Name: matrix-assisted autologous chondrocyte transplantation for remodeling and repair of chondral defects in a rabbit model
Uploaded: 2013-05-21T12:00:00
Description: Watch this Scientific Journal Video about Matrix-assisted Autologous Chondrocyte Transplantation for Remodeling and Repair of Chondral Defects in a Rabbit Model at JoVE.com

このプロジェクトは、ドイツ研究協会（DFG、HE 4578/3-1）によって賄われていた。

A.軟骨生検（手術室、非滅菌準備室の手順1-5） <ol><li>適切に用量薬することができるように、手術後の体重を監視するために、ウサギ（ニュージーランドホワイトウサギ、女性、3.5〜4.0キロの体重、生後6ヶ月）の最終重量の制御を行う。 </li><li> 10 mg / kgをプロポフォールの静脈内注射によりウサギに麻酔を誘導する。 </li><li>挿管後、静脈内に1.5 mg / kg体重/分プロポフォール及び0.05 mg / kgで...

<ol>
	<li>Albrecht, C., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Gene+expression+and+cell+differentiation+in+matrix-associated+chondrocyte+transplantation+grafts:+a+comparative+study.">Gene expression and cell differentiation in matrix-associated chondrocyte transplantation grafts: a comparative study.</a> Osteoarthritis Cartilage. 19, 1219-1227 (2011).</li><li>Pridie, K. H. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=A+method+of+resurfacing+osteoarthritic+knee+joints.">A method of resurfacing osteoarthritic knee joints.</a> J. Bone Joint Surg. Br. 41, 618-619 (1959).</li><li>Johnson, L. L. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Arthroscopic+abrasion+arthroplasty+historical+and+pathologic+perspective:+present+status.">Arthroscopic abrasion arthroplasty historical and pathologic perspective: present status.</a> Arthroscopy. 2, 54-69 (1986).</li><li>Steadman, J. R., Rodkey, W. G., Singelton, S. B., Briggs, K. K. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Microfracture+technique+for+full-thickness+chondral+defects:+technique+and+clinical+result.">Microfracture technique for full-thickness chondral defects: technique and clinical result.</a> Operat. Tech. Orthop. 7, 300-304 (1997).</li><li>Brittberg, M., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Treatment+of+deep+cartilage+defects+in+the+knee+with+autologous+chondrocyte+transplantation.">Treatment of deep cartilage defects in the knee with autologous chondrocyte transplantation.</a> N. Engl. J. Med. 331, 889-895 (1994).</li><li>Peterson, L., Vasiliadis, H. S., Brittberg, M., Lindahl, A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Autologous+chondrocyte+implantation:+a+long-term+follow-up.">Autologous chondrocyte implantation: a long-term follow-up.</a> Am. J. Sports Med. 38, 1117-1124 (2010).</li><li>Nehrer, S., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Chondrocyte-seeded+collagen+matrices+implanted+in+a+chondral+defect+in+a+canine+model.">Chondrocyte-seeded collagen matrices implanted in a chondral defect in a canine model.</a> Biomaterials. 19, 2313-2328 (1998).</li><li>Frenkel, S. R., Toolan, B., Menche, D., Pitman, M. I., Pachence, J. M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Chondrocyte+transplantation+using+a+collagen+bilayer+matrix+for+cartilage+repair.">Chondrocyte transplantation using a collagen bilayer matrix for cartilage repair.</a> J. Bone. Joint Surg. Br. 79, 831-836 (1997).</li><li>Salzmann, G. M., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+dependence+of+autologous+chondrocyte+transplantation+on+varying+cellular+passage,+yield+and+culture+duration.">The dependence of autologous chondrocyte transplantation on varying cellular passage, yield and culture duration.</a> Biomaterials. 32, 5810-5818 (2011).</li><li>Frohlich, M., Malicev, E., Gorensek, M., Knezevic, M., Kregar Velikonja, N. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Evaluation+of+rabbit+auricular+chondrocyte+isolation+and+growth+parameters+in+cell+culture.">Evaluation of rabbit auricular chondrocyte isolation and growth parameters in cell culture.</a> Cell Biol. Int. 31, 620-625 (2007).</li><li>Willers, C., Chen, J., Wood, D., Xu, J., Zheng, M. H. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Autologous+chondrocyte+implantation+with+collagen+bioscaffold+for+the+treatment+of+osteochondral+defects+in+rabbits.">Autologous chondrocyte implantation with collagen bioscaffold for the treatment of osteochondral defects in rabbits.</a> Tissue Eng. 11, 1065-1076 (2005).</li><li>Vogt, S., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+influence+of+the+stable+expression+of+BMP2+in+fibrin+clots+on+the+remodelling+and+repair+of+osteochondral+defects.">The influence of the stable expression of BMP2 in fibrin clots on the remodelling and repair of osteochondral defects.</a> Biomaterials. 30, 2385-2392 (2009).