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Liu Y, Chen C, Lu T, Liu S, Wu Z, Tang Z. Free-aldehyde neutralized and oligohyaluronan loaded bovine pericardium with improved anti-calcification and endothelialization for bioprosthetic heart valves. Front Bioeng Biotechnol 2023; 11:1138972. [PMID: 37077226 PMCID: PMC10106738 DOI: 10.3389/fbioe.2023.1138972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Accepted: 03/27/2023] [Indexed: 04/05/2023] Open
Abstract
The number of patients with valvular heart disease is increasing yearly, and valve replacement is the most effective treatment, during which bioprosthetic heart valves (BHVs) are the most widely used. Commercial BHVs are mainly prepared with glutaraldehyde (Glut) cross-linked bovine pericardial or porcine aortic valves, but the residual free aldehyde groups in these tissues can cause calcification and cytotoxicity. Moreover, insufficient glycosaminoglycans (GAGs) in tissues can further reduce biocompatibility and durability. However, the anti-calcification performance and biocompatibility might be improved by blocking the free aldehyde groups and increasing the GAGs content in Glut-crosslinked tissues. In our study, adipic dihydrazide (ADH) was used to neutralize the residual free aldehyde groups in tissues and provide sites to blind with oligohyaluronan (OHA) to increase the content of GAGs in tissues. The modified bovine pericardium was evaluated for its content of residual aldehyde groups, the amount of OHA loaded, physical/chemical characteristics, biomechanical properties, biocompatibility, and in vivo anticalcification assay and endothelialization effects in juvenile Sprague-Dawley rats. The results showed that ADH could completely neutralize the free aldehyde groups in the Glut-crosslinked bovine pericardium, the amount of OHA loaded increased and the cytotoxicity was reduced. Moreover, the in vivo results also showed that the level of calcification and inflammatory response in the modified pericardial tissue was significantly reduced in a rat subcutaneous implantation model, and the results from the rat abdominal aorta vascular patch repair model further demonstrated the improved capability of the modified pericardial tissues for endothelialization. Furthermore, more α-SMA+ smooth muscle cells and fewer CD68+ macrophages infiltrated in the neointima of the modified pericardial patch. In summary, blocking free-aldehydes and loading OHA improved the anti-calcification, anti-inflammation and endothelialization properties of Glut-crosslinked BHVs and in particularly, this modified strategy may be a promising candidate for the next-generation of BHVs.
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Affiliation(s)
- Yuhong Liu
- Department of Cardiovascular Surgery, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
- Engineering Laboratory of Human Province for Cardiovascular Biomaterials, Changsha, Hunan, China
| | - Chunyang Chen
- Department of Cardiovascular Surgery, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
- Engineering Laboratory of Human Province for Cardiovascular Biomaterials, Changsha, Hunan, China
| | - Ting Lu
- Department of Cardiovascular Surgery, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
- Engineering Laboratory of Human Province for Cardiovascular Biomaterials, Changsha, Hunan, China
| | - Sixi Liu
- Department of Cardiovascular Surgery, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
- Engineering Laboratory of Human Province for Cardiovascular Biomaterials, Changsha, Hunan, China
| | - Zhongshi Wu
- Department of Cardiovascular Surgery, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
- Engineering Laboratory of Human Province for Cardiovascular Biomaterials, Changsha, Hunan, China
- *Correspondence: Zhongshi Wu, ; Zhenjie Tang,
| | - Zhenjie Tang
- Department of Cardiovascular Surgery, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
- Engineering Laboratory of Human Province for Cardiovascular Biomaterials, Changsha, Hunan, China
- *Correspondence: Zhongshi Wu, ; Zhenjie Tang,
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2
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Strategies for development of decellularized heart valve scaffolds for tissue engineering. Biomaterials 2022; 288:121675. [DOI: 10.1016/j.biomaterials.2022.121675] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Revised: 07/02/2022] [Accepted: 07/06/2022] [Indexed: 01/01/2023]
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3
