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Bartolf-Kopp M, Jungst T. The Past, Present, and Future of Tubular Melt Electrowritten Constructs to Mimic Small Diameter Blood Vessels - A Stable Process? Adv Healthc Mater 2024; 13:e2400426. [PMID: 38607966 DOI: 10.1002/adhm.202400426] [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: 02/03/2024] [Revised: 03/20/2024] [Indexed: 04/14/2024]
Abstract
Melt Electrowriting (MEW) is a continuously growing manufacturing platform. Its advantage is the consistent production of micro- to nanometer fibers, that stack intricately, forming complex geometrical shapes. MEW allows tuning of the mechanical properties of constructs via the geometry of deposited fibers. Due to this, MEW can create complex mechanics only seen in multi-material compounds and serve as guiding structures for cellular alignment. The advantage of MEW is also shown in combination with other biotechnological manufacturing methods to create multilayered constructs that increase mechanical approximation to native tissues, biocompatibility, and cellular response. These features make MEW constructs a perfect candidate for small-diameter vascular graft structures. Recently, studies have presented fascinating results in this regard, but is this truly the direction that tubular MEW will follow or are there also other options on the horizon? This perspective will explore the origins and developments of tubular MEW and present its growing importance in the field of artificial small-diameter vascular grafts with mechanical modulation and improved biomimicry and the impact of it in convergence with other manufacturing methods and how future technologies like AI may influence its progress.
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Affiliation(s)
- Michael Bartolf-Kopp
- Department for Functional Materials in Medicine and Dentistry, Institute of Biofabrication and Functional Materials, University of Würzburg and KeyLab Polymers for Medicine of the Bavarian Polymer Institute (BPI), Würzburg, Germany
| | - Tomasz Jungst
- Department for Functional Materials in Medicine and Dentistry, Institute of Biofabrication and Functional Materials, University of Würzburg and KeyLab Polymers for Medicine of the Bavarian Polymer Institute (BPI), Würzburg, Germany
- Department of Orthopedics, Regenerative Medicine Center Utrecht, University Medical Center Utrecht, Utrecht, Netherlands
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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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Breuer T, Jimenez M, Humphrey JD, Shinoka T, Breuer CK. Tissue Engineering of Vascular Grafts: A Case Report From Bench to Bedside and Back. Arterioscler Thromb Vasc Biol 2023; 43:399-409. [PMID: 36633008 PMCID: PMC9974789 DOI: 10.1161/atvbaha.122.318236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Accepted: 12/29/2022] [Indexed: 01/13/2023]
Abstract
For over 25 years, our group has used regenerative medicine strategies to develop improved biomaterials for use in congenital heart surgery. Among other applications, we developed a tissue-engineered vascular graft (TEVG) by seeding tubular biodegradable polymeric scaffolds with autologous bone marrow-derived mononuclear cells. Results of our first-in-human study demonstrated feasibility as the TEVG transformed into a living vascular graft having an ability to grow, making it the first engineered graft with growth potential. Yet, outcomes of this first Food and Drug Administration-approved clinical trial evaluating safety revealed a prohibitively high incidence of early TEVG stenosis, preventing the widespread use of this promising technology. Mechanistic studies in mouse models provided important insight into the development of stenosis and enabled advanced computational models. Computational simulations suggested both a novel inflammation-driven, mechano-mediated process of in vivo TEVG development and an unexpected natural history, including spontaneous reversal of the stenosis. Based on these in vivo and in silico discoveries, we have been able to rationally design strategies for inhibiting TEVG stenosis that have been validated in preclinical large animal studies and translated to the clinic via a new Food and Drug Administration-approved clinical trial. This progress would not have been possible without the multidisciplinary approach, ranging from small to large animal models and computational simulations. This same process is expected to lead to further advances in scaffold design, and thus next generation TEVGs.
