Table 6.

Various methods for in vitro recellularization of decellularized valve scaffolds with chemical conditioning.

Recell method	Cell source	Conditioning	Implant model	Details	Results
In vitro—chemical conditioning	rMSC,124 mMF,125 hMF,125 hEC125	Valves coated with P3/4HB before seeding	None	Hybrid valves seeded in vitro	Hybrid valves had increased mechanics; in vitro seeding led to cell coverage, but no infiltration
	rMF,126 hECs,127,128 hMF129	Leaflets modified with PEG plus TGF-β1, VEGF, or RGD peptides	None	PEG-peptide-modified leaflets seeded with cells	PEGylation increased mechanics and cell surface density, regardless of additional peptide; no cellular infiltration
	gMSC130	Encapsulation of cells in PEG before seeding	Goat aorta	PEG encapsulated cells seeded on decell scaffold and then implanted in goats	PEG cell seeding increased tensile strength, increased ratio of endothelial cells, and decreased thrombosis
	rMSC,131 hEPC132,133	Polyelectrolyte layers of heparin and SDF-1α/chitosan/VEGF adsorbed onto valve	None,132,133 rAorta131	Valve scaffolds coated with polyelectrolyte multilayers and then seeded with cells	Treated valves led to reduced platelet activation; chitosan and VEGF increased EC adherence and proliferation in vitro; SDF-1α had increased endothelial layer after implant in vivo
	oECs134	Valves coated in CCN1	oPV	Valves coated in CCN1 and before implant	Treated valves had good recell in vivo; cell coverage higher on ventricularis with mild infiltration of VIM+ and αSMA+ cells
	rMSCs135	Valves conjugated with CD90 antibody	None	Treated leaflets cultured in shear flow chamber with MSCs	Treated leaflets had increased cell attachment distributed across surface
	pVIC,136 hMSC11	Valves treated with fibronectin before seeding	None	Treated leaflets seeded statically	Leaflet surface coverage and mild cell infiltration by appropriate phenotypes
	oECs137	Valves treated with fibronectin before seeding	oPV	Treated valves seeded and then implanted	Treated valves had complete EC layer and good interstitial repopulation
	hECs19–21	Valve treated with ProNectin F before seeding	hPV	Treated valves seeded and implanted in 11 patients	100% survival at 10 years 3 months biopsy of valve wall showed endothelialization and partial recell by fibroblast cells

MSC: mesenchymal stem cell; MF: myofibroblast; EC: endothelial cell; P3/4HB: poly(3-hydroxybutyrate-co-4-hydroxybutyrate); PEG: polyethylene glycol; TGF-β1: transforming growth factor beta 1; VEGF: vascular endothelial growth factor; EPC: endothelial progenitor cell; SDF-1α: stromal cell–derived factor 1α; VIM: vimentin; αSMA: alpha-smooth muscle actin; VIC: valvular interstitial cell.

The results are overall observations and the outcome of individual studies may vary. Lower case letters in acronyms denote species (o = ovine, p = porcine, h = human, m = mouse, r = rat, g = goat).