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Arabzadeh Bahri R, Peisepar M, Maleki S, Esmaeilpur Abianeh F, A Basti F, Kolahdooz A. Current evidence regarding alternative techniques for enterocystoplasty using regenerative medicine methods: a systematic review. Eur J Med Res 2024; 29:163. [PMID: 38475865 PMCID: PMC10929228 DOI: 10.1186/s40001-024-01757-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Accepted: 02/29/2024] [Indexed: 03/14/2024] Open
Abstract
Enterocystoplasty is the most commonly used treatment for bladder reconstruction. However, it has some major complications. In this study, we systematically reviewed the alternative techniques for enterocystoplasty using different scaffolds. A comprehensive search was conducted in PubMed, Embase, and Cochrane Library, and a total of 10 studies were included in this study. Five different scaffolds were evaluated, including small intestinal submucosa (SIS), biodegradable scaffolds seeded with autologous bladder muscle and urothelial cells, dura mater, human cadaveric bladder acellular matrix graft, and bovine pericardium. The overall results revealed that bladder reconstruction using regenerative medicine is an excellent alternative method to enterocystoplasty regarding the improvement of bladder capacity, bladder compliance, and maximum detrusor pressure; however, more large-scale studies are required.
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Affiliation(s)
- Razman Arabzadeh Bahri
- Urology Research Center, Tehran University of Medical Sciences, Tehran, Iran.
- Universal Scientific Education and Research Network (USERN), Tehran, Iran.
| | - Maral Peisepar
- Universal Scientific Education and Research Network (USERN), Tehran, Iran
- School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Saba Maleki
- School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
| | - Fatemeh Esmaeilpur Abianeh
- Universal Scientific Education and Research Network (USERN), Tehran, Iran
- School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Fatemeh A Basti
- Tehran Medical Branch, Islamic Azad University, Tehran, Iran
| | - Ali Kolahdooz
- Student Research Committee, School of Medicine, Alborz University of Medical Sciences, Karaj, Iran
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Gundogdu G, Nguyen T, Hosseini Sharifi SH, Starek S, Costa K, Jones CE, Barham D, Gelman J, Clayman RV, Mauney JR. Evaluation of silk fibroin-based urinary conduits in a porcine model of urinary diversion. Front Bioeng Biotechnol 2023; 11:1100507. [PMID: 36726743 PMCID: PMC9885082 DOI: 10.3389/fbioe.2023.1100507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Accepted: 01/03/2023] [Indexed: 01/17/2023] Open
Abstract
Background: The primary strategy for urinary diversion in radical cystectomy patients involves incorporation of autologous gastrointestinal conduits into the urinary tract which leads to deleterious consequences including chronic infections and metabolic abnormalities. This report investigates the efficacy of an acellular, tubular bi-layer silk fibroin (BLSF) graft to function as an alternative urinary conduit in a porcine model of urinary diversion. Materials and methods: Unilateral urinary diversion with stented BLSF conduits was executed in five adult female, Yucatan mini-swine over a 3 month period. Longitudinal imaging analyses including ultrasonography, retrograde ureteropyelography and video-endoscopy were carried out monthly. Histological, immunohistochemical (IHC), and histomorphometric assessments were performed on neoconduits at harvest. Results: All animals survived until scheduled euthanasia and displayed moderate hydronephrosis (Grades 1-3) in reconstructed collecting systems over the course of the study period. Stented BLSF constructs supported formation of vascularized, retroperitoneal tubes capable of facilitating external urinary drainage. By 3 months post-operative, neoconduits contained α-smooth muscle actin+ and SM22α+ smooth muscle as well as uroplakin 3A+ and pan-cytokeratin + urothelium. However, the degree of tissue regeneration in neotissues was significantly lower in comparison to ureteral controls as determined by histomorphometry. In addition, neoconduit stenting was necessary to prevent stomal occlusion. Conclusion: BLSF biomaterials represent emerging platforms for urinary conduit construction and may offer a functional replacement for conventional urinary diversion techniques following further optimization of mechanical properties and regenerative responses.
