Personalized Cartilage Graft Offers New Option for Infants with Severe Airway Narrowing

The condition can leave infants dependent on tracheostomy while awaiting reconstructive surgery to enable safe breathing. Standard laryngotracheal reconstruction relies on rib cartilage grafts, but many young children lack sufficient tissue and face donor-site morbidity and surgical delays. To help address this challenge, researchers have developed a personalized cartilage graft approach intended to enlarge pediatric airways more quickly and reliably.

A team at Children’s Hospital of Philadelphia (CHOP), working with the Perelman School of Medicine at the University of Pennsylvania, engineered a cartilage scaffold using meniscal cartilage decellularization, known as MEND (MENiscus Decellularization). The method aims to create a graft that integrates with surrounding tissue and behaves like native cartilage in a growing airway. The study reports that the approach was designed to overcome limitations of autologous costal cartilage, including insufficient tissue volume, donor site morbidity, and delayed surgical timelines.

The MEND scaffold is produced by removing cells, elastin, and blood vessels from meniscal cartilage to reduce immunogenicity while preserving a structure amenable to recellularization and integration. Ear-derived cartilage progenitor cells, which can mature into chondrocytes, are then used to repopulate the scaffold. The researchers demonstrated that the construct can be prepared for implantation in less than a month.

In a preclinical in vivo model, the recellularized MEND graft showed better performance than costal cartilage, the current standard of care, and no adverse events were reported. The team noted that harvesting seed cells within days and producing a scaffold within three to four weeks fits a clinically relevant one- to two-month window, compared with approximately six months typically required for engineered cartilage. The findings were published in Nature Communications on June 17, 2026.

The researchers stated that further validation is planned before proposing the procedure for infants with severe subglottic stenosis, which affects an estimated 20,000 infants annually. They indicated that the accelerated timeline could reduce periods of tracheostomy dependence while addressing re-narrowing risk after reconstruction.

“We needed something that could be equivalent to a piece of cartilage, integrate well with the surrounding tissue, be well tolerated by the patient, behave like native tissues and regrow and be part of the airway. This required quite a bit of creative thinking because of the additional challenges in children who are so small and still growing,” said Riccardo Gottardi, Ph.D., assistant professor with the Perelman School of Medicine at the University of Pennsylvania and leader of the Bioengineering and Biomaterials Lab.

“This research shows really promising data that suggests this novel approach could overcome the autograft-associated limitations we sometimes encounter when attempting laryngotracheal reconstruction in infants. With more research, we expect this could decrease the need for invasive surgery, and we may be able to apply the technology to other conditions that require a cartilage graft,” said Ian Jacobs, MD, medical director of the Center for Pediatric Airway Disorders in the Division of Otolaryngology (ENT) at CHOP.

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