Tracheal tissue engineering: building on a strong foundation

Evaluation of: Elliott MJ, De Coppi P, Speggiorin S et al. Stem-cell-based, tissue engineered tracheal replacement in a child: a 2-year follow-up study. Lancet 380 (9846) 994-1000 (2012). Tissue-engineered tracheal transplants may offer a treatment strategy to address advanced structural disorders of the large airway. The approach aims to offer an alternative to the typically applied slide tracheoplasty, which can lead to stent erosion or even death. Laryngotracheal agenesis or severe stenosis can be fatal for developing fetuses and often leads to the decision to terminate the pregnancy. A tissue-engineered, autologous (stem) cell-seeded construct might be a promising option for children, as this alternative surgical replacement strategy has been successfully used in clinics for bladder repair and tracheal replacement in adults. In the reviewed 2-year follow-up study, Elliott and colleagues implanted an allogeneic, decellularized trachea that was supported with an absorbable polydioxanone stent, which was saturated with an autologous, bone marrow-derived stem cell mixture prior to implantation into a pediatric patient.