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Verzeletti V, Mammana M, Zambello G, Dell'Amore A, Rea F. Human tracheal transplantation: A systematic review of case reports. Clin Transplant 2024; 38:e15238. [PMID: 38289888 DOI: 10.1111/ctr.15238] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 12/19/2023] [Accepted: 12/21/2023] [Indexed: 02/01/2024]
Abstract
BACKGROUND Patients with long-segment airway stenosis not amenable to conventional surgery may benefit from tracheal transplantation. However, this procedure has been only anecdotally reported, and its indications, techniques, and outcomes have not been extensively reviewed. METHODS We conducted a systematic Literature search to identify all original articles reporting attempts at tracheal transplantation in humans. RESULTS Of 699 articles found by the initial search, 11 were included in the systematic review, describing 14 cases of tracheal transplantation. Patients underwent transplantation for benign stenosis in nine cases, and for malignancies in five cases. In 12 cases blood supply to the trachea was provided by wrapping the graft in a vascularized recipient's tissue, while in 2 cases the trachea was directly transplanted as a vascularized composite allograft. The transplantation procedure was aborted before orthotopic transplantation in two patients. Among the remaining 12 patients, there was 1 operative mortality, while 4 patients experienced complications. Immunosuppressants drugs were administered to the majority of patients postoperatively, and only one group of authors attempted their withdrawal, in five patients. At the end of follow-up, all 11 patients surviving the operation were alive, but 2 had a recurrent tracheal stenosis requiring an airway appliance for breathing. CONCLUSION Human tracheal transplantation is still at an embryonic phase. Studies available in the Literature report different surgical techniques, and information on long-term outcomes is still limited. Future research is needed in order to understand the clinical value of this procedure.
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Affiliation(s)
- Vincenzo Verzeletti
- Thoracic Surgery Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Marco Mammana
- Thoracic Surgery Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Giovanni Zambello
- Thoracic Surgery Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Andrea Dell'Amore
- Thoracic Surgery Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Federico Rea
- Thoracic Surgery Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
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2
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Zeng N, Chen Y, Wu Y, Zang M, Largo RD, Chang EI, Schaverien MV, Yu P, Zhang Q. Pre-epithelialized cryopreserved tracheal allograft for neo-trachea flap engineering. Front Bioeng Biotechnol 2023; 11:1196521. [PMID: 37214293 PMCID: PMC10198577 DOI: 10.3389/fbioe.2023.1196521] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 04/26/2023] [Indexed: 05/24/2023] Open
Abstract
Background: Tracheal reconstruction presents a challenge because of the difficulty in maintaining the rigidity of the trachea to ensure an open lumen and in achieving an intact luminal lining that secretes mucus to protect against infection. Methods: On the basis of the finding that tracheal cartilage has immune privilege, researchers recently started subjecting tracheal allografts to "partial decellularization" (in which only the epithelium and its antigenicity are removed), rather than complete decellularization, to maintain the tracheal cartilage as an ideal scaffold for tracheal tissue engineering and reconstruction. In the present study, we combined a bioengineering approach and a cryopreservation technique to fabricate a neo-trachea using pre-epithelialized cryopreserved tracheal allograft (ReCTA). Results: Our findings in rat heterotopic and orthotopic implantation models confirmed that tracheal cartilage has sufficient mechanical properties to bear neck movement and compression; indicated that pre-epithelialization with respiratory epithelial cells can prevent fibrosis obliteration and maintain lumen/airway patency; and showed that a pedicled adipose tissue flap can be easily integrated with a tracheal construct to achieve neovascularization. Conclusion: ReCTA can be pre-epithelialized and pre-vascularized using a 2-stage bioengineering approach and thus provides a promising strategy for tracheal tissue engineering.
