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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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2
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Hannon E, Pellegrini M, Scottoni F, Durkin N, Shibuya S, Lutman R, Proctor TJ, Hutchinson JC, Arthurs OJ, Phylactopoulos DE, Maughan EF, Butler CR, Eaton S, Lowdell MW, Bonfanti P, Urbani L, De Coppi P. Lessons learned from pre-clinical testing of xenogeneic decellularized esophagi in a rabbit model. iScience 2022; 25:105174. [PMID: 36217545 PMCID: PMC9547295 DOI: 10.1016/j.isci.2022.105174] [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: 12/13/2021] [Revised: 06/21/2022] [Accepted: 09/19/2022] [Indexed: 11/04/2022] Open
Abstract
Decellularization of esophagi from several species for tissue engineering is well described, but successful implantation in animal models of esophageal replacement has been challenging. The purpose of this study was to assess feasibility and applicability of esophageal replacement using decellularized porcine esophageal scaffolds in a new pre-clinical model. Following surgical replacement in rabbits with a vascularizing muscle flap, we observed successful anastomoses of decellularized scaffolds, cues of early neovascularization, and prevention of luminal collapse by the use of biodegradable stents. However, despite the success of the surgical procedure, the long-term survival was limited by the fragility of the animal model. Our results indicate that transplantation of a decellularized porcine scaffold is possible and vascular flaps may be useful to provide a vascular supply, but long-term outcomes require further pre-clinical testing in a different large animal model.
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Affiliation(s)
- Edward Hannon
- Great Ormond Street Institute of Child Health, University College London, London WC1N 1EH, UK,Department of Paediatric Surgery, Leeds Children’s Hospital, Leeds Teaching Hospitals NHS Trust, Leeds LS1 3EX, UK
| | - Marco Pellegrini
- Great Ormond Street Institute of Child Health, University College London, London WC1N 1EH, UK
| | - Federico Scottoni
- Great Ormond Street Institute of Child Health, University College London, London WC1N 1EH, UK,Department of Pediatric Surgery, Regina Margherita Children’s Hospital, Turin 10126, Italy
| | - Natalie Durkin
- Great Ormond Street Institute of Child Health, University College London, London WC1N 1EH, UK
| | - Soichi Shibuya
- Great Ormond Street Institute of Child Health, University College London, London WC1N 1EH, UK
| | - Roberto Lutman
- Great Ormond Street Institute of Child Health, University College London, London WC1N 1EH, UK
| | - Toby J. Proctor
- Centre for Cell, Gene and Tissue Therapies, Royal Free Hospital & University College London, London NW3 2PF, UK
| | - J. Ciaran Hutchinson
- Great Ormond Street Institute of Child Health, University College London, London WC1N 1EH, UK,Department of Histopathology, Great Ormond Street Hospital for Children NHS Foundation Trust, London WC1N 3JH, UK
| | - Owen J. Arthurs
- Great Ormond Street Institute of Child Health, University College London, London WC1N 1EH, UK,Department of Radiology, Great Ormond Street Hospital for Children NHS Foundation Trust, London WC1N 3JH, UK
| | - Demetra-Ellie Phylactopoulos
- Great Ormond Street Institute of Child Health, University College London, London WC1N 1EH, UK,Epithelial Stem Cell Biology & Regenerative Medicine Laboratory, The Francis Crick Institute, London NW1 1AT, UK
| | - Elizabeth F. Maughan
- Great Ormond Street Institute of Child Health, University College London, London WC1N 1EH, UK,Charing Cross Airway Service, Department of Otolaryngology, Charing Cross Hospital, Imperial Healthcare NHS Trust, London W6 8RF, UK
| | - Colin R. Butler
- Great Ormond Street Institute of Child Health, University College London, London WC1N 1EH, UK,ENT Department, Great Ormond Street Hospital for Children NHS Foundation Trust, London WC1N 3JH, UK
| | - Simon Eaton
- Great Ormond Street Institute of Child Health, University College London, London WC1N 1EH, UK
| | - Mark W. Lowdell
- Centre for Cell, Gene and Tissue Therapies, Royal Free Hospital & University College London, London NW3 2PF, UK
| | - Paola Bonfanti
- Great Ormond Street Institute of Child Health, University College London, London WC1N 1EH, UK,Epithelial Stem Cell Biology & Regenerative Medicine Laboratory, The Francis Crick Institute, London NW1 1AT, UK,Institute of Immunity & Transplantation, University College London, London NW3 2PP, UK
| | - Luca Urbani
- The Roger Williams Institute of Hepatology, Foundation for Liver Research, London SE5 9NT, UK,Faculty of Life Sciences and Medicine, King’s College London, London SE5 8AF, UK
| | - Paolo De Coppi
- Great Ormond Street Institute of Child Health, University College London, London WC1N 1EH, UK,Specialist Neonatal and Paediatric Surgery, Great Ormond Street Hospital for Children NHS Foundation Trust, London WC1N 3JH, UK,Corresponding author
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3
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Advances in the application of regenerative medicine in prevention of post-endoscopic submucosal dissection for esophageal stenosis. J Transl Int Med 2022; 10:28-35. [PMID: 35702182 PMCID: PMC8997800 DOI: 10.2478/jtim-2022-0011] [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] [Indexed: 11/30/2022] Open
Abstract
Endoscopic submucosal dissection (ESD) is a curative treatment for superficial esophageal cancer with distinct advantages. However, esophageal stenosis after ESD remains a tough problem, especially after large circumferential proportion of esophageal mucosa is removed, which limits the wide use of ESD, especially in circumferential lesions. In this scenario, preventive procedures are highly recommended against post-ESD esophageal stenosis. However, the efficacy and safety of traditional prophylactic methods (steroids, metal and biodegradable stents, balloon dilation, radial incision, etc.) are not satisfactory and novel strategies need to be developed. Regenerative medicine has been showing enormous potential in the reconstruction of organs including the esophagus. In this review, we aimed to describe the current status of regenerative medicine in prevention of post-ESD esophageal stenosis. Cell injection, cell sheet transplantation, and extracellular matrix implantation have been proved effective. However, numerous obstacles still exist and further studies are necessary.
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Eftekharzadeh S, Akbarzadeh A, Sabetkish N, Rostami M, Zabolian AH, Hashemi J, Tavangar SM, Kajbafzadeh AM. Esophagus tissue engineering: from decellularization to in vivo recellularization in two sites. Cell Tissue Bank 2021; 23:301-312. [PMID: 34414549 DOI: 10.1007/s10561-021-09944-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Accepted: 06/27/2021] [Indexed: 10/20/2022]
Abstract
To produce an esophageal scaffold with suitable features and evaluate the result of in vivo cell seeding after its implantation in the omentum and near its original anatomical position in the rat model. The esophagus of twelve rats were resected, cannulated, and decellularized via a peristaltic pump. After confirmation of decellularization and preservation of extracellular matrix, decellularized scaffolds were implanted either in the abdominal cavity (group I, n = 6) or cervical area (group II, n = 6). Histological evaluations were performed after 3 and 6 months of implantation. The results of histological evaluations, scanning electron microscopy, and the tensile test confirmed the maintenance of extracellular matrix and removal of all cellular constituents. At the time of biopsy, no evidence of inflammation was detected and the implanted scaffolds appeared normal. Histopathological evaluations of implanted tissues revealed that undifferentiated cells were seen in scaffolds of all follow-ups in both groups. Epithelial cell seeding was more advanced in biopsies of group II obtained after 6 months of operation and was accompanied by angiogenesis in surrounding adventitia. It seems that the implantation of scaffold near its original place may have an important role in further cell seeding. This method may be surpassing in comparison with traditional implantation techniques for perfecting esophageal transplantation.
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Affiliation(s)
- Sahar Eftekharzadeh
- Pediatric Urology and Regenerative Medicine Research Center, Section of Tissue Engineering and Stem Cells Therapy, Children's Hospital Medical Center, Tehran University of Medical Sciences, No. 62, Dr. Gharib's Street, Keshavarz Boulevard, Tehran, 1419433151, Iran
| | - Aram Akbarzadeh
- Pediatric Urology and Regenerative Medicine Research Center, Section of Tissue Engineering and Stem Cells Therapy, Children's Hospital Medical Center, Tehran University of Medical Sciences, No. 62, Dr. Gharib's Street, Keshavarz Boulevard, Tehran, 1419433151, Iran
| | - Nastaran Sabetkish
- Pediatric Urology and Regenerative Medicine Research Center, Section of Tissue Engineering and Stem Cells Therapy, Children's Hospital Medical Center, Tehran University of Medical Sciences, No. 62, Dr. Gharib's Street, Keshavarz Boulevard, Tehran, 1419433151, Iran
| | - Minoo Rostami
- Pediatric Urology and Regenerative Medicine Research Center, Section of Tissue Engineering and Stem Cells Therapy, Children's Hospital Medical Center, Tehran University of Medical Sciences, No. 62, Dr. Gharib's Street, Keshavarz Boulevard, Tehran, 1419433151, Iran
| | - Amir Hossein Zabolian
- Pediatric Urology and Regenerative Medicine Research Center, Section of Tissue Engineering and Stem Cells Therapy, Children's Hospital Medical Center, Tehran University of Medical Sciences, No. 62, Dr. Gharib's Street, Keshavarz Boulevard, Tehran, 1419433151, Iran
| | - Javad Hashemi
- Department of Clinical Biochemistry, School of Medicine, North Khorasan University of Medical Sciences, Bojnurd, Iran
| | - Seyed Mohammad Tavangar
- Department of Pathology, Dr. Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Abdol-Mohammad Kajbafzadeh
- Pediatric Urology and Regenerative Medicine Research Center, Section of Tissue Engineering and Stem Cells Therapy, Children's Hospital Medical Center, Tehran University of Medical Sciences, No. 62, Dr. Gharib's Street, Keshavarz Boulevard, Tehran, 1419433151, Iran.
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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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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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Gundogdu G, Morhardt D, Cristofaro V, Algarrahi K, Yang X, Costa K, Alegria CG, Sullivan MP, Mauney JR. Evaluation of Bilayer Silk Fibroin Grafts for Tubular Esophagoplasty in a Porcine Defect Model. Tissue Eng Part A 2021; 27:103-116. [PMID: 32460641 PMCID: PMC7826443 DOI: 10.1089/ten.tea.2020.0061] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Accepted: 05/19/2020] [Indexed: 12/14/2022] Open
Abstract
Surgical reconstruction of tubular esophageal defects with autologous gastrointestinal segments is the gold standard treatment to replace damaged or diseased esophageal tissues. Unfortunately, this approach is associated with adverse complications, including dysphagia, donor-site morbidity, and in some cases patient death. Bilayer silk fibroin (BLSF) scaffolds were investigated as alternative, acellular grafts for tubular esophagoplasty in a porcine defect model for 3 months of implantation. Adult Yucatan mini-swine (n = 5) were subjected to esophageal reconstruction with tubular BLSF grafts (2 cm in length) in combination with transient esophageal stenting for 2 months followed by a 1-month period, where the graft site was unstented. All animals receiving BLSF grafts survived and were capable of solid food consumption, however strictures were noted at graft regions in 60% of the experimental cohort between 2 and 3 months postop and required balloon dilation. In addition, fluoroscopic analysis showed peristaltic function in only 1/5 neotissues. Following swine harvest at 3 months, ex vivo tissue bath evaluations revealed that neoconduits exhibited contractile responses to carbachol, electric field stimulation, and KCl, whereas sodium nitroprusside and isoproterenol induced relaxation effects. Histological (Masson's Trichrome) and immunohistochemical analyses of regenerated tissue conduits showed a stratified, squamous epithelium expressing pan-cytokeratins buttressed by a vascularized lamina propria containing a smooth muscle-rich muscularis mucosa surrounded by a muscularis externa. Neuronal density, characterized by the presence of synaptophysin-positive boutons, was significantly lower in neotissues in comparison to nonsurgical controls. BLSF scaffolds represent a promising platform for the repair of tubular esophageal defects, however improvements in scaffold design are needed to reduce the rate of complications and improve the extent of constructive tissue remodeling. Impact statement The search for a superior "off-the-shelf" scaffold capable of repairing tubularesophageal defects as well as overcoming limitations associated with conventional autologous gastrointestinal segments remains elusive. The purpose of this study was to investigate the performance of an acellular, bilayer silk fibroin graft (BLSF) for tubular esophagoplasty in a porcine model. Our results demonstrated that BLSF scaffolds supported the formation of tubular neotissues with innervated, vascularized epithelial and muscular components capable of contractile and relaxation responses. BLSF scaffolds represent a promising platform for esophageal tissue engineering.
