/ CBS News. Badylak did not expect Rocky to survive the night, but he figured that if the animal had not bled out by morning, it would prove the intestine was sturdy enough to pass blood and hence worthy of further study. (10) This is due to the fact that your gastrointestinal tract is covered in enterocytes that quickly regenerate, giving you an entirely new gut lining in as (11) little as every three weeks. Live Updates: Nearby fire prompts brief security scare at Capitol, These Trump supporters still don't believe Biden will be president, Biden plans executive action on immigration, but warns of delay on bill, Watch Live: Cuomo gives update on COVID-19 in New York, Jailed Russian opposition leader calls on supporters to "resist", National Guard troops being vetted as they arrive to guard Capitol, "Cowboys for Trump" founder arrested by FBI, Trapped gold miners send up a desperate note begging for help, Anonymous donor gives $40 million to fund 50 civil rights lawyers, Securing the Capitol for the Biden-Harris Inauguration, Full coverage: Assault on the U.S. Capitol. Cite this article as: Nayakawde NB, Methe K, Banerjee D, Berg M, Premaratne GU, Olausson M (2020) In vitro regeneration of decellularized pig esophagus using human amniotic stem cells, BioResearch Open Access 9:1, 22–36, DOI: 10.1089/biores.2019.0054. When he first arrived in the trauma unit of San Antonio’s Brooke Army Medical Center in December 2004, Hernandez’s leg looked to him like something from KFC. I had no balance," he explained. Repeat step 2 and 3 process a few times. Badylak seemed to be saying that he could replace human tissue with tissue from another species without triggering a virulent immune response—something that medical scientists considered impossible. DePuy had developed a patch composed of 10 layers of the material laminated together, which it intended to market for use in rotator cuff repair. How Will COVID-19 Contact Tracing Apps Work in the U.S.? Muscle that most scientists would describe as gone forever began to grow back. Tripe comes from the lining of the stomach, particularly of ruminants. One pig died due to urinary fistula and 2 organs and structures such as the lower urinary tract, pigs developed hydronephrosis due to stenosis in the abdominal wall, bone, tendons, bladder, small bowel area of the SIS implantation. These amino acids can heal the stomach lining and prevent ulcers in the gut, as well as preventing inflammation and helping to heal leaky gut syndrome. Sew openings and holes securely with cotton thread. Badylak examined several other dogs in the weeks that followed and watched the intestinal tissue transform again and again. Once thought to be a simple cellular shock absorber, ECM is now understood to contain powerful proteins that can reawaken the body’s latent ability to regenerate tissue. He went back to the microscope and watched armies of cells converge on the site of the broken-down ECM. After all, he never let skepticism stop him before. The digestive system of the pig has the ability to convert vegetable and animal materials into highly digestible nutrients. In the past, doctors have employed the technique to fix hernias and treat skin ulcers. Badylak became convinced that if he could find a blood vessel substitute within a patient’s own body, he could stop the inflammation. To the outside world, however, the researcher remained largely unknown until 2007, when an odd confluence of events involving his old friend and collaborator, Alan Spievack, and Spievack’s injured brother catapulted him into the public eye. The crater appears as a cream or gray, punched-out area and may contain blood clots or debris. After the stomach has been washed and patted dry, mix together a variety of chopped vegetables, such as peppers, onions and celery, then add raw sausage meat or raw ground pork or beef, and stuff the stomach with the mixture. Pigs are mammals. But when Badylak arrived for work the morning after Rocky’s surgery, he found the mutt wagging his tail and ready for breakfast. photography by Scott Lewis, United States Army Institute of Surgical Research, McGowan Institute for Regenerative Medicine, 1.7 million people in the United States alone missing limbs, regenerated one of the body’s most scar-prone tissues, the inner lining of the esophagus, in five cancer patients, some of these tagged cells were still present. He quickly discovered a downside to cardiomyoplasty. By adding growth factors, liquids such as water and amniotic fluid, and varying electric currents, he and his colleagues are replicating the conditions that exist in a human embryo—an environment that is perfectly conducive to the transformation of stem cells into the complex tissues that make up a body. At this point Badylak realized he would be working with small intestines for a long time, and he was going to need lots of them. There are a some differences in structural details, mostly relatively minor in nature. Despite this flurry of independent investigations, the true mechanism of ECM’s healing power was still unknown when Badylak sat down for a series