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Battistella A, Linger M, Nguyen AT, Madukwe D, Roy-Chaudhury P, Tan W. Rebuilding vascular access: from the viewpoint of mechanics and materials. Front Bioeng Biotechnol 2024; 12:1448186. [PMID: 39295847 PMCID: PMC11409097 DOI: 10.3389/fbioe.2024.1448186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2024] [Accepted: 08/22/2024] [Indexed: 09/21/2024] Open
Abstract
This review presents a comprehensive analysis of vascular access in hemodialysis, focusing on the current modalities, their associated challenges, and recent technological advancements. It closely examines the status of three primary types of vascular access: arteriovenous fistulas, arteriovenous grafts, and central venous catheters. The review delves into the complications and pathologies associated with these access types, emphasizing the mechanobiology-related pathogenesis of arteriovenous access. Furthermore, it explores recent clinical trials, biomaterials, and device innovations, highlighting novel pharmaceutical approaches, advanced materials, device designs, and cutting-edge technologies aimed at enhancing the efficacy, safety, and longevity of vascular access in hemodialysis. This synthesis of current knowledge and emerging trends underscores the dynamic evolution of vascular access strategies and their critical role in improving patient care in hemodialysis.
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Affiliation(s)
- Aurora Battistella
- Paul M. Rady Mechanical Engineering, University of Colorado at Boulder, Boulder, CO, United States
| | - Morgan Linger
- Paul M. Rady Mechanical Engineering, University of Colorado at Boulder, Boulder, CO, United States
- Department of Biomedical Engineering, University of Colorado at Boulder, Boulder, CO, United States
| | - Anh Thy Nguyen
- Paul M. Rady Mechanical Engineering, University of Colorado at Boulder, Boulder, CO, United States
| | - David Madukwe
- Paul M. Rady Mechanical Engineering, University of Colorado at Boulder, Boulder, CO, United States
| | - Prabir Roy-Chaudhury
- Department of Medicine, University of North Carolina Kidney Center, Chapel Hill, NC, United States
- WG (Bill) Hefner VA Medical Center, Salisbury, NC, United States
| | - Wei Tan
- Paul M. Rady Mechanical Engineering, University of Colorado at Boulder, Boulder, CO, United States
- Department of Biomedical Engineering, University of Colorado at Boulder, Boulder, CO, United States
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2
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Singh M, Roubertie F, Ozturk C, Borchiellini P, Rames A, Bonnemain J, Gollob SD, Wang SX, Naulin J, El Hamrani D, Dugot-Senant N, Gosselin I, Grenet C, L'Heureux N, Roche ET, Kawecki F. Hemodynamic evaluation of biomaterial-based surgery for Tetralogy of Fallot using a biorobotic heart, in silico, and ovine models. Sci Transl Med 2024; 16:eadk2936. [PMID: 38985852 DOI: 10.1126/scitranslmed.adk2936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 03/12/2024] [Accepted: 06/20/2024] [Indexed: 07/12/2024]
Abstract
Tetralogy of Fallot is a congenital heart disease affecting newborns and involves stenosis of the right ventricular outflow tract (RVOT). Surgical correction often widens the RVOT with a transannular enlargement patch, but this causes issues including pulmonary valve insufficiency and progressive right ventricle failure. A monocusp valve can prevent pulmonary regurgitation; however, valve failure resulting from factors including leaflet design, morphology, and immune response can occur, ultimately resulting in pulmonary insufficiency. A multimodal platform to quantitatively evaluate the effect of shape, size, and material on clinical outcomes could optimize monocusp design. This study introduces a benchtop soft biorobotic heart model, a computational fluid model of the RVOT, and a monocusp valve made from an entirely biological cell-assembled extracellular matrix (CAM) to tackle the multifaceted issue of monocusp failure. The hydrodynamic and mechanical performance of RVOT repair strategies was assessed in biorobotic and computational platforms. The monocusp valve design was validated in vivo in ovine models through echocardiography, cardiac magnetic resonance, and catheterization. These models supported assessment of surgical feasibility, handling, suturability, and hemodynamic and mechanical monocusp capabilities. The CAM-based monocusp offered a competent pulmonary valve with regurgitation of 4.6 ± 0.9% and a transvalvular pressure gradient of 4.3 ± 1.4 millimeters of mercury after 7 days of implantation in sheep. The biorobotic heart model, in silico analysis, and in vivo RVOT modeling allowed iteration in monocusp design not now feasible in a clinical environment and will support future surgical testing of biomaterials for complex congenital heart malformations.
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Affiliation(s)
- Manisha Singh
- Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, MA 02142, USA
| | - François Roubertie
- IHU Liryc, Electrophysiology and Heart Modeling Institute, F-33604 Pessac, France
- Congenital Heart Diseases Department, CHU de Bordeaux, F-33604 Pessac, France
| | - Caglar Ozturk
- Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, MA 02142, USA
| | - Paul Borchiellini
- University of Bordeaux, INSERM, BioTis, U1026, F-33000 Bordeaux, France
| | - Adeline Rames
- University of Bordeaux, INSERM, BioTis, U1026, F-33000 Bordeaux, France
| | - Jean Bonnemain
- Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, MA 02142, USA
- Department of Adult Intensive Care Medicine, Lausanne University Hospital and University of Lausanne, CH-1011 Lausanne, Switzerland
| | - Samuel Dutra Gollob
- Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| | - Sophie X Wang
- Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, MA 02142, USA
- Department of Surgery, Beth Israel Deaconess Medical Center, Boston, MA 02215, USA
| | - Jérôme Naulin
- IHU Liryc, Electrophysiology and Heart Modeling Institute, F-33604 Pessac, France
| | - Dounia El Hamrani
- IHU Liryc, Electrophysiology and Heart Modeling Institute, F-33604 Pessac, France
| | - Nathalie Dugot-Senant
- Plateforme d'histopathologie, TBMcore INSERM US005-CNRS 3427, F-33000 Bordeaux, France
| | - Isalyne Gosselin
- Plateforme d'histopathologie, TBMcore INSERM US005-CNRS 3427, F-33000 Bordeaux, France
| | - Célia Grenet
- University of Bordeaux, INSERM, BioTis, U1026, F-33000 Bordeaux, France
| | - Nicolas L'Heureux
- University of Bordeaux, INSERM, BioTis, U1026, F-33000 Bordeaux, France
| | - Ellen T Roche
- Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, MA 02142, USA
- Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| | - Fabien Kawecki
- University of Bordeaux, INSERM, BioTis, U1026, F-33000 Bordeaux, France
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3
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Singal K, Dimitriyev MS, Gonzalez SE, Cachine AP, Quinn S, Matsumoto EA. Programming mechanics in knitted materials, stitch by stitch. Nat Commun 2024; 15:2622. [PMID: 38521784 PMCID: PMC10960873 DOI: 10.1038/s41467-024-46498-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 02/29/2024] [Indexed: 03/25/2024] Open
Abstract
Knitting turns yarn, a 1D material, into a 2D fabric that is flexible, durable, and can be patterned to adopt a wide range of 3D geometries. Like other mechanical metamaterials, the elasticity of knitted fabrics is an emergent property of the local stitch topology and pattern that cannot solely be attributed to the yarn itself. Thus, knitting can be viewed as an additive manufacturing technique that allows for stitch-by-stitch programming of elastic properties and has applications in many fields ranging from soft robotics and wearable electronics to engineered tissue and architected materials. However, predicting these mechanical properties based on the stitch type remains elusive. Here we untangle the relationship between changes in stitch topology and emergent elasticity in several types of knitted fabrics. We combine experiment and simulation to construct a constitutive model for the nonlinear bulk response of these fabrics. This model serves as a basis for composite fabrics with bespoke mechanical properties, which crucially do not depend on the constituent yarn.
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Affiliation(s)
- Krishma Singal
- School of Physics, Georgia Institute of Technology, Atlanta, GA, 30332, USA
| | - Michael S Dimitriyev
- Department of Polymer Science and Engineering, University of Massachusetts, Amherst, MA, 01003, USA
- Department of Materials Science and Engineering, Texas A&M University, College Station, TX, 77843, USA
| | - Sarah E Gonzalez
- School of Physics, Georgia Institute of Technology, Atlanta, GA, 30332, USA
| | - A Patrick Cachine
- School of Physics, Georgia Institute of Technology, Atlanta, GA, 30332, USA
| | - Sam Quinn
- School of Physics, Georgia Institute of Technology, Atlanta, GA, 30332, USA
| | - Elisabetta A Matsumoto
- School of Physics, Georgia Institute of Technology, Atlanta, GA, 30332, USA.
- International Institute for Sustainability with Knotted Chiral Meta Matter (WPI-SKCM2), Hiroshima University, Higashihiroshima, 739-8526, Japan.
