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MacGrogan D, Luxán G, Driessen-Mol A, Bouten C, Baaijens F, de la Pompa JL. How to make a heart valve: from embryonic development to bioengineering of living valve substitutes. Cold Spring Harb Perspect Med 2014; 4:a013912. [PMID: 25368013 DOI: 10.1101/cshperspect.a013912] [Citation(s) in RCA: 54] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Cardiac valve disease is a significant cause of ill health and death worldwide, and valve replacement remains one of the most common cardiac interventions in high-income economies. Despite major advances in surgical treatment, long-term therapy remains inadequate because none of the current valve substitutes have the potential for remodeling, regeneration, and growth of native structures. Valve development is coordinated by a complex interplay of signaling pathways and environmental cues that cause disease when perturbed. Cardiac valves develop from endocardial cushions that become populated by valve precursor mesenchyme formed by an epithelial-mesenchymal transition (EMT). The mesenchymal precursors, subsequently, undergo directed growth, characterized by cellular compartmentalization and layering of a structured extracellular matrix (ECM). Knowledge gained from research into the development of cardiac valves is driving exploration into valve biomechanics and tissue engineering directed at creating novel valve substitutes endowed with native form and function.
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Affiliation(s)
- Donal MacGrogan
- Program of Cardiovascular Developmental Biology, Department of Cardiovascular Development and Repair, Centro Nacional de Investigaciones Cardiovasculares (CNIC), 28029 Madrid, Spain
| | - Guillermo Luxán
- Program of Cardiovascular Developmental Biology, Department of Cardiovascular Development and Repair, Centro Nacional de Investigaciones Cardiovasculares (CNIC), 28029 Madrid, Spain
| | - Anita Driessen-Mol
- Biomedical Engineering/Eindhoven University of Technology, 5600 MB Eindhoven, The Netherlands
| | - Carlijn Bouten
- Biomedical Engineering/Eindhoven University of Technology, 5600 MB Eindhoven, The Netherlands
| | - Frank Baaijens
- Biomedical Engineering/Eindhoven University of Technology, 5600 MB Eindhoven, The Netherlands
| | - José Luis de la Pompa
- Program of Cardiovascular Developmental Biology, Department of Cardiovascular Development and Repair, Centro Nacional de Investigaciones Cardiovasculares (CNIC), 28029 Madrid, Spain
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53
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Immunogenicity of intensively decellularized equine carotid arteries is conferred by the extracellular matrix protein collagen type VI. PLoS One 2014; 9:e105964. [PMID: 25157402 PMCID: PMC4144968 DOI: 10.1371/journal.pone.0105964] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2014] [Accepted: 07/30/2014] [Indexed: 12/16/2022] Open
Abstract
The limited biocompatibility of decellularized scaffolds is an ongoing challenge in tissue engineering. Here, we demonstrate the residual immunogenicity of an extensively decellularized equine carotid artery (dEACintens) and identify the involved immunogenic components. EAC were submitted to an elaborated intensified decellularization protocol with SDS/sodium desoxycholate for 72 h using increased processing volumes (dEACintens), and compared to dEACord prepared by an ordinary protocol (40 h, normal volumes). Matrix integrity was checked via correlative volumetric visualization which revealed only minor structural changes in the arterial wall. In dEACintens, a substantial depletion of cellular components was obvious for smooth muscle actin (100%), MHC I complexes (97.8%), alphaGal epitops (98.4% and 91.3%) and for DNA (final concentration of 0.34±0.16 ng/mg tissue). However, dEACintens still evoked antibody formation in mice after immunization with dEACintens extracts, although to a lower extent than dEACord. Mouse plasma antibodies recognized a 140 kDa band which was revealed to contain collagen VI alpha1 and alpha2 chains via mass spectrometry of both 2D electrophoretically separated and immunoprecipitated proteins. Thus, even the complete removal of cellular proteins did not yield non-immunogenic dEAC as the extracellular matrix still conferred immunogenicity by collagen VI. However, as lower antibody levels were achieved by the intensified decellularization protocol, this seems to be a promising basis for further development.
