1
|
Ramaraju H, Sferra SR, Kunisaki SM, Hollister SJ. Finite element analysis of esophageal atresia repair with biodegradable polymer sleeves. J Mech Behav Biomed Mater 2022; 133:105349. [DOI: 10.1016/j.jmbbm.2022.105349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 06/20/2022] [Accepted: 06/28/2022] [Indexed: 10/17/2022]
|
2
|
Abstract
INTRODUCTION Long gap pure esophageal atresia (LGPEA) is a congenital disorder in which the esophagus is in discontinuity, and the proximal and distal ends cannot be anastomosed in a primary fashion. No animal model for pure esophageal atresia exists. Here we describe a survival animal model for LGPEA, which will ultimately serve to test novel devices and techniques to restore continuity. METHODS A non-survival study was first conducted in six rabbits to refine a protocol for the survival model. An open gastrostomy tube was placed, followed by a partial esophagectomy. Next, a survival study was performed with seven rabbits in which the same procedures were performed. Finally, the procedure was optimized in domestic swine. RESULTS Despite developing the techniques and gaining valuable information in the non-survival study, none of the rabbits in the survival portion of the study lived beyond post-operative day four. Due to this complication with the rabbit, the LGPEA model was attempted in a porcine model. The pig survived to post-operative day ten, and was healthy enough to be used for further study. CONCLUSION A porcine model of long gap pure esophageal atresia was developed which is effective and feasible to be used for testing new methods of treatment of LGPEA.
Collapse
|
3
|
Jönsson L, Dellenmark Blom M, Friberg L, Gatzinsky V, Holmquist O, Jennische E, Sandin A, Abrahamsson K. Macrophage Phenotype Is Associated With the Regenerative Response in Experimental Replacement of the Porcine Esophagus. Artif Organs 2015; 40:950-958. [PMID: 26667982 DOI: 10.1111/aor.12652] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
A porcine model for bridging circumferential defects in the intrathoracic esophagus has been developed in order to improve the treatment of children born with long-gap esophageal atresia. The aim of this study was to identify factors beneficial for tissue regeneration in the bridging area in this model and to describe the histological progression 20 days after replacement with a silicone-stented Biodesign mesh. Resection of 3 cm of intrathoracic esophagus and replacement with a bridging graft was performed in six newly weaned piglets. They were fed through a gastrostomy for 10 days, and then had probe formula orally for another 10 days prior to sacrifice. Two out of six piglets had stent loss prior to sacrifice. In the four piglets with the stent in place, a tissue tube, with visible muscle in the wall, was seen at sacrifice. Histology showed that the wall of the healing area was well organized with layers of inflammatory cells, in-growing vessels, and smooth muscle cells. CD163+ macrophages was seen toward the esophageal lumen. In the animals where the stent was lost, the bridging area was narrow, and histology showed a less organized structure in the bridging area without the presence of CD163+ macrophages. This study indicates that regenerative healing was seen in the porcine esophagus 20 days after replacement of a part of the intrathoracic esophagus with a silicone-stented Biodesign mesh, if the bridging graft is retained. If the graft is lost, the inflammatory pattern changes with invasion of proinflammatory, M1 macrophages in the entire wall, which seems to redirect the healing process toward scar formation.
Collapse
Affiliation(s)
- Linus Jönsson
- Institute of Clinical Sciences, Department of Pediatric Surgery, University of Gothenburg, Gothenburg, Sweden.
