1
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Sesa M, Holthusen H, Lamm L, Böhm C, Brepols T, Jockenhövel S, Reese S. Mechanical modeling of the maturation process for tissue-engineered implants: Application to biohybrid heart valves. Comput Biol Med 2023; 167:107623. [PMID: 37922603 DOI: 10.1016/j.compbiomed.2023.107623] [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] [Received: 07/09/2023] [Revised: 09/18/2023] [Accepted: 10/23/2023] [Indexed: 11/07/2023]
Abstract
The development of tissue-engineered cardiovascular implants can improve the lives of large segments of our society who suffer from cardiovascular diseases. Regenerative tissues are fabricated using a process called tissue maturation. Furthermore, it is highly challenging to produce cardiovascular regenerative implants with sufficient mechanical strength to withstand the loading conditions within the human body. Therefore, biohybrid implants for which the regenerative tissue is reinforced by standard reinforcement material (e.g. textile or 3d printed scaffold) can be an interesting solution. In silico models can significantly contribute to characterizing, designing, and optimizing biohybrid implants. The first step towards this goal is to develop a computational model for the maturation process of tissue-engineered implants. This paper focuses on the mechanical modeling of textile-reinforced tissue-engineered cardiovascular implants. First, an energy-based approach is proposed to compute the collagen evolution during the maturation process. Then, the concept of structural tensors is applied to model the anisotropic behavior of the extracellular matrix and the textile scaffold. Next, the newly developed material model is embedded into a special solid-shell finite element formulation with reduced integration. Finally, our framework is used to compute two structural problems: a pressurized shell construct and a tubular-shaped heart valve. The results show the ability of the model to predict collagen growth in response to the boundary conditions applied during the maturation process. Consequently, the model can predict the implant's mechanical response, such as the deformation and stresses of the implant.
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Affiliation(s)
- Mahmoud Sesa
- Institute of Applied Mechanics, RWTH Aachen University, Mies-van-der-Rohe-Str. 1, 52074 Aachen, Germany.
| | - Hagen Holthusen
- Institute of Applied Mechanics, RWTH Aachen University, Mies-van-der-Rohe-Str. 1, 52074 Aachen, Germany
| | - Lukas Lamm
- Institute of Applied Mechanics, RWTH Aachen University, Mies-van-der-Rohe-Str. 1, 52074 Aachen, Germany
| | - Christian Böhm
- Biohybrid & Medical Textiles, Institute of Applied Medical Engineering, RWTH Aachen University, Forckenbeckstr. 55, 52074 Aachen, Germany
| | - Tim Brepols
- Institute of Applied Mechanics, RWTH Aachen University, Mies-van-der-Rohe-Str. 1, 52074 Aachen, Germany
| | - Stefan Jockenhövel
- Biohybrid & Medical Textiles, Institute of Applied Medical Engineering, RWTH Aachen University, Forckenbeckstr. 55, 52074 Aachen, Germany
| | - Stefanie Reese
- Institute of Applied Mechanics, RWTH Aachen University, Mies-van-der-Rohe-Str. 1, 52074 Aachen, Germany
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2
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Snyder Y, Jana S. Strategies for Development of Synthetic Heart Valve Tissue Engineering Scaffolds. PROGRESS IN MATERIALS SCIENCE 2023; 139:101173. [PMID: 37981978 PMCID: PMC10655624 DOI: 10.1016/j.pmatsci.2023.101173] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2023]
Abstract
The current clinical solutions, including mechanical and bioprosthetic valves for valvular heart diseases, are plagued by coagulation, calcification, nondurability, and the inability to grow with patients. The tissue engineering approach attempts to resolve these shortcomings by producing heart valve scaffolds that may deliver patients a life-long solution. Heart valve scaffolds serve as a three-dimensional support structure made of biocompatible materials that provide adequate porosity for cell infiltration, and nutrient and waste transport, sponsor cell adhesion, proliferation, and differentiation, and allow for extracellular matrix production that together contributes to the generation of functional neotissue. The foundation of successful heart valve tissue engineering is replicating native heart valve architecture, mechanics, and cellular attributes through appropriate biomaterials and scaffold designs. This article reviews biomaterials, the fabrication of heart valve scaffolds, and their in-vitro and in-vivo evaluations applied for heart valve tissue engineering.
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Affiliation(s)
- Yuriy Snyder
- Department of Bioengineering, University of Missouri, Columbia, MO 65211, USA
| | - Soumen Jana
- Department of Bioengineering, University of Missouri, Columbia, MO 65211, USA
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3
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de Kanter AFJ, Jongsma KR, Bouten CVC, Bredenoord AL. How Smart are Smart Materials? A Conceptual and Ethical Analysis of Smart Lifelike Materials for the Design of Regenerative Valve Implants. SCIENCE AND ENGINEERING ETHICS 2023; 29:33. [PMID: 37668955 PMCID: PMC10480256 DOI: 10.1007/s11948-023-00453-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Accepted: 08/09/2023] [Indexed: 09/06/2023]
Abstract
It may soon become possible not just to replace, but to re-grow healthy tissues after injury or disease, because of innovations in the field of Regenerative Medicine. One particularly promising innovation is a regenerative valve implant to treat people with heart valve disease. These implants are fabricated from so-called 'smart', 'lifelike' materials. Implanted inside a heart, these implants stimulate re-growth of a healthy, living heart valve. While the technological development advances, the ethical implications of this new technology are still unclear and a clear conceptual understanding of the notions 'smart' and 'lifelike' is currently lacking. In this paper, we explore the conceptual and ethical implications of the development of smart lifelike materials for the design of regenerative implants, by analysing heart valve implants as a showcase. In our conceptual analysis, we show that the materials are considered 'smart' because they can communicate with human tissues, and 'lifelike' because they are structurally similar to these tissues. This shows that regenerative valve implants become intimately integrated in the living tissues of the human body. As such, they manifest the ontological entanglement of body and technology. In our ethical analysis, we argue this is ethically significant in at least two ways: It exacerbates the irreversibility of the implantation procedure, and it might affect the embodied experience of the implant recipient. With our conceptual and ethical analysis, we aim to contribute to responsible development of smart lifelike materials and regenerative implants.
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Affiliation(s)
- Anne-Floor J de Kanter
- Department of Bioethics and Health Humanities, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, 3508 GA, Utrecht, The Netherlands.
| | - Karin R Jongsma
- Department of Bioethics and Health Humanities, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, 3508 GA, Utrecht, The Netherlands
| | - Carlijn V C Bouten
- Department of Biomedical Engineering and Institute for Complex Molecular Systems, Eindhoven University of Technology, 5600 MB, Eindhoven, The Netherlands
| | - Annelien L Bredenoord
- Department of Bioethics and Health Humanities, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, 3508 GA, Utrecht, The Netherlands
- Erasmus School of Philosophy, Erasmus University Rotterdam, 3062 PA, Rotterdam, The Netherlands
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4
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Terzano M, Wollner MP, Kainz MP, Rolf-Pissarczyk M, Götzen N, Holzapfel GA. Modelling the anisotropic inelastic response of polymeric scaffolds for in situ tissue engineering applications. J R Soc Interface 2023; 20:20230318. [PMID: 37700713 PMCID: PMC10498354 DOI: 10.1098/rsif.2023.0318] [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: 06/01/2023] [Accepted: 08/18/2023] [Indexed: 09/14/2023] Open
Abstract
In situ tissue engineering offers an innovative solution for replacement valves and grafts in cardiovascular medicine. In this approach, a scaffold, which can be obtained by polymer electrospinning, is implanted into the human body and then infiltrated by cells, eventually replacing the scaffold with native tissue. In silico simulations of the whole process in patient-specific models, including implantation, growth and degradation, are very attractive to study the factors that might influence the end result. In our research, we focused on the mechanical behaviour of the polymeric scaffold and its short-term response. Following a recently proposed constitutive model for the anisotropic inelastic behaviour of fibrous polymeric materials, we present here its numerical implementation in a finite element framework. The numerical model is developed as user material for commercial finite element software. The verification of the implementation is performed for elementary deformations. Furthermore, a parallel-plate test is proposed as a large-scale representative example, and the model is validated by comparison with experiments.
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Affiliation(s)
- Michele Terzano
- Institute of Biomechanics, Graz University of Technology, Graz, Austria
| | | | - Manuel P. Kainz
- Institute of Biomechanics, Graz University of Technology, Graz, Austria
| | | | - Nils Götzen
- 4RealSim Services BV, IJsselstein, The Netherlands
| | - Gerhard A. Holzapfel
- Institute of Biomechanics, Graz University of Technology, Graz, Austria
- Department of Structural Engineering, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
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5
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Carrel T. Past, present, and future options for right ventricular outflow tract reconstruction. Front Surg 2023; 10:1185324. [PMID: 37334202 PMCID: PMC10272445 DOI: 10.3389/fsurg.2023.1185324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 04/17/2023] [Indexed: 06/20/2023] Open
Abstract
The pulmonary valve is the most frequently replaced cardiac valve in congenital heart diseases. Whether the valve alone or part of the right ventricular outflow tract have to be repaired or replaced depends on the specific pathological anatomy of the malformation. Once the decision to replace the pulmonary valve has been made, two options are available: the isolated transcatheter pulmonary valve replacement and the surgical implantation of a prosthetic valve either isolated or in combination with a procedure on the right ventricular outflow tract. In this paper, we will focus on the different past and present surgical options and present a new concept called "endogenous tissue restoration," a promising alternative to the hitherto existing implants. From a general point of view, neither the transcatheter nor the surgical valvular implants are magic bullets in the arsenal for the management of valvular diseases. Smaller valves have to be frequently replaced because of outgrowth of the patients, larger tissue valves may present late structural valve deterioration, while xenograft and homograft conduits may calcify and therefore become narrowed within unpredictable incidence and interval following implantation. Based on long-term research efforts combining the knowledge of supramolecular chemistry, electrospinning, and regenerative medicine, endogenous tissue restoration has emerged most recently as a promising option to create long-term functioning implants. This technology is appealing because following resorption of the polymer scaffold and timely replacement through autologous tissue, no foreign material remain at all in the cardiovascular system. Proof-of-concept studies as well as small first-in-man series have been completed and have demonstrated favorable anatomic and hemodynamic results, comparable to currently available implants in the short term. Based on the initial experience, important modifications to improve the pulmonary valve function have been initiated.
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van der Valk DC, Fomina A, Uiterwijk M, Hooijmans CR, Akiva A, Kluin J, Bouten CV, Smits AI. Calcification in Pulmonary Heart Valve Tissue Engineering. JACC Basic Transl Sci 2023. [DOI: 10.1016/j.jacbts.2022.09.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
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7
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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: 27] [Impact Index Per Article: 9.0] [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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8
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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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9
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Chester AH, Grande-Allen KJ. Which Biological Properties of Heart Valves Are Relevant to Tissue Engineering? Front Cardiovasc Med 2020; 7:63. [PMID: 32373630 PMCID: PMC7186395 DOI: 10.3389/fcvm.2020.00063] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Accepted: 03/27/2020] [Indexed: 12/30/2022] Open
Abstract
Over the last 20 years, the designs of tissue engineered heart valves have evolved considerably. An initial focus on replicating the mechanical and structural features of semilunar valves has expanded to endeavors to mimic the biological behavior of heart valve cells as well. Studies on the biology of heart valves have shown that the function and durability of native valves is underpinned by complex interactions between the valve cells, the extracellular matrix, and the mechanical environment in which heart valves function. The ability of valve interstitial cells to synthesize extracellular matrix proteins and remodeling enzymes and the protective mediators released by endothelial cells are key factors in the homeostasis of valve function. The extracellular matrix provides the mechanical strength and flexibility required for the valve to function, as well as communicating with the cells that are bound within. There are a number of regulatory mechanisms that influence valve function, which include neuronal mechanisms and the tight regulation of growth and angiogenic factors. Together, studies into valve biology have provided a blueprint for what a tissue engineered valve would need to be capable of, in order to truly match the function of the native valve. This review addresses the biological functions of heart valve cells, in addition to the influence of the cells' environment on this behavior and examines how well these functions are addressed within the current strategies for tissue engineering heart valves in vitro, in vivo, and in situ.
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Affiliation(s)
- Adrian H Chester
- Heart Science Centre, The Magdi Yacoub Institute, Harefield, United Kingdom
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10
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Wollmann LC, Suss PH, Kraft L, Ribeiro VS, Noronha L, da Costa FDA, Tuon FF. Histological and Biomechanical Characteristics of Human Decellularized Allograft Heart Valves After Eighteen Months of Storage in Saline Solution. Biopreserv Biobank 2020; 18:90-101. [PMID: 31990593 DOI: 10.1089/bio.2019.0106] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Background: The best storage preservation method for maintaining the quality and safety of human decellularized allograft heart valves is yet to be established. Objective: The aim of the present study was to evaluate the stability in terms of extracellular matrix (ECM) integrity of human heart valve allografts decellularized using sodium dodecyl sulfate-ethylenediaminetetraacetic acid (SDS-EDTA) and stored for 6, 12, and 18 months. Methods: A total of 70 decellularized aortic and pulmonary valves were analyzed across different storage times (0, 6, 12, and 18 months) for solution pH measurements, histological findings, cytotoxicity assay results, biomechanical test results, and microbiological suitability test results. Continuous data were analyzed using one-way analysis of variance comparing the follow-up times. Results: The pH of the stock solution did not change during the different time points, and no microbial growth occurred up to 18 months. Histological analysis showed that the decellularized allografts did not present deleterious outcomes or signs of structural degeneration in the ECM up to 12 months. The biomechanical properties showed changes over time in different aspects. Allografts stored for 18 months presented lower tensile strength and elasticity than those stored for 12 months (p < 0.05). The microbiological suitability test suggested no residual antimicrobial effects. Conclusion: Changes in the structure and functionality of SDS-EDTA decellularized heart valve allografts occur after 12 months of storage.
