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Adly HA, El-Okby AWY, Yehya AA, El-Shamy AA, Galhom RA, Hashem MA, Ahmed MF. Circumferential Esophageal Reconstruction Using a Tissue-engineered Decellularized Tunica Vaginalis Graft in a Rabbit Model. J Pediatr Surg 2024:S0022-3468(24)00250-1. [PMID: 38692944 DOI: 10.1016/j.jpedsurg.2024.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Revised: 03/26/2024] [Accepted: 04/05/2024] [Indexed: 05/03/2024]
Abstract
BACKGROUND Pediatric surgeons have faced esophageal reconstruction challenges for decades owing to a variety of congenital and acquired conditions. This work aimed to introduce a reproducible and efficient approach for creating tissue-engineered esophageal tissue using bone marrow mesenchymal stem cells (BMSCs) cultured in preconditioned mediums seeded on a sheep decellularized tunica vaginalis (DTV) scaffold for partial reconstruction of a rabbit's esophagus. METHODS DTV was performed using SDS and Triton X-100 solutions. The decellularized grafts were employed alone (DTV group) or after recellularization with BMSCs cultured for 10 days in preconditioned mediums (RTV group) for reconstructing a 3 cm segmental defect in the cervical esophagus of rabbits (n = 20) after the decellularization process was confirmed. Rabbits were observed for one month, after which they were euthanized, and the reconstructed esophagi were harvested for histological analysis. RESULTS Six rabbits in the DTV group and eight rabbits in the RTV group survived until the end of the one-month study period. Despite histological examination demonstrating that both grafts completely repaired the esophageal defect, the RTV graft demonstrated a histological structure similar to that of the normal esophagus. The reconstructed esophagi in the RTV group revealed the arrangement of the different layers of the esophageal wall with the formation of newly formed blood vessels and Schwann-like cells. CONCLUSION DTV xenograft is a novel scaffold that promotes cell adhesion and differentiation and might be effectively utilized for regenerating esophageal tissue, paving the way for future clinical trials in pediatric patients.
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Affiliation(s)
- Hassan A Adly
- Pediatric Surgery Unit, General Surgery Department, Faculty of Medicine, Al-Azhar University (Assiut Branch), Assiut, Egypt.
| | - Abdel-Wahab Y El-Okby
- Department of Pediatric Surgery, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | - Abdel-Aziz Yehya
- Department of Pediatric Surgery, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | - Ahmed A El-Shamy
- Pediatric Surgery Unit, General Surgery Department, Faculty of Medicine, Al-Azhar University (Assiut Branch), Assiut, Egypt
| | - Rania A Galhom
- Department of Human Anatomy and Embryology, Faculty of Medicine, Suez Canal University, Ismailia, Egypt; Tissue Culture Lab, Center of Excellence of Molecular and Cellular Medicine (CEMCM), Faculty of Medicine, Suez Canal University, Ismailia, Egypt; Department of Human Anatomy and Embryology, Faculty of Medicine, Badr University in Cairo (BUC), Cairo, Egypt
| | - Mohamed A Hashem
- Department of Surgery, Anesthesiology and Radiology, Faculty of Veterinary Medicine, Suez Canal University, Ismailia, Egypt
| | - Mahmoud F Ahmed
- Department of Surgery, Anesthesiology and Radiology, Faculty of Veterinary Medicine, Suez Canal University, Ismailia, Egypt
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2
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Hashem MA, Metwally E, Mahmoud YK, Helal IE, Ahmed MF. Reconstruction of a partial esophageal defect using tunica vaginalis and buccal mucosa autograft: an experimental study in mongrel dogs. J Vet Med Sci 2023; 85:344-357. [PMID: 36709969 PMCID: PMC10076192 DOI: 10.1292/jvms.22-0319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
In veterinary clinics, esophageal reconstruction is essential in many clinical situations. In this study, two autografts, the tunica vaginalis (TV) and the buccal mucosa (BM), were proposed to reconstruct a semi-circumferential cervical esophageal defect in dogs. This study aimed to verify whether these two grafts could successfully patch esophageal defects. Twelve male mongrel dogs were divided into two groups. Following cervical esophagoplasty, the defective area was patched with either a TV or a BM graft. Comprehensive clinical, serum biochemical, and histological analyses were performed to evaluate the two grafts. Throughout the study (120 days), the dogs survived the procedure well with minor complications. The lumen of the patched areas was covered with mucosa, with slight scar retraction. Compared with that of the natural esophagus, the average relative luminal diameter was not significantly decreased. Importantly, the measured cortisol and inflammatory marker levels returned to the preoperative levels after 14 days. Although histological examination revealed that both grafts repaired the esophageal defect with complete re-epithelialization, the BM graft showed a histological structure similar to that of the natural esophagus. Both grafts effectively repaired the esophageal defect with minor complications; therefore, both are recommended as promising low-cost clinical alternatives for cervical esophagoplasty in dogs.
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Affiliation(s)
- Mohamed A Hashem
- Department of Surgery, Anesthesiology and Radiology, Faculty of Veterinary Medicine, Suez Canal University, Ismailia, Egypt
| | - Elsayed Metwally
- Department of Cytology and Histology, Faculty of Veterinary Medicine, Suez Canal University, Ismailia, Egypt
| | - Yasmina K Mahmoud
- Department of Biochemistry, Faculty of Veterinary Medicine, Suez Canal University, Ismailia, Egypt
| | - Ibrahim E Helal
- Department of Surgery, Anesthesiology and Radiology, Faculty of Veterinary Medicine, Suez Canal University, Ismailia, Egypt
| | - Mahmoud F Ahmed
- Department of Surgery, Anesthesiology and Radiology, Faculty of Veterinary Medicine, Suez Canal University, Ismailia, Egypt
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3
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Elia E, Brownell D, Chabaud S, Bolduc S. Tissue Engineering for Gastrointestinal and Genitourinary Tracts. Int J Mol Sci 2022; 24:ijms24010009. [PMID: 36613452 PMCID: PMC9820091 DOI: 10.3390/ijms24010009] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 12/10/2022] [Accepted: 12/14/2022] [Indexed: 12/24/2022] Open
Abstract
The gastrointestinal and genitourinary tracts share several similarities. Primarily, these tissues are composed of hollow structures lined by an epithelium through which materials need to flow with the help of peristalsis brought by muscle contraction. In the case of the gastrointestinal tract, solid or liquid food must circulate to be digested and absorbed and the waste products eliminated. In the case of the urinary tract, the urine produced by the kidneys must flow to the bladder, where it is stored until its elimination from the body. Finally, in the case of the vagina, it must allow the evacuation of blood during menstruation, accommodate the male sexual organ during coitus, and is the natural way to birth a child. The present review describes the anatomy, pathologies, and treatments of such organs, emphasizing tissue engineering strategies.
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Affiliation(s)
- Elissa Elia
- Centre de Recherche en Organogénèse Expérimentale/LOEX, Regenerative Medicine Division, CHU de Québec-Université Laval Research Center, Québec, QC G1J 1Z4, Canada
| | - David Brownell
- Centre de Recherche en Organogénèse Expérimentale/LOEX, Regenerative Medicine Division, CHU de Québec-Université Laval Research Center, Québec, QC G1J 1Z4, Canada
| | - Stéphane Chabaud
- Centre de Recherche en Organogénèse Expérimentale/LOEX, Regenerative Medicine Division, CHU de Québec-Université Laval Research Center, Québec, QC G1J 1Z4, Canada
| | - Stéphane Bolduc
- Centre de Recherche en Organogénèse Expérimentale/LOEX, Regenerative Medicine Division, CHU de Québec-Université Laval Research Center, Québec, QC G1J 1Z4, Canada
- Department of Surgery, Faculty of Medicine, Université Laval, Québec, QC G1V 0A6, Canada
- Correspondence: ; Tel.: +1-418-525-4444 (ext. 42282)
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4
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Marzaro M, Pozzato G, Tedesco S, Algeri M, Pozzato A, Tomao L, Montano I, Torroni F, Balassone V, Contini ACI, Guerra L, D’Angelo T, Federici di Abriola G, Lupoi L, Caristo ME, Boškoski I, Costamagna G, Francalanci P, Astori G, Bozza A, Bagno A, Todesco M, Trovalusci E, Oglio LD, Locatelli F, Caldaro T. Decellularized esophageal tubular scaffold microperforated by quantum molecular resonance technology and seeded with mesenchymal stromal cells for tissue engineering esophageal regeneration. Front Bioeng Biotechnol 2022; 10:912617. [PMID: 36267444 PMCID: PMC9576845 DOI: 10.3389/fbioe.2022.912617] [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: 04/04/2022] [Accepted: 08/17/2022] [Indexed: 11/25/2022] Open
Abstract
Current surgical options for patients requiring esophageal replacement suffer from several limitations and do not assure a satisfactory quality of life. Tissue engineering techniques for the creation of customized “self-developing” esophageal substitutes, which are obtained by seeding autologous cells on artificial or natural scaffolds, allow simplifying surgical procedures and achieving good clinical outcomes. In this context, an appealing approach is based on the exploitation of decellularized tissues as biological matrices to be colonized by the appropriate cell types to regenerate the desired organs. With specific regard to the esophagus, the presence of a thick connective texture in the decellularized scaffold hampers an adequate penetration and spatial distribution of cells. In the present work, the Quantum Molecular Resonance® (QMR) technology was used to create a regular microchannel structure inside the connective tissue of full-thickness decellularized tubular porcine esophagi to facilitate a diffuse and uniform spreading of seeded mesenchymal stromal cells within the scaffold. Esophageal samples were thoroughly characterized before and after decellularization and microperforation in terms of residual DNA content, matrix composition, structure and biomechanical features. The scaffold was seeded with mesenchymal stromal cells under dynamic conditions, to assess the ability to be repopulated before its implantation in a large animal model. At the end of the procedure, they resemble the original esophagus, preserving the characteristic multilayer composition and maintaining biomechanical properties adequate for surgery. After the sacrifice we had histological and immunohistochemical evidence of the full-thickness regeneration of the esophageal wall, resembling the native organ. These results suggest the QMR microperforated decellularized esophageal scaffold as a promising device for esophagus regeneration in patients needing esophageal substitution.
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Affiliation(s)
| | | | | | - Mattia Algeri
- Department of Pediatric Onco-Hematology and Cell and Gene Therapy, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | | | - Luigi Tomao
- Department of Pediatric Onco-Hematology and Cell and Gene Therapy, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Ilaria Montano
- Department of Pediatric Onco-Hematology and Cell and Gene Therapy, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Filippo Torroni
- Digestive Endoscopy and Surgical Unit, Bambino Gesù Children’s Hospital, Rome, Italy
| | - Valerio Balassone
- Digestive Endoscopy and Surgical Unit, Bambino Gesù Children’s Hospital, Rome, Italy
| | | | - Luciano Guerra
- Digestive Endoscopy and Surgical Unit, Bambino Gesù Children’s Hospital, Rome, Italy
| | - Tommaso D’Angelo
- Digestive Endoscopy and Surgical Unit, Bambino Gesù Children’s Hospital, Rome, Italy
| | | | - Lorenzo Lupoi
- Cen.Ri.S. Policlinico Gemelli UNICATT Rome, Rome, Italy
| | | | - Ivo Boškoski
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Digestive Endoscopy Unit, Rome, Italy
- Università Cattolica del Sacro Cuore, Centre For Endoscopic Research Therapeutics and Training (CERTT), Rome, Italy—CERTT Gemelli, Rome, Italy
- *Correspondence: Ivo Boškoski,
| | - Guido Costamagna
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Digestive Endoscopy Unit, Rome, Italy
- Università Cattolica del Sacro Cuore, Centre For Endoscopic Research Therapeutics and Training (CERTT), Rome, Italy—CERTT Gemelli, Rome, Italy
| | | | - Giuseppe Astori
- Advanced Cellular Therapy Laboratory, Haematology Unit, San Bortolo Hospital, Vicenza, Italy
| | - Angela Bozza
- Advanced Cellular Therapy Laboratory, Haematology Unit, San Bortolo Hospital, Vicenza, Italy
- Consorzio Per la Ricerca Sanitaria (CORIS) of the Veneto Region, Padova, Italy
| | - Andrea Bagno
- Department of Industrial Engineering, University of Padova, Padova, Italy
| | - Martina Todesco
- Department of Industrial Engineering, University of Padova, Padova, Italy
| | - Emanuele Trovalusci
- Pediatric Surgery Department AULSS2 Treviso, University of Padova, Padova, Italy
| | - Luigi Dall’ Oglio
- Digestive Endoscopy and Surgical Unit, Bambino Gesù Children’s Hospital, Rome, Italy
| | - Franco Locatelli
- Department of Pediatric Onco-Hematology and Cell and Gene Therapy, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
- Department of Pediatrics, Sapienza University of Rome, Roma, Italy
| | - Tamara Caldaro
- Digestive Endoscopy and Surgical Unit, Bambino Gesù Children’s Hospital, Rome, Italy
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5
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Hannon E, Pellegrini M, Scottoni F, Durkin N, Shibuya S, Lutman R, Proctor TJ, Hutchinson JC, Arthurs OJ, Phylactopoulos DE, Maughan EF, Butler CR, Eaton S, Lowdell MW, Bonfanti P, Urbani L, De Coppi P. Lessons learned from pre-clinical testing of xenogeneic decellularized esophagi in a rabbit model. iScience 2022; 25:105174. [PMID: 36217545 PMCID: PMC9547295 DOI: 10.1016/j.isci.2022.105174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 06/21/2022] [Accepted: 09/19/2022] [Indexed: 11/04/2022] Open
Abstract
Decellularization of esophagi from several species for tissue engineering is well described, but successful implantation in animal models of esophageal replacement has been challenging. The purpose of this study was to assess feasibility and applicability of esophageal replacement using decellularized porcine esophageal scaffolds in a new pre-clinical model. Following surgical replacement in rabbits with a vascularizing muscle flap, we observed successful anastomoses of decellularized scaffolds, cues of early neovascularization, and prevention of luminal collapse by the use of biodegradable stents. However, despite the success of the surgical procedure, the long-term survival was limited by the fragility of the animal model. Our results indicate that transplantation of a decellularized porcine scaffold is possible and vascular flaps may be useful to provide a vascular supply, but long-term outcomes require further pre-clinical testing in a different large animal model.
