Biggest organ in the body?

 says “What’s your body’s biggest organ? Get your mind out of the gutter! It’s me, the .

So runs the publicity-grabbing SoMed campaign of neil theise @neiltheise last author of

Structure and Distribution of an Unrecognized Interstitium in Human Tissues

Before I look at the science let me point you to a nice bit of investigative journalism by Grant Jacobs revealing more about Dr  Theise and his unorthodox approach. So I don’t need to go there…

I’ve long been a fan of the interstitium. So many patients became Michelin Tyre Men on my ICU that I used to ask family to bring in a recent photo so we could know the person within the patient. I enjoyed the work and lectures of burn specialist Robert Demling and long suspected better knowledge could unlock ways to prevent or treat oedema. Hence this Blog!

If we accept this New York City view, we need to shift our impression of the interstitium from the collagen-mucopolysaccharide matrix between cells in the various tissues  to collagen bundles partially lined by cells staining for CD34 creating dynamically compressible and distensible sinuses through which interstitial fluid flows around the body.

Not too big a shift, and as you will notice no claim of a New Organ. The major difference is the presence of not-quite-vascular-endothelial-cells attached to the collagen bundles which form sinuses. As we always say, more research is needed to confirm these findings and to further elucidate any possible function of these cells. If you have come to terms with the existence of an interstitial fluid circulation from the inter-endothelial junction breaks to the lymphatic collecting vessels (see JR Levick’s Introduction to Cardiovascular Physiology Ve) then the New Yorkers have identified some primitive conducting channels for this essential flow. Perhaps there are parallels with the recently-discovered fluid channels associated with the central nervous system. Research investment and time will tell.

 

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