1
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Mungai RW, Hartman RJ, Jolin GE, Piskorowski KW, Billiar KL. Towards a More Objective and High-throughput Spheroid Invasion Assay Quantification Method. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2024:2024.06.27.600893. [PMID: 39005385 PMCID: PMC11244881 DOI: 10.1101/2024.06.27.600893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 07/16/2024]
Abstract
Multicellular spheroids embedded in 3D hydrogels are prominent in vitro models for 3D cell invasion. Yet, quantification methods for spheroid cell invasion that are high-throughput, objective and accessible are still lacking. Variations in spheroid sizes and the shapes of the cells within render it difficult to objectively assess invasion extent. The goal of this work is to develop a high-throughput quantification method of cell invasion into 3D matrices that minimizes sensitivity to initial spheroid size and cell spreading and provides precise integrative directionally-dependent metrics of invasion. By analyzing images of fluorescent cell nuclei, invasion metrics are automatically calculated at the pixel level. The initial spheroid boundary is segmented and automated calculations of the nuclear pixel distances from the initial boundary are used to compute common invasion metrics (i.e., the change in invasion area, mean distance) for the same spheroid at a later timepoint. We also introduce the area moment of inertia as an integrative metric of cell invasion that considers the invasion area as well as the pixel distances from the initial spheroid boundary. Further, we show that principal component analysis can be used to quantify the directional influence of a stimuli to invasion (e.g., due to a chemotactic gradient or contact guidance). To demonstrate the power of the analysis for cell types with different invasive potentials and the utility of this method for a variety of biological applications, the method is used to analyze the invasiveness of five different cell types. In all, implementation of this high-throughput quantification method results in consistent and objective analysis of 3D multicellular spheroid invasion. We provide the analysis code in both MATLAB and Python languages as well as a GUI for ease of use for researchers with a range of computer programming skills and for applications in a variety of biological research areas such as wound healing and cancer metastasis.
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Affiliation(s)
- Rozanne W. Mungai
- Department of Biomedical Engineering, Worcester Polytechnic Institute, Worcester, MA, USA 01605
| | | | - Grace E. Jolin
- Department of Biomedical Engineering, Worcester Polytechnic Institute, Worcester, MA, USA 01605
| | - Kevin W. Piskorowski
- Department of Biomedical Engineering, Worcester Polytechnic Institute, Worcester, MA, USA 01605
| | - Kristen L. Billiar
- Department of Biomedical Engineering, Worcester Polytechnic Institute, Worcester, MA, USA 01605
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2
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De Kanter AJ, Daal MV, Gunn CJ, Bredenoord AL, Graeff ND, Jongsma KR. A value hierarchy for inclusive design of heart valve implants in regenerative medicine. Regen Med 2024; 19:289-301. [PMID: 39177570 DOI: 10.1080/17460751.2024.2357500] [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: 01/15/2024] [Accepted: 05/16/2024] [Indexed: 08/24/2024] Open
Abstract
Aim: This paper investigates the conditions for inclusive design of regenerative medicine interventions from a bioethical perspective, taking regenerative valve implants as a showcase.Methods: A value hierarchy is construed to translate the value of justice into norms and design requirements for inclusive design of regenerative valve implants.Results: Three norms are proposed and translated into design requirements: regenerative valve implants should be designed to promote equal opportunity to good health for all potential users; equal respect for all potential users should be shown; and the implants should be designed to be accessible to everyone in need.Conclusion: The norms and design requirements help to design regenerative valve implants that are appropriate, respectful and available for everyone in need.
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Affiliation(s)
- Anne Johanna De Kanter
- Department of Bioethics & Health Humanities, Julius Center for Health Sciences & Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, 3508 GA, The Netherlands
| | - Manon Van Daal
- Department of Bioethics & Health Humanities, Julius Center for Health Sciences & Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, 3508 GA, The Netherlands
| | - Callum J Gunn
- Department of Bioethics & Health Humanities, Julius Center for Health Sciences & Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, 3508 GA, The Netherlands
| | - Annelien L Bredenoord
- Erasmus School of Philosophy, Erasmus University Rotterdam, Rotterdam, 3062 PA, The Netherlands
| | - Nienke De Graeff
- Department of Medical Ethics & Health Law, Leiden University Medical Center, Leiden University, Leiden, The Netherlands
| | - Karin R Jongsma
- Department of Bioethics & Health Humanities, Julius Center for Health Sciences & Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, 3508 GA, The Netherlands
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3
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Vernon MJ, Mela P, Dilley RJ, Jansen S, Doyle BJ, Ihdayhid AR, De-Juan-Pardo EM. 3D printing of heart valves. Trends Biotechnol 2024; 42:612-630. [PMID: 38238246 DOI: 10.1016/j.tibtech.2023.11.001] [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: 08/31/2023] [Revised: 10/31/2023] [Accepted: 11/01/2023] [Indexed: 05/04/2024]
Abstract
3D printing technologies have the potential to revolutionize the manufacture of heart valves through the ability to create bespoke, complex constructs. In light of recent technological advances, we review the progress made towards 3D printing of heart valves, focusing on studies that have utilised these technologies beyond manufacturing patient-specific moulds. We first overview the key requirements of a heart valve to assess functionality. We then present the 3D printing technologies used to engineer heart valves. By referencing International Organisation for Standardisation (ISO) Standard 5840 (Cardiovascular implants - Cardiac valve prostheses), we provide insight into the achieved functionality of these valves. Overall, 3D printing promises to have a significant positive impact on the creation of artificial heart valves and potentially unlock full complex functionality.
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Affiliation(s)
- Michael J Vernon
- T3mPLATE, Harry Perkins Institute of Medical Research, Queen Elizabeth II Medical Centre and University of Western Australia Centre for Medical Research, The University of Western Australia, Perth, WA 6009, Australia; Vascular Engineering Laboratory, Harry Perkins Institute of Medical Research, Queen Elizabeth II Medical Centre and University of Western Australia Centre for Medical Research, The University of Western Australia, Perth, WA 6009, Australia; School of Engineering, The University of Western Australia, Perth, WA 6009, Australia
| | - Petra Mela
- Medical Materials and Implants, Department of Mechanical Engineering, Munich Institute of Biomedical Engineering and TUM School of Engineering and Design, Technical University of Munich, Boltzmannstrasse 15, 85748 Garching, Germany
| | - Rodney J Dilley
- T3mPLATE, Harry Perkins Institute of Medical Research, Queen Elizabeth II Medical Centre and University of Western Australia Centre for Medical Research, The University of Western Australia, Perth, WA 6009, Australia
| | - Shirley Jansen
- Curtin Medical School, Curtin University, Perth, WA 6102, Australia; School of Medicine, Faculty of Health and Medical Sciences, The University of Western Australia, Perth, WA 6009, Australia; Department of Vascular and Endovascular Surgery, Sir Charles Gairdner Hospital, Perth, WA 6009, Australia; Heart and Vascular Research Institute, Harry Perkins Institute of Medical Research, Perth, WA 6009, Australia
| | - Barry J Doyle
- Vascular Engineering Laboratory, Harry Perkins Institute of Medical Research, Queen Elizabeth II Medical Centre and University of Western Australia Centre for Medical Research, The University of Western Australia, Perth, WA 6009, Australia; School of Engineering, The University of Western Australia, Perth, WA 6009, Australia
| | - Abdul R Ihdayhid
- T3mPLATE, Harry Perkins Institute of Medical Research, Queen Elizabeth II Medical Centre and University of Western Australia Centre for Medical Research, The University of Western Australia, Perth, WA 6009, Australia; Curtin Medical School, Curtin University, Perth, WA 6102, Australia; Department of Cardiology, Fiona Stanley Hospital, Perth, WA 6150, Australia
| | - Elena M De-Juan-Pardo
- T3mPLATE, Harry Perkins Institute of Medical Research, Queen Elizabeth II Medical Centre and University of Western Australia Centre for Medical Research, The University of Western Australia, Perth, WA 6009, Australia; School of Engineering, The University of Western Australia, Perth, WA 6009, Australia; Curtin Medical School, Curtin University, Perth, WA 6102, Australia.
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4
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Vis A, de Kort BJ, Szymczyk W, van Rijswijk JW, Dekker S, Driessen R, Wijkstra N, Gründeman PF, Niessen HWM, Janssen HM, Söntjens SHM, Dankers PYW, Smits AIPM, Bouten CVC, Kluin J. Evaluation of pliable bioresorbable, elastomeric aortic valve prostheses in sheep during 12 months post implantation. Commun Biol 2023; 6:1166. [PMID: 37964029 PMCID: PMC10646052 DOI: 10.1038/s42003-023-05533-3] [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: 05/30/2023] [Accepted: 11/01/2023] [Indexed: 11/16/2023] Open
Abstract
Pliable microfibrous, bioresorbable elastomeric heart valve prostheses are investigated in search of sustainable heart valve replacement. These cell-free implants recruit cells and trigger tissue formation on the valves in situ. Our aim is to investigate the behaviour of these heart valve prostheses when exposed to the high-pressure circulation. We conducted a 12-month follow-up study in sheep to evaluate the in vivo functionality and neo-tissue formation of these valves in the aortic position. All valves remained free from endocarditis, thrombotic complications and macroscopic calcifications. Cell colonisation in the leaflets was mainly restricted to the hinge area, while resorption of synthetic fibers was limited. Most valves were pliable and structurally intact (10/15), however, other valves (5/15) showed cusp thickening, retraction or holes in the leaflets. Further research is needed to assess whether in-situ heart valve tissue engineering in the aortic position is possible or whether non-resorbable synthetic pliable prostheses are preferred.
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Affiliation(s)
- Annemijn Vis
- Department of Cardiothoracic Surgery, Amsterdam University Medical Centers location University of Amsterdam, Amsterdam, The Netherlands
| | - Bente J de Kort
- Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
- Institute for Complex Molecular Systems (ICMS), Eindhoven University of Technology, Eindhoven, The Netherlands
| | - Wojciech Szymczyk
- Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
- Institute for Complex Molecular Systems (ICMS), Eindhoven University of Technology, Eindhoven, The Netherlands
| | - Jan Willem van Rijswijk
- Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
- Institute for Complex Molecular Systems (ICMS), Eindhoven University of Technology, Eindhoven, The Netherlands
| | - Sylvia Dekker
- Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
- Institute for Complex Molecular Systems (ICMS), Eindhoven University of Technology, Eindhoven, The Netherlands
| | - Rob Driessen
- Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
- Institute for Complex Molecular Systems (ICMS), Eindhoven University of Technology, Eindhoven, The Netherlands
| | - Niels Wijkstra
- Department of Cardiology, Amsterdam University Medical Centers location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Paul F Gründeman
- Department of Cardiothoracic Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Hans W M Niessen
- Department of Pathology, Amsterdam University Medical Centers location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | | | | | - Patricia Y W Dankers
- Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
- Institute for Complex Molecular Systems (ICMS), Eindhoven University of Technology, Eindhoven, The Netherlands
| | - Anthal I P M Smits
- Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
- Institute for Complex Molecular Systems (ICMS), Eindhoven 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 (ICMS), Eindhoven University of Technology, Eindhoven, The Netherlands.
| | - Jolanda Kluin
- Department of Cardiothoracic Surgery, Amsterdam University Medical Centers location University of Amsterdam, Amsterdam, The Netherlands.
- Department of Cardiothoracic Surgery, Erasmus MC, Rotterdam, The Netherlands.