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Affiliation(s)
- Edward Hannon
- Great Ormond Street Institute of Child Health, University College London, London WC1N 1EH, UK,Department of Paediatric Surgery, Leeds Children’s Hospital, Leeds Teaching Hospitals NHS Trust, Leeds LS1 3EX, UK
| | - Marco Pellegrini
- Great Ormond Street Institute of Child Health, University College London, London WC1N 1EH, UK
| | - Federico Scottoni
- Great Ormond Street Institute of Child Health, University College London, London WC1N 1EH, UK,Department of Pediatric Surgery, Regina Margherita Children’s Hospital, Turin 10126, Italy
| | - Natalie Durkin
- Great Ormond Street Institute of Child Health, University College London, London WC1N 1EH, UK
| | - Soichi Shibuya
- Great Ormond Street Institute of Child Health, University College London, London WC1N 1EH, UK
| | - Roberto Lutman
- Great Ormond Street Institute of Child Health, University College London, London WC1N 1EH, UK
| | - Toby J. Proctor
- Centre for Cell, Gene and Tissue Therapies, Royal Free Hospital & University College London, London NW3 2PF, UK
| | - J. Ciaran Hutchinson
- Great Ormond Street Institute of Child Health, University College London, London WC1N 1EH, UK,Department of Histopathology, Great Ormond Street Hospital for Children NHS Foundation Trust, London WC1N 3JH, UK
| | - Owen J. Arthurs
- Great Ormond Street Institute of Child Health, University College London, London WC1N 1EH, UK,Department of Radiology, Great Ormond Street Hospital for Children NHS Foundation Trust, London WC1N 3JH, UK
| | - Demetra-Ellie Phylactopoulos
- Great Ormond Street Institute of Child Health, University College London, London WC1N 1EH, UK,Epithelial Stem Cell Biology & Regenerative Medicine Laboratory, The Francis Crick Institute, London NW1 1AT, UK
| | - Elizabeth F. Maughan
- Great Ormond Street Institute of Child Health, University College London, London WC1N 1EH, UK,Charing Cross Airway Service, Department of Otolaryngology, Charing Cross Hospital, Imperial Healthcare NHS Trust, London W6 8RF, UK
| | - Colin R. Butler
- Great Ormond Street Institute of Child Health, University College London, London WC1N 1EH, UK,ENT Department, Great Ormond Street Hospital for Children NHS Foundation Trust, London WC1N 3JH, UK
| | - Simon Eaton
- Great Ormond Street Institute of Child Health, University College London, London WC1N 1EH, UK
| | - Mark W. Lowdell
- Centre for Cell, Gene and Tissue Therapies, Royal Free Hospital & University College London, London NW3 2PF, UK
| | - Paola Bonfanti
- Great Ormond Street Institute of Child Health, University College London, London WC1N 1EH, UK,Epithelial Stem Cell Biology & Regenerative Medicine Laboratory, The Francis Crick Institute, London NW1 1AT, UK,Institute of Immunity & Transplantation, University College London, London NW3 2PP, UK
| | - Luca Urbani
- The Roger Williams Institute of Hepatology, Foundation for Liver Research, London SE5 9NT, UK,Faculty of Life Sciences and Medicine, King’s College London, London SE5 8AF, UK
| | - Paolo De Coppi
- Great Ormond Street Institute of Child Health, University College London, London WC1N 1EH, UK,Specialist Neonatal and Paediatric Surgery, Great Ormond Street Hospital for Children NHS Foundation Trust, London WC1N 3JH, UK,Corresponding author
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6
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Barbon S, Biccari A, Stocco E, Capovilla G, D’Angelo E, Todesco M, Sandrin D, Bagno A, Romanato F, Macchi V, De Caro R, Agostini M, Merigliano S, Valmasoni M, Porzionato A. Bio-Engineered Scaffolds Derived from Decellularized Human Esophagus for Functional Organ Reconstruction. Cells 2022; 11:cells11192945. [PMID: 36230907 PMCID: PMC9563623 DOI: 10.3390/cells11192945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Revised: 09/14/2022] [Accepted: 09/15/2022] [Indexed: 11/16/2022] Open
Abstract
Esophageal reconstruction through bio-engineered allografts that highly resemble the peculiar properties of the tissue extracellular matrix (ECM) is a prospective strategy to overcome the limitations of current surgical approaches. In this work, human esophagus was decellularized for the first time in the literature by comparing three detergent-enzymatic protocols. After decellularization, residual DNA quantification and histological analyses showed that all protocols efficiently removed cells, DNA (<50 ng/mg of tissue) and muscle fibers, preserving collagen/elastin components. The glycosaminoglycan fraction was maintained (70–98%) in the decellularized versus native tissues, while immunohistochemistry showed unchanged expression of specific ECM markers (collagen IV, laminin). The proteomic signature of acellular esophagi corroborated the retention of structural collagens, basement membrane and matrix–cell interaction proteins. Conversely, decellularization led to the loss of HLA-DR expression, producing non-immunogenic allografts. According to hydroxyproline quantification, matrix collagen was preserved (2–6 µg/mg of tissue) after decellularization, while Second-Harmonic Generation imaging highlighted a decrease in collagen intensity. Based on uniaxial tensile tests, decellularization affected tissue stiffness, but sample integrity/manipulability was still maintained. Finally, the cytotoxicity test revealed that no harmful remnants/contaminants were present on acellular esophageal matrices, suggesting allograft biosafety. Despite the different outcomes showed by the three decellularization methods (regarding, for example, tissue manipulability, DNA removal, and glycosaminoglycans/hydroxyproline contents) the ultimate validation should be provided by future repopulation tests and in vivo orthotopic implant of esophageal scaffolds.
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Affiliation(s)
- Silvia Barbon
- Section of Human Anatomy, Department of Neuroscience, University of Padova, 35121 Padova, Italy
- L.i.f.e.L.a.b. Program, Consorzio per la Ricerca Sanitaria, 35128 Padova, Italy
- Foundation for Biology and Regenerative Medicine, Tissue Engineering and Signaling—TES, Onlus, 35136 Padova, Italy
| | - Andrea Biccari
- L.i.f.e.L.a.b. Program, Consorzio per la Ricerca Sanitaria, 35128 Padova, Italy
- Department of Surgical Oncological and Gastroenterological Sciences, University of Padova, 35128 Padova, Italy
| | - Elena Stocco
- Section of Human Anatomy, Department of Neuroscience, University of Padova, 35121 Padova, Italy
- L.i.f.e.L.a.b. Program, Consorzio per la Ricerca Sanitaria, 35128 Padova, Italy
- Foundation for Biology and Regenerative Medicine, Tissue Engineering and Signaling—TES, Onlus, 35136 Padova, Italy
| | - Giovanni Capovilla
- Department of Surgical Oncological and Gastroenterological Sciences, University of Padova, 35128 Padova, Italy
| | - Edoardo D’Angelo
- Department of Surgical Oncological and Gastroenterological Sciences, University of Padova, 35128 Padova, Italy
| | - Martina Todesco
- L.i.f.e.L.a.b. Program, Consorzio per la Ricerca Sanitaria, 35128 Padova, Italy
- Department of Industrial Engineering, University of Padova, 35131 Padova, Italy
| | - Deborah Sandrin
- L.i.f.e.L.a.b. Program, Consorzio per la Ricerca Sanitaria, 35128 Padova, Italy
- Department of Physics and Astronomy “G. Galilei”, University of Padova, 35131 Padova, Italy
| | - Andrea Bagno
- L.i.f.e.L.a.b. Program, Consorzio per la Ricerca Sanitaria, 35128 Padova, Italy
- Department of Industrial Engineering, University of Padova, 35131 Padova, Italy
| | - Filippo Romanato
- L.i.f.e.L.a.b. Program, Consorzio per la Ricerca Sanitaria, 35128 Padova, Italy
- Department of Physics and Astronomy “G. Galilei”, University of Padova, 35131 Padova, Italy
| | - Veronica Macchi
- Section of Human Anatomy, Department of Neuroscience, University of Padova, 35121 Padova, Italy
- L.i.f.e.L.a.b. Program, Consorzio per la Ricerca Sanitaria, 35128 Padova, Italy
| | - Raffaele De Caro
- Section of Human Anatomy, Department of Neuroscience, University of Padova, 35121 Padova, Italy
- L.i.f.e.L.a.b. Program, Consorzio per la Ricerca Sanitaria, 35128 Padova, Italy
- Foundation for Biology and Regenerative Medicine, Tissue Engineering and Signaling—TES, Onlus, 35136 Padova, Italy
| | - Marco Agostini
- L.i.f.e.L.a.b. Program, Consorzio per la Ricerca Sanitaria, 35128 Padova, Italy
- Department of Surgical Oncological and Gastroenterological Sciences, University of Padova, 35128 Padova, Italy
- Correspondence: ; Tel.: +39-049-96-40-160
| | - Stefano Merigliano
- L.i.f.e.L.a.b. Program, Consorzio per la Ricerca Sanitaria, 35128 Padova, Italy
- Department of Surgical Oncological and Gastroenterological Sciences, University of Padova, 35128 Padova, Italy
| | - Michele Valmasoni
- L.i.f.e.L.a.b. Program, Consorzio per la Ricerca Sanitaria, 35128 Padova, Italy
- Department of Surgical Oncological and Gastroenterological Sciences, University of Padova, 35128 Padova, Italy
| | - Andrea Porzionato
- Section of Human Anatomy, Department of Neuroscience, University of Padova, 35121 Padova, Italy
- L.i.f.e.L.a.b. Program, Consorzio per la Ricerca Sanitaria, 35128 Padova, Italy
- Foundation for Biology and Regenerative Medicine, Tissue Engineering and Signaling—TES, Onlus, 35136 Padova, Italy
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7
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Ozcakir E, Celik F, Guler S, Avci Z, Kaya M. The Use of Acellular Matrices Obtained by the Esophagus, Intestine, and Trachea for Esophageal Wall Repair: an Experimental Study on a Rat Model. Indian J Surg 2022. [DOI: 10.1007/s12262-022-03542-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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8
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Orozco-Vega A, Montes-Rodríguez MI, Luévano-Colmenero GH, Barros-Gómez J, Muñoz-González PU, Flores-Moreno M, Delgadillo-Holtfort I, Vega-González A, Rojo FJ, Guinea GV, Mendoza-Novelo B. Decellularization of porcine esophageal tissue at three diameters and the bioscaffold modification with EETs-ECM gel. J Biomed Mater Res A 2022; 110:1669-1680. [PMID: 35703732 DOI: 10.1002/jbm.a.37416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 05/30/2022] [Accepted: 06/02/2022] [Indexed: 11/07/2022]
Abstract
Damaged complex modular organs repair is a current clinical challenge in which one of the primary goals is to keep their biological response. An interesting case of study it is the porcine esophagus since it is a tubular muscular tissue selected as raw material for tissue engineering. The design of esophageal constructs can draw on properties of the processed homologous extracellular matrix (ECM). In this work, we report the decellularization of multilayered esophagus tissue from 1-, 21- and 45-days old piglets through the combination of reversible alkaline swelling and detergent perfusion. The bioscaffolds were characterized in terms of their residual composition and tensile mechanical properties. The biological response to esophageal submucosal derived bioscaffolds modified with ECM gel containing epoxyeicosatrienoic acids (EETs) was then evaluated. Results suggest that the composition (laminin, fibronectin, and sulphated glycosaminoglycans/sGAG) depends on the donor age: a better efficiency of the decellularization process combined with a higher retention of sGAG and fibronectin is observed in piglet esophageal scaffolds. The heterogeneity of this esophageal ECM is maintained, which implied the preservation of anisotropic tensile properties. Coating of bioscaffolds with ECM gel is suitable for carrying esophageal epithelial cells and EETs. Bioactivity of EETs-ECM gel modified esophageal submucosal bioscaffolds is observed to promote neovascularization and antiinflammatory after rabbit full-thickness esophageal defect replacement.
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Affiliation(s)
- Adriana Orozco-Vega
- División de Ciencias e Ingenierías, Universidad de Guanajuato, León, Gto, Mexico
| | - Metzeri I Montes-Rodríguez
- División de Ciencias e Ingenierías, Universidad de Guanajuato, León, Gto, Mexico.,Hospital Gineco-Pediatra No 48, Centro Médico Nacional del Bajío, UMAE, Instituto Mexicano del Seguro Social, León, Gto, Mexico
| | - Guadalupe H Luévano-Colmenero
- División de Ciencias e Ingenierías, Universidad de Guanajuato, León, Gto, Mexico.,Unidad Profesional Interdisciplinaria de Ingeniería, Campus Guanajuato, Instituto Politécnico Nacional, Silao de la Victoria, Gto, Mexico
| | - Jimena Barros-Gómez
- División de Ciencias e Ingenierías, Universidad de Guanajuato, León, Gto, Mexico
| | | | | | | | - Arturo Vega-González
- División de Ciencias e Ingenierías, Universidad de Guanajuato, León, Gto, Mexico
| | - Francisco J Rojo
- Centro de Tecnología Biomédica, Universidad Politécnica de Madrid, Pozuelo de Alarcón, Spain.,Departamento de Ciencia de Materiales, ETSI de Caminos, Canales y Puertos, Universidad Politécnica de Madrid, Madrid, Spain.,Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - Gustavo V Guinea
- Centro de Tecnología Biomédica, Universidad Politécnica de Madrid, Pozuelo de Alarcón, Spain.,Departamento de Ciencia de Materiales, ETSI de Caminos, Canales y Puertos, Universidad Politécnica de Madrid, Madrid, Spain.,Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain.,Biomedical Research Networking Center in Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), Madrid, Spain
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9
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Vos EL, Nakauchi M, Capanu M, Park BJ, Coit DG, Molena D, Yoon SS, Jones DR, Strong VE. Phase II Trial Evaluating Esophageal Anastomotic Reinforcement with a Biologic, Degradable, Extracellular Matrix after Total Gastrectomy and Esophagectomy. J Am Coll Surg 2022; 234:910-917. [PMID: 35426405 PMCID: PMC9128801 DOI: 10.1097/xcs.0000000000000113] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND A biologic, degradable extracellular matrix (ECM) has been shown to support esophageal tissue remodeling, which could reduce the risk of anastomotic leak following total gastrectomy and esophagectomy. We evaluated the safety and efficacy of reinforcing the anastomosis with ECM in reducing anastomotic leak as compared to a matched cohort. STUDY DESIGN In this single-center, nonrandomized phase II trial, gastric or esophageal adenocarcinoma patients undergoing total gastrectomy or esophagectomy were recruited from November 2013 through December 2018. ECM was surgically wrapped circumferentially around the anastomosis. Anastomotic leak was assessed clinically and by contrast study and defined as clinically significant if requiring invasive treatment (grade 3 or higher). Anastomotic stenosis, other adverse events, symptoms, and dysphagia score were collected by standardized forms at regular follow-up visits at approximately postoperative days (POD) 21 and 90. Patients receiving ECM were compared to a cohort matched for surgery type and age. RESULTS ECM placement was not feasible in 9 of 75 patients (12%), resulting in 66 patients receiving ECM. Total gastrectomy was performed in 50 patients (76%) and esophagectomy in 16 (24%). Clinically significant anastomotic leak was diagnosed in 6 of 66 patients (9.1%) (3/50 [6.0%] after gastrectomy, 3/16 [18.8%] after esophagectomy); this rate did not differ from that in the matched cohort (p = 0.57). Stenosis requiring invasive treatment occurred in 8 patients (12.5%), and 10 patients (15.6%) reported not being able to eat a normal diet at POD 90. No adverse events related to ECM were reported. CONCLUSIONS Esophageal anastomotic reinforcement after total gastrectomy or esophagectomy with a biologic, degradable ECM was mostly feasible and safe, but was not associated with a statistically significant decrease in anastomotic leak.
