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Saxena AK, Biro E, Sommer G, Holzapfel GA. Esophagus stretch tests: Biomechanics for tissue engineering and possible implications on the outcome of esophageal atresia repairs performed under excessive tension. Esophagus 2021; 18:346-352. [PMID: 32816188 DOI: 10.1007/s10388-020-00769-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Accepted: 08/13/2020] [Indexed: 02/03/2023]
Abstract
BACKGROUND Esophageal biomechanical studies are important to understand structural changes resulting from stretches during repair of esophageal atresias as well as to obtain values to compare with the biomechanics of tissue-engineered esophagus in the future. This study aimed to investigate light microscopic changes after uniaxial stretching of the ovine esophagus. METHODS In vitro uniaxial stretching was performed on esophagi (n = 20) of 1-month-old lambs within 4-6 h post-mortem. Esophagi were divided into 5 groups: control and stretched (1.1, 1.2, 1.3 and 1.4). Force and lengthening were measured with 5 cycles performed on every specimen using a PBS organ bath at 37 °C. Histological studies were performed on the 5 groups. RESULTS Low forces of ~ 2 N (N) were sufficient for a 1.2-1.25 stretch in the 1st cycle, whereas a three times higher force (~ 6 N) was needed for a stretch of 1.3. In the 2nd to 5th cycle, the tissue weakened and a force of ~ 3 N was sufficient for a stretch of 1.3. Histologically, in the 1.3-1.4 stretch groups, rupture of muscle fibers and capillaries were observed, respectively. Changes in mucosa and collagen fibers could not be observed. CONCLUSIONS These results offer norm values from the native esophagus to compare with the biomechanics of future tissue-engineered esophagus. Esophageal stretching > 1.3 leads to tears in muscle fibers and to rupture of capillaries. These findings can explain the decrease in microcirculation and scarring in mobilized tissue and possibly offer clues to impaired motility in esophagus atresias repaired under excessive tension.
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Affiliation(s)
- Amulya K Saxena
- Department of Pediatric Surgery, Chelsea Children's Hospital, Chelsea and Westminster Hospital NHS Fdn Trust, Imperial College London, 369 Fulham Road, London, SW10 9NH, UK.
| | - Ede Biro
- Department of Pediatric Surgery, Medical University of Pecs, Pecs, Hungary
| | - Gerhard Sommer
- Institute of Biomechanics, Graz University of Technology, Graz, Austria
| | - Gerhard A Holzapfel
- Institute of Biomechanics, Graz University of Technology, Graz, Austria.,Norwegian University of Science and Technology, Trondheim, Norway
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Saxena AK, Klimbacher G. Comparison of esophageal submucosal glands in experimental models for esophagus tissue engineering applications. Esophagus 2019; 16:77-84. [PMID: 30097829 DOI: 10.1007/s10388-018-0633-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Accepted: 07/31/2018] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Esophagus tissue engineering holds promises to overcome the limitations of the presently employed esophageal replacement procedures. This study investigated 5 animal models for esophageal submucosal glands (ESMG) to identify models appropriate for regenerative medicine applications. Furthermore, this study aimed to measure geometric parameters of ESMG that could be utilized for fabrication of ESMG-specific scaffolds for esophagus tissue engineering applications. METHODS Ovine, avian, bovine, murine, and porcine esophagus were investigated using Hematoxylin-Eosin (HE), Periodic Acid Schiff (PAS), and Alcian Blue (AB), with AB applied in 3 pH levels (0.2, 1.0, and 2.5) to detect sulphated mucous. Celleye® (version F) was employed to gain parametric data on ESMGs (size, perimeter, distance to lumen, and acini concentration) necessary for scaffold fabrication. RESULTS Murine, bovine, and ovine esophagus were devoid of ESMG. Avian esophagus demonstrated sulphated acid mucous producing ESMGs with a holocrine secretion pattern, whereas sulphated acid and neutral mucous producing ESMGs with a merocrine secretion pattern were observed in porcine esophagus. Distance of ESMGs to lumen ranged from 127-340 μm (avian) to 916-983 μm (porcine). ESMGs comprised 35% (avian) to 45% (porcine) area of the submucosa. ESMG had an area of 125000 μm2 (avian) to 580000 μm2 (porcine). CONCLUSION Avian and porcine esophagus possesses ESMGs. However, porcine esophagus correlates with data available on human ESMGs. Geometric and parametric data obtained from ESMG are valuable for the fabrication of ESMG-specific scaffolds for esophagus tissue engineering using the hybrid construct approach.
