1
|
Islamagič L, Tjørnild MJ, Carlson Hanse L, Nygaard JV, Hasenkam JM. Biomechanical comparison of porcine mitral leaflets with porcine small intestinal submucosa extracellular matrix. Proc Inst Mech Eng H 2023; 237:435-442. [PMID: 36882979 DOI: 10.1177/09544119231158248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/09/2023]
Abstract
Porcine small intestinal submucosa extracellular matrix (SIS-ECM) used for cardiac valve repair has shown conflicting clinical outcomes with respect to calcification and failure. This may be related to differences in biomechanical properties of the material compared with the host site. The aim of this study was to compare the biomechanical properties of porcine mitral valve leaflets with SIS-ECM. Fresh porcine anterior and posterior mitral leaflet samples were cut radially and circumferentially. Similarly, 2- and 4-layered SIS-ECM were cut in orthogonal directions: length and width. Samples were subjected to a uniaxial tensile test or a dynamic mechanical analysis. Results show that the load of the porcine anterior circumferential leaflet was 39.5 N (2.4-48.5 N), which was significantly higher compared with the 2-layered length SIS-ECM which was 7.5 N (7-7.9 N), and the 4- layered length SIS-ECM which was 7.5 N (7.1-8.1 N) (p < 0.001). The load of the posterior circumferential leaflet was 9.7 N (8.3-10.7 N), which is still significantly higher when compared with the two versions of SIS-ECM. The degree of anisotropy (i.e. the ratio between circumferential-radial and width-length properties) was higher for the anterior- (ratio: 19) and posterior leaflet (ratio: 6) than the 2-layered (ratio: 5.1) and 4-layered SIS-ECM (ratio: 1.9). Especially 2-layered SIS-ECM more closely resembles the posterior mitral leaflet than the anterior mitral leaflet tissue and would be more suitable as a repair material in this position. Additionally, the anisotropic properties of mitral leaflets and SIS-ECM underscore the importance of correct orientation of the implant to ensure optimal reconstruction.
Collapse
Affiliation(s)
- Lejla Islamagič
- Department of Cardiothoracic and Vascular Surgery, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Marcell Juan Tjørnild
- Department of Cardiothoracic and Vascular Surgery, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Lisa Carlson Hanse
- Department of Cardiothoracic and Vascular Surgery, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Jens Vinge Nygaard
- Department of Biological and Chemical Engineering, Aarhus University, Aarhus, Denmark
| | - John Michael Hasenkam
- Department of Cardiothoracic and Vascular Surgery, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| |
Collapse
|
2
|
Linares-Gonzalez L, Rodenas-Herranz T, Campos F, Ruiz-Villaverde R, Carriel V. Basic Quality Controls Used in Skin Tissue Engineering. Life (Basel) 2021; 11:1033. [PMID: 34685402 PMCID: PMC8541591 DOI: 10.3390/life11101033] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 09/25/2021] [Accepted: 09/25/2021] [Indexed: 12/15/2022] Open
Abstract
Reconstruction of skin defects is often a challenging effort due to the currently limited reconstructive options. In this sense, tissue engineering has emerged as a possible alternative to replace or repair diseased or damaged tissues from the patient's own cells. A substantial number of tissue-engineered skin substitutes (TESSs) have been conceived and evaluated in vitro and in vivo showing promising results in the preclinical stage. However, only a few constructs have been used in the clinic. The lack of standardization in evaluation methods employed may in part be responsible for this discrepancy. This review covers the most well-known and up-to-date methods for evaluating the optimization of new TESSs and orientative guidelines for the evaluation of TESSs are proposed.
Collapse
Affiliation(s)
- Laura Linares-Gonzalez
- Servicio de Dermatología, Hospital Universitario San Cecilio, 18016 Granada, Spain; (L.L.-G.); (T.R.-H.)
- Ibs. GRANADA, Instituto Biosanitario de Granada, 18016 Granada, Spain; (F.C.); (V.C.)
- Department of Histology, University of Granada, 18016 Granada, Spain
| | - Teresa Rodenas-Herranz
- Servicio de Dermatología, Hospital Universitario San Cecilio, 18016 Granada, Spain; (L.L.-G.); (T.R.-H.)
- Ibs. GRANADA, Instituto Biosanitario de Granada, 18016 Granada, Spain; (F.C.); (V.C.)
- Department of Histology, University of Granada, 18016 Granada, Spain
| | - Fernando Campos
- Ibs. GRANADA, Instituto Biosanitario de Granada, 18016 Granada, Spain; (F.C.); (V.C.)
- Department of Histology, University of Granada, 18016 Granada, Spain
| | - Ricardo Ruiz-Villaverde
- Servicio de Dermatología, Hospital Universitario San Cecilio, 18016 Granada, Spain; (L.L.-G.); (T.R.-H.)
- Ibs. GRANADA, Instituto Biosanitario de Granada, 18016 Granada, Spain; (F.C.); (V.C.)
- Department of Histology, University of Granada, 18016 Granada, Spain
| | - Víctor Carriel
- Ibs. GRANADA, Instituto Biosanitario de Granada, 18016 Granada, Spain; (F.C.); (V.C.)
- Department of Histology, University of Granada, 18016 Granada, Spain
| |
Collapse
|
3
|
Liang X, Zhang L, Lv Y. Treatment of total pelvic organ prolapse using a whole biological patch: A pilot study of 17 patients. J Obstet Gynaecol Res 2016; 43:164-172. [PMID: 27762472 DOI: 10.1111/jog.13155] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2016] [Accepted: 08/07/2016] [Indexed: 11/29/2022]
Affiliation(s)
- Xianghua Liang
- Department of Obstetrics and Gynecology; Beijing Jishuital Hospital; Beijing China
| | - Lili Zhang
- Department of Obstetrics and Gynecology; Beijing Jishuital Hospital; Beijing China
| | - Yanwei Lv
- Department of Beijing Research Institute of Traumatology and Orthopaedics; Beijing Jishuitan Hospital; Beijing China
| |
Collapse
|
4
|
Tachaboonyakiat W, Ogomi D, Serizawa T, Akashi M. Evaluation of Cell Adhesion and Proliferation on a Novel Tissue Engineering Scaffold Containing Chitosan and Hydroxyapatite. J BIOACT COMPAT POL 2016. [DOI: 10.1177/0883911506070441] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Porous chitosan-hxdroxyapatite hybrids were developed by partial enzymatic degradation [14] of the chitin/chitosan surface using chitosanase and lysozyme. This article evaluates the influence of chitosan and hydroxyapatite components, substrate roughness, stability, as well as surface porosity produced by enzymatic hydrolysis to cell adhesion and proliferation. L929 mouse fibroblastic lung cells were cultured on enzymatic degraded porous chitosan-hydroxyapatite hybrids. The presence of hydroxyapatite and porosity produced by partial lysozyme hydrolysis enhance cell proliferation. Besides, cell adhesion and proliferation are primarily dependent on substrate roughness and stability.
