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Schlör S, Pflaum M, Höffler K, Kühn C, Haverich A, Wiegmann B. Towards Biohybrid Lung Development: Establishment of a Porcine In Vitro Model. MEMBRANES 2022; 12:membranes12070687. [PMID: 35877890 PMCID: PMC9325277 DOI: 10.3390/membranes12070687] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Revised: 06/29/2022] [Accepted: 07/01/2022] [Indexed: 02/04/2023]
Abstract
Lung transplantation (LTx) is the only curative therapy option for patients with end-stage lung diseases, though only available for chosen patients. To provide an alternative treatment option to LTx, we aim for the development of an implantable biohybrid lung (BHL) based on hollow fiber membrane (HFM) technology used in extracorporeal membrane oxygenators. Crucial for long-lasting BHL durability is complete hemocompatibility of all blood contacting surfaces, which can be achieved by their endothelialization. In continuation to successful in vitro investigations using human endothelial cells (ECs), indicating general feasibility, the appropriate porcine in vivo model needs to be prepared and established to fill the translational data gap prior to patient’s application. Therefore, isolation of porcine ECs from carotid arteries (pCECs) was established. Following, pCECs were used for HFM endothelialization and examined under static and dynamic conditions using cell medium or heparinized blood, to assess their proliferation capacity, flow resistance and activation state, especially under clinically relevant conditions. Additionally, comparative hemocompatibility tests between native and endothelialized HFMs were performed. Overall, pure pCECs formed a viable and confluent monolayer, which resisted applied flow conditions, in particular due to physiological extracellular matrix synthesis. Additionally, pCECs remained the non-inflammatory and anti-thrombogenic status, significantly improving the hemocompatibility of endothelialized HFMs. Finally, as relevant for reliable porcine to human translation, pCECs behaved in the same way as human ECs. Concluding, generated in vitro data justify further steps towards pre-clinical BHL examination, in particular BHL application to porcine lung injury models, reflecting the clinical scenario with end-stage lung-diseased patients.
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Affiliation(s)
- Simon Schlör
- Department for Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany; (S.S.); (M.P.); (K.H.); (C.K.); (A.H.)
- Lower Saxony Center for Biomedical Engineering, Implant Research and Development (NIFE), Stadtfelddamm 34, 30625 Hannover, Germany
| | - Michael Pflaum
- Department for Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany; (S.S.); (M.P.); (K.H.); (C.K.); (A.H.)
- Lower Saxony Center for Biomedical Engineering, Implant Research and Development (NIFE), Stadtfelddamm 34, 30625 Hannover, Germany
| | - Klaus Höffler
- Department for Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany; (S.S.); (M.P.); (K.H.); (C.K.); (A.H.)
- Lower Saxony Center for Biomedical Engineering, Implant Research and Development (NIFE), Stadtfelddamm 34, 30625 Hannover, Germany
| | - Christian Kühn
- Department for Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany; (S.S.); (M.P.); (K.H.); (C.K.); (A.H.)
- Lower Saxony Center for Biomedical Engineering, Implant Research and Development (NIFE), Stadtfelddamm 34, 30625 Hannover, Germany
- German Center for Lung Research (DZL), Carl-Neuberg-Str. 1, 30625 Hannover, Germany
| | - Axel Haverich
- Department for Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany; (S.S.); (M.P.); (K.H.); (C.K.); (A.H.)
- Lower Saxony Center for Biomedical Engineering, Implant Research and Development (NIFE), Stadtfelddamm 34, 30625 Hannover, Germany
- German Center for Lung Research (DZL), Carl-Neuberg-Str. 1, 30625 Hannover, Germany
| | - Bettina Wiegmann
- Department for Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany; (S.S.); (M.P.); (K.H.); (C.K.); (A.H.)