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Affiliation(s)
- Amulya K Saxena
- Department of Pediatric Surgery, Chelsea Children's Hospital, Chelsea and Westminster NHS Fdn Trust, Imperial College London, London, UK.
| | - Guenther Klimbacher
- Department of General and Visceral Surgery, Kepler Universitatsklinikum, Linz, Austria
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Mantakaki A, Fakoya AOJ, Sharifpanah F. Recent advances and challenges on application of tissue engineering for treatment of congenital heart disease. PeerJ 2018; 6:e5805. [PMID: 30386701 PMCID: PMC6204240 DOI: 10.7717/peerj.5805] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Accepted: 09/21/2018] [Indexed: 12/11/2022] Open
Abstract
Congenital heart disease (CHD) affects a considerable number of children and adults worldwide. This implicates not only developmental disorders, high mortality, and reduced quality of life but also, high costs for the healthcare systems. CHD refers to a variety of heart and vascular malformations which could be very challenging to reconstruct the malformed region surgically, especially when the patient is an infant or a child. Advanced technology and research have offered a better mechanistic insight on the impact of CHD in the heart and vascular system of infants, children, and adults and identified potential therapeutic solutions. Many artificial materials and devices have been used for cardiovascular surgery. Surgeons and the medical industry created and evolved the ball valves to the carbon-based leaflet valves and introduced bioprosthesis as an alternative. However, with research further progressing, contracting tissue has been developed in laboratories and tissue engineering (TE) could represent a revolutionary answer for CHD surgery. Development of engineered tissue for cardiac and aortic reconstruction for developing bodies of infants and children can be very challenging. Nevertheless, using acellular scaffolds, allograft, xenografts, and autografts is already very common. Seeding of cells on surface and within scaffold is a key challenging factor for use of the above. The use of different types of stem cells has been investigated and proven to be suitable for tissue engineering. They are the most promising source of cells for heart reconstruction in a developing body, even for adults. Some stem cell types are more effective than others, with some disadvantages which may be eliminated in the future.
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Affiliation(s)
| | | | - Fatemeh Sharifpanah
- Department of Physiology, Faculty of Medicine, Justus Liebig University, Giessen, Germany
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Soft Tissue Repair with Easy-Accessible Autologous Newborn Placenta or Umbilical Cord Blood in Severe Malformations: A Primary Evaluation. Stem Cells Int 2018; 2017:1626741. [PMID: 29403534 PMCID: PMC5748284 DOI: 10.1155/2017/1626741] [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: 08/03/2017] [Revised: 10/12/2017] [Accepted: 10/22/2017] [Indexed: 11/25/2022] Open
Abstract
Disrupted organogenesis leads to permanent malformations that may require surgical correction. Autologous tissue grafts may be needed in severe lack of orthotopic tissue but include donor site morbidity. The placenta is commonly discarded after birth and has a therapeutic potential. The aim of this study was to determine if the amnion from placenta or plasma rich of growth factors (PRGF) with mononuclear cells (MNC) from umbilical cord blood (UCB), collected noninvasively, could be used as bio-constructs for autologous transplantation as an easy-accessible no cell culture-required method. Human amnion and PRGF gel were isolated and kept in culture for up to 21 days with or without small intestine submucosa (SIS). The cells in the constructs showed a robust phenotype without induced increased proliferation (Ki67) or apoptosis (caspase 3), but the constructs showed decreased integrity of the amnion-epithelial layer at the end of culture. Amnion-residing cells in the SIS constructs expressed CD73 or pan-cytokeratin, and cells in the PRGF-SIS constructs expressed CD45 and CD34. This study shows that amnion and UCB are potential sources for production of autologous grafts in the correction of congenital soft tissue defects. The constructs can be made promptly after birth with minimal handling or cell expansion needed.