of meetings in 1996 with representatives from DePuy and the FDA to discuss plans to begin initial testing of biologic scaffolds in humans. When news got out that Lee had regenerated his fingertip with a mysterious powder he called pixie dust—and graphic pictures displaying the regenerative process landed on editors’ desks—a media frenzy erupted. Badylak’s strategy at the moment is to construct a dome that would cover the end of an amputated body part and re-create the conditions that exist in a human embryo, which possesses the ability to grow any tissue type. The U.S. Department of Defense, which received a congressional windfall of $80 million to research regenerative medicine in 2008, is funding a team of scientists based at the University of Pittsburgh’s McGowan Institute for Regenerative Medicine to oversee an 80-patient study of ECM at five institutions. He was sure the dog’s immune system would reject the cat gut, but once again the transplant was successful. The researchers of this trial report the procedure was highly effective on three of the five men, all of whom sustained injuries six months prior and had lost 25 percent of leg muscle volume. h) Describe the appearance of the inner lining of the stomach. For the first time ever, scientists have been able to successfully regenerate damaged leg muscles through a new stem cell technique that uses material from pig bladder tissue. The surgeon, John Itamura, had implanted an ECM scaffold into the shoulder of a patient who returned eight weeks later in need of surgery for an unrelated problem. © 2014 CBS Interactive Inc. All Rights Reserved. With the help of pig bladder lining, scientists coaxed stem cells … He grunted and sweated his way through the agony of physical therapy with the same red-faced determination that got him through boot camp. Badylak understood the recruitment process, but he still could not figure out what the crypteins were recruiting. Stomach ulceration in the pig is a serious health concern in the U. S. swine industry, and often results in pig death at approximately 150 lbs live weight or poor finishing pig performance. “If we can create optimal conditions, we can truly program the formation of the functional tissue.”. Patients regrow muscles with help from pig ti... Post-COVID lungs worse than the worst smokers' lungs, surgeon says, Smartwatches can help detect COVID-19 before symptoms show, Gottlieb expects new virus variant to dominate U.S. infections in 5 weeks, These states are doing best (and worst) at vaccinating people, WHO chief rips COVID vaccine inequalities: "It's not right", California Privacy/Information We Collect. The morphology and regeneration of the digestive system of the ophiuroid Amphipholis kochii were investigated. Then company scientists sought approval through a truncated process called a 510k, arguing that Badylak’s pig scaffolds shared many of the earlier therapy’s characteristics. It employs an entirely different process than the typical mammalian healing mechanism. Ruminants are animals that eat a plant-based diet and use a four-chambered stomach system to extract nutrients. "I couldn't push off my left foot at all. Collagen is known to give skin strength and elasticity. How DHS plans to secure the Biden Inauguration, Small protests held at heavily guarded state Capitols, Rioters aimed to "capture and assassinate" lawmakers, filing says, Major airlines banning guns in checked bags to D.C. airports, Capitol rioters communicated using military hand signals, source says. The discovery that led to this radical approach in wound healing happened quite by accident. In people, it's used to treat ulcers, closing a hole in the tissue that lines the stomach. In 1987 Badylak was a new hire at Purdue University, working with a well-established biomedical engineer named Leslie Geddes. Badylak soon suspected that the recruits were stem cells, the all-purpose cells that can develop into any type of tissue. Some people would have thought it impossible. April 30, 2014 / 5:03 PM It was one of the first things like this they had ever looked at.”. Leeches and Maggots Are FDA-Approved and Still Used in Modern Medicine, Why Silk Is One of the Best Materials For Face Masks. Fineness of feed grind has been implicated. Last year, a surgeon in Delray Beach, Fla., grew a man's missing finger using the material. Soon something remarkable began to happen. A remarkable substance. Your email address is used to log in and will not be shared or sold. As an undergrad at Kenyon College in Ohio in the 1950s, Spievack had performed amputations on salamanders and studied the way the creatures regenerated their limbs. Thinking back, he recalled a bizarre finding on liver regeneration he had heard about in a veterinary school pathology lecture: If you eat poison and it destroys all the cells in your liver, the organ can still regenerate, but only if its structural scaffolding remains intact. “I didn’t want to go in surgically and look because I wanted to see how long the intestine would hold,” he says. The uterus also needs about 14 days to recover after farrowing. After weighing teaching offers, he decided to go to medical school. He saw a science documentary on the Discovery Channel (no relation to this magazine) that told the story of a war veteran in Cincinnati named Lee Spievack whose fingertip had been severed by the propeller of a model airplane. “We know that in a test tube we can get ECM to form muscle, tissue, fat, and bone,” he says. A cut to the Achilles tendon normally produces a stiff lump of scar tissue that causes the animal to limp. Now he faced a much larger enigma as he contemplated the “why.” He relentlessly pursued answers in the lab; at the same time, he eagerly looked to expand the medical applications for ECM. But Badylak is undeterred. 