Skin-derived epithelial lining facilitates orthotopic tracheal transplantation by protecting the tracheal cartilage and inhibiting granulation hyperplasia

Bioengineered tracheal graft with enhanced vascularization and mechanical stability for functional airway reconstruction

Tracheal reconstruction remains a formidable clinical challenge due to the complex structural, biomechanical, and physiological requirements of the airway. Traditional approaches, including autologous grafts, allografts, and synthetic prostheses, suffer from limitations such as donor site morbidity, immune rejection, and mechanical instability. Tissue-engineered tracheal grafts have emerged as a promising alternative, integrating advanced biomaterials, cellular therapies, and biofabrication techniques to create functional airway replacements. Synthetic polymers, such as polycaprolactone and polylactic acid, provide mechanical stability and tunable degradation properties, while extracellular matrix - derived biomaterials enhance biocompatibility and support cellular integration. Recent advances in stem cell biology, particularly the application of mesenchymal stem cells, induced pluripotent stem cells, and adipose-derived stem cells, have facilitated cartilage regeneration, epithelialization, and immune modulation within engineered constructs. However, achieving adequate vascularization remains a major bottleneck, necessitating the development of pre-vascularized scaffolds, growth factor delivery systems, and in vivo bioreactor strategies. Emerging technologies, including 3D bioprinting, electrospinning, and AI-driven scaffold design, are transforming the landscape of tracheal tissue engineering by enabling precise control over scaffold architecture, cellular distribution, and functional integration. Despite these advances, challenges such as mechanical failure, chronic inflammation, and regulatory hurdles must be addressed to ensure clinical translation. This review critically examines the latest advancements, persisting challenges, and future perspectives in artificial trachea engineering, providing a comprehensive roadmap for its development and clinical implementation.

Xanthohumol bulk-modified polyurethane for tracheal repair: A 'killing two birds with one stone' strategy for tailorable mechanics and durable anti-inflammatory efficacy

Restoring tracheal defects remains a significant challenge in tissue engineering and regenerative medicine. Current scaffolds fall short of achieving optimal tracheal repair due to unmatched mechanical properties and limited anti-inflammatory properties. In this study, we incorporated the natural plant-derived anti-inflammatory molecule Xanthohumol (XN) into the backbone of a degradable polyurethane (PEUU) to create a porous PEXUU scaffold with tailorable mechanical properties and sustained anti-inflammatory activity. Materials Studio software was initially employed to simulate the feasibility of synthesizing the PEXUU elastomer using XN as a chain extender and poly(ε-caprolactone) as the soft segment. Mechanical tests confirmed the synthesized PEXUU elastomer exhibited excellent elasticity and fatigue resistance that closely mimic the mechanical properties of the natural trachea. The PEXUU elastomers were then processed into porous scaffolds via thermally induced phase separation, exhibited high porosity and favorable hydrophilicity while providing durable XN release kinetic in a sustained manner during degradation. In vitro co-culture studies demonstrated that the scaffold not only exhibited favorable biocompatibility and supported cartilage regeneration but also effectively downregulated pro-inflammatory factor expression and promoted the polarization of M1 macrophages toward the M2 phenotype. Furthermore, in vivo experiments revealed that implantation of the PEXUU scaffold significantly alleviated local inflammation and facilitated the formation of mature cartilage tissue. In a rabbit tracheal window defect model, the scaffold markedly reduced granulation tissue formation and preserved luminal patency, ultimately yielding excellent repair outcomes. In conclusion, XN bulk-modified PEUU represents a dual-function strategy that combines tailorable mechanical compliance with sustained anti-inflammatory activity. This approach significantly promotes tracheal regeneration and repair, offering promising prospects for clinical application.

