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Zhao Y, Peng H, Sun L, Tong J, Cui C, Bai Z, Yan J, Qin D, Liu Y, Wang J, Wu X, Li B. The application of small intestinal submucosa in tissue regeneration. Mater Today Bio 2024; 26:101032. [PMID: 38533376 PMCID: PMC10963656 DOI: 10.1016/j.mtbio.2024.101032] [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: 12/13/2023] [Revised: 03/04/2024] [Accepted: 03/15/2024] [Indexed: 03/28/2024] Open
Abstract
The distinctive three-dimensional architecture, biological functionality, minimal immunogenicity, and inherent biodegradability of small intestinal submucosa extracellular matrix materials have attracted considerable interest and found wide-ranging applications in the domain of tissue regeneration engineering. This article presents a comprehensive examination of the structure and role of small intestinal submucosa, delving into diverse preparation techniques and classifications. Additionally, it proposes approaches for evaluating and modifying SIS scaffolds. Moreover, the advancements of SIS in the regeneration of skin, bone, heart valves, blood vessels, bladder, uterus, and urethra are thoroughly explored, accompanied by their respective future prospects. Consequently, this review enhances our understanding of the applications of SIS in tissue and organ repair and keeps researchers up-to-date with the latest research advancements in this area.
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Affiliation(s)
- Yifan Zhao
- Shanxi Medical University School and Hospital of Stomatology, Taiyuan, 030001, Shanxi, China
- Shanxi Province Key Laboratory of Oral Diseases Prevention and New Materials, Taiyuan, 030001, Shanxi, China
| | - Hongyi Peng
- Shanxi Medical University School and Hospital of Stomatology, Taiyuan, 030001, Shanxi, China
- Shanxi Province Key Laboratory of Oral Diseases Prevention and New Materials, Taiyuan, 030001, Shanxi, China
- Academy of Medical Sciences, Shanxi Medical University, Taiyuan, 030001, Shanxi, China
| | - Lingxiang Sun
- Shanxi Medical University School and Hospital of Stomatology, Taiyuan, 030001, Shanxi, China
- Shanxi Province Key Laboratory of Oral Diseases Prevention and New Materials, Taiyuan, 030001, Shanxi, China
| | - Jiahui Tong
- Shanxi Medical University School and Hospital of Stomatology, Taiyuan, 030001, Shanxi, China
- Shanxi Province Key Laboratory of Oral Diseases Prevention and New Materials, Taiyuan, 030001, Shanxi, China
| | - Chenying Cui
- Shanxi Medical University School and Hospital of Stomatology, Taiyuan, 030001, Shanxi, China
- Shanxi Province Key Laboratory of Oral Diseases Prevention and New Materials, Taiyuan, 030001, Shanxi, China
| | - Ziyang Bai
- Shanxi Medical University School and Hospital of Stomatology, Taiyuan, 030001, Shanxi, China
- Shanxi Province Key Laboratory of Oral Diseases Prevention and New Materials, Taiyuan, 030001, Shanxi, China
| | - Jingyu Yan
- Shanxi Medical University School and Hospital of Stomatology, Taiyuan, 030001, Shanxi, China
- Shanxi Province Key Laboratory of Oral Diseases Prevention and New Materials, Taiyuan, 030001, Shanxi, China
| | - Danlei Qin
- Shanxi Medical University School and Hospital of Stomatology, Taiyuan, 030001, Shanxi, China
- Shanxi Province Key Laboratory of Oral Diseases Prevention and New Materials, Taiyuan, 030001, Shanxi, China
| | - Yingyu Liu
- Shanxi Medical University School and Hospital of Stomatology, Taiyuan, 030001, Shanxi, China
- Shanxi Province Key Laboratory of Oral Diseases Prevention and New Materials, Taiyuan, 030001, Shanxi, China
| | - Jue Wang
- The First Hospital of Shanxi Medical University, Taiyuan, 030001, Shanxi, China
| | - Xiuping Wu
- Shanxi Medical University School and Hospital of Stomatology, Taiyuan, 030001, Shanxi, China
- Shanxi Province Key Laboratory of Oral Diseases Prevention and New Materials, Taiyuan, 030001, Shanxi, China
| | - Bing Li
- Shanxi Medical University School and Hospital of Stomatology, Taiyuan, 030001, Shanxi, China
- Shanxi Province Key Laboratory of Oral Diseases Prevention and New Materials, Taiyuan, 030001, Shanxi, China
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Viet-Nhi NK, Chen YC, Dang LH, Tseng H, Hung SH. Degassing a Decellularized Scaffold Enhances Wound Healing and Reduces Fibrosis during Tracheal Defect Reconstruction: A Preliminary Animal Study. J Funct Biomater 2023; 14:jfb14030147. [PMID: 36976071 PMCID: PMC10051568 DOI: 10.3390/jfb14030147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 02/22/2023] [Accepted: 03/01/2023] [Indexed: 03/08/2023] Open
