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Adly HA, El-Okby AWY, Yehya AA, El-Shamy AA, Galhom RA, Hashem MA, Ahmed MF. Circumferential Esophageal Reconstruction Using a Tissue-engineered Decellularized Tunica Vaginalis Graft in a Rabbit Model. J Pediatr Surg 2024; 59:1486-1497. [PMID: 38692944 DOI: 10.1016/j.jpedsurg.2024.04.003] [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: 08/18/2023] [Revised: 03/26/2024] [Accepted: 04/05/2024] [Indexed: 05/03/2024]
Abstract
BACKGROUND Pediatric surgeons have faced esophageal reconstruction challenges for decades owing to a variety of congenital and acquired conditions. This work aimed to introduce a reproducible and efficient approach for creating tissue-engineered esophageal tissue using bone marrow mesenchymal stem cells (BMSCs) cultured in preconditioned mediums seeded on a sheep decellularized tunica vaginalis (DTV) scaffold for partial reconstruction of a rabbit's esophagus. METHODS DTV was performed using SDS and Triton X-100 solutions. The decellularized grafts were employed alone (DTV group) or after recellularization with BMSCs cultured for 10 days in preconditioned mediums (RTV group) for reconstructing a 3 cm segmental defect in the cervical esophagus of rabbits (n = 20) after the decellularization process was confirmed. Rabbits were observed for one month, after which they were euthanized, and the reconstructed esophagi were harvested for histological analysis. RESULTS Six rabbits in the DTV group and eight rabbits in the RTV group survived until the end of the one-month study period. Despite histological examination demonstrating that both grafts completely repaired the esophageal defect, the RTV graft demonstrated a histological structure similar to that of the normal esophagus. The reconstructed esophagi in the RTV group revealed the arrangement of the different layers of the esophageal wall with the formation of newly formed blood vessels and Schwann-like cells. CONCLUSION DTV xenograft is a novel scaffold that promotes cell adhesion and differentiation and might be effectively utilized for regenerating esophageal tissue, paving the way for future clinical trials in pediatric patients.
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Affiliation(s)
- Hassan A Adly
- Pediatric Surgery Unit, General Surgery Department, Faculty of Medicine, Al-Azhar University (Assiut Branch), Assiut, Egypt.
| | - Abdel-Wahab Y El-Okby
- Department of Pediatric Surgery, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | - Abdel-Aziz Yehya
- Department of Pediatric Surgery, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | - Ahmed A El-Shamy
- Pediatric Surgery Unit, General Surgery Department, Faculty of Medicine, Al-Azhar University (Assiut Branch), Assiut, Egypt
| | - Rania A Galhom
- Department of Human Anatomy and Embryology, Faculty of Medicine, Suez Canal University, Ismailia, Egypt; Tissue Culture Lab, Center of Excellence of Molecular and Cellular Medicine (CEMCM), Faculty of Medicine, Suez Canal University, Ismailia, Egypt; Department of Human Anatomy and Embryology, Faculty of Medicine, Badr University in Cairo (BUC), Cairo, Egypt
| | - Mohamed A Hashem
- Department of Surgery, Anesthesiology and Radiology, Faculty of Veterinary Medicine, Suez Canal University, Ismailia, Egypt
| | - Mahmoud F Ahmed
- Department of Surgery, Anesthesiology and Radiology, Faculty of Veterinary Medicine, Suez Canal University, Ismailia, Egypt
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Elia E, Brownell D, Chabaud S, Bolduc S. Tissue Engineering for Gastrointestinal and Genitourinary Tracts. Int J Mol Sci 2022; 24:ijms24010009. [PMID: 36613452 PMCID: PMC9820091 DOI: 10.3390/ijms24010009] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 12/10/2022] [Accepted: 12/14/2022] [Indexed: 12/24/2022] Open
Abstract
The gastrointestinal and genitourinary tracts share several similarities. Primarily, these tissues are composed of hollow structures lined by an epithelium through which materials need to flow with the help of peristalsis brought by muscle contraction. In the case of the gastrointestinal tract, solid or liquid food must circulate to be digested and absorbed and the waste products eliminated. In the case of the urinary tract, the urine produced by the kidneys must flow to the bladder, where it is stored until its elimination from the body. Finally, in the case of the vagina, it must allow the evacuation of blood during menstruation, accommodate the male sexual organ during coitus, and is the natural way to birth a child. The present review describes the anatomy, pathologies, and treatments of such organs, emphasizing tissue engineering strategies.
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Affiliation(s)
- Elissa Elia
- Centre de Recherche en Organogénèse Expérimentale/LOEX, Regenerative Medicine Division, CHU de Québec-Université Laval Research Center, Québec, QC G1J 1Z4, Canada
| | - David Brownell
- Centre de Recherche en Organogénèse Expérimentale/LOEX, Regenerative Medicine Division, CHU de Québec-Université Laval Research Center, Québec, QC G1J 1Z4, Canada
| | - Stéphane Chabaud
- Centre de Recherche en Organogénèse Expérimentale/LOEX, Regenerative Medicine Division, CHU de Québec-Université Laval Research Center, Québec, QC G1J 1Z4, Canada
| | - Stéphane Bolduc
- Centre de Recherche en Organogénèse Expérimentale/LOEX, Regenerative Medicine Division, CHU de Québec-Université Laval Research Center, Québec, QC G1J 1Z4, Canada
- Department of Surgery, Faculty of Medicine, Université Laval, Québec, QC G1V 0A6, Canada
- Correspondence: ; Tel.: +1-418-525-4444 (ext. 42282)
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Haghdel M, Imanieh MH, Hosseinpour H, Ghasemi Y, Alizadeh AA. Development of Bio-artificial Esophageal Tissue Engineering Utilization for Circumferential Lesion Transplantation: A Narrative Review. IRANIAN JOURNAL OF MEDICAL SCIENCES 2022; 47:406-421. [PMID: 36117582 PMCID: PMC9445863 DOI: 10.30476/ijms.2021.89194.1991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Revised: 02/12/2021] [Accepted: 04/06/2021] [Indexed: 11/19/2022]
Abstract
The esophagus is the gastrointestinal tract's primary organ that transfers bolus into the stomach with peristaltic motion. Therefore, its lesions cause a significant disturbance in the nutrition and digestive system. Esophageal disease treatment sometimes requires surgical procedures that involve removal and circumferential full-thickness replacement. Unlike other organs, the esophagus has a limited regeneration ability and cannot be transplanted from donors. There are various methods of restoring the esophageal continuity; however, they are associated with certain flaws that lead to a non-functional recovery. As an exponentially growing science, tissue engineering has become a leading technique for the development of tissue replacement to repair damaged esophageal segments. Scaffold plays a significant role in the process of tissue engineering, as it acts as a template for the regeneration of growing tissue. A variety of scaffolds have been studied to replace the esophagus. Due to the many tissue quality challenges, the results are still inadequate and need to be improved. The success of esophageal tissue regeneration will finally depend on the scaffold's capability to mimic natural tissue properties and provide a qualified environment for regeneration. Thereby, scaffold fabrication techniques are fundamental. This article reviews the recent developments in esophageal tissue engineering for the treatment of circumferential lesions based on scaffold biomaterial engineering approaches.
