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Cohn D, Sloutski A, Elyashiv A, Varma VB, Ramanujan R. In Situ Generated Medical Devices. Adv Healthc Mater 2019; 8:e1801066. [PMID: 30828989 DOI: 10.1002/adhm.201801066] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Revised: 11/25/2018] [Indexed: 12/19/2022]
Abstract
Medical devices play a major role in all areas of modern medicine, largely contributing to the success of clinical procedures and to the health of patients worldwide. They span from simple commodity products such as gauzes and catheters, to highly advanced implants, e.g., heart valves and vascular grafts. In situ generated devices are an important family of devices that are formed at their site of clinical function that have distinct advantages. Among them, since they are formed within the body, they only require minimally invasive procedures, avoiding the pain and risks associated with open surgery. These devices also display enhanced conformability to local tissues and can reach sites that otherwise are inaccessible. This review aims at shedding light on the unique features of in situ generated devices and to underscore leading trends in the field, as they are reflected by key developments recently in the field over the last several years. Since the uniqueness of these devices stems from their in situ generation, the way they are formed is crucial. It is because of this fact that in this review, the medical devices are classified depending on whether their in situ generation entails chemical or physical phenomena.
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Affiliation(s)
- Daniel Cohn
- Casali Center of Applied ChemistryInstitute of ChemistryHebrew University of Jerusalem Jerusalem 91904 Israel
| | - Aaron Sloutski
- Casali Center of Applied ChemistryInstitute of ChemistryHebrew University of Jerusalem Jerusalem 91904 Israel
| | - Ariel Elyashiv
- Casali Center of Applied ChemistryInstitute of ChemistryHebrew University of Jerusalem Jerusalem 91904 Israel
| | - Vijaykumar B. Varma
- School of Materials Science and EngineeringNanyang Technological University 639798 Singapore Singapore
| | - Raju Ramanujan
- School of Materials Science and EngineeringNanyang Technological University 639798 Singapore Singapore
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Geelhoed WJ, Moroni L, Rotmans JI. Utilizing the Foreign Body Response to Grow Tissue Engineered Blood Vessels in Vivo. J Cardiovasc Transl Res 2017; 10:167-179. [PMID: 28205013 PMCID: PMC5437130 DOI: 10.1007/s12265-017-9731-7] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Accepted: 01/23/2017] [Indexed: 12/21/2022]
Abstract
It is well known that the number of patients requiring a vascular grafts for use as vessel replacement in cardiovascular diseases, or as vascular access site for hemodialysis is ever increasing. The development of tissue engineered blood vessels (TEBV's) is a promising method to meet this increasing demand vascular grafts, without having to rely on poorly performing synthetic options such as polytetrafluoroethylene (PTFE) or Dacron. The generation of in vivo TEBV's involves utilizing the host reaction to an implanted biomaterial for the generation of completely autologous tissues. Essentially this approach to the development of TEBV's makes use of the foreign body response to biomaterials for the construction of the entire vascular replacement tissue within the patient's own body. In this review we will discuss the method of developing in vivo TEBV's, and debate the approaches of several research groups that have implemented this method.
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Affiliation(s)
- Wouter J Geelhoed
- Department of Internal Medicine, Leiden University Medical Center, Leiden, The Netherlands.,Eindhoven Laboratory of Experimental Vascular Medicine, Leiden University Medical Center, Leiden, The Netherlands
| | - Lorenzo Moroni
- MERLN Institute for Technology Inspired Regenerative Medicine, Complex Tissue Regeneration, Maastricht University, Maastricht, The Netherlands
| | - Joris I Rotmans
- Department of Internal Medicine, Leiden University Medical Center, Leiden, The Netherlands. .,Eindhoven Laboratory of Experimental Vascular Medicine, Leiden University Medical Center, Leiden, The Netherlands.
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Abstract
Since the introduction of synthetic vascular grafts in the 1960s, only two-stage endothelial cell seeding has demonstrated any significant improvement over conventional vascular grafts, and its benefits have yet to be demonstrated on a large scale. Tissue engineering is a rapidly expanding field with great potential, but efforts to construct tissue-engineered arterial grafts have, to date, yielded little clinical success. This review explores the latest approaches to the construction of a superior vascular graft, along with its potential for use in the clinic in the future.
