6.21 Tissue-Engineering Hollow Noncardiac Intrathoracic Organs: State-of-the-Art 2010

Abstract

Prosthetic replacements, autologous tissue transfer, and allografts have so far failed to offer functional solutions for the treatment of long circumferential tracheal defects and loss of a functional larynx. Interest has therefore turned increasingly to the field of tissue engineering, which applies the principles and methods of bioengineering, material science, cell transplantation, and the life sciences in an effort to develop in vitro biological substitutes that can restore, maintain, or improve tissue and organ function. The basic components of tissue engineering are cells, scaffolds, and signals. The recent advances in the field of tissue engineering have provided a new attractive approach toward the concept of functional substitutes and may represent a solution to the shortage of suitable grafts for reconstructive airway surgery. In addition, the stem cell field is advancing rapidly, opening new avenues for this type of therapy. This chapter gives an overview of the tissue-engineering approach to airway replacement and describes the encouraging results obtained so far in tracheal regeneration. The replacement of movement, as would be necessary to replace an entire larynx introduces another order of magnitude of complexity, although progress in this area, and also in the closely related field of esophageal tissue engineering, is starting to bear fruit.