| | - Michaela Dellenmark Blom
- Institute of Clinical Sciences, Department of Pediatric Surgery, University of Gothenburg, Gothenburg, Sweden
| | - Lars Friberg
- Institute of Clinical Sciences, Department of Pediatric Surgery, University of Gothenburg, Gothenburg, Sweden
| | - Vladimir Gatzinsky
- Institute of Clinical Sciences, Department of Pediatric Surgery, University of Gothenburg, Gothenburg, Sweden
| | - Olof Holmquist
- Institute of Clinical Sciences, Department of Pediatric Surgery, University of Gothenburg, Gothenburg, Sweden
| | - Eva Jennische
- Institute of Biomedicine, Department of Medical Biochemistry and Cell Biology, University of Gothenburg, Gothenburg, Sweden
| | - Anders Sandin
- Institute of Clinical Sciences, Department of Pediatric Surgery, University of Gothenburg, Gothenburg, Sweden
| | - Kate Abrahamsson
- Institute of Clinical Sciences, Department of Pediatric Surgery, University of Gothenburg, Gothenburg, Sweden
| |
Collapse
|
4
|
Algarrahi K, Franck D, Ghezzi CE, Cristofaro V, Yang X, Sullivan MP, Chung YG, Affas S, Jennings R, Kaplan DL, Estrada CR, Mauney JR. Acellular bi-layer silk fibroin scaffolds support functional tissue regeneration in a rat model of onlay esophagoplasty. Biomaterials 2015; 53:149-59. [PMID: 25890715 DOI: 10.1016/j.biomaterials.2015.02.092] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2014] [Revised: 02/18/2015] [Accepted: 02/21/2015] [Indexed: 02/07/2023]
Abstract
Surgical management of long-gap esophageal defects with autologous gastrointestinal tissues is frequently associated with adverse complications including organ dysmotility, dysphagia, and donor site morbidity. In order to develop alternative graft options, bi-layer silk fibroin (SF) scaffolds were investigated for their potential to support functional tissue regeneration in a rodent model of esophageal repair. Onlay esophagoplasty was performed with SF matrices (N = 40) in adult rats for up to 2 m of implantation. Parallel groups consisted of animals implanted with small intestinal submucosa (SIS) scaffolds (N = 22) or sham controls receiving esophagotomy alone (N = 20). Sham controls exhibited a 100% survival rate while rats implanted with SF and SIS scaffolds displayed respective survival rates of 93% and 91% prior to scheduled euthanasia. Animals in each experimental group were capable of solid food consumption following a 3 d post-op liquid diet and demonstrated similar degrees of weight gain throughout the study period. End-point μ-computed tomography at 2 m post-op revealed no evidence of contrast extravasation, fistulas, strictures, or diverticula in any of the implant groups. Ex vivo tissue bath studies demonstrated that reconstructed esophageal conduits supported by both SF and SIS scaffolds displayed contractile responses to carbachol, KCl and electrical field stimulation while isoproterenol produced tissue relaxation. Histological (Masson's trichrome and hematoxylin and eosin) and immunohistochemical (IHC) evaluations demonstrated both implant groups produced de novo formation of skeletal and smooth muscle bundles positive for contractile protein expression [fast myosin heavy chain (MY32) and α-smooth muscle actin (α-SMA)] within the graft site. However, SF matrices promoted a significant 4-fold increase in MY32+ skeletal muscle and a 2-fold gain in α-SMA+ smooth muscle in comparison to the SIS cohort as determined by histomorphometric analyses. A stratified squamous, keratinized epithelium expressing cytokeratin 5 and involucrin proteins was also present at 2 m post-op in all experimental groups. De novo innervation and vascularization were evident in all regenerated tissues indicated by the presence of synaptophysin (SYP38)+ boutons and vessels lined with CD31 expressing endothelial cells. In respect to SIS, the SF group supported a significant 4-fold increase in the density of SYP38+ boutons within the implant region. Evaluation of host tissue responses revealed that SIS matrices elicited chronic inflammatory reactions and severe fibrosis throughout the neotissues, in contrast to SF scaffolds. The results of this study demonstrate that bi-layer SF scaffolds represent promising biomaterials for onlay esophagoplasty, capable of producing superior regenerative outcomes in comparison to conventional SIS scaffolds.
