Respiratory function in the horse can be severely compromised by arytenoid chondritis, or arytenoid chondropathy, a pathologic condition leading to deformity and dysfunction of the affected cartilage. Current treatment in cases unresponsive to medical management is removal of the cartilage, which can improve the airway obstruction, but predisposes the patient to other complications like tracheal penetration of oropharyngeal content and dynamic collapse of the now unsupported soft tissue lateral to the cartilage. A tissue engineering approach to reconstructing the arytenoid cartilage would represent a significant advantage in the management of arytenoid chondritis. In this study, we explored if decellularized matrix could potentially be incorporated into the high motion environment of the arytenoid cartilages of horses. Equine arytenoid cartilages were decellularized and a portion of the resultant acellular scaffolds was implanted in a full-thickness defect created in the arytenoids of eight horses. The implantation was performed bilaterally in each horse, with one side randomly selected to receive an implant seeded with autologous bone marrow-derived nucleated cells (BMNCs). Arytenoids structure and function were monitored up to 4 months. In vivo assessments included laryngeal ultrasound, and laryngeal endoscopy at rest and during exercise on a high-speed treadmill. Histologic evaluation of the arytenoids was performed postmortem. Implantation of the cartilaginous graft had no adverse effect on laryngeal respiratory function or swallowing, despite induction of a transient granuloma on the medial aspect of the arytenoids. Ultrasonographic monitoring detected a postoperative increase in the thickness and cross-sectional area of the arytenoid body that receded faster in the arytenoids not seeded with BMNCs. The explanted tissue showed epithelialization of the mucosal surface, integration of the implant into the native arytenoid, with minimal adverse cellular reaction. Remodeling of the scaffold material was evident by 2 months after implantation. Preseeding the scaffold with BMNCs increased the rate of scaffold degradation and incorporation. Replacement of arytenoid portion with a tissue-engineered cartilaginous graft preseeded with BMNCs is surgically feasible in the horse, is well tolerated, and results in appropriate integration within the native tissue, also preventing laryngeal tissue collapse during exercise.

中文翻译：

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马杓状软骨支架植入的探索性研究

马的呼吸功能可能会因杓状软骨炎或杓状软骨病而严重受损，这是一种导致受影响软骨畸形和功能障碍的病理状况。目前对药物治疗无反应的病例的治疗方法是切除软骨，这可以改善气道阻塞，但使患者容易出现其他并发症，例如气管穿透口咽内容物以及软骨侧面目前无支撑的软组织动态塌陷。重建杓状软骨的组织工程方法将在杓状软骨炎的治疗中具有显着优势。在这项研究中，我们探讨了脱细胞基质是否有可能融入马杓状软骨的高运动环境中。将马杓状软骨脱细胞，并将所得脱细胞支架的一部分植入八匹马杓状软骨中产生的全层缺损中。每匹马的两侧均进行植入，随机选择一侧接受植入自体骨髓源性有核细胞（BMNC）的植入物。对杓状软骨的结构和功能进行长达 4 个月的监测。体内评估包括休息时和高速跑步机运动期间的喉部超声和喉内窥镜检查。死后对杓状软骨进行组织学评估。尽管在杓状软骨的内侧诱导了短暂的肉芽肿，但软骨移植物的植入对喉部呼吸功能或吞咽没有不利影响。超声监测发现术后杓状体的厚度和横截面积增加，在未接种 BMNC 的杓状体中消退得更快。外植组织显示粘膜表面上皮化，植入物与天然杓状软骨融合，不良细胞反应最小。植入后 2 个月，支架材料的重塑明显。用 BMNC 预先接种支架增加了支架降解和掺入的速率。用预先植入 BMNC 的组织工程软骨移植物替换杓状软骨部分在马中是可行的，具有良好的耐受性，并且可以在天然组织中适当整合，还可以防止运动过程中喉部组织塌陷。