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4
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Pereira-Lobato C, Echeverry-Rendón M, Fernández-Blázquez JP, González C, LLorca J. Mechanical properties, in vitro degradation and cytocompatibility of woven textiles manufactured from PLA/PCL commingled yarns. J Mech Behav Biomed Mater 2024; 150:106340. [PMID: 38147762 DOI: 10.1016/j.jmbbm.2023.106340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 12/15/2023] [Accepted: 12/18/2023] [Indexed: 12/28/2023]
Abstract
The mechanical, thermal, and biological performance of fabrics manufactured with hybrid PLA/PCL commingled yarns were studied. Commingled hybrid yarns take advantage of the higher elastic modulus of PLA and the higher ductility and toughness of PCL to produce yarns and fabrics with high strength and ductility that is transferred to the woven textiles. Furthermore, PLA and PCL exhibit different degradation rates and also allow to tailor this property. Degradation of the textiles was carried out in phosphate-buffered saline solution for up to 160 days at 37 °C and 50 °C (accelerated degradation). Neither the thermal nor the mechanical properties were altered by immersion at 37 °C during 80 days and a slight degradation was observed as a result of chain scission of the PLA fibres after 160 days. However, immersion at 50 °C led to a rapid reduction in strength after 40 days due to the hydrolysis of PLA, and the fabric was highly degraded after 160 days as a result of chain scission in PCL. Finally, while indirect tests did not predict optimal biocompatibility, the direct tests provided a different perspective of the cell interaction between the textile and pre-osteoblasts regarding cell attachment and cell morphology. These results show the potential of hybrid commingled yarns to manufacture textile scaffolds of biodegradable polymers with tailored mechanical properties and good ductility for connective tissue engineering (ligaments and tendons).
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Affiliation(s)
- C Pereira-Lobato
- IMDEA Materials Institute, C/Eric Kandel 2, 28906 - Getafe, Madrid, Spain; Materials Science and Engineering Department, Universidad Carlos III de Madrid, Avda. Universidad 30, 28911 Leganés, Madrid, Spain
| | - M Echeverry-Rendón
- IMDEA Materials Institute, C/Eric Kandel 2, 28906 - Getafe, Madrid, Spain
| | | | - C González
- IMDEA Materials Institute, C/Eric Kandel 2, 28906 - Getafe, Madrid, Spain; Department of Materials Science, Polytechnic University of Madrid, E.T.S. de Ingenieros de Caminos, 28040 Madrid, Spain
| | - J LLorca
- IMDEA Materials Institute, C/Eric Kandel 2, 28906 - Getafe, Madrid, Spain; Department of Materials Science, Polytechnic University of Madrid, E.T.S. de Ingenieros de Caminos, 28040 Madrid, Spain.
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5
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Pirraco RP. Macro, Micro, and Everything in Between. Bridging the Gap: A Vision Toward the Creation of Multiscale Vascular Networks. Adv Biol (Weinh) 2023; 7:e2300291. [PMID: 37566782 DOI: 10.1002/adbi.202300291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 07/27/2023] [Indexed: 08/13/2023]
Abstract
Vascularization is a key issue for the clinical translation of tissue engineering strategies. This has been recognized in the field for almost two decades. Several strategies to solve this issue are proposed but none has decisively tackled the problem. This is in part due to an excessive focus on microvascularization that ignores the need of having macrovessels capable of being surgically connected to the patient's circulation upon implantation. Indeed, a strategy for macrovessel engineering must co-exist with a strategy for microvessels. And if this is true, all the intermediate scales have to be addressed as well. Therefore, multiscale vascular networks must be the focus of tissue engineering vascularization efforts. In this work, a reflection is made on a possible path forward for researchers and engineers in the field to achieve the ultimate goal of efficient vascularization of engineered tissues and organs.
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Affiliation(s)
- Rogério Pedro Pirraco
- 3B's Research Group, I3Bs - Research Institute on Biomaterials, Biodegradables and Biomimetics, Headquarters of the European Institute of Excellence on Tissue Engineering and Regenerative Medicine, University of Minho, Guimarães, 4805-017, Portugal
- ICVS/3B's-PT Government Associate Laboratory, Braga/Guimarães, 4805-017, Portugal
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6
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Kawecki F. The potential of cell-assembled extracellular matrix for biological sutures: A promising innovation. Sci Prog 2023; 106:368504231219180. [PMID: 38189326 PMCID: PMC10775734 DOI: 10.1177/00368504231219180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2024]
Abstract
Most surgical procedures require using suture materials that are mechanically efficient and accepted by the patient's body. These sutures are essentially composed of synthetic polymers. However, once implanted in patients, they are recognized as foreign bodies and generate chronic inflammation. Thereafter, the patient's immune system will degrade, encapsulate, or even expel the materials. Our innovation, the Cell-Assembled extracellular Matrix (CAM), synthesized from mesenchymal cells, replicates native tissue environments and promotes integration, reducing complications. In a recent study, we introduced CAM-based biological sutures, demonstrating favorable mechanical properties and vascular surgery compatibility. Controlled culture duration tailors CAM for specific applications. Diverse CAM-based suture models were ex vivo tested in animal aorta anastomoses, confirming compatibility. In vivo carotid anastomoses in sheep validated the clinical significance of these innovative sutures. CAM sutures, derived from immunologically favorable allogeneic fibroblast cells, offer high biocompatibility and exhibit superior mechanical properties compared to synthetics by reducing permeability and increasing burst resistance. In vivo testing in sheep underscores clinical applicability, achieving hemostasis and immediate complication prevention. Importantly, CAM-based sutures are compatible with existing vascular surgery techniques, facilitating adoption by surgeons. In conclusion, our findings underscore the effectiveness and clinical significance of these innovative biological sutures.
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Affiliation(s)
- Fabien Kawecki
- University of Bordeaux, INSERM, BioTis, Bordeaux, France
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7
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Di Francesco D, Pigliafreddo A, Casarella S, Di Nunno L, Mantovani D, Boccafoschi F. Biological Materials for Tissue-Engineered Vascular Grafts: Overview of Recent Advancements. Biomolecules 2023; 13:1389. [PMID: 37759789 PMCID: PMC10526356 DOI: 10.3390/biom13091389] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Revised: 09/11/2023] [Accepted: 09/12/2023] [Indexed: 09/29/2023] Open
Abstract
The clinical demand for tissue-engineered vascular grafts is still rising, and there are many challenges that need to be overcome, in particular, to obtain functional small-diameter grafts. The many advances made in cell culture, biomaterials, manufacturing techniques, and tissue engineering methods have led to various promising solutions for vascular graft production, with available options able to recapitulate both biological and mechanical properties of native blood vessels. Due to the rising interest in materials with bioactive potentials, materials from natural sources have also recently gained more attention for vascular tissue engineering, and new strategies have been developed to solve the disadvantages related to their use. In this review, the progress made in tissue-engineered vascular graft production is discussed. We highlight, in particular, the use of natural materials as scaffolds for vascular tissue engineering.
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Affiliation(s)
- Dalila Di Francesco
- Department of Health Sciences, University of Piemonte Orientale “A. Avogadro”, 28100 Novara, Italy; (D.D.F.); (S.C.); (L.D.N.)
- Laboratory for Biomaterials and Bioengineering, CRC-I, Department of Min-Met-Materials Engineering, University Hospital Research Center, Regenerative Medicine, Laval University, Quebec City, QC G1V 0A6, Canada;
| | - Alexa Pigliafreddo
- Department of Health Sciences, University of Piemonte Orientale “A. Avogadro”, 28100 Novara, Italy; (D.D.F.); (S.C.); (L.D.N.)
| | - Simona Casarella
- Department of Health Sciences, University of Piemonte Orientale “A. Avogadro”, 28100 Novara, Italy; (D.D.F.); (S.C.); (L.D.N.)
| | - Luca Di Nunno
- Department of Health Sciences, University of Piemonte Orientale “A. Avogadro”, 28100 Novara, Italy; (D.D.F.); (S.C.); (L.D.N.)
| | - Diego Mantovani
- Laboratory for Biomaterials and Bioengineering, CRC-I, Department of Min-Met-Materials Engineering, University Hospital Research Center, Regenerative Medicine, Laval University, Quebec City, QC G1V 0A6, Canada;
| | - Francesca Boccafoschi
- Department of Health Sciences, University of Piemonte Orientale “A. Avogadro”, 28100 Novara, Italy; (D.D.F.); (S.C.); (L.D.N.)
