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Tajikawa T, Sekido Y, Mori K, Kawashima T, Nakashima Y, Miyamoto S, Nakayama Y. Diverse Shape Design and Physical Property Evaluation of In-Body Tissue Architecture-Induced Tissues. Bioengineering (Basel) 2024; 11:598. [PMID: 38927834 PMCID: PMC11200934 DOI: 10.3390/bioengineering11060598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2024] [Revised: 06/01/2024] [Accepted: 06/06/2024] [Indexed: 06/28/2024] Open
Abstract
Autologous-engineered artificial tissues constitute an ideal alternative for radical surgery in terms of natural anticoagulation, self-repair, tissue regeneration, and the possibility of growth. Previously, we focused on the development and practical application of artificial tissues using "in-body tissue architecture (iBTA)", a technique that uses living bodies as bioreactors. This study aimed to further develop iBTA by fabricating tissues with diverse shapes and evaluating their physical properties. Although the breaking strength increased with tissue thickness, the nominal breaking stress increased with thinner tissues. By carving narrow grooves on the outer periphery of an inner core with narrow grooves, we fabricated approximately 2.2 m long cord-shaped tissues and net-shaped tissues with various designs. By assembling the two inner cores inside the branched stainless-steel pipes, a large graft with branching was successfully fabricated, and its aortic arch replacement was conducted in a donor goat without causing damage. In conclusion, by applying iBTA technology, we have made it possible, for the first time, to create tissues of various shapes and designs that are difficult using existing tissue-engineering techniques. Thicker iBTA-induced tissues exhibited higher rupture strength; however, rupture stress was inversely proportional to thickness. These findings broaden the range of iBTA-induced tissue applications.
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Affiliation(s)
- Tsutomu Tajikawa
- Department of Mechanical Engineering, Faculty of Engineering Science, Kansai University, Osaka 564-8680, Japan
| | - Yota Sekido
- Graduate School of Science and Engineering, Kansai University, Osaka 564-8680, Japan;
| | - Kazuki Mori
- Department of Cardiovascular Surgery, Oita University Hospital, Oita 879-5593, Japan; (K.M.); (T.K.); (Y.N.); (S.M.)
| | - Takayuki Kawashima
- Department of Cardiovascular Surgery, Oita University Hospital, Oita 879-5593, Japan; (K.M.); (T.K.); (Y.N.); (S.M.)
| | - Yumiko Nakashima
- Department of Cardiovascular Surgery, Oita University Hospital, Oita 879-5593, Japan; (K.M.); (T.K.); (Y.N.); (S.M.)
| | - Shinji Miyamoto
- Department of Cardiovascular Surgery, Oita University Hospital, Oita 879-5593, Japan; (K.M.); (T.K.); (Y.N.); (S.M.)
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Rashidi F, Mohammadzadeh M, Abdolmaleki A, Asadi A, Sheikhlou M. Acellular carotid scaffold and evaluation the biological and biomechanical properties for tissue engineering. J Cardiovasc Thorac Res 2024; 16:28-37. [PMID: 38584661 PMCID: PMC10997974 DOI: 10.34172/jcvtr.32899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 02/10/2024] [Indexed: 04/09/2024] Open
Abstract
Introduction The issues associated with the limitation of appropriate autologous vessels for vascular reconstruction via bypass surgery highlight the need for new alternative strategies based on tissue engineering. The present study aimed to prepare decellularized scaffolds from ovine carotid using chemical decellularization method. Methods Ovine carotid were decellularized with Triton X-100 and tri-n-butyl phosphate (TnBP) at 37 °C. Histological analysis, biochemical tests, biomechanical assay and biocompatibility assay were used to investigate the efficacy of decellularization. Results Decellularization method could successfully decellularize ovine carotid without leaving any cell remnants. Scaffolds showed minimal destruction of the three-dimensional structure and extracellular matrix, as well as adequate mechanical resistance and biocompatibility for cell growth and proliferation. Conclusion Prepared acellular scaffold exhibited the necessary characteristics for clinical applications.
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Affiliation(s)
- Farina Rashidi
- Department of Biology, Faculty of Science, University of Urmia, Urmia, Iran
| | | | - Arash Abdolmaleki
- Department of Biophysics, Faculty of Advanced Technologies, University of Mohaghegh Ardabili, Namin, Iran
| | - Asadollah Asadi
- Department of Biology, Faculty of Science, University of Mohaghegh Ardabili, Ardabil, Iran
| | - Mehrdad Sheikhlou
- Department of Engineering Sciences, Faculty of Advanced Technologies, University of Mohaghegh Ardabili, Namin, Iran
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Falkner F, Mayer SA, Thomas B, Zimmermann SO, Walter S, Heimel P, Thiele W, Sleeman JP, Bigdeli AK, Kiss H, Podesser BK, Kneser U, Bergmeister H, Schneider KH. Acellular Human Placenta Small-Diameter Vessels as a Favorable Source of Super-Microsurgical Vascular Replacements: A Proof of Concept. Bioengineering (Basel) 2023; 10:337. [PMID: 36978728 PMCID: PMC10045636 DOI: 10.3390/bioengineering10030337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 02/19/2023] [Accepted: 02/27/2023] [Indexed: 03/30/2023] Open
Abstract
In this study, we aimed to evaluate the human placenta as a source of blood vessels that can be harvested for vascular graft fabrication in the submillimeter range. Our approach included graft modification to prevent thrombotic events. Submillimeter arterial grafts harvested from the human placenta were decellularized and chemically crosslinked to heparin. Graft performance was evaluated using a microsurgical arteriovenous loop (AVL) model in Lewis rats. Specimens were evaluated through hematoxylin-eosin and CD31 staining of histological sections to analyze host cell immigration and vascular remodeling. Graft patency was determined 3 weeks after implantation using a vascular patency test, histology, and micro-computed tomography. A total of 14 human placenta submillimeter vessel grafts were successfully decellularized and implanted into AVLs in rats. An appropriate inner diameter to graft length ratio of 0.81 ± 0.16 mm to 7.72 ± 3.20 mm was achieved in all animals. Grafts were left in situ for a mean of 24 ± 4 days. Decellularized human placental grafts had an overall patency rate of 71% and elicited no apparent immunological responses. Histological staining revealed host cell immigration into the graft and re-endothelialization of the vessel luminal surface. This study demonstrates that decellularized vascular grafts from the human placenta have the potential to serve as super-microsurgical vascular replacements.
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Affiliation(s)
- Florian Falkner
- Department of Hand, Plastic and Reconstructive Surgery, BG Trauma Center Ludwigshafen, University of Heidelberg, 69117 Heidelberg, Germany
| | - Simon Andreas Mayer
- Department of Hand, Plastic and Reconstructive Surgery, BG Trauma Center Ludwigshafen, University of Heidelberg, 69117 Heidelberg, Germany
| | - Benjamin Thomas
- Department of Hand, Plastic and Reconstructive Surgery, BG Trauma Center Ludwigshafen, University of Heidelberg, 69117 Heidelberg, Germany
| | - Sarah Onon Zimmermann
- Center for Biomedical Research and Translational Surgery, Medical University of Vienna, 1090 Vienna, Austria
| | - Sonja Walter
- Department of Hand, Plastic and Reconstructive Surgery, BG Trauma Center Ludwigshafen, University of Heidelberg, 69117 Heidelberg, Germany
| | - Patrick Heimel
- Ludwig Boltzmann Institute for Experimental and Clinical Traumatology, 1200 Vienna, Austria
- Core Facility Hard Tissue and Biomaterial Research, Karl Donath Laboratory, University Clinic of Dentistry, Medical University of Vienna, 1090 Vienna, Austria
| | - Wilko Thiele
- Department of Microvascular Biology and Pathobiology, European Center for Angioscience (ECAS), Medical Faculty Mannheim, University of Heidelberg, 68167 Mannheim, Germany
| | - Jonathan Paul Sleeman
- Department of Microvascular Biology and Pathobiology, European Center for Angioscience (ECAS), Medical Faculty Mannheim, University of Heidelberg, 68167 Mannheim, Germany
- Institute for Biological and Chemical Systems, Karlsruhe Institute of Technology, Campus North, 76131 Karlsruhe, Germany
| | - Amir Khosrow Bigdeli
- Department of Hand, Plastic and Reconstructive Surgery, BG Trauma Center Ludwigshafen, University of Heidelberg, 69117 Heidelberg, Germany
| | - Herbert Kiss
- Department of Obstetrics and Gynecology, Division of Obstetrics and Feto-Maternal Medicine, Medical University of Vienna, 1090 Vienna, Austria
| | - Bruno Karl Podesser
- Center for Biomedical Research and Translational Surgery, Medical University of Vienna, 1090 Vienna, Austria
- Department of Obstetrics and Gynecology, Division of Obstetrics and Feto-Maternal Medicine, Medical University of Vienna, 1090 Vienna, Austria
| | - Ulrich Kneser
- Department of Hand, Plastic and Reconstructive Surgery, BG Trauma Center Ludwigshafen, University of Heidelberg, 69117 Heidelberg, Germany
| | - Helga Bergmeister
- Center for Biomedical Research and Translational Surgery, Medical University of Vienna, 1090 Vienna, Austria
- Ludwig Boltzmann Institute for Cardiovascular Research, 1090 Vienna, Austria
- Austrian Cluster for Tissue Regeneration, 1200 Vienna, Austria
| | - Karl Heinrich Schneider
- Center for Biomedical Research and Translational Surgery, Medical University of Vienna, 1090 Vienna, Austria
- Ludwig Boltzmann Institute for Cardiovascular Research, 1090 Vienna, Austria
- Austrian Cluster for Tissue Regeneration, 1200 Vienna, Austria
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Wang B, Wang X, Kenneth A, Drena A, Pacheco A, Kalvin L, Ibrahim ES, Rossi PJ, Thatcher K, Lincoln J. Developing small-diameter vascular grafts with human amniotic membrane: long-term evaluation of transplantation outcomes in a small animal model. Biofabrication 2023; 15. [PMID: 36626826 DOI: 10.1088/1758-5090/acb1da] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Accepted: 01/10/2023] [Indexed: 01/11/2023]
Abstract
While current clinical utilization of large vascular grafts for vascular transplantation is encouraging, tissue engineering of small grafts still faces numerous challenges. This study aims to investigate the feasibility of constructing a small vascular graft from decellularized amniotic membranes (DAMs). DAMs were rolled around a catheter and each of the resulting grafts was crosslinked with (a) 0.1% glutaraldehyde; (b) 1-ethyl-3-(3-dimethylaminopropyl) crbodiimidehydro-chloride (20 mM)-N-hydroxy-succinimide (10 mM); (c) 0.5% genipin; and (d) no-crosslinking, respectively. Our results demonstrated the feasibility of using a rolling technique followed by lyophilization to transform DAM into a vessel-like structure. The genipin-crosslinked DAM graft showed an improved integrated structure, prolonged stability, proper mechanical property, and superior biocompatibility. After transplantation in rat abdominal aorta, the genipin-crosslinked DAM graft remained patent up to 16 months, with both endothelial and smooth muscle cell regeneration, which suggests that the genipin-crosslinked DAM graft has great potential to beimplementedas a small tissue engineered graft for futurevasculartransplantation.
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Affiliation(s)
- Bo Wang
- Joint Department of Biomedical Engineering, Marquette University and the Medical College of Wisconsin, Milwaukee, WI 53226, United States of America
| | - Xiaolong Wang
- Joint Department of Biomedical Engineering, Marquette University and the Medical College of Wisconsin, Milwaukee, WI 53226, United States of America
| | - Allen Kenneth
- Biomedical Resource Center, Medical College of Wisconsin, Milwaukee, WI 53226, United States of America
| | - Alexander Drena
- Department of Chemistry and Biochemistry, University of Wisconsin-Milwaukee, Milwaukee, WI 53211, United States of America
| | - Arsenio Pacheco
- Department of Chemistry and Biochemistry, University of Wisconsin-Milwaukee, Milwaukee, WI 53211, United States of America
| | - Lindsey Kalvin
- Department of Medicine, Division of Cardiovascular Medicine, Medical College of Wisconsin, Milwaukee, WI 53226, United States of America
| | - Ei-Sayed Ibrahim
- Department of Radiology, Medical College of Wisconsin, Milwaukee, WI 53226, United States of America
| | - Peter J Rossi
- Heart and Vascular Center, Froedtert Hospital, Milwaukee, WI 53226, United States of America
| | - Kaitlyn Thatcher
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI 53226, United States of America
| | - Joy Lincoln
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI 53226, United States of America
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Li Y, Zhou Y, Qiao W, Shi J, Qiu X, Dong N. Application of decellularized vascular matrix in small-diameter vascular grafts. Front Bioeng Biotechnol 2023; 10:1081233. [PMID: 36686240 PMCID: PMC9852870 DOI: 10.3389/fbioe.2022.1081233] [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: 10/27/2022] [Accepted: 12/13/2022] [Indexed: 01/09/2023] Open
Abstract
Coronary artery bypass grafting (CABG) remains the most common procedure used in cardiovascular surgery for the treatment of severe coronary atherosclerotic heart disease. In coronary artery bypass grafting, small-diameter vascular grafts can potentially replace the vessels of the patient. The complete retention of the extracellular matrix, superior biocompatibility, and non-immunogenicity of the decellularized vascular matrix are unique advantages of small-diameter tissue-engineered vascular grafts. However, after vascular implantation, the decellularized vascular matrix is also subject to thrombosis and neoplastic endothelial hyperplasia, the two major problems that hinder its clinical application. The keys to improving the long-term patency of the decellularized matrix as vascular grafts include facilitating early endothelialization and avoiding intravascular thrombosis. This review article sequentially introduces six aspects of the decellularized vascular matrix as follows: design criteria of vascular grafts, components of the decellularized vascular matrix, the changing sources of the decellularized vascular matrix, the advantages and shortcomings of decellularization technologies, modification methods and the commercialization progress as well as the application prospects in small-diameter vascular grafts.
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Affiliation(s)
| | | | | | | | - Xuefeng Qiu
- *Correspondence: Xuefeng Qiu, ; Nianguo Dong,
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Wang X, Chan V, Corridon PR. Decellularized blood vessel development: Current state-of-the-art and future directions. Front Bioeng Biotechnol 2022; 10:951644. [PMID: 36003539 PMCID: PMC9394443 DOI: 10.3389/fbioe.2022.951644] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Accepted: 07/14/2022] [Indexed: 12/31/2022] Open
Abstract
Vascular diseases contribute to intensive and irreversible damage, and current treatments include medications, rehabilitation, and surgical interventions. Often, these diseases require some form of vascular replacement therapy (VRT) to help patients overcome life-threatening conditions and traumatic injuries annually. Current VRTs rely on harvesting blood vessels from various regions of the body like the arms, legs, chest, and abdomen. However, these procedures also produce further complications like donor site morbidity. Such common comorbidities may lead to substantial pain, infections, decreased function, and additional reconstructive or cosmetic surgeries. Vascular tissue engineering technology promises to reduce or eliminate these issues, and the existing state-of-the-art approach is based on synthetic or natural polymer tubes aiming to mimic various types of blood vessel. Burgeoning decellularization techniques are considered as the most viable tissue engineering strategy to fill these gaps. This review discusses various approaches and the mechanisms behind decellularization techniques and outlines a simplified model for a replacement vascular unit. The current state-of-the-art method used to create decellularized vessel segments is identified. Also, perspectives on future directions to engineer small- (inner diameter >1 mm and <6 mm) to large-caliber (inner diameter >6 mm) vessel substitutes are presented.