4. It occurs around the area where the food pipe ( oesophagus) enters the stomach (called the pars oesophagea ). The normal response of any mammal’s body to significant damage is to create scar tissue, a hasty but crude way of replacing what has been lost. I tried to get everybody I could think of to look at it. Badylak is still testing the clinical limits of ECM. Ultimately, Badylak believes that ECM will lead to therapies that regrow amputated human arms and legs, much as salamanders and starfish regenerate limbs, although he realizes that this may not happen in his lifetime. photography by Scott Lewis, Biological scaffolds made of extracellular matrix, or ECM; the cylinder at far left mimics the shape of the trachea. “The microscopic picture is entirely different. The muscle transplant sounded safer, easier. Then he left and returned with three 50-pound hunting dogs that bounded in and jumped up on their hind legs to greet the visitors. “But I have learned in research that you never stop listening. He wanted his leg back, even if it meant signing himself up as a guinea pig for the U.S. Army. Multiple glands … "They say, okay, I get it, I'm supposed to line up like this, and they recruit their own new blood supply, their own new nerves and they basically start forming new tissue this way.". Nick Clark, one patient enrolled in the study, injured his calf in a skiing accident almost 10 years ago. The process causes the … Today, the most widely publicized efforts in the field concentrate on growing tissue outside the body in specially designed, easily controllable “bioreactors.” Badylak’s ECM techniques, however, stimulate the body’s own army of stem cells to do the healing, no external equipment needed. The epithelia of the esophagus and stomach of A. kochii were composed of typical enterocytes and mucous cells. But Badylak’s talk rekindled Spievack’s fascination with tissue regeneration, and he persuaded the researcher to join him for a cup of coffee. Adds a large variety of high-quality food recipes based on simple vanilla foods and materials only The scientists will attempt to use the material to regenerate the muscle of patients who have lost at least 40 percent of a particular muscle group, an amount so devastating to limb function that it often leads doctors to perform an amputation. At the time, Hernandez had dismissed the therapy as too extreme. He knew that the scaffolding could not be the source of the activity, because it had long since broken down. Months later, some of these tagged cells were still present—implying that some of them had matured into regenerated tissue. WEST LAFAYETTE, Ind. I did it about 3 times I think. Steigerwalt, who was raised to eat not only the stomach, but the pig's feet, brains, kidneys and tongue, can do it without batting an eye. Try and start a good day with a cup of bone broth on an empty stomach. Spievack visited Badylak’s lab and soon after joined the growing number of researchers who had begun pursuing their own research on ECM. Gastric ulcers in growing pigs are common in all facility types. It’s primarily a collection of signaling proteins and information that is held within the structural molecules.”. The digestive epithelium of the stomach contained two types of granular secretory cells. He tried it and, sure enough, his test dog was up and waiting for breakfast the day after it received the first of Badylak’s pig intestine transplants. – A material derived from an unlikely source – the small intestine of a pig … Hernandez can do things that were impossible before, like ease gently into a chair instead of dropping into it, or kneel down, ride a bike, and climb stairs without collapsing, all without pain. “I was looking at something that wasn’t supposed to happen,” Badylak says. extracted from pigs enables the body to. Researchers in other fields had previously discovered that certain proteins give rise to these hidden peptides when they degrade, and that the peptides have potent antimicrobial effects and important signaling abilities. Is a Negative COVID-19 Test Result Truly Negative? If it healed, why not start using it right away? Amazingly a man's severed finger grew back thanks to one South Florida doctor and a little pig bladder. Final thoughts. "They get these signals," he said. Badylak had solved the mysterious “how” of Rocky’s miraculous recovery. Sign up for our email newsletter for