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Zareian R, Zuke SD, Morisawa D, Geertsema RS, Majid M, Wynne C, Milliken JC, Kheradvar A. Early Feasibility Study of a Hybrid Tissue-Engineered Mitral Valve in an Ovine Model. J Cardiovasc Dev Dis 2024; 11:69. [PMID: 38392283 PMCID: PMC10889135 DOI: 10.3390/jcdd11020069] [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: 01/12/2024] [Revised: 02/02/2024] [Accepted: 02/08/2024] [Indexed: 02/24/2024] Open
Abstract
Tissue engineering aims to overcome the current limitations of heart valves by providing a viable alternative using living tissue. Nevertheless, the valves constructed from either decellularized xenogeneic or purely biologic scaffolds are unable to withstand the hemodynamic loads, particularly in the left ventricle. To address this, we have been developing a hybrid tissue-engineered heart valve (H-TEHV) concept consisting of a nondegradable elastomeric scaffold enclosed in a valve-like living tissue constructed from autologous cells. We developed a 21 mm mitral valve scaffold for implantation in an ovine model. Smooth muscle cells/fibroblasts and endothelial cells were extracted, isolated, and expanded from the animal's jugular vein. Next, the scaffold underwent a sequential coating with the sorted cells mixed with collagen type I. The resulting H-TEHV was then implanted into the mitral position of the same sheep through open-heart surgery. Echocardiography scans following the procedure revealed an acceptable valve performance, with no signs of regurgitation. The valve orifice area, measured by planimetry, was 2.9 cm2, the ejection fraction reached 67%, and the mean transmitral pressure gradient was measured at 8.39 mmHg. The animal successfully recovered from anesthesia and was transferred to the vivarium. Upon autopsy, the examination confirmed the integrity of the H-TEHV, with no evidence of tissue dehiscence. The preliminary results from the animal implantation suggest the feasibility of the H-TEHV.
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Affiliation(s)
- Ramin Zareian
- Department of Biomedical Engineering, University of California, Irvine, CA 92697, USA
| | - Samuel D Zuke
- Department of Biomedical Engineering, University of California, Irvine, CA 92697, USA
| | - Daisuke Morisawa
- Department of Biomedical Engineering, University of California, Irvine, CA 92697, USA
| | - Roger S Geertsema
- University Laboratory Animal Resources, Office of Research, University of California, Irvine, CA 92697, USA
| | - Mariwan Majid
- Division of Cardiothoracic Surgery, UC Irvine Medical Center, Orange, CA 92868, USA
| | | | - Jeffrey C Milliken
- Division of Cardiothoracic Surgery, UC Irvine Medical Center, Orange, CA 92868, USA
| | - Arash Kheradvar
- Department of Biomedical Engineering, University of California, Irvine, CA 92697, USA
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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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van der Valk DC, Fomina A, Uiterwijk M, Hooijmans CR, Akiva A, Kluin J, Bouten CV, Smits AI. Calcification in Pulmonary Heart Valve Tissue Engineering. JACC Basic Transl Sci 2023. [DOI: 10.1016/j.jacbts.2022.09.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
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Sustainable applications of polyhydroxyalkanoates in various fields: A critical review. Int J Biol Macromol 2022; 221:1184-1201. [PMID: 36113591 DOI: 10.1016/j.ijbiomac.2022.09.098] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 09/06/2022] [Accepted: 09/10/2022] [Indexed: 01/23/2023]
Abstract
PHA is one of the most promising candidates in bio-polymer family which is biodegradable and environment-friendly in nature. In recent years, it has been applied as a biodegradable alternative for petroleum-based plastic across different domains. In literature, several research groups have scrutinised the biocompatibility and biodegradability of PHA in both in vivo settings as well as in in vitro conditions. Microbial yield polyhydroxyalkanoates (PHAs) are promoted at present as biodegradable plastics. On the other hand, only a limited number of products is being commercially manufactured out of PHAs (e.g., bottles). A succession of microbes (prokaryotes in addition to eukaryotes) has been identified as potential candidates that can disintegrate PHAs. These materials have been successfully employed in packaging industry, medical devices and implants, moulded goods, paper coatings, adhesives, performance additives, mulch films, non-woven fabrics, etc. The present paper reviews and focuses on the potential applications of PHA and its derivatives in different industries.
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Biomedical Applications of Polyhydroxyalkanoate in Tissue Engineering. Polymers (Basel) 2022; 14:polym14112141. [PMID: 35683815 PMCID: PMC9182786 DOI: 10.3390/polym14112141] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 05/19/2022] [Accepted: 05/23/2022] [Indexed: 02/06/2023] Open
Abstract
Tissue engineering technology aids in the regeneration of new tissue to replace damaged or wounded tissue. Three-dimensional biodegradable and porous scaffolds are often utilized in this area to mimic the structure and function of the extracellular matrix. Scaffold material and design are significant areas of biomaterial research and the most favorable material for seeding of in vitro and in vivo cells. Polyhydroxyalkanoates (PHAs) are biopolyesters (thermoplastic) that are appropriate for this application due to their biodegradability, thermo-processability, enhanced biocompatibility, mechanical properties, non-toxicity, and environmental origin. Additionally, they offer enormous potential for modification through biological, chemical and physical alteration, including blending with various other materials. PHAs are produced by bacterial fermentation under nutrient-limiting circumstances and have been reported to offer new perspectives for devices in biological applications. The present review discusses PHAs in the applications of conventional medical devices, especially for soft tissue (sutures, wound dressings, cardiac patches and blood vessels) and hard tissue (bone and cartilage scaffolds) regeneration applications. The paper also addresses a recent advance highlighting the usage of PHAs in implantable devices, such as heart valves, stents, nerve guidance conduits and nanoparticles, including drug delivery. This review summarizes the in vivo and in vitro biodegradability of PHAs and conducts an overview of current scientific research and achievements in the development of PHAs in the biomedical sector. In the future, PHAs may replace synthetic plastics as the material of choice for medical researchers and practitioners.
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Review of the Developments of Bacterial Medium-Chain-Length Polyhydroxyalkanoates (mcl-PHAs). Bioengineering (Basel) 2022; 9:bioengineering9050225. [PMID: 35621503 PMCID: PMC9137849 DOI: 10.3390/bioengineering9050225] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Revised: 05/13/2022] [Accepted: 05/17/2022] [Indexed: 12/30/2022] Open
Abstract
Synthetic plastics derived from fossil fuels—such as polyethylene, polypropylene, polyvinyl chloride, and polystyrene—are non-degradable. A large amount of plastic waste enters landfills and pollutes the environment. Hence, there is an urgent need to produce biodegradable plastics such as polyhydroxyalkanoates (PHAs). PHAs have garnered increasing interest as replaceable materials to conventional plastics due to their broad applicability in various purposes such as food packaging, agriculture, tissue-engineering scaffolds, and drug delivery. Based on the chain length of 3-hydroxyalkanoate repeat units, there are three types PHAs, i.e., short-chain-length (scl-PHAs, 4 to 5 carbon atoms), medium-chain-length (mcl-PHAs, 6 to 14 carbon atoms), and long-chain-length (lcl-PHAs, more than 14 carbon atoms). Previous reviews discussed the recent developments in scl-PHAs, but there are limited reviews specifically focused on the developments of mcl-PHAs. Hence, this review focused on the mcl-PHA production, using various carbon (organic/inorganic) sources and at different operation modes (continuous, batch, fed-batch, and high-cell density). This review also focused on recent developments on extraction methods of mcl-PHAs (solvent, non-solvent, enzymatic, ultrasound); physical/thermal properties (Mw, Mn, PDI, Tm, Tg, and crystallinity); applications in various fields; and their production at pilot and industrial scales in Asia, Europe, North America, and South America.
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Jana S, Morse D, Lerman A. Leaflet Tissue Generation from Microfibrous Heart Valve Leaflet Scaffolds with Native Characteristics. ACS APPLIED BIO MATERIALS 2021; 4:7836-7847. [PMID: 35006765 DOI: 10.1021/acsabm.1c00768] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Mechanical and bioprosthetic valves that are currently applied for replacing diseased heart valves are not fully efficient. Heart valve tissue engineering may solve the issues faced by the prosthetic valves in heart valve replacement. The leaflets of native heart valves have a trilayered structure with layer-specific orientations; thus, it is imperative to develop functional leaflet tissue constructs with a native trilayered, oriented structure. Its key solution is to develop leaflet scaffolds with a native morphology and structure. In this study, microfibrous leaflet scaffolds with a native trilayered and oriented structure were developed in an electrospinning system. The scaffolds were implanted for 3 months in rats subcutaneously to study the scaffold efficiencies in generating functional tissue-engineered leaflet constructs. These in vivo tissue-engineered leaflet constructs had a trilayered, oriented structure similar to native leaflets. The tensile properties of constructs indicated that they were able to endure the hydrodynamic load of the native heart valve. Collagen, glycosaminoglycans, and elastin─the predominant extracellular matrix components of native leaflets─were found sufficiently in the leaflet tissue constructs. The residing cells in the leaflet tissue constructs showed vimentin and α-smooth muscle actin expression, i.e., the constructs were in a growing state. Thus, the trilayered, oriented fibrous leaflet scaffolds produced in this study could be useful to develop heart valve scaffolds for successful heart valve replacements.
