Abstract

Replacement of large tracheal defects remains an unmet clinical need. While recellularization of acellular tracheal grafts appeared to be a viable pathway, evidence from the clinic suggests otherwise. In hindsight, complete removal of chondrocytes and repopulation of the tracheal chondroid matrix to achieve functional tracheal cartilage may have been unrealistic. In contrast, the concept of a hybrid graft whereby the epithelium is removed and the immune-privileged cartilage is preserved is a radically different path with initial reports indicating potential clinical success. Here, we present a novel approach using a double-chamber bioreactor to de-epithelialize tracheal grafts and subsequently repopulate the grafts with exogenous cells. A 3 h treatment with sodium dodecyl sulfate perfused through the inner chamber efficiently removes the majority of the tracheal epithelium while the outer chamber, perfused with growth media, keeps most (68.6 ± 7.3%) of the chondrocyte population viable. De-epithelialized grafts support human bronchial epithelial cell (BEAS-2B) attachment, viability and growth over 7 days. While not without limitations, our approach suggests value in the ultimate use of a chimeric allograft with intact donor cartilage re-epithelialized with recipient-derived epithelium. By adopting a brief and partial decellularization approach, specifically removing the epithelium, we avoid the need for cartilage regeneration.

Highlights

  • Tracheal replacement is necessary when the extent of the damaged organ is more than 50% of the length in adults or 30% in children[1]

  • Selection of the 3 h de-epithelialization time was based on balancing complete removal of epithelium and cellular debris with adverse effects of detergent on tissue and shows that a 3 h treatment with 1% sodium dodecyl sulfate (SDS) efficiently removes the majority of the epithelium

  • We present here a clinically relevant system using a short 3 h detergent-based treatment method in a bioreactor setting to remove native epithelium from porcine tracheal grafts

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Summary

Introduction

Tracheal replacement is necessary when the extent of the damaged organ is more than 50% of the length in adults or 30% in children[1]. Several sources for tracheal repair and replacement have been evaluated over the last few decades These can be divided into: the use of autologous[2] and nonviable tissues[3], foreign materials[4], and naturally-derived biological acellular scaffolds[5]. Given the low immunogenicity of the tracheal cartilage[17,18,19,20,21], complete decellularization of tracheal grafts may not be required. This is a completely different approach in which a hybrid graft is generated after removal of only the epithelium, with proof-of-concept studies suggesting clinical applicability[15,20,22]. The entire process is completed in a bioreactor setting, which is used for re-epithelialization

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