Acellular Tissue-Engineered Vascular Grafts from Polymers: Methods, Achievements, Characterization, and Challenges

Extensive and permanent damage to the vasculature leading to different pathogenesis calls for developing innovative therapeutics, including drugs, medical devices, and cell therapies. Innovative strategies to engineer bioartificial/biomimetic vessels have been extensively exploited as an effective replacement for vessels that have seriously malfunctioned. However, further studies in polymer chemistry, additive manufacturing, and rapid prototyping are required to generate highly engineered vascular segments that can be effectively integrated into the existing vasculature of patients. One recently developed approach involves designing and fabricating acellular vessel equivalents from novel polymeric materials. This review aims to assess the design criteria, engineering factors, and innovative approaches for the fabrication and characterization of biomimetic macro- and micro-scale vessels. At the same time, the engineering correlation between the physical properties of the polymer and biological functionalities of multiscale acellular vascular segments are thoroughly elucidated. Moreover, several emerging characterization techniques for probing the mechanical properties of tissue-engineered vascular grafts are revealed. Finally, significant challenges to the clinical transformation of the highly promising engineered vessels derived from polymers are identified, and unique perspectives on future research directions are presented.

Electrospun nanofiber scaffold for vascular tissue engineering

Due to the prevalence of cardiovascular diseases, there is a large need for small diameter vascular grafts that cannot be fulfilled using autologous vessels. Although medium to large diameter synthetic vessels are in use, no suitable small diameter vascular graft has been developed due to the unique dynamic environment that exists in small vessels. To achieve long term patency, a successful tissue engineered vascular graft would need to closely match the mechanical properties of native tissue, be non-thrombotic and non-immunogenic, and elicit the proper healing response and undergo remodeling to incorporate into the native vasculature. Electrospinning presents a promising approach to the development of a suitable tissue engineered vascular graft. This review provides a comprehensive overview of the different polymers, techniques, and functionalization approaches that have been used to develop an electrospun tissue engineered vascular graft.

Tubular Electrospun Vancomycin-Loaded Vascular Grafts: Formulation Study and Physicochemical Characterization

This work aimed at formulating tubular grafts electrospun with a size < 6 mm and incorporating vancomycin as an antimicrobial agent. Compared to other papers, the present study succeeded in using medical healthcare-grade polymers and solvents permitted by ICH Topic Q3C (R4). Vancomycin (VMC) was incorporated into polyester synthetic polymers (poly-L-lactide-co-poly-ε-caprolactone and poly lactide-co-glycolide) using permitted solvents; moreover, a surfactant was added to the formulation in order to avoid the precipitation of VMC on fiber surface. A preliminary preformulation study was carried out to evaluate solubility of VMC in different aqueous and organic solvents and its stability. To reduce size of fibers and their orientation, we studied a solvent system based on methylene chloride and acetone (DCM/acetone), at different ratios (80:20, 70:30, and 60:40). Considering conductivity of solutions and their spinnability, solvent system at a 80:20 ratio was selected for the study. SEM images demonstrated that size of fibers, their distribution, and their orientation were affected by the incorporation of VMC and surfactant into polymer solution. Surfactant allowed for the reduction of precipitates of VMC on fiber surface, which are responsible of the high burst release in the first six hours; the release was mainly dependent on graft structure porosity, number of pores, and graft absorbent capability. A controlled release of VMC was achieved, covering a period from 96 to 168 h as a function of composition and structure; the concentration of VMC was significantly beyond VMC minimum inhibitory concentration (MIC, 2 ug/mL). These results indicated that the VMC tubular electrospun grafts not only controlled the local release of VMC, but also avoided onset of antibiotic resistance.

