1
|
Wei S, Yang B, Bi T, Zhang W, Sun H, Cui Y, Li G, Zhang A. Tracheal replacement with aortic grafts: Bench to clinical practice. Regen Ther 2023; 24:434-442. [PMID: 37744679 PMCID: PMC10514392 DOI: 10.1016/j.reth.2023.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 08/26/2023] [Accepted: 09/07/2023] [Indexed: 09/26/2023] Open
Abstract
Tracheal reconstruction following extensive resection for malignant or benign lesions remains a major challenge in thoracic surgery. Numerous studies have attempted to identify the optimal tracheal replacement with different biological or prosthetic materials, such as various homologous and autologous tissues, with no encouraging outcomes. Recently, a few clinical studies reported attaining favorable outcomes using in vitro or stem cell-based airway engineering and also with tracheal allograft implantation following heterotopic revascularization. However, none of the relevant studies offered a standardized technology for airway replacement. In 1997, a novel approach to airway reconstruction was proposed, which involved using aortic grafts as the biological matrix. Studies on animal models reported achieving in-vivo cartilage and epithelial regeneration using this approach. These encouraging results inspired the subsequent application of cryopreserved aortic allografts in humans for the first time. Cryopreserved aortic allografts offered further advantages, such as easy availability in tissue banks and no requirement for immunosuppressive treatments. Currently, stented aortic matrix-based airway replacement has emerged as a standard approach, and its effectiveness was also verified in the recently reported TRITON-01 study. In this context, the present review aims to summarize the current status of the application of aortic grafts in tracheal replacement, including the latest advancements in experimental and clinical practice.
Collapse
Affiliation(s)
- Shixiong Wei
- The Department of Thoracic Surgery, The First Hospital of Jilin University, Changchun, Jilin Province, 130021, China
- The Department of Hepatobiliary and Pancreatic Surgery, General Surgery Center, The First Hospital of Jilin University, Changchun, Jilin Province, 130021, China
| | - Bo Yang
- The Department of Thoracic Surgery, The First Hospital of Jilin University, Changchun, Jilin Province, 130021, China
| | - Taiyu Bi
- The Department of Thoracic Surgery, The First Hospital of Jilin University, Changchun, Jilin Province, 130021, China
| | - Wenyu Zhang
- The Department of Thoracic Surgery, The First Hospital of Jilin University, Changchun, Jilin Province, 130021, China
| | - He Sun
- The Department of Thoracic Surgery, The First Hospital of Jilin University, Changchun, Jilin Province, 130021, China
| | - Yongsheng Cui
- The Department of Thoracic Surgery, The First Hospital of Jilin University, Changchun, Jilin Province, 130021, China
| | - Guanghu Li
- The Department of Thoracic Surgery, The First Hospital of Jilin University, Changchun, Jilin Province, 130021, China
| | - Anling Zhang
- The Department of Maxillofacial Surgery, Jilin FAW General Hospital, Changchun, Jilin Province, 130000, China
| |
Collapse
|
2
|
Liu Y, Zheng K, Meng Z, Wang L, Liu X, Guo B, He J, Tang X, Liu M, Ma N, Li X, Zhao J. A cell-free tissue-engineered tracheal substitute with sequential cytokine release maintained airway opening in a rabbit tracheal full circumferential defect model. Biomaterials 2023; 300:122208. [PMID: 37352607 DOI: 10.1016/j.biomaterials.2023.122208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Revised: 05/21/2023] [Accepted: 06/12/2023] [Indexed: 06/25/2023]
Abstract
In this study, a cell-free tissue-engineered tracheal substitute was developed, which is based on a 3D-printed polycaprolactone scaffold coated with a gelatin-methacryloyl (GelMA) hydrogel, with transforming growth factor-β1 (TGF-β) and stromal cell-derived factor-1α (SDF-1) sequentially embedded, to facilitate cell recruitment and differentiation toward chondrocyte-phenotype. TGF-β was loaded onto polydopamine particles, and then encapsulated into the GelMA together with SDF-1, and called G/S/P@T, which was used to coat 3D-printed PCL scaffold to form the tracheal substitute. A rapid release of SDF-1 was observed during the first week, followed by a slow and sustained release of TGF-β for approximately four weeks. The tracheal substitute significantly promoted the recruitment of mesenchymal stromal cells (MSCs) or human bronchial epithelial cells in vitro, and enhanced the ability of MSCs to differentiate towards chondrocyte phenotype. Implantation of the tissue-engineered tracheal substitute with a rabbit tracheal anterior defect model improved regeneration of airway epithelium, recruitment of endogenous MSCs and expression of markers of chondrocytes at the tracheal defect site. Moreover, the tracheal substitute maintained airway opening for 4 weeks in a tracheal full circumferential defect model with airway epithelium coverage at the defect sites without granulation tissue accumulation in the tracheal lumen or underneath. The promising results suggest that this simple, cell-free tissue-engineered tracheal substitute can be used directly after tracheal defect removal and should be further developed towards clinical application.
Collapse
Affiliation(s)
- Yujian Liu
- Department of Thoracic Surgery, Tangdu Hospital, Air Force Medical University, Xi'an, Shaanxi, 710038, China; Department of Cardiothoracic Surgery, Central Theater Command General Hospital of Chinese People's Liberation Army, Wuhan, Hubei, 430070, China
| | - Kaifu Zheng
- Department of Thoracic Surgery, Tangdu Hospital, Air Force Medical University, Xi'an, Shaanxi, 710038, China; Department of General Surgery, The 991st Hospital of the Chinese People's Liberation Army Joint Logistic Support Force, Xiangyang, Hubei, 441000, China
| | - Zijie Meng
- State Key Laboratory for Manufacturing Systems Engineering, Xi'an Jiaotong University, Xi'an, Shaanxi, 710049, China
| | - Lei Wang
- Department of Thoracic Surgery, Tangdu Hospital, Air Force Medical University, Xi'an, Shaanxi, 710038, China
| | - Xi Liu
- Department of Cardiothoracic Surgery, The 980th Hospital of the Chinese People's Liberation Army Joint Logistic Support Force, Shijiazhuang, Hebei, 052460, China
| | - Baolin Guo
- State Key Laboratory for Mechanical Behavior of Materials, And Frontier Institute of Science and Technology, Xi'an Jiaotong University, Xi'an, Shaanxi, 710049, China
| | - Jiankang He
- State Key Laboratory for Manufacturing Systems Engineering, Xi'an Jiaotong University, Xi'an, Shaanxi, 710049, China
| | - Xiyang Tang
- Department of Thoracic Surgery, Tangdu Hospital, Air Force Medical University, Xi'an, Shaanxi, 710038, China
| | - Mingyao Liu
- Institute of Medical Science, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Latner Thoracic Surgery Research Laboratories, Toronto General Hospital Research Institute, University Health Network, Toronto, Ontario, Canada
| | - Nan Ma
- Department of Ophthalmology, Tangdu Hospital, Air Force Medical University, Xi'an, Shaanxi, 710038, China.
| | - Xiaofei Li
- Department of Thoracic Surgery, Tangdu Hospital, Air Force Medical University, Xi'an, Shaanxi, 710038, China.
| | - Jinbo Zhao
- Department of Thoracic Surgery, Tangdu Hospital, Air Force Medical University, Xi'an, Shaanxi, 710038, China.
| |
Collapse
|
3
|
Tsou KC, Hung WT, Ju YT, Liao HC, Hsu HH, Chen JS. Application of aortic allograft in trachea transplantation. J Formos Med Assoc 2023; 122:940-946. [PMID: 37002174 DOI: 10.1016/j.jfma.2023.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 02/08/2023] [Accepted: 03/07/2023] [Indexed: 03/31/2023] Open
Abstract
BACKGROUND The use of tracheal implants for tracheal reconstruction remains a challenge in thoracic medicine due to the complex structure of the trachea in mammalian organisms, including smooth muscles, cartilage, mucosa, blood vessels, cilia, and other tissues, and the difficulty in achieving tracheal regeneration using implants from either allografts or synthetic biomaterials. METHODS This project used the Lee-Sung strain pig, a swine breed local to Taiwan, as the experimental subject. The aorta of the pig was harvested, decellularized to form the scaffold, and transplanted into the trachea of allogeneic pigs together with growth factors. Postoperative physiological function and tissue changes were observed. The postoperative physiological parameters of the LSP were monitored, and they were sacrificed after a certain period to observe the pathological changes in the tracheal epithelial cells and cartilages. RESULTS Overall, six LSP tracheal transplantations were performed between March 4, 2020, and March 10, 2021. These included aortic patch anastomosis for pig 1 and aortic segmental anastomosis for pigs 2-6. The shortest and longest survival periods were 1 day and 147 days, respectively. Excluding the pig that survived for only 1 day due to a ruptured graft anastomosis, all other subjects survived for over 1 month on average. CONCLUSION In this study, we grafted a decellularized porcine aorta into a recipient pig with a tracheal defect. We found cryopreservation of the allogeneic aorta transplantation was a feasible and safe method for the management of airway disease, and immunosuppressants were unnecessary during the treatment course.
Collapse
Affiliation(s)
- Kuan-Chuan Tsou
- Division of Thoracic Surgery, Department of Surgery, Taipei City Hospital Zhongxiao Branch, Taipei, Taiwan; Graduate Institute of Clinical Medicine, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Wan-Ting Hung
- Graduate Institute of Clinical Medicine, National Taiwan University College of Medicine, Taipei, Taiwan; Department of Surgery, National Taiwan University Hospital, Taipei, Taiwan
| | - Yu-Ten Ju
- Department of Animal Science and Technology, National Taiwan University, Taipei, Taiwan
| | - Hsien-Chi Liao
- Graduate Institute of Clinical Medicine, National Taiwan University College of Medicine, Taipei, Taiwan; Department of Traumatology, National Taiwan University Hospital, Taipei, Taiwan.
| | - Hsao-Hsun Hsu
- Division of Thoracic Surgery, Department of Surgery, National Taiwan University Hospital, Taipei, Taiwan; Department of Surgery, National Taiwan University Hospital, Taipei, Taiwan
| | - Jin-Shing Chen
- Department of Surgery, National Taiwan University Hospital, Taipei, Taiwan; Department of Surgical Oncology, National Taiwan University Cancer Center, Taipei, Taiwan
| |
Collapse
|
4
|
Chen Y, Yan X, Yuan F, Lin L, Wang S, Ye J, Zhang J, Yang M, Wu D, Wang X, Yu J. Kartogenin-Conjugated Double-Network Hydrogel Combined with Stem Cell Transplantation and Tracing for Cartilage Repair. ADVANCED SCIENCE (WEINHEIM, BADEN-WURTTEMBERG, GERMANY) 2022; 9:e2105571. [PMID: 36253092 PMCID: PMC9762312 DOI: 10.1002/advs.202105571] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 09/01/2022] [Indexed: 06/16/2023]
Abstract
The effectiveness of existing tissue-engineering cartilage (TEC) is known to be hampered by weak integration of biocompatibility, biodegradation, mechanical strength, and microenvironment supplies. The strategy of hydrogel-based TEC holds considerable promise in circumventing these problems. Herein, a non-toxic, biodegradable, and mechanically optimized double-network (DN) hydrogel consisting of polyethylene glycol (PEG) and kartogenin (KGN)-conjugated chitosan (CHI) is constructed using a simple soaking strategy. This PEG-CHI-KGN DN hydrogel possesses favorable architectures, suitable mechanics, remarkable cellular affinity, and sustained KGN release, which can facilitate the cartilage-specific genes expression and extracellular matrix secretion of peripheral blood-derived mesenchymal stem cells (PB-MSCs). Notably, after tracing the transplanted cells by detecting the rabbit sex-determining region Y-linked gene sequence, the allogeneic PB-MSCs are found to survive for even 3 months in the regenerated cartilage. Here, the long-term release of KGN is able to efficiently and persistently activate multiple genes and signaling pathways to promote the chondrogenesis, chondrocyte differentiation, and survival of PB-MSCs. Thus, the regenerated tissues exhibit well-matched histomorphology and biomechanical performance such as native cartilage. Consequently, it is believed this innovative work can expand the choice for developing the next generation of orthopedic implants in the loadbearing region of a living body.
