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.

Fig. 1

Flowchart showing the pipeline of translational-clinical research for airway diseases

Fig. 2

Key components used to generate the tissue-engineered airway: a human donor decellularized trachea, b mesenchymal stem cell-derived chondrocytes, c epithelial cells, and d novel double-chamber bioreactor

Fig. 3

Scanning electron microscopy (SEM) images, at different amplifications, showing decellularized matrices seeded with chondrocytes after 24-h (a, b) and 72-h (c, d) dynamic culture periods

Fig. 4

DEM approach used for tracheal decellularization

Fig. 5

Hematoxylin and eosin (H&E) staining of transversal sections of native (a, c) and decellularized (b, d) trachea. As the figures show, a complete decellularization of both cartilagineous (a, b, 400×) and epithelial (c, d, 200×) tracheal side was obtained, preserving all ECM structural components