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Affiliation(s)
- Luciana Cristina Wollmann
- School of Medicine, Pontifícia Universidade Católica do Paraná, Curitiba, Brazil.,Tissue Bank, Pontifícia Universidade Católica do Paraná, Curitiba, Brazil
| | - Paula Hansen Suss
- School of Medicine, Pontifícia Universidade Católica do Paraná, Curitiba, Brazil
| | - Leticia Kraft
- School of Medicine, Pontifícia Universidade Católica do Paraná, Curitiba, Brazil
| | | | - Lúcia Noronha
- School of Medicine, Pontifícia Universidade Católica do Paraná, Curitiba, Brazil.,Experimental Pathology Laboratory, Pontifícia Universidade Católica do Paraná, Curitiba, Brazil
| | - Francisco Diniz Affonso da Costa
- School of Medicine, Pontifícia Universidade Católica do Paraná, Curitiba, Brazil.,Tissue Bank, Pontifícia Universidade Católica do Paraná, Curitiba, Brazil
| | - Felipe Francisco Tuon
- School of Medicine, Pontifícia Universidade Católica do Paraná, Curitiba, Brazil.,Tissue Bank, Pontifícia Universidade Católica do Paraná, Curitiba, Brazil
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11
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Chen Q, Bruyneel A, Carr C, Czernuszka J. Trilayer scaffold with cardiosphere-derived cells for heart valve tissue engineering. J Biomed Mater Res B Appl Biomater 2019; 108:729-737. [PMID: 31184806 DOI: 10.1002/jbm.b.34427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Revised: 05/01/2019] [Accepted: 05/17/2019] [Indexed: 11/08/2022]
Abstract
Natural polymers collagen, glycosaminoglycans, and elastin are promising candidate materials for heart valve tissue engineering scaffolds. This work produced trilayer scaffolds that resembled the layered structures of the extracellular matrices of native heart valves. The scaffolds showed anisotropic bending moduli (in both dry and hydrated statuses) depending on the loading directions (lower in the With Curvature direction than in the Against Curvature direction), which mimicked the characteristic behavior of the native heart valves. The interactions between cardiosphere-derived cells and the scaffolds were characterized by multiphoton microscopy, and relatively similar cell distributions were observed on different layers (a cell density of 3,000-4,000 mm-3 and a migration depth of 0.3-0.4 mm). The trilayer scaffold has represented a forwarding step from the previous studies, in attempting to better replicate a native heart valve structurally, mechanically, and biologically.
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Affiliation(s)
- Qi Chen
- R&D.cn, Guangzhou International Bio-Island, Guangzhou, China.,Department of Materials, University of Oxford, Oxford, UK
| | - Arne Bruyneel
- Cardiovascular Institute, Stanford University, Stanford, California
| | - Carolyn Carr
- Department of Physiology, Anatomy and Genetics, University of Oxford, Oxford, UK
| | - Jan Czernuszka
- Department of Materials, University of Oxford, Oxford, UK
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12
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van Kelle MAJ, Oomen PJA, Janssen-van den Broek WJT, Lopata RGP, Loerakker S, Bouten CVC. Initial scaffold thickness affects the emergence of a geometrical and mechanical equilibrium in engineered cardiovascular tissues. J R Soc Interface 2018; 15:rsif.2018.0359. [PMID: 30429259 DOI: 10.1098/rsif.2018.0359] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Accepted: 10/16/2018] [Indexed: 01/22/2023] Open
Abstract
In situ cardiovascular tissue-engineering can potentially address the shortcomings of the current replacement therapies, in particular, their inability to grow and remodel. In native tissues, it is widely accepted that physiological growth and remodelling occur to maintain a homeostatic mechanical state to conserve its function, regardless of changes in the mechanical environment. A similar homeostatic state should be reached for tissue-engineered (TE) prostheses to ensure proper functioning. For in situ tissue-engineering approaches obtaining such a state greatly relies on the initial scaffold design parameters. In this study, it is investigated if the simple scaffold design parameter initial thickness, influences the emergence of a mechanical and geometrical equilibrium state in in vitro TE constructs, which resemble thin cardiovascular tissues such as heart valves and arteries. Towards this end, two sample groups with different initial thicknesses of myofibroblast-seeded polycaprolactone-bisurea constructs were cultured for three weeks under dynamic loading conditions, while tracking geometrical and mechanical changes temporally using non-destructive ultrasound imaging. A mechanical equilibrium was reached in both groups, although at different magnitudes of the investigated mechanical quantities. Interestingly, a geometrically stable state was only established in the thicker constructs, while the thinner constructs' length continuously increased. This demonstrates that reaching geometrical and mechanical stability in TE constructs is highly dependent on functional scaffold design.
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Affiliation(s)
- M A J van Kelle
- Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands.,Institute for Complex Molecular Systems, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - P J A Oomen
- Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands.,Institute for Complex Molecular Systems, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - W J T Janssen-van den Broek
- Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands.,Institute for Complex Molecular Systems, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - R G P Lopata
- Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - S Loerakker
- Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands .,Institute for Complex Molecular Systems, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - C 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
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13
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Dekker S, van Geemen D, van den Bogaerdt AJ, Driessen-Mol A, Aikawa E, Smits AIPM. Sheep-Specific Immunohistochemical Panel for the Evaluation of Regenerative and Inflammatory Processes in Tissue-Engineered Heart Valves. Front Cardiovasc Med 2018; 5:105. [PMID: 30159315 PMCID: PMC6104173 DOI: 10.3389/fcvm.2018.00105] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2018] [Accepted: 07/13/2018] [Indexed: 12/27/2022] Open
Abstract
The creation of living heart valve replacements via tissue engineering is actively being pursued by many research groups. Numerous strategies have been described, aimed either at culturing autologous living valves in a bioreactor (in vitro) or inducing endogenous regeneration by the host via resorbable scaffolds (in situ). Whereas a lot of effort is being invested in the optimization of heart valve scaffold parameters and culturing conditions, the pathophysiological in vivo remodeling processes to which tissue-engineered heart valves are subjected upon implantation have been largely under-investigated. This is partly due to the unavailability of suitable immunohistochemical tools specific to sheep, which serves as the gold standard animal model in translational research on heart valve replacements. Therefore, the goal of this study was to comprise and validate a comprehensive sheep-specific panel of antibodies for the immunohistochemical analysis of tissue-engineered heart valve explants. For the selection of our panel we took inspiration from previous histopathological studies describing the morphology, extracellular matrix composition and cellular composition of native human heart valves throughout development and adult stages. Moreover, we included a range of immunological markers, which are particularly relevant to assess the host inflammatory response evoked by the implanted heart valve. The markers specifically identifying extracellular matrix components and cell phenotypes were tested on formalin-fixed paraffin-embedded sections of native sheep aortic valves. Markers for inflammation and apoptosis were tested on ovine spleen and kidney tissues. Taken together, this panel of antibodies could serve as a tool to study the spatiotemporal expression of proteins in remodeling tissue-engineered heart valves after implantation in a sheep model, thereby contributing to our understanding of the in vivo processes which ultimately determine long-term success or failure of tissue-engineered heart valves.
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Affiliation(s)
- Sylvia Dekker
- Soft Tissue Engineering & Mechanobiology Division, Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, Netherlands
| | - Daphne van Geemen
- Soft Tissue Engineering & Mechanobiology Division, Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, Netherlands
| | | | - Anita Driessen-Mol
- Soft Tissue Engineering & Mechanobiology Division, Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, Netherlands
- Institute for Complex Molecular Systems (ICMS), Eindhoven University of Technology, Eindhoven, Netherlands
| | - Elena Aikawa
- Division of Cardiovascular Medicine, Department of Medicine, Center for Excellence in Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA, United States
| | - Anthal I. P. M. Smits
- Soft Tissue Engineering & Mechanobiology Division, Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, Netherlands
- Institute for Complex Molecular Systems (ICMS), Eindhoven University of Technology, Eindhoven, Netherlands
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14
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Sakaue T, Nakaoka H, Shikata F, Aono J, Kurata M, Uetani T, Hamaguchi M, Kojima A, Uchita S, Yasugi T, Higashi H, Suzuki J, Ikeda S, Higaki J, Higashiyama S, Izutani H. Biochemical and histological evidence of deteriorated bioprosthetic valve leaflets: the accumulation of fibrinogen and plasminogen. Biol Open 2018; 7:bio.034009. [PMID: 30089611 PMCID: PMC6124578 DOI: 10.1242/bio.034009] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Calcification of bioprosthetic valves (BVs) implanted in aortic position can result in gradual deterioration and necessitate aortic valve replacement. The molecular mechanism of calcium deposition on BV leaflets has been investigated, but remains to be fully elucidated. The present study aimed to identify explanted bioprosthetic valve (eBV)-specific proteins using a proteomics approach and to unveil their biochemical and histological involvements in calcium deposition on BV leaflets. Calcification, fibrosis, and glycosylation of the valves were histologically assessed using Von Kossa, Masson's Trichrome and Alcian Blue staining, as well as immunostaining. Protein expression in the explanted biological valves was analysed using proteomics and western blotting. In a histological evaluation, αSMA-positive myofibroblasts were not observed in eBV, whereas severe fibrosis occurred around calcified areas. SDS-PAGE revealed three major bands with considerably increased intensity in BV leaflets that were identified as plasminogen and fibrinogen gamma chain (100 kDa), and fibrinogen beta chain (50 and 37 kDa) by mass analysis. Immunohistochemistry showed that fibrinogen β-chain was distributed throughout the valve tissue. On the contrary, plasminogen was strongly stained in CD68-positive macrophages, as evidenced by immunofluorescence. The results suggest that two important blood coagulation-related proteins, plasminogen and fibrinogen, might affect the progression of BV degeneration. Summary: Fibrinogen was specifically deposited on whole deteriorated tissue valve leaflets, and plasminogen-positive macrophages strongly invaded the areas around calcified bioprosthetic and native tissues.
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Affiliation(s)
- Tomohisa Sakaue
- Department of Cardiovascular and Thoracic Surgery, Ehime University Graduate School of Medicine, Ehime 791-0295, Japan .,Department of Cell Growth and Tumor Regulation, Proteo-Science Center (PROS), Toon, Ehime 791-0295, Japan
| | - Hirotomo Nakaoka
- Department of Cardiovascular and Thoracic Surgery, Ehime University Graduate School of Medicine, Ehime 791-0295, Japan.,Division of Laboratory Animal Research, Advanced Research Support Center (ADRES), Toon, Ehime 791-0295, Japan
| | - Fumiaki Shikata
- Department of Cardiovascular and Thoracic Surgery, Ehime University Graduate School of Medicine, Ehime 791-0295, Japan.,Department of Cardiothoracic Surgery, St Vincent's Hospital Sydney, NSW 791-0295, Australia
| | - Jun Aono
- Department of Cardiology, Pulmonology, Hypertension, and Nephrology, Ehime University Graduate School of Medicine, Ehime 791-0295, Japan
| | - Mie Kurata
- Department of Pathology, Division of Analytical Pathology, Ehime University Graduate School of Medicine, Ehime 791-0295, Japan.,Department of Pathology, Proteo-Science Center (PROS), Toon, Ehime 791-0295, Japan
| | - Teruyoshi Uetani
- Department of Cardiology, Pulmonology, Hypertension, and Nephrology, Ehime University Graduate School of Medicine, Ehime 791-0295, Japan
| | - Mika Hamaguchi
- Department of Cardiology, Pulmonology, Hypertension, and Nephrology, Ehime University Graduate School of Medicine, Ehime 791-0295, Japan
| | - Ai Kojima
- Department of Cardiovascular and Thoracic Surgery, Ehime University Graduate School of Medicine, Ehime 791-0295, Japan
| | - Shunji Uchita
- Department of Cardiovascular and Thoracic Surgery, Ehime University Graduate School of Medicine, Ehime 791-0295, Japan
| | - Takumi Yasugi
- Department of Cardiovascular and Thoracic Surgery, Ehime University Graduate School of Medicine, Ehime 791-0295, Japan
| | - Haruhiko Higashi
- Department of Cardiology, Pulmonology, Hypertension, and Nephrology, Ehime University Graduate School of Medicine, Ehime 791-0295, Japan
| | - Jun Suzuki
- Department of Cardiology, Pulmonology, Hypertension, and Nephrology, Ehime University Graduate School of Medicine, Ehime 791-0295, Japan
| | - Shuntaro Ikeda
- Department of Cardiology, Pulmonology, Hypertension, and Nephrology, Ehime University Graduate School of Medicine, Ehime 791-0295, Japan
| | - Jitsuo Higaki
- Department of Cardiology, Pulmonology, Hypertension, and Nephrology, Ehime University Graduate School of Medicine, Ehime 791-0295, Japan
| | - Shigeki Higashiyama
- Department of Cell Growth and Tumor Regulation, Proteo-Science Center (PROS), Toon, Ehime 791-0295, Japan.,Department of Biochemistry and Molecular Genetics, Ehime University Graduate School of Medicine, Toon, Ehime 791-0295, Japan
| | - Hironori Izutani
- Department of Cardiovascular and Thoracic Surgery, Ehime University Graduate School of Medicine, Ehime 791-0295, Japan
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15
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Serruys PW, Miyazaki Y, Katsikis A, Abdelghani M, Leon MB, Virmani R, Carrel T, Cox M, Onuma Y, Soliman OII. Restorative valve therapy by endogenous tissue restoration: tomorrow's world? Reflection on the EuroPCR 2017 session on endogenous tissue restoration. EUROINTERVENTION 2018; 13:AA68-AA77. [PMID: 28942388 DOI: 10.4244/eij-d-17-00509] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
The current standard of treatment of valvular diseases with severe functional and/or clinical consequences is the repair or replacement of the valve, which is usually surgical or, in specific scenarios, percutaneous. The available prosthetic valves, however, are not a magic bullet in the physicians' arsenal for the management of valvular diseases, since the age-dependent structural valve deterioration (SVD) and the need for prolonged systemic anticoagulation in the case of metallic prosthetic valves are not inconsequential during the lifespan of a patient with an implanted prosthetic valve. Based on decades of research combining the scientific disciplines of supramolecular chemistry, electrospinning and regenerative medicine, endogenous tissue restoration has emerged as a very promising domain to provide this magic bullet, in the form of valves, which enables functional restoration by the body itself. The concept of a restorative material that will set the framework for the creation of a new, endogenous valve is very appealing and, recently, proof of concept studies have been completed at both preclinical and clinical levels. These studies have shown favourable pathologic, anatomic and haemodynamic characteristics compared to currently available prosthetic valves, in sheep and in young children undergoing right ventricular outflow tract reconstruction, and may represent an alternative to the bioprosthesis made of xenopericardial tissue. The present manuscript reviews the rationale, background knowledge and historic development of endogenous tissue restoration and presents preliminary data about the Xeltis valve, which appears to have the potential to make restorative valve therapy a reality in clinical practice.
