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Motta SE, Lintas V, Fioretta ES, Dijkman PE, Putti M, Caliskan E, Rodriguez Cetina Biefer H, Lipiski M, Sauer M, Cesarovic N, Hoerstrup SP, Emmert MY. Human cell-derived tissue-engineered heart valve with integrated Valsalva sinuses: towards native-like transcatheter pulmonary valve replacements. NPJ Regen Med 2019; 4:14. [PMID: 31240114 PMCID: PMC6572861 DOI: 10.1038/s41536-019-0077-4] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Accepted: 05/21/2019] [Indexed: 02/06/2023] Open
Abstract
Transcatheter valve replacement indication is currently being extended to younger and lower-risk patients. However, transcatheter prostheses are still based on glutaraldehyde-fixed xenogeneic materials. Hence, they are prone to calcification and long-term structural degeneration, which are particularly accelerated in younger patients. Tissue-engineered heart valves based on decellularized in vitro grown tissue-engineered matrices (TEM) have been suggested as a valid alternative to currently used bioprostheses, showing good performance and remodeling capacity as transcatheter pulmonary valve replacement (TPVR) in sheep. Here, we first describe the in vitro development of human cell-derived TEM (hTEM) and their application as tissue-engineered sinus valves (hTESVs), endowed with Valsalva sinuses for TPVR. The hTEM and hTESVs were systematically characterized in vitro by histology, immunofluorescence, and biochemical analyses, before they were evaluated in a pulse duplicator system under physiological pulmonary pressure conditions. Thereafter, transapical delivery of hTESVs was tested for feasibility and safety in a translational sheep model, achieving good valve performance and early cellular infiltration. This study demonstrates the principal feasibility of clinically relevant hTEM to manufacture hTESVs for TPVR.
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Affiliation(s)
- Sarah E Motta
- 1Institute for Regenerative Medicine (IREM), University of Zurich, Zurich, Switzerland
| | - Valentina Lintas
- 1Institute for Regenerative Medicine (IREM), University of Zurich, Zurich, Switzerland
| | - Emanuela S Fioretta
- 1Institute for Regenerative Medicine (IREM), University of Zurich, Zurich, Switzerland
| | - Petra E Dijkman
- 1Institute for Regenerative Medicine (IREM), University of Zurich, Zurich, Switzerland
| | - Matilde Putti
- 2Department of Biomedical Engineering, Technische Universiteit Eindhoven, Eindhoven, The Netherlands
| | - Etem Caliskan
- 3Department of Cardiovascular Surgery, Charité Universitätsmedizin Berlin, Berlin, Germany.,Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany
| | - Héctor Rodriguez Cetina Biefer
- 3Department of Cardiovascular Surgery, Charité Universitätsmedizin Berlin, Berlin, Germany.,Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany
| | - Miriam Lipiski
- 5Division of Surgical Research, University Hospital Zürich, University of Zurich, Zurich, Switzerland
| | - Mareike Sauer
- 5Division of Surgical Research, University Hospital Zürich, University of Zurich, Zurich, Switzerland
| | - Nikola Cesarovic
- 5Division of Surgical Research, University Hospital Zürich, University of Zurich, Zurich, Switzerland
| | - Simon P Hoerstrup
- 1Institute for Regenerative Medicine (IREM), University of Zurich, Zurich, Switzerland.,6Wyss Translational Center Zurich, University of Zurich and ETH Zurich, Zurich, Switzerland
| | - Maximilian Y Emmert
- 1Institute for Regenerative Medicine (IREM), University of Zurich, Zurich, Switzerland.,3Department of Cardiovascular Surgery, Charité Universitätsmedizin Berlin, Berlin, Germany.,Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany.,6Wyss Translational Center Zurich, University of Zurich and ETH Zurich, Zurich, Switzerland
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Motta SE, Lintas V, Fioretta ES, Hoerstrup SP, Emmert MY. Off-the-shelf tissue engineered heart valves for in situ regeneration: current state, challenges and future directions. Expert Rev Med Devices 2017; 15:35-45. [PMID: 29257706 DOI: 10.1080/17434440.2018.1419865] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
INTRODUCTION Transcatheter aortic valve replacement (TAVR) is continuously evolving and is expected to surpass surgical valve implantation in the near future. Combining durable valve substitutes with minimally invasive implantation techniques might increase the clinical relevance of this therapeutic option for younger patient populations. Tissue engineering offers the possibility to create tissue engineered heart valves (TEHVs) with regenerative and self-repair capacities which may overcome the pitfalls of current TAVR prostheses. AREAS COVERED This review focuses on off-the-shelf TEHVs which rely on a clinically-relevant in situ tissue engineering approach and which have already advanced into preclinical or first-in-human investigation. EXPERT COMMENTARY Among the off-the-shelf in situ TEHVs reported in literature, the vast majority covers pulmonary valve substitutes, and only few are combined with transcatheter implantation technologies. Hence, further innovations should include the development of transcatheter tissue engineered aortic valve substitutes, which would considerably increase the clinical relevance of such prostheses.
