Davik Petter, Chabadova Zuzana, Altreuther Martin, Leinan Ingeborg, Bandaru Sashidar, Akyürek Levent M, Mattsson Erney
Department of Surgery, St Olavs Hospital, Trondheim, Norway.
Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway.
EJVES Vasc Forum. 2020 Oct 13;49:23-29. doi: 10.1016/j.ejvsvf.2020.10.001. eCollection 2020.
Current vascular grafts all have limitations. This study examined peritoneum as a potential graft material and the transfer of peritoneum into a functional artery like conduit after end to end anastomosis into the common carotid artery of sheep. The aim was to investigate whether implantation of a peritoneal tube into the arterial tree results in a structure with function, histological findings, and gene expression like an artery, and whether such arterialisation occurs through a conversion of the phenotype of peritoneal cells or from host cell migration into the implant.
Peritoneum with adherent rectus aponeurosis from sheep was used to form tubular vascular grafts that were implanted into the common carotid artery of six sheep, then removed after five months. Two sheep received allogenic peritoneal grafts and four sheep received autologous peritoneal grafts.
One sheep died shortly after implantation, so five of the six sheep were followed. Five months after implantation, four of the five remaining grafts were patent. Three of four patent grafts were aneurysmal. The four patent grafts had developed an endothelial layer indistinguishable from that of the adjacent normal artery, and a medial layer with smooth muscle cells with a surrounding adventitia. The new conduit displayed vasomotor function not present at the time of implantation. DNA genotyping showed that the media in the new conduit consisted of recipient smooth muscle cells. Little difference in mRNA expression was demonstrated between the post-implantation conduit and normal artery.
During a five month implantation period in the arterial system, peritoneum converted into a tissue that histologically and functionally resembled a normal artery, with a functional genetic expression that resembled that of an artery. Single nucleotide polymorphism analysis indicated that this conversion occurs through host cell migration into the graft.
目前的血管移植物都有局限性。本研究将腹膜作为一种潜在的移植物材料进行检测，并观察在与绵羊颈总动脉进行端端吻合后，腹膜能否转化为具有功能的动脉样管道。目的是研究将腹膜管植入动脉系统后是否会形成一种在结构、功能、组织学表现及基因表达方面都类似动脉的结构，以及这种动脉化是通过腹膜细胞表型的转变还是宿主细胞迁移至移植物中而发生的。
使用带有绵羊腹直肌腱膜的腹膜来构建管状血管移植物，将其植入6只绵羊的颈总动脉，5个月后取出。2只绵羊接受同种异体腹膜移植物，4只绵羊接受自体腹膜移植物。
1只绵羊在植入后不久死亡，因此对6只绵羊中的5只进行了随访。植入5个月后，剩余5个移植物中有4个通畅。4个通畅的移植物中有3个形成了动脉瘤。4个通畅的移植物形成了一层与相邻正常动脉难以区分的内皮细胞层，以及一层含有平滑肌细胞并伴有外膜的中层结构。新形成的管道展现出植入时所没有的血管舒缩功能。DNA基因分型显示新管道的中层由受体平滑肌细胞组成。植入后的管道与正常动脉之间在mRNA表达上几乎没有差异。
在动脉系统中植入5个月期间，腹膜转化为一种在组织学和功能上类似于正常动脉的组织，其功能性基因表达也与动脉相似。单核苷酸多态性分析表明这种转化是通过宿主细胞迁移至移植物中而发生的。
