Scientific paper:
"A novel hybrid silk-fibroin/polyurethane three-layered vascular graft: towards in situ tissue engineered vascular accesses for haemodialysis."
Keywords:
In situ tissue engineering, haemodialysis vascular access, electrospinning, early cannulation, hybrid vascular graft, fibroin, polyurethane
Introduction:
Patients undergoing chronic haemodialysis need a vascular access to connect the vascular system to an external dialysis equipment.
However, Clinically available alternatives of vascular access for long-term haemodialysis (currently limited to native arteriovenous fistulae and synthetic grafts) suffer from several drawbacks and are associated to high failure rates.
![Webimage In Situ Tissue](/sites/default/files/styles/full_width_mobile/public/2022-11/Webimage%20In%20Situ%20Tissue.jpg?itok=W1VFIwa6)
The best practice for recurrent long-term haemodialysis is the creation of an AVF, i.e., the direct surgical connection between an artery and a vein, which provides the highest long-term patency rates (approximately 70%) due to its capability of remodelling and evolving together with the patient’s system.
![AV Fistula for Dialysis](/sites/default/files/styles/full_width_mobile/public/2022-11/AV%20Fistula%20for%20Dialysis.png.jpg?itok=G7ui3kV0)
![Explanation Arteriovenous Fistula](/sites/default/files/styles/full_width_mobile/public/2022-11/Explanation%20Arteriovenous%20Fistula%20-%20AVF.jpg?itok=YIAnabK7)
However, AVF is not always feasible in all patients (e.g., elderly, diabetics, patients with high Body Mass Index), and it usually requires 6-8 weeks to reach a sufficient maturation stage to allow for puncturing (process known as “arterialization”)
Abstract
Clinically available alternatives of vascular access for long-term haemodialysis(currently limited to native arteriovenous fistulae and synthetic grafts) suffer from several drawbacks and are associated to high failure rates.
Bioprosthetic grafts and tissue-engineered blood vessels are costly alternatives without clearly demonstrated increased performance.
![Screencapture](/sites/default/files/styles/full_width_mobile/public/2022-11/Screencapture.png.jpg?itok=hhYb2vZe)
"In situ tissue engineering could be the ideal approach"
In situ tissue engineering could be the ideal approach to provide a vascularaccess that profits from the advantages of vascular grafts in the short-term (e.g. early cannulation) and of fistulae in the long-term (e.g. high success rates driven by biointegration).
Hence, in this study a three-layered silk fibroin/polyurethane vascular graft was developed by electrospinning to be applied as long-term haemodialysisvascular access pursuing a 'hybrid' in situ engineering approach (i.e. based on a semi-degradable scaffold).
![Bioengineering Laboratories Srl, Cantù, Italy](/sites/default/files/styles/full_width_mobile/public/2022-11/Bioengineering%20Laboratories%20Srl%2C%20Cant%C3%B9%2C%20Italy%20-%20fig1.jpg?itok=oib5D-iI)
![Bioengineering Laboratories Srl, Cantù, Italy](/sites/default/files/styles/full_width_mobile/public/2022-11/Bioengineering%20Laboratories%20Srl%2C%20Cant%C3%B9%2C%20Italy%20-%20fig2.jpg?itok=dCQHU1RY)
![Bioengineering Laboratories Srl, Cantù, Italy](/sites/default/files/styles/full_width_mobile/public/2022-11/Bioengineering%20Laboratories%20Srl%2C%20Cant%C3%B9%2C%20Italy%20-%20fig3.jpg?itok=7Xwyxh_Q)
"three-layered silk fibroin/polyurethane vascular graft"
This Silkothane® graft was characterized concerning morphology, mechanics, physical properties, blood contact and vascular cell adhesion/viability. The full three-layered graft structure, influenced by the polyurethane presence, ensured mechanical properties that are a determinant factor for the success of a vascular access (e.g. vein-graft compliance matching).
The Silkothane® graft demonstrated early cannulation potential in line with self-sealing commercial synthetic arteriovenous grafts, and a degradability driven by enzymatic activity.
Moreover, the fibroin-only layers and extracellular matrix-like morphology, presented by the graft, revealed to be crucial in providing a non-haemolytic character, long clotting time, and favourable adhesion of human umbilical vein endothelial cells with increasing viability after 3 and 7 d.
Accordingly, the proposed approach may represent a step forward towards an in situ engineered hybrid vascular access with potentialities for vein-graft anastomosis stability, early cannulation, and biointegration.
Testimonials
Authors:
Sebastião van Uden, Noemi Vanerio, Valentina Catto, Barbara Bonandrini, Matteo Tironi, Marina Figliuzzi, Andrea Remuzzi, Linda Kock, Alberto C L Redaelli, Francesco G Greco, Stefania A. Riboldi
- Bioengineering Laboratories S.r.l., Cantù (MB), Italy
- Dipartimento di Elettronica Informazione e Bioingegneria, Politecnico di Milano, Milan (MI), Italy
- LifeTec Group BV, Eindhoven, The Netherlands
- Department of Cardiothoracic Surgery & Amsterdam Cardiovascular Sciences, Amsterdam University Medical Center, Amsterdam, The Netherlands
- Department of Chemistry, Materials and Chemical Engineering Giulio Natta, Politecnico di Milano, Milan (MI), Italy
- Istituto di Ricerche Farmacologiche Mario Negri IRCCS
- Dipartimento di Ingegneria gestionale, dell'informazione e della produzione, Università degli Studi di
Relevant links and background information:
- IOP Publishing Ltd [link]
- LifeTec Group - Vascular Bioreactor Platform [fact page]
- LifeTec Group - MUSICARE [case description page]
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