- Lower Saxony Center for Biomedical Engineering, Implant Research and Development (NIFE), Stadtfelddamm 34, 30625 Hannover, Germany
- German Center for Lung Research (DZL), Carl-Neuberg-Str. 1, 30625 Hannover, Germany
- Correspondence:
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Caspari S, Schwärzel LS, Jungmann AM, Schmoll N, Seiler F, Muellenbach RM, Krawczyk M, Dinh QT, Bals R, Lepper PM, Omlor AJ. A Novel Mock Circuit to Test Full-Flow Extracorporeal Membrane Oxygenation. MEMBRANES 2022; 12:membranes12050493. [PMID: 35629818 PMCID: PMC9147719 DOI: 10.3390/membranes12050493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 04/22/2022] [Accepted: 04/28/2022] [Indexed: 02/04/2023]
Abstract
Extracorporeal membrane oxygenation (ECMO) has become an important therapeutic approach in the COVID-19 pandemic. The development and research in this field strongly relies on animal models; however, efforts are being made to find alternatives. In this work, we present a new mock circuit for ECMO that allows measurements of the oxygen transfer rate of a membrane lung at full ECMO blood flow. The mock utilizes a large reservoir of heparinized porcine blood to measure the oxygen transfer rate of the membrane lung in a single passage. The oxygen transfer rate is calculated from blood flow, hemoglobin value, venous saturation, and post-membrane arterial oxygen pressure. Before the next measuring sequence, the blood is regenerated to a venous condition with a sweep gas of nitrogen and carbon dioxide. The presented mock was applied to investigate the effect of a recirculation loop on the oxygen transfer rate of an ECMO setup. The recirculation loop caused a significant increase in post-membrane arterial oxygen pressure (paO2). The effect was strongest for the highest recirculation flow. This was attributed to a smaller boundary layer on gas fibers due to the increased blood velocity. However, the increase in paO2 did not translate to significant increases in the oxygen transfer rate because of the minor significance of physically dissolved oxygen for gas transfer. In conclusion, our results regarding a new ECMO mock setup demonstrate that recirculation loops can improve ECMO performance, but not enough to be clinically relevant.
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Affiliation(s)
- Stefan Caspari
- Department of Internal Medicine V—Pneumology, Allergology and Intensive Care Medicine, University Hospital of Saarland, 66424 Homburg, Germany; (S.C.); (L.S.S.); (A.M.J.); (N.S.); (F.S.); (Q.T.D.); (R.B.); (A.J.O.)
| | - Leonie S. Schwärzel
- Department of Internal Medicine V—Pneumology, Allergology and Intensive Care Medicine, University Hospital of Saarland, 66424 Homburg, Germany; (S.C.); (L.S.S.); (A.M.J.); (N.S.); (F.S.); (Q.T.D.); (R.B.); (A.J.O.)
| | - Anna M. Jungmann
- Department of Internal Medicine V—Pneumology, Allergology and Intensive Care Medicine, University Hospital of Saarland, 66424 Homburg, Germany; (S.C.); (L.S.S.); (A.M.J.); (N.S.); (F.S.); (Q.T.D.); (R.B.); (A.J.O.)
| | - Nicole Schmoll
- Department of Internal Medicine V—Pneumology, Allergology and Intensive Care Medicine, University Hospital of Saarland, 66424 Homburg, Germany; (S.C.); (L.S.S.); (A.M.J.); (N.S.); (F.S.); (Q.T.D.); (R.B.); (A.J.O.)
| | - Frederik Seiler
- Department of Internal Medicine V—Pneumology, Allergology and Intensive Care Medicine, University Hospital of Saarland, 66424 Homburg, Germany; (S.C.); (L.S.S.); (A.M.J.); (N.S.); (F.S.); (Q.T.D.); (R.B.); (A.J.O.)
| | - Ralf M. Muellenbach
- Department of Anaesthesiology and Critical Care, Campus Kassel of the University of Southampton, 34125 Kassel, Germany;
| | - Marcin Krawczyk
- Department of Internal Medicine II, University Hospital of Saarland, 66424 Homburg, Germany;
- Laboratory of Metabolic Liver Diseases, Department of General, Transplant and Liver Surgery, Centre for Preclinical Research, Medical University of Warsaw, 02091 Warsaw, Poland
| | - Quoc Thai Dinh
- Department of Internal Medicine V—Pneumology, Allergology and Intensive Care Medicine, University Hospital of Saarland, 66424 Homburg, Germany; (S.C.); (L.S.S.); (A.M.J.); (N.S.); (F.S.); (Q.T.D.); (R.B.); (A.J.O.)
| | - Robert Bals
- Department of Internal Medicine V—Pneumology, Allergology and Intensive Care Medicine, University Hospital of Saarland, 66424 Homburg, Germany; (S.C.); (L.S.S.); (A.M.J.); (N.S.); (F.S.); (Q.T.D.); (R.B.); (A.J.O.)
| | - Philipp M. Lepper
- Department of Internal Medicine V—Pneumology, Allergology and Intensive Care Medicine, University Hospital of Saarland, 66424 Homburg, Germany; (S.C.); (L.S.S.); (A.M.J.); (N.S.); (F.S.); (Q.T.D.); (R.B.); (A.J.O.)
