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Maughan EF, Hynds RE, Pennycuick A, Nigro E, Gowers KH, Denais C, Gómez-López S, Lazarus KA, Orr JC, Pearce DR, Clarke SE, Lee DDH, Woodall MN, Masonou T, Case KM, Teixeira VH, Hartley BE, Hewitt RJ, Al Yaghchi C, Sandhu GS, Birchall MA, O’Callaghan C, Smith CM, De Coppi P, Butler CR, Janes SM. Cell-intrinsic differences between human airway epithelial cells from children and adults. iScience 2022; 25:105409. [PMID: 36388965 PMCID: PMC9664344 DOI: 10.1016/j.isci.2022.105409] [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: 02/01/2022] [Revised: 09/30/2022] [Accepted: 10/18/2022] [Indexed: 11/06/2022] Open
Abstract
The airway epithelium is a protective barrier that is maintained by the self-renewal and differentiation of basal stem cells. Increasing age is a principle risk factor for chronic lung diseases, but few studies have explored age-related molecular or functional changes in the airway epithelium. We retrieved epithelial biopsies from histologically normal tracheobronchial sites from pediatric and adult donors and compared their cellular composition and gene expression profile (in laser capture-microdissected whole epithelium, fluorescence-activated cell-sorted basal cells, and basal cells in cell culture). Histologically, pediatric and adult tracheobronchial epithelium was similar in composition. We observed age-associated changes in RNA sequencing studies, including higher interferon-associated gene expression in pediatric epithelium. In cell culture, pediatric cells had higher colony formation ability, sustained in vitro growth, and outcompeted adult cells in a direct competitive proliferation assay. Our results demonstrate cell-intrinsic differences between airway epithelial cells from children and adults in both homeostatic and proliferative states.
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Affiliation(s)
- Elizabeth F. Maughan
- Lungs for Living Research Centre, UCL Respiratory, University College London, London WC1E 6JF, UK
- Epithelial Cell Biology in ENT Research (EpiCENTR) Group, Developmental Biology and Cancer Department, UCL Great Ormond Street Institute of Child Health, University College London, London WC1N 1DZ, UK
| | - Robert E. Hynds
- Epithelial Cell Biology in ENT Research (EpiCENTR) Group, Developmental Biology and Cancer Department, UCL Great Ormond Street Institute of Child Health, University College London, London WC1N 1DZ, UK
| | - Adam Pennycuick
- Lungs for Living Research Centre, UCL Respiratory, University College London, London WC1E 6JF, UK
| | - Ersilia Nigro
- Lungs for Living Research Centre, UCL Respiratory, University College London, London WC1E 6JF, UK
| | - Kate H.C. Gowers
- Lungs for Living Research Centre, UCL Respiratory, University College London, London WC1E 6JF, UK
| | - Celine Denais
- Lungs for Living Research Centre, UCL Respiratory, University College London, London WC1E 6JF, UK
| | - Sandra Gómez-López
- Lungs for Living Research Centre, UCL Respiratory, University College London, London WC1E 6JF, UK
| | - Kyren A. Lazarus
- Lungs for Living Research Centre, UCL Respiratory, University College London, London WC1E 6JF, UK
| | - Jessica C. Orr
- Lungs for Living Research Centre, UCL Respiratory, University College London, London WC1E 6JF, UK
| | - David R. Pearce
- University College London Cancer Institute, University College London, London WC1E 6DD, UK
| | - Sarah E. Clarke
- Lungs for Living Research Centre, UCL Respiratory, University College London, London WC1E 6JF, UK
| | - Dani Do Hyang Lee
- Infection, Immunity and Inflammation Department, UCL Great Ormond Street Institute of Child Health, University College London, London WC1E 1EH, UK
| | - Maximillian N.J. Woodall
- Infection, Immunity and Inflammation Department, UCL Great Ormond Street Institute of Child Health, University College London, London WC1E 1EH, UK
| | - Tereza Masonou
- Infection, Immunity and Inflammation Department, UCL Great Ormond Street Institute of Child Health, University College London, London WC1E 1EH, UK
| | - Katie-Marie Case
- Infection, Immunity and Inflammation Department, UCL Great Ormond Street Institute of Child Health, University College London, London WC1E 1EH, UK
| | - Vitor H. Teixeira
- Lungs for Living Research Centre, UCL Respiratory, University College London, London WC1E 6JF, UK
| | | | | | - Chadwan Al Yaghchi
- The National Centre for Airway Reconstruction, Department of Otolaryngology, Charing Cross Hospital, London W6 8RF, UK
| | - Gurpreet S. Sandhu
- The National Centre for Airway Reconstruction, Department of Otolaryngology, Charing Cross Hospital, London W6 8RF, UK
| | - Martin A. Birchall
- University College London Ear Institute, University College London, London WC1X 8EE, UK
| | - Christopher O’Callaghan
- Infection, Immunity and Inflammation Department, UCL Great Ormond Street Institute of Child Health, University College London, London WC1E 1EH, UK
| | - Claire M. Smith
- Infection, Immunity and Inflammation Department, UCL Great Ormond Street Institute of Child Health, University College London, London WC1E 1EH, UK
| | - Paolo De Coppi
- Stem Cell and Regenerative Medicine Section, University College London Great Ormond Street Institute of Child Health, University College London, London WC1N 1DZ, UK
| | - Colin R. Butler
- Epithelial Cell Biology in ENT Research (EpiCENTR) Group, Developmental Biology and Cancer Department, UCL Great Ormond Street Institute of Child Health, University College London, London WC1N 1DZ, UK
- Tracheal Service, Great Ormond Street Hospital, London WC1N 3JH, UK
| | - Sam M. Janes
- Lungs for Living Research Centre, UCL Respiratory, University College London, London WC1E 6JF, UK
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2
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Birchall MA, Lam CM, Wood G. Throat and voice problems in Ehlers-Danlos syndromes and hypermobility spectrum disorders. Am J Med Genet C Semin Med Genet 2021; 187:527-532. [PMID: 34799986 DOI: 10.1002/ajmg.c.31956] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Accepted: 11/09/2021] [Indexed: 12/17/2022]
Abstract
A small number of case reports and observational studies describe chronic nasal congestion, upper airway obstruction, dysphonia, vocal cord abnormalities, and swallowing abnormalities in the Ehlers-Danlos syndromes. Little is known of the causes and therefore treatments of these, yet they are not uncommon findings in persons with hypermobility-related conditions presenting in the healthcare setting. We have a specialist multidisciplinary ear, nose, and throat and speech therapy practice with accumulating observational and empirical experience of managing these conditions, which include altered voice, choking, high dysphagia and anterior and deep neck pains. Here, we present our experience, some illustrative cases, and suggestions for future work in this evolving field.
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Affiliation(s)
- Martin A Birchall
- Department of Otolaryngology, Royal National ENT and Eastman Dental Hospitals, University College Hospitals NHS Foundation Trust and University College London, London, UK
| | - Chon Meng Lam
- Department of Otolaryngology, Royal National ENT and Eastman Dental Hospitals, University College Hospitals NHS Foundation Trust and University College London, London, UK.,University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Gary Wood
- Department of Otolaryngology, Royal National ENT and Eastman Dental Hospitals, University College Hospitals NHS Foundation Trust and University College London, London, UK
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3
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Tait A, Proctor T, Hamilton NJI, Birchall MA, Lowdell MW. GMP compliant isolation of mucosal epithelial cells and fibroblasts from biopsy samples for clinical tissue engineering. Sci Rep 2021; 11:12392. [PMID: 34117337 PMCID: PMC8196163 DOI: 10.1038/s41598-021-91939-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 02/15/2021] [Accepted: 06/01/2021] [Indexed: 12/11/2022] Open
Abstract
Engineered epithelial cell sheets for clinical replacement of non-functional upper aerodigestive tract mucosa are regulated as medicinal products and should be manufactured to the standards of good manufacturing practice (GMP). The current gold standard for growth of epithelial cells for research utilises growth arrested murine 3T3 J2 feeder layers, which are not available for use as a GMP compliant raw material. Using porcine mucosal tissue, we demonstrate a new method for obtaining and growing non-keratinised squamous epithelial cells and fibroblast cells from a single biopsy, replacing the 3T3 J2 with a growth arrested primary fibroblast feeder layer and using pooled Human Platelet lysate (HPL) as the media serum supplement to replace foetal bovine serum (FBS). The initial isolation of the cells was semi-automated using an Octodissociator and the resultant cell suspension cryopreservation for future use. When compared to the gold standard of 3T3 J2 and FBS containing medium there was no reduction in growth, viability, stem cell population or ability to differentiate to mature epithelial cells. Furthermore, this method was replicated with Human buccal tissue, providing cells of sufficient quality and number to create a tissue engineered sheet.
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Affiliation(s)
- Angela Tait
- Cancer Institute, Department of Haematology, University College London, London, UK.
| | - Toby Proctor
- Department of Biochemical Engineering, University College London, London, UK
| | | | | | - Mark W Lowdell
- Cancer Institute, Department of Haematology, University College London, London, UK
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4
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Mehrban N, Cardinale D, Gallo SC, Lee DDH, Arne Scott D, Dong H, Bowen J, Woolfson DN, Birchall MA, O'Callaghan C. α-Helical peptides on plasma-treated polymers promote ciliation of airway epithelial cells. Mater Sci Eng C Mater Biol Appl 2021; 122:111935. [PMID: 33641925 DOI: 10.1016/j.msec.2021.111935] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Revised: 01/11/2021] [Accepted: 01/30/2021] [Indexed: 11/30/2022]
Abstract
Airway respiratory epithelium forms a physical barrier through intercellular tight junctions, which prevents debris from passing through to the internal environment while ciliated epithelial cells expel particulate-trapping mucus up the airway. Polymeric solutions to loss of airway structure and integrity have been unable to fully restore functional epithelium. We hypothesised that plasma treatment of polymers would permit adsorption of α-helical peptides and that this would promote functional differentiation of airway epithelial cells. Five candidate plasma compositions are compared; Air, N2, H2, H2:N2 and Air:N2. X-ray photoelectron spectroscopy shows changes in at% N and C 1s peaks after plasma treatment while electron microscopy indicates successful adsorption of hydrogelating self-assembling fibres (hSAF) on all samples. Subsequently, adsorbed hSAFs support human nasal epithelial cell attachment and proliferation and induce differentiation at an air-liquid interface. Transepithelial measurements show that the cells form tight junctions and produce cilia beating at the normal expected frequency of 10-11 Hz after 28 days in culture. The synthetic peptide system described in this study offers potential superiority as an epithelial regeneration substrate over present "gold-standard" materials, such as collagen, as they are controllable and can be chemically functionalised to support a variety of in vivo environments. Using the hSAF peptides described here in combination with plasma-treated polymeric surfaces could offer a way of improving the functionality and integration of implantable polymers for aerodigestive tract reconstruction and regeneration.
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Affiliation(s)
- Nazia Mehrban
- UCL Ear Institute, University College London, 332 Grays Inn Rd, London WC1X 8EE, UK.
| | - Daniela Cardinale
- Infection, Immunity and Inflammation Department, UCL Great Ormond Street Institute of Child Health, University College London, 30 Guilford St, London WC1N 1EH, UK
| | - Santiago C Gallo
- Institute for Frontier Materials, Deakin University, 75 Pigdons Rd, Victoria, VIC 3216, Australia
| | - Dani D H Lee
- Infection, Immunity and Inflammation Department, UCL Great Ormond Street Institute of Child Health, University College London, 30 Guilford St, London WC1N 1EH, UK
| | - D Arne Scott
- School of Chemistry, University of Bristol, Cantock's Close, Bristol BS8 1TS, UK
| | - Hanshan Dong
- School of Metallurgy and Materials, University of Birmingham, Elms Rd, Birmingham B15 2SE, UK
| | - James Bowen
- School of Engineering & Innovation, The Open University, Walton Hall, Milton Keynes MK7 6AA, UK
| | - Derek N Woolfson
- School of Chemistry, University of Bristol, Cantock's Close, Bristol BS8 1TS, UK; School of Biochemistry, University of Bristol, University Walk, Bristol BS8 1TD, UK; Bristol BioDesign Institute, University of Bristol, 24 Tyndall Avenue, Bristol BS8 1TQ, UK
| | - Martin A Birchall
- UCL Ear Institute, University College London, 332 Grays Inn Rd, London WC1X 8EE, UK
| | - Christopher O'Callaghan
- Infection, Immunity and Inflammation Department, UCL Great Ormond Street Institute of Child Health, University College London, 30 Guilford St, London WC1N 1EH, UK
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5
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Mehrban N, Pineda Molina C, Quijano LM, Bowen J, Johnson SA, Bartolacci J, Chang JT, Scott DA, Woolfson DN, Birchall MA, Badylak SF. Host macrophage response to injectable hydrogels derived from ECM and α-helical peptides. Acta Biomater 2020; 111:141-152. [PMID: 32447065 DOI: 10.1016/j.actbio.2020.05.022] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Revised: 04/21/2020] [Accepted: 05/14/2020] [Indexed: 12/14/2022]
Abstract
Tissue engineering materials play a key role in how closely the complex architectural and functional characteristics of native healthy tissue can be replicated. Traditional natural and synthetic materials are superseded by bespoke materials that cross the boundary between these two categories. Here we present hydrogels that are derived from decellularised extracellular matrix and those that are synthesised from de novo α-helical peptides. We assess in vitro activation of murine macrophages to our hydrogels and whether these gels induce an M1-like or M2-like phenotype. This was followed by the in vivo immune macrophage response to hydrogels injected into rat partial-thickness abdominal wall defects. Over 28 days we observe an increase in mononuclear cell infiltration at the hydrogel-tissue interface without promoting a foreign body reaction and see no evidence of hydrogel encapsulation or formation of multinucleate giant cells. We also note an upregulation of myogenic differentiation markers and the expression of anti-inflammatory markers Arginase1, IL-10, and CD206, indicating pro-remodelling for all injected hydrogels. Furthermore, all hydrogels promote an anti-inflammatory environment after an initial spike in the pro-inflammatory phenotype. No difference between the injected site and the healthy tissue is observed after 28 days, indicating full integration. These materials offer great potential for future applications in regenerative medicine and towards unmet clinical needs. STATEMENT OF SIGNIFICANCE: Materials play a key role in how closely the complex architectural and functional characteristics of native healthy tissue can be replicated in tissue engineering. Here we present injectable hydrogels derived from decellularised extracellular matrix and de novo designed α-helical peptides. Over 28 days in the rat abdominal wall we observe an increase in mononuclear cell infiltration at the hydrogel-tissue interface with no foreign body reaction, no evidence of hydrogel encapsulation and no multinucleate giant cells. Our data indicate pro-remodelling and the promotion of an anti-inflammatory environment for all injected hydrogels with evidence of full integration with healthy tissue after 28 days. These unique materials offer great potential for future applications in regenerative medicine and towards designing materials for unmet clinical needs.