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Affiliation(s)
| | | | | | | | | | | | | | - Peirong Yu
- Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Qixu Zhang
- Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
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3
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A Standardised Approach to the Biomechanical Evaluation of Tracheal Grafts. Biomolecules 2021; 11:biom11101461. [PMID: 34680094 PMCID: PMC8533576 DOI: 10.3390/biom11101461] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Revised: 09/28/2021] [Accepted: 10/04/2021] [Indexed: 11/17/2022] Open
Abstract
The ideal tracheal substitute must have biomechanical properties comparable to the native trachea, but currently there is no standardised approach to evaluating these properties. Here we propose a novel method for evaluating and comparing the properties of tracheal substitutes, thus systematising both measurement and data curation. This system was tested by comparing native rabbit tracheas to frozen and decellularised specimens and determining the histological characteristics of those specimens. We performed radial compression tests on the anteroposterior tracheal axis and longitudinal axial tensile tests with the specimens anastomosed to the jaw connected to a measuring system. All calculations and results were adjusted according to tracheal size, always using variables relative to the tracheal dimensions, thus permitting comparison of different sized organs. The biomechanical properties of the decellularised specimens were only slightly reduced compared to controls and significant in regard to the maximum stress withstood in the longitudinal axis (-0.246 MPa CI [-0.248, -0.145] MPa) and the energy stored per volume unit (-0.124 mJ·mm-3 CI [-0.195, -0.055] mJ·mm-3). The proposed method is suitable for the systematic characterisation of the biomechanical properties of different tracheal substitutes, regardless of the size or nature of the substitute, thus allowing for direct comparisons.
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4
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Martínez-Hernández NJ, Díaz-Cuevas A, Milián-Medina L, Sancho-Tello M, Roselló-Ferrando J, Morcillo-Aixelá A, Campo-Cañaveral JL, Roig-Bataller A, Mata-Roig M. Decellularized tracheal prelamination implant: A proposed bilateral double organ technique. Artif Organs 2021; 45:1491-1500. [PMID: 34310703 DOI: 10.1111/aor.14043] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 07/09/2021] [Accepted: 07/14/2021] [Indexed: 01/08/2023]
Abstract
In tracheal replacement transplantation, prelamination is a critical stage. Nowadays, the most widely used prelamination technique is the prethoracic fascia flap with lateral thoracic artery. We propose a flap based on the internal thoracic artery, which allows a relatively non-aggressive double organ implant, and we have tested its efficacy in decellularized tracheas. Tracheas of albino New Zealand rabbits were decellularized following a protocol that uses detergents and cryogenization, sterilized with 1kGy gamma radiation, and tutorized with a stent. Bilateral pedicled flaps made of pectoral fascia and a muscular component were harvested through a longitudinal 3-cm central thoracic incision, wrapping the tracheas with them in 16 rabbits, remaining them implanted for 2, 4, 8, and 12 weeks. The tracheas were then studied histologically using standard stainings plus immunohistochemistry (CD31). The models were adjusted with Bayesian statistics using ordinal regression; results as odds ratios and credibility intervals. All analysis were performed using R software. Acute inflammatory cell invasion was observed at 2 weeks, which almost disappeared at week 8 after implant. Only macrophages and giant cells increased between Weeks 8 and 12 (OR 10.487, CI [1.603-97.327]). The cartilage maintained its structure, with slight signs of ischemia in a few cases. New CD31-positive vessels were observed from Week 2 and increasing thereafter, reaching a maximum peak at Week 8. We propose a bilateral implant technique that is viable and effective as a prelamination option for two concurrent tracheas, achieving perfect vascularization and integration of the organ with hardly any inflammatory response in the medium or long term.
