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Mammana M, Bonis A, Verzeletti V, Dell'Amore A, Rea F. Tracheal Tissue Engineering: Principles and State of the Art. Bioengineering (Basel) 2024; 11:198. [PMID: 38391684 PMCID: PMC10886658 DOI: 10.3390/bioengineering11020198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Revised: 02/16/2024] [Accepted: 02/17/2024] [Indexed: 02/24/2024] Open
Abstract
Patients affected by long-segment tracheal defects or stenoses represent an unsolved surgical issue, since they cannot be treated with the conventional surgery of tracheal resection and consequent anastomosis. Hence, different strategies for tracheal replacement have been proposed (synthetic materials, aortic allografts, transplantation, autologous tissue composites, and tissue engineering), each with advantages and drawbacks. Tracheal tissue engineering, on the other hand, aims at recreating a fully functional tracheal substitute, without the need for the patient to receive lifelong immunosuppression or endotracheal stents. Tissue engineering approaches involve the use of a scaffold, stem cells, and humoral signals. This paper reviews the main aspects of tracheal TE, starting from the choice of the scaffold to the type of stem cells that can be used to seed the scaffold, the methods for their culture and expansion, the issue of graft revascularization at the moment of in vivo implantation, and experimental models of tracheal research. Moreover, a critical insight on the state of the art of tracheal tissue engineering is also presented.
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Affiliation(s)
- Marco Mammana
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, 35128 Padua, Italy
| | - Alessandro Bonis
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, 35128 Padua, Italy
| | - Vincenzo Verzeletti
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, 35128 Padua, Italy
| | - Andrea Dell'Amore
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, 35128 Padua, Italy
| | - Federico Rea
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, 35128 Padua, Italy
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Wei S, Yang B, Bi T, Zhang W, Sun H, Cui Y, Li G, Zhang A. Tracheal replacement with aortic grafts: Bench to clinical practice. Regen Ther 2023; 24:434-442. [PMID: 37744679 PMCID: PMC10514392 DOI: 10.1016/j.reth.2023.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 08/26/2023] [Accepted: 09/07/2023] [Indexed: 09/26/2023] Open
Abstract
Tracheal reconstruction following extensive resection for malignant or benign lesions remains a major challenge in thoracic surgery. Numerous studies have attempted to identify the optimal tracheal replacement with different biological or prosthetic materials, such as various homologous and autologous tissues, with no encouraging outcomes. Recently, a few clinical studies reported attaining favorable outcomes using in vitro or stem cell-based airway engineering and also with tracheal allograft implantation following heterotopic revascularization. However, none of the relevant studies offered a standardized technology for airway replacement. In 1997, a novel approach to airway reconstruction was proposed, which involved using aortic grafts as the biological matrix. Studies on animal models reported achieving in-vivo cartilage and epithelial regeneration using this approach. These encouraging results inspired the subsequent application of cryopreserved aortic allografts in humans for the first time. Cryopreserved aortic allografts offered further advantages, such as easy availability in tissue banks and no requirement for immunosuppressive treatments. Currently, stented aortic matrix-based airway replacement has emerged as a standard approach, and its effectiveness was also verified in the recently reported TRITON-01 study. In this context, the present review aims to summarize the current status of the application of aortic grafts in tracheal replacement, including the latest advancements in experimental and clinical practice.
