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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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2
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Liu B, Liu Z, Wei H, Meng Y, Hou Q, Wang A, Zhang Y, Han E, Hu S, Zhou J. Performance characterization and biocompatibility assessment of silicone polyurethanes for polymer heart valve applications. RSC Adv 2024; 14:10858-10873. [PMID: 38577430 PMCID: PMC10989511 DOI: 10.1039/d4ra00183d] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Accepted: 03/27/2024] [Indexed: 04/06/2024] Open
Abstract
Silicone polyurethanes have gained widespread application in the biomedical field due to their excellent biocompatibility. This study comprehensively investigates four silicone polyurethane materials suitable for polymer heart valves, each exhibiting distinct chemical compositions and structural characteristics, leading to significant differences, particularly in mechanical performance and biocompatibility. Surface analysis reveals an elevated surface silicon element content in all materials compared to the bulk, indicating a migration of silicon elements towards the surface, providing a structural basis for enhancing biological stability and biocompatibility. However, higher silicon content leads to a decrease in mechanical performance, potentially resulting in mechanical failure and rupture in artificial heart valves. Concerning biocompatibility, an increase in silicone content diminishes the material's adsorption capability for cells and proteins, consequently improving its biocompatibility and biological stability. In summary, while high silicone content leads to a reduction in mechanical performance, the formation of a "silicon protective layer" on the material surface mitigates cell and protein adsorption, thereby enhancing biocompatibility and biological stability. Through comprehensive testing of the four silicone polyurethane materials, this study aims to provide insightful perspectives and methods for selecting materials suitable for polymer heart valves. Additionally, the thorough performance exploration of these materials serves as a crucial reference for the performance assessment and biocompatibility research of polymeric artificial heart valve materials.
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Affiliation(s)
- Bixuan Liu
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College Beijing 100037 China
| | - Zhihua Liu
- School of Materials Science and Engineering, Beijing Institute of Technology Beijing 100081 China
| | - Haiyang Wei
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College Beijing 100037 China
| | - Yana Meng
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College Beijing 100037 China
| | - Qianwen Hou
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College Beijing 100037 China
| | - Aili Wang
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College Beijing 100037 China
| | - Yongkai Zhang
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College Beijing 100037 China
| | - Enhui Han
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College Beijing 100037 China
| | - Shengshou Hu
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College Beijing 100037 China
| | - Jianye Zhou
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College Beijing 100037 China
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Pedersen DD, Kim S, D'Amore A, Wagner WR. Influence of Polymer Stiffness and Geometric Design on Fluid Mechanics in Tissue-Engineered Pulmonary Valve Scaffolds. Ann Biomed Eng 2024; 52:575-587. [PMID: 37935910 DOI: 10.1007/s10439-023-03401-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: 08/11/2023] [Accepted: 10/29/2023] [Indexed: 11/09/2023]
Abstract
There is still much unknown about the fluid mechanical response to cardiac valve scaffolds, even as their implementation in the clinic is on the horizon. Specifically, while degradable polymer valve scaffolds are currently being tested in the pulmonary valve position, their material and mechanical properties have not been fully elucidated. Optimizing these properties are important determinants not only of acute function, but long-term remodeling prospects. This study aimed to characterize fluid profiles downstream of electrospun valve scaffolds under dynamic pulmonary conditions. Valve scaffold design was changed by either blending poly(carbonate urethane) urea (PCUU) with poly(ε-caprolactone) (PCL) to modulate material stiffness or by changing the geometric design of the valve scaffolds. Specifically, two designs were utilized: one modeled after a clinically used bioprosthetic valve design (termed Mk1 design), and another using a geometrically "optimized" design (termed Mk2) based on anatomical data. Particle image velocimetry results showed that material stiffness only had a mild impact on fluid mechanics, measured by velocity magnitude, vorticity, viscous shear stress, Reynolds shear stress, and turbulent kinetic energy. However, comparing the two geometric designs yielded a much greater impact, with the Mk2 valve groups containing the highest PCUU/PCL ratio demonstrating the overall best performance. This report highlights the easily manipulable design features of polymeric valve scaffolds and demonstrates their relative significance for valve function.
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Affiliation(s)
- Drake D Pedersen
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, USA
- McGowan Institute for Regenerative Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Seungil Kim
- McGowan Institute for Regenerative Medicine, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Surgery, University of Pittsburgh, Pittsburgh, PA, USA
| | - Antonio D'Amore
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, USA
- McGowan Institute for Regenerative Medicine, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Surgery, University of Pittsburgh, Pittsburgh, PA, USA
- Fondazione Ri.MED, Palermo, Italy
- Clinical and Translational Science Institute, University of Pittsburgh, Pittsburgh, PA, USA
| | - William R Wagner
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, USA.
- McGowan Institute for Regenerative Medicine, University of Pittsburgh, Pittsburgh, PA, USA.
- Department of Surgery, University of Pittsburgh, Pittsburgh, PA, USA.
- Department of Chemical Engineering, University of Pittsburgh, Pittsburgh, PA, USA.
- Clinical and Translational Science Institute, University of Pittsburgh, Pittsburgh, PA, USA.
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4
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Machaidze Z, D’Amore A, Freitas RC, Joyce AJ, Bayoumi A, Rich K, Brown DW, Aikawa E, Wagner WR, Sacks MS, Mayer JE. Tissue formation and host remodeling of an elastomeric biodegradable scaffold in an ovine pulmonary leaflet replacement model. J Biomed Mater Res A 2024; 112:276-287. [PMID: 37772456 PMCID: PMC11034854 DOI: 10.1002/jbm.a.37622] [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: 06/29/2023] [Revised: 09/01/2023] [Accepted: 09/12/2023] [Indexed: 09/30/2023]
Abstract
In pursuit of a suitable scaffold material for cardiac valve tissue engineering applications, an acellular, electrospun, biodegradable polyester carbonate urethane urea (PECUU) scaffold was evaluated as a pulmonary valve leaflet replacement in vivo. In sheep (n = 8), a single pulmonary valve leaflet was replaced with a PECUU leaflet and followed for 1, 6, and 12 weeks. Implanted leaflet function was assessed in vivo by echocardiography. Explanted samples were studied for gross pathology, microscopic changes in the extracellular matrix, host cellular re-population, and immune responses, and for biomechanical properties. PECUU leaflets showed normal leaflet motion at implant, but decreased leaflet motion and dimensions at 6 weeks. The leaflets accumulated α-SMA and CD45 positive cells, with surfaces covered with endothelial cells (CD31+). New collagen formation occurred (Picrosirius Red). Accumulated tissue thickness correlated with the decrease in leaflet motion. The PECUU scaffolds had histologic evidence of scaffold degradation and an accumulation of pro-inflammatory/M1 and anti-inflammatory/M2 macrophages over time in vivo. The extent of inflammatory cell accumulation correlated with tissue formation and polymer degradation but was also associated with leaflet thickening and decreased leaflet motion. Future studies should explore pre-implant seeding of polymer scaffolds, more advanced polymer fabrication methods able to more closely approximate native tissue structure and function, and other techniques to control and balance the degradation of biomaterials and new tissue formation by modulation of the host immune response.
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Affiliation(s)
- Zurab Machaidze
- Department of Cardiac Surgery, Boston Children’s Hospital, Harvard Medical School. 300 Longwood Ave. Boston, MA. 02115. USA
| | - Antonio D’Amore
- McGowan Institute for Regenerative Medicine. Departments of Surgery and Bioengineering. University of Pittsburgh, 450 Technology Drive. Suite 300. Pittsburgh, PA 15219
- Fondazione RiMED, Via Bandiera 11, 90133 Palermo, Italy
| | - Renata C.C. Freitas
- Department of Cardiac Surgery, Boston Children’s Hospital, Harvard Medical School. 300 Longwood Ave. Boston, MA. 02115. USA
| | - Angelina J. Joyce
- Department of Cardiac Surgery, Boston Children’s Hospital, Harvard Medical School. 300 Longwood Ave. Boston, MA. 02115. USA
| | - Ahmed Bayoumi
- Department of Cardiac Surgery, Boston Children’s Hospital, Harvard Medical School. 300 Longwood Ave. Boston, MA. 02115. USA
| | - Kimberly Rich
- Department of Cardiac Surgery, Boston Children’s Hospital, Harvard Medical School. 300 Longwood Ave. Boston, MA. 02115. USA
| | - David W. Brown
- Department of Cardiology, Boston Children’s Hospital, Harvard Medical School. 300 Longwood Ave. Boston, MA. 02115. USA
| | - Elena Aikawa
- Center for Excellence in Vascular Biology, Brigham and Women’s Hospital, Harvard Medical School. 77 Ave Louis Pasteur, NRB-7, Boston, MA 02115
| | - William R. Wagner
- McGowan Institute for Regenerative Medicine. Departments of Surgery and Bioengineering. University of Pittsburgh, 450 Technology Drive. Suite 300. Pittsburgh, PA 15219
| | - Michael S. Sacks
- Willerson Center for Cardiovascular Modeling and Simulation. Institute for Computational Engineering and Sciences. Department of Biomedical Engineering. The University of Texas at Austin 201 East 24th Street, Stop C0200. Austin, TX 78712-1229
| | - John E. Mayer
- Department of Cardiac Surgery, Boston Children’s Hospital, Harvard Medical School. 300 Longwood Ave. Boston, MA. 02115. USA
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5
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Pedersen DD, Kim S, D'Amore A, Wagner WR. Cardiac valve scaffold design: Implications of material properties and geometric configuration on performance and mechanics. J Mech Behav Biomed Mater 2023; 146:106043. [PMID: 37531773 DOI: 10.1016/j.jmbbm.2023.106043] [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: 04/27/2023] [Revised: 06/07/2023] [Accepted: 07/22/2023] [Indexed: 08/04/2023]
Abstract
Development of tissue engineered scaffolds for cardiac valve replacement is nearing clinical translation. While much work has been done to characterize mechanical behavior of native and bioprosthetic valves, and incorporate those data into models improving valve design, similar work for degradable valve scaffolds is lacking. This is particularly important given the implications mechanics have on short-term survival and long-term remodeling. As such, this study aimed to characterize spatially-resolved strain profiles on the leaflets of degradable polymeric valve scaffolds, manipulating common design features such as material stiffness by blending poly(carbonate urethane)urea with stiffer polymers, and geometric configuration, modeled after either a clinically-used valve design (Mk1 design) or an anatomically "optimized" design (Mk2 design). It was shown that material stiffness plays a significant role in overall valve performance, with the stiffest valve groups showing asymmetric and incomplete opening during systole. However, the geometric configuration had a significantly greater effect on valve performance as well as strain magnitude and distribution. Major findings in the strain maps included systolic strains having overall higher strain magnitudes than diastole, and peak radial-direction strain concentrations in the base region of Mk1 valves during systole, with a significant mitigation of radial strain in Mk2 valves. The high tunability of tissue engineered scaffolds is a great advantage for valve design, and the results reported here indicate that design parameters have significant and unequal impact on valve performance and mechanics.