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8
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Borchiellini P, Rames A, Roubertie F, L'Heureux N, Kawecki F. Development and characterization of biological sutures made of cell-assembled extracellular matrix. Biofabrication 2023; 15:045018. [PMID: 37595608 DOI: 10.1088/1758-5090/acf1cf] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Accepted: 08/18/2023] [Indexed: 08/20/2023]
Abstract
Most vascular surgical repair procedures, such as vessel anastomoses, requires using suture materials that are mechanically efficient and accepted by the patient's body. These materials are essentially composed of synthetic polymers, such as polypropylene (ProleneTM) or polyglactin (VicrylTM). However, once implanted in patients, they are recognized as foreign bodies, and the patient's immune system will degrade, encapsulate, or even expel them. In this study, we developed innovative biological sutures for cardiovascular surgical repairs using Cell-Assembled extracellular Matrix (CAM)-based ribbons. After a mechanical characterization of the CAM-based ribbons, sutures were made with hydrated or twisted/dried ribbons with an initial width of 2 or 3 mm. These biological sutures were mechanically characterized and used to anastomoseex vivoanimal aortas. Data showed that our biological sutures display lower permeability and higher burst resistance than standard ProleneTMsuture material.In vivocarotid anastomoses realized in sheep demonstrated that our biological sutures are compatible with standard vascular surgery techniques. Echography confirmed the absence of thrombus and perfect homeostasis with no blood leakage was obtained within the first 10 min after closing the anastomosis. Finally, our findings confirmed the effectiveness and clinical relevance of these innovative biological sutures.
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Affiliation(s)
| | - Adeline Rames
- Univ. Bordeaux, INSERM, BIOTIS, UMR1026, Bordeaux F-33000, France
| | - François Roubertie
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Pessac, France
- Congenital Heart Diseases Department, CHU de Bordeaux, Pessac, France
| | | | - Fabien Kawecki
- Univ. Bordeaux, INSERM, BIOTIS, UMR1026, Bordeaux F-33000, France
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9
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Fernández-Pérez J, van Kampen KA, Mota C, Baker M, Moroni L. Flexible, Suturable, and Leak-free Scaffolds for Vascular Tissue Engineering Using Melt Spinning. ACS Biomater Sci Eng 2023; 9:5006-5014. [PMID: 37490420 PMCID: PMC10428091 DOI: 10.1021/acsbiomaterials.3c00535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Accepted: 07/06/2023] [Indexed: 07/27/2023]
Abstract
Coronary artery disease affects millions worldwide. Bypass surgery remains the gold standard; however, autologous tissue is not always available. Hence, the need for an off-the-shelf graft to treat these patients remains extremely high. Using melt spinning, we describe here the fabrication of tubular scaffolds composed of microfibers aligned in the circumferential orientation mimicking the organized extracellular matrix in the tunica media of arteries. By variation of the translational extruder speed, the angle between fibers ranged from 0 to ∼30°. Scaffolds with the highest angle showed the best performance in a three-point bending test. These constructs could be bent up to 160% strain without kinking or breakage. Furthermore, when liquid was passed through the scaffolds, no leakage was observed. Suturing of native arteries was successful. Mesenchymal stromal cells were seeded on the scaffolds and differentiated into vascular smooth muscle-like cells (vSMCs) by reduction of serum and addition of transforming growth factor beta 1 and ascorbic acid. The scaffolds with a higher angle between fibers showed increased expression of vSMC markers alpha smooth muscle actin, calponin, and smooth muscle protein 22-alpha, whereas a decrease in collagen 1 expression was observed, indicating a positive contractile phenotype. Endothelial cells were seeded on the repopulated scaffolds and formed a tightly packed monolayer on the luminal side. Our study shows a one-step fabrication for ECM-mimicking scaffolds with good handleability, leak-free property, and suturability; the excellent biocompatibility allowed the growth of a bilayered construct. Future work will explore the possibility of using these scaffolds as vascular conduits in in vivo settings.
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Affiliation(s)
- Julia Fernández-Pérez
- Department of Complex Tissue
Regeneration, MERLN Institute for Technology-Inspired Regenerative
Medicine, Maastricht University, Universiteitssingel 40, 6229ER Maastricht, The Netherlands
| | - Kenny A. van Kampen
- Department of Complex Tissue
Regeneration, MERLN Institute for Technology-Inspired Regenerative
Medicine, Maastricht University, Universiteitssingel 40, 6229ER Maastricht, The Netherlands
| | - Carlos Mota
- Department of Complex Tissue
Regeneration, MERLN Institute for Technology-Inspired Regenerative
Medicine, Maastricht University, Universiteitssingel 40, 6229ER Maastricht, The Netherlands
| | - Matthew Baker
- Department of Complex Tissue
Regeneration, MERLN Institute for Technology-Inspired Regenerative
Medicine, Maastricht University, Universiteitssingel 40, 6229ER Maastricht, The Netherlands
| | - Lorenzo Moroni
- Department of Complex Tissue
Regeneration, MERLN Institute for Technology-Inspired Regenerative
Medicine, Maastricht University, Universiteitssingel 40, 6229ER Maastricht, The Netherlands
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10
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Potart D, Gluais M, Gaubert A, Da Silva N, Hourques M, Sarrazin M, Izotte J, Mora Charrot L, L'Heureux N. The cell-assembled extracellular matrix: A focus on the storage stability and terminal sterilization of this human "bio" material. Acta Biomater 2023; 166:133-146. [PMID: 37149079 PMCID: PMC7614989 DOI: 10.1016/j.actbio.2023.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 04/18/2023] [Accepted: 05/02/2023] [Indexed: 05/08/2023]
Abstract
The Cell-Assembled extracellular Matrix (CAM) is an attractive biomaterial because it provided the backbone of vascular grafts that were successfully implanted in patients, and because it can now be assembled in "human textiles". For future clinical development, it is important to consider key manufacturing questions. In this study, the impact of various storage conditions and sterilization methods were evaluated. After 1 year of dry frozen storage, no change in mechanical nor physicochemical properties were detected. However, storage at 4 °C and room temperature resulted in some mechanical changes, especially for dry CAM, but physicochemical changes were minor. Sterilization modified CAM mechanical and physicochemical properties marginally except for hydrated gamma treatment. All sterilized CAM supported cell proliferation. CAM ribbons were implanted subcutaneously in immunodeficient rats to assess the impact of sterilization on the innate immune response. Sterilization accelerated strength loss but no significant difference could be shown at 10 months. Very mild and transient inflammatory responses were observed. Supercritical CO2 sterilization had the least effect. In conclusion, the CAM is a promising biomaterial since it is unaffected by long-term storage in conditions available in hospitals (hydrated at 4 °C), and can be sterilized terminally (scCO2) without compromising in vitro nor in vivo performance. STATEMENT OF SIGNIFICANCE: In the field of tissue engineering, the use of extracellular matrix (ECM) proteins as a scaffolding biomaterial has become very popular. Recently, many investigators have focused on ECM produced by cells in vitro to produce unprocessed biological scaffolds. As this new kind of "biomaterial" becomes more and more relevant, it is critical to consider key manufacturing questions to facilitate future transition to the clinic. This article presents an extensive evaluation of long-term storage stability and terminal sterilization effects on an extracellular matrix assembled by cells in vitro. We believe that this article will be of great interest to help tissue engineers involved in so-called scaffold-free approaches to better prepare the translation from benchtop to bedside.
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Affiliation(s)
- Diane Potart
- BIOTIS - Laboratory for the Bioengineering of Tissues (UMR Inserm 1026), University of Bordeaux, Inserm, BIOTIS, UMR1026, Campus Carreire, 146 Rue Léo-Saignat, case 45, Bordeaux F-33076, France
| | - Maude Gluais
- BIOTIS - Laboratory for the Bioengineering of Tissues (UMR Inserm 1026), University of Bordeaux, Inserm, BIOTIS, UMR1026, Campus Carreire, 146 Rue Léo-Saignat, case 45, Bordeaux F-33076, France
| | - Alexandra Gaubert
- University of Bordeaux, CNRS, UMR 5320, Inserm, UMR121, ANRA, Bordeaux F-33076, France
| | - Nicolas Da Silva
- BIOTIS - Laboratory for the Bioengineering of Tissues (UMR Inserm 1026), University of Bordeaux, Inserm, BIOTIS, UMR1026, Campus Carreire, 146 Rue Léo-Saignat, case 45, Bordeaux F-33076, France
| | - Marie Hourques
- BIOTIS - Laboratory for the Bioengineering of Tissues (UMR Inserm 1026), University of Bordeaux, Inserm, BIOTIS, UMR1026, Campus Carreire, 146 Rue Léo-Saignat, case 45, Bordeaux F-33076, France
| | - Marie Sarrazin
- BIOTIS - Laboratory for the Bioengineering of Tissues (UMR Inserm 1026), University of Bordeaux, Inserm, BIOTIS, UMR1026, Campus Carreire, 146 Rue Léo-Saignat, case 45, Bordeaux F-33076, France
| | - Julien Izotte
- Animal Facility A2, University of Bordeaux, Bordeaux F-33076, France
| | - Léa Mora Charrot
- Animal Facility A2, University of Bordeaux, Bordeaux F-33076, France
| | - Nicolas L'Heureux
- BIOTIS - Laboratory for the Bioengineering of Tissues (UMR Inserm 1026), University of Bordeaux, Inserm, BIOTIS, UMR1026, Campus Carreire, 146 Rue Léo-Saignat, case 45, Bordeaux F-33076, France.