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Affiliation(s)
| | | | - Lara Milián-Medina
- Pathology Department, Medicine and Odontology Faculty, Universitat de València, València, Spain
| | | | | | | | | | | | - Manuel Mata-Roig
- Pathology Department, Medicine and Odontology Faculty, Universitat de València, València, Spain.,Networking Research Center on Respiratory Diseases (CIBERER), ISCIII, Madrid, Spain
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5
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Sun F, Lu Y, Wang Z, Shi H. Vascularization strategies for tissue engineering for tracheal reconstruction. Regen Med 2021; 16:549-566. [PMID: 34114475 DOI: 10.2217/rme-2020-0091] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Tissue engineering technology provides effective alternative treatments for tracheal reconstruction. The formation of a functional microvascular network is essential to support cell metabolism and ensure the long-term survival of grafts. Although several tracheal replacement therapy strategies have been developed in the past, the critical significance of the formation of microvascular networks in 3D scaffolds has not attracted sufficient attention. Here, we review key technologies and related factors of microvascular network construction in tissue-engineered trachea and explore optimized preparation processes of vascularized functional tissues for clinical applications.
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Affiliation(s)
- Fei Sun
- Clinical Medical College, Yangzhou University, Yangzhou, 225001, PR China.,Institute of Translational Medicine, Medical College, Yangzhou University, Yangzhou, 225001, PR China.,Jiangsu Key Laboratory of Integrated Traditional Chinese & Western Medicine for Prevention & Treatment of Senile Diseases, Yangzhou University, Yangzhou, 225001, PR China
| | - Yi Lu
- Clinical Medical College, Yangzhou University, Yangzhou, 225001, PR China.,Institute of Translational Medicine, Medical College, Yangzhou University, Yangzhou, 225001, PR China.,Jiangsu Key Laboratory of Integrated Traditional Chinese & Western Medicine for Prevention & Treatment of Senile Diseases, Yangzhou University, Yangzhou, 225001, PR China
| | - Zhihao Wang
- Clinical Medical College, Yangzhou University, Yangzhou, 225001, PR China.,Institute of Translational Medicine, Medical College, Yangzhou University, Yangzhou, 225001, PR China.,Jiangsu Key Laboratory of Integrated Traditional Chinese & Western Medicine for Prevention & Treatment of Senile Diseases, Yangzhou University, Yangzhou, 225001, PR China
| | - Hongcan Shi
- Clinical Medical College, Yangzhou University, Yangzhou, 225001, PR China.,Institute of Translational Medicine, Medical College, Yangzhou University, Yangzhou, 225001, PR China.,Jiangsu Key Laboratory of Integrated Traditional Chinese & Western Medicine for Prevention & Treatment of Senile Diseases, Yangzhou University, Yangzhou, 225001, PR China
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6
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Cui P, Liu P, Li S, Ma R. De-Epithelialized Heterotopic Tracheal Allografts without Immunosuppressants in Dogs: Long-Term Results for Cartilage Viability and Structural Integrity. Ann Otol Rhinol Laryngol 2020; 130:441-449. [PMID: 32911959 DOI: 10.1177/0003489420957357] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECTIVES Reconstruction of long segmental tracheal defects is difficult because no ideal tracheal substitutes are currently available. Tracheal allotransplantation maintains cartilage and epithelium viability but requires immunosuppression because of epithelial immunogenicity. We aimed to obtain an epithelium-decellularized allograft that maintains cartilage viability and to evaluate long-term outcomes of such allografts implanted on dog backs without immunosuppressants. METHODS Twenty-five tracheas harvested from mongrel dogs were used to explore the period of epithelium decellularization by combined use of 1% sodium dodecyl sulfate and an organ preservation solution and to assess the chondrocyte viability and immunogenicity of the tracheas after decellularization. Sixteen epithelium-decellularized tracheal allografts and 10 fresh tracheal segments (6 cm long) were implanted in 26 beagles for durations of 10 days and 1, 3, 6, and 12 months. Macroscopic and microscopic examinations were used to evaluate the morphology, viability, and immune rejection of the allografts. Safranin-O staining was used to detect glycosaminoglycans. RESULTS The epithelium disappeared after 24 hours of decellularization. At 72 hours, almost no nuclei remained in the mucosa, while the mean survival rate of chondrocytes was 88.1%. Histological analysis demonstrated that the allograft retained intact tracheal rings and viable cartilage after heterotopic implantation for 1 year, with no immunological rejection. There were no significant differences in the glycosaminoglycan contents among the implanted epithelium-decellularized allografts. CONCLUSIONS Epithelium-decellularized tracheal allografts with chondrocyte viability can be achieved by combined use of a detergent and organ preservation solution, which showed satisfactory cartilage viability and structural integrity after long-term heterotopic transplantation. Further studies on orthotopic transplantation are needed to assess the feasibility of allografts in reconstructing long segmental tracheal defects.