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Affiliation(s)
- Gokhan Gundogdu
- Departments of Urology and Biomedical Engineering, University of California, Irvine, Orange, California, USA
| | - Duncan Morhardt
- Urological Diseases Research Center, Boston Children's Hospital, Boston, Massachusetts, USA
- Department of Surgery, Harvard Medical School, Boston, Massachusetts, USA
| | - Vivian Cristofaro
- Department of Surgery, Harvard Medical School, Boston, Massachusetts, USA
- Division of Urology, Veterans Affairs Boston Healthcare System, Boston, Massachusetts, USA
- Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Khalid Algarrahi
- Urological Diseases Research Center, Boston Children's Hospital, Boston, Massachusetts, USA
- Department of Surgery, Harvard Medical School, Boston, Massachusetts, USA
| | - Xuehui Yang
- Urological Diseases Research Center, Boston Children's Hospital, Boston, Massachusetts, USA
- Department of Surgery, Harvard Medical School, Boston, Massachusetts, USA
| | - Kyle Costa
- Urological Diseases Research Center, Boston Children's Hospital, Boston, Massachusetts, USA
- Department of Surgery, Harvard Medical School, Boston, Massachusetts, USA
| | - Cinthia Galvez Alegria
- Urological Diseases Research Center, Boston Children's Hospital, Boston, Massachusetts, USA
- Department of Surgery, Harvard Medical School, Boston, Massachusetts, USA
| | - Maryrose P. Sullivan
- Department of Surgery, Harvard Medical School, Boston, Massachusetts, USA
- Division of Urology, Veterans Affairs Boston Healthcare System, Boston, Massachusetts, USA
- Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Joshua R. Mauney
- Departments of Urology and Biomedical Engineering, University of California, Irvine, Orange, California, USA
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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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9
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Marzaro M, Algeri M, Tomao L, Tedesco S, Caldaro T, Balassone V, Contini AC, Guerra L, Federici D’Abriola G, Francalanci P, Caristo ME, Lupoi L, Boskoski I, Bozza A, Astori G, Pozzato G, Pozzato A, Costamagna G, Dall’Oglio L. Successful muscle regeneration by a homologous microperforated scaffold seeded with autologous mesenchymal stromal cells in a porcine esophageal substitution model. Therap Adv Gastroenterol 2020; 13:1756284820923220. [PMID: 32523626 PMCID: PMC7257852 DOI: 10.1177/1756284820923220] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Accepted: 04/06/2020] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Since the esophagus has no redundancy, congenital and acquired esophageal diseases often require esophageal substitution, with complicated surgery and intestinal or gastric transposition. Peri-and-post-operative complications are frequent, with major problems related to the food transit and reflux. During the last years tissue engineering products became an interesting therapeutic alternative for esophageal replacement, since they could mimic the organ structure and potentially help to restore the native functions and physiology. The use of acellular matrices pre-seeded with cells showed promising results for esophageal replacement approaches, but cell homing and adhesion to the scaffold remain an important issue and were investigated. METHODS A porcine esophageal substitute constituted of a decellularized scaffold seeded with autologous bone marrow-derived mesenchymal stromal cells (BM-MSCs) was developed. In order to improve cell seeding and distribution throughout the scaffolds, they were micro-perforated by Quantum Molecular Resonance (QMR) technology (Telea Electronic Engineering). RESULTS The treatment created a microporous network and cells were able to colonize both outer and inner layers of the scaffolds. Non seeded (NSS) and BM-MSCs seeded scaffolds (SS) were implanted on the thoracic esophagus of 4 and 8 pigs respectively, substituting only the muscle layer in a mucosal sparing technique. After 3 months from surgery, we observed an esophageal substenosis in 2/4 NSS pigs and in 6/8 SS pigs and a non-practicable stricture in 1/4 NSS pigs and 2/8 SS pigs. All the animals exhibited a normal weight increase, except one case in the SS group. Actin and desmin staining of the post-implant scaffolds evidenced the regeneration of a muscular layer from one anastomosis to another in the SS group but not in the NSS one. CONCLUSIONS A muscle esophageal substitute starting from a porcine scaffold was developed and it was fully repopulated by BM-MSCs after seeding. The substitute was able to recapitulate in shape and function the original esophageal muscle layer.
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Affiliation(s)
| | - Mattia Algeri
- Hemato-Oncology, Ospedale Pediatrico Bambino
Gesù, Roma, Italy
| | - Luigi Tomao
- Hemato-Oncology, Ospedale Pediatrico Bambino
Gesù, Roma, Italy
| | | | - Tamara Caldaro
- Digestive Endoscopy and Surgical Unit, Ospedale
Pediatrico Bambino Gesù, Roma, Italy
| | - Valerio Balassone
- Digestive Endoscopy and Surgical Unit, Ospedale
Pediatrico Bambino Gesù, Roma, Italy
| | - Anna Chiara Contini
- Digestive Endoscopy and Surgical Unit, Ospedale
Pediatrico Bambino Gesù, Roma, Italy
| | - Luciano Guerra
- Digestive Endoscopy and Surgical Unit, Ospedale
Pediatrico Bambino Gesù, Roma, Italy
| | | | | | | | | | | | - Angela Bozza
- LTCA, ULSS 8 Berica, Vicenza, Italy,Laboratorio di Terapie Cellulari Avanzate,
Vicenza, Italy
| | - Giuseppe Astori
- LTCA, ULSS 8 Berica, Vicenza, Italy,Laboratorio di Terapie Cellulari Avanzate,
Vicenza, Italy
| | | | | | - Guido Costamagna
- Digestive Endoscopy Unit, Fondazione
Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Luigi Dall’Oglio
- Digestive Endoscopy and Surgical Unit, Ospedale
Pediatrico Bambino Gesù, Roma, Italy
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10
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Syed O, Kim JH, Keskin-Erdogan Z, Day RM, El-Fiqi A, Kim HW, Knowles JC. SIS/aligned fibre scaffold designed to meet layered oesophageal tissue complexity and properties. Acta Biomater 2019; 99:181-195. [PMID: 31446049 DOI: 10.1016/j.actbio.2019.08.015] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Revised: 07/17/2019] [Accepted: 08/08/2019] [Indexed: 12/27/2022]
Abstract
With donor organs not readily available, the need for a tissue-engineered oesophagus remains high, particularly for congenital childhood conditions such as atresia. Previous attempts have not been successful, and challenges remain. Small intestine submucosa (SIS) is an acellular matrix material with good biological properties; however, as is common with these types of materials, they demonstrate poor mechanical properties. In this work, electrospinning was performed to mechanically reinforce tubular SIS with polylactic-co-glycolic acid (PLGA) nanofibres. It was hypothesised that if attachment could be achieved between the two materials, then this would (i) improve the SIS mechanical properties, (ii) facilitate smooth muscle cell alignment to support directional growth of muscle cells and (iii) allow for the delivery of bioactive molecules (VEGF in this instance). Through a relatively simple multistage process, adhesion between the layers was achieved without chemically altering the SIS. It was also found that altering mandrel rotation speed affected the alignment of the PLGA nanofibres. SIS-PLGA scaffolds performed mechanically better than SIS alone; yield stress improvement was 200% and 400% along the longitudinal and circumferential directions, respectively. Smooth muscle cells cultured on the aligned fibres showed resultant unidirectional alignment. In vivo the SIS-PLGA scaffolds demonstrated limited foreign body reaction judged by the type and proportion of immune cells present and lack of fibrous encapsulation. The scaffolds remained intact at 4 weeks in vivo, and good cellular infiltration was observed. The incorporation of VEGF within SIS-PLGA scaffolds increased the blood vessel density of the surrounding tissues, highlighting the possible stimulation of endothelialisation by angiogenic factor delivery. Overall, the designed SIS-PLGA-VEGF hybrid scaffolds might be used as a potential matrix platform for oesophageal tissue engineering. In addition to this, achieving improved attachment between layers of acellular matrix materials and electrospun fibre layers offers the potential utility in other applications. STATEMENT OF SIGNIFICANCE: Because of its multi-layered nature and complex structure, the oesophagus tissue poses several challenges for successful clinical grafting. Therefore, it is promising to utilise tissue engineering strategies to mimic and form structural compartments for its recovery. In this context, we investigated the use of tubular small intestine submucosa (SIS) reinforced with polylactic-co-glycolic acid (PLGA) nanofibres by using electrospinning and also, amongst other parameters, the integrity of the bilayered structure created. This was carried out to facilitate smooth muscle cell alignment, support directional growth of muscle cells and allow the delivery of bioactive molecules (VEGF in this study). We evaluated this approach by using in vitro and in vivo models to determine the efficacy of this new system.
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11
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Jensen T, Wanczyk H, Sharma I, Mitchell A, Sayej WN, Finck C. Polyurethane scaffolds seeded with autologous cells can regenerate long esophageal gaps: An esophageal atresia treatment model. J Pediatr Surg 2019; 54:1744-1754. [PMID: 30429066 DOI: 10.1016/j.jpedsurg.2018.09.024] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Revised: 09/04/2018] [Accepted: 09/17/2018] [Indexed: 12/16/2022]
Abstract
BACKGROUND Pediatric patients suffering from long gap esophageal defects or injuries are in desperate need of innovative treatment options. Our study demonstrates that two different cell sources can adhere to and proliferate on a retrievable synthetic scaffold. In feasibility testing of translational applicability, these cell seeded scaffolds were implanted into piglets and demonstrated esophageal regeneration. METHODS Either porcine esophageal epithelial cells or porcine amniotic fluid was obtained and cultured in 3 dimensions on a polyurethane scaffold (Biostage). The amniotic fluid was obtained prior to birth of the piglet and was a source of mesenchymal stem cells (AF-MSC). Scaffolds that had been seeded were implanted into their respective Yucatan mini-swine. The cell seeded scaffolds in the bioreactor were evaluated for cell viability, proliferation, genotypic expression, and metabolism. Feasibility studies with implantation evaluated tissue regeneration and functional recovery of the esophagus. RESULTS Both cell types seeded onto scaffolds in the bioreactor demonstrated viability, adherence and metabolism over time. The seeded scaffolds demonstrated increased expression of VEGF after 6 days in culture. Once implanted, endoscopy 3 weeks after surgery revealed an extruded scaffold with newly regenerated tissue. Both cell seeded scaffolds demonstrated epithelial and muscle regeneration and the piglets were able to eat and grow over time. CONCLUSIONS Autologous esophageal epithelial cells or maternal AF-MSC can be cultured on a 3D scaffold in a bioreactor. These cells maintain viability, proliferation, and adherence over time. Implantation into piglets demonstrated esophageal regeneration with extrusion of the scaffold. This sets the stage for translational application in a neonatal model of esophageal atresia.
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Affiliation(s)
- Todd Jensen
- University of Connecticut School of Medicine, Department of Pediatrics.
| | - Heather Wanczyk
- University of Connecticut School of Medicine, Department of Pediatrics
| | - Ishna Sharma
- University of Connecticut School of Medicine, Department of Surgery
| | - Adam Mitchell
- University of Connecticut School of Medicine, Department of Pediatrics
| | - Wael N Sayej
- University of Connecticut School of Medicine, Department of Pediatrics; Connecticut Children's Medical Center, Department of Digestive Diseases
| | - Christine Finck
- University of Connecticut School of Medicine, Department of Pediatrics; Connecticut Children's Medical Center, Department of Pediatric Surgery.
