Application of Extracellular Matrix to Repair the Tissue Injuries and Damages Induced by Combat: A Review Study

Document Type : Review

Authors

Department of Physiology and Medical Physics, School of Medicine, Baqiyatallah University of Medical Sciences, Tehran, Iran

Abstract

Background and Aim: Using the extracellular matrix (ECM) and biological scaffolds have created a new field in repairing non-healing tissue injuries due to the promising results. These materials provide a suitable milieu for the cells' survival, proliferation, and differentiation due to their biocompatibility and growth stimulating factors, and accelerate tissue repair. The present study investigated the importance of ECM in the healing and regeneration of tissue damages, especially in combat.
Methods: In order to obtain the data, the keywords of ECM, war injuries, tissue injuries (such as skin, muscle, brain-spinal, pulmonary, visceral, kidney, and bone), and tissue repair were used. Using these words, the articles were searched in the reliable databases of Scopus, PubMed, ScienceDirect, IranDoc, and Google Scholar during the period 2002-2022. Finally, the most important findings were reported as a narrative review article.
Results: According to the results of the reviewed studies, it can be said that the use of ECM obtained from different tissues in the form of prepared powders, hydrogels and bio-scaffolds is able to heal the damages and injuries of different tissues such as nervous (brain and spinal cord), visceral (liver and kidney), bone, skin, muscle, and lung, which have been damaged due to various reasons, especially in combat.
Conclusion: Using the valuable therapeutic potential of ECM, as a suitable and available method for repairing tissue injuries and damages, can greatly improve the non-healing tissue injuries and wounds, especially in combat, and lead to proper and even normal tissue function.