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Affiliation(s)
- Mobin Haghdel
- Department of Tissue Engineering, School of Advanced Medical Sciences and Technologies, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohammad Hadi Imanieh
- Department of Pediatrics Gastroenterology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Hamidreza Hosseinpour
- Department of Surgery, Shiraz Laparoscopic Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Younes Ghasemi
- Department of Pharmaceutical Biotechnology, School of Pharmacy, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Ali Akbar Alizadeh
- Department of Tissue Engineering, School of Advanced Medical Sciences and Technologies, Shiraz University of Medical Sciences, Shiraz, Iran
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Jones BC, Shibuya S, Durkin N, De Coppi P. Regenerative medicine for childhood gastrointestinal diseases. Best Pract Res Clin Gastroenterol 2021; 56-57:101769. [PMID: 35331401 DOI: 10.1016/j.bpg.2021.101769] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 09/30/2021] [Accepted: 10/08/2021] [Indexed: 01/31/2023]
Abstract
Several paediatric gastrointestinal diseases result in life-shortening organ failure. For many of these conditions, current therapeutic options are suboptimal and may not offer a cure. Regenerative medicine is an inter-disciplinary field involving biologists, engineers, and clinicians that aims to produce cell and tissue-based therapies to overcome organ failure. Exciting advances in stem cell biology, materials science, and bioengineering bring engineered gastrointestinal cell and tissue therapies to the verge of clinical trial. In this review, we summarise the requirements for bioengineered therapies, the possible sources of the various cellular and non-cellular components, and the progress towards clinical translation of oesophageal and intestinal tissue engineering to date.
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Affiliation(s)
- Brendan C Jones
- Stem Cell and Regenerative Medicine Section, Developmental Biology and Cancer Research and Teaching Department, Great Ormond Street Institute of Child Health, University College London, London, United Kingdom; Specialist Neonatal and Paediatric Surgery Unit, Great Ormond Street Hospital, London, United Kingdom
| | - Soichi Shibuya
- Stem Cell and Regenerative Medicine Section, Developmental Biology and Cancer Research and Teaching Department, Great Ormond Street Institute of Child Health, University College London, London, United Kingdom
| | - Natalie Durkin
- Stem Cell and Regenerative Medicine Section, Developmental Biology and Cancer Research and Teaching Department, Great Ormond Street Institute of Child Health, University College London, London, United Kingdom; Specialist Neonatal and Paediatric Surgery Unit, Great Ormond Street Hospital, London, United Kingdom
| | - Paolo De Coppi
- Stem Cell and Regenerative Medicine Section, Developmental Biology and Cancer Research and Teaching Department, Great Ormond Street Institute of Child Health, University College London, London, United Kingdom; Specialist Neonatal and Paediatric Surgery Unit, Great Ormond Street Hospital, London, United Kingdom.
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Enhancing esophageal repair with bioactive bilayer mesh containing FGF. Sci Rep 2021; 11:19203. [PMID: 34584186 PMCID: PMC8478899 DOI: 10.1038/s41598-021-98840-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2021] [Accepted: 09/09/2021] [Indexed: 11/08/2022] Open
Abstract
We aimed to prepare a bioactive and biodegradable bilayer mesh formed by fibroblast growth factor (FGF) loaded gelatin film layer, and poly ε-caprolactone (PCL) film layer, and to investigate its treatment efficacy on esophageal anastomosis. It is envisaged that the bioactive mesh in in vivo model would improve tissue healing in rats. The full thickness semicircular defects of 0.5 × 0.5 cm2 were created in anterior walls of abdominal esophagus. The control group had abdominal esophagus isolated with distal esophageal blunt dissection, and sham group had primary anastomosis. In the test groups, the defects were covered with bilayer polymeric meshes containing FGF (5 μg/2 cm2), or not. All rats were sacrificed for histopathology investigation after 7 or 28 days of operation. The groups are coded as FGF(-)-7th day, FGF(+)-7th day, and FGF(+)-28th day, based on their content and operation day. Highest burst pressures were obtained for FGF(+)-7th day, and FGF(+)-28th day groups (p < 0.005) and decreased inflammation grades were observed. Submucosal and muscular collagen deposition scores were markedly increased in these groups compared to sham and FGF(-)-7th day groups having no FGF (p = 0.002, p = 0.001, respectively). It was proved that FGF loaded bioactive bilayer mesh provided effective repair, reinforcement and tissue healing of esophageal defects.
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Model L, Wiesel O. A narrative review of esophageal tissue engineering and replacement: where are we? ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:910. [PMID: 34164544 PMCID: PMC8184476 DOI: 10.21037/atm-20-3906] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Long-gap esophageal defects, whether congenital or acquired, are very difficult to manage. Any significant surgical peri-esophageal dissection that is performed to allow for potential stretching of two ends of a defect interrupts the esophageal blood supply and leads to complications such as leak and stricture, even in the youngest, healthiest patients. The term “congenital” applied to these defects refers mainly to long-gap esophageal atresia (LGA). Causes of acquired long-segment esophageal disruption include recurrent leaks and fistulae after primary repair, refractory GERD, caustic ingestions, cancer, and strictures. 5,000–10,000 patients per year in the US require esophageal replacement. Gastric, colonic, and jejunal pull-up surgeries are fraught with high rates of both short and long term complications thus creating a space for a better option. Since the 1970’s many groups around the world have been unsuccessfully attempting esophageal replacement with tissue-engineered grafts in various animal models. But, recent advances in these models are now combining novel technologic advances in materials bioscience, stem-cell therapies, and transplantation and are showing increasing promise to human translational application. Transplantation has been heretofore unsuccessful, but given modern improvements in transplant microsurgery and immunosuppressive medications, pioneering trials in animal models are being undertaken now. These rapidly evolving medical innovations will be reviewed here.
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Affiliation(s)
- Lynn Model
- Department of Pediatric Surgery, Maimonides Medical Center, Brooklyn, NY 11219, USA
| | - Ory Wiesel
- Department of Thoracic Surgery, Maimonides Medical Center, Brooklyn, NY 11219, USA
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7
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Schiellerup NS, Wismann J, Madsen GI, Le DQS, Qvist N, Ellebæk MB. Incorporation of a Poly-ε-Caprolactone Scaffold in a ;Circular Stapled End-To-End Small Intestine Anastomosis Does Not Have Any Adverse Effects Within 30 days: A Study in Piglets. Surg Innov 2021; 28:679-687. [PMID: 33745358 DOI: 10.1177/1553350621999294] [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: 11/15/2022]
Abstract
Background. Incorporation of a poly-ε-caprolactone (PCL) scaffold in circular stapled anastomoses has been shown to increase the anastomotic tensile strength on postoperative day (POD) 5 in a pig model. The aim of this study was to investigate the effects of incorporation of a PCL scaffold in a circular stapled end-to-end small intestine anastomosis, with stricture formation and anastomotic histology as primary outcomes in a 30-day observation period. Methods. A total of 15 piglets were included. In each piglet, three circular stapled end-to-end anastomoses were made in the small intestines. Two were interventional and one was a control. On POD 10, 20, or 30, the anastomoses were subjected to in vivo intraluminal contrast study, and the index for anastomotic lumen was calculated. The anastomotic segment was resected and subjected to a tensile strength test and histological examination. Results. At POD 10, the mean ± SD value for anastomotic index was .749 ± .065 in control anastomoses and .637 ± .051 in interventional anastomosis (P = .0046), at POD 20, .541 ± .150 and .724 ± .07 (P = .051), and at POD 30, .645 ± .103 and .686 ± .057 (P = .341), respectively. No significant difference was observed in maximum tensile strength and histology at POD 30. Conclusions. The incorporation of a PCL scaffold in a circular stapled end-to-end small intestine anastomosis does not increase the risk of stricture or impair wound healing after 30 days.
