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Tseng WH, Liu EW, Cheng KY, Wee SJ, Lee JJ, Chen HC. Tracheal Replacement Techniques and Associated Mortality: A Systematic Review. Laryngoscope 2024; 134:1517-1522. [PMID: 37916766 DOI: 10.1002/lary.31100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2023] [Revised: 09/18/2023] [Accepted: 09/22/2023] [Indexed: 11/03/2023]
Abstract
OBJECTIVE Tracheal replacement is a crucial operation to enhance the quality of life for patients with extensive tracheal lesions. The most suitable surgical techniques for different clinical conditions remain a topic of debate. Through a reviewing of the relevant literature, this study investigated the association between surgical techniques and mortality rate. DATA SOURCES Studies were collected from PubMed, Embase, the Web of Science, the Cochrane Center Register of Controlled Trials, and ClinicalTrials.gov. METHODS This systematic review encompassed literature from the inception of each database to May 10, 2023, focusing on tracheal replacement for patients who underwent circumferential resection of the trachea or partial resection with preservation of the posterior membranous wall. Non-human and non-clinical studies were excluded. RESULTS About 31 studies were included in the assessment comprising a combination of case reports and case series, and 118 patients underwent tracheal replacement through four underlying methodologies, including tracheal allotransplantation, autologous tissue reconstruction, bioprosthetic reconstruction, or tissue engineering surgery. Each modality exhibits unique advantages and disadvantages, leading to variable outcomes in clinical application. CONCLUSION Tracheal replacement is challenging due to the absence of an ideal substitution or graft material. Despite limited clinical successes observed across various modalities, we believe autologous tissue reconstruction for tracheal replacement has the advantage of broadest indications, low rejection rate, and avoidance of immunosuppressive agents. Future research should focus on achieving tracheal replacement that preserves mucociliary clearance, lateral rigidity, and longitudinal flexibility. LEVEL OF EVIDENCE NA Laryngoscope, 134:1517-1522, 2024.
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Affiliation(s)
- Wen-Hui Tseng
- Department of Plastic and Reconstructive Surgery, China Medical University Hospital, Taichung City, Taiwan
| | - En-Wei Liu
- Department of Plastic and Reconstructive Surgery, China Medical University Hospital, Taichung City, Taiwan
| | - Kai-Yuan Cheng
- Department of Plastic and Reconstructive Surgery, China Medical University Hospital, Taichung City, Taiwan
| | - Shyun-Jing Wee
- Department of Plastic and Reconstructive Surgery, China Medical University Hospital, Taichung City, Taiwan
| | - Jian-Jr Lee
- Department of Plastic and Reconstructive Surgery, China Medical University Hospital, Taichung City, Taiwan
- College of Medicine, China Medical University, Taichung City, Taiwan
| | - Hung-Chi Chen
- Department of Plastic and Reconstructive Surgery, China Medical University Hospital, Taichung City, Taiwan
- College of Medicine, China Medical University, Taichung City, Taiwan
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Iwasaki S, Deguchi K, Iwai R, Nakayama Y, Okuyama H. Regeneration Process of an Autologous Tissue-Engineered Trachea (aTET) in a Rat Patch Tracheoplasty Model. Bioengineering (Basel) 2024; 11:243. [PMID: 38534518 DOI: 10.3390/bioengineering11030243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Revised: 02/18/2024] [Accepted: 02/26/2024] [Indexed: 03/28/2024] Open
Abstract
The treatment of long-tracheal lesion is difficult because there are currently no viable grafts for tracheal replacement. To solve this problem, we have developed an autologous Tissue-Engineered Trachea (aTET), which is made up of collagenous tissues and cartilage-like structures derived from rat chondrocytes. This graft induced successful long-term survival in a small-animal experiment in our previous study. In this study, we investigated the regeneration process of an aTET to attain reproducible success. We prepared an aTET by using a specially designed mold and performed patch tracheoplasty with an aTET. We assigned twenty-seven rats to three groups according to the three types of patch grafts used: aTET patches (the aTET group), fresh tracheal autograft patches (the Ag group), or polylactic acid and polycaprolactone copolymer sheets (the PPc group). In each group, gross and histological evaluations were performed at 1 month (n = 3), 3 months (n = 3), and 6 months (n = 3) after implantation. We obtained high survival rates in all groups, but only the PPc group attained thick tracheal walls with granular tissues and no tracheal regeneration. On the other hand, the aTET and Ag groups reproducibly achieved complete tracheal regeneration in 6 months. So, an aTET could be a promising candidate for tracheal regeneration grafts.