Collapse
Affiliation(s)
- Wanpen Tachaboonyakiat
- Department of Materials Science, Faculty of Science, Chulalongkorn University, Phyathai, Bangkok 10330, Thailand
| | - Daisuke Ogomi
- Nitto Denko Corporation, 455-6 Hongo, Minogo, Onomichi, Hiroshima 722-0212, Japan
| | - Takeshi Serizawa
- Research Center for Advanced Science and Technology, The University of Tokyo, 4-6-1 Komaba, Meguro-ku, Tokyo 153-8904, Japan
| | - Mitsuru Akashi
- Department of Applied Chemistry, Graduate School of Engineering, Osaka University, Yamada-oka, Suita 565-0871, Japan
| |
Collapse
|
5
|
Long-term outcomes of cruroplasty reinforcement with composite versus biologic mesh for gastroesophageal reflux disease. Surg Endosc 2015; 30:2865-72. [DOI: 10.1007/s00464-015-4570-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2015] [Accepted: 09/15/2015] [Indexed: 12/13/2022]
|
6
|
Sánchez-Palencia DM, D'Amore A, González-Mancera A, Wagner WR, Briceño JC. Effects of fabrication on the mechanics, microstructure and micromechanical environment of small intestinal submucosa scaffolds for vascular tissue engineering. J Biomech 2014; 47:2766-73. [PMID: 24877881 DOI: 10.1016/j.jbiomech.2014.04.048] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2013] [Revised: 04/08/2014] [Accepted: 04/26/2014] [Indexed: 11/25/2022]
Abstract
In small intestinal submucosa scaffolds for functional tissue engineering, the impact of scaffold fabrication parameters on success rate may be related to the mechanotransductory properties of the final microstructural organization of collagen fibers. We hypothesized that two fabrication parameters, 1) preservation (P) or removal (R) of a dense collagen layer present in SIS and 2) SIS in a final dehydrated (D) or hydrated (H) state, have an effect on scaffold void area, microstructural anisotropy (fiber alignment) and mechanical anisotropy (global mechanical compliance). We further integrated our experimental measurements in a constitutive model to explore final effects on the micromechanical environment inside the scaffold volume. Our results indicated that PH scaffolds might exhibit recurrent and large force fluctuations between layers (up to 195 pN), while fluctuations in RH scaffolds might be larger (up to 256 pN) but not as recurrent. In contrast, both PD and RD groups were estimated to produce scarcer and smaller fluctuations (not larger than 50 pN). We concluded that the hydration parameter strongly affects the micromechanics of SIS and that an adequate choice of fabrication parameters, assisted by the herein developed method, might leverage the use of SIS for functional tissue engineering applications, where forces at the cellular level are of concern in the guidance of new tissue formation.
Collapse
Affiliation(s)
- Diana M Sánchez-Palencia
- Department of Biomedical Engineering, Universidad de los Andes, Bogota 111711, Colombia; CEIBA Complex Systems Research Center, Bogota 111711, Colombia.
| | - Antonio D'Amore
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA 15261, USA; McGowan Institute for Regenerative Medicine, Pittsburgh, PA 15219-3110, USA; RiMED Foundation, Palermo 90133, Italy; Dipartimento di Ingegneria, Chimica, Gestionale, Informatica Meccanica (DICGIM), Universita' di Palermo, Palermo 90128, Italy
| | | | - William R Wagner
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA 15261, USA; McGowan Institute for Regenerative Medicine, Pittsburgh, PA 15219-3110, USA; Department of Surgery, University of Pittsburgh, Pittsburgh 15213, PA, USA; Department of Chemical Engineering, University of Pittsburgh, Pittsburgh 15261, PA, USA
| | - Juan C Briceño
- Department of Biomedical Engineering, Universidad de los Andes, Bogota 111711, Colombia; CEIBA Complex Systems Research Center, Bogota 111711, Colombia
| |
Collapse
|
7
|
Rectus abdominus fascial sheath usage for crural reinforcement during surgical management of GERD: preliminary report of a prospective randomized clinical trial. Surg Laparosc Endosc Percutan Tech 2012; 22:333-7. [PMID: 22874682 DOI: 10.1097/sle.0b013e3182523fa3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
PURPOSE Many materials are currently being used to reinforce the crural repair. Perforation, intensive fibrosis, and price are limiting the usage of these materials. Our purpose was to seek an alternative, cheap, always available, and inert material to use for cruroplasty reinforcement. METHODS Twenty-four patients participated and were randomly divided into 2 groups (graft+laparoscopic Nissen fundoplication and laparoscopic Nissen fundoplication alone) with 12 patients in each group. Total operation time, postoperative dysphagia rate, dysphagia improvement time, postoperative pain, recurrence, and incisional hernia rate were compared. RESULTS There was no difference in terms of study parameters between both groups except for the mean operation time. CONCLUSIONS Autograft hiatoplasty seems to be a good alternative for crural reinforcement. It provides safe reinforcement, has the same dysphagia rates as meshless hiatoplasty, and avoids potential complications of redo surgery by minimizing extensive fibrosis. Furthermore, the rectus abdominus sheath is always available and inexpensive.
Collapse
|
8
|
Cloonan AJ, O’Donnell MR, Lee WT, Walsh MT, De Barra E, McGloughlin TM. Spherical indentation of free-standing acellular extracellular matrix membranes. Acta Biomater 2012; 8:262-73. [PMID: 21864728 DOI: 10.1016/j.actbio.2011.08.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2011] [Revised: 07/13/2011] [Accepted: 08/05/2011] [Indexed: 10/17/2022]
Abstract
Numerous scaffold materials have been developed for tissue engineering and regenerative medicine applications to replace or repair damaged tissues and organs. Naturally occurring scaffold materials derived from acellular xenogeneic and autologous extracellular matrix (ECM) are currently in clinical use. These biological scaffold materials possess inherent variations in mechanical properties. Spherical indentation or ball burst testing has commonly been used to evaluate ECM and harvested tissue due to its ease of use and simulation of physiological biaxial loading, but has been limited by complex material deformation profiles. An analytical methodology has been developed and applied to experimental load-deflection data of a model hyperelastic material and lyophilized ECM scaffolds. An optimum rehydration protocol was developed based on water absorption, hydration relaxation and dynamic mechanical analysis. The analytical methodology was compared with finite element simulations of the tests and excellent correlation was seen between the computed biaxial stress resultants and geometry deformations. A minimum rehydration period of 5 min at 37°C was sufficient for the evaluated multilaminated ECM materials. The proposed approach may be implemented for convenient comparative analysis of ECM materials and source tissues, process optimization or during lot release testing.
Collapse
|
9
|
Paraesophageal hernia repair with biomesh does not increase postoperative dysphagia. J Gastrointest Surg 2011; 15:1743-9. [PMID: 21773871 DOI: 10.1007/s11605-011-1596-5] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2010] [Accepted: 06/20/2011] [Indexed: 01/31/2023]
Abstract
INTRODUCTION Laparoscopic techniques have led to hiatal procedures being performed with less morbidity but higher failure rates. Biologic mesh (biomesh) has been proposed as an alternative to plastic mesh to achieve durable repairs while minimizing stricturing and erosion. This paper documents the lack of significant dysphagia after the placement of biomesh during hiatal hernia repair. METHODS A retrospective chart review of patients who underwent paraesophageal hiatal hernia repairs with and without biomesh was performed. Hernias were diagnosed with esophagogastroscopy and esophageal manometry. Demographic, procedural, and pre- and post-surgery symptom data were recorded. RESULTS Fifty-six patients underwent biomesh repair while 33 patients underwent non-mesh repairs. The procedure time for mesh repairs was significantly longer (p = 0.004). Hospital stays, resting lower esophageal sphincter pressure, and mean contraction amplitudes were similar between groups. Residual pressure was measured to be significantly higher in patients who had mesh repairs (p = 0.0001). Normal esophageal peristalsis was maintained in both groups. At first follow-up, mesh patients complained of more dysphagia and bloating, but non-mesh patients had more heartburn. At second follow-up, non-mesh patients had more symptom complaints than mesh patients. CONCLUSION The addition of biomesh for hiatal hernia repair does not result in significantly increased patient dysphagia rates postoperatively compared with patients who underwent primary repair.
