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Salih T, Caputo M, Ghorbel MT. Recent Advances in Hydrogel-Based 3D Bioprinting and Its Potential Application in the Treatment of Congenital Heart Disease. Biomolecules 2024; 14:861. [PMID: 39062575 PMCID: PMC11274841 DOI: 10.3390/biom14070861] [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: 05/15/2024] [Revised: 07/04/2024] [Accepted: 07/05/2024] [Indexed: 07/28/2024] Open
Abstract
Congenital heart disease (CHD) is the most common birth defect, requiring invasive surgery often before a child's first birthday. Current materials used during CHD surgery lack the ability to grow, remodel, and regenerate. To solve those limitations, 3D bioprinting is an emerging tool with the capability to create tailored constructs based on patients' own imaging data with the ability to grow and remodel once implanted in children with CHD. It has the potential to integrate multiple bioinks with several cell types and biomolecules within 3D-bioprinted constructs that exhibit good structural fidelity, stability, and mechanical integrity. This review gives an overview of CHD and recent advancements in 3D bioprinting technologies with potential use in the treatment of CHD. Moreover, the selection of appropriate biomaterials based on their chemical, physical, and biological properties that are further manipulated to suit their application are also discussed. An introduction to bioink formulations composed of various biomaterials with emphasis on multiple cell types and biomolecules is briefly overviewed. Vasculogenesis and angiogenesis of prefabricated 3D-bioprinted structures and novel 4D printing technology are also summarized. Finally, we discuss several restrictions and our perspective on future directions in 3D bioprinting technologies in the treatment of CHD.
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Affiliation(s)
- Tasneem Salih
- Bristol Heart Institute, Bristol Medical School, University of Bristol, Bristol BS2 8HW, UK; (T.S.); (M.C.)
| | - Massimo Caputo
- Bristol Heart Institute, Bristol Medical School, University of Bristol, Bristol BS2 8HW, UK; (T.S.); (M.C.)
- Cardiac Surgery, University Hospitals Bristol, NHS Foundation Trust, Bristol BS2 8HW, UK
| | - Mohamed T. Ghorbel
- Bristol Heart Institute, Bristol Medical School, University of Bristol, Bristol BS2 8HW, UK; (T.S.); (M.C.)
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2
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Qiu B, Cheng Q, Chen R, Liu C, Qin J, Jiang Q. Mussel-Mimetic Hydrogel Coating with Anticoagulant and Antiinflammatory Properties on a Poly(lactic acid) Vascular Stent. Biomacromolecules 2024; 25:3098-3111. [PMID: 38606583 DOI: 10.1021/acs.biomac.4c00201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/13/2024]
Abstract
Biodegradable stents are the most promising alternatives for the treatment of cardiovascular disease nowadays, and the strategy of preparing functional coatings on the surface is highly anticipated for addressing adverse effects such as in-stent restenosis and stent thrombosis. Yet, inadequate mechanical stability and biomultifunctionality limit their clinical application. In this study, we developed a multicross-linking hydrogel on the polylactic acid substrates by dip coating that boasts impressive antithrombotic ability, antibacterial capability, mechanical stability, and self-healing ability. Gelatin methacryloyl, carboxymethyl chitosan, and oxidized sodium alginate construct a double-cross-linking hydrogel through the dynamic Schiff base chemical and in situ blue initiation reaction. Inspired by the adhesion mechanism employed by mussels, a triple-cross-linked hydrogel is formed with the addition of tannic acid to increase the adhesion and antibiofouling properties. The strength and hydrophilicity of hydrogel coating are regulated by changing the composition ratio and cross-linking degree. It has been demonstrated in tests in vitro that the hydrogel coating significantly reduces the adhesion of proteins, MC3T3-E1 cells, platelets, and bacteria by 85% and minimizes the formation of blood clots. The hydrogel coating also exhibits excellent antimicrobial in vitro and antiinflammatory properties in vivo, indicating its potential value in vascular intervention and other biomedical fields.
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Affiliation(s)
- Biwei Qiu
- School of Materials and Chemistry, University of Shanghai for Science and Technology, Shanghai 200093, China
| | - Qianqian Cheng
- School of Materials and Chemistry, University of Shanghai for Science and Technology, Shanghai 200093, China
| | - Rukun Chen
- Department of Cardiology, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200336, China
- Faculty of Medicine, University of Southampton, University Road, Southampton SO17 1BJ, United Kingdom
| | - Chunling Liu
- School of Materials and Chemistry, University of Shanghai for Science and Technology, Shanghai 200093, China
| | - Jinchao Qin
- School of Materials and Chemistry, University of Shanghai for Science and Technology, Shanghai 200093, China
| | - Qixia Jiang
- Department of Cardiology, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200336, China
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3
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Jin C, Chen D, Zhu T, Chen S, Du J, Zhang H, Dong W. Poly(ferulic acid)-hybrid nanofibers for reducing thrombosis and restraining intimal hyperplasia in vascular tissue engineering. BIOMATERIALS ADVANCES 2023; 146:213278. [PMID: 36638698 DOI: 10.1016/j.bioadv.2023.213278] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Revised: 11/19/2022] [Accepted: 01/02/2023] [Indexed: 01/09/2023]
Abstract
Small-diameter blood vascular transplantation failure is mainly caused by the vascular materials' unreliable hemocompatibility and histocompatibility and the unmatched mechanical properties, which will cause unstable blood flow. How to solve the problems of coagulation and intimal hyperplasia caused by the above factors is formidable in vascular replacement. In this work, we have synthesized poly(ferulic acid) (PFA) and prepared poly(ester-urethane)urea (PEUU)/silk fibroin (SF)/poly(ferulic acid) (PFA) hybrid nanofibers vascular graft (PSPG) by random electrospinning and post-double network bond crosslinking for process optimization. The results in vitro demonstrated that the graft is of significant anti-oxidation, matched mechanical properties, reliable cytocompatibility, and blood compatibility. Replacing resected rat abdominal aorta and rabbit carotid artery models with PSPG vascular grafts indicated that the grafts are capable of homogeneous hybrid PFA significantly promoted the stabilization of endothelial cells and the ingrowth of smooth muscle cells, meanwhile stabilizing the immune microenvironment. This research demonstrates the PSPG vascular graft with substantial patency, indicating their potential for injured vascular healing.
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Affiliation(s)
- Changjie Jin
- School of Chemistry and Chemical Engineering, Shanghai Engineering Research Center of Pharmaceutical Intelligent Equipment, Shanghai Frontiers Science Research Center for Druggability of Cardiovascular Non-coding RNA, Institute for Frontier Medical Technology, Shanghai University of Engineering Science, 333 Longteng Rd., Shanghai 201620, PR China
| | - Dian Chen
- Department of Cardiothoracic Surgery, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, 1678 Dongfang Rd., Shanghai 200127, PR China
| | - Tonghe Zhu
- School of Chemistry and Chemical Engineering, Shanghai Engineering Research Center of Pharmaceutical Intelligent Equipment, Shanghai Frontiers Science Research Center for Druggability of Cardiovascular Non-coding RNA, Institute for Frontier Medical Technology, Shanghai University of Engineering Science, 333 Longteng Rd., Shanghai 201620, PR China; Shanghai PINE&POWER Biotech Co., Ltd, 500 Huaxi Rd., Shanghai 201108, PR China.
| | - Sihao Chen
- School of Chemistry and Chemical Engineering, Shanghai Engineering Research Center of Pharmaceutical Intelligent Equipment, Shanghai Frontiers Science Research Center for Druggability of Cardiovascular Non-coding RNA, Institute for Frontier Medical Technology, Shanghai University of Engineering Science, 333 Longteng Rd., Shanghai 201620, PR China
| | - Juan Du
- School of Chemistry and Chemical Engineering, Shanghai Engineering Research Center of Pharmaceutical Intelligent Equipment, Shanghai Frontiers Science Research Center for Druggability of Cardiovascular Non-coding RNA, Institute for Frontier Medical Technology, Shanghai University of Engineering Science, 333 Longteng Rd., Shanghai 201620, PR China
| | - Haibo Zhang
- Department of Cardiothoracic Surgery, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, 1678 Dongfang Rd., Shanghai 200127, PR China.
| | - Wei Dong
- Department of Cardiothoracic Surgery, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, 1678 Dongfang Rd., Shanghai 200127, PR China.
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4
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Tan W, Boodagh P, Selvakumar PP, Keyser S. Strategies to counteract adverse remodeling of vascular graft: A 3D view of current graft innovations. Front Bioeng Biotechnol 2023; 10:1097334. [PMID: 36704297 PMCID: PMC9871289 DOI: 10.3389/fbioe.2022.1097334] [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: 11/13/2022] [Accepted: 12/23/2022] [Indexed: 01/11/2023] Open
Abstract
Vascular grafts are widely used for vascular surgeries, to bypass a diseased artery or function as a vascular access for hemodialysis. Bioengineered or tissue-engineered vascular grafts have long been envisioned to take the place of bioinert synthetic grafts and even vein grafts under certain clinical circumstances. However, host responses to a graft device induce adverse remodeling, to varied degrees depending on the graft property and host's developmental and health conditions. This in turn leads to invention or failure. Herein, we have mapped out the relationship between the design constraints and outcomes for vascular grafts, by analyzing impairment factors involved in the adverse graft remodeling. Strategies to tackle these impairment factors and counteract adverse healing are then summarized by outlining the research landscape of graft innovations in three dimensions-cell technology, scaffold technology and graft translation. Such a comprehensive view of cell and scaffold technological innovations in the translational context may benefit the future advancements in vascular grafts. From this perspective, we conclude the review with recommendations for future design endeavors.
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Affiliation(s)
- Wei Tan
- Department of Mechanical Engineering, University of Colorado Boulder, Boulder, CO, United States,*Correspondence: Wei Tan,
| | - Parnaz Boodagh
- McGowan Institute for Regenerative Medicine, University of Pittsburgh, Pittsburgh, PA, United States
| | | | - Sean Keyser
- Department of Mechanical Engineering, University of Colorado Boulder, Boulder, CO, United States
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5
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Xie X, Wu Q, Liu Y, Chen C, Chen Z, Xie C, Song M, Jiang Z, Qi X, Liu S, Tang Z, Wu Z. Vascular endothelial growth factor attenuates neointimal hyperplasia of decellularized small-diameter vascular grafts by modulating the local inflammatory response. Front Bioeng Biotechnol 2022; 10:1066266. [PMID: 36605251 PMCID: PMC9808043 DOI: 10.3389/fbioe.2022.1066266] [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: 10/10/2022] [Accepted: 12/09/2022] [Indexed: 12/24/2022] Open
Abstract
Small-diameter vascular grafts (diameter <6 mm) are in high demand in clinical practice. Neointimal hyperplasia, a common complication after implantation of small-diameter vascular grafts, is one of the common causes of graft failure. Modulation of local inflammatory responses is a promising strategy to attenuates neointimal hyperplasia. Vascular endothelial growth factor (VEGF) is an angiogenesis stimulator that also induces macrophage polarization and modulates inflammatory responses. In the present study, we evaluated the effect of VEGF on the neointima hyperplasia and local inflammatory responses of decellularized vascular grafts. In the presence of rhVEGF-165 in RAW264.6 macrophage culture, rhVEGF-165 induces RAW264.6 macrophage polarization to M2 phenotype. Decellularized bovine internal mammary arteries were implanted into the subcutaneous and infrarenal abdominal aorta of New Zealand rabbits, with rhVEGF-165 applied locally to the adventitial of the grafts. The vascular grafts were removed en-bloc and submitted to histological and immunofluorescence analyses on days 7 and 28 following implantation. The thickness of the fibrous capsule and neointima was thinner in the VEGF group than that in the control group. In the immunofluorescence analysis, the number of M2 macrophages and the ratio of M2/M1 macrophages in vascular grafts in the VEGF group were higher than those in the control group, and the proinflammatory factor IL-1 was expressed less than in the control group, but the anti-inflammatory factor IL-10 was expressed more. In conclusion, local VEGF administration attenuates neointimal hyperplasia in decellularized small-diameter vascular grafts by inducing macrophage M2 polarization and modulating the inflammatory response.
