Name: scaling of engineered vascular grafts using 3d printed guides and the ring stacking method
Uploaded: 2017-03-27T11:30:00
Description: Watch this Scientific Journal Video about Scaling of Engineered Vascular Grafts Using 3D Printed Guides and the Ring Stacking Method at JoVE.com

The authors would like to thank our fellow Lam lab colleagues Ammar Chishti and Bijal Patel for their kind assistance with some of the histology and cell culture. Funding was provided by the Wayne State University Nanomedicine Fellowship (CBP), Start-Up Funds and Cardiovascular Research Institute Seed Grant (MTL).

1. Cell Culture Preparation
<ol>
	<li>Utilize human aortic smooth muscle cells purchased commercially.</li>
	<li>Maintain cells in smooth muscle cell growth media composed of 88.6% 231 media, 0.1% each of recombinant human insulin (rH-insulin), recombinant human fibroblast growth factor (rH-FGF), recombinant human epidermal growth factor (rH-FGF), and ascorbic acid; and 5% each of fetal bovine serum (FBS) and L-glutamine; and 1% antibiotic/antimycotic. 
	NOTE: Each growth factor, FBS and L-glutamine are purchased ...

<ol>
	<li>Luciani, G. B., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Operative+risk+and+outcome+of+surgery+in+adults+with+congenital+valve+disease.">Operative risk and outcome of surgery in adults with congenital valve disease.</a> ASAIO J. 54 (5), 458-462 (2008).</li><li>Lawson, J. H., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Bioengineered+human+acellular+vessels+for+dialysis+access+in+patients+with+end-stage+renal+disease:+two+phase+2+single-arm+trials.">Bioengineered human acellular vessels for dialysis access in patients with end-stage renal disease: two phase 2 single-arm trials.</a> Lancet. 14 (387), 2026-2034 (2016).</li><li>McAllister, T. N., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Effectiveness+of+haemodialysis+access+with+an+autologous+tissue-engineered+vascular+graft:+a+multicentre+cohort+study.">Effectiveness of haemodialysis access with an autologous tissue-engineered vascular graft: a multicentre cohort study.</a> Lancet. 373 (9673), 1440-1446 (2009).</li><li>Wystrychowski, W., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=First+human+use+of+an+allogeneic+tissue-engineered+vascular+graft+for+hemodialysis+access.">First human use of an allogeneic tissue-engineered vascular graft for hemodialysis access.</a> J Vasc Surg. 60 (5), 1353-1357 (2014).</li><li>Konig, G., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Mechanical+properties+of+completely+autologous+human+tissue+engineered+blood+vessels+compared+to+human+saphenous+vein+and+mammary+artery.">Mechanical properties of completely autologous human tissue engineered blood vessels compared to human saphenous vein and mammary artery.</a> Biomaterials. 30 (8), 1542-1550 (2009).</li><li>Gui, L., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Construction+of+tissue-engineered+small-diameter+vascular+grafts+in+fibrin+scaffolds+in+30+days.">Construction of tissue-engineered small-diameter vascular grafts in fibrin scaffolds in 30 days.</a> Tissue Eng Part A. 20 (9-10), 1499-1507 (2014).</li><li>Sundaram, S., Echter, A., Sivarapatna, A., Qiu, C., Niklason, L. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Small-diameter+vascular+graft+engineered+using+human+embryonic+stem+cell-derived+mesenchymal+cells.">Small-diameter vascular graft engineered using human embryonic stem cell-derived mesenchymal cells.</a> Tissue Eng Part A. 20 (3-4), 740-750 (2014).</li><li>Quint, C., Arief, M., Muto, A., Dardik, A., Niklason, L. E. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Allogeneic+human+tissue-engineered+blood+vessel.">Allogeneic human tissue-engineered blood vessel.</a> J Vasc Surg. 55 (3), 790-798 (2012).</li><li>Quint, C., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Decellularized+tissue-engineered+blood+vessel+as+an+arterial+conduit.">Decellularized tissue-engineered blood vessel as an arterial conduit.</a> Proc Natl Acad Sci U S A. 31 (108), 9214-9219 (2011).</li><li>Dahl, S. L., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Readily+available+tissue-engineered+vascular+grafts.">Readily available tissue-engineered vascular grafts.</a> Sci Transl Med. 2 (68), (2011).