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Uiterwijk M, Coolen B, Rijswijk van JW, Söntjens S, van Houtem M, Szymczyk W, Rijns L, Janssen H, Wal van der A, Mol de B, Bouten C, Strijkers G, Dankers P, Kluin J. BALANCING SCAFFOLD DEGRADATION AND NEO-TISSUE FORMATION IN IN-SITU TISSUE ENGINEERED VASCULAR GRAFTS. Tissue Eng Part A 2024. [PMID: 38420632 DOI: 10.1089/ten.tea.2023.0019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2024] Open
Abstract
An essential aspect of cardiovascular in situ tissue engineering (TE) is to ensure balance between scaffold degradation and neo-tissue formation. We evaluated the degradation velocity and neo-tissue formation of three electrospun supramolecular bisurea-based biodegradable scaffolds that differ in their soft-block backbone compositions only. Scaffolds were implanted as interposition grafts in the abdominal aorta in rats, and evaluated at different time points (t = 1, 6, 12, 24 and 40 weeks) on function, tissue formation, strength and scaffold degradation. The fully carbonate-based biomaterial showed minor degradation after 40 weeks in vivo, while the other two ester-containing biomaterials showed (near) complete degradation within 6 to 12 weeks. Local dilatation was only observed in these faster degrading scaffolds. All materials showed to some extent calcifications, at early as well as late time points. Histological evaluation showed equal and non-native like neo-tissue formation after total degradation. The fully carbonate based scaffolds lagged in neo-tissue formation, presumably as its degradation was (far from) complete at 40 weeks. A significant difference in vessel wall contrast enhancement was observed by MRI between grafts with total compared to minimal degraded scaffolds.
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Affiliation(s)
- Marcelle Uiterwijk
- Amsterdam UMC Location AMC, 26066, Cardiothoracic surgery, Meibergdreef 9, Amsterdam, Netherlands, 1105 AZ;
| | - Bram Coolen
- Amsterdam UMC Locatie AMC, 26066, Department of Biomedical Engineering & Physics, Amsterdam, Netherlands;
| | | | - Serge Söntjens
- Eindhoven University of Technology, 3169, Symochem b.v., Eindhoven, Netherlands;
| | - Michel van Houtem
- Eindhoven University of Technology, 3169, Symochem b.v. , Eindhoven, Netherlands;
| | - Wojciech Szymczyk
- Eindhoven University of Technology, 3169, Department of Biomedical Engineering, Eindhoven, Netherlands;
| | - Laura Rijns
- Eindhoven University of Technology, 3169, Biomedical Engineering, Eindhoven, Netherlands
- Eindhoven University of Technology, 3169, Institute for Complex Molecular Systems, Eindhoven, Netherlands;
| | - Henk Janssen
- Eindhoven University of Technology, 3169, Symochem b.v. , Eindhoven, Noord-Brabant, Netherlands;
| | | | - Bas Mol de
- Amsterdam UMC Location AMC, 26066, Cardiothoracic surgery, Amsterdam, Netherlands;
| | - Carlijn Bouten
- Eindhoven University of Technology, 3169, Biomedical Engineering, Eindhoven, Netherlands
- Eindhoven University of Technology, 3169, Institute for Complex Molecular Systems, Eindhoven, Netherlands;
| | - Gustav Strijkers
- Amsterdam UMC Locatie AMC, 26066, Biomedical Engineering and Physics, Amsterdam, Netherlands;
| | - Patricia Dankers
- Eindhoven University of Technology, 3169, Biomedical Engineering, Eindhoven, Netherlands
- Eindhoven University of Technology, 3169, Institute for Complex Molecular Systems, Eindhoven, Netherlands;
| | - Jolanda Kluin
- Erasmus Medical Center, 6993, Cardiothoracic surgery, Rotterdam, Netherlands;
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2
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Brown AL, Sexton ZA, Hu Z, Yang W, Marsden AL. Computational approaches for mechanobiology in cardiovascular development and diseases. Curr Top Dev Biol 2024; 156:19-50. [PMID: 38556423 DOI: 10.1016/bs.ctdb.2024.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/02/2024]
Abstract
The cardiovascular development in vertebrates evolves in response to genetic and mechanical cues. The dynamic interplay among mechanics, cell biology, and anatomy continually shapes the hydraulic networks, characterized by complex, non-linear changes in anatomical structure and blood flow dynamics. To better understand this interplay, a diverse set of molecular and computational tools has been used to comprehensively study cardiovascular mechanobiology. With the continual advancement of computational capacity and numerical techniques, cardiovascular simulation is increasingly vital in both basic science research for understanding developmental mechanisms and disease etiologies, as well as in clinical studies aimed at enhancing treatment outcomes. This review provides an overview of computational cardiovascular modeling. Beginning with the fundamental concepts of computational cardiovascular modeling, it navigates through the applications of computational modeling in investigating mechanobiology during cardiac development. Second, the article illustrates the utility of computational hemodynamic modeling in the context of treatment planning for congenital heart diseases. It then delves into the predictive potential of computational models for elucidating tissue growth and remodeling processes. In closing, we outline prevailing challenges and future prospects, underscoring the transformative impact of computational cardiovascular modeling in reshaping cardiovascular science and clinical practice.
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Affiliation(s)
- Aaron L Brown
- Department of Mechanical Engineering, Stanford University, Stanford, CA, United States
| | - Zachary A Sexton
- Department of Bioengineering, Stanford University, Stanford, CA, United States
| | - Zinan Hu
- Department of Mechanical Engineering, Stanford University, Stanford, CA, United States
| | - Weiguang Yang
- Department of Pediatrics, Stanford University, Stanford, CA, United States
| | - Alison L Marsden
- Department of Bioengineering, Stanford University, Stanford, CA, United States; Department of Pediatrics, Stanford University, Stanford, CA, United States.
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3
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Greaney AM, Ramachandra AB, Yuan Y, Korneva A, Humphrey JD, Niklason LE. Decellularization compromises mechanical and structural properties of the native trachea. BIOMATERIALS AND BIOSYSTEMS 2023; 9:100074. [PMID: 36967724 PMCID: PMC10036236 DOI: 10.1016/j.bbiosy.2023.100074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 01/01/2023] [Accepted: 01/27/2023] [Indexed: 02/05/2023] Open
Abstract
Tracheal replacement using tissue engineering technologies offers great potential to improve previously intractable clinical interventions, and interest in this area has increased in recent years. Many engineered airway constructs currently rely on decellularized native tracheas to serve as the scaffold for tissue repair. Yet, mechanical failure leading to airway narrowing and collapse remains a major cause of morbidity and mortality following clinical implantation of decellularized tracheal grafts. To understand better the factors contributing to mechanical failure in vivo, we characterized the histo-mechanical properties of tracheas following two different decellularization protocols, including one that has been used clinically. All decellularized tracheas deviated from native mechanical behavior, which may provide insights into observed in vivo graft failures. We further analyzed protein content by western blot and analyzed microstructure by histological staining and found that the specific method of decellularization resulted in significant differences in the depletion of proteoglycans and degradation of collagens I, II, III, and elastin. Taken together, this work demonstrates that the heterogeneous architecture and mechanical behavior of the trachea is severely compromised by decellularization. Such structural deterioration may contribute to graft failure clinically and limit the potential of decellularized native tracheas as viable long-term orthotopic airway replacements.
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Affiliation(s)
- Allison M. Greaney
- Department of Biomedical Engineering, Yale University, New Haven, CT 06511, USA
- Vascular Biology and Therapeutics Program, Yale School of Medicine, New Haven, CT 06511, USA
| | | | - Yifan Yuan
- Vascular Biology and Therapeutics Program, Yale School of Medicine, New Haven, CT 06511, USA
- Department of Anesthesiology, Yale School of Medicine, New Haven, CT 06510, USA
| | - Arina Korneva
- Department of Biomedical Engineering, Yale University, New Haven, CT 06511, USA
| | - Jay D. Humphrey
- Department of Biomedical Engineering, Yale University, New Haven, CT 06511, USA
- Vascular Biology and Therapeutics Program, Yale School of Medicine, New Haven, CT 06511, USA
| | - Laura E. Niklason
- Department of Biomedical Engineering, Yale University, New Haven, CT 06511, USA
- Vascular Biology and Therapeutics Program, Yale School of Medicine, New Haven, CT 06511, USA
- Department of Anesthesiology, Yale School of Medicine, New Haven, CT 06510, USA
- Humacyte Inc., Durham, NC 27713, USA
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4
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Breuer T, Jimenez M, Humphrey JD, Shinoka T, Breuer CK. Tissue Engineering of Vascular Grafts: A Case Report From Bench to Bedside and Back. Arterioscler Thromb Vasc Biol 2023; 43:399-409. [PMID: 36633008 PMCID: PMC9974789 DOI: 10.1161/atvbaha.122.318236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Accepted: 12/29/2022] [Indexed: 01/13/2023]
Abstract
For over 25 years, our group has used regenerative medicine strategies to develop improved biomaterials for use in congenital heart surgery. Among other applications, we developed a tissue-engineered vascular graft (TEVG) by seeding tubular biodegradable polymeric scaffolds with autologous bone marrow-derived mononuclear cells. Results of our first-in-human study demonstrated feasibility as the TEVG transformed into a living vascular graft having an ability to grow, making it the first engineered graft with growth potential. Yet, outcomes of this first Food and Drug Administration-approved clinical trial evaluating safety revealed a prohibitively high incidence of early TEVG stenosis, preventing the widespread use of this promising technology. Mechanistic studies in mouse models provided important insight into the development of stenosis and enabled advanced computational models. Computational simulations suggested both a novel inflammation-driven, mechano-mediated process of in vivo TEVG development and an unexpected natural history, including spontaneous reversal of the stenosis. Based on these in vivo and in silico discoveries, we have been able to rationally design strategies for inhibiting TEVG stenosis that have been validated in preclinical large animal studies and translated to the clinic via a new Food and Drug Administration-approved clinical trial. This progress would not have been possible without the multidisciplinary approach, ranging from small to large animal models and computational simulations. This same process is expected to lead to further advances in scaffold design, and thus next generation TEVGs.
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Affiliation(s)
- Thomas Breuer
- Nationwide Children's Hospital, Columbus, OH (T.B., M.J., T.S., C.K.B.)
| | - Michael Jimenez
- Nationwide Children's Hospital, Columbus, OH (T.B., M.J., T.S., C.K.B.)
| | - Jay D Humphrey
- Yale University, School of Engineering and Applied Science, New Haven, CT (J.D.H.)
| | - Toshiharu Shinoka
- Nationwide Children's Hospital, Columbus, OH (T.B., M.J., T.S., C.K.B.)
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5
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Loerakker S, Humphrey JD. Computer Model-Driven Design in Cardiovascular Regenerative Medicine. Ann Biomed Eng 2023; 51:45-57. [PMID: 35974236 PMCID: PMC9832109 DOI: 10.1007/s10439-022-03037-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Accepted: 07/20/2022] [Indexed: 01/28/2023]
Abstract
Continuing advances in genomics, molecular and cellular mechanobiology and immunobiology, including transcriptomics and proteomics, and biomechanics increasingly reveal the complexity underlying native tissue and organ structure and function. Identifying methods to repair, regenerate, or replace vital tissues and organs remains one of the greatest challenges of modern biomedical engineering, one that deserves our very best effort. Notwithstanding the continuing need for improving standard methods of investigation, including cell, organoid, and tissue culture, biomaterials development and fabrication, animal models, and clinical research, it is increasingly evident that modern computational methods should play increasingly greater roles in advancing the basic science, bioengineering, and clinical application of regenerative medicine. This brief review focuses on the development and application of computational models of tissue and organ mechanobiology and mechanics for purposes of designing tissue engineered constructs and understanding their development in vitro and in situ. Although the basic approaches are general, for illustrative purposes we describe two recent examples from cardiovascular medicine-tissue engineered heart valves (TEHVs) and tissue engineered vascular grafts (TEVGs)-to highlight current methods of approach as well as continuing needs.
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Affiliation(s)
- Sandra Loerakker
- Department of Biomedical Engineering and Institute for Complex Molecular Systems, Eindhoven University of Technology, Eindhoven, Netherlands
| | - Jay D Humphrey
- Department of Biomedical Engineering and Vascular Biology & Therapeutics Program, Yale University and Yale School of Medicine, New Haven, CT, USA.
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6
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Latorre M, Szafron JM, Ramachandra AB, Humphrey JD. In vivo development of tissue engineered vascular grafts: a fluid-solid-growth model. Biomech Model Mechanobiol 2022; 21:827-848. [PMID: 35179675 PMCID: PMC9133046 DOI: 10.1007/s10237-022-01562-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Accepted: 01/24/2022] [Indexed: 11/02/2022]
Abstract
Methods of tissue engineering continue to advance, and multiple clinical trials are underway evaluating tissue engineered vascular grafts (TEVGs). Whereas initial concerns focused on suture retention and burst pressure, there is now a pressing need to design grafts to have optimal performance, including an ability to grow and remodel in response to changing hemodynamic loads. Toward this end, there is similarly a need for computational methods that can describe and predict the evolution of TEVG geometry, composition, and material properties while accounting for changes in hemodynamics. Although the ultimate goal is a fluid-solid-growth (FSG) model incorporating fully 3D growth and remodeling and 3D hemodynamics, lower fidelity models having high computational efficiency promise to play important roles, especially in the design of candidate grafts. We introduce here an efficient FSG model of in vivo development of a TEVG based on two simplifying concepts: mechanobiologically equilibrated growth and remodeling of the graft and an embedded control volume analysis of the hemodynamics. Illustrative simulations for a model Fontan conduit reveal the utility of this approach, which promises to be particularly useful in initial design considerations involving formal methods of optimization which otherwise add considerably to the computational expense.