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Affiliation(s)
- Elvira L Vos
- From the Gastric and Mixed Tumor Service (Vos, Nakauchi, Coit, Yoon, Strong), Memorial Sloan Kettering Cancer Center, New York, NY
| | - Masaya Nakauchi
- From the Gastric and Mixed Tumor Service (Vos, Nakauchi, Coit, Yoon, Strong), Memorial Sloan Kettering Cancer Center, New York, NY
| | - Marinela Capanu
- Department of Surgery, Department of Epidemiology & Biostatistics (Capanu), Memorial Sloan Kettering Cancer Center, New York, NY
| | - Bernard J Park
- Thoracic Service (Park, Molena, Jones), Memorial Sloan Kettering Cancer Center, New York, NY
| | - Daniel G Coit
- From the Gastric and Mixed Tumor Service (Vos, Nakauchi, Coit, Yoon, Strong), Memorial Sloan Kettering Cancer Center, New York, NY
| | - Daniela Molena
- Thoracic Service (Park, Molena, Jones), Memorial Sloan Kettering Cancer Center, New York, NY
| | - Samuel S Yoon
- From the Gastric and Mixed Tumor Service (Vos, Nakauchi, Coit, Yoon, Strong), Memorial Sloan Kettering Cancer Center, New York, NY
| | - David R Jones
- Thoracic Service (Park, Molena, Jones), Memorial Sloan Kettering Cancer Center, New York, NY
| | - Vivian E Strong
- From the Gastric and Mixed Tumor Service (Vos, Nakauchi, Coit, Yoon, Strong), Memorial Sloan Kettering Cancer Center, New York, NY
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10
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Xu R, Fang X, Wu S, Wang Y, Zhong Y, Hou R, Zhang L, Shao L, Pang Q, Zhang J, Cui X, Zuo R, Yao L, Zhu Y. Development and Prospect of Esophageal Tissue Engineering. Front Bioeng Biotechnol 2022; 10:853193. [PMID: 35252159 PMCID: PMC8892191 DOI: 10.3389/fbioe.2022.853193] [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: 01/12/2022] [Accepted: 01/31/2022] [Indexed: 11/13/2022] Open
Abstract
Currently, patients with esophageal cancer, especially advanced patients, usually use autologous tissue for esophageal alternative therapy. However, an alternative therapy is often accompanied by serious complications such as ischemia and leakage, which seriously affect the prognosis of patients. Tissue engineering has been widely studied as one of the ideal methods for the treatment of esophageal cancer. In view of the complex multi-layer structure of the natural esophagus, how to use the tissue engineering method to design the scaffold with structure and function matching with the natural tissue is the principle that the tissue engineering method must follow. This article will analyze and summarize the construction methods, with or without cells, and repair effects of single-layer scaffold and multi-layer scaffold. Especially in the repair of full-thickness and circumferential esophageal defects, the flexible design method and the binding force between the layers of the scaffold are very important. In short, esophageal tissue engineering technology has broad prospects and plays a more and more important role in the treatment of esophageal diseases.
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Affiliation(s)
- Rui Xu
- The Affiliated Hospital of Medical School, Ningbo University, Ningbo, China
- School of Medicine, Ningbo University, Ningbo, China
| | - Xinnan Fang
- School of Medicine, Ningbo University, Ningbo, China
| | - Shengqian Wu
- School of Medicine, Ningbo University, Ningbo, China
| | - Yiyin Wang
- School of Medicine, Ningbo University, Ningbo, China
| | - Yi Zhong
- School of Medicine, Ningbo University, Ningbo, China
| | - Ruixia Hou
- The Affiliated Hospital of Medical School, Ningbo University, Ningbo, China
- School of Medicine, Ningbo University, Ningbo, China
- *Correspondence: Ruixia Hou,
| | - Libing Zhang
- Ningbo Institute of Materials Technology and Engineering, Chinese Academy of Sciences, Ningbo, China
| | - Lei Shao
- School of Medicine, Ningbo University, Ningbo, China
| | - Qian Pang
- School of Medicine, Ningbo University, Ningbo, China
| | - Jian Zhang
- The Affiliated Lihuili Hospital, Ningbo University, Ningbo, China
| | - Xiang Cui
- The Affiliated Lihuili Hospital, Ningbo University, Ningbo, China
| | - Rongyue Zuo
- The Affiliated Hospital of Medical School, Ningbo University, Ningbo, China
| | - Liwei Yao
- The Affiliated Hospital of Medical School, Ningbo University, Ningbo, China
| | - Yabin Zhu
- School of Medicine, Ningbo University, Ningbo, China
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11
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Decellularized extracellular matrix mediates tissue construction and regeneration. Front Med 2021; 16:56-82. [PMID: 34962624 PMCID: PMC8976706 DOI: 10.1007/s11684-021-0900-3] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Accepted: 09/23/2021] [Indexed: 02/05/2023]
Abstract
Contributing to organ formation and tissue regeneration, extracellular matrix (ECM) constituents provide tissue with three-dimensional (3D) structural integrity and cellular-function regulation. Containing the crucial traits of the cellular microenvironment, ECM substitutes mediate cell–matrix interactions to prompt stem-cell proliferation and differentiation for 3D organoid construction in vitro or tissue regeneration in vivo. However, these ECMs are often applied generically and have yet to be extensively developed for specific cell types in 3D cultures. Cultured cells also produce rich ECM, particularly stromal cells. Cellular ECM improves 3D culture development in vitro and tissue remodeling during wound healing after implantation into the host as well. Gaining better insight into ECM derived from either tissue or cells that regulate 3D tissue reconstruction or organ regeneration helps us to select, produce, and implant the most suitable ECM and thus promote 3D organoid culture and tissue remodeling for in vivo regeneration. Overall, the decellularization methodologies and tissue/cell-derived ECM as scaffolds or cellular-growth supplements used in cell propagation and differentiation for 3D tissue culture in vitro are discussed. Moreover, current preclinical applications by which ECM components modulate the wound-healing process are reviewed.
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12
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Jones BC, Shibuya S, Durkin N, De Coppi P. Regenerative medicine for childhood gastrointestinal diseases. Best Pract Res Clin Gastroenterol 2021; 56-57:101769. [PMID: 35331401 DOI: 10.1016/j.bpg.2021.101769] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 09/30/2021] [Accepted: 10/08/2021] [Indexed: 01/31/2023]
Abstract
Several paediatric gastrointestinal diseases result in life-shortening organ failure. For many of these conditions, current therapeutic options are suboptimal and may not offer a cure. Regenerative medicine is an inter-disciplinary field involving biologists, engineers, and clinicians that aims to produce cell and tissue-based therapies to overcome organ failure. Exciting advances in stem cell biology, materials science, and bioengineering bring engineered gastrointestinal cell and tissue therapies to the verge of clinical trial. In this review, we summarise the requirements for bioengineered therapies, the possible sources of the various cellular and non-cellular components, and the progress towards clinical translation of oesophageal and intestinal tissue engineering to date.
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Affiliation(s)
- Brendan C Jones
- Stem Cell and Regenerative Medicine Section, Developmental Biology and Cancer Research and Teaching Department, Great Ormond Street Institute of Child Health, University College London, London, United Kingdom; Specialist Neonatal and Paediatric Surgery Unit, Great Ormond Street Hospital, London, United Kingdom
| | - Soichi Shibuya
- Stem Cell and Regenerative Medicine Section, Developmental Biology and Cancer Research and Teaching Department, Great Ormond Street Institute of Child Health, University College London, London, United Kingdom
| | - Natalie Durkin
- Stem Cell and Regenerative Medicine Section, Developmental Biology and Cancer Research and Teaching Department, Great Ormond Street Institute of Child Health, University College London, London, United Kingdom; Specialist Neonatal and Paediatric Surgery Unit, Great Ormond Street Hospital, London, United Kingdom
| | - Paolo De Coppi
- Stem Cell and Regenerative Medicine Section, Developmental Biology and Cancer Research and Teaching Department, Great Ormond Street Institute of Child Health, University College London, London, United Kingdom; Specialist Neonatal and Paediatric Surgery Unit, Great Ormond Street Hospital, London, United Kingdom.
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13
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Ward A, Morgante D, Fisher J, Ingham E, Southgate J. Translation of mechanical strain to a scalable biomanufacturing process for acellular matrix production from full thickness porcine bladders. Biomed Mater 2021; 16. [PMID: 34652283 DOI: 10.1088/1748-605x/ac2ab8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Accepted: 09/28/2021] [Indexed: 11/12/2022]
Abstract
Bladder acellular matrix has promising applications in urological and other reconstructive surgery as it represents a naturally compliant, non-immunogenic and highly tissue-integrative material. As the bladder fills and distends, the loosely-coiled bundles of collagen fibres in the wall become extended and orientate parallel to the lumen, resulting in a physical thinning of the muscular wall. This accommodating property can be exploited to achieve complete decellularisation of the full-thickness bladder wall by immersing the distended bladder through a series of hypotonic buffers, detergents and nucleases, but the process is empirical, idiosyncratic and does not lend itself to manufacturing scale up. In this study we have taken a mechanical engineering approach to determine the relationship between porcine bladder size and capacity, to define the biaxial deformation state of the tissue during decellularisation and to apply these principles to the design and testing of a scalable novel laser-printed flat-bed apparatus in order to achieve reproducible and full-thickness bladder tissue decellularisation. We demonstrate how the procedure can be applied reproducibly to fresh, frozen or twice-frozen bladders to render8×8 cm2patches of DNA-free acellular matrix suitable for surgical applications.
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Affiliation(s)
- Ashley Ward
- School of Mechanical Engineering, Institute of Medical and Biological Engineering, University of Leeds, Leeds LS2 9JT, United Kingdom
| | - Debora Morgante
- Jack Birch Unit, Department of Biology, York Biomedical Research Institute, The University of York, York YO10 5DD, United Kingdom
| | - John Fisher
- School of Mechanical Engineering, Institute of Medical and Biological Engineering, University of Leeds, Leeds LS2 9JT, United Kingdom
| | - Eileen Ingham
- School of Biomedical Sciences, Institute of Medical and Biological Engineering, University of Leeds, Leeds LS2 9JT, United Kingdom
| | - Jennifer Southgate
- Jack Birch Unit, Department of Biology, York Biomedical Research Institute, The University of York, York YO10 5DD, United Kingdom
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14
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Jelodari S, Sadroddiny E. Decellularization of Small Intestinal Submucosa. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2021; 1345:71-84. [PMID: 34582015 DOI: 10.1007/978-3-030-82735-9_7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Small intestinal submucosa (SIS) is the most studied extracellular matrix (ECM) for repair and regeneration of different organs and tissues. Promising results of SIS-ECM as a vascular graft, led scientists to examine its applicability for repairing other tissues. Overall results indicated that SIS grafts induce tissue regeneration and remodeling to almost native condition. Investigating immunomodulatory effects of SIS is another interesting field of research. SIS can be utilized in different forms for multiple clinical and experimental studies. The aim of this chapter is to investigate the decellularization process of SIS and its common clinical application.
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Affiliation(s)
- Sahar Jelodari
- Department of Tissue Engineering and Applied Cell Sciences, School of Advanced Technologies in Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Esmaeil Sadroddiny
- Department of Medical Biotechnology, School of Advanced Technologies in Medicine, Tehran University of Medical Sciences, Tehran, Iran.
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15
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Model L, Wiesel O. A narrative review of esophageal tissue engineering and replacement: where are we? ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:910. [PMID: 34164544 PMCID: PMC8184476 DOI: 10.21037/atm-20-3906] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Long-gap esophageal defects, whether congenital or acquired, are very difficult to manage. Any significant surgical peri-esophageal dissection that is performed to allow for potential stretching of two ends of a defect interrupts the esophageal blood supply and leads to complications such as leak and stricture, even in the youngest, healthiest patients. The term “congenital” applied to these defects refers mainly to long-gap esophageal atresia (LGA). Causes of acquired long-segment esophageal disruption include recurrent leaks and fistulae after primary repair, refractory GERD, caustic ingestions, cancer, and strictures. 5,000–10,000 patients per year in the US require esophageal replacement. Gastric, colonic, and jejunal pull-up surgeries are fraught with high rates of both short and long term complications thus creating a space for a better option. Since the 1970’s many groups around the world have been unsuccessfully attempting esophageal replacement with tissue-engineered grafts in various animal models. But, recent advances in these models are now combining novel technologic advances in materials bioscience, stem-cell therapies, and transplantation and are showing increasing promise to human translational application. Transplantation has been heretofore unsuccessful, but given modern improvements in transplant microsurgery and immunosuppressive medications, pioneering trials in animal models are being undertaken now. These rapidly evolving medical innovations will be reviewed here.
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Affiliation(s)
- Lynn Model
- Department of Pediatric Surgery, Maimonides Medical Center, Brooklyn, NY 11219, USA
| | - Ory Wiesel
- Department of Thoracic Surgery, Maimonides Medical Center, Brooklyn, NY 11219, USA
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16
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Gundogdu G, Tosun M, Morhardt D, Gheinani AH, Algarrahi K, Yang X, Costa K, Alegria CG, Adam RM, Yang W, Mauney JR. Molecular mechanisms of esophageal epithelial regeneration following repair of surgical defects with acellular silk fibroin grafts. Sci Rep 2021; 11:7086. [PMID: 33782465 PMCID: PMC8007829 DOI: 10.1038/s41598-021-86511-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Accepted: 03/16/2021] [Indexed: 12/11/2022] Open
Abstract
Constructive remodeling of focal esophageal defects with biodegradable acellular grafts relies on the ability of host progenitor cell populations to repopulate implant regions and facilitate growth of de novo functional tissue. Intrinsic molecular mechanisms governing esophageal repair processes following biomaterial-based, surgical reconstruction is largely unknown. In the present study, we utilized mass spectrometry-based quantitative proteomics and in silico pathway evaluations to identify signaling cascades which were significantly activated during neoepithelial formation in a Sprague Dawley rat model of onlay esophagoplasty with acellular silk fibroin scaffolds. Pharmacologic inhibitor and rescue experiments revealed that epithelialization of neotissues is significantly dependent in part on pro-survival stimuli capable of suppressing caspase activity in epithelial progenitors via activation of hepatocyte growth factor receptor (c-MET), tropomyosin receptor kinase A (TrkA), phosphoinositide 3-kinase (PI3K), and protein kinase B (Akt) signaling mechanisms. These data highlight the molecular machinery involved in esophageal epithelial regeneration following surgical repair with acellular implants.