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Affiliation(s)
- Xinlong Xie
- Department of Cardiovascular Surgery, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China,Department of Cardiothoracic Surgery, The First Affiliated Hospital, Hunan University of Chinese Medicine, Changsha, Hunan, China
| | - Qiying Wu
- Department of Cardiovascular Surgery, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Yuhong Liu
- Department of Cardiovascular Surgery, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Chunyang Chen
- Department of Cardiovascular Surgery, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Zeguo Chen
- Department of Cardiovascular Surgery, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Chao Xie
- Department of Cardiovascular Surgery, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Mingzhe Song
- Department of Cardiovascular Surgery, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Zhenlin Jiang
- Department of Cardiovascular Surgery, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Xiaoke Qi
- Department of Cardiovascular Surgery, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Sixi Liu
- Department of Cardiovascular Surgery, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Zhenjie Tang
- Department of Cardiovascular Surgery, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China,Engineering Laboratory of Hunan Province for Cardiovascular Biomaterials, Changsha, Hunan, China
| | - Zhongshi Wu
- Department of Cardiovascular Surgery, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China,Engineering Laboratory of Hunan Province for Cardiovascular Biomaterials, Changsha, Hunan, China,*Correspondence: Zhongshi Wu,
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Abstract
Cardiovascular defects, injuries, and degenerative diseases often require surgical intervention and the use of implantable replacement material and conduits. Traditional vascular grafts made of synthetic polymers, animal and cadaveric tissues, or autologous vasculature have been utilized for almost a century with well-characterized outcomes, leaving areas of unmet need for the patients in terms of durability and long-term patency, susceptibility to infection, immunogenicity associated with the risk of rejection, and inflammation and mechanical failure. Research to address these limitations is exploring avenues as diverse as gene therapy, cell therapy, cell reprogramming, and bioengineering of human tissue and replacement organs. Tissue-engineered vascular conduits, either with viable autologous cells or decellularized, are the forefront of technology in cardiovascular reconstruction and offer many benefits over traditional graft materials, particularly in the potential for the implanted material to be adopted and remodeled into host tissue and thus offer safer, more durable performance. This review discusses the key advances and future directions in the field of surgical vascular repair, replacement, and reconstruction, with a focus on the challenges and expected benefits of bioengineering human tissues and blood vessels.
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Affiliation(s)
- Kaleb M. Naegeli
- Humacyte, Inc, Durham, NC (K.M.N., M.H.K., Y.L., J.W., E.A.H., L.E.N.)
| | - Mehmet H. Kural
- Humacyte, Inc, Durham, NC (K.M.N., M.H.K., Y.L., J.W., E.A.H., L.E.N.)
| | - Yuling Li
- Humacyte, Inc, Durham, NC (K.M.N., M.H.K., Y.L., J.W., E.A.H., L.E.N.)
| | - Juan Wang
- Humacyte, Inc, Durham, NC (K.M.N., M.H.K., Y.L., J.W., E.A.H., L.E.N.)
| | | | - Laura E. Niklason
- Department of Anesthesiology and Biomedical Engineering, Yale University, New Haven, CT (L.E.N.)
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Chernonosova VS, Laktionov PP. Structural Aspects of Electrospun Scaffolds Intended for Prosthetics of Blood Vessels. Polymers (Basel) 2022; 14:polym14091698. [PMID: 35566866 PMCID: PMC9105676 DOI: 10.3390/polym14091698] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 04/12/2022] [Accepted: 04/17/2022] [Indexed: 12/28/2022] Open
Abstract
Electrospinning is a popular method used to fabricate small-diameter vascular grafts. However, the importance of structural characteristics of the scaffold determining interaction with endothelial cells and their precursors and blood cells is still not exhaustively clear. This review discusses current research on the significance and impact of scaffold architecture (fiber characteristics, porosity, and surface roughness of material) on interactions between cells and blood with the material. In addition, data about the effects of scaffold topography on cellular behaviour (adhesion, proliferation, and migration) are necessary to improve the rational design of electrospun vascular grafts with a long-term perspective.
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Affiliation(s)
- Vera S. Chernonosova
- Institute of Chemical Biology and Fundamental Medicine, Siberian Branch, Russian Academy of Sciences, 630090 Novosibirsk, Russia;
- Meshalkin National Medical Research Center, Ministry of Health of the Russian Federation, 630055 Novosibirsk, Russia
- Correspondence: ; Tel.: +7-(383)-363-51-44
| | - Pavel P. Laktionov
- Institute of Chemical Biology and Fundamental Medicine, Siberian Branch, Russian Academy of Sciences, 630090 Novosibirsk, Russia;
- Meshalkin National Medical Research Center, Ministry of Health of the Russian Federation, 630055 Novosibirsk, Russia
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8
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Mayoral I, Bevilacqua E, Gómez G, Hmadcha A, González-Loscertales I, Reina E, Sotelo J, Domínguez A, Pérez-Alcántara P, Smani Y, González-Puertas P, Mendez A, Uribe S, Smani T, Ordoñez A, Valverde I. Tissue engineered in-vitro vascular patch fabrication using hybrid 3D printing and electrospinning. Mater Today Bio 2022; 14:100252. [PMID: 35509864 PMCID: PMC9059085 DOI: 10.1016/j.mtbio.2022.100252] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 03/29/2022] [Accepted: 03/31/2022] [Indexed: 11/05/2022] Open
Abstract
Three-dimensional (3D) engineered cardiovascular tissues have shown great promise to replace damaged structures. Specifically, tissue engineering vascular grafts (TEVG) have the potential to replace biological and synthetic grafts. We aimed to design an in-vitro patient-specific patch based on a hybrid 3D print combined with vascular smooth muscle cells (VSMC) differentiation. Based on the medical images of a 2 months-old girl with aortic arch hypoplasia and using computational modelling, we evaluated the most hemodynamically efficient aortic patch surgical repair. Using the designed 3D patch geometry, the scaffold was printed using a hybrid fused deposition modelling (FDM) and electrospinning techniques. The scaffold was seeded with multipotent mesenchymal stem cells (MSC) for later maturation to derived VSMC (dVSMC). The graft showed adequate resistance to physiological aortic pressure (burst pressure 101 ± 15 mmHg) and a porosity gradient ranging from 80 to 10 μm allowing cells to infiltrate through the entire thickness of the patch. The bio-scaffolds showed good cell viability at days 4 and 12 and adequate functional vasoactive response to endothelin-1. In summary, we have shown that our method of generating patient-specific patch shows adequate hemodynamic profile, mechanical properties, dVSMC infiltration, viability and functionality. This innovative 3D biotechnology has the potential for broad application in regenerative medicine and potentially in heart disease prevention.
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Key Words
- 3D printing
- Electrospinning
- Endothelin Receptor A, ETA
- Endothelin Receptor B, ETB
- Mesenchymal stem cells
- Reverse Transcription, Rt
- Three-dimensional, 3D
- Tissue engineering
- Vascular graft
- anti-alpha-smooth muscle actin, α-SMA
- anti-cluster of differentiation 31, CD31
- anti-fibroblast specific protein 1, FSP1
- anti-smooth muscle protein 22, SM-22
- bone morphogenetic protein, BMP4
- computation fluid dynamic, CFD
- computed tomography, CT
- derived VSMC, dVSMC
- endothelin-1, ET-1
- extracellular matrix, ECM
- fused deposition modelling, FDM
- mesenchymal stem cells, MSC
- platelet-derived growth factor composed by two beta chains, PDGF-BB
- room temperature, RT
- tissue engineering vascular grafts, TEVG
- transforming growth factor beta 1, TGFβ-1
- vascular smooth muscle cells, VSMC
- wall shear stress, WSS
- western blotting, WB
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Affiliation(s)
- Isabel Mayoral
- Cardiovascular Pathophysiology Group, Institute of Biomedicine of Seville- IBiS, University of Seville /HUVR/CSIC, Seville, Spain
| | - Elisa Bevilacqua
- Cardiovascular Pathophysiology Group, Institute of Biomedicine of Seville- IBiS, University of Seville /HUVR/CSIC, Seville, Spain
| | - Gorka Gómez
- Cardiovascular Pathophysiology Group, Institute of Biomedicine of Seville- IBiS, University of Seville /HUVR/CSIC, Seville, Spain
| | - Abdelkrim Hmadcha
- Advanced Therapies and Regenerative Medicine Research Group.General Hospital, Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante, Spain
- Department of Molecular Biology and Biochemical Engineering, Universidad Pablo de Olavide, Seville, Spain
| | - Ignacio González-Loscertales
- Department Mechanical, Thermal and Fluids Engineering, School of Engineering, University of Málaga, Málaga, Spain
| | - Esther Reina
- Department of Mechanical and Manufacturing Engineering, University of Seville, Seville, Spain
| | - Julio Sotelo
- School of Biomedical Engineering, Universidad de Valparaíso, Valparaíso, Chile
- Millennium Institute for Intelligent Healthcare Engineering, iHEALTH, Millennium Nucleus in Cardiovascular Magnetic Resonance, Cardio MR, and Biomedical Imaging Center, Pontificia Universidad Católica de Chile, Santiago, Chile
| | | | - Pedro Pérez-Alcántara
- Department of Mechanical and Manufacturing Engineering, University of Seville, Seville, Spain
| | - Younes Smani
- Department of Molecular Biology and Biochemical Engineering, Andalusian Center of Developmental Biology, CSIC, University of Pablo de Olavide, Seville, Spain
| | | | - Ana Mendez
- Pediatric Cardiology Unit, Hospital Virgen Del Rocio, Seville, Spain
| | - Sergio Uribe
- Millennium Institute for Intelligent Healthcare Engineering, iHEALTH, Millennium Nucleus in Cardiovascular Magnetic Resonance, Cardio MR, and Biomedical Imaging Center, Pontificia Universidad Católica de Chile, Santiago, Chile
- Radiology Department, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Tarik Smani
- Cardiovascular Pathophysiology Group, Institute of Biomedicine of Seville- IBiS, University of Seville /HUVR/CSIC, Seville, Spain
- Department of Medical Physiology and Biophysics, School of Medicine, University of Seville, Seville, Spain
| | - Antonio Ordoñez
- Cardiovascular Pathophysiology Group, Institute of Biomedicine of Seville- IBiS, University of Seville /HUVR/CSIC, Seville, Spain
| | - Israel Valverde
- Cardiovascular Pathophysiology Group, Institute of Biomedicine of Seville- IBiS, University of Seville /HUVR/CSIC, Seville, Spain
- Pediatric Cardiology Unit, Hospital Virgen Del Rocio, Seville, Spain
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
- Department of Pharmacology, Pediatric and Radiology, School of Medicine, University of Seville, Seville, Spain
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9
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Blume C, Kraus X, Heene S, Loewner S, Stanislawski N, Cholewa F, Blume H. Vascular implants - new aspects for in situ tissue engineering. Eng Life Sci 2022; 22:344-360. [PMID: 35382534 PMCID: PMC8961049 DOI: 10.1002/elsc.202100100] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 12/10/2021] [Accepted: 12/19/2021] [Indexed: 12/12/2022] Open
Abstract
Conventional synthetic vascular grafts require ongoing anticoagulation, and autologous venous grafts are often not available in elderly patients. This review highlights the development of bioartificial vessels replacing brain-dead donor- or animal-deriving vessels with ongoing immune reactivity. The vision for such bio-hybrids exists in a combination of biodegradable scaffolds and seeding with immune-neutral cells, and here different cells sources such as autologous progenitor cells or stem cells are relevant. This kind of in situ tissue engineering depends on a suitable bioreactor system with elaborate monitoring systems, three-dimensional (3D) visualization and a potential of cell conditioning into the direction of the targeted vascular cell phenotype. Necessary bioreactor tools for dynamic and pulsatile cultivation are described. In addition, a concept for design of vasa vasorum is outlined, that is needed for sustainable nutrition of the wall structure in large caliber vessels. For scaffold design and cell adhesion additives, different materials and technologies are discussed. 3D printing is introduced as a relatively new field with promising prospects, for example, to create complex geometries or micro-structured surfaces for optimal cell adhesion and ingrowth in a standardized and custom designed procedure. Summarizing, a bio-hybrid vascular prosthesis from a controlled biotechnological process is thus coming more and more into view. It has the potential to withstand strict approval requirements applied for advanced therapy medicinal products.
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Affiliation(s)
- Cornelia Blume
- Institute for Technical ChemistryLeibniz University HannoverHannoverGermany
| | - Xenia Kraus
- Institute for Technical ChemistryLeibniz University HannoverHannoverGermany
| | - Sebastian Heene
- Institute for Technical ChemistryLeibniz University HannoverHannoverGermany
| | - Sebastian Loewner
- Institute for Technical ChemistryLeibniz University HannoverHannoverGermany
| | - Nils Stanislawski
- Institute for Microelectronic SystemsLeibniz University HannoverHannoverGermany
| | - Fabian Cholewa
- Institute for Microelectronic SystemsLeibniz University HannoverHannoverGermany
| | - Holger Blume
- Institute for Microelectronic SystemsLeibniz University HannoverHannoverGermany
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10
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Garven E, Rodell CB, Shema K, Govender K, Cassel SE, Ferrick B, Kupsho G, Kung E, Spiller KL, Stevens R, Throckmorton AL. Tunable Blood Shunt for Neonates With Complex Congenital Heart Defects. Front Bioeng Biotechnol 2022; 9:734310. [PMID: 35096785 PMCID: PMC8794538 DOI: 10.3389/fbioe.2021.734310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 11/17/2021] [Indexed: 11/13/2022] Open
Abstract
Despite advancements in procedures and patient care, mortality rates for neonatal recipients of the Norwood procedure, a palliation for single ventricle congenital malformations, remain high due to the use of a fixed-diameter blood shunt. In this study, a new geometrically tunable blood shunt was investigated to address limitations of the current treatment paradigm (e.g., Modified Blalock-Taussig Shunt) by allowing for controlled modulation of blood flow through the shunt to accommodate physiological changes due to the patient’s growth. First, mathematical and computational cardiovascular models were established to investigate the hemodynamic requirements of growing neonatal patients with shunts and to inform design criteria for shunt diameter changes. Then, two stages of prototyping were performed to design, build and test responsive hydrogel systems that facilitate tuning of the shunt diameter by adjusting the hydrogel’s degree of crosslinking. We examined two mechanisms to drive crosslinking: infusion of chemical crosslinking agents and near-UV photoinitiation. The growth model showed that 15–18% increases in shunt diameter were required to accommodate growing patients’ increasing blood flow; similarly, the computational models demonstrated that blood flow magnitudes were in agreement with previous reports. These target levels of diameter increases were achieved experimentally with model hydrogel systems. We also verified that the photocrosslinkable hydrogel, composed of methacrylated dextran, was contact-nonhemolytic. These results demonstrate proof-of-concept feasibility and reflect the first steps in the development of this novel blood shunt. A tunable shunt design offers a new methodology to rebalance blood flow in this vulnerable patient population during growth and development.
