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Liu J, Yao X, Wang Z, Ye J, Luan C, He Y, Lin H, Fu J. A flexible porous chiral auxetic tracheal stent with ciliated epithelium. Acta Biomater 2021; 124:153-165. [PMID: 33529770 DOI: 10.1016/j.actbio.2021.01.044] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2020] [Revised: 01/24/2021] [Accepted: 01/26/2021] [Indexed: 12/13/2022]
Abstract
Tracheal stent placement is a principal treatment for tracheobronchial stenosis, but complications such as mucus plugging, secondary stenosis, migration, and strong foreign body sensation remain unavoidable challenges. In this study, we designed a flexible porous chiral tracheal stent intended to reduce or overcome these complications. The stent was innovatively designed with a flexible tetrachiral and anti-tetrachiral hybrid structure as the frame and hollows filled with porous silicone sponge. Detailed finite element analysis (FEA) showed that the designed frame can maintain a Poisson's ratio that is negative or close to zero at up to 50% tensile strain. This contributes to improved airway ventilation and better resistance to migration during physiological activities such as respiration and neck movement. The preparation process combined indirect 3D printing with gas foaming and particulate leaching methods to efficiently fabricate the stent. The stent was then subjected to uniaxial tension and local radial compression tests, which indicated that it not only has the same desirable auxetic performance but also has flexibility similar to the native trachea. The porous sponge facilitated the adhesion of cells, allowed nutrient diffusion, and would prevent the ingrowth of granulation tissue. Furthermore, a ciliated tracheal epithelium similar to that of the native trachea was differentiated from normal human bronchial primary epithelial cells on the internal wall of the stent under air-liquid interface conditions. These results suggest that the designed stent has the potential for application in the treatment of tracheobronchial stenosis.
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Affiliation(s)
- Jiapeng Liu
- State Key Laboratory of Fluid Power & Mechatronic Systems, College of Mechanical Engineering, Zhejiang University, Hangzhou 310027, People's Republic of China; Key Laboratory of 3D Printing Process and Equipment of Zhejiang Province, College of Mechanical Engineering, Zhejiang University, Hangzhou 310027, People's Republic of China
| | - Xinhua Yao
- State Key Laboratory of Fluid Power & Mechatronic Systems, College of Mechanical Engineering, Zhejiang University, Hangzhou 310027, People's Republic of China; Key Laboratory of 3D Printing Process and Equipment of Zhejiang Province, College of Mechanical Engineering, Zhejiang University, Hangzhou 310027, People's Republic of China.
| | - Zhenwei Wang
- State Key Laboratory of Fluid Power & Mechatronic Systems, College of Mechanical Engineering, Zhejiang University, Hangzhou 310027, People's Republic of China; Key Laboratory of 3D Printing Process and Equipment of Zhejiang Province, College of Mechanical Engineering, Zhejiang University, Hangzhou 310027, People's Republic of China
| | - Jian Ye
- Department of Pneumology, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou 310006, People's Republic of China
| | - Congcong Luan
- State Key Laboratory of Fluid Power & Mechatronic Systems, College of Mechanical Engineering, Zhejiang University, Hangzhou 310027, People's Republic of China; Key Laboratory of 3D Printing Process and Equipment of Zhejiang Province, College of Mechanical Engineering, Zhejiang University, Hangzhou 310027, People's Republic of China
| | - Yong He
- State Key Laboratory of Fluid Power & Mechatronic Systems, College of Mechanical Engineering, Zhejiang University, Hangzhou 310027, People's Republic of China; Key Laboratory of 3D Printing Process and Equipment of Zhejiang Province, College of Mechanical Engineering, Zhejiang University, Hangzhou 310027, People's Republic of China
| | - Hui Lin
- Department of General Surgery, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang 310058, People's Republic of China
| | - Jianzhong Fu
- State Key Laboratory of Fluid Power & Mechatronic Systems, College of Mechanical Engineering, Zhejiang University, Hangzhou 310027, People's Republic of China; Key Laboratory of 3D Printing Process and Equipment of Zhejiang Province, College of Mechanical Engineering, Zhejiang University, Hangzhou 310027, People's Republic of China
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Abstract
Trachea replacement for nonoperable defects remains an unsolved problem due to complications with stenosis and mechanical insufficiency. While native trachea has anisotropic mechanical properties, the vast majority of engineered constructs focus on uniform cartilaginous-like conduits. These conduits often lack quantitative mechanical analysis at the construct level, which limits analysis of functional outcomes in vivo, as well as comparisons across studies. This review aims to present a clear picture of native tracheal mechanics at the tissue and organ level, as well as loading conditions to establish design criteria for trachea replacements. We further explore the implications of failing to match native properties with regards to implant collapse, stenosis, and infection.
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Affiliation(s)
- Elizabeth M Boazak
- Department of Biomedical Engineering, The City College of New York, Steinman Hall, 160 Convent Avenue, New York, New York 10031, United States
| | - Debra T Auguste
- Department of Biomedical Engineering, The City College of New York, Steinman Hall, 160 Convent Avenue, New York, New York 10031, United States.,Department of Chemical Engineering, Northeastern University, 360 Huntington Avenue, Boston, Massachusetts 02115, United States
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