acell and ITs
Two prongs in rebuilding the ITs. One is relying on tissue engineering to develop the IT tissue in the lab and grow it to a large scale, then transplant back to the sinus, combining the acell product during transplantation. The other is using only the Acell material or SIS to enlarge the IT's size locally. The first one is surely better, but may take many years to develop. ANd, much more expensive. The second one might help many people by simply cut a slit or inject the Acell material into a small portion(the outer layer) of the ITs. For example, during the first several trials(or animal tirals), the amount of the Acell or SIS material can be very small amount and injecting into the noticeable area of ITs. Then, observing the absorption and the epthilial function of the ITs. Presumably, if it works, it can be even done under local anethesia. I think the second option can come very soon since dr. houser already trying alloderm for a few years. Of course, it probably will not regrow the whole ITs unless after years of experiment to develop the optimal methods. But, it can surely alleviate some of out symptoms. In some cases like me, my health is deteriorating. I will surely try the seocnd option first. Any feedback??

ENS symptoms are not caused only because of loss of mucosal glands. They're mainly caused because of loss of normal inner nasal airflow pattern and airflow resistance, resulting in loss of airflow sensation, humidification, heating and smelling. In other words - the most important thing in curing ENS is to restore the missing mass of the turbinates at the right strategic locations. I don't see ACELL doing that. In the cases it's helped it facilitated the growth of relatively very small portions, the end portions (like the finger tip and nail) of the comprised organ. I don't think it can regenerate an entire organ. This ability is theoretically possible in humans, as we possess the genes for it, like lizards and salamanders, but these genes have been turned off in our evolutionary development as mammals and not reptiles...so sadly, discovering how to effectively and safely manipulate this genetic ability is still no to be seen in the foreseeable future. On the other hand, as the most important thing about the turbinates is not necessarily their unique tissue, but rather their structure and function as airflow controllers and regulators - swelling existing turbinates with Alloderm or creating completely new neo-turbinate structures with Alloderm is an available and an effective treatment. If your health is truly deteriorating because of your ENS, then why are you not getting Alloderm implants now, instead of waiting for solutions that are still many years away? When one sees or reads about medical research reports - scientists and doctors always talk with great optimism about future developments being "round the corner", meaning that as soon as not more than 20 or 30 years... they will begin to have the ability to.... - In scientific terms it is round the corner, but for a truly suffering person - this means a life time. Nothing will replace your health which will be lost by then, or the best years of your life. Time is critical. I think we should all focus on existing available options, instead of relying on an arm-chair very non-professional analysis of future possible medical advances. I opt for implants now. If I am still alive and still suffering when these future technologies will be available - I will get them then, but why not take what is available now, even if it is not a 100% cure?

I dont think he was negating the benifits of implants just future possibilities, near and far.

wow this still goes on...happy holidays all

Happy Christmas and a Merry New Year.

TE,havent you seen the video where a man who had a big hole in the foot grew back the entire missing bone,tendons,ligaments and what about the horse with almost half the nose missing also grew back everything to its original state,i think youre underestimating its true potential.

I think its important to remember that although TE is correct if you are suffering now you should get implants not everyone is a good candidate and technology can always be improved on. Which is why this section and speculation can be very important. We dont know when, where or how the next big break will be made. We should not rely on any one technology that might or might not happen and build up false hope but we also cannot forget that technology is moving at light speed due to the era we are in and hopelessness would in itself be a false perception. And as TE has mentioned (I think it was TE) and others ...patient advocacy does work and is working. It is important for use to keep looking, researching and talking to people in an appropriate manner. Some of the biggest breakthroughs happen not becasue something is possible but the right person or group is motivated to connect the dots that others have laid before them. This happens in science every day. As much as many doctors will not say a cure is around the corner casue its the conservative response and they have to, however if a good laid out path is given to the right person human ego will tend to want to make it happen. Alot of good information has come out of this forum in the last year and that is how a good idea starts with good information and good information will eventally lead to accurate information and that is what will give all of us a cure one day eventually and in the mean time at least more options for a better way. Te needs due credit for his practical thinking but I will admit I am an idealist as well as others on this forum. Its with both schools of thoughts that patient advocacy is working and with both a solution to our problems can be found.

