Combining tissue repair and tissue engineering ; bioactivating implantable cell-free vascular scaffolds

Synthetic replacement grafts for heart valves and small-diameter blood vessels such as coronary arteries have the potential to circumvent many of the limitations of currently available autologous grafting materials. Cell-free material incorporating biologically active compounds may guide the formation of fully autologous new tissue in situ derived from host cells after implantation. Inspiration for such bioactive compounds and their dynamics can be found in in vivo repair processes. Molecules such as stromal cell-derived factor 1a (SDF1a) that can attract progenitor cells from the bloodstream and modulate immune responses may be able to improve neotissue development in cell-free vascular and valvular grafts. Advances in the development of fully synthetic molecules and scaffold materials allow the spatial and temporal control of biologically active factors, enabling tissue engineers to mimic complex cellular signalling. This review focuses on combining knowledge of the molecular dynamics of factors involved in in vivo damage repair with the possibilities offered by newly developed synthetic materials. This approach has lead to encouraging results in the field of in situ vascular tissue engineering, and can ultimately lead to the development of off-the-shelf available vascular and valvular replacement grafts. © 2014 BMJ Publishing Group Ltd & British Cardiovascular Society.