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Affiliation(s)
- Ellen Garven
- BioCirc Research Laboratory, School of Biomedical Engineering, Science, and Health Systems, Drexel University, Philadelphia, PA, United States
| | - Christopher B. Rodell
- Tissue Instructive Materials Laboratory, School of Biomedical Engineering, Science, and Health Systems, Drexel University, Philadelphia, PA, United States
| | - Kristen Shema
- BioCirc Research Laboratory, School of Biomedical Engineering, Science, and Health Systems, Drexel University, Philadelphia, PA, United States
- Biomaterials and Regenerative Medicine Laboratory, School of Biomedical Engineering, Science, and Health Systems, Drexel University, Philadelphia, PA, United States
| | - Krianthan Govender
- BioCirc Research Laboratory, School of Biomedical Engineering, Science, and Health Systems, Drexel University, Philadelphia, PA, United States
- Biomaterials and Regenerative Medicine Laboratory, School of Biomedical Engineering, Science, and Health Systems, Drexel University, Philadelphia, PA, United States
| | - Samantha E. Cassel
- BioCirc Research Laboratory, School of Biomedical Engineering, Science, and Health Systems, Drexel University, Philadelphia, PA, United States
- Biomaterials and Regenerative Medicine Laboratory, School of Biomedical Engineering, Science, and Health Systems, Drexel University, Philadelphia, PA, United States
| | - Bryan Ferrick
- BioCirc Research Laboratory, School of Biomedical Engineering, Science, and Health Systems, Drexel University, Philadelphia, PA, United States
- Biomaterials and Regenerative Medicine Laboratory, School of Biomedical Engineering, Science, and Health Systems, Drexel University, Philadelphia, PA, United States
| | - Gabriella Kupsho
- BioCirc Research Laboratory, School of Biomedical Engineering, Science, and Health Systems, Drexel University, Philadelphia, PA, United States
| | - Ethan Kung
- Department of Mechanical Engineering and Bioengineering, Clemson University, Clemson, SC, United States
| | - Kara L. Spiller
- Biomaterials and Regenerative Medicine Laboratory, School of Biomedical Engineering, Science, and Health Systems, Drexel University, Philadelphia, PA, United States
| | - Randy Stevens
- Pediatrics, College of Medicine, Drexel University, Philadelphia, PA, United States
- Heart Center for Children, St. Christopher’s Hospital for Children, Philadelphia, PA, United States
| | - Amy L. Throckmorton
- BioCirc Research Laboratory, School of Biomedical Engineering, Science, and Health Systems, Drexel University, Philadelphia, PA, United States
- *Correspondence: Amy L. Throckmorton,
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11
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Blum KM, Zbinden JC, Ramachandra AB, Lindsey SE, Szafron JM, Reinhardt JW, Heitkemper M, Best CA, Mirhaidari GJM, Chang YC, Ulziibayar A, Kelly J, Shah KV, Drews JD, Zakko J, Miyamoto S, Matsuzaki Y, Iwaki R, Ahmad H, Daulton R, Musgrave D, Wiet MG, Heuer E, Lawson E, Schwarz E, McDermott MR, Krishnamurthy R, Krishnamurthy R, Hor K, Armstrong AK, Boe BA, Berman DP, Trask AJ, Humphrey JD, Marsden AL, Shinoka T, Breuer CK. Tissue engineered vascular grafts transform into autologous neovessels capable of native function and growth. COMMUNICATIONS MEDICINE 2022; 2:3. [PMID: 35603301 PMCID: PMC9053249 DOI: 10.1038/s43856-021-00063-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Accepted: 11/30/2021] [Indexed: 11/09/2022] Open
Abstract
Background Tissue-engineered vascular grafts (TEVGs) have the potential to advance the surgical management of infants and children requiring congenital heart surgery by creating functional vascular conduits with growth capacity. Methods Herein, we used an integrative computational-experimental approach to elucidate the natural history of neovessel formation in a large animal preclinical model; combining an in vitro accelerated degradation study with mechanical testing, large animal implantation studies with in vivo imaging and histology, and data-informed computational growth and remodeling models. Results Our findings demonstrate that the structural integrity of the polymeric scaffold is lost over the first 26 weeks in vivo, while polymeric fragments persist for up to 52 weeks. Our models predict that early neotissue accumulation is driven primarily by inflammatory processes in response to the implanted polymeric scaffold, but that turnover becomes progressively mechano-mediated as the scaffold degrades. Using a lamb model, we confirm that early neotissue formation results primarily from the foreign body reaction induced by the scaffold, resulting in an early period of dynamic remodeling characterized by transient TEVG narrowing. As the scaffold degrades, mechano-mediated neotissue remodeling becomes dominant around 26 weeks. After the scaffold degrades completely, the resulting neovessel undergoes growth and remodeling that mimicks native vessel behavior, including biological growth capacity, further supported by fluid-structure interaction simulations providing detailed hemodynamic and wall stress information. Conclusions These findings provide insights into TEVG remodeling, and have important implications for clinical use and future development of TEVGs for children with congenital heart disease.
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Affiliation(s)
- Kevin M. Blum
- Center for Regenerative Medicine, Abigail Wexner Research Institute at Nationwide Children’s Hospital, Columbus, OH 43205 USA
- Department of Biomedical Engineering, The Ohio State University, Columbus, OH 43210 USA
| | - Jacob C. Zbinden
- Center for Regenerative Medicine, Abigail Wexner Research Institute at Nationwide Children’s Hospital, Columbus, OH 43205 USA
- Department of Biomedical Engineering, The Ohio State University, Columbus, OH 43210 USA
| | | | - Stephanie E. Lindsey
- Department of Pediatrics (Cardiology), Stanford University, Stanford, CA 94305 USA
- Institute for Computational and Mathematical Engineering (ICME), Stanford University, Stanford, CA 94305 USA
| | - Jason M. Szafron
- Department of Biomedical Engineering, Yale University, New Haven, CT 06520 USA
| | - James W. Reinhardt
- Center for Regenerative Medicine, Abigail Wexner Research Institute at Nationwide Children’s Hospital, Columbus, OH 43205 USA
| | - Megan Heitkemper
- Center for Regenerative Medicine, Abigail Wexner Research Institute at Nationwide Children’s Hospital, Columbus, OH 43205 USA
| | - Cameron A. Best
- Center for Regenerative Medicine, Abigail Wexner Research Institute at Nationwide Children’s Hospital, Columbus, OH 43205 USA
- The Ohio State University College of Medicine, Columbus, OH 43210 USA
| | - Gabriel J. M. Mirhaidari
- Center for Regenerative Medicine, Abigail Wexner Research Institute at Nationwide Children’s Hospital, Columbus, OH 43205 USA
| | - Yu-Chun Chang
- Center for Regenerative Medicine, Abigail Wexner Research Institute at Nationwide Children’s Hospital, Columbus, OH 43205 USA
| | - Anudari Ulziibayar
- Center for Regenerative Medicine, Abigail Wexner Research Institute at Nationwide Children’s Hospital, Columbus, OH 43205 USA
| | - John Kelly
- Center for Regenerative Medicine, Abigail Wexner Research Institute at Nationwide Children’s Hospital, Columbus, OH 43205 USA
- The Heart Center, Nationwide Children’s Hospital, Columbus, OH 43205 USA
| | - Kejal V. Shah
- Center for Regenerative Medicine, Abigail Wexner Research Institute at Nationwide Children’s Hospital, Columbus, OH 43205 USA
| | - Joseph D. Drews
- Center for Regenerative Medicine, Abigail Wexner Research Institute at Nationwide Children’s Hospital, Columbus, OH 43205 USA
- Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH 43210 USA
| | - Jason Zakko
- Center for Regenerative Medicine, Abigail Wexner Research Institute at Nationwide Children’s Hospital, Columbus, OH 43205 USA
- Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH 43210 USA
| | - Shinka Miyamoto
- Center for Regenerative Medicine, Abigail Wexner Research Institute at Nationwide Children’s Hospital, Columbus, OH 43205 USA
- Department of Cardiovascular Surgery at Tokyo Women’s Medical University, Tokyo, Japan
| | - Yuichi Matsuzaki
- Center for Regenerative Medicine, Abigail Wexner Research Institute at Nationwide Children’s Hospital, Columbus, OH 43205 USA
| | - Ryuma Iwaki
- Center for Regenerative Medicine, Abigail Wexner Research Institute at Nationwide Children’s Hospital, Columbus, OH 43205 USA
| | - Hira Ahmad
- Center for Regenerative Medicine, Abigail Wexner Research Institute at Nationwide Children’s Hospital, Columbus, OH 43205 USA
- Department of Pediatric Colorectal and Pelvic Reconstructive Surgery, Nationwide Children’s Hospital, Columbus, OH 43205 USA
| | - Robbie Daulton
- Center for Regenerative Medicine, Abigail Wexner Research Institute at Nationwide Children’s Hospital, Columbus, OH 43205 USA
- University of Cincinnati College of Medicine 3230 Eden Ave, Cincinnati, OH 45267 USA
| | - Drew Musgrave
- Center for Regenerative Medicine, Abigail Wexner Research Institute at Nationwide Children’s Hospital, Columbus, OH 43205 USA
| | - Matthew G. Wiet
- Center for Regenerative Medicine, Abigail Wexner Research Institute at Nationwide Children’s Hospital, Columbus, OH 43205 USA
- The Ohio State University College of Medicine, Columbus, OH 43210 USA
| | - Eric Heuer
- Center for Regenerative Medicine, Abigail Wexner Research Institute at Nationwide Children’s Hospital, Columbus, OH 43205 USA
| | - Emily Lawson
- The Ohio State University College of Medicine, Columbus, OH 43210 USA
| | - Erica Schwarz
- Department of Bioengineering, Stanford University, Stanford, CA 94304 USA
| | - Michael R. McDermott
- Center for Cardiovascular Research, Abigail Wexner Research Institute at Nationwide Children’s Hospital, Columbus, OH 43205 USA
| | - Rajesh Krishnamurthy
- Department of Radiology, Nationwide Children’s Hospital, Columbus, Ohio 43205 USA
| | | | - Kan Hor
- The Heart Center, Nationwide Children’s Hospital, Columbus, OH 43205 USA
| | - Aimee K. Armstrong
- The Heart Center, Nationwide Children’s Hospital, Columbus, OH 43205 USA
| | - Brian A. Boe
- The Heart Center, Nationwide Children’s Hospital, Columbus, OH 43205 USA
| | - Darren P. Berman
- The Heart Center, Nationwide Children’s Hospital, Columbus, OH 43205 USA
| | - Aaron J. Trask
- Center for Cardiovascular Research, Abigail Wexner Research Institute at Nationwide Children’s Hospital, Columbus, OH 43205 USA
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH 43210 USA
| | - Jay D. Humphrey
- Department of Biomedical Engineering, Yale University, New Haven, CT 06520 USA
| | - Alison L. Marsden
- Institute for Computational and Mathematical Engineering (ICME), Stanford University, Stanford, CA 94305 USA
- Department of Bioengineering, Stanford University, Stanford, CA 94304 USA
| | - Toshiharu Shinoka
- The Heart Center, Nationwide Children’s Hospital, Columbus, OH 43205 USA
- Department of Cardiothoracic Surgery, The Ohio State University College of Medicine, Columbus, OH 43205 USA
| | - Christopher K. Breuer
- Center for Regenerative Medicine, Abigail Wexner Research Institute at Nationwide Children’s Hospital, Columbus, OH 43205 USA
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12
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Yousefi-Ahmadipour A, Asadi F, Pirsadeghi A, Nazeri N, Vahidi R, Abazari MF, Afgar A, Mirzaei-Parsa MJ. Current Status of Stem Cell Therapy and Nanofibrous Scaffolds in Cardiovascular Tissue Engineering. REGENERATIVE ENGINEERING AND TRANSLATIONAL MEDICINE 2021. [DOI: 10.1007/s40883-021-00230-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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13
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Schwarz EL, Kelly JM, Blum KM, Hor KN, Yates AR, Zbinden JC, Verma A, Lindsey SE, Ramachandra AB, Szafron JM, Humphrey JD, Shin'oka T, Marsden AL, Breuer CK. Hemodynamic performance of tissue-engineered vascular grafts in Fontan patients. NPJ Regen Med 2021; 6:38. [PMID: 34294733 PMCID: PMC8298568 DOI: 10.1038/s41536-021-00148-w] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Accepted: 06/11/2021] [Indexed: 02/06/2023] Open
Abstract
In the field of congenital heart surgery, tissue-engineered vascular grafts (TEVGs) are a promising alternative to traditionally used synthetic grafts. Our group has pioneered the use of TEVGs as a conduit between the inferior vena cava and the pulmonary arteries in the Fontan operation. The natural history of graft remodeling and its effect on hemodynamic performance has not been well characterized. In this study, we provide a detailed analysis of the first U.S. clinical trial evaluating TEVGs in the treatment of congenital heart disease. We show two distinct phases of graft remodeling: an early phase distinguished by rapid changes in graft geometry and a second phase of sustained growth and decreased graft stiffness. Using clinically informed and patient-specific computational fluid dynamics (CFD) simulations, we demonstrate how changes to TEVG geometry, thickness, and stiffness affect patient hemodynamics. We show that metrics of patient hemodynamics remain within normal ranges despite clinically observed levels of graft narrowing. These insights strengthen the continued clinical evaluation of this technology while supporting recent indications that reversible graft narrowing can be well tolerated, thus suggesting caution before intervening clinically.
