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Maljaars L, Gudde A, Oosthuysen A, Roovers JP, Guler Z. The Regenerative Capacity of Tissue-Engineered Amniotic Membranes. ACS APPLIED BIO MATERIALS 2024; 7:1441-1448. [PMID: 38391263 PMCID: PMC10951947 DOI: 10.1021/acsabm.3c00765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Revised: 02/07/2024] [Accepted: 02/08/2024] [Indexed: 02/24/2024]
Abstract
Scaffolds can be introduced as a source of tissue in reconstructive surgery and can help to improve wound healing. Amniotic membranes (AMs) as scaffolds for tissue engineering have emerged as promising biomaterials for surgical reconstruction due to their regenerative capacity, biocompatibility, gradual degradability, and availability. They also promote fetal-like scarless healing and provide a bioactive matrix that stimulates cell adhesion, migration, and proliferation. The aim of this study was to create a tissue-engineered AM-based implant for the repair of vesicovaginal fistula (VVF), a defect between the bladder and vagina caused by prolonged obstructed labor. Layers of AMs (with or without cross-linking) and electrospun poly-4-hydroxybutyrate (P4HB) (a synthetic, degradable polymer) scaffold were joined together by fibrin glue to produce a multilayer scaffold. Human vaginal fibroblasts were seeded on the different constructs and cultured for 28 days. Cell proliferation, cell morphology, collagen deposition, and metabolism measured by matrix metalloproteinase (MMP) activity were evaluated. Vaginal fibroblasts proliferated and were metabolically active on the different constructs, producing a distributed layer of collagen and proMMP-2. Cell proliferation and the amount of produced collagen were similar across different groups, indicating that the different AM-based constructs support vaginal fibroblast function. Cell morphology and collagen images showed slightly better alignment and organization on the un-cross-linked constructs compared to the cross-linked constructs. It was concluded that the regenerative capacity of AM does not seem to be affected by mechanical reinforcement with cross-linking or the addition of P4HB and fibrin glue. An AM-based implant for surgical repair of internal organs requiring load-bearing functionality can be directly translated to other types of surgical reconstruction of internal organs.
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Affiliation(s)
- Lennart Maljaars
- Department
of Obstetrics and Gynecology, Amsterdam
UMC location University of Amsterdam, Meibergdreef 9, 1105
AZ Amsterdam, The
Netherlands
- Amsterdam
Reproduction and Development research institute, Meibergdreef 9, 1105
AZ Amsterdam, The
Netherlands
| | - Aksel Gudde
- Department
of Obstetrics and Gynecology, Amsterdam
UMC location University of Amsterdam, Meibergdreef 9, 1105
AZ Amsterdam, The
Netherlands
- Amsterdam
Reproduction and Development research institute, Meibergdreef 9, 1105
AZ Amsterdam, The
Netherlands
| | - Anel Oosthuysen
- Cardiovascular
Research Unit, University of Cape Town, Anzio Road, Observatory, 7925 Cape Town, South Africa
| | - Jan-Paul Roovers
- Department
of Obstetrics and Gynecology, Amsterdam
UMC location University of Amsterdam, Meibergdreef 9, 1105
AZ Amsterdam, The
Netherlands
- Amsterdam
Reproduction and Development research institute, Meibergdreef 9, 1105
AZ Amsterdam, The
Netherlands
| | - Zeliha Guler
- Department
of Obstetrics and Gynecology, Amsterdam
UMC location University of Amsterdam, Meibergdreef 9, 1105
AZ Amsterdam, The
Netherlands
- Amsterdam
Reproduction and Development research institute, Meibergdreef 9, 1105
AZ Amsterdam, The
Netherlands
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2
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Maljaars LP, Bendaoud S, Kastelein AW, Guler Z, Hooijmans CR, Roovers JPWR. Application of amniotic membranes in reconstructive surgery of internal organs-A systematic review and meta-analysis. J Tissue Eng Regen Med 2022; 16:1069-1090. [PMID: 36333859 PMCID: PMC10099938 DOI: 10.1002/term.3357] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 10/20/2022] [Indexed: 11/08/2022]
Abstract
Amniotic membrane (AM) has great potential as a scaffold for tissue regeneration in reconstructive surgery. To date, no systematic review of the literature has been performed for the applications of AM in wound closure of internal organs. Therefore, in this systematic review and meta-analysis, we summarize the literature on the safety and efficacy of AM for the closure of internal organs. A systematic search was performed in MEDLINE-PubMed database and OVID Embase to retrieve human and controlled animal studies on wound closure of internal organs. The Cochrane Risk of Bias tool for randomized clinical trials and the SYRCLE risk of bias tool for animal studies were used. Meta-analyses (MAs) were conducted for controlled animal studies to assess efficacy of closure, mortality and complications in subjects who underwent surgical wound closure in internal organs with the application of AM. Sixty references containing 26 human experiments and 36 animal experiments were included. The MAs of the controlled animal studies showed comparable results with regard to closure, mortality and complications, and suggested improved mechanical strength and lower inflammation scores after AM application when compared to standard surgical closure techniques. This systematic review and MAs demonstrate that the application of AM to promote wound healing of internal organs appears to be safe, efficacious, and feasible.