Abstract
Few efforts have been made regarding the optimization of porcine small intestinal submucosa (SIS) to improve its biocompatibility. This study aims to evaluate the effect of SIS degassing on the promotion of cell attachment and wound healing. The degassed SIS was evaluated in vitro and in vivo, compared with the nondegassed SIS control. In the cell sheet reattachment model, the reattached cell sheet coverage was significantly higher in the degassed SIS group than in the nondegassed group. Cell sheet viability was also significantly higher in the SIS group than in the control group. In vivo studies showed that the tracheal defect repaired by the degassed SIS patch showed enhanced healing and reductions in fibrosis and luminal stenosis compared to the nondegassed SIS control group, with the thickness of the transplanted grafts in the degassed SIS group significantly lower than those in the control group (346.82 ± 28.02 µm vs. 771.29 ± 20.41 µm, p < 0.05). Degassing the SIS mesh significantly promoted cell sheet attachment and wound healing by reducing luminal fibrosis and stenosis compared to the nondegassed control SIS. The results suggest that the degassing processing might be a simple and effective way to improve the biocompatibility of SIS.
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Affiliation(s)
- Nguyen-Kieu Viet-Nhi
- International Master/Ph.D. Program in Medicine, College of Medicine, Taipei Medical University, Taipei 110, Taiwan
| | - Yen-Chun Chen
- Department of Otolaryngology, Taipei Medical University Hospital, Taipei 110, Taiwan
- Graduate Institute of Medical Sciences, College of Medicine, Taipei Medical University, Taipei 110, Taiwan
| | - Luong Huu Dang
- Department of Otolaryngology, Faculty of Medicine, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City 70000, Vietnam
| | - How Tseng
- Graduate Institute of Medical Sciences, College of Medicine, Taipei Medical University, Taipei 110, Taiwan
- Department of Biochemistry and Molecular Cell Biology, School of Medicine, College of Medicine, Taipei Medical University, Taipei 110, Taiwan
| | - Shih-Han Hung
- International Master/Ph.D. Program in Medicine, College of Medicine, Taipei Medical University, Taipei 110, Taiwan
- Department of Otolaryngology, School of Medicine, College of Medicine, Taipei Medical University, Taipei 110, Taiwan
- Department of Otolaryngology, Wan Fang Hospital, Taipei Medical University, Taipei 116, Taiwan
- Correspondence:
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Kim IG, Park SA, Lee SH, Choi JS, Cho H, Lee SJ, Kwon YW, Kwon SK. Transplantation of a 3D-printed tracheal graft combined with iPS cell-derived MSCs and chondrocytes. Sci Rep 2020; 10:4326. [PMID: 32152475 PMCID: PMC7062776 DOI: 10.1038/s41598-020-61405-4] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Accepted: 02/24/2020] [Indexed: 11/09/2022] Open
Abstract
For successful tracheal reconstruction, tissue-engineered artificial trachea should meet several requirements, such as biocompatible constructs comparable to natural trachea, coverage with ciliated respiratory mucosa, and adequate cartilage remodeling to support a cylindrical structure. Here, we designed an artificial trachea with mechanical properties similar to the native trachea that can enhance the regeneration of tracheal mucosa and cartilage through the optimal combination of a two-layered tubular scaffold and human induced pluripotent stem cell (iPSC)-derived cells. The framework of the artificial trachea was fabricated with electrospun polycaprolactone (PCL) nanofibers (inner) and 3D-printed PCL microfibers (outer). Also, human bronchial epithelial cells (hBECs), iPSC-derived mesenchymal stem cells (iPSC-MSCs), and iPSC-derived chondrocytes (iPSC-Chds) were used to maximize the regeneration of tracheal mucosa and cartilage in vivo. After 2 days of cultivation using a bioreactor system, tissue-engineered artificial tracheas were transplanted into a segmental trachea defect (1.5-cm length) rabbit model. Endoscopy did not reveal granulation ingrowth into tracheal lumen. Alcian blue staining clearly showed the formation of ciliated columnar epithelium in iPSC-MSC groups. In addition, micro-CT analysis showed that iPSC-Chd groups were effective in forming neocartilage at defect sites. Therefore, this study describes a promising approach for long-term functional reconstruction of a segmental tracheal defect.