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16
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Shafiq M, Zhang Q, Zhi D, Wang K, Kong D, Kim DH, Kim SH. In Situ Blood Vessel Regeneration Using SP (Substance P) and SDF (Stromal Cell-Derived Factor)-1α Peptide Eluting Vascular Grafts. Arterioscler Thromb Vasc Biol 2018; 38:e117-e134. [PMID: 29853570 PMCID: PMC6039427 DOI: 10.1161/atvbaha.118.310934] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2017] [Accepted: 05/16/2018] [Indexed: 01/22/2023]
Abstract
OBJECTIVE The objective of this study was to develop small-diameter vascular grafts capable of eluting SDF (stromal cell-derived factor)-1α-derived peptide and SP (substance P) for in situ vascular regeneration. APPROACH AND RESULTS Polycaprolactone (PCL)/collagen grafts containing SP or SDF-1α-derived peptide were fabricated by electrospinning. SP and SDF-1α peptide-loaded grafts recruited significantly higher numbers of mesenchymal stem cells than that of the control group. The in vivo potential of PCL/collagen, SDF-1, and SP grafts was assessed by implanting them in a rat abdominal aorta for up to 4 weeks. All grafts remained patent as observed using color Doppler and stereomicroscope. Host cells infiltrated into the graft wall and the neointima was formed in peptides-eluting grafts. The lumen of the SP grafts was covered by the endothelial cells with cobblestone-like morphology, which were elongated in the direction of the blood flow, as discerned using scanning electron microscopy. Moreover, SDF-1α and SP grafts led to the formation of a confluent endothelium as evaluated using immunofluorescence staining with von Willebrand factor antibody. SP and SDF-1α grafts also promoted smooth muscle cell regeneration, endogenous stem cell recruitment, and blood vessel formation, which was the most prominent in the SP grafts. Evaluation of inflammatory response showed that 3 groups did not significantly differ in terms of the numbers of proinflammatory macrophages, whereas SP grafts showed significantly higher numbers of proremodeling macrophages than that of the control and SDF-1α grafts. CONCLUSIONS SDF-1α and SP grafts can be potential candidates for in situ vascular regeneration and are worthy for future investigations.
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MESH Headings
- Angiogenesis Inducing Agents/chemistry
- Angiogenesis Inducing Agents/pharmacology
- Animals
- Aorta, Abdominal/diagnostic imaging
- Aorta, Abdominal/pathology
- Aorta, Abdominal/physiopathology
- Aorta, Abdominal/surgery
- Blood Vessel Prosthesis
- Blood Vessel Prosthesis Implantation/instrumentation
- Cell Movement/drug effects
- Cell Proliferation/drug effects
- Cells, Cultured
- Chemokine CXCL12/chemistry
- Chemokine CXCL12/pharmacology
- Coated Materials, Biocompatible
- Collagen Type I/chemistry
- Humans
- Male
- Mesenchymal Stem Cells/drug effects
- Neointima
- Neovascularization, Physiologic/drug effects
- Peptide Fragments/chemistry
- Peptide Fragments/pharmacology
- Polyesters/chemistry
- Prosthesis Design
- Rats, Sprague-Dawley
- Substance P/chemistry
- Substance P/pharmacology
- Time Factors
- Ultrasonography, Doppler, Color
- Vascular Patency
- Vascular Remodeling
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Affiliation(s)
- Muhammad Shafiq
- From the Department of Biomedical Engineering, Korea University of Science and Technology, Daejeon (M.S., S.H.K.)
- Center for Biomaterials, Biomedical Research Institute, Department of Biomedical Engineering, Korea Institute of Science and Technology, Seoul, Republic of Korea (M.S., S.H.K.)
- State Key Laboratory of Medicinal Chemical Biology, Key Laboratory of Bioactive Materials of Ministry of Education, Collaborative Innovation Center of Chemical Science and Engineering (Tianjin), College of Life Science, Department of Biochemistry and Molecular Biology, Nankai University, China (M.S., Q.Z., D.Z., K.W., D.K.)
| | - Qiuying Zhang
- State Key Laboratory of Medicinal Chemical Biology, Key Laboratory of Bioactive Materials of Ministry of Education, Collaborative Innovation Center of Chemical Science and Engineering (Tianjin), College of Life Science, Department of Biochemistry and Molecular Biology, Nankai University, China (M.S., Q.Z., D.Z., K.W., D.K.)
| | - Dengke Zhi
- State Key Laboratory of Medicinal Chemical Biology, Key Laboratory of Bioactive Materials of Ministry of Education, Collaborative Innovation Center of Chemical Science and Engineering (Tianjin), College of Life Science, Department of Biochemistry and Molecular Biology, Nankai University, China (M.S., Q.Z., D.Z., K.W., D.K.)
| | - Kai Wang
- State Key Laboratory of Medicinal Chemical Biology, Key Laboratory of Bioactive Materials of Ministry of Education, Collaborative Innovation Center of Chemical Science and Engineering (Tianjin), College of Life Science, Department of Biochemistry and Molecular Biology, Nankai University, China (M.S., Q.Z., D.Z., K.W., D.K.)
| | - Deling Kong
- State Key Laboratory of Medicinal Chemical Biology, Key Laboratory of Bioactive Materials of Ministry of Education, Collaborative Innovation Center of Chemical Science and Engineering (Tianjin), College of Life Science, Department of Biochemistry and Molecular Biology, Nankai University, China (M.S., Q.Z., D.Z., K.W., D.K.)
| | - Dong-Hwee Kim
- Tianjin Key Laboratory of Biomedical Materials, Institute of Biomedical Engineering, Chinese Academy of Medical Sciences and Peking Union Medical College, China (D.K.)
- Department of Nano-Bio-Information Technology (NBIT), KU-KIST Graduate School of Converging Science and Technology, Korea University, Seoul (D.-H.K., S.H.K.)
| | - Soo Hyun Kim
- From the Department of Biomedical Engineering, Korea University of Science and Technology, Daejeon (M.S., S.H.K.)
- Center for Biomaterials, Biomedical Research Institute, Department of Biomedical Engineering, Korea Institute of Science and Technology, Seoul, Republic of Korea (M.S., S.H.K.)
- Department of Nano-Bio-Information Technology (NBIT), KU-KIST Graduate School of Converging Science and Technology, Korea University, Seoul (D.-H.K., S.H.K.)
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17
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Gonzalez de Torre I, Weber M, Quintanilla L, Alonso M, Jockenhoevel S, Rodríguez Cabello JC, Mela P. Hybrid elastin-like recombinamer-fibrin gels: physical characterization and in vitro evaluation for cardiovascular tissue engineering applications. Biomater Sci 2018; 4:1361-70. [PMID: 27430365 DOI: 10.1039/c6bm00300a] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
In the field of tissue engineering, the properties of the scaffolds are of crucial importance for the success of the application. Hybrid materials combine the properties of the different components that constitute them. In this study hybrid gels of Elastin-Like Recombinamer (ELR) and fibrin were prepared with a range of polymer concentrations and ELR-to-fibrin ratios. The correlation between SEM micrographs, porosities, swelling ratios and rheological properties was discussed and a poroelastic mechanism was suggested to explain the mechanical behavior of the hybrid gels. Applicability as scaffold materials for cardiovascular tissue engineering was shown by the realization of cell-laden matrixes which supported the synthesis of collagens as revealed by immunohistochemical analysis. As a proof of concept, a tissue-engineered heart valve was fabricated by injection moulding and cultivated in a bioreactor for 3 weeks under dynamic conditions. Tissue analysis revealed the production of collagen I and III, fundamental proteins for cardiovascular constructs.
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Affiliation(s)
- Israel Gonzalez de Torre
- BIOFORGE, CIBER-BBN, Campus "Miguel Delibes" Edificio LUCIA, Universidad de Valladolid, Paseo Belén 19, 47011, Valladolid, Spain and TECHNICAL PROTEINS NANOBIOTECHNOLOGY S.L., Campus "Miguel Delibes" Edificio CTTA, Universidad de Valladolid, Paseo Belén 9A, 47011, Valladolid, Spain
| | - Miriam Weber
- Tissue Engineering and Textile Implants, AME, Helmholtz Institute, RWTH Aachen University, Pauwelsstr. 20, 52074 Aachen, Germany
| | - Luis Quintanilla
- BIOFORGE, CIBER-BBN, Campus "Miguel Delibes" Edificio LUCIA, Universidad de Valladolid, Paseo Belén 19, 47011, Valladolid, Spain
| | - Matilde Alonso
- BIOFORGE, CIBER-BBN, Campus "Miguel Delibes" Edificio LUCIA, Universidad de Valladolid, Paseo Belén 19, 47011, Valladolid, Spain
| | - Stefan Jockenhoevel
- Tissue Engineering and Textile Implants, AME, Helmholtz Institute, RWTH Aachen University, Pauwelsstr. 20, 52074 Aachen, Germany
| | - José Carlos Rodríguez Cabello
- BIOFORGE, CIBER-BBN, Campus "Miguel Delibes" Edificio LUCIA, Universidad de Valladolid, Paseo Belén 19, 47011, Valladolid, Spain
| | - Petra Mela
- Tissue Engineering and Textile Implants, AME, Helmholtz Institute, RWTH Aachen University, Pauwelsstr. 20, 52074 Aachen, Germany
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18
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Malischewski A, Moreira R, Hurtado L, Gesché V, Schmitz-Rode T, Jockenhoevel S, Mela P. Umbilical cord as human cell source for mitral valve tissue engineering - venous vs. arterial cells. ACTA ACUST UNITED AC 2017; 62:457-466. [PMID: 28453437 DOI: 10.1515/bmt-2016-0218] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2016] [Accepted: 03/01/2017] [Indexed: 11/15/2022]
Abstract
Around 2% of the population in developed nations are affected by mitral valve disease and available valvular replacements are not designed for the atrioventricular position. Recently our group developed the first tissue-engineered heart valve (TEHV) specifically designed for the mitral position - the TexMi valve. The valve recapitulates the main components of the native valve, i.e. annulus, asymmetric leaflets and the crucial chordae tendineae. In the present study, we evaluated the human umbilical cord as a clinically applicable cell source for the TexMi valve. Valves produced with cells isolated from human umbilical cord veins (HUVs) and human umbilical cord arteries (HUAs) were conditioned for 21 days in custom-made bioreactors and evaluated in terms of extracellular matrix (ECM) composition and mechanical properties. In addition, static cell-laden fibrin discs were molded to investigate cell-mediated tissue contraction and differences in ECM production. HUA and HUV cells were able to deliver functional valves with a rich ECM composed mainly of collagen. Particularly noteworthy was the synthesis of elastin, which has been observed rarely in TEHV. The elastin synthesis was significantly higher in TexMi valves produced with HUV cells and therefore the HUV is considered to be the preferred cell source.