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Affiliation(s)
- Gokhan Gundogdu
- Department of Urology, University of California, Irvine, Orange, CA, United States
| | - Travis Nguyen
- Department of Biomedical Engineering, University of California, Irvine, Irvine, CA, United States
| | | | - Stephanie Starek
- Department of Urology, University of California, Irvine, Orange, CA, United States
| | - Kyle Costa
- Department of Urology, University of California, Irvine, Orange, CA, United States
| | - Clara E. Jones
- Department of Biomedical Engineering, University of California, Irvine, Irvine, CA, United States
| | - David Barham
- Department of Urology, University of California, Irvine, Orange, CA, United States
| | - Joel Gelman
- Department of Urology, University of California, Irvine, Orange, CA, United States
| | - Ralph V. Clayman
- Department of Urology, University of California, Irvine, Orange, CA, United States
| | - Joshua R. Mauney
- Department of Urology, University of California, Irvine, Orange, CA, United States
- Department of Biomedical Engineering, University of California, Irvine, Irvine, CA, United States
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Tissue Engineering and Regenerative Medicine in Pediatric Urology: Urethral and Urinary Bladder Reconstruction. Int J Mol Sci 2022; 23:ijms23126360. [PMID: 35742803 PMCID: PMC9224288 DOI: 10.3390/ijms23126360] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 06/03/2022] [Accepted: 06/05/2022] [Indexed: 11/22/2022] Open
Abstract
In the case of pediatric urology there are several congenital conditions, such as hypospadias and neurogenic bladder, which affect, respectively, the urethra and the urinary bladder. In fact, the gold standard consists of a urethroplasty procedure in the case of urethral malformations and enterocystoplasty in the case of urinary bladder disorders. However, both surgical procedures are associated with severe complications, such as fistulas, urethral strictures, and dehiscence of the repair or recurrence of chordee in the case of urethroplasty, and metabolic disturbances, stone formation, urine leakage, and chronic infections in the case of enterocystoplasty. With the aim of overcoming the issue related to the lack of sufficient and appropriate autologous tissue, increasing attention has been focused on tissue engineering. In this review, both the urethral and the urinary bladder reconstruction strategies were summarized, focusing on pediatric applications and evaluating all the biomaterials tested in both animal models and patients. Particular attention was paid to the capability for tissue regeneration in dependence on the eventual presence of seeded cell and growth factor combinations in several types of scaffolds. Moreover, the main critical features needed for urinary tissue engineering have been highlighted and specifically focused on for pediatric application.
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Wang X, Shi C, Hou X, Song S, Li C, Cao W, Chen W, Li L. Application of biomaterials and tissue engineering in bladder regeneration. J Biomater Appl 2022; 36:1484-1502. [DOI: 10.1177/08853282211048574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The primary functions of the bladder are storing urine under low and stable pressure and micturition. Various forms of trauma, tumors, and iatrogenic injuries can cause the loss of or reduce bladder function or capacity. If such damage is not treated in time, it will eventually lead to kidney damage and can even be life-threatening in severe cases. The emergence of tissue engineering technology has led to the development of more possibilities for bladder repair and reconstruction, in which the selection of scaffolds is crucial. In recent years, a growing number of tissue-engineered bladder scaffolds have been constructed. Therefore, this paper will discuss the development of tissue-engineered bladder scaffolds and will further analyze the limitations of and challenges encountered in bladder reconstruction.
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Affiliation(s)
- Xiaoya Wang
- Department of Human Anatomy, Histology and Embryology, School of Basic Medicine, Qingdao University, Qingdao, Shandong, China
| | - Chunying Shi
- Department of Human Anatomy, Histology and Embryology, School of Basic Medicine, Qingdao University, Qingdao, Shandong, China
| | - Xianglin Hou
- Institute of genetics and developmental biology, Chinese Academy of Sciences, Beijing, China
| | - Siqi Song
- Department of Human Anatomy, Histology and Embryology, School of Basic Medicine, Qingdao University, Qingdao, Shandong, China
| | - Chenglin Li
- Department of Human Anatomy, Histology and Embryology, School of Basic Medicine, Qingdao University, Qingdao, Shandong, China
| | - Wenxuan Cao
- Department of Human Anatomy, Histology and Embryology, School of Basic Medicine, Qingdao University, Qingdao, Shandong, China
| | - Wei Chen
- Department of Urology, Xinqiao Hospital, Army Medical University, Chongqing, China
| | - Ling Li
- Department of Human Anatomy, Histology and Embryology, School of Basic Medicine, Qingdao University, Qingdao, Shandong, China
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Spheroids of Bladder Smooth Muscle Cells for Bladder Tissue Engineering. BIOMED RESEARCH INTERNATIONAL 2021; 2021:9391575. [PMID: 34805410 PMCID: PMC8601859 DOI: 10.1155/2021/9391575] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Accepted: 10/28/2021] [Indexed: 12/02/2022]
Abstract
Cell-based tissue engineering (TE) has been proposed to improve treatment outcomes in end-stage bladder disease, but TE approaches with 2D smooth muscle cell (SMC) culture have so far been unsuccessful. Here, we report the development of primary bladder-derived 3D SMC spheroids that outperform 2D SMC cultures in differentiation, maturation, and extracellular matrix (ECM) production. Bladder SMC spheroids were compared with 2D cultures using live-dead staining, qRT-PCR, immunofluorescence, and immunoblotting to investigate culture conditions, contractile phenotype, and ECM deposition. The SMC spheroids were viable for up to 14 days and differentiated rather than proliferating. Spheroids predominantly expressed the late myogenic differentiation marker MyH11, whereas 2D SMC expressed more of the general SMC differentiation marker α-SMA and less MyH11. Furthermore, the expression of bladder wall-specific ECM proteins in SMC spheroids was markedly higher. This first establishment and analysis of primary bladder SMC spheroids are particularly promising for TE because differentiated SMCs and ECM deposition are a prerequisite to building a functional bladder wall substitute. We were able to confirm that SMC spheroids are promising building blocks for studying detrusor regeneration in detail and may provide improved function and regenerative potential, contributing to taking bladder TE a significant step forward.
