1
|
Feng TM, Wei JM, Tan S, Chen LX, Liu GN. Involvement of PD-1 +CD4 + T cells in the development of traumatic tracheal stenosis by regulating the IL-17/STAT3 pathway. Biochim Biophys Acta Mol Basis Dis 2024; 1870:167216. [PMID: 38718843 DOI: 10.1016/j.bbadis.2024.167216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2023] [Revised: 04/30/2024] [Accepted: 04/30/2024] [Indexed: 05/18/2024]
Abstract
Studies have highlighted an upregulation of PD-1 expression in CD4+ T cells, which accelerates lung fibrosis by activating the IL-17/STAT3 pathway, leading to IL-17A and TGF-β1 secretion. However, the relation with traumatic tracheal stenosis (TS) remains unexplored. Our analysis found significant increases in PD-1+CD4+ T cells, IL-17A, and TGF-β1 in the TS patients (n = 10). The cellular model used CD4+ T cells co-cultured with bronchial fibroblasts while the animal model used a nylon brush to scrape the damaged tracheal mucosa. Interventions with PD-1 and STAT3 inhibitors both in vitro (n = 5) and in vivo (n = 6) showed decreased expression of TGF-β1 and IL-17A in CD4+ T cells, decreased collagen I synthesis in vitro, and reduced tractal fibrosis in vivo. Furthermore, PD-1's modulation of the STAT3 was evident. This research unveils PD-1+CD4+ T cells' role in TS, thus suggesting a novel immunotherapeutic strategy to counteract tracheal fibrosis.
Collapse
Affiliation(s)
- T M Feng
- Department of Respiratory Medicine, The Second Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - J M Wei
- Department of Respiratory Medicine, The Second Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - S Tan
- Department of Respiratory Medicine, The Second Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - L X Chen
- Department of Respiratory Medicine, The Second Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - G N Liu
- Department of Respiratory Medicine, The Second Affiliated Hospital of Guangxi Medical University, Nanning, China.
| |
Collapse
|
2
|
Thierry B, Arakelian L, Denoyelle F, Larghero J, Wurtz A. Full circumferential human tracheal replacement: a systematic review. Eur J Cardiothorac Surg 2024; 66:ezae269. [PMID: 38984816 DOI: 10.1093/ejcts/ezae269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2024] [Revised: 06/14/2024] [Accepted: 07/08/2024] [Indexed: 07/11/2024] Open
Abstract
Full Circumferential Tracheal Replacement (FCTR) is a surgical challenge, indicated in rare cases of extensive tracheal resection, with no consensus on surgical technique or materials. A systematic review according to PRISMA guidelines was carried out from 2000 to 2022 to identify cases of FCTR, to compare surgical indications, the nature of the tracheal substitutes and their immunological characteristics, surgical replacement techniques and vascularization. Thirty-seven patients, including five children, underwent FCTR surgery using 4 different techniques: thyrotracheal complex allograft (n = 2), aorta (n = 12), autologous surgical reconstruction (n = 19), tissue-engineered decellularized trachea (n = 4). The mean follow-up was 4 years. Of the 15 deceased patients, 10 died of the progression of the initial pathology. For the majority of the teams, particular care was given to the vascularization of the substitute, in order to guarantee long-term biointegration. This included either direct vascularization via vascular anastomosis, or an indirect technique involving envelopment of the avascular substitute in a richly vascularized tissue. Stent placement was standard, except for autologous surgical reconstructions where tracheal caliber was stable. Internal stents were frequently complicated by granulation and stenosis. Although epithelial coverage is essential to limit endoluminal proliferation and act as a barrier, fully functional ciliated airway epithelium did not seem to be necessary. In order to facilitate future comparisons, a standardized clinical trial, respecting regulatory constraints, including routine follow-up with tracheal biomechanics assessment and scheduled biopsies could be proposed. It would help collecting information such as dynamics and mechanisms of tracheal bio-integration and regeneration.
Collapse
Affiliation(s)
- Briac Thierry
- Department of Paediatric Otolaryngology - Head and Neck Surgery, Hôpital Universitaire Necker - Enfants Malades, Assistance Publique - Hôpitaux de Paris, Université Paris Cité, Paris, France
- Department of biotherapy clinical investigation, INSERM U976, Assistance Publique - Hôpitaux de Paris, Université Paris Cité, Paris, France
| | - Lousineh Arakelian
- Department of biotherapy clinical investigation, INSERM U976, Assistance Publique - Hôpitaux de Paris, Université Paris Cité, Paris, France
- Department of cell therapy, Hôpital St Louis, AP-HP, Paris, France
| | - Françoise Denoyelle
- Department of Paediatric Otolaryngology - Head and Neck Surgery, Hôpital Universitaire Necker - Enfants Malades, Assistance Publique - Hôpitaux de Paris, Université Paris Cité, Paris, France
| | - Jérôme Larghero
- Department of biotherapy clinical investigation, INSERM U976, Assistance Publique - Hôpitaux de Paris, Université Paris Cité, Paris, France
- Department of cell therapy, Hôpital St Louis, AP-HP, Paris, France
| | - Alain Wurtz
- Emis Platform, Limoges University Hospital, Limoges, France
| |
Collapse
|
3
|
Laitman BM, Cruz-Encarnacion P, Gordon RE, Genden EM. Case Report: Human Tracheal Transplantation Undergoes Progressive Reepithelialization Over Time. Laryngoscope 2024; 134:2664-2671. [PMID: 37975487 DOI: 10.1002/lary.31170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 06/29/2023] [Accepted: 07/18/2023] [Indexed: 11/19/2023]
Abstract
OBJECTIVES Tracheal transplantation is an ideal option for the reconstruction of long-segment circumferential tracheal defects. Our group performed the first successful vascularized single-staged tracheal transplantation in January 2021. Although a rigid biocompatible structure is necessary for a functioning tracheal replacement, the importance of ciliated epithelium, which allows for critical mucociliary clearance, is now being appreciated. Here, we examined the histological changes of the first single-staged human tracheal transplant from serial endoscopic biopsies. METHODS Biopsies of the tracheal mucosa were serially obtained since the time of the tracheal transplantation. Samples were examined via hematoxylin and eosin, electron microscopy, and immunohistochemistry. RESULTS One week after transplantation, there is loss of ciliated epithelium and seromucinous cells, with only a basal layer of epithelium remaining. By 2 weeks, however, the epithelium begins to recover, albeit differently depending on the location of the biopsy. Near the site of tracheal anastomosis, there is epithelial proliferation, with the appearance of early ciliated cells. However, in the midgraft, there appears to be evidence of squamous metaplasia. Over time, however, normal ciliated epithelium and mucous cells appear without signs of chronic inflammation. CONCLUSIONS Critically, the tracheal allograft regained normal appearing respiratory epithelium after initial ischemic injury. The histologic differences at the midgraft versus anastomosis may suggest unique mechanisms of reepithelialization. At the recipient-donor interface, there may be a faster direct migration of recipient-derived epithelial cells, in line with preclinical studies. The midgraft, in contrast, responds with epithelial proliferation from the donor basal cells or dedifferentiated mucous cells. LEVEL OF EVIDENCE N/A Laryngoscope, 134:2664-2671, 2024.
