Andrea Bagno

Cells, scaffolds and bioreactors for tissue-engineered heart valves: a journey from basic concepts to contemporary developmental innovations

The development of viable and functional tissue-engineered heart valves (TEHVs) is a challenge that, for almost two decades, the scientific community has been committed to face to create life-lasting prosthetic devices for treating heart valve diseases. One of the main drawbacks of tissue-based commercial substitutes, xenografts and homografts, is their lack of viability, and hence failure to grow, repair, and remodel. In adults, the average bioprostheses life span is around 13 years, followed by structural valve degeneration, such as calcification; in pediatric, mechanical valves are commonly used instead of biological substitutes, as in young patients, the mobilization of calcium, due to bone remodeling, accelerates the calcification process. Moreover, neither mechanical nor bioprostheses are able to follow childrens body growth. Cell seeding and repopulation of acellular heart valve scaffolds, biological and polymeric, appears as a promising way to create a living valve. Biomechanical stimuli have significant impact on cell behavior including in vitro differentiation, and physiological hemodynamic conditioning has been found to promote new tissue development. These concepts have led scientists to design bioreactors to mimic the in vivo environment of heart valves. Many different types of somatic and stem cells have been tested for colonizing both the surface and the core of the valve matrix but controversial results have been achieved so far.

Covalent surface modification of titanium oxide with different adhesive peptides: surface characterization and osteoblast-like cell adhesion.

A fundamental goal in the field of implantology is the design of innovative devices suitable for promoting implant-to-tissue integration. This result can be achieved by means of surface modifications aimed at optimizing tissue regeneration. In the framework of oral and orthopedic implantology, surface modifications concern both the optimization of titanium/titanium alloy surface roughness and the attachment of biochemical factors able to guide cellular adhesion and/or growth. This article focuses on the covalent attachment of two different adhesive peptides to rough titanium disks. The capability of biomimetic surfaces to increase osteoblast adhesion and the specificity of their biological activity due to the presence of cell adhesion signal-motif have also been investigated. In addition, surface analyses by profilometry, X-ray photoelectron spectroscopy, and time of flight-secondary ion mass spectrometry have been carried out to investigate the effects and modifications induced by grafting procedures.

Electrospun scaffolds of self-assembling peptides with poly(ethylene oxide) for bone tissue engineering

Structural, mechanical and biochemical properties have to be considered when searching for suitable extracellular matrix substitutes. Fibrous structures of synthetic or natural polymers have received increasing interest as three-dimensional scaffolds for tissue engineering applications as they can be easily produced by electrospinning with different topographical features by changing the process parameters. On the other hand, the nanobiotechnology approach suggests mimicking molecular architectures in nature through self-assembly. In particular, self-assembling peptide-based biomaterials have been successfully used as scaffolds for cell growth. In order to amalgamate these two strategies nanofibrous electrospun scaffolds of hybrid polymer were designed and obtained by mixing poly(ethylene oxide) and self-assembling peptides in aqueous solution. The results of in vitro osteoblast adhesion and proliferation assays on the electrospun scaffolds obtained using different self-assembling peptide sequences are discussed.

Assessment of novel chemical strategies for covalent attachment of adhesive peptides to rough titanium surfaces: XPS analysis and biological evaluation

Bioactive molecules have been proposed to promote beneficial interactions at bone-implant interfaces for enhancing integration. The main objective of this study was to develop novel methods to functionalize oxidized titanium surfaces by the covalent immobilization of bioactive peptides, through selective reaction involving single functional groups. In the first protocol, an aminoalkylsilane was covalently linked to the Ti oxide layer, followed by covalent binding of glutaric anhydride to the free NH(2) groups. The carboxylic group of glutaric anhydride was used to condense the free N-terminal group of the side-chain protected peptide sequence. Finally, the surface was treated with trifluoroacetic acid to deprotect side-chain groups. In the second protocol, the peptide was directly anchored to the Ti oxide surface via UV activation of an arylazide peptide analogue. X-ray photoelectron spectroscopy analyses confirmed that modifications induced onto surface composition were in agreement with the reactions performed. The peptide density of each biomimetic surface was determined on the basis of radiolabeling and XPS derived reaction yields. The in vitro cellular response of the biomimetic surfaces was evaluated using a primary human osteoblast cell model. Cell adhesion, proliferation, differentiation, and mineralization were examined at initial-, short-, and long-time periods. In was shown that the biomimetic surface obtained through photoprobe-marked analogue that combines an easily-performed modification provides a favorable surface for an enhanced cellular response.