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Production and Preparation of Porcine Urinary Bladder Matrix (UBM) for Urinary Bladder Tissue-Engineering Purposes. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2021; 1345:119-128. [PMID: 34582018 DOI: 10.1007/978-3-030-82735-9_10] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/30/2023]
Abstract
Surgical repair for the end stage bladder disease utilises vascularised, autogenous and mucus-secreting gastrointestinal tissue to replace the diseased organ or to augment inadequate bladder tissue. Post-operatively, the compliance of the bowel is often enough to restore the basic shape, structure and function of the urinary bladder; however, lifelong post-operative complications are common. Comorbidities that result from interposition of intestinal tissue are metabolic and/or neuromechanical, and their incidence approaches 100%. The debilitating comorbidities and complications associated with such urological procedures may be mitigated by the availability of alternative, tissue-engineered, animal-derived extracellular matrix (ECM) scaffolds such as porcine urinary bladder matrix (UBM). Porcine UBM is a decellularized biocompatible, biodegradable biomaterial derived from the porcine urinary bladder. This chapter aims to describe the production and preparation techniques for porcine UBM for urinary bladder regenerative purposes.
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A tissue-engineered urinary conduit in a porcine urinary diversion model. Sci Rep 2021; 11:16754. [PMID: 34408168 PMCID: PMC8373918 DOI: 10.1038/s41598-021-94613-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Accepted: 07/01/2021] [Indexed: 12/25/2022] Open
Abstract
The use of an ileal segment is a standard method for urinary diversion after radical cystectomy. Unfortunately, utilization of this method can lead to numerous surgical and metabolic complications. This study aimed to assess the tissue-engineered artificial conduit for urinary diversion in a porcine model. Tissue-engineered tubular polypropylene mesh scaffolds were used for the right ureter incontinent urostomy model. Eighteen male pigs were divided into three equal groups: Group 1 (control ureterocutaneostomy), Group 2 (the right ureter-artificial conduit-skin anastomoses), and Group 3 (4 weeks before urostomy reconstruction, the artificial conduit was implanted between abdomen muscles). Follow-up was 6 months. Computed tomography, ultrasound examination, and pyelogram were used to confirm the patency of created diversions. Morphological and histological analyses were used to evaluate the tissue-engineered urinary diversion. All animals survived the experimental procedures and follow-up. The longest average patency was observed in the 3rd Group (15.8 weeks) compared to the 2nd Group (10 weeks) and the 1st Group (5.8 weeks). The implant's remnants created a retroperitoneal post-inflammation tunnel confirmed by computed tomography and histological evaluation, which constitutes urostomy. The simultaneous urinary diversion using a tissue-engineered scaffold connected directly with the skin is inappropriate for clinical application.
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Adamowicz J, Kloskowski T, Stopel M, Gniadek M, Rasmus M, Balcerczyk D, Buhl M, Gagat M, Antosik P, Grzanka D, Sionkowska A, Drewa T, Pokrywczynska M. The development of marine biomaterial derived from decellularized squid mantle for potential application as tissue engineered urinary conduit. MATERIALS SCIENCE & ENGINEERING. C, MATERIALS FOR BIOLOGICAL APPLICATIONS 2020; 119:111579. [PMID: 33321625 DOI: 10.1016/j.msec.2020.111579] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 08/12/2020] [Accepted: 09/24/2020] [Indexed: 11/26/2022]
Abstract
Tissue engineering is focusing research effort on search for new biomaterials that might be applied to create artificial urinary conduit. Nevertheless, the demanding biomechanical characteristics necessary for proper conduit function is difficult to be replicated. In this study, we are introducing novel marine biomaterial obtained by decellularization of squid mantle derived from Loligo vulgaris. Squid mantles underwent decellularization according to developed dynamic flow two-staged procedure. Efficacy of the method was confirmed by computational dynamic flow analysis. Subsequently Decellularized Squid Mantle (DSM) underwent extensive histological analysis and mechanical evaluation. Based on gained biomechanical data the computational modelling using finite element method was utilized to simulate behavior of DSM used as a urinary conduit. Taking into account potential application in reconstructive urology, the DSM was then evaluated as a scaffold for urothelial and smooth muscle cells derived from porcine urinary bladder. Conducted analysis showed that DSM created favorable environment for cells growth. In addition, due to polarized structure and natural external polysaccharide layer, it protected seeded cells from urine.
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Affiliation(s)
- J Adamowicz
- Chair of Urology, Department of Regenerative Medicine, Collegium Medicum, Nicolaus Copernicus University, Curie-Skłodowskiej 9, 85-094 Bydgoszcz, Poland; Reconstructive Urology Working Group, Young Academic Urologists, European Association of Urology, the Netherlands.