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Affiliation(s)
- Lennart P Maljaars
- Department of Obstetrics and Gynecology, Amsterdam University Medical Centers, location University of Amsterdam, Amsterdam, The Netherlands.,Amsterdam Reproduction and Development research institute, Amsterdam, The Netherlands
| | - Sohayla Bendaoud
- Department of Obstetrics and Gynecology, Amsterdam University Medical Centers, location University of Amsterdam, Amsterdam, The Netherlands.,Amsterdam Reproduction and Development research institute, Amsterdam, The Netherlands
| | - Arnoud W Kastelein
- Department of Obstetrics and Gynecology, Amsterdam University Medical Centers, location University of Amsterdam, Amsterdam, The Netherlands.,Amsterdam Reproduction and Development research institute, Amsterdam, The Netherlands
| | - Zeliha Guler
- Department of Obstetrics and Gynecology, Amsterdam University Medical Centers, location University of Amsterdam, Amsterdam, The Netherlands.,Amsterdam Reproduction and Development research institute, Amsterdam, The Netherlands
| | - Carlijn R Hooijmans
- Department of Anesthesiology, Pain and Palliative Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Jan-Paul W R Roovers
- Department of Obstetrics and Gynecology, Amsterdam University Medical Centers, location University of Amsterdam, Amsterdam, The Netherlands.,Amsterdam Reproduction and Development research institute, Amsterdam, The Netherlands
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Ławkowska K, Rosenbaum C, Petrasz P, Kluth L, Koper K, Drewa T, Pokrywczynska M, Adamowicz J. Tissue engineering in reconstructive urology-The current status and critical insights to set future directions-critical review. Front Bioeng Biotechnol 2022; 10:1040987. [PMID: 36950181 PMCID: PMC10026841 DOI: 10.3389/fbioe.2022.1040987] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Accepted: 12/13/2022] [Indexed: 03/05/2023] Open
Abstract
Advanced techniques of reconstructive urology are gradually reaching their limits in terms of their ability to restore urinary tract function and patients' quality of life. A tissue engineering-based approach to urinary tract reconstruction, utilizing cells and biomaterials, offers an opportunity to overcome current limitations. Although tissue engineering studies have been heralding the imminent introduction of this method into clinics for over a decade, tissue engineering is only marginally applied. In this review, we discuss the role of tissue engineering in reconstructive urology and try to answer the question of why such a promising technology has not proven its clinical usability so far.