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Affiliation(s)
- Shun Iwasaki
- Department of Pediatric Surgery, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita 565-0871, Japan
| | - Koichi Deguchi
- Department of Pediatric Surgery, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita 565-0871, Japan
| | - Ryosuke Iwai
- Research Institute of Technology, Okayama University of Science, 1-1, Ridaicho, Kita-Ku, Okayama 700-0005, Japan
| | - Yasuhide Nakayama
- Osaka Laboratory, Biotube Co., Ltd., 3-10-1 Senriyama-Higashi, Suita 565-0842, Japan
| | - Hiroomi Okuyama
- Department of Pediatric Surgery, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita 565-0871, Japan
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Xu X, Shen Z, Shan Y, Sun F, Lu Y, Zhu J, Sun Y, Shi H. Application of tissue engineering techniques in tracheal repair: a bibliometric study. Bioengineered 2023; 14:2274150. [PMID: 37927226 PMCID: PMC10629433 DOI: 10.1080/21655979.2023.2274150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2023] [Accepted: 10/16/2023] [Indexed: 11/07/2023] Open
Abstract
Transplantation of tissue-engineered trachea is an effective treatment for long-segment tracheal injury. This technology avoids problems associated with a lack of donor resources and immune rejection, generating an artificial trachea with good biocompatibility. To our knowledge, a systematic summary of basic and clinical research on tissue-engineered trachea in the last 20 years has not been conducted. Here, we analyzed the development trends of tissue-engineered trachea research by bibliometric means and outlined the future perspectives in this field. The Web of Science portal was selected as the data source. CiteSpace, VOSviewer, and the Bibliometric Online Analysis Platform were used to analyze the number of publications, journals, countries, institutions, authors, and keywords from 475 screened studies. Between 2000 and 2023, the number of published studies on tissue-engineered trachea has been increasing. Biomaterials published the largest number of papers. The United States and China have made the largest contributions to this field. University College London published the highest number of studies, and the most productive researcher was an Italian scholar, Paolo Macchiarini. However, close collaborations between various researchers and institutions from different countries were generally lacking. Despite this, keyword analysis showed that manufacturing methods for tracheal stents, hydrogel materials, and 3D bioprinting technology are current popular research topics. Our bibliometric study will help scientists in this field gain an in-depth understanding of the current research progress and development trends to guide their future work, and researchers in related fields will benefit from the introduction to transplantation methods of tissue-engineered trachea.
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Affiliation(s)
- Xiangyu Xu
- Clinical Medical College, Yangzhou University, Yangzhou, China
- Institute of Translational Medicine, Medical College, Yangzhou University, Yangzhou, China
- Jiangsu Key Laboratory of Integrated Traditional Chinese and Western Medicine for Prevention and Treatment of Senile Diseases, Yangzhou University, Yangzhou, China
| | - Zhiming Shen
- Clinical Medical College, Yangzhou University, Yangzhou, China
- Institute of Translational Medicine, Medical College, Yangzhou University, Yangzhou, China
- Jiangsu Key Laboratory of Integrated Traditional Chinese and Western Medicine for Prevention and Treatment of Senile Diseases, Yangzhou University, Yangzhou, China
| | - Yibo Shan
- Clinical Medical College, Yangzhou University, Yangzhou, China
- Institute of Translational Medicine, Medical College, Yangzhou University, Yangzhou, China
- Jiangsu Key Laboratory of Integrated Traditional Chinese and Western Medicine for Prevention and Treatment of Senile Diseases, Yangzhou University, Yangzhou, China
| | - Fei Sun
- Clinical Medical College, Yangzhou University, Yangzhou, China
- Institute of Translational Medicine, Medical College, Yangzhou University, Yangzhou, China
- Jiangsu Key Laboratory of Integrated Traditional Chinese and Western Medicine for Prevention and Treatment of Senile Diseases, Yangzhou University, Yangzhou, China
| | - Yi Lu
- Clinical Medical College, Yangzhou University, Yangzhou, China
- Institute of Translational Medicine, Medical College, Yangzhou University, Yangzhou, China
