Center for Regenerative Medicine, Massachusetts General Hospital, Boston, MA.
Harvard Medical School, Boston, MA.
Ann Surg. 2018 Mar;267(3):590-598. doi: 10.1097/SLA.0000000000002129.
Bioengineering of viable, functional, and implantable human lung grafts on porcine matrix.
Implantable bioartificial organ grafts could revolutionize transplant surgery. To date, several milestones toward that goal have been achieved in rodent models. To make bioengineered organ grafts clinically relevant, scaling to human cells and graft size are the next steps.
We seeded porcine decellularized lung scaffolds with human airway epithelial progenitor cells derived from rejected donor lungs, and banked human umbilical vein endothelial cells. We subsequently enabled tissue formation in whole organ culture. The resulting grafts were then either analyzed in vitro (n = 15) or transplanted into porcine recipients in vivo (n = 3).
By repopulating porcine extracellular matrix scaffolds with human endothelial cells, we generated pulmonary vasculature with mature endothelial lining and sufficient anti-thrombotic function to enable blood perfusion. By repopulating the epithelial surface with human epithelial progenitor cells, we created a living, functioning gas exchange graft. After surgical implantation, the bioengineered lung grafts were able to withstand physiological blood flow from the recipient's pulmonary circulation, and exchanged gases upon ventilation during the 1-hour observation.
Engineering and transplantation of viable lung grafts based on decellularized porcine lung scaffolds and human endothelial and epithelial cells is technically feasible. Further graft maturation will be necessary to enable higher-level functions such as mucociliary clearance, and ventilation-perfusion matching.
在猪基质上对可行的、功能性的和可植入的人肺移植物进行生物工程改造。
可植入的生物人工器官移植物可以彻底改变移植手术。迄今为止,在啮齿动物模型中已经实现了几个朝着这一目标迈进的里程碑。为了使生物工程器官移植物具有临床相关性,扩大到人类细胞和移植物大小是下一步。
我们用人呼吸道上皮祖细胞(来源于被排斥的供体肺)和人脐静脉内皮细胞对猪去细胞化肺支架进行接种,随后在整个器官培养中使组织形成。然后将得到的移植物在体外进行分析(n = 15)或在体内移植到猪受体中(n = 3)。
通过用人类内皮细胞再填充猪细胞外基质支架,我们生成了具有成熟内皮衬里和足够抗血栓功能的肺脉管系统,从而能够进行血液灌注。通过用人类上皮祖细胞再填充上皮表面,我们创建了一个具有生命力的、功能正常的气体交换移植物。在手术植入后,生物工程肺移植物能够承受来自受体肺循环的生理血流,并在 1 小时的观察期间通过通气进行气体交换。
基于去细胞化猪肺支架和人内皮细胞和上皮细胞的可行肺移植物的工程和移植在技术上是可行的。需要进一步的移植物成熟,以实现更高水平的功能,如黏液清除和通气-灌注匹配。