Tissue-engineering of vascular grafts containing endothelium and smooth-muscle using triple-coaxial cell printing

Tissue engineering has emerged as a promising approach to viable small-diameter vascular grafts that may be used to treat cardiovascular diseases. One challenge in constructing such blood vessels is proper localization of endothelial cells and smooth muscle cells, as well as promotion of their cellular functions to generate functional tissues. Thus far, construction of small-diameter vascular substitutes with both endothelial and muscular tissues, which is essential for the grafts to acquire antithrombosis function and sufficient strength to avoid thrombus formation as well as to withstand blood pressure, has not yet been demonstrated. In this study, we engineer small-diameter blood vessel grafts containing both functional endothelial and muscular cell layers, which has been demonstrated in vivo in a living rat model. Our construction of the blood vessel grafts uses vascular-tissue-derived extracellular matrix bioinks and a reservoir-assisted triple-coaxial cell printing technique. The prematured vessel was implanted for three weeks as a graft of rat abdominal aorta in a proof-of-concept study where all implants showed great patency, intact endothelium, remodeled smooth muscle, and integration with host tissues at the end of the study. These outcomes suggest that our approach to tissue-engineered biomimetic blood vessels provides a promising route for the construction of durable small-diameter vascular grafts that may be used in future treatments of cardiovascular diseases.