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Kaye R, Cao A, Goldstein T, Grande DA, Zeltsman D, Smith LP. Biomechanical properties of the ex vivo porcine trachea: A benchmark for three-dimensional bioprinted airway replacements. Am J Otolaryngol 2022; 43:103217. [PMID: 34537505 DOI: 10.1016/j.amjoto.2021.103217] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Accepted: 09/05/2021] [Indexed: 11/19/2022]
Abstract
PURPOSE Combining tissue engineering and three-dimensional (3D) printing may allow for the introduction of a living functional tracheal replacement graft. However, defining the biomechanical properties of the native trachea is a key prerequisite to clinical translation. To achieve this, we set out to define the rotation, axial stretch capacity, and positive intraluminal pressure capabilities for ex vivo porcine tracheas. STUDY DESIGN Animal study. MATERIALS AND METHODS Six full-length ex vivo porcine tracheas were bisected into 5.5 cm segments. Maximal positive intraluminal pressure was measured by sealing segment ends with custom designed 3D printed caps through which a pressure transducer was introduced. Axial stretch capacity and rotation were evaluated by stretching and rotating the segments along their axis between two clamps, respectively. RESULTS Six segments were tested for axial lengthening and the average post-stretch length percentage was 148.92% (range 136.81-163.48%, 95% CI 153-143%). The mean amount of length gain achieved per cartilaginous ring was 7.82% (range 4.71-10.95%, 95% CI 6.3-9.35%). Four tracheal segments were tested for maximal positive intraluminal pressure, which was over 400 mmHg. Degree of rotation testing found that the tracheal segments easily transformed 180° in anterior-posterior bending, lateral bending, and axial rotational twisting. CONCLUSIONS We define several biomechanical properties of the ex vivo porcine trachea by reporting the rotation, axial stretch capacity, and positive intraluminal pressure capabilities. We hope that this will aid future work in the clinical translation of 3D bioprinted airway replacement grafts and ensure their compatibility with native tracheal properties.
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Affiliation(s)
- Rachel Kaye
- Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, NJ, United States of America.
| | - Angela Cao
- Department of Otolaryngology-Head and Neck Surgery, Albert Einstein School of Medicine/Montefiore Medical Center, Bronx, NY, United States of America
| | - Todd Goldstein
- The Feinstein Institute for Medical Research, Manhasset, NY, United States of America; The Donald and Barbara Zucker School of Medicine at Hofstra/Northwell Health, Hempstead, NY, United States of America
| | - Daniel A Grande
- The Feinstein Institute for Medical Research, Manhasset, NY, United States of America; The Donald and Barbara Zucker School of Medicine at Hofstra/Northwell Health, Hempstead, NY, United States of America
| | - David Zeltsman
- The Donald and Barbara Zucker School of Medicine at Hofstra/Northwell Health, Hempstead, NY, United States of America; Division of Thoracic Surgery, Northwell Health System, New Hyde Park, NY, United States of America
| | - Lee P Smith
- The Donald and Barbara Zucker School of Medicine at Hofstra/Northwell Health, Hempstead, NY, United States of America; Division of Pediatric Otolaryngology, Steven and Alexandra Cohen Children's Medical Center, New Hyde Park, NY, United States of America
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Balla Z, Andrási N, Pólai Z, Visy B, Czaller I, Temesszentandrási G, Csuka D, Varga L, Farkas H. The characteristics of upper airway edema in hereditary and acquired angioedema with C1-inhibitor deficiency. Clin Transl Allergy 2021; 11:e12083. [PMID: 34962723 PMCID: PMC8805691 DOI: 10.1002/clt2.12083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Revised: 11/02/2021] [Accepted: 11/14/2021] [Indexed: 11/24/2022] Open
Abstract
Background Angioedemas localized in the upper airway are potentially life threatening, and without proper treatment, they may lead to death by suffocation. Upper airway edemas (UAE) in bradykinin‐mediated angioedemas can even be the first symptoms of the disease. Methods Our survey was performed with a retrospective long‐term follow‐up method from the medical history of 197 hereditary (C1‐INH‐HAE) and 20 acquired C1‐inhibitor deficiency (C1‐INH‐AAE), 3 factor XII and 3 plasminogen gene mutation (FXII‐HAE, PLG‐HAE) patients treated at our center between 1990 and 2020. The UAE group included edemas localized to the mesopharynx, hypopharynx, and larynx, as narrowing of these anatomical regions can lead to suffocation. Results 98/197 C1‐INH‐HAE (47 families) and 13/20 C1‐INH‐AAE, 1/3 PLG‐HAE, 1/3 FXII‐HAE patients had experienced UAE at least once according to their medical history. In case of C1‐INH‐HAE patients, in 6/47 families who had undiagnosed ancestors had 13 members who died of suffocation. After the diagnosis, 1‐1 member of two families died of UAE. 44/64 C1‐INH‐HAE patients did not smoke, 20/64 did. The occurrence of UAE was significantly higher in smoker patients. We analyzed 7607 HAE attacks of 56/98 patients. Out of all attacks, the incidence of UAE in the C1‐INH‐HAE group was 4%, and 9.5% in the C1‐INH‐AAE group, respectively. Conclusion Early diagnosis is key in bradykinin‐mediated angioedemas cases, since the patient must be provided with adequate treatment; and also it is essential to inform patients about the importance of avoiding the trigger factors and the early symptoms of UAE, as these measures could significantly decrease the incidence of lethal UAEs.