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5
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Kabirian F, Mozafari M, Mela P, Heying R. Incorporation of Controlled Release Systems Improves the Functionality of Biodegradable 3D Printed Cardiovascular Implants. ACS Biomater Sci Eng 2023; 9:5953-5967. [PMID: 37856240 DOI: 10.1021/acsbiomaterials.3c00559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2023]
Abstract
New horizons in cardiovascular research are opened by using 3D printing for biodegradable implants. This additive manufacturing approach allows the design and fabrication of complex structures according to the patient's imaging data in an accurate, reproducible, cost-effective, and quick manner. Acellular cardiovascular implants produced from biodegradable materials have the potential to provide enough support for in situ tissue regeneration while gradually being replaced by neo-autologous tissue. Subsequently, they have the potential to prevent long-term complications. In this Review, we discuss the current status of 3D printing applications in the development of biodegradable cardiovascular implants with a focus on design, biomaterial selection, fabrication methods, and advantages of implantable controlled release systems. Moreover, we delve into the intricate challenges that accompany the clinical translation of these groundbreaking innovations, presenting a glimpse of potential solutions poised to enable the realization of these technologies in the realm of cardiovascular medicine.
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Affiliation(s)
- Fatemeh Kabirian
- Cardiovascular Developmental Biology, Department of Cardiovascular Sciences, KU Leuven, Leuven 3000, Belgium
| | - Masoud Mozafari
- Research Unit of Health Sciences and Technology, Faculty of Medicine, University of Oulu, Oulu FI-90014, Finland
| | - Petra Mela
- Medical Materials and Implants, Department of Mechanical Engineering, Munich Institute of Biomedical Engineering, and TUM School of Engineering and Design, Technical University of Munich, Munich 80333, Germany
| | - Ruth Heying
- Cardiovascular Developmental Biology, Department of Cardiovascular Sciences, KU Leuven, Leuven 3000, Belgium
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6
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Yacoub MH, Tseng YT, Kluin J, Vis A, Stock U, Smail H, Sarathchandra P, Aikawa E, El-Nashar H, Chester AH, Shehata N, Nagy M, El-Sawy A, Li W, Burriesci G, Salmonsmith J, Romeih S, Latif N. Valvulogenesis of a living, innervated pulmonary root induced by an acellular scaffold. Commun Biol 2023; 6:1017. [PMID: 37805576 PMCID: PMC10560219 DOI: 10.1038/s42003-023-05383-z] [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: 12/13/2022] [Accepted: 09/21/2023] [Indexed: 10/09/2023] Open
Abstract
Heart valve disease is a major cause of mortality and morbidity worldwide with no effective medical therapy and no ideal valve substitute emulating the extremely sophisticated functions of a living heart valve. These functions influence survival and quality of life. This has stimulated extensive attempts at tissue engineering "living" heart valves. These attempts utilised combinations of allogeneic/ autologous cells and biological scaffolds with practical, regulatory, and ethical issues. In situ regeneration depends on scaffolds that attract, house and instruct cells and promote connective tissue formation. We describe a surgical, tissue-engineered, anatomically precise, novel off-the-shelf, acellular, synthetic scaffold inducing a rapid process of morphogenesis involving relevant cell types, extracellular matrix, regulatory elements including nerves and humoral components. This process relies on specific material characteristics, design and "morphodynamism".
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Affiliation(s)
- Magdi H Yacoub
- Magdi Yacoub Institute, Harefield, UK.
- National Heart and Lung Institute, Imperial College London, London, UK.
- Aswan Heart Science Center, Magdi Yacoub Foundation, Aswan, Egypt.
| | - Yuan-Tsan Tseng
- Magdi Yacoub Institute, Harefield, UK
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Jolanda Kluin
- Department of Cardiothoracic Surgery, Erasmus MC, Rotterdam, The Netherlands
| | - Annemijn Vis
- Amsterdam UMC, University of Amsterdam, Department of Cardiothoracic Surgery, Amsterdam, The Netherlands
| | - Ulrich Stock
- National Heart and Lung Institute, Imperial College London, London, UK
- Royal Brompton and Harefield Hospital, London, UK
| | | | - Padmini Sarathchandra
- Magdi Yacoub Institute, Harefield, UK
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Elena Aikawa
- Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, USA
| | - Hussam El-Nashar
- Aswan Heart Science Center, Magdi Yacoub Foundation, Aswan, Egypt
- Department of Bioengineering, Imperial College London, London, UK
| | - Adrian H Chester
- Magdi Yacoub Institute, Harefield, UK
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Nairouz Shehata
- Aswan Heart Science Center, Magdi Yacoub Foundation, Aswan, Egypt
- Department of Computing, Imperial College London, London, UK
| | - Mohamed Nagy
- Aswan Heart Science Center, Magdi Yacoub Foundation, Aswan, Egypt
| | - Amr El-Sawy
- Aswan Heart Science Center, Magdi Yacoub Foundation, Aswan, Egypt
| | - Wei Li
- Royal Brompton and Harefield Hospital, London, UK
| | - Gaetano Burriesci
- Cardiovascular Engineering Laboratory, UCL Mechanical Engineering, University College London, London, UK
- Bioengineering Unit, Ri.MED Foundation, Palermo, Italy
| | - Jacob Salmonsmith
- Cardiovascular Engineering Laboratory, UCL Mechanical Engineering, University College London, London, UK
| | - Soha Romeih
- Aswan Heart Science Center, Magdi Yacoub Foundation, Aswan, Egypt
| | - Najma Latif
- Magdi Yacoub Institute, Harefield, UK
- National Heart and Lung Institute, Imperial College London, London, UK
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7
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Boehm CA, Donay C, Lubig A, Ruetten S, Sesa M, Fernández-Colino A, Reese S, Jockenhoevel S. Bio-Inspired Fiber Reinforcement for Aortic Valves: Scaffold Production Process and Characterization. Bioengineering (Basel) 2023; 10:1064. [PMID: 37760166 PMCID: PMC10525898 DOI: 10.3390/bioengineering10091064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 09/04/2023] [Accepted: 09/07/2023] [Indexed: 09/29/2023] Open
Abstract
The application of tissue-engineered heart valves in the high-pressure circulatory system is still challenging. One possible solution is the development of biohybrid scaffolds with textile reinforcement to achieve improved mechanical properties. In this article, we present a manufacturing process of bio-inspired fiber reinforcement for an aortic valve scaffold. The reinforcement structure consists of polyvinylidene difluoride monofilament fibers that are biomimetically arranged by a novel winding process. The fibers were embedded and fixated into electrospun polycarbonate urethane on a cylindrical collector. The scaffold was characterized by biaxial tensile strength, bending stiffness, burst pressure and hemodynamically in a mock circulation system. The produced fiber-reinforced scaffold showed adequate acute mechanical and hemodynamic properties. The transvalvular pressure gradient was 3.02 ± 0.26 mmHg with an effective orifice area of 2.12 ± 0.22 cm2. The valves sustained aortic conditions, fulfilling the ISO-5840 standards. The fiber-reinforced scaffold failed in a circumferential direction at a stress of 461.64 ± 58.87 N/m and a strain of 49.43 ± 7.53%. These values were above the levels of tested native heart valve tissue. Overall, we demonstrated a novel manufacturing approach to develop a fiber-reinforced biomimetic scaffold for aortic heart valve tissue engineering. The characterization showed that this approach is promising for an in situ valve replacement.
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Affiliation(s)
- Christian A. Boehm
- Department of Biohybrid & Medical Textiles (BioTex), AME Institute of Applied Medical Engineering, Helmholtz Institute, RWTH Aachen University, Forckenbeckstr. 55, 52074 Aachen, Germany; (C.A.B.); (C.D.); (A.L.); (A.F.-C.)
| | - Christine Donay
- Department of Biohybrid & Medical Textiles (BioTex), AME Institute of Applied Medical Engineering, Helmholtz Institute, RWTH Aachen University, Forckenbeckstr. 55, 52074 Aachen, Germany; (C.A.B.); (C.D.); (A.L.); (A.F.-C.)
| | - Andreas Lubig
- Department of Biohybrid & Medical Textiles (BioTex), AME Institute of Applied Medical Engineering, Helmholtz Institute, RWTH Aachen University, Forckenbeckstr. 55, 52074 Aachen, Germany; (C.A.B.); (C.D.); (A.L.); (A.F.-C.)
| | - Stephan Ruetten
- Electron Microscopy Facility, University Hospital Aachen, Pauwelstr. 30, 52074 Aachen, Germany;
| | - Mahmoud Sesa
- Institute of Applied Mechanics, RWTH Aachen University, Mies-van-der-Rohe-Str. 1, 52074 Aachen, Germany; (M.S.); (S.R.)
| | - Alicia Fernández-Colino
- Department of Biohybrid & Medical Textiles (BioTex), AME Institute of Applied Medical Engineering, Helmholtz Institute, RWTH Aachen University, Forckenbeckstr. 55, 52074 Aachen, Germany; (C.A.B.); (C.D.); (A.L.); (A.F.-C.)
| | - Stefanie Reese
- Institute of Applied Mechanics, RWTH Aachen University, Mies-van-der-Rohe-Str. 1, 52074 Aachen, Germany; (M.S.); (S.R.)
| | - Stefan Jockenhoevel
- Department of Biohybrid & Medical Textiles (BioTex), AME Institute of Applied Medical Engineering, Helmholtz Institute, RWTH Aachen University, Forckenbeckstr. 55, 52074 Aachen, Germany; (C.A.B.); (C.D.); (A.L.); (A.F.-C.)
- Aachen-Maastricht Institute for Biobased Materials, Maastricht University at Chemelot Campus, Urmonderbaan 22, 6167 Geleen, The Netherlands
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8
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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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9
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Li RL, Sun M, Russ JB, Pousse PL, Kossar AP, Gibson I, Paschalides C, Herschman AR, Abyaneh MH, Ferrari G, Bacha E, Waisman H, Vedula V, Kysar JW, Kalfa D. In Vitro Proof of Concept of a First-Generation Growth-Accommodating Heart Valved Conduit for Pediatric Use. Macromol Biosci 2023; 23:e2300011. [PMID: 36905285 PMCID: PMC10363995 DOI: 10.1002/mabi.202300011] [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: 01/11/2023] [Revised: 02/27/2023] [Indexed: 03/12/2023]
Abstract
Currently available heart valve prostheses have no growth potential, requiring children with heart valve diseases to endure multiple valve replacement surgeries with compounding risks. This study demonstrates the in vitro proof of concept of a biostable polymeric trileaflet valved conduit designed for surgical implantation and subsequent expansion via transcatheter balloon dilation to accommodate the growth of pediatric patients and delay or avoid repeated open-heart surgeries. The valved conduit is formed via dip molding using a polydimethylsiloxane-based polyurethane, a biocompatible material shown here to be capable of permanent stretching under mechanical loading. The valve leaflets are designed with an increased coaptation area to preserve valve competence at expanded diameters. Four 22 mm diameter valved conduits are tested in vitro for hydrodynamics, balloon dilated to new permanent diameters of 23.26 ± 0.38 mm, and then tested again. Upon further dilation, two valved conduits sustain leaflet tears, while the two surviving devices reach final diameters of 24.38 ± 0.19 mm. After each successful dilation, the valved conduits show increased effective orifice areas and decreased transvalvular pressure differentials while maintaining low regurgitation. These results demonstrate concept feasibility and motivate further development of a polymeric balloon-expandable device to replace valves in children and avoid reoperations.
