Tissue Engineered Nasal Cartilage for Reconstruction of the Alar Lobule

Autologous native cartilage from the nasal septum, ear, or rib is currently the standard material for surgical reconstruction of the nasal alar lobule after two-layer excision of non-melanoma skin cancer. We assessed in a phase I clinical study whether engineered autologous cartilage grafts allow safe and functional alar lobule restoration. These grafts are based on the use of chondrocytes from the nasal septum of the patient and the implantation of a tissue rather than cells.

The reproducible and durable repair of articular cartilage following traumatic injuries is still an unmet clinical need. The most advanced cell-based therapies are based on the use of autologous chondrocytes harvested from the damaged joint, which display a large and uncontrollable inter- and intra-donor variability.

We have identify that chondrocytes from the nasal septum, as compared to those from articular cartilage, have a superior and more reproducible chondrogenic capacity following in vitro expansion, in addition to being available in an autologous setting, under minimally invasive conditions. The possibility of generating cartilage tissues from nasal chondrocytes (Figure aside) has inspired plastic surgeons to use the materials as autologous grafts for the reconstruction of the alar lobule of the nose after skin tumor resection, a procedure for which normally cartilage from ears, ribs or large parts of the nasal septum from the same patient would be use.

The results of a first-in-man clinical trial (Clinical-trials.gov NCT 01242618, Swissmedic TpP-I-2010-002) have demonstrated that the engineered grafts could lead to complete structural, functional and aesthetic needs, bypassing additional morbidity of native cartilage tissue harvest.

Completed (Oct. 2010-Feb 2013)

These results are now opening the way to implementation into more challenging and larger facial defects.

Publication:

Fulco I and Miot S et al. Engineered autologous cartilage tissue for nasal reconstruction after tumour resection: an observational first-in-human trial. Lancet. Jul 26;384(9940):337-46 (2014). Pubmed.

Engineering of autologous nasal cartilage grafts. (A) Collection of a nasal cartilage biopsy from a patient, this procedure is performed under local anaesthesia and results in minimal donor site morbidity. (B) Biopsy of nasal cartilage septum. (C-D) Tissue engineered cartilage graft: macroscopic (C) and histological appearance (Safranin-O staining specific for sulfated glycosaminoglycans (D).