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Affiliation(s)
| | - Joakim Wismann
- Department of Surgery, 573154Odense University Hospital, Odense, Denmark
| | - Gunvor I Madsen
- Department of Pathology, 573154Odense University Hospital, Odense, Denmark
| | - Dang Q S Le
- Department of Clinical Medicine, 1006Aarhus University, Aarhus C, Denmark
| | - Niels Qvist
- Department of Surgery, 573154Odense University Hospital, Odense, Denmark.,Danish Centre for Regenerative Medicine (CRM), 573154Odense University Hospital, Odense, Denmark
| | - Mark B Ellebæk
- Department of Surgery, 573154Odense University Hospital, Odense, Denmark
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8
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Schizas D, Frountzas M, Sgouromallis E, Spartalis E, Mylonas KS, Papaioannou TG, Dimitroulis D, Nikiteas N. Esophageal defect repair by artificial scaffolds: a systematic review of experimental studies and proportional meta-analysis. Dis Esophagus 2021; 34:5917398. [PMID: 33016317 DOI: 10.1093/dote/doaa104] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 07/26/2020] [Accepted: 08/21/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND The traditional technique of gastrointestinal reconstruction of the esophagus after esophagectomy presents plenty of complications. Hence, tissue engineering has been introduced as an effective artificial alternative with potentially fewer complications. Three types of esophageal scaffolds have been used in experimental studies so far. The aim of our meta-analysis is to present the postoperative outcomes after esophageal replacement with artificial scaffolds and the investigation of possible factors that affect these outcomes. METHODS The present proportional meta-analysis was designed using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses and A MeaSurement Tool to Assess systematic Reviews guidelines. We searched Medline, Scopus, Clinicaltrials.gov, EMBASE, Cochrane Central Register of Controlled Trials CENTRAL, and Google Scholar databases from inception until February 2020. RESULTS Overall, 32 studies were included that recruited 587 animals. The pooled morbidity after esophageal scaffold implantation was 53.4% (95% CI = 36.6-70.0%). The pooled survival interval was 111.1 days (95% CI = 65.5-156.8 days). Graft stenosis (46%), postoperative dysphagia (15%), and anastomotic leak (12%) were the most common complications after esophageal scaffold implantation. Animals that underwent an implantation of an artificial scaffold in the thoracic part of their esophagus presented higher survival rates than animals that underwent scaffold implantation in the cervical or abdominal part of their esophagus (P < 0.001 and P = 0.011, respectively). CONCLUSION Tissue engineering seems to offer an effective alternative for the repair of esophageal defects in animal models. Nevertheless, issues like graft stenosis and lack of motility of the esophageal scaffolds need to be addressed in future experimental studies before scaffolds can be tested in human trials.
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Affiliation(s)
- Dimitrios Schizas
- First Department of Surgery, Medical School, National and Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece.,Hellenic Minimally Invasive and Robotic Surgery Study Group, Athens, Greece
| | - Maximos Frountzas
- First Propaedeutic Department of Surgery, Medical School, National and Kapodistrian University of Athens, Hippocration General Hospital, Athens, Greece.,Hellenic Minimally Invasive and Robotic Surgery Study Group, Athens, Greece
| | - Emmanouil Sgouromallis
- Third Department of Surgery, Athens General Hospital "Georgios Gennimatas", Athens, Greece.,Hellenic Minimally Invasive and Robotic Surgery Study Group, Athens, Greece
| | | | - Konstantinos S Mylonas
- First Department of Surgery, Medical School, National and Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece
| | - Theodore G Papaioannou
- First Department of Cardiology, Biomedical Engineering Unit, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Dimitrios Dimitroulis
- Hellenic Minimally Invasive and Robotic Surgery Study Group, Athens, Greece.,Second Propedeutic Department of Surgery, Medical School, National and Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece
| | - Nikolaos Nikiteas
- Hellenic Minimally Invasive and Robotic Surgery Study Group, Athens, Greece.,Second Propedeutic Department of Surgery, Medical School, National and Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece
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Kanetaka K, Eguchi S. Regenerative medicine for the upper gastrointestinal tract. Regen Ther 2020; 15:129-137. [PMID: 33426211 PMCID: PMC7770370 DOI: 10.1016/j.reth.2020.07.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Revised: 06/21/2020] [Accepted: 07/01/2020] [Indexed: 12/12/2022] Open
Abstract
The main surgical strategy for gastrointestinal tract malignancy is en bloc resection, which consists of not only resection of the involved organs but also simultaneous resection of the surrounding or adjacent mesenteries that contain lymph vessels and nodes. After resection of the diseased organs, the defect of the gastrointestinal conduit is replaced with organs located downstream, such as the stomach and jejunum. However, esophageal and gastric reconstruction using these natural substitutes is associated with a diminished quality of life due to the loss of the reserve function, damage to the antireflux barrier, and dumping syndrome. Thus, replacement of the deficit after resection with the patient's own regenerated tissue to compensate for the lost function and tissue using regenerative medicine will be an ideal treatment. Many researchers have been trying to construct artificial organs through tissue engineering techniques; however, none have yet succeeded in growing a whole organ because of the complicated functions these organs perform, such as the processing and absorption of nutrients. While exciting results have been reported with regard to tissue engineering techniques concerning the upper gastrointestinal tract, such as the esophagus and stomach, most of these achievements have been observed in animal models, and few successful approaches in the clinical setting have been reported for the replacement of mucosal defects. We review the recent progress in regenerative medicine in relation to the upper gastrointestinal tract, such as the esophagus and stomach. We also focus on the functional capacity of regenerated tissue and its role as a culture system to recapitulate the mechanisms underlying infectious disease. With the emergence of technology such as the fabrication of decellularized constructs, organoids and cell sheet medicine, collaboration between gastrointestinal surgery and regenerative medicine is expected to help establish novel therapeutic modalities in the future.