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Affiliation(s)
- Pengcheng Cui
- Department of Otolaryngology-Head and Neck Surgery, Tangdu Hospital and Laryngotracheal Reconstruction Center, Air Force Medical University (Fourth Military Medical University), Xi'an, China
| | - Pengfei Liu
- Department of Otolaryngology-Head and Neck Surgery, Tangdu Hospital and Laryngotracheal Reconstruction Center, Air Force Medical University (Fourth Military Medical University), Xi'an, China
| | - Shuqin Li
- Department of Otolaryngology-Head and Neck Surgery, Tangdu Hospital and Laryngotracheal Reconstruction Center, Air Force Medical University (Fourth Military Medical University), Xi'an, China
| | - Ruina Ma
- Department of Otolaryngology-Head and Neck Surgery, Tangdu Hospital and Laryngotracheal Reconstruction Center, Air Force Medical University (Fourth Military Medical University), Xi'an, China
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7
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De Wolf J, Brieu M, Zawadzki C, Ung A, Kipnis E, Jashari R, Hubert T, Fayoux P, Mariette C, Copin MC, Wurtz A. Successful immunosuppressant-free heterotopic transplantation of tracheal allografts in the pig. Eur J Cardiothorac Surg 2018; 52:248-255. [PMID: 28472471 DOI: 10.1093/ejcts/ezx116] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2016] [Accepted: 03/04/2017] [Indexed: 02/02/2023] Open
Abstract
OBJECTIVES It has been demonstrated that both heterotopic and orthotopic transplants of epithelium-denuded cryopreserved tracheal allografts are feasible in immunosuppressant-free rabbits. Validation of these results in large animals is required before considering clinical applications. We evaluated the viability, immune tolerance and strain properties of such tracheal allografts heterotopically transplanted in a pig model. METHODS Ten tracheal segments, 5 short (5 rings) and 5 long (10 rings), were obtained from male Landrace pigs. The tracheal segments were surgically denuded of their epithelium, then cryopreserved and stored in a tissue bank for 33 to 232 days. After thawing, tracheal segments stented with a silicone tube were wrapped in the omentum in 2 groups of 5 female recipients. The animals did not receive any immunosuppressive drugs. The animals were euthanized from Day 6 to Day 90 in both groups. RESULTS An effective revascularization of allografts regardless of length was observed. Lymphocyte infiltrate was shown in the early postoperative period and became non-significant after 30 days. Allografts displayed high levels of neoangiogenesis and viable cartilage rings with islets of calcification. Biomechanical measurements demonstrated strain properties similar to those of a fresh tracheal segment from Day 58. CONCLUSIONS Our results demonstrate the acceptability and satisfactory stiffness of epithelium-denuded cryopreserved tracheal allografts implanted in the omentum, despite the absence of immunosuppressive drugs. Since the omentum has the capability to reach the tracheal region, this approach should be investigated in the setting of orthotopic transplants in a pig model before considering clinical applications.