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Ekblad Å, Westgren M, Fossum M, Götherström C. Fetal subcutaneous cells have potential for autologous tissue engineering. J Tissue Eng Regen Med 2018; 12:1177-1185. [PMID: 29327490 DOI: 10.1002/term.2639] [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] [Received: 05/12/2017] [Revised: 12/18/2017] [Accepted: 01/02/2018] [Indexed: 12/19/2022]
Abstract
Major congenital malformations affect up to 3% of newborns. Infants with prenatally diagnosed soft tissue defects should benefit from having autologous tissue readily available for surgical implantation in the perinatal period. In this study, we investigate fetal subcutaneous cells as cellular source for tissue engineering. Fetal subcutaneous biopsies were collected from elective terminations at gestational Week 20-21. Cells were isolated, expanded, and characterized in vitro. To determine cell coverage, localization, viability, and proliferation in different constructs, the cells were seeded onto a matrix (small intestine submucosa) or in collagen gel with or without poly(ε-caprolactone) mesh and were kept in culture for up to 8 weeks before analysis. Angiogenesis was analysed through a tube-forming assay. Fetal subcutaneous cells could be expanded until 43 ± 3 population doublings, expressed mesenchymal markers, and readily differentiate into adipogenic and osteogenic lineages. The cells showed low adherence to small intestine submucosa and did not migrate deep into the matrix. However, in collagen gels, the cells migrated into the gel and proliferated with sustained viability for up to 8 weeks. The cells in the matrices expressed Ki67, CD73, and α-smooth muscle actin but not cytokeratin or CD31. Fetal cells derived from subcutaneous tissue demonstrated favourable characteristics for preparation of autologous tissue transplants before birth. Our study supports the theory that cells could be obtained from the fetus during pregnancy for tissue engineering purposes after birth. In a future clinical situation, autologous transplants could be used for reconstructive surgery in severe congenital malformations.
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Affiliation(s)
- Åsa Ekblad
- Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Magnus Westgren
- Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Magdalena Fossum
- Department of Women's and Children's Health at Centre of Molecular Medicine, Karolinska Institutet, Stockholm, Sweden.,Patient area Children with diseases of the abdomen and blood or cancer, Section of Urology, Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden
| | - Cecilia Götherström
- Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
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Ekblad Å, Qian H, Westgren M, Le Blanc K, Fossum M, Götherström C. Amniotic Fluid—A Source for Clinical Therapeutics in the Newborn? Stem Cells Dev 2015; 24:1405-14. [DOI: 10.1089/scd.2014.0426] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Affiliation(s)
- Åsa Ekblad
- Division of Obstetrics and Gynecology, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
- Center for Hematology and Regenerative Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Hong Qian
- Center for Hematology and Regenerative Medicine, Karolinska Institutet, Stockholm, Sweden
- Department of Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Magnus Westgren
- Division of Obstetrics and Gynecology, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Katarina Le Blanc
- Center for Hematology and Regenerative Medicine, Karolinska Institutet, Stockholm, Sweden
- Hematology Center, Karolinska University Hospital, Stockholm, Sweden
| | - Magdalena Fossum
- Department of Women's and Children's Health, Center for Molecular Medicine, Karolinska Institutet, Stockholm, Sweden
- Department of Pediatric Surgery, Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden
| | - Cecilia Götherström
- Division of Obstetrics and Gynecology, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
- Center for Hematology and Regenerative Medicine, Karolinska Institutet, Stockholm, Sweden
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Hosper NA, Bank RA, van den Berg PP. Human amniotic fluid-derived mesenchymal cells from fetuses with a neural tube defect do not deposit collagen type i protein after TGF-β1 stimulation in vitro. Stem Cells Dev 2013; 23:555-62. [PMID: 24171700 DOI: 10.1089/scd.2013.0334] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
In spina bifida, the neural tube fails to close during the embryonic period. Exposure of the neural tube to the amniotic fluid during pregnancy causes additional neural damage. Intrauterine tissue engineering using a biomaterial seeded with stem cells might prevent this additional damage. For this purpose, autologous cells from the amniotic fluid are an attractive source. To close the defect, it is important that these cells deposit an extracellular matrix. However, it is not known if amniotic fluid mesenchymal cells (AFMCs) from a fetus with a neural tube defect (NTD) share the same characteristics as AFMCs from a healthy fetus. We found that cells derived from fetuses with a NTD, in contrast to healthy human amniotic fluid cells, did not deposit collagen type I. Furthermore, the NTD cells showed, compared with both healthy amniotic fluid cells and fetal fibroblasts, much lower mRNA expression levels of genes that are involved in collagen biosynthesis [procollagen C-endopeptidase enhancer proteins (PCOLCE), PCOLCE2, ADAM metallopeptidase with thrombospondin type 1 motif, 2 (ADAMTS2), ADAMTS14]. This indicates that NTD-AFMCs have different characteristics compared with healthy AFMCs and might not be suitable for fetal therapy to close the defect in spina bifida patients.
