Evaluation of in situ tissue-engineered arteriovenous grafts suitable for cannulation in a large animal model

Paul J. Besseling; Wojciech Szymczyk; Martin Teraa; Raechel J. Toorop; Paul A.A. Bartels; Boris Arts; Rob C.H. Driessen; Arturo M. Lichauco; Hidde C. Bakker; Joost O. Fledderus; Gert J. de Borst; Patricia Y.W. Dankers; Carlijn V.C. Bouten; Marianne C. Verhaar

doi:10.1038/s43246-025-00879-z

Evaluation of in situ tissue-engineered arteriovenous grafts suitable for cannulation in a large animal model

Paul J. Besseling
, Wojciech Szymczyk
, Martin Teraa
, Raechel J. Toorop
, Paul A.A. Bartels
, Boris Arts
, Rob C.H. Driessen
, Arturo M. Lichauco
, Hidde C. Bakker
, Joost O. Fledderus
, Gert J. de Borst
, Patricia Y.W. Dankers
, Carlijn V.C. Bouten
, Marianne C. Verhaar (Corresponding author)

Onderzoeksoutput: Bijdrage aan tijdschrift › Tijdschriftartikel › Academic › peer review

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The sustainability of vascular access for hemodialysis is limited by frequent interventions and the inability of synthetic grafts to self-heal. Tissue engineering offers a solution through biodegradable grafts that remodel into autologous tissue. Here we assess electrospun polycarbonate-bis urea (PC-BU) vascular scaffolds (6mm-inner-Ø), reinforced with 3D-printed polycaprolactone coils, in a goat model, and compared them to expanded polytetrafluoroethylene (ePTFE) controls. The tissue-engineered grafts were repeatedly cannulated starting two weeks after implantation and were evaluated using computed tomography and histological analyses. By 12 weeks, the PC-BU grafts remodel into autologous tissue while maintaining structural integrity, maintaining integrity without dilations, ruptures, or aneurysms. Cannulation does not interfere with scaffold degradation or neo-tissue formation. Although the patency rate is lower for the PC-BU grafts (50%) compared to ePTFE (100%), the engineered grafts exhibit a self-healing response not seen in ePTFE. These findings demonstrate the potential of PC-BU tissue-engineered grafts as healing, functional vascular access solutions for hemodialysis, supporting cannulation during tissue transformation.

Originele taal-2	Engels
Artikelnummer	151
Aantal pagina's	12
Tijdschrift	Communications Materials
Volume	6
Nummer van het tijdschrift	1
DOI's	https://doi.org/10.1038/s43246-025-00879-z
Status	Gepubliceerd - jul 2025

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The authors thank M. van de Kaa, B.C.T. van de Laar, K.R.D. Vaessen, DVM, N.J.M. Attevelt, and H.M.L. de Bruin for their assistance with the animal studies. K. den Ouden, P. M. de Bree for their assistance with the processing of the samples. This study was supported by a grant from ZonMw within the LSH 2Treat program, the Dutch Kidney Foundation [436001003 (InSiTeVx)], and the Gravitation Program “Materials Driven Regeneration”, funded by the Netherlands Organization for Scientific Research (024.003.013).

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Besseling, P. J., Szymczyk, W., Teraa, M., Toorop, R. J., Bartels, P. A. A., Arts, B., Driessen, R. C. H., Lichauco, A. M., Bakker, H. C., Fledderus, J. O., de Borst, G. J., Dankers, P. Y. W., Bouten, C. V. C., & Verhaar, M. C. (2025). Evaluation of in situ tissue-engineered arteriovenous grafts suitable for cannulation in a large animal model. Communications Materials, 6(1), Artikel 151. https://doi.org/10.1038/s43246-025-00879-z