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Affiliation(s)
- Soumen Jana
- Department of Bioengineering, University of Missouri, Columbia, Missouri 65211, United States.,Division of Cardiovascular Diseases, Mayo Clinic, 200 First Street SW, Rochester, Minnesota 55905, United States
| | - David Morse
- Division of Cardiovascular Diseases, Mayo Clinic, 200 First Street SW, Rochester, Minnesota 55905, United States
| | - Amir Lerman
- Division of Cardiovascular Diseases, Mayo Clinic, 200 First Street SW, Rochester, Minnesota 55905, United States
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Kaga N, Fujimoto H, Morita S, Yamaguchi Y, Matsuura T. Contact Angle and Cell Adhesion of Micro/Nano-Structured Poly(lactic- co-glycolic acid) Membranes for Dental Regenerative Therapy. Dent J (Basel) 2021; 9:dj9110124. [PMID: 34821588 PMCID: PMC8622355 DOI: 10.3390/dj9110124] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Revised: 10/12/2021] [Accepted: 10/18/2021] [Indexed: 01/03/2023] Open
Abstract
Biodegradable membranes are used in regenerative dentistry for guided tissue regeneration (GTR) and guided bone regeneration (GBR). In this study, patterned poly(lactic-co-glycolic acid) (PLGA) membranes with groove, pillar, and hole structures were successfully fabricated by thermal nanoimprinting. Their surfaces were evaluated for topography by scanning electron microscopy and laser microscopy, for hydrophobicity/hydrophilicity by contact angle analysis, and for MC3T3-E1 cell adhesion. The sizes of the patterns on the surfaces of the membranes were 0.5, 1.0, and 2.0 μm, respectively, with the height/depth being 1.0 μm. The pillared and holed PLGA membranes were significantly more hydrophobic than the non-patterned PLGA membranes (p < 0.05). However, the 0.5 μm- and 1.0 μm-grooved PLGA membranes were significantly more hydrophilic than the non-patterned PLGA membranes (p < 0.05). The 0.5 μm-grooved, pillared, and holed membranes exhibited significantly superior adhesion to the MC3T3-E1 cells than the non-patterned PLGA (p < 0.05). These results suggest that patterned PLGA membranes can be clinically used for GTR and GBR in the dental regeneration field.
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Affiliation(s)
- Naoyuki Kaga
- Section of Fixed Prosthodontics, Department of Oral Rehabilitation, Fukuoka Dental College, Fukuoka 814-0193, Japan; (H.F.); (S.M.); (Y.Y.); (T.M.)
- Oral Medicine Research Center, Fukuoka Dental College, Fukuoka 814-0193, Japan
- Correspondence: ; Tel.: +81-92-801-0411
| | - Hiroki Fujimoto
- Section of Fixed Prosthodontics, Department of Oral Rehabilitation, Fukuoka Dental College, Fukuoka 814-0193, Japan; (H.F.); (S.M.); (Y.Y.); (T.M.)
| | - Sho Morita
- Section of Fixed Prosthodontics, Department of Oral Rehabilitation, Fukuoka Dental College, Fukuoka 814-0193, Japan; (H.F.); (S.M.); (Y.Y.); (T.M.)
| | - Yuichiro Yamaguchi
- Section of Fixed Prosthodontics, Department of Oral Rehabilitation, Fukuoka Dental College, Fukuoka 814-0193, Japan; (H.F.); (S.M.); (Y.Y.); (T.M.)
| | - Takashi Matsuura
- Section of Fixed Prosthodontics, Department of Oral Rehabilitation, Fukuoka Dental College, Fukuoka 814-0193, Japan; (H.F.); (S.M.); (Y.Y.); (T.M.)
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Uiterwijk M, van der Valk DC, van Vliet R, de Brouwer IJ, Hooijmans CR, Kluin J. Pulmonary valve tissue engineering strategies in large animal models. PLoS One 2021; 16:e0258046. [PMID: 34610023 PMCID: PMC8491907 DOI: 10.1371/journal.pone.0258046] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Accepted: 09/16/2021] [Indexed: 01/10/2023] Open
Abstract
In the last 25 years, numerous tissue engineered heart valve (TEHV) strategies have been studied in large animal models. To evaluate, qualify and summarize all available publications, we conducted a systematic review and meta-analysis. We identified 80 reports that studied TEHVs of synthetic or natural scaffolds in pulmonary position (n = 693 animals). We identified substantial heterogeneity in study designs, methods and outcomes. Most importantly, the quality assessment showed poor reporting in randomization and blinding strategies. Meta-analysis showed no differences in mortality and rate of valve regurgitation between different scaffolds or strategies. However, it revealed a higher transvalvular pressure gradient in synthetic scaffolds (11.6 mmHg; 95% CI, [7.31-15.89]) compared to natural scaffolds (4,67 mmHg; 95% CI, [3,94-5.39]; p = 0.003). These results should be interpreted with caution due to lack of a standardized control group, substantial study heterogeneity, and relatively low number of comparable studies in subgroup analyses. Based on this review, the most adequate scaffold model is still undefined. This review endorses that, to move the TEHV field forward and enable reliable comparisons, it is essential to define standardized methods and ways of reporting. This would greatly enhance the value of individual large animal studies.
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Affiliation(s)
- M. Uiterwijk
- Heart Center, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - D. C. van der Valk
- Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
- Institute for Complex Molecular Systems, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - R. van Vliet
- Faculty of medicine, University of Amsterdam, Amsterdam, The Netherlands
| | - I. J. de Brouwer
- Faculty of medicine, University of Amsterdam, Amsterdam, The Netherlands
| | - C. R. Hooijmans
- Department for Health Evidence Unit SYRCLE, Radboud University Medical Center, Nijmegen, The Netherlands
- Department of Anesthesiology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - J. Kluin
- Heart Center, Amsterdam University Medical Center, Amsterdam, The Netherlands
- * E-mail:
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Karakaya C, van Asten JGM, Ristori T, Sahlgren CM, Loerakker S. Mechano-regulated cell-cell signaling in the context of cardiovascular tissue engineering. Biomech Model Mechanobiol 2021; 21:5-54. [PMID: 34613528 PMCID: PMC8807458 DOI: 10.1007/s10237-021-01521-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 09/15/2021] [Indexed: 01/18/2023]
Abstract
Cardiovascular tissue engineering (CVTE) aims to create living tissues, with the ability to grow and remodel, as replacements for diseased blood vessels and heart valves. Despite promising results, the (long-term) functionality of these engineered tissues still needs improvement to reach broad clinical application. The functionality of native tissues is ensured by their specific mechanical properties directly arising from tissue organization. We therefore hypothesize that establishing a native-like tissue organization is vital to overcome the limitations of current CVTE approaches. To achieve this aim, a better understanding of the growth and remodeling (G&R) mechanisms of cardiovascular tissues is necessary. Cells are the main mediators of tissue G&R, and their behavior is strongly influenced by both mechanical stimuli and cell-cell signaling. An increasing number of signaling pathways has also been identified as mechanosensitive. As such, they may have a key underlying role in regulating the G&R of tissues in response to mechanical stimuli. A more detailed understanding of mechano-regulated cell-cell signaling may thus be crucial to advance CVTE, as it could inspire new methods to control tissue G&R and improve the organization and functionality of engineered tissues, thereby accelerating clinical translation. In this review, we discuss the organization and biomechanics of native cardiovascular tissues; recent CVTE studies emphasizing the obtained engineered tissue organization; and the interplay between mechanical stimuli, cell behavior, and cell-cell signaling. In addition, we review past contributions of computational models in understanding and predicting mechano-regulated tissue G&R and cell-cell signaling to highlight their potential role in future CVTE strategies.
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Affiliation(s)
- Cansu Karakaya
- Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands.,Institute for Complex Molecular Systems, Eindhoven University of Technology, Eindhoven, the Netherlands
| | - Jordy G M van Asten
- Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands.,Institute for Complex Molecular Systems, Eindhoven University of Technology, Eindhoven, the Netherlands
| | - Tommaso Ristori
- Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands.,Institute for Complex Molecular Systems, Eindhoven University of Technology, Eindhoven, the Netherlands.,Department of Biomedical Engineering, Boston University, Boston, MA, USA
| | - Cecilia M Sahlgren
- Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands.,Institute for Complex Molecular Systems, Eindhoven University of Technology, Eindhoven, the Netherlands.,Faculty of Science and Engineering, Biosciences, Åbo Akademi, Turku, Finland
| | - Sandra Loerakker
- Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands. .,Institute for Complex Molecular Systems, Eindhoven University of Technology, Eindhoven, the Netherlands.
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12
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Heim F. Heart valves from polymeric fibers: potential and limits. THE JOURNAL OF CARDIOVASCULAR SURGERY 2020; 61:586-595. [DOI: 10.23736/s0021-9509.20.11604-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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13
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Biermann AC, Marzi J, Brauchle E, Wichmann JL, Arendt CT, Puntmann V, Nagel E, Abdelaziz S, Winter AG, Brockbank KGM, Layland S, Schenke-Layland K, Stock UA. Improved long-term durability of allogeneic heart valves in the orthotopic sheep model. Eur J Cardiothorac Surg 2020; 55:484-493. [PMID: 30165639 DOI: 10.1093/ejcts/ezy292] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2018] [Revised: 07/16/2018] [Accepted: 07/20/2018] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES Frozen cryopreservation (FC) with the vapour phase of liquid nitrogen storage (-135°C) is a standard biobank technique to preserve allogeneic heart valves to enable a preferable allograft valve replacement in clinical settings. However, their long-term function is limited by immune responses, inflammation and structural degeneration. Ice-free cryopreserved (IFC) valves with warmer storage possibilities at -80°C showed better matrix preservation and decreased immunological response in preliminary short-term in vivo studies. Our study aimed to assess the prolonged performance of IFC allografts in an orthotopic pulmonary sheep model. METHODS FC (n = 6) and IFC (n = 6) allografts were transplanted into juvenile Merino sheep. After 12 months of implantation, functionality testing via 2-dimensional echocardiography and histological analyses was performed. In addition, multiphoton autofluorescence imaging and Raman microspectroscopy analysis were applied to qualitatively and quantitatively assess the matrix integrity of the leaflets. RESULTS Six animals from the FC group and 5 animals from the IFC group were included in the analysis. Histological explant analysis showed early inflammation in the FC valves, whereas sustainable, fully functional, devitalized acellular IFC grafts were obtained. IFC valves showed excellent haemodynamic data with fewer gradients, no pulmonary regurgitation, no calcification and acellularity. Structural remodelling of the leaflet matrix structure was only detected in FC-treated tissue, whereas IFC valves maintained matrix integrity comparable to that of native controls. The collagen crimp period and amplitude and elastin structure were significantly different in the FC valve cusps compared to IFC and native cusps. Collagen fibres in the FC valves were less aligned and straightened. CONCLUSIONS IFC heart valves with good haemodynamic function, reduced immunogenicity and preserved matrix structures have the potential to overcome the known limitations of the clinically applied FC valve.