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19
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VeDepo MC, Detamore MS, Hopkins RA, Converse GL. Recellularization of decellularized heart valves: Progress toward the tissue-engineered heart valve. J Tissue Eng 2017; 8:2041731417726327. [PMID: 28890780 PMCID: PMC5574480 DOI: 10.1177/2041731417726327] [Citation(s) in RCA: 63] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2017] [Accepted: 07/24/2017] [Indexed: 01/08/2023] Open
Abstract
The tissue-engineered heart valve portends a new era in the field of valve replacement. Decellularized heart valves are of great interest as a scaffold for the tissue-engineered heart valve due to their naturally bioactive composition, clinical relevance as a stand-alone implant, and partial recellularization in vivo. However, a significant challenge remains in realizing the tissue-engineered heart valve: assuring consistent recellularization of the entire valve leaflets by phenotypically appropriate cells. Many creative strategies have pursued complete biological valve recellularization; however, identifying the optimal recellularization method, including in situ or in vitro recellularization and chemical and/or mechanical conditioning, has proven difficult. Furthermore, while many studies have focused on individual parameters for increasing valve interstitial recellularization, a general understanding of the interacting dynamics is likely necessary to achieve success. Therefore, the purpose of this review is to explore and compare the various processing strategies used for the decellularization and subsequent recellularization of tissue-engineered heart valves.
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Affiliation(s)
- Mitchell C VeDepo
- Cardiac Regenerative Surgery Research Laboratories of the Ward Family Heart Center, Children's Mercy Kansas City, Kansas City, MO, USA.,Bioengineering Program, The University of Kansas, Lawrence, KS, USA
| | - Michael S Detamore
- Stephenson School of Biomedical Engineering, The University of Oklahoma, Norman, OK, USA
| | - Richard A Hopkins
- Cardiac Regenerative Surgery Research Laboratories of the Ward Family Heart Center, Children's Mercy Kansas City, Kansas City, MO, USA
| | - Gabriel L Converse
- Cardiac Regenerative Surgery Research Laboratories of the Ward Family Heart Center, Children's Mercy Kansas City, Kansas City, MO, USA
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20
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Stassen OMJA, Muylaert DEP, Bouten CVC, Hjortnaes J. Current Challenges in Translating Tissue-Engineered Heart Valves. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2017; 19:71. [PMID: 28782083 PMCID: PMC5545463 DOI: 10.1007/s11936-017-0566-y] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Heart valve disease is a major health burden, treated by either valve repair or valve replacement, depending on the affected valve. Nearly 300,000 valve replacements are performed worldwide per year. Valve replacement is lifesaving, but not without complications. The in situ tissue-engineered heart valve is a promising alternative to current treatments, but the translation of this novel technology to the clinic still faces several challenges. These challenges originate from the variety encountered in the patient population, the conversion of an implant into a living tissue, the highly mechanical nature of the heart valve, the complex homeostatic tissue that has to be reached at the end stage of the regenerating heart valve, and all the biomaterial properties that can be controlled to obtain this tissue. Many of these challenges are multidimensional and multiscalar, and both the macroscopic properties of the complete heart valve and the microscopic properties of the patient’s cells interacting with the materials have to be optimal. Using newly developed in vitro models, or bioreactors, where variables of interest can be controlled tightly and complex mixtures of cell populations similar to those encountered in the regenerating valve can be cultured, it is likely that the challenges can be overcome.
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Affiliation(s)
- O M J A Stassen
- Department of Biomedical Engineering, Eindhoven University of Technology, PO Box 513, 5600 MB, Eindhoven, The Netherlands.
| | - D E P Muylaert
- Department of Cardiothoracic Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - C 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, Eindhoven, The Netherlands
| | - J Hjortnaes
- Department of Cardiothoracic Surgery, University Medical Center Utrecht, Utrecht, The Netherlands.,Regenerative Medicine Center Utrecht, University Medical Center Utrecht, Utrecht, The Netherlands
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21
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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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22
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Jones TW, Seckeler MD. Use of 3D models of vascular rings and slings to improve resident education. CONGENIT HEART DIS 2017; 12:578-582. [PMID: 28608434 DOI: 10.1111/chd.12486] [Citation(s) in RCA: 57] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2017] [Revised: 05/05/2017] [Accepted: 05/11/2017] [Indexed: 01/17/2023]
Abstract
OBJECTIVE Three-dimensional (3D) printing is a manufacturing method by which an object is created in an additive process, and can be used with medical imaging data to generate accurate physical reproductions of organs and tissues for a variety of applications. We hypothesized that using 3D printed models of congenital cardiovascular lesions to supplement an educational lecture would improve learners' scores on a board-style examination. DESIGN AND INTERVENTION Patients with normal and abnormal aortic arches were selected and anonymized to generate 3D printed models. A cohort of pediatric and combined pediatric/emergency medicine residents were then randomized to intervention and control groups. Each participant was given a subjective survey and an objective board-style pretest. Each group received the same 20-minutes lecture on vascular rings and slings. During the intervention group's lecture, 3D printed physical models of each lesion were distributed for inspection. After each lecture, both groups completed the same subjective survey and objective board-style test to assess their comfort with and postlecture knowledge of vascular rings. RESULTS There were no differences in the basic demographics of the two groups. After the lectures, both groups' subjective comfort levels increased. Both groups' scores on the objective test improved, but the intervention group scored higher on the posttest. CONCLUSIONS This study demonstrated a measurable gain in knowledge about vascular rings and pulmonary artery slings with the addition of 3D printed models of the defects. Future applications of this teaching modality could extend to other congenital cardiac lesions and different learners.
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Affiliation(s)
- Trahern W Jones
- Department of Pediatrics, University of Arizona College of Medicine, Arizona, USA
| | - Michael D Seckeler
- Department of Pediatrics, University of Arizona College of Medicine, Arizona, USA
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23
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VeDepo MC, Buse EE, Quinn RW, Williams TD, Detamore MS, Hopkins RA, Converse GL. Species-specific effects of aortic valve decellularization. Acta Biomater 2017; 50:249-258. [PMID: 28069510 DOI: 10.1016/j.actbio.2017.01.008] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2016] [Revised: 12/05/2016] [Accepted: 01/05/2017] [Indexed: 01/12/2023]
Abstract
Decellularized heart valves have great potential as a stand-alone valve replacement or as a scaffold for tissue engineering heart valves. Before decellularized valves can be widely used clinically, regulatory standards require pre-clinical testing in an animal model, often sheep. Numerous decellularization protocols have been applied to both human and ovine valves; however, the ways in which a specific process may affect valves of these species differently have not been reported. In the current study, the comparative effects of decellularization were evaluated for human and ovine aortic valves by measuring mechanical and biochemical properties. Cell removal was equally effective for both species. The initial cell density of the ovine valve leaflets (2036±673cells/mm2) was almost triple the cell density of human leaflets (760±386cells/mm2; p<0.001). Interestingly, post-decellularization ovine leaflets exhibited significant increases in biaxial areal strain (p<0.001) and circumferential peak stretch (p<0.001); however, this effect was not observed in the human counterparts (p>0.10). This species-dependent difference in the effect of decellularization was likely due to the higher initial cellularity in ovine valves, as well as a significant decrease in collagen crosslinking following the decellularization of ovine leaflets that was not observed in the human leaflet. Decellularization also caused a significant decrease in the circumferential relaxation of ovine leaflets (p<0.05), but not human leaflets (p>0.30), which was credited to a greater reduction of glycosaminoglycans in the ovine tissue post-decellularization. These results indicate that an identical decellularization process can have differing species-specific effects on heart valves. STATEMENT OF SIGNIFICANCE The decellularized heart valve offers potential as an improved heart valve substitute and as a scaffold for the tissue engineered heart valve; however, the consequences of processing must be fully characterized. To date, the effects of decellularization on donor valves from different species have not been evaluated in such a way that permits direct comparison between species. In this manuscript, we report species-dependent variation in the biochemical and biomechanical properties of human and ovine aortic heart valve leaflets following decellularization. This is of clinical significance, as current regulatory guidelines required pre-clinical use of the ovine model to evaluate candidate heart valve substitutes.
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Affiliation(s)
- Mitchell C VeDepo
- Cardiac Regenerative Surgery Research Laboratories of The Ward Family Heart Center, Children's Mercy Kansas City, 2401 Gillham Road, Kansas City, MO 64108, United States; Bioengineering Program, University of Kansas, 3135A Learned Hall, 1530 W. 15th St., Lawrence, KS 66045, United States
| | - Eric E Buse
- Cardiac Regenerative Surgery Research Laboratories of The Ward Family Heart Center, Children's Mercy Kansas City, 2401 Gillham Road, Kansas City, MO 64108, United States
| | - Rachael W Quinn
- Cardiac Regenerative Surgery Research Laboratories of The Ward Family Heart Center, Children's Mercy Kansas City, 2401 Gillham Road, Kansas City, MO 64108, United States
| | - Todd D Williams
- University of Kansas Mass Spectrometry Laboratory, 3006 Malott Hall, 1251 Wescoe Hall Drive, Lawrence, KS 66045, United States
| | - Michael S Detamore
- Stephenson School of Biomedical Engineering, University of Oklahoma, Norman, OK 73019, United States
| | - Richard A Hopkins
- Cardiac Regenerative Surgery Research Laboratories of The Ward Family Heart Center, Children's Mercy Kansas City, 2401 Gillham Road, Kansas City, MO 64108, United States
| | - Gabriel L Converse
- Cardiac Regenerative Surgery Research Laboratories of The Ward Family Heart Center, Children's Mercy Kansas City, 2401 Gillham Road, Kansas City, MO 64108, United States.
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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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25
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A Tri-Leaflet Nitinol Mesh Scaffold for Engineering Heart Valves. Ann Biomed Eng 2016; 45:413-426. [DOI: 10.1007/s10439-016-1778-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2016] [Accepted: 12/09/2016] [Indexed: 01/03/2023]
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van Loosdregt IAEW, Dekker S, Alford PW, Oomens CWJ, Loerakker S, Bouten CVC. Intrinsic Cell Stress is Independent of Organization in Engineered Cell Sheets. Cardiovasc Eng Technol 2016; 9:181-192. [PMID: 27778297 PMCID: PMC5988777 DOI: 10.1007/s13239-016-0283-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2016] [Accepted: 10/11/2016] [Indexed: 11/27/2022]
Abstract
Understanding cell contractility is of fundamental importance for cardiovascular tissue engineering, due to its major impact on the tissue’s mechanical properties as well as the development of permanent dimensional changes, e.g., by contraction or dilatation of the tissue. Previous attempts to quantify contractile cellular stresses mostly used strongly aligned monolayers of cells, which might not represent the actual organization in engineered cardiovascular tissues such as heart valves. In the present study, therefore, we investigated whether differences in organization affect the magnitude of intrinsic stress generated by individual myofibroblasts, a frequently used cell source for in vitro engineered heart valves. Four different monolayer organizations were created via micro-contact printing of fibronectin lines on thin PDMS films, ranging from strongly anisotropic to isotropic. Thin film curvature, cell density, and actin stress fiber distribution were quantified, and subsequently, intrinsic stress and contractility of the monolayers were determined by incorporating these data into sample-specific finite element models. Our data indicate that the intrinsic stress exerted by the monolayers in each group correlates with cell density. Additionally, after normalizing for cell density and accounting for differences in alignment, no consistent differences in intrinsic contractility were found between the different monolayer organizations, suggesting that the intrinsic stress exerted by individual myofibroblasts is independent of the organization. Consequently, this study emphasizes the importance of choosing proper architectural properties for scaffolds in cardiovascular tissue engineering, as these directly affect the stresses in the tissue, which play a crucial role in both the functionality and remodeling of (engineered) cardiovascular tissues.
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Affiliation(s)
- Inge A E W van Loosdregt
- 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, Eindhoven, The Netherlands
| | - Sylvia Dekker
- 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, Eindhoven, The Netherlands
| | - Patrick W Alford
- Department of Biomedical Engineering, University of Minnesota, Minneapolis, MN, USA
| | - Cees W J Oomens
- 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, Eindhoven, The Netherlands
| | - Sandra Loerakker
- 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, 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, Eindhoven, The Netherlands
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Huygens SA, Rutten-van Mölken MPMH, Bekkers JA, Bogers AJJC, Bouten CVC, Chamuleau SAJ, de Jaegere PPT, Kappetein AP, Kluin J, van Mieghem NMDA, Versteegh MIM, Witsenburg M, Takkenberg JJM. Conceptual model for early health technology assessment of current and novel heart valve interventions. Open Heart 2016; 3:e000500. [PMID: 27843569 PMCID: PMC5073474 DOI: 10.1136/openhrt-2016-000500] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2016] [Accepted: 08/02/2016] [Indexed: 01/02/2023] Open
Abstract
Objective The future promises many technological advances in the field of heart valve interventions, like tissue-engineered heart valves (TEHV). Prior to introduction in clinical practice, it is essential to perform early health technology assessment. We aim to develop a conceptual model (CM) that can be used to investigate the performance and costs requirements for TEHV to become cost-effective. Methods After scoping the decision problem, a workgroup developed the draft CM based on clinical guidelines. This model was compared with existing models for cost-effectiveness of heart valve interventions, identified by systematic literature search. Next, it was discussed with a Delphi panel of cardiothoracic surgeons, cardiologists and a biomedical scientist (n=10). Results The CM starts with the valve implantation. If patients survive the intervention, they can remain alive without complications, die from non-valve-related causes or experience a valve-related event. The events are separated in early and late events. After surviving an event, patients can experience another event or die due to non-valve-related causes. Predictors will include age, gender, NYHA class, left ventricular function and diabetes. Costs and quality adjusted life years are to be attached to health conditions to estimate long-term costs and health outcomes. Conclusions We developed a CM that will serve as foundation of a decision-analytic model that can estimate the potential cost-effectiveness of TEHV in early development stages. This supports developers in deciding about further development of TEHV and identifies promising interventions that may result in faster take-up in clinical practice by clinicians and reimbursement by payers.
