Neo-regeneration of urinary bladder: a desired metaplasia of autologous membrane from rectosigmoid colon containing stem cells of intestinal crypts.

The current management of diseases of urinary bladder requiring resection is by augmentation cystoplasty or transplantation of ureters. Transplantation of ureters is associated with morbidity and mortality. Ideal management will be by regenerating urinary bladder in vivo. Neo-regeneration of tissues and organs like abdominal wall, aponeurosis etc., has been attempted and patented. After neo-regeneration of mesoderm tissues and organs, regeneration of urinary bladder (developed from endoderm) was. In vivo surgical techniques were developed in dogs. It is known that the embryonic morphogenesis of urinary bladder is from uro-genital sinus of hind gut. A membrane, containing endoderm stem cells in crypts of recto-sigmoid colon, was surgically isolated and colonized with remnant of urinary bladder wall after extensive resection. Experimental study was performed in dogs, for 60 days to one and a half year. Regeneration of all the layers of tissues of the wall of urinary bladder was observed. The neo-regeneration phenomenon has been recognized as "desired metaplasia". The regenerated neo tissue/organ on histological examination and cystometry studies was found compatible with normal urinary bladder. The hypothesis, neo-regeneration and desired metaplasia, is discussed.

Neoorganogenesis and neohistogenesis by desired metaplasia of autogenous tissue stem cells in vivo: a critical and scientific evaluation with 125 years of review literature.

Organogenesis and histogenesis during embryogenesis is well known. In the adult, it is minimal or absent in higher animals-mammals and humans. Neoformation of tissues and organs in vivo in dogs, monkey, and humans has been demonstrated using autogenous pluripotent stem cells. This is possible with the body's own potential, and the phenomena has been described as "desired metaplasia." The stem cells are surgically colonized with the tissues and/or tissue system where the tissue or organ is to be regenerated. Neoformation of abdominal wall aponeurosis, ureter, etc. has been possible by this technique. The technology has also been used in the management of human diseases like large incisional hernias and complex genitourinary or rectal fistulae. Because desired metaplasia is a new concept, the literature of the past 125 years has been scrutinized, selected articles on experimental colonization of tissues and cells have been analytically studied, and relevant articles have been critically analyzed with a new found concept of desired metaplasia and the proposed hypothesis of the first author based on embryologic principles. The literature reviewed revealed no article with the concept of desired metaplasia being responsible for neoorganogenesis and neohistogenesis. New organ and tissue formation is possible with the help of autogenous pluripotent stem cells if exposed to the proper environment and functional need, provided the tissues are embryologic neighbors. The phenomenon of desired metaplasia is discussed on a scientific basis.

A new physiological phenomenon of mammalian body for organ and tissue neo-regeneration in vivo: adult stem cell technology in the perspective of literature.

A new phenomenon by which adult developed mammalian and human body, can neo-regenerate its own tissue/organ in vivo, is recognized as "Desired Metaplasia". Reserve stem cells present in the tissues of adult developed body, are responsible for repair and replacement of lost tissues and cells during life, is plasia. Chronic tissue damage, due to long-standing causative factor, is taken care of and protected by forming resistant tissues, is metaplasia. Both these changes take place at the anatomical abode of the tissues. When stem cells of one tissue are colonized with another tissue/organ system, away from its anatomical abode, the neo-organo-histogenesis takes place by a phenomenon of desired metaplasia. This being new is critically, analytically and scientifically studied and discussed with reference to the available literature. An attempt has been made to establish the scientific account of the phenomenon. The laws of nature and embryology, as well as the basic philosophy responsible for neo-regeneration of tissues and organs in vivo, are discussed. In conclusion, the mammalian and human bodies can neo-regenerate their tissues and organs in vivo by desired metaplasia, provided certain criteria of embryological organogenesis are strictly observed.

Organogenesis and tissue regeneration of fallopian tube: a desired metaplastic transformation of mesodermal stem cells in live animal models (dogs).

The capacity of stem cells of peritonium of mesodermal origin to undergo metaplastic transformation and form different tissues developed from mesoderm germ layer is exploited with ulterior motive to use it in the management of human diseases. The excised fallopian tube was replaced with a tube on a stent constructed from autogenous peritoneum from a suitable donor site. The effect of the surroundings environment of the new tissue system to which the peritoneum stem cells are now exposed was studied for 3, 6 and 12 months period in live animal models. The gross and histological studies revealed development of all the component of the wall of the fallopian tube. The lumen of the constructed peritoneal tube was well preserved in its whole length including the anastomotic sites. The scientific rationale of the working hypothesis on which the work is based, is discussed.

Regeneration of abdominal wall aponeurosis: new dimension in Marlex peritoneal sandwich repair of incisional hernia.

Loss of abdominal wall substance is a major cause of incisional hernia formation. It makes repair of this iatrogenic human ailment a difficult surgical problem. The abdominal wall substance loss has compelled the world's surgical community dealing with this condition to substantiate the repair with extra material such as skin, fascia, wire mesh, and lately biocompatible synthetic mesh. Even though the synthetic mesh is compatible and well tolerated by body tissues, it is not without complications. Regenerative repair in the region of the abdominal wall with substance loss is probably the best repair if it can be achieved. With reasonable success in animal experiments and the positive regenerative capacity of stem cells to transform the peritoneum into an aponeurotic layer, the new technique using a Marlex peritoneal sandwich for repair of large incisional hernias was attempted but was not reported in the article published in the World Journal of Surgery in 1991. The present study is based on experiments on seven mongrel dogs. A suitable embryonal segment of autogenous peritoneum was excised and transferred to the rectus sheath region. The gross appearance of the grafted membrane 3 months after operation revealed tough, thick tissue formation. The histology confirmed the presence of collagen fiber tissue in layers similar to the aponeurosis in the grafted peritoneal membrane. The use of this regeneration in the Marlex peritoneal sandwich technique of repair of large incisional hernias and the scientific rationale of tissue regeneration by desired metaplasia is discussed.

Formation of neoureter from peritoneum in live animal model (dog).

Regeneration of ureter in vivo is possible from peritoneal stem cells as both are derivative of embryonal germ layer mesoderm. The peritoneal stem cells are engaged in repair of loss due to normal wear and tear by differentiation and proliferation. With pluripotent nature, they have a capacity to undergo metaplastic transformation to various mesodermal tissues. The intrinsic cell factor along with regional tissue organisers coupled with functional need of the region, a desired metaplastic transformation to ureteric wall components is possible.

A new technique of "Marlex-peritoneal sandwich" in the repair of large incisional hernias.

Repair of a large abdominal wall incisional hernia is a difficult surgical problem with recurrence being a common complication. In addition, other complications such as hematomas, seromas, and sinus formation result from the use of foreign material. A new technique to obviate these complications was used in 60 patients with large incisional hernias repaired over the last 15 years. Marlex polypropylene mesh was used for repair, sandwiched between 2 layers of peritoneum of the overstretched hernia sac. There was no operative mortality and no recurrence in follow up from 3 years to 7 years. Postoperative complications encountered could be managed conservatively, without necessitating any major surgical procedure or mesh removal.