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Affiliation(s)
- Nynke A Hosper
- 1 Medical Biology Section, Department of Pathology and Medical Biology, University Medical Centre Groningen , University of Groningen, GZ Groningen, The Netherlands
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Szpinda M, Daroszewski M, Szpinda A, Woźniak A, Wiśniewski M, Mila-Kierzenkowska C, Baumgart M, Paruszewska-Achtel M. New quantitative patterns of the growing trachea in human fetuses. Med Sci Monit 2012; 18:PH63-70. [PMID: 22648261 PMCID: PMC3560714 DOI: 10.12659/msm.882890] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Rapid progress in perinatal medicine has resulted in numerous tracheo-bronchial interventions on fetal and neonatal airways. The present study was performed to compile normative data for tracheal dimensions at varying gestational ages. MATERIAL/METHODS Using anatomical dissection, digital image analysis (NIS-Elements BR 3.0) and statistical analysis (Wilcoxon signed-rank test, Student's t test, one-way ANOVA, post-hoc Bonferroni test, linear and nonlinear regression analysis) a range of the 4 variables (length in mm, middle external transverse diameter in mm, proximal internal cross-sectional area in mm², internal volume in mm³) for the trachea in 73 spontaneously aborted human fetuses (39 male, 34 female) aged 14-25 weeks was examined. RESULTS No significant male-female differences were found (P>0.05). The length ranged from 10.37±2.15 to 26.54±0.26 mm as y=-65.098 + 28.796 × ln (Age) ±1.794 (R²=0.82). The middle external transverse diameter varied from 2.53±0.09 to 5.09±0.42 mm with the model y=-11.020 + 5.049 × ln (Age) ±0.330 (R²=0.81). The trachea indicated a proportional evolution because the middle external transverse diameter-to-length ratio was stable (0.23±0.03). The proximal internal cross-sectional area rose from 1.46±0.04 to 5.76±1.04 mm² as y=-3.562 + 0.352 × Age ±0.519 (R²=0.76). The internal volumetric growth from 11.89±2.49 to 119.63±4.95 mm³ generated the function y=-135.248 + 9.919 × Age ±10.478 (R²=0.86). CONCLUSIONS The growth in both length and middle external transverse diameter of the trachea follows logarithmic functions, whereas growth of both its proximal internal cross-sectional area and internal volume follow linear functions. The length and middle external transverse diameter of the trachea develop proportionally to each other. The tracheal dimensions may be helpful in the prenatal diagnosis and monitoring of tracheal malformations and obstructive anomalies of the upper respiratory tract.
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Affiliation(s)
- Michał Szpinda
- Department of Normal Anatomy, Ludwik Rydygier Collegium Medicum in Bydgoszcz, The Nicolaus Copernicus University in Torun, Bydgoszcz, Poland.
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Effects of sodium hydroxide exposure on esophageal epithelial cells in an in vitro ovine model: implications for esophagus tissue engineering. J Pediatr Surg 2012; 47:874-80. [PMID: 22595564 DOI: 10.1016/j.jpedsurg.2012.01.033] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2012] [Accepted: 01/26/2012] [Indexed: 11/20/2022]
Abstract
BACKGROUND Esophagus tissue engineering holds promises for esophageal replacement after severe caustic injuries. The aim of this study was to determine whether viable esophageal epithelial cells could be isolated from an esophagus exposed to varying concentrations of alkali with regard to number, viability, and morphology during in vitro culture. METHODS Ovine esophagi were exposed to phosphate-buffered saline 2.5%, 15%, or 25% sodium hydroxide (NaOH). The effect of NaOH concentrations on epithelial damage was assessed histologically. Esophageal epithelial cells were then isolated, and cell count and viability were investigated. Finally, cell number, viability, and morphology of esophageal epithelial cells were determined for 24 days of in vitro culture. RESULTS Histologic analysis showed a progressive destruction of the epithelium proportional to increasing NaOH concentrations. Esophagi treated with phosphate-buffered saline and 2.5% NaOH showed significantly higher viable cell counts after isolation and culture in comparison with those treated with 15% to 5% NaOH. CONCLUSION The evidence presented in this study indicates that epithelial biopsies from an esophagus exposed to low concentrations (2.5%) of NaOH will still yield large numbers of viable cells suitable for tissue engineering applications. In cases of exposure to higher concentrations (15%-25%), alternative cell sources for epithelial regeneration, such as stem cells, will be necessary for tissue engineering applications.
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Kofler K, Ainoedhofer H, Tausendschön J, Höllwarth ME, Saxena AK. Esophageal smooth muscle cells dedifferentiate with loss of α-smooth muscle actin expression after 8 weeks of explant expansion in vitro culture: Implications on esophagus tissue engineering. Eur Surg 2011. [DOI: 10.1007/s10353-011-0617-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Klemmt PAB, Vafaizadeh V, Groner B. The potential of amniotic fluid stem cells for cellular therapy and tissue engineering. Expert Opin Biol Ther 2011; 11:1297-314. [DOI: 10.1517/14712598.2011.587800] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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