Human Blood Vessel–Derived Endothelial Progenitors for Endothelialization of Small Diameter Vascular Prosthesis

BACKGROUND:Coronary bypass graft failure as a result of acute thrombosis and intimal hyperplasia has been the major challenge in surgical procedures involving small-diameter vascular prosthesis. Coating synthetic grafts with patients' own endothelial cells has been suggested to improve the patency rate and overall success of bypass surgeries. METHODOLOGY/PRINCIPAL FINDINGS:We isolated endothelial progenitor cells (EPCs) from leftover pieces of human saphenous vein/mammary artery. We demonstrate that EPCs can be expanded to generate millions of cells under low-density culture conditions. Exposure to high-density conditions induces differentiation to endothelial cell phenotype. EPC-derived endothelial cells show expression of CD144high, CD31, and vWF. We then assessed the ability of differentiated endothelial cells to adhere and grow on small diameter expanded polytetrafluoroethylene (ePTFE) tubings. Since ePTFE tubings are highly hydrophobic, we optimized protocols to introduce hydrophilic groups on luminal surface of ePTFE tubings. We demonstrate here a stepwise protocol that involves introduction of hydrophilic moieties and coating with defined ECM components that support adhesion of endothelial cells, but not of blood platelets. CONCLUSION/SIGNIFICANCE:Our data confirms that endothelial progenitors obtained from adult human blood vessels can be expanded in vitro under xenoprotein-free conditions, for potential use in endothelialization of small diameter ePTFE grafts. These endothelialized grafts may represent a promising treatment strategy for improving the clinical outcome of small-caliber vascular grafts in cardiac bypass surgeries

Fluorescence labeling to study platelet and leucocyte deposition onto vascular grafts in vitro

Platelets and leucocytes are important participants in the response of the body to small diameter vascular grafts implanted into the arterial circulation. A sensitive and quick method for measuring platelet and leucocyte deposition contributes to material evaluation. With a newly developed fluorescence labeling method we examined the deposition of platelets and leucocytes onto vascular grafts in vitro. Human platelets and leucocytes were isolated and labeled with the fluorescence label Europium trichloride (EuCl3). After reconstitution of the labeled cells in plasma their functionality appeared intact and competitive with unlabeled cells. Eu-labeled platelets or leucocytes were then incubated with expanded polytetrafluoroethylene (ePTFE), Dacron and polyurethane (PU) vascular grafts in autologous plasma. beta-thromboglobin and thromboxane release from platelets and beta-glucuronidase release from leucocytes during the incubation experiments were measured. Platelets and leucocytes deposited significantly less onto ePTFE compared to Dacron and polyurethane (P <0.01). Our results are in accordance with results of in vivo studies using radio-active labeling to study platelet and leucocyte deposition. However, a new finding was that this reduced cell deposition may in part be due to possible toxic effects of ePTFE, shown by increased haemolysis and beta-thromboglobin release. (C) 1999 Elsevier Science Ltd. All rights reserved

Fluorescence labeling to study platelet and leucocyte deposition onto vascular grafts in vitro

Platelets and leucocytes are important participants in the response of the body to small diameter vascular grafts implanted into the arterial circulation. A sensitive and quick method for measuring platelet and leucocyte deposition contributes to material evaluation. With a newly developed fluorescence labeling method we examined the deposition of platelets and leucocytes onto vascular grafts in vitro. Human platelets and leucocytes were isolated and labeled with the fluorescence label Europium trichloride (EuCl3). After reconstitution of the labeled cells in plasma their functionality appeared intact and competitive with unlabeled cells. Eu-labeled platelets or leucocytes were then incubated with expanded polytetrafluoroethylene (ePTFE), Dacron and polyurethane (PU) vascular grafts in autologous plasma. beta-thromboglobin and thromboxane release from platelets and beta-glucuronidase release from leucocytes during the incubation experiments were measured. Platelets and leucocytes deposited significantly less onto ePTFE compared to Dacron and polyurethane (P <0.01). Our results are in accordance with results of in vivo studies using radio-active labeling to study platelet and leucocyte deposition. However, a new finding was that this reduced cell deposition may in part be due to possible toxic effects of ePTFE, shown by increased haemolysis and beta-thromboglobin release. (C) 1999 Elsevier Science Ltd. All rights reserved

Superhydrophobic modification fails to improve the performance of small diameter expanded polytetrafluoroethylene vascular grafts

To determine whether superhydrophobic modification of small diameter expanded polytetrafluoroethylene (ePTFE) vascular grafts improves the performance of these grafts, we assessed neointima formation and platelet deposition in standard and superhydrophobic modified ePTFE grafts. Standard and superhydrophobic vascular grafts were implanted in the carotid arteries of two rabbits and two pigs. Furthermore, standard and superhydrophobic vascular patches were implanted in the carotid arteries of seven pigs. After 4 weeks of implantation all patches were removed and histomorphometric data were analyzed. The early thrombotic effect of superhydrophobic modification was examined by quantifying platelet glycoprotein receptor IIIa deposition onto each type of vascular graft after 15 min of in vitro circulation with human blood. All superhydrophobic and standard ePTFE vascular grafts occluded 15 min to I h after implantation in both rabbit and pie carotid arteries. All implanted patches remained patent and were completely covered by endothelium. Superhydrophobic modification of ePTFE vascular grafts did not lead to less neointima formation and resulted in significantly more platelet deposition than did standard ePTFE vascular grafts. Thus. superhydrophobic modification does not improve the performance of small diameter ePTFE vascular grafts. (C) 2001 Elsevier Science Ltd. All rights reserved