Mechanisms underlying the attachment and spreading of human osteoblasts: from transient interactions to focal adhesions on vitronectin-grafted bioactive surfaces.

The features of implant devices and the reactions of bone-derived cells to foreign surfaces determine implant success during osseointegration. In an attempt to better understand the mechanisms underlying osteoblasts attachment and spreading, in this study adhesive peptides containing the fibronectin sequence motif for integrin binding (Arg-Gly-Asp, RGD) or mapping the human vitronectin protein (HVP) were grafted on glass and titanium surfaces with or without chemically induced controlled immobilization. As shown by total internal reflection fluorescence microscopy, human osteoblasts develop adhesion patches only on specifically immobilized peptides. Indeed, cells quickly develop focal adhesions on RGD-grafted surfaces, while HVP peptide promotes filopodia, structures involved in cellular spreading. As indicated by immunocytochemistry and quantitative polymerase chain reaction, focal adhesions kinase activation is delayed on HVP peptides with respect to RGD while an osteogenic phenotypic response appears within 24h on osteoblasts cultured on both peptides. Cellular pathways underlying osteoblasts attachment are, however, different. As demonstrated by adhesion blocking assays, integrins are mainly involved in osteoblast adhesion to RGD peptide, while HVP selects osteoblasts for attachment through proteoglycan-mediated interactions. Thus an interfacial layer of an endosseous device grafted with specifically immobilized HVP peptide not only selects the attachment and supports differentiation of osteoblasts but also promotes cellular migration.

Mechanical testing of pericardium for manufacturing prosthetic heart valves

Mammalian pericardia are currently used for the production of percutaneous prosthetic heart valves. The characteristics of biological tissues largely influence the durability of prosthetic devices used in the percutaneous approach and in traditional surgery, too. This paper reviews methodologies employed to assess and compare mechanical properties of pericardial patches from different mammalian species in order to identify the biomaterials adequate for manufacturing prosthetic heart valves.

Bileaflet mechanical heart valve closing sounds: in vitro classification by phonocardiographic analysis

Bileaflet mechanical heart valves, which exhibit hemodynamic performance fairly similar to that of native valves, can be investigated by the analysis of their closing sounds. Signal spectra calculated from the closing sounds are characterized by specific features that are suitable for the functional evaluation of the valves. Five commercial bileaflet mechanical heart valves were studied under different conditions that were simulated in vitro using a Sheffield pulse duplicator for the aortic position. The closing sounds were acquired by means of a phonocardiographic apparatus, analyzed by a specifically implemented algorithm, and were statistically compared. This article was aimed at classifying the investigated valves on the basis of their signal spectra: different profiles were identified, depending on the working conditions; moreover, closing sound reproducibility and intensity allowed the ranking of valve performances with respect to the “noise” produced by valve closure. In particular, results demonstrated which valves were characterized by the lowest noise (i.e., the Medtronic Advantage and St. Jude Regent valves) and which were characterized by the highest reproducibility (OnX, Medtronic Advantage, and St. Jude Regent valves) under the examined experimental conditions.