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Affiliation(s)
- Zsuzsanna Balla
- Department of Internal Medicine and Haematology, Hungarian Angioedema Center of Reference and Excellence, Semmelweis University, Budapest, Hungary.,School of PhD Studies, Semmelweis University, Budapest, Hungary
| | - Noémi Andrási
- Department of Internal Medicine and Haematology, Hungarian Angioedema Center of Reference and Excellence, Semmelweis University, Budapest, Hungary.,School of PhD Studies, Semmelweis University, Budapest, Hungary.,2nd Department of Pediatrics, Semmelweis University, Budapest, Hungary
| | - Zsófia Pólai
- Department of Internal Medicine and Haematology, Hungarian Angioedema Center of Reference and Excellence, Semmelweis University, Budapest, Hungary.,School of PhD Studies, Semmelweis University, Budapest, Hungary
| | - Beáta Visy
- Department of Internal Medicine and Haematology, Hungarian Angioedema Center of Reference and Excellence, Semmelweis University, Budapest, Hungary.,Heim Pál Children's Hospital, Budapest, Hungary
| | - Ibolya Czaller
- Department of Pulmonology, Semmelweis University, Budapest, Hungary
| | | | - Dorottya Csuka
- Research Laboratory, Department of Internal Medicine and Haematology, Semmelweis University, Budapest, Hungary.,MTA-SE Research Group of Immunology and Hematology, Hungarian Academy of Sciences and Semmelweis University, Budapest, Hungary
| | - Lilian Varga
- Department of Internal Medicine and Haematology, Hungarian Angioedema Center of Reference and Excellence, Semmelweis University, Budapest, Hungary
| | - Henriette Farkas
- Department of Internal Medicine and Haematology, Hungarian Angioedema Center of Reference and Excellence, Semmelweis University, Budapest, Hungary
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Kaye R, Goldstein T, Grande DA, Zeltsman D, Smith LP. A 3-dimensional bioprinted tracheal segment implant pilot study: Rabbit tracheal resection with graft implantation. Int J Pediatr Otorhinolaryngol 2019; 117:175-178. [PMID: 30579077 DOI: 10.1016/j.ijporl.2018.11.010] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Revised: 11/06/2018] [Accepted: 11/08/2018] [Indexed: 01/26/2023]
Abstract
OBJECTIVES Surgical reconstruction of tracheal disease has expanded to include bioengineering and three dimensional (3D) printing. This pilot study investigates the viability of introducing a living functional tracheal replacement graft in a rabbit animal model. METHODS Seven New Zealand White rabbits were enrolled and six completed participation (one intraoperative mortality). Tracheal replacement grafts were created by impregnating 3D printed biodegradable polycaprolactone (PCL) tracheal scaffolds with rabbit tracheal hyaline chondrocytes. 2 cm of native trachea was resected and the tracheal replacement graft implanted. Subjects were divided into two equal groups (n = 3) that differed in their time of harvest following implantation (three or six weeks). Tracheal specimens were analyzed with intraluminal telescopic visualization and histopathology. RESULTS The two groups did not significantly differ in histopathology or intraluminal diameter. All sections wherein the implant telescoped over native trachea (anastomotic ends) contained adequate hyaline cartilage formation (i.e. chondrocytes within lacuna, surrounding extracellular matrix, and strong Safranin O staining). Furthermore, the PCL scaffold was surrounded by a thin layer of fibrous tissue. All areas without membranous coverage contained inadequate or immature cartilage formation with inflammation. The average intraluminal stenosis was 83.4% (range 34.2-95%). CONCLUSIONS We report normal cartilage growth in a tracheal replacement graft when chondrocytes are separated from the tracheal lumen by an intervening membrane. When no such membrane exists there is a propensity for inflammation and stenosis. These findings are important for future construction and implantation of tracheal replacement grafts. LEVEL OF EVIDENCE Not applicable: this is an in vivo animal trial.