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Affiliation(s)
- Gokhan Gundogdu
- Departments of Urology and Biomedical Engineering, University of California, Irvine, Orange, CA, 92868, USA
| | - Mehmet Tosun
- Departments of Urology and Biomedical Engineering, University of California, Irvine, Orange, CA, 92868, USA
| | - Duncan Morhardt
- Urological Diseases Research Center, Boston Children's Hospital, Boston, MA, 02115, USA
- Department of Surgery, Harvard Medical School, Boston, MA, 02115, USA
| | - Ali Hashemi Gheinani
- Urological Diseases Research Center, Boston Children's Hospital, Boston, MA, 02115, USA
- Department of Surgery, Harvard Medical School, Boston, MA, 02115, USA
- Broad Institute of the Massachusetts Institute of Technology and Harvard University, Cambridge, MA, 02142, USA
| | - Khalid Algarrahi
- Urological Diseases Research Center, Boston Children's Hospital, Boston, MA, 02115, USA
- Department of Surgery, Harvard Medical School, Boston, MA, 02115, USA
| | - Xuehui Yang
- Urological Diseases Research Center, Boston Children's Hospital, Boston, MA, 02115, USA
- Department of Surgery, Harvard Medical School, Boston, MA, 02115, USA
| | - Kyle Costa
- Urological Diseases Research Center, Boston Children's Hospital, Boston, MA, 02115, USA
- Department of Surgery, Harvard Medical School, Boston, MA, 02115, USA
| | - Cinthia Galvez Alegria
- Urological Diseases Research Center, Boston Children's Hospital, Boston, MA, 02115, USA
- Department of Surgery, Harvard Medical School, Boston, MA, 02115, USA
| | - Rosalyn M Adam
- Urological Diseases Research Center, Boston Children's Hospital, Boston, MA, 02115, USA
- Department of Surgery, Harvard Medical School, Boston, MA, 02115, USA
- Broad Institute of the Massachusetts Institute of Technology and Harvard University, Cambridge, MA, 02142, USA
| | - Wei Yang
- Division of Cancer Biology and Therapeutics, Departments of Surgery and Biomedical Sciences, Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA, 90048, USA
- Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, 90095, USA
| | - Joshua R Mauney
- Departments of Urology and Biomedical Engineering, University of California, Irvine, Orange, CA, 92868, USA.
- Departments of Urology and Biomedical Engineering, University of California, Irvine, Building 55, 101 The City Drive South., Rm. 300, Orange, CA, 92868, USA.
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17
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Schizas D, Frountzas M, Sgouromallis E, Spartalis E, Mylonas KS, Papaioannou TG, Dimitroulis D, Nikiteas N. Esophageal defect repair by artificial scaffolds: a systematic review of experimental studies and proportional meta-analysis. Dis Esophagus 2021; 34:5917398. [PMID: 33016317 DOI: 10.1093/dote/doaa104] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 07/26/2020] [Accepted: 08/21/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND The traditional technique of gastrointestinal reconstruction of the esophagus after esophagectomy presents plenty of complications. Hence, tissue engineering has been introduced as an effective artificial alternative with potentially fewer complications. Three types of esophageal scaffolds have been used in experimental studies so far. The aim of our meta-analysis is to present the postoperative outcomes after esophageal replacement with artificial scaffolds and the investigation of possible factors that affect these outcomes. METHODS The present proportional meta-analysis was designed using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses and A MeaSurement Tool to Assess systematic Reviews guidelines. We searched Medline, Scopus, Clinicaltrials.gov, EMBASE, Cochrane Central Register of Controlled Trials CENTRAL, and Google Scholar databases from inception until February 2020. RESULTS Overall, 32 studies were included that recruited 587 animals. The pooled morbidity after esophageal scaffold implantation was 53.4% (95% CI = 36.6-70.0%). The pooled survival interval was 111.1 days (95% CI = 65.5-156.8 days). Graft stenosis (46%), postoperative dysphagia (15%), and anastomotic leak (12%) were the most common complications after esophageal scaffold implantation. Animals that underwent an implantation of an artificial scaffold in the thoracic part of their esophagus presented higher survival rates than animals that underwent scaffold implantation in the cervical or abdominal part of their esophagus (P < 0.001 and P = 0.011, respectively). CONCLUSION Tissue engineering seems to offer an effective alternative for the repair of esophageal defects in animal models. Nevertheless, issues like graft stenosis and lack of motility of the esophageal scaffolds need to be addressed in future experimental studies before scaffolds can be tested in human trials.
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Affiliation(s)
- Dimitrios Schizas
- First Department of Surgery, Medical School, National and Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece.,Hellenic Minimally Invasive and Robotic Surgery Study Group, Athens, Greece
| | - Maximos Frountzas
- First Propaedeutic Department of Surgery, Medical School, National and Kapodistrian University of Athens, Hippocration General Hospital, Athens, Greece.,Hellenic Minimally Invasive and Robotic Surgery Study Group, Athens, Greece
| | - Emmanouil Sgouromallis
- Third Department of Surgery, Athens General Hospital "Georgios Gennimatas", Athens, Greece.,Hellenic Minimally Invasive and Robotic Surgery Study Group, Athens, Greece
| | | | - Konstantinos S Mylonas
- First Department of Surgery, Medical School, National and Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece
| | - Theodore G Papaioannou
- First Department of Cardiology, Biomedical Engineering Unit, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Dimitrios Dimitroulis
- Hellenic Minimally Invasive and Robotic Surgery Study Group, Athens, Greece.,Second Propedeutic Department of Surgery, Medical School, National and Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece
| | - Nikolaos Nikiteas
- Hellenic Minimally Invasive and Robotic Surgery Study Group, Athens, Greece.,Second Propedeutic Department of Surgery, Medical School, National and Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece
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18
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Gundogdu G, Morhardt D, Cristofaro V, Algarrahi K, Yang X, Costa K, Alegria CG, Sullivan MP, Mauney JR. Evaluation of Bilayer Silk Fibroin Grafts for Tubular Esophagoplasty in a Porcine Defect Model. Tissue Eng Part A 2021; 27:103-116. [PMID: 32460641 PMCID: PMC7826443 DOI: 10.1089/ten.tea.2020.0061] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Accepted: 05/19/2020] [Indexed: 12/14/2022] Open
Abstract
Surgical reconstruction of tubular esophageal defects with autologous gastrointestinal segments is the gold standard treatment to replace damaged or diseased esophageal tissues. Unfortunately, this approach is associated with adverse complications, including dysphagia, donor-site morbidity, and in some cases patient death. Bilayer silk fibroin (BLSF) scaffolds were investigated as alternative, acellular grafts for tubular esophagoplasty in a porcine defect model for 3 months of implantation. Adult Yucatan mini-swine (n = 5) were subjected to esophageal reconstruction with tubular BLSF grafts (2 cm in length) in combination with transient esophageal stenting for 2 months followed by a 1-month period, where the graft site was unstented. All animals receiving BLSF grafts survived and were capable of solid food consumption, however strictures were noted at graft regions in 60% of the experimental cohort between 2 and 3 months postop and required balloon dilation. In addition, fluoroscopic analysis showed peristaltic function in only 1/5 neotissues. Following swine harvest at 3 months, ex vivo tissue bath evaluations revealed that neoconduits exhibited contractile responses to carbachol, electric field stimulation, and KCl, whereas sodium nitroprusside and isoproterenol induced relaxation effects. Histological (Masson's Trichrome) and immunohistochemical analyses of regenerated tissue conduits showed a stratified, squamous epithelium expressing pan-cytokeratins buttressed by a vascularized lamina propria containing a smooth muscle-rich muscularis mucosa surrounded by a muscularis externa. Neuronal density, characterized by the presence of synaptophysin-positive boutons, was significantly lower in neotissues in comparison to nonsurgical controls. BLSF scaffolds represent a promising platform for the repair of tubular esophageal defects, however improvements in scaffold design are needed to reduce the rate of complications and improve the extent of constructive tissue remodeling. Impact statement The search for a superior "off-the-shelf" scaffold capable of repairing tubularesophageal defects as well as overcoming limitations associated with conventional autologous gastrointestinal segments remains elusive. The purpose of this study was to investigate the performance of an acellular, bilayer silk fibroin graft (BLSF) for tubular esophagoplasty in a porcine model. Our results demonstrated that BLSF scaffolds supported the formation of tubular neotissues with innervated, vascularized epithelial and muscular components capable of contractile and relaxation responses. BLSF scaffolds represent a promising platform for esophageal tissue engineering.
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Affiliation(s)
- Gokhan Gundogdu
- Departments of Urology and Biomedical Engineering, University of California, Irvine, Orange, California, USA
| | - Duncan Morhardt
- Urological Diseases Research Center, Boston Children's Hospital, Boston, Massachusetts, USA
- Department of Surgery, Harvard Medical School, Boston, Massachusetts, USA
| | - Vivian Cristofaro
- Department of Surgery, Harvard Medical School, Boston, Massachusetts, USA
- Division of Urology, Veterans Affairs Boston Healthcare System, Boston, Massachusetts, USA
- Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Khalid Algarrahi
- Urological Diseases Research Center, Boston Children's Hospital, Boston, Massachusetts, USA
- Department of Surgery, Harvard Medical School, Boston, Massachusetts, USA
| | - Xuehui Yang
- Urological Diseases Research Center, Boston Children's Hospital, Boston, Massachusetts, USA
- Department of Surgery, Harvard Medical School, Boston, Massachusetts, USA
| | - Kyle Costa
- Urological Diseases Research Center, Boston Children's Hospital, Boston, Massachusetts, USA
- Department of Surgery, Harvard Medical School, Boston, Massachusetts, USA
| | - Cinthia Galvez Alegria
- Urological Diseases Research Center, Boston Children's Hospital, Boston, Massachusetts, USA
- Department of Surgery, Harvard Medical School, Boston, Massachusetts, USA
| | - Maryrose P. Sullivan
- Department of Surgery, Harvard Medical School, Boston, Massachusetts, USA
- Division of Urology, Veterans Affairs Boston Healthcare System, Boston, Massachusetts, USA
- Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Joshua R. Mauney
- Departments of Urology and Biomedical Engineering, University of California, Irvine, Orange, California, USA
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19
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Kanetaka K, Eguchi S. Regenerative medicine for the upper gastrointestinal tract. Regen Ther 2020; 15:129-137. [PMID: 33426211 PMCID: PMC7770370 DOI: 10.1016/j.reth.2020.07.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Revised: 06/21/2020] [Accepted: 07/01/2020] [Indexed: 12/12/2022] Open
Abstract
The main surgical strategy for gastrointestinal tract malignancy is en bloc resection, which consists of not only resection of the involved organs but also simultaneous resection of the surrounding or adjacent mesenteries that contain lymph vessels and nodes. After resection of the diseased organs, the defect of the gastrointestinal conduit is replaced with organs located downstream, such as the stomach and jejunum. However, esophageal and gastric reconstruction using these natural substitutes is associated with a diminished quality of life due to the loss of the reserve function, damage to the antireflux barrier, and dumping syndrome. Thus, replacement of the deficit after resection with the patient's own regenerated tissue to compensate for the lost function and tissue using regenerative medicine will be an ideal treatment. Many researchers have been trying to construct artificial organs through tissue engineering techniques; however, none have yet succeeded in growing a whole organ because of the complicated functions these organs perform, such as the processing and absorption of nutrients. While exciting results have been reported with regard to tissue engineering techniques concerning the upper gastrointestinal tract, such as the esophagus and stomach, most of these achievements have been observed in animal models, and few successful approaches in the clinical setting have been reported for the replacement of mucosal defects. We review the recent progress in regenerative medicine in relation to the upper gastrointestinal tract, such as the esophagus and stomach. We also focus on the functional capacity of regenerated tissue and its role as a culture system to recapitulate the mechanisms underlying infectious disease. With the emergence of technology such as the fabrication of decellularized constructs, organoids and cell sheet medicine, collaboration between gastrointestinal surgery and regenerative medicine is expected to help establish novel therapeutic modalities in the future. The recent progress in regenerative medicine in upper gastrointestinal tract.
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Affiliation(s)
- Kengo Kanetaka
- Tissue Engineering and Regenerative Therapeutics in Gastrointestinal Surgery, Nagasaki University Graduate School of Biomedical Sciences, Japan
| | - Susumu Eguchi
- Department of Surgery, Nagasaki University Graduate School of Biomedical Sciences, Japan
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20
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Marzaro M, Algeri M, Tomao L, Tedesco S, Caldaro T, Balassone V, Contini AC, Guerra L, Federici D’Abriola G, Francalanci P, Caristo ME, Lupoi L, Boskoski I, Bozza A, Astori G, Pozzato G, Pozzato A, Costamagna G, Dall’Oglio L. Successful muscle regeneration by a homologous microperforated scaffold seeded with autologous mesenchymal stromal cells in a porcine esophageal substitution model. Therap Adv Gastroenterol 2020; 13:1756284820923220. [PMID: 32523626 PMCID: PMC7257852 DOI: 10.1177/1756284820923220] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Accepted: 04/06/2020] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Since the esophagus has no redundancy, congenital and acquired esophageal diseases often require esophageal substitution, with complicated surgery and intestinal or gastric transposition. Peri-and-post-operative complications are frequent, with major problems related to the food transit and reflux. During the last years tissue engineering products became an interesting therapeutic alternative for esophageal replacement, since they could mimic the organ structure and potentially help to restore the native functions and physiology. The use of acellular matrices pre-seeded with cells showed promising results for esophageal replacement approaches, but cell homing and adhesion to the scaffold remain an important issue and were investigated. METHODS A porcine esophageal substitute constituted of a decellularized scaffold seeded with autologous bone marrow-derived mesenchymal stromal cells (BM-MSCs) was developed. In order to improve cell seeding and distribution throughout the scaffolds, they were micro-perforated by Quantum Molecular Resonance (QMR) technology (Telea Electronic Engineering). RESULTS The treatment created a microporous network and cells were able to colonize both outer and inner layers of the scaffolds. Non seeded (NSS) and BM-MSCs seeded scaffolds (SS) were implanted on the thoracic esophagus of 4 and 8 pigs respectively, substituting only the muscle layer in a mucosal sparing technique. After 3 months from surgery, we observed an esophageal substenosis in 2/4 NSS pigs and in 6/8 SS pigs and a non-practicable stricture in 1/4 NSS pigs and 2/8 SS pigs. All the animals exhibited a normal weight increase, except one case in the SS group. Actin and desmin staining of the post-implant scaffolds evidenced the regeneration of a muscular layer from one anastomosis to another in the SS group but not in the NSS one. CONCLUSIONS A muscle esophageal substitute starting from a porcine scaffold was developed and it was fully repopulated by BM-MSCs after seeding. The substitute was able to recapitulate in shape and function the original esophageal muscle layer.