| | - T Kloskowski
- Chair of Urology, Department of Regenerative Medicine, Collegium Medicum, Nicolaus Copernicus University, Curie-Skłodowskiej 9, 85-094 Bydgoszcz, Poland
| | - M Stopel
- Department of Mechanics and Computer Methods, University of Science and Technology, Kaliskiego 7, 85-796 Bydgoszcz, Poland
| | - M Gniadek
- Department of Fundamentals of Machine Design and Biomedical Engineering, University of Science and Technology, Kaliskiego 7, 85-796 Bydgoszcz, Poland
| | - M Rasmus
- Chair of Urology, Department of Regenerative Medicine, Collegium Medicum, Nicolaus Copernicus University, Curie-Skłodowskiej 9, 85-094 Bydgoszcz, Poland
| | - D Balcerczyk
- Chair of Urology, Department of Regenerative Medicine, Collegium Medicum, Nicolaus Copernicus University, Curie-Skłodowskiej 9, 85-094 Bydgoszcz, Poland
| | - M Buhl
- Chair of Urology, Department of Regenerative Medicine, Collegium Medicum, Nicolaus Copernicus University, Curie-Skłodowskiej 9, 85-094 Bydgoszcz, Poland
| | - M Gagat
- Department of Histology and Embryology, Collegium Medicum, Nicolaus Copernicus University, Bydgoszcz Curie-Skłodowskiej 9, 85-094 Bydgoszcz, Poland
| | - P Antosik
- Department of Clinical Pathomorphology, Collegium Medicum, Nicolaus Copernicus University, Bydgoszcz Curie-Skłodowskiej 9, 85-094 Bydgoszcz, Poland
| | - D Grzanka
- Department of Clinical Pathomorphology, Collegium Medicum, Nicolaus Copernicus University, Bydgoszcz Curie-Skłodowskiej 9, 85-094 Bydgoszcz, Poland
| | - A Sionkowska
- Department of Chemistry of Biomaterials and Cosmetics, Nicolaus Copernicus University, Gagarina 11, 87-100 Torun, Poland
| | - T Drewa
- Chair of Urology, Department of Regenerative Medicine, Collegium Medicum, Nicolaus Copernicus University, Curie-Skłodowskiej 9, 85-094 Bydgoszcz, Poland
| | - M Pokrywczynska
- Chair of Urology, Department of Regenerative Medicine, Collegium Medicum, Nicolaus Copernicus University, Curie-Skłodowskiej 9, 85-094 Bydgoszcz, Poland
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Das S, Gordián-Vélez WJ, Ledebur HC, Mourkioti F, Rompolas P, Chen HI, Serruya MD, Cullen DK. Innervation: the missing link for biofabricated tissues and organs. NPJ Regen Med 2020; 5:11. [PMID: 32550009 PMCID: PMC7275031 DOI: 10.1038/s41536-020-0096-1] [Citation(s) in RCA: 51] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Accepted: 04/29/2020] [Indexed: 12/15/2022] Open
Abstract
Innervation plays a pivotal role as a driver of tissue and organ development as well as a means for their functional control and modulation. Therefore, innervation should be carefully considered throughout the process of biofabrication of engineered tissues and organs. Unfortunately, innervation has generally been overlooked in most non-neural tissue engineering applications, in part due to the intrinsic complexity of building organs containing heterogeneous native cell types and structures. To achieve proper innervation of engineered tissues and organs, specific host axon populations typically need to be precisely driven to appropriate location(s) within the construct, often over long distances. As such, neural tissue engineering and/or axon guidance strategies should be a necessary adjunct to most organogenesis endeavors across multiple tissue and organ systems. To address this challenge, our team is actively building axon-based "living scaffolds" that may physically wire in during organ development in bioreactors and/or serve as a substrate to effectively drive targeted long-distance growth and integration of host axons after implantation. This article reviews the neuroanatomy and the role of innervation in the functional regulation of cardiac, skeletal, and smooth muscle tissue and highlights potential strategies to promote innervation of biofabricated engineered muscles, as well as the use of "living scaffolds" in this endeavor for both in vitro and in vivo applications. We assert that innervation should be included as a necessary component for tissue and organ biofabrication, and that strategies to orchestrate host axonal integration are advantageous to ensure proper function, tolerance, assimilation, and bio-regulation with the recipient post-implant.
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Affiliation(s)
- Suradip Das
- Center for Brain Injury & Repair, Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA USA
- Center for Neurotrauma, Neurodegeneration & Restoration, Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, PA USA
| | - Wisberty J. Gordián-Vélez
- Center for Brain Injury & Repair, Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA USA
- Center for Neurotrauma, Neurodegeneration & Restoration, Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, PA USA
- Department of Bioengineering, School of Engineering and Applied Science, University of Pennsylvania, Philadelphia, PA USA
| | | | - Foteini Mourkioti
- Department of Orthopedic Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA USA
- Department of Cell and Developmental Biology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA USA
| | - Panteleimon Rompolas
- Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA USA
| | - H. Isaac Chen
- Center for Brain Injury & Repair, Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA USA
- Center for Neurotrauma, Neurodegeneration & Restoration, Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, PA USA
| | - Mijail D. Serruya
- Center for Neurotrauma, Neurodegeneration & Restoration, Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, PA USA
- Department of Neurology, Thomas Jefferson University, Philadelphia, PA USA
| | - D. Kacy Cullen
- Center for Brain Injury & Repair, Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA USA