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Affiliation(s)
- Marcos Latorre
- Department of Biomedical Engineering, Yale University, New Haven, CT, 06520, USA.
- Center for Research and Innovation in Bioengineering, Universitat Politècnica de València, València, 46022, Spain.
| | - Jason M Szafron
- Department of Biomedical Engineering, Yale University, New Haven, CT, 06520, USA
- Departments of Pediatrics and Bioengineering, Stanford University, Stanford, CA, 94305, USA
| | - Abhay B Ramachandra
- Department of Biomedical Engineering, Yale University, New Haven, CT, 06520, USA
| | - Jay D Humphrey
- Vascular Biology and Therapeutics Program, Yale School of Medicine, New Haven, CT, 06520, USA
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7
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Bonito V, Koch SE, Krebber MM, Carvajal-Berrio DA, Marzi J, Duijvelshoff R, Lurier EB, Buscone S, Dekker S, de Jong SMJ, Mes T, Vaessen KRD, Brauchle EM, Bosman AW, Schenke-Layland K, Verhaar MC, Dankers PYW, Smits AIPM, Bouten CVC. Distinct Effects of Heparin and Interleukin-4 Functionalization on Macrophage Polarization and In Situ Arterial Tissue Regeneration Using Resorbable Supramolecular Vascular Grafts in Rats. Adv Healthc Mater 2021; 10:e2101103. [PMID: 34523263 DOI: 10.1002/adhm.202101103] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2021] [Revised: 08/12/2021] [Indexed: 12/16/2022]
Abstract
Two of the greatest challenges for successful application of small-diameter in situ tissue-engineered vascular grafts are 1) preventing thrombus formation and 2) harnessing the inflammatory response to the graft to guide functional tissue regeneration. This study evaluates the in vivo performance of electrospun resorbable elastomeric vascular grafts, dual-functionalized with anti-thrombogenic heparin (hep) and anti-inflammatory interleukin 4 (IL-4) using a supramolecular approach. The regenerative capacity of IL-4/hep, hep-only, and bare grafts is investigated as interposition graft in the rat abdominal aorta, with follow-up at key timepoints in the healing cascade (1, 3, 7 days, and 3 months). Routine analyses are augmented with Raman microspectroscopy, in order to acquire the local molecular fingerprints of the resorbing scaffold and developing tissue. Thrombosis is found not to be a confounding factor in any of the groups. Hep-only-functionalized grafts resulted in adverse tissue remodeling, with cases of local intimal hyperplasia. This is negated with the addition of IL-4, which promoted M2 macrophage polarization and more mature neotissue formation. This study shows that with bioactive functionalization, the early inflammatory response can be modulated and affect the composition of neotissue. Nevertheless, variability between graft outcomes is observed within each group, warranting further evaluation in light of clinical translation.
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Affiliation(s)
- Valentina Bonito
- Department of Biomedical Engineering and Institute for Complex Molecular Systems (ICMS), Eindhoven University of Technology, Eindhoven, 5600 MB, The Netherlands
| | - Suzanne E Koch
- Department of Biomedical Engineering and Institute for Complex Molecular Systems (ICMS), Eindhoven University of Technology, Eindhoven, 5600 MB, The Netherlands
| | - Merle M Krebber
- Department of Nephrology and Hypertension, University Medical Center Utrecht, Utrecht, 3584 CX, The Netherlands
| | - Daniel A Carvajal-Berrio
- Department of Biomedical Engineering, Research Institute of Women's Health and Cluster of Excellence iFIT (EXC 2180) "Image-Guided and Functionally Instructed Tumor Therapies", Eberhard Karls University Tübingen, Tübingen, 72076, Germany
- NMI Natural and Medical Sciences Institute at the University of Tübingen, Reutlingen, 72770, Germany
| | - Julia Marzi
- Department of Biomedical Engineering, Research Institute of Women's Health and Cluster of Excellence iFIT (EXC 2180) "Image-Guided and Functionally Instructed Tumor Therapies", Eberhard Karls University Tübingen, Tübingen, 72076, Germany
- NMI Natural and Medical Sciences Institute at the University of Tübingen, Reutlingen, 72770, Germany
| | - Renee Duijvelshoff
- Department of Biomedical Engineering and Institute for Complex Molecular Systems (ICMS), Eindhoven University of Technology, Eindhoven, 5600 MB, The Netherlands
- Department of Cardiology, Isala Hospital, van Heesweg 2, Zwolle, 8025 AB, The Netherlands
| | - Emily B Lurier
- Department of Biomedical Engineering and Institute for Complex Molecular Systems (ICMS), Eindhoven University of Technology, Eindhoven, 5600 MB, The Netherlands
- School of Biomedical Engineering, Science and Health Systems, Drexel University, Philadelphia, PA, 19104, USA
| | - Serena Buscone
- Department of Biomedical Engineering and Institute for Complex Molecular Systems (ICMS), Eindhoven University of Technology, Eindhoven, 5600 MB, The Netherlands
| | - Sylvia Dekker
- Department of Biomedical Engineering and Institute for Complex Molecular Systems (ICMS), Eindhoven University of Technology, Eindhoven, 5600 MB, The Netherlands
| | - Simone M J de Jong
- Department of Biomedical Engineering and Institute for Complex Molecular Systems (ICMS), Eindhoven University of Technology, Eindhoven, 5600 MB, The Netherlands
| | - Tristan Mes
- SupraPolix BV, Eindhoven, 5612 AX, The Netherlands
| | - Koen R D Vaessen
- Central Laboratory Animal Research Facility (CLARF), Utrecht University, Utrecht, 3584 CX, The Netherlands
| | - Eva M Brauchle
- Department of Biomedical Engineering, Research Institute of Women's Health and Cluster of Excellence iFIT (EXC 2180) "Image-Guided and Functionally Instructed Tumor Therapies", Eberhard Karls University Tübingen, Tübingen, 72076, Germany
- NMI Natural and Medical Sciences Institute at the University of Tübingen, Reutlingen, 72770, Germany
| | | | - Katja Schenke-Layland
- Department of Biomedical Engineering, Research Institute of Women's Health and Cluster of Excellence iFIT (EXC 2180) "Image-Guided and Functionally Instructed Tumor Therapies", Eberhard Karls University Tübingen, Tübingen, 72076, Germany
- NMI Natural and Medical Sciences Institute at the University of Tübingen, Reutlingen, 72770, Germany
| | - Marianne C Verhaar
- Department of Nephrology and Hypertension, University Medical Center Utrecht, Utrecht, 3584 CX, The Netherlands
| | - Patricia Y W Dankers
- Department of Biomedical Engineering and Institute for Complex Molecular Systems (ICMS), Eindhoven University of Technology, Eindhoven, 5600 MB, The Netherlands
| | - Anthal I P M Smits
- Department of Biomedical Engineering and Institute for Complex Molecular Systems (ICMS), Eindhoven University of Technology, Eindhoven, 5600 MB, The Netherlands
| | - Carlijn V C Bouten
- Department of Biomedical Engineering and Institute for Complex Molecular Systems (ICMS), Eindhoven University of Technology, Eindhoven, 5600 MB, The Netherlands
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8
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Immuno-regenerative biomaterials for in situ cardiovascular tissue engineering - Do patient characteristics warrant precision engineering? Adv Drug Deliv Rev 2021; 178:113960. [PMID: 34481036 DOI: 10.1016/j.addr.2021.113960] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 08/20/2021] [Accepted: 08/30/2021] [Indexed: 02/07/2023]
Abstract
In situ tissue engineering using bioresorbable material implants - or scaffolds - that harness the patient's immune response while guiding neotissue formation at the site of implantation is emerging as a novel therapy to regenerate human tissues. For the cardiovascular system, the use of such implants, like blood vessels and heart valves, is gradually entering the stage of clinical translation. This opens up the question if and to what extent patient characteristics influence tissue outcomes, necessitating the precision engineering of scaffolds to guide patient-specific neo-tissue formation. Because of the current scarcity of human in vivo data, herein we review and evaluate in vitro and preclinical investigations to predict the potential role of patient-specific parameters like sex, age, ethnicity, hemodynamics, and a multifactorial disease profile, with special emphasis on their contribution to the inflammation-driven processes of in situ tissue engineering. We conclude that patient-specific conditions have a strong impact on key aspects of in situ cardiovascular tissue engineering, including inflammation, hemodynamic conditions, scaffold resorption, and tissue remodeling capacity, suggesting that a tailored approach may be required to engineer immuno-regenerative biomaterials for safe and predictive clinical applicability.
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9
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Gupta P, Mandal BB. Silk biomaterials for vascular tissue engineering applications. Acta Biomater 2021; 134:79-106. [PMID: 34384912 DOI: 10.1016/j.actbio.2021.08.004] [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: 04/16/2021] [Revised: 08/04/2021] [Accepted: 08/05/2021] [Indexed: 02/07/2023]
Abstract
Vascular tissue engineering is a rapidly growing field of regenerative medicine, which strives to find innovative solutions for vascular reconstruction. Considering the limited success of synthetic grafts, research impetus in the field is now shifted towards finding biologically active vascular substitutes bestowing in situ growth potential. In this regard, silk biomaterials have shown remarkable potential owing to their favorable inherent biological and mechanical properties. This review provides a comprehensive overview of the progressive development of silk-based small diameter (<6 mm) tissue-engineered vascular grafts (TEVGs), emphasizing their pre-clinical implications. Herein, we first discuss the molecular structure of various mulberry and non-mulberry silkworm silk and identify their favorable properties at the onset of vascular regeneration. The emergence of various state-of-the-art fabrication methodologies for the advancement of silk TEVGs is rationally appraised in terms of their in vivo performance considering the following parameters: ease of handling, long-term patency, resistance to acute thrombosis, stenosis and aneurysm formation, immune reaction, neo-tissue formation, and overall remodeling. Finally, we provide an update on the pre-clinical status of silk-based TEVGs, followed by current challenges and future prospects. STATEMENT OF SIGNIFICANCE: Limited availability of healthy autologous blood vessels to replace their diseased counterpart is concerning and demands other artificial substitutes. Currently available synthetic grafts are not suitable for small diameter blood vessels owing to frequent blockage. Tissue-engineered biological grafts tend to integrate well with the native tissue via remodeling and have lately witnessed remarkable success. Silk fibroin is a natural biomaterial, which has long been used as medical sutures. This review aims to identify several favorable properties of silk enabling vascular regeneration. Furthermore, various methodologies to fabricate tubular grafts are discussed and highlight their performance in animal models. An overview of our understanding to rationally improve the biological activity fostering the clinical success of silk-based grafts is finally discussed.
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10
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Karakaya C, van Asten JGM, Ristori T, Sahlgren CM, Loerakker S. Mechano-regulated cell-cell signaling in the context of cardiovascular tissue engineering. Biomech Model Mechanobiol 2021; 21:5-54. [PMID: 34613528 PMCID: PMC8807458 DOI: 10.1007/s10237-021-01521-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 09/15/2021] [Indexed: 01/18/2023]
Abstract
Cardiovascular tissue engineering (CVTE) aims to create living tissues, with the ability to grow and remodel, as replacements for diseased blood vessels and heart valves. Despite promising results, the (long-term) functionality of these engineered tissues still needs improvement to reach broad clinical application. The functionality of native tissues is ensured by their specific mechanical properties directly arising from tissue organization. We therefore hypothesize that establishing a native-like tissue organization is vital to overcome the limitations of current CVTE approaches. To achieve this aim, a better understanding of the growth and remodeling (G&R) mechanisms of cardiovascular tissues is necessary. Cells are the main mediators of tissue G&R, and their behavior is strongly influenced by both mechanical stimuli and cell-cell signaling. An increasing number of signaling pathways has also been identified as mechanosensitive. As such, they may have a key underlying role in regulating the G&R of tissues in response to mechanical stimuli. A more detailed understanding of mechano-regulated cell-cell signaling may thus be crucial to advance CVTE, as it could inspire new methods to control tissue G&R and improve the organization and functionality of engineered tissues, thereby accelerating clinical translation. In this review, we discuss the organization and biomechanics of native cardiovascular tissues; recent CVTE studies emphasizing the obtained engineered tissue organization; and the interplay between mechanical stimuli, cell behavior, and cell-cell signaling. In addition, we review past contributions of computational models in understanding and predicting mechano-regulated tissue G&R and cell-cell signaling to highlight their potential role in future CVTE strategies.