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Affiliation(s)
- Simone A Huygens
- Department of Cardio-Thoracic Surgery, Erasmus University Medical Centre, Rotterdam, The Netherlands; Institute for Medical Technology Assessment, Erasmus University, Rotterdam, The Netherlands; Department of Health Policy and Management, Erasmus University, Rotterdam, The Netherlands
| | - Maureen P M H Rutten-van Mölken
- Institute for Medical Technology Assessment, Erasmus University, Rotterdam, The Netherlands; Department of Health Policy and Management, Erasmus University, Rotterdam, The Netherlands
| | - Jos A Bekkers
- Department of Cardio-Thoracic Surgery , Erasmus University Medical Centre , Rotterdam , The Netherlands
| | - Ad J J C Bogers
- Department of Cardio-Thoracic Surgery , Erasmus University Medical Centre , Rotterdam , The Netherlands
| | - Carlijn V C Bouten
- Department of Biomedical Engineering , Eindhoven University of Technology , Eindhoven , The Netherlands
| | - Steven A J Chamuleau
- Department of Cardiology , University Medical Centre , Utrecht , The Netherlands
| | - Peter P T de Jaegere
- Department of Cardiology , Erasmus University Medical Centre , Rotterdam , The Netherlands
| | - Arie Pieter Kappetein
- Department of Cardio-Thoracic Surgery , Erasmus University Medical Centre , Rotterdam , The Netherlands
| | - Jolanda Kluin
- Department of Cardio-Thoracic Surgery , Academic Medical Centre , Amsterdam , The Netherlands
| | | | - Michel I M Versteegh
- Department of Cardio-Thoracic Surgery , Leiden University Medical Centre , Leiden , The Netherlands
| | - Maarten Witsenburg
- Department of Cardiology , Erasmus University Medical Centre , Rotterdam , The Netherlands
| | - Johanna J M Takkenberg
- Department of Cardio-Thoracic Surgery , Erasmus University Medical Centre , Rotterdam , The Netherlands
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Liberski A, Ayad N, Wojciechowska D, Zielińska D, Struszczyk MH, Latif N, Yacoub M. Knitting for heart valve tissue engineering. Glob Cardiol Sci Pract 2016; 2016:e201631. [PMID: 29043276 PMCID: PMC5642840 DOI: 10.21542/gcsp.2016.31] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
Knitting is a versatile technology which offers a large portfolio of products and solutions of interest in heart valve (HV) tissue engineering (TE). One of the main advantages of knitting is its ability to construct complex shapes and structures by precisely assembling the yarns in the desired position. With this in mind, knitting could be employed to construct a HV scaffold that closely resembles the authentic valve. This has the potential to reproduce the anisotropic structure that is characteristic of the heart valve with the yarns, in particular the 3-layered architecture of the leaflets. These yarns can provide oriented growth of cells lengthwise and consequently enable the deposition of extracellular matrix (ECM) proteins in an oriented manner. This technique, therefore, has a potential to provide a functional knitted scaffold, but to achieve that textile engineers need to gain a basic understanding of structural and mechanical aspects of the heart valve and in addition, tissue engineers must acquire the knowledge of tools and capacities that are essential in knitting technology. The aim of this review is to provide a platform to consolidate these two fields as well as to enable an efficient communication and cooperation among these two research areas.
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Affiliation(s)
- Albert Liberski
- Sidra Medical and Research Center, P.O. Box 26999, Doha, Qatar
| | - Nadia Ayad
- Mechanical Engineering and Material Science Department, Military Institute of Engineering (IME), Rio de Janeiro, RJ, Brazil
| | - Dorota Wojciechowska
- Lodz University of Technology, Faculty of Material Technologies and Textile Design, Department of Material and Commodity Sciences and Textile Metrology, ul. Zeromskiego 116, 90-924, Lodz, Poland
| | - Dorota Zielińska
- Institute of Security Technologies "Moratex" 3 M, Skłodowskiej-Curie Street 90-505 Lodz, Poland
| | - Marcin H Struszczyk
- Institute of Security Technologies "Moratex" 3 M, Skłodowskiej-Curie Street 90-505 Lodz, Poland
| | - Najma Latif
- Imperial College of Science and Technology, London, UK
| | - Magdi Yacoub
- Sidra Medical and Research Center, P.O. Box 26999, Doha, Qatar
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Syedain Z, Reimer J, Lahti M, Berry J, Johnson S, Tranquillo RT. Tissue engineering of acellular vascular grafts capable of somatic growth in young lambs. Nat Commun 2016; 7:12951. [PMID: 27676438 PMCID: PMC5052664 DOI: 10.1038/ncomms12951] [Citation(s) in RCA: 111] [Impact Index Per Article: 13.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2016] [Accepted: 08/18/2016] [Indexed: 01/17/2023] Open
Abstract
Treatment of congenital heart defects in children requiring right ventricular outflow tract reconstruction typically involves multiple open-heart surgeries because all existing graft materials have no growth potential. Here we present an ‘off-the-shelf' vascular graft grown from donor fibroblasts in a fibrin gel to address this critical unmet need. In a proof-of-concept study, the decellularized grafts are implanted as a pulmonary artery replacement in three young lambs and evaluated to adulthood. Longitudinal ultrasounds document dimensional growth of the grafts. The lambs show normal growth, increasing body weight by 366% and graft diameter and volume by 56% and 216%, respectively. Explanted grafts display physiological strength and stiffness, complete lumen endothelialization and extensive population by mature smooth muscle cells. The grafts also show substantial elastin deposition and a 465% increase in collagen content, without signs of calcification, aneurysm or stenosis. Collectively, our data support somatic growth of this completely biological graft. Current vessel grafts must be surgically replaced when the recipient outgrows them. Here, Syedain et al. bioengineer a tube of acellular matrix produced from sheep fibroblasts that is capable of cellularizaton and somatic growth when transplanted into growing lambs, eliminating the need for multiple graft surgeries.
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Affiliation(s)
- Zeeshan Syedain
- Department of Biomedical Engineering, University of Minnesota, Minneapolis, Minnesota 55455, USA
| | - Jay Reimer
- Department of Biomedical Engineering, University of Minnesota, Minneapolis, Minnesota 55455, USA
| | - Matthew Lahti
- Experimental Surgical Services, Department of Surgery, University of Minnesota, Minneapolis, Minnesota 55455, USA
| | - James Berry
- Experimental Surgical Services, Department of Surgery, University of Minnesota, Minneapolis, Minnesota 55455, USA
| | - Sandra Johnson
- Department of Biomedical Engineering, University of Minnesota, Minneapolis, Minnesota 55455, USA
| | - Robert T Tranquillo
- Department of Biomedical Engineering, University of Minnesota, Minneapolis, Minnesota 55455, USA.,Department of Chemical Engineering &Materials Science, University of Minnesota, Minneapolis, Minnesota 55455, USA
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30
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Sierad LN, Shaw EL, Bina A, Brazile B, Rierson N, Patnaik SS, Kennamer A, Odum R, Cotoi O, Terezia P, Branzaniuc K, Smallwood H, Deac R, Egyed I, Pavai Z, Szanto A, Harceaga L, Suciu H, Raicea V, Olah P, Simionescu A, Liao J, Movileanu I, Harpa M, Simionescu DT. Functional Heart Valve Scaffolds Obtained by Complete Decellularization of Porcine Aortic Roots in a Novel Differential Pressure Gradient Perfusion System. Tissue Eng Part C Methods 2016; 21:1284-96. [PMID: 26467108 DOI: 10.1089/ten.tec.2015.0170] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
There is a great need for living valve replacements for patients of all ages. Such constructs could be built by tissue engineering, with perspective of the unique structure and biology of the aortic root. The aortic valve root is composed of several different tissues, and careful structural and functional consideration has to be given to each segment and component. Previous work has shown that immersion techniques are inadequate for whole-root decellularization, with the aortic wall segment being particularly resistant to decellularization. The aim of this study was to develop a differential pressure gradient perfusion system capable of being rigorous enough to decellularize the aortic root wall while gentle enough to preserve the integrity of the cusps. Fresh porcine aortic roots have been subjected to various regimens of perfusion decellularization using detergents and enzymes and results compared to immersion decellularized roots. Success criteria for evaluation of each root segment (cusp, muscle, sinus, wall) for decellularization completeness, tissue integrity, and valve functionality were defined using complementary methods of cell analysis (histology with nuclear and matrix stains and DNA analysis), biomechanics (biaxial and bending tests), and physiologic heart valve bioreactor testing (with advanced image analysis of open-close cycles and geometric orifice area measurement). Fully acellular porcine roots treated with the optimized method exhibited preserved macroscopic structures and microscopic matrix components, which translated into conserved anisotropic mechanical properties, including bending and excellent valve functionality when tested in aortic flow and pressure conditions. This study highlighted the importance of (1) adapting decellularization methods to specific target tissues, (2) combining several methods of cell analysis compared to relying solely on histology, (3) developing relevant valve-specific mechanical tests, and (4) in vitro testing of valve functionality.
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Affiliation(s)
- Leslie Neil Sierad
- 1 Biocompatibility and Tissue Regeneration Laboratories, Department of Bioengineering, Clemson University , Clemson, South Carolina
| | - Eliza Laine Shaw
- 1 Biocompatibility and Tissue Regeneration Laboratories, Department of Bioengineering, Clemson University , Clemson, South Carolina
| | - Alexander Bina
- 1 Biocompatibility and Tissue Regeneration Laboratories, Department of Bioengineering, Clemson University , Clemson, South Carolina
| | - Bryn Brazile
- 2 Tissue Bioengineering Laboratory, Department of Agricultural and Biological Engineering, Mississippi State University , Starkville, Mississippi
| | - Nicholas Rierson
- 1 Biocompatibility and Tissue Regeneration Laboratories, Department of Bioengineering, Clemson University , Clemson, South Carolina
| | - Sourav S Patnaik
- 2 Tissue Bioengineering Laboratory, Department of Agricultural and Biological Engineering, Mississippi State University , Starkville, Mississippi
| | - Allison Kennamer
- 1 Biocompatibility and Tissue Regeneration Laboratories, Department of Bioengineering, Clemson University , Clemson, South Carolina
| | - Rebekah Odum
- 1 Biocompatibility and Tissue Regeneration Laboratories, Department of Bioengineering, Clemson University , Clemson, South Carolina
| | - Ovidiu Cotoi
- 3 Tissue Engineering and Regenerative Medicine Laboratory, Department of Anatomy, University of Medicine and Pharmacy , Targu Mures, Romania
| | - Preda Terezia
- 3 Tissue Engineering and Regenerative Medicine Laboratory, Department of Anatomy, University of Medicine and Pharmacy , Targu Mures, Romania
| | - Klara Branzaniuc
- 3 Tissue Engineering and Regenerative Medicine Laboratory, Department of Anatomy, University of Medicine and Pharmacy , Targu Mures, Romania
| | - Harrison Smallwood
- 1 Biocompatibility and Tissue Regeneration Laboratories, Department of Bioengineering, Clemson University , Clemson, South Carolina
| | - Radu Deac
- 3 Tissue Engineering and Regenerative Medicine Laboratory, Department of Anatomy, University of Medicine and Pharmacy , Targu Mures, Romania
| | - Imre Egyed
- 3 Tissue Engineering and Regenerative Medicine Laboratory, Department of Anatomy, University of Medicine and Pharmacy , Targu Mures, Romania
| | - Zoltan Pavai
- 3 Tissue Engineering and Regenerative Medicine Laboratory, Department of Anatomy, University of Medicine and Pharmacy , Targu Mures, Romania
| | - Annamaria Szanto
- 3 Tissue Engineering and Regenerative Medicine Laboratory, Department of Anatomy, University of Medicine and Pharmacy , Targu Mures, Romania
| | - Lucian Harceaga
- 3 Tissue Engineering and Regenerative Medicine Laboratory, Department of Anatomy, University of Medicine and Pharmacy , Targu Mures, Romania
| | - Horatiu Suciu
- 3 Tissue Engineering and Regenerative Medicine Laboratory, Department of Anatomy, University of Medicine and Pharmacy , Targu Mures, Romania
| | - Victor Raicea
- 3 Tissue Engineering and Regenerative Medicine Laboratory, Department of Anatomy, University of Medicine and Pharmacy , Targu Mures, Romania
| | - Peter Olah
- 3 Tissue Engineering and Regenerative Medicine Laboratory, Department of Anatomy, University of Medicine and Pharmacy , Targu Mures, Romania
| | - Agneta Simionescu
- 4 Cardiovascular Tissue Engineering and Regenerative Medicine Laboratory, Department of Bioengineering, Clemson University , Clemson, South Carolina
| | - Jun Liao
- 2 Tissue Bioengineering Laboratory, Department of Agricultural and Biological Engineering, Mississippi State University , Starkville, Mississippi
| | - Ionela Movileanu
- 3 Tissue Engineering and Regenerative Medicine Laboratory, Department of Anatomy, University of Medicine and Pharmacy , Targu Mures, Romania
| | - Marius Harpa
- 3 Tissue Engineering and Regenerative Medicine Laboratory, Department of Anatomy, University of Medicine and Pharmacy , Targu Mures, Romania
| | - Dan Teodor Simionescu
- 1 Biocompatibility and Tissue Regeneration Laboratories, Department of Bioengineering, Clemson University , Clemson, South Carolina
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Coombs KE, Leonard AT, Rush MN, Santistevan DA, Hedberg-Dirk EL. Isolated effect of material stiffness on valvular interstitial cell differentiation. J Biomed Mater Res A 2016; 105:51-61. [DOI: 10.1002/jbm.a.35864] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2016] [Accepted: 08/05/2016] [Indexed: 01/03/2023]
Affiliation(s)
- Kent E. Coombs
- Center for Biomedical Engineering; University of New Mexico; Albuquerque New Mexico
- Biomedical Sciences Graduate Program; University of New Mexico; Albuquerque New Mexico
| | - Alexander T. Leonard
- Center for Biomedical Engineering; University of New Mexico; Albuquerque New Mexico
- Department of Chemical and Biological Engineering; University of New Mexico; Albuquerque New Mexico
| | - Matthew N. Rush
- Center for Biomedical Engineering; University of New Mexico; Albuquerque New Mexico
- Nanoscience and Microsystems Engineering; University of New Mexico; Albuquerque New Mexico
| | - David A. Santistevan
- Center for Biomedical Engineering; University of New Mexico; Albuquerque New Mexico
| | - Elizabeth L. Hedberg-Dirk
- Center for Biomedical Engineering; University of New Mexico; Albuquerque New Mexico
- Department of Chemical and Biological Engineering; University of New Mexico; Albuquerque New Mexico
- Nanoscience and Microsystems Engineering; University of New Mexico; Albuquerque New Mexico
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Moreira R, Neusser C, Kruse M, Mulderrig S, Wolf F, Spillner J, Schmitz-Rode T, Jockenhoevel S, Mela P. Tissue-Engineered Fibrin-Based Heart Valve with Bio-Inspired Textile Reinforcement. Adv Healthc Mater 2016; 5:2113-21. [PMID: 27377438 DOI: 10.1002/adhm.201600300] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2016] [Revised: 04/28/2016] [Indexed: 12/12/2022]
Abstract
The mechanical properties of tissue-engineered heart valves still need to be improved to enable their implantation in the systemic circulation. The aim of this study is to develop a tissue-engineered valve for the aortic position - the BioTexValve - by exploiting a bio-inspired composite textile scaffold to confer native-like mechanical strength and anisotropy to the leaflets. This is achieved by multifilament fibers arranged similarly to the collagen bundles in the native aortic leaflet, fixed by a thin electrospun layer directly deposited on the pattern. The textile-based leaflets are positioned into a 3D mould where the components to form a fibrin gel containing human vascular smooth muscle cells are introduced. Upon fibrin polymerization, a complete valve is obtained. After 21 d of maturation by static and dynamic stimulation in a custom-made bioreactor, the valve shows excellent functionality under aortic pressure and flow conditions, as demonstrated by hydrodynamic tests performed according to ISO standards in a mock circulation system. The leaflets possess remarkable burst strength (1086 mmHg) while remaining pliable; pronounced extracellular matrix production is revealed by immunohistochemistry and biochemical assay. This study demonstrates the potential of bio-inspired textile-reinforcement for the fabrication of functional tissue-engineered heart valves for the aortic position.