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Affiliation(s)
- Richard L Li
- Department of Surgery, Division of Cardiac, Thoracic and Vascular Surgery, Section of Pediatric and Congenital Cardiac Surgery, New-York Presbyterian - Morgan Stanley Children's Hospital, Columbia University Medical Center, 3959 Broadway, CHN-274, New York, NY, 10032, USA
- Department of Mechanical Engineering, Fu Foundation School of Engineering and Applied Science, Columbia University, 220 Mudd Building, 500 W. 120th Street, New York, NY, 10027, USA
| | - Mingze Sun
- Department of Surgery, Division of Cardiac, Thoracic and Vascular Surgery, Section of Pediatric and Congenital Cardiac Surgery, New-York Presbyterian - Morgan Stanley Children's Hospital, Columbia University Medical Center, 3959 Broadway, CHN-274, New York, NY, 10032, USA
| | - Jonathan B Russ
- Department of Civil Engineering and Engineering Mechanics, Fu Foundation School of Engineering and Applied Science, Columbia University, 610 Mudd Building, 500 W. 120th Street, New York, NY, 10027, USA
| | - Pierre-Louis Pousse
- Department of Surgery, Division of Cardiac, Thoracic and Vascular Surgery, Section of Pediatric and Congenital Cardiac Surgery, New-York Presbyterian - Morgan Stanley Children's Hospital, Columbia University Medical Center, 3959 Broadway, CHN-274, New York, NY, 10032, USA
| | - Alexander P Kossar
- Department of Surgery, Division of Cardiac, Thoracic and Vascular Surgery, Section of Pediatric and Congenital Cardiac Surgery, New-York Presbyterian - Morgan Stanley Children's Hospital, Columbia University Medical Center, 3959 Broadway, CHN-274, New York, NY, 10032, USA
| | - Isabel Gibson
- Department of Surgery, Division of Cardiac, Thoracic and Vascular Surgery, Section of Pediatric and Congenital Cardiac Surgery, New-York Presbyterian - Morgan Stanley Children's Hospital, Columbia University Medical Center, 3959 Broadway, CHN-274, New York, NY, 10032, USA
| | - Costas Paschalides
- Department of Mechanical Engineering, Fu Foundation School of Engineering and Applied Science, Columbia University, 220 Mudd Building, 500 W. 120th Street, New York, NY, 10027, USA
| | - Abigail R Herschman
- Department of Surgery, Division of Cardiac, Thoracic and Vascular Surgery, Section of Pediatric and Congenital Cardiac Surgery, New-York Presbyterian - Morgan Stanley Children's Hospital, Columbia University Medical Center, 3959 Broadway, CHN-274, New York, NY, 10032, USA
- Department of Mechanical Engineering, Fu Foundation School of Engineering and Applied Science, Columbia University, 220 Mudd Building, 500 W. 120th Street, New York, NY, 10027, USA
| | - Maryam H Abyaneh
- Department of Surgery, Division of Cardiac, Thoracic and Vascular Surgery, Section of Pediatric and Congenital Cardiac Surgery, New-York Presbyterian - Morgan Stanley Children's Hospital, Columbia University Medical Center, 3959 Broadway, CHN-274, New York, NY, 10032, USA
| | - Giovanni Ferrari
- Department of Surgery, Division of Cardiac, Thoracic and Vascular Surgery, Section of Pediatric and Congenital Cardiac Surgery, New-York Presbyterian - Morgan Stanley Children's Hospital, Columbia University Medical Center, 3959 Broadway, CHN-274, New York, NY, 10032, USA
| | - Emile Bacha
- Department of Surgery, Division of Cardiac, Thoracic and Vascular Surgery, Section of Pediatric and Congenital Cardiac Surgery, New-York Presbyterian - Morgan Stanley Children's Hospital, Columbia University Medical Center, 3959 Broadway, CHN-274, New York, NY, 10032, USA
| | - Haim Waisman
- Department of Civil Engineering and Engineering Mechanics, Fu Foundation School of Engineering and Applied Science, Columbia University, 610 Mudd Building, 500 W. 120th Street, New York, NY, 10027, USA
| | - Vijay Vedula
- Department of Mechanical Engineering, Fu Foundation School of Engineering and Applied Science, Columbia University, 220 Mudd Building, 500 W. 120th Street, New York, NY, 10027, USA
| | - Jeffrey W Kysar
- Department of Mechanical Engineering, Fu Foundation School of Engineering and Applied Science, Columbia University, 220 Mudd Building, 500 W. 120th Street, New York, NY, 10027, USA
- Department of Otolaryngology-Head and Neck Surgery, Columbia University Medical Center, 3959 Broadway, 5th Floor, New York, NY, 10032, USA
| | - David Kalfa
- Department of Surgery, Division of Cardiac, Thoracic and Vascular Surgery, Section of Pediatric and Congenital Cardiac Surgery, New-York Presbyterian - Morgan Stanley Children's Hospital, Columbia University Medical Center, 3959 Broadway, CHN-274, New York, NY, 10032, USA
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10
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Cordoves EM, Vunjak-Novakovic G, Kalfa DM. Designing Biocompatible Tissue Engineered Heart Valves In Situ: JACC Review Topic of the Week. J Am Coll Cardiol 2023; 81:994-1003. [PMID: 36889879 PMCID: PMC10666973 DOI: 10.1016/j.jacc.2022.12.022] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Accepted: 12/19/2022] [Indexed: 03/08/2023]
Abstract
Valvular heart disease is a globally prevalent cause of morbidity and mortality, with both congenital and acquired clinical presentations. Tissue engineered heart valves (TEHVs) have the potential to radically shift the treatment landscape for valvular disease by functioning as life-long valve replacements that overcome the current limitations of bioprosthetic and mechanical valves. TEHVs are envisioned to meet these goals by functioning as bioinstructive scaffolds that guide the in situ generation of autologous valves capable of growth, repair, and remodeling within the patient. Despite their promise, clinical translation of in situ TEHVs has proven challenging largely because of the unpredictable and patient-specific nature of the TEHV and host interaction following implantation. In light of this challenge, we propose a framework for the development and clinical translation of biocompatible TEHVs, wherein the native valvular environment actively informs the valve's design parameters and sets the benchmarks by which it is functionally evaluated.
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Affiliation(s)
- Elizabeth M Cordoves
- Vagelos College of Physicians and Surgeons, Columbia University, New York, New York, USA; Department of Biomedical Engineering, Columbia University, New York, New York, USA
| | - Gordana Vunjak-Novakovic
- Department of Biomedical Engineering, Columbia University, New York, New York, USA; Department of Medicine, Columbia University, New York, New York, USA.
| | - David M Kalfa
- Division of Cardiac, Thoracic and Vascular Surgery, Section of Pediatric and Congenital Cardiac Surgery, New-York Presbyterian-Morgan Stanley Children's Hospital, Columbia University Medical Center, New York, New York, USA.
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11
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Poulis N, Breitenstein P, Hofstede S, Hoerstrup SP, Emmert MY, Fioretta ES. Multiscale analysis of human tissue engineered matrices for next generation heart valve applications. Acta Biomater 2023; 158:101-114. [PMID: 36638939 DOI: 10.1016/j.actbio.2023.01.007] [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: 08/02/2022] [Revised: 12/15/2022] [Accepted: 01/03/2023] [Indexed: 01/12/2023]
Abstract
Human tissue-engineered matrices (hTEMs) have been proposed as a promising approach for in situ tissue engineered heart valves (TEHVs). However, there is still a limited understanding on how ECM composition in hTEMs develops over tissue culture time. Therefore, we performed a longitudinal hTEM assessment by 1) multiscale evaluation of hTEM composition during culture time (2, 4, 6-weeks), using (immuno)histology, biochemical assays, and mass spectrometry (LC-MS/MS); 2) analysis of protein pathways involved in ECM development using gene set enrichment analysis (GSEA); and 3) assessment of hTEM mechanical characterization using uniaxial tensile testing. Finally, as a proof-of-concept, TEHVs manufactured using 6-weeks hTEM samples were tested in a pulse duplicator. LC-MS/MS confirmed the tissue culture time-dependent increase in ECM proteins observed in histology and biochemical assays, revealing the most abundant collagens (COL6, COL12), proteoglycans (HSPG2, VCAN), and glycoproteins (FN, TNC). GSEA identified the most represented protein pathways in the hTEM at 2-weeks (mRNA metabolic processes), 4-weeks (ECM production), and 6-weeks (ECM organization and maturation). Uniaxial mechanical testing showed increased stiffness and stress at failure, and reduction in strain over tissue culture time. hTEM-based TEHVs demonstrated promising in vitro performance at both pulmonary and aortic pressure conditions, with symmetric leaflet coaptation and no stenosis. In conclusion, ECM protein abundance and maturation increased over tissue culture time, with consequent improvement of hTEM mechanical characteristics. These findings suggest that longer tissue culture impacts tissue organization, leading to an hTEM that may be suitable for high-pressure applications. STATEMENT OF SIGNIFICANCE: It is believed that the composition of the extracellular matrix (ECM) in the human tissue engineered matrices (hTEM) may favor tissue engineered heart valve (TEHV) remodeling upon implantation. However, the exact protein composition of the hTEM, and how this impacts tissue mechanical properties, remains unclear. Hence, we developed a reproducible rotation-based tissue culture method to produce hTEM samples. We performed a longitudinal assessment using different analytical techniques and mass spectrometry. Our data provided an in-depth characterization of the hTEM proteome with focus on ECM components, their development, and how they may impact the mechanical properties. Based on these results, we manufactured functional hTEM-based TEHVs at aortic-like condition in vitro. These outcomes pose an important step in translating hTEM-based TEHVs into clinics and in predicting their remodeling potential upon implantation.
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Affiliation(s)
- N Poulis
- Institute for Regenerative Medicine (IREM), University of Zurich, Wagistrasse 12, 8952 Schlieren, Switzerland
| | - P Breitenstein
- Institute for Regenerative Medicine (IREM), University of Zurich, Wagistrasse 12, 8952 Schlieren, Switzerland
| | - S Hofstede
- Laboratory for Orthopaedic Biomechanics, Institute for Biomechanics, ETH Zurich, Lengghalde 5, 8008 Zurich, Switzerland
| | - S P Hoerstrup
- Institute for Regenerative Medicine (IREM), University of Zurich, Wagistrasse 12, 8952 Schlieren, Switzerland; Wyss Zurich, University and ETH Zurich, Zurich, Switzerland
| | - M Y Emmert
- Institute for Regenerative Medicine (IREM), University of Zurich, Wagistrasse 12, 8952 Schlieren, Switzerland; Wyss Zurich, University and ETH Zurich, Zurich, Switzerland; Charité Universitätsmedizin Berlin, Berlin, Germany; Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum der Charite (DHZC), Berlin, Germany.
| | - E S Fioretta
- Institute for Regenerative Medicine (IREM), University of Zurich, Wagistrasse 12, 8952 Schlieren, Switzerland
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12
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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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13
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Albert BJ, Butcher JT. Future prospects in the tissue engineering of heart valves: a focus on the role of stem cells. Expert Opin Biol Ther 2023; 23:553-564. [PMID: 37171790 PMCID: PMC10461076 DOI: 10.1080/14712598.2023.2214313] [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: 02/02/2023] [Accepted: 05/11/2023] [Indexed: 05/13/2023]
Abstract
INTRODUCTION Heart valve disease is a growing burden on the healthcare system. Current solutions are insufficient for young patients and do not offer relief from reintervention. Tissue engineered heart valves (TEHVs) offer a solution that grows and responds to the native environment in a similar way to a healthy valve. Stem cells hold potential to populate these valves as a malleable source that can adapt to environmental cues. AREAS COVERED This review covers current methods of recapitulating features of native heart valves with tissue engineering through use of stem cell populations with in situ and in vitro methods. EXPERT OPINION In the field of TEHVs, we see a variety of approaches in cell source, biomaterial, and maturation methods. Choosing appropriate cell populations may be very patient specific; consistency and predictability will be key to long-term success. In situ methods are closer to translation but struggle with consistent cellularization. In vitro culture requires specialized methods but may recapitulate native valve cell populations with higher fidelity. Understanding how cell populations react to valve conditions and immune response is vital for success. Detrimental valve pathologies have proven to be difficult to avoid in early translation attempts.