Collapse
Affiliation(s)
- Khalid Algarrahi
- Urological Diseases Research Center, Boston Children's Hospital, Boston, MA 02115, USA; Department of Surgery, Harvard Medical School, Boston, MA 02115, USA
| | - Debra Franck
- Urological Diseases Research Center, Boston Children's Hospital, Boston, MA 02115, USA
| | - Chiara E Ghezzi
- Department of Biomedical Engineering, Tufts University, Medford, MA 02155, USA
| | - Vivian Cristofaro
- Department of Surgery, Harvard Medical School, Boston, MA 02115, USA; Division of Urology, Veterans Administration Boston Healthcare System, West Roxbury, MA 02132, USA; Department of Surgery, Brigham and Women's Hospital, Boston, MA 02115, USA
| | - Xuehui Yang
- Urological Diseases Research Center, Boston Children's Hospital, Boston, MA 02115, USA
| | - Maryrose P Sullivan
- Department of Surgery, Harvard Medical School, Boston, MA 02115, USA; Division of Urology, Veterans Administration Boston Healthcare System, West Roxbury, MA 02132, USA; Department of Surgery, Brigham and Women's Hospital, Boston, MA 02115, USA
| | - Yeun Goo Chung
- Urological Diseases Research Center, Boston Children's Hospital, Boston, MA 02115, USA; Department of Surgery, Harvard Medical School, Boston, MA 02115, USA
| | - Saif Affas
- Urological Diseases Research Center, Boston Children's Hospital, Boston, MA 02115, USA; Department of Surgery, Harvard Medical School, Boston, MA 02115, USA
| | - Russell Jennings
- Department of Surgery, Harvard Medical School, Boston, MA 02115, USA
| | - David L Kaplan
- Department of Biomedical Engineering, Tufts University, Medford, MA 02155, USA
| | - Carlos R Estrada
- Urological Diseases Research Center, Boston Children's Hospital, Boston, MA 02115, USA; Department of Surgery, Harvard Medical School, Boston, MA 02115, USA.
| | - Joshua R Mauney
- Urological Diseases Research Center, Boston Children's Hospital, Boston, MA 02115, USA; Department of Surgery, Harvard Medical School, Boston, MA 02115, USA.
| |
Collapse
|
5
|
Takase K, Aikawa M, Okada K, Watanabe Y, Okamoto K, Sato H, Nonaka K, Yamaguchi S, Sakuramoto S, Koyama I, Miyazawa M. Development of novel treatment with a bioabsorbable esophageal patch for benign esophageal stricture. Dis Esophagus 2014; 28:728-34. [PMID: 25286827 DOI: 10.1111/dote.12281] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Using a large animal model, we examined whether circumferential stricture after esophageal endoscopic submucosal dissection (ESD) can be treated by grafting a bioabsorbable esophageal patch. Circumferential ESD was performed on the thoracic esophagus in pigs (n = 6) to create a stricture, for which one of the following interventions was performed: (1) the stricture site was longitudinally incised, and an artificial esophageal wall (AEW) was grafted after placing a bioabsorbable stent (AEW patch group, n = 3); (2) endoscopic balloon dilation (EBD) was performed every other week after stricture development (EBD group, n = 3). In both groups, esophageal fluoroscopy was performed 8 weeks after the interventions, and the esophagus was excised for histological examination of the patched site. In the AEW patch group, esophageal fluoroscopy revealed favorable passage through the patched site. Histologically, the mucosal epithelium and lamina propria had regenerated as in the normal area. In the EBD group, the circumferential stricture site showed marked thickening, and there were hypertrophic scars associated with epithelial defects on the luminal surface. Histologically, defects of the mucosal epithelium and full-thickness proliferation of connective tissue were observed. AEW patch grafting was suggested to be a potentially novel treatment strategy for post-ESD esophageal circumferential stricture.
Collapse
Affiliation(s)
- K Takase
- Department of Surgery, Gastrointestinal Center, Saitama Medical University, International Medical Center, Saitama, Japan
| | - M Aikawa
- Department of Surgery, Gastrointestinal Center, Saitama Medical University, International Medical Center, Saitama, Japan
| | - K Okada
- Department of Surgery, Gastrointestinal Center, Saitama Medical University, International Medical Center, Saitama, Japan
| | - Y Watanabe
- Department of Surgery, Gastrointestinal Center, Saitama Medical University, International Medical Center, Saitama, Japan
| | - K Okamoto
- Department of Surgery, Gastrointestinal Center, Saitama Medical University, International Medical Center, Saitama, Japan
| | - H Sato
- Department of Surgery, Gastrointestinal Center, Saitama Medical University, International Medical Center, Saitama, Japan
| | - K Nonaka
- Department of Surgery, Gastrointestinal Center, Saitama Medical University, International Medical Center, Saitama, Japan
| | - S Yamaguchi
- Department of Surgery, Gastrointestinal Center, Saitama Medical University, International Medical Center, Saitama, Japan