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Affiliation(s)
- Thomas Breuer
- Nationwide Children's Hospital, Columbus, OH (T.B., M.J., T.S., C.K.B.)
| | - Michael Jimenez
- Nationwide Children's Hospital, Columbus, OH (T.B., M.J., T.S., C.K.B.)
| | - Jay D Humphrey
- Yale University, School of Engineering and Applied Science, New Haven, CT (J.D.H.)
| | - Toshiharu Shinoka
- Nationwide Children's Hospital, Columbus, OH (T.B., M.J., T.S., C.K.B.)
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4
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Loerakker S, Humphrey JD. Computer Model-Driven Design in Cardiovascular Regenerative Medicine. Ann Biomed Eng 2023; 51:45-57. [PMID: 35974236 PMCID: PMC9832109 DOI: 10.1007/s10439-022-03037-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Accepted: 07/20/2022] [Indexed: 01/28/2023]
Abstract
Continuing advances in genomics, molecular and cellular mechanobiology and immunobiology, including transcriptomics and proteomics, and biomechanics increasingly reveal the complexity underlying native tissue and organ structure and function. Identifying methods to repair, regenerate, or replace vital tissues and organs remains one of the greatest challenges of modern biomedical engineering, one that deserves our very best effort. Notwithstanding the continuing need for improving standard methods of investigation, including cell, organoid, and tissue culture, biomaterials development and fabrication, animal models, and clinical research, it is increasingly evident that modern computational methods should play increasingly greater roles in advancing the basic science, bioengineering, and clinical application of regenerative medicine. This brief review focuses on the development and application of computational models of tissue and organ mechanobiology and mechanics for purposes of designing tissue engineered constructs and understanding their development in vitro and in situ. Although the basic approaches are general, for illustrative purposes we describe two recent examples from cardiovascular medicine-tissue engineered heart valves (TEHVs) and tissue engineered vascular grafts (TEVGs)-to highlight current methods of approach as well as continuing needs.
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Affiliation(s)
- Sandra Loerakker
- Department of Biomedical Engineering and Institute for Complex Molecular Systems, Eindhoven University of Technology, Eindhoven, Netherlands
| | - Jay D Humphrey
- Department of Biomedical Engineering and Vascular Biology & Therapeutics Program, Yale University and Yale School of Medicine, New Haven, CT, USA.
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5
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Caldiroli A, Pederzani E, Pezzotta M, Azzollini N, Fiori S, Tironi M, Rizzo P, Sangalli F, Figliuzzi M, Fiore GB, Remuzzi A, Riboldi SA, Soncini M, Redaelli A. Hybrid fibroin/polyurethane small-diameter vascular grafts: from fabrication to in vivo preliminary assessment. Biomed Mater 2022; 17. [PMID: 35944550 DOI: 10.1088/1748-605x/ac885a] [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: 11/09/2021] [Accepted: 08/08/2022] [Indexed: 11/12/2022]
Abstract
To address the need of alternatives to autologous vessels for small-calibre vascular applications (e.g. cardiac surgery), a hybrid semi-degradable material composed of silk fibroin and polyurethane (Silkothane®) was herein used to fabricate very small-calibre grafts (innner diameter = 1.5 mm) via electrospinning. Hybrid grafts were in vitro characterized in terms of morphology and mechanical behaviour, and compared to similar grafts of pure silk fibroin. Similarly, two native vessels from a rodent model (abdominal aorta and vena cava) were harvested and characterized. Preliminary implants were performed on Lewis rats to confirm the suitability of Silkothane® grafts for small-calibre applications, specifically as aortic insertion and femoral shunt. The manufacturing process generated pliable grafts consisting of a randomized fibrous mesh and exhibiting similar geometrical features to rat aortas. Both Silkothane® and pure silk fibroin grafts showed radial compliances in the range from 1.37 ± 0.86 to 1.88 ± 1.01 % 10-2 mmHg-1, lower than that of native vessels. The Silkothane® small-calibre devices were also implanted in rats demonstrating to be adequate for vascular applications; all the treated rats survived the surgery for 3 months after implantation, and 16 rats out of 17 (94%) still showed blood flow inside the graft at sacrifice. The obtained results lay the basis for a deeper investigation of the interaction between the Silktohane® graft and the implant site, which may deal with further analysis on the potentialities in terms of degradability and tissue formation, on longer time-points.
