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Verzeletti V, Mammana M, Zambello G, Dell'Amore A, Rea F. Human tracheal transplantation: A systematic review of case reports. Clin Transplant 2024; 38:e15238. [PMID: 38289888 DOI: 10.1111/ctr.15238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 12/19/2023] [Accepted: 12/21/2023] [Indexed: 02/01/2024]
Abstract
BACKGROUND Patients with long-segment airway stenosis not amenable to conventional surgery may benefit from tracheal transplantation. However, this procedure has been only anecdotally reported, and its indications, techniques, and outcomes have not been extensively reviewed. METHODS We conducted a systematic Literature search to identify all original articles reporting attempts at tracheal transplantation in humans. RESULTS Of 699 articles found by the initial search, 11 were included in the systematic review, describing 14 cases of tracheal transplantation. Patients underwent transplantation for benign stenosis in nine cases, and for malignancies in five cases. In 12 cases blood supply to the trachea was provided by wrapping the graft in a vascularized recipient's tissue, while in 2 cases the trachea was directly transplanted as a vascularized composite allograft. The transplantation procedure was aborted before orthotopic transplantation in two patients. Among the remaining 12 patients, there was 1 operative mortality, while 4 patients experienced complications. Immunosuppressants drugs were administered to the majority of patients postoperatively, and only one group of authors attempted their withdrawal, in five patients. At the end of follow-up, all 11 patients surviving the operation were alive, but 2 had a recurrent tracheal stenosis requiring an airway appliance for breathing. CONCLUSION Human tracheal transplantation is still at an embryonic phase. Studies available in the Literature report different surgical techniques, and information on long-term outcomes is still limited. Future research is needed in order to understand the clinical value of this procedure.
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Affiliation(s)
- Vincenzo Verzeletti
- Thoracic Surgery Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Marco Mammana
- Thoracic Surgery Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Giovanni Zambello
- Thoracic Surgery Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Andrea Dell'Amore
- Thoracic Surgery Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Federico Rea
- Thoracic Surgery Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
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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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Mahoney C, Conklin D, Waterman J, Sankar J, Bhattarai N. Electrospun nanofibers of poly(ε-caprolactone)/depolymerized chitosan for respiratory tissue engineering applications. JOURNAL OF BIOMATERIALS SCIENCE-POLYMER EDITION 2016; 27:611-25. [DOI: 10.1080/09205063.2016.1144454] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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Lee DY, Park SA, Lee SJ, Kim TH, Oh SH, Lee JH, Kwon SK. Segmental tracheal reconstruction by 3D-printed scaffold: Pivotal role of asymmetrically porous membrane. Laryngoscope 2015; 126:E304-9. [DOI: 10.1002/lary.25806] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2015] [Revised: 10/26/2015] [Accepted: 11/04/2015] [Indexed: 01/10/2023]
Affiliation(s)
- Doh Young Lee
- Department of Otorhinolaryngology-Head and Neck Surgery; Korea University College of Medicine; Seoul Republic of Korea
| | - Su A Park
- Department of Nature-Inspired Nanoconvergence Systems; Korea Institute of Machinery and Materials; Daejeon Republic of Korea
| | - Sang Jin Lee
- Department of Maxillofacial Biomedical Engineering and Institute of Oral Biology; School of Dentistry, Kyung Hee University; Seoul Republic of Korea
- Department of Nature-Inspired Nanoconvergence Systems; Korea Institute of Machinery and Materials; Daejeon Republic of Korea
| | - Tae Ho Kim
- Department of Advanced Materials; Hannam University; Daejeon Republic of Korea
| | - Se Heang Oh
- Department of Nanobiomedical Science and BK21 PLUS NBM Global Research Center for Regenerative Medicine; Dankook University; Cheonan Republic of Korea
| | - Jin Ho Lee
- Department of Advanced Materials; Hannam University; Daejeon Republic of Korea
| | - Seong Keun Kwon
- Department of Otorhinolaryngology-Head and Neck Surgery; Seoul National University Hospital; Seoul Republic of Korea
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Peng C, Ma J, Cheema M, Sun Q, Ahan N, Hao Y, Zhao Y, Cong B. Application of a bioengineered composite neotrachea in a dog model. J Surg Res 2015; 194:638-643. [DOI: 10.1016/j.jss.2014.11.029] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2014] [Revised: 11/18/2014] [Accepted: 11/20/2014] [Indexed: 12/16/2022]