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Affiliation(s)
- Cansu Karakaya
- Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands.,Institute for Complex Molecular Systems, Eindhoven University of Technology, Eindhoven, the Netherlands
| | - Jordy G M van Asten
- Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands.,Institute for Complex Molecular Systems, Eindhoven University of Technology, Eindhoven, the Netherlands
| | - Tommaso Ristori
- Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands.,Institute for Complex Molecular Systems, Eindhoven University of Technology, Eindhoven, the Netherlands.,Department of Biomedical Engineering, Boston University, Boston, MA, USA
| | - Cecilia M Sahlgren
- Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands.,Institute for Complex Molecular Systems, Eindhoven University of Technology, Eindhoven, the Netherlands.,Faculty of Science and Engineering, Biosciences, Åbo Akademi, Turku, Finland
| | - Sandra Loerakker
- Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands. .,Institute for Complex Molecular Systems, Eindhoven University of Technology, Eindhoven, the Netherlands.
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11
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Humphrey JD. Constrained Mixture Models of Soft Tissue Growth and Remodeling - Twenty Years After. JOURNAL OF ELASTICITY 2021; 145:49-75. [PMID: 34483462 PMCID: PMC8415366 DOI: 10.1007/s10659-020-09809-1] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Accepted: 12/29/2020] [Indexed: 05/06/2023]
Abstract
Soft biological tissues compromise diverse cell types and extracellular matrix constituents, each of which can possess individual natural configurations, material properties, and rates of turnover. For this reason, mixture-based models of growth (changes in mass) and remodeling (change in microstructure) are well-suited for studying tissue adaptations, disease progression, and responses to injury or clinical intervention. Such approaches also can be used to design improved tissue engineered constructs to repair, replace, or regenerate tissues. Focusing on blood vessels as archetypes of soft tissues, this paper reviews a constrained mixture theory introduced twenty years ago and explores its usage since by contrasting simulations of diverse vascular conditions. The discussion is framed within the concept of mechanical homeostasis, with consideration of solid-fluid interactions, inflammation, and cell signaling highlighting both past accomplishments and future opportunities as we seek to understand better the evolving composition, geometry, and material behaviors of soft tissues under complex conditions.
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Affiliation(s)
- J D Humphrey
- Department of Biomedical Engineering, Yale University, New Haven, CT 06520 USA
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12
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Schwarz EL, Kelly JM, Blum KM, Hor KN, Yates AR, Zbinden JC, Verma A, Lindsey SE, Ramachandra AB, Szafron JM, Humphrey JD, Shin'oka T, Marsden AL, Breuer CK. Hemodynamic performance of tissue-engineered vascular grafts in Fontan patients. NPJ Regen Med 2021; 6:38. [PMID: 34294733 PMCID: PMC8298568 DOI: 10.1038/s41536-021-00148-w] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Accepted: 06/11/2021] [Indexed: 02/06/2023] Open
Abstract
In the field of congenital heart surgery, tissue-engineered vascular grafts (TEVGs) are a promising alternative to traditionally used synthetic grafts. Our group has pioneered the use of TEVGs as a conduit between the inferior vena cava and the pulmonary arteries in the Fontan operation. The natural history of graft remodeling and its effect on hemodynamic performance has not been well characterized. In this study, we provide a detailed analysis of the first U.S. clinical trial evaluating TEVGs in the treatment of congenital heart disease. We show two distinct phases of graft remodeling: an early phase distinguished by rapid changes in graft geometry and a second phase of sustained growth and decreased graft stiffness. Using clinically informed and patient-specific computational fluid dynamics (CFD) simulations, we demonstrate how changes to TEVG geometry, thickness, and stiffness affect patient hemodynamics. We show that metrics of patient hemodynamics remain within normal ranges despite clinically observed levels of graft narrowing. These insights strengthen the continued clinical evaluation of this technology while supporting recent indications that reversible graft narrowing can be well tolerated, thus suggesting caution before intervening clinically.
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Affiliation(s)
- Erica L Schwarz
- Department of Bioengineering, Stanford University, Stanford, CA, USA.
| | - John M Kelly
- Center for Regenerative Medicine, Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH, USA
- The Heart Center, Nationwide Children's Hospital, Columbus, OH, USA
| | - Kevin M Blum
- Center for Regenerative Medicine, Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH, USA
- Department of Biomedical Engineering, The Ohio State University, Columbus, OH, USA
| | - Kan N Hor
- The Heart Center, Nationwide Children's Hospital, Columbus, OH, USA
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Andrew R Yates
- The Heart Center, Nationwide Children's Hospital, Columbus, OH, USA
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Jacob C Zbinden
- Center for Regenerative Medicine, Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH, USA
- Department of Biomedical Engineering, The Ohio State University, Columbus, OH, USA
| | - Aekaansh Verma
- Department of Bioengineering, Stanford University, Stanford, CA, USA
| | - Stephanie E Lindsey
- Department of Bioengineering, Stanford University, Stanford, CA, USA
- Department of Pediatrics, Stanford University, Stanford, CA, USA
| | | | - Jason M Szafron
- Department of Biomedical Engineering, Yale University, New Haven, CT, USA
| | - Jay D Humphrey
- Department of Biomedical Engineering, Yale University, New Haven, CT, USA
| | - Toshiharu Shin'oka
- Center for Regenerative Medicine, Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH, USA
- The Heart Center, Nationwide Children's Hospital, Columbus, OH, USA
- Department of Cardiothoracic Surgery, Nationwide Children's Hospital, Columbus, OH, USA
| | - Alison L Marsden
- Department of Bioengineering, Stanford University, Stanford, CA, USA
- Department of Pediatrics, Stanford University, Stanford, CA, USA
| | - Christopher K Breuer
- Center for Regenerative Medicine, Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH, USA
- Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA
- Department of Surgery, Nationwide Children's Hospital, Columbus, OH, USA
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13
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Abstract
Cells of the vascular wall are exquisitely sensitive to changes in their mechanical environment. In healthy vessels, mechanical forces regulate signaling and gene expression to direct the remodeling needed for the vessel wall to maintain optimal function. Major diseases of arteries involve maladaptive remodeling with compromised or lost homeostatic mechanisms. Whereas homeostasis invokes negative feedback loops at multiple scales to mediate mechanobiological stability, disease progression often occurs via positive feedback that generates mechanobiological instabilities. In this review, we focus on the cell biology, wall mechanics, and regulatory pathways associated with arterial health and how changes in these processes lead to disease. We discuss how positive feedback loops arise via biomechanical and biochemical means. We conclude that inflammation plays a central role in overriding homeostatic pathways and suggest future directions for addressing therapeutic needs.
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Affiliation(s)
- Jay D Humphrey
- Department of Biomedical Engineering, Yale University, New Haven, Connecticut 06520, USA;
| | - Martin A Schwartz
- Department of Biomedical Engineering, Yale University, New Haven, Connecticut 06520, USA;
- Department of Cell Biology, Department of Internal Medicine (Cardiology), and Cardiovascular Research Center, Yale University, New Haven, Connecticut 06520, USA
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14
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Drews JD, Pepper VK, Best CA, Szafron JM, Cheatham JP, Yates AR, Hor KN, Zbinden JC, Chang YC, Mirhaidari GJM, Ramachandra AB, Miyamoto S, Blum KM, Onwuka EA, Zakko J, Kelly J, Cheatham SL, King N, Reinhardt JW, Sugiura T, Miyachi H, Matsuzaki Y, Breuer J, Heuer ED, West TA, Shoji T, Berman D, Boe BA, Asnes J, Galantowicz M, Matsumura G, Hibino N, Marsden AL, Pober JS, Humphrey JD, Shinoka T, Breuer CK. Spontaneous reversal of stenosis in tissue-engineered vascular grafts. Sci Transl Med 2021; 12:12/537/eaax6919. [PMID: 32238576 DOI: 10.1126/scitranslmed.aax6919] [Citation(s) in RCA: 64] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2019] [Revised: 10/27/2019] [Accepted: 02/21/2020] [Indexed: 12/12/2022]
Abstract
We developed a tissue-engineered vascular graft (TEVG) for use in children and present results of a U.S. Food and Drug Administration (FDA)-approved clinical trial evaluating this graft in patients with single-ventricle cardiac anomalies. The TEVG was used as a Fontan conduit to connect the inferior vena cava and pulmonary artery, but a high incidence of graft narrowing manifested within the first 6 months, which was treated successfully with angioplasty. To elucidate mechanisms underlying this early stenosis, we used a data-informed, computational model to perform in silico parametric studies of TEVG development. The simulations predicted early stenosis as observed in our clinical trial but suggested further that such narrowing could reverse spontaneously through an inflammation-driven, mechano-mediated mechanism. We tested this unexpected, model-generated hypothesis by implanting TEVGs in an ovine inferior vena cava interposition graft model, which confirmed the prediction that TEVG stenosis resolved spontaneously and was typically well tolerated. These findings have important implications for our translational research because they suggest that angioplasty may be safely avoided in patients with asymptomatic early stenosis, although there will remain a need for appropriate medical monitoring. The simulations further predicted that the degree of reversible narrowing can be mitigated by altering the scaffold design to attenuate early inflammation and increase mechano-sensing by the synthetic cells, thus suggesting a new paradigm for optimizing next-generation TEVGs. We submit that there is considerable translational advantage to combined computational-experimental studies when designing cutting-edge technologies and their clinical management.
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Affiliation(s)
- Joseph D Drews
- Center for Regenerative Medicine, Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH 43205, USA.,Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA
| | - Victoria K Pepper
- Center for Regenerative Medicine, Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH 43205, USA
| | - Cameron A Best
- Center for Regenerative Medicine, Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH 43205, USA.,Biomedical Sciences Graduate Program, The Ohio State University College of Medicine, Columbus, OH 43210, USA
| | - Jason M Szafron
- Department of Biomedical Engineering, Yale University, New Haven, CT 06520, USA
| | - John P Cheatham
- The Heart Center, Nationwide Children's Hospital, Columbus, OH 43205, USA
| | - Andrew R Yates
- The Heart Center, Nationwide Children's Hospital, Columbus, OH 43205, USA.,Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH 43210, USA
| | - Kan N Hor
- The Heart Center, Nationwide Children's Hospital, Columbus, OH 43205, USA.,Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH 43210, USA
| | - Jacob C Zbinden
- Center for Regenerative Medicine, Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH 43205, USA.,Department of Biomedical Engineering, The Ohio State University, Columbus, OH 43210, USA
| | - Yu-Chun Chang
- Center for Regenerative Medicine, Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH 43205, USA.,Biomedical Sciences Graduate Program, The Ohio State University College of Medicine, Columbus, OH 43210, USA
| | - Gabriel J M Mirhaidari
- Center for Regenerative Medicine, Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH 43205, USA.,Biomedical Sciences Graduate Program, The Ohio State University College of Medicine, Columbus, OH 43210, USA
| | - Abhay B Ramachandra
- Department of Biomedical Engineering, Yale University, New Haven, CT 06520, USA
| | - Shinka Miyamoto
- Center for Regenerative Medicine, Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH 43205, USA
| | - Kevin M Blum
- Center for Regenerative Medicine, Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH 43205, USA.,Department of Biomedical Engineering, The Ohio State University, Columbus, OH 43210, USA
| | - Ekene A Onwuka
- Center for Regenerative Medicine, Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH 43205, USA.,Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA
| | - Jason Zakko
- Center for Regenerative Medicine, Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH 43205, USA.,Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA
| | - John Kelly
- Center for Regenerative Medicine, Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH 43205, USA.,The Heart Center, Nationwide Children's Hospital, Columbus, OH 43205, USA
| | - Sharon L Cheatham
- The Heart Center, Nationwide Children's Hospital, Columbus, OH 43205, USA
| | - Nakesha King
- Center for Regenerative Medicine, Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH 43205, USA.,Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA
| | - James W Reinhardt
- Center for Regenerative Medicine, Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH 43205, USA
| | - Tadahisa Sugiura
- Center for Regenerative Medicine, Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH 43205, USA
| | - Hideki Miyachi
- Center for Regenerative Medicine, Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH 43205, USA
| | - Yuichi Matsuzaki
- Center for Regenerative Medicine, Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH 43205, USA
| | - Julie Breuer
- Center for Regenerative Medicine, Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH 43205, USA
| | - Eric D Heuer
- Center for Regenerative Medicine, Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH 43205, USA
| | - T Aaron West
- Center for Regenerative Medicine, Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH 43205, USA
| | - Toshihiro Shoji
- Center for Regenerative Medicine, Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH 43205, USA
| | - Darren Berman
- The Heart Center, Nationwide Children's Hospital, Columbus, OH 43205, USA
| | - Brian A Boe
- The Heart Center, Nationwide Children's Hospital, Columbus, OH 43205, USA
| | - Jeremy Asnes
- Department of Pediatrics, Yale School of Medicine, New Haven, CT 06520, USA
| | - Mark Galantowicz
- The Heart Center, Nationwide Children's Hospital, Columbus, OH 43205, USA.,Department of Cardiothoracic Surgery, Nationwide Children's Hospital, Columbus, OH 43205, USA
| | - Goki Matsumura
- Department of Cardiovascular Surgery, Tokyo Women's Medical University, Tokyo, Japan
| | - Narutoshi Hibino
- Department of Surgery, University of Chicago/Advocate Children's Hospital, Chicago, IL 60453, USA
| | - Alison L Marsden
- Departments of Pediatrics and Bioengineering, Stanford University, Stanford, CA 94304, USA
| | - Jordan S Pober
- Department of Immunobiology, Yale University, New Haven, CT 06520, USA
| | - Jay D Humphrey
- Department of Biomedical Engineering, Yale University, New Haven, CT 06520, USA
| | - Toshiharu Shinoka
- Center for Regenerative Medicine, Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH 43205, USA.,The Heart Center, Nationwide Children's Hospital, Columbus, OH 43205, USA.,Department of Cardiothoracic Surgery, Nationwide Children's Hospital, Columbus, OH 43205, USA
| | - Christopher K Breuer
- Center for Regenerative Medicine, Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH 43205, USA. .,Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA.,Department of Surgery, Nationwide Children's Hospital, Columbus, OH 43205, USA
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15
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Khosravi R, Ramachandra AB, Szafron JM, Schiavazzi DE, Breuer CK, Humphrey JD. A computational bio-chemo-mechanical model of in vivo tissue-engineered vascular graft development. Integr Biol (Camb) 2021; 12:47-63. [PMID: 32222759 DOI: 10.1093/intbio/zyaa004] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Revised: 01/26/2020] [Accepted: 02/04/2020] [Indexed: 12/15/2022]
Abstract
Stenosis is the primary complication of current tissue-engineered vascular grafts used in pediatric congenital cardiac surgery. Murine models provide considerable insight into the possible mechanisms underlying this situation, but they are not efficient for identifying optimal changes in scaffold design or therapeutic strategies to prevent narrowing. In contrast, computational modeling promises to enable time- and cost-efficient examinations of factors leading to narrowing. Whereas past models have been limited by their phenomenological basis, we present a new mechanistic model that integrates molecular- and cellular-driven immuno- and mechano-mediated contributions to in vivo neotissue development within implanted polymeric scaffolds. Model parameters are inferred directly from in vivo measurements for an inferior vena cava interposition graft model in the mouse that are augmented by data from the literature. By complementing Bayesian estimation with identifiability analysis and simplex optimization, we found optimal parameter values that match model outputs with experimental targets and quantify variability due to measurement uncertainty. Utility is illustrated by parametrically exploring possible graft narrowing as a function of scaffold pore size, macrophage activity, and the immunomodulatory cytokine transforming growth factor beta 1 (TGF-β1). The model captures salient temporal profiles of infiltrating immune and synthetic cells and associated secretion of cytokines, proteases, and matrix constituents throughout neovessel evolution, and parametric studies suggest that modulating scaffold immunogenicity with early immunomodulatory therapies may reduce graft narrowing without compromising compliance.
