1
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Hildebrandt I, Culp WTN, Griffin MA. A Systematic Review of Canine Cystectomy: Indications, Techniques, and Outcomes. Animals (Basel) 2023; 13:2896. [PMID: 37760296 PMCID: PMC10525623 DOI: 10.3390/ani13182896] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 08/30/2023] [Accepted: 09/07/2023] [Indexed: 09/29/2023] Open
Abstract
This review provides a summary of the literature encompassing partial and total cystectomy procedures in dogs and subsequent conclusions that can be drawn. Surgical excision as a component of treatment for lower urinary tract neoplasia in dogs may enhance survival time and result in acceptable quality of life, though risk for surgical complications is substantial, particularly following total cystectomy procedures. However, for dogs with urothelial carcinoma, cystectomy is generally not considered curative and disease progression is common. Appropriate case selection and thorough preoperative discussion with owners regarding potential risks and benefits of cystectomy are imperative for successful outcomes.
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Affiliation(s)
- Isabella Hildebrandt
- Department of Clinical Sciences and Advanced Medicine, School of Veterinary Medicine, University of Pennsylvania, 3800 Spruce St., Philadelphia, PA 19104, USA
| | - William T. N. Culp
- Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California-Davis, One Garrod Avenue, Davis, CA 95616, USA
| | - Maureen A. Griffin
- Department of Clinical Sciences and Advanced Medicine, School of Veterinary Medicine, University of Pennsylvania, 3800 Spruce St., Philadelphia, PA 19104, USA
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2
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Augmentation cystoplasty in dogs: A comparative study of different tunica vaginalis grafts. Vet Anim Sci 2022; 16:100247. [PMID: 35345763 PMCID: PMC8957053 DOI: 10.1016/j.vas.2022.100247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 03/15/2022] [Accepted: 03/16/2022] [Indexed: 11/22/2022] Open
Abstract
Tunica vaginalis allograft and sheep tunica vaginalis decellularized extracellular matrix successfully rebuilt the bladder wall with minor complications in dogs. Sheep tunica vaginalis xenograft has disappointing results in the canine model since the bladders became contracted with decreased capacity. Tunica vaginalis grafts represent a simple and low-cost choice for augmentation cystoplasty in dogs.
In veterinary practice, numerous urological disorders that cause bladder dysfunction necessitate augmentation cystoplasty (AC). The purpose of this study is to evaluate the dog tunica vaginalis allograft (DTVA), sheep tunica vaginalis xenograft (STVX) and sheep tunica vaginalis decellularized extracellular matrix (STVDEM) as graft materials for urinary bladder (UB) reconstruction following a 45±5% cystectomy model in dogs. In this study, 18 adult apparently healthy mongrel dogs of both sexes were divided into three groups (6 dogs each): the DTVA group, the STVX group, and the STVDEM group. The evaluation of the AC in different groups was carried out using clinical, hematological, serum biochemical, urine, ultrasonographic, retrograde positive cystogram, and histopathological analysis all over the study period of 12 weeks. The dogs in all groups survived the procedures, except three dogs died from both STVX and DTVA groups. The mean bladder capacity indicated that the DTVA and STVX groups had regained 82.22% and 68.62%, respectively, of their preoperative baseline capacity. Interestingly, the STVDEM group's bladder capacity increased to 113.70%. Although histological analysis revealed that the three grafts successfully rebuilt the bladder wall, the STVDEM demonstrated well-organized and well-differentiated epithelial and muscular tissues that resembled, but were not identical to, native UB tissues. As a result, STVDEM is proposed as an ideal and potential acellular graft for UB reconstruction in dogs, whereas DTVA and STVX could be employed in emergencies requiring UB reconstruction.
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3
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Peró M, Casani L, Castells-Sala C, Pérez ML, Moga Naranjo E, Juan-Babot O, Alserawan De Lamo L, López-Chicón P, Vilarrodona Serrat A, Badimon L, Porta Roda O. Rabbit as an animal model for the study of biological grafts in pelvic floor dysfunctions. Sci Rep 2021; 11:10545. [PMID: 34006889 PMCID: PMC8131625 DOI: 10.1038/s41598-021-89698-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2020] [Accepted: 04/22/2021] [Indexed: 11/28/2022] Open
Abstract
The aims of this study were to evaluate the feasibility of the New Zealand White (NZW) rabbit for studying implanted biomaterials in pelvic reconstructive surgery; and to compare the occurrence of graft-related complications of a commercial polypropylene (PP) mesh and new developed human dermal matrix implanted at vaginal and abdominal level. 20 white female NZW rabbits were randomized into two groups, experimental group (human acellular dermal matrices-hADM-graft) and control group (commercial PP graft). In each animal, grafts were surgically implanted subcutaneously in the abdominal wall and in the vaginal submucosa layer for 180 days. The graft segments were then removed and the surgical and clinical results were analyzed. The main surgical challenges during graft implantation were: (a) an adequate vaginal exposure while maintaining the integrity of the vaginal mucosa layer; (b) to keep aseptic conditions; (c) to locate and dissect the breast vein abdominal surgery; and (d) to withdraw blood samples from the ear artery. The most abnormal findings during the explant surgery were found in the PP group (33% of vaginal mesh extrusion) in comparison with the hADM group (0% of vaginal graft extrusion), p = 0.015. Interestingly, macroscopic observation showed that the integration of the vaginal grafts was more common in the hADM group (40%) than in the PP group, in which the vaginal mesh was identified in 100% of the animals (p = 0.014). The NZW rabbit is a good model for assessing materials to be used as grafts for pelvic reconstructive surgery and vaginal surgery. Animals are easily managed during the procedures, including surgical intervention and vaginal mucosa approach. Additionally, hADM is associated with fewer clinical complications, as well as better macroscopic tissue integration, compared to PP mesh.
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Affiliation(s)
- Marta Peró
- Department of Obstetrics and Gynecology, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Carrer Sant Quintí, 89, 08041, Barcelona, Spain.
| | - Laura Casani
- Research Institute of the Hospital de Sant Pau-IIB Sant Pau, Barcelona, Spain
| | - Cristina Castells-Sala
- Barcelona Tissue Bank, Banc de Sang i Teixits (BST), Barcelona, Spain.,Biomedical Research Institute (IIB-Sant Pau; SGR1113), Barcelona, Spain
| | - Maria Luisa Pérez
- Barcelona Tissue Bank, Banc de Sang i Teixits (BST), Barcelona, Spain.,Biomedical Research Institute (IIB-Sant Pau; SGR1113), Barcelona, Spain
| | - Esther Moga Naranjo
- Department of Immunology, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau (IIB Sant Pau), Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Oriol Juan-Babot
- Research Institute of the Hospital de Sant Pau-IIB Sant Pau, Barcelona, Spain
| | - Leticia Alserawan De Lamo
- Department of Immunology, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau (IIB Sant Pau), Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Patricia López-Chicón
- Barcelona Tissue Bank, Banc de Sang i Teixits (BST), Barcelona, Spain.,Biomedical Research Institute (IIB-Sant Pau; SGR1113), Barcelona, Spain
| | - Anna Vilarrodona Serrat
- Barcelona Tissue Bank, Banc de Sang i Teixits (BST), Barcelona, Spain.,Biomedical Research Institute (IIB-Sant Pau; SGR1113), Barcelona, Spain
| | - Lina Badimon
- Research Institute of the Hospital de Sant Pau-IIB Sant Pau, Barcelona, Spain
| | - Oriol Porta Roda
- Department of Obstetrics and Gynecology, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Carrer Sant Quintí, 89, 08041, Barcelona, Spain
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4
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Pereira AR, Rudert M, Herrmann M. Decellularized human bone as a 3D model to study skeletal progenitor cells in a natural environment. Methods Cell Biol 2019; 157:123-141. [PMID: 32334712 DOI: 10.1016/bs.mcb.2019.11.018] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
There has been an increasing interest in exploring naturally derived extracellular matrices as an material mimicking the complexity of the cell microenvironment in vivo. Bone tissue-derived decellularized constructs are able to preserve native structural, biochemical, and biomechanical cues of the tissue, therefore providing a suitable environment to study skeletal progenitor cells. Particularly for bone decellularization, different methods have been reported in the literature. However, the used methods critically affect the final ultrastructure and surface chemistry as well as the decellularization efficiency, consequently causing complications to draw conclusions and compare results in between studies. In this chapter, an optimized protocol for the preparation of human bone derived scaffolds is described, including processing techniques and further characterization methods, which allow the final construct to be recognized as a major platform for bone therapeutic and/or diagnostic applications.
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Affiliation(s)
- Ana Rita Pereira
- IZKF Group Tissue Regeneration in Musculoskeletal Diseases, University Clinics, Wuerzburg, Germany
| | - Maximilian Rudert
- Department of Orthopaedic Surgery, König-Ludwig-Haus, University of Wuerzburg, Wuerzburg, Germany
| | - Marietta Herrmann
- IZKF Group Tissue Regeneration in Musculoskeletal Diseases, University Clinics, Wuerzburg, Germany; Bernhard-Heine Center for Locomotion Research, University of Wuerzburg, Wuerzburg, Germany.
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5
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Kajbafzadeh AM, Khorramirouz R, Masoumi A, Keihani S, Nabavizadeh B. Decellularized human fetal intestine as a bioscaffold for regeneration of the rabbit bladder submucosa. J Pediatr Surg 2018; 53:1781-1788. [PMID: 29459044 DOI: 10.1016/j.jpedsurg.2018.01.018] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Revised: 12/15/2017] [Accepted: 01/26/2018] [Indexed: 10/18/2022]
Abstract
PURPOSE We aim to report a method to create a natural acellular scaffold from human fetal small intestine for augmentation cystoplasty in rabbits. METHODS Fetal intestines were decellularized by immersion in a hypotonic solution. The success of this protocol was evaluated by histological analysis, scanning electron microscopy and measurement of collagen and sulfated glycosaminoglycan of the acellular tissues. Eight mature rabbits were selected and acellular scaffolds were implanted on the exposed urothelium. Urodynamic studies and cystography were performed after six months. At 14, 120 and 180days animals were sacrificed and augmented bladders were resected. RESULTS Histological analysis revealed formation of muscular layer and blood vessels in implanted scaffolds similar to normal bladder. These findings demonstrate the effective seeding of scaffold by host bladder cells. The tissue architecture of recellularized scaffold was similar to the native bladder. CONCLUSIONS Fetal intestine acellular matrix could be an exceptional scaffold for bladder augmentation cystoplasty and may pave the road for future studies in order to be used for clinical application.
