Tissue-engineered autologous urethras for patients who need reconstruction: an observational study.
Tissue-engineered autologous urethras for patients who need reconstruction: an observational study.
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DOI：
10.1016/s0140-6736(10)62354-9
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发表时间：
2011-04-02
期刊：
影响因子：
168.9
通讯作者：
Atala, Anthony
中科院分区：
文献类型：
--
作者：
Raya-Rivera, Atlantida;Esquiliano, Diego R.;Yoo, James J.;Lopez-Bayghen, Esther;Soker, Shay;Atala, Anthony
受伤、疾病或先天性缺陷可能会导致复杂的尿道问题，而治疗选择往往很有限。尿道与其他长管状组织类似，重建后可能会狭窄。我们的目的是评估使用患者自身细胞的组织工程尿道对需要尿道重建的患者的有效性。该研究包括五名患有尿道缺陷的男孩。对每位患者进行组织活检，将肌肉和上皮细胞扩增并接种到管状聚乙醇酸：聚（丙交酯-乙交酯酸）支架上。然后患者使用组织工程管状尿道进行尿道重建。我们记录患者病史，要求患者填写国际尿控协会 (ICS) 的调查问卷，并在术后 3、6、12、24、36、48、60 和 72 个月进行尿液分析、膀胱尿道镜检查、膀胱尿道造影和流量测量。我们在 3、12 和 36 个月时进行了连续的内窥镜杯活检，每次都在工程尿道的不同区域进行。患者于2004年3月19日至2007年7月20日期间接受手术。随访于2010年7月31日完成。手术时中位年龄为11岁（范围10-14），中位随访时间为71个月（范围36-76个月）。 AE1/AE3、α肌动蛋白、结蛋白和肌球蛋白抗体证实了所有培养物中上皮细胞和肌肉谱系细胞的存在。中位最终最大尿流率为 27·1 mL/s（范围 16-28），系列放射线照相和内窥镜研究显示尿道口径保持宽而无狭窄。尿道活检显示，植入后 3 个月，工程移植物已形成正常的外观结构。管状尿道可以被设计并在临床环境中保持功能长达 6 年。这些工程尿道可用于需要复杂尿道重建的患者。国立糖尿病、消化和肾脏疾病研究所、国立卫生研究院。
Complex urethral problems can occur as a result of injury, disease, or congenital defects and treatment options are often limited. Urethras, similar to other long tubularised tissues, can stricture after reconstruction. We aimed to assess the effectiveness of tissue-engineered urethras using patients’ own cells in patients who needed urethral reconstruction. Five boys who had urethral defects were included in the study. A tissue biopsy was taken from each patient, and the muscle and epithelial cells were expanded and seeded onto tubularised polyglycolic acid:poly(lactide-co-glycolide acid) scaffolds. Patients then underwent urethral reconstruction with the tissue-engineered tubularised urethras. We took patient history, asked patients to complete questionnaires from the International Continence Society (ICS), and did urine analyses, cystourethroscopy, cystourethrography, and flow measurements at 3, 6, 12, 24, 36, 48, 60, and 72 months after surgery. We did serial endoscopic cup biopsies at 3, 12, and 36 months, each time in a different area of the engineered urethras. Patients had surgery between March 19, 2004, and July 20, 2007. Follow-up was completed by July 31, 2010. Median age was 11 years (range 10–14) at time of surgery and median follow-up was 71 months (range 36–76 months). AE1/AE3, α actin, desmin, and myosin antibodies confirmed the presence of cells of epithelial and muscle lineages on all cultures. The median end maximum urinary flow rate was 27·1 mL/s (range 16–28), and serial radiographic and endoscopic studies showed the maintenance of wide urethral calibres without strictures. Urethral biopsies showed that the engineered grafts had developed a normal appearing architecture by 3 months after implantation. Tubularised urethras can be engineered and remain functional in a clinical setting for up to 6 years. These engineered urethras can be used in patients who need complex urethral reconstruction. National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health.