Luis5150, I answered your question many times in the past: Yes - a cavity with in a confined area of flesh (like the sort of wound you mentioned) can fill in. But, no, I am sorry, I have never seen or heard of a resected limb that grew back - have you???????????????? See the difference between the two??????????? A resected turbinate (including bone) - is just like a resected limb - it will not grow back spotaneously!!!!!!!!!!!!!!!! ACELL - has so far had it's largest success with growing back a resected TIP (please note "tip"!) of a finger. If you read their report clearly and look at their pictures - you can see that it was basically only the top part (the nail area) of the small finger that was somewhat mashed up, or filed down. I had such an injury myself in my army service - and my pinky completely healed with my nail area completely restored (grew back if you wish) spontaneously without ACELL or any other medication. ACELL is a commercial company, and as such will highlight their accomplishments in an exaggerating manner. Here's my question to all of you - has anyone of you actually had a serious meeting with a doctor who studied the capabilities of ACELL who told you - yes ACELL can definitely grow back some, or part of your turbinate bone? jdog, While I thank you for your credit for me applying "practical thinking" on what is available now - may I remind you that that is not the only thing I did. May I remind you that it was my idea to start this "Research Ideas" forum section (and Anthony who I asked to act as the moderator here - can vouch to this) - so I think that I cannot be categorized as someone who doesn't believe in advances. One of the main reasons why I approached David three years ago and suggested to form this association and forum was precisely that - so that we can all share information and keep track on new technologies. Heck - I chose my forum initials - TE - because they stand out for "Tissue Engineering" - as I was and still am the biggest advocate for that. All I am saying is that posting five six web links a day of non-scientific media reports, and web-pages of commercial biotechnological companies, can be very misleading, and is not very helpful. In any case - it is not close to enough. The minimum is to follow them up seriously - and that means more than sending an email or making a phone call talking to someone you're not even sure about on the other end. Has anyone here done more than that with all the thousands of links and publications which were posted here over the years??? To conclude, all I'm saying is this: While it is crucial to keep an eye on emerging and futuristic technologies - don't assume anything about it's relevance unless you seriously looked into it and cross checked their information with regenerative medicine specialist doctors. At the same time - you have a good viable solution on the table available now - Houser's implants, which is a form of therapy that in no way prevents you from having other form of therapies if and when they will be available. So why not take the available solution while keeping an eye out for future possibilities? PS: I completely disagree with jdog's comment that not everyone is suitable for implants. That is completely unfounded. let me explain: Some have had their turbinates partially reduced in such a way where the missing mass is not at the front but in a place which is practically impossible to possibly check out effectively with the cotton test - because the cotton itself is a very poor imitator of an implant (it's only done to give a general idea - not to rule out if augmentation will help or not). Those people (who aren't many amongst the truly resected ENS patients) - are told by doctor Houser that he can't guarantee improvement but never the less they can still try. Not enough data has been gathered on those people as not many have opted to try yet (for no good reason really...) - but they do not represent most ENS patients - as their amount of resection is usually minimal and have other complications (like over enlarged sinus ostiums - the drainage holes of the sinuses enlarged is FESS surgeries - like in jdog's case) which prompts them to fear that their symptoms result mostly from other structures than the turbinates. I want to state a fact here: Anyone whose symptoms originate in too much loss of turbinate tissue can significantly benefit from either some form of tissue expansion/augmentation surgery done in the right location (which is the key to success), regardless of whether the cotton test indicates success or nor not.

I wasnt trying to label or attack you TE, i was just trying to point out there are two ways of thinking about it. There are always two way to see something. Your assumtions about my post were not intended or meant to be implied I'm sorry you felt that way about it. It sounds as if you have had the implants, did they work well for you?