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Affiliation(s)
- Nazia Mehrban
- McGowan Institute for Regenerative Medicine, University of Pittsburgh, 450 Technology Drive, Suite 300, Pittsburgh, PA 15219-3110, USA; UCL Ear Institute, University College London, 332 Grays Inn Rd, London, WC1X 8EE, UK.
| | - Catalina Pineda Molina
- McGowan Institute for Regenerative Medicine, University of Pittsburgh, 450 Technology Drive, Suite 300, Pittsburgh, PA 15219-3110, USA; Department of Surgery, School of Medicine, University of Pittsburgh, University of Pittsburgh Medical Center Presbyterian Hospital, 200 Lothrop Street, Pittsburgh, PA 15213, USA
| | - Lina M Quijano
- McGowan Institute for Regenerative Medicine, University of Pittsburgh, 450 Technology Drive, Suite 300, Pittsburgh, PA 15219-3110, USA; Department of Surgery, School of Medicine, University of Pittsburgh, University of Pittsburgh Medical Center Presbyterian Hospital, 200 Lothrop Street, Pittsburgh, PA 15213, USA
| | - James Bowen
- School of Engineering & Innovation, The Open University, Walton Hall, Milton Keynes, MK7 6AA, UK
| | - Scott A Johnson
- McGowan Institute for Regenerative Medicine, University of Pittsburgh, 450 Technology Drive, Suite 300, Pittsburgh, PA 15219-3110, USA; Department of Surgery, School of Medicine, University of Pittsburgh, University of Pittsburgh Medical Center Presbyterian Hospital, 200 Lothrop Street, Pittsburgh, PA 15213, USA
| | - Joseph Bartolacci
- McGowan Institute for Regenerative Medicine, University of Pittsburgh, 450 Technology Drive, Suite 300, Pittsburgh, PA 15219-3110, USA; Department of Bioengineering, University of Pittsburgh, 3700 O'Hara Street, Pittsburgh, PA, 15261, USA
| | - Jordan T Chang
- McGowan Institute for Regenerative Medicine, University of Pittsburgh, 450 Technology Drive, Suite 300, Pittsburgh, PA 15219-3110, USA
| | - David A Scott
- School of Chemistry, University of Bristol, Cantock's Close, Bristol, BS8 1TS, UK
| | - Derek N Woolfson
- School of Chemistry, University of Bristol, Cantock's Close, Bristol, BS8 1TS, UK; School of Biochemistry, University of Bristol, University Walk, Bristol, BS8 1TD, UK; Bristol BioDesign Institute, University of Bristol, 24 Tyndall Avenue, Bristol, BS8 1TQ, UK
| | - Martin A Birchall
- UCL Ear Institute, University College London, 332 Grays Inn Rd, London, WC1X 8EE, UK
| | - Stephen F Badylak
- McGowan Institute for Regenerative Medicine, University of Pittsburgh, 450 Technology Drive, Suite 300, Pittsburgh, PA 15219-3110, USA; Department of Surgery, School of Medicine, University of Pittsburgh, University of Pittsburgh Medical Center Presbyterian Hospital, 200 Lothrop Street, Pittsburgh, PA 15213, USA; Department of Bioengineering, University of Pittsburgh, 3700 O'Hara Street, Pittsburgh, PA, 15261, USA
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6
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Hamilton NJI, Lee DDH, Gowers KHC, Butler CR, Maughan EF, Jevans B, Orr JC, McCann CJ, Burns AJ, MacNeil S, Birchall MA, O'Callaghan C, Hynds RE, Janes SM. Bioengineered airway epithelial grafts with mucociliary function based on collagen IV- and laminin-containing extracellular matrix scaffolds. Eur Respir J 2020; 55:1901200. [PMID: 32444408 PMCID: PMC7301290 DOI: 10.1183/13993003.01200-2019] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Accepted: 02/26/2020] [Indexed: 12/15/2022]
Abstract
Current methods to replace damaged upper airway epithelium with exogenous cells are limited. Existing strategies use grafts that lack mucociliary function, leading to infection and the retention of secretions and keratin debris. Strategies that regenerate airway epithelium with mucociliary function are clearly desirable and would enable new treatments for complex airway disease.Here, we investigated the influence of the extracellular matrix (ECM) on airway epithelial cell adherence, proliferation and mucociliary function in the context of bioengineered mucosal grafts. In vitro, primary human bronchial epithelial cells (HBECs) adhered most readily to collagen IV. Biological, biomimetic and synthetic scaffolds were compared in terms of their ECM protein content and airway epithelial cell adherence.Collagen IV and laminin were preserved on the surface of decellularised dermis and epithelial cell attachment to decellularised dermis was greater than to the biomimetic or synthetic alternatives tested. Blocking epithelial integrin α2 led to decreased adherence to collagen IV and to decellularised dermis scaffolds. At air-liquid interface (ALI), bronchial epithelial cells cultured on decellularised dermis scaffolds formed a differentiated respiratory epithelium with mucociliary function. Using in vivo chick chorioallantoic membrane (CAM), rabbit airway and immunocompromised mouse models, we showed short-term preservation of the cell layer following transplantation.Our results demonstrate the feasibility of generating HBEC grafts on clinically applicable decellularised dermis scaffolds and identify matrix proteins and integrins important for this process. The long-term survivability of pre-differentiated epithelia and the relative merits of this approach against transplanting basal cells should be assessed further in pre-clinical airway transplantation models.
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Affiliation(s)
- Nick J I Hamilton
- Lungs for Living Research Centre, UCL Respiratory, University College London, London, UK
- UCL Ear Institute, The Royal National Throat Nose and Ear Hospital, London, UK
- Nick J.I. Hamilton and Sam M. Janes are joint-senior authors
| | - Dani Do Hyang Lee
- Respiratory, Critical Care and Anaesthesia, UCL Great Ormond Street Institute of Child Health, London, UK
| | - Kate H C Gowers
- Lungs for Living Research Centre, UCL Respiratory, University College London, London, UK
| | - Colin R Butler
- Lungs for Living Research Centre, UCL Respiratory, University College London, London, UK
| | - Elizabeth F Maughan
- Lungs for Living Research Centre, UCL Respiratory, University College London, London, UK
| | - Benjamin Jevans
- Stem Cell and Regenerative Medicine, Birth Defects Research Centre, UCL Great Ormond Street Institute of Child Health, London, UK
| | - Jessica C Orr
- Lungs for Living Research Centre, UCL Respiratory, University College London, London, UK
| | - Conor J McCann
- Stem Cell and Regenerative Medicine, Birth Defects Research Centre, UCL Great Ormond Street Institute of Child Health, London, UK
| | - Alan J Burns
- Stem Cell and Regenerative Medicine, Birth Defects Research Centre, UCL Great Ormond Street Institute of Child Health, London, UK
| | - Sheila MacNeil
- Dept of Materials and Science Engineering, The Kroto Research Institute, North Campus, University of Sheffield, Sheffield, UK
| | - Martin A Birchall
- UCL Ear Institute, The Royal National Throat Nose and Ear Hospital, London, UK
| | - Christopher O'Callaghan
- Respiratory, Critical Care and Anaesthesia, UCL Great Ormond Street Institute of Child Health, London, UK
| | - Robert E Hynds
- Lungs for Living Research Centre, UCL Respiratory, University College London, London, UK
| | - Sam M Janes
- Lungs for Living Research Centre, UCL Respiratory, University College London, London, UK
- Nick J.I. Hamilton and Sam M. Janes are joint-senior authors
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7
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Lechner M, Sutton L, Fishman JM, Kaylie DM, Moon RE, Masterson L, Klingmann C, Birchall MA, Lund VJ, Rubin JS. Otorhinolaryngology and Diving-Part 2: Otorhinolaryngological Fitness for Compressed Gas Scuba Diving: A Review. JAMA Otolaryngol Head Neck Surg 2019; 144:259-263. [PMID: 29450499 DOI: 10.1001/jamaoto.2017.2616] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance Self-contained underwater breathing apparatus (scuba) diving has become increasingly popular with millions of people diving each year. Otorhinolaryngologists are often consulted either by patients or diving physicians regarding fitness to dive, and at present, the guidelines do not provide comprehensive information regarding the evaluation of this patient cohort. The aim of this review is to provide a comprehensive overview of existing otorhinolaryngological guidelines for fitness to dive recreationally. Observations There is a paucity of guidelines for assessing otorhinolaryngological fitness to dive in the recreational diver. Comprehensive guidelines exist from US, European, and UK regulatory bodies regarding fitness for commercial diving; however, not all of these can be directly extrapolated to the recreational diver. There are also a variety of conditions that are not covered either by the existing fitness for recreational diving guidelines or the commercial regulatory bodies. Conclusions and Relevance With the paucity of recreational fitness to dive guidelines we must draw on information from the commercial diving regulatory bodies. We have provided our own recommendations on the conditions that are not covered by either of the above, to provide otorhinolaryngologists with the information they require to assess fitness for recreational diving.
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Affiliation(s)
- Matt Lechner
- Royal National Throat, Nose and Ear Hospital, University College London Hospitals NHS Trust, London, England
| | - Liam Sutton
- Royal National Throat, Nose and Ear Hospital, University College London Hospitals NHS Trust, London, England
| | - Jonathan M Fishman
- Royal National Throat, Nose and Ear Hospital, University College London Hospitals NHS Trust, London, England
| | - David M Kaylie
- Duke Skull Base Center, Duke University School of Medicine, Durham, North Carolina.,Departments of Anesthesiology and Medicine, and Center for Hyperbaric Medicine and Environmental Physiology, Duke University School of Medicine, Durham, North Carolina
| | - Richard E Moon
- Departments of Anesthesiology and Medicine, and Center for Hyperbaric Medicine and Environmental Physiology, Duke University School of Medicine, Durham, North Carolina
| | - Liam Masterson
- Department of Otolaryngology, Addenbrooke's Hospital, Cambridge, England
| | | | - Martin A Birchall
- Royal National Throat, Nose and Ear Hospital, University College London Hospitals NHS Trust, London, England
| | - Valerie J Lund
- Royal National Throat, Nose and Ear Hospital, University College London Hospitals NHS Trust, London, England
| | - John S Rubin
- Royal National Throat, Nose and Ear Hospital, University College London Hospitals NHS Trust, London, England.,City, University of London, London, England
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8
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Lechner M, Sutton L, Fishman JM, Kaylie DM, Moon RE, Masterson L, Klingmann C, Birchall MA, Lund VJ, Rubin JS. Otorhinolaryngology and Diving-Part 1: Otorhinolaryngological Hazards Related to Compressed Gas Scuba Diving: A Review. JAMA Otolaryngol Head Neck Surg 2019; 144:252-258. [PMID: 29450472 DOI: 10.1001/jamaoto.2017.2617] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance Scuba diving is becoming increasingly popular. However, scuba diving is associated with specific risks; 80% of adults and 85% of juvenile divers (aged 6-17 years) have been reputed to have an ear, nose, or throat complaint related to diving at some point during their diving career. Divers frequently seek advice from primary care physicians, diving physicians, and otorhinolaryngologists, not only in the acute setting, but also related to the long-term effects of diving. Observations The principles underpinning diving-related injuries that may present to the otorhinolaryngologist rely on gas volume and gas saturation laws, and the prevention of these injuries requires both that the diver is skilled and that their anatomy allows for pressure equalization between the various anatomical compartments. The overlapping symptoms of middle ear barotrauma, inner ear barotrauma, and inner ear decompression sickness can cause a diagnostic conundrum, and a thorough history of both the diver's symptoms and the dive itself are required to elucidate the diagnosis. Correct diagnosis and appropriate treatment result in a more timely return to safe diving. Conclusions and Relevance The aim of this review is to provide a comprehensive overview of otorhinolaryngological complications during diving. With the increasing popularity of diving and the frequency of ear, nose, or throat-related injuries, it could be expected that these injuries will become more common and this review provides a resource for otorhinolaryngologists to diagnose and treat these conditions.
