a Department of Urology, Royal Hallamshire Hospital, Sheffield, UK b Department of Materials Science & Engineering, Kroto Research Institute, University of Sheffield,Sheffield, UK
Urethral stricture disease is increasingly common occurring in about 1% of males over the age of 55. The stricture tissue is rich in myofibroblasts and multi-nucleated giant cells which are thought to be related to stricture formation and collagen synthesis. An increase in collagen is associated with the loss of the normal vasculature of the normal urethra. The actual incidence differs based on worldwide populations, geography, and income. The stricture aetiology, location, length and patient's age and comorbidity are important in deciding the course of treatment. In this review we aim to summarise the existing knowledge of the aetiology of urethral strictures, review current treatment regimens, and present the challenges of using tissue-engineered buccal mucosa (TEBM) to repair scarring of the urethra. In asking this question we are also mindful that recurrent fibrosis occurs in other tissues—how can we learn from these other pathologies?
Simsek Abdulmuttalip,Aldamanhori Reem,R.Chapple Christopher, et al. Overcoming scarring in the urethra: Challenges for tissue engineering[J]. Asian Journal of Urology,
2018, 5(2): 69-77.
Iatrogenic stricture aetiology (%) by location [13].
Algorithm of anterior urethral stricture treatment (A) and bulbar urethral stricture treatment (B) [4].
Factors
Risk ratio (range)
Diseases
Smoking
1.8 (1.0-3.1)
Diabetes mellitus
2.0 (0.8-4.9)
Chronic obstructive pulmonary disease
1.3 (0.4-4.4)
Connective tissue disease
1.3 (0.3-4.7)
Coronary artery disease
1.0 (0.4-2.5)
Stricture aetiology
Trauma
2.6 (0.98-6.9)
Iatrogenic
3.4 (1.2-10)
Infectious
7.3 (2.3-23.7)
Lichen sclerosus
5.9 (2.1-16.5)
Radiation
3.3 (0.8-14)
Location
Anterior
0.49 (0.2-1.2)
Posterior
0.67 (0.3-1.7)
Panurethral
1.4 (0.38-5)
Prior treatment
Urethroplast
6.9 (2.1-22.6)
Urethrotomy
0.8 (0.2-2.8)
Dilation
0.7 (0.3-1.4)
Hypospadias
1.6 (0.7-3.9)
Stricture length >5 cm
2.3 (1.2-4.5)
Age
0.99 (0.98-1.01)
[1]
R.A. Santucci, G.F. Joyce, M. Wise , Male urethral stricture disease, J Urol, 177(2007), pp. 1667-1674.
doi: 10.1016/j.juro.2007.01.041
[2]
R.T. Warwick , Urethral surgery, A.R. Mundy (Ed.), Current operative surgery: urology, Balliere Tindall, London(1988), pp. 160-218.
[3]
J.T. Anger, J.C. Buckley, R.A. Santucci, S.P. Elliott, C.S. Saigal , Trends in stricture management among male Medicare beneficiaries: underuse of urethroplasty?, Urology, 77(2011), pp. 481-485.
doi: 10.1016/j.urology.2010.05.055
pmid: 21168194
[4]
H. Wessells, K.W. Angermeier, S.P. Elliott, C.M. Gonzalez, R.T. Kodama, A.C. Peterson , et al., Male urethral stricture: AUA guideline, ( 2016), pp. 1-32,
[5]
S. Bhargava, J.M. Patterson, R.D. Inman, S. MacNeil, C.R. Chapple , Tissue-engineered buccal mucosa urethroplasty-clinical outcomes, Eur Urol, 53(2008), pp. 1263-1269.
doi: 10.1016/j.eururo.2008.01.061
pmid: 18262717
[6]
N.I. Osman, J.M. Patterson, S. MacNeil, C.R. Chapple , Long-term follow-up after tissue-engineered buccal mucosa urethroplasty, Eur Urol, 66(2014), pp. 790-791.
doi: 10.1016/j.eururo.2014.07.007
pmid: 25065526
[7]
A.G. Cavalcanti, W.S. Costa, L.S. Baskin , J.A. McAninch, F.J. Sampaio, A morphometric analysis of bulbar urethral strictures, BJU Int, 100(2007), pp. 397-402.