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Affiliation(s)
- Shixiong Wei
- The Department of Thoracic Surgery, The First Hospital of Jilin University, Changchun, Jilin Province, 130021, China
- The Department of Hepatobiliary and Pancreatic Surgery, General Surgery Center, The First Hospital of Jilin University, Changchun, Jilin Province, 130021, China
| | - Bo Yang
- The Department of Thoracic Surgery, The First Hospital of Jilin University, Changchun, Jilin Province, 130021, China
| | - Taiyu Bi
- The Department of Thoracic Surgery, The First Hospital of Jilin University, Changchun, Jilin Province, 130021, China
| | - Wenyu Zhang
- The Department of Thoracic Surgery, The First Hospital of Jilin University, Changchun, Jilin Province, 130021, China
| | - He Sun
- The Department of Thoracic Surgery, The First Hospital of Jilin University, Changchun, Jilin Province, 130021, China
| | - Yongsheng Cui
- The Department of Thoracic Surgery, The First Hospital of Jilin University, Changchun, Jilin Province, 130021, China
| | - Guanghu Li
- The Department of Thoracic Surgery, The First Hospital of Jilin University, Changchun, Jilin Province, 130021, China
| | - Anling Zhang
- The Department of Maxillofacial Surgery, Jilin FAW General Hospital, Changchun, Jilin Province, 130000, China
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Stocco E, Barbon S, Mammana M, Zambello G, Contran M, Parnigotto PP, Macchi V, Conconi MT, Rea F, De Caro R, Porzionato A. Preclinical and clinical orthotopic transplantation of decellularized/engineered tracheal scaffolds: A systematic literature review. J Tissue Eng 2023; 14:20417314231151826. [PMID: 36874984 PMCID: PMC9974632 DOI: 10.1177/20417314231151826] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Accepted: 01/04/2023] [Indexed: 03/07/2023] Open
Abstract
Severe tracheal injuries that cannot be managed by mobilization and end-to-end anastomosis represent an unmet clinical need and an urgent challenge to face in surgical practice; within this scenario, decellularized scaffolds (eventually bioengineered) are currently a tempting option among tissue engineered substitutes. The success of a decellularized trachea is expression of a balanced approach in cells removal while preserving the extracellular matrix (ECM) architecture/mechanical properties. Revising the literature, many Authors report about different methods for acellular tracheal ECMs development; however, only few of them verified the devices effectiveness by an orthotopic implant in animal models of disease. To support translational medicine in this field, here we provide a systematic review on studies recurring to decellularized/bioengineered tracheas implantation. After describing the specific methodological aspects, orthotopic implant results are verified. Furtherly, the only three clinical cases of compassionate use of tissue engineered tracheas are reported with a focus on outcomes.
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Affiliation(s)
- Elena Stocco
- Department of Neurosciences, Section of Human Anatomy, University of Padova, Padova, Italy.,L.i.f.e.L.a.b. Program, Consorzio per la Ricerca Sanitaria (CORIS), Veneto Region, Padova, Italy.,Foundation for Biology and Regenerative Medicine, Tissue Engineering and Signaling-TES, Onlus, Padova, Italy
| | - Silvia Barbon
- Department of Neurosciences, Section of Human Anatomy, University of Padova, Padova, Italy.,L.i.f.e.L.a.b. Program, Consorzio per la Ricerca Sanitaria (CORIS), Veneto Region, Padova, Italy.,Foundation for Biology and Regenerative Medicine, Tissue Engineering and Signaling-TES, Onlus, Padova, Italy
| | - Marco Mammana
- L.i.f.e.L.a.b. Program, Consorzio per la Ricerca Sanitaria (CORIS), Veneto Region, Padova, Italy.,Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University Hospital of Padova, Padova, Italy
| | - Giovanni Zambello
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University Hospital of Padova, Padova, Italy
| | - Martina Contran
- Department of Neurosciences, Section of Human Anatomy, University of Padova, Padova, Italy
| | - Pier Paolo Parnigotto
- Foundation for Biology and Regenerative Medicine, Tissue Engineering and Signaling-TES, Onlus, Padova, Italy
| | - Veronica Macchi
- Department of Neurosciences, Section of Human Anatomy, University of Padova, Padova, Italy.,L.i.f.e.L.a.b. Program, Consorzio per la Ricerca Sanitaria (CORIS), Veneto Region, Padova, Italy.,Foundation for Biology and Regenerative Medicine, Tissue Engineering and Signaling-TES, Onlus, Padova, Italy
| | - Maria Teresa Conconi
- Foundation for Biology and Regenerative Medicine, Tissue Engineering and Signaling-TES, Onlus, Padova, Italy.,Department of Pharmaceutical and Pharmacological Sciences, University of Padova, Padova, Italy
| | - Federico Rea
- L.i.f.e.L.a.b. Program, Consorzio per la Ricerca Sanitaria (CORIS), Veneto Region, Padova, Italy.,Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University Hospital of Padova, Padova, Italy