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Affiliation(s)
- In Gul Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Hospital, Seoul, 03080, Republic of Korea
| | - Su A Park
- Department of Nature-Inspired Nanoconvergence Systems, Korea Institute of Machinery and Materials, Daejeon, 34103, Republic of Korea
| | - Shin-Hyae Lee
- Biomedical Research Institute Seoul National University Hospital, Seoul, 03080, Republic of Korea
| | - Ji Suk Choi
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Hospital, Seoul, 03080, Republic of Korea
| | - Hana Cho
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Hospital, Seoul, 03080, Republic of Korea
| | - Sang Jin Lee
- Department of Nature-Inspired Nanoconvergence Systems, Korea Institute of Machinery and Materials, Daejeon, 34103, Republic of Korea
| | - Yoo-Wook Kwon
- Biomedical Research Institute Seoul National University Hospital, Seoul, 03080, Republic of Korea.
| | - Seong Keun Kwon
- Biomedical Research Institute Seoul National University Hospital, Seoul, 03080, Republic of Korea.
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Zhang F, Wang Z, Zheng C, Zhao C, Shi H, Pan S, Zhang W. Biocompatibility and cellular compatibility of decellularized tracheal matrix derived from rabbits. Int J Artif Organs 2019; 42:500-507. [PMID: 31081418 DOI: 10.1177/0391398819847216] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective: To study the different concentrations of Triton X-100 and nuclease needed to remove cells from the tracheal matrix of rabbits and analyse their biocompatibility and cellular compatibility. Methods: Fifty tracheas were harvested from donor New Zealand rabbits. Thirty tracheas were randomly divided into five groups (n = 6 each). The tracheas in group A were untreated and served as a control group, and those in groups B, C, D and E were treated with different concentrations of Triton X-100 (1%, 2%, 3% and 4%), respectively. The tracheas of the five groups were assessed by histological observation, scanning electron microscopy and mechanical evaluation. The remaining 20 donor tracheas, which were divided into a control group and an optimally decellularized group, were used for xenogeneic transplantation and cell seeding. Results: Many epithelial cells and cartilage cells were observed in the tracheas of group A. There were fewer cartilage cells in the tracheas of groups C, D and E than in the tracheas of groups A and B under histological observation. In scanning electron microscopy, there were many ciliated epithelial cells in the tracheas of group A; in groups B and C, the ciliated epithelial cells disappeared, but the basement membrane was intact. The basement membranes were broken in the tracheas of groups D and E. Implanted decellularized tracheas showed good biocompatibility. Bone marrow mesenchymal stem cells grown in the decellularized tracheal matrix grew well. Conclusion: Decellularized tracheal matrix obtained from rabbits by 2% Triton X-100 may be suitable for the construction of tissue-engineered trachea because of its favourable morphological and biomechanical properties as well as its biocompatibility and cellular compatibly.
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Affiliation(s)
- Fangbiao Zhang
- Department of Cardiothoracic Surgery, Lishui Municipal Central Hospital, Lishui, China
| | - Zhihao Wang
- Department of Cardiothoracic Surgery, Clinical College of Yangzhou University, Yangzhou, China
| | - Chunhui Zheng
- Department of Cardiothoracic Surgery, Lishui Municipal Central Hospital, Lishui, China
| | - Chun Zhao
- Department of Cardiothoracic Surgery, Lishui Municipal Central Hospital, Lishui, China
| | - Hongcan Shi
- Department of Cardiothoracic Surgery, Clinical College of Yangzhou University, Yangzhou, China
| | - Shu Pan
- Department of Thoracic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Weidong Zhang
- Department of Cardiothoracic Surgery, Henan Chest Hospital, Zhengzhou, China
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Galvez Alegria C, Gundogdu G, Yang X, Costa K, Mauney JR. Evaluation of Acellular Bilayer Silk Fibroin Grafts for Onlay Tracheoplasty in a Rat Defect Model. Otolaryngol Head Neck Surg 2018; 160:310-319. [PMID: 30274546 DOI: 10.1177/0194599818802267] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To assess the efficacy of acellular bilayer silk fibroin (BLSF) grafts to repair full-thickness tracheal defects and to compare the performance with conventional porcine small intestinal submucosa (SIS) implants. STUDY DESIGN A prospective controlled animal trial in a rat model of onlay tracheoplasty. SETTING Pediatric medical center. SUBJECTS AND METHODS Tracheal reconstruction of adult Sprague-Dawley rats was performed with BLSF (n = 38) or SIS (n = 32) matrices for up to 3 months of implantation. Functional evaluations of repaired conduits as well as histologic, immunohistochemical, and histomorphometric analyses of neotissues were assessed. RESULTS Prior to scheduled euthanasia, survival rates of rats receiving BLSF or SIS grafts were ≥94%, with no clinical signs of airway obstruction observed over the course of the study. Micro-computed tomography analysis revealed that the mean percentage of stenosis was <20% in both implant groups. BLSF and SIS grafts supported formation of pseudostratified ciliated columnar epithelium by 1 week postoperatively; however, each matrix failed to promote de novo chondrogenesis by 3 months following repair. CONCLUSIONS BLSF scaffolds can be used for reconstruction of rat tracheal patch defects with functional outcomes comparable to those of SIS matrices.
