Once thought to be separate components, the new model of a contiguous mesentery could lead to new medical laboratory tools for diagnosing and treating digestive diseases such as Crohn’s and colorectal cancer
For more than a century, pathology professionals have treated the network of tissue folds surrounding the human digestive system, known as the mesentery, as separate entities. However, new research indicates the mesentery is in fact a single, continuous organ and therefore reverses that thinking. This could impact the way pathologists and medical laboratories currently perform diagnostics and testing of digestive diseases.
Dr. J. Calvin Coffey, Professor of Surgery at the University of Limerick, Ireland, and Dr. Peter O’Leary, PhD, MBBS, of the Royal College of Surgeons in Ireland (RCSI), published their findings in The Lancet Gastroenterology and Hepatology.
“This organ is far from fragmented and complex. It is simply one continuous structure,” said Coffey in an article posted on the University of Limerick’s website. “During the initial research, we noticed in particular that the mesentery, which connects the gut to the body, was one continuous organ. Up to that it was regarded as fragmented—present here, absent elsewhere—and a very complex structure. The anatomic description that had been laid down over 100 years of anatomy was incorrect,” he concluded.
Understanding Function to Identify Abnormal Function
While Dr. Coffey’s research has uncovered differences in the anatomy and structure from previously accepted standards, more research is needed to determine the function of the mesentery. In the published research, Coffey notes, “The next step is the function. If you understand the function you can identify abnormal function, and then you have disease. Put them all together and you have the field of mesenteric science … the basis for a whole new area of science. This is relevant universally as it affects all of us.”
Research published in the March 2016 issue of World Journal of Gastrointestinal Oncology highlights how study of the mesenteric organ already improved patient outcomes and 5-year survival rates for colorectal cancer. Research authors attribute research into the anatomical form of the mesenteric organ to increased ability for surgeons to perform complete mesocolic excision (CME) and total mesorectum excision (TME) procedures.
It is already known that the mesentery carries lymphatic fluid and blood between the intestine and the surrounding body. As abnormal functions and diseases are uncovered, pathology and clinical laboratories will likely see an increase in samples and diagnostic tests related to the new organ.
In the published research, Dr. Coffey notes, “Increasing data point to the occurrence of cellular mesenteropathies. The concept of cellular mesenteropathies is supported by findings in sclerosing mesenteritis and adhesion formation. With increasing investigation of the histological basis of the mesentery in health and disease, further examples of this disease subtype are likely to emerge.”
Other diseases and disorders Coffey believes the mesentery might help to highlight include:
• Metabolic syndrome; and
The Potential of Mesenteric Diagnostics for Clinical Laboratories
As the known form of the mesentery continues to improve, the ability to collect diagnostic samples, and standardize non-invasive and minimally invasive means of observation, will improve as well. Coffey’s research notes, “Endoscopic mesenteric sampling aims to provide clinically relevant data in an array of abdominal and non-abdominal disorders and will be addressed in studies. It is anticipated that these data will culminate in the development of non-invasive mesenteric-based therapies [i.e., mesenteric pharmacotherapeutics], which might obviate surgical intervention.”
Medical laboratories will play a major role in much of this process, both in analyzing samples to help determine normal functions and conditions, and in identifying abnormalities. Coffey believes that the discovery will be of particular value to pathologists saying, “Pathology will benefit from [enhanced] comprehensive understanding in an array of abdominal and non-abdominal conditions.”
However, he also highlights that the new data on the structure of the mesentery raises as many questions as it answers. First, he says that anatomical and other features need further study. He then points out that the functional unit of the mesentery is still unknown and might lead to important insights into the role the mesentery plays at hematological, immunological, and other levels.
As these insights occur, pathologists, clinical laboratories, and other providers of diagnostic testing, will likely see a new wave of tests to further improve diagnosis and shape the future of treatments across a variety of diseases.