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Affiliation(s)
- Matt Lechner
- Royal National Throat, Nose and Ear Hospital, University College London Hospitals NHS Trust, London, England
| | - Liam Sutton
- Royal National Throat, Nose and Ear Hospital, University College London Hospitals NHS Trust, London, England
| | - Jonathan M Fishman
- Royal National Throat, Nose and Ear Hospital, University College London Hospitals NHS Trust, London, England
| | - David M Kaylie
- Duke Skull Base Center, Duke University School of Medicine, Durham, North Carolina.,Departments of Anesthesiology and Medicine, and Center for Hyperbaric Medicine and Environmental Physiology, Duke University School of Medicine, Durham, North Carolina
| | - Richard E Moon
- Departments of Anesthesiology and Medicine, and Center for Hyperbaric Medicine and Environmental Physiology, Duke University School of Medicine, Durham, North Carolina
| | - Liam Masterson
- Department of Otolaryngology, Addenbrooke's Hospital, Cambridge, England
| | | | - Martin A Birchall
- Royal National Throat, Nose and Ear Hospital, University College London Hospitals NHS Trust, London, England
| | - Valerie J Lund
- Royal National Throat, Nose and Ear Hospital, University College London Hospitals NHS Trust, London, England
| | - John S Rubin
- Royal National Throat, Nose and Ear Hospital, University College London Hospitals NHS Trust, London, England.,City, University of London, London, England
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9
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Elliott MJ, Butler CR, Varanou-Jenkins A, Partington L, Carvalho C, Samuel E, Crowley C, Lange P, Hamilton NJ, Hynds RE, Ansari T, Sibbons P, Fierens A, McLaren C, Roebuck D, Wallis C, Muthialu N, Hewitt R, Crabbe D, Janes SM, De Coppi P, Lowdell MW, Birchall MA. Tracheal Replacement Therapy with a Stem Cell-Seeded Graft: Lessons from Compassionate Use Application of a GMP-Compliant Tissue-Engineered Medicine. Stem Cells Transl Med 2019; 6:1458-1464. [PMID: 28544662 PMCID: PMC5689750 DOI: 10.1002/sctm.16-0443] [Citation(s) in RCA: 58] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2016] [Accepted: 03/03/2017] [Indexed: 12/15/2022] Open
Abstract
Tracheal replacement for the treatment of end‐stage airway disease remains an elusive goal. The use of tissue‐engineered tracheae in compassionate use cases suggests that such an approach is a viable option. Here, a stem cell‐seeded, decellularized tissue‐engineered tracheal graft was used on a compassionate basis for a girl with critical tracheal stenosis after conventional reconstructive techniques failed. The graft represents the first cell‐seeded tracheal graft manufactured to full good manufacturing practice (GMP) standards. We report important preclinical and clinical data from the case, which ended in the death of the recipient. Early results were encouraging, but an acute event, hypothesized to be an intrathoracic bleed, caused sudden airway obstruction 3 weeks post‐transplantation, resulting in her death. We detail the clinical events and identify areas of priority to improve future grafts. In particular, we advocate the use of stents during the first few months post‐implantation. The negative outcome of this case highlights the inherent difficulties in clinical translation where preclinical in vivo models cannot replicate complex clinical scenarios that are encountered. The practical difficulties in delivering GMP grafts underscore the need to refine protocols for phase I clinical trials. Stem Cells Translational Medicine2017;6:1458–1464
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Affiliation(s)
- Martin J Elliott
- Tracheal Team, Great Ormond Street Children's Hospital, London, United Kingdom
| | - Colin R Butler
- Tracheal Team, Great Ormond Street Children's Hospital, London, United Kingdom.,Lungs for Living Research Centre, UCL Respiratory, University College London, United Kingdom
| | | | - Leanne Partington
- Centre for Cell, Gene & Tissue Therapeutics, Royal Free Hospital & UCL, London, United Kingdom
| | - Carla Carvalho
- Centre for Cell, Gene & Tissue Therapeutics, Royal Free Hospital & UCL, London, United Kingdom
| | - Edward Samuel
- Centre for Cell, Gene & Tissue Therapeutics, Royal Free Hospital & UCL, London, United Kingdom
| | - Claire Crowley
- Department of Paediatric Surgery, Great Ormond Street Children's Hospital and UCL Institute of Child Health, London, United Kingdom
| | - Peggy Lange
- Department of Surgical Research, Northwick Park Institute of Medical Research, Northwick Park Hospital, Harrow, United Kingdom
| | - Nicholas J Hamilton
- Lungs for Living Research Centre, UCL Respiratory, University College London, United Kingdom
| | - Robert E Hynds
- Lungs for Living Research Centre, UCL Respiratory, University College London, United Kingdom
| | - Tahera Ansari
- Department of Surgical Research, Northwick Park Institute of Medical Research, Northwick Park Hospital, Harrow, United Kingdom
| | - Paul Sibbons
- Department of Surgical Research, Northwick Park Institute of Medical Research, Northwick Park Hospital, Harrow, United Kingdom
| | - Anja Fierens
- Tracheal Team, Great Ormond Street Children's Hospital, London, United Kingdom
| | - Claire McLaren
- Department of Interventional Radiology, Great Ormond Street Children's Hospital and UCL Institute of Child Health, London, United Kingdom
| | - Derek Roebuck
- Department of Interventional Radiology, Great Ormond Street Children's Hospital and UCL Institute of Child Health, London, United Kingdom
| | - Colin Wallis
- Department of Respiratory Medicine, Great Ormond Street Children's Hospital and UCL Institute of Child Health, London, United Kingdom
| | - Nagarajan Muthialu
- Tracheal Team, Great Ormond Street Children's Hospital, London, United Kingdom
| | - Richard Hewitt
- Tracheal Team, Great Ormond Street Children's Hospital, London, United Kingdom
| | - David Crabbe
- Department of Paediatric Surgery, Leeds General Infirmary, Leeds, United Kingdom
| | - Sam M Janes
- Lungs for Living Research Centre, UCL Respiratory, University College London, United Kingdom
| | - Paolo De Coppi
- Department of Paediatric Surgery, Great Ormond Street Children's Hospital and UCL Institute of Child Health, London, United Kingdom
| | - Mark W Lowdell
- Centre for Cell, Gene & Tissue Therapeutics, Royal Free Hospital & UCL, London, United Kingdom
| | - Martin A Birchall
- UCL Ear Institute and The Royal National Throat Nose and Ear Hospital, London, United Kingdom
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10
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Abstract
Vocal fold nodules present the voice clinic team with a number of clinical dilemmas which are not as simple as previously thought. The definition, aetiology, prevalence and diagnosis are all poorly understood. Furthermore, treatment evidence for both behavioural and surgical approaches is weak. This paper reviews the published evidence pertaining to all of these aspects. Specific areas of uncertainty that remain include poorly defined nomenclature, the natural history of paediatric vocal nodules, the establishment of criteria to measure successful treatment, optimal configuration of speech therapy regimens and the rationale for surgical intervention. The authors suggest the development of evidence-based guidelines for UK practice.
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Affiliation(s)
- Martin A Birchall
- Royal National Throat Nose and Ear Hospital, University College London, London, UK
| | - Paul Carding
- Oxford Institute of Nursing, Midwifery and Allied Health Research, Oxford, UK
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11
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Ogunlade O, Ho JO, Kalber TL, Hynds RE, Zhang E, Janes SM, Birchall MA, Butler CR, Beard P. Monitoring neovascularization and integration of decellularized human scaffolds using photoacoustic imaging. Photoacoustics 2019; 13:76-84. [PMID: 30805295 PMCID: PMC6374504 DOI: 10.1016/j.pacs.2019.01.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Revised: 12/21/2018] [Accepted: 01/04/2019] [Indexed: 05/22/2023]
Abstract
Tissue engineering is a branch of regenerative medicine that aims to manipulate cells and scaffolds to create bioartificial tissues and organs for patients. A major challenge lies in monitoring the blood supply to the new tissue following transplantation: the integration and neovascularization of scaffolds in vivo is critical to their functionality. Photoacoustic imaging (PAI) is a laser-generated ultrasound-based technique that is particularly well suited to visualising microvasculature due to the high optical absorption of haemoglobin. Here, we describe an early proof-of-concept study in which PAI in widefield tomography mode is used to image biological, decellularized human tracheal scaffolds. We found that PAI allowed the longitudinal tracking of scaffold integration into subcutaneous murine tissue with high spatial resolution at depth over an extended period of time. The results of the study were consistent with post-imaging histological analyses, demonstrating that PAI can be used to non-invasively monitor the extent of vascularization in biological tissue-engineered scaffolds. We propose that this technique may be a valuable tool for studies designed to test interventions aimed at improving the speed and extent of scaffold neovascularization in tissue engineering. With technological refinement, it could also permit in vivo monitoring of revascularization in patients, for example to determine timing of heterotopic graft transfer.
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Affiliation(s)
- Olumide Ogunlade
- Department of Medical Physics & Biomedical Engineering, University College London, London, UK
| | | | - Tammy L. Kalber
- UCL Centre for Advanced Biomedical Imaging, Division of Medicine, University College London, UK
| | - Robert E. Hynds
- Lungs for Living Research Centre, UCL Respiratory, University College London, London, UK
| | - Edward Zhang
- Department of Medical Physics & Biomedical Engineering, University College London, London, UK
| | - Sam M. Janes
- Lungs for Living Research Centre, UCL Respiratory, University College London, London, UK
| | | | - Colin R. Butler
- Lungs for Living Research Centre, UCL Respiratory, University College London, London, UK
| | - Paul Beard
- Department of Medical Physics & Biomedical Engineering, University College London, London, UK
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12
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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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13
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Mehrban N, Bowen J, Tait A, Darbyshire A, Virasami AK, Lowdell MW, Birchall MA. Silsesquioxane polymer as a potential scaffold for laryngeal reconstruction. Mater Sci Eng C Mater Biol Appl 2018; 92:565-574. [PMID: 30184783 PMCID: PMC6134134 DOI: 10.1016/j.msec.2018.07.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/27/2017] [Revised: 06/13/2018] [Accepted: 07/01/2018] [Indexed: 02/01/2023]
Abstract
Cancer, disease and trauma to the larynx and their treatment can lead to permanent loss of structures critical to voice, breathing and swallowing. Engineered partial or total laryngeal replacements would need to match the ambitious specifications of replicating functionality, outer biocompatibility, and permissiveness for an inner mucosal lining. Here we present porous polyhedral oligomeric silsesquioxane-poly(carbonate urea) urethane (POSS-PCUU) as a potential scaffold for engineering laryngeal tissue. Specifically, we employ a precipitation and porogen leaching technique for manufacturing the polymer. The polymer is chemically consistent across all sample types and produces a foam-like scaffold with two distinct topographies and an internal structure composed of nano- and micro-pores. While the highly porous internal structure of the scaffold contributes to the complex tensile behaviour of the polymer, the surface of the scaffold remains largely non-porous. The low number of pores minimise access for cells, although primary fibroblasts and epithelial cells do attach and proliferate on the polymer surface. Our data show that with a change in manufacturing protocol to produce porous polymer surfaces, POSS-PCUU may be a potential candidate for overcoming some of the limitations associated with laryngeal reconstruction and regeneration.
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Affiliation(s)
- Nazia Mehrban
- Division of Surgery, University College London, London, WC1E 6BT, United Kingdom.
| | - James Bowen
- School of Engineering and Innovation, The Open University, Milton Keynes, MK7 6AA, United Kingdom
| | - Angela Tait
- Department of Biochemical Engineering, University College London, London, WC1E 6BT, United Kingdom
| | - Arnold Darbyshire
- Division of Surgery, University College London, London, WC1E 6BT, United Kingdom
| | - Alex K Virasami
- Department of Histopathology, University College London, London, WC1N 3JH, United Kingdom
| | - Mark W Lowdell
- Department of Haematology, University College London, London, NW3 2QG, United Kingdom
| | - Martin A Birchall
- UCL Ear Institute, University College London, London, WC1X 8DA, United Kingdom
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14
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Birchall MA, O'Connell F, Henderson J, Moorat A, Jacques L, Pride NB, Fuller RW. Topical Salmeterol Reduces Protein Content of Nasal Lavage Fluid in Response to Allergen and Histamine Challenge: Double-Blind Cross-over Placebo-Controlled Studies in Adults. ACTA ACUST UNITED AC 2018. [DOI: 10.2500/105065896782103108] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
We have studied the effects of topical intranasal β-2-adrenoceptor agonists on nasal airflow resistance (Rnaw) and secretions. Pretreatment with salmeterol (SM) and salbutamol (SB) was given in two double-blind, placebo-controlled studies. In Protocol 1, 15 patients with allergic rhinitis were challenged with a threshold dose of allergen. Rnawand lavage fluid total protein, albumin, mucin, lysozyme, tryptase, histamine, and eosinophil cationic protein (ECP) were measured. In Protocol 2, 20 normal subjects were challenged with ascending doses of histamine and Rnawand lavage fluid total protein and albumin were measured. After allergen challenge, there was a significant, increase in Rnawtotal protein, albumin, and tryptase. SM significantly attenuated the rise in total protein (post-allergen challenge mean 218 mcg/mL, 95% c.i. 16–447; SB 344, 45–641; placebo 365, 105–725: P = 0.036). SM significantly reduced albumin concentration at 30 minutes post-drug (post-histamine challenge geometric mean 17.1 mcg/mL, interquartile range 8.2–29.4; SB 25.1, 15.2–43.0; placebo 24.2, 16.6–37.8: P = 0.027). SM has acute effects on the nasal response to allergen in allergic rhinitis and to histamine in normal subjects. These results imply an effect on glands and blood vessels in vivo that may represent part of the drug's clinical activity.
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Affiliation(s)
- Martin A. Birchall
- Departments of Clinical Pharmacology, Respiratory Division, Royal Postgraduate Medical School, Hammersmith Hospital, London
| | - Finbarr O'Connell
- Departments of Clinical Pharmacology, Respiratory Division, Royal Postgraduate Medical School, Hammersmith Hospital, London
| | - Jane Henderson
- Departments of Clinical Pharmacology, Respiratory Division, Royal Postgraduate Medical School, Hammersmith Hospital, London
| | - Alison Moorat
- Glaxo Research and Development Ltd., Greenford, Middlesex, United Kingdom
| | - Loretta Jacques
- Glaxo Research and Development Ltd., Greenford, Middlesex, United Kingdom
| | - Neil B. Pride
- Departments of Medicine, Respiratory Division, Royal Postgraduate Medical School, Hammersmith Hospital, London
| | - Rick W. Fuller
- Departments of Clinical Pharmacology, Respiratory Division, Royal Postgraduate Medical School, Hammersmith Hospital, London
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15
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Banus MS, Birchall MA, Graveston JA. Developing control algorithms of a voluntary cough for an artificial bioengineered larynx using surface electromyography of chest muscles: A prospective cohort study. Clin Otolaryngol 2018; 43:562-566. [PMID: 29069534 DOI: 10.1111/coa.13022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/19/2017] [Indexed: 11/27/2022]
Abstract
OBJECTIVE This prospective cohort study investigates the prediction of a voluntary cough using surface electromyography (EMG) of intercostal and diaphragm muscles, to develop control algorithms for an EMG-controlled artificial larynx. SETTING The Ear Institute, London. MAIN OUTCOME MEASURES Electromyography onset compared to voluntary cough exhalation onset and to 100 ms (to give the artificial larynx the time to close the bioengineered vocal cords) before voluntary cough exhalation onset, in twelve healthy participants. RESULTS In the 189 EMG of intercostal muscle-detected voluntary coughs, 172 coughs (91% CI 70-112) were detected before onset of cough exhalation and 128 coughs (67.6% CI 33.7-101.7) 100 ms before onset of cough exhalation. In the 158 EMG of diaphragm muscle-detected voluntary coughs, 149 coughs (94.3% CI 76.3-112.3) were detected before onset of cough exhalation and 102 coughs (64.6% CI 26.6-102.6) 100 ms before onset of cough exhalation. More coughs were detected before onset of cough exhalation when combining EMG activity of intercostal and diaphragm muscles and comparing this to intercostal muscle activity alone (183 coughs [96.8% CI 83.8-109.8] vs 172 coughs, P = .0294). When comparing the mentioned combination to diaphragm muscle activity alone, the higher percentage of detected coughs before cough exhalation onset was not found to be significant (183 coughs vs 149 coughs, P = .295). In addition, more coughs were detected 100 ms before onset of cough exhalation with the mentioned combination of EMG activity and comparing this to intercostal muscles alone (149 coughs [78.8% CI 48.8-108.8] vs 128 coughs, P = .0198) and to diaphragm muscles alone (149 coughs vs 102 coughs, P = .0038). CONCLUSIONS Most voluntary coughs can be predicted based on combined EMG signals of intercostal and diaphragm muscles, and therefore, these two muscle groups will be useful in controlling the bioengineered vocal cords within the artificial larynx during a voluntary cough.
