Diaphragmatic reconstruction with autologous tendon engineered from mesenchymal amniocytes.
OBJECTIVE
This study examined the effects of amniocyte-based engineered tendons on partial diaphragmatic replacement.


METHODS
Ovine mesenchymal amniocytes were labeled with green fluorescent protein (GFP), expanded, and seeded into a collagen hydrogel. Composite grafts (20 to 25 cm2) based on acellular dermis (group I), or acellular small intestinal submucosa (group II) received either a cell-seeded or an acellular hydrogel within their layers. Newborn lambs (n = 20) underwent partial diaphragmatic replacement with either an acellular or a cellular autologous construct from either group. At 3 to 12 months' postoperatively, implants were subjected to multiple analyses.


RESULTS
Diaphragmatic hernia recurrence was significantly higher in animals with acellular grafts (5 of 5) then in animals with cellular ones (1 of 4) in group I (P <.05) but not in group II (3 of 6 and 4 of 5, respectively). Cellular grafts had higher modular (5.27 +/- 1.98 v. 1.27 +/- 0.38 MPa) and ultimate (1.94 +/- 0.70 v. 0.29 +/- 0.05 MPa) tensile strength than acellular implants in group I (P <.05), but not in group II. Quantitative analyses showed no differences in extracellular matrix components between cellular and acellular implants in either group. All cellular implants showed GFP-positive cells.


CONCLUSIONS
Diaphragmatic repair with an autologous tendon engineered from mesenchymal amniocytes leads to improved mechanical and functional outcomes when compared with an equivalent acellular bioprosthetic repair, depending on scaffold composition. The amniotic fluid may be a preferred cell source for engineered diaphragmatic reconstruction.
Fuchs
Julie R
JR
Departments of Surgery, Children's Hospital and Harvard Medical School, Boston, MA 02115, USA.
Kaviani
Amir
A
Oh
Jung-Tak
JT
LaVan
David
D
Udagawa
Taturo
T
Jennings
Russell W
RW
Wilson
Jay M
JM
Fauza
Dario O
DO
D000653:Amniotic Fluid / Q000166:cytology*; D000818:Animals; D000831:Animals, Newborn; D002454:Cell Differentiation; D002478:Cells, Cultured / Q000637:transplantation; D003094:Collagen; D024042:Collagen Type I / Q000032:analysis; D003964:Diaphragm / Q000601:surgery*; D004195:Disease Models, Animal; D004549:Elastin / Q000032:analysis; D017930:Genes, Reporter; D006025:Glycosaminoglycans / Q000032:analysis; D006548:Hernia, Diaphragmatic / Q000601:surgery; D006549:Hernia, Diaphragmatic, Traumatic / Q000601:surgery; D065630:Hernias, Diaphragmatic, Congenital; D020100:Hydrogels; D007813:Laparotomy; D045164:Mesenchymal Stem Cell Transplantation / Q000379:methods*; D059630:Mesenchymal Stem Cells / Q000166:cytology*; D012756:Sheep; D013710:Tendons / Q000637:transplantation*; D013718:Tensile Strength; D023822:Tissue Engineering; D014182:Transplantation, Autologous
D024042:Collagen Type I; D006025:Glycosaminoglycans; D020100:Hydrogels; D003094:Collagen; D004549:Elastin