- Jiangsu Key Laboratory of Integrated Traditional Chinese and Western Medicine for Prevention and Treatment of Senile Diseases, Yangzhou University, Yangzhou, China
| | - Jianwei Zhu
- Clinical Medical College, Yangzhou University, Yangzhou, China
- Institute of Translational Medicine, Medical College, Yangzhou University, Yangzhou, China
- Jiangsu Key Laboratory of Integrated Traditional Chinese and Western Medicine for Prevention and Treatment of Senile Diseases, Yangzhou University, Yangzhou, China
| | - Yiqi Sun
- Clinical Medical College, Yangzhou University, Yangzhou, China
- Institute of Translational Medicine, Medical College, Yangzhou University, Yangzhou, China
- Jiangsu Key Laboratory of Integrated Traditional Chinese and Western Medicine for Prevention and Treatment of Senile Diseases, Yangzhou University, Yangzhou, China
| | - Hongcan Shi
- Clinical Medical College, Yangzhou University, Yangzhou, China
- Institute of Translational Medicine, Medical College, Yangzhou University, Yangzhou, China
- Jiangsu Key Laboratory of Integrated Traditional Chinese and Western Medicine for Prevention and Treatment of Senile Diseases, Yangzhou University, Yangzhou, China
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Sun F, Shen Z, Zhang B, Lu Y, Shan Y, Wu Q, Yuan L, Zhu J, Pan S, Wang Z, Wu C, Zhang G, Yang W, Xu X, Shi H. Biomimetic in situ tracheal microvascularization for segmental tracheal reconstruction in one-step. Bioeng Transl Med 2023; 8:e10534. [PMID: 37476057 PMCID: PMC10354772 DOI: 10.1002/btm2.10534] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Revised: 04/04/2023] [Accepted: 04/12/2023] [Indexed: 07/22/2023] Open
Abstract
Formation of functional and perfusable vascular network is critical to ensure the long-term survival and functionality of the engineered tissue tracheae after transplantation. However, the greatest challenge in tracheal-replacement therapy is the promotion of tissue regeneration by rapid graft vascularization. Traditional prevascularization methods for tracheal grafts typically utilize omentum or muscle flap wrapping, which requires a second operation; vascularized segment tracheal orthotopic transplantation in one step remains difficult. This study proposes a method to construct a tissue-engineered tracheal graft, which directly forms the microvascular network after orthotopic transplantation in vivo. The focus of this study was the preparation of a hybrid tracheal graft that is non-immunogenic, has good biomechanical properties, supports cell proliferation, and quickly vascularizes. The results showed that vacuum-assisted decellularized trachea-polycaprolactone hybrid scaffold could match most of the above requirements as closely as possible. Furthermore, endothelial progenitor cells (EPCs) were extracted and used as vascularized seed cells and seeded on the surfaces of hybrid grafts before and during the tracheal orthotopic transplantation. The results showed that the microvascularized tracheal grafts formed maintained the survival of the recipient, showing a satisfactory therapeutic outcome. This is the first study to utilize EPCs for microvascular construction of long-segment trachea in one-step; the approach represents a promising method for microvascular tracheal reconstruction.
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Affiliation(s)
- Fei Sun
- Clinical Medical CollegeYangzhou UniversityYangzhouChina
- Institute of Translational Medicine, Medical CollegeYangzhou UniversityYangzhouChina
- Jiangsu Key Laboratory of Integrated Traditional Chinese and Western Medicine for Prevention and Treatment of Senile DiseasesYangzhou UniversityYangzhouChina
| | - Zhiming Shen
- Clinical Medical CollegeYangzhou UniversityYangzhouChina
- Institute of Translational Medicine, Medical CollegeYangzhou UniversityYangzhouChina
- Jiangsu Key Laboratory of Integrated Traditional Chinese and Western Medicine for Prevention and Treatment of Senile DiseasesYangzhou UniversityYangzhouChina
| | - Boyou Zhang
- Institute of Translational Medicine, Medical CollegeYangzhou UniversityYangzhouChina
- Jiangsu Key Laboratory of Integrated Traditional Chinese and Western Medicine for Prevention and Treatment of Senile DiseasesYangzhou UniversityYangzhouChina
| | - Yi Lu
- Clinical Medical CollegeYangzhou UniversityYangzhouChina
- Institute of Translational Medicine, Medical CollegeYangzhou UniversityYangzhouChina
- Jiangsu Key Laboratory of Integrated Traditional Chinese and Western Medicine for Prevention and Treatment of Senile DiseasesYangzhou UniversityYangzhouChina