</li><li>Ueblacker, P., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=In+vivo+analysis+of+retroviral+gene+transfer+to+chondrocytes+within+collagen+scaffolds+for+the+treatment+of+osteochondral+defects.">In vivo analysis of retroviral gene transfer to chondrocytes within collagen scaffolds for the treatment of osteochondral defects.</a> Biomaterials. 28, 4480-4487 (2007).</li><li>Marlovits, S., Zeller, P., Singer, P., Resinger, C., Vecsei, V. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Cartilage+repair:+generations+of+autologous+chondrocyte+transplantation.">Cartilage repair: generations of autologous chondrocyte transplantation.</a> Eur. J. Radiol. 57, 24-31 (2006).</li><li>Benya, P. D., Shaffer, J. D. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Dedifferentiated+chondrocytes+reexpress+the+differentiated+collagen+phenotype+when+cultured+in+agarose+gels.">Dedifferentiated chondrocytes reexpress the differentiated collagen phenotype when cultured in agarose gels.</a> Cell. 30, 215-224 (1982).</li><li>Rudert, M., Hirschmann, F., Wirth, C. J. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Growth+behavior+of+chondrocytes+on+various+biomaterials.">Growth behavior of chondrocytes on various biomaterials.</a> Orthopade. 28, 68-75 (1999).</li><li>Hsu, S. H., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Evaluation+of+biodegradable+polyesters+modified+by+type+II+collagen+and+Arg-Gly-Asp+as+Tissue+Engineering+scaffolding+materials+for+cartilage+regeneration.">Evaluation of biodegradable polyesters modified by type II collagen and Arg-Gly-Asp as Tissue Engineering scaffolding materials for cartilage regeneration.</a> Artificial Organs. 30, 42-55 (2006).</li><li>Brun, P., Cortivo, R., Zavan, B., Vecchiato, N., Abatangelo, G. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=In+vitro++reconstructed+tissues+on+hyaluronan-based+temporary+scaffolding.">In vitro reconstructed tissues on hyaluronan-based temporary scaffolding.</a> J. Mater. Sci. Mater. Med. 10, 683-688 (1999).</li><li>Domm, C., Fay, J., Schunke, M., Kurz, B. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Redifferentiation+of+dedifferentiated+joint+cartilage+cells+in+alginate+culture.+Effect+of+intermittent+hydrostatic+pressure+and+low+oxygen+partial+pressure.">Redifferentiation of dedifferentiated joint cartilage cells in alginate culture. Effect of intermittent hydrostatic pressure and low oxygen partial pressure.</a> Orthopade. 29, 91-99 (2000).</li><li>Kimura, T., Yasui, N., Ohsawa, S., Ono, K. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Chondrocytes+embedded+in+collagen+gels+maintain+cartilage+phenotype+during+long-term+cultures.">Chondrocytes embedded in collagen gels maintain cartilage phenotype during long-term cultures.</a> Clin. Orthop. Relat. Res. , 231-239 (1984).</li><li>Kon, E., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Second-generation+autologous+chondrocyte+implantation:+results+in+patients+older+than+40+years.">Second-generation autologous chondrocyte implantation: results in patients older than 40 years.</a> Am. J. Sports Med. 39, 1668-1675 (2011).</li><li>Gavenis, K., Schmidt-Rohlfing, B., Mueller-Rath, R., Andereya, S., Schneider, U. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=In+vitro+comparison+of+six+different+matrix+systems+for+the+cultivation+of+human+chondrocytes.">In vitro comparison of six different matrix systems for the cultivation of human chondrocytes.</a> In Vitro Cell Dev. Biol. Anim. 42, 159-167 (2006).</li><li>Niemeyer, P., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Characteristic+complications+after+autologous+chondrocyte+implantation+for+cartilage+defects+of+the+knee+joint.">Characteristic complications after autologous chondrocyte implantation for cartilage defects of the knee joint.</a> Am. J. Sports Med. 36, 2091-2099 (2008).</li><li>Tay, L. X., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Treatment+outcomes+of+alginate-embedded+allogenic+mesenchymal+stem+cells+versus+autologous+chondrocytes+for+the+repair+of+focal+articular+cartilage+defects+in+a+rabbit+model.">Treatment outcomes of alginate-embedded allogenic mesenchymal stem cells versus autologous chondrocytes for the repair of focal articular cartilage defects in a rabbit model.</a> The American Journal of Sports Medicine. 40, 83-90 (2012).</li><li>Brittberg, M., Nilsson, A., Lindahl, A., Ohlsson, C., Peterson, L. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Rabbit+articular+cartilage+defects+treated+with+autologous+cultured+chondrocytes.">Rabbit articular cartilage defects treated with autologous cultured chondrocytes.</a> Clin. Orthop. Relat. Res. , 270-283 (1996).</li></ol>