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Affiliation(s)
- Xinyu Wang
- Biomedical Engineering and Healthcare Engineering Innovation Center, Khalifa University, Abu Dhabi, United Arab Emirates
- Department of Immunology and Physiology, College of Medicine and Health Sciences, Khalifa University, Abu Dhabi, United Arab Emirates
| | - Vincent Chan
- Biomedical Engineering and Healthcare Engineering Innovation Center, Khalifa University, Abu Dhabi, United Arab Emirates
| | - Peter R. Corridon
- Department of Immunology and Physiology, College of Medicine and Health Sciences, Khalifa University, Abu Dhabi, United Arab Emirates
- Center for Biotechnology, Khalifa University, Abu Dhabi, United Arab Emirates
- *Correspondence: Peter R. Corridon,
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Lopera Higuita M, Shortreed NA, Dasari S, Griffiths LG. Basement Membrane of Tissue Engineered Extracellular Matrix Scaffolds Modulates Rapid Human Endothelial Cell Recellularization and Promote Quiescent Behavior After Monolayer Formation. Front Bioeng Biotechnol 2022; 10:903907. [PMID: 35983533 PMCID: PMC9379346 DOI: 10.3389/fbioe.2022.903907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Accepted: 05/31/2022] [Indexed: 11/13/2022] Open
Abstract
Off-the-shelf small diameter vascular grafts are an attractive alternative to eliminate the shortcomings of autologous tissues for vascular grafting. Bovine saphenous vein (SV) extracellular matrix (ECM) scaffolds are potentially ideal small diameter vascular grafts, due to their inherent architecture and signaling molecules capable of driving repopulating cell behavior and regeneration. However, harnessing this potential is predicated on the ability of the scaffold generation technique to maintain the delicate structure, composition, and associated functions of native vascular ECM. Previous de-cellularization methods have been uniformly demonstrated to disrupt the delicate basement membrane components of native vascular ECM. The antigen removal (AR) tissue processing method utilizes the protein chemistry principle of differential solubility to achieve a step-wise removal of antigens with similar physiochemical properties. Briefly, the cellular components of SV are permeabilized and the actomyosin crossbridges are relaxed, followed by lipophilic antigen removal, sarcomeric disassembly, hydrophilic antigen removal, nuclease digestion, and washout. Here, we demonstrate that bovine SV ECM scaffolds generated using the novel AR approach results in the retention of native basement membrane protein structure, composition (e.g., Collagen IV and laminin), and associated cell modulatory function. Presence of basement membrane proteins in AR vascular ECM scaffolds increases the rate of endothelial cell monolayer formation by enhancing cell migration and proliferation. Following monolayer formation, basement membrane proteins promote appropriate formation of adherence junction and apicobasal polarization, increasing the secretion of nitric oxide, and driving repopulating endothelial cells toward a quiescent phenotype. We conclude that the presence of an intact native vascular basement membrane in the AR SV ECM scaffolds modulates human endothelial cell quiescent monolayer formation which is essential for vessel homeostasis.
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Sembiring YE, Ledyastatin RA, Nurrahmah A, Sulistyaningsih NK, Sinatra JAR, Puruhito I, Suroto H. Comparative Assessment of Various Concentration and Exposure Time of Sodium Dodecyl Sulfate as Decellularization Agents for Small-Vessels Vascular Tissue Engineering. Open Access Maced J Med Sci 2022. [DOI: 10.3889/oamjms.2022.9396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND: Finding the optimum vascular grafts (VG) to replace damaged blood arteries in cardiac surgery is still a work in progress. To be employed, a tissue-engineered VG (TEVG) must have the appropriate biological and mechanical qualities. Decellularized arteries may be a better TEVG than synthetic grafts because of their natural three-dimensional architecture.
AIM: The goal of this study was to compare different concentrations and times of sodium dodecyl sulfate (SDS) to decellularize tissue to find the best decellularized VG.
METHODS: In all decellularized scaffolds, which are 1% SDS-2 weeks group, hematoxylin and eosin and Masson’s trichrome staining exhibited looser collagen networks and fewer nuclei.
RESULTS: The orientation of collagen fibers was identical to native vascular scaffolds. Collagen I deposition was seen in the immunohistochemistry assay. A tensile strength test revealed that the decellularized scaffold (0.5% SDS for 4 weeks and 0.5% SDS for 2 weeks) had exceeded the native arteries’ maximal strength. In comparison to 1% SDS in 4 weeks treated groups, scanning electron microscopy following decellularization revealed no endothelial cells on the inner side of 1% SDS in 2 weeks group with minimum extracellular matrix damage. The endothelial cells remained marginally visible on the inner side of all 0.5% SDS treated groups. The 3-(4,5-dimethylthiazol-2yl)2,5-diphenyltetrazolium bromide test was used to determine the cytotoxicity of the decellularized scaffolds.
CONCLUSION: This study reveals that exposing a bovine mesenteric artery to 1% SDS for 2 weeks is an excellent procedure for extracting the most acellular VG, potentially serving as a biological scaffold for TEVGs.
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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, Méndez 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] [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. This study combines multidisciplinary approach for bioprinting patient-specific. We create a 3D scaffold, printed using a hybrid fused deposition modelling and electrospinning techniques. The graft shows adequate resistance to physiological aortic pressure and a porosity gradient. Multipotent mesenchymal stem cells seeded in the scaffold are differentiated to derived vascular smooth muscle cells. dVSMC shows adequate endothelin- 1 induced Ca2+ increase associated with ETA overexpression.
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Kim H, Choi KH, Sung SC, Kim YS. Effect of ethanol washing on porcine pulmonary artery wall decellularization using sodium dodecyl sulfate. Artif Organs 2022; 46:1281-1293. [PMID: 35107179 DOI: 10.1111/aor.14192] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 12/19/2021] [Accepted: 01/24/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND To determine the effectiveness of ethanol (EtOH) washing on porcine pulmonary artery (PA) wall decellularization using sodium dodecyl sulfate (SDS), we compared three different washing methods (phosphate-buffered saline [PBS], pH 9 alkali, and EtOH washing). METHODS Fresh porcine PA walls were decellularized using 0.5% SDS and 0.5% sodium deoxycholate (SDC). The decellularized tissues were rinsed using three different washing techniques. Histological, biochemical, and mechanical analyses were conducted. Implantation into the subcutaneous tissue of rats and patch implantation into the carotid artery of dogs were performed as preliminary in vivo studies. RESULTS The decellularization protocol based on SDS and SDC effectively removed the cells. The major extracellular matrix (ECM) structures (collagen, elastic fiber, and glycosaminoglycan) were properly preserved with the 75% EtOH-washing method. Significantly reduced residual SDS content was identified in EtOH-washed tissues compared to that in the other methods. No significant difference in the mechanical strength test was observed between the washing methods, and the EtOH-washing method showed better results in the metabolic activity test compared to the PBS-washing method. In the rat study model, no acute rejection or massive calcification was observed. The in vivo preliminary canine study showed better cell repopulation in the EtOH-washed group. CONCLUSION EtOH washing of SDS-based decellularized porcine PA wall can reduce the residual SDS content and preserve ECM structures, especially the elastin content, and could also enhance cell repopulation after re-implantation.
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Affiliation(s)
- Hyungtae Kim
- Department of Thoracic and Cardiovascular Surgery, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Kwang Ho Choi
- Department of Thoracic and Cardiovascular Surgery, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Si Chan Sung
- Department of Thoracic and Cardiovascular Surgery, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Young Suk Kim
- Department of Thoracic and Cardiovascular Surgery, Pusan National University Yangsan Hospital, Biomedical Research Institute, Yangsan, Korea
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Lopera Higuita M, Lopera Giraldo JF, Sarrafian TL, Griffiths LG. Tissue engineered bovine saphenous vein extracellular matrix scaffolds produced via antigen removal achieve high in vivo patency rates. Acta Biomater 2021; 134:144-159. [PMID: 34192567 DOI: 10.1016/j.actbio.2021.06.034] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 06/17/2021] [Accepted: 06/22/2021] [Indexed: 12/11/2022]
Abstract
Diseases of small diameter blood vessels encompass the largest portion of cardiovascular diseases, with over 4.2 million people undergoing autologous vascular grafting every year. However, approximately one third of patients are ineligible for autologous vascular grafting due to lack of suitable donor vasculature. Acellular extracellular matrix (ECM) scaffolds derived from xenogeneic vascular tissue have potential to serve as ideal biomaterials for production of off-the-shelf vascular grafts capable of eliminating the need for autologous vessel harvest. A modified antigen removal (AR) tissue process, employing aminosulfabetaine-16 (ASB-16) was used to create off-the-shelf small diameter (< 3 mm) vascular graft from bovine saphenous vein ECM scaffolds with significantly reduced antigenic content, while retaining native vascular ECM protein structure and function. Elimination of native tissue antigen content conferred graft-specific adaptive immune avoidance, while retention of native ECM protein macromolecular structure resulted in pro-regenerative cellular infiltration, ECM turnover and innate immune self-recognition in a rabbit subpannicular model. Finally, retention of the delicate vascular basement membrane protein integrity conferred endothelial cell repopulation and 100% patency rate in a rabbit jugular interposition model, comparable only to Autograft implants. Alternatively, the lack of these important basement membrane proteins in otherwise identical scaffolds yielded a patency rate of only 20%. We conclude that acellular antigen removed bovine saphenous vein ECM scaffolds have potential to serve as ideal off-the-shelf small diameter vascular scaffolds with high in vivo patency rates due to their low antigen content, retained native tissue basement membrane integrity and preserved native ECM structure, composition and functional properties. STATEMENT OF SIGNIFICANCE: The use of autologous vessels for the treatment of small diameter vascular diseases is common practice. However, the use of autologous tissue poses significant complications due to tissue harvest and limited availability. Developing an alternative vessel for use for the treatment of small diameter vessel diseases can potentially increase the success rate of autologous vascular grafting by eliminating complications related to the use of autologous vessel and increased availability. This manuscript demonstrates the potential of non-antigenic extracellular matrix (ECM) scaffolds derived from xenogeneic vascular tissue as off-the-shelf vascular grafts for the treatment of small diameter vascular diseases.
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Affiliation(s)
| | - Juan F Lopera Giraldo
- Department of Plastic Surgery, Clínica Las Américas, Antioquia, Dg. 75B ##2A-80/140, Medellín, Colombia
| | - Tiffany L Sarrafian
- Department of Thoracic Surgery, Mayo Clinic, 200 1st St SW, Rochester MN, USA
| | - Leigh G Griffiths
- Department of Cardiovascular Diseases, Mayo Clinic, 200 1st St SW, Rochester, MN 55905, USA.
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12
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Du P, Li X, Sun L, Pan Y, Zhu H, Li Y, Yang Y, Wei X, Jing C, Chen H, Shi Q, Li W, Zhao L. Improved hemocompatibility by modifying acellular blood vessels with bivalirudin and its biocompatibility evaluation. J Biomed Mater Res A 2021; 110:635-651. [PMID: 34599549 DOI: 10.1002/jbm.a.37316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Revised: 09/14/2021] [Accepted: 09/22/2021] [Indexed: 11/08/2022]
Abstract
The incidence rate of cardiovascular diseases is increasing year by year. The demand for coronary artery bypass grafting has been very large. Acellular blood vessels have potential clinical application because of their natural vascular basis, but their biocompatibility and anticoagulant energy need to be improved. We decellularized the abdominal aorta of SD rats, and then modified with bivalirudin via polydopamine. The mechanical properties, blood compatibility, cytocompatibility, immune response, and anticoagulant properties were evaluated, and then the bivalirudin-modified acellular blood vessels were implanted into rats for remodeling evaluation in vivo. The results we got show that the bivalirudin-modified acellular blood vessels showed good cytocompatibility and blood compatibility, and its anti-inflammatory trend was dominant in the immune response. After 3 months of transplantation, the bivalirudin-modified acellular blood vessels did not easily form thrombus. It was not easy to form calcification and could make the host cells grow better. Through vascular stimulation and immunofluorescence test, we found that vascular smooth muscle cells and endothelial cells proliferated well in the bivalirudin group. Bivalirudin-modified acellular blood vessels provided new idea for small diameter tissue engineering blood vessels, and may become a potential clinical substitute for small-diameter vascular grafts.
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Affiliation(s)
- Pengchong Du
- Key Laboratory of Cardiac Structure Research, Zhengzhou Seventh People's Hospital, College of Life Science and Technology, Xinxiang Medical University, Xinxiang, China.,Department of Cardiothoracic Surgery, Third Affiliated Hospital of Xinxiang Medical University, Xinxiang, China
| | - Xiafei Li
- College of Medical Engineering, Xinxiang Medical University, Xinxiang, China
| | - Lulu Sun
- Key Laboratory of Cardiac Structure Research, Zhengzhou Seventh People's Hospital, College of Life Science and Technology, Xinxiang Medical University, Xinxiang, China
| | - Yuxue Pan
- Key Laboratory of Cardiac Structure Research, Zhengzhou Seventh People's Hospital, College of Life Science and Technology, Xinxiang Medical University, Xinxiang, China
| | - Hengchao Zhu
- Key Laboratory of Cardiac Structure Research, Zhengzhou Seventh People's Hospital, College of Life Science and Technology, Xinxiang Medical University, Xinxiang, China
| | - Yangyang Li
- Department of Cardiothoracic Surgery, Third Affiliated Hospital of Xinxiang Medical University, Xinxiang, China
| | - Yingjie Yang
- Department of Cardiothoracic Surgery, Third Affiliated Hospital of Xinxiang Medical University, Xinxiang, China
| | - Xieze Wei
- Department of Anesthesiology, Xinxiang Central Hospital of Xinxiang Medical University, Xinxiang, China
| | - Changqin Jing
- Key Laboratory of Cardiac Structure Research, Zhengzhou Seventh People's Hospital, College of Life Science and Technology, Xinxiang Medical University, Xinxiang, China
| | - Hongli Chen
- Key Laboratory of Cardiac Structure Research, Zhengzhou Seventh People's Hospital, College of Life Science and Technology, Xinxiang Medical University, Xinxiang, China
| | - Qizhong Shi
- Department of Cardiothoracic Surgery, Third Affiliated Hospital of Xinxiang Medical University, Xinxiang, China
| | - Wenbin Li
- Department of Cardiothoracic Surgery, Third Affiliated Hospital of Xinxiang Medical University, Xinxiang, China
| | - Liang Zhao
- Key Laboratory of Cardiac Structure Research, Zhengzhou Seventh People's Hospital, College of Life Science and Technology, Xinxiang Medical University, Xinxiang, China
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13
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Yu C, Yang H, Wang L, Thomson JA, Turng LS, Guan G. Surface modification of polytetrafluoroethylene (PTFE) with a heparin-immobilized extracellular matrix (ECM) coating for small-diameter vascular grafts applications. MATERIALS SCIENCE & ENGINEERING. C, MATERIALS FOR BIOLOGICAL APPLICATIONS 2021; 128:112301. [PMID: 34474852 PMCID: PMC8417426 DOI: 10.1016/j.msec.2021.112301] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Revised: 06/08/2021] [Accepted: 07/05/2021] [Indexed: 11/16/2022]
Abstract
Intimal hyperplasia, thrombosis formation, and delayed endothelium regeneration are the main causes that restrict the clinical applications of PTFE small-diameter vascular grafts (inner diameter < 6 mm). An ideal strategy to solve such problems is to facilitate in situ endothelialization. Since the natural vascular endothelium adheres onto the basement membrane, which is a specialized form of extracellular matrix (ECM) secreted by endothelial cells (ECs) and smooth muscle cells (SMCs), functionalizing PTFE with an ECM coating was proposed. However, besides ECs, the ECM-modified PTFE improved SMC growth as well, thereby increasing the risk of intimal hyperplasia. In the present study, heparin was immobilized on the ECM coating at different densities (4.89 ± 1.02 μg/cm2, 7.24 ± 1.56 μg/cm2, 15.63 ± 2.45 μg/cm2, and 26.59 ± 3.48 μg/cm2), aiming to develop a bio-favorable environment that possessed excellent hemocompatibility and selectively inhibited SMC growth while promoting endothelialization. The results indicated that a low heparin density (4.89 ± 1.02 μg/cm2) was not enough to restrict platelet adhesion, whereas a high heparin density (26.59 ± 3.48 μg/cm2) resulted in decreased EC growth and enhanced SMC proliferation. Therefore, a heparin density at 7.24 ± 1.56 μg/cm2 was the optimal level in terms of antithrombogenicity, endothelialization, and SMC inhibition. Collectively, this study proposed a heparin-immobilized ECM coating to modify PTFE, offering a promising means to functionalize biomaterials for developing small-diameter vascular grafts.
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Affiliation(s)
- Chenglong Yu
- Key Laboratory of Textile Industry for Biomedical Textile Materials and Technology, College of Textiles, Donghua University, Shanghai 201620, China; Engineering Research Center of Technical Textiles of Ministry of Education, College of Textiles, Donghua University, Shanghai 201620, China; Wisconsin Institute for Discovery, University of Wisconsin-Madison, Madison, WI 53715, United States; Department of Mechanical Engineering, University of Wisconsin-Madison, Madison, WI 53706, United States
| | - Huaguang Yang
- Wisconsin Institute for Discovery, University of Wisconsin-Madison, Madison, WI 53715, United States; Department of Mechanical Engineering, University of Wisconsin-Madison, Madison, WI 53706, United States
| | - Lu Wang
- Key Laboratory of Textile Industry for Biomedical Textile Materials and Technology, College of Textiles, Donghua University, Shanghai 201620, China; Engineering Research Center of Technical Textiles of Ministry of Education, College of Textiles, Donghua University, Shanghai 201620, China
| | - James A Thomson
- Morgridge Institute for Research, University of Wisconsin-Madison, Madison, WI 53715, United States
| | - Lih-Sheng Turng
- Wisconsin Institute for Discovery, University of Wisconsin-Madison, Madison, WI 53715, United States; Department of Mechanical Engineering, University of Wisconsin-Madison, Madison, WI 53706, United States.
| | - Guoping Guan
- Key Laboratory of Textile Industry for Biomedical Textile Materials and Technology, College of Textiles, Donghua University, Shanghai 201620, China; Engineering Research Center of Technical Textiles of Ministry of Education, College of Textiles, Donghua University, Shanghai 201620, China.