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Ceresnakova M, Murray D, McGourty KD, Butler J, Neilan J, Soulimane T, Hudson SP. Citric acid functionalized nitinol stent surface promotes endothelial cell healing. J Biomed Mater Res A 2021; 109:1549-1559. [PMID: 33624931 DOI: 10.1002/jbm.a.37150] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 12/13/2020] [Accepted: 02/10/2021] [Indexed: 11/09/2022]
Abstract
While drug-eluting stents containing anti-proliferative agents inhibit proliferation of smooth muscle cells (SMCs), they also delay the regrowth of the endothelial cells which can result in subsequent development of restenosis. Acidic extracellular environments promote cell anchorage and migration by inducing conformational change in integrins, the main cell adhesion proteins. This study addresses the feasibility of a citric acid (CA) functionalized nitinol stent for improving vascular biocompatibility, specifically enhancing endothelialization. CA functionalized nitinol vascular stents are compared to commercial bare metal (Zilver Flex) and paclitaxel eluting stents (Zilver PTX) in terms of re-endothelialization. To study the effect of stent coatings, a stent conditioned media methodology was developed in an attempt to represent in vivo conditions. Overall, distinct advantages of the CA functionalized nitinol stent over commercial Zilver PTX DES and Zilver Flex BMS stents in terms of endothelial cell adhesion, migration, and proliferation are reported. These novel findings indicate the potential of a CA functionalized stent to serve as a bioactive and therapeutic surface for re-endothelialization, perhaps in combination with a SMC proliferation inhibitor coating, to prevent restenosis.
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Affiliation(s)
- Miriama Ceresnakova
- Department of Chemical Sciences, Bernal Institute, University of Limerick, Limerick, Ireland
| | | | - Kieran D McGourty
- Department of Chemical Sciences, Bernal Institute, University of Limerick, Limerick, Ireland
| | | | | | - Tewfik Soulimane
- Department of Chemical Sciences, Bernal Institute, University of Limerick, Limerick, Ireland
| | - Sarah P Hudson
- Department of Chemical Sciences, Bernal Institute, University of Limerick, Limerick, Ireland
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4
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Jana S. Endothelialization of cardiovascular devices. Acta Biomater 2019; 99:53-71. [PMID: 31454565 DOI: 10.1016/j.actbio.2019.08.042] [Citation(s) in RCA: 74] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Revised: 07/19/2019] [Accepted: 08/22/2019] [Indexed: 01/10/2023]
Abstract
Blood-contacting surfaces of cardiovascular devices are not biocompatible for creating an endothelial layer on them. Numerous research studies have mainly sought to modify these surfaces through physical, chemical and biological means to ease early endothelial cell (EC) adhesion, migration and proliferation, and eventually to build an endothelial layer on the surfaces. The first priority for surface modification is inhibition of protein adsorption that leads to inhibition of platelet adhesion to the device surfaces, which may favor EC adhesion. Surface modification through surface texturing, if applicable, can bring some hopeful outcomes in this regard. Surface modifications through chemical and/or biological means may play a significant role in easy endothelialization of cardiovascular devices and inhibit smooth muscle cell proliferation. Cellular engineering of cells relevant to endothelialization can boost the positive outcomes obtained through surface engineering. This review briefly summarizes recent developments and research in early endothelialization of cardiovascular devices. STATEMENT OF SIGNIFICANCE: Endothelialization of cardiovascular implants, including heart valves, vascular stents and vascular grafts is crucial to solve many problems in our health care system. Numerous research efforts have been made to improve endothelialization on the surfaces of cardiovascular implants, mainly through surface modifications in three ways - physically, chemically and biologically. This review is intended to highlight comprehensive research studies to date on surface modifications aiming for early endothelialization on the blood-contacting surfaces of cardiovascular implants. It also discusses future perspectives to help guide endothelialization strategies and inspire further innovations.
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Affiliation(s)
- Soumen Jana
- Department of Bioengineering, University of Missouri, Columbia, MO 65211, USA.