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Affiliation(s)
- Rachel Kaye
- Rutgers New Jersey Medical School, Newark, NJ, USA.
| | - Todd Goldstein
- The Feinstein Institute for Medical Research, Northwell Health, Manhasset, NY, USA; Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
| | - Daniel A Grande
- The Feinstein Institute for Medical Research, Northwell Health, Manhasset, NY, USA; Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
| | - David Zeltsman
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA; Division of Thoracic Surgery, Northwell Health System, New Hyde Park, NY, USA
| | - Lee P Smith
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA; Division of Pediatric Otolaryngology, Steven and Alexandra Cohen Children's Medical Center, New Hyde Park, NY, USA
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Ershadi R, Rahim M, Jahany S, Rakei S. Transplantation of the decellularized tracheal allograft in animal model (rabbit). Asian J Surg 2018; 41:328-332. [DOI: 10.1016/j.asjsur.2017.02.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2017] [Revised: 02/15/2017] [Accepted: 02/20/2017] [Indexed: 10/19/2022] Open
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Jetté ME, Seroogy CM, Thibeault SL. Laryngeal T regulatory cells in the setting of smoking and reflux. Laryngoscope 2016; 127:882-887. [PMID: 27653511 DOI: 10.1002/lary.26223] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2016] [Revised: 06/22/2016] [Accepted: 07/07/2016] [Indexed: 01/13/2023]
Abstract
OBJECTIVES/HYPOTHESIS The larynx is a mucosal organ rich in lymphatic tissue that is regularly exposed to a multitude of inhaled, ingested, and refluxed microorganisms and irritants. The first line of mucosal immune defense is the barrier, including resident immune cells. T regulatory (Treg) cells are a specialized subset of CD4+ T cells that suppress or dampen immune responses to prevent damaging immunopathology. As Treg cells have been shown to preferentially accumulate at sites of infection, and Treg responses may contribute to persistence of infection by impairing antibacterial immunity, we sought to quantify these cells in laryngeal tissue exposed to smoking and reflux. STUDY DESIGN Cross-sectional study. METHODS Using an epigenetic assay, we quantified Treg and T cells and calculated the ratio of Treg to T cells (i.e., cellular ratio of immune tolerance [ImmunoCRIT]) in disease-free laryngeal biopsies representing four inflammatory states: 1) tobacco-exposed tissue, 2) refluxate and tobacco-exposed tissue, 3) refluxate-exposed tissue, and 4) unexposed tissue. RESULTS There was epigenetic evidence of Treg cells in all tissues, and we found no differences in Treg cell frequency relative to smoking and reflux in laryngeal tissue collected from 42 non-treatment-seeking participants. There was a decrease in total T cell frequency and an increase in ImmunoCRIT values in smokers regardless of reflux status. CONCLUSIONS In this study, laryngeal tissue from smokers show decreased overall T cells and increased ImmunoCRIT values. Our findings indicate that laryngeal inflammation is not directly mediated by loss of Treg cells in response to smoking and reflux in local tissue and increased ImmunoCRIT values in smokers implicate a role for this environmental exposure in modulating laryngeal immune homeostasis. More studies are indicated to explore Treg cell dysfunction in the pathophysiology of laryngeal disease. LEVEL OF EVIDENCE NA Laryngoscope, 127:882-887, 2017.