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Affiliation(s)
- Anna Christina Biermann
- Department of Thoracic and Cardiovascular Surgery, University Hospital Frankfurt, Goethe University, Frankfurt am Main, Germany.,Department of Cardiothoracic Surgery, Royal Brompton and Harefield Foundation Trust, Harefield, UK.,Department of Women's Health, Research Institute for Women's Health, Eberhard-Karls-University Tuebingen, Tuebingen, Germany
| | - Julia Marzi
- Department of Women's Health, Research Institute for Women's Health, Eberhard-Karls-University Tuebingen, Tuebingen, Germany
| | - Eva Brauchle
- Department of Women's Health, Research Institute for Women's Health, Eberhard-Karls-University Tuebingen, Tuebingen, Germany
| | - Julian Lukas Wichmann
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Goethe University, Frankfurt am Main, Germany
| | - Christophe Theo Arendt
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Goethe University, Frankfurt am Main, Germany
| | - Valentina Puntmann
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Goethe University, Frankfurt am Main, Germany
| | - Eike Nagel
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Goethe University, Frankfurt am Main, Germany
| | - Sherif Abdelaziz
- Department of Thoracic and Cardiovascular Surgery, University Hospital Frankfurt, Goethe University, Frankfurt am Main, Germany
| | - Andreas Gerhard Winter
- Department of Thoracic and Cardiovascular Surgery, University Hospital Frankfurt, Goethe University, Frankfurt am Main, Germany
| | - Kelvin Gordon Mashader Brockbank
- Tissue Testing Technologies LLC, North Charleston, SC, USA.,Department of Bioengineering, Clemson University, North Charleston, SC, USA
| | - Shannon Layland
- Department of Women's Health, Research Institute for Women's Health, Eberhard-Karls-University Tuebingen, Tuebingen, Germany
| | - Katja Schenke-Layland
- Department of Women's Health, Research Institute for Women's Health, Eberhard-Karls-University Tuebingen, Tuebingen, Germany.,Department of Medicine/Cardiology, Cardiovascular Research Laboratories, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.,Natural and Medical Sciences Institute at the University of Tuebingen (NMI), Reutlingen, Germany
| | - Ulrich Alfred Stock
- Department of Thoracic and Cardiovascular Surgery, University Hospital Frankfurt, Goethe University, Frankfurt am Main, Germany.,Department of Cardiothoracic Surgery, Royal Brompton and Harefield Foundation Trust, Harefield, UK.,Faculty of Medicine, Imperial College London, London, UK.,Magdi Yacoube Institute, Heart Science Center, Harefield, UK
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Bédard P, Gauvin S, Ferland K, Caneparo C, Pellerin È, Chabaud S, Bolduc S. Innovative Human Three-Dimensional Tissue-Engineered Models as an Alternative to Animal Testing. Bioengineering (Basel) 2020; 7:E115. [PMID: 32957528 PMCID: PMC7552665 DOI: 10.3390/bioengineering7030115] [Citation(s) in RCA: 56] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2020] [Revised: 09/11/2020] [Accepted: 09/15/2020] [Indexed: 12/12/2022] Open
Abstract
Animal testing has long been used in science to study complex biological phenomena that cannot be investigated using two-dimensional cell cultures in plastic dishes. With time, it appeared that more differences could exist between animal models and even more when translated to human patients. Innovative models became essential to develop more accurate knowledge. Tissue engineering provides some of those models, but it mostly relies on the use of prefabricated scaffolds on which cells are seeded. The self-assembly protocol has recently produced organ-specific human-derived three-dimensional models without the need for exogenous material. This strategy will help to achieve the 3R principles.
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Affiliation(s)
- Patrick Bédard
- Faculté de Médecine, Sciences Biomédicales, Université Laval, Québec, QC G1V 0A6, Canada; (P.B.); (S.G.); (K.F.)
- Centre de Recherche en Organogénèse Expérimentale de l’Université Laval/LOEX, Centre de Recherche du CHU de Québec-Université Laval, Axe Médecine Régénératrice, Québec, QC G1J 1Z4, Canada; (C.C.); (È.P.); (S.C.)
| | - Sara Gauvin
- Faculté de Médecine, Sciences Biomédicales, Université Laval, Québec, QC G1V 0A6, Canada; (P.B.); (S.G.); (K.F.)
- Centre de Recherche en Organogénèse Expérimentale de l’Université Laval/LOEX, Centre de Recherche du CHU de Québec-Université Laval, Axe Médecine Régénératrice, Québec, QC G1J 1Z4, Canada; (C.C.); (È.P.); (S.C.)
| | - Karel Ferland
- Faculté de Médecine, Sciences Biomédicales, Université Laval, Québec, QC G1V 0A6, Canada; (P.B.); (S.G.); (K.F.)
- Centre de Recherche en Organogénèse Expérimentale de l’Université Laval/LOEX, Centre de Recherche du CHU de Québec-Université Laval, Axe Médecine Régénératrice, Québec, QC G1J 1Z4, Canada; (C.C.); (È.P.); (S.C.)
| | - Christophe Caneparo
- Centre de Recherche en Organogénèse Expérimentale de l’Université Laval/LOEX, Centre de Recherche du CHU de Québec-Université Laval, Axe Médecine Régénératrice, Québec, QC G1J 1Z4, Canada; (C.C.); (È.P.); (S.C.)
| | - Ève Pellerin
- Centre de Recherche en Organogénèse Expérimentale de l’Université Laval/LOEX, Centre de Recherche du CHU de Québec-Université Laval, Axe Médecine Régénératrice, Québec, QC G1J 1Z4, Canada; (C.C.); (È.P.); (S.C.)
| | - Stéphane Chabaud
- Centre de Recherche en Organogénèse Expérimentale de l’Université Laval/LOEX, Centre de Recherche du CHU de Québec-Université Laval, Axe Médecine Régénératrice, Québec, QC G1J 1Z4, Canada; (C.C.); (È.P.); (S.C.)
| | - Stéphane Bolduc
- Centre de Recherche en Organogénèse Expérimentale de l’Université Laval/LOEX, Centre de Recherche du CHU de Québec-Université Laval, Axe Médecine Régénératrice, Québec, QC G1J 1Z4, Canada; (C.C.); (È.P.); (S.C.)
- Département de Chirurgie, Faculté de Médecine, Université Laval, Québec, QC G1V 0A6, Canada
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15
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Choi SY, Cho IJ, Lee Y, Kim YJ, Kim KJ, Lee SY. Microbial Polyhydroxyalkanoates and Nonnatural Polyesters. ADVANCED MATERIALS (DEERFIELD BEACH, FLA.) 2020; 32:e1907138. [PMID: 32249983 DOI: 10.1002/adma.201907138] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Revised: 01/20/2020] [Indexed: 06/11/2023]
Abstract
Microorganisms produce diverse polymers for various purposes such as storing genetic information, energy, and reducing power, and serving as structural materials and scaffolds. Among these polymers, polyhydroxyalkanoates (PHAs) are microbial polyesters synthesized and accumulated intracellularly as a storage material of carbon, energy, and reducing power under unfavorable growth conditions in the presence of excess carbon source. PHAs have attracted considerable attention for their wide range of applications in industrial and medical fields. Since the first discovery of PHA accumulating bacteria about 100 years ago, remarkable advances have been made in the understanding of PHA biosynthesis and metabolic engineering of microorganisms toward developing efficient PHA producers. Recently, nonnatural polyesters have also been synthesized by metabolically engineered microorganisms, which opened a new avenue toward sustainable production of more diverse plastics. Herein, the current state of PHAs and nonnatural polyesters is reviewed, covering mechanisms of microbial polyester biosynthesis, metabolic pathways, and enzymes involved in biosynthesis of short-chain-length PHAs, medium-chain-length PHAs, and nonnatural polyesters, especially 2-hydroxyacid-containing polyesters, metabolic engineering strategies to produce novel polymers and enhance production capabilities and fermentation, and downstream processing strategies for cost-effective production of these microbial polyesters. In addition, the applications of PHAs and prospects are discussed.