TE,when i looked at the pictures i couldnt believe me eyes,but its true it works,a picture is worth a thousands words.You say that regenerating a turbinate is different,how different is it from regenerating a horse´s completly damaged sinus cavity,its the same with the rest of the body,the nerves,the tendons would grow back,and best of all its been tested on humans and by looks of it,the people who tried it were very satisfied with the results.I understand your point of view,you have to try yourself before you can truly appreciate it.

to Luis, I don't know how to explain myself any more clearer than I did. Reading your last post makes me question if you really understand what I'm saying, and that's very frustrating... Where did I say that I don't believe the pictures they show on the ACELL site??? why are you putting words in my mouth??? I'll try to say again my main points in the most explicit way: 1. Closing a hole in the sinus or in the septum, or any where else in the body is much easier then regenerating a resected bone - like a finger an arm or a leg. A resected turbinate bone resembels the latter examples not the first (hole in sinus). In the first case - simply closing a hole - by filling the hole with a cell matrix tissue (like in SIS and even Alloderm for example) you can get the edges to start growing towards the center of the hole thus - eventually closing the hole. That's very different then making resected bone grow onwards straight into mid air - which is what you need the turbinate bone to do in our case.... If ACELL could do that then every amputee on earth would be rushing to get it and the ACELL company would annoounce that they can get fingers, limbs and fallen teeth to grow back. They would be richer than Bill Gates over-night... Why don't they announce that - because they can't do that! Now, and please pay attention: I do think that ACELL might be able to help improving the condition of some nasal patients. Like - closing over open sinus cavities (like in jdog's case), or closing septal perforations, but as far as turbinates are concerned - according to their published literature - they can perhaps help reverse light cases of atrophic mucosa and perhaps improve the function of remaining turbinate stumps by causing their vascular bed to thicken. This might be enough for those who are ENS-type, meaning have very slight reductions of their turbinates. But, it will not be enough for those who have significant amounts of their turbinates bones missing. As far as I understand ACELL's reports- when it comes to regenerating resected bone into mid-air (into space if you wish) - like in the fingers they did - they could only cause the roughed up end tip to regenerate, not the entire bone, and not even 1/3 of it. Please correct me if I am wrong - and add the link too. All the other cases they reported where causing flesh to regerate in a confined space - to cover a hole - not bone growing into midair like a lizard growing a new leg... 2. I'm all for fostering and embracing new techologies. As I said one-million times before here (and for some reason it's not getting through) - I call myself TE because those are the initials of "Tissue Engineering" - which is precisely the type of medicla research which ACELL belongs too. I founded this forum together with David in hope that patients here get in touch with TE scientists to get them interested in finding ways to regenerate resected turbinates. Luis, if you believe in ACELL - go ahead and contact them - see if they think they can help and how. Have you done that yet? if not - why not? 3. Once and for all, and for the last time: Having Alloderm implants now - will help an ENS patient to cope better with life now and then he/she will have much more ability and energy to focus on looking for better solutions that are not available now, but may be in the future. Having Alloderm implants does not prevent the patient from having any other form of therapy in the future when and if desired! to jdog, Yes I firmly know (not only believe) that implants can help those who suffer from ENS/secondary atrophic rhinitis which is caused by over esection of their turbinates. I know that it can help because I have aided Dr Houser in performing his research study on Alloderm implants for ENS, and further more - by canvancing the written literature of the past 100 years on implants for atrophic rhinitis - I found that in every single study that what ever done on them - it was found that the implants helped a lot to improve the symtoms of atrophic rhinitis, especially in secondary strophic rhinitis (meaning - following turbinate resections). The problem with those older studies was that they never had more than a year or two of follow up, so the critics could always argued that the implants resorbed in the long term. Houser is the first to publish a study following patients implanted with Alloderm. He claims that the Alloderm is stable and doesn't resorb after the initial first period of incorporation and therefore improvement in ENS symptoms remains constant for many years. His oldest patients were implanted more than four and five years ago and their implants are still intact. His research coincides with all the studies done on implants previously. He simply used a material not previously used - Alloderm, pioneered a simple technique to augment existing partially resected turbinates, which was not done before, and also conducted longer follow ups than usual. The main weakness of his study is in the relative small amount of patients which the study has followed up (eight cases). Nevertheless - 8 cases are considered a good enough number to conduct a medical statistical study on, and though it is always better to have the largest sample possible, conclusions can be drawn from such a sample, providing the tests applied and results reached where analyzed with the proper research method and statistical tools. This was verified by experts assigned by the publishing journal, which is probably the most respected journal in the field of otorhinolaryngology. Since the first initial 8, Dr Houser has implanted about 25 more ENS patients, which he intends to report about in a second follow up study, which will be conducted in a year or two.