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Decellularized allogeneic heart valves demonstrate self-regeneration potential after a long-term preclinical evaluation. PLoS One 2014; 9:e99593. [PMID: 24940754 PMCID: PMC4062459 DOI: 10.1371/journal.pone.0099593] [Citation(s) in RCA: 64] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2014] [Accepted: 05/16/2014] [Indexed: 01/02/2023] Open
Abstract
Tissue-engineered heart valves are proposed as novel viable replacements granting longer durability and growth potential. However, they require extensive in vitro cell-conditioning in bioreactor before implantation. Here, the propensity of non-preconditioned decellularized heart valves to spontaneous in body self-regeneration was investigated in a large animal model. Decellularized porcine aortic valves were evaluated for right ventricular outflow tract (RVOT) reconstruction in Vietnamese Pigs (n = 11) with 6 (n = 5) and 15 (n = 6) follow-up months. Repositioned native valves (n = 2 for each time) were considered as control. Tissue and cell components from explanted valves were investigated by histology, immunohistochemistry, electron microscopy, and gene expression. Most substitutes constantly demonstrated in vivo adequate hemodynamic performances and ex vivo progressive repopulation during the 15 implantation months without signs of calcifications, fibrosis and/or thrombosis, as revealed by histological, immunohistochemical, ultrastructural, metabolic and transcriptomic profiles. Colonizing cells displayed native-like phenotypes and actively synthesized novel extracellular matrix elements, as collagen and elastin fibers. New mature blood vessels, i.e. capillaries and vasa vasorum, were identified in repopulated valves especially in the medial and adventitial tunicae of regenerated arterial walls. Such findings correlated to the up-regulated vascular gene transcription. Neoinnervation hallmarks were appreciated at histological and ultrastructural levels. Macrophage populations with reparative M2 phenotype were highly represented in repopulated valves. Indeed, no aspects of adverse/immune reaction were revealed in immunohistochemical and transcriptomic patterns. Among differentiated elements, several cells were identified expressing typical stem cell markers of embryonic, hematopoietic, neural and mesenchymal lineages in significantly higher number and specific topographic distribution in respect to control valves. Following the longest follow-up ever realized in preclinical models, non-preconditioned decellularized allogeneic valves offer suitable microenvironment for in vivo cell homing and tissue remodeling. Manufactured with simple, timesaving and cost-effective procedures, these promising valve replacements hold promise to become an effective alternative, especially for pediatric patients.
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55
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Luo J, Korossis SA, Wilshaw SP, Jennings LM, Fisher J, Ingham E. Development and characterization of acellular porcine pulmonary valve scaffolds for tissue engineering. Tissue Eng Part A 2014; 20:2963-74. [PMID: 24786313 DOI: 10.1089/ten.tea.2013.0573] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Currently available replacement heart valves all have limitations. This study aimed to produce and characterize an acellular, biocompatible porcine pulmonary root conduit for reconstruction of the right ventricular outflow tract e.g., during Ross procedure. A process for the decellularization of porcine pulmonary roots was developed incorporating trypsin treatment of the adventitial surface of the scraped pulmonary artery and sequential treatment with hypotonic Tris buffer (HTB; 10 mM Tris pH 8.0, 0.1% (w/v) EDTA, and 10 KIU aprotinin), 0.1% (w/v) sodium dodecyl sulfate in HTB, two cycles of DNase and RNase, and sterilization with 0.1% (v/v) peracetic acid. Histology confirmed an absence of cells and retention of the gross histoarchitecture. Immunohistochemistry further confirmed cell removal and partial retention of the extracellular matrix, but a loss of collagen type IV. DNA levels were reduced by more than 96% throughout all regions of the acellular tissue and no functional genes were detected using polymerase chain reaction. Total collagen levels were retained but there was a significant loss of glycosaminoglycans following decellularization. The biomechanical, hydrodynamic, and leaflet kinematics properties were minimally affected by the process. Both immunohistochemical labeling and antibody absorption assay confirmed a lack of α-gal epitopes in the acellular porcine pulmonary roots and in vitro biocompatibility studies indicated that acellular leaflets and pulmonary arteries were not cytotoxic. Overall the acellular porcine pulmonary roots have excellent potential for development of a tissue substitute for right ventricular outflow tract reconstruction e.g., during the Ross procedure.
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Affiliation(s)
- Ji Luo
- 1 Institute of Medical and Biological Engineering, The University of Leeds , Leeds, United Kingdom
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56
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Interaction of cells with decellularized biological materials. ADVANCES IN BIOCHEMICAL ENGINEERING/BIOTECHNOLOGY 2014. [PMID: 21989486 DOI: 10.1007/10_2011_109] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register]
Abstract
The idea to create the concept of cardiovascular "tissue engineering" is based on the recognition that until then all known allogeneic/xenogeneic biological or alloplastic implant materials were associated with shortcomings, which led to graft deterioration, degradation and finally destruction. Thus, it aims to develop viable cardiovascular structures, e.g. heart valves, myocardium or blood vessels, which ideally demonstrate mechanisms of remodeling and self-repair, a high microbiological resistance, complete immunological integrity and a functional endothelial cell layer to guarantee physiological hemostasis. In our current review we aim to identify basic limitations of previous concepts, explain why the use of decellularized matrices was a logical consequence and which limitations still exist.