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11
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Kawecki F, L'Heureux N. Current biofabrication methods for vascular tissue engineering and an introduction to biological textiles. Biofabrication 2023; 15:022004. [PMID: 36848675 DOI: 10.1088/1758-5090/acbf7a] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 02/27/2023] [Indexed: 03/01/2023]
Abstract
Cardiovascular diseases are the leading cause of mortality in the world and encompass several important pathologies, including atherosclerosis. In the cases of severe vessel occlusion, surgical intervention using bypass grafts may be required. Synthetic vascular grafts provide poor patency for small-diameter applications (< 6 mm) but are widely used for hemodialysis access and, with success, larger vessel repairs. In very small vessels, such as coronary arteries, synthetics outcomes are unacceptable, leading to the exclusive use of autologous (native) vessels despite their limited availability and, sometimes, quality. Consequently, there is a clear clinical need for a small-diameter vascular graft that can provide outcomes similar to native vessels. Many tissue-engineering approaches have been developed to offer native-like tissues with the appropriate mechanical and biological properties in order to overcome the limitations of synthetic and autologous grafts. This review overviews current scaffold-based and scaffold-free approaches developed to biofabricate tissue-engineered vascular grafts (TEVGs) with an introduction to the biological textile approaches. Indeed, these assembly methods show a reduced production time compared to processes that require long bioreactor-based maturation steps. Another advantage of the textile-inspired approaches is that they can provide better directional and regional control of the TEVG mechanical properties.
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Affiliation(s)
- Fabien Kawecki
- Univ. Bordeaux, INSERM, BIOTIS, UMR1026, Bordeaux, F-33000, France
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12
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McInnes AD, Moser MAJ, Chen X. Preparation and Use of Decellularized Extracellular Matrix for Tissue Engineering. J Funct Biomater 2022; 13:jfb13040240. [PMID: 36412881 PMCID: PMC9680265 DOI: 10.3390/jfb13040240] [Citation(s) in RCA: 33] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 10/22/2022] [Accepted: 11/05/2022] [Indexed: 11/16/2022] Open
Abstract
The multidisciplinary fields of tissue engineering and regenerative medicine have the potential to revolutionize the practise of medicine through the abilities to repair, regenerate, or replace tissues and organs with functional engineered constructs. To this end, tissue engineering combines scaffolding materials with cells and biologically active molecules into constructs with the appropriate structures and properties for tissue/organ regeneration, where scaffolding materials and biomolecules are the keys to mimic the native extracellular matrix (ECM). For this, one emerging way is to decellularize the native ECM into the materials suitable for, directly or in combination with other materials, creating functional constructs. Over the past decade, decellularized ECM (or dECM) has greatly facilitated the advance of tissue engineering and regenerative medicine, while being challenged in many ways. This article reviews the recent development of dECM for tissue engineering and regenerative medicine, with a focus on the preparation of dECM along with its influence on cell culture, the modification of dECM for use as a scaffolding material, and the novel techniques and emerging trends in processing dECM into functional constructs. We highlight the success of dECM and constructs in the in vitro, in vivo, and clinical applications and further identify the key issues and challenges involved, along with a discussion of future research directions.
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Affiliation(s)
- Adam D. McInnes
- Division of Biomedical Engineering, College of Engineering, University of Saskatchewan, Saskatoon, SK S7N 5A9, Canada
- Correspondence: ; Tel.: +1-306-966-5435
| | - Michael A. J. Moser
- Department of Surgery, Health Sciences Building, University of Saskatchewan, Saskatoon, SK S7N 0W8, Canada
| | - Xiongbiao Chen
- Division of Biomedical Engineering, College of Engineering, University of Saskatchewan, Saskatoon, SK S7N 5A9, Canada
- Department of Mechanical Engineering, College of Engineering, University of Saskatchewan, Saskatoon, SK S7N 5A9, Canada
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13
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Grémare A, Thibes L, Gluais M, Torres Y, Potart D, Da Silva N, Dusserre N, Fénelon M, Senthilhes L, Lacomme S, Svahn I, Gontier É, Fricain JC, L'Heureux N. Development of a vascular substitute produced by weaving yarn made from human amniotic membrane. Biofabrication 2022; 14. [PMID: 35896106 DOI: 10.1088/1758-5090/ac84ae] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 07/27/2022] [Indexed: 11/12/2022]
Abstract
Because synthetic vascular prostheses perform poorly in small-diameter revascularization, biological vascular substitutes are being developed as an alternative. Although their in vivo results are promising, their production involves long, complex, and expensive tissue engineering methods. To overcome these limitations, we propose an innovative approach that combines the human amniotic membrane (HAM), which is a widely available and cost-effective biological raw material, with a rapid and robust textile-inspired assembly strategy. Fetal membranes were collected after cesarean deliveries at term. Once isolated by dissection, HAM sheets were cut into ribbons that could be further processed by twisting into threads. Characterization of the HAM yarns (both ribbons and threads) showed that their physical and mechanical properties could be easily tuned. Since our clinical strategy will be to provide an off-the-shelf allogeneic implant, we studied the effects of decellularization and/or gamma sterilization on the histological, mechanical, and biological properties of HAM ribbons. Gamma irradiation of hydrated HAMs, with or without decellularization, did not interfere with the ability of the matrix to support endothelium formation in vitro. Finally, our HAM-based, woven tissue-engineered vascular grafts (TEVGs) exhibited clinically relevant mechanical properties. Thus, this study demonstrates that human, completely biological, allogeneic, small-diameter TEVGs can be produced from HAM, thereby avoiding costly cell culture and bioreactors.
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Affiliation(s)
- Agathe Grémare
- Heath Sciences and Technologies, University of Bordeaux, Campus Carreire, 146, Rue Léo Saignat, Bâtiment 4A, 2ième étage, Case 84, Bordeaux, Aquitaine, 33076, FRANCE
| | - Lisa Thibes
- Heath Sciences and Technologies, University of Bordeaux, Campus Carreire, 146, Rue Léo Saignat, Bâtiment 4A, 2ième étage, Case 84, Bordeaux, Aquitaine, 33076, FRANCE
| | - Maude Gluais
- Heath Sciences and Technologies, University of Bordeaux, Campus Carreire, 146, Rue Léo Saignat, Bâtiment 4A, 2ième étage, Case 84, Bordeaux, Aquitaine, 33076, FRANCE
| | - Yoann Torres
- Heath Sciences and Technologies, University of Bordeaux, Campus Carreire, 146, Rue Léo Saignat, Bâtiment 4A, 2ième étage, Case 84, Bordeaux, Aquitaine, 33076, FRANCE
| | - Diane Potart
- Heath Sciences and Technologies, University of Bordeaux, Campus Carreire, 146, Rue Léo Saignat, Bâtiment 4A, 2ième étage, Case 84, Bordeaux, Aquitaine, 33076, FRANCE
| | - Nicolas Da Silva
- Heath Sciences and Technologies, University of Bordeaux, Campus Carreire, 146, Rue Léo Saignat, Bâtiment 4A, 2ième étage, Case 84, Bordeaux, Aquitaine, 33076, FRANCE
| | - Nathalie Dusserre
- Heath Sciences and Technologies, University of Bordeaux, Campus Carreire, 146, Rue Léo Saignat, Bâtiment 4A, 2ième étage, Case 84, Bordeaux, Aquitaine, 33076, FRANCE
| | - Mathilde Fénelon
- Heath Sciences and Technologies, University of Bordeaux, Campus Carreire, 146, Rue Léo Saignat, Bâtiment 4A, 2ième étage, Case 84, Bordeaux, Aquitaine, 33076, FRANCE
| | - Loïc Senthilhes
- Obstetrics and Gynecology, CHU de Bordeaux, Hopital Pellegrin, 146, Rue Léo Saignat, Bordeaux, Aquitaine, 33076, FRANCE
| | - Sabrina Lacomme
- University of Bordeaux, 146, Rue Léo Saignat, Bordeaux, Aquitaine, 33000, FRANCE
| | - Isabelle Svahn
- University of Bordeaux, 146, Rue Léo Saignat, Bordeaux, Aquitaine, 33000, FRANCE
| | - Étienne Gontier
- University of Bordeaux, 146, Rue Léo Saignat, Bordeaux, Aquitaine, 33000, FRANCE
| | - Jean-Christophe Fricain
- Heath Sciences and Technologies, University of Bordeaux, Campus Carreire, 146, Rue Léo Saignat, Bâtiment 4A, 2ième étage, Case 84, Bordeaux, Aquitaine, 33076, FRANCE
| | - Nicolas L'Heureux
- Heath Sciences and Technologies, University of Bordeaux, Campus Carreire, 146, Rue Léo Saignat, Bâtiment 4A, 2ième étage, Case 84, Bordeaux, Aquitaine, 33076, FRANCE
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14
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Kawecki F, Gluais M, Claverol S, Dusserre N, McAllister T, L'Heureux N. Inter-donor variability of extracellular matrix production in long-term cultures of human fibroblasts. Biomater Sci 2022; 10:3935-3950. [PMID: 35700514 PMCID: PMC9275472 DOI: 10.1039/d1bm01933c] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Several tissue engineering approaches are based on the ability of mesenchymal cells to endogenously synthesize an extracellular matrix (ECM) in vitro, which can be seen as a form of biomaterial. Accordingly, the inter-donor variability of cell-assembled extracellular matrix (CAM) production is a key parameter to understand in order to progress towards clinical applications, especially for autologous strategies. In this study, CAMs were produced, under good manufacturing process conditions, from skin fibroblasts of 21 patients as part of a clinical trial to evaluate a tissue-engineered vascular graft. The inter-donor variability of CAM strength, thickness, hydroxyproline, and glycosaminoglycan was substantial (coefficient of variability of 33%, 19%, 24%, and 19%, respectively), but a significant correlation was observed between all four properties (Pearson r: 0.43 to 0.70; p-value ≤ 0.05). A CAM matrisome analysis, performed by mass spectrometry, revealed the presence of 70 ECM-related proteins. Our study shows that the relative abundance of 16 proteins (15 non-collagenous) correlated with CAM thickness. These proteins also correlated with CAM hydroxyproline content, as well as 21 other proteins that included fibrillar collagens and non-collagenous proteins. However, data demonstrated that only the relative abundance of type I collagen subunit alpha-1 was correlated to CAM strength. This study is the most extensive evaluation of CAM inter-donor variability to date and will help tissue engineers working with this type of biomaterial to design strategies that take into account this variability, especially for autologous tissue manufacturing. Several tissue engineering approaches are based on the ability of mesenchymal cells to endogenously synthesize an extracellular matrix (ECM) in vitro, which can be seen as a form of biomaterial.![]()
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Affiliation(s)
- Fabien Kawecki
- Univ. Bordeaux, Inserm, BioTis, UMR1026, F-33000 Bordeaux, France.