| | - S Sakuramoto
- Department of Surgery, Gastrointestinal Center, Saitama Medical University, International Medical Center, Saitama, Japan
| | - I Koyama
- Department of Surgery, Gastrointestinal Center, Saitama Medical University, International Medical Center, Saitama, Japan
| | - M Miyazawa
- Department of Surgery, Gastrointestinal Center, Saitama Medical University, International Medical Center, Saitama, Japan
| |
Collapse
|
6
|
Sjöqvist S, Jungebluth P, Lim ML, Haag JC, Gustafsson Y, Lemon G, Baiguera S, Burguillos MA, Del Gaudio C, Rodríguez AB, Sotnichenko A, Kublickiene K, Ullman H, Kielstein H, Damberg P, Bianco A, Heuchel R, Zhao Y, Ribatti D, Ibarra C, Joseph B, Taylor DA, Macchiarini P. Experimental orthotopic transplantation of a tissue-engineered oesophagus in rats. Nat Commun 2014; 5:3562. [PMID: 24736316 PMCID: PMC4354271 DOI: 10.1038/ncomms4562] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2013] [Accepted: 03/05/2014] [Indexed: 12/22/2022] Open
Abstract
A tissue-engineered oesophageal scaffold could be very useful for the treatment of pediatric and adult patients with benign or malignant diseases such as carcinomas, trauma or congenital malformations. Here we decellularize rat oesophagi inside a perfusion bioreactor to create biocompatible biological rat scaffolds that mimic native architecture, resist mechanical stress and induce angiogenesis. Seeded allogeneic mesenchymal stromal cells spontaneously differentiate (proven by gene-, protein and functional evaluations) into epithelial- and muscle-like cells. The reseeded scaffolds are used to orthotopically replace the entire cervical oesophagus in immunocompetent rats. All animals survive the 14-day study period, with patent and functional grafts, and gain significantly more weight than sham-operated animals. Explanted grafts show regeneration of all the major cell and tissue components of the oesophagus including functional epithelium, muscle fibres, nerves and vasculature. We consider the presented tissue-engineered oesophageal scaffolds a significant step towards the clinical application of bioengineered oesophagi.
Collapse
Affiliation(s)
- Sebastian Sjöqvist
- 1] Advanced Center for Translational Regenerative Medicine (ACTREM), Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, SE-141 86, Stockholm, Sweden [2] Division of Ear, Nose and Throat, Karolinska University Hospital, SE-141 86 Stockholm, Sweden
| | - Philipp Jungebluth
- 1] Advanced Center for Translational Regenerative Medicine (ACTREM), Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, SE-141 86, Stockholm, Sweden [2] Division of Ear, Nose and Throat, Karolinska University Hospital, SE-141 86 Stockholm, Sweden
| | - Mei Ling Lim
- 1] Advanced Center for Translational Regenerative Medicine (ACTREM), Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, SE-141 86, Stockholm, Sweden [2] Division of Ear, Nose and Throat, Karolinska University Hospital, SE-141 86 Stockholm, Sweden
| | - Johannes C Haag
- 1] Advanced Center for Translational Regenerative Medicine (ACTREM), Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, SE-141 86, Stockholm, Sweden [2] Division of Ear, Nose and Throat, Karolinska University Hospital, SE-141 86 Stockholm, Sweden
| | - Ylva Gustafsson
- 1] Advanced Center for Translational Regenerative Medicine (ACTREM), Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, SE-141 86, Stockholm, Sweden [2] Division of Ear, Nose and Throat, Karolinska University Hospital, SE-141 86 Stockholm, Sweden
| | - Greg Lemon
- Advanced Center for Translational Regenerative Medicine (ACTREM), Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, SE-141 86, Stockholm, Sweden
| | - Silvia Baiguera
- Advanced Center for Translational Regenerative Medicine (ACTREM), Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, SE-141 86, Stockholm, Sweden
| | | | - Costantino Del Gaudio
- Department of Industrial Engineering, Intrauniversitary Consortium for Material Science and Technology (INSTM) Research Unit Tor Vergata, University of Rome, Rome 00133, Italy
| | - Antonio Beltrán Rodríguez
- 1] Advanced Center for Translational Regenerative Medicine (ACTREM), Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, SE-141 86, Stockholm, Sweden [2] Division of Ear, Nose and Throat, Karolinska University Hospital, SE-141 86 Stockholm, Sweden
| | - Alexander Sotnichenko
- International Scientific-Research Clinical and Educational Center of Regenerative Medicine, Kuban State Medical University, Krasnodar 350040, Russian Federation
| | - Karolina Kublickiene
- 1] Center for Gender Medicine, Karolinska Institutet, SE-141 86 Stockholm, Sweden [2] Division of Obstetrics and Gynecology, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, SE-141 86 Stockholm, Sweden