doi: 10.1111/j.1464-410X.2007.06904.x
pmid: 17617144
[8]
M. Singh, J.P. Blandy , The pathology of urethral stricture, J Urol, 115(1976), pp. 673-676.
doi: 10.1016/S0022-5347(17)59331-3
pmid: 781310
[9]
L.S. Baskin, S.C. Constantinescu, P.S. Howard , J.W. McAninch, D.H. Ewalt, J.W. Duckett, et al., Biochemical characterization and quantitation of the collagenous components of urethral stricture tissue, J Urol, 150(1993), pp. 642-647.
doi: 10.1089/end.1993.7.337
pmid: 8326613
[10]
A.G. Cavalcanti, S. Yucel, D.Y. Deng , J.W. McAninch, L.S. Baskin, The distribution of neuronal and inducible nitric oxide synthase in urethral stricture formation, J Urol, 171(2004), pp. 1943-1947.
doi: 10.1097/01.ju.0000121261.03616.63
pmid: 15076317
[11]
E.A. Da-Silva, F.J. Sampaio, M.C. Dornas, R. Damiao, L.E. Cardoso, Extracellular matrix changes in urethral stricture disease, J Urol, 168(2002), pp. 805-807.
doi: 10.1016/S0022-5347(05)64747-7
pmid: 12131371
N. Lumen, P. Hoebeke, P. Willemsen, B. De Troyer, R. Pieters, W. Oosterlinck , Etiology of urethral stricture disease in the 21st century, J Urol, 182(2009), pp. 983-987.
doi: 10.1016/j.juro.2009.05.023
pmid: 19616805
[14]
A.S. Fenton, A.F. Morey, R. Aviles, C.R. Garcia , Anterior urethral strictures: etiology and characteristics, Urology, 65(2005), pp. 1055-1058.
doi: 10.1016/j.urology.2004.12.018
pmid: 15913734
[15]
S. Das, H.S. Tunuguntla , Balanitis xerotica obliterans—a review, World J Urol, 18(2000), pp. 382-387.
doi: 10.1007/PL00007083
pmid: 11204255
[16]
K. Miller, M. Posh, S.B. Brandes, Urethral stricture and urethroplasy in the pelvic irradiated patient, S.B. Brandes (Ed.), Urethral reconstructive surgery , Springer, Saint Louis, ( 2008), pp. 241-249.
[17]
J.W. McAninch, F.C. Laing, R.B. Jeffrey Jr., Sonourethrography in the evaluation of urethral strictures: a preliminary report, J Urol, 139(1988), pp. 294-297.
doi: 10.1111/j.1464-410X.1988.tb05076.x
pmid: 3276926
[18]
J.W. Steenkamp, C.F. Heyns , M.L. de Kock, Outpatient treatment for male urethral strictures—dilatation versus internal urethrotomy, S Afr J Surg, 35(1997), pp. 125-130.
doi: 10.1097/00024382-199708000-00017
pmid: 9429329
[19]
J.W. Steenkamp, C.F. Heyns , M.L. de Kock, Internal urethrotomy versus dilation as treatment for male urethral strictures: a prospective, randomized comparison, J Urol, 157(1997), pp. 98-101.
doi: 10.1097/00005392-199701000-00033
pmid: 8976225
[20]
J.B. Tonkin, G.H. Jordan , Management of distal anterior urethral strictures, Nat Rev Urol, 6(2009), pp. 533-538.
doi: 10.1038/nrurol.2009.181
pmid: 19736550
[21]
P. Albers, J. Fichtner, P. Bruhl, S.C. Muller , Long-term results of internal urethrotomy, J Urol, 156(1996), pp. 1611-1614.
doi: 10.1016/S0022-5347(01)65461-2
pmid: 8863550
[22]
V. Pansadoro, P. Emiliozzi , Internal urethrotomy in the management of anterior urethral strictures: long-term followup, J Urol, 156(1996), pp. 73-75.
doi: 10.1016/S0022-5347(01)65942-1
pmid: 8648841
[23]
C.F. Heyns, J.W. Steenkamp , M.L. De Kock, P. Whitaker, Treatment of male urethral strictures: is repeated dilation or internal urethrotomy useful?, J Urol, 160(1998), pp. 356-358.
doi: 10.1097/00005392-199905000-00063
pmid: 9679876
[24]
A.M. Naude, C.F. Heyns , What is the place of internal urethrotomy in the treatment of urethral stricture disease?, Nat Clin Pract Urol, 2(2005), pp. 538-545.