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Wong ML, Griffiths LG. Immunogenicity in xenogeneic scaffold generation: antigen removal vs. decellularization. Acta Biomater 2014; 10:1806-16. [PMID: 24486910 DOI: 10.1016/j.actbio.2014.01.028] [Citation(s) in RCA: 165] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2013] [Revised: 12/15/2013] [Accepted: 01/23/2014] [Indexed: 12/11/2022]
Abstract
Decades of research have been undertaken towards the goal of tissue engineering using xenogeneic scaffolds. The primary advantages associated with use of xenogeneic tissue-derived scaffolds for in vitro development of replacement tissues and organs stem from the inherent extracellular matrix (ECM) composition and architecture. Native ECM possesses appropriate mechanical properties for physiological function of the biomaterial and signals for cell binding, growth and differentiation. Additionally, xenogeneic tissue is readily available. However, translation of xenogeneic scaffold-derived engineered tissues or organs into clinical therapies requires xenoantigenicity of the material to be adequately addressed prior to implantation. Failure to achieve this goal will result in a graft-specific host immune rejection response, jeopardizing in vivo survival of the resultant scaffold, tissue or organ. This review explores (i) the appropriateness of scaffold acellularity as an outcome measure for assessing reduction of the immunological barriers to the use of xenogeneic scaffolds for tissue engineering applications and (ii) the need for tissue engineers to strive for antigen removal during xenogeneic scaffold generation.
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Affiliation(s)
- Maelene L Wong
- Department of Veterinary Medicine: Medicine and Epidemiology, University of California, Davis, One Shields Ave., Davis, CA 95616, USA; Department of Biomedical Engineering, University of California, Davis, One Shields Ave., Davis, CA 95616, USA
| | - Leigh G Griffiths
- Department of Veterinary Medicine: Medicine and Epidemiology, University of California, Davis, One Shields Ave., Davis, CA 95616, USA.
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Backhoff D, Steinmetz M, Sigler M, Schneider H. Formation of multiple conduit aneurysms following Matrix P conduit implantation in a boy with tetralogy of Fallot and pulmonary atresia. Eur J Cardiothorac Surg 2014; 46:500-2. [PMID: 24448074 DOI: 10.1093/ejcts/ezt635] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
We report on a 6-year old boy with tetralogy of Fallot and pulmonary atresia in whom a 16 m Matrix P conduit was implanted between the pulmonary artery and the right ventricle at the age of 16 months. Five years later he developed severe stenosis of the distal conduit anastomosis. The notable findings were several aneurysms of the conduit proximal to the distal stenosis within the high-pressure region. The wall of the aneurysms contained xenogeneic conduit tissue without inflammatory or foreign-body response. We believe that aneurysm formation of the conduit was a result of fatigue of the conduit wall under suprasystemic pressure.