Collapse
Affiliation(s)
- Benjamin M Laitman
- Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, U.S.A
| | - Pamela Cruz-Encarnacion
- Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, U.S.A
| | - Ronald E Gordon
- Department of Pathology, Icahn School of Medicine at Mount Sinai, New York, New York, U.S.A
| | - Eric M Genden
- Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, U.S.A
| |
Collapse
|
4
|
Zhu J, Lu Y, Shan Y, Yuan L, Wu Q, Shen Z, Sun F, Shi H. Global Bibliometric and Visualized Analysis of Tracheal Tissue Engineering Research. TISSUE ENGINEERING. PART B, REVIEWS 2024; 30:198-216. [PMID: 37658839 DOI: 10.1089/ten.teb.2023.0129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/05/2023]
Abstract
The development of tracheal tissue engineering (TTE) has seen a rapid growth in recent years. The purpose of this study was to investigate the global status, trends, and hotspots of TTE research based on bibliometrics and visualization analysis. Publications related to TTE were retrieved and included in the Web of Science Core Collection. VOSviewer and CiteSpace were used to generate knowledge maps. Six hundred fifty-five publications were identified, and the quantity of the annual publications worldwide was on the increase. International collaboration is a widespread reality. The United States led the world in the field of trachea tissue engineering, whereas University College London was the institution with the greatest contribution. In addition, Biomaterials had a great influence in this field, attracting the largest number of papers. Moreover, the topics of TTE research largely concentrated on the biomechanical scaffold preparation, the vascularization and epithelialization of scaffold, the tracheal cartilage regeneration, and the tissue-engineered tracheal transplantation. And the research on the application of decellularization and 3D printing for the construction of a tissue-engineered trachea was likely to receive more widespread attention in the future. Impact statement In recent years, tracheal tissue engineering (TTE) has experienced rapid growth. In this study, we investigated the worldwide status and trends of TTE research, and revealed the countries, institutions, journals, and authors that had made significant contributions to the field of TTE. Moreover, the possible research hotspots in the future were predicted. According to our research, researchers can gain a better understanding of the trends in this field, and stay informed of the most current research by tracking key journals, institutions, and authors.
Collapse
Affiliation(s)
- Jianwei Zhu
- Clinical Medical College, Yangzhou University, Yangzhou, China
- Institute of Translational Medicine, Medical College, Yangzhou University, Yangzhou, China
- Jiangsu Key Laboratory of Integrated Traditional Chinese and Western Medicine for Prevention and Treatment of Senile Diseases, Yangzhou University, Yangzhou, China
| | - Yi Lu
- Clinical Medical College, Yangzhou University, Yangzhou, China
- Institute of Translational Medicine, Medical College, Yangzhou University, Yangzhou, China
- Jiangsu Key Laboratory of Integrated Traditional Chinese and Western Medicine for Prevention and Treatment of Senile Diseases, Yangzhou University, Yangzhou, China
| | - Yibo Shan
- Clinical Medical College, Yangzhou University, Yangzhou, China
- Institute of Translational Medicine, Medical College, Yangzhou University, Yangzhou, China
- Jiangsu Key Laboratory of Integrated Traditional Chinese and Western Medicine for Prevention and Treatment of Senile Diseases, Yangzhou University, Yangzhou, China
| | - Lei Yuan
- Clinical Medical College, Yangzhou University, Yangzhou, China
- Institute of Translational Medicine, Medical College, Yangzhou University, Yangzhou, China
- Jiangsu Key Laboratory of Integrated Traditional Chinese and Western Medicine for Prevention and Treatment of Senile Diseases, Yangzhou University, Yangzhou, China
| | - Qiang Wu
- Clinical Medical College, Yangzhou University, Yangzhou, China
- Jiangsu Key Laboratory of Integrated Traditional Chinese and Western Medicine for Prevention and Treatment of Senile Diseases, Yangzhou University, Yangzhou, China
- The Second Xiangya Hospital, Central South University, Changsha, China
| | - Zhiming Shen
- Clinical Medical College, Yangzhou University, Yangzhou, China
- Institute of Translational Medicine, Medical College, Yangzhou University, Yangzhou, China
- Jiangsu Key Laboratory of Integrated Traditional Chinese and Western Medicine for Prevention and Treatment of Senile Diseases, Yangzhou University, Yangzhou, China
| | - Fei Sun
- Clinical Medical College, Yangzhou University, Yangzhou, China
- Institute of Translational Medicine, Medical College, Yangzhou University, Yangzhou, China
- Jiangsu Key Laboratory of Integrated Traditional Chinese and Western Medicine for Prevention and Treatment of Senile Diseases, Yangzhou University, Yangzhou, China
| | - Hongcan Shi
- Clinical Medical College, Yangzhou University, Yangzhou, China
- Institute of Translational Medicine, Medical College, Yangzhou University, Yangzhou, China
- Jiangsu Key Laboratory of Integrated Traditional Chinese and Western Medicine for Prevention and Treatment of Senile Diseases, Yangzhou University, Yangzhou, China
- The Second Xiangya Hospital, Central South University, Changsha, China
| |
Collapse
|
5
|
Tseng WH, Liu EW, Cheng KY, Wee SJ, Lee JJ, Chen HC. Tracheal Replacement Techniques and Associated Mortality: A Systematic Review. Laryngoscope 2024; 134:1517-1522. [PMID: 37916766 DOI: 10.1002/lary.31100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2023] [Revised: 09/18/2023] [Accepted: 09/22/2023] [Indexed: 11/03/2023]
Abstract
OBJECTIVE Tracheal replacement is a crucial operation to enhance the quality of life for patients with extensive tracheal lesions. The most suitable surgical techniques for different clinical conditions remain a topic of debate. Through a reviewing of the relevant literature, this study investigated the association between surgical techniques and mortality rate. DATA SOURCES Studies were collected from PubMed, Embase, the Web of Science, the Cochrane Center Register of Controlled Trials, and ClinicalTrials.gov. METHODS This systematic review encompassed literature from the inception of each database to May 10, 2023, focusing on tracheal replacement for patients who underwent circumferential resection of the trachea or partial resection with preservation of the posterior membranous wall. Non-human and non-clinical studies were excluded. RESULTS About 31 studies were included in the assessment comprising a combination of case reports and case series, and 118 patients underwent tracheal replacement through four underlying methodologies, including tracheal allotransplantation, autologous tissue reconstruction, bioprosthetic reconstruction, or tissue engineering surgery. Each modality exhibits unique advantages and disadvantages, leading to variable outcomes in clinical application. CONCLUSION Tracheal replacement is challenging due to the absence of an ideal substitution or graft material. Despite limited clinical successes observed across various modalities, we believe autologous tissue reconstruction for tracheal replacement has the advantage of broadest indications, low rejection rate, and avoidance of immunosuppressive agents. Future research should focus on achieving tracheal replacement that preserves mucociliary clearance, lateral rigidity, and longitudinal flexibility. LEVEL OF EVIDENCE NA Laryngoscope, 134:1517-1522, 2024.