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Affiliation(s)
- Julien De Wolf
- Department of Thoracic Surgery, CHU Lille, Lille, France.,Environnement Périnatal et Santé (EA 4489), Université Lille, Lille, France
| | - Mathias Brieu
- Laboratoire de Mécanique de Lille, UMR CNRS 8107, Centrale Lille, Villeneuve d'Ascq, France
| | | | - Alexandre Ung
- Environnement Périnatal et Santé (EA 4489), Université Lille, Lille, France
| | - Eric Kipnis
- Department of Surgical Critical Care, CHU Lille, Lille, France
| | | | - Thomas Hubert
- Environnement Périnatal et Santé (EA 4489), Université Lille, Lille, France
| | - Pierre Fayoux
- Department of Otolaryngology-Head and Neck Surgery, CHU Lille, Lille, France
| | | | | | - Alain Wurtz
- Department of Thoracic Surgery, CHU Lille, Lille, France.,Environnement Périnatal et Santé (EA 4489), Université Lille, Lille, France
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8
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Taniguchi D, Matsumoto K, Tsuchiya T, Machino R, Takeoka Y, Elgalad A, Gunge K, Takagi K, Taura Y, Hatachi G, Matsuo N, Yamasaki N, Nakayama K, Nagayasu T. Scaffold-free trachea regeneration by tissue engineering with bio-3D printing†. Interact Cardiovasc Thorac Surg 2018; 26:745-752. [DOI: 10.1093/icvts/ivx444] [Citation(s) in RCA: 82] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2017] [Accepted: 12/22/2017] [Indexed: 12/17/2022] Open
Affiliation(s)
- Daisuke Taniguchi
- Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
- Medical-Engineering Hybrid Professional Development Center, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Keitaro Matsumoto
- Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
- Medical-Engineering Hybrid Professional Development Center, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Tomoshi Tsuchiya
- Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Ryusuke Machino
- Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Yosuke Takeoka
- Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
- Medical-Engineering Hybrid Professional Development Center, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Abdelmotagaly Elgalad
- Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
- Medical-Engineering Hybrid Professional Development Center, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Kiyofumi Gunge
- Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
- Medical-Engineering Hybrid Professional Development Center, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Katsunori Takagi
- Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
- Medical-Engineering Hybrid Professional Development Center, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Yasuaki Taura
- Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Go Hatachi
- Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Naoto Matsuo
- Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
- Medical-Engineering Hybrid Professional Development Center, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Naoya Yamasaki
- Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
- Medical-Engineering Hybrid Professional Development Center, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Koichi Nakayama
- Department of Regenerative Medicine and Biomedical Engineering, Faculty of Medicine, Saga University, Saga, Japan
| | - Takeshi Nagayasu
- Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
- Medical-Engineering Hybrid Professional Development Center, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
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9
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Den Hondt M, Vanaudenaerde BM, Verbeken EK, Vranckx JJ. Epithelial grafting of a decellularized whole-tracheal segment: an in vivo experimental model. Interact Cardiovasc Thorac Surg 2018; 26:753-760. [DOI: 10.1093/icvts/ivx442] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2017] [Accepted: 12/21/2017] [Indexed: 11/12/2022] Open
Affiliation(s)
- Margot Den Hondt
- Department of Plastic and Reconstructive Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Bart M Vanaudenaerde
- Department of Chronic Diseases, Metabolism and Ageing, Lung Transplant Unit, Laboratory of Pulmonology, KU Leuven—University of Leuven, Leuven, Belgium
| | - Eric K Verbeken
- Department of Pathology, University Hospitals Leuven, Leuven, Belgium
| | - Jan J Vranckx
