Tissue-engineered blood vessels for clinical translation: Design logic, representative advances and persistent...

Area of Science:

• Biomaterials Science
• Regenerative Medicine
• Vascular Surgery

Background:

• Tissue-engineered blood vessels (TEBVs) show promise for small-diameter vascular reconstruction.
• Clinical translation is hindered by issues such as thrombosis, compliance mismatch, delayed endothelialization, and host remodeling.
• Current TEBV technologies require further optimization for widespread clinical application.

Purpose of the Study:

• To review recent advances in TEBV development, focusing on scaffold design, cell selection, bioactive factors, and biofabrication.
• To analyze the interplay between TEBV components and hemodynamic forces.
• To propose a framework for matching TEBV strategies to specific clinical indications for improved translational success.

Main Methods:

• Synthesis of representative advances in scaffold materials and architecture.
• Review of seed-cell choices and bioactive molecule incorporation.
• Analysis of biofabrication techniques and their impact on TEBV properties.
• Evaluation of TEBV performance under hemodynamic load.

Main Results:

• Significant progress has been made in scaffold design, cell sourcing, and biofabrication techniques.
• The interaction between TEBV components and hemodynamic forces is critical for graft function.
• Acellular or host-repopulating grafts may be suitable for trauma and vascular access.
• Coronary and peripheral reconstruction demand precise control over endothelialization and mechanical properties.

Conclusions:

• Translational success of TEBVs hinges on aligning material properties, cellular behavior, immune response, and manufacturing with specific clinical requirements.
• TEBVs should be assessed as indication-specific products using clinically relevant benchmarks, moving beyond short-term patency.
• Future research should focus on developing TEBVs tailored to distinct vascular reconstruction needs.