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12
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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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13
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Regeneration of esophagus using a scaffold-free biomimetic structure created with bio-three-dimensional printing. PLoS One 2019; 14:e0211339. [PMID: 30849123 PMCID: PMC6408002 DOI: 10.1371/journal.pone.0211339] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Accepted: 01/11/2019] [Indexed: 02/07/2023] Open
Abstract
Various strategies have been attempted to replace esophageal defects with natural or artificial substitutes using tissue engineering. However, these methods have not yet reached clinical application because of the high risks related to their immunogenicity or insufficient biocompatibility. In this study, we developed a scaffold-free structure with a mixture of cell types using bio-three-dimensional (3D) printing technology and assessed its characteristics in vitro and in vivo after transplantation into rats. Normal human dermal fibroblasts, human esophageal smooth muscle cells, human bone marrow-derived mesenchymal stem cells, and human umbilical vein endothelial cells were purchased and used as a cell source. After the preparation of multicellular spheroids, esophageal-like tube structures were prepared by bio-3D printing. The structures were matured in a bioreactor and transplanted into 10-12-week-old F344 male rats as esophageal grafts under general anesthesia. Mechanical and histochemical assessment of the structures were performed. Among 4 types of structures evaluated, those with the larger proportion of mesenchymal stem cells tended to show greater strength and expansion on mechanical testing and highly expressed α-smooth muscle actin and vascular endothelial growth factor on immunohistochemistry. Therefore, the structure with the larger proportion of mesenchymal stem cells was selected for transplantation. The scaffold-free structures had sufficient strength for transplantation between the esophagus and stomach using silicon stents. The structures were maintained in vivo for 30 days after transplantation. Smooth muscle cells were maintained, and flat epithelium extended and covered the inner surface of the lumen. Food had also passed through the structure. These results suggested that the esophagus-like scaffold-free tubular structures created using bio-3D printing could hold promise as a substitute for the repair of esophageal defects.
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14
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Multi-stage bioengineering of a layered oesophagus with in vitro expanded muscle and epithelial adult progenitors. Nat Commun 2018; 9:4286. [PMID: 30327457 PMCID: PMC6191423 DOI: 10.1038/s41467-018-06385-w] [Citation(s) in RCA: 56] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Accepted: 07/19/2018] [Indexed: 12/21/2022] Open
Abstract
A tissue engineered oesophagus could overcome limitations associated with oesophageal substitution. Combining decellularized scaffolds with patient-derived cells shows promise for regeneration of tissue defects. In this proof-of-principle study, a two-stage approach for generation of a bio-artificial oesophageal graft addresses some major challenges in organ engineering, namely: (i) development of multi-strata tubular structures, (ii) appropriate re-population/maturation of constructs before transplantation, (iii) cryopreservation of bio-engineered organs and (iv) in vivo pre-vascularization. The graft comprises decellularized rat oesophagus homogeneously re-populated with mesoangioblasts and fibroblasts for the muscle layer. The oesophageal muscle reaches organised maturation after dynamic culture in a bioreactor and functional integration with neural crest stem cells. Grafts are pre-vascularised in vivo in the omentum prior to mucosa reconstitution with expanded epithelial progenitors. Overall, our optimised two-stage approach produces a fully re-populated, structurally organized and pre-vascularized oesophageal substitute, which could become an alternative to current oesophageal substitutes. Combining decellularised scaffolds with patient-derived cells holds promise for bioengineering of functional tissues. Here the authors develop a two-stage approach to engineer an oesophageal graft that retains the structural organisation of native oesophagus.
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15
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Arakelian L, Kanai N, Dua K, Durand M, Cattan P, Ohki T. Esophageal tissue engineering: from bench to bedside. Ann N Y Acad Sci 2018; 1434:156-163. [PMID: 30088660 DOI: 10.1111/nyas.13951] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2018] [Revised: 07/09/2018] [Accepted: 07/17/2018] [Indexed: 12/12/2022]
Abstract
For various esophageal diseases, the search for alternative techniques for tissue repair has led to significant developments in basic and translational research in the field of tissue engineering. Applied to the esophagus, this concept is based on the in vitro combination of elements judged necessary for in vivo implantation to promote esophageal tissue remodeling. Different methods are currently being explored to develop substitutes using cells, scaffolds, or a combination of both, according to the severity of lesions to be treated. In this review, we discuss recent advances in (1) cell sheet technology for preventing stricture after extended esophageal mucosectomy and (2) full-thickness circumferential esophageal replacement using tissue-engineered substitutes.
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Affiliation(s)
- Lousineh Arakelian
- Cell Therapy Unit, AP-HP, Saint-Louis Hospital, Paris Diderot University, Paris, France.,INSERM, Clinical Investigation Center in Biotherapies (CBT-501) and U1160, Institut Universitaire d'Hématologie, Saint-Louis Hospital, Paris, France
| | - Nobuo Kanai
- Department of Surgery, Institute of Gastroenterology, Tokyo Women's Medical University, Tokyo, Japan.,Institute of Advanced Biomedical Engineering and Science, Tokyo Women's Medical University, Tokyo, Japan
| | - Kulwinder Dua
- Division of Gastroenterology and Hepatology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Marlène Durand
- University of Bordeaux, CHU Bordeaux, CIC1401 Inserm, Bordeaux, France.,Inserm, Bioingénierie Tissulaire, U1026, Bordeaux, France
| | - Pierre Cattan
- Cell Therapy Unit, AP-HP, Saint-Louis Hospital, Paris Diderot University, Paris, France.,INSERM, Clinical Investigation Center in Biotherapies (CBT-501) and U1160, Institut Universitaire d'Hématologie, Saint-Louis Hospital, Paris, France.,Department of Digestive and Endocrine Surgery, AP-HP, Saint-Louis Hospital, Paris Diderot University, Paris, France
| | - Takeshi Ohki
- Department of Surgery, Institute of Gastroenterology, Tokyo Women's Medical University, Tokyo, Japan.,Institute of Advanced Biomedical Engineering and Science, Tokyo Women's Medical University, Tokyo, Japan
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16
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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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17
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Colorectal wall regeneration resulting from the association of chitosan hydrogel and stromal vascular fraction from adipose tissue. J Biomed Mater Res A 2017; 106:460-467. [DOI: 10.1002/jbm.a.36243] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2016] [Revised: 06/28/2017] [Accepted: 09/19/2017] [Indexed: 12/13/2022]
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18
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Algarrahi K, Franck D, Savarino A, Cristofaro V, Yang X, Affas S, Schäfer FM, Sullivan MP, Estrada CR, Mauney JR. Bilayer silk fibroin grafts support functional oesophageal repair in a rodent model of caustic injury. J Tissue Eng Regen Med 2017; 12:e1068-e1075. [PMID: 28371514 DOI: 10.1002/term.2434] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2016] [Revised: 12/15/2016] [Accepted: 03/29/2017] [Indexed: 01/07/2023]
Abstract
Surgical repair of caustic oesophageal injuries with autologous gastrointestinal segments is often associated with dysmotility, dysphagia and donor site morbidity, and therefore alternative graft options are needed. Bilayer silk fibroin (BLSF) scaffolds were assessed for their ability to support functional restoration of damaged oesophageal tissues in a rat model of onlay oesophagoplasty. Transient exposure of isolated oesophageal segments with 40% NaOH led to corrosive oesophagitis and a 91% reduction in the luminal cross-sectional area of damaged sites. Oesophageal repair with BLSF matrices was performed in injured rats (n = 27) as well as a nondiseased cohort (n = 12) for up to 2 months after implantation. Both implant groups exhibited >80% survival rates, displayed similar degrees of weight gain, and were capable of solid food consumption following a 3-day liquid diet. End-point μ-computed tomography of repaired sites demonstrated a 4.5-fold increase in luminal cross-sectional area over baseline injury levels. Reconstructed oesophageal conduits from damaged and nondiseased animals produced comparable contractile responses to KCl and electric field stimulation while isoproterenol generated similar tissue relaxation responses. Histological and immunohistochemical evaluations of neotissues from both implant groups showed formation of a stratified, squamous epithelium with robust cytokeratin expression as well as skeletal and smooth muscle layers positive for contractile protein expression. In addition, synaptophysin positive neuronal junctions and vessels lined with CD31 positive endothelial cells were also observed at graft sites in each setting. These results provide preclinical validation for the use of BLSF scaffolds in reconstructive strategies for oesophageal repair following caustic injury.
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Affiliation(s)
- Khalid Algarrahi
- Urological Diseases Research Center, Boston Children's Hospital, Boston, Massachusetts, USA.,Department of Surgery, Harvard Medical School, Boston, Massachusetts, USA
| | - Debra Franck
- Urological Diseases Research Center, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Alyssa Savarino
- Urological Diseases Research Center, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Vivian Cristofaro
- Department of Surgery, Harvard Medical School, Boston, Massachusetts, USA.,Division of Urology, Veterans Affairs Boston Healthcare System, West Roxbury, Massachusetts, USA.,Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Xuehui Yang
- Urological Diseases Research Center, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Saif Affas
- Urological Diseases Research Center, Boston Children's Hospital, Boston, Massachusetts, USA.,Department of Surgery, Harvard Medical School, Boston, Massachusetts, USA
| | - Frank-Mattias Schäfer
- Urological Diseases Research Center, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Maryrose P Sullivan
- Department of Surgery, Harvard Medical School, Boston, Massachusetts, USA.,Division of Urology, Veterans Affairs Boston Healthcare System, West Roxbury, Massachusetts, USA.,Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Carlos R Estrada
- Urological Diseases Research Center, Boston Children's Hospital, Boston, Massachusetts, USA.,Department of Surgery, Harvard Medical School, Boston, Massachusetts, USA
| | - Joshua R Mauney
- Urological Diseases Research Center, Boston Children's Hospital, Boston, Massachusetts, USA.,Department of Surgery, Harvard Medical School, Boston, Massachusetts, USA
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19
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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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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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21
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Poghosyan T, Catry J, Luong-Nguyen M, Bruneval P, Domet T, Arakelian L, Sfeir R, Michaud L, Vanneaux V, Gottrand F, Larghero J, Cattan P. Esophageal tissue engineering: Current status and perspectives. J Visc Surg 2015; 153:21-9. [PMID: 26711880 DOI: 10.1016/j.jviscsurg.2015.11.009] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Tissue engineering, which consists of the combination and in vivo implantation of elements required for tissue remodeling toward a specific organ phenotype, could be an alternative for classical techniques of esophageal replacement. The current hybrid approach entails creation of an esophageal substitute composed of an acellular matrix and autologous epithelial and muscle cells provides the most successful results. Current research is based on the use of mesenchymal stem cells, whose potential for differentiation and proangioogenic, immune-modulator and anti-inflammatory properties are important assets. In the near future, esophageal substitutes could be constructed from acellular "intelligent matrices" that contain the molecules necessary for tissue regeneration; this should allow circumvention of the implantation step and still obtain standardized in vivo biological responses. At present, tissue engineering applications to esophageal replacement are limited to enlargement plasties with absorbable, non-cellular matrices. Nevertheless, the application of existing clinical techniques for replacement of other organs by tissue engineering in combination with a multiplication of translational research protocols for esophageal replacement in large animals should soon pave the way for health agencies to authorize clinical trials.