</li><li>Syedain, Z. H., Meier, L. A., Lahti, M. T., Johnson, S. L., Tranquillo, R. T. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Implantation+of+completely+biological+engineered+grafts+following+decellularization+into+the+sheep+femoral+artery.">Implantation of completely biological engineered grafts following decellularization into the sheep femoral artery.</a> Tissue Eng Part A. 20 (11-12), 1726-1734 (2014).</li><li>Syedain, Z. H., Meier, L. A., Bjork, J. W., Lee, A., Tranquillo, R. T. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Implantable+arterial+grafts+from+human+fibroblasts+and+fibrin+using+a+multi-graft+pulsed+flow-stretch+bioreactor+with+noninvasive+strength+monitoring.">Implantable arterial grafts from human fibroblasts and fibrin using a multi-graft pulsed flow-stretch bioreactor with noninvasive strength monitoring.</a> Biomaterials. 32 (3), 714-722 (2011).</li><li>Meier, L. A., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Blood+outgrowth+endothelial+cells+alter+remodeling+of+completely+biological+engineered+grafts+implanted+into+the+sheep+femoral+artery.">Blood outgrowth endothelial cells alter remodeling of completely biological engineered grafts implanted into the sheep femoral artery.</a> J Cardiovasc Transl Res. 7 (2), 242-249 (2014).</li><li>Pinnock, C. B., Meier, E. M., Joshi, N. N., Wu, B., Lam, M. T. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Customizable+engineered+blood+vessels+using+3D+printed+inserts.">Customizable engineered blood vessels using 3D printed inserts.</a> Methods. S1046-2023 (15), 30184-30185 (2015).</li><li>Blakely, A. M., Manning, K. L., Tripathi, A., Morgan, J. R. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Bio-Pick,+Place,and+Perfuse:+A+New+Instrument+for+Three-Dimensional+Tissue+Engineering.">Bio-Pick, Place,and Perfuse: A New Instrument for Three-Dimensional Tissue Engineering.</a> Tissue Eng Part C Methods. 21 (7), 737-746 (2015).</li><li>Gwyther, T. A., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Engineered+vascular+tissue+fabricated+from+aggregated+smooth+muscle+cells.">Engineered vascular tissue fabricated from aggregated smooth muscle cells.</a> Cells Tissues Organs. 194 (1), 13-24 (2011).</li><li>Fearon, W. F., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Changes+in+coronary+arterial+dimensions+early+after+cardiac+transplantation.">Changes in coronary arterial dimensions early after cardiac transplantation.</a> Transplantation. 27 (6), 700-705 (2007).</li><li>Erbel, R., Eggebrecht, H. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Aortic+dimensions+and+the+risk+of+dissection.">Aortic dimensions and the risk of dissection.</a> Heart. 92 (1), 137-142 (2006).</li><li>Ha, D. M., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Transforming+growth+factor-beta+1+produced+by+vascular+smooth+muscle+cells+predicts+fibrosis+in+the+gastrocnemius+of+patients+with+peripheral+artery+disease.">Transforming growth factor-beta 1 produced by vascular smooth muscle cells predicts fibrosis in the gastrocnemius of patients with peripheral artery disease.</a> J Transl Med. 14, 39 (2016).</li><li>Skalli, O., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Alpha-smooth+muscle+actin,+a+differentiation+marker+of+smooth+muscle+cells,+is+present+in+microfilamentous+bundles+of+pericytes.">Alpha-smooth muscle actin, a differentiation marker of smooth muscle cells, is present in microfilamentous bundles of pericytes.</a> J Histochem Cytochem. 37 (3), 315-321 (1989).</li><li>von der Ecken, J., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Structure+of+the+F-actin-tropomyosin+complex.">Structure of the F-actin-tropomyosin complex.</a> Nature. 519 (7541), 114-117 (2015).</li></ol>

The Ring Stacking Method presents multiple advantages over current vascular tissue engineered construct techniques. The RSM can be adapted to create human vessels of any size by simply customizing the post and outer shell dimensions. Our method allows for development of polymer-free engineered vessels composed solely of human cells and rapidly degrading support material found in the body&#39;s natural wound healing process. Polymer grafts are known to cause restenosis in the clinic and could become problematic if contain...