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Affiliation(s)
- So Young Choi
- Metabolic and Biomolecular Engineering National Research Laboratory, Systems Metabolic Engineering and Systems Healthcare Cross-Generation Collaborative Laboratory, Department of Chemical and Biomolecular Engineering (BK21 Plus Program), Institute for the BioCentury, Korea Advanced Institute of Science and Technology (KAIST), 291 Daehak-ro, Yuseong-gu, Daejeon, 34141, Republic of Korea
| | - In Jin Cho
- Metabolic and Biomolecular Engineering National Research Laboratory, Systems Metabolic Engineering and Systems Healthcare Cross-Generation Collaborative Laboratory, Department of Chemical and Biomolecular Engineering (BK21 Plus Program), Institute for the BioCentury, Korea Advanced Institute of Science and Technology (KAIST), 291 Daehak-ro, Yuseong-gu, Daejeon, 34141, Republic of Korea
| | - Youngjoon Lee
- Metabolic and Biomolecular Engineering National Research Laboratory, Systems Metabolic Engineering and Systems Healthcare Cross-Generation Collaborative Laboratory, Department of Chemical and Biomolecular Engineering (BK21 Plus Program), Institute for the BioCentury, Korea Advanced Institute of Science and Technology (KAIST), 291 Daehak-ro, Yuseong-gu, Daejeon, 34141, Republic of Korea
| | - Yeo-Jin Kim
- School of Life Sciences (KNU Creative BioResearch Group), KNU Institute for Microorganisms, Kyungpook National University, 80 Daehak-ro, Buk-gu, Daegu, 41566, Republic of Korea
| | - Kyung-Jin Kim
- School of Life Sciences (KNU Creative BioResearch Group), KNU Institute for Microorganisms, Kyungpook National University, 80 Daehak-ro, Buk-gu, Daegu, 41566, Republic of Korea
| | - Sang Yup Lee
- Metabolic and Biomolecular Engineering National Research Laboratory, Systems Metabolic Engineering and Systems Healthcare Cross-Generation Collaborative Laboratory, Department of Chemical and Biomolecular Engineering (BK21 Plus Program), Institute for the BioCentury, Korea Advanced Institute of Science and Technology (KAIST), 291 Daehak-ro, Yuseong-gu, Daejeon, 34141, Republic of Korea
- BioProcess Engineering Research Center and Bioinformatics Research Center, Korea Advanced Institute of Science and Technology (KAIST), 291 Daehak-ro, Yuseong-gu, Daejeon, 34141, Republic of Korea
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16
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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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18
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Jana S. Endothelialization of cardiovascular devices. Acta Biomater 2019; 99:53-71. [PMID: 31454565 DOI: 10.1016/j.actbio.2019.08.042] [Citation(s) in RCA: 74] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Revised: 07/19/2019] [Accepted: 08/22/2019] [Indexed: 01/10/2023]
Abstract
Blood-contacting surfaces of cardiovascular devices are not biocompatible for creating an endothelial layer on them. Numerous research studies have mainly sought to modify these surfaces through physical, chemical and biological means to ease early endothelial cell (EC) adhesion, migration and proliferation, and eventually to build an endothelial layer on the surfaces. The first priority for surface modification is inhibition of protein adsorption that leads to inhibition of platelet adhesion to the device surfaces, which may favor EC adhesion. Surface modification through surface texturing, if applicable, can bring some hopeful outcomes in this regard. Surface modifications through chemical and/or biological means may play a significant role in easy endothelialization of cardiovascular devices and inhibit smooth muscle cell proliferation. Cellular engineering of cells relevant to endothelialization can boost the positive outcomes obtained through surface engineering. This review briefly summarizes recent developments and research in early endothelialization of cardiovascular devices. STATEMENT OF SIGNIFICANCE: Endothelialization of cardiovascular implants, including heart valves, vascular stents and vascular grafts is crucial to solve many problems in our health care system. Numerous research efforts have been made to improve endothelialization on the surfaces of cardiovascular implants, mainly through surface modifications in three ways - physically, chemically and biologically. This review is intended to highlight comprehensive research studies to date on surface modifications aiming for early endothelialization on the blood-contacting surfaces of cardiovascular implants. It also discusses future perspectives to help guide endothelialization strategies and inspire further innovations.
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Affiliation(s)
- Soumen Jana
- Department of Bioengineering, University of Missouri, Columbia, MO 65211, USA.
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19
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Current Challenges and Emergent Technologies for Manufacturing Artificial Right Ventricle to Pulmonary Artery (RV-PA) Cardiac Conduits. Cardiovasc Eng Technol 2019; 10:205-215. [DOI: 10.1007/s13239-019-00406-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Accepted: 02/05/2019] [Indexed: 01/12/2023]
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20
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Ye H, Zhang K, Kai D, Li Z, Loh XJ. Polyester elastomers for soft tissue engineering. Chem Soc Rev 2018; 47:4545-4580. [PMID: 29722412 DOI: 10.1039/c8cs00161h] [Citation(s) in RCA: 115] [Impact Index Per Article: 19.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Polyester elastomers are soft, biodegradable and biocompatible and are commonly used in various biomedical applications, especially in tissue engineering. These synthetic polyesters can be easily fabricated using various techniques such as solvent casting, particle leaching, molding, electrospinning, 3-dimensional printing, photolithography, microablation etc. A large proportion of tissue engineering research efforts have focused on the use of allografts, decellularized animal scaffolds or other biological materials as scaffolds, but they face the major concern of triggering immunological responses from the host, on top of other issues. This review paper will introduce the recent developments in elastomeric polyesters, their synthesis and fabrication techniques, as well as their application in the biomedical field, focusing primarily on tissue engineering in ophthalmology, cardiac and vascular systems. Some of the commercial and near-commercial polyesters used in these tissue engineering fields will also be described.
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Affiliation(s)
- Hongye Ye
- Institute of Materials Research and Engineering (IMRE), 2 Fusionopolis Way, #08-03 Innovis, Singapore 138634, Singapore.
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21
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Murala JS, Vela RJ, Geoffrion T, Chopra S, Guhathakurtha S, Pezzella T, Cherian KM. Right ventricular outflow tract obstruction: a quest for ideal management. Asian Cardiovasc Thorac Ann 2018; 26:451-460. [PMID: 29860893 DOI: 10.1177/0218492318779963] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Management of right ventricular outflow tract obstruction has undergone much change over the last century. Techniques described in the literature include anatomical repairs and the use of various patches, conduits, and innovative grafts. However, many of these approaches require reoperations or catheter-based interventions, leading to increased morbidity, mortality, and cost. The search for the ideal long-lasting conduit continues and there are new techniques on the horizon, using genetic engineering and nanotechnology. This review discusses the evolution of various techniques for repair of right ventricular outflow tract obstruction, past and current conduits, as well as ongoing research.
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Affiliation(s)
- John Sk Murala
- 1 Department of Cardiovascular and Thoracic Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Ryan J Vela
- 1 Department of Cardiovascular and Thoracic Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Tracy Geoffrion
- 1 Department of Cardiovascular and Thoracic Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Surpreet Chopra
- 2 Department of Cardiovascular and Thoracic Surgery, Government Medical College and Super Specialty Hospital, Nagpur, India
| | - Soma Guhathakurtha
- 3 Department of Engineering Design, Indian Institute of Technology Chennai, India
| | - Thomas Pezzella
- 4 International Children's Heart Fund, Boca Raton, Florida, USA
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22
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Adamski M, Fontana G, Gershlak JR, Gaudette GR, Le HD, Murphy WL. Two Methods for Decellularization of Plant Tissues for Tissue Engineering Applications. J Vis Exp 2018:57586. [PMID: 29912197 PMCID: PMC6101437 DOI: 10.3791/57586] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
The autologous, synthetic, and animal-derived grafts currently used as scaffolds for tissue replacement have limitations due to low availability, poor biocompatibility, and cost. Plant tissues have favorable characteristics that make them uniquely suited for use as scaffolds, such as high surface area, excellent water transport and retention, interconnected porosity, preexisting vascular networks, and a wide range of mechanical properties. Two successful methods of plant decellularization for tissue engineering applications are described here. The first method is based on detergent baths to remove cellular matter, which is similar to previously established methods used to clear mammalian tissues. The second is a detergent-free method adapted from a protocol that isolates leaf vasculature and involves the use of a heated bleach and salt bath to clear the leaves and stems. Both methods yield scaffolds with comparable mechanical properties and low cellular metabolic impact, thus allowing the user to select the protocol which better suits their intended application.
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Affiliation(s)
| | - Gianluca Fontana
- Department of Orthopedics and Rehabilitation, University of Wisconsin School of Medicine and Public Health
| | - Joshua R Gershlak
- Department of Biomedical Engineering, Worcester Polytechnic Institute
| | - Glenn R Gaudette
- Department of Biomedical Engineering, Worcester Polytechnic Institute
| | - Hau D Le
- Department of Surgery, University of Wisconsin-Madison
| | - William L Murphy
- Department of Orthopedics and Rehabilitation, University of Wisconsin School of Medicine and Public Health; Department of Biomedical Engineering, University of Wisconsin College of Engineering;
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23
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Biermann AC, Marzi J, Brauchle E, Schneider M, Kornberger A, Abdelaziz S, Wichmann JL, Arendt CT, Nagel E, Brockbank KGM, Seifert M, Schenke-Layland K, Stock UA. Impact of T-cell-mediated immune response on xenogeneic heart valve transplantation: short-term success and mid-term failure. Eur J Cardiothorac Surg 2018; 53:784-792. [PMID: 29186380 DOI: 10.1093/ejcts/ezx396] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Accepted: 10/23/2017] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES Allogeneic frozen cryopreserved heart valves (allografts or homografts) are commonly used in clinical practice. A major obstacle for their application is the limited availability in particular for paediatrics. Allogeneic large animal studies revealed that alternative ice-free cryopreservation (IFC) results in better matrix preservation and reduced immunogenicity. The objective of this study was to evaluate xenogeneic (porcine) compared with allogeneic (ovine) IFC heart valves in a large animal study. METHODS IFC xenografts and allografts were transplanted in 12 juvenile merino sheep for 1-12 weeks. Immunohistochemistry, ex vivo computed tomography scans and transforming growth factor-β release profiles were analysed to evaluate postimplantation immunopathology. In addition, near-infrared multiphoton imaging and Raman spectroscopy were employed to evaluate matrix integrity of the leaflets. RESULTS Acellular leaflets were observed in both groups 1 week after implantation. Allogeneic leaflets remained acellular throughout the entire study. In contrast, xenogeneic valves were infiltrated with abundant T-cells and severely thickened over time. No collagen or elastin changes could be detected in either group using multiphoton imaging. Raman spectroscopy with principal component analysis focusing on matrix-specific peaks confirmed no significant differences for explanted allografts. However, xenografts demonstrated clear matrix changes, enabling detection of distinct inflammatory-driven changes but without variations in the level of transforming growth factor-β. CONCLUSIONS Despite short-term success, mid-term failure of xenogeneic IFC grafts due to a T-cell-mediated extracellular matrix-triggered immune response was shown.