Construction of multifunctional tracheal substitute based on silk fibroin methacryloyl and hyaluronic acid methacryloyl with decellularized cartilaginous matrix for tracheal defect repair

The regeneration and functional recovery of tracheal tissue are of paramount importance in the research of tissue-engineered trachea. Current constructs still face some limitations in simulating the complex natural microenvironment and achieving better regenerative capacity and functional recovery. To address these challenges, the application of hydrogels with three-dimensional (3D) network structure and extracellular matrix derived from decellularized tissues and cells has become a more promising strategy. This study aims to introduce a novel bilayer multifunctional tissue-engineered tracheal substitute. Firstly, the mesh polycaprolactone (PCL) scaffold was printed by 3D printing technology, and the concentration of Silk Fibroin Methacryloyl (SilMA) hydrogel suitable for cell adhesion and proliferation and the concentration of Hyaluronic Acid Methacryloyl (HAMA) hydrogel suitable for 3D culture of chondrocytes were selected. Subsequently, the decellularized cartilaginous matrix (DCM) solution was obtained and the concentration that promotes chondrocyte proliferation and migration was screened. Finally, the multifunctional tracheal substitute, which features a HAMA-DCM composite hydrogel loaded with autologous chondrocytes as the basic framework to simulate the outer cartilaginous layer, and a 3D-printed PCL mesh scaffold coated with SilMA hydrogel loaded with autologous epithelial cells serves as internal support to simulate the inner airway epithelial layer, was prepared. Whether it was for repairing window-shape defect for 8 w or conducting long-segment in situ transplantation for 12 w, it achieved satisfactory surgical outcomes, including epithelial crawling, cartilage regeneration, and vascular remodeling.

Copper hydrogen phosphate nanosheets functionalized hydrogel with tissue adhesive, antibacterial, and angiogenic capabilities for tracheal mucosal regeneration

Timely and effective interventions after tracheal mucosal injury are lack in clinical practices, which elevate the risks of airway infection, tracheal cartilage deterioration, and even asphyxiated death. Herein, we proposed a biomaterial-based strategy for the repair of injured tracheal mucosal based on a copper hydrogen phosphate nanosheets (CuHP NSs) functionalized commercial hydrogel (polyethylene glycol disuccinimidyl succinate-human serum albumin, PH). Such CuHP/PH hydrogel achieved favorable injectability, stable gelation, and excellent adhesiveness within the tracheal lumen. Moreover, CuHP NSs within the CuHP/PH hydrogel effectively stimulate the proliferation and migration of endothelial/epithelial cells, enhancing angiogenesis and demonstrating excellent tissue regenerative potential. Additionally, it exhibited significant inhibitory effects on both bacteria and bacterial biofilms. More importantly, when injected injured site of tracheal mucosa under fiberoptic bronchoscopy guidance, our results demonstrated CuHP/PH hydrogel adhered tightly to the tracheal mucosa. The therapeutic effects of the CuHP/PH hydrogel were further confirmed, which significantly improved survival rates, vascular and mucosal regeneration, reduced occurrences of intraluminal infections, tracheal stenosis, and cartilage damage complications. This research presents an initial proposition outlining a strategy employing biomaterials to mitigate tracheal mucosal injury, offering novel perspectives on the treatment of mucosal injuries and other tracheal diseases.

Reconstruction of tracheal window-shape defect by 3D printed polycaprolatone scaffold coated with Silk Fibroin Methacryloyl

In this study, we aimed to utilize autologous tracheal epithelia and BMSCs as the seeding cells, utilize PCL coated with SilMA as the hybrid scaffold to carry the cells and KGN, which can selectively stimulate chondrogenic differentiation of BMSCs. This hybrid tracheal substitution was carried out to repair the tracheal partial window-shape defect. Firstly, SilMA with the concentration of 10%, 15% and 20% was prepared, and the experiment of swelling and degradation was performed. With the increase of the concentration, the swelling ratio of SilMA decreased, and the degradation progress slowed down. Upon the result of CCK-8 test and HE staining of 3D co-culture, the SilMA with concentration of 20% was selected. Next, SilMA and the cells attached to SilMA were characterized by SEM. Furthermore, in vitro cytotoxicity test shows that 20% SilMA has good cytocompatibility. The hybrid scaffold was then made by PCL coated with 20% SilMA. The mechanical test shows this hybrid scaffold has better biomechanical properties than native trachea. In vivo tracheal defect repair assays were conducted to evaluate the effect of the hybrid substitution. H&E staining, IHC staining and IF staining showed that this hybrid substitution ensured the viability, proliferation and migration of epithelium. However, it is sad that the results of chondrogenesis were not obvious. This study is expected to provide new strategies for the fields of tracheal replacement therapy needing mechanical properties and epithelization.

