Intestinal Failure and Regeneration, Nutritional Disorders and Support, Surgically Modified Gut, and Transplantation
Presentation at the November 19, 2007 NCDD Meeting
Chair: Barbara L. Bass, MD
Vice Chair: Margaret Heitkemper, PhD, RN
Research Goal 1
Define mechanisms of intestinal growth and differentiation.
Research Goal 1
Objectives
-
Isolate, characterize, manipulate, and expand human intestinal stem cells in vitro.
-
Define optimal factors-growth factors, nutrients, extracellular matrix or milieu-to enhance post-resectional adaptation in human patients.
Research Goal 1
Objectives (continued)
-
Develop an optimal bioartificial scaffold for neomucosal growth.
-
Develop artificial intestinal constructs for replacement of diseased bowel.
-
Conduct a clinical trial of exogenous factors to optimize post-resectional adaptation.
Research Goal 2
Develop new strategies to treat short bowel syndrome and intestinal failure.
Research Goal 2
Objectives
-
Evaluate the effect of specific micronutrients and diet on postoperative intestinal adaptation.
-
Develop and validate non-invasive markers of intestinal growth and adaptation in short gut models.
-
Develop reliable non-invasive methods to measure intestinal growth and adaptation in patients.
Research Goal 2
Objectives (continued)
-
Develop more effective techniques and strategies to reduce septic, metabolic, and hepatic complications of parenteral nutrition and intestinal failure.
-
Define the molecular basis of radiation enteritis and prevent and treat radiation enteritis and proctitis.
-
Conduct a clinical trial of optimal growth factor (or synergistic combination) therapy following massive intestinal resection.
Research Goal 2
Objectives (continued)
-
Reduce the thrombotic, infective, hepatic and metabolic complication of PN to prevent PN-failure.
-
Develop prognostic indicators for PN failure to guide the timing of intestinal transplant evaluation in optimal candidates.
Research Goal 3
Improve the success of intestinal transplantation.
Research Goal 3
Objectives
-
Determine the role of exogenous growth factors and micronutrients post-transplantation.
-
Improve methods for donor bowel preservation pre-transplant.
-
Identify new targeted pathways for novel immunosuppressive therapies.
Research Goal 3
Objectives (continued)
-
Develop artificial intestinal conduits from native tissues and cells for autotransplantation.
-
Identify biomarkers for non-invasive diagnosis of intestinal transplant rejection.
-
Identify factors that diminish long-term post transplant survival and appropriate countermeasures.
Research Goal 4
Understand and treat the metabolic and nutritional consequences of bariatric procedures and other surgical modifications of the gut.
Research Goal 4
Objectives
-
Identify pre-operative biomarkers to predict weight loss and metabolic correction.
-
Characterize the neuroendocrine, hormonal, cytokine, proteomic response to bariatric procedures in animal models and humans.
Research Goal 4
Objectives (continued)
-
Characterize the long-term metabolic (vitamins, calcium, minerals, other) sequelae and changes in anorexic and orexigenic hormones in bariatric surgical patients.
-
Develop non-surgical therapy that "mimics" neurohumoral sequelae of bariatric procedures.
Research Goal 5
Optimize nutritional support of patients with gastrointestinal disorders.
Research Goal 5
Objectives
-
Develop and validate quality-of-life measures for patients with chronic GI dysfunction to allow assessment of efficacy of different treatments.
-
Evaluate the effect of specific micronutrients and diet on GI absorption, motility and immunity.
-
Investigate the importance of the gut microbiome in the prevention and causation of GI diseases. (Overlap with importance in nutrient metabolism and regeneration)
Research Goal 5
Objectives (continued)
-
Assess the safety and potential efficacy of probiotics, probiotics, and symbiotics in the prevention of necrotizing enterocolitis and catheter-related sepsis.
-
Design and test diet formulations to prevent neonatal feeding intolerance and necrotizing enterocolitis.
Major Challenges/Steps To Achieve Goals
Major Challenges/Steps To Achieve Goals
National Research Resources
-
Multi-center clinical and basic research networks to foster collaboration and sharing of resources
-
A national registry for intestinal failure/short bowel syndrome patients and for those with small intestine allografts
-
Centralized tissue banks of biosamples from patients with different gastrointestinal disorders or who are undergoing bariatric surgery and follow-up
Major Challenges/Steps To Achieve Goals
Standardized Clinical Definitions
-
Standardized system to characterize short gut and intestinal failure in terms of anatomy, nutritional support, and complications
-
Consensus on data points, definitions, and outcome measures to understand the relative effectiveness of medical, nutritional, and surgical intervention strategies
-
ICD-9 codes to assist in the tracking of afflicted patients
-
A health outcomes research consortium to promote standardization
Major Challenges/Steps To Achieve Goals
Advanced Technologies
-
Novel, less invasive technologies to access the intestinal lumen
-
Identification of serum or other surveillance markers to enhance the ability to care for patients with small intestinal disorders, including short gut syndrome, intestinal failure and other with intestinal transplants
Page last updated: January 07, 2008