| | - Yibo Shan
- Clinical Medical CollegeYangzhou UniversityYangzhouChina
- Institute of Translational Medicine, Medical CollegeYangzhou UniversityYangzhouChina
- Jiangsu Key Laboratory of Integrated Traditional Chinese and Western Medicine for Prevention and Treatment of Senile DiseasesYangzhou UniversityYangzhouChina
| | - Qiang Wu
- Clinical Medical CollegeYangzhou UniversityYangzhouChina
- Institute of Translational Medicine, Medical CollegeYangzhou UniversityYangzhouChina
- Jiangsu Key Laboratory of Integrated Traditional Chinese and Western Medicine for Prevention and Treatment of Senile DiseasesYangzhou UniversityYangzhouChina
| | - Lei Yuan
- Clinical Medical CollegeYangzhou UniversityYangzhouChina
- Institute of Translational Medicine, Medical CollegeYangzhou UniversityYangzhouChina
- Jiangsu Key Laboratory of Integrated Traditional Chinese and Western Medicine for Prevention and Treatment of Senile DiseasesYangzhou UniversityYangzhouChina
| | - Jianwei Zhu
- Clinical Medical CollegeYangzhou UniversityYangzhouChina
- Institute of Translational Medicine, Medical CollegeYangzhou UniversityYangzhouChina
- Jiangsu Key Laboratory of Integrated Traditional Chinese and Western Medicine for Prevention and Treatment of Senile DiseasesYangzhou UniversityYangzhouChina
| | - Shu Pan
- Department of Thoracic SurgeryThe First Affiliated Hospital of Soochow UniversitySuzhouChina
| | - Zhihao Wang
- Institute of Translational Medicine, Medical CollegeYangzhou UniversityYangzhouChina
- Jiangsu Key Laboratory of Integrated Traditional Chinese and Western Medicine for Prevention and Treatment of Senile DiseasesYangzhou UniversityYangzhouChina
| | - Cong Wu
- Institute of Translational Medicine, Medical CollegeYangzhou UniversityYangzhouChina
- Jiangsu Key Laboratory of Integrated Traditional Chinese and Western Medicine for Prevention and Treatment of Senile DiseasesYangzhou UniversityYangzhouChina
| | - Guozhong Zhang
- Clinical Medical CollegeYangzhou UniversityYangzhouChina
| | - Wenlong Yang
- Clinical Medical CollegeYangzhou UniversityYangzhouChina
| | - Xiangyu Xu
- Institute of Translational Medicine, Medical CollegeYangzhou UniversityYangzhouChina
- Jiangsu Key Laboratory of Integrated Traditional Chinese and Western Medicine for Prevention and Treatment of Senile DiseasesYangzhou UniversityYangzhouChina
| | - Hongcan Shi
- Clinical Medical CollegeYangzhou UniversityYangzhouChina
- Institute of Translational Medicine, Medical CollegeYangzhou UniversityYangzhouChina
- Jiangsu Key Laboratory of Integrated Traditional Chinese and Western Medicine for Prevention and Treatment of Senile DiseasesYangzhou UniversityYangzhouChina
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Dang LH, Tseng Y, Tseng H, Hung SH. Partial Decellularization for Segmental Tracheal Scaffold Tissue Engineering: A Preliminary Study in Rabbits. Biomolecules 2021; 11:biom11060866. [PMID: 34200705 PMCID: PMC8230409 DOI: 10.3390/biom11060866] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 06/08/2021] [Accepted: 06/09/2021] [Indexed: 01/24/2023] Open
Abstract
In this study, we developed a new procedure for the rapid partial decellularization of the harvested trachea. Partial decellularization was performed using a combination of detergent and sonication to completely remove the epithelial layers outside of the cartilage ring. The post-decellularized tracheal segments were assessed with vital staining, which showed that the core cartilage cells remarkably remained intact while the cells outside of the cartilage were no longer viable. The ability of the decellularized tracheal segments to evade immune rejection was evaluated through heterotopic implantation of the segments into the chest muscle of rabbits without any immunosuppressive therapy, which demonstrated no evidence of severe rejection or tissue necrosis under H&E staining, as well as the mechanical stability under stress-pressure testing. Finally, orthotopic transplantation of partially decellularized trachea with no immunosuppression treatment resulted in 2 months of survival in two rabbits and one long-term survival (2 years) in one rabbit. Through evaluations of posttransplantation histology and endoscopy, we confirmed that our partial decellularization method could be a potential method of producing low-immunogenic cartilage scaffolds with viable, functional core cartilage cells that can achieve long-term survival after in vivo transplantation.