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Affiliation(s)
- Alice Caldiroli
- Bioengineering Laboratories Srl, Via Vivaldi 32/A, Cantù, 22063, ITALY
| | - Elia Pederzani
- Politecnico di Milano Dipartimento di Elettronica Informazione e Bioingegneria, Via Giuseppe Ponzio 34, Milano, Lombardia, 20133, ITALY
| | - Marco Pezzotta
- Politecnico di Milano Dipartimento di Elettronica Informazione e Bioingegneria, Via Giuseppe Ponzio 34, Milano, Lombardia, 20133, ITALY
| | - Nadia Azzollini
- Istituto di Ricerche Farmacologiche Mario Negri IRCCS , Via Stezzano 87, Bergamo, 24126, ITALY
| | - Sonia Fiori
- , Istituto di ricerche farmacologiche mario negri IRCCS, via Stezzano 87, Bergamo, Lombardia, 24126, ITALY
| | - Matteo Tironi
- Istituto di Ricerche Farmacologiche Mario Negri IRCCS , Via Stezzano 87, Bergamo, 24126, ITALY
| | - Paola Rizzo
- IRCCS Istituto di Ricerche Farmacologiche Mario Negri Centro Anna Maria Astori, via Stezzano 87, Bergamo, 24126, ITALY
| | - Fabio Sangalli
- Istituto di Ricerche Farmacologiche Mario Negri IRCCS, via Stezzano 87, Bergamo, 24126, ITALY
| | - Marina Figliuzzi
- Bioengineering, Istituto di ricerche farmacologiche mario negri IRCCS, via Stezzano 87, Bergamo, Bergamo, 24126, ITALY
| | - Gianfranco Beniamino Fiore
- Politecnico di Milano Dipartimento di Elettronica Informazione e Bioingegneria, Via Giuseppe Ponzio, 34, Milano, Lombardia, 20133, ITALY
| | - Andrea Remuzzi
- Università degli Studi di Bergamo, Via Pignolo 123, Bergamo, Lombardia, 24121, ITALY
| | | | - Monica Soncini
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Piazza L Da Vinci ,32, Milano, 20133, ITALY
| | - Alberto Redaelli
- Politecnico di Milano Dipartimento di Elettronica Informazione e Bioingegneria, Via Giuseppe Ponzio 34, Milano, 20133, ITALY
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6
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Abstract
Cardiovascular defects, injuries, and degenerative diseases often require surgical intervention and the use of implantable replacement material and conduits. Traditional vascular grafts made of synthetic polymers, animal and cadaveric tissues, or autologous vasculature have been utilized for almost a century with well-characterized outcomes, leaving areas of unmet need for the patients in terms of durability and long-term patency, susceptibility to infection, immunogenicity associated with the risk of rejection, and inflammation and mechanical failure. Research to address these limitations is exploring avenues as diverse as gene therapy, cell therapy, cell reprogramming, and bioengineering of human tissue and replacement organs. Tissue-engineered vascular conduits, either with viable autologous cells or decellularized, are the forefront of technology in cardiovascular reconstruction and offer many benefits over traditional graft materials, particularly in the potential for the implanted material to be adopted and remodeled into host tissue and thus offer safer, more durable performance. This review discusses the key advances and future directions in the field of surgical vascular repair, replacement, and reconstruction, with a focus on the challenges and expected benefits of bioengineering human tissues and blood vessels.