Keywords


1. Mohebbi H, Nejad Sangsari J, Saghafinia M, Khavanin A. Moharam zadeh Y. Survey of Injuries due to Bullet and Fragmentation Munitions according to Files of Supreme Medical Commission. Journal of Military Medicine. 2007;9(3):225-31. 2. Taebi G, Soroush M, Modirian E, Khateri S, Mousavi B, Ganjparvar Z, et al. Human Costs of Iraq's chemical war against Iran; an epidemiological study. Iranian Journal of War and Public Health. 2015;7(2):115-21. 3. Wright RB, Wright R. Dreams and shadows: The future of the Middle East: Penguin; 2008. 4. Rajaee F. The Iran-Iraq war: the politics of aggression: University Press of Florida; 1993. 5. Zhu M, Li W, Dong X, Yuan X, Midgley AC, Chang H, et al. In vivo engineered extracellular matrix scaffolds with instructive niches for oriented tissue regeneration. Nature communications. 2019;10(1):1-14. 6. Yi S, Ding F, Gong L, Gu X. Extracellular matrix scaffolds for tissue engineering and regenerative medicine. Current stem cell research & therapy. 2017;12(3):233-46. 7. Assunção M, Dehghan-Baniani D, Yiu CHK, Später T, Beyer S, Blocki A. Cell-derived extracellular matrix for tissue engineering and regenerative medicine. Frontiers in bioengineering and biotechnology. 2020;8:602009. 8. Kwon SG, Kwon YW, Lee TW, Park GT, Kim JH. Recent advances in stem cell therapeutics and tissue engineering strategies. Biomaterials Research. 2018;22(1):1-8. 9. Han F, Wang J, Ding L, Hu Y, Li W, Yuan Z, et al. Tissue engineering and regenerative medicine: achievements, future, and sustainability in Asia. Frontiers in bioengineering and biotechnology. 2020;8:83. 10. Caldeira J, Sousa A, Sousa D, Barros D. Extracellular matrix constitution and function for tissue regeneration and repair. Peptides and proteins as biomaterials for tissue regeneration and repair: Elsevier; 2018. p. 29-72. 11. Travascio F. Composition and function of the extracellular matrix in the human body: BoD–Books on Demand; 2016. 12. Hussey GS, Dziki JL, Badylak SF. Extracellular matrix-based materials for regenerative medicine. Nature Reviews Materials. 2018;3(7):159-73. 13. Zhang X, Chen X, Hong H, Hu R, Liu J, Liu C. Decellularized extracellular matrix scaffolds: Recent trends and emerging strategies in tissue engineering. Bioactive materials. 2022;10:15-31. 14. Yao Q, Zheng Y-W, Lan Q-H, Kou L, Xu H-L, Zhao Y-Z. Recent development and biomedical applications of decellularized extracellular matrix biomaterials. Materials Science and Engineering: C. 2019;104:109942. 15. Liao J, Xu B, Zhang R, Fan Y, Xie H, Li X. Applications of decellularized materials in tissue engineering: advantages, drawbacks and current improvements, and future perspectives. Journal of Materials Chemistry B. 2020;8(44):10023-49. 16. Parmaksiz M, Dogan A, Odabas S, Elçin AE, Elçin YM. Clinical applications of decellularized extracellular matrices for tissue engineering and regenerative medicine. Biomedical materials. 2016;11(2):022003. 17. Sart S, Jeske R, Chen X, Ma T, Li Y. Engineering stem cell-derived extracellular matrices: decellularization, characterization, and biological function. Tissue Engineering Part B: Reviews. 2020;26(5):402-22. 18. Krishtul S, Baruch L, Machluf M. Processed tissue–derived extracellular matrices: tailored platforms empowering diverse therapeutic applications. Advanced Functional Materials. 2020;30(18):1900386. 19. Hong Y, Huber A, Takanari K, Amoroso NJ, Hashizume R, Badylak SF, et al. Mechanical properties and in vivo behavior of a biodegradable synthetic polymer microfiber-extracellular matrix hydrogel biohybrid scaffold. Biomaterials. 2011;32(13):3387-94. 20. Elmashhady HH, Kraemer BA, Patel KH, Sell SA, Garg K. Decellularized extracellular matrices for tissue engineering applications. Electrospinning. 2017;1(1):87-99. 21. Minas T, Ogura T, Headrick J, Bryant T. Autologous Chondrocyte Implantation "Sandwich" Technique Compared With Autologous Bone Grafting for Deep Osteochondral Lesions in the Knee. The American journal of sports medicine. 2018;46(2):322-32. 22. Hesse E, Hefferan TE, Tarara JE, Haasper C, Meller R, Krettek C, et al. Collagen type I hydrogel allows migration, proliferation, and osteogenic differentiation of rat bone marrow stromal cells. Journal of Biomedical Materials Research Part A. 2010;94(2):442-9. 23. Smith EL, Kanczler JM, Gothard D, Roberts CA, Wells JA, White LJ, et al. Evaluation of skeletal tissue repair, part 1: assessment of novel growth-factor-releasing hydrogels in an ex vivo chick femur defect model. Acta biomaterialia. 2014;10(10):4186-96. 