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Affiliation(s)
- Erica L Schwarz
- Department of Bioengineering, Stanford University, Stanford, CA, USA.
| | - John M Kelly
- Center for Regenerative Medicine, Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH, USA
- The Heart Center, Nationwide Children's Hospital, Columbus, OH, USA
| | - Kevin M Blum
- Center for Regenerative Medicine, Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH, USA
- Department of Biomedical Engineering, The Ohio State University, Columbus, OH, USA
| | - Kan N Hor
- The Heart Center, Nationwide Children's Hospital, Columbus, OH, USA
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Andrew R Yates
- The Heart Center, Nationwide Children's Hospital, Columbus, OH, USA
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Jacob C Zbinden
- Center for Regenerative Medicine, Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH, USA
- Department of Biomedical Engineering, The Ohio State University, Columbus, OH, USA
| | - Aekaansh Verma
- Department of Bioengineering, Stanford University, Stanford, CA, USA
| | - Stephanie E Lindsey
- Department of Bioengineering, Stanford University, Stanford, CA, USA
- Department of Pediatrics, Stanford University, Stanford, CA, USA
| | | | - Jason M Szafron
- Department of Biomedical Engineering, Yale University, New Haven, CT, USA
| | - Jay D Humphrey
- Department of Biomedical Engineering, Yale University, New Haven, CT, USA
| | - Toshiharu Shin'oka
- Center for Regenerative Medicine, Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH, USA
- The Heart Center, Nationwide Children's Hospital, Columbus, OH, USA
- Department of Cardiothoracic Surgery, Nationwide Children's Hospital, Columbus, OH, USA
| | - Alison L Marsden
- Department of Bioengineering, Stanford University, Stanford, CA, USA
- Department of Pediatrics, Stanford University, Stanford, CA, USA
| | - Christopher K Breuer
- Center for Regenerative Medicine, Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH, USA
- Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA
- Department of Surgery, Nationwide Children's Hospital, Columbus, OH, USA
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14
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Assessment of Electrospun Pellethane-Based Scaffolds for Vascular Tissue Engineering. MATERIALS 2021; 14:ma14133678. [PMID: 34279249 PMCID: PMC8269885 DOI: 10.3390/ma14133678] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 06/12/2021] [Accepted: 06/28/2021] [Indexed: 11/16/2022]
Abstract
We examined the physicochemical properties and the biocompatibility and hemocompatibility of electrospun 3D matrices produced using polyurethane Pellethane 2363-80A (Pel-80A) blends Pel-80A with gelatin or/and bivalirudin. Two layers of vascular grafts of 1.8 mm in diameter were manufactured and studied for hemocompatibility ex vivo and functioning in the infrarenal position of Wistar rat abdominal aorta in vivo (n = 18). Expanded polytetrafluoroethylene (ePTFE) vascular grafts of similar diameter were implanted as a control (n = 18). Scaffolds produced from Pel-80A with Gel showed high stiffness with a long proportional limit and limited influence of wetting on mechanical characteristics. The electrospun matrices with gelatin have moderate capacity to support cell adhesion and proliferation (~30–47%), whereas vascular grafts with bivalirudin in the inner layer have good hemocompatibility ex vivo. The introduction of bivalirudin into grafts inhibited platelet adhesion and does not lead to a change hemolysis and D-dimers concentration. Study in vivo indicates the advantages of Pel-80A grafts over ePTFE in terms of graft occlusion, calcification level, and blood velocity after 6 months of implantation. The thickness of neointima in Pel-80A–based grafts stabilizes after three months (41.84 ± 20.21 µm) and does not increase until six months, demonstrating potential for long-term functioning without stenosis and as a suitable candidate for subsequent preclinical studies in large animals.
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15
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Birer M, Acartürk F. Telmisartan loaded polycaprolactone/gelatin-based electrospun vascular scaffolds. INT J POLYM MATER PO 2021. [DOI: 10.1080/00914037.2021.1915785] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Affiliation(s)
- Mehmet Birer
- Department of Pharmaceutical Technology, Gazi University Faculty of Pharmacy, Ankara, Turkey
| | - Füsun Acartürk
- Department of Pharmaceutical Technology, Gazi University Faculty of Pharmacy, Ankara, Turkey
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16
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Drews JD, Pepper VK, Best CA, Szafron JM, Cheatham JP, Yates AR, Hor KN, Zbinden JC, Chang YC, Mirhaidari GJM, Ramachandra AB, Miyamoto S, Blum KM, Onwuka EA, Zakko J, Kelly J, Cheatham SL, King N, Reinhardt JW, Sugiura T, Miyachi H, Matsuzaki Y, Breuer J, Heuer ED, West TA, Shoji T, Berman D, Boe BA, Asnes J, Galantowicz M, Matsumura G, Hibino N, Marsden AL, Pober JS, Humphrey JD, Shinoka T, Breuer CK. Spontaneous reversal of stenosis in tissue-engineered vascular grafts. Sci Transl Med 2021; 12:12/537/eaax6919. [PMID: 32238576 DOI: 10.1126/scitranslmed.aax6919] [Citation(s) in RCA: 64] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2019] [Revised: 10/27/2019] [Accepted: 02/21/2020] [Indexed: 12/12/2022]
Abstract
We developed a tissue-engineered vascular graft (TEVG) for use in children and present results of a U.S. Food and Drug Administration (FDA)-approved clinical trial evaluating this graft in patients with single-ventricle cardiac anomalies. The TEVG was used as a Fontan conduit to connect the inferior vena cava and pulmonary artery, but a high incidence of graft narrowing manifested within the first 6 months, which was treated successfully with angioplasty. To elucidate mechanisms underlying this early stenosis, we used a data-informed, computational model to perform in silico parametric studies of TEVG development. The simulations predicted early stenosis as observed in our clinical trial but suggested further that such narrowing could reverse spontaneously through an inflammation-driven, mechano-mediated mechanism. We tested this unexpected, model-generated hypothesis by implanting TEVGs in an ovine inferior vena cava interposition graft model, which confirmed the prediction that TEVG stenosis resolved spontaneously and was typically well tolerated. These findings have important implications for our translational research because they suggest that angioplasty may be safely avoided in patients with asymptomatic early stenosis, although there will remain a need for appropriate medical monitoring. The simulations further predicted that the degree of reversible narrowing can be mitigated by altering the scaffold design to attenuate early inflammation and increase mechano-sensing by the synthetic cells, thus suggesting a new paradigm for optimizing next-generation TEVGs. We submit that there is considerable translational advantage to combined computational-experimental studies when designing cutting-edge technologies and their clinical management.
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Affiliation(s)
- Joseph D Drews
- Center for Regenerative Medicine, Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH 43205, USA.,Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA
| | - Victoria K Pepper
- Center for Regenerative Medicine, Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH 43205, USA
| | - Cameron A Best
- Center for Regenerative Medicine, Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH 43205, USA.,Biomedical Sciences Graduate Program, The Ohio State University College of Medicine, Columbus, OH 43210, USA
| | - Jason M Szafron
- Department of Biomedical Engineering, Yale University, New Haven, CT 06520, USA
| | - John P Cheatham
- The Heart Center, Nationwide Children's Hospital, Columbus, OH 43205, USA
| | - Andrew R Yates
- The Heart Center, Nationwide Children's Hospital, Columbus, OH 43205, USA.,Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH 43210, USA
| | - Kan N Hor
- The Heart Center, Nationwide Children's Hospital, Columbus, OH 43205, USA.,Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH 43210, USA
| | - Jacob C Zbinden
- Center for Regenerative Medicine, Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH 43205, USA.,Department of Biomedical Engineering, The Ohio State University, Columbus, OH 43210, USA
| | - Yu-Chun Chang
- Center for Regenerative Medicine, Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH 43205, USA.,Biomedical Sciences Graduate Program, The Ohio State University College of Medicine, Columbus, OH 43210, USA
| | - Gabriel J M Mirhaidari
- Center for Regenerative Medicine, Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH 43205, USA.,Biomedical Sciences Graduate Program, The Ohio State University College of Medicine, Columbus, OH 43210, USA
| | - Abhay B Ramachandra
- Department of Biomedical Engineering, Yale University, New Haven, CT 06520, USA
| | - Shinka Miyamoto
- Center for Regenerative Medicine, Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH 43205, USA
| | - Kevin M Blum
- Center for Regenerative Medicine, Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH 43205, USA.,Department of Biomedical Engineering, The Ohio State University, Columbus, OH 43210, USA
| | - Ekene A Onwuka
- Center for Regenerative Medicine, Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH 43205, USA.,Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA
| | - Jason Zakko
- Center for Regenerative Medicine, Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH 43205, USA.,Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA
| | - John Kelly
- Center for Regenerative Medicine, Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH 43205, USA.,The Heart Center, Nationwide Children's Hospital, Columbus, OH 43205, USA
| | - Sharon L Cheatham
- The Heart Center, Nationwide Children's Hospital, Columbus, OH 43205, USA
| | - Nakesha King
- Center for Regenerative Medicine, Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH 43205, USA.,Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA
| | - James W Reinhardt
- Center for Regenerative Medicine, Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH 43205, USA
| | - Tadahisa Sugiura
- Center for Regenerative Medicine, Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH 43205, USA
| | - Hideki Miyachi
- Center for Regenerative Medicine, Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH 43205, USA
| | - Yuichi Matsuzaki
- Center for Regenerative Medicine, Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH 43205, USA
| | - Julie Breuer
- Center for Regenerative Medicine, Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH 43205, USA
| | - Eric D Heuer
- Center for Regenerative Medicine, Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH 43205, USA
| | - T Aaron West
- Center for Regenerative Medicine, Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH 43205, USA
| | - Toshihiro Shoji
- Center for Regenerative Medicine, Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH 43205, USA
| | - Darren Berman
- The Heart Center, Nationwide Children's Hospital, Columbus, OH 43205, USA
| | - Brian A Boe
- The Heart Center, Nationwide Children's Hospital, Columbus, OH 43205, USA
| | - Jeremy Asnes
- Department of Pediatrics, Yale School of Medicine, New Haven, CT 06520, USA
| | - Mark Galantowicz
- The Heart Center, Nationwide Children's Hospital, Columbus, OH 43205, USA.,Department of Cardiothoracic Surgery, Nationwide Children's Hospital, Columbus, OH 43205, USA
| | - Goki Matsumura
- Department of Cardiovascular Surgery, Tokyo Women's Medical University, Tokyo, Japan
| | - Narutoshi Hibino
- Department of Surgery, University of Chicago/Advocate Children's Hospital, Chicago, IL 60453, USA
| | - Alison L Marsden
- Departments of Pediatrics and Bioengineering, Stanford University, Stanford, CA 94304, USA
| | - Jordan S Pober
- Department of Immunobiology, Yale University, New Haven, CT 06520, USA
| | - Jay D Humphrey
- Department of Biomedical Engineering, Yale University, New Haven, CT 06520, USA
| | - Toshiharu Shinoka
- Center for Regenerative Medicine, Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH 43205, USA.,The Heart Center, Nationwide Children's Hospital, Columbus, OH 43205, USA.,Department of Cardiothoracic Surgery, Nationwide Children's Hospital, Columbus, OH 43205, USA
| | - Christopher K Breuer
- Center for Regenerative Medicine, Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH 43205, USA. .,Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA.,Department of Surgery, Nationwide Children's Hospital, Columbus, OH 43205, USA
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17
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Kim TH, Yan JJ, Jang JY, Lee GM, Lee SK, Kim BS, Chung JJ, Kim SH, Jung Y, Yang J. Tissue-engineered vascular microphysiological platform to study immune modulation of xenograft rejection. SCIENCE ADVANCES 2021; 7:7/22/eabg2237. [PMID: 34049875 PMCID: PMC8163083 DOI: 10.1126/sciadv.abg2237] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Accepted: 04/09/2021] [Indexed: 06/12/2023]
Abstract
Most of the vascular platforms currently being studied are lab-on-a-chip types that mimic capillary networks and are applied for vascular response analysis in vitro. However, these platforms have a limitation in clearly assessing the physiological phenomena of native blood vessels compared to in vivo evaluation. Here, we developed a simply fabricable tissue-engineered vascular microphysiological platform (TEVMP) with a three-dimensional (3D) vascular structure similar to an artery that can be applied for ex vivo and in vivo evaluation. Furthermore, we applied the TEVMP as ex vivo and in vivo screening systems to evaluate the effect of human CD200 (hCD200) overexpression in porcine endothelial cells (PECs) on vascular xenogeneic immune responses. These screening systems, in contrast to 2D in vitro and cellular xenotransplantation in vivo models, clearly demonstrated that hCD200 overexpression effectively suppressed vascular xenograft rejection. The TEVMP has a high potential as a platform to assess various vascular-related responses.