| | - Henrik Ullman
- Department of Neuroscience, Karolinska Institutet, SE-171 77 Stockholm, Sweden
| | - Heike Kielstein
- Department of Anatomy and Cell Biology, Faculty of Medicine, Martin Luther University Halle-Wittenberg, 06108 Halle (Saale), Germany
| | - Peter Damberg
- Division of Medical Imaging and Technology, Department of Clinical Science, Intervention and Technology (CLINTEC) Karolinska Institutet, SE-171 77 Stockholm, Sweden
| | - Alessandra Bianco
- Department of Industrial Engineering, Intrauniversitary Consortium for Material Science and Technology (INSTM) Research Unit Tor Vergata, University of Rome, Rome 00133, Italy
| | - Rainer Heuchel
- 1] Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, SE-141 86 Stockholm, Sweden [2] Center of Biosciences, Karolinska Institutet, SE-141 86 Stockholm, Sweden
| | - Ying Zhao
- 1] Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, SE-141 86 Stockholm, Sweden [2] Center of Biosciences, Karolinska Institutet, SE-141 86 Stockholm, Sweden
| | - Domenico Ribatti
- Department of Basic Medical Sciences, Neurosciences and Sensory Organs, University of Bari Medical School, National Cancer Institute 'Giovanni Paolo II', Bari 70121, Italy
| | - Cristián Ibarra
- Department of Medical Biochemistry and Biophysics, Karolinska Institutet, SE-171 77 Stockholm, Sweden
| | - Bertrand Joseph
- Cancer Centrum Karolinska, Karolinska Institutet, SE-171 77 Stockholm, Sweden
| | - Doris A Taylor
- Texas Heart Institute, Center for Regenerative Medicine, Houston, Texas 770-30, USA
| | - Paolo Macchiarini
- 1] Advanced Center for Translational Regenerative Medicine (ACTREM), Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, SE-141 86, Stockholm, Sweden [2] Division of Ear, Nose and Throat, Karolinska University Hospital, SE-141 86 Stockholm, Sweden
| |
Collapse
|
7
|
Jönsson L, Friberg LG, Gatzinsky V, Jennische E, Sandin A, Abrahamsson K. Early Regenerative Response in the Intrathoracic Porcine Esophagus-The Impact of the Inflammation. Artif Organs 2013; 38:439-46. [DOI: 10.1111/aor.12216] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
- Linus Jönsson
- Department of Pediatric Surgery, The Queen Silvia Children's Hospital; The Sahlgrenska Academy at University of Gothenburg; Gothenburg Sweden
| | - Lars-Göran Friberg
- Department of Pediatric Surgery, The Queen Silvia Children's Hospital; The Sahlgrenska Academy at University of Gothenburg; Gothenburg Sweden
| | - Vladimir Gatzinsky
- Department of Pediatric Surgery, The Queen Silvia Children's Hospital; The Sahlgrenska Academy at University of Gothenburg; Gothenburg Sweden
| | - Eva Jennische
- Department of Medical Chemistry and Cell Biology, Institute of Biomedicine; University of Gothenburg; Gothenburg Sweden
| | - Anders Sandin
- Department of Pediatric Surgery, The Queen Silvia Children's Hospital; The Sahlgrenska Academy at University of Gothenburg; Gothenburg Sweden
| | - Kate Abrahamsson
- Department of Pediatric Surgery, The Queen Silvia Children's Hospital; The Sahlgrenska Academy at University of Gothenburg; Gothenburg Sweden
| |
Collapse
|
8
|
Lim ML, Jungebluth P, Ajalloueian F, Friedrich LH, Gilevich I, Grinnemo KH, Gubareva E, Haag JC, Lemon G, Sjöqvist S, Caplan AL, Macchiarini P. Whole organ and tissue reconstruction in thoracic regenerative surgery. Mayo Clin Proc 2013; 88:1151-66. [PMID: 24079685 DOI: 10.1016/j.mayocp.2013.03.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2012] [Revised: 03/09/2013] [Accepted: 03/15/2013] [Indexed: 12/25/2022]
Abstract
Development of novel prognostic, diagnostic, and treatment options will provide major benefits for millions of patients with acute or chronic respiratory dysfunction, cardiac-related disorders, esophageal problems, or other diseases in the thorax. Allogeneic organ transplant is currently available. However, it remains a trap because of its dependency on a very limited supply of donated organs, which may be needed for both initial and subsequent transplants. Furthermore, it requires lifelong treatment with immunosuppressants, which are associated with adverse effects. Despite early clinical applications of bioengineered organs and tissues, routine implementation is still far off. For this review, we searched the PubMed, MEDLINE, and Ovid databases for the following keywords for each tissue or organ: tissue engineering, biological and synthetic scaffold/graft, acellular and decelluar(ized), reseeding, bioreactor, tissue replacement, and transplantation. We identified the current state-of-the-art practices in tissue engineering with a focus on advances during the past 5 years. We discuss advantages and disadvantages of biological and synthetic solutions and introduce novel strategies and technologies for the field. The ethical challenges of innovation in this area are also reviewed.
