The Journal of Thoracic and Cardiovascular Surgery
Volume 138, Issue 4 , Pages 811-819, October 2009

In situ tissue engineering for tracheal reconstruction using a luminar remodeling type of artificial trachea

  • Tatsuo Nakamura, MD

      Affiliations

    • Department of Bioartificial Organs, Institute for Frontier Medical Sciences, Kyoto University, Kyoto, Japan
    • Corresponding Author InformationAddress for reprints: Tatsuo Nakamura, MD, Department of Bioartificial Organs, Institute for Frontier Medical Sciences, Kyoto University, 53 Kawahara cho, Sakyo-ku, Kyoto 606-8507, Japan.
    • ,
  • Toshihiko Sato

      Affiliations

    • Department of Bioartificial Organs, Institute for Frontier Medical Sciences, Kyoto University, Kyoto, Japan
    • ,
  • Masato Araki, MD

      Affiliations

    • Department of Bioartificial Organs, Institute for Frontier Medical Sciences, Kyoto University, Kyoto, Japan
    • ,
  • Satoshi Ichihara, MD

      Affiliations

    • Department of Bioartificial Organs, Institute for Frontier Medical Sciences, Kyoto University, Kyoto, Japan
    • ,
  • Akira Nakada, MD

      Affiliations

    • Department of Bioartificial Organs, Institute for Frontier Medical Sciences, Kyoto University, Kyoto, Japan
    • ,
  • Makoto Yoshitani, MD

      Affiliations

    • Department of Bioartificial Organs, Institute for Frontier Medical Sciences, Kyoto University, Kyoto, Japan
    • ,
  • Shin-ichi Itoi, MD

      Affiliations

    • Department of Bioartificial Organs, Institute for Frontier Medical Sciences, Kyoto University, Kyoto, Japan
    • ,
  • Masaru Yamashita, MD

      Affiliations

    • Department of Otolaryngology, Kyoto University, Kyoto, Japan
    • ,
  • Shin-ichi Kanemaru, MD

      Affiliations

    • Department of Otolaryngology, Kyoto University, Kyoto, Japan
    • ,
  • Kouichi Omori, MD

      Affiliations

    • Department of Otolaryngology, Fukushima Medical University, Fukushima, Japan
    • ,
  • Yoshio Hori, MD

      Affiliations

    • Department of Bioartificial Organs, Institute for Frontier Medical Sciences, Kyoto University, Kyoto, Japan
    • ,
  • Katsuaki Endo, MD

      Affiliations

    • Department of Physiology, Kyoto Nerve Regeneration Research Center, Kyoto, Japan
    • ,
  • Yuji Inada, MD

      Affiliations

    • Department of Bioartificial Organs, Institute for Frontier Medical Sciences, Kyoto University, Kyoto, Japan
    • ,
  • Katsumi Hayakawa, MD

      Affiliations

    • Department of Bioartificial Organs, Institute for Frontier Medical Sciences, Kyoto University, Kyoto, Japan

Received 2 February 2008; received in revised form 12 May 2008; accepted 3 July 2008. published online 13 May 2009.

Background

After successful trials of tracheal reconstruction using mesh-type prostheses in canine models, the technique has been applied clinically to human patients since 2002. To enhance tissue regeneration, we have applied a new tissue engineering approach to this mesh-type prosthesis.

Methods

The prosthesis consists of a polypropylene mesh tube reinforced with a polypropylene spiral and atelocollagen layer. The cervical tracheas of 18 beagle dogs were replaced with the prosthesis. The collagen layer was soaked with peripheral blood in 6 of the dogs, with bone marrow aspirate in another 6, and with autologous multipotential bone marrow–derived cells (mesenchymal stem cells) in another 6. The dogs were humanely killed at 1 to 12 months after the operation.

Results

All 18 dogs survived the postoperative period. Bronchoscopically, 3 of 4 dogs in the peripheral blood group showed stenosis, whereas no stenosis was evident in all 8 of the dogs in the bone marrow and mesenchymal stem cell groups 6 months after the operation. Faster epithelialization and fewer complications, such as mesh exposure and luminal stenosis, were observed in these two groups than in the peripheral blood group. Histologically, the cells from autologous bone marrow were found to proliferate into the tracheal tissue during the first month. Cilial movement in these two groups was faster than that in the peripheral blood group and recovered to 80% to 90% of the normal level.

Conclusions

Bone marrow aspirate and mesenchymal stem cells enhance the regeneration of the tracheal mucosa on this prosthesis. This in situ tissue engineering approach may facilitate tracheal reconstruction in the clinical setting.

Abbreviations and Acronyms: CBF, cilial beat frequency, MRI, magnetic resonance imaging, MSC, mesenchymal stem cell

CTSNet classification: 15

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 This work was supported partly by a Health and Labor Science Research Grant for Research on the Human Genome, and Tissue Engineering, from the Ministry of Health, Labor and Welfare of Japan.

PII: S0022-5223(09)00407-3

doi:10.1016/j.jtcvs.2008.07.072

The Journal of Thoracic and Cardiovascular Surgery
Volume 138, Issue 4 , Pages 811-819, October 2009

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