Collapse
Affiliation(s)
- You‐Rong Chen
- Department of Sports MedicineBeijing Key Laboratory of Sports InjuriesPeking University Third HospitalBeijing100191China
- Institute of Sports MedicinePeking UniversityBeijing100191China
| | - Xin Yan
- Department of Sports MedicineBeijing Key Laboratory of Sports InjuriesPeking University Third HospitalBeijing100191China
- Institute of Sports MedicinePeking UniversityBeijing100191China
| | - Fu‐Zhen Yuan
- Department of Sports MedicineBeijing Key Laboratory of Sports InjuriesPeking University Third HospitalBeijing100191China
- Institute of Sports MedicinePeking UniversityBeijing100191China
| | - Lin Lin
- Department of Sports MedicineBeijing Key Laboratory of Sports InjuriesPeking University Third HospitalBeijing100191China
- Institute of Sports MedicinePeking UniversityBeijing100191China
| | - Shao‐Jie Wang
- Department of Joint Surgery and Sports Medicine, Zhongshan HospitalXiamen UniversityXiamen361000China
| | - Jing Ye
- Department of Sports MedicineBeijing Key Laboratory of Sports InjuriesPeking University Third HospitalBeijing100191China
- Institute of Sports MedicinePeking UniversityBeijing100191China
| | - Ji‐Ying Zhang
- Department of Sports MedicineBeijing Key Laboratory of Sports InjuriesPeking University Third HospitalBeijing100191China
- Institute of Sports MedicinePeking UniversityBeijing100191China
| | - Meng Yang
- Department of Sports MedicineBeijing Key Laboratory of Sports InjuriesPeking University Third HospitalBeijing100191China
- Institute of Sports MedicinePeking UniversityBeijing100191China
| | - De‐Cheng Wu
- Department of Biomedical EngineeringSouthern University of Science and TechnologyShenzhen518055China
| | - Xing Wang
- Beijing National Laboratory for Molecular SciencesState Key Laboratory of Polymer Physics and ChemistryInstitute of Chemistry Chinese Academy of SciencesBeijing100190China
| | - Jia‐Kuo Yu
- Department of Sports MedicineBeijing Key Laboratory of Sports InjuriesPeking University Third HospitalBeijing100191China
- Institute of Sports MedicinePeking UniversityBeijing100191China
| |
Collapse
|
5
|
Martinod E, Radu DM, Onorati I, Portela AMS, Peretti M, Guiraudet P, Destable MD, Uzunhan Y, Freynet O, Chouahnia K, Duchemann B, Kabbani J, Maurer C, Brillet PY, Fath L, Brenet E, Debry C, Buffet C, Leenhardt L, Clero D, Julien N, Vénissac N, Tronc F, Dutau H, Marquette CH, Juvin C, Lebreton G, Cohen Y, Zogheib E, Beloucif S, Planès C, Trésallet C, Bensidhoum M, Petite H, Rouard H, Miyara M, Vicaut E. Airway replacement using stented aortic matrices: Long-term follow-up and results of the TRITON-01 study in 35 adult patients. Am J Transplant 2022; 22:2961-2970. [PMID: 35778956 DOI: 10.1111/ajt.17137] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 06/14/2022] [Accepted: 06/23/2022] [Indexed: 01/25/2023]
Abstract
Over the past 25 years, we have demonstrated the feasibility of airway bioengineering using stented aortic matrices experimentally then in a first-in-human trial (n = 13). The present TRITON-01 study analyzed all the patients who had airway replacement at our center to confirm that this innovative approach can be now used as usual care. For each patient, the following data were prospectively collected: postoperative mortality and morbidity, late airway complications, stent removal and status at last follow-up on November 2, 2021. From October 2009 to October 2021, 35 patients had airway replacement for malignant (n = 29) or benign (n = 6) lesions. The 30-day postoperative mortality and morbidity rates were 2.9% (n = 1/35) and 22.9% (n = 8/35) respectively. At a median follow-up of 29.5 months (range 1-133 months), 27 patients were alive. There have been no deaths directly related to the implanted bioprosthesis. Eighteen patients (52.9%) had stent-related granulomas requiring a bronchoscopic treatment. Ten among 35 patients (28.6%) achieved a stent free survival. The actuarial 2- and 5-year survival rates (Kaplan-Meier estimates) were respectively 88% and 75%. The TRITON-01 study confirmed that airway replacement using stented aortic matrices can be proposed as usual care at our center. Clinicaltrials.gov Identifier: NCT04263129.
Collapse
Affiliation(s)
- Emmanuel Martinod
- Assistance Publique - Hôpitaux de Paris (AP-HP), Hôpitaux Universitaires Paris Seine-Saint-Denis, Hôpital Avicenne, Chirurgie Thoracique et Vasculaire, Université Sorbonne Paris Nord, Faculté de Médecine SMBH, Bobigny, France.,Inserm UMR1272, Hypoxie et Poumon, Université Sorbonne Paris Nord, Faculté de Médecine SMBH, Bobigny, France.,Université Paris Cité, Fondation Alain Carpentier, Laboratoire de Recherche Bio-chirurgicale, AP-HP, Hôpital Européen Georges Pompidou, Paris, France
| | - Dana M Radu
- Assistance Publique - Hôpitaux de Paris (AP-HP), Hôpitaux Universitaires Paris Seine-Saint-Denis, Hôpital Avicenne, Chirurgie Thoracique et Vasculaire, Université Sorbonne Paris Nord, Faculté de Médecine SMBH, Bobigny, France.,Inserm UMR1272, Hypoxie et Poumon, Université Sorbonne Paris Nord, Faculté de Médecine SMBH, Bobigny, France.,Université Paris Cité, Fondation Alain Carpentier, Laboratoire de Recherche Bio-chirurgicale, AP-HP, Hôpital Européen Georges Pompidou, Paris, France
| | - Ilaria Onorati
- Assistance Publique - Hôpitaux de Paris (AP-HP), Hôpitaux Universitaires Paris Seine-Saint-Denis, Hôpital Avicenne, Chirurgie Thoracique et Vasculaire, Université Sorbonne Paris Nord, Faculté de Médecine SMBH, Bobigny, France.,Inserm UMR1272, Hypoxie et Poumon, Université Sorbonne Paris Nord, Faculté de Médecine SMBH, Bobigny, France.,Université Paris Cité, Fondation Alain Carpentier, Laboratoire de Recherche Bio-chirurgicale, AP-HP, Hôpital Européen Georges Pompidou, Paris, France
| | - Ana Maria Santos Portela
- Assistance Publique - Hôpitaux de Paris (AP-HP), Hôpitaux Universitaires Paris Seine-Saint-Denis, Hôpital Avicenne, Chirurgie Thoracique et Vasculaire, Université Sorbonne Paris Nord, Faculté de Médecine SMBH, Bobigny, France
| | - Marine Peretti
- Assistance Publique - Hôpitaux de Paris (AP-HP), Hôpitaux Universitaires Paris Seine-Saint-Denis, Hôpital Avicenne, Chirurgie Thoracique et Vasculaire, Université Sorbonne Paris Nord, Faculté de Médecine SMBH, Bobigny, France
| | - Patrice Guiraudet
- Assistance Publique - Hôpitaux de Paris (AP-HP), Hôpitaux Universitaires Paris Seine-Saint-Denis, Hôpital Avicenne, Chirurgie Thoracique et Vasculaire, Université Sorbonne Paris Nord, Faculté de Médecine SMBH, Bobigny, France.,Inserm UMR1272, Hypoxie et Poumon, Université Sorbonne Paris Nord, Faculté de Médecine SMBH, Bobigny, France
| | - Marie-Dominique Destable
- Assistance Publique - Hôpitaux de Paris (AP-HP), Hôpitaux Universitaires Paris Seine-Saint-Denis, Hôpital Avicenne, Chirurgie Thoracique et Vasculaire, Université Sorbonne Paris Nord, Faculté de Médecine SMBH, Bobigny, France
| | - Yurdagül Uzunhan
- Inserm UMR1272, Hypoxie et Poumon, Université Sorbonne Paris Nord, Faculté de Médecine SMBH, Bobigny, France.,AP-HP, Hôpitaux Universitaires Paris Seine-Saint-Denis, Hôpital Avicenne, Pneumologie, Université Sorbonne Paris Nord, Faculté de Médecine SMBH, Bobigny, France
| | - Olivia Freynet
- AP-HP, Hôpitaux Universitaires Paris Seine-Saint-Denis, Hôpital Avicenne, Pneumologie, Université Sorbonne Paris Nord, Faculté de Médecine SMBH, Bobigny, France
| | - Kader Chouahnia
- AP-HP, Hôpitaux Universitaires Paris Seine-Saint-Denis, Hôpital Avicenne, Oncologie, Université Sorbonne Paris Nord, Faculté de Médecine SMBH, Bobigny, France
| | - Boris Duchemann
- AP-HP, Hôpitaux Universitaires Paris Seine-Saint-Denis, Hôpital Avicenne, Oncologie, Université Sorbonne Paris Nord, Faculté de Médecine SMBH, Bobigny, France
| | - Jamal Kabbani
- Hôpital Le Raincy-Montfermeil, Pneumologie, Montfermeil, France
| | - Cyril Maurer
- Hôpital Le Raincy-Montfermeil, Pneumologie, Montfermeil, France
| | - Pierre-Yves Brillet
- Inserm UMR1272, Hypoxie et Poumon, Université Sorbonne Paris Nord, Faculté de Médecine SMBH, Bobigny, France.,AP-HP, Hôpitaux Universitaires Paris Seine-Saint-Denis, Hôpital Avicenne, Radiologie, Université Sorbonne Paris Nord, Faculté de Médecine SMBH, Bobigny, France
| | - Léa Fath
- Hôpitaux Universitaires de Strasbourg, Oto-Rhino-Laryngologie, Strasbourg, France
| | - Esteban Brenet
- Centre Hospitalier Universitaire de Reims, Oto-Rhino-Laryngologie, Reims, France
| | - Christian Debry
- Hôpitaux Universitaires de Strasbourg, Oto-Rhino-Laryngologie, Strasbourg, France