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Affiliation(s)
- T Poghosyan
- Service de chirurgie digestive, oncologique et métabolique, hôpital Ambroise-Paré, AP-HP, 92100 Boulogne-Billancourt, France; CIC de biothérapies, Inserm UMR 1160, institut universitaire d'hématologie, hôpital Saint-Louis, 1, avenue Claude-Vellefaux, 75010 Paris, France
| | - J Catry
- CIC de biothérapies, Inserm UMR 1160, institut universitaire d'hématologie, hôpital Saint-Louis, 1, avenue Claude-Vellefaux, 75010 Paris, France; Service de chirurgie générale, digestive et endocrinienne, hôpital Saint-Louis, AP-HP, 75010 Paris, France
| | - M Luong-Nguyen
- CIC de biothérapies, Inserm UMR 1160, institut universitaire d'hématologie, hôpital Saint-Louis, 1, avenue Claude-Vellefaux, 75010 Paris, France; Service de chirurgie générale, digestive et endocrinienne, hôpital Saint-Louis, AP-HP, 75010 Paris, France
| | - P Bruneval
- Service d'anatomopathologie, hôpital européen Georges-Pompidou, AP-HP, 75015 Paris, France
| | - T Domet
- CIC de biothérapies, Inserm UMR 1160, institut universitaire d'hématologie, hôpital Saint-Louis, 1, avenue Claude-Vellefaux, 75010 Paris, France; Unité de thérapie cellulaire, hôpital Saint-Louis, AP-HP, 75010 Paris, France
| | - L Arakelian
- CIC de biothérapies, Inserm UMR 1160, institut universitaire d'hématologie, hôpital Saint-Louis, 1, avenue Claude-Vellefaux, 75010 Paris, France
| | - R Sfeir
- Centre de référence des affections congénitales et malformatives de l'œsophage, CHRU de Lille, 59000 Lille, France
| | - L Michaud
- Centre de référence des affections congénitales et malformatives de l'œsophage, CHRU de Lille, 59000 Lille, France
| | - V Vanneaux
- CIC de biothérapies, Inserm UMR 1160, institut universitaire d'hématologie, hôpital Saint-Louis, 1, avenue Claude-Vellefaux, 75010 Paris, France; Unité de thérapie cellulaire, hôpital Saint-Louis, AP-HP, 75010 Paris, France
| | - F Gottrand
- Centre de référence des affections congénitales et malformatives de l'œsophage, CHRU de Lille, 59000 Lille, France
| | - J Larghero
- CIC de biothérapies, Inserm UMR 1160, institut universitaire d'hématologie, hôpital Saint-Louis, 1, avenue Claude-Vellefaux, 75010 Paris, France; Unité de thérapie cellulaire, hôpital Saint-Louis, AP-HP, 75010 Paris, France
| | - P Cattan
- CIC de biothérapies, Inserm UMR 1160, institut universitaire d'hématologie, hôpital Saint-Louis, 1, avenue Claude-Vellefaux, 75010 Paris, France; Service de chirurgie générale, digestive et endocrinienne, hôpital Saint-Louis, AP-HP, 75010 Paris, France.
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22
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Jönsson L, Dellenmark Blom M, Friberg L, Gatzinsky V, Holmquist O, Jennische E, Sandin A, Abrahamsson K. Macrophage Phenotype Is Associated With the Regenerative Response in Experimental Replacement of the Porcine Esophagus. Artif Organs 2015; 40:950-958. [PMID: 26667982 DOI: 10.1111/aor.12652] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
A porcine model for bridging circumferential defects in the intrathoracic esophagus has been developed in order to improve the treatment of children born with long-gap esophageal atresia. The aim of this study was to identify factors beneficial for tissue regeneration in the bridging area in this model and to describe the histological progression 20 days after replacement with a silicone-stented Biodesign mesh. Resection of 3 cm of intrathoracic esophagus and replacement with a bridging graft was performed in six newly weaned piglets. They were fed through a gastrostomy for 10 days, and then had probe formula orally for another 10 days prior to sacrifice. Two out of six piglets had stent loss prior to sacrifice. In the four piglets with the stent in place, a tissue tube, with visible muscle in the wall, was seen at sacrifice. Histology showed that the wall of the healing area was well organized with layers of inflammatory cells, in-growing vessels, and smooth muscle cells. CD163+ macrophages was seen toward the esophageal lumen. In the animals where the stent was lost, the bridging area was narrow, and histology showed a less organized structure in the bridging area without the presence of CD163+ macrophages. This study indicates that regenerative healing was seen in the porcine esophagus 20 days after replacement of a part of the intrathoracic esophagus with a silicone-stented Biodesign mesh, if the bridging graft is retained. If the graft is lost, the inflammatory pattern changes with invasion of proinflammatory, M1 macrophages in the entire wall, which seems to redirect the healing process toward scar formation.
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Affiliation(s)
- Linus Jönsson
- Institute of Clinical Sciences, Department of Pediatric Surgery, University of Gothenburg, Gothenburg, Sweden.
| | - Michaela Dellenmark Blom
- Institute of Clinical Sciences, Department of Pediatric Surgery, University of Gothenburg, Gothenburg, Sweden
| | - Lars Friberg
- Institute of Clinical Sciences, Department of Pediatric Surgery, University of Gothenburg, Gothenburg, Sweden
| | - Vladimir Gatzinsky
- Institute of Clinical Sciences, Department of Pediatric Surgery, University of Gothenburg, Gothenburg, Sweden
| | - Olof Holmquist
- Institute of Clinical Sciences, Department of Pediatric Surgery, University of Gothenburg, Gothenburg, Sweden
| | - Eva Jennische
- Institute of Biomedicine, Department of Medical Biochemistry and Cell Biology, University of Gothenburg, Gothenburg, Sweden
| | - Anders Sandin
- Institute of Clinical Sciences, Department of Pediatric Surgery, University of Gothenburg, Gothenburg, Sweden
| | - Kate Abrahamsson
- Institute of Clinical Sciences, Department of Pediatric Surgery, University of Gothenburg, Gothenburg, Sweden
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23
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Sicari BM, Londono R, Badylak SF. Strategies for skeletal muscle tissue engineering: seed vs. soil. J Mater Chem B 2015; 3:7881-7895. [PMID: 32262901 DOI: 10.1039/c5tb01714a] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
The most commonly used tissue engineering approach includes the ex vivo combination of site-appropriate cell(s) and scaffold material(s) to create three-dimensional constructs for tissue replacement or reconstruction. These three-dimensional combinations are typically subjected to a period of culture and conditioning (i.e., self-assembly and maturation) to promote the development of ex vivo constructs which closely mimic native target tissue. This cell-based approach is challenged by the host response to the engineered tissue construct following surgical implantation. As an alternative to the cell-based approach, acellular biologic scaffolds attract endogenous cells and remodel into partially functional mimics of native tissue upon implantation. The present review examines cell-types (i.e., seed), scaffold materials (i.e., soil), and challenges associated with functional tissue engineering. Skeletal muscle is used as the target tissue prototype but the discussed principles will largely apply to most body systems.
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Affiliation(s)
- Brian M Sicari
- McGowan Institute for Regenerative Medicine, University of Pittsburgh, Suite 300, 450 Technology Drive, Pittsburgh, PA 15218, USA.
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24
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Nakao M, Ueno T, Oga A, Kuramitsu Y, Nakatsu H, Oka M. Proposal of intestinal tissue engineering combined with Bianchi's procedure. J Pediatr Surg 2015; 50:573-80. [PMID: 25840066 DOI: 10.1016/j.jpedsurg.2014.11.035] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2013] [Revised: 10/02/2014] [Accepted: 11/05/2014] [Indexed: 12/16/2022]
Abstract
AIM The aim of this study is to examine the feasibility of the small intestinal submucosa (SIS) when the longitudinal staples during Bianchi's procedure are replaced with SIS graft. METHODS The mesentery of the bowel was separated based on the bifurcated vessels in five beagles. A 2×7-cm longitudinal half of the bowel was excised and the defect was repaired using SIS with similar blood supply in Bianchi's operation. Six months later, intestinal motility in the SIS-grafted area was recorded. Tissue preparations were obtained from the reorganized area. An organ bath technique with electrical field stimulation was applied. Both the native small intestine and grafted area were morphologically investigated using immunohistochemistry. MAIN RESULTS All dogs survived and thrived with no anastomotic leakage. Isoperistaltic migrating contractility during fasting was observed through the grafted segment including the reorganized area. The SIS-reorganized tissue contracted in response to an acetylcholine agonist and electrical field stimulation. The mucosa was covered with normal epithelium. Reorganization of neural and smooth muscle cells was observed. CONCLUSIONS SIS has the potential for use as a scaffold that promotes the formation of a physical and physiological neointestine. Our present proposal approaches a novel surgical treatment in patients with short bowel syndrome.
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Affiliation(s)
- Mitsuhiro Nakao
- Department of Digestive Surgery and Surgical Oncology (Department of Surgery II), Yamaguchi University Graduate School of Medicine, Yamaguchi, Japan
| | - Tomio Ueno
- Department of Digestive Surgery and Surgical Oncology (Department of Surgery II), Yamaguchi University Graduate School of Medicine, Yamaguchi, Japan.
| | - Atsunori Oga
- Department of Molecular Pathology, Yamaguchi University Graduate School of Medicine, Yamaguchi, Japan
| | - Yasuhiro Kuramitsu
- Department of Biochemistry and Functional Proteomics, Yamaguchi University Graduate School of Medicine, Yamaguchi, Japan
| | - Hiroki Nakatsu
- Department of Digestive Surgery and Surgical Oncology (Department of Surgery II), Yamaguchi University Graduate School of Medicine, Yamaguchi, Japan
| | - Masaaki Oka
- Department of Digestive Surgery and Surgical Oncology (Department of Surgery II), Yamaguchi University Graduate School of Medicine, Yamaguchi, Japan
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25
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Chian KS, Leong MF, Kono K. Regenerative medicine for oesophageal reconstruction after cancer treatment. Lancet Oncol 2015; 16:e84-92. [PMID: 25638684 DOI: 10.1016/s1470-2045(14)70410-3] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Removal of malignant tissue in patients with oesophageal cancer and replacement with autologous grafts from the stomach and colon can lead to problems. The need to reduce stenosis and anastomotic leakage after oesophagectomy is a high priority. Developments in tissue-engineering methods and cell-sheet technology have improved scaffold materials for oesophageal repair. Despite the many successful animal studies, few tissue-engineering approaches have progressed to clinical trials. In this Review, we discuss the status of oesophagus reconstruction after surgery. In particular, we highlight two clinical trials that used decellularised constructs and epithelial cell sheets to replace excised tissues after endoscopic submucosal dissection or mucosal resection procedures. Results from the trials showed that both decellularised grafts and epithelial-cell sheets prevented stenosis. By contrast, animal studies have shown that the use of tissue-engineered constructs after oesophagectomy remains a challenge.
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Affiliation(s)
- Kerm Sin Chian
- School of Mechanical and Aerospace Engineering, Nanyang Technological University, Singapore, Singapore.
| | - Meng Fatt Leong
- Department of Cell and Tissue Engineering, Institute of Bioengineering and Nanotechnology, Singapore, Singapore
| | - Koji Kono
- Department of Surgery, National University of Singapore, Singapore, Singapore; Cancer Science Institute of Singapore, National University of Singapore, Singapore, Singapore; Department of Organ Regulatory Surgery and Advanced Cancer Immunotherapy, Fukushima Medical University, Fukushima, Japan
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26
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Poghosyan T, Sfeir R, Michaud L, Bruneval P, Domet T, Vanneaux V, Luong-Nguyen M, Gaujoux S, Gottrand F, Larghero J, Cattan P. Circumferential esophageal replacement using a tube-shaped tissue-engineered substitute: An experimental study in minipigs. Surgery 2015; 158:266-77. [PMID: 25796416 DOI: 10.1016/j.surg.2015.01.020] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2014] [Revised: 01/14/2015] [Accepted: 01/29/2015] [Indexed: 01/02/2023]
Abstract
BACKGROUND Esophageal replacement by the colon or the stomach for malignant and nonmalignant esophageal diseases exposes to significant morbidity and mortality. In this setting, tissue engineering seems to be a seductive alternative. METHODS In a porcine model, we performed a 5-cm-long circumferential replacement of the cervical esophagus by a tubulized acellular matrix (small intestinal submucosa) cellularized with autologous skeletal myoblasts and covered by a human amniotic membrane seeded with autologous oral epithelial cells. The substitute was grown for 2 weeks in the great omentum before esophageal replacement. Eighteen minipigs (divided into 3 groups: group A [substitute with esophageal endoprothesis; n = 6], group B [substitute alone; n = 6], and group C [endoprothesis alone; n = 6]) were included. The esophageal endoprothesis was removed at 6 months. Animals were killed sequentially over a 12 month-period. Clinical, endoscopic, radiologic and histologic outcomes were analyzed. RESULTS All animals except 1 of in groups B and C died during the first 2 months owing to refractory esophageal stenosis or endoprothesis extrusion. Nutritional autonomy without endoprothesis was observed in all animals of group A with a follow-up of >6 months (n = 3). A phenotype similar to that of native esophagus, consisting of a mature epithelium, submucosal glands, and a circular muscular layer, was observed after 9 months. CONCLUSION In this model, the circumferential replacement of the cervical esophagus by a tube-shaped tissue-engineered substitute under the temporary cover of an esophageal endoprothesis allowed nutritional autonomy and tissue remodeling toward an esophageal phenotype.