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Affiliation(s)
- M S Banus
- Department of Otolaryngology, Head and Neck surgery, The Ear Institute, University College of London, London, UK
| | - M A Birchall
- Department of Otolaryngology, Head and Neck surgery, The Ear Institute, University College of London, London, UK
| | - J A Graveston
- Department of Otolaryngology, Head and Neck surgery, The Ear Institute, University College of London, London, UK
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16
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Herrmann P, Ansari T, Southgate A, Varanou Jenkins A, Partington L, Carvalho C, Janes S, Lowdell M, Sibbons PD, Birchall MA. In vivo implantation of a tissue engineered stem cell seeded hemi-laryngeal replacement maintains airway, phonation, and swallowing in pigs. J Tissue Eng Regen Med 2017; 13:1943-1954. [PMID: 29048769 DOI: 10.1002/term.2596] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [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: 03/09/2017] [Revised: 08/15/2017] [Accepted: 10/09/2017] [Indexed: 01/27/2023]
Abstract
Laryngeal functional impairment relating to swallowing, vocalisation, and respiration can be life changing and devastating for patients. A tissue engineering approach to regenerating vocal folds would represent a significant advantage over current clinical practice. Porcine hemi-larynx were de-cellularised under negative pressure. The resultant acellular scaffold was seeded with human bone marrow derived mesenchymal stem cells and primary human epithelial cells. Seeded scaffolds were implanted orthotopically into a defect created in the thyroid cartilage in 8 pigs and monitored in vivo for 2 months. In vivo assessments consisted of mucosal brushing and bronchoscopy at 1, 2, 4, and 8 weeks post implantation followed by histological evaluation post termination. The implanted graft had no adverse effect on respiratory function in 6 of the 8 pigs; none of the pigs had problems with swallowing or vocalisation. Six out of the 8 animals survived to the planned termination date; 2 animals were terminated due to mild stenosis and deep tissue abscess formation, respectively. Human epithelial cells from mucosal brushings could only be identified at Weeks 1 and 4. The explanted tissue showed complete epithelialisation of the mucosal surface and the development of rudimentary vocal folds. However, there was no evidence of cartilage remodelling at the relatively early censor point. Single stage partial laryngeal replacement is a safe surgical procedure. Replacement with a tissue engineered laryngeal graft as a single procedure is surgically feasible and results in appropriate mucosal coverage and rudimentary vocal fold development.
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Affiliation(s)
- P Herrmann
- NPIMR, Harrow, UK.,UCL Ear Institute, Royal National Throat Nose and Ear Hospital, London, UK
| | | | | | - A Varanou Jenkins
- Department Lungs for Living Research Centre, Division of Medicine, Rayne Building, University College London, London, UK
| | - L Partington
- Department of Haematology, University College London, London, UK
| | - C Carvalho
- Department of Haematology, University College London, London, UK
| | - S Janes
- Department Lungs for Living Research Centre, Division of Medicine, Rayne Building, University College London, London, UK
| | - M Lowdell
- Department of Haematology, University College London, London, UK
| | | | - M A Birchall
- UCL Ear Institute, Royal National Throat Nose and Ear Hospital, London, UK
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17
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Gowers KHC, Hynds RE, Thakrar RM, Carroll B, Birchall MA, Janes SM. Optimized isolation and expansion of human airway epithelial basal cells from endobronchial biopsy samples. J Tissue Eng Regen Med 2017; 12:e313-e317. [PMID: 28488809 PMCID: PMC5811901 DOI: 10.1002/term.2466] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2016] [Revised: 04/12/2017] [Accepted: 05/04/2017] [Indexed: 01/15/2023]
Abstract
Autologous airway epithelial cells have been used in clinical tissue‐engineered airway transplantation procedures with a view to assisting mucosal regeneration and restoring mucociliary escalator function. However, limited time is available for epithelial cell expansion due to the urgent nature of these interventions and slow epithelial regeneration has been observed in patients. Human airway epithelial cells can be expanded from small biopsies or brushings taken during bronchoscopy procedures, but the optimal mode of tissue acquisition from patients has not been investigated. Here, we compared endobronchial brushing and endobronchial biopsy samples in terms of their cell number and their ability to initiate basal epithelial stem cell cultures. We found that direct co‐culture of samples with 3T3‐J2 feeder cells in culture medium containing a Rho‐associated protein kinase inhibitor, Y‐27632, led to the selective expansion of greater numbers of basal epithelial stem cells during the critical early stages of culture than traditional techniques. Additionally, we established the benefit of initiating cell cultures from cell suspensions, either using brushing samples or through enzymatic digestion of biopsies, over explant culture. Primary epithelial cell cultures were initiated from endobronchial biopsy samples that had been cryopreserved before the initiation of cell cultures, suggesting that cryopreservation could eliminate the requirement for close proximity between the clinical facility in which biopsy samples are taken and the specialist laboratory in which epithelial cells are cultured. Overall, our results suggest ways to expedite epithelial cell preparation in future airway cell therapy or bioengineered airway transplantation procedures.
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Affiliation(s)
- Kate H C Gowers
- Lungs for Living Research Centre, UCL Respiratory, University College London, London, UK
| | - Robert E Hynds
- Lungs for Living Research Centre, UCL Respiratory, University College London, London, UK
| | - Ricky M Thakrar
- Lungs for Living Research Centre, UCL Respiratory, University College London, London, UK.,Department of Thoracic Medicine, University College Hospital, London, UK
| | - Bernadette Carroll
- Lungs for Living Research Centre, UCL Respiratory, University College London, London, UK.,Department of Thoracic Medicine, University College Hospital, London, UK
| | - Martin A Birchall
- The Royal National Throat Nose and Ear Hospital, UCL Ear Institute, London, UK
| | - Sam M Janes
- Lungs for Living Research Centre, UCL Respiratory, University College London, London, UK.,Department of Thoracic Medicine, University College Hospital, London, UK
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18
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Hachani R, Birchall MA, Lowdell MW, Kasparis G, Tung LD, Manshian BB, Soenen SJ, Gsell W, Himmelreich U, Gharagouzloo CA, Sridhar S, Thanh NTK. Assessing cell-nanoparticle interactions by high content imaging of biocompatible iron oxide nanoparticles as potential contrast agents for magnetic resonance imaging. Sci Rep 2017; 7:7850. [PMID: 28798327 PMCID: PMC5552868 DOI: 10.1038/s41598-017-08092-w] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2017] [Accepted: 07/06/2017] [Indexed: 01/03/2023] Open
Abstract
Stem cell tracking in cellular therapy and regenerative medicine is an urgent need, superparamagnetic iron oxide nanoparticles (IONPs) could be used as contrast agents in magnetic resonance imaging (MRI) that allows visualization of the implanted cells ensuring they reach the desired sites in vivo. Herein, we report the study of the interaction of 3,4-dihydroxyhydrocinnamic acid (DHCA) functionalized IONPs that have desirable properties for T2 - weighted MRI, with bone marrow-derived primary human mesenchymal stem cells (hMSCs). Using the multiparametric high-content imaging method, we evaluate cell viability, formation of reactive oxygen species, mitochondrial health, as well as cell morphology and determine that the hMSCs are minimally affected after labelling with IONPs. Their cellular uptake is visualized by transmission electron microscopy (TEM) and Prussian Blue staining, and quantified using an iron specific colourimetric method. In vitro and in vivo studies demonstrate that these IONPs are biocompatible and can produce significant contrast enhancement in T2-weighted MRI. Iron oxide nanoparticles are detected in vivo as hypointense regions in the liver up to two weeks post injection using 9.4 T MRI. These DHCA functionalized IONPs are promising contrast agents for stem cell tracking by T2-weighted MRI as they are biocompatible and show no evidence of cytotoxic effects on hMSCs.
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Affiliation(s)
- Roxanne Hachani
- Biophysics Group, Department of Physics and Astronomy, University College London, Gower Street, London, WC1E 6BT, UK
- UCL Healthcare and Biomagnetics and Nanomaterials Laboratory, 21 Albemarle Street, London, W1S 4BS, UK
| | - Martin A Birchall
- University College London Ear Institute, 332 Gray's Inn Road, London, WC1X 8EE, UK
| | - Mark W Lowdell
- Department of Haematology, Royal Free Hospital, University College London, London, NW3 2QG, UK
| | - Georgios Kasparis
- Biophysics Group, Department of Physics and Astronomy, University College London, Gower Street, London, WC1E 6BT, UK
- UCL Healthcare and Biomagnetics and Nanomaterials Laboratory, 21 Albemarle Street, London, W1S 4BS, UK
| | - Le D Tung
- Biophysics Group, Department of Physics and Astronomy, University College London, Gower Street, London, WC1E 6BT, UK
- UCL Healthcare and Biomagnetics and Nanomaterials Laboratory, 21 Albemarle Street, London, W1S 4BS, UK
| | - Bella B Manshian
- MoSAIC/Biomedical MRI Unit, Department of Imaging and Pathology, University of Leuven, B3000, Leuven, Belgium
| | - Stefaan J Soenen
- MoSAIC/Biomedical MRI Unit, Department of Imaging and Pathology, University of Leuven, B3000, Leuven, Belgium
| | - Willy Gsell
- MoSAIC/Biomedical MRI Unit, Department of Imaging and Pathology, University of Leuven, B3000, Leuven, Belgium
| | - Uwe Himmelreich
- MoSAIC/Biomedical MRI Unit, Department of Imaging and Pathology, University of Leuven, B3000, Leuven, Belgium
| | - Codi A Gharagouzloo
- Gordon Centre for Medical Imaging, Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Nanomedicine Science and Technology Centre, Northeastern University, Boston, Massachusetts, USA
| | - Srinivas Sridhar
- Nanomedicine Science and Technology Centre, Northeastern University, Boston, Massachusetts, USA
- Department of Radiation Oncology, Harvard Medical School, Boston, Massachusetts, USA
| | - Nguyen T K Thanh
- Biophysics Group, Department of Physics and Astronomy, University College London, Gower Street, London, WC1E 6BT, UK.
- UCL Healthcare and Biomagnetics and Nanomaterials Laboratory, 21 Albemarle Street, London, W1S 4BS, UK.
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19
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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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20
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Butler CR, Hynds RE, Gowers KHC, Lee DDH, Brown JM, Crowley C, Teixeira VH, Smith CM, Urbani L, Hamilton NJ, Thakrar RM, Booth HL, Birchall MA, De Coppi P, Giangreco A, O'Callaghan C, Janes SM. Rapid Expansion of Human Epithelial Stem Cells Suitable for Airway Tissue Engineering. Am J Respir Crit Care Med 2017; 194:156-68. [PMID: 26840431 DOI: 10.1164/rccm.201507-1414oc] [Citation(s) in RCA: 141] [Impact Index Per Article: 20.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
RATIONALE Stem cell-based tracheal replacement represents an emerging therapeutic option for patients with otherwise untreatable airway diseases including long-segment congenital tracheal stenosis and upper airway tumors. Clinical experience demonstrates that restoration of mucociliary clearance in the lungs after transplantation of tissue-engineered grafts is critical, with preclinical studies showing that seeding scaffolds with autologous mucosa improves regeneration. High epithelial cell-seeding densities are required in regenerative medicine, and existing techniques are inadequate to achieve coverage of clinically suitable grafts. OBJECTIVES To define a scalable cell culture system to deliver airway epithelium to clinical grafts. METHODS Human respiratory epithelial cells derived from endobronchial biopsies were cultured using a combination of mitotically inactivated fibroblasts and Rho-associated protein kinase (ROCK) inhibition using Y-27632 (3T3+Y). Cells were analyzed by immunofluorescence, quantitative polymerase chain reaction, and flow cytometry to assess airway stem cell marker expression. Karyotyping and multiplex ligation-dependent probe amplification were performed to assess cell safety. Differentiation capacity was tested in three-dimensional tracheospheres, organotypic cultures, air-liquid interface cultures, and an in vivo tracheal xenograft model. Ciliary function was assessed in air-liquid interface cultures. MEASUREMENTS AND MAIN RESULTS 3T3-J2 feeder cells and ROCK inhibition allowed rapid expansion of airway basal cells. These cells were capable of multipotent differentiation in vitro, generating both ciliated and goblet cell lineages. Cilia were functional with normal beat frequency and pattern. Cultured cells repopulated tracheal scaffolds in a heterotopic transplantation xenograft model. CONCLUSIONS Our method generates large numbers of functional airway basal epithelial cells with the efficiency demanded by clinical transplantation, suggesting its suitability for use in tracheal reconstruction.
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Affiliation(s)
- Colin R Butler
- 1 Lungs for Living Research Centre, UCL Respiratory, University College London, London, United Kingdom
| | - Robert E Hynds
- 1 Lungs for Living Research Centre, UCL Respiratory, University College London, London, United Kingdom
| | - Kate H C Gowers
- 1 Lungs for Living Research Centre, UCL Respiratory, University College London, London, United Kingdom
| | - Dani Do Hyang Lee
- 2 Respiratory, Critical Care, and Anesthesia, Institute of Child Health, University College London, London, United Kingdom
| | - James M Brown
- 1 Lungs for Living Research Centre, UCL Respiratory, University College London, London, United Kingdom
| | - Claire Crowley
- 3 Stem Cell and Regenerative Medicine Section, Great Ormond Street Hospital and UCL Institute of Child Health, London, United Kingdom
| | - Vitor H Teixeira
- 1 Lungs for Living Research Centre, UCL Respiratory, University College London, London, United Kingdom
| | - Claire M Smith
- 2 Respiratory, Critical Care, and Anesthesia, Institute of Child Health, University College London, London, United Kingdom
| | - Luca Urbani
- 3 Stem Cell and Regenerative Medicine Section, Great Ormond Street Hospital and UCL Institute of Child Health, London, United Kingdom
| | - Nicholas J Hamilton
- 1 Lungs for Living Research Centre, UCL Respiratory, University College London, London, United Kingdom
| | - Ricky M Thakrar
- 1 Lungs for Living Research Centre, UCL Respiratory, University College London, London, United Kingdom
| | - Helen L Booth
- 4 Department of Thoracic Medicine, University College London Hospitals, London, United Kingdom; and
| | - Martin A Birchall
- 5 UCL Ear Institute, Royal National Throat, Nose and Ear Hospital, London, United Kingdom
| | - Paolo De Coppi
- 3 Stem Cell and Regenerative Medicine Section, Great Ormond Street Hospital and UCL Institute of Child Health, London, United Kingdom
| | - Adam Giangreco
- 1 Lungs for Living Research Centre, UCL Respiratory, University College London, London, United Kingdom
| | - Christopher O'Callaghan
- 2 Respiratory, Critical Care, and Anesthesia, Institute of Child Health, University College London, London, United Kingdom
| | - Sam M Janes
- 1 Lungs for Living Research Centre, UCL Respiratory, University College London, London, United Kingdom.,4 Department of Thoracic Medicine, University College London Hospitals, London, United Kingdom; and
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21
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Elliott MJ, Butler CR, Varanou-Jenkins A, Partington L, Carvalho C, Samuel E, Crowley C, Lange P, Hamilton NJ, Hynds RE, Ansari T, Sibbons P, Fierens A, McLaren C, Roebuck D, Wallis C, Muthialu N, Hewitt R, Crabbe D, Janes SM, De Coppi P, Lowdell MW, Birchall MA. Tracheal Replacement Therapy with a Stem Cell-Seeded Graft: Lessons from Compassionate Use Application of a GMP-Compliant Tissue-Engineered Medicine. Stem Cells Transl Med 2017. [PMID: 28544662 DOI: 10.1002/sctm.16-0443.] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Tracheal replacement for the treatment of end-stage airway disease remains an elusive goal. The use of tissue-engineered tracheae in compassionate use cases suggests that such an approach is a viable option. Here, a stem cell-seeded, decellularized tissue-engineered tracheal graft was used on a compassionate basis for a girl with critical tracheal stenosis after conventional reconstructive techniques failed. The graft represents the first cell-seeded tracheal graft manufactured to full good manufacturing practice (GMP) standards. We report important preclinical and clinical data from the case, which ended in the death of the recipient. Early results were encouraging, but an acute event, hypothesized to be an intrathoracic bleed, caused sudden airway obstruction 3 weeks post-transplantation, resulting in her death. We detail the clinical events and identify areas of priority to improve future grafts. In particular, we advocate the use of stents during the first few months post-implantation. The negative outcome of this case highlights the inherent difficulties in clinical translation where preclinical in vivo models cannot replicate complex clinical scenarios that are encountered. The practical difficulties in delivering GMP grafts underscore the need to refine protocols for phase I clinical trials. Stem Cells Translational Medicine 2017;6:1458-1464.