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14
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Lepedda AJ, Nieddu G, Formato M, Baker MB, Fernández-Pérez J, Moroni L. Glycosaminoglycans: From Vascular Physiology to Tissue Engineering Applications. Front Chem 2021; 9:680836. [PMID: 34084767 PMCID: PMC8167061 DOI: 10.3389/fchem.2021.680836] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 05/03/2021] [Indexed: 12/27/2022] Open
Abstract
Cardiovascular diseases represent the number one cause of death globally, with atherosclerosis a major contributor. Despite the clinical need for functional arterial substitutes, success has been limited to arterial replacements of large-caliber vessels (diameter > 6 mm), leaving the bulk of demand unmet. In this respect, one of the most challenging goals in tissue engineering is to design a "bioactive" resorbable scaffold, analogous to the natural extracellular matrix (ECM), able to guide the process of vascular tissue regeneration. Besides adequate mechanical properties to sustain the hemodynamic flow forces, scaffold's properties should include biocompatibility, controlled biodegradability with non-toxic products, low inflammatory/thrombotic potential, porosity, and a specific combination of molecular signals allowing vascular cells to attach, proliferate and synthesize their own ECM. Different fabrication methods, such as phase separation, self-assembly and electrospinning are currently used to obtain nanofibrous scaffolds with a well-organized architecture and mechanical properties suitable for vascular tissue regeneration. However, several studies have shown that naked scaffolds, although fabricated with biocompatible polymers, represent a poor substrate to be populated by vascular cells. In this respect, surface functionalization with bioactive natural molecules, such as collagen, elastin, fibrinogen, silk fibroin, alginate, chitosan, dextran, glycosaminoglycans (GAGs), and growth factors has proven to be effective. GAGs are complex anionic unbranched heteropolysaccharides that represent major structural and functional ECM components of connective tissues. GAGs are very heterogeneous in terms of type of repeating disaccharide unit, relative molecular mass, charge density, degree and pattern of sulfation, degree of epimerization and physicochemical properties. These molecules participate in a number of vascular events such as the regulation of vascular permeability, lipid metabolism, hemostasis, and thrombosis, but also interact with vascular cells, growth factors, and cytokines to modulate cell adhesion, migration, and proliferation. The primary goal of this review is to perform a critical analysis of the last twenty-years of literature in which GAGs have been used as molecular cues, able to guide the processes leading to correct endothelialization and neo-artery formation, as well as to provide readers with an overall picture of their potential as functional molecules for small-diameter vascular regeneration.
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Affiliation(s)
| | - Gabriele Nieddu
- Department of Biomedical Sciences, University of Sassari, Sassari, Italy
| | - Marilena Formato
- Department of Biomedical Sciences, University of Sassari, Sassari, Italy
| | - Matthew Brandon Baker
- Complex Tissue Regeneration Department, MERLN Institute for Technology Inspired Regenerative Medicine, Maastricht, Netherlands
| | - Julia Fernández-Pérez
- Complex Tissue Regeneration Department, MERLN Institute for Technology Inspired Regenerative Medicine, Maastricht, Netherlands
| | - Lorenzo Moroni
- Complex Tissue Regeneration Department, MERLN Institute for Technology Inspired Regenerative Medicine, Maastricht, Netherlands
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15
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Seiffert N, Tang P, Keshi E, Reutzel-Selke A, Moosburner S, Everwien H, Wulsten D, Napierala H, Pratschke J, Sauer IM, Hillebrandt KH, Struecker B. In vitro recellularization of decellularized bovine carotid arteries using human endothelial colony forming cells. J Biol Eng 2021; 15:15. [PMID: 33882982 PMCID: PMC8059238 DOI: 10.1186/s13036-021-00266-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2020] [Accepted: 04/07/2021] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Many patients suffering from peripheral arterial disease (PAD) are dependent on bypass surgery. However, in some patients no suitable replacements (i.e. autologous or prosthetic bypass grafts) are available. Advances have been made to develop autologous tissue engineered vascular grafts (TEVG) using endothelial colony forming cells (ECFC) obtained by peripheral blood draw in large animal trials. Clinical translation of this technique, however, still requires additional data for usability of isolated ECFC from high cardiovascular risk patients. Bovine carotid arteries (BCA) were decellularized using a combined SDS (sodium dodecyl sulfate) -free mechanical-osmotic-enzymatic-detergent approach to show the feasibility of xenogenous vessel decellularization. Decellularized BCA chips were seeded with human ECFC, isolated from a high cardiovascular risk patient group, suffering from diabetes, hypertension and/or chronic renal failure. ECFC were cultured alone or in coculture with rat or human mesenchymal stromal cells (rMSC/hMSC). Decellularized BCA chips were evaluated for biochemical, histological and mechanical properties. Successful isolation of ECFC and recellularization capabilities were analyzed by histology. RESULTS Decellularized BCA showed retained extracellular matrix (ECM) composition and mechanical properties upon cell removal. Isolation of ECFC from the intended target group was successfully performed (80% isolation efficiency). Isolated cells showed a typical ECFC-phenotype. Upon recellularization, co-seeding of patient-isolated ECFC with rMSC/hMSC and further incubation was successful for 14 (n = 9) and 23 (n = 5) days. Reendothelialization (rMSC) and partial reendothelialization (hMSC) was achieved. Seeded cells were CD31 and vWF positive, however, human cells were detectable for up to 14 days in xenogenic cell-culture only. Seeding of ECFC without rMSC was not successful. CONCLUSION Using our refined decellularization process we generated easily obtainable TEVG with retained ECM- and mechanical quality, serving as a platform to develop small-diameter (< 6 mm) TEVG. ECFC isolation from the cardiovascular risk target group is possible and sufficient. Survival of diabetic ECFC appears to be highly dependent on perivascular support by rMSC/hMSC under static conditions. ECFC survival was limited to 14 days post seeding.
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Affiliation(s)
- Nicolai Seiffert
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt- Universität zu Berlin, Department of Surgery, Campus Charité Mitte
- Campus Virchow-Klinikum, Augustenburger Platz 1, 13353, Berlin, Germany.,Department for Trauma and Orthopedic Surgery, Vivantes-Hospital Spandau, Berlin, Germany
| | - Peter Tang
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt- Universität zu Berlin, Department of Surgery, Campus Charité Mitte
- Campus Virchow-Klinikum, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Eriselda Keshi
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt- Universität zu Berlin, Department of Surgery, Campus Charité Mitte
- Campus Virchow-Klinikum, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Anja Reutzel-Selke
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt- Universität zu Berlin, Department of Surgery, Campus Charité Mitte
- Campus Virchow-Klinikum, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Simon Moosburner
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt- Universität zu Berlin, Department of Surgery, Campus Charité Mitte
- Campus Virchow-Klinikum, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Hannah Everwien
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt- Universität zu Berlin, Department of Surgery, Campus Charité Mitte
- Campus Virchow-Klinikum, Augustenburger Platz 1, 13353, Berlin, Germany.,Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Dag Wulsten
- Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany.,Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt- Universität zu Berlin, Julius Wolff Institute, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Hendrik Napierala
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt- Universität zu Berlin, Department of Surgery, Campus Charité Mitte
- Campus Virchow-Klinikum, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Johann Pratschke
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt- Universität zu Berlin, Department of Surgery, Campus Charité Mitte
- Campus Virchow-Klinikum, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Igor M Sauer
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt- Universität zu Berlin, Department of Surgery, Campus Charité Mitte
- Campus Virchow-Klinikum, Augustenburger Platz 1, 13353, Berlin, Germany.
| | - Karl H Hillebrandt
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt- Universität zu Berlin, Department of Surgery, Campus Charité Mitte
- Campus Virchow-Klinikum, Augustenburger Platz 1, 13353, Berlin, Germany.,Berlin Institute of Health at Charité - Universitätsmedizin Berlin, BIH Academy, Clinician Scientist Program, Charitéplatz 1, 10117, Berlin, Germany
| | - Benjamin Struecker
- Berlin Institute of Health at Charité - Universitätsmedizin Berlin, BIH Academy, Clinician Scientist Program, Charitéplatz 1, 10117, Berlin, Germany.,Department of General, Visceral and Transplant Surgery, University Hospital Münster, Münster, Germany
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16
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Wang J, Kong L, Gafur A, Peng X, Kristi N, Xu J, Ma X, Wang N, Humphry R, Durkan C, Zhang H, Ye Z, Wang G. Photooxidation crosslinking to recover residual stress in decellularized blood vessel. Regen Biomater 2021; 8:rbaa058. [PMID: 33738112 PMCID: PMC7955719 DOI: 10.1093/rb/rbaa058] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 11/17/2020] [Accepted: 12/07/2020] [Indexed: 12/01/2022] Open
Abstract
Decellularization method based on trypsin-digestion is widely used to construct small diameter vascular grafts. However, this method will reduce the opening angle of the blood vessel and result in the reduction of residual stress. Residual stress reduced has an adverse effect on the compliance and permeability of small diameter vascular grafts. To improve the situation, acellular blood vessels were treated with glutaraldehyde and photooxidation crosslinking respectively, and the changes of opening angle, circumferential residual strain of native blood vessels, decellularized arteries and crosslinked blood vessels were measured by means of histological examination, scanning electron microscopy (SEM) and transmission electron microscopy (TEM) in this study. The opening angle of decellularized arteries significantly restored after photooxidation crosslinking (P = 0.0216), while that of glutaraldehyde crosslinking blood vessels reduced. The elastic fibers inside the blood vessels became densely rearranged after photooxidation crosslinking. The results of finite element simulation showed that the residual stress increased with the increase of opening angle. In this study, we found at the first time that photooxidation crosslinking method could significantly increase the residual stress of decellularized vessels, which provides biomechanical support for the development of new biomaterials of vascular grafts.
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Affiliation(s)
- Jintao Wang
- Key Laboratory of Biorheological Science and Technology (Chongqing University), Ministry of Education, State and Local Joint Engineering Laboratory for Vascular Implants, Bioengineering College of Chongqing University, Chongqing 400030, China
| | - Lingwen Kong
- Department of Cardiothoracic Surgery, Central Hospital of Chongqing University, Chongqing Emergency Medical Center, Chongqing 400014, China
| | - Alidha Gafur
- Key Laboratory of Biorheological Science and Technology (Chongqing University), Ministry of Education, State and Local Joint Engineering Laboratory for Vascular Implants, Bioengineering College of Chongqing University, Chongqing 400030, China
| | - Xiaobo Peng
- Key Laboratory of Biorheological Science and Technology (Chongqing University), Ministry of Education, State and Local Joint Engineering Laboratory for Vascular Implants, Bioengineering College of Chongqing University, Chongqing 400030, China
| | - Natalia Kristi
- Key Laboratory of Biorheological Science and Technology (Chongqing University), Ministry of Education, State and Local Joint Engineering Laboratory for Vascular Implants, Bioengineering College of Chongqing University, Chongqing 400030, China
| | - Jing Xu
- Key Laboratory of Biorheological Science and Technology (Chongqing University), Ministry of Education, State and Local Joint Engineering Laboratory for Vascular Implants, Bioengineering College of Chongqing University, Chongqing 400030, China
| | - Xingshuang Ma
- Key Laboratory of Biorheological Science and Technology (Chongqing University), Ministry of Education, State and Local Joint Engineering Laboratory for Vascular Implants, Bioengineering College of Chongqing University, Chongqing 400030, China
| | - Nan Wang
- The Nanoscience Centre, University of Cambridge, Cambridge CB3 0FF, UK
| | - Rose Humphry
- The Nanoscience Centre, University of Cambridge, Cambridge CB3 0FF, UK
| | - Colm Durkan
- The Nanoscience Centre, University of Cambridge, Cambridge CB3 0FF, UK
| | - Haijun Zhang
- National Local Joint Engineering Laboratory for Biomedical Material Modification, Dezhou, Shandong 251100, China
| | - Zhiyi Ye
- Key Laboratory of Biorheological Science and Technology (Chongqing University), Ministry of Education, State and Local Joint Engineering Laboratory for Vascular Implants, Bioengineering College of Chongqing University, Chongqing 400030, China
| | - Guixue Wang
- Key Laboratory of Biorheological Science and Technology (Chongqing University), Ministry of Education, State and Local Joint Engineering Laboratory for Vascular Implants, Bioengineering College of Chongqing University, Chongqing 400030, China
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17
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Chun SY, Lee JN, Ha YS, Yoon BH, Lee EH, Kim BM, Gil H, Han MH, Oh WS, Kwon TG, Kim TH, Kim BS. Optimization of extracellular matrix extraction from human perirenal adipose tissue. J Biomater Appl 2021; 35:1180-1191. [PMID: 33435802 DOI: 10.1177/0885328220984594] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Human adipose tissue includes useful substrates for regenerative medicine such as the extracellular matrix (ECM), but most perirenal fat tissue is wasted after kidney surgery. Since a lot of adipose tissue can be procured after a kidney, we extracted ECM from human perirenal adipose tissue and optimized the extraction process. To verify the efficacy for ECM extraction, we compared the products in several steps. Perirenal adipose tissue was either finely homogenized or underwent crude manual dissection. The amount of extracted ECM was quantified with ELISA for verification of the initial tissue downsizing effect. To validate the drying effect for fast and complete delipidation, tissues were prepared in a dry or wet phase, and residual lipids were visualized with Oil-Red-O staining. The extracted lipid was assayed at each time point to quantify the appropriate delipidation time. To select the optimal decellularization method, tissues were treated with physical, chemical, or enzymatic method, and the residual cell debris were identified with histological staining. The biochemical properties of the ECM extracted by the above methods were analyzed. The ECM extracted by fine homogenization showed a significantly enhanced amount of collagen, laminin and fibronectin compared to the crude dissection method. The dried tissue showed fast and complete lipid elimination compared to the wet tissue. Complete delipidation was achieved at 45 min after acetone treatment. Additionally, 1% triton X-100 chemical treatment showed complete decellularization with well-preserved collagen fibers. Biochemical analysis revealed preserved ECM proteins, a high cell proliferation rate and normal cell morphology without cell debris or lipids. The established process of homogenization, drying, delipidation with acetone, and decellularization with Triton X-100 treatment can be an optimal method for ECM extraction from human perirenal adipose tissue. Using this technique, human perirenal adipose tissue may be a valuable source for tissue engineering and regenerative medicine.
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Affiliation(s)
- So Young Chun
- BioMedical Research Institute, Kyungpook National University Hospital, Daegu, South Korea
| | - Jun Nyung Lee
- Department of Urology, School of Medicine, Kyungpook National University, Kyungpook National University Chilgok Hospital, Daegu, South Korea
| | - Yun-Sok Ha
- Department of Urology, School of Medicine, Kyungpook National University, Kyungpook National University Chilgok Hospital, Daegu, South Korea
| | - Bo Hyun Yoon
- BioMedical Research Institute, Kyungpook National University Hospital, Daegu, South Korea
| | - Eun Hye Lee
- BioMedical Research Institute, Kyungpook National University Hospital, Daegu, South Korea
| | - Bo Mi Kim
- BioMedical Research Institute, Kyungpook National University Hospital, Daegu, South Korea
| | - Haejung Gil
- BioMedical Research Institute, Kyungpook National University Hospital, Daegu, South Korea
| | - Man-Hoon Han
- Department of Pathology, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu, South Korea
| | - Woo Seok Oh
- Department of Urology, School of Medicine, Kyungpook National University, Kyungpook National University Chilgok Hospital, Daegu, South Korea
| | - Tae Gyun Kwon
- Department of Urology, School of Medicine, Kyungpook National University, Kyungpook National University Chilgok Hospital, Daegu, South Korea
| | - Tae-Hwan Kim
- Department of Urology, School of Medicine, Kyungpook National University, Kyungpook National University Chilgok Hospital, Daegu, South Korea
| | - Bum Soo Kim
- Department of Urology, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu, South Korea
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18
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Mallis P, Kostakis A, Stavropoulos-Giokas C, Michalopoulos E. Future Perspectives in Small-Diameter Vascular Graft Engineering. Bioengineering (Basel) 2020; 7:E160. [PMID: 33321830 PMCID: PMC7763104 DOI: 10.3390/bioengineering7040160] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2020] [Revised: 12/04/2020] [Accepted: 12/09/2020] [Indexed: 02/07/2023] Open
Abstract
The increased demands of small-diameter vascular grafts (SDVGs) globally has forced the scientific society to explore alternative strategies utilizing the tissue engineering approaches. Cardiovascular disease (CVD) comprises one of the most lethal groups of non-communicable disorders worldwide. It has been estimated that in Europe, the healthcare cost for the administration of CVD is more than 169 billion €. Common manifestations involve the narrowing or occlusion of blood vessels. The replacement of damaged vessels with autologous grafts represents one of the applied therapeutic approaches in CVD. However, significant drawbacks are accompanying the above procedure; therefore, the exploration of alternative vessel sources must be performed. Engineered SDVGs can be produced through the utilization of non-degradable/degradable and naturally derived materials. Decellularized vessels represent also an alternative valuable source for the development of SDVGs. In this review, a great number of SDVG engineering approaches will be highlighted. Importantly, the state-of-the-art methodologies, which are currently employed, will be comprehensively presented. A discussion summarizing the key marks and the future perspectives of SDVG engineering will be included in this review. Taking into consideration the increased number of patients with CVD, SDVG engineering may assist significantly in cardiovascular reconstructive surgery and, therefore, the overall improvement of patients' life.