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Affiliation(s)
- Ricardo Moreira
- Department of Tissue Engineering and Textile Implant; AME-Helmholtz Institute for Biomedical Engineering; University Hospital RWTH Aachen; Pauwelsstr. 20 52074 Aachen Germany
| | - Christine Neusser
- Institute for Textile Engineering; RWTH Aachen University; Otto-Blumenthal-Str. 1 52074 Aachen Germany
| | - Magnus Kruse
- Institute for Textile Engineering; RWTH Aachen University; Otto-Blumenthal-Str. 1 52074 Aachen Germany
| | - Shane Mulderrig
- Department of Tissue Engineering and Textile Implant; AME-Helmholtz Institute for Biomedical Engineering; University Hospital RWTH Aachen; Pauwelsstr. 20 52074 Aachen Germany
| | - Frederic Wolf
- Department of Tissue Engineering and Textile Implant; AME-Helmholtz Institute for Biomedical Engineering; University Hospital RWTH Aachen; Pauwelsstr. 20 52074 Aachen Germany
| | - Jan Spillner
- Department for Cardiothoracic- and Vascular Surgery; University Hospital RWTH Aachen; Pauwelsstr. 30 52074 Aachen Germany
| | - Thomas Schmitz-Rode
- Department of Tissue Engineering and Textile Implant; AME-Helmholtz Institute for Biomedical Engineering; University Hospital RWTH Aachen; Pauwelsstr. 20 52074 Aachen Germany
| | - Stefan Jockenhoevel
- Department of Tissue Engineering and Textile Implant; AME-Helmholtz Institute for Biomedical Engineering; University Hospital RWTH Aachen; Pauwelsstr. 20 52074 Aachen Germany
- Institute for Textile Engineering; RWTH Aachen University; Otto-Blumenthal-Str. 1 52074 Aachen Germany
- Department of Tissue Engineering and Textile Implants; AME-Helmholtz Institute for Biomedical Engineering; University Hospital RWTH Aachen; Pauwelsstr. 20 52074 Aachen Germany
| | - Petra Mela
- Department of Tissue Engineering and Textile Implant; AME-Helmholtz Institute for Biomedical Engineering; University Hospital RWTH Aachen; Pauwelsstr. 20 52074 Aachen Germany
- Department of Tissue Engineering and Textile Implants; AME-Helmholtz Institute for Biomedical Engineering; University Hospital RWTH Aachen; Pauwelsstr. 20 52074 Aachen Germany
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Dijkman PE, Fioretta ES, Frese L, Pasqualini FS, Hoerstrup SP. Heart Valve Replacements with Regenerative Capacity. Transfus Med Hemother 2016; 43:282-290. [PMID: 27721704 DOI: 10.1159/000448181] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2016] [Accepted: 07/04/2016] [Indexed: 01/14/2023] Open
Abstract
The incidence of severe valvular dysfunctions (e.g., stenosis and insufficiency) is increasing, leading to over 300,000 valves implanted worldwide yearly. Clinically used heart valve replacements lack the capacity to grow, inherently requiring repetitive and high-risk surgical interventions during childhood. The aim of this review is to present how different tissue engineering strategies can overcome these limitations, providing innovative valve replacements that proved to be able to integrate and remodel in pre-clinical experiments and to have promising results in clinical studies. Upon description of the different types of heart valve tissue engineering (e.g., in vitro, in situ, in vivo, and the pre-seeding approach) we focus on the clinical translation of this technology. In particular, we will deepen the many technical, clinical, and regulatory aspects that need to be solved to endure the clinical adaptation and the commercialization of these promising regenerative valves.
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Affiliation(s)
- Petra E Dijkman
- Institute for Regenerative Medicine (IREM), University of Zurich, Zurich, Switzerland
| | - Emanuela S Fioretta
- Institute for Regenerative Medicine (IREM), University of Zurich, Zurich, Switzerland
| | - Laura Frese
- Institute for Regenerative Medicine (IREM), University of Zurich, Zurich, Switzerland
| | | | - Simon P Hoerstrup
- Institute for Regenerative Medicine (IREM), University of Zurich, Zurich, Switzerland; Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands; Wyss Translational Center Zurich, University of Zurich and ETH Zurich, Zurich, Switzerland
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Hasan A, Saliba J, Pezeshgi Modarres H, Bakhaty A, Nasajpour A, Mofrad MRK, Sanati-Nezhad A. Micro and nanotechnologies in heart valve tissue engineering. Biomaterials 2016; 103:278-292. [PMID: 27414719 DOI: 10.1016/j.biomaterials.2016.07.001] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2016] [Revised: 06/26/2016] [Accepted: 07/01/2016] [Indexed: 02/04/2023]
Abstract
Due to the increased morbidity and mortality resulting from heart valve diseases, there is a growing demand for off-the-shelf implantable tissue engineered heart valves (TEHVs). Despite the significant progress in recent years in improving the design and performance of TEHV constructs, viable and functional human implantable TEHV constructs have remained elusive. The recent advances in micro and nanoscale technologies including the microfabrication, nano-microfiber based scaffolds preparation, 3D cell encapsulated hydrogels preparation, microfluidic, micro-bioreactors, nano-microscale biosensors as well as the computational methods and models for simulation of biological tissues have increased the potential for realizing viable, functional and implantable TEHV constructs. In this review, we aim to present an overview of the importance and recent advances in micro and nano-scale technologies for the development of TEHV constructs.
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Affiliation(s)
- Anwarul Hasan
- Department of Mechanical and Industrial Engineering, College of Engineering, Qatar University, Doha 2713, Qatar; Department of Mechanical Engineering, Faculty of Engineering and Architecture, American University of Beirut, Beirut 1107 2020, Lebanon; Biomaterials Innovation Research Center, Division of Biomedical Engineering, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Cambridge, MA 02139, USA.
| | - John Saliba
- Department of Mechanical Engineering, Faculty of Engineering and Architecture, American University of Beirut, Beirut 1107 2020, Lebanon
| | - Hassan Pezeshgi Modarres
- BioMEMS and Bioinspired Microfluidic Laboratory, Department of Mechanical and Manufacturing Engineering, University of Calgary, Calgary, Canada; Center for BioEngineering Research and Education, University of Calgary, Calgary, Canada; Molecular Cell Biomechanics Laboratory, Departments of Bioengineering and Mechanical Engineering, University of California Berkeley, 208A Stanley Hall, Berkeley, CA 94720-1762, USA
| | - Ahmed Bakhaty
- Molecular Cell Biomechanics Laboratory, Departments of Bioengineering and Mechanical Engineering, University of California Berkeley, 208A Stanley Hall, Berkeley, CA 94720-1762, USA
| | - Amir Nasajpour
- Biomaterials Innovation Research Center, Division of Biomedical Engineering, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Cambridge, MA 02139, USA
| | - Mohammad R K Mofrad
- Molecular Cell Biomechanics Laboratory, Departments of Bioengineering and Mechanical Engineering, University of California Berkeley, 208A Stanley Hall, Berkeley, CA 94720-1762, USA; Physical Biosciences Division, Lawrence Berkeley National Lab, Berkeley, CA 94720, USA
| | - Amir Sanati-Nezhad
- BioMEMS and Bioinspired Microfluidic Laboratory, Department of Mechanical and Manufacturing Engineering, University of Calgary, Calgary, Canada; Center for BioEngineering Research and Education, University of Calgary, Calgary, Canada.
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Shafiq M, Jung Y, Kim SH. Covalent immobilization of stem cell inducing/recruiting factor and heparin on cell-free small-diameter vascular graft for accelerated in situ tissue regeneration. J Biomed Mater Res A 2016; 104:1352-71. [PMID: 26822178 DOI: 10.1002/jbm.a.35666] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2016] [Revised: 01/17/2016] [Accepted: 01/25/2016] [Indexed: 12/12/2022]
Abstract
The development of cell-free vascular grafts has tremendous potential for tissue engineering. However, thrombus formation, less-than-ideal cell infiltration, and a lack of growth potential limit the application of electrospun scaffolds for in situ tissue-engineered vasculature. To overcome these challenges, here we present development of an acellular tissue-engineered vessel based on electrospun poly(L-lactide-co-ɛ-caprolactone) scaffolds. Heparin was conjugated to suppress thrombogenic responses, and substance P (SP) was immobilized to recruit host cells. SP was released in a sustained manner from scaffolds and recruited human bone marrow-derived mesenchymal stem cells. The biocompatibility and biological performance of the grafts were evaluated by in vivo experiments involving subcutaneous scaffold implantation in Sprague-Dawley rats (n = 12) for up to 4 weeks. Histological analysis revealed a higher extent of accumulative host cell infiltration, neotissue formation, collagen deposition, and elastin deposition in scaffolds containing either SP or heparin/SP than in the control groups. We also observed the presence of a large number of laminin-positive blood vessels, von Willebrand factor (vWF(+) ) cells, and alpha smooth muscle actin-positive cells in the explants containing SP and heparin/SP. Additionally, SP and heparin/SP grafts showed the existence of CD90(+) and CD105(+) MSCs and induced a large number of M2 macrophages to infiltrate the graft wall compared with that observed with the control group. Our cell-free grafts could enhance vascular regeneration by endogenous cell recruitment and by mediating macrophage polarization into the M2 phenotype, suggesting that these constructs may be a promising cell-free graft candidate and are worthy of further in vivo evaluation. © 2016 Wiley Periodicals, Inc. J Biomed Mater Res Part A: 104A: 1352-1371, 2016.
