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Wang L, Yu M, Yang Y, Lv Y, Xie H, Chen J, Peng X, Peng Z, Zhou L, Wang Y, Huang Y, Chen F. Porous Photocrosslinkable Hydrogel Functionalized with USC Derived Small Extracellular Vesicles for Corpus Spongiosum Repair. Adv Healthc Mater 2024:e2304387. [PMID: 39036844 DOI: 10.1002/adhm.202304387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Revised: 06/21/2024] [Indexed: 07/23/2024]
Abstract
Reconstruction of a full-thickness spongy urethra is difficult because a corpus spongiosum (CS) defect cannot be repaired using self-healing or substitution urethroplasty. Small extracellular vesicles (sEVs) secreted by urine-derived stem cells (USC-sEVs) strongly promote vascular regeneration. In this study, it is aimed to explore whether USC-sEVs promote the repair of CS defects. To prolong the in vivo effects of USC-sEVs, a void-forming photoinduced imine crosslinking hydrogel (vHG) is prepared and mixed with the USC-sEV suspension. vHG encapsulated with USC-sEVs (vHG-sEVs) is used to repair a CS defect with length of 1.5 cm and width of 0.8 cm. The results show that vHG-sEVs promote the regeneration and repair of CS defects. Histological analysis reveals abundant sinusoid-like vascular structures in the vHG-sEV group. Photoacoustic microscopy indicates that blood flow and microvascular structure of the defect area in the vHG-sEV group are similar to those in the normal CS group. This study confirms that the in situ-formed vHG-sEV patch appears to be a valid and promising strategy for repairing CS defects.
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Affiliation(s)
- Lin Wang
- Department of Urology, Shanghai Children's Hospital, School of medicine, Shanghai Jiao Tong University, Shanghai, 200240, China
- Department of Urology, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200233, China
- Shanghai Eastern Institute of Urologic Reconstruction, Shanghai, 200233, China
- Department of Urology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200240, China
| | - Mingming Yu
- Department of Urology, Shanghai Children's Hospital, School of medicine, Shanghai Jiao Tong University, Shanghai, 200240, China
- Department of Ultrasound in Medicine, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200233, China
| | - Yunlong Yang
- Institute of Microsurgery on Extremities, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200233, China
| | - Yiqing Lv
- Department of Urology, Shanghai Children's Hospital, School of medicine, Shanghai Jiao Tong University, Shanghai, 200240, China
| | - Hua Xie
- Department of Urology, Shanghai Children's Hospital, School of medicine, Shanghai Jiao Tong University, Shanghai, 200240, China
| | - Jiasheng Chen
- Department of Urology, Shanghai Children's Hospital, School of medicine, Shanghai Jiao Tong University, Shanghai, 200240, China
| | - Xufeng Peng
- Department of Urology, Shanghai Children's Hospital, School of medicine, Shanghai Jiao Tong University, Shanghai, 200240, China
| | - Zhiwei Peng
- Department of Urology, Shanghai Children's Hospital, School of medicine, Shanghai Jiao Tong University, Shanghai, 200240, China
| | - Lijun Zhou
- Department of Urology, Shanghai Children's Hospital, School of medicine, Shanghai Jiao Tong University, Shanghai, 200240, China
| | - Yang Wang
- Institute of Microsurgery on Extremities, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200233, China
| | - Yichen Huang
- Department of Urology, Shanghai Children's Hospital, School of medicine, Shanghai Jiao Tong University, Shanghai, 200240, China
| | - Fang Chen
- Department of Urology, Shanghai Children's Hospital, School of medicine, Shanghai Jiao Tong University, Shanghai, 200240, China
- Department of Urology, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200233, China
- Shanghai Eastern Institute of Urologic Reconstruction, Shanghai, 200233, China
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2
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Zhang Y, Zhang C, Li Y, Zhou L, Dan N, Min J, Chen Y, Wang Y. Evolution of biomimetic ECM scaffolds from decellularized tissue matrix for tissue engineering: A comprehensive review. Int J Biol Macromol 2023; 246:125672. [PMID: 37406920 DOI: 10.1016/j.ijbiomac.2023.125672] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 06/18/2023] [Accepted: 07/01/2023] [Indexed: 07/07/2023]
Abstract
Tissue engineering is essentially a technique for imitating nature. Natural tissues are made up of three parts: extracellular matrix (ECM), signaling systems, and cells. Therefore, biomimetic ECM scaffold is one of the best candidates for tissue engineering scaffolds. Among the many scaffold materials of biomimetic ECM structure, decellularized ECM scaffolds (dECMs) obtained from natural ECM after acellular treatment stand out because of their inherent natural components and microenvironment. First, an overview of the family of dECMs is provided. The principle, mechanism, advances, and shortfalls of various decellularization technologies, including physical, chemical, and biochemical methods are then critically discussed. Subsequently, a comprehensive review is provided on recent advances in the versatile applications of dECMs including but not limited to decellularized small intestinal submucosa, dermal matrix, amniotic matrix, tendon, vessel, bladder, heart valves. And detailed examples are also drawn from scientific research and practical work. Furthermore, we outline the underlying development directions of dECMs from the perspective that tissue engineering scaffolds play an important role as an important foothold and fulcrum at the intersection of materials and medicine. As scaffolds that have already found diverse applications, dECMs will continue to present both challenges and exciting opportunities for regenerative medicine and tissue engineering.
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Affiliation(s)
- Ying Zhang
- Department of Pharmacy, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Chenyu Zhang
- Department of Pharmacy, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Yuwen Li
- Department of Pharmacy, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Lingyan Zhou
- Department of Pharmacy, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Nianhua Dan
- Key Laboratory of Leather Chemistry and Engineering (Sichuan University), Ministry of Education, Chengdu 610065, China; Research Center of Biomedical Engineering, Sichuan University, Chengdu, Sichuan 610065, China
| | - Jie Min
- Department of Pharmacy, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Yining Chen
- Key Laboratory of Leather Chemistry and Engineering (Sichuan University), Ministry of Education, Chengdu 610065, China; Research Center of Biomedical Engineering, Sichuan University, Chengdu, Sichuan 610065, China.
| | - Yunbing Wang
- National Engineering Research Center for Biomaterials, Sichuan University, 29 Wang Jiang Road, Chengdu 610065, China
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Song L, Deng K, Yuan W, Zhang J, Lin J, Hu X, Huang J, Zhang K, Zhang H, Si J, Li H, Xu T, Fu Q. Anterior substitutional urethroplasty using a biomimetic poly-l-lactide nanofiber membrane: Preclinical and clinical outcomes. Bioeng Transl Med 2022; 7:e10308. [PMID: 36176613 PMCID: PMC9472005 DOI: 10.1002/btm2.10308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Revised: 01/27/2022] [Accepted: 02/08/2022] [Indexed: 11/18/2022] Open
Abstract
The aim of this study is to investigate the feasibility and efficacy of a novel biomimetic poly-l-lactide (PLLA) nanofiber membrane in repairing anterior urethral strictures from both preclinic and clinic. Biomimetic PLLA membrane was fabricated layer by layer according to the structure of human extracellular matrix. Microstructure, tensile strength, and suture retention strength were fully assessed. Before the clinical application, the safety and toxicology test of the biomimetic PLLA membrane was performed in vitro and in experimental animals. The patients underwent urethroplasty used dorsal onlay or lateral onlay technique. Then, they were followed up for 1 month, 3 months, 6 months, and then annually after the surgery. The mechanical experiments showed well property for application. Biomimetic PLLA membrane was safe according to the in vitro and animal studies. Then, a total of 25 patients (mean age 48.96 years) were included in the study from September 2016 to December 2018. After a mean follow-up of 33.56 months, 20 patients successfully treated with biomimetic PLLA membrane. Five patients (2 bulbar and 3 penile) suffered postoperational urethral stricture recurrence. None of infection or urinary fistula or any other adverse events related to the use of biomimetic PLLA membrane were observed during the follow-up period for all patients. The preliminary result confirmed the feasibility and efficacy of the biomimetic PLLA membrane as a novel material for anterior urethral repair. The long-term effects with more patients should be investigated in further studies.
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Affiliation(s)
- Lujie Song
- Department of UrologyShanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai Oriental Institute for Urologic ReconstructionShanghaiChina
| | - Kunxue Deng
- Department of Research and DevelopmentMedprin Regenerative Medical Technologies Co., Ltd.GuangzhouChina
| | - Wei Yuan
- Department of UrologyShanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai Oriental Institute for Urologic ReconstructionShanghaiChina
| | - Jing Zhang
- Department of Research and DevelopmentMedprin Regenerative Medical Technologies Co., Ltd.GuangzhouChina
- East China Institute of Digital Medical EngineeringShangraoChina
| | - Jiahao Lin
- Department of UrologyShanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai Oriental Institute for Urologic ReconstructionShanghaiChina
| | - Xiaoyong Hu
- Department of UrologyShanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai Oriental Institute for Urologic ReconstructionShanghaiChina
| | - Jianwen Huang
- Department of UrologyShanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai Oriental Institute for Urologic ReconstructionShanghaiChina
| | - Kaile Zhang
- Department of UrologyShanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai Oriental Institute for Urologic ReconstructionShanghaiChina
| | - Haitao Zhang
- Department of Research and DevelopmentMedprin Regenerative Medical Technologies Co., Ltd.GuangzhouChina
- East China Institute of Digital Medical EngineeringShangraoChina
| | - Jiemin Si
- Department of UrologyShanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai Oriental Institute for Urologic ReconstructionShanghaiChina
| | - Hongbin Li
- Department of UrologyShanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai Oriental Institute for Urologic ReconstructionShanghaiChina
| | - Tao Xu
- Biomanufacturing Center, Department of Mechanical EngineeringTsinghua UniversityBeijingChina
- Department of Precision Medicine and HealthcareTsinghua‐Berkeley Shenzhen InstituteShenzhenChina
| | - Qiang Fu
- Department of UrologyShanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai Oriental Institute for Urologic ReconstructionShanghaiChina
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Urine-Derived Stem Cells for Epithelial Tissues Reconstruction and Wound Healing. Pharmaceutics 2022; 14:pharmaceutics14081669. [PMID: 36015295 PMCID: PMC9415563 DOI: 10.3390/pharmaceutics14081669] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Revised: 08/09/2022] [Accepted: 08/09/2022] [Indexed: 11/17/2022] Open
Abstract
Epithelial tissue injury can occur on any surface site of the body, particularly in the skin or urethral mucosa tissue, due to trauma, infection, inflammation, and toxic compounds. Both internal and external body epithelial tissue injuries can significantly affect patients’ quality of life, increase healthcare spending, and increase the global economic burden. Transplantation of epithelial tissue grafts is an effective treatment strategy in clinical settings. Autologous bio-engineered epithelia are common clinical skin substitutes that have the specific advantages of avoiding tissue rejection, obviating ethical concerns, reducing the risk of infection, and decreasing scarring compared to donor grafts. However, epithelial cells are often obtained from the individual’s skin and mucosa through invasive methods, which cause further injury or damage. Urine-derived stem cells (USC) of kidney origin, obtained via non-invasive acquisition, possess high stemness properties, self-renewal ability, trophic effects, multipotent differentiation potential, and immunomodulatory ability. These cells show versatile potential for tissue regeneration, with extensive evidence supporting their use in the repair of epidermal and urothelial injuries. We discuss the collection, isolation, culture, characterization, and differentiation of USC. We also discuss the use of USC for cellular therapies as well as the administration of USC-derived paracrine factors for epidermal and urothelial tissue repair. Specifically, we will discuss 3D constructions involving multiple types of USC-loaded hydrogels and USC-seeded scaffolds for use in cosmetic production testing, drug development, and disease modeling. In conclusion, urine-derived stem cells are a readily accessible autologous stem cell source well-suited for developing personalized medical treatments in epithelial tissue regeneration and drug testing.