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Affiliation(s)
- Anna C Biermann
- Department of Thoracic and Cardiovascular Surgery, University Hospital Frankfurt, Goethe University, Frankfurt am Main, Germany.,Department of Cardiothoracic Surgery, Royal Brompton and Harefield Foundation Trust, Harefield, UK.,Department of Women's Health, Research Institute for Women's Health, Eberhard-Karls-University, Tuebingen, Germany
| | - Julia Marzi
- Department of Women's Health, Research Institute for Women's Health, Eberhard-Karls-University, Tuebingen, Germany.,Department of Cell and Tissue Engineering, Fraunhofer Institute for Interfacial Engineering and Biotechnology (IGB), Stuttgart, Germany
| | - Eva Brauchle
- Department of Women's Health, Research Institute for Women's Health, Eberhard-Karls-University, Tuebingen, Germany.,Department of Cell and Tissue Engineering, Fraunhofer Institute for Interfacial Engineering and Biotechnology (IGB), Stuttgart, Germany
| | - Maria Schneider
- Institue of Medical Immunology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Berlin, Germany.,Berlin-Brandenburg Center of Regenerative Therapies (BCRT), Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Berlin, Germany
| | - Angela Kornberger
- Department of Cardiothoracic and Vascular Surgery, Johannes Gutenberg-University, Mainz, Germany
| | - Sherif Abdelaziz
- Department of Thoracic and Cardiovascular Surgery, University Hospital Frankfurt, Goethe University, Frankfurt am Main, Germany
| | - Julian L Wichmann
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Goethe University, Frankfurt am Main, Germany
| | - Christophe T Arendt
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Goethe University, Frankfurt am Main, Germany
| | - Eike Nagel
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Goethe University, Frankfurt am Main, Germany
| | - Kelvin G M Brockbank
- Tissue Testing Technologies LLC, North Charleston, SC, USA.,Department of Bioengineering, Clemson University, North Charleston, SC, USA
| | - Martina Seifert
- Institue of Medical Immunology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Berlin, Germany.,Berlin-Brandenburg Center of Regenerative Therapies (BCRT), Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Berlin, Germany
| | - Katja Schenke-Layland
- Department of Women's Health, Research Institute for Women's Health, Eberhard-Karls-University, Tuebingen, Germany.,Department of Cell and Tissue Engineering, Fraunhofer Institute for Interfacial Engineering and Biotechnology (IGB), Stuttgart, Germany.,Department of Medicine / Cardiology, Cardiovascular Research Laboratories, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Ulrich A Stock
- Department of Thoracic and Cardiovascular Surgery, University Hospital Frankfurt, Goethe University, Frankfurt am Main, Germany.,Department of Cardiothoracic Surgery, Royal Brompton and Harefield Foundation Trust, Harefield, UK.,Faculty of Medicine, Imperial College London, London, UK.,Magdi Yacoub Institute, Heart Science Centre, Harefield, UK
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24
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Kim W, Park J, Park Y, Hwang C, Jo Y, Min B, Yoon C, Lee TY. Tissue-Engineered Heart Valve Leaflets: An Effective Method for Seeding Autologous Cells on Scaffolds. Int J Artif Organs 2018. [DOI: 10.1177/039139880002300905] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background A precondition for the successful formation of tissue-engineered heart valves is the generation of a proper matrix on biodegradable scaffolds over a limited period of time. The aim of this study was to find an effective method of seeding autologous cells on these scaffolds to create a new matrix for heart valves. Methods Myofibroblasts and endothelial cells were isolated and cultured from an ovine artery. A synthetic biodegradable scaffold consisting of polyglycolic and polylactic acids was seeded first with the myofibroblasts, then coated with endothelial cells. Three different methods of myofibroblast seeding were compared: I) daily seeding of myofibroblasts (1×106) for ten days and culture for four days; II) seeding of myofibroblasts (1×107) and culture for 14 days with the use of a simple medium; III) seeding of myofibroblasts (1×107) with the use of a medium containing collagen and culture for 14 days. Light and electron microscopic analyses were perfomed. Results The group that used the medium containing collagen showed the best results in terms of seeding efficiency. Conclusion Seeding autologous cells with a medium containing collagen onto the scaffold showed the largest cell population and might generate the best matrix on the scaffold.
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Affiliation(s)
- W.G. Kim
- Department of Thoracic and Cardiovascular Surgery and Clinical Research Institute, BK21 Human Life Sciences
| | | | - Y.N. Park
- Department of Biomedical Engineering, Seoul National University College of Medicine and Heart Research Institute, Seoul National University Hospital
| | - C.M. Hwang
- Department of Biomedical Engineering, Seoul National University College of Medicine and Heart Research Institute, Seoul National University Hospital
| | - Y.H. Jo
- Department of Biomedical Engineering, Seoul National University College of Medicine and Heart Research Institute, Seoul National University Hospital
| | - B.G. Min
- Department of Biomedical Engineering, Seoul National University College of Medicine and Heart Research Institute, Seoul National University Hospital
| | - C.J. Yoon
- Department of Thoracic and Cardiovascular Surgery and Clinical Research Institute, BK21 Human Life Sciences
| | - T.-Y. Lee
- Sanggye Paik Hospital, Seoul - Korea
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25
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Kim W, Cho S, Kang MC, Lee TY, Park J. Tissue-Engineered Heart Valve Leaflets: An Animal Study. Int J Artif Organs 2018. [DOI: 10.1177/039139880102400907] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Tissue-engineered heart valve leaflets are a promising way to overcome the inherent limitations of current prosthetic valves. The aim of this study was to compare the biological responses of an autologous cell seeded scaffold and an acellular scaffold implanted in the pulmonary valve leaflet in the same animal. Methods Myofibroblasts and endothelial cells were isolated and cultured from an ovine artery. A synthetic biodegradable scaffold consisting of polyglycolic acid and polylactic acid was initially seeded with the myofibroblasts, then coated with endothelial cells. Cells were seeded using a medium containing collagen and cultured. A tissue-engineered construct and a plain scaffold were implanted as double pulmonary valve leaflet replacement in the same animal in an ovine model (n=3). Additionally, the tissue-engineered construct (n=2) and the plain scaffold (n=2) were implanted as single valve leaflet replacements for long-term analysis. After sacrifice, the implanted valve leaflet tissues were retrieved, analyzed visually and using light microscopy. Results Three animals that underwent replacement of two valve leaflets with a tissue-engineered construct and a plain scaffold, survived only a short-time (12, 24, 36 hours). The death was attributed to heart failure caused by severe pulmonary insufficiency. Animals that underwent single valve leaflet replacement survived longer and were electively sacrificed at 6 and 9 weeks after operation. The analysis of the leaflets from the short-term survivors showed that the tissue-engineered constructs contained less fibrins and protein exudates than the plain scaffold. In contrast, leaflets obtained from animals surviving 6 and 9 weeks showed similar well organized granulation tissues in the tissue-engineered constructs and the plain scaffolds. Conclusion This animal experiment demonstrates that in the early phase of implantation, the tissue-engineered construct shows a better biological response in terms of antithrombogenicity than the plain scaffold, although both of them have similar results in the later reparative phase.
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Affiliation(s)
- W.G. Kim
- Department of Thoracic and Cardiovascular Surgery and Heart Research Institute, Seoul National University College of Medicine and Clinical Research Institute, Seoul National University Hospital, Seoul - Korea
| | - S.K. Cho
- Department of Thoracic and Cardiovascular Surgery and Heart Research Institute, Seoul National University College of Medicine and Clinical Research Institute, Seoul National University Hospital, Seoul - Korea
| | - M-C. Kang
- Department of Thoracic and Cardiovascular Surgery and Heart Research Institute, Seoul National University College of Medicine and Clinical Research Institute, Seoul National University Hospital, Seoul - Korea
| | - T-Y. Lee
- Department of Thoracic and Cardiovascular Surgery and Heart Research Institute, Seoul National University College of Medicine and Clinical Research Institute, Seoul National University Hospital, Seoul - Korea
| | - J.K. Park
- Department of Thoracic and Cardiovascular Surgery and Heart Research Institute, Seoul National University College of Medicine and Clinical Research Institute, Seoul National University Hospital, Seoul - Korea
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26
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Blum KM, Drews JD, Breuer CK. Tissue-Engineered Heart Valves: A Call for Mechanistic Studies. TISSUE ENGINEERING PART B-REVIEWS 2018; 24:240-253. [PMID: 29327671 DOI: 10.1089/ten.teb.2017.0425] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Heart valve disease carries a substantial risk of morbidity and mortality. Outcomes are significantly improved by valve replacement, but currently available mechanical and biological replacement valves are associated with complications of their own. Mechanical valves have a high rate of thromboembolism and require lifelong anticoagulation. Biological prosthetic valves have a much shorter lifespan, and they are prone to tearing and degradation. Both types of valves lack the capacity for growth, making them particularly problematic in pediatric patients. Tissue engineering has the potential to overcome these challenges by creating a neovalve composed of native tissue that is capable of growth and remodeling. The first tissue-engineered heart valve (TEHV) was created more than 20 years ago in an ovine model, and the technology has been advanced to clinical trials in the intervening decades. Some TEHVs have had clinical success, whereas others have failed, with structural degeneration resulting in patient deaths. The etiologies of these complications are poorly understood because much of the research in this field has been performed in large animals and humans, and, therefore, there are few studies of the mechanisms of neotissue formation. This review examines the need for a TEHV to treat pediatric patients with valve disease, the history of TEHVs, and a future that would benefit from extension of the reverse translational trend in this field to include small animal studies.