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Affiliation(s)
- Muhammad Shafiq
- Department of Biomedical Engineering, Korea University of Science and Technology (UST) (305-350), Gajeong-Ro, Yuseong-Gu, Daejeon, Korea.,Center for Biomaterials 5, Hwarang-Ro 14-Gil, Biomedical Research Institute, Korea Institute of Science and Technology (KIST), Seongbuk-Gu, Seoul, 136-791, Republic of Korea
| | - Youngmee Jung
- Department of Biomedical Engineering, Korea University of Science and Technology (UST) (305-350), Gajeong-Ro, Yuseong-Gu, Daejeon, Korea.,Center for Biomaterials 5, Hwarang-Ro 14-Gil, Biomedical Research Institute, Korea Institute of Science and Technology (KIST), Seongbuk-Gu, Seoul, 136-791, Republic of Korea
| | - Soo Hyun Kim
- Department of Biomedical Engineering, Korea University of Science and Technology (UST) (305-350), Gajeong-Ro, Yuseong-Gu, Daejeon, Korea.,Center for Biomaterials 5, Hwarang-Ro 14-Gil, Biomedical Research Institute, Korea Institute of Science and Technology (KIST), Seongbuk-Gu, Seoul, 136-791, Republic of Korea.,NBIT, KU-KIST Graduate School of Converging Science and Technology, Korea University, Seoul, Korea
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36
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Usprech J, Chen WLK, Simmons CA. Heart valve regeneration: the need for systems approaches. WILEY INTERDISCIPLINARY REVIEWS-SYSTEMS BIOLOGY AND MEDICINE 2016; 8:169-82. [PMID: 26862013 DOI: 10.1002/wsbm.1329] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/07/2015] [Revised: 12/22/2015] [Accepted: 12/29/2015] [Indexed: 01/10/2023]
Abstract
Tissue-engineered heart valves are promising alternatives to address the limitations of current valve replacements, particularly for growing children. Current heart valve tissue engineering strategies involve the selection of biomaterial scaffolds, cell types, and often in vitro culture conditions aimed at regenerating a valve for implantation and subsequent maturation in vivo. However, identifying optimal combinations of cell sources, biomaterials, and/or bioreactor conditions to produce functional, durable valve tissue remains a challenge. Despite some short-term success in animal models, attempts to recapitulate aspects of the native heart valve environment based on 'best guesses' of a limited number of regulatory factors have not proven effective. Better outcomes for valve tissue regeneration will likely require a systems-level understanding of the relationships between multiple interacting regulatory factors and their effects on cell function and tissue formation. Until recently, conventional culture methods have not allowed for multiple design parameters to be considered at once. Emerging microtechnologies are well suited to systematically probe multiple inputs, in combination, in high throughput and with great precision. When combined with statistical and network systems analyses, these microtechnologies have excellent potential to define multivariate signal-response relationships and reveal key regulatory pathways for robust functional tissue regeneration.
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Affiliation(s)
- Jenna Usprech
- Institute of Biomaterials and Biomedical Engineering, University of Toronto, Toronto, ON, Canada
| | - Wen Li Kelly Chen
- Institute of Biomaterials and Biomedical Engineering, University of Toronto, Toronto, ON, Canada
| | - Craig A Simmons
- Institute of Biomaterials and Biomedical Engineering, University of Toronto, Toronto, ON, Canada.,Department of Mechanical and Industrial Engineering, University of Toronto, Toronto, ON, Canada
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Reineke D, Gisler F, Englberger L, Carrel T. Mechanical versus biological aortic valve replacement strategies. Expert Rev Cardiovasc Ther 2016; 14:423-30. [DOI: 10.1586/14779072.2016.1133293] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Parvin Nejad S, Blaser MC, Santerre JP, Caldarone CA, Simmons CA. Biomechanical conditioning of tissue engineered heart valves: Too much of a good thing? Adv Drug Deliv Rev 2016; 96:161-75. [PMID: 26555371 DOI: 10.1016/j.addr.2015.11.003] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2015] [Revised: 10/23/2015] [Accepted: 11/02/2015] [Indexed: 12/13/2022]
Abstract
Surgical replacement of dysfunctional valves is the primary option for the treatment of valvular disease and congenital defects. Existing mechanical and bioprosthetic replacement valves are far from ideal, requiring concomitant anticoagulation therapy or having limited durability, thus necessitating further surgical intervention. Heart valve tissue engineering (HVTE) is a promising alternative to existing replacement options, with the potential to synthesize mechanically robust tissue capable of growth, repair, and remodeling. The clinical realization of a bioengineered valve relies on the appropriate combination of cells, biomaterials, and/or bioreactor conditioning. Biomechanical conditioning of valves in vitro promotes differentiation of progenitor cells to tissue-synthesizing myofibroblasts and prepares the construct to withstand the complex hemodynamic environment of the native valve. While this is a crucial step in most HVTE strategies, it also may contribute to fibrosis, the primary limitation of engineered valves, through sustained myofibrogenesis. In this review, we examine the progress of HVTE and the role of mechanical conditioning in the synthesis of mechanically robust tissue, and suggest approaches to achieve myofibroblast quiescence and prevent fibrosis.
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39
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Etnel JR, Elmont LC, Ertekin E, Mokhles MM, Heuvelman HJ, Roos-Hesselink JW, de Jong PL, Helbing WA, Bogers AJ, Takkenberg JJ. Outcome after aortic valve replacement in children: A systematic review and meta-analysis. J Thorac Cardiovasc Surg 2016; 151:143-52.e1-3. [DOI: 10.1016/j.jtcvs.2015.09.083] [Citation(s) in RCA: 58] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2014] [Revised: 08/18/2015] [Accepted: 09/15/2015] [Indexed: 10/23/2022]
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40
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Eslami M, Javadi G, Agdami N, Shokrgozar MA. Expression of COLLAGEN 1 and ELASTIN Genes in Mitral Valvular Interstitial Cells within Microfiber Reinforced Hydrogel. CELL JOURNAL 2015; 17:478-88. [PMID: 26464819 PMCID: PMC4601868 DOI: 10.22074/cellj.2015.22] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/26/2014] [Accepted: 07/22/2014] [Indexed: 11/30/2022]
Abstract
Objective The incidence of heart valve disease is increasing worldwide and the number
of heart valve replacements is expected to increase in the future. By mimicking the main
tissue structures and properties of heart valve, tissue engineering offers new options for
the replacements. Applying an appropriate scaffold in fabricating tissue-engineered heart
valves (TEHVs) is of importance since it affects the secretion of the main extracellular matrix (ECM) components, collagen 1 and elastin, which are crucial in providing the proper
mechanical properties of TEHVs.
Materials and Methods Using real-time polymerase chain reaction (PCR) in this experi-
mental study, the relative expression levels of COLLAGEN 1 and ELASTIN were obtained
for three samples of each examined sheep mitral valvular interstitial cells (MVICs)-seeded
onto electrospun poly (glycerol sebacate) (PGS)-poly (ε-caprolactone) (PCL) microfibrous, gelatin and hyaluronic acid based hydrogel-only and composite (PGS-PCL/hydrogel) scaffolds. This composite has been shown to create a synthetic three-dimensional
(3D) microenvironment with appropriate mechanical and biological properties for MVICs.
Results Cell viability and metabolic activity were similar among all scaffold types. Our
results showed that the level of relative expression of COLLAGEN 1 and ELASTIN genes
was higher in the encapsulated composite scaffolds compared to PGS-PCL-only and hydrogel-only scaffolds with the difference being statistically significant (P<0.05).
Conclusion The encapsulated composite scaffolds are more conducive to ECM secretion over the PGS-PCL-only and hydrogel-only scaffolds. This composite scaffold
can serve as a model scaffold for heart valve tissue engineering.
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Affiliation(s)
- Maryam Eslami
- Department of Biology, Science and Research Branch, Islamic Azad University, Tehran, Iran ; Department of Genetics,Tehran Medical Sciences Branch, Islamic Azad University, Tehran, Iran ; Applied Biotechnology Research Center, Tehran Medical Sciences Branch, Islamic Azad University, Tehran, Iran
| | - Gholamreza Javadi
- Department of Biology, Science and Research Branch, Islamic Azad University, Tehran, Iran
| | - Nasser Agdami
- Department of Stem Cells and Developmental Biology, Cell Science Research Center, Royan Institute for Stem Cell Biology and Technology, ACECR, Tehran, Iran
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Abstract
Three-dimensional (3-D) printing technology has rapidly developed in the last few decades. Meanwhile, the application of this technology has reached beyond the engineering field and expanded to almost all disciplines, including medicine. There has been much research on the medical applications of 3-D printing in neurosurgery, orthopedics, maxillofacial surgery, plastic surgery, tissue engineering, as well as other fields. Because of the complexity of the cardiovascular system, the application of this technology is limited and difficult, as compared to other disciplines, and thus there is much room for future development. Many of the difficulties associated with this technology must be overcome. Nonetheless, there is no doubt that 3-D printing technology will benefit patients with cardiovascular diseases in the near future.
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Affiliation(s)
- Di Shi
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Kai Liu
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Xin Zhang
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Hang Liao
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Xiaoping Chen
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, 610041, China.
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Talacua H, Smits AI, Muylaert DE, van Rijswijk JW, Vink A, Verhaar MC, Driessen-Mol A, van Herwerden LA, Bouten CV, Kluin J, Baaijens FP. In Situ Tissue Engineering of Functional Small-Diameter Blood Vessels by Host Circulating Cells Only. Tissue Eng Part A 2015. [DOI: 10.1089/ten.tea.2015.0066] [Citation(s) in RCA: 82] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Affiliation(s)
- Hanna Talacua
- Department of Cardiothoracic Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Anthal I.P.M Smits
- Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - Dimitri E.P. Muylaert
- Department of Nephrology and Hypertension, University Medical Center Utrecht, Utrecht, The Netherlands
| | | | - Aryan Vink
- Department of Pathology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Marianne C. Verhaar
- Department of Nephrology and Hypertension, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Anita Driessen-Mol
- Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - Lex A. van Herwerden
- 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, The Netherlands
| | - Jolanda Kluin
- Department of Cardiothoracic Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Frank P.T. Baaijens
- Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
- Institute for Complex Molecular Systems, Eindhoven, The Netherlands
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43
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Abstract
Heart disease, including valve pathologies, is the leading cause of death worldwide. Despite the progress made thanks to improving transplantation techniques, a perfect valve substitute has not yet been developed: once a diseased valve is replaced with current technologies, the newly implanted valve still needs to be changed some time in the future. This situation is particularly dramatic in the case of children and young adults, because of the necessity of valve growth during the patient's life. Our review focuses on the current status of heart valve (HV) therapy and the challenges that must be solved in the development of new approaches based on tissue engineering. Scientists and physicians have proposed tissue-engineered heart valves (TEHVs) as the most promising solution for HV replacement, especially given that they can help to avoid thrombosis, structural deterioration and xenoinfections. Lastly, TEHVs might also serve as a model for studying human valve development and pathologies.
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44
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Thrombogenicity and biocompatibility studies of reduced graphene oxide modified acellular pulmonary valve tissue. MATERIALS SCIENCE & ENGINEERING. C, MATERIALS FOR BIOLOGICAL APPLICATIONS 2015; 53:310-21. [DOI: 10.1016/j.msec.2015.04.044] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/29/2014] [Revised: 01/31/2015] [Accepted: 04/24/2015] [Indexed: 12/12/2022]
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Sanders B, Loerakker S, Fioretta ES, Bax DJP, Driessen-Mol A, Hoerstrup SP, Baaijens FPT. Improved Geometry of Decellularized Tissue Engineered Heart Valves to Prevent Leaflet Retraction. Ann Biomed Eng 2015; 44:1061-71. [PMID: 26183964 PMCID: PMC4826662 DOI: 10.1007/s10439-015-1386-4] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2015] [Accepted: 07/07/2015] [Indexed: 11/25/2022]
Abstract
Recent studies on decellularized tissue engineered heart valves (DTEHVs) showed rapid host cell repopulation and increased valvular insufficiency developing over time, associated with leaflet shortening. A possible explanation for this result was found using computational simulations, which revealed radial leaflet compression in the original valvular geometry when subjected to physiological pressure conditions. Therefore, an improved geometry was suggested to enable radial leaflet extension to counteract for host cell mediated retraction. In this study, we propose a solution to impose this new geometry by using a constraining bioreactor insert during culture. Human cell based DTEHVs (n = 5) were produced as such, resulting in an enlarged coaptation area and profound belly curvature. Extracellular matrix was homogeneously distributed, with circumferential collagen alignment in the coaptation region and global tissue anisotropy. Based on in vitro functionality experiments, these DTEHVs showed competent hydrodynamic functionality under physiological pulmonary conditions and were fatigue resistant, with stable functionality up to 16 weeks in vivo simulation. Based on implemented mechanical data, our computational models revealed a considerable decrease in radial tissue compression with the obtained geometrical adjustments. Therefore, these improved DTEHV are expected to be less prone to host cell mediated leaflet retraction and will remain competent after implantation.
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Affiliation(s)
- Bart Sanders
- Department of Biomedical Engineering, Eindhoven University of Technology, Postbus 513, 5600 MB, Eindhoven, The Netherlands.