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Yao X, Zou S, Fan S, Niu Q, Zhang Y. Bioinspired silk fibroin materials: From silk building blocks extraction and reconstruction to advanced biomedical applications. Mater Today Bio 2022; 16:100381. [PMID: 36017107 PMCID: PMC9395666 DOI: 10.1016/j.mtbio.2022.100381] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Revised: 07/22/2022] [Accepted: 07/23/2022] [Indexed: 12/27/2022]
Abstract
Silk fibroin has become a promising biomaterial owing to its remarkable mechanical property, biocompatibility, biodegradability, and sufficient supply. However, it is difficult to directly construct materials with other formats except for yarn, fabric and nonwoven based on natural silk. A promising bioinspired strategy is firstly extracting desired building blocks of silk, then reconstructing them into functional regenerated silk fibroin (RSF) materials with controllable formats and structures. This strategy could give it excellent processability and modifiability, thus well meet the diversified needs in biomedical applications. Recently, to engineer RSF materials with properties similar to or beyond the hierarchical structured natural silk, novel extraction and reconstruction strategies have been developed. In this review, we seek to describe varied building blocks of silk at different levels used in biomedical field and their effective extraction and reconstruction strategies. This review also present recent discoveries and research progresses on how these functional RSF biomaterials used in advanced biomedical applications, especially in the fields of cell-material interactions, soft tissue regeneration, and flexible bioelectronic devices. Finally, potential study and application for future opportunities, and current challenges for these bioinspired strategies and corresponding usage were also comprehensively discussed. In this way, it aims to provide valuable references for the design and modification of novel silk biomaterials, and further promote the high-quality-utilization of silk or other biopolymers.
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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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7
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Abstract
Tissue engineering could play a major role in the setting of urinary diversion. Several conditions cause the functional or anatomic loss of urinary bladder, requiring reconstructive procedures on the urinary tract. Three main approaches are possible: (i) incontinent cutaneous diversion, such as ureterocutaneostomy, colonic or ileal conduit, (ii) continent pouch created using different segments of the gastrointestinal system and a cutaneous stoma, and (iii) orthotopic urinary diversion with an intestinal segment with spherical configuration and anastomosis to the urethra (neobladder, orthotopic bladder substitution). However, urinary diversions are associated with numerous complications, such as mucus production, electrolyte imbalances and increased malignant transformation potential. In this context, tissue engineering would have the fundamental role of creating a suitable material for urinary diversion, avoiding the use of bowel segments, and reducing complications. Materials used for the purpose of urinary substitution are biological in case of acellular tissue matrices and naturally derived materials, or artificial in case of synthetic polymers. However, only limited success has been achieved so far. The aim of this review is to present the ideal properties of a urinary tissue engineered scaffold and to examine the results achieved so far. The most promising studies have been highlighted in order to guide the choice of scaffolds and cells type for further evolutions.
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Tissue engineering: recent advances and review of clinical outcome for urethral strictures. Curr Opin Urol 2021; 31:498-503. [PMID: 34397507 DOI: 10.1097/mou.0000000000000921] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
PURPOSE OF REVIEW Urethrotomy remains the first-line therapy in the treatment of a urethral stricture despite data showing no real chance of a cure after repeated urethrotomies. An anastomotic or an augmentation urethroplasty using oral mucosa can be offered to patients following failed urethrotomy. The potential for a tissue engineered solution as an alternative to native tissue has been explored in recent years and is reviewed in this article. RECENT FINDINGS More than 80 preclinical studies have investigated a tissue-engineered approach for urethral reconstruction mostly using decellularized natural scaffolds derived from natural extracellular matrix with or without cell seeding. The animal models used in preclinical testing are not representative of disease processes seen with strictures in man. The available clinical studies are based on small noncontrolled series. SUMMARY There is a potential role for tissue engineering to provide a material for substitution urethroplasty and work has demonstrated this. Further work will require a rigorous basic science programme and adequate evaluation of the material prior to its introduction into clinical practice. The research with tissue engineering applied to the urethra has not yet been resulted in a widely available material for clinical use that approaches the efficacy seen with the use of autologous grafts.
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Amesty MV, Chamorro CI, López-Pereira P, Martínez-Urrutia MJ, Sanz B, Rivas S, Lobato R, Fossum M. Creation of Tissue-Engineered Urethras for Large Urethral Defect Repair in a Rabbit Experimental Model. Front Pediatr 2021; 9:691131. [PMID: 34239850 PMCID: PMC8258112 DOI: 10.3389/fped.2021.691131] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Accepted: 05/12/2021] [Indexed: 11/26/2022] Open
Abstract
Introduction: Tissue engineering is a potential source of urethral substitutes to treat severe urethral defects. Our aim was to create tissue-engineered urethras by harvesting autologous cells obtained by bladder washes and then using these cells to create a neourethra in a chronic large urethral defect in a rabbit model. Methods: A large urethral defect was first created in male New Zealand rabbits by resecting an elliptic defect (70 mm2) in the ventral penile urethra and then letting it settle down as a chronic defect for 5-6 weeks. Urothelial cells were harvested noninvasively by washing the bladder with saline and isolating urothelial cells. Neourethras were created by seeding urothelial cells on a commercially available decellularized intestinal submucosa matrix (Biodesign® Cook-Biotech®). Twenty-two rabbits were divided into three groups. Group-A (n = 2) is a control group (urethral defect unrepaired). Group-B (n = 10) and group-C (n = 10) underwent on-lay urethroplasty, with unseeded matrix (group-B) and urothelial cell-seeded matrix (group-C). Macroscopic appearance, radiology, and histology were assessed. Results: The chronic large urethral defect model was successfully created. Stratified urothelial cultures attached to the matrix were obtained. All group-A rabbits kept the urethral defect size unchanged (70 ± 2.5 mm2). All group-B rabbits presented urethroplasty dehiscence, with a median defect of 61 mm2 (range 34-70). In group-C, five presented complete correction and five almost total correction with fistula, with a median defect of 0.3 mm2 (range 0-12.5), demonstrating a significant better result (p = 7.85 × 10-5). Urethrography showed more fistulas in group-B (10/10, versus 5/10 in group-C) (p = 0.04). No strictures were found in any of the groups. Group-B histology identified the absence of ventral urethra in unrepaired areas, with squamous cell metaplasia in the edges toward the defect. In group-C repaired areas, ventral multilayer urothelium was identified with cells staining for urothelial cell marker cytokeratin-7. Conclusions: The importance of this study is that we used a chronic large urethral defect animal model and clearly found that cell-seeded transplants were superior to nonseeded. In addition, bladder washing was a feasible method for harvesting viable autologous cells in a noninvasive way. There is a place for considering tissue-engineered transplants in the surgical armamentarium for treating complex urethral defects and hypospadias cases.
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Affiliation(s)
| | - Clara Ibel Chamorro
- Department of Women's and Children's Health, Bioclinicum J10:20, Karolinska Institutet, Stockholm, Sweden
| | - Pedro López-Pereira
- Department of Pediatric Urology, Hospital Universitario La Paz, Madrid, Spain
| | | | - Beatriz Sanz
- Department of Cell Culture, IdiPAZ Instituto de Investigación Hospital Universitario La Paz, Madrid, Spain
| | - Susana Rivas
- Department of Pediatric Urology, Hospital Universitario La Paz, Madrid, Spain
| | - Roberto Lobato
- Department of Pediatric Urology, Hospital Universitario La Paz, Madrid, Spain
| | - Magdalena Fossum
- Department of Women's and Children's Health, Bioclinicum J10:20, Karolinska Institutet, Stockholm, Sweden.,Division of Pediatric Surgery, Department of Surgical Gastroenterology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark.,Department of Health Sciences, Copenhagen University, Copenhagen, Denmark
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10
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Wang L, Yu M, Peng X, Wang Y, Chen F. Assessing the potential regeneration ability of corpus spongiosum in rabbit models. Andrologia 2020; 53:e13901. [PMID: 33141934 DOI: 10.1111/and.13901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 09/30/2020] [Accepted: 10/19/2020] [Indexed: 11/30/2022] Open
Abstract
Most congenital or acquired urethral diseases are usually accompanied by corpus spongiosum (CS) defects. However, Substitution urethroplasty can only reconstruct urethral lumen, not the CS. Many long-term complications occur due to the lack of protection from CS. Is CS a kind of tissue that cannot be repaired by regeneration and self-healing? In this study, the CS defect with urethral mucosa intact model was established in rabbits by removing the ventral CS tissue. Based on this model, three groups of different CS defect sizes, with lengths of 0.5 cm (Group A), 1.0 cm (Group B) and 1.5 cm (Group C), were then constructed, respectively, to assess the potential regeneration ability of CS. Three months later, the entire urethra, including the CS defect, was assessed by histological staining. Results showed that the vascular sinusoids were completely removed from urethral mucosa. The rabbit model of CS defect was established successfully. Three months post-operatively, the CS defects in all the 3 groups were replaced by disordered collagen instead of regenerating typical sinusoid-like vascular structure, which is significantly different from the normal CS rich in vascular sinusoids. The CS defects could not be repaired through self-healing. The potential regeneration ability of CS is extremely poor.
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Affiliation(s)
- Lin Wang
- Department of Urology, Shanghai Children's Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Mingming Yu
- Department of Urology, Shanghai Children's Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Xufeng Peng
- Department of Urology, Shanghai Children's Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Yang Wang
- Institute of Microsurgery on Extremities, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Fang Chen
- Department of Urology, Shanghai Children's Hospital, Shanghai Jiao Tong University, Shanghai, China.,Department of Urology, Shanghai Jiaotong University Affiliated Sixth People's Hospital, Shanghai, China.,Shanghai Eastern Institute of Urologic Reconstruction, Shanghai, China
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11
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Guo HL, Jia ZM, Wang L, Bao XQ, Huang YC, Zhou JM, Xie H, Yang XJ, Chen F. Tubularized urethral reconstruction using a prevascularized capsular tissue prelaminated with buccal mucosa graft in a rabbit model. Asian J Androl 2020; 21:381-386. [PMID: 31267985 PMCID: PMC6628739 DOI: 10.4103/aja.aja_43_19] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Tubularized graft urethroplasty fails largely because of inadequate graft take. Prefabrication of buccal mucosa lined flap has theoretical indications for constructing neourethra with an independent blood supply. The efficacy of using a tissue expander capsule as an induced vascular bed to prefabricate an axial vascularized buccal mucosa-lined flap for tubularized urethral reconstruction in a rabbit model was tested. The experiments were performed in three stages. First, silicone tissue expanders were inserted into the groin to induce vascularized capsule pouch formation. Next, buccal mucosa grafts were transplanted to the newly formed capsular tissue supplied by the axial vessel for buccal mucosa-lined flap prefabrication. Then, circumferential urethral defects were created and repaired by buccal mucosa graft (Group 1), capsule flap (Group 2) and prefabricated capsule buccal mucosa composite flap (Group 3). With retrograde urethrography, no rabbits in Group 1 maintained a wide urethral caliber. In Group 2, the discontinued epithelial layer regenerated at 1 month, and the constructed neourethra narrowed even though the lumen surface formed intact urothelial cells at 3 months. In Group 3, buccal mucosa formed the lining in the neourethra and kept a wide urethral caliber for 3 months. The capsule may serve as an induced vascular bed for buccal mucosa-lined flap prefabrication. The prefabricated buccal mucosa-lined flap may serve as a neourethra flap for circumferential urethral replacement.