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Affiliation(s)
- Luong Huu Dang
- International Ph.D. Program in Medicine, College of Medicine, Taipei Medical University, Taipei 110, Taiwan;
- Department of Otolaryngology, Faculty of Medicine, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City 70000, Vietnam
| | - Yuan Tseng
- Graduate Institute of Medical Sciences, College of Medicine, Taipei Medical University, Taipei 110, Taiwan;
| | - How Tseng
- Graduate Institute of Medical Sciences, College of Medicine, Taipei Medical University, Taipei 110, Taiwan;
- Department of Biochemistry and Molecular Cell Biology, School of Medicine, College of Medicine, Taipei Medical University, Taipei 110, Taiwan
- Correspondence: (H.T.); (S.-H.H.)
| | - Shih-Han Hung
- International Ph.D. Program in Medicine, College of Medicine, Taipei Medical University, Taipei 110, Taiwan;
- Department of Otolaryngology, School of Medicine, College of Medicine, Taipei Medical University, Taipei 110, Taiwan
- Department of Otolaryngology, Wan Fang Hospital, Taipei Medical University, Taipei 116, Taiwan
- Correspondence: (H.T.); (S.-H.H.)
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Sharma D, Iyer S, Subramaniam S, Ramu J, Sharma M, Nambiar A, Unni A, S S. Evaluation of Antigenicity of Components of Tracheal Allotransplant and Effect of Immunosuppressant Regime in a Rodent Model. Indian J Plast Surg 2020; 53:357-362. [PMID: 33402765 PMCID: PMC7775257 DOI: 10.1055/s-0040-1721860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Background Tracheal transplantation seems to be the logical step in the process of reconstruction of the trachea following a long-segment resection, which is usually done to treat malignant disease or benign stenosis of the airway caused by a traumatic, congenital, inflammatory, or iatrogenic lesion. Immunosuppression following transplant is essential but not ideal after oncoresection. Methods The tracheal allografts, harvested from Sprague Dawley rats, were implanted in the Wistar strain rat. The harvested tracheal grafts were divided into groups and subgroups, based on the layers of trachea, method of decellularization, and immunosuppression. The antigenicity of different layers of trachea and the effect of various decellularization methods were studied within three time frames, that is, day 3, 9, and 15. Result On structural analysis, the day 3 and day 15 samples showed no meaningful comparison could be made, due to extensive neutrophil infiltration in all three layers. The day 9 tracheal grafts showed loss of epithelium, with no signs of regeneration in most of the allografts. The subepithelial lymphoid infiltration was found to be severe in nonimmunosuppressed allografts. The group in which both inner and outer layers were removed showed moderate-to-severe infiltrate of lymphoid cells in all the allografts, but there was no cartilage loss, irrespective of the method of decellularization. The irradiated specimens retained the cartilage but showed extensive ischemic damage. Conclusion Rat trachea is a good model for tracheal transplant research but not adequately sturdy to sustain mechanical debridement. Irradiation and chemical decellularization eliminates the immune response but causes intense ischemic damage. Out of the three time frames, day 9 seemed to be the best to study the immune response. To substantiate the results obtained in this study, the immunohistochemical study of the allografts is needed to be performed among a larger group of animals.
