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Advanced Tissue-Repair Products


Cook Biotech develops advanced tissue-repair products from biomaterials that contain a naturally occurring extracellular matrix (ECM).
ECM’s role in tissue repair
ECM is the structural and functional material that surrounds cells in nearly all body tissue. It serves as the support structure upon which cells orient and move in response to other cells and signals and provides a healthy environment necessary for tissue maintenance and repair.1
Tissue-repair processes occur through the coordinated activity of cells that reside within the ECM. Because the ECM is necessary for tissue maintenance, it also plays a major role in tissue repair.1 Without a functional ECM, the body can no longer support normal cellular processes, and tissue repair fails to progress.2
ECM composition and function
Various components of the ECM play vital roles in supporting cell function. While the composition of the ECM varies by tissue, there are generally four groups of components:
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Small intestinal submucosa

(SIS) products

Cook Biotech’s SIS products are biologic grafts made from a byproduct of the U.S. food supply chain,
a highly regulated industry that ensures a high level of consumer and product safety.
SIS is derived from porcine small intestinal submucosa, a naturally occurring ECM located between the mucosal and muscular layers of the small intestine. A complex organization of collagen and other molecules that forms a fibrous matrix, the submucosal layer of the intestine is responsible for most of its strength.

SIS material is obtained from the intestine in a manner that removes all viable cells, but leaves the naturally fibrous and porous nature of the matrix behind.11 These proprietary processing methods retain the complex architecture and composition of the extracellular matrix, providing not only the structural collagen framework but also the natural non-collagenous ECM components that are essential for cell interaction, function, and ingrowth.11,12

SIS provides a natural scaffold that allows the body to restore itself through site-specific tissue remodeling.

Small Intestinal Submucosa

Recruit, Renew, Reinforce

Tissue Remodeling

Tissue remodeling is a complex natural process that involves the recruitment of cells,
the renewal of tissue composition, and the reinforcement of structural tissue architecture.13
As the body heals, SIS is gradually remodeled and integrated into the body, leaving behind organized tissue that provides long-term strength.14-16
Immediately after implantation, the remodeling process starts when the body’s Inflammatory and progenitor cells populate the matrix and release cytokines and growth factors that recruit collagen-secreting fibroblasts.17,18 In this phase, SIS acts as a scaffold material to support the population of the ECM with patient-derived cells.
As remodeling progresses, host macrophages and fibroblasts in the newly populated matrix work together to renew the tissue through the complementary processes of phagocytosis, collagen deposition, and angiogenesis (blood vessel formation).19 In this phase, SIS is gradually replaced by the patient’s own tissue and cells.
Over time, the resident fibroblasts secrete cytokines and growth factors to signal reinforcement of the deposited tissue through the processes of additional collagen deposition and maturation, resulting in a strong, repaired tissue.12, 14-16 In this phase, SIS is no longer needed as the patient’s own collagen has gradually matured into a stable structure that has long-term strength but is entirely the patient’s own.14-16


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