Collapse
|
10
|
Reing JE, Brown BN, Daly KA, Freund JM, Gilbert TW, Hsiong SX, Huber A, Kullas KE, Tottey S, Wolf MT, Badylak SF. The effects of processing methods upon mechanical and biologic properties of porcine dermal extracellular matrix scaffolds. Biomaterials 2010; 31:8626-33. [PMID: 20728934 DOI: 10.1016/j.biomaterials.2010.07.083] [Citation(s) in RCA: 314] [Impact Index Per Article: 22.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2010] [Accepted: 07/23/2010] [Indexed: 12/13/2022]
Abstract
Biologic materials from various species and tissues are commonly used as surgical meshes or scaffolds for tissue reconstruction. Extracellular matrix (ECM) represents the secreted product of the cells comprising each tissue and organ, and therefore provides a unique biologic material for selected regenerative medicine applications. Minimal disruption of ECM ultrastructure and content during tissue processing is typically desirable. The objective of this study was to systematically evaluate effects of commonly used tissue processing steps upon porcine dermal ECM scaffold composition, mechanical properties, and cytocompatibility. Processing steps evaluated included liming and hot water sanitation, trypsin/SDS/TritonX-100 decellularization, and trypsin/TritonX-100 decellularization. Liming decreased the growth factor and glycosaminoglycan content, the mechanical strength, and the ability of the ECM to support in vitro cell growth (p ≤ 0.05 for all). Hot water sanitation treatment decreased only the growth factor content of the ECM (p ≤ 0.05). Trypsin/SDS/TritonX-100 decellularization decreased the growth factor content and the ability of the ECM to support in vitro cell growth (p ≤ 0.05 for both). Trypsin/Triton X-100 decellularization also decreased the growth factor content of the ECM but increased the ability of the ECM to support in vitro cell growth (p ≤ 0.05 for both). We conclude that processing steps evaluated in the present study affect content, mechanical strength, and/or cytocompatibility of the resultant porcine dermal ECM, and therefore care must be taken in choosing appropriate processing steps to maintain the beneficial effects of ECM in biologic scaffolds.
Collapse
Affiliation(s)
- Janet E Reing
- McGowan Institute for Regenerative Medicine, University of Pittsburgh, Pittsburgh, PA 15219, USA
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
11
|
Abstract
Practically, hiatal hernias are divided into sliding hiatal hernias (type I) and PEH (types II, III, or IV). Patients with PEH are usually symptomatic with GERD or obstructive symptoms, such as dysphagia. Rarely, patients present with acute symptoms of hernia incarceration, such as severe epigastric pain and retching. A thorough evaluation includes a complete history and physical examination, chest radiograph, UGI series, esophagogastroscopy, and manometry. These investigations define the patient's anatomy, rule out other disease processes, and confirm the diagnosis. Operable symptomatic patients with PEH should be repaired. The underlying surgical principles for successful repair include reduction of hernia contents, removal of the hernia sac, closure of the hiatal defect, and an antireflux procedure. Debate remains whether a transthoracic, transabdominal, or laparoscopic approach is best with good surgical outcomes being reported with all three techniques. Placement of mesh to buttress the hiatal closure is reported to reduce hernia recurrence. Long-term follow-up is required to determine whether the laparoscopic approach with mesh hiatoplasty becomes the procedure of choice.
Collapse
|
12
|
Taveau JW, Tartaglia M, Buchannan D, Smith B, Koenig G, Thomfohrde K, Stouch B, Jeck S, Greene CH. Regeneration of Uterine Horn Using Porcine Small Intestinal Submucosa Grafts in Rabbits. J INVEST SURG 2009; 17:81-92. [PMID: 15204714 DOI: 10.1080/08941930490422456] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Tubal factor infertility may be reversed using porcine small-intestinal submucosa (SIS). The method uses as a model the New Zealand White rabbit uerine horn. In surgery, SIS grafts were prepared from porcine jejunum; the uterine horn segment was resected and a graft was placed; then the contralateral adnexa was resected. Fecundability was tested with natural mating. Three out of six rabbits became pregnant. Gross and microscopic examination confirmed regeneration of all tissue layers. Thus, this study determined that SIS facilitates successful regeneration of uterine horn morphology in a manner similar to that observed in other tissues and species.
Collapse
Affiliation(s)
- Jon W Taveau
- Department of Biomedical Sciences, Division of Physiology, Philadelphia College of Osteopathic Medicine, Philadelphia, Pennsylvania, USA
| | | | | | | | | | | | | | | | | |
Collapse
|
13
|
Lu SH, Wei CF, Yang AH, Chancellor MB, Wang LS, Chen KK. Isolation and characterization of human muscle-derived cells. Urology 2009; 74:440-5. [PMID: 19362337 DOI: 10.1016/j.urology.2009.01.048] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2008] [Revised: 12/21/2008] [Accepted: 01/27/2009] [Indexed: 11/16/2022]
Abstract
OBJECTIVES To isolate and characterize human muscle-derived cells (MDCs) for future management applications on lower urinary tract symptoms, including stress urinary incontinence and bladder reconstitution. The development of muscle stem cells for transplantation or gene transfer in patients with muscle disorders has become more attractive and challenging recently. METHODS Human MDCs were isolated from the skeletal muscles of the limbs. The muscle tissues were minced, digested at 37 degrees C by 0.2% collagenase, trypsinized, filtered, and cultured in F12 medium with 15% fetal bovine serum at 37 degrees C. Human MDCs were then isolated using a modified preplate technique. After isolation, the MDCs were characterized by immunohistochemistry, flow cytometry, and indirect immunofluorescence. RESULTS The growth doubling time of the MDCs was approximately 24 hours. Immunohistochemistry study was performed with the stem cell markers CD34, CD117, vascular cell adhesion molecule, and vascular endothelial growth factor receptor 2, and the relative stem cell position was identified. Positive immunofluorescence outcomes were found with the stem cell markers, myoblast markers CXCR4, CD56, desmin, and a fibroblast marker AB-1. Flow cytometry analysis identified markers CD34 and CD56 in the isolated MDCs, with a percentage of 5.12% and 10.34%, respectively. CONCLUSIONS The isolation and characterization of human MDCs was successfully achieved. Human MDCs might have the potential to be a novel tool for the management of stress urinary incontinence and bladder reconstitution.
Collapse
Affiliation(s)
- Shing-Hwa Lu
- Department of Urology, National Yang-Ming University School of Medicine, Taipei, Taiwan.
| | | | | | | | | | | |
Collapse
|
14
|
Al-Sahaf O, El-Masry S. The use of porcine small intestinal submucosa mesh (SURGISIS) as a pelvic sling in a man and a woman with previous pelvic surgery: two case reports. J Med Case Rep 2009; 3:70. [PMID: 19236700 PMCID: PMC2654899 DOI: 10.1186/1752-1947-3-70] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2008] [Accepted: 02/23/2009] [Indexed: 12/03/2022] Open
Abstract
Introduction Closing the pelvic peritoneum to prevent the small bowel dropping into the pelvis after surgery for locally recurrent rectal cancer is important to prevent adhesions deep in the pelvis or complications of adjuvant radiotherapy. Achieving this could be difficult because sufficient native tissue is unavailable; we report on the use of small intestine submucosa extra-cellular matrix mesh in the obliteration of the pelvic brim. Case presentation We describe two cases in which submucosa extra-cellular matrix mesh was used to obliterate the pelvic brim following resection of a recurrent rectal tumour; the first patient, a 78-year-old Caucasian man, presented with small bowel obstruction caused by adhesions to a recurrent rectal tumour. The second patient, an 84-year-old Caucasian woman, presented with vaginal discharge caused by an entero-vaginal fistula due to a recurrent rectal tumour. Conclusion We report on the use of submucosa extra-cellular matrix mesh as a pelvic sling in cases where primary closure of the pelvic peritoneum is unfeasible. Its use had no infective complications and added minimal morbidity to the postoperative period. This is an original case report that would be of interest to general and colorectal surgeons.