- Correspondence:
| | - Albert J. Omlor
- Department of Internal Medicine V—Pneumology, Allergology and Intensive Care Medicine, University Hospital of Saarland, 66424 Homburg, Germany; (S.C.); (L.S.S.); (A.M.J.); (N.S.); (F.S.); (Q.T.D.); (R.B.); (A.J.O.)
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Towards Biohybrid Lung Development-Fibronectin-Coating Bestows Hemocompatibility of Gas Exchange Hollow Fiber Membranes by Improving Flow-Resistant Endothelialization. MEMBRANES 2021; 12:membranes12010035. [PMID: 35054561 PMCID: PMC8779364 DOI: 10.3390/membranes12010035] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 12/22/2021] [Accepted: 12/22/2021] [Indexed: 01/26/2023]
Abstract
To provide an alternative treatment option for patients with end-stage lung disease, we aim for biohybrid lung development (BHL) based on hollow fiber membrane (HFM) technology used in extracorporeal membrane oxygenators. For long-term BHL application, complete hemocompatibility of all blood-contacting surfaces is indispensable and can be achieved by their endothelialization. Indeed, albumin/heparin (AH) coated HFM enables initial endothelialization, but as inexplicable cell loss under flow conditions was seen, we assessed an alternative HFM coating using fibronectin (FN). Therefore, endothelial cell (EC) adherence and viability on both coated HFM were analyzed by fluorescence-based staining. Functional leukocyte and thrombocyte adhesion assays were performed to evaluate hemocompatibility, also in comparison to blood plasma coated HFM as a clinically relevant control. To assess monolayer resistance and EC behavior under clinically relevant flow conditions, a mock circulation setup was established, which also facilitates imitation of lung-disease specific blood gas settings. Besides quantification of flow-associated cell loss, endothelial responses towards external stimuli, like flow exposure or TNFα stimulation, were analyzed by qRT-PCR, focusing on inflammation, thrombus formation and extracellular matrix production. Under static conditions, both coated HFM enabled the generation of a viable, confluent, non-inflammatory and anti-thrombogenic monolayer. However, by means of homogenous FN coating, cell retention and physiologic gene regulation towards an improved hemocompatible-and extracellular matrix producing phenotype, was significantly superior compared to the inhomogeneous AH coating. In summary, our adaptable in-house FN coating secures the endothelial requirements for long-term BHL application and may promote monolayer establishment on all other blood contacting surfaces of the BHL (e.g., cannulae).
