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Frontiers of Medicine

ISSN 2095-0217

ISSN 2095-0225(Online)

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Front. Med.    2022, Vol. 16 Issue (1) : 56-82    https://doi.org/10.1007/s11684-021-0900-3
REVIEW
Decellularized extracellular matrix mediates tissue construction and regeneration
Chuanqi Liu1,2, Ming Pei3, Qingfeng Li2(), Yuanyuan Zhang4()
1. Department of Plastic and Burn Surgery, West China Hospital, Sichuan University, Chengdu 610041, China
2. Department of Plastic and Reconstructive Surgery, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China
3. Stem Cell and Tissue Engineering Laboratory, Department of Orthopaedics, West Virginia University, Morgantown, WV 26506, USA
4. Wake Forest Institute for Regenerative Medicine, Wake Forest University Health Sciences, Winston-Salem, NC 27109, USA
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Abstract

Contributing to organ formation and tissue regeneration, extracellular matrix (ECM) constituents provide tissue with three-dimensional (3D) structural integrity and cellular-function regulation. Containing the crucial traits of the cellular microenvironment, ECM substitutes mediate cell–matrix interactions to prompt stem-cell proliferation and differentiation for 3D organoid construction in vitro or tissue regeneration in vivo. However, these ECMs are often applied generically and have yet to be extensively developed for specific cell types in 3D cultures. Cultured cells also produce rich ECM, particularly stromal cells. Cellular ECM improves 3D culture development in vitro and tissue remodeling during wound healing after implantation into the host as well. Gaining better insight into ECM derived from either tissue or cells that regulate 3D tissue reconstruction or organ regeneration helps us to select, produce, and implant the most suitable ECM and thus promote 3D organoid culture and tissue remodeling for in vivo regeneration. Overall, the decellularization methodologies and tissue/cell-derived ECM as scaffolds or cellular-growth supplements used in cell propagation and differentiation for 3D tissue culture in vitro are discussed. Moreover, current preclinical applications by which ECM components modulate the wound-healing process are reviewed.
Keywords decellularized extracellular matrix      3D culture      organoids      tissue repair     
Corresponding Author(s): Qingfeng Li,Yuanyuan Zhang   
Just Accepted Date: 02 December 2021   Online First Date: 27 December 2021    Issue Date: 28 March 2022
 Cite this article:   
Chuanqi Liu,Ming Pei,Qingfeng Li, et al. Decellularized extracellular matrix mediates tissue construction and regeneration[J]. Front. Med., 2022, 16(1): 56-82.
 URL:  
https://academic.hep.com.cn/fmd/EN/10.1007/s11684-021-0900-3
https://academic.hep.com.cn/fmd/EN/Y2022/V16/I1/56
ECM protein Tissue sources Functions
Collagen Resists tensile and shearing forces, affects various cellular ?functions [29,36]
?Collagen I (80%)
?Collagen II
?Collagen III
?Collagen IV
?Collagen V		 Skin, tendon, internal organs, organic parts of bone
Cartilage
Bone marrow, lymphoid tissues
Basement membrane
Hair, surfaces of cells
Fibronectin Plasma, surfaces of cells Cell adhesion sites, influences cellular behaviors [29,37]
Laminin Basal lamina, placenta Cell adhesion sites [29]
Elastin Blood vessels, ligaments, skin, lung, bladder, elastic ?cartilage Recoil [33]
Proteoglycans Connective tissues, intracellular compartments, surfaces ?of cells Resists compressive forces, provides recoil and participates in ?cell signaling and cellular behaviors [29,36]
Hyaluronan Placenta, amniotic fluid, vitreous body, articular cartilage, ?dermis of skin Lubricates, absorbs shock, affects cellular behaviors and ?signaling molecules [38,39]
Tab.1  Composition of ECM
Fig.1  Role and composition of stem-cell niche. The stem-cell niches retain the stemness of adult stem cells in a quiescent state. When tissue is injured, the surrounding microenvironment actively signals stem cells to promote either self-renewal or differentiation to form new tissues. The niches include cell–matrix, cell–protein, protein–matrix, cell–cell interactions, hypoxia, and metabolism. Among these niche factors, cell–matrix interactions play a key role in prompting cell adhesion, migration, proliferation, and differentiation for tissue regeneration. The matrix regulates stem-cell behavior through structural supports, biochemical signaling, growth factor induction, and biomechanical regulation during tissue repair.