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Affiliation(s)
- Tae Hee Kim
- Center for Biomaterials, Biomedical Research Institute, Korea Institute of Science and Technology (KIST), Seoul, Republic of Korea
| | - Ji-Jing Yan
- Biomedical Research Institute, Seoul National University Hospital, Seoul, Republic of Korea
| | - Joon Young Jang
- Biomedical Research Institute, Seoul National University Hospital, Seoul, Republic of Korea
| | - Gwang-Min Lee
- Biomedical Research Institute, Seoul National University Hospital, Seoul, Republic of Korea
- Department of Medicine, Graduate School, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Sun-Kyung Lee
- Biomedical Research Institute, Seoul National University Hospital, Seoul, Republic of Korea
- Department of Medicine, Graduate School, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Beom Seok Kim
- Division of Nephrology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Justin J Chung
- Center for Biomaterials, Biomedical Research Institute, Korea Institute of Science and Technology (KIST), Seoul, Republic of Korea
| | - Soo Hyun Kim
- Center for Biomaterials, Biomedical Research Institute, Korea Institute of Science and Technology (KIST), Seoul, Republic of Korea
| | - Youngmee Jung
- Center for Biomaterials, Biomedical Research Institute, Korea Institute of Science and Technology (KIST), Seoul, Republic of Korea.
- School of Electrical and Electronic Engineering, YU-KIST Institute, Yonsei University, Seoul, Republic of Korea
| | - Jaeseok Yang
- Biomedical Research Institute, Seoul National University Hospital, Seoul, Republic of Korea.
- Transplantation Center, Seoul National University hospital, Seoul, Republic of Korea
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18
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Matsuzaki Y, Wiet MG, Boe BA, Shinoka T. The Real Need for Regenerative Medicine in the Future of Congenital Heart Disease Treatment. Biomedicines 2021; 9:478. [PMID: 33925558 PMCID: PMC8145070 DOI: 10.3390/biomedicines9050478] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 04/19/2021] [Accepted: 04/24/2021] [Indexed: 11/23/2022] Open
Abstract
Bioabsorbable materials made from polymeric compounds have been used in many fields of regenerative medicine to promote tissue regeneration. These materials replace autologous tissue and, due to their growth potential, make excellent substitutes for cardiovascular applications in the treatment of congenital heart disease. However, there remains a sizable gap between their theoretical advantages and actual clinical application within pediatric cardiovascular surgery. This review will focus on four areas of regenerative medicine in which bioabsorbable materials have the potential to alleviate the burden where current treatment options have been unable to within the field of pediatric cardiovascular surgery. These four areas include tissue-engineered pulmonary valves, tissue-engineered patches, regenerative medicine options for treatment of pulmonary vein stenosis and tissue-engineered vascular grafts. We will discuss the research and development of biocompatible materials reported to date, the evaluation of materials in vitro, and the results of studies that have progressed to clinical trials.
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Affiliation(s)
- Yuichi Matsuzaki
- Center for Regenerative Medicine, The Abigail Wexner Research Institute at Nationwide Children’s Hospital, 700 Children’s Drive, T2294, Columbus, OH 43205, USA; (Y.M.); (M.G.W.)
| | - Matthew G. Wiet
- Center for Regenerative Medicine, The Abigail Wexner Research Institute at Nationwide Children’s Hospital, 700 Children’s Drive, T2294, Columbus, OH 43205, USA; (Y.M.); (M.G.W.)
| | - Brian A. Boe
- Department of Cardiology, The Heart Center, Nationwide Children’s Hospital, 700 Children’s Drive, T2294, Columbus, OH 43205, USA;
| | - Toshiharu Shinoka
- Center for Regenerative Medicine, The Abigail Wexner Research Institute at Nationwide Children’s Hospital, 700 Children’s Drive, T2294, Columbus, OH 43205, USA; (Y.M.); (M.G.W.)
- Department of Cardiothoracic Surgery, The Heart Center, Nationwide Children’s Hospital, 700 Children’s Drive, T2294, Columbus, OH 43205, USA
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Maleckis K, Kamenskiy A, Lichter EZ, Oberley-Deegan R, Dzenis Y, MacTaggart J. Mechanically tuned vascular graft demonstrates rapid endothelialization and integration into the porcine iliac artery wall. Acta Biomater 2021; 125:126-137. [PMID: 33549808 DOI: 10.1016/j.actbio.2021.01.047] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 01/26/2021] [Accepted: 01/28/2021] [Indexed: 12/12/2022]
Abstract
Mechanical properties of vascular grafts likely play important roles in healing and tissue regeneration. Healthy arteries are compliant at low pressures but stiffen rapidly with increasing load, ensuring sufficient volumetric expansion without overstretching the vessel. Commercial synthetic vascular grafts are stiff and unable to expand under physiologic loads, which may result in altered hemodynamics, deleterious cellular responses, and compromised clinical performance. The goal of this study was to develop an Elastomeric Nanofibrillar Graft (ENG) with artery-tuned nonlinear compliance and compare its healing responses to conventional expanded polytetrafluoroethylene (ePTFE) grafts in a porcine iliac artery model. Human and porcine iliac arteries were mechanically characterized, and an ENG with similar properties was created by utilizing residual strains within electrospun nanofibers. The ENG was tested for implantation suitability and implanted onto n = 5 domestic swine iliac arteries, with control ePTFE grafts implanted onto the contralateral iliac arteries. After two weeks in vivo, all iliac arteries and grafts remained patent with no signs of thrombosis or dilation. The mechanically tuned ENG implants exhibited a more confluent CD31-positive cell monolayer (1.53 ± 0.73 µm2/mm vs 0.52 ± 0.55 µm2/mm, p = 0.042) on the graft lumenal surface and a higher fraction of αSMA-positive cells (16.2 ± 8.6% vs 1.4 ± 0.7%, p = 0.018) within the graft wall than the ePTFE controls. Despite heavy cellular infiltration, the ENG retained its artery-like mechanical characteristics after two weeks in vivo. These short-term results demonstrate potential advantages of mechanically tuned biomimetic vascular grafts over standard ePTFE grafts. STATEMENT OF SIGNIFICANCE: Off-the-shelf synthetic vascular grafts are often the only option available for treating advanced stages of vascular disease. Despite significant efforts devoted to improving their biochemical characteristics, synthetic peripheral arterial grafts continue to demonstrate poor clinical outcomes leading to costly reinterventions. Here, we hypothesized that a synthetic vascular graft with elastomeric mechanical properties tuned to a healthy peripheral artery promotes better healing responses than a synthetic stiff graft. To test this hypothesis, we developed an Elastomeric Nanofibrillar Graft (ENG) with artery-tuned mechanical properties and compared its performance to a commercial ePTFE graft in a preclinical porcine iliac artery model. Our results suggest that mechanically tuned ENGs can offer better healing responses, potentially leading to better clinical outcomes for peripheral arterial repairs.
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Abstract
Since the advent of the vascular anastomosis by Alexis Carrel in the early 20th century, the repair and replacement of blood vessels have been key to treating acute injuries, as well as chronic atherosclerotic disease. Arteries serve diverse mechanical and biological functions, such as conducting blood to tissues, interacting with the coagulation system, and modulating resistance to blood flow. Early approaches for arterial replacement used artificial materials, which were supplanted by polymer fabrics in recent decades. With recent advances in the engineering of connective tissues, including arteries, we are on the cusp of seeing engineered human arteries become mainstays of surgical therapy for vascular disease. Progress in our understanding of physiology, cell biology, and biomanufacturing over the past several decades has made these advances possible.
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Affiliation(s)
- Laura E Niklason
- Departments of Anesthesiology and Biomedical Engineering, Yale University, New Haven, CT, USA. .,Humacyte Inc., Durham, NC 27713, USA
| | - Jeffrey H Lawson
- Humacyte Inc., Durham, NC 27713, USA. .,Department of Surgery, Duke University, Durham, NC, USA
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21
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Ebrahimi P, Youssef D, Salve G, Ayer J, Dehghani F, Fletcher DF, Winlaw DS. Evaluation of personalized right ventricle to pulmonary artery conduits using in silico design and computational analysis of flow. JTCVS OPEN 2020; 1:33-48. [PMID: 36003197 PMCID: PMC9390144 DOI: 10.1016/j.xjon.2020.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/09/2019] [Revised: 11/09/2019] [Accepted: 02/03/2020] [Indexed: 11/28/2022]
Abstract
Objectives Right ventricle to pulmonary artery (RV-PA) conduits are required for the surgical management of pulmonary atresia with ventricular septal defect and truncus arteriosus. Bioengineered RV-PA connections may address some of the shortcomings of homografts and xenografts, such as lack of growth potential and structural deterioration and may be manufactured to accommodate patient-specific anatomy. The aim of this study was to develop a methodology for in silico patient-specific design and analysis of RV-PA conduits. Methods Cross-sectional imaging was obtained from patients with truncus arteriosus (n = 5) and pulmonary atresia with ventricular septal defect (n = 5) who underwent complete repair with a RV-PA conduit. Three-dimensional models of the heart were constructed by segmentation of the right ventricle, existing conduit, branch pulmonary arteries, and surrounding structures. A customized conduit design for each patient was proposed. Computational fluid dynamics analysis was performed and outputs, including wall shear stress and energy loss, were used to compare the performance of the existing conduits and the customized geometries. Results In this study, a methodology for patient-specific analysis of RV-PA conduit in silico was developed. The results of simulations for 10 patients showed between 23% and 56% decrease in the average wall shear stress and between 24% and 87% reduction in average power requirements in customized designs compared with the stenosed conduits, translating into better hemodynamic performance. Conclusions Creation of an optimal conduit for an individual patient can be achieved using surgeon-guided design and computational fluid dynamics analysis. Manufacture of personalized RV-PA conduits may obviate the need for surgical customization to accommodate existing materials and provide superior long-term outcomes.
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Affiliation(s)
- Pegah Ebrahimi
- School of Chemical and Biomolecular Engineering, The University of Sydney, Sydney, Australia
- Heart Centre for Children, The Children's Hospital at Westmead, Sydney, Australia
| | - David Youssef
- Heart Centre for Children, The Children's Hospital at Westmead, Sydney, Australia
| | - Gananjay Salve
- Heart Centre for Children, The Children's Hospital at Westmead, Sydney, Australia
| | - Julian Ayer
- Heart Centre for Children, The Children's Hospital at Westmead, Sydney, Australia
- Faculty of Medicine and Health, Discipline of Paediatrics and Child Health, Sydney Medical School, The University of Sydney, Sydney, Australia
| | - Fariba Dehghani
- School of Chemical and Biomolecular Engineering, The University of Sydney, Sydney, Australia
| | - David F. Fletcher
- School of Chemical and Biomolecular Engineering, The University of Sydney, Sydney, Australia
| | - David S. Winlaw
- School of Chemical and Biomolecular Engineering, The University of Sydney, Sydney, Australia
- Faculty of Medicine and Health, Discipline of Paediatrics and Child Health, Sydney Medical School, The University of Sydney, Sydney, Australia
- Address for reprints: David S. Winlaw, MBBS, MD, FRACS, Heart Centre for Children, The Children's Hospital at Westmead, Locked Bag 4001, Corner Hawkesbury Rd and Hainsworth St, Westmead, 2145, Sydney, Australia.