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Affiliation(s)
| | - Mattia Algeri
- Hemato-Oncology, Ospedale Pediatrico Bambino
Gesù, Roma, Italy
| | - Luigi Tomao
- Hemato-Oncology, Ospedale Pediatrico Bambino
Gesù, Roma, Italy
| | | | - Tamara Caldaro
- Digestive Endoscopy and Surgical Unit, Ospedale
Pediatrico Bambino Gesù, Roma, Italy
| | - Valerio Balassone
- Digestive Endoscopy and Surgical Unit, Ospedale
Pediatrico Bambino Gesù, Roma, Italy
| | - Anna Chiara Contini
- Digestive Endoscopy and Surgical Unit, Ospedale
Pediatrico Bambino Gesù, Roma, Italy
| | - Luciano Guerra
- Digestive Endoscopy and Surgical Unit, Ospedale
Pediatrico Bambino Gesù, Roma, Italy
| | | | | | | | | | | | - Angela Bozza
- LTCA, ULSS 8 Berica, Vicenza, Italy,Laboratorio di Terapie Cellulari Avanzate,
Vicenza, Italy
| | - Giuseppe Astori
- LTCA, ULSS 8 Berica, Vicenza, Italy,Laboratorio di Terapie Cellulari Avanzate,
Vicenza, Italy
| | | | | | - Guido Costamagna
- Digestive Endoscopy Unit, Fondazione
Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Luigi Dall’Oglio
- Digestive Endoscopy and Surgical Unit, Ospedale
Pediatrico Bambino Gesù, Roma, Italy
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21
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Vogt CD, Panoskaltsis-Mortari A. Tissue engineering of the gastroesophageal junction. J Tissue Eng Regen Med 2020; 14:855-868. [PMID: 32304170 DOI: 10.1002/term.3045] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Accepted: 04/03/2020] [Indexed: 12/12/2022]
Abstract
The gastroesophageal junction has been of clinical interest for some time due to its important role in preventing reflux of caustic stomach contents upward into the esophagus. Failure of this role has been identified as a key driver in gastroesophageal reflux disease, cancer of the lower esophagus, and aspiration-induced lung complications. Due to the large population burden and significant morbidity and mortality related to reflux barrier dysfunction, there is a pressing need to develop tissue engineering solutions which can replace diseased junctions. While good progress has been made in engineering the bodies of the esophagus and stomach, little has been done for the junction between the two. In this review, we discuss pertinent topics which should be considered as tissue engineers begin to address this anatomical region. The embryological development and adult anatomy and histology are discussed to provide context about the native structures which must be replicated. The roles of smooth muscle structures in the esophagus and stomach, as well as the contribution of the diaphragm to normal anti-reflux function are then examined. Finally, engineering considerations including mechanics and current progress in the field of tissue engineering are presented.
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Affiliation(s)
- Caleb D Vogt
- Department of Pediatrics, University of Minnesota, Minneapolis, MN, USA
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22
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Sundar G, Joseph J, C P, John A, Abraham A. Natural collagen bioscaffolds for skin tissue engineering strategies in burns: a critical review. INT J POLYM MATER PO 2020. [DOI: 10.1080/00914037.2020.1740991] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Gayathri Sundar
- Department of Biochemistry, Advanced Center for Tissue Engineering, University of Kerala, Thiruvananthapuram, India
- Department of Biotechnology, CEPCI Laboratory and Research Institute, Kollam, India
| | - Josna Joseph
- Department of Biochemistry, Advanced Center for Tissue Engineering, University of Kerala, Thiruvananthapuram, India
| | - Prabhakumari C
- Department of Biotechnology, CEPCI Laboratory and Research Institute, Kollam, India
| | - Annie John
- Department of Biochemistry, Advanced Center for Tissue Engineering, University of Kerala, Thiruvananthapuram, India
| | - Annie Abraham
- Department of Biochemistry, Advanced Center for Tissue Engineering, University of Kerala, Thiruvananthapuram, India
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23
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Pisani S, Croce S, Chiesa E, Dorati R, Lenta E, Genta I, Bruni G, Mauramati S, Benazzo A, Cobianchi L, Morbini P, Caliogna L, Benazzo M, Avanzini MA, Conti B. Tissue Engineered Esophageal Patch by Mesenchymal Stromal Cells: Optimization of Electrospun Patch Engineering. Int J Mol Sci 2020; 21:ijms21051764. [PMID: 32143536 PMCID: PMC7084816 DOI: 10.3390/ijms21051764] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Revised: 02/28/2020] [Accepted: 03/02/2020] [Indexed: 12/16/2022] Open
Abstract
Aim of work was to locate a simple, reproducible protocol for uniform seeding and optimal cellularization of biodegradable patch minimizing the risk of structural damages of patch and its contamination in long-term culture. Two seeding procedures are exploited, namely static seeding procedures on biodegradable and biocompatible patches incubated as free floating (floating conditions) or supported by CellCrownTM insert (fixed conditions) and engineered by porcine bone marrow MSCs (p-MSCs). Scaffold prototypes having specific structural features with regard to pore size, pore orientation, porosity, and pore distribution were produced using two different techniques, such as temperature-induced precipitation method and electrospinning technology. The investigation on different prototypes allowed achieving several implementations in terms of cell distribution uniformity, seeding efficiency, and cellularization timing. The cell seeding protocol in stating conditions demonstrated to be the most suitable method, as these conditions successfully improved the cellularization of polymeric patches. Furthermore, the investigation provided interesting information on patches’ stability in physiological simulating experimental conditions. Considering the in vitro results, it can be stated that the in vitro protocol proposed for patches cellularization is suitable to achieve homogeneous and complete cellularizations of patch. Moreover, the protocol turned out to be simple, repeatable, and reproducible.
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Affiliation(s)
- Silvia Pisani
- Department of Drug Sciences, University of Pavia, 27100 Pavia, Italy; (S.P.); (E.C.); (I.G.); (B.C.)
| | - Stefania Croce
- Department of Clinical, Surgical, Diagnostic & Pediatric Sciences, University of Pavia, IRCCS Policlinico S. Matteo, 27100 Pavia, Italy; (S.C.); (L.C.)
| | - Enrica Chiesa
- Department of Drug Sciences, University of Pavia, 27100 Pavia, Italy; (S.P.); (E.C.); (I.G.); (B.C.)
| | - Rossella Dorati
- Department of Drug Sciences, University of Pavia, 27100 Pavia, Italy; (S.P.); (E.C.); (I.G.); (B.C.)
- Correspondence:
| | - Elisa Lenta
- Department of Paediatric Oncoaematology, IRCCS Policlinico S. Matteo, 27100 Pavia, Italy; (E.L.); (M.A.A.)
| | - Ida Genta
- Department of Drug Sciences, University of Pavia, 27100 Pavia, Italy; (S.P.); (E.C.); (I.G.); (B.C.)
| | - Giovanna Bruni
- Department of Chemistry, University of Pavia, 27100 Pavia, Italy;
| | - Simone Mauramati
- Department of Surgery, Otolaryngologist section, IRCCS Policlinico S. Matteo, 27100 Pavia, Italy; (S.M.); (M.B.)
| | - Alberto Benazzo
- Department of Surgery, Medical University of Vienna, 1090 Vienna, Austria;
| | - Lorenzo Cobianchi
- Department of Clinical, Surgical, Diagnostic & Pediatric Sciences, University of Pavia, IRCCS Policlinico S. Matteo, 27100 Pavia, Italy; (S.C.); (L.C.)
| | - Patrizia Morbini
- Department of Diagnostic Medicine, IRCCS Policlinico S. Matteo, 27100 Pavia, Italy;
| | - Laura Caliogna
- Orthopaedic and Traumatology, IRCCS Policlinico San Matteo, 27100 Pavia, Italy;
| | - Marco Benazzo
- Department of Surgery, Otolaryngologist section, IRCCS Policlinico S. Matteo, 27100 Pavia, Italy; (S.M.); (M.B.)
| | - Maria Antonietta Avanzini
- Department of Paediatric Oncoaematology, IRCCS Policlinico S. Matteo, 27100 Pavia, Italy; (E.L.); (M.A.A.)
| | - Bice Conti
- Department of Drug Sciences, University of Pavia, 27100 Pavia, Italy; (S.P.); (E.C.); (I.G.); (B.C.)
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24
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Nayakawde NB, Methe K, Banerjee D, Berg M, Premaratne GU, Olausson M. In Vitro Regeneration of Decellularized Pig Esophagus Using Human Amniotic Stem Cells. Biores Open Access 2020; 9:22-36. [PMID: 32117597 PMCID: PMC7047253 DOI: 10.1089/biores.2019.0054] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Decellularization of esophagus was studied using three different protocols. The sodium deoxycholate/DNase-I (SDC/DNase-I) method was the most successful as evidenced by histology and DNA quantification of the acellular scaffolds. Acellular scaffolds were further analyzed and compared with native tissue by histology, quantitative analysis of DNA, and extracellular matrix (ECM) proteins. Histologically, the SDC/DNase-I protocol effectively produced scaffold with preserved structural architecture similar to native tissue architecture devoid of any cell nucleus. ECM proteins, such as collagen, elastin, and glycosaminoglycans were present even after detergent-enzymatic decellularization. Immunohistochemical analysis of acellular scaffold showed weak expression of Gal 1, 3 Gal epitope compared with native tissue. For performing recellularization, human amnion-derived mesenchymal stem cells (MSCs) and epithelial cells were seeded onto acellular esophagus in a perfusion–rotation bioreactor. In recellularized esophagus, immunohistochemistry showed infiltration of MSCs from adventitia into the muscularis externa and differentiation of MSCs into the smooth muscle actin and few endothelial cells (CD31). Our study demonstrates successful preparation and characterization of a decellularized esophagus with reduced load of Gal 1, 3 Gal epitope with preserved architecture and ECM proteins similar to native tissue. Upon subsequent recellularization, xenogeneic acellular esophagus also supported stem cell growth and partial differentiation of stem cells. Hence, the current study offers the hope for preparing a tissue-engineered esophagus in vitro which can be transplanted further into pigs for further in vivo evaluation.
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Affiliation(s)
- Nikhil B Nayakawde
- Laboratory for Transplantation and Regenerative Medicine, Sahlgrenska Academy at Gothenburg University and the Sahlgrenska Transplant Institute at Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Ketaki Methe
- Laboratory for Transplantation and Regenerative Medicine, Sahlgrenska Academy at Gothenburg University and the Sahlgrenska Transplant Institute at Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Debashish Banerjee
- Laboratory for Transplantation and Regenerative Medicine, Sahlgrenska Academy at Gothenburg University and the Sahlgrenska Transplant Institute at Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Malin Berg
- Department of Otolaryngology, Head and Neck Surgery, and Sahlgrenska Academy at Gothenburg University and the Sahlgrenska Transplant Institute at Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Goditha U Premaratne
- Laboratory for Transplantation and Regenerative Medicine, Sahlgrenska Academy at Gothenburg University and the Sahlgrenska Transplant Institute at Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Michael Olausson
- Laboratory for Transplantation and Regenerative Medicine, Sahlgrenska Academy at Gothenburg University and the Sahlgrenska Transplant Institute at Sahlgrenska University Hospital, Gothenburg, Sweden.,Department of Transplantation Surgery, Sahlgrenska Academy at Gothenburg University and the Sahlgrenska Transplant Institute at Sahlgrenska University Hospital, Gothenburg, Sweden
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25
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Amigo N, Zubieta C, Riganti JM, Ramirez M, Renda P, Lovera R, Pascaner A, Vigliano C, Craiem D, Young DA, Gilbert TW, Nieponice A. Biomechanical Features of Reinforced Esophageal Hiatus Repair in a Porcine Model. J Surg Res 2020; 246:62-72. [DOI: 10.1016/j.jss.2019.08.026] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Revised: 07/24/2019] [Accepted: 08/29/2019] [Indexed: 12/18/2022]
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26
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Urinary Bladder Matrix Scaffolds Promote Pericardium Repair in a Porcine Model. J Surg Res 2020; 249:216-224. [PMID: 32001387 DOI: 10.1016/j.jss.2019.12.033] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Revised: 11/14/2019] [Accepted: 12/27/2019] [Indexed: 01/01/2023]
Abstract
Pericardium closure after cardiac surgery is recommended to prevent postoperative adhesions to the sternum. Synthetic materials have been used as substitutes, with limited results because of impaired remodeling and fibrotic tissue formation. Urinary bladder matrix (UBM) scaffolds promote constructive remodeling that more closely resemble the native tissue. The aim of the study is to evaluate the host response to UBM scaffolds in a porcine model of partial pericardial resection. Twelve Landrace pigs were subjected to a median sternotomy. A 5 × 7 cm pericardial defect was created and then closed with a 5 × 7 cm multilayer UBM patch (UBM group) or left as an open defect (control group). Animals were survived for 8 wk. End points included gross morphology, biomechanical testing, histology with semiquantitative score, and cardiac function. The UBM group showed mild adhesions, whereas the control group showed fibrosis at the repair site, with robust adhesions and injury to the coronary bed. Load at failure (gr) and stiffness (gr/mm) were lower in the UBM group compared with the native pericardium (199.9 ± 59.2 versus 405.3 ± 99.89 g, P = 0.0536 and 44.23 ± 15.01 versus 146.5 ± 24.38 g/mm, P = 0.0025, respectively). In the UBM group, the histology resembled native pericardial tissue, with neovascularization, neofibroblasts, and little inflammatory signs. In contrast, control group showed fibrotic tissue with mononuclear infiltrates and a lack of organized collagen fibers validated with a histologic score. Both groups had normal ultrasonography results without cardiac motility disorders. In this setting, UBM scaffolds showed appropriate features for pericardial repair, restoring tissue properties that could help reduce postsurgical adhesions and prevent its associated complications.