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Affiliation(s)
- Marie E Jetté
- Department of Otolaryngology , School of Medicine, University of Colorado Denver, Anschutz Medical Campus, Aurora, Colorado
| | - Christine M Seroogy
- Department of Otolaryngology , School of Medicine, University of Colorado Denver, Anschutz Medical Campus, Aurora, Colorado
| | - Susan L Thibeault
- Department of Pediatrics , School of Medicine and Public Health, University of Wisconsin, Madison, Madison, U.S.A. Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, School of Medicine and Public Health, University of Wisconsin, Madison, Wisconsin, U.S.A
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Jetté M. Toward an Understanding of the Pathophysiology of Chronic Laryngitis. PERSPECTIVES OF THE ASHA SPECIAL INTEREST GROUPS 2016; 1:14-25. [PMID: 32864454 PMCID: PMC7451247 DOI: 10.1044/persp1.sig3.14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Chronic laryngitis, characterized by inflammation of the laryngeal tissues, is the most commonly diagnosed organic voice disorder, yet treatments targeting suspected etiologic factors have demonstrated limited efficacy. A major barrier to the development of improved medical therapies for chronic laryngitis is a fundamental gap in knowledge related to the pathophysiology of laryngeal inflammation. This article provides a review of the literature specific to laryngeal immunity in health and disease.
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Hoffman B, Martin M, Brown BN, Bonassar LJ, Cheetham J. Biomechanical and biochemical characterization of porcine tracheal cartilage. Laryngoscope 2016; 126:E325-31. [DOI: 10.1002/lary.25861] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2015] [Revised: 12/11/2015] [Accepted: 12/15/2015] [Indexed: 11/05/2022]
Affiliation(s)
- Benjamin Hoffman
- Department of Clinical Sciences; College of Veterinary Medicine, Cornell University; Ithaca New York
| | - Matthew Martin
- Department of Clinical Sciences; College of Veterinary Medicine, Cornell University; Ithaca New York
| | - Bryan N. Brown
- Department of Clinical Sciences; College of Veterinary Medicine, Cornell University; Ithaca New York
- McGowan Institute for Regenerative Medicine, University of Pittsburgh; Pittsburgh Pennsylvania U.S.A
| | | | - Jonathan Cheetham
- Department of Clinical Sciences; College of Veterinary Medicine, Cornell University; Ithaca New York
- McGowan Institute for Regenerative Medicine, University of Pittsburgh; Pittsburgh Pennsylvania U.S.A
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Cheetham J, Perkins JD, Jarvis JC, Cercone M, Maw M, Hermanson JW, Mitchell LM, Piercy RJ, Ducharme NG. Effects of Functional Electrical Stimulation on Denervated Laryngeal Muscle in a Large Animal Model. Artif Organs 2015; 39:876-85. [DOI: 10.1111/aor.12624] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Jon Cheetham
- Department of Clinical Sciences; College of Veterinary Medicine; Cornell University; Ithaca NY USA
| | - Justin D. Perkins
- Comparative Neuromuscular Disease Laboratory; Royal Veterinary College; London
| | | | - Marta Cercone
- Department of Clinical Sciences; College of Veterinary Medicine; Cornell University; Ithaca NY USA
| | | | - John W. Hermanson
- Department of Biomedical Sciences; College of Veterinary Medicine; Cornell University; Ithaca NY USA
| | - Lisa M. Mitchell
- Department of Clinical Sciences; College of Veterinary Medicine; Cornell University; Ithaca NY USA
| | - Richard J. Piercy
- Comparative Neuromuscular Disease Laboratory; Royal Veterinary College; London
| | - Norm G. Ducharme
- Department of Clinical Sciences; College of Veterinary Medicine; Cornell University; Ithaca NY USA
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Partington L, Mordan NJ, Mason C, Knowles JC, Kim HW, Lowdell MW, Birchall MA, Wall IB. Biochemical changes caused by decellularization may compromise mechanical integrity of tracheal scaffolds. Acta Biomater 2013; 9:5251-61. [PMID: 23059415 DOI: 10.1016/j.actbio.2012.10.004] [Citation(s) in RCA: 85] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2012] [Revised: 09/29/2012] [Accepted: 10/03/2012] [Indexed: 12/13/2022]
Abstract
Tissue-engineered airways have achieved clinical success, but concerns remain about short-term loss of biomechanical properties, necessitating a stent. This study investigated the effect of chemical-enzymatic decellularization on biochemical properties of trachea important for cell attachment and vascularization (fibronectin and laminin) and cartilage matrix homeostasis (type II collagen and glycosaminoglycans (GAG)), as well as biomechanical status. Native trachea was used as a control, and NDC trachea stored in phosphate buffered saline (PBS) in parallel to decellularization was used as a time-matched control. Decellularization removed most cells, but chondrocytes and DNA remained after 25 cycles. Fibronectin was retained throughout the lamina propria and laminin at basement membranes. DNA accumulation along ECM fibres was seen. A decline in soluble collagen was observed in decellularized tissue. GAG content of cartilage rings was reduced, even in PBS control tissue from 20 cycles onwards (p<0.05), but decellularization caused the greatest loss (p<0.01). Tensile strength declined throughout the process, but was significant only at later time points. The data demonstrate that the substantial reduction in GAG might contribute to loss of mechanical integrity of biotracheas. Overcoming structural changes that cause an imbalance in cartilage matrix equilibrium will be necessary to optimize clinical benefit, enabling widespread use of biotracheas.
