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Replacement of a Tracheal Stenosis with a Tissue-Engineered Human Trachea Using Autologous Stem Cells: A Case Report

Journal article
Authors Malin Berg
Hasse Ejnell
Anikó Kovács
Nikhil Nayakawde
Pradeep B Patil
Meghnad Joshi
Luaay Aziz
Göran Rådberg
Shahin Hajizadeh
Michael Olausson
Suchitra Sumitran-Holgersson
Published in Tissue Engineering. Part A
Volume 20
Issue 1-2
Pages 389-397
ISSN 1937-3341
Publication year 2014
Published at Institute of Clinical Sciences, Department of Surgery
Institute of Biomedicine, Department of Pathology
Institute of Clinical Sciences, Department of Otorhinolaryngology
Pages 389-397
Language en
Links dx.doi.org/10.1089/ten.TEA.2012.051...
Subject categories Cell Biology, Cell and Molecular Biology, Surgery, Transplantation surgery, Otorhinolaryngology

Abstract

Cell-based therapies, involving tissue engineering represent interesting and potentially important strategies for treatment of patients with various disorders. Here, using a detergent-enzymatic method we prepared an intact 3-dimensional scaffold of an extracellular matrix (ECM) derived from a human cadaver donor trachea, which we repopulated with autologous stem cells and implanted into a 76-year old patient with tracheal stenosis including lower part of the larynx. Although the graft provided the patient with an open airway, a week after surgery, the mucous membrane of the graft was covered by a 1-2mm thick fungal infection, which was treated with local and systemic anti-fungal therapy. The airway lumen was postoperatively controlled by fiberbrandoscopy and found stable and sufficient. However, twenty-three days later the patient died due to cardiac arrest but with a patent, open, stable tracheal transplant and intact anastomoses. Histopathological results of the transplanted tracheal graft at autopsy showed a squamous but not ciliated epithelium, neovascularization, bundles of -sma positive muscle cells, serous glands and nerve fibres with S-100 positive nerve cells in the submucosa and intact chondrocytes in the cartilage. Our findings suggest that although autologous stem cells- engineered tracheal matrices may represent a tool for clinical tracheal replacement. Further preclinical studies are required for generating functional airway grafts and long term effects of such grafts.

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