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Affiliation(s)
- Benjamin J Albert
- Cornell University, Meinig School of Biomedical Engineering, Ithaca, NY, USA
| | - Jonathan T Butcher
- Cornell University, Meinig School of Biomedical Engineering, Ithaca, NY, USA
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14
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Wang Z, Mithieux SM, Vindin H, Wang Y, Zhang M, Liu L, Zbinden J, Blum KM, Yi T, Matsuzaki Y, Oveissi F, Akdemir R, Lockley KM, Zhang L, Ma K, Guan J, Waterhouse A, Pham NTH, Hawkett BS, Shinoka T, Breuer CK, Weiss AS. Rapid Regeneration of a Neoartery with Elastic Lamellae. ADVANCED MATERIALS (DEERFIELD BEACH, FLA.) 2022; 34:e2205614. [PMID: 36120809 DOI: 10.1002/adma.202205614] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 08/24/2022] [Indexed: 06/15/2023]
Abstract
Native arteries contain a distinctive intima-media composed of organized elastin and an adventitia containing mature collagen fibrils. In contrast, implanted biodegradable small-diameter vascular grafts do not present spatially regenerated, organized elastin. The elastin-containing structures within the intima-media region encompass the elastic lamellae (EL) and internal elastic lamina (IEL) and are crucial for normal arterial function. Here, the development of a novel electrospun small-diameter vascular graft that facilitates de novo formation of a structurally appropriate elastin-containing intima-media region following implantation is described. The graft comprises a non-porous microstructure characterized by tropoelastin fibers that are embedded in a PGS matrix. After implantation in mouse abdominal aorta, the graft develops distinct cell and extracellular matrix profiles that approximate the native adventitia and intima-media by 8 weeks. Within the newly formed intima-media region there are circumferentially aligned smooth muscle cell layers that alternate with multiple EL similar to that found in the arterial wall. By 8 months, the developed adventitia region contains mature collagen fibrils and the neoartery presents a distinct IEL with thickness comparable to that in mouse abdominal aorta. It is proposed that this new class of material can generate the critically required, organized elastin needed for arterial regeneration.
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Affiliation(s)
- Ziyu Wang
- School of Life and Environmental Sciences, University of Sydney, Sydney, NSW, 2006, Australia
- Charles Perkins Centre, University of Sydney, Sydney, NSW, 2006, Australia
| | - Suzanne M Mithieux
- School of Life and Environmental Sciences, University of Sydney, Sydney, NSW, 2006, Australia
- Charles Perkins Centre, University of Sydney, Sydney, NSW, 2006, Australia
| | - Howard Vindin
- School of Life and Environmental Sciences, University of Sydney, Sydney, NSW, 2006, Australia
- Charles Perkins Centre, University of Sydney, Sydney, NSW, 2006, Australia
| | - Yiwei Wang
- Burns Research and Reconstructive Surgery, Anzac Research Institute, Sydney, NSW, 2139, Australia
- Jiangsu Provincial Engineering Research Centre of TCM External Medication Development and Application, Nanjing University of Chinese Medicine, Nanjing, Jiangsu, 210023, China
| | - Miao Zhang
- School of Life and Environmental Sciences, University of Sydney, Sydney, NSW, 2006, Australia
- Charles Perkins Centre, University of Sydney, Sydney, NSW, 2006, Australia
| | - Linyang Liu
- School of Life and Environmental Sciences, University of Sydney, Sydney, NSW, 2006, Australia
- Charles Perkins Centre, University of Sydney, Sydney, NSW, 2006, Australia
| | - Jacob Zbinden
- Center for Regenerative Medicine, Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH, 43215, USA
| | - Kevin M Blum
- Center for Regenerative Medicine, Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH, 43215, USA
| | - Tai Yi
- Center for Regenerative Medicine, Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH, 43215, USA
| | - Yuichi Matsuzaki
- Center for Regenerative Medicine, Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH, 43215, USA
| | - Farshad Oveissi
- School of Chemical and Biomolecular Engineering, University of Sydney, Sydney, NSW, 2006, Australia
| | - Reyda Akdemir
- Department of Chemical Engineering, University Rovira i Virgili, Tarragona, E-43007, Spain
| | - Karen M Lockley
- School of Life and Environmental Sciences, University of Sydney, Sydney, NSW, 2006, Australia
- Charles Perkins Centre, University of Sydney, Sydney, NSW, 2006, Australia
| | - Lingyue Zhang
- International Research Center for Advanced Structural and Biomaterials, School of Materials Science and Engineering, Beihang University, Beijing, 100191, China
| | - Ke Ma
- International Research Center for Advanced Structural and Biomaterials, School of Materials Science and Engineering, Beihang University, Beijing, 100191, China
| | - Juan Guan
- International Research Center for Advanced Structural and Biomaterials, School of Materials Science and Engineering, Beihang University, Beijing, 100191, China
| | - Anna Waterhouse
- Charles Perkins Centre, University of Sydney, Sydney, NSW, 2006, Australia
- School of Medical Science, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, 2006, Australia
- The Heart Research Institute, University of Sydney, Sydney, NSW, 204206, Australia
- The University of Sydney Nano Institute, University of Sydney, Sydney, NSW, 2006, Australia
| | - Nguyen T H Pham
- Key Centre for Polymers and Colloids, School of Chemistry, University of Sydney, Sydney, NSW, 2006, Australia
| | - Brian S Hawkett
- The University of Sydney Nano Institute, University of Sydney, Sydney, NSW, 2006, Australia
- Key Centre for Polymers and Colloids, School of Chemistry, University of Sydney, Sydney, NSW, 2006, Australia
| | - Toshiharu Shinoka
- Center for Regenerative Medicine, Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH, 43215, USA
| | - Christopher K Breuer
- Center for Regenerative Medicine, Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH, 43215, USA
| | - Anthony S Weiss
- School of Life and Environmental Sciences, University of Sydney, Sydney, NSW, 2006, Australia
- Charles Perkins Centre, University of Sydney, Sydney, NSW, 2006, Australia
- The University of Sydney Nano Institute, University of Sydney, Sydney, NSW, 2006, Australia
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15
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Natural Polymers in Heart Valve Tissue Engineering: Strategies, Advances and Challenges. Biomedicines 2022; 10:biomedicines10051095. [PMID: 35625830 PMCID: PMC9139175 DOI: 10.3390/biomedicines10051095] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 05/03/2022] [Accepted: 05/04/2022] [Indexed: 12/04/2022] Open
Abstract
In the history of biomedicine and biomedical devices, heart valve manufacturing techniques have undergone a spectacular evolution. However, important limitations in the development and use of these devices are known and heart valve tissue engineering has proven to be the solution to the problems faced by mechanical and prosthetic valves. The new generation of heart valves developed by tissue engineering has the ability to repair, reshape and regenerate cardiac tissue. Achieving a sustainable and functional tissue-engineered heart valve (TEHV) requires deep understanding of the complex interactions that occur among valve cells, the extracellular matrix (ECM) and the mechanical environment. Starting from this idea, the review presents a comprehensive overview related not only to the structural components of the heart valve, such as cells sources, potential materials and scaffolds fabrication, but also to the advances in the development of heart valve replacements. The focus of the review is on the recent achievements concerning the utilization of natural polymers (polysaccharides and proteins) in TEHV; thus, their extensive presentation is provided. In addition, the technological progresses in heart valve tissue engineering (HVTE) are shown, with several inherent challenges and limitations. The available strategies to design, validate and remodel heart valves are discussed in depth by a comparative analysis of in vitro, in vivo (pre-clinical models) and in situ (clinical translation) tissue engineering studies.
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16
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Pulmonary valve replacement: a new paradigm with tissue engineering. Curr Probl Cardiol 2022:101212. [PMID: 35460681 DOI: 10.1016/j.cpcardiol.2022.101212] [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: 04/04/2022] [Accepted: 04/13/2022] [Indexed: 11/21/2022]
Abstract
Prevalence of congenital heart diseases worldwide is around 9 per 1000 newborns, 20% of which affect the pulmonary valve or right ventricular outflow tract. As survival after surgical repair of these defects has improved over time, there is the need to address the long-term issues of older children and young adults with "repaired" congenital heart diseases. In recent decades, the most used types of valves are the mechanical and bioprosthetic valves. Despite improving patients' quality of life, these effects are suboptimal due to their limitations, such as the inability to grow and adapt to hemodynamic changes. These issues have led to the search for living valve solutions through tissue engineering to respond to these challenges. This review aims to review the performance of traditional pulmonary valves and understand how tissue engineering-based valves can improve the management of these patients.
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17
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Cramer M, Chang J, Li H, Serrero A, El-Kurdi M, Cox M, Schoen FJ, Badylak SF. Tissue response, macrophage phenotype, and intrinsic calcification induced by cardiovascular biomaterials: Can clinical regenerative potential be predicted in a rat subcutaneous implant model? J Biomed Mater Res A 2022; 110:245-256. [PMID: 34323360 PMCID: PMC8678182 DOI: 10.1002/jbm.a.37280] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 06/24/2021] [Accepted: 07/20/2021] [Indexed: 12/17/2022]
Abstract
The host immune response to an implanted biomaterial, particularly the phenotype of infiltrating macrophages, is a key determinant of biocompatibility and downstream remodeling outcome. The present study used a subcutaneous rat model to compare the tissue response, including macrophage phenotype, remodeling potential, and calcification propensity of a biologic scaffold composed of glutaraldehyde-fixed bovine pericardium (GF-BP), the standard of care for heart valve replacement, with those of an electrospun polycarbonate-based supramolecular polymer scaffold (ePC-UPy), urinary bladder extracellular matrix (UBM-ECM), and a polypropylene mesh (PP). The ePC-UPy and UBM-ECM materials induced infiltration of mononuclear cells throughout the thickness of the scaffold within 2 days and neovascularization at 14 days. GF-BP and PP elicited a balance of pro-inflammatory (M1-like) and anti-inflammatory (M2-like) macrophages, while UBM-ECM and ePC-UPy supported a dominant M2-like macrophage phenotype at all timepoints. Relative to GF-BP, ePC-UPy was markedly less susceptible to calcification for the 180 day duration of the study. UBM-ECM induced an archetypical constructive remodeling response dominated by M2-like macrophages and the PP caused a typical foreign body reaction dominated by M1-like macrophages. The results of this study highlight the divergent macrophage and host remodeling response to biomaterials with distinct physical and chemical properties and suggest that the rat subcutaneous implantation model can be used to predict in vivo biocompatibility and regenerative potential for clinical application of cardiovascular biomaterials.