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Affiliation(s)
- Karolina Ławkowska
- Department of Regenerative Medicine, Collegium Medicum, Nicolaus Copernicus University, Bydgoszcz, Poland
- *Correspondence: Karolina Ławkowska, ; Clemens Rosenbaum, ; Piotr Petrasz, ; Krzysztof Koper, ; Luis Kluth, ; Tomasz Drewa, ; Marta Pokrywczynska, ; Jan Adamowicz,
| | - Clemens Rosenbaum
- Department of Urology Asklepios Klinik Barmbek Germany, Urologist in Hamburg, Hamburg, Germany
- *Correspondence: Karolina Ławkowska, ; Clemens Rosenbaum, ; Piotr Petrasz, ; Krzysztof Koper, ; Luis Kluth, ; Tomasz Drewa, ; Marta Pokrywczynska, ; Jan Adamowicz,
| | - Piotr Petrasz
- Department of Urology Voivodeship Hospital Gorzów Wielkopolski, Gorzów Wielkopolski, Poland
- *Correspondence: Karolina Ławkowska, ; Clemens Rosenbaum, ; Piotr Petrasz, ; Krzysztof Koper, ; Luis Kluth, ; Tomasz Drewa, ; Marta Pokrywczynska, ; Jan Adamowicz,
| | - Luis Kluth
- Department of Urology, University Medical Center Frankfurt, Frankfurt am Main, Germany
- *Correspondence: Karolina Ławkowska, ; Clemens Rosenbaum, ; Piotr Petrasz, ; Krzysztof Koper, ; Luis Kluth, ; Tomasz Drewa, ; Marta Pokrywczynska, ; Jan Adamowicz,
| | - Krzysztof Koper
- Department of Clinical Oncology and Nursing, Collegium Medicum, Nicolaus Copernicus University, Curie-Skłodowskiej 9, Bydgoszcz, Poland
- *Correspondence: Karolina Ławkowska, ; Clemens Rosenbaum, ; Piotr Petrasz, ; Krzysztof Koper, ; Luis Kluth, ; Tomasz Drewa, ; Marta Pokrywczynska, ; Jan Adamowicz,
| | - Tomasz Drewa
- Department of Regenerative Medicine, Collegium Medicum, Nicolaus Copernicus University, Bydgoszcz, Poland
- *Correspondence: Karolina Ławkowska, ; Clemens Rosenbaum, ; Piotr Petrasz, ; Krzysztof Koper, ; Luis Kluth, ; Tomasz Drewa, ; Marta Pokrywczynska, ; Jan Adamowicz,
| | - Marta Pokrywczynska
- Department of Regenerative Medicine, Collegium Medicum, Nicolaus Copernicus University, Bydgoszcz, Poland
- *Correspondence: Karolina Ławkowska, ; Clemens Rosenbaum, ; Piotr Petrasz, ; Krzysztof Koper, ; Luis Kluth, ; Tomasz Drewa, ; Marta Pokrywczynska, ; Jan Adamowicz,
| | - Jan Adamowicz
- Department of Regenerative Medicine, Collegium Medicum, Nicolaus Copernicus University, Bydgoszcz, Poland
- *Correspondence: Karolina Ławkowska, ; Clemens Rosenbaum, ; Piotr Petrasz, ; Krzysztof Koper, ; Luis Kluth, ; Tomasz Drewa, ; Marta Pokrywczynska, ; Jan Adamowicz,
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Abbas TO, Elawad A, Kareem A, Pullattayil S AK, Ali M, Alnaimi A. Preclinical Experiments for Hypospadias Surgery: Systematic Review and Quality Assessment. Front Pediatr 2021; 9:718647. [PMID: 34458213 PMCID: PMC8386350 DOI: 10.3389/fped.2021.718647] [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: 06/01/2021] [Accepted: 07/05/2021] [Indexed: 12/09/2022] Open
Abstract
Background: There is a steadily growing number of different reconstructive surgical procedures for hypospadias that were tested on animal models prior to their human application. However, the clinical translatability and reproducibility of the results encountered in preclinical urethral reconstruction experiments is considered poor, with significant factors contributing to the poor design and reporting of animal experiments. Our objective was to evaluate the quality of the design and reporting in published articles of urethral reconstructive preclinical studies. Methods: Both PubMed and EMBASE databases were searched for animal urethral repair experiments between January 2014 and September 2019. Internal quality (bias) was evaluated through several signaling questions arising from the Systematic Review Centre for Laboratory animal Experimentation (SYRCLE), while the quality of reporting was assessed by the Animal Research: Reporting of In vivo Experiments (ARRIVE) guidelines by scoring of a 20-item checklist. Results: A total of 638 articles were initially screened after the literature search. Employing the inclusion and exclusion criteria, 30 studies were chosen for full-text screening and 21 studies were considered eligible for the quality assessment. The mean score of the checklist was 66%. The elements that accomplished the highest grades included the number of animals utilized, the number in each investigational and control group, and the delineation of investigational conclusions. The items that were least commonly stated comprised information about the experimental method, housing and husbandry, rationalization of the number of animals, and reporting of adverse events. No paper stated the sample size estimation. Conclusion: We found that several critical experiment design principles were poorly reported, which hinders a rigorous appraisal of the scientific quality and reproducibility of the experiments. A comprehensive implementation of the ARRIVE guidelines in animal studies exploring urethral repair is necessary to facilitate the effective translation of preclinical research findings into clinical therapies.
