Application of stem cells for cardiovascular grafts tissue engineering

Reduced graphene oxide–reinforced gellan gum thermoresponsive hydrogels as a myocardial tissue engineering scaffold

Myocardial infarction is one of the most prevalent diseases around the world. Cardiac tissue engineering is a new approach to repair and revive the structure and functionality of cardiac damaged tissue. In this study, gellan gum/reduced graphene oxide composite hydrogels were fabricated, characterized, and evaluated. The hydrogels were prepared using the solvent casting method and characterized via scanning electron microscopy and Fourier-transform infrared spectroscopy. Compressive mechanical analysis, injectability as well as electrical conductivity test were run. Furthermore, water swelling and degradation analyses were conducted. MTT assay was performed using rat myoblasts (H9C2) to determine the cytotoxicity of our samples. Results showed that reduced graphene oxide fillers dispersed acceptably and enhanced the compressive modulus and electrical conductivity of gellan gum hydrogels. However, in this regard, compressive strength and ductility were not significantly boosted with reduced graphene oxide addition. The water-swelling ratio (%) rised in the presence of reduced graphene oxide, whereas the degradation rate was not significantly affected by them. Meanwhile, synthesized hydrogels showed suitable injectability. MTT assay results revealed that gellan gum hydrogels containing 1% and 2% reduced graphene oxide were not cytotoxic. According to the findings, gellan gum/2% reduced graphene oxide composite hydrogel can be a promising candidate for repairing and healing infarcted myocardial tissue.

Neonatal Human Dermal Fibroblasts Immobilized in RGD–Alginate Induce Angiogenesis

Promoting angiogenesis in a damaged tissue is a major challenge for tissue regeneration. Recent findings in tissue engineering suggest that fibroblasts (FBs) play an important role in orchestrating the angiogenic process. Fibroblasts maintain the structural integrity of connective tissue by continuously secreting growth factors and extracellular matrix precursors, which are essential for endothelial cell (EC) adhesion and spreading, thus playing a crucial role in angiogenesis. We hypothesized that FBs immobilized in alginate gels grafted with the RGD peptidic sequence could influence the recruitment of ECs to improve vascularization. In this work, the modulation of immobilized human FBs within the 3D synthetic extracellular matrix was assessed. Experiments using cocultures of ECs and FBs in indirect contact as well as angiogenic assays were performed to assess the influence of FBs immobilized in RGD–alginate in ECs' viability, stabilization, sprouting, and assembly into capillary-like structures. This study demonstrates the ability of FBs immobilized within RGD–alginate microspheres to modulate and support capillary-like structures' assembly. These findings indicate that the microenvironment created by these stromal cells in the scaffold modulates capillary morphogenesis, thus stimulating angiogenesis in situ and can potentially be used in regenerative medicine in clinical scenarios where vascularization is essential.

Development of a bone reconstruction technique using a solid free-form fabrication (SFF)-based drug releasing scaffold and adipose-derived stem cells

For tissue regeneration, three essential components of scaffolds, signals (biomolecules), and cells are required. Moreover, because bony defects are three-dimensional in many clinical circumstances, an exact 3D scaffold is important. Therefore, we proposed an effective reconstruction tool for cranial defects using human adipose-derived stem cells (hADSCs) and a 3D functional scaffold fabricated by solid free-form fabrication (SFF) technology that secretes biomolecules. We fabricated poly(propylene fumarate)-based 3D scaffolds with embedded microsphere-deliverable bone morphogenetic protein-2 (BMP-2) by microstereolithography. BMP-2-loaded SFF scaffolds with/without hADSCs (SFF/BMP/hADSCs scaffolds and SFF/BMP scaffolds, respectively) and BMP-2-unloaded SFF scaffolds (SFF scaffolds) were then implanted in rat crania, and in vivo bone formation was observed. Analyses of bone formation areas using micro-computed tomography (micro-CT) showed the superiority of SFF/BMP/hADSCs scaffolds. Hematoxylin and eosin stain, Masson's trichrome stain, and collagen type-I stain supported the results of the micro-CT scan. And human leukocyte antigen-ABC showed that seeded, differentiated hADSCs were well grown and changed to the bone tissue at the inside of the scaffold. Results showed that our combination of a functional 3D scaffold and hADSCs may be a useful tool for improving the reconstruction quality of severe bony defects in which thick bone is required.

