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Abstract
The field of Tissue Engineering and Regenerative Medicine has evolved rapidly over the past thirty years. This review will summarize its history, current status and direction through the lens of clinical need, its progress through science in the laboratory and application back into patients. We can take pride in the fact that much effort and progress began with the surgical problems of children and that many surgeons in the pediatric surgical specialties have become pioneers and investigators in this new field of science, engineering, and medicine. Although the field has yet to fulfill its great promise, there have been several examples where a therapy has progressed from the first idea to human application within a short span of time and, in many cases, it has been applied in the surgical care of children.
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A Novel Biodegradable Polyurethane Matrix for Auricular Cartilage Repair: An In Vitro and In Vivo Study. J Burn Care Res 2018; 37:e353-64. [PMID: 26284639 DOI: 10.1097/bcr.0000000000000281] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Auricular reconstruction poses a challenge for reconstructive and burns surgeons. Techniques involving cartilage tissue engineering have shown potential in recent years. A biodegradable polyurethane matrix developed for dermal reconstruction offers an alternative to autologous, allogeneic, or xenogeneic biologicals for cartilage reconstruction. This study assesses such a polyurethane matrix for this indication in vivo and in vitro. To evaluate intrinsic cartilage repair, three pigs underwent auricular surgery to create excisional cartilage ± perichondrial defects, measuring 2 × 3 cm in each ear, into which acellular polyurethane matrices were implanted. Biopsies were taken at day 28 for histological assessment. Porcine chondrocytes ± perichondrocytes were cultured and seeded in vitro onto 1 × 1 cm polyurethane scaffolds. The total culture period was 42 days; confocal, histological, and immunohistochemical analyses of scaffold cultures were performed on days 14, 28, and 42. In vivo, the polyurethane matrices integrated with granulation tissue filling all biopsy samples. Minimal neocartilage invasion was observed marginally on some samples. Tissue composition was identical between ears whether perichondrium was left intact, or not. In vitro, the polyurethane matrix was biocompatible with chondrocytes ± perichondrocytes and supported production of extracellular matrix and Type II collagen. No difference was observed between chondrocyte culture alone and chondrocyte/perichondrocyte scaffold coculture. The polyurethane matrix successfully integrated into the auricular defect and was a suitable scaffold in vitro for cartilage tissue engineering, demonstrating its potential application in auricular reconstruction.
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Reighard CL, Hollister SJ, Zopf DA. Auricular reconstruction from rib to 3D printing. JOURNAL OF 3D PRINTING IN MEDICINE 2018; 2:35-41. [PMID: 29607095 PMCID: PMC5824712 DOI: 10.2217/3dp-2017-0017] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/07/2017] [Accepted: 11/16/2017] [Indexed: 12/19/2022]
Abstract
The human ear imparts critical form and function and remains one of the most challenging facial features to reconstruct. Over the past century, surgeons have developed numerous techniques and materials for total auricular reconstruction. Refined costal cartilage techniques have remained the gold standard for the past half-century. Recent advancements with novel materials, tissue engineering and 3D printing provide immense potential; however, prohibitive costs and regulatory steps remain as barriers to clinical translation.
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Affiliation(s)
| | - Scott J Hollister
- Department of Biomedical Engineering, Georgia Institute of Technology, Atlanta, GA, USA
| | - David A Zopf
- Otolaryngology – Head & Neck Surgery, Pediatric Division, University of Michigan Health Systems, CS Mott Children's Hospital, Ann Arbor, MI, USA
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI, USA
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Nimeskern L, Pleumeekers MM, Pawson DJ, Koevoet WLM, Lehtoviita I, Soyka MB, Röösli C, Holzmann D, van Osch GJVM, Müller R, Stok KS. Mechanical and biochemical mapping of human auricular cartilage for reliable assessment of tissue-engineered constructs. J Biomech 2015; 48:1721-9. [PMID: 26065333 DOI: 10.1016/j.jbiomech.2015.05.019] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2015] [Revised: 05/07/2015] [Accepted: 05/14/2015] [Indexed: 11/28/2022]
Abstract
It is key for successful auricular (AUR) cartilage tissue-engineering (TE) to ensure that the engineered cartilage mimics the mechanics of the native tissue. This study provides a spatial map of the mechanical and biochemical properties of human auricular cartilage, thus establishing a benchmark for the evaluation of functional competency in AUR cartilage TE. Stress-relaxation indentation (instantaneous modulus, Ein; maximum stress, σmax; equilibrium modulus, Eeq; relaxation half-life time, t1/2; thickness, h) and biochemical parameters (content of DNA; sulfated-glycosaminoglycan, sGAG; hydroxyproline, HYP; elastin, ELN) of fresh human AUR cartilage were evaluated. Samples were categorized into age groups and according to their harvesting region in the human auricle (for AUR cartilage only). AUR cartilage displayed significantly lower Ein, σmax, Eeq, sGAG content; and significantly higher t1/2, and DNA content than NAS cartilage. Large amounts of ELN were measured in AUR cartilage (>15% ELN content per sample wet mass). No effect of gender was observed for either auricular or nasoseptal samples. For auricular samples, significant differences between age groups for h, sGAG and HYP, and significant regional variations for Ein, σmax, Eeq, t1/2, h, DNA and sGAG were measured. However, only low correlations between mechanical and biochemical parameters were seen (R<0.44). In conclusion, this study established the first comprehensive mechanical and biochemical map of human auricular cartilage. Regional variations in mechanical and biochemical properties were demonstrated in the auricle. This finding highlights the importance of focusing future research on efforts to produce cartilage grafts with spatially tunable mechanics.