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Affiliation(s)
- Chris D Daly
- University of Queensland, Centre for Research in Vascular Biology, 4072, QLD, Australia
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Tissue engineered vascular grafts--preclinical aspects. Int J Cardiol 2012; 167:1091-100. [PMID: 23040078 DOI: 10.1016/j.ijcard.2012.09.069] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2011] [Revised: 06/01/2012] [Accepted: 09/14/2012] [Indexed: 11/23/2022]
Abstract
Tissue engineering enables the development of fully biological vascular substitutes that restore, maintain and improve tissue function in a manner identical to natural host tissue. However the development of the appropriate preclinical evaluation techniques for the generation of fully functional tissue-engineered vascular graft (TEVG) is required to establish their safety for use in clinical trials and to test clinical effectiveness. This review gives an insight on the various preclinical studies performed in the area of tissue engineered vascular grafts highlighting the different strategies used with respect to cells and scaffolds, typical animal models used and the major in vivo evaluation studies that have been carried out. The review emphasizes the combined effort of engineers, biologists and clinicians which can take this clinical research to new heights of regenerative therapy.
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Byrom MJ, Bannon PG, White GH, Ng MKC. Animal models for the assessment of novel vascular conduits. J Vasc Surg 2010; 52:176-95. [PMID: 20299181 DOI: 10.1016/j.jvs.2009.10.080] [Citation(s) in RCA: 130] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2010] [Revised: 09/25/2009] [Accepted: 10/04/2010] [Indexed: 11/19/2022]
Abstract
The development of an ideal small-diameter conduit for use in vascular bypass surgery has yet to be achieved. The ongoing innovation in biomaterial design generates novel conduits that require preclinical assessment in vivo, and a number of animal models have been used for this purpose. This article examines the rationale behind animal models used in the assessment of small-diameter vascular conduits encompassing the commonly used species: baboons, sheep, pigs, dogs, rabbits, and rodents. Studies on the comparative hematology for these species relative to humans are summarized, and the hydrodynamic values for common implant locations are also compared. The large- and small-animal models are then explored, highlighting the characteristics of each that determine their relative utility in the assessment of vascular conduits. Where possible, the performance of expanded polytetrafluoroethylene is given in each animal and in each location to allow direct comparisons between species. New challenges in animal modeling are outlined for the assessment of tissue-engineered graft designs. Finally, recommendations are given for the selection of animal models for the assessment of future vascular conduits.
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Baguneid MS, Seifalian AM, Salacinski HJ, Murray D, Hamilton G, Walker MG. Tissue engineering of blood vessels. Br J Surg 2006; 93:282-90. [PMID: 16498591 DOI: 10.1002/bjs.5256] [Citation(s) in RCA: 96] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Tissue engineering techniques have been employed successfully in the management of wounds, burns and cartilage repair. Current prosthetic alternatives to autologous vascular bypass grafts remain poor in terms of patency and infection risk. Growing biological blood vessels has been proposed as an alternative. METHODS This review is based on a literature search using Medline, PubMed, ISIS and CAS of original articles and reviews, and unpublished material and abstracts. RESULTS AND CONCLUSIONS Complete incorporation into host tissues and the maintenance of a viable and self-renewing endothelial layer are the fundamental goals to be achieved when developing a tissue-engineered blood vessel. Sourcing of cells and modulating their interaction with extracellular matrix and supporting scaffold have been the focus of intense research. Although the use of tissue-engineered blood vessels in humans is so far limited, advances in our knowledge of stem cell precursors and the development of new biomaterials should enable this technology to reach routine clinical practice within a decade.
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Affiliation(s)
- M S Baguneid
- Department of Vascular Surgery, Manchester Royal Infirmary and Medical School, Manchester, UK
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Hoenig MR, Campbell GR, Rolfe BE, Campbell JH. Tissue-engineered blood vessels: alternative to autologous grafts? Arterioscler Thromb Vasc Biol 2005; 25:1128-34. [PMID: 15705929 DOI: 10.1161/01.atv.0000158996.03867.72] [Citation(s) in RCA: 125] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Although vascular bypass grafting remains the mainstay for revascularization for ischemic heart disease and peripheral vascular disease, many patients do not have healthy vessels suitable for harvest. Thus, prosthetic grafts made of synthetic polymers were developed, but their use is limited to high-flow/low-resistance conditions because of poor elasticity, low compliance, and thrombogenicity of their synthetic surfaces. To fill this need, several laboratories have produced in vivo or in vitro tissue-engineered blood vessels using molds or prosthetic or biodegradable scaffolds, but each artificial graft has significant problems. Recently, conduits have been grown in the peritoneal cavity of the same animals in which they will be grafted, ensuring no rejection, in the short time of 2 to 3 weeks. Remodeling occurs after grafting such that the tissue is almost indistinguishable from native vessels. This conduit is derived from cells of bone marrow origin, opening new possibilities in vascular modeling and remodeling.
