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Ojha AK, Rajasekaran R, Hansda AK, Choudhury P, Biswas A, Sharma S, Chaudhuri PP, Dogra N, Goswami R, Chaudhury K, Dhara S. Biochemical and immunomodulatory insights of extracellular matrix from decellularized human whole cervix: recellularization and in vivoECM remodeling interplay. Biofabrication 2024; 16:035014. [PMID: 38663394 DOI: 10.1088/1758-5090/ad4393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2023] [Accepted: 04/25/2024] [Indexed: 05/08/2024]
Abstract
Extracellular matrix (ECM) rich whole organ bio-scaffolds, preserving structural integrity and essential growth factors, has potential towards regeneration and reconstruction. Women with cervical anomalies or trauma can benefit from clinical cervicovaginal repair using constructs rich in site specific ECM. In this study, complete human cervix decellularization was achieved using a modified perfusion-based stir bench top decellularization method. This was followed by physico-chemical processes including perfusion of ionic agents, enzymatic treatment and washing using detergent solutions for a duration of 10-12 d. Histopathological analysis, as well as DNA quantification confirmed the efficacy of the decellularization process. Tissue ultrastructure integrity was preserved and the same was validated via scanning electron microscopy and transmission electron microscopy studies. Biochemical analysis and structural characterizations like Fourier transform infrared, Raman spectroscopy of decellularized tissues demonstrated preservation of important proteins, crucial growth factors, collagen, and glycosaminoglycans.In vitrostudies, using THP-1 and human umbilical vein endothelial cell (HUVEC) cells, demonstrated macrophage polarization from M1 to M2 and vascular functional genes enhancement, respectively, when treated with decellularized human cervical matrix (DHCp). Crosslinked DHC scaffolds were recellularized with site specific human cervical epithelial cells and HUVEC, showing non-cytotoxic cell viability and enhanced proliferation. Furthermore, DHC scaffolds showed immunomodulatory effectsin vivoon small rodent model via upregulation of M2 macrophage genes as compared to decellularized rat cervix matrix scaffolds (DRC). DHC scaffolds underwent neo-vascularization followed by ECM remodeling with enhanced tissue integration.
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Affiliation(s)
- Atul Kumar Ojha
- School of Medical Science and Technology, Indian Institute of Technology Kharagpur, Kharagpur, India
| | - Ragavi Rajasekaran
- School of Medical Science and Technology, Indian Institute of Technology Kharagpur, Kharagpur, India
| | - Arman Kunwar Hansda
- School of Bioscience, Indian Institute of Technology Kharagpur, Kharagpur, India
| | - Priyanka Choudhury
- School of Medical Science and Technology, Indian Institute of Technology Kharagpur, Kharagpur, India
| | - Asmita Biswas
- School of Medical Science and Technology, Indian Institute of Technology Kharagpur, Kharagpur, India
| | - Sunita Sharma
- Institute of Reproductive Medicine, Salt Lake, Kolkata, India
| | - Prithwis Pal Chaudhuri
- Department of Obstetrics and Gynecology, Zenith Super specialty hospital, Kolkata, India
| | - Nantu Dogra
- School of Medical Science and Technology, Indian Institute of Technology Kharagpur, Kharagpur, India
| | - Ritobrata Goswami
- School of Bioscience, Indian Institute of Technology Kharagpur, Kharagpur, India
| | - Koel Chaudhury
- School of Medical Science and Technology, Indian Institute of Technology Kharagpur, Kharagpur, India
| | - Santanu Dhara
- School of Medical Science and Technology, Indian Institute of Technology Kharagpur, Kharagpur, India
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Elia E, Caneparo C, McMartin C, Chabaud S, Bolduc S. Tissue Engineering for Penile Reconstruction. Bioengineering (Basel) 2024; 11:230. [PMID: 38534504 DOI: 10.3390/bioengineering11030230] [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: 11/08/2023] [Revised: 02/19/2024] [Accepted: 02/23/2024] [Indexed: 03/28/2024] Open
Abstract
The penis is a complex organ with a development cycle from the fetal stage to puberty. In addition, it may suffer from either congenital or acquired anomalies. Penile surgical reconstruction has been the center of interest for many researchers but is still challenging due to the complexity of its anatomy and functionality. In this review, penile anatomy, pathologies, and current treatments are described, including surgical techniques and tissue engineering approaches. The self-assembly technique currently applied is emphasized since it is considered promising for an adequate tissue-engineered penile reconstructed substitute.
