A new and simple technique to achieve a confluent and flow resistant endothelium on vascular ePTFE-grafts using human serum

Endothelial cell function on 2D and 3D micro-fabricated polymer scaffolds: applications in cardiovascular tissue engineering

Polymeric structures of a polylactide-polycaprolactone blend were micro-fabricated using the Pressure Assisted Microsyringe (PAM) system. Human umbilical vein endothelial cells were cultured on the scaffolds, and apoptosis, cell adhesion, proliferation and metabolism were evaluated. In addition, more specific indicators of endothelial cell function, namely nitric oxide and endothelin production, were also assessed. Thin films of the blend, as well as gelatine-coated glass slides (as controls) were used. The results show that as far as adhesion, apoptosis and metabolism are concerned, the scaffolds do not interfere with cell function compared with gelatin controls. However, the nitric oxide/endothelin ratio was higher than that observed on the gelatin films, suggesting that the scaffolds could be used for engineering small diameter blood vessels without risk of occlusion.

The modulation of platelet and endothelial cell adhesion to vascular graft materials by perlecan

Controlled neo-endothelialisation is critical to the patency of small diameter vascular grafts. Endothelialisation and platelet adhesion to purified endothelial cell-derived perlecan, the major heparan sulfate (HS) proteoglycan in basement membranes, were investigated using in vivo and in vitro assays. Expanded polytetrafluoroethylene (ePTFE) vascular grafts were coated with perlecan and tested in an ovine carotid interposition model for a period of 6 weeks and assessed using light and scanning microscopy. Enhanced endothelial cell growth and reduced platelet adhesion were observed on the perlecan coated grafts when compared to uncoated controls implanted in the same sheep (n=5). Perlecan was also found to stimulate endothelial cell proliferation in vitro over a period of 6 days in the presence of plasma proteins and fibroblastic growth factor 2 (FGF-2), however in the absence of FGF-2 endothelial cell growth could not be maintained during this period. Perlecan was found to be anti-adhesive for platelets, however after removal of the HS chains attached to perlecan, platelet adhesion and aggregation were supported. These results suggest a role for HS chains of perlecan in improving graft patency by selectively promoting endothelial cell proliferation while modulating platelet adhesion.

Development of an artificial vessel lined with human vascular cells

OBJECTIVES

Thrombogenity of small-diameter vascular prostheses might be reduced by complete coverage of the luminal surface with vascular cells. We investigated cell seeding on polyurethane vascular prostheses.

METHODS

Thirty polyurethane vascular prostheses were divided into 3 groups of 10 each: group A, diameter of 20 mm and gamma-sterilized; group B, diameter of 4 mm and gamma-sterilized; and group C, diameter of 4 mm and ethylene oxide sterilized. Human smooth muscle cells, fibroblasts, and endothelial cells were isolated from saphenous vein segments and expanded in culture. Five polyurethane vascular prostheses of each group were seeded with endothelial cells alone (mean, 4.8 +/- 1.2 x 10(6) cells), and the remaining 5 polyurethane vascular prostheses were preseeded with a mixed culture of fibroblasts and smooth muscle cells (mean, 7.7 +/- 2.3 x 10(6) cells), followed by endothelial cell seeding (mean, 4.4 +/- 0.9 x 10(6) cells). Seven days after cell seeding, the polyurethane vascular prostheses were perfused under a pulsatile flow (80 pulses/min, 140/80 mm Hg, and 120 mL/min) for 2 hours. Specimens were taken after each seeding procedure both before and after perfusion and then examined both with a scanning electron microscope and immunohistochemically.

RESULTS

Isolated endothelial cell seeding revealed better initial adhesion in groups A and B than in group C (63% vs 33%). After 7 days, the cells had covered approximately 80% of the luminal surface in groups A and B, whereas group C cells rounded up and lost adhesion. After perfusion testing of group A and B prostheses, only 10% of the surface was still covered with endothelial cells. Preseeding with the mixed culture again revealed a better initial adhesion in groups A and B compared with that in group C (76% vs 41%). In groups A and B endothelial cell seeding (adhesion, 72%) resulted in a confluent endothelial cell layer. The results of immunohistochemical staining were positive for collagen IV, laminin, CD31, and Factor VIII. In group C only isolated cells were found after each seeding procedure, which rounded up and vanished during the next days. Perfusion testing of group A and B prostheses revealed that the confluent cell layer remained stable, with only small defects (<10% of the surface). The cells stained positivively for endothelial nitric oxide synthase.

CONCLUSION

Seeding of a mixed culture out of fibroblasts and smooth muscle cells resulted in improved endothelial cell adhesion and resistance to shear stress. This outcome was caused by an increased synthesis of extracellular matrix proteins. Cell attachment was better on gamma-sterilized polyurethane vascular prostheses compared with on those undergoing ethylene oxide sterilization.

Complete in vitro prosthesis endothelialization induced by artificial extracellular matrix

This report presents our research on the conditions necessary to substain optimal in vitro prosthetic endothelialization using human endothelium cultures. Human vein endothelial cells were seeded at a concentration of 3 x 10(5)/cm2 in a gelatinized Dacron patch graft coated with a commercial collagen film, using a solution of fibrin glue. Endothelium adhesion, proliferation, and survival were measured by [3H]thymidine incorporation, after 7 days of incubation. Finally, the morphology of prosthetic endothelialization was analyzed by scanning electron microscopy. We observed that the Dacron patch grafts coated with collagen film were able to promote endothelialization better than the prostheses coated with highly concentrated collagen solution or gelatin. We therefore concluded that the collagen film that supports endothelial cell adhesion and proliferation uniformly covers the entire synthetic endoluminal surface of the Dacron graft, thus preventing endothelial cell alterations induced by direct contact with the synthetic prosthetic surface.