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Affiliation(s)
- Kaleb M. Naegeli
- Humacyte, Inc, Durham, NC (K.M.N., M.H.K., Y.L., J.W., E.A.H., L.E.N.)
| | - Mehmet H. Kural
- Humacyte, Inc, Durham, NC (K.M.N., M.H.K., Y.L., J.W., E.A.H., L.E.N.)
| | - Yuling Li
- Humacyte, Inc, Durham, NC (K.M.N., M.H.K., Y.L., J.W., E.A.H., L.E.N.)
| | - Juan Wang
- Humacyte, Inc, Durham, NC (K.M.N., M.H.K., Y.L., J.W., E.A.H., L.E.N.)
| | | | - Laura E. Niklason
- Department of Anesthesiology and Biomedical Engineering, Yale University, New Haven, CT (L.E.N.)
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7
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Latorre M, Szafron JM, Ramachandra AB, Humphrey JD. In vivo development of tissue engineered vascular grafts: a fluid-solid-growth model. Biomech Model Mechanobiol 2022; 21:827-848. [PMID: 35179675 PMCID: PMC9133046 DOI: 10.1007/s10237-022-01562-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Accepted: 01/24/2022] [Indexed: 11/02/2022]
Abstract
Methods of tissue engineering continue to advance, and multiple clinical trials are underway evaluating tissue engineered vascular grafts (TEVGs). Whereas initial concerns focused on suture retention and burst pressure, there is now a pressing need to design grafts to have optimal performance, including an ability to grow and remodel in response to changing hemodynamic loads. Toward this end, there is similarly a need for computational methods that can describe and predict the evolution of TEVG geometry, composition, and material properties while accounting for changes in hemodynamics. Although the ultimate goal is a fluid-solid-growth (FSG) model incorporating fully 3D growth and remodeling and 3D hemodynamics, lower fidelity models having high computational efficiency promise to play important roles, especially in the design of candidate grafts. We introduce here an efficient FSG model of in vivo development of a TEVG based on two simplifying concepts: mechanobiologically equilibrated growth and remodeling of the graft and an embedded control volume analysis of the hemodynamics. Illustrative simulations for a model Fontan conduit reveal the utility of this approach, which promises to be particularly useful in initial design considerations involving formal methods of optimization which otherwise add considerably to the computational expense.
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Affiliation(s)
- Marcos Latorre
- Department of Biomedical Engineering, Yale University, New Haven, CT, 06520, USA.
- Center for Research and Innovation in Bioengineering, Universitat Politècnica de València, València, 46022, Spain.
| | - Jason M Szafron
- Department of Biomedical Engineering, Yale University, New Haven, CT, 06520, USA
- Departments of Pediatrics and Bioengineering, Stanford University, Stanford, CA, 94305, USA
| | - Abhay B Ramachandra
- Department of Biomedical Engineering, Yale University, New Haven, CT, 06520, USA
| | - Jay D Humphrey
- Vascular Biology and Therapeutics Program, Yale School of Medicine, New Haven, CT, 06520, USA
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8
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Bouten CVC, Cheng C, Vermue IM, Gawlitta D, Passier R. Cardiovascular tissue engineering and regeneration: A plead for further knowledge convergence. Tissue Eng Part A 2022; 28:525-541. [PMID: 35382591 DOI: 10.1089/ten.tea.2021.0231] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Cardiovascular tissue engineering and regeneration strive to provide long-term, effective solutions for a growing group of patients in need of myocardial repair, vascular (access) grafts, heart valves, and regeneration of organ microcirculation. In the past two decades, ongoing convergence of disciplines and multidisciplinary collaborations between cardiothoracic surgeons, cardiologists, bioengineers, material scientists, and cell biologists have resulted in better understanding of the problems at hand and novel regenerative approaches. As a side effect, however, the field has become strongly organized and differentiated around topical areas at risk of reinvention of technologies and repetition of approaches and across the areas. A better integration of knowledge and technologies from the individual topical areas and regenerative approaches and technologies may pave the way towards faster and more effective treatments to cure the cardiovascular system. This review summarizes the evolution of research and regenerative approaches in the areas of myocardial regeneration, heart valve and vascular tissue engineering, and regeneration of microcirculations and discusses previous and potential future integration of these individual areas and developed technologies for improved clinical impact. Finally, it provides a perspective on the further integration of research organization, knowledge implementation, and valorization as a contributor to advancing cardiovascular tissue engineering and regenerative medicine.