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27
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Barachetti L, Zanni M, Stefanello D, Rampazzo A. Use of four-layer porcine small intestinal submucosa alone as a scaffold for the treatment of deep corneal defects in dogs and cats: preliminary results. Vet Rec 2020; 186:e28. [PMID: 31937546 DOI: 10.1136/vr.105513] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Revised: 10/20/2019] [Accepted: 12/05/2019] [Indexed: 01/18/2023]
Abstract
BACKGROUND To describe the efficacy of four-layer porcine small intestinal submucosa (Vetrix BioSIS plus+) as single scaffold for the treatment of deep corneal lesions in dogs and cats. METHODS 10 dogs and 3 cats with deep or full thickness corneal defects were treated surgically with BioSIS plus graft. Corneal transparency scores and vision were evaluated. RESULTS Lesions in dogs were four perforations, three descemetoceles, two limbal melanocytomas and one deep corneal ulcer. In cats, there were one limbal melanocytoma and two perforations. The average length of the follow-up was 86 days. In all, 12 out of 13 eyes treated were visual at last recheck (92.3 per cent). The scars were mild eight cases (66.7 per cent), but denser in four cases (33.4 per cent). Complication were partial collagenolysis in three cases (25 per cent), which resolved with medical therapy, mild corneal pigmentation in one case (8.4 per cent) and anterior synechia in one case (8.4 per cent). One case experienced severe collagenolysis and was enucleated 21 days postoperatively. CONCLUSIONS Four-layer porcine SIS graft was successfully used for surgical treatment of deep corneal lesions in selected corneal diseases in a small series of dogs and cats, with good results in terms of mechanic support and corneal transparency.
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Affiliation(s)
- Laura Barachetti
- Department of Veterinary Medicine, University of Milan, Milan, Italy .,Dipartimento di Oftalmologia, Istituto Veterinario di Novara, Granozzo con Monticello, Italy
| | - Marco Zanni
- Department of Veterinary Science and Public Health, University of Milan, Milan, Italy
| | | | - Antonella Rampazzo
- Equine Department, Universitat Zurich Vetsuisse-Fakultat, Zurich, Switzerland
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28
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van Rijswijk JW, Talacua H, Mulder K, van Hout GPJ, Bouten CVC, Gründeman PF, Kluin J. Failure of decellularized porcine small intestinal submucosa as a heart valved conduit. J Thorac Cardiovasc Surg 2020; 160:e201-e215. [PMID: 32151387 DOI: 10.1016/j.jtcvs.2019.09.164] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Revised: 09/08/2019] [Accepted: 09/23/2019] [Indexed: 12/18/2022]
Abstract
OBJECTIVE Decellularized extracellular matrix made from porcine small intestinal submucosa, commercially available as CorMatrix (CorMatrix Cardiovascular, Inc, Roswell, Ga) is used off-label to reconstruct heart valves. Recently, surgeons experienced failures and words of caution were raised. The aim of this study was to evaluate decellularized porcine small intestinal submucosa as right-sided heart valved conduit in a xenogeneic animal model. METHODS A pulmonary valve replacement was performed with custom-made valved conduits in 10 lambs and 10 sheep (1 month [3 lambs and 3 sheep], 3 months [3 lambs and 3 sheep], 6 months [4 lambs and 4 sheep]). Valve function was assessed after implantation and before the animal was put to death. Explanted conduits were inspected macroscopically and analyzed using immunohistochemistry and scanning electron microscopy. They also underwent mechanical testing and testing for biochemical composition. RESULTS All valved conduits were successfully implanted. Five sheep and 2 lambs died due to congestive heart failure within 2 months after surgery. In the animals that died, the valve leaflets were thickened with signs of inflammation (endocarditis in 4). Five sheep and 8 lambs (1 month: 6 out of 6 animals, 3 months: 4 out of 6 animals, 6 months: 3 out of 8 animals) survived planned follow-up. At the time they were put to death, 5 lambs had significant pulmonary stenosis and 1 sheep showed severe regurgitation. A well-functioning valve was seen in 4 sheep and 3 lambs for up to 3 months. These leaflets showed limited signs of remodeling. CONCLUSIONS Fifty percent of sheep and 20% of lambs died due to valve failure before the planned follow-up period was complete. A well-functioning valve was seen in 35% of animals, albeit with limited signs of tissue remodeling at ≤3 months after implantation. Further analysis is needed to understand the disturbing dichotomous outcome before clinical application can be advised.
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Affiliation(s)
- Jan Willem van Rijswijk
- Department of Cardiothoracic Surgery, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, The Netherlands; Department of Pathology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Hanna Talacua
- Department of Cardiothoracic Surgery, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, The Netherlands; Department of Cardiothoracic Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Khadija Mulder
- Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - Gerardus P J van Hout
- Department of Experimental Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Carlijn V C Bouten
- Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands; Institute for Complex Molecular Systems, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - Paul F Gründeman
- Department of Experimental Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Jolanda Kluin
- Department of Cardiothoracic Surgery, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
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29
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Kim IG, Wu Y, Park SA, Cho H, Choi JJ, Kwon SK, Shin JW, Chung EJ. Tissue-Engineered Esophagus via Bioreactor Cultivation for Circumferential Esophageal Reconstruction. Tissue Eng Part A 2019; 25:1478-1492. [DOI: 10.1089/ten.tea.2018.0277] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Affiliation(s)
- In Gul Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University, College of Medicine, Seoul, Republic of Korea
| | - Yanru Wu
- Department of Biomedical Engineering, Inje University, Gimhae, Republic of Korea
| | - Su A. Park
- Department of Nature-Inspired Nanoconvergence Systems, Korea Institute of Machinery and Materials, Daejeon, Republic of Korea
| | - Hana Cho
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University, College of Medicine, Seoul, Republic of Korea
| | - Jun Jae Choi
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University, College of Medicine, Seoul, Republic of Korea
| | - Seong Keun Kwon
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University, College of Medicine, Seoul, Republic of Korea
| | - Jung-Woog Shin
- Department of Biomedical Engineering, Inje University, Gimhae, Republic of Korea
| | - Eun-Jae Chung
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University, College of Medicine, Seoul, Republic of Korea
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30
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Syed O, Kim JH, Keskin-Erdogan Z, Day RM, El-Fiqi A, Kim HW, Knowles JC. SIS/aligned fibre scaffold designed to meet layered oesophageal tissue complexity and properties. Acta Biomater 2019; 99:181-195. [PMID: 31446049 DOI: 10.1016/j.actbio.2019.08.015] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Revised: 07/17/2019] [Accepted: 08/08/2019] [Indexed: 12/27/2022]
Abstract
With donor organs not readily available, the need for a tissue-engineered oesophagus remains high, particularly for congenital childhood conditions such as atresia. Previous attempts have not been successful, and challenges remain. Small intestine submucosa (SIS) is an acellular matrix material with good biological properties; however, as is common with these types of materials, they demonstrate poor mechanical properties. In this work, electrospinning was performed to mechanically reinforce tubular SIS with polylactic-co-glycolic acid (PLGA) nanofibres. It was hypothesised that if attachment could be achieved between the two materials, then this would (i) improve the SIS mechanical properties, (ii) facilitate smooth muscle cell alignment to support directional growth of muscle cells and (iii) allow for the delivery of bioactive molecules (VEGF in this instance). Through a relatively simple multistage process, adhesion between the layers was achieved without chemically altering the SIS. It was also found that altering mandrel rotation speed affected the alignment of the PLGA nanofibres. SIS-PLGA scaffolds performed mechanically better than SIS alone; yield stress improvement was 200% and 400% along the longitudinal and circumferential directions, respectively. Smooth muscle cells cultured on the aligned fibres showed resultant unidirectional alignment. In vivo the SIS-PLGA scaffolds demonstrated limited foreign body reaction judged by the type and proportion of immune cells present and lack of fibrous encapsulation. The scaffolds remained intact at 4 weeks in vivo, and good cellular infiltration was observed. The incorporation of VEGF within SIS-PLGA scaffolds increased the blood vessel density of the surrounding tissues, highlighting the possible stimulation of endothelialisation by angiogenic factor delivery. Overall, the designed SIS-PLGA-VEGF hybrid scaffolds might be used as a potential matrix platform for oesophageal tissue engineering. In addition to this, achieving improved attachment between layers of acellular matrix materials and electrospun fibre layers offers the potential utility in other applications. STATEMENT OF SIGNIFICANCE: Because of its multi-layered nature and complex structure, the oesophagus tissue poses several challenges for successful clinical grafting. Therefore, it is promising to utilise tissue engineering strategies to mimic and form structural compartments for its recovery. In this context, we investigated the use of tubular small intestine submucosa (SIS) reinforced with polylactic-co-glycolic acid (PLGA) nanofibres by using electrospinning and also, amongst other parameters, the integrity of the bilayered structure created. This was carried out to facilitate smooth muscle cell alignment, support directional growth of muscle cells and allow the delivery of bioactive molecules (VEGF in this study). We evaluated this approach by using in vitro and in vivo models to determine the efficacy of this new system.
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Saldin LT, Patel S, Zhang L, Huleihel L, Hussey GS, Nascari DG, Quijano LM, Li X, Raghu D, Bajwa AK, Smith NG, Chung CC, Omstead AN, Kosovec JE, Jobe BA, Turner NJ, Zaidi AH, Badylak SF. Extracellular Matrix Degradation Products Downregulate Neoplastic Esophageal Cell Phenotype. Tissue Eng Part A 2019; 25:487-498. [PMID: 30259795 DOI: 10.1089/ten.tea.2018.0105] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
IMPACT STATEMENT Extracellular matrix (ECM) biomaterials were used to treat esophageal cancer patients after cancer resection and promoted regrowth of normal mucosa without recurrence of cancer. The present study investigates the mechanisms by which these materials were successful to prevent the cancerous phenotype. ECM downregulated neoplastic esophageal cell function (proliferation, metabolism), but normal esophageal epithelial cells were unaffected in vitro, and suggests a molecular basis (downregulation of PI3K-Akt, cell cycle) for the promising clinical results. The therapeutic effect appeared to be enhanced using homologous esophageal ECM. This study suggests that ECM can be further investigated to treat cancer patients after resection or in combination with targeted therapy.
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Affiliation(s)
- Lindsey T Saldin
- 1 Department of Bioengineering, University of Pittsburgh, Pittsburgh, Pennsylvania.,2 McGowan Institute for Regenerative Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Shil Patel
- 2 McGowan Institute for Regenerative Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Li Zhang
- 2 McGowan Institute for Regenerative Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Luai Huleihel
- 2 McGowan Institute for Regenerative Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - George S Hussey
- 2 McGowan Institute for Regenerative Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - David G Nascari
- 2 McGowan Institute for Regenerative Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Lina M Quijano
- 2 McGowan Institute for Regenerative Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Xue Li
- 2 McGowan Institute for Regenerative Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Divya Raghu
- 2 McGowan Institute for Regenerative Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Anant K Bajwa
- 1 Department of Bioengineering, University of Pittsburgh, Pittsburgh, Pennsylvania.,2 McGowan Institute for Regenerative Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Nicholas G Smith
- 2 McGowan Institute for Regenerative Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Christopher C Chung
- 2 McGowan Institute for Regenerative Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Ashten N Omstead
- 3 Esophageal and Lung Institute, Allegheny Health Network, Pittsburgh, Pennsylvania
| | - Juliann E Kosovec
- 3 Esophageal and Lung Institute, Allegheny Health Network, Pittsburgh, Pennsylvania
| | - Blair A Jobe
- 3 Esophageal and Lung Institute, Allegheny Health Network, Pittsburgh, Pennsylvania
| | - Neill J Turner
- 2 McGowan Institute for Regenerative Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania.,4 Department of Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Ali H Zaidi
- 3 Esophageal and Lung Institute, Allegheny Health Network, Pittsburgh, Pennsylvania
| | - Stephen F Badylak
- 2 McGowan Institute for Regenerative Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania.,4 Department of Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania
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Bio-Based Covered Stents: The Potential of Biologically Derived Membranes. TISSUE ENGINEERING PART B-REVIEWS 2019; 25:135-151. [DOI: 10.1089/ten.teb.2018.0207] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Zakhem E, Raghavan S, Suhar RA, Bitar KN. Bioengineering and regeneration of gastrointestinal tissue: where are we now and what comes next? Expert Opin Biol Ther 2019; 19:527-537. [PMID: 30880502 DOI: 10.1080/14712598.2019.1595579] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
INTRODUCTION The field of tissue engineering and regenerative medicine has been applied to the gastrointestinal (GI) tract for a couple decades. Several achievements have been accomplished that provide promising tools for treating diseases of the GI tract. AREAS COVERED The work described in this review covers the traditional aspect of using cells and scaffolds to replace parts of the tract. Several studies investigated different types of biomaterials and different types of cells. A more recent approach involved the use of gut-derived organoid units that can differentiate into all gut cell layers. The most recent approach introduced the use of organ-on-a-chip concept to understand the physiology and pathophysiology of the GI system. EXPERT OPINION The different approaches tackle the diseases of the GI tract from different perspectives. While all these different approaches provide a promising and encouraging future for this field, the translational aspect is yet to be studied.
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Affiliation(s)
- Elie Zakhem
- a Wake Forest Institute for Regenerative Medicine , Wake Forest School of Medicine , Winston Salem , NC , USA.,b Section on Gastroenterology , Wake Forest School of Medicine , Winston Salem , NC , USA
| | - Shreya Raghavan
- c Department of Materials Science and Engineering , University of Michigan , Ann Arbor , MI , USA
| | - Riley A Suhar
- d Department of Materials Science and Engineering , Stanford University , Stanford , CA , USA
| | - Khalil N Bitar
- a Wake Forest Institute for Regenerative Medicine , Wake Forest School of Medicine , Winston Salem , NC , USA.,b Section on Gastroenterology , Wake Forest School of Medicine , Winston Salem , NC , USA.,e Virginia Tech-Wake Forest School of Biomedical Engineering Sciences , Winston-Salem , NC , USA
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Regeneration of esophagus using a scaffold-free biomimetic structure created with bio-three-dimensional printing. PLoS One 2019; 14:e0211339. [PMID: 30849123 PMCID: PMC6408002 DOI: 10.1371/journal.pone.0211339] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Accepted: 01/11/2019] [Indexed: 02/07/2023] Open
Abstract
Various strategies have been attempted to replace esophageal defects with natural or artificial substitutes using tissue engineering. However, these methods have not yet reached clinical application because of the high risks related to their immunogenicity or insufficient biocompatibility. In this study, we developed a scaffold-free structure with a mixture of cell types using bio-three-dimensional (3D) printing technology and assessed its characteristics in vitro and in vivo after transplantation into rats. Normal human dermal fibroblasts, human esophageal smooth muscle cells, human bone marrow-derived mesenchymal stem cells, and human umbilical vein endothelial cells were purchased and used as a cell source. After the preparation of multicellular spheroids, esophageal-like tube structures were prepared by bio-3D printing. The structures were matured in a bioreactor and transplanted into 10-12-week-old F344 male rats as esophageal grafts under general anesthesia. Mechanical and histochemical assessment of the structures were performed. Among 4 types of structures evaluated, those with the larger proportion of mesenchymal stem cells tended to show greater strength and expansion on mechanical testing and highly expressed α-smooth muscle actin and vascular endothelial growth factor on immunohistochemistry. Therefore, the structure with the larger proportion of mesenchymal stem cells was selected for transplantation. The scaffold-free structures had sufficient strength for transplantation between the esophagus and stomach using silicon stents. The structures were maintained in vivo for 30 days after transplantation. Smooth muscle cells were maintained, and flat epithelium extended and covered the inner surface of the lumen. Food had also passed through the structure. These results suggested that the esophagus-like scaffold-free tubular structures created using bio-3D printing could hold promise as a substitute for the repair of esophageal defects.