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5
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Fabrication of aortic bioprosthesis by decellularization, fibrin glue coating and re-endothelization: a cell scaffold approach. Prog Biomater 2019; 8:197-210. [PMID: 31606862 PMCID: PMC6825630 DOI: 10.1007/s40204-019-00122-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Accepted: 09/27/2019] [Indexed: 12/13/2022] Open
Abstract
Aortic dysfunctions (aneurysm, aortitis) lead to the most serious conditions related to aortic wall with life-threatening complications. The most common modality of management for such conditions is replacement (diseased part) of aorta by a larger diameter stent (reconstructive vascular surgery) which in itself is a big trial. The most natural way is to use a re-endothelized scaffold. Developing a scaffold with biomimetic properties is an experimental aim for most of the scientists and surgeons. We aim to structure a strategy to overcome the well-known problems associated with aorta. In this study, we plan to remold a larger diameter blood vessel such as aorta from xenogeneic origin using different protocols to decellularize and comparing them with normal aorta. The chemicals and enzymes used for bovine aorta decellularization are 1% SDS (group II), 70% ethanol + 0.25% trypsin (group III), 70% ethanol (group IV), and 0.25% trypsin (group V). Group I served as control (without decellularization). Histology and SEM study were conducted for cellular presence/absence in all scaffolds. Later, the scaffolds were coated with the fibrin glue (FG) and endothelial cells were proliferated over them. 3D images were taken showing the remolding of the endothelial cells on FG-coated surfaces. The re-endothelization was confirmed by lectin and vWF+/+ expression. Graft elasticity and burst pressure were confirmed by biomechanical tensile testing. Further, the absence of host tissue DNA and presence of cellular DNA after re-endothelialization were confirmed by PicoGreen assay. The acceptability for metabolically active cellular proliferation on scaffolds and its non-toxicity were proved by cell viability assay. Current findings accomplish that larger diameter aorta extracellular matrix scaffold (group II) can be fabricated and re-endothelialized to develop non-thrombotic surfaces with improved graft patency with promising results compared to other fabricated scaffold groups.
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Lopez-Moya M, Melgar-Lesmes P, Kolandaivelu K, de la Torre Hernández JM, Edelman ER, Balcells M. Optimizing Glutaraldehyde-Fixed Tissue Heart Valves with Chondroitin Sulfate Hydrogel for Endothelialization and Shielding against Deterioration. Biomacromolecules 2018. [PMID: 29539266 DOI: 10.1021/acs.biomac.8b00077] [Citation(s) in RCA: 58] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Porcine glutaraldehyde-fixed pericardium is widely used to replace human heart valves. Despite the stabilizing effects of glutaraldehyde fixation, the lack of endothelialization and the occurrence of immune reactions contribute to calcification and structural valve deterioration, which is particularly significant in young patients, in whom valve longevity is crucial. This report shows an optimization system with which to enhance endothelialization of fixed pericardium to mimic the biological function of a native heart valve. The glutaraldehyde detoxification, together with the application of a biodegradable methacrylated chondroitin sulfate hydrogel, reduces aldehydes cytotoxicity, increases the migration and proliferation of endothelial cells and the recruitment of endothelial cell progenitors, and confers thromboresistance in fixed pericardium. The combination of glutaraldehyde detoxification and a coating with chondroitin sulfate hydrogel promotes in situ mechanisms of endothelialization in fixed pericardium. We offer a new solution for improving the long life of bioprosthetic valves and exploring the means of making valves suitable to endothelialization.