Collapse
Affiliation(s)
- Osama Al-Sahaf
- Department of General Surgery, Our Lady of Lourdes Hospital, Drogheda, Co, Louth, Ireland.
| | | |
Collapse
|
15
|
Abstract
The management of paraesophageal hernia (PEH) has become one of the most widely debated and controversial areas in surgery. PEHs are relatively uncommon, often presenting in patients entering their seventh or eighth decades of life. Patients who have PEH often bear complicating medical comorbidities making them potentially poor operative candidates. Taking this into account makes surgical management of these patients all the more complex. Many considerations must be taken into account in formulating a management strategy for patients who have PEHs, and these considerations have led surgeons into ongoing debates in recent decades.
Collapse
Affiliation(s)
- S Scott Davis
- Emory Endosurgery Unit, Emory University, Emory Clinic Building A, 1365 Clifton Road, Suite H-124, Atlanta, GA 30322, USA.
| |
Collapse
|
16
|
Simultaneous laparoscopic type III paraesophageal hernia repair with porcine small intestine submucosa and Roux-en-Y gastric bypass. Surg Obes Relat Dis 2008; 4:764-7. [DOI: 10.1016/j.soard.2008.08.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2008] [Revised: 08/02/2008] [Accepted: 08/06/2008] [Indexed: 11/17/2022]
|
17
|
Gilbert TW, Wognum S, Joyce EM, Freytes DO, Sacks MS, Badylak SF. Collagen fiber alignment and biaxial mechanical behavior of porcine urinary bladder derived extracellular matrix. Biomaterials 2008; 29:4775-82. [PMID: 18801572 DOI: 10.1016/j.biomaterials.2008.08.022] [Citation(s) in RCA: 113] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2008] [Accepted: 08/22/2008] [Indexed: 12/27/2022]
Abstract
The collagen fiber alignment and biomechanical behavior of naturally occurring extracellular matrix (ECM) scaffolds are important considerations for the design of medical devices from these materials. Both should be considered in order to produce a device to meet tissue specific mechanical requirements (e.g., tendon vs. urinary bladder), and could ultimately affect the remodeling response in vivo. The present study evaluated the collagen fiber alignment and biaxial mechanical behavior of ECM scaffold material harvested from porcine urinary bladder tunica mucosa and basement membrane (together referred to as urinary bladder matrix (UBM)) and ECM harvested from urinary bladder submucosa (UBS). Since the preparation of UBM allows for control of the direction of delamination, the effect of the delamination method on the mechanical behavior of UBM was determined by delaminating the submucosa and other abluminal layers by scraping along the longitudinal axis of the bladder (apex to neck) (UBML) or along the circumferential direction (UBMC). The processing of UBS does not allow for similar directional control. UBML and UBS had similar collagen fiber distributions, with a preferred collagen fiber alignment along the longitudinal direction. UBMC showed a more homogenous collagen fiber orientation. All samples showed a stiffer mechanical behavior in the longitudinal direction. Despite similar collagen fiber distributions, UBML and UBS showed quite different mechanical behavior for the applied loading patterns with UBS showing a much more pronounced toe region. The mechanical behavior for UBMC in both directions was similar to the mechanical behavior of UBML. There are distinct differences in the mechanical behavior of different layers of ECM from the porcine urinary bladder, and the processing methods can substantially alter the mechanical behavior observed.
Collapse
Affiliation(s)
- Thomas W Gilbert
- McGowan Institute for Regenerative Medicine, Department of Surgery, University of Pittsburgh, Pittsburgh, PA 15219, USA
| | | | | | | | | | | |
Collapse
|
18
|
Coburn JC, Brody S, Billiar KL, Pandit A. Biaxial mechanical evaluation of cholecyst-derived extracellular matrix: a weakly anisotropic potential tissue engineered biomaterial. J Biomed Mater Res A 2007; 81:250-6. [PMID: 17269134 DOI: 10.1002/jbm.a.30943] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
A new acellular, natural, biodegradable matrix has been discovered in the cholecyst-derived extracellular matrix (CEM). This matrix is rich in collagen and contains several other macromolecules useful in tissue remodeling. In this study, the principal material axes, collagen fiber orientations, and biaxial mechanical properties in a physiological loading regime were characterized. Fiber direction was determined by polarized light microscopy, and the principal axes and degree of anisotropy were determined mechanically. Macroscopic equibiaxial strain tests were then conducted on preconditioned specimens. While 13% of the area of CEM contains collagen fibers oriented between 50 degrees and 60 degrees from the neck-fundus axis, the principal material axis was oriented 63 degrees +/- 13.7 degrees , with an aspect ratio of 0.11 +/- 0.06, indicating a weak anisotropy in that direction. Under biaxial loading, CEM exhibited a large toe region followed by an exponential rise in stress in both principal and perpendicular axis directions, similar to other materials currently under research. There was no significant difference between the biaxial stress-strain profile and the burst stress-strain profile. The results demonstrate that CEM is weakly anisotropic and it has the ability to support large strains across a physiological loading regime.
Collapse
Affiliation(s)
- James C Coburn
- National Centre for Biomedical Engineering Science, National University of Ireland, Galway, Ireland
| | | | | | | |
Collapse
|
19
|
Gilbert TW, Stewart-Akers AM, Sydeski J, Nguyen TD, Badylak SF, Woo SLY. Gene Expression by Fibroblasts Seeded on Small Intestinal Submucosa and Subjected to Cyclic Stretching. ACTA ACUST UNITED AC 2007; 13:1313-23. [PMID: 17518717 DOI: 10.1089/ten.2006.0318] [Citation(s) in RCA: 69] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Extracellular matrix scaffolds derived from porcine small intestinal submucosa (SIS-ECM) have been shown to promote the formation of site-specific tissue in a number of preclinical animal studies. However, this constructive remodeling process requires that the scaffold be subjected to a site-specific mechanical environment. The specific quantitative effects of mechanical loading on the gene expression patterns of fibroblasts seeded on SIS-ECM are unknown and yet very important in the tissue remodeling process. The objective of the present study was to evaluate the expression of collagen type I (Col I), collagen type III (Col III), smooth muscle actin (SMA), tenascin-C (TN-C), matrix metalloprotease-2 (MMP-2), matrix metalloprotease-9 (MMP-9), transforming growth factor-beta1 (TGF-beta1), and transforming growth factor-beta3 (TGF-beta3) by fibroblasts subjected to various magnitudes (0%, 5%, 10%, and 15%) and frequencies (0.1 Hz, 0.3 Hz, and 0.5 Hz) of stretch. A new cyclic-stretching tissue culture (CSTC) system was developed. This system consists of eight independently controlled culture chambers that can be operated in a sterile incubator. Each chamber includes a load cell so that the load in each scaffold can be monitored. It was found that different stretching regimens led to complex and distinctive patterns of gene expression by fibroblasts seeded onto SIS-ECM. In general, the fibroblasts increased expression of Col I up to 5-fold and decreased that of Col III with increased frequency of stretch. In addition, the fibroblasts exhibited a contractile phenotype with increased expression of SMA, TN-C, and TGF-beta1. These findings support the concept that the mechanical environment of a remodeling ECM scaffold may have substantial effects on the behavior of cells within the scaffold and contribute to the site-specific tissue remodeling that has been observed in in vivo studies.
Collapse
Affiliation(s)
- Thomas W Gilbert
- McGowan Institute for Regenerative Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | | | | | | | | | | |
Collapse
|
20
|
|
21
|
Gilbert TW, Sacks MS, Grashow JS, Woo SLY, Badylak SF, Chancellor MB. Fiber kinematics of small intestinal submucosa under biaxial and uniaxial stretch. J Biomech Eng 2007; 128:890-8. [PMID: 17154691 DOI: 10.1115/1.2354200] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Improving our understanding of the design requirements of biologically derived collagenous scaffolds is necessary for their effective use in tissue reconstruction. In the present study, the collagen fiber kinematics of small intestinal submucosa (SIS) was quantified using small angle light scattering (SALS) while the specimen was subjected to prescribed uniaxial or biaxial strain paths. A modified biaxial stretching device based on Billiar and Sacks (J. Biomech., 30, pp. 753-7, 1997) was used, with a real-time analysis of the fiber kinematics made possible due to the natural translucency of SIS. Results indicated that the angular distribution of collagen fibers in specimens subjected to 10% equibiaxial strain was not significantly different from the initial unloaded condition, regardless of the loading path (p=0.31). Both 10% strip biaxial stretch and uniaxial stretches of greater than 5% in the preferred fiber direction led to an increase in the collagen fiber alignment along the same direction, while 10% strip biaxial stretch in the cross preferred fiber direction led to a broadening of the distribution. While an affine deformation model accurately predicted the experimental findings for a biaxial strain state, uniaxial stretch paths were not accurately predicted. Nonaffine structural models will be necessary to fully predict the fiber kinematics under large uniaxial strains in SIS.
