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Besseling PJ, Szymczyk W, Teraa M, Toorop RJ, Wu DJ, Driessen RCH, Lichauco AM, Janssen HM, van de Kaa M, den Ouden K, de Bree PM, Fledderus JO, Bouten CVC, de Borst GJ, Dankers PYW, Verhaar MC. Off-the-Shelf Synthetic Biodegradable Grafts Transform In Situ into a Living Arteriovenous Fistula in a Large Animal Model. Adv Healthc Mater 2024:e2303888. [PMID: 38451476 DOI: 10.1002/adhm.202303888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Revised: 01/31/2024] [Indexed: 03/08/2024]
Abstract
Current vascular access options require frequent interventions. In situ tissue engineering (TE) may overcome these limitations by combining the initial success of synthetic grafts with long-term advantages of autologous vessels by using biodegradable grafts that transform into autologous vascular tissue at the site of implantation. Scaffolds (6 mm-Ø) made of supramolecular polycarbonate-bisurea (PC-BU), with a polycaprolactone (PCL) anti-kinking-coil, are implanted between the carotid artery and jugular vein in goats. A subset is bio-functionalized using bisurea-modified-Stromal cell-derived factor-1α (SDF1α) derived peptides and ePTFE grafts as controls. Grafts are explanted after 1 and 3 months, and evaluated for material degradation, tissue formation, compliance, and patency. At 3 months, the scaffold is resorbed and replaced by vascular neo-tissue, including elastin, contractile markers, and endothelial lining. No dilations, ruptures, or aneurysms are observed and grafts are successfully cannulated at termination. SDF-1α-peptide-biofunctionalization does not influence outcomes. Patency is lower in TE grafts (50%) compared to controls (100% patency), predominantly caused by intimal hyperplasia. Rapid remodeling of a synthetic, biodegradable vascular scaffold into a living, compliant arteriovenous fistula is demonstrated in a large animal model. Despite lower patency compared to ePTFE, transformation into autologous and compliant living tissue with self-healing capacity may have long-term advantages.
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Affiliation(s)
- Paul J Besseling
- Department of Nephrology and Hypertension, Regenerative Medicine Center Utrecht, University Medical Center Utrecht, Utrecht University, Utrecht, 3584 CX, the Netherlands
- Department of Vascular Surgery, University Medical Center Utrecht, Utrecht, 3584 CX, the Netherlands
| | - Wojciech Szymczyk
- Department of Biomedical Engineering, and Institute for Complex Molecular Systems, Eindhoven University of Technology, Eindhoven, 5612 AZ, the Netherlands
| | - Martin Teraa
- Department of Nephrology and Hypertension, Regenerative Medicine Center Utrecht, University Medical Center Utrecht, Utrecht University, Utrecht, 3584 CX, the Netherlands
- Department of Vascular Surgery, University Medical Center Utrecht, Utrecht, 3584 CX, the Netherlands
| | - Raechel J Toorop
- Department of Vascular Surgery, University Medical Center Utrecht, Utrecht, 3584 CX, the Netherlands
| | - Dan Jing Wu
- Department of Biomedical Engineering, and Institute for Complex Molecular Systems, Eindhoven University of Technology, Eindhoven, 5612 AZ, the Netherlands
| | - Rob C H Driessen
- Department of Biomedical Engineering, and Institute for Complex Molecular Systems, Eindhoven University of Technology, Eindhoven, 5612 AZ, the Netherlands
- Mechanobiology Services Eindhoven, Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, 5612 AZ, the Netherlands
| | - Arturo M Lichauco
- Department of Biomedical Engineering, and Institute for Complex Molecular Systems, Eindhoven University of Technology, Eindhoven, 5612 AZ, the Netherlands
| | | | - Melanie van de Kaa
- Department of Nephrology and Hypertension, Regenerative Medicine Center Utrecht, University Medical Center Utrecht, Utrecht University, Utrecht, 3584 CX, the Netherlands
| | - Krista den Ouden
- Department of Nephrology and Hypertension, Regenerative Medicine Center Utrecht, University Medical Center Utrecht, Utrecht University, Utrecht, 3584 CX, the Netherlands
| | - Petra M de Bree
- Department of Nephrology and Hypertension, Regenerative Medicine Center Utrecht, University Medical Center Utrecht, Utrecht University, Utrecht, 3584 CX, the Netherlands
| | - Joost O Fledderus
- Department of Nephrology and Hypertension, Regenerative Medicine Center Utrecht, University Medical Center Utrecht, Utrecht University, Utrecht, 3584 CX, the Netherlands
| | - Carlijn V C Bouten
- Department of Biomedical Engineering, and Institute for Complex Molecular Systems, Eindhoven University of Technology, Eindhoven, 5612 AZ, the Netherlands
| | - Gert J de Borst
- Department of Vascular Surgery, University Medical Center Utrecht, Utrecht, 3584 CX, the Netherlands
| | - Patricia Y W Dankers
- Department of Biomedical Engineering, and Institute for Complex Molecular Systems, Eindhoven University of Technology, Eindhoven, 5612 AZ, the Netherlands
| | - Marianne C Verhaar
- Department of Nephrology and Hypertension, Regenerative Medicine Center Utrecht, University Medical Center Utrecht, Utrecht University, Utrecht, 3584 CX, the Netherlands
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