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Affiliation(s)
- Mario Lopez-Moya
- Massachusetts Institute of Technology, Institute for Medical Engineering and Science , Cambridge , Massachusetts 02139 , United States.,Bioengineering Department , Institut Químic de Sarrià, Ramon Llull Univ , Barcelona 08017 , Spain
| | - Pedro Melgar-Lesmes
- Massachusetts Institute of Technology, Institute for Medical Engineering and Science , Cambridge , Massachusetts 02139 , United States.,Department of Biomedicine , Fundació Clínic per a la Recerca Biomèdica, University of Barcelona , Barcelona 08036 , Spain
| | - Kumaran Kolandaivelu
- Massachusetts Institute of Technology, Institute for Medical Engineering and Science , Cambridge , Massachusetts 02139 , United States.,Cardiovascular Division , Brigham and Women's Hospital and Harvard Medical School , Boston , Massachusetts 02115 , United States
| | | | - Elazer R Edelman
- Massachusetts Institute of Technology, Institute for Medical Engineering and Science , Cambridge , Massachusetts 02139 , United States.,Cardiovascular Division , Brigham and Women's Hospital and Harvard Medical School , Boston , Massachusetts 02115 , United States
| | - Mercedes Balcells
- Massachusetts Institute of Technology, Institute for Medical Engineering and Science , Cambridge , Massachusetts 02139 , United States.,Bioengineering Department , Institut Químic de Sarrià, Ramon Llull Univ , Barcelona 08017 , Spain
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7
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Meuris B, De Praetere H, Strasly M, Trabucco P, Lai JC, Verbrugghe P, Herijgers P. A novel tissue treatment to reduce mineralization of bovine pericardial heart valves. J Thorac Cardiovasc Surg 2018; 156:197-206. [PMID: 29572021 DOI: 10.1016/j.jtcvs.2018.01.099] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2017] [Revised: 01/15/2018] [Accepted: 01/29/2018] [Indexed: 11/25/2022]
Abstract
OBJECTIVE With the increasing use of bioprostheses worldwide, continuous efforts have been made to improve tissue durability. We introduce a new treatment for bovine pericardium combining octanediol-ethanol based phospholipid removal with taurine-based glutaraldehyde neutralization and storage in an aldehyde-free solution (FREE). METHODS Treated tissues were evaluated by mechanical and biochemical characterization, phospholipid content, aldehyde levels, cell cultures on pericardial samples (L929 fibroblasts and human umbilical vein endothelial cells), rat subcutaneous implantations, and long-term juvenile sheep mitral valve implantations (n = 3). Comparisons were made to glutaraldehyde-fixed bovine pericardium or to samples from commercially available biological valves (ie, Trifecta [St Jude Medical, Saint Paul, Minn] and Perimount Magna Ease [Edwards Lifesciences, Irvine, Calif]). RESULTS FREE-treated pericardium had similar mechanical strength and biochemical properties as commercially available valves. Compared with glutaraldehyde-only samples, FREE-treated samples showed lower phospholipid levels (P < .01), significantly better growth of L929 fibroblasts, and lower calcification levels in rat subcutaneous implants (P < .01). Compared with samples from Linx- (Trifecta) and ThermaFix-treated (Perimount Magna Ease) valves, similar low levels of phospholipids were observed as were similar low calcification levels in subcutaneous implants, but tissue extractions from FREE-treated samples showed the lowest levels of extracted aldehydes (P < .01). Mitral implants of FREE-treated valves in juvenile sheep had excellent hemodynamic behavior without any sign of degeneration or calcification at 5 months. CONCLUSIONS The new FREE treatment combines an adequate phospholipid reduction and aldehyde neutralization with storage in an aldehyde-free solution. This combination enhances the anticalcification properties and may thereby improve long-term durability of the tissue.
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Affiliation(s)
- Bart Meuris
- Department of Cardiovascular Sciences, Cardiac Surgery, KU Leuven, Leuven, Belgium.