- Department of Plastic and Reconstructive Surgery, University Hospitals Leuven, Leuven, Belgium
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10
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Maughan EF, Butler CR, Crowley C, Teoh GZ, den Hondt M, Hamilton NJ, Hynds RE, Lange P, Ansari T, Urbani L, Janes SM, de Coppi P, Birchall MA, Elliott MJ. A comparison of tracheal scaffold strategies for pediatric transplantation in a rabbit model. Laryngoscope 2017; 127:E449-E457. [PMID: 28776693 DOI: 10.1002/lary.26611] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2017] [Revised: 02/15/2017] [Accepted: 03/08/2017] [Indexed: 12/13/2022]
Abstract
OBJECTIVES/HYPOTHESIS Despite surgical advances, childhood tracheal stenosis is associated with high morbidity and mortality. Various tracheal scaffold strategies have been developed as the basis for bioengineered substitutes, but there is no consensus on which may be superior in vivo. We hypothesized that there would be no difference in morbidity and mortality between three competing scaffold strategies in rabbits. STUDY DESIGN Pilot preclinical study. METHODS Tracheal scaffolds were prepared by three methods that have been applied clinically and reported: preserved cadaveric ("Herberhold") allografts, detergent-enzymatically decellularized allografts, and synthetic scaffolds (nanocomposite polymer [polyhedral oligomeric silsesquioxane poly(carbonate-urea) urethane (POSS-PCU)]). Scaffolds were implanted into cervical trachea of New Zealand White rabbits (n = 4 per group) without cell seeding. Control animals (n = 4) received autotransplanted tracheal segments using the same technique. Animals underwent bronchoscopic monitoring of the grafts for 30 days. Macroscopic evaluation of tissue integration, graft stenosis, and collapsibility and histological examinations were performed on explants at termination. RESULTS All surgical controls survived to termination without airway compromise. Mild to moderate anastomotic stenosis from granulation tissue was detected, but there was evidence suggestive of vascular reconnection with minimal fibrous encapsulation. In contrast, three of the four animals in the Herberhold and POSS-PCU groups, and all animals receiving decellularized allografts, required early termination due to respiratory distress. Herberhold grafts showed intense inflammatory reactions, anastomotic stenoses, and mucus plugging. Synthetic graft integration and vascularization were poor, whereas decellularized grafts demonstrated malacia and collapse but had features suggestive of vascular connection or revascularization. CONCLUSIONS There are mirror-image benefits and drawbacks to nonrecellularized, decellularized, and synthetic grafts, such that none emerged as the preferred option. Results from prevascularized and/or cell-seeded grafts (as applied clinically) may elucidate clearer advantages of one scaffold type over another. LEVEL OF EVIDENCE NA. Laryngoscope, 127:E449-E457, 2017.
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Affiliation(s)
- Elizabeth F Maughan
- Lungs for Living Research Centre, UCL Respiratory, University College London, London, United Kingdom.,Stem Cell and Regenerative Medicine Section, Department of Surgery, UCL Institute of Child Health and Great Ormond Street Children's Hospital, London, United Kingdom
| | - Colin R Butler
- Lungs for Living Research Centre, UCL Respiratory, University College London, London, United Kingdom.,Stem Cell and Regenerative Medicine Section, Department of Surgery, UCL Institute of Child Health and Great Ormond Street Children's Hospital, London, United Kingdom
| | - Claire Crowley
- Stem Cell and Regenerative Medicine Section, Department of Surgery, UCL Institute of Child Health and Great Ormond Street Children's Hospital, London, United Kingdom
| | - Gui Zhen Teoh
- Division of Surgery and Interventional Science, UCL Centre of Nanotechnology and Regenerative Medicine, University College London, Royal Free London NHS Foundation Trust Hospital, London, United Kingdom
| | - Margot den Hondt
- Department of Plastic and Reconstructive Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Nicholas J Hamilton
- Lungs for Living Research Centre, UCL Respiratory, University College London, London, United Kingdom.,UCL Ear Institute, Royal National Throat, Nose, and Ear Hospital, London, United Kingdom
| | - Robert E Hynds