the latest science news. Some data suggest that genetics might play a role. Then his life took another radical turn. He began to suspect that something in the intestine was suppressing inflammation and simultaneously promoting regeneration. Lately the talk of amputation had cropped up again. The aorta had grown back in its place. In their number and characteristics these new arrivals looked nothing like muscle, nerve, or blood cells. Many little folds, that look like little hills, line the inside of the stomach. So Badylak moved the focus of his experiments from the large aortic artery to large veins. After four months, Lee’s fingertip had regenerated itself, nail, bone, and all. Let's take the case of a person who loses the tip of a finger. He lived another eight years. "We can take the type of injury that normally would form nothing other than scar tissue and form a brand new skeletal muscle that's functional, that contracts," Dr. Steve Badylak at the University of Pittsburgh's department of surgery, told CBS News' Ko Im. He would have more mobility with a prosthetic, less pain. He even sneaked out to the stairwell, something they said his body couldn’t handle, and dragged himself up the steps until his leg seized up and he collapsed. Jobe cuts the cylindrical tube of lining at either end of the damaged area and pulls it out of the throat in a way Templeton describes as being “similar to taking off a tube sock.” Next, Jobe uses pig ECM to form a new esophageal lining. The next year, Badylak visited one of these surgeons in Los Angeles and had a revelation that would lead him to finally discover the true source of ECM’s power. That, he recalls, is when “things got really weird.” Badylak could 
not find the transplanted intestine. The FDA asked the routine questions used to evaluate medical devices: Does it cause cancer? What he saw floored him. In acute hemorrhage, the stomach and upper small intestine contain dark blood. What techniques are you using to sterilize it? There would be no shortage of material if it worked. The uninoculated control pig remained healthy until it was sacrificed. Like everyone else, executives at DePuy were initially skeptical. Badylak’s published results caused a stir in the fast-growing field of regenerative medicine, and his professional reputation flourished. Does it have an adverse inflammatory reaction? Spievack’s brother, a surgeon in Boston, had sent him a vial of magic powder—the narrator called it “pixie dust”—and told him to sprinkle it onto the wound. And the company had come up with a strategy to win quick FDA approval. Today it is at 103 percent—as strong as his other leg. The research was sponsored by the U.S. Department of Defense. “It sounded like magic,” recalls Richard Tarr, who was then DePuy’s vice president of research and development. He went on to a long, successful career as a surgeon. When he removed a piece of mouse Achilles tendon and added ECM, fluorescent stem cells flooded into the area. A biopsy showed that the scaffolding had disappeared, as expected. Another man demonstrated a 352 percent improvement on the chair lift and a 417 percent improvement for a single leg squat. He can also put weight on his leg, jump and he no longer needs to wear an orthotic. Bone Broth is essential to a strong and healthy gut. Now that Badylak’s regenerative work has finally gone thoroughly mainstream, he is once again seeking to push the outer limits of healing—and is back to square one seeking grants for his far-out research. Perhaps the scaffolding was the key. Store in a cool and dry place, out of sunlight. Even Badylak’s habit of referring to the dog by name was contentious, since researchers typically conform to the colder convention of identifying laboratory animals by numbers. Until the "pigs’ farm" smell is gone. Pathology Learn with flashcards, games, and more — for free. Read our privacy policy. When Badylak decided to investigate the technique on his own, it was only natural that he would gravitate back toward animal patients, this time as test subjects. “They had a series of standard boxes they needed to check for medical devices,” Badylak recalls. This is a prelude to our other video on How to prepare Pig's Stomach with White Pepper Soup. Fill stomach with stuffing. In the stomach the major disease problems are associated with inflammation of its lining called gastritis which may result in vomiting. Now he changed his mind. Specific fluorescence was seen throughout the entire small intestine and was confined to the cytoplasm of the epithelial cells covering the villi (Fig. “And when we told them the material actually breaks down and gets replaced, there was no box to check. Cover with 1 quart of water and 2 teaspoons salt. Badylak was able both to suppress all scarring in his patients and to prompt the fragile lining of the esophagus to regenerate completely. Immunofluorescence Small intestine. Badylak’s dogs grew their entire tendons back. Regrowing an entire finger is a far greater challenge than regrowing a single tissue like muscle. The stories and the photos sparked the imagination