| | - Herbert De Praetere
- Department of Cardiovascular Sciences, Cardiac Surgery, KU Leuven, Leuven, Belgium
| | | | | | | | - Peter Verbrugghe
- Department of Cardiovascular Sciences, Cardiac Surgery, KU Leuven, Leuven, Belgium
| | - Paul Herijgers
- Department of Cardiovascular Sciences, Cardiac Surgery, KU Leuven, Leuven, Belgium
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8
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Polak R, Rodas AC, Chicoma DL, Giudici R, Beppu MM, Higa OZ, Pitombo RN. Inhibition of calcification of bovine pericardium after treatment with biopolymers, E-beam irradiation and in vitro endothelization. MATERIALS SCIENCE & ENGINEERING. C, MATERIALS FOR BIOLOGICAL APPLICATIONS 2013; 33:85-90. [DOI: 10.1016/j.msec.2012.08.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/23/2012] [Revised: 06/21/2012] [Accepted: 08/07/2012] [Indexed: 10/28/2022]
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9
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In vivo evaluation of an in-body, tissue-engineered, completely autologous valved conduit (biovalve type VI) as an aortic valve in a goat model. J Artif Organs 2012; 16:176-84. [DOI: 10.1007/s10047-012-0679-8] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2012] [Accepted: 11/25/2012] [Indexed: 10/27/2022]
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10
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Simionescu DT, Chen J, Jaeggli M, Wang B, Liao J. Form Follows Function: Advances in Trilayered Structure Replication for Aortic Heart Valve Tissue Engineering. JOURNAL OF HEALTHCARE ENGINEERING 2012; 3:179-202. [PMID: 23355946 DOI: 10.1260/2040-2295.3.2.179] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Tissue engineering the aortic heart valve is a challenging endeavor because of the particular hemodynamic and biologic conditions present in the native aortic heart valve. The backbone of an ideal valve substitute should be a scaffold that is strong enough to withstand billions of repetitive bending, flexing and stretching cycles, while also being slowly degradable to allow for remodeling. In this review we highlight three overlooked aspects that might influence the long term durability of tissue engineered valves: replication of the native valve trilayered histoarchitecture, duplication of the three-dimensional shape of the valve and cell integration efforts focused on getting the right number and type of cells to the right place within the valve structure and driving them towards homeostatic maintenance of the valve matrix. We propose that the trilayered structure in the native aortic valve that includes a middle spongiosa layer cushioning the motions of the two external fibrous layers should be our template for creation of novel scaffolds with improved mechanical durability. Furthermore, since cells adapt to micro-loads within the valve structure, we believe that interstitial cell remodeling of the valvular matrix will depend on the accurate replication of the structures and loads, resulting in successful regeneration of the valve tissue and extended durability.
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Affiliation(s)
- Dan T Simionescu
- Biocompatibility and Tissue Regeneration Laboratory, Department of Bioengineering, Clemson University, Clemson, SC 29634
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11
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MORSI YOSS, WONG CYNTHIAS. CURRENT DEVELOPMENTS AND FUTURE CHALLENGES FOR THE CREATION OF AORTIC HEART VALVE. J MECH MED BIOL 2011. [DOI: 10.1142/s0219519408002528] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The concept of tissue-engineered heart valves offers an alternative to current heart valve replacements that is capable of addressing shortcomings such as life-long administration of anticoagulants, inadequate durability, and inability to grow. Since tissue engineering is a multifaceted area, studies conducted have focused on different aspects such as hemodynamics, cellular interactions and mechanisms, scaffold designs, and mechanical characteristics in the form of both in vitro and in vivo investigations. This review concentrates on the advancements of scaffold materials and manufacturing processes, and on cell–scaffold interactions. Aside from the commonly used materials, polyglycolic acid and polylactic acid, novel polymers such as hydrogels and trimethylene carbonate-based polymers are being developed to simulate the natural mechanical characteristics of heart valves. Electrospinning has been examined as a new manufacturing technique that has the potential to facilitate tissue formation via increased surface area. The type of cells utilized for seeding onto the scaffolds is another factor to take into consideration; currently, stem cells are of great interest because of their potential to differentiate into various types of cells. Although extensive studies have been conducted, the creation of a fully functional heart valve that is clinically applicable still requires further investigation due to the complexity and intricacies of the heart valve.
