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DOI: 10.1055/s-0032-1328659
Biomedizin in der Thoraxchirurgie: eine Standortbestimmung
Biomedicine in Thoracic Surgery: State of the ArtPublikationsverlauf
Publikationsdatum:
27. Juni 2013 (online)

Zusammenfassung
Die Biomedizin ist ein neues interdisziplinäres Arbeitsgebiet an der Schnittstelle zwischen Human-, Molekular- und Zellbiologie und Medizin und umfasst die Stammzellforschung, das Tissue Engineering und die Materialwissenschaften. Sie liefert neue Forschungs- und Behandlungsansätze für bisher ungelöste medizinische Probleme. In vielen medizinischen Fachbereichen, insbesondere in den einzelnen chirurgischen Disziplinen wird biomedizinische Forschung betrieben und erste erfolgreiche Entwicklungen wurden bereits in die Klinik transferiert. In der Thoraxchirurgie werden biomedizinische Forschungsansätze vor allem für den Gewebe- und Organersatz der oberen Atemwege, Lunge und Brustwand verfolgt. Trotz eines vergleichsweise kleinen Forschungsfundaments wurden im Bereich des tracheobronchialen Ersatzes weltweit bereits 5 verschiedene Ansätze zur klinischen Anwendung am Patienten gebracht, was im Wesentlichen einem Mangel an etablierten Behandlungsoptionen im Falle ausgedehnter Erkrankungen der großen Atemwege geschuldet ist. In diesem Übersichtsartikel werden der klinische Hintergrund und die gewebespezifischen Grundlagen der tracheobronchialen Biomedizin dargelegt.
Abstract
Biomedicine represents a new scientific field at the interface of human, molecular and cell biology and medicine. Comprising the diverse disciplines of stem cell research, tissue engineering and material sciences, biomedicine gives rise to new approaches in research and therapy for – to date – unmet medical issues. Biomedical research is currently conducted in many medical, especially surgical subspecialties, and a number of successful developments have already been brought to clinical application. Concerning thoracic surgery, biomedical approaches are pursued primarily for tissue and organ replacement of the upper airways, lung and thoracic wall. In spite of a comparatively small research foundation, five different concepts have been clinically implemented worldwide, due to a lack of established treatment options in the case of extensive disease of the greater airways. In this review, the clinical background and the tissue-specific basics of tracheobronchial biomedicine are presented.
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Literatur
- 1 Sequist LV, Heist RS, Shaw AT, Fidias P et al. Implementing multiplexed genotyping of non-small-cell lung cancers into routine clinical practice. Ann Oncol 2011; 22: 2616-2624
- 2 Jakob F, Egbert R, Rudert M et al. In situ guided tissue regeneration in musculoskeletal diseases and aging. Cell Tiss Res 2012; 347: 725-735
- 3 Mooney DJ, Mikos AG. Growing new organs. Sci Am 1999; 280: 60-65
- 4 Walles T. Tracheobronchial bio-engineering: biotechnology fulfilling unmet medical needs. Adv Drug Del Rev 2011; 63: 367-374
- 5 Delaere P, Vranckx J, Verleden G et al. Tracheal allotransplantation after withdrawal of immune-suppressive therapy. N Engl J Med 2010; 362: 138-145
- 6 Duque E, Duque J, Nieves M et al. Management of larynx and trachea donors. Transplant Proc 2007; 39: 2076-2078
- 7 Brucklacher U, Walles T. Nationale und europäische Rahmenbedingungen für Tissue Engineering. PharmR 2010; 11: 581-586
- 8 Brucklacher U, Walles T. Das neue Gewebegesetz und seine Bedeutung für chirurgische Therapie und Forschung. Chir Allg Zeit 2010; 11: 65-69
- 9 Omori K, Nakamura T, Kanemaru S et al. Regenerative medicine of the trachea: the first human case. Ann Otol Rhinol Laryngol 2005; 114: 429-433
- 10 Macchiarini P, Walles T, Biancosino C et al. First human transplantation of a bioengineered airway tissue. J Thorac Cardiovasc Surg 2004; 128: 638-641
- 11 Wurt A, Porte H, Conti M et al. Tracheal replacement with aortic allografts. N Engl J Med 2006; 355: 1938-1940
- 12 Macchiarini P, Jungebluth P, Go T et al. Clinical transplantation of a tissue-engineered airway. Lancet 2008; 372: 2023-2030
- 13 Jungebluth P, Alici E, Baiguera S et al. Tracheobronchial transplantation with a stem-cell-seeded bioartificial nanocomposite: a proof-of-concept study. Lancet 2011; 378: 1997-2004