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O'Leary C, Gilbert JL, O'Dea S, O'Brien FJ, Cryan SA. Respiratory Tissue Engineering: Current Status and Opportunities for the Future. TISSUE ENGINEERING PART B-REVIEWS 2015; 21:323-44. [PMID: 25587703 DOI: 10.1089/ten.teb.2014.0525] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Currently, lung disease and major airway trauma constitute a major global healthcare burden with limited treatment options. Airway diseases such as chronic obstructive pulmonary disease and cystic fibrosis have been identified as the fifth highest cause of mortality worldwide and are estimated to rise to fourth place by 2030. Alternate approaches and therapeutic modalities are urgently needed to improve clinical outcomes for chronic lung disease. This can be achieved through tissue engineering of the respiratory tract. Interest is growing in the use of airway tissue-engineered constructs as both a research tool, to further our understanding of airway pathology, validate new drugs, and pave the way for novel drug therapies, and also as regenerative medical devices or as an alternative to transplant tissue. This review provides a concise summary of the field of respiratory tissue engineering to date. An initial overview of airway anatomy and physiology is given, followed by a description of the stem cell populations and signaling processes involved in parenchymal healing and tissue repair. We then focus on the different biomaterials and tissue-engineered systems employed in upper and lower respiratory tract engineering and give a final perspective of the opportunities and challenges facing the field of respiratory tissue engineering.
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Affiliation(s)
- Cian O'Leary
- 1 Tissue Engineering Research Group, Department of Anatomy, Royal College of Surgeons in Ireland , Dublin, Ireland .,2 School of Pharmacy, Royal College of Surgeons in Ireland , Dublin, Ireland .,3 Advanced Materials and Bioengineering Research (AMBER) Centre, Royal College of Surgeons in Ireland and Trinity College Dublin , Dublin, Ireland
| | - Jennifer L Gilbert
- 4 Department of Biology, Institute of Immunology, University of Ireland , Maynooth, Ireland
| | - Shirley O'Dea
- 4 Department of Biology, Institute of Immunology, University of Ireland , Maynooth, Ireland
| | - Fergal J O'Brien
- 1 Tissue Engineering Research Group, Department of Anatomy, Royal College of Surgeons in Ireland , Dublin, Ireland .,3 Advanced Materials and Bioengineering Research (AMBER) Centre, Royal College of Surgeons in Ireland and Trinity College Dublin , Dublin, Ireland .,5 Trinity Centre of Bioengineering, Trinity College Dublin , Dublin, Ireland
| | - Sally-Ann Cryan
- 1 Tissue Engineering Research Group, Department of Anatomy, Royal College of Surgeons in Ireland , Dublin, Ireland .,2 School of Pharmacy, Royal College of Surgeons in Ireland , Dublin, Ireland .,5 Trinity Centre of Bioengineering, Trinity College Dublin , Dublin, Ireland
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Lee DY, Lee JH, Ahn HJ, Oh SH, Kim TH, Kim HB, Park SW, Kwon SK. Synergistic effect of laminin and mesenchymal stem cells on tracheal mucosal regeneration. Biomaterials 2015; 44:134-42. [DOI: 10.1016/j.biomaterials.2014.12.029] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2014] [Revised: 12/17/2014] [Accepted: 12/20/2014] [Indexed: 12/21/2022]
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Chen L, Gong B, Wu Z, Jetton J, Chen R, Qu C. A new method using xenogeneicacellular dermal matrix in the reconstruction of lacrimal drainage. Br J Ophthalmol 2014; 98:1583-7. [PMID: 25271909 PMCID: PMC4215284 DOI: 10.1136/bjophthalmol-2014-304932] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Aims To prospectively evaluate the reliability and efficacy of a new treatment for the reconstruction of the lacrimal duct using a new histo-engineered material, xenogeneic (bovine) acellular dermal matrix. Method Five patients (five eyes) with partial or total absence of the lacrimal duct were included in the study. Four patients (four eyes) suffered from traumatic injuries to the lacrimal duct and one patient (one eye) had congenital absence of the lacrimal drainage system. A pedal graft of conjunctiva was taken from the fornix area and rolled into a tube structure after being attached to the acellular dermal matrix. Results The average duration of follow-up for the patients was 7.2 months (ranging from 6 to 12 months). After surgery, the new duct in the nasal cavity could be observed above the middle turbinate by nasal endoscopy. Patency was confirmed by pressing in the area of the lacrimal sac and visualising air bubbles in the nasal cavity. Additionally, the meatus above the middle turbinate of the nasal cavity was stained and visualised after patients underwent Jones dye test 1 (JDT1). Five tear ducts proved to be effective through irrigation testing and epiphora symptoms were alleviated in all cases. Conclusions The newly reconstructed lacrimal duct, formed by the shift of autogenous conjunctival petal and the attachment of acellular dermal matrix, was successful in all five cases and suggests a new solution for the complex lacrimal duct lesion and congenital anomalies of the lacrimal duct.