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22
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23
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Miyachi H, Tara S, Otsuru S, Yi T, Lee YU, Drews JD, Nakayama H, Miyamoto S, Sugiura T, Shoji T, Breuer CK, Shinoka T. Imatinib attenuates neotissue formation during vascular remodeling in an arterial bioresorbable vascular graft. JVS Vasc Sci 2020; 1:57-67. [PMID: 34223286 PMCID: PMC8248522 DOI: 10.1016/j.jvssci.2020.03.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
Background Bioresorbable vascular grafts (BVGs) can transform biologically into active blood vessels and represent an alternative to traditional synthetic conduits, which are prone to complications such as infection and thrombosis. Although platelet-derived growth factors and c-Kit positive cells play an important role in smooth muscle cell (SMC) migration and proliferation in vascular injury, atherosclerosis, or allograft, their roles in the vascular remodeling process of an arterial BVG remains unknown. Thus, we assessed the neottisue formation on arterial BVG remodeling by administrating imatinib, which is both a platelet-derived growth factor receptor kinase inhibitor and c-Kit receptor kinase inhibitor, in a murine model. Methods BVGs were composed of an inner poly(L-lactic-co-ε-caprolactone) copolymer sponge layer and an outer electrospun poly(L-lactic acid) nanofiber layer, which were implanted into the infrarenal abdominal aortas of C57BL/6 mice. After graft implantation, saline or 100 mg/kg of imatinib was administrated intraperitoneally daily for 2 weeks (n = 20 per group). Five mice in each group were scheduled to be humanely killed at 3 weeks and 15 at 8 weeks, and BVGs were explanted for histologic assessments. Results Graft patency during the 8-week observational period was not significantly different between groups (control, 86.7% vs imatinib, 80.0%; P > .999). Neotissue formation consisting of endothelialization, smooth muscle proliferation, and deposition of collagen and elastin was not observed in either group at 3 weeks. Similar endothelialization was achieved in both groups at 8 weeks, but thickness and percent area of neotissue formation were significantly higher in the control group than in the imatinib group, (thickness, 30.1 ± 7.2 μm vs 19.6 ± 4.5 μm [P = .001]; percent area, 9.8 ± 2.7% vs 6.8 ± 1.8% [P = .005]). Furthermore, SMC layer and deposition of collagen and elastin were better organized at 8 weeks in the control group compared with the imatinib group. The thickness of SMC layer and collagen fiber area were significantly greater at 8 weeks in the control group than in the imatinib group (P < .001 and P = .026, respectively). Because there was no difference in the inner diameter of explanted BVGs (831.7 ± 63.4 μm vs 841.8 ± 41.9 μm; P = .689), neotissue formation was thought to advance toward the outer portion of the BVG with degradation of the polymer scaffold. Conclusions Imatinib attenuates neotissue formation during vascular remodeling in arterial bioresorbable vascular grafts (BVGs) by inhibiting SMC layer formation and extracellular matrix deposition. This study demonstrated that imatinib attenuated neotissue formation during vascular remodeling in arterial Bioresorbable vascular graft (BVG) by inhibiting smooth muscle cell formation and extracellular matrix deposition. In addition, as imatinib did not modify the inner diameter of BVG, neotissue advanced circumferentially toward the outer portion of the neovessel. Currently, BVGs have not yet been clinically applied to the arterial circulation. The results of this study are helpful for the design of BVG that can achieve an optimal balance between polymer degradation and neotissue formation.
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Affiliation(s)
- Hideki Miyachi
- Center for Regenerative Medicine, Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus.,Department of Cardiovascular Medicine, Nippon Medical School, Tokyo
| | - Shuhei Tara
- Center for Regenerative Medicine, Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus.,Department of Cardiovascular Medicine, Nippon Medical School, Tokyo
| | - Satoru Otsuru
- Center for Childhood Cancer and Blood Disease, Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus.,Department of Orthopaedics, University of Maryland School of Medicine, Baltimore
| | - Tai Yi
- Center for Regenerative Medicine, Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus
| | - Yong-Ung Lee
- Center for Regenerative Medicine, Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus
| | - Joseph D Drews
- Center for Regenerative Medicine, Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus
| | | | - Shinka Miyamoto
- Center for Regenerative Medicine, Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus
| | - Tadahisa Sugiura
- Center for Regenerative Medicine, Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus
| | - Toshihiro Shoji
- Center for Regenerative Medicine, Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus
| | - Christopher K Breuer
- Center for Regenerative Medicine, Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus
| | - Toshiharu Shinoka
- Center for Regenerative Medicine, Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus.,Department of Cardiothoracic Surgery, The Heart Center, Nationwide Children's Hospital, Columbus
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Ferrari MR, Di Maria MV, Jacot JG. Review on Mechanical Support and Cell-Based Therapies for the Prevention and Recovery of the Failed Fontan-Kreutzer Circulation. Front Pediatr 2020; 8:627660. [PMID: 33575233 PMCID: PMC7870783 DOI: 10.3389/fped.2020.627660] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Accepted: 12/31/2020] [Indexed: 12/13/2022] Open
Abstract
Though the current staged surgical strategy for palliation of single ventricle heart disease, culminating in a Fontan circulation, has increased short-term survival, mounting evidence has shown that the single ventricle, especially a morphologic right ventricle (RV), is inadequate for long-term circulatory support. In addition to high rates of ventricular failure, high central venous pressures (CVP) lead to liver fibrosis or cirrhosis, lymphatic dysfunction, kidney failure, and other comorbidities. In this review, we discuss the complications seen with Fontan physiology, including causes of ventricular and multi-organ failure. We then evaluate the clinical use, results, and limitations of long-term mechanical assist devices intended to reduce RV work and high CVP, as well as biological therapies for failed Fontan circulations. Finally, we discuss experimental tissue engineering solutions designed to prevent Fontan circulation failure and evaluate knowledge gaps and needed technology development to realize a more robust single ventricle therapy.
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Affiliation(s)
- Margaret R Ferrari
- Department of Bioengineering, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Michael V Di Maria
- Division of Cardiology, Heart Institute, Children's Hospital Colorado, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Jeffrey G Jacot
- Department of Bioengineering, University of Colorado Anschutz Medical Campus, Aurora, CO, United States.,Department of Pediatrics, Children's Hospital Colorado, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
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25
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Ilanlou S, Khakbiz M, Amoabediny G, Mohammadi J. Preclinical studies of acellular extracellular matrices as small-caliber vascular grafts. Tissue Cell 2019; 60:25-32. [DOI: 10.1016/j.tice.2019.07.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2019] [Revised: 07/28/2019] [Accepted: 07/30/2019] [Indexed: 01/09/2023]
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26
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Yang C, Zhou ZH, Zheng DN, Xu XF, Huang J, Lian Y, Qiao J. Sperm origins and concentration do not impact the clinical outcomes in intracytoplasmic sperm injection cycles. Asian J Androl 2019; 20:454-458. [PMID: 29798938 PMCID: PMC6116677 DOI: 10.4103/aja.aja_27_18] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
In the present study, we evaluated the impact of sperm origins and concentration on the clinical outcomes of intracytoplasmic sperm injection (ICSI) cycles. A total of 1201 ICSI cycles were retrospectively analyzed for male azoospermia or oligozoospermia between January 2015 and December 2015 in the Peking University Third Hospital. Patients were divided into three groups (Group 1 vs Group 2/3; surgically extracted sperm vs ejaculated sperms): Group 1 included 343 ICSI cycles and Group 2 analyzed 388 cycles on semen with sperm concentration <5 × 106 ml−1 (severe oligozoospermia group). Group 3 included 470 cycles with sperm concentration between 5 × 106 ml−1 and 15 × 106 ml−1 (mild oligozoospermia group). Fertilization rates, clinical pregnancy rates, and live birth rates were analyzed and compared among groups of different semen origins and concentrations on the oocyte retrieval day. Group 2 showed a lower fertilization rate than Group 3 (62.9% ± 21.6% vs 66.8% ± 22.1%,P < 0.05). There were no statistically significant differences in clinical pregnancy rate per transfer (51.3%, 46.7%, and 50.0%, respectively), live birth rate per transfer (44.4%, 40.9%, and 41.4%, respectively), accumulative live birth rate (58.3%, 51.0%, and 52.1%, respectively), twin birth rate (18.4%, 10.6%, and 12.6%, respectively), and birth defects rate (0, 0.3%, and 0.2%, respectively) among three groups. The results of this study indicated that sperm origins and concentration do not impact the clinical outcomes in ICSI cycles.
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Affiliation(s)
- Cen Yang
- Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing 100191, China.,Beijing Key Laboratory of Reproductive Endocrinology and Assisted Reproduction Technology, Beijing 100191, China.,Key Laboratory of Assisted Reproduction, Ministry of Education, Beijing 100191, China
| | - Ze-Hong Zhou
- Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing 100191, China.,Beijing Key Laboratory of Reproductive Endocrinology and Assisted Reproduction Technology, Beijing 100191, China.,Key Laboratory of Assisted Reproduction, Ministry of Education, Beijing 100191, China
| | - Dan-Ni Zheng
- Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing 100191, China.,Beijing Key Laboratory of Reproductive Endocrinology and Assisted Reproduction Technology, Beijing 100191, China.,Key Laboratory of Assisted Reproduction, Ministry of Education, Beijing 100191, China
| | - Xiao-Fei Xu
- Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing 100191, China.,Beijing Key Laboratory of Reproductive Endocrinology and Assisted Reproduction Technology, Beijing 100191, China.,Key Laboratory of Assisted Reproduction, Ministry of Education, Beijing 100191, China
| | - Jin Huang
- Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing 100191, China.,Beijing Key Laboratory of Reproductive Endocrinology and Assisted Reproduction Technology, Beijing 100191, China.,Key Laboratory of Assisted Reproduction, Ministry of Education, Beijing 100191, China
| | - Ying Lian
- Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing 100191, China.,Beijing Key Laboratory of Reproductive Endocrinology and Assisted Reproduction Technology, Beijing 100191, China.,Key Laboratory of Assisted Reproduction, Ministry of Education, Beijing 100191, China
| | - Jie Qiao
- Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing 100191, China.,Beijing Key Laboratory of Reproductive Endocrinology and Assisted Reproduction Technology, Beijing 100191, China.,Key Laboratory of Assisted Reproduction, Ministry of Education, Beijing 100191, China
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27
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Szafron JM, Ramachandra AB, Breuer CK, Marsden AL, Humphrey JD. Optimization of Tissue-Engineered Vascular Graft Design Using Computational Modeling. Tissue Eng Part C Methods 2019; 25:561-570. [PMID: 31218941 DOI: 10.1089/ten.tec.2019.0086] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
Tissue-engineered vascular grafts hold great promise in many clinical applications, especially in pediatrics wherein growth potential is critical. A continuing challenge, however, is identification of optimal scaffold parameters for promoting favorable neovessel development. In particular, given the countless design parameters available, including those related to polymeric microstructure, material behavior, and degradation kinetics, the number of possible scaffold designs is almost limitless. Advances in computationally modeling the growth and remodeling of native blood vessels suggest that similar simulations could help reduce the search space for candidate scaffold designs in tissue engineering. In this study, we meld a computational model of in vivo neovessel formation with a surrogate management framework to identify optimal scaffold designs for use in the extracardiac Fontan circulation while comparing the utility of different objective functions. We show that evolving luminal radius and graft compliance can be matched to that of the native vein by the end of the simulation period with judicious combinations of scaffold parameters, although the inability to match these metrics at all times reveals constraints engendered by current materials. We emphasize further that there is yet a need to examine additional metrics, and combinations thereof, when seeking to optimize functionality and reduce the potential for adverse outcomes. Impact Statement Tissue-engineered vascular grafts have considerable promise for treating myriad conditions, and multiple designs are now in FDA-approved trials. Nevertheless, the search continues for the optimal design of the underlying polymeric scaffold. We present a novel melding of a computational model of vascular adaptation and a formal method of optimization that can aid in identifying optimal design parameters, with potential to save development time and costs while improving clinical outcomes.
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Affiliation(s)
- Jason M Szafron
- Department of Biomedical Engineering, Yale University, New Haven, Connecticut
| | - Abhay B Ramachandra
- Department of Biomedical Engineering, Yale University, New Haven, Connecticut
| | | | - Alison L Marsden
- Departments of Pediatrics and Bioengineering, Stanford University, Stanford, California
| | - Jay D Humphrey
- Department of Biomedical Engineering, Yale University, New Haven, Connecticut.,Vascular Biology and Therapeutics Program, Yale School of Medicine, New Haven, Connecticut
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28
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Ellison EC. Time and Change: The Importance of Innovation and Leadership to the Future of Surgery. Ann Surg 2019; 270:391-399. [PMID: 31283564 DOI: 10.1097/sla.0000000000003457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Abstract
Tissue-engineered vascular grafts (TEVGs) are considered one of the most effective means of fabricating vascular grafts. However, for small-diameter TEVGs, there are ongoing issues regarding long-term patency and limitations related to long-term in vitro culture and immune reactions. The use of acellular TEVG is a more convincing method, which can achieve in situ blood vessel regeneration and better meet clinical needs. This review focuses on the current state of acellular TEVGs based on scaffolds and gives a summary of the methodologies and in vitro/in vivo test results related to acellular TEVGs obtained in recent years. Various strategies for improving the properties of acellular TEVGs are also discussed.