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Affiliation(s)
- Hai-Lin Guo
- Department of Urology, Shanghai Children's Hospital, Shanghai Jiao Tong University, Shanghai 200062, China.,Department of Urology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai 200233, China.,Shanghai Eastern Urological Reconstruction and Repair Institute, Shanghai 200233, China
| | - Zhi-Ming Jia
- Department of Urology, Shanghai Children's Hospital, Shanghai Jiao Tong University, Shanghai 200062, China
| | - Lin Wang
- Department of Urology, Shanghai Children's Hospital, Shanghai Jiao Tong University, Shanghai 200062, China.,Department of Urology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai 200233, China.,Shanghai Eastern Urological Reconstruction and Repair Institute, Shanghai 200233, China
| | - Xing-Qi Bao
- Department of Urology, Shanghai Children's Hospital, Shanghai Jiao Tong University, Shanghai 200062, China
| | - Yi-Chen Huang
- Department of Urology, Shanghai Children's Hospital, Shanghai Jiao Tong University, Shanghai 200062, China
| | - Jun-Mei Zhou
- Central Laboratory, Shanghai Children's Hospital, Shanghai Jiao Tong University, Shanghai 200062, China
| | - Hua Xie
- Department of Urology, Shanghai Children's Hospital, Shanghai Jiao Tong University, Shanghai 200062, China
| | - Xiu-Jun Yang
- Department of Radiology, Shanghai Children's Hospital, Shanghai Jiao Tong University, Shanghai 200062, China
| | - Fang Chen
- Department of Urology, Shanghai Children's Hospital, Shanghai Jiao Tong University, Shanghai 200062, China.,Department of Urology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai 200233, China.,Shanghai Eastern Urological Reconstruction and Repair Institute, Shanghai 200233, China
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Liu Y, Huang L, Yuan W, Zhang D, Gu Y, Huang J, Murphy S, Ali M, Zhang Y, Song L. Sustained release of stromal cell-derived factor-1 alpha from silk fibroin microfiber promotes urethral reconstruction in rabbits. J Biomed Mater Res A 2020; 108:1760-1773. [PMID: 32276293 DOI: 10.1002/jbm.a.36943] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Revised: 03/10/2020] [Accepted: 03/18/2020] [Indexed: 12/18/2022]
Abstract
We developed a stromal cell-derived factor-1 alpha (SDF-1α)-aligned silk fibroin (SF)/three-dimensional porous bladder acellular matrix graft (3D-BAMG) composite scaffold for long-section ventral urethral regeneration and repair in vivo. SDF-1α-aligned SF microfiber/3D-BAMG, aligned SF microfiber/3D-BAMG, and nonaligned SF microfiber/3D-BAMG scaffolds were prepared using electrostatic spinning and wet processing. Adipose-derived stem cell (ADSC) and bone marrow stromal cell (BMSC) migration was assessed in the SDF-1α-loaded scaffolds. Sustained SDF-1α release in vitro and vivo was analyzed using enzyme-linked immunosorbent assay (ELISA) and western blotting, respectively. The scaffolds were used to repair a 1.5 × 1 cm2 ventral urethral defect in male rabbits in vivo. General observation and retrograde urinary tract contrast assessment were used to examine urethral lumen patency and continuity at 1 and 3 months post-surgery. Postoperative rehabilitation was evaluated using histological detection. The composite scaffolds sustained SDF-1α release for over 16 days in vitro. SDF-1α-aligned SF nanofiber promoted regeneration of urethral mucosa, submucosal smooth muscles, and microvasculature, increased cellular proliferation, and reduced collagen deposition. SDF-1α expression was increased in reconstructed urethra at 3 months post-surgery in SDF-1α-aligned SF group. SDF-1α-aligned SF microfiber/3D-BAMG scaffolds may be used to repair and reconstruct long urethral defects because they accelerate urethral regeneration.
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Affiliation(s)
- Yang Liu
- Department of Urology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China.,Shanghai Eastern Institute of Urologic Reconstruction, Shanghai, China.,Department of Urology, Weifang People's Hospital, Weifang Medical University, Weifang, Shandong, China
| | - Li Huang
- State Key Laboratory for Modification of Chemical Fibers and Polymer Materials, College of Materials Science and Engineering, Donghua University, Shanghai, China
| | - Wei Yuan
- Department of Urology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China.,Shanghai Eastern Institute of Urologic Reconstruction, Shanghai, China.,Department of Urology, Weifang People's Hospital, Weifang Medical University, Weifang, Shandong, China.,State Key Laboratory for Modification of Chemical Fibers and Polymer Materials, College of Materials Science and Engineering, Donghua University, Shanghai, China
| | - Dongliang Zhang
- Department of Urology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Yubo Gu
- Department of Urology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Jianwen Huang
- Department of Urology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Sean Murphy
- Wake Forest Institute for Regenerative Medicine, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, North Carolina
| | - Mohamed Ali
- Wake Forest Institute for Regenerative Medicine, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, North Carolina.,Department of Chemistry, Faculty of Science, Zagazig University, Zagazig, Egypt
| | - Yaopeng Zhang
- State Key Laboratory for Modification of Chemical Fibers and Polymer Materials, College of Materials Science and Engineering, Donghua University, Shanghai, China
| | - Lujie Song
- Department of Urology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
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The Fabrication and Evaluation of a Potential Biomaterial Produced with Stem Cell Sheet Technology for Future Regenerative Medicine. Stem Cells Int 2020; 2020:9567362. [PMID: 32104186 PMCID: PMC7035578 DOI: 10.1155/2020/9567362] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2019] [Revised: 11/04/2019] [Accepted: 11/29/2019] [Indexed: 12/17/2022] Open
Abstract
To date, the decellularized scaffold has been widely explored as a source of biological scaffolds for regenerative medicine. However, the acellular matrix derived from natural tissues and organs has a lot of defects, including the limited amount of autogenous tissue and surgical complication such as risk of blood loss, wound infection, pain, shock, and functional damage in the donor part of the body. In this study, we prepared acellular matrix using adipose-derived stem cell (ADSC) sheets and evaluate the cellular compatibility and immunoreactivity. The ADSC sheets were fabricated and subsequently decellularized using repeated freeze-thaw, Triton X-100 and SDS decellularization. Oral mucosal epithelial cells were seeded onto the decellularized ADSC sheets to evaluate the cell replantation ability, and silk fibroin was used as the control. Then, acellular matrix was transplanted onto subcutaneous tissue for 1 week or 3 weeks; H&E staining and immunohistochemical analysis of CD68 expression and quantitative real-time PCR (qPCR) were performed to evaluate the immunogenicity and biocompatibility. The ADSC sheet-derived ECM scaffolds preserved the three-dimensional architecture of ECM and retained the cytokines by Triton X-100 decellularization protocols. Compared with silk fibroin in vitro, the oral mucosal epithelial cells survived better on the decellularized ADSC sheets with an intact and consecutive epidermal cellular layer. Compared with porcine small intestinal submucosa (SIS) in vivo, the homogeneous decellularized ADSC sheets had less monocyte-macrophage infiltrating in vivo implantation. During 3 weeks after transplantation, the mRNA expression of cytokines, such as IL-4/IL-10, was obviously higher in decellularized ADSC sheets than that of porcine SIS. A Triton X-100 method can achieve effective cell removal, retain major ECM components, and preserve the ultrastructure of ADSC sheets. The decellularized ADSC sheets possess good recellularization capacity and excellent biocompatibility. This study demonstrated the potential suitability of utilizing acellular matrix from ADSC sheets for soft tissue regeneration and repair.
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Pederzoli F, Joice G, Salonia A, Bivalacqua TJ, Sopko NA. Regenerative and engineered options for urethroplasty. Nat Rev Urol 2019; 16:453-464. [PMID: 31171866 DOI: 10.1038/s41585-019-0198-y] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/04/2019] [Indexed: 02/07/2023]
Abstract
Surgical correction of urethral strictures by substitution urethroplasty - the use of grafts or flaps to correct the urethral narrowing - remains one of the most challenging procedures in urology and is frequently associated with complications, restenosis and poor quality of life for the affected individual. Tissue engineering using different cell types and tissue scaffolds offers a promising alternative for tissue repair and replacement. The past 30 years of tissue engineering has resulted in the development of several therapies that are now in use in the clinic, especially in treating cutaneous, bone and cartilage defects. Advances in tissue engineering for urethral replacement have resulted in several clinical applications that have shown promise but have not yet become the standard of care.
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Affiliation(s)
- Filippo Pederzoli
- Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy
- Department of Urology, James Buchanan Brady Urological Institute, Johns Hopkins Medical Institutions, Baltimore, MD, USA
- Università Vita-Salute San Raffaele, Milan, Italy
| | - Gregory Joice
- Department of Urology, James Buchanan Brady Urological Institute, Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | - Andrea Salonia
- Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy
- Università Vita-Salute San Raffaele, Milan, Italy
| | - Trinity J Bivalacqua
- Department of Urology, James Buchanan Brady Urological Institute, Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | - Nikolai A Sopko
- Department of Urology, James Buchanan Brady Urological Institute, Johns Hopkins Medical Institutions, Baltimore, MD, USA.
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15
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Tissue engineering of the urethra: where are we in 2019? World J Urol 2019; 38:2101-2105. [PMID: 31190151 PMCID: PMC7423849 DOI: 10.1007/s00345-019-02826-3] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Accepted: 05/27/2019] [Indexed: 01/04/2023] Open
Abstract
Purpose The purpose of this review is to assess the potential role of tissue engineering for urethral reconstruction. It is well- recognised that urethrotomy remains the first-line therapy in the treatment of urethral stricture. Following on from the randomised study which recommended no difference between urethrotomy and urethral dilation, Steenkamp et al. reported long-term success rates of only 20%. Patients with longer strictures, penile or distal urethral strictures, and extensive periurethral spongiofibrosis typically do not respond well to repeated incisions. This report reviews the potential role of tissue engineering as applied to augmentation urethroplasty, which is the treatment of choice following failed urethrotomy. Methods A review of the literature was carried out. The principal emphasis was on tissue engineering as applied to augmentation urethroplasty, but an introductory section reviews the use of urethrotomy and the background to contemporary practise with augmentation urethroplasty using oral mucosa. Results It is evident that a cellular matrix which requires the ingrowth of cells is unlikely to be successful except for very short strictures. Other approaches such as injection of stem cells have not been adequately trialled in humans to date. Tissue-engineered substitute for autologous oral mucosa has been used and the results relating to this are reviewed. Conclusions Tissue engineering of autologous tissue for urethroplasty is expensive. It is unnecessary for the majority of cases, but could be potentially useful for very lengthy strictures, for instance, relating to lichen sclerosis. Whilst tissue-engineered oral mucosa has been successfully used, a great deal more work would be necessary to develop an appropriate matrix. Another study has looked at a larger series using an alternative tissue-engineered substitute, but the results have been very disappointing. At present, it has to be concluded that there is no effective and validated tissue engineering solution for the management of urethral stricture disease.
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Abbas TO, Yalcin HC, Pennisi CP. From Acellular Matrices to Smart Polymers: Degradable Scaffolds that are Transforming the Shape of Urethral Tissue Engineering. Int J Mol Sci 2019; 20:E1763. [PMID: 30974769 PMCID: PMC6479944 DOI: 10.3390/ijms20071763] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Revised: 03/29/2019] [Accepted: 04/02/2019] [Indexed: 12/24/2022] Open
Abstract
Several congenital and acquired conditions may result in severe narrowing of the urethra in men, which represent an ongoing surgical challenge and a significant burden on both health and quality of life. In the field of urethral reconstruction, tissue engineering has emerged as a promising alternative to overcome some of the limitations associated with autologous tissue grafts. In this direction, preclinical as well as clinical studies, have shown that degradable scaffolds are able to restore the normal urethral architecture, supporting neo-vascularization and stratification of the tissue. While a wide variety of degradable biomaterials are under scrutiny, such as decellularized matrices, natural, and synthetic polymers, the search for scaffold materials that could fulfill the clinical performance requirements continues. In this article, we discuss the design requirements of the scaffold that appear to be crucial to better resemble the structural, physical, and biological properties of the native urethra and are expected to support an adequate recovery of the urethral function. In this context, we review the biological performance of the degradable polymers currently applied for urethral reconstruction and outline the perspectives on novel functional polymers, which could find application in the design of customized urethral constructs.