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Affiliation(s)
- Elissa Elia
- Centre de Recherche en Organogénèse Expérimentale/LOEX, Regenerative Medicine Division, CHU de Québec-Université Laval Research Center, Québec, QC G1J 1Z4, Canada
| | - Christophe Caneparo
- Centre de Recherche en Organogénèse Expérimentale/LOEX, Regenerative Medicine Division, CHU de Québec-Université Laval Research Center, Québec, QC G1J 1Z4, Canada
| | - Catherine McMartin
- Division of Urology, Department of Surgery, CHU de Québec-Université Laval, Québec, QC G1V 4G2, Canada
| | - Stéphane Chabaud
- Centre de Recherche en Organogénèse Expérimentale/LOEX, Regenerative Medicine Division, CHU de Québec-Université Laval Research Center, Québec, QC G1J 1Z4, Canada
| | - Stéphane Bolduc
- Centre de Recherche en Organogénèse Expérimentale/LOEX, Regenerative Medicine Division, CHU de Québec-Université Laval Research Center, Québec, QC G1J 1Z4, Canada
- Division of Urology, Department of Surgery, CHU de Québec-Université Laval, Québec, QC G1V 4G2, Canada
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Kuniakova M, Klein M, Galfiova P, Csobonyeiova M, Feitscherova C, Polak S, Novakova ZV, Topoliova K, Trebaticky B, Varga I, Danisovic L, Ziaran S. Decellularization of the human urethra for tissue engineering applications. Exp Biol Med (Maywood) 2023; 248:1034-1042. [PMID: 37073134 PMCID: PMC10581165 DOI: 10.1177/15353702231162092] [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: 10/25/2022] [Accepted: 01/24/2023] [Indexed: 04/20/2023] Open
Abstract
Recently, several scaffolds have been introduced for urethral tissue engineering. However, acellular human urethral scaffold harvested from deceased donors may provide significant advantages compared to synthetic, composite, or other biological scaffolds. This study aims to develop the protocol for decellularization of the human urethra that preserves substantial extracellular matrix (ECM) components, which are essential for subsequent recellularization mimicking the natural environment of the native ECM. A total of 12 human urethras were harvested from deceased donors. An equal part of every harvested urethra was used as a control sample for analyses. The protocol design was based on the enzyme-detergent-enzyme method. Trypsin and Triton X-100 were used to remove cells, followed by DNase treatment to remove DNA residues. Subsequently, the specimens were continually rinsed in deionized water for seven days. The efficiency of decellularization was determined by histochemistry, immunohistochemical staining, scanning electron microscopy (SEM), and DNA quantification. Histological analysis confirmed cell removal and preservation of urethral structure after decellularization. The preservation of collagen IV and fibronectin was confirmed by histologic examination and immunohistochemical staining. SEM confirmed the maintenance of the ultrastructural architecture of ECM and fibers. DNA content in decellularized urethra was significantly lower compared to the native sample (P < 0.001), and so the criteria for decellularized tissue were met. Cytotoxicity analysis data showed that the matrix-conditioned medium did not contain soluble toxins and had no significant inhibitory effect on cell proliferation, providing evidence that the decellularized samples are not toxic. This study demonstrates the feasibility of the enzyme-detergent-enzyme-based decellularization protocol for removing cellular components and maintaining urethral ECM and its ultrastructure. Moreover, obtained results provide solid ground for recellularization and urethral tissue engineering, which will follow.
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Affiliation(s)
- Marcela Kuniakova
- Institute of Medical Biology, Genetics and Clinical Genetics, Faculty of Medicine, Comenius University Bratislava 811 08, Slovakia
- National Institute of Rheumatic Diseases, Piestany 921 12, Slovakia
| | - Martin Klein
- National Institute of Rheumatic Diseases, Piestany 921 12, Slovakia
- Institute of Histology and Embryology, Faculty of Medicine, Comenius University Bratislava, Bratislava 811 08, Slovakia
| | - Paulina Galfiova
- Institute of Histology and Embryology, Faculty of Medicine, Comenius University Bratislava, Bratislava 811 08, Slovakia
| | - Maria Csobonyeiova
- National Institute of Rheumatic Diseases, Piestany 921 12, Slovakia
- Institute of Histology and Embryology, Faculty of Medicine, Comenius University Bratislava, Bratislava 811 08, Slovakia
| | - Claudia Feitscherova
- National Institute of Rheumatic Diseases, Piestany 921 12, Slovakia
- Institute of Histology and Embryology, Faculty of Medicine, Comenius University Bratislava, Bratislava 811 08, Slovakia
| | - Stefan Polak
- Institute of Histology and Embryology, Faculty of Medicine, Comenius University Bratislava, Bratislava 811 08, Slovakia
| | - Zuzana Varchulova Novakova
- Institute of Medical Biology, Genetics and Clinical Genetics, Faculty of Medicine, Comenius University Bratislava 811 08, Slovakia
- National Institute of Rheumatic Diseases, Piestany 921 12, Slovakia
| | - Katarina Topoliova
- Department of Urology, Faculty of Medicine, Comenius University Bratislava, Bratislava 833 05, Slovakia
| | - Branislav Trebaticky
- National Institute of Rheumatic Diseases, Piestany 921 12, Slovakia
- Department of Urology, Faculty of Medicine, Comenius University Bratislava, Bratislava 833 05, Slovakia
| | - Ivan Varga
- National Institute of Rheumatic Diseases, Piestany 921 12, Slovakia
- Institute of Histology and Embryology, Faculty of Medicine, Comenius University Bratislava, Bratislava 811 08, Slovakia
| | - Lubos Danisovic
- Institute of Medical Biology, Genetics and Clinical Genetics, Faculty of Medicine, Comenius University Bratislava 811 08, Slovakia
- National Institute of Rheumatic Diseases, Piestany 921 12, Slovakia
| | - Stanislav Ziaran
- National Institute of Rheumatic Diseases, Piestany 921 12, Slovakia
- Department of Urology, Faculty of Medicine, Comenius University Bratislava, Bratislava 833 05, Slovakia
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Cao Z, Liu L, Yang Z, Li Y, Jiao H, Zhang T, Zhou L. The pedicled gracilis muscle combined with the fascia lata: a preliminary clinical study of a new biomimetic dynamic phalloplasty method. J Sex Med 2023; 20:573-579. [PMID: 36763921 DOI: 10.1093/jsxmed/qdac022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Revised: 10/18/2022] [Accepted: 10/18/2022] [Indexed: 01/13/2023]