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Affiliation(s)
- David Backhoff
- Department of Paediatric Cardiology and Intensive Care Medicine, Georg-August-University Hospital Göttingen, University of Göttingen, Göttingen, Germany
| | - Michael Steinmetz
- Department of Paediatric Cardiology and Intensive Care Medicine, Georg-August-University Hospital Göttingen, University of Göttingen, Göttingen, Germany
| | - Matthias Sigler
- Department of Paediatric Cardiology and Intensive Care Medicine, Georg-August-University Hospital Göttingen, University of Göttingen, Göttingen, Germany
| | - Heike Schneider
- Department of Paediatric Cardiology and Intensive Care Medicine, Georg-August-University Hospital Göttingen, University of Göttingen, Göttingen, Germany
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Naso F, Iop L, Spina M, Gerosa G. Are FDA and CE sacrificing safety for a faster commercialization of xenogeneic tissue devices? Unavoidable need for legislation in decellularized tissue manufacturing. ACTA ACUST UNITED AC 2014; 83:193-4. [DOI: 10.1111/tan.12275] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2013] [Accepted: 11/28/2013] [Indexed: 11/30/2022]
Affiliation(s)
- F. Naso
- Department of Cardiac, Thoracic and Vascular Sciences; University Hospital of Padova; Padova Italy
| | - L. Iop
- Department of Cardiac, Thoracic and Vascular Sciences; University Hospital of Padova; Padova Italy
| | - M. Spina
- Department of Experimental Biomedical Sciences; University of Padova; Padova Italy
| | - G. Gerosa
- Department of Cardiac, Thoracic and Vascular Sciences; University Hospital of Padova; Padova Italy
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60
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Lim ML, Jungebluth P, Ajalloueian F, Friedrich LH, Gilevich I, Grinnemo KH, Gubareva E, Haag JC, Lemon G, Sjöqvist S, Caplan AL, Macchiarini P. Whole organ and tissue reconstruction in thoracic regenerative surgery. Mayo Clin Proc 2013; 88:1151-66. [PMID: 24079685 DOI: 10.1016/j.mayocp.2013.03.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2012] [Revised: 03/09/2013] [Accepted: 03/15/2013] [Indexed: 12/25/2022]
Abstract
Development of novel prognostic, diagnostic, and treatment options will provide major benefits for millions of patients with acute or chronic respiratory dysfunction, cardiac-related disorders, esophageal problems, or other diseases in the thorax. Allogeneic organ transplant is currently available. However, it remains a trap because of its dependency on a very limited supply of donated organs, which may be needed for both initial and subsequent transplants. Furthermore, it requires lifelong treatment with immunosuppressants, which are associated with adverse effects. Despite early clinical applications of bioengineered organs and tissues, routine implementation is still far off. For this review, we searched the PubMed, MEDLINE, and Ovid databases for the following keywords for each tissue or organ: tissue engineering, biological and synthetic scaffold/graft, acellular and decelluar(ized), reseeding, bioreactor, tissue replacement, and transplantation. We identified the current state-of-the-art practices in tissue engineering with a focus on advances during the past 5 years. We discuss advantages and disadvantages of biological and synthetic solutions and introduce novel strategies and technologies for the field. The ethical challenges of innovation in this area are also reviewed.
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Affiliation(s)
- Mei Ling Lim
- Advanced Center for Translational Regenerative Medicine, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden
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Voges I, Bräsen JH, Entenmann A, Scheid M, Scheewe J, Fischer G, Hart C, Andrade A, Pham HM, Kramer HH, Rickers C. Adverse results of a decellularized tissue-engineered pulmonary valve in humans assessed with magnetic resonance imaging. Eur J Cardiothorac Surg 2013; 44:e272-9. [PMID: 23818571 DOI: 10.1093/ejcts/ezt328] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
OBJECTIVES Matrix P® and Matrix P plus® tissue-engineered pulmonary valves (TEPV) were offered as an improvement for pulmonary valve replacement (PVR) because of recellularization by host cells. The high frequency of graft failure gave reason to evaluate the underlying morphological substrate using magnetic resonance imaging (MRI) and histology. METHODS Between June 2006 and August 2008, 17 Matrix P® and 10 Matrix P plus® TEPVs were implanted in 26 patients with a median age of 12.4 (range: 0.8-38.7, interquartile range: 6.1-18.1) years. The grafts were studied by MRI, and underwent histological examination when explantation was required. RESULTS Surgical (n = 13) or transcatheter (n = 1) TEPV replacement because of graft failure was needed in 14 cases (52%) 19 (0.5-53) months after implantation. MRI detected significant TEPV stenosis with mild insufficiency (V(max) = 3.7 ± (standard deviation) 0.5 m/s, regurgitant fraction (RGF) = 10 ± 3%) and stenosis with moderate-to-severe insufficiency (V(max) = 3.5 ± 0.8 m/s, RGF = 38 ± 10%) in 6 patients, respectively, and severe insufficiency (RGF = 40%) in 1 patient. In patients with graft failure, MRI showed hyperenhancement and TEPV wall thickening. Histology revealed severe inflammation, increased fibrous tissue and foreign-body reaction against valve leaflets and fascial tissue, while TEPV endothelialization was not detected in any case. CONCLUSIONS The high frequency of Matrix P® and Matrix P plus® graft failure can be related to inflammation and fibrosis revealed by MRI and histology. Our results do not support the use of these valves for PVR and suggest careful follow-up examinations, including MRI for early detection of graft inflammation and fibrosis.