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Affiliation(s)
- Tigran Poghosyan
- Cell Therapy Unit and CIC-BT, Saint-Louis Hospital, AP-HP, Paris, France; Department of Digestive and Endocrine Surgery, Saint-Louis Hospital, AP-HP, Paris, France; Inserm UMR 1160, Université Paris Diderot, Sorbonne Paris Cité, Paris, France.
| | - Rony Sfeir
- Department of Pediatric Surgery, Jeanne de Flandre Hospital and Université Lille 2, Lille, France
| | - Laurent Michaud
- Reference Center for Congenital and Malformative Esophageal Diseases, Department of Pediatric Gastroenterology and Nutrition, Jeanne de Flandre Hospital and Université Lille 2, Lille, France
| | - Patrick Bruneval
- Department of Pathology, Georges Pompidou European Hospital, AP-HP, Paris, France
| | - Thomas Domet
- Cell Therapy Unit and CIC-BT, Saint-Louis Hospital, AP-HP, Paris, France
| | - Valerie Vanneaux
- Cell Therapy Unit and CIC-BT, Saint-Louis Hospital, AP-HP, Paris, France; Inserm UMR 1160, Université Paris Diderot, Sorbonne Paris Cité, Paris, France
| | - Minh Luong-Nguyen
- Cell Therapy Unit and CIC-BT, Saint-Louis Hospital, AP-HP, Paris, France; Inserm UMR 1160, Université Paris Diderot, Sorbonne Paris Cité, Paris, France
| | - Sebastien Gaujoux
- Department of Digestive and Endocrine Surgery, Cochin Hospital, AP-HP, Paris, France
| | - Frederic Gottrand
- Reference Center for Congenital and Malformative Esophageal Diseases, Department of Pediatric Gastroenterology and Nutrition, Jeanne de Flandre Hospital and Université Lille 2, Lille, France
| | - Jerome Larghero
- Cell Therapy Unit and CIC-BT, Saint-Louis Hospital, AP-HP, Paris, France; Inserm UMR 1160, Université Paris Diderot, Sorbonne Paris Cité, Paris, France
| | - Pierre Cattan
- Cell Therapy Unit and CIC-BT, Saint-Louis Hospital, AP-HP, Paris, France; Department of Digestive and Endocrine Surgery, Saint-Louis Hospital, AP-HP, Paris, France; Inserm UMR 1160, Université Paris Diderot, Sorbonne Paris Cité, Paris, France
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27
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Algarrahi K, Franck D, Ghezzi CE, Cristofaro V, Yang X, Sullivan MP, Chung YG, Affas S, Jennings R, Kaplan DL, Estrada CR, Mauney JR. Acellular bi-layer silk fibroin scaffolds support functional tissue regeneration in a rat model of onlay esophagoplasty. Biomaterials 2015; 53:149-59. [PMID: 25890715 DOI: 10.1016/j.biomaterials.2015.02.092] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2014] [Revised: 02/18/2015] [Accepted: 02/21/2015] [Indexed: 02/07/2023]
Abstract
Surgical management of long-gap esophageal defects with autologous gastrointestinal tissues is frequently associated with adverse complications including organ dysmotility, dysphagia, and donor site morbidity. In order to develop alternative graft options, bi-layer silk fibroin (SF) scaffolds were investigated for their potential to support functional tissue regeneration in a rodent model of esophageal repair. Onlay esophagoplasty was performed with SF matrices (N = 40) in adult rats for up to 2 m of implantation. Parallel groups consisted of animals implanted with small intestinal submucosa (SIS) scaffolds (N = 22) or sham controls receiving esophagotomy alone (N = 20). Sham controls exhibited a 100% survival rate while rats implanted with SF and SIS scaffolds displayed respective survival rates of 93% and 91% prior to scheduled euthanasia. Animals in each experimental group were capable of solid food consumption following a 3 d post-op liquid diet and demonstrated similar degrees of weight gain throughout the study period. End-point μ-computed tomography at 2 m post-op revealed no evidence of contrast extravasation, fistulas, strictures, or diverticula in any of the implant groups. Ex vivo tissue bath studies demonstrated that reconstructed esophageal conduits supported by both SF and SIS scaffolds displayed contractile responses to carbachol, KCl and electrical field stimulation while isoproterenol produced tissue relaxation. Histological (Masson's trichrome and hematoxylin and eosin) and immunohistochemical (IHC) evaluations demonstrated both implant groups produced de novo formation of skeletal and smooth muscle bundles positive for contractile protein expression [fast myosin heavy chain (MY32) and α-smooth muscle actin (α-SMA)] within the graft site. However, SF matrices promoted a significant 4-fold increase in MY32+ skeletal muscle and a 2-fold gain in α-SMA+ smooth muscle in comparison to the SIS cohort as determined by histomorphometric analyses. A stratified squamous, keratinized epithelium expressing cytokeratin 5 and involucrin proteins was also present at 2 m post-op in all experimental groups. De novo innervation and vascularization were evident in all regenerated tissues indicated by the presence of synaptophysin (SYP38)+ boutons and vessels lined with CD31 expressing endothelial cells. In respect to SIS, the SF group supported a significant 4-fold increase in the density of SYP38+ boutons within the implant region. Evaluation of host tissue responses revealed that SIS matrices elicited chronic inflammatory reactions and severe fibrosis throughout the neotissues, in contrast to SF scaffolds. The results of this study demonstrate that bi-layer SF scaffolds represent promising biomaterials for onlay esophagoplasty, capable of producing superior regenerative outcomes in comparison to conventional SIS scaffolds.
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Affiliation(s)
- Khalid Algarrahi
- Urological Diseases Research Center, Boston Children's Hospital, Boston, MA 02115, USA; Department of Surgery, Harvard Medical School, Boston, MA 02115, USA
| | - Debra Franck
- Urological Diseases Research Center, Boston Children's Hospital, Boston, MA 02115, USA
| | - Chiara E Ghezzi
- Department of Biomedical Engineering, Tufts University, Medford, MA 02155, USA
| | - Vivian Cristofaro
- Department of Surgery, Harvard Medical School, Boston, MA 02115, USA; Division of Urology, Veterans Administration Boston Healthcare System, West Roxbury, MA 02132, USA; Department of Surgery, Brigham and Women's Hospital, Boston, MA 02115, USA
| | - Xuehui Yang
- Urological Diseases Research Center, Boston Children's Hospital, Boston, MA 02115, USA
| | - Maryrose P Sullivan
- Department of Surgery, Harvard Medical School, Boston, MA 02115, USA; Division of Urology, Veterans Administration Boston Healthcare System, West Roxbury, MA 02132, USA; Department of Surgery, Brigham and Women's Hospital, Boston, MA 02115, USA
| | - Yeun Goo Chung
- Urological Diseases Research Center, Boston Children's Hospital, Boston, MA 02115, USA; Department of Surgery, Harvard Medical School, Boston, MA 02115, USA
| | - Saif Affas
- Urological Diseases Research Center, Boston Children's Hospital, Boston, MA 02115, USA; Department of Surgery, Harvard Medical School, Boston, MA 02115, USA
| | - Russell Jennings
- Department of Surgery, Harvard Medical School, Boston, MA 02115, USA
| | - David L Kaplan
- Department of Biomedical Engineering, Tufts University, Medford, MA 02155, USA
| | - Carlos R Estrada
- Urological Diseases Research Center, Boston Children's Hospital, Boston, MA 02115, USA; Department of Surgery, Harvard Medical School, Boston, MA 02115, USA.
| | - Joshua R Mauney
- Urological Diseases Research Center, Boston Children's Hospital, Boston, MA 02115, USA; Department of Surgery, Harvard Medical School, Boston, MA 02115, USA.
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28
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Schumacher MA, Aihara E, Feng R, Engevik A, Shroyer NF, Ottemann KM, Worrell RT, Montrose MH, Shivdasani RA, Zavros Y. The use of murine-derived fundic organoids in studies of gastric physiology. J Physiol 2015; 593:1809-27. [PMID: 25605613 DOI: 10.1113/jphysiol.2014.283028] [Citation(s) in RCA: 88] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2014] [Accepted: 01/16/2015] [Indexed: 02/06/2023] Open
Abstract
KEY POINTS An in vitro approach to study gastric development is primary mouse-derived epithelium cultured as three-dimensional spheroids known as organoids. We have devised two unique gastric fundic-derived organoid cultures: model 1 for the expansion of gastric fundic stem cells, and model 2 for the maintenance of mature cell lineages. Organoids maintained in co-culture with immortalized stomach mesenchymal cells express robust numbers of surface pit, mucous neck, chief, endocrine and parietal cells. Histamine induced a significant decrease in intraluminal pH that was reversed by omeprazole in fundic organoids and indicated functional activity and regulation of parietal cells. Localized photodamage resulted in rapid cell exfoliation coincident with migration of neighbouring cells to the damaged area, sustaining epithelial continuity. We report the use of these models for studies of epithelial cell biology and cell damage and repair. ABSTRACT Studies of gastric function and disease have been limited by the lack of extended primary cultures of the epithelium. An in vitro approach to study gastric development is primary mouse-derived antral epithelium cultured as three-dimensional spheroids known as organoids. There have been no reports on the use of organoids for gastric function. We have devised two unique gastric fundic-derived organoid cultures: model 1 for the expansion of gastric fundic stem cells, and model 2 for the maintenance of mature cell lineages. Both models were generated from single glands dissociated from whole fundic tissue and grown in basement membrane matrix (Matrigel) and organoid growth medium. Model 1 enriches for a stem cell-like niche via simple passage of the organoids. Maintained in Matrigel and growth medium, proliferating organoids expressed high levels of stem cell markers CD44 and Lgr5. Model 2 is a system of gastric organoids co-cultured with immortalized stomach mesenchymal cells (ISMCs). Organoids maintained in co-culture with ISMCs express robust numbers of surface pit, mucous neck, chief, endocrine and parietal cells. Histamine induced a significant decrease in intraluminal pH that was reversed by omeprazole in fundic organoids and indicated functional activity and regulation of parietal cells. Localized photodamage resulted in rapid cell exfoliation coincident with migration of neighbouring cells to the damaged area, sustaining epithelial continuity. Thus, we report the use of these models for studies of epithelial cell biology and cell damage and repair.
