Zusammenfassung
Das „tissue engineering“ von Gefäßprothesen ist ein neues, aufgrund des zunehmenden Bedarfs an besseren Gefäßprothesen für Koronar- und periphere Revaskularisationseingriffe schnell wachsendes Forschungsgebiet. Klinisch verwendete kleinkalibrige künstliche Gefäßprothesen zeigen wegen Thrombose und intimaler Hyperplasie eine hohe Verschlussrate. Neue Ansätze wie dezellularisierte, natürliche oder synthetische dreidimensionale stabile oder abbaubare Matrizen werden für das zellfreie oder zellbasierte Gefäß-Tissue-Engineering entwickelt. Trotz der initialen limitierten klinischen Anwendungen der zellulären bioreaktorbasierten Methoden bestehen Nachteile wie die nicht sofortige Verfügbarkeit sowie ein hoher Zeit- und Kostenaufwand. Dem entgegengesetzt basiert unsere Forschung auf der Verwendung von zellfreien bioabbaubaren elektrogesponnenen porösen 3-D-Strukturen hergestellt aus Nano- und Mikro-Polycaprolacton-Fasern. Tierversuche bei Ratten und Schweinen haben gute Kurz- und Langzeitergebnisse nach arteriellem Gefäßersatz gezeigt mit optimaler Offenheitsrate, keiner Aneurysmabildung und Einwachsen von körpereigenen Zellen, welche eine vollständige luminale Endothelbeschichtung und eine homogene Besiedlung der Prothesenwand mit extrazellulärer Matrix und Angiogenesebildung ermöglichen. Darum glauben wir, dass unser In-vivo-Konzept des Gefäßprothesen-Tissue-Engineerings eine zukünftige klinische Option für kleinkalibrige bioabbaubare synthetische Gefäßprothesen darstellt.
Abstract
Vascular tissue engineering represents a new but rapidly growing field due to the need for better vascular prostheses for coronary or peripheral revascularization procedures. Current synthetic prostheses have a high incidence of failure due to thrombosis and/or intimal hyperplasia especially in small caliber artificial vascular prostheses. New approaches such as decellularized, natural or synthetic, 3-D stable/degradable scaffolds are being developed for acellular or cell-based vascular replacements. The drawbacks of cellular bioreactor matured prostheses are delayed availability and that they are, labor and cost-intensive. However, some research groups have shown limited clinical applications. The acellular approach is based on a biodegradable, electrospun, porous 3-D structure made of nano- and micro-sized polycaprolactone fibers. Animal studies in rats and pigs have shown good short and long-term results after arterial replacement with autologous cellular and matrix ingrowth, angiogenesis, confluent endothelialization and absence of occlusions or aneurysm formation. Therefore, the in vivo vascular tissue engineering approach produces shelf-ready biodegradable vascular prostheses which might be an option for future clinical applications.
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Walpoth, B., Möller, M. Tissue Engineering von Gefäßprothesen. Chirurg 82, 303–310 (2011). https://doi.org/10.1007/s00104-010-2029-9
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DOI: https://doi.org/10.1007/s00104-010-2029-9