In situ tissue engineering for tracheal reconstruction using a luminar remodeling type of artificial trachea Tatsuo Nakamura, MD, Toshihiko Sato, Masato.

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Presentation transcript:

In situ tissue engineering for tracheal reconstruction using a luminar remodeling type of artificial trachea Tatsuo Nakamura, MD, Toshihiko Sato, Masato Araki, MD, Satoshi Ichihara, MD, Akira Nakada, MD, Makoto Yoshitani, MD, Shin-ichi Itoi, MD, Masaru Yamashita, MD, Shin-ichi Kanemaru, MD, Kouichi Omori, MD, Yoshio Hori, MD, Katsuaki Endo, MD, Yuji Inada, MD, Katsumi Hayakawa, MD The Journal of Thoracic and Cardiovascular Surgery Volume 138, Issue 4, Pages 811-819 (October 2009) DOI: 10.1016/j.jtcvs.2008.07.072 Copyright © 2009 The American Association for Thoracic Surgery Terms and Conditions

Figure 1 Mesh-type tracheal prosthesis. The framework is a polypropylene mesh tube reinforced with a spiral stent (right). Freeze-dried collagen layers were made both inside and outside the framework as a scaffold of tissue regeneration (left). The Journal of Thoracic and Cardiovascular Surgery 2009 138, 811-819DOI: (10.1016/j.jtcvs.2008.07.072) Copyright © 2009 The American Association for Thoracic Surgery Terms and Conditions

Figure 2 Intraoperative view of the reconstruction of a canine trachea with the prosthesis. The prosthesis was soaked with each medium before anastomosis. The prosthetic wall became airtight with this process. The Journal of Thoracic and Cardiovascular Surgery 2009 138, 811-819DOI: (10.1016/j.jtcvs.2008.07.072) Copyright © 2009 The American Association for Thoracic Surgery Terms and Conditions

Figure 3 Bronchoscopic views of the reconstructed site of the bone marrow group (dog 11) 1 month (left) and 12 months (right) after the operation. Neither stenosis nor granulation is evident at the site of anastomosis with the trachea. Complete coverage of the mesh by regenerated tissue is evident. The Journal of Thoracic and Cardiovascular Surgery 2009 138, 811-819DOI: (10.1016/j.jtcvs.2008.07.072) Copyright © 2009 The American Association for Thoracic Surgery Terms and Conditions

Figure 4 Luminal surface of the prosthesis (bone marrow group, dog 8). Three months after reconstruction, the prosthesis was incorporated into the native tracheas and inner surface was covered with glossy and whitish tissue. Polypropylene stents were seen in the cross-section of the reconstructed tracheal wall. The Journal of Thoracic and Cardiovascular Surgery 2009 138, 811-819DOI: (10.1016/j.jtcvs.2008.07.072) Copyright © 2009 The American Association for Thoracic Surgery Terms and Conditions

Figure 5 MRI appearance of the prosthesis implanted into the cervical trachea of a dog 12 months after the operation (MSC group). Replaced area is indicated by the arrows. The Journal of Thoracic and Cardiovascular Surgery 2009 138, 811-819DOI: (10.1016/j.jtcvs.2008.07.072) Copyright © 2009 The American Association for Thoracic Surgery Terms and Conditions

Figure 6 Regenerated mucosa with epithelial lining on the mesh of the prosthesis from a dog in the bone marrow group after 12 months. The mucosa is thicker than the normal tracheal mucosa. L, Tracheal lumen; M, mesh of the prosthesis (hematoxylin and eosin staining; original magnification, ×400). The Journal of Thoracic and Cardiovascular Surgery 2009 138, 811-819DOI: (10.1016/j.jtcvs.2008.07.072) Copyright © 2009 The American Association for Thoracic Surgery Terms and Conditions

Figure 7 Ciliated epithelium is present on the regenerated mucosa near the anastomosis (upper left), but only squamous epithelium is present in the middle of the prosthesis (upper right) in a dog in the bone marrow group after 12 months (hematoxylin and eosin staining; original magnification, ×200). Bottom, Scanning electron microscopy (SEM) views of the luminal surface. Dense cilia like those of the normal tracheal epithelium are present on the prosthesis near the anastomosis (lower left) and a few ciliated epithelial cells are present in areas where only a squamous cell lining was demonstrated by light microscopy (lower right). Although these findings were evident in all three groups, there were more ciliated cells in the bone marrow and MSC groups than in the peripheral blood group. The Journal of Thoracic and Cardiovascular Surgery 2009 138, 811-819DOI: (10.1016/j.jtcvs.2008.07.072) Copyright © 2009 The American Association for Thoracic Surgery Terms and Conditions

Figure 8 Transmission electron microscopic view of the regenerated mucosa of the reconstructed segment (center) 12 months after reconstruction in the MSC group (A). In the area where ciliated cells were absent, the luminal surface was covered with the squamous cells (B). The Journal of Thoracic and Cardiovascular Surgery 2009 138, 811-819DOI: (10.1016/j.jtcvs.2008.07.072) Copyright © 2009 The American Association for Thoracic Surgery Terms and Conditions

Figure 9 Cilial beat frequency of the regenerated cilia. MSC, Mesenchymal blood cell. The Journal of Thoracic and Cardiovascular Surgery 2009 138, 811-819DOI: (10.1016/j.jtcvs.2008.07.072) Copyright © 2009 The American Association for Thoracic Surgery Terms and Conditions

Figure 10 Microscopic appearance of the regenerated part of the tracheal wall after 1 month, showing numerous seeding MSCs, which are labeled with FM-DiI fluorescent tracer (original magnification, ×100). The labeled cells remained in the submucosa tissue around the polypropylene mesh and did not exist in the mucosa. M, Mesh of the prosthesis). The Journal of Thoracic and Cardiovascular Surgery 2009 138, 811-819DOI: (10.1016/j.jtcvs.2008.07.072) Copyright © 2009 The American Association for Thoracic Surgery Terms and Conditions