- Lungs for Living Research Centre, UCL Respiratory, University College London, London, United Kingdom
| | - Peggy Lange
- Northwick Park Institute for Medical Research, Northwick Park, London, United Kingdom
| | - Tahera Ansari
- Northwick Park Institute for Medical Research, Northwick Park, London, United Kingdom
| | - Luca Urbani
- Stem Cell and Regenerative Medicine Section, Department of Surgery, UCL Institute of Child Health and Great Ormond Street Children's Hospital, London, United Kingdom
| | - Samuel M Janes
- Lungs for Living Research Centre, UCL Respiratory, University College London, London, United Kingdom
| | - Paolo de Coppi
- Stem Cell and Regenerative Medicine Section, Department of Surgery, UCL Institute of Child Health and Great Ormond Street Children's Hospital, London, United Kingdom
| | - Martin A Birchall
- UCL Ear Institute, Royal National Throat, Nose, and Ear Hospital, London, United Kingdom
| | - Martin J Elliott
- Department of Thoracic Surgery, Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom
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11
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Den Hondt M, Vanaudenaerde BM, Verbeken EK, Vranckx JJ. Tracheal tissue-engineering: in-vivo biocompatibility of mechanically-stripped allogenic rabbit trachea with autologous epithelial covering. Acta Chir Belg 2016; 116:164-174. [PMID: 27696973 DOI: 10.1080/00015458.2016.1210844] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Successful trachea transplantation comprises the use of biocompatible constructs with little immune-reactivity, submucosal revascularization and creation of an epithelial covering. Allogenic chondrocytes might be protected from an overt immune-response due to physical isolation. Our aim was to evaluate in-vivo biocompatibility of allotracheae, stripped of their highly-immunogenic inner lining. Secondly, we established whether these constructs might serve as suitable scaffolds for autologous epithelial grafting. METHODS Mucosa and submucosa of 12 rabbit donor tracheae were mechanically peeled off. Cartilage was covered with Integra™ regeneration-template. Constructs were implanted within the recipient's lateral thoracic artery flap. Integra of 6 revascularized allotracheae was grafted with autologous buccal mucosa. Macroscopical, histological analysis and immunohistochemistry were performed. RESULTS Revascularization and buccal grafting was incomplete in the first 2 circular constructs. To enhance blood-vessel outgrowth, the following 10 transplants were opened longitudinally before implantation. Integra revascularized well. Grafted tracheae showed satisfactory mucosa-adherence, albeit with invasion of migrating epithelium within the Integra-scaffold. CONCLUSIONS Mechanically-stripped allotracheae exhibited beneficial biocompatibility up to two months. This approach might open doors in the treatment of long-segment tracheal pathologies of which immunosuppression is contra-indicated. Thickness of this layered construct limited practical feasibility of orthotopic transfer, though with further refinements, a clinically-useful transplant could be created.
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12
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Wurtz A, Hysi I, Kipnis E, Copin MC. Recent Advances in Circumferential Tracheal Replacement and Transplantation. Am J Transplant 2016; 16:1334-5. [PMID: 26695386 DOI: 10.1111/ajt.13633] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Affiliation(s)
- A Wurtz
- IMPRT-IFR 114, EA 4489, Lille University Medical School, UDSL-Université Lille Nord de France, Lille, France.,Cardiac and Thoracic Surgery Division, Lille University Teaching Hospital, CHULille, Lille, France
| | - I Hysi
- IMPRT-IFR 114, EA 4489, Lille University Medical School, UDSL-Université Lille Nord de France, Lille, France
| | - E Kipnis
- Surgical Critical Care Unit-Department of Anesthesiology and Critical Care, Lille University Teaching Hospital, CHULille, Lille, France
| | - M C Copin
- Institute of Pathology, Lille University Teaching Hospital, CHULille, Lille, France
