Research of "Autologous fibrin coated small caliber vascular prostheses improve the antithrombogenicity by less immunological response"

前言：小口径血管假体的发展仍然具有挑战性。最近，我们开发了一种用于血管移植物的纤维蛋白涂层新技术。我们推测，自体纤维蛋白涂层可以通过减少免疫反应来提高移植物的抗血栓形成能力。方法：用改良的乙醇法将内径为2 mm的涤纶针织人造血管与自体(兔，A-移植物)或异种(人，X-移植物)纤维蛋白复合。将50只日本大白兔植入双侧颈总动脉，根据移植物的选择分为三组：A+X组(I组，n=40)、A+A组(II组，n=5)、X+X组(III组，n=5)。为了评估移植物的通畅性、抗移植物血清抗体、铟血小板显像和组织学，组I在术后天数(Pod)…移植移植物多于1、3、7、10、14、30、60、180(每组n=5)。比较两组的免疫、凝血和纤溶反应。结果：除1例移植血管POD10外，其余移植血管通畅，无狭窄和血栓形成。移植后60d，单层内皮样细胞覆盖于移植物的整个表面。I组最大抗移植物血清抗体在490 nm处的吸光度为0.17±0.02(O.D.)A组最大血小板沉积量(10.3±1.6×10 6/mm^2)显著低于X组(0.46±0.0 6)和17.4±1.4×10 6/mm^2(P均<0.0 1)。在移植肾纤维蛋白降解的第7~14天，血清中的免疫球蛋白、免疫球蛋白M、组织型纤溶酶原激活物和纤溶酶原激活物-1水平均升高，但II组显著低于III组(P&lt；0.01，ANOVA)。两组的PAI-1/tPA比值均随着移植物中血小板沉积的增加而降低。结论：自体纤维蛋白涂层通过减少免疫反应提高了抗血栓形成能力，在混合型小口径血管假体中具有潜在的应用前景。较少

Introduction : Development of small caliber vascular prostheses is still challenging. Recently we have developed a new technique of fibrin coatings for vascular grafts. We hypothesized that autologous fibrin coatings could improve the antithrombogenicity of grafts by less immunological response. We also examine the graft healing characteristics after implantation.Methods : Knitted polyester fabric vascular prostheses, 2mm in internal diameter, were coated with autologous (rabbit, A-graft) or xenologous (human, X-graft) fibrin by modified ethanol method from plasma. Fifty Japanese white rabbits were implanted with the grafts in bilateral carotid arteries and divided into three groups by the selection of grafts in the individual rabbit : A&X-grafts (group I, n40), A&A-grafts (group II, n=5), X&X-grafts (group III, n=5). To evaluate graft patency, anti-graft serum antibody, ^<111>Indium platelet scintigraphy and histology, the grafts in group I were explanted on postoperative days (PODs) … More 1, 3, 7, 10, 14, 30, 60, 180 (n=5 for each). Serum levels of immunoglobulin G (IgG) and M (IgM), tissue-type plasminogen activator (tPA) and plasminogen activator inhibitor-1 (PAI-1) in group II and III were measured serially to compare immunological, coagulative and fibrinolytic reactions.Rsults : All of grafts except one X-graft on POD 10 were patent without stenosis and thrombus. Monolayer endothelial-like cells were covered on the entire surface of the A-grafts on POD 60. In group I, the maximal anti-graft serum antibodies (0.17±0.02 optical density at 490 nm [O.D.]) and the maximal platelet deposition (10.3±1.6x10^6/mm^2) in A-grafts were significantly less than those in X-grafts (0.46±0.06 O.D. and 17.4±1.4x10^6/mm^2, respectively ; p<0.0001 in both). Although serum levels of IgG, IgM, tPA and PAI-1 were increased at the time of fibrin degradation of grafts during POD 7 to 14, those in group II were significantly less than those in group III (p<0.O1, ANOVA). The PAI-1/tPA ratio in both groups was decreased as platelet deposition of the grafts was increased.Conclusion : These findings suggest that autologous fibrin coatings improve the antithrombogenicity by less immunological response and have a potential use for hybrid small caliber vascular prostheses. Less