Translating tissue-engineered tracheal replacement from bench to bedside

Abstract

There are a variety of airway diseases with different clinical settings, which may extend from a surgical approach to total organ replacement. Tissue engineering involves modifying cells or tissues in order to repair, regenerate, or replace tissue in the body and seems to be a promising approach for airway replacement. The successful implantation of stem-cell-based tissue-engineered trachea in a young woman with end-stage post-tuberculosis left main bronchus collapse serves as a prototype for the airway tissue-engineered-based approach. The trachea indeed could represent a perfect model system to investigate the translational aspects of tissue engineering, largely due to its low-oxygen needs. This review highlights the anatomy of the airways, the various disease conditions that cause damage to the airways, elaborates on the essential components of the tissue-engineering approach, and discusses the success of the revolutionary trachea transplantation approach.

Evaluación del método químico-enzimático de descelularización para la obtención de matrices extracelulares de tráquea en el modelo porcino

“…La ingeniería de tejidos se basa en la combinación de tres factores: las células vivas, una matriz que soporte el crecimiento y desarrollo de las células y un sistema de señalización celular que estimule a la célula y su ambiente para mantener, reparar, reemplazar o mejorar la función de un tejido u órgano (2). De estos tres elementos, la matriz juega un papel fundamental, ya que no solo provee el sostén mecánico y estructural al tejido, sino que también influye sobre la migración, la morfogénesis y el comportamiento celular.…”

“…Muchas situaciones patológicas y traumas pueden alterar la anatomía de la tráquea, lo que tiene consecuencias serias en la calidad de vida de los pacientes (2). En Colombia las causas más comunes que afectan la anatomía y funcionalidad de la vía aérea son las siguientes: estenosis traqueal, granulomas, tumores traqueales benignos, cáncer y tuberculosis, esta última con cerca de 9 millones de casos nuevos reportados en el 2010 (3).…”

Overview of Tracheal Tissue Engineering: Clinical Need Drives the Laboratory Approach

“…In the pediatric case, the transplanted segment was lengthy (7 cm), so a polydioxanone (PDS) stent was placed in the lumen and successfully removed after 2 months. 27 The patient was reported to be healthy, at last report. 27 In an attempt to reduce construct preparation time, the European group incorporated cells and growth factors (erythropoietin, granulocyte colony stimulating factor, and transforming growth factor-beta) into the decellularized scaffold intra-operatively.…”

“…53,57 They have also coated the lumen of the polypropylene/collagen construct with poly (L-lactic-acid-co-e-caprolactone) to delay degradation of the underlying collagen layer, which is intended to allow time for the host's epithelium to migrate onto the collagen layer. 73 According to news reports 4,99 and the medical literature, 27 the European group has since repeated the decellularized trachea transplantation in additional patients, including two cancer patients and a pediatric patient. In the pediatric case, the transplanted segment was lengthy (7 cm), so a polydioxanone (PDS) stent was placed in the lumen and successfully removed after 2 months.…”

“…27 In an attempt to reduce construct preparation time, the European group incorporated cells and growth factors (erythropoietin, granulocyte colony stimulating factor, and transforming growth factor-beta) into the decellularized scaffold intra-operatively. 27 This in situ approach followed the bionic tissue engineering concept proposed by Bader, 2 where a cocktail of growth factors was used to prompt cell growth and differentiation (i.e., boosting factors, recruitment factors, and commitment factors).…”