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Langer S, Radtke C, Györi E, Springer A, Metzelder ML. Bladder augmentation in children: current problems and experimental strategies for reconstruction. Wien Med Wochenschr 2018; 169:61-70. [PMID: 30084093 PMCID: PMC6394595 DOI: 10.1007/s10354-018-0645-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Accepted: 06/21/2018] [Indexed: 12/31/2022]
Abstract
Bladder augmentation is a demanding surgical procedure and exclusively offered for selected children and has only a small spectrum of indications. Paediatric bladder voiding dysfunction occurs either on a basis of neurological dysfunction caused by congenital neural tube defects or on a basis of rare congenital anatomic malformations. Neurogenic bladder dysfunction often responds well to a combination of specific drugs and/or intermittent self-catheterization. However, selected patients with spinal dysraphism and children with congenital malformations like bladder exstrophy and resulting small bladder capacity might require bladder augmentation. Ileocystoplasty is the preferred method of bladder augmentation to date. Because of the substantial long-and short-term morbidity of augmentation cystoplasty, recent studies have tried to incorporate new techniques and technologies, such as the use of biomaterials to overcome or reduce the adverse effects. In this regard, homografts and allografts have been implemented in bladder augmentation with varying results, but recent studies have shown promising data in terms of proliferation of urothelium and muscle cells by using biological silk grafts.
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Affiliation(s)
- Sophie Langer
- General Hospital Vienna, Clinical Department of Paediatric Surgery, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Christine Radtke
- General Hospital Vienna, Clinical Department of Plastic and Reconstructive Surgery, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Eva Györi
- General Hospital Vienna, Clinical Department of Plastic and Reconstructive Surgery, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Alexander Springer
- General Hospital Vienna, Clinical Department of Paediatric Surgery, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Martin L Metzelder
- General Hospital Vienna, Clinical Department of Paediatric Surgery, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria.
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Zou L, Mao S, Liu S, Zhang L, Xu H, Yang T, Wen H, Hu Y, Ding Q, Jiang H. Unilateral long-segment ureteral reconstruction using a bilateral Boari flap bridge: An experimental model in dogs. Scand J Urol 2016; 50:401-4. [PMID: 27326539 DOI: 10.1080/21681805.2016.1194461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE The aim of this experimental study was to evaluate the feasibility of a bilateral Boari flap bridge as a novel method for unilateral long-segment ureteral reconstruction. MATERIALS AND METHODS The study was conducted on eight dogs. After resection of 10 cm of right-sided distal ureter, bilateral Boari flaps were made from the anterior upper wall of the bladder and then anastomosed head to head, forming a flap bridge. The left base of the flap bridge was transected, and the free end was then anastomosed to the proximal stump of the ureter with a stent inside. A retrograde urography through a cystostomy was performed 8 weeks after the ureteral reconstruction. The animals were killed and the neoureters were examined histologically. RESULTS There were almost no obvious complications during the postoperative period. The urography suggested patent urine excretion and no obvious fistula or stenosis. Histopathological examinations showed an open lumen with complete urothelial lining and a healthy muscular layer with nutrient vessels. CONCLUSION This study showed that ureteral reconstruction by a bilateral Boari flap bridge was anatomically possible in an animal model. Further studies are needed to confirm long-term functional efficacy.
