Clinical applications of decellularized extracellular matrices for tissue engineering and regenerative medicine

Abstract

Decellularization is the process of removing the cellular components from tissues or organs. It is a promising technology for obtaining a biomaterial with a highly preserved extracellular matrix (ECM), which may also act as a biological scaffold for tissue engineering and regenerative therapies. Decellularized products are gaining clinical importance and market space due to their ease of standardized production, constant availability for grafting and mechanical or biochemical superiority against competing clinical options, yielding clinical results ahead of the ones with autografts in some applications. Current drawbacks and limitations of traditional treatments and clinical applications can be overcome by using decellularized or acellular matrices. Several companies are leading the market with versatile acellular products designed for diverse use in the reconstruction of tissues and organs. This review describes ECM-based decellularized and acellular products that are currently in use for different branches of clinic.

Cartilage extracellular matrix as a biomaterial for cartilage regeneration

“…Eliminating the donor cells with decellularization processes is thought to be desirable to reduce the risk of disease transmission and an immune response from the recipient. Decellularizing ECM scaffolds is intended to remove immunogenic antigens and has been successfully used with other tissues, such as human dermis and porcine heart valves, that are approved for human use and in clinical use . However, the limited porosity of cartilage matrices makes decellularization procedures less efficient because reagents may not adequately penetrate into dense cartilage matrices.…”

“…Decellularizing ECM scaffolds is intended to remove immunogenic antigens and has been successfully used with other tissues, such as human dermis and porcine heart valves, that are approved for human use and in clinical use. 12 However, the limited porosity of cartilage matrices makes decellularization procedures less efficient because reagents may not adequately penetrate into dense cartilage matrices. Various research groups have adapted different decellularization protocols on the basis of other tissue decellularization techniques and combated this problem by physically breaking down the matrix into fragments to increase surface area and enhance permeation into the matrix.…”

A novel technique for decellularization of allogenic nerves and in vivo study of their use for peripheral nerve reconstruction

“…Acellular nerve allografts (ANAs) rather than fresh allografts, do not need immunosuppression and appear to be safe and effective based on recent clinical studies [11,12]. Using the natural structure of the peripheral nerves means exploiting a highly preserved extracellular matrix (ECM) [13,14], which has been cleared from degenerated cells and axons. It is expected that, by eliminating the cell remnants, the ANA antigenicity could substantially decrease but the nerve regeneration could be increased by Schwann cell migration and neural outgrowth into the preserved basal lamina [15].…”

Implications of Extracellular Matrix Production by Adipose Tissue-Derived Stem Cells for Development of Wound Healing Therapies

“…There are various commercially available ECM-derived materials that are routinely used for the treatment of burns and chronic wounds, including materials obtained by the decellularization of animal tissues, such as porcine or bovine skin [68,69], or from allogeneic human skin [70]. A more detailed review of the variety of decellularized ECM scaffolds that are currently available for clinical use can be found in the literature [71]. Despite the relatively high success rates associated with these materials, some issues may still appear, such as sustained inflammatory responses and incomplete healing due to poor integrity of the native ECM molecules after decellularization [72].…”