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Affiliation(s)
- YOS S. MORSI
- Biomechanics and Tissue Engineering Group, IRIS, Swinburne University of Technology, Hawthorn, VIC, Australia
| | - CYNTHIA S. WONG
- Institute of Biotechnology, Deakin University, Geelong, VIC, Australia
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12
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Rodas AC, Polak R, Hara PH, Lee EI, Pitombo RN, Higa OZ. Cytotoxicity and Endothelial Cell Adhesion of Lyophilized and Irradiated Bovine Pericardium Modified With Silk Fibroin and Chitosan. Artif Organs 2011; 35:502-7. [DOI: 10.1111/j.1525-1594.2011.01255.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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13
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Wang X, Zhao Y, Fu Z, He Y, Xiang D, Zhang L. Prelining autogenic endothelial cells in allogeneic vessels inhibits thrombosis and intimal hyperplasia: an efficacy study in dogs. J Surg Res 2010; 169:148-55. [PMID: 20080261 DOI: 10.1016/j.jss.2009.09.029] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2009] [Revised: 08/31/2009] [Accepted: 09/11/2009] [Indexed: 10/20/2022]
Abstract
BACKGROUND The long-term patency rates in vascular transplants (diameter<3.0-4.0mm) are very low due to thrombus formation and intimal hyperplasia. A possible mechanism is the loss of the endothelial cells (ECs) lining. Previous attempts to reseed ECs had poor results due to seeded cell loss, severe antigenicity, and low compliance. The objectives of this study were to generate an allogeneic vascular substitution with autogenic ECs and low antigenicity. METHODS ECs from mongrels were obtained and multiplied in vitro, then seeded to the allogeneic vein luminal surface, which was preserved by freeze-drying radiation. The cultivated cells' secretory function was confirmed by von Willebrand factor detection. The allogeneic vascular was then transplanted into animals' necks in situ. The physical properties, EC state, and vascular structure of the allogeneic vascular grafts were studied. RESULTS The secretory function of ECs did not vary in vitro. The expression level of MHC-II antigen in freeze-dried radiation-treated vasculature was lower than normal fresh vasculature (P<0.05). ECs covered the vascular inner surface and adhered tightly after implantation. As assessed by scanning electron micrograph, most ECs adhered tightly, and the cell polarity changed in accordance with the direction of the force. Allograft blood vessels with autogenic ECs implanted showed significant decreases in both thrombosis and intimal hyperplasia. CONCLUSION Allograft blood vessels seeded with autogenic ECs improved the patency of small-diameter grafts in a canine model. Our study showed a significant decrease in both thrombosis and intimal hyperplasia.
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Affiliation(s)
- Xuehu Wang
- Department of Vascular Surgery, First Affiliated Hospital of Chongqing Medical University, Chongqing, China
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14
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Orthotopic replacement of the aortic valve with decellularized allograft in a sheep model. Biomaterials 2009; 30:6240-6. [DOI: 10.1016/j.biomaterials.2009.07.068] [Citation(s) in RCA: 94] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2009] [Accepted: 07/27/2009] [Indexed: 11/20/2022]
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15
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Guldner NW, Jasmund I, Zimmermann H, Heinlein M, Girndt B, Großherr M, Klinger M, Sievers HH. The first self-endothelialized titanium-coated glutaraldehyde-fixed heart valve prosthesis within systemic circulation. J Thorac Cardiovasc Surg 2009; 138:248-50. [DOI: 10.1016/j.jtcvs.2008.11.045] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2008] [Revised: 11/05/2008] [Accepted: 11/24/2008] [Indexed: 10/21/2022]
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Guldner NW, Jasmund I, Zimmermann H, Heinlein M, Girndt B, Meier V, Flüß F, Rohde D, Gebert A, Sievers HH. Detoxification and Endothelialization of Glutaraldehyde-Fixed Bovine Pericardium With Titanium Coating. Circulation 2009; 119:1653-60. [DOI: 10.1161/circulationaha.108.823948] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background—
Endothelial cell seeding of glutardialdehyde-fixed biological heart valves is hypothesized to improve biocompatibility and durability; however, the toxicity of glutardialdehyde prevents its use as a biological coating. Therefore, different detoxification strategies are applied, including surface coating with titanium, before in vitro endothelialization of glutaraldehyde-fixed bovine pericardium as the base material for prosthetic heart valves.
