Ex vivo vascular perfusion systems constitute a unique platform to study the function and behavior of vascular cells within their native tissues under controlled conditions, which enables the dissection of complex processes such as post-injury vascular remodeling22. However, most reported bioreactors are in-house made systems based on custom-made components and are often difficult to replicate by others23. Alternative commercial solutions exist, but lack flexibility in the design and can be relatively costly24.
We have developed an alternative system that provides an easy, cheap, and reproducible platform that can be manufactured using open-source 3D printing techniques13. The present article describes the system's setup to enable reproducible applications by end-users. This setup enables the application of physiological and pathological conditions of pressure (40-180 mmHg), flow rate (6-30 mL/min), and in combination with media mimicking the blood viscosity, with varying degrees of shear stress.
Reproducibility is an essential aspect of the scientific process, as it allows researchers to validate the findings of others and build upon them to progress our understanding of vascular diseases. Furthermore, tools that enable and promote collaborations between groups are essential for advancing scientific knowledge. EasyFlow represents an example of such open-source, accessible solutions that can be easily produced and adopted by labs working on a wide range of projects within the field of vascular sciences and beyond.
We report that this device culture maintains arterial tissue viability for at least 7 days, and can be used to model specific steps of vascular disease. Using this, one could model physiological flow rates and pressure conditions13. Importantly, this perfusion culture is cost-effective due to the low production costs and the low volume of medium necessary to operate the system.
The 3D design can also be adapted to new applications, and new materials for printing can be tested. Even in its current format, the sample lodging space can be easily adapted to samples of different sizes by changing the length of the fittings or the bore of the luer connectors. It is important to note that, given the modular nature of the device and its small dimensions, this bioreactor can be used in several setups (Figure 5) and can be applied to multiplex cultures, where several samples can be exposed to different conditions at the same time in separate bioreactors.
It is envisioned that the use of the system be expanded in the future to support the culture of blood vessels from different origins (e.g., different species) and of different natures (e.g., veins, lymphatic), and perhaps applied to the culture of other hollow tissues (e.g., trachea, intestine). In particular, research shows that culturing tissue-engineered scaffolds in constant perfusion helps the homogenous distribution of cells within the construct and maturation of the resulting tissue25,26. In addition, seeding vascular grafts in perfusion contributes to achieving a more uniformly cellularized vascular lumen, as compared to static methods27. For this reason, we envision the system being applied to tissue engineering to help address the current challenges, allowing for the future development of reproducible synthetic blood vessel substitutes28.
The protocol described here presents some important steps critical to the success of the flow culture. Establishing and monitoring appropriate flow conditions is not trivial and needs to be performed on each system when it is set up for the first time, to ensure that the culture conditions are physiological. The flow and pressure were monitored using pressure sensors and ultrasound imaging. Another critical point is ensuring that the tissue is viable and intact at the beginning of the culture. This requires a fresh source, careful handling and can be verified by histological analysis. Additionally, troubleshooting must be performed at the start of every experiment to identify any potential bacterial contamination or media leakage source.
It is important to highlight that the perfusion system described, while providing physiological pressure and flow conditions, is unable to entirely mimic the complex pressure wave patterns recorded in vivo. This limitation is ascribable to using a peristaltic pump and can be resolved using more specialized equipment to reproduce advanced hemodynamic conditions. The culture of blood vessels in a bioreactor is also unable to address studies where the immune system or the interaction with other organs is critical.
In conclusion, a simple 3D printed perfusion system that can mimic the physiological hemodynamic environment is presented, which is expected to contribute to the standardization of ex vivo blood vessel cultures. Its potential for customization and application to long-term culture makes it an essential tool for advancing the understanding of these complex biological systems in physiology and pathological conditions.