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Affiliation(s)
- Inga Voges
- Department of Congenital Heart Disease and Pediatric Cardiology, University Hospital of Schleswig-Holstein, Kiel, Germany
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Boldt J, Lutter G, Pohanke J, Fischer G, Schoettler J, Cremer J, Metzner A. Percutaneous Tissue-Engineered Pulmonary Valved Stent Implantation: Comparison of Bone Marrow-Derived CD133+-Cells and Cells Obtained from Carotid Artery. Tissue Eng Part C Methods 2013; 19:363-74. [DOI: 10.1089/ten.tec.2012.0078] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Jessica Boldt
- Department of Cardiovascular Surgery, Christian-Albrechts-University of Kiel, Kiel, Germany
| | - Georg Lutter
- Department of Cardiovascular Surgery, Christian-Albrechts-University of Kiel, Kiel, Germany
| | - Judith Pohanke
- Department of Cardiovascular Surgery, Christian-Albrechts-University of Kiel, Kiel, Germany
| | - Gunther Fischer
- Department of Pediatric Cardiology School of Medicine, Christian-Albrechts-University of Kiel, Kiel, Germany
| | - Jan Schoettler
- Department of Cardiovascular Surgery, Christian-Albrechts-University of Kiel, Kiel, Germany
| | - Jochen Cremer
- Department of Cardiovascular Surgery, Christian-Albrechts-University of Kiel, Kiel, Germany
| | - Anja Metzner
- Department of Cardiovascular Surgery, Christian-Albrechts-University of Kiel, Kiel, Germany
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63
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Syedain ZH, Bradee AR, Kren S, Taylor DA, Tranquillo RT. Decellularized tissue-engineered heart valve leaflets with recellularization potential. Tissue Eng Part A 2012; 19:759-69. [PMID: 23088577 DOI: 10.1089/ten.tea.2012.0365] [Citation(s) in RCA: 76] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
Tissue-engineered heart valves (TEHV) have been proposed as a promising solution for the clinical needs of pediatric patients. In vivo studies have shown TEHV leaflet contraction and regurgitation after several months of implantation. This has been attributed to contractile cells utilized to produce the extracellular matrix (ECM) during TEHV culture. Here, we utilized such cells to develop a mature ECM in a fibrin-based scaffold that generates commissural alignment in TEHV leaflets and then removed these cells using detergents. Further, we evaluated recellularization with potentially noncontractile cells. A tissue-engineered leaflet model was developed with mechanical anisotropy and tensile properties comparable to an ovine pulmonary valve leaflet. No change in tensile properties occurred after decellularization using 1% sodium dodecyl sulfate and 1% Triton detergent treatment. Cell removal was verified by DNA quantitation and western blot analysis for cellular proteins. Histological and scanning electron microscope imaging showed no significant change in the ECM organization and microstructure. We further tested the recellularization potential of decellularized leaflets by seeding human mesenchymal stem cells (hMSC) on the surface of the leaflets and evaluated them at 1 and 3 weeks in two culture conditions. One medium (M1) was chosen to maintain the MSC phenotype while a second medium (M2) was used to potentially differentiate cells to an interstitial cell phenotype. Cellular quantitation showed that the engineered leaflets were recellularized to the highest concentration with M2 followed by M1, with minimum cell invasion of decellularized native leaflets. Histology showed cellular invasion throughout the thickness of the leaflets in M2 and partial invasion in M1. hMSC stained positive for MSC markers, but also for α-smooth muscle actin in both media at 1 week, with no presence of MSC markers at 3 weeks with the exception of CD90. These results show that engineered leaflets, while having similar tensile properties and collagen content compared to native leaflets, have better recellularization potential.
