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McGregor CGA, Byrne GW, Fan Z, Davies CJ, Polejaeva IA. Genetically engineered sheep: A new paradigm for future preclinical testing of biological heart valves. J Thorac Cardiovasc Surg 2023; 166:e142-e152. [PMID: 36914518 DOI: 10.1016/j.jtcvs.2023.02.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 01/24/2023] [Accepted: 02/06/2023] [Indexed: 02/17/2023]
Abstract
BACKGROUND Heart valve implantation in juvenile sheep to demonstrate biocompatibility and physiologic performance is the accepted model for regulatory approval of new biological heart valves (BHVs). However, this standard model does not detect the immunologic incompatibility between the major xenogeneic antigen, galactose-α-1,3-galactose (Gal), which is present in all current commercial BHVs, and patients who universally produce anti-Gal antibody. This clinical discordance leads to induced anti-Gal antibody in BHV recipients, promoting tissue calcification and premature structural valve degeneration, especially in young patients. The objective of the present study was to develop genetically engineered sheep that, like humans, produce anti-Gal antibody and mirror current clinical immune discordance. METHODS Guide RNA for CRISPR Cas9 nuclease was transfected into sheep fetal fibroblasts, creating a biallelic frame shift mutation in exon 4 of the ovine α-galactosyltransferase gene (GGTA1). Somatic cell nuclear transfer was performed, and cloned embryos were transferred to synchronized recipients. Cloned offspring were analyzed for expression of Gal antigen and spontaneous production of anti-Gal antibody. RESULTS Two of 4 surviving sheep survived long-term. One of the 2 was devoid of the Gal antigen (GalKO) and expressed cytotoxic anti-Gal antibody by age 2 to 3 months, which increased to clinically relevant levels by 6 months. CONCLUSIONS GalKO sheep represent a new, clinically relevant advanced standard for preclinical testing of BHVs (surgical or transcatheter) by accounting for the first time for human immune responses to residual Gal antigen that persists after current BHV tissue processing. This will identify the consequences of immune disparity preclinically and avoid unexpected past clinical sequelae.
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Affiliation(s)
- Christopher G A McGregor
- Department of Surgery, University of Minnesota Twin Cities, Minneapolis, Minn; Institute of Cardiovascular Sciences, University College London, London, United Kingdom.
| | - Guerard W Byrne
- Department of Surgery, University of Minnesota Twin Cities, Minneapolis, Minn; Institute of Cardiovascular Sciences, University College London, London, United Kingdom
| | - Zhiqiang Fan
- Department of Animal, Dairy, and Veterinary Sciences, Utah State University, Logan, Utah
| | - Christopher J Davies
- Department of Animal, Dairy, and Veterinary Sciences, Utah State University, Logan, Utah
| | - Irina A Polejaeva
- Department of Animal, Dairy, and Veterinary Sciences, Utah State University, Logan, Utah.
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2
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Lewies A, Botes L, van den Heever JJ, Dohmen PM, Smit FE. Monomeric glutaraldehyde fixation and amino acid detoxification of decellularized bovine pericardium for production of biocompatible tissue with tissue-guided regenerative potential. Heliyon 2023; 9:e19712. [PMID: 37809671 PMCID: PMC10559009 DOI: 10.1016/j.heliyon.2023.e19712] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 08/23/2023] [Accepted: 08/30/2023] [Indexed: 10/10/2023] Open
Abstract
The effect of monomeric glutaraldehyde fixation and amino acid detoxification on biocompatibility and tissue-guided regenerative potential of decellularized bovine pericardium was evaluated. The degree of cross-linking, porosity, enzymatic degradation, alpha-galactosyl content, the efficacy of detoxification, and cytotoxicity towards human epithelial cells were assessed. Tissue was subcutaneously implanted for eight weeks in male juvenile Sprague-Dawley rats, and mechanical properties, host cell infiltration, and calcification were evaluated. Three groups were compared i) decellularized tissue, ii) decellularized, monomeric glutaraldehyde fixed and amino acid detoxified tissue, and iii) commercial glutaraldehyde fixed non-decellularized tissue (Glycar®) (n = 6 rats per group). The fixation process gave a high degree of cross-linking (>85%), and was resistant to enzymatic degradation, with no significant effect on porosity. The detoxification process was effective, and the tissue was not toxic to mammalian cells in vitro. Tissue from both decellularized groups had significantly higher (p < 0.05) porosity and host cell infiltration in vivo. The process mitigated calcification. A non-significant decrease in the alpha-galactosyl content was observed, which increased when including the alpha-galactosidase enzyme. Mechanical properties were maintained. The fixation and detoxification process adequately removes free aldehyde groups and reduces toxicity, preventing enzymatic degradation and allowing for host cell infiltration while mitigating calcification and retaining the mechanical properties of the tissue. This process can be considered for processing decellularized bovine pericardium with tissue-guided regeneration potential for use in cardiovascular bioprostheses; however, methods of further reducing antigenicity, such as the use of enzymes, should be investigated.
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Affiliation(s)
- Angélique Lewies
- Department of Cardiothoracic Surgery, Faculty of Health Sciences, University of the Free State, Bloemfontein, South Africa
| | - Lezelle Botes
- Department of Health Sciences, Central University of Technology, Free State, Bloemfontein, South Africa
| | | | - Pascal Maria Dohmen
- Department of Cardiothoracic Surgery, Faculty of Health Sciences, University of the Free State, Bloemfontein, South Africa
- Department of Cardiac Surgery, Heart Centre Rostock, University of Rostock, Germany
| | - Francis Edwin Smit
- Department of Cardiothoracic Surgery, Faculty of Health Sciences, University of the Free State, Bloemfontein, South Africa
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3
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Naso F, Colli A, Zilla P, Calafiore AM, Lotan C, Padalino MA, Sturaro G, Gandaglia A, Spina M. Correlations between the alpha-Gal antigen, antibody response and calcification of cardiac valve bioprostheses: experimental evidence obtained using an alpha-Gal knockout mouse animal model. Front Immunol 2023; 14:1210098. [PMID: 37426661 PMCID: PMC10327888 DOI: 10.3389/fimmu.2023.1210098] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Accepted: 06/06/2023] [Indexed: 07/11/2023] Open
Abstract
Introduction Preformed antibodies against αGal in the human and the presence of αGal antigens on the tissue constituting the commercial bioprosthetic heart valves (BHVs, mainly bovine or porcine pericardium), lead to opsonization of the implanted BHV, leading to deterioration and calcification. Murine subcutaneous implantation of BHVs leaflets has been widely used for testing the efficacy of anti-calcification treatments. Unfortunately, commercial BHVs leaflets implanted into a murine model will not be able to elicit an αGal immune response because such antigen is expressed in the recipient and therefore immunologically tolerated. Methods This study evaluates the calcium deposition on commercial BHV using a new humanized murine αGal knockout (KO) animal model. Furtherly, the anti-calcification efficacy of a polyphenol-based treatment was deeply investigated. By using CRISPR/Cas9 approach an αGal KO mouse was created and adopted for the evaluation of the calcific propensity of original and polyphenols treated BHV by subcutaneous implantation. The calcium quantification was carried out by plasma analysis; the immune response evaluation was performed by histology and immunological assays. Anti-αGal antibodies level in KO mice increases at least double after 2 months of implantation of original commercial BHV compared to WT mice, conversely, the polyphenols-based treatment seems to effectively mask the antigen to the KO mice's immune system. Results Commercial leaflets explanted after 1 month from KO mice showed a four-time increased calcium deposition than what was observed on that explanted from WT. Polyphenol treatment prevents calcium deposition by over 99% in both KO and WT animals. The implantation of commercial BHV leaflets significantly stimulates the KO mouse immune system resulting in massive production of anti-Gal antibodies and the exacerbation of the αGal-related calcific effect if compared with the WT mouse. Discussion The polyphenol-based treatment applied in this investigation showed an unexpected ability to inhibit the recognition of BHV xenoantigens by circulating antibodies almost completely preventing calcific depositions compared to the untreated counterpart.
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Affiliation(s)
- Filippo Naso
- Biocompatibility Innovation Srl, Este, Padua, Italy
| | - Andrea Colli
- Cardiac Surgery Unit, Department of Surgical, Medical and Molecular Pathology and Critical Care, University of Pisa, Pisa, Italy
| | - Peter Zilla
- Christian Barnard Department of Cardiothoracic Surgery, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa
| | | | - Chaim Lotan
- Hadassah University Hospital - Cardiovascular Division, Ein Kerem, Jerusalem, Israel
| | - Massimo A. Padalino
- Pediatric and Congenital Cardiac Surgery Unit, Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | | | | | - Michele Spina
- Department of Biomedical Sciences, University of Padua, Padua, Italy
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4
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Strategies for development of decellularized heart valve scaffolds for tissue engineering. Biomaterials 2022; 288:121675. [DOI: 10.1016/j.biomaterials.2022.121675] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Revised: 07/02/2022] [Accepted: 07/06/2022] [Indexed: 01/01/2023]
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5
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Talaei-Khozani T, Yaghoubi A. An overview of post transplantation events of decellularized scaffolds. Transpl Immunol 2022; 74:101640. [PMID: 35667545 DOI: 10.1016/j.trim.2022.101640] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 05/29/2022] [Accepted: 05/31/2022] [Indexed: 12/19/2022]
Abstract
Regenerative medicine and tissue engineering are reasonable techniques for repairing failed tissues and could be a suitable alternative to organ transplantation. One of the most widely used methods for preparing bioscaffolds is the decellularization procedure. Although cell debris and DNA are removed from the decellularized tissues, important compositions of the extracellular matrix including proteins, proteoglycans, and glycoproteins are nearly preserved. Moreover, the obtained scaffolds have a 3-dimensional (3D) structure, appropriate naïve mechanical properties, and good biocompatibility. After transplantation, different types of host cells migrate to the decellularized tissues. Histological and immunohistochemical assessment of the different bioscaffolds after implantation reveals the migration of parenchymal cells, angiogenesis, as well as the invasion of inflammatory and giant foreign cells. In this review, the events after transplantation including angiogenesis, scaffold degradation, and the presence of immune and tissue-specific progenitor cells in the decellularized scaffolds in various hosts, are discussed.
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Affiliation(s)
- Tahereh Talaei-Khozani
- Histotomorphometry and stereology research center, Shiraz University of Medical Sciences, Shiraz, Iran; Tissue engineering lab, Anatomy Department, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Atefeh Yaghoubi
- Tissue engineering lab, Anatomy Department, Shiraz University of Medical Sciences, Shiraz, Iran.
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Liu Y, Chen C, Xie X, Yuan H, Tang Z, Qian T, Liu Y, Song M, Liu S, Lu T, Wu Z. Photooxidation and Pentagalloyl Glucose Cross-Linking Improves the Performance of Decellularized Small-Diameter Vascular Xenograft In Vivo. Front Bioeng Biotechnol 2022; 10:816513. [PMID: 35402413 PMCID: PMC8987116 DOI: 10.3389/fbioe.2022.816513] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 03/04/2022] [Indexed: 12/11/2022] Open
Abstract
Small-diameter vascular grafts have a significant need in peripheral vascular surgery and procedures of coronary artery bypass graft (CABG); however, autografts are not always available, synthetic grafts perform poorly, and allografts and xenografts dilate, calcify, and induce inflammation after implantation. We hypothesized that cross-linking of decellularized xenogeneic vascular grafts would improve the mechanical properties and biocompatibility and reduce inflammation, degradation, and calcification in vivo. To test this hypothesis, the bovine internal mammary artery (BIMA) was decellularized by detergents and ribozymes with sonication and perfusion. Photooxidation and pentagalloyl glucose (PGG) were used to cross-link the collagen and elastin fibers of decellularized xenografts. Modified grafts’ characteristics and biocompatibility were studied in vitro and in vivo; the grafts were implanted as transposition grafts in the subcutaneous of rats and the abdominal aorta of rabbits. The decellularized grafts were cross-linked by photooxidation and PGG, which improved the grafts’ biomechanical properties and biocompatibility, prevented elastic fibers from early degradation, and reduced inflammation and calcification in vivo. Short-term aortic implants in the rabbits showed collagen regeneration and differentiation of host smooth muscle cells. No occlusion and stenosis occurred due to remodeling and stabilization of the neointima. A good patency rate (100%) was maintained. Notably, implantation of non-treated grafts exhibited marked thrombosis, an inflammatory response, calcification, and elastin degeneration. Thus, photooxidation and PGG cross-linking are potential tools for improving grafts’ biological performance within decellularized small-diameter vascular xenografts.