24. Chen G, Lv Y. Decellularized bone matrix scaffold for bone regeneration. Decellularized Scaffolds and Organogenesis: Springer; 2017. p. 239-54. 25. Mizuno H, Hata K, Kojima K, Bonassar LJ, Vacanti CA, Ueda M. A novel approach to regenerating periodontal tissue by grafting autologous cultured periosteum. Tissue engineering. 2006;12(5):1227-335. 26. Hesse E, Kluge G, Atfi A, Correa D, Haasper C, Berding G, et al. Repair of a segmental long bone defect in human by implantation of a novel multiple disc graft. Bone. 2010;46(5):1457-63. 27. Pipino G, Risitano S, Alviano F, Wu EJ, Bonsi L, Vaccarisi DC, et al. Microfractures and hydrogel scaffolds in the treatment of osteochondral knee defects: A clinical and histological evaluation. Journal of clinical orthopaedics and trauma. 2019;10(1):67-75. 28. Gu Y, Li Z, Huang J, Wang H, Gu X, Gu J. Application of marrow mesenchymal stem cell‐derived extracellular matrix in peripheral nerve tissue engineering. Journal of Tissue Engineering and Regenerative Medicine. 2017;11(8):2250-60. 29. Meder T, Prest T, Skillen C, Marchal L, Yupanqui V, Soletti L, et al. Nerve-specific extracellular matrix hydrogel promotes functional regeneration following nerve gap injury. NPJ Regenerative Medicine. 2021;6(1):1-9. 30. Prest TA, Yeager E, LoPresti ST, Zygelyte E, Martin MJ, Dong L, et al. Nerve‐specific, xenogeneic extracellular matrix hydrogel promotes recovery following peripheral nerve injury. Journal of Biomedical Materials Research Part A. 2018;106(2):450-9. 31. Wang Y, Zhao Z, Ren Z, Zhao B, Zhang L, Chen J, et al. Recellularized nerve allografts with differentiated mesenchymal stem cells promote peripheral nerve regeneration. Neuroscience letters. 2012;514(1):96-101. 32. Haase SC, Rovak JM, Dennis RG, Kuzon Jr WM, Cederna PS. Recovery of muscle contractile function following nerve gap repair with chemically acellularized peripheral nerve grafts. Journal of reconstructive microsurgery. 2003;19(04):241-8. 33. Ghuman H, Mauney C, Donnelly J, Massensini AR, Badylak SF, Modo M. Biodegradation of ECM hydrogel promotes endogenous brain tissue restoration in a rat model of stroke. Acta biomaterialia. 2018;80:66-84. 34. Zhao Y, Tang F, Xiao Z, Han G, Wang N, Yin N, et al. Clinical study of NeuroRegen scaffold combined with human mesenchymal stem cells for the repair of chronic complete spinal cord injury. Cell transplantation. 2017;26(5):891-900. 35. Liu J, Chen J, Liu B, Yang C, Xie D, Zheng X, et al. Acellular spinal cord scaffold seeded with mesenchymal stem cells promotes long-distance axon regeneration and functional recovery in spinal cord injured rats. Journal of the neurological sciences. 2013;325(1-2):127-36. 36. Xiao Z, Tang F, Tang J, Yang H, Zhao Y, Chen B, et al. One-year clinical study of NeuroRegen scaffold implantation following scar resection in complete chronic spinal cord injury patients. Science China Life Sciences. 2016;59(7):647-55. 37. Xiao Z, Tang F, Zhao Y, Han G, Yin N, Li X, et al. Significant improvement of acute complete spinal cord injury patients diagnosed by a combined criteria implanted with NeuroRegen scaffolds and mesenchymal stem cells. Cell Transplantation. 2018;27(6):907-15. 38. Macchiarini P, Jungebluth P, Go T, Asnaghi MA, Rees LE, Cogan TA, et al. Clinical transplantation of a tissue-engineered airway. The Lancet. 2008;372(9655):2023-30. 39. Elliott MJ, De Coppi P, Speggiorin S, Roebuck D, Butler CR, Samuel E, et al. Stem-cell-based, tissue engineered tracheal replacement in a child: a 2-year follow-up study. The Lancet. 2012;380(9846):994-1000. 40. Delaere PR, Hermans R. Clinical transplantation of a tissue-engineered airway. The Lancet. 2009;373(9665):717-8. 41. Gonfiotti A, Jaus MO, Barale D, Baiguera S, Comin C, Lavorini F, et al. The first tissue-engineered airway transplantation: 5-year follow-up results. The Lancet. 2014;383(9913):238-44. 42. Baiguera S, Gonfiotti A, Jaus M, Comin CE, Paglierani M, Del Gaudio C, et al. Development of bioengineered human larynx. Biomaterials. 2011;32(19):4433-42. 43. Nichols JE, Niles J, Riddle M, Vargas G, Schilagard T, Ma L, et al. Production and assessment of decellularized pig and human lung scaffolds. Tissue Engineering Part A. 2013;19(17-18):2045-62. 44. Faulk DM, Wildemann JD, Badylak SF. Decellularization and cell seeding of whole liver biologic scaffolds composed of extracellular matrix. Journal of clinical and experimental hepatology. 2015;5(1):69-80. 45. Verstegen MM, Willemse J, Van Den Hoek S, Kremers G-J, Luider TM, van Huizen NA, et al. Decellularization of whole human liver grafts using controlled perfusion for transplantable organ bioscaffolds. Stem cells and development. 