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Affiliation(s)
- Dimpy Sharma
- Department of Plastic and Reconstructive Surgery, Amrita Institute of Medical Sciences and Research Centre, Kochi, Kerala, India
| | - Subramania Iyer
- Department of Plastic and Reconstructive Surgery, Amrita Institute of Medical Sciences and Research Centre, Kochi, Kerala, India.,Department of Head and Neck Surgical Oncology, Amrita Institute of Medical Sciences and Research Centre, Kochi, Kerala, India
| | - Sobha Subramaniam
- Department of Pulmonary Medicine, Amrita Institute of Medical Sciences and Research Centre, Kochi, Kerala, India
| | - Janarthanan Ramu
- Department of Plastic and Reconstructive Surgery, Amrita Institute of Medical Sciences and Research Centre, Kochi, Kerala, India
| | - Mohit Sharma
- Department of Plastic and Reconstructive Surgery, Amrita Institute of Medical Sciences and Research Centre, Kochi, Kerala, India
| | - Ajit Nambiar
- Department of Clinical Pathology, Amrita Institute of Medical Sciences and Research Centre, Kochi, Kerala, India
| | - Akk Unni
- Department of Central Animal Research Facility, Amrita Institute of Medical Sciences and Research Centre, Kochi, Kerala, India
| | - Sivanarayanan S
- Department of Central Animal Research Facility, Amrita Institute of Medical Sciences and Research Centre, Kochi, Kerala, India
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Hamilton NJ, Hynds RE, Gowers KH, Tait A, Butler CR, Hopper C, Burns AJ, Birchall MA, Lowdell M, Janes SM. Using a Three-Dimensional Collagen Matrix to Deliver Respiratory Progenitor Cells to Decellularized Trachea In Vivo. Tissue Eng Part C Methods 2019; 25:93-102. [PMID: 30648458 PMCID: PMC6389769 DOI: 10.1089/ten.tec.2018.0241] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Accepted: 01/14/2019] [Indexed: 10/27/2022] Open
Abstract
IMPACT STATEMENT This article describes a method for engrafting epithelial progenitor cells to a revascularized scaffold in a protective and supportive collagen-rich environment. This method has the potential to overcome two key limitations of existing grafting techniques as epithelial cells are protected from mechanical shear and the relatively hypoxic phase that occurs while grafts revascularize, offering the opportunity to provide epithelial cells to decellularized allografts at the point of implantation. Advances in this area will improve the safety and efficacy of bioengineered organ transplantation.
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Affiliation(s)
- Nick J.I. Hamilton
- Lungs for Living Research Centre, UCL Respiratory, Division of Medicine, University College London, London, United Kingdom
- UCL Ear Institute, The Royal National Throat Nose and Ear Hospital, London, United Kingdom
| | - Robert E. Hynds
- Lungs for Living Research Centre, UCL Respiratory, Division of Medicine, University College London, London, United Kingdom
| | - Kate H.C. Gowers
- Lungs for Living Research Centre, UCL Respiratory, Division of Medicine, University College London, London, United Kingdom
| | - Angela Tait
- Department of Biochemical Engineering, University College London, London, United Kingdom
| | - Colin R. Butler
- Lungs for Living Research Centre, UCL Respiratory, Division of Medicine, University College London, London, United Kingdom
| | - Colin Hopper
- Maxillofacial Surgery, Eastman Dental Institute, London, United Kingdom
| | - Alan J. Burns
- Stem Cell and Regenerative Medicine, Birth Defects Research Centre, UCL Great Ormond Institute of Child Health, London, United Kingdom
| | - Martin A. Birchall
- UCL Ear Institute, The Royal National Throat Nose and Ear Hospital, London, United Kingdom
| | - Mark Lowdell
- Institute of Immunity and Transplantation, Centre for Cell, Gene and Tissue Therapeutics, Royal Free Hospital, London, United Kingdom
| | - Sam M. Janes
- Lungs for Living Research Centre, UCL Respiratory, Division of Medicine, University College London, London, United Kingdom
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Abstract
AIM To analyze long-term outcomes of tracheal transplantation. MATERIAL AND METHODS There were 1128 patients with cicatricial tracheal stenosis who have been operated at the Petrovsky Russian Research Center for Surgery and the Sechenov First Moscow State Medical University for the period 1963-2015. RESULTS Operations have become safer. Postoperative morbidity and mortality reduced from 41.4% (1963-1980) to 5.6% (2001-2015) and from 21.9% (1963-1980) to 0.5% (2001-2015), respectively. Tracheal transplantation was performed in 2 cases and fundamentally different tracheal structures were applied. Donor thyreotracheal complex with restored blood supply through thyroid vessels was used in the first case (2006). Perennial experimental trials preceded clinical application of this technique. In the second case (2010) we applied scientific results of foreign colleagues (cellular technologies and methods of regenerative medicine to create artificial trachea). Patients are still alive after 12 and 8 years, respectively. Restoration of blood supply of donor trachea is possible through thyroid collaterals. This technique is successful in long-term period. Tissue-engineered trachea cannot be considered true trachea due to no all tracheal components. However, such trachea provides air-conducting, evacuation and protective functions. Tracheomalacia requires further researches as one of the main problems of tracheal transplantation.