| | - Maude Gluais
- Univ. Bordeaux, Inserm, BioTis, UMR1026, F-33000 Bordeaux, France.
| | - Stéphane Claverol
- Centre de Génomique Fonctionnelle, Plateforme Protéome, University of Bordeaux, F-33000, Bordeaux, France
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15
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Zhang F, King MW. Immunomodulation Strategies for the Successful Regeneration of a Tissue-Engineered Vascular Graft. Adv Healthc Mater 2022; 11:e2200045. [PMID: 35286778 DOI: 10.1002/adhm.202200045] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Revised: 02/18/2022] [Indexed: 01/02/2023]
Abstract
Cardiovascular disease leads to the highest morbidity worldwide. There is an urgent need to solve the lack of a viable arterial graft for patients requiring coronary artery bypass surgery. The current gold standard is to use the patient's own blood vessel, such as a saphenous vein graft. However, some patients do not have appropriate vessels to use because of systemic disease or secondary surgery. On the other hand, there is no commercially available synthetic vascular graft available on the market for small diameter (<6 mm) blood vessels like coronary, carotid, and peripheral popliteal arteries. Tissue-engineered vascular grafts (TEVGs) are studied in recent decades as a promising alternative to synthetic arterial prostheses. Yet only a few studies have proceeded to a clinical trial. Recent studies have uncovered that the host immune response can be directed toward increasing the success of a TEVG by shedding light on ways to modulate the macrophage response and improve the tissue regeneration outcome. In this review, the basic concepts of vascular tissue engineering and immunoengineering are considered. The state-of-art of TEVGs is summarized and the role of macrophages in TEVG regeneration is analyzed. Current immunomodulatory strategies based on biomaterials are also discussed.
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Affiliation(s)
- Fan Zhang
- Wilson College of Textiles North Carolina State University Raleigh NC 27606 USA
| | - Martin W. King
- Wilson College of Textiles North Carolina State University Raleigh NC 27606 USA
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16
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Lau S, Gossen M, Lendlein A. Designing Cardiovascular Implants Taking in View the Endothelial Basement Membrane. Int J Mol Sci 2021; 22:ijms222313120. [PMID: 34884923 PMCID: PMC8658568 DOI: 10.3390/ijms222313120] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 11/25/2021] [Accepted: 11/29/2021] [Indexed: 12/28/2022] Open
Abstract
Insufficient endothelialization of cardiovascular grafts is a major hurdle in vascular surgery and regenerative medicine, bearing a risk for early graft thrombosis. Neither of the numerous strategies pursued to solve these problems were conclusive. Endothelialization is regulated by the endothelial basement membrane (EBM), a highly specialized part of the vascular extracellular matrix. Thus, a detailed understanding of the structure–function interrelations of the EBM components is fundamental for designing biomimetic materials aiming to mimic EBM functions. In this review, a detailed description of the structure and functions of the EBM are provided, including the luminal and abluminal interactions with adjacent cell types, such as vascular smooth muscle cells. Moreover, in vivo as well as in vitro strategies to build or renew EBM are summarized and critically discussed. The spectrum of methods includes vessel decellularization and implant biofunctionalization strategies as well as tissue engineering-based approaches and bioprinting. Finally, the limitations of these methods are highlighted, and future directions are suggested to help improve future design strategies for EBM-inspired materials in the cardiovascular field.
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Affiliation(s)
- Skadi Lau
- Institute of Active Polymers and Berlin-Brandenburg Center for Regenerative Therapies, Helmholtz-Zentrum Hereon, Kantstraße 55, 14513 Teltow, Germany; (S.L.); (M.G.)
| | - Manfred Gossen
- Institute of Active Polymers and Berlin-Brandenburg Center for Regenerative Therapies, Helmholtz-Zentrum Hereon, Kantstraße 55, 14513 Teltow, Germany; (S.L.); (M.G.)
| | - Andreas Lendlein
- Institute of Active Polymers and Berlin-Brandenburg Center for Regenerative Therapies, Helmholtz-Zentrum Hereon, Kantstraße 55, 14513 Teltow, Germany; (S.L.); (M.G.)
- Institute of Chemistry, University of Potsdam, Karl-Liebknecht-Straße 25, 14476 Potsdam, Germany
- Correspondence:
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17
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Oliveira H, Médina C, Labrunie G, Dusserre N, Catros S, Magnan L, Handschin C, Stachowicz ML, Fricain JC, L'Heureux N. Cell-assembled extracellular matrix (CAM): a human biopaper for the biofabrication of pre-vascularized tissues able to connect to the host circulation in vivo. Biofabrication 2021; 14. [PMID: 34695012 DOI: 10.1088/1758-5090/ac2f81] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Accepted: 10/13/2021] [Indexed: 01/18/2023]
Abstract
When considering regenerative approaches, the efficient creation of a functional vasculature, that can support the metabolic needs of bioengineered tissues, is essential for their survival after implantation. However, it is widely recognized that the post-implantation microenvironment of the engineered tissues is often hypoxic due to insufficient vascularization, resulting in ischemia injury and necrosis. This is one of the main limitations of current tissue engineering applications aiming at replacing significant tissue volumes. Here, we have explored the use of a new biomaterial, the cell-assembled extracellular matrix (CAM), as a biopaper to biofabricate a vascular system. CAM sheets are a unique, fully biological and fully human material that has already shown stable long-term implantation in humans. We demonstrated, for the first time, the use of this unprocessed human ECM as a microperforated biopaper. Using microvalve dispensing bioprinting, concentrated human endothelial cells (30 millions ml-1) were deposited in a controlled geometry in CAM sheets and cocultured with HSFs. Following multilayer assembly, thick ECM-based constructs fused and supported the survival and maturation of capillary-like structures for up to 26 d of culture. Following 3 weeks of subcutaneous implantation in a mice model, constructs showed limited degradative response and the pre-formed vasculature successfully connected with the host circulatory system to establish active perfusion.This mechanically resilient tissue equivalent has great potential for the creation of more complex implantable tissues, where rapid anastomosis is sine qua non for cell survival and efficient tissue integration.