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Affiliation(s)
- Abdol-Mohammad Kajbafzadeh
- Pediatric Urology and Regenerative Medicine Research Center, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran.
| | - Reza Khorramirouz
- Pediatric Urology and Regenerative Medicine Research Center, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Ahmad Masoumi
- Pediatric Urology and Regenerative Medicine Research Center, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Sorena Keihani
- Pediatric Urology and Regenerative Medicine Research Center, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Behnam Nabavizadeh
- Pediatric Urology and Regenerative Medicine Research Center, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran
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6
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Langer S, Radtke C, Györi E, Springer A, Metzelder ML. Bladder augmentation in children: current problems and experimental strategies for reconstruction. Wien Med Wochenschr 2018; 169:61-70. [PMID: 30084093 PMCID: PMC6394595 DOI: 10.1007/s10354-018-0645-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Accepted: 06/21/2018] [Indexed: 12/31/2022]
Abstract
Bladder augmentation is a demanding surgical procedure and exclusively offered for selected children and has only a small spectrum of indications. Paediatric bladder voiding dysfunction occurs either on a basis of neurological dysfunction caused by congenital neural tube defects or on a basis of rare congenital anatomic malformations. Neurogenic bladder dysfunction often responds well to a combination of specific drugs and/or intermittent self-catheterization. However, selected patients with spinal dysraphism and children with congenital malformations like bladder exstrophy and resulting small bladder capacity might require bladder augmentation. Ileocystoplasty is the preferred method of bladder augmentation to date. Because of the substantial long-and short-term morbidity of augmentation cystoplasty, recent studies have tried to incorporate new techniques and technologies, such as the use of biomaterials to overcome or reduce the adverse effects. In this regard, homografts and allografts have been implemented in bladder augmentation with varying results, but recent studies have shown promising data in terms of proliferation of urothelium and muscle cells by using biological silk grafts.
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Affiliation(s)
- Sophie Langer
- General Hospital Vienna, Clinical Department of Paediatric Surgery, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Christine Radtke
- General Hospital Vienna, Clinical Department of Plastic and Reconstructive Surgery, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Eva Györi
- General Hospital Vienna, Clinical Department of Plastic and Reconstructive Surgery, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Alexander Springer
- General Hospital Vienna, Clinical Department of Paediatric Surgery, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Martin L Metzelder
- General Hospital Vienna, Clinical Department of Paediatric Surgery, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria.
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7
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Alberti C, Tizzani A, Piovano M, Greco A. What's in the Pipeline about Bladder Reconstructive Surgery? Some Remarks on the State of the Art. Int J Artif Organs 2018; 27:737-43. [PMID: 15521212 DOI: 10.1177/039139880402700902] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The fusion of engineering with cell biology and advances in biomaterials may lead to de novo construction of implantable organs. Engineering of neobladder from autologous urothelial and smooth muscle cells cultured on biocompatible, either synthetic or naturally-derived substrates, is now feasible in preclinical studies and may have clinical applicability in the near future. The development of a bioartificial bladder would warrant the prevention of both the metabolic and neoplastic shortcomings of the intestinal neobladder. Two tissue-engineering techniques for bladder reconstruction have been tested on animals: 1) the in vivo technique involves the use of naturally-derived biomaterials for functional native bladder regeneration 2) the in vitro technique involves the establishment of autologous urothelial and smooth muscle cell culture from the host's urinary tract, after which the cells are seeded on the biodegradable matrix-scaffold to create a composite graft that is implanted into the same host for complete histotectonic regeneration. Waiting for the creation of a complete tissue-engineered bladder with a trigone-shaped base, we suggest, in surgical oncology after radical cystectomy, the realization of conduit or continent pouch using tissue-engineered material.
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Affiliation(s)
- C Alberti
- I Clinical Urology, University of Turin, Turin, Italy
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8
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Barski D, Gerullis H, Ecke T, Yang J, Varga G, Boros M, Pintelon I, Timmermans JP, Otto T. Bladder Reconstruction with Human Amniotic Membrane in a Xenograft Rat Model: A Preclinical Study. Int J Med Sci 2017; 14:310-318. [PMID: 28553162 PMCID: PMC5436472 DOI: 10.7150/ijms.18127] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2016] [Accepted: 01/30/2017] [Indexed: 12/23/2022] Open
Abstract
Background: Human amniotic membranes (HAMs) are assumed to have a number of unique characteristics including durability, hypoallergenic and anti-inflammatory properties. Materials and Methods: Multilayer HAMs from caesarian sections were applied to repair defined bladder defects in male Sprague-Dawley rats. The animals were sacrificed at 7, 21 and 42 days after implantation. Bladder volume capacity after grafting was measured. Histological analyses were performed to asses a number of parameters including HAM degradation, inflammatory reaction, graft rejection and smooth muscle ingrowth. Results: One rat died from sepsis in the treated group. No severe complications or signs of leakage were observed. Bladder capacity did not change over time. The initially increased inflammation in the HAM group diminished significantly over time (p<0.05). No signs of HAM degradation were observed and smooth muscle staining increased over time. Conclusions: HAMs appear to be durable and hypoallergenic grafts. The assumed suitability for the reconstruction of urinary tract justifies further research on detailed immunological process in larger grafts.
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Affiliation(s)
| | - Holger Gerullis
- University Hospital for Urology, School of Medicine and Health Sciences, Carl von Ossietzky University, Oldenburg, Germany
| | - Thorsten Ecke
- Department of Urology, Helios Hospital, Bad Saarow, Germany
| | - Jin Yang
- Department of Urology, Affiliated Hospital of Chengdu University, Chengdu, China
| | - Gabriella Varga
- Institute of Experimental Surgery, University of Szeged, Hungary
| | - Mihaly Boros
- Institute of Experimental Surgery, University of Szeged, Hungary
| | - Isabel Pintelon
- University of Antwerp, Laboratory of Cell Biology and Histology, Antwerp, Belgium
| | | | - Thomas Otto
- Department of Urology, Lukas Hospital Neuss, Germany
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9
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Xiao D, Wang Q, Yan H, Qin A, Lv X, Zhao Y, Zhang M, Zhou Z, Xu J, Hu Q, Lu M. Comparison of morphological and functional restoration between asymmetric bilayer chitosan and bladder acellular matrix graft for bladder augmentation in a rat model. RSC Adv 2017. [DOI: 10.1039/c7ra07601k] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Asymmetric bilayer chitosan promoted bladder reconstruction with enhanced smooth muscle regeneration and angiogenesis, and functional restoration with augmented bladder capacity.
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10
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Rossetto V, Souza P, Doiche D, Mamprim M, Padovani C, Brandão C. Sonographic abnormalities in augmented bladder using porcine intestinal submucosa (SIS). ARQ BRAS MED VET ZOO 2016. [DOI: 10.1590/1678-4162-8697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
ABSTRACT Among the different materials for bladder augmentation, porcine intestinal submucosa (SIS) is the most widely investigated and stands out for its ability as a cell scaffold. In this context, the ultrasound examination allows the detection of changes from the surgical procedure, enabling the early verification of potential complications and evaluation of patient outcomes. The aim of this paper is to describe the main sonographic findings in dogs submitted to cystoplasty using acellular SIS and seeded with homologous smooth muscle cells at 30 (M30) and 60 (M60) days postoperatively. Sonographic changes included irregularities and thickening of bladder wall especially at M30. Additionally, were visualized urinary sediment and uroliths in animals submitted to acellular SIS cistoplasty. Abdominal ultrasonography was useful in the postoperative evaluation of animals undergoing cystoplasty with acellular or seeded SIS.
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11
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Abstract
Urologic tissue engineering efforts have been largely focused on bladder and urethral defect repair. The current surgical gold standard for treatment of poorly compliant pathological bladders and severe urethral stricture disease is enterocystoplasty and onlay urethroplasty with autologous tissue, respectively. The complications associated with autologous tissue use and harvesting have led to efforts to develop tissue-engineered alternatives. Natural and synthetic materials have been used with varying degrees of success, but none has proved consistently reliable for urologic tissue defect repair in humans. Silk fibroin (SF) scaffolds have been tested in bladder and urethral repair because of their favorable biomechanical properties including structural strength, elasticity, biodegradability, and biocompatibility. SF scaffolds have been used in multiple animal models and have demonstrated robust regeneration of smooth muscle and urothelium. The pre-clinical data involving SF scaffolds in urologic defect repair are encouraging and suggest that they hold potential for future clinical use.
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Affiliation(s)
- Bryan S Sack
- Urological Diseases Research Center, Boston Children's Hospital, Boston, MA, 02115, USA. .,Department of Surgery, Harvard Medical School, Boston, MA, 02115, USA.
| | - Joshua R Mauney
- Urological Diseases Research Center, Boston Children's Hospital, Boston, MA, 02115, USA. .,Department of Surgery, Harvard Medical School, Boston, MA, 02115, USA. .,Department of Urology, John F. Enders Research Laboratories, Boston Children's Hospital, 300 Longwood Ave., Rm. 1009, Boston, MA, 02115, USA.
| | - Carlos R Estrada
- Urological Diseases Research Center, Boston Children's Hospital, Boston, MA, 02115, USA. .,Department of Surgery, Harvard Medical School, Boston, MA, 02115, USA. .,Department of Urology, Boston Children's Hospital, 300 Longwood Ave., Hunnewell 3, Boston, MA, 02115, USA.