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Affiliation(s)
- Drake D Pedersen
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, USA; McGowan Institute for Regenerative Medicine, University of Pittsburgh, PA, USA
| | - Seungil Kim
- McGowan Institute for Regenerative Medicine, University of Pittsburgh, PA, USA; Department of Surgery, University of Pittsburgh, PA, USA
| | - Antonio D'Amore
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, USA; McGowan Institute for Regenerative Medicine, University of Pittsburgh, PA, USA; Department of Surgery, University of Pittsburgh, PA, USA; Fondazione Ri.MED, Palermo, Italy; Clinical and Translational Science Institute, University of Pittsburgh, PA, USA
| | - William R Wagner
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, USA; McGowan Institute for Regenerative Medicine, University of Pittsburgh, PA, USA; Department of Surgery, University of Pittsburgh, PA, USA; Department of Chemical Engineering, University of Pittsburgh, PA, USA; Clinical and Translational Science Institute, University of Pittsburgh, PA, USA.
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6
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Snyder Y, Jana S. Strategies for Development of Synthetic Heart Valve Tissue Engineering Scaffolds. PROGRESS IN MATERIALS SCIENCE 2023; 139:101173. [PMID: 37981978 PMCID: PMC10655624 DOI: 10.1016/j.pmatsci.2023.101173] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2023]
Abstract
The current clinical solutions, including mechanical and bioprosthetic valves for valvular heart diseases, are plagued by coagulation, calcification, nondurability, and the inability to grow with patients. The tissue engineering approach attempts to resolve these shortcomings by producing heart valve scaffolds that may deliver patients a life-long solution. Heart valve scaffolds serve as a three-dimensional support structure made of biocompatible materials that provide adequate porosity for cell infiltration, and nutrient and waste transport, sponsor cell adhesion, proliferation, and differentiation, and allow for extracellular matrix production that together contributes to the generation of functional neotissue. The foundation of successful heart valve tissue engineering is replicating native heart valve architecture, mechanics, and cellular attributes through appropriate biomaterials and scaffold designs. This article reviews biomaterials, the fabrication of heart valve scaffolds, and their in-vitro and in-vivo evaluations applied for heart valve tissue engineering.
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Affiliation(s)
- Yuriy Snyder
- Department of Bioengineering, University of Missouri, Columbia, MO 65211, USA
| | - Soumen Jana
- Department of Bioengineering, University of Missouri, Columbia, MO 65211, USA
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7
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Ibrahim DM, Fomina A, Bouten CVC, Smits AIPM. Functional regeneration at the blood-biomaterial interface. Adv Drug Deliv Rev 2023; 201:115085. [PMID: 37690484 DOI: 10.1016/j.addr.2023.115085] [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: 10/31/2022] [Revised: 06/01/2023] [Accepted: 09/07/2023] [Indexed: 09/12/2023]
Abstract
The use of cardiovascular implants is commonplace in clinical practice. However, reproducing the key bioactive and adaptive properties of native cardiovascular tissues with an artificial replacement is highly challenging. Exciting new treatment strategies are under development to regenerate (parts of) cardiovascular tissues directly in situ using immunomodulatory biomaterials. Direct exposure to the bloodstream and hemodynamic loads is a particular challenge, given the risk of thrombosis and adverse remodeling that it brings. However, the blood is also a source of (immune) cells and proteins that dominantly contribute to functional tissue regeneration. This review explores the potential of the blood as a source for the complete or partial in situ regeneration of cardiovascular tissues, with a particular focus on the endothelium, being the natural blood-tissue barrier. We pinpoint the current scientific challenges to enable rational engineering and testing of blood-contacting implants to leverage the regenerative potential of the blood.
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Affiliation(s)
- Dina M Ibrahim
- Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands; Institute for Complex Molecular Systems, Eindhoven University of Technology, Eindhoven, the Netherlands.
| | - Aleksandra Fomina
- Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands; Graduate School of Life Sciences, Utrecht University, 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.
| | - 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.
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8
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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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9
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Chen X, Dong N, Xu X, Zhou Y, Shi J, Qiao W, Hong H. Re-endothelialization of Decellularized Scaffolds With Endothelial Progenitor Cell Capturing Aptamer: A New Strategy for Tissue-Engineered Heart Valve. ASAIO J 2023; 69:885-893. [PMID: 37506117 DOI: 10.1097/mat.0000000000001979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/30/2023] Open
Abstract
Tissue-engineered heart valve (TEHV) is a promising alternative to current heart valve substitute. Decellularized porcine aortic heart valves (DAVs) are the most common scaffolds of TEHV. Hard to endothelialization is one of the disadvantages of DAVs. Therefore, we aimed to immobilize endothelial progenitor cell (EPC)-aptamer onto DAVs for accelerating endothelialization. In this study, three groups of scaffolds were constructed: DAVs, aptamer-immobilized DAVs (aptamer-DAVs), and glutaraldehyde crosslinked DAVs (GA-DAVs). The results of flow cytometry revealed that EPC-aptamer was specific to EPCs and was immobilized onto DAVs. Cells adhesion experiments demonstrated that EPCs adhered more tightly onto aptamer-DAVs group than other two groups of scaffolds. And cell proliferation assay indicated that EPCs seeded onto aptamer-DAVs group grew faster than DAVs group and GA-DAVs group. Moreover, dynamic capture experiment in flow conditions revealed that the number of EPCs captured by aptamer-DAVs group was more than other two groups. In conclusion, aptamer-DAVs could specifically promote adhesion and proliferation of EPCs and had ability to capture EPCs in simulated flow condition. This could promote re-endothelialization of scaffolds.
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Affiliation(s)
- Xue Chen
- From the Department of Cardiovascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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10
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Georgy M, Salhiyyah K, Yacoub MH, Chester AH. Role of hypoxia inducible factor HIF-1 α in heart valves. Glob Cardiol Sci Pract 2023; 2023:e202309. [PMID: 37351095 PMCID: PMC10282783 DOI: 10.21542/gcsp.2023.9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Accepted: 04/10/2023] [Indexed: 06/24/2023] Open
Abstract
The 2016 Albert Lasker Basic Medical Research Award and subsequently the 2019 Nobel Prize in Physiology or Medicine were awarded to William Kaelin, Jr., Sir Peter Ratcliffe, and Gregg Semenza for their work on how cells sense and adapt to hypoxic conditions. Their work showed that the changes in gene expression, cell metabolism, and tissue remodelling that occur in response to low oxygen concentrations are orchestrated by the transcription factor, hypoxia inducible factor-1α (HIF-1α). While the effects mediated by HIF-1α have been widely studied, its role in heart valves has only recently been investigated. These studies have shown that HIF-1α expression is evident in mechanisms that regulate the structure and function of heart valves. These include embryonic development, the regulation of the extracellular matrix, angiogenesis and the initiation of the calcification process. This review provides a background on the role and function of HIF-1α in response to hypoxia and a discussion of the available evidence of its involvement in the regulation of heart valves in health and disease.
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Affiliation(s)
- Mark Georgy
- Magdi Yacoub Institute, Heart Science Centre, Harefield, Middlesex, U.K.
| | - Kareem Salhiyyah
- Magdi Yacoub Institute, Heart Science Centre, Harefield, Middlesex, U.K.
- Farah General Hospital, Farah Medical Campus, Mai Ziyadeh Street, Amman, Jordan
| | - Magdi H. Yacoub
- Magdi Yacoub Institute, Heart Science Centre, Harefield, Middlesex, U.K.
| | - Adrian H. Chester
- Magdi Yacoub Institute, Heart Science Centre, Harefield, Middlesex, U.K.
- National Heart & Lung Institute, Imperial College London, ICTEM Building, Du Cane Road, London
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11
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Rezvova MA, Klyshnikov KY, Gritskevich AA, Ovcharenko EA. Polymeric Heart Valves Will Displace Mechanical and Tissue Heart Valves: A New Era for the Medical Devices. Int J Mol Sci 2023; 24:ijms24043963. [PMID: 36835389 PMCID: PMC9967268 DOI: 10.3390/ijms24043963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Revised: 02/12/2023] [Accepted: 02/14/2023] [Indexed: 02/18/2023] Open
Abstract
The development of a novel artificial heart valve with outstanding durability and safety has remained a challenge since the first mechanical heart valve entered the market 65 years ago. Recent progress in high-molecular compounds opened new horizons in overcoming major drawbacks of mechanical and tissue heart valves (dysfunction and failure, tissue degradation, calcification, high immunogenic potential, and high risk of thrombosis), providing new insights into the development of an ideal artificial heart valve. Polymeric heart valves can best mimic the tissue-level mechanical behavior of the native valves. This review summarizes the evolution of polymeric heart valves and the state-of-the-art approaches to their development, fabrication, and manufacturing. The review discusses the biocompatibility and durability testing of previously investigated polymeric materials and presents the most recent developments, including the first human clinical trials of LifePolymer. New promising functional polymers, nanocomposite biomaterials, and valve designs are discussed in terms of their potential application in the development of an ideal polymeric heart valve. The superiority and inferiority of nanocomposite and hybrid materials to non-modified polymers are reported. The review proposes several concepts potentially suitable to address the above-mentioned challenges arising in the R&D of polymeric heart valves from the properties, structure, and surface of polymeric materials. Additive manufacturing, nanotechnology, anisotropy control, machine learning, and advanced modeling tools have given the green light to set new directions for polymeric heart valves.