Role Mechanism(s) Function(s)
Structural support Porosity, mechanical properties, ?cell–matrix communication Regulating cell adhesion, growth, differentiation and forming 3D tissue ?structures [43]
Biochemical regulation Integrins Regulating cell proliferation, adhesion, migration, differentiation, homing ?[45,46,49,64]
Growth factor regulation Reservoir, gradients, sequestration, ?activation, autocrine, paracrine Regulating growth factor bioavailability dynamically [52]; maintaining ?stem-cell survival, self-renewal, differentiation [64–66]
Biomechanical regulation ECM topography, microstructure, ?stiffness, elasticity Modulating cell shape, tissue elongation, cell–ECM interactions; regulating ?stem-cell fate [55–57,59,62–64]
Tab.2  Role of ECM in inducing stem-cell fate
Agents/techniques Mode of action Effects on ECM
Physical treatments
?Freeze and dry Xenogeneic cellular compounds can be washed away ?after microscopic ice crystals disrupt cell membrane Disrupt or fracture ECM fibers [92–94]
?Mechanical-shaking ??force Shaking action promotes cell debris removal from matrix Disrupt ECM structure and clean up the cellular fragments ?[95–97]
?NTIRE Electrical pulse disrupts cellular membranes Can disrupt ECM [98,99]
?scCO2 Deeply penetrates into tissues and solubilizes non-polar ?molecules Can disrupt ECM when the system is rapidly depressurized ?[81]
Chemical treatments
?Acids and bases Disrupts both intracellular organelles and cell membranes Break down collagen and GAGs and denature proteins or ?growth factors [95,100]
?Ionic detergents Solubilizes plasma membranes and nuclear membranes Denature proteins via damaging bonds between proteins ?[82,101,102]
?Non-ionic detergents Disrupts bonds between lipids and between lipids ?and proteins Beneficial to keep the ECM intact, may disrupt ultrastructure ?and GAGs [83,101,102]
Enzymatic treatments
?Trypsin Cleaves cell adhesion from ECM Extended exposure can destroy the structure of ECM, remove ?fibronectin, laminin, elastin, GAG [103–105]
?Dispase Cleaves collagen IV and fibronectin Extended exposure can destroy the ultrastructure of ECM ?[95,106]
?Nuclease ??(DNase and RNase) Degrades nucleic acids Hard to remove, may induce immune reaction [107–109]
?FBS (serum containing ??DNase and RNase) Retains bioactive proteins, degrades remaining DNA/RNA Can minimize the loss of major bioactive proteins, decrease ?xenogeneic immune response [86–88]
Combined methodologies
?Shaking action+ FBS Optimizes approaches to remove xenogeneic cellular ?compounds by maintaining bioactive proteins and ?ECM structure
Tab.3  Methodology of decellularized tissue or cell-derived ECM
Application ECM types Cell types and
?animal models		 Outcomes
Tissue regeneration
?Cartilage tissue Porcine SDSCs Porcine SDSCs
In vitro and in vivo ?(13 minipigs)		 Enhancing SDSCs’ expansion, chondrogenic ?potential, and repair of cartilage defects [139]
Human adult vs. ?fetal SDSCs Human adult SDSCs Promoting adult SDSCs’ chondrogenic capacity by ?fetal ECM [140]
Human fetal MSCs Human adult MSCs Promoting adult MSCs’ proliferation, multipotency, ?and stemness [141]
Porcine chondrocytes ?vs. rabbit BMSCs Rabbit
?chondrocytes		 Supporting attachment and proliferation of ?chondrocytes [142]
Porcine SDSCs Porcine chondrocytes Delaying chondrocyte dedifferentiation and ?enhanced redifferentiation [134]
Porcine SDSCs vs. NPCs ?vs. SDSCs/NPCs Porcine SDSCs Guiding SDSCs’ differentiation toward the NP ?lineage [137]
Porcine SDSCs Porcine NPCs Rejuvenating NPCs in proliferation and ?redifferentiation capacity [136]
?Bone tissue Mouse BMSCs Mouse BMSCs
In vitro and in vivo ?(nude mice)		 Enhancing colony formation ability and retaining ?stemness [143]
Human BMSCs Human BMSCs
In vitro and in vivo ?(nude mice)		 Stimulating MSCs’ expansion and preserving their ?properties [144]
?Nerve tissue Rat Schwann cells Rat dorsal root ?ganglion neurons Improving axonal growth of dorsal root ganglion ?neurons [145]
Lineage commitment
?ESC differentiation Murine ESCs line Undifferentiated ?murine ESCs Boosting early differentiation of ESCs [131]
?Osteogenic differentiation Rat osteoblasts Human MSCs Inducing osteogenic differentiation [146]
Human BMSCs Human BMSCs Enhancing osteogenesis [124,125]
Human BMSCs Human BMSCs Further enhancing proliferation and osteogenesis ?when combined with melatonin [123]
Human USCs Human BMSCs (passage 8) Recharging BMSCs’ capacity in endochondral bone ?formation [125]
Human UCMSCs Human UCMSCs Enhancing UCMSCs’ osteogenic differentiation by ?protecting from H2O2 induced senescence [127]
