Atala Anthony, Bauer Stuart B, Soker Shay, Yoo James J, Retik Alan B
Department of Urology and Wake Forest Institute for Regenerative Medicine, Wake Forest University School of Medicine, Winston-Salem, NC 27157, USA.
Lancet. 2006 Apr 15;367(9518):1241-6. doi: 10.1016/S0140-6736(06)68438-9.
Patients with end-stage bladder disease can be treated with cystoplasty using gastrointestinal segments. The presence of such segments in the urinary tract has been associated with many complications. We explored an alternative approach using autologous engineered bladder tissues for reconstruction.
Seven patients with myelomeningocele, aged 4-19 years, with high-pressure or poorly compliant bladders, were identified as candidates for cystoplasty. A bladder biopsy was obtained from each patient. Urothelial and muscle cells were grown in culture, and seeded on a biodegradable bladder-shaped scaffold made of collagen, or a composite of collagen and polyglycolic acid. About 7 weeks after the biopsy, the autologous engineered bladder constructs were used for reconstruction and implanted either with or without an omental wrap. Serial urodynamics, cystograms, ultrasounds, bladder biopsies, and serum analyses were done.
Follow-up range was 22-61 months (mean 46 months). Post-operatively, the mean bladder leak point pressure decrease at capacity, and the volume and compliance increase was greatest in the composite engineered bladders with an omental wrap (56%, 1.58-fold, and 2.79-fold, respectively). Bowel function returned promptly after surgery. No metabolic consequences were noted, urinary calculi did not form, mucus production was normal, and renal function was preserved. The engineered bladder biopsies showed an adequate structural architecture and phenotype.
Engineered bladder tissues, created with autologous cells seeded on collagen-polyglycolic acid scaffolds, and wrapped in omentum after implantation, can be used in patients who need cystoplasty.
终末期膀胱疾病患者可采用胃肠道段进行膀胱扩大术治疗。尿路中存在此类肠道段与许多并发症相关。我们探索了一种使用自体工程化膀胱组织进行重建的替代方法。
确定7例年龄在4至19岁、患有脊髓脊膜膨出且膀胱高压或顺应性差的患者为膀胱扩大术候选者。从每位患者获取膀胱活检组织。将尿路上皮细胞和肌肉细胞进行培养，然后接种到由胶原蛋白或胶原蛋白与聚乙醇酸复合材料制成的可生物降解膀胱形状支架上。活检后约7周，将自体工程化膀胱构建体用于重建，并在有或无网膜包裹的情况下植入。进行了系列尿动力学检查、膀胱造影、超声检查、膀胱活检和血清分析。
随访时间为22至61个月（平均46个月）。术后，在有网膜包裹的复合工程化膀胱中，平均膀胱容量时漏点压力下降、体积和顺应性增加最为显著（分别为56%、1.58倍和2.79倍）。术后肠道功能迅速恢复。未观察到代谢方面的后果，未形成尿路结石，黏液分泌正常，肾功能得以保留。工程化膀胱活检显示结构和表型良好。
用接种于胶原 - 聚乙醇酸支架上的自体细胞构建并在植入后用网膜包裹的工程化膀胱组织，可用于需要进行膀胱扩大术的患者。