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Affiliation(s)
- Lujia Zou
- a Department of Urology , Huashan Hospital, Fudan University , Shanghai , PR China
| | - Shanhua Mao
- a Department of Urology , Huashan Hospital, Fudan University , Shanghai , PR China
| | - Shenghua Liu
- a Department of Urology , Huashan Hospital, Fudan University , Shanghai , PR China
| | - Limin Zhang
- a Department of Urology , Huashan Hospital, Fudan University , Shanghai , PR China
| | - Hua Xu
- a Department of Urology , Huashan Hospital, Fudan University , Shanghai , PR China
| | - Tian Yang
- a Department of Urology , Huashan Hospital, Fudan University , Shanghai , PR China
| | - Hui Wen
- a Department of Urology , Huashan Hospital, Fudan University , Shanghai , PR China
| | - Yun Hu
- a Department of Urology , Huashan Hospital, Fudan University , Shanghai , PR China
| | - Qiang Ding
- a Department of Urology , Huashan Hospital, Fudan University , Shanghai , PR China
| | - Haowen Jiang
- a Department of Urology , Huashan Hospital, Fudan University , Shanghai , PR China
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Hidas G, Lee HJ, Bahoric A, Kelly MS, Watts B, Liu Z, Saharti S, Lusch A, Alamsahebpour A, Kerbl D, Truong H, Zi X, Khoury AE. Aerosol transfer of bladder urothelial and smooth muscle cells onto demucosalized colonic segments for bladder augmentation: in vivo, long term, and functional pilot study. J Pediatr Urol 2015; 11:260.e1-6. [PMID: 26022502 PMCID: PMC4623943 DOI: 10.1016/j.jpurol.2015.02.020] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2014] [Accepted: 02/26/2015] [Indexed: 01/24/2023]
Abstract
BACKGROUND Bladder augmentation technique has changed over the years and the current practice has significant adverse health effects and long-term sequelae. Previously, we reported a novel cell transfer technology for covering demucosalized colonic segments with bladder urothelium and smooth muscle cells through an aerosol spraying of these cells and a fibrin glue mixture. OBJECTIVE To determine the long-term durability and functional characteristics of demucosalized segments of colon repopulated with urothelial cells in the bladder of swine for use in augmentation cystoplasty. STUDY DESIGN Nine swine were divided into three groups. The first group (control) underwent standard colocystoplasty; the second group underwent colocystoplasty with colonic demucosalization and aerosol application of fibrin glue and urothelial cell mixture; in the third group detrusor cells were added to the mixture described in group two. The animals were kept for 6 months. Absorptive and secretory function was assessed. Bladders were harvested for histological and immunohistochemical evaluation. RESULTS All animals but one in the experimental groups showed confluent urothelial coverage of the colonic segment in the bladder without any evidence of fibrosis, inflammation, or regrowth of colonic epithelial cells. Ten percent of the instilled water in the bladder was absorbed within an hour in the control group, but none in experimental groups(p = 0.02). The total urine sediment and protein contents were higher in the control group compared with experimental groups (p < 0.05). DISCUSSION Both study groups developed a uniform urothelial lining. Histologically, the group with smooth muscle had an added layer of submucosal smooth muscle. Six months after bladder augmentation the new lining was durable. We were also able to demonstrate that the reconstituted augmented segments secrete and absorb significantly less than the control colocystoplasty group. We used a non-validated simple method to evaluate permeability of the new urothelial lining to water. To determine if the aerosol transfer of bladder cells would have behaved differently in the neurogenic bladder population, this experiment should have been performed in animals with neuropathic bladders. CONCLUSION Aerosol spraying of single cell suspension of urothelial and muscular cells with fibrin glue resulted in coverage of the demucosalized intestinal segment with a uniform urothelial layer. This new lining segment was durable without regrowth of colonic mucosa after 6 months. The new reconstituted segment absorbs and secretes significantly less than control colocystoplasty.
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Affiliation(s)
- Guy Hidas
- Urology Department, University of California, Irvine, Orange, CA, USA
| | - Hak J Lee
- Urology Department, University of California, Irvine, Orange, CA, USA
| | | | - Maryellen S Kelly
- Urology Department, University of California, Irvine, Orange, CA, USA
| | - Blake Watts
- Urology Department, University of California, Irvine, Orange, CA, USA
| | - Zhongbo Liu
- Urology Department, University of California, Irvine, Orange, CA, USA
| | - Samah Saharti
- Pathology Department, University of California, Irvine, Orange, CA, USA
| | - Achim Lusch
- Urology Department, University of California, Irvine, Orange, CA, USA
| | | | - David Kerbl
- Urology Department, University of California, Irvine, Orange, CA, USA
| | - Hung Truong
- Urology Department, University of California, Irvine, Orange, CA, USA
| | - Xiaolin Zi
- Urology Department, University of California, Irvine, Orange, CA, USA
| | - Antoine E Khoury
- Urology Department, University of California, Irvine, Orange, CA, USA.
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Thiebes AL, Albers S, Klopsch C, Jockenhoevel S, Cornelissen CG. Spraying Respiratory Epithelial Cells to Coat Tissue-Engineered Constructs. Biores Open Access 2015; 4:278-87. [PMID: 26309803 PMCID: PMC4497665 DOI: 10.1089/biores.2015.0015] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Applying cells in a spray can overcome current hurdles in coating tissue engineered constructs with a thin layer of endo- or epithelial cells. We report here a structured study on the influences of spray application with a medical spray device on vascular smooth muscle cells (vSMCs) and respiratory epithelial cells (RECs) with and without fibrin gel. Next to viability and cytotoxicity assays, the in vitro differentiation capacity after spray processing was analyzed. For vSMC, no influence of air pressures till 0.8 bar could be shown, whereas the viability decreased for higher pressures. The viability of RECs was reduced to 88.5% with 0.4 bar air pressure. Lactate dehydrogenase-levels in the culture medium increased the first day after spraying but normalized afterward. In the short term, no differences by means of morphology and expression-specific markers for vSMCs and RECs were seen between the control and study group. In addition, in a long-term study for 28 days with the air–liquid interface, RECs differentiated and built up an organized epithelial layer with ciliary development that was comparable to the control for cells sprayed without fibrin gel. When spraying within fibrin gel, ciliary development was lower at 28 days. Thus, spraying of vSMCs and RECs was proved to be a suitable method for tissue engineering. Especially for RECs, this application is of special significance when coating luminal structures or other unfavorable topographies.
