Long-term patency of small-diameter vascular graft made from fibroin, a silk-based biodegradable material Soichiro Enomoto, MD, PhD, Makoto Sumi, MD,

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Presentation transcript:

Long-term patency of small-diameter vascular graft made from fibroin, a silk-based biodegradable material Soichiro Enomoto, MD, PhD, Makoto Sumi, MD, PhD, Kan Kajimoto, MD, PhD, Yasumoto Nakazawa, PhD, Rui Takahashi, MS, Chiyuki Takabayashi, PhD, Tetsuo Asakura, PhD, Masataka Sata, MD, PhD Journal of Vascular Surgery Volume 51, Issue 1, Pages 155-164 (January 2010) DOI: 10.1016/j.jvs.2009.09.005 Copyright © 2010 Society for Vascular Surgery Terms and Conditions

Fig 1 A, Scanning electron microscopic (SEM) image shows silk fibroin filaments after removal of sericin proteins (scale bar, 60 μm). B, A small artificial vascular graft was made from fibroin fibers. C and D, Attachment and differentiation of bone marrow cells (BMCs) on fibroin graft. Rat BMCs were isolated as described previously. At 7 days after seeding, BMCs had spread and grown on the fibroin graft, forming cell sheets with a possible extracellular matrix (C, scale bar, 200 μm; D, scale bar, 50 μm). E, The fibroin-based graft (1.5 mm internal diameter) was implanted into rat abdominal aorta by end-to-end anastomosis (F). The arrows indicate anastomosis sites. Scale, 1 mm. Ao, Aorta; IVC, inferior vena cava. G, Blood flow within the graft was monitored by (upper panel) color Doppler imaging and (lower panel) pulse wave velocity measurement. H, Angiography revealed a patent fibroin graft. The arrows indicate anastomotic sites. G, Graft; V, inferior vena cava. Journal of Vascular Surgery 2010 51, 155-164DOI: (10.1016/j.jvs.2009.09.005) Copyright © 2010 Society for Vascular Surgery Terms and Conditions

Fig 2 A, Cross-sections of fibroin grafts at 2 and 12 weeks after implantation stained with anti-CD31 antibody (scale bar, 100 μm). Endothelial cell coverage was partial at 2 weeks after implantation. The arrowheads indicate CD31-positive endothelial cells. At 12 weeks after implantation, most of the luminal surface of the fibroin grafts was covered by endothelial cells. B, Anti-α-smooth muscle actin (α-SMA) immunostaining of fibroin grafts was performed at 2 and 12 weeks after implantation (scale bar, 100 μm). The thickness of the α-SMA-positive cell layer gradually increased. The newly formed media-like structure within the fibroin graft was highly cellular with α-SMA-positive cells. C, Polarization microscopic images of fibroin grafts after Sirius red staining. The content of fibroin (white) gradually decreased, while collagen (red) content increased after implantation (*P < .05 vs 2 weeks). The error bars indicate the standard error of the mean. D, The internal diameter of the fibroin graft was measured. The diameter remained unchanged. Journal of Vascular Surgery 2010 51, 155-164DOI: (10.1016/j.jvs.2009.09.005) Copyright © 2010 Society for Vascular Surgery Terms and Conditions

Fig 3 A, Kaplan-Meier analysis shows graft patency for 27 fibroin and 10 polytetrafluoroethylene (PTFE) grafts implanted into rat aortas at 2, 4, 8, 12, 24, 48, and 72 weeks (see text for details). B, Histologic analysis of fibroin grafts. Left, Cross section of the fibroin graft at 4 weeks after implantation (hematoxylin and eosin staining; scale bar, 100 μm). Cells migrated to the fibroin grafts and covered the luminal side completely. F, Fibroin graft. L, lumen. Right, The arrowheads indicate media-like layer and endothelium-like layer, and the arrows indicate fibroin fibers (scale bar, 50 μm). C, Histological analysis of PTFE (P) grafts. Left, Cross section of the PTFE graft at 4 weeks after implantation (hematoxylin and eosin staining staining; scale bar, 100 μm). L, Lumen. Right, Very few cells attached on the luminal side of PTFE graft (scale bar, 50 μm). Bottom, Thrombus formation in the occluded PTFE graft (scale bar, 250 μm). Journal of Vascular Surgery 2010 51, 155-164DOI: (10.1016/j.jvs.2009.09.005) Copyright © 2010 Society for Vascular Surgery Terms and Conditions

Fig 4 A, Macroscopic image of implanted fibroin graft (G) at 1 year shows no aneurysm formation. The arrows indicate anastomotic sites. The fibroin grafts appeared to be integrated into the surrounding tissue and showed no signs of thrombosis, stenosis, or mechanical failure. Ao, Aorta; IVC, inferior vena cava. B, Histologic analysis of the fibroin graft at 1 year showed a confluent endothelial layer and smooth muscle cell layers, as determined by immunostaining against CD31 and α-smooth muscle actin (α-SMA), respectively. Immunostaining for CD68 revealed substantial macrophage infiltration in the adventitia. Formation of vasa vasorum was noted (arrowheads). Scale bar, 100 μm (upper and lower panels). Journal of Vascular Surgery 2010 51, 155-164DOI: (10.1016/j.jvs.2009.09.005) Copyright © 2010 Society for Vascular Surgery Terms and Conditions

Fig 5 A, At 4 to 16 weeks after BMT from GFP rats to wild-type SD rats, fibroin grafts were implanted into the chimeric rats. Fibroin grafts transplanted in BMT rats were snap-frozen at 4 or 12 weeks. Nuclei were counterstained with Hoechst 33258 (blue). We readily detected GFP-positive cells (green) that were positive for α-SMA or SM1 (red). There were few GFP and CD31 (red) double-positive cells. Few CD45-positive cells (red) were observed within the newly formed vessel wall-like structure. Scale bar, 100 μm. B, Representative images of BM-derived smooth muscle-like cells on fibroin graft at 12 weeks after implantation into BMT rat. Frozen sections were stained for GFP (green) and SM1 (red). The arrows indicate double-positive cells. Scale bar, 20 μm. Lower panels are higher magnification images of the media-like layer. The lower right panel shows a differential interference contrast microscopic image with nuclei (blue). Scale bar, 10 μm. C, Frequency of GFP- and SM1-positive cells in the media-like structure of fibroin grafts was measured at 1 and 3 months after implantation. The error bars indicate the standard error of the mean. Journal of Vascular Surgery 2010 51, 155-164DOI: (10.1016/j.jvs.2009.09.005) Copyright © 2010 Society for Vascular Surgery Terms and Conditions