Fermentation diagnosis by multivariate statistical analysis

During the course of fermentation, online measuring procedures able to estimate the performance of the current operation are highly desired. Unfortunately, the poor mechanistic understanding of most biologic systems hampers attempts at direct online evaluation of the bioprocess, which is further complicated by the lack of appropriate online sensors and the long lag time associated with offline assays. Quite often available data lack sufficient detail to be directly used, and after a cursory evaluation are stored away. However, these historic databases of process measurements may still retain some useful information. A multivariate statistical procedure has been applied for analyzing the measurement profiles acquired during the monitoring of several fed-batch fermentations for the production of erythromycin. Multivariate principal component analysis has been used to extract information from the multivariate historic database by projecting the process variables onto a low-dimensional space defined by the principal components. Thus, each fermentation is identified by a temporal profile in the principal component plane. The projections represent monitoring charts, consistent with the concept of statistical process control, which are useful for tracking the progress of each fermentation batch and identifying anomalous behaviors (process diagnosis and fault detection).

Preliminary study of laser doppler perfusion signal by wavelet transform in patients with critical limb ischemia before and after revascularization

The haemodynamics of skin microcirculation can be quantitatively evaluated by Laser Doppler Fluxmetry (LDF). LDF signal in human skin shows periodic oscillations. Spectral analysis by wavelet transform displays six characteristic frequency intervals (FI) from 0.005 to 2 Hz, related to distinct vascular structures activities: heart (0.6-2 Hz), sympathetic respiratory (0.145-0.6 Hz), myogenic (0.052-0.145 Hz), local sympathetic nerve (0.021-0.052 Hz) and endothelial cells NO dependent (0.0095-0.021 Hz) and NO independent (0.005-0.0095 Hz). The most advanced stage of peripheral arterial obstructive disease is the critical limb ischemia (CLI), which causes the reduction of blood perfusion threatening limb viability. Besides macrocirculatory alterations, many studies have shown microvascular misdistribution of skin blood flow as the main factor that leads patients to CLI. Revascularization can save limb and patients life, too. In the present study, LDF signals have been recorded on the skin of the foot dorsum in 15 patients suffering from CLI. LDF signals have been analyzed before and after limb revascularization by means of the wavelet analysis. Significant changes in frequency distribution before and after limb revascularization have been detected: the median normalized values of spectral power increases for 49.8% (p = 0.0341) in the frequency range 0.050328-0.053707 Hz, whereas spectral power decreases for 77.1% (p = 0.0179) in the frequency range 0.018988-0.029284 Hz. We can conclude that changes in the frequency intervals occur after revascularization, shifting from a prevailing endothelial activity toward a prevailing sympathetic activity.

Changes of the cutaneous flowmotion pattern after limb revascularization in patients with critical ischemia

The skin flowmotion of 13 patients suffering from critical limb ischemia (CLI) was studied with wavelet analysis (WA) of the laser Doppler signals (LDS). The WA selects six different frequency components (FCs), each relating to a specific cardiovascular system structures activities; FC I 1-2 Hz heart, FC II 0.2 Hz respiratory, FC III 0.1 Hz myogenic, FC IV 0.04 Hz, sympathetic, FC V 0.01 Hz, and FC VI 0.007 Hz endothelial. The aim of the study was to observe which FC changed after the limb revascularization. The LDS was measured at the dorsum of the foot, one week before and no later than 30 days after revascularisation. The absolute and relative amplitude and energy of the flowmotion WA FCs, the ankle brachial pressure index (ABI) and the transcutaneous pressure of oxygen (TcpO2) were assessed before and after revascularization. The results showed that after successful revascularization ABI and TcpO2 increased from 0.34 ± 0.10 to 0.54 ± 0.09 (p 0.0003) and from 20.3 ± 13.4 to 43.8 ± 18.7 mmHg (p 0.0002) whereas only the absolute amplitude and energy of the cardiac FC I increased from 0.57 ± 0.44 to 1.07 ± 0.69 (P 0.002) AU and 1.14 ± 1.78 AU2 to 3.54 ± 3.78 AU2 (p 0.004). In conclusion after limb revascularization the cardiac component of the flowmotion increased maybe because the cardiac stroke volume had more influence over the skin arterioles.