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Affiliation(s)
- Yuhong Liu
- Department of Cardiovascular Surgery, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Chunyang Chen
- Department of Cardiovascular Surgery, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Xinlong Xie
- Department of Cardiovascular Surgery, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Haoyong Yuan
- Department of Cardiovascular Surgery, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Zhenjie Tang
- Department of Cardiovascular Surgery, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Tao Qian
- Department of Cardiovascular Surgery, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Yalin Liu
- Department of Cardiovascular Surgery, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Mingzhe Song
- Department of Cardiovascular Surgery, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Sixi Liu
- Department of Cardiovascular Surgery, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Ting Lu
- Department of Cardiovascular Surgery, The Second Xiangya Hospital of Central South University, Changsha, China
- *Correspondence: Ting Lu, ; Zhongshi Wu,
| | - Zhongshi Wu
- Department of Cardiovascular Surgery, The Second Xiangya Hospital of Central South University, Changsha, China
- NHC Key Laboratory of Birth Defect for Research and Prevention, Hunan Provincial Maternal and Child Health Care Hospital, Changsha, China
- *Correspondence: Ting Lu, ; Zhongshi Wu,
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7
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Vafaee T, Walker F, Thomas D, Roderjan JG, Veiga Lopes S, da Costa FDA, Desai A, Rooney P, Jennings LM, Fisher J, Berry HE, Ingham E. Repopulation of decellularised porcine pulmonary valves in the right ventricular outflow tract of sheep: Role of macrophages. J Tissue Eng 2022; 13:20417314221102680. [PMID: 35782993 PMCID: PMC9243591 DOI: 10.1177/20417314221102680] [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: 04/04/2022] [Accepted: 05/09/2022] [Indexed: 11/16/2022] Open
Abstract
The primary objective was to evaluate performance of low concentration SDS decellularised porcine pulmonary roots in the right ventricular outflow tract of juvenile sheep. Secondary objectives were to explore the cellular population of the roots over time. Animals were monitored by echocardiography and roots explanted at 1, 3, 6 (n = 4) and 12 months (n = 8) for gross analysis. Explanted roots were subject to histological, immunohistochemical and quantitative calcium analysis (n = 4 at 1, 3 and 12 months) and determination of material properties (n = 4; 12 months). Cryopreserved ovine pulmonary root allografts (n = 4) implanted for 12 months, and non-implanted cellular ovine roots were analysed for comparative purposes. Decellularised porcine pulmonary roots functioned well and were in very good condition with soft, thin and pliable leaflets. Morphometric analysis showed cellular population by 1 month. However, by 12 months the total number of cells was less than 50% of the total cells in non-implanted native ovine roots. Repopulation of the decellularised porcine tissues with stromal (α-SMA+; vimentin+) and progenitor cells (CD34+; CD271+) appeared to be orchestrated by macrophages (MAC 387+/ CD163low and CD163+/MAC 387-). The calcium content of the decellularised porcine pulmonary root tissues increased over the 12-month period but remained low (except suture points) at 401 ppm (wet weight) or below. The material properties of the decellularised porcine pulmonary root wall were unchanged compared to pre-implantation. There were some changes in the leaflets but importantly, the porcine tissues did not become stiffer. The decellularised porcine pulmonary roots showed good functional performance in vivo and were repopulated with ovine cells of the appropriate phenotype in a process orchestrated by M2 macrophages, highlighting the importance of these cells in the constructive tissue remodelling of cardiac root tissues.
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Affiliation(s)
- Tayyebeh Vafaee
- Institute of Medical and Biological
Engineering, School of Biomedical Sciences, Faculty of Biological Sciences,
University of Leeds, Leeds, UK
| | - Fiona Walker
- Institute of Medical and Biological
Engineering, School of Biomedical Sciences, Faculty of Biological Sciences,
University of Leeds, Leeds, UK
| | - Dan Thomas
- Institute of Medical and Biological
Engineering, School of Biomedical Sciences, Faculty of Biological Sciences,
University of Leeds, Leeds, UK
| | - João Gabriel Roderjan
- Department of Cardiac Surgery, Santa
Casa de Curitiba, Pontifica Universidade Catolica do Parana, Curitiba, Brazil
| | - Sergio Veiga Lopes
- Department of Cardiac Surgery, Santa
Casa de Curitiba, Pontifica Universidade Catolica do Parana, Curitiba, Brazil
| | - Francisco DA da Costa
- Department of Cardiac Surgery, Santa
Casa de Curitiba, Pontifica Universidade Catolica do Parana, Curitiba, Brazil
| | - Amisha Desai
- Institute of Medical and Biological
Engineering, School of Mechanical Engineering, University of Leeds, Leeds, UK
| | - Paul Rooney
- NHS Blood and Transplant, Tissue and
Eye Services, Estuary Banks, Liverpool, UK
| | - Louise M Jennings
- Institute of Medical and Biological
Engineering, School of Mechanical Engineering, University of Leeds, Leeds, UK
| | - John Fisher
- Institute of Medical and Biological
Engineering, School of Mechanical Engineering, University of Leeds, Leeds, UK
| | - Helen E Berry
- Institute of Medical and Biological
Engineering, School of Biomedical Sciences, Faculty of Biological Sciences,
University of Leeds, Leeds, UK
| | - Eileen Ingham
- Institute of Medical and Biological
Engineering, School of Biomedical Sciences, Faculty of Biological Sciences,
University of Leeds, Leeds, UK
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Ground M, Waqanivavalagi S, Walker R, Milsom P, Cornish J. Models of immunogenicity in preclinical assessment of tissue engineered heart valves. Acta Biomater 2021; 133:102-113. [PMID: 34082103 DOI: 10.1016/j.actbio.2021.05.049] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Revised: 05/21/2021] [Accepted: 05/25/2021] [Indexed: 12/20/2022]
Abstract
Tissue engineered heart valves may one day offer an exciting alternative to traditional valve prostheses. Methods of construction vary, from decellularised animal tissue to synthetic hydrogels, but the goal is the same: the creation of a 'living valve' populated with autologous cells that may persist indefinitely upon implantation. Previous failed attempts in humans have highlighted the difficulty in predicting how a novel heart valve will perform in vivo. A significant hurdle in bringing these prostheses to market is understanding the immune reaction in the short and long term. With respect to innate immunity, the chronic remodelling of a tissue engineered implant by macrophages remains poorly understood. Also unclear are the mechanisms behind unknown antigens and their effect on the adaptive immune system. No silver bullet exists, rather researchers must draw upon a number of in vitro and in vivo models to fully elucidate the effect a host will exert on the graft. This review details the methods by which the immunogenicity of tissue engineered heart valves may be investigated and reveals areas that would benefit from more research. STATEMENT OF SIGNIFICANCE: Both academic and private institutions around the world are committed to the creation of a valve prosthesis that will perform safely upon implantation. To date, however, no truly non-immunogenic valves have emerged. This review highlights the importance of preclinical immunogenicity assessment, and summarizes the available techniques used in vitro and in vivo to elucidate the immune response. To the authors knowledge, this is the first review that details the immune testing regimen specific to a TEHV candidate.
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9
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Ramm R, Goecke T, Köhler P, Tudorache I, Cebotari S, Ciubotaru A, Sarikouch S, Höffler K, Bothe F, Petersen B, Haverich A, Niemann H, Hilfiker A. Immunological and functional features of decellularized xenogeneic heart valves after transplantation into GGTA1-KO pigs. Regen Biomater 2021; 8:rbab036. [PMID: 35928180 PMCID: PMC8329474 DOI: 10.1093/rb/rbab036] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 05/27/2021] [Accepted: 06/11/2021] [Indexed: 07/22/2023] Open
Abstract
Decellularization of xenogeneic heart valves might lead to excellent regenerative implants, from which many patients could benefit. However, this material carries various xenogeneic epitopes and thus bears a considerable inherent immunological risk. Here, we investigated the regenerative and immunogenic potential of xenogeneic decellularized heart valve implants using pigs deficient for the galactosyltransferase gene (GGTA1-KO) as novel large animal model. Decellularized aortic and pulmonary heart valves obtained from sheep, wild-type pigs or GGTA1-KO pigs were implanted into GGTA1-KO pigs for 3, or 6 months, respectively. Explants were analyzed histologically, immunhistologically (CD3, CD21 and CD172a) and anti-αGal antibody serum titers were determined by ELISA. Xenogeneic sheep derived implants exhibited a strong immune reaction upon implantation into GGTA1-KO pigs, characterized by massive inflammatory cells infiltrates, presence of foreign body giant cells, a dramatic increase of anti-αGal antibody titers and ultimately destruction of the graft, whereas wild-type porcine grafts induced only a mild reaction in GGTA1-KO pigs. Allogeneic implants, wild-type/wild-type and GGTA1-KO/GGTA1-KO valves did not induce a measurable immune reaction. Thus, GGTA1-KO pigs developed a 'human-like' immune response toward decellularized xenogeneic implants showing that immunogenicity of xenogeneic implants is not sufficiently reduced by decellularization, which detracts from their regenerative potential.
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Affiliation(s)
- Robert Ramm
- Leibniz Research Laboratories for Biotechnology and Artificial Organs (LEBAO), Hannover Medical School, Carl-Neuberg Str. 1, Hannover 30625, Germany
| | - Tobias Goecke
- Leibniz Research Laboratories for Biotechnology and Artificial Organs (LEBAO), Hannover Medical School, Carl-Neuberg Str. 1, Hannover 30625, Germany
- Department of Cardiac-, Thoracic-, Transplantation and Vascular Surgery, Hannover Medical School, Carl-Neuberg Str. 1, Hannover 30625, Germany
| | - Peter Köhler
- Institute of Farm Animal Genetics, Friedrich-Loeffler-Institut, Hoeltystr. 10, 31535 Mariensee/Neustadt am Ruebenberge, Germany
| | - Igor Tudorache
- Department of Cardiac-, Thoracic-, Transplantation and Vascular Surgery, Hannover Medical School, Carl-Neuberg Str. 1, Hannover 30625, Germany
| | - Serghei Cebotari
- Department of Cardiac-, Thoracic-, Transplantation and Vascular Surgery, Hannover Medical School, Carl-Neuberg Str. 1, Hannover 30625, Germany
| | - Anatol Ciubotaru
- Department of Cardiac-, Thoracic-, Transplantation and Vascular Surgery, Hannover Medical School, Carl-Neuberg Str. 1, Hannover 30625, Germany
| | - Samir Sarikouch
- Department of Cardiac-, Thoracic-, Transplantation and Vascular Surgery, Hannover Medical School, Carl-Neuberg Str. 1, Hannover 30625, Germany
| | - Klaus Höffler
- Department of Cardiac-, Thoracic-, Transplantation and Vascular Surgery, Hannover Medical School, Carl-Neuberg Str. 1, Hannover 30625, Germany
| | | | - Björn Petersen
- Institute of Farm Animal Genetics, Friedrich-Loeffler-Institut, Hoeltystr. 10, 31535 Mariensee/Neustadt am Ruebenberge, Germany
| | - Axel Haverich
- Leibniz Research Laboratories for Biotechnology and Artificial Organs (LEBAO), Hannover Medical School, Carl-Neuberg Str. 1, Hannover 30625, Germany
- Department of Cardiac-, Thoracic-, Transplantation and Vascular Surgery, Hannover Medical School, Carl-Neuberg Str. 1, Hannover 30625, Germany
| | - Heiner Niemann
- Institute of Farm Animal Genetics, Friedrich-Loeffler-Institut, Hoeltystr. 10, 31535 Mariensee/Neustadt am Ruebenberge, Germany
| | - Andres Hilfiker
- Leibniz Research Laboratories for Biotechnology and Artificial Organs (LEBAO), Hannover Medical School, Carl-Neuberg Str. 1, Hannover 30625, Germany
- Department of Cardiac-, Thoracic-, Transplantation and Vascular Surgery, Hannover Medical School, Carl-Neuberg Str. 1, Hannover 30625, Germany
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10
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Comparative immunogenicity of decellularized wild type and alpha 1,3 galactosyltransferase knockout pig lungs. Biomaterials 2021; 276:121029. [PMID: 34311317 DOI: 10.1016/j.biomaterials.2021.121029] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 07/08/2021] [Accepted: 07/13/2021] [Indexed: 12/23/2022]
Abstract
Decellularized pig lungs recellularized with human lung cells offer a novel approach for organ transplantation. However, the potential immunogenicity of decellularized pig lungs following exposure to human tissues has not been assessed. We found that exposure of native lungs from wildtype and transgenic pigs lacking alpha (1,3)-galactosyltransferase (α-gal KO) to sera from normal healthy human volunteers demonstrated similar robust IgM and IgG immunoreactivity, comparably decreased in decellularized lungs. Similar results were observed with sera from patients who had previously undergone transcutaneous porcine aortic valve replacement (TAVR) or from patients with increased circulating anti-α-gal IgE antibodies (α-gal syndrome). Depleting anti-α-gal antibodies from the sera demonstrated both specificity of α-gal immunoreactivity and also residual immunoreactivity similar between wildtype and α-gal KO pig lungs. Exposure of human monocytes and macrophages to native wildtype lungs demonstrated greater induction of M2 phenotype than native α-gal KO pig lungs, which was less marked with decellularized lungs of either type. Overall, these results demonstrate that native wildtype and α-gal KO pig lungs provoke similar immune responses that are comparably decreased following decellularization. This provides a further platform for potential use of decellularized pig lungs in tissue engineering approaches and subsequent transplantation schemes but no obvious overall immunologic advantage of utilizing lungs obtained from α-gal KO pigs.
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Schulz A, Buratto E, Konstantinov IE. Commentary: From Old World monkeys to New World humans-Evolved protection from tick bites and bioprosthetic material. JTCVS OPEN 2021; 6:97-98. [PMID: 36003557 PMCID: PMC9390648 DOI: 10.1016/j.xjon.2021.03.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 03/26/2021] [Accepted: 03/29/2021] [Indexed: 11/29/2022]
Affiliation(s)
- Antonia Schulz
- Department of Cardiac Surgery, Royal Children's Hospital, Melbourne, Australia
| | - Edward Buratto
- Department of Cardiac Surgery, Royal Children's Hospital, Melbourne, Australia
- Department of Paediatrics, University of Melbourne, Melbourne, Australia
- Heart Research Group, Murdoch Children's Research Institute, Melbourne, Australia
| | - Igor E. Konstantinov
- Department of Cardiac Surgery, Royal Children's Hospital, Melbourne, Australia
- Department of Paediatrics, University of Melbourne, Melbourne, Australia
- Heart Research Group, Murdoch Children's Research Institute, Melbourne, Australia
- Melbourne Centre for Cardiovascular Genomics and Regenerative Medicine, Melbourne, Australia
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12
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Bozso SJ, El-Andari R, Al-Adra D, Moon MC, Freed DH, Nagendran J, Nagendran J. A review of the immune response stimulated by xenogenic tissue heart valves. Scand J Immunol 2021; 93:e13018. [PMID: 33372305 DOI: 10.1111/sji.13018] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 11/30/2020] [Accepted: 12/26/2020] [Indexed: 12/23/2022]
Abstract
Valvular heart disease continues to afflict millions of people around the world. In many cases, the only corrective treatment for valvular heart disease is valve replacement. Valve replacement options are currently limited, and the most common construct utilized are xenogenic tissue heart valves. The main limitation with the use of this valve type is the development of valvular deterioration. Valve deterioration results in intrinsic permanent changes in the valve structure, often leading to hemodynamic compromise and clinical symptoms of valve re-stenosis. A significant amount of research has been performed regarding the incidence of valve deterioration and determination of significant risk factors for its development. As a result, many believe that the underlying driver of valve deterioration is a chronic immune-mediated rejection process of the foreign xenogenic-derived tissue. The underlying mechanisms of how this occurs are an area of ongoing research and active debate. In this review, we provide an overview of the important components of the immune system and how they respond to xenografts. A review of the proposed mechanisms of xenogenic heart valve deterioration is provided including the immune response to xenografts. Finally, we discuss the role of strategies to combat valve degeneration such as preservation protocols, epitope modification and decellularization.
