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1. Culture of Human Vena Saphena Cells
- Isolate cells from the vena saphena magna, acquired from a donor in accordance to guidelines for secondary use material, according to the protocol by Schnell et al.9 and store these in liquid nitrogen. From the part of the vena saphena magna from one donor cut pieces of 2 x 2 mm to culture in a six-well plate. Use 2 pieces per well. Generally enough cells can be obtained to fill about 3 vials with 0.25 x 106 cells in liquid nitrogen. HVSCs are characterized as myofibroblasts, by showing expression of vimentin, no expression of desmin and a subpopulation expressing α smooth muscle actin10. Next start the protocol to thaw the cells from the liquid nitrogen to increase the number of cells.
- Place the cells from one vial into a T75 tissue culture flask and add growth medium (GM), consisting of Advanced DMEM, 50 ml fetal bovine serum (FBS), 5 ml penicillin/streptomycin and 5 ml L-glutamax. Change medium every 2-3 days.
- Cells grow confluent approximately after 14 days. Store 0.5 x 106 cells in one vial in liquid nitrogen, referred to as passage 1.
Note: Freezing of the cells is not necessary when harvesting HVSCs, but is solely used for storage.
- Place the HVSCs from one vial into a T175 tissue culture flask and add GM. Change medium every 2-3 days. Cells grow confluent after approximately 7 days. Store 3 x 106 cells in one vial in liquid nitrogen, referred to as passage 2.
- Place the cells from one vial into a rollerbottle and add GM. Change medium every 2-3 days. Cells grow confluent approximately after 8 days. One rollerbottle contains approximately 20-30 x 106 cells. Culture cells up to passage 6. Do not use cells of a passage higher than passage 9, since cell phenotype may change.
2. Engineering of Fibrin-based Tissue Constructs
- Prepare silicone glue by mixing the elastomer with the curing agent (10:1). Cut 7 x 3 mm rectangular segments of Velcro. Glue the Velcro into a 6 well culture plate, with flexible membranes to form a cross, and to leave a squared space of 3 mm between the Velcro strips.
Notes: Only use the soft side of the Velcro and face this side upwards. When gluing the Velcro, only cover the Velcro with silicone glue, do not spread glue throughout the well. Since the culture plates have silicone membrane bottoms, use something underneath the well plate for reinforcing the flexible membranes, to ensure easy gluing in to the plate.
- Dry the silicone glue overnight in an oven at 60 °C to ensure hardening of the glue. Sterilize by adding 70% EtOH to the wells and incubate for 30 min. Rinse 3x with PBS and remove all PBS from the wells and the Velcro. Put under UV for 30 min and keep sterile until use.
- Prepare Tissue Engineering medium (TM), consisting of GM and 130 mg of L-ascorbic acid 2-phosphate.
- Add 1 mg/ml ε-Amino Caproic Acid (ACA) to the TM. ACA is used for the first 7 days of culture to prevent the fibrin from degrading11. Alternatively, aprotinin can be used.
- To prevent clump formation, allow fibrinogen to reach room temperature before opening. Without clumps fibrinogen will dissolve more easily. Dissolve fibrinogen to a concentration of 10 mg actual protein/ml TM7 supplemented with ACA. Sterile filter the fibrinogen solution, multiple filters might be needed. Store on ice until use.
Note: To dissolve fibrinogen mix gently to prevent too much foam formation.
- Dissolve thrombin to a concentration of 10 IU/ml TM7 supplemented with ACA. Store on ice until use.
Note: Storage on ice is needed to prevent early gelation of thrombin and fibrinogen.
- Trypsinize the cells, resuspend in GM and count.
- Use 15 x 106 cells/ml for seeding the fibrin-based tissue constructs (concentration based on methods for tissue engineering heart valves7). A single gel consists of 100 μl gof el, and thus of 1.5 x 106 cells. Put 1.5 x 106 cells in one centrifuge tube, resulting in as many centrifuge tubes as the number of gels that will be made.
- Centrifuge the cells at 350 x g for 7 min and discard the supernatant. Resuspend the cells in 50 μl thrombin. Add 4 μl of blue fluorescent polystyrene microspheres to this suspension. Put 50 μl of fibrinogen in a vial. Use a pipette to take up the 50 μl thrombin with cells. Increase the volume of the pipette to 100 μl. Pipette the 50 μl solution of thrombin with cells into the vial with fibrinogen to mix the thrombin and fibrinogen, and take up the 100 μl mixture.
Note: The fluorescent polystyrene microspheres are used as internal reference markers for image analysis. When mixing thrombin and fibrinogen, prevent the formation of air bubbles by carefully pipetting the mixture. Air bubbles will result in holes in the fibrin gel.
- Pipette the gel mixture into and in between the Velcro strips. The typical gelation time for the fibrin gels, once the components are mixed, is of the order of 20 sec.
Notes: Do this as quickly as possible to prevent gelation before the mixture is pipetted in the well plate. Practice before using cells and beads.
- Incubate suspensions for 30 min at 37 °C in a humidified 95% air/5% CO2 incubator to allow gelation before adding culture TM with ACA.
- Replace TM with ACA every 2-3 days for the first 7 days. Gels are stable enough after one week to be cultured without ACA. After the first week replace TM every 2-3 days. Add 6 ml of TM per well. On day 12 cells have produced enough collagen for visualization.
3. Applying Strain and Inducing Changes in Strain and Constraints
- Static strain is applied by the cells directly, due to cell traction and compaction12. To induce collagen reorganization, cut the tissue construct loose from two Velcro strips in one direction. This results in unidirectional constraints (Figure 1A). Perform this on day 12, since the construct is then stable enough and collagen has been deposited.
- Apply cyclic strain by applying a vacuum to the bottom of the culture plates with flexible membranes, with the use of the Flexcell FX4000T system. Place the plates on a baseplate, on top of loading posts (which are a part of the cyclic loading device). The pump applies a vacuum onto the membrane and thereby pulls the membrane over the rectangular post lying underneath. Due to the cross shaped attachments of the tissue constructs to the membrane (via the Velcro) and the rectangular post the applied cyclic strain is uniaxial (Figure 1B).
- Initially, use static culture for 5 days to achieve initial mechanical integrity, before application of cyclic strain starting on day 6. Program a cyclic stain protocol into the controller for the vacuum pump. For example use a previously established intermittent cyclic strain protocol, with uniaxial direction13. This consists of an intermittent strain of a sine wave with 1 Hz, straining from 0 to 5% strain, for periods of 3 hr, alternated with 3 hr resting periods. Perform this cyclic strain protocol for 7 days, inducing an aligned collagen organization.
- Typically after 12 days HVSCs have produced an aligned collagen organization. After an aligned collagen organization is reached, change the uniaxial cyclic strain direction, to be perpendicular to the original strain direction. Do this by turning the rectangular posts by 90°.
4. Visualizing Cells and Collagen
- To visualize active, real-time collagen remodeling, label samples with probes that do not interfere with cell viability or collagen formation. Use probes to fluorescently stain the cell cytoplasm and collagen.
- Alternatively second harmonic generation using confocal laser scanning microscopy can be used to visualize collagen structures using autofluorescence14, with excitation at 780 nm and detection between 500-550 nm.
- Remove the culture plates from the setup and the incubator, for the cyclically strained samples during the 3 hr rest period, and transport them to a confocal laser scanning microscope to visualize cells and collagen.