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Affiliation(s)
- Li Chen
- Department of Ophthalmology, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, Chengdu, Sichuan, China School of Medicine, University of Electronic Science and Technology of China, Chengdu, Sichuan, China Chengdu Institute of Biology, Chinese Academy of Sciences, Chengdu, Sichuan, China
| | - Bo Gong
- School of Medicine, University of Electronic Science and Technology of China, Chengdu, Sichuan, China Chengdu Institute of Biology, Chinese Academy of Sciences, Chengdu, Sichuan, China Sichuan Key Laboratory for Disease Gene Study, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, Chengdu, Sichuan, China
| | - Zhengzheng Wu
- Department of Ophthalmology, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, Chengdu, Sichuan, China School of Medicine, University of Electronic Science and Technology of China, Chengdu, Sichuan, China Chengdu Institute of Biology, Chinese Academy of Sciences, Chengdu, Sichuan, China
| | - Jacquelyn Jetton
- Department of Ophthalmology, University of Oklahoma, Dean McGee Eye Institute, Oklahoma City, OK, USA
| | - Rong Chen
- School of Medicine, University of Electronic Science and Technology of China, Chengdu, Sichuan, China Chengdu Institute of Biology, Chinese Academy of Sciences, Chengdu, Sichuan, China Sichuan Key Laboratory for Disease Gene Study, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, Chengdu, Sichuan, China
| | - Chao Qu
- Department of Ophthalmology, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, Chengdu, Sichuan, China School of Medicine, University of Electronic Science and Technology of China, Chengdu, Sichuan, China Chengdu Institute of Biology, Chinese Academy of Sciences, Chengdu, Sichuan, China
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Gonfiotti A, Jaus MO, Barale D, Baiguera S, Comin C, Lavorini F, Fontana G, Sibila O, Rombolà G, Jungebluth P, Macchiarini P. The first tissue-engineered airway transplantation: 5-year follow-up results. Lancet 2014; 383:238-44. [PMID: 24161821 DOI: 10.1016/s0140-6736(13)62033-4] [Citation(s) in RCA: 197] [Impact Index Per Article: 19.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND In 2008, the first transplantation of a tissue-engineered trachea in a human being was done to replace an end-staged left main bronchus with malacia in a 30-year-old woman. We report 5 year follow-up results. METHODS The patient was followed up approximately every 3 months with multidetector CT scan and bronchoscopic assessment. We obtained mucosal biopsy samples every 6 months for histological, immunohistochemical, and electron microscopy assessment. We also assessed quality of life, respiratory function, cough reflex test, and production and specificity of recipient antibodies against donor human leucocyte antigen. FINDINGS By 12 months after transplantation, a progressive cicatricial stenosis had developed in the native trachea close to the tissue-engineered trachea anastomosis, which needed repeated endoluminal stenting. However, the tissue-engineered trachea itself remained open over its entire length, well vascularised, completely re-cellularised with respiratory epithelium, and had normal ciliary function and mucus clearance. Lung function and cough reflex were normal. No stem-cell-related teratoma formed and no anti-donor antibodies developed. Aside from intermittent bronchoscopic interventions, the patient had a normal social and working life. INTERPRETATION These clinical results provide evidence that a tissue-engineering strategy including decellularisation of a human trachea, autologous epithelial and stem-cell culture and differentiation, and cell-scaffold seeding with a bioreactor is safe and promising. FUNDING European Commission, Knut and Alice Wallenberg Foundation, Swedish Research Council, ALF Medicine.