Time-course for in vitro development of basement membrane, gap junctions, and repair by adult endothelial cells seeded on precoated ePTFE

OBJECTIVES

To establish some functional characteristics after in vitro endothelialisation of precoated ePTFE grafts.

MATERIALS AND METHODS

Saphenous vein endothelial cells were confluently seeded on human serum-precoated ePTFE. Collagen I-precoated ePTFE served as control. Time-courses for development of laminin, collagen IV and connexin43 was followed-up with immunofluorescence. Endothelial migration and proliferation was studied with cresyl violet staining and tritiated thymidine-labelling.

RESULTS

Six hours post-seeding, basement membrane components were visualised subendothelially as thin fibrils. After 24 h, there was a distinct fibril network, which did not seem to be further enhanced. Connexin43 was detected 6 h post-seeding, and the number of intercellular connections appeared to be similar up to day 7. The time-courses were similar on serum- and collagen I-precoated ePTFE. Endothelialisation of a 4 mm wide gap showed migrating fronts largely composed of proliferating cells. The process was completed within 10 days on collagen I-precoated ePTFE, and 15 days on serum-precoated ePTFE.

CONCLUSIONS

These findings suggest human endothelial cells, seeded on precoated ePTFE, maintain some differentiated functions seen in vivo. This is of importance for cell retention, functionality and endothelial repair of in vitro endothelialised ePTFE-grafts after implantation in man.

In vitro endothelialisation of arteriovenous loop grafts for haemodialysis

OBJECTIVES

To evaluate the feasibility in a pilot study of in vitro endothelialisation of PTFE grafts used as interposition arteriovenous fistulas in uraemic patients.

METHODS

Autologous saphenous vein endothelial cells were harvested and cultured on PTFE grafts in seven patients undergoing maintenance haemodialysis. The patients had several previous failures of vascular access sites. The patients were followed with duplex ultrasound, clinical examination and in one case an explanted graft was examined.

RESULTS

At the end of follow-up four of the seven patients had patent grafts. One patient occluded the graft immediately postoperatively and another after 3.5 months. The former patient received a second endothelialised graft. In two further patients revision of the outflow was performed. In two patients a functioning graft was excised, in one case because of bleeding of a venous aneurysm and in one case because of suspected infection. The former which was excised 5 weeks postoperatively revealed that 85% of the surface was covered by endothelial cells.

CONCLUSIONS

This pilot study shows that in vitro endothelialisation of PTFE grafts used for haemodialysis is possible in uraemic patients. In this highly problematic patient group the results are promising with endothelial cell coverage after 5 weeks of implantation.

Cell adhesion and short-term patency in human endothelium preseeded 1.5-mm polytetrafluoroethylene vascular grafts: an experimental study

It has been shown that endothelialization improves short-term patency of 1.5-mm expanded polytetrafluoroethylene vascular grafts. A model for endothelialization of 1.5-mm expanded polytetrafluoroethylene vascular grafts with human endothelial cells is described. In this model, the adherence of endothelial cells was increased significantly in grafts coated with serum proteins and collagen. By means of this protocol, graft patency was tested after implantation in two animal models: the rat aorta and the rabbit common carotid artery. Anastomosis was performed with a 3M Precise Microvascular Anastomotic System. In both animal models, no significant loss of endothelial cells in the precoated grafts (rat, n = 8) were noted 1 hour after blood flow restoration. All uncoated grafts showed significant endothelial cell loss. In the rabbit model, all nonendothelialized grafts (n = 8) clotted 5 to 25 minutes after flow restoration. Seven (n = 8) endothelialized grafts showed no clotting during 1 hour's observation: one clotted immediately for a patency rate of 87.5 percent. These results indicate that endothelialization of 1.5-mm grafts is practical. Furthermore, adhesion of endothelial cells to the graft walls is not affected by short-term, pulsatile, high-pressure blood flow.

Secretion of prostacyclin, tissue plasminogen activator and its inhibitor by cultured adult human endothelial cells grown on different matrices

OBJECTIVES

The aim of this study was to investigate the secretion of prostacyclin (PGI2), tissue plasminogen activator (tPA) and plasminogen activator inhibitor type 1 (PAI- 1) produced by human great saphenous vein endothelial cells (HSVECs) in vitro when seeded to confluency on different matrices.

METHODS

The matrices compared were: uncoated plastic, gelatin, collagen type-I gel, fibronectin, fibrin glue, de-endothelialized porcine aorta and ePTFE vascular grafts pre-coated with collagen type-I or human serum.

RESULTS

There were no significant differences between basal production of PGI2 on the different matrices. The HSVECs responded with a significant increase in PGI2 secretion after stimulation with thrombin on all matrices, including the ePTFE grafts. A statistically significant higher secretion of tPA secretion was found in supernatants from cells cultured on collagen type-I gel. Interestingly, tPA secretion was lower by cells seeded on both collagen type-I and serum precoated ePTFE as compared to collagen type-1 gel. PAI-1 secretion however was significantly higher on collagen type-1 gel, gelatin, fibrin glue and porcine aorta but not on pre-coated ePTFE grafts.

CONCLUSIONS

The findings emphasise the important effect of the matrix on endothelial secretion of PGI2, tPA and PAI-1. Differences in patency after implantation of in vitro endothelialized grafts, may be due to cellular function depending on the types of graft and matrix chosen.