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Affiliation(s)
- Maria A. Rezvova
- Research Institute for Complex Issues of Cardiovascular Diseases, 650002 Kemerovo, Russia
| | - Kirill Y. Klyshnikov
- Research Institute for Complex Issues of Cardiovascular Diseases, 650002 Kemerovo, Russia
| | | | - Evgeny A. Ovcharenko
- Research Institute for Complex Issues of Cardiovascular Diseases, 650002 Kemerovo, Russia
- Correspondence:
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12
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Vernon MJ, Lu J, Padman B, Lamb C, Kent R, Mela P, Doyle B, Ihdayhid AR, Jansen S, Dilley RJ, De-Juan-Pardo EM. Engineering Heart Valve Interfaces Using Melt Electrowriting: Biomimetic Design Strategies from Multi-Modal Imaging. Adv Healthc Mater 2022; 11:e2201028. [PMID: 36300603 DOI: 10.1002/adhm.202201028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Revised: 09/12/2022] [Indexed: 01/28/2023]
Abstract
Interfaces within biological tissues not only connect different regions but also contribute to the overall functionality of the tissue. This is especially true in the case of the aortic heart valve. Here, melt electrowriting (MEW) is used to engineer complex, user-defined, interfaces for heart valve scaffolds. First, a multi-modal imaging investigation into the interfacial regions of the valve reveals differences in collagen orientation, density, and recruitment in previously unexplored regions including the commissure and inter-leaflet triangle. Overlapping, suturing, and continuous printing methods for interfacing MEW scaffolds are then investigated for their morphological, tensile, and flexural properties, demonstrating the superior performance of continuous interfaces. G-codes for MEW scaffolds with complex interfaces are designed and generated using a novel software and graphical user interface. Finally, a singular MEW scaffold for the interfacial region of the aortic heart valve is presented incorporating continuous interfaces, gradient porosities, variable layer numbers across regions, and tailored fiber orientations inspired by the collagen distribution and orientation from the multi-modal imaging study. The scaffold exhibits similar yield strain, hysteresis, and relaxation behavior to porcine heart valves. This work demonstrates the ability of a bioinspired approach for MEW scaffold design to address the functional complexity of biological tissues.
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Affiliation(s)
- Michael J Vernon
- T3mPLATE, Harry Perkins Institute of Medical Research, QEII Medical Centre, and UWA Centre for Medical Research, The University of Western Australia, Perth, WA, 6009, Australia.,Vascular Engineering Laboratory, Harry Perkins Institute of Medical Research, QEII Medical Centre, and UWA 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
| | - Jason Lu
- T3mPLATE, Harry Perkins Institute of Medical Research, QEII Medical Centre, and UWA 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
| | - Benjamin Padman
- Centre for Microscopy, Characterisation and Analysis, The University of Western Australia, Perth, WA, 6009, Australia
| | - Christopher Lamb
- T3mPLATE, Harry Perkins Institute of Medical Research, QEII Medical Centre, and UWA 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
| | - Ross Kent
- Regenerative Medicine Program, CIMA, Universidad de Navarra, Pamplona, Navarra, 31008, Spain
| | - 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, Boltzmannstr. 15, 85748, Garching, Germany
| | - Barry Doyle
- Vascular Engineering Laboratory, Harry Perkins Institute of Medical Research, QEII Medical Centre, and UWA 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.,Australian Research Council Centre for Personalised Therapeutics Technologies, Australian Research Council, Parkville, ACT, 2609, Australia.,British Heart Foundation Centre of Cardiovascular Science, The University of Edinburgh, Edinburgh, EH1-3AT, UK
| | - Abdul Rahman Ihdayhid
- Department of Cardiology, Fiona Stanley Hospital, Perth, WA, 6150, Australia.,Curtin Medical School, Curtin University, Perth, WA, 6102, Australia
| | - Shirley Jansen
- Vascular Engineering Laboratory, Harry Perkins Institute of Medical Research, QEII Medical Centre, and UWA Centre for Medical Research, The University of Western Australia, Perth, WA, 6009, Australia.,Curtin Medical School, Curtin University, Perth, WA, 6102, 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
| | - Rodney J Dilley
- T3mPLATE, Harry Perkins Institute of Medical Research, QEII Medical Centre, and UWA 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
| | - Elena M De-Juan-Pardo
- T3mPLATE, Harry Perkins Institute of Medical Research, QEII Medical Centre, and UWA 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
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13
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Poulis N, Martin M, Hoerstrup SP, Emmert MY, Fioretta ES. Macrophage-extracellular matrix interactions: Perspectives for tissue engineered heart valve remodeling. Front Cardiovasc Med 2022; 9:952178. [PMID: 36176991 PMCID: PMC9513146 DOI: 10.3389/fcvm.2022.952178] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Accepted: 08/15/2022] [Indexed: 11/16/2022] Open
Abstract
In situ heart valve tissue engineering approaches have been proposed as promising strategies to overcome the limitations of current heart valve replacements. Tissue engineered heart valves (TEHVs) generated from in vitro grown tissue engineered matrices (TEMs) aim at mimicking the microenvironmental cues from the extracellular matrix (ECM) to favor integration and remodeling of the implant. A key role of the ECM is to provide mechanical support to and attract host cells into the construct. Additionally, each ECM component plays a critical role in regulating cell adhesion, growth, migration, and differentiation potential. Importantly, the immune response to the implanted TEHV is also modulated biophysically via macrophage-ECM protein interactions. Therefore, the aim of this review is to summarize what is currently known about the interactions and signaling networks occurring between ECM proteins and macrophages, and how these interactions may impact the long-term in situ remodeling outcomes of TEMs. First, we provide an overview of in situ tissue engineering approaches and their clinical relevance, followed by a discussion on the fundamentals of the remodeling cascades. We then focus on the role of circulation-derived and resident tissue macrophages, with particular emphasis on the ramifications that ECM proteins and peptides may have in regulating the host immune response. Finally, the relevance of these findings for heart valve tissue engineering applications is discussed.
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Affiliation(s)
- Nikolaos Poulis
- Institute for Regenerative Medicine, University of Zurich, Schlieren, Switzerland
| | - Marcy Martin
- Institute for Regenerative Medicine, University of Zurich, Schlieren, Switzerland
| | - Simon P. Hoerstrup
- Institute for Regenerative Medicine, University of Zurich, Schlieren, Switzerland
- Wyss Zurich, University and Swiss Federal Institute of Technology (ETH) Zurich, Zurich, Switzerland
| | - Maximilian Y. Emmert
- Institute for Regenerative Medicine, University of Zurich, Schlieren, Switzerland
- Wyss Zurich, University and Swiss Federal Institute of Technology (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
- *Correspondence: Maximilian Y. Emmert, ,
| | - Emanuela S. Fioretta
- Institute for Regenerative Medicine, University of Zurich, Schlieren, Switzerland
- Emanuela S. Fioretta,
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14
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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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15
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Pedersen DD, Kim S, Wagner WR. Biodegradable polyurethane scaffolds in regenerative medicine: Clinical translation review. J Biomed Mater Res A 2022; 110:1460-1487. [PMID: 35481723 DOI: 10.1002/jbm.a.37394] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Revised: 04/07/2022] [Accepted: 04/09/2022] [Indexed: 12/14/2022]
Abstract
Early explorations of tissue engineering and regenerative medicine concepts commonly utilized simple polyesters such as polyglycolide, polylactide, and their copolymers as scaffolds. These biomaterials were deemed clinically acceptable, readily accessible, and provided processability and a generally known biological response. With experience and refinement of approaches, greater control of material properties and integrated bioactivity has received emphasis and a broadened palette of synthetic biomaterials has been employed. Biodegradable polyurethanes (PUs) have emerged as an attractive option for synthetic scaffolds in a variety of tissue applications because of their flexibility in molecular design and ability to fulfill mechanical property objectives, particularly in soft tissue applications. Biodegradable PUs are highly customizable based on their composition and processability to impart tailored mechanical and degradation behavior. Additionally, bioactive agents can be readily incorporated into these scaffolds to drive a desired biological response. Enthusiasm for biodegradable PU scaffolds has soared in recent years, leading to rapid growth in the literature documenting novel PU chemistries, scaffold designs, mechanical properties, and aspects of biocompatibility. Despite the enthusiasm in the field, there are still few examples of biodegradable PU scaffolds that have achieved regulatory approval and routine clinical use. However, there is a growing literature where biodegradable PU scaffolds are being specifically developed for a wide range of pathologies and where relevant pre-clinical models are being employed. The purpose of this review is first to highlight examples of clinically used biodegradable PU scaffolds, and then to summarize the growing body of reports on pre-clinical applications of biodegradable PU scaffolds.
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Affiliation(s)
- Drake D Pedersen
- McGowan Institute for Regenerative Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.,Department of Bioengineering, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Seungil Kim
- McGowan Institute for Regenerative Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.,Department of Bioengineering, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - William R Wagner
- McGowan Institute for Regenerative Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.,Department of Bioengineering, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.,Department of Chemical Engineering, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.,Department of Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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16
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Rizzi S, Ragazzini S, Pesce M. Engineering Efforts to Refine Compatibility and Duration of Aortic Valve Replacements: An Overview of Previous Expectations and New Promises. Front Cardiovasc Med 2022; 9:863136. [PMID: 35509271 PMCID: PMC9058060 DOI: 10.3389/fcvm.2022.863136] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Accepted: 03/28/2022] [Indexed: 01/18/2023] Open
Abstract
The absence of pharmacological treatments to reduce or retard the progression of cardiac valve diseases makes replacement with artificial prostheses (mechanical or bio-prosthetic) essential. Given the increasing incidence of cardiac valve pathologies, there is always a more stringent need for valve replacements that offer enhanced performance and durability. Unfortunately, surgical valve replacement with mechanical or biological substitutes still leads to disadvantages over time. In fact, mechanical valves require a lifetime anticoagulation therapy that leads to a rise in thromboembolic complications, while biological valves are still manufactured with non-living tissue, consisting of aldehyde-treated xenograft material (e.g., bovine pericardium) whose integration into the host fails in the mid- to long-term due to unresolved issues regarding immune-compatibility. While various solutions to these shortcomings are currently under scrutiny, the possibility to implant fully biologically compatible valve replacements remains elusive, at least for large-scale deployment. In this regard, the failure in translation of most of the designed tissue engineered heart valves (TEHVs) to a viable clinical solution has played a major role. In this review, we present a comprehensive overview of the TEHVs developed until now, and critically analyze their strengths and limitations emerging from basic research and clinical trials. Starting from these aspects, we will also discuss strategies currently under investigation to produce valve replacements endowed with a true ability to self-repair, remodel and regenerate. We will discuss these new developments not only considering the scientific/technical framework inherent to the design of novel valve prostheses, but also economical and regulatory aspects, which may be crucial for the success of these novel designs.