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Affiliation(s)
- Cinthia Galvez Alegria
- 1 Urological Diseases Research Center, Boston Children's Hospital, Boston, Massachusetts, USA.,2 Department of Surgery, Harvard Medical School, Boston, Massachusetts, USA
| | - Gokhan Gundogdu
- 1 Urological Diseases Research Center, Boston Children's Hospital, Boston, Massachusetts, USA.,2 Department of Surgery, Harvard Medical School, Boston, Massachusetts, USA
| | - Xuehui Yang
- 1 Urological Diseases Research Center, Boston Children's Hospital, Boston, Massachusetts, USA.,2 Department of Surgery, Harvard Medical School, Boston, Massachusetts, USA
| | - Kyle Costa
- 1 Urological Diseases Research Center, Boston Children's Hospital, Boston, Massachusetts, USA.,2 Department of Surgery, Harvard Medical School, Boston, Massachusetts, USA
| | - Joshua R Mauney
- 1 Urological Diseases Research Center, Boston Children's Hospital, Boston, Massachusetts, USA.,2 Department of Surgery, Harvard Medical School, Boston, Massachusetts, USA
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Hintze JM, Tchoukalova YD, Sista R, Shah MK, Zhang N, Lott DG. Development of xeno-free epithelial differentiation media for adherent, non-expanded adipose stromal vascular cell cultures. Biochem Biophys Res Commun 2018; 503:3128-3133. [PMID: 30166060 DOI: 10.1016/j.bbrc.2018.08.104] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Accepted: 08/15/2018] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Reconstruction of respiratory epithelium is critical for the fabrication of bioengineered airway implants. Epithelial differentiation is typically achieved using bovine pituitary extract (BPE). Due to the xenogenic nature and undefined composition of BPE, an alternative for human clinical applications, devoid of BPE, must be developed. The goal of this study was to develop two different BPE-free media, with and without select pituitary hormone (PH), which could initiate epithelial differentiation for use in human implantation. METHODS The ability of the two BPE-free media to initiate epithelial differentiation of adherent, non-expanded stromal-vascular cells grown on porcine small intestinal submucosa was compared to traditional BPE-containing media (M1). Nanostring® was used to measure differences in gene expression of stemness (MSC), basal cell (basal), and ciliated markers (muco-cil), and staining was performed support the gene data. RESULTS Compared to baseline, both BPE-free media upregulated epithelial and stemness genes, however this was to a lower degree than BPE-containing media. In general, the expression of basal cell markers (COL17A1, DSG3, ITGA6, KRT6A, LOXL2) and secreted mucous proteins (PLUNC, MUC5B, SCGB2A1) was upregulated. The gene expression of ciliated markers C9orf24, TUBA3 and DNCL2B but not of the key transcription factor for cilagenesis FOXJ1 were upregulated, indicating that mucus-secreting cell differentiation occurs more rapidly than ciliogenesis. The ability of the adherent stromal vascular cells to upregulate gene expression of both epithelial and stemness markers suggests maintenance of the self-renewal capacity of undifferentiated and/or basal cell-like cells contributing to proliferation and ensuring a persisting source of cells for regenerative medicine applications. CONCLUSION This study provides the initial step to defining a BPE-free epithelial differentiation medium for clinical translation. Thus, either of the proposed BPE-free medium are viable alternatives to BPE-containing medium for partial epithelial differentiation for human translational applications.