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Affiliation(s)
- Martin J Elliott
- Tracheal Team, Great Ormond Street Children's Hospital, London, United Kingdom
| | - Colin R Butler
- Tracheal Team, Great Ormond Street Children's Hospital, London, United Kingdom.,Lungs for Living Research Centre, UCL Respiratory, University College London, United Kingdom
| | | | - Leanne Partington
- Centre for Cell, Gene & Tissue Therapeutics, Royal Free Hospital & UCL, London, United Kingdom
| | - Carla Carvalho
- Centre for Cell, Gene & Tissue Therapeutics, Royal Free Hospital & UCL, London, United Kingdom
| | - Edward Samuel
- Centre for Cell, Gene & Tissue Therapeutics, Royal Free Hospital & UCL, London, United Kingdom
| | - Claire Crowley
- Department of Paediatric Surgery, Great Ormond Street Children's Hospital and UCL Institute of Child Health, London, United Kingdom
| | - Peggy Lange
- Department of Surgical Research, Northwick Park Institute of Medical Research, Northwick Park Hospital, Harrow, United Kingdom
| | - Nicholas J Hamilton
- Lungs for Living Research Centre, UCL Respiratory, University College London, United Kingdom
| | - Robert E Hynds
- Lungs for Living Research Centre, UCL Respiratory, University College London, United Kingdom
| | - Tahera Ansari
- Department of Surgical Research, Northwick Park Institute of Medical Research, Northwick Park Hospital, Harrow, United Kingdom
| | - Paul Sibbons
- Department of Surgical Research, Northwick Park Institute of Medical Research, Northwick Park Hospital, Harrow, United Kingdom
| | - Anja Fierens
- Tracheal Team, Great Ormond Street Children's Hospital, London, United Kingdom
| | - Claire McLaren
- Department of Interventional Radiology, Great Ormond Street Children's Hospital and UCL Institute of Child Health, London, United Kingdom
| | - Derek Roebuck
- Department of Interventional Radiology, Great Ormond Street Children's Hospital and UCL Institute of Child Health, London, United Kingdom
| | - Colin Wallis
- Department of Respiratory Medicine, Great Ormond Street Children's Hospital and UCL Institute of Child Health, London, United Kingdom
| | - Nagarajan Muthialu
- Tracheal Team, Great Ormond Street Children's Hospital, London, United Kingdom
| | - Richard Hewitt
- Tracheal Team, Great Ormond Street Children's Hospital, London, United Kingdom
| | - David Crabbe
- Department of Paediatric Surgery, Leeds General Infirmary, Leeds, United Kingdom
| | - Sam M Janes
- Lungs for Living Research Centre, UCL Respiratory, University College London, United Kingdom
| | - Paolo De Coppi
- Department of Paediatric Surgery, Great Ormond Street Children's Hospital and UCL Institute of Child Health, London, United Kingdom
| | - Mark W Lowdell
- Centre for Cell, Gene & Tissue Therapeutics, Royal Free Hospital & UCL, London, United Kingdom
| | - Martin A Birchall
- UCL Ear Institute and The Royal National Throat Nose and Ear Hospital, London, United Kingdom
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22
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Abstract
Purpose of Review This article reviews the latest developments in tissue engineering for the larynx with a specific focus on the treatment of laryngeal cancer. Recent Findings Challenges in tissue engineering a total larynx can be divided into scaffold design, methods of re-mucosalization, and how to restore laryngeal function. The literature described a range of methods to deliver a laryngeal scaffold including examples of synthetic, biomimetic, and biological scaffolds. Methods to regenerate laryngeal mucosa can be divided into examples that use a biological dressing and those that engineer a new mucosal layer de novo. Studies aiming to restore laryngeal function have been reported, but to date, the optimum method for achieving this as part of a total laryngeal transplant is yet to be determined. Summary There is great potential for tissue engineering to improve the treatments available for laryngeal cancer within the next 10 years. A number of challenges exist however and advances in restoring function must keep pace with developments in scaffold design.
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23
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Krishnan G, Du C, Fishman JM, Foreman A, Lott DG, Farwell G, Belafsky P, Krishnan S, Birchall MA. The current status of human laryngeal transplantation in 2017: A state of the field review. Laryngoscope 2017; 127:1861-1868. [PMID: 28224630 DOI: 10.1002/lary.26503] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/28/2016] [Indexed: 01/31/2023]
Abstract
OBJECTIVES Human laryngeal allotransplantation has long been contemplated as a surgical option following laryngectomy, but there is a paucity of information regarding the indications, surgical procedure, and patient outcomes. Our objectives were to identify all human laryngeal allotransplants that have been undertaken and reported in the English literature and to evaluate the success of the procedure. DATA SOURCES MEDLINE, Embase, Current Index to Nursing and Allied Health Literature, Web of Science and Scopus, and the Gray literature. REVIEW METHODS A comprehensive search strategy was undertaken across multiple databases. Inclusion criteria were case reports of patients who had undergone human laryngeal allotransplantation. Information regarding indications, operative techniques, complications, graft viability, and functional outcomes were extracted. RESULTS A total of 5,961 articles, following removal of duplicates, matched the search criteria and were screened, with five case reports relating to two patients, ultimately fulfilling the entry criteria. CONCLUSIONS Two laryngeal transplants have been reported in the medical literature. Although both patients report improved quality of life relating to their ability to communicate with voice, further research is necessary to shape our understanding of this complicated operation, its indications, and its functional outcomes. Laryngoscope, 127:1861-1868, 2017.
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Affiliation(s)
- Giri Krishnan
- Department of Otolaryngology-Head and Neck Surgery, The Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Charles Du
- Department of Otolaryngology-Head and Neck Surgery, The Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Jonathan M Fishman
- Department of Otolaryngology-Head and Neck Surgery, UCL Ear Institute, University College London, London, United Kingdom
| | - Andrew Foreman
- Department of Otolaryngology-Head and Neck Surgery, The Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - David G Lott
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Phoenix, Arizona, U.S.A
| | - Gregory Farwell
- Department of Otolaryngology, Division of Head and Neck Surgery, University of California Davis, Sacramento, California, U.S.A
| | - Peter Belafsky
- Department of Otolaryngology, Division of Head and Neck Surgery, University of California Davis, Sacramento, California, U.S.A
| | - Suren Krishnan
- Department of Otolaryngology-Head and Neck Surgery, The Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Martin A Birchall
- Department of Otolaryngology-Head and Neck Surgery, UCL Ear Institute, University College London, London, United Kingdom
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24
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Butler CR, Hynds RE, Crowley C, Gowers KHC, Partington L, Hamilton NJ, Carvalho C, Platé M, Samuel ER, Burns AJ, Urbani L, Birchall MA, Lowdell MW, De Coppi P, Janes SM. Vacuum-assisted decellularization: an accelerated protocol to generate tissue-engineered human tracheal scaffolds. Biomaterials 2017; 124:95-105. [PMID: 28189871 PMCID: PMC5332556 DOI: 10.1016/j.biomaterials.2017.02.001] [Citation(s) in RCA: 57] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2016] [Revised: 01/30/2017] [Accepted: 02/01/2017] [Indexed: 12/22/2022]
Abstract
Patients with large tracheal lesions unsuitable for conventional endoscopic or open operations may require a tracheal replacement but there is no present consensus of how this may be achieved. Tissue engineering using decellularized or synthetic tracheal scaffolds offers a new avenue for airway reconstruction. Decellularized human donor tracheal scaffolds have been applied in compassionate-use clinical cases but naturally derived extracellular matrix (ECM) scaffolds demand lengthy preparation times. Here, we compare a clinically applied detergent-enzymatic method (DEM) with an accelerated vacuum-assisted decellularization (VAD) protocol. We examined the histological appearance, DNA content and extracellular matrix composition of human donor tracheae decellularized using these techniques. Further, we performed scanning electron microscopy (SEM) and biomechanical testing to analyze decellularization performance. To assess the biocompatibility of scaffolds generated using VAD, we seeded scaffolds with primary human airway epithelial cells in vitro and performed in vivo chick chorioallantoic membrane (CAM) and subcutaneous implantation assays. Both DEM and VAD protocols produced well-decellularized tracheal scaffolds with no adverse mechanical effects and scaffolds retained the capacity for in vitro and in vivo cellular integration. We conclude that the substantial reduction in time required to produce scaffolds using VAD compared to DEM (approximately 9 days vs. 3–8 weeks) does not compromise the quality of human tracheal scaffold generated. These findings might inform clinical decellularization techniques as VAD offers accelerated scaffold production and reduces the associated costs.
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Affiliation(s)
- Colin R Butler
- Lungs for Living Research Centre, UCL Respiratory, University College London, London, UK; Stem Cell and Regenerative Medicine Section, UCL Institute of Child Health and Great Ormond Street Hospital, London, UK
| | - Robert E Hynds
- Lungs for Living Research Centre, UCL Respiratory, University College London, London, UK
| | - Claire Crowley
- Stem Cell and Regenerative Medicine Section, UCL Institute of Child Health and Great Ormond Street Hospital, London, UK
| | - Kate H C Gowers
- Lungs for Living Research Centre, UCL Respiratory, University College London, London, UK
| | - Leanne Partington
- Department of Haematology, Royal Free Hospital and University College London, London, UK
| | - Nicholas J Hamilton
- Lungs for Living Research Centre, UCL Respiratory, University College London, London, UK
| | - Carla Carvalho
- Department of Haematology, Royal Free Hospital and University College London, London, UK
| | - Manuela Platé
- Lungs for Living Research Centre, UCL Respiratory, University College London, London, UK
| | - Edward R Samuel
- Stem Cell and Regenerative Medicine Section, UCL Institute of Child Health and Great Ormond Street Hospital, London, UK
| | - Alan J Burns
- Stem Cell and Regenerative Medicine Section, UCL Institute of Child Health and Great Ormond Street Hospital, London, UK; Department of Clinical Genetics, Erasmus MC, Rotterdam, Netherlands
| | - Luca Urbani
- Stem Cell and Regenerative Medicine Section, UCL Institute of Child Health and Great Ormond Street Hospital, London, UK
| | - Martin A Birchall
- UCL Ear Institute, The Royal National Throat Nose and Ear Hospital, London, UK
| | - Mark W Lowdell
- Department of Haematology, Royal Free Hospital and University College London, London, UK
| | - Paolo De Coppi
- Stem Cell and Regenerative Medicine Section, UCL Institute of Child Health and Great Ormond Street Hospital, London, UK.
| | - Sam M Janes
- Lungs for Living Research Centre, UCL Respiratory, University College London, London, UK.
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25
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El Aziz Y, Mehrban N, Taylor PG, Birchall MA, Bowen J, Bassindale AR, Pitak MB, Coles SJ. Facile synthesis of novel hybrid POSS biomolecules via “Click” reactions. RSC Adv 2017. [DOI: 10.1039/c7ra07915j] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
A novel alkyne-terminated cubic-octameric POSS was synthesised in high yield and click chemistry has been used to attach bio-oligomers.