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Affiliation(s)
- Ramak Khosravi
- Department of Biomedical Engineering, Yale University, New Haven, CT, USA
| | | | - Jason M Szafron
- Department of Biomedical Engineering, Yale University, New Haven, CT, USA
| | - Daniele E Schiavazzi
- Department of Applied and Computational Mathematics and Statistics, University of Notre Dame, Notre Dame, IN, USA
| | - Christopher K Breuer
- Center for Regenerative Medicine, Research Institute at Nationwide Children's Hospital, Columbus, OH, USA
| | - Jay D Humphrey
- Department of Biomedical Engineering, Yale University, New Haven, CT, USA.,Vascular Biology and Therapeutics Program, Yale School of Medicine, New Haven, CT, USA
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16
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Blum KM, Roby LC, Zbinden JC, Chang YC, Mirhaidari GJM, Reinhardt JW, Yi T, Barker JC, Breuer CK. Sex and Tamoxifen confound murine experimental studies in cardiovascular tissue engineering. Sci Rep 2021; 11:8037. [PMID: 33850181 PMCID: PMC8044102 DOI: 10.1038/s41598-021-87006-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Accepted: 02/25/2021] [Indexed: 02/01/2023] Open
Abstract
Tissue engineered vascular grafts hold promise for the creation of functional blood vessels from biodegradable scaffolds. Because the precise mechanisms regulating this process are still under investigation, inducible genetic mouse models are an important and widely used research tool. However, here we describe the importance of challenging the baseline assumption that tamoxifen is inert when used as a small molecule inducer in the context of cardiovascular tissue engineering. Employing a standard inferior vena cava vascular interposition graft model in C57BL/6 mice, we discovered differences in the immunologic response between control and tamoxifen-treated animals, including occlusion rate, macrophage infiltration and phenotype, the extent of foreign body giant cell development, and collagen deposition. Further, differences were noted between untreated males and females. Our findings demonstrate that the host-response to materials commonly used in cardiovascular tissue engineering is sex-specific and critically impacted by exposure to tamoxifen, necessitating careful model selection and interpretation of results.
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Affiliation(s)
- Kevin M Blum
- Center for Regenerative Medicine, The Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, USA
- Department of Biomedical Engineering, The Ohio State University, Columbus, USA
| | - Lauren C Roby
- Center for Regenerative Medicine, The Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, USA
- College of Medicine, The Ohio State University, Columbus, USA
| | - Jacob C Zbinden
- Center for Regenerative Medicine, The Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, USA
- Department of Biomedical Engineering, The Ohio State University, Columbus, USA
| | - Yu-Chun Chang
- Center for Regenerative Medicine, The Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, USA
- Biomedical Sciences Graduate Program, College of Medicine, The Ohio State University, Columbus, USA
| | - Gabriel J M Mirhaidari
- Center for Regenerative Medicine, The Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, USA
- Biomedical Sciences Graduate Program, College of Medicine, The Ohio State University, Columbus, USA
| | - James W Reinhardt
- Center for Regenerative Medicine, The Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, USA
| | - Tai Yi
- Center for Regenerative Medicine, The Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, USA
| | - Jenny C Barker
- Center for Regenerative Medicine, The Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, USA
- Department of Plastic and Reconstructive Surgery, The Ohio State University, Columbus, USA
| | - Christopher K Breuer
- Center for Regenerative Medicine, The Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, USA.
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17
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Sang C, Kallmes DF, Kadirvel R, Durka MJ, Ding YH, Dai D, Watkins SC, Robertson AM. Adaptive Remodeling in the Elastase-induced Rabbit Aneurysms. EXPERIMENTAL MECHANICS 2021; 61:263-283. [PMID: 33814553 PMCID: PMC8011419 DOI: 10.1007/s11340-020-00671-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Accepted: 09/29/2020] [Indexed: 05/11/2023]
Abstract
BACKGROUND Rupture of brain aneurysms is associated with high fatality and morbidity rates. Through remodeling of the collagen matrix, many aneurysms can remain unruptured for decades, despite an enlarging and evolving geometry. OBJECTIVE Our objective was to explore this adaptive remodeling for the first time in an elastase induced aneurysm model in rabbits. METHODS Saccular aneurysms were created in 22 New Zealand white rabbits and remodeling was assessed in tissue harvested 2, 4, 8 and 12 weeks after creation. RESULTS The intramural principal stress ratio doubled after aneurysm creation due to increased longitudinal loads, triggering a remodeling response. A distinct wall layer with multi-directional collagen fibers developed between the media and adventitia as early as 2 weeks, and in all cases by 4 weeks with an average thickness of 50.6 ± 14.3 μm. Collagen fibers in this layer were multi-directional (AI = 0.56 ± 0.15) with low tortuosity (1.08 ± 0.02) compared with adjacent circumferentially aligned medial fibers (AI = 0.78 ± 0.12) and highly tortuous adventitial fibers (1.22 ± 0.03). A second phase of remodeling replaced circumferentially aligned fibers in the inner media with longitudinal fibers. A structurally motivated constitutive model with both remodeling modes was introduced along with methodology for determining material parameters from mechanical testing and multiphoton imaging. CONCLUSIONS A new mechanism was identified by which aneurysm walls can rapidly adapt to changes in load, ensuring the structural integrity of the aneurysm until a slower process of medial reorganization occurs. The rabbit model can be used to evaluate therapies to increase aneurysm wall stability.
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Affiliation(s)
- C Sang
- Department of Mechanical Engineering and Materials Science, University of Pittsburgh, 3700 O'Hara Street, Pittsburgh, PA 15261
| | - D F Kallmes
- Department of Radiology, Mayo Clinic, Rochester, MN
| | - R Kadirvel
- Department of Radiology, Mayo Clinic, Rochester, MN
| | - M J Durka
- Department of Mechanical Engineering and Materials Science, University of Pittsburgh, 3700 O'Hara Street, Pittsburgh, PA 15261
| | - Y-H Ding
- Department of Radiology, Mayo Clinic, Rochester, MN
| | - D Dai
- Department of Radiology, Mayo Clinic, Rochester, MN
| | - S C Watkins
- Center for Biological Imaging, University of Pittsburgh, Pittsburgh, PA
| | - A M Robertson
- Department of Mechanical Engineering and Materials Science, University of Pittsburgh, 3700 O'Hara Street, Pittsburgh, PA 15261
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18
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Uiterwijk M, Smits AIPM, van Geemen D, van Klarenbosch B, Dekker S, Cramer MJ, van Rijswijk JW, Lurier EB, Di Luca A, Brugmans MCP, Mes T, Bosman AW, Aikawa E, Gründeman PF, Bouten CVC, Kluin J. In Situ Remodeling Overrules Bioinspired Scaffold Architecture of Supramolecular Elastomeric Tissue-Engineered Heart Valves. ACTA ACUST UNITED AC 2020; 5:1187-1206. [PMID: 33426376 PMCID: PMC7775962 DOI: 10.1016/j.jacbts.2020.09.011] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Revised: 09/22/2020] [Accepted: 09/22/2020] [Indexed: 11/17/2022]
Abstract
In situ tissue engineering that uses resorbable synthetic heart valve scaffolds is an affordable and practical approach for heart valve replacement; therefore, it is attractive for clinical use. This study showed no consistent collagen organization in the predefined direction of electrospun scaffolds made from a resorbable supramolecular elastomer with random or circumferentially aligned fibers, after 12 months of implantation in sheep. These unexpected findings and the observed intervalvular variability highlight the need for a mechanistic understanding of the long-term in situ remodeling processes in large animal models to improve predictability of outcome toward robust and safe clinical application.
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Affiliation(s)
- Marcelle Uiterwijk
- Department of Cardiothoracic Surgery, Amsterdam University Medical Center, Amsterdam, the Netherlands
| | - Anthal I P M Smits
- Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands.,Institute for Complex Molecular Systems, Eindhoven University of Technology, Eindhoven, the Netherlands
| | - Daphne van Geemen
- Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands
| | - Bas van Klarenbosch
- Department of Cardiology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Sylvia Dekker
- Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands
| | - Maarten Jan Cramer
- Department of Cardiology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Jan Willem van Rijswijk
- Department of Cardiothoracic Surgery, Amsterdam University Medical Center, Amsterdam, the Netherlands
| | - Emily B Lurier
- Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands.,School of Biomedical Engineering, Science and Health Systems, Drexel University, Philadelphia, Pennsylvania, USA
| | - Andrea Di Luca
- Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands
| | | | | | | | - Elena Aikawa
- Center for Excellence in Vascular Biology, Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Paul F Gründeman
- Department of Cardiothoracic Surgery, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Carlijn V C Bouten
- Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands.,Institute for Complex Molecular Systems, Eindhoven University of Technology, Eindhoven, the Netherlands
| | - Jolanda Kluin
- Department of Cardiothoracic Surgery, Amsterdam University Medical Center, Amsterdam, the Netherlands.,Institute for Complex Molecular Systems, Eindhoven University of Technology, Eindhoven, the Netherlands
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19
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Duijvelshoff R, di Luca A, van Haaften EE, Dekker S, Söntjens SHM, Janssen HM, Smits AIPM, Dankers PYW, Bouten CVC. Inconsistency in Graft Outcome of Bilayered Bioresorbable Supramolecular Arterial Scaffolds in Rats. Tissue Eng Part A 2020; 27:894-904. [PMID: 32873211 DOI: 10.1089/ten.tea.2020.0185] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
There is a continuous search for the ideal bioresorbable material to develop scaffolds for in situ vascular tissue engineering. As these scaffolds are exposed to the harsh hemodynamic environment during the entire transformation process from scaffold to neotissue, it is of crucial importance to maintain mechanical integrity and stability at all times. Bilayered scaffolds made of supramolecular polycarbonate-ester-bisurea were manufactured using dual electrospinning. These scaffolds contained a porous inner layer to allow for cellular infiltration and a dense outer layer to provide strength. Scaffolds (n = 21) were implanted as an interposition graft into the abdominal aorta of male Lewis rats and explanted after 1, 3, and 5 months in vivo to assess mechanical functionality and neotissue formation upon scaffold resorption. Results demonstrated conflicting graft outcomes despite homogeneity in the experimental group and scaffold production. Most grafts exhibited adverse remodeling, resulting in aneurysmal dilatation and calcification. However, a few grafts did not demonstrate such features, but instead were characterized by graft extension and smooth muscle cell proliferation in the absence of endothelium, while remaining patent throughout the study. We conclude that it remains extremely difficult to anticipate graft development and performance in vivo. Next to rational mechanical design and good performance in vitro, a thorough understanding of the mechanobiological mechanisms governing scaffold-driven arterial regeneration as well as potential influences of surgical procedures is warranted to further optimize scaffold designs. Careful analysis of the differences between preclinical successes and failures, as is done in this study, may provide initial handles for scaffold optimization and standardized surgical procedures to improve graft performance in vivo. Impact statement In situ vascular tissue engineering using cell-free bioresorbable scaffolds is investigated as an off-the-shelf option to grow small caliber arteries inside the body. In this study, we developed a bilayered electrospun supramolecular scaffold with a dense outer layer to provide mechanical integrity and a porous inner layer for cell recruitment and tissue formation. Despite homogenous scaffold properties and mechanical performance in vitro, in vivo testing as rat aorta interposition grafts revealed distinct graft outcomes, ranging from aneurysms to functional arteries. Careful analysis of this variability provided valuable insights into materials-driven in situ artery formation relevant for scaffold design and implantation procedures.