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Affiliation(s)
- Kevin M Blum
- 1 Center for Regenerative Medicine, The Research Institute at Nationwide Children's Hospital , Columbus, Ohio.,2 The Ohio State University College of Medicine , Columbus, Ohio
| | - Joseph D Drews
- 1 Center for Regenerative Medicine, The Research Institute at Nationwide Children's Hospital , Columbus, Ohio.,3 Department of Surgery, The Ohio State University Wexner Medical Center , Columbus, Ohio
| | - Christopher K Breuer
- 1 Center for Regenerative Medicine, The Research Institute at Nationwide Children's Hospital , Columbus, Ohio.,3 Department of Surgery, The Ohio State University Wexner Medical Center , Columbus, Ohio
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27
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Abstract
This review discusses strategies that may address some of the limitations associated with replacing diseased or dysfunctional aortic valves with mechanical or tissue valves. These limitations range from structural failure and thromboembolic complications associated with mechanical valves to a limited durability and calcification with tissue valves. In pediatric patients there is an issue with the inability of substitutes to grow with the recipient. The emerging science of tissue engineering potentially provides an attractive alternative by creating viable tissue structures based on a resorbable scaffold. Morphometrically precise, biodegradable polymer scaffolds may be fabricated from data obtained from scans of natural valves by rapid prototyping technologies such as fused deposition modelling. The scaffold provides a mechanical profile until seeded cells produce their own extra cellular matrix. The microstructure of the forming tissue may be aligned into predetermined spatial orientations via fluid transduction in a bioreactor. Although there are many technical obstacles that must be overcome before tissue engineered heart valves are introduced into routine surgical practice these valves have the potential to overcome many of the shortcomings of current heart valve substitutes.
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Affiliation(s)
- Y S Morsi
- Tissue Engineering Research Group, Industrial Research Institute, Swinburne University of Technology, Melbourne, Australia.
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Fabrication of Hydrogel Materials for Biomedical Applications. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2018; 1077:197-224. [PMID: 30357691 DOI: 10.1007/978-981-13-0947-2_12] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Hydrogels are three-dimensional hydrophilic polymeric networks that can be made from a wide range of natural and synthetic polymers. This review discusses recent advanced engineering methods to fabricate hydrogels for biomedical applications with emphasis in cardiac constructs and wound healing. Layer-by-Layer (LbL) assembly offers a tissue-engineered construct with robust and highly ordered structures for cell proliferation and differentiation. Three-dimensional printings, including inkjet printing, fused deposition modeling, and stereolithographic apparatus, have been widely employed to fabricate complex structures (e.g., heart valves). Moreover, the state-of-the-art design of intelligent/stimulus-responsive hydrogels can be used for a wide range of biomedical applications, including drug delivery, glucose delivery, shape memory, wound dressings, and so on. In the future, an increasing number of hydrogels with tunable mechanical properties and versatile functions will be developed for biomedical applications by employing advanced engineering techniques with novel material design.
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Nachlas ALY, Li S, Davis ME. Developing a Clinically Relevant Tissue Engineered Heart Valve-A Review of Current Approaches. Adv Healthc Mater 2017; 6. [PMID: 29171921 DOI: 10.1002/adhm.201700918] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Revised: 09/25/2017] [Indexed: 11/08/2022]
Abstract
Tissue engineered heart valves (TEHVs) have the potential to address the shortcomings of current implants through the combination of cells and bioactive biomaterials that promote growth and proper mechanical function in physiological conditions. The ideal TEHV should be anti-thrombogenic, biocompatible, durable, and resistant to calcification, and should exhibit a physiological hemodynamic profile. In addition, TEHVs may possess the capability to integrate and grow with somatic growth, eliminating the need for multiple surgeries children must undergo. Thus, this review assesses clinically available heart valve prostheses, outlines the design criteria for developing a heart valve, and evaluates three types of biomaterials (decellularized, natural, and synthetic) for tissue engineering heart valves. While significant progress has been made in biomaterials and fabrication techniques, a viable tissue engineered heart valve has yet to be translated into a clinical product. Thus, current strategies and future perspectives are also discussed to facilitate the development of new approaches and considerations for heart valve tissue engineering.
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Affiliation(s)
- Aline L. Y. Nachlas
- Wallace H Coulter Department of Biomedical Engineering Georgia Institute of Technology and Emory University Atlanta GA 30332 USA
| | - Siyi Li
- Wallace H Coulter Department of Biomedical Engineering Georgia Institute of Technology and Emory University Atlanta GA 30332 USA
| | - Michael E. Davis
- Wallace H Coulter Department of Biomedical Engineering Georgia Institute of Technology and Emory University Atlanta GA 30332 USA
- Children's Heart Research & Outcomes (HeRO) Center Children's Healthcare of Atlanta & Emory University Atlanta GA 30322 USA
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Namdari M, Negahdari B, Eatemadi A. Paediatric nanofibrous bioprosthetic heart valve. IET Nanobiotechnol 2017; 11:493-500. [PMID: 28745279 PMCID: PMC8676244 DOI: 10.1049/iet-nbt.2016.0159] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2016] [Revised: 11/28/2016] [Accepted: 11/30/2016] [Indexed: 09/22/2023] Open
Abstract
The search for an optimal aortic valve implant with durability, calcification resistance, excellent haemodynamic parameters and ability to withstand mechanical loading is yet to be met. Thus, there has been struggled to fabricate bio-prosthetics heart valve using bioengineering. The consequential product must be resilient with suitable mechanical features, biocompatible and possess the capacity to grow. Defective heart valves replacement by surgery is now common, this improves the value and survival of life for a lot of patients. The recent paediatric heart valve implant is suboptimal due to their inability of somatic growth. They usually have multiple surgeries to change outgrown valves. Short-lived valve bio-prostheses occurring in older patients and younger ones who more usually need the replacement of its damaged heart with prosthesis led to a new invasive surgical interventions with an improved quality of life. The authors propose that nanofibre scaffold for paediatric tissue-engineered heart valve will meet most of these conditions, most particularly those related to somatic growth, and, as the nanofibre scaffold is eroded, new valve is produced, the valve matures in the child until adulthood.
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Affiliation(s)
- Mehrdad Namdari
- Department of Cardiology, Lorestan University of Medical Sciences, Khoramabad, Iran
| | - Babak Negahdari
- Department of Medical Biotechnology, School of Advanced Technologies in Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Ali Eatemadi
- Department of Medical Biotechnology, School of Medicine, Lorestan University of Medical Sciences, Lorestan, Iran.
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Fioretta ES, Dijkman PE, Emmert MY, Hoerstrup SP. The future of heart valve replacement: recent developments and translational challenges for heart valve tissue engineering. J Tissue Eng Regen Med 2017; 12:e323-e335. [PMID: 27696730 DOI: 10.1002/term.2326] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2016] [Revised: 07/25/2016] [Accepted: 09/26/2016] [Indexed: 12/18/2022]
Abstract
Heart valve replacement is often the only solution for patients suffering from valvular heart disease. However, currently available valve replacements require either life-long anticoagulation or are associated with valve degeneration and calcification. Moreover, they are suboptimal for young patients, because they do not adapt to the somatic growth. Tissue-engineering has been proposed as a promising approach to fulfil the urgent need for heart valve replacements with regenerative and growth capacity. This review will start with an overview on the currently available valve substitutes and the techniques for heart valve replacement. The main focus will be on the evolution of and different approaches for heart valve tissue engineering, namely the in vitro, in vivo and in situ approaches. More specifically, several heart valve tissue-engineering studies will be discussed with regard to their shortcomings or successes and their possible suitability for novel minimally invasive implantation techniques. As in situ heart valve tissue engineering based on cell-free functionalized starter materials is considered to be a promising approach for clinical translation, this review will also analyse the techniques used to tune the inflammatory response and cell recruitment upon implantation in order to stir a favourable outcome: controlling the blood-material interface, regulating the cytokine release, and influencing cell adhesion and differentiation. In the last section, the authors provide their opinion about the future developments and the challenges towards clinical translation and adaptation of heart valve tissue engineering for valve replacement. Copyright © 2016 John Wiley & Sons, Ltd.
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Affiliation(s)
- Emanuela S Fioretta
- Institute for Regenerative Medicine (IREM), University of Zurich, Switzerland
| | - Petra E Dijkman
- Institute for Regenerative Medicine (IREM), University of Zurich, Switzerland
| | - Maximilian Y Emmert
- Institute for Regenerative Medicine (IREM), University of Zurich, Switzerland.,Heart Center Zurich, University Hospital Zurich, Switzerland.,Wyss Translational Center Zurich, Switzerland
| | - Simon P Hoerstrup
- Institute for Regenerative Medicine (IREM), University of Zurich, Switzerland.,Wyss Translational Center Zurich, Switzerland.,Department of Biomedical Engineering, Eindhoven University of Technology, The Netherlands
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Nkrumah-Agyeefi S, Scholz C. Chemical modification of functionalized polyhydroxyalkanoates via “Click” chemistry: A proof of concept. Int J Biol Macromol 2017; 95:796-808. [DOI: 10.1016/j.ijbiomac.2016.11.118] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2016] [Revised: 11/28/2016] [Accepted: 11/29/2016] [Indexed: 01/14/2023]
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Ke Y, Zhang X, Ramakrishna S, He L, Wu G. Reactive blends based on polyhydroxyalkanoates: Preparation and biomedical application. MATERIALS SCIENCE & ENGINEERING. C, MATERIALS FOR BIOLOGICAL APPLICATIONS 2017; 70:1107-1119. [DOI: 10.1016/j.msec.2016.03.114] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/16/2016] [Revised: 03/06/2016] [Accepted: 03/31/2016] [Indexed: 01/11/2023]
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Shinoka T, Miyachi H. Current Status of Tissue Engineering Heart Valve. World J Pediatr Congenit Heart Surg 2016; 7:677-684. [DOI: 10.1177/2150135116664873] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2016] [Accepted: 07/26/2016] [Indexed: 12/31/2022]
Abstract
The development of surgically implantable heart valve prostheses has contributed to improved outcomes in patients with cardiovascular disease. However, there are drawbacks, such as risk of infection and lack of growth potential. Tissue-engineered heart valve (TEHV) holds great promise to address these drawbacks as the ideal TEHV is easily implanted, biocompatible, non-thrombogenic, durable, degradable, and ultimately remodels into native-like tissue. In general, three main components used in creating a tissue-engineered construct are (1) a scaffold material, (2) a cell type for seeding the scaffold, and (3) a subsequent remodeling process driven by cell accumulation and proliferation, and/or biochemical and mechanical signaling. Despite rapid progress in the field over the past decade, TEHVs have not been translated into clinical applications successfully. To successfully utilize TEHVs clinically, further elucidation of the mechanisms for TEHV remodeling and further translational research outcome evaluations will be required. Tissue engineering is a major breakthrough in cardiovascular medicine that holds amazing promise for the future of reconstructive surgical procedures. In this article, we review the history of regenerative medicine, advances in the field, and state-of-the-art in valvular tissue engineering.