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title = "Evaluation of in situ tissue-engineered arteriovenous grafts suitable for cannulation in a large animal model",

abstract = "The sustainability of vascular access for hemodialysis is limited by frequent interventions and the inability of synthetic grafts to self-heal. Tissue engineering offers a solution through biodegradable grafts that remodel into autologous tissue. Here we assess electrospun polycarbonate-bis urea (PC-BU) vascular scaffolds (6mm-inner-{\O}), reinforced with 3D-printed polycaprolactone coils, in a goat model, and compared them to expanded polytetrafluoroethylene (ePTFE) controls. The tissue-engineered grafts were repeatedly cannulated starting two weeks after implantation and were evaluated using computed tomography and histological analyses. By 12 weeks, the PC-BU grafts remodel into autologous tissue while maintaining structural integrity, maintaining integrity without dilations, ruptures, or aneurysms. Cannulation does not interfere with scaffold degradation or neo-tissue formation. Although the patency rate is lower for the PC-BU grafts (50\%) compared to ePTFE (100\%), the engineered grafts exhibit a self-healing response not seen in ePTFE. These findings demonstrate the potential of PC-BU tissue-engineered grafts as healing, functional vascular access solutions for hemodialysis, supporting cannulation during tissue transformation.",

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doi = "10.1038/s43246-025-00879-z",

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Besseling, PJ, Szymczyk, W, Teraa, M, Toorop, RJ, Bartels, PAA, Arts, B, Driessen, RCH, Lichauco, AM, Bakker, HC, Fledderus, JO, de Borst, GJ, Dankers, PYW , Bouten, CVC & Verhaar, MC 2025, 'Evaluation of in situ tissue-engineered arteriovenous grafts suitable for cannulation in a large animal model', Communications Materials, vol. 6, nr. 1, 151. https://doi.org/10.1038/s43246-025-00879-z

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AU - Besseling, Paul J.

AU - Szymczyk, Wojciech

AU - Teraa, Martin

AU - Toorop, Raechel J.

AU - Bartels, Paul A.A.

AU - Arts, Boris

AU - Driessen, Rob C.H.

AU - Lichauco, Arturo M.

AU - Bakker, Hidde C.

AU - Fledderus, Joost O.

AU - de Borst, Gert J.

AU - Dankers, Patricia Y.W.

AU - Bouten, Carlijn V.C.

AU - Verhaar, Marianne C.

PY - 2025/7

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N2 - The sustainability of vascular access for hemodialysis is limited by frequent interventions and the inability of synthetic grafts to self-heal. Tissue engineering offers a solution through biodegradable grafts that remodel into autologous tissue. Here we assess electrospun polycarbonate-bis urea (PC-BU) vascular scaffolds (6mm-inner-Ø), reinforced with 3D-printed polycaprolactone coils, in a goat model, and compared them to expanded polytetrafluoroethylene (ePTFE) controls. The tissue-engineered grafts were repeatedly cannulated starting two weeks after implantation and were evaluated using computed tomography and histological analyses. By 12 weeks, the PC-BU grafts remodel into autologous tissue while maintaining structural integrity, maintaining integrity without dilations, ruptures, or aneurysms. Cannulation does not interfere with scaffold degradation or neo-tissue formation. Although the patency rate is lower for the PC-BU grafts (50%) compared to ePTFE (100%), the engineered grafts exhibit a self-healing response not seen in ePTFE. These findings demonstrate the potential of PC-BU tissue-engineered grafts as healing, functional vascular access solutions for hemodialysis, supporting cannulation during tissue transformation.

AB - The sustainability of vascular access for hemodialysis is limited by frequent interventions and the inability of synthetic grafts to self-heal. Tissue engineering offers a solution through biodegradable grafts that remodel into autologous tissue. Here we assess electrospun polycarbonate-bis urea (PC-BU) vascular scaffolds (6mm-inner-Ø), reinforced with 3D-printed polycaprolactone coils, in a goat model, and compared them to expanded polytetrafluoroethylene (ePTFE) controls. The tissue-engineered grafts were repeatedly cannulated starting two weeks after implantation and were evaluated using computed tomography and histological analyses. By 12 weeks, the PC-BU grafts remodel into autologous tissue while maintaining structural integrity, maintaining integrity without dilations, ruptures, or aneurysms. Cannulation does not interfere with scaffold degradation or neo-tissue formation. Although the patency rate is lower for the PC-BU grafts (50%) compared to ePTFE (100%), the engineered grafts exhibit a self-healing response not seen in ePTFE. These findings demonstrate the potential of PC-BU tissue-engineered grafts as healing, functional vascular access solutions for hemodialysis, supporting cannulation during tissue transformation.

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Evaluation of in situ tissue-engineered arteriovenous grafts suitable for cannulation in a large animal model

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