doi: 10.1038/ncpuro0320
pmid: 16474597
[25]
A.J. Vanni, L.N. Zinman, J.C. Buckley , Radial urethrotomy and intralesional mitomycin C for the management of recurrent bladder neck contractures, J Urol, 186(2011), pp. 156-160.
doi: 10.1016/j.juro.2011.03.019
pmid: 21575962
[26]
H. Mazdak, I. Meshki, F. Ghassami , Effect of mitomycin C on anterior urethral stricture recurrence after internal urethrotomy, Eur Urol, 51 ( 2007), pp. 1089-1092, [discussion 92]
doi: 10.1016/j.eururo.2006.11.038
pmid: 17157434
[27]
K. Tavakkoli Tabassi, A. Yarmohamadi, S. Mohammadi , Triamcinolone injection following internal urethrotomy for treatment of urethral stricture, Urol J, 8(2011), pp. 132-136
doi: 10.3747/pdi.2010.00102
pmid: 21656472
[28]
H. Mazdak, M.H. Izadpanahi, A. Ghalamkari, M. Kabiri, M.H. Khorrami, K. Nouri-Mahdavi , et al., Internal urethrotomy and intraurethral submucosal injection of triamcinolone in short bulbar urethral strictures, Int Urol Nephrol, 42(2010), pp. 565-568.
doi: 10.1007/s11255-009-9663-5
pmid: 19949861
[29]
T. Jin, H. Li, L.H. Jiang, L. Wang, K.J. Wang , Safety and efficacy of laser and cold knife urethrotomy for urethral stricture, Chin Med J, 123(2010), pp. 1589-1595.
doi: 10.3760/cma.j.issn.0366-6999.2010.12.020
pmid: 20819517
[30]
D.W. McDermott, R.J. Bates, N.M. Heney, A. Althausen, Erectile impotence as complication of direct vision cold knife urethrotomy, Urology, 18(1981), pp. 467-469.
doi: 10.1016/0090-4295(81)90291-0
pmid: 7314336
[31]
P.H. Graversen, P. Rosenkilde, H. Colstrup , Erectile dysfunction following direct vision internal urethrotomy, Scand J Urol Nephrol, 25(1991), pp. 175-178.
doi: 10.3109/00365599109107943
pmid: 1947846
[32]
S.A. Dutkiewicz, M. Wroblewski , Comparison of treatment results between holmium laser endourethrotomy and optical internal urethrotomy for urethral stricture, Int Urol Nephrol, 44(2012), pp. 717-724.
doi: 10.1007/s11255-011-0094-8
pmid: 3358556
[33]
M. Atak, H. Tokgoz, B. Akduman, B. Erol, I. Donmez, V. Hanci , et al., Low-power holmium:YAG laser urethrotomy for urethral stricture disease: comparison of outcomes with the cold-knife technique, Kaohsiung J Med Sci, 27(2011), pp. 503-507.
doi: 10.1016/j.kjms.2011.06.013
pmid: 22005159
[34]
M. Hussain, M. Lal, S.H. Askari, A. Hashmi, S.A. Rizvi , Holmium laser urethrotomy for treatment of traumatic stricture urethra: a review of 78 patients, JPMA. J Pak Med Assoc, 60(2010), pp. 829-832.
doi: 10.1007/s00109-010-0648-8
pmid: 21381613
[35]
G.D. Webster, J. Ramon , Repair of pelvic fracture posterior urethral defects using an elaborated perineal approach: experience with 74 cases, J Urol, 145(1991), pp. 744-748.
doi: 10.1111/j.1464-410X.1991.tb15182.x
pmid: 2005693
[36]
E.A. Eltahawy, R. Virasoro, S.M. Schlossberg , K.A. McCammon, G.H. Jordan, Long-term followup for excision and primary anastomosis for anterior urethral strictures, J Urol, 177(2007), pp. 1803-1806.
doi: 10.1016/j.juro.2007.01.033
pmid: 17437824
[37]
S. Park , J.W. McAninch, Straddle injuries to the bulbar urethra: management and outcomes in 78 patients, J Urol, 171(2004), pp. 722-725.