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Affiliation(s)
- Kengo Kanetaka
- Tissue Engineering and Regenerative Therapeutics in Gastrointestinal Surgery, Nagasaki University Graduate School of Biomedical Sciences, Japan
| | - Susumu Eguchi
- Department of Surgery, Nagasaki University Graduate School of Biomedical Sciences, Japan
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10
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O'Leary C, Soriano L, Fagan-Murphy A, Ivankovic I, Cavanagh B, O'Brien FJ, Cryan SA. The Fabrication and in vitro Evaluation of Retinoic Acid-Loaded Electrospun Composite Biomaterials for Tracheal Tissue Regeneration. Front Bioeng Biotechnol 2020; 8:190. [PMID: 32266229 PMCID: PMC7103641 DOI: 10.3389/fbioe.2020.00190] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Accepted: 02/27/2020] [Indexed: 12/24/2022] Open
Abstract
Although relatively rare, major trauma to the tracheal region of the airways poses a significant clinical challenge with few effective treatments. Bioengineering and regenerative medicine strategies have the potential to create biocompatible, implantable biomaterial scaffolds, with the capacity to restore lost tissue with functional neo-trachea. The main goal of this study was to develop a nanofibrous polycaprolactone-chitosan (PCL-Chitosan) scaffold loaded with a signaling molecule, all-trans retinoic acid (atRA), as a novel biomaterial approach for tracheal tissue engineering. Using the Spraybase® electrospinning platform, polymer concentration, solvent selection, and instrument parameters were optimized to yield a co-polymer with nanofibers of 181-197 nm in diameter that mimicked tracheobronchial tissue architecture. Thereafter, scaffolds were assessed for their biocompatibility and capacity to induce mucociliary functionalization using the Calu-3 cell line. PCL-Chitosan scaffolds were found to be biocompatible in nature and support Calu-3 cell viability over a 14 day time period. Additionally, the inclusion of atRA did not compromise Calu-3 cell viability, while still achieving an efficient encapsulation of the signaling molecule over a range of atRA concentrations. atRA release from scaffolds led to an increase in mucociliary gene expression at high scaffold loading doses, with augmented MUC5AC and FOXJ1 detected by RT-PCR. Overall, this scaffold integrates a synthetic polymer that has been used in human tracheal stents, a natural polymer generally regarded as safe (GRAS), and a drug with decades of use in patients. Coupled with the scalable nature of electrospinning as a fabrication method, all of these characteristics make the biomaterial outlined in this study amenable as an implantable device for an unmet clinical need in tracheal replacement.
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Affiliation(s)
- Cian O'Leary
- School of Pharmacy and Biomolecular Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland
- Tissue Engineering Research Group, Department of Anatomy and Regenerative Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland
- SFI Advanced Materials and Bioengineering Research (AMBER) Center, Royal College of Surgeons in Ireland and Trinity College Dublin, Dublin, Ireland
- SFI Center for Research in Medical Devices (CÚRAM), Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Luis Soriano
- School of Pharmacy and Biomolecular Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland
- Tissue Engineering Research Group, Department of Anatomy and Regenerative Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland
- SFI Advanced Materials and Bioengineering Research (AMBER) Center, Royal College of Surgeons in Ireland and Trinity College Dublin, Dublin, Ireland
- SFI Center for Research in Medical Devices (CÚRAM), Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Aidan Fagan-Murphy
- School of Pharmacy and Biomolecular Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland
- Tissue Engineering Research Group, Department of Anatomy and Regenerative Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland
- SFI Advanced Materials and Bioengineering Research (AMBER) Center, Royal College of Surgeons in Ireland and Trinity College Dublin, Dublin, Ireland
- SFI Center for Research in Medical Devices (CÚRAM), Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Ivana Ivankovic
- School of Pharmacy and Biomolecular Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland
- Tissue Engineering Research Group, Department of Anatomy and Regenerative Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland
- SFI Advanced Materials and Bioengineering Research (AMBER) Center, Royal College of Surgeons in Ireland and Trinity College Dublin, Dublin, Ireland
- SFI Center for Research in Medical Devices (CÚRAM), Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Brenton Cavanagh
- Cellular and Molecular Imaging Core, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Fergal J. O'Brien
- Tissue Engineering Research Group, Department of Anatomy and Regenerative Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland
- SFI Advanced Materials and Bioengineering Research (AMBER) Center, Royal College of Surgeons in Ireland and Trinity College Dublin, Dublin, Ireland
- SFI Center for Research in Medical Devices (CÚRAM), Royal College of Surgeons in Ireland, Dublin, Ireland
- Trinity Center for Biomedical Engineering, Trinity College Dublin, Dublin, Ireland
| | - Sally-Ann Cryan
- School of Pharmacy and Biomolecular Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland
- Tissue Engineering Research Group, Department of Anatomy and Regenerative Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland
- SFI Advanced Materials and Bioengineering Research (AMBER) Center, Royal College of Surgeons in Ireland and Trinity College Dublin, Dublin, Ireland
- SFI Center for Research in Medical Devices (CÚRAM), Royal College of Surgeons in Ireland, Dublin, Ireland
- Trinity Center for Biomedical Engineering, Trinity College Dublin, Dublin, Ireland
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11
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Poly-ε-caprolactone scaffold for the reinforcement of stapled small intestinal anastomoses: a randomized experimental study. Langenbecks Arch Surg 2019; 404:1009-1016. [PMID: 31776655 DOI: 10.1007/s00423-019-01843-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Accepted: 11/13/2019] [Indexed: 12/14/2022]
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12
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Oetzmann von Sochaczewski C, Lindner A, Heimann A, Balus A, Patel VH, Harrison MR, Muensterer OJ. Beyond Magnamosis: A Method to Test Sutureless Esophageal Anastomotic Devices in Living Swine by Creating an Esophageal Bypass Loop for Natural Oral Nutrition. J Laparoendosc Adv Surg Tech A 2019; 29:852-855. [PMID: 30882275 DOI: 10.1089/lap.2018.0778] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Introduction: Thoracoscopic esophageal atresia repair has become increasingly popular, but is still limited to a few expert centers and has some challenges and shortcomings. One of them has a longer operation time compared with conventional thoracotomy. Magnetic compression anastomosis may contribute toward shorter operation times by avoiding the time-consuming anastomotic suturing. We aimed to establish a method of testing sutureless anastomoses in parallel to having swine eating the natural way. Materials and Methods: We used four juvenile Pietrain swine-aged 8 weeks, weighing 15 kg-to establish a living animal model after preceding cadaver tests. Esophagi were fully mobilized through right-sided thoracotomy to gain sufficient length to create an esophageal loop that served as a bypass for food after magnet deployment. Six hours later, patency of the bypass esophageal loop was assessed by passing an orogastric tube and by allowing swine to drink methylene blue-stained water. We also tested the device stability using the classical burst pressure test. Results: The esophageal lumen was patent for feeding tube. Swine were able to drink and methylene blue colored fluid reached the stomach. Clinical signs of obstruction such as regurgitation or coughing were absent. Magnets sustained burst pressures up to 200,000 Pascal until they became disrupted. At 6 hours after magnet placing, we already saw subtle esophageal mucosa erosions indicating the beginning of anastomotic formation. Conclusion: This animal model is useful to test different magnet designs for sutureless esophageal anastomosis or even future devices for in vivo tissue engineering.
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Affiliation(s)
| | - Andreas Lindner
- 1 Department of Paediatric Surgery, and Universitätsmedizin Mainz der Johannes-Gutenberg-Universität, Mainz, Germany
| | - Axel Heimann
- 2 Department of Neurosurgical Pathophysiology, Universitätsmedizin Mainz der Johannes-Gutenberg-Universität, Mainz, Germany
| | - Alexandru Balus
- 3 Division of Pediatric Surgery, University of California, San Francisco, California
| | - Veeshal H Patel
- 3 Division of Pediatric Surgery, University of California, San Francisco, California
| | - Michael R Harrison
- 3 Division of Pediatric Surgery, University of California, San Francisco, California
| | - Oliver J Muensterer
- 1 Department of Paediatric Surgery, and Universitätsmedizin Mainz der Johannes-Gutenberg-Universität, Mainz, Germany
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13
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Huang J, Ren Y, Wu X, Li Z, Ren J. Gut bioengineering promotes gut repair and pharmaceutical research: a review. J Tissue Eng 2019; 10:2041731419839846. [PMID: 31037215 PMCID: PMC6475831 DOI: 10.1177/2041731419839846] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2018] [Accepted: 03/05/2019] [Indexed: 12/11/2022] Open
Abstract
The gastrointestinal (GI) tract has a diverse set of physiological functions, including peristalsis, immune defense, and nutrient absorptions. These functions are mediated by various intestinal cells such as epithelial cells, interstitial cells, smooth muscle cells, and neurocytes. The loss or dysfunction of specific cells directly results in GI disease, while supplementation of normal cells promotes gut healing. Gut bioengineering has been developing for this purpose to reconstruct the damaged tissues. Moreover, GI tract provides an accessible route for drug delivery, but the collateral damages induced by side effects cannot be ignored. Bioengineered intestinal tissues provide three-dimensional platforms that mimic the in vivo environment to study drug functions. Given the importance of gut bioengineering in current research, in this review, we summarize the advances in the technologies of gut bioengineering and their applications. We were able to identify several ground-breaking discoveries in our review, while more work is needed to promote the clinical translation of gut bioengineering.