提示プロトコルは、ウサギのひざで人工的に作成された軟骨欠損へのその後の増殖および再移植のため自家軟骨細胞を単離する9,12,13を設立し、簡単に再現可能な技術を提供する。関節軟骨損傷のリモデリングおよび修復のための自家軟骨細胞の使用は満足な長期的結果を提供すること6臨床既に使用されている。 骨膜肥大や石灰化などのような主...

<table border="1">
	<tbody>
		<tr>
			<td>Name of reagent/equipment</td>
			<td>Company</td>
			<td>Catalogue Number</td>
			<td>Comments</td>
		</tr>
		<tr>
			<td>DMEM</td>
			<td>Biochrom AG</td>
			<td>F 0415</td>
			<td></td>
		</tr>
		<tr>
			<td>Collagenase A</td>
			<td>Roche</td>
			<td>10 103 586 001</td>
			<td>0.21 U/mg</td>
		</tr>
		<tr>
			<td>Fetal calf serum (FCS)</td>
			<td>PAN Biotech GmbH</td>
			<td>3702-P103009</td>
			<td></td>
		</tr>
		<tr>
			<td>Propofol</td>
			<td>Fresenius Kabi</td>
			<td></td>
			<td></td>
		</tr>
		<tr>
			<td>Penicillin/Streptomycin</td>
			<td>Biochrom AG</td>
			<td>A 2213</td>
			<td>10,000 U/ml/10,000 &mu;g/ml</td>
		</tr>
		<tr>
			<td>PBS Dulbecco (1X)</td>
			<td>Biochrom AG</td>
			<td>L1815</td>
			<td></td>
		</tr>
		<tr>
			<td>Ethanol (70%)</td>
			<td>Merck KgaA</td>
			<td>410230</td>
			<td></td>
		</tr>
		<tr>
			<td>Trypsin-EDTA 0.25 %/0.02 %</td>
			<td>Biochrom AG</td>
			<td>L2163</td>
			<td>in PBS w/o Ca2+, Mg2+</td>
		</tr>
		<tr>
			<td>Fentanyl</td>
			<td>Delta Select GmBH</td>
			<td>1819340</td>
			<td></td>
		</tr>
		<tr>
			<td>NaCl solution (0.9%)</td>
			<td>Bbraun</td>
			<td>8333A193</td>
			<td></td>
		</tr>
		<tr>
			<td>Tissue culture dishes 100 mm/150 mm</td>
			<td>TPP AG</td>
			<td>93100/93150</td>
			<td>Growth area 60.1 mm2/147.8 mm2</td>
		</tr>
		<tr>
			<td>Tissue culture flasks 25/75 mm2</td>
			<td>TPP AG</td>
			<td>90025/90075</td>
			<td>25 mm2, 75 mm2</td>
		</tr>
		<tr>
			<td>Centrifuge Tubes (50 ml)</td>
			<td>TPP AG</td>
			<td>91050</td>
			<td>Gamma-sterilized</td>
		</tr>
		<tr>
			<td>Hemocytometer</td>
			<td>Brand GmbH+Co KG</td>
			<td>717810</td>
			<td>Neubauer</td>
		</tr>
		<tr>
			<td>Trypan Blue Solution 0.4%</td>
			<td>Sigma-Aldrich</td>
			<td>L8154</td>
			<td></td>
		</tr>
		<tr>
			<td>Spray dressing (OpSite)</td>
			<td>Smith&amp;Nephew</td>
			<td>66004978</td>
			<td>Permeable for water vapor</td>
		</tr>
		<tr>
			<td>Chondro-Gide&Ograve;</td>
			<td>Geistlich Pharma AG</td>
			<td>30915.5</td>
			<td></td>
		</tr>
		<tr>
			<td>Biopsy Punch</td>
			<td>pfm medical ag</td>
			<td>48351</td>
			<td></td>
		</tr>
		<tr>
			<td>Tissucol Duo S</td>
			<td>Baxter</td>
			<td>3419627</td>
			<td>0.5 ml</td>
		</tr>
	</tbody>
</table>