Abstract
BACKGROUND Phalloplasty is a challenging procedure in the field of repair and reconstruction. Traditional skin flap methods with prostheses or autologous tissue implantation are still common; however, with this method the reconstructed phallus is static and has a high risk of complications. AIM We aimed to use novel methods for phalloplasty to mimic the normal structure of the phallus while maintaining the patient's ability to obtain sufficient hardness and subjective controllability. METHODS The neophallus comprised the bilateral pedicled neurovascular gracilis muscle, which provided neophallus volitional control; the pedicled fascia lata, which mimicked the tunica albuginea; the pedicled anterolateral thigh flap, which was used to reconstruct the neourethra and neoglans; and the thin split-thickness skin grafted on the surface of the fascia lata. The urethral anastomosis was performed simultaneously. The appearance and function of the neophallus, as well as patient satisfaction, were evaluated postoperatively. OUTCOMES The biomimetic dynamic phalloplasty using the bilateral pedicled gracilis muscle combined with the fascia lata was successfully performed in 4 patients. RESULTS During follow-up at 10-21 months after the procedure, all 4 patients could complete sexual intercourse and were satisfied with the appearance and self-controllability of the neophallus. The size of the neophallus stabilized within 6 months. The tactile, deep touch sensation, and pain sensations of the neophallus partially recovered. All of the patients could stand to urinate. CLINICAL IMPLICATIONS We used the gracilis muscle combined with the fascia lata to mimic the basic structure of the corpus cavernosum and tunica albuginea and successfully reconstructed the biomimetic dynamic neophallus. STRENGTHS AND LIMITATIONS This is to our knowledge the first report of biomimetic dynamic phalloplasty using the bilateral pedicled gracilis muscle combined with the fascia lata to mimic the complex structure of the phallus and enable the achievement of erection. However, due to the small number of patients included in this study, the data have no statistical significance. More cases are needed to obtain conclusive data and examine the long-term clinical effects of this procedure. CONCLUSION Using novel methods for phalloplasty, we successfully maintained the patient's ability to obtain sufficient hardness and subjective controllability without the use of implants, and the preliminary clinical results are encouraging.
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Affiliation(s)
- Zilong Cao
- Ninth Department, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Liqiang Liu
- Ninth Department, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Zhe Yang
- Second Department, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yangqun Li
- Second Department, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Hu Jiao
- Ninth Department, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Tiran Zhang
- Ninth Department, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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Cao Z, Liu L, Jiao H, Gan C, Tian J, Zhang T, Han B. A Preliminary Study of Constructing the Tissue-Engineered Corpus Cavernosum With Autologous Adipose Stem Cells In Vivo. Sex Med 2022; 10:100563. [PMID: 36087453 PMCID: PMC9537274 DOI: 10.1016/j.esxm.2022.100563] [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: 05/24/2022] [Revised: 07/20/2022] [Accepted: 08/02/2022] [Indexed: 11/28/2022] Open
Abstract
Introduction The autologous skin flap is still the mainstream method for penile reconstruction, but it is very difficult to reconstruct a functional corpus cavernosum. Tissue engineering provides a new idea aiming to restore the damaged or absent corpus cavernosum. Aim To assess the feasibility of constructing the tissue-engineered corpus cavernosum with autologous adipose stem cells in a rabbit model. Methods A total of 30 New Zealand male white rabbits. Among them, 20 rabbits were used to obtain the original corpus cavernosum which were used to prepare the acellular corporal scaffolds (ACSs). The others were used for acquiring autologous adipose stem cells (ADSCs) and constructing tissue-engineered corpus cavernosum in vivo. Outcome ACSs were obtained from rabbit penile tissues through an established decellularization procedure. Rabbit autologous ADSCs as seed cells were harvested and expanded. The ADSCs seeded and unseeded ACSs were implanted back into the intramuscular and subcutaneous site in vivo, and the tissue-engineered corpus cavernosum was harvested and analyzed with gross morphology, histological staining, and real-time PCR assay after 1, 3, and 6 months. Results ACSs were successfully prepared. The cell non-cytotoxicity and integrity of micro-architecture of ACSs was confirmed in vitro. The cell-seeded scaffold in the intramuscular group was considered as the better strategy for constructing the tissue-engineered corpus cavernosum compared with the other groups. Some α-SMA and CD31 positive cells were detected and identified by immunofluorescent staining and real-time PCR assay in the tissue-engineered corpus cavernosum. Clinical Translation This study provides a new method for constructing the tissue-engineered corpus cavernosum. Strengths and Limitations First, it is urgent to improve the transformation rate of the endothelial cells and smooth muscle cells from ADSCs. Second, the scaffold harvested in this study was not a complete matrix. Third, further study is needed to explore the potential mechanism of which scaffolds are more suitable for living in intramuscular rather than subcutaneous environment. Conclusion In this study, we used the autologous ADSCs as seed cells, the acellular corpus cavernosum as scaffolds, and implanted the grafts back into the rabbit model to preliminarily construct the tissue-engineered corpus cavernosum. This study would provide help for further development in tissue-engineered corpus cavernosum. Cao Z, Liu L, Jiao H, et al. A Preliminary Study of Constructing the Tissue-Engineered Corpus Cavernosum With Autologous Adipose Stem Cells In Vivo. Sex Med 2022;10:100563.