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Affiliation(s)
- Panagiotis Mallis
- Hellenic Cord Blood Bank, Biomedical Research Foundation Academy of Athens, 4 Soranou Ephessiou Street, 115 27 Athens, Greece; (C.S.-G.); (E.M.)
| | - Alkiviadis Kostakis
- Center of Experimental Surgery and Translational Research, Biomedical Research Foundation Academy of Athens, 4 Soranou Ephessiou Street, 115 27 Athens, Greece;
| | - Catherine Stavropoulos-Giokas
- Hellenic Cord Blood Bank, Biomedical Research Foundation Academy of Athens, 4 Soranou Ephessiou Street, 115 27 Athens, Greece; (C.S.-G.); (E.M.)
| | - Efstathios Michalopoulos
- Hellenic Cord Blood Bank, Biomedical Research Foundation Academy of Athens, 4 Soranou Ephessiou Street, 115 27 Athens, Greece; (C.S.-G.); (E.M.)
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19
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Cheng J, Li J, Cai Z, Xing Y, Wang C, Guo L, Gu Y. Decellularization of porcine carotid arteries using low-concentration sodium dodecyl sulfate. Int J Artif Organs 2020; 44:497-508. [PMID: 33222583 DOI: 10.1177/0391398820975420] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND The decellularized scaffold is a promising material for producing tissue-engineered vascular grafts (TEVGs) because of its complex, native-like three-dimensional structure and mechanical properties. Sodium dodecyl sulfate (SDS), one of the most commonly used decellularization reagents, appears to be more effective than other detergents for removing cells from dense tissues. The concentrations of SDS used in previous studies and their effects on decellularization are not consistent. METHODS In this study, porcine carotid arteries were decellularized using detergent-based protocols using Triton X-100 followed by SDS at different concentrations and exposing time. Cell removal efficiency and composition were evaluated by histological analysis, and DNA and collagen quantification. Ultrastructure, mechanical properties, pore size distribution, and in vivo biocompatibility of decellularized arteries were also evaluated. RESULTS The DNA content of decellularized scaffolds treated with 0.3% SDS for 72 h or 0.5% SDS for 48 h was significantly less than that treated with 1% SDS for 30 h. There was a significant loss of soluble collagen after treatment with 1% SDS relative to native arteries. The extensive loss of elastin and glycosaminoglycans was observed in decellularized arteries treated with 0.5% SDS or 1% SDS. The basement membrane and biomechanics were also damaged by these two protocols. Moreover, decellularized scaffolds became more porous with many large pores after treatment with 0.3% SDS. CONCLUSION Low-concentration SDS could be a suitable choice for artery decellularization. Decellularized porcine carotid arteries, prepared using Triton X-100 followed by 0.3% SDS, may be a promising biological scaffold for TEVGs.
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Affiliation(s)
- Jin Cheng
- Department of Vascular Surgery, Xuanwu Hospital, Capital Medical University, Beijing, P.R. China
| | - Ji Li
- Department of Vascular Surgery, Xuanwu Hospital, Capital Medical University, Beijing, P.R. China
| | - Zhiwen Cai
- Department of Vascular Surgery, Xuanwu Hospital, Capital Medical University, Beijing, P.R. China
| | - Yuehao Xing
- Department of Vascular Surgery, Xuanwu Hospital, Capital Medical University, Beijing, P.R. China
| | - Cong Wang
- Department of Vascular Surgery, Xuanwu Hospital, Capital Medical University, Beijing, P.R. China
| | - Lianrui Guo
- Department of Vascular Surgery, Xuanwu Hospital, Capital Medical University, Beijing, P.R. China
| | - Yongquan Gu
- Department of Vascular Surgery, Xuanwu Hospital, Capital Medical University, Beijing, P.R. China
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20
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Cai Z, Gu Y, Xiao Y, Wang C, Wang Z. Porcine carotid arteries decellularized with a suitable concentration combination of Triton X-100 and sodium dodecyl sulfate for tissue engineering vascular grafts. Cell Tissue Bank 2020; 22:277-286. [PMID: 33123849 DOI: 10.1007/s10561-020-09876-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Revised: 10/14/2020] [Accepted: 10/16/2020] [Indexed: 10/23/2022]
Abstract
Tissue engineering vascular grafts (TEVGs) constructed by decellularized arteries have the potential to replace autologous blood vessels in bypass surgery for patients with cardiovascular disease. There are various methods of decellularization without a standard protocol. Detergents approaches are simple, and easy control of experimental conditions. Non-ionic detergent Triton X-100 and ionic detergent sodium dodecyl sulfate (SDS) are the most commonly used detergents. In this study, we used Triton X-100 and SDS with different concentrations to decellularize porcine carotid arteries. After that, we investigated the acellular effect and mechanical properties of decellularized arteries to find a promising concentration combination for decellularization. Results showed that any detergents' combination would damage the inherent structure of extracellular matrix, and the destruction increased with the increase of detergents' concentration. We concluded that the decellularization approach of 0.5% Triton X-100 for 24 h combined with 0.25% SDS for 72 h could help to obtain decellularized arteries with minimum destruction. This protocol may be able to prepare a clinically suitable vascular scaffold for TEVGs.
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Affiliation(s)
- Zhiwen Cai
- Department of Vascular Surgery, Xuan Wu Hospital, Capital Medical University, No. 45, Changchun Street, Xicheng District, Beijing, 100053, China
| | - Yongquan Gu
- Department of Vascular Surgery, Xuan Wu Hospital, Capital Medical University, No. 45, Changchun Street, Xicheng District, Beijing, 100053, China.
| | - Yonghao Xiao
- School of Materials Science and Engineering, Beijing Institute of Technology, Beijing, 100081, China
| | - Cong Wang
- Department of Vascular Surgery, Xuan Wu Hospital, Capital Medical University, No. 45, Changchun Street, Xicheng District, Beijing, 100053, China
| | - Zhonggao Wang
- Department of Vascular Surgery, Xuan Wu Hospital, Capital Medical University, No. 45, Changchun Street, Xicheng District, Beijing, 100053, China.
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21
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Schneider KH, Rohringer S, Kapeller B, Grasl C, Kiss H, Heber S, Walter I, Teuschl AH, Podesser BK, Bergmeister H. Riboflavin-mediated photooxidation to improve the characteristics of decellularized human arterial small diameter vascular grafts. Acta Biomater 2020; 116:246-258. [PMID: 32871281 DOI: 10.1016/j.actbio.2020.08.037] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 07/27/2020] [Accepted: 08/25/2020] [Indexed: 02/06/2023]
Abstract
Vascular grafts with a diameter of less than 6 mm are made from a variety of materials and techniques to provide alternatives to autologous vascular grafts. Decellularized materials have been proposed as a possible approach to create extracellular matrix (ECM) vascular prostheses as they are naturally derived and inherently support various cell functions. However, these desirable graft characteristics may be limited by alterations of the ECM during the decellularization process leading to decreased biomechanical properties and hemocompatibility. In this study, arteries from the human placenta chorion were decellularized using two distinct detergents (Triton X-100 or SDS), which differently affect ECM ultrastructure. To overcome biomechanical strength loss and collagen fiber exposure after decellularization, riboflavin-mediated UV (RUV) crosslinking was used to uniformly crosslink the collagenous ECM of the grafts. Graft characteristics and biocompatibility with and without RUV crosslinking were studied in vitro and in vivo. RUV-crosslinked ECM grafts showed significantly improved mechanical strength and smoothening of the luminal graft surfaces. Cell seeding using human endothelial cells revealed no cytotoxic effects of the RUV treatment. Short-term aortic implants in rats showed cell migration and differentiation of host cells. Functional graft remodeling was evident in all grafts. Thus, RUV crosslinking is a preferable tool to improve graft characteristics of decellularized matrix conduits.
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22
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Hamideh RA, Akbari B, Fathi P, Misra SK, Sutrisno A, Lam F, Pan D. Biodegradable MRI Visible Drug Eluting Stent Reinforced by Metal Organic Frameworks. Adv Healthc Mater 2020; 9:e2000136. [PMID: 32548977 DOI: 10.1002/adhm.202000136] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Revised: 04/13/2020] [Indexed: 12/18/2022]
Abstract
Metal-organic frameworks (MOFs) have applications in numerous fields. However, the development of MOF-based "theranostic" macroscale devices is not achieved. Here, heparin-coated biocompatible MOF/poly(ε-caprolactone) (PCL) "theranostic" stents are developed, where NH2 -Materials of Institute Lavoisier (MIL)-101(Fe) encapsulates and releases rapamycin (an immunosuppressive drug). These stents also act as a remarkable source of contrast in ex vivo magnetic resonance imaging (MRI) compared to the invisible polymeric stent. The in vitro release patterns of heparin and rapamycin respectively can ensure a type of programmed model to prevent blood coagulation immediately after stent placement in the artery and stenosis over a longer term. Due to the presence of hydrolysable functionalities in MOFs, the stents are shown to be highly biodegradable in degradation tests under various conditions. Furthermore, there is no compromise of mechanical strength or flexibility with MOF compositing. The system described here promises many biomedical applications in macroscale theranostic devices. The use of MOF@PCL can render a medical device MRI-visible while simultaneously acting as a carrier for therapeutic agents.
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Affiliation(s)
- Rezvani Alanagh Hamideh
- Department of Life Science Engineering, Faculty of New Sciences and Technologies, University of Tehran, P.O. Box 14395-1561, Tehran, Iran
- Department of Bioengineering, Beckman Institute of Advanced Science and Technology, Department of Materials Science and Engineering, University of Illinois at Urbana-Champaign, Carle Foundation Hospital, 611 West Park Street, Urbana, IL, 61801, USA
| | - Babak Akbari
- Department of Life Science Engineering, Faculty of New Sciences and Technologies, University of Tehran, P.O. Box 14395-1561, Tehran, Iran
| | - Parinaz Fathi
- Department of Bioengineering, Beckman Institute of Advanced Science and Technology, Department of Materials Science and Engineering, University of Illinois at Urbana-Champaign, Carle Foundation Hospital, 611 West Park Street, Urbana, IL, 61801, USA
| | - Santosh K Misra
- Department of Bioengineering, Beckman Institute of Advanced Science and Technology, Department of Materials Science and Engineering, University of Illinois at Urbana-Champaign, Carle Foundation Hospital, 611 West Park Street, Urbana, IL, 61801, USA
| | - Andre Sutrisno
- NMR/EPR Laboratory, School of Chemical Sciences, University of Illinois at Urbana-Champaign, IL, USA
| | - Fan Lam
- Department of Bioengineering, Beckman Institute of Advanced Science and Technology, Department of Materials Science and Engineering, University of Illinois at Urbana-Champaign, Carle Foundation Hospital, 611 West Park Street, Urbana, IL, 61801, USA
| | - Dipanjan Pan
- Department of Bioengineering, Beckman Institute of Advanced Science and Technology, Department of Materials Science and Engineering, University of Illinois at Urbana-Champaign, Carle Foundation Hospital, 611 West Park Street, Urbana, IL, 61801, USA
- Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland Baltimore, Health Sciences Facility III, 670 W Baltimore St., Baltimore, MD, 21201, USA
- Department of Pediatrics, University of Maryland Baltimore, Health Sciences Facility III, 670 W Baltimore St., Baltimore, MD, 21201, USA
- Department of Chemical, Biochemical and Environmental Engineering, University of Maryland Baltimore County, Interdisciplinary Health Sciences Facility, 1000 Hilltop Circle, Baltimore, MD, 21250, USA
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Lopera Higuita M, Griffiths LG. Antigen removal process preserves function of small diameter venous valved conduits, whereas SDS-decellularization results in significant valvular insufficiency. Acta Biomater 2020; 107:115-128. [PMID: 32151701 DOI: 10.1016/j.actbio.2020.03.003] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Revised: 02/28/2020] [Accepted: 03/03/2020] [Indexed: 12/18/2022]
Abstract
Chronic venous disease (CVD) is the most common reported chronic condition in the United States, affecting more than 25 million Americans. Regardless of its high occurrence, current therapeutic options are far from ideal due to their palliative nature. For best treatment outcomes, challenging cases of chronic venous insufficiency (CVI) are treated by repair or replacement of venous valves. Regrettably, the success of venous valve transplant is dependent on the availability of autologous venous valves and hindered by the possibility of donor site complications and increased patient morbidity. Therefore, the use of alternative tissue sources to provide off-the-shelf venous valve replacements has potential to be extremely beneficial to the field of CVI. This manuscript demonstrates the capability of producing off-the-shelf fully functional venous valved extracellular matrix (ECM) scaffold conduits from bovine saphenous vein (SV), using an antigen removal (AR) method. AR ECM scaffolds maintained native SV structure-function relationships and associated venous valves function. Conversely, SDS decellularization caused significant changes to the collagen and elastin macromolecular structures, resulting in collagen fibril merging, elimination of fibril crimp, amalgaming collagen fibers and fragmentation of the inner elastic lamina. ECM changes induced by SDS decellularization resulted in significant venous valve dysfunction. Venous valved conduits generated using the AR approach have potential to serve as off-the-shelf venous valve replacements for CVI. STATEMENT OF SIGNIFICANCE: Retention of the structure and composition of extracellular matrix (ECM) proteins within xenogeneic scaffolds for tissue engineering is of crucial importance, due to the undeniable effect ECM proteins can impose on repopulating cells and function of the resultant biomaterial. This manuscript demonstrates that alteration or elimination of ECM proteins via commonly utilized decellularization approach results in complete disruption of venous valve function. Conversely, retention of the delicate ECM structure and composition of native venous tissue, using an antigen removal tissue processing method, results in preservation of native venous valve function.
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24
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Hung HS, Hsu SH. Surface Modification by Nanobiomaterials for Vascular Tissue Engineering Applications. Curr Med Chem 2020; 27:1634-1646. [DOI: 10.2174/0929867325666180914104633] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2016] [Revised: 05/17/2017] [Accepted: 06/16/2017] [Indexed: 12/13/2022]
Abstract
Treatment of cardiovascular disease has achieved great success using artificial implants,
particularly synthetic-polymer made grafts. However, thrombus formation and
restenosis are the current clinical problems need to be conquered. New biomaterials, modifying
the surface of synthetic vascular grafts, have been created to improve long-term patency
for the better hemocompatibility. The vascular biomaterials can be fabricated from synthetic
or natural polymers for vascular tissue engineering. Stem cells can be seeded by different
techniques into tissue-engineered vascular grafts in vitro and implanted in vivo to repair the
vascular tissues. To overcome the thrombogenesis and promote the endothelialization
effect, vascular biomaterials employing nanotopography are more bio-mimic to the native tissue
made and have been engineered by various approaches such as prepared as a simple surface
coating on the vascular biomaterials. It has now become an important and interesting
field to find novel approaches to better endothelization of vascular biomaterials. In this article,
we focus to review the techniques with better potential improving endothelization and summarize
for vascular biomaterial application. This review article will enable the development
of biomaterials with a high degree of originality, innovative research on novel techniques for
surface fabrication for vascular biomaterials application.