Collapse
Affiliation(s)
- Thomas W Gilbert
- Department of Bioengineering, McGowan Institute of Regenerative Medicine, University of Pittsburgh, Pittsburgh, PA 15219, USA
| | | | | | | | | | | |
Collapse
|
22
|
Androjna C, Spragg RK, Derwin KA. Mechanical Conditioning of Cell-Seeded Small Intestine Submucosa: A Potential Tissue-Engineering Strategy for Tendon Repair. ACTA ACUST UNITED AC 2007; 13:233-43. [PMID: 17518560 DOI: 10.1089/ten.2006.0050] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Our long-term objective is to enhance tendon repair by delivering cells on natural biologic scaffolds to the repair site. Clinical outcomes may be improved by first preconditioning these cell-seeded constructs in bioreactors to enhance their properties at implantation and to deliver cells expressing a desired phenotype. In this work, we have investigated the effect of in vitro mechanical conditioning on small-intestine submucosa (SIS) scaffolds seeded with primary tendon cells (tenocytes). SIS scaffolds (with and without cells) were conditioned under various loading regimes over a 2-week period. In vitro cyclic loading significantly increased the biomechanical properties (e.g., stiffness) of cell-seeded SIS constructs (129.1 +/- 10.2%) from time 0. The stiffness change of cyclically loaded constructs without cells was 33.9 +/- 13.8% and of statically loaded constructs with cells was 34.0 +/- 15.2% and without cells was 33.4 +/- 10.7%. In the cell-seeded groups, our data demonstrate a direct role (e.g., cell tensioning) for cells in construct stiffening. In addition, the initial stiffness of the cell-seeded, cyclically loaded constructs was found to be a strong predictor of the change in construct stiffness. Despite the mechanical integrity of these constructs being significantly less than native tendon, our data show that structural properties can be improved with in vitro mechanical conditioning. These data provide the basis for future studies investigating in vitro conditioning (mechanical, chemical) of cell-seeded ECM scaffolds and the use of such constructs for enhancing tendon repair in vivo.
Collapse
Affiliation(s)
- Caroline Androjna
- The Cleveland Clinic, Department of Biomedical Engineering, Cleveland, Ohio 44195, USA
| | | | | |
Collapse
|
23
|
Androjna C, Spragg RK, Derwin KA. Mechanical Conditioning of Cell-Seeded Small Intestine Submucosa: A Potential Tissue-Engineering Strategy for Tendon Repair. ACTA ACUST UNITED AC 2007. [DOI: 10.1089/ten.2007.13.ft-331] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
|
24
|
Abstract
Paraesophageal hernias are difficult surgical problems that often need repair. Meticulous work-up and surgical technique are required for optimal results. A laparoscopic approach is associated with reduced morbidity and, if combined with the use of biologic mesh, provides relief of symptoms and a durable repair.
Collapse
Affiliation(s)
- Patrick S Wolf
- Department of Surgery, University of Washington, 1959 NE Pacific Street, Box 356410, Seattle, WA 98195, USA
| | | |
Collapse
|
25
|
Desai KM, Diaz S, Dorward IG, Winslow ER, La Regina MC, Halpin V, Soper NJ. Histologic results 1 year after bioprosthetic repair of paraesophageal hernia in a canine model. Surg Endosc 2006; 20:1693-7. [PMID: 17031737 DOI: 10.1007/s00464-006-0680-5] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND The use of prosthetic materials for the repair of paraesophageal hiatal hernia (PEH) may lead to esophageal stricture and perforation. High recurrence rates after primary repair have led surgeons to explore other options, including various bioprostheses. However, the long-term effects of these newer materials when placed at the esophageal hiatus are unknown. This study assessed the anatomic and histologic characteristics 1 year after PEH repair using a U-shaped configuration of commercially available small intestinal submucosa (SIS) mesh in a canine model. METHODS Six dogs underwent laparoscopic PEH repair with SIS mesh 4 weeks after thoracoscopic creation of PEH. When the six dogs were sacrificed 12 months later, endoscopy and barium x-ray were performed, and biopsies of the esophagus and crura were obtained. RESULTS The mean weight of the dogs 1 year after surgery was identical to their entry weight. No dog had gross dysphagia, evidence of esophageal stricture, or reherniation. At sacrifice, the biomaterial was not identifiable grossly. Biopsies of the hiatal region showed fibrosis as well as muscle fiber proliferation and regeneration. No dog had erosion of the mesh into the esophagus. CONCLUSIONS This reproducible canine model of PEH formation and repair did not result in erosion of SIS mesh into the esophagus or in stricture formation. Native muscle ingrowth was noted 1 year after placement of the biomaterial. According to the findings, SIS may provide a scaffold for ingrowth of crural muscle and a durable repair of PEH over the long term.
Collapse
Affiliation(s)
- K M Desai
- Department of Surgery and Institute for Minimally Invasive Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | | | | | | | | | | | | |
Collapse
|
26
|
Derwin KA, Baker AR, Spragg RK, Leigh DR, Iannotti JP. Commercial extracellular matrix scaffolds for rotator cuff tendon repair. Biomechanical, biochemical, and cellular properties. J Bone Joint Surg Am 2006; 88:2665-72. [PMID: 17142417 DOI: 10.2106/jbjs.e.01307] [Citation(s) in RCA: 205] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND We are not aware of any in vitro study comparing the biomechanical, biochemical, and cellular properties of commercial extracellular matrix materials marketed for rotator cuff tendon repair. In this study, the properties of GraftJacket, TissueMend, Restore, and CuffPatch were quantified and compared with each other. The elastic moduli were also compared with that of normal canine infraspinatus tendon. METHODS Samples were tested from different manufacturing lots of four materials: GraftJacket (ten lots), TissueMend (six), Restore (ten), and CuffPatch (six). The Kruskal-Wallis test was used to compare thickness, stiffness, and modulus as well as hydroxyproline, chondroitin/dermatan sulfate glycosaminoglycan, hyaluronan, and DNA contents among these matrices. The moduli of the extracellular matrices were also compared with those of normal canine infraspinatus tendon. RESULTS All four extracellular matrices required 10% to 30% stretch before they began to carry substantial load. Their maximum moduli were realized in their linear region at 30% to 80% strain. The elastic moduli of all four commercial matrices were an order of magnitude lower than that of canine infraspinatus tendon. TissueMend had significantly higher DNA content than the other three matrices (p<0.0001), although both Restore and GraftJacket also had measurable amounts of DNA. CONCLUSIONS Our data demonstrate chemical and mechanical differences among the four commercial extracellular matrices that we evaluated. Probably, the source (dermis or small intestine submucosa), species (human, porcine, or bovine), age of the donor (fetal or adult), and processing of these matrices all contribute to the unique biophysical properties of the delivered product. The biochemical composition of commercial extracellular matrices is similar to that of tendon. However, the elastic moduli of these materials are an order of magnitude lower than that of tendon, suggesting a limited mechanical role in augmentation of tendon repair.