Collapse
Affiliation(s)
- Wen-Hui Tseng
- Department of Plastic and Reconstructive Surgery, China Medical University Hospital, Taichung City, Taiwan
| | - En-Wei Liu
- Department of Plastic and Reconstructive Surgery, China Medical University Hospital, Taichung City, Taiwan
| | - Kai-Yuan Cheng
- Department of Plastic and Reconstructive Surgery, China Medical University Hospital, Taichung City, Taiwan
| | - Shyun-Jing Wee
- Department of Plastic and Reconstructive Surgery, China Medical University Hospital, Taichung City, Taiwan
| | - Jian-Jr Lee
- Department of Plastic and Reconstructive Surgery, China Medical University Hospital, Taichung City, Taiwan
- College of Medicine, China Medical University, Taichung City, Taiwan
| | - Hung-Chi Chen
- Department of Plastic and Reconstructive Surgery, China Medical University Hospital, Taichung City, Taiwan
- College of Medicine, China Medical University, Taichung City, Taiwan
| |
Collapse
|
6
|
Kreber L, Liu L, Dharmadhikari S, Tan ZH, Chan C, Huddle J, Hussein Z, Shontz K, Breuer CK, Johnson J, Chiang T. Assessing the Biocompatibility and Regeneration of Electrospun-Nanofiber Composite Tracheal Grafts. Laryngoscope 2024; 134:1155-1162. [PMID: 37578209 PMCID: PMC10864676 DOI: 10.1002/lary.30955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 07/25/2023] [Accepted: 07/26/2023] [Indexed: 08/15/2023]
Abstract
OBJECTIVE Composite tracheal grafts (CTG) combining decellularized scaffolds with external biomaterial support have been shown to support host-derived neotissue formation. In this study, we examine the biocompatibility, graft epithelialization, vascularization, and patency of three prototype CTG using a mouse microsurgical model. STUDY DESIGN Tracheal replacement, regenerative medicine, biocompatible airway splints, animal model. METHOD CTG electrospun splints made by combining partially decellularized tracheal grafts (PDTG) with polyglycolic acid (PGA), poly(lactide-co-ε-caprolactone) (PLCL), or PLCL/PGA were orthotopically implanted in mice (N = 10/group). Tracheas were explanted two weeks post-implantation. Micro-Computed Tomography was conducted to assess for graft patency, and histological analysis was used to assess for epithelialization and neovascularization. RESULT Most animals (greater than 80%) survived until the planned endpoint and did not exhibit respiratory symptoms. MicroCT confirmed the preservation of graft patency. Grossly, the PDTG component of CTG remained intact. Examining the electrospun component of CTG, PGA degraded significantly, while PLCL+PDTG and PLCL/PGA + PDTG maintained their structure. Microvasculature was observed across the surface of CTG and infiltrating the pores. There were no signs of excessive cellular infiltration or encapsulation. Graft microvasculature and epithelium appear similar in all groups, suggesting that CTG did not hinder endothelialization and epithelialization. CONCLUSION We found that all electrospun nanofiber CTGs are biocompatible and did not affect graft patency, endothelialization and epithelialization. Future directions will explore methods to accelerate graft regeneration of CTG. LEVEL OF EVIDENCE N/A Laryngoscope, 134:1155-1162, 2024.
Collapse
Affiliation(s)
- Lily Kreber
- College of Medicine, the Ohio State University, Columbus, OH, USA
| | - Lumei Liu
- Center of Regenerative Medicine, Abigail Wexner Research Institute, Nationwide Children’s Hospital, Columbus, OH, USA
| | - Sayali Dharmadhikari
- Center of Regenerative Medicine, Abigail Wexner Research Institute, Nationwide Children’s Hospital, Columbus, OH, USA
- College of Medicine, the Ohio State University, Columbus, OH, USA
| | - Zheng Hong Tan
- College of Medicine, the Ohio State University, Columbus, OH, USA
- Department of Pediatric Otolaryngology, Nationwide Children’s Hospital, Columbus, OH, USA
| | - Coreena Chan
- College of Medicine, the Ohio State University, Columbus, OH, USA
| | | | - Zakarie Hussein
- College of Medicine, the Ohio State University, Columbus, OH, USA
| | - Kimberly Shontz
- Center of Regenerative Medicine, Abigail Wexner Research Institute, Nationwide Children’s Hospital, Columbus, OH, USA
| | - Christopher K. Breuer
- Center of Regenerative Medicine, Abigail Wexner Research Institute, Nationwide Children’s Hospital, Columbus, OH, USA
- Department of Pediatric Surgery, Nationwide Children’s Hospital, Columbus, OH, USA
| | | | - Tendy Chiang
- Center of Regenerative Medicine, Abigail Wexner Research Institute, Nationwide Children’s Hospital, Columbus, OH, USA
- College of Medicine, the Ohio State University, Columbus, OH, USA
- Department of Pediatric Otolaryngology, Nationwide Children’s Hospital, Columbus, OH, USA
| |
Collapse
|
7
|
Mammana M, Bonis A, Verzeletti V, Dell'Amore A, Rea F. Tracheal Tissue Engineering: Principles and State of the Art. Bioengineering (Basel) 2024; 11:198. [PMID: 38391684 PMCID: PMC10886658 DOI: 10.3390/bioengineering11020198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Revised: 02/16/2024] [Accepted: 02/17/2024] [Indexed: 02/24/2024] Open
Abstract
Patients affected by long-segment tracheal defects or stenoses represent an unsolved surgical issue, since they cannot be treated with the conventional surgery of tracheal resection and consequent anastomosis. Hence, different strategies for tracheal replacement have been proposed (synthetic materials, aortic allografts, transplantation, autologous tissue composites, and tissue engineering), each with advantages and drawbacks. Tracheal tissue engineering, on the other hand, aims at recreating a fully functional tracheal substitute, without the need for the patient to receive lifelong immunosuppression or endotracheal stents. Tissue engineering approaches involve the use of a scaffold, stem cells, and humoral signals. This paper reviews the main aspects of tracheal TE, starting from the choice of the scaffold to the type of stem cells that can be used to seed the scaffold, the methods for their culture and expansion, the issue of graft revascularization at the moment of in vivo implantation, and experimental models of tracheal research. Moreover, a critical insight on the state of the art of tracheal tissue engineering is also presented.
Collapse
Affiliation(s)
- Marco Mammana
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, 35128 Padua, Italy
| | - Alessandro Bonis
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, 35128 Padua, Italy
| | - Vincenzo Verzeletti
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, 35128 Padua, Italy
| | - Andrea Dell'Amore
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, 35128 Padua, Italy
| | - Federico Rea
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, 35128 Padua, Italy
| |
Collapse
|
8
|
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.
Collapse
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
| |
Collapse
|
9
|
Brusis T. [The first allogenic tracheal transplantation in humans 45 years ago : Procedure, course, and outcome]. HNO 2023; 71:763-766. [PMID: 37819274 DOI: 10.1007/s00106-023-01374-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/21/2023] [Indexed: 10/13/2023]
Abstract
In November/December 1978, the first successful tracheal transplantation in humans was performed at the University ENT Clinic in Cologne by the then senior physicians Kurt G. Rose (later chief physician in Dortmund) and Klaus Sesterhenn (later chief physician in Duisburg). Director of the clinic at that time was Prof. Dr. Dr. Fritz Wustrow [10]. The immunological foundations and preliminary work were laid by Sesterhenn in the context of a total of 338 tracheal transplants in Lewis rats in the 1970s (details in the text). The first successful tracheal transplantation was performed on 18 November 1978 in a, then 19-year-old patient who had previously had a motorcycle accident. The donor organ was explanted in the University Hospital Essen and transplanted about 160 min later in the Cologne University ENT Clinic, first into a pocket of the right sternocleidomastoid muscle. The definitive transplantation took place on 06 December 1978. In the article, the circumstances at that time and the perioperative course in the Cologne University ENT Clinic are described by an eyewitness. The former patient is still well and without complications after more than four decades.