| | - Camille Buffet
- AP-HP, Sorbonne Université, Hôpital La Pitié-Salpêtrière, Endocrinologie, Paris, France
| | - Laurence Leenhardt
- AP-HP, Sorbonne Université, Hôpital La Pitié-Salpêtrière, Endocrinologie, Paris, France
| | - Dominique Clero
- AP-HP, Sorbonne Université, Hôpital La Pitié-Salpêtrière, Oto-Rhino-Laryngologie, Paris, France
| | - Nicolas Julien
- AP-HP, Sorbonne Université, Hôpital La Pitié-Salpêtrière, Oto-Rhino-Laryngologie, Paris, France
| | - Nicolas Vénissac
- Hôpitaux Universitaires de Lille, Chirurgie Thoracique, Lille, France
| | - François Tronc
- Hôpitaux Universitaires de Lyon, Chirurgie Thoracique, Lyon, France
| | - Hervé Dutau
- Assistance Publique - Hôpitaux de Marseille, Pneumologie, Hôpital Universitaire Nord, Marseille, France
| | | | - Charles Juvin
- AP-HP, Sorbonne Université, Hôpital La Pitié-Salpêtrière, Chirurgie Cardiaque, Paris, France
| | - Guillaume Lebreton
- AP-HP, Sorbonne Université, Hôpital La Pitié-Salpêtrière, Chirurgie Cardiaque, Paris, France
| | - Yves Cohen
- AP-HP, Hôpitaux Universitaires Paris Seine-Saint-Denis, Hôpital Avicenne, Réanimation, Université Sorbonne Paris Nord, Faculté de Médecine SMBH, Bobigny, France
| | - Elie Zogheib
- AP-HP, Hôpitaux Universitaires Paris Seine-Saint-Denis, Hôpital Avicenne, Anesthésie-Réanimation, Université Sorbonne Paris Nord, Faculté de Médecine SMBH, Bobigny, France
| | - Sadek Beloucif
- AP-HP, Hôpitaux Universitaires Paris Seine-Saint-Denis, Hôpital Avicenne, Anesthésie-Réanimation, Université Sorbonne Paris Nord, Faculté de Médecine SMBH, Bobigny, France
| | - Carole Planès
- Inserm UMR1272, Hypoxie et Poumon, Université Sorbonne Paris Nord, Faculté de Médecine SMBH, Bobigny, France
| | - Christophe Trésallet
- AP-HP, Hôpitaux Universitaires Paris Seine-Saint-Denis, Hôpital Avicenne, Chirurgie Digestive, Université Sorbonne Paris Nord, Faculté de Médecine SMBH, Bobigny, France
| | | | - Hervé Petite
- B3OA UMR CNRS 7052, Université Paris Cité CNRS, Paris, France
| | - Hélène Rouard
- AP-HP, EFS Ile de France, Banque des Tissus, La Plaine Saint-Denis, France
| | - Makoto Miyara
- Sorbonne Université, Inserm, Centre d'Immunologie et des Maladies Infectieuses (CIMI-Paris), Département d'Immunologie, AP-HP, Hôpital Pitié-Salpêtrière, Paris, France
| | - Eric Vicaut
- AP-HP, Unité de Recherche Clinique, Hôpitaux Saint Louis-Lariboisière-Fernand Widal, Université Paris Cité, Paris, France
| |
Collapse
|
6
|
Current Strategies for Tracheal Replacement: A Review. Life (Basel) 2021; 11:life11070618. [PMID: 34202398 PMCID: PMC8306535 DOI: 10.3390/life11070618] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 06/18/2021] [Accepted: 06/19/2021] [Indexed: 01/30/2023] Open
Abstract
Airway cancers have been increasing in recent years. Tracheal resection is commonly performed during surgery and is burdened from post-operative complications severely affecting quality of life. Tracheal resection is usually carried out in primary tracheal tumors or other neoplasms of the neck region. Regenerative medicine for tracheal replacement using bio-prosthesis is under current research. In recent years, attempts were made to replace and transplant human cadaver trachea. An effective vascular supply is fundamental for a successful tracheal transplantation. The use of biological scaffolds derived from decellularized tissues has the advantage of a three-dimensional structure based on the native extracellular matrix promoting the perfusion, vascularization, and differentiation of the seeded cell typologies. By appropriately modulating some experimental parameters, it is possible to change the characteristics of the surface. The obtained membranes could theoretically be affixed to a decellularized tissue, but, in practice, it needs to ensure adhesion to the biological substrate and/or glue adhesion with biocompatible glues. It is also known that many of the biocompatible glues can be toxic or poorly tolerated and induce inflammatory phenomena or rejection. In tissue and organ transplants, decellularized tissues must not produce adverse immunological reactions and lead to rejection phenomena; at the same time, the transplant tissue must retain the mechanical properties of the original tissue. This review describes the attempts so far developed and the current lines of research in the field of tracheal replacement.
Collapse
|
7
|
Cameron RB. Commentary: The search for a breakthrough in tracheal replacement surgery: The good, the bad, and the downright ugly. JTCVS OPEN 2021; 5:161-162. [PMID: 36003179 PMCID: PMC9390394 DOI: 10.1016/j.xjon.2020.12.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Revised: 11/27/2020] [Accepted: 12/15/2020] [Indexed: 06/15/2023]
Affiliation(s)
- Robert B. Cameron
- Address for reprints: Robert B. Cameron, MD, Division of Thoracic Surgery, Department of Surgery, David Geffen School of Medicine, Room 64-132, Box 957313, 10833 Le Conte Ave, Los Angeles, CA 90095-7313.
| |
Collapse
|
8
|
Abstract
Head and neck structures govern the vital functions of breathing and swallowing. Additionally, these structures facilitate our sense of self through vocal communication, hearing, facial animation, and physical appearance. Loss of these functions can lead to loss of life or greatly affect quality of life. Regenerative medicine is a rapidly developing field that aims to repair or replace damaged cells, tissues, and organs. Although the field is largely in its nascence, regenerative medicine holds promise for improving on conventional treatments for head and neck disorders or providing therapies where no current standard exists. This review presents milestones in the research of regenerative medicine in head and neck surgery.
Collapse
Affiliation(s)
- Michael J McPhail
- Head and Neck Regenerative Medicine Laboratory, Mayo Clinic Arizona, Scottsdale, AZ, USA
| | - Jeffrey R Janus
- Department of Otolaryngology - Head and Neck Surgery, Mayo Clinic Florida, Jacksonville, FL, USA
| | - David G Lott
- Head and Neck Regenerative Medicine Laboratory, Mayo Clinic Arizona, Scottsdale, AZ, USA
- Department of Otolaryngology - Head and Neck Surgery, Mayo Clinic Arizona, Phoenix, AZ, USA
| |
Collapse
|
9
|
Are we close to bioengineering a human-sized, functional heart? J Thorac Cardiovasc Surg 2019; 159:1357-1360. [PMID: 31668610 DOI: 10.1016/j.jtcvs.2019.06.135] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Revised: 06/07/2019] [Accepted: 06/16/2019] [Indexed: 11/23/2022]
|
10
|
Machino R, Matsumoto K, Taniguchi D, Tsuchiya T, Takeoka Y, Taura Y, Moriyama M, Tetsuo T, Oyama S, Takagi K, Miyazaki T, Hatachi G, Doi R, Shimoyama K, Matsuo N, Yamasaki N, Nakayama K, Nagayasu T. Replacement of Rat Tracheas by Layered, Trachea-Like, Scaffold-Free Structures of Human Cells Using a Bio-3D Printing System. Adv Healthc Mater 2019; 8:e1800983. [PMID: 30632706 DOI: 10.1002/adhm.201800983] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2018] [Revised: 10/17/2018] [Indexed: 01/23/2023]
Abstract
Current scaffold-based tissue engineering approaches are subject to several limitations, such as design inflexibility, poor cytocompatibility, toxicity, and post-transplant degradation. Thus, scaffold-free tissue-engineered structures can be a promising solution to overcome the issues associated with classical scaffold-based materials in clinical transplantation. The present study seeks to optimize the culture conditions and cell combinations used to generate scaffold-free structures using a Bio-3D printing system. Human cartilage cells, human fibroblasts, human umbilical vein endothelial cells, and human mesenchymal stem cells from bone marrow are aggregated into spheroids and placed into a Bio-3D printing system with dedicated needles positioned according to 3D configuration data, to develop scaffold-free trachea-like tubes. Culturing the Bio-3D-printed structures with proper flow of specific medium in a bioreactor facilitates the rearrangement and self-organization of cells, improving physical strength and tissue function. The Bio-3D-printed tissue forms small-diameter trachea-like tubes that are implanted into rats with the support of catheters. It is confirmed that the tubes are viable in vivo and that the tracheal epithelium and capillaries proliferate. This tissue-engineered, scaffold-free, tubular structure can represent a significant step toward clinical application of bioengineered organs.