2017;26(18):1304-15. 46. Chen Y, Geerts S, Jaramillo M, Uygun BE. Preparation of decellularized liver scaffolds and recellularized liver grafts. Decellularized Scaffolds and Organogenesis: Springer; 2017. p. 255-70. 47. Ansari T, Southgate A, Obiri-Yeboa I, Jones LG, Greco K, Olayanju A, et al. Development and characterization of a porcine liver scaffold. Stem Cells and Development. 2020;29(5):314-26. 48. Lee JS, Shin J, Park H-M, Kim Y-G, Kim B-G, Oh J-W, et al. Liver extracellular matrix providing dual functions of two-dimensional substrate coating and three-dimensional injectable hydrogel platform for liver tissue engineering. Biomacromolecules. 2014;15(1):206-18. 49. Hussein KH, Saleh T, Ahmed E, Kwak HH, Park KM, Yang SR, et al. Biocompatibility and hemocompatibility of efficiently decellularized whole porcine kidney for tissue engineering. Journal of Biomedical Materials Research Part A. 2018;106(7):2034-47. 50. Zambon JP, Ko IK, Abolbashari M, Huling J, Clouse C, Kim TH, et al. Comparative analysis of two porcine kidney decellularization methods for maintenance of functional vascular architectures. Acta biomaterialia. 2018;75:226-34. 51. Bonandrini B, Figliuzzi M, Papadimou E, Morigi M, Perico N, Casiraghi F, et al. Recellularization of well-preserved acellular kidney scaffold using embryonic stem cells. Tissue Engineering Part A. 2014;20(9-10):1486-98. 52. Testa S, Fornetti E, Fuoco C, Sanchez-Riera C, Rizzo F, Ciccotti M, et al. The War after War: Volumetric Muscle Loss Incidence, Implication, Current Therapies and Emerging Reconstructive Strategies, a Comprehensive Review. Biomedicines. 2021;9(5):564. 53. Sicari BM, Rubin JP, Dearth CL, Wolf MT, Ambrosio F, Boninger M, et al. An acellular biologic scaffold promotes skeletal muscle formation in mice and humans with volumetric muscle loss. Science translational medicine. 2014;6(234):234ra58-ra58. 54. Valerio IL, Campbell P, Sabino J, Dearth CL, Fleming M. The use of urinary bladder matrix in the treatment of trauma and combat casualty wound care. Regenerative Medicine. 2015;10(5):611-22. 55. Griffiths TLS. A Rat Model of Volumetric Muscle Loss Repaired with Extracellular Matrix and Stem Cells: University of California, Davis; 2016. 56. Kim YS, Majid M, Melchiorri AJ, Mikos AG. Applications of decellularized extracellular matrix in bone and cartilage tissue engineering. Bioengineering & translational medicine. 2019;4(1):83-95. 57. Haggerty AE, Marlow MM, Oudega M. Extracellular matrix components as therapeutics for spinal cord injury. Neuroscience letters. 2017;652:50-5. 58. Karamanos NK, Theocharis AD, Piperigkou Z, Manou D, Passi A, Skandalis SS, et al. A guide to the composition and functions of the extracellular matrix. The FEBS journal. 2021;288(24):6850-912. 59. Theocharis AD, Manou D, Karamanos NK. The extracellular matrix as a multitasking player in disease. The FEBS journal. 2019;286(15):2830-69. 60. Chaffey N. Alberts, B., Johnson, A., Lewis, J., Raff, M., Roberts, K. and Walter, P. Molecular biology of the cell. 4th edn. Oxford University Press; 2003. 61. Karsdal MA, Nielsen MJ, Sand JM, Henriksen K, Genovese F, Bay-Jensen A-C, et al. Extracellular matrix remodeling: the common denominator in connective tissue diseases possibilities for evaluation and current understanding of the matrix as more than a passive architecture, but a key player in tissue failure. Assay and drug development technologies. 2013;11(2):70-92. 62. Brown NH. Extracellular matrix in development: insights from mechanisms conserved between invertebrates and vertebrates. Cold Spring Harbor perspectives in biology. 2011;3(12):a005082. 63. Humphrey JD, Dufresne ER, Schwartz MA. Mechanotransduction and extracellular matrix homeostasis. Nature reviews Molecular cell biology. 2014;15(12):802-12. 64. Chen C, Loe F, Blocki A, Peng Y, Raghunath M. Applying macromolecular crowding to enhance extracellular matrix deposition and its remodeling in vitro for tissue engineering and cell-based therapies. Advanced drug delivery reviews. 2011;63(4-5):277-90. 65. Tibbitt MW, Anseth KS. Hydrogels as extracellular matrix mimics for 3D cell culture. Biotechnology and bioengineering. 2009;103(4):655-63. 66. Cox TR, Erler JT. Remodeling and homeostasis of the extracellular matrix: implications for fibrotic diseases and cancer. Disease models & mechanisms. 2011;4(2):165-78. 67. Fleming ME, Bharmal H, Valerio I. Regenerative medicine applications in combat casualty care. Regenerative medicine. 2014;9(2):179-90.