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Affiliation(s)
- Carlijn V C Bouten
- Soft Tissue Engineering and Mechanobiology, Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
- Institute for Complex Molecular Systems (ICMS), Eindhoven, The Netherlands
| | - Caroline Cheng
- Department of Nephrology and Hypertension, University Medical Center Utrecht, Utrecht, The Netherlands
- Experimental Cardiology, Department of Cardiology, Thoraxcenter Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Ijsbrand M Vermue
- Department of Nephrology and Hypertension, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Debby Gawlitta
- Department of Oral and Maxillofacial Surgery, Prosthodontics and Special Dental Care, University Medical Center, Utrecht, The Netherlands
| | - Robert Passier
- Department of Applied Stem Cell Technologies, Faculty of Science and Technology, University of Twente, Enschede, The Netherlands
- Department of Anatomy and Embryology, Leiden University Medical Center, Leiden, The Netherlands
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9
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Wu X, Ono M, Poon EKW, O'Leary N, Torii R, Janssen JP, Zhu SJ, Vijgeboom Y, El-Kurdi MS, Cox M, Reinöhl J, Dijkstra J, Barlis P, Wijns W, Reiber JHC, Bourantas CV, Virmani R, Onuma Y, Serruys PW. One-year performance of biorestorative polymeric coronary bypass grafts in an ovine model: correlation between early biomechanics and late serial Quantitative Flow Ratio. Eur J Cardiothorac Surg 2022; 61:1402-1411. [PMID: 35022681 DOI: 10.1093/ejcts/ezab554] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 11/07/2021] [Accepted: 11/23/2021] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES This study aimed to investigate the impact of mechanical factors at baseline on the patency of a restorative conduit for coronary bypass grafts in an ovine model at serial follow-up up to 1 year. METHODS The analyses of 4 mechanical factors [i.e. bending angle, superficial wall strain and minimum and maximum endothelial shear stress (ESS)] were performed in 3D graft models reconstructed on baseline (1-month) angiograms frame by frame by a core laboratory blinded for the late follow-up. The late patency was documented by Quantitative Flow Ratio (QFR®) that reflects the physiological status of the graft. The correlation between 4 mechanical factors and segmental QFR (△QFR) were analysed on 10 equal-length segments of each graft. RESULTS A total of 69 graft geometries of 7 animals were performed in the study. The highest △QFR at 12 months was colocalized in segments of the grafts with the largest bending angles at baseline. Higher △QFR at 3 months were both at the anastomotic ends and were colocalized with the highest superficial wall strain at baseline. High baseline ESS was topographically associated with higher △QFR at the latest follow-up. Correlations of minimum and maximum ESS with △QFR at 3 months were the strongest among these parameters (ρ = 0.30, 95% CI [-0.05 to 0.56] and ρ = 0.27, 95% CI [-0.05 to 0.54], respectively). CONCLUSIONS Despite the limited number of grafts, this study suggests an association between early abnormal mechanical factors and late flow metrics of the grafts. The understanding of the mechanical characteristics could help to improve this novel conduit.
