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European Respiratory Review : An... Dec 2021Effective restoration of extensive tracheal damage arising from cancer, stenosis, infection or congenital abnormalities remains an unmet clinical need in respiratory... (Review)
Review
Effective restoration of extensive tracheal damage arising from cancer, stenosis, infection or congenital abnormalities remains an unmet clinical need in respiratory medicine. The trachea is a 10-11 cm long fibrocartilaginous tube of the lower respiratory tract, with 16-20 tracheal cartilages anterolaterally and a dynamic trachealis muscle posteriorly. Tracheal resection is commonly offered to patients suffering from short-length tracheal defects, but replacement is required when the trauma exceeds 50% of total length of the trachea in adults and 30% in children. Recently, tissue engineering (TE) has shown promise to fabricate biocompatible tissue-engineered tracheal implants for tracheal replacement and regeneration. However, its widespread use is hampered by inadequate re-epithelialisation, poor mechanical properties, insufficient revascularisation and unsatisfactory durability, leading to little success in the clinical use of tissue-engineered tracheal implants to date. Here, we describe in detail the historical attempts and the lessons learned for tracheal TE approaches by contextualising the clinical needs and essential requirements for a functional tracheal graft. TE manufacturing approaches explored to date and the clinical translation of both TE and non-TE strategies for tracheal regeneration are summarised to fully understand the big picture of tracheal TE and its impact on clinical treatment of extensive tracheal defects.
Topics: Adult; Child; Humans; Tissue Engineering; Tissue Scaffolds; Trachea
PubMed: 34750116
DOI: 10.1183/16000617.0154-2021 -
Seminars in Pediatric Surgery Dec 2022Anomalies in tracheo-esophageal development result in a spectrum of congenital malformations ranging from, most commonly, esophageal atresia with or without...
Anomalies in tracheo-esophageal development result in a spectrum of congenital malformations ranging from, most commonly, esophageal atresia with or without trachea-esophageal fistula (EA+/-TEF) to esophageal web, duplication, stricture, tracheomalacia and tracheal agenesis. Despite the relative frequency of EA, however, the underlying etiology remains unknown and is likely due to a combination of genetic, epigenetic and environmental factors. In recent years, animal models have dramatically increased our understanding of the molecular and morphological processes involved in normal esophageal development during the key stages of anterior-posterior regionalization, dorsal-ventral patterning and morphogenic separation. Moreover, the use of animal models in conjunction with increasingly advanced techniques such as genomic sequencing, sophisticated live imaging studies and organoid models have more recently cast light on potential mechanisms involved in EA pathogenesis. This article aims to unravel some of the mysteries behind the anatomy and embryology of EA whilst providing insights into future directions for research.
Topics: Animals; Humans; Tracheoesophageal Fistula; Esophageal Atresia; Trachea; Tracheomalacia
PubMed: 36459913
DOI: 10.1016/j.sempedsurg.2022.151231 -
Anaesthesia Jul 2016
Review
Topics: Bronchi; Humans; Tomography, X-Ray Computed; Trachea
PubMed: 27291599
DOI: 10.1111/anae.13531 -
Developmental Dynamics : An Official... Nov 2021The trachea is a rigid air duct with some mobility, which comprises the upper region of the respiratory tract and delivers inhaled air to alveoli for gas exchange.... (Review)
Review
The trachea is a rigid air duct with some mobility, which comprises the upper region of the respiratory tract and delivers inhaled air to alveoli for gas exchange. During development, the tracheal primordium is first established at the ventral anterior foregut by interactions between the epithelium and mesenchyme through various signaling pathways, such as Wnt, Bmp, retinoic acid, Shh, and Fgf, and then segregates from digestive organs. Abnormalities in this crosstalk result in lethal congenital diseases, such as tracheal agenesis. Interestingly, these molecular mechanisms also play roles in tissue regeneration in adulthood, although it remains less understood compared with their roles in embryonic development. In this review, we discuss cellular and molecular mechanisms of trachea development that regulate the morphogenesis of this simple tubular structure and identities of individual differentiated cells. We also discuss how the facultative regeneration capacity of the epithelium is established during development and maintained in adulthood.