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Affiliation(s)
- Michael A Schumacher
- Department of Molecular and Cellular Physiology, University of Cincinnati College of Medicine, Cincinnati, OH, USA
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29
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Syed O, Walters NJ, Day RM, Kim HW, Knowles JC. Evaluation of decellularization protocols for production of tubular small intestine submucosa scaffolds for use in oesophageal tissue engineering. Acta Biomater 2014; 10:5043-5054. [PMID: 25173840 DOI: 10.1016/j.actbio.2014.08.024] [Citation(s) in RCA: 126] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2014] [Revised: 07/24/2014] [Accepted: 08/22/2014] [Indexed: 12/11/2022]
Abstract
Small intestine submucosa (SIS) has emerged as one of a number of naturally derived extracellular matrix (ECM) biomaterials currently in clinical use. In addition to clinical applications, ECM materials form the basis for a variety of approaches within tissue engineering research. In our preliminary work it was found that SIS can be consistently and reliably made into tubular scaffolds which confer certain potential advantages. Given that decellularization protocols for SIS are applied to sheet-form SIS, it was hypothesized that a tubular-form SIS would behave differently to pre-existing protocols. In this work, tubular SIS was produced and decellularized by the conventional peracetic acid-agitation method, peracetic acid under perfusion along with two commonly used detergent-perfusion protocols. The aim of this was to produce a tubular SIS that was both adequately decellularized and possessing the mechanical properties which would make it a suitable scaffold for oesophageal tissue engineering, which was one of the goals of this work. Analysis was carried out via mechanical tensile testing, DNA quantification, scanning electron and light microscopy, and a metabolic assay, which was used to give an indication of the biocompatibility of each decellularization method. Both peracetic acid protocols were shown to be unsuitable methods with the agitation-protocol-produced SIS, which was poorly decellularized, and the perfusion protocol resulted in poor mechanical properties. Both detergent-based protocols produced well-decellularized SIS, with no adverse mechanical effects; however, one protocol emerged, SDS/Triton X-100, which proved superior in both respects. However, this SIS showed reduced metabolic activity, and this cytotoxic effect was attributed to residual reagents. Consequently, the use of SIS produced using the detergent SD as the decellularization agent was deemed to be the most suitable, although the elimination of the DNase enzyme would give further improvement.
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30
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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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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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32
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Sjöqvist S, Jungebluth P, Lim ML, Haag JC, Gustafsson Y, Lemon G, Baiguera S, Burguillos MA, Del Gaudio C, Rodríguez AB, Sotnichenko A, Kublickiene K, Ullman H, Kielstein H, Damberg P, Bianco A, Heuchel R, Zhao Y, Ribatti D, Ibarra C, Joseph B, Taylor DA, Macchiarini P. Experimental orthotopic transplantation of a tissue-engineered oesophagus in rats. Nat Commun 2014; 5:3562. [PMID: 24736316 PMCID: PMC4354271 DOI: 10.1038/ncomms4562] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2013] [Accepted: 03/05/2014] [Indexed: 12/22/2022] Open
Abstract
A tissue-engineered oesophageal scaffold could be very useful for the treatment of pediatric and adult patients with benign or malignant diseases such as carcinomas, trauma or congenital malformations. Here we decellularize rat oesophagi inside a perfusion bioreactor to create biocompatible biological rat scaffolds that mimic native architecture, resist mechanical stress and induce angiogenesis. Seeded allogeneic mesenchymal stromal cells spontaneously differentiate (proven by gene-, protein and functional evaluations) into epithelial- and muscle-like cells. The reseeded scaffolds are used to orthotopically replace the entire cervical oesophagus in immunocompetent rats. All animals survive the 14-day study period, with patent and functional grafts, and gain significantly more weight than sham-operated animals. Explanted grafts show regeneration of all the major cell and tissue components of the oesophagus including functional epithelium, muscle fibres, nerves and vasculature. We consider the presented tissue-engineered oesophageal scaffolds a significant step towards the clinical application of bioengineered oesophagi.
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Affiliation(s)
- Sebastian Sjöqvist
- 1] Advanced Center for Translational Regenerative Medicine (ACTREM), Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, SE-141 86, Stockholm, Sweden [2] Division of Ear, Nose and Throat, Karolinska University Hospital, SE-141 86 Stockholm, Sweden
| | - Philipp Jungebluth
- 1] Advanced Center for Translational Regenerative Medicine (ACTREM), Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, SE-141 86, Stockholm, Sweden [2] Division of Ear, Nose and Throat, Karolinska University Hospital, SE-141 86 Stockholm, Sweden
| | - Mei Ling Lim
- 1] Advanced Center for Translational Regenerative Medicine (ACTREM), Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, SE-141 86, Stockholm, Sweden [2] Division of Ear, Nose and Throat, Karolinska University Hospital, SE-141 86 Stockholm, Sweden
| | - Johannes C Haag
- 1] Advanced Center for Translational Regenerative Medicine (ACTREM), Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, SE-141 86, Stockholm, Sweden [2] Division of Ear, Nose and Throat, Karolinska University Hospital, SE-141 86 Stockholm, Sweden
| | - Ylva Gustafsson
- 1] Advanced Center for Translational Regenerative Medicine (ACTREM), Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, SE-141 86, Stockholm, Sweden [2] Division of Ear, Nose and Throat, Karolinska University Hospital, SE-141 86 Stockholm, Sweden
| | - Greg Lemon
- Advanced Center for Translational Regenerative Medicine (ACTREM), Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, SE-141 86, Stockholm, Sweden
| | - Silvia Baiguera
- Advanced Center for Translational Regenerative Medicine (ACTREM), Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, SE-141 86, Stockholm, Sweden
| | | | - Costantino Del Gaudio
- Department of Industrial Engineering, Intrauniversitary Consortium for Material Science and Technology (INSTM) Research Unit Tor Vergata, University of Rome, Rome 00133, Italy
| | - Antonio Beltrán Rodríguez
- 1] Advanced Center for Translational Regenerative Medicine (ACTREM), Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, SE-141 86, Stockholm, Sweden [2] Division of Ear, Nose and Throat, Karolinska University Hospital, SE-141 86 Stockholm, Sweden
| | - Alexander Sotnichenko
- International Scientific-Research Clinical and Educational Center of Regenerative Medicine, Kuban State Medical University, Krasnodar 350040, Russian Federation
| | - Karolina Kublickiene
- 1] Center for Gender Medicine, Karolinska Institutet, SE-141 86 Stockholm, Sweden [2] Division of Obstetrics and Gynecology, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, SE-141 86 Stockholm, Sweden
| | - Henrik Ullman
- Department of Neuroscience, Karolinska Institutet, SE-171 77 Stockholm, Sweden
| | - Heike Kielstein
- Department of Anatomy and Cell Biology, Faculty of Medicine, Martin Luther University Halle-Wittenberg, 06108 Halle (Saale), Germany
| | - Peter Damberg
- Division of Medical Imaging and Technology, Department of Clinical Science, Intervention and Technology (CLINTEC) Karolinska Institutet, SE-171 77 Stockholm, Sweden
| | - Alessandra Bianco
- Department of Industrial Engineering, Intrauniversitary Consortium for Material Science and Technology (INSTM) Research Unit Tor Vergata, University of Rome, Rome 00133, Italy
| | - Rainer Heuchel
- 1] Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, SE-141 86 Stockholm, Sweden [2] Center of Biosciences, Karolinska Institutet, SE-141 86 Stockholm, Sweden
| | - Ying Zhao
- 1] Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, SE-141 86 Stockholm, Sweden [2] Center of Biosciences, Karolinska Institutet, SE-141 86 Stockholm, Sweden
| | - Domenico Ribatti
- Department of Basic Medical Sciences, Neurosciences and Sensory Organs, University of Bari Medical School, National Cancer Institute 'Giovanni Paolo II', Bari 70121, Italy
| | - Cristián Ibarra
- Department of Medical Biochemistry and Biophysics, Karolinska Institutet, SE-171 77 Stockholm, Sweden
| | - Bertrand Joseph
- Cancer Centrum Karolinska, Karolinska Institutet, SE-171 77 Stockholm, Sweden
| | - Doris A Taylor
- Texas Heart Institute, Center for Regenerative Medicine, Houston, Texas 770-30, USA
| | - Paolo Macchiarini
- 1] Advanced Center for Translational Regenerative Medicine (ACTREM), Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, SE-141 86, Stockholm, Sweden [2] Division of Ear, Nose and Throat, Karolinska University Hospital, SE-141 86 Stockholm, Sweden
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Hoogenkamp HR, Koens MJW, Geutjes PJ, Ainoedhofer H, Wanten G, Tiemessen DM, Hilborn J, Gupta B, Feitz WFJ, Daamen WF, Saxena AK, Oosterwijk E, van Kuppevelt TH. Seamless vascularized large-diameter tubular collagen scaffolds reinforced with polymer knittings for esophageal regenerative medicine. Tissue Eng Part C Methods 2014; 20:423-30. [PMID: 24099067 DOI: 10.1089/ten.tec.2013.0485] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
A clinical demand exists for alternatives to repair the esophagus in case of congenital defects, cancer, or trauma. A seamless biocompatible off-the-shelf large-diameter tubular scaffold, which is accessible for vascularization, could set the stage for regenerative medicine of the esophagus. The use of seamless scaffolds eliminates the error-prone tubularization step, which is necessary when emanating from flat scaffolds. In this study, we developed and characterized three different types of seamless tubular scaffolds, and evaluated in vivo tissue compatibility, including vascularization by omental wrapping. Scaffolds (luminal Ø ∼ 1.5 cm) were constructed using freezing, lyophilizing, and cross-linking techniques and included (1) single-layered porous collagen scaffold, (2) dual-layered (porous+dense) collagen scaffold, and (3) hybrid scaffold (collagen+incorporated polycaprolacton knitting). The latter had an ultimate tensile strength comparable to a porcine esophagus. To induce rapid vascularization, scaffolds were implanted in the omentum of sheep using a wrapping technique. After 6 weeks of biocompatibility, vascularization, calcification, and hypoxia were evaluated using immunohistochemistry. Scaffolds were biocompatible, and cellular influx and ingrowth of blood vessels were observed throughout the whole scaffold. No calcification was observed, and slight hypoxic conditions were detected only in the direct vicinity of the polymer knitting. It is concluded that seamless large-diameter tubular collagen-based scaffolds can be constructed and vascularized in vivo. Such scaffolds provide novel tools for esophageal reconstruction.
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Affiliation(s)
- Henk R Hoogenkamp
- 1 Department of Biochemistry 280, RIMLS, Radboud University Medical Center , Nijmegen, The Netherlands
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Fan MR, Gong M, Da LC, Bai L, Li XQ, Chen KF, Li-Ling J, Yang ZM, Xie HQ. Tissue engineered esophagus scaffold constructed with porcine small intestinal submucosa and synthetic polymers. Biomed Mater 2014; 9:015012. [DOI: 10.1088/1748-6041/9/1/015012] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Naso F, Iop L, Spina M, Gerosa G. Are FDA and CE sacrificing safety for a faster commercialization of xenogeneic tissue devices? Unavoidable need for legislation in decellularized tissue manufacturing. ACTA ACUST UNITED AC 2014; 83:193-4. [DOI: 10.1111/tan.12275] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2013] [Accepted: 11/28/2013] [Indexed: 11/30/2022]
Affiliation(s)
- F. Naso
- Department of Cardiac, Thoracic and Vascular Sciences; University Hospital of Padova; Padova Italy
| | - L. Iop
- Department of Cardiac, Thoracic and Vascular Sciences; University Hospital of Padova; Padova Italy
| | - M. Spina
- Department of Experimental Biomedical Sciences; University of Padova; Padova Italy
| | - G. Gerosa
- Department of Cardiac, Thoracic and Vascular Sciences; University Hospital of Padova; Padova Italy
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Turner NJ, Londono R, Dearth CL, Culiat CT, Badylak SF. Human NELL1 protein augments constructive tissue remodeling with biologic scaffolds. Cells Tissues Organs 2013; 198:249-65. [PMID: 24335144 DOI: 10.1159/000356491] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/18/2013] [Indexed: 11/19/2022] Open
Abstract
Biologic scaffolds composed of extracellular matrix (ECM) derived from decellularized tissues effectively reprogram key stages of the mammalian response to injury, altering the wound microenvironment from one that promotes scar tissue formation to one that stimulates constructive and functional tissue remodeling. In contrast, engineered scaffolds, composed of purified ECM components such as collagen, lack the complex ultrastructure and composition of intact ECM and may promote wound healing but lack factors that facilitate constructive and functional tissue remodeling. The objective of the present study was to test the hypothesis that addition of NELL1, a signaling protein that controls cell growth and differentiation, enhances the constructive tissue remodeling of a purified collagen scaffold. An abdominal wall defect model in the rat of 1.5-cm(2) partial thickness was used to compare the constructive remodeling of a bovine type I collagen scaffold to a biologic scaffold derived from small intestinal submucosa (SIS)-ECM with and without augmentation with 17 μg NELL1 protein. Samples were evaluated histologically at 14 days and 4 months. The contractile response of the defect site was also evaluated at 4 months. Addition of NELL1 protein improved the constructive remodeling of collagen scaffolds but not SIS-ECM scaffolds. Results showed an increase in the contractile force of the remodeled skeletal muscle and a fast:slow muscle composition similar to native tissue in the collagen-treated group. The already robust remodeling response to SIS-ECM was not enhanced by NELL1 at the dose tested. These findings suggest that NELL1 protein does contribute to the enhanced constructive remodeling of skeletal muscle.