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Affiliation(s)
- Zeeshan H Syedain
- Department of Biomedical Engineering, University of Minnesota, Minneapolis, Minnesota, USA
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Klopsch C, Gäbel R, Kaminski A, Mark P, Wang W, Toelk A, Delyagina E, Kleiner G, Koch L, Chichkov B, Mela P, Jockenhoevel S, Ma N, Steinhoff G. Spray- and laser-assisted biomaterial processing for fast and efficient autologous cell-plus-matrix tissue engineering. J Tissue Eng Regen Med 2012. [DOI: 10.1002/term.1657] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Christian Klopsch
- Reference and Translation Centre for Cardiac Stem Cell Therapy; University of Rostock; Germany
- Department of Cardiac Surgery, Medical Faculty; University of Rostock; Germany
| | - Ralf Gäbel
- Reference and Translation Centre for Cardiac Stem Cell Therapy; University of Rostock; Germany
- Department of Cardiac Surgery, Medical Faculty; University of Rostock; Germany
| | - Alexander Kaminski
- Reference and Translation Centre for Cardiac Stem Cell Therapy; University of Rostock; Germany
- Department of Cardiac Surgery, Medical Faculty; University of Rostock; Germany
| | - Peter Mark
- Reference and Translation Centre for Cardiac Stem Cell Therapy; University of Rostock; Germany
- Department of Cardiac Surgery, Medical Faculty; University of Rostock; Germany
| | - Weiwei Wang
- Reference and Translation Centre for Cardiac Stem Cell Therapy; University of Rostock; Germany
- Department of Cardiac Surgery, Medical Faculty; University of Rostock; Germany
| | - Anita Toelk
- Reference and Translation Centre for Cardiac Stem Cell Therapy; University of Rostock; Germany
- Department of Cardiac Surgery, Medical Faculty; University of Rostock; Germany
| | - Evgenya Delyagina
- Reference and Translation Centre for Cardiac Stem Cell Therapy; University of Rostock; Germany
- Department of Cardiac Surgery, Medical Faculty; University of Rostock; Germany
| | - Gabriela Kleiner
- Reference and Translation Centre for Cardiac Stem Cell Therapy; University of Rostock; Germany
- Department of Cardiac Surgery, Medical Faculty; University of Rostock; Germany
| | | | | | - Petra Mela
- Department of Tissue Engineering and Textile Implants, AME-Helmholtz Institute for Biomedical Engineering; RWTH Aachen University; Germany
| | - Stefan Jockenhoevel
- Department of Tissue Engineering and Textile Implants, AME-Helmholtz Institute for Biomedical Engineering; RWTH Aachen University; Germany
| | - Nan Ma
- Reference and Translation Centre for Cardiac Stem Cell Therapy; University of Rostock; Germany
- Department of Cardiac Surgery, Medical Faculty; University of Rostock; Germany
| | - Gustav Steinhoff
- Reference and Translation Centre for Cardiac Stem Cell Therapy; University of Rostock; Germany
- Department of Cardiac Surgery, Medical Faculty; University of Rostock; Germany
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Naso F, Gandaglia A, Iop L, Spina M, Gerosa G. Alpha-Gal detectors in xenotransplantation research: a word of caution. Xenotransplantation 2012; 19:215-20. [DOI: 10.1111/j.1399-3089.2012.00714.x] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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66
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Hopkins RA, Bert AA, Hilbert SL, Quinn RW, Brasky KM, Drake WB, Lofland GK. Bioengineered human and allogeneic pulmonary valve conduits chronically implanted orthotopically in baboons: hemodynamic performance and immunologic consequences. J Thorac Cardiovasc Surg 2012; 145:1098-1107.e3. [PMID: 22841171 DOI: 10.1016/j.jtcvs.2012.06.024] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2012] [Revised: 05/10/2012] [Accepted: 06/12/2012] [Indexed: 12/16/2022]
Abstract
OBJECTIVE This study assesses in a baboon model the hemodynamics and human leukocyte antigen immunogenicity of chronically implanted bioengineered (decellularized with collagen conditioning treatments) human and baboon heart valve scaffolds. METHODS Fourteen baboons underwent pulmonary valve replacement, 8 with decellularized and conditioned (bioengineered) pulmonary valves derived from allogeneic (N = 3) or xenogeneic (human) (N = 5) hearts; for comparison, 6 baboons received clinically relevant reference cryopreserved or porcine valved conduits. Panel-reactive serum antibodies (human leukocyte antigen class I and II), complement fixing antibodies (C1q binding), and C-reactive protein titers were measured serially until elective sacrifice at 10 or 26 weeks. Serial transesophageal echocardiograms measured valve function and geometry. Differences were analyzed with Kruskal-Wallis and Wilcoxon rank-sum tests. RESULTS All animals survived and thrived, exhibiting excellent immediate implanted valve function by transesophageal echocardiograms. Over time, reference valves developed a smaller effective orifice area index (median, 0.84 cm(2)/m(2); range, 1.22 cm(2)/m(2)), whereas all bioengineered valves remained normal (effective orifice area index median, 2.45 cm(2)/m(2); range, 1.35 cm(2)/m(2); P = .005). None of the bioengineered valves developed elevated peak transvalvular gradients: 5.5 (6.0) mm Hg versus 12.5 (23.0) mm Hg (P = .003). Cryopreserved valves provoked the most intense antibody responses. Two of 5 human bioengineered and 2 of 3 baboon bioengineered valves did not provoke any class I antibodies. Bioengineered human (but not baboon) scaffolds provoked class II antibodies. C1q(+) antibodies developed in 4 recipients. CONCLUSIONS Valve dysfunction correlated with markers for more intense inflammatory provocation. The tested bioengineering methods reduced antigenicity of both human and baboon valves. Bioengineered replacement valves from both species were hemodynamically equivalent to native valves.