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Affiliation(s)
- Zilong Cao
- Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Liqiang Liu
- Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
| | - Hu Jiao
- Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Cheng Gan
- Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jia Tian
- Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Tiran Zhang
- Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Bing Han
- Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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Nicholls DL, Rostami S, Karoubi G, Haykal S. Perfusion decellularization for vascularized composite allotransplantation. SAGE Open Med 2022; 10:20503121221123893. [PMID: 36120388 PMCID: PMC9478687 DOI: 10.1177/20503121221123893] [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: 01/20/2021] [Accepted: 08/12/2022] [Indexed: 11/01/2022] Open
Abstract
Vascularized composite allotransplantation is becoming the emerging standard for reconstructive surgery treatment for patients with limb trauma and facial injuries involving soft tissue loss. Due to the complex immunogenicity of composite grafts, patients who undergo vascularized composite allotransplantation are reliant on lifelong immunosuppressive therapy. Decellularization of donor grafts to create an extracellular matrix bio-scaffold provides an immunomodulatory graft that preserves the structural and bioactive function of the extracellular matrix. Retention of extracellular matrix proteins, growth factors, and signaling cascades allow for cell adhesion, migration, proliferation, and tissue regeneration. Perfusion decellularization of detergents through the graft vasculature allows for increased regent access to all tissue layers, and removal of cellular debris through the venous system. Grafts can subsequently be repopulated with appropriate cells through the vasculature to facilitate tissue regeneration. The present work reviews methods of decellularization, process parameters, evaluation of adequate cellular and nuclear removal, successful applications of perfusion decellularization for use in vascularized composite allotransplantation, and current limitations.
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Affiliation(s)
| | - Sara Rostami
- Latner Thoracic Surgery Laboratories, Toronto General Hospital Research Institute, Toronto General Hospital, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Golnaz Karoubi
- Latner Thoracic Surgery Laboratories, Toronto General Hospital Research Institute, Toronto General Hospital, University Health Network, University of Toronto, Toronto, ON, Canada.,Departments of Mechanical and Industrial Engineering and Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada
| | - Siba Haykal
- Latner Thoracic Surgery Laboratories, Toronto General Hospital Research Institute, Toronto General Hospital, University Health Network, University of Toronto, Toronto, ON, Canada.,Division of Plastic & Reconstructive Surgery, Department of Surgery, University of Toronto, Toronto, ON, Canada
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Girard P, Dulong J, Duisit J, Mocquard C, Le Gallou S, Chaput B, Lupon E, Watier E, Varin A, Tarte K, Bertheuil N. Modified nanofat grafting: Stromal vascular fraction simple and efficient mechanical isolation technique and perspectives in clinical recellularization applications. Front Bioeng Biotechnol 2022; 10:895735. [PMID: 36177178 PMCID: PMC9513316 DOI: 10.3389/fbioe.2022.895735] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 08/17/2022] [Indexed: 11/17/2022] Open
Abstract
Background: Nanofat grafting (NG) is a simple and cost-effective method of lipoaspirates with inter-syringe passages, to produce stromal vascular fraction (SVF) and isolate adipose-derived stem cells (ASCs). This represents a tremendous interest in the future clinical needs of tissue engineering. In this study, we optimized the NG technique to increase the yield of ASC extractions. Methods: We analyzed three groups of SVF obtained by 20, 30, and 40 inter-syringe passages. The control group was an SVF obtained by enzymatic digestion with Celase. We studied their cell composition by flow cytometry, observed their architecture by confocal microscopy, and observed immunomodulatory properties of the ASCs from each of the SVFs by measuring inflammatory markers of macrophages obtained by an ASC monocyte co-culture. Results: We have established the first cell mapping of the stromal vascular fraction of adipose tissue. The results showed that SVF obtained by 20 inter-syringe passages contains more statistically significant total cells, more cells expressing the ASC phenotype, more endothelial cells, and produces more CFU-F than the SVF obtained by 30 and 40 passages and by enzymatic digestion. Confocal microscopy showed the presence of residual adipocytes in SVF obtained by inter-syringe passages but not by enzymatic digestion. The functional study indicates an orientation toward a more anti-inflammatory profile and homogenization of their immunomodulatory properties. Conclusion: This study places mechanically dissociated SVF in the center of approaches to easily extract ASCs and a wide variety and number of other progenitor cells, immediately available in a clinical setting to provide both the amount and quality of cells required for decellularized tissues.