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Affiliation(s)
- Huey-Shan Hung
- Graduate Institute of Biomedical Science, China Medical University, Taichung, Taiwan, China
| | - Shan-hui Hsu
- Institute of Polymer Science and Engineering, National Taiwan University, Taipei, Taiwan, China
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25
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Li J, Cai Z, Cheng J, Wang C, Fang Z, Xiao Y, Feng ZG, Gu Y. Characterization of a heparinized decellularized scaffold and its effects on mechanical and structural properties. JOURNAL OF BIOMATERIALS SCIENCE-POLYMER EDITION 2020; 31:999-1023. [PMID: 32138617 DOI: 10.1080/09205063.2020.1736741] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Decellularization is a promising approach in tissue engineering to generate small-diameter blood vessels. However, some challenges still exist. We performed two decellularization phases to develop an optimal decellularized scaffold and analyze the relationship between the extracellular matrix (ECM) composition and mechanical properties. In decellularization phase I, we tested sodium dodecylsulfate (SDS), Triton X-100 (TX100) and trypsin at different concentrations and exposure times. In decellularization phase II, we systematically compared five combined decellularization protocols based on the results of phase I to identify the optimal method. These protocols tested cell removal, ECM preservation, mechanical properties, and residual cytotoxicity. We further immobilized heparin to optimal decellularized scaffolds and determined its anticoagulant activity and mechanical properties. The combined decellularization protocol comprising treatment with 0.5% SDS followed by 1% TX100 could completely remove the cellular contents and preserve the mechanical properties and ECM architecture better. In addition, the heparinized decellularized scaffolds not only had sustained anticoagulant activity, but also similar mechanical properties to native vessels. In conclusion, heparinized decellularized scaffolds represent a promising direction for small-diameter vascular grafts, although further in vivo studies are needed.
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Affiliation(s)
- Ji Li
- Department of Vascular Surgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Zhiwen Cai
- Department of Vascular Surgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Jin Cheng
- Department of Vascular Surgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Cong Wang
- Department of Vascular Surgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Zhiping Fang
- School of Materials Science and Engineering, Beijing Institute of Technology, Beijing, China
| | - Yonghao Xiao
- School of Materials Science and Engineering, Beijing Institute of Technology, Beijing, China
| | - Zeng-Guo Feng
- School of Materials Science and Engineering, Beijing Institute of Technology, Beijing, China
| | - Yongquan Gu
- Department of Vascular Surgery, Xuanwu Hospital, Capital Medical University, Beijing, China
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26
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Lv J, Liu W, Shi G, Zhu F, He X, Zhu Z, Chen H. Human cardiac extracellular matrix-chitosan-gelatin composite scaffold and its endothelialization. Exp Ther Med 2020; 19:1225-1234. [PMID: 32010293 PMCID: PMC6966153 DOI: 10.3892/etm.2019.8349] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Accepted: 11/08/2019] [Indexed: 12/12/2022] Open
Abstract
The present study developed a cardiac extracellular matrix-chitosan-gelatin (cECM-CG) composite scaffold that can be used as a tissue-engineered heart patch and investigated its endothelialization potential by incorporating CD34+ endothelial progenitor cells (EPCs). The cECM-CG composite scaffold was prepared by blending cardiac extracellular matrix (cECM) with biodegradable chitosan-gelatin (CG). The mixture was lyophilized using vacuum freeze-drying. CD34+ EPCs were isolated and seeded on the scaffolds, and then the endothelialization effect was subsequently investigated. Effects of the scaffolds on CD34+ EPCs survival and proliferation were evaluated by immunofluorescence staining and MTT assay. Cell differentiation into endothelial cells and the influence of the scaffolds on cell differentiation were investigated by reverse transcription-quantitative PCR (RT-qPCR), immunofluorescence staining and tube formation assay. The present results indicated that most cells were removed after decellularization, but the main extracellular matrix components were retained. Scanning electron microscopy imaging illustrated three-dimensional and porous scaffolds. The present results suggested the cECM-CG composite scaffold had a higher water absorption ability compared with the CG scaffold. Additionally, compared with the CG scaffold, the cECM-CG composite scaffold significantly increased cell survival and proliferation, which suggested its non-toxicity and biocompatibility. Furthermore, RT-qPCR, immunofluorescence and tube formation assay results indicated that CD34+ EPCs differentiated into endothelial cells, and the cECM-CG composite scaffold promoted this differentiation process. In conclusion, the present results indicated that the human cECM-CG composite scaffold generated in the present study was a highly porous, biodegradable three-dimensional scaffold which supported endothelialization of seeded CD34+ EPCs. The present results suggested that this cECM-CG composite scaffold may be a promising heart patch for use in heart tissue engineering for congenital heart disease.
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Affiliation(s)
- Jingjing Lv
- Heart Center, Shanghai Children's Medical Center, Shanghai Jiaotong University, School of Medicine, Shanghai 200127, P.R. China
| | - Wei Liu
- Department of Pediatric Cardiothoracic Surgery, Xinhua Hospital Affiliated to Shanghai Jiaotong University, School of Medicine, Shanghai 200092, P.R. China
| | - Guocheng Shi
- Heart Center, Shanghai Children's Medical Center, Shanghai Jiaotong University, School of Medicine, Shanghai 200127, P.R. China
| | - Fang Zhu
- Heart Center, Shanghai Children's Medical Center, Shanghai Jiaotong University, School of Medicine, Shanghai 200127, P.R. China
| | - Xiaomin He
- Heart Center, Shanghai Children's Medical Center, Shanghai Jiaotong University, School of Medicine, Shanghai 200127, P.R. China
| | - Zhongqun Zhu
- Heart Center, Shanghai Children's Medical Center, Shanghai Jiaotong University, School of Medicine, Shanghai 200127, P.R. China
| | - Huiwen Chen
- Heart Center, Shanghai Children's Medical Center, Shanghai Jiaotong University, School of Medicine, Shanghai 200127, P.R. China
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27
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Lopera Higuita M, Griffiths LG. Small Diameter Xenogeneic Extracellular Matrix Scaffolds for Vascular Applications. TISSUE ENGINEERING PART B-REVIEWS 2019; 26:26-45. [PMID: 31663438 DOI: 10.1089/ten.teb.2019.0229] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Currently, despite the success of percutaneous coronary intervention (PCI), coronary artery bypass graft (CABG) remains among the most commonly performed cardiac surgical procedures in the United States. Unfortunately, the use of autologous grafts in CABG presents a major clinical challenge as complications due to autologous vessel harvest and limited vessel availability pose a significant setback in the success rate of CABG surgeries. Acellular extracellular matrix (ECM) scaffolds derived from xenogeneic vascular tissues have the potential to overcome these challenges, as they offer unlimited availability and sufficient length to serve as "off-the-shelf" CABGs. Unfortunately, regardless of numerous efforts to produce a fully functional small diameter xenogeneic ECM scaffold, the combination of factors required to overcome all failure mechanisms in a single graft remains elusive. This article covers the major failure mechanisms of current xenogeneic small diameter vessel ECM scaffolds, and reviews the recent advances in the field to overcome these failure mechanisms and ultimately develop a small diameter ECM xenogeneic scaffold for CABG. Impact Statement Currently, the use of autologous vessel in coronary artery bypass graft (CABG) is common practice. However, the use of autologous tissue poses significant complications due to tissue harvest and limited availability. Developing an alternative vessel for use in CABG can potentially increase the success rate of CABG surgery by eliminating complications related to the use of autologous vessel. However, this development has been hindered by an array of failure mechanisms that currently have not been overcome. This article describes the currently identified failure mechanisms of small diameter vascular xenogeneic extracellular matrix scaffolds and reviews current research targeted to overcoming these failure mechanisms toward ensuring long-term graft patency.
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Affiliation(s)
| | - Leigh G Griffiths
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota
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28
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Cheng J, Wang C, Gu Y. Combination of freeze-thaw with detergents: A promising approach to the decellularization of porcine carotid arteries. Biomed Mater Eng 2019; 30:191-205. [PMID: 30741667 DOI: 10.3233/bme-191044] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- Jin Cheng
- Department of Vascular Surgery, Xuanwu Hospital, Capital Medical University, , P.R. China
| | - Cong Wang
- Department of Vascular Surgery, Xuanwu Hospital, Capital Medical University, , P.R. China
| | - Yongquan Gu
- Department of Vascular Surgery, Xuanwu Hospital, Capital Medical University, , P.R. China
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29
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Li N, Sanyour H, Remund T, Kelly P, Hong Z. Vascular extracellular matrix and fibroblasts-coculture directed differentiation of human mesenchymal stem cells toward smooth muscle-like cells for vascular tissue engineering. MATERIALS SCIENCE & ENGINEERING. C, MATERIALS FOR BIOLOGICAL APPLICATIONS 2018; 93:61-69. [PMID: 30274093 PMCID: PMC11264340 DOI: 10.1016/j.msec.2018.07.061] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Accepted: 07/23/2018] [Indexed: 02/06/2023]
Abstract
Construction of an artificial vascular graft is widely considered a promising strategy in vascular tissue engineering. However, limited sources of functional vascular smooth muscle cells (VSMCs) remain a major obstacle in vascular tissue engineering. In this study, we innovatively developed an approach to obtain functional VSMCs by onsite differentiating human bone marrow-derived mesenchymal stem cells (MSCs) directed by decellularized extracellular matrix (ECM) and fibroblasts. The resulting cells and ECM-cells constructs were characterized by real time RT-PCR, immunofluorescence staining, cell contractile functions, and migration capacity. Our results showed both ECM and fibroblasts induced MSCs differentiation toward VSMC-like cells with increased transcription of marker genes, upregulated expression of contractile apparatus proteins, and enhanced functional activity of VSMC phenotype. Interestingly, our findings revealed that native ECM and fibroblasts-coculture had a higher potential to promote MSCs differentiation into VSMCs than growth factors cocktail (GFC) supplemented culture, thereby providing a potential source of VSMCs for blood vessel constitution.
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Affiliation(s)
- Na Li
- Department of Biomedical Engineering, University of South Dakota, SD, United States of America; BioSNTR, Sioux Falls, SD, United States of America
| | - Hanna Sanyour
- Department of Biomedical Engineering, University of South Dakota, SD, United States of America; BioSNTR, Sioux Falls, SD, United States of America
| | - Tyler Remund
- Sanford Health, Sioux Falls, SD, United States of America
| | - Patrick Kelly
- Sanford Health, Sioux Falls, SD, United States of America; School of Medicine, University of South Dakota, SD, United States of America
| | - Zhongkui Hong
- Department of Biomedical Engineering, University of South Dakota, SD, United States of America; BioSNTR, Sioux Falls, SD, United States of America.
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30
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Xu Z, Gu Y, Li J, Feng Z, Guo L, Tong Z, Ye L, Wang C, Wang R, Geng X, Wang C, Zhang J. Vascular Remodeling Process of Heparin-Conjugated Poly(ε-Caprolactone) Scaffold in a Rat Abdominal Aorta Replacement Model. J Vasc Res 2018; 55:338-349. [PMID: 30485863 DOI: 10.1159/000494509] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2018] [Accepted: 10/15/2018] [Indexed: 11/19/2022] Open
Abstract
In the field of vascular graft research, poly-ε-caprolactone (PCL) is used owing to its good mechanical strength and biocompatibility. In this study, PCL scaffold was prepared by electrospinning and surface modification with heparin via hexamethylenediamine. Then the scaffolds were implanted into the infrarenal abdominal aorta of Wistar rats and contrast-enhanced micro-ultrasound was used to monitor the patency of grafts after implantation. These grafts were extracted from the rats at 1, 3, and 6 months for histological analysis, immunofluorescence staining, and scanning electron microscopy observation. Although some grafts experienced aneurysmal change, results showed that all implanted grafts were patent during the course of 6 months and these grafts demonstrated well-organized neotissue with endothelium formation, smooth muscle regeneration, and extracellular matrix formation. Such findings confirm feasibility to create heparin-conjugated scaffolds of next-generation vascular grafts.
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Affiliation(s)
- Zeqin Xu
- Department of Vascular Surgery, Xuan Wu Hospital and Institute of Vascular Surgery, Capital Medical University, Beijing, China
| | - Yongquan Gu
- Department of Vascular Surgery, Xuan Wu Hospital and Institute of Vascular Surgery, Capital Medical University, Beijing, China
| | - Jianxin Li
- Department of Vascular Surgery, Xuan Wu Hospital and Institute of Vascular Surgery, Capital Medical University, Beijing, China
| | - Zengguo Feng
- School of Materials Science and Engineering, Beijing Institute of Technology, Beijing, China
| | - Lianrui Guo
- Department of Vascular Surgery, Xuan Wu Hospital and Institute of Vascular Surgery, Capital Medical University, Beijing, China
| | - Zhu Tong
- Department of Vascular Surgery, Xuan Wu Hospital and Institute of Vascular Surgery, Capital Medical University, Beijing, China
| | - Lin Ye
- School of Materials Science and Engineering, Beijing Institute of Technology, Beijing, China
| | - Chunmei Wang
- Department of Vascular Surgery, Xuan Wu Hospital and Institute of Vascular Surgery, Capital Medical University, Beijing, China
| | - Rong Wang
- Department of Central Laboratory, Xuan Wu Hospital, Capital Medical University, Beijing, China
| | - Xue Geng
- School of Materials Science and Engineering, Beijing Institute of Technology, Beijing, China
| | - Cong Wang
- Department of Vascular Surgery, Xuan Wu Hospital and Institute of Vascular Surgery, Capital Medical University, Beijing, China
| | - Jian Zhang
- Department of Vascular Surgery, Xuan Wu Hospital and Institute of Vascular Surgery, Capital Medical University, Beijing, China,
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31
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Genderen AM, Jansen J, Cheng C, Vermonden T, Masereeuw R. Renal Tubular- and Vascular Basement Membranes and their Mimicry in Engineering Vascularized Kidney Tubules. Adv Healthc Mater 2018; 7:e1800529. [PMID: 30091856 DOI: 10.1002/adhm.201800529] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Revised: 07/18/2018] [Indexed: 01/09/2023]
Abstract
The high prevalence of chronic kidney disease leads to an increased need for renal replacement therapies. While there are simply not enough donor organs available for transplantation, there is a need to seek other therapeutic avenues as current dialysis modalities are insufficient. The field of regenerative medicine and whole organ engineering is emerging, and researchers are looking for innovative ways to create (part of) a functional new organ. To biofabricate a kidney or its functional units, it is necessary to understand and learn from physiology to be able to mimic the specific tissue properties. Herein is provided an overview of the knowledge on tubular and vascular basement membranes' biochemical components and biophysical properties, and the major differences between the two basement membranes are highlighted. Furthermore, an overview of current trends in membrane technology for developing renal replacement therapies and to stimulate kidney regeneration is provided.
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Affiliation(s)
- Anne Metje Genderen
- Division of PharmacologyUtrecht Institute for Pharmaceutical Sciences 3584 CG Utrecht The Netherlands
| | - Jitske Jansen
- Division of PharmacologyUtrecht Institute for Pharmaceutical Sciences 3584 CG Utrecht The Netherlands
| | - Caroline Cheng
- Regenerative Medicine Center UtrechtUniversity Medical Center Utrecht 3584 CT Utrecht The Netherlands
- Department of Nephrology and HypertensionUniversity Medical Center Utrecht 3508 GA Utrecht The Netherlands
- Department of Experimental CardiologyErasmus Medical Center 3015 GD Rotterdam The Netherlands
| | - Tina Vermonden
- Division of PharmaceuticsUtrecht Institute for Pharmaceutical Sciences 3584 CG Utrecht The Netherlands
| | - Rosalinde Masereeuw
- Division of PharmacologyUtrecht Institute for Pharmaceutical Sciences 3584 CG Utrecht The Netherlands
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32
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Ran X, Ye Z, Fu M, Wang Q, Wu H, Lin S, Yin T, Hu T, Wang G. Design, Preparation, and Performance of a Novel Bilayer Tissue-Engineered Small-Diameter Vascular Graft. Macromol Biosci 2018; 19:e1800189. [PMID: 30259649 DOI: 10.1002/mabi.201800189] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Revised: 08/22/2018] [Indexed: 01/20/2023]
Abstract
In clinical practice, the need for small-diameter vascular grafts continues to increase. Decellularized xenografts are commonly used for vascular reconstructive procedures. Here, porcine coronary arteries are decellularized, which destroys the extracellular matrix structure, leading to the decrease of vascular strength and the increase of vascular permeability. A bilayer tissue-engineered vascular graft (BTEV) is fabricated by electrospinning poly(l-lactide-co-carprolactone)/gelatin outside of the decellularized vessels and functionalized by immobilizing heparin, which increases the biomechanical strength and anticoagulant activity of decellularized vessels. The biosafety and efficacy of the heparin-modified BTEVs (HBTEVs) are verified by implanting in rat models. HBTEVs remain patent and display no expansion or aneurism. After 4 weeks of implantation, a cell monolayer in the internal surface and a dense middle layer have formed, and the mechanical properties of regenerated vessels are similar to those of rat abdominal aorta. Therefore, HBTEVs can be used for rapid remodeling of small-diameter blood vessels.