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Affiliation(s)
- Youssef El Aziz
- The Open University
- Faculty of Science, Technology, Engineering & Mathematics
- Milton Keynes
- UK
| | - Nazia Mehrban
- University College London
- Ear Institute
- Brain Sciences
- London WC1X 8EE
- UK
| | - Peter G. Taylor
- The Open University
- Faculty of Science, Technology, Engineering & Mathematics
- Milton Keynes
- UK
| | | | - James Bowen
- The Open University
- Faculty of Science, Technology, Engineering & Mathematics
- Milton Keynes
- UK
| | - Alan R. Bassindale
- The Open University
- Faculty of Science, Technology, Engineering & Mathematics
- Milton Keynes
- UK
| | - Mateusz B. Pitak
- UK National Crystallography Service
- Chemistry
- University of Southampton
- Southampton
- UK
| | - Simon J. Coles
- UK National Crystallography Service
- Chemistry
- University of Southampton
- Southampton
- UK
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26
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Ansari T, Lange P, Southgate A, Greco K, Carvalho C, Partington L, Bullock A, MacNeil S, Lowdell MW, Sibbons PD, Birchall MA. Stem Cell-Based Tissue-Engineered Laryngeal Replacement. Stem Cells Transl Med 2016; 6:677-687. [PMID: 28191770 PMCID: PMC5442815 DOI: 10.5966/sctm.2016-0130] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [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: 03/14/2016] [Accepted: 07/28/2016] [Indexed: 11/16/2022] Open
Abstract
Patients with laryngeal disorders may have severe morbidity relating to swallowing, vocalization, and respiratory function, for which conventional therapies are suboptimal. A tissue‐engineered approach would aim to restore the vocal folds and maintain respiratory function while limiting the extent of scarring in the regenerated tissue. Under Good Laboratory Practice conditions, we decellularized porcine larynges, using detergents and enzymes under negative pressure to produce an acellular scaffold comprising cartilage, muscle, and mucosa. To assess safety and functionality before clinical trials, a decellularized hemilarynx seeded with human bone marrow‐derived mesenchymal stem cells and a tissue‐engineered oral mucosal sheet was implanted orthotopically into six pigs. The seeded grafts were left in situ for 6 months and assessed using computed tomography imaging, bronchoscopy, and mucosal brushings, together with vocal recording and histological analysis on explantation. The graft caused no adverse respiratory function, nor did it impact swallowing or vocalization. Rudimentary vocal folds covered by contiguous epithelium were easily identifiable. In conclusion, the proposed tissue‐engineered approach represents a viable alternative treatment for laryngeal defects. Stem Cells Translational Medicine2017;6:677–687
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Affiliation(s)
- Tahera Ansari
- Department of Surgical Research, Northwick Park Institute for Medical Research, Harrow, United Kingdom
| | - Peggy Lange
- Department of Surgical Research, Northwick Park Institute for Medical Research, Harrow, United Kingdom
- University College London Ear Institute, Royal National Throat Nose and Ear Hospital, London, United Kingdom
| | - Aaron Southgate
- Department of Surgical Research, Northwick Park Institute for Medical Research, Harrow, United Kingdom
| | - Karin Greco
- Department of Surgical Research, Northwick Park Institute for Medical Research, Harrow, United Kingdom
| | - Carla Carvalho
- Department of Haematology, University College London Medical School, London, United Kingdom
| | - Leanne Partington
- Department of Haematology, University College London Medical School, London, United Kingdom
| | - Anthony Bullock
- Department of Material Science and Engineering, University of Sheffield, Sheffield, United Kingdom
| | - Sheila MacNeil
- Department of Material Science and Engineering, University of Sheffield, Sheffield, United Kingdom
| | - Mark W. Lowdell
- Department of Haematology, University College London Medical School, London, United Kingdom
| | - Paul D. Sibbons
- Department of Surgical Research, Northwick Park Institute for Medical Research, Harrow, United Kingdom
| | - Martin A. Birchall
- University College London Ear Institute, Royal National Throat Nose and Ear Hospital, London, United Kingdom
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27
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Arulanandam S, Hakim AJ, Aziz Q, Sandhu G, Birchall MA. Laryngological presentations of Ehlers-Danlos syndrome: case series of nine patients from two London tertiary referral centres. Clin Otolaryngol 2016; 42:860-863. [PMID: 27434416 DOI: 10.1111/coa.12708] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/14/2016] [Indexed: 11/28/2022]
Affiliation(s)
- S Arulanandam
- Department of Otolaryngology, Singapore General Hospital, Singapore
| | - A J Hakim
- The Hospital of St John and St Elizabeth, London, UK
| | - Q Aziz
- Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - G Sandhu
- Charing Cross Hospital, London, UK
| | - M A Birchall
- Royal National Throat Nose and Ear Hospital, London, UK
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28
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Wiles K, Fishman JM, De Coppi P, Birchall MA. The Host Immune Response to Tissue-Engineered Organs: Current Problems and Future Directions. Tissue Engineering Part B: Reviews 2016; 22:208-19. [DOI: 10.1089/ten.teb.2015.0376] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Affiliation(s)
| | | | | | - Martin A. Birchall
- UCL Ear Institute & Royal National Throat, Nose and Ear Hospital, London, United Kingdom
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29
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Culme-Seymour EJ, Carvalho C, Bain O, Omakobia E, Wilson S, Knowles H, Tebbs S, Champion K, Round J, Ambler G, Birchall MA, Lowdell MW, Mason C. 452. RegenVOX - Translational Exploitation Strategy for Stem Cell-Based Tissue-Engineered Laryngeal Implants Undergoing Phase I/II Clinical Trial. Mol Ther 2016. [DOI: 10.1016/s1525-0016(16)33261-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Bogan SL, Teoh GZ, Birchall MA. Tissue Engineered Airways: A Prospects Article. J Cell Biochem 2016; 117:1497-505. [PMID: 26853803 DOI: 10.1002/jcb.25512] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2016] [Accepted: 02/05/2016] [Indexed: 11/11/2022]
Abstract
An ideal tracheal scaffold must withstand luminal collapse yet be flexible, have a sufficient degree of porosity to permit vascular and cellular ingrowth, but also be airtight and must facilitate growth of functional airway epithelium to avoid infection and aid in mucocilliary clearance. Finally, the scaffold must also be biocompatible to avoid implant rejection. Over the last 40 years, efforts to design and manufacture the airway have been undertaken worldwide but success has been limited and far apart. As a result, tracheal resection with primary repair remains the Gold Standard of care for patients presenting with airway disorders and malignancies. However, the maximum resectable length of the trachea is restricted to 30% of the total length in children or 50% in adults. Attempts to provide autologous grafts for human application have also been disappointing for a host of different reasons, including lack of implant integration, insufficient donor organs, and poor mechanical strength resulting in an unmet clinical need. The two main approaches researchers have taken to address this issue have been the development of synthetic scaffolds and the use of decellularized organs. To date, a number of different decellularization techniques and a variety of materials, including polyglycolic acid (PGA) and nanocomposite polymers have been explored. The findings thus far have shown great promise, however, there remain a significant number of caveats accompanying each approach. That being said, the possibilities presented by these two approaches could be combined to produce a highly successful, clinically viable hybrid scaffold. This article aims to highlight advances in airway tissue engineering and provide an overview of areas to explore and utilize in accomplishing the aim of developing an ideal tracheal prosthesis. J. Cell. Biochem. 117: 1497-1505, 2016. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Stephanie L Bogan
- University College London, Gower Street London WC1E 6BT, United Kingdom of Great Britain and Northern Ireland
| | - Gui Zhen Teoh
- University College London, Gower Street London WC1E 6BT, United Kingdom of Great Britain and Northern Ireland
| | - Martin A Birchall
- University College London, Gower Street London WC1E 6BT, United Kingdom of Great Britain and Northern Ireland.,Royal National Throat Nose and Ear Hospital, London WC1X 8DA, United Kingdom of Great Britain and Northern Ireland
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Hamilton NJ, Kanani M, Roebuck DJ, Hewitt RJ, Cetto R, McLaren CA, Butler CR, Crowley C, Janes SM, O'Callaghan C, Culme-Seymour EJ, Mason C, De Coppi P, Lowdell MW, Elliott MJ, Birchall MA. Reply to: "Recent Advances in Circumferential Tracheal Replacement and Transplantation". Am J Transplant 2016; 16:1336-7. [PMID: 26813777 DOI: 10.1111/ajt.13736] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Affiliation(s)
- N J Hamilton
- University College London Ear Institute, Royal National Throat Nose and Ear Hospital, London, UK
| | - M Kanani
- Department of Cardiothoracic Surgery, Great Ormond Street Hospital, London, UK
| | - D J Roebuck
- Department of Radiology, Great Ormond Street Hospital, London, UK
| | - R J Hewitt
- Department of Otorhinolaryngology, Great Ormond Street Hospital, London, UK
| | - R Cetto
- Department of Aeronautics, Imperial College London, London, UK
| | - C A McLaren
- Department of Radiology, Great Ormond Street Hospital, London, UK
| | - C R Butler
- Lungs for Living Research Centre, Rayne Institute, London, UK
| | - C Crowley
- University College London Centre for Nanotechnology and Regenerative Medicine, Royal Free Hospital, London, UK
| | - S M Janes
- Lungs for Living Research Centre, Rayne Institute, London, UK
| | - C O'Callaghan
- Department of Respiratory Medicine, Great Ormond Street Hospital, London, UK
| | | | - C Mason
- London Regenerative Medicine Network, London, UK
| | - P De Coppi
- Department of Surgery, Great Ormond Street Hospital, London, UK
| | - M W Lowdell
- Department of Haematology, Royal Free Hospital, University College London Paul O'Gorman Laboratory of Cellular Therapeutics, London, UK
| | - M J Elliott
- Department of Cardiothoracic Surgery, Great Ormond Street Hospital, London, UK
| | - M A Birchall
- University College London Ear Institute, Royal National Throat Nose and Ear Hospital, London, UK
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Fishman JM, Long J, Gugatschka M, De Coppi P, Hirano S, Hertegard S, Thibeault SL, Birchall MA. Stem cell approaches for vocal fold regeneration. Laryngoscope 2016; 126:1865-70. [PMID: 26774977 DOI: 10.1002/lary.25820] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 10/20/2015] [Accepted: 11/13/2015] [Indexed: 12/31/2022]
Abstract
OBJECTIVES/HYPOTHESIS Current interventions in the management of vocal fold (VF) dysfunction focus on conservative and surgical approaches. However, the complex structure and precise biomechanical properties of the human VF mean that these strategies have their limitations in clinical practice and in some cases offer inadequate levels of success. Regenerative medicine is an exciting development in this field and has the potential to further enhance VF recovery beyond conventional treatments. Our aim in this review is to discuss advances in the field of regenerative medicine; that is, advances in the process of replacing, engineering, or regenerating the VF through utilization of stem cells, with the intention of restoring normal VF structure and function. DATA SOURCES English literature (1946-2015) review. METHODS We conducted a systematic review of MEDLINE for cases and studies of VF tissue engineering utilizing stem cells. RESULTS The three main approaches by which regenerative medicine is currently applied to VF regeneration include cell therapy, scaffold development, and utilization of growth factors. CONCLUSION Exciting advances have been made in stem cell biology in recent years, including use of induced pluripotent stem cells. We expect such advances to be translated into the field in the forthcoming years. Laryngoscope, 126:1865-1870, 2016.
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Affiliation(s)
- Jonathan M Fishman
- UCL Institute of Child Health, London, United Kingdom.,UCL Ear Institute and Royal National Throat, Nose and Ear Hospital and, London, United Kingdom
| | - Jenny Long
- UCL Institute of Child Health, London, United Kingdom
| | - Markus Gugatschka
- Department of Phoniatrics, ENT University Hospital Graz, Medical University Graz, Graz, Austria
| | | | - Shigeru Hirano
- Department of Otolaryngology-Head and Neck Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Stellan Hertegard
- Department of Otorhinolaryngology, Karolinska Institutet Clintec, Karolinska University Hospital Huddinge, Stockholm, Sweden
| | - Susan L Thibeault
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of Wisconsin-Madison, Wisconsin Institutes for Medical Research, Madison, Wisconsin, U.S.A
| | - Martin A Birchall
- UCL Ear Institute and Royal National Throat, Nose and Ear Hospital and, London, United Kingdom
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Crowley C, Klanrit P, Butler CR, Varanou A, Platé M, Hynds RE, Chambers RC, Seifalian AM, Birchall MA, Janes SM. Surface modification of a POSS-nanocomposite material to enhance cellular integration of a synthetic bioscaffold. Biomaterials 2016; 83:283-93. [PMID: 26790147 PMCID: PMC4762251 DOI: 10.1016/j.biomaterials.2016.01.005] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2015] [Revised: 12/27/2015] [Accepted: 01/01/2016] [Indexed: 12/20/2022]
Abstract
Polyhedral oligomeric silsesquioxane poly(carbonate-urea) urethane (POSS-PCU) is a versatile nanocomposite biomaterial with growing applications as a bioscaffold for tissue engineering. Integration of synthetic implants with host tissue can be problematic but could be improved by topographical modifications. We describe optimization of POSS-PCU by dispersion of porogens (sodium bicarbonate (NaHCO3), sodium chloride (NaCl) and sucrose) onto the material surface, with the principle aim of increasing surface porosity, thus providing additional opportunities for improved cellular and vascular ingrowth. We assess the effect of the porogens on the material's mechanical strength, surface chemistry, wettability and cytocompatibilty. Surface porosity was characterized by scanning electron microscopy (SEM). There was no alteration in surface chemistry and wettability and only modest changes in mechanical properties were detected. The size of porogens correlated well with the porosity of the construct produced and larger porogens improved interconnectivity of spaces within constructs. Using primary human bronchial epithelial cells (HBECs) we demonstrate moderate in vitro cytocompatibility for all surface modifications; however, larger pores resulted in cellular aggregation. These cells were able to differentiate on POSS-PCU scaffolds. Implantation of the scaffold in vivo demonstrated that larger pore sizes favor cellular integration and vascular ingrowth. These experiments demonstrate that surface modification with large porogens can improve POSS-PCU nanocomposite scaffold integration and suggest the need to strike a balance between the non-porous surfaces required for epithelial coverage and the porous structure required for integration and vascularization of synthetic scaffolds in future construct design.
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Affiliation(s)
- Claire Crowley
- Lungs for Living Research Centre, UCL Respiratory, University College London, London, UK; UCL Centre of Nanotechnology and Regenerative Medicine, Division of Surgery and Interventional Science, Royal Free London NHS Foundation Trust Hospital and University College London, London, UK
| | - Poramate Klanrit
- UCL Centre of Nanotechnology and Regenerative Medicine, Division of Surgery and Interventional Science, Royal Free London NHS Foundation Trust Hospital and University College London, London, UK
| | - Colin R Butler
- Lungs for Living Research Centre, UCL Respiratory, University College London, London, UK
| | - Aikaterini Varanou
- Lungs for Living Research Centre, UCL Respiratory, University College London, London, UK
| | - Manuela Platé
- Lungs for Living Research Centre, UCL Respiratory, University College London, London, UK; Centre for Inflammation and Tissue Repair, UCL Respiratory, University College London, London, UK
| | - Robert E Hynds
- Lungs for Living Research Centre, UCL Respiratory, University College London, London, UK
| | - Rachel C Chambers
- Centre for Inflammation and Tissue Repair, UCL Respiratory, University College London, London, UK
| | - Alexander M Seifalian
- UCL Centre of Nanotechnology and Regenerative Medicine, Division of Surgery and Interventional Science, Royal Free London NHS Foundation Trust Hospital and University College London, London, UK
| | - Martin A Birchall
- UCL Ear Institute, Royal National Throat Nose and Ear Hospital and University College London, London, UK.
| | - Sam M Janes
- Lungs for Living Research Centre, UCL Respiratory, University College London, London, UK.
