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Nikolskiy VI, Sergatskiy KI, Sheremet DP, Shabrov AV. [Scaffold technologies in regenerative medicine: history of the issue, current state and prospects of application]. Khirurgiia (Mosk) 2022:36-41. [PMID: 36398953 DOI: 10.17116/hirurgia202211136] [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: 06/16/2023]
Abstract
Development of methods for replacing human tissue defects based on scaffold technologies in regenerative surgery proves the prospects of this industry. High-tech manufacturing of scaffold matrices suggests complete replacement of obsolete methods of treatment with new developments in the near future. At the same time, additional studies devoted to these methods and their results are needed. One of the promising goals for development of scaffold technologies is creation of versatile materials used in various fields of regenerative medicine.
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Nappi F, Singh SSA. Gene therapy and regenerative tissue engineering in congenital heart disease. Transl Pediatr 2019; 8:356-359. [PMID: 31993346 PMCID: PMC6970115 DOI: 10.21037/tp.2019.04.10] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Affiliation(s)
- Francesco Nappi
- Cardiac Surgery, Centre Cardiologique du Nord de Saint-Denis (CCN), Paris, France
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Vanderveken E, Vastmans J, Verbelen T, Verbrugghe P, Famaey N, Verbeken E, Treasure T, Rega F. Reinforcing the pulmonary artery autograft in the aortic position with a textile mesh: a histological evaluation. Interact Cardiovasc Thorac Surg 2019; 27:566-573. [PMID: 29912400 DOI: 10.1093/icvts/ivy134] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2018] [Accepted: 03/25/2018] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES The Ross procedure involves replacing a patient's diseased aortic valve with their own pulmonary valve. The most common failure mode is dilatation of the autograft. Various strategies to reinforce the autograft have been proposed. Personalized external aortic root support has been shown to be effective in stabilizing the aortic root in Marfan patients. In this study, the use of a similar external mesh to support a pulmonary artery autograft was evaluated. METHODS The pulmonary artery was translocated as an interposition autograft in the descending thoracic aortas of 10 sheep. The autograft was reinforced with a polyethylene terephthalate mesh (n = 7) or left unreinforced (n = 3). After 6 months, a computed tomography scan was taken, and the descending aorta was excised and histologically examined using the haematoxylin-eosin and Elastica van Gieson stains. RESULTS The autograft/aortic diameter ratio was 1.59 in the unreinforced group but much less in the reinforced group (1.11) (P < 0.05). A fibrotic sheet, variable in thickness and containing fibroblasts, neovessels and foreign body giant cells, was incorporated in the mesh. Histological examination of the reinforced autograft and the adjacent aorta revealed thinning of the vessel wall due to atrophy of the smooth muscle cells. Potential spaces between the vessel wall and the mesh were filled with oedema. CONCLUSIONS Reinforcing an interposition pulmonary autograft in the descending aorta with a macroporous mesh showed promising results in limiting autograft dilatation in this sheep model. Histological evaluation revealed atrophy of the smooth muscle cell and consequently thinning of the vessel wall within the mesh support.
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Affiliation(s)
- Emma Vanderveken
- Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
| | - Julie Vastmans
- Department of Mechanical Engineering, KU Leuven, Leuven, Belgium
| | - Tom Verbelen
- Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium.,Department of Cardiac Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Peter Verbrugghe
- Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium.,Department of Cardiac Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Nele Famaey
- Department of Mechanical Engineering, KU Leuven, Leuven, Belgium
| | - Eric Verbeken
- Department of Imaging and Pathology, KU Leuven, Leuven, Belgium
| | - Tom Treasure
- Clinical Operational Research Unit, UCL, London, UK
| | - Filip Rega
- Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium.,Department of Cardiac Surgery, University Hospitals Leuven, Leuven, Belgium
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Fernández-Colino A, Iop L, Ventura Ferreira MS, Mela P. Fibrosis in tissue engineering and regenerative medicine: treat or trigger? Adv Drug Deliv Rev 2019; 146:17-36. [PMID: 31295523 DOI: 10.1016/j.addr.2019.07.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2018] [Revised: 05/11/2019] [Accepted: 07/04/2019] [Indexed: 02/07/2023]
Abstract
Fibrosis is a life-threatening pathological condition resulting from a dysfunctional tissue repair process. There is no efficient treatment and organ transplantation is in many cases the only therapeutic option. Here we review tissue engineering and regenerative medicine (TERM) approaches to address fibrosis in the cardiovascular system, the kidney, the lung and the liver. These strategies have great potential to achieve repair or replacement of diseased organs by cell- and material-based therapies. However, paradoxically, they might also trigger fibrosis. Cases of TERM interventions with adverse outcome are also included in this review. Furthermore, we emphasize the fact that, although organ engineering is still in its infancy, the advances in the field are leading to biomedically relevant in vitro models with tremendous potential for disease recapitulation and development of therapies. These human tissue models might have increased predictive power for human drug responses thereby reducing the need for animal testing.