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Affiliation(s)
- Tariq O Abbas
- Laboratory for Stem Cell Research, Department of Health Science and Technology, Aalborg University, 9220 Aalborg, Denmark.
- Pediatric Surgery Department, Hamad General Hospital, 3050 Doha, Qatar.
- College of Medicine, Qatar University, 2713 Doha, Qatar.
- Surgery Department, Weill Cornell Medicine⁻Qatar, 24144 Doha, Qatar.
| | | | - Cristian P Pennisi
- Laboratory for Stem Cell Research, Department of Health Science and Technology, Aalborg University, 9220 Aalborg, Denmark.
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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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Liu W, Cao N, Fan S, Zhang H, Shao H, Song L, Cao C, Huang J, Zhang Y. Angiogenesis Potential of Bladder Acellular Matrix Hydrogel by Compounding Endothelial Cells. ACS APPLIED BIO MATERIALS 2019; 2:1158-1167. [DOI: 10.1021/acsabm.8b00760] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
- Wenjing Liu
- State Key Laboratory for Modification of Chemical Fibers and Polymer Materials, International Joint Laboratory for Advanced Fiber and Low-Dimension Materials, College of Materials Science and Engineering, Donghua University, Shanghai 201620, P. R. China
| | - Nailong Cao
- Department of Urology, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai 200233, P. R. China
| | - Suna Fan
- State Key Laboratory for Modification of Chemical Fibers and Polymer Materials, International Joint Laboratory for Advanced Fiber and Low-Dimension Materials, College of Materials Science and Engineering, Donghua University, Shanghai 201620, P. R. China
| | - Huihui Zhang
- State Key Laboratory for Modification of Chemical Fibers and Polymer Materials, International Joint Laboratory for Advanced Fiber and Low-Dimension Materials, College of Materials Science and Engineering, Donghua University, Shanghai 201620, P. R. China
| | - Huili Shao
- State Key Laboratory for Modification of Chemical Fibers and Polymer Materials, International Joint Laboratory for Advanced Fiber and Low-Dimension Materials, College of Materials Science and Engineering, Donghua University, Shanghai 201620, P. R. China
| | - Lujie Song
- Department of Urology, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai 200233, P. R. China
- Shanghai Eastern
Institute of Urologic Reconstruction, Shanghai 200233, P. R. China
| | - Chengbo Cao
- School of Chemistry and Chemical Engineering, Shandong University, Jinan 250100, P. R. China
- School of Chemistry and Chemical Engineering, YanTai University, YanTai 264005, P. R. China
| | - Jianwen Huang
- Department of Urology, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai 200233, P. R. China
- Shanghai Eastern
Institute of Urologic Reconstruction, Shanghai 200233, P. R. China
| | - Yaopeng Zhang
- State Key Laboratory for Modification of Chemical Fibers and Polymer Materials, International Joint Laboratory for Advanced Fiber and Low-Dimension Materials, College of Materials Science and Engineering, Donghua University, Shanghai 201620, P. R. China
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Pearlman AM, Mujumdar V, McAbee KE, Terlecki RP. Outcomes of adult urethroplasty with commercially available acellular matrix. Ther Adv Urol 2018; 10:351-355. [PMID: 30344647 DOI: 10.1177/1756287218790370] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2018] [Accepted: 06/22/2018] [Indexed: 11/16/2022] Open
Abstract
Background Reconstruction for complex urethral strictures may necessitate grafting. Buccal mucosal graft (BMG) harvest involves additional morbidity, making 'off-the-shelf' options attractive. Multiple extracellular matrices (ECMs) have been used with varying degrees of success. We reviewed our experience with MatriStem (ACell, Inc., Columbia, MD, USA) to assess safety and clinical/histologic outcomes. Methods All patients undergoing acellular matrix-based reconstruction were included. Data regarding indications for surgery, patient demographics, subsequent procedures, clinical outcomes, and histologic analysis, when present, were collected. Results Eight patients undergoing urethral reconstruction with ECM were identified. All repairs were performed as staged procedures. Grafting was performed with either MatriStem alone or MatriStem and concomitant BMG. Seven patients (88%) underwent prior endoscopic intervention and five patients (71%) had failed to respond to one or multiple prior urethroplasties. Length of involved segments ranged from 2.5 to 15 cm. ECM graft placement was feasible and demonstrated excellent graft take. Among patients undergoing second-stage repairs (four of eight, 50%), 50% remained patent without the need for subsequent dilation. Conclusions Use of acellular matrix grafts in urethral reconstruction appears safe and feasible. Acellular matrix performs similarly to BMG with respect to graft take and contraction following staged repair. Further study is warranted.
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Affiliation(s)
- Amy Marcia Pearlman
- Urology, Wake Forest Baptist Medical Center, Medical Center Boulevard, Winston-Salem, NC 27157-0001, USA
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20
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Schäfer FM, Stehr M. Tissue engineering in pediatric urology - a critical appraisal. Innov Surg Sci 2018; 3:107-118. [PMID: 31579774 PMCID: PMC6604568 DOI: 10.1515/iss-2018-0011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Accepted: 04/17/2018] [Indexed: 01/01/2023] Open
Abstract
Tissue engineering is defined as the combination of biomaterials and bioengineering principles together with cell transplantation or directed growth of host cells to develop a biological replacement tissue or organ that can be a substitute for normal tissue both in structure and function. Despite early promising preclinical studies, clinical translation of tissue engineering in pediatric urology into humans has been unsuccessful both for cell-seeded and acellular scaffolds. This can be ascribed to various factors, including the use of only non-diseased models that inaccurately describe the structural and functional modifications of diseased tissue. The paper addresses potential future strategies to overcome the limitations experienced in clinical applications so far. This includes the use of stem cells of various origins (mesenchymal stem cells, hematopoietic stem/progenitor cells, urine-derived stem cells, and progenitor cells of the urothelium) as well as the need for a deeper understanding of signaling pathways and directing tissue ingrowth and differentiation through the concept of dynamic reciprocity. The development of smart scaffolds that release trophic factors in a set and timely manner will probably improve regeneration. Modulation of innate immune response as a major contributor to tissue regeneration outcome is also addressed. It is unlikely that only one of these strategies alone will lead to clinically applicable tissue engineering strategies in pediatric urology. In the meanwhile, the fundamental new insights into regenerative processes already obtained in the attempts of tissue engineering of the lower urogenital tract remain our greatest gain.
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Affiliation(s)
- Frank-Mattias Schäfer
- Department of Pediatric Surgery and Pediatric Urology, Cnopfsche Kinderklinik, Nürnberg, Germany
| | - Maximilian Stehr
- Department of Pediatric Surgery and Pediatric Urology, Cnopfsche Kinderklinik, Nürnberg, Germany
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Lv X, Feng C, Liu Y, Peng X, Chen S, Xiao D, Wang H, Li Z, Xu Y, Lu M. A smart bilayered scaffold supporting keratinocytes and muscle cells in micro/nano-scale for urethral reconstruction. Am J Cancer Res 2018; 8:3153-3163. [PMID: 29896309 PMCID: PMC5996367 DOI: 10.7150/thno.22080] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2017] [Accepted: 01/30/2018] [Indexed: 11/05/2022] Open
Abstract
Rationale: In urethral tissue engineering, the currently available reconstructive procedures are insufficient due to a lack of appropriate scaffolds that would support the needs of various cell types. To address this problem, we developed a bilayer scaffold comprising a microporous network of silk fibroin (SF) and a nanoporous bacterial cellulose (BC) scaffold and evaluated its feasibility and potential for long-segment urethral regeneration in a dog model. Methods: The freeze-drying and self-assembling method was used to fabricate the bilayer scaffold by stationary cultivation G. xylinus using SF scaffold as a template. The surface morphology, porosity and mechanical properties of all prepared SF-BC scaffolds were characterized using Scanning electron microscopy (SEM), microcomputed tomography and universal testing machine. To further investigate the suitability of the bilayer scaffolds for tissue engineering applications, biocompatibility was assessed using an MTT assay. The cell distribution, viability and morphology were evaluated by seeding epithelial cells and muscle cells on the scaffolds, using the 3D laser scanning confocal microscopy, and SEM. The effects of urethral reconstruction with SF-BC bilayer scaffold was evaluated in dog urethral defect models. Results: Scanning electron microscopy revealed that SF-BC scaffold had a clear bilayer structure. The SF-BC bilayer scaffold is highly porous with a porosity of 85%. The average pore diameter of the porous layer in the bilayer SF-BC composites was 210.2±117.8 μm. Cultures established with lingual keratinocytes and lingual muscle cells confirmed the suitability of the SF-BC structures to support cell adhesion and proliferation. In addition, SEM demonstrated the ability of cells to attach to scaffold surfaces and the biocompatibility of the matrices with cells. At 3 months after implantation, urethra reconstructed with the SF-BC scaffold seeded with keratinocytes and muscle cells displayed superior structure compared to those with only SF-BC scaffold. Principal Conclusion: These results demonstrate that the bilayer SF-BC scaffold may be a promising biomaterial with good biocompatibility for urethral regeneration and could be used for numerous other types of hollow-organ tissue engineering grafts, including vascular, bladder, ureteral, bowel, and intestinal.
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Repair of injured urethras with silk fibroin scaffolds in a rabbit model of onlay urethroplasty. J Surg Res 2018; 229:192-199. [PMID: 29936989 DOI: 10.1016/j.jss.2018.04.006] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Revised: 02/19/2018] [Accepted: 04/03/2018] [Indexed: 11/21/2022]
Abstract
BACKGROUND Preclinical validation of scaffold-based technologies in animal models of urethral disease is desired to assess wound healing efficacy in scenarios that mimic the target patient population. This study investigates the feasibility of bilayer silk fibroin (BLSF) scaffolds for the repair of previously damaged urethras in a rabbit model of onlay urethroplasty. MATERIALS AND METHODS A focal, partial thickness urethral injury was created in adult male rabbits (n = 12) via electrocoagulation and then onlay urethroplasty with 50 mm2 BLSF grafts was carried out 2 wk after injury. Animals were randomly divided into three experimental groups and harvested at 2 wk after electrocoagulation (n = 3), and 1 (n = 3) or 3 (n = 6) months after scaffold implantation. Outcome analyses were performed preoperatively and at 2 wk after injury in all groups as well as at 1 or 3 mo after scaffold grafting and included urethroscopy, retrograde urethrography (RUG), and histological and immunohistochemical analyses. RESULTS At 2 wk after electrocoagulation, urethroscopic and RUG evaluations confirmed urethral stricture formation in 92% (n = 11/12) of rabbits. Gross tissue assessments at 1 (n = 3) and 3 (n = 6) mo after onlay urethroplasty revealed host tissue ingrowth covering the entire implant site. At 3 mo post-op, RUG analyses of repaired urethral segments demonstrated a 39% reduction in urethral stenosis detected following electrocoagulation injury. Histological and immunohistochemical analyses revealed the formation of innervated, vascularized neotissues with α-smooth muscle actin+ and SM22α+ smooth muscle bundles and pan-cytokeratin + epithelium at graft sites. CONCLUSIONS These results demonstrate the feasibility of BLSF matrices to support the repair of previously damaged urethral tissues.