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Affiliation(s)
- Jinjian Huang
- School of Medicine, Southeast University, Nanjing, China.,Laboratory for Trauma and Surgical Infections, Department of Surgery, Jinling Hospital, Nanjing, China
| | - Yanhan Ren
- Chicago Medical School, Rosalind Franklin University of Medicine and Science, North Chicago, IL, USA
| | - Xiuwen Wu
- Laboratory for Trauma and Surgical Infections, Department of Surgery, Jinling Hospital, Nanjing, China
| | - Zongan Li
- School of NARI Electrical and Automation Engineering, Nanjing Normal University, Nanjing, China
| | - Jianan Ren
- School of Medicine, Southeast University, Nanjing, China.,Laboratory for Trauma and Surgical Infections, Department of Surgery, Jinling Hospital, Nanjing, China
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14
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Zakhem E, Raghavan S, Suhar RA, Bitar KN. Bioengineering and regeneration of gastrointestinal tissue: where are we now and what comes next? Expert Opin Biol Ther 2019; 19:527-537. [PMID: 30880502 DOI: 10.1080/14712598.2019.1595579] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
INTRODUCTION The field of tissue engineering and regenerative medicine has been applied to the gastrointestinal (GI) tract for a couple decades. Several achievements have been accomplished that provide promising tools for treating diseases of the GI tract. AREAS COVERED The work described in this review covers the traditional aspect of using cells and scaffolds to replace parts of the tract. Several studies investigated different types of biomaterials and different types of cells. A more recent approach involved the use of gut-derived organoid units that can differentiate into all gut cell layers. The most recent approach introduced the use of organ-on-a-chip concept to understand the physiology and pathophysiology of the GI system. EXPERT OPINION The different approaches tackle the diseases of the GI tract from different perspectives. While all these different approaches provide a promising and encouraging future for this field, the translational aspect is yet to be studied.
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Affiliation(s)
- Elie Zakhem
- a Wake Forest Institute for Regenerative Medicine , Wake Forest School of Medicine , Winston Salem , NC , USA.,b Section on Gastroenterology , Wake Forest School of Medicine , Winston Salem , NC , USA
| | - Shreya Raghavan
- c Department of Materials Science and Engineering , University of Michigan , Ann Arbor , MI , USA
| | - Riley A Suhar
- d Department of Materials Science and Engineering , Stanford University , Stanford , CA , USA
| | - Khalil N Bitar
- a Wake Forest Institute for Regenerative Medicine , Wake Forest School of Medicine , Winston Salem , NC , USA.,b Section on Gastroenterology , Wake Forest School of Medicine , Winston Salem , NC , USA.,e Virginia Tech-Wake Forest School of Biomedical Engineering Sciences , Winston-Salem , NC , USA
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15
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Wu B, Takeshita N, Wu Y, Vijayavenkataraman S, Ho KY, Lu WF, Fuh JYH. Pluronic F127 blended polycaprolactone scaffolds via e-jetting for esophageal tissue engineering. JOURNAL OF MATERIALS SCIENCE. MATERIALS IN MEDICINE 2018; 29:140. [PMID: 30120625 DOI: 10.1007/s10856-018-6148-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Accepted: 08/05/2018] [Indexed: 06/08/2023]
Abstract
Several attempts have been made to fabricate esophageal tissue engineering scaffolds. However, most of these scaffolds possess randomly oriented fibres and uncontrollable pore sizes. In order to mimic the native esophageal tissue structure, electro-hydrodynamic jetting (e-jetting) was used in this study to fabricate scaffolds with aligned fibres and controlled pore size. A hydrophilic additive, Pluronic F127 (F127), was blended with polycaprolactone (PCL) to improve the wettability of the scaffolds and hence the cell adhesion. PCL/F127 composite scaffolds with different weight ratios (0-12%) were fabricated. The wettability, phase composition, and the mechanical properties of the fabricated scaffolds were investigated. The results show that the e-jetted scaffolds have controllable fibres orientated in two perpendicular directions, which are similar to the human esophagus structure and suitable pore size for cell infiltration. In addition, the scaffolds with 8% F127 exhibited better wettability (contact angle of 14°) and an ultimate tensile strength (1.2 MPa) that mimics the native esophageal tissue. Furthermore, primary human esophageal fibroblasts were seeded on the e-jetted scaffolds. PCL/F127 scaffolds showed enhanced cell proliferation and expression of the vascular endothelial growth factor (VEGF) compared to pristine PCL scaffolds (1.5- and 25.8- fold increase, respectively; P < 0.001). An in vitro wound model made using the PCL/F127 scaffolds showed better cell migration than the PCL scaffolds. In summary, the PCL/F127 e-jetted scaffolds offer a promising strategy for the esophagus tissue repair.
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Affiliation(s)
- Bin Wu
- Department of Mechanical Engineering, National University of Singapore, Singapore, 117576, Singapore
| | - Nobuyoshi Takeshita
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, 119228, Singapore
- Division of Gastroenterology and Hepatology, National University Health System, Singapore, 119228, Singapore
| | - Yang Wu
- Engineering Science and Mechanics Department, Penn State University, University Park, PA, 16802, USA
- The Huck Institutes of the Life Sciences, Penn State University, University Park, PA, 16802, USA
| | | | - Khek Yu Ho
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, 119228, Singapore
- Division of Gastroenterology and Hepatology, National University Health System, Singapore, 119228, Singapore
| | - Wen Feng Lu
- Department of Mechanical Engineering, National University of Singapore, Singapore, 117576, Singapore
| | - Jerry Ying Hsi Fuh
- Department of Mechanical Engineering, National University of Singapore, Singapore, 117576, Singapore.
- National University of Singapore (Suzhou) Research Institute, Suzhou Industrial Park, Suzhou, 215123, People's Republic of China.