- 14 Grillo HC. Tracheal Replacement. In: Grillo HC, ed. Surgery of the Trachea and Bronchi. Hamilton (Canada): BC Decker Inc; 2004: 839-854
- 15 Grillo HC. Development of Tracheal Surgery: a Historical Review. In: Grillo HC, ed. Surgery of the Trachea and Bronchi. Hamilton (Canada): BC Decker Inc; 2004: 1-35
- 16 Walles T. Bioartificial tracheal grafts: can tissue engineering keep its promise?. Expert Rev Med Devices 2004; 1: 241-250
- 17 Kucera KA, Doss AE, Dunn SS et al. Tracheal replacements: Part 1. ASAIO J 2007; 53: 497-505
- 18 Steger V, Hampel M, Trick I et al. Clinical tracheal replacement: transplantation, bioprostheses and artificial grafts. Expert Rev Med Devices 2008; 5: 605-612
- 19 Okumura N, Teramachi M, Takimoto Y et al. Experimental reconstruction of the intrathoracic trachea using a new prosthesis made from collagen grafted mesh. ASAIO J 1994; 40: M834-M839
- 20 Doss AE, Dunn SS, Kucera KA et al. Tracheal replacements: Part 2. ASAIO J 2007; 53: 631-639
- 21 Suzuki T, Kobayashi K, Tada Y et al. Regeneration of the trachea using a bioengineered scaffold with adipose-derived stem cells. Ann Otol Rhinol Laryngol 2008; 117: 453-463
- 22 Okano W, Nomoto Y, Wada I et al. Bioengineered trachea with fibroblasts in a rabbit model. Ann Otol Rhinol Laryngol 2009; 118: 796-804
- 23 Kobayashi K, Suzuki T, Nomoto Y et al. A tissue-engineered trachea derived from a framed collagen scaffold, gingival fibroblasts and adipose-derived stem cells. Biomaterials 2010; 31: 4855-4863
- 24 Sato T, Araki M, Nakajima N et al. Biodegradable polymer coating promotes the epithelialization of tissue-engineered airway prostheses. J Thorac Cardiovasc Surg 2010; 139: 26-31
- 25 Nakamura T, Sato T, Araki M et al. In situ tissue engineering for tracheal reconstruction using a luminar remodeling type of artificial trachea. J Thorac Cardiovasc Surg 2009; 138: 811-819
- 26 Imaizumi M, Nomoto Y, Sugino T et al. Potential of induced pluripotent stem cells for the regeneration of the tracheal wall. Ann Otol Rhinol Laryngol 2010; 119: 697-703
- 27 Mertsching H, Walles T, Hofmann M et al. Engineering of a vascularized scaffold for artificial tissue and organ generation. Biomaterials 2005; 26: 6610-6617
- 28 Walles T, Giere B, Hofmann M et al. Experimental generation of a tissue-engineered functional and vascularized trachea. J Thorac Cardiovasc Surg 2004; 128: 900-906
- 29 Walles T, Biancosino C, Zardo P et al. Tissue remodeling in a bioartificial fibromuscular patch following transplantation in a human. Transplantation 2005; 80: 284-285
- 30 Mertsching H, Schanz J, Steger V et al. Generation and transplantation of an autologous vascularized bioartificial human tissue. Transplantation 2009; 88: 203-210
- 31 Martinod E, Seguin A, Pfeuty K et al. Long-term evaluation of the replacement of the trachea with an autologous aortic graft. Ann Thorac Surg 2003; 75: 1572-1578
- 32 Martinod E, Seguin A, Holder-Espinasse M et al. Tracheal regeneration following tracheal replacement with an allogenic aorta. Ann Thorac Surg 2005; 79: 942-948
- 33 Wurtz A. Tracheal replacement with banked cryopreserved aortic allograft. Ann Thorac Surg 2010; 89: 2072
- 34 Wurtz A, Porte H, Conti M et al. Surgical technique and results of tracheal and carinal replacement with aortic allografts for salivary gland-type carcinoma. J Thorac Cardiovasc Surg 2010; 140: 387-393
- 35 Mertsching H, Walles T, Macchiarini P. Replacement of the trachea with an autologous aortic graft. Ann Thorac Surg 2004; 78: 1132-1133
- 36 Martinod E, Seguin A, Radu D et al. Advances in tracheal surgery: are we close to finding the ideal tracheal substitute?. Rev Mal Respir 2010; 27: 554-564
- 37 Seguin A, Radu D, Holder-Espinasse M et al. Tracheal replacement with cryopreserved, decellularized, or glutaraldehyde-treated aortic allografts. Ann Thorac Surg 2009; 87: 861-867
- 38 Makris D, Holder-Espinasse M, Wurtz A et al. Tracheal replacement with cryopreserved allogenic aorta. Chest 2010; 137: 60-67
- 39 Wu W, Liu Y, Zhao Y. Clinical transplantation of a tissue-engineered airway. Lancet 2009; 373: 717
- 40 Badylak SF, Gilbert TW. Immune response to biologic scaffold materials. Semin Immunol 2008; 20: 109-116
- 41 Gustafsson Y, Haag J, Jungebluth P et al. Viability and proliferation of rat MSCs on adhesion protein-modified PET and PU scaffolds. Biomaterials 2012; 33: 8094-8103