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Affiliation(s)
- Toshiharu Shinoka
- Department of Cardiothoracic Surgery, Nationwide Children’s Hospital, Columbus, OH, USA
| | - Hideki Miyachi
- Department of Cardiothoracic Surgery, Nationwide Children’s Hospital, Columbus, OH, USA
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Dijkman PE, Fioretta ES, Frese L, Pasqualini FS, Hoerstrup SP. Heart Valve Replacements with Regenerative Capacity. Transfus Med Hemother 2016; 43:282-290. [PMID: 27721704 DOI: 10.1159/000448181] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2016] [Accepted: 07/04/2016] [Indexed: 01/14/2023] Open
Abstract
The incidence of severe valvular dysfunctions (e.g., stenosis and insufficiency) is increasing, leading to over 300,000 valves implanted worldwide yearly. Clinically used heart valve replacements lack the capacity to grow, inherently requiring repetitive and high-risk surgical interventions during childhood. The aim of this review is to present how different tissue engineering strategies can overcome these limitations, providing innovative valve replacements that proved to be able to integrate and remodel in pre-clinical experiments and to have promising results in clinical studies. Upon description of the different types of heart valve tissue engineering (e.g., in vitro, in situ, in vivo, and the pre-seeding approach) we focus on the clinical translation of this technology. In particular, we will deepen the many technical, clinical, and regulatory aspects that need to be solved to endure the clinical adaptation and the commercialization of these promising regenerative valves.
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Affiliation(s)
- Petra E Dijkman
- Institute for Regenerative Medicine (IREM), University of Zurich, Zurich, Switzerland
| | - Emanuela S Fioretta
- Institute for Regenerative Medicine (IREM), University of Zurich, Zurich, Switzerland
| | - Laura Frese
- Institute for Regenerative Medicine (IREM), University of Zurich, Zurich, Switzerland
| | | | - Simon P Hoerstrup
- Institute for Regenerative Medicine (IREM), University of Zurich, Zurich, Switzerland; Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands; Wyss Translational Center Zurich, University of Zurich and ETH Zurich, Zurich, Switzerland
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36
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Usprech J, Chen WLK, Simmons CA. Heart valve regeneration: the need for systems approaches. WILEY INTERDISCIPLINARY REVIEWS-SYSTEMS BIOLOGY AND MEDICINE 2016; 8:169-82. [PMID: 26862013 DOI: 10.1002/wsbm.1329] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/07/2015] [Revised: 12/22/2015] [Accepted: 12/29/2015] [Indexed: 01/10/2023]
Abstract
Tissue-engineered heart valves are promising alternatives to address the limitations of current valve replacements, particularly for growing children. Current heart valve tissue engineering strategies involve the selection of biomaterial scaffolds, cell types, and often in vitro culture conditions aimed at regenerating a valve for implantation and subsequent maturation in vivo. However, identifying optimal combinations of cell sources, biomaterials, and/or bioreactor conditions to produce functional, durable valve tissue remains a challenge. Despite some short-term success in animal models, attempts to recapitulate aspects of the native heart valve environment based on 'best guesses' of a limited number of regulatory factors have not proven effective. Better outcomes for valve tissue regeneration will likely require a systems-level understanding of the relationships between multiple interacting regulatory factors and their effects on cell function and tissue formation. Until recently, conventional culture methods have not allowed for multiple design parameters to be considered at once. Emerging microtechnologies are well suited to systematically probe multiple inputs, in combination, in high throughput and with great precision. When combined with statistical and network systems analyses, these microtechnologies have excellent potential to define multivariate signal-response relationships and reveal key regulatory pathways for robust functional tissue regeneration.
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Affiliation(s)
- Jenna Usprech
- Institute of Biomaterials and Biomedical Engineering, University of Toronto, Toronto, ON, Canada
| | - Wen Li Kelly Chen
- Institute of Biomaterials and Biomedical Engineering, University of Toronto, Toronto, ON, Canada
| | - Craig A Simmons
- Institute of Biomaterials and Biomedical Engineering, University of Toronto, Toronto, ON, Canada.,Department of Mechanical and Industrial Engineering, University of Toronto, Toronto, ON, Canada
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Parvin Nejad S, Blaser MC, Santerre JP, Caldarone CA, Simmons CA. Biomechanical conditioning of tissue engineered heart valves: Too much of a good thing? Adv Drug Deliv Rev 2016; 96:161-75. [PMID: 26555371 DOI: 10.1016/j.addr.2015.11.003] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2015] [Revised: 10/23/2015] [Accepted: 11/02/2015] [Indexed: 12/13/2022]
Abstract
Surgical replacement of dysfunctional valves is the primary option for the treatment of valvular disease and congenital defects. Existing mechanical and bioprosthetic replacement valves are far from ideal, requiring concomitant anticoagulation therapy or having limited durability, thus necessitating further surgical intervention. Heart valve tissue engineering (HVTE) is a promising alternative to existing replacement options, with the potential to synthesize mechanically robust tissue capable of growth, repair, and remodeling. The clinical realization of a bioengineered valve relies on the appropriate combination of cells, biomaterials, and/or bioreactor conditioning. Biomechanical conditioning of valves in vitro promotes differentiation of progenitor cells to tissue-synthesizing myofibroblasts and prepares the construct to withstand the complex hemodynamic environment of the native valve. While this is a crucial step in most HVTE strategies, it also may contribute to fibrosis, the primary limitation of engineered valves, through sustained myofibrogenesis. In this review, we examine the progress of HVTE and the role of mechanical conditioning in the synthesis of mechanically robust tissue, and suggest approaches to achieve myofibroblast quiescence and prevent fibrosis.
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38
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Bioprinting a cardiac valve. Biotechnol Adv 2015; 33:1503-21. [DOI: 10.1016/j.biotechadv.2015.07.006] [Citation(s) in RCA: 97] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2015] [Revised: 06/30/2015] [Accepted: 07/27/2015] [Indexed: 12/13/2022]
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Schmack B, Szabó G, Karck M, Weymann A. Tissue-Engineering von Atrioventrikularklappen. ZEITSCHRIFT FUR HERZ THORAX UND GEFASSCHIRURGIE 2015. [DOI: 10.1007/s00398-015-0028-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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40
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Abstract
Heart disease, including valve pathologies, is the leading cause of death worldwide. Despite the progress made thanks to improving transplantation techniques, a perfect valve substitute has not yet been developed: once a diseased valve is replaced with current technologies, the newly implanted valve still needs to be changed some time in the future. This situation is particularly dramatic in the case of children and young adults, because of the necessity of valve growth during the patient's life. Our review focuses on the current status of heart valve (HV) therapy and the challenges that must be solved in the development of new approaches based on tissue engineering. Scientists and physicians have proposed tissue-engineered heart valves (TEHVs) as the most promising solution for HV replacement, especially given that they can help to avoid thrombosis, structural deterioration and xenoinfections. Lastly, TEHVs might also serve as a model for studying human valve development and pathologies.
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41
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A review of: Application of synthetic scaffold in tissue engineering heart valves. MATERIALS SCIENCE & ENGINEERING. C, MATERIALS FOR BIOLOGICAL APPLICATIONS 2015; 48:556-65. [DOI: 10.1016/j.msec.2014.12.016] [Citation(s) in RCA: 59] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/04/2014] [Revised: 08/26/2014] [Accepted: 12/05/2014] [Indexed: 01/28/2023]
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Jana S, Tranquillo RT, Lerman A. Cells for tissue engineering of cardiac valves. J Tissue Eng Regen Med 2015; 10:804-824. [DOI: 10.1002/term.2010] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2014] [Revised: 12/15/2014] [Accepted: 01/12/2015] [Indexed: 12/20/2022]
Affiliation(s)
- Soumen Jana
- Division of Cardiovascular Diseases; Mayo Clinic; Rochester MN USA
| | - Robert T. Tranquillo
- Department of Biomedical Engineering; University of Minnesota; Minneapolis MN USA
| | - Amir Lerman
- Division of Cardiovascular Diseases; Mayo Clinic; Rochester MN USA
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Tseng H, Puperi DS, Kim EJ, Ayoub S, Shah JV, Cuchiara ML, West JL, Grande-Allen KJ. Anisotropic poly(ethylene glycol)/polycaprolactone hydrogel-fiber composites for heart valve tissue engineering. Tissue Eng Part A 2014; 20:2634-45. [PMID: 24712446 PMCID: PMC4195534 DOI: 10.1089/ten.tea.2013.0397] [Citation(s) in RCA: 79] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2013] [Accepted: 03/19/2014] [Indexed: 11/12/2022] Open
Abstract
The recapitulation of the material properties and structure of the native aortic valve leaflet, specifically its anisotropy and laminate structure, is a major design goal for scaffolds for heart valve tissue engineering. Poly(ethylene glycol) (PEG) hydrogels are attractive scaffolds for this purpose as they are biocompatible, can be modified for their mechanical and biofunctional properties, and can be laminated. This study investigated augmenting PEG hydrogels with polycaprolactone (PCL) as an analog to the fibrosa to improve strength and introduce anisotropic mechanical behavior. However, due to its hydrophobicity, PCL must be modified prior to embedding within PEG hydrogels. In this study, PCL was electrospun (ePCL) and modified in three different ways, by protein adsorption (pPCL), alkali digestion (hPCL), and acrylation (aPCL). Modified PCL of all types maintained the anisotropic elastic moduli and yield strain of unmodified anisotropic ePCL. Composites of PEG and PCL (PPCs) maintained anisotropic elastic moduli, but aPCL and pPCL had isotropic yield strains. Overall, PPCs of all modifications had elastic moduli of 3.79±0.90 MPa and 0.46±0.21 MPa in the parallel and perpendicular directions, respectively. Valvular interstitial cells seeded atop anisotropic aPCL displayed an actin distribution aligned in the direction of the underlying fibers. The resulting scaffold combines the biocompatibility and tunable fabrication of PEG with the strength and anisotropy of ePCL to form a foundation for future engineered valve scaffolds.