Collapse
|
10
|
Nyirjesy SC, Yu J, Dharmadhikari S, Liu L, Bergman M, Tan ZH, VanKoevering KK, Chiang T. Successful Early Neovascularization in Composite Tracheal Grafts. Otolaryngol Head Neck Surg 2023; 169:1035-1040. [PMID: 37036314 PMCID: PMC10524236 DOI: 10.1002/ohn.350] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 03/06/2023] [Accepted: 03/23/2023] [Indexed: 04/11/2023]
Abstract
OBJECTIVE Long-segment tracheal defects require tissue replacement for successful reconstruction. Rapid revascularization is imperative to maintain graft function. We previously showed that partially decellularized tracheal grafts (PDTG) and composite tracheal grafts (CTG; PDTG supported by a 3-dimensionally printed external splint) regenerate respiratory epithelium and may support the regeneration of endothelial cells (CD31+). However, the capability of graft endothelial cells to organize or contribute to tracheal revascularization remains unclear. In this study, we quantified endothelial cells (CD31+) and neovessel formation in PDTG and CTG. We hypothesize that PDTG and CTG support tracheal neovascularization to a similar extent as surgical (syngeneic tracheal graft [STG]) and native trachea (NT) controls. STUDY DESIGN The animal study, a randomized control trial. SETTING Center for Regenerative Medicine, Nationwide Children's Hospital. METHODS PDTG was created via an established decellularization protocol. Segmental tracheal reconstruction was performed with STG, PDTG, or CTG using a mouse microsurgical model. NT was used as a nonsurgical control. At 1 month, mice were euthanized, grafts harvested, sectioned, and stained with CD31 and hematoxylin and eosin. Neovessel formation was quantified by the number of formed blood vessels in the lamina propria and vessel size (vessel/graft area, mm2 ). RESULTS Decellularization eliminated all endothelial cells and there were no perfused vessels at implantation. At 1 month, PDTG and CTG supported neovessel formation with tubular vessels lined with endothelial cells. There was no difference in the number or size of vessels compared to controls. CONCLUSION PDTG and CTG support tracheal endothelial cell regeneration and neovessel formation. Future directions to assess the function, kinetics, and distribution of graft neovessels are needed.
Collapse
Affiliation(s)
- Sarah C. Nyirjesy
- Department of Otolaryngology-Head & Neck Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Jane Yu
- Department of Otolaryngology-Head & Neck Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Sayali Dharmadhikari
- Center of Regenerative Medicine, Abigail Wexner Research Institute, Nationwide Children’s Hospital, Columbus, Ohio, USA
| | - Lumei Liu
- Center of Regenerative Medicine, Abigail Wexner Research Institute, Nationwide Children’s Hospital, Columbus, Ohio, USA
| | - Maxwell Bergman
- Department of Otolaryngology-Head & Neck Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Zheng Hong Tan
- Center of Regenerative Medicine, Abigail Wexner Research Institute, Nationwide Children’s Hospital, Columbus, Ohio, USA
| | - Kyle K. VanKoevering
- Department of Otolaryngology-Head & Neck Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Tendy Chiang
- Department of Otolaryngology-Head & Neck Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
- Center of Regenerative Medicine, Abigail Wexner Research Institute, Nationwide Children’s Hospital, Columbus, Ohio, USA
- Department of Pediatric Otolaryngology, Nationwide Children’s Hospital, Columbus, Ohio, USA
| |
Collapse
|
11
|
Feng T, Chen Y, Wei J, Tan S, Guangnan L. Distribution and chemotactic mechanism of CD4 + T cells in traumatic tracheal stenosis. Immun Inflamm Dis 2023; 11:e916. [PMID: 37647429 PMCID: PMC10411395 DOI: 10.1002/iid3.916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Revised: 05/31/2023] [Accepted: 06/01/2023] [Indexed: 09/01/2023] Open
Abstract
A systemic and local inflammatory immune imbalance is thought to be the cause of traumatic tracheal stenosis (TS). However, with CD4+ T lymphocytes being the predominant immune cells in TS, the mechanism of action and recruitment has not been described. In our research, using flow cytometry, ELISA, immunofluorescence, and Transwell chamber assays, the expression, distribution, and potential chemotactic function of CD4+ T cells in TS patients were examined before and after treatment. The results showed that the untreated group had significantly more CD4+ T cells and their secreted TGF-β1 than the treated group. Additionally, the untreated group's CD4+ T cells showed a significant rise in CCL22 and CCL1, as well as a larger proportion of CCR4 and CCR8. CD4+ T cells and CD68+ macrophages located in TS also expressed CCL1 and CCL22. In vitro, anti-CCL1 and anti-CCL22 can partially block the chemoattractant effect of TS bronchoalveolar lavage (BAL) on purified CD4+ T cells. The findings of this study indicated that TS contained unbalanced CD4 immune cells that were actively recruited locally by CCR4/CCL22 and CCR8/CCL1. As a result, it is anticipated that CD4 immune rebalancing can serve as a novel treatment for TS.
Collapse
Affiliation(s)
- Tingmei Feng
- Guangxi Medical UniversityNanningChina
- Department of Respiratory MedicineThe Second Affiliated Hospital of Guangxi Medical UniversityNanningChina
| | - Yan Chen
- Department of Respiratory MedicineThe Second Affiliated Hospital of Guangxi Medical UniversityNanningChina
| | - Jinmei Wei
- Department of Respiratory MedicineThe Second Affiliated Hospital of Guangxi Medical UniversityNanningChina
| | - Sen Tan
- Department of Respiratory MedicineThe Second Affiliated Hospital of Guangxi Medical UniversityNanningChina
| | - Liu Guangnan
- Department of Respiratory MedicineThe Second Affiliated Hospital of Guangxi Medical UniversityNanningChina
| |
Collapse
|
12
|
Abstract
Long-segment tracheal airway defects may be congenital or result from burns, trauma, iatrogenic intubation damage, or tumor invasion. Although airway defects <6 cm in length may be reconstructed using existing end-to-end reconstructive techniques, defects >6 cm continue to challenge surgeons worldwide. The reconstruction of long-segment tracheal defects has long been a reconstructive dilemma, and these defects are associated with significant morbidity and mortality. Many of these defects are not compatible with life or require a permanent extended-length tracheostomy that is fraught with complications including mucus plugging and tracheoesophageal fistula. Extensive circumferential tracheal defects require a reconstructive technique that provides a rigid structure able to withstand the inspiratory pressures, a structure that will biologically integrate, and contain functional ciliated epithelium to allow for normal mucociliary clearance. Tracheal transplantation has been considered the reconstructive "Holy Grail;" however, there has been a long-held scientific dogma that revascularization of the trachea was not possible. This dogma stifled research to achieve single-staged vascularized tracheal transplantation and prompted the introduction of many creative and inventive alternatives. Throughout history, alloplastic material, nonvascularized allografts, and homografts have been used to address this dilemma. However, these techniques have largely been unsuccessful. The recent introduction of a technique for single-staged vascularized tracheal transplantation may offer a solution to this dilemma and potentially a solution to management of the fatal tracheoesophageal fistula.
Collapse
Affiliation(s)
- Eric M Genden
- Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, NY
| | | |
Collapse
|
13
|
Sun F, Shen Z, Zhang B, Lu Y, Shan Y, Wu Q, Yuan L, Zhu J, Pan S, Wang Z, Wu C, Zhang G, Yang W, Xu X, Shi H. Biomimetic in situ tracheal microvascularization for segmental tracheal reconstruction in one-step. Bioeng Transl Med 2023; 8:e10534. [PMID: 37476057 PMCID: PMC10354772 DOI: 10.1002/btm2.10534] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Revised: 04/04/2023] [Accepted: 04/12/2023] [Indexed: 07/22/2023] Open
Abstract
Formation of functional and perfusable vascular network is critical to ensure the long-term survival and functionality of the engineered tissue tracheae after transplantation. However, the greatest challenge in tracheal-replacement therapy is the promotion of tissue regeneration by rapid graft vascularization. Traditional prevascularization methods for tracheal grafts typically utilize omentum or muscle flap wrapping, which requires a second operation; vascularized segment tracheal orthotopic transplantation in one step remains difficult. This study proposes a method to construct a tissue-engineered tracheal graft, which directly forms the microvascular network after orthotopic transplantation in vivo. The focus of this study was the preparation of a hybrid tracheal graft that is non-immunogenic, has good biomechanical properties, supports cell proliferation, and quickly vascularizes. The results showed that vacuum-assisted decellularized trachea-polycaprolactone hybrid scaffold could match most of the above requirements as closely as possible. Furthermore, endothelial progenitor cells (EPCs) were extracted and used as vascularized seed cells and seeded on the surfaces of hybrid grafts before and during the tracheal orthotopic transplantation. The results showed that the microvascularized tracheal grafts formed maintained the survival of the recipient, showing a satisfactory therapeutic outcome. This is the first study to utilize EPCs for microvascular construction of long-segment trachea in one-step; the approach represents a promising method for microvascular tracheal reconstruction.
