The trachea: The first tissue-engineered organ?

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Presentation transcript:

The trachea: The first tissue-engineered organ? Pierre R. Delaere, MD, PhD, Dirk Van Raemdonck, MD, PhD The Journal of Thoracic and Cardiovascular Surgery Volume 147, Issue 4, Pages 1128-1132 (April 2014) DOI: 10.1016/j.jtcvs.2013.12.024 Copyright © 2014 The American Association for Thoracic Surgery Terms and Conditions

Figure 1 Wound healing of a tracheal mucosal defect. A, The trachea has a segmental blood supply that reaches the mucosal lining through the intercartilaginous ligaments and the membranous trachea (A1 and A2). The basement membrane of the mucosal layer supports a pseudostratified epithelium, the surface layer of which is columnar and ciliated, with deeper layers of basal cells. A superficial epithelial wound can heal through regeneration of the surface epithelium (A3). B, The healing pattern of a circumferential full-thickness mucosal defect (B1 and B2) is shown. Healing of full-thickness mucosal wounds combines granulation tissue formation, wound contraction, and reepithelialization from the wound edges (arrows). Airway stenosis in the middle part of the denuded segment can develop from circumferential wounds. Healing of anastomotic sites can enable several millimeters of respiratory epithelium to grow into the wound margins (B3) while the remaining tissue between those margins is left as uncovered granular tissue (B4 and B5). C, Research in tracheal tissue engineering should concentrate on attempts to regenerate the mucosal lining by applying epithelial stem cells (C1 and C2) to a tracheal segment with a preserved blood supply and cartilaginous support. The Journal of Thoracic and Cardiovascular Surgery 2014 147, 1128-1132DOI: (10.1016/j.jtcvs.2013.12.024) Copyright © 2014 The American Association for Thoracic Surgery Terms and Conditions

Figure 2 Prosthetic versus regenerated trachea A, Blood vessel prosthesis. Endothelialization of the luminal surface of vascular grafts occurs only 1 to 2 cm into the graft from the anastomotic site. These endothelial cells are derived from adjacent, native arterial endothelium, and they enable the anastomosis to heal. B, In the respiratory tract, the flow of inspired air will lead to bacterial contamination and wound breakdown at the anastomoses. The respiratory epithelium will not grow over the prosthesis-airway anastomosis. C, Airway prosthesis wrapped in vascularized tissue. A prosthesis may act as a temporary airway stent when it is wrapped by well-vascularized tissue (eg, omentum). The vascularized tissue around the prosthesis can temporary avoid the complications of wound breakdown at the anastomotic sites. D, A scaffold soaked in bone marrow cells will behave in similarly to a prosthesis. Granulation tissue at the anastomoses will be formed in patients surviving for longer periods. E, A stent can be placed as a temporary airway. The Journal of Thoracic and Cardiovascular Surgery 2014 147, 1128-1132DOI: (10.1016/j.jtcvs.2013.12.024) Copyright © 2014 The American Association for Thoracic Surgery Terms and Conditions

Figure 3 Visualization of the bioengineered tissue approach when applied to an external ear (theoretic example). A, The external ear has a comparable tissue composition (cartilage framework and epithelial lining) to the trachea. Here, an enzymatically decellularized allograft treated with bone marrow cells and cultured epithelial cells is attached to a recipient area without restoration of the blood supply. B, Direct visualization of the healing and revascularization of the bioengineered ear should be mandatory to prove (the hypothetical) success of the bioengineering process. The Journal of Thoracic and Cardiovascular Surgery 2014 147, 1128-1132DOI: (10.1016/j.jtcvs.2013.12.024) Copyright © 2014 The American Association for Thoracic Surgery Terms and Conditions