal colonic mucosa. Hussey, G. S. et al. (2017) The extracellular matrix of the gastrointestinal tract: a regenerative medicine platform Nat. Rev. Gastroenterol. Hepatol. doi:10.1038/nrgastro.2017.76