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Affiliation(s)
- Renee Duijvelshoff
- Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands.,Institute for Complex Molecular Systems (ICMS), Eindhoven, The Netherlands
| | - Andrea di Luca
- Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - Eline E van Haaften
- Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - Sylvia Dekker
- Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
| | | | | | - Anthal I P M Smits
- Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands.,Institute for Complex Molecular Systems (ICMS), Eindhoven, The Netherlands
| | - Patricia Y W Dankers
- Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands.,Institute for Complex Molecular Systems (ICMS), Eindhoven, The Netherlands
| | - Carlijn V C Bouten
- Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands.,Institute for Complex Molecular Systems (ICMS), Eindhoven, The Netherlands
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20
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Next-generation tissue-engineered heart valves with repair, remodelling and regeneration capacity. Nat Rev Cardiol 2020; 18:92-116. [PMID: 32908285 DOI: 10.1038/s41569-020-0422-8] [Citation(s) in RCA: 100] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/09/2020] [Indexed: 02/06/2023]
Abstract
Valvular heart disease is a major cause of morbidity and mortality worldwide. Surgical valve repair or replacement has been the standard of care for patients with valvular heart disease for many decades, but transcatheter heart valve therapy has revolutionized the field in the past 15 years. However, despite the tremendous technical evolution of transcatheter heart valves, to date, the clinically available heart valve prostheses for surgical and transcatheter replacement have considerable limitations. The design of next-generation tissue-engineered heart valves (TEHVs) with repair, remodelling and regenerative capacity can address these limitations, and TEHVs could become a promising therapeutic alternative for patients with valvular disease. In this Review, we present a comprehensive overview of current clinically adopted heart valve replacement options, with a focus on transcatheter prostheses. We discuss the various concepts of heart valve tissue engineering underlying the design of next-generation TEHVs, focusing on off-the-shelf technologies. We also summarize the latest preclinical and clinical evidence for the use of these TEHVs and describe the current scientific, regulatory and clinical challenges associated with the safe and broad clinical translation of this technology.
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21
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Modeling biological growth and remodeling: Contrasting methods, contrasting needs. CURRENT OPINION IN BIOMEDICAL ENGINEERING 2020. [DOI: 10.1016/j.cobme.2019.11.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
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22
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Loerakker S, Ristori T. Computational modeling for cardiovascular tissue engineering: the importance of including cell behavior in growth and remodeling algorithms. CURRENT OPINION IN BIOMEDICAL ENGINEERING 2020; 15:1-9. [PMID: 33997580 PMCID: PMC8105589 DOI: 10.1016/j.cobme.2019.12.007] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Understanding cardiovascular growth and remodeling (G&R) is fundamental for designing robust cardiovascular tissue engineering strategies, which enable synthetic or biological scaffolds to transform into healthy living tissues after implantation. Computational modeling, particularly when integrated with experimental research, is key for advancing our understanding, predicting the in vivo evolution of engineered tissues, and efficiently optimizing scaffold designs. As cells are ultimately the drivers of G&R and known to change their behavior in response to mechanical cues, increasing efforts are currently undertaken to capture (mechano-mediated) cell behavior in computational models. In this selective review, we highlight some recent examples that are relevant in the context of cardiovascular tissue engineering and discuss the current and future biological and computational challenges for modeling cell-mediated G&R.
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Affiliation(s)
- Sandra Loerakker
- Department of Biomedical Engineering, Eindhoven University of Technology, Groene Loper Building 15, 5612 AP, Eindhoven, the Netherlands.,Institute for Complex Molecular Systems, Eindhoven University of Technology, Groene Loper Building 7, 5612 AJ, Eindhoven, the Netherlands
| | - Tommaso Ristori
- Department of Biomedical Engineering, Eindhoven University of Technology, Groene Loper Building 15, 5612 AP, Eindhoven, the Netherlands.,Institute for Complex Molecular Systems, Eindhoven University of Technology, Groene Loper Building 7, 5612 AJ, Eindhoven, the Netherlands
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23
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Szafron JM, Ramachandra AB, Breuer CK, Marsden AL, Humphrey JD. Optimization of Tissue-Engineered Vascular Graft Design Using Computational Modeling. Tissue Eng Part C Methods 2019; 25:561-570. [PMID: 31218941 DOI: 10.1089/ten.tec.2019.0086] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
Tissue-engineered vascular grafts hold great promise in many clinical applications, especially in pediatrics wherein growth potential is critical. A continuing challenge, however, is identification of optimal scaffold parameters for promoting favorable neovessel development. In particular, given the countless design parameters available, including those related to polymeric microstructure, material behavior, and degradation kinetics, the number of possible scaffold designs is almost limitless. Advances in computationally modeling the growth and remodeling of native blood vessels suggest that similar simulations could help reduce the search space for candidate scaffold designs in tissue engineering. In this study, we meld a computational model of in vivo neovessel formation with a surrogate management framework to identify optimal scaffold designs for use in the extracardiac Fontan circulation while comparing the utility of different objective functions. We show that evolving luminal radius and graft compliance can be matched to that of the native vein by the end of the simulation period with judicious combinations of scaffold parameters, although the inability to match these metrics at all times reveals constraints engendered by current materials. We emphasize further that there is yet a need to examine additional metrics, and combinations thereof, when seeking to optimize functionality and reduce the potential for adverse outcomes. Impact Statement Tissue-engineered vascular grafts have considerable promise for treating myriad conditions, and multiple designs are now in FDA-approved trials. Nevertheless, the search continues for the optimal design of the underlying polymeric scaffold. We present a novel melding of a computational model of vascular adaptation and a formal method of optimization that can aid in identifying optimal design parameters, with potential to save development time and costs while improving clinical outcomes.
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Affiliation(s)
- Jason M Szafron
- Department of Biomedical Engineering, Yale University, New Haven, Connecticut
| | - Abhay B Ramachandra
- Department of Biomedical Engineering, Yale University, New Haven, Connecticut
| | | | - Alison L Marsden
- Departments of Pediatrics and Bioengineering, Stanford University, Stanford, California
| | - Jay D Humphrey
- Department of Biomedical Engineering, Yale University, New Haven, Connecticut.,Vascular Biology and Therapeutics Program, Yale School of Medicine, New Haven, Connecticut
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24
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Ambrosi D, Ben Amar M, Cyron CJ, DeSimone A, Goriely A, Humphrey JD, Kuhl E. Growth and remodelling of living tissues: perspectives, challenges and opportunities. J R Soc Interface 2019; 16:20190233. [PMID: 31431183 PMCID: PMC6731508 DOI: 10.1098/rsif.2019.0233] [Citation(s) in RCA: 76] [Impact Index Per Article: 15.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Accepted: 07/26/2019] [Indexed: 12/29/2022] Open
Abstract
One of the most remarkable differences between classical engineering materials and living matter is the ability of the latter to grow and remodel in response to diverse stimuli. The mechanical behaviour of living matter is governed not only by an elastic or viscoelastic response to loading on short time scales up to several minutes, but also by often crucial growth and remodelling responses on time scales from hours to months. Phenomena of growth and remodelling play important roles, for example during morphogenesis in early life as well as in homeostasis and pathogenesis in adult tissues, which often adapt to changes in their chemo-mechanical environment as a result of ageing, diseases, injury or surgical intervention. Mechano-regulated growth and remodelling are observed in various soft tissues, ranging from tendons and arteries to the eye and brain, but also in bone, lower organisms and plants. Understanding and predicting growth and remodelling of living systems is one of the most important challenges in biomechanics and mechanobiology. This article reviews the current state of growth and remodelling as it applies primarily to soft tissues, and provides a perspective on critical challenges and future directions.
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Affiliation(s)
- Davide Ambrosi
- Dipartimento di Matematica, Politecnico di Milano, Milan, Italy
| | - Martine Ben Amar
- Laboratoire de Physique Statistique, Ecole Normale Supérieure, Paris, France
| | - Christian J. Cyron
- Institute of Continuum Mechanics and Materials, Hamburg University of Technology, Hamburg, Germany
- Institute of Materials Research, Helmholtz-Zentrum Geesthacht, Geesthacht, Germany
| | - Antonio DeSimone
- Scuola Internazionale Superiore di Studi Avanzati, Trieste, Italy
| | - Alain Goriely
- Mathematical Institute, University of Oxford, Oxford, UK
| | - Jay D. Humphrey
- Department of Biomedical Engineering, Yale University, New Haven, CT, USA
| | - Ellen Kuhl
- Department of Mechanical Engineering, Stanford University, Stanford, CA, USA
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25
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Best CA, Szafron JM, Rocco KA, Zbinden J, Dean EW, Maxfield MW, Kurobe H, Tara S, Bagi PS, Udelsman BV, Khosravi R, Yi T, Shinoka T, Humphrey JD, Breuer CK. Differential outcomes of venous and arterial tissue engineered vascular grafts highlight the importance of coupling long-term implantation studies with computational modeling. Acta Biomater 2019; 94:183-194. [PMID: 31200116 PMCID: PMC6819998 DOI: 10.1016/j.actbio.2019.05.063] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Revised: 05/07/2019] [Accepted: 05/24/2019] [Indexed: 12/13/2022]
Abstract
Electrospinning is commonly used to generate polymeric scaffolds for tissue engineering. Using this approach, we developed a small-diameter tissue engineered vascular graft (TEVG) composed of poly-ε-caprolactone-co-l-lactic acid (PCLA) fibers and longitudinally assessed its performance within both the venous and arterial circulations of immunodeficient (SCID/bg) mice. Based on in vitro analysis demonstrating complete loss of graft strength by 12 weeks, we evaluated neovessel formation in vivo over 6-, 12- and 24-week periods. Mid-term observations indicated physiologic graft function, characterized by 100% patency and luminal matching with adjoining native vessel in both the venous and arterial circulations. An active and robust remodeling process was characterized by a confluent endothelial cell monolayer, macrophage infiltrate, and extracellular matrix deposition and remodeling. Long-term follow-up of venous TEVGs at 24 weeks revealed viable neovessel formation beyond graft degradation when implanted in this high flow, low-pressure environment. Arterial TEVGs experienced catastrophic graft failure due to aneurysmal dilatation and rupture after 14 weeks. Scaffold parameters such as porosity, fiber diameter, and degradation rate informed a previously described computational model of vascular growth and remodeling, and simulations predicted the gross differential performance of the venous and arterial TEVGs over the 24-week time course. Taken together, these results highlight the requirement for in vivo implantation studies to extend past the critical time period of polymer degradation, the importance of differential neotissue deposition relative to the mechanical (pressure) environment, and further support the utility of predictive modeling in the design, use, and evaluation of TEVGs in vivo. STATEMENT OF SIGNIFICANCE: Herein, we apply a biodegradable electrospun vascular graft to the arterial and venous circulations of the mouse and follow recipients beyond the point of polymer degradation. While venous implants formed viable neovessels, arterial grafts experienced catastrophic rupture due to aneurysmal dilation. We then inform a previously developed computational model of tissue engineered vascular graft growth and remodeling with parameters specific to the electrospun scaffolds utilized in this study. Remarkably, model simulations predict the differential performance of the venous and arterial constructs over 24 weeks. We conclude that computational simulations should inform the rational selection of scaffold parameters to fabricate tissue engineered vascular grafts that must be followed in vivo over time courses extending beyond polymer degradation.