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Towards Biohybrid Lung: Induced Pluripotent Stem Cell Derived Endothelial Cells as Clinically Relevant Cell Source for Biologization. MICROMACHINES 2021; 12:mi12080981. [PMID: 34442603 PMCID: PMC8401467 DOI: 10.3390/mi12080981] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Revised: 08/03/2021] [Accepted: 08/11/2021] [Indexed: 11/16/2022]
Abstract
In order to provide an alternative treatment option to lung transplantation for patients with end-stage lung disease, we aim for the development of an implantable biohybrid lung (BHL), based on hollow fiber membrane (HFM) technology used in extracorporeal membrane oxygenators. Complete hemocompatibility of all blood contacting surfaces is crucial for long-lasting BHL durability and can be achieved by their endothelialization. Autologous endothelial cells (ECs) would be the ideal cell source, but their limited proliferation potential excludes them for this purpose. As induced pluripotent stem cell-derived ECs enable the generation of a large number of ECs, we assessed and compared their capacity to form a viable and confluent monolayer on HFM, while indicating physiologic EC-specific anti-thrombogenic and anti-inflammatory properties. ECs were generated from three different human iPSC lines, and seeded onto fibronectin-coated poly-4-methyl-1-pentene (PMP) HFM. Following phenotypical characterization, ECs were analyzed for their thrombogenic and inflammatory behavior with or without TNFα induction, using FACS and qRT-PCR. Complementary, leukocyte- and platelet adhesion assays were carried out. The capacity of the iPSC-ECs to reendothelialize cell-free monolayer areas was assessed in a scratch assay. ECs sourced from umbilical cord blood (hCBECs) were used as control. iPSC-derived ECs formed confluent monolayers on the HFM and showed the typical EC-phenotype by expression of VE-cadherin and collagen-IV. A low protein and gene expression level of E-selectin and tissue factor was detected for all iPSC-ECs and the hCBECs, while a strong upregulation of these markers was noted upon stimulation with TNFα. This was in line with the physiological and strong induction of leukocyte adhesion detected after treatment with TNFα, iPSC-EC and hCBEC monolayers were capable of reducing thrombocyte adhesion and repopulating scratched areas. iPSCs offer the possibility to provide patient-specific ECs in abundant numbers needed to cover all blood contacting surfaces of the BHL with a viable, non-thrombogenic and non-inflammatory monolayer. iPSC-EC clones can differ in terms of their reendothelialization rate, and pro-inflammatory response. However, a less profound inflammatory response may even be advantageous for BHL application. With the proven ability of the seeded iPSC-ECs to reduce thrombocyte adhesion, we expect that thrombotic events that could lead to BHL occlusion can be avoided, and thus, justifies further studies on enabling BHL long-term application.
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Schwärzel LS, Jungmann AM, Schmoll N, Seiler F, Muellenbach RM, Schenk J, Dinh QT, Bals R, Lepper PM, Omlor AJ. A mock circulation loop to test extracorporeal CO 2 elimination setups. Intensive Care Med Exp 2020; 8:52. [PMID: 32915322 PMCID: PMC7484925 DOI: 10.1186/s40635-020-00341-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Accepted: 09/02/2020] [Indexed: 01/01/2023] Open
Abstract
Background Extracorporeal carbon dioxide removal (ECCO2R) is a promising yet limited researched therapy for hypercapnic respiratory failure in acute respiratory distress syndrome and exacerbated chronic obstructive pulmonary disease. Herein, we describe a new mock circuit that enables experimental ECCO2R research without animal models. In a second step, we use this model to investigate three experimental scenarios of ECCO2R: (I) the influence of hemoglobin concentration on CO2 removal. (II) a potentially portable ECCO2R that uses air instead of oxygen, (III) a low-flow ECCO2R that achieves effective CO2 clearance by recirculation and acidification of the limited blood volume of a small dual lumen cannula (such as a dialysis catheter). Results With the presented ECCO2R mock, CO2 removal rates comparable to previous studies were obtained. The mock works with either fresh porcine blood or diluted expired human packed red blood cells. However, fresh porcine blood was preferred because of better handling and availability. In the second step of this work, hemoglobin concentration was identified as an important factor for CO2 removal. In the second scenario, an air-driven ECCO2R setup showed only a slightly lower CO2 wash-out than the same setup with pure oxygen as sweep gas. In the last scenario, the low-flow ECCO2R, the blood flow at the test membrane lung was successfully raised with a recirculation channel without the need to increase cannula flow. Low recirculation ratios resulted in increased efficiency, while high recirculation ratios caused slightly reduced CO2 removal rates. Acidification of the CO2 depleted blood in the recirculation channel caused an increase in CO2 removal rate. Conclusions We demonstrate a simple and cost effective, yet powerful, “in-vitro” ECCO2R model that can be used as an alternative to animal experiments for many research scenarios. Moreover, in our approach parameters such as hemoglobin level can be modified more easily than in animal models.