Current Strategies for the Regeneration of Skeletal Muscle Tissue

Traumatic injuries, tumor resections, and degenerative diseases can damage skeletal muscle and lead to functional impairment and severe disability. Skeletal muscle regeneration is a complex process that depends on various cell types, signaling molecules, architectural cues, and physicochemical properties to be successful. To promote muscle repair and regeneration, various strategies for skeletal muscle tissue engineering have been developed in the last decades. However, there is still a high demand for the development of new methods and materials that promote skeletal muscle repair and functional regeneration to bring approaches closer to therapies in the clinic that structurally and functionally repair muscle. The combination of stem cells, biomaterials, and biomolecules is used to induce skeletal muscle regeneration. In this review, we provide an overview of different cell types used to treat skeletal muscle injury, highlight current strategies in biomaterial-based approaches, the importance of topography for the successful creation of functional striated muscle fibers, and discuss novel methods for muscle regeneration and challenges for their future clinical implementation.

An integrated strategy for designing and fabricating triple-layer vascular graft with oriented microgrooves to promote endothelialization

Compared with native blood vessels and existing vascular grafts, design and manufacture of vascular grafts with a three-dimensional topological structure is a key to induce cells and tissue growth, which remains an essential issue in both tissue engineering and regenerative medicine. This study sought to develop a novel triple-layer vascular graft (TLVG) with oriented microgrooves to investigate the mechanical property and endothelialization. The TLVGs were composed of electrospun Poly-ε-caprolactone (PCL)/thermoplastic polyurethane (TPU) as the inner layer, albumen/sodium alginate (SA) hydrogel as the middle layer, and electrospun PCL/TPU as the outer layer. In detail, a cylindrical sacrificial template was designed and printed using polyvinyl alcohol (PVA), served as the electrospinning receiving platform to form the oriented microgrooves in the inner layer of TLVGs. The highly elastic albumen/SA hydrogel and PCL/TPU nanofibers were able to simulate the elastin in blood vessels. In addition, the introduction of the albumen/SA hydrogel layer not only solves the leakage problem of a porous vascular graft but also improves the wettability of the scaffolds. The physicochemical properties and biological characteristics of TLVGs were evaluated by tensile testing, Surface wettability test, Fourier transform-infrared spectroscopy (FTIR) measurement, Live-Dead cell staining assay, and CCK-8 assay. Especially, the oriented microgrooves on the inner surface of the TLVGs can promote human umbilical vein endothelial cells (HUVECs) directed growth and migration in favor of endothelialization. All results showed that the fabricated TLVGs with excellent physicochemical properties and biocompatibility has great potential in clinic application.

Electrospun tubular vascular grafts to replace damaged peripheral arteries: A preliminary formulation study

Polymeric tubular vascular grafts represent a likely alternative to autologous vascular grafts for treating peripheral artery occlusive disease. This preliminary research study applied cutting-edge electrospinning technique for manufacturing prototypes with diameter ≤ 6 mm and based on biocompatible and biodegradable polymers such as polylactide-polycaprolactone, polylactide-co-glycolide and polyhydroxyethylmethacrylate combined in different design approaches (layering and blending). Samples were characterized about fiber morphology, diameter, size distribution, porosity, fluid uptake capability, and mechanical properties. Biocompatibility and cell interaction were evaluated by in vitro test. Goal of this preliminary study was to discriminate among the prototypes and select which composition and design approach could better suit tissue regeneration purposes. Results showed that electrospinning technique is suitable to obtain grafts with a diameter < 6 mm and thickness between 140 ± 7-175 ± 4 μm. Scanning electron microscopy analysis showed fibers with suitable micrometric diameters and pore size between 5 and 35 μm. polyhydroxyethylmethacrylate provided high hydrophilicity (≃ 100°) and optimal cell short term proliferation (cell viability ≃ 160%) in accordance with maximum fluid uptake ability (300-350%). Moreover, addition of polyhydroxyethylmethacrylate lowered suture retention strength at value < 1 N. Prototypes obtaining combining polylactide-co-glycolide and polylactide-coglycolide/ polyhydroxyethylmethacrylate with polylactide-polycaprolactone in a bilayered structure showed optimal mechanical behavior resembling native bovine vessel.