doi: 10.1590/S1677-55382009000400009
pmid: 14713796
[38]
M.R. Cooperberg, J.W. McAninch, N.F. Alsikafi, S.P. Elliott , Elliott, Urethral reconstruction for traumatic posterior urethral disruption: outcomes of a 25-year experience, J Urol 178 ( 2007), pp. 2006-2010, [discussion 10]
doi: 10.1016/j.juro.2007.07.020
pmid: 17869302
[39]
A.F. Morey, W.S. Kizer , Proximal bulbar urethroplasty via extended anastomotic approach—what are the limits?, J Urol 175 ( 2006), pp. 2145-2149, [discussion 9]
doi: 10.1016/S0022-5347(06)00259-X
pmid: 16697823
[40]
B.A. Erickson, M.A. Granieri, J.J. Meeks, J.P. Cashy, C.M. Gonzalez , Prospective analysis of erectile dysfunction after anterior urethroplasty: incidence and recovery of function, J Urol, 183(2010), pp. 657-661.
doi: 10.1016/j.juro.2009.10.017
pmid: 20018319
[41]
J.M. Patterson, C.R. Chapple , Surgical techniques in substitution urethroplasty using buccal mucosa for the treatment of anterior urethral strictures, Eur Urol, 53(2008), pp. 1162-1171.
doi: 10.1016/j.eururo.2007.10.011
[42]
T.J. Greenwell, S.N. Venn, A.R. Mundy , Changing practice in anterior urethroplasty, BJU Int, 83(1999), pp. 631-635.
doi: 10.1046/j.1464-410x.1999.00010.x
pmid: 10233570
[43]
H. Wessells, J.W. McAninch, , Current controversies in anterior urethral stricture repair: free-graft versus pedicled skin-flap reconstruction, World J Urol, 16(1998), pp. 175-180.
doi: 10.1007/s003450050048
pmid: 9666540
[44]
C.A. Harrison, S. MacNeil , The mechanism of skin graft contraction: an update on current research and potential future therapies, Burns, 34(2008), pp. 153-163.
doi: 10.1016/j.burns.2007.08.011
pmid: 18226455
[45]
N. Lumen, W. Oosterlinck, P. Hoebeke , Urethral reconstruction using buccal mucosa or penile skin grafts: systematic review and meta-analysis, Urol Int, 89(2012), pp. 387-394.
doi: 10.1159/000341138
pmid: 22889835
[46]
G. Barbagli, S. Sansalone, R. Djinovic, G. Romano, M. Lazzeri , Current controversies in reconstructive surgery of the anterior urethra: a clinical overview, Int Braz J Urol 38 ( 2012), pp. 307-316, [discussion 16]
doi: 10.1590/S1677-55382012000300003
pmid: 23312175
[47]
G. Barbagli , When and how to use buccal mucosa grafts in penile and bulbar urethroplasty, Minerva Urol Nefrol, 56(2004), pp. 189-203.
pmid: 15195026
[48]
M.R. Markiewicz, M.A. Lukose , J.E. Margarone 3rd, G. Barbagli, K.S. Miller, S.K. Chuang, The oral mucosa graft: a systematic review, J Urol, 178(2007), pp. 387-394.
doi: 10.1016/j.juro.2007.03.094
pmid: 17561150
[49]
G. Barbagli, S. Vallasciani, G. Romano, F. Fabbri, G. Guazzoni, M. Lazzeri , Morbidity of oral mucosa graft harvesting from a single cheek, Eur Urol, 58(2010), pp. 33-41.
doi: 10.1016/j.eururo.2010.01.012
pmid: 20106587
[50]
A. Mangera, J.M. Patterson, C.R. Chapple , A systematic review of graft augmentation urethroplasty techniques for the treatment of anterior urethral strictures, Eur Urol, 59(2011), pp. 797-814.
doi: 10.1016/j.eururo.2011.02.010
pmid: 21353379
[51]
G. Barbagli, E. Palminteri, G. Guazzoni, F. Montorsi, D. Turini, M. Lazzeri , Bulbar urethroplasty using buccal mucosa grafts placed on the ventral,dorsal or lateral surface of the urethra: are results affected by the surgical technique?, J Urol 174 ( 2005), pp. 955-957, [discussion 7-8]
doi: 10.1097/01.ju.0000169422.46721.d7
pmid: 16094007
[52]
G. Barbagli, M. De Angelis, E. Palminteri, M. Lazzeri, Failed hypospadias repair presenting in adults, Eur Urol , 49 ( 2006), pp. 887-894, [discussion 95]
[53]
G. Barbagli, S. Perovic, R. Djinovic, S. Sansalone, M. Lazzeri , Retrospective descriptive analysis of 1,176 patients with failed hypospadias repair, J Urol, 183(2010), pp. 207-211.