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Affiliation(s)
- Xiaolin Ran
- Key Laboratory for Biorheological Science and Technology of Ministry of Education, State and Local Joint Engineering Laboratory for Vascular Implants, Bioengineering College of Chongqing University, No. 174, Shazheng Street, Shapingba District, Chongqing, 400030, China
| | - Zhiyi Ye
- Key Laboratory for Biorheological Science and Technology of Ministry of Education, State and Local Joint Engineering Laboratory for Vascular Implants, Bioengineering College of Chongqing University, No. 174, Shazheng Street, Shapingba District, Chongqing, 400030, China
| | - Meiling Fu
- Key Laboratory for Biorheological Science and Technology of Ministry of Education, State and Local Joint Engineering Laboratory for Vascular Implants, Bioengineering College of Chongqing University, No. 174, Shazheng Street, Shapingba District, Chongqing, 400030, China
| | - Qilong Wang
- Key Laboratory for Biorheological Science and Technology of Ministry of Education, State and Local Joint Engineering Laboratory for Vascular Implants, Bioengineering College of Chongqing University, No. 174, Shazheng Street, Shapingba District, Chongqing, 400030, China
| | - Haide Wu
- Key Laboratory for Biorheological Science and Technology of Ministry of Education, State and Local Joint Engineering Laboratory for Vascular Implants, Bioengineering College of Chongqing University, No. 174, Shazheng Street, Shapingba District, Chongqing, 400030, China
| | - Song Lin
- Key Laboratory for Biorheological Science and Technology of Ministry of Education, State and Local Joint Engineering Laboratory for Vascular Implants, Bioengineering College of Chongqing University, No. 174, Shazheng Street, Shapingba District, Chongqing, 400030, China
| | - Tieying Yin
- Key Laboratory for Biorheological Science and Technology of Ministry of Education, State and Local Joint Engineering Laboratory for Vascular Implants, Bioengineering College of Chongqing University, No. 174, Shazheng Street, Shapingba District, Chongqing, 400030, China
| | - Tingzhang Hu
- Key Laboratory for Biorheological Science and Technology of Ministry of Education, State and Local Joint Engineering Laboratory for Vascular Implants, Bioengineering College of Chongqing University, No. 174, Shazheng Street, Shapingba District, Chongqing, 400030, China
| | - Guixue Wang
- Key Laboratory for Biorheological Science and Technology of Ministry of Education, State and Local Joint Engineering Laboratory for Vascular Implants, Bioengineering College of Chongqing University, No. 174, Shazheng Street, Shapingba District, Chongqing, 400030, China
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Lin CH, Kao YC, Ma H, Tsay RY. An investigation on the correlation between the mechanical property change and the alterations in composition and microstructure of a porcine vascular tissue underwent trypsin-based decellularization treatment. J Mech Behav Biomed Mater 2018; 86:199-207. [PMID: 29986294 DOI: 10.1016/j.jmbbm.2018.06.029] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Revised: 06/14/2018] [Accepted: 06/19/2018] [Indexed: 01/15/2023]
Abstract
PURPOSE The nonlinear pseudoelastic behavior of a native/decellularized vascular tissue is closely related to the detailed composition and microstructure of the extracellular matrix and is important in maintaining the patency of a small-caliber vascular graft. A commonly used enzyme-detergent based decellularization protocol is effective in cell component removal but it also changes the microstructure and composition of the decellularized tissues. Previous studies provide limited information to correlate the mechanical property change with the alterations in composition and microstructure in a decellularization process. In this study, the correlations were studied by implementing a previously established fiber-progressive-engagement model to describe the nonlinear pseudoelastic behavior of a vascular tissue and to evaluate the effects of trypsin concentration and exposure duration on porcine coronary artery decellularization RESULTS: Results showed that tissue length and width increased and thickness and wet weight decreased with the exposure of trypsin. The effects of trypsin exposure times on the four mechanical parameters, i.e. initial strain, turning strain, initial modulus and stiffness modulus, in the longitudinal and circumferential directions were similar, but stronger in the circumferential direction. Major components of the extracellular matrix were vulnerable to the trypsin-based decellularization process. The decreases in initial and turning strain and the increase in initial modulus in circumferential direction were correlated with the significant decrease of collagen and glycosaminoglycans in the media layer. CONCLUSIONS Although trypsin-based decellularization achieved cell component removal and preservation of ultimate tensile stress, the microstructure and composition changed with alterations in the pseudoelastic behavior of the porcine coronary artery. Taken together, the current observations suggested less waviness, early engagement, or re-alignment of insoluble collagen fibers in the media layer, which resulted in turning from anisotropic into isotropic uniaxial mechanical property of porcine vascular tissue. Selecting the proper trypsin concentration (< 0.03-0.5%) and duration (< 12 h) of trypsin exposure in combination with other methods will achieve optimal porcine coronary artery decellularization.
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Affiliation(s)
- Chih-Hsun Lin
- Division of Plastic Surgery, Department of Surgery, Taipei Veterans General Hospital, No. 201, Section 2, Shipai Rd., Beitou Dist., Taipei City 112, Taiwan, ROC; Department of Surgery, School of Medicine, National Yang-Ming University, No. 155, Section 2, Linong St., Beitou Dist., Taipei City 112, Taiwan, ROC
| | - Yun-Chu Kao
- Institute of Biomedical Engineering, National Yang-Ming University, No. 155, Section 2, Linong St., Beitou Dist., Taipei City 112, Taiwan, ROC
| | - Hsu Ma
- Division of Plastic Surgery, Department of Surgery, Taipei Veterans General Hospital, No. 201, Section 2, Shipai Rd., Beitou Dist., Taipei City 112, Taiwan, ROC; Department of Surgery, School of Medicine, National Yang-Ming University, No. 155, Section 2, Linong St., Beitou Dist., Taipei City 112, Taiwan, ROC
| | - Ruey-Yug Tsay
- Institute of Biomedical Engineering, National Yang-Ming University, No. 155, Section 2, Linong St., Beitou Dist., Taipei City 112, Taiwan, ROC; Center for Advanced Pharmaceutics and Drug Delivery Research, National Yang-Ming University, No. 155, Section 2, Linong St., Beitou Dist., Taipei City 112, Taiwan, ROC.
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Schneider KH, Enayati M, Grasl C, Walter I, Budinsky L, Zebic G, Kaun C, Wagner A, Kratochwill K, Redl H, Teuschl AH, Podesser BK, Bergmeister H. Acellular vascular matrix grafts from human placenta chorion: Impact of ECM preservation on graft characteristics, protein composition and in vivo performance. Biomaterials 2018; 177:14-26. [PMID: 29885585 DOI: 10.1016/j.biomaterials.2018.05.045] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Revised: 05/18/2018] [Accepted: 05/26/2018] [Indexed: 02/06/2023]
Abstract
Small diameter vascular grafts from human placenta, decellularized with either Triton X-100 (Triton) or SDS and crosslinked with heparin were constructed and characterized. Graft biochemical properties, residual DNA, and protein composition were evaluated to compare the effect of the two detergents on graft matrix composition and structural alterations. Biocompatibility was tested in vitro by culturing the grafts with primary human macrophages and in vivo by subcutaneous implantation of graft conduits (n = 7 per group) into the flanks of nude rats. Subsequently, graft performance was evaluated using an aortic implantation model in Sprague Dawley rats (one month, n = 14). In situ graft imaging was performed using MRI angiography. Retrieved specimens were analyzed by electromyography, scanning electron microscopy, histology and immunohistochemistry to evaluate cell migration and the degree of functional tissue remodeling. Both decellularization methods resulted in grafts of excellent biocompatibility in vitro and in vivo, with low immunogenic potential. Proteomic data revealed removal of cytoplasmic proteins with relative enrichment of ECM proteins in decelluarized specimens of both groups. Noteworthy, LC-Mass Spectrometry analysis revealed that 16 proteins were exclusively preserved in Triton decellularized specimens in comparison to SDS-treated specimens. Aortic grafts showed high patency rates, no signs of thrombus formation, aneurysms or rupture. Conduits of both groups revealed tissue-specific cell migration indicative of functional remodeling. This study strongly suggests that decellularized allogenic grafts from the human placenta have the potential to be used as vascular replacement materials. Both detergents produced grafts with low residual immunogenicity and appropriate mechanical properties. Observed differences in graft characteristics due to preservation method had no impact on successful in vivo performance in the rodent model.
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Affiliation(s)
- Karl H Schneider
- Ludwig Boltzmann Cluster for Cardiovascular Research, Vienna, Austria; Center for Biomedical Research Medical University of Vienna, Vienna, Austria; Austrian Cluster for Tissue Regeneration, Vienna, Austria
| | - Marjan Enayati
- Ludwig Boltzmann Cluster for Cardiovascular Research, Vienna, Austria; Center for Biomedical Research Medical University of Vienna, Vienna, Austria
| | - Christian Grasl
- Center for Biomedical Research Medical University of Vienna, Vienna, Austria; Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Austria
| | - Ingrid Walter
- Department of Pathobiology, University of Veterinary Medicine Vienna, Vienna, Austria
| | - Lubos Budinsky
- Preclinical Imaging Laboratory, Division of Molecular and Gender Imaging, Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Gabriel Zebic
- Center for Biomedical Research Medical University of Vienna, Vienna, Austria
| | - Christoph Kaun
- Division of Internal Medicine II, Medical University of Vienna, Vienna, Austria
| | - Anja Wagner
- Department of Pediatric and Adolescent Medicine, Medical University of Vienna, Vienna, Austria; Christian Doppler Laboratory for Molecular Stress Research in Peritoneal Dialysis, Vienna, Austria
| | - Klaus Kratochwill
- Department of Pediatric and Adolescent Medicine, Medical University of Vienna, Vienna, Austria; Christian Doppler Laboratory for Molecular Stress Research in Peritoneal Dialysis, Vienna, Austria
| | - Heinz Redl
- Ludwig Boltzmann Institute for Experimental and Clinical Traumatology in AUVA Trauma Center, Vienna, Austria; Austrian Cluster for Tissue Regeneration, Vienna, Austria
| | - Andreas H Teuschl
- Department of Biochemical Engineering, University of Applied Sciences Technikum Wien, Vienna, Austria; Austrian Cluster for Tissue Regeneration, Vienna, Austria; City of Vienna Competence Team Siganltransduction, Vienna, Austria
| | - Bruno K Podesser
- Ludwig Boltzmann Cluster for Cardiovascular Research, Vienna, Austria; Center for Biomedical Research Medical University of Vienna, Vienna, Austria; Austrian Cluster for Tissue Regeneration, Vienna, Austria
| | - Helga Bergmeister
- Ludwig Boltzmann Cluster for Cardiovascular Research, Vienna, Austria; Center for Biomedical Research Medical University of Vienna, Vienna, Austria; Austrian Cluster for Tissue Regeneration, Vienna, Austria.
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Chen YW, Hsieh SC, Yang YC, Hsu SH, Kung ML, Lin PY, Hsieh HH, Lin CH, Tang CM, Hung HS. Functional engineered mesenchymal stem cells with fibronectin-gold composite coated catheters for vascular tissue regeneration. NANOMEDICINE-NANOTECHNOLOGY BIOLOGY AND MEDICINE 2018; 14:699-711. [PMID: 29325741 DOI: 10.1016/j.nano.2017.12.023] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/15/2017] [Revised: 11/20/2017] [Accepted: 12/29/2017] [Indexed: 11/30/2022]
Abstract
Vascularization of engineered tissues remains one of the key problems. Here, we described a novel approach to promote vascularization of engineered tissues using fibronectin (FN) incorporated gold nanoparticles (AuNP) coated onto catheters with mesenchymal stem cells (MSCs) for tissue engineering. We found that the FN-AuNP composite with 43.5 ppm of AuNP exhibited better biomechanical properties and thermal stability than pure FN. FN-AuNP composites promoted MSC proliferation and increased the biocompatibility. Mechanistically, vascular endothelial growth factor (VEGF) promoted MSC migration on FN-AuNP through the endothelial oxide synthase (eNOS)/metalloproteinase (MMP) signaling pathway. Vascular femoral artery tissues isolated from the implanted FN-AuNP-coated catheters with MSCs expressed substantial CD31 and alpha-smooth muscle actin (α-SMA), displayed higher antithrombotic activity, as well as better endothelialization ability than those coated with all other materials. These data suggested that the implantation of FN-AuNP-coated catheter with MSCs could be a novel strategy for vascular biomaterials applications.
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Affiliation(s)
- Yun-Wen Chen
- Department of Pharmacology, College of Medicine, National Cheng Kung University, Tainan, Taiwan, R.O.C
| | - Shu-Chen Hsieh
- Department of Chemistry, National Sun Yat-Sen University, Kaohsiung, Taiwan, R.O.C; Center for Stem Cell Research, Kaohsiung Medical University, Kaohsiung, Taiwan, R.O.C
| | - Yi-Chin Yang
- Department of Neurosurgery, Taichung Veterans General Hospital, Taichung, Taiwan, R.O.C
| | - Shan-Hui Hsu
- Institute of Polymer Science and Engineering, National Taiwan University, Taipei, Taiwan, R.O.C
| | - Mei-Lang Kung
- Department of Chemistry, National Sun Yat-Sen University, Kaohsiung, Taiwan, R.O.C
| | - Pei-Ying Lin
- Department of Chemistry, National Sun Yat-Sen University, Kaohsiung, Taiwan, R.O.C
| | - Hsien-Hsu Hsieh
- Blood Bank, Taichung Veterans General Hospital, Taichung, Taiwan, R. O. C
| | - Ching-Hao Lin
- Graduate Institute of Biomedical Science, China Medical University, Taichung, Taiwan, R.O.C
| | - Cheng-Ming Tang
- Institute of Oral Sciences, Chung Shan Medical University, Taichung, Taiwan, R.O.C
| | - Huey-Shan Hung
- Graduate Institute of Biomedical Science, China Medical University, Taichung, Taiwan, R.O.C; Translational Medicine Research, China Medical University Hospital, Taichung, Taiwan, R.O.C.
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Huang S, Li Y, Wang X, Ma X, Zhang X. Injectable co-gels of collagen and decellularized vascular matrix improve MSC-based therapy for acute kidney injury. JOURNAL OF BIOMATERIALS SCIENCE-POLYMER EDITION 2017; 28:2186-2195. [PMID: 28976282 DOI: 10.1080/09205063.2017.1388556] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Transplantation of mesenchymal stem cells (MSCs) is promising for treatment of acute kidney injury (AKI), but their therapeutic effects are often limited under normal conditions. In this study, we prepared the co-gels of decellularized vascular matrix and collagen, and investigated whether the co-gels increase the therapeutic potentials of MSCs on AKI. In vitro studies indicated that the co-gels enhanced the paracrine effects of MSCs, and significantly reduced the apoptosis of MSCs under oxidative environments. When the co-gels were co-transplanted with MSCs into the kidney of model rats with ischemia-reperfusion (I/R)-induced AKI, the survival and paracrine effects of MSCs were enhanced in the injured kidney. More importantly, the co-gels increased the therapeutic effects of MSCs for AKI, as indicated by cell apoptosis, tissue damage, vascularization and renal function. Therefore, the co-gels of decellularized vascular matrix and collagen improved the therapeutic effects of MSCs, and might be promising for AKI treatment.