In treatment of coronary artery disease (CAD), a patient&#39;s own blood vessels are harvested as graft material for bypass surgery. However, oftentimes, ill patients do not have viable vessels to donate to themselves, and in cases where they do, the donor site causes considerable additional harm and has a serious risk for infection.1 Engineered vascular grafts could fill this need. Scalability is of utmost importance for engineering vessels in order to meet the wide range of patient vessel size requirements. However, present methods for engineering vessels are not easily scalable, and typically require remanufacture of complex molds or polymer scaffolds. Most engineered grafts either utilize a polymer tubular scaffold that is seeded with vascular fibroblasts, smooth muscle, or endothelial cells; or rolling a cell sheet around a mandrel to create a tissue tube. Two engineered vascular grafts in clinical trials are based on a decellularized polymer-ECM platform.2,3,4 Polymer grafts available for use in vascular repair are already known to have issues with patency, which could arise as a major issue with long-term application of a graft with a sustained polymer presence. Tubular molds have been used to fabricate completely cellular vessels,5,6,7,8,9,10,11,12,13 which procedures would require additional design and tool manufacturing for custom molds in order to produce vessels in a variety of sizes.
The method described herein encompasses a novel technique for creating easily scalable engineered vascular grafts using customizable 3D printed inserts and traditional culture plates.14 Cells are seeded into plates with inserts of a central post and outer shell. The post controls lumen diameter and allows the cell monolayer to self-assemble into a ring of tissue. The outer shell controls thickness of the ring, and thus wall thickness of the final vessel. Completed tissue rings are then stacked to form a tubular, vascular graft. The advantage to this method, termed the &#34;Ring Stacking Method,&#34; is that any adherent cell type can be seeded into the plate setup and tissue rings or tubes of any size needed for the desired application can be generated by simply modifying guide inserts. Comparative techniques in tissue engineering creating rings of tissue remain difficult to scale,15,16 requiring remanufacture of molds for each desired size. Additionally, vascular grafts made using this method can be produced in 2-3 weeks, several weeks faster compared to other engineered vessels.6 For the clinic, this time discrepancy can make a significant difference in the treatment of a deteriorating patient.