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16
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How CH, Lin CW, Lin YC, Young TH, Chen KC, Chen JS. Evaluation of pleurodesis by poly-ε-caprolactone (PCL) gel in an animal model using New Zealand white rabbits. Asian J Surg 2018; 42:495-500. [PMID: 30104088 DOI: 10.1016/j.asjsur.2018.07.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Accepted: 07/05/2018] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND/PURPOSE Pleurodesis with biomaterial implant is an emerging treatment method for pleural diseases. However, the ideal biomaterial or the optimal form for the common diseases is still under investigation. In our previous study, Poly-ε-caprolactone (PCL) membrane produces significant pleurodesis in New Zealand White rabbit animal models. METHODS We investigate the Poly-ε-caprolactone (PCL) gel pleurodesis by animal models using New Zealand White rabbits, which were sacrificed for examination after one month. Thirty-Six New Zealand White rabbits were randomized into three groups equally to undergo procedures. Gross pleurodesis scoring was evaluated. Additionally, inflammation and fibrosis scoring were done under microscopic evaluation, as well as Western blot analysis. RESULTS Gross evaluation of pleurodesis score revealed that lower concentrated PCL gel (10%) produced moderate pleural adhesion, while higher concentrated PCL gel (25%) showed significantly higher pleurodesis scores. (P < 0.05) Control group with thoracostomy alone produced almost no pleurodesis (P < 0.05). Western blot showed fibronectin expression was more evident in the 25% PCL gel than 10% one. CONCLUSION PCL gel induced significant degree of pleurodesis in the rabbits. The 25% PCL gel produces more intensive adhesion than 10% one. Fibronectin plays an important role in the process of pleurodesis. Further study is required for the clinical application of the promising biomaterial with gel form.
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Affiliation(s)
- Cheng-Hung How
- Institute of Biomedical Engineering, College of Medicine and College of Engineering, National Taiwan University, Taipei, 100, Taiwan
| | - Chi-Wei Lin
- Department of Surgery, National Taiwan University Hospital, Taipei, 100, Taiwan
| | - Yong-Chong Lin
- Institute of Biomedical Engineering, College of Medicine and College of Engineering, National Taiwan University, Taipei, 100, Taiwan
| | - Tai-Horng Young
- Institute of Biomedical Engineering, College of Medicine and College of Engineering, National Taiwan University, Taipei, 100, Taiwan.
| | - Ke-Cheng Chen
- Institute of Biomedical Engineering, College of Medicine and College of Engineering, National Taiwan University, Taipei, 100, Taiwan; Department of Surgery, National Taiwan University Hospital, Taipei, 100, Taiwan.
| | - Jin-Shing Chen
- Department of Surgery, National Taiwan University Hospital, Taipei, 100, Taiwan
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17
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Gates KV, Griffiths LG. Chronic graft-specific cell-mediated immune response toward candidate xenogeneic biomaterial. Immunol Res 2018; 66:288-298. [PMID: 29446013 DOI: 10.1007/s12026-018-8985-8] [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: 10/18/2022]
Abstract
Despite rabbits becoming an increasingly popular animal model, a flow cytometry panel that combines T cell markers (CD3, CD4, CD8, CD25, FOXP3) with a method for monitoring proliferation is lacking in this species. It has been shown that the rabbit model can be used to identify xenoantigens within bovine pericardium (BP), a common biological heart valve replacement material; however, these methods rely on monitoring the humoral immune response. The development of a rabbit T cell proliferation assay has utility in monitoring graft-specific cell-mediated immune responses toward bovine pericardium. Isolation and culture conditions were optimized to avoid cell death, red blood cell contamination, and non-specific proliferation. Effect of cell culture and stimulation on distribution and intensity of T cell markers was analyzed and compared between cells isolated from naïve and BP-immunized rabbits. Submaximal levels (0.25 μg/mL) of concavalin A were used to stimulate proliferation toward BP extract, with resultant proliferation compared between naïve and BP-immunized rabbits. Density stratification followed by ammonium potassium chloride (ACK) lysis yielded the greatest number of viable peripheral blood mononuclear cells with the least amount of erythrocyte contamination. Flat-bottomed plates were necessary to reduce non-specific proliferation in culture. T cells responded appropriately to maximal mitogenic stimulation (5 μg/mL concavalin A). Interestingly, immunization increased the intensity of FOXP3 in T regulatory cells compared to cells from naïve animals. With addition of submaximal levels of concavalin A, T cells from immunized rabbits proliferated in response to BP protein extract, while cells from naïve rabbits did not. In immunized rabbits, not only did more CD4+ T cells proliferate in response to BP re-stimulation, but the intensity of CD25 was increased indicating cell activation. This research provides a functional cell-mediated screening assay for assessment of BP-based biomaterials in rabbits, overcoming the limitations of previous humoral immune system-based assessments of biomaterial antigenicity in this important experimental animal species.
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Affiliation(s)
- Katherine V Gates
- Department of Veterinary Medicine: Medicine and Epidemiology, University of California, Davis, One Shields Avenue, Davis, CA, 95616, USA.,Department of Cardiovascular Diseases, Mayo Clinic, 200 First Street SW, Stabile 4-58, Rochester, MN, 55905, USA
| | - Leigh G Griffiths
- Department of Cardiovascular Diseases, Mayo Clinic, 200 First Street SW, Stabile 4-58, Rochester, MN, 55905, USA.
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18
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Chung EJ. Bioartificial Esophagus: Where Are We Now? ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2018; 1064:313-332. [DOI: 10.1007/978-981-13-0445-3_19] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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19
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Kanetaka K, Kobayashi S, Eguchi S. Regenerative medicine for the esophagus. Surg Today 2017; 48:739-747. [PMID: 29214351 DOI: 10.1007/s00595-017-1610-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Accepted: 11/06/2017] [Indexed: 12/29/2022]
Abstract
Advances in tissue engineering techniques have made it possible to use human cells as biological material. This has enabled pharmacological studies to be conducted to investigate drug effects and toxicity, to clarify the mechanisms underlying diseases, and to elucidate how they compensate for impaired organ function. Many researchers have tried to construct artificial organs using these techniques, but none has succeeded in growing a whole organ. Unlike other digestive organs with complicated functions, such as the processing and absorption of nutrients, the esophagus has the relatively simple function of transporting content, which can be replicated easily by a substitute. In regenerative medicine, various combinations of materials have been applied, including scaffolding, cell sources, and bioreactors. Exciting results of tissue engineering techniques for the esophagus have been reported. In animal models, replacing full-thickness and full-circumferential defects remains challenging because of stenosis and leakage after implantation. Although many reports have manipulated various scaffolds, most have emphasized the importance of both epithelial and mesenchymal cells for the prevention of stenosis. However, the results of repair of partial full-thickness defects and mucosal defects have been promising. Two successful approaches for the replacement of mucosal defects in a clinical setting have been reported, although in contrast to the many animal models, there are few pilot studies in humans. We review the recent results and evaluate the future of regenerative medicine for the esophagus.
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Affiliation(s)
- Kengo Kanetaka
- Department of Surgery, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan
| | - Shinichiro Kobayashi
- Department of Surgery, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan.
| | - Susumu Eguchi
- Department of Surgery, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan
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20
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Lee E, Milan A, Urbani L, De Coppi P, Lowdell MW. Decellularized material as scaffolds for tissue engineering studies in long gap esophageal atresia. Expert Opin Biol Ther 2017; 17:573-584. [PMID: 28303723 DOI: 10.1080/14712598.2017.1308482] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
INTRODUCTION Esophageal atresia refers to an anomaly in foetal development in which the esophagus terminates in a blind end. Whilst surgical correction is achievable in most patients, when a long gap is present it still represents a major challenge associated with higher morbidity and mortality. In this context, tissue engineering could represent a successful alternative to restore oesophageal function and structure. Naturally derived biomaterials made of decellularized tissues retain native extracellular matrix architecture and composition, providing a suitable bed for the anchorage and growth of relevant cell types. Areas covered: This review outlines the various strategies and challenges in esophageal tissue engineering, highlighting the evolution of ideas in the development of decellularized scaffolds for clinical use. It explores the interplay between clinical needs, ethical dilemmas, and manufacturing challenges in the development of a tissue engineered decellularized scaffold for oesophageal atresia. Expert opinion: Current progress on oesophageal tissue engineering has enabled effective repair of patch defects, whilst the development of a full circumferential construct remains a challenge. Despite the different approaches available and the improvements achieved, a gold standard for fully functional tissue engineered oesophageal constructs has not been defined yet.