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Affiliation(s)
- Cameron A Best
- Center for Regenerative Medicine, Tissue Engineering Program, The Research Institute at Nationwide Children's Hospital, Columbus, OH, United States; Biomedical Sciences Graduate Program, The Ohio State University College of Medicine, Columbus, OH, United States.
| | - Jason M Szafron
- Department of Biomedical Engineering, Yale University, New Haven, CT, United States
| | | | - Jacob Zbinden
- Center for Regenerative Medicine, Tissue Engineering Program, The Research Institute at Nationwide Children's Hospital, Columbus, OH, United States; Biomedical Engineering Graduate Program, The Ohio State University College of Engineering, Columbus, OH, United States
| | - Ethan W Dean
- Department of Orthopaedic Surgery, University of Florida, Gainesville, FL, United States
| | - Mark W Maxfield
- Department of Thoracic Surgery, University of Massachusetts Memorial Medical Center, Worcester, MA, United States
| | - Hirotsugu Kurobe
- Department of Cardiovascular Surgery, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima, Japan
| | - Shuhei Tara
- Department of Cardiovascular Medicine, Nippon Medical School, Tokyo, Japan
| | - Paul S Bagi
- Department of Orthopaedic Surgery, Yale-New Haven Hospital, New Haven, CT, United States
| | - Brooks V Udelsman
- Department of Surgery, Massachusetts General Hospital, Boston, MA, United States
| | - Ramak Khosravi
- Department of Biomedical Engineering, Yale University, New Haven, CT, United States
| | - Tai Yi
- Center for Regenerative Medicine, Tissue Engineering Program, The Research Institute at Nationwide Children's Hospital, Columbus, OH, United States
| | - Toshiharu Shinoka
- Center for Regenerative Medicine, Tissue Engineering Program, The Research Institute at Nationwide Children's Hospital, Columbus, OH, United States; Department of Cardiac Surgery, Nationwide Children's Hospital, Columbus, OH, United States
| | - Jay D Humphrey
- Department of Biomedical Engineering, Yale University, New Haven, CT, United States; Vascular Biology and Therapeutics Program, Yale University School of Medicine, New Haven, CT, United States
| | - Christopher K Breuer
- Center for Regenerative Medicine, Tissue Engineering Program, The Research Institute at Nationwide Children's Hospital, Columbus, OH, United States; Department of Surgery, Nationwide Children's Hospital, Columbus, OH, United States
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26
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Duijvelshoff R, van Engeland NCA, Gabriels KMR, Söntjens SHM, Smits AIPM, Dankers PYW, Bouten CVC. Host Response and Neo-Tissue Development during Resorption of a Fast Degrading Supramolecular Electrospun Arterial Scaffold. Bioengineering (Basel) 2018; 5:bioengineering5030061. [PMID: 30082586 PMCID: PMC6164451 DOI: 10.3390/bioengineering5030061] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Revised: 07/23/2018] [Accepted: 08/03/2018] [Indexed: 01/16/2023] Open
Abstract
In situ vascular tissue engineering aims to regenerate vessels "at the target site" using synthetic scaffolds that are capable of inducing endogenous regeneration. Critical to the success of this approach is a fine balance between functional neo-tissue formation and scaffold degradation. Circulating immune cells are important regulators of this process as they drive the host response to the scaffold and they play a central role in scaffold resorption. Despite the progress made with synthetic scaffolds, little is known about the host response and neo-tissue development during and after scaffold resorption. In this study, we designed a fast-degrading biodegradable supramolecular scaffold for arterial applications and evaluated this development in vivo. Bisurea-modified polycaprolactone (PCL2000-U4U) was electrospun in tubular scaffolds and shielded by non-degradable expanded polytetrafluoroethylene in order to restrict transmural and transanastomotic cell ingrowth. In addition, this shield prevented graft failure, permitting the study of neo-tissue and host response development after degradation. Scaffolds were implanted in 60 healthy male Lewis rats as an interposition graft into the abdominal aorta and explanted at different time points up to 56 days after implantation to monitor sequential cell infiltration, differentiation, and tissue formation in the scaffold. Endogenous tissue formation started with an acute immune response, followed by a dominant presence of pro-inflammatory macrophages during the first 28 days. Next, a shift towards tissue-producing cells was observed, with a striking increase in α-Smooth Muscle Actin-positive cells and extracellular matrix by day 56. At that time, the scaffold was resorbed and immune markers were low. These results suggest that neo-tissue formation was still in progress, while the host response became quiescent, favoring a regenerative tissue outcome. Future studies should confirm long-term tissue homeostasis, but require the strengthening of the supramolecular scaffold if a non-shielded model will be used.
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Affiliation(s)
- Renee Duijvelshoff
- Department of Biomedical Engineering, Eindhoven University of Technology, 5600 MB Eindhoven, The Netherlands.
- Institute for Complex Molecular Systems (ICMS), 5600 MB Eindhoven, The Netherlands.
| | - Nicole C A van Engeland
- Department of Biomedical Engineering, Eindhoven University of Technology, 5600 MB Eindhoven, The Netherlands.
| | - Karen M R Gabriels
- Department of Biomedical Engineering, Eindhoven University of Technology, 5600 MB Eindhoven, The Netherlands.
- Institute for Complex Molecular Systems (ICMS), 5600 MB Eindhoven, The Netherlands.
| | | | - Anthal I P M Smits
- Department of Biomedical Engineering, Eindhoven University of Technology, 5600 MB Eindhoven, The Netherlands.
- Institute for Complex Molecular Systems (ICMS), 5600 MB Eindhoven, The Netherlands.
| | - Patricia Y W Dankers
- Department of Biomedical Engineering, Eindhoven University of Technology, 5600 MB Eindhoven, The Netherlands.
- Institute for Complex Molecular Systems (ICMS), 5600 MB Eindhoven, The Netherlands.
| | - Carlijn V C Bouten
- Department of Biomedical Engineering, Eindhoven University of Technology, 5600 MB Eindhoven, The Netherlands.
- Institute for Complex Molecular Systems (ICMS), 5600 MB Eindhoven, The Netherlands.
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27
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Immuno-driven and Mechano-mediated Neotissue Formation in Tissue Engineered Vascular Grafts. Ann Biomed Eng 2018; 46:1938-1950. [PMID: 29987541 DOI: 10.1007/s10439-018-2086-7] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Accepted: 06/27/2018] [Indexed: 12/13/2022]
Abstract
In vivo development of a neovessel from an implanted biodegradable polymeric scaffold depends on a delicate balance between polymer degradation and native matrix deposition. Studies in mice suggest that this balance is dictated by immuno-driven and mechanotransduction-mediated processes, with neotissue increasingly balancing the hemodynamically induced loads as the polymer degrades. Computational models of neovessel development can help delineate relative time-dependent contributions of the immunobiological and mechanobiological processes that determine graft success or failure. In this paper, we compare computational results informed by long-term studies of neovessel development in immuno-compromised and immuno-competent mice. Simulations suggest that an early exuberant inflammatory response can limit subsequent mechano-sensing by synthetic intramural cells and thereby attenuate the desired long-term mechano-mediated production of matrix. Simulations also highlight key inflammatory differences in the two mouse models, which allow grafts in the immuno-compromised mouse to better match the biomechanical properties of the native vessel. Finally, the predicted inflammatory time courses revealed critical periods of graft remodeling. We submit that computational modeling can help uncover mechanisms of observed neovessel development and improve the design of the scaffold or its clinical use.
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28
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Santisteban-Espejo A, Campos F, Martin-Piedra L, Durand-Herrera D, Moral-Munoz JA, Campos A, Martin-Piedra MA. Global Tissue Engineering Trends: A Scientometric and Evolutive Study. Tissue Eng Part A 2018; 24:1504-1517. [PMID: 29687749 DOI: 10.1089/ten.tea.2018.0007] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
Tissue engineering (TE) is defined as a multidisciplinary scientific discipline with the main objective to develop artificial bioengineered living tissues to regenerate damaged or lost tissues. Since its appearance in 1988, TE has globally spread to improve current therapeutic approaches, entailing a revolution in clinical practice. The aim of this study is to analyze global research trends on TE publications to realize the scenario of TE research from 1991 to 2016 by using document retrieval from Web of Science database and bibliometric analysis. Document type, language, source title, authorship, countries and filiation centers, and citation count were evaluated in 31,859 documents. Obtained results suggest a great multidisciplinary role of TE due to a wide spectrum-up to 51-of scientific research areas identified in the corpus of literature, being predominant technological disciplines as Material Sciences or Engineering, followed by biological and biomedical areas, as Cell Biology, Biotechnology, or Biochemistry. Distribution of authorship, journals, and countries revealed a clear imbalance, in which a minority is responsible for a majority of documents. Such imbalance is notorious in authorship, where a 0.3% of authors are involved in half of the whole production.
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Affiliation(s)
- Antonio Santisteban-Espejo
- 1 Department of Hematology and Hemotherapy, Puerta del Mar Hospital , Cadiz, Spain .,2 Department of Biomedicine, University of Granada , Spain
| | - Fernando Campos
- 3 Andalusian Initiative for Advanced Therapies , Sevilla, Spain
| | | | - Daniel Durand-Herrera
- 5 Tissue Engineering Group, Department of Histology, University of Granada , Granada, Spain
| | - Jose Antonio Moral-Munoz
- 6 Department of Nursing and Physiotherapy; and Institute of Research and Innovation in Biomedical Sciences of the Province of Cadiz (INiBICA), University of Cadiz , Cadiz, Spain
| | - Antonio Campos
- 5 Tissue Engineering Group, Department of Histology, University of Granada , Granada, Spain
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29
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Szafron JM, Breuer CK, Wang Y, Humphrey JD. Stress Analysis-Driven Design of Bilayered Scaffolds for Tissue-Engineered Vascular Grafts. J Biomech Eng 2018; 139:2653976. [PMID: 28886204 DOI: 10.1115/1.4037856] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2017] [Indexed: 12/28/2022]
Abstract
Continuing advances in the fabrication of scaffolds for tissue-engineered vascular grafts (TEVGs) are greatly expanding the scope of potential designs. Increasing recognition of the importance of local biomechanical cues for cell-mediated neotissue formation, neovessel growth, and subsequent remodeling is similarly influencing the design process. This study examines directly the potential effects of different combinations of key geometric and material properties of polymeric scaffolds on the initial mechanical state of an implanted graft into which cells are seeded or migrate. Toward this end, we developed a bilayered computational model that accounts for layer-specific thickness and stiffness as well as the potential to be residually stressed during fabrication or to swell during implantation. We found that, for realistic ranges of parameter values, the circumferential stress that would be presented to seeded or infiltrating cells is typically much lower than ideal, often by an order of magnitude. Indeed, accounting for layer-specific intrinsic swelling resulting from hydrophilicity or residual stresses not relieved via annealing revealed potentially large compressive stresses, which could lead to unintended cell phenotypes and associated maladaptive growth or, in extreme cases, graft failure. Metrics of global hemodynamics were also found to be inversely related to markers of a favorable local mechanobiological environment, suggesting a tradeoff in designs that seek mechanical homeostasis at a single scale. These findings highlight the importance of the initial mechanical state in tissue engineering scaffold design and the utility of computational modeling in reducing the experimental search space for future graft development and testing.
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Affiliation(s)
- Jason M Szafron
- Department of Biomedical Engineering, Yale University, New Haven, CT 06520 e-mail:
| | - Christopher K Breuer
- Tissue Engineering Program, Nationwide Children's Hospital, Columbus, OH 43215 e-mail:
| | - Yadong Wang
- Meinig School of Biomedical Engineering, Cornell University, Ithaca, NY 14853 e-mail:
| | - Jay D Humphrey
- Fellow ASME Department of Biomedical Engineering, Yale University, New Haven, CT 06520 e-mail:
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30
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Onwuka E, King N, Heuer E, Breuer C. The Heart and Great Vessels. Cold Spring Harb Perspect Med 2018; 8:cshperspect.a031922. [PMID: 28289246 DOI: 10.1101/cshperspect.a031922] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Cardiovascular disease is the leading cause of mortality worldwide. We have made large strides over the past few decades in management, but definitive therapeutic options to address this health-care burden are still limited. Given the ever-increasing need, much effort has been spent creating engineered tissue to replaced diseased tissue. This article gives a general overview of this work as it pertains to the development of great vessels, myocardium, and heart valves. In each area, we focus on currently studied methods, limitations, and areas for future study.
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Affiliation(s)
- Ekene Onwuka
- Tissue Engineering and Surgical Research, The Research Institute at Nationwide Children's Hospital, Columbus, Ohio 43205.,College of Medicine, The Ohio State University, Columbus, Ohio 43210
| | - Nakesha King
- Tissue Engineering and Surgical Research, The Research Institute at Nationwide Children's Hospital, Columbus, Ohio 43205.,College of Medicine, The Ohio State University, Columbus, Ohio 43210
| | - Eric Heuer
- Tissue Engineering and Surgical Research, The Research Institute at Nationwide Children's Hospital, Columbus, Ohio 43205
| | - Christopher Breuer
- Tissue Engineering and Surgical Research, The Research Institute at Nationwide Children's Hospital, Columbus, Ohio 43205.,College of Medicine, The Ohio State University, Columbus, Ohio 43210.,Department of Pediatric Surgery, Nationwide Children's Hospital, Columbus, Ohio 43205
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31
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Evaluation of microstructurally motivated constitutive models to describe age-dependent tendon healing. Biomech Model Mechanobiol 2017; 17:793-814. [PMID: 29234987 PMCID: PMC5948310 DOI: 10.1007/s10237-017-0993-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2017] [Accepted: 11/30/2017] [Indexed: 12/27/2022]
Abstract
Tendon injuries are common to all ages. Injured tendons typically do not recover full functionality. The amount and organization of tendon constituents dictate their mechanical properties. The impact of changes in these constituents during (patho)physiologic processes (e.g., aging and healing) are not fully understood. Toward this end, microstructurally motivated strain energy functions (SEFs) offer insight into underlying mechanisms of age-dependent healing. Several SEFs have been adapted for tendon; however, most are phenomenological. Therefore, the aims of this study are: (1) evaluate the descriptive capability of SEFs in age-dependent murine patellar tendon healing and (2) identify a SEF for implementation in a growth and remodeling (G&R) model. To accomplish these aims, models were fitted to patellar tendon tensile data from multiple age groups and post-injury timepoints. Model sensitivity to parameters and the determinability of the parameters were assessed. A two-way analysis of variance was used to identify changes in parameters and the feasibility of implementing each model into a G&R model is discussed. The evaluated SEFs exhibited adequate descriptive capability. Parameter determinability and sensitivity analysis, however, highlighted the need for additional data to inform and validate the models to increase physiologic relevance and enable G&R model formulation to determine underlying mechanisms of age-dependent healing. This work, as a first, evaluated changes in tendon mechanical properties both as functions of age and injury in an age-dependent manner using microstructurally motivated models, highlights inherent dependencies between parameters of widely used hyperelastic models, and identified unique post-injury behavior by the aging group compared to the mature and aged groups.