Collapse
Affiliation(s)
- Fei Sun
- Clinical Medical CollegeYangzhou UniversityYangzhouChina
- Institute of Translational Medicine, Medical CollegeYangzhou UniversityYangzhouChina
- Jiangsu Key Laboratory of Integrated Traditional Chinese and Western Medicine for Prevention and Treatment of Senile DiseasesYangzhou UniversityYangzhouChina
| | - Zhiming Shen
- Clinical Medical CollegeYangzhou UniversityYangzhouChina
- Institute of Translational Medicine, Medical CollegeYangzhou UniversityYangzhouChina
- Jiangsu Key Laboratory of Integrated Traditional Chinese and Western Medicine for Prevention and Treatment of Senile DiseasesYangzhou UniversityYangzhouChina
| | - Boyou Zhang
- Institute of Translational Medicine, Medical CollegeYangzhou UniversityYangzhouChina
- Jiangsu Key Laboratory of Integrated Traditional Chinese and Western Medicine for Prevention and Treatment of Senile DiseasesYangzhou UniversityYangzhouChina
| | - Yi Lu
- Clinical Medical CollegeYangzhou UniversityYangzhouChina
- Institute of Translational Medicine, Medical CollegeYangzhou UniversityYangzhouChina
- Jiangsu Key Laboratory of Integrated Traditional Chinese and Western Medicine for Prevention and Treatment of Senile DiseasesYangzhou UniversityYangzhouChina
| | - Yibo Shan
- Clinical Medical CollegeYangzhou UniversityYangzhouChina
- Institute of Translational Medicine, Medical CollegeYangzhou UniversityYangzhouChina
- Jiangsu Key Laboratory of Integrated Traditional Chinese and Western Medicine for Prevention and Treatment of Senile DiseasesYangzhou UniversityYangzhouChina
| | - Qiang Wu
- Clinical Medical CollegeYangzhou UniversityYangzhouChina
- Institute of Translational Medicine, Medical CollegeYangzhou UniversityYangzhouChina
- Jiangsu Key Laboratory of Integrated Traditional Chinese and Western Medicine for Prevention and Treatment of Senile DiseasesYangzhou UniversityYangzhouChina
| | - Lei Yuan
- Clinical Medical CollegeYangzhou UniversityYangzhouChina
- Institute of Translational Medicine, Medical CollegeYangzhou UniversityYangzhouChina
- Jiangsu Key Laboratory of Integrated Traditional Chinese and Western Medicine for Prevention and Treatment of Senile DiseasesYangzhou UniversityYangzhouChina
| | - Jianwei Zhu
- Clinical Medical CollegeYangzhou UniversityYangzhouChina
- Institute of Translational Medicine, Medical CollegeYangzhou UniversityYangzhouChina
- Jiangsu Key Laboratory of Integrated Traditional Chinese and Western Medicine for Prevention and Treatment of Senile DiseasesYangzhou UniversityYangzhouChina
| | - Shu Pan
- Department of Thoracic SurgeryThe First Affiliated Hospital of Soochow UniversitySuzhouChina
| | - Zhihao Wang
- Institute of Translational Medicine, Medical CollegeYangzhou UniversityYangzhouChina
- Jiangsu Key Laboratory of Integrated Traditional Chinese and Western Medicine for Prevention and Treatment of Senile DiseasesYangzhou UniversityYangzhouChina
| | - Cong Wu
- Institute of Translational Medicine, Medical CollegeYangzhou UniversityYangzhouChina
- Jiangsu Key Laboratory of Integrated Traditional Chinese and Western Medicine for Prevention and Treatment of Senile DiseasesYangzhou UniversityYangzhouChina
| | - Guozhong Zhang
- Clinical Medical CollegeYangzhou UniversityYangzhouChina
| | - Wenlong Yang
- Clinical Medical CollegeYangzhou UniversityYangzhouChina
| | - Xiangyu Xu
- Institute of Translational Medicine, Medical CollegeYangzhou UniversityYangzhouChina
- Jiangsu Key Laboratory of Integrated Traditional Chinese and Western Medicine for Prevention and Treatment of Senile DiseasesYangzhou UniversityYangzhouChina
| | - Hongcan Shi
- Clinical Medical CollegeYangzhou UniversityYangzhouChina
- Institute of Translational Medicine, Medical CollegeYangzhou UniversityYangzhouChina
- Jiangsu Key Laboratory of Integrated Traditional Chinese and Western Medicine for Prevention and Treatment of Senile DiseasesYangzhou UniversityYangzhouChina
| |
Collapse
|
14
|
Pai AC, Swatek AM, Lynch TJ, Ahlers BA, Ievlev V, Engelhardt JF, Parekh KR. Orthotopic Ferret Tracheal Transplantation Using a Recellularized Bioengineered Graft Produces Functional Epithelia. Bioengineering (Basel) 2023; 10:777. [PMID: 37508804 PMCID: PMC10376427 DOI: 10.3390/bioengineering10070777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 06/22/2023] [Accepted: 06/28/2023] [Indexed: 07/30/2023] Open
Abstract
Tracheal grafts may be necessary to bridge long-segment defects after curative resection for airway obstructions. Bioengineered grafts have emerged as an appealing option, given the possibilities of altering the histologic and cellular profile of the conduit. We previously designed a bioreactor capable of luminally decellularizing and recellularizing a ferret trachea with surface airway epithelia (SAE) basal cells (BCs), and we sought to assess the fate of these grafts when transplanted in an orthotopic fashion. As adjuncts to the procedure, we investigated the use of a vascular endothelial growth factor (VEGF)-laden hydrogel and of immunosuppression (IS) in graft revascularization and viability. IS was shown to limit early graft revascularization, but this effect could be counteracted with VEGF supplementation. Submucosal gland (SMG) loss was shown to be inevitable regardless of the revascularization strategy. Lastly, the bioengineered tracheas survived one month after transplant with differentiation of our implanted BCs that then transitioned into a recipient-derived functional epithelium. The work presented in this manuscript has important implications for future cellular and regenerative therapies.
Collapse
Affiliation(s)
- Albert C. Pai
- Department of Cardiothoracic Surgery, University of Iowa Hospitals and Clinics, Iowa City, IA 52242, USA; (A.C.P.); (A.M.S.)
| | - Anthony M. Swatek
- Department of Cardiothoracic Surgery, University of Iowa Hospitals and Clinics, Iowa City, IA 52242, USA; (A.C.P.); (A.M.S.)
| | - Thomas J. Lynch
- Department of Anatomy and Cell Biology, University of Iowa, Iowa City, IA 52242, USA; (T.J.L.); (B.A.A.); (V.I.); (J.F.E.)
| | - Bethany A. Ahlers
- Department of Anatomy and Cell Biology, University of Iowa, Iowa City, IA 52242, USA; (T.J.L.); (B.A.A.); (V.I.); (J.F.E.)
| | - Vitaly Ievlev
- Department of Anatomy and Cell Biology, University of Iowa, Iowa City, IA 52242, USA; (T.J.L.); (B.A.A.); (V.I.); (J.F.E.)
| | - John F. Engelhardt
- Department of Anatomy and Cell Biology, University of Iowa, Iowa City, IA 52242, USA; (T.J.L.); (B.A.A.); (V.I.); (J.F.E.)
| | - Kalpaj R. Parekh
- Department of Cardiothoracic Surgery, University of Iowa Hospitals and Clinics, Iowa City, IA 52242, USA; (A.C.P.); (A.M.S.)
| |
Collapse
|
15
|
Perryman MC, Kraft SM, Kavookjian HL. Laryngotracheal Reconstruction for Subglottic and Tracheal Stenosis. Otolaryngol Clin North Am 2023:S0030-6665(23)00075-0. [PMID: 37268515 DOI: 10.1016/j.otc.2023.04.018] [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: 06/04/2023]
Abstract
Laryngotracheal stenosis is the common endpoint for any process that results in the narrowing of the airway at the level of the glottis, subglottis, or trachea. Although endoscopic procedures are effective in opening the airway lumen, open resection and reconstruction can be necessary to reconstitute a functional airway. When resection and anastomosis are insufficient due to extensive length or location of the stenosis, autologous grafts can be used to expand the airway. Future directions in airway reconstruction include tissue engineering and allotransplantation.
