Abstract
Rapid repair of the denuded alveolar surface after injury is a key to survival. The respiratory tract contains several sources of endogenous adult stem cells residing within the basal layer of the upper airways, within or near pulmonary neuroendocrine cell rests, at the bronchoalveolar junction, and within the alveolar epithelial surface, which contribute to the repair of the airway wall. Bone marrow-derived adult mesenchymal stem cells circulating in blood are also involved in tracheal regeneration. However, an organism is frequently incapable of repairing serious damage and defects of the respiratory tract resulting from acute trauma, lung cancers, and chronic pulmonary and airway diseases. Therefore, replacement of the tracheal tissue should be urgently considered. The shortage of donor trachea remains a major obstacle in tracheal transplantation. However, implementation of tissue engineering and stem cell therapy-based approaches helps to successfully solve this problem. To date, huge progress has been achieved in tracheal bioengineering. Several sources of stem cells have been used for transplantation and airway reconstitution in animal models with experimentally induced tracheal defects. Most tracheal tissue engineering approaches use biodegradable three-dimensional scaffolds, which are important for neotracheal formation by promoting cell attachment, cell redifferentiation, and production of the extracellular matrix. The advances in tracheal bioengineering recently resulted in successful transplantation of the world's first bioengineered trachea. Current trends in tracheal transplantation include the use of autologous cells, development of bioactive cell-free scaffolds capable of supporting activation and differentiation of host stem cells on the site of injury, with a future perspective of using human native sites as micro-niche for potentiation of the human body's site-specific response by sequential adding, boosting, permissive, and recruitment impulses.
Highlights
Transplantation of the airway and lung tissue is an accepted modality of treatment for end-stage lung disease
The decellularized trachea was seeded with two types of preexpanded and predifferentiated autologous cells; i.e. mesenchymal stem cell-derived cartilage-like cells and epithelial respiratory cells
We characterize the important role of cell-cell interactions and extracellular matrix (ECM) in airway epithelium repair; consider the resources of endogenous and exogenous stem/progenitor cells that have been used or have a potential to be applied in lung regeneration; and analyze current strategies in tracheal bioengineering and transplantation
Summary
Transplantation of the airway and lung tissue is an accepted modality of treatment for end-stage lung disease.
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