Collapse
Affiliation(s)
- Kathleen A Derwin
- Department of Biomedical Engineering, ND-20, Lerner Research Institute, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH 44195, USA.
| | | | | | | | | |
Collapse
|
27
|
Oelschlager BK, Pellegrini CA, Hunter J, Soper N, Brunt M, Sheppard B, Jobe B, Polissar N, Mitsumori L, Nelson J, Swanstrom L. Biologic prosthesis reduces recurrence after laparoscopic paraesophageal hernia repair: a multicenter, prospective, randomized trial. Ann Surg 2006; 244:481-90. [PMID: 16998356 PMCID: PMC1856552 DOI: 10.1097/01.sla.0000237759.42831.03] [Citation(s) in RCA: 160] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Laparoscopic paraesophageal hernia repair (LPEHR) is associated with a high recurrence rate. Repair with synthetic mesh lowers recurrence but can cause dysphagia and visceral erosions. This trial was designed to study the value of a biologic prosthesis, small intestinal submucosa (SIS), in LPEHR. METHODS Patients undergoing LPEHR (n = 108) at 4 institutions were randomized to primary repair -1 degrees (n = 57) or primary repair buttressed with SIS (n = 51) using a standardized technique. The primary outcome measure was evidence of recurrent hernia (> or =2 cm) on UGI, read by a study radiologist blinded to the randomization status, 6 months after operation. RESULTS At 6 months, 99 (93%) patients completed clinical symptomatic follow-up and 95 (90%) patients had an UGI. The groups had similar clinical presentations (symptom profile, quality of life, type and size of hernia, esophageal length, and BMI). Operative times (SIS 202 minutes vs. 1 degrees 183 minutes, P = 0.15) and perioperative complications did not differ. There were no operations for recurrent hernia nor mesh-related complications. At 6 months, 4 patients (9%) developed a recurrent hernia >2 cm in the SIS group and 12 patients (24%) in the 1 degrees group (P = 0.04). Both groups experienced a significant reduction in all measured symptoms (heartburn, regurgitation, dysphagia, chest pain, early satiety, and postprandial pain) and improved QOL (SF-36) after operation. There was no difference between groups in either pre or postoperative symptom severity. Patients with a recurrent hernia had more chest pain (2.7 vs. 1.0, P = 0.03) and early satiety (2.8 vs. 1.3, P = 0.02) and worse physical functioning (63 vs. 72, P = 0.03 per SF-36). CONCLUSIONS Adding a biologic prosthesis during LPEHR reduces the likelihood of recurrence at 6 months, without mesh-related complications or side effects.
Collapse
|
28
|
Santucci RA, Barber TD. Resorbable extracellular matrix grafts in urologic reconstruction. Int Braz J Urol 2005; 31:192-203. [PMID: 15992421 DOI: 10.1590/s1677-55382005000300002] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2005] [Accepted: 03/05/2005] [Indexed: 11/21/2022] Open
Abstract
PURPOSE There is an increasingly large body of literature concerning tissue-engineering products that may be used in urology. Some of these are quite complex (such as multilayer patient-specific cell-seeded implants) yet the most simple and successful products to date are also the most uncomplicated: resorbable acellular extra-cellular matrices (ECMs) harvested from animals. ECMs have been used in a variety of difficult urologic reconstruction problems, and this review is intended to summarize this complex literature for the practicing urologist. METHODS Medline search of related terms such as "SIS, small intestinal submucosa, ECM, extracellular matrix, acellular matrix and urologic reconstruction". Manuscripts missed in the initial search were taken from the bibliographies of the primary references. RESULTS Full review of potential clinical uses of resorbable extra-cellular matrices in urologic reconstruction. CONCLUSIONS Currently, the "state of the art" in tissue engineering solutions for urologic reconstruction means resorbable acellular xenograft matrices. They show promise when used as a pubovaginal sling or extra bolstering layers in ureteral or urethral repairs, although recent problems with inflammation following 8-ply pubovaginal sling use and failures after 1- and 4-ply SIS repair of Peyronie's disease underscore the need for research before wide adoption. Preliminary data is mixed concerning the potential for ECM urethral patch graft, and more data is needed before extended uses such as bladder augmentation and ureteral replacement are contemplated. The distant future of ECMs in urology likely will include cell-seeded grafts with the eventual hope of producing "off the shelf" replacement materials. Until that day arrives, ECMs only fulfill some of the requirements for the reconstructive urologist.
Collapse
|
29
|
Raghavan D, Kropp BP, Lin HK, Zhang Y, Cowan R, Madihally SV. Physical characteristics of small intestinal submucosa scaffolds are location-dependent. J Biomed Mater Res A 2005; 73:90-6. [PMID: 15693016 DOI: 10.1002/jbm.a.30268] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Using biodegradable scaffolds as an alternative to engineer new tissues has become an attractive candidate in various transplantation protocols. In particular, small intestinal submucosa (SIS), a dense connective matrix harvested from the small intestine, has gained attention due to a number of favorable properties. However, use of SIS is constrained by obtaining reliable, reproducible products in large-scale preparations that affect the regenerative process. To better understand the heterogeneous nature of SIS, this study focused on evaluating the location-dependent alterations in the physical characteristics of the matrices harvested from distal and proximal ends and processed in-house (referred as hand-made). Additionally, results were compared with a commercially available machine-made Cook SIS. Tensile properties during monotonic loading and cyclical loading were compared in wet conditions. Furthermore, permeability of these membranes to urea was analyzed using a custom-built chamber, and the microarchitecture was analyzed via scanning electron microscopy. These results showed that distal samples were more elastic and less permeable to urea relative to other samples. However, permeability in each sample was direction-dependent, that is, mucosal to serosal direction was less permeable compared to sorasal to mucosal direction in all the samples. Cook SIS was more susceptible to cyclical loading and had a shorter range of load carrying capacity. In summary, results show that physical characteristics of SIS are location-dependent.
Collapse
Affiliation(s)
- Devanathan Raghavan
- School of Mechanical Engineering, Oklahoma State University, Stillwater, Oklahoma 74078, USA
| | | | | | | | | | | |
Collapse
|
30
|
Lu SH, Sacks MS, Chung SY, Gloeckner DC, Pruchnic R, Huard J, de Groat WC, Chancellor MB. Biaxial mechanical properties of muscle-derived cell seeded small intestinal submucosa for bladder wall reconstitution. Biomaterials 2005; 26:443-9. [PMID: 15275818 DOI: 10.1016/j.biomaterials.2004.05.006] [Citation(s) in RCA: 60] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Bladder wall replacement remains a challenging problem for urological surgery due to leakage, infection, stone formation, and extensive time needed for tissue regeneration. To explore the feasibility of producing a more functional biomaterial for bladder reconstitution, we incorporated muscle-derived cells (MDC) into small intestinal submucosa (SIS) scaffolds. MDC were harvested from mice hindleg muscle, transfected with a plasmid encoding for beta-galactosidase, and placed into single-layer SIS cell culture inserts. Twenty-five MDC and/or SIS specimens were incubated at 37 degrees C for either 10 or 20 days. After harvesting, mechanical properties were characterized using biaxial testing, and the areal strain under 1 MPa peak stress used to quantify tissue compliance. Histological results indicated that MDC migrated throughout the SIS after 20 days. The mean (+/-SE) areal strain of the 0 day control group was 0.182 +/- 0.027 (n=5). After 10 days incubation, the mean (+/-SE) areal strain in MDC/SIS was 0.247 +/- 0.014 (n=5) compared to 10 day control SIS 0.200 +/- 0.024 (n=6). After 20 days incubation, the mean areal strain of MDC/SIS was 0.255 +/- 0.019 (n=5) compared to control SIS 0.170 +/- 0.025 (n=5). Both 10 and 20 days seeded groups were significantly different (p=0.027) than that of incubated SIS alone, but were not different from each other. These results suggest that MDC growth was supported by SIS and that initial remodeling of the SIS ECM had occurred within the first 10 days of incubation, but may have slowed once the MDC had grown to confluence within the SIS.