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12
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Zhou Z, Zhang M, Xu M, Zhang K, Zhao Y, Zhou J, Zhu Y, Wang Z, Lu M. Intraperitoneal incubation of bladder acellular matrix grafts improves bladder smooth muscle regeneration via neovascularization. BIOTECHNOL BIOPROC E 2015. [DOI: 10.1007/s12257-014-0705-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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13
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Mauney JR, Adam RM. Dynamic reciprocity in cell-scaffold interactions. Adv Drug Deliv Rev 2015; 82-83:77-85. [PMID: 25453262 DOI: 10.1016/j.addr.2014.10.016] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2014] [Revised: 09/07/2014] [Accepted: 10/15/2014] [Indexed: 12/14/2022]
Abstract
Tissue engineering in urology has shown considerable promise. However, there is still much to understand, particularly regarding the interactions between scaffolds and their host environment, how these interactions regulate regeneration and how they may be enhanced for optimal tissue repair. In this review, we discuss the concept of dynamic reciprocity as applied to tissue engineering, i.e. how bi-directional signaling between implanted scaffolds and host tissues such as the bladder drives the process of constructive remodeling to ensure successful graft integration and tissue repair. The impact of scaffold content and configuration, the contribution of endogenous and exogenous bioactive factors, the influence of the host immune response and the functional interaction with mechanical stimulation are all considered. In addition, the temporal relationships of host tissue ingrowth, bioactive factor mobilization, scaffold degradation and immune cell infiltration, as well as the reciprocal signaling between discrete cell types and scaffolds are discussed. Improved understanding of these aspects of tissue repair will identify opportunities for optimization of repair that could be exploited to enhance regenerative medicine strategies for urology in future studies.
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14
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Lin HK, Madihally SV, Palmer B, Frimberger D, Fung KM, Kropp BP. Biomatrices for bladder reconstruction. Adv Drug Deliv Rev 2015; 82-83:47-63. [PMID: 25477305 DOI: 10.1016/j.addr.2014.11.020] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2014] [Revised: 11/17/2014] [Accepted: 11/24/2014] [Indexed: 12/22/2022]
Abstract
There is a demand for tissue engineering of the bladder needed by patients who experience a neurogenic bladder or idiopathic detrusor overactivity. To avoid complications from augmentation cystoplasty, the field of tissue engineering seeks optimal scaffolds for bladder reconstruction. Naturally derived biomaterials as well as synthetic and natural polymers have been explored as bladder substitutes. To improve regenerative properties, these biomaterials have been conjugated with functional molecules, combined with nanotechology, or seeded with exogenous cells. Although most studies reported complete and functional bladder regeneration in small-animal models, results from large-animal models and human clinical trials varied. For functional bladder regeneration, procedures for biomaterial fabrication, incorporation of biologically active agents, introduction of nanotechnology, and application of stem-cell technology need to be standardized. Advanced molecular and medical technologies such as next generation sequencing and magnetic resonance imaging can be introduced for mechanistic understanding and non-invasive monitoring of regeneration processes, respectively.
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Affiliation(s)
- Hsueh-Kung Lin
- Department of Urology, The Children's Hospital of Oklahoma, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104, USA
| | - Sundar V Madihally
- Department of Chemical Engineering, 423 Engineering North, Oklahoma State University, Stillwater, OK 74078, USA
| | - Blake Palmer
- Department of Urology, The Children's Hospital of Oklahoma, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104, USA
| | - Dominic Frimberger
- Department of Urology, The Children's Hospital of Oklahoma, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104, USA
| | - Kar-Ming Fung
- Department of Urology, The Children's Hospital of Oklahoma, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104, USA; Department of Pathology, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104, USA
| | - Bradley P Kropp
- Department of Urology, The Children's Hospital of Oklahoma, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104, USA.
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15
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Tissue engineering in animal models for urinary diversion: a systematic review. PLoS One 2014; 9:e98734. [PMID: 24964011 PMCID: PMC4070912 DOI: 10.1371/journal.pone.0098734] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2013] [Accepted: 05/07/2014] [Indexed: 11/28/2022] Open
Abstract
Tissue engineering and regenerative medicine (TERM) approaches may provide alternatives for gastrointestinal tissue in urinary diversion. To continue to clinically translatable studies, TERM alternatives need to be evaluated in (large) controlled and standardized animal studies. Here, we investigated all evidence for the efficacy of tissue engineered constructs in animal models for urinary diversion. Studies investigating this subject were identified through a systematic search of three different databases (PubMed, Embase and Web of Science). From each study, animal characteristics, study characteristics and experimental outcomes for meta-analyses were tabulated. Furthermore, the reporting of items vital for study replication was assessed. The retrieved studies (8 in total) showed extreme heterogeneity in study design, including animal models, biomaterials and type of urinary diversion. All studies were feasibility studies, indicating the novelty of this field. None of the studies included appropriate control groups, i.e. a comparison with the classical treatment using GI tissue. The meta-analysis showed a trend towards successful experimentation in larger animals although no specific animal species could be identified as the most suitable model. Larger animals appear to allow a better translation to the human situation, with respect to anatomy and surgical approaches. It was unclear whether the use of cells benefits the formation of a neo urinary conduit. The reporting of the methodology and data according to standardized guidelines was insufficient and should be improved to increase the value of such publications. In conclusion, animal models in the field of TERM for urinary diversion have probably been chosen for reasons other than their predictive value. Controlled and comparative long term animal studies, with adequate methodological reporting are needed to proceed to clinical translatable studies. This will aid in good quality research with the reduction in the use of animals and an increase in empirical evidence of biomedical research.
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16
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Arenas da Silva LF, Micol L, Tiemessen D, van Kuppevelt TH, Frey P, Oosterwijk E, Geutjes P, Feitz WF. Is There a Need for Smooth Muscle Cell Transplantation in Urethral Reconstruction? Tissue Eng Part A 2014; 20:1542-9. [DOI: 10.1089/ten.tea.2013.0185] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
| | - Lionel Micol
- Institute for Bioengineering, School of Life Sciences and School of Engineering, École Polytechnique Fédérale de Lausanne, Lausanne, Switzerland
| | - Dorien Tiemessen
- Department of Urology, Radboud University Nijmegen, Medical Centre, Nijmegen, Netherlands
| | - Toin H. van Kuppevelt
- Department of Biochemistry, Radboud University Nijmegen Medical Centre, NCMLS, Nijmegen, Netherlands
| | - Peter Frey
- Institute for Bioengineering, School of Life Sciences and School of Engineering, École Polytechnique Fédérale de Lausanne, Lausanne, Switzerland
| | - Egbert Oosterwijk
- Department of Urology, Radboud University Nijmegen, Medical Centre, Nijmegen, Netherlands
| | - Paul Geutjes
- Department of Urology, Radboud University Nijmegen, Medical Centre, Nijmegen, Netherlands
| | - Wout F. Feitz
- Institute for Bioengineering, School of Life Sciences and School of Engineering, École Polytechnique Fédérale de Lausanne, Lausanne, Switzerland
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Song L, Murphy SV, Yang B, Xu Y, Zhang Y, Atala A. Bladder Acellular Matrix and Its Application in Bladder Augmentation. TISSUE ENGINEERING PART B-REVIEWS 2014; 20:163-72. [DOI: 10.1089/ten.teb.2013.0103] [Citation(s) in RCA: 65] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Affiliation(s)
- Lujie Song
- Wake Forest Institute for Regenerative Medicine, Wake Forest School of Medicine, Winston Salem, North Carolina
- Department of Urology, Shanghai Sixth People's Hospital, Shanghai Jiaotong University, Shanghai, China
- Shanghai Oriental Institute for Urologic Reconstruction, Shanghai, China
| | - Sean V. Murphy
- Wake Forest Institute for Regenerative Medicine, Wake Forest School of Medicine, Winston Salem, North Carolina
| | - Bin Yang
- Wake Forest Institute for Regenerative Medicine, Wake Forest School of Medicine, Winston Salem, North Carolina
- Department of Urology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Yuemin Xu
- Department of Urology, Shanghai Sixth People's Hospital, Shanghai Jiaotong University, Shanghai, China
- Shanghai Oriental Institute for Urologic Reconstruction, Shanghai, China
| | - Yuanyuan Zhang
- Wake Forest Institute for Regenerative Medicine, Wake Forest School of Medicine, Winston Salem, North Carolina
| | - Anthony Atala
- Wake Forest Institute for Regenerative Medicine, Wake Forest School of Medicine, Winston Salem, North Carolina
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Sabetkish N, Kajbafzadeh AM, Sabetkish S, Tavangar SM. Augmentation cystoplasty using decellularized vermiform appendix in rabbit model. J Pediatr Surg 2014; 49:477-83. [PMID: 24650482 DOI: 10.1016/j.jpedsurg.2013.07.016] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2013] [Revised: 07/22/2013] [Accepted: 07/25/2013] [Indexed: 11/16/2022]
Abstract
PURPOSE The aim of this study was to produce a decellularized rabbit vermiform appendix (sacculus rotundus) and investigate its feasibility in bladder augmentation or appendicovesicostomy. The superiority of sacculus rotundus over other tissues is its unique mechanical properties as well as its abundant collagen content. MATERIALS AND METHODS The acellular matrix of vermiform appendix underwent different laboratory investigations prior to transplantation. We divided 12 rabbits into 3 groups: group I underwent bladder augmentation cystoplasty by detubularized acellular matrix. Group II underwent implantation of the tapered (tubularized) acellular matrix just beneath the seromuscular part of the bladder without connection to the bladder urothelium. Group III underwent the same procedure as group II plus reimplantation of tapered and tubularized acellular matrix (simulating an appendicovesicostomy). The distal end of the transplanted graft was connected to the bladder mucosal opening and was intubated by a 5Fr double blind ended feeding tube catheter. Biopsies were taken 3, 12, and 36months post-operatively for further histological and immunohistochemical analyses. RESULTS The results of the examinations performed prior to transplantation, revealed a decellularized structure resembling the native tissue with intact extracellular matrix, normal pits and appropriate gaps that will be suitable for further cell seeding. Histopathology examination of the biopsies after transplantations confirmed successful cell seeding with urothelial lining in groups I and III, while the inner lumen in group II showed no urothelial lining. CONCLUSION The results suggest that we can prospect to perform bladder reconstruction by the application of this method without complications of previously reported augmentation cystoplasty. In the current study we used the bladder as a natural bioreactor for autologous recellularization which may pave the road for clinical application in acellular matrix augmentation cystoplasty.