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Affiliation(s)
- Alessandro Gonfiotti
- Department of General Thoracic and Regenerative Surgery, University Hospital Careggi, Florence, Italy
| | - Massimo O Jaus
- Department of General Thoracic and Regenerative Surgery, University Hospital Careggi, Florence, Italy
| | - Daniel Barale
- Department of General Thoracic and Regenerative Surgery, University Hospital Careggi, Florence, Italy
| | - Silvia Baiguera
- Advanced Center for Translational Regenerative Medicine, Division of Ear, Nose, and Throat, Karolinska Institutet, Huddinge, Stockholm, Sweden
| | - Camilla Comin
- Division of Pathological Anatomy, Department of Critical Care Medicine and Surgery, University of Florence, Florence, Italy
| | - Federico Lavorini
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Giovanni Fontana
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Oriol Sibila
- Department of Respiratory Medicine, Hospital de la Santa Creu i Sant Pau, Institut d'Investigació Biomèdica Sant Pau, Universitat Autonoma de Barcelona, Barcelona, Spain
| | - Giovanni Rombolà
- Department of Biomedicine, University Hospital Careggi, Florence, Italy
| | - Philipp Jungebluth
- Advanced Center for Translational Regenerative Medicine, Division of Ear, Nose, and Throat, Karolinska Institutet, Huddinge, Stockholm, Sweden
| | - Paolo Macchiarini
- Advanced Center for Translational Regenerative Medicine, Division of Ear, Nose, and Throat, Karolinska Institutet, Huddinge, Stockholm, Sweden.
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Zaric B, Perin B. Use of narrow-band imaging bronchoscopy in detection of lung cancer. Expert Rev Med Devices 2014; 7:395-406. [DOI: 10.1586/erd.10.12] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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Shin YS, Lee BH, Choi JW, Min BH, Chang JW, Yang SS, Kim CH. Tissue-engineered tracheal reconstruction using chondrocyte seeded on a porcine cartilage-derived substance scaffold. Int J Pediatr Otorhinolaryngol 2014; 78:32-8. [PMID: 24280440 DOI: 10.1016/j.ijporl.2013.10.014] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2013] [Revised: 10/18/2013] [Accepted: 10/19/2013] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Tracheal reconstruction with tissue-engineering technique has come into the limelight in the realm of head and neck surgery. We intended to evaluate the plausibility of allogenic chondrocytes cultured with porcine cartilage-derived substance (PCS) scaffold for partial tracheal defect reconstruction. METHODS Powder made from crushed and decellularized porcine articular cartilage was formed as 5 mm × 12 mm (height × diameter) scaffold. Chondrocytes from rabbit articular cartilage were expanded and cultured with PCS scaffold. After 7 weeks culture, the scaffolds were implanted on a 5 mm × 10 mm artificial tracheal defect in six rabbits. Two, four and eight weeks postoperatively, the sites were evaluated endoscopically, radiologically, histologically and functionally. RESULTS None of the six rabbits showed any sign of respiratory distress. Endoscopic examination did not show any collapse or blockage of the reconstructed trachea and the defects were completely covered with regenerated respiratory epithelium. Computed tomography showed good luminal contour of trachea. Postoperative histologic data showed that the implanted chondrocyte successfully formed neo-cartilage with minimal inflammatory response and granulation tissue. Ciliary beat frequency of regenerated epithelium was similar to those of normal adjacent mucosa. CONCLUSIONS The shape and function of reconstructed trachea using allogenic chondrocytes cultured with PCS scaffold was restored successfully without any graft rejection.
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Affiliation(s)
- Yoo Seob Shin
- Department of Otolaryngology, School of Medicine, Ajou University, Republic of Korea
| | - Bum Hee Lee
- Department of Otolaryngology, School of Medicine, Ajou University, Republic of Korea
| | - Jae Won Choi
- Department of Molecular Science and Technology, School of Medicine, Ajou University, Republic of Korea
| | - Byoung-Hyun Min
- Department of Molecular Science and Technology, School of Medicine, Ajou University, Republic of Korea; Department of Orthopedic Surgery, School of Medicine, Ajou University, Republic of Korea; Cell Therapy Center, Ajou University Medical Center, Suwon, Republic of Korea
| | - Jae Won Chang
- Department of Otolaryngology, School of Medicine, Ajou University, Republic of Korea
| | - Soon Sim Yang
- Department of Molecular Science and Technology, School of Medicine, Ajou University, Republic of Korea; Cell Therapy Center, Ajou University Medical Center, Suwon, Republic of Korea
| | - Chul-Ho Kim
- Department of Otolaryngology, School of Medicine, Ajou University, Republic of Korea; Department of Molecular Science and Technology, School of Medicine, Ajou University, Republic of Korea.