Stromal cell-induced immune regulation in a transplantable lymphoid-like cell constructs

Engineering of cell-based constructs for treating a variety of immune-related diseases by local transplantation of the cells in a pre-designed matrix is an emerging therapeutic approach, which can potentially reduce the side effects associated with systemic cell injection. Stromal cells have been shown to exert immunosuppressive properties and thus can be exploited for autoimmune regulation and cell transplantation. Here, we demonstrate the fabrication of a stromal cell-based construct, which serves as a lymphoid-like organ with immune regulatory characteristics. In the proposed system, stromal cells are co-seeded with dendritic cells (DC) in a macro-porous alginate scaffold containing the encephalitogenic myelin-derived peptide, proteolipid protein (PLP). We demonstrate that the presence of stromal cells attenuates DC maturation upon lipopolysaccharide stimulus. In vitro, we show that while the migration of pathogenic PLP-specific T cells to construct cultivated with or without stromal cells does not differ, their activation and proliferation are significantly suppressed in the presence of stromal cells. Upon in vivo transplantation, under the kidney capsule of mice, the pathogenic activation and proliferation of T cells which were drawn into the construct were suppressed in the co-seeded constructs. This system thus serves as a lymphoid-like organ with regulatory characteristics, which can be applied for local tolerance induction, for application in cell transplantations as well as autoimmune diseases.

Embryoid body formation from embryonic and induced pluripotent stem cells: Benefits of bioreactors

Embryonic stem (ES) cells have the ability to differentiate into all germ layers, holding great promise not only for a model of early embryonic development but also for a robust cell source for cell-replacement therapies and for drug screening. Embryoid body (EB) formation from ES cells is a common method for producing different cell lineages for further applications. However, conventional techniques such as hanging drop or static suspension culture are either inherently incapable of large scale production or exhibit limited control over cell aggregation during EB formation and subsequent EB aggregation. For standardized mass EB production, a well defined scale-up platform is necessary. Recently, novel scenario methods of EB formation in hydrodynamic conditions created by bioreactor culture systems using stirred suspension systems (spinner flasks), rotating cell culture system and rotary orbital culture have allowed large-scale EB formation. Their use allows for continuous monitoring and control of the physical and chemical environment which is difficult to achieve by traditional methods. This review summarizes the current state of production of EBs derived from pluripotent cells in various culture systems. Furthermore, an overview of high quality EB formation strategies coupled with systems for in vitro differentiation into various cell types to be applied in cell replacement therapy is provided in this review. Recently, new insights in induced pluripotent stem (iPS) cell technology showed that differentiation and lineage commitment are not irreversible processes and this has opened new avenues in stem cell research. These cells are equivalent to ES cells in terms of both self-renewal and differentiation capacity. Hence, culture systems for expansion and differentiation of iPS cells can also apply methodologies developed with ES cells, although direct evidence of their use for iPS cells is still limited.

In vivo recruitment of hematopoietic cells using stromal cell-derived factor 1 alpha-loaded heparinized three-dimensional collagen scaffolds

Implantable three-dimensional (3D) constructs to engineer tissue have great therapeutic potential in regenerative medicine and immunotherapy. However, autonomous recruitment of cells into the engineered scaffold in vivo is hampered by lack of attracting scaffolds. As a first step to engineering immune tissue, 3D collagen scaffolds were investigated for their ability to enhance in vivo recruitment and growth of various hematopoietic cells. Scaffolds containing immobilized heparin to trap the stem cell chemo-attractant stromal cell-derived factor 1 alpha (SDF1alpha) were implanted subcutaneously into C57Bl6 mice, and influx of cells was monitored using immunohistochemistry. Five weeks post-implantation, heparinized scaffolds were always populated by cells, but incorporating SDF1alpha considerably stimulated recruitment of cells. SDF1alpha could not exert this effect when the formation of a SDF1alpha gradient was abrogated. Scaffolds were mainly populated by CD11b+ and CD11c+ myeloid cells and fibroblasts. One week after implantation, scaffolds harbored only low numbers of cells. Apparently, not all CXCR4-expressing cells, like large numbers of granulocytes, migrate into the scaffold, but retransplantation of a 1-week-old scaffold from a CD45.2(+) into a CD45.1(+) mouse yielded a scaffold harboring mainly CD45.2(+) cells after 5 weeks. These data confirm that only a few progenitor cells are recruited early after implantation. These cells then proliferate and differentiate along different lineages and determine the outcome after 5 weeks.