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Affiliation(s)
- Nastaran Sabetkish
- Pediatric Urology Research Center, Section of Tissue Engineering and Stem Cells Therapy, Children's Hospital Medical Center, Tehran University of Medical Sciences, Tehran, Iran (IRI)
| | - Abdol-Mohammad Kajbafzadeh
- Pediatric Urology Research Center, Section of Tissue Engineering and Stem Cells Therapy, Children's Hospital Medical Center, Tehran University of Medical Sciences, Tehran, Iran (IRI).
| | - Shabnam Sabetkish
- Pediatric Urology Research Center, Section of Tissue Engineering and Stem Cells Therapy, Children's Hospital Medical Center, Tehran University of Medical Sciences, Tehran, Iran (IRI)
| | - Seyyed Mohammad Tavangar
- Department of Pathology, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran (IRI)
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Zhou L, Yang B, Sun C, Qiu X, Sun Z, Chen Y, Zhang Y, Dai Y. Coadministration of platelet-derived growth factor-BB and vascular endothelial growth factor with bladder acellular matrix enhances smooth muscle regeneration and vascularization for bladder augmentation in a rabbit model. Tissue Eng Part A 2012; 19:264-76. [PMID: 22894544 DOI: 10.1089/ten.tea.2011.0609] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Tissue-engineering techniques have brought a great hope for bladder repair and reconstruction. The crucial requirements of a tissue-engineered bladder are bladder smooth muscle regeneration and vascularization. In this study, partial rabbit bladder (4×5 cm) was removed and replaced with a porcine bladder acellular matrix (BAM) that was equal in size. BAM was incorporated with platelet-derived growth factor-BB (PDGF-BB) and vascular endothelial growth factor (VEGF) in the experimental group while with no bioactive factors in the control group. The bladder tissue strip contractility in the experimental rabbits was better than that in the control ones postoperation. Histological evaluation revealed that smooth muscle regeneration and vascularization in the experimental group were significantly improved compared with those in the control group (p<0.05), while multilayered urothelium was formed in both groups. Muscle strip contractility of neobladder in the experimental group exhibited significantly better than that in the control (p<0.05) assessed with electrical field stimulation and carbachol interference. The activity of matrix metalloproteinase-2 (MMP-2) and MMP-9 in the native bladder tissue around tissue-engineered neobladder in the experimental group was significantly higher than that in the control (p<0.05). This work suggests that smooth muscle regeneration and vascularization in tissue-engineered neobladder and recovery of bladder function could be enhanced by PDGF-BB and VEGF incorporated within BAM, which promoted the upregulation of the activity of MMP-2 and MMP-9 of native bladder tissue around the tissue-engineered neobladder.
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Affiliation(s)
- Liuhua Zhou
- Department of Urology, Nanjing University School of Medicine, Affiliated Drum Tower Hospital, Nanjing, China
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20
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Mitsui Y, Shiina H, Hiraoka T, Arichi N, Yasumoto H, Dahiya R, Tanagho EA, Igawa M. Simultaneous implantation of bilateral ureters into bladder acellular matrix graft after partial cystectomy in a porcine model. BJU Int 2012; 110:E1212-7. [DOI: 10.1111/j.1464-410x.2012.11553.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Abstract
Many congenital and acquired anomalies affect the genitourinary tract, necessitating surgical intervention. Among these are bladder exstrophy, hypospadias, epispadias, posterior urethral valves, myelomeningocele, bladder carcinoma, urethral stricture disease, stress urinary incontinence, pelvic organ prolapse, vesicoureteral reflux and traumatic injuries of the urinary tract. Surgical repair of these conditions often utilizes skin, oral mucosa or bowel autograft or xenograft material to replace missing tissue or to augment inadequate tissues. These materials are often sufficient to restore the basic anatomy of the organ to which they are being grafted, but they usually do not completely restore normal function. In addition, postoperative complications are common, especially in the case of bladder augmentation or neobladder creation with autologous bowel. The complications and inherent limitations of these procedures may be mitigated by the availability of alternative tissue sources. Therefore, there has been a great deal of interest in developing tissues engineered from autologous materials, such as mature bladder cells, bone marrow-derived stem cells and adipose tissue. Ideally, an engineered tissue would restore or preserve the normal function of the organ it is augmenting or replacing. In addition, the engineered tissue should be nonimmunogenic to minimize rejection or foreign-body reactions. For the purposes of this article, we will focus on selection of scaffolding materials, selection of cell sources, and the current applications and potential future roles of tissue engineering in urology.
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22
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Zhu WD, Xu YM, Feng C, Fu Q, Song LJ. Different bladder defects reconstructed with bladder acellular matrix grafts in a rabbit model. Urologe A 2012; 50:1420-5. [PMID: 21720832 DOI: 10.1007/s00120-011-2627-2] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
OBJECTIVE To evaluate the potential use of the bladder acellular matrix graft (BAMG), two different bladder defects in the rabbit model were reconstructed. MATERIALS AND METHODS Two groups of rabbits underwent partial bladder wall cystectomy (group A, 30-40%; group B, 70-60%) and reconstruction of the defects with an equally sized BAMG. After 4, 12, and 24 weeks, bladder cystographs were performed. Then the rabbits were killed after uneventful postoperative periods, and the grafts were harvested for H&E staining and immunohistochemical staining. RESULTS Two rabbits died on the postoperative days 3 and 6 in group A due to urinary peritonitis. At 24 weeks, in group A, the reconstructed bladders reached a mean volume of 94.39±0.54% of the precystectomy bladder capacity. Histologically, complete regeneration of smooth muscle and urothelium tissue was evident. Regenerated SMCs and urothelium stained positive for α-smooth muscle actin and AE1/AE3. In group B, the mean bladder volume was 64.5±3.19% of the precystectomy volume. Histologically, group B was characterized by multilayered urothelium without organized muscle tissue. CONCLUSION The BAMG was an effective scaffold for bladder wall regeneration in the rabbit model. However, the use of BAMG reconstruction in larger bladder defects did not induce the same quality and quantity of bladder regeneration as the reconstruction of smaller bladder defects.
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Affiliation(s)
- W-D Zhu
- Department of Urology, Affiliated Sixth People's Hospital, Shanghai Jiaotong University, 600 Yi Shan Road, Shanghai, China
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23
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Bajek A, Drewa T, Joachimiak R, Marszałek A, Gagat M, Grzanka A. Stem cells for urinary tract regeneration. Cent European J Urol 2012; 65:7-10. [PMID: 24578913 PMCID: PMC3921771 DOI: 10.5173/ceju.2012.01.art2] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2011] [Revised: 07/16/2011] [Accepted: 09/15/2011] [Indexed: 01/14/2023] Open
Abstract
Regeneration of the urinary bladder is a complicated task, due to organ dimensions and diseases (cancer, interstitial cystitis) when autologous bladder cells cannot be used. Cancer is the most frequent indication for bladder removal (cystectomy). Stem cells can be used with the guarantee of the sufficient cell number for the in vitro construction of the urinary bladder wall. Tissue engineering techniques hold great promise for regeneration of dysfunctional urinary sphincter. Denervation following surgical procedures or injuries results in weakness of the urethral sphincter and stress urinary incontinence. Injectable therapies and the potential of stem cells for sphincter restoration was presented in this review. The aim of this review was to present possibilities of urinary bladder regeneration with the use of stem cells and tissue engineering techniques.
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Affiliation(s)
- Anna Bajek
- Department of Tissue Engineering, Nicolaus Copernicus University, Bydgoszcz, Poland
| | - Tomasz Drewa
- Department of Tissue Engineering, Nicolaus Copernicus University, Bydgoszcz, Poland ; Department of Urology, Institute of Oncology, Bydgoszcz, Poland
| | - Romana Joachimiak
- Department of Tissue Engineering, Nicolaus Copernicus University, Bydgoszcz, Poland
| | - Andrzej Marszałek
- Department of Clinical Pathomorphology, Nicolaus Copernicus University, Bydgoszcz, Poland ; Department of Clinical Pathomorphology, University of Medical Sciences, Poznań, Poland
| | - Maciej Gagat
- Department of Histology and Embryology, Nicolaus Copernicus University, Bydgoszcz, Poland
| | - Alina Grzanka
- Department of Histology and Embryology, Nicolaus Copernicus University, Bydgoszcz, Poland
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Sharma AK, Bury MI, Marks AJ, Fuller NJ, Meisner JW, Tapaskar N, Halliday LC, Matoka DJ, Cheng EY. A nonhuman primate model for urinary bladder regeneration using autologous sources of bone marrow-derived mesenchymal stem cells. Stem Cells 2011; 29:241-50. [PMID: 21732482 DOI: 10.1002/stem.568] [Citation(s) in RCA: 87] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Animal models that have been used to examine the regenerative capacity of cell-seeded scaffolds in a urinary bladder augmentation model have ultimately translated poorly in the clinical setting. This may be due to a number of factors including cell types used for regeneration and anatomical/physiological differences between lower primate species and their human counterparts. We postulated that mesenchymal stem cells (MSCs) could provide a cell source for partial bladder regeneration in a newly described nonhuman primate bladder (baboon) augmentation model. Cell-sorted CD105(+) /CD73(+) /CD34(-) /CD45(-) baboon MSCs transduced with green fluorescent protein (GFP) were seeded onto small intestinal submucosa (SIS) scaffolds. Baboons underwent an approximate 40%-50% cystectomy followed by augmentation cystoplasty with the aforementioned scaffolds or controls and finally enveloped with omentum. Bladders from sham, unseeded SIS, and MSC/SIS scaffolds were subjected to trichrome, H&E, and immunofluorescent staining 10 weeks postaugmentation. Immunofluorescence staining for muscle markers combined with an anti-GFP antibody revealed that >90% of the cells were GFP(+) /muscle marker(+) and >70% were GFP(+) /Ki-67(+) demonstrating grafted cells were present and actively proliferating within the grafted region. Trichrome staining of MSC/SIS-augmented bladders exhibited typical bladder architecture and quantitative morphometry analyses revealed an approximate 32% and 52% muscle to collagen ratio in unseeded versus seeded animals, respectively. H&E staining revealed a lack of infiltration of inflammatory cells in grafted animals and in corresponding kidneys and ureters. Simple cystometry indicated recovery between 28% and 40% of native bladder capacity. Data demonstrate MSC/SIS composites support regeneration of bladder tissue and validate this new bladder augmentation model.