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Affiliation(s)
- Sabin J Bozso
- Department of Surgery, Division of Cardiac Surgery, University of Alberta, Edmonton, AB, Canada
| | - Ryaan El-Andari
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - David Al-Adra
- Department of Surgery, Division of Transplantation, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Michael C Moon
- Department of Surgery, Division of Cardiac Surgery, University of Alberta, Edmonton, AB, Canada
| | - Darren H Freed
- Department of Surgery, Division of Cardiac Surgery, University of Alberta, Edmonton, AB, Canada
| | - Jayan Nagendran
- Department of Surgery, Division of Cardiac Surgery, University of Alberta, Edmonton, AB, Canada
| | - Jeevan Nagendran
- Department of Surgery, Division of Cardiac Surgery, University of Alberta, Edmonton, AB, Canada
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Breimer ME, Holgersson J. The Structural Complexity and Animal Tissue Distribution of N-Glycolylneuraminic Acid (Neu5Gc)-Terminated Glycans. Implications for Their Immunogenicity in Clinical Xenografting. Front Mol Biosci 2019; 6:57. [PMID: 31428616 PMCID: PMC6690001 DOI: 10.3389/fmolb.2019.00057] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Accepted: 07/04/2019] [Indexed: 12/13/2022] Open
Abstract
N-Glycolylneuraminic acid (Neu5Gc)-terminated glycans are present in all animal cells/tissues that are already used in the clinic such as bioprosthetic heart valves (BHV) as well as in those that potentially will be xenografted in the future to overcome end stage cell/organ failure. Humans, as a species lack this antigen determinant and can react with an immune response after exposure to Neu5Gc present in these products/cells/tissues. Genetically engineered source animals lacking Neu5Gc has been generated and so has animals that in addition lack the major αGal xenoantigen. The use of cells/tissues/organs from such animals may improve the long-term performance of BHV and allow future xenografting. This review summarizes the present knowledge regarding structural complexity and tissue distribution of Neu5Gc on glycans of cells/tissue/organs already used in the clinic or intended for treatment of end stage organ failure by xenografting. In addition, we briefly discuss the role of anti-Neu5Gc antibodies in the xenorejection process and how knowledge about Neu5Gc structural complexity can be used to design novel diagnostics for anti-Neu5Gc antibody detection.
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Affiliation(s)
- Michael E Breimer
- Department of Surgery, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Jan Holgersson
- Laboratory Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Bonetti A, Marchini M, Ortolani F. Ectopic mineralization in heart valves: new insights from in vivo and in vitro procalcific models and promising perspectives on noncalcifiable bioengineered valves. J Thorac Dis 2019; 11:2126-2143. [PMID: 31285908 DOI: 10.21037/jtd.2019.04.78] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Ectopic calcification of native and bioprosthetic heart valves represents a major public health problem causing severe morbidity and mortality worldwide. Valve procalcific degeneration is known to be caused mainly by calcium salt precipitation onto membranes of suffering non-scavenged cells and dead-cell-derived products acting as major hydroxyapatite nucleators. Although etiopathogenesis of calcification in native valves is still far from being exhaustively elucidated, it is well known that bioprosthesis mineralization may be primed by glutaraldehyde-mediated toxicity for xenografts, cryopreservation-related damage for allografts and graft immune rejection for both. Instead, mechanical valves, which are free from calcification, are extremely thrombogenic, requiring chronic anticoagulation therapies for transplanted patients. Since surgical substitution of failed valves is still the leading therapeutic option, progressive improvements in tissue engineering techniques are crucial to attain readily available valve implants with good biocompatibility, proper functionality and long-term durability in order to meet the considerable clinical demand for valve substitutes. Bioengineered valves obtained from acellular non-valvular scaffolds or decellularized native valves are proving to be a compelling alternative to mechanical and bioprosthetic valve implants, as they appear to permit repopulation by the host's own cells with associated tissue remodelling, growth and repair, besides showing less propensity to calcification and adequate hemodynamic performances. In this review, insights into valve calcification onset as revealed by in vivo and in vitro procalcific models are updated as well as advances in the field of valve bioengineering.
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Xia C, Mei S, Gu C, Zheng L, Fang C, Shi Y, Wu K, Lu T, Jin Y, Lin X, Chen P. Decellularized cartilage as a prospective scaffold for cartilage repair. MATERIALS SCIENCE & ENGINEERING. C, MATERIALS FOR BIOLOGICAL APPLICATIONS 2019; 101:588-595. [PMID: 31029352 DOI: 10.1016/j.msec.2019.04.002] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Revised: 03/29/2019] [Accepted: 04/01/2019] [Indexed: 01/10/2023]
Abstract
Articular cartilage lacks self-healing capacity, and there is no effective therapy facilitating cartilage repair. Osteoarthritis (OA) due to cartilage defects represents large and increasing healthcare burdens worldwide. Nowadays, the generation of scaffolds to preserve bioactive factors and the biophysical environment has received increasing attention. Furthermore, improved decellularization technology has provided novel insights into OA treatment. This review provides a comparative account of different cartilage defect therapies. Furthermore, some recent effective decellularization protocols have been discussed. In particular, this review focuses on the decellularization ratio of each protocol. Moreover, these protocols were compared particularly on the basis of immunogenicity and mechanical functionality. Further, various recellularization methods have been enlisted and the reparative capacity of decellularized cartilage scaffolds is evaluated herein. The advantages and limitations of different recellularization processes have been described herein. This provides a basis for the generation of decellularized cartilage scaffolds, thereby potentially promoting the possibility of decellularization as a clinical therapeutic target.
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Affiliation(s)
- Chen Xia
- Department of Orthopaedic Surgery, Sir Run Run Shaw Hospital, Medical College of Zhejiang University, Hangzhou, China; Key Laboratory of Musculoskeletal System Degeneration and Regeneration Translational Research of Zhejiang Province, China; Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou, China
| | - Sheng Mei
- Department of Orthopaedic Surgery, Sir Run Run Shaw Hospital, Medical College of Zhejiang University, Hangzhou, China; Key Laboratory of Musculoskeletal System Degeneration and Regeneration Translational Research of Zhejiang Province, China
| | - Chenhui Gu
- Department of Orthopaedic Surgery, Sir Run Run Shaw Hospital, Medical College of Zhejiang University, Hangzhou, China; Key Laboratory of Musculoskeletal System Degeneration and Regeneration Translational Research of Zhejiang Province, China
| | - Lin Zheng
- Department of Orthopaedic Surgery, Sir Run Run Shaw Hospital, Medical College of Zhejiang University, Hangzhou, China; Key Laboratory of Musculoskeletal System Degeneration and Regeneration Translational Research of Zhejiang Province, China; Department of Orthopedics, 5th Affiliated Hospital, Lishui Municipal Central Hospital, Wenzhou Medical University, Lishui, China
| | - Chen Fang
- Department of Orthopaedic Surgery, Sir Run Run Shaw Hospital, Medical College of Zhejiang University, Hangzhou, China; Key Laboratory of Musculoskeletal System Degeneration and Regeneration Translational Research of Zhejiang Province, China
| | - Yiling Shi
- Department of Orthopaedic Surgery, Sir Run Run Shaw Hospital, Medical College of Zhejiang University, Hangzhou, China; Key Laboratory of Musculoskeletal System Degeneration and Regeneration Translational Research of Zhejiang Province, China
| | - Kaiwei Wu
- Department of Orthopaedic Surgery, Sir Run Run Shaw Hospital, Medical College of Zhejiang University, Hangzhou, China; Key Laboratory of Musculoskeletal System Degeneration and Regeneration Translational Research of Zhejiang Province, China
| | - Tongtong Lu
- Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou, China
| | - Yongming Jin
- Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou, China.
| | - Xianfeng Lin
- Department of Orthopaedic Surgery, Sir Run Run Shaw Hospital, Medical College of Zhejiang University, Hangzhou, China; Key Laboratory of Musculoskeletal System Degeneration and Regeneration Translational Research of Zhejiang Province, China.
| | - Pengfei Chen
- Department of Orthopaedic Surgery, Sir Run Run Shaw Hospital, Medical College of Zhejiang University, Hangzhou, China; Key Laboratory of Musculoskeletal System Degeneration and Regeneration Translational Research of Zhejiang Province, China.
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Koenig F, Kilzer M, Hagl C, Thierfelder N. Successful decellularization of thick-walled tissue: Highlighting pitfalls and the need for a multifactorial approach. Int J Artif Organs 2018; 42:17-24. [PMID: 30442045 DOI: 10.1177/0391398818805624] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
INTRODUCTION: Decellularization of thick tissue is challenging and varying. Therefore, we tried to establish a multifactorial approach for reliable aortic wall decellularization. METHODS: Porcine aortic walls were decellularized according to different procedures. Decellularization was performed for 24 (G1), 48 (G2), and 72 h (G3) with a solution of 0.5% desoxycholate and 0.5% dodecyl sulfate. The procedure was characterized using intermittent washing steps, the inclusion of sonication as well as DNase and α-galactosidase treatment. The decellularization efficiency was measured by the evaluation of 4',6-diamidino-2-phenylindole and hematoxylin and eosin staining and quantitative DNA assays. Pentachrome and picrosirius red staining, scanning electron microscopy as well as glycosaminoglycan assays were performed to evaluate the effect of the procedure on the extracellular matrix. RESULTS: 4',6-Diamidino-2-phenylindole and hematoxylin and eosin staining revealed a large amount of remaining nuclei in all groups. However, consecutive DNase treatment had a significant effect. While the remaining DNA was detected in some samples of G1 and G2, samples of G3 were fully decellularized. Glycosaminoglycan content was significantly reduced to 50% after 24 h (G1) but remained constant for G2 and G3. Picrosirius red staining revealed an intact and stable collagen network without any visible defects. Pentachrome staining substantiated these results. Nonetheless, the fiber network remains intact, which could be confirmed by reflection electron microscopy analysis. CONCLUSION: In this study, we developed a procedure that grants successful decellularization of porcine aortic wall while maintaining the fibrous microstructure. We highlighted the significant effect of DNase and α-galactosidase treatment. In addition, we could show the need for a multifactorial treatment and comprehensive evaluation protocols for thick tissue decellularization.
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Affiliation(s)
- Fabian Koenig
- Department of Cardiac Surgery, Laboratory for Tissue Engineering, Grosshadern Medical Centre, Ludwig-Maximilians-University, Munich, Germany
| | - Marie Kilzer
- Department of Cardiac Surgery, Laboratory for Tissue Engineering, Grosshadern Medical Centre, Ludwig-Maximilians-University, Munich, Germany
| | - Christian Hagl
- Department of Cardiac Surgery, Laboratory for Tissue Engineering, Grosshadern Medical Centre, Ludwig-Maximilians-University, Munich, Germany
| | - Nikolaus Thierfelder
- Department of Cardiac Surgery, Laboratory for Tissue Engineering, Grosshadern Medical Centre, Ludwig-Maximilians-University, Munich, Germany
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Swim MM, Albertario A, Iacobazzi D, Caputo M, Ghorbel MT. Amnion-Based Scaffold with Enhanced Strength and Biocompatibility for In Vivo Vascular Repair. Tissue Eng Part A 2018; 25:603-619. [PMID: 30284966 DOI: 10.1089/ten.tea.2018.0175] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
IMPACT STATEMENT This study aimed at developing an amnion-based scaffold suitable for vascular tissue engineering applications and in vivo usage. We successfully produced a multilayered scaffold with improved biomechanical properties and biocompatibility for in vivo vascular implantation. Our approach not only offers an allogeneic "off-the-shelf" solution for clinical use but also it provides the possibility of personalized medicine using a patient's own amnion and stem cells for the production of tissue engineered grafts for reconstructive heart surgery.
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Affiliation(s)
- Megan M Swim
- Bristol Heart Institute, Bristol Medical School, University of Bristol , Bristol, United Kingdom
| | - Ambra Albertario
- Bristol Heart Institute, Bristol Medical School, University of Bristol , Bristol, United Kingdom
| | - Dominga Iacobazzi
- Bristol Heart Institute, Bristol Medical School, University of Bristol , Bristol, United Kingdom
| | - Massimo Caputo
- Bristol Heart Institute, Bristol Medical School, University of Bristol , Bristol, United Kingdom
| | - Mohamed T Ghorbel
- Bristol Heart Institute, Bristol Medical School, University of Bristol , Bristol, United Kingdom
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Dalgliesh AJ, Parvizi M, Lopera-Higuita M, Shklover J, Griffiths LG. Graft-specific immune tolerance is determined by residual antigenicity of xenogeneic extracellular matrix scaffolds. Acta Biomater 2018; 79:253-264. [PMID: 30130615 DOI: 10.1016/j.actbio.2018.08.016] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Revised: 07/28/2018] [Accepted: 08/17/2018] [Indexed: 12/11/2022]
Abstract
Antigenicity remains the primary barrier towards expanding the use of unfixed xenogeneic biomaterials in clinical applications. An unfixed xenogeneic biomaterial devoid of antigenicity, with maintained structural and mechanical integrity, has potential to overcome the limitations of current clinically utilized glutaraldehyde-fixed xenogeneic biomaterials, such as heart valve bioprostheses. Unfortunately, the threshold level of residual antigenicity necessary to overcome graft-specific immune responses in unfixed xenogeneic tissue has yet to be determined. Furthermore, little information is known regarding the extent to which in vitro disruption of native ECM properties, resulting from decellularization or antigen removal procedures, are tolerated following in vivo implantation. This manuscript demonstrates that humoral adaptive immune responses are more sensitive to residual xenogeneic biomaterial antigen content than are cell-mediated adaptive responses. Critically, the threshold for tolerable residual antigenicity is identified, with removal of ≥92% of lipophilic antigens required to reduce adaptive immune responses to levels equivalent to glutaraldehyde fixed tissue. Finally, the results demonstrated that the innate immune system tolerates minor changes in protein organization provided that molecular structure is maintained. Antigen removed xenogeneic biomaterials achieving these in vitro success criteria induce in vivo adaptive and innate tolerance, while modulating pro-regenerative constructive remodeling. STATEMENT OF SIGNIFICANCE Removal of antigenic components from candidate xenogeneic biomaterials is the primary success criteria for development of extracellular matrix (ECM) scaffolds in tissue engineering applications. Currently, the threshold level of residual biomaterial antigenicity required to overcome recipient graft-specific adaptive immune responses is unknown. Additionally, the extent to which the innate immune response tolerates changes to the native ECM, resulting from the ECM scaffold production process, has yet to be determined. This manuscript not only establishes the threshold for tolerable residual antigenicity, but also demonstrates that deviations in protein organization are tolerated by the innate immune system, provided macromolecular structure remains intact. In doing so, we provide the foundation of an immunologically-acceptable unfixed xenogeneic biomaterial for use in clinical applications.