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32
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Maxfield MW, Stacy MR, Kurobe H, Tara S, Yi T, Cleary MA, Zhuang ZW, Rodriguez-Davalos MI, Emre SH, Iwakiri Y, Shinoka T, Breuer CK. Novel application and serial evaluation of tissue-engineered portal vein grafts in a murine model. Regen Med 2017; 12:929-938. [PMID: 29215317 DOI: 10.2217/rme-2017-0021] [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: 01/22/2023] Open
Abstract
AIM Surgical management of pediatric extrahepatic portal vein obstruction requires meso-Rex bypass using autologous or synthetic grafts. Tissue-engineered vascular grafts (TEVGs) provide an alternative, but no validated animal models using portal TEVGs exist. Herein, we preclinically assess TEVGs as portal vein bypass grafts. MATERIALS & METHODS TEVGs were implanted as portal vein interposition conduits in SCID-beige mice, monitored by ultrasound and micro-computed tomography, and histologically assessed postmortem at 12 months. RESULTS TEVGs remained patent for 12 months. Histologic analysis demonstrated formation of neovessels that resembled native portal veins, with similar content of smooth muscle cells, collagen type III and elastin. CONCLUSION TEVGs are feasible portal vein conduits in a murine model. Further preclinical evaluation of TEVGs may facilitate pediatric clinical translation.
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Affiliation(s)
- Mark W Maxfield
- Department of Surgery, Yale University School of Medicine, New Haven, CT, USA
| | - Mitchel R Stacy
- Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Hirotsugu Kurobe
- Department of Surgery, Yale University School of Medicine, New Haven, CT, USA
| | - Shuhei Tara
- Department of Surgery, Yale University School of Medicine, New Haven, CT, USA
| | - Tai Yi
- Department of Surgery, Yale University School of Medicine, New Haven, CT, USA
| | - Muriel A Cleary
- Department of Surgery, Yale University School of Medicine, New Haven, CT, USA
| | - Zhen W Zhuang
- Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Manuel I Rodriguez-Davalos
- Department of Surgery, Yale University School of Medicine, New Haven, CT, USA.,Department of Pediatrics, Yale University School of Medicine, New Haven, CT, USA
| | - Sukru H Emre
- Department of Surgery, Yale University School of Medicine, New Haven, CT, USA.,Department of Pediatrics, Yale University School of Medicine, New Haven, CT, USA
| | - Yasuko Iwakiri
- Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Toshiharu Shinoka
- Department of Surgery, Yale University School of Medicine, New Haven, CT, USA.,Department of Pediatrics, Yale University School of Medicine, New Haven, CT, USA
| | - Christopher K Breuer
- Department of Surgery, Yale University School of Medicine, New Haven, CT, USA.,Department of Pediatrics, Yale University School of Medicine, New Haven, CT, USA
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van Haaften EE, Bouten CVC, Kurniawan NA. Vascular Mechanobiology: Towards Control of In Situ Regeneration. Cells 2017; 6:E19. [PMID: 28671618 PMCID: PMC5617965 DOI: 10.3390/cells6030019] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2017] [Revised: 06/16/2017] [Accepted: 06/23/2017] [Indexed: 01/08/2023] Open
Abstract
The paradigm of regenerative medicine has recently shifted from in vitro to in situ tissue engineering: implanting a cell-free, biodegradable, off-the-shelf available scaffold and inducing the development of functional tissue by utilizing the regenerative potential of the body itself. This approach offers a prospect of not only alleviating the clinical demand for autologous vessels but also circumventing the current challenges with synthetic grafts. In order to move towards a hypothesis-driven engineering approach, we review three crucial aspects that need to be taken into account when regenerating vessels: (1) the structure-function relation for attaining mechanical homeostasis of vascular tissues, (2) the environmental cues governing cell function, and (3) the available experimental platforms to test instructive scaffolds for in situ tissue engineering. The understanding of cellular responses to environmental cues leads to the development of computational models to predict tissue formation and maturation, which are validated using experimental platforms recapitulating the (patho)physiological micro-environment. With the current advances, a progressive shift is anticipated towards a rational and effective approach of building instructive scaffolds for in situ vascular tissue regeneration.
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Affiliation(s)
- Eline E van Haaften
- Department of Biomedical Engineering, Eindhoven University of Technology, PO Box 513, 5600 MB Eindhoven, The Netherlands.
- Institute for Complex Molecular Systems, Eindhoven University of Technology, PO Box 513, 5600 MB Eindhoven, The Netherlands.
| | - Carlijn V C Bouten
- Department of Biomedical Engineering, Eindhoven University of Technology, PO Box 513, 5600 MB Eindhoven, The Netherlands.
- Institute for Complex Molecular Systems, Eindhoven University of Technology, PO Box 513, 5600 MB Eindhoven, The Netherlands.
| | - Nicholas A Kurniawan
- Department of Biomedical Engineering, Eindhoven University of Technology, PO Box 513, 5600 MB Eindhoven, The Netherlands.
- Institute for Complex Molecular Systems, Eindhoven University of Technology, PO Box 513, 5600 MB Eindhoven, The Netherlands.
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Wissing TB, Bonito V, Bouten CVC, Smits AIPM. Biomaterial-driven in situ cardiovascular tissue engineering-a multi-disciplinary perspective. NPJ Regen Med 2017; 2:18. [PMID: 29302354 PMCID: PMC5677971 DOI: 10.1038/s41536-017-0023-2] [Citation(s) in RCA: 135] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2016] [Revised: 05/11/2017] [Accepted: 05/19/2017] [Indexed: 12/13/2022] Open
Abstract
There is a persistent and growing clinical need for readily-available substitutes for heart valves and small-diameter blood vessels. In situ tissue engineering is emerging as a disruptive new technology, providing ready-to-use biodegradable, cell-free constructs which are designed to induce regeneration upon implantation, directly in the functional site. The induced regenerative process hinges around the host response to the implanted biomaterial and the interplay between immune cells, stem/progenitor cell and tissue cells in the microenvironment provided by the scaffold in the hemodynamic environment. Recapitulating the complex tissue microstructure and function of cardiovascular tissues is a highly challenging target. Therein the scaffold plays an instructive role, providing the microenvironment that attracts and harbors host cells, modulating the inflammatory response, and acting as a temporal roadmap for new tissue to be formed. Moreover, the biomechanical loads imposed by the hemodynamic environment play a pivotal role. Here, we provide a multidisciplinary view on in situ cardiovascular tissue engineering using synthetic scaffolds; starting from the state-of-the art, the principles of the biomaterial-driven host response and wound healing and the cellular players involved, toward the impact of the biomechanical, physical, and biochemical microenvironmental cues that are given by the scaffold design. To conclude, we pinpoint and further address the main current challenges for in situ cardiovascular regeneration, namely the achievement of tissue homeostasis, the development of predictive models for long-term performances of the implanted grafts, and the necessity for stratification for successful clinical translation.
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Affiliation(s)
- Tamar B Wissing
- Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands.,Institute for Complex Molecular Systems, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - Valentina Bonito
- Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands.,Institute for Complex Molecular Systems, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - Carlijn V C Bouten
- Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands.,Institute for Complex Molecular Systems, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - Anthal I P M Smits
- Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands.,Institute for Complex Molecular Systems, Eindhoven University of Technology, Eindhoven, The Netherlands
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Fukunishi T, Best CA, Ong CS, Groehl T, Reinhardt J, Yi T, Miyachi H, Zhang H, Shinoka T, Breuer CK, Johnson J, Hibino N. Role of Bone Marrow Mononuclear Cell Seeding for Nanofiber Vascular Grafts. Tissue Eng Part A 2017; 24:135-144. [PMID: 28486019 DOI: 10.1089/ten.tea.2017.0044] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
OBJECTIVE Electrospinning is a promising technology that provides biodegradable nanofiber scaffolds for cardiovascular tissue engineering. However, success with these materials has been limited, and the optimal combination of scaffold parameters for a tissue-engineered vascular graft (TEVG) remains elusive. The purpose of the present study is to evaluate the effect of bone marrow mononuclear cell (BM-MNC) seeding in electrospun scaffolds to support the rational design of optimized TEVGs. METHODS Nanofiber scaffolds were fabricated from co-electrospinning a solution of polyglycolic acid and a solution of poly(ι-lactide-co-ɛ-caprolactone) and characterized with scanning electron microscopy. Platelet activation and cell seeding efficiency were assessed by ATP secretion and DNA assays, respectively. Cell-free and BM-MNC seeded scaffolds were implanted in C57BL/6 mice (n = 15/group) as infrarenal inferior vena cava (IVC) interposition conduits. Animals were followed with serial ultrasonography for 6 months, after which grafts were harvested for evaluation of patency and neotissue formation by histology and immunohistochemistry (n = 10/group) and PCR (n = 5/group) analyses. RESULTS BM-MNC seeding of electrospun scaffolds prevented stenosis compared with unseeded scaffolds (seeded: 9/10 patent vs. unseeded: 1/10 patent, p = 0.0003). Seeded vascular grafts demonstrated concentric laminated smooth muscle cells, a confluent endothelial monolayer, and a collagen-rich extracellular matrix. Platelet-derived ATP, a marker of platelet activation, was significantly reduced after incubating thrombin-activated platelets in the presence of seeded scaffolds compared with unseeded scaffolds (p < 0.0001). In addition, reduced macrophage infiltration and a higher M2 macrophage percentage were observed in seeded grafts. CONCLUSIONS The beneficial effects of BM-MNC seeding apply to electrospun TEVG scaffolds by attenuating stenosis through the regulation of platelet activation and inflammatory macrophage function, leading to well-organized neotissue formation. BM-MNC seeding is a valuable technique that can be used in the rational design of optimal TEVG scaffolds.
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Affiliation(s)
- Takuma Fukunishi
- 1 Department of Cardiac Surgery, Johns Hopkins University , Baltimore, Maryland
| | - Cameron A Best
- 2 Tissue Engineering and Surgical Research, Nationwide Children's Hospital , Columbus, Ohio
| | - Chin Siang Ong
- 1 Department of Cardiac Surgery, Johns Hopkins University , Baltimore, Maryland
| | | | - James Reinhardt
- 2 Tissue Engineering and Surgical Research, Nationwide Children's Hospital , Columbus, Ohio
| | - Tai Yi
- 2 Tissue Engineering and Surgical Research, Nationwide Children's Hospital , Columbus, Ohio
| | - Hideki Miyachi
- 2 Tissue Engineering and Surgical Research, Nationwide Children's Hospital , Columbus, Ohio
| | - Huaitao Zhang
- 1 Department of Cardiac Surgery, Johns Hopkins University , Baltimore, Maryland
| | - Toshiharu Shinoka
- 2 Tissue Engineering and Surgical Research, Nationwide Children's Hospital , Columbus, Ohio
| | - Christopher K Breuer
- 2 Tissue Engineering and Surgical Research, Nationwide Children's Hospital , Columbus, Ohio
| | - Jed Johnson
- 3 Nanofiber Solutions, Inc. , Columbus, Ohio
| | - Narutoshi Hibino
- 1 Department of Cardiac Surgery, Johns Hopkins University , Baltimore, Maryland
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36
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Kluin J, Talacua H, Smits AIPM, Emmert MY, Brugmans MCP, Fioretta ES, Dijkman PE, Söntjens SHM, Duijvelshoff R, Dekker S, Janssen-van den Broek MWJT, Lintas V, Vink A, Hoerstrup SP, Janssen HM, Dankers PYW, Baaijens FPT, Bouten CVC. In situ heart valve tissue engineering using a bioresorbable elastomeric implant - From material design to 12 months follow-up in sheep. Biomaterials 2017; 125:101-117. [PMID: 28253994 DOI: 10.1016/j.biomaterials.2017.02.007] [Citation(s) in RCA: 191] [Impact Index Per Article: 27.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2016] [Revised: 12/21/2016] [Accepted: 02/06/2017] [Indexed: 01/09/2023]
Abstract
The creation of a living heart valve is a much-wanted alternative for current valve prostheses that suffer from limited durability and thromboembolic complications. Current strategies to create such valves, however, require the use of cells for in vitro culture, or decellularized human- or animal-derived donor tissue for in situ engineering. Here, we propose and demonstrate proof-of-concept of in situ heart valve tissue engineering using a synthetic approach, in which a cell-free, slow degrading elastomeric valvular implant is populated by endogenous cells to form new valvular tissue inside the heart. We designed a fibrous valvular scaffold, fabricated from a novel supramolecular elastomer, that enables endogenous cells to enter and produce matrix. Orthotopic implantations as pulmonary valve in sheep demonstrated sustained functionality up to 12 months, while the implant was gradually replaced by a layered collagen and elastic matrix in pace with cell-driven polymer resorption. Our results offer new perspectives for endogenous heart valve replacement starting from a readily-available synthetic graft that is compatible with surgical and transcatheter implantation procedures.