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Affiliation(s)
- L Partington
- Department of Biochemical Engineering, University College London, Torrington Place, London WC1E 7JE, UK
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Birchall MA, Ayling SM, Harley R, Murison PJ, Burt R, Mitchard L, Jones A, Macchiarini P, Stokes CR, Bailey M. Laryngeal transplantation in minipigs: early immunological outcomes. Clin Exp Immunol 2012; 167:556-64. [PMID: 22288599 DOI: 10.1111/j.1365-2249.2011.04531.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Despite recent tissue-engineering advances, there is no effective way of replacing all the functions of the larynx in those requiring laryngectomy. A recent clinical transplant was a success. Using quantitative immunofluorescence targeted at immunologically relevant molecules, we have studied the early (48 h and 1 week) immunological responses within larynxes transplantated between seven pairs of National Institutes of Health (NIH) minipigs fully homozygous at the major histocompatibility complex (MHC) locus. There were only small changes in expression of some molecules (relative to interindividual variation) and these were clearest in samples from the subglottic region, where the areas of co-expression of CD25(+) CD45RC(-) CD8(-) and of CD163(+) CD172(+) MHC-II(-) increased at 1 week after transplant. In one case, infiltration by recipient T cells was analysed by T cell receptor (TCR) Vβ spectratype analysis; this suggested that changes in the T cell repertoire occur in the donor subglottis mucosal tissues from day 0 to day 7, but that the donor and recipient mucosal Vβ repertoires remain distinct. The observed lack of strong immunological responses to the trauma of surgery and ischaemia provides encouraging evidence to support clinical trials of laryngeal transplantation, and a basis on which to interpret future studies involving mismatches.
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Affiliation(s)
- M A Birchall
- Department of Clinical Sciences at South Bristol, University of Bristol, Bristol, UK.
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11
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Birchall MA, Kingham PJ, Murison PJ, Ayling SM, Burt R, Mitchard L, Jones A, Lear P, Stokes CR, Terenghi G, Bailey M, Macchiarini P. Laryngeal transplantation in minipigs: vascular, myologic and functional outcomes. Eur Arch Otorhinolaryngol 2011; 268:405-14. [PMID: 20842506 PMCID: PMC3192951 DOI: 10.1007/s00405-010-1355-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2010] [Accepted: 07/25/2010] [Indexed: 12/01/2022]
Abstract
There is no effective way of replacing all the functions of the larynx in those requiring laryngectomy. Regenerative medicine offers promise, but cannot presently deliver implants with functioning neuromuscular units. A single well-documented laryngeal transplant in man was a qualified success, but more information is required before clinical trials may be proposed. We studied the early response of the larynx to laryngeal transplantation between 17 pairs of NIH minipigs full matched at the MHC2 locus. Following iterative technical improvements, pigs had good swallowing and a patent airway at 1 week. No significant changes in mucosal blood flux were observed compared with pre-operative measurements. Changes in muscle morphology and fibre phenotype were observed in transplant muscles retrieved after 7 days: the levels of fast and slow myosin heavy chain (MyHC) protein were reduced and embryonic MyHC was up regulated consistent with denervation induced atrophy. At 1 week laryngeal transplantation can result in good swallowing, and is not associated with clinical evidence of ischemia-reperfusion injury in MHC-matched pigs.