Adipose derived stem cells and smooth muscle cells: implications for regenerative medicine

The treatment of chronic wounds and other damaged tissues and organs remains a difficult task, in spite of greater adherence to recognised standards of care and a better understanding of pathophysiologic principles. Adipose derived stem cells (ADSCs), with their proliferative and impressive differentiation potential, may be used in the future in autologous cell therapy or grafting to replace damaged tissues. At this point in time, transplanted tissues are often rejected by the body. Autologous grafting would eliminate this problem. ADSCs are able to differentiate into a number of cells in vitro, for example smooth muscle cells (SMCs), when treated with lineage specific factors. SMCs play a key role in physiology and pathology as they form the principle layer of all SMC tissues. Smooth muscle biopsies are often impractical and morbid, and often lead to a low cell harvest. It has also been shown that SMCs derived from a diseased organ can lead to abnormal cells. Therefore, there is a great need for alternative sources of healthy SMCs. The use of ADSCs for cell-based tissue engineering (TE) represents a promising alternative for smooth muscle repair. This review discusses the potential uses of ADSCs and SMCs in regenerative medicine, and the potential of ADSCs to be differentiated into functional SMCs for TE and regenerative cellular therapies to repair diseased organs.

[Legal regulation in the field of tissue engineering]

In the past few years, biotechnology and tissue engineering have developed a great deal. Legislation, however, has not been able to keep pace with the rapid changes in the research and treatment using tissue-engineered products. The authors tried to explore and compare all the regulatory factors concerning cell and tissue engineering in the Hungarian and foreign law. The thorough study elucidated that the Hungarian regulation in this area is fairly deficient when compared with the regulations of other European countries, where quite extensive directives are applied. A currently accepted regulation fills this void efficiently in the European Union providing strong base for tissue engineering-related research and therapy for the future.

The development of tissue-engineered grafts for reconstructive cardiothoracic surgical applications

Surgical correction of congenital heart defects often requires the use of valves, patches, or conduits to establish anatomic continuity. Homografts, xenografts, or mechanical prosthetic devices are frequently implanted during these surgical procedures. These grafts however lack growth potential, are associated with increased risk of thrombosis and infection and have limited durability, thus increasing the morbidity and mortality of their application in pediatric cardiac surgery. These limitations are being addressed through the development of living, biologic tissue-engineered valves, patches, and conduits. Pilot studies and phase 1 clinical trials are currently underway to evaluate their feasibility, safety, and efficacy. The optimal scaffold, cell source, and conditioning parameters, however, still remain to be determined and are areas of active research.

Synthetic tissue biology: tissue engineering meets synthetic biology

We propose the term "synthetic tissue biology" to describe the use of engineered tissues to form biological systems with metazoan-like complexity. The increasing maturity of tissue engineering is beginning to render this goal attainable. As in other synthetic biology approaches, the perspective is bottom-up; here, the premise is that complex functional phenotypes (on par with those in whole metazoan organisms) can be effected by engineering biology at the tissue level. To be successful, current efforts to understand and engineer multicellular systems must continue, and new efforts to integrate different tissues into a coherent structure will need to emerge. The fruits of this research may include improved understanding of how tissue systems can be integrated, as well as useful biomedical technologies not traditionally considered in tissue engineering, such as autonomous devices, sensors, and manufacturing.