- Center for Neurotrauma, Neurodegeneration & Restoration, Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, PA USA
- Department of Bioengineering, School of Engineering and Applied Science, University of Pennsylvania, Philadelphia, PA USA
- Axonova Medical, LLC., Philadelphia, PA USA
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Cho E, Kim YY, Noh K, Ku S. A new possibility in fertility preservation: The artificial ovary. J Tissue Eng Regen Med 2019; 13:1294-1315. [DOI: 10.1002/term.2870] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Revised: 04/02/2019] [Accepted: 04/22/2019] [Indexed: 12/13/2022]
Affiliation(s)
- Eun Cho
- College of MedicineSeoul National University Seoul South Korea
| | - Yoon Young Kim
- College of MedicineSeoul National University Seoul South Korea
- Department of Obstetrics and GynecologySeoul National University Hospital Seoul South Korea
| | - Kevin Noh
- College of Human EcologyCornell University Ithaca New York USA
| | - Seung‐Yup Ku
- College of MedicineSeoul National University Seoul South Korea
- Department of Obstetrics and GynecologySeoul National University Hospital Seoul South Korea
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11
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Horst M, Eberli D, Gobet R, Salemi S. Tissue Engineering in Pediatric Bladder Reconstruction-The Road to Success. Front Pediatr 2019; 7:91. [PMID: 30984717 PMCID: PMC6449422 DOI: 10.3389/fped.2019.00091] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2018] [Accepted: 03/01/2019] [Indexed: 12/20/2022] Open
Abstract
Several congenital disorders can cause end stage bladder disease and possibly renal damage in children. The current gold standard therapy is enterocystoplasty, a bladder augmentation using an intestinal segment. However, the use of bowel tissue is associated with numerous complications such as metabolic disturbance, stone formation, urine leakage, chronic infections, and malignancy. Urinary diversions using engineered bladder tissue would obviate the need for bowel for bladder reconstruction. Despite impressive progress in the field of bladder tissue engineering over the past decades, the successful transfer of the approach into clinical routine still represents a major challenge. In this review, we discuss major achievements and challenges in bladder tissue regeneration with a focus on different strategies to overcome the obstacles and to meet the need for living functional tissue replacements with a good growth potential and a long life span matching the pediatric population.
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Affiliation(s)
- Maya Horst
- Laboratory for Urologic Tissue Engineering and Stem Cell Therapy, Department of Urology, University Hospital, Zurich, Switzerland
- Division of Pediatric Urology, Department of Pediatric Surgery, University Children‘s Hospital, Zurich, Switzerland
| | - Daniel Eberli
- Division of Pediatric Urology, Department of Pediatric Surgery, University Children‘s Hospital, Zurich, Switzerland
| | - Rita Gobet
- Laboratory for Urologic Tissue Engineering and Stem Cell Therapy, Department of Urology, University Hospital, Zurich, Switzerland
| | - Souzan Salemi
- Division of Pediatric Urology, Department of Pediatric Surgery, University Children‘s Hospital, Zurich, Switzerland
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Adamowicz J, Kuffel B, Van Breda SV, Pokrwczynska M, Drewa T. Reconstructive urology and tissue engineering: Converging developmental paths. J Tissue Eng Regen Med 2019; 13:522-533. [DOI: 10.1002/term.2812] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Revised: 10/23/2018] [Accepted: 12/17/2018] [Indexed: 12/12/2022]
Affiliation(s)
- Jan Adamowicz
- Chair of Urology, Department of Regenerative MedicineCollegium Medicum Nicolaus Copernicus University Bydgoszcz Poland
| | - Blazej Kuffel
- Chair of Urology, Department of Regenerative MedicineCollegium Medicum Nicolaus Copernicus University Bydgoszcz Poland
| | | | - Marta Pokrwczynska
- Chair of Urology, Department of Regenerative MedicineCollegium Medicum Nicolaus Copernicus University Bydgoszcz Poland
| | - Tomasz Drewa
- Chair of Urology, Department of Regenerative MedicineCollegium Medicum Nicolaus Copernicus University Bydgoszcz Poland
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13
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Adamowicz J, Van Breda SV, Kloskowski T, Juszczak K, Pokrywczynska M, Drewa T. Constructing artificial urinary conduits: current capabilities and future potential. Expert Rev Med Devices 2018; 16:135-144. [PMID: 30588868 DOI: 10.1080/17434440.2019.1562901] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
INTRODUCTION Intestinal segments are currently used in reconstructive urology to create urinary diversion after cystectomy. Ileal conduit (IC) is the dominant type of urinary diversion. Nevertheless, IC is not an ideal solution as the procedure still requires entero-enterostomy to restore the bowel continuity. This step is a source of relevant complications that might prolong recovery time. Fabrication of artificial urinary conduit is a tempting idea to introduce an alternative form of urinary diversion which might improve cystectomy outcomes. AREAS COVERED The aim of this review is to discuss available research data about artificial urinary conduit and identify major challenges for future studies. EXPERT OPINION Fabrication of artificial urinary conduit is in range of current tissue engineering technology but there are still many challenges to overcome. There is an urgent need for studies to be conducted on large animal models with long follow up to expose the limitation of experimental strategies and to gather data for translational research.