Collapse
Affiliation(s)
- Mollie C Perryman
- Department of Otolaryngology-Head & Neck Surgery, University of Kansas, The University of Kansas Medical Center, 3901 Rainbow Boulevard, MS 3010, Kansas City, KS 66160, USA
| | - Shannon M Kraft
- Department of Otolaryngology-Head & Neck Surgery, University of Kansas, The University of Kansas Medical Center, 3901 Rainbow Boulevard, MS 3010, Kansas City, KS 66160, USA
| | - Hannah L Kavookjian
- Department of Otolaryngology-Head & Neck Surgery, University of Kansas, The University of Kansas Medical Center, 3901 Rainbow Boulevard, MS 3010, Kansas City, KS 66160, USA.
| |
Collapse
|
16
|
Rendina EA, Patterson GA. Tracheal replacement: A never-ending search. Am J Transplant 2022; 22:2721-2722. [PMID: 35986710 DOI: 10.1111/ajt.17179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 08/15/2022] [Accepted: 08/17/2022] [Indexed: 01/25/2023]
Affiliation(s)
- Erino A Rendina
- Sapienza University of Rome, Sant'Andrea Hospital, Rome, Italy
| | - G Alexander Patterson
- Division of Cardiothoracic Surgery, Washington University School of Medicine, St Louis, Missouri, USA
| |
Collapse
|
17
|
Martinod E, Radu DM, Onorati I, Portela AMS, Peretti M, Guiraudet P, Destable MD, Uzunhan Y, Freynet O, Chouahnia K, Duchemann B, Kabbani J, Maurer C, Brillet PY, Fath L, Brenet E, Debry C, Buffet C, Leenhardt L, Clero D, Julien N, Vénissac N, Tronc F, Dutau H, Marquette CH, Juvin C, Lebreton G, Cohen Y, Zogheib E, Beloucif S, Planès C, Trésallet C, Bensidhoum M, Petite H, Rouard H, Miyara M, Vicaut E. Airway replacement using stented aortic matrices: Long-term follow-up and results of the TRITON-01 study in 35 adult patients. Am J Transplant 2022; 22:2961-2970. [PMID: 35778956 DOI: 10.1111/ajt.17137] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 06/14/2022] [Accepted: 06/23/2022] [Indexed: 01/25/2023]
Abstract
Over the past 25 years, we have demonstrated the feasibility of airway bioengineering using stented aortic matrices experimentally then in a first-in-human trial (n = 13). The present TRITON-01 study analyzed all the patients who had airway replacement at our center to confirm that this innovative approach can be now used as usual care. For each patient, the following data were prospectively collected: postoperative mortality and morbidity, late airway complications, stent removal and status at last follow-up on November 2, 2021. From October 2009 to October 2021, 35 patients had airway replacement for malignant (n = 29) or benign (n = 6) lesions. The 30-day postoperative mortality and morbidity rates were 2.9% (n = 1/35) and 22.9% (n = 8/35) respectively. At a median follow-up of 29.5 months (range 1-133 months), 27 patients were alive. There have been no deaths directly related to the implanted bioprosthesis. Eighteen patients (52.9%) had stent-related granulomas requiring a bronchoscopic treatment. Ten among 35 patients (28.6%) achieved a stent free survival. The actuarial 2- and 5-year survival rates (Kaplan-Meier estimates) were respectively 88% and 75%. The TRITON-01 study confirmed that airway replacement using stented aortic matrices can be proposed as usual care at our center. Clinicaltrials.gov Identifier: NCT04263129.
Collapse
Affiliation(s)
- Emmanuel Martinod
- Assistance Publique - Hôpitaux de Paris (AP-HP), Hôpitaux Universitaires Paris Seine-Saint-Denis, Hôpital Avicenne, Chirurgie Thoracique et Vasculaire, Université Sorbonne Paris Nord, Faculté de Médecine SMBH, Bobigny, France.,Inserm UMR1272, Hypoxie et Poumon, Université Sorbonne Paris Nord, Faculté de Médecine SMBH, Bobigny, France.,Université Paris Cité, Fondation Alain Carpentier, Laboratoire de Recherche Bio-chirurgicale, AP-HP, Hôpital Européen Georges Pompidou, Paris, France
| | - Dana M Radu
- Assistance Publique - Hôpitaux de Paris (AP-HP), Hôpitaux Universitaires Paris Seine-Saint-Denis, Hôpital Avicenne, Chirurgie Thoracique et Vasculaire, Université Sorbonne Paris Nord, Faculté de Médecine SMBH, Bobigny, France.,Inserm UMR1272, Hypoxie et Poumon, Université Sorbonne Paris Nord, Faculté de Médecine SMBH, Bobigny, France.,Université Paris Cité, Fondation Alain Carpentier, Laboratoire de Recherche Bio-chirurgicale, AP-HP, Hôpital Européen Georges Pompidou, Paris, France
| | - Ilaria Onorati
- Assistance Publique - Hôpitaux de Paris (AP-HP), Hôpitaux Universitaires Paris Seine-Saint-Denis, Hôpital Avicenne, Chirurgie Thoracique et Vasculaire, Université Sorbonne Paris Nord, Faculté de Médecine SMBH, Bobigny, France.,Inserm UMR1272, Hypoxie et Poumon, Université Sorbonne Paris Nord, Faculté de Médecine SMBH, Bobigny, France.,Université Paris Cité, Fondation Alain Carpentier, Laboratoire de Recherche Bio-chirurgicale, AP-HP, Hôpital Européen Georges Pompidou, Paris, France
| | - Ana Maria Santos Portela
- Assistance Publique - Hôpitaux de Paris (AP-HP), Hôpitaux Universitaires Paris Seine-Saint-Denis, Hôpital Avicenne, Chirurgie Thoracique et Vasculaire, Université Sorbonne Paris Nord, Faculté de Médecine SMBH, Bobigny, France
| | - Marine Peretti
- Assistance Publique - Hôpitaux de Paris (AP-HP), Hôpitaux Universitaires Paris Seine-Saint-Denis, Hôpital Avicenne, Chirurgie Thoracique et Vasculaire, Université Sorbonne Paris Nord, Faculté de Médecine SMBH, Bobigny, France
| | - Patrice Guiraudet
- Assistance Publique - Hôpitaux de Paris (AP-HP), Hôpitaux Universitaires Paris Seine-Saint-Denis, Hôpital Avicenne, Chirurgie Thoracique et Vasculaire, Université Sorbonne Paris Nord, Faculté de Médecine SMBH, Bobigny, France.,Inserm UMR1272, Hypoxie et Poumon, Université Sorbonne Paris Nord, Faculté de Médecine SMBH, Bobigny, France
| | - Marie-Dominique Destable
- Assistance Publique - Hôpitaux de Paris (AP-HP), Hôpitaux Universitaires Paris Seine-Saint-Denis, Hôpital Avicenne, Chirurgie Thoracique et Vasculaire, Université Sorbonne Paris Nord, Faculté de Médecine SMBH, Bobigny, France
| | - Yurdagül Uzunhan
- Inserm UMR1272, Hypoxie et Poumon, Université Sorbonne Paris Nord, Faculté de Médecine SMBH, Bobigny, France.,AP-HP, Hôpitaux Universitaires Paris Seine-Saint-Denis, Hôpital Avicenne, Pneumologie, Université Sorbonne Paris Nord, Faculté de Médecine SMBH, Bobigny, France
| | - Olivia Freynet