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Ishihara R. Prevention of esophageal stricture after endoscopic resection. Dig Endosc 2019; 31:134-145. [PMID: 30427076 DOI: 10.1111/den.13296] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Accepted: 11/08/2018] [Indexed: 01/10/2023]
Abstract
Stricture formation after esophageal endoscopic resection has a negative impact on patients' quality of life because it causes dysphagia and requires multiple endoscopic dilations. Various methods by which to prevent stricture have recently been developed and reported. Among these methods, local steroid injection is the most commonly used and is currently considered the standard method for noncircumferential resection. However, local steroid injection has a limited effect on circumferential resection. Thus, oral steroid administration is used for such cases because it may have a stronger effect than local injection. Steroid treatment, both by local injection and oral administration, is effective and low-cost; however, it may cause fragility of the esophageal wall, resulting in adverse events such as perforation during balloon dilatation. Many innovative approaches have been developed, such as tissue-shielding methods with polyglycolic acid, tissue engineering approaches with autologous oral mucosal epithelial cell sheet transplantation, and stent insertion. These methods may be promising, but they are limited by a scarcity of data. Further investigations are needed to confirm the efficacy of these methods.
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Affiliation(s)
- Ryu Ishihara
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
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Multi-stage bioengineering of a layered oesophagus with in vitro expanded muscle and epithelial adult progenitors. Nat Commun 2018; 9:4286. [PMID: 30327457 PMCID: PMC6191423 DOI: 10.1038/s41467-018-06385-w] [Citation(s) in RCA: 56] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Accepted: 07/19/2018] [Indexed: 12/21/2022] Open
Abstract
A tissue engineered oesophagus could overcome limitations associated with oesophageal substitution. Combining decellularized scaffolds with patient-derived cells shows promise for regeneration of tissue defects. In this proof-of-principle study, a two-stage approach for generation of a bio-artificial oesophageal graft addresses some major challenges in organ engineering, namely: (i) development of multi-strata tubular structures, (ii) appropriate re-population/maturation of constructs before transplantation, (iii) cryopreservation of bio-engineered organs and (iv) in vivo pre-vascularization. The graft comprises decellularized rat oesophagus homogeneously re-populated with mesoangioblasts and fibroblasts for the muscle layer. The oesophageal muscle reaches organised maturation after dynamic culture in a bioreactor and functional integration with neural crest stem cells. Grafts are pre-vascularised in vivo in the omentum prior to mucosa reconstitution with expanded epithelial progenitors. Overall, our optimised two-stage approach produces a fully re-populated, structurally organized and pre-vascularized oesophageal substitute, which could become an alternative to current oesophageal substitutes. Combining decellularised scaffolds with patient-derived cells holds promise for bioengineering of functional tissues. Here the authors develop a two-stage approach to engineer an oesophageal graft that retains the structural organisation of native oesophagus.
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Dua KS, Sasikala M. Repairing the human esophagus with tissue engineering. Gastrointest Endosc 2018; 88:579-588. [PMID: 30220298 DOI: 10.1016/j.gie.2018.06.032] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2018] [Accepted: 06/29/2018] [Indexed: 02/06/2023]
Affiliation(s)
- Kulwinder S Dua
- Division of Gastroenterology and Hepatology, Medical College of Wisconsin, Milwaukee, Wisconsin, U.S.A
| | - Mitnala Sasikala
- Institute of Basic Sciences and Translational Research, Asian Healthcare Foundation, Asian Institute of Gastroenterology, Hyderabad, India
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Luc G, Charles G, Gronnier C, Cabau M, Kalisky C, Meulle M, Bareille R, Roques S, Couraud L, Rannou J, Bordenave L, Collet D, Durand M. Decellularized and matured esophageal scaffold for circumferential esophagus replacement: Proof of concept in a pig model. Biomaterials 2018; 175:1-18. [PMID: 29793088 DOI: 10.1016/j.biomaterials.2018.05.023] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Revised: 05/09/2018] [Accepted: 05/14/2018] [Indexed: 10/16/2022]
Abstract
Surgical resection of the esophagus requires sacrificing a long portion of it. Its replacement by the demanding gastric pull-up or colonic interposition techniques may be avoided by using short biologic scaffolds composed of decellularized matrix (DM). The aim of this study was to prepare, characterize, and assess the in vivo remodeling of DM and its clinical impact in a preclinical model. A dynamic chemical and enzymatic decellularization protocol of porcine esophagus was set up and optimized. The resulting DM was mechanically and biologically characterized by DNA quantification, histology, and histomorphometry techniques. Then, in vitro and in vivo tests were performed, such as DM recellularization with human or porcine adipose-derived stem cells, or porcine stromal vascular fraction, and maturation in rat omentum. Finally, the DM, matured or not, was implanted as a 5-cm-long esophagus substitute in an esophagectomized pig model. The developed protocol for esophageal DM fulfilled previously established criteria of decellularization and resulted in a scaffold that maintained important biologic components and an ultrastructure consistent with a basement membrane complex. In vivo implantation was compatible with life without major clinical complications. The DM's scaffold in vitro characteristics and in vivo implantation showed a pattern of constructive remodeling mimicking major native esophageal characteristics.
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Affiliation(s)
- Guillaume Luc
- CHU Bordeaux, CIC1401, F-33000, Bordeaux, France; Univ. Bordeaux, F-33000, Bordeaux, France; Inserm, Bioingénierie tissulaire, U1026, F-33000, Bordeaux, France; CHU Bordeaux, Department of Digestive Surgery, F-33000, Bordeaux, France
| | - Guillaume Charles
- CHU Bordeaux, CIC1401, F-33000, Bordeaux, France; Univ. Bordeaux, F-33000, Bordeaux, France
| | - Caroline Gronnier
- Univ. Bordeaux, F-33000, Bordeaux, France; CHU Bordeaux, Department of Digestive Surgery, F-33000, Bordeaux, France
| | - Magali Cabau
- CHU Bordeaux, CIC1401, F-33000, Bordeaux, France; Univ. Bordeaux, F-33000, Bordeaux, France; CHU Bordeaux, Department of Digestive Surgery, F-33000, Bordeaux, France
| | - Charlotte Kalisky
- CHU Bordeaux, CIC1401, F-33000, Bordeaux, France; Univ. Bordeaux, F-33000, Bordeaux, France
| | - Mallory Meulle
- CHU Bordeaux, CIC1401, F-33000, Bordeaux, France; Univ. Bordeaux, F-33000, Bordeaux, France
| | - Reine Bareille
- Univ. Bordeaux, F-33000, Bordeaux, France; Inserm, Bioingénierie tissulaire, U1026, F-33000, Bordeaux, France
| | - Samantha Roques
- CHU Bordeaux, CIC1401, F-33000, Bordeaux, France; Univ. Bordeaux, F-33000, Bordeaux, France
| | - Lionel Couraud
- CHU Bordeaux, CIC1401, F-33000, Bordeaux, France; Univ. Bordeaux, F-33000, Bordeaux, France; LAPVSO, F-31201, Toulouse Cedex 2, France
| | - Johanna Rannou
- CHU Bordeaux, CIC1401, F-33000, Bordeaux, France; Univ. Bordeaux, F-33000, Bordeaux, France
| | - Laurence Bordenave
- CHU Bordeaux, CIC1401, F-33000, Bordeaux, France; Univ. Bordeaux, F-33000, Bordeaux, France; Inserm, Bioingénierie tissulaire, U1026, F-33000, Bordeaux, France
| | - Denis Collet
- CHU Bordeaux, Department of Digestive Surgery, F-33000, Bordeaux, France
| | - Marlène Durand
- CHU Bordeaux, CIC1401, F-33000, Bordeaux, France; Univ. Bordeaux, F-33000, Bordeaux, France; Inserm, Bioingénierie tissulaire, U1026, F-33000, Bordeaux, France.
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Progress on the Prevention of Esophageal Stricture after Endoscopic Submucosal Dissection. Gastroenterol Res Pract 2018; 2018:1696849. [PMID: 29686699 PMCID: PMC5857296 DOI: 10.1155/2018/1696849] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2017] [Accepted: 01/28/2018] [Indexed: 12/13/2022] Open
Abstract
Endoscopic submucosal dissection (ESD) has been widely accepted as an effective, minimally invasive treatment for superficial esophageal cancers. However, esophageal stricture often occurs in patients with large mucosal defects after ESD. In this review, we discuss various approaches recently researched to prevent esophageal strictures after ESD. These approaches can be classified as pharmacological treatments, esophageal stent treatments, and tissue engineering approaches. Most of the preventive approaches still have their limitations and require further research. With the improvement of current therapies, ESD can be more widely utilized as a minimally invasive treatment with minimal complications.
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Chung EJ, Ju HW, Yeon YK, Lee JS, Lee YJ, Seo YB, Chan Hum P. Development of an omentum-cultured oesophageal scaffold reinforced by a 3D-printed ring: feasibility of an in vivo bioreactor. ARTIFICIAL CELLS NANOMEDICINE AND BIOTECHNOLOGY 2018; 46:885-895. [PMID: 29446982 DOI: 10.1080/21691401.2018.1439039] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Current treatments of oesophageal diseases, such as carcinoma, congenital abnormality or trauma, require surgical intervention and oesophageal reconstruction with the stomach, jejunum or colon. However, serious side effects are possible with each treatment option. Despite tissue engineering promising to be an effective regenerative strategy, no functional solution currently exists for oesophageal reconstruction. Here, we developed an omentum-cultured oesophageal scaffold reinforced by a 3D-printed ring. The nano-structured scaffolds were wrapped into the omentum of rats and orthotopically transplanted for the repair of circumferential oesophageal defects two weeks later. The artificial oesophagus exhibited complete healing of the surgically created circumferential defects by the second week. The integration of the omentum-cultured oesophageal scaffold and the regenerative tissue remained intact. Macroscopically, there was no evidence of a fistula, perforation, abscess formation or surrounding soft-tissue necrosis. The omentum-cultured nano-structure scaffold reinforced by a 3D-printed ring is a more practical model with better vascularization for artificial neo-oesophagus reconstruction in a rat model.
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Affiliation(s)
- Eun-Jae Chung
- a Department of Otorhinolaryngology-Head and Neck Surgery , College of Medicine, Seoul National University , Korea
| | - Hyung Woo Ju
- b Nano-Bio Regenerative Medical Institute , Collage of Medicine, Hallym University , Chuncheon , Korea
| | - Yeung Kyu Yeon
- b Nano-Bio Regenerative Medical Institute , Collage of Medicine, Hallym University , Chuncheon , Korea
| | - Ji Seung Lee
- b Nano-Bio Regenerative Medical Institute , Collage of Medicine, Hallym University , Chuncheon , Korea
| | - Young Jin Lee
- b Nano-Bio Regenerative Medical Institute , Collage of Medicine, Hallym University , Chuncheon , Korea
| | - Ye Been Seo
- b Nano-Bio Regenerative Medical Institute , Collage of Medicine, Hallym University , Chuncheon , Korea
| | - Park Chan Hum
- b Nano-Bio Regenerative Medical Institute , Collage of Medicine, Hallym University , Chuncheon , Korea.,c Department of Otorhinolaryngology-Head and Neck Surgery , Collage of Medicine, Hallym University , Chuncheon , Korea
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Okuyama H, Umeda S, Takama Y, Terasawa T, Nakayama Y. Patch esophagoplasty using an in-body-tissue-engineered collagenous connective tissue membrane. J Pediatr Surg 2018; 53:223-226. [PMID: 29223663 DOI: 10.1016/j.jpedsurg.2017.11.004] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2017] [Accepted: 11/08/2017] [Indexed: 11/17/2022]
Abstract
AIM Although many approaches to esophageal replacement have been investigated, these efforts have thus far only met limited success. In-body-tissue-engineered connective tissue tubes have been reported to be effective as vascular replacement grafts. The aim of this study was to investigate the usefulness of an In-body-tissue-engineered collagenous connective tissue membrane, "Biosheet", as a novel esophageal scaffold in a beagle model. METHODS We prepared Biosheets by embedding specially designed molds into subcutaneous pouches in beagles. After 1-2months, the molds, which were filled with ingrown connective tissues, were harvested. Rectangular-shaped Biosheets (10×20mm) were then implanted to replace defects of the same size that had been created in the cervical esophagus of the beagle. An endoscopic evaluation was performed at 4 and 12weeks after implantation. The esophagus was harvested and subjected to a histological evaluation at 4 (n=2) and 12weeks (n=2) after implantation. The animal study protocols were approved by the National Cerebral and Cardiovascular Centre Research Institute Committee (No. 16048). RESULTS The Biosheets showed sufficient strength and flexibility to replace the esophagus defect. All animals survived with full oral feeding during the study period. No anastomotic leakage was observed. An endoscopic study at 4 and 12weeks after implantation revealed that the anastomotic sites and the internal surface of the Biosheets were smooth, without stenosis. A histological analysis at 4weeks after implantation demonstrated that stratified squamous epithelium was regenerated on the internal surface of the Biosheets. A histological analysis at 12weeks after implantation showed the regeneration of muscle tissue in the implanted Biosheets. CONCLUSION The long-term results of patch esophagoplasty using Biosheets showed regeneration of stratified squamous epithelium and muscular tissues in the implanted sheets. These results suggest that Biosheets may be useful as a novel esophageal scaffold.