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Affiliation(s)
- Neill J Turner
- McGowan Institute for Regenerative Medicine, University of Pittsburgh, Pittsburgh, Pa., USA
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Jönsson L, Friberg LG, Gatzinsky V, Jennische E, Sandin A, Abrahamsson K. Early Regenerative Response in the Intrathoracic Porcine Esophagus-The Impact of the Inflammation. Artif Organs 2013; 38:439-46. [DOI: 10.1111/aor.12216] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
- Linus Jönsson
- Department of Pediatric Surgery, The Queen Silvia Children's Hospital; The Sahlgrenska Academy at University of Gothenburg; Gothenburg Sweden
| | - Lars-Göran Friberg
- Department of Pediatric Surgery, The Queen Silvia Children's Hospital; The Sahlgrenska Academy at University of Gothenburg; Gothenburg Sweden
| | - Vladimir Gatzinsky
- Department of Pediatric Surgery, The Queen Silvia Children's Hospital; The Sahlgrenska Academy at University of Gothenburg; Gothenburg Sweden
| | - Eva Jennische
- Department of Medical Chemistry and Cell Biology, Institute of Biomedicine; University of Gothenburg; Gothenburg Sweden
| | - Anders Sandin
- Department of Pediatric Surgery, The Queen Silvia Children's Hospital; The Sahlgrenska Academy at University of Gothenburg; Gothenburg Sweden
| | - Kate Abrahamsson
- Department of Pediatric Surgery, The Queen Silvia Children's Hospital; The Sahlgrenska Academy at University of Gothenburg; Gothenburg Sweden
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Sicari BM, Dearth CL, Badylak SF. Tissue Engineering and Regenerative Medicine Approaches to Enhance the Functional Response to Skeletal Muscle Injury. Anat Rec (Hoboken) 2013; 297:51-64. [DOI: 10.1002/ar.22794] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 09/13/2013] [Accepted: 09/13/2013] [Indexed: 12/14/2022]
Affiliation(s)
- Brian M. Sicari
- McGowan Institute for Regenerative Medicine; Pittsburgh Pennsylvania
- Cellular and Molecular Pathology Graduate Program; University of Pittsburgh School of Medicine; Pittsburgh Pennsylvania
| | - Christopher L. Dearth
- McGowan Institute for Regenerative Medicine; Pittsburgh Pennsylvania
- Department of Surgery; University of Pittsburgh School of Medicine; Pittsburgh Pennsylvania
| | - Stephen F. Badylak
- McGowan Institute for Regenerative Medicine; Pittsburgh Pennsylvania
- Department of Surgery; University of Pittsburgh School of Medicine; Pittsburgh Pennsylvania
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Abstract
Regenerative biology/tissue engineering offers potential solutions for the repair and augmentation of diseased tissues and organs. Tissue engineering technology platforms currently under development for organ regeneration may function in part by recapitulating key mechanistic and signaling pathways associated with embryonic organogenesis. Temporal observations of observed morphological outcomes from the regeneration of tubular organs provide insights into the mechanisms of action associated with the activation of regenerative pathways in preclinical animal models and humans. These include induction of a neo-blastema, regeneration of laminarily organized mural elements (i.e., lamina propria, sub-mucosa, and muscularis), and formation of context appropriate transitional junctions at the point of anastomosis with other tissue elements. These results provide the foundation for a regenerative technology applicable to hollow organs of the gastrointestinal (GI) tract including esophagus and small intestine. Factors affecting the efficacy of observed regenerative outcomes within the GI tract include the roles of vascularization, innervations, and mesenchymal signaling. These will be discussed in the context of an overall mechanism of adult regeneration potentially applicable by the tissue engineering and regenerative medicine industry for continued development of hollow neo-organ products.
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Affiliation(s)
- Joydeep Basu
- 1Tengion, Inc., Winston-Salem, North Carolina, USA
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Lim ML, Jungebluth P, Ajalloueian F, Friedrich LH, Gilevich I, Grinnemo KH, Gubareva E, Haag JC, Lemon G, Sjöqvist S, Caplan AL, Macchiarini P. Whole organ and tissue reconstruction in thoracic regenerative surgery. Mayo Clin Proc 2013; 88:1151-66. [PMID: 24079685 DOI: 10.1016/j.mayocp.2013.03.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2012] [Revised: 03/09/2013] [Accepted: 03/15/2013] [Indexed: 12/25/2022]
Abstract
Development of novel prognostic, diagnostic, and treatment options will provide major benefits for millions of patients with acute or chronic respiratory dysfunction, cardiac-related disorders, esophageal problems, or other diseases in the thorax. Allogeneic organ transplant is currently available. However, it remains a trap because of its dependency on a very limited supply of donated organs, which may be needed for both initial and subsequent transplants. Furthermore, it requires lifelong treatment with immunosuppressants, which are associated with adverse effects. Despite early clinical applications of bioengineered organs and tissues, routine implementation is still far off. For this review, we searched the PubMed, MEDLINE, and Ovid databases for the following keywords for each tissue or organ: tissue engineering, biological and synthetic scaffold/graft, acellular and decelluar(ized), reseeding, bioreactor, tissue replacement, and transplantation. We identified the current state-of-the-art practices in tissue engineering with a focus on advances during the past 5 years. We discuss advantages and disadvantages of biological and synthetic solutions and introduce novel strategies and technologies for the field. The ethical challenges of innovation in this area are also reviewed.
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Affiliation(s)
- Mei Ling Lim
- Advanced Center for Translational Regenerative Medicine, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden
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Nakatsu H, Ueno T, Oga A, Nakao M, Nishimura T, Kobayashi S, Oka M. Influence of mesenchymal stem cells on stomach tissue engineering using small intestinal submucosa. J Tissue Eng Regen Med 2013; 9:296-304. [PMID: 23913876 PMCID: PMC4409104 DOI: 10.1002/term.1794] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2012] [Revised: 05/12/2013] [Accepted: 06/12/2013] [Indexed: 12/23/2022]
Abstract
Small intestinal submucosa (SIS) is a biodegradable collagen-rich matrix containing functional growth factors. We have previously reported encouraging outcomes for regeneration of an artificial defect in the rodent stomach using SIS grafts, although the muscular layer was diminutive. In this study, we investigated the feasibility of SIS in conjunction with mesenchymal stem cells (MSCs) for regeneration of the gastrointestinal tract. MSCs from the bone marrow of green fluorescence protein (GFP)-transgenic Sprague-Dawley (SD) rats were isolated and expanded ex vivo. A 1 cm whole-layer stomach defect in SD rats was repaired using: a plain SIS graft without MSCs (group 1, control); a plain SIS graft followed by intravenous injection of MSCs (group 2); a SIS graft co-cultured with MSCs (group 3); or a SIS sandwich containing an MSC sheet (group 4). Pharmacological, electrophysiological and immunohistochemical examination was performed to evaluate the regenerated stomach tissue. Contractility in response to a muscarinic receptor agonist, a nitric oxide precursor or electrical field stimulation was observed in all groups. SIS grafts seeded with MSCs (groups 3 and 4) appeared to support improved regeneration compared with SIS grafts not seeded with MSCs (groups 1 and 2), by enabling the development of well-structured smooth muscle layers of significantly increased length. GFP expression was detected in the regenerated interstitial tissue, with fibroblast-like cells in the seeded-SIS groups. SIS potently induced pharmacological and electrophysiological regeneration of the digestive tract, and seeded MSCs provided an enriched environment that supported tissue regeneration by the SIS graft in the engineered stomach.
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Affiliation(s)
- Hiroki Nakatsu
- Department of Digestive Surgery and Surgical Oncology (Department of Surgery II), Yamaguchi University Graduate School of Medicine, Japan
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Poghosyan T, Gaujoux S, Vanneaux V, Bruneval P, Domet T, Lecourt S, Jarraya M, Sfeir R, Larghero J, Cattan P. In vitro development and characterization of a tissue-engineered conduit resembling esophageal wall using human and pig skeletal myoblast, oral epithelial cells, and biologic scaffolds. Tissue Eng Part A 2013; 19:2242-52. [PMID: 23672649 DOI: 10.1089/ten.tea.2012.0565] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
INTRODUCTION Tissue engineering represents a promising approach for esophageal replacement, considering the complexity and drawbacks of conventional techniques. AIM To create the components necessary to reconstruct in vitro or in vivo an esophageal wall, we analyzed the feasibility and the optimal conditions of human and pig skeletal myoblast (HSM and PSM) and porcine oral epithelial cell (OEC) culture on biologic scaffolds. MATERIALS AND METHODS PSM and HSM were isolated from striated muscle and porcine OECs were extracted from oral mucosa biopsies. Myoblasts were seeded on an acellular scaffold issue from porcine small intestinal submucosa (SIS) and OEC on decellularized human amniotic membrane (HAM). Seeding conditions (cell concentrations [0.5×10(6) versus 10(6) cells/cm(2)] and culture periods [7, 14 and 21 days]), were analyzed using the methyl thiazoltetrazolium assay, quantitative PCR, flow cytometry, and immunohistochemistry. RESULTS Phenotypic stability was observed after cellular expansion for PSM and HSM (85% and 97% CD56-positive cells, respectively), and OECs (90% AE1/AE3- positive cells). After PSM and HSM seeding, quantities of viable cells were similar whatever the initial cell concentration used and remained stable at all time points. During cell culture on SIS, a decrease of CD56-positive cells was observed (76% and 76% by D7, 56% and 70% by D14, 28% and 60% by D21, for PSM and HSM, respectively). Multilayered surface of α-actin smooth muscle and Desmine-positive cells organized in bundles was seen as soon as D7, with no evidence of cell within the SIS. Myoblasts fusion was observed at D21. Pax3 and Pax7 expression was downregulated and MyoD expression upregulated, at D14.OEC proliferation was observed on HAM with both cell concentrations from D7 to D21. The cell metabolism activity was more important on matrix seeded by 10(6) cells/cm(2). With 0.5×10(6) OEC/cm(2), a single layer of pancytokeratin-positive cells was seen at D7, which became pluristratified by D14, while when 10(6) OEC/cm(2) were used, a pluristratified epithelial structure was seen as soon as D7. Proliferative cells (Proliferating Cell Nuclear Antigen staining) were mainly located at the basal layer. CONCLUSION In this model, the optimal conditions of cell seeding in terms of cell concentration and culture duration were 0.5×10(6) myoblasts/cm(2) and 10(6) OEC/cm(2), and 7 days.