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Affiliation(s)
- Justin M Hintze
- Head and Neck Regeneration Program, Center for Regenerative Medicine, Mayo Clinic, USA
| | - Yourka D Tchoukalova
- Head and Neck Regeneration Program, Center for Regenerative Medicine, Mayo Clinic, USA
| | - Ramachandra Sista
- Department of Pulmonary and Critical Care Medicine, Mayo Clinic, Phoenix, AZ, USA
| | - Manisha K Shah
- Head and Neck Regeneration Program, Center for Regenerative Medicine, Mayo Clinic, USA
| | - Nan Zhang
- Department of Biostatistics, Mayo Clinic, Scottsdale, AZ, USA
| | - David G Lott
- Head and Neck Regeneration Program, Center for Regenerative Medicine, Mayo Clinic, USA; Department of Otolaryngology - Head and Neck Surgery, Mayo Clinic, Phoenix, AZ, USA.
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Regeneration of Tracheal Tissue in Partial Defects Using Porcine Small Intestinal Submucosa. Stem Cells Int 2018; 2018:5102630. [PMID: 29681948 PMCID: PMC5846444 DOI: 10.1155/2018/5102630] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2017] [Revised: 10/12/2017] [Accepted: 10/26/2017] [Indexed: 02/03/2023] Open
Abstract
Background Surgical correction of tracheal defects is a complex procedure when the gold standard treatment with primary end-to-end anastomosis is not possible. An alternative treatment may be the use of porcine small intestinal submucosa (SIS). It has been used as graft material for bioengineering applications and to promote tissue regeneration. The aim of this study was to evaluate whether SIS grafts improved tracheal tissue regeneration in a rabbit model of experimental tracheostomy. Methods Sixteen rabbits were randomized into two groups. Animals in the control group underwent only surgical tracheostomy, while animals in the SIS group underwent surgical tracheostomy with an SIS graft covering the defect. We examined tissues at the site of tracheostomy 60 days after surgery using histological analysis with hematoxylin and eosin (H&E) staining and analyzed the perimeter and area of the defect with Image-Pro® PLUS 4.5 (Media Cybernetics). Results The average perimeter and area of the defects were smaller by 15.3% (p = 0.034) and 21.8% (p = 0.151), respectively, in the SIS group than in the control group. Histological analysis revealed immature cartilage, pseudostratified ciliated epithelium, and connective tissue in 54.5% (p = 0.018) of the SIS group, while no cartilaginous regeneration was observed in the control group. Conclusions Although tracheal SIS engraftment could not prevent stenosis in a rabbit model of tracheal injury, it produced some remarkable changes, efficiently facilitating neovascularization, reepithelialization, and neoformation of immature cartilage.
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Abstract
Regenerative medicine has recently been established as an emerging interdisciplinary field focused on the repair; replacement or regeneration of cells, tissues and organs. It involves various disciplines, which are focused on different aspects of the regeneration process such as cell biology, gene therapy, bioengineering, material science and pharmacology. In this article, we will outline progress on tissue engineering of specific tissues and organs relevant to paediatric surgery.
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Affiliation(s)
- Panagiotis Maghsoudlou
- Surgery Unit, Institute of Child Health and Great Ormond Street Hospital, University College London, 30 Guilford St, London WC1N 1EH, UK
| | - Luca Urbani
- Surgery Unit, Institute of Child Health and Great Ormond Street Hospital, University College London, 30 Guilford St, London WC1N 1EH, UK
| | - Paolo De Coppi
- Surgery Unit, Institute of Child Health and Great Ormond Street Hospital, University College London, 30 Guilford St, London WC1N 1EH, UK.
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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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Clinical and biological acceptance of a fibrocollagen-coated mersylene patch for tracheal repair in growing dogs. The Journal of Laryngology & Otology 2014; 128:630-40. [PMID: 25075948 DOI: 10.1017/s0022215114001339] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Collagen-covered prostheses can be used as a non-circumferential segmental tracheal replacement. However, the applicability of these implants in young subjects has not yet been reported. METHODS In this experimental, longitudinal study, dogs aged 29-32 days underwent limited segmental tracheal replacement with a polyester prosthesis or were allocated to a control, untreated group. The dogs were evaluated clinically, endoscopically and tomographically for up to one year. RESULTS Although there was evidence of tracheal growth in the experimental group, tomographic measurements were significantly smaller in this group than in the control group throughout the observation period. At the end of the study, there was no evidence of implant rejection, stenosis or collapse. Normal respiratory epithelium had grown across the implanted membrane in the experimental group. CONCLUSION The homologous collagen mersylene membrane allowed for limited structural tracheal growth and was functionally integrated into the segmented tracheal wall in growing dogs.