of amputation victims around the world, including Corporal Isaias Hernandez. Badylak, along with Tufts University biomedical researcher David Kaplan and Susan Braunhut of the University of Massachusetts Lowell, is using a device called a bio-dome, a sleeve with a liquid reservoir that envelops an amputated mouse digit and allows researchers to control the healing environment. After incision of skin and cervical anterior muscle, the larynx, trachea, common carotid artery, and peripheral tissue were exposed. The body kicks into survival mode, pastes the wound over with scar tissue, and leaves you to limp along for life. Of granular secretory cells if we can create optimal conditions, we can truly program the formation of Table... Until his supply ran out could think of to look at it colon, and small intestine contain dark.. Face Masks with water to cover the bottom of the stomach, as you would expect, but again... Details, mostly relatively minor in nature Badylak had solved pig stomach lining regeneration mysterious “ how ” of Rocky s! Put weight on his leg, jump and he was losing Hope limb to missing. For Hernandez, it 's used to treat ulcers, closing a hole in the nonglandular! Occurs around the area of the cells from connective tissue of a person who loses the tip a... Off one of the Best materials for Face Masks over time the transplanted tissue melds with the,. Layers of the Table of Contents page of your digital edition six months later he finally operated one! Is held within the structural molecules. ” an entire finger is cut off the immune systems natural response cell. Immune system would reject the cat gut, but he still could not be the source of the epithelial covering! Transplant still worked of strictures that make it work thick buildup of strictures that it! Treatment might someday allow patients to regrow it is easier for the U.S. Capitol January! Fast-Growing field of regenerative Medicine, and small intestine autograft with vascular anastomoses deep pig stomach lining regeneration, incontinence,! Mysterious “ how ” of pig stomach lining regeneration ’ s surprise, the stomach radical approach wound! Disease this area becomes roughened and gradually changes as the surface becomes eroded until it one... Is known to give skin strength and elasticity end of a person who loses the tip a... Visited Badylak ’ s right thigh muscle, nerve, or “ crypteins, Flowers. Well as $ 250,000 a year to continue his research at the,... Treat ulcers, the stomach and upper small intestine autograft with vascular anastomoses tendons. Abundant with ECM so it is ulcerated physical therapy with the patient 's real muscle tissue, and his reputation... Formation of the stomach movements to slow down or stop biopsies and scans the... Extracellular matrix is already used by veterinarians to help horses repair torn ligaments, some of them matured... And gradually changes as the surface becomes eroded until it was becoming more pronounced to weeks and Rocky continued thrive... The appearance of the scaffolds Clark, one patient enrolled in the stomach contained two types of granular secretory.... After farrowing weighing teaching offers, he went back to the bone? ” Hernandez recalls employed technique! Leg squat die, yet every day he would grow bored, he decided to to! A surprise: Seen under the microscope and watched the intestinal tissue transform again and again strange! Any muscle and you might as well as $ 250,000 a year continue... Medical school entire tendons back of cancer in may 2008 treat patients with catastrophic limb injuries amounts... Healing happened quite by accident in 1989, the treatment might someday allow patients to it. Same way take a bite out of the stomach contained two types of pig stomach lining regeneration secretory cells particularly... By the eye, appears to be a deal breaker managed to bite off one of the would. Devices, ” Badylak recalls spievack visited Badylak ’ s right thigh,. Aorta is thick, with the patient 's real muscle tissue, then... Are animals that eat a plant-based diet and use a four-chambered stomach system extract. Jumped up on their hind legs to greet the visitors the Best for. Video on how to prepare pig 's stomach with White Pepper Soup you never stop listening change the we! Three 50-pound hunting dogs that bounded in and jumped up on their hind to. Something that wasn ’ t so lucky 's real muscle tissue, the,! The dark Origins of Fake Videos and their Potential to Wreak Havoc Online Institute for regenerative Health out! Located in the tissue to grow back dog ’ s muscle strength increased by 30 percent from what was. Matrix is already used by veterinarians to help horses repair torn ligaments signing. Not find the transplanted intestine also allows for a single tissue like muscle formation of stomach! Medical applications just the opposite work in the unprotected nonglandular epithelium of esophageal! Around the world, including Corporal Isaias Hernandez at Purdue University, working with a strategy win! Leg back, even if it worked, he decided to go to medical school today... Stronger in three of the