Application of decellularization-recellularization technique in plastic and reconstructive surgery

Abstract

In the field of plastic and reconstructive surgery, the loss of organs or tissues caused by diseases or injuries has resulted in challenges, such as donor shortage and immunosuppression. In recent years, with the development of regenerative medicine, the decellularization-recellularization strategy seems to be a promising and attractive method to resolve these difficulties. The decellularized extracellular matrix contains no cells and genetic materials, while retaining the complex ultrastructure, and it can be used as a scaffold for cell seeding and subsequent transplantation, thereby promoting the regeneration of diseased or damaged tissues and organs. This review provided an overview of decellularization-recellularization technique, and mainly concentrated on the application of decellularization-recellularization technique in the field of plastic and reconstructive surgery, including the remodeling of skin, nose, ears, face, and limbs. Finally, we proposed the challenges in and the direction of future development of decellularization-recellularization technique in plastic surgery.

Figure 1

Rationale of skin decellularization. Jejunum, adipose tissue, or skin flap derived from human or animal donors undergo a decellularization process to obtain ECM. Next, regenerative cells (such as endothelial cells, fibroblasts, mesenchymal stem cells, etc) are seeded into the acellular ECM scaffold. The refilled scaffold is placed in a bioreactor for 3D culture to produce tissue engineered skin. Finally, the obtained construct can be transplanted in vivo to evaluate the effect of skin remodeling. ECM: Extracellular matrix.

Figure 2

Rationale of nose decellularization. Cartilage derived from human or animal donors undergoes decellularization to obtain ECM scaffold. The obtained ECM scaffold can be directly transplanted into body to stimulate cells for endogenous repair. In addition, before implantation, ECM can also be seeded with regenerative cells (eg, chondrocytes and ASCs). For other strategies, the 3D cultured cartilage construct is decellularized without destroying its structure. The acellular construct can infiltrate and seed chondrocytes, and the recellularized construct can mature in vitro and in vivo. ASCs: Adipose-derived stem cells; ECM: Extracellular matrix.

Figure 3

Rationale of ear decellularization. Cartilage or the entire ear graft undergo decellularization to obtain ECM. On the one hand, the obtained ECM scaffold can be seeded with regenerative cells (such as chondrocytes, mesenchymal stem cells, endothelial cells, etc) and transplanted into the body after 3D culture. On the other hand, the ECM scaffold can be pulverized, then processed into photo-crosslinkable hydrogel by methacrylation, and mixed with chondrocytes to produce printable biological links. After 3D bio-printing, the ear construct was finally obtained, showing sufficient mechanical properties and structural integrity. DMEM: Dulbecco's Modified Eagle's Medium; ECM: Extracellular matrix; UV: Ultraviolet.

Figure 4

Rationale of facial decellularization. Muscles, pulp, condylar bone, skin, or the entire face of humans and animals undergo decellularization to obtain ECM. Next, regenerative cells (eg, osteoblasts, mesenchymal stem cells, fibroblasts, etc) are seeded into the acellular ECM scaffold. The refilled scaffold is placed in a bioreactor for 3D culture to produce tissue engineered construct. Finally, the obtained construct can be transplanted in vivo to promote facial reconstruction. ECM: Extracellular matrix.

Figure 5

Rationale of limb decellularization. Bone, muscle, skeletal muscle or the entire limbs of humans and animals undergo decellularization to obtain ECM. Next, regenerative cells (such as myoblasts, endothelial cells, fibroblasts, mesenchymal stem cells, etc) are seeded into the acellular ECM scaffold. The refilled scaffold is placed in a bioreactor for 3D culture to produce tissue engineered construct. Finally, the obtained construct can be transplanted in vivo to promote limb reconstruction. ECM: Extracellular matrix.