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Affiliation(s)
- Arun K Sharma
- Division of Pediatric Urology; Children's Memorial Hospital of Chicago, Chicago, Illinois, USA.
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Aboushwareb T, McKenzie P, Wezel F, Southgate J, Badlani G. Is tissue engineering and biomaterials the future for lower urinary tract dysfunction (LUTD)/pelvic organ prolapse (POP)? Neurourol Urodyn 2011; 30:775-82. [PMID: 21661029 DOI: 10.1002/nau.21101] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
The fields of tissue engineering and regenerative medicine have seen major advances over the span of the past two decades, with biomaterials playing a central role. Although the term "regenerative medicine" has been applied to encompass most fields of medicine, in fact urology has been one of the most progressive. Many urological applications have been investigated over the past decades, with the culmination of these technologies in the introduction of the first laboratory-produced organ to be placed in a human body.1 With the quality of life issues associated with urinary incontinence, there is a strong driver to identify and introduce new technologies and the potential exists for further major advancements from regenerative medicine approaches using biomaterials, cells or a combination of both. A central question is why use biomaterials? The answer rests on the need to make up for inadequate or lack of autologous tissue, to decrease morbidity and to improve long-term efficacy. Thus, the ideal biomaterial needs to meet the following criteria: (1) Provide mechanical and structural support, (2) Maintain compliance and be biocompatible with surrounding tissues, and (3) Be "fit for purpose" by meeting specific application needs ranging from static support to bioactive cell signaling. In essence, this represents a wide range of biomaterials with a spectrum of potential applications, from use as a supportive or bulking implant alone, to implanted biomaterials that promote integration and eventual replacement by infiltrating host cells, or scaffolds pre-seeded with cells prior to implant. In this review we shall discuss the structural versus the integrative uses of biomaterials by referring to two key areas in urology of (1) pelvic organ support for prolapse and stress urinary incontinence, and (2) bladder replacement/augmentation.
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Abstract
The term 'regenerative medicine' encompasses strategies for restoring or renewing tissue or organ function by: (i) in vivo tissue repair by in-growth of host cells into an acellular natural or synthetic biomaterial, (ii) implantation of tissue 'engineered'in vitro by seeding cultured cells into a biomaterial scaffold, and (iii) therapeutic cloning and stem cell-based tissue regeneration. In this article, we review recent developments underpinning the emerging science of regenerative medicine and critically assess where successful implementation of novel regenerative medicine approaches into urology practice might genuinely transform the quality of life of affected individuals. We advocate the need for an evidence-based approach supported by strong science and clinical objectivity.
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Affiliation(s)
- Felix Wezel
- Jack Birch Unit for Molecular Carcinogenesis, Department of Biology, University of York, York, UK
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Bladder augmentation using tissue-engineered autologous oral mucosal epithelial cell sheets grafted on demucosalized gastric flaps. Transplantation 2011; 91:700-6. [PMID: 21301400 DOI: 10.1097/tp.0b013e31820e0170] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND At present, autologous intestinal segments are often used for bladder reconstruction. However, the gastrointestinal mucosa often causes various complications. METHODS Oral mucosal tissues were obtained from the buccal cavity of beagle dogs. Primary oral mucosal epithelial cells were cultured on temperature-responsive culture dishes with a mitomycin C-treated 3T3 feeder layer for 2 weeks. Cultured epithelial cells were harvested as contiguous sheets by reducing the temperature to 20°C. The study consisted of three groups. In group 1, oral mucosal epithelial cell sheets were autografted on demucosalized gastric flaps. Next, the gastric flaps with the oral mucosal epithelial cell sheets were used for bladder reconstruction. Bladder reconstruction was once immediately and then 5 days after epithelial cell sheet grafting in groups 2 and 3, respectively. Three weeks after bladder reconstruction, the gastric flaps with the oral mucosal epithelial cell sheets were examined by immunohistology. RESULTS Flaps grafted with oral mucosal epithelial cell sheets showed epithelial regeneration in groups 1 and 3. Regenerated epithelia were stratified and similar to native oral mucosa. However, the regenerated epithelium was absent from the reconstructive segment, and urothelial ingrowth was observed in group 2. Macroscopically, all reconstructive segments showed contracture. CONCLUSIONS We successfully performed a bladder reconstruction using oral mucosal epithelial cell sheet-grafted flaps that exhibited epithelial regeneration. Further study should consider shrinkage prevention.
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Kajbafzadeh AM, Esfahani SA, Talab SS, Elmi A, Monajemzadeh M. In-vivo autologous bladder muscular wall regeneration: application of tissue-engineered pericardium in a model of bladder as a bioreactor. J Pediatr Urol 2011; 7:317-23. [PMID: 21527218 DOI: 10.1016/j.jpurol.2011.02.014] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
PURPOSE Tissue-engineered pericardium (TEP) is a collagen-rich matrix that has previously been shown to promote in vivo and in vitro tissue regeneration. We evaluated the potential of TEP as a source for the in-vivo creation of bladder muscular wall grafts. We used bladder wall as a bioreactor to create a natural environment for cellular growth and differentiation. MATERIALS AND METHODS Sixteen rabbits were divided into four groups. A control group underwent classical bladder autoaugmentation. Other groups underwent insertion of TEP between bladder mucosa and muscular layer: group 2 with insertion of TEP, group 3 with TEP over autologous bladder muscular wall fragments, and group 4 with autologous bladder smooth muscle cells (SMCs) seeded on TEP. After 4 and 8 weeks, grafts were biopsied for histopathological evaluations. RESULTS Frames from groups 3 and 4 demonstrated more organized muscular wall generation with a significantly higher number of CD34 + endothelial progenitor cells and CD31 + microvessels, and maintenance of α-smooth muscle actin expression through immunohistochemistry. Group 4 showed significant enhancement of SMC penetration to TEP. Although the fragment-seeded group required a simpler procedure, the cell-seeded group showed superior organization of the muscular layer on histopathology. We found a semi-organized muscular layer and new vessels in the margins of TEP in group 3, while there was a homogeneous pattern of SMCs and new vessels in both the margins and center of TEP in group 4. CONCLUSIONS This preliminary work has important functional and clinical implications, as it indicates that use of the autologous SMC seeding method may enhance the properties of TEP in terms of bladder wall regeneration.
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Affiliation(s)
- Abdol-Mohammad Kajbafzadeh
- Pediatric Urology Research Center, Department of Pediatric Urology, Children's Hospital Medical Center, Tehran University of Medical Sciences, No. 32, 2nd Floor, 7th Street, Saadat-Abad, Ave. Tehran 1998714616, Iran.
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Yang B, Zhang Y, Zhou L, Sun Z, Zheng J, Chen Y, Dai Y. Development of a porcine bladder acellular matrix with well-preserved extracellular bioactive factors for tissue engineering. Tissue Eng Part C Methods 2011; 16:1201-11. [PMID: 20170425 DOI: 10.1089/ten.tec.2009.0311] [Citation(s) in RCA: 154] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
In this study, we compared four decellularization protocols and finally developed an optimized one through which a porcine bladder acellular matrix (BAM) with well-preserved extracellular bioactive factors had been prepared. In this protocol, the intact bladder was treated with trypsin/ethylenediaminetetraacetic acid to remove the urothelium, then with hypotonic buffer and Triton X-100 in hypertonic buffer to remove the membranous and cytoplasmic materials, and finally with nuclease to degrade the cellular nuclear components. Bladder distention and mechanical agitation were simultaneously used to facilitate cell removal. Meanwhile, several preservative techniques, including limitation of wash time, supplement with inhibitors of proteinase, control of the pH value and temperature of the wash buffer, ethylene oxide sterilization, and lyophilization of the scaffold for storage, were used to protect the extracellular bioactive factors. This decellularization protocol had completely removed the cellular materials and well preserved the extracellular collagen, sulfated glycosaminoglycan (GAG), and bioactive factors. The preserved bioactive factors had a great potential of promoting the proliferation and migration of both human bladder smooth muscle cell and human umbilical vein endothelial cell. It was also found that the amount of two representative bioactive factors, platelet-derived growth factor BB and vascular endothelial growth factor, was positively correlated with the sulfated GAG content in the porcine BAM, implying that the amount of sulfated GAG might be a determinant for preservation of bioactive factors in the decellularized tissues. In conclusion, the porcine BAM with well-preserved extracellular bioactive factors might be a favorable scaffold for tissue engineering applications.
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Affiliation(s)
- Bin Yang
- Department of Urology, Affiliated Drum Tower Hospital, Nanjing University School of Medicine, Nanjing, Jiangsu, PR China
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Allen RA, Seltz LM, Jiang H, Kasick RT, Sellaro TL, Badylak SF, Ogilvie JB. Adrenal extracellular matrix scaffolds support adrenocortical cell proliferation and function in vitro. Tissue Eng Part A 2010; 16:3363-74. [PMID: 20528677 DOI: 10.1089/ten.tea.2010.0005] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Transplantation of functional adrenal cortex cells could reduce morbidity and increase the quality of life of patients with adrenal insufficiency. Our aim was to determine whether adrenal extracellular matrix (ECM) scaffolds promote adrenocortical cell endocrine function and proliferation in vitro. We seeded decellularized porcine adrenal ECM with primary human fetal adrenocortical (HFA) cells. Adrenocortical function was quantified by cortisol secretion of HFA-ECM constructs after stimulation with adrenocorticotropic hormone. Proliferation was assessed by adenosine triphosphate assay. HFA-ECM construct morphology was evaluated by immunofluorescence microscopy and scanning electron microscopy. Adrenal HFA-ECM constructs coated with laminin were compared to uncoated constructs. Laminin coating did not significantly affect HFA morphology, proliferation, or function. We demonstrated HFA cell attachment to adrenal ECM scaffolds. Cortisol production and HFA cell proliferation were significantly increased in HFA-ECM constructs compared to controls (p < 0.05), and cortisol secretion rate per cell is comparable to that of human adult and fetal explants. We conclude that adrenal ECM supports endocrine function and proliferation of adrenocortical cells in vitro. Adrenal ECM scaffolds may form the basis for biocompatible tissue-engineered adrenal replacements.
