title: Clinic application of tissue engineered bronchus for lung cancer treatment.
abstract: BACKGROUND
  Delayed revascularization process and substitute infection remain to be key challenges in tissue engineered (TE) airway reconstruction. We propose an "in-vivobioreactor" design, defined as an implanted TE substitutes perfused with an intra-scaffold medium flow created by an extracorporeal portable pump system forin situorgan regeneration. The perfusate keeps pre-seeded cells alive before revascularization. Meanwhile the antibiotic inside the perfusate controls topical infection.
  
  
  METHODS
  A stage IIIA squamous lung cancer patient received a 5-cm TE airway substitute, bridging left basal segment bronchus to carina, with thein-vivobioreactor design to avoid left pneumonectomy. Continuous intra-scaffold Ringer's-gentamicin perfusion lasted for 1 month, together with orthotopic peripheral total nucleated cells (TNCs) injection twice a week.
  
  
  RESULTS
  The patient recovered uneventfully. Bronchoscopy follow-up confirmed complete revascularization and reepithelialization four months postoperatively. Perfusate waste test demonstrated various revascularization growth factors secreted by TNCs. The patient received two cycles of chemotherapy and 30 Gy radiotherapy thereafter without complications related to the TE substitute.
  
  
  CONCLUSIONS
  In-vivobioreactor design combines the traditionally separatedin vitro3D cell-scaffold culture system and thein vivoregenerative processes associated with TE substitutes, while treating the recipients as bioreactors for their own TE prostheses. This design can be applied clinically. We also proved for the first time that TE airway substitute is able to tolerate chemo-radiotherapy and suitable to be used in cancer treatment.
authors.affiliation: Shanghai Lung Cancer Center, Shanghai Chest Hospital Affiliated to Shanghai Jiao Tong University, Shanghai 200030, China.
authors.forename: Qiang
authors.initials: Q
authors.lastname: Tan
authors.affiliation: Shanghai Lung Cancer Center, Shanghai Chest Hospital Affiliated to Shanghai Jiao Tong University, Shanghai 200030, China.
authors.forename: Ruijun
authors.initials: R
authors.lastname: Liu
authors.affiliation: Shanghai Lung Cancer Center, Shanghai Chest Hospital Affiliated to Shanghai Jiao Tong University, Shanghai 200030, China.
authors.forename: Xiaoke
authors.initials: X
authors.lastname: Chen
authors.affiliation: Department of Anesthesia, Shanghai Chest Hospital Affiliated to Shanghai Jiao Tong University, Shanghai 200030, China.
authors.forename: Jingxiang
authors.initials: J
authors.lastname: Wu
authors.affiliation: Department of Plastic Surgery, Qidong People's Hospital, Qidong 226200, China.
authors.forename: Yinggen
authors.initials: Y
authors.lastname: Pan
authors.affiliation: Shanghai Lung Cancer Center, Shanghai Chest Hospital Affiliated to Shanghai Jiao Tong University, Shanghai 200030, China.
authors.forename: Shun
authors.initials: S
authors.lastname: Lu
authors.affiliation: Clinic of Thoracic Surgeon, University Hospital Zurich, Zurich, Switzerland.
authors.forename: Walter
authors.initials: W
authors.lastname: Weder
authors.affiliation: Shanghai Lung Cancer Center, Shanghai Chest Hospital Affiliated to Shanghai Jiao Tong University, Shanghai 200030, China.
authors.forename: Qingquan
authors.initials: Q
authors.lastname: Luo
keywords: Trachea replacement; in-vivo bioreactor; lung cancer treatment; tissue engineering