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Affiliation(s)
- Madeline Cramer
- Department of Bioengineering, University of Pittsburgh, 3700 O’Hara Street, Pittsburgh, PA, 15261, USA
- McGowan Institute for Regenerative Medicine, University of Pittsburgh, 450 Technology Drive, Suite 300, Pittsburgh, PA 15219, USA
| | - Jordan Chang
- McGowan Institute for Regenerative Medicine, University of Pittsburgh, 450 Technology Drive, Suite 300, Pittsburgh, PA 15219, USA
| | - Hongshuai Li
- Musculoskeletal Growth and Regeneration Laboratory, Department of Orthopedic Surgery, University of Pittsburgh, 450 Technology Drive, Suite 206, Pittsburgh, PA 15219, USA
| | - Aurelie Serrero
- Xeltis BV, De Lismortel 31, 5612 AR Eindhoven, The Netherlands
| | | | - Martijn Cox
- Xeltis BV, De Lismortel 31, 5612 AR Eindhoven, The Netherlands
| | - Frederick J. Schoen
- Department of Pathology, Brigham and Women’s Hospital and Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA
| | - Stephen F. Badylak
- Department of Bioengineering, University of Pittsburgh, 3700 O’Hara Street, Pittsburgh, PA, 15261, USA
- McGowan Institute for Regenerative Medicine, University of Pittsburgh, 450 Technology Drive, Suite 300, Pittsburgh, PA 15219, USA
- Department of Surgery, School of Medicine, University of Pittsburgh, University of Pittsburgh Medical Center Presbyterian Hospital, 200 Lothrop Street, Pittsburgh, PA 15213, USA
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18
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Blum KM, Mirhaidari G, Breuer CK. Tissue engineering: Relevance to neonatal congenital heart disease. Semin Fetal Neonatal Med 2022; 27:101225. [PMID: 33674254 PMCID: PMC8390581 DOI: 10.1016/j.siny.2021.101225] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Congenital heart disease (CHD) represents a large clinical burden, representing the most common cause of birth defect-related death in the newborn. The mainstay of treatment for CHD remains palliative surgery using prosthetic vascular grafts and valves. These devices have limited effectiveness in pediatric patients due to thrombosis, infection, limited endothelialization, and a lack of growth potential. Tissue engineering has shown promise in providing new solutions for pediatric CHD patients through the development of tissue engineered vascular grafts, heart patches, and heart valves. In this review, we examine the current surgical treatments for congenital heart disease and the research being conducted to create tissue engineered products for these patients. While much research remains to be done before tissue engineering becomes a mainstay of clinical treatment for CHD patients, developments have been progressing rapidly towards translation of tissue engineering devices to the clinic.
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Affiliation(s)
- Kevin M Blum
- Center for Regenerative Medicine, The Abigail Wexner Research Institute, Nationwide Childrens Hospital, Columbus, OH, USA; Department of Biomedical Engineering, The Ohio State University, Columbus, OH, USA.
| | - Gabriel Mirhaidari
- Center for Regenerative Medicine, The Abigail Wexner Research Institute, Nationwide Childrens Hospital, Columbus OH, USA,Biomedical Sciences Graduate Program, The Ohio State University College of Medicine, Columbus OH, USA
| | - Christopher K Breuer
- Center for Regenerative Medicine, The Abigail Wexner Research Institute, Nationwide Childrens Hospital, Columbus, OH, USA.
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19
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Inflammatory and regenerative processes in bioresorbable synthetic pulmonary valves up to two years in sheep-Spatiotemporal insights augmented by Raman microspectroscopy. Acta Biomater 2021; 135:243-259. [PMID: 34509697 DOI: 10.1016/j.actbio.2021.09.005] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 08/18/2021] [Accepted: 09/06/2021] [Indexed: 12/14/2022]
Abstract
In situ heart valve tissue engineering is an emerging approach in which resorbable, off-the-shelf available scaffolds are used to induce endogenous heart valve restoration. Such scaffolds are designed to recruit endogenous cells in vivo, which subsequently resorb polymer and produce and remodel new valvular tissue in situ. Recently, preclinical studies using electrospun supramolecular elastomeric valvular grafts have shown that this approach enables in situ regeneration of pulmonary valves with long-term functionality in vivo. However, the evolution and mechanisms of inflammation, polymer absorption and tissue regeneration are largely unknown, and adverse valve remodeling and intra- and inter-valvular variability have been reported. Therefore, the goal of the present study was to gain a mechanistic understanding of the in vivo regenerative processes by combining routine histology and immunohistochemistry, using a comprehensive sheep-specific antibody panel, with Raman microspectroscopy for the spatiotemporal analysis of in situ tissue-engineered pulmonary valves with follow-up to 24 months from a previous preclinical study in sheep. The analyses revealed a strong spatial heterogeneity in the influx of inflammatory cells, graft resorption, and foreign body giant cells. Collagen maturation occurred predominantly between 6 and 12 months after implantation, which was accompanied by a progressive switch to a more quiescent phenotype of infiltrating cells with properties of valvular interstitial cells. Variability among specimens in the extent of tissue remodeling was observed for follow-up times after 6 months. Taken together, these findings advance the understanding of key events and mechanisms in material-driven in situ heart valve tissue engineering. STATEMENT OF SIGNIFICANCE: This study describes for the first time the long-term in vivo inflammatory and regenerative processes that underly in situ heart valve tissue engineering using resorbable synthetic scaffolds. Using a unique combinatorial analysis of immunohistochemistry and Raman microspectroscopy, important spatiotemporal variability in graft resorption and tissue formation was pinpointed in in situ tissue-engineered heart valves, with a follow-up time of up to 24 months in sheep. This variability was correlated to heterogenous regional cellular repopulation, most likely instigated by region-specific differences in surrounding tissue and hemodynamics. The findings of this research contribute to the mechanistic understanding of in situ tissue engineering using resorbable synthetics, which is necessary to enable rational design of improved grafts, and ensure safe and robust clinical translation.
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20
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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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21
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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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22
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Ramm R, Goecke T, Köhler P, Tudorache I, Cebotari S, Ciubotaru A, Sarikouch S, Höffler K, Bothe F, Petersen B, Haverich A, Niemann H, Hilfiker A. Immunological and functional features of decellularized xenogeneic heart valves after transplantation into GGTA1-KO pigs. Regen Biomater 2021; 8:rbab036. [PMID: 35928180 PMCID: PMC8329474 DOI: 10.1093/rb/rbab036] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 05/27/2021] [Accepted: 06/11/2021] [Indexed: 07/22/2023] Open
Abstract
Decellularization of xenogeneic heart valves might lead to excellent regenerative implants, from which many patients could benefit. However, this material carries various xenogeneic epitopes and thus bears a considerable inherent immunological risk. Here, we investigated the regenerative and immunogenic potential of xenogeneic decellularized heart valve implants using pigs deficient for the galactosyltransferase gene (GGTA1-KO) as novel large animal model. Decellularized aortic and pulmonary heart valves obtained from sheep, wild-type pigs or GGTA1-KO pigs were implanted into GGTA1-KO pigs for 3, or 6 months, respectively. Explants were analyzed histologically, immunhistologically (CD3, CD21 and CD172a) and anti-αGal antibody serum titers were determined by ELISA. Xenogeneic sheep derived implants exhibited a strong immune reaction upon implantation into GGTA1-KO pigs, characterized by massive inflammatory cells infiltrates, presence of foreign body giant cells, a dramatic increase of anti-αGal antibody titers and ultimately destruction of the graft, whereas wild-type porcine grafts induced only a mild reaction in GGTA1-KO pigs. Allogeneic implants, wild-type/wild-type and GGTA1-KO/GGTA1-KO valves did not induce a measurable immune reaction. Thus, GGTA1-KO pigs developed a 'human-like' immune response toward decellularized xenogeneic implants showing that immunogenicity of xenogeneic implants is not sufficiently reduced by decellularization, which detracts from their regenerative potential.
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Affiliation(s)
- Robert Ramm
- Leibniz Research Laboratories for Biotechnology and Artificial Organs (LEBAO), Hannover Medical School, Carl-Neuberg Str. 1, Hannover 30625, Germany
| | - Tobias Goecke
- Leibniz Research Laboratories for Biotechnology and Artificial Organs (LEBAO), Hannover Medical School, Carl-Neuberg Str. 1, Hannover 30625, Germany
- Department of Cardiac-, Thoracic-, Transplantation and Vascular Surgery, Hannover Medical School, Carl-Neuberg Str. 1, Hannover 30625, Germany
| | - Peter Köhler
- Institute of Farm Animal Genetics, Friedrich-Loeffler-Institut, Hoeltystr. 10, 31535 Mariensee/Neustadt am Ruebenberge, Germany
| | - Igor Tudorache
- Department of Cardiac-, Thoracic-, Transplantation and Vascular Surgery, Hannover Medical School, Carl-Neuberg Str. 1, Hannover 30625, Germany
| | - Serghei Cebotari
- Department of Cardiac-, Thoracic-, Transplantation and Vascular Surgery, Hannover Medical School, Carl-Neuberg Str. 1, Hannover 30625, Germany
| | - Anatol Ciubotaru
- Department of Cardiac-, Thoracic-, Transplantation and Vascular Surgery, Hannover Medical School, Carl-Neuberg Str. 1, Hannover 30625, Germany
| | - Samir Sarikouch
- Department of Cardiac-, Thoracic-, Transplantation and Vascular Surgery, Hannover Medical School, Carl-Neuberg Str. 1, Hannover 30625, Germany
| | - Klaus Höffler
- Department of Cardiac-, Thoracic-, Transplantation and Vascular Surgery, Hannover Medical School, Carl-Neuberg Str. 1, Hannover 30625, Germany
| | | | - Björn Petersen
- Institute of Farm Animal Genetics, Friedrich-Loeffler-Institut, Hoeltystr. 10, 31535 Mariensee/Neustadt am Ruebenberge, Germany
| | - Axel Haverich
- Leibniz Research Laboratories for Biotechnology and Artificial Organs (LEBAO), Hannover Medical School, Carl-Neuberg Str. 1, Hannover 30625, Germany
- Department of Cardiac-, Thoracic-, Transplantation and Vascular Surgery, Hannover Medical School, Carl-Neuberg Str. 1, Hannover 30625, Germany
| | - Heiner Niemann
- Institute of Farm Animal Genetics, Friedrich-Loeffler-Institut, Hoeltystr. 10, 31535 Mariensee/Neustadt am Ruebenberge, Germany
| | - Andres Hilfiker
- Leibniz Research Laboratories for Biotechnology and Artificial Organs (LEBAO), Hannover Medical School, Carl-Neuberg Str. 1, Hannover 30625, Germany
- Department of Cardiac-, Thoracic-, Transplantation and Vascular Surgery, Hannover Medical School, Carl-Neuberg Str. 1, Hannover 30625, Germany
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23
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Latifi N, Lecce M, Simmons CA. Porcine Umbilical Cord Perivascular Cells for Preclinical Testing of Tissue-Engineered Heart Valves. Tissue Eng Part C Methods 2021; 27:35-46. [PMID: 33349127 DOI: 10.1089/ten.tec.2020.0314] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Many children born with congenital heart disease need a heart valve repair or replacement. Currently available repair materials and valve replacements are incapable of growth, repair, and adaptation, rendering them inadequate for growing children. Heart valve tissue engineering (HVTE) aims to develop living replacement valves that can meet these needs. Among numerous cell sources for in vitro HVTE, umbilical cord perivascular cells (UCPVCs) are particularly attractive because they are autologous, readily available, and have excellent regenerative capacity. As an essential step toward preclinical testing of heart valves engineered from UCPVCs, the goal of this study was to establish methods to isolate, expand, and promote extracellular matrix (ECM) synthesis by UCPVCs from pigs (porcine umbilical cord perivascular cells [pUCPVCs]), as a relevant preclinical model. We determined that Dulbecco's modified Eagle's medium with 20% fetal bovine serum supported isolation and substantial expansion of pUCPVCs, whereas media designed for human mesenchymal stromal cell (MSC) expansion did not. We further demonstrated the capacity of pUCPVCs to synthesize the main ECM components of heart valves (collagen type I, elastin, and glycosaminoglycans), with maximal collagen and elastin per-cell production occurring in serum-free culture conditions using StemMACS™ MSC Expansion Media. Altogether, these results establish protocols that enable the use of pUCPVCs as a viable cell source for preclinical testing of engineered heart valves. Impact statement This study establishes methods to successfully isolate, expand, and promote the synthesis of the main extracellular matrix components of heart valves (collagen type I, elastin, and glycosaminoglycans) by porcine umbilical cord perivascular cells (pUCPVCs). These protocols enable further evaluation of pUCPVCs as an autologous, readily available, and clinically relevant cell source for preclinical testing of pediatric tissue-engineered heart valves.