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Affiliation(s)
- Stefano Rizzi
- Tissue Engineering Unit, Centro Cardiologico Monzino, Istituto di ricovero e cura a carattere scientifico (IRCCS), Milan, Italy
- Department of Chemistry, Materials and Chemical Engineering “Giulio Natta”, Politecnico di Milano, Milan, Italy
- Stefano Rizzi
| | - Sara Ragazzini
- Tissue Engineering Unit, Centro Cardiologico Monzino, Istituto di ricovero e cura a carattere scientifico (IRCCS), Milan, Italy
| | - Maurizio Pesce
- Tissue Engineering Unit, Centro Cardiologico Monzino, Istituto di ricovero e cura a carattere scientifico (IRCCS), Milan, Italy
- *Correspondence: Maurizio Pesce
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17
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Adamo A, Bartolacci JG, Pedersen DD, Traina MG, Kim S, Pantano A, Ghersi G, Watkins SC, Wagner WR, Badylak SF, D'Amore A. Continuous Microfiber Wire Mandrel-Less Biofabrication for Soft Tissue Engineering Applications. Adv Healthc Mater 2022; 11:e2102613. [PMID: 35394654 DOI: 10.1002/adhm.202102613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 03/27/2022] [Indexed: 11/10/2022]
Abstract
Suture materials are the most common bioimplants in surgical and clinical practice, playing a crucial role in wound healing and tendon and ligament repair. Despite the assortment available on the market, sutures are still affected by significant disadvantages, including failure in mimicking the mechanical properties of the tissue, excessive fibrosis, and inflammation. This study introduces a mandrel-less electrodeposition apparatus to fabricate continuous microfiber wires of indefinite length. The mandrel-less biofabrication produces wires, potentially used as medical fibers, with different microfiber bundles, that imitate the hierarchical organization of native tissues, and tailored mechanical properties. Microfiber wire morphology and mechanical properties are characterized by scanning electron microscopy, digital image processing, and uniaxial tensile test. Wires are tested in vitro on monocyte/macrophage stimulation and in vivo on a rat surgical wound model. The wires produced by mandrel-less deposition show an increased M2 macrophage phenotype in vitro. The in vivo assessment demonstrates that microfiber wires, compared to the medical fibers currently used, reduce pro-inflammatory macrophage response and preserve their mechanical properties after 30 days of use. These results make this microfiber wire an ideal candidate as a suture material for soft tissue surgery, suggesting a crucial role of microarchitecture in more favorable host response.
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Affiliation(s)
- Arianna Adamo
- McGowan Institute for Regenerative Medicine Pittsburgh PA 15219 USA
- Ri. MED Foundation Palermo 90133 Italy
| | | | - Drake D. Pedersen
- McGowan Institute for Regenerative Medicine Pittsburgh PA 15219 USA
- Department of Bioengineering University of Pittsburgh Pittsburgh PA 15260 USA
| | - Marco G. Traina
- McGowan Institute for Regenerative Medicine Pittsburgh PA 15219 USA
- Department of Engineering University of Palermo Palermo 90133 Italy
| | - Seungil Kim
- McGowan Institute for Regenerative Medicine Pittsburgh PA 15219 USA
| | - Antonio Pantano
- Department of Engineering University of Palermo Palermo 90133 Italy
| | - Giulio Ghersi
- Department of Biological Chemical and Pharmaceutical Sciences and Technologies Palermo 90123 Italy
| | - Simon C. Watkins
- Department of Cell Biology University of Pittsburgh School of Medicine Pittsburgh PA 15213 USA
| | - William R. Wagner
- McGowan Institute for Regenerative Medicine Pittsburgh PA 15219 USA
- Department of Bioengineering University of Pittsburgh Pittsburgh PA 15260 USA
- Department of Surgery School of Medicine University of Pittsburgh Pittsburgh PA 15260 USA
- Department of Chemical Engineering University of Pittsburgh Pittsburgh PA 15260 USA
| | - Stephen F. Badylak
- McGowan Institute for Regenerative Medicine Pittsburgh PA 15219 USA
- Department of Bioengineering University of Pittsburgh Pittsburgh PA 15260 USA
- Department of Surgery School of Medicine University of Pittsburgh Pittsburgh PA 15260 USA
| | - Antonio D'Amore
- McGowan Institute for Regenerative Medicine Pittsburgh PA 15219 USA
- Ri. MED Foundation Palermo 90133 Italy
- Department of Bioengineering University of Pittsburgh Pittsburgh PA 15260 USA
- Department of Surgery School of Medicine University of Pittsburgh Pittsburgh PA 15260 USA
- Clinical Translational Science Institute University of Pittsburgh Pittsburgh PA 15260 USA
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18
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Luketich SK, Cosentino F, Di Giuseppe M, Menallo G, Nasello G, Livreri P, Wagner WR, D'Amore A. Engineering in-plane mechanics of electrospun polyurethane scaffolds for cardiovascular tissue applications. J Mech Behav Biomed Mater 2022; 128:105126. [DOI: 10.1016/j.jmbbm.2022.105126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 01/31/2022] [Accepted: 02/08/2022] [Indexed: 10/19/2022]
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19
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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: 27] [Impact Index Per Article: 9.0] [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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20
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Lou L, Lopez KO, Nautiyal P, Agarwal A. Integrated Perspective of Scaffold Designing and Multiscale Mechanics in Cardiac Bioengineering. ADVANCED NANOBIOMED RESEARCH 2021. [DOI: 10.1002/anbr.202100075] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Affiliation(s)
- Lihua Lou
- Department of Mechanical and Materials Engineering Florida International University Miami FL 33174 USA
| | - Kazue Orikasa Lopez
- Department of Mechanical and Materials Engineering Florida International University Miami FL 33174 USA
| | - Pranjal Nautiyal
- Mechanical Engineering and Applied Mechanics University of Pennsylvania Philadelphia PA 19104 USA
| | - Arvind Agarwal
- Plasma Forming Laboratory Advanced Materials Engineering Research Institute (AMERI) Mechanical and Materials Engineering College of Engineering and Computing Florida International University Miami FL 33174 USA
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21
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Electrospun Janus Beads-On-A-String Structures for Different Types of Controlled Release Profiles of Double Drugs. Biomolecules 2021; 11:biom11050635. [PMID: 33922935 PMCID: PMC8146616 DOI: 10.3390/biom11050635] [Citation(s) in RCA: 46] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Revised: 04/01/2021] [Accepted: 04/23/2021] [Indexed: 12/15/2022] Open
Abstract
A side-by-side electrospinning process characterized by a home-made eccentric spinneret was established to produce the Janus beads-on-a-string products. In this study, ketoprofen (KET) and methylene blue (MB) were used as model drugs, which loaded in Janus beads-on-a-string products, in which polyvinylpyrrolidone K90 (PVP K90) and ethyl cellulose (EC) were exploited as the polymer matrices. From SEM images, distinct nanofibers and microparticles in the Janus beads-on-a-string structures could be observed clearly. X-ray diffraction demonstrated that all crystalline drugs loaded in Janus beads-on-a-string products were transferred into the amorphous state. ATR-FTIR revealed that the components of prepared Janus nanostructures were compatibility. In vitro dissolution tests showed that Janus beads-on-a-string products could provide typical double drugs controlled-release profiles, which provided a faster immediate release of MB and a slower sustained release of KET than the electrospun Janus nanofibers. Drug releases from the Janus beads-on-a-string products were controlled through a combination of erosion mechanism (linear MB-PVP sides) and a typical Fickian diffusion mechanism (bead KET-EC sides). This work developed a brand-new approach for the preparation of the Janus beads-on-a-string nanostructures using side-by-side electrospinning, and also provided a fresh idea for double drugs controlled release and the potential combined therapy.
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22
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Mirani B, Parvin Nejad S, Simmons CA. Recent Progress Toward Clinical Translation of Tissue-Engineered Heart Valves. Can J Cardiol 2021; 37:1064-1077. [PMID: 33839245 DOI: 10.1016/j.cjca.2021.03.022] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 03/04/2021] [Accepted: 03/14/2021] [Indexed: 01/02/2023] Open
Abstract
Surgical replacement remains the primary option to treat the rapidly growing number of patients with severe valvular heart disease. Although current valve replacements-mechanical, bioprosthetic, and cryopreserved homograft valves-enhance survival and quality of life for many patients, the ideal prosthetic heart valve that is abundantly available, immunocompatible, and capable of growth, self-repair, and life-long performance has yet to be developed. These features are essential for pediatric patients with congenital defects, children and young adult patients with rheumatic fever, and active adult patients with valve disease. Heart valve tissue engineering promises to address these needs by providing living valve replacements that function similarly to their native counterparts. This is best evidenced by the long-term clinical success of decellularised pulmonary and aortic homografts, but the supply of homografts cannot meet the demand for replacement valves. A more abundant and consistent source of replacement valves may come from cellularised valves grown in vitro or acellular off-the-shelf biomaterial/tissue constructs that recellularise in situ, but neither tissue engineering approach has yet achieved long-term success in preclinical testing. Beyond the technical challenges, heart valve tissue engineering faces logistical, economic, and regulatory challenges. In this review, we summarise recent progress in heart valve tissue engineering, highlight important outcomes from preclinical and clinical testing, and discuss challenges and future directions toward clinical translation.
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Affiliation(s)
- Bahram Mirani
- Translational Biology and Engineering Program, Ted Rogers Centre for Heart Research, Toronto, Ontario, Canada; Institute of Biomedical Engineering, University of Toronto, Toronto, Ontario, Canada; Department of Mechanical and Industrial Engineering, University of Toronto, Toronto, Ontario, Canada
| | - Shouka Parvin Nejad
- Translational Biology and Engineering Program, Ted Rogers Centre for Heart Research, Toronto, Ontario, Canada; Institute of Biomedical Engineering, University of Toronto, Toronto, Ontario, Canada
| | - Craig A Simmons
- Translational Biology and Engineering Program, Ted Rogers Centre for Heart Research, Toronto, Ontario, Canada; Institute of Biomedical Engineering, University of Toronto, Toronto, Ontario, Canada; Department of Mechanical and Industrial Engineering, University of Toronto, Toronto, Ontario, Canada.
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23
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Guo G, Jin L, Wu B, He H, Yang F, Xu L, Lei Y, Wang Y. A method for simultaneously crosslinking and functionalizing extracellular matrix-based biomaterials as bioprosthetic heart valves with enhanced endothelialization and reduced inflammation. Acta Biomater 2021; 119:89-100. [PMID: 33099025 DOI: 10.1016/j.actbio.2020.10.029] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Revised: 10/12/2020] [Accepted: 10/15/2020] [Indexed: 11/18/2022]
Abstract
With the coming of an aging society and the emergence of transcatheter valve technology, the implantation of bioprosthetic heart valves (BHVs) in patients with valvular disease has significantly increased worldwide. Currently, most clinically available BHVs are crosslinked with glutaraldehyde (GLUT). However, the GLUT treated BHV is less durable due to the combined effect of multiple factors such as cytotoxicity, immune responses, and calcification. In this study, the in-situ polymerization of sulfonic monomers with a decellularized extracellular matrix (ECM) was performed to simultaneously achieve the crosslinking and functionalization of ECM. Subsequently, the feasibility of the hybrid ECM used as leaflet material of BHV was evaluated. In in-vitro tests, the results indicated that the hybrid ECM fixed collagen efficiently and the introduction of sulfonic polymer promoted the proliferation and migration of human umbilical vein endothelial cells (HUVECs). In in-vivo tests, after being implanted in SD rats and mice, the hybrid ECM significantly inhibited immune response and calcification compared with the non-hybrid counterpart and GLUT crosslinked tissue. These results indicated that the hybrid ECM exhibited more competitive stability and better biocompatibility compared to these features in GLUT-crosslinked valve. Therefore, the sulfonic polymer hybrid ECM provides a potential material for more durable BHV and the in-situ polymerization strategy can serve as a general treatment method for tissue crosslinking as well as tailoring the biophysical properties of ECM.