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Affiliation(s)
- Leonie S Schwärzel
- Department of Internal Medicine V - Pneumology and Intensive Care Medicine, University Hospital of Saarland, Kirrbergerstr. 1, 66421, Homburg, Germany
| | - Anna M Jungmann
- Department of Internal Medicine V - Pneumology and Intensive Care Medicine, University Hospital of Saarland, Kirrbergerstr. 1, 66421, Homburg, Germany
| | - Nicole Schmoll
- Department of Internal Medicine V - Pneumology and Intensive Care Medicine, University Hospital of Saarland, Kirrbergerstr. 1, 66421, Homburg, Germany
| | - Frederik Seiler
- Department of Internal Medicine V - Pneumology and Intensive Care Medicine, University Hospital of Saarland, Kirrbergerstr. 1, 66421, Homburg, Germany
| | - Ralf M Muellenbach
- Department of Anaesthesiology and Critical Care, Campus Kassel of the University of Southampton, Kassel, Germany
| | - Joachim Schenk
- Department of Transfusion Medicine and Hemostaseology, University Hospital of Saarland, Homburg, Germany
| | - Quoc Thai Dinh
- Department of Internal Medicine V - Pneumology and Intensive Care Medicine, University Hospital of Saarland, Kirrbergerstr. 1, 66421, Homburg, Germany
| | - Robert Bals
- Department of Internal Medicine V - Pneumology and Intensive Care Medicine, University Hospital of Saarland, Kirrbergerstr. 1, 66421, Homburg, Germany
| | - Philipp M Lepper
- Department of Internal Medicine V - Pneumology and Intensive Care Medicine, University Hospital of Saarland, Kirrbergerstr. 1, 66421, Homburg, Germany.
| | - Albert J Omlor
- Department of Internal Medicine V - Pneumology and Intensive Care Medicine, University Hospital of Saarland, Kirrbergerstr. 1, 66421, Homburg, Germany
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Shi Y, Yang H. Mock circulatory test rigs for the in vitro testing of artificial cardiovascular organs. J Med Eng Technol 2019; 43:223-234. [PMID: 31464556 DOI: 10.1080/03091902.2019.1653390] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
In vitro study plays an important role in the experimental study of cardiovascular dynamics. An essential hardware facility that mimics the blood flow changes and provides the required test conditions, a mock circulatory test rig (MCTR), is imperative for the execution of in vitro study. This paper examines the current MCTRs in use for the testing of artificial cardiovascular organs. Various aspects of the MCTRs are surveyed, including the necessity of in vitro study, the building of MCTRs, relevant standards, general system structure (e.g., the motion and driving, fluid, measurement subsystems), classification, motion driving mechanism of MCTRs, and the considerations for the modelling of the physiological impedance of MCTRs. Examples of the steady and pulsatile flow types of the MCTRs are introduced. Recent developments in MCTRs are inspected and possible future design improvements suggested. This study will help researchers in the design, construction, analysis, and selection of MCTRs for cardiovascular research.
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Affiliation(s)
- Yubing Shi
- College of Medical Technology, Shaanxi University of Chinese Medicine , Xianyang , PR China
| | - Hongyi Yang
- College of Medical Technology, Shaanxi University of Chinese Medicine , Xianyang , PR China
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Shi Y, Korakianitis T, Li Z, Shi Y. Structure and motion design of a mock circulatory test rig. J Med Eng Technol 2018; 42:443-452. [PMID: 30499728 DOI: 10.1080/03091902.2018.1543467] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Mock circulatory test rig (MCTR) is the essential and indispensable facility in the cardiovascular in vitro studies. The system configuration and the motion profile of the MCTR design directly influence the validity, precision, and accuracy of the experimental data collected. Previous studies gave the schematic but never describe the structure and motion design details of the MCTRs used, which makes comparison of the experimental data reported by different research groups plausible but not fully convincing. This article presents the detailed structure and motion design of a sophisticated MCTR system, and examines the important issues such as the determination of the ventricular motion waveform, modelling of the physiological impedance, etc., in the MCTR designing. The study demonstrates the overall design procedures from the system conception, cardiac model devising, motion planning, to the motor and accessories selection. This can be used as a reference to aid researchers in the design and construction of their own in-house MCTRs for cardiovascular studies.
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Affiliation(s)
- Yuhui Shi
- a Northwest Institute of Mechanical and Electrical Engineering , Xianyang , Shaanxi Province , China
| | - Theodosios Korakianitis
- b Parks College of Engineering, Aviation and Technology , Saint Louis University , Saint Louis , MO , USA
| | - Zhongjian Li
- c College of Automation , Northwestern Polytechnical University , Xi'an , China
| | - Yubing Shi
- d Faculty of Arts, Science and Technology , University of Northampton , Northampton , UK
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