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Affiliation(s)
- Robert A Allen
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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Bladder reconstruction with adipose-derived stem cell-seeded bladder acellular matrix grafts improve morphology composition. World J Urol 2010; 28:493-8. [PMID: 20091038 DOI: 10.1007/s00345-010-0508-8] [Citation(s) in RCA: 67] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2009] [Accepted: 01/08/2010] [Indexed: 01/10/2023] Open
Abstract
PURPOSE To assess the feasibility of seeding adipose-derived stem cells (ADSCs) onto bladder acellular matrix grafts (BAMGs) for bladder reconstruction in a rabbit model. METHODS Autologous ADSCs were isolated, expanded and identified by flow cytometry. In the experimental group, ADSCs were seeded onto BAMGS for reconstructing bladder defects in 12 male rabbits. Unseeded BAMGs were used for bladder reconstruction in the control group of 12 rabbits. Cystography was performed at 4, 12 and 24 weeks after grafts implantation. Following cystography, the animals were killed and grafts were harvested; H&E and immunohistochemical staining were performed with cytokeratin AE1/AE3, smooth muscle alpha-actin and S-100 markers. RESULTS Flow cytometry demonstrated that the ADSCs expressed CD90, CD44, CD105, CD166 and CD34, but not CD45 or CD106. The cells demonstrated good biocompatibility with BAMGs. At 24 weeks, in the experimental group, the reconstructed bladders reached a mean volume of 94.68 +/- 3.31% of the pre-cystectomy bladder capacity. Complete regeneration of smooth muscle and nerve tissue was evident. Regenerated SMCs, urothelium and nerve cells stained positively for alpha-smooth muscle actin, AE1/AE3 and S-100. In the control group, the mean bladder volume was 69.33 +/- 5.05% of the pre-cystectomy volume; histologically, the control group was characterized by multi-layered urothelium without evidence for organized muscle or nerve tissue. CONCLUSIONS These data demonstrate that seeding ADSCs onto BAMGs promote regeneration of smooth muscle and nervous tissue regeneration in a rabbit model. This compound graft was more suitable for bladder reconstruction than BAMG alone.
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Abstract
Many medical conditions require surgical reconstruction of hollow organs. Tissue engineering of organs and tissues is a promising new technique without harvest site morbidity. An ideal biomaterial should be biocompatible, support tissue formation and provide adequate structural support. It should degrade gradually and provide an environment allowing for cell-cell interaction, adhesion, proliferation, migration, and differentiation. Although tissue formation is feasible, functionality has never been demonstrated. Mainly the lack of proper innervation and vascularisation are hindering contractility and normal function. In this chapter we critically review the current state of engineering hollow organs with a special focus on innervation and vascularisation.
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VandeVord PJ, Broadrick KM, Krishnamurthy B, Singla AK. A comparative study evaluating the in vivo incorporation of biological sling materials. Urology 2009; 75:1228-33. [PMID: 19773037 DOI: 10.1016/j.urology.2009.06.046] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2008] [Revised: 06/17/2009] [Accepted: 06/21/2009] [Indexed: 01/13/2023]
Abstract
OBJECTIVES To comparatively investigate biological tissues that are clinical products currently used for implantation in urological reconstruction. Specifically, we examined biological materials in vivo and evidence regarding the tissue response observed. Biological tissues are widely used in urological surgeries to treat conditions such as pelvic organ prolapse and stress urinary incontinence. METHODS Histologic data from 4 biological sling materials, that is, small intestinal submucosa (SIS), cadaveric fascia lata, cadaveric dermis, and porcine dermis, implanted within mice (n = 64) were evaluated at 2, 4, 8, and 12 weeks. Recovered tissue was assessed by several biocompatibility parameters such as capsule formation (collagen deposition), cellular number, cell morphology, and angiogenesis. RESULTS Data provide a scientific depiction of the cellular response to these biomaterials through a 12-week evaluation. SIS had a significantly higher level of angiogenesis and cell infiltrate as compared with all other material tested. Collectively, the data suggest that SIS has improved biocompatibility over other tested materials. CONCLUSIONS This study compared SIS with other biological tissues in an animal model and was found to have superior biocompatibility as seen in humans. This may be helpful for clinicians while selecting a particular biological material. The study provides evidence of the varying stages of remodeling each implant, with hopes to better understand the material response in vivo.
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Affiliation(s)
- Pamela J VandeVord
- Department of Biomedical Engineering, Wayne State University, Detroit, MI 48201, USA.
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Lee YS, Cho SY, Kim HW, Kang SH, Kim HY, Lee JY, Kwon EB, Hong SK, Lee JY. Preliminary Study of Tissue-Engineered Ileal Conduit Using Poly (ε-Caprolactone) (PCL) Nano-Sheet Seeded with Muscle-Derived Stem Cells. Korean J Urol 2009. [DOI: 10.4111/kju.2009.50.3.282] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- Yong Seok Lee
- Department of Urology, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Soo Yeon Cho
- Department of Urology, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Hyun Woo Kim
- Department of Urology, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Se Hee Kang
- Department of Urology, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Hee Youn Kim
- Department of Urology, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Ji Young Lee
- Department of Urology, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Eun Bi Kwon
- Department of Urology, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Song Karp Hong
- Department of Urology, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Ji Youl Lee
- Department of Urology, College of Medicine, The Catholic University of Korea, Seoul, Korea
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Magnan M, Lévesque P, Gauvin R, Dubé J, Barrieras D, El-Hakim A, Bolduc S. Tissue Engineering of a Genitourinary Tubular Tissue Graft Resistant to Suturing and High Internal Pressures. Tissue Eng Part A 2009; 15:197-202. [DOI: 10.1089/ten.tea.2007.0303] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Martine Magnan
- Laboratoire des Grands Brûlés/Laboratory of Experimental Tissue Engineering, Centre Hospitalier Affilié, Hôpital du Saint-Sacrement, and Department of Surgery, Université Laval, Québec, Québec, Canada
| | - Philippe Lévesque
- Laboratoire des Grands Brûlés/Laboratory of Experimental Tissue Engineering, Centre Hospitalier Affilié, Hôpital du Saint-Sacrement, and Department of Surgery, Université Laval, Québec, Québec, Canada
| | - Robert Gauvin
- Laboratoire des Grands Brûlés/Laboratory of Experimental Tissue Engineering, Centre Hospitalier Affilié, Hôpital du Saint-Sacrement, and Department of Surgery, Université Laval, Québec, Québec, Canada
| | - Jean Dubé
- Laboratoire des Grands Brûlés/Laboratory of Experimental Tissue Engineering, Centre Hospitalier Affilié, Hôpital du Saint-Sacrement, and Department of Surgery, Université Laval, Québec, Québec, Canada
| | - Diego Barrieras
- Department of Surgery, Université de Montréal, Montréal, Québec, Canada
| | - Assaad El-Hakim
- Department of Surgery, McGill University, Montréal, Québec, Canada
| | - Stéphane Bolduc
- Laboratoire des Grands Brûlés/Laboratory of Experimental Tissue Engineering, Centre Hospitalier Affilié, Hôpital du Saint-Sacrement, and Department of Surgery, Université Laval, Québec, Québec, Canada
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Khorrami MH, Salehi P, Nouri-Mahdavi K, Ghalamkari A, Tadayyon F. Dramatic Effect of a Somatostatin Analogue in Decreasing Mucus Production by the Intestinal Segment After Enterocystoplasty. J Urol 2008; 180:2501-3. [DOI: 10.1016/j.juro.2008.08.024] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2008] [Indexed: 11/25/2022]
Affiliation(s)
| | - Peyman Salehi
- Department of Urology, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Kia Nouri-Mahdavi
- Department of Urology, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Asghar Ghalamkari
- Department of Urology, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Farhad Tadayyon
- Department of Urology, Isfahan University of Medical Sciences, Isfahan, Iran
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Frederiksen H, Davidsson T, Gabella G, Uvelius B. Nerve distribution in rat urinary bladder after incorporation of acellular matrix graft or subtotal cystectomy. ACTA ACUST UNITED AC 2008; 42:205-12. [PMID: 18432527 DOI: 10.1080/00365590701871641] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVE In the treatment of reduced bladder capacity, matrix grafts have been used as a scaffold into which cell elements from the native bladder grow, eventually forming a new bladder segment. Functioning motor nerve endings in such segments in the rat have been demonstrated, although little is known about nerve distribution. We compare the pattern of nerve distribution in scaffold-augmented rat bladders with that in bladders regrown after subtotal cystectomy and that in control bladders. MATERIAL AND METHODS Female Sprague-Dawley rats were either subtotally cystectomized (n=7) or had a part of the bladder dome replaced by an acellular collagen (small intestinal submucosa) matrix graft (n=10). Fourteen age-matched, unoperated animals were used as controls. Two and a half to 10 months after surgery the bladders were stained for acetylcholinesterase and studied in wholemounts. RESULTS No ganglion neurons were observed in any of the bladders. On their ventral side the control bladders showed longitudinal nerve trunks, running in parallel along the longitudinally oriented muscle bundles, while on the lateral and dorsal aspects the nerves were thinner, more irregularly arranged and frequently branched. In the bladders regrown after subtotal cystectomy, the ventral nerves were seen running obliquely to the still longitudinally oriented muscle bundles, resembling the pattern of the normal bladder base; the pattern of the dorsolateral nerves was the same as that in the controls. In the matrix bladders, the muscle and nerve patterns in the native part were the same as those in controls. Muscle bundles were growing into the matrix, accompanied by nerves, which showed limited branching when entering the matrix, usually running in parallel to the muscle, but then branching within the matrix. CONCLUSIONS The nerves in the matrix grafts and the regrown parts of the subtotally cystectomized bladders derive from preexisting nerves in the bladder. In neither case does the nerve trunk or muscle bundle arrangement fully attain the pattern found in normal bladders.