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Martinod E, Seguin A, Radu DM, Boddaert G, Chouahnia K, Fialaire-Legendre A, Dutau H, Vénissac N, Marquette CH, Baillard C, Valeyre D, Carpentier A. Airway transplantation: a challenge for regenerative medicine. Eur J Med Res 2013; 18:25. [PMID: 24059453 PMCID: PMC3750833 DOI: 10.1186/2047-783x-18-25] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2013] [Accepted: 06/20/2013] [Indexed: 12/11/2022] Open
Abstract
After more than 50 years of research, airway transplantation remains a major challenge in the fields of thoracic surgery and regenerative medicine. Five principal types of tracheobronchial substitutes, including synthetic prostheses, bioprostheses, allografts, autografts and bioengineered conduits have been evaluated experimentally in numerous studies. However, none of these works have provided a standardized technique for the replacement of the airways. More recently, few clinical attempts have offered encouraging results with ex vivo or stem cell-based engineered airways and tracheal allografts implanted after heterotopic revascularization. In 1997, we proposed a novel approach: the use of aortic grafts as a biological matrix for extensive airway reconstruction. In vivo regeneration of epithelium and cartilage were demonstrated in animal models. This led to the first human applications using cryopreserved aortic allografts that present key advantages because they are available in tissue banks and do not require immunosuppressive therapy. Favorable results obtained in pioneering cases have to be confirmed in larger series of patients with extensive tracheobronchial diseases.
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Affiliation(s)
- Emmanuel Martinod
- Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires Paris-Seine-Saint-Denis, Avicenne Hospital, Department of Thoracic and Vascular Surgery, Paris 13 University, Sorbonne Paris Cité, Faculty of Medicine SMBH, Bobigny, France
- Alain Carpentier Foundation, EA Laboratory for Biosurgical Research, Assistance Publique-Hôpitaux de Paris, George Pompidou European Hospital, Paris Descartes University, Paris, France
| | - Agathe Seguin
- Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires Paris-Seine-Saint-Denis, Avicenne Hospital, Department of Thoracic and Vascular Surgery, Paris 13 University, Sorbonne Paris Cité, Faculty of Medicine SMBH, Bobigny, France
- Alain Carpentier Foundation, EA Laboratory for Biosurgical Research, Assistance Publique-Hôpitaux de Paris, George Pompidou European Hospital, Paris Descartes University, Paris, France
| | - Dana M Radu
- Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires Paris-Seine-Saint-Denis, Avicenne Hospital, Department of Thoracic and Vascular Surgery, Paris 13 University, Sorbonne Paris Cité, Faculty of Medicine SMBH, Bobigny, France
- Alain Carpentier Foundation, EA Laboratory for Biosurgical Research, Assistance Publique-Hôpitaux de Paris, George Pompidou European Hospital, Paris Descartes University, Paris, France
| | - Guillaume Boddaert
- Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires Paris-Seine-Saint-Denis, Avicenne Hospital, Department of Thoracic and Vascular Surgery, Paris 13 University, Sorbonne Paris Cité, Faculty of Medicine SMBH, Bobigny, France
- Alain Carpentier Foundation, EA Laboratory for Biosurgical Research, Assistance Publique-Hôpitaux de Paris, George Pompidou European Hospital, Paris Descartes University, Paris, France
| | - Kader Chouahnia
- Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires Paris-Seine-Saint-Denis, Avicenne Hospital, Department of Oncology, Paris 13 University, Sorbonne Paris Cité, Faculty of Medicine SMBH, Bobigny, France
| | - Anne Fialaire-Legendre
- Assistance Publique-Hôpitaux de Paris, Saint Antoine Hospital, EFS Ile de France, Tissue Bank, Paris, France
| | - Hervé Dutau
- Assistance Publique-Hôpitaux de Marseille, Thoracic Oncology, Pleural Diseases and Interventional Pulmonology Department, North University Hospital, Marseille, France
| | - Nicolas Vénissac
- CHU Nice, Pasteur Hospital, Department of Thoracic Surgery, Nice, France
| | | | - Christophe Baillard
- Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires Paris-Seine-Saint-Denis, Avicenne Hospital, Department of Anesthesiology and Intensive Care, Paris 13 University, Sorbonne Paris Cité, Faculty of Medicine SMBH, Bobigny, France
| | - Dominique Valeyre
- Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires Paris-Seine-Saint-Denis, Avicenne Hospital, Department of Pneumonology, Paris 13 University, Sorbonne Paris Cité, Faculty of Medicine SMBH, Bobigny, France
| | - Alain Carpentier
- Alain Carpentier Foundation, EA Laboratory for Biosurgical Research, Assistance Publique-Hôpitaux de Paris, George Pompidou European Hospital, Paris Descartes University, Paris, France
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Liu J, Yang X, Shi W. Overexpression of CXCR4 in tracheal epithelial cells promotes their proliferation and migration to a stromal cell-derived factor-1 gradient. Exp Biol Med (Maywood) 2013; 238:144-50. [PMID: 23576796 DOI: 10.1177/1535370213477598] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Tracheal reconstruction has been an important issue in clinic, but it is limited for the ability of epithelial regeneration. Several reports have shown that stromal cell-derived factor-1 (SDF-1) and chemokine receptor CXCR4 play an important role in cell proliferation and migration of multiple cell types. But there is no report of SDF-1 and CXCR4 in tracheal cells. In this paper, the rat tracheal epithelial cells covered with cilium were isolated and cultured using two enzyme digestions, and CXCR4 lentivirus was constructed and infected to the tracheal cells successfully. The results showed that the expression of CXCR4 which was covered on cellular membrane majorly was low in normal cells, and the cell proliferation was increased accompanied with the increase in SDF-1 concentration. The cell proliferation, migration and intracellular free calcium were increased significantly in CXCR4 lentivirus infected groups in a dose-dependent manner, and these effects could be inhibited after CXCR4 inhibitor AMD3100 treated because the expression of CXCR4 was decreased. Our findings indicate that the activation of CXCR4 may promote tracheal cell proliferation and migration to the sites of airway injury where SDF-1 is regulated.
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Affiliation(s)
- Jun Liu
- Department of Thoracic Surgery, Shengjing Hospital, China Medical University, Shenyang 110004, China
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15
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Shi HC, Lu D, Li HJ, Han S, Zeng YJ. In vitro isolation and cultivation of rabbit tracheal epithelial cells using tissue explant technique. In Vitro Cell Dev Biol Anim 2013; 49:245-9. [PMID: 23494268 DOI: 10.1007/s11626-012-9572-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2012] [Accepted: 11/18/2012] [Indexed: 12/16/2022]
Abstract
Epithelial cells from tracheal mucosa offer significant potential as a cell source in development of tissue-engineered trachea. The purpose of this study was to investigate and optimize a suitable culture system for tracheal epithelial cells, including the methods of primary culture, passage, identification, and cryopreservation. Epithelial cells were isolated from rabbit tracheal mucosa using tissue explant technique and were subjected to immunohistochemistry, immunofluorescence, and cryopreservation after purification. Epithelial cells reached confluency at 14-15 d. Immunohistochemical staining for cytokeratin showed brown yellow-positive cytoplasm and blue-counterstained nuclei, while immunofluorescence staining for cytokeratin showed green-positive cytoplasm and clear cell outline, indicating that the cultured cells had properties of epithelial cells. After recovery, epithelial cells exhibited high survival and viability. The results demonstrated that in vitro isolation and cultivation model was successfully established to provide high proliferative capacity, typical morphology and characteristics of tracheal epithelial cells from trachea mucosa by the use of the tissue explant technique.
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Affiliation(s)
- Hong-Can Shi
- College of Clinical Medicine, Yangzhou University, Yangzhou 225001, Jiangsu Province, China.