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Affiliation(s)
- M A Birchall
- Department of Clinical Sciences at South Bristol, Bristol, UK.
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12
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Jungebluth P, Go T, Asnaghi A, Bellini S, Martorell J, Calore C, Urbani L, Ostertag H, Mantero S, Conconi MT, Macchiarini P. Structural and morphologic evaluation of a novel detergent-enzymatic tissue-engineered tracheal tubular matrix. J Thorac Cardiovasc Surg 2009; 138:586-93; discussion 592-3. [PMID: 19698839 DOI: 10.1016/j.jtcvs.2008.09.085] [Citation(s) in RCA: 96] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2008] [Revised: 09/02/2008] [Accepted: 09/12/2008] [Indexed: 10/20/2022]
Abstract
OBJECTIVE We sought to bioengineer a nonimmunogenic tracheal tubular matrix of 6 cm in length and test its structural, functional, and immunologic properties in vitro and in vivo. METHODS Twelve-centimeter tracheal segments were harvested from Yorkshire boars. Half of each segment was subjected to a detergent-enzymatic method (containing sodium deoxycholate/DNase lavations) of decellularization for as many cycles as needed, and the other half was stored in phosphate-buffered saline at 4 degrees C as a control. Bioengineered and control tracheas were then implanted in major histocompatibility complex-unmatched pigs (allograft) or mice (xenograft) heterotopically for 30 days. Structural and functional analysis and immunostaining were performed after each detergent-enzymatic method cycle and transplantation. RESULTS Compared with control tracheas, bioengineered matrices displayed no major histocompatibility complex class I and II antigens after 17 detergent-enzymatic method cycles, without significant (P > .05) differences in their strain ability (rupture force, 56.1 +/- 3.3 vs 55.5 +/- 2.4 N; tissue deformation at 203% +/- 13% vs 200% +/- 8% or 12.2 +/- 0.8 vs 12 +/- 0.5 cm; and applied maximum force, 173.4 +/- 3.2 vs 171.5 +/- 4.6 N). Thirty days after implantation, significantly (P < .01) smaller inflammatory reactions (392 vs 15 macrophages/mm(2) and 874 vs 167 T lymphocytes/mm(2)) and P-selectin expressions (1/6 vs 6/6) were observed in both the xenograft and allograft models with bioengineered matrices compared with those seen with control tracheas. There was no development of anti-pig leukocyte antigen antibodies or increase in both IgM and IgG content in mice implanted with bioengineered tracheas. CONCLUSIONS Bioengineered tracheal matrices displayed similar structural and mechanical characteristics to native tracheas and excite no immune response to 30 days when implanted as allografts or xenografts. This method holds great promise for the future of tissue-engineered airway replacement.
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Affiliation(s)
- Philipp Jungebluth
- Department of General Thoracic Surgery, Hospital Clinic, Fundació Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer, CIBER Enfermedades Respiratorias, Universitat de Barcelona, Barcelona, Spain
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13
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Curry JM, Grindle CR, Merton DA, Goldberg BB, Rosen D, Pribitkin EA. Lymphosonographic sentinel node biopsy of the supraglottis in a swine model. Otolaryngol Head Neck Surg 2009; 139:798-804. [PMID: 19041506 DOI: 10.1016/j.otohns.2008.08.029] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2008] [Revised: 08/27/2008] [Accepted: 08/28/2008] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To test the feasibility of a novel contrast-enhanced ultrasound (CEUS) technique, or lymphosonography, for sentinel node biopsy (SNB) of the supraglottis in a porcine model. STUDY DESIGN AND SETTING In this prospective, nonrandomized animal study, blue dye and ultrasound contrast agent were injected into the supraglottis in seven 50-kg Yorkshire swine. Transcutaneous CEUS was used to identify real-time lymphatic flow of contrast through lymph channels (LC) to the sentinel lymph node (SLN). SNB was carried out, visually identifying a blue node, with the assistance of intraoperative CEUS. Bilateral modified radical neck dissections were performed to search for any residual contrast-positive or blue SLNs. RESULTS In each case, at least one SLN was identified by preoperative CEUS. A total of 12 nodes were identified on preoperative CEUS, and 11 of 12 nodes were stained with blue dye (91.7%). No residual blue or contrast-positive nodes were identified on neck dissection. CONCLUSIONS Lymphosonographic SNB of the supraglottis in a porcine model is technically feasible, and yields results comparable to traditional blue dye-guided techniques. No "shine-through" effect or nonsequential nodal enhancement occurred. This technique holds promise for sentinel node biopsy and allows a novel method for in vivo investigation of the lymphatic system.