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Affiliation(s)
- Jan Adamowicz
- a Chair of Urology, Department of Regenerative Medicine, Collegium Medicum , Nicolaus Copernicus University , Bydgoszcz , Poland
| | - Shane V Van Breda
- b Department of Biomedicine , University Hospital Basel , Basel , Switzerland
| | - Tomasz Kloskowski
- a Chair of Urology, Department of Regenerative Medicine, Collegium Medicum , Nicolaus Copernicus University , Bydgoszcz , Poland
| | - Kajetan Juszczak
- c Department of Urology , Memorial Rydygier Hospital , Cracow , Poland
| | - Marta Pokrywczynska
- a Chair of Urology, Department of Regenerative Medicine, Collegium Medicum , Nicolaus Copernicus University , Bydgoszcz , Poland
| | - Tomasz Drewa
- a Chair of Urology, Department of Regenerative Medicine, Collegium Medicum , Nicolaus Copernicus University , Bydgoszcz , Poland
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14
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Maj M, Kokocha A, Bajek A, Drewa T. The interplay between adipose-derived stem cells and bladder cancer cells. Sci Rep 2018; 8:15118. [PMID: 30310111 PMCID: PMC6181926 DOI: 10.1038/s41598-018-33397-9] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Accepted: 09/26/2018] [Indexed: 12/13/2022] Open
Abstract
Tissue engineering approaches offer alternative strategies for urinary diversion after radical cystectomy. Possible triggering of cancer recurrence remains, however, a significant concern in the application of stem-cell based therapies for oncological patients. Soluble mediators secreted by stem cells induce tissue remodelling effects, but may also promote cancer cells growth and metastasis. We observed a substantial increase in the concentration of IL-6 and IL-8 in the secretome of adipose-derived stem cells (ASCs) co-cultured with bladder cancer cells. Concentrations of GM-CSF, MCP-1 and RANTES were also elevated. Bioactive molecules produced by ASCs increased the viability of 5637 and HT-1376 cells by respectively 15.4% and 10.4% (p < 0.0001). A trend in reduction of adhesion to ECM components was also noted, even though no differences in β-catenin expression were detected. When HT-1376 cells were co-cultured with ASCs their migration and invasion increased by 24.5% (p < 0.0002) and 18.2% (p < 0.002). Expression of p-ERK1/2 increased in 5637 cells (2.2-fold; p < 0.001) and p-AKT in HB-CLS-1 cells (2.0-fold; p < 0.001). Our results confirm that ASCs crosstalk with bladder cancer cells in vitro what influences their proliferation and invasive properties. Since ASCs tropism to tumour microenvironment is well documented their application towards post-oncologic reconstruction should be approached with caution.
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Affiliation(s)
- Malgorzata Maj
- Chair of Urology, Department of Tissue Engineering, Collegium Medicum, Nicolaus Copernicus University, Karlowicza 24, 85-092, Bydgoszcz, Poland.
| | - Anna Kokocha
- Chair of Urology, Department of Tissue Engineering, Collegium Medicum, Nicolaus Copernicus University, Karlowicza 24, 85-092, Bydgoszcz, Poland
| | - Anna Bajek
- Chair of Urology, Department of Tissue Engineering, Collegium Medicum, Nicolaus Copernicus University, Karlowicza 24, 85-092, Bydgoszcz, Poland
| | - Tomasz Drewa
- Chair of Urology, Department of Tissue Engineering, Collegium Medicum, Nicolaus Copernicus University, Karlowicza 24, 85-092, Bydgoszcz, Poland
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Gasanz C, Raventós C, Morote J. Current status of tissue engineering applied to bladder reconstruction in humans. Actas Urol Esp 2018; 42:435-441. [PMID: 29336836 DOI: 10.1016/j.acuro.2017.11.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2017] [Accepted: 11/10/2017] [Indexed: 12/18/2022]
Abstract
CONTEXT AND OBJECTIVE Bladder reconstruction is performed to replace or expand the bladder. The intestine is used in standard clinical practice for tissue in this procedure. The complications of bladder reconstruction range from those of intestinal resection to those resulting from the continuous contact of urine with tissue not prepared for this contact. In this article, we describe and classify the various biomaterials and cell cultures used in bladder tissue engineering and reviews the studies performed with humans. ACQUISITION OF EVIDENCE We conducted a review of literature published in the PubMed database between 1950 and 2017, following the principles of the PRISM declaration. SYNTHESIS OF THE EVIDENCE Numerous in vitro and animal model studies have been conducted, but only 18 experiments have been performed with humans, with a total of 169 patients. The current evidence suggests that an acellular matrix, a synthetic polymer with urothelial and autologous smooth muscle cells attached in vitro or stem cells would be the most practical approach for experimental bladder reconstruction. CONCLUSIONS Bladder replacement or expansion without using intestinal tissue is still a challenge, despite progress in the manufacture of biomaterials and the development of cell therapy. Well-designed studies with large numbers of patients and long follow-up times are needed to establish an effective clinical translation and standardisation of the check-up functional tests.