Collapse
Affiliation(s)
- Ryusuke Machino
- Department of Surgical OncologyNagasaki University Graduate School of Biomedical Sciences Nagasaki 852‐8501 Japan
- Medical‐Engineering Hybrid Professional Development CenterNagasaki University Graduate School of Biomedical Sciences Nagasaki 8528501 Japan
| | - Keitaro Matsumoto
- Department of Surgical OncologyNagasaki University Graduate School of Biomedical Sciences Nagasaki 852‐8501 Japan
- Medical‐Engineering Hybrid Professional Development CenterNagasaki University Graduate School of Biomedical Sciences Nagasaki 8528501 Japan
| | - Daisuke Taniguchi
- Department of Surgical OncologyNagasaki University Graduate School of Biomedical Sciences Nagasaki 852‐8501 Japan
- Medical‐Engineering Hybrid Professional Development CenterNagasaki University Graduate School of Biomedical Sciences Nagasaki 8528501 Japan
| | - Tomoshi Tsuchiya
- Department of Surgical OncologyNagasaki University Graduate School of Biomedical Sciences Nagasaki 852‐8501 Japan
- Medical‐Engineering Hybrid Professional Development CenterNagasaki University Graduate School of Biomedical Sciences Nagasaki 8528501 Japan
| | - Yosuke Takeoka
- Department of Surgical OncologyNagasaki University Graduate School of Biomedical Sciences Nagasaki 852‐8501 Japan
- Medical‐Engineering Hybrid Professional Development CenterNagasaki University Graduate School of Biomedical Sciences Nagasaki 8528501 Japan
| | - Yasuaki Taura
- Department of Surgical OncologyNagasaki University Graduate School of Biomedical Sciences Nagasaki 852‐8501 Japan
- Medical‐Engineering Hybrid Professional Development CenterNagasaki University Graduate School of Biomedical Sciences Nagasaki 8528501 Japan
| | - Masaaki Moriyama
- Department of Surgical OncologyNagasaki University Graduate School of Biomedical Sciences Nagasaki 852‐8501 Japan
- Medical‐Engineering Hybrid Professional Development CenterNagasaki University Graduate School of Biomedical Sciences Nagasaki 8528501 Japan
| | - Tomoyuki Tetsuo
- Department of Surgical OncologyNagasaki University Graduate School of Biomedical Sciences Nagasaki 852‐8501 Japan
- Medical‐Engineering Hybrid Professional Development CenterNagasaki University Graduate School of Biomedical Sciences Nagasaki 8528501 Japan
| | - Shosaburo Oyama
- Department of Surgical OncologyNagasaki University Graduate School of Biomedical Sciences Nagasaki 852‐8501 Japan
- Medical‐Engineering Hybrid Professional Development CenterNagasaki University Graduate School of Biomedical Sciences Nagasaki 8528501 Japan
| | - Katsunori Takagi
- Department of Surgical OncologyNagasaki University Graduate School of Biomedical Sciences Nagasaki 852‐8501 Japan
- Medical‐Engineering Hybrid Professional Development CenterNagasaki University Graduate School of Biomedical Sciences Nagasaki 8528501 Japan
| | - Takuro Miyazaki
- Department of Surgical OncologyNagasaki University Graduate School of Biomedical Sciences Nagasaki 852‐8501 Japan
- Medical‐Engineering Hybrid Professional Development CenterNagasaki University Graduate School of Biomedical Sciences Nagasaki 8528501 Japan
| | - Go Hatachi
- Department of Surgical OncologyNagasaki University Graduate School of Biomedical Sciences Nagasaki 852‐8501 Japan
- Medical‐Engineering Hybrid Professional Development CenterNagasaki University Graduate School of Biomedical Sciences Nagasaki 8528501 Japan
| | - Ryoichiro Doi
- Department of Surgical OncologyNagasaki University Graduate School of Biomedical Sciences Nagasaki 852‐8501 Japan
- Medical‐Engineering Hybrid Professional Development CenterNagasaki University Graduate School of Biomedical Sciences Nagasaki 8528501 Japan
| | - Koichiro Shimoyama
- Department of Surgical OncologyNagasaki University Graduate School of Biomedical Sciences Nagasaki 852‐8501 Japan
- Medical‐Engineering Hybrid Professional Development CenterNagasaki University Graduate School of Biomedical Sciences Nagasaki 8528501 Japan
| | - Naoto Matsuo
- Department of Surgical OncologyNagasaki University Graduate School of Biomedical Sciences Nagasaki 852‐8501 Japan
- Medical‐Engineering Hybrid Professional Development CenterNagasaki University Graduate School of Biomedical Sciences Nagasaki 8528501 Japan
| | - Naoya Yamasaki
- Department of Surgical OncologyNagasaki University Graduate School of Biomedical Sciences Nagasaki 852‐8501 Japan
- Medical‐Engineering Hybrid Professional Development CenterNagasaki University Graduate School of Biomedical Sciences Nagasaki 8528501 Japan
| | - Koichi Nakayama
- Department of Regenerative Medicine and Biomedical Engineering Faculty of MedicineSaga University Saga 840‐8502 Japan
| | - Takeshi Nagayasu
- Department of Surgical OncologyNagasaki University Graduate School of Biomedical Sciences Nagasaki 852‐8501 Japan
- Medical‐Engineering Hybrid Professional Development CenterNagasaki University Graduate School of Biomedical Sciences Nagasaki 8528501 Japan
| |
Collapse
|
11
|
Park JH, Yoon JK, Lee JB, Shin YM, Lee KW, Bae SW, Lee J, Yu J, Jung CR, Youn YN, Kim HY, Kim DH. Experimental Tracheal Replacement Using 3-dimensional Bioprinted Artificial Trachea with Autologous Epithelial Cells and Chondrocytes. Sci Rep 2019; 9:2103. [PMID: 30765760 PMCID: PMC6375946 DOI: 10.1038/s41598-019-38565-z] [Citation(s) in RCA: 52] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2017] [Accepted: 12/17/2018] [Indexed: 12/19/2022] Open
Abstract
Various treatment methods for tracheal defects have been attempted, such as artificial implants, allografts, autogenous grafts, and tissue engineering; however, no perfect method has been established. We attempted to create an effective artificial trachea via a tissue engineering method using 3D bio-printing. A multi-layered scaffold was fabricated using a 3D printer. Polycaprolactone (PCL) and hydrogel were used with nasal epithelial and auricular cartilage cells in the printing process. An artificial trachea was transplanted into 15 rabbits and a PCL scaffold without the addition of cells was transplanted into 6 rabbits (controls). All animals were followed up with radiography, CT, and endoscopy at 3, 6, and 12 months. In the control group, 3 out of 6 rabbits died from respiratory symptoms. Surviving rabbits in control group had narrowed tracheas due to the formation of granulation tissue and absence of epithelium regeneration. In the experimental group, 13 of 15 animals survived, and the histologic examination confirmed the regeneration of epithelial cells. Neonatal cartilage was also confirmed at 6 and 12 months. Our artificial trachea was effective in the regeneration of respiratory epithelium, but not in cartilage regeneration. Additional studies are needed to promote cartilage regeneration and improve implant stability.
Collapse
Affiliation(s)
- Jae-Hyun Park
- Department of Veterinary Surgery, College of Veterinary Medicine, Konkuk University, 120 Neungdong-ro, Gwangjin-gu, Seoul, 05029, Republic of Korea.,Division of Cardiovascular Surgery, Severance Cardiovascular Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Sedaemun-gu, Seoul, 03722, Republic of Korea
| | - Jeong-Kee Yoon
- Severance Biomedical Science Institute, Yonsei University College of Medicine, 50-1 Yonsei-ro, Sedaemun-gu, Seoul, 03722, Republic of Korea
| | - Jung Bok Lee
- Severance Biomedical Science Institute, Yonsei University College of Medicine, 50-1 Yonsei-ro, Sedaemun-gu, Seoul, 03722, Republic of Korea
| | - Young Min Shin
- Severance Biomedical Science Institute, Yonsei University College of Medicine, 50-1 Yonsei-ro, Sedaemun-gu, Seoul, 03722, Republic of Korea
| | - Kang-Woog Lee
- Division of Cardiovascular Surgery, Severance Cardiovascular Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Sedaemun-gu, Seoul, 03722, Republic of Korea
| | - Sang-Woo Bae
- Department of Veterinary Surgery, College of Veterinary Medicine, Konkuk University, 120 Neungdong-ro, Gwangjin-gu, Seoul, 05029, Republic of Korea.,Division of Cardiovascular Surgery, Severance Cardiovascular Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Sedaemun-gu, Seoul, 03722, Republic of Korea
| | - JunHee Lee
- Department of Nature-Inspired Nanoconvergence System, Korea Institute of Machinery and Materials, 156 Gajeongbuk-Ro, Yuseong-Gu, Daejeon, 34103, Republic of Korea
| | - JunJie Yu
- Department of Nature-Inspired Nanoconvergence System, Korea Institute of Machinery and Materials, 156 Gajeongbuk-Ro, Yuseong-Gu, Daejeon, 34103, Republic of Korea.,Department of Biomedical Engineering, School of Integrative Engineering, Chung-Ang University, 84 Heukseok-Ro, Dongjak-Gu, Seoul, 06974, Republic of Korea
| | - Cho-Rok Jung
- Gene Therapy Research Unit, Korea Research Institute of Bioscience and Biotechnology, 125 Gwahak-ro, Yuseong-gu, Daejeon, Republic of Korea
| | - Young-Nam Youn
- Division of Cardiovascular Surgery, Severance Cardiovascular Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Sedaemun-gu, Seoul, 03722, Republic of Korea
| | - Hwi-Yool Kim
- Department of Veterinary Surgery, College of Veterinary Medicine, Konkuk University, 120 Neungdong-ro, Gwangjin-gu, Seoul, 05029, Republic of Korea
| | - Dae-Hyun Kim
- Division of Cardiovascular Surgery, Severance Cardiovascular Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Sedaemun-gu, Seoul, 03722, Republic of Korea.
| |
Collapse
|
12
|
Siddiqi S, de Wit R, van der Heide S, Oosterwijk E, Verhagen A. Aortic allografts: final destination?-a summary of clinical tracheal substitutes. J Thorac Dis 2018; 10:5149-5153. [PMID: 30233891 DOI: 10.21037/jtd.2018.07.108] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
The patient population in desperate need for an airway substitute are individuals with long segment tracheal defects that are considered, technically, inoperable. Regardless of the underlying etiology, benign or malignant growing processes, this patient category enters a palliative setting or require tracheal transplantation. Different airway substitutes have been categorized by Grillo as follows; tracheal transplantation, autogenous tissue, non-viable tissue, tissue-engineering and foreign materials. These fields have been explored in the past in animal models and in clinical patients. Research on airway replacement has been exposed to a level of controversies in the past years. The field has been turbulent and apocryphal. In particular, the area of tissue-engineering using stem cells has suffered from a major set-back leaving scientists, clinicians and ethical committees skeptical. Recently, a hopeful study emerged using aortic allografts as tracheal substitutes in patients with airway defects. The initial results seem promising and reliable. The developments of the field at this point seem striking and hopeful. The focus of this review is to shed light on developments in the field of aortic allografts as substitute for tracheal replacement.
Collapse
Affiliation(s)
- Sailay Siddiqi
- Department of Cardiothoracic Surgery, Radboud Medical Center, Nijmegen, The Netherlands
| | - Rayna de Wit
- Department of Cardiothoracic Surgery, Radboud Medical Center, Nijmegen, The Netherlands
| | - Stefan van der Heide
- Department of Cardiothoracic Surgery, Radboud Medical Center, Nijmegen, The Netherlands
| | - Egbert Oosterwijk
- Department of Urology, Radboud Medical Center, Nijmegen, The Netherlands
| | - Ad Verhagen
- Department of Cardiothoracic Surgery, Radboud Medical Center, Nijmegen, The Netherlands
| |
Collapse
|
13
|
Martinod E, Chouahnia K, Radu DM, Joudiou P, Uzunhan Y, Bensidhoum M, Santos Portela AM, Guiraudet P, Peretti M, Destable MD, Solis A, Benachi S, Fialaire-Legendre A, Rouard H, Collon T, Piquet J, Leroy S, Vénissac N, Santini J, Tresallet C, Dutau H, Sebbane G, Cohen Y, Beloucif S, d’Audiffret AC, Petite H, Valeyre D, Carpentier A, Vicaut E. Feasibility of Bioengineered Tracheal and Bronchial Reconstruction Using Stented Aortic Matrices. JAMA 2018; 319:2212-2222. [PMID: 29800033 PMCID: PMC6134437 DOI: 10.1001/jama.2018.4653] [Citation(s) in RCA: 67] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
IMPORTANCE Airway transplantation could be an option for patients with proximal lung tumor or with end-stage tracheobronchial disease. New methods for airway transplantation remain highly controversial. OBJECTIVE To establish the feasibility of airway bioengineering using a technique based on the implantation of stented aortic matrices. DESIGN, SETTING, AND PARTICIPANTS Uncontrolled single-center cohort study including 20 patients with end-stage tracheal lesions or with proximal lung tumors requiring a pneumonectomy. The study was conducted in Paris, France, from October 2009 through February 2017; final follow-up for all patients occurred on November 2, 2017. EXPOSURES Radical resection of the lesions was performed using standard surgical techniques. After resection, airway reconstruction was performed using a human cryopreserved (-80°C) aortic allograft, which was not matched by the ABO and leukocyte antigen systems. To prevent airway collapse, a custom-made stent was inserted into the allograft. In patients with proximal lung tumors, the lung-sparing intervention of bronchial transplantation was used. MAIN OUTCOMES AND MEASURES The primary outcome was 90-day mortality. The secondary outcome was 90-day morbidity. RESULTS Twenty patients were included in the study (mean age, 54.9 years; age range, 24-79 years; 13 men [65%]). Thirteen patients underwent tracheal (n = 5), bronchial (n = 7), or carinal (n = 1) transplantation. Airway transplantation was not performed in 7 patients for the following reasons: medical contraindication (n = 1), unavoidable pneumonectomy (n = 1), exploratory thoracotomy only (n = 2), and a lobectomy or bilobectomy was possible (n = 3). Among the 20 patients initially included, the overall 90-day mortality rate was 5% (1 patient underwent a carinal transplantation and died). No mortality at 90 days was observed among patients who underwent tracheal or bronchial reconstruction. Among the 13 patients who underwent airway transplantation, major 90-day morbidity events occurred in 4 (30.8%) and included laryngeal edema, acute lung edema, acute respiratory distress syndrome, and atrial fibrillation. There was no adverse event directly related to the surgical technique. Stent removal was performed at a postoperative mean of 18.2 months. At a median follow-up of 3 years 11 months, 10 of the 13 patients (76.9%) were alive. Of these 10 patients, 8 (80%) breathed normally through newly formed airways after stent removal. Regeneration of epithelium and de novo generation of cartilage were observed within aortic matrices from recipient cells. CONCLUSIONS AND RELEVANCE In this uncontrolled study, airway bioengineering using stented aortic matrices demonstrated feasibility for complex tracheal and bronchial reconstruction. Further research is needed to assess efficacy and safety. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT01331863.