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Abbas TO, Mahdi E, Hasan A, AlAnsari A, Pennisi CP. Current Status of Tissue Engineering in the Management of Severe Hypospadias. Front Pediatr 2018; 5:283. [PMID: 29404308 PMCID: PMC5786532 DOI: 10.3389/fped.2017.00283] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2017] [Accepted: 12/13/2017] [Indexed: 01/29/2023] Open
Abstract
Hypospadias, characterized by misplacement of the urinary meatus in the lower side of the penis, is a frequent birth defect in male children. Because of the huge variation in the anatomic presentation of hypospadias, no single urethroplasty procedure is suitable for all situations. Hence, many surgical techniques have emerged to address the shortage of tissues required to bridge the gap in the urethra particularly in the severe forms of hypospadias. However, the rate of postoperative complications of currently available surgical procedures reaches up to one-fourth of the patients having severe hypospadias. Moreover, these urethroplasty techniques are technically demanding and require considerable surgical experience. These limitations have fueled the development of novel tissue engineering techniques that aim to simplify the surgical procedures and to reduce the rate of complications. Several types of biomaterials have been considered for urethral repair, including synthetic and natural polymers, which in some cases have been seeded with cells prior to implantation. These methods have been tested in preclinical and clinical studies, with variable degrees of success. This review describes the different urethral tissue engineering methodologies, with focus on the approaches used for the treatment of hypospadias. At present, despite many significant advances, the search for a suitable tissue engineering approach for use in routine clinical applications continues.
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Affiliation(s)
- Tariq O. Abbas
- Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Aalborg, Denmark
- Department of Pediatric Surgery and Urology, Hamad General Hospital, Doha, Qatar
- College of Medicine, Qatar University, Doha, Qatar
| | - Elsadig Mahdi
- Department of Mechanical and Industrial Engineering, Qatar University, Doha, Qatar
| | - Anwarul Hasan
- Department of Mechanical and Industrial Engineering, Qatar University, Doha, Qatar
| | | | - Cristian Pablo Pennisi
- Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Aalborg, Denmark
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Protective effect of platelet‐rich plasma on urethral injury model of male rats. Neurourol Urodyn 2017; 37:1286-1293. [DOI: 10.1002/nau.23460] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2017] [Accepted: 11/10/2017] [Indexed: 01/15/2023]
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Urethral Reconstruction Using Mesothelial Cell-Seeded Autogenous Granulation Tissue Tube: An Experimental Study in Male Rabbits. BIOMED RESEARCH INTERNATIONAL 2017; 2017:1850256. [PMID: 28337443 PMCID: PMC5350385 DOI: 10.1155/2017/1850256] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Revised: 01/24/2017] [Accepted: 01/26/2017] [Indexed: 11/30/2022]
Abstract
Objective. This study was to evaluate the utility of the compound graft for tubularized urethroplasty by seeding mesothelial cells onto autogenous granulation tissue. Methods. Silastic tubes were implanted subcutaneously in 18 male rabbits, of which nine underwent omentum biopsies simultaneously for in vitro expansion of mesothelial cells. The granulation tissue covering the tubes was harvested 2 weeks after operation. Mesothelial cells were seeded onto and cocultured with the tissue for 7 days. A pendulous urethral segment of 1.5 cm was totally excised. Urethroplasty was performed with mesothelial cell-seeded tissue tubes in an end-to-end fashion in nine rabbits and with unseeded grafts in others as controls. Serial urethrograms were performed at 1, 2, and 6 months postoperatively. Meanwhile, the neourethra was harvested and analyzed grossly and histologically. Results. Urethrograms showed cell-seeded grafts maintained wide at each time point, while strictures formation was found in unseeded grafts. Histologically, layers of urothelium surrounded by increasingly organized smooth muscles were observed in seeded grafts. In contrast, myofibroblasts accumulation and extensive scarring occurred in unseeded grafts. Conclusions. Mesothelial cell-seeded granulation tissue tube can be successfully used for tubularized urethroplasty in male rabbits.
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Xue JD, Gao J, Fu Q, Feng C, Xie H. Seeding cell approach for tissue-engineered urethral reconstruction in animal study: A systematic review and meta-analysis. Exp Biol Med (Maywood) 2016; 241:1416-28. [PMID: 27022134 DOI: 10.1177/1535370216640148] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2015] [Accepted: 02/22/2016] [Indexed: 11/16/2022] Open
Abstract
We systematically reviewed published preclinical studies to evaluate the effectiveness of cell-seeded tissue engineering approach for urethral reconstruction in an animal model. The outcomes were summarized by success factors in the animal experiments, which evaluate the possibility and feasibility of a clinical application in the future. Preclinical studies of tissue engineering approaches for urethral reconstruction were identified through a systematic search in PubMed, Embase, and Biosis Previews (web of science SP) databases for studies published from 1 January 1980 to 23 November 2014. Primary studies were included if urethral reconstruction was performed using a tissue-engineered biomaterial in any animal species (with the experiment group being a cell-seeded scaffold and the control group being a cell-free scaffold) with histology and urethrography as the outcome measure. A total of 15 preclinical studies were included in our meta-analysis. The histology and urethrography outcome between the experimental and control groups were considered to be the most clinically relevant. Through this systematic approach, our outcomes suggested that applying the cell-seeded biomaterial in creating a neo-urethra was stable and effective. And multi-type cells including epithelial cells as well as smooth muscle cells or fibroblasts seemed to be a better strategy. Stem cells, especially after epithelial differentiation, could be a promising choice for future researches.
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Affiliation(s)
- Jing-Dong Xue
- Department of Urology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai 200233, China
| | - Jing Gao
- Department of Obstetrics & Gynecology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
| | - Qiang Fu
- Department of Urology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai 200233, China
| | - Chao Feng
- Department of Urology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai 200233, China
| | - Hong Xie
- Department of Urology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai 200233, China
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Development of a cell-seeded modified small intestinal submucosa for urethroplasty. Heliyon 2016; 2:e00087. [PMID: 27441265 PMCID: PMC4946073 DOI: 10.1016/j.heliyon.2016.e00087] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2015] [Revised: 01/28/2016] [Accepted: 03/01/2016] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE To explore the feasibility of a modified 3D porous small intestinal submucosa (SIS) scaffold seeded with urothelial cells (UC) for surgical reconstruction in a rabbit model. MATERIAL AND METHODS Eighteen New England white male rabbits were divided into three groups and a 0.8 × 1.5 cm(2) section of the anterior urethral mucosa was removed from each animal. Ventral onlay urethroplasty was performed with a 1.0 × 1.7 cm(2) SIS scaffold that was either cell-seeded and treated with 5% peracetic acid (PAA) (n = 6), or cell-seeded and untreated (n = 6), or unseeded and treated with 5% PAA (n = 6). Animals were sacrificed at 6 months post-repair and retrograde urethrography and histological analyses performed. RESULTS In animals implanted with cell-seeded and PAA treated SIS scaffolds, urethrography showed wide-caliber urethra without any signs of stricture or fistulae, and histological analyses confirmed a complete urethral structure. In contrast, ulceration and fistula occurred in the reconstructed urethra of animals implanted with cell-seeded but untreated SIS scaffolds, and evident stricture was present in the unseeded, PAA treated group. Histological analyses demonstrated less urothelial coverage and smooth muscle in the cell-seeded and untreated SIS scaffold group, and serious fibrosis formation occurred in the unseeded, treated group. CONCLUSIONS A modified 3D porous SIS scaffold seeded with UC and treated with PAA produces better urethroplasty results than cell-seeded untreated SIS scaffolds, or unseeded PAA treated SIS scaffolds.
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Atala A, Danilevskiy M, Lyundup A, Glybochko P, Butnaru D, Vinarov A, Yoo JJ. The potential role of tissue-engineered urethral substitution: clinical and preclinical studies. J Tissue Eng Regen Med 2015; 11:3-19. [PMID: 26631921 DOI: 10.1002/term.2112] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2015] [Revised: 10/01/2015] [Accepted: 10/15/2015] [Indexed: 01/10/2023]
Abstract
Urethral strictures and anomalies remain among the difficult problems in urology, with urethroplasty procedures being the most effective treatment options. The two major types of urethroplasty are anastomotic urethroplasty and widening the urethral lumen using flaps or grafts (i.e. substitution urethroplasty). However, no ideal material for the latter has been found so far. Designing and selecting such a material is a necessary and challenging endeavour, driving the need for further bioengineered urethral tissue research. This article reviews currently available studies on the potentialities of tissue engineering in urethral reconstruction, in particular those describing the use of both acellular and recellularized tissue-engineered constructs in animal and human models. Possible future developments in this field are also discussed. Copyright © 2015 John Wiley & Sons, Ltd.
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Affiliation(s)
- Anthony Atala
- Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Mikhail Danilevskiy
- Research Institute of Uronephrology and Reproductive Health, I. M. Sechenov First Moscow State Medical University, Moscow, Russian Federation
| | - Alexey Lyundup
- Research Institute of Molecular Medicine, I. M. Sechenov First Moscow State Medical University, Moscow, Russian Federation
| | - Petr Glybochko
- I. M. Sechenov First Moscow State Medical University, Moscow, Russian Federation
| | - Denis Butnaru
- Research Institute of Uronephrology and Reproductive Health, I. M. Sechenov First Moscow State Medical University, Moscow, Russian Federation
| | - Andrey Vinarov
- Research Institute of Uronephrology and Reproductive Health, I. M. Sechenov First Moscow State Medical University, Moscow, Russian Federation
| | - James J Yoo
- Wake Forest Institute for Regenerative Medicine, Wake Forest University, Winston-Salem, NC, USA
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Huang JW, Lv XG, Li Z, Song LJ, Feng C, Xie MK, Li C, Li HB, Wang JH, Zhu WD, Chen SY, Wang HP, Xu YM. Urethral reconstruction with a 3D porous bacterial cellulose scaffold seeded with lingual keratinocytes in a rabbit model. ACTA ACUST UNITED AC 2015; 10:055005. [PMID: 26358641 DOI: 10.1088/1748-6041/10/5/055005] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
The goal of this study was to evaluate the effects of urethral reconstruction with a three-dimensional (3D) porous bacterial cellulose (BC) scaffold seeded with lingual keratinocytes in a rabbit model. A novel 3D porous BC scaffold was prepared by gelatin sponge interfering in the BC fermentation process. Rabbit lingual keratinocytes were isolated, expanded, and seeded onto 3D porous BC. BC alone (group 1, N = 10), 3D porous BC alone (group 2, N = 10), and 3D porous BC seeded with lingual keratinocytes (group 3, N = 10) were used to repair rabbit ventral urethral defects (2.0 × 0.8 cm). Scanning electron microscopy revealed that BC consisted of a compact laminate while 3D porous BC was composed of a porous sheet buttressed by a dense outer layer. The average pore diameter and porosity of the 3D porous BC were 4.23 ± 1.14 μm and 67.00 ± 6.80%, respectively. At 3 months postoperatively, macroscopic examinations and retrograde urethrograms of urethras revealed that all urethras maintained wide calibers in group 3. Strictures were found in all rabbits in groups 1 and 2. Histologically, at 1 month postoperatively, intact epithelium occurred in group 3, and discontinued epithelium was found in groups 1 and 2. However, groups 2 and 3 exhibited similar epithelial regeneration, which was superior to that of group 1 at 3 months (p < 0.05). Comparisons of smooth muscle content and endothelia density among the three groups revealed a significant increase at each time point (p < 0.05). Our results demonstrated that 3D porous BC seeded with lingual keratinocytes enhanced urethral tissue regeneration. 3D porous BC could potentially be used as an optimized scaffold for urethral reconstruction.