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Affiliation(s)
- Joseph M Curry
- Department of Otolaryngology-Head and Neck Surgery, Thomas Jefferson University, Philadelphia, PA 19107, USA.
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14
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Thibeault S, Rees L, Pazmany L, Birchall MA. At the crossroads: mucosal immunology of the larynx. Mucosal Immunol 2009; 2:122-8. [PMID: 19129759 PMCID: PMC2666820 DOI: 10.1038/mi.2008.82] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The larynx sits at the crossroads between gastrointestinal and respiratory tracts. Besides its intrinsic importance in breathing, swallowing and voice production, the larynx is also exposed to unique immunological challenges. Given the propensity of chronic inflammatory conditions such as chronic laryngitis, which affects up to 20% of Western populations, it is surprising that our understanding of the immunology of this organ remains relatively limited. Recent work on the immunological architecture of the laryngeal mucosa, and its changes that result from external challenges and inflammatory conditions, provided valuable insight into the fascinating immunology of this organ. The lessons learnt from these investigations may go beyond devising improved therapy for chronic laryngeal inflammation. Establishing whether and how the laryngeal mucosa may be involved in the modulation of wider mucosal responses may provide novel routes to the treatment of inflammatory diseases of the respiratory and alimentary tracts such as asthma and inflammatory bowel disease.
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Affiliation(s)
- Susan Thibeault
- Assistant Professor, Division of Otolaryngology – Head and Neck Surgery, Department of Surgery, University of Wisconsin Madison, 5107 WIMR, 1111 Highland Ave, Madison, WI 53705- 2275, , T: 608 263 6751, Fax: 608-252-0939
| | - Louisa Rees
- Research Associate, School of Clinical Veterinary Science, Division of Veterinary Pathology, Infection and Immunity, University of Bristol, Churchill Building, Langford, Bristol BS40 5DU t: 0117 9289289, e:
| | - Laszlo Pazmany
- School of Clinical Sciences, University of Liverpool, 3.48 Clinical Sciences Building, University Hospital Aintree, Liverpool, , T: +44 (0) 1515295896, F01515295222
| | - Martin A. Birchall
- John Farndon Professor of Surgery and Professor of Laryngology, Laryngeal Research Group, Clinical Sciences at South Bristol, University of Bristol, Churchill Building, Langford House, Bristol BS40 5DU, Btinternet.com, T: (0044)-117-33-19060, F: (+44)-117-9289282
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Trasplante de la laringe: ¿una opción terapéutica para el siglo XXI? Revisión de la literatura. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2008. [DOI: 10.1016/s0001-6519(08)73280-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Larynx Transplant: A Therapeutic Option for the 21st Century? Literature Review. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2008. [DOI: 10.1016/s2173-5735(08)70208-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Abstract
INTRODUCTION Laryngeal transplantation remains an increasingly viable option for patients with irreversible disease or damage to the larynx. Successful organ transplantation relies on minimising surgical, ischaemic and immunological insults. The inherent immunogenicity of an organ is dependent on the amount of immunologically active cells within it. The presence of immunologically active cells within non-transplanted NIH-minipigs was investigated and an in vivo laryngeal transplant model was developed. MATERIALS AND METHODS Quantitative, multiple-colour immunofluorescence using pig-specific monoclonal antibodies was used to assess the normal immunological architecture and the short-term immunological changes associated with 3 h of cold ischaemia and 8 h of reperfusion in an MHC-matched animal model. RESULTS AND CONCLUSIONS There is a complex immunological architecture within the non-transplanted, healthy pig larynx. In addition, an in vivo laryngeal transplant model was developed that allowed successful perfusion for 8 h post transplantation. There were significant changes in cell numbers within different anatomical subsites of the larynx. However, the biological significance remains debatable in view of the large range of cell numbers both within and between individual animals.
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Affiliation(s)
- Emma V Barker
- Department of Otorhinolaryngology, Wessex Deanery, Southampton, UK.
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