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Affiliation(s)
- Neda Latifi
- Translational Biology and Engineering Program, The Ted Rogers Centre for Heart Research, Toronto, Canada.,Department of Mechanical and Industrial Engineering, University of Toronto, Toronto, Canada
| | - Monica Lecce
- Translational Biology and Engineering Program, The Ted Rogers Centre for Heart Research, Toronto, Canada.,Department of Chemical Engineering and Applied Chemistry, University of Toronto, Toronto, Canada.,Institute of Biomedical Engineering, University of Toronto, Toronto, Canada
| | - Craig A Simmons
- Translational Biology and Engineering Program, The Ted Rogers Centre for Heart Research, Toronto, Canada.,Department of Mechanical and Industrial Engineering, University of Toronto, Toronto, Canada.,Institute of Biomedical Engineering, University of Toronto, Toronto, Canada
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24
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Badria AF, Koutsoukos PG, Mavrilas D. Decellularized tissue-engineered heart valves calcification: what do animal and clinical studies tell us? JOURNAL OF MATERIALS SCIENCE. MATERIALS IN MEDICINE 2020; 31:132. [PMID: 33278023 PMCID: PMC7719105 DOI: 10.1007/s10856-020-06462-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Accepted: 10/31/2020] [Indexed: 06/12/2023]
Abstract
Cardiovascular diseases are the first cause of death worldwide. Among different heart malfunctions, heart valve failure due to calcification is still a challenging problem. While drug-dependent treatment for the early stage calcification could slow down its progression, heart valve replacement is inevitable in the late stages. Currently, heart valve replacements involve mainly two types of substitutes: mechanical and biological heart valves. Despite their significant advantages in restoring the cardiac function, both types of valves suffered from serious drawbacks in the long term. On the one hand, the mechanical one showed non-physiological hemodynamics and the need for the chronic anticoagulation therapy. On the other hand, the biological one showed stenosis and/or regurgitation due to calcification. Nowadays, new promising heart valve substitutes have emerged, known as decellularized tissue-engineered heart valves (dTEHV). Decellularized tissues of different types have been widely tested in bioprosthetic and tissue-engineered valves because of their superior biomechanics, biocompatibility, and biomimetic material composition. Such advantages allow successful cell attachment, growth and function leading finally to a living regenerative valvular tissue in vivo. Yet, there are no comprehensive studies that are covering the performance of dTEHV scaffolds in terms of their efficiency for the calcification problem. In this review article, we sought to answer the question of whether decellularized heart valves calcify or not. Also, which factors make them calcify and which ones lower and/or prevent their calcification. In addition, the review discussed the possible mechanisms for dTEHV calcification in comparison to the calcification in the native and bioprosthetic heart valves. For this purpose, we did a retrospective study for all the published work of decellularized heart valves. Only animal and clinical studies were included in this review. Those animal and clinical studies were further subcategorized into 4 categories for each depending on the effect of decellularization on calcification. Due to the complex nature of calcification in heart valves, other in vitro and in silico studies were not included. Finally, we compared the different results and summed up all the solid findings of whether decellularized heart valves calcify or not. Based on our review, the selection of the proper heart valve tissue sources (no immunological provoking residues), decellularization technique (no damaged exposed residues of the decellularized tissues, no remnants of dead cells, no remnants of decellularizing agents) and implantation techniques (avoiding suturing during the surgical implantation) could provide a perfect anticalcification potential even without in vitro cell seeding or additional scaffold treatment.
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Affiliation(s)
- Adel F Badria
- Department of Fiber and Polymer Technology, Division of Coating Technology, KTH Royal Institute of Technology, Stockholm, Sweden.
- Department of Mechanical Engineering and Aeronautics, Division of Applied Mechanics, Technology of Materials and Biomechanics, University of Patras, Patras, Greece.
| | - Petros G Koutsoukos
- Department of Chemical Engineering, University of Patras, Patras University Campus, 26504, Patras, Greece
| | - Dimosthenis Mavrilas
- Department of Mechanical Engineering and Aeronautics, Division of Applied Mechanics, Technology of Materials and Biomechanics, University of Patras, Patras, Greece
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25
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Uiterwijk M, Smits AIPM, van Geemen D, van Klarenbosch B, Dekker S, Cramer MJ, van Rijswijk JW, Lurier EB, Di Luca A, Brugmans MCP, Mes T, Bosman AW, Aikawa E, Gründeman PF, Bouten CVC, Kluin J. In Situ Remodeling Overrules Bioinspired Scaffold Architecture of Supramolecular Elastomeric Tissue-Engineered Heart Valves. ACTA ACUST UNITED AC 2020; 5:1187-1206. [PMID: 33426376 PMCID: PMC7775962 DOI: 10.1016/j.jacbts.2020.09.011] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Revised: 09/22/2020] [Accepted: 09/22/2020] [Indexed: 11/17/2022]
Abstract
In situ tissue engineering that uses resorbable synthetic heart valve scaffolds is an affordable and practical approach for heart valve replacement; therefore, it is attractive for clinical use. This study showed no consistent collagen organization in the predefined direction of electrospun scaffolds made from a resorbable supramolecular elastomer with random or circumferentially aligned fibers, after 12 months of implantation in sheep. These unexpected findings and the observed intervalvular variability highlight the need for a mechanistic understanding of the long-term in situ remodeling processes in large animal models to improve predictability of outcome toward robust and safe clinical application.
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Affiliation(s)
- Marcelle Uiterwijk
- Department of Cardiothoracic Surgery, Amsterdam University Medical Center, Amsterdam, the Netherlands
| | - Anthal I P M Smits
- Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands.,Institute for Complex Molecular Systems, Eindhoven University of Technology, Eindhoven, the Netherlands
| | - Daphne van Geemen
- Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands
| | - Bas van Klarenbosch
- Department of Cardiology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Sylvia Dekker
- Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands
| | - Maarten Jan Cramer
- Department of Cardiology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Jan Willem van Rijswijk
- Department of Cardiothoracic Surgery, Amsterdam University Medical Center, Amsterdam, the Netherlands
| | - Emily B Lurier
- Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands.,School of Biomedical Engineering, Science and Health Systems, Drexel University, Philadelphia, Pennsylvania, USA
| | - Andrea Di Luca
- Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands
| | | | | | | | - Elena Aikawa
- Center for Excellence in Vascular Biology, Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Paul F Gründeman
- Department of Cardiothoracic Surgery, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Carlijn V C Bouten
- Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands.,Institute for Complex Molecular Systems, Eindhoven University of Technology, Eindhoven, the Netherlands
| | - Jolanda Kluin
- Department of Cardiothoracic Surgery, Amsterdam University Medical Center, Amsterdam, the Netherlands.,Institute for Complex Molecular Systems, Eindhoven University of Technology, Eindhoven, the Netherlands
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26
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Harnessing Mechanosensation in Next Generation Cardiovascular Tissue Engineering. Biomolecules 2020; 10:biom10101419. [PMID: 33036467 PMCID: PMC7599461 DOI: 10.3390/biom10101419] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Revised: 10/06/2020] [Accepted: 10/07/2020] [Indexed: 12/11/2022] Open
Abstract
The ability of the cells to sense mechanical cues is an integral component of ”social” cell behavior inside tissues with a complex architecture. Through ”mechanosensation” cells are in fact able to decrypt motion, geometries and physical information of surrounding cells and extracellular matrices by activating intracellular pathways converging onto gene expression circuitries controlling cell and tissue homeostasis. Additionally, only recently cell mechanosensation has been integrated systematically as a crucial element in tissue pathophysiology. In the present review, we highlight some of the current efforts to assess the relevance of mechanical sensing into pathology modeling and manufacturing criteria for a next generation of cardiovascular tissue implants.
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27
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Poulis N, Zaytseva P, Gähwiler EKN, Motta SE, Fioretta ES, Cesarovic N, Falk V, Hoerstrup SP, Emmert MY. Tissue engineered heart valves for transcatheter aortic valve implantation: current state, challenges, and future developments. Expert Rev Cardiovasc Ther 2020; 18:681-696. [DOI: 10.1080/14779072.2020.1792777] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Affiliation(s)
- Nikolaos Poulis
- Institute for Regenerative Medicine, University of Zurich, Zurich, Switzerland
| | - Polina Zaytseva
- Institute for Regenerative Medicine, University of Zurich, Zurich, Switzerland
| | - Eric K. N. Gähwiler
- Institute for Regenerative Medicine, University of Zurich, Zurich, Switzerland
| | - Sarah E. Motta
- Institute for Regenerative Medicine, University of Zurich, Zurich, Switzerland
- Wyss Translational Center Zurich, University of Zurich and ETH Zurich, Zurich, Switzerland
| | | | - Nikola Cesarovic
- Department of Cardiovascular Surgery, Charité Universitätsmedizin Berlin, Berlin, Germany
- Department of Health Sciences and Technology, Swiss Federal Institute of Technology in Zurich, Zurich, Switzerland
| | - Volkmar Falk
- Department of Cardiovascular Surgery, Charité Universitätsmedizin Berlin, Berlin, Germany
- Department of Health Sciences and Technology, Swiss Federal Institute of Technology in Zurich, Zurich, Switzerland
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany
- German Center of Cardiovascular Research, Partner Site Berlin, Berlin, Germany
| | - Simon P. Hoerstrup
- Institute for Regenerative Medicine, University of Zurich, Zurich, Switzerland
- Wyss Translational Center Zurich, University of Zurich and ETH Zurich, Zurich, Switzerland
| | - Maximilian Y. Emmert
- Institute for Regenerative Medicine, University of Zurich, Zurich, Switzerland
- Wyss Translational Center Zurich, University of Zurich and ETH Zurich, Zurich, Switzerland
- Department of Cardiovascular Surgery, Charité Universitätsmedizin Berlin, Berlin, Germany
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany
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28
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Ravishankar P, Ozkizilcik A, Husain A, Balachandran K. Anisotropic Fiber-Reinforced Glycosaminoglycan Hydrogels for Heart Valve Tissue Engineering. Tissue Eng Part A 2020; 27:513-525. [PMID: 32723024 DOI: 10.1089/ten.tea.2020.0118] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
This study investigates polymer fiber-reinforced protein-polysaccharide-based hydrogels for heart valve tissue engineering applications. Polycaprolactone and gelatin (3:1) blends were jet-spun to fabricate aligned fibers that possessed fiber diameters in the range found in the native heart valve. These fibers were embedded in methacrylated hydrogels made from gelatin, sodium hyaluronate, and chondroitin sulfate to create fiber-reinforced hydrogel composites (HCs). The fiber-reinforced gelatin glycosaminoglycan (GAG)-based HC possessed interconnected porous structures and porosity higher than fiber-only conditions. These fiber-reinforced HCs exhibited compressive modulus and biaxial mechanical behavior comparable to that of native porcine aortic valves. The fiber-reinforced HCs were able to swell higher and degraded less than the hydrogels. Elution studies revealed that less than 20% of incorporated gelatin methacrylate and GAGs were released over 2 weeks, with a steady-state release after the first day. When cultured with porcine valve interstitial cells (VICs), the fiber-reinforced composites were able to maintain higher cell viability compared with fiber-only samples. Quiescent VICs expressed alpha smooth muscle actin and calponin showing an activated phenotype, along with a few cells expressing the proliferation marker Ki67 and negative expression for RUNX2, an osteogenic marker. Our study demonstrated that compared with the hydrogels and fibers alone, combining both components can yield durable, reinforced composites that mimic heart valve mechanical behavior, while maintaining high cell viability and expressing positive activation as well as proliferation markers.