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Affiliation(s)
- Gaoyang Guo
- National Engineering Research Center for Biomaterials, Sichuan University, Chengdu 610064, China
| | - Linhe Jin
- National Engineering Research Center for Biomaterials, Sichuan University, Chengdu 610064, China
| | - Binggang Wu
- National Engineering Research Center for Biomaterials, Sichuan University, Chengdu 610064, China
| | - Haiyang He
- National Engineering Research Center for Biomaterials, Sichuan University, Chengdu 610064, China
| | - Fan Yang
- National Engineering Research Center for Biomaterials, Sichuan University, Chengdu 610064, China
| | - Liangpeng Xu
- National Engineering Research Center for Biomaterials, Sichuan University, Chengdu 610064, China
| | - Yang Lei
- National Engineering Research Center for Biomaterials, Sichuan University, Chengdu 610064, China.
| | - Yunbing Wang
- National Engineering Research Center for Biomaterials, Sichuan University, Chengdu 610064, China.
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24
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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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25
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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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26
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Long L, Wu C, Hu X, Wang Y. Biodegradable synthetic polymeric composite scaffold‐based tissue engineered heart valve with minimally invasive transcatheter implantation. POLYM ADVAN TECHNOL 2020. [DOI: 10.1002/pat.5012] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Affiliation(s)
- Lin‐yu Long
- National Engineering Research Center for Biomaterials Sichuan University Chengdu China
| | - Can Wu
- National Engineering Research Center for Biomaterials Sichuan University Chengdu China
| | - Xue‐feng Hu
- National Engineering Research Center for Biomaterials Sichuan University Chengdu China
| | - Yun‐bing Wang
- National Engineering Research Center for Biomaterials Sichuan University Chengdu China
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27
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Saidy NT, Shabab T, Bas O, Rojas-González DM, Menne M, Henry T, Hutmacher DW, Mela P, De-Juan-Pardo EM. Melt Electrowriting of Complex 3D Anatomically Relevant Scaffolds. Front Bioeng Biotechnol 2020; 8:793. [PMID: 32850700 PMCID: PMC7396698 DOI: 10.3389/fbioe.2020.00793] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Accepted: 06/22/2020] [Indexed: 12/11/2022] Open
Abstract
The manufacture of fibrous scaffolds with tailored micrometric features and anatomically relevant three-dimensional (3D) geometries for soft tissue engineering applications remains a great challenge. Melt electrowriting (MEW) is an advanced additive manufacturing technique capable of depositing predefined micrometric fibers. However, it has been so far inherently limited to simple planar and tubular scaffold geometries because of the need to avoid polymer jet instabilities. In this work, we surmount the technical boundaries of MEW to enable the manufacture of complex fibrous scaffolds with simultaneous controlled micrometric and patient-specific anatomic features. As an example of complex geometry, aortic root scaffolds featuring the sinuses of Valsalva were realized. By modeling the electric field strength associated with the MEW process for these constructs, we found that the combination of a conductive core mandrel with a non-conductive 3D printed model reproducing the complex geometry minimized the variability of the electric field thus enabling the accurate deposition of fibers. We validated these findings experimentally and leveraged the micrometric resolution of MEW to fabricate unprecedented fibrous aortic root scaffolds with anatomically relevant shapes and biomimetic microstructures and mechanical properties. Furthermore, we demonstrated the fabrication of patient-specific aortic root constructs from the 3D reconstruction of computed tomography clinical data.
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Affiliation(s)
- Navid T Saidy
- Centre in Regenerative Medicine, Institute of Health and Biomedical Innovation (IHBI), Queensland University of Technology (QUT), Kelvin Grove, QLD, Australia.,School of Dentistry, The University of Queensland, Herston, QLD, Australia
| | - Tara Shabab
- Centre in Regenerative Medicine, Institute of Health and Biomedical Innovation (IHBI), Queensland University of Technology (QUT), Kelvin Grove, QLD, Australia
| | - Onur Bas
- Centre in Regenerative Medicine, Institute of Health and Biomedical Innovation (IHBI), Queensland University of Technology (QUT), Kelvin Grove, QLD, Australia.,ARC ITTC in Additive Biomanufacturing, Queensland University of Technology, Musk Avenue, Brisbane, QLD, Australia
| | - Diana M Rojas-González
- Medical Materials and Implants, Department of Mechanical Engineering, Technical University of Munich, Garching, Germany
| | - Matthias Menne
- Department of Cardiovascular Engineering, Institute of Applied Medical Engineering, Helmholtz Institute, Medical Faculty, RWTH Aachen University, Aachen, Germany
| | - Tim Henry
- Centre in Regenerative Medicine, Institute of Health and Biomedical Innovation (IHBI), Queensland University of Technology (QUT), Kelvin Grove, QLD, Australia
| | - Dietmar W Hutmacher
- Centre in Regenerative Medicine, Institute of Health and Biomedical Innovation (IHBI), Queensland University of Technology (QUT), Kelvin Grove, QLD, Australia.,ARC ITTC in Additive Biomanufacturing, Queensland University of Technology, Musk Avenue, Brisbane, QLD, Australia.,Institute for Advanced Study, Technical University of Munich, Garching, Germany
| | - Petra Mela
- Medical Materials and Implants, Department of Mechanical Engineering, Technical University of Munich, Garching, Germany.,Department of Biohybrid and Medical Textiles (BioTex), AME-Institute of Applied Medical Engineering, Helmholtz Institute, RWTH Aachen University, Aachen, Germany
| | - Elena M De-Juan-Pardo
- Centre in Regenerative Medicine, Institute of Health and Biomedical Innovation (IHBI), Queensland University of Technology (QUT), Kelvin Grove, QLD, Australia.,Translational 3d Printing Laboratory for Advanced Tissue Engineering (T3mPLATE), Harry Perkins Institute of Medical Research, QEII Medical Centre, Nedlands and Centre for Medical Research, The University of Western Australia, Perth, WA, Australia.,Department of Mechanical Engineering, School of Engineering, The University of Western Australia, Perth, WA, Australia
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28
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Chester AH, Grande-Allen KJ. Which Biological Properties of Heart Valves Are Relevant to Tissue Engineering? Front Cardiovasc Med 2020; 7:63. [PMID: 32373630 PMCID: PMC7186395 DOI: 10.3389/fcvm.2020.00063] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Accepted: 03/27/2020] [Indexed: 12/30/2022] Open
Abstract
Over the last 20 years, the designs of tissue engineered heart valves have evolved considerably. An initial focus on replicating the mechanical and structural features of semilunar valves has expanded to endeavors to mimic the biological behavior of heart valve cells as well. Studies on the biology of heart valves have shown that the function and durability of native valves is underpinned by complex interactions between the valve cells, the extracellular matrix, and the mechanical environment in which heart valves function. The ability of valve interstitial cells to synthesize extracellular matrix proteins and remodeling enzymes and the protective mediators released by endothelial cells are key factors in the homeostasis of valve function. The extracellular matrix provides the mechanical strength and flexibility required for the valve to function, as well as communicating with the cells that are bound within. There are a number of regulatory mechanisms that influence valve function, which include neuronal mechanisms and the tight regulation of growth and angiogenic factors. Together, studies into valve biology have provided a blueprint for what a tissue engineered valve would need to be capable of, in order to truly match the function of the native valve. This review addresses the biological functions of heart valve cells, in addition to the influence of the cells' environment on this behavior and examines how well these functions are addressed within the current strategies for tissue engineering heart valves in vitro, in vivo, and in situ.
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Affiliation(s)
- Adrian H Chester
- Heart Science Centre, The Magdi Yacoub Institute, Harefield, United Kingdom
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29
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In Vivo Stability of Polyurethane-Based Electrospun Vascular Grafts in Terms of Chemistry and Mechanics. Polymers (Basel) 2020; 12:polym12040845. [PMID: 32272564 PMCID: PMC7240619 DOI: 10.3390/polym12040845] [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: 03/13/2020] [Revised: 03/25/2020] [Accepted: 03/27/2020] [Indexed: 12/31/2022] Open
Abstract
The biostability of the polyurethanes Tecoflex EG-80A and Pellethane 2363-80A, used as basic polymers of the vascular grafts (VGs) produced by electrospinning, as well as the tensile strength of Tecoflex VGs, are studied. Solutions of Tecoflex or Pellethane with gelatin and bivalirudin in 1,1,1,3,3,3-hexafluoroisopropanol are used for VG production. After 1, 12, and 24 weeks of VG implantation in the infrarenal position of the abdominal aorta of Wistar rats, VGs are explanted, fixed in formalin, freed from outer tissues, dialyzed, and dried. The polyurethanes are extracted from VGs by dispersion/extraction in tetrahydrofuran (THF) and freed from the excess of THF-insoluble biopolymers. The stability of polyurethanes is assessed by IR spectroscopy and gel permeation chromatography. Pellethane has emerged to be stable at all experimental points. Tecoflex loses approximately 10% of its molecular weight (both Mn and Mw) after 3 months and restored its initial value within 6 months of its functioning as a graft. Mechanical testing demonstrates a 30% reduction in the tensile strength after 3 months in VG and a 10% increase after 6 months. The stability and mechanical properties of polyurethane-based VGs demonstrate their utility for the reconstitution of damaged arteries.
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30
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Acute In Vivo Functional Assessment of a Biodegradable Stentless Elastomeric Tricuspid Valve. J Cardiovasc Transl Res 2020; 13:796-805. [DOI: 10.1007/s12265-020-09960-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Accepted: 01/21/2020] [Indexed: 02/07/2023]
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31
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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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32
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Liu C, Qiao W, Cao H, Dai J, Li F, Shi J, Dong N. A riboflavin–ultraviolet light A-crosslinked decellularized heart valve for improved biomechanical properties, stability, and biocompatibility. Biomater Sci 2020; 8:2549-2563. [DOI: 10.1039/c9bm01956a] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Riboflavin–ultraviolet light A could effectively crosslink a decellularized heart valve to improve its biomechanical properties, stability and biocompatibility.