Collapse
Affiliation(s)
- Emmanuel Martinod
- Assistance Publique–Hôpitaux de Paris, Hôpitaux Universitaires Paris Seine-Saint-Denis, Hôpital Avicenne, Chirurgie Thoracique et Vasculaire, Université Paris 13, Sorbonne Paris Cité, UFR Santé, Médecine et Biologie Humaine, Bobigny, France
- Université Paris Descartes, Fondation Alain Carpentier, Laboratoire de Recherche Bio-chirurgicale, Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Paris, France
| | - Kader Chouahnia
- Assistance Publique–Hôpitaux de Paris, Hôpitaux Universitaires Paris Seine-Saint-Denis, Hôpital Avicenne, Oncologie, Université Paris 13, Sorbonne Paris Cité, UFR Santé, Médecine et Biologie Humaine, Bobigny, France
| | - Dana M. Radu
- Assistance Publique–Hôpitaux de Paris, Hôpitaux Universitaires Paris Seine-Saint-Denis, Hôpital Avicenne, Chirurgie Thoracique et Vasculaire, Université Paris 13, Sorbonne Paris Cité, UFR Santé, Médecine et Biologie Humaine, Bobigny, France
- Université Paris Descartes, Fondation Alain Carpentier, Laboratoire de Recherche Bio-chirurgicale, Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Paris, France
| | - Pascal Joudiou
- Assistance Publique–Hôpitaux de Paris, Hôpitaux Universitaires Paris Seine-Saint-Denis, Hôpital Avicenne, Pneumologie, Université Paris 13, Sorbonne Paris Cité, UFR Santé, Médecine et Biologie Humaine, Bobigny, France
| | - Yurdagul Uzunhan
- Assistance Publique–Hôpitaux de Paris, Hôpitaux Universitaires Paris Seine-Saint-Denis, Hôpital Avicenne, Pneumologie, Université Paris 13, Sorbonne Paris Cité, UFR Santé, Médecine et Biologie Humaine, Bobigny, France
| | - Morad Bensidhoum
- B2OA UMR CNRS 7052, Université Paris Diderot, Sorbonne Paris Cité, CNRS, F-75010 Paris, France
- Ecole Nationale Vétérinaire d’Alfort, Université, Paris-Est, Maisons-Alfort, France
| | - Ana M. Santos Portela
- Assistance Publique–Hôpitaux de Paris, Hôpitaux Universitaires Paris Seine-Saint-Denis, Hôpital Avicenne, Chirurgie Thoracique et Vasculaire, Université Paris 13, Sorbonne Paris Cité, UFR Santé, Médecine et Biologie Humaine, Bobigny, France
| | - Patrice Guiraudet
- Assistance Publique–Hôpitaux de Paris, Hôpitaux Universitaires Paris Seine-Saint-Denis, Hôpital Avicenne, Chirurgie Thoracique et Vasculaire, Université Paris 13, Sorbonne Paris Cité, UFR Santé, Médecine et Biologie Humaine, Bobigny, France
- Université Paris Descartes, Fondation Alain Carpentier, Laboratoire de Recherche Bio-chirurgicale, Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Paris, France
| | - Marine Peretti
- Assistance Publique–Hôpitaux de Paris, Hôpitaux Universitaires Paris Seine-Saint-Denis, Hôpital Avicenne, Chirurgie Thoracique et Vasculaire, Université Paris 13, Sorbonne Paris Cité, UFR Santé, Médecine et Biologie Humaine, Bobigny, France
| | - Marie-Dominique Destable
- Assistance Publique–Hôpitaux de Paris, Hôpitaux Universitaires Paris Seine-Saint-Denis, Hôpital Avicenne, Chirurgie Thoracique et Vasculaire, Université Paris 13, Sorbonne Paris Cité, UFR Santé, Médecine et Biologie Humaine, Bobigny, France
| | - Audrey Solis
- Assistance Publique–Hôpitaux de Paris, Hôpitaux Universitaires Paris Seine-Saint-Denis, Hôpital Avicenne, Anesthésie-Réanimation, Université Paris 13, Sorbonne Paris Cité, UFR Santé, Médecine et Biologie Humaine, Bobigny, France
| | - Sabiha Benachi
- Assistance Publique–Hôpitaux de Paris, Hôpitaux Universitaires Paris Seine-Saint-Denis, Hôpital Avicenne, Anesthésie-Réanimation, Université Paris 13, Sorbonne Paris Cité, UFR Santé, Médecine et Biologie Humaine, Bobigny, France
| | - Anne Fialaire-Legendre
- Assistance Publique–Hôpitaux de Paris, EFS Ile de France, Banque des Tissus, Creteil, France
| | - Hélène Rouard
- Assistance Publique–Hôpitaux de Paris, EFS Ile de France, Banque des Tissus, Creteil, France
| | - Thierry Collon
- Hôpital Le Raincy-Montfermeil, Pneumologie, Montfermeil, France
| | - Jacques Piquet
- Hôpital Le Raincy-Montfermeil, Pneumologie, Montfermeil, France
| | - Sylvie Leroy
- Université Côte d’Azur, Centre Hospitalier Universitaire de Nice, Pneumologie, Chirurgie Thoracique, Oto-Rhino-Laryngologie, Nice, France
| | - Nicolas Vénissac
- Université Côte d’Azur, Centre Hospitalier Universitaire de Nice, Pneumologie, Chirurgie Thoracique, Oto-Rhino-Laryngologie, Nice, France
| | - Joseph Santini
- Université Côte d’Azur, Centre Hospitalier Universitaire de Nice, Pneumologie, Chirurgie Thoracique, Oto-Rhino-Laryngologie, Nice, France
| | - Christophe Tresallet
- Assistance Publique–Hôpitaux de Paris, Hôpital La Pitié-Salpêtrière, Chirurgie Digestive et Endocrinienne, Université Paris 6 Pierre et Marie Curie, Paris, France
| | - Hervé Dutau
- Assistance Publique–Hôpitaux de Marseille, Pneumologie, Hôpital Universitaire Nord, Marseille, France
| | - Georges Sebbane
- Assistance Publique–Hôpitaux de Paris, Hôpitaux Universitaires Paris Seine-Saint-Denis, Hôpital Avicenne, Gériatrie, Université Paris 13, Sorbonne Paris Cité, UFR Santé, Médecine et Biologie Humaine, Bobigny, France
| | - Yves Cohen
- Assistance Publique–Hôpitaux de Paris, Hôpitaux Universitaires Paris Seine-Saint-Denis, Hôpital Avicenne, Anesthésie-Réanimation, Université Paris 13, Sorbonne Paris Cité, UFR Santé, Médecine et Biologie Humaine, Bobigny, France
| | - Sadek Beloucif
- Assistance Publique–Hôpitaux de Paris, Hôpitaux Universitaires Paris Seine-Saint-Denis, Hôpital Avicenne, Anesthésie-Réanimation, Université Paris 13, Sorbonne Paris Cité, UFR Santé, Médecine et Biologie Humaine, Bobigny, France
| | | | - Hervé Petite
- B2OA UMR CNRS 7052, Université Paris Diderot, Sorbonne Paris Cité, CNRS, F-75010 Paris, France
- Ecole Nationale Vétérinaire d’Alfort, Université, Paris-Est, Maisons-Alfort, France
| | - Dominique Valeyre
- Assistance Publique–Hôpitaux de Paris, Hôpitaux Universitaires Paris Seine-Saint-Denis, Hôpital Avicenne, Pneumologie, Université Paris 13, Sorbonne Paris Cité, UFR Santé, Médecine et Biologie Humaine, Bobigny, France
| | - Alain Carpentier
- Université Paris Descartes, Fondation Alain Carpentier, Laboratoire de Recherche Bio-chirurgicale, Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Paris, France
| | - Eric Vicaut
- Assistance Publique–Hôpitaux de Paris, Unité de Recherche Clinique, Hôpitaux Saint Louis-Lariboisière-Fernand Widal, Université Paris Diderot, Paris, France
| |
Collapse
|
14
|
Affiliation(s)
- Valerie W Rusch
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| |
Collapse
|
15
|
Taniguchi D, Matsumoto K, Tsuchiya T, Machino R, Takeoka Y, Elgalad A, Gunge K, Takagi K, Taura Y, Hatachi G, Matsuo N, Yamasaki N, Nakayama K, Nagayasu T. Scaffold-free trachea regeneration by tissue engineering with bio-3D printing†. Interact Cardiovasc Thorac Surg 2018; 26:745-752. [DOI: 10.1093/icvts/ivx444] [Citation(s) in RCA: 82] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2017] [Accepted: 12/22/2017] [Indexed: 12/17/2022] Open
Affiliation(s)
- Daisuke Taniguchi
- Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
- Medical-Engineering Hybrid Professional Development Center, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Keitaro Matsumoto
- Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
- Medical-Engineering Hybrid Professional Development Center, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Tomoshi Tsuchiya
- Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Ryusuke Machino
- Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Yosuke Takeoka
- Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
- Medical-Engineering Hybrid Professional Development Center, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Abdelmotagaly Elgalad
- Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
- Medical-Engineering Hybrid Professional Development Center, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Kiyofumi Gunge
- Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
- Medical-Engineering Hybrid Professional Development Center, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Katsunori Takagi
- Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
- Medical-Engineering Hybrid Professional Development Center, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Yasuaki Taura
- Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Go Hatachi
- Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Naoto Matsuo
- Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
- Medical-Engineering Hybrid Professional Development Center, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Naoya Yamasaki
- Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
- Medical-Engineering Hybrid Professional Development Center, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Koichi Nakayama
- Department of Regenerative Medicine and Biomedical Engineering, Faculty of Medicine, Saga University, Saga, Japan
| | - Takeshi Nagayasu
- Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
- Medical-Engineering Hybrid Professional Development Center, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| |
Collapse
|
16
|
Abstract
Purpose of Review There is no consensus on the best technology to be employed for tracheal replacement. One particularly promising approach is based upon tissue engineering and involves applying autologous cells to transplantable scaffolds. Here, we present the reported pre-clinical and clinical data exploring the various options for achieving such seeding. Recent Findings Various cell combinations, delivery strategies, and outcome measures are described. Mesenchymal stem cells (MSCs) are the most widely employed cell type in tracheal bioengineering. Airway epithelial cell luminal seeding is also widely employed, alone or in combination with other cell types. Combinations have thus far shown the greatest promise. Chondrocytes may improve mechanical outcomes in pre-clinical models, but have not been clinically tested. Rapid or pre-vascularization of scaffolds is an important consideration. Overall, there are few published objective measures of post-seeding cell viability, survival, or overall efficacy. Summary There is no clear consensus on the optimal cell-scaffold combination and mechanisms for seeding. Systematic in vivo work is required to assess differences between tracheal grafts seeded with combinations of clinically deliverable cell types using objective outcome measures, including those for functionality and host immune response. Electronic supplementary material The online version of this article (10.1007/s40778-017-0108-2) contains supplementary material, which is available to authorized users.