?Chondrogenic differentiation Rabbit articular ?chondrocytes Human MSCs Guiding chondrogenic differentiation [146]
Porcine SDSCs Porcine SDSCs Promoting SDSCs’ proliferation and chondrogenic ?potential [115]
Porcine Porcine SDSCs Maximizing SDSCs’ proliferation while maintaining ?chondrogenic potential when combined with FGF2 ?and low oxygen [116]
Human fetal SDSCs Human fetal SDSCs Enhancing fetal SDSCs’ chondrogenic potential ?[118]
Human adult vs. ?fetal SDSCs Human fetal SDSCs Enhancing SDSCs’ proliferation and chondrogenic ?capacity in a pellet culture under hypoxia [117]
Passage 5 vs. ?15 human IPFSCs Passage 15 human IPFSCs Promoting IPFSCs’ proliferation and chondrogenic ?potential by C-ECM deposited by passage 5 cells ?[130]
Human adult SDSCs Human adult SDSCs Enhancing SDSCs’ chondrogenic potential ?compared with those in ECM [121]
Porcine IPFSCs ?vs. SDSCs Porcine IPFSCs Enhancing IPFSCs’ proliferation and ?chondrogenic potential in both ECM groups [128]
?Hepatic differentiation Human liver progenitor ?HepaRG Human DE cells Aiding hepatic differentiation [138]
Tab.4  Applications of cell-derived ECM for in vitro tissue formation and in vivo tissue repairing
Application ECM type Seeded cell types Culture condition(s) Outcomes
In vitro 3D cultures
?Powder substrates Acellular rat skeletal muscle ?ECM; acellular rat liver ?ECM; acellular swine ?skin ECM Rat muscle cells; HepG2; ?human foreskin cells In vitro Promoting cell proliferation ?and differentiation [147]
?Hydrogel substrates Acellular skeletal muscle ?ECM combined with ?hyaluronan-based ?hydrogel and heparin MPCs In vitro Promoting MPCs’ proliferation ?and differentiation [30]
Cell sheet tissue ?regeneration
?Skin (dermis) Acellular human
dermal ECM, allogeneic		 None In vivo (14 patients) [161]; ?in vivo (2 patients) [163] Reducing scar and?contracture [161,163]
?Cornea Acellular porcine cornea ?ECM, xenogeneic None In vivo (10 chinchilla ?bastard rabbits) [164]; ?in vivo (six eyes of rabbits) ?[165] Biocompatible with the host’s ?epithelium [164,165]
Tubular organ ?regeneration
?Blood vessels Acellular porcine aorta, ?xenogeneic Human ECs and ?myofibroblasts In vivo (5 Lewis rats) Successfully implanted ?subcutaneously in a rat ?model [176]
Acellular bovine pericardial ?ECM combined with poly ?propylene fumarate, ?xenogeneic None In vitro and in vivo ?(2 Lewis nude rats) Remaining patent for two ?weeks in rat model [178]
?Esophagus Acellular porcine SIS, ?xenogeneic None In vivo (5 patients) Promoting reconstruction of ?functional esophageal mucosa ?in patients [180]
Acellular porcine SIS Porcine BMSCs In vitro Meeting clinical-grade criteria, ?promising for clinical use ?[184]
?Bladder Acellular porcine SIS, ?xenogeneic None, or seeded with ?dog UCs and SMCs In vitro and in vivo ?(22 dogs) Not achieving the desired ?bladder regeneration resulting ?in a subtotal cystectomy model ?as in the 40% cystectomy ?model [185]
Acellular porcine SIS ?cross-linked with ?procyanidins, xenogeneic None In vitro and in vivo ?(48 New Zealand ?white rabbits) Promoting in situ tissue ?regrowth and regeneration of ?rabbit bladder [187]
3D organ regeneration
?Liver Acellular human liver ?ECM, allogeneic hUVECs, hFLCs In vitro Decellularizing a whole liver ?organ for liver regeneration ?in vitro [201]
Acellular human liver ?ECM, xenogeneic LX2, Sk-Hep-1, HepG2 In vitro and in vivo ?(6 C57BL/6J mice) Showing excellent viability, ?motility, proliferation and ?remodeling of the ECM in a ?mouse model [204]
?Lung Acellular adult rat lung ?ECM, allogeneic Neonatal rat lung ?epithelial cells In vitro and in vivo ?(344 rats) Engineered lungs participated ?in gas exchange in a rat model ?[85]
Acellular porcine lung ?ECM, xenogeneic Human airway epithelial ?progenitor cells In vitro and in vivo ?(3 pigs) Demonstrating the feasibility of ?engineering of viable lung ?scaffolds in a porcine model ?[208]
?Kidney Perfusion decellularization ?of rat kidney and mounted ?in a whole-organ bioreactor, ?autologous hUVECs, rat NKCs In vitro and in vivo ?(68 Sprague-Dawley rats) The resulting grafts produced ?rudimentary urine in an ?orthotopic transplantation ?model [210]
Tab.5  Applications of tissue-specific ECM in in vitro tissue construction or in vivo tissue regeneration
Fig.2  Cell-seeded decellularized small intestine submucosa scaffolds. (A) Masson trichrome staining of canine bone marrow stromal stem cells (red) seeded on SIS scaffolds (blue). (B) Immunohistochemistry staining of α-smooth muscle actin of bone marrow stromal cells (Brown). The photomicrograph of cell-seeded SIS scaffolds is adapted from BJU International [168] with permission.