matrix-assisted autologous chondrocyte transplantation for remodeling and repair of chondral defects in a rabbit model

関節軟骨は自己再生1限られた容量を有するので、関節軟骨の欠陥が重大な健康問題と考えられている。未処理の軟骨病変は進行中の痛みにつながる、否定的に生活の質に影響を与えると変形性関節症のためにやすく。過去数十年の間に、いくつかの外科技術は、このような病変を治療するために開発されてきた。しかし、今まで、硝子関節軟骨を有する欠陥を覆う又は十分な長期の回復2-4を提供するという点で完全な修復を達成することは不可能であった。したがって、関節軟骨の損傷は、そのような組織工学などの再生技術のための主な目標のまま。多くの場合、繊維状または線維軟骨組織の形成をもたらす他の外科技術とは対照的に、組織工学は、完全に移植された細胞の軟骨産生能を使用して、元の関節軟骨複合体の構造および特性を回復することを目的とする。 Recent発展は再生軟骨の治療のための有望な可能性を開いた。 全層軟骨や骨軟骨病変の治療のための最初のセルベースのアプローチは、臨床自家軟骨細胞移植（ACI）5を開拓ラース·ピーターソンとマットBrittbergによって1994年に行われた。今日では、技術は臨床的にも、10〜20年後に移植6良好な臨床結果を維持し、膝の大硝子軟骨欠損の治療のために十分に確立されています。近年では、自家軟骨細胞の移植は、急速な進行を受けた。その後、細胞を植え替えされた人工的な三次元コラーゲンマトリックスの使用は、ますます人気7-9となった。 MACTが2つの外科的処置を含む：軟骨細胞を収集するために、まず、軟骨生検は、tの非体重を支える軟骨領域から行う必要がある彼は膝関節を。その後、軟骨細胞は、抽出、精製し、 インビトロで十分な細胞数に拡張されている。軟骨細胞は、その後、三次元マトリックス上に播種され、その後、再移植することができる。組織工学インプラントを調製する場合、増殖速度および分化能力が成功した組織再生10にとって極めて重要である。細胞担体としての三次元マトリクスの使用は、これらの細胞の特性11を支持すると考えられる。 以下のプロトコルは、3Dマトリックス（ 軟骨·ジッド 、Geistlichバイオマテリアル、Wollhusen、スイス）の上に軟骨生検、in vitroでのそれらの増殖とその播種から軟骨細胞を単離するための手法を要約し、デモンストレーションを行います。最終的に、ウサギの膝関節の人工的に作成された軟骨細胞の欠陥にマトリクス構築物の注入について説明する。この技術は、実験的な設定として使用することができる軟骨修復のさらなる実験のために。

記載外科技術は、人工軟骨欠損部に自家軟骨細胞の正常な分離と移植を可能にします。実験装置は、周囲の軟骨にインプラント統合の成功をもたらした。 in vivoでの 12週間後、軟骨欠損は、インプラント（ 図4）にせん断応力及び損傷を低減均一で無傷の表面で修復組織によって充填した。また、インプラントのない肥大や石灰化が見られなかった。?...