Topics: Endoderm; Female; Gene Expression Regulation, Developmental; Humans; Mesoderm; Organogenesis; Pregnancy; Trachea
PubMed: 33840142
DOI: 10.1002/dvdy.345 -
Revista de Gastroenterologia de Mexico 2014
Topics: Anal Canal; Child; Esophageal Fistula; Esophagus; Heart Defects, Congenital; Humans; Kidney; Limb Deformities, Congenital; Male; Radiography; Spine; Trachea
PubMed: 24875595
DOI: 10.1016/j.rgmx.2013.07.009 -
The Journal of Thoracic and... Jun 2017
Topics: Constriction, Pathologic; Esophagus; Humans; Infant, Newborn; Salvage Therapy; Trachea
PubMed: 28242020
DOI: 10.1016/j.jtcvs.2017.01.039 -
RoFo : Fortschritte Auf Dem Gebiete Der... Sep 2019
Topics: Bronchi; Bronchopulmonary Sequestration; Cystic Adenomatoid Malformation of Lung, Congenital; Female; Humans; Infant; Infant, Newborn; Lung; Lung Diseases; Lymphangiectasis; Magnetic Resonance Imaging; Pregnancy; Prognosis; Pulmonary Emphysema; Trachea; Ultrasonography, Prenatal
PubMed: 31430779
DOI: 10.1055/a-0943-1293 -
The Laryngoscope Apr 2021To characterize tracheal cartilage morphology in mouse models of fibroblast growth factor receptor (Fgfr2)-related craniosynostosis syndromes. To establish relationships...
OBJECTIVES
To characterize tracheal cartilage morphology in mouse models of fibroblast growth factor receptor (Fgfr2)-related craniosynostosis syndromes. To establish relationships between specific Fgfr2 mutations and tracheal cartilaginous sleeve (TCS) phenotypes in these mouse models.
METHODS
Postnatal day 0 knock-in mouse lines with disease-specific genetic variations in the Fgfr2 gene (Fgfr2 , Fgfr2 , Fgfr2 , Fgfr2 , and Fgfr2 ) as well as line-specific controls were utilized. Tracheal cartilage morphology as measured by gross analyses, microcomputed tomography (μCT), and histopathology were compared using Chi-squared and single-factor analysis of variance statistical tests.
RESULTS
A greater proportion of rings per trachea were abnormal in Fgfr2 tracheas (63%) than Fgfr2 (17%), Fgfr2 (17%), Fgfr2 (12%), and controls (10%) (P < .001 for each vs. Fgfr2 ). TCS segments were found only in Fgfr2 (100%) and Fgfr2 (72%) tracheas. Cricoid and first-tracheal ring fusion was noted in all Fgfr2 and 94% of Fgfr2 samples. The Fgfr2 and Fgfr2 groups were found to have greater areas and volumes of cartilage than other lines on gross analysis and μCT. Histologic analyses confirmed TCS among the Fgfr2 and Fgfr2 groups, without appreciable differences in cartilage morphology, cell size, or density; no histologic differences were observed among other Fgfr2 lines compared to controls.
CONCLUSION
This study found TCS phenotypes only in the Fgfr2 mouse lines. These lines also had increased tracheal cartilage compared to other mutant lines and controls. These data support further study of the Fgfr2 mouse lines and the investigation of other Fgfr2 variants to better understand their role in tracheal development and TCS formation.
LEVEL OF EVIDENCE
NA Laryngoscope, 131:E1349-E1356, 2021.