| | - Raffaele De Caro
- Department of Neurosciences, Section of Human Anatomy, University of Padova, Padova, Italy.,L.i.f.e.L.a.b. Program, Consorzio per la Ricerca Sanitaria (CORIS), Veneto Region, Padova, Italy.,Foundation for Biology and Regenerative Medicine, Tissue Engineering and Signaling-TES, Onlus, Padova, Italy
| | - Andrea Porzionato
- Department of Neurosciences, Section of Human Anatomy, University of Padova, Padova, Italy.,L.i.f.e.L.a.b. Program, Consorzio per la Ricerca Sanitaria (CORIS), Veneto Region, Padova, Italy.,Foundation for Biology and Regenerative Medicine, Tissue Engineering and Signaling-TES, Onlus, Padova, Italy
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Hiwatashi S, Iwai R, Nakayama Y, Moriwaki T, Okuyama H. Successful tracheal regeneration using biofabricated autologous analogues without artificial supports. Sci Rep 2022; 12:20279. [PMID: 36434016 PMCID: PMC9700768 DOI: 10.1038/s41598-022-24798-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 11/21/2022] [Indexed: 11/27/2022] Open
Abstract
Tracheas have a tubular structure consisting of cartilage rings continuously joined by a connective tissue membrane comprising a capillary network for tissue survival. Several tissue engineering efforts have been devoted to the design of scaffolds to produce complex structures. In this study, we successfully fabricated an artificial materials-free autologous tracheal analogue with engraftment ability by combining in vitro cell self-aggregation technique and in-body tissue architecture. The cartilage rings prepared by aggregating chondrocytes on designated culture grooves that induce cell self-aggregation were alternately connected to the connective tissues to form tubular tracheal analogues by subcutaneous embedding as in-body tissue architecture. The tracheal analogues allogeneically implanted into the rat trachea matured into native-like tracheal tissue by covering of luminal surfaces by the ciliated epithelium with mucus-producing goblet cells within eight months after implantation, while maintaining their structural integrity. Such autologous tracheal analogues would provide a foundation for further clinical research on the application of tissue-engineered tracheas to ensure their long-term functionality.
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Affiliation(s)
- Shohei Hiwatashi
- grid.136593.b0000 0004 0373 3971Department of Pediatric Surgery, Osaka University Graduate School of Medicine, Osaka, 565-0871 Japan
| | - Ryosuke Iwai
- grid.444568.f0000 0001 0672 2184Institute of Frontier Science and Technology, Okayama University of Science, Okayama, 700-0005 Japan
| | | | - Takeshi Moriwaki
- grid.257016.70000 0001 0673 6172Faculty of Science and Technology, Hirosaki University, Aomori, 036-8561 Japan
| | - Hiroomi Okuyama
- grid.136593.b0000 0004 0373 3971Department of Pediatric Surgery, Osaka University Graduate School of Medicine, Osaka, 565-0871 Japan
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Xu C, Ma Y, Huang H, Ruan Z, Li Y. A Review of Woven Tracheal Stents: Materials, Structures, and Application. J Funct Biomater 2022; 13:jfb13030096. [PMID: 35893464 PMCID: PMC9326637 DOI: 10.3390/jfb13030096] [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: 05/13/2022] [Revised: 06/30/2022] [Accepted: 07/12/2022] [Indexed: 11/16/2022] Open
Abstract
The repair and reconstruction of tracheal defects is a challenging clinical problem. Due to the wide choice of materials and structures, weaving technology has shown unique advantages in simulating the multilayer structure of the trachea and providing reliable performance. Currently, most woven stent-based stents focus only on the effect of materials on stent performance while ignoring the direct effect of woven process parameters on stent performance, and the advantages of weaving technology in tissue regeneration have not been fully exploited. Therefore, this review will introduce the effects of stent materials and fabric construction on the performance of tracheal stents, focusing on the effects of weaving process parameters on stent performance. We will summarize the problems faced by woven stents and possible directions of development in the hope of broadening the technical field of artificial trachea preparation.
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Affiliation(s)
- Chen Xu
- College of Textiles, Donghua University, Shanghai 201620, China; (C.X.); (Y.M.)
| | - Yanxue Ma
- College of Textiles, Donghua University, Shanghai 201620, China; (C.X.); (Y.M.)
| | - Haihua Huang
- Department of Thoracic Surgery, Shanghai General Hospital, Shanghai Jiaotong University, Shanghai 200080, China;
| | - Zheng Ruan
- Department of Thoracic Surgery, Shanghai General Hospital, Shanghai Jiaotong University, Shanghai 200080, China;
- Correspondence: (Z.R.); (Y.L.)
| | - Yuling Li
- College of Textiles, Donghua University, Shanghai 201620, China; (C.X.); (Y.M.)