Fig.3  Bone marrow stromal cells-seeded decellularized extracellular matrix promoted in vivo bladder tissue regeneration. Both autologous bone marrow stromal cells-seeded (A) and bladder cells-seeded SIS scaffolds (B) expressed α-smooth muscle actin 10 weeks after transplantation in a canine model following partial cystectomy, assessed by immunohistochemistry staining. The images are adapted from BJU International [168] with permission.
Function Involved signaling pathway Cell–matrix interaction related with genes and proteins
Musculoskeletal system
?Osteogenesis BMP/TGFβ Mesenchymal progenitors-BMP2-deficient mice [212], BMP4-deficient mice [213], ?BMP7-deficient mice [214]
Wnt Primary osteoprogenitors in Axin2LacZ/LacZ mice-Wnt protein [215]
Fracture callus tissues-PTH [216]
Mesenchymal skeletal cells-peptide ligand with high affinity integrin (CRRETAWAC) [217]
Notch MSCs-Notch ligand (Jag1) [218–220]
?Chondrogenesis Wnt/β-catenin Mesenchymal progenitors-ablation of β-catenin in mesenchymal condensations [221]
Micromass of MSCs-protein kinase C inhibitor (PMA), p38 kinase inhibitor (SB203580) [222]
TGFβ/Smad FSTL1 KO MSCs-exogenous recombinant FSTL1 [223]
Chondrocytes-Adamtsl2 KO growth plate [224]
BMP MSC pellets-BMP inhibitor (dorsomorphin) [225]
BMP/TGFβ hACs and hMSCs-BMP-2, TGFβ1 [226]
SDSCs-BMP-2, TGFβ1 (dexamethasone absent) [227]
IHH Chondrocytes-PPR–/– wild-type chimeric mice vs. Ihh–/–PPR–/– wild-type chimeric mice [228]
BMSCs-IHH, SHH [229]
?Skeletal myogenesis Wnt Adult muscle stem cells-combining APC and β-catenin siRNAs [230]
Satellite cells-Islr cKO mice [231]
Wnt/IGF Satellite cell-like reserve myoblasts-GSK-3 inhibitor (LiCl or SB216763), insulin [232]
Notch Adult muscle stem cells-COLV depleted mice (compound Tg: Pax7-CreERT2; Col5a1flox/flox; ?R26mTmG(Col5a1 cKO)), CALCR ligand (Elcatonin) injection [233]
Satellite cells-Syndecan-3 ablation [234]
Nervous system
?Neurogenesis in CNC PI3K/AKT/mTOR Cerebral organoids-mTOR activators (INSR, ITGB8, IFNAR1) and repressors (PTEN) [235]
Notch Neuronal progenitor cells-NOTCH2NL [236]
hSpS spheroids-Notch inhibitor (DAPT) [237]
Wnt/FGF mESCs-FGF/Wnt agonist (CHIR)/RA [238]
TGFβ/Shh/Wnt Astrocytes-TGFβ, Shh, and Wnt activators [239]
?Neurogenesis in PNS c-Myc-TERT Sensory axon-p53 inhibitor (PFTα), p53 activator (Tenovin-6) [240]
Circulatory system
?Cardiomyogenesis Wnt Cardiac organoids-Wnt agonist (CHIR) [241–243], WNT inhibitor (IWP2) [243]
TGFβ Cardiac organoids-TGFβ receptor inhibitor (e.g., SB431542) or overexpression of TGFβ ?receptor negative form [244,245]
BMP NKX2-5+CD31+ endocardial-like cells from hPSCs-BMP4, CHIR/BMP10, VEGF/BMP10 ?[246]
?Angiogenesis Notch Vascular organoids-Notch inhibitor (DAPT), Notch ligands (Dll4, Notch3) [247]
Wnt/VEGF-A hPSCs aggregates-3D collagen I-matrigel gel driven by Wnt agonist (CHIR), BMP-4, VEGF-A, ?FGF-2 subsequently [248]
Digestive system
??Stomach tissue ???reconstruction Wnt Lgr5+ stem cells-matrigel containing Wnt activator (R-spondin1), Wnt3A [249]
Axin2+/Lgr5− stem cells-Wnt activator (R-spondin3) [250]
