Vascular tissue engineering: pathological considerations, mechanisms, and translational implications

Clinical translation of vascular tissue engineering is hampered by inconsistencies in graft outcomes. In this chapter, we argue that variation in graft outcomes is largely due to our lack of fully understanding vascular regeneration and remodeling in response to specific graft properties. In addition, results obtained from animal studies are difficult to translate into patients. This is mainly due to interspecies variation in vascular regeneration, as well as inter-patient variation in factors influencing regeneration, such as gender, age, clinical condition, and use of medication. Following a review of vascular structure as a blueprint for tissue-engineered grafts and vascular pathologies necessitating such grafts, we describe potential mechanisms of host-graft interaction that explain outcome variability. Next, we propose research strategies to carefully move from understanding (variability in) vascular regeneration to robust and personalized graft design and outcomes.