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Affiliation(s)
- Jolanda Kluin
- Department of Cardiothoracic Surgery, Academic Medical Center, Amsterdam, The Netherlands; Department of Cardiothoracic Surgery, University Medical Center, Utrecht, The Netherlands
| | - Hanna Talacua
- Department of Cardiothoracic Surgery, Academic Medical Center, Amsterdam, The Netherlands; Department of Cardiothoracic Surgery, University Medical Center, Utrecht, The Netherlands
| | - Anthal I P M Smits
- Department of Biomedical Engineering, Eindhoven University of Technology, The Netherlands; Institute for Complex Molecular Systems (ICMS), Eindhoven University of Technology, The Netherlands
| | - Maximilian Y Emmert
- Institute for Regenerative Medicine (IREM), University of Zürich, Switzerland; Heart Center Zürich, University Hospital Zürich, Switzerland; Wyss Translational Center Zürich, ETH and University of Zürich, Switzerland
| | | | - Emanuela S Fioretta
- Institute for Regenerative Medicine (IREM), University of Zürich, Switzerland
| | - Petra E Dijkman
- Institute for Regenerative Medicine (IREM), University of Zürich, Switzerland
| | | | - Renée Duijvelshoff
- Department of Biomedical Engineering, Eindhoven University of Technology, The Netherlands; Institute for Complex Molecular Systems (ICMS), Eindhoven University of Technology, The Netherlands
| | - Sylvia Dekker
- Department of Biomedical Engineering, Eindhoven University of Technology, The Netherlands
| | | | - Valentina Lintas
- Institute for Regenerative Medicine (IREM), University of Zürich, Switzerland
| | - Aryan Vink
- Department of Pathology, University Medical Center, Utrecht, The Netherlands
| | - Simon P Hoerstrup
- Department of Biomedical Engineering, Eindhoven University of Technology, The Netherlands; Institute for Regenerative Medicine (IREM), University of Zürich, Switzerland; Wyss Translational Center Zürich, ETH and University of Zürich, Switzerland
| | | | - Patricia Y W Dankers
- Department of Biomedical Engineering, Eindhoven University of Technology, The Netherlands; Institute for Complex Molecular Systems (ICMS), Eindhoven University of Technology, The Netherlands
| | - Frank P T Baaijens
- Department of Biomedical Engineering, Eindhoven University of Technology, The Netherlands; Institute for Complex Molecular Systems (ICMS), Eindhoven University of Technology, The Netherlands
| | - Carlijn V C Bouten
- Department of Biomedical Engineering, Eindhoven University of Technology, The Netherlands; Institute for Complex Molecular Systems (ICMS), Eindhoven University of Technology, The Netherlands.
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37
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Cyron CJ, Humphrey JD. Growth and Remodeling of Load-Bearing Biological Soft Tissues. MECCANICA 2017; 52:645-664. [PMID: 28286348 PMCID: PMC5342900 DOI: 10.1007/s11012-016-0472-5] [Citation(s) in RCA: 71] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
The past two decades reveal a growing role of continuum biomechanics in understanding homeostasis, adaptation, and disease progression in soft tissues. In this paper, we briefly review the two primary theoretical approaches for describing mechano-regulated soft tissue growth and remodeling on the continuum level as well as hybrid approaches that attempt to combine the advantages of these two approaches while avoiding their disadvantages. We also discuss emerging concepts, including that of mechanobiological stability. Moreover, to motivate and put into context the different theoretical approaches, we briefly review findings from mechanobiology that show the importance of mass turnover and the prestressing of both extant and new extracellular matrix in most cases of growth and remodeling. For illustrative purposes, these concepts and findings are discussed, in large part, within the context of two load-bearing, collagen dominated soft tissues - tendons/ligaments and blood vessels. We conclude by emphasizing further examples, needs, and opportunities in this exciting field of modeling soft tissues.
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Affiliation(s)
- C J Cyron
- Institute for Computational Mechanics, Technische Universität München, Garching, Germany
| | - J D Humphrey
- Department of Biomedical Engineering, Yale University, New Haven, CT, USA; Vascular Biology and Therapeutics Program, Yale School of Medicine, New Haven, CT, USA
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38
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Pepper VK, Clark ES, Best CA, Onwuka EA, Sugiura T, Heuer ED, Moko LE, Miyamoto S, Miyachi H, Berman DP, Cheatham SL, Chisolm JL, Shinoka T, Breuer CK, Cheatham JP. Intravascular Ultrasound Characterization of a Tissue-Engineered Vascular Graft in an Ovine Model. J Cardiovasc Transl Res 2017; 10:128-138. [PMID: 28097523 DOI: 10.1007/s12265-016-9725-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2016] [Accepted: 12/22/2016] [Indexed: 12/19/2022]
Abstract
Patients who undergo implantation of a tissue-engineered vascular graft (TEVG) for congenital cardiac anomalies are monitored with echocardiography, followed by magnetic resonance imaging or angiography when indicated. While these methods provide data regarding the lumen, minimal information regarding neotissue formation is obtained. Intravascular ultrasound (IVUS) has previously been used in a variety of conditions to evaluate the vessel wall. The purpose of this study was to evaluate the utility of IVUS for evaluation of TEVGs in our ovine model. Eight sheep underwent implantation of TEVGs either unseeded or seeded with bone marrow-derived mononuclear cells. Angiography, IVUS, and histology were directly compared. Endothelium, tunica media, and graft were identifiable on IVUS and histology at multiple time points. There was strong agreement between IVUS and angiography for evaluation of luminal diameter. IVUS offers a valuable tool to evaluate the changes within TEVGs, and clinical translation of this application is warranted.
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Affiliation(s)
- Victoria K Pepper
- Tissue Engineering Program, Research Institute at Nationwide Children's Hospital, 700 Children's Drive, WB 4154, Columbus, OH, 43205, USA
- Department of Pediatric Surgery, Nationwide Children's Hospital, Columbus, OH, USA
| | - Elizabeth S Clark
- Tissue Engineering Program, Research Institute at Nationwide Children's Hospital, 700 Children's Drive, WB 4154, Columbus, OH, 43205, USA
- College of Veterinary Medicine, The Ohio State University, Columbus, OH, USA
| | - Cameron A Best
- Tissue Engineering Program, Research Institute at Nationwide Children's Hospital, 700 Children's Drive, WB 4154, Columbus, OH, 43205, USA
| | - Ekene A Onwuka
- Tissue Engineering Program, Research Institute at Nationwide Children's Hospital, 700 Children's Drive, WB 4154, Columbus, OH, 43205, USA
- Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Tadahisa Sugiura
- Division of Cardiothoracic Transplant & Mechanical Circulatory Support, Texas Heart Institute at Baylor St. Luke's Medical Center, Houston, TX, USA
| | - Eric D Heuer
- Tissue Engineering Program, Research Institute at Nationwide Children's Hospital, 700 Children's Drive, WB 4154, Columbus, OH, 43205, USA
| | - Lilamarie E Moko
- Tissue Engineering Program, Research Institute at Nationwide Children's Hospital, 700 Children's Drive, WB 4154, Columbus, OH, 43205, USA
| | - Shinka Miyamoto
- Tissue Engineering Program, Research Institute at Nationwide Children's Hospital, 700 Children's Drive, WB 4154, Columbus, OH, 43205, USA
| | - Hideki Miyachi
- Tissue Engineering Program, Research Institute at Nationwide Children's Hospital, 700 Children's Drive, WB 4154, Columbus, OH, 43205, USA
| | - Darren P Berman
- The Heart Center, Nationwide Children's Hospital, Columbus, OH, USA
| | | | - Joanne L Chisolm
- The Heart Center, Nationwide Children's Hospital, Columbus, OH, USA
| | - Toshiharu Shinoka
- Tissue Engineering Program, Research Institute at Nationwide Children's Hospital, 700 Children's Drive, WB 4154, Columbus, OH, 43205, USA
- The Heart Center, Nationwide Children's Hospital, Columbus, OH, USA
- Department of Cardiothoracic Surgery, Nationwide Children's Hospital, Columbus, OH, USA
| | - Christopher K Breuer
- Tissue Engineering Program, Research Institute at Nationwide Children's Hospital, 700 Children's Drive, WB 4154, Columbus, OH, 43205, USA.
- Department of Pediatric Surgery, Nationwide Children's Hospital, Columbus, OH, USA.
| | - John P Cheatham
- The Heart Center, Nationwide Children's Hospital, Columbus, OH, USA
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39
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Best C, Onwuka E, Pepper V, Sams M, Breuer J, Breuer C. Cardiovascular Tissue Engineering: Preclinical Validation to Bedside Application. Physiology (Bethesda) 2017; 31:7-15. [PMID: 26661524 DOI: 10.1152/physiol.00018.2015] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Advancements in biomaterial science and available cell sources have spurred the translation of tissue-engineering technology to the bedside, addressing the pressing clinical demands for replacement cardiovascular tissues. Here, the in vivo status of tissue-engineered blood vessels, heart valves, and myocardium is briefly reviewed, illustrating progress toward a tissue-engineered heart for clinical use.
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Affiliation(s)
- Cameron Best
- Tissue Engineering and Surgical Research, The Research Institute at Nationwide Children's Hospital, Columbus, Ohio
| | - Ekene Onwuka
- Tissue Engineering and Surgical Research, The Research Institute at Nationwide Children's Hospital, Columbus, Ohio; Department of Surgery, The Ohio State University, Wexner Medical Center, Columbus, Ohio; and
| | - Victoria Pepper
- Tissue Engineering and Surgical Research, The Research Institute at Nationwide Children's Hospital, Columbus, Ohio; Department of Pediatric Surgery, Nationwide Children's Hospital, Columbus, Ohio
| | - Malik Sams
- Tissue Engineering and Surgical Research, The Research Institute at Nationwide Children's Hospital, Columbus, Ohio
| | - Jake Breuer
- Tissue Engineering and Surgical Research, The Research Institute at Nationwide Children's Hospital, Columbus, Ohio
| | - Christopher Breuer
- Tissue Engineering and Surgical Research, The Research Institute at Nationwide Children's Hospital, Columbus, Ohio; Department of Surgery, The Ohio State University, Wexner Medical Center, Columbus, Ohio; and Department of Pediatric Surgery, Nationwide Children's Hospital, Columbus, Ohio
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40
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Smits AI, Bonito V, Stoddart M. In Situ Tissue Engineering: Seducing the Body to Regenerate. Tissue Eng Part A 2016; 22:1061-2. [DOI: 10.1089/ten.tea.2016.0247] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Anthal I.P.M. Smits
- Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
- Institute for Complex Molecular Systems, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - Valentina Bonito
- Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
- Institute for Complex Molecular Systems, Eindhoven University of Technology, Eindhoven, The Netherlands
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41
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Loerakker S, Ristori T, Baaijens FPT. A computational analysis of cell-mediated compaction and collagen remodeling in tissue-engineered heart valves. J Mech Behav Biomed Mater 2015; 58:173-187. [PMID: 26608336 DOI: 10.1016/j.jmbbm.2015.10.001] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2015] [Revised: 09/28/2015] [Accepted: 10/01/2015] [Indexed: 12/11/2022]
Abstract
One of the most critical problems in heart valve tissue engineering is the progressive development of valvular insufficiency due to leaflet retraction. Understanding the underlying mechanisms of this process is crucial for developing tissue-engineered heart valves (TEHVs) that maintain their functionality in the long term. In the present study, we adopted a computational approach to predict the remodeling process in TEHVs subjected to dynamic pulmonary and aortic pressure conditions, and to assess the risk of valvular insufficiency. In addition, we investigated the importance of the intrinsic cell contractility on the final outcome of the remodeling process. For valves implanted in the aortic position, the model predictions suggest that valvular insufficiency is not likely to occur as the blood pressure is high enough to prevent the development of leaflet retraction. In addition, the collagen network was always predicted to remodel towards a circumferentially aligned network, which is corresponding to the native situation. In contrast, for valves implanted in the pulmonary position, our model predicted that there is a high risk for the development of valvular insufficiency, unless the cell contractility is very low. Conversely, the development of a circumferential collagen network was only predicted at these pressure conditions when cell contractility was high. Overall, these results, therefore, suggest that tissue remodeling at aortic pressure conditions is much more stable and favorable compared to tissue remodeling at pulmonary pressure conditions.
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Affiliation(s)
- Sandra Loerakker
- Department of Biomedical Engineering, Eindhoven University of Technology, P.O. Box 513, 5600 MB Eindhoven, The Netherlands; Institute for Complex Molecular Systems, Eindhoven University of Technology, P.O. Box 513, 5600 MB Eindhoven, The Netherlands.
| | - Tommaso Ristori
- Department of Biomedical Engineering, Eindhoven University of Technology, P.O. Box 513, 5600 MB Eindhoven, The Netherlands; Institute for Complex Molecular Systems, Eindhoven University of Technology, P.O. Box 513, 5600 MB Eindhoven, The Netherlands
| | - Frank P T Baaijens
- Department of Biomedical Engineering, Eindhoven University of Technology, P.O. Box 513, 5600 MB Eindhoven, The Netherlands; Institute for Complex Molecular Systems, Eindhoven University of Technology, P.O. Box 513, 5600 MB Eindhoven, The Netherlands
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