食道ESDに対する培養口腔粘膜上皮細胞シートの臨床応用

Clinical Application of Cultured Oral Mucosal Epithelial Cell Sheets for Esophageal ESD

要旨　早期食道癌に対して低侵襲性治療であるESDが積極的に行われるようになってきた．ESDは大きさにかかわらず一括切除可能なため，ESD後の大きな潰瘍に起因する狭窄が問題となってきた．筆者らは，細胞シート工学技術を応用した再生医療的治療法を，動物実験段階から開発し，さらに臨床研究を進め，10症例経験してきた．患者の自己口腔粘膜組織を採取し，単離した口腔粘膜上皮細胞を温度応答性培養皿に播種，16日間培養する．培養口腔粘膜上皮細胞シートは低温処理のみで非侵襲的に回収することが可能で，それをESD直後の潰瘍面に経内視鏡的に移植する．本研究のように消化器領域の再生医療は始まったばかりで，癌治療分野での応用が期待される．

　Esophageal ESD（endoscopic submucosal dissection）has come to apply more aggressively as an endoscopic technique for the treatment of early esophageal cancer. However, it involves en-bloc resection of the tumor, regardless of its size, resulting in esophageal ulcerations. One of the major complications that often occurs as a result of the removal of large lesions is esophageal stricture. Starting with research on animals, we then proceeded to clinical research on 10 patients. This eventually resulted in the development of a new regenerative medical treatment using a cell sheet tissue engineering technique. Epithelial cells derived from the patients' own isolated oral mucosal tissue were seeded on temperature-responsive culture dishes and cultured for 16 days. By a simple reduction in temperature, the cell sheet was non-invasively collected and was attached directly to the bed of the esophageal ulcer by endoscopy immediately after endoscopic resection. This study on regenerative medicine in gastroenterology showed promising results, and we hope that it will eventually lead to successful application for cancer treatments.