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Affiliation(s)
- V D Parshin
- Sechenov First Moscow State Medical University, Moscow, Russia
| | - A V Lyundup
- Sechenov First Moscow State Medical University, Moscow, Russia
| | - E A Tarabrin
- Sechenov First Moscow State Medical University, Moscow, Russia
| | - V V Parshin
- Sechenov First Moscow State Medical University, Moscow, Russia
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Maughan EF, Butler CR, Crowley C, Teoh GZ, den Hondt M, Hamilton NJ, Hynds RE, Lange P, Ansari T, Urbani L, Janes SM, de Coppi P, Birchall MA, Elliott MJ. A comparison of tracheal scaffold strategies for pediatric transplantation in a rabbit model. Laryngoscope 2017; 127:E449-E457. [PMID: 28776693 DOI: 10.1002/lary.26611] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2017] [Revised: 02/15/2017] [Accepted: 03/08/2017] [Indexed: 12/13/2022]
Abstract
OBJECTIVES/HYPOTHESIS Despite surgical advances, childhood tracheal stenosis is associated with high morbidity and mortality. Various tracheal scaffold strategies have been developed as the basis for bioengineered substitutes, but there is no consensus on which may be superior in vivo. We hypothesized that there would be no difference in morbidity and mortality between three competing scaffold strategies in rabbits. STUDY DESIGN Pilot preclinical study. METHODS Tracheal scaffolds were prepared by three methods that have been applied clinically and reported: preserved cadaveric ("Herberhold") allografts, detergent-enzymatically decellularized allografts, and synthetic scaffolds (nanocomposite polymer [polyhedral oligomeric silsesquioxane poly(carbonate-urea) urethane (POSS-PCU)]). Scaffolds were implanted into cervical trachea of New Zealand White rabbits (n = 4 per group) without cell seeding. Control animals (n = 4) received autotransplanted tracheal segments using the same technique. Animals underwent bronchoscopic monitoring of the grafts for 30 days. Macroscopic evaluation of tissue integration, graft stenosis, and collapsibility and histological examinations were performed on explants at termination. RESULTS All surgical controls survived to termination without airway compromise. Mild to moderate anastomotic stenosis from granulation tissue was detected, but there was evidence suggestive of vascular reconnection with minimal fibrous encapsulation. In contrast, three of the four animals in the Herberhold and POSS-PCU groups, and all animals receiving decellularized allografts, required early termination due to respiratory distress. Herberhold grafts showed intense inflammatory reactions, anastomotic stenoses, and mucus plugging. Synthetic graft integration and vascularization were poor, whereas decellularized grafts demonstrated malacia and collapse but had features suggestive of vascular connection or revascularization. CONCLUSIONS There are mirror-image benefits and drawbacks to nonrecellularized, decellularized, and synthetic grafts, such that none emerged as the preferred option. Results from prevascularized and/or cell-seeded grafts (as applied clinically) may elucidate clearer advantages of one scaffold type over another. LEVEL OF EVIDENCE NA. Laryngoscope, 127:E449-E457, 2017.
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Affiliation(s)
- Elizabeth F Maughan
- Lungs for Living Research Centre, UCL Respiratory, University College London, London, United Kingdom.,Stem Cell and Regenerative Medicine Section, Department of Surgery, UCL Institute of Child Health and Great Ormond Street Children's Hospital, London, United Kingdom
| | - Colin R Butler
- Lungs for Living Research Centre, UCL Respiratory, University College London, London, United Kingdom.,Stem Cell and Regenerative Medicine Section, Department of Surgery, UCL Institute of Child Health and Great Ormond Street Children's Hospital, London, United Kingdom
| | - Claire Crowley
- Stem Cell and Regenerative Medicine Section, Department of Surgery, UCL Institute of Child Health and Great Ormond Street Children's Hospital, London, United Kingdom
| | - Gui Zhen Teoh
- Division of Surgery and Interventional Science, UCL Centre of Nanotechnology and Regenerative Medicine, University College London, Royal Free London NHS Foundation Trust Hospital, London, United Kingdom
| | - Margot den Hondt
- Department of Plastic and Reconstructive Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Nicholas J Hamilton
- Lungs for Living Research Centre, UCL Respiratory, University College London, London, United Kingdom.,UCL Ear Institute, Royal National Throat, Nose, and Ear Hospital, London, United Kingdom
| | - Robert E Hynds
- Lungs for Living Research Centre, UCL Respiratory, University College London, London, United Kingdom
| | - Peggy Lange
- Northwick Park Institute for Medical Research, Northwick Park, London, United Kingdom
| | - Tahera Ansari
- Northwick Park Institute for Medical Research, Northwick Park, London, United Kingdom
| | - Luca Urbani
- Stem Cell and Regenerative Medicine Section, Department of Surgery, UCL Institute of Child Health and Great Ormond Street Children's Hospital, London, United Kingdom
| | - Samuel M Janes
- Lungs for Living Research Centre, UCL Respiratory, University College London, London, United Kingdom
