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As the number of patients suffering from end-stage renal failure continues to increase, there is a severe and growing shortage in the number of donor kidneys available for transplantation. The inability to meet the demand of a continually rising number of candidates wait-listed for kidney transplantation has prompted research in kidney organ engineering with the ultimate goal of developing customized, implantable kidney grafts on demand1,2. Building functioning kidney tissue from a patient’s own cells would eliminate the need for lifelong immunosuppression, decrease the amount of time patients spend on dialysis waiting for a kidney transplant, and extend life-saving transplantation to more patients with chronic kidney disease.
The first step toward bioengineering a kidney tissue using patient-derived cells is to develop a scaffold that serves as a supportive substrate for renal parenchyma (e.g. tubular epithelial), stroma fibroblast, and vascular cell growth. Biomaterial scaffolds derived from natural organ extracellular matrices (ECMs) have several characteristics that make them desirable for use in tissue engineering, including their natural biological composition; appropriate macro- and microstructure to endow physiological function; and cellular biocompatibility, promoting cell adhesion, migration, and constructive tissue remodeling3. A promising method to produce scaffolds for renal tissue regeneration is through decellularization of allogeneic or xenogeneic kidneys that preserve much of the complex natural protein composition of the kidney ECM4, retain the inherent architectural intricacy of the organ, and overcome the difficulty associated with bottom-up engineering of thick cellularized tissues by providing a vascular supply to developing cells after scaffold recellularization5.
Perfusion decellularization is a process in which detergents, enzymes, or other cell-disrupting solutions are uniformly delivered through the vascular network of the organ6. This strategy has been established as an efficient process to derive acellular organ-based ECM scaffolds as three-dimensional (3D), biological templates for whole-organ engineering6-8, as evidenced by the development of acellular renal templates from discarded human kidneys9 and xenogeneic kidneys obtained from large-animal (e.g. pig10, goat11) and rodent sources12. In particular, the use of small animal models such as rodents requires fewer cells and culture media, which is especially helpful for organ recellularization studies in which cell numbers are usually limited, as is the case with stem cell-derived tissues. The goal of the described decellularization protocol is to produce an acellular renal ECM that can be used as a 3D scaffolding system for regeneration of kidney structures, including nephron tubules that are repopulated in the present example with human renal cortical tubular epithelial (RCTE) cells. We previously described our rigorous evaluation of an optimal, detergent-based rat kidney decellularization protocol7, which is more rapid (approximately one day) than other methods previously reported (Ross et al.- 5 days12, Song et al.- 4.5 days13), and exposes the organ to a considerably lower concentration (0.1%) of the denaturant sodium dodecyl sulfate (SDS) during decellularization than prior reports12-15.
A limited number of studies have described the use of rodent kidneys for decellularization and subsequent use as a 3D scaffold for cellular repopulation (reviewed elsewhere1)12-16. In this protocol, we provide a detailed description of our previously established, optimal decellularization strategy for producing acellular kidney scaffolds from Sprague Dawley rat kidneys7. Using custom-designed perfusion bioreactors capable of dual seeding and maintenance perfusion culture17, we recellularize the acellular kidney scaffolds with human RCTE cells, which consistently repopulate the tubular component in these decellularized matrices, proliferate, and survive in perfusion culture for over a week. We further demonstrate our use of the resazurin perfusion assay – an inexpensive, non-cytotoxic, and non-invasive metabolic assessment previously used for cytotoxicity studies17– to provide an indication of cell viability and proliferation within the recellularized kidneys over time7.