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Affiliation(s)
- Chungeng Liu
- Department of Cardiovascular Surgery
- Union Hospital
- Tongji Medical College
- Huazhong University of Science and Technology
- Wuhan
| | - Weihua Qiao
- Department of Cardiovascular Surgery
- Union Hospital
- Tongji Medical College
- Huazhong University of Science and Technology
- Wuhan
| | - Hong Cao
- Department of Cardiovascular Surgery
- Union Hospital
- Tongji Medical College
- Huazhong University of Science and Technology
- Wuhan
| | - Jinchi Dai
- Department of Cardiovascular Surgery
- Union Hospital
- Tongji Medical College
- Huazhong University of Science and Technology
- Wuhan
| | - Fei Li
- Department of Cardiovascular Surgery
- Union Hospital
- Tongji Medical College
- Huazhong University of Science and Technology
- Wuhan
| | - Jiawei Shi
- Department of Cardiovascular Surgery
- Union Hospital
- Tongji Medical College
- Huazhong University of Science and Technology
- Wuhan
| | - Nianguo Dong
- Department of Cardiovascular Surgery
- Union Hospital
- Tongji Medical College
- Huazhong University of Science and Technology
- Wuhan
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33
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General Study and Gene Expression Profiling of Endotheliocytes Cultivated on Electrospun Materials. MATERIALS 2019; 12:ma12244082. [PMID: 31817735 PMCID: PMC6947544 DOI: 10.3390/ma12244082] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Revised: 11/20/2019] [Accepted: 12/03/2019] [Indexed: 12/27/2022]
Abstract
Endothelization of the luminal surface of vascular grafts is required for their long-term functioning. Here, we have cultivated human endothelial cells (HUVEC) on different 3D matrices to assess cell proliferation, gene expression and select the best substrate for endothelization. 3D matrices were produced by electrospinning from solutions of poly(D,L-lactide-co-glycolide) (PLGA), polycaprolactone (PCL), and blends of PCL with gelatin (Gl) in hexafluoroisopropanol. Structure and surface properties of 3D matrices were characterized by SEM, AFM, and sessile drop analysis. Cell adhesion, viability, and proliferation were studied by SEM, Alamar Blue staining, and 5-ethynyl-2’-deoxyuridine (EdU) assay. Gene expression profiling was done on an Illumina HiSeq 2500 platform. Obtained data indicated that 3D matrices produced from PCL with Gl and treated with glutaraldehyde provide the most suitable support for HUVEC adhesion and proliferation. Transcriptome sequencing has demonstrated a minimal difference of gene expression profile in HUVEC cultivated on the surface of these matrices as compared to tissue culture plastic, thus confirming these matrices as the best support for endothelization.
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34
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Xue Y, Ravishankar P, Zeballos MA, Sant V, Balachandran K, Sant S. Valve leaflet‐inspired elastomeric scaffolds with tunable and anisotropic mechanical properties. POLYM ADVAN TECHNOL 2019. [DOI: 10.1002/pat.4750] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Affiliation(s)
- Yingfei Xue
- Department of Pharmaceutical SciencesUniversity of Pittsburgh Pittsburgh PA USA
| | | | | | - Vinayak Sant
- Department of Pharmaceutical SciencesUniversity of Pittsburgh Pittsburgh PA USA
| | - Kartik Balachandran
- Department of Biomedical EngineeringUniversity of Arkansas Fayetteville AR USA
| | - Shilpa Sant
- Department of Pharmaceutical SciencesUniversity of Pittsburgh Pittsburgh PA USA
- Department of BioengineeringUniversity of Pittsburgh Pittsburgh PA USA
- McGowan Institute for Regenerative MedicineUniversity of Pittsburgh Pittsburgh PA USA
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35
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Thomas VS, Lai V, Amini R. A computational multi-scale approach to investigate mechanically-induced changes in tricuspid valve anterior leaflet microstructure. Acta Biomater 2019; 94:524-535. [PMID: 31229629 DOI: 10.1016/j.actbio.2019.05.074] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Revised: 05/10/2019] [Accepted: 05/16/2019] [Indexed: 12/12/2022]
Abstract
The tricuspid valve is an atrioventricular valve that prevents blood backflow from the right ventricle into the right atrium during ventricular contractions. It is important to study mechanically induced microstructural alterations in the tricuspid valve leaflets, as this aids both in understanding valvular diseases and in the development of new engineered tissue replacements. The structure and composition of the extracellular matrix (ECM) fiber networks are closely tied to an overall biomechanical function of the tricuspid valve. In this study, we conducted experiments and implemented a multiscale modeling approach to predict ECM microstructural changes to tissue-level mechanical responses in a controlled loading environment. In particular, we characterized a sample of a porcine anterior leaflet at a macroscale using a biaxial mechanical testing method. We then generated a three-dimensional finite element model, to which computational representations of corresponding fiber networks were incorporated based on properties of the microstructural architecture obtained from small angle light scattering. Using five different biaxial boundary conditions, we performed iterative simulations to obtain model parameters with an overall R2 value of 0.93. We observed that mechanical loading could markedly alter the underlying ECM architecture. For example, a relatively isotropic fiber network (with an anisotropy index value α of 28%) became noticeably more anisotropic (with an α of 40%) when it underwent mechanical loading. We also observed that the mechanical strain was distributed in a different manner at the ECM/fiber level as compared to the tissue level. The approach presented in this study has the potential to be implemented in pathophysiologically altered biomechanical and structural conditions and to bring insights into the mechanobiology of the tricuspid valve. STATEMENT OF SIGNIFICANCE: Quantifying abnormal cellar/ECM-level deformation of tricuspid valve leaflets subjected to a modified loading environment is of great importance, as it is believed to be linked to valvular remodeling responses. For example, developing surgical procedures or engineered tissue replacements that maintain/mimic ECM-level mechanical homeostasis could lead to more durable outcomes. To quantify leaflet deformation, we built a multiscale framework encompassing the contributions of disorganized ECM components and organized fibers, which can predict the behavior of the tricuspid valve leaflets under physiological loading conditions both at the tissue level and at the ECM level. In addition to future in-depth studies of tricuspid valve pathologies, our model can be used to characterize tissues in other valves of the heart.
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36
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Commentary: Polymer prosthetic heart valves-A new era. J Thorac Cardiovasc Surg 2019; 157:1817-1818. [PMID: 31288360 DOI: 10.1016/j.jtcvs.2019.02.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2019] [Accepted: 02/04/2019] [Indexed: 11/20/2022]
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37
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van Haaften EE, Duijvelshoff R, Ippel BD, Söntjens SHM, van Houtem MHCJ, Janssen HM, Smits AIPM, Kurniawan NA, Dankers PYW, Bouten CVC. The degradation and performance of electrospun supramolecular vascular scaffolds examined upon in vitro enzymatic exposure. Acta Biomater 2019; 92:48-59. [PMID: 31108258 DOI: 10.1016/j.actbio.2019.05.037] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Revised: 05/11/2019] [Accepted: 05/15/2019] [Indexed: 12/24/2022]
Abstract
To maintain functionality during in situ vascular regeneration, the rate of implant degradation should be closely balanced by neo-tissue formation. It is unknown, however, how the implant's functionality is affected by the degradation of the polymers it is composed of. We therefore examined the macro- and microscopic features as well as the mechanical performance of vascular scaffolds upon in vitro enzymatic degradation. Three candidate biomaterials with supramolecularly interacting bis-urea (BU) hard blocks ('slow-degrading' polycarbonate-BU (PC-BU), 'intermediate-degrading' polycarbonate-ester-BU (PC(e)-BU), and 'fast-degrading' polycaprolactone-ester-BU (PCL-BU)) were synthesized and electrospun into microporous scaffolds. These materials possess a sequence-controlled macromolecular structure, so their susceptibility to degradation is tunable by controlling the nature of the polymer backbone. The scaffolds were incubated in lipase and monitored for changes in physical, chemical, and mechanical properties. Remarkably, comparing PC-BU to PC(e)-BU, we observed that small changes in macromolecular structure led to significant differences in degradation kinetics. All three scaffold types degraded via surface erosion, which was accompanied by fiber swelling for PC-BU scaffolds, and some bulk degradation and a collapsing network for PCL-BU scaffolds. For the PC-BU and PC(e)-BU scaffolds this resulted in retention of mechanical properties, whereas for the PCL-BU scaffolds this resulted in stiffening. Our in vitro study demonstrates that vascular scaffolds, electrospun from sequence-controlled supramolecular materials with varying ester contents, not only display different susceptibilities to degradation, but also degrade via different mechanisms. STATEMENT OF SIGNIFICANCE: One of the key elements to successfully engineer vascular tissues in situ, is to balance the rate of implant degradation and neo-tissue formation. Due to their tunable properties, supramolecular polymers can be customized into attractive biomaterials for vascular tissue engineering. Here, we have exploited this tunability and prepared a set of polymers with different susceptibility to degradation. The polymers, which were electrospun into microporous scaffolds, displayed not only different susceptibilities to degradation, but also obeyed different degradation mechanisms. This study illustrates how the class of supramolecular polymers continues to represent a promising group of materials for tissue engineering approaches.
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Affiliation(s)
- E E van Haaften
- Eindhoven University of Technology, Department of Biomedical Engineering, PO Box 513, 5600 MB Eindhoven, The Netherlands; Institute for Complex Molecular Systems (ICMS), PO Box 513, 5600 MB Eindhoven, The Netherlands
| | - R Duijvelshoff
- Eindhoven University of Technology, Department of Biomedical Engineering, PO Box 513, 5600 MB Eindhoven, The Netherlands; Institute for Complex Molecular Systems (ICMS), PO Box 513, 5600 MB Eindhoven, The Netherlands
| | - B D Ippel
- Eindhoven University of Technology, Department of Biomedical Engineering, PO Box 513, 5600 MB Eindhoven, The Netherlands; Institute for Complex Molecular Systems (ICMS), PO Box 513, 5600 MB Eindhoven, The Netherlands
| | - S H M Söntjens
- SyMO-Chem B.V., Den Dolech 2, 5612 AZ Eindhoven, The Netherlands
| | | | - H M Janssen
- SyMO-Chem B.V., Den Dolech 2, 5612 AZ Eindhoven, The Netherlands
| | - A I P M Smits
- Eindhoven University of Technology, Department of Biomedical Engineering, PO Box 513, 5600 MB Eindhoven, The Netherlands; Institute for Complex Molecular Systems (ICMS), PO Box 513, 5600 MB Eindhoven, The Netherlands
| | - N A Kurniawan
- Eindhoven University of Technology, Department of Biomedical Engineering, PO Box 513, 5600 MB Eindhoven, The Netherlands; Institute for Complex Molecular Systems (ICMS), PO Box 513, 5600 MB Eindhoven, The Netherlands
| | - P Y W Dankers
- Eindhoven University of Technology, Department of Biomedical Engineering, PO Box 513, 5600 MB Eindhoven, The Netherlands; Institute for Complex Molecular Systems (ICMS), PO Box 513, 5600 MB Eindhoven, The Netherlands
| | - C V C Bouten
- Eindhoven University of Technology, Department of Biomedical Engineering, PO Box 513, 5600 MB Eindhoven, The Netherlands; Institute for Complex Molecular Systems (ICMS), PO Box 513, 5600 MB Eindhoven, The Netherlands.