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Affiliation(s)
- Paul Girard
- Department of Plastic, Reconstructive and Aesthetic Surgery, CHU Rennes, University of Rennes I, Rennes, France
- INSERM U1236, University of Rennes I, Rennes, France
- SITI Laboratory, CHU Rennes, Rennes, France
- *Correspondence: Paul Girard, ; Nicolas Bertheuil,
| | - Joelle Dulong
- INSERM U1236, University of Rennes I, Rennes, France
- SITI Laboratory, CHU Rennes, Rennes, France
| | - Jerome Duisit
- Department of Plastic, Reconstructive and Aesthetic Surgery, CHU Rennes, University of Rennes I, Rennes, France
| | - Camille Mocquard
- Department of Plastic, Reconstructive and Aesthetic Surgery, CHU Rennes, University of Rennes I, Rennes, France
- INSERM U1236, University of Rennes I, Rennes, France
- SITI Laboratory, CHU Rennes, Rennes, France
| | - Simon Le Gallou
- INSERM U1236, University of Rennes I, Rennes, France
- SITI Laboratory, CHU Rennes, Rennes, France
| | - Benoit Chaput
- Department of Plastic, Reconstructive and Aesthetic Surgery, Rangueil Hospital, CHU Toulouse, Toulouse, France
- INSERM U1031 STROMALab, Toulouse, France
| | - Elise Lupon
- Department of Plastic, Reconstructive and Aesthetic Surgery, Rangueil Hospital, CHU Toulouse, Toulouse, France
| | - Eric Watier
- Department of Plastic, Reconstructive and Aesthetic Surgery, CHU Rennes, University of Rennes I, Rennes, France
| | | | - Karin Tarte
- INSERM U1236, University of Rennes I, Rennes, France
- SITI Laboratory, CHU Rennes, Rennes, France
| | - Nicolas Bertheuil
- Department of Plastic, Reconstructive and Aesthetic Surgery, CHU Rennes, University of Rennes I, Rennes, France
- INSERM U1236, University of Rennes I, Rennes, France
- SITI Laboratory, CHU Rennes, Rennes, France
- *Correspondence: Paul Girard, ; Nicolas Bertheuil,
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Adil A, Xu M, Haykal S. Recellularization of Bioengineered Scaffolds for Vascular Composite Allotransplantation. Front Surg 2022; 9:843677. [PMID: 35693318 PMCID: PMC9174637 DOI: 10.3389/fsurg.2022.843677] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Accepted: 05/09/2022] [Indexed: 12/20/2022] Open
Abstract
Traumatic injuries or cancer resection resulting in large volumetric soft tissue loss requires surgical reconstruction. Vascular composite allotransplantation (VCA) is an emerging reconstructive option that transfers multiple, complex tissues as a whole subunit from donor to recipient. Although promising, VCA is limited due to side effects of immunosuppression. Tissue-engineered scaffolds obtained by decellularization and recellularization hold great promise. Decellularization is a process that removes cellular materials while preserving the extracellular matrix architecture. Subsequent recellularization of these acellular scaffolds with recipient-specific cells can help circumvent adverse immune-mediated host responses and allow transplantation of allografts by reducing and possibly eliminating the need for immunosuppression. Recellularization of acellular tissue scaffolds is a technique that was first investigated and reported in whole organs. More recently, work has been performed to apply this technique to VCA. Additional work is needed to address barriers associated with tissue recellularization such as: cell type selection, cell distribution, and functionalization of the vasculature and musculature. These factors ultimately contribute to achieving tissue integration and viability following allotransplantation. The present work will review the current state-of-the-art in soft tissue scaffolds with specific emphasis on recellularization techniques. We will discuss biological and engineering process considerations, technical and scientific challenges, and the potential clinical impact of this technology to advance the field of VCA and reconstructive surgery.