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Culme-Seymour EJ, Mason K, Vallejo-Torres L, Carvalho C, Partington L, Crowley C, Hamilton NJ, Toll EC, Butler CR, Elliott MJ, Birchall MA, Lowdell MW, Mason C. Cost of Stem Cell-Based Tissue-Engineered Airway Transplants in the United Kingdom: Case Series. Tissue Eng Part A 2015; 22:208-13. [PMID: 26559535 DOI: 10.1089/ten.tea.2015.0283] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Stem cell-based tissue-engineered tracheas are at an early stage in their product development cycle. Tens of patients have been treated worldwide in predominantly compassionate use settings, demonstrating significant promise. This potentially life-saving treatment is complex, and the cost and its implications for such treatments are yet to be fully understood. The costs are compounded by varying strategies for graft preparation and transplant, resulting in differing clinical and laboratory costs from different research groups. In this study, we present a detailed breakdown of the clinical and manufacturing costs for three of the United Kingdom (UK) patients treated with such transplants. All three patients were treated under Compassionate Use legislation, within the UK National Health Service (NHS) hospital setting. The total costs for the three UK patients treated ranged from $174,420 to $740,500. All three patients were in a state of poor health at time of treatment and had a number of complexities in addition to the restricted airway. This is the first time a cost analysis has been made for a tissue-engineered organ and provides a benchmark for future studies, as well as comparative data for use in reimbursement considerations.
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Affiliation(s)
| | - Katrina Mason
- 2 Centre for Cutaneous Research, Blizard Institute of Cell and Molecular Science , London, United Kingdom
| | | | - Carla Carvalho
- 4 Centre for Cell, Gene & Tissue Therapeutics, Royal Free Hospital , London, United Kingdom
| | - Leanne Partington
- 4 Centre for Cell, Gene & Tissue Therapeutics, Royal Free Hospital , London, United Kingdom
| | - Claire Crowley
- 5 Ear Institute, University College London , Royal National Throat Nose and Ear Hospital, London, United Kingdom
| | - Nick J Hamilton
- 5 Ear Institute, University College London , Royal National Throat Nose and Ear Hospital, London, United Kingdom
| | - Ed C Toll
- 6 Great Ormond Street Hospital , Cardiothoracic Surgery, and Tracheal Services, London, United Kingdom
| | - Colin R Butler
- 6 Great Ormond Street Hospital , Cardiothoracic Surgery, and Tracheal Services, London, United Kingdom
| | - Martin J Elliott
- 6 Great Ormond Street Hospital , Cardiothoracic Surgery, and Tracheal Services, London, United Kingdom
| | - Martin A Birchall
- 5 Ear Institute, University College London , Royal National Throat Nose and Ear Hospital, London, United Kingdom
| | - Mark W Lowdell
- 4 Centre for Cell, Gene & Tissue Therapeutics, Royal Free Hospital , London, United Kingdom
| | - Chris Mason
- 7 Advanced Centre for Biochemical Engineering, University College London , London, United Kingdom
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Hughes OR, Ayling SM, Birchall MA. Innate Immune Response of the Pig Laryngeal Mucosa to Endotracheal Intubation. Otolaryngol Head Neck Surg 2015; 154:138-43. [PMID: 26567047 DOI: 10.1177/0194599815617125] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2015] [Accepted: 10/23/2015] [Indexed: 12/17/2022]
Abstract
Objective The aim of this study was to measure the effects of endotracheal intubation on innate immune response within the pig laryngeal mucosa. Study Design Prospective controlled basic science study. Setting The animal experiments and analyses were conducted at the University of Bristol. Samples and Methods Eighteen pigs, matched at the major histocompatibility complex (MHC), were used in the study. The pigs were divided into 9 pairs. One of each pair (9 pigs in total) was intubated with an endotracheal tube under general anesthesia for 90 minutes. Two days later, pinch biopsies were taken from the supraglottis (specifically the false cords) and subglottis of both pigs. The experiment was repeated 8 more times. Based on quantitative immunohistochemistry, percentage areas of positive staining for CD172a, CD163, MHC class II, CD14, and CD16 were calculated separately for the epithelium and lamina propria of each biopsy. Results Total areas of laryngeal mucosa (epithelium and lamina propria) expressing CD172a and coexpressing CD163 and CD172a were significantly reduced at 2 days following endotracheal intubation ( P = .039 and P = .037, respectively). MHC class II expression and MHC class II coexpression with CD172a were similarly reduced following intubation ( P = .003 and P = .005, respectively). In the supraglottis, MHC class II coexpression with CD16 and CD14 was also reduced following endotracheal intubation ( P = .037). Conclusions Our results indicate that endotracheal intubation reduces the number of innate immune cells within the upper airway mucosa. This may be an important first step in a cascade leading to chronic wound and scar formation causing airway stenosis.
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Affiliation(s)
- Owain R. Hughes
- Molecular Immunology Unit, Institute of Child Health, University College London, London, UK
| | - Sarah M. Ayling
- Department of Geography and Environmental Management, University of the West of England, Bristol, UK
| | - Martin A. Birchall
- Department of Otorhinolaryngology–Head and Neck Surgery, Royal National Throat, Nose and Ear Hospital, and University College London, London, UK
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Mat Baki M, Wood G, Alston M, Ratcliffe P, Sandhu G, Rubin JS, Birchall MA. Reliability of OperaVOX against Multidimensional Voice Program (MDVP). Clin Otolaryngol 2015; 40:22-8. [PMID: 25263076 DOI: 10.1111/coa.12313] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/07/2014] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To evaluate the agreement between OperaVOX and MDVP. DESIGN Cross sectional reliability study. SETTING University teaching hospital. METHODS Fifty healthy volunteers and 50 voice disorder patients had supervised recordings in a quiet room using OperaVOX by the iPod's internal microphone with sampling rate of 45 kHz. A five-seconds recording of vowel/a/was used to measure fundamental frequency (F0), jitter, shimmer and noise-to-harmonic ratio (NHR). All healthy volunteers and 21 patients had a second recording. The recorded voices were also analysed using the MDVP. The inter- and intrasoftware reliability was analysed using intraclass correlation (ICC) test and Bland-Altman (BA) method. Mann-Whitney test was used to compare the acoustic parameters between healthy volunteers and patients. RESULTS Nine of 50 patients had severe aperiodic voice. The ICC was high with a confidence interval of >0.75 for the inter- and intrasoftware reliability except for the NHR. For the intersoftware BA analysis, excluding the severe aperiodic voice data sets, the bias (95% LOA) of F0, jitter, shimmer and NHR was 0.81 (11.32, -9.71); -0.13 (1.26, -1.52); -0.52 (1.68, -2.72); and 0.08 (0.27, -0.10). For the intrasoftware reliability, it was -1.48 (18.43, -21.39); 0.05 (1.31, -1.21); -0.01 (2.87, -2.89); and 0.005 (0.20, -0.18), respectively. Normative data from the healthy volunteers were obtained. There was a significant difference in all acoustic parameters between volunteers and patients measured by the Opera-VOX (P < 0.001) except for F0 in females (P = 0.87). CONCLUSION OperaVOX is comparable to MDVP and has high internal consistency for measuring the F0, jitter and shimmer of voice except for the NHR.
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Affiliation(s)
- M Mat Baki
- Ear Institute, University College London, London, UK; Royal National Throat Nose Ear Hospital, University College London Hospital NHS Trust, London, UK; Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
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Hughes OR, Baki MM, El-Sheemy A, Madoyan H, Rubin JS, Wood G, Alexander A, Forth O, Mochloulis G, Ghufoor K, Sandhu G, Birchall MA. 9. Is it possible to use acoustic analysis of a patient's voice, measured on a mobile device, to accurately exclude vocal cord paralysis after thyroid surgery? European Journal of Surgical Oncology (EJSO) 2015. [DOI: 10.1016/j.ejso.2015.08.085] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Hamilton NJ, Kanani M, Roebuck DJ, Hewitt RJ, Cetto R, Culme-Seymour EJ, Toll E, Bates AJ, Comerford AP, McLaren CA, Butler CR, Crowley C, McIntyre D, Sebire NJ, Janes SM, O'Callaghan C, Mason C, De Coppi P, Lowdell MW, Elliott MJ, Birchall MA. Tissue-Engineered Tracheal Replacement in a Child: A 4-Year Follow-Up Study. Am J Transplant 2015. [PMID: 26037782 DOI: 10.1111/ajt.13318.] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
In 2010, a tissue-engineered trachea was transplanted into a 10-year-old child using a decellularized deceased donor trachea repopulated with the recipient's respiratory epithelium and mesenchymal stromal cells. We report the child's clinical progress, tracheal epithelialization and costs over the 4 years. A chronology of events was derived from clinical notes and costs determined using reference costs per procedure. Serial tracheoscopy images, lung function tests and anti-HLA blood samples were compared. Epithelial morphology and T cell, Ki67 and cleaved caspase 3 activity were examined. Computational fluid dynamic simulations determined flow, velocity and airway pressure drops. After the first year following transplantation, the number of interventions fell and the child is currently clinically well and continues in education. Endoscopy demonstrated a complete mucosal lining at 15 months, despite retention of a stent. Histocytology indicates a differentiated respiratory layer and no abnormal immune activity. Computational fluid dynamic analysis demonstrated increased velocity and pressure drops around a distal tracheal narrowing. Cross-sectional area analysis showed restriction of growth within an area of in-stent stenosis. This report demonstrates the long-term viability of a decellularized tissue-engineered trachea within a child. Further research is needed to develop bioengineered pediatric tracheal replacements with lower morbidity, better biomechanics and lower costs.
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Affiliation(s)
- N J Hamilton
- University College London Ear Institute, Royal National Throat Nose and Ear Hospital, London, UK
| | - M Kanani
- Department of Cardiothoracic Surgery, Great Ormond Street Hospital, London, UK
| | - D J Roebuck
- Department of Radiology, Great Ormond Street Hospital, London, UK
| | - R J Hewitt
- Department of Otorhinolaryngology, Great Ormond Street Hospital, London, UK
| | - R Cetto
- Imperial College London, Department of Aeronautics, London, UK
| | | | - E Toll
- Department of Cardiothoracic Surgery, Great Ormond Street Hospital, London, UK
| | - A J Bates
- Imperial College London, Department of Aeronautics, London, UK
| | - A P Comerford
- Imperial College London, Department of Aeronautics, London, UK
| | - C A McLaren
- Department of Radiology, Great Ormond Street Hospital, London, UK
| | - C R Butler
- Lungs for Living Research Centre, Rayne Institute, London, UK
| | - C Crowley
- University College London Centre for Nanotechnology and Regenerative Medicine, Royal Free Hospital, London, UK
| | - D McIntyre
- Department of Cardiothoracic Surgery, Great Ormond Street Hospital, London, UK
| | - N J Sebire
- Department of Histopathology, Great Ormond Street Hospital, London, UK
| | - S M Janes
- Lungs for Living Research Centre, Rayne Institute, London, UK
| | - C O'Callaghan
- Department of Respiratory Medicine, Great Ormond Street Hospital, London, UK
| | - C Mason
- London Regenerative Medicine Network, London, UK
| | - P De Coppi
- Department of Surgery, Great Ormond Street Hospital, London, UK
| | - M W Lowdell
- Department of Haematology, Royal Free Hospital, University College London Paul O'Gorman Laboratory of Cellular Therapeutics, London, UK
| | - M J Elliott
- Department of Cardiothoracic Surgery, Great Ormond Street Hospital, London, UK
| | - M A Birchall
- University College London Ear Institute, Royal National Throat Nose and Ear Hospital, London, UK
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Culme-Seymour E, Mason K, Vallejo-Torres L, Carvalho C, Partington L, Crowley C, Hamilton N, Toll E, Butler C, Elliott MJ, Birchall MA, Mason C, Lowdell M. Cost of stem cell-based tissue-engineered airway transplants in the UK: Case series. Cytotherapy 2015. [DOI: 10.1016/j.jcyt.2015.03.332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Birchall MA, Schilder AG, Janes S, Ansari T, Tebbs S, Sheridan R, Ezra R, Round J, Seifalian A, Carvalho C, Sandhu G, Culme-Seymour E, Mason C, Lowdell M. RegenVOX: a Phase I/II clinical trial of stem cell-based tissue-engineered laryngeal implants. Cytotherapy 2015. [DOI: 10.1016/j.jcyt.2015.03.541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Mehrban N, Zhu B, Tamagnini F, Young FI, Wasmuth A, Hudson KL, Thomson AR, Birchall MA, Randall AD, Song B, Woolfson DN. Functionalized α-Helical Peptide Hydrogels for Neural Tissue Engineering. ACS Biomater Sci Eng 2015; 1:431-439. [PMID: 26240838 PMCID: PMC4517957 DOI: 10.1021/acsbiomaterials.5b00051] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2015] [Accepted: 04/28/2015] [Indexed: 12/31/2022]
Abstract
![]()
Trauma to the central and peripheral
nervous systems often lead
to serious morbidity. Current surgical methods for repairing or replacing
such damage have limitations. Tissue engineering offers a potential
alternative. Here we show that functionalized α-helical-peptide
hydrogels can be used to induce attachment, migration, proliferation
and differentiation of murine embryonic neural stem cells (NSCs).
Specifically, compared with undecorated gels, those functionalized
with Arg-Gly-Asp-Ser (RGDS) peptides increase the proliferative activity
of NSCs; promote their directional migration; induce differentiation,
with increased expression of microtubule-associated protein-2, and
a low expression of glial fibrillary acidic protein; and lead to the
formation of larger neurospheres. Electrophysiological measurements
from NSCs grown in RGDS-decorated gels indicate developmental progress
toward mature neuron-like behavior. Our data indicate that these functional
peptide hydrogels may go some way toward overcoming the limitations
of current approaches to nerve-tissue repair.