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Affiliation(s)
- Sarah E Motta
- a Institute for Regenerative Medicine (IREM) , University of Zurich , Zurich , Switzerland
| | - Valentina Lintas
- a Institute for Regenerative Medicine (IREM) , University of Zurich , Zurich , Switzerland
| | - Emanuela S Fioretta
- a Institute for Regenerative Medicine (IREM) , University of Zurich , Zurich , Switzerland
| | - Simon P Hoerstrup
- a Institute for Regenerative Medicine (IREM) , University of Zurich , Zurich , Switzerland.,b Wyss Translational Center Zurich , University and ETH Zurich , Zurich , Switzerland
| | - Maximilian Y Emmert
- a Institute for Regenerative Medicine (IREM) , University of Zurich , Zurich , Switzerland.,b Wyss Translational Center Zurich , University and ETH Zurich , Zurich , Switzerland.,c Heart Center Zurich , University Hospital Zurich , Zurich , Switzerland
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Yeo GC, Kondyurin A, Kosobrodova E, Weiss AS, Bilek MMM. A sterilizable, biocompatible, tropoelastin surface coating immobilized by energetic ion activation. J R Soc Interface 2017; 14:20160837. [PMID: 28179545 PMCID: PMC5332567 DOI: 10.1098/rsif.2016.0837] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2016] [Accepted: 01/10/2017] [Indexed: 02/05/2023] Open
Abstract
Biomimetic materials which integrate with surrounding tissues and regulate new tissue formation are attractive for tissue engineering and regenerative medicine. Plasma immersion ion-implanted (PIII) polyethersulfone (PES) provides an excellent platform for the irreversible immobilization of bioactive proteins and peptides. PIII treatment significantly improves PES wettability and results in the formation of acidic groups on the PES surface, with the highest concentration observed at 40-80 s of PIII treatment. The elastomeric protein tropoelastin can be stably adhered to PIII-treated PES in a cell-interactive conformation by tailoring the pH and salt levels of the protein-surface association conditions. Tropoelastin-coated PIII-treated PES surfaces are resistant to molecular fouling, and actively promote high levels of fibroblast adhesion and proliferation while maintaining cell morphology. Tropoelastin, unlike other extracellular matrix proteins such as fibronectin, uniquely retains full bioactivity even after medical-grade ethylene oxide sterilization. This dual approach of PIII treatment and tropoelastin cloaking allows for the stable, robust functionalization of clinically used polymer materials for directed cellular interactions.
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Affiliation(s)
- Giselle C Yeo
- School of Physics, University of Sydney, Sydney, New South Wales 2006, Australia
- Charles Perkins Centre, University of Sydney, Sydney, New South Wales 2006, Australia
- School of Life and Environmental Sciences, University of Sydney, Sydney, New South Wales 2006, Australia
| | - Alexey Kondyurin
- School of Physics, University of Sydney, Sydney, New South Wales 2006, Australia
| | - Elena Kosobrodova
- School of Physics, University of Sydney, Sydney, New South Wales 2006, Australia
| | - Anthony S Weiss
- Charles Perkins Centre, University of Sydney, Sydney, New South Wales 2006, Australia
- School of Life and Environmental Sciences, University of Sydney, Sydney, New South Wales 2006, Australia
- Bosch Institute, University of Sydney, Sydney, New South Wales 2006, Australia
| | - Marcela M M Bilek
- School of Physics, University of Sydney, Sydney, New South Wales 2006, Australia
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Boddupalli A, Zhu L, Bratlie KM. Methods for Implant Acceptance and Wound Healing: Material Selection and Implant Location Modulate Macrophage and Fibroblast Phenotypes. Adv Healthc Mater 2016; 5:2575-2594. [PMID: 27593734 DOI: 10.1002/adhm.201600532] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2016] [Revised: 06/17/2016] [Indexed: 12/12/2022]
Abstract
This review focuses on materials and methods used to induce phenotypic changes in macrophages and fibroblasts. Herein, we give a brief overview on how changes in macrophages and fibroblasts phenotypes are critical biomarkers for identification of implant acceptance, wound healing effectiveness, and are also essential for evaluating the regenerative capabilities of some hybrid strategies that involve the combination of natural and synthetic materials. The different types of cells present during the host response have been extensively studied for evaluating the reaction to different materials and there are varied material approaches towards fabrication of biocompatible substrates. We discuss how natural and synthetic materials have been used to engineer desirable outcomes in lung, heart, liver, skin, and musculoskeletal implants, and how certain properties such as rigidity, surface shape, and porosity play key roles in the progression of the host response. Several fabrication strategies are discussed to control the phenotype of infiltrating macrophages and fibroblasts: decellularization of scaffolds, surface coatings, implant shape, and pore size apart from biochemical signaling pathways that can inhibit or accelerate unfavorable host responses. It is essential to factor all the different design principles and material fabrication criteria for evaluating the choice of implant materials or regenerative therapeutic strategies.
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Affiliation(s)
- Anuraag Boddupalli
- Department of Chemical & Biological Engineering; Iowa State University; 2114 Sweeney Hall Ames IA 50011 USA
| | - Lida Zhu
- Department of Chemical & Biological Engineering; Iowa State University; 2114 Sweeney Hall Ames IA 50011 USA
| | - Kaitlin M. Bratlie
- Department of Chemical & Biological Engineering; Iowa State University; 2114 Sweeney Hall Ames IA 50011 USA
- Department of Materials Science & Engineering; Iowa State University; 2220 Hoover Hall Ames IA 50011 USA
- Division of Materials Science & Engineering; Ames National Laboratory; 126 Metals Development Ames IA 50011 USA
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