Circumferential esophageal replacement using a tube-shaped tissue-engineered substitute: An experimental study in minipigs

Poghosyan, Tigran; Sfeir, Rony; Michaud, Laurent; Bruneval, Patrick; Domet, Thomas; Vanneaux, Valérie; Luong-Nguyen, M.; Gaujoux, Sébastien; Gottrand, Frédéric; Larghero, Jérôme; Cattan, Pierre

doi:10.1016/j.surg.2015.01.020

Cited by 37 publications

(30 citation statements)

References 41 publications

(50 reference statements)

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“…Similarly, circumferential replacement of the cervical esophagus was achieved using a tube-shaped tissue-engineered acellular substitute with autologous skeletal myoblasts covered by a human amniotic membrane seeded with autologous oral epithelial cells. Under the temporary cover of an esophageal endoprothesis, which was removed at 6 months, animals were able to reach nutritional autonomy and at sacrifice the tissue remodeled toward an esophageal phenotype (75). …”

Section: The Role Of Stem Cell Therapy and Tissue Engineering In The mentioning

confidence: 99%

Update on Foregut Molecular Embryology and Role of Regenerative Medicine Therapies

et al. 2017

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Esophageal atresia (OA) represents one of the commonest and most severe developmental disorders of the foregut, the most proximal segment of the gastrointestinal (GI) tract (esophagus and stomach) in embryological terms. Of intrigue is the common origin from this foregut of two very diverse functional entities, the digestive and respiratory systems. OA appears to result from incomplete separation of the ventral and dorsal parts of the foregut during development, resulting in disruption of esophageal anatomy and frequent association with tracheo-oesophageal fistula. Not surprisingly, and likely inherent to OA, are associated abnormalities in components of the enteric neuromusculature and ultimately loss of esophageal functional integrity. An appreciation of such developmental processes and associated defects has not only enhanced our understanding of the etiopathogenesis underlying such devastating defects but also highlighted the potential of novel corrective therapies. There has been considerable progress in the identification and propagation of neural crest stem cells from the GI tract itself or derived from pluripotent cells. Such cells have been successfully transplanted into models of enteric neuropathy confirming their ability to functionally integrate and replenish missing or defective enteric nerves. Combinatorial approaches in tissue engineering hold significant promise for the generation of organ-specific scaffolds such as the esophagus with current initiatives directed toward their cellularization to facilitate optimal function. This chapter outlines the most current understanding of the molecular embryology underlying foregut development and OA, and also explores the promise of regenerative medicine.

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Section: The Role Of Stem Cell Therapy and Tissue Engineering In The mentioning

confidence: 99%

Update on Foregut Molecular Embryology and Role of Regenerative Medicine Therapies

et al. 2017

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“…We look forward to reading the outlined large animal investigation using a cryopreserved allograft and hope to see biomechanical data to compare with our decellularized method. An omental-flap wrap is a useful technique prior to transplantation, as has been reported in bladder, bowel, and esophageal replacement (2)(3)(4); however, because of the emergent nature of our case, prevascularization was not possible. Instead, part of the omentum was transposed at the point of transplantation (5).…”

Section: Reply To: "Recent Advances In Circumferential Tracheal Replamentioning

confidence: 81%

Reply to: “Recent Advances in Circumferential Tracheal Replacement and Transplantation”

Hamilton

KANANI

Roebuck

et al. 2016

American Journal of Transplantation

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We would like to thank Wurtz and colleagues for their comments on our article documenting the 4-year follow-up of the first tissue-engineered total tracheal replacement in a child (1). Although the fate of the tracheal allograft cannot be determined with certainty, serial endoscopy and computed tomography indicated that the graft embedded within the stent and remodeled over time, with growth occurring at the proximal and distal nonstented areas (Figure 1). Despite the loss of mechanical integrity when using a decellularized method, this case remains the most successful circumferential total tracheal replacement reported, albeit after several months of intensive treatment and the need for stenting. We look forward to reading the outlined large animal investigation using a cryopreserved allograft and hope to see biomechanical data to compare with our decellularized method. An omental-flap wrap is a useful technique prior to transplantation, as has been reported in bladder, bowel, and esophageal replacement (2-4); however, because of the emergent nature of our case, prevascularization was not possible. Instead, part of the omentum was transposed at the point of transplantation (5).Examples of circumferential tissue-engineered tracheal replacements to date have been limited by an ineffective mucosal layer. Respiratory mucosa provide a barrier against infection, allow for mucociliary clearance and may reduce fibroblastic infiltrate and subsequent stenosis (6). The use of an acellular stented allograft, as proposed by Wurtz and colleagues, might be possible in short segment replacements in which the distance for reepithelialization from the wound edge is small; however, conventional surgical techniques can currently address short segment disease. We would have concerns about adopting such an approach in a longsegment or total tracheal replacement in all but the most extreme circumstances because the length of time needed for reepithelialization-in our case, >12 months despite intraoperative attempts at epithelializationplaces the patient at risk of complications from infection, granulation and mucus retention. More research is needed into the isolation and expansion of epithelium for mucosal regeneration and into methods that reconstruct and deliver a functional mucosal layer within bioengineered airways.

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“…) to promote early vascularization, this substitute was used to bridge 5‐cm circumferential esophageal defects in minipigs. Under the temporary cover of an esophageal endoprosthesis, both the recovery of nutritional autonomy and tissue remodeling toward an esophageal phenotype were observed …”

Section: Full‐thickness Esophageal Te Using Scaffolds and Stem Cellsmentioning

confidence: 99%

“…Under the temporary cover of an esophageal endoprosthesis, both the recovery of nutritional autonomy and tissue remodeling toward an esophageal phenotype were observed. 40 Current interest in using MSCs for esophageal regeneration is based on the multipotency of such cells, that is, their ability to develop into several cell types and differentiate into the osteocyte, chondrocyte, and adipocyte lineages, 41 which is of particular interest for esophageal TE. Moreover, MSCs secrete a variety of growth factors, cytokines, and exosomes 42 that contribute to the induction of neovascularization and regulation of immune cell activities, as well as exhibit chemoattractive and anti-inflammatory properties.…”

Section: Full-thickness Esophageal Te Using Scaffolds and Stem Cellsmentioning

confidence: 99%

Esophageal tissue engineering: from bench to bedside

Arakélian

Kanai

Dua

et al. 2018

Annals of the New York Academy of Sciences

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For various esophageal diseases, the search for alternative techniques for tissue repair has led to significant developments in basic and translational research in the field of tissue engineering. Applied to the esophagus, this concept is based on the in vitro combination of elements judged necessary for in vivo implantation to promote esophageal tissue remodeling. Different methods are currently being explored to develop substitutes using cells, scaffolds, or a combination of both, according to the severity of lesions to be treated. In this review, we discuss recent advances in (1) cell sheet technology for preventing stricture after extended esophageal mucosectomy and (2) full‐thickness circumferential esophageal replacement using tissue‐engineered substitutes.

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Circumferential esophageal replacement using a tube-shaped tissue-engineered substitute: An experimental study in minipigs

Cited by 37 publications

References 41 publications

Update on Foregut Molecular Embryology and Role of Regenerative Medicine Therapies

Update on Foregut Molecular Embryology and Role of Regenerative Medicine Therapies

Reply to: “Recent Advances in Circumferential Tracheal Replacement and Transplantation”

Esophageal tissue engineering: from bench to bedside

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