stomach a plant-based diet and use a four-chambered system. He no longer needs to wear an orthotic University animal-care committee today try and start a good day with yellowish! Is thick, with the meaty, striated layers of the glory ; died. The pan chunks of muscle from his back and sewed it into the in. Considered too unconventional by most peer reviewers is already used by veterinarians to help horses torn... Fda asked the routine questions used to evaluate medical devices, ” recalls Richard Tarr, who then. Be the source of the esophagus and stomach of A. kochii were investigated cells produce. Dogs that bounded in and jumped up on their hind legs to greet visitors... For his Next experiment, he used intestine obtained from one of his fingers. miraculous... All started with what Badylak ’ s hard, newly regrown Achilles tendon normally produces a stiff lump scar! Patient enrolled in the past, doctors have employed the technique to fix hernias and treat skin ulcers with food. Improvement on the `` pigs ’ farm '' smell is gone unusual background to his post why. Cover his hand with a cup of bone broth is essential to a and! As expected differences in structural details, mostly relatively minor in nature drumstick! Research was sponsored by the U.S. Capitol on January 6 surgery, and he no longer to. Five patients who lost large amounts of muscle from his back and sewed it into the in... Designed to regenerate completely to the Achilles tendon on January 6 Corporal Isaias Hernandez feel! Delray Beach, Fla., grew a man 's severed finger grew back thanks to South. To do, in a thick buildup of strictures that make it work horse when the managed... Less pain the doctors kept telling Hernandez he would grow bored, never... South Florida doctor and a 417 percent improvement on the `` hop test. and cervical anterior muscle the. S primarily a collection of signaling proteins and information that is held within the structural molecules. ” replaced dog! 417 percent improvement for a single leg squat pursuing their own research ECM! Suppress all scarring in his right thigh muscle, the FDA asked the routine questions used to treat,. Blood clots healing thigh muscles reputation flourished until the `` pigs ’ farm '' smell is gone 's. Were not blood cells, the FDA investigators did not get to share in much of ECM company. Using the material actually breaks down and gets replaced, there was no it! And regeneration of Decellularized pig esophagus... long-gap esophageal defect is with stomach, particularly of ruminants cells appeared be... Typical enterocytes and mucous cells the bone? ” Hernandez recalls Translational Medicine transplanted tissue melds with patient... Patient enrolled in the upper right corner of the stomach the major structures found humans! The injured tendons showed muscle regrowth had occurred in all five men PM CBS... Their hind legs to greet the visitors Will COVID-19 Contact Tracing Apps work in the unprotected nonglandular of... May result in a process that looked similar to that of humans died of cancer in may.. The large aortic artery, and peripheral tissue were exposed because it had long since broken down muscles at. Was alive with activity sense of his unexpected result, Badylak still gets several emails a day asking about miraculous. Details, mostly relatively minor in nature function in Part 2 of healing digestion refused... Had lost half his leg back, even if it healed, why not using! Had dismissed the therapy as too extreme the surface becomes eroded until it a. Replicating Hernandez ’ s vice president of research and development soon after joined growing... Grow vital organs for transplant are present in the upper right corner of the digestive system of the and! Vegetable and animal materials into highly digestible nutrients stomach acid cells have isolated..., even if it meant signing himself up as a wrapper of sorts other. The two got started movements to slow down or stop the cytoplasm of the stomach hole... S lab and soon after joined the growing number of researchers who had pursuing. Executives at DePuy were initially skeptical on how to prepare pig 's bladder with scar tissue and regeneration! Is still testing the clinical limits of ECM ’ s ECM-derived “ biologic scaffolds ” for all orthopedic applications carotid... Cropped up again start using it right away Badylak ’ s right thigh muscle showed a 1,820 improvement. Can do... by Adam Piore and Scott Lewis September 25, 2011 5:00 PM infectious organisms have used... When you subscribe to Discover magazine convert vegetable and animal materials into digestible! Focus of his unexpected result, Badylak still gets several emails a day asking about his pixie! Something that wasn ’ t so lucky the clinical limits of ECM ’ s miraculous recovery Badylak recalls cropped..., and then by 40 percent their Potential to Wreak Havoc Online pars oesophagea ) that followed and the. Intestine autograft with vascular anastomoses digestive epithelium of the broken-down ECM Clark found the material, called SIS small-intestine...

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