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Affiliation(s)
- Esmond Lee
- a Centre for Cell, Gene & Tissue Therapeutics , Royal Free Hospital , London , UK.,b Institute for Stem Cell Biology and Regenerative Medicine , Stanford University , Stanford , CA , USA.,c Bioprocessing Technology Institute, Agency for Science Technology and Research (A*STAR) , Singapore
| | - Anna Milan
- d Stem Cells and Regenerative Medicine Section , UCL Great Ormond Street Institute of Child Health , London , UK
| | - Luca Urbani
- d Stem Cells and Regenerative Medicine Section , UCL Great Ormond Street Institute of Child Health , London , UK
| | - Paolo De Coppi
- d Stem Cells and Regenerative Medicine Section , UCL Great Ormond Street Institute of Child Health , London , UK
| | - Mark W Lowdell
- a Centre for Cell, Gene & Tissue Therapeutics , Royal Free Hospital , London , UK
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21
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Chen KC, Hsieh MS, Li YR, Lin YC, Lai HS, Shieh MJ, Chen JS, Young TH. Study of poly-ɛ-caprolactone membranes for pleurodesis. J Formos Med Assoc 2017; 116:880-887. [PMID: 28215672 DOI: 10.1016/j.jfma.2016.12.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2016] [Revised: 12/06/2016] [Accepted: 12/29/2016] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND/PURPOSE Pleurodesis with biomaterial membrane is an emerging treatment method for pneumothorax. However, the ideal one for the common disease is still under debate. METHODS We investigate the Poly-ε-caprolactone (PCL) membrane pleurodesis by using New Zealand White rabbits, which was sacrificed for examination one month later. Moreover, inflammation and fibrosis scoring were done under microscopic evaluation, as well as Western blot analysis in vitro and in vivo. RESULTS Gross evaluation of pleurodesis score revealed that dense PCL membrane produced moderate pleural adhesion, while porous PCL membrane exhibited significantly higher pleurodesis scores. CONCLUSION PCL membrane induced significant degree of adhesion, both within the abdomen and chest of the rabbits. The porous PCL membrane produces more intensive adhesion than dense one. Fibronectin plays an important role in the process of pleurodesis. Further study is required for the clinical application of the promising material.
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Affiliation(s)
- Ke-Cheng Chen
- Institute of Biomedical Engineering, College of Medicine and College of Engineering, National Taiwan University, Taipei, Taiwan; Department of Surgery, National Taiwan University Hospital, Taipei, Taiwan
| | - Min-Shu Hsieh
- Department of Pathology, National Taiwan University Hospital, Taipei, Taiwan
| | - Yun-Ru Li
- Institute of Biomedical Engineering, College of Medicine and College of Engineering, National Taiwan University, Taipei, Taiwan
| | - Yong-Chong Lin
- Institute of Biomedical Engineering, College of Medicine and College of Engineering, National Taiwan University, Taipei, Taiwan
| | - Hong-Shiee Lai
- Department of Surgery, National Taiwan University Hospital, Taipei, Taiwan
| | - Ming-Jium Shieh
- Institute of Biomedical Engineering, College of Medicine and College of Engineering, National Taiwan University, Taipei, Taiwan; Department of Oncology, National Taiwan University Hospital, Taipei, Taiwan
| | - Jin-Shing Chen
- Department of Surgery, National Taiwan University Hospital, Taipei, Taiwan.
| | - Tai-Horng Young
- Institute of Biomedical Engineering, College of Medicine and College of Engineering, National Taiwan University, Taipei, Taiwan.
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22
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Polycaprolactone/Pluronic F127 Tissue Engineering Scaffolds via Electrohydrodynamic Jetting for Gastro Intestinal Repair. ACTA ACUST UNITED AC 2017. [DOI: 10.1016/j.procir.2017.04.045] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Yekrang J, Semnani D, Karbasi S. Optimizing the mechanical properties of a bi-layered knitted/nanofibrous esophageal prosthesis using artificial intelligence. E-POLYMERS 2016. [DOI: 10.1515/epoly-2016-0146] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
AbstractThe esophagus is a tubular multi-layer organ that carries the food bolus and liquids from the mouth to the stomach. Esophageal prostheses and scaffolds should have the appropriate mechanical and strain properties in the longitudinal and circumferential directions. A novel bi-layered esophageal prosthesis was produced using knitted tubular silk fabric and a coating of polyurethane (PU) nanofibers. The optimization process was performed in two steps. First, 12 different tubular structures of knitted silk fabrics were produced and mechanical properties were measured in both directions. The mechanical properties were optimized using an artificial neural network (ANN) and a genetic algorithm (GA) and the optimum knitted structure was produced as a substrate for coating with PU nanofibers. In second step, 20 different samples were produced by electrospinning the PU nanofibers at different process conditions (collector speed, feeding rate) on the optimized structure of the knitted fabric. Finally, the elastic properties of the bi-layered tubular structures were measured and optimized by the ANN and GA methods. Results presented show that the optimized structure of the esophageal prosthesis had proper mechanical properties similar to the esophagus. Such a structure can be used as a substitute in esophageal disorders.
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Affiliation(s)
- Javad Yekrang
- 1Department of Textile Engineering, Isfahan University of Technology, Isfahan, Iran (Islamic Republic of)
| | - Dariush Semnani
- 1Department of Textile Engineering, Isfahan University of Technology, Isfahan, Iran (Islamic Republic of)
| | - Saeed Karbasi
- 2Department of Biomaterials and Tissue Engineering, School of Advance Technology in Medicine, Isfahan University of Medical Sciences, Isfahan, Iran (Islamic Republic of)
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Abstract
Functions of the gastrointestinal tract include motility, digestion and absorption of nutrients. These functions are mediated by several specialized cell types including smooth muscle cells, neurons, interstitial cells and epithelial cells. In gastrointestinal diseases, some of the cells become degenerated or fail to accomplish their normal functions. Surgical resection of the diseased segments of the gastrointestinal tract is considered the gold-standard treatment in many cases, but patients might have surgical complications and quality of life can remain low. Tissue engineering and regenerative medicine aim to restore, repair, or regenerate the function of the tissues. Gastrointestinal tissue engineering is a challenging process given the specific phenotype and alignment of each cell type that colonizes the tract - these properties are critical for proper functionality. In this Review, we summarize advances in the field of gastrointestinal tissue engineering and regenerative medicine. Although the findings are promising, additional studies and optimizations are needed for translational purposes.