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Affiliation(s)
- Richard A Hopkins
- Cardiac Regenerative Surgery Research Laboratories, The Ward Family Center for Congenital Heart Disease, Children's Mercy Hospital, Kansas City, Mo.
| | - Arthur A Bert
- Cardiac Regenerative Surgery Research Laboratories, The Ward Family Center for Congenital Heart Disease, Children's Mercy Hospital, Kansas City, Mo; Department of Surgery (Division of Cardiac Anesthesiology), Warren Alpert School of Medicine, Brown University, Providence, RI
| | - Stephen L Hilbert
- Cardiac Regenerative Surgery Research Laboratories, The Ward Family Center for Congenital Heart Disease, Children's Mercy Hospital, Kansas City, Mo
| | - Rachael W Quinn
- Cardiac Regenerative Surgery Research Laboratories, The Ward Family Center for Congenital Heart Disease, Children's Mercy Hospital, Kansas City, Mo
| | - Kathleen M Brasky
- Southwest National Primate Research Center, Texas Biomedical Research Institute, San Antonio, Tex
| | - William B Drake
- Cardiac Regenerative Surgery Research Laboratories, The Ward Family Center for Congenital Heart Disease, Children's Mercy Hospital, Kansas City, Mo
| | - Gary K Lofland
- Cardiac Regenerative Surgery Research Laboratories, The Ward Family Center for Congenital Heart Disease, Children's Mercy Hospital, Kansas City, Mo
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Ruffer A, Wittmann J, Potapov S, Purbojo A, Glockler M, Koch AM, Dittrich S, Cesnjevar RA. Mid-term experience with the Hancock porcine-valved Dacron conduit for right ventricular outflow tract reconstruction. Eur J Cardiothorac Surg 2012; 42:988-95. [DOI: 10.1093/ejcts/ezs103] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Oda T, Hoashi T, Kagisaki K, Shiraishi I, Yagihara T, Ichikawa H. Alternative to pulmonary allograft for reconstruction of right ventricular outflow tract in small patients undergoing the Ross procedure. Eur J Cardiothorac Surg 2012; 42:226-32; discussion 232. [DOI: 10.1093/ejcts/ezs013] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Perri G, Polito A, Esposito C, Albanese SB, Francalanci P, Pongiglione G, Carotti A. Early and late failure of tissue-engineered pulmonary valve conduits used for right ventricular outflow tract reconstruction in patients with congenital heart disease. Eur J Cardiothorac Surg 2012; 41:1320-5. [DOI: 10.1093/ejcts/ezr221] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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The effect of detergent-based decellularization procedures on cellular proteins and immunogenicity in equine carotid artery grafts. Biomaterials 2011; 32:9730-7. [PMID: 21944468 DOI: 10.1016/j.biomaterials.2011.09.015] [Citation(s) in RCA: 73] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2011] [Accepted: 09/06/2011] [Indexed: 12/14/2022]
Abstract
Decellularized equine carotid arteries (dEAC) may represent a reasonable alternative to alloplastic materials in vascular replacement therapy. Acellularity of the matrix is standardly evaluated by DNA quantification what however may not record sufficiently the degree of matrix immunogenicity. Thus, our aim was to analyze dEAC with a low DNA content for residual cellular proteins. A detergent-based decellularization protocol including endonuclease treatment resulted in dEAC with 0.6 ± 0.15 ng DNA/mg dry weight representing 0.33 ± 0.14% of native tissue DNA content. In contrast, when matrices were homogenized and extracted by high detergent concentrations westernblot analyses revealed cytosolic and cytosceleton proteins like GAPDH and smooth muscle actin which were depleted to 4.1 ± 1.9% and 13.8 ± 0.55%, resp. Also putative immunogenic MHC I complexes and the alpha-Gal epitop were reduced to only 14.8 ± 1.2% and 15.1 ± 2.05%. Mass spectrometry of matrix extracts identified 306 proteins belonging to cytosol, organelles, nucleus and cell membrane. Moreover, aqueous matrix extracts evoked a pronounced antibody formation when administered in mice and thus display high immunogenic potential. Our data indicate that an established decellularization protocol which results in acellular matrices evaluated by low DNA content reduces but not eliminates cellular components which may contribute to its immunogenic potential in vivo.