| | - Paolo de Coppi
- Stem Cell and Regenerative Medicine Section, Department of Surgery, UCL Institute of Child Health and Great Ormond Street Children's Hospital, London, United Kingdom
| | - Martin A Birchall
- UCL Ear Institute, Royal National Throat, Nose, and Ear Hospital, London, United Kingdom
| | - Martin J Elliott
- Department of Thoracic Surgery, Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom
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Abouarab AA, Elsayed HH, Elkhayat H, Mostafa A, Cleveland DC, Nori AE. Current Solutions for Long-Segment Tracheal Reconstruction. Ann Thorac Cardiovasc Surg 2017; 23:66-75. [PMID: 28228614 DOI: 10.5761/atcs.ra.16-00251] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
This article is a continuation of previous reviews about the appropriate method for long-segment tracheal reconstruction. We attempted to cover the most recent, successful and promising results of the different solutions for reconstruction that are rather innovative and suitable for imminent clinical application. Latest efforts to minimize the limitations associated with each method have been covered as well. In summary, autologous and allogenic tissue reconstruction of the trachea have been successful methods for reconstruction experimentally and clinically. Autologous tissues were best utilized clinically to enhance revascularization, whether as a definitive airway or as an adjunct to allografts or tissue-engineered trachea (TET). Allogenic tissue transplantation is, currently, the most suitable for clinical application, especially after elimination of the need for immunosuppressive therapy with unlimited supply of tissues. Similar results have been reported in many studies that used TET. However, clinical application of this method was limited to use as a salvage treatment in a few studies with promising results. These results still need to be solidified by further clinical and long-term follow-up reports. Combining different methods of reconstruction was often required to establish a physiological rather than an anatomical trachea and have shown superior outcomes.
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Affiliation(s)
- Ahmed A Abouarab
- Cardiothoracic Surgery Division, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Hany H Elsayed
- Thoracic Surgery, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Hussein Elkhayat
- Cardiothoracic Surgery, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Ahmed Mostafa
- Thoracic Surgery, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - David C Cleveland
- Cardiothoracic Surgery Division, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Ahmed El Nori
- Thoracic Surgery, Faculty of Medicine, Ain Shams University, Cairo, Egypt
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Jones MC, Rueggeberg FA, Faircloth HA, Cunningham AJ, Bush CM, Prosser JD, Waller JL, Postma GN, Weinberger PM. Defining the biomechanical properties of the rabbit trachea. Laryngoscope 2014; 124:2352-8. [PMID: 24782429 DOI: 10.1002/lary.24739] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2014] [Revised: 04/02/2014] [Accepted: 04/22/2014] [Indexed: 11/11/2022]
Abstract
OBJECTIVES/HYPOTHESIS Surgical advancements rely heavily on validated animal models. The New Zealand White (NZW) rabbit is a widely used model for airway research, including regenerative medicine applications. Currently, the biomechanical properties of the normal rabbit trachea are not known. Our objective was to define these properties to assist in the standardization and understanding of future airway research using this model. STUDY DESIGN Laboratory-based study. METHODS Fresh tracheas from four adult NZW rabbits were dissected into 20 segments. To examine the biomechanical properties, segments were subjected to uniaxial tension (n = 9) and compression (n = 11) testing. Yield and maximum load (tension) and force at 50% displacement (compression) were recorded, and differences between segments were examined using analysis of covariance. RESULTS Normative data for native rabbit trachea show mean maximum load = 6.44 newtons (N), yield load = 5.93 N, and compressive strength = 2.10 N. In addition to establishing the baseline measurements, statistically significant differences in tensile measures based on location along the trachea and diameter were identified. Proximal segments had significantly higher maximum load (P = .0029) and yield load (P = .0062) than distal segments. Association between diameter and both maximum load (P = .0139) and yield load (P = .0082) was observed. CONCLUSIONS The adult NZW rabbit trachea is intrinsically less able to withstand tensile and compressive forces, compared to other airway models such as sheep or cadaveric human. Establishment of normative values will enable future research into changes in tracheal biomechanical properties during regenerative medicine manipulation and processing.
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Affiliation(s)
- Matthew C Jones
- Center for Voice, Airway and Swallowing, Department of Otolaryngology, Georgia Regents University, Augusta, Georgia, U.S.A
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