Abstract
Objective: Design a single-stage stem-cell based tracheal replacement technique to expand tracheal reconstructive options.
Method: A pilot study using 4 rabbits was performed in October through December of 2011 at Wake Forest Institute of Regenerative Medicine. Two procedures were performed on cadaveric animals, and 2 survival surgeries were performed on live animals. Our technique combined a segment of fixed, cell-free cadaveric donor trachea and adipose or marrow derived stem cells harvested from the recipient animal. These acellular donor conduits were seeded with host stem cells and implanted.
Results: Tracheal reconstruction for tracheal stenosis is an evolving field. Recent success using a stem-cell based engineered trachea required a prolonged incubation ex vivo in a novel “bioreactor.” Taking this idea a step further, a single-stage method would be optimal. After completion of both cadaveric surgeries, the surgical procedure was optimized. The following 2 live-animal procedures were successful demonstrations of the ability to suspend stem cells in fibrin glue, seed the conduit, and replace a segment of trachea. Although both animals were euthanized following completion according to approved IACUC protocol, the final animal was extubated prior to euthanasia, and demonstrated comfortable, spontaneous respiration.
Conclusion: Based on pilot study technical success of short segment tracheal replacement with the use of fixed donor trachea and stem cell support, additional animal studies with extended follow-up will provide the necessary data to improve tracheal reconstruction in a single-stage surgical model.
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