- Correspondence: (Z.R.); (Y.L.)
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Zeng T, Yuan P, Liang L, Zhang X, Zhang H, Wu W. Cartilaginous Extracellular Matrix Enriched with Human Gingival Mesenchymal Stem Cells Derived "Matrix Bound Extracellular Vesicles" Enabled Functional Reconstruction of Tracheal Defect. ADVANCED SCIENCE (WEINHEIM, BADEN-WURTTEMBERG, GERMANY) 2022; 9:e2102735. [PMID: 34841733 PMCID: PMC8805569 DOI: 10.1002/advs.202102735] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/26/2021] [Revised: 10/14/2021] [Indexed: 05/27/2023]
Abstract
Stem cells derived extracellular vesicles (EVs) conceive cues essential for tissue repair. Mammalian cartilaginous extracellular matrix (cECM) may not be optimally inductive for tracheal regeneration because of the granulomatous, instead of regenerative, responses in injured adult mammalian tracheas. Given the high regenerative capacity of gingiva, it is hypothesized human gingival mesenchymal stem cells derived EVs (gEVs) can induce mammalian tracheal epithelia regeneration. Coculturing chondrocytes with GMSCs produce abundant "matrix bound gEVs (gMVs)" in forming cartilaginous ECM, which are further preserved in acellular cECM (cACM) following mild, short-period decellularization. The results show that gMVs-cACM could be well anchored on polyglycerol sebacate microporous patch thus enforce the surgical suturability and mechanical strength. In rabbit tracheal defect, the gMVs-cACM patch induces rapid regeneration of vascularized ciliated columnar epithelium, which supports long-term survival of animals. gMVs-cACM treated groups exhibit proliferation of tracheal progenitors-basal epithelial cells, as well as, activation of JAK2/STAT1 pathway in reparative cells. This study departs from conventional focuses on tissue derived ECM and introduces a new approach for tracheal tissue regeneration.
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Affiliation(s)
- Tian Zeng
- State Key Laboratory of Military Stomatology & National Clinical Research Center for Oral Diseases & Shaanxi Key Laboratory of StomatologyDepartment of Anesthesiologyand Department of Oral & Maxillofacial SurgerySchool of Stomatologythe Fourth Military Medical UniversityXi'an710032P. R. China
- Department of Anesthesiologythe 986th Air Force Hospital, Xijing hospitalthe Fourth Military Medical UniversityXi'an710032P. R. China
| | - Pingping Yuan
- State Key Laboratory of Military Stomatology & National Clinical Research Center for Oral Diseases & Shaanxi Key Laboratory of StomatologyDepartment of Oral & Maxillofacial SurgerySchool of Stomatologythe Fourth Military Medical UniversityXi'an710032P. R. China
| | - Lirong Liang
- State Key Laboratory of Military Stomatology & National Clinical Research Center for Oral Diseases & Shaanxi Key Laboratory of StomatologyDepartment of AnesthesiologySchool of Stomatologythe Fourth Military Medical UniversityXi'an710032P. R. China
| | - Xinchi Zhang
- State Key Laboratory of Military Stomatology & National Clinical Research Center for Oral Diseases & Shaanxi Key Laboratory of StomatologyDepartment of Oral & Maxillofacial SurgerySchool of Stomatologythe Fourth Military Medical UniversityXi'an710032P. R. China
| | - Hui Zhang
- State Key Laboratory of Military Stomatology & National Clinical Research Center for Oral Diseases & Shaanxi Key Laboratory of StomatologyDepartment of AnesthesiologySchool of Stomatologythe Fourth Military Medical UniversityXi'an710032P. R. China
| | - Wei Wu
- State Key Laboratory of Military Stomatology & National Clinical Research Center for Oral Diseases & Shaanxi Key Laboratory of StomatologyDepartment of Oral & Maxillofacial SurgerySchool of Stomatologythe Fourth Military Medical UniversityXi'an710032P. R. China
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