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30
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Tejeda-Alejandre R, Lammel-Lindemann JA, Lara-Padilla H, Dean D, Rodriguez CA. Influence of Electrical Field Collector Positioning and Motion Scheme on Electrospun Bifurcated Vascular Graft Membranes. MATERIALS 2019; 12:ma12132123. [PMID: 31269641 PMCID: PMC6651616 DOI: 10.3390/ma12132123] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Revised: 06/26/2019] [Accepted: 06/27/2019] [Indexed: 11/19/2022]
Abstract
Currently, electrospinning membranes for vascular graft applications has been limited, due to random fiber alignment, to use in mandrel-spun, straight tubular shapes. However, straight, circular tubes with constant diameters are rare in the body. This study presents a method to fabricate curved, non-circular, and bifurcated vascular grafts based on electrospinning. In order to create a system capable of electrospinning membranes to meet specific patient needs, this study focused on characterizing the influence of fiber source, electrical field collector position (inside vs. outside the mandrel), and the motion scheme of the mandrel (rotation vs. rotation and tilting) on the vascular graft membrane morphology and mechanical properties. Given the extensive use of poly(ε-caprolactone) (PCL) in tubular vascular graft membranes, the same material was used here to facilitate a comparison. Our results showed that the best morphology was obtained using orthogonal sources and collector positioning, and a well-timed rotation and tilting motion scheme. In terms of mechanical properties, our bifurcated vascular graft membranes showed burst pressure comparable to that of tubular vascular graft membranes previously reported, with values up to 5126 mmHg. However, the suture retention strength shown by the bifurcated vascular graft membranes was less than desired, not clinically viable values. Process improvements are being contemplated to introduce these devices into the clinical range.
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Affiliation(s)
- Raquel Tejeda-Alejandre
- Tecnologico de Monterrey, Escuela de Ingeniería y Ciencias, Monterrey, N.L. 64849, Mexico
- Laboratorio Nacional de Manufactura Aditiva y Digital (MADIT), Apodaca, N.L. 66629, Mexico
- Department of Plastic and Reconstructive Surgery, The Ohio State University, Columbus, OH 43210, USA
| | - Jan A Lammel-Lindemann
- Tecnologico de Monterrey, Escuela de Ingeniería y Ciencias, Monterrey, N.L. 64849, Mexico
- Department of Plastic and Reconstructive Surgery, The Ohio State University, Columbus, OH 43210, USA
- Department of Surgery, Houston Methodist Hospital, Houston, TX 77030, USA
| | - Hernan Lara-Padilla
- Departamento de Ciencias de la Energía y Mecánica, Universidad de las Fuerzas Armadas ESPE, Sangolquí 171-5-231B, Ecuador
| | - David Dean
- Department of Plastic and Reconstructive Surgery, The Ohio State University, Columbus, OH 43210, USA
| | - Ciro A Rodriguez
- Tecnologico de Monterrey, Escuela de Ingeniería y Ciencias, Monterrey, N.L. 64849, Mexico.
- Laboratorio Nacional de Manufactura Aditiva y Digital (MADIT), Apodaca, N.L. 66629, Mexico.
- Department of Plastic and Reconstructive Surgery, The Ohio State University, Columbus, OH 43210, USA.
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31
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Boyd R, Parisi F, Kalfa D. State of the Art: Tissue Engineering in Congenital Heart Surgery. Semin Thorac Cardiovasc Surg 2019; 31:807-817. [PMID: 31176798 DOI: 10.1053/j.semtcvs.2019.05.023] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Accepted: 05/28/2019] [Indexed: 12/17/2022]
Abstract
Congenital heart disease is the leading cause of death secondary to congenital abnormalities in the United States and the incidence has increased significantly over the last 50 years. For those defects requiring surgical repair, bioprosthetic xenografts, allografts, and synthetic materials have traditionally been used. However, none of these modalities offer the potential for growth and accommodation within the pediatric population. Tissue engineering has been an area of great interest in a variety of cardiac applications as an innovative solution to create a product that can grow and regenerate within the body over time. Over the last 30 years, the original tissue engineering paradigm of a scaffold seeded with cells and cultured in a bioreactor has been expanded upon to include innovative methods of decellularization and production of "off-the-shelf" tissue-engineered products capable of in situ host cell repopulation. Despite progress in conceptual design and promising clinical results, widespread use of tissue-engineered products remains limited due to both regulatory and ongoing scientific challenges. Here, we describe the current state of the art with regards to in vitro, in vivo, and in situ tissue engineering as applicable within the field of congenital heart surgery and provide a brief overview of challenges and future directions.
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Affiliation(s)
- Rebekah Boyd
- Division of Cardiac, Thoracic and Vascular Surgery, Section of Pediatric and Congenital Cardiac Surgery, New-York Presbyterian Morgan Stanley Children's Hospital, Columbia University Medical Center, New York, New York
| | - Frank Parisi
- Division of Cardiac, Thoracic and Vascular Surgery, Section of Pediatric and Congenital Cardiac Surgery, New-York Presbyterian Morgan Stanley Children's Hospital, Columbia University Medical Center, New York, New York
| | - David Kalfa
- Division of Cardiac, Thoracic and Vascular Surgery, Section of Pediatric and Congenital Cardiac Surgery, New-York Presbyterian Morgan Stanley Children's Hospital, Columbia University Medical Center, New York, New York.
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32
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Matsuzaki Y, John K, Shoji T, Shinoka T. The Evolution of Tissue Engineered Vascular Graft Technologies: From Preclinical Trials to Advancing Patient Care. APPLIED SCIENCES (BASEL, SWITZERLAND) 2019; 9:1274. [PMID: 31890320 PMCID: PMC6937136 DOI: 10.3390/app9071274] [Citation(s) in RCA: 68] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Currently available synthetic grafts have contributed to improved outcomes in cardiovascular surgery. However, the implementation of these graft materials at small diameters have demonstrated poor patency, inhibiting their use for coronary artery bypass surgery in adults. Additionally, when applied to a pediatric patient population, they are handicapped by their lack of growth ability. Tissue engineered alternatives could possibly address these limitations by producing biocompatible implants with the ability to repair, remodel, grow, and regenerate. A tissue engineered vascular graft (TEVG) generally consists of a scaffold, seeded cells, and the appropriate environmental cues (i.e., growth factors, physical stimulation) to induce tissue formation. This review critically appraises current state-of-the-art techniques for vascular graft production. We additionally examine current graft shortcomings and future prospects, as they relate to cardiovascular surgery, from two major clinical trials.
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Affiliation(s)
- Yuichi Matsuzaki
- Center for Regenerative Medicine, Nationwide Children’s Hospital, Columbus, OH 43205, USA
| | - Kelly John
- Center for Regenerative Medicine, Nationwide Children’s Hospital, Columbus, OH 43205, USA
| | - Toshihiro Shoji
- Center for Regenerative Medicine, Nationwide Children’s Hospital, Columbus, OH 43205, USA
| | - Toshiharu Shinoka
- Center for Regenerative Medicine, Nationwide Children’s Hospital, Columbus, OH 43205, USA
- Department of Cardiothoracic Surgery, Nationwide Children’s Hospital, Columbus, OH 43205, USA
- Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA
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Colunga T, Hayworth M, Kreß S, Reynolds DM, Chen L, Nazor KL, Baur J, Singh AM, Loring JF, Metzger M, Dalton S. Human Pluripotent Stem Cell-Derived Multipotent Vascular Progenitors of the Mesothelium Lineage Have Utility in Tissue Engineering and Repair. Cell Rep 2019; 26:2566-2579.e10. [PMID: 30840882 PMCID: PMC6585464 DOI: 10.1016/j.celrep.2019.02.016] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Revised: 11/30/2018] [Accepted: 02/02/2019] [Indexed: 01/01/2023] Open
Abstract
In this report we describe a human pluripotent stem cell-derived vascular progenitor (MesoT) cell of the mesothelium lineage. MesoT cells are multipotent and generate smooth muscle cells, endothelial cells, and pericytes and self-assemble into vessel-like networks in vitro. MesoT cells transplanted into mechanically damaged neonatal mouse heart migrate into the injured tissue and contribute to nascent coronary vessels in the repair zone. When seeded onto decellularized vascular scaffolds, MesoT cells differentiate into the major vascular lineages and self-assemble into vasculature capable of supporting peripheral blood flow following transplantation. These findings demonstrate in vivo functionality and the potential utility of MesoT cells in vascular engineering applications.
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Affiliation(s)
- Thomas Colunga
- Department of Biochemistry and Molecular Biology and Center for Molecular Medicine, University of Georgia, 325 Riverbend Road, Athens, GA 30605, USA
| | - Miranda Hayworth
- Department of Biochemistry and Molecular Biology and Center for Molecular Medicine, University of Georgia, 325 Riverbend Road, Athens, GA 30605, USA
| | - Sebastian Kreß
- Department of Tissue Engineering & Regenerative Medicine, University Hospital Würzburg, 97070 Würzburg, Germany
| | - David M Reynolds
- Department of Biochemistry and Molecular Biology and Center for Molecular Medicine, University of Georgia, 325 Riverbend Road, Athens, GA 30605, USA
| | - Luoman Chen
- Department of Biochemistry and Molecular Biology and Center for Molecular Medicine, University of Georgia, 325 Riverbend Road, Athens, GA 30605, USA
| | - Kristopher L Nazor
- The Scripps Research Institute, 10550 North Torrey Pines Road, La Jolla, CA 92037, USA
| | - Johannes Baur
- Department of General, Visceral, Vascular and Pediatric Surgery, University Hospital of Würzburg, 97080 Würzburg, Germany
| | - Amar M Singh
- Department of Biochemistry and Molecular Biology and Center for Molecular Medicine, University of Georgia, 325 Riverbend Road, Athens, GA 30605, USA
| | - Jeanne F Loring
- The Scripps Research Institute, 10550 North Torrey Pines Road, La Jolla, CA 92037, USA
| | - Marco Metzger
- Translational Centre for Regenerative Therapies TLZ-RT, Fraunhofer Institute for Silicate Research ISC, Röntgenring 11, 97070 Würzburg, Germany
| | - Stephen Dalton
- Department of Biochemistry and Molecular Biology and Center for Molecular Medicine, University of Georgia, 325 Riverbend Road, Athens, GA 30605, USA.
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Liu J, Qin Y, Wu Y, Sun Z, Li B, Jing H, Zhang C, Li C, Leng X, Wang Z, Kong D. The surrounding tissue contributes to smooth muscle cells’ regeneration and vascularization of small diameter vascular grafts. Biomater Sci 2019; 7:914-925. [DOI: 10.1039/c8bm01277f] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
The surrounding tissue contributes to smooth muscle cells’ regeneration and vascularization in the vascular regeneration process.
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Stowell CET, Wang Y. Quickening: Translational design of resorbable synthetic vascular grafts. Biomaterials 2018; 173:71-86. [PMID: 29772461 PMCID: PMC6492619 DOI: 10.1016/j.biomaterials.2018.05.006] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2018] [Revised: 04/19/2018] [Accepted: 05/03/2018] [Indexed: 12/17/2022]
Abstract
Traditional tissue-engineered vascular grafts have yet to gain wide clinical use. The difficulty of scaling production of these cell- or biologic-based products has hindered commercialization. In situ tissue engineering bypasses such logistical challenges by using acellular resorbable scaffolds. Upon implant, the scaffolds become remodeled by host cells. This review describes the scientific and translational advantages of acellular, synthetic vascular grafts. It surveys in vivo results obtained with acellular synthetics over their fifty years of technological development. Finally, it discusses emerging principles, highlights strategic considerations for designers, and identifies questions needing additional research.
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Affiliation(s)
| | - Yadong Wang
- Meinig School of Biomedical Engineering, Cornell University, USA.
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Immuno-driven and Mechano-mediated Neotissue Formation in Tissue Engineered Vascular Grafts. Ann Biomed Eng 2018; 46:1938-1950. [PMID: 29987541 DOI: 10.1007/s10439-018-2086-7] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Accepted: 06/27/2018] [Indexed: 12/13/2022]
Abstract
In vivo development of a neovessel from an implanted biodegradable polymeric scaffold depends on a delicate balance between polymer degradation and native matrix deposition. Studies in mice suggest that this balance is dictated by immuno-driven and mechanotransduction-mediated processes, with neotissue increasingly balancing the hemodynamically induced loads as the polymer degrades. Computational models of neovessel development can help delineate relative time-dependent contributions of the immunobiological and mechanobiological processes that determine graft success or failure. In this paper, we compare computational results informed by long-term studies of neovessel development in immuno-compromised and immuno-competent mice. Simulations suggest that an early exuberant inflammatory response can limit subsequent mechano-sensing by synthetic intramural cells and thereby attenuate the desired long-term mechano-mediated production of matrix. Simulations also highlight key inflammatory differences in the two mouse models, which allow grafts in the immuno-compromised mouse to better match the biomechanical properties of the native vessel. Finally, the predicted inflammatory time courses revealed critical periods of graft remodeling. We submit that computational modeling can help uncover mechanisms of observed neovessel development and improve the design of the scaffold or its clinical use.
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Colunga T, Dalton S. Building Blood Vessels with Vascular Progenitor Cells. Trends Mol Med 2018; 24:630-641. [PMID: 29802036 PMCID: PMC6050017 DOI: 10.1016/j.molmed.2018.05.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Revised: 05/02/2018] [Accepted: 05/03/2018] [Indexed: 12/20/2022]
Abstract
Vascular progenitor cells have been identified from perivascular cell fractions and peripheral blood and bone marrow mononuclear fractions. These vascular progenitors share the ability to generate some of the vascular lineages, including endothelial cells, smooth muscle cells, and pericytes. The potential therapeutic uses for vascular progenitor cells are broad and relate to stroke, ischemic disease, and to the engineering of whole organs and tissues that require a vascular component. This review summarizes the best-characterized sources of vascular progenitor cells and discusses advances in 3D printing and electrospinning using blended polymers for the creation of biomimetic vascular grafts. These advances are pushing the field of regenerative medicine closer to the creation of small-diameter vascular grafts with long-term clinical utility.