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Affiliation(s)
- Jian-Wen Huang
- Department of Urology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600 Yishan Road, Shanghai, 200233, People's Republic of China
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Huang JW, Xu YM, Li ZB, Murphy SV, Zhao W, Liu QQ, Zhu WD, Fu Q, Zhang YP, Song LJ. Tissue performance of bladder following stretched electrospun silk fibroin matrix and bladder acellular matrix implantation in a rabbit model. J Biomed Mater Res A 2015; 104:9-16. [PMID: 26148477 DOI: 10.1002/jbm.a.35535] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2015] [Revised: 06/07/2015] [Accepted: 06/25/2015] [Indexed: 12/26/2022]
Affiliation(s)
- Jian-Wen Huang
- Department of Urology; Shanghai Jiao Tong University Affiliated Sixth People's Hospital; Shanghai 200233 China
| | - Yue-Min Xu
- Department of Urology; Shanghai Jiao Tong University Affiliated Sixth People's Hospital; Shanghai 200233 China
| | - Zhao-Bo Li
- State Key Laboratory for Modification of Chemical Fibers and Polymer Materials; College of Materials Science and Engineering, Donghua University; Shanghai 201620 China
| | - Sean V. Murphy
- Wake Forest Institute for Regenerative Medicine, Wake Forest University Health Sciences, Medical Center Blvd; Winston Salem North Carolina 27157
| | - Weixin Zhao
- Wake Forest Institute for Regenerative Medicine, Wake Forest University Health Sciences, Medical Center Blvd; Winston Salem North Carolina 27157
| | - Qiang-Qiang Liu
- State Key Laboratory for Modification of Chemical Fibers and Polymer Materials; College of Materials Science and Engineering, Donghua University; Shanghai 201620 China
| | - Wei-Dong Zhu
- Department of Urology; Shanghai Jiao Tong University Affiliated Sixth People's Hospital; Shanghai 200233 China
| | - Qiang Fu
- Department of Urology; Shanghai Jiao Tong University Affiliated Sixth People's Hospital; Shanghai 200233 China
| | - Yao-Peng Zhang
- State Key Laboratory for Modification of Chemical Fibers and Polymer Materials; College of Materials Science and Engineering, Donghua University; Shanghai 201620 China
| | - Lu-Jie Song
- Department of Urology; Shanghai Jiao Tong University Affiliated Sixth People's Hospital; Shanghai 200233 China
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Osman NI, Hillary C, Bullock AJ, MacNeil S, Chapple CR. Tissue engineered buccal mucosa for urethroplasty: progress and future directions. Adv Drug Deliv Rev 2015; 82-83:69-76. [PMID: 25451857 DOI: 10.1016/j.addr.2014.10.006] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2014] [Revised: 09/22/2014] [Accepted: 10/03/2014] [Indexed: 01/15/2023]
Abstract
PURPOSE Autologous buccal mucosa is commonly utilized in the surgical treatment of urethral strictures. Extensive strictures require a larger quantity of tissue, which may lead to donor site morbidity. This review assesses progress in producing tissue engineered buccal mucosa as an alternative graft material. RESULTS Few clinical studies have introduced cells onto biological or synthetic scaffolds and implanted resulting constructs in patients. The available studies show that buccal mucosa cells on acellular human dermis or on collagen matrix lead to good acute stage tissue integration. Urothelial cells on a synthetic substrate also perform well. However while some patients do well many years post-grafting, others develop stricture recurrence. Acellular biomaterials used to treat long urethral defects in animals commonly lead to fibrosis. CONCLUSIONS Tissue engineered buccal mucosa shows promise as a substitute for native tissue. The fibrosis which occurs months post-implantation may reflect the underlying disease process recurring in these patients.
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Affiliation(s)
- N I Osman
- Kroto Research Institute, University of Sheffield, Sheffield, UK; Department of Urology, Royal Hallamshire Hospital, Sheffield, UK
| | - C Hillary
- Kroto Research Institute, University of Sheffield, Sheffield, UK; Department of Urology, Royal Hallamshire Hospital, Sheffield, UK
| | - A J Bullock
- Kroto Research Institute, University of Sheffield, Sheffield, UK
| | - S MacNeil
- Kroto Research Institute, University of Sheffield, Sheffield, UK
| | - C R Chapple
- Department of Urology, Royal Hallamshire Hospital, Sheffield, UK.
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Wei G, Li C, Fu Q, Xu Y, Li H. Preparation of PCL/silk fibroin/collagen electrospun fiber for urethral reconstruction. Int Urol Nephrol 2014; 47:95-9. [PMID: 25281313 DOI: 10.1007/s11255-014-0854-3] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2014] [Accepted: 09/25/2014] [Indexed: 11/24/2022]
Abstract
PURPOSE To prepare polycaprolactone (PCL)/silk fibroin/collagen electrospun nanofiber scaffold and test its effects on growth and proliferation of oral mucosal epithelial cells. METHODS Regenerated silk fibroin film, water-soluble collagen powder, and PCL, at mass ratios of 1:1:4, 1:1:8, and 1:1:10, were dissolved in hexafluoroisopropanol, and electrostatic spinning method was adopted to prepare PCL/silk fibroin/collagen electrospun nanofiber scaffold. In vitro cultured oral mucosal epithelial cells were inoculated on the material surface, MTT assay and scanning electron microscopy were adopted to study the growth and proliferation of oral mucosal epithelial cells on the material surface, and cell compatibility of PCL/silk fibroin/collagen electrospun nanofiber was evaluated. RESULTS The result of MTT assay showed that oral mucosal epithelial cells were growing well on the PCL/silk fibroin/collagen electrospun nanofiber scaffold. Scanning electron microscopy showed that the prepared electrospun fiber was uniform in diameter and presented an interconnected porous net structure, and oral mucosal epithelial cells had a good growth form on the surface of the modified material. CONCLUSIONS PCL/silk fibroin/collagen electrospun nanofiber scaffold has appropriate pore size and porosity, is suitable for the growth of oral mucosal epithelial cells, has good cell compatibility, and is a good scaffold for tissue engineering urethral reconstruction.
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Affiliation(s)
- Gaijie Wei
- Department of Urology, Affiliated Sixth People's Hospital, Shanghai Jiaotong University, 600 Yishan Road, Shanghai, 200233, China
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Tissue engineered scaffolds for an effective healing and regeneration: reviewing orthotopic studies. BIOMED RESEARCH INTERNATIONAL 2014; 2014:398069. [PMID: 25250319 PMCID: PMC4163448 DOI: 10.1155/2014/398069] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/18/2014] [Accepted: 07/22/2014] [Indexed: 12/20/2022]
Abstract
It is commonly stated that tissue engineering is the most promising approach to treat or replace failing tissues/organs. For this aim, a specific strategy should be planned including proper selection of biomaterials, fabrication techniques, cell lines, and signaling cues. A great effort has been pursued to develop suitable scaffolds for the restoration of a variety of tissues and a huge number of protocols ranging from in vitro to in vivo studies, the latter further differentiating into several procedures depending on the type of implantation (i.e., subcutaneous or orthotopic) and the model adopted (i.e., animal or human), have been developed. All together, the published reports demonstrate that the proposed tissue engineering approaches spread toward multiple directions. The critical review of this scenario might suggest, at the same time, that a limited number of studies gave a real improvement to the field, especially referring to in vivo investigations. In this regard, the present paper aims to review the results of in vivo tissue engineering experimentations, focusing on the role of the scaffold and its specificity with respect to the tissue to be regenerated, in order to verify whether an extracellular matrix-like device, as usually stated, could promote an expected positive outcome.
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Xie M, Xu Y, Song L, Wang J, Lv X, Zhang Y. Tissue-engineered buccal mucosa using silk fibroin matrices for urethral reconstruction in a canine model. J Surg Res 2014; 188:1-7. [PMID: 24411303 DOI: 10.1016/j.jss.2013.11.1102] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2013] [Revised: 10/26/2013] [Accepted: 11/20/2013] [Indexed: 11/16/2022]
Abstract
BACKGROUND To investigate the feasibility of urethral reconstruction using tissue-engineered buccal mucosa (TEBM) with silk fibroin (SF) matrices in a canine model. MATERIALS AND METHODS Autologous oral keratinocytes and autologous fibroblasts were isolated, expanded, and seeded onto SF matrices to obtain TEBM. The TEBM was assessed using hematoxylin and eosin staining and scanning electron microscopy. A 5-cm urethral mucosal defect was created in 10 female canines. Urethroplasty was performed using TEBM in five canines in the experimental group and with SF matrices without cells in the five canines in the comparison group. Retrograde urethrography was performed after 6 mo of grafting. The urethral grafts were analyzed grossly and histologically. RESULTS The oral keratinocytes and fibroblasts exhibited good biocompatibility with the SF matrices. TEBM could be constructed using SF matrices. The canines implanted with the tissue-engineered mucosa voided without difficulty. The retrograde urethrography revealed no sign of stricture. The histologic staining showed that epithelial cells developed gradually and exhibited stratified epithelial layers at 6 mo. In the comparison group, the canines had difficulty voiding, and the retrograde urethrography showed urethra stricture. The histologic staining showed that one to two layers of epithelial cells developed. CONCLUSIONS The TEBM using SF matrices could be a potential material for urethra reconstruction.
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Affiliation(s)
- Minkai Xie
- Department of Urology, Shanghai Jiaotong University Affiliated Sixth People's Hospital, Shanghai, People's Republic of China
| | - Yuemin Xu
- Department of Urology, Shanghai Jiaotong University Affiliated Sixth People's Hospital, Shanghai, People's Republic of China.
| | - Lujie Song
- Department of Urology, Shanghai Jiaotong University Affiliated Sixth People's Hospital, Shanghai, People's Republic of China
| | - Jihong Wang
- Department of Urology, Shanghai Jiaotong University Affiliated Sixth People's Hospital, Shanghai, People's Republic of China
| | - Xiangguo Lv
- Department of Urology, Shanghai Jiaotong University Affiliated Sixth People's Hospital, Shanghai, People's Republic of China
| | - Yaopeng Zhang
- State Key Laboratory for Modification of Chemical Fibers and Polymer Materials, College of Materials Science and Engineering, Donghua University, Shanghai, People's Republic of China.
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Song L, Murphy SV, Yang B, Xu Y, Zhang Y, Atala A. Bladder Acellular Matrix and Its Application in Bladder Augmentation. TISSUE ENGINEERING PART B-REVIEWS 2014; 20:163-72. [DOI: 10.1089/ten.teb.2013.0103] [Citation(s) in RCA: 65] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Affiliation(s)
- Lujie Song
- Wake Forest Institute for Regenerative Medicine, Wake Forest School of Medicine, Winston Salem, North Carolina
- Department of Urology, Shanghai Sixth People's Hospital, Shanghai Jiaotong University, Shanghai, China
- Shanghai Oriental Institute for Urologic Reconstruction, Shanghai, China
| | - Sean V. Murphy
- Wake Forest Institute for Regenerative Medicine, Wake Forest School of Medicine, Winston Salem, North Carolina
| | - Bin Yang
- Wake Forest Institute for Regenerative Medicine, Wake Forest School of Medicine, Winston Salem, North Carolina
- Department of Urology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Yuemin Xu
- Department of Urology, Shanghai Sixth People's Hospital, Shanghai Jiaotong University, Shanghai, China
- Shanghai Oriental Institute for Urologic Reconstruction, Shanghai, China
| | - Yuanyuan Zhang
- Wake Forest Institute for Regenerative Medicine, Wake Forest School of Medicine, Winston Salem, North Carolina
| | - Anthony Atala
- Wake Forest Institute for Regenerative Medicine, Wake Forest School of Medicine, Winston Salem, North Carolina
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Li H, Xu Y, Xie H, Li C, Song L, Feng C, Zhang Q, Xie M, Wang Y, Lv X. Epithelial-differentiated adipose-derived stem cells seeded bladder acellular matrix grafts for urethral reconstruction: an animal model. Tissue Eng Part A 2014; 20:774-84. [PMID: 24329501 DOI: 10.1089/ten.tea.2013.0122] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
The limited amount of available epithelial tissue is considered a main cause of the high rate of urethral reconstruction failures. The aim of this study was to investigate whether epithelial-differentiated rabbit adipose-derived stem cells (Epith-rASCs) could play a role of epithelium in vivo functionally and be a potential substitute of urothelium. Substitution urethroplasty was performed to repair an anterior urethral defect in male New Zealand rabbits using Epith-rASCs seeded bladder acellular matrix grafts (BAMGs) after 5-bromo-2'-deoxyuridine (BrdU) labeling, based on the in vitro epithelial induction system we previously described. Urethroplasty with cell-free BAMGs and with undifferentiated rASCs (Und-rASCs) seeded BAMGs were performed as controls. After surgery, a notable amelioration of graft contracture and recovery of urethral continuity were observed in the Epith-rASCs/BAMG group by retrograde urethrograms and macroscopic inspection. Immunofluorescence revealed that the BrdU-labeled Epith-rASCs/Und-rASCs colocalized with cytokeratin 13 or myosin. Consistent with the results of western blotting, at early postimplantation stage, the continuous epithelial layer with local multilayered structure was observed in the Epith-rASCs/BAMG group, whereas no significant growth and local monolayer growth profile of epithelial cells were observed in the BAMG and Und-rASCs/BAMG group, respectively. The results showed that Epith-rASCs could serve as a potential substitute of urothelium for urethral tissue engineering and be available to prevent lumen contracture and subsequent complications including recurrent stricture.