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Affiliation(s)
- Luc Nimeskern
- Institute for Biomechanics, ETH Zürich, Zürich, Switzerland
| | - Mieke M Pleumeekers
- Department of Otorhinolaryngology, Head and Neck Surgery, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | | | - Wendy L M Koevoet
- Department of Otorhinolaryngology, Head and Neck Surgery, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | | | - Michael B Soyka
- Department of Otorhinolaryngology and Head and Neck Surgery, University Hospital Zürich, Zürich, Switzerland
| | - Christof Röösli
- Department of Otorhinolaryngology and Head and Neck Surgery, University Hospital Zürich, Zürich, Switzerland
| | - David Holzmann
- Department of Otorhinolaryngology and Head and Neck Surgery, University Hospital Zürich, Zürich, Switzerland
| | - Gerjo J V M van Osch
- Department of Otorhinolaryngology, Head and Neck Surgery, Erasmus MC, University Medical Center, Rotterdam, The Netherlands; Department of Orthopaedics, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Ralph Müller
- Institute for Biomechanics, ETH Zürich, Zürich, Switzerland
| | - Kathryn S Stok
- Institute for Biomechanics, ETH Zürich, Zürich, Switzerland.
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Nimeskern L, Rotter N, van Osch GJ, Müller R, Stok KS. Response to Letter to the Editor Concerning “Quantitative Evaluation of Mechanical Properties in Tissue-Engineered Auricular Cartilage”. TISSUE ENGINEERING PART B-REVIEWS 2015; 21:244-5. [DOI: 10.1089/ten.teb.2014.0517] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Luc Nimeskern
- Institute for Biomechanics, ETH Zürich, Zürich, Switzerland
| | - Nicole Rotter
- Department of Otorhinolaryngology, Ulm University Medical Center, Ulm, Germany
| | - Gerjo J.V.M. van Osch
- Department of Otorhinolaryngology, University Medical Center Rotterdam, Rotterdam, The Netherlands
- Department of Orthopaedics, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Ralph Müller
- Institute for Biomechanics, ETH Zürich, Zürich, Switzerland
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Nimeskern L, van Osch GJ, Müller R, Stok KS. Quantitative Evaluation of Mechanical Properties in Tissue-Engineered Auricular Cartilage. TISSUE ENGINEERING PART B-REVIEWS 2014; 20:17-27. [DOI: 10.1089/ten.teb.2013.0117] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Affiliation(s)
- Luc Nimeskern
- Institute for Biomechanics, ETH Zurich, Zurich, Switzerland
| | - Gerjo J.V.M. van Osch
- Departments of Otorhinolaryngology and Orthopaedics, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Ralph Müller
- Institute for Biomechanics, ETH Zurich, Zurich, Switzerland
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Bichara DA, Pomerantseva I, Zhao X, Zhou L, Kulig KM, Tseng A, Kimura AM, Johnson MA, Vacanti JP, Randolph MA, Sundback CA. Successful creation of tissue-engineered autologous auricular cartilage in an immunocompetent large animal model. Tissue Eng Part A 2013; 20:303-12. [PMID: 23980800 DOI: 10.1089/ten.tea.2013.0150] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Tissue-engineered cartilage has historically been an attractive alternative treatment option for auricular reconstruction. However, the ability to reliably generate autologous auricular neocartilage in an immunocompetent preclinical model should first be established. The objectives of this study were to demonstrate engineered autologous auricular cartilage in the immunologically aggressive subcutaneous environment of an immunocompetent animal model, and to determine the impact of in vitro culture duration of chondrocyte-seeded constructs on the quality of neocartilage maturation in vivo. Auricular cartilage was harvested from eight adult sheep; chondrocytes were isolated, expanded in vitro, and seeded onto fibrous collagen scaffolds. Constructs were cultured in vitro for 2, 6, and 12 weeks, and then implanted autologously in sheep and in control nude mice for 6 and 12 weeks. Explanted tissue was stained with hematoxylin and eosin, safranin O, toluidine blue, collagen type II, and elastin. DNA and glycosaminoglycans (GAGs) were quantified. The quality of