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These studies suggest that small blood vessels play crucial roles in physiological and pathological processes, are implicated in diseases like stroke, dementia, and renal failure, and that advancements in 3D bioprinting and tissue engineering hold promise for creating functional replacements for clinical applications.
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Small vessel disease (SVD) is a disorder affecting cerebral microvessels, leading to various brain abnormalities such as white matter hyperintensities, small subcortical infarcts, and lacunes. These abnormalities are linked to endothelial dysfunction, including blood-brain barrier issues, impaired vasodilation, vessel stiffening, and inflammation, which collectively contribute to conditions like stroke and vascular dementia. The variability in lesion progression and symptomatology poses significant challenges in understanding and treating SVD.
SVD is not confined to the brain; it also affects other organs receiving significant cardiac output, such as the kidneys and retina. This systemic nature of SVD can lead to renal failure, blindness, and dementia. Factors contributing to SVD include uncontrolled vascular risk factors, sedentary lifestyles, obesity, poor sleep patterns, and depression. The interconnectedness of microvascular changes in the brain, retina, and kidneys underscores the need for comprehensive diagnostic and therapeutic approaches.
Recent advancements in 3D bioprinting have enabled the creation of small-diameter blood vessels with biomimetic biphasic cell layers. These vessels are designed using vascular endothelial cells (VECs) and vascular smooth muscle cells (VSMCs) to mimic natural blood vessel composition. The use of novel bioinks and computational fluid dynamics simulations has demonstrated the mechanical and perfusable properties of these bioprinted vessels, making them promising candidates for clinical applications .
The development of artificial small-diameter blood vessels (SDBVs) involves various materials and fabrication techniques. Natural and synthetic polymers, such as polycaprolactone (PCL) and gelatin, are commonly used. Techniques like electrospinning, 3D printing, and hydrogel tubing are employed to create vessels with the necessary mechanical strength and bioactive functionalities. Surface modifications, such as plasma treatment and chemical immobilization, enhance the biological performance of these vessels.
Functional small-diameter blood vessels have been engineered using fibrin-based constructs embedded with smooth muscle and endothelial cells. These tissue-engineered vessels exhibit significant mechanical strength and reactivity, making them suitable for implantation. Studies have shown that these vessels integrate well with native tissues and maintain patency and blood flow rates comparable to natural vessels. Additionally, bioengineered vessels using human adipose-derived stem cells (hASCs) have demonstrated biomechanical properties similar to human saphenous veins, highlighting their potential for clinical use.
Research on small blood vessels spans from understanding the pathogenesis of small vessel disease to innovating bioengineered solutions for vascular replacements. The systemic impact of SVD necessitates a holistic approach to diagnosis and treatment, while advancements in 3D bioprinting and tissue engineering offer promising avenues for creating functional small-diameter blood vessels. These innovations hold significant potential for improving clinical outcomes in patients with vascular diseases.
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