[54]
J.S. Davis, E.A. Kitlowski , The Immediate contraction of cutaneous grafts and its cause, Arch Surg, 23(1931), pp. 954-965.
[55]
J.R. Hinshaw, E.R. Miller , Histology of healing split-thickness, full-thickness autogenous skin grafts and donor sites, Arch Surg, 91(1965), pp. 658-670.
[56]
B.V. Corps , The effect of graft thickness, donor site and graft bed on graft shrinkage in the hooded rat, Br J Plast Surg, 22(1969), pp. 125-133.
[57]
R. Rudolph , The effect of skin graft preparation on wound contraction, Surg Gynecol Obstet, 142(1976), pp. 49-56.
[58]
D.M. Davies , Plastic and reconstructive surgery. Scars, hypertrophic scars, and keloids, Br Med J (Clin Res Ed), 290(1985), pp. 1056-1058.
[59]
R. Rudolph , Contraction and the control of contraction, World J Surg, 4(1980), pp. 279-287.
[60]
G. Gabbiani, G. Majno , Dupuytren's contracture: fibroblast contraction? An ultrastructural study, Am J Pathol, 66(1972), pp. 131-146.
[61]
J.J. Tomasek, C.J. Haaksma , Fibronectin filaments and actin microfilaments are organized into a fibronexus in Dupuytren's diseased tissue, Anat Rec, 230(1991), pp. 175-182.
[62]
M.P. Welch, G.F. Odland, R.A. Clark , Temporal relationships of F-actin bundle formation, collagen and fibronectin matrix assembly, and fibronectin receptor expression to wound contraction, J Cell Biol, 110(1990), pp. 133-145.
[63]
C.S. Osborne, W.H. Reid, M.H. Grant , Investigation into the biological stability of collagen/chondroitin-6-sulphate gels and their contraction by fibroblasts and keratinocytes: the effect of crosslinking agents and diamines, Biomaterials, 20(1999), pp. 283-290.
[64]
H. Green, O. Kehinde, J. Thomas , Growth of cultured human epidermal cells into multiple epithelia suitable for grafting, Proc Natl Acad Sci U S A, 76(1979), pp. 5665-5668.
[65]
J.P. Denefle, J.P. Lechaire, Q.L. Zhu , Cultured epidermis influences the fibril organization of purified type I collagen gels, Tissue Cell, 19(1987), pp. 469-478.
[66]
M.M. Ghosh, S. Boyce, C. Layton, E. Freedlander, S. Mac Neil , A comparison of methodologies for the preparation of human epidermal-dermal composites, Ann Plast Surg, 39(1997), pp. 390-404.
[67]
C.A. Harrison, F. Gossiel, C.M. Layton, A.J. Bullock, T. Johnson, A. Blumsohn , et al., Use of an in vitro model of tissue-engineered skin to investigate the mechanism of skin graft contraction, Tissue Eng, 12(2006), pp. 3119-3133.
[68]
C.A. Harrison, M.J. Heaton, C.M. Layton, S. Mac Neil , Use of an in vitro model of tissue-engineered human skin to study keratinocyte attachment and migration in the process of reepithelialization, Wound Repair Regen, 14(2006), pp. 203-209.
[69]
D.R. Ralston, C. Layton, A.J. Dalley, S.G. Boyce, E. Freedlander, S. MacNeil , Keratinocytes contract human dermal extracellular matrix and reduce soluble fibronectin production by fibroblasts in a skin composite model, Br J Plast Surg, 50(1997), pp. 408-415.
[70]
K.H. Chakrabarty, M. Heaton, A.J. Dalley, R.A. Dawson, E. Freedlander, P.T. Khaw , et al., Keratinocyte-driven contraction of reconstructed human skin, Wound Repair Regen, 9(2001), pp. 95-106.
[71]
R.A. Redden, E.J. Doolin , Collagen crosslinking and cell density have distinct effects on fibroblast-mediated contraction of collagen gels, Skin Res Technol, 9(2003), pp. 290-293.
[72]
A. Raya-Rivera, D.R. Esquiliano, J.J. Yoo, E. Lopez-Bayghen, S. Soker, A. Atala , Tissue-engineered autologous urethras for patients who need reconstruction: an observational study, Lancet, 377(2011), pp. 1175-1182.
[73]
T.Y. Lee, G.S. Chin, W.J. Kim, D. Chau, G.K. Gittes, M.T. Longaker , Expression of transforming growth factor beta 1, 2, and 3 proteins in keloids, Ann Plast Surg, 43(1999), pp. 179-184.