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Singh A, Lee D, Jeong H, Yu C, Li J, Fang CH, Sabnekar P, Liu X, Yoshida T, Sopko N, Bivalacqua TJ. Tissue-Engineered Neo-Urinary Conduit from Decellularized Trachea. Tissue Eng Part A 2018; 24:1456-1467. [PMID: 29649957 DOI: 10.1089/ten.tea.2017.0436] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Decellularized tissues have been increasingly popular for constructing scaffolds for tissue engineering applications due to their beneficial biological compositions and mechanical properties. It is therefore natural to consider decellularized trachea for construction of tissue-engineered trachea, as well as other tubular organs. A Neo-Urinary Conduit (NUC) is such a tubular organ that works as a passage for urine removal in bladder cancer patients who need a urinary diversion after their diseased bladder is removed. In this study, we report our findings on the feasibility of using a decellularized trachea for NUC applications. As a NUC scaffold, decellularized trachea provides benefits of having not only naturally occurring biological components but also having sufficient mechanical properties and structural integrity. We, therefore, decellularized rabbit trachea, evaluated its mechanical performance, and investigated its ability to support in vitro growth of human smooth muscle cells (hSMCs) and human urothelial cells (hUCs). The decellularized trachea had appropriate biomechanical properties with ultimate tensile strength of ∼0.34 MPa in longitudinal direction and ∼1.0 MPa in circumferential direction and resisted a radial burst pressure of >155 mm Hg. Cell morphology study by scanning electron microscopy further showed that hUCs grown on decellularized trachea adopted a typical flatten and interconnected network structure in the lumen of the scaffold, while they formed a round spherical shape and did not spread on the outer surfaces. SMCs, on the other hand, spread well throughout the scaffold. The gene expression analysis by real time quantitative polymerase chain reaction (RT-qPCR) and immunofluorescence studies further confirmed scaffold's ability to support long-term growth of hSMCs. Since uroepithelium has been shown to regenerate itself over time in vivo, these findings suggest that it is possible to construct a NUC from decellularized trachea without any preseeding of UCs. In future, we plan to translate decellularized trachea in a preclinical animal model and evaluate its biological performance.
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Affiliation(s)
- Anirudha Singh
- 1 Department of Urology, The James Buchanan Brady Urological Institute , The Johns Hopkins School of Medicine, Baltimore, Maryland
- 2 Department of Chemical and Biomolecular Engineering, Johns Hopkins University , Baltimore, Maryland
- 3 Translational Tissue Engineering Center, Johns Hopkins University , Baltimore, Maryland
| | - David Lee
- 3 Translational Tissue Engineering Center, Johns Hopkins University , Baltimore, Maryland
| | - Harrison Jeong
- 2 Department of Chemical and Biomolecular Engineering, Johns Hopkins University , Baltimore, Maryland
| | - Christine Yu
- 4 Department of Biomedical Engineering, Johns Hopkins University , Baltimore, Maryland
| | - Jiuru Li
- 2 Department of Chemical and Biomolecular Engineering, Johns Hopkins University , Baltimore, Maryland
| | - Chen Hao Fang
- 2 Department of Chemical and Biomolecular Engineering, Johns Hopkins University , Baltimore, Maryland
| | - Praveena Sabnekar
- 1 Department of Urology, The James Buchanan Brady Urological Institute , The Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Xiaopu Liu
- 1 Department of Urology, The James Buchanan Brady Urological Institute , The Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Takahiro Yoshida
- 1 Department of Urology, The James Buchanan Brady Urological Institute , The Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Nikolai Sopko
- 1 Department of Urology, The James Buchanan Brady Urological Institute , The Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Trinity J Bivalacqua
- 1 Department of Urology, The James Buchanan Brady Urological Institute , The Johns Hopkins School of Medicine, Baltimore, Maryland
- 5 Department of Surgery, Johns Hopkins Medical Institutions and Sidney Kimmel Comprehensive Cancer Center (SKCC) , Baltimore, Maryland
- 6 Department of Oncology, Johns Hopkins Medical Institutions and Sidney Kimmel Comprehensive Cancer Center (SKCC) , Baltimore, Maryland
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Biomaterials and Regenerative Medicine in Urology. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2018; 1107:189-198. [DOI: 10.1007/5584_2017_139] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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Urinary Tissue Engineering: Challenges and Opportunities. Sex Med Rev 2017; 6:35-44. [PMID: 29066225 DOI: 10.1016/j.sxmr.2017.08.004] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Revised: 08/09/2017] [Accepted: 08/17/2017] [Indexed: 01/14/2023]
Abstract
INTRODUCTION In this review, we discuss major advancements and common challenges in constructing and regenerating a neo-urinary conduit (NUC). First, we focus on the need for regenerating the urothelium, the hallmark the urine barrier, unique to urinary tissues. Second, we focus on clinically feasible scaffolds based on decellularized matrices and molded collagen that are currently of great research interest. AIM To discuss the major advancements in constructing a tissue-engineered NUC (TE-NUC) and the challenges involved in their successful clinical translation. METHODS A comprehensive search of peer-reviewed literature from PubMed and Google Scholar on subjects related to urothelium regeneration, decellularized tissue matrices, and collagen scaffolds was conducted. MAIN OUTCOME MEASURE We evaluated the main biological and mechanical functions of urinary tissues, the need for TE implants to create a urinary diversion, the reasons for their failures in clinical settings, and the applications of decellularized tissue matrices and collagen-based molded scaffolds in their regeneration. RESULTS It is necessary to create a urine barrier that prevents urine leakage into the stroma that can cause failure of the graft. Despite the regeneration potential of the urothelium, the limited supply of healthy urothelial cells in patients with bladder cancer remains a major challenge. In this context, alternative strategies, such as transdifferentiation of cells into urothelium or engineered scaffolds based on decellularized tissues and molded collagen with robust urine barrier properties, are active areas of research. CONCLUSION There is an immediate need for developing a functional TE-NUC that can improve the quality of life of patients with bladder cancer. It is possible to achieve a TE-NUC by bioengineering an implant that has appropriate biological and mechanical properties to store and transport urine. We anticipate that future advancements in urothelium regeneration and material design will lead us closer to successful neo-urinary tissue constructs. Singh A, Bivalacqua TJ, Sopko N. Urinary Tissue Engineering: Challenges and Opportunities. Sex Med Rev 2018;6:35-44.
