Reinforced biotubes as readily available and regenerative vascular grafts

The increasing prevalence of cardiovascular diseases and haemodialysis access drive high clinical demand for vascular grafts. Bioinert synthetic and decellularized or cryopreserved artery grafts exhibit poor regeneration and associated complications. Here, we present an approach that combines in vivo bioengineering and decellularization to prepare polycaprolactone skeleton-reinforced biotubes (dPB), which demonstrate appropriate mechanical strength, anti-kinking properties, resistance to repeat puncture, and are compatible with long-term storage at 4 °C. The loose and porous microstructure and immunomodulatory bioactivity of dPB induce rapid recellularization and promote pro-regenerative M2 macrophage polarization, which together facilitate remodelling to native artery-like tissue. In porcine coronary artery bypass grafting, canine carotid artery replacements and arteriovenous grafting models, ovine-derived dPB show high patency without dilatation, calcification and intimal hyperplasia. In summary, dPB offer a readily available and pro-regenerative vascular graft with a broad application prospect for patients with unavailable autologous vessels. Cardiovascular surgery and haemodialysis urgently need durable vascular grafts. Here, authors develop a decellularized polymer skeleton-reinforced biotube as a readily-available vascular graft and demonstrate utility in vivo across multiple large animal preclinical models.