Collapse
Affiliation(s)
- Shing-Hwa Lu
- Department of Urology, University of Pittsburgh, Pittsburgh, PA 15219, USA
| | | | | | | | | | | | | | | |
Collapse
|
31
|
Brody S, Pandit A. Microarchitectural characterization of the aortic heart valve. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2004; 553:167-86. [PMID: 15503455 DOI: 10.1007/978-0-306-48584-8_13] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
Affiliation(s)
- Sarah Brody
- National Centre for Biomedical Engineering Science and Department of Mechanical and Biomedical Engineering, National University of Ireland, Galway, Ireland
| | | |
Collapse
|
32
|
Driessen NJB, Bouten CVC, Baaijens FPT. Improved Prediction of the Collagen Fiber Architecture in the Aortic Heart Valve. J Biomech Eng 2004; 127:329-36. [PMID: 15971711 DOI: 10.1115/1.1865187] [Citation(s) in RCA: 65] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Living tissues show an adaptive response to mechanical loading by changing their internal structure and morphology. Understanding this response is essential for successful tissue engineering of load-bearing structures, such as the aortic valve. In this study, mechanically induced remodeling of the collagen architecture in the aortic valve was investigated. It was hypothesized that, in uniaxially loaded regions, the fibers aligned with the tensile principal stretch direction. For biaxial loading conditions, on the other hand, it was assumed that the collagen fibers aligned with directions situated between the principal stretch directions. This hypothesis has already been applied successfully to study collagen remodeling in arteries. The predicted fiber architecture represented a branching network and resembled the macroscopically visible collagen bundles in the native leaflet. In addition, the complex biaxial mechanical behavior of the native valve could be simulated qualitatively with the predicted fiber directions. The results of the present model might be used to gain further insight into the response of tissue engineered constructs during mechanical conditioning.
Collapse
Affiliation(s)
- Niels J B Driessen
- Department of Biomedical Engineering, Eindhoven University of Technology, P.O. Box 513, 5600 MB Eindhoven, The Netherlands.
| | | | | |
Collapse
|
33
|
Freytes DO, Badylak SF, Webster TJ, Geddes LA, Rundell AE. Biaxial strength of multilaminated extracellular matrix scaffolds. Biomaterials 2004; 25:2353-61. [PMID: 14741600 DOI: 10.1016/j.biomaterials.2003.09.015] [Citation(s) in RCA: 152] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Xenogeneic extracellular matrix (ECM) can be harvested and configured to function as a bioscaffold for tissue and organ reconstruction. The mechanical properties of the ECM vary depending upon the tissue from which it is harvested. Likewise, the manufacturing steps required to develop ECMs into medical grade devices will affect the surface morphology and the mechanical properties of the bioscaffold; important properties for constructive tissue remodeling. The present study compared the ball-burst strength of five different ECM scaffolds before and after treatment with peracetic acid (PAA): porcine small intestinal submucosa (SIS), porcine urinary bladder submucosa (UBS), porcine urinary bladder matrix (UBM), a composite of UBS + UBM, and canine stomach submucosa (SS). This study also compared the mechanical properties of 2- and 4-layer ECM scaffolds. Results showed 2-layer SS devices had the highest ball-burst value of all 2-layer ECM devices. Moreover, all 4-layer ECM devices had similar ball-burst strength except for 4-layer UBM devices which was the weakest. PAA-treatment decreased the ball-burst strength of SS and increased the ball-burst strength of UBS 2-layer devices. This study showed the material properties of the ECM scaffolds could be engineered to mimic those of native soft tissues (i.e. vascular, musculotendinous, etc) by varying the number of layers and modifying the disinfection/sterilization treatments used for manufacturing.
Collapse
Affiliation(s)
- Donald O Freytes
- Department of Biomedical Engineering, Purdue University, West Lafayette, IN 47907-2022, USA
| | | | | | | | | |
Collapse
|
34
|
Greca FH, Noronha L, Bendhack M, Feres A, Soccol A, Duda JR. Use of small intestine submucosa as ureteral allograft in pigs. Int Braz J Urol 2004; 30:327-34; discussion 335. [PMID: 15679971 DOI: 10.1590/s1677-55382004000400013] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2004] [Accepted: 06/06/2004] [Indexed: 11/22/2022] Open
Abstract
PURPOSE The aim of the present study was to evaluate the biocompatibility of small intestine submucosa (SIS) in the reconstruction of the ureter in swine. MATERIALS AND METHODS An experimental study was performed in 10 half-breed pigs weighing between 20 and 30 K, in which a previously prepared segment of SIS measuring approximately 2.0 cm was implanted in the upper third part of the right ureter. RESULTS Of the 10 operated animals, one died 14 days after the surgery due to a dehiscence on the suture line of the implanted graft. The remaining 9 animals were submitted to ultrasound examination of the urinary tract and were sacrificed on the 40th postoperative day. The macroscopic evaluation showed no calculus, incrustation, fistula, abscesses or adhesions in the ureters with the graft. Microscopic evaluation with hematoxylin-eosin and Sirius red showed in the experimental area (graft) the presence of urothelium in 100% of the cases, collagen in 100% of the cases, and smooth muscle layer in 87.5% of the animals. In the area adjacent to the graft (proximal and distal), we observed 92.86% of urothelium, 42.86% of collagen and 71.43% of smooth muscle. In the contralateral ureter, it was found 100% of urothelium and smooth muscle and just 11.11% of collagen. The microscopic analysis of the kidneys whose ureters received the graft of SIS evidenced congestion in 55.55%, pelvic edema in 66.66% and interstitial nephritis in 77.78%. Hydronephrosis was present in 33.33% and chronic pyelonephritis in 44%. Only 1 animal presented total absence of glomerulus in the renal parenchyma. CONCLUSION The SIS graft behaved as a biological tissue support, allowing the regeneration of the urothelium and smooth muscle grow, despite of chronic inflammatory process.
Collapse
Affiliation(s)
- Fernando H Greca
- Department of Experimental Surgery, Pontifical Catholic University of Parana, Curitiba, Parana, Brazil.
| | | | | | | | | | | |
Collapse
|
35
|
Abstract
Arterial occlusive disease remains the leading cause of death in western countries and often requires vascular reconstructive surgery. The limited supply of suitable small-diameter vascular grafts has led to the development of tissue engineered blood vessel substitutes. Many different approaches have been examined, including natural scaffolds containing one or more ECM proteins and degradable polymeric scaffolds. For optimal graft development, many efforts have modified the culture environment to enhance ECM synthesis and organization using bioreactors under physiologic conditions and biochemical supplements. In the past couple of decades, a great deal of progress on TEVGs has been made. Many challenges remain and are being addressed, particularly with regard to the prevention of thrombosis and the improvement of graft mechanical properties. To develop a patent TEVG that grossly resembles native tissue, required culture times in most studies exceed 8 weeks. Even with further advances in the field, TEVGs will likely not be used in emergency situations because of the time necessary to allow for cell expansion, ECM production and organization, and attainment of desired mechanical strength. Furthermore, TEVGs will probably require the use of autologous tissue to prevent an immunogenic response, unless advances in immune acceptance render allogenic and xenogenic tissue use feasible. TEVGs have not yet been subjected to clinical trials, which will determine the efficacy of such grafts in the long term. Finally, off-the-shelf availability and cost will become the biggest hurdles in the development of a feasible TEVG product. Although many obstacles exist in the effort to develop a small-diameter TEVG, the potential benefits of such an achievement are exciting. In the near future, a nonthrombogenic TEVG with sufficient mechanical strength may be developed for clinical trials. Such a graft will have the minimum characteristics of biological tissue necessary to remain patent over a period comparable to current vein graft therapies. As science and technology advance, TEVGs may evolve into complex blood vessel substitutes. TEVGs may become living grafts, capable of growing, remodeling, and responding to mechanical and biochemical stimuli in the surrounding environment. These blood vessel substitutes will closely resemble native vessels in almost every way, including structure, composition, mechanical properties, and function. They will possess vasoactive properties and be able to dilate and constrict in response to stimuli. Close mimicry of native blood vessels may aid in the engineering of other tissues dependent upon vasculature to sustain function. With further understanding of the factors involved in cardiovascular development and function combined with the foundation of knowledge already in place, the development of TEVGs should one day lead to improved quality of life for those with vascular disease and other life-threatening conditions.