- AP-HP, Hôpitaux Universitaires Paris Seine-Saint-Denis, Hôpital Avicenne, Pneumologie, Université Sorbonne Paris Nord, Faculté de Médecine SMBH, Bobigny, France
| | - Kader Chouahnia
- AP-HP, Hôpitaux Universitaires Paris Seine-Saint-Denis, Hôpital Avicenne, Oncologie, Université Sorbonne Paris Nord, Faculté de Médecine SMBH, Bobigny, France
| | - Boris Duchemann
- AP-HP, Hôpitaux Universitaires Paris Seine-Saint-Denis, Hôpital Avicenne, Oncologie, Université Sorbonne Paris Nord, Faculté de Médecine SMBH, Bobigny, France
| | - Jamal Kabbani
- Hôpital Le Raincy-Montfermeil, Pneumologie, Montfermeil, France
| | - Cyril Maurer
- Hôpital Le Raincy-Montfermeil, Pneumologie, Montfermeil, France
| | - Pierre-Yves Brillet
- Inserm UMR1272, Hypoxie et Poumon, Université Sorbonne Paris Nord, Faculté de Médecine SMBH, Bobigny, France.,AP-HP, Hôpitaux Universitaires Paris Seine-Saint-Denis, Hôpital Avicenne, Radiologie, Université Sorbonne Paris Nord, Faculté de Médecine SMBH, Bobigny, France
| | - Léa Fath
- Hôpitaux Universitaires de Strasbourg, Oto-Rhino-Laryngologie, Strasbourg, France
| | - Esteban Brenet
- Centre Hospitalier Universitaire de Reims, Oto-Rhino-Laryngologie, Reims, France
| | - Christian Debry
- Hôpitaux Universitaires de Strasbourg, Oto-Rhino-Laryngologie, Strasbourg, France
| | - Camille Buffet
- AP-HP, Sorbonne Université, Hôpital La Pitié-Salpêtrière, Endocrinologie, Paris, France
| | - Laurence Leenhardt
- AP-HP, Sorbonne Université, Hôpital La Pitié-Salpêtrière, Endocrinologie, Paris, France
| | - Dominique Clero
- AP-HP, Sorbonne Université, Hôpital La Pitié-Salpêtrière, Oto-Rhino-Laryngologie, Paris, France
| | - Nicolas Julien
- AP-HP, Sorbonne Université, Hôpital La Pitié-Salpêtrière, Oto-Rhino-Laryngologie, Paris, France
| | - Nicolas Vénissac
- Hôpitaux Universitaires de Lille, Chirurgie Thoracique, Lille, France
| | - François Tronc
- Hôpitaux Universitaires de Lyon, Chirurgie Thoracique, Lyon, France
| | - Hervé Dutau
- Assistance Publique - Hôpitaux de Marseille, Pneumologie, Hôpital Universitaire Nord, Marseille, France
| | | | - Charles Juvin
- AP-HP, Sorbonne Université, Hôpital La Pitié-Salpêtrière, Chirurgie Cardiaque, Paris, France
| | - Guillaume Lebreton
- AP-HP, Sorbonne Université, Hôpital La Pitié-Salpêtrière, Chirurgie Cardiaque, Paris, France
| | - Yves Cohen
- AP-HP, Hôpitaux Universitaires Paris Seine-Saint-Denis, Hôpital Avicenne, Réanimation, Université Sorbonne Paris Nord, Faculté de Médecine SMBH, Bobigny, France
| | - Elie Zogheib
- AP-HP, Hôpitaux Universitaires Paris Seine-Saint-Denis, Hôpital Avicenne, Anesthésie-Réanimation, Université Sorbonne Paris Nord, Faculté de Médecine SMBH, Bobigny, France
| | - Sadek Beloucif
- AP-HP, Hôpitaux Universitaires Paris Seine-Saint-Denis, Hôpital Avicenne, Anesthésie-Réanimation, Université Sorbonne Paris Nord, Faculté de Médecine SMBH, Bobigny, France
| | - Carole Planès
- Inserm UMR1272, Hypoxie et Poumon, Université Sorbonne Paris Nord, Faculté de Médecine SMBH, Bobigny, France
| | - Christophe Trésallet
- AP-HP, Hôpitaux Universitaires Paris Seine-Saint-Denis, Hôpital Avicenne, Chirurgie Digestive, Université Sorbonne Paris Nord, Faculté de Médecine SMBH, Bobigny, France
| | | | - Hervé Petite
- B3OA UMR CNRS 7052, Université Paris Cité CNRS, Paris, France
| | - Hélène Rouard
- AP-HP, EFS Ile de France, Banque des Tissus, La Plaine Saint-Denis, France
| | - Makoto Miyara
- Sorbonne Université, Inserm, Centre d'Immunologie et des Maladies Infectieuses (CIMI-Paris), Département d'Immunologie, AP-HP, Hôpital Pitié-Salpêtrière, Paris, France
| | - Eric Vicaut
- AP-HP, Unité de Recherche Clinique, Hôpitaux Saint Louis-Lariboisière-Fernand Widal, Université Paris Cité, Paris, France
| |
Collapse
|
18
|
Genden EM, Harkin T, Laitman BM, Florman SS. Vascularized Tracheal Transplantation: A Twenty Month Follow Up. Laryngoscope 2022. [PMID: 36239630 DOI: 10.1002/lary.30444] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2022] [Revised: 09/07/2022] [Accepted: 09/29/2022] [Indexed: 11/12/2022]
Abstract
BACKGROUND Tracheal transplantation has been considered the ideal option for the reconstruction of long-segment circumferential tracheal defects. Our group developed a technique for vascularized single-staged tracheal transplantation. Twenty months ago, we performed the first-in-human tracheal transplantation. Herein, we report a twenty-month follow-up. METHODS The recipient presented with a 9.0 cm airway tracheal stenosis and complete cricoid stenosis. The patient previously failed six major conventional surgical procedures. Prior to transplantation, the patient's airway was maintained with an extended tracheostomy and stent. The patient experienced repeated life-threatening airway obstruction because of mucous plugging and obstructive granulation tissue. In January 2020 the patient underwent a single-staged tracheal transplantation treated with triple-therapy immunosuppression. Organ rejection was monitored with endoscopic tracheoscopy, narrow-band imaging, free-cell DNA assessment, and histological and cytogenetic analysis of tracheal biopsies. Mucociliary function was assessed with dye motility studies. RESULTS Twenty months following transplantation, there has been no evidence of acute or chronic rejection. Since day 60, there has been no detectable free cell DNA, a surrogate marker for immune-mediated allograft rejection. Fluorescence in situ hybridization (FISH) cytogenetics demonstrated that the donor trachea was repopulated with recipient epithelium establishing a chimeric allograft. Narrow-band imaging demonstrates a well-vascularized epithelial mucosa and bronchoscopic biopsies demonstrate normal ciliated epithelial architecture and viable epithelial lining with functional ciliated epithelium. The patient has resumed a normal life without a stent or tracheostomy and has returned to work. CONCLUSIONS Twenty months after single-staged vascularized tracheal transplantation, the trachea is functional and the patient breathes without the need for a tracheostomy or stent. Single-staged long-segment tracheal transplantation is a viable option for tracheal defects that are not amenable to conventional reconstructive techniques. LEVEL OF EVIDENCE 4 Laryngoscope, 2022.