<table border="1" fo:keep-together.within-page="1" fo:keep-with-next.within-page="always">
	<tbody>
		<tr>
			<td>Human Aortic Smooth Muscle Cells&#160;</td>
			<td>ATCC</td>
			<td>PCS-100-012</td>
			<td>vascular smooth muscle cells</td>
		</tr>
		<tr>
			<td>Medium 231</td>
			<td>Gibco (Life Technologies&#160;</td>
			<td>M-231-500</td>
			<td>media specific to vascular smooth muscle cells</td>
		</tr>
		<tr>
			<td>Human Aortic Smooth Muscle Cell Growth Kit&#160;</td>
			<td>ATCC</td>
			<td>PSC-100-042</td>
			<td>growth factors for maintaining vascular smooth muscle cell viability</td>
		</tr>
		<tr>
			<td>Replicator Mini 3D printer&#160;</td>
			<td>MakerBot&#160;</td>
			<td>N/A</td>
			<td>3D printer</td>
		</tr>
		<tr>
			<td>Poly(lactic acid) 3D ink (PLA)</td>
			<td>MakerBot&#160;</td>
			<td>N/A</td>
			<td>3D printer filament</td>
		</tr>
		<tr>
			<td>Poly(dimethlysiloxane) (PDMS)</td>
			<td>Ellworth Adhesives&#160;</td>
			<td>3097358-1004</td>
			<td>polymer for gluing plate parts</td>
		</tr>
		<tr>
			<td>Fibrinogen</td>
			<td>Hyclone Labratories, Inc.</td>
			<td>SH30256.01</td>
			<td>fibrin gel component</td>
		</tr>
		<tr>
			<td>Thrombin&#160;</td>
			<td>Sigma Life Sciences</td>
			<td>F3879-5G</td>
			<td>fibrin gel component</td>
		</tr>
		<tr>
			<td>Tranforming Growth Factor-Beta 1&#160;</td>
			<td>PeproTech</td>
			<td>100-21</td>
			<td>growth factor for stimulating collagen production</td>
		</tr>
		<tr>
			<td>Hemocytometer&#160;</td>
			<td>Hausser Scientific Co.</td>
			<td>3200</td>
			<td>for cell counting</td>
		</tr>
		<tr>
			<td>Polycarbonate tubing&#160;</td>
			<td>US Plastics&#160;</td>
			<td>PCTUB1.750X1.625</td>
			<td>material for making tall, ring stacking plates</td>
		</tr>
		<tr>
			<td>Polycarbonate sheet&#160;</td>
			<td>Home Depot</td>
			<td>409497</td>
			<td>material for making tall, ring stacking plates</td>
		</tr>
		<tr>
			<td>Adhesive polymer solvent&#160;</td>
			<td>SCIGRIP</td>
			<td>10799</td>
			<td>material for making tall, ring stacking plates</td>
		</tr>
		<tr>
			<td>Instron&#160; 5940</td>
			<td>Instron</td>
			<td>N/A</td>
			<td>tensile testing machine</td>
		</tr>
		<tr>
			<td>U-Stretch</td>
			<td>Cell Scale</td>
			<td>N/A</td>
			<td>tensile testing machine</td>
		</tr>
		<tr>
			<td>Smooth Muscle Actin&#160;</td>
			<td>MA5-11547</td>
			<td>Thermo Fisher</td>
			<td>antibody</td>
		</tr>
		<tr>
			<td>Tropomyosin</td>
			<td>MA5-11783</td>
			<td>Thermo Fisher</td>
			<td>antibody</td>
		</tr>
	</tbody>
</table>

scaling of engineered vascular grafts using 3d printed guides and the ring stacking method

Coronary artery disease remains a leading cause of death, affecting millions of Americans. With the lack of autologous vascular grafts available, engineered grafts offer great potential for patient treatment. However, engineered vascular grafts are generally not easily scalable, requiring manufacture of custom molds or polymer tubes in order to customize to different sizes, constituting a time-consuming and costly practice. Human arteries range in lumen diameter from about 2.0-38 mm and in wall thickness from about 0.5-2.5 mm. We have created a method, termed the "Ring Stacking Method," in which variable size rings of tissue of the desired cell type, demonstrated here with vascular smooth muscle cells (SMCs), can be created using guides of center posts to control lumen diameter and outer shells to dictate vessel wall thickness. These tissue rings are then stacked to create a tubular construct, mimicking the natural form of a blood vessel. The vessel length can be tailored by simply stacking the number of rings required to constitute the length needed. With our technique, tissues of tubular forms, similar to a blood vessel, can be readily manufactured in a variety of dimensions and lengths to meet the needs of the clinic and patient.

Demonstrated here is fabrication of 3 different engineered vascular graft sizes (Figure 1), showing that the Ring Stacking Method (RSM) is scalable. To prove applicability, the 3 different vessel sizes chosen correlate to actual human vessel size for the left anterior descending artery (small; lumen diameter = 4 mm)17, descending aorta (intermediate; lumen diameter = 10 mm) and ascending aorta (large; lumen diameter = 20 mm)18</su...

Watch this Scientific Journal Video about Scaling of Engineered Vascular Grafts Using 3D Printed Guides and the Ring Stacking Method at JoVE.com

Scaling of Engineered Vascular Grafts Using 3D Printed Guides and the Ring Stacking Method

Scalable engineered blood vessels would improve clinical applicability. Using easily sizable 3D-printed guides, rings of vascular smooth muscle were created and stacked into a tubular form, forming a vascular graft. Grafts can be sized to meet the range of human coronary artery dimensions by simply changing the 3D-printed guide size.

Coronary artery disease remains a leading cause of death, affecting millions of Americans. With the lack of autologous vascular grafts available, ...

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