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Affiliation(s)
- Nazia Mehrban
- School of Chemistry, University of Bristol , Bristol BS8 1TS, United Kingdom
| | - Bangfu Zhu
- School of Dentistry, Cardiff University , Cardiff CF10 3XQ, United Kingdom
| | | | - Fraser I Young
- School of Dentistry, Cardiff University , Cardiff CF10 3XQ, United Kingdom
| | - Alexandra Wasmuth
- School of Chemistry, University of Bristol , Bristol BS8 1TS, United Kingdom
| | - Kieran L Hudson
- School of Chemistry, University of Bristol , Bristol BS8 1TS, United Kingdom
| | - Andrew R Thomson
- School of Chemistry, University of Bristol , Bristol BS8 1TS, United Kingdom
| | - Martin A Birchall
- University College London Ear Institute , London WC1X 8DA, United Kingdom
| | - Andrew D Randall
- Medical School, University of Exeter , Exeter EX4 4PS, United Kingdom
| | - Bing Song
- School of Dentistry, Cardiff University , Cardiff CF10 3XQ, United Kingdom
| | - Derek N Woolfson
- School of Chemistry, University of Bristol , Bristol BS8 1TS, United Kingdom ; School of Biochemistry, University of Bristol , Bristol BS8 1TD, United Kingdom ; BrisSynBio, University of Bristol , Bristol BS8 1TQ, United Kingdom
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de Mel A, Yap T, Cittadella G, Hale LR, Maghsoudlou P, de Coppi P, Birchall MA, Seifalian AM. A potential platform for developing 3D tubular scaffolds for paediatric organ development. J Mater Sci Mater Med 2015; 26:141. [PMID: 25737129 DOI: 10.1007/s10856-015-5477-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/20/2014] [Accepted: 01/20/2015] [Indexed: 06/04/2023]
Abstract
Children suffer from damaged or loss of hollow organs i.e. trachea, oesophagus or arteries from birth defects or diseases. Generally these organs possess an outer matrix consisting of collagen, elastin, and cells such as smooth muscle cells (SMC) and a luminal layer consisting of endothelial or epithelial cells, whilst presenting a barrier to luminal content. Tissue engineering research enables the construction of such organs and this study explores this possibility with a bioabsorbable nanocomposite biomaterial, polyhedral oligomeric silsesquioxane poly(ε-caprolactone) urea urethane (POSS-PCL).Our established methods of tubular graft extrusion were modified using a porogen-incorporated POSS-PCL and a new lamination method was explored. Porogen (40, 60 or 105 µm) were introduced to POSS-PCL, which were fabricated into a bilayered, dual topography matching the exterior and luminal interior of tubular organs. POSS-PCL with different amounts of porogen were tested for their suitability as a SMC layer by measuring optimal interactions with human adipose derived stem cells. Angiogenesis potential was tested with the chorioallantoic membrane assay. Tensile strength and burst pressures of bilayared tubular grafts were determined. Scaffolds made with 40 µm porogen demonstrated optimal adipose derived stem cell integration and the scaffolds were able to accommodate angiogenesis. Mechanical properties of the grafts confirmed their potential to match the relevant physiological and biophysical parameters. This study presents a platform for the development of hollow organs for transplantation based on POSS-PCL. These bilayered-tubular structures can be tailor-made for cellular integration and match physico-mechanical properties of physiological systems of interest. More specific luminal cell integration and sources of SMC for the external layer could be further explored.
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Affiliation(s)
- Achala de Mel
- UCL Division of Surgery & Interventional Science, Royal Free NHS Trust Hospital Campus, 9th Floor, Rm 355 Pond Street, London, NW3 2QG, UK,
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Lange P, Greco K, Partington L, Carvalho C, Oliani S, Birchall MA, Sibbons PD, Lowdell MW, Ansari T. Pilot study of a novel vacuum-assisted method for decellularization of tracheae for clinical tissue engineering applications. J Tissue Eng Regen Med 2015; 11:800-811. [PMID: 25689270 DOI: 10.1002/term.1979] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [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: 04/16/2014] [Revised: 10/07/2014] [Accepted: 11/07/2014] [Indexed: 12/18/2022]
Abstract
Tissue engineered tracheae have been successfully implanted to treat a small number of patients on compassionate grounds. The treatment has not become mainstream due to the time taken to produce the scaffold and the resultant financial costs. We have developed a method for decellularization (DC) based on vacuum technology, which when combined with an enzyme/detergent protocol significantly reduces the time required to create clinically suitable scaffolds. We have applied this technology to prepare porcine tracheal scaffolds and compared the results to scaffolds produced under normal atmospheric pressures. The principal outcome measures were the reduction in time (9 days to prepare the scaffold) followed by a reduction in residual DNA levels (DC no-vac: 137.8±48.82 ng/mg vs. DC vac 36.83±18.45 ng/mg, p<0.05.). Our approach did not impact on the collagen or glycosaminoglycan content or on the biomechanical properties of the scaffolds. We applied the vacuum technology to human tracheae, which, when implanted in vivo showed no significant adverse immunological response. The addition of a vacuum to a conventional decellularization protocol significantly reduces production time, whilst providing a suitable scaffold. This increases clinical utility and lowers production costs. To our knowledge this is the first time that vacuum assisted decellularization has been explored. Copyright © 2015 John Wiley & Sons, Ltd.
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Affiliation(s)
- P Lange
- Department of Surgical Research, NPIMR, Watford Rd, Harrow, UK.,Department of Haematology, UCL, Medical School, London, UK
| | - K Greco
- Department of Surgical Research, NPIMR, Watford Rd, Harrow, UK
| | - L Partington
- Department of Haematology, UCL, Medical School, London, UK
| | - C Carvalho
- Department of Haematology, UCL, Medical School, London, UK
| | - S Oliani
- Immunomorphology Laboratory, Department of Biology, IBILCE-UNESP, São José do Rio Preto, Brazil
| | - M A Birchall
- UCL Ear Institute, Royal National Throat Nose and Ear Hospital, London, UK
| | - P D Sibbons
- Department of Surgical Research, NPIMR, Watford Rd, Harrow, UK
| | - M W Lowdell
- Department of Haematology, UCL, Medical School, London, UK
| | - T Ansari
- Department of Surgical Research, NPIMR, Watford Rd, Harrow, UK
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Teoh GZ, Crowley C, Birchall MA, Seifalian AM. Development of resorbable nanocomposite tracheal and bronchial scaffolds for paediatric applications. Br J Surg 2015; 102:e140-50. [DOI: 10.1002/bjs.9700] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2014] [Revised: 09/12/2014] [Accepted: 10/10/2014] [Indexed: 11/07/2022]
Abstract
Abstract
Background
Congenital tracheal defects and prolonged intubation following premature birth have resulted in an unmet clinical need for tracheal replacement. Advances in stem cell technology, tissue engineering and material sciences have inspired the development of a resorbable, nanocomposite tracheal and bronchial scaffold.
Methods
A bifurcated scaffold was designed and constructed using a novel, resorbable nanocomposite polymer, polyhedral oligomeric silsesquioxane poly(ϵ-caprolactone) urea urethane (POSS-PCL). Material characterization studies included tensile strength, suture retention and surface characteristics. Bone marrow-derived mesenchymal stem cells (bmMSCs) and human tracheobronchial epithelial cells (HBECs) were cultured on POSS-PCL for up to 14 days, and metabolic activity and cell morphology were assessed. Quantum dots conjugated to RGD (l-arginine, glycine and l-aspartic acid) tripeptides and anticollagen type I antibody were then employed to observe cell migration throughout the scaffold.
Results
POSS-PCL exhibited good mechanical properties, and the relationship between the solid elastomer and foam elastomer of POSS-PCL was comparable to that between the cartilaginous U-shaped rings and interconnective cartilage of the native human trachea. Good suture retention was also achieved. Cell attachment and a significant, steady increase in proliferation were observed for both cell types (bmMSCs, P = 0·001; HBECs, P = 0·003). Quantum dot imaging illustrated adequate cell penetration throughout the scaffold, which was confirmed by scanning electron microscopy.
Conclusion
This mechanically viable scaffold successfully supports bmMSC and HBEC attachment and proliferation, demonstrating its potential as a tissue-engineered solution to tracheal replacement.
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Affiliation(s)
- G Z Teoh
- Division of Surgery and Interventional Science, London, UK
- University College London Centre for Nanotechnology and Regenerative Medicine, London, UK
| | - C Crowley
- Division of Surgery and Interventional Science, London, UK
- Institute of Child Health, London, UK
| | - M A Birchall
- Ear Institute, University College London, London, UK
- Department of Surgery, Royal National Throat, Nose and Ear Hospital, London, UK
| | - A M Seifalian
- Division of Surgery and Interventional Science, London, UK
- University College London Centre for Nanotechnology and Regenerative Medicine, London, UK
- Department of Surgery, Royal Free NHS Foundation Trust Hospital, London, UK
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Fishman JM, Wormald JCR, Lowdell MW, Coppi PDE, Birchall MA. Operating RegenMed: development of better in-theater strategies for handling tissue-engineered organs and tissues. Regen Med 2014; 9:785-91. [PMID: 25431914 DOI: 10.2217/rme.14.46] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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: 11/21/2022] Open
Abstract
Tissue engineering ex vivo and direct cellular application with bioscaffolds in vivo has allowed surgeons to restore and establish function throughout the human body. The evidence for regenerative surgery is growing, and consequently there is a need for the development of more advanced regenerative surgery facilities. Regenerative medicine in the surgical field is changing rapidly and this must be reflected in the design of any future operating suite. The theater environment needs to be highly adaptable to account for future significant advances within the field. Development of purpose built, combined operating suites and tissue-engineering laboratories will provide the facility for modern surgeons to treat patients with organ deficits, using bespoke, regenerated constructs without the need for immunosuppression.
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Mehrban N, Abelardo E, Wasmuth A, Hudson KL, Mullen LM, Thomson AR, Birchall MA, Woolfson DN. Assessing cellular response to functionalized α-helical peptide hydrogels. Adv Healthc Mater 2014; 3:1387-91. [PMID: 24659615 PMCID: PMC4276410 DOI: 10.1002/adhm.201400065] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [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: 01/31/2014] [Indexed: 01/18/2023]
Abstract
α-Helical peptide hydrogels are decorated with a cell-binding peptide motif (RGDS), which is shown to promote adhesion, proliferation, and differentiation of PC12 cells. Gel structure and integrity are maintained after functionalization. This opens possibilities for the bottom-up design and engineering of complex functional scaffolds for 2D and 3D cell cultures.
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Affiliation(s)
- Nazia Mehrban
- School of Chemistry, University of Bristol, Cantock's Close, Bristol, BS8 1TS, UK
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Abstract
INTRODUCTION Prosthetic materials, autologous tissues, cryopreserved homografts and allogeneic tissues have thus far proven unsuccessful in providing long-term functional solutions to extensive upper airway disease and damage. Research is therefore focusing on the rapidly expanding fields of regenerative medicine and tissue engineering in order to provide stem cell-based constructs for airway reconstruction, substitution and/or regeneration. AREAS COVERED Advances in stem cell technology, biomaterials and growth factor interactions have been instrumental in guiding optimization of tissue-engineered airways, leading to several first-in-man studies investigating stem cell-based tissue-engineered tracheal transplants in patients. Here, we summarize current progress, outstanding research questions, as well as future directions within the field. EXPERT OPINION The complex immune interaction between the transplant and host in vivo is only beginning to be untangled. Recent progress in our understanding of stem cell biology, decellularization techniques, biomaterials and transplantation immunobiology offers the prospect of transplanting airways without the need for lifelong immunosuppression. In addition, progress in airway revascularization, reinnervation and ever-increasingly sophisticated bioreactor design is opening up new avenues for the construction of a tissue-engineered larynx. Finally, 3D printing is a novel technique with the potential to render microscopic control over how cells are incorporated and grown onto the tissue-engineered airway.
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Affiliation(s)
- Jonathan M Fishman
- UCL Institute of Child Health, Department of Surgery , 30 Guilford Street, London WC1N 1EH , UK +44 07989 331573 ;
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Affiliation(s)
- Martin A Birchall
- UCL Ear Institute, Royal National Throat Nose and Ear Hospital, London WC1X 8DA, UK.
| | - Alexander M Seifalian
- Nanotechnology and Regenerative Medicine, Division of Surgery and Interventional Science, University College London, Royal Free London NHS Foundation Trust Hospital, London, UK
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Abstract
Tissue engineering requires the use of cells seeded onto scaffolds, often in conjunction with bioactive molecules, to regenerate or replace tissues. Significant advances have been made in recent years within the fields of stem cell biology and biomaterials, leading to some exciting developments in airway tissue engineering, including the first use of stem cell-based tissue-engineered tracheal replacements in humans. In addition, recent advances within the fields of scaffold biology and decellularization offer the potential to transplant patients without the use of immunosuppression.
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Affiliation(s)
- Jonathan M Fishman
- UCL Centre for Stem Cells, Tissue Engineering and Regenerative Medicine, London, UK; The Royal National Throat, Nose and Ear Hospital, London, UK; UCL Ear Institute, University College London, 332 Gray׳s Inn Road, London WC1X 8EE, UK
| | - Mark Lowdell
- Department of Haematology, Royal Free Hospital, UCL, London, UK
| | - Martin A Birchall
- UCL Centre for Stem Cells, Tissue Engineering and Regenerative Medicine, London, UK; The Royal National Throat, Nose and Ear Hospital, London, UK; UCL Ear Institute, University College London, 332 Gray׳s Inn Road, London WC1X 8EE, UK.
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Jetté ME, Gaumnitz EA, Birchall MA, Welham NV, Thibeault SL. Correlation between Reflux and multichannel intraluminal impedance pH monitoring in untreated volunteers. Laryngoscope 2014; 124:2345-51. [PMID: 24782404 DOI: 10.1002/lary.24737] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2014] [Revised: 04/14/2014] [Accepted: 04/22/2014] [Indexed: 12/12/2022]
Abstract
OBJECTIVES/HYPOTHESIS Although probable causative agents have been identified (e.g., refluxate components, tobacco smoke), the definitive mechanism for inflammation-related laryngeal mucosal damage remains elusive. Multichannel intraluminal impedance combined with pH monitoring (MII/pH) has emerged as a sensitive tool for diagnosis and characterization of gastroesophageal reflux disease with laryngopharyngeal manifestations. To determine the relationship between laryngeal signs and MII/pH, we examined correlations between Reflux Finding Score (RFS) ratings of videostroboscopic laryngeal examinations and findings from MII/pH. STUDY DESIGN Correlational study. METHODS Healthy, untreated volunteers (n = 142) underwent reflux diagnosis using data acquired from MII/pH testing. Eight trained clinicians performed RFS ratings of corresponding laryngeal examinations. Averaged RFS ratings were compared to MII/pH data using Pearson correlation coefficients. The relationship between RFS and MII/pH findings and demographic/clinical information (age, sex, smoking status, reflux) was assessed using general linear modeling. Rater reliability was evaluated. RESULTS Posterior commissure hypertrophy was negatively correlated with minutes of nonacid refluxate (R = -0.21, P = .0115). General linear modeling revealed that 28% to 40% of the variance in ratings of ventricular obliteration, erythema/hyperemia, vocal fold edema, diffuse laryngeal edema, posterior commissure hypertrophy, and granulation/granuloma could be explained by main and interaction effects of age, sex, smoking status, and reflux. Intra- and inter-rater reliability for RFS were poor-fair. CONCLUSIONS These results support the theory that the RFS is not specific for reflux in healthy, untreated volunteers, suggesting there may be alternate explanations for inflammatory clinical signs commonly ascribed to reflux in this population.
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Affiliation(s)
- Marie E Jetté
- Department of Surgery, Department of Communication Sciences and Disorders , University of Wisconsin-Madison, Madison, Wisconsin, U.S.A
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