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Adamowicz J, Pokrywczynska M, Van Breda SV, Kloskowski T, Drewa T. Concise Review: Tissue Engineering of Urinary Bladder; We Still Have a Long Way to Go? Stem Cells Transl Med 2017; 6:2033-2043. [PMID: 29024555 PMCID: PMC6430044 DOI: 10.1002/sctm.17-0101] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2017] [Accepted: 07/18/2017] [Indexed: 12/18/2022] Open
Abstract
Regenerative medicine is a new branch of medicine based on tissue engineering technology. This rapidly developing field of science offers revolutionary treatment strategy aimed at urinary bladder regeneration. Despite many promising announcements of experimental urinary bladder reconstruction, there has been a lack in commercialization of therapies based on current investigations. This is due to numerous obstacles that are slowly being identified and precisely overcome. The goal of this review is to present the current status of research on urinary bladder regeneration and highlight further challenges that need to be gradually addressed. We put an emphasis on expectations of urologists that are awaiting tissue engineering based solutions in clinical practice. This review also presents a detailed characteristic of obstacles on the road to successful urinary bladder regeneration from urological clinician perspective. A defined interdisciplinary approach might help to accelerate planning transitional research tissue engineering focused on urinary tracts. Stem Cells Translational Medicine 2017;6:2033-2043.
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Affiliation(s)
- Jan Adamowicz
- Chair of Urology, Department of Regenerative Medicine, Collegium Medicum, Nicolaus Copernicus University, Bydgoszcz, Poland
| | - Marta Pokrywczynska
- Chair of Urology, Department of Regenerative Medicine, Collegium Medicum, Nicolaus Copernicus University, Bydgoszcz, Poland
| | | | - Tomasz Kloskowski
- Chair of Urology, Department of Regenerative Medicine, Collegium Medicum, Nicolaus Copernicus University, Bydgoszcz, Poland
| | - Tomasz Drewa
- Chair of Urology, Department of Regenerative Medicine, Collegium Medicum, Nicolaus Copernicus University, Bydgoszcz, Poland
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20
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Davis NF, Cunnane EM, O'Brien FJ, Mulvihill JJ, Walsh MT. Tissue engineered extracellular matrices (ECMs) in urology: Evolution and future directions. Surgeon 2017; 16:55-65. [PMID: 28811169 DOI: 10.1016/j.surge.2017.07.002] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2017] [Accepted: 07/18/2017] [Indexed: 12/21/2022]
Abstract
Autologous gastrointestinal tissue has remained the gold-standard reconstructive biomaterial in urology for >100 years. Mucus-secreting epithelium is associated with lifelong metabolic and neuromechanical complications when implanted into the urinary tract. Therefore, the availability of biocompatible tissue-engineered biomaterials such as extracellular matrix (ECM) scaffolds may provide an attractive alternative for urologists. ECMs are decellularised, biodegradable membranes that have shown promise for repairing defective urinary tract segments in vitro and in vivo by inducing a host-derived tissue remodelling response after implantation. In urology, porcine small intestinal submucosa (SIS) and porcine urinary bladder matrix (UBM) are commonly selected as ECMs for tissue regeneration. Both ECMs support ingrowth of native tissue and differentiation of multi-layered urothelial and smooth muscle cells layers while providing mechanical support in vivo. In their native acellular state, ECM scaffolds can repair small urinary tract defects. Larger urinary tract segments can be repaired when ECMs are manipulated by seeding them with various cell types prior to in vivo implantation. In the present review, we evaluate and summarise the clinical potential of tissue engineered ECMs in reconstructive urology with emphasis on their long-term outcomes in urological clinical trials.
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Affiliation(s)
- N F Davis
- Department of Urology and Transplant Surgery, Beaumont Hospital, Dublin, Ireland.
| | - E M Cunnane
- School of Engineering, Bernal Institute, Health Research Institute, University of Limerick, Limerick, Ireland; Tissue Engineering Research Group, Department of Anatomy, Royal College of Surgeons in Ireland, Dublin 2, Ireland
| | - F J O'Brien
- Tissue Engineering Research Group, Department of Anatomy, Royal College of Surgeons in Ireland, Dublin 2, Ireland
| | - J J Mulvihill
- School of Engineering, Bernal Institute, Health Research Institute, University of Limerick, Limerick, Ireland
| | - M T Walsh
- School of Engineering, Bernal Institute, Health Research Institute, University of Limerick, Limerick, Ireland
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Mukhopadhyay SK, Naskar D, Bhattacharjee P, Mishra A, Kundu SC, Dey S. Silk fibroin-Thelebolan matrix: A promising chemopreventive scaffold for soft tissue cancer. Colloids Surf B Biointerfaces 2017; 155:379-389. [DOI: 10.1016/j.colsurfb.2017.04.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2016] [Revised: 03/20/2017] [Accepted: 04/05/2017] [Indexed: 02/07/2023]
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