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Affiliation(s)
- Tariq O Abbas
- Regenerative Medicine Research Group, Department of Health Science and Technology, Aalborg University, Aalborg, Denmark.,Pediatric Urology Section, Sidra Medicine, Doha, Qatar.,College of Medicine, Qatar University, Doha, Qatar.,Weill Cornell Medicine Qatar, Doha, Qatar
| | | | - Aamir Kareem
- Pediatric Urology Section, Sidra Medicine, Doha, Qatar
| | | | - Mansour Ali
- Pediatric Urology Section, Sidra Medicine, Doha, Qatar
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Placental membrane grafts for urethral replacement in a rabbit model: a pilot study. World J Urol 2019; 38:2133-2138. [PMID: 31201521 DOI: 10.1007/s00345-019-02836-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Accepted: 06/03/2019] [Indexed: 12/12/2022] Open
Abstract
PURPOSE Several graft materials are available for use in the treatment of urethral stricture disease. Placental membrane is being used in a variety of settings as a graft in wound healing and tissue repair. We aim to evaluate the effect of implanting decellularized human placental membrane into rabbit urethras. METHODS Dorsal onlay graft urethroplasty using prepared human placental membrane was performed in 10 New Zealand White rabbits (Oryctolagus cuniculus). After 3 months, the rabbits underwent cystourethroscopy to evaluate urethral patency. The rabbits were then euthanized and the urethras examined for pathological findings. RESULTS All urethroplasties were performed without complication. There were no observed episodes of urinary retention, infection, or renal failure. Urethral patency was achieved in all rabbits 3 months postoperatively. Urothelial replacement of the placental membrane graft was observed in all rabbits without malignant transformation. CONCLUSION Dorsal onlay urethroplasty using decellularized human placental membrane can safely be performed in a rabbit model. This pilot study demonstrated urothelial replacement of human placental membrane in the rabbit urethra without stricture formation. Placental membrane is a promising biomaterial for urethral reconstruction.
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Adamowicz J, Van Breda S, Tyloch D, Pokrywczynska M, Drewa T. Application of amniotic membrane in reconstructive urology; the promising biomaterial worth further investigation. Expert Opin Biol Ther 2018; 19:9-24. [PMID: 30521409 DOI: 10.1080/14712598.2019.1556255] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Introduction: In reconstructive urology, autologous tissues such as intestinal segments, skin, and oral mucosa are used. Due to their limitations, reconstructive urologists are waiting for a novel material, which would be suitable for urinary tract wall replacement. Human amniotic membrane (AM) is a naturally derived biomaterial with a capacity to support reepithelization and inhibit scar formation. AM has a potential to become a considerable asset for reconstructive urology, i.e., reconstruction of ureters, urinary bladder, and urethrae. Areas covered: This review aims to discuss the potential application of human AM in reconstructive urology. The environment for urinary tract healing is particularly unfavorable due to the presence of urine. Due to its fetal origin, the bioactivity of AM is orientated to induce intrinsic regeneration mechanisms and inhibit scarring. This review introduces the concept of applying human AM in reconstructive urology procedures to improve their outcomes and future tissue engineering based strategies. Expert opinion: Many fields of medicine that have accomplished translational research have proven the usefulness of AM in clinical practice. There is an urgent need for studies to be conducted on large animal models that might convincingly demonstrate the underestimated potential of AM to urologists around the world.
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Affiliation(s)
- Jan Adamowicz
- a Chair of Urology, Department of Regenerative Medicine, Collegium Medicum , Nicolaus Copernicus University , Bydgoszcz , Poland
| | - Shane Van Breda
- b Department of Biomedicine , University Hospital Basel , Basel , Switzerland
| | - Dominik Tyloch
- a Chair of Urology, Department of Regenerative Medicine, Collegium Medicum , Nicolaus Copernicus University , Bydgoszcz , Poland
| | - Marta Pokrywczynska
- a Chair of Urology, Department of Regenerative Medicine, Collegium Medicum , Nicolaus Copernicus University , Bydgoszcz , Poland
| | - Tomasz Drewa
- a Chair of Urology, Department of Regenerative Medicine, Collegium Medicum , Nicolaus Copernicus University , Bydgoszcz , Poland
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7
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Affiliation(s)
- Jason Akerman
- Department of Urology, McMaster University, Hamilton, Ontario, Canada
| | - Jason R Kovac
- Men's Health Center, Indianapolis, Indiana 46260, USA
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