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Brouwer KM, Hoogenkamp HR, Daamen WF, van Kuppevelt TH. Regenerative medicine for the respiratory system: distant future or tomorrow's treatment? Am J Respir Crit Care Med 2012; 187:468-75. [PMID: 23220914 DOI: 10.1164/rccm.201208-1558pp] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Regenerative medicine (RM) is a new field of biomedical science that focuses on the regeneration of tissues and organs and the restoration of organ function. Although regeneration of organ systems such as bone, cartilage, and heart has attracted intense scientific research over recent decades, RM research regarding the respiratory system, including the trachea, the lung proper, and the diaphragm, has lagged behind. However, the last 5 years have witnessed novel approaches and initial clinical applications of tissue-engineered constructs to restore organ structure and function. In this regard, this article briefly addresses the basics of RM and introduces the key elements necessary for tissue regeneration, including (stem) cells, biomaterials, and extracellular matrices. In addition, the current status of the (clinical) application of RM to the respiratory system is discussed, and bottlenecks and recent approaches are identified. For the trachea, several initial clinical studies have been reported and have used various combinations of cells and scaffolds. Although promising, the methods used in these studies require optimization and standardization. For the lung proper, only (stem) cell-based approaches have been probed clinically, but it is becoming apparent that combinations of cells and scaffolds are required to successfully restore the lung's architecture and function. In the case of the diaphragm, clinical applications have focused on the use of decellularized scaffolds, but novel scaffolds, with or without cells, are clearly needed for true regeneration of diaphragmatic tissue. We conclude that respiratory treatment with RM will not be realized tomorrow, but its future looks promising.
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Affiliation(s)
- Katrien M Brouwer
- Department of Biochemistry, Nijmegen Centre for Molecular Life Sciences, Radboud University Medical Centre, Nijmegen, The Netherlands
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Hinderer S, Schesny M, Bayrak A, Ibold B, Hampel M, Walles T, Stock UA, Seifert M, Schenke-Layland K. Engineering of fibrillar decorin matrices for a tissue-engineered trachea. Biomaterials 2012; 33:5259-66. [DOI: 10.1016/j.biomaterials.2012.03.075] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2012] [Accepted: 03/24/2012] [Indexed: 10/28/2022]
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Bone marrow-derived mesenchymal stem cells enhance cryopreserved trachea allograft epithelium regeneration and vascular endothelial growth factor expression. Transplantation 2011; 92:620-6. [PMID: 21804442 DOI: 10.1097/tp.0b013e31822a4082] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Epithelium regeneration and revascularization of tracheal implants are challenging issues to be solved in tracheal transplantation research. Bone marrow-derived mesenchymal stem cells (BMSCs) can migrate to the damaged tissue and promote functional restoration. Here, we applied intravenous transplantation of BMSCs combined with a cryopreserved allograft to investigate the role of BMSCs in enhancing implant survival, tracheal epithelium regeneration and revascularization. METHODS After transplantation with cryopreserved allografts, PKH-26 labeled 3 to 5 passage BMSCs were injected into recipient rats through the tail vein. Rats in the control groups were injected with a comparable amount of phosphate-buffered saline. We observed the histology of the tracheal allograft and measured vascular endothelial growth factor (VEGF) protein levels in the epithelium to evaluate the effect of BMSCs on epithelium regeneration and revascularization. RESULTS Histologic observation of the rats from the BMSCs injection groups showed that the tracheal lumen was covered by pseudostriated ciliated columnar epithelium. The cartilage structure was intact. There were no signs of denaturation or necrosis. PKH-26 labeled BMSCs migrated to the implant site and exhibited red fluorescence, with the brightest red fluorescence at the anastomotic site. VEGF protein levels in the allograft epithelium of the BMSCs injection group were higher than the levels in the phosphate-buffered saline injection group. CONCLUSIONS Our results indicate that given systemic administration, BMSCs may enhance epithelium regeneration and revascularization by upregulating VEGF expression.