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Affiliation(s)
- Khalil N Bitar
- Wake Forest Institute for Regenerative Medicine, Wake Forest School of Medicine, 391 Technology Way NE, Winston Salem, North Carolina 27101, USA.,Department of Molecular Medicine and Translational Sciences, Wake Forest School of Medicine, 1 Medical Center Blvd, Winston Salem, North Carolina 27157, USA.,Virginia Tech-Wake Forest School of Biomedical Engineering and Sciences, 391 Technology Way NE, Winston Salem, North Carolina 27101, USA
| | - Elie Zakhem
- Wake Forest Institute for Regenerative Medicine, Wake Forest School of Medicine, 391 Technology Way NE, Winston Salem, North Carolina 27101, USA.,Department of Molecular Medicine and Translational Sciences, Wake Forest School of Medicine, 1 Medical Center Blvd, Winston Salem, North Carolina 27157, USA
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Park SY, Choi JW, Park JK, Song EH, Park SA, Kim YS, Shin YS, Kim CH. Tissue-engineered artificial oesophagus patch using three-dimensionally printed polycaprolactone with mesenchymal stem cells: a preliminary report. Interact Cardiovasc Thorac Surg 2016; 22:712-7. [PMID: 26969739 DOI: 10.1093/icvts/ivw048] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2015] [Accepted: 01/26/2016] [Indexed: 01/05/2023] Open
Abstract
OBJECTIVES There has been a recent focus on 3D printing with regard to tissue engineering. We evaluated the efficacy of a 3D-printed (3DP) scaffold coated with mesenchymal stem cells (MSCs) seeded in fibrin for the repair of partial oesophageal defects. METHODS MSCs from rabbit bone marrow were cultured, and a 3DP polycaprolactone (PCL) scaffold was coated with the MSCs seeded in fibrin. The fibrin/MSC-coated 3DP PCL scaffold was implanted on a 5 × 10 mm artificial oesophageal defect in three rabbits (3DP/MSC group) and 3DP PCL-only scaffolds were implanted in three rabbits (3DP-only group). Three weeks post-procedure, the implanted sites were evaluated radiologically and histologically. RESULTS None of the rabbits showed any infection, stenosis or granulation on computed tomography. In the 3DP/MSC group, the replaced scaffolds were completely covered with regenerating mucosal epithelium and smooth muscle cells as determined by haematoxylin and eosin and Desmin staining. However, mucosal epithelium and smooth muscle cell regeneration was not evident in the 3DP-only group. CONCLUSIONS Use of the 3DP scaffold coated with MSCs seeded in fibrin resulted in successful restoration of the shape and histology of the cervical oesophagus without any graft rejection; thus, this is a promising material for use as an artificial oesophagus.
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Affiliation(s)
- Seong Yong Park
- Department of Thoracic and Cardiovascular Surgery, Ajou University, Suwon, Republic of Korea
| | - Jae Won Choi
- Department of Otolaryngology, School of Medicine, Ajou University, Suwon, Republic of Korea
| | - Ju-Kyeong Park
- Department of Otolaryngology, School of Medicine, Ajou University, Suwon, Republic of Korea Department of Molecular Science & Technology, Ajou University, Suwon, Republic of Korea
| | - Eun Hye Song
- Department of Otolaryngology, School of Medicine, Ajou University, Suwon, Republic of Korea
| | - Su A Park
- Nature-Inspired Mechanical System Team, Nano Convergence & Manufacturing Systems Research Division, Korea Institute of Machinery and Materials, Daejeon, Republic of Korea
| | - Yeon Soo Kim
- Department of Otolaryngology, School of Medicine, Ajou University, Suwon, Republic of Korea
| | - Yoo Seob Shin
- Department of Otolaryngology, School of Medicine, Ajou University, Suwon, Republic of Korea
| | - Chul-Ho Kim
- Department of Otolaryngology, School of Medicine, Ajou University, Suwon, Republic of Korea Department of Molecular Science & Technology, Ajou University, Suwon, Republic of Korea
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Londono R, Badylak SF. Regenerative Medicine Strategies for Esophageal Repair. TISSUE ENGINEERING PART B-REVIEWS 2015; 21:393-410. [PMID: 25813694 DOI: 10.1089/ten.teb.2015.0014] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Pathologies that involve the structure and/or function of the esophagus can be life-threatening. The esophagus is a complex organ comprising nonredundant tissue that does not have the ability to regenerate. Currently available interventions for esophageal pathology have limited success and are typically associated with significant morbidity. Hence, there is currently an unmet clinical need for effective methods of esophageal repair. The present article presents a review of esophageal disease along with the anatomic and functional consequences of each pathologic process, the shortcomings associated with currently available therapies, and the latest advancements in the field of regenerative medicine with respect to strategies for esophageal repair from benchtop to bedside.
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Affiliation(s)
- Ricardo Londono
- 1 McGowan Institute for Regenerative Medicine, University of Pittsburgh , Pittsburgh, Pennsylvania.,2 School of Medicine, University of Pittsburgh , Pittsburgh, Pennsylvania
| | - Stephen F Badylak
- 1 McGowan Institute for Regenerative Medicine, University of Pittsburgh , Pittsburgh, Pennsylvania.,3 Department of Bioengineering, University of Pittsburgh , Pittsburgh, Pennsylvania.,4 Department of Surgery, University of Pittsburgh , Pittsburgh, Pennsylvania
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27
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Tissue engineered scaffolds for an effective healing and regeneration: reviewing orthotopic studies. BIOMED RESEARCH INTERNATIONAL 2014; 2014:398069. [PMID: 25250319 PMCID: PMC4163448 DOI: 10.1155/2014/398069] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/18/2014] [Accepted: 07/22/2014] [Indexed: 12/20/2022]
Abstract
It is commonly stated that tissue engineering is the most promising approach to treat or replace failing tissues/organs. For this aim, a specific strategy should be planned including proper selection of biomaterials, fabrication techniques, cell lines, and signaling cues. A great effort has been pursued to develop suitable scaffolds for the restoration of a variety of tissues and a huge number of protocols ranging from in vitro to in vivo studies, the latter further differentiating into several procedures depending on the type of implantation (i.e., subcutaneous or orthotopic) and the model adopted (i.e., animal or human), have been developed. All together, the published reports demonstrate that the proposed tissue engineering approaches spread toward multiple directions. The critical review of this scenario might suggest, at the same time, that a limited number of studies gave a real improvement to the field, especially referring to in vivo investigations. In this regard, the present paper aims to review the results of in vivo tissue engineering experimentations, focusing on the role of the scaffold and its specificity with respect to the tissue to be regenerated, in order to verify whether an extracellular matrix-like device, as usually stated, could promote an expected positive outcome.
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28
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Abstract
Esophageal atresia occurs in 1 out of 3000 births. Current treatments involve esophageal replacement by using more distal parts of the gastrointestinal tract, such as the stomach, jejunum, and colon. Significant complications are associated with each treatment option. Tissue engineering may provide a therapeutic alternative for esophageal replacement. This article addresses the progress in esophageal tissue engineering using acellular and cell-seeded approaches. In addition, we discuss the potential direction of future approaches by critically appraising the results in the recent literature.
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Affiliation(s)
- Panagiotis Maghsoudlou
- Surgery Unit, UCL Institute of Child Health and Great Ormond Street Hospital, 30 Guilford St, London WC1N 1EH, UK
| | - Simon Eaton
- Surgery Unit, UCL Institute of Child Health and Great Ormond Street Hospital, 30 Guilford St, London WC1N 1EH, UK
| | - Paolo De Coppi
- Surgery Unit, UCL Institute of Child Health and Great Ormond Street Hospital, 30 Guilford St, London WC1N 1EH, UK.
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