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Affiliation(s)
- Hubert Tseng
- Department of Bioengineering, Rice University, Houston, Texas
| | | | - Eric J. Kim
- Department of Bioengineering, Rice University, Houston, Texas
| | - Salma Ayoub
- Department of Bioengineering, Rice University, Houston, Texas
| | - Jay V. Shah
- Department of Bioengineering, Rice University, Houston, Texas
| | - Maude L. Cuchiara
- Department of Biomedical Engineering, Duke University, Durham, North Carolina
| | - Jennifer L. West
- Department of Biomedical Engineering, Duke University, Durham, North Carolina
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Bioengineering Strategies for Polymeric Scaffold for Tissue Engineering an Aortic Heart Valve: An Update. Int J Artif Organs 2014; 37:651-67. [DOI: 10.5301/ijao.5000339] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/30/2014] [Indexed: 12/17/2022]
Abstract
The occurrence of dysfunctional aortic valves is increasing every year, and current replacement heart valves, although having been shown to be clinically successful, are only short-term solutions and suffer from many agonizing long-term drawbacks. The tissue engineering of heart valves is recognized as one of the most promising answers for aortic valve disease therapy, but overcoming current shortcomings will require multidisciplinary efforts. The use of a polymeric scaffold to guide the growth of the tissue is the most common approach to generate a new tissue for an aortic heart valve. However, optimizing the design of the scaffold, in terms of biocompatibility, surface morphology for cell attachments and the correct rate of degradation is critical in creating a viable tissue-engineered aortic heart valve. This paper highlights the bioengineering strategies that need to be followed to construct a polymeric scaffold of sufficient mechanical integrity, with superior surface morphologies, that is capable of mimicking the valve dynamics in vivo. The current challenges and future directions of research for creating tissue-engineered aortic heart valves are also discussed.
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Hazer DB, Bal E, Nurlu G, Benli K, Balci S, Öztürk F, Hazer B. In vivo application of poly-3-hydroxyoctanoate as peripheral nerve graft. J Zhejiang Univ Sci B 2014; 14:993-1003. [PMID: 24190445 DOI: 10.1631/jzus.b1300016] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE This study aims to investigate the degree of biocompatibility and neuroregeneration of a polymer tube, poly-3-hydroxyoctanoate (PHO) in nerve gap repair. METHODS Forty Wistar Albino male rats were randomized into two groups: autologous nerve gap repair group and PHO tube repair group. In each group, a 10-mm right sciatic nerve defect was created and reconstructed accordingly. Neuroregeneration was studied by sciatic function index (SFI), electromyography, and immunohistochemical studies on Days 7, 21, 45 and 60 of implantation. Biocompatibility was analyzed by the capsule formation around the conduit. Biodegradation was analyzed by the molecular weight loss in vivo. RESULTS Electrophysiological and histomorphometric assessments demonstrated neuroregeneration in both groups over time. In the experimental group, a straight alignment of the Schwann cells parallel to the axons was detected. However, autologous nerve graft seems to have a superior neuroregeneration compared to PHO grafts. Minor biodegradation was observed in PHO conduit at the end of 60 d. CONCLUSIONS Although neuroregeneration is detected in PHO grafts with minor degradation in 60 d, autologous nerve graft is found to be superior in axonal regeneration compared to PHO nerve tube grafts. PHO conduits were found to create minor inflammatory reaction in vivo, resulting in good soft tissue response.
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Affiliation(s)
- D Burcu Hazer
- Department of Neurosurgery, Faculty of Medicine, Muğla Sıtkı Koçman University, Muğla 48000, Turkey; Atatürk Research and Medical Center, Neurosurgery Clinic, Ministry of Health of the Republic of Turkey, Ankara 06110, Turkey; Department of Neurology, Faculty of Medicine, School of Medicine, Hacettepe University, Ankara 06100, Turkey; Department of Neurosurgery, Faculty of Medicine, School of Medicine, Hacettepe University, Ankara 06100, Turkey; Atatürk Research and Medical Center, Department of Pathology, Yıldırım Beyazıt University, Ankara 06110, Turkey; Department of Histology and Embryology, Faculty of Medicine, Muğla Sıtkı Koçman University, Muğla 48000, Turkey; Department of Chemistry, Bülent Ecevit University, Zonguldak 67100, Turkey
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46
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Jana S, Tefft BJ, Spoon DB, Simari RD. Scaffolds for tissue engineering of cardiac valves. Acta Biomater 2014; 10:2877-93. [PMID: 24675108 DOI: 10.1016/j.actbio.2014.03.014] [Citation(s) in RCA: 90] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2013] [Revised: 02/25/2014] [Accepted: 03/12/2014] [Indexed: 01/09/2023]
Abstract
Tissue engineered heart valves offer a promising alternative for the replacement of diseased heart valves avoiding the limitations faced with currently available bioprosthetic and mechanical heart valves. In the paradigm of tissue engineering, a three-dimensional platform - the so-called scaffold - is essential for cell proliferation, growth and differentiation, as well as the ultimate generation of a functional tissue. A foundation for success in heart valve tissue engineering is a recapitulation of the complex design and diverse mechanical properties of a native valve. This article reviews technological details of the scaffolds that have been applied to date in heart valve tissue engineering research.
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Affiliation(s)
- S Jana
- Division of Cardiovascular Diseases, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
| | - B J Tefft
- Division of Cardiovascular Diseases, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
| | - D B Spoon
- Division of Cardiovascular Diseases, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
| | - R D Simari
- Division of Cardiovascular Diseases, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA.
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Solomon NAG, Pranav SK, Jain KA, Kumar M, Kulkarni CB, Akbari J. In search of a pediatric cardiac surgeon’s ‘Holy Grail’: the ideal pulmonary conduit. Expert Rev Cardiovasc Ther 2014; 4:861-70. [PMID: 17173502 DOI: 10.1586/14779072.4.6.861] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The limited lifespan of all currently available conduits leads to repeat operations and interventional procedures in many children. Each reoperation entails considerable risk to life, expenditure and compromised quality of life as the conduit degenerates. The ideal conduit should be available freely, inexpensive, require no anticoagulation, be resistant to infection, free from thromboembolism, have no gradients or regurgitation and have unlimited durability. This review explores various options as surgeons and researchers endeavor to develop the ideal conduit--which will fulfill all of the above-mentioned criteria. Various currently available conduits are analyzed. Special emphasis is given to tissue-engineered valves and percutaneous valve implantations.
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Affiliation(s)
- Neville A G Solomon
- Apollo Hospital, Department of Cardiothoracic Surgery, 21 Greams Lane, Off Greams Road, Chennai-600006, India.
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Arrington CB, Shaddy RE. Immune response to allograft implantation in children with congenital heart defects. Expert Rev Cardiovasc Ther 2014; 4:695-701. [PMID: 17081091 DOI: 10.1586/14779072.4.5.695] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Cryopreserved valved allografts are frequently used in the repair of congenital heart defects in children. Although the longevity of these grafts is generally good in most patients, there continue to be ongoing problems with allograft dysfunction and subsequent failure, particularly in infants and young children. The aim of this review is to discuss the immunogenicity of cryopreserved allograft tissue and measures that may minimize the deleterious effect of the immune system on allograft function and durability.
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Affiliation(s)
- Cammon B Arrington
- University of Utah, Department of Pediatrics, Division of Pediatric Cardiology, 100 N. Medical Drive, Salt Lake City, UT 84132, USA.
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Mol A, Smits AIPM, Bouten CVC, Baaijens FPT. Tissue engineering of heart valves: advances and current challenges. Expert Rev Med Devices 2014; 6:259-75. [DOI: 10.1586/erd.09.12] [Citation(s) in RCA: 115] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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Valappil SP, Misra SK, Boccaccini AR, Roy I. Biomedical applications of polyhydroxyalkanoates, an overview of animal testing andin vivoresponses. Expert Rev Med Devices 2014; 3:853-68. [PMID: 17280548 DOI: 10.1586/17434440.3.6.853] [Citation(s) in RCA: 196] [Impact Index Per Article: 19.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Polyhydroxyalkanoates (PHAs) have been established as biodegradable polymers since the second half of the twentieth century. Altering monomer composition of PHAs allows the development of polymers with favorable mechanical properties, biocompatibility and desirable degradation rates, under specific physiological conditions. Hence, the medical applications of PHAs have been explored extensively in recent years. PHAs have been used to develop devices, including sutures, nerve repair devices, repair patches, slings, cardiovascular patches, orthopedic pins, adhesion barriers, stents, guided tissue repair/regeneration devices, articular cartilage repair devices, nerve guides, tendon repair devices, bone-marrow scaffolds, tissue engineered cardiovascular devices and wound dressings. So far, various tests on animal models have shown polymers, from the PHA family, to be compatible with a range of tissues. Often, pyrogenic contaminants copurified with PHAs limit their pharmacological application rather than the monomeric composition of the PHAs and thus the purity of the PHA material is critical. This review summarizes the animal testing, tissue response, in vivo molecular stability and challenges of using PHAs for medical applications. In future, PHAs may become the materials of choice for various medical applications.
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Affiliation(s)
- Sabeel P Valappil
- Department of Molecular & Applied Biosciences, University of Westminster, 115 New Cavendish Street, London, UK.
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