Methods and Results—
Bovine pericardium was fixed with 0.25% glutardialdehyde. Detoxification was performed with citric acid, aldehyde dehydrogenase, and plasma deposition with titanium at low temperatures of 30°C to 35°C. Toxic glutaraldehyde ligands were quantified photometrically, and the vitality of seeded cells was tested to validate detoxification methods. Detoxification agents and titanium coating were applied before seeding with human endothelial cells. Endothelial cells were visualized by electron microscopic surface scanning. To evaluate cell adhesion, shear stress was applied by a flow of 5 L/min over 24 hours. Compared with untreated glutaraldehyde-fixed samples, treatment with the different agents reduced free aldehyde groups gradually (citric acid 5% < citric acid 10% < titanium < aldehyde dehydrogenase). A combination of citric acid 10%, aldehyde dehydrogenase, and titanium coating resulted in a reduction of free aldehyde ligands to 17.3±4.6% (
P
≤0.05) and demonstrated a vitality of seeded cells of 94±6.7% (
P
≤0.05). This procedure yielded a completely confluent layer of regular human endothelial cells (n=5). After application of shear stress for 24 hours on these endothelial layers, cell vitality was 81%.
Conclusions—
Titanium coating combined with chemical procedures yielded significant detoxification and complete endothelialization of conventional glutaraldehyde-fixed pericardium. This new technique might improve glutardialdehyde-fixed cardiovascular bioimplants for better biocompatibility and longer durability.
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Affiliation(s)
- Norbert W. Guldner
- From Klinik für Herzchirurgie (N.G., I.J., V.M., F.F., H.-H.S.), Universitätsklinikum Schleswig-Holstein, Lübeck, Germany; Gesellschaft für Elektrometallurgie Medizintechnik GmbH (H.Z., M.H., B.G.), Höfener Straße, Nürnberg, Germany; University of Applied Sciences (D.R.), Lübeck, Germany; and Institut für Anatomie (A.G.), Universität zu Lübeck, Lübeck, Germany
| | - Inka Jasmund
- From Klinik für Herzchirurgie (N.G., I.J., V.M., F.F., H.-H.S.), Universitätsklinikum Schleswig-Holstein, Lübeck, Germany; Gesellschaft für Elektrometallurgie Medizintechnik GmbH (H.Z., M.H., B.G.), Höfener Straße, Nürnberg, Germany; University of Applied Sciences (D.R.), Lübeck, Germany; and Institut für Anatomie (A.G.), Universität zu Lübeck, Lübeck, Germany
| | - Hanngörg Zimmermann
- From Klinik für Herzchirurgie (N.G., I.J., V.M., F.F., H.-H.S.), Universitätsklinikum Schleswig-Holstein, Lübeck, Germany; Gesellschaft für Elektrometallurgie Medizintechnik GmbH (H.Z., M.H., B.G.), Höfener Straße, Nürnberg, Germany; University of Applied Sciences (D.R.), Lübeck, Germany; and Institut für Anatomie (A.G.), Universität zu Lübeck, Lübeck, Germany
| | - Markus Heinlein
- From Klinik für Herzchirurgie (N.G., I.J., V.M., F.F., H.-H.S.), Universitätsklinikum Schleswig-Holstein, Lübeck, Germany; Gesellschaft für Elektrometallurgie Medizintechnik GmbH (H.Z., M.H., B.G.), Höfener Straße, Nürnberg, Germany; University of Applied Sciences (D.R.), Lübeck, Germany; and Institut für Anatomie (A.G.), Universität zu Lübeck, Lübeck, Germany
| | - Britta Girndt
- From Klinik für Herzchirurgie (N.G., I.J., V.M., F.F., H.-H.S.), Universitätsklinikum Schleswig-Holstein, Lübeck, Germany; Gesellschaft für Elektrometallurgie Medizintechnik GmbH (H.Z., M.H., B.G.), Höfener Straße, Nürnberg, Germany; University of Applied Sciences (D.R.), Lübeck, Germany; and Institut für Anatomie (A.G.), Universität zu Lübeck, Lübeck, Germany
| | - Veronika Meier