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38
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Kwon TG, Yoo JJ, Atala A. Local and Systemic Effects of a Tissue Engineered Neobladder in a Canine Cystoplasty Model. J Urol 2008; 179:2035-41. [DOI: 10.1016/j.juro.2008.01.005] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2007] [Indexed: 10/22/2022]
Affiliation(s)
- Tae Gyun Kwon
- Department of Urology and Wake Forest Institute for Regenerative Medicine, Wake Forest University Health Sciences, Winston-Salem, North Carolina and Kyungpook National University Hospital, Daegu, Korea
| | - James J. Yoo
- Department of Urology and Wake Forest Institute for Regenerative Medicine, Wake Forest University Health Sciences, Winston-Salem, North Carolina and Kyungpook National University Hospital, Daegu, Korea
| | - Anthony Atala
- Department of Urology and Wake Forest Institute for Regenerative Medicine, Wake Forest University Health Sciences, Winston-Salem, North Carolina and Kyungpook National University Hospital, Daegu, Korea
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Baumert H, Simon P, Hekmati M, Fromont G, Levy M, Balaton A, Molinié V, Malavaud B. Development of a Seeded Scaffold in the Great Omentum: Feasibility of an in vivo Bioreactor for Bladder Tissue Engineering. Eur Urol 2007; 52:884-90. [PMID: 17229515 DOI: 10.1016/j.eururo.2006.11.044] [Citation(s) in RCA: 72] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2006] [Accepted: 11/20/2006] [Indexed: 11/18/2022]
Abstract
OBJECTIVES Tissue engineering is very promising in bladder reconstruction. However, one of the main problems is to limit the development of ischaemic fibrosis during tissue maturation. We describe a model using the omentum as an in vivo bioreactor for a previously seeded scaffold. METHODS Bladder biopsies were taken from five female pigs, from which both urothelial and smooth muscle cells cultures were made. These cultured cells were used to seed a sphere-shaped small intestinal submucosa (SIS) matrix, which was transferred into the omentum after 3 wk of cell growth. The grafts were harvested 3 wk later and histologic, immunohistochemical, and functional studies were performed. RESULTS We obtained a highly vascularized tissue-engineered construct that contracted in response to acetylcholine stimulation. The wall thickness was 4mm, on average. Histologic and immunostaining analysis of the construct confirmed the presence of a multilayer urothelium on the luminal aspect and deeper fascicles organised tissue composed of differentiated smooth muscle cells and mature fibroblasts without evidence of inflammation or necrosis. Large- and small-diameter vessels were clearly identified histologically in the tissue obtained. CONCLUSION The omentum permitted in vivo maturation of seeded scaffolds with the development of a dense vascularisation that is anticipated to prevent fibrosis and loss of contractility. This in vivo maturation into the omentum could be the first step before in situ implantation of the construct.
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Affiliation(s)
- Hervé Baumert
- Department of Urology, Paris Saint Joseph Hospital Trust, Paris, France.
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Iijima K, Igawa Y, Imamura T, Moriizumi T, Nikaido T, Konishi I, Nishizawa O. Transplantation of Preserved Human Amniotic Membrane for Bladder Augmentation in Rats. ACTA ACUST UNITED AC 2007; 13:513-24. [PMID: 17518600 DOI: 10.1089/ten.2006.0170] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Although gastrointestinal segments have been widely used for bladder reconstruction, they are not ideal because of the possible complications. Searches have therefore continued for an alternative material for augmentation. Here, we performed bladder augmentation in rats using human amniotic membrane (hAM). Morphologically, the hAM-augmented bladder revealed regeneration of urothelium, detrusor smooth muscle, and nerve fibers within 3 months post-operatively. In our functional evaluation of bladder strips, we compared hAM-augmented bladders with bladders augmented using small intestinal submucosa (SIS). For example, at 6 months post-operatively, contractions of the following size (as a percentage of the responses in the control-bladder group) were obtained in response to high potassium, carbachol, and electrical field stimulation, respectively: hAM 22% vs SIS 15%, hAM 15% vs SIS 7%, hAM 5.3% vs SIS 1.3% (no significant differences, hAM vs SIS). Both hAM- and SIS-augmented bladders displayed adequate capacity and compliance. The present results indicate that, for bladder augmentation, hAM can be used as a scaffold and is comparable in this respect with SIS. hAM can be more easily obtained than SIS and requires little preparation, and its use raises few ethical questions. Hence, hAM may represent a new therapeutic alternative for urological reconstructions.
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Affiliation(s)
- Kazuyoshi Iijima
- Department of Urology, Shinshu University School of Medicine, Matsumoto, Japan
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41
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Xu CC, Chan RW, Tirunagari N. A Biodegradable, Acellular Xenogeneic Scaffold for Regeneration of the Vocal Fold Lamina Propria. ACTA ACUST UNITED AC 2007; 13:551-66. [PMID: 17518602 DOI: 10.1089/ten.2006.0169] [Citation(s) in RCA: 108] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
A novel method for preparing an acellular xenogeneic extracellular matrix scaffold for tissue engineering was developed. Bovine vocal fold lamina propria specimens were treated with high-concentration sodium chloride, nucleic acid digestion, and ethanol dehydration for decellularization and removal of immunogenic foreign epitopes. Human vocal fold fibroblasts from primary culture were seeded onto the acellular scaffolds and cultured for 21 days. The decellularized and the recellularized scaffolds were examined by light microscopy, fluorescent microscopy, and scanning electron microscopy. Collagen synthesis and release by fibroblasts were quantified by the Sircol assay, whereas the synthesis and release of hyaluronic acid, decorin, and fibronectin were assessed by enzyme-linked immunosorbent assays. Viscoelastic shear properties of the scaffolds were quantified by a simple-shear rheometer at frequencies of up to 250 Hz. Preliminary results showed that a biodegradable, acellular extracellular matrix scaffold with an intact basement membrane and 3-dimensional structure of the matrix proteins was engineered. Vocal fold fibroblasts readily attached to and infiltrated the scaffold with high viability and active protein synthesis, demonstrating the biocompatibility. The elastic shear modulus and dynamic viscosity of the acellular scaffold and the fibroblast-repopulated scaffold were comparable to those of the human vocal fold cover. These findings support the potential of the scaffold as a xenograft for vocal fold reconstruction and regeneration.
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Affiliation(s)
- Chet C Xu
- Graduate Program in Biomedical Engineering, University of Texas Southwestern Medical Center, Dallas, TX 75390-9035, USA
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42
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Byun SS, Chung YS, Lee SS, Lee HN, Lee JY, Lee JY. Augmentation Cystoplasty using Hydroxapatite/chitosan Composite Sheet Seeded with Autologous Muscle-derived Stem Cells. Korean J Urol 2007. [DOI: 10.4111/kju.2007.48.4.433] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- Seok-Soo Byun
- Department of Urology, Seoul National University College of Medicine, Seoul, Korea
| | - Yong Sik Chung
- Department of Textile Engineering, Chonbuk National University, Jeonju, Korea
| | - Sang Sub Lee
- Depratment of Biology, Kyonggi University, Seoul, Korea
| | - Haet Nim Lee
- Department of Urology, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Ji Young Lee
- Department of Urology, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Ji Youl Lee
- Department of Urology, College of Medicine, The Catholic University of Korea, Seoul, Korea
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McAteer H, Cosh E, Freeman G, Pandit A, Wood P, Lilford R. Cost-effectiveness analysis at the development phase of a potential health technology: examples based on tissue engineering of bladder and urethra. J Tissue Eng Regen Med 2007; 1:343-9. [DOI: 10.1002/term.36] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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44
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Xu CC, Chan RW, Tirunagari N. A Biodegradable, Acellular Xenogeneic Scaffold for Regeneration of the Vocal Fold Lamina Propria. ACTA ACUST UNITED AC 2006. [DOI: 10.1089/ten.2007.13.ft-328] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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45
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Obara T, Matsuura S, Narita S, Satoh S, Tsuchiya N, Habuchi T. Bladder acellular matrix grafting regenerates urinary bladder in the spinal cord injury rat. Urology 2006; 68:892-7. [PMID: 17070388 DOI: 10.1016/j.urology.2006.04.030] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2005] [Revised: 03/22/2006] [Accepted: 04/25/2006] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To assess the feasibility of bladder acellular matrix (BAM) grafting onto the bladder of rats with spinal cord injury (SCI). METHODS Female Wistar rats, weighing 100 to 150 g, were divided into four groups: neurologically intact groups with sham operation or BAM grafting and SCI rats with or without BAM grafting (grafted groups, n = 15 each; nongrafted groups, n = 5 each). The BAM was prepared from other normal rat bladder tissue. During BAM surgery, the rats underwent partial cystectomy, followed by BAM grafting as a bladder augmentation. The SCI was created by compressing the spinal cord at the 10th thoracic level. BAM grafting in SCI rats was performed 2 to 3 weeks after SCI. At 2, 4, and 12 weeks after grafting, cystometry was performed with the rats under pentobarbital anesthesia, and the bladders were subsequently harvested and immunostained with anti-PGP9.5, uroplakin III, and alpha-smooth muscle actin antibodies (n = 5 each time). For comparison, similar examinations were performed in the nongrafted groups (n = 5 each). RESULTS Regenerated urothelium, smooth muscles, and nerve fibers in the grafted BAM appeared at 2, 4, and 12 weeks, respectively, in both intact and SCI rats. Immunohistologic examination showed that these regenerated tissues inherited each characteristic of the host bladder tissue. The grafted BAM itself also showed the proper storage function of distensibility in the intact and SCI groups receiving BAM. CONCLUSIONS Our data have indicated that BAM grafting is feasible, even in animals with spinal injury, suggesting that BAM may be one of the alternatives for patients with a neurogenic bladder who require augmentation enterocystoplasty in clinical situations.