Collapse
Affiliation(s)
- Eric M Genden
- Department of Otolaryngology - Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA.,The Recanati/Miller Transplantation Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Timothy Harkin
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA.,Department of Thoracic Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA.,Critical Care Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Benjamin M Laitman
- Department of Otolaryngology - Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Sander S Florman
- The Recanati/Miller Transplantation Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| |
Collapse
|
19
|
Abia-Trujillo D, Fernandez-Bussy S. Nonmalignant Central Airway Obstruction: Options for Challenging Cases. Semin Respir Crit Care Med 2022; 43:530-535. [PMID: 35728604 DOI: 10.1055/s-0042-1747937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Benign central airway obstruction is commonly referred as nonmalignant central airway obstruction (NMCAO). This is in part related to its lack of benign nature and significant life-quality impairment in patients. It is a pathologic entity with various etiologies and therefore a wide range of therapeutic options are available. Evidence regarding the optimal management that could provide a sustained restoration of airway patency is lacking. The lack of a common pathophysiologic pathway translating into a nonspecific symptom presenting as NMCAO has complicated treatment standardization and subsequently limited solid research to favor of one approach over another one. Our intent is to describe the limited evidence of the most utilized nonsurgical treatment for NMCAO as well as some upcoming promising therapeutic options such as mitomycin C injection, microdebrider, biodegradable stents, radiotherapy, Hybrid Knife, and endoluminal spray cryotherapy. Our goal with this manuscript is to motivate other authors to venture into prospective, multicenter, open-label trials aimed to describe long-term outcomes in patients with NMCAO.
Collapse
Affiliation(s)
- David Abia-Trujillo
- Divisions of Pulmonary, Allergy, Sleep Medicine & Respiratory Services, Mayo Clinic, Jacksonville, Florida
| | - Sebastian Fernandez-Bussy
- Divisions of Pulmonary, Allergy, Sleep Medicine & Respiratory Services, Mayo Clinic, Jacksonville, Florida
| |
Collapse
|
20
|
Illuzzi E, Wells C, Hackett A, Ricco D, Haran A, Gittens C, Sevillano M, Castro M, Develleres E, Ramos MS, Zhang Z, Oropello J, Kohli-Seth R. Postoperative Nursing Care of a Deceased Donor Tracheal Transplant Recipient. Crit Care Nurse 2022; 42:12-18. [PMID: 35640895 DOI: 10.4037/ccn2022747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
INTRODUCTION Certain airway disorders, such as tracheal stenosis, can severely affect the ability to breathe, reduce quality of life, and increase morbidity and mortality. Treatment options for long-segment tracheal stenosis include multistage tracheal replacement with biosynthetic material, autotransplantation, and allotransplantation. These interventions have not demonstrated long-term dependable results because of lack of adequate blood supply to the organ and ciliated epithelium. A new transplant program featuring single-stage long-segment tracheal transplant addresses this concern. CLINICAL FINDINGS The patient was a 56-year-old woman with a history of obesity, type 2 diabetes, hypertension, hyperlipidemia, liver sarcoidosis, 105-pack-year smoking history, and asthma. A severe asthma exacerbation in 2014 required prolonged intubation, and she subsequently developed long-segment cricotracheal stenosis. In 2015 she underwent an unsuccessful tracheal resection followed by failed attempts at tracheal stenting and dilation procedures. These attempts at stenting resulted in a permanent extended-length tracheostomy and ultimately ventilator dependency. INTERVENTIONS The patient underwent a single-stage long-segment deceased donor tracheal transplant. Important nursing considerations included hemodynamic monitoring, airway management and securement, graft assessment, stoma and wound care, nutrition, medication administration, and patient education. CONCLUSION High-quality nursing care postoperatively in the intensive care unit is critical to safe and effective treatment of the tracheal transplant recipient and success of the graft. To effectively treat these patients, nurses need relevant education and training. This article is the first documentation of postoperative nursing care following single-stage long-segment tracheal transplant.
Collapse
Affiliation(s)
- Ella Illuzzi
- Ella Illuzzi is a nurse practitioner in the transplant intensive care unit at Mount Sinai Hospital, New York, New York
| | - Celia Wells
- Celia Wells is the Senior Director of Nursing at Mount Sinai Hospital
| | - Anna Hackett
- Anna Hackett is a clinical research assistant at Mount Sinai Hospital
| | - Darlene Ricco
- Darlene Ricco is a staff nurse in the surgical and transplant intensive care units at Mount Sinai Hospital
| | - Anne Haran
- Anne Haran is a staff nurse in the surgical and transplant intensive care units at Mount Sinai Hospital
| | - Christal Gittens
- Christal Gittens is a staff nurse in the surgical and transplant intensive care units at Mount Sinai Hospital
| | - Maria Sevillano
- Maria Sevillano is a certified wound care nurse at Mount Sinai Hospital
| | - Meryl Castro
- Meryl Castro is a staff nurse in the surgical and transplant intensive care units at Mount Sinai Hospital
| | - Eva Develleres
- Eva Develleres is a staff nurse in the surgical and transplant intensive care units at Mount Sinai Hospital
| | - Mardisa Samson Ramos
- Mardisa Samson Ramos is the nurse manager of the surgical and transplant intensive care units at Mount Sinai Hospital
| | - Ziya Zhang
- Ziya Zhang is a clinical research assistant at Mount Sinai Hospital
| | - John Oropello
- John Oropello is the Director of the transplant intensive care unit at Mount Sinai Hospital
| | - Roopa Kohli-Seth
- Roopa Kohli-Seth is the Director of the Institute for Critical Care Medicine at Mount Sinai Hospital
| |
Collapse
|
21
|
Adamo D, Galaverni G, Genna VG, Lococo F, Pellegrini G. The Growing Medical Need for Tracheal Replacement: Reconstructive Strategies Should Overcome Their Limits. Front Bioeng Biotechnol 2022; 10:846632. [PMID: 35646864 PMCID: PMC9132048 DOI: 10.3389/fbioe.2022.846632] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Accepted: 03/08/2022] [Indexed: 11/13/2022] Open
Abstract
Breathing, being predominantly an automatic action, is often taken for granted. However, respiratory diseases affect millions of people globally, emerging as one of the major causes of disability and death overall. Among the respiratory dysfunctions, tracheal alterations have always represented a primary challenge for clinicians, biologists, and engineers. Indeed, in the case of wide structural alterations involving more than 50% of the tracheal length in adults or 30% in children, the available medical treatments are ineffective or inapplicable. So far, a plethora of reconstructive approaches have been proposed and clinically applied to face this growing, unmet medical need. Unfortunately, none of them has become a well-established and routinely applied clinical procedure to date. This review summarizes the main clinical reconstructive attempts and classifies them as non-tissue engineering and tissue engineering strategies. The analysis of the achievements and the main difficulties that still hinder this field, together with the evaluation of the forefront preclinical experiences in tracheal repair/replacement, is functional to promote a safer and more effective clinical translation in the near future.
Collapse
Affiliation(s)
- Davide Adamo
- Interdepartmental Centre for Regenerative Medicine “Stefano Ferrari”, University of Modena and Reggio Emilia, Modena, Italy
| | - Giulia Galaverni
- Interdepartmental Centre for Regenerative Medicine “Stefano Ferrari”, University of Modena and Reggio Emilia, Modena, Italy
| | | | - Filippo Lococo
- Università Cattolica del Sacro Cuore, Rome, Italy
- Thoracic Surgery Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Graziella Pellegrini
- Interdepartmental Centre for Regenerative Medicine “Stefano Ferrari”, University of Modena and Reggio Emilia, Modena, Italy
- Holostem Terapie Avanzate S.r.l., Modena, Italy
| |
Collapse
|