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Affiliation(s)
- Ailsa J Dalgliesh
- Department of Veterinary Medicine: Medicine and Epidemiology, University of California, Davis, One Shields Avenue, Davis, CA 95616, USA; Department of Cardiovascular Diseases, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA.
| | - Mojtaba Parvizi
- Department of Cardiovascular Diseases, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA.
| | - Manuela Lopera-Higuita
- Department of Cardiovascular Diseases, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA.
| | - Jeny Shklover
- Department of Veterinary Medicine: Medicine and Epidemiology, University of California, Davis, One Shields Avenue, Davis, CA 95616, USA
| | - Leigh G Griffiths
- Department of Cardiovascular Diseases, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA.
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Barone A, Benktander J, Whiddon C, Jin C, Galli C, Teneberg S, Breimer ME. Glycosphingolipids of porcine, bovine, and equine pericardia as potential immune targets in bioprosthetic heart valve grafts. Xenotransplantation 2018; 25:e12406. [PMID: 29932253 DOI: 10.1111/xen.12406] [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: 12/08/2017] [Revised: 02/28/2018] [Accepted: 04/13/2018] [Indexed: 02/04/2023]
Abstract
BACKGROUND Pericardial tissue from various animal species is utilized for the production of the bioprosthetic heart valves (BHV) used clinically. Experimental data show that the eventual breakdown of BHV is partly due to immunological interactions with carbohydrate tissue antigens. To understand these processes, we have examined the glycolipid-based carbohydrate antigens in naïve porcine, bovine, and equine pericardia. EXPERIMENTAL Total non-acid and acid glycosphingolipid fractions were isolated from porcine, bovine, and equine pericardia, and individual glycolipid compounds were characterized by thin-layer chromatography, mass spectrometry, and binding of monoclonal antibodies, lectins and bacteria in chromatogram binding assays. RESULTS The non-acid glycolipid fractions from all species contained glycosphingolipids based on the globo- and neolacto-series, including pentaglycosylceramides with terminal Galα3 determinants. Terminal blood group A and H (O) structures based on type 2 core chains were present in porcine pericardium, while the Forssman pentaosylceramide was found in equine pericardium. All acid glycolipid fractions contained sulfatide and several gangliosides with both N-acetyl- and N-glycolyl-neuraminic acid as terminal saccharide chain determinants. CONCLUSION Several carbohydrate antigens which are potential targets for the human immune system have been identified in the animal pericardial tissues used for the production of BHV. Which of these antigens are left in the tissues after industrial BHV production processes, as well as their potential role in eventual BHV degradation, remains to be elucidated.
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Affiliation(s)
- Angela Barone
- Department of Medical Biochemistry and Cell Biology, Institute of Biomedicine, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - John Benktander
- Department of Medical Biochemistry and Cell Biology, Institute of Biomedicine, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Christy Whiddon
- Department of Medical Biochemistry and Cell Biology, Institute of Biomedicine, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Chunsheng Jin
- Department of Medical Biochemistry and Cell Biology, Institute of Biomedicine, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Cesare Galli
- Avantea Laboratory of Reproductive Technologies, Cremona, Italy
| | - Susann Teneberg
- Department of Medical Biochemistry and Cell Biology, Institute of Biomedicine, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Michael E Breimer
- Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
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Daugs A, Lehmann N, Eroglu D, Meinke MC, Markhoff A, Bloch O. In VitroDetection System to Evaluate the Immunogenic Potential of Xenografts. Tissue Eng Part C Methods 2018; 24:280-288. [DOI: 10.1089/ten.tec.2017.0532] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Affiliation(s)
- Aila Daugs
- Auto Tissue Berlin GmbH, Berlin, Germany
| | | | | | - Martina C. Meinke
- Center of Experimental and Applied Cutaneous Physiology, Charité—Universitätsmedizin Berlin, Berlin, Germany
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21
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van Steenberghe M, Schubert T, Gerelli S, Bouzin C, Guiot Y, Xhema D, Bollen X, Abdelhamid K, Gianello P. Porcine pulmonary valve decellularization with NaOH-based vs detergent process: preliminary in vitro and in vivo assessments. J Cardiothorac Surg 2018; 13:34. [PMID: 29695259 PMCID: PMC5918872 DOI: 10.1186/s13019-018-0720-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2017] [Accepted: 04/05/2018] [Indexed: 12/01/2022] Open
Abstract
Background Glutaraldehyde fixed xenogeneic heart valve prosthesis are hindered by calcification and lack of growth potential. The aim of tissue decellularization is to remove tissue antigenicity, avoiding the use of glutaraldehyde and improve valve integration with low inflammation and host cell recolonization. In this preliminary study, we investigated the efficacy of a NaOH-based process for decellularization and biocompatibility improvement of porcine pulmonary heart valves in comparison to a detergent-based process (SDS-SDC0, 5%). Methods Native cryopreserved porcine pulmonary heart valves were treated with detergent and NaOH-based processes. Decellularization was assessed by Hematoxylin and eosin/DAPI/alpha-gal/SLA-I staining and DNA quantification of native and processed leaflets, walls and muscles. Elongation stress test investigated mechanical integrity of leaflets and walls (n = 3 tests/valve component) of valves in the native and treated groups (n = 4/group). Biochemical integrity (collagen/elastin/glycosaminoglycans content) of leaflet-wall and muscle of the valves (n = 4/group) was assessed and compared between groups with trichrome staining (Sirius Red/Miller/Alcian blue). Secondly, a preliminary in vivo study assessed biocompatibility (CD3 and CD68 immunostaining) and remodeling (Hematoxylin and eosin/CD31 and ASMA immunofluorescent staining) of NaOH processed valves implanted in orthotopic position in young Landrace pigs, at 1 (n = 1) and 3 months (n = 2). Results Decellularization was better achieved with the NaOH-based process (92% vs 69% DNA reduction in the wall). Both treatments did not significantly alter mechanical properties. The detergent-based process induced a significant loss of glycosaminoglycans (p < 0,05). In vivo, explanted valves exhibited normal morphology without any sign of graft dilatation, degeneration or rejection. Low inflammation was noticed at one and three months follow-up (1,8 +/− 3,03 and 0,9836 +/− 1,3605 CD3 cells/0,12 mm2 in the leaflets). In one animal, at three months we documented minimal calcification in the area of sinus leaflet and in one, microthrombi formation on the leaflet surface at 1 month. The endoluminal side of the valves showed partial reendothelialization. Conclusions NaOH-based process offers better porcine pulmonary valve decellularization than the detergent process. In vivo, the NaOH processed valves showed low inflammatory response at 3 months and partial recellularization. Regarding additional property of securing, this treatment should be considered for the new generation of heart valves prosthesis. Graphical abstract Graphical abstract of the study![]()
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Affiliation(s)
- Mathieu van Steenberghe
- Pôle de Chirurgie Expérimentale et Transplantation (CHEX), Institut de Recherche Expérimentale et Clinique (IREC), Secteur des Sciences de la Sante, Université Catholique de Louvain, Avenue Hippocrate 55/B1.55.04, B-1200, Brussels, Belgium. .,Service de chirurgie cardiaque et vasculaire, Clinique Cecil, avenue Louis Ruchonnet 53, 1003, Lausanne, Switzerland.
| | - Thomas Schubert
- Service d'orthopédie et de traumatologie de l'appareil locomoteur, Cliniques universitaires Saint-Luc, Avenue Hippocrate 10, B-1200, Brussels, Belgium.,Unité de thérapie tissulaire et cellulaire de l'appareil locomoteur, Cliniques universitaires Saint Luc, Avenue Hippocrate 10, B-1200, Brussels, Belgium
| | - Sébastien Gerelli
- Service de chirurgie cardiaque, Centre hospitalier Annecy-Genevois, site Annecy, 1 Avenue de l'Hopital, F-74370, Pringy, France
| | - Caroline Bouzin
- Institut de Recherche Expérimentale et Clinique (IREC), IREC Imaging Platform (2IP), Université catholique de Louvain, Avenue Hippocrate 55/B1.55.20, B-1200, Brussels, Belgium
| | - Yves Guiot
- Service d'anatomie pathologique, Cliniques universitaires Saint Luc, Avenue Hippocrate 10, B-1200, Brussels, Belgium
| | - Daela Xhema
- Pôle de Chirurgie Expérimentale et Transplantation (CHEX), Institut de Recherche Expérimentale et Clinique (IREC), Secteur des Sciences de la Sante, Université Catholique de Louvain, Avenue Hippocrate 55/B1.55.04, B-1200, Brussels, Belgium
| | - Xavier Bollen
- Institute of Mechanics, Materials and Civil Engineering, Mechatronic, Electrical Energy, and Dynamic Systems (MEED), Secteur des Sciences et Technologies, Université Catholique de Louvain, Place du Levant 2/L5.04.02, B-1348, Louvain-la-Neuve, Belgium
| | - Karim Abdelhamid
- Service d'oncologie, Centre hospitalier universitaire vaudois, Rue du Bugnon 46, CH-1011, Lausanne, Vaud, Switzerland
| | - Pierre Gianello
- Pôle de Chirurgie Expérimentale et Transplantation (CHEX), Institut de Recherche Expérimentale et Clinique (IREC), Secteur des Sciences de la Sante, Université Catholique de Louvain, Avenue Hippocrate 55/B1.55.04, B-1200, Brussels, Belgium
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22
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Liu X, Li N, Gong D, Xia C, Xu Z. Comparison of detergent-based decellularization protocols for the removal of antigenic cellular components in porcine aortic valve. Xenotransplantation 2018; 25:e12380. [PMID: 29446183 DOI: 10.1111/xen.12380] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2017] [Revised: 12/18/2017] [Accepted: 12/24/2017] [Indexed: 12/30/2022]
Affiliation(s)
- Xiaohong Liu
- Institute of Cardiothoracic Surgery; Changhai Hospital; Second Military Medical University; Shanghai China
| | - Ning Li
- Institute of Cardiothoracic Surgery; Changhai Hospital; Second Military Medical University; Shanghai China
- Department of Cardiothoracic Surgery Lab; Changhai Hospital; Second Military Medical University; Shanghai China
| | - Dejun Gong
- Department of Cardiothoracic Surgery Lab; Changhai Hospital; Second Military Medical University; Shanghai China
| | - Cuiping Xia
- Department of Cardiothoracic Surgery Lab; Changhai Hospital; Second Military Medical University; Shanghai China
| | - Zhiyun Xu
- Institute of Cardiothoracic Surgery; Changhai Hospital; Second Military Medical University; Shanghai China
- Department of Cardiothoracic Surgery Lab; Changhai Hospital; Second Military Medical University; Shanghai China
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23
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Blum KM, Drews JD, Breuer CK. Tissue-Engineered Heart Valves: A Call for Mechanistic Studies. TISSUE ENGINEERING PART B-REVIEWS 2018; 24:240-253. [PMID: 29327671 DOI: 10.1089/ten.teb.2017.0425] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Heart valve disease carries a substantial risk of morbidity and mortality. Outcomes are significantly improved by valve replacement, but currently available mechanical and biological replacement valves are associated with complications of their own. Mechanical valves have a high rate of thromboembolism and require lifelong anticoagulation. Biological prosthetic valves have a much shorter lifespan, and they are prone to tearing and degradation. Both types of valves lack the capacity for growth, making them particularly problematic in pediatric patients. Tissue engineering has the potential to overcome these challenges by creating a neovalve composed of native tissue that is capable of growth and remodeling. The first tissue-engineered heart valve (TEHV) was created more than 20 years ago in an ovine model, and the technology has been advanced to clinical trials in the intervening decades. Some TEHVs have had clinical success, whereas others have failed, with structural degeneration resulting in patient deaths. The etiologies of these complications are poorly understood because much of the research in this field has been performed in large animals and humans, and, therefore, there are few studies of the mechanisms of neotissue formation. This review examines the need for a TEHV to treat pediatric patients with valve disease, the history of TEHVs, and a future that would benefit from extension of the reverse translational trend in this field to include small animal studies.