The best way to figure the debate out might be to see what it healed in the foot example. I know it said it healed the bones and since the foot has many many bones if it regenerated one completely that might be a good sign of how effective it could be. I honestly can't answer the specifics in that case. I do know acell has said they think it probably would work but have not tried it's application so they cannot confirm. They also have not done research of yet into it so they cannot recommend a particular type of application for it. But I dont think anyone could truely know if it will work or not till its tried.

jdog, what you say about little bones in the foot (there are a few dozens there, most are quite tiny) - sounds much more possible than turbinates - because once again - a bone growing in the foot grows in a closed confined solid piece of living flesh - where the surrounding nerves and blood supply are all intact. That differs greatly from a resected turbinate. The only thing that resembles the type of growth needed in a resected turbinate is their report about regeneration of the tip of the small finger. Please note that they only succeeded to regenerate the mashed up tip of the finger (the nail area) the degree of resection was tiny and did not even reach the first knuckle. When comparing this to say an IT bone - one can say that it resembles perhaps a 5% degree of resection. What's more trubbling about their report is that although they show a picture of a mashed up finger tip, they do not provide any X-Ray to prove that there was an actual piece of bone that was resected, nor do they say so specifically in their report. I have learnt in life that what people say is important, but what they don't say is even more important. As far as I read - they did not manage to regenerate truly amputated digits (like in cases where at least one or two finger joints are missing). If you have established contact with them - you might want to ask them on that. All I know is that the US Ministry of defense has issued huge grants for research into how to reconstruct or regenerate amputated digits, as it turns out that it is one of the most common wounds of soldiers today in Iraq. Therefore I would assume that had ACELL been really able to regenerate amputated fingers - it would have been huge news which would be heard all over the world. On the practical side of applying it - it should be very hard to do, and probably quite uncomfortable in nose - but I'm sure that they can find away if they would like to try it. I will tell you here and now - that if you will arrange a proper clinical trial for this stuff in ENS patients in the next few months - I will travel all the way from Israel to try it out. I am sure many more here would be willing to try it with me.

Unfortunatly from some references I've read it appears (don't quote me on this) that the bigger companies are giving Acell a hard time (maybe why the miltiary trial was canceled?). Unfortunatly this happens alot with new business but if the product is good I would think they will gain momentum very quickly. If the product is as appears lets hope this happens sooner than later alot of people besides just us could greatly benifit from its use I'm sure. Especially with the condition many of our soldiers are returning from the Gulf region. It's sad when politics gets in the way of a good idea but fortunatly eventually a good idea will eventually win out. Some articles have dubbed the year of 2008 as the year of Tissue Regeneration becoming a reality lets hope it isn't just hype.

Politics or not. One thing is sure: Had they been able to make an amputated finger grow back they wouldn't hesitate one second before they went to the media with that. They didn't do so did they... I'll say again - if you are willing to set up a properly managed clinical trial for ACELL in ENS patients in the next few months - you'll have many volunteers (hopefully you and Luis included). Will you take it upon yourself to organize?