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Affiliation(s)
- Shuang Huang
- a Department of Urology , The General Hospital of the People's Liberation Army , Beijing , China
| | - Yajian Li
- b Department of Urology , Cancer Hospital Chinese Academy of Medical Sciences , Beijing , China
| | - Xinning Wang
- a Department of Urology , The General Hospital of the People's Liberation Army , Beijing , China
| | - Xin Ma
- a Department of Urology , The General Hospital of the People's Liberation Army , Beijing , China
| | - Xu Zhang
- a Department of Urology , The General Hospital of the People's Liberation Army , Beijing , China
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Gao LP, Du MJ, Lv JJ, Schmull S, Huang RT, Li J. Use of human aortic extracellular matrix as a scaffold for construction of a patient-specific tissue engineered vascular patch. ACTA ACUST UNITED AC 2017; 12:065006. [PMID: 28714856 DOI: 10.1088/1748-605x/aa801b] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Synthetic or biologic materials are usually used to repair vascular malformation in congenital heart defects; however, non-autologous materials show both mismatch compliance and antigenicity, as well as a lack of recellularization on its surface. Here, we constructed a tissue-engineered vascular patch (TEVP) using decellularized extracellular matrix (ECM) scaffold obtained from excised human aorta during surgery, which was seeded with patient-derived bone marrow CD34-positive (CD34+) progenitor cells. While cellular components were removed, the decellularized ECM scaffold retained native ECM composition, similar mechanical performance to undecellularized aortic tissue, and supported the adhesion, survival and proliferation of CD34+ progenitor cells. Interestingly, after in vitro seeding of decellularized aortic ECM scaffold for 21 d, CD34+ progenitor cells differentiated into mature vascular endothelial cells without addition of any growth factors, as confirmed by the increased levels of endothelial surface markers (CD31, Von Willebrand factor (VWF), VE-cadherin and ICAM-2) and upregulated gene levels (CD31, VWF and eNOS) concurrently with decreased expression of stem cell markers (CD133 and CD34), thus, resulting in surface endothelialization of decellularized ECM scaffold. Consequently, the patient-specific TEVP constructed in this study holds great potential for clinical use in pediatric patients with vascular malformation.
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Affiliation(s)
- Li-Ping Gao
- Renji-Med X Clinical Stem Cell Research Center, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, People's Republic of China
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Improving in vivo outcomes of decellularized vascular grafts via incorporation of a novel extracellular matrix. Biomaterials 2017; 141:63-73. [PMID: 28667900 DOI: 10.1016/j.biomaterials.2017.06.025] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2017] [Revised: 06/19/2017] [Accepted: 06/19/2017] [Indexed: 12/30/2022]
Abstract
Each year, hundreds of thousands coronary bypass procedures are performed in the US, yet there currently exists no off-the-shelf alternative to autologous vessel transplant. In the present study, we investigated the use of mouse thrombospondin-2 knockout (TSP2 KO) cells, which secrete a non-thrombogenic and pro-migratory extracellular matrix (TSP2 KO ECM), to modify small diameter vascular grafts. To accomplish this, we first optimized the incorporation of TSP2 KO ECM on decellularized rat aortas. Because MMP levels are known to be elevated in TSP2 KO cell culture, it was necessary to probe the effect of the modification process on the graft's mechanical properties. However, no differences were found in suture retention, Young's modulus, or ultimate tensile strength between modified and unmodified grafts. Platelet studies were then performed to determine the time point at which the TSP2 KO ECM sufficiently reduced thrombogenicity. Finally, grafts modified by either TSP2 KO or WT cells or unmodified grafts, were implanted in an abdominal aortic interposition model in rats. After 4 weeks, grafts with incorporated TSP2 KO ECM showed improved endothelial and mural cell recruitment, and a decreased failure rate compared to control grafts. Therefore, our studies show that TSP2 KO ECM could enable the production of off-the-shelf vascular grafts while promoting reconstruction of native vessels.
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Hu YT, Pan XD, Zheng J, Ma WG, Sun LZ. In vitro and in vivo evaluation of a small-caliber coaxial electrospun vascular graft loaded with heparin and VEGF. Int J Surg 2017. [PMID: 28648794 DOI: 10.1016/j.ijsu.2017.06.077] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
INTRODUCTION To date, clinically available expanded polytetrafluoro-ethylene (ePTFE) vascular grafts are suboptimal for reconstructing small caliber (D < 6 mm) arteries, owing to thrombosis in early and restenosis in late stage. Our aim in this preliminary study was to fabricate a nano-fibrous vascular graft which was biofunctionalized with VEGF165 and heparin. The short term performance was evaluated both in vitro and in vivo. METHOD Four-mm caliber grafts were prepared by the coaxial-elctrospun technique, which consisted of poly(l-lactide-co-caprolactone) [P(LLA-CL)] collagen and elastin. Heparin and endothelial cell growth factor-165 (VEGF165) were encapsulated in the core of the fibrous. Controlled release of the heparin and VEGF165 were evaluated for 28 days. Endothelial cells were cultured on the electrospun grafts or ePTFE grafts as controls. The cellular adhesion, proliferation and morphology were examined. Electrospun or ePTFE grafts were randomly implanted into a rabbit infrarenal aortic replacement model (n = 30) for 28 days without any antiplatelet therapy. At the termination, all grafts were examined by Doppler ultrasound and then evaluated with histology and scanning electron microscopy. RESULTS The cumulative release amount of heparin (6.93 ± 1.03 mg) and VEGF165 (22.17 ± 5.56 μg) during 28 days were measured. Endothelial cells cultured on electrospun grafts showed significantly higher attachment efficiency and proliferation compared to the ePTFE ones (P < 0.001). At 2 h more ECs had attached to the P(LLA-CL)/Collagen/Elatin grafts (83.26 ± 8.02%) compared to P(LLA-CL) (67.07 ± 4.16%) and ePTFE (46.87 ± 8.85%). ECs proliferated faster on VEGF loaded grafts (O.D = 2.9 ± 1.2, n = 12) compared to ePTFE (O.D = 1.7 ± 1.0, n = 12). The patency was significantly higher in electrospun grafts (86.6%) than ePTFE grafts (40.0%) (P = 0.021). Correspondingly, the microscope images of electrospun implants showed little thrombus when compared with the ePTFE implants. CONCLUSION Biofunctionalized electrospun graft showed surgical properties, hemocompatibility and higher short-term patency compared with the ePTFE grafts. Despite good early performances, profound study should be designed for long-term evaluation.
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Affiliation(s)
- Yun-Tao Hu
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vascular Diseases, Beijing, China
| | - Xu-Dong Pan
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vascular Diseases, Beijing, China
| | - Jun Zheng
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vascular Diseases, Beijing, China
| | - Wei-Guo Ma
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vascular Diseases, Beijing, China
| | - Li-Zhong Sun
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vascular Diseases, Beijing, China.
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López-Ruiz E, Venkateswaran S, Perán M, Jiménez G, Pernagallo S, Díaz-Mochón JJ, Tura-Ceide O, Arrebola F, Melchor J, Soto J, Rus G, Real PJ, Diaz-Ricart M, Conde-González A, Bradley M, Marchal JA. Poly(ethylmethacrylate-co-diethylaminoethyl acrylate) coating improves endothelial re-population, bio-mechanical and anti-thrombogenic properties of decellularized carotid arteries for blood vessel replacement. Sci Rep 2017; 7:407. [PMID: 28341826 PMCID: PMC5412652 DOI: 10.1038/s41598-017-00294-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2016] [Accepted: 02/17/2017] [Indexed: 12/02/2022] Open
Abstract
Decellularized vascular scaffolds are promising materials for vessel replacements. However, despite the natural origin of decellularized vessels, issues such as biomechanical incompatibility, immunogenicity risks and the hazards of thrombus formation, still need to be addressed. In this study, we coated decellularized vessels obtained from porcine carotid arteries with poly (ethylmethacrylate-co-diethylaminoethylacrylate) (8g7) with the purpose of improving endothelial coverage and minimizing platelet attachment while enhancing the mechanical properties of the decellularized vascular scaffolds. The polymer facilitated binding of endothelial cells (ECs) with high affinity and also induced endothelial cell capillary tube formation. In addition, platelets showed reduced adhesion on the polymer under flow conditions. Moreover, the coating of the decellularized arteries improved biomechanical properties by increasing its tensile strength and load. In addition, after 5 days in culture, ECs seeded on the luminal surface of 8g7-coated decellularized arteries showed good regeneration of the endothelium. Overall, this study shows that polymer coating of decellularized vessels provides a new strategy to improve re-endothelialization of vascular grafts, maintaining or enhancing mechanical properties while reducing the risk of thrombogenesis. These results could have potential applications in improving tissue-engineered vascular grafts for cardiovascular therapies with small caliber vessels.
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Affiliation(s)
- Elena López-Ruiz
- Department of Health Sciences, University of Jaén, Jaén, Spain.,Biopathology and Regenerative Medicine Institute (IBIMER), Centre for Biomedical Research, University of Granada, Granada, Spain
| | | | - Macarena Perán
- Department of Health Sciences, University of Jaén, Jaén, Spain.,Biopathology and Regenerative Medicine Institute (IBIMER), Centre for Biomedical Research, University of Granada, Granada, Spain
| | - Gema Jiménez
- Biopathology and Regenerative Medicine Institute (IBIMER), Centre for Biomedical Research, University of Granada, Granada, Spain.,Department of Human Anatomy and Embryology, Faculty of Medicine, University of Granada, Granada, Spain.,Biosanitary Research Institute of Granada (ibs.GRANADA), University Hospitals of Granada-University of Granada, Granada, Spain
| | - Salvatore Pernagallo
- School of Chemistry, EaStCHEM, University of Edinburgh, King's Buildings, Edinburgh, UK
| | - Juan J Díaz-Mochón
- Pfizer-Universidad de Granada-Junta de Andalucía Centre for Genomics and Oncological Research (GENYO), Granada, Spain
| | - Olga Tura-Ceide
- Department of Pulmonary Medicine, Hospital Clínic; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain.,Biomedical Research Networking Center on Respiratory Diseases (CIBERES), Madrid, Spain
| | - Francisco Arrebola
- Department of Histology, Faculty of Medicine, Institute of Neuroscience, Biomedical Research Centre, University of Granada, Granada, Spain
| | - Juan Melchor
- Biosanitary Research Institute of Granada (ibs.GRANADA), University Hospitals of Granada-University of Granada, Granada, Spain.,Department of Structural Mechanics, University of Granada, Politécnico de Fuentenueva, Granada, Spain
| | - Juan Soto
- Department of Structural Mechanics, University of Granada, Politécnico de Fuentenueva, Granada, Spain
| | - Guillermo Rus
- Biosanitary Research Institute of Granada (ibs.GRANADA), University Hospitals of Granada-University of Granada, Granada, Spain.,Department of Structural Mechanics, University of Granada, Politécnico de Fuentenueva, Granada, Spain
| | - Pedro J Real
- Pfizer-Universidad de Granada-Junta de Andalucía Centre for Genomics and Oncological Research (GENYO), Granada, Spain
| | - María Diaz-Ricart
- Department of Hemotherapy and Hemostasis, Hospital Clinic, Centre de Diagnostic Biomedic (CDB), Institute of Biomedical Research August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | | | - Mark Bradley
- School of Chemistry, EaStCHEM, University of Edinburgh, King's Buildings, Edinburgh, UK.
| | - Juan A Marchal
- Biopathology and Regenerative Medicine Institute (IBIMER), Centre for Biomedical Research, University of Granada, Granada, Spain. .,Department of Human Anatomy and Embryology, Faculty of Medicine, University of Granada, Granada, Spain. .,Biosanitary Research Institute of Granada (ibs.GRANADA), University Hospitals of Granada-University of Granada, Granada, Spain.
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Cronce MJ, Faulknor RA, Pomerantseva I, Liu XH, Goldman SM, Ekwueme EC, Mwizerwa O, Neville CM, Sundback CA. In vivo response to decellularized mesothelium scaffolds. J Biomed Mater Res B Appl Biomater 2017; 106:716-725. [PMID: 28323397 DOI: 10.1002/jbm.b.33879] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2016] [Revised: 02/13/2017] [Accepted: 02/28/2017] [Indexed: 11/05/2022]
Abstract
Biological surgical scaffolds are used in plastic and reconstructive surgery to support structural reinforcement and regeneration of soft tissue defects. Macrophage and fibroblast cell populations heavily regulate scaffold integration into host tissue following implantation. In the present study, the biological host response to a commercially available surgical scaffold (Meso BioMatrix Surgical Mesh (MBM)) was investigated for up to 9 weeks after subcutaneous implantation; this scaffold promoted superior cell migration and infiltration previously in in vitro studies relative to other commercially available scaffolds. Infiltrating macrophages and fibroblasts phenotypes were assessed for evidence of inflammation and remodeling. At week 1, macrophages were the dominant cell population, but fibroblasts were most abundant at subsequent time points. At week 4, the scaffold supported inflammation modulation as indicated by M1 to M2 macrophage polarization; the foreign body giant cell response resolved by week 9. Unexpectedly, a fibroblast subpopulation expressed macrophage phenotypic markers, following a similar trend in transitioning from a proinflammatory to anti-inflammatory phenotype. Also, α-smooth muscle actin-expressing myofibroblasts were abundant at weeks 4 and 9, mirroring collagen expression and remodeling activity. MBM supported physiologic responses observed during normal wound healing, including cellular infiltration, host tissue ingrowth, remodeling of matrix proteins, and immune modulation. © 2017 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater, 106B: 716-725, 2018.
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Affiliation(s)
- Michael J Cronce
- Center for Regenerative Medicine, Massachusetts General Hospital, Boston, Massachusetts, 02114
| | - Renea A Faulknor
- Center for Regenerative Medicine, Massachusetts General Hospital, Boston, Massachusetts, 02114.,Harvard Medical School, Boston, Massachusetts, 02115
| | - Irina Pomerantseva
- Center for Regenerative Medicine, Massachusetts General Hospital, Boston, Massachusetts, 02114.,Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts, 02114.,Harvard Medical School, Boston, Massachusetts, 02115
| | | | | | - Emmanuel C Ekwueme
- Center for Regenerative Medicine, Massachusetts General Hospital, Boston, Massachusetts, 02114.,Harvard Medical School, Boston, Massachusetts, 02115
| | - Olive Mwizerwa
- Center for Regenerative Medicine, Massachusetts General Hospital, Boston, Massachusetts, 02114
| | - Craig M Neville
- Center for Regenerative Medicine, Massachusetts General Hospital, Boston, Massachusetts, 02114.,Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts, 02114.,Harvard Medical School, Boston, Massachusetts, 02115
| | - Cathryn A Sundback
- Center for Regenerative Medicine, Massachusetts General Hospital, Boston, Massachusetts, 02114.,Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts, 02114.,Harvard Medical School, Boston, Massachusetts, 02115
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Row S, Santandreu A, Swartz DD, Andreadis ST. Cell-free vascular grafts: Recent developments and clinical potential. TECHNOLOGY 2017; 5:13-20. [PMID: 28674697 PMCID: PMC5492388 DOI: 10.1142/s2339547817400015] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
Recent advances in vascular tissue engineering have led to the development of cell-free grafts that are available off-the-shelf for on demand surgery. Challenges associated with cell-based technologies including cell sourcing, cell expansion and long-term bioreactor culture motivated the development of completely cell-free vascular grafts. These are based on decellularized arteries, decellularized cultured cell-based tissue engineered grafts or biomaterials functionalized with biological signals that promote in situ tissue regeneration. Clinical trials undertaken to demonstrate the applicability of these grafts are also discussed. This comprehensive review summarizes recent developments in vascular graft technologies, with potential applications in coronary artery bypass procedures, lower extremity bypass, vascular injury and trauma, congenital heart diseases and dialysis access shunts, to name a few.
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Affiliation(s)
- Sindhu Row
- Department of Chemical and Biological Engineering, University at Buffalo, The State University of New York, Amherst, NY 14260-4200, USA
- Angiograft LLC, Amherst NY
| | - Ana Santandreu
- Department of Chemical and Biological Engineering, University at Buffalo, The State University of New York, Amherst, NY 14260-4200, USA
| | | | - Stelios T Andreadis
- Department of Chemical and Biological Engineering, University at Buffalo, The State University of New York, Amherst, NY 14260-4200, USA
- Department of Biomedical Engineering, University at Buffalo, The State University of New York, Amherst, NY 14260-4200, USA
- New York State Center of Excellence in Bioinformatics and Life Sciences, Buffalo, NY
- Angiograft LLC, Amherst NY
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White LJ, Taylor AJ, Faulk DM, Keane TJ, Saldin LT, Reing JE, Swinehart IT, Turner NJ, Ratner BD, Badylak SF.. The impact of detergents on the tissue decellularization process: A ToF-SIMS study. Acta Biomater 2017; 50:207-219. [PMID: 27993639 DOI: 10.1016/j.actbio.2016.12.033] [Citation(s) in RCA: 157] [Impact Index Per Article: 22.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2016] [Revised: 12/08/2016] [Accepted: 12/14/2016] [Indexed: 02/02/2023]
Abstract
Biologic scaffolds are derived from mammalian tissues, which must be decellularized to remove cellular antigens that would otherwise incite an adverse immune response. Although widely used clinically, the optimum balance between cell removal and the disruption of matrix architecture and surface ligand landscape remains a considerable challenge. Here we describe the use of time of flight secondary ion mass spectroscopy (ToF-SIMS) to provide sensitive, molecular specific, localized analysis of detergent decellularized biologic scaffolds. We detected residual detergent fragments, specifically from Triton X-100, sodium deoxycholate and sodium dodecyl sulphate (SDS) in decellularized scaffolds; increased SDS concentrations from 0.1% to 1.0% increased both the intensity of SDS fragments and adverse cell outcomes. We also identified cellular remnants, by detecting phosphate and phosphocholine ions in PAA and CHAPS decellularized scaffolds. The present study demonstrates ToF-SIMS is not only a powerful tool for characterization of biologic scaffold surface molecular functionality, but also enables sensitive assessment of decellularization efficacy. STATEMENT OF SIGNIFICANCE We report here on the use of a highly sensitive analytical technique, time of flight secondary ion mass spectroscopy (ToF-SIMS) to characterize detergent decellularized scaffolds. ToF-SIMS detected cellular remnants and residual detergent fragments; increased intensity of the detergent fragments correlated with adverse cell matrix interactions. This study demonstrates the importance of maintaining a balance between cell removal and detergent disruption of matrix architecture and matrix surface ligand landscape. This study also demonstrates the power of ToF-SIMS for the characterization of decellularized scaffolds and capability for assessment of decellularization efficacy. Future use of biologic scaffolds in clinical tissue reconstruction will benefit from the fundamental results described in this work.
