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(Circulation. 2009;119:290-297.)
© 2009 American Heart Association, Inc.

Valvular Heart Disease

Hypoxia Induces Near-Native Mechanical Properties in Engineered Heart Valve Tissue

Angelique Balguid, PhD; Anita Mol, PhD; Marijke A.A. van Vlimmeren, MSc; Frank P.T. Baaijens, PhD; Carlijn V.C. Bouten, PhD

From Eindhoven University of Technology, Department of Biomedical Engineering, Eindhoven, The Netherlands.

Correspondence to Carlijn Bouten, Eindhoven University of Technology, Department of Biomedical Engineering, PO Box 513, 5600 MB Eindhoven, The Netherlands. E-mail c.v.c.bouten{at}tue.nl

Received November 1, 2007; accepted October 23, 2008.

Background— Previous attempts in heart valve tissue engineering (TE) failed to produce autologous valve replacements with native-like mechanical behavior to allow for systemic pressure applications. Because hypoxia and insulin are known to promote protein synthesis by adaptive cellular responses, a physiologically relevant oxygen tension and insulin supplements were applied to the growing heart valve tissues to enhance their mechanical properties.

Methods and Results— Scaffolds of rapid-degrading polyglycolic acid meshes coated with poly-4-hydroxybutyrate were seeded with human saphenous vein myofibroblasts. The tissue-engineered constructs were cultured under normal oxygen tension (normoxia) or hypoxia (7% O₂) and incubated with or without insulin. Glycosaminoglycan production in the constructs approached that of native values under the influence of hypoxia and under the influence of insulin. Both insulin and hypoxia were associated with enhanced matrix production and improved mechanical properties; however, a synergistic effect was not observed. Although the amount of collagen and cross-links in the engineered tissues was still lower than that in native adult human aortic valves, constructs cultured under hypoxic conditions reached native human aortic valve levels of tissue strength and stiffness after 4 weeks of culturing.

Conclusions— These results indicate that oxygen tension may be a key parameter for the achievement of sufficient tissue quality and mechanical integrity in tissue-engineered heart valves. Engineered tissues of such strength, based on rapid-degrading polymers, have not been achieved to date. These findings bring the potential use of tissue-engineered heart valves for systemic applications a step closer and represent an important improvement in heart valve tissue engineering.

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CLINICAL PERSPECTIVE

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Clinical Summaries
Circulation 2009 119: 201-203. [Extract] [Full Text]