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Nguyen AH, Marsh P, Schmiess-Heine L, Burke PJ, Lee A, Lee J, Cao H. Cardiac tissue engineering: state-of-the-art methods and outlook. J Biol Eng 2019; 13:57. [PMID: 31297148 PMCID: PMC6599291 DOI: 10.1186/s13036-019-0185-0] [Citation(s) in RCA: 69] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Accepted: 06/03/2019] [Indexed: 12/17/2022] Open
Abstract
The purpose of this review is to assess the state-of-the-art fabrication methods, advances in genome editing, and the use of machine learning to shape the prospective growth in cardiac tissue engineering. Those interdisciplinary emerging innovations would move forward basic research in this field and their clinical applications. The long-entrenched challenges in this field could be addressed by novel 3-dimensional (3D) scaffold substrates for cardiomyocyte (CM) growth and maturation. Stem cell-based therapy through genome editing techniques can repair gene mutation, control better maturation of CMs or even reveal its molecular clock. Finally, machine learning and precision control for improvements of the construct fabrication process and optimization in tissue-specific clonal selections with an outlook of cardiac tissue engineering are also presented.
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Affiliation(s)
- Anh H. Nguyen
- Electrical and Computer Engineering Department, University of Alberta, Edmonton, Alberta Canada
- Electrical Engineering and Computer Science Department, University of California Irvine, Irvine, CA USA
| | - Paul Marsh
- Electrical Engineering and Computer Science Department, University of California Irvine, Irvine, CA USA
| | - Lauren Schmiess-Heine
- Electrical Engineering and Computer Science Department, University of California Irvine, Irvine, CA USA
| | - Peter J. Burke
- Electrical Engineering and Computer Science Department, University of California Irvine, Irvine, CA USA
- Biomedical Engineering Department, University of California Irvine, Irvine, CA USA
- Chemical Engineering and Materials Science Department, University of California Irvine, Irvine, CA USA
| | - Abraham Lee
- Biomedical Engineering Department, University of California Irvine, Irvine, CA USA
- Mechanical and Aerospace Engineering Department, University of California Irvine, Irvine, CA USA
| | - Juhyun Lee
- Bioengineering Department, University of Texas at Arlington, Arlington, TX USA
| | - Hung Cao
- Electrical Engineering and Computer Science Department, University of California Irvine, Irvine, CA USA
- Biomedical Engineering Department, University of California Irvine, Irvine, CA USA
- Henry Samueli School of Engineering, University of California, Irvine, USA
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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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A hierarchical integration pyramid to increase translation of biomaterials based on recent successes in multiscale synthetic biomaterials research. CURRENT OPINION IN BIOMEDICAL ENGINEERING 2019. [DOI: 10.1016/j.cobme.2019.04.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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Saidy NT, Wolf F, Bas O, Keijdener H, Hutmacher DW, Mela P, De-Juan-Pardo EM. Biologically Inspired Scaffolds for Heart Valve Tissue Engineering via Melt Electrowriting. SMALL (WEINHEIM AN DER BERGSTRASSE, GERMANY) 2019; 15:e1900873. [PMID: 31058444 DOI: 10.1002/smll.201900873] [Citation(s) in RCA: 84] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Revised: 04/14/2019] [Indexed: 06/09/2023]
Abstract
Heart valves are characterized to be highly flexible yet tough, and exhibit complex deformation characteristics such as nonlinearity, anisotropy, and viscoelasticity, which are, at best, only partially recapitulated in scaffolds for heart valve tissue engineering (HVTE). These biomechanical features are dictated by the structural properties and microarchitecture of the major tissue constituents, in particular collagen fibers. In this study, the unique capabilities of melt electrowriting (MEW) are exploited to create functional scaffolds with highly controlled fibrous microarchitectures mimicking the wavy nature of the collagen fibers and their load-dependent recruitment. Scaffolds with precisely-defined serpentine architectures reproduce the J-shaped strain stiffening, anisotropic and viscoelastic behavior of native heart valve leaflets, as demonstrated by quasistatic and dynamic mechanical characterization. They also support the growth of human vascular smooth muscle cells seeded both directly or encapsulated in fibrin, and promote the deposition of valvular extracellular matrix components. Finally, proof-of-principle MEW trileaflet valves display excellent acute hydrodynamic performance under aortic physiological conditions in a custom-made flow loop. The convergence of MEW and a biomimetic design approach enables a new paradigm for the manufacturing of scaffolds with highly controlled microarchitectures, biocompatibility, and stringent nonlinear and anisotropic mechanical properties required for HVTE.
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Affiliation(s)
- Navid T Saidy
- Centre in Regenerative Medicine, Institute of Health and Biomedical Innovation (IHBI), Queensland University of Technology (QUT), 60 Musk Avenue, Kelvin Grove, Brisbane, Queensland, 4059, Australia
- Department of Biohybrid & Medical Textiles (BioTex), AME-Institute of Applied Medical Engineering, Helmholtz Institute, RWTH Aachen University, Forckenbeckstr. 55, 52074, Aachen, Germany
| | - Frederic Wolf
- Department of Biohybrid & Medical Textiles (BioTex), AME-Institute of Applied Medical Engineering, Helmholtz Institute, RWTH Aachen University, Forckenbeckstr. 55, 52074, Aachen, Germany
| | - Onur Bas
- Centre in Regenerative Medicine, Institute of Health and Biomedical Innovation (IHBI), Queensland University of Technology (QUT), 60 Musk Avenue, Kelvin Grove, Brisbane, Queensland, 4059, Australia
- ARC ITTC in Additive Biomanufacturing, Queensland University of Technology, 60 Musk Avenue, Kelvin Grove, Brisbane, Queensland, 4059, Australia
| | - Hans Keijdener
- Department of Biohybrid & Medical Textiles (BioTex), AME-Institute of Applied Medical Engineering, Helmholtz Institute, RWTH Aachen University, Forckenbeckstr. 55, 52074, Aachen, Germany
| | - Dietmar W Hutmacher
- Centre in Regenerative Medicine, Institute of Health and Biomedical Innovation (IHBI), Queensland University of Technology (QUT), 60 Musk Avenue, Kelvin Grove, Brisbane, Queensland, 4059, Australia
- ARC ITTC in Additive Biomanufacturing, Queensland University of Technology, 60 Musk Avenue, Kelvin Grove, Brisbane, Queensland, 4059, Australia
- Institute for Advanced Study, Technische Universität München, D-85748, Garching, Germany
| | - Petra Mela
- Department of Biohybrid & Medical Textiles (BioTex), AME-Institute of Applied Medical Engineering, Helmholtz Institute, RWTH Aachen University, Forckenbeckstr. 55, 52074, Aachen, Germany
- Medical Materials and Medical Implant Design, Department of Mechanical Engineering, Technical University of Munich, Boltzmannstr. 15, 85748, Garching,
| | - Elena M De-Juan-Pardo
- Centre in Regenerative Medicine, Institute of Health and Biomedical Innovation (IHBI), Queensland University of Technology (QUT), 60 Musk Avenue, Kelvin Grove, Brisbane, Queensland, 4059, Australia
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Portillo-Lara R, Spencer AR, Walker BW, Shirzaei Sani E, Annabi N. Biomimetic cardiovascular platforms for in vitro disease modeling and therapeutic validation. Biomaterials 2019; 198:78-94. [PMID: 30201502 PMCID: PMC11044891 DOI: 10.1016/j.biomaterials.2018.08.010] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Revised: 08/02/2018] [Accepted: 08/03/2018] [Indexed: 02/07/2023]
Abstract
Bioengineered tissues have become increasingly more sophisticated owing to recent advancements in the fields of biomaterials, microfabrication, microfluidics, genetic engineering, and stem cell and developmental biology. In the coming years, the ability to engineer artificial constructs that accurately mimic the compositional, architectural, and functional properties of human tissues, will profoundly impact the therapeutic and diagnostic aspects of the healthcare industry. In this regard, bioengineered cardiac tissues are of particular importance due to the extremely limited ability of the myocardium to self-regenerate, as well as the remarkably high mortality associated with cardiovascular diseases worldwide. As novel microphysiological systems make the transition from bench to bedside, their implementation in high throughput drug screening, personalized diagnostics, disease modeling, and targeted therapy validation will bring forth a paradigm shift in the clinical management of cardiovascular diseases. Here, we will review the current state of the art in experimental in vitro platforms for next generation diagnostics and therapy validation. We will describe recent advancements in the development of smart biomaterials, biofabrication techniques, and stem cell engineering, aimed at recapitulating cardiovascular function at the tissue- and organ levels. In addition, integrative and multidisciplinary approaches to engineer biomimetic cardiovascular constructs with unprecedented human and clinical relevance will be discussed. We will comment on the implementation of these platforms in high throughput drug screening, in vitro disease modeling and therapy validation. Lastly, future perspectives will be provided on how these biomimetic platforms will aid in the transition towards patient centered diagnostics, and the development of personalized targeted therapeutics.
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Affiliation(s)
- Roberto Portillo-Lara
- Department of Chemical Engineering, Northeastern University, Boston, USA; Tecnologico de Monterrey, Escuela de Ingeniería y Ciencias, Zapopan, JAL, Mexico
| | - Andrew R Spencer
- Department of Chemical Engineering, Northeastern University, Boston, USA
| | - Brian W Walker
- Department of Chemical and Biomolecular Engineering, University of California- Los Angeles, Los Angeles, CA 90095, USA
| | - Ehsan Shirzaei Sani
- Department of Chemical and Biomolecular Engineering, University of California- Los Angeles, Los Angeles, CA 90095, USA
| | - Nasim Annabi
- Department of Chemical and Biomolecular Engineering, University of California- Los Angeles, Los Angeles, CA 90095, USA; Center for Minimally Invasive Therapeutics (C-MIT), University of California-Los Angeles, Los Angeles, CA, USA; Harvard-MIT Division of Health Sciences and Technology, Massachusetts Institute of Technology, Cambridge, MA, USA.