[74]
H. Steenfos, E.M. Spencer, T. Hunt , Insulin-like growth factor I has a major role in wound healing, Surg Forum, 40(1989), p. 68.
[75]
K. Scharffetter, M. Heckmann, A. Hatamochi, C. Mauch, B. Stein, G. Riethmuller , et al., Synergistic effect of tumor necrosis factor-alpha and interferon-gamma on collagen synthesis of human skin fibroblasts in vitro, Exp Cell Res, 181(1989), pp. 409-419.
[76]
A. Ghahary, Y.J. Shen, B. Nedelec, P.G. Scott, E.E. Tredget , Enhanced expression of mRNA for insulin-like growth factor-1 in post-burn hypertrophic scar tissue and its fibrogenic role by dermal fibroblasts, Mol Cell Biochem, 148(1995), pp. 25-32.
[77]
A. El-Kassaby, T. Abou Shwareb, A. Atala , Randomized comparative study between buccal mucosal and acellular bladder matrix grafts in complex anterior urethral strictures, J Urol, 179(2008), pp. 1432-1436.
[78]
M. Fossum, J. Skikuniene, A. Orrego, A. Nordenskjold , Prepubertal follow-up after hypospadias repair with autologous in vitro cultured urothelial cells, Acta Paediatr, 101(2012), pp. 755-760.
[79]
J.M. Patterson, A.J. Bullock, S. MacNeil, C.R. Chapple , Methods to reduce the contraction of tissue-engineered buccal mucosa for use in substitution urethroplasty, Eur Urol, 60(2011), pp. 856-861.
[80]
B.N. Breyer , J.W. McAninch, J.M. Whitson, M.L. Eisenberg, J.F. Mehdizadeh, J.B. Myers, et al., Multivariate analysis of risk factors for long-term urethroplasty outcome, J Urol, 183(2010), pp. 613-617.
[81]
A.S. Kinnaird, M.A. Levine, D. Ambati, J.D. Zorn, K.F. Rourke , Stricture length and etiology as preoperative independent predictors of recurrence after urethroplasty: a multivariate analysis of 604 urethroplasties, Can Urol Assoc J 8 ( 2014), pp. E296-E300
[82]
J.N. Warner, I. Malkawi, M. Dhradkeh, P.M. Joshi, S.B. Kulkarni, M. Lazzeri , et al., A multi-institutional evaluation of the management and outcomes of long-segment urethral strictures Urology, 85(2015), pp. 1483-1487.
[83]
J.S. Han, J. Liu, M.D. Hofer, A. Fuchs, A. Chi, D. Stein , et al., Risk of urethral stricture recurrence increases over time after urethroplasty, Int J Urol, 22(2015), pp. 695-699.
[84]
S. Worrall , J. de Jersey, R. Nicholls, P. Wilce, Acetaldehyde/protein interactions: are they involved in the pathogenesis of alcoholic liver disease?, Dig Dis, 11(1993), pp. 265-277.
[85]
Y.I. Miller, S.H. Choi, P. Wiesner, L. Fang, R. Harkewicz, K. Hartvigsen , et al., Oxidation-specific epitopes are danger-associated molecular patterns recognized by pattern recognition receptors of innate immunity, Circ Res, 108(2011), pp. 235-248.
[86]
G. Wick, H. Brunner, E. Penner, R. Timpl , The diagnostic application of specific antiprocollagen sera. II. Analysis of liver biopsies, Int Arch Allergy Appl Immunol, 56(1978), pp. 316-324.
[87]
G. Wick, C. Grundtman, C. Mayerl, T.F. Wimpissinger, J. Feichtinger, B. Zelger , et al., The immunology of fibrosis, Annu Rev Immunol, 31(2013), pp. 107-135.
[88]
S. Grenier, M. Sandig, K. Mequanint , Smooth muscle alpha-actin and calponin expression and extracellular matrix production of human coronary artery smooth muscle cells in 3D scaffolds, Tissue Eng Part A, 15(2009), pp. 3001-3011.
[89]
B. Shih, A. Bayat , Scientific understanding and clinical management of Dupuytren disease, Nat Rev Rheumatol, 6(2010), pp. 715-726.
[90]
F. Strutz, E.G. Neilson , New insights into mechanisms of fibrosis in immune renal injury, Springer Semin Immunopathol, 24(2003), pp. 459-476