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Affiliation(s)
- Xinlei Wu
- Institute of Cardiovascular Development and Translational Medicine, The Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, China.,Department of Cardiology, National University of Ireland Galway (NUIG), Galway, Ireland
| | - Masafumi Ono
- Department of Cardiology, National University of Ireland Galway (NUIG), Galway, Ireland.,Department of Clinical and Experimental Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Heart Center, Amsterdam, Netherlands
| | - Eric K W Poon
- Department of Medicine, St Vincent's Hospital, Melbourne Medical School, University of Melbourne, Parkville, VIC, Australia
| | - Neil O'Leary
- Department of Cardiology, National University of Ireland Galway (NUIG), Galway, Ireland
| | - Ryo Torii
- Department of Mechanical Engineering, University College London, London, UK
| | | | - Shuang Jie Zhu
- Department of Mechanical Engineering, Melbourne School of Engineering, University of Melbourne, Parkville, VIC, Australia
| | | | | | | | | | - Jouke Dijkstra
- Department of Radiology, Leiden University Medical Center, Leiden, Netherlands
| | - Peter Barlis
- Department of Medicine, St Vincent's Hospital, Melbourne Medical School, University of Melbourne, Parkville, VIC, Australia
| | - William Wijns
- Department of Cardiology, National University of Ireland Galway (NUIG), Galway, Ireland
| | - Johan H C Reiber
- Department of Radiology, Leiden University Medical Center, Leiden, Netherlands
| | - Christos V Bourantas
- Institute of Cardiovascular Science, University College London, London, UK.,Department of Cardiology, Barts Heart Centre, London, UK
| | | | - Yoshinobu Onuma
- Department of Cardiology, National University of Ireland Galway (NUIG), Galway, Ireland
| | - Patrick W Serruys
- Department of Cardiology, National University of Ireland Galway (NUIG), Galway, Ireland.,National Heart & Lung Institute, Imperial College London, London, UK
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10
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Blum KM, Zbinden JC, Ramachandra AB, Lindsey SE, Szafron JM, Reinhardt JW, Heitkemper M, Best CA, Mirhaidari GJM, Chang YC, Ulziibayar A, Kelly J, Shah KV, Drews JD, Zakko J, Miyamoto S, Matsuzaki Y, Iwaki R, Ahmad H, Daulton R, Musgrave D, Wiet MG, Heuer E, Lawson E, Schwarz E, McDermott MR, Krishnamurthy R, Krishnamurthy R, Hor K, Armstrong AK, Boe BA, Berman DP, Trask AJ, Humphrey JD, Marsden AL, Shinoka T, Breuer CK. Tissue engineered vascular grafts transform into autologous neovessels capable of native function and growth. COMMUNICATIONS MEDICINE 2022; 2:3. [PMID: 35603301 PMCID: PMC9053249 DOI: 10.1038/s43856-021-00063-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Accepted: 11/30/2021] [Indexed: 11/09/2022] Open
Abstract
Background Tissue-engineered vascular grafts (TEVGs) have the potential to advance the surgical management of infants and children requiring congenital heart surgery by creating functional vascular conduits with growth capacity. Methods Herein, we used an integrative computational-experimental approach to elucidate the natural history of neovessel formation in a large animal preclinical model; combining an in vitro accelerated degradation study with mechanical testing, large animal implantation studies with in vivo imaging and histology, and data-informed computational growth and remodeling models. Results Our findings demonstrate that the structural integrity of the polymeric scaffold is lost over the first 26 weeks in vivo, while polymeric fragments persist for up to 52 weeks. Our models predict that early neotissue accumulation is driven primarily by inflammatory processes in response to the implanted polymeric scaffold, but that turnover becomes progressively mechano-mediated as the scaffold degrades. Using a lamb model, we confirm that early neotissue formation results primarily from the foreign body reaction induced by the scaffold, resulting in an early period of dynamic remodeling characterized by transient TEVG narrowing. As the scaffold degrades, mechano-mediated neotissue remodeling becomes dominant around 26 weeks. After the scaffold degrades completely, the resulting neovessel undergoes growth and remodeling that mimicks native vessel behavior, including biological growth capacity, further supported by fluid-structure interaction simulations providing detailed hemodynamic and wall stress information. Conclusions These findings provide insights into TEVG remodeling, and have important implications for clinical use and future development of TEVGs for children with congenital heart disease.