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Hysi I, Kipnis E, Fayoux P, Copin MC, Zawadzki C, Jashari R, Hubert T, Ung A, Ramon P, Jude B, Wurtz A. Successful orthotopic transplantation of short tracheal segments without immunosuppressive therapy. Eur J Cardiothorac Surg 2014; 47:e54-61. [PMID: 25475944 DOI: 10.1093/ejcts/ezu444] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVES Results of tracheal transplantation have been disappointing due to of ischaemia and rejection. It has been experimentally demonstrated that results of tracheal autograft/allograft transplantation were correlated with both graft length and revascularization method. Recently, we demonstrated that heterotopic epithelium-denuded-cryopreserved tracheal allograft (TA) displayed satisfactory immune tolerance. We aimed at evaluating the results of such allografts in orthotopic transplantation according to graft length and prior heterotopic or single-stage orthotopic revascularization in a rabbit model. METHODS Twenty New Zealand rabbits were used. Six females served as donors. Tracheal mucosa was mechanically peeled off and then the TAs were cryopreserved. Male recipients were divided into three groups receiving: (i) long TA segment with prior heterotopic revascularization (10-12 tracheal rings, n = 3); (ii) average TA segment with single-stage orthotopic revascularization (6-8 tracheal rings, n = 4); (iii) short TA segment with single-stage orthotopic revascularization (4-5 tracheal rings, n = 7). No immunosuppressive therapy was administered. Grafts were assessed bronchoscopically and upon death or sacrifice by macroscopic evaluation, histology and immunohistochemical staining for apoptosis. RESULTS Four animals were sacrificed from Day 33 to Day 220. The survival time of other recipients was 0-47 days (mean 19.6 ± 16.7 days). Aside from three animals that died from complications, all TA segments had satisfactory stiffness, were well vascularized, showed varying levels of neoangiogenesis and inflammatory infiltration devoid of lymphocytes, and showed evidence of only low levels of apoptosis. Varying degrees of fibroblastic proliferation originating from the lamina propria were observed in the lumen of all TAs and evolved over time into collagenized fibrosis in animals surviving over 45 days. Likewise, cartilage tracheal rings exhibited central calcification deposits, which started on Day 16 and increased over time. Epithelial regeneration was constantly observed. Intense fibroblastic proliferation led to stenosis in all animals from Groups (i) and (ii) but only one of seven animals from Group (iii). CONCLUSIONS Our results suggest that short segments of epithelium-denuded-cryopreserved TA may be reliable for tracheal transplantation in the rabbit model without problems related to graft stiffness or immune rejection. Before considering clinical applications, investigations should be conducted in larger mammals.
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Affiliation(s)
- Ilir Hysi
- Cardiac and Thoracic Surgery Division, Lille University Teaching Hospital, CHU Lille, Lille, France IMPRT-IFR 114, EA 2693, Lille University Medical School, UDSL, Université Lille Nord de France, Lille, France
| | - Eric Kipnis
- Department of Surgical Critical Care, Lille University Teaching Hospital, CHU Lille, Lille, France
| | - Pierre Fayoux
- Department of Otolaryngology-Head and Neck Surgery, Lille University Teaching Hospital, CHU Lille, Lille, France
| | - Marie-Christine Copin
- Institute of Pathology, Lille University Teaching Hospital, CHU Lille, Lille, France
| | - Christophe Zawadzki
- IMPRT-IFR 114, EA 2693, Lille University Medical School, UDSL, Université Lille Nord de France, Lille, France Institute of Hematology-Transfusion, Lille University Teaching Hospital, CHU Lille, Lille, France
| | | | - Thomas Hubert
- IMPRT-IFR 114, EA 2693, Lille University Medical School, UDSL, Université Lille Nord de France, Lille, France
| | - Alexandre Ung
- IMPRT-IFR 114, EA 2693, Lille University Medical School, UDSL, Université Lille Nord de France, Lille, France
| | - Philippe Ramon
- Department of Pneumology, Lille University Teaching Hospital, CHU Lille, Lille, France
| | - Brigitte Jude
- IMPRT-IFR 114, EA 2693, Lille University Medical School, UDSL, Université Lille Nord de France, Lille, France Institute of Hematology-Transfusion, Lille University Teaching Hospital, CHU Lille, Lille, France
| | - Alain Wurtz
- Cardiac and Thoracic Surgery Division, Lille University Teaching Hospital, CHU Lille, Lille, France IMPRT-IFR 114, EA 2693, Lille University Medical School, UDSL, Université Lille Nord de France, Lille, France
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