Collapse
Affiliation(s)
- Rachael H Schmedlen
- Department of Bioengineering, Rice University, 6100 Main Street, MS 142 Houston, TX 77005-1892, USA
| | | | | | | |
Collapse
|
36
|
Oelschlager BK, Barreca M, Chang L, Pellegrini CA. The use of small intestine submucosa in the repair of paraesophageal hernias: initial observations of a new technique. Am J Surg 2003; 186:4-8. [PMID: 12842738 DOI: 10.1016/s0002-9610(03)00114-4] [Citation(s) in RCA: 119] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND Recent reports suggest that when laparoscopy is used to repair paraesophageal hernias recurrence rates reach 20% to 40%. Tension-free hernia closure with synthetic mesh reduces recurrence but occasionally results in esophageal injury. We hypothesized that reinforcement of the hiatal closure with small intestine submucosa (SIS) mesh, in some unusually large hernias, might reduce recurrence rates without causing injury to the esophagus. METHODS From January 2001 to March 2002 we treated 18 large paraesophageal hernias via a laparoscopic approach. In 9 of the largest hernias (one type II and 8 type III, of which 1 was recurrent) the repair was reinforced with SIS mesh (Surgisis, Cook Surgical) and represent the subjects of this study. Nissen fundoplication with gastropexy was performed in all patients. Clinical follow-up ranged from 3 to 16 months (median 8). Every patient was evaluated with barium esophagram or endoscopy or both 1 to 8 months (median 2) postoperatively. RESULTS The presenting symptoms were postprandial pain/fullness (9 of 9), heartburn (4 of 9), anemia (4 of 9), dysphagia (3 of 9), regurgitation (3 of 9), and chest pain (3 of 9). One patient died of a hemorrhagic stroke within 30 days of the operation. Postoperatively, presenting symptoms resolved (83%) or improved (17%) in each of the remaining 8 patients. One patient required endoscopic dilation for mild dysphagia. Seven of 8 patients had a normal barium esophagram without evidence of hernia. One morbidly obese (body mass index = 47) patient had a small (2 cm) sliding hiatal hernia postoperatively. There were no other complications, and specifically no perforations or mesh erosions. CONCLUSIONS These observations suggest that the use of SIS in the repair of paraesophageal hernias is safe and may reduce recurrence. Longer follow-up and a randomized study are needed to validate these results.
Collapse
Affiliation(s)
- Brant K Oelschlager
- The Swallowing Center, and Department of Surgery, 1959 NE Pacific St., Box 356410, Seattle, WA 98195-6410, USA.
| | | | | | | |
Collapse
|
37
|
Badylak S, Kokini K, Tullius B, Simmons-Byrd A, Morff R. Morphologic study of small intestinal submucosa as a body wall repair device. J Surg Res 2002; 103:190-202. [PMID: 11922734 DOI: 10.1006/jsre.2001.6349] [Citation(s) in RCA: 235] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
BACKGROUND The extracellular matrix (ECM) derived from porcine small intestinal submucosa (SIS) has been used as a constructive scaffold for tissue repair in both preclinical animal studies and human clinical trials. Quantitative characterization of the host tissue response to this xenogeneic scaffold material has been lacking. MATERIALS AND METHODS The morphologic response to a multilaminate form of the SIS-ECM was evaluated in a chronic, 2-year study of body wall repair in two separate species: the dog and the rat. Morphologic response to the SIS-ECM was compared to that for three other commonly used bioscaffold materials including Marlex mesh, Dexon, and Perigard. Quantitative measurements were made of tissue consistency, polymorphonuclear cell response, mononuclear cell response, tissue organization, and vascularity at five time points after surgical implantation: 1 week, 1, 3, and 6 months, and 2 years. RESULTS All bioscaffold materials functioned well as a repair device for large ventral abdominal wall defects created in these two animal models. The SIS-ECM bioscaffold showed a greater number of polymorphonuclear leukocytes at the 1-week time point and a greater degree of graft site tissue organization after 3 months compared to the other three scaffold materials. There was no evidence for local infection or other detrimental local pathology to any of the graft materials at any time point. CONCLUSIONS Like Marlex, Dexon, and Perigard, the SIS-ECM is an effective bioscaffold for long-term repair of body wall defects. Unlike the other scaffold materials, the resorbable SIS-ECM scaffold was replaced by well-organized host tissues including differentiated skeletal muscle.
Collapse
Affiliation(s)
- Stephen Badylak
- Department of Biomedical Engineering, Purdue University, West Lafayette, Indiana 47907, USA
| | | | | | | | | |
Collapse
|
38
|
Seifalian AM, Tiwari A, Hamilton G, Salacinski HJ. Improving the clinical patency of prosthetic vascular and coronary bypass grafts: the role of seeding and tissue engineering. Artif Organs 2002; 26:307-20. [PMID: 11952502 DOI: 10.1046/j.1525-1594.2002.06841.x] [Citation(s) in RCA: 173] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
In patients requiring coronary or peripheral vascular bypass procedures, autogenous vein is currently the conduit of choice. If this is unavailable, then a prosthetic material is used. Prosthetic graft is liable to fail due to occlusion of the graft. To prevent graft occlusion, seeding of the graft lumen with endothelial cells is undertaken. Recent advances have also looked at developing a completely artificial biological graft engineered from the patient's cells with properties similar to autogenous vessels. This review encompasses the developments in the two principal technologies used in developing hybrid coronary and peripheral vascular bypass grafts, that is, seeding and tissue engineering.
Collapse
Affiliation(s)
- Alexander M Seifalian
- Tissue Engineering Center, University Department of Surgery, Royal Free and University College Medical School, University College London and The Royal Free Hospital, U.K.
| | | | | | | |
Collapse
|
39
|
Badylak S, Kokini K, Tullius B, Whitson B. Strength over time of a resorbable bioscaffold for body wall repair in a dog model. J Surg Res 2001; 99:282-7. [PMID: 11469898 DOI: 10.1006/jsre.2001.6176] [Citation(s) in RCA: 190] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
The change in strength over time of a biomaterial derived from the small intestinal submucosa (SIS) was determined in a dog model of body wall repair. Full-thickness body wall defects measuring 8 x 12 cm were surgically created and then repaired with a multilaminate eight-layer form of SIS in 40 dogs. Five dogs were sacrificed at each of the following time points: 1 day, 4 days, 7 days, 10 days, and 1, 3, 6, and 24 months. Ball burst tests that measured biaxial ultimate load-bearing capability were performed on the device prior to implantation and on the device/implant site at the time of sacrifice. The strength of the device at the time of implant was approximately 73 +/- 12 pounds. The strength of the implant site diminished to 40 +/- 18 pounds at 10 days, and then progressively increased to a value of 156 +/- 26 pounds at 24 months (P < 0.05). The clinical utility of a degradable biomaterial such as SIS depends on a balance between the rate of degradation and the rate of host remodeling. Naturally occurring extracellular matrix scaffolds such as SIS show rapid degradation with associated and subsequent remodeling to a tissue with strength that exceeds that of the native tissue when used as a body wall repair device.
Collapse
Affiliation(s)
- S Badylak
- Department of Biomedical Engineering, Purdue University, West Lafayette, Indiana 47907, USA.
| | | | | | | |
Collapse
|