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Affiliation(s)
- Anja Lena Thiebes
- Department of Tissue Engineering and Textile Implants, Institute of Applied Medical Engineering, Helmholtz Institute, RWTH Aachen University , Aachen, Germany
| | - Stefanie Albers
- Department of Tissue Engineering and Textile Implants, Institute of Applied Medical Engineering, Helmholtz Institute, RWTH Aachen University , Aachen, Germany
| | - Christian Klopsch
- Clinic and Policlinic for Cardiac Surgery, University of Rostock , Rostock, Germany
| | - Stefan Jockenhoevel
- Department of Tissue Engineering and Textile Implants, Institute of Applied Medical Engineering, Helmholtz Institute, RWTH Aachen University , Aachen, Germany . ; Aachen-Maastricht Institute for Biobased Materials, Maastricht University at Chemelot Campus , Geleen, The Netherlands
| | - Christian G Cornelissen
- Department of Tissue Engineering and Textile Implants, Institute of Applied Medical Engineering, Helmholtz Institute, RWTH Aachen University , Aachen, Germany . ; Section for Pneumology, Department for Internal Medicine, Medical Faculty, RWTH Aachen University , Aachen, Germany
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Zou Z, Denny E, Brown CE, Jensen MC, Li G, Fujii T, Neman J, Jandial R, Chen M. Cytotoxic T lymphocyte trafficking and survival in an augmented fibrin matrix carrier. PLoS One 2012; 7:e34652. [PMID: 22496835 PMCID: PMC3319597 DOI: 10.1371/journal.pone.0034652] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2011] [Accepted: 03/08/2012] [Indexed: 12/02/2022] Open
Abstract
Cell-based therapies have intriguing potential for the treatment of a variety of neurological disorders. One such example is genetically engineered cytotoxic T lymphocytes (CTLs) that are being investigated in brain tumor clinical trials. The development of methods for CTL delivery is critical to their use in the laboratory and clinical setting. In our study, we determined whether CTLs can migrate through fibrin matrices and if their migration, survival, and function could be modulated by adding chemokines to the matrix. Our results indicated that CTLs can freely migrate through fibrin matrices. As expected, the addition of the monocyte chemotactic protein-1 (MCP-1), also known as chemokine C-C motif ligand 2 (CCL2), to the surrounding media increased egress of the CTLs out of the fibrin clot. Interleukin (IL) -2 and/or IL-15 embedded in the matrix enhanced T cell survival and further promoted T cell migration. The interleukin-13 receptor alpha 2 specific (IL-13R alpha2) T cells that traveled out of the fibrin clot retained the capacity to kill U251 glioma cells. In summary, CTLs can survive and migrate robustly in fibrin matrices. These processes can be influenced by modification of matrix constituents. We conclude that fibrin matrices may be suitable T cell carriers and can be used to facilitate understanding of T cell interaction with the surrounding microenvironment.