- Institute for Complex Molecular Systems, Eindhoven University of Technology, Eindhoven, The Netherlands.
| | - Sandra Loerakker
- Department of Biomedical Engineering, Eindhoven University of Technology, Postbus 513, 5600 MB, Eindhoven, The Netherlands
- Institute for Complex Molecular Systems, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - Emanuela S Fioretta
- Department of Biomedical Engineering, Eindhoven University of Technology, Postbus 513, 5600 MB, Eindhoven, The Netherlands
| | - Dave J P Bax
- Equipment & Prototype Center, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - Anita Driessen-Mol
- Department of Biomedical Engineering, Eindhoven University of Technology, Postbus 513, 5600 MB, Eindhoven, The Netherlands
- Institute for Complex Molecular Systems, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - Simon P Hoerstrup
- Department of Biomedical Engineering, Eindhoven University of Technology, Postbus 513, 5600 MB, Eindhoven, The Netherlands
- Swiss Center for Regenerative Medicine, University Hospital of Zürich, Zurich, Switzerland
| | - Frank P T Baaijens
- Department of Biomedical Engineering, Eindhoven University of Technology, Postbus 513, 5600 MB, Eindhoven, The Netherlands
- Institute for Complex Molecular Systems, Eindhoven University of Technology, Eindhoven, The Netherlands
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Wang S, Oldenhof H, Goecke T, Ramm R, Harder M, Haverich A, Hilfiker A, Wolkers WF. Sucrose Diffusion in Decellularized Heart Valves for Freeze-Drying. Tissue Eng Part C Methods 2015; 21:922-31. [PMID: 25809201 DOI: 10.1089/ten.tec.2014.0681] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Decellularized heart valves can be used as starter matrix implants for heart valve replacement therapies in terms of guided tissue regeneration. Decellularized matrices ideally need to be long-term storable to assure off-the-shelf availability. Freeze-drying is an attractive preservation method, allowing storage at room temperature in a dried state. However, the two inherent processing steps, freezing and drying, can cause severe damage to extracellular matrix (ECM) proteins and the overall tissue histoarchitecture and thus impair biomechanical characteristics of resulting matrices. Freeze-drying therefore requires a lyoprotective agent that stabilizes endogenous structural proteins during both substeps and that forms a protective glassy state at room temperature. To estimate incubation times needed to infiltrate decellularized heart valves with the lyoprotectant sucrose, temperature-dependent diffusion studies were done using Fourier transform infrared spectroscopy. Glycerol, a cryoprotective agent, was studied for comparison. Diffusion of both protectants was found to exhibit Arrhenius behavior. The activation energies of sucrose and glycerol diffusion were found to be 15.9 and 37.7 kJ·mol(-1), respectively. It was estimated that 4 h of incubation at 37°C is sufficient to infiltrate heart valves with sucrose before freeze-drying. Application of a 5% sucrose solution was shown to stabilize acellular valve scaffolds during freeze-drying. Such freeze-dried tissues, however, displayed pores, which were attributed to ice crystal damage, whereas vacuum-dried scaffolds in comparison revealed no pores after drying and rehydration. Exposure to a hygroscopic sucrose solution (80%) before freeze-drying was shown to be an effective method to diminish pore formation in freeze-dried ECMs: matrix structures closely resembled those of control samples that were not freeze-dried. Heart valve matrices were shown to be in a glassy state after drying, suggesting that they can be stored at room temperature.
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Affiliation(s)
- Shangping Wang
- 1 Institute of Multiphase Processes, Leibniz Universität Hannover , Hannover, Germany
| | - Harriëtte Oldenhof
- 2 Clinic for Horses-Unit for Reproductive Medicine, University of Veterinary Medicine Hannover , Hannover, Germany
| | - Tobias Goecke
- 3 Leibniz Research Laboratories for Biotechnology and Artificial Organs, Hannover Medical School , Hannover, Germany
| | - Robert Ramm
- 3 Leibniz Research Laboratories for Biotechnology and Artificial Organs, Hannover Medical School , Hannover, Germany
| | | | - Axel Haverich
- 3 Leibniz Research Laboratories for Biotechnology and Artificial Organs, Hannover Medical School , Hannover, Germany
| | - Andres Hilfiker
- 3 Leibniz Research Laboratories for Biotechnology and Artificial Organs, Hannover Medical School , Hannover, Germany
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47
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Weber M, Gonzalez de Torre I, Moreira R, Frese J, Oedekoven C, Alonso M, Rodriguez Cabello CJ, Jockenhoevel S, Mela P. Multiple-Step Injection Molding for Fibrin-Based Tissue-Engineered Heart Valves. Tissue Eng Part C Methods 2015; 21:832-40. [PMID: 25654448 PMCID: PMC4523041 DOI: 10.1089/ten.tec.2014.0396] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Heart valves are elaborate and highly heterogeneous structures of the circulatory system. Despite the well accepted relationship between the structural and mechanical anisotropy and the optimal function of the valves, most approaches to create tissue-engineered heart valves (TEHVs) do not try to mimic this complexity and rely on one homogenous combination of cells and materials for the whole construct. The aim of this study was to establish an easy and versatile method to introduce spatial diversity into a heart valve fibrin scaffold. We developed a multiple-step injection molding process that enables the fabrication of TEHVs with heterogeneous composition (cell/scaffold material) of wall and leaflets without the need of gluing or suturing components together, with the leaflets firmly connected to the wall. The integrity of the valves and their functionality was proved by either opening/closing cycles in a bioreactor (proof of principle without cells) or with continuous stimulation over 2 weeks. We demonstrated the potential of the method by the two-step molding of the wall and the leaflets containing different cell lines. Immunohistology after stimulation confirmed tissue formation and demonstrated the localization of the different cell types. Furthermore, we showed the proof of principle fabrication of valves using different materials for wall (fibrin) and leaflets (hybrid gel of fibrin/elastin-like recombinamer) and with layered leaflets. The method is easy to implement, does not require special facilities, and can be reproduced in any tissue-engineering lab. While it has been demonstrated here with fibrin, it can easily be extended to other hydrogels.
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Affiliation(s)
- Miriam Weber
- 1 Department of Tissue Engineering and Textile Implants, Institute of Applied Medical Engineering, Helmholtz Institute, RWTH Aachen University , Aachen, Germany
| | | | - Ricardo Moreira
- 1 Department of Tissue Engineering and Textile Implants, Institute of Applied Medical Engineering, Helmholtz Institute, RWTH Aachen University , Aachen, Germany
| | - Julia Frese
- 1 Department of Tissue Engineering and Textile Implants, Institute of Applied Medical Engineering, Helmholtz Institute, RWTH Aachen University , Aachen, Germany
| | - Caroline Oedekoven
- 1 Department of Tissue Engineering and Textile Implants, Institute of Applied Medical Engineering, Helmholtz Institute, RWTH Aachen University , Aachen, Germany
| | - Matilde Alonso
- 2 G.I.R. Bioforge, University of Valladolid , CIBER-BBN, Valladolid, Spain
| | | | - Stefan Jockenhoevel
- 1 Department of Tissue Engineering and Textile Implants, Institute of Applied Medical Engineering, Helmholtz Institute, RWTH Aachen University , Aachen, Germany .,3 Institut für Textiltecknik, RWTH Aachen University , Aachen, Germany
| | - Petra Mela
- 1 Department of Tissue Engineering and Textile Implants, Institute of Applied Medical Engineering, Helmholtz Institute, RWTH Aachen University , Aachen, Germany
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Hobson CM, Amoroso NJ, Amini R, Ungchusri E, Hong Y, D'Amore A, Sacks MS, Wagner WR. Fabrication of elastomeric scaffolds with curvilinear fibrous structures for heart valve leaflet engineering. J Biomed Mater Res A 2015; 103:3101-6. [PMID: 25771748 DOI: 10.1002/jbm.a.35450] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2014] [Revised: 02/13/2015] [Accepted: 02/27/2015] [Indexed: 01/10/2023]
Abstract
Native semi-lunar heart valves are composed of a dense fibrous network that generally follows a curvilinear path along the width of the leaflet. Recent models of engineered valve leaflets have predicted that such curvilinear fiber orientations would homogenize the strain field and reduce stress concentrations at the commissure. In the present work, a method was developed to reproduce this curvilinear fiber alignment in electrospun scaffolds by varying the geometry of the collecting mandrel. Elastomeric poly(ester urethane)urea was electrospun onto rotating conical mandrels of varying angles to produce fibrous scaffolds where the angle of fiber alignment varied linearly over scaffold length. By matching the radius of the conical mandrel to the radius of curvature for the native pulmonary valve, the electrospun constructs exhibited a curvilinear fiber structure similar to the native leaflet. Moreover, the constructs had local mechanical properties comparable to conventional scaffolds and native heart valves. In agreement with prior modeling results, it was found under quasi-static loading that curvilinear fiber microstructures reduced strain concentrations compared to scaffolds generated on a conventional cylindrical mandrels. Thus, this simple technique offers an attractive means for fabricating scaffolds where key microstructural features of the native leaflet are imitated for heart valve tissue engineering.
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Affiliation(s)
- Christopher M Hobson
- Bioengineering and Surgery, McGowan Institute for Regenerative Medicine.,Department of Bioengineering
| | - Nicholas J Amoroso
- Bioengineering and Surgery, McGowan Institute for Regenerative Medicine.,Department of Surgery
| | - Rouzbeh Amini
- Department of Biomedical Engineering, the University of Akron, Ohio
| | - Ethan Ungchusri
- Bioengineering and Surgery, McGowan Institute for Regenerative Medicine
| | - Yi Hong
- Bioengineering and Surgery, McGowan Institute for Regenerative Medicine.,Department of Bioengineering, University of Texas at Arlington, Arlington, Texas, 76019
| | - Antonio D'Amore
- Bioengineering and Surgery, McGowan Institute for Regenerative Medicine.,Department of Bioengineering.,Department of Surgery.,Foundation RiMED, Palermo, Italy.,DICGIM, University of Palermo, Palermo, Italy
| | - Michael S Sacks
- Center for Cardiovascular Simulation, Institute for Computational Engineering and Sciences, Department of Biomedical Engineering and the University of Texas at Austin, Austin, Texas
| | - William R Wagner
- Bioengineering and Surgery, McGowan Institute for Regenerative Medicine.,Department of Bioengineering.,Department of Surgery.,Department of Chemical Engineering, University of Pittsburgh, Pennsylvania
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Zhang X, Xu B, Puperi DS, Yonezawa AL, Wu Y, Tseng H, Cuchiara ML, West JL, Grande-Allen KJ. Integrating valve-inspired design features into poly(ethylene glycol) hydrogel scaffolds for heart valve tissue engineering. Acta Biomater 2015; 14:11-21. [PMID: 25433168 PMCID: PMC4334908 DOI: 10.1016/j.actbio.2014.11.042] [Citation(s) in RCA: 85] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2014] [Revised: 11/10/2014] [Accepted: 11/19/2014] [Indexed: 12/31/2022]
Abstract
The development of advanced scaffolds that recapitulate the anisotropic mechanical behavior and biological functions of the extracellular matrix in leaflets would be transformative for heart valve tissue engineering. In this study, anisotropic mechanical properties were established in poly(ethylene glycol) (PEG) hydrogels by crosslinking stripes of 3.4 kDa PEG diacrylate (PEGDA) within 20 kDa PEGDA base hydrogels using a photolithographic patterning method. Varying the stripe width and spacing resulted in a tensile elastic modulus parallel to the stripes that was 4.1-6.8 times greater than that in the perpendicular direction, comparable to the degree of anisotropy between the circumferential and radial orientations in native valve leaflets. Biomimetic PEG-peptide hydrogels were prepared by tethering the cell-adhesive peptide RGDS and incorporating the collagenase-degradable peptide PQ (GGGPQG↓IWGQGK) into the polymer network. The specific amounts of RGDS and PEG-PQ within the resulting hydrogels influenced the elongation, de novo extracellular matrix deposition and hydrogel degradation behavior of encapsulated valvular interstitial cells (VICs). In addition, the morphology and activation of VICs grown atop PEG hydrogels could be modulated by controlling the concentration or micro-patterning profile of PEG-RGDS. These results are promising for the fabrication of PEG-based hydrogels using anatomically and biologically inspired scaffold design features for heart valve tissue engineering.
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Affiliation(s)
- Xing Zhang
- Department of Bioengineering, Rice University, Houston, TX, USA
| | - Bin Xu
- Department of Bioengineering, Rice University, Houston, TX, USA
| | - Daniel S Puperi
- Department of Bioengineering, Rice University, Houston, TX, USA
| | - Aline L Yonezawa
- Department of Biomedical Engineering, University of Florida, Gainesville, FL, USA
| | - Yan Wu
- Department of Biomedical Engineering, Duke University, Durham, NC, USA
| | - Hubert Tseng
- Department of Bioengineering, Rice University, Houston, TX, USA
| | - Maude L Cuchiara
- Department of Biomedical Engineering, Duke University, Durham, NC, USA
| | - Jennifer L West
- Department of Biomedical Engineering, Duke University, Durham, NC, USA
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50
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Jana S, Tranquillo RT, Lerman A. Cells for tissue engineering of cardiac valves. J Tissue Eng Regen Med 2015; 10:804-824. [DOI: 10.1002/term.2010] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2014] [Revised: 12/15/2014] [Accepted: 01/12/2015] [Indexed: 12/20/2022]
Affiliation(s)
- Soumen Jana
- Division of Cardiovascular Diseases; Mayo Clinic; Rochester MN USA
| | - Robert T. Tranquillo
- Department of Biomedical Engineering; University of Minnesota; Minneapolis MN USA
| | - Amir Lerman
- Division of Cardiovascular Diseases; Mayo Clinic; Rochester MN USA
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