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Affiliation(s)
- Thomas Colunga
- Center for Molecular Medicine, University of Georgia, 325 Riverbend Road, Athens, GA 30605, USA; Department of Biochemistry and Molecular Biology, University of Georgia, 325 Riverbend Road, Athens, GA 30605, USA
| | - Stephen Dalton
- Center for Molecular Medicine, University of Georgia, 325 Riverbend Road, Athens, GA 30605, USA; Department of Biochemistry and Molecular Biology, University of Georgia, 325 Riverbend Road, Athens, GA 30605, USA.
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Abstract
New technologies and science have contributed to improved surgical outcomes in patients with congenital cardiovascular diseases. However, current materials display shortcomings, such as risk of infection and lack of growth capacity when applied to the pediatric patient population. Tissue engineering has the potential to address these limitations as the ideal tissue engineered vascular graft (TEVG) would be durable, biocompatible, nonthrombogenic, and ultimately remodel into native tissue. The traditional TEVG paradigm consists of a scaffold, cell source, and the integration of the scaffold and cells via seeding. The subsequent remodeling process is driven by cellular adhesion and proliferation, as well as, biochemical and mechanical signaling. Clinical trials have displayed encouraging results, but graft stenosis is observed as a frequent complication. Recent investigations have suggested that a host's immune response plays a vital role in neotissue formation. Current and future studies will focus on modulating host immunity as a means of reducing the incidence of stenosis.
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Affiliation(s)
- Toshihiro Shoji
- The Tissue Engineering Program and Center for Cardiovascular and Pulmonary Research, Nationwide Children's Hospital, Columbus, OH, USA
| | - Toshiharu Shinoka
- The Tissue Engineering Program and Center for Cardiovascular and Pulmonary Research, Nationwide Children's Hospital, Columbus, OH, USA.,Department of Cardiothoracic Surgery, Nationwide Children's Hospital, Columbus, OH, USA.,Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA
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Best C, Strouse R, Hor K, Pepper V, Tipton A, Kelly J, Shinoka T, Breuer C. Toward a patient-specific tissue engineered vascular graft. J Tissue Eng 2018; 9:2041731418764709. [PMID: 29568478 PMCID: PMC5858675 DOI: 10.1177/2041731418764709] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Accepted: 02/20/2018] [Indexed: 12/15/2022] Open
Abstract
Integrating three-dimensional printing with the creation of tissue-engineered vascular grafts could provide a readily available, patient-specific, autologous tissue source that could significantly improve outcomes in newborns with congenital heart disease. Here, we present the recent case of a candidate for our tissue-engineered vascular graft clinical trial deemed ineligible due to complex anatomical requirements and consider the application of three-dimensional printing technologies for a patient-specific graft. We 3D-printed a closed-disposable seeding device and validated that it performed equivalently to the traditional open seeding technique using ovine bone marrow–derived mononuclear cells. Next, our candidate’s preoperative imaging was reviewed to propose a patient-specific graft. A seeding apparatus was then designed to accommodate the custom graft and 3D-printed on a commodity fused deposition modeler. This exploratory feasibility study represents an important proof of concept advancing progress toward a rationally designed patient-specific tissue-engineered vascular graft for clinical application.
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Affiliation(s)
- Cameron Best
- Center for Regenerative Medicine, The Research Institute, Nationwide Children's Hospital, Columbus, OH, USA.,Biomedical Sciences Graduate Program, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Robert Strouse
- Research Innovation and Solutions, The Research Institute, Nationwide Children's Hospital, Columbus, OH, USA
| | - Kan Hor
- Department of Cardiology, The Heart Center, Nationwide Children's Hospital, Columbus, OH, USA
| | - Victoria Pepper
- Center for Regenerative Medicine, The Research Institute, Nationwide Children's Hospital, Columbus, OH, USA.,Department of Surgery, Nationwide Children's Hospital, Columbus, OH, USA
| | - Amy Tipton
- Advanced Cardiac Imaging Laboratory, The Heart Center, Nationwide Children's Hospital, Columbus, OH, USA
| | - John Kelly
- Center for Regenerative Medicine, The Research Institute, Nationwide Children's Hospital, Columbus, OH, USA.,Department of Cardiology, The Heart Center, Nationwide Children's Hospital, Columbus, OH, USA
| | - Toshiharu Shinoka
- Center for Regenerative Medicine, The Research Institute, Nationwide Children's Hospital, Columbus, OH, USA.,Department of Cardiothoracic Surgery, The Heart Center, Nationwide Children's Hospital, Columbus, OH, USA
| | - Christopher Breuer
- Center for Regenerative Medicine, The Research Institute, Nationwide Children's Hospital, Columbus, OH, USA.,Department of Surgery, Nationwide Children's Hospital, Columbus, OH, USA
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Saporito F, Sandri G, Bonferoni MC, Rossi S, Malavasi L, Fante CD, Vigani B, Black L, Ferrari F. Electrospun Gelatin⁻Chondroitin Sulfate Scaffolds Loaded with Platelet Lysate Promote Immature Cardiomyocyte Proliferation. Polymers (Basel) 2018; 10:polym10020208. [PMID: 30966244 PMCID: PMC6415061 DOI: 10.3390/polym10020208] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Revised: 02/15/2018] [Accepted: 02/20/2018] [Indexed: 12/11/2022] Open
Abstract
The aim of the present work was the development of heart patches based on gelatin (G) and chondroitin sulfate (CS) to be used as implants to improve heart recovery after corrective surgery for critical congenital heart defects (CHD). Patches were prepared by means of electrospinning to obtain nanofibrous scaffolds and they were loaded with platelet lysate (PL) as a source of growth factors to further enhance the repair process. Scaffolds were characterized for morphology and mechanical properties and for the capability to support in vitro adhesion and proliferation of dermal fibroblasts in order to assess the system’s general biocompatibility. Adhesion and proliferation of endothelial cells and cardiac cells (cardiomyocytes and cardiac fibroblasts from rat fetuses) onto PL-loaded patches was evaluated. Patches presented good elasticity and high stiffness suitable for in vivo adaptation to heart contraction. CS improved adhesion and proliferation of dermal fibroblasts, as proof of their biocompatibility. Moreover, they enhanced the adhesion and proliferation of endothelial cells, a crucial mediator of cardiac repair. Cell adhesion and proliferation could be related to elastic properties, which could favor cell motility. The presence of platelet lysate and CS was crucial for the adhesion and proliferation of cardiac cells and, in particular, of cardiomyocytes: G/CS scaffold embedded with PL appeared to selectively promote proliferation in cardiomyocytes but not cardiac fibroblasts. In conclusion, G/CS scaffold seems to be a promising system to assist myocardial-repair processes in young patient, preserving cardiomyocyte viability and preventing cardiac fibroblast proliferation, likely reducing subsequent uncontrolled collagen deposition by fibroblasts following repair.
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Affiliation(s)
- Francesca Saporito
- Department of Drug Sciences, University of Pavia, Viale Taramelli 12, 27100 Pavia, Italy.
| | - Giuseppina Sandri
- Department of Drug Sciences, University of Pavia, Viale Taramelli 12, 27100 Pavia, Italy.
| | | | - Silvia Rossi
- Department of Drug Sciences, University of Pavia, Viale Taramelli 12, 27100 Pavia, Italy.
| | - Lorenzo Malavasi
- Department of Chemistry, Physical Chemistry Section, University of Pavia, Viale Taramelli 16, 27100 Pavia, Italy.
| | - Claudia Del Fante
- Immunohaematology and Transfusion Service, Apheresis and Cell Therapy Unit, Fondazione IRCCS Policlinico S. Matteo, Viale Golgi 19, Pavia 27100, Italy.
| | - Barbara Vigani
- Department of Drug Sciences, University of Pavia, Viale Taramelli 12, 27100 Pavia, Italy.
| | - Lauren Black
- Department of Biomedical Engineering, Tufts University, Medford, MA, 02155, USA.
| | - Franca Ferrari
- Department of Drug Sciences, University of Pavia, Viale Taramelli 12, 27100 Pavia, Italy.
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Nemoto S, Konishi H, Shimada R, Suzuki T, Katsumata T, Yamada H, Sakurai J, Sakamoto Y, Kohno K, Onishi A, Ito M. In situ tissue regeneration using a warp-knitted fabric in the canine aorta and inferior vena cava†. Eur J Cardiothorac Surg 2018; 54:318-327. [DOI: 10.1093/ejcts/ezy045] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2017] [Accepted: 01/19/2018] [Indexed: 12/31/2022] Open
Affiliation(s)
- Shintaro Nemoto
- Department of Thoracic and Cardiovascular Surgery, Osaka Medical College, Takatsuki, Osaka, Japan
| | - Hayato Konishi
- Department of Thoracic and Cardiovascular Surgery, Osaka Medical College, Takatsuki, Osaka, Japan
| | - Ryo Shimada
- Department of Thoracic and Cardiovascular Surgery, Osaka Medical College, Takatsuki, Osaka, Japan
| | - Tatsuya Suzuki
- Department of Thoracic and Cardiovascular Surgery, Osaka Medical College, Takatsuki, Osaka, Japan
| | - Takahiro Katsumata
- Department of Thoracic and Cardiovascular Surgery, Osaka Medical College, Takatsuki, Osaka, Japan
| | - Hideaki Yamada
- Production Development Section, Fukui Tateami Co., Ltd, Fukui, Japan
| | - Jun Sakurai
- Production Development Section, Fukui Tateami Co., Ltd, Fukui, Japan
| | - Yohei Sakamoto
- Toxicology Research Department, Teijin Institute for Biomedical Research, Teijin Pharma Limited, Hino, Tokyo, Japan
| | - Kazuteru Kohno
- Healthcare Business Development, Teijin Limited, Hino, Tokyo, Japan
| | - Atsuko Onishi
- Healthcare Business Development, Teijin Limited, Hino, Tokyo, Japan
| | - Masaya Ito
- Healthcare Business Development, Teijin Limited, Hino, Tokyo, Japan
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Jafarkhani M, Salehi Z, Kowsari-Esfahan R, Shokrgozar MA, Rezaa Mohammadi M, Rajadas J, Mozafari M. Strategies for directing cells into building functional hearts and parts. Biomater Sci 2018; 6:1664-1690. [DOI: 10.1039/c7bm01176h] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
This review presents the current state-of-the-art, emerging directions and future trends to direct cells for building functional heart parts.
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Affiliation(s)
- Mahboubeh Jafarkhani
- School of Chemical Engineering
- College of Engineering
- University of Tehran
- Iran
- Center for Nanomedicine and Theranostics
| | - Zeinab Salehi
- School of Chemical Engineering
- College of Engineering
- University of Tehran
- Iran
| | | | | | - M. Rezaa Mohammadi
- Biomaterials and Advanced Drug Delivery Laboratory
- Stanford University School of Medicine
- Palo Alto
- USA
- Division of Cardiovascular Medicine
| | - Jayakumar Rajadas
- Biomaterials and Advanced Drug Delivery Laboratory
- Stanford University School of Medicine
- Palo Alto
- USA
- Division of Cardiovascular Medicine
| | - Masoud Mozafari
- Bioengineering Research Group
- Nanotechnology and Advanced Materials Department
- Materials and Energy Research Center (MERC)
- Tehran
- Iran
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Recent Progress in Vascular Tissue-Engineered Blood Vessels. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2018; 1064:123-144. [PMID: 30471030 DOI: 10.1007/978-981-13-0445-3_8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Cardiovascular disease is the number one cause of death in the U.S and results in the loss of approximately one million lives and more than 400 billion U.S. dollars for treatments every year. Recently, tissue engineered blood vessels have been studied and developed as promising replacements for treatment with autologous veins. Here, we summarize the cell sources and methods to make tissue-engineered blood vessels (TEBVs), the recent progress in TEBV related research, and also the recent progress in TEBV related clinical studies.
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van den Berg G, Krasemann T, Postma AV. Editorial Commentary: Keeping the congenitally malformed heart in shape. Trends Cardiovasc Med 2017; 27:532-533. [PMID: 28735782 DOI: 10.1016/j.tcm.2017.06.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Accepted: 06/30/2017] [Indexed: 11/16/2022]
Affiliation(s)
- Gert van den Berg
- Department of Pediatric Cardiology, Sophia Children's Hospital, Erasmus Medical Center, Rotterdam, The Netherlands; Department of Medical Biology, Academic Medical Center, Amsterdam, The Netherlands
| | - Thomas Krasemann
- Department of Pediatric Cardiology, Sophia Children's Hospital, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Alex V Postma
- Department of Medical Biology, Academic Medical Center, Amsterdam, The Netherlands; Department of Clinical Genetics, Academic Medical Center, Amsterdam, The Netherlands.
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