Surgical Innovations in Tracheal Reconstruction: A Review on Synthetic Material Fabrication

Background and Objectives: The aim of this review is to explore the recent surgical innovations in tracheal reconstruction by evaluating the uses of synthetic material fabrication when dealing with tracheomalacia or stenotic pathologies, then discussing the challenges holding back these innovations. Materials and Methods: A targeted non-systematic review of published literature relating to tracheal reconstruction was performed within the PubMed database to help identify how synthetic materials are utilised to innovate tracheal reconstruction. Results: The advancements in 3D printing to aid synthetic material fabrication have unveiled promising alternatives to conventional approaches. Achieving successful tracheal reconstruction through this technology demands that the 3D models exhibit biocompatibility with neighbouring tracheal elements by encompassing vasculature, chondral foundation, and immunocompatibility. Tracheal reconstruction has employed grafts and scaffolds, showing a promising beginning in vivo. Concurrently, the integration of resorbable models and stem cell therapy serves to underscore their viability and application in the context of tracheal pathologies. Despite this, certain barriers hinder its advancement in surgery. The intricate tracheal structure has posed a challenge for researchers seeking novel approaches to support its growth and regeneration. Conclusions: The potential of synthetic material fabrication has shown promising outcomes in initial studies involving smaller animals. Yet, to fully realise the applicability of these innovative developments, research must progress toward clinical trials. These trials would ascertain the anatomical and physiological effects on the human body, enabling a thorough evaluation of post-operative outcomes and any potential complications linked to the materials or cells implanted in the trachea.

The Immunosuppressive Niche Established with a Curcumin-Loaded Electrospun Nanofibrous Membrane Promotes Cartilage Regeneration in Immunocompetent Animals

Inflammatory cells mount an immune response against in vitro engineered cartilage implanted into immunocompetent animals, consequently limiting the usage of tissue-engineered cartilage to repair cartilage defects. In this study, curcumin (Cur)-an anti-inflammatory agent-was mixed with poly(lactic-co-glycolic acid) (PLGA) to develop a Cur/PLGA nanofibrous membrane with nanoscale pore size and anti-inflammatory properties. Fourier-transform infrared spectroscopy and high-performance liquid chromatography analyses confirmed the successful loading of Cur into the Cur/PLGA nanofibrous membrane. The results of the in vitro assay demonstrated the sustained release kinetics and enhanced stability of Cur in the Cur/PLGA nanofibrous membrane. Western blotting and enzyme-linked immunosorbent assay analyses revealed that the Cur/PLGA nanofibrous membrane significantly downregulated the expression of inflammatory cytokines (IL-1β, IL-6, and TNF-α). A chondrocyte suspension was seeded into a porous PLGA scaffold, and the loaded scaffold was cultured for 3 weeks in vitro to engineer cartilage tissues. The cartilage was packed with the in vitro engineered Cur/PLGA nanofibrous membrane and subcutaneously implanted into rats to generate an immunosuppressive niche. Compared with those in the PLGA-implanted and pure cartilage (without nanofibrous membrane package)-implanted groups, the cartilage was well preserved and the inflammatory response was suppressed in the Cur/PLGA-implanted group at weeks 2 and 4 post-implantation. Thus, this study demonstrated that packaging the cartilage with the Cur/PLGA nanofibrous membrane effectively generated an immunosuppressive niche to protect the cartilage against inflammatory invasion. These findings enable the clinical translation of tissue-engineered cartilage to repair cartilage defects.