Collapse
Affiliation(s)
- Mei Ling Lim
- Advanced Center for Translational Regenerative Medicine, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
9
|
A bioabsorbable polymer patch for the treatment of esophageal defect in a porcine model. J Gastroenterol 2013; 48:822-9. [PMID: 23229769 DOI: 10.1007/s00535-012-0716-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2012] [Accepted: 11/08/2012] [Indexed: 02/04/2023]
Abstract
BACKGROUND Although several materials have been used to replace the esophagus, none of the materials appears to be feasible for clinical use. Our group has developed a bioabsorbable polymer that can be used to repair the defects of stomach, small intestine, biliary tract, and veins. In this study, we implanted a bioabsorbable polymer patch (BAPP) into an esophageal defect and we investigated the clinical utility of BAPP and evaluated the process of esophageal regeneration. METHODS Pigs (n = 9) underwent right thoracotomy under general anesthesia. A 4 × 2-cm oval-shaped portion of the esophageal wall was excised, and a BAPP was implanted at the excision site. Esophageal endoscopy was performed at 2 weeks after the implantation. At 4, 8, and 12 weeks after implantation, the whole esophagus was resected for gross and histological examinations of the graft sites. RESULT Esophageal endoscopy at 2 weeks revealed a tiny ulceration at the implantation site with no stenosis. At 4 weeks, the epithelium at the graft site was similar to that of the native esophagus, but it lacked a proper muscle layer. At 8 weeks, a rough muscle layer had developed. At 12 weeks, normal mucosa and a proper muscle layer similar to that of the native wall were confirmed. CONCLUSION BAPP repaired the defective esophageal wall without complications, and a neo esophageal wall identical to the native esophageal wall had formed by 12 weeks after implantation. Hence, this newly designed substitute has the potential for application as a novel treatment for defective esophagus.
Collapse
|
10
|
Andrée B, Bär A, Haverich A, Hilfiker A. Small intestinal submucosa segments as matrix for tissue engineering: review. TISSUE ENGINEERING PART B-REVIEWS 2013; 19:279-91. [PMID: 23216258 DOI: 10.1089/ten.teb.2012.0583] [Citation(s) in RCA: 70] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Tissue engineering (TE) is an emerging interdisciplinary field aiming at the restoration or improvement of impaired tissue function. A combination of cells, scaffold materials, engineering methods, and biochemical and physiological factors is employed to generate the desired tissue substitute. Scaffolds often play a pivotal role in the engineering process supporting a three-dimensional tissue formation. The ideal scaffold should mimic the native extracellular environment providing mechanical and biological properties to allow cell attachment, migration, and differentiation, as well as remodeling by the host organism. The scaffold should be nonimmunogenic and should ideally be resorbed by the host over time, leaving behind only the regenerated tissue. More than 40 years ago, a preparation of the small intestine was introduced for the replacement of vascular structures. Since then the small intestinal submucosa (SIS) has gained a lot of interest in TE and subsequent clinical applications, as this material exhibits key features of a highly supportive scaffold. This review will focus on the general properties of the SIS and its applications in therapeutical approaches as well as in generating tissue substitutes in vitro. Furthermore, the main problem of TE, which is the insufficient nourishment of cells within three-dimensional, artificial tissues exceeding certain dimensions is addressed. To solve this issue the implementation of another small intestine-derived preparation, the biological vascularized matrix (BioVaM), could be a feasible option. The BioVaM comprises in addition to SIS the arterial and venous mesenteric pedicles and exhibits thereby a perfusable vessel bed that is preserved after decellularization.
Collapse
|