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Hsieh SC, Chen HJ, Hsu SH, Yang YC, Tang CM, Chu MY, Lin PY, Fu RH, Kung ML, Chen YW, Yeh BW, Hung HS. Prominent Vascularization Capacity of Mesenchymal Stem Cells in Collagen-Gold Nanocomposites. ACS APPLIED MATERIALS & INTERFACES 2016; 8:28982-29000. [PMID: 27714998 DOI: 10.1021/acsami.6b09330] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
The ideal characteristics of surface modification on the vascular graft for clinical application would be with excellent hemocompatibility, endothelialization capacity, and antirestenosis ability. Here, Fourier transform infrared spectroscopy (FTIR), surface enhanced Raman spectroscopy (SERS), atomic force microscopy (AFM), contact angle (θ) measurement, and thermogravimetric analysis (TGA) were used to evaluate the chemical and mechanical properties of collagen-gold nanocomposites (collagen+Au) with 17.4, 43.5, and 174 ppm of Au and suggested that the collagen+Au with 43.5 ppm of Au had better biomechanical properties and thermal stability than pure collagen. Besides, stromal-derived factor-1α (SDF-1α) at 50 ng/mL promoted the migration of mesenchymal stem cells (MSCs) on collagen+Au material through the α5β3 integrin/endothelial oxide synthase (eNOS)/metalloproteinase (MMP) signaling pathway which can be abolished by the knockdown of vascular endothelial growth factor (VEGF). The potentiality of collagen+Au with MSCs for vascular regeneration was evaluated by our in vivo rat model system. Artery tissues isolated from an implanted collagen+Au-coated catheter with MSCs expressed substantial CD-31 and α-SMA, displayed higher antifibrotic ability, antithrombotic activity, as well as anti-inflammatory response than all other materials. Our results indicated that the implantation of collagen+Au-coated catheters with MSCs could be a promising strategy for vascular regeneration.
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Affiliation(s)
- Shu-Chen Hsieh
- Department of Chemistry, National Sun Yat-Sen University , Kaohsiung, Taiwan, R.O.C
- Center for Stem Cell Research, Kaohsiung Medical University , Kaohsiung, Taiwan, R.O.C
- School of Pharmacy, College of Pharmacy, Kaohsiung Medical University , Kaohsiung, Taiwan, R.O.C
| | - Hui-Jye Chen
- Graduate Institute of Basic Medical Science, China Medical University , Taichung, Taiwan, R.O.C
| | - Shan-Hui Hsu
- Institute of Polymer Science and Engineering, National Taiwan University , Taipei, Taiwan, R.O.C
- Rehabilitation Engineering Research Center, National Taiwan University , Taipei, Taiwan, R.O.C
| | - Yi-Chin Yang
- Department of Neurosurgery, Taichung Veterans General Hospital , Taichung, Taiwan, R.O.C
| | - Cheng-Ming Tang
- Institute of Oral Sciences, Chung Shan Medical University , Taichung, Taiwan, R.O.C
| | - Mei-Yun Chu
- Graduate Institute of Basic Medical Science, China Medical University , Taichung, Taiwan, R.O.C
| | - Pei-Ying Lin
- Department of Chemistry, National Sun Yat-Sen University , Kaohsiung, Taiwan, R.O.C
| | - Ru-Huei Fu
- Graduate Institute of Immunology, China Medical University , Taichung, Taiwan, R.O.C
| | - Mei-Lang Kung
- Department of Chemistry, National Sun Yat-Sen University , Kaohsiung, Taiwan, R.O.C
| | - Yun-Wen Chen
- Department of Pharmacology, National Cheng Kung University , Tainan, Taiwan, R.O.C
| | - Bi-Wen Yeh
- Department of Urology, Kaohsiung Medical University Hospital, Kaohsiung Medical University , Kaohsiung, Taiwan, R.O.C
| | - Huey-Shan Hung
- Graduate Institute of Basic Medical Science, China Medical University , Taichung, Taiwan, R.O.C
- Translational Medicine Research, China Medical University Hospital , Taichung, Taiwan, R.O.C
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Zhang W, Huo Y, Wang X, Jia Y, Su L, Wang C, Li Y, Yang Y, Liu Y. Decellularized ovine arteries as biomatrix scaffold support endothelial of mesenchymal stem cells. Heart Vessels 2016; 31:1874-1881. [DOI: 10.1007/s00380-016-0834-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2015] [Accepted: 04/08/2016] [Indexed: 12/20/2022]
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46
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Spector M. Decellularized tissues and organs: an historical perspective and prospects for the future. Biomed Mater 2016; 11:020201. [DOI: 10.1088/1748-6041/11/2/020201] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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Abstract
Biomaterials have played an increasingly prominent role in the success of biomedical devices and in the development of tissue engineering, which seeks to unlock the regenerative potential innate to human tissues/organs in a state of deterioration and to restore or reestablish normal bodily function. Advances in our understanding of regenerative biomaterials and their roles in new tissue formation can potentially open a new frontier in the fast-growing field of regenerative medicine. Taking inspiration from the role and multi-component construction of native extracellular matrices (ECMs) for cell accommodation, the synthetic biomaterials produced today routinely incorporate biologically active components to define an artificial in vivo milieu with complex and dynamic interactions that foster and regulate stem cells, similar to the events occurring in a natural cellular microenvironment. The range and degree of biomaterial sophistication have also dramatically increased as more knowledge has accumulated through materials science, matrix biology and tissue engineering. However, achieving clinical translation and commercial success requires regenerative biomaterials to be not only efficacious and safe but also cost-effective and convenient for use and production. Utilizing biomaterials of human origin as building blocks for therapeutic purposes has provided a facilitated approach that closely mimics the critical aspects of natural tissue with regard to its physical and chemical properties for the orchestration of wound healing and tissue regeneration. In addition to directly using tissue transfers and transplants for repair, new applications of human-derived biomaterials are now focusing on the use of naturally occurring biomacromolecules, decellularized ECM scaffolds and autologous preparations rich in growth factors/non-expanded stem cells to either target acceleration/magnification of the body's own repair capacity or use nature's paradigms to create new tissues for restoration. In particular, there is increasing interest in separating ECMs into simplified functional domains and/or biopolymeric assemblies so that these components/constituents can be discretely exploited and manipulated for the production of bioscaffolds and new biomimetic biomaterials. Here, following an overview of tissue auto-/allo-transplantation, we discuss the recent trends and advances as well as the challenges and future directions in the evolution and application of human-derived biomaterials for reconstructive surgery and tissue engineering. In particular, we focus on an exploration of the structural, mechanical, biochemical and biological information present in native human tissue for bioengineering applications and to provide inspiration for the design of future biomaterials.
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48
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Decellularized human placenta chorion matrix as a favorable source of small-diameter vascular grafts. Acta Biomater 2016; 29:125-134. [PMID: 26432442 DOI: 10.1016/j.actbio.2015.09.038] [Citation(s) in RCA: 70] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2015] [Revised: 08/21/2015] [Accepted: 09/28/2015] [Indexed: 12/31/2022]
Abstract
Biomaterials based on decellularized tissues are increasingly attracting attention as functional alternatives to other natural or synthetic materials. However, a source of non-cadaver human allograft material would be favorable. Here we establish a decellularization method of vascular tissue from cryopreserved human placenta chorionic plate starting with an initial freeze-thaw step followed by a series of chemical treatments applied with a custom-made perfusion system. This novel pulsatile perfusion set-up enabled us to successfully decellularize the vascular tissue with lower concentrations of chemicals and shorter exposure times compared to a non-perfusion process. The decellularization procedure described here lead to the preservation of the native extracellular matrix architecture and the removal of cells. Quantitative analysis revealed no significant changes in collagen content and a retained glycosaminoglycan content of approximately 29%. In strain-to-failure tests, the decellularized grafts showed similar mechanical behavior compared to native controls. In addition, the mechanical values for ultimate tensile strength and stiffness were in an acceptable range for in vivo applications. Furthermore, biocompatibility of the decellularized tissue and its recellularizationability to serve as an adequate substratum for upcoming recellularization strategies using primary human umbilical vein endothelial cells (HUVECs) was demonstrated. HUVECs cultured on the decellularized placenta vessel matrix performed endothelialization and maintained phenotypical characteristics and cell specific expression patterns. Overall, the decellularized human placenta vessels can be a versatile tool for experimental studies on vascularization and as potent graft material for future in vivo applications. STATEMENT OF SIGNIFICANCE In the US alone more than 1million vascular grafts are needed in clinical practice every year. Despite severe disadvantages, such as donor site morbidity, autologous grafting from the patient's own arteries or veins is regarded as the gold standard for vascular tissue repair. Besides, strategies based on synthetic or natural materials have shown limited success. Tissue engineering approaches based on decellularized tissues are regarded as a promising alternative to clinically used treatments to overcome the observed limitations. However, a source for supply of non-cadaver human allograft material would be favorable. Here, we established a decellularization method of vascular tissue from the human placenta chorionic plate, a suitable human tissue source of consistent quality. The decellularized human placenta vessels can be a potent graft material for future in vivo applications and furthermore might be a versatile tool for experimental studies on vascularization.
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49
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Luo X, Kulig KM, Finkelstein EB, Nicholson MF, Liu XH, Goldman SM, Vacanti JP, Grottkau BE, Pomerantseva I, Sundback CA, Neville CM. In vitro evaluation of decellularized ECM-derived surgical scaffold biomaterials. J Biomed Mater Res B Appl Biomater 2015; 105:585-593. [PMID: 26663848 DOI: 10.1002/jbm.b.33572] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2015] [Revised: 10/19/2015] [Accepted: 11/02/2015] [Indexed: 11/10/2022]
Abstract
Decellularized extracellular matrix (ECM) biomaterials are increasingly used in regenerative medicine for abdominal tissue repair. Emerging ECM biomaterials with greater compliance target surgical procedures like breast and craniofacial reconstruction to enhance aesthetic outcome. Clinical studies report improved outcomes with newly designed ECM scaffolds, but their comparative biological characteristics have received less attention. In this study, we investigated scaffolds derived from dermis (AlloDerm Regenerative Tissue Matrix), small intestinal submucosa (Surgisis 4-layer Tissue Graft and OASIS Wound Matrix), and mesothelium (Meso BioMatrix Surgical Mesh and Veritas Collagen Matrix) and evaluated biological properties that modulate cellular responses and recruitment. An assay panel was utilized to assess the ECM scaffold effects upon cells. Results of the material-conditioned media study demonstrated Meso BioMatrix and OASIS best supported cell proliferation. Meso BioMatrix promoted the greatest migration and chemotaxis signaling, followed by Veritas and OASIS; OASIS had superior suppression of cell apoptosis. The direct adhesion assay indicated that AlloDerm, Meso BioMatrix, Surgisis, and Veritas had sidedness that affected cell-material interactions. In the chick chorioallantoic membrane assay, Meso BioMatrix and OASIS best supported cell infiltration. Among tested materials, Meso BioMatrix and OASIS demonstrated characteristics that facilitate scaffold incorporation, making them promising choices for many clinical applications. © 2015 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater, 105B: 585-593, 2017.
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Affiliation(s)
- Xiao Luo
- Center for Regenerative Medicine, Massachusetts General Hospital, Boston, Massachusetts, 02114.,Tongji Hospital, Huazhong University of Science and Technology, Wuhan, Hubei, 434300, People's Republic of China
| | - Katherine M Kulig
- Center for Regenerative Medicine, Massachusetts General Hospital, Boston, Massachusetts, 02114
| | - Eric B Finkelstein
- Center for Regenerative Medicine, Massachusetts General Hospital, Boston, Massachusetts, 02114.,The Department of Biomedical and Chemical Engineering, Syracuse Biomaterials Institute, Syracuse University, Syracuse, New York, 13244
| | - Margaret F Nicholson
- Center for Regenerative Medicine, Massachusetts General Hospital, Boston, Massachusetts, 02114
| | | | | | - Joseph P Vacanti
- Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts, 02114.,Harvard Medical School, Boston, Massachusetts, 02115
| | - Brian E Grottkau
- Harvard Medical School, Boston, Massachusetts, 02115.,Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, Massachusetts, 02114
| | - Irina Pomerantseva
- Center for Regenerative Medicine, Massachusetts General Hospital, Boston, Massachusetts, 02114.,Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts, 02114.,Harvard Medical School, Boston, Massachusetts, 02115
| | - Cathryn A Sundback
- Center for Regenerative Medicine, Massachusetts General Hospital, Boston, Massachusetts, 02114.,Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts, 02114.,Harvard Medical School, Boston, Massachusetts, 02115
| | - Craig M Neville
- Center for Regenerative Medicine, Massachusetts General Hospital, Boston, Massachusetts, 02114.,Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts, 02114.,Harvard Medical School, Boston, Massachusetts, 02115.,Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, Massachusetts, 02114
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50
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Boccafoschi F, Botta M, Fusaro L, Copes F, Ramella M, Cannas M. Decellularized biological matrices: an interesting approach for cardiovascular tissue repair and regeneration. J Tissue Eng Regen Med 2015; 11:1648-1657. [PMID: 26511323 DOI: 10.1002/term.2103] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2015] [Revised: 07/02/2015] [Accepted: 09/15/2015] [Indexed: 12/22/2022]
Abstract
The repair and replacement of blood vessels is one of the most challenging topics for biomedical research. Autologous vessels are preferred as graft materials, but they still have many issues to overcome: for instance, they need multiple surgical procedures and often patients may not have healthy and surgically valuable arteries useful as an autograft. A tissue-engineering approach is widely desirable to generate biological vascular prostheses. Recently, decellularization of native tissue has gained significant attention in the biomedical research field. This method is used to obtain biological scaffolds that are expected to maintain the complex three-dimensional structure of the extracellular matrix, preserving the biomechanical properties of the native tissues. The decellularizing methods and the biomechanical characteristics of these products are presented in this review. Decellularization of biological matrices induces the loss of major histocompatibility complex (MHC), which is expected to promote an immunological response by the host. All the studies showed that decellularized biomaterials possess adequate properties for xenografting. Concerning their mechanical properties, several studies have demonstrated that, although chemical decellularization methods do not affect the scaffolds' mechanical properties, these materials can be modified through different treatments in order to provide the desired mechanical characteristics, depending on the specific application. A short overview of legislative issues concerning the use of decellularized substitutes and future perspectives in surgical applications is also presented. Copyright © 2015 John Wiley & Sons, Ltd.
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Affiliation(s)
- Francesca Boccafoschi
- Department of Health Sciences, University of Piemonte Orientale 'A. Avogadro', Novara, Italy
| | - Margherita Botta
- Department of Health Sciences, University of Piemonte Orientale 'A. Avogadro', Novara, Italy
| | - Luca Fusaro
- Department of Health Sciences, University of Piemonte Orientale 'A. Avogadro', Novara, Italy
| | - Francesco Copes
- Department of Health Sciences, University of Piemonte Orientale 'A. Avogadro', Novara, Italy
| | - Martina Ramella
- Department of Health Sciences, University of Piemonte Orientale 'A. Avogadro', Novara, Italy
| | - Mario Cannas
- Department of Health Sciences, University of Piemonte Orientale 'A. Avogadro', Novara, Italy
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