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Baiguera S, D’Innocenzo B, Macchiarini P. Current status of regenerative replacement of the airway. Expert Rev Respir Med 2014; 5:487-94. [DOI: 10.1586/ers.11.42] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Du XF, Kwon SK, Song JJ, Cho CG, Park SW. Tracheal reconstruction by mesenchymal stem cells with small intestine submucosa in rabbits. Int J Pediatr Otorhinolaryngol 2012; 76:345-51. [PMID: 22209333 DOI: 10.1016/j.ijporl.2011.12.005] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2011] [Revised: 12/06/2011] [Accepted: 12/07/2011] [Indexed: 12/14/2022]
Abstract
AIM The increasing number of newborns requiring intubation and artificial ventilation in the sophisticated premature and intensive care units of recent years has been followed by a concomitant increase in the number of children who develop tracheal stenosis as a sequela of prolonged intubation, with a consequent increasing need for tracheal surgical repair. The aim of this study was to evaluate tracheal reconstruction by monolayered autologous mesenchymal stem cells (MSCs) with small intestine submucosa (SIS) in a rabbit model. METHODS Twelve male rabbits were randomly divided into three groups: rabbits with tracheal defects without reconstruction (untreated group, n=4), rabbits with tracheal defects given porcine small intestine submucosa graft (SIS group, n=4), and rabbits with tracheal defects that underwent transplantation of monolayered mesenchymal stem cells on SIS (SIS+MSC group, n=4). Histological and endoscopic analyses were performed by hematoxylin-eosin staining (H&E), Prussian blue staining and endoscopy. RESULTS Tracheal stenosis in the SIS+MSC group was minimal, compared to the untreated group and SIS group. Specimens obtained from the untreated and SIS groups showed severe infiltration of inflammatory cells and granulation tissue formation into the trachea. In the SIS+MSC group, however, minimal infiltration of the inflammatory cells and granulation tissue formation were observed. Twelve weeks following the operation, regeneration of pseudostratified columnar epithelium was confirmed by H&E staining with minimal inflammatory cell infiltration in the SIS+MSC group. Moreover, Prussian blue staining clearly demonstrated the presence of labeled MSCs in the regenerated tissue of SIS+MSC group. CONCLUSIONS These results demonstrate that tracheal reconstruction by MSCs with SIS is effective in rabbits with tracheal defects with minimal mortality and morbidity, which appears to be a promising strategy in the treatment of tracheal defects.
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Affiliation(s)
- Xiao Fei Du
- Medical Science Research Institute and Department of Otorhinolaryngology - Head and Neck Surgery, Dongguk University Ilsan Hospital, Gyeonggi, Republic of Korea
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Liu XK, Zhang Q, Li Q, Liu WW, Li H, Zeng ZY, Guo ZM. Laryngeal framework reconstruction using titanium mesh in glottic cancer after frontolateral vertical partial laryngectomy. Laryngoscope 2011; 120:2197-202. [PMID: 20824791 DOI: 10.1002/lary.21103] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVES To investigate the feasibility and efficacy of laryngeal framework reconstruction using titanium mesh in patients with glottic cancer after frontolateral vertical partial laryngectomy. STUDY DESIGN Prospective study. METHODS Defect of laryngeal framework, caused by frontolateral vertical partial laryngectomy in nine patients with T2 or T3 squamous cell carcinoma of glottic, were reconstructed with titanium mesh from 2007 to 2009. Computed tomography (CT) and fiberscopic examinations were performed at two weeks and three months postoperatively. RESULTS No aspiration and laryngeal stenosis was observed in the nine patients. CT scanning showed that titanium mesh was fastened well without displacement and deformity and that there was no laryngeal stenosis. Fiberscopic inspection showed that the larynx lumen was maintained well without stricture, shrinkage, and necrosis. No titanium mesh was exposed to the larynx lumen. CONCLUSIONS Titanium mesh was a good alternative for reconstruction of the laryngeal framework. It provided adequate structural support to maintain airway patency.