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Perichondrium directed cartilage formation in silk fibroin and chitosan blend scaffolds for tracheal transplantation. Acta Biomater 2011; 7:3422-31. [PMID: 21640205 DOI: 10.1016/j.actbio.2011.05.012] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2010] [Revised: 05/09/2011] [Accepted: 05/11/2011] [Indexed: 11/23/2022]
Abstract
The purpose of this study was to investigate the potential of silk fibroin and chitosan blend (SFCS) biological scaffolds for the purpose of cartilage tissue engineering with applications in tracheal tissue reconstruction. The capability of these scaffolds as cell carrier systems for chondrocytes was determined in vitro and cartilage generation in vivo on engineered chondrocyte-scaffold constructs with and without a perichondrium wrapping was tested in an in vivo nude mouse model. SFCS scaffolds supported chondrocyte adhesion, proliferation, and differentiation, determined as features of the cells based on the spherical cell morphology, increased accumulation of glycosaminoglycans, and increased collagen type II deposition with time within the scaffold framework. Perichondrium wrapping significantly (P<0.001) improved chondrogenesis within the cell-scaffold constructs in vivo. In vivo implantation for 6weeks did not generate cartilage structures resembling native trachea, although cartilage-like structures were present. The mechanical properties of the regenerated tissue increased due to the deposition of chondrogenic matrix within the SFCS scaffold structural framework of the trachea. The support of chondrogenesis by the SFCS tubular scaffold construct resulted in a mechanically sound structure and thus is a step towards an engineered trachea that could potentially support the growth of an epithelial lining resulting in a tracheal transplant with properties resembling those of the fully functional native trachea.
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Walles T. Tracheobronchial bio-engineering: biotechnology fulfilling unmet medical needs. Adv Drug Deliv Rev 2011; 63:367-74. [PMID: 21295094 DOI: 10.1016/j.addr.2011.01.011] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2010] [Revised: 01/25/2011] [Accepted: 01/27/2011] [Indexed: 12/11/2022]
Abstract
The development of substitutes for the human trachea or its bronchial tree represents a niche application in the rapidly advancing scientific field of Regenerative Medicine. Despite a comparatively small research foundation in the field of tracheo-bronchial bioengineering, four different approaches have already been translated into clinical settings and applied in patients. This can be attributed to the lack of established treatment options for a small group of patients with extensive major airway disease. In this review, the clinical background and tissue-specific basics of tracheo-bronchial bioengineering will be evaluated. Focusing on the clinical applications of bioengineered tracheal tissues, a "top-down" or "bedside-to-bench" analysis is performed in order to guide future basic and clinical research activities for airway bioengineering.
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Affiliation(s)
- Thorsten Walles
- Robert-Bosch-Hospital GmbH, Schillerhoehe Hospital, Department of General Thoracic Surgery, Gerlingen, Germany.
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Remplacement de trachée par reconstructions chirurgicales : état actuel de la recherche. ACTA ACUST UNITED AC 2009; 126:272-7. [DOI: 10.1016/j.aorl.2009.10.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2009] [Accepted: 10/07/2009] [Indexed: 12/21/2022]
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Animal models of tracheal allotransplantation using vitrified cryopreservation. J Thorac Cardiovasc Surg 2009; 138:1222-6. [PMID: 19660277 DOI: 10.1016/j.jtcvs.2009.05.028] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2008] [Revised: 05/01/2009] [Accepted: 05/31/2009] [Indexed: 11/21/2022]
Abstract
OBJECTIVE Tracheal reconstruction continues to pose a significant challenge in thoracic surgery. The study objective was to develop a novel method to eliminate the antigenicity of tracheal allografts by using vitrified cryopreservation and present the experimental results after cervical tracheal replacement in rabbits. METHODS Fifteen New Zealand rabbits, irrespective of gender, weighing 2.5 to 3.0 kg, were randomly divided into 3 groups: (A), the experimental group (n = 5), tracheal allotransplantation after 4 weeks of vitrified cryopreservation; (B), the negative control group (n = 5), fresh tracheal autotransplantation; and (C), the positive control group (n = 5), fresh tracheal segments implanted as allografts. The patency of implanted grafts, lymphocytic infiltrate, cartilage scores, and ink perfusion to evaluate revascularization were used to investigate the impact of vitrified cryopreservation on the antigenicity of tracheal grafts and vascular regeneration. RESULTS Rabbits in groups A and B all had uneventful postoperative courses with patent lumens and structural integrity, with obvious vascular regeneration and less lymphocytic infiltrate. Although in excellent condition, animals were sacrificed after a short-term follow-up of 4 weeks for further examination as scheduled. In group C, massive lymphocytic infiltrate and inflammatory cells without noticeable revascularization were observed, and rabbits died within 2 weeks after surgery for airway stenosis or severe obstruction. CONCLUSION The antigenicity of tracheal allografts was significantly decreased by using the vitrified cryopreservation method, which would be a novel alternative method to store donor trachea to make tracheal banking possible.
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