Collapse
|
17
|
In Vivo Tissue Engineering of Human Airways. Ann Thorac Surg 2017; 103:1631-1640. [PMID: 28109571 DOI: 10.1016/j.athoracsur.2016.11.027] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2016] [Revised: 10/02/2016] [Accepted: 11/07/2016] [Indexed: 12/11/2022]
Abstract
BACKGROUND Airway transplantation remains a major challenge in thoracic surgery. Based on our previous laboratory work, we developed the techniques required to bioengineer a tracheal substitute in vivo using cryopreserved aortic allografts as biological matrices (Replacement of the Airways and/or the Pulmonary Vessels Using a Cryopreserved Arterial Allograft [TRACHEOBRONCART] Study, NCT01331863). We present here 2 patients who had a definitive tracheostomy for complex laryngotracheal stenoses refractory to conventional therapy. METHODS According to our protocol, a stented gender-mismatched -80°C cryopreserved aortic allograft was used for airway reconstruction. Follow-up assessments were done at regular intervals using clinical, imaging, and endoscopic evaluations. Immunohistochemical and XX/XY chimerism studies were performed at time of stent removal using graft biopsy specimens. Chemotactic and angiogenic properties of implanted matrices were also investigated. RESULTS At a maximal follow-up of 5 years and 7 months, the patients were breathing and speaking normally, without tracheostomy or stent. Regeneration of cartilage within the aortic grafts was demonstrated by positive immunodetection of type II collagen and markers specific for Sox9. Chimerism study from samples of neotissues demonstrated that regenerated cartilage came from recipient cells. The remaining viable matrix cells released a functionally relevant amount of proangiogenic, chemoattractant, proinflammatory/immunomodulatory cytokines, and growth factors. CONCLUSIONS This report documents the feasibility of in vivo tissue engineering for long-term functional airway transplantation in humans.
Collapse
|
18
|
Tan Q, Liu R, Chen X, Wu J, Pan Y, Lu S, Weder W, Luo Q. Clinic application of tissue engineered bronchus for lung cancer treatment. J Thorac Dis 2017; 9:22-29. [PMID: 28203403 DOI: 10.21037/jtd.2017.01.50] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
BACKGROUND Delayed revascularization process and substitute infection remain to be key challenges in tissue engineered (TE) airway reconstruction. We propose an "in-vivo bioreactor" design, defined as an implanted TE substitutes perfused with an intra-scaffold medium flow created by an extracorporeal portable pump system for in situ organ regeneration. The perfusate keeps pre-seeded cells alive before revascularization. Meanwhile the antibiotic inside the perfusate controls topical infection. METHODS A stage IIIA squamous lung cancer patient received a 5-cm TE airway substitute, bridging left basal segment bronchus to carina, with the in-vivo bioreactor design to avoid left pneumonectomy. Continuous intra-scaffold Ringer's-gentamicin perfusion lasted for 1 month, together with orthotopic peripheral total nucleated cells (TNCs) injection twice a week. RESULTS The patient recovered uneventfully. Bronchoscopy follow-up confirmed complete revascularization and reepithelialization four months postoperatively. Perfusate waste test demonstrated various revascularization growth factors secreted by TNCs. The patient received two cycles of chemotherapy and 30 Gy radiotherapy thereafter without complications related to the TE substitute. CONCLUSIONS In-vivo bioreactor design combines the traditionally separated in vitro 3D cell-scaffold culture system and the in vivo regenerative processes associated with TE substitutes, while treating the recipients as bioreactors for their own TE prostheses. This design can be applied clinically. We also proved for the first time that TE airway substitute is able to tolerate chemo-radiotherapy and suitable to be used in cancer treatment.
Collapse
Affiliation(s)
- Qiang Tan
- Shanghai Lung Cancer Center, Shanghai Chest Hospital Affiliated to Shanghai Jiao Tong University, Shanghai 200030, China
| | - Ruijun Liu
- Shanghai Lung Cancer Center, Shanghai Chest Hospital Affiliated to Shanghai Jiao Tong University, Shanghai 200030, China
| | - Xiaoke Chen
- Shanghai Lung Cancer Center, Shanghai Chest Hospital Affiliated to Shanghai Jiao Tong University, Shanghai 200030, China
| | - Jingxiang Wu
- Department of Anesthesia, Shanghai Chest Hospital Affiliated to Shanghai Jiao Tong University, Shanghai 200030, China
| | - Yinggen Pan
- Department of Plastic Surgery, Qidong People's Hospital, Qidong 226200, China
| | - Shun Lu
- Shanghai Lung Cancer Center, Shanghai Chest Hospital Affiliated to Shanghai Jiao Tong University, Shanghai 200030, China
| | - Walter Weder
- Clinic of Thoracic Surgeon, University Hospital Zurich, Zurich, Switzerland
| | - Qingquan Luo
- Shanghai Lung Cancer Center, Shanghai Chest Hospital Affiliated to Shanghai Jiao Tong University, Shanghai 200030, China
| |
Collapse
|
19
|
Zhang GY, Liao T, Zhou SB, Fu XB, Li QF. Mesenchymal stem (stromal) cells for treatment of acute respiratory distress syndrome. THE LANCET RESPIRATORY MEDICINE 2016; 3:e11-2. [PMID: 25890654 DOI: 10.1016/s2213-2600(15)00049-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Guo-You Zhang
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200011, China
| | - Tian Liao
- Department of Head and Neck Surgery, Fudan University Shanghai Cancer Center, Shanghai, China
| | - Shuang-Bai Zhou
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200011, China
| | - Xiao-Bing Fu
- Wound Healing and Cell Biology Laboratory, Institute of Basic Medical Science, First Hospital Affiliated to the PLA General Hospital, Beijing, China
| | - Qing-Feng Li
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200011, China.
| |
Collapse
|
20
|
Ott LM, Vu CH, Farris AL, Fox KD, Galbraith RA, Weiss ML, Weatherly RA, Detamore MS. Functional Reconstruction of Tracheal Defects by Protein-Loaded, Cell-Seeded, Fibrous Constructs in Rabbits. Tissue Eng Part A 2015; 21:2390-403. [PMID: 26094554 DOI: 10.1089/ten.tea.2015.0157] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Tracheal stenosis is a life-threatening disease and current treatments include surgical reconstruction with autologous rib cartilage and the highly complex slide tracheoplasty surgical technique. We propose using a sustainable implant, composed of a tunable, fibrous scaffold with encapsulated chondrogenic growth factor (transforming growth factor-beta3 [TGF-β3]) or seeded allogeneic rabbit bone marrow mesenchymal stromal cells (BMSCs). In vivo functionality of these constructs was determined by implanting them in induced tracheal defects in rabbits for 6 or 12 weeks. The scaffolds maintained functional airways in a majority of the cases, with the BMSC-seeded group having an improved survival rate and the Scaffold-only group having a higher occurrence of more patent airways as determined by microcomputed tomography. The BMSC group had a greater accumulation of inflammatory cells over the graft, while also exhibiting normal epithelium, subepithelium, and cartilage formation. Overall, it was concluded that a simple, acellular scaffold is a viable option for tracheal tissue engineering, with the intraoperative addition of cells being an optional variation to the scaffolds.
Collapse
Affiliation(s)
- Lindsey M Ott
- 1 Bioengineering Program, University of Kansas , Lawrence, Kansas
| | - Cindy H Vu
- 2 School of Medicine, University of Kansas , Kansas City, Kansas
| | - Ashley L Farris
- 3 Department of Molecular Biosciences, University of Kansas , Lawrence, Kansas
| | - Katrina D Fox
- 4 College of Veterinary Medicine, Kansas State University , Manhattan, Kansas
| | - Richard A Galbraith
- 5 Anatomic and Clinical Pathology, Lawrence Memorial Hospital , Lawrence, Kansas
| | - Mark L Weiss
- 4 College of Veterinary Medicine, Kansas State University , Manhattan, Kansas
| | - Robert A Weatherly
- 6 Section of Otolaryngology, Children's Mercy Hospital , Kansas City, Missouri
| | - Michael S Detamore
- 1 Bioengineering Program, University of Kansas , Lawrence, Kansas
- 7 Department of Chemical and Petroleum Engineering, University of Kansas , Lawrence, Kansas
| |
Collapse
|
21
|
Jungebluth P, Haag J, Macchiarini P. Regenerative Medizin. ZEITSCHRIFT FUR HERZ THORAX UND GEFASSCHIRURGIE 2015. [DOI: 10.1007/s00398-014-1094-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|
22
|
Peloso A, Dhal A, Zambon JP, Li P, Orlando G, Atala A, Soker S. Current achievements and future perspectives in whole-organ bioengineering. Stem Cell Res Ther 2015; 6:107. [PMID: 26028404 PMCID: PMC4450459 DOI: 10.1186/s13287-015-0089-y] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2014] [Accepted: 05/06/2015] [Indexed: 12/11/2022] Open
Abstract
Irreversible end-stage organ failure represents one of the leading causes of death, and organ transplantation is currently the only curative solution. Donor organ shortage and adverse effects of immunosuppressive regimens are the major limiting factors for this definitive practice. Recent developments in bioengineering and regenerative medicine could provide a solid base for the future creation of implantable, bioengineered organs. Whole-organ detergent-perfusion protocols permit clinicians to gently remove all the cells and at the same time preserve the natural three-dimensional framework of the native organ. Several decellularized organs, including liver, kidney, and pancreas, have been created as a platform for further successful seeding. These scaffolds are composed of organ-specific extracellular matrix that contains growth factors important for cellular growth and function. Macro- and microvascular tree is entirely maintained and can be incorporated in the recipient's vascular system after the implant. This review will emphasize recent achievements in the whole-organ scaffolds and at the same time underline complications that the scientific community has to resolve before reaching a functional bioengineered organ.