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Affiliation(s)
- H Oliveira
- University of Bordeaux, Laboratory for the Bioengineering of Tissues (BIOTIS), UMR1026 INSERM, F-33076 Bordeaux, France.,University of Bordeaux, Laboratory for the Bioengineering of Tissues (BIOTIS), UMR1026 INSERM, ART BioPrint, F-33076 Bordeaux, France
| | - C Médina
- University of Bordeaux, Laboratory for the Bioengineering of Tissues (BIOTIS), UMR1026 INSERM, F-33076 Bordeaux, France.,University of Bordeaux, Laboratory for the Bioengineering of Tissues (BIOTIS), UMR1026 INSERM, ART BioPrint, F-33076 Bordeaux, France
| | - G Labrunie
- University of Bordeaux, Laboratory for the Bioengineering of Tissues (BIOTIS), UMR1026 INSERM, F-33076 Bordeaux, France
| | - N Dusserre
- University of Bordeaux, Laboratory for the Bioengineering of Tissues (BIOTIS), UMR1026 INSERM, F-33076 Bordeaux, France.,University of Bordeaux, Laboratory for the Bioengineering of Tissues (BIOTIS), UMR1026 INSERM, ART BioPrint, F-33076 Bordeaux, France
| | - S Catros
- University of Bordeaux, Laboratory for the Bioengineering of Tissues (BIOTIS), UMR1026 INSERM, F-33076 Bordeaux, France.,University of Bordeaux, Laboratory for the Bioengineering of Tissues (BIOTIS), UMR1026 INSERM, ART BioPrint, F-33076 Bordeaux, France.,CHU Bordeaux, Services d'Odontologie et de Santé Buccale, F-33076 Bordeaux, France
| | - L Magnan
- University of Bordeaux, Laboratory for the Bioengineering of Tissues (BIOTIS), UMR1026 INSERM, F-33076 Bordeaux, France
| | - C Handschin
- University of Bordeaux, Laboratory for the Bioengineering of Tissues (BIOTIS), UMR1026 INSERM, F-33076 Bordeaux, France.,University of Bordeaux, Laboratory for the Bioengineering of Tissues (BIOTIS), UMR1026 INSERM, ART BioPrint, F-33076 Bordeaux, France
| | - M L Stachowicz
- University of Bordeaux, Laboratory for the Bioengineering of Tissues (BIOTIS), UMR1026 INSERM, F-33076 Bordeaux, France.,University of Bordeaux, Laboratory for the Bioengineering of Tissues (BIOTIS), UMR1026 INSERM, ART BioPrint, F-33076 Bordeaux, France
| | - J-C Fricain
- University of Bordeaux, Laboratory for the Bioengineering of Tissues (BIOTIS), UMR1026 INSERM, F-33076 Bordeaux, France.,University of Bordeaux, Laboratory for the Bioengineering of Tissues (BIOTIS), UMR1026 INSERM, ART BioPrint, F-33076 Bordeaux, France.,CHU Bordeaux, Services d'Odontologie et de Santé Buccale, F-33076 Bordeaux, France
| | - N L'Heureux
- University of Bordeaux, Laboratory for the Bioengineering of Tissues (BIOTIS), UMR1026 INSERM, F-33076 Bordeaux, France
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18
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Fayon A, Menu P, El Omar R. Cellularized small-caliber tissue-engineered vascular grafts: looking for the ultimate gold standard. NPJ Regen Med 2021; 6:46. [PMID: 34385472 PMCID: PMC8361171 DOI: 10.1038/s41536-021-00155-x] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Accepted: 07/23/2021] [Indexed: 02/07/2023] Open
Abstract
Due to the lack of efficacy of synthetic vascular substitutes in the replacement of small-caliber arteries, vascular tissue engineering (VTE) has emerged as a promising solution to produce viable small-caliber tissue-engineered vascular grafts (TEVG). Previous studies have shown the importance of a cellular intimal layer at the luminal surface of TEVG to prevent thrombotic events. However, the cellularization of a TEVG seems to be a critical approach to consider in the development of a TEVG. To date, no standard cellularization method or cell type has been established to create the ideal TEVG by promoting its long-term patency and function. In this review, advances in VTE are described and discussed with a particular focus on the construction approaches of cellularized small-caliber TEVGs, the cell types used, as well as their preclinical and clinical applications.
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Affiliation(s)
- Adrien Fayon
- Université de Lorraine, CNRS, IMoPA, F-54000 Nancy, France
| | - Patrick Menu
- Université de Lorraine, CNRS, IMoPA, F-54000 Nancy, France.
- Université de Lorraine, Faculté de Pharmacie, Nancy, F-54000, France.
| | - Reine El Omar
- Université de Lorraine, CNRS, IMoPA, F-54000 Nancy, France
- Université de Lorraine, Faculté de Pharmacie, Nancy, F-54000, France
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19
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Frazão LP, Fernandes AM, Oliveira C, Martins A, Silva TH, Vieira de Castro J, Nogueira-Silva C, Neves NM. New Vascular Graft Using the Decellularized Human Chorion Membrane. ACS Biomater Sci Eng 2021; 7:3423-3433. [PMID: 34097827 DOI: 10.1021/acsbiomaterials.1c00293] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The increase of both arterial occlusive diseases and coronary heart diseases leads to a higher demand for small-diameter vascular grafts (<6 mm). The gold standard for small-diameter vessel replacement is the use of autologous veins. Nevertheless, up to 30% of these patients need to use vascular grafts. Although synthetic polymers have been successfully used for the replacement of large-diameter vascular grafts (>6 mm), they are associated with thrombosis, intimal hyperplasia, calcification, and chronic inflammation when used as small-diameter vascular grafts. Therefore, natural materials have been studied for this application. In this study, a decellularized human chorion membrane (dHCM) vascular graft with a 3-4 mm diameter was created. Herein, the biocompatibility of dHCM with endothelial cells was demonstrated in vitro and ex ovo. Blood biocompatibility of dHCM was also shown by studying plasma protein adsorption, platelet adhesion and activation, and its hemolytic potential. Furthermore, dHCM antibacterial properties against Staphylococcus aureus were also studied. In summary, the dHCM reticular layer side presented all the needed characteristics to be used in the inner side of a vascular graft. Additionally, the mechanical properties of the dHCM tubular construct were studied, being similar to the ones of the saphenous vein, the gold standard for autologous small-diameter vessel replacement.
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Affiliation(s)
- Laura P Frazão
- I3B's-Research Institute on Biomaterials, Biodegradables and Biomimetics of University of Minho: 3Bs Research Group, 4805-017 Guimarães, Portugal.,ICVS/3B's-PT Government Associate Laboratory, Braga/Guimarães, Portugal
| | - Ana M Fernandes
- I3B's-Research Institute on Biomaterials, Biodegradables and Biomimetics of University of Minho: 3Bs Research Group, 4805-017 Guimarães, Portugal.,ICVS/3B's-PT Government Associate Laboratory, Braga/Guimarães, Portugal
| | - Catarina Oliveira
- I3B's-Research Institute on Biomaterials, Biodegradables and Biomimetics of University of Minho: 3Bs Research Group, 4805-017 Guimarães, Portugal.,ICVS/3B's-PT Government Associate Laboratory, Braga/Guimarães, Portugal
| | - Albino Martins
- I3B's-Research Institute on Biomaterials, Biodegradables and Biomimetics of University of Minho: 3Bs Research Group, 4805-017 Guimarães, Portugal.,ICVS/3B's-PT Government Associate Laboratory, Braga/Guimarães, Portugal
| | - Tiago H Silva
- I3B's-Research Institute on Biomaterials, Biodegradables and Biomimetics of University of Minho: 3Bs Research Group, 4805-017 Guimarães, Portugal.,ICVS/3B's-PT Government Associate Laboratory, Braga/Guimarães, Portugal
| | - Joana Vieira de Castro
- I3B's-Research Institute on Biomaterials, Biodegradables and Biomimetics of University of Minho: 3Bs Research Group, 4805-017 Guimarães, Portugal.,ICVS/3B's-PT Government Associate Laboratory, Braga/Guimarães, Portugal
| | - Cristina Nogueira-Silva
- ICVS/3B's-PT Government Associate Laboratory, Braga/Guimarães, Portugal.,Life and Health Sciences Research Institute, School of Medicine, University of Minho, 4710-057 Braga, Portugal.,Department of Obstetrics and Gynecology, Hospital de Braga, 4710-243 Braga, Portugal
| | - Nuno M Neves
- I3B's-Research Institute on Biomaterials, Biodegradables and Biomimetics of University of Minho: 3Bs Research Group, 4805-017 Guimarães, Portugal.,ICVS/3B's-PT Government Associate Laboratory, Braga/Guimarães, Portugal
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20
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Lepedda AJ, Nieddu G, Formato M, Baker MB, Fernández-Pérez J, Moroni L. Glycosaminoglycans: From Vascular Physiology to Tissue Engineering Applications. Front Chem 2021; 9:680836. [PMID: 34084767 PMCID: PMC8167061 DOI: 10.3389/fchem.2021.680836] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 05/03/2021] [Indexed: 12/27/2022] Open
Abstract
Cardiovascular diseases represent the number one cause of death globally, with atherosclerosis a major contributor. Despite the clinical need for functional arterial substitutes, success has been limited to arterial replacements of large-caliber vessels (diameter > 6 mm), leaving the bulk of demand unmet. In this respect, one of the most challenging goals in tissue engineering is to design a "bioactive" resorbable scaffold, analogous to the natural extracellular matrix (ECM), able to guide the process of vascular tissue regeneration. Besides adequate mechanical properties to sustain the hemodynamic flow forces, scaffold's properties should include biocompatibility, controlled biodegradability with non-toxic products, low inflammatory/thrombotic potential, porosity, and a specific combination of molecular signals allowing vascular cells to attach, proliferate and synthesize their own ECM. Different fabrication methods, such as phase separation, self-assembly and electrospinning are currently used to obtain nanofibrous scaffolds with a well-organized architecture and mechanical properties suitable for vascular tissue regeneration. However, several studies have shown that naked scaffolds, although fabricated with biocompatible polymers, represent a poor substrate to be populated by vascular cells. In this respect, surface functionalization with bioactive natural molecules, such as collagen, elastin, fibrinogen, silk fibroin, alginate, chitosan, dextran, glycosaminoglycans (GAGs), and growth factors has proven to be effective. GAGs are complex anionic unbranched heteropolysaccharides that represent major structural and functional ECM components of connective tissues. GAGs are very heterogeneous in terms of type of repeating disaccharide unit, relative molecular mass, charge density, degree and pattern of sulfation, degree of epimerization and physicochemical properties. These molecules participate in a number of vascular events such as the regulation of vascular permeability, lipid metabolism, hemostasis, and thrombosis, but also interact with vascular cells, growth factors, and cytokines to modulate cell adhesion, migration, and proliferation. The primary goal of this review is to perform a critical analysis of the last twenty-years of literature in which GAGs have been used as molecular cues, able to guide the processes leading to correct endothelialization and neo-artery formation, as well as to provide readers with an overall picture of their potential as functional molecules for small-diameter vascular regeneration.