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Biomechanical evaluation of a personalized external aortic root support applied in the Ross procedure. J Mech Behav Biomed Mater 2017; 78:164-174. [PMID: 29156355 DOI: 10.1016/j.jmbbm.2017.11.018] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2017] [Revised: 11/07/2017] [Accepted: 11/09/2017] [Indexed: 02/07/2023]
Abstract
A commonly heard concern in the Ross procedure, where a diseased aortic valve is replaced by the patient's own pulmonary valve, is the possibility of pulmonary autograft dilatation. We performed a biomechanical investigation of the use of a personalized external aortic root support or exostent as a possibility for supporting the autograft. In ten sheep a short length of pulmonary artery was interposed in the descending aorta, serving as a simplified version of the Ross procedure. In seven of these cases, the autograft was supported by an external mesh or so-called exostent. Three sheep served as control, of which one was excluded from the mechanical testing. The sheep were sacrificed six months after the procedure. Samples of the relevant tissues were obtained for subsequent mechanical testing: normal aorta, normal pulmonary artery, aorta with exostent, pulmonary artery with exostent, and pulmonary artery in aortic position for six months. After mechanical testing, the material parameters of the Gasser-Ogden-Holzapfel model were determined for the different tissue types. Stress-strain curves of the different tissue types show significantly different mechanical behavior. At baseline, stress-strain curves of the pulmonary artery are lower than aortic stress-strain curves, but at the strain levels at which the collagen fibers are recruited, the pulmonary artery behaves stiffer than the aorta. After being in aortic position for six months, the pulmonary artery tends towards aorta-like behavior, indicating that growth and remodeling processes have taken place. When adding an exostent around the pulmonary autograft, the mechanical behavior of the composite artery (exostent + artery) differs from the artery alone, the non-linearity being more evident in the former.
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Abstract
The Ross operation provides several advantages compared to other valve substitutes to manage aortic valve disease, such as growth potential, excellent hemodynamics, freedom from oral anticoagulation and hemolysis, and better durability. However, progressive dilatation of the pulmonary autografts after Ross operation reflects the inadequate remodeling of the native pulmonary root in the systemic circulation, which results in impaired adaptability to systemic pressure and risk of reoperation after the first decade. A recently published article showed that remodeling increased wall thickness and decreased stiffness in the failed specimens after Ross operation, and the increased compliance might play a key role in determining the progressive long-term autograft root dilatation. Late dilatation can be counteracted by an external barrier which prevents failure. Therefore, an inclusion cylinder technique with a native aorta or a synthetic external support, such as Dacron, might stabilize the autograft root and improve long-term outcomes. In this article, we offer a prospective about the importance of biomechanical features in future developments of the Ross operation. Pre-clinical and clinical evaluations of the biomechanical properties of these reinforced pulmonary autografts might shed new light on the current debate about the long-term fate of the pulmonary autograft after Ross procedure.
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Affiliation(s)
- Francesco Nappi
- Department of Cardiac Surgery, Centre Cardiologique du Nord de Saint-Denis, Paris, France
| | - Antonio Nenna
- Department of Cardiovascular Surgery, Università Campus Bio-Medico di Roma, Rome, Italy
| | - Cristiano Spadaccio
- Department of Cardiothoracic Surgery, Golden Jubilee National Hospital, Glasgow, UK
| | - Massimo Chello
- Department of Cardiovascular Surgery, Università Campus Bio-Medico di Roma, Rome, Italy
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Suwannasom P, Sotomi Y, Tateishi H, Tenekecioglu E, Zeng Y, Kraak RP, Wykrzykowska JJ, De Winter RJ, Serruys PW, Onuma Y. Bioresorbable drug-eluting scaffolds for treatment of vascular disease. Expert Opin Drug Deliv 2016; 13:725-39. [PMID: 26865247 DOI: 10.1517/17425247.2016.1153062] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
INTRODUCTION Theoretical advantages of fully bioresorbable scaffold (BRS) stem from transient vessel support without rigid caging. Therefore, it could reduce long-term adverse events associated with the presence of foreign materials. AREAS COVERED This article will provide an overview of: drug-eluting BRS for various applications in the treatment of vascular disease; The mechanisms of active agent release from such scaffolds; currently available drug-eluting BRS and their future applications are also discussed. EXPERT OPINION The current BRS have been developed in order to achieve optimal vascular patency while providing long-term safety. The clinical efficacy and safety of BRS in coronary treatment have been reported as equal to that of the current metallic drug eluting stents in simple lesions. The application of BRS can potentially be expanded to other vascular beds. The research in bioengineering for the appropriate materials should not only focus on biocompatibility but also should be tailored according to the sites of implantation, which may require different strength and supporting period. The ultimate goal in this field is to develop a biocompatible device that provides equivalent and complementary therapy to other devices, and is able to disappear when the mechanical support and drug delivery are no longer required.
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Affiliation(s)
- Pannipa Suwannasom
- a AMC Heartcenter, Academic Medical Center , University of Amsterdam , Amsterdam , The Netherlands.,b ThoraxCenter , Erasmus Medical Center , Rotterdam , The Netherlands.,c Northern Region Heart Center, Faculty of Medicine , Chiang Mai University , Chiang Mai , Thailand
| | - Yohei Sotomi
- a AMC Heartcenter, Academic Medical Center , University of Amsterdam , Amsterdam , The Netherlands
| | - Hiroki Tateishi
- b ThoraxCenter , Erasmus Medical Center , Rotterdam , The Netherlands
| | | | - Yaping Zeng
- b ThoraxCenter , Erasmus Medical Center , Rotterdam , The Netherlands
| | - Robin P Kraak
- a AMC Heartcenter, Academic Medical Center , University of Amsterdam , Amsterdam , The Netherlands
| | - Joanna J Wykrzykowska
- a AMC Heartcenter, Academic Medical Center , University of Amsterdam , Amsterdam , The Netherlands
| | - Robbert J De Winter
- a AMC Heartcenter, Academic Medical Center , University of Amsterdam , Amsterdam , The Netherlands
| | - Patrick W Serruys
- d International Centre for Circulatory Health, NHLI , Imperial College London , London , UK
| | - Yoshinobu Onuma
- b ThoraxCenter , Erasmus Medical Center , Rotterdam , The Netherlands
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