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Affiliation(s)
- Aisha Adil
- Latner Thoracic Surgery Laboratories, University Health Network, Toronto General Hospital, University of Toronto, Toronto, ON, Canada
- Institute of Medical Science, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Michael Xu
- Latner Thoracic Surgery Laboratories, University Health Network, Toronto General Hospital, University of Toronto, Toronto, ON, Canada
- Institute of Medical Science, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Division of General Surgery, Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Siba Haykal
- Latner Thoracic Surgery Laboratories, University Health Network, Toronto General Hospital, University of Toronto, Toronto, ON, Canada
- Institute of Medical Science, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Division of Plastic & Reconstructive Surgery, Department of Surgery, University of Toronto, Toronto, ON, Canada
- Correspondence: Siba Haykal
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Parker A, Blasdel G, Kloer C, Kimberly L, Shakir N, Robinson I, Bluebond-Langner R, Zhao LC. "Postulating Penis: What Influences the Interest of Transmasculine Patients in Gender Affirming Penile Reconstruction Techniques?". J Sex Med 2022; 19:385-393. [PMID: 34920952 DOI: 10.1016/j.jsxm.2021.10.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 09/15/2021] [Accepted: 10/10/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND The limitations of metoidioplasty and phalloplasty have been reported as deterrents for transgender and other gender expansive individuals (T/GE) desiring gender affirming surgery, and thus penile transplantation, epithesis, and composite tissue engineering (CTE) are being explored as alternative interventions. AIM We aim to understand the acceptability of novel techniques and factors that may influence patient preferences in surgery to best treat this diverse population. METHODS Descriptions of metoidioplasty, phalloplasty, epithesis, CTE, and penile transplant were delivered via online survey from January 2020 to May 2020. Respondents provided ordinal ranking of interest in each intervention from 1 to 5, with 1 representing greatest personal interest. Demographics found to be significant on univariable analysis underwent multivariable ordinal logistic regression to determine independent predictors of interest. OUTCOMES Sexual orientation, gender, and age were independent predictors of interest in interventions. RESULTS There were 965 qualifying respondents. Gay respondents were less likely to be interested in epithesis (OR: 2.282; P = .001) compared to other sexual orientations. Straight individuals were the least likely to be interested in metoidioplasty (OR 3.251; P = .001), and most interested in penile transplantation (OR 0.382; P = .005) and phalloplasty (OR 0.288, P < .001) as potential interventions. Gay and queer respondents showed a significant interest in phalloplasty (Gay: OR 0.472; P = .004; Queer: OR 0.594; P = .017). Those who identify as men were more interested in phalloplasty (OR 0.552; P < .001) than those with differing gender identities. Older age was the only variable associated with a decreased interest in phalloplasty (OR 1.033; P = .001). No demographic analyzed was an independent predictor of interest in CTE. CLINICAL IMPLICATIONS A thorough understanding of patient gender identity, sexual orientation, and sexual behavior should be obtained during consultation for gender affirming penile reconstruction, as these factors influence patient preferences for surgical interventions. STRENGTHS AND LIMITATIONS This study used an anonymous online survey that was distributed through community channels and allowed for the collection of a high quantity of responses throughout the T/GE population that would otherwise be impossible through single-center or in-person means. The community-based methodology minimized barriers to honesty, such as courtesy bias. The survey was only available in English and respondents skewed young and White. CONCLUSION Despite previously reported concerns about the limitations of metoidioplasty, participants ranked it highly, along with CTE, in terms of personal interest, with sexual orientation, gender, and age independently influencing patient preferences, emphasizing their relevance in patient-surgeon consultations. A. Parker, G. Blasdel, C. Kloer et al. "Postulating Penis: What Influences the Interest of Transmasculine Patients in Gender Affirming Penile Reconstruction Techniques?". J Sex Med 2022;19:385-393.
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Affiliation(s)
- Augustus Parker
- NYU Grossman School of Medicine, NYU Langone Health Systems, New York, NY, USA
| | - Gaines Blasdel
- Department of Urology, New York University Langone Health, New York, NY, USA
| | - Carmen Kloer
- Duke University School of Medicine, Duke Health Systems, Durham, NC, USA; Hansjörg Wyss Department of Plastic Surgery, New York University Langone Health, New York, NY, USA
| | - Laura Kimberly
- Hansjörg Wyss Department of Plastic Surgery, New York University Langone Health, New York, NY, USA
| | - Nabeel Shakir
- Department of Urology, New York University Langone Health, New York, NY, USA
| | - Isabel Robinson
- Hansjörg Wyss Department of Plastic Surgery, New York University Langone Health, New York, NY, USA
| | - Rachel Bluebond-Langner
- Hansjörg Wyss Department of Plastic Surgery, New York University Langone Health, New York, NY, USA
| | - Lee C Zhao
- Department of Urology, New York University Langone Health, New York, NY, USA.