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Affiliation(s)
- Hiroomi Okuyama
- Department of Pediatric Surgery, Osaka University Graduate School of Medicine, Osaka, Japan.
| | - Satoshi Umeda
- Department of Pediatric Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Yuichi Takama
- Department of Pediatric Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Takeshi Terasawa
- Division of Medical Engineering and Materials, National Cerebral and Cardiovascular Centre Research Institute, Osaka, Japan
| | - Yasuhide Nakayama
- Division of Medical Engineering and Materials, National Cerebral and Cardiovascular Centre Research Institute, Osaka, Japan
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Nakashima S, Nakamura T, Miyagawa K, Yoshikawa T, Kin S, Kuriu Y, Nakase Y, Sakakura C, Otsuji E, Hagiwara A, Yamagishi H. In Situ Tissue Engineering of the Bile Duct Using Polypropylene Mesh-Collagen Tubes. Int J Artif Organs 2018; 30:75-85. [PMID: 17295195 DOI: 10.1177/039139880703000110] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Multiple attempts have been made to replace biliary defects with a variety of materials. Recently, successful biliary reconstruction using the Gore-Tex vascular graft has been reported experimentally and clinically We designed a new artificial bile duct consisting of collagen sponge and polypropylene mesh. We presently evaluated the feasibility of using this prosthesis as a scaffold for bile duct tissue regeneration in a canine model. Our prosthesis, a sponge made from porcine dermal collagen, is reinforced with a polypropylene mesh cylinder. We used the prosthesis to reconstruct the middle portion of the common bile duct in seven beagle dogs to evaluate its efficacy. While one dog died of biliary stricture 8 months after operation, six survived without problems to scheduled time points for tissue evaluation at 1 to 12 months. All prostheses had become completely incorporated into the host. A confluent epithelial lining was observed within 3 months. In cholangiograms the prosthesis displayed long-term patency in the six dogs and provided satisfactory bile drainage for up to 12 months. Our graft thus shows promise for repair of biliary defects and should lead to development of a new treatment for biliary reconstruction.
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Affiliation(s)
- S Nakashima
- Department of Surgery and Regenerative Medicine, Division of Surgery and Physiology of Digestive System, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan.
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Chung EJ. Bioartificial Esophagus: Where Are We Now? ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2018; 1064:313-332. [DOI: 10.1007/978-981-13-0445-3_19] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Kanetaka K, Kobayashi S, Eguchi S. Regenerative medicine for the esophagus. Surg Today 2017; 48:739-747. [PMID: 29214351 DOI: 10.1007/s00595-017-1610-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Accepted: 11/06/2017] [Indexed: 12/29/2022]
Abstract
Advances in tissue engineering techniques have made it possible to use human cells as biological material. This has enabled pharmacological studies to be conducted to investigate drug effects and toxicity, to clarify the mechanisms underlying diseases, and to elucidate how they compensate for impaired organ function. Many researchers have tried to construct artificial organs using these techniques, but none has succeeded in growing a whole organ. Unlike other digestive organs with complicated functions, such as the processing and absorption of nutrients, the esophagus has the relatively simple function of transporting content, which can be replicated easily by a substitute. In regenerative medicine, various combinations of materials have been applied, including scaffolding, cell sources, and bioreactors. Exciting results of tissue engineering techniques for the esophagus have been reported. In animal models, replacing full-thickness and full-circumferential defects remains challenging because of stenosis and leakage after implantation. Although many reports have manipulated various scaffolds, most have emphasized the importance of both epithelial and mesenchymal cells for the prevention of stenosis. However, the results of repair of partial full-thickness defects and mucosal defects have been promising. Two successful approaches for the replacement of mucosal defects in a clinical setting have been reported, although in contrast to the many animal models, there are few pilot studies in humans. We review the recent results and evaluate the future of regenerative medicine for the esophagus.
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Affiliation(s)
- Kengo Kanetaka
- Department of Surgery, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan
| | - Shinichiro Kobayashi
- Department of Surgery, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan.
| | - Susumu Eguchi
- Department of Surgery, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan
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45
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Patra C, Boccaccini A, Engel F. Vascularisation for cardiac tissue engineering: the extracellular matrix. Thromb Haemost 2017; 113:532-47. [DOI: 10.1160/th14-05-0480] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2014] [Accepted: 09/03/2014] [Indexed: 02/07/2023]
Abstract
SummaryCardiovascular diseases present a major socio-economic burden. One major problem underlying most cardiovascular and congenital heart diseases is the irreversible loss of contractile heart muscle cells, the cardiomyocytes. To reverse damage incurred by myocardial infarction or by surgical correction of cardiac malformations, the loss of cardiac tissue with a thickness of a few millimetres needs to be compensated. A promising approach to this issue is cardiac tissue engineering. In this review we focus on the problem of in vitro vascularisation as implantation of cardiac patches consisting of more than three layers of cardiomyocytes (> 100 μm thick) already results in necrosis. We explain the need for vascularisation and elaborate on the importance to include non-myocytes in order to generate functional vascularised cardiac tissue. We discuss the potential of extracellular matrix molecules in promoting vascularisation and introduce nephronectin as an example of a new promising candidate. Finally, we discuss current biomaterial- based approaches including micropatterning, electrospinning, 3D micro-manufacturing technology and porogens. Collectively, the current literature supports the notion that cardiac tissue engineering is a realistic option for future treatment of paediatric and adult patients with cardiac disease.
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46
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Colorectal wall regeneration resulting from the association of chitosan hydrogel and stromal vascular fraction from adipose tissue. J Biomed Mater Res A 2017; 106:460-467. [DOI: 10.1002/jbm.a.36243] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2016] [Revised: 06/28/2017] [Accepted: 09/19/2017] [Indexed: 12/13/2022]
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47
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Hussey GS, Cramer MC, Badylak SF. Extracellular Matrix Bioscaffolds for Building Gastrointestinal Tissue. Cell Mol Gastroenterol Hepatol 2017; 5:1-13. [PMID: 29276748 PMCID: PMC5736871 DOI: 10.1016/j.jcmgh.2017.09.004] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Accepted: 09/08/2017] [Indexed: 12/14/2022]
Abstract
Regenerative medicine is a rapidly advancing field that uses principles of tissue engineering, developmental biology, stem cell biology, immunology, and bioengineering to reconstruct diseased or damaged tissues. Biologic scaffolds composed of extracellular matrix have shown great promise as an inductive substrate to facilitate the constructive remodeling of gastrointestinal (GI) tissue damaged by neoplasia, inflammatory bowel disease, and congenital or acquired defects. The present review summarizes the preparation and use of extracellular matrix scaffolds for bioengineering of the GI tract, identifies significant advances made in regenerative medicine for the reconstruction of functional GI tissue, and describes an emerging therapeutic approach.
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Affiliation(s)
- George S. Hussey
- McGowan Institute for Regenerative Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
- Department of Surgery, School of Medicine, University of Pittsburgh Medical Center Presbyterian Hospital, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Madeline C. Cramer
- McGowan Institute for Regenerative Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Stephen F. Badylak
- McGowan Institute for Regenerative Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, Pennsylvania
- Department of Surgery, School of Medicine, University of Pittsburgh Medical Center Presbyterian Hospital, University of Pittsburgh, Pittsburgh, Pennsylvania
- Correspondence Address correspondence to: Stephen F. Badylak, DVM, PhD, MD, McGowan Institute for Regenerative Medicine, University of Pittsburgh, 450 Technology Drive, Suite 300, Pittsburgh, Pennsylvania 15219-3110. fax: (412) 624-5256.McGowan Institute for Regenerative MedicineUniversity of Pittsburgh450 Technology Drive, Suite 300PittsburghPennsylvania15219-3110
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48
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Davis AM, Riggs CM, Chow DWY. The use of porcine urinary bladder matrix (
UBM
) to repair a perforated corneal ulcer with iris prolapse in a horse. EQUINE VET EDUC 2017. [DOI: 10.1111/eve.12779] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Affiliation(s)
- A. M. Davis
- Veterinary Clinical Services The Hong Kong Jockey Club Sha TinHong Kong
| | - C. M. Riggs
- Veterinary Clinical Services The Hong Kong Jockey Club Sha TinHong Kong
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49
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Algarrahi K, Franck D, Savarino A, Cristofaro V, Yang X, Affas S, Schäfer FM, Sullivan MP, Estrada CR, Mauney JR. Bilayer silk fibroin grafts support functional oesophageal repair in a rodent model of caustic injury. J Tissue Eng Regen Med 2017; 12:e1068-e1075. [PMID: 28371514 DOI: 10.1002/term.2434] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2016] [Revised: 12/15/2016] [Accepted: 03/29/2017] [Indexed: 01/07/2023]
Abstract
Surgical repair of caustic oesophageal injuries with autologous gastrointestinal segments is often associated with dysmotility, dysphagia and donor site morbidity, and therefore alternative graft options are needed. Bilayer silk fibroin (BLSF) scaffolds were assessed for their ability to support functional restoration of damaged oesophageal tissues in a rat model of onlay oesophagoplasty. Transient exposure of isolated oesophageal segments with 40% NaOH led to corrosive oesophagitis and a 91% reduction in the luminal cross-sectional area of damaged sites. Oesophageal repair with BLSF matrices was performed in injured rats (n = 27) as well as a nondiseased cohort (n = 12) for up to 2 months after implantation. Both implant groups exhibited >80% survival rates, displayed similar degrees of weight gain, and were capable of solid food consumption following a 3-day liquid diet. End-point μ-computed tomography of repaired sites demonstrated a 4.5-fold increase in luminal cross-sectional area over baseline injury levels. Reconstructed oesophageal conduits from damaged and nondiseased animals produced comparable contractile responses to KCl and electric field stimulation while isoproterenol generated similar tissue relaxation responses. Histological and immunohistochemical evaluations of neotissues from both implant groups showed formation of a stratified, squamous epithelium with robust cytokeratin expression as well as skeletal and smooth muscle layers positive for contractile protein expression. In addition, synaptophysin positive neuronal junctions and vessels lined with CD31 positive endothelial cells were also observed at graft sites in each setting. These results provide preclinical validation for the use of BLSF scaffolds in reconstructive strategies for oesophageal repair following caustic injury.
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Affiliation(s)
- Khalid Algarrahi
- Urological Diseases Research Center, Boston Children's Hospital, Boston, Massachusetts, USA.,Department of Surgery, Harvard Medical School, Boston, Massachusetts, USA
| | - Debra Franck
- Urological Diseases Research Center, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Alyssa Savarino
- Urological Diseases Research Center, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Vivian Cristofaro
- Department of Surgery, Harvard Medical School, Boston, Massachusetts, USA.,Division of Urology, Veterans Affairs Boston Healthcare System, West Roxbury, Massachusetts, USA.,Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Xuehui Yang
- Urological Diseases Research Center, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Saif Affas
- Urological Diseases Research Center, Boston Children's Hospital, Boston, Massachusetts, USA.,Department of Surgery, Harvard Medical School, Boston, Massachusetts, USA
| | - Frank-Mattias Schäfer
- Urological Diseases Research Center, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Maryrose P Sullivan
- Department of Surgery, Harvard Medical School, Boston, Massachusetts, USA.,Division of Urology, Veterans Affairs Boston Healthcare System, West Roxbury, Massachusetts, USA.,Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Carlos R Estrada
- Urological Diseases Research Center, Boston Children's Hospital, Boston, Massachusetts, USA.,Department of Surgery, Harvard Medical School, Boston, Massachusetts, USA
| | - Joshua R Mauney
- Urological Diseases Research Center, Boston Children's Hospital, Boston, Massachusetts, USA.,Department of Surgery, Harvard Medical School, Boston, Massachusetts, USA
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50
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Algarrahi K, Franck D, Cristofaro V, Yang X, Savarino A, Affas S, Schäfer FM, Ghezzi C, Jennings R, Nedder A, Kaplan DL, Sullivan MP, Estrada CR, Mauney JR. Bi-layer silk fibroin grafts support functional tissue regeneration in a porcine model of onlay esophagoplasty. J Tissue Eng Regen Med 2017; 12:e894-e904. [PMID: 28084044 DOI: 10.1002/term.2402] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2016] [Revised: 11/17/2016] [Accepted: 01/09/2017] [Indexed: 12/27/2022]
Abstract
Partial circumferential, full thickness defects of the esophagus can occur as a result of organ perforation or tumour resection, or during surgical reconstruction of strictured segments. Complications associated with autologous tissue flaps conventionally utilized for defect repair necessitate the development of new graft options. In this study, bi-layer silk fibroin (BLSF) scaffolds were investigated for their potential to support functional restoration of partial circumferential defects in a porcine model of esophageal repair. Onlay thoracic esophagoplasty with BLSF matrices (~3 x 1.5 cm) was performed in adult swine (N = 6) for 3 months of implantation. All animals receiving BLSF grafts survived with no complications and were capable of solid food consumption. Radiographic esophagrams revealed preservation of organ continuity with no evidence of contrast extravasation or strictures. Fluoroscopic analysis demonstrated peristaltic contractions. Ex vivo tissue bath studies displayed contractile responses to carbachol, electric field stimulation, and KCl while isoproterenol produced tissue relaxation. Histological and immunohistochemical evaluations of neotissues showed a stratified, squamous epithelium, a muscularis mucosa composed of smooth muscle bundles, and a muscularis externa organized into circular and longitudinal layers, with a mix of striated skeletal muscle fascicles interspersed with smooth muscle. De novo innervation and vascularization were observed throughout the graft sites and consisted of synaptophysin-positive neuronal boutons and vessels lined with CD31-positive endothelial cells. The results of this study demonstrate that BLSF scaffolds can facilitate constructive remodeling of partial circumferential, full thickness esophageal defects in a large animal model. Copyright © 2017 John Wiley & Sons, Ltd.
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Affiliation(s)
- Khalid Algarrahi
- Urological Diseases Research Center, Boston Children's Hospital, Boston, MA, USA.,Department of Surgery, Harvard Medical School, Boston, MA, USA
| | - Debra Franck
- Urological Diseases Research Center, Boston Children's Hospital, Boston, MA, USA
| | - Vivian Cristofaro
- Department of Surgery, Harvard Medical School, Boston, MA, USA.,Division of Urology, Veterans Affairs Boston Healthcare System, West Roxbury, MA, USA.,Department of Surgery, Brigham and Women's Hospital, Boston, MA, USA
| | - Xuehui Yang
- Urological Diseases Research Center, Boston Children's Hospital, Boston, MA, USA
| | - Alyssa Savarino
- Urological Diseases Research Center, Boston Children's Hospital, Boston, MA, USA
| | - Saif Affas
- Urological Diseases Research Center, Boston Children's Hospital, Boston, MA, USA.,Department of Surgery, Harvard Medical School, Boston, MA, USA
| | | | - Chiara Ghezzi
- Department of Biomedical Engineering, Tufts University, Medford, MA, USA
| | | | - Arthur Nedder
- Animal Resource at Children's Hospital, Boston Children's Hospital, Boston, MA, USA
| | - David L Kaplan
- Department of Biomedical Engineering, Tufts University, Medford, MA, USA
| | - Maryrose P Sullivan
- Department of Surgery, Harvard Medical School, Boston, MA, USA.,Division of Urology, Veterans Affairs Boston Healthcare System, West Roxbury, MA, USA.,Department of Surgery, Brigham and Women's Hospital, Boston, MA, USA
| | - Carlos R Estrada
- Urological Diseases Research Center, Boston Children's Hospital, Boston, MA, USA.,Department of Surgery, Harvard Medical School, Boston, MA, USA
| | - Joshua R Mauney
- Urological Diseases Research Center, Boston Children's Hospital, Boston, MA, USA.,Department of Surgery, Harvard Medical School, Boston, MA, USA
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