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Immunomodulation Strategies for the Successful Regeneration of a Tissue-Engineered Vascular Graft
1Wilson College of Textiles, North Carolina State University, Raleigh, NC, 27606, USA.
Insights
Tissue-engineered vascular grafts (TEVGs) offer a promising solution for cardiovascular disease, addressing the shortage of suitable arterial grafts. Modulating the host immune response, particularly macrophage activity, is key to improving TEVG success and tissue regeneration.
Area of Science:
- Biomedical Engineering
- Immunology
- Regenerative Medicine
Background:
- Cardiovascular disease is a leading cause of global morbidity, creating a critical need for effective arterial grafts.
- Autologous vessels (e.g., saphenous vein grafts) are the gold standard but are unavailable for some patients.
- No synthetic grafts exist for small-diameter (<6 mm) arteries, highlighting the need for alternatives like tissue-engineered vascular grafts (TEVGs).
Purpose of the Study:
- To review the current state of TEVGs.
- To analyze the role of macrophages in TEVG regeneration.
- To discuss immunomodulatory strategies for enhancing TEVG outcomes.
Main Methods:
- Literature review of vascular tissue engineering and immunoengineering.
- Analysis of the host immune response, focusing on macrophages.
- Examination of biomaterial-based immunomodulatory strategies.
Main Results:
- TEVGs show promise as alternatives to synthetic grafts for small-diameter arteries.
- Host immune responses, especially macrophage activity, significantly influence TEVG success.
- Immunomodulatory strategies can direct the host response to improve tissue regeneration.
Conclusions:
- TEVGs represent a viable future for treating cardiovascular disease.
- Understanding and manipulating macrophage responses are crucial for advancing TEVG technology.
- Biomaterials offer a platform for developing effective immunomodulatory strategies to enhance TEVG integration and function.
Abstract:
Cardiovascular disease leads to the highest morbidity worldwide. There is an urgent need to solve the lack of a viable arterial graft for patients requiring coronary artery bypass surgery. The current gold standard is to use the patient's own blood vessel, such as a saphenous vein graft. However, some patients do not have appropriate vessels to use because of systemic disease or secondary surgery. On the other hand, there is no commercially available synthetic vascular graft available on the market for small diameter (<6 mm) blood vessels like coronary, carotid, and peripheral popliteal arteries. Tissue-engineered vascular grafts (TEVGs) are studied in recent decades as a promising alternative to synthetic arterial prostheses. Yet only a few studies have proceeded to a clinical trial. Recent studies have uncovered that the host immune response can be directed toward increasing the success of a TEVG by shedding light on ways to modulate the macrophage response and improve the tissue regeneration outcome. In this review, the basic concepts of vascular tissue engineering and immunoengineering are considered. The state-of-art of TEVGs is summarized and the role of macrophages in TEVG regeneration is analyzed. Current immunomodulatory strategies based on biomaterials are also discussed.