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Affiliation(s)
- Takashi Obara
- Department of Urology, Akita University School of Medicine, Akita, Japan
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Brown AL, Srokowski EM, Shu XZ, Prestwich GD, Woodhouse KA. Development of a Model Bladder Extracellular Matrix Combining Disulfide Cross-Linked Hyaluronan with Decellularized Bladder Tissue. Macromol Biosci 2006; 6:648-57. [PMID: 16881043 DOI: 10.1002/mabi.200600052] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
[Image: see text] In this work we investigate the feasibility of modifying porcine-derived BAM to include HA with a view to developing a model, artificial extracellular matrix for the study of bladder cell-matrix interactions. HA-DPTH was incorporated into BAM disks and then cross-linked oxidatively to a disulfide containing hydrogel. Disks were seeded with bladder smooth muscle cells (BSMC) and UEC under three culture configurations and incubated for 3, 7, and 14 d. At each time point, matrix contraction was measured, and media supernatants assayed for cell-secreted gelatinase activity. To evaluate cell adherence and organization, triple immunofluorescent labeling of cell nuclei, actin cytoskeleton, and focal contacts was performed. HA-modified BAM exhibited a significant increase in matrix contraction and induced a higher level of cell-secreted gelatinase activity compared to unmodified BAM. Immunofluorescent labeling demonstrated that BSMCs remained adherent to both scaffold types over time. The distribution and organization of the cytoskeleton and focal contacts did not appear to be altered by the presence of HA. Interestingly, cellular infiltration into modified BAM was evident by 7 d and continued beyond 14 d, while BSMCs seeded onto unmodified BAM remained localized to the surface out to 14 d, with minimal infiltration evident only at day 28. These differences in cell infiltration support the gelatinase activity results. Increases in cell migration and matrix proteolysis in the presence of HA may be contributing factors toward BAM remodeling leading to increased matrix contraction with time. The model ECM developed in this work will be utilized for future studies aimed at elucidating the mechanisms controlling key remodeling events associated with bladder repair. Matrix contraction of cell-seeded BAM scaffolds.
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Affiliation(s)
- Allison L Brown
- Department of Chemical Engineering and Applied Chemistry, Institute for Biomaterials and Biomedical Engineering, University of Toronto, 200 College Street, Toronto, Ontario, Canada M5S 3E5
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Joo KJ, Kim BS, Han JH, Kim CJ, Kwon CH, Park HJ. Porcine vesical acellular matrix graft of tunica albuginea for penile reconstruction. Asian J Androl 2006; 8:543-8. [PMID: 16752002 DOI: 10.1111/j.1745-7262.2006.00192.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
AIM To characterize the feasibility of the surgical replacement of the penile tunica albuginea (TA) and to evaluate the value of a porcine bladder acellular matrix (BAM) graft. METHODS Acellular matrices were constructed from pigs' bladders by cell lysis, and then examined by scanning electron microscopy (SEM). Expression levels of the mRNA of the vascular endothelial growth factor (VEGF) receptor, fibroblast growth factor (FGF)-1 receptor, neuregulin, and brain-derived neurotrophic factor (BDNF) in the acellular matrix and submucosa of the pigs'bladders were determined through the reverse transcription-polymerase chain reaction (PCR). A 5 mm X 5 mm square was excised from the penile TA of nine rabbits. The defective TA was then covered in porcine BAM. Equal numbers of animals were sacrificed and histochemically examined at 2, 4 and 6 months after implantation. RESULTS SEM of the BAM showed collagen fibers with many pores. VEGF receptor, FGF-1 receptor and neuregulin mRNA were expressed in the porcine BAM; BDNF mRNA was not detected. Two months after implantation, the graft sites exhibited excellent healing without contracture, and the fusion between the graft and the neighboring normal TA appeared to be well established. There were no significant histological differences between the implanted tunica and the normal control tunica at 6 months after implantation. CONCLUSION The porcine BAM graft resulted in a structure which was sufficiently like that of the normal TA. This implantation might be considered applicable to the reconstruction of the TA in conditions such as trauma or Peyronie's disease.
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Affiliation(s)
- Kwan-Joong Joo
- Department of Urology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, 108 Pyung-Dong, Jongro-Ku, Seoul 110-746, Korea
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El-Hakim A, Marcovich R, Chiu KY, Lee BR, Smith AD. First prize: ureteral segmental replacement revisited. J Endourol 2006; 19:1069-74. [PMID: 16283842 DOI: 10.1089/end.2005.19.1069] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND AND PURPOSE Long strictures of the proximal ureter are difficult to manage, and circumferential replacement with various natural and synthetic materials has been unsuccessful. We sought to use cultured autologous cells seeded onto graft material for proximal-ureteral replacement. Additionally, we wished to determine if urothelial cell-seeded de-epithelialized small bowel would generate adequate ureteral replacement. MATERIALS AND METHODS Three sets of experiments were performed. First, autologous pig-bladder smooth-muscle and urothelial cells were expanded in culture on large sheets of multilayer small-intestinal submucosa (SIS). These sheets were then tubularized and used to replace a 5-cm segment of proximal ureter in pigs. Second, autologous cells harvested from the bladders of Beagle dogs were cultured and seeded on porcine ureteral acellular matrix, which was used to replace a 3-cm segment of ureter in dogs. Segments were wrapped in omentum to enhance vascularity. Third, a de-epithelialized small-bowel segment seeded with autologous bladder-epithelial cells was transversally retubularized (Monti) into a 4-cm ureteral replacement. Follow-up studies consisted of retrograde pyelography, serum chemistry assays, hematoxylin/eosin studies, and immunohistopathologic examination using antibodies against alpha-smooth-muscle actin and pancytokeratin AE1-AE3. RESULTS Coculture of urinary-tract cells on large segments of SIS failed to create adequate ureteral replacement. All grafts were contracted and stenotic, with complete obstruction of the ipsilateral renal unit. Similar results were seen in the Beagles. Despite clinical obstruction and gross contraction of the graft, a circumferential muscular ureteral wall lined with multilayer transitional epithelium was present. Urotheliumseeded de-epithelialized Monti bowel segments resulted in patent ureteral replacement without hydroureteronephrosis and with normal renal function, serum electrolytes, and acid-base balance. However, bowel mucosa fully regenerated, with multilayer transitional epithelium growing adluminally in continuity with the proximal and distal anastomotic sites. CONCLUSIONS Seeding of ureteral grafts with autologous bladder cells does not promote success in two largeanimal models using different xenogenic acellular matrices. However, muscle and urothelium regeneration occurs with ureteral acellular matrix in the dog. Urothelium-seeded de-epithelialized Monti bowel segments may be an acceptable substitute for long proximal ureteral segments. Further technical refinements are required to replace the bowel mucosa completely with normal urothelium.
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Affiliation(s)
- Assaad El-Hakim
- Department of Urology, Long Island Jewish Medical Center, New Hyde Park, New York, USA.
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Matsunuma H, Kagami H, Narita Y, Hata KI, Ono Y, Ohshima S, Ueda M. Constructing a Tissue-Engineered Ureter Using a Decellularized Matrix with Cultured Uroepithelial Cells and Bone Marrow-Derived Mononuclear Cells. ACTA ACUST UNITED AC 2006; 12:509-18. [PMID: 16579684 DOI: 10.1089/ten.2006.12.509] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
This study investigated the efficacy of the ureteral decellularized matrix (UDM) as a scaffold material for a tissue-engineered ureter, and the effect of bone marrow-derived mononuclear cells (BM-MNC) on the neovascularization of the scaffold. Canine ureters were treated with deoxycholic acid to remove all cells. Uroepithelial cells (UEC) were obtained from canine bladders, cultured, and then seeded onto the inner surface of the UDM before transplantation into the subcutaneous space of nude mice or the omentum of nude rats. The cultured UECs began showing vacuolar degeneration 3 days after transplantation and gradually disappeared thereafter. To facilitate neovascularization in the implant, BM-MNCs were seeded around the UDM before transplantation. This facilitated the survival of the UECs, which formed three to five cellular layers after 14 days. The mean microvessel density was significantly increased in tissues seeded with BM-MNCs. However, cell-tracking experiments revealed that the increased number of capillaries in the experimental group was not due to the direct differentiation of transplanted endothelial progenitor cells. Our results demonstrate that the UDM is a useful scaffold for a tissue-engineered ureter, especially when seeded with BM-MNCs to enhance angiogenesis.
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Affiliation(s)
- Hiroshi Matsunuma
- Department of Urology, Nagoya University Graduate School of Medicine, Nagoya, Japan
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50
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Sievert KD, Fandel T, Wefer J, Gleason CA, Nunes L, Dahiya R, Tanagho EA. Collagen I:III ratio in canine heterologous bladder acellular matrix grafts. World J Urol 2006; 24:101-9. [PMID: 16474953 DOI: 10.1007/s00345-006-0052-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2005] [Accepted: 12/15/2005] [Indexed: 11/28/2022] Open
Abstract
The objective of this study was to investigate the limitations of a heterologous bladder acellular matrix graft (BAMG) and the influence of the collagen ratio on functional regeneration in a large animal model. Ten female dogs underwent partial cystectomy; eight received BAMG (two homologous; six heterologous) and two partial cystectomy only. A cystometry was performed prior to surgery and 7 months postoperatively when all animals underwent sacral root stimulation. Tissue specimens were studied by histologic and immunohistochemical techniques and for collagen types. At month 7, all animals survived and bladder capacity in the grafted animals was increased. All grafts demonstrated all components of a normal bladder wall. Nerves were seen with the density decreasing with distance from the anastomosis. The BAMG processing and follow-up demonstrated no changes in the homologous tissue, whereas in the heterologous tissue, the amount of collagen changed with the processing during implantation. None of these heterologous specimens demonstrated a similar collagen ratio to the hosts'. The homologous BAMG undergoes more complete regeneration. In the heterologous BAMG, collagen seems not to be replaced. The amounts and ratio of collagen types I and III seem to influence smooth muscle regeneration.
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Affiliation(s)
- Karl-Dietrich Sievert
- Department of Urology, University of California School of Medicine, San Francisco, CA, USA.
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