Myocardial tissue engineering: a review

Myocardial tissue engineering, a concept that intends to overcome the obstacles to prolonging patients' life after myocardial infarction, is continuously improving. It comprises a biomaterial based 'vehicle', either a porous scaffold or dense patch, made of either natural or synthetic polymeric materials, to aid transportation of cells into the diseased region in the heart. Many different cell types have been suggested for cell therapy and myocardial tissue engineering. These include both autologous and embryonic stem cells, both having their advantages and disadvantages. Biomaterials suggested for this specific tissue-engineering application need to be biocompatible with the cardiac cells and have particular mechanical properties matching those of native myocardium, so that the delivered donor cells integrate and remain intact in vivo. Although much research is being carried out, many questions still remain unanswered requiring further research efforts. In this review, we discuss the various approaches reported in the field of myocardial tissue engineering, focusing on the achievements of combining biomaterials and cells by various techniques to repair the infarcted region, also providing an insight on clinical trials and possible cell sources in cell therapy. Alternative suggestions to myocardial tissue engineering, in situ engineering and left ventricular devices are also discussed.

Stem cells for tissue engineering of myocardial constructs

Cardiovascular diseases are the leading cause of morbidity and mortality. Tissue engineering offers new option in the myocardial repair techniques. The cellular component of this regenerative approach will play a key role in bringing these tissue engineered constructs from the laboratory bench to the clinical bedside. However, the ideal source of cells still remains unclear and may differ depending upon the application. Current research for many applications is focused on the use of stem cells. The combination of stem cell technology and tissue engineering has been investigated and offers promising avenues for myocardial tissue regeneration, and this shows great promise in future reconstructive surgery. We explore the basic concepts and methods for myocardial tissue reconstruction and emphasize the progress made and remaining challenges of stem cells in myocardial tissue engineering.

Embryonic stem cell transplantation for the treatment of myocardial infarction: immune privilege or rejection

Stem cell transplantation (SCT) has emerged to be an appealing tool for repair medicine. In the treatment of ischemic heart diseases, SCT will be of great help because it is capable of replacing scar with new myocardial tissue. Among the many candidate cell lines for SCT, embryonic stem cells (ESCs) have their unique advantages. However, the controversy about the host immune attack and the transplanted ESCs or their derivatives transplanted into ischemic heart still existed. In this review, the immune properties of ESCs and ESC-derived cardiomyocytes and possible mechanisms were discussed; furthermore, the prevention strategies against potential immune responses were also identified.

In vitro and in vivo differentiation of human umbilical cord derived stem cells into endothelial cells

The successful use of tissue-engineered transplants is hampered by the need for vascularization. Recent advances have made possible the using of stem cells as cell sources for therapeutic angiogenesis, including the vascularization of engineered tissue grafts. The goal of this study was to examine the endothelial potential of human umbilical cord-derived stem (UCDS) cells. UCDS cells were initially characterized and differentiated in an endothelial differentiation medium containing VEGF and bFGF. Differentiation into endothelial cells was determined by acetylated low-density lipoprotein incorporation and expression of endothelial-specific proteins, such as PECAM and CD34. In vivo, the transplanted UCDS cells were sprouting from local injection and differentiated into endothelial cells in a hindlimb ischemia mouse model. These findings indicate the presence of a cell population within the human umbilical cord that exhibits characteristics of endothelial progenitor cells. Therefore, human umbilical cord might represent a source of stem cells useful for therapeutic angiogenesis and re-endothelialization of engineered tissue grafts.

Human umbilical cord derived stem cells for the injured heart

The limited ability of the heart to regenerate damaged tissue following a myocardial infarct results in progressive dysfunctions and consequently leads to heart failure. Cell therapy with stem cells for cardiac repair is emerging as an alternative strategy and demonstrates promising results. Recent advances suggest human umbilical cord may be a new source for stem cells. Human umbilical cords are easy to obtain and umbilical cord derived stem cells can be easily extracted and cryopreserved, allowing for individuals to store their own samples for possible future autologous use even if there were no immediate indication that stem cell therapy would be required. Therefore, we hypothesize that human umbilical cord derived stem cells may be the new cell source for the injured heart.