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Affiliation(s)
- Hongbin Li
- 1 Department of Urology, Sixth People's Hospital, Jiao Tong University of Shanghai , Shanghai, P.R. China
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Liao W, Yang S, Song C, Li X, Li Y, Xiong Y. Construction of ureteral grafts by seeding bone marrow mesenchymal stem cells and smooth muscle cells into bladder acellular matrix. Transplant Proc 2013; 45:730-4. [PMID: 23498814 DOI: 10.1016/j.transproceed.2012.08.023] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2012] [Revised: 08/17/2012] [Accepted: 08/30/2012] [Indexed: 10/27/2022]
Abstract
BACKGROUND Congenital or acquired abnormalities may cause an ureteral injury or defect. The main methods to reconstruct a long ureter often cause serious complications. In this study, we sought to construct a tissue-engineered graft by seeding bone marrow mesenchymal stem cells (MSCs) and smooth muscle cells (SMCs) into a bladder acellular matrix (BAM) for ureteral reconstruction. METHODS Isolated, proliferated, and in vitro identified rabbit bone marrow MSCs and SMCs were seeded into BAM as the experimental group. Grafts only seeding SMCs were the control group. Cell-seeded grafts were used to construct tissue-engineered tubular grafts (TETG) for transplantation into the rabbit's omentum for 2 weeks before ureteral reconstruction. Evolutionary histology was performed at 2, 4, 8, and 16 weeks postoperatively. Renal function and ureteral obstruction were evaluated using intravenous urography at 16 weeks. RESULTS Flow cytometry demonstrated bone marrow MSCs to express CD29, CD44, CD90, but not CD34. Histological examination revealed consistent regeneration of TETG urothelium in the experimental group. At 8 and 16 weeks after TETG grafting in vivo, multilayer urothelium covered the entire lumen with visible neovascularization within the center. Organized smooth muscle bundles were observed. Intravenous urography demonstrated no ureteral stricture or hydronephrosis. The 5 rabbits were dead within 4 weeks postoperatively. Autopsy showed scar formation inside the graft with severe hydronephrosis. CONCLUSION We successfully constructed a TETG by seeding bone marrow MSCs and SMCs into BAM for ureteral reconstruction. Thus bone marrow MSCs can potentially promote urothelial regeneration to achieve a tissue-engineered ureter.
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Affiliation(s)
- W Liao
- Department of Urology, Renmin Hospital of Wuhan University, Wuhan, China
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Li C, Xu YM, Li HB. Preliminary experimental study of urethral reconstruction with tissue engineering and RNA interference techniques. Asian J Androl 2013; 15:430-3. [PMID: 23542139 PMCID: PMC3739635 DOI: 10.1038/aja.2013.2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2012] [Revised: 11/19/2012] [Accepted: 01/04/2013] [Indexed: 12/13/2022] Open
Abstract
This study investigated the feasibility of replacing urinary epithelial cells with oral keratinocytes and transforming growth factor-β1 (TGF-β1) small interfering RNA (siRNA)-transfected fibroblasts seeded on bladder acellular matrix graft (BAMG) in order to reconstruct tissue-engineered urethra. Constructed siRNAs, which expressed plasmids targeting TGF-β1, were transfected into rabbit fibroblasts. The effective siRNA was screened out by RT-PCR and was transfected into rabbit fibroblasts again. Synthesis of type I collagen in culture medium was measured by enzyme-linked immuno sorbent assay (ELISA). Autologous oral keratinocytes and TGF-β1 siRNA-transfected fibroblasts were seeded onto BAMGs to obtain a tissue-engineered mucosa. The tissue-engineered mucosa was assessed morphologically and with the help of scanning electron microscopy. The TGF-β1 siRNA decreased the expression of fibroblasts synthesis type I collagen. Oral keratinocytes and TGF-β1 siRNA-transfected fibroblasts were seeded onto sterilized BAMG to obtain a tissue-engineered mucosa for urethral reconstruction. The compound graft was assessed using scanning electron microscope. Oral keratinocytes and TGF-β1 siRNA-transfected fibroblasts had a good compatibility with BAMG. The downregulation of fibroblasts synthesis type I collagen expression by constructed siRNA interfering TGF-β1 provided a potential basis for genetic therapy of urethral scar. Oral keratinocytes and TGF-β1 siRNA-transfected fibroblasts had good compatibility with BAMG and the compound graft could be a new choice for urethral reconstruction.
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Affiliation(s)
- Chao Li
- Department of Urology, Sixth People’s Hospital, Shanghai Jiaotong University, Shanghai 200233, China.
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Xie M, Song L, Wang J, Fan S, Zhang Y, Xu Y. Evaluation of stretched electrospun silk fibroin matrices seeded with urothelial cells for urethra reconstruction. J Surg Res 2013; 184:774-81. [PMID: 23706393 DOI: 10.1016/j.jss.2013.04.016] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2013] [Revised: 03/26/2013] [Accepted: 04/05/2013] [Indexed: 12/26/2022]
Abstract
BACKGROUND We investigated the feasibility of urethral reconstruction using stretched electrospun silk fibroin matrices. MATERIALS AND METHODS A novel electrospun silk fibroin matrix was prepared. The structure of the material was assessed by scanning electron microscopy and a porosity test. Canine urothelial cells were isolated, expanded, and seeded onto the material for 1 wk to obtain a tissue-engineered graft. The tissue-engineered graft was assessed using hematoxylin and eosin staining and scanning electron microscopy. A dorsal urethral mucosal defect was created in nine female beagle dogs. In the experimental group, tissue-engineered mucosa was used to repair urethra mucosa defects in six dogs. No substitute was used in the three dogs of the control group. Retrograde urethrography was performed at 1, 2, and 6 mo after grafting. The urethral grafts were analyzed grossly and histologically. RESULTS Scanning electron microscope and a porosity test revealed that the material had a three-dimensional porous structure. Urothelial cells grew on the material and showed good biocompatibility with the stretched silk fibroin matrices. Canines implanted with tissue-engineered mucosa voided without difficulty. Retrograde urethrography revealed no signs of stricture. Histologic staining showed gradual epithelial cell development and stratified epithelial layers at 1, 2, and 6 mo. The canines in the control group showed difficulty in voiding. Retrograde urethrography showed urethra stricture. Histologic staining showed that no or only one layer of epithelial cells developed. A severe inflammatory reaction was also observed in the control group. CONCLUSIONS Stretched electrospun silk fibroin matrices have good biocompatibility with urothelial cells, which could prove to be a potential material for use in urethra reconstruction.
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Affiliation(s)
- Minkai Xie
- Department of Urology, Shanghai Jiaotong University Affiliated Sixth People's Hospital, Shanghai, P.R. China
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Orabi H, AbouShwareb T, Zhang Y, Yoo JJ, Atala A. Cell-seeded tubularized scaffolds for reconstruction of long urethral defects: a preclinical study. Eur Urol 2013; 63:531-8. [PMID: 22877501 PMCID: PMC3554849 DOI: 10.1016/j.eururo.2012.07.041] [Citation(s) in RCA: 82] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2012] [Accepted: 07/20/2012] [Indexed: 02/05/2023]
Abstract
BACKGROUND The treatment options for patients requiring repair of a long segment of the urethra are limited by the availability of autologous tissues. We previously reported that acellular collagen-based tubularized constructs seeded with cells are able to repair small urethral defects in a rabbit model. OBJECTIVE We explored the feasibility of engineering clinically relevant long urethras for surgical reconstruction in a canine preclinical model. DESIGN, SETTING, AND PARTICIPANTS Autologous bladder epithelial and smooth muscle cells from 15 male dogs were grown and seeded onto preconfigured collagen-based tubular matrices (6 cm in length). The perineal urethral segment was removed in 21 male dogs. Urethroplasties were performed with tubularized collagen scaffolds seeded with cells in 15 animals. Tubularized constructs without cells were implanted in six animals. Serial urethrography and three-dimensional computed tomography (CT) scans were performed pre- and postoperatively at 1, 3, 6, and 12 mo. The animals were euthanized at their predetermined time points (three animals at 1 mo, and four at 3, 6, and 12 mo) for analyses. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Statistical analysis of CT imaging and histology was not needed. RESULTS AND LIMITATIONS CT urethrograms showed wide-caliber urethras without strictures in animals implanted with cell-seeded matrices. The urethral segments replaced with acellular scaffolds collapsed. Gross examination of the urethral implants seeded with cells showed normal-appearing tissue without evidence of fibrosis. Histologically, an epithelial cell layer surrounded by muscle fiber bundles was observed on the cell-seeded constructs, and cellular organization increased over time. The epithelial and smooth muscle phenotypes were confirmed using antibodies to pancytokeratins AE1/AE3 and smooth muscle-specific desmin. Formation of an epithelial cell layer occurred in the unseeded constructs, but few muscle fibers formed. CONCLUSIONS Cell-seeded tubularized collagen scaffolds can be used to repair long urethral defects, whereas scaffolds without cells lead to poor tissue development and strictures. This study demonstrates that long tissue-engineered tubularized urethral segments may be used for urethroplasty in patients.
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Affiliation(s)
- Hazem Orabi
- Department of Urology and Institute for Regenerative Medicine, Wake Forest School of Medicine, Winston Salem, NC, USA
- Urology Department, Assiut University, Egypt 71516
| | - Tamer AbouShwareb
- Department of Urology and Institute for Regenerative Medicine, Wake Forest School of Medicine, Winston Salem, NC, USA
| | - Yuanyuan Zhang
- Department of Urology and Institute for Regenerative Medicine, Wake Forest School of Medicine, Winston Salem, NC, USA
| | - James J. Yoo
- Department of Urology and Institute for Regenerative Medicine, Wake Forest School of Medicine, Winston Salem, NC, USA
| | - Anthony Atala
- Department of Urology and Institute for Regenerative Medicine, Wake Forest School of Medicine, Winston Salem, NC, USA
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[Stem cells and tissue engineering techniques]. Urologia 2013; 80:11-9. [PMID: 23423680 DOI: 10.5301/ru.2013.10762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/20/2012] [Indexed: 11/20/2022]
Abstract
The therapeutic use of stem cells and tissue engineering techniques are emerging in urology. Here, stem cell types, their differentiating potential and fundamental characteristics are illustrated. The cancer stem cell hypothesis is reported with reference to the role played by stem cells in the origin, development and progression of neoplastic lesions. In addition, recent reports of results obtained with stem cells alone or seeded in scaffolds to overcome problems of damaged urinary tract tissue are summarized. Among others, the application of these biotechnologies in urinary bladder, and urethra are delineated. Nevertheless, apart from the ethical concerns raised from the use of embryonic stem cells, a lot of questions need to be solved concerning the biology of stem cells before their widespread use in clinical trials. Further investigation is also required in tissue engineering utilizing animal models.