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10
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Lupon E, Lellouch AG, Acun A, Andrews AR, Oganesyan R, Goutard M, Taveau CB, Lantieri LA, Cetrulo CL, Uygun BE. Engineering Vascularized Composite Allografts Using Natural Scaffolds: A Systematic Review. TISSUE ENGINEERING PART B-REVIEWS 2021; 28:677-693. [PMID: 34238047 DOI: 10.1089/ten.teb.2021.0102] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
INTRODUCTION Vascularized Composite Allotransplantation refers to the transplantation of multiple tissues as a functional unit from a deceased donor to a recipient with a severe injury. These grafts serve as potential replacements for traumatic tissue losses. The main problems are the consequences of the long immunosuppressive drugs medications and the lake of compatible donor. To avoid these limitations, decellularization/recellularization constitute an attractive approach. The aim of decellularization/recellularization technology is to develop immunogenic free biological substitutes that will restore, maintain, or improve tissue and organ's function. METHODS A PubMed search was performed for articles on decellularization and recellularization of composite tissue allografts between March and February 2021, with no restrictions in publication year. The selected reports were evaluated in terms of decellularization protocols, assessment of decellularized grafts, and evaluation of their biocompatibility and repopulation with cells both in vitro and in vivo. RESULTS The search resulted in a total of 88 articles. Each article was reviewed, 77 were excluded and the remaining 11 articles reported decellularization of 12 different vascular composite allografts in humans (four), large animals (three), and small animals (rodents) (five). The decellularization protocol for vascularized composite allotransplantation varies slightly between studies, but majority of the reports employ 1% sodium dodecyl sulfate as the main reagent for decellularization. The immunological response of the decellularized scaffolds remains poorly evaluated. Few authors have been able to attempt the recellularization and transplantation of these scaffolds. Successful transplantation seems to require prior recellularization. CONCLUSION Decellularization/recellularization is a promising, growing, emerging developing research field in vascular composite allotransplantation.
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Affiliation(s)
- Elise Lupon
- University Toulouse III Paul Sabatier, Department of Plastic Surgery, Toulouse, Occitanie, France.,Massachusetts General Hospital, Harvard Medical School, Vascularized Composite Allotransplantation Laboratory, Center for Transplantation Sciences, Boston, Massachusetts, United States.,Shriners Hospitals for Children Boston, 24172, Boston, Massachusetts, United States.,Massachusetts General Hospital, 2348, Division of Plastic and Reconstructive Surgery, Boston, Massachusetts, United States;
| | - Alexandre G Lellouch
- Massachusetts General Hospital, Harvard Medical School, Vascularized Composite Allotransplantation Laboratory, Center for Transplantation Sciences, Boston, Massachusetts, United States.,Shriners Hospitals for Children Boston, 24172, Boston, Massachusetts, United States.,Hospital European George Pompidou, 55647, Department of Plastic Surgery, Paris, Île-de-France, France.,Massachusetts General Hospital, 2348, Division of Plastic and Reconstructive Surgery, Boston, Massachusetts, United States;
| | - Aylin Acun
- Shriners Hospitals for Children Boston, 24172, Boston, Massachusetts, United States.,Massachusetts General Hospital, Harvard Medical School, Center for Engineering in Medicine and Surgery, Boston, Massachusetts, United States;
| | - Alec R Andrews
- Massachusetts General Hospital, Harvard Medical School, Vascularized Composite Allotransplantation Laboratory, Center for Transplantation Sciences, Boston, Massachusetts, United States.,Shriners Hospitals for Children Boston, 24172, Boston, Massachusetts, United States.,Massachusetts General Hospital, 2348, Division of Plastic and Reconstructive Surgery, Boston, Massachusetts, United States;
| | - Ruben Oganesyan
- Shriners Hospitals for Children Boston, 24172, Boston, Massachusetts, United States.,Massachusetts General Hospital, Harvard Medical School, Center for Engineering in Medicine and Surgery, Boston, Massachusetts, United States;
| | - Marion Goutard
- Massachusetts General Hospital, Harvard Medical School, Vascularized Composite Allotransplantation Laboratory, Center for Transplantation Sciences, Boston, Massachusetts, United States.,Shriners Hospitals for Children Boston, 24172, Boston, Massachusetts, United States.,Hospital European George Pompidou, 55647, Department of Plastic Surgery, Paris, Île-de-France, France.,Massachusetts General Hospital, 2348, Division of Plastic and Reconstructive Surgery, Boston, Massachusetts, United States;
| | - Corentin B Taveau
- Hospital European George Pompidou, 55647, Department of Plastic Surgery, Paris, Île-de-France, France;
| | - Laurent A Lantieri
- Hospital European George Pompidou, 55647, Department of Plastic Surgery, Paris, Île-de-France, France;
| | - Curtis L Cetrulo
- Massachusetts General Hospital, Harvard Medical School, Vascularized Composite Allotransplantation Laboratory, Center for Transplantation Sciences, Boston, Massachusetts, United States.,Shriners Hospitals for Children Boston, 24172, Boston, Massachusetts, United States.,Massachusetts General Hospital, 2348, Division of Plastic and Reconstructive Surgery, Boston, Massachusetts, United States;
| | - Basak E Uygun