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Guo G, Jin L, Jin W, Chen L, Lei Y, Wang Y. Radical polymerization-crosslinking method for improving extracellular matrix stability in bioprosthetic heart valves with reduced potential for calcification and inflammatory response. Acta Biomater 2018; 82:44-55. [PMID: 30326277 DOI: 10.1016/j.actbio.2018.10.017] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Revised: 09/04/2018] [Accepted: 10/11/2018] [Indexed: 02/07/2023]
Abstract
In recent years, the number of heart valve replacements has multiplied with valve diseases because of aging populations and the surge in rheumatic heart disease in young people. Among them, bioprosthetic heart valves (BHVs) have become increasingly popular. Transcatheter aortic valve implantation (TAVI) valve as an emerging BHV has been increasingly applied to patients. However, the current commercially used BHVs treated with glutaraldehyde (Glut) still face the problem of durability. BHVs derived from Glut-treated xenogenetic tissues would undergo structural degeneration and calcification sometimes even as short as less than 10 years. This issue has already become a big challenge considering more and more young patients at the age of 50-60 s are receiving the BHV replacement. In our study, an approach that is totally different from the previous techniques named by us as the radical polymerization-crosslinking (RPC) method was developed to improve extracellular matrix stability, prevent calcification, and reduce inflammatory response in BHVs. The porcine pericardium (PP) tissue was decellularized, functionalized with methacryloyl groups, and subsequently crosslinked by radical polymerization. We found that high-density RPC treatment remarkably improved the stability of collagen and elastin of PP, enhanced its endothelialization potential, and provided reliable biomechanical performance as compared to Glut treatment. The in vivo rat model also confirmed the increased componential stability and the reduced inflammatory response of RPC-treated PP. Moreover, the RPC-treated PP showed better in vivo anticalcification potential than Glut-treated PP. STATEMENT OF SIGNIFICANCE: Bioprosthetic heart valves (BHVs) manufactured from glutaraldehyde (Glut)-treated xenogeneic tissues have been used to treat valve-related diseases for several decades. However, the durability of BHVs remains unresolved and becomes more pronounced particularly in younger patients. Although a number of new alternative methods for Glut crosslinking have been proposed, their overall performance is still far from ready to use in humans. In this study, radical polymerization was investigated for crosslinking the porcine pericardium (PP). This treatment was found to have advantages compared to Glut-treated PP in terms of stability, biocompatibility, and anticalcification potential with the hope of addressing the needs of more robust biomaterials for the fabrication of BHVs.
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Coyan GN, D'Amore A, Matsumura Y, Pedersen DD, Luketich SK, Shanov V, Katz WE, David TE, Wagner WR, Badhwar V. In vivo functional assessment of a novel degradable metal and elastomeric scaffold-based tissue engineered heart valve. J Thorac Cardiovasc Surg 2018; 157:1809-1816. [PMID: 30578064 DOI: 10.1016/j.jtcvs.2018.09.128] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2018] [Revised: 09/01/2018] [Accepted: 09/22/2018] [Indexed: 01/08/2023]
Abstract
OBJECTIVE Ideal heart valve solutions aim to provide thrombosis-free durability. A scaffold-based polycarbonate urethane urea tissue-engineered heart valve designed to mimic native valve microstructure and function was used. This study examined the acute in vivo function of a stented tissue-engineered heart valve in a porcine model. METHODS Trileaflet valves were fabricated by electrospinning polycarbonate urethane urea using double component fiber deposition. The tissue-engineered heart valve was mounted on an AZ31 magnesium alloy biodegradable stent frame. Five 80-kg Yorkshire pigs underwent open tissue-engineered heart valve implantation on cardiopulmonary bypass in the pulmonary position. Tissue-engineered heart valve function was echocardiographically evaluated immediately postimplant and at planned study end points at 1, 4, 8, and 12 hours. Explanted valves underwent biaxial mechanical testing and scanning electron microscopy for ultrastructural analysis and thrombosis detection. RESULTS All 5 animals underwent successful valve implantation. All were weaned from cardiopulmonary bypass, closed, and recovered until harvest study end point except 1 animal that was found to have congenital tricuspid valve dysplasia and that was euthanized postimplant. All 5 cases revealed postcardiopulmonary bypass normal leaflet function, no regurgitation, and an average peak velocity of 2 m/s, unchanged at end point. All tissue-engineered heart valve leaflets retained microstructural architecture with no platelet activation or thrombosis by scanning electron microscopy. There was microscopic evidence of fibrin deposition on 2 of 5 stent frames, not on the tissue-engineered heart valve. Biaxial stress examination revealed retained postimplant mechanics of tissue-engineered heart valve fibers without functional or ultrastructural degradation. CONCLUSIONS A biodegradable elastomeric heart valve scaffold for in situ tissue-engineered leaflet replacement is acutely functional and devoid of leaflet microthrombosis.
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Affiliation(s)
- Garrett N Coyan
- Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, Pa; McGowan Institute for Regenerative Medicine, Pittsburgh, Pa
| | - Antonio D'Amore
- Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, Pa; McGowan Institute for Regenerative Medicine, Pittsburgh, Pa; Fondazione RiMED, Palermo, Italy
| | - Yasumoto Matsumura
- Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, Pa; McGowan Institute for Regenerative Medicine, Pittsburgh, Pa
| | - Drake D Pedersen
- Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, Pa; McGowan Institute for Regenerative Medicine, Pittsburgh, Pa
| | - Samuel K Luketich
- Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, Pa; McGowan Institute for Regenerative Medicine, Pittsburgh, Pa
| | - Vesselin Shanov
- Department of Bioengineering, University of Cincinnati, Cincinnati, Ohio
| | - William E Katz
- Division of Cardiology, University of Pittsburgh, Pittsburgh, Pa
| | - Tirone E David
- Division of Cardiac Surgery, Toronto General Hospital, Toronto, Ontario, Canada
| | - William R Wagner
- Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, Pa; McGowan Institute for Regenerative Medicine, Pittsburgh, Pa
| | - Vinay Badhwar
- McGowan Institute for Regenerative Medicine, Pittsburgh, Pa; Department of Cardiovascular and Thoracic Surgery, West Virginia University, Morgantown, WVa.
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D'Amore A, Nasello G, Luketich SK, Denisenko D, Jacobs DL, Hoff R, Gibson G, Bruno A, T Raimondi M, Wagner WR. Meso-scale topological cues influence extracellular matrix production in a large deformation, elastomeric scaffold model. SOFT MATTER 2018; 14:8483-8495. [PMID: 30357253 DOI: 10.1039/c8sm01352g] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Physical cues are decisive factors in extracellular matrix (ECM) formation and elaboration. Their transduction across scale lengths is an inherently symbiotic phenomenon that while influencing ECM fate is also mediated by the ECM structure itself. This study investigates the possibility of enhancing ECM elaboration by topological cues that, while not modifying the substrate macro scale mechanics, can affect the meso-scale strain range acting on cells incorporated within the scaffold. Vascular smooth muscle cell micro-integrated, electrospun scaffolds were fabricated with comparable macroscopic biaxial mechanical response, but different meso-scale topology. Seeded scaffolds were conditioned on a stretch bioreactor and exposed to large strain deformations. Samples were processed to evaluate ECM quantity and quality via: biochemical assay, qualitative and quantitative histological assessment and multi-photon analysis. Experimental evaluation was coupled to a numerical model that elucidated the relationship between the scaffold micro-architecture and the strain acting on the cells. Results showed an higher amount of ECM formation for the scaffold type characterized by lowest fiber intersection density. The numerical model simulations associated this result with the differences found for the change in cell nuclear aspect ratio and showed that given comparable macro scale mechanics, a difference in material topology created significant differences in cell-scaffold meso-scale deformations. These findings reaffirmed the role of cell shape in ECM formation and introduced a novel notion for the engineering of cardiac tissue where biomaterial structure can be designed to both mimick the organ level mechanics of a specific tissue of interest and elicit a desirable cellular response.
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Affiliation(s)
- Antonio D'Amore
- Departments of Bioengineering and Surgery, McGowan Institute for Regenerative Medicine, University of Pittsburgh, 450 Technology Drive, Pittsburgh, 15216, USA.
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Bouten CVC, Smits AIPM, Baaijens FPT. Can We Grow Valves Inside the Heart? Perspective on Material-based In Situ Heart Valve Tissue Engineering. Front Cardiovasc Med 2018; 5:54. [PMID: 29896481 PMCID: PMC5987128 DOI: 10.3389/fcvm.2018.00054] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Accepted: 05/09/2018] [Indexed: 12/14/2022] Open
Abstract
In situ heart valve tissue engineering using cell-free synthetic, biodegradable scaffolds is under development as a clinically attractive approach to create living valves right inside the heart of a patient. In this approach, a valve-shaped porous scaffold "implant" is rapidly populated by endogenous cells that initiate neo-tissue formation in pace with scaffold degradation. While this may constitute a cost-effective procedure, compatible with regulatory and clinical standards worldwide, the new technology heavily relies on the development of advanced biomaterials, the processing thereof into (minimally invasive deliverable) scaffolds, and the interaction of such materials with endogenous cells and neo-tissue under hemodynamic conditions. Despite the first positive preclinical results and the initiation of a small-scale clinical trial by commercial parties, in situ tissue formation is not well understood. In addition, it remains to be determined whether the resulting neo-tissue can grow with the body and preserves functional homeostasis throughout life. More important yet, it is still unknown if and how in situ tissue formation can be controlled under conditions of genetic or acquired disease. Here, we discuss the recent advances of material-based in situ heart valve tissue engineering and highlight the most critical issues that remain before clinical application can be expected. We argue that a combination of basic science - unveiling the mechanisms of the human body to respond to the implanted biomaterial under (patho)physiological conditions - and technological advancements - relating to the development of next generation materials and the prediction of in situ tissue growth and adaptation - is essential to take the next step towards a realistic and rewarding translation of in situ heart valve tissue engineering.
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Affiliation(s)
- Carlijn V. C. Bouten
- Soft Tissue Engineering and Mechanobiology, Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, Netherlands
- Institute for Complex Molecular Systems (ICMS), Eindhoven University of Technology, Eindhoven, Netherlands
| | - Anthal I. P. M. Smits
- Soft Tissue Engineering and Mechanobiology, Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, Netherlands
- Institute for Complex Molecular Systems (ICMS), Eindhoven University of Technology, Eindhoven, Netherlands
| | - Frank P. T. Baaijens
- Soft Tissue Engineering and Mechanobiology, Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, Netherlands
- Institute for Complex Molecular Systems (ICMS), Eindhoven University of Technology, Eindhoven, Netherlands
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