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Li B, Lu Y, Liu C, Zheng S, Li H, Pu J, Wang X, Li L. Urethral reconstruction using allogenic frozen-thawed bladder mucosa: an experimental study. Urol Int 2012; 90:422-9. [PMID: 23257408 DOI: 10.1159/000345441] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2012] [Accepted: 10/21/2012] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To determine the feasibility and effectivity of allogenic frozen-thawed bladder mucosa for urethroplasty. METHODS Bladder mucosa was harvested from 6 New Zealand rabbits. Changes in the bladder mucosa as seen by histological and electron microscope examination were compared between the frozen-thawed and fresh groups. Twelve urethral stricture models were established and randomly divided into two groups. In the test group, we performed urethroplasty with allogenic frozen-thawed bladder mucosa, and the same operation was done in the control group, but using fresh bladder mucosa. The result of retrograde urethrography and histological changes of the urethral sample were compared postoperatively. RESULTS No obvious changes on histological and electron microscope examination were observed in the frozen-thawed bladder mucosa. Inflammation reaction of the surgical site in the test group was milder than that of the controls 2 weeks after surgery. The urethral epithelial cells grew well 2 weeks after surgery, but lots of epithelia were necrotic in the control group. The urethra of all rabbits in the test group had good continuity and the urethral lumen was large in the test group 2 months after surgery. There was a layer of urethral epithelium in the test group 2 months after surgery, whereas scar tissue was found in the control group. CONCLUSIONS The freeze-thaw technique can maintain bladder mucosa structure and biological function. Frozen-thawed allogenic bladder mucosa may be a potential material for urethroplasty.
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Affiliation(s)
- Bingkun Li
- Department of Urology, Zhujiang Hospital, Southern Medical University, Guangzhou, China
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Liao W, Yang S, Song C, Li Y, Meng L, Li X, Xiong Y. Tissue-engineered tubular graft for urinary diversion after radical cystectomy in rabbits. J Surg Res 2012; 182:185-91. [PMID: 23140788 DOI: 10.1016/j.jss.2012.10.024] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2012] [Revised: 10/05/2012] [Accepted: 10/12/2012] [Indexed: 12/22/2022]
Abstract
BACKGROUND Clinically, using ileal conduit for urinary diversion often caused many serious complications. Tissue engineering technology may offer an alternative method for urinary diversion after radical cystectomy. In this study, we aimed to make a tissue-engineered tubular graft (TETG) using bladder epithelial cells and bladder acellular matrix (BAM) for urinary diversion in rabbits. METHODS Bladder epithelial cells of rabbit were cultivated and expanded in vitro, which were then seeded on BAM and cultured for 7 d. Then, cell-seeded grafts of 4 cm length and 0.8 cm diameter were used to make TETGs and transferred into the omentum for 2 wk before urinary diversion. In the experimental group, bladders of the rabbits were removed. The proximal ends of TETGs were anastomosed with ureters, and the distal ends were anastomosed with the abdominal stomas. In the control group, TETGs were constructed using unseeded BAM. Newly formed tissue structures were functionally and microscopically evaluated using urography and immunohistochemistry at 1, 2, 4, and 8 wk after operation, respectively. Histologic examination with hematoxylin and eosin staining was conducted to assess tissue regeneration. Immunohistochemistry was performed with AE1/AE3, uroplakin Ⅲa, and zonula occludens 1 (ZO-1) antibodies. RESULTS All animals were alive in the experimental group. Hematoxylin and eosin staining showed epithelial coverage in TETG. Immunohistochemistry showed positive stain with AE1/AE3, uroplakin Ⅲa, and ZO-1, which indicated mature and functional epithelial cells on the lumen of TETG. Intravenous urography showed that there were no obstructions in TETGs. In the control group, four rabbits were dead within 2 wk, and scar formation, atresia, and severe hydronephrosis were found. CONCLUSIONS It was feasible that TETG constructed using bladder epithelial cells and BAM for urinary diversion after radical cystectomy in rabbits.
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Affiliation(s)
- Wenbiao Liao
- Department of Urology, Renmin Hospital of Wuhan University, Wuhan, China
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Sartoneva R, Haaparanta AM, Lahdes-Vasama T, Mannerström B, Kellomäki M, Salomäki M, Sándor G, Seppänen R, Miettinen S, Haimi S. Characterizing and optimizing poly-L-lactide-co-ε-caprolactone membranes for urothelial tissue engineering. J R Soc Interface 2012; 9:3444-54. [PMID: 22896571 DOI: 10.1098/rsif.2012.0458] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
Different synthetic biomaterials such as polylactide (PLA), polycaprolactone and poly-l-lactide-co-ε-caprolactone (PLCL) have been studied for urothelial tissue engineering, with favourable results. The aim of this research was to further optimize the growth surface for human urothelial cells (hUCs) by comparing different PLCL-based membranes: smooth (s) and textured (t) PLCL and knitted PLA mesh with compression-moulded PLCL (cPLCL). The effects of topographical texturing on urothelial cell response and mechanical properties under hydrolysis were studied. The main finding was that both sPLCL and tPLCL supported hUC growth significantly better than cPLCL. Interestingly, tPLCL gave no significant advantage to hUC attachment or proliferation compared with sPLCL. However, during the 14 day assessment period, the majority of cells were viable and maintained phenotype on all the membranes studied. The material characterization exhibited potential mechanical characteristics of sPLCL and tPLCL for urothelial applications. Furthermore, the highest elongation of tPLCL supports the use of this kind of texturing. In conclusion, in light of our cell culture results and mechanical characterization, both sPLCL and tPLCL should be further studied for urothelial tissue engineering.
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Affiliation(s)
- Reetta Sartoneva
- Institute of Biomedical Technology, University of Tampere, Tampere, Finland.
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Gu GL, Xia SJ, Zhang J, Liu GH, Yan L, Xu ZH, Zhu YJ. Tubularized urethral replacement using tissue-engineered peritoneum-like tissue in a rabbit model. Urol Int 2012; 89:358-64. [PMID: 22797559 DOI: 10.1159/000339745] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2011] [Accepted: 05/28/2012] [Indexed: 11/19/2022]
Abstract
INTRODUCTION This study aims to investigate whether mesothelial cells could function as seed cells to construct tissue-engineered peritoneum-like tissue for urethral reconstruction in a rabbit model. MATERIALS AND METHODS Bladder acellular matrices were prepared and trimmed to 1.5 × 1 cm. Nine male rabbits underwent omentum biopsy and autologous mesothelial cells were isolated. After in vitro expansion, the cells were seeded onto the matrices and incubated for 7 days. In 18 rabbits, a pendulous urethral segment 1.5 cm long was totally excised and urethroplasty was performed with tubularized matrices seeded with cells in 9 animals and without cells in 9 as controls. Urethrography was performed at 1, 2 and 6 months postoperatively. Meanwhile, the neourethras were harvested and analyzed grossly and histologically. RESULTS Histological analysis of the cell-seeded grafts revealed a loose collagen matrix covered with a single layer of mesothelim. Serial urethrography indicated a wide urethral caliber without stricture formation in animals implanted with cell-seeded matrices, while all animals of the control group developed stricture. Histological analysis of the implanted cell-seeded matrices demonstrated a normal urethral architecture by 1 month, composed of multilayers of urothelium surrounded by smooth muscle bundles, which became increasingly organized with time. By 6 months, the neourethra could be hardly distinguished from native urethra both grossly and histologically. CONCLUSIONS Autologous mesothelial cells could be successfully used as seed cells for tubularized urethral reconstruction in male rabbits.
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Affiliation(s)
- Gang-Li Gu
- Department of Urology, Qilu Hospital, Shandong University, Jinan, China
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Two-Layer Tissue Engineered Urethra Using Oral Epithelial and Muscle Derived Cells. J Urol 2012; 187:1882-9. [DOI: 10.1016/j.juro.2011.12.059] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2011] [Indexed: 12/20/2022]
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El-Tabey N, Shokeir A, Barakat N, El-Refaie H, El-Hamid MA, Gabr M. Cell-seeded tubular acellular matrix for replacing a long circumferential urethral defect in a canine model: Is it clinically applicable? Arab J Urol 2012; 10:192-8. [PMID: 26558025 PMCID: PMC4442891 DOI: 10.1016/j.aju.2012.01.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2011] [Revised: 01/29/2012] [Accepted: 01/30/2012] [Indexed: 11/30/2022] Open
Abstract
Objective To evaluate the feasibility of replacing a relatively long segment of the canine urethra by a tube of cell-seeded acellular collagen bladder matrix. Materials and methods The study included 14 female mongrel dogs in which a 3-cm segment of the whole urethral circumference was excised and replaced by a tube of acellular matrix seeded with autologous urothelial cells. The acellular matrix was obtained from the excised bladder of female donor dogs that were not included in the study. Autologous cells were obtained from the study dogs by open bladder biopsy, with subsequent in vitro expansion and cultivation. Urethroplasty was performed over a 16 F urethral catheter that was kept for 4 weeks. The dogs were killed humanely (one every week for 4 weeks and then one monthly for 10 months). After stent removal, retrograde urethrography was used each month in the living dogs. If retention occurred a urethrogram was taken and then the dog was killed humanely. All grafts from dogs were harvested and sent for histopathological examination. Results Exploration at 1, 2, 3 and 4 weeks showed progressive shrinkage in length, together with relative narrowing of the lumen. Three dogs developed retention within a week after stent removal and the other seven developed retention within 4 months. Retrograde urethrograms showed evidence of stricture and/or fistula at the graft site in all dogs. On exploration, grafts showed marked shrinkage (0.6–1.2 cm in length) with complete obliteration of their lumens. Histopathological examination showed extensive fibrosis of the matrix with no evident urothelial architecture. Conclusion Cell-seeded acellular matrix tube is insufficient to replace a 3-cm circumferential urethral defect in dogs.
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Affiliation(s)
- Nasr El-Tabey
- Urology and Nephrology Center, Mansoura University, Mansoura, Egypt
| | - Ahmed Shokeir
- Urology and Nephrology Center, Mansoura University, Mansoura, Egypt
| | - Nashwa Barakat
- Urology and Nephrology Center, Mansoura University, Mansoura, Egypt
| | - Hoda El-Refaie
- Urology and Nephrology Center, Mansoura University, Mansoura, Egypt
| | | | - Mahmoud Gabr
- Urology and Nephrology Center, Mansoura University, Mansoura, Egypt
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Introducing a Large Animal Model to Create Urethral Stricture Similar to Human Stricture Disease: A Comparative Experimental Microscopic Study. J Urol 2012; 187:1101-9. [DOI: 10.1016/j.juro.2011.10.132] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2011] [Indexed: 12/11/2022]
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49
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Feng C, Xu YM, Fu Q, Zhu WD, Cui L. Reconstruction of Three-Dimensional Neourethra Using Lingual Keratinocytes and Corporal Smooth Muscle Cells Seeded Acellular Corporal Spongiosum. Tissue Eng Part A 2011; 17:3011-9. [PMID: 21736450 DOI: 10.1089/ten.tea.2011.0061] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Chao Feng
- Department of Urology, Affiliated Sixth People's Hospital, Shanghai Jiaotong University, Shanghai, People's Republic of China
| | - Yue-min Xu
- Department of Urology, Affiliated Sixth People's Hospital, Shanghai Jiaotong University, Shanghai, People's Republic of China
| | - Qiang Fu
- Department of Urology, Affiliated Sixth People's Hospital, Shanghai Jiaotong University, Shanghai, People's Republic of China
| | - Wei-dong Zhu
- Department of Urology, Affiliated Sixth People's Hospital, Shanghai Jiaotong University, Shanghai, People's Republic of China
| | - Lei Cui
- Shanghai Tissue Engineering Research and Development Center, Shanghai, People's Republic of China
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Davis NF, Callanan A, McGuire BB, Flood HD, McGloughlin TM. Evaluation of Viability and Proliferative Activity of Human Urothelial Cells Cultured Onto Xenogenic Tissue-Engineered Extracellular Matrices. Urology 2011; 77:1007.e1-7. [DOI: 10.1016/j.urology.2010.11.036] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2010] [Revised: 11/03/2010] [Accepted: 11/27/2010] [Indexed: 12/14/2022]
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