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Affiliation(s)
- Xue-Kui Liu
- State Key Laboratory of Oncology in South China, Department of Head and Neck Surgery, Cancer Center, Sun Yat-Sen University, Guangzhou, Guangdong, P.R. China
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Baiguera S, Jungebluth P, Burns A, Mavilia C, Haag J, De Coppi P, Macchiarini P. Tissue engineered human tracheas for in vivo implantation. Biomaterials 2010; 31:8931-8. [PMID: 20800273 DOI: 10.1016/j.biomaterials.2010.08.005] [Citation(s) in RCA: 143] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2010] [Accepted: 08/04/2010] [Indexed: 10/19/2022]
Abstract
Two years ago we performed the first clinical successful transplantation of a fully tissue engineered trachea. Despite the clinically positive outcome, the graft production took almost 3 months, a not feasible period of time for patients with the need of an urgent transplantation. We have then improved decellularization process and herein, for the first time, we completely describe and characterize the obtainment of human tracheal bioactive supports. Histological and molecular biology analysis demonstrated that all cellular components and nuclear material were removed and quantitative PCR confirmed it. SEM analysis revealed that the decellularized matrices retained the hierarchical structures of native trachea, and biomechanical tests showed that decellularization approach did not led to any influence on tracheal morphological and mechanical properties. Moreover immunohistological staining showed the preservation of angiogenic factors and angiogenic assays demonstrated that acellular human tracheal scaffolds exert an in vitro chemo-active action and induce strong in vivo angiogenic response (CAM analysis). We are now able to obtained, in a short and clinically useful time (approximately 3 weeks), a bioengineered trachea that is structurally and mechanically similar to native trachea, which exert chemotactive and pro-angiogenic properties and which could be successfully used for clinical tissue engineered airway clinical replacements.
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Affiliation(s)
- Silvia Baiguera
- BIOAIR Lab, Department of General Thoracic and Regenerative Surgery and Intrathoracic Biotransplantation University Hospital Careggi, Largo Brambilla 3, I-50134 Florence, Italy
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Bader A, Macchiarini P. Moving towards in situ tracheal regeneration: the bionic tissue engineered transplantation approach. J Cell Mol Med 2010; 14:1877-89. [PMID: 20406329 PMCID: PMC3823270 DOI: 10.1111/j.1582-4934.2010.01073.x] [Citation(s) in RCA: 68] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
In June 2008, the world's first whole tissue-engineered organ - the windpipe - was successfully transplanted into a 31-year-old lady, and about 18 months following surgery she is leading a near normal life without immunosuppression. This outcome has been achieved by employing three groundbreaking technologies of regenerative medicine: (i) a donor trachea first decellularized using a detergent (without denaturing the collagenous matrix), (ii) the two main autologous tracheal cells, namely mesenchymal stem cell derived cartilage-like cells and epithelial respiratory cells and (iii) a specifically designed bioreactor that reseed, before implantation, the in vitro pre-expanded and pre-differentiated autologous cells on the desired surfaces of the decellularized matrix. Given the long-term safety, efficacy and efforts using such a conventional approach and the potential advantages of regenerative implants to make them available for anyone, we have investigated a novel alternative concept how to fully avoid in vitro cell replication, expansion and differentiation, use the human native site as micro-niche, potentiate the human body's site-specific response by adding boosting, permissive and recruitment impulses in full respect of sociological and regulatory prerequisites. This tissue-engineered approach and ongoing research in airway transplantation is reviewed and presented here.
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Affiliation(s)
- Augustinus Bader
- Centre for Biotechnology and Biomedicine, Department of Applied Stem Cell Biology and Cell Techniques, University of Leipzig, Leipzig, Germany
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16
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Animal models of tracheal allotransplantation using vitrified cryopreservation. J Thorac Cardiovasc Surg 2009; 138:1222-6. [PMID: 19660277 DOI: 10.1016/j.jtcvs.2009.05.028] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2008] [Revised: 05/01/2009] [Accepted: 05/31/2009] [Indexed: 11/21/2022]
Abstract
OBJECTIVE Tracheal reconstruction continues to pose a significant challenge in thoracic surgery. The study objective was to develop a novel method to eliminate the antigenicity of tracheal allografts by using vitrified cryopreservation and present the experimental results after cervical tracheal replacement in rabbits. METHODS Fifteen New Zealand rabbits, irrespective of gender, weighing 2.5 to 3.0 kg, were randomly divided into 3 groups: (A), the experimental group (n = 5), tracheal allotransplantation after 4 weeks of vitrified cryopreservation; (B), the negative control group (n = 5), fresh tracheal autotransplantation; and (C), the positive control group (n = 5), fresh tracheal segments implanted as allografts. The patency of implanted grafts, lymphocytic infiltrate, cartilage scores, and ink perfusion to evaluate revascularization were used to investigate the impact of vitrified cryopreservation on the antigenicity of tracheal grafts and vascular regeneration. RESULTS Rabbits in groups A and B all had uneventful postoperative courses with patent lumens and structural integrity, with obvious vascular regeneration and less lymphocytic infiltrate. Although in excellent condition, animals were sacrificed after a short-term follow-up of 4 weeks for further examination as scheduled. In group C, massive lymphocytic infiltrate and inflammatory cells without noticeable revascularization were observed, and rabbits died within 2 weeks after surgery for airway stenosis or severe obstruction. CONCLUSION The antigenicity of tracheal allografts was significantly decreased by using the vitrified cryopreservation method, which would be a novel alternative method to store donor trachea to make tracheal banking possible.