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Affiliation(s)
- Kevin M Blum
- 1 Center for Regenerative Medicine, The Research Institute at Nationwide Children's Hospital , Columbus, Ohio.,2 The Ohio State University College of Medicine , Columbus, Ohio
| | - Joseph D Drews
- 1 Center for Regenerative Medicine, The Research Institute at Nationwide Children's Hospital , Columbus, Ohio.,3 Department of Surgery, The Ohio State University Wexner Medical Center , Columbus, Ohio
| | - Christopher K Breuer
- 1 Center for Regenerative Medicine, The Research Institute at Nationwide Children's Hospital , Columbus, Ohio.,3 Department of Surgery, The Ohio State University Wexner Medical Center , Columbus, Ohio
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Hofmann M, Schmiady MO, Burkhardt BE, Dave HH, Hübler M, Kretschmar O, Bode PK. Congenital aortic valve repair using CorMatrix ® : A histologic evaluation. Xenotransplantation 2017; 24. [PMID: 28940406 DOI: 10.1111/xen.12341] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2017] [Revised: 07/28/2017] [Accepted: 08/14/2017] [Indexed: 11/29/2022]
Abstract
BACKGROUND The reconstruction of heart valves provides substantial benefits, particularly in the pediatric population. We present our experience using decellularized extracellular matrix (dECM, CorMatrix® ) for aortic valve procedures. METHODS We retrospectively reviewed the case histories of 6 patients (aged from 2 months - 14 years) who underwent surgery for severe aortic valve stenosis (n = 4) or regurgitation (n = 2). Aortic valve repair was performed on all patients using dECM as a leaflet replacement or leaflet extension. Follow-ups were performed using echocardiography. Reoperation was necessary in 4 cases, and the dECM was explanted and examined histologically and immunohistochemically. RESULTS The early post-operative period was uneventful, and the scaffold fulfilled the mechanical requirements. Significant valve insufficiency developed in 5 patients during the post-operative period (119-441 days postoperatively). In all specimens, only a migration of inflammatory cells was identified, which induced structural and functional changes caused by the chronic inflammatory response. CONCLUSIONS Our results suggest a mixed immunological response of remodeling and inflammation following the implantation. The expected process of seeding/migration and remodeling of the bioscaffold into the typical 3-layered architecture were not observed in our explanted specimens.
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Affiliation(s)
- Michael Hofmann
- Division of Congenital Cardiovascular Surgery, University Children's Hospital Zurich, Zurich, Switzerland
| | - Martin O Schmiady
- Division of Congenital Cardiovascular Surgery, University Children's Hospital Zurich, Zurich, Switzerland
| | - Barbara E Burkhardt
- Division of Pediatric Cardiology, University Children's Hospital Zurich, Zurich, Switzerland
| | - Hitendu H Dave
- Division of Congenital Cardiovascular Surgery, University Children's Hospital Zurich, Zurich, Switzerland
| | - Michael Hübler
- Division of Congenital Cardiovascular Surgery, University Children's Hospital Zurich, Zurich, Switzerland
| | - Oliver Kretschmar
- Division of Pediatric Cardiology, University Children's Hospital Zurich, Zurich, Switzerland
| | - Peter K Bode
- Institute of Surgical Pathology, University Hospital Zurich, Zurich, Switzerland
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Helder MRK, Stoyles NJ, Tefft BJ, Hennessy RS, Hennessy RRC, Dyer R, Witt T, Simari RD, Lerman A. Xenoantigenicity of porcine decellularized valves. J Cardiothorac Surg 2017; 12:56. [PMID: 28716099 PMCID: PMC5514525 DOI: 10.1186/s13019-017-0621-5] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Accepted: 07/12/2017] [Indexed: 11/11/2022] Open
Abstract
Background The xenoantigenicity of porcine bioprosthetic valves is implicated as an etiology leading to calcification and subsequent valve failure. Decellularization of porcine valves theoretically could erase the antigenicity of the tissue leading to more durable prosthetic valves, but the effectiveness of decellularization protocols in regard to completely removing antigens has yet to be verified. Our hypothesis was that decellularization would remove the more abundant α-gal antigens but not remove all the non α-gal antigens, which could mount a response. Methods Porcine aortic valves were decellularized with 1% sodium dodecyl sulfate for 4 days. Decellularized cusps were evaluated for α-gal epitopes by ELISA. To test for non α-gal antigens, valves were implanted into sheep. Serum was obtained from the sheep preoperatively and 1 week, 1 month, and 2 months postoperatively. This serum was utilized for anti-porcine antibody staining and for quantification of anti-pig IgM and IgG antibodies and complement. Results Decellularized porcine cusps had 2.8 ± 2.0% relative α-gal epitope as compared to fresh porcine aortic valve cusps and was not statistically significantly different (p = 0.4) from the human aortic valve cusp which had a 2.0 ± 0.4% relative concentration. Anti-pig IgM and IgG increased postoperatively from baseline levels. Preoperatively anti-pig IgM was 27.7 ± 1.7 μg/mL and it increased to 71.9 ± 12.1 μg/mL average of all time points postoperatively (p = 0.04). Preoperatively anti-pig IgG in sheep serum was 44.9 ± 1.5 μg/mL and it increased to 72.6 ± 6.0 μg/mL average of all time points postoperatively (p = 0.01). There was a statistically significant difference (p = 0.00007) in the serum C1q concentration before valve implantation (2.5 ± 0.2 IU/mL) and at averaged time points after valve implantation (5.3 ± 0.3 IU/mL). Conclusions Decellularization with 1% sodium dodecyl sulfate does not fully eliminate non α-gal antigens; however, significant reduction in α-gal presence on decellularized cusps was observed. Clinical implications of the non α-gal antigenic response are yet to be determined. As such, evaluation of any novel decellularized xenografts must include rigorous antigen testing prior to human trials. Electronic supplementary material The online version of this article (doi:10.1186/s13019-017-0621-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
| | - Nicholas J Stoyles
- Department of Cardiovascular Diseases, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA
| | - Brandon J Tefft
- Department of Cardiovascular Diseases, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA
| | - Ryan S Hennessy
- Department of Cardiovascular Diseases, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA
| | - Rebecca R C Hennessy
- Department of Cardiovascular Diseases, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA
| | - Roy Dyer
- Divisions of Immunochemical Core Lab, Mayo Clinic, Rochester, MN, USA
| | - Tyra Witt
- Department of Cardiovascular Diseases, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA
| | - Robert D Simari
- Department of Cardiovascular Diseases, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA
| | - Amir Lerman
- Department of Cardiovascular Diseases, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA.
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Qiao WH, Liu P, Hu D, Al Shirbini M, Zhou XM, Dong NG. Sequential hydrophile and lipophile solubilization as an efficient method for decellularization of porcine aortic valve leaflets: Structure, mechanical property and biocompatibility study. J Tissue Eng Regen Med 2017; 12:e828-e840. [PMID: 27957807 DOI: 10.1002/term.2388] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2015] [Revised: 10/03/2016] [Accepted: 12/06/2016] [Indexed: 01/25/2023]
Abstract
Antigenicity of xenogeneic tissues is the major obstacle to increased use of these materials in clinical medicine. Residual xenoantigens in decellularized tissue elicit the immune response after implantation, causing graft failure. With this in mind, the potential use is proposed of three protein solubilization-based protocols for porcine aortic valve leaflets decellularization. It was demonstrated that hydrophile solubilization alone achieved incomplete decellularization; lipophile solubilization alone (LSA) completely removed all cells and two most critical xenoantigens - galactose-α(1,3)-galactose (α-Gal) and major histocompatibility complex I (MHC I) - but caused severe alterations of the structure and mechanical properties; sequential hydrophile and lipophile solubilization (SHLS) resulted in a complete removal of cells, α-Gal and MHC I, and good preservation of the structure and mechanical properties. In contrast, a previously reported method using Triton X-100, sodium deoxycholate and IGEPAL CA-630 resulted in a complete removal of all cells and MHC I, but with remaining α-Gal epitope. LSA- and SHLS-treated leaflets showed significantly reduced leucocyte activation (polymorphonuclear elastase) upon interaction with human blood in vitro. When implanted subdermally in rats for 6 weeks, LSA- or SHLS-treated leaflets were presented with more biocompatible implants and all four decellularized leaflets were highly resistant to calcification. These findings illustrate that the SHLS protocol could be considered as a promising decellularization method for the decellularization of xenogeneic tissues in tissue engineering and regenerative medicine. Copyright © 2016 John Wiley & Sons, Ltd.
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Affiliation(s)
- Wei-Hua Qiao
- Department of Cardiovascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Peng Liu
- Department of Cardiovascular Surgery, Henan Provincial People's Hospital, Henan Cardiovascular Disease Institute, Zhengzhou, China
| | - Dan Hu
- Department of Cardiovascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Mahmoud Al Shirbini
- Department of Cardiovascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xian-Ming Zhou
- Department of Cardiovascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Nian-Guo Dong
- Department of Cardiovascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Dalgliesh AJ, Liu ZZ, Griffiths LG. Magnesium Presence Prevents Removal of Antigenic Nuclear-Associated Proteins from Bovine Pericardium for Heart Valve Engineering. Tissue Eng Part A 2017; 23:609-621. [PMID: 28178887 DOI: 10.1089/ten.tea.2016.0405] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Current heart valve prostheses are associated with significant complications, including aggressive immune response, limited valve life expectancy, and inability to grow in juvenile patients. Animal derived "tissue" valves undergo glutaraldehyde fixation to mask tissue antigenicity; however, chronic immunological responses and associated calcification still commonly occur. A heart valve formed from an unfixed bovine pericardium (BP) extracellular matrix (ECM) scaffold, in which antigenic burden has been eliminated or significantly reduced, has potential to overcome deficiencies of current bioprostheses. Decellularization and antigen removal methods frequently use sequential solutions extrapolated from analytical chemistry approaches to promote solubility and removal of tissue components from resultant ECM scaffolds. However, the extent to which such prefractionation strategies may inhibit removal of antigenic tissue components has not been explored. We hypothesize that presence of magnesium in prefractionation steps causes DNA precipitation and reduces removal of nuclear-associated antigenic proteins. Keeping all variables consistent bar the addition or absence of magnesium (2 mM magnesium chloride hexahydrate), residual BP ECM scaffold antigenicity and removed antigenicity were assessed, along with residual and removed DNA content, ECM morphology, scaffold composition, and recellularization potential. Furthermore, we used proteomic methods to determine the mechanism by which magnesium presence or absence affects scaffold residual antigenicity. This study demonstrates that absence of magnesium from antigen removal solutions enhances solubility and subsequent removal of antigenic nuclear-associated proteins from BP. We therefore conclude that the primary mechanism of action for magnesium removal during antigen removal processes is avoidance of DNA precipitation, facilitating solubilization and removal of nuclear-associated antigenic proteins. Future studies are necessary to further facilitate solubility and removal of nuclear-associated antigenic proteins from xenogeneic ECM scaffolds, in addition to an in vivo assessing of the material.
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Affiliation(s)
- Ailsa J Dalgliesh
- 1 Department of Veterinary Medicine, Medicine and Epidemiology, University of California , Davis, Davis, California.,2 Department of Cardiovascular Diseases, Mayo Clinic , Rochester, Minnesota
| | - Zhi Zhao Liu
- 1 Department of Veterinary Medicine, Medicine and Epidemiology, University of California , Davis, Davis, California
| | - Leigh G Griffiths
- 1 Department of Veterinary Medicine, Medicine and Epidemiology, University of California , Davis, Davis, California.,2 Department of Cardiovascular Diseases, Mayo Clinic , Rochester, Minnesota
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28
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Böer U, Buettner FFR, Schridde A, Klingenberg M, Sarikouch S, Haverich A, Wilhelmi M. Antibody formation towards porcine tissue in patients implanted with crosslinked heart valves is directed to antigenic tissue proteins and αGal epitopes and is reduced in healthy vegetarian subjects. Xenotransplantation 2017; 24. [DOI: 10.1111/xen.12288] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2016] [Revised: 12/14/2016] [Accepted: 12/27/2016] [Indexed: 12/31/2022]
Affiliation(s)
- Ulrike Böer
- Lower Saxony Centre of Biotechnology Implant Research and Development (NIFE); Hannover Medical School; Hannover Germany
- Division for Cardiothoracic-, Transplantation- and Vascular Surgery; Hannover Medical School; Hannover Germany
| | | | - Ariane Schridde
- Lower Saxony Centre of Biotechnology Implant Research and Development (NIFE); Hannover Medical School; Hannover Germany
| | - Melanie Klingenberg
- Lower Saxony Centre of Biotechnology Implant Research and Development (NIFE); Hannover Medical School; Hannover Germany
- Division for Cardiothoracic-, Transplantation- and Vascular Surgery; Hannover Medical School; Hannover Germany
| | - Samir Sarikouch
- Division for Cardiothoracic-, Transplantation- and Vascular Surgery; Hannover Medical School; Hannover Germany
| | - Axel Haverich
- Lower Saxony Centre of Biotechnology Implant Research and Development (NIFE); Hannover Medical School; Hannover Germany
- Division for Cardiothoracic-, Transplantation- and Vascular Surgery; Hannover Medical School; Hannover Germany
| | - Mathias Wilhelmi
- Lower Saxony Centre of Biotechnology Implant Research and Development (NIFE); Hannover Medical School; Hannover Germany
- Division for Cardiothoracic-, Transplantation- and Vascular Surgery; Hannover Medical School; Hannover Germany
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29
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Lee W, Long C, Ramsoondar J, Ayares D, Cooper DKC, Manji RA, Hara H. Human antibody recognition of xenogeneic antigens (NeuGc and Gal) on porcine heart valves: could genetically modified pig heart valves reduce structural valve deterioration? Xenotransplantation 2016; 23:370-80. [DOI: 10.1111/xen.12254] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2016] [Accepted: 07/07/2016] [Indexed: 02/02/2023]
Affiliation(s)
- Whayoung Lee
- Thomas E. Starzl Transplantation Institute; University of Pittsburgh; Pittsburgh PA USA
| | - Cassandra Long
- Thomas E. Starzl Transplantation Institute; University of Pittsburgh; Pittsburgh PA USA
| | | | | | - David K. C. Cooper
- Thomas E. Starzl Transplantation Institute; University of Pittsburgh; Pittsburgh PA USA
| | - Rizwan A. Manji
- Department of Surgery; University of Manitoba; Winnipeg MB Canada
- Cardiac Sciences Program; Winnipeg Regional Health Authority and St Boniface Hospital; Winnipeg MB Canada
| | - Hidetaka Hara
- Thomas E. Starzl Transplantation Institute; University of Pittsburgh; Pittsburgh PA USA
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30
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Platz J, Bonenfant NR, Uhl FE, Coffey AL, McKnight T, Parsons C, Sokocevic D, Borg ZD, Lam YW, Deng B, Fields JG, DeSarno M, Loi R, Hoffman AM, Bianchi J, Dacken B, Petersen T, Wagner DE, Weiss DJ. Comparative Decellularization and Recellularization of Wild-Type and Alpha 1,3 Galactosyltransferase Knockout Pig Lungs: A Model for Ex Vivo Xenogeneic Lung Bioengineering and Transplantation. Tissue Eng Part C Methods 2016; 22:725-39. [PMID: 27310581 DOI: 10.1089/ten.tec.2016.0109] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND A novel potential approach for lung transplantation could be to utilize xenogeneic decellularized pig lung scaffolds that are recellularized with human lung cells. However, pig tissues express several immunogenic proteins, notably galactosylated cell surface glycoproteins resulting from alpha 1,3 galactosyltransferase (α-gal) activity, that could conceivably prevent effective use. Use of lungs from α-gal knock out (α-gal KO) pigs presents a potential alternative and thus comparative de- and recellularization of wild-type and α-gal KO pig lungs was assessed. METHODS Decellularized lungs were compared by histologic, immunohistochemical, and mass spectrometric techniques. Recellularization was assessed following compartmental inoculation of human lung bronchial epithelial cells, human lung fibroblasts, human bone marrow-derived mesenchymal stromal cells (all via airway inoculation), and human pulmonary vascular endothelial cells (CBF) (vascular inoculation). RESULTS No obvious differences in histologic structure was observed but an approximate 25% difference in retention of residual proteins was determined between decellularized wild-type and α-gal KO pig lungs, including retention of α-galactosylated epitopes in acellular wild-type pig lungs. However, robust initial recellularization and subsequent growth and proliferation was observed for all cell types with no obvious differences between cells seeded into wild-type versus α-gal KO lungs. CONCLUSION These proof of concept studies demonstrate that decellularized wild-type and α-gal KO pig lungs can be comparably decellularized and comparably support initial growth of human lung cells, despite some differences in retained proteins. α-Gal KO pig lungs are a suitable platform for further studies of xenogeneic lung regeneration.
