Bioengineered vascular grafts with a pathogenic TGFBR1 variant model aneurysm formation in vivo and reveal underlying collagen defects

Thoracic aortic aneurysm (TAA) is a life-threatening vascular disease frequently associated with underlying genetic causes. An inadequate understanding of human TAA pathogenesis highlights the need for better disease models. Here, we established a functional human TAA model in an animal host by combining human induced pluripotent stem cells (hiPSCs), bioengineered vascular grafts (BVGs), and gene editing. We generated BVGs from isogenic control hiPSC-derived vascular smooth muscle cells (SMCs) and mutant SMCs gene-edited to carry a Loeys-Dietz syndrome (LDS)–associated pathogenic variant ( TGFBR1 A230T ). We also generated hiPSC-derived BVGs using cells from a patient with LDS ( Patient A230T/+ ) and using genetically corrected cells ( Patient +/+ ). Control and experimental BVGs were then implanted into the common carotid arteries of nude rats. The TGFBR1 A230T variant led to impaired mechanical properties of BVGs, resulting in lower burst pressure and suture retention strength. BVGs carrying the variant dilated over time in vivo, resembling human TAA formation. Spatial transcriptomics profiling revealed defective expression of extracellular matrix (ECM) formation genes in Patient A230T/+ BVGs compared with Patient +/+ BVGs. Histological analysis and protein assays validated quantitative and qualitative ECM defects in Patient A230T/+ BVGs and patient tissue, including decreased collagen hydroxylation. SMC organization was also impaired in Patient A230T/+ BVGs as confirmed by vascular contraction testing. Silencing of collagen-modifying enzymes with small interfering RNAs reduced collagen proline hydroxylation in SMC-derived tissue constructs. These studies demonstrated the utility of BVGs to model human TAA formation in an animal host and highlighted the role of reduced collagen modifying enzyme activity in human TAA formation.