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Affiliation(s)
- Prashanth Ravishankar
- Department of Biomedical Engineering, University of Arkansas, Fayetteville, Arkansas, USA
| | - Asya Ozkizilcik
- Department of Biomedical Engineering, University of Arkansas, Fayetteville, Arkansas, USA
| | - Anushae Husain
- Department of Biomedical Engineering, University of Arkansas, Fayetteville, Arkansas, USA
| | - Kartik Balachandran
- Department of Biomedical Engineering, University of Arkansas, Fayetteville, Arkansas, USA
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29
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Gonzalez de Torre I, Alonso M, Rodriguez-Cabello JC. Elastin-Based Materials: Promising Candidates for Cardiac Tissue Regeneration. Front Bioeng Biotechnol 2020; 8:657. [PMID: 32695756 PMCID: PMC7338576 DOI: 10.3389/fbioe.2020.00657] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Accepted: 05/27/2020] [Indexed: 11/15/2022] Open
Abstract
Stroke and cardiovascular episodes are still some of the most common diseases worldwide, causing millions of deaths and costing billions of Euros to healthcare systems. The use of new biomaterials with enhanced biological and physical properties has opened the door to new approaches in cardiovascular applications. Elastin-based materials are biomaterials with some of the most promising properties. Indeed, these biomaterials have started to yield good results in cardiovascular and angiogenesis applications. In this review, we explore the latest trends in elastin-derived materials for cardiac regeneration and the different possibilities that are being explored by researchers to regenerate an infarcted muscle and restore its normal function. Elastin-based materials can be processed in different manners to create injectable systems or hydrogel scaffolds that can be applied by simple injection or as patches to cover the damaged area and regenerate it. Such materials have been applied to directly regenerate the damaged cardiac muscle and to create complex structures, such as heart valves or new bio-stents that could help to restore the normal function of the heart or to minimize damage after a stroke. We will discuss the possibilities that elastin-based materials offer in cardiac tissue engineering, either alone or in combination with other biomaterials, in order to illustrate the wide range of options that are being explored. Moreover, although tremendous advances have been achieved with such elastin-based materials, there is still room for new approaches that could trigger advances in cardiac tissue regeneration.
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30
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Huygens SA, Ramos IC, Bouten CVC, Kluin J, Chiu ST, Grunkemeier GL, Takkenberg JJM, Rutten-van Mölken MPMH. Early cost-utility analysis of tissue-engineered heart valves compared to bioprostheses in the aortic position in elderly patients. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2020; 21:557-572. [PMID: 31982976 PMCID: PMC7214484 DOI: 10.1007/s10198-020-01159-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Accepted: 01/07/2020] [Indexed: 06/10/2023]
Abstract
OBJECTIVES Aortic valve disease is the most frequent indication for heart valve replacement with the highest prevalence in elderly. Tissue-engineered heart valves (TEHV) are foreseen to have important advantages over currently used bioprosthetic heart valve substitutes, most importantly reducing valve degeneration with subsequent reduction of re-intervention. We performed early Health Technology Assessment of hypothetical TEHV in elderly patients (≥ 70 years) requiring surgical (SAVR) or transcatheter aortic valve implantation (TAVI) to assess the potential of TEHV and to inform future development decisions. METHODS Using a patient-level simulation model, the potential cost-effectiveness of TEHV compared with bioprostheses was predicted from a societal perspective. Anticipated, but currently hypothetical improvements in performance of TEHV, divided in durability, thrombogenicity, and infection resistance, were explored in scenario analyses to estimate quality-adjusted life-year (QALY) gain, cost reduction, headroom, and budget impact. RESULTS Durability of TEHV had the highest impact on QALY gain and costs, followed by infection resistance. Improved TEHV performance (- 50% prosthetic valve-related events) resulted in lifetime QALY gains of 0.131 and 0.043, lifetime cost reductions of €639 and €368, translating to headrooms of €3255 and €2498 per hypothetical TEHV compared to SAVR and TAVI, respectively. National savings in the first decade after implementation varied between €2.8 and €11.2 million (SAVR) and €3.2-€12.8 million (TAVI) for TEHV substitution rates of 25-100%. CONCLUSIONS Despite the relatively short life expectancy of elderly patients undergoing SAVR/TAVI, hypothetical TEHV are predicted to be cost-effective compared to bioprostheses, commercially viable and result in national cost savings when biomedical engineers succeed in realising improved durability and/or infection resistance of TEHV.
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Affiliation(s)
- Simone A Huygens
- Department of Cardiothoracic Surgery, Erasmus MC, University Medical Center, Rotterdam, The Netherlands.
- Erasmus School of Health Policy and Management, Erasmus University, Rotterdam, The Netherlands.
- Institute for Medical Technology Assessment, Erasmus University, Rotterdam, The Netherlands.
| | - Isaac Corro Ramos
- Institute for Medical Technology Assessment, Erasmus University, Rotterdam, The Netherlands
| | - Carlijn V C Bouten
- Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - Jolanda Kluin
- Department of Cardio-Thoracic Surgery, Academic Medical Centre, Amsterdam, The Netherlands
| | - Shih Ting Chiu
- Medical Data Research Centre, Providence Health and Service, Portland, OR, USA
| | - Gary L Grunkemeier
- Medical Data Research Centre, Providence Health and Service, Portland, OR, USA
| | - Johanna J M Takkenberg
- Department of Cardiothoracic Surgery, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Maureen P M H Rutten-van Mölken
- Erasmus School of Health Policy and Management, Erasmus University, Rotterdam, The Netherlands
- Institute for Medical Technology Assessment, Erasmus University, Rotterdam, The Netherlands
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31
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van Dijk CG, Louzao-Martinez L, van Mulligen E, Boermans B, Demmers JA, van den Bosch TP, Goumans MJ, Duncker DJ, Verhaar MC, Cheng C. Extracellular Matrix Analysis of Human Renal Arteries in Both Quiescent and Active Vascular State. Int J Mol Sci 2020; 21:E3905. [PMID: 32486169 PMCID: PMC7313045 DOI: 10.3390/ijms21113905] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 05/27/2020] [Accepted: 05/29/2020] [Indexed: 01/30/2023] Open
Abstract
In vascular tissue engineering strategies, the addition of vascular-specific extracellular matrix (ECM) components may better mimic the in vivo microenvironment and potentially enhance cell-matrix interactions and subsequent tissue growth. For this purpose, the exact composition of the human vascular ECM first needs to be fully characterized. Most research has focused on characterizing ECM components in mature vascular tissue; however, the developing fetal ECM matches the active environment required in vascular tissue engineering more closely. Consequently, we characterized the ECM protein composition of active (fetal) and quiescent (mature) renal arteries using a proteome analysis of decellularized tissue. The obtained human fetal renal artery ECM proteome dataset contains higher levels of 15 ECM proteins versus the mature renal artery ECM proteome, whereas 16 ECM proteins showed higher levels in the mature tissue compared to fetal. Elastic ECM proteins EMILIN1 and FBN1 are significantly enriched in fetal renal arteries and are mainly produced by cells of mesenchymal origin. We functionally tested the role of EMILIN1 and FBN1 by anchoring the ECM secreted by vascular smooth muscle cells (SMCs) to glass coverslips. This ECM layer was depleted from either EMILIN1 or FBN1 by using siRNA targeting of the SMCs. Cultured endothelial cells (ECs) on this modified ECM layer showed alterations on the transcriptome level of multiple pathways, especially the Rho GTPase controlled pathways. However, no significant alterations in adhesion, migration or proliferation were observed when ECs were cultured on EMILIN1- or FNB1-deficient ECM. To conclude, the proteome analysis identified unique ECM proteins involved in the embryonic development of renal arteries. Alterations in transcriptome levels of ECs cultured on EMILIN1- or FBN1-deficient ECM showed that these candidate proteins could affect the endothelial (regenerative) response.
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Affiliation(s)
- Christian G.M. van Dijk
- Department of Nephrology and Hypertension, Division of Internal Medicine and Dermatology, University Medical Center Utrecht, PO Box 85500, 3508 GA Utrecht, The Netherlands; (C.G.M.v.D.); (E.v.M.); (B.B.); (M.C.V.)
| | - Laura Louzao-Martinez
- Center for Proteomics, Erasmus Medical Center, 3015 CN Rotterdam, The Netherlands; (L.L.-M.); (J.A.A.D.)
| | - Elise van Mulligen
- Department of Nephrology and Hypertension, Division of Internal Medicine and Dermatology, University Medical Center Utrecht, PO Box 85500, 3508 GA Utrecht, The Netherlands; (C.G.M.v.D.); (E.v.M.); (B.B.); (M.C.V.)
| | - Bart Boermans
- Department of Nephrology and Hypertension, Division of Internal Medicine and Dermatology, University Medical Center Utrecht, PO Box 85500, 3508 GA Utrecht, The Netherlands; (C.G.M.v.D.); (E.v.M.); (B.B.); (M.C.V.)
| | - Jeroen A.A. Demmers
- Center for Proteomics, Erasmus Medical Center, 3015 CN Rotterdam, The Netherlands; (L.L.-M.); (J.A.A.D.)
| | | | - Marie-José Goumans
- Department of Cell and Chemical Biology, Leiden University Medical Center, PO Box 9600, 2300 RC Leiden, The Netherlands;
| | - Dirk J. Duncker
- Experimental Cardiology, Department of Cardiology, Thorax center, Erasmus MC, University Medical Center Rotterdam, PO Box 2040, 3000 CA Rotterdam, The Netherlands;
| | - Marianne C. Verhaar
- Department of Nephrology and Hypertension, Division of Internal Medicine and Dermatology, University Medical Center Utrecht, PO Box 85500, 3508 GA Utrecht, The Netherlands; (C.G.M.v.D.); (E.v.M.); (B.B.); (M.C.V.)
| | - Caroline Cheng
- Department of Nephrology and Hypertension, Division of Internal Medicine and Dermatology, University Medical Center Utrecht, PO Box 85500, 3508 GA Utrecht, The Netherlands; (C.G.M.v.D.); (E.v.M.); (B.B.); (M.C.V.)
- Experimental Cardiology, Department of Cardiology, Thorax center, Erasmus MC, University Medical Center Rotterdam, PO Box 2040, 3000 CA Rotterdam, The Netherlands;
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The Potential Impact and Timeline of Engineering on Congenital Interventions. Pediatr Cardiol 2020; 41:522-538. [PMID: 32198587 DOI: 10.1007/s00246-020-02335-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2019] [Accepted: 02/22/2020] [Indexed: 10/24/2022]
Abstract
Congenital interventional cardiology has seen rapid growth in recent decades due to the expansion of available medical devices. Percutaneous interventions have become standard of care for many common congenital conditions. Unfortunately, patients with congenital heart disease often require multiple interventions throughout their lifespan. The availability of transcatheter devices that are biodegradable, biocompatible, durable, scalable, and can be delivered in the smallest sized patients will rely on continued advances in engineering. The development pipeline for these devices will require contributions of many individuals in academia and industry including experts in material science and tissue engineering. Advances in tissue engineering, bioresorbable technology, and even new nanotechnologies and nitinol fabrication techniques which may have an impact on the field of transcatheter congenital device in the next decade are summarized in this review. This review highlights recent advances in the engineering of transcatheter-based therapies and discusses future opportunities for engineering of transcatheter devices.