Collapse
Affiliation(s)
- Andrea Peloso
- IRCCS Policlinico San Matteo, Department of General Surgery, University of Pavia, Viale Golgi 19, Pavia, 27100, Italy. .,Wake Forest Institute for Regenerative Medicine, Medical Centre Boulevard, Winston-Salem, NC, 27157, USA.
| | - Abritee Dhal
- Wake Forest Institute for Regenerative Medicine, Medical Centre Boulevard, Winston-Salem, NC, 27157, USA.
| | - Joao P Zambon
- Wake Forest Institute for Regenerative Medicine, Medical Centre Boulevard, Winston-Salem, NC, 27157, USA.
| | - Peng Li
- Wake Forest Institute for Regenerative Medicine, Medical Centre Boulevard, Winston-Salem, NC, 27157, USA. .,Department of General Surgery Affiliated Hospital of Nantong University, Nantong University, Nantong, Jiangsu, 226001, China.
| | - Giuseppe Orlando
- Wake Forest Institute for Regenerative Medicine, Medical Centre Boulevard, Winston-Salem, NC, 27157, USA. .,Wake Forest School of Medicine, Medical Centre Boulevard, Winston-Salem, NC, 27517, USA.
| | - Anthony Atala
- Wake Forest Institute for Regenerative Medicine, Medical Centre Boulevard, Winston-Salem, NC, 27157, USA. .,Wake Forest School of Medicine, Medical Centre Boulevard, Winston-Salem, NC, 27517, USA.
| | - Shay Soker
- Wake Forest Institute for Regenerative Medicine, Medical Centre Boulevard, Winston-Salem, NC, 27157, USA.
| |
Collapse
|
23
|
O'Leary C, Gilbert JL, O'Dea S, O'Brien FJ, Cryan SA. Respiratory Tissue Engineering: Current Status and Opportunities for the Future. TISSUE ENGINEERING PART B-REVIEWS 2015; 21:323-44. [PMID: 25587703 DOI: 10.1089/ten.teb.2014.0525] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Currently, lung disease and major airway trauma constitute a major global healthcare burden with limited treatment options. Airway diseases such as chronic obstructive pulmonary disease and cystic fibrosis have been identified as the fifth highest cause of mortality worldwide and are estimated to rise to fourth place by 2030. Alternate approaches and therapeutic modalities are urgently needed to improve clinical outcomes for chronic lung disease. This can be achieved through tissue engineering of the respiratory tract. Interest is growing in the use of airway tissue-engineered constructs as both a research tool, to further our understanding of airway pathology, validate new drugs, and pave the way for novel drug therapies, and also as regenerative medical devices or as an alternative to transplant tissue. This review provides a concise summary of the field of respiratory tissue engineering to date. An initial overview of airway anatomy and physiology is given, followed by a description of the stem cell populations and signaling processes involved in parenchymal healing and tissue repair. We then focus on the different biomaterials and tissue-engineered systems employed in upper and lower respiratory tract engineering and give a final perspective of the opportunities and challenges facing the field of respiratory tissue engineering.
Collapse
Affiliation(s)
- Cian O'Leary
- 1 Tissue Engineering Research Group, Department of Anatomy, Royal College of Surgeons in Ireland , Dublin, Ireland .,2 School of Pharmacy, Royal College of Surgeons in Ireland , Dublin, Ireland .,3 Advanced Materials and Bioengineering Research (AMBER) Centre, Royal College of Surgeons in Ireland and Trinity College Dublin , Dublin, Ireland
| | - Jennifer L Gilbert
- 4 Department of Biology, Institute of Immunology, University of Ireland , Maynooth, Ireland
| | - Shirley O'Dea
- 4 Department of Biology, Institute of Immunology, University of Ireland , Maynooth, Ireland
| | - Fergal J O'Brien
- 1 Tissue Engineering Research Group, Department of Anatomy, Royal College of Surgeons in Ireland , Dublin, Ireland .,3 Advanced Materials and Bioengineering Research (AMBER) Centre, Royal College of Surgeons in Ireland and Trinity College Dublin , Dublin, Ireland .,5 Trinity Centre of Bioengineering, Trinity College Dublin , Dublin, Ireland
| | - Sally-Ann Cryan
- 1 Tissue Engineering Research Group, Department of Anatomy, Royal College of Surgeons in Ireland , Dublin, Ireland .,2 School of Pharmacy, Royal College of Surgeons in Ireland , Dublin, Ireland .,5 Trinity Centre of Bioengineering, Trinity College Dublin , Dublin, Ireland
| |
Collapse
|
24
|
Hysi I, Kipnis E, Fayoux P, Copin MC, Zawadzki C, Jashari R, Hubert T, Ung A, Ramon P, Jude B, Wurtz A. Successful orthotopic transplantation of short tracheal segments without immunosuppressive therapy. Eur J Cardiothorac Surg 2014; 47:e54-61. [PMID: 25475944 DOI: 10.1093/ejcts/ezu444] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVES Results of tracheal transplantation have been disappointing due to of ischaemia and rejection. It has been experimentally demonstrated that results of tracheal autograft/allograft transplantation were correlated with both graft length and revascularization method. Recently, we demonstrated that heterotopic epithelium-denuded-cryopreserved tracheal allograft (TA) displayed satisfactory immune tolerance. We aimed at evaluating the results of such allografts in orthotopic transplantation according to graft length and prior heterotopic or single-stage orthotopic revascularization in a rabbit model. METHODS Twenty New Zealand rabbits were used. Six females served as donors. Tracheal mucosa was mechanically peeled off and then the TAs were cryopreserved. Male recipients were divided into three groups receiving: (i) long TA segment with prior heterotopic revascularization (10-12 tracheal rings, n = 3); (ii) average TA segment with single-stage orthotopic revascularization (6-8 tracheal rings, n = 4); (iii) short TA segment with single-stage orthotopic revascularization (4-5 tracheal rings, n = 7). No immunosuppressive therapy was administered. Grafts were assessed bronchoscopically and upon death or sacrifice by macroscopic evaluation, histology and immunohistochemical staining for apoptosis. RESULTS Four animals were sacrificed from Day 33 to Day 220. The survival time of other recipients was 0-47 days (mean 19.6 ± 16.7 days). Aside from three animals that died from complications, all TA segments had satisfactory stiffness, were well vascularized, showed varying levels of neoangiogenesis and inflammatory infiltration devoid of lymphocytes, and showed evidence of only low levels of apoptosis. Varying degrees of fibroblastic proliferation originating from the lamina propria were observed in the lumen of all TAs and evolved over time into collagenized fibrosis in animals surviving over 45 days. Likewise, cartilage tracheal rings exhibited central calcification deposits, which started on Day 16 and increased over time. Epithelial regeneration was constantly observed. Intense fibroblastic proliferation led to stenosis in all animals from Groups (i) and (ii) but only one of seven animals from Group (iii). CONCLUSIONS Our results suggest that short segments of epithelium-denuded-cryopreserved TA may be reliable for tracheal transplantation in the rabbit model without problems related to graft stiffness or immune rejection. Before considering clinical applications, investigations should be conducted in larger mammals.
Collapse
Affiliation(s)
- Ilir Hysi
- Cardiac and Thoracic Surgery Division, Lille University Teaching Hospital, CHU Lille, Lille, France IMPRT-IFR 114, EA 2693, Lille University Medical School, UDSL, Université Lille Nord de France, Lille, France
| | - Eric Kipnis
- Department of Surgical Critical Care, Lille University Teaching Hospital, CHU Lille, Lille, France
| | - Pierre Fayoux
- Department of Otolaryngology-Head and Neck Surgery, Lille University Teaching Hospital, CHU Lille, Lille, France
| | - Marie-Christine Copin
- Institute of Pathology, Lille University Teaching Hospital, CHU Lille, Lille, France
| | - Christophe Zawadzki
- IMPRT-IFR 114, EA 2693, Lille University Medical School, UDSL, Université Lille Nord de France, Lille, France Institute of Hematology-Transfusion, Lille University Teaching Hospital, CHU Lille, Lille, France
| | | | - Thomas Hubert
- IMPRT-IFR 114, EA 2693, Lille University Medical School, UDSL, Université Lille Nord de France, Lille, France
| | - Alexandre Ung
- IMPRT-IFR 114, EA 2693, Lille University Medical School, UDSL, Université Lille Nord de France, Lille, France
| | - Philippe Ramon
- Department of Pneumology, Lille University Teaching Hospital, CHU Lille, Lille, France
| | - Brigitte Jude
- IMPRT-IFR 114, EA 2693, Lille University Medical School, UDSL, Université Lille Nord de France, Lille, France Institute of Hematology-Transfusion, Lille University Teaching Hospital, CHU Lille, Lille, France
| | - Alain Wurtz
- Cardiac and Thoracic Surgery Division, Lille University Teaching Hospital, CHU Lille, Lille, France IMPRT-IFR 114, EA 2693, Lille University Medical School, UDSL, Université Lille Nord de France, Lille, France
| |
Collapse
|
25
|
Weiss DJ, Elliott M, Jang Q, Poole B, Birchall M. Tracheal bioengineering: the next steps. Proceeds of an International Society of Cell Therapy Pulmonary Cellular Therapy Signature Series Workshop, Paris, France, April 22, 2014. Cytotherapy 2014; 16:1601-13. [PMID: 25457172 DOI: 10.1016/j.jcyt.2014.10.012] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2014] [Revised: 10/29/2014] [Accepted: 10/30/2014] [Indexed: 11/15/2022]
Abstract
There has been significant and exciting recent progress in the development of bioengineering approaches for generating tracheal tissue that can be used for congenital and acquired tracheal diseases. This includes a growing clinical experience in both pediatric and adult patients with life-threatening tracheal diseases. However, not all of these attempts have been successful, and there is ongoing discussion and debate about the optimal approaches to be used. These include considerations of optimal materials, particularly use of synthetic versus biologic scaffolds, appropriate cellularization of the scaffolds, optimal surgical approaches and optimal measure of both clinical and biologic outcomes. To address these issues, the International Society of Cell Therapy convened a first-ever meeting of the leading clinicians and tracheal biologists, along with experts in regulatory and ethical affairs, to discuss and debate the issues. A series of recommendations are presented for how to best move the field ahead.
Collapse
Affiliation(s)
- Daniel J Weiss
- Department of Medicine, University of Vermont, Burlington, Vermont, USA
| | - Martin Elliott
- Department of Cardiothoracic Surgery, Great Ormond Street Hospital, London, United Kingdom
| | - Queenie Jang
- International Society for Cell Therapy, Vancouver, British Columbia, Canada
| | - Brian Poole
- International Society for Cell Therapy, Vancouver, British Columbia, Canada
| | - Martin Birchall
- Royal National Throat Nose, and Ear Hospital and University College London, London, United Kingdom.
| |
Collapse
|
26
|
|
27
|
Fishman JM, Wiles K, Lowdell MW, De Coppi P, Elliott MJ, Atala A, Birchall MA. Airway tissue engineering: an update. Expert Opin Biol Ther 2014; 14:1477-91. [PMID: 25102044 DOI: 10.1517/14712598.2014.938631] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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.
