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(Circulation. 1996;93:1319-1320.)
© 1996 American Heart Association, Inc.

Articles

Improving the Interface Between Biomaterials and the Blood

The Gene Therapy Approach

Alexander W. Clowes, MD

From the Department of Surgery, University of Washington School of Medicine, Seattle.

Correspondence to Alexander W. Clowes, MD, Department of Surgery, University of Washington School of Medicine, BB442 HSB, Box 356410, Seattle, WA 98195-6410.

Key Words: Editorials • plasminogen activators • vessels • genes • endothelium

	Introduction

 
Synthetic grafts can substitute for diseased arteries and function well as long as there is high blood flow. In low-flow situations, they are prone to sudden thrombosis. They also provoke a wound-healing response from the adjacent vessels and the surrounding tissue that under some circumstances narrows the lumen and reduces blood flow.¹ Despite 50 years of investigation and development, we still lack "smart biomaterials" that possess the properties characteristic of normal vessels needed for the regulation of coagulation and luminal diameter. What can we do to improve this situation?

A great deal of effort has been put into making materials with nonthrombotic and nonanticoagulant surfaces. Although these materials are relatively inert in the short term, they are soon modified by the deposition of proteins from the blood, and they do not necessarily form smooth junctions with the adjacent arteries. One way to improve their performance is to encourage the formation of a surface on the biomaterial that mimics the surface of a normal vessel. Most investigators would consider a monolayer of endothelial cells as the right surface, even though other cell types (eg, vascular smooth muscle cells, mesothelial cells) and certain antithrombotic proteins might be able to form a suitable covering.^{2 3 4} If the endothelium is the right surface, then certain assumptions must be made. First, endothelium can be seeded onto the graft or induced to grow from local sources to form a confluent layer at the surface. Second, the endothelium over a graft behaves like endothelium over a normal artery . . . [Full Text of this Article]

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