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Affiliation(s)
- Tigran Poghosyan
- Cell Therapy Unit and Clinical Investigation Center in Biotherapies (CIC-BT501), Saint-Louis Hospital, AP-HP Paris, France
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Tan B, Wei RQ, Tan MY, Luo JC, Deng L, Chen XH, Hou JL, Li XQ, Yang ZM, Xie HQ. Tissue engineered esophagus by mesenchymal stem cell seeding for esophageal repair in a canine model. J Surg Res 2013; 182:40-8. [PMID: 22925499 DOI: 10.1016/j.jss.2012.07.054] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2012] [Revised: 06/20/2012] [Accepted: 07/20/2012] [Indexed: 02/05/2023]
Abstract
PURPOSE Acellular porcine small intestinal submucosa (SIS) has been successfully used for esophagoplasty in dogs. However, this has not led to complete epithelialization and muscular regeneration. We undertook the present study to assess the effect of tissue-engineered esophagus generated by seeding bone marrow mesenchymal stem cells (BMSCs) onto an SIS scaffold (BMSCs-SIS) in a canine model. METHODS We cultured, passaged, and measured autologous BMSCs and myoblasts with cell proliferation and immunohistochemical assays. We labeled the third passage of BMSCs with PKH-26, a fluorescent dye, before seeded it onto the SIS. We resected canine cervical esophagus to generate a defect 5 cm in length and 50% in circumference, which we repaired with BMSCs-SIS or SIS alone. RESULTS Four weeks later, barium esophagram demonstrated that esophageal lumen surface of the patch graft was smoother in the BMSCs-SIS group compared with the SIS group. Histological examination suggested a strong similarity between BMSCs and esophageal myoblasts in terms of morphology and function. Although both BMSCs-SIS and SIS repaired the esophageal defects, we noted complete re-epithelialization with almost no inflammation only in the former group. By 12 wk after the surgery, we observed long bundles of skeletal muscles only in the BMSCs-SIS group, where the microvessel density was also much greater. CONCLUSIONS Bone marrow mesenchymal stem cells on an SIS scaffold can promote re-epithelialization, revascularization, and muscular regeneration. This approach may provide an attractive option for esophageal regeneration.
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Affiliation(s)
- Bo Tan
- Laboratory of Stem Cell and Tissue Engineering, Regenerative Medicine Research Center and State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, PR China
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Detergent enzymatic treatment for the development of a natural acellular matrix for oesophageal regeneration. Pediatr Surg Int 2013; 29:87-95. [PMID: 23124129 DOI: 10.1007/s00383-012-3194-3] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
PURPOSE Tissue engineering of the oesophagus has been proposed as a therapeutic alternative to organ transplantation. We previously demonstrated that a detergent enzymatic treatment (DET) is a valid method to obtain an acellular matrix with preservation of the native architecture. In this study, we aimed to develop a natural acellular matrix from pig oesophagus, as a valid framework for oesophageal replacement. METHODS Pig oesophagi (n = 4) were decellularized with continuous luminal infusion of DET. To evaluate the efficiency of the decellularization, samples were assessed by histology and DNA quantification. Moreover, the ultra-structural characteristics of the acellular matrix were investigated by scanning electron microscopy (SEM) and transmission electron microscopy (TEM). RESULTS Decellularization of the oesophagus was achieved after three cycles of DET. Histological analysis showed the maintenance of tissue matrix architecture with absence of cellular elements, verified by measurement of DNA. SEM and TEM analysis confirmed preservation of the ultra-structural characteristics of the native tissue. CONCLUSIONS Oesophageal acellular matrix can be successfully obtained by decellularization of pig oesophagus using a gentle DET via the oesophageal lumen. This decellularization method preserves the ultrastructure of the native tissue and could represent the basis for a tissue-engineered oesophagus.
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Totonelli G, Maghsoudlou P, Fishman JM, Orlando G, Ansari T, Sibbons P, Birchall MA, Pierro A, Eaton S, De Coppi P. Esophageal tissue engineering: A new approach for esophageal replacement. World J Gastroenterol 2012; 18:6900-7. [PMID: 23322987 PMCID: PMC3531673 DOI: 10.3748/wjg.v18.i47.6900] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2012] [Revised: 06/14/2012] [Accepted: 06/28/2012] [Indexed: 02/06/2023] Open
Abstract
A number of congenital and acquired disorders require esophageal tissue replacement. Various surgical techniques, such as gastric and colonic interposition, are standards of treatment, but frequently complicated by stenosis and other problems. Regenerative medicine approaches facilitate the use of biological constructs to replace or regenerate normal tissue function. We review the literature of esophageal tissue engineering, discuss its implications, compare the methodologies that have been employed and suggest possible directions for the future. Medline, Embase, the Cochrane Library, National Research Register and ClinicalTrials.gov databases were searched with the following search terms: stem cell and esophagus, esophageal replacement, esophageal tissue engineering, esophageal substitution. Reference lists of papers identified were also examined and experts in this field contacted for further information. All full-text articles in English of all potentially relevant abstracts were reviewed. Tissue engineering has involved acellular scaffolds that were either transplanted with the aim of being repopulated by host cells or seeded prior to transplantation. When acellular scaffolds were used to replace patch and short tubular defects they allowed epithelial and partial muscular migration whereas when employed for long tubular defects the results were poor leading to an increased rate of stenosis and mortality. Stenting has been shown as an effective means to reduce stenotic changes and promote cell migration, whilst omental wrapping to induce vascularization of the construct has an uncertain benefit. Decellularized matrices have been recently suggested as the optimal choice for scaffolds, but smart polymers that will incorporate signalling to promote cell-scaffold interaction may provide a more reproducible and available solution. Results in animal models that have used seeded scaffolds strongly sug- gest that seeding of both muscle and epithelial cells on scaffolds prior to implantation is a prerequisite for complete esophageal replacement. Novel approaches need to be designed to allow for peristalsis and vascularization in the engineered esophagus. Although esophageal tissue engineering potentially offers a real alternative to conventional treatments for severe esophageal disease, important barriers remain that need to be addressed.
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The effect of source animal age upon the in vivo remodeling characteristics of an extracellular matrix scaffold. Biomaterials 2012; 33:5524-33. [PMID: 22575834 DOI: 10.1016/j.biomaterials.2012.04.017] [Citation(s) in RCA: 92] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2012] [Accepted: 04/07/2012] [Indexed: 12/22/2022]
Abstract
Biologic scaffolds composed of mammalian extracellular matrix (ECM) are routinely used for the repair and reconstruction of injured or missing tissues in a variety of pre-clinical and clinical applications. However, the structural and functional outcomes have varied considerably. An important variable of xenogeneic biologic scaffolds is the age of the animal from which the ECM is derived. The present study compared the in vivo host response and remodeling outcomes of biologic scaffolds composed of small intestinal submucosa (SIS)-ECM harvested from pigs that differed only in age. Results showed that there are distinct differences in the remodeling characteristics as a consequence of source animal age. Scaffolds derived from younger animals were associated with a more constructive, site appropriate, tissue remodeling response than scaffolds derived from older animals. Furthermore, the constructive remodeling response was associated with a dominant M2 macrophage response.
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47
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Kuppan P, Sethuraman S, Krishnan UM. Tissue engineering interventions for esophageal disorders--promises and challenges. Biotechnol Adv 2012; 30:1481-92. [PMID: 22484299 DOI: 10.1016/j.biotechadv.2012.03.005] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2012] [Revised: 03/12/2012] [Accepted: 03/15/2012] [Indexed: 01/11/2023]
Abstract
The diseases of the esophagus include congenital defects like atresia, tracheoesophageal fistula as well as others such as gastro-esophageal reflux disease (GERD), Barrett's esophagus, carcinoma and strictures. All esophageal disorders require surgical intervention and reconstruction with appropriate substitutes. Primary anastomosis is used to treat most cases but treatment of long gap atresia still remains a clinical challenge. Autologous graft therapies using tissues from colon, and small and large intestine or gastric transplantations have been attempted but have constraints like leakage, infection and stenosis at the implanted site, which leads to severe morbidity and mortality. An alternative for autologous grafts are allogenic and xenogenic grafts, which have better availability but disease transmission and immunogenicity limit their applications. Use of biodegradable and biocompatible scaffolds to engineer the esophagus promises to be an effective regenerative strategy for treatment of esophageal disorders. Nanotopography of the fibrous scaffolds mimics the natural extracellular matrix (ECM) of the tissue and incorporation of chemical cues and tailoring mechanical properties provide the right microenvironment for co-culture of different cell types. Scaffolds cultured with esophageal cells (epithelial cells, fibroblast and smooth muscle cells) might show enhancement of the biofunctionality in vivo. This review attempts to address the various strategies and challenges involved in successful tissue engineering of the esophagus.
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Affiliation(s)
- Purushothaman Kuppan
- Centre for Nanotechnology & Advanced Biomaterials, SASTRA University, Thanjavur, Tamil Nadu, India
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Keane TJ, Londono R, Turner NJ, Badylak SF. Consequences of ineffective decellularization of biologic scaffolds on the host response. Biomaterials 2011; 33:1771-81. [PMID: 22137126 DOI: 10.1016/j.biomaterials.2011.10.054] [Citation(s) in RCA: 429] [Impact Index Per Article: 33.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2011] [Accepted: 10/20/2011] [Indexed: 11/17/2022]
Abstract
Biologic scaffold materials composed of extracellular matrix (ECM) are routinely used for a variety of clinical applications. Despite known variations in tissue remodeling outcomes, quantitative criteria by which decellularization can be assessed were only recently described and as a result, the amount of retained cellular material varies widely among commercial products. The objective of this study was to evaluate the consequences of ineffective decellularization on the host response. Three different methods of decellularization were used to decellularize porcine small intestinal ECM (SIS-ECM). The amount of cell remnants was quantified by the amount and fragmentation of DNA within the scaffold materials. The M1/M2 phenotypic polarization profile of macrophages, activated in response to these ECM scaffolds, was assessed in vitro and in vivo using a rodent model of body wall repair. The results show that, in vitro, more aggressive decellularization is associated with a shift in macrophage phenotype predominance from M1 to M2. While this shift was not quantitatively apparent in vivo, notable differences were found in the distribution of M1 vs. M2 macrophages within the various scaffolds. A clear association between macrophage phenotype and remodeling outcome exists and effective decellularization remains an important component in the processing of ECM-based scaffolds.
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Affiliation(s)
- Timothy J Keane
- McGowan Institute for Regenerative Medicine, University of Pittsburgh, Pittsburgh, PA 15219, USA
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Tan J, Chua C, Leong K, Chian K, Leong W, Tan L. Esophageal tissue engineering: An in-depth review on scaffold design. Biotechnol Bioeng 2011; 109:1-15. [DOI: 10.1002/bit.23323] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2011] [Revised: 08/29/2011] [Accepted: 08/31/2011] [Indexed: 01/29/2023]
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Regeneration of uterine horns in rats by collagen scaffolds loaded with collagen-binding human basic fibroblast growth factor. Biomaterials 2011; 32:8172-81. [PMID: 21821282 DOI: 10.1016/j.biomaterials.2011.07.050] [Citation(s) in RCA: 110] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2011] [Accepted: 07/16/2011] [Indexed: 12/14/2022]
Abstract
Severe damages of uterine endometrium which prevent embryos from implantation and placentation finally often result in infertility or pregnant complications. There is lack of effective treatments due to the limitation of native materials available and complexity of the function and internal environment of uterus. In the present study, a collagen targeting basic fibroblast growth factor (bFGF) delivery system was constructed by a collagen membrane loaded with bFGF fused a collagen-binding domain (CBD) to the N-terminal which limits the diffusion of bFGF from collagen. We tested the bFGF delivery system in rats under the severe uterine damage model (partial rat uterine horn excision/reconstruction), and found this delivery system improved regeneration abilities of uterine endometrium and muscular cells, improved vascularization, as well as better pregnancy outcomes in rats. Therefore, this targeting delivery system may be an effective strategy for uterine tissue regeneration.
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