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Affiliation(s)
- Michel R Hoenig
- Centre for Research in Vascular Biology, School of Biomedical Sciences, The University of Queensland, Brisbane, Queensland, Australia
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Rashid ST, Salacinski HJ, Fuller BJ, Hamilton G, Seifalian AM. Engineering of bypass conduits to improve patency. Cell Prolif 2004; 37:351-66. [PMID: 15377334 PMCID: PMC6495671 DOI: 10.1111/j.1365-2184.2004.00318.x] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
For patients with severe coronary artery and distal peripheral vascular disease not amenable to angioplasty and lacking sufficient autologous vessels there is a pressing need for improvements to current surgical bypass options. It has been decades since any real progress in bypass material has reached mainstream surgical practice. This review looks at possible remedies to this situation. Options considered are methods to reduce prosthetic graft thrombogenicity, including endothelial cell seeding and developments of new prosthetic materials. The promise of tissue-engineered blood vessels is examined with a specific look at how peptides can improve cell adhesion to scaffolds.
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Affiliation(s)
- S T Rashid
- Biomaterials and Tissue Engineering Centre, University Department of Surgery, Royal Free and University College Medical School, University College London, Royal Free Hospital, London, UK
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Rashid ST, Salacinski HJ, Hamilton G, Seifalian AM. The use of animal models in developing the discipline of cardiovascular tissue engineering: a review. Biomaterials 2004; 25:1627-37. [PMID: 14697864 DOI: 10.1016/s0142-9612(03)00522-2] [Citation(s) in RCA: 75] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Cardiovascular disease remains one of the major causes of death and disability in the Western world. Tissue engineering offers the prospect of being able to meet the demand for replacement of heart valves, vessels for coronary and lower limb bypass surgery and the generation of cardiac tissue for addition to the diseased heart. In order to test prospective tissue-engineered devices, these constructs must first be proven in animal models before receiving CE marking or FDA approval for a clinical trial. The choice of animal depends on the nature of the tissue-engineered construct being tested. Factors that need to be considered include technical requirements of implanting the construct, availability of the animal, cost and ethical considerations. In this paper, we review the history of animal studies in cardiovascular tissue engineering and the uses of animal tissue as sources for tissue engineering.
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Affiliation(s)
- S Tawqeer Rashid
- Tissue Engineering Centre, University Department of Surgery, Royal Free and University College Medical School, University College London, Royal Free Hospital, Pond Street, London, NW3 2QG, UK
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Meddahi-Pellé A, Bataille I, Subra P, Letourneur D. Biomatériaux vasculaires : du génie biologique et médical au génie tissulaire. Med Sci (Paris) 2004; 20:679-84. [PMID: 15329819 DOI: 10.1051/medsci/2004206-7679] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Biomaterials are already widely used in medical sciences. The field of biomaterials began to shift to produce materials able to stimulate specific cellular responses at the molecular level. The combined efforts of cell biologists, engineers, materials scientists, mathematicians, geneticists, and clinicians are now used in tissue engineering to restore, maintain, or improve tissue functions or organs. This rapidly expanding approach combines the fields of material sciences and cell biology for the molecular design of polymeric scaffolds with appropriate 3D configuration and biological responses. Future developments for new blood vessels will require improvements in technology of materials and biotechnology together with the increased knowledge of the interactions between materials, blood, and living tissues. Biomaterials represent a crucial mainstay for all these studies.
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Affiliation(s)
- Anne Meddahi-Pellé
- Inserm U.460, CHU Xavier Bichat-Claude Bernard, Bâtiment Inserm 13, 46, rue Henri-Huchard, 75877 Paris Cedex 18, France
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Abstract
Tissue engineering, using either polymer or biological based scaffolds, represents the newest approach to overcoming limitations of small diameter prosthetic vascular grafts. Their disadvantages include thromboembolism and thrombosis, anticoagulant related haemorrhage, compliance mismatch, neointimal hyperplasia, as well as aneurysm formation. This current review represents an overview about previous and contemporary studies in the field of artificial vascular conduits development regarding arterial and venous autografts, allografts, xenografts, alloplastic prostheses, and tissue engineering.
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Affiliation(s)
- Omke E Teebken
- Leibniz Research Laboratories for Biotechnology & Artificial Organs, LEBAO, Thoracic & Cardiovascular Surgery, Hannover Medical School, Hannover, Germany
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