According to this review, techniques for the culture of autologous MCs and subsequent tissue engineering processes are available for clinical use. comprehensively reviewed the use of MCs in tissue engineering and addressed the future directions for MC-based therapeutic applications. Cell sheet technology can provide an acellular, naturally occurring 3D biological scaffold for cell culture, which can be used for MCs as well as other cell types ( Figure 1). However, tissue engineering has made astonishing progress over the past eight years, including the production of biological scaffolds from natural polymers and extracellular matrix proteins, decellularized scaffolds and scaffold-free “cell sheet technology” in order to construct whole organs. Joanna Witkowicz produced a systematic review on the use of MC transplantation, including this tissue engineering approach. Clinical applications of this technique include the treatment of peritoneal dialysis-related injury or infections, postoperative peritoneal adhesions and myocardial infarction. This MC transplantation was followed by the injection of enzyme-treated cell suspensions, which were usually trypsinized prior to injection via intraabdominal or intrapericardial route. The use of cultured MCs began in the 1980s, where these cells were seeded onto prosthetic vascular grafts instead of endothelial cells, based on the evidence that MCs also produce prostaglandin I2. These techniques have several advantages including increased availability, usability and reasonable costs in a clinical setting. Alternatively, the use of bioprosthetic aortic valves, composed of porcine aortic valve or calf pericardium (xenograft) and fixed by glutaraldehyde to reduce immunogenicity, have been widely and successfully applied in patients. The process of aortic valve replacement with autologous pericardium has improved with the recent development of new devices and methods, based on the concept that the size of the aortic cusp has to be customized for a single patient for a better hemodynamic performance. The use of mesothelium has been successfully established in clinical settings, and has been used in surgeries for over 50 years, some examples of which include autologous omental patch repair for perforated peptic ulcers and glutaraldehyde-treated autologous pericardium for aortic valve reconstruction. *Visceral adipose tissue development and remodeling Production of cytokines and growth factors Protective barrier (inflammation and cancer) Key roles of the biological functions of mesothelial cells in health and disease (*potential role). Finally, the recent developments in xenotransplantation technologies are discussed to evaluate other feasible alternatives to mesothelial cell transplantation. This review firstly summarizes the history of the use of mesothelial cell transplantation in tissue engineering, and then critically discusses the barriers for the clinical application of mesothelial cell transplantation. Moreover, the current methods of mesothelial cell transplantation are expensive and are not yet available in clinical practice. However, the use of mesothelial cell transplantation in patients remains challenging, as it requires additional operations under general anesthesia in order to obtain enough intact cells for culture. Various methods for mesothelial cell transplantation have also been established and developed, particularly within the area of tissue engineering, including scaffold and non-scaffold cell sheet technologies. Mesothelium has been used in surgical operations in clinical settings, such as omental patching for perforated peptic ulcers and in glutaraldehyde-treated autologous pericardium for aortic valve reconstruction. One of their main functions is to act as a non-adhesive barrier to protect against physical damage, however, over the past decades their physiological and pathological properties have been revealed in association with a variety of conditions and diseases. Mesothelial cells line the surface of the pleura, pericardium, peritoneum and internal reproductive organs.
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