- Shriners Hospitals for Children Boston, 24172, Boston, Massachusetts, United States.,Massachusetts General Hospital, Harvard Medical School, Center for Engineering in Medicine and Surgery, Boston, Massachusetts, United States;
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11
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Duisit J, Maistriaux L, Bertheuil N, Lellouch AG. Engineering Vascularized Composite Tissues by Perfusion Decellularization/Recellularization: Review. CURRENT TRANSPLANTATION REPORTS 2021. [DOI: 10.1007/s40472-021-00317-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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12
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Medeiros-Fonseca B, Cubilla A, Brito H, Martins T, Medeiros R, Oliveira P, Gil da Costa RM. Experimental Models for Studying HPV-Positive and HPV-Negative Penile Cancer: New Tools for An Old Disease. Cancers (Basel) 2021; 13:cancers13030460. [PMID: 33530343 PMCID: PMC7865362 DOI: 10.3390/cancers13030460] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2020] [Revised: 01/11/2021] [Accepted: 01/23/2021] [Indexed: 12/28/2022] Open
Abstract
Simple Summary Penile cancer is an uncommon and understudied malignancy that is most commonly diagnosed in developing countries. Therapeutic advances have been slow, in part due to the lack of in vitro and in vivo models for testing new drugs before performing clinical trials. Recently, this difficulty has been partly overcome and multiple new pre-clinical models were reported. These important developments will help develop new therapies for penile cancer patients. The present review summarizes and discusses the available data concerning the pre-clinical models of penile cancer and their uses. Comparisons are drawn between different models, allowing researchers to choose the most adequate setting for their experiments. The remaining gaps in this array of penile cancer models are also discussed, in particular the lack of models for studying metastatic disease and cell lines representing tumors associated with human papillomavirus. Abstract Penile cancer is an uncommon malignancy that occurs most frequently in developing countries. Two pathways for penile carcinogenesis are currently recognized: one driven by human papillomavirus (HPV) infection and another HPV-independent route, associated with chronic inflammation. Progress on the clinical management of this disease has been slow, partly due to the lack of preclinical models for translational research. However, exciting recent developments are changing this landscape, with new in vitro and in vivo models becoming available. These include mouse models for HPV+ and HPV− penile cancer and multiple cell lines representing HPV− lesions. The present review addresses these new advances, summarizing available models, comparing their characteristics and potential uses and discussing areas that require further improvement. Recent breakthroughs achieved using these models are also discussed, particularly those developments pertaining to HPV-driven cancer. Two key aspects that still require improvement are the establishment of cell lines that can represent HPV+ penile carcinomas and the development of mouse models to study metastatic disease. Overall, the growing array of in vitro and in vivo models for penile cancer provides new and useful tools for researchers in the field and is expected to accelerate pre-clinical research on this disease.
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Affiliation(s)
- Beatriz Medeiros-Fonseca
- Centre for the Research and Technology of Agro-Environmental and Biological Sciences (CITAB), University of Trás-os-Montes and Alto Douro, UTAD, 5001-801 Vila Real, Portugal; (B.M.-F.); (T.M.); (P.O.)
| | - Antonio Cubilla
- Instituto de Patología e Investigación and Universidad Nacional de Asunción, Asunción, Paraguay;
| | - Haissa Brito
- Maranhão Tumour and DNA Biobank (BTMA), Post-graduate Programme in Adult Health (PPGSAD), Federal University of Maranhão (UFMA), São Luís 65080-805, Brazil;
| | - Tânia Martins
- Centre for the Research and Technology of Agro-Environmental and Biological Sciences (CITAB), University of Trás-os-Montes and Alto Douro, UTAD, 5001-801 Vila Real, Portugal; (B.M.-F.); (T.M.); (P.O.)
- Veterinary Sciences Department, University of Trás-os-Montes and Alto Douro, UTAD, 5000-801 Vila Real, Portugal
| | - Rui Medeiros
- Molecular Oncology and Viral Pathology Group, CI-IPOP, IPO-Porto, 4200-072 Porto, Portugal;
- Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal
- Virology Service, IPO-Porto, 4200-072 Porto, Portugal
- Biomedicine Research Center (CEBIMED), Faculty of Health Sciences, Fernando Pessoa University, 4249-004 Porto, Portugal
| | - Paula Oliveira
- Centre for the Research and Technology of Agro-Environmental and Biological Sciences (CITAB), University of Trás-os-Montes and Alto Douro, UTAD, 5001-801 Vila Real, Portugal; (B.M.-F.); (T.M.); (P.O.)
- Veterinary Sciences Department, University of Trás-os-Montes and Alto Douro, UTAD, 5000-801 Vila Real, Portugal
| | - Rui M. Gil da Costa
- Centre for the Research and Technology of Agro-Environmental and Biological Sciences (CITAB), University of Trás-os-Montes and Alto Douro, UTAD, 5001-801 Vila Real, Portugal; (B.M.-F.); (T.M.); (P.O.)
- Maranhão Tumour and DNA Biobank (BTMA), Post-graduate Programme in Adult Health (PPGSAD), Federal University of Maranhão (UFMA), São Luís 65080-805, Brazil;
- Molecular Oncology and Viral Pathology Group, CI-IPOP, IPO-Porto, 4200-072 Porto, Portugal;
- Laboratory for Process Engineering, Environment, Biotechnology and Energy (LEPABE), Faculty of Engineering, University of Porto, 4200-465 Porto, Portugal
- Correspondence: ; Tel.: +55-9132728000
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