??Intestine tissue ???reconstruction Wnt Lgr5+ ISCs-Wnt activator (R-spondin1), Wnt ligands [251–253]
Wnt/Notch Lgr5+ ISCs-Wnt inhibitor (IWP-2)/Lgr5+ ISCs-Notch inhibitor (DAPT) [254]
Notch ISCs-Notch ligands driven by transient Yap1 activation [255]
??Hepatogenesis Wnt Lgr5+ stem cells-matrigel containing EGF, Wnt activator (R-spondin1) [256]
Lgr5+ stem cells-HGF/Wnt activator (R-spondin1) [257]
Hedgehog Hepatocytes and ductular cells-Hh ligands [258]
Stellate cells-JNK1 [259]
Urinary system
?Nephrogenesis Wnt Lgr5+ stem cells-Wnt receptor (Lgr5) [260]
hPSCs-Wnt agonist (CHIR), Wnt inhibitor (DAPT) [261]
Wnt, FGF hPSCs-Wnt agonist (CHIR), FGF9 [262,263]
?Urothelium ??regeneration Hedgehog/Wnt Stromal cells and epithelial cells in bladder-Shh-blocking antibody/stromal cells and epithelial ?cells-inactivation of essential component of Wnt pathway (Ctnnb1) [264]
Hedgehog Long-term bladder organoids-smoothened agonist (SAG), Hh inhibitor (vismodegib), genetic ?manipulation [265]
Wnt/Notch Urothelial organoids-Wnt agonist (CHIR)/urothelial organoids-Notch inhibitor (DBZ) [266]
Reproductive system
?Fallopian tube and ??oviduct tissue ??reconstruction Wnt/Notch Fallopian tube organoids-Wnt modulators (Wnt3a, R-spondin1, EGF, FGF10), TGFβ inhibitor ?(ALK4/5), BMP inhibitor (Noggin)/fallopian tube organoids-Notch inhibitor (DBZ) [267]
Fallopian tube organoids-Wnt antagonist (PKF118–310)/fallopian tube organoids-Notch ?inhibitor (DBZ) [268]
?Endometrium Wnt Endometrial organoids-Wnt activator (R-spondin1), Wnt inhibitor (IWP2), WNT3A, WNT7A, ?EGF, Noggin [269]
Endometrial organoids-WNT3A, Wnt activator (R-spondin1), EGF, Noggin [270]
?Vagina tissue ??reconstruction Wnt Vaginal organoids-EGF, TGFb/Alk inhibitor (A83-01), ROCK inhibitor (Y-27632), PALL ?Corporation (Ultraserum-G) [271]
?Prostate tissue ??reconstruction Notch Prostate organoids-Notch inhibitor (DAPT) [272]
Tab.6  Mechanisms for 3D tissue regeneration
Fig.4  Hippo signaling pathway YAP/TAZ for regulating cell behaviors and tissue regeneration. The Hippo pathway is regulated by an intracellular network relaying a multitude of external inputs. Mechanical stress and cell-extracellular matrix (ECM) adhesion changes can regulate the Hippo pathway through integrin signaling. Activation of the Hippo pathway is associated with the phosphorylation of the core Hippo pathway kinases, including mammal Ste20-like kinase 1 (MST1) and MST2, Salvador 1 (SAV1), MOB1A and MOB1B, large tumor suppressor kinase 1 (LATS1) and LATS2, the transcriptional co-activators Yes-associated protein (YAP) and transcriptional co-activator with PDZ binding motif (TAZ), which leads to proteasomal degradation. Conversely, when the Hippo kinase cascade is not activated, unphosphorylated YAP/TAZ binding with TEAD transcription factor can activate specific genes, regulating ECM remodeling, cellular behaviors (cell attachment, proliferation, migration, and differentiation) and tissue regeneration.
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