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Affiliation(s)
- Kevin M. Blum
- Center for Regenerative Medicine, Abigail Wexner Research Institute at Nationwide Children’s Hospital, Columbus, OH 43205 USA
- Department of Biomedical Engineering, The Ohio State University, Columbus, OH 43210 USA
| | - Jacob C. Zbinden
- Center for Regenerative Medicine, Abigail Wexner Research Institute at Nationwide Children’s Hospital, Columbus, OH 43205 USA
- Department of Biomedical Engineering, The Ohio State University, Columbus, OH 43210 USA
| | | | - Stephanie E. Lindsey
- Department of Pediatrics (Cardiology), Stanford University, Stanford, CA 94305 USA
- Institute for Computational and Mathematical Engineering (ICME), Stanford University, Stanford, CA 94305 USA
| | - Jason M. Szafron
- Department of Biomedical Engineering, Yale University, New Haven, CT 06520 USA
| | - James W. Reinhardt
- Center for Regenerative Medicine, Abigail Wexner Research Institute at Nationwide Children’s Hospital, Columbus, OH 43205 USA
| | - Megan Heitkemper
- Center for Regenerative Medicine, Abigail Wexner Research Institute at Nationwide Children’s Hospital, Columbus, OH 43205 USA
| | - Cameron A. Best
- Center for Regenerative Medicine, Abigail Wexner Research Institute at Nationwide Children’s Hospital, Columbus, OH 43205 USA
- The Ohio State University College of Medicine, Columbus, OH 43210 USA
| | - Gabriel J. M. Mirhaidari
- Center for Regenerative Medicine, Abigail Wexner Research Institute at Nationwide Children’s Hospital, Columbus, OH 43205 USA
| | - Yu-Chun Chang
- Center for Regenerative Medicine, Abigail Wexner Research Institute at Nationwide Children’s Hospital, Columbus, OH 43205 USA
| | - Anudari Ulziibayar
- Center for Regenerative Medicine, Abigail Wexner Research Institute at Nationwide Children’s Hospital, Columbus, OH 43205 USA
| | - John Kelly
- Center for Regenerative Medicine, Abigail Wexner Research Institute at Nationwide Children’s Hospital, Columbus, OH 43205 USA
- The Heart Center, Nationwide Children’s Hospital, Columbus, OH 43205 USA
| | - Kejal V. Shah
- Center for Regenerative Medicine, Abigail Wexner Research Institute at Nationwide Children’s Hospital, Columbus, OH 43205 USA
| | - Joseph D. Drews
- Center for Regenerative Medicine, Abigail Wexner Research Institute at Nationwide Children’s Hospital, Columbus, OH 43205 USA
- Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH 43210 USA
| | - Jason Zakko
- Center for Regenerative Medicine, Abigail Wexner Research Institute at Nationwide Children’s Hospital, Columbus, OH 43205 USA
- Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH 43210 USA
| | - Shinka Miyamoto
- Center for Regenerative Medicine, Abigail Wexner Research Institute at Nationwide Children’s Hospital, Columbus, OH 43205 USA
- Department of Cardiovascular Surgery at Tokyo Women’s Medical University, Tokyo, Japan
| | - Yuichi Matsuzaki
- Center for Regenerative Medicine, Abigail Wexner Research Institute at Nationwide Children’s Hospital, Columbus, OH 43205 USA
| | - Ryuma Iwaki
- Center for Regenerative Medicine, Abigail Wexner Research Institute at Nationwide Children’s Hospital, Columbus, OH 43205 USA
| | - Hira Ahmad
- Center for Regenerative Medicine, Abigail Wexner Research Institute at Nationwide Children’s Hospital, Columbus, OH 43205 USA
- Department of Pediatric Colorectal and Pelvic Reconstructive Surgery, Nationwide Children’s Hospital, Columbus, OH 43205 USA
| | - Robbie Daulton
- Center for Regenerative Medicine, Abigail Wexner Research Institute at Nationwide Children’s Hospital, Columbus, OH 43205 USA
- University of Cincinnati College of Medicine 3230 Eden Ave, Cincinnati, OH 45267 USA
| | - Drew Musgrave
- Center for Regenerative Medicine, Abigail Wexner Research Institute at Nationwide Children’s Hospital, Columbus, OH 43205 USA
| | - Matthew G. Wiet
- Center for Regenerative Medicine, Abigail Wexner Research Institute at Nationwide Children’s Hospital, Columbus, OH 43205 USA
- The Ohio State University College of Medicine, Columbus, OH 43210 USA
