Autologous fibrin-coated small-caliber vascular prostheses improve antithrombogenicity by reducing immunologic response.
OBJECTIVE
We have recently developed a thrombin-free fibrin-coated vascular prosthesis that has a high performance rate in producing graft antithrombogenicity. We hypothesized that autologous, compared with xenologous, fibrin coatings could improve the antithrombogenicity of grafts by reducing immunologic response.


METHODS
Autologous fibrin-coated vascular prostheses and/or xenologous fibrin-coated vascular prostheses (internal diameter, 2 mm; length, 2.5 cm) were implanted in the bilateral carotid arteries of 50 Japanese white rabbits. They were classified into 2 groups by the selection of grafts in the individual: group I (autologous fibrin-coated vascular prosthesis and xenologous fibrin-coated vascular prosthesis); and group II (group IIa: both autologous fibrin-coated vascular prostheses, or group IIx: both xenologous fibrin-coated vascular prostheses). During a maximum of 180 days after implantation, we evaluated the thrombotic, inflammatory, and immunologic responses associated with both types of graft.


RESULTS
All grafts were patent at each end point. In group I, both platelet deposition and anti-graft antibodies in autologous fibrin-coated vascular prostheses were significantly less than those in xenologous fibrin-coated vascular prostheses until postoperative day 30. At postoperative day 10, there were significantly fewer CD45-positive infiltrating cells in autologous fibrin-coated vascular prostheses, and intercellular adhesion molecule-1, vascular cell adhesion molecule-1, and nuclear factor-kappa B expression in autologous fibrin-coated vascular prostheses were less than those in xenologous fibrin-coated vascular prostheses. The neointimal hyperplasia in autologous fibrin-coated vascular prostheses was significantly decreased at postoperative day 180. In group II, serial changes of serum levels of immunoglobulin M, immunoglobulin G, interleukin-1beta, and tissue-type plasminogen activator/plasminogen activator inhibitor-1 ratio in autologous fibrin-coated vascular prostheses were significantly less than those in xenologous fibrin-coated vascular prostheses. In both grafts, platelet deposition significantly correlated with serum immunoglobulin G level and tissue-type plasminogen activator/plasminogen activator inhibitor-1 ratio.


CONCLUSIONS
These findings suggest that autologous fibrin coating in thrombin-free fibrin-coated vascular prostheses improve antithrombogenicity by reducing immunologic response and have a potential for clinical use in hybrid small-caliber vascular grafts.
Hasegawa
Tomomi
T
Division of Cardiovascular, Thoracic, and Pediatric Surgery, Department of Cardio-Pulmonary and Vascular Medicine, Kobe University Graduate School of Medicine, Kobe, Japan.
Okada
Kenji
K
Takano
Yoshihito
Y
Hiraishi
Yoshiaki
Y
Okita
Yutaka
Y
D000818:Animals; D000917:Antibody Formation; D001807:Blood Vessel Prosthesis; D017536:Carotid Artery, Common / Q000601:surgery*; D020099:Coated Materials, Biocompatible; D004797:Enzyme-Linked Immunosorbent Assay; D005337:Fibrin / Q000276:immunology*; D007074:Immunoglobulin G / Q000097:blood; D018799:Intercellular Adhesion Molecule-1; D053583:Interleukin-1beta / Q000097:blood; D016328:NF-kappa B / Q000097:blood; D017395:Plasminogen Activator Inhibitor 1 / Q000097:blood; D010973:Platelet Adhesiveness; D011817:Rabbits; D013927:Thrombosis / Q000517:prevention & control*; D010959:Tissue Plasminogen Activator / Q000097:blood; D017539:Tunica Intima / Q000473:pathology; D019010:Vascular Cell Adhesion Molecule-1; D014654:Vascular Patency
D020099:Coated Materials, Biocompatible; D007074:Immunoglobulin G; D053583:Interleukin-1beta; D016328:NF-kappa B; D017395:Plasminogen Activator Inhibitor 1; D019010:Vascular Cell Adhesion Molecule-1; D018799:Intercellular Adhesion Molecule-1; D005337:Fibrin; D010959:Tissue Plasminogen Activator