Topics: Acanthosis Nigricans; Acrocephalosyndactylia; Animals; Cartilage; Craniofacial Dysostosis; Craniosynostoses; Disease Models, Animal; Ear; Genetic Association Studies; Humans; Mice; Mutation; Phenotype; Receptor, Fibroblast Growth Factor, Type 2; Scalp Dermatoses; Skin Abnormalities; Trachea; Tracheal Diseases; X-Ray Microtomography
PubMed: 32886384
DOI: 10.1002/lary.29060 -
Translational Lung Cancer Research Jun 2022Surgical resection and reconstruction are effective and radical treatments for tracheal tumors. Tension-free, well-perfused anastomosis plays a crucial role in...
BACKGROUND
Surgical resection and reconstruction are effective and radical treatments for tracheal tumors. Tension-free, well-perfused anastomosis plays a crucial role in postoperative prognosis. The use of various release maneuvers may be required to minimize anastomotic tension. However, the detailed procedures and effectiveness of them are seldomly reported. In the current study, we demonstrated the procedures and advantages of various release maneuvers during tracheal resection and reconstruction.
METHODS
All patients who underwent tracheobronchial resection and reconstruction between January 2019 to December 2021 were included in the study. The patients underwent tracheal release maneuvers, including laryngeal suprahyoid, pericardial, hilar, and inferior pulmonary ligament releasing. The patients' clinical features, surgical procedures, complications and postoperative outcomes were also described.
RESULTS
A total of 67 patients received release maneuvers during tracheobronchial surgery. Males accounted for a greater proportion (46/67, 65.7%) of the cohort. The mean age was 44.4 years. Most lesions were located in the thoracic and cervical trachea (21/67 and 17/67, respectively), and 18 cases of carinal (9/67) and bronchial (9/67) lesions were also included. Inferior pulmonary ligament releasing was applied to most noncervical lesion patients (39/67). Two cases of thyroid carcinoma with tracheal invasion received laryngeal suprahyoid release maneuvers. Adenoid cystic carcinoma (26.9%) and squamous cell carcinoma (14.9%) were the most commonly seen malignancies. Postoperative bronchoscopy showed no anastomotic abnormalities, including ischemic change, necrosis, or dehiscence. The median postoperative hospital stay was 7 days, ranging from 4 to 38 days. In the current study, a patient with postoperative aspiration had the longest hospital stay. In addition, 3 cases of anastomotic stenosis and laryngeal edema were observed. No other maneuver-related complications or particular discomforts were reported during the 6-month follow-up.
CONCLUSIONS
Anastomosis is the key to successful tracheobronchial resection and reconstruction. Release maneuvers are recommended to facilitate tension-free anastomosis. In addition to simple neck flexion and paratracheal dissection, laryngeal, hilar, and pericardial releasing allow longer trachea to be resected and preservation of well-vascularized anastomosis. The release maneuvers showed acceptable effect and reliable safety without significant morbidity or mortality.
PubMed: 35832456
DOI: 10.21037/tlcr-22-385 -
Development (Cambridge, England) Jul 2021The trachea delivers inhaled air into the lungs for gas exchange. Anomalies in tracheal development can result in life-threatening malformations, such as...
The trachea delivers inhaled air into the lungs for gas exchange. Anomalies in tracheal development can result in life-threatening malformations, such as tracheoesophageal fistula and tracheomalacia. Given the limitations of current therapeutic approaches, development of technologies for the reconstitution of a three-dimensional trachea from stem cells is urgently required. Recently, single-cell sequencing technologies and quantitative analyses from cell to tissue scale have been employed to decipher the cellular basis of tracheal morphogenesis. In this Review, recent advances in mammalian tracheal development and the generation of tracheal tissues from pluripotent stem cells are summarized.
Topics: Animals; Cartilage; Cell Differentiation; Epithelium; Humans; Lung; Mesoderm; Mice; Morphogenesis; Respiratory System; Trachea; Tracheoesophageal Fistula; Tracheomalacia; Transcriptome
PubMed: 34228796
DOI: 10.1242/dev.198192