Collapse
Affiliation(s)
- Jonathan M Fishman
- UCL Institute of Child Health, Department of Surgery , 30 Guilford Street, London WC1N 1EH , UK +44 07989 331573 ;
| | | | | | | | | | | | | |
Collapse
|
28
|
Abstract
No definitive solution has been discovered for replacing long segments or the entire trachea in humans. Most of this challenge stems from the specific function and mechanics that are almost impossible to replicate except in the setting of an allotransplantation, which requires lifelong immunosuppressive medication. Recently, tissue engineering provided significant evidence concerning the next promising therapeutic alternative for tracheal replacement. Underlying mechanism and pathways of cell-surface interactions, cell migration, and differentiation are essential to understand the complexity of tracheal tissue regeneration. Tracheal replacement remains challenging but initial steps toward an ideal therapeutic concept have been made.
Collapse
Affiliation(s)
- Philipp Jungebluth
- Division of Ear, Nose, and Throat (CLINTEC), Advanced Center for Translational Regenerative Medicine (ACTREM), Karolinska Institutet, Alfred Nobel Allé 8, Huddinge/Stockholm 14186, Sweden
| | - Paolo Macchiarini
- Division of Ear, Nose, and Throat (CLINTEC), Advanced Center for Translational Regenerative Medicine (ACTREM), Karolinska Institutet, Alfred Nobel Allé 8, Huddinge/Stockholm 14186, Sweden.
| |
Collapse
|
29
|
Martinod E, Seguin A, Radu DM, Boddaert G, Chouahnia K, Fialaire-Legendre A, Dutau H, Vénissac N, Marquette CH, Baillard C, Valeyre D, Carpentier A. Airway transplantation: a challenge for regenerative medicine. Eur J Med Res 2013; 18:25. [PMID: 24059453 PMCID: PMC3750833 DOI: 10.1186/2047-783x-18-25] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2013] [Accepted: 06/20/2013] [Indexed: 12/11/2022] Open
Abstract
After more than 50 years of research, airway transplantation remains a major challenge in the fields of thoracic surgery and regenerative medicine. Five principal types of tracheobronchial substitutes, including synthetic prostheses, bioprostheses, allografts, autografts and bioengineered conduits have been evaluated experimentally in numerous studies. However, none of these works have provided a standardized technique for the replacement of the airways. More recently, few clinical attempts have offered encouraging results with ex vivo or stem cell-based engineered airways and tracheal allografts implanted after heterotopic revascularization. In 1997, we proposed a novel approach: the use of aortic grafts as a biological matrix for extensive airway reconstruction. In vivo regeneration of epithelium and cartilage were demonstrated in animal models. This led to the first human applications using cryopreserved aortic allografts that present key advantages because they are available in tissue banks and do not require immunosuppressive therapy. Favorable results obtained in pioneering cases have to be confirmed in larger series of patients with extensive tracheobronchial diseases.
Collapse
Affiliation(s)
- Emmanuel Martinod
- Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires Paris-Seine-Saint-Denis, Avicenne Hospital, Department of Thoracic and Vascular Surgery, Paris 13 University, Sorbonne Paris Cité, Faculty of Medicine SMBH, Bobigny, France
- Alain Carpentier Foundation, EA Laboratory for Biosurgical Research, Assistance Publique-Hôpitaux de Paris, George Pompidou European Hospital, Paris Descartes University, Paris, France
| | - Agathe Seguin
- Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires Paris-Seine-Saint-Denis, Avicenne Hospital, Department of Thoracic and Vascular Surgery, Paris 13 University, Sorbonne Paris Cité, Faculty of Medicine SMBH, Bobigny, France
- Alain Carpentier Foundation, EA Laboratory for Biosurgical Research, Assistance Publique-Hôpitaux de Paris, George Pompidou European Hospital, Paris Descartes University, Paris, France
| | - Dana M Radu
- Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires Paris-Seine-Saint-Denis, Avicenne Hospital, Department of Thoracic and Vascular Surgery, Paris 13 University, Sorbonne Paris Cité, Faculty of Medicine SMBH, Bobigny, France
- Alain Carpentier Foundation, EA Laboratory for Biosurgical Research, Assistance Publique-Hôpitaux de Paris, George Pompidou European Hospital, Paris Descartes University, Paris, France
| | - Guillaume Boddaert
- Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires Paris-Seine-Saint-Denis, Avicenne Hospital, Department of Thoracic and Vascular Surgery, Paris 13 University, Sorbonne Paris Cité, Faculty of Medicine SMBH, Bobigny, France
- Alain Carpentier Foundation, EA Laboratory for Biosurgical Research, Assistance Publique-Hôpitaux de Paris, George Pompidou European Hospital, Paris Descartes University, Paris, France
| | - Kader Chouahnia
- Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires Paris-Seine-Saint-Denis, Avicenne Hospital, Department of Oncology, Paris 13 University, Sorbonne Paris Cité, Faculty of Medicine SMBH, Bobigny, France
| | - Anne Fialaire-Legendre
- Assistance Publique-Hôpitaux de Paris, Saint Antoine Hospital, EFS Ile de France, Tissue Bank, Paris, France
| | - Hervé Dutau
- Assistance Publique-Hôpitaux de Marseille, Thoracic Oncology, Pleural Diseases and Interventional Pulmonology Department, North University Hospital, Marseille, France
| | - Nicolas Vénissac
- CHU Nice, Pasteur Hospital, Department of Thoracic Surgery, Nice, France
| | | | - Christophe Baillard
- Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires Paris-Seine-Saint-Denis, Avicenne Hospital, Department of Anesthesiology and Intensive Care, Paris 13 University, Sorbonne Paris Cité, Faculty of Medicine SMBH, Bobigny, France
| | - Dominique Valeyre
- Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires Paris-Seine-Saint-Denis, Avicenne Hospital, Department of Pneumonology, Paris 13 University, Sorbonne Paris Cité, Faculty of Medicine SMBH, Bobigny, France
| | - Alain Carpentier
- Alain Carpentier Foundation, EA Laboratory for Biosurgical Research, Assistance Publique-Hôpitaux de Paris, George Pompidou European Hospital, Paris Descartes University, Paris, France
| | | |
Collapse
|
30
|
Wurtz A, Hysi I, Copin MC. Tracheal regeneration: Myth or fact? J Thorac Cardiovasc Surg 2013; 145:1416-8. [DOI: 10.1016/j.jtcvs.2012.12.088] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2012] [Accepted: 12/11/2012] [Indexed: 12/01/2022]
|
31
|
Seguin A, Radu DM, Martinod E. Reply to the editor. J Thorac Cardiovasc Surg 2013; 145:1418-9. [PMID: 23597629 DOI: 10.1016/j.jtcvs.2013.01.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2012] [Accepted: 01/11/2013] [Indexed: 11/16/2022]
|
32
|
Jungebluth P, Haag JC, Lim ML, Lemon G, Sjöqvist S, Gustafsson Y, Ajalloueian F, Gilevich I, Simonson OE, Grinnemo KH, Corbascio M, Baiguera S, Del Gaudio C, Strömblad S, Macchiarini P. Verification of cell viability in bioengineered tissues and organs before clinical transplantation. Biomaterials 2013; 34:4057-4067. [PMID: 23473965 DOI: 10.1016/j.biomaterials.2013.02.057] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2013] [Accepted: 02/20/2013] [Indexed: 11/19/2022]
Abstract
The clinical outcome of transplantations of bioartificial tissues and organs depends on the presence of living cells. There are still no standard operative protocols that are simple, fast and reliable for confirming the presence of viable cells on bioartificial scaffolds prior to transplantation. By using mathematical modeling, we have developed a colorimetric-based system (colorimetric scale bar) to predict the cell viability and density for sufficient surface coverage. First, we refined a method which can provide information about cell viability and numbers in an in vitro setting: i) immunohistological staining by Phalloidin/DAPI and ii) a modified colorimetric cell viability assay. These laboratory-based methods and the developed colorimetric-based system were then validated in rat transplantation studies of unseeded and seeded tracheal grafts. This was done to provide critical information on whether the graft would be suitable for transplantation or if additional cell seeding was necessary. The potential clinical impact of the colorimetric scale bar was confirmed using patient samples. In conclusion, we have developed a robust, fast and reproducible colorimetric tool that can verify and warrant viability and integrity of an engineered tissue/organ prior to transplantation. This should facilitate a successful transplantation outcome and ensure patient safety.
Collapse
Affiliation(s)
- Philipp Jungebluth
- Advanced Center for Translational Regenerative Medicine (ACTREM), Karolinska Institutet, Huddinge, Stockholm, Sweden
| | - Johannes C Haag
- Advanced Center for Translational Regenerative Medicine (ACTREM), Karolinska Institutet, Huddinge, Stockholm, Sweden
| | - Mei L Lim
- Advanced Center for Translational Regenerative Medicine (ACTREM), Karolinska Institutet, Huddinge, Stockholm, Sweden
| | - Greg Lemon
- Advanced Center for Translational Regenerative Medicine (ACTREM), Karolinska Institutet, Huddinge, Stockholm, Sweden
| | - Sebastian Sjöqvist
- Advanced Center for Translational Regenerative Medicine (ACTREM), Karolinska Institutet, Huddinge, Stockholm, Sweden
| | - Ylva Gustafsson
- Advanced Center for Translational Regenerative Medicine (ACTREM), Karolinska Institutet, Huddinge, Stockholm, Sweden
| | - Fatemeh Ajalloueian
- Advanced Center for Translational Regenerative Medicine (ACTREM), Karolinska Institutet, Huddinge, Stockholm, Sweden
| | - Irina Gilevich
- Advanced Center for Translational Regenerative Medicine (ACTREM), Karolinska Institutet, Huddinge, Stockholm, Sweden
| | - Oscar E Simonson
- Department of Molecular Medicine and Surgery, Division of Cardiothoracic Surgery, Karolinska Institutet, Karolinska University Hospital, Solna, Stockholm, Sweden
| | - Karl H Grinnemo
- Department of Molecular Medicine and Surgery, Division of Cardiothoracic Surgery, Karolinska Institutet, Karolinska University Hospital, Solna, Stockholm, Sweden
| | - Matthias Corbascio
- Department of Molecular Medicine and Surgery, Division of Cardiothoracic Surgery, Karolinska Institutet, Karolinska University Hospital, Solna, Stockholm, Sweden
| | - Silvia Baiguera
- Advanced Center for Translational Regenerative Medicine (ACTREM), Karolinska Institutet, Huddinge, Stockholm, Sweden
| | - Costantino Del Gaudio
- University of Rome "Tor Vergata", Department of Industrial Engineering, Intrauniversitary Consortium for Material Science and Technology (INSTM), Research Unit "Tor Vergata", Rome, Italy
| | - Staffan Strömblad
- Center for Bioscience, Department of Biosciences and Nutrition, Karolinska Institutet, Huddinge, Stockholm, Sweden
| | - Paolo Macchiarini
- Advanced Center for Translational Regenerative Medicine (ACTREM), Karolinska Institutet, Huddinge, Stockholm, Sweden.
| |
Collapse
|