| | - Eric Heuer
- Center for Regenerative Medicine, Abigail Wexner Research Institute at Nationwide Children’s Hospital, Columbus, OH 43205 USA
| | - Emily Lawson
- The Ohio State University College of Medicine, Columbus, OH 43210 USA
| | - Erica Schwarz
- Department of Bioengineering, Stanford University, Stanford, CA 94304 USA
| | - Michael R. McDermott
- Center for Cardiovascular Research, Abigail Wexner Research Institute at Nationwide Children’s Hospital, Columbus, OH 43205 USA
| | - Rajesh Krishnamurthy
- Department of Radiology, Nationwide Children’s Hospital, Columbus, Ohio 43205 USA
| | | | - Kan Hor
- The Heart Center, Nationwide Children’s Hospital, Columbus, OH 43205 USA
| | - Aimee K. Armstrong
- The Heart Center, Nationwide Children’s Hospital, Columbus, OH 43205 USA
| | - Brian A. Boe
- The Heart Center, Nationwide Children’s Hospital, Columbus, OH 43205 USA
| | - Darren P. Berman
- The Heart Center, Nationwide Children’s Hospital, Columbus, OH 43205 USA
| | - Aaron J. Trask
- Center for Cardiovascular Research, Abigail Wexner Research Institute at Nationwide Children’s Hospital, Columbus, OH 43205 USA
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH 43210 USA
| | - Jay D. Humphrey
- Department of Biomedical Engineering, Yale University, New Haven, CT 06520 USA
| | - Alison L. Marsden
- Institute for Computational and Mathematical Engineering (ICME), Stanford University, Stanford, CA 94305 USA
- Department of Bioengineering, Stanford University, Stanford, CA 94304 USA
| | - Toshiharu Shinoka
- The Heart Center, Nationwide Children’s Hospital, Columbus, OH 43205 USA
- Department of Cardiothoracic Surgery, The Ohio State University College of Medicine, Columbus, OH 43205 USA
| | - Christopher K. Breuer
- Center for Regenerative Medicine, Abigail Wexner Research Institute at Nationwide Children’s Hospital, Columbus, OH 43205 USA
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Immuno-regenerative biomaterials for in situ cardiovascular tissue engineering - Do patient characteristics warrant precision engineering? Adv Drug Deliv Rev 2021; 178:113960. [PMID: 34481036 DOI: 10.1016/j.addr.2021.113960] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 08/20/2021] [Accepted: 08/30/2021] [Indexed: 02/07/2023]
Abstract
In situ tissue engineering using bioresorbable material implants - or scaffolds - that harness the patient's immune response while guiding neotissue formation at the site of implantation is emerging as a novel therapy to regenerate human tissues. For the cardiovascular system, the use of such implants, like blood vessels and heart valves, is gradually entering the stage of clinical translation. This opens up the question if and to what extent patient characteristics influence tissue outcomes, necessitating the precision engineering of scaffolds to guide patient-specific neo-tissue formation. Because of the current scarcity of human in vivo data, herein we review and evaluate in vitro and preclinical investigations to predict the potential role of patient-specific parameters like sex, age, ethnicity, hemodynamics, and a multifactorial disease profile, with special emphasis on their contribution to the inflammation-driven processes of in situ tissue engineering. We conclude that patient-specific conditions have a strong impact on key aspects of in situ cardiovascular tissue engineering, including inflammation, hemodynamic conditions, scaffold resorption, and tissue remodeling capacity, suggesting that a tailored approach may be required to engineer immuno-regenerative biomaterials for safe and predictive clinical applicability.
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Han LF, Geng X, Ye L, Zhang AY, Feng ZG. Constructing solvent-free inclusion complexes from β-cyclodextrin- and adamantane-terminated polycaprolactones and their mechanical and shape memory properties. POLYMER 2021. [DOI: 10.1016/j.polymer.2021.124047] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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