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Abstract
Cardiac function, including the heart muscle and valves, can be severely altered by congenital and acquired heart diseases. Several graft materials are currently used to replace diseased cardiac tissue and valvular segments. Implantable grafts are either non-vital or can trigger an immune response which leads to graft calcification and degeneration. None of the existing grafts have the ability to remodel and grow in tandem with the physiological growth of a child and therefore require re-operation. Novel approaches such as tissue engineering have emerged as possible alternatives for cardiac reconstruction. The main concept of tissue engineering includes the use of biological and artificial scaffolds that form the shape of the organ structures for subsequent tissue replacement, which will provide absolute biocompatibility, no thrombogenicity, no teratogenicity, long-term durability and growth.Heart valve tissue engineering represents an important field especially in pediatric patients with valve pathologies. In order to create an autologous valve equivalent myofibroblasts and/or endothelial cells are seeded on specially designed scaffolds. Here we describe the different types of cell sources and different types of matrices currently used in heart valve tissue engineering. Valve manufacture is carried out in specially designed bioreactors providing physiological conditions. The number of clinical studies using tissue engineered valves is still limited; however, several promising results have already demonstrated their durability and ability to grow.Myocardial tissue engineering aims to repair, replace and regenerate damaged cardiac tissue using tissue constructs created ex vivo. Conceivable indications for clinical application of tissue engineered myocardial-implant substitutes include ischemic cardiomyopathies, as well as right ventricular outflow tract reconstruction in patients with congenital heart diseases. Therapeutic application of functional (contractile) tissue engineered heart muscle appears feasible once key issues such as identification of the suitable human cell source, large scale expansion and suitable scaffolds are solved. In addition, the present article discusses the importance of vascularization as an important prerequisite for successful bio-artificial myocardial tissue.Further experimental and clinical research on cardiovascular tissue engineering is felt to be of great importance for others as well as for us in order to create an ideal heart valve/myocardial substitute and help our patients with advanced cardiac pathologies.
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Affiliation(s)
- Serghei Cebotari
- Klinik für Herz-, Thorax-, Transplantations- und Gefäßchirurgie, Medizinische Hochschule Hannover, Carl-Neuberg-Strasse 1, Hannover, Germany.
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Reply to Erdbrügger and Stein-Konertz. Eur J Cardiothorac Surg 2011. [DOI: 10.1016/j.ejcts.2010.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Re: Early failure of xenogenous de-cellularised pulmonary valve conduits: a word of caution! Eur J Cardiothorac Surg 2011; 39:283-4; author reply 284. [PMID: 21255720 DOI: 10.1016/j.ejcts.2010.05.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2010] [Revised: 03/31/2010] [Accepted: 05/07/2010] [Indexed: 11/23/2022] Open
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Metzner A, Stock UA, Iino K, Fischer G, Huemme T, Boldt J, Braesen JH, Bein B, Renner J, Cremer J, Lutter G. Percutaneous pulmonary valve replacement: autologous tissue-engineered valved stents. Cardiovasc Res 2010; 88:453-61. [DOI: 10.1093/cvr/cvq212] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Ward TH, Brandizzi F. Dynamics of proteins in Golgi membranes: comparisons between mammalian and plant cells highlighted by photobleaching techniques. Cell Mol Life Sci 2004; 61:172-85. [PMID: 14745496 PMCID: PMC11138903 DOI: 10.1007/s00018-003-3355-6] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
In less than a decade the green fluorescent protein (GFP) has become one of the most popular tools for cell biologists for the study of dynamic processes in vivo. GFP has revolutionised the scientific approach for the study of vital organelles, such as the Golgi apparatus. As Golgi proteins can be tagged with GFP, in most cases without altering their targeting and function, it is a great substitute to conventional dyes used in the past to highlight this compartment. In this review, we cover the application of GFP and its spectral derivatives in the study of Golgi dynamics in mammalian and plant cells. In particular, we focus on the technique of selective photobleaching known as fluorescence recovery after photobleaching, which has successfully shed light on essential differences in the biology of the Golgi apparatus in mammalian and plant cells.
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Affiliation(s)
- T. H. Ward
- Immunology Unit, Department of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, Keppel Street, WC1E 7HT London, United Kingdom
| | - F. Brandizzi
- School of Biological and Molecular Sciences, Oxford Brookes University, Gipsy Lane Campus, OX3 0BP Oxford, United Kingdom
- Department of Biology, University of Saskatchewan, S7N 5E2 Saskatoon, Canada
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