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Affiliation(s)
- Joseph Platz
- 1 Department of Medicine, University of Vermont College of Medicine , Burlington, Vermont
| | - Nicholas R Bonenfant
- 1 Department of Medicine, University of Vermont College of Medicine , Burlington, Vermont
| | - Franziska E Uhl
- 1 Department of Medicine, University of Vermont College of Medicine , Burlington, Vermont
| | - Amy L Coffey
- 1 Department of Medicine, University of Vermont College of Medicine , Burlington, Vermont
| | - Tristan McKnight
- 1 Department of Medicine, University of Vermont College of Medicine , Burlington, Vermont
| | - Charles Parsons
- 1 Department of Medicine, University of Vermont College of Medicine , Burlington, Vermont
| | - Dino Sokocevic
- 1 Department of Medicine, University of Vermont College of Medicine , Burlington, Vermont
| | - Zachary D Borg
- 1 Department of Medicine, University of Vermont College of Medicine , Burlington, Vermont
| | - Ying-Wai Lam
- 2 Department of Biology and VGN Proteomics Facility, University of Vermont College of Arts and Sciences , Burlington, Vermont
| | - Bin Deng
- 2 Department of Biology and VGN Proteomics Facility, University of Vermont College of Arts and Sciences , Burlington, Vermont
| | - Julia G Fields
- 2 Department of Biology and VGN Proteomics Facility, University of Vermont College of Arts and Sciences , Burlington, Vermont
| | - Michael DeSarno
- 3 Biostatistics Unit, University of Vermont College of Medicine , Burlington, Vermont
| | - Roberto Loi
- 4 Department of Biomedical Sciences, University of Cagliari , Cagliari, Italy
| | - Andrew M Hoffman
- 5 Department of Clinical Sciences, Tufts University , Cummings School of Veterinary Medicine, North Grafton, Massachusetts
| | | | | | - Thomas Petersen
- 8 United Therapeutics Corp., Research Triangle Park , Durham, North Carolina
| | - Darcy E Wagner
- 1 Department of Medicine, University of Vermont College of Medicine , Burlington, Vermont.,9 Comprehensive Pneumonology Center, Helmholtz Center Munich, Ludwig Maximilians University Munich , Munich, Germany
| | - Daniel J Weiss
- 1 Department of Medicine, University of Vermont College of Medicine , Burlington, Vermont
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31
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Hussein KH, Park KM, Kang KS, Woo HM. Biocompatibility evaluation of tissue-engineered decellularized scaffolds for biomedical application. MATERIALS SCIENCE & ENGINEERING. C, MATERIALS FOR BIOLOGICAL APPLICATIONS 2016; 67:766-778. [PMID: 27287176 DOI: 10.1016/j.msec.2016.05.068] [Citation(s) in RCA: 118] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/10/2015] [Revised: 04/07/2016] [Accepted: 05/16/2016] [Indexed: 12/20/2022]
Abstract
Biomaterials based on seeding of cells on decellularized scaffolds have gained increasing interest in the last few years and suggested to serve as an alternative approach to bioengineer artificial organs and tissues for transplantation. The reaction of the host toward the decellularized scaffold and transplanted cells depends on the biocompatibility of the construct. Before proceeding to the clinical application step of decellularized scaffolds, it is greatly important to apply a number of biocompatibility tests in vitro and in vivo. This review describes the different methodology involved in cytotoxicity, pathogenicity, immunogenicity and biodegradability testing for evaluating the biocompatibility of various decellularized matrices obtained from human or animals.
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Affiliation(s)
- Kamal Hany Hussein
- Stem Cell Institute, Kangwon National University, Chuncheon, Gangwon 200-701, Korea; Research Institute for Veterinary Science, College of Veterinary Medicine, Seoul National University, Seoul 151-742, South Korea; Adult Stem Cell Research Center, College of Veterinary Medicine, Seoul National University, Seoul 08826, South Korea
| | - Kyung-Mee Park
- Stem Cell Institute, Kangwon National University, Chuncheon, Gangwon 200-701, Korea; Research Institute for Veterinary Science, College of Veterinary Medicine, Seoul National University, Seoul 151-742, South Korea; Adult Stem Cell Research Center, College of Veterinary Medicine, Seoul National University, Seoul 08826, South Korea
| | - Kyung-Sun Kang
- Adult Stem Cell Research Center, College of Veterinary Medicine, Seoul National University, Seoul 08826, South Korea; Institue of Veterinary Medicine, College of Veterinary Medicine, Kangwon National University, Chuncheon, Gangwon 200-701, South Korea
| | - Heung-Myong Woo
- Stem Cell Institute, Kangwon National University, Chuncheon, Gangwon 200-701, Korea; Institue of Veterinary Medicine, College of Veterinary Medicine, Kangwon National University, Chuncheon, Gangwon 200-701, South Korea; Harvard Stem Cell Institute, Renal Division, Brigham and Women's Hospital, Harvard Medical School, MA 02115, USA.
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Decellularized GGTA1-KO pig heart valves do not bind preformed human xenoantibodies. Basic Res Cardiol 2016; 111:39. [DOI: 10.1007/s00395-016-0560-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2016] [Accepted: 05/03/2016] [Indexed: 10/21/2022]
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33
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Akhyari P. Kardiovaskuläres Tissue-Engineering. ZEITSCHRIFT FUR HERZ THORAX UND GEFASSCHIRURGIE 2016. [DOI: 10.1007/s00398-015-0035-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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34
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Namiri M, Ashtiani MK, Mashinchian O, Hasani-Sadrabadi MM, Mahmoudi M, Aghdami N, Baharvand H. Engineering natural heart valves: possibilities and challenges. J Tissue Eng Regen Med 2016; 11:1675-1683. [PMID: 26799729 DOI: 10.1002/term.2127] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2015] [Revised: 11/07/2015] [Accepted: 11/30/2015] [Indexed: 12/23/2022]
Abstract
Heart valve replacement is considered to be the most prevalent treatment approach for cardiac valve-related diseases. Among current solutions for heart valve replacement, e.g. mechanical and bioprosthetic valves, the main shortcoming is the lack of growth capability, repair and remodelling of the substitute valve. During the past three decades, tissue engineering-based approaches have shown tremendous potential to overcome these limitations by the development of a biodegradable scaffold, which provides biomechanical and biochemical properties of the native tissue. Among various scaffolds employed for tissue engineering, the decellularized heart valve (DHV) has attracted much attention, due to its native structure as well as comparable haemodynamic characteristics. Although the human DHV has shown optimal properties for valve replacement, the limitation of valve donors in terms of time and size is their main clinical issue. In this regard, xenogenic DHV can be a promising candidate for heart valve replacement. Xenogenic DHVs have similar composition to human valves, which will overcome the need for human DHVs. The main concern regarding xenogeneic DHV replacement is the immunological reaction and calcification following implantation, weak mechanical properties and insufficient recellularization capacity. In this review, we describe the essential steps required to address these impediments through novel engineering approaches. Copyright © 2016 John Wiley & Sons, Ltd.
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Affiliation(s)
- Mehrnaz Namiri
- Department of Stem Cells and Developmental Biology, Cell Science Research Centre, Royan Institute for Stem Cell Biology and Technology, ACECR, Tehran, Iran.,Department of Developmental Biology, University of Science and Culture, ACECR, Tehran, Iran
| | - Mohammad Kazemi Ashtiani
- Department of Stem Cells and Developmental Biology, Cell Science Research Centre, Royan Institute for Stem Cell Biology and Technology, ACECR, Tehran, Iran
| | - Omid Mashinchian
- Department of Stem Cells and Developmental Biology, Cell Science Research Centre, Royan Institute for Stem Cell Biology and Technology, ACECR, Tehran, Iran
| | - Mohammad Mahdi Hasani-Sadrabadi
- Department of Stem Cells and Developmental Biology, Cell Science Research Centre, Royan Institute for Stem Cell Biology and Technology, ACECR, Tehran, Iran.,Department of Bioengineering, Georgia Institute of Technology, Atlanta, GA, USA
| | - Morteza Mahmoudi
- Division of Cardiovascular Medicine, Department of Medicine, Stanford University School of Medicine, CA, USA.,Department of Nanotechnology and Nanotechnology Research Centre, Tehran University of Medical Sciences, Iran.,Cardiovascular Institute, Stanford University School of Medicine, CA, USA
| | - Nasser Aghdami
- Department of Stem Cells and Developmental Biology, Cell Science Research Centre, Royan Institute for Stem Cell Biology and Technology, ACECR, Tehran, Iran
| | - Hossein Baharvand
- Department of Stem Cells and Developmental Biology, Cell Science Research Centre, Royan Institute for Stem Cell Biology and Technology, ACECR, Tehran, Iran.,Department of Developmental Biology, University of Science and Culture, ACECR, Tehran, Iran
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Huai G, Qi P, Yang H, Wang Y. Characteristics of α-Gal epitope, anti-Gal antibody, α1,3 galactosyltransferase and its clinical exploitation (Review). Int J Mol Med 2015; 37:11-20. [PMID: 26531137 PMCID: PMC4687435 DOI: 10.3892/ijmm.2015.2397] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2015] [Accepted: 10/08/2015] [Indexed: 12/15/2022] Open
Abstract
The α-Gal epitope (Galα1,3Galα1,4GlcNAc-R) is ubiquitously presented in non-primate mammals, marsupials and New World Monkeys, but it is absent in humans, apes and Old World monkeys. However, the anti-Gal antibody (~1% of immunoglobulins) is naturally generated in human, and is found as the immunoglobulin G (IgG), IgM and IgA isotypes. Owing to the specific binding of the anti-Gal antibody with the α-Gal epitope, humans have a distinct anti-α-gal reactivity, which is responsible for hyperacute rejection of organs transplanted from α-gal donors. In addition, the α1,3 galactosyltransferases (α1,3GT) can catalyze the synthesis of the α-Gal epitope. Therefore, the α1,3GT gene, which encodes the α1,3GT, is developed profoundly. The distributions of the α-Gal epitope and anti-Gal antibody, and the activation of α1,3GT, reveal that the enzyme of α1,3GT in ancestral primates is ineffective. Comparison of the nucleotide sequence of the human α1,3-GT pseudogene to the corresponding different species sequence, and according to the evolutionary tree of different species, the results of evolutionary inactivation of the α1,3GT gene in ancestral primates attribute to the mutations under a stronger selective pressure. However, on the basis of the structure, the mechanism and the specificity of the α-Gal epitope and anti-Gal antibody, they can be applied to clinical exploitation. Knocking out the α1,3GT gene will eliminate the xenoantigen, Gal(α1,3)Gal, so that the transplantation of α1,3GT gene knockout pig organ into human becomes a potential clinically acceptable treatment for solving the problem of organ shortage. By contrast, the α-Gal epitope expressed through the application of chemical, biochemical and genetic engineering can be exploited for the clinical use. Targeting anti-Gal-mediated autologous tumor vaccines, which express α-Gal epitope to antigen-presenting cells, would increase their immunogenicity and elicit an immune response, which will be potent enough to eradicate the residual tumor cells. For tumor vaccines, the way of increasing immunogenicity of certain viral vaccines, including flu vaccines and human immunodeficiency virus vaccines, can also be used in the elderly. Recently, α-Gal epitope nanoparticles have been applied to accelerate wound healing and further directions on regeneration of internally injured tissues.
