In Vivo Tissue Engineering of Human Airways

Abstract

This report documents the feasibility of in vivo tissue engineering for long-term functional airway transplantation in humans.

A reassessment of tracheal substitutes—a systematic review

“…The majority of bioprosthetic repairs have been patch repairs in which the bioprosthetic material is not used for circumferential repair or creation of a neo-trachea. Nonetheless, since 2001, the use of aortic interpositional grafts in circumferential repairs has been reported by four different groups of investigators and used in 11 individual patients (17)(18)(19)(20)(21)(22). Extracellular dermal matrix has been used only once in circumferential repair and was associated with graft migration requiring revision (23).…”

“…The most recent reports of aortic homograft repair have come from Martinod et al Repair was accomplished in two patients with benign laryngeal tracheal stenosis through aortic homograft reconstruction supported by Nitinol stents and buttressed with strap muscle (22). Importantly, Martinod preserved the membranous portion of the native trachea in their repair and used aortic grafts preserved at −80 ℃ rather than the standard −150 ℃.…”

“…The group reported eventual stent removal between 15 and 39 months with the regeneration of cartilage within the graft. The authors proposed an "in vivo tissue engineering" mechanism in which retained growth and angiogenic factors with within the donor extracellular matrix are released and lead to the migration, proliferation, and differentiation of host cells (22). While these early results are exciting the robustness of this type of repair and the underlying mechanism require further study and validation, especially if it is to be used in patients with underlying malignancy, in which the repair will be further stressed by adjuvant therapy.…”

“…An additional pediatric patient with multiple congenital abnormalities of the airway as well as multiple prior interventions underwent treatment with a tissue engineered tracheal conduit in 2012 (22). In this case, the decellularized cadaveric tracheal graft was seeded over a period of 48 hours in a bioreactor with expanded bone marrow-derived mesenchymal stromal cells as well as autologous respiratory epithelial cell obtained from mucosal biopsies of the nasal septum.…”

Bioprosthetics and repair of complex aerodigestive defects

“…In patients who underwent treatment with aortic homograft, bioprosthetic repair was limited to the trachea and bronchus (5,18,(27)(28)(29)(30)(31). The underlying pathology within this group was more heterogeneous than that of patients repaired with acellular dermal matrix and included a substantial percent with tracheal neoplastic disease (42%).…”