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Oveissi F, Naficy S, Lee A, Winlaw D, Dehghani F. Materials and manufacturing perspectives in engineering heart valves: a review. Mater Today Bio 2020; 5:100038. [PMID: 32211604 PMCID: PMC7083765 DOI: 10.1016/j.mtbio.2019.100038] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Revised: 11/26/2019] [Accepted: 11/27/2019] [Indexed: 12/27/2022] Open
Abstract
Valvular heart diseases (VHD) are a major health burden, affecting millions of people worldwide. The treatments for such diseases rely on medicine, valve repair, and artificial heart valves including mechanical and bioprosthetic valves. Yet, there are countless reports on possible alternatives noting long-term stability and biocompatibility issues and highlighting the need for fabrication of more durable and effective replacements. This review discusses the current and potential materials that can be used for developing such valves along with existing and developing fabrication methods. With this perspective, we quantitatively compare mechanical properties of various materials that are currently used or proposed for heart valves along with their fabrication processes to identify challenges we face in creating new materials and manufacturing techniques to better mimick the performance of native heart valves.
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Key Words
- 3D printing
- Biofabrication
- Biomaterials
- E, Young's modulus
- Electrospinning
- Gal, galactose-α1,3-galactose
- GelMa, gelatin methacrylate
- HA, hyaluronic acid
- HAVIC, human aortic valvular interstitial cells
- MA-HA, methacrylated hyaluronic acid
- NeuGc, N-glycolylneuraminic acid
- P4HB, poly(4-hydroxybutyrate)
- PAAm, polyacrylamide
- PCE, polycitrate-(ε-polypeptide)
- PCL, polycaprolactone
- PE, polyethylene
- PEG, polyethylene glycol
- PEGDA, polyethylene glycol diacrylate
- PGA, poly(glycolic acid)
- PHA, poly(hydroxyalkanoate)
- PLA, polylactide
- PMMA, poly(methyl methacrylate)
- PPG, polypropylene glycol
- PTFE, polytetrafluoroethylene
- PU, polyurethane
- SIBS, poly(styrene-b-isobutylene-b-styrene)
- SMC, smooth muscle cells
- VHD, valvular heart disease
- VIC, aortic valve leaflet interstitial cells
- Valvular heart diseases
- dECM, decellularized extracellular matrix
- ePTFE, expanded PTFE
- xSIBS, crosslinked version of SIBS
- α-SMA, alpha-smooth muscle actin
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Affiliation(s)
- F. Oveissi
- School of Chemical and Biomolecular Engineering, The University of Sydney, Sydney, New South Wales, 2006, Australia
| | - S. Naficy
- School of Chemical and Biomolecular Engineering, The University of Sydney, Sydney, New South Wales, 2006, Australia
| | - A. Lee
- School of Chemical and Biomolecular Engineering, The University of Sydney, Sydney, New South Wales, 2006, Australia
- Discipline of Child and Adolescent Health, Sydney Medical School, Faculty of Health and Medicine, The University of Sydney, New South Wales, 2006, Australia
- Heart Centre for Children, The Children's Hospital at Westmead, New South Wales, 2145, Australia
| | - D.S. Winlaw
- Discipline of Child and Adolescent Health, Sydney Medical School, Faculty of Health and Medicine, The University of Sydney, New South Wales, 2006, Australia
- Heart Centre for Children, The Children's Hospital at Westmead, New South Wales, 2145, Australia
| | - F. Dehghani
- School of Chemical and Biomolecular Engineering, The University of Sydney, Sydney, New South Wales, 2006, Australia
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Bensimon-Brito A, Ramkumar S, Boezio GLM, Guenther S, Kuenne C, Helker CSM, Sánchez-Iranzo H, Iloska D, Piesker J, Pullamsetti S, Mercader N, Beis D, Stainier DYR. TGF-β Signaling Promotes Tissue Formation during Cardiac Valve Regeneration in Adult Zebrafish. Dev Cell 2019; 52:9-20.e7. [PMID: 31786069 DOI: 10.1016/j.devcel.2019.10.027] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Revised: 09/17/2019] [Accepted: 10/28/2019] [Indexed: 12/14/2022]
Abstract
Cardiac valve disease can lead to severe cardiac dysfunction and is thus a frequent cause of morbidity and mortality. Its main treatment is valve replacement, which is currently greatly limited by the poor recellularization and tissue formation potential of the implanted valves. As we still lack suitable animal models to identify modulators of these processes, here we used adult zebrafish and found that, upon valve decellularization, they initiate a rapid regenerative program that leads to the formation of new functional valves. After injury, endothelial and kidney marrow-derived cells undergo cell cycle re-entry and differentiate into new extracellular matrix-secreting valve cells. The TGF-β signaling pathway promotes the regenerative process by enhancing progenitor cell proliferation as well as valve cell differentiation. These findings reveal a key role for TGF-β signaling in cardiac valve regeneration and establish the zebrafish as a model to identify and test factors promoting cardiac valve recellularization and growth.
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Affiliation(s)
- Anabela Bensimon-Brito
- Department of Developmental Genetics, Max Planck Institute for Heart and Lung Research, Bad Nauheim 61231, Germany.
| | - Srinath Ramkumar
- Department of Developmental Genetics, Max Planck Institute for Heart and Lung Research, Bad Nauheim 61231, Germany
| | - Giulia L M Boezio
- Department of Developmental Genetics, Max Planck Institute for Heart and Lung Research, Bad Nauheim 61231, Germany
| | - Stefan Guenther
- Bioinformatics and Deep Sequencing Platform, Max Planck Institute for Heart and Lung Research, Bad Nauheim 61231, Germany
| | - Carsten Kuenne
- Bioinformatics Core Unit, Max Planck Institute for Heart and Lung Research, Bad Nauheim 61231, Germany
| | - Christian S M Helker
- Department of Developmental Genetics, Max Planck Institute for Heart and Lung Research, Bad Nauheim 61231, Germany
| | - Héctor Sánchez-Iranzo
- Cell Biology and Biophysics Research Unit, EMBL Heidelberg, Heidelberg 69117, Germany
| | - Dijana Iloska
- Department of Lung Development and Remodeling, Max Planck Institute for Heart and Lung Research, Bad Nauheim 61231, Germany
| | - Janett Piesker
- Scientific Service Group Microscopy, Max Planck Institute for Heart and Lung Research, Bad Nauheim 61231, Germany
| | - Soni Pullamsetti
- Department of Lung Development and Remodeling, Max Planck Institute for Heart and Lung Research, Bad Nauheim 61231, Germany
| | - Nadia Mercader
- Institute of Anatomy, University of Bern, Bern 3012, Switzerland; Centro Nacional de Investigaciones Cardiovasculares, CNIC, Madrid 28049, Spain
| | - Dimitris Beis
- Developmental Biology, Biomedical Research Foundation of the Academy of Athens, Athens 11527, Greece
| | - Didier Y R Stainier
- Department of Developmental Genetics, Max Planck Institute for Heart and Lung Research, Bad Nauheim 61231, Germany.
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D'Amore A, Luketich SK, Hoff R, Ye SH, Wagner WR. Blending Polymer Labile Elements at Differing Scales to Affect Degradation Profiles in Heart Valve Scaffolds. Biomacromolecules 2019; 20:2494-2505. [PMID: 31083976 DOI: 10.1021/acs.biomac.9b00189] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
After more than 22 years of research challenges and innovation, the heart valve tissue engineering paradigm still attracts attention as an approach to overcome limitations which exist with clinically utilized mechanical or bioprosthetic heart valves. Despite encouraging results, delayed translation can be attributed to limited knowledge on the concurrent mechanisms of biomaterial degradation in vivo, host inflammatory response, cell recruitment, and de novo tissue elaboration. This study aimed to reduce this gap by evaluating three alternative levels at which lability could be incorporated into candidate polyurethane materials electroprocessed into a valve scaffold. Specifically, polyester and polycarbonate labile soft segment diols were reacted into thermoplastic elastomeric polyurethane ureas that formed scaffolds where (1) a single polyurethane containing both of the two diols in the polymer backbone was synthesized and processed, (2) two polyurethanes were physically blended, one with exclusively polycarbonate and one with exclusively polyester diols, followed by processing of the blend, and (3) the two polyurethane types were concurrently processed to form individual fiber populations in a valve scaffold. The resulting valve scaffolds were characterized in terms of their mechanics before and after exposure to varying periods of pulsatile flow in an enzymatic (lipase) buffer solution. The results showed that valve scaffolds made from the first type of polymer and processing combination experienced more extensive degradation. This approach, although demonstrated with polyurethane scaffolds, can generally be translated to investigate biomaterial approaches where labile elements are introduced at different structural levels to alter degradation properties while largely preserving the overall chemical composition and initial mechanical behavior.
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Huygens SA, Rutten-van Mölken MP, Noruzi A, Etnel JR, Corro Ramos I, Bouten CV, Kluin J, Takkenberg JJ. What Is the Potential of Tissue-Engineered Pulmonary Valves in Children? Ann Thorac Surg 2019; 107:1845-1853. [DOI: 10.1016/j.athoracsur.2018.11.066] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Revised: 11/25/2018] [Accepted: 11/27/2018] [Indexed: 10/27/2022]
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van Uden S, Vanerio N, Catto V, Bonandrini B, Tironi M, Figliuzzi M, Remuzzi A, Kock L, Redaelli ACL, Greco FG, Riboldi SA. A novel hybrid silk-fibroin/polyurethane three-layered vascular graft: towards in situ tissue-engineered vascular accesses for haemodialysis. ACTA ACUST UNITED AC 2019; 14:025007. [PMID: 30620939 DOI: 10.1088/1748-605x/aafc96] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Clinically available alternatives of vascular access for long-term haemodialysis-currently limited to native arteriovenous fistulae and synthetic grafts-suffer from several drawbacks and are associated to high failure rates. Bioprosthetic grafts and tissue-engineered blood vessels are costly alternatives without clearly demonstrated increased performance. In situ tissue engineering could be the ideal approach to provide a vascular access that profits from the advantages of vascular grafts in the short-term (e.g. early cannulation) and of fistulae in the long-term (e.g. high success rates driven by biointegration). Hence, in this study a three-layered silk fibroin/polyurethane vascular graft was developed by electrospinning to be applied as long-term haemodialysis vascular access pursuing a 'hybrid' in situ engineering approach (i.e. based on a semi-degradable scaffold). This Silkothane® graft was characterized concerning morphology, mechanics, physical properties, blood contact and vascular cell adhesion/viability. The full three-layered graft structure, influenced by the polyurethane presence, ensured mechanical properties that are a determinant factor for the success of a vascular access (e.g. vein-graft compliance matching). The Silkothane® graft demonstrated early cannulation potential in line with self-sealing commercial synthetic arteriovenous grafts, and a degradability driven by enzymatic activity. Moreover, the fibroin-only layers and extracellular matrix-like morphology, presented by the graft, revealed to be crucial in providing a non-haemolytic character, long clotting time, and favourable adhesion of human umbilical vein endothelial cells with increasing viability after 3 and 7 d. Accordingly, the proposed approach may represent a step forward towards an in situ engineered hybrid vascular access with potentialities for vein-graft anastomosis stability, early cannulation, and biointegration.
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Affiliation(s)
- Sebastião van Uden
- Bioengineering Laboratories S.r.l., Cantù, Italy. Dipartimento di Elettronica Informazione e Bioingegneria, Politecnico di Milano, Milan, Italy
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Brugmans M, Serrero A, Cox M, Svanidze O, Schoen FJ. Morphology and mechanisms of a novel absorbable polymeric conduit in the pulmonary circulation of sheep. Cardiovasc Pathol 2019; 38:31-38. [DOI: 10.1016/j.carpath.2018.10.008] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Revised: 10/18/2018] [Accepted: 10/19/2018] [Indexed: 12/23/2022] Open
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