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Gilbert TW, Gilbert S, Madden M, Reynolds SD, Badylak SF. Morphologic Assessment of Extracellular Matrix Scaffolds for Patch Tracheoplasty in a Canine Model. Ann Thorac Surg 2008; 86:967-74; discussion 967-74. [DOI: 10.1016/j.athoracsur.2008.04.071] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2008] [Revised: 04/17/2008] [Accepted: 04/21/2008] [Indexed: 02/09/2023]
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Mondalek FG, Lawrence BJ, Kropp BP, Grady BP, Fung KM, Madihally SV, Lin HK. The incorporation of poly(lactic-co-glycolic) acid nanoparticles into porcine small intestinal submucosa biomaterials. Biomaterials 2008; 29:1159-66. [PMID: 18076986 DOI: 10.1016/j.biomaterials.2007.11.020] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2007] [Accepted: 11/15/2007] [Indexed: 11/18/2022]
Abstract
Small intestinal submucosa (SIS) derived from porcine small intestine has been intensively studied for its capacity in repairing and regenerating wounded and dysfunctional tissues. However, SIS suffers from a large spectrum of heterogeneity in microarchitecture leading to inconsistent results. In this study, we introduced nanoparticles (NPs) to SIS with an intention of decreasing the heterogeneity and improving the consistency of this biomaterial. As determined by scanning electron microscopy and urea permeability, the optimum NP size was estimated to be between 200 nm and 500 nm using commercial monodisperse latex spheres. The concentration of NPs that is required to alter pore sizes of SIS as determined by urea permeability was estimated to be 1 mg/ml 260 nm poly(lactic-co-glycolic) acid (PLGA) NPs. The 1mg/ml PLGA NPs loaded in the SIS did not change the tensile properties of the unmodified SIS or even alter pH values in a cell culture environment. More importantly, PLGA NP modified SIS did not affect human mammary endothelial cells (HMEC-1) morphology or adhesion, but actually enhanced HEMC-1 cell growth.
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Affiliation(s)
- Fadee G Mondalek
- Department of Chemical, Biological and Materials Engineering, University of Oklahoma, Norman, OK 73019, USA
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Gaafar AA, El-Daly AA, Gaafar HA. Laryngotracheal augmentation using titanium mesh. The Journal of Laryngology & Otology 2007; 122:391-6. [PMID: 17498337 DOI: 10.1017/s0022215107008109] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
AbstractBackground:The management of laryngotracheal stenosis is still a serious surgical challenge. The fact that there are currently numerous reconstruction procedures indicates that there is at present no standard treatment.Study design:Titanium mesh was used instead of traditional homografts in reconstruction of the anterior laryngotracheal wall in 12 tracheostomised patients with benign chronic laryngotracheal stenosis. The anterior laryngotracheal wall was split, followed by excision of scar tissue and fixation of the titanium plate at the split end. A Silastic®stent was inserted above the tracheostomy tube and fixed in place by running sutures fixed to the skin by buttons. The stent was removed endoscopically six weeks later and a trial of decannulation was undertaken.Results:Endoscopically, good epithelisation was seen on the inner surface of the mesh in 10 cases and decannulation was possible. Four of these patients required endoscopic debulking of granulation tissue. Decannulation was impossible in two cases, one due to excessive granulation tissue and the other due to prolapse of the titanium mesh into the tracheal lumen (the mesh was removed endoscopically and a Montgomery T-tube inserted).Conclusion:Titanium mesh was found to be a good alternative for augmentation of the anterior laryngotracheal wall. It offered rigid support, with fewer of the complications reported with other grafts.
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Affiliation(s)
- A A Gaafar
- Department of Otolaryngology Head & Neck Surgery, University of Alexandria, Egypt.
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Yamashita M, Kanemaru SI, Hirano S, Tamura Y, Umeda H, Ohno T, Suehiro A, Omori K, Nakamura T, Ito J. A regenerative approach for partial tracheal defects, an in vivo canine model. Inflamm Regen 2007. [DOI: 10.2492/inflammregen.27.570] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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