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Affiliation(s)
| | - Gabriele Nieddu
- Department of Biomedical Sciences, University of Sassari, Sassari, Italy
| | - Marilena Formato
- Department of Biomedical Sciences, University of Sassari, Sassari, Italy
| | - Matthew Brandon Baker
- Complex Tissue Regeneration Department, MERLN Institute for Technology Inspired Regenerative Medicine, Maastricht, Netherlands
| | - Julia Fernández-Pérez
- Complex Tissue Regeneration Department, MERLN Institute for Technology Inspired Regenerative Medicine, Maastricht, Netherlands
| | - Lorenzo Moroni
- Complex Tissue Regeneration Department, MERLN Institute for Technology Inspired Regenerative Medicine, Maastricht, Netherlands
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21
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Magnan L, Kawecki F, Labrunie G, Gluais M, Izotte J, Marais S, Foulc MP, Lafourcade M, L'Heureux N. In vivo remodeling of human cell-assembled extracellular matrix yarns. Biomaterials 2021; 273:120815. [PMID: 33894404 DOI: 10.1016/j.biomaterials.2021.120815] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 04/03/2021] [Accepted: 04/06/2021] [Indexed: 12/22/2022]
Abstract
Cell-assembled extracellular matrix (CAM) has been used to produce vascular grafts. While these completely biological vascular grafts performed well in clinical trials, the in vivo remodeling and inflammatory response of this truly "bio" material has not yet been investigated. In this study, human CAM yarns were implanted subcutaneously in nude rats to investigate the innate immune response to this matrix. The impact of processing steps relevant to yarn manufacturing was evaluated (devitalization, decellularization, gamma sterilization, and twisting). We observed that yarns were still present after six months, and were integrated into a non-inflamed loose connective tissue. The CAM was repopulated by fibroblastic cells and blood vessels. While other yarns caused minor peripheral inflammation at an early stage (two weeks of implantation), gamma sterilization triggered a more intense host response dominated by the presence of M1 macrophages. The inflammatory response was resolved at six months. Yarn mechanical strength was decreased two weeks after implantation except for the more compact "twisted" yarn. While the strength of other yarns was stable after initial remodeling, the gamma-sterilized yarn continued to lose mechanical strength over time and was weaker than devitalized (control) yarns at six months. This is the first study to formally demonstrate that devitalized human CAM is very long-lived in vivo and does not trigger a degradative response, but rather is very slowly remodeled. This data supports a strategy to produce human textiles from CAM yarn for regenerative medicine applications where a scaffold with low inflammation and long-term mechanical properties are critical.
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Affiliation(s)
- Laure Magnan
- Univ. Bordeaux, INSERM, BIOTIS, UMR1026, F-33000, Bordeaux, France
| | - Fabien Kawecki
- Univ. Bordeaux, INSERM, BIOTIS, UMR1026, F-33000, Bordeaux, France
| | - Gaëlle Labrunie
- Univ. Bordeaux, INSERM, BIOTIS, UMR1026, F-33000, Bordeaux, France
| | - Maude Gluais
- Univ. Bordeaux, INSERM, BIOTIS, UMR1026, F-33000, Bordeaux, France
| | - Julien Izotte
- Animal Facility A2, University of Bordeaux, F-33076, Bordeaux, France
| | - Sébastien Marais
- UMS 3420 CNRS, US4 INSERM, Bordeaux Imaging Center, University of Bordeaux, F-33000, Bordeaux, France
| | - Marie-Pierre Foulc
- Rescoll Société de Recherche, 8 Allée Geoffroy Saint-Hilaire, CS 30021, F-33615, Pessac, France
| | - Mickaël Lafourcade
- Rescoll Société de Recherche, 8 Allée Geoffroy Saint-Hilaire, CS 30021, F-33615, Pessac, France
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22
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Dorogin J, Townsend JM, Hettiaratchi MH. Biomaterials for protein delivery for complex tissue healing responses. Biomater Sci 2021; 9:2339-2361. [PMID: 33432960 DOI: 10.1039/d0bm01804j] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Tissue repair requires a complex cascade of events mediated by a variety of cells, proteins, and matrix molecules; however, the healing cascade can be easily disrupted by numerous factors, resulting in impaired tissue regeneration. Recent advances in biomaterials for tissue regeneration have increased the ability to tailor the delivery of proteins and other biomolecules to injury sites to restore normal healing cascades and stimulate robust tissue repair. In this review, we discuss the evolution of the field toward creating biomaterials that precisely control protein delivery to stimulate tissue regeneration, with a focus on addressing complex and dynamic injury environments. We highlight biomaterials that leverage different mechanisms to deliver and present proteins involved in healing cascades, tissue targeting and mimicking strategies, materials that can be triggered by environmental cues, and integrated strategies that combine multiple biomaterial properties to improve protein delivery. Improvements in biomaterial design to address complex injury environments will expand our understanding of both normal and aberrant tissue repair processes and ultimately provide a better standard of patient care.
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Affiliation(s)
- Jonathan Dorogin
- Knight Campus for Accelerating Scientific Impact, University of Oregon, 6321 University of Oregon, Eugene, OR 97401, USA.
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23
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Abstract
Tissue engineering is one of the most promising scientific breakthroughs of the late 20th century. Its objective is to produce in vitro tissues or organs to repair and replace damaged ones using various techniques, biomaterials, and cells. Tissue engineering emerged to substitute the use of native autologous tissues, whose quantities are sometimes insufficient to correct the most severe pathologies. Indeed, the patient’s health status, regulations, or fibrotic scars at the site of the initial biopsy limit their availability, especially to treat recurrence. This new technology relies on the use of biomaterials to create scaffolds on which the patient’s cells can be seeded. This review focuses on the reconstruction, by tissue engineering, of two types of tissue with tubular structures: vascular and urological grafts. The emphasis is on self-assembly methods which allow the production of tissue/organ substitute without the use of exogenous material, with the patient’s cells producing their own scaffold. These continuously improved techniques, which allow rapid graft integration without immune rejection in the treatment of severely burned patients, give hope that similar results will be observed in the vascular and urological fields.
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24
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Moysidou CM, Barberio C, Owens RM. Advances in Engineering Human Tissue Models. Front Bioeng Biotechnol 2021; 8:620962. [PMID: 33585419 PMCID: PMC7877542 DOI: 10.3389/fbioe.2020.620962] [Citation(s) in RCA: 49] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2020] [Accepted: 12/22/2020] [Indexed: 12/11/2022] Open
Abstract
Research in cell biology greatly relies on cell-based in vitro assays and models that facilitate the investigation and understanding of specific biological events and processes under different conditions. The quality of such experimental models and particularly the level at which they represent cell behavior in the native tissue, is of critical importance for our understanding of cell interactions within tissues and organs. Conventionally, in vitro models are based on experimental manipulation of mammalian cells, grown as monolayers on flat, two-dimensional (2D) substrates. Despite the amazing progress and discoveries achieved with flat biology models, our ability to translate biological insights has been limited, since the 2D environment does not reflect the physiological behavior of cells in real tissues. Advances in 3D cell biology and engineering have led to the development of a new generation of cell culture formats that can better recapitulate the in vivo microenvironment, allowing us to examine cells and their interactions in a more biomimetic context. Modern biomedical research has at its disposal novel technological approaches that promote development of more sophisticated and robust tissue engineering in vitro models, including scaffold- or hydrogel-based formats, organotypic cultures, and organs-on-chips. Even though such systems are necessarily simplified to capture a particular range of physiology, their ability to model specific processes of human biology is greatly valued for their potential to close the gap between conventional animal studies and human (patho-) physiology. Here, we review recent advances in 3D biomimetic cultures, focusing on the technological bricks available to develop more physiologically relevant in vitro models of human tissues. By highlighting applications and examples of several physiological and disease models, we identify the limitations and challenges which the field needs to address in order to more effectively incorporate synthetic biomimetic culture platforms into biomedical research.