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Affiliation(s)
- Guoli Huai
- Department of Biomedical Engineering, Medical School of University of Electronic Science and Technology of China, Chengdu, Sichuan 610054, P.R. China
| | - Ping Qi
- Department of Pediatrics, Sichuan Academy of Medical Science and Sichuan Provincial People's Hospital, Chengdu, Sichuan 610072, P.R. China
| | - Hongji Yang
- Department of Biomedical Engineering, Medical School of University of Electronic Science and Technology of China, Chengdu, Sichuan 610054, P.R. China
| | - Yi Wang
- Department of Pharmacy, Sichuan Academy of Medical Science and Sichuan Provincial People's Hospital, Chengdu, Sichuan 610072, P.R. China
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Guided tissue regeneration in heart valve replacement: from preclinical research to first-in-human trials. BIOMED RESEARCH INTERNATIONAL 2015; 2015:432901. [PMID: 26495295 PMCID: PMC4606187 DOI: 10.1155/2015/432901] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/20/2015] [Accepted: 05/21/2015] [Indexed: 11/18/2022]
Abstract
Heart valve tissue-guided regeneration aims to offer a functional and viable alternative to current prosthetic replacements. Not requiring previous cell seeding and conditioning in bioreactors, such exceptional tissue engineering approach is a very fascinating translational regenerative strategy. After in vivo implantation, decellularized heart valve scaffolds drive their same repopulation by recipient's cells for a prospective autologous-like tissue reconstruction, remodeling, and adaptation to the somatic growth of the patient. With such a viability, tissue-guided regenerated conduits can be delivered as off-the-shelf biodevices and possess all the potentialities for a long-lasting resolution of the dramatic inconvenience of heart valve diseases, both in children and in the elderly. A review on preclinical and clinical investigations of this therapeutic concept is provided with evaluation of the issues still to be well deliberated for an effective and safe in-human application.
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The Immune Response to Crosslinked Tissue is Reduced in Decellularized Xenogeneic and Absent in Decellularized Allogeneic Heart Valves. Int J Artif Organs 2015; 38:199-209. [DOI: 10.5301/ijao.5000395] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/18/2015] [Indexed: 11/20/2022]
Abstract
Background The degeneration and failure of xenogeneic heart valves, such as the Matrix P Plus valve (MP-V) consisting of decellularized porcine valves (dec-pV) and equine glutaraldehyde-fixed conduits (ga-eC) have been linked to tissue immunogenicity accompanied by antibody formation. In contrast, decellularized allograft valves (dec-aV) are well-tolerated. Here, we determined tissue-specific antibody levels in patients after implantation of MP-V or dec-aV and related them to valve failure or time period after implantation. Methods and Results Specific antibodies toward whole tissue-homogenates or alphaGal were determined retrospectively by ELISA analyses from patients who received MP-V with an uneventful course of 56.1 ± 5.1 months (n = 15), or with valve failure after 25.3 ± 14.6 months (n = 3), dec-aV for various times from 4 to 46 months (n = 14, uneventful) and from healthy controls (n = 4). All explanted valves were assessed histopathologically. MP-V induced antibodies toward both tissue components with significantly higher levels toward ga-eC than toward dec-pV (68.7 and 26.65 μg/ml IgG). In patients with valve failure, levels were not significantly higher and were related to inflammatory tissue infiltration. Anti-Gal antibodies in MP-V patients were significantly increased in both, the uneventful and the failure group. In contrast, in dec-aV patients only a slight tissue-specific antibody formation was observed after 4 months (6.24 μg/ml) that normalized to control levels after 1 year. Conclusions The strong humoral immune response to glutaraldehyde-fixed tissues is reduced in decellularized xenogeneic valves and almost absent in decellularized allogeneic tissue up to 4.5 years after implantation.
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González-Andrades M, Carriel V, Rivera-Izquierdo M, Garzón I, González-Andrades E, Medialdea S, Alaminos M, Campos A. Effects of Detergent-Based Protocols on Decellularization of Corneas With Sclerocorneal Limbus. Evaluation of Regional Differences. Transl Vis Sci Technol 2015; 4:13. [PMID: 25909036 DOI: 10.1167/tvst.4.2.13] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2014] [Accepted: 01/21/2015] [Indexed: 11/24/2022] Open
Abstract
PURPOSE In this work, we decellularized whole porcine corneas including the sclerocorneal limbus (SCL) and we evaluated regional differences in order to identify an efficient method to decellularize whole corneas for future clinical use. METHODS We analyzed the efficiency of four decellularization protocols based on benzalkonium chloride (BAK), Igepal, sodium dodecyl sulfate (SDS), and Triton X-100 detergents on whole porcine corneas. RESULTS Results showed that the decellularization efficiency of most protocols was low, with the specific protocol resulting in more efficient levels of decellularization being 0.1% SDS for 48 hours, especially in the medium and posterior cornea regions. A significant correlation was found between the decellularization efficiency and the concentration of agent used (P = 0.0174; r = 0.1540), but not for the incubation time (P > 0.05). The analysis of cornea components preservation demonstrated that all protocols were able to preserve the integrity of the Bowman's layer and Descemet's membrane. Although the collagen structure was partially altered, the global decellularization groups showing highest preservation of the ECM collagen contents and orientation were Igepal and SDS, with differences among the three regions of the cornea. All global groups showed high levels of proteoglycan and glycoprotein preservation after decellularization, with the best results were found in the SDS group followed by the Igepal group. CONCLUSIONS These results suggest that very powerful protocols are necessary for whole-cornea decellularization. For the generation of lamelar corneas for clinical use, decellularization regional differences should be taken into account. TRANSLATIONAL RELEVANCE Decellularized whole corneas may be potential therapeutic agents for lamelar keratoplasty.
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Affiliation(s)
- Miguel González-Andrades
- Tissue Engineering Group, Department of Histology, University of Granada, Spain and Instituto de Investigación Biosanitaria ibs.GRANADA, Spain ; Division of Ophthalmology, University Hospital San Cecilio, Granada, Spain
| | - Victor Carriel
- Tissue Engineering Group, Department of Histology, University of Granada, Spain and Instituto de Investigación Biosanitaria ibs.GRANADA, Spain
| | - Mario Rivera-Izquierdo
- Tissue Engineering Group, Department of Histology, University of Granada, Spain and Instituto de Investigación Biosanitaria ibs.GRANADA, Spain
| | - Ingrid Garzón
- Tissue Engineering Group, Department of Histology, University of Granada, Spain and Instituto de Investigación Biosanitaria ibs.GRANADA, Spain
| | - Elena González-Andrades
- Tissue Engineering Group, Department of Histology, University of Granada, Spain and Instituto de Investigación Biosanitaria ibs.GRANADA, Spain
| | - Santiago Medialdea
- Division of Ophthalmology, University Hospital Virgen de las Nieves, Granada, Spain
| | - Miguel Alaminos
- Tissue Engineering Group, Department of Histology, University of Granada, Spain and Instituto de Investigación Biosanitaria ibs.GRANADA, Spain
| | - Antonio Campos
- Tissue Engineering Group, Department of Histology, University of Granada, Spain and Instituto de Investigación Biosanitaria ibs.GRANADA, Spain
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Galili U. Avoiding Detrimental Human Immune Response Against Mammalian Extracellular Matrix Implants. TISSUE ENGINEERING PART B-REVIEWS 2015; 21:231-41. [DOI: 10.1089/ten.teb.2014.0392] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- Uri Galili
- Department of Surgery, University of Massachusetts Medical School, Worcester, Massachusetts
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Sutherland AJ, Detamore MS. Bioactive Microsphere-Based Scaffolds Containing Decellularized Cartilage. Macromol Biosci 2015; 15:979-89. [PMID: 25821206 DOI: 10.1002/mabi.201400472] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2014] [Revised: 02/03/2015] [Indexed: 12/15/2022]
Abstract
The aim of this study was to fabricate mechanically functional microsphere-based scaffolds containing decellularized cartilage (DCC), with the hypothesis that this approach would induce chondrogenesis of rat bone marrow-derived mesenchymal stem cells (rBMSCs) in vitro. The DCC was derived from porcine articular cartilage and decellularized using a combination of physical and chemical methods. Four types of scaffolds were fabricated: poly(d,l-lactic-co-glycolic acid) (PLGA) only (negative control), TGF-β-encapsulated (positive control), PLGA surface coated with DCC, and DCC-encapsulated. These scaffolds were seeded with rBMSCs and cultured up to 6 weeks. The compressive modulus of the DCC-coated scaffolds prior to cell seeding was significantly lower than all other scaffold types. Gene expression was comparable between DCC-encapsulated and TGF-β-encapsulated groups. Notably, DCC-encapsulated scaffolds contained 70% higher glycosaminoglyan (GAG) content and 85% more hydroxyproline compared to the TGF-β group at week 3 (with baseline levels subtracted out from acellular DCC scaffolds). Certainly, bioactivity was demonstrated in eliciting a biosynthetic response from the cells with DCC, although true demonstration of chondrogenesis remained elusive under the prescribed conditions. Encapsulation of DCC appeared to lead to improved cell performance relative to coating with DCC, although this finding may be a dose-dependent observation. Overall, DCC introduced via microsphere-based scaffolds appears to be promising as a bioactive approach to cartilage regeneration, although additional studies will be required to conclusively demonstrate chondroinductivity.
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Affiliation(s)
- Amanda J Sutherland
- Bioengineering Graduate Program, University of Kansas, Lawrence, 66045, Kansas, USA
| | - Michael S Detamore
- Bioengineering Graduate Program, University of Kansas, Lawrence, 66045, Kansas, USA. .,Department of Chemical and Petroleum Engineering, University of Kansas, 4149 Learned Hall, 1530 W 15th St., Lawrence, 66045, Kansas, USA.
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Iablonskii P, Cebotari S, Tudorache I, Granados M, Morticelli L, Goecke T, Klein N, Korossis S, Hilfiker A, Haverich A. Tissue-engineered mitral valve: morphology and biomechanics †. Interact Cardiovasc Thorac Surg 2015; 20:712-9; discussion 719. [PMID: 25762708 DOI: 10.1093/icvts/ivv039] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2014] [Accepted: 02/04/2015] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES The present study aimed at developing tissue-engineered mitral valves based on cell-free ovine mitral allografts. METHODS The ovine mitral valves (OMVs) (n = 46) were harvested in the local slaughter house. They were decellularized using detergent solutions and DNase. The effectiveness of decellularization was assessed by histological (haematoxylin-eosin, Movat's pentachrome) and immunofluorescent staining (for DNA and α-Gal), and DNA-quantification. To reveal the receptiveness of decellularized tissue to endothelial cells (ECs), the valve leaflets were reseeded with ovine ECs, derived from endothelial progenitor cells in vitro. For assessment of biomechanical properties, uniaxial tensile tests were carried out. RESULTS Histology and immunofluorescent staining revealed absence of cell nuclei in decellularized leaflets, chordae and papillary muscles. According to the software for immunofluorescence analysis, reduction in DNA and α-Gal was 99.9 and 99.6%, respectively. DNA-quantification showed 71.2% reduction in DNA content without DNase and 96.4% reduction after DNase treatment. Decellularized leaflets were comparable with native in ultimate tensile strain (native, 0.34 ± 0.09 mm/mm, vs decellularized, 0.44 ± 0.1 mm/mm; P = 0.09), and elastin modulus (native, 0.39 ± 0.27, vs decellularized, 0.57 ± 0.55, P = 0.46), had increased ultimate tensile stress (native, 1.23 ± 0.35 MPa, vs decellularized 2.12 ± 0.43 MPa; P = 0.001) and collagen modulus (native, 5.5 ± 1.26, vs decellularized, 8.29 ± 2.9; P = 0.04). After EC seeding, immunofluorescent staining revealed a monolayer of CD31-, eNOS- and vWF-positive cells on the surface of the leaflet, as well as a typical cobble-stone morphology of those cells. CONCLUSIONS Decellularization of ovine mitral valve results in a mitral valves scaffold with mechanical properties comparable with native tissue, and a graft surface, which can be repopulated by endothelial cells.
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Affiliation(s)
- Pavel Iablonskii
- Department of Cardiothoracic, Transplantation and Vascular Surgery (HTTG) Hannover Medical School, Hannover, Germany
| | - Serghei Cebotari
- Department of Cardiothoracic, Transplantation and Vascular Surgery (HTTG) Hannover Medical School, Hannover, Germany
| | - Igor Tudorache
- Department of Cardiothoracic, Transplantation and Vascular Surgery (HTTG) Hannover Medical School, Hannover, Germany
| | - Marisa Granados
- Department of Cardiothoracic, Transplantation and Vascular Surgery (HTTG) Hannover Medical School, Hannover, Germany
| | - Lucrezia Morticelli
- Department of Cardiothoracic, Transplantation and Vascular Surgery (HTTG) Hannover Medical School, Hannover, Germany
| | - Tobias Goecke
- Department of Cardiothoracic, Transplantation and Vascular Surgery (HTTG) Hannover Medical School, Hannover, Germany
| | - Norman Klein
- Department of Cardiothoracic, Transplantation and Vascular Surgery (HTTG) Hannover Medical School, Hannover, Germany
| | - Sotirios Korossis
- Department of Cardiothoracic, Transplantation and Vascular Surgery (HTTG) Hannover Medical School, Hannover, Germany
| | - Andres Hilfiker
- Department of Cardiothoracic, Transplantation and Vascular Surgery (HTTG) Hannover Medical School, Hannover, Germany
| | - Axel Haverich
- Department of Cardiothoracic, Transplantation and Vascular Surgery (HTTG) Hannover Medical School, Hannover, Germany
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Sutherland AJ, Converse GL, Hopkins RA, Detamore MS. The bioactivity of cartilage extracellular matrix in articular cartilage regeneration. Adv Healthc Mater 2015; 4:29-39. [PMID: 25044502 DOI: 10.1002/adhm.201400165] [Citation(s) in RCA: 117] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2014] [Revised: 05/28/2014] [Indexed: 01/08/2023]
Abstract
Cartilage matrix is a promising material for cartilage regeneration given the evidence supporting its chondroinductive character. The "raw materials" of cartilage matrix can serve as building blocks and signals for tissue regeneration. These matrices can be created by chemical or physical processing: physical methods disrupt cellular membranes and nuclei but may not fully remove all cell components and DNA, whereas chemical methods combined with physical methods are effective in fully decellularizing such materials. It is important to delineate between the sources of the cartilage matrix, that is, derived from matrix in vitro or from native tissue, and then to further characterize the cartilage matrix based on the processing method, decellularization or devitalization. With these distinctions, four types of cartilage matrices exist: decellularized native cartilage (DCC), devitalized native cartilage (DVC), decellularized cell-derived matrix (DCCM), and devitalized cell-derived matrix (DVCM). One currently marketed cartilage matrix device is decellularized, although trends in patents suggest additional decellularized products may be available in the future. To identify the most relevant source and processing for cartilage matrix, testing needs to include targeting the desired application, optimizing delivery of the material, identify relevant FDA regulations, assess availability of materials, and immunogenic properties of the product.