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Affiliation(s)
- Zhaoxia Zou
- Division of Neurosurgery, City of Hope National Medical Center, Duarte, California, United States of America
| | - Erin Denny
- Division of Neurosurgery, City of Hope National Medical Center, Duarte, California, United States of America
| | - Christine E. Brown
- Department of Cancer Immunotherapeutics & Tumor Immunology, City of Hope National Medical Center, Duarte, California, United States of America
| | - Michael C. Jensen
- Department of Cancer Immunotherapeutics & Tumor Immunology, City of Hope National Medical Center, Duarte, California, United States of America
| | - Gang Li
- Division of Neurosurgery, City of Hope National Medical Center, Duarte, California, United States of America
| | - Tatsuhiro Fujii
- Division of Neurosurgery, City of Hope National Medical Center, Duarte, California, United States of America
| | - Josh Neman
- Division of Neurosurgery, City of Hope National Medical Center, Duarte, California, United States of America
| | - Rahul Jandial
- Division of Neurosurgery, City of Hope National Medical Center, Duarte, California, United States of America
| | - Mike Chen
- Division of Neurosurgery, City of Hope National Medical Center, Duarte, California, United States of America
- * E-mail:
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Zhang Y, Liu G, Kropp BP. Re-epithelialization of demucosalized stomach patch with tissue-engineered urothelial mucosa combined with Botox A in bladder augmentation. BJU Int 2012; 110:E106-12. [PMID: 22288946 DOI: 10.1111/j.1464-410x.2011.10845.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
UNLABELLED Re-epithelialization demucosa stomach patch is important to prevent the patch being exposed to urine that might cause patch shrinkage and fibrosis formation due to urine-derived chemical irritation. Additionally, Botox A acts by blocking the transmission of nerve impulses to smooth muscles and so paralysing the muscles, which is commonly used to relax muscle for treatment of oesophageal achalasia due to overactive smooth muscle and sphincters of gastrointestinal tract. We fabricated in vitro tissue engineered urothelial mucosa with multi-layers of urothelium and smooth muscle layers seeded on SIS scaffold and then used this cell-scaffold construct to cover nuke gastro patch combining with Botox A for gastrocystoplasty in a canine model. OBJECTIVE To evaluate the demucosalized stomach patch covered with tissue-engineered urothelium for gastrocystoplasty and to determine whether or not injections of Botox A into the re-epithelialized stomach patch can protect the graft from contraction in a canine bladder reconstruction model. MATERIALS AND METHODS Gastrocystoplasty was performed in 10 adult beagles after hemi-cystectomy using five types of stomach patch (n = 2 per group): entire stomach patches (group I); demucosalized patches (group II); demucosalized patches covered with cell-free small intestinal submucosa (SIS) (group III); demucosalized patches with urothelial and smooth muscle cell-seeded SIS (group IV); and demucosalized patches with the cell-seeded SIS combined with injections of Botox A (group V). The bladder volume/pressure and the graft sizes were measured before surgery and again 10 weeks after bladder augmentation. The graft tissues were examined both histologically and using immunohistochemistry. RESULTS All dogs survived and their gastric grafts were all vital with a good blood supply. Gastric metaplasia of urothelium appeared on the top of stomach mucosa patches in two animals in group I. There was calcification formation at the centre of the graft in one animal in group II. As compared with urothelium that was partially covered over with stomach patches in groups II and III, stratified urothelium completely covered the demucosalized gastric patches in groups IV and V. There was less shrinkage of the stomach grafts in groups I and V, which shrank to half of their original size, than of the stomach grafts in groups II, III, and IV, which shrank significantly to one-quarter of their original sizes. CONCLUSIONS Botox A injections appear to protect the graft contraction in the re-epithelialized stomach flaps. The gastrocystoplasty using demucosalized patches covered with tissue-engineered urothelial mucosa combined with an injection of Botox A could have clinical potential for use in bladder reconstruction.
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Affiliation(s)
- Yuanyuan Zhang
- Wake Forest Institute for Regenerative Medicine, Wake Forest University School of Medicine, Winston Salem, NC 27157, USA.
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Bolland F, Southgate J. Bio-engineering urothelial cells for bladder tissue transplant. Expert Opin Biol Ther 2008; 8:1039-49. [DOI: 10.1517/14712598.8.8.1039] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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Abstract
During the last decade, there has been a dramatic increase in studies aimed at regeneration of the urinary bladder. Many studies employed animal-derived or synthetic materials as grafts for experimental bladder augmentation models, with or without additional measures to promote regeneration, such as autologous cell transplantation or growth factor loading. However, in spite of encouraging results in several reports, few methodologies have shown proven definitive clinical utility. One major problem in these studies is the lack of a clear distinction between native and regenerated bladder in total bladder function after augmentation. Another crucial problem is the absorption and shrinkage of larger grafts, which may result from insufficient vascular supply and smooth muscle regeneration. In contrast, researchers have recently attempted to establish alternative regenerative strategies for treating bladder diseases, and have employed far more diverse approaches according to the various pathological conditions to be treated. For total replacement of the bladder after cystectomy for invasive bladder cancer, urothelium-covered neobladder with non-urinary tract backbone remains a viable choice. In addition, functional bladder diseases such as urinary incontinence, weak detrusor, or non-compliant fibrotic bladder have also been major targets for many leading research groups in this field. These conditions are studied much more from different therapeutic standpoints, aiming at the prevention or reversal of pathological conditions in muscle remodeling or neural control. Such altered research direction would inevitably lead to less surgically based basic biological research, and also would include a far wider spectrum of adult and pediatric bladder diseases, from overactive bladder to dysfunctional voiding.
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