Watch this Scientific Journal Video about Matrix-assisted Autologous Chondrocyte Transplantation for Remodeling and Repair of Chondral Defects in a Rabbit Model at JoVE.com

Matrix-assisted Autologous Chondrocyte Transplantation for Remodeling and Repair of Chondral Defects in a Rabbit Model

ウサギの膝関節内の軟骨欠損の治療のための実験技術が記載されている。マトリックス上に播種自家軟骨細胞の移植は、満足の長期的な結果を提供する関節軟骨病変の改造や修理のために広く受け入れ方法です。マトリックス支援自家軟骨細胞移植（MACT）が標準化され、臨床的に確立された注入方法を提供しています。

ウサギモデルにおける軟骨欠陥の改造と修理のためのマトリックス支援自家軟骨細胞移植

Articular cartilage defects are considered a major health problem because articular cartilage has a limited capacity for self-regeneration 1. Untreated ...

Research

JoVE Journal

Medicine

A Mouse Model of in Utero Transplantation

A Mouse Model of in Utero Transplantation

のマウスモデル子宮内で移植

The transplantation of stem cells and viruses in utero has tremendous potential for treating congenital disorders in the human fetus.  For example, in ...

Development of Obliterative Bronchiolitis in a Murine Model of Orthotopic Lung Transplantation

同所性肺移植のマウスモデルにおける閉塞性細気管支炎の開発

Orthotopic lung transplantation in rats was first reported by Asimacopoulos and colleagues in 1971 1. Currently, this method is well accepted and ...

A Mouse Fetal Skin Model of Scarless Wound Repair

瘢痕創傷修復のマウス胎児皮膚モデル

Early in utero, but not in postnatal life, cutaneous wounds undergo regeneration and heal without formation of a scar. Scarless fetal wound healing occurs ...

A Rat Carotid Balloon Injury Model to Test Anti-vascular Remodeling Therapeutics

ラット頸動脈バルーン損傷モデルは、抗血管リモデリングの治療薬をテストします

The rat carotid balloon injury is a well-established surgical model that has been used to study arterial remodeling and vascular cell proliferation. It is ...

A Model of Cardiac Remodeling Through Constriction of the Abdominal Aorta in Rats

ラットの腹部大動脈の収縮を通じて心臓リモデリングのモデル

Heart failure is one of the leading causes of death worldwide. It is a complex clinical syndromethat includes fatigue, dyspnea, exercise intolerance, and ...

Lentiviral Vector-mediated Gene Therapy of Hepatocytes Ex Vivo for Autologous Transplantation in Swine

Lentiviral Vector-mediated Gene Therapy of Hepatocytes Ex Vivo for Autologous Transplantation in Swine

豚に自家移植用肝細胞Ex Vivoのレンチ ウイルス媒介性遺伝子治療

Gene therapy is an ideal choice to cure many inborn errors of metabolism of the liver. Ex-vivo, lentiviral vectors have been used successfully in the ...

Transthoracic Echocardiographic Examination in the Rabbit Model

ウサギモデルにおける経胸部心エコー検査

Large animal models such as the rabbit are valuable for translational preclinical research. Rabbits have a similar cardiac electrophysiology compared to ...

Retinal Pigment Epithelium Transplantation in a Non-human Primate Model for Degenerative Retinal Diseases

ヒト以外の霊長類モデルにおける変性網膜疾患の網膜色素上皮移植

Retinal pigment epithelial (RPE) transplantation holds great promise for the treatment of inherited and acquired retinal degenerative diseases. These ...

A Simplified Model for Heterotopic Heart Valve Transplantation in Rodents

げっ歯類におけるヘテロトピック心臓弁移植のための簡略モデル

There is an urgent clinical need for heart valve replacements that can grow in children. Heart valve transplantation is proposed as a new type of ...

Left Lung Orthotopic Transplantation in a Juvenile Porcine Model for ESLP

ESLPのブタ幼体モデルにおける左肺同所性移植

Lung transplantation is the gold-standard treatment for end-stage lung disease, with over 4,600 lung transplantations performed worldwide annually. ...