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Affiliation(s)
| | | | - Róisín Meabh Owens
- Department of Chemical Engineering and Biotechnology, University of Cambridge, Cambridge, United Kingdom
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25
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Leal BBJ, Wakabayashi N, Oyama K, Kamiya H, Braghirolli DI, Pranke P. Vascular Tissue Engineering: Polymers and Methodologies for Small Caliber Vascular Grafts. Front Cardiovasc Med 2021; 7:592361. [PMID: 33585576 PMCID: PMC7873993 DOI: 10.3389/fcvm.2020.592361] [Citation(s) in RCA: 81] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Accepted: 12/09/2020] [Indexed: 12/24/2022] Open
Abstract
Cardiovascular disease is the most common cause of death in the world. In severe cases, replacement or revascularization using vascular grafts are the treatment options. While several synthetic vascular grafts are clinically used with common approval for medium to large-caliber vessels, autologous vascular grafts are the only options clinically approved for small-caliber revascularizations. Autologous grafts have, however, some limitations in quantity and quality, and cause an invasiveness to patients when harvested. Therefore, the development of small-caliber synthetic vascular grafts (<5 mm) has been urged. Since small-caliber synthetic grafts made from the same materials as middle and large-caliber grafts have poor patency rates due to thrombus formation and intimal hyperplasia within the graft, newly innovative methodologies with vascular tissue engineering such as electrospinning, decellularization, lyophilization, and 3D printing, and novel polymers have been developed. This review article represents topics on the methodologies used in the development of scaffold-based vascular grafts and the polymers used in vitro and in vivo.
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Affiliation(s)
- Bruna B J Leal
- Hematology and Stem Cell Laboratory, Faculty of Pharmacy, Universidade Federal Do Rio Grande Do Sul, Porto Alegre, Brazil.,Post-graduate Program in Physiology, Universidade Federal Do Rio Grande Do Sul, Porto Alegre, Brazil
| | - Naohiro Wakabayashi
- Division of Cardiac Surgery, Department of Medicine, Asahikawa Medical University, Asahikawa, Japan
| | - Kyohei Oyama
- Division of Cardiac Surgery, Department of Medicine, Asahikawa Medical University, Asahikawa, Japan
| | - Hiroyuki Kamiya
- Division of Cardiac Surgery, Department of Medicine, Asahikawa Medical University, Asahikawa, Japan
| | - Daikelly I Braghirolli
- Hematology and Stem Cell Laboratory, Faculty of Pharmacy, Universidade Federal Do Rio Grande Do Sul, Porto Alegre, Brazil
| | - Patricia Pranke
- Hematology and Stem Cell Laboratory, Faculty of Pharmacy, Universidade Federal Do Rio Grande Do Sul, Porto Alegre, Brazil.,Post-graduate Program in Physiology, Universidade Federal Do Rio Grande Do Sul, Porto Alegre, Brazil.,Stem Cell Research Institute, Porto Alegre, Brazil
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26
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Torres Y, Gluais M, Da Silva N, Rey S, Grémare A, Magnan L, Kawecki F, L’Heureux N. Cell-assembled extracellular matrix (CAM) sheet production: Translation from using human to large animal cells. J Tissue Eng 2021; 12:2041731420978327. [PMID: 33633827 PMCID: PMC7887678 DOI: 10.1177/2041731420978327] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Accepted: 11/13/2020] [Indexed: 11/16/2022] Open
Abstract
We have created entirely biological tissue-engineered vascular grafts (TEVGs) using sheets of cell-assembled extracellular matrix (CAM) produced by human fibroblasts in vitro. A large animal TEVG would allow long-term pre-clinical studies in a clinically relevant setting (graft size and allogeneic setting). Therefore, canine, porcine, ovine, and human skin fibroblasts were compared for their ability to form CAM sheets. Serum sourcing greatly influenced CAM production in a species-dependent manner. Ovine cells produced the most homogenous and strongest animal CAM sheets but remained ≈3-fold weaker than human sheets despite variations of serum, ascorbate, insulin, or growth factor supplementations. Key differences in cell growth dynamics, tissue development, and tissue architecture and composition were observed between human and ovine. This study demonstrates critical species-to-species differences in fibroblast behavior and how they pose a challenge when attempting to substitute animal cells for human cells during the development of tissue-engineered constructs that require long-term cultures.
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Affiliation(s)
- Yoann Torres
- University of Bordeaux, INSERM, BIOTIS, Bordeaux, France
| | - Maude Gluais
- University of Bordeaux, INSERM, BIOTIS, Bordeaux, France
| | | | - Sylvie Rey
- University of Bordeaux, INSERM, BIOTIS, Bordeaux, France
| | - Agathe Grémare
- University of Bordeaux, INSERM, BIOTIS, Bordeaux, France
- CHU Bordeaux, Services d’Odontologie et de Santé Buccale, Bordeaux, France
| | - Laure Magnan
- University of Bordeaux, INSERM, BIOTIS, Bordeaux, France
| | - Fabien Kawecki
- University of Bordeaux, INSERM, BIOTIS, Bordeaux, France
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27
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Zilla P, Deutsch M, Bezuidenhout D, Davies NH, Pennel T. Progressive Reinvention or Destination Lost? Half a Century of Cardiovascular Tissue Engineering. Front Cardiovasc Med 2020; 7:159. [PMID: 33033720 PMCID: PMC7509093 DOI: 10.3389/fcvm.2020.00159] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Accepted: 07/28/2020] [Indexed: 12/19/2022] Open
Abstract
The concept of tissue engineering evolved long before the phrase was forged, driven by the thromboembolic complications associated with the early total artificial heart programs of the 1960s. Yet more than half a century of dedicated research has not fulfilled the promise of successful broad clinical implementation. A historical account outlines reasons for this scientific impasse. For one, there was a disconnect between distinct eras each characterized by different clinical needs and different advocates. Initiated by the pioneers of cardiac surgery attempting to create neointimas on total artificial hearts, tissue engineering became fashionable when vascular surgeons pursued the endothelialisation of vascular grafts in the late 1970s. A decade later, it were cardiac surgeons again who strived to improve the longevity of tissue heart valves, and lastly, cardiologists entered the fray pursuing myocardial regeneration. Each of these disciplines and eras started with immense enthusiasm but were only remotely aware of the preceding efforts. Over the decades, the growing complexity of cellular and molecular biology as well as polymer sciences have led to surgeons gradually being replaced by scientists as the champions of tissue engineering. Together with a widening chasm between clinical purpose, human pathobiology and laboratory-based solutions, clinical implementation increasingly faded away as the singular endpoint of all strategies. Moreover, a loss of insight into the healing of cardiovascular prostheses in humans resulted in the acceptance of misleading animal models compromising the translation from laboratory to clinical reality. This was most evident in vascular graft healing, where the two main impediments to the in-situ generation of functional tissue in humans remained unheeded–the trans-anastomotic outgrowth stoppage of endothelium and the build-up of an impenetrable surface thrombus. To overcome this dead-lock, research focus needs to shift from a biologically possible tissue regeneration response to one that is feasible at the intended site and in the intended host environment of patients. Equipped with an impressive toolbox of modern biomaterials and deep insight into cues for facilitated healing, reconnecting to the “user needs” of patients would bring one of the most exciting concepts of cardiovascular medicine closer to clinical reality.
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Affiliation(s)
- Peter Zilla
- Christiaan Barnard Division for Cardiothoracic Surgery, University of Cape Town, Cape Town, South Africa.,Cardiovascular Research Unit, University of Cape Town, Cape Town, South Africa
| | - Manfred Deutsch
- Karl Landsteiner Institute for Cardiovascular Surgical Research, Vienna, Austria
| | - Deon Bezuidenhout
- Cardiovascular Research Unit, University of Cape Town, Cape Town, South Africa
| | - Neil H Davies
- Cardiovascular Research Unit, University of Cape Town, Cape Town, South Africa
| | - Tim Pennel
- Christiaan Barnard Division for Cardiothoracic Surgery, University of Cape Town, Cape Town, South Africa
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