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Affiliation(s)
| | - Gabriel L. Converse
- Children's Mercy Hospital; Cardiac Surgery Research Lab; Ward Family Center for Congenital Heart Disease; 2401 Gillham Rd Kansas City MO 64108 USA
| | - Richard A. Hopkins
- Children's Mercy Hospital; Cardiac Surgery Research Lab; Ward Family Center for Congenital Heart Disease; 2401 Gillham Rd Kansas City MO 64108 USA
| | - Michael S. Detamore
- Bioengineering Graduate Program; University of Kansas; Lawrence KS 66045 USA
- Department of Chemical and Petroleum Engineering; University of Kansas; Lawrence KS 66045 USA
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Paniagua Gutierrez JR, Berry H, Korossis S, Mirsadraee S, Lopes SV, da Costa F, Kearney J, Watterson K, Fisher J, Ingham E. Regenerative potential of low-concentration SDS-decellularized porcine aortic valved conduits in vivo. Tissue Eng Part A 2014; 21:332-42. [PMID: 25156153 DOI: 10.1089/ten.tea.2014.0003] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
The aims of this study were to determine the functional biocompatibility of low-concentration SDS-decellularized porcine aortic roots in vivo. A previously developed process was modified for 9- and 15-mm-diameter aortic roots to facilitate implantation into the porcine abdominal aorta (n=3) and juvenile sheep right ventricular outflow tract (n=7), respectively. Native allogeneic aortic roots were used as controls. Acellular porcine roots explanted from pigs at weeks were largely repopulated with stromal cells of appropriate phenotype, and there was evidence that macrophages were involved in the regenerative process. Native allogeneic roots were subject to a classic allograft rejection response. Acellular porcine roots explanted from sheep at 6 months showed evidence of appropriate cellular repopulation, again with evidence of a role for macrophages in the regenerative process. There was some degree of calcification of two of the explanted acellular roots, likely due to incomplete removal of DNA before implantation. Native allogeneic ovine roots were subject to a classic allograft rejection response involving T cells, which resulted in overtly calcified and damaged tissues. The study highlighted (1) the importance of removal of DNA from acellular porcine valved roots to avoid calcification and (2) a role for macrophages in the regeneration of low-concentration SDS-decellularized aortic roots, as has been reported for other acellular biological extracellular matrix scaffolds.
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Mozzicato SM, Tripathi A, Posthumus JB, Platts-Mills TAE, Commins SP. Porcine or bovine valve replacement in 3 patients with IgE antibodies to the mammalian oligosaccharide galactose-alpha-1,3-galactose. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2014; 2:637-638. [PMID: 25213067 DOI: 10.1016/j.jaip.2014.04.016] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Subscribe] [Scholar Register] [Received: 11/01/2013] [Revised: 04/11/2014] [Accepted: 04/25/2014] [Indexed: 01/25/2023]
Affiliation(s)
| | - Anubha Tripathi
- Division of Asthma, Allergy and Immunology, Asthma and Allergic Diseases Center, University of Virginia Health System, Charlottesville, VA
| | | | - Thomas A E Platts-Mills
- Division of Asthma, Allergy and Immunology, Asthma and Allergic Diseases Center, University of Virginia Health System, Charlottesville, VA
| | - Scott P Commins
- Division of Asthma, Allergy and Immunology, Asthma and Allergic Diseases Center, University of Virginia Health System, Charlottesville, VA
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45
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Simpson DL, Wehman B, Galat Y, Sharma S, Mishra R, Galat V, Kaushal S. Engineering patient-specific valves using stem cells generated from skin biopsy specimens. Ann Thorac Surg 2014; 98:947-54. [PMID: 25038011 DOI: 10.1016/j.athoracsur.2014.04.075] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2013] [Revised: 04/12/2014] [Accepted: 04/14/2014] [Indexed: 11/17/2022]
Abstract
BACKGROUND Pediatric patients requiring valve replacement will likely require reoperations due to a progressive deterioration of valve durability and limited repair and growth potential. To address these concerns, we sought to generate a biologically active pulmonary valve using patient-specific valvular cells and decellularized human pulmonary valves. METHODS We generated induced pluripotent stem cells (iPSCs) by reprogramming skin fibroblast cells. We then differentiated iPSCs to mesenchymal stem cells (iPCSs-MSCs) using culture conditions that favored an epithelial-to-mesenchymal transition. Next, decellularized human pulmonary heart valves were seeded with iPCS-MSCs using a combination of static and dynamic culture conditions and cultured up to 30 days. RESULTS The iPSCs-MSCs displayed cluster of differentiation CD105 and CD90 expression exceeding 90% after four passages and could differentiate into osteocytes, chondrocytes, and adipocytes (n = 4). Consistent with an MSC phenotype, iPSCs-MSCs lacked expression of CD45 and CD34. Compared with bone marrow MSCs, iPSCs-MSC proliferated more readily by twofold but maintained a gene expression profile exceeding 80% identical to bone marrow MSCs. In repopulated pulmonary valves compared with decellularized pulmonary valves, immunohistochemistry demonstrated increased cellularity, α-smooth muscle actin expression, and increased presence of extracellular matrix components, such as proteoglycans and glycosaminoglycans, suggesting sustained cell function and maturation. CONCLUSIONS Our results demonstrate the feasibility of constructing a biologically active human pulmonary valve using a sustainable and proliferative cell source. The bioactive pulmonary valve is expected to have advantages over existing valvular replacements, which will require further validation.
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Affiliation(s)
- David L Simpson
- Division of Cardiac Surgery, University of Maryland Medical School, Baltimore, Maryland
| | - Brody Wehman
- Division of Cardiac Surgery, University of Maryland Medical School, Baltimore, Maryland
| | - Yekaterina Galat
- Developmental Biology Program, iPS and Human Stem Cell Core Facility, Children's Memorial Research Center, Northwestern University, Feinberg School of Medicine, Chicago, Illinois
| | - Sudhish Sharma
- Division of Cardiac Surgery, University of Maryland Medical School, Baltimore, Maryland
| | - Rachana Mishra
- Division of Cardiac Surgery, University of Maryland Medical School, Baltimore, Maryland
| | - Vasiliy Galat
- Developmental Biology Program, iPS and Human Stem Cell Core Facility, Children's Memorial Research Center, Northwestern University, Feinberg School of Medicine, Chicago, Illinois
| | - Sunjay Kaushal
- Division of Cardiac Surgery, University of Maryland Medical School, Baltimore, Maryland.
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Barone A, Benktander J, Teneberg S, Breimer ME. Characterization of acid and non-acid glycosphingolipids of porcine heart valve cusps as potential immune targets in biological heart valve grafts. Xenotransplantation 2014; 21:510-22. [PMID: 25041314 DOI: 10.1111/xen.12123] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2014] [Accepted: 05/28/2014] [Indexed: 02/03/2023]
Abstract
BACKGROUND Although xenotransplantation of vascularized organs/cells has not yet reached the clinic, glutaraldehyde-treated bioprosthetic heart valves (BHV), derived from porcine or bovine tissues, are today used for clinical replacement of diseased heart valves. However, the durability of these valve cusps is limited partly due to the onset of immune responses to the grafts. The xenoantigen-determinant Galα3Gal- and corresponding anti-Gal antibodies have been postulated to in part contribute to BHV damage. However, the presence of other non-Gal carbohydrate antigen determinants as well as the immune response to these non-Gal antigens and the inflammatory response generated by their interaction with the immune system has not been studied. In this study, we have isolated and structurally characterized both non-acid and acid glycosphingolipids from naïve porcine aortic and pulmonary valve cusps. METHODS Total non-acid and acid glycosphingolipids were isolated from porcine aortic and pulmonalis valve cusps of 20 animals. Glycosphingolipid components were structurally characterized by thin-layer chromatography, liquid chromatography-mass spectrometry and binding of monoclonal antibodies and lectins. RESULTS The non-acid glycosphingolipids were characterized as globotetraosylceramide, H-type 2 pentaosylceramide, fucosyl-gangliotetraosylceramide, and Galα3neolactotetraosylceramide. The acid glycosphingolipid fractions had both sulfatide and gangliosides (GM3, GM2, GM1, fucosyl-GM1, GD3 and GD1a), and all gangliosides contained N-acetyl-neuraminic acid. Significantly, the N-glycolyl-neuraminic acid (NeuGc) variant, a major component in many pig organs and to which humans can develop antibodies, was not detected among the gangliosides. CONCLUSIONS Pig valve cusps contain several complex lipid-bound carbohydrate structures that may be targets for the human immune system. Notable, the NeuGc determinant was absent in the cusp gangliosides. This work forms a platform for further characterizing the antibody reactivity of patients with porcine-derived BHV.
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Affiliation(s)
- Angela Barone
- Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
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Wong ML, Griffiths LG. Immunogenicity in xenogeneic scaffold generation: antigen removal vs. decellularization. Acta Biomater 2014; 10:1806-16. [PMID: 24486910 DOI: 10.1016/j.actbio.2014.01.028] [Citation(s) in RCA: 167] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2013] [Revised: 12/15/2013] [Accepted: 01/23/2014] [Indexed: 12/11/2022]
Abstract
Decades of research have been undertaken towards the goal of tissue engineering using xenogeneic scaffolds. The primary advantages associated with use of xenogeneic tissue-derived scaffolds for in vitro development of replacement tissues and organs stem from the inherent extracellular matrix (ECM) composition and architecture. Native ECM possesses appropriate mechanical properties for physiological function of the biomaterial and signals for cell binding, growth and differentiation. Additionally, xenogeneic tissue is readily available. However, translation of xenogeneic scaffold-derived engineered tissues or organs into clinical therapies requires xenoantigenicity of the material to be adequately addressed prior to implantation. Failure to achieve this goal will result in a graft-specific host immune rejection response, jeopardizing in vivo survival of the resultant scaffold, tissue or organ. This review explores (i) the appropriateness of scaffold acellularity as an outcome measure for assessing reduction of the immunological barriers to the use of xenogeneic scaffolds for tissue engineering applications and (ii) the need for tissue engineers to strive for antigen removal during xenogeneic scaffold generation.
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Affiliation(s)
- Maelene L Wong
- Department of Veterinary Medicine: Medicine and Epidemiology, University of California, Davis, One Shields Ave., Davis, CA 95616, USA; Department of Biomedical Engineering, University of California, Davis, One Shields Ave., Davis, CA 95616, USA
| | - Leigh G Griffiths
- Department of Veterinary Medicine: Medicine and Epidemiology, University of California, Davis, One Shields Ave., Davis, CA 95616, USA.
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Regenerative implants for cardiovascular tissue engineering. Transl Res 2014; 163:321-41. [PMID: 24589506 DOI: 10.1016/j.trsl.2014.01.014] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2013] [Revised: 01/27/2014] [Accepted: 01/27/2014] [Indexed: 01/22/2023]
Abstract
A fundamental problem that affects the field of cardiovascular surgery is the paucity of autologous tissue available for surgical reconstructive procedures. Although the best results are obtained when an individual's own tissues are used for surgical repair, this is often not possible as a result of pathology of autologous tissues or lack of a compatible replacement source from the body. The use of prosthetics is a popular solution to overcome shortage of autologous tissue, but implantation of these devices comes with an array of additional problems and complications related to biocompatibility. Transplantation offers another option that is widely used but complicated by problems related to rejection and donor organ scarcity. The field of tissue engineering represents a promising new option for replacement surgical procedures. Throughout the years, intensive interdisciplinary, translational research into cardiovascular regenerative implants has been undertaken in an effort to improve surgical outcome and better quality of life for patients with cardiovascular defects. Vascular, valvular, and heart tissue repair are the focus of these efforts. Implants for these neotissues can be divided into 2 groups: biologic and synthetic. These materials are used to facilitate the delivery of cells or drugs to diseased, damaged, or absent tissue. Furthermore, they can function as a tissue-forming device used to enhance the body's own repair mechanisms. Various preclinical studies and clinical trials using these advances have shown that tissue-engineered materials are a viable option for surgical repair, but require refinement if they are going to reach their clinical potential. With the growth and accomplishments this field has already achieved, meeting those goals in the future should be attainable.
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Manji RA, Ekser B, Menkis AH, Cooper DKC. Bioprosthetic heart valves of the future. Xenotransplantation 2014; 21:1-10. [PMID: 24444036 DOI: 10.1111/xen.12080] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2013] [Accepted: 11/25/2013] [Indexed: 01/31/2023]
Abstract
Glutaraldehyde-fixed bioprosthetic heart valves (GBHVs), derived from pigs or cows, undergo structural valve deterioration (SVD) over time, with calcification and eventual failure. It is generally accepted that SVD is due to chemical processes between glutaraldehyde and free calcium ions in the blood. Valve companies have made significant progress in decreasing SVD from calcification through various valve chemical treatments. However, there are still groups of patients (e.g., children and young adults) that have accelerated SVD of GBHV. Unfortunately, these patients are not ideal patients for valve replacement with mechanical heart valve prostheses as they are at high long-term risk from complications of the mandatory anticoagulation that is required. Thus, there is no "ideal" heart valve replacement for children and young adults. GBHVs represent a form of xenotransplantation, and there is increasing evidence that SVD seen in these valves is at least in part associated with xenograft rejection. We review the evidence that suggests that xenograft rejection of GBHVs is occurring, and that calcification of the valve may be related to this rejection. Furthermore, we review recent research into the transplantation of live porcine organs in non-human primates that may be applicable to GBHVs and consider the potential use of genetically modified pigs as sources of bioprosthetic heart valves.
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Affiliation(s)
- Rizwan A Manji
- Department of Surgery, University of Manitoba, Winnipeg, MB, Canada; Cardiac Sciences Program, Winnipeg Regional Health Authority and St. Boniface Hospital, Winnipeg, MB, Canada
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