cartilage engineered in sheep decreased with prolonged in vitro culture time. Superior cartilage formation was demonstrated after 2 weeks of in vitro culture; the neocartilage quality improved with increased implantation time. In nude mice, neocartilage resembled native sheep auricular cartilage regardless of the in vitro culture length, with the exception of elastin expression. The DNA quantification was similar in all engineered and native cartilage (p>0.1). All cartilage engineered in sheep had significantly less GAG than native cartilage (p<0.02); significantly more GAG was observed with increased implantation time (p<0.02). In mice, the GAG content was similar to that of native cartilage and became significantly higher with increased in vitro or in vivo durations (p<0.02). Autologous auricular cartilage was successfully engineered in the subcutaneous environment of an ovine model using expanded chondrocytes seeded on a fibrous collagen scaffold after a 2-week in vitro culture period.
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Affiliation(s)
- David A Bichara
- 1 Plastic Surgery Research Laboratory, Massachusetts General Hospital , Boston, Massachusetts
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Josh F, Kobe K, Tobita M, Tanaka R, Suzuki K, Ono K, Hyakusoku H, Mizuno H. Accelerated and Safe Proliferation of Human Adipose-derived Stem Cells in Medium Supplemented with Human Serum. J NIPPON MED SCH 2012; 79:444-52. [DOI: 10.1272/jnms.79.444] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Fonny Josh
- Department of Plastic and Reconstructive Surgery, Juntendo University School of Medicine
| | - Kyoko Kobe
- Department of Plastic and Reconstructive Surgery, Nippon Medical School
| | - Morikuni Tobita
- Department of Plastic and Reconstructive Surgery, Juntendo University School of Medicine
| | - Rica Tanaka
- Department of Plastic and Reconstructive Surgery, Juntendo University School of Medicine
| | - Koji Suzuki
- R&D Central Research Laboratory, JMS Co. Ltd
| | - Kasumi Ono
- R&D Central Research Laboratory, JMS Co. Ltd
| | - Hiko Hyakusoku
- Department of Plastic and Reconstructive Surgery, Nippon Medical School
| | - Hiroshi Mizuno
- Department of Plastic and Reconstructive Surgery, Juntendo University School of Medicine
- Department of Plastic and Reconstructive Surgery, Nippon Medical School
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Bichara DA, O'Sullivan NA, Pomerantseva I, Zhao X, Sundback CA, Vacanti JP, Randolph MA. The tissue-engineered auricle: past, present, and future. TISSUE ENGINEERING PART B-REVIEWS 2011; 18:51-61. [PMID: 21827281 DOI: 10.1089/ten.teb.2011.0326] [Citation(s) in RCA: 102] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
The reconstruction, repair, and regeneration of the external auricular framework continue to be one of the greatest challenges in the field of tissue engineering. To replace like with like, we should emulate the native structure and composition of auricular cartilage by combining a suitable chondrogenic cell source with an appropriate scaffold under optimal in vitro and in vivo conditions. Due to the fact that a suitable and reliable substitute for auricular cartilage has yet to be engineered, hand-carved autologous costal cartilage grafts and ear-shaped porous polyethylene implants are the current treatment modalities for auricular reconstruction. However, over the last decade, significant advances have been made in the field of regenerative medicine and tissue engineering. A variety of scaffolds and innovative approaches have been investigated as alternatives to using autologous carved costal cartilage or porous polyethylene implants. A review of recent developments and the current state of the art and science is presented, focusing on scaffolds, cell sources, seeding densities, and mechanical characteristics of tissue-engineered auricular cartilage.
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Affiliation(s)
- David A Bichara
- Plastic Surgery Research Laboratory, Division of Plastic Surgery, Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts 02114, USA
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