- From Klinik für Herzchirurgie (N.G., I.J., V.M., F.F., H.-H.S.), Universitätsklinikum Schleswig-Holstein, Lübeck, Germany; Gesellschaft für Elektrometallurgie Medizintechnik GmbH (H.Z., M.H., B.G.), Höfener Straße, Nürnberg, Germany; University of Applied Sciences (D.R.), Lübeck, Germany; and Institut für Anatomie (A.G.), Universität zu Lübeck, Lübeck, Germany
| | - Florian Flüß
- From Klinik für Herzchirurgie (N.G., I.J., V.M., F.F., H.-H.S.), Universitätsklinikum Schleswig-Holstein, Lübeck, Germany; Gesellschaft für Elektrometallurgie Medizintechnik GmbH (H.Z., M.H., B.G.), Höfener Straße, Nürnberg, Germany; University of Applied Sciences (D.R.), Lübeck, Germany; and Institut für Anatomie (A.G.), Universität zu Lübeck, Lübeck, Germany
| | - Daniel Rohde
- From Klinik für Herzchirurgie (N.G., I.J., V.M., F.F., H.-H.S.), Universitätsklinikum Schleswig-Holstein, Lübeck, Germany; Gesellschaft für Elektrometallurgie Medizintechnik GmbH (H.Z., M.H., B.G.), Höfener Straße, Nürnberg, Germany; University of Applied Sciences (D.R.), Lübeck, Germany; and Institut für Anatomie (A.G.), Universität zu Lübeck, Lübeck, Germany
| | - Andreas Gebert
- From Klinik für Herzchirurgie (N.G., I.J., V.M., F.F., H.-H.S.), Universitätsklinikum Schleswig-Holstein, Lübeck, Germany; Gesellschaft für Elektrometallurgie Medizintechnik GmbH (H.Z., M.H., B.G.), Höfener Straße, Nürnberg, Germany; University of Applied Sciences (D.R.), Lübeck, Germany; and Institut für Anatomie (A.G.), Universität zu Lübeck, Lübeck, Germany
| | - Hans-Hinrich Sievers
- From Klinik für Herzchirurgie (N.G., I.J., V.M., F.F., H.-H.S.), Universitätsklinikum Schleswig-Holstein, Lübeck, Germany; Gesellschaft für Elektrometallurgie Medizintechnik GmbH (H.Z., M.H., B.G.), Höfener Straße, Nürnberg, Germany; University of Applied Sciences (D.R.), Lübeck, Germany; and Institut für Anatomie (A.G.), Universität zu Lübeck, Lübeck, Germany
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Schopka S, Schmid FX, Hirt S, Birnbaum DE, Schmid C, Lehle K. Recellularization of biological heart valves with human vascular cells:In vitrohemocompatibility assessment. J Biomed Mater Res B Appl Biomater 2009; 88:130-8. [DOI: 10.1002/jbm.b.31159] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Zarbiv G, Preis M, Ben-Yosef Y, Flugelman MY. Engineering blood vessels by gene and cell therapy. Expert Opin Biol Ther 2007; 7:1183-91. [PMID: 17696817 DOI: 10.1517/14712598.7.8.1183] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Cardiovascular-related syndromes are the leading cause of morbidity and mortality worldwide. Arterial narrowing and blockage due to atherosclerosis cause reduced blood flow to the brain, heart and legs. Bypass surgery to improve blood flow to the heart and legs in these patients is performed in hundreds of thousands of patients every year. Autologous grafts, such as the internal thoracic artery and saphenous vein, are used in most patients, but in a significant number of patients such grafts are not available and synthetic grafts are used. Synthetic grafts have higher failure rates than autologous grafts due to thrombosis and scar formation within graft lumen. Cell and gene therapy combined with tissue engineering hold a great promise to provide grafts that will be biocompatible and durable. This review describes the field of vascular grafts in the context of tissue engineering using cell and gene therapies.
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Affiliation(s)
- Gabriel Zarbiv
- MultiGene Vascular Systems Ltd, Lady Davis Carmel Medical Center, Haifa, Israel
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