Doctor discusses man-made blood vessel

On June 5th, Duke’s Dr. Jeffrey Lawson implanted a genetically engineered blood vessel into the arm of a man with kidney failure—the first time that such a procedure had been done in the United States. The technology was developed at Duke over the course of several years by Dr. Lawson and Dr. Laura Niklason, who was a faculty member from 1998 to 2005. The Chronicle’s Emma Baccellieri spoke with Lawson about the project.

The Chronicle: How would you describe the project in layman’s terms?

Jeffrey Lawson: We set out to make something that really would mimic your own blood vessel. The replacement blood vessels we have right now are mostly artificial materials—made of Teflon, plastic, knitted fabrics—and although they’re strong, they don’t mimic what your body makes.

What we’ve done is grow the culture in the shape of a tube. We set out to use vascular cells—the muscular cells that make arteries—from the aorta and realign them with endothelial cells. We learned early on that we could do that, but we couldn’t manufacture them in large enough quantities for clinical use. What we do now is grow the blood vessel in the lab with human cells, in the shape of tube the size of your little finger—about 40 centimeters long—initially made from cells collected from organ donors. It’s a biodegradable scaffold, and as the scaffold melts away, the cells that are seated into that scaffold make their own matrix—they stick.

It took a long time to figure out how to grow them strong enough, to grow enough collagen, to make it available to be universally implantable. We kill the cells in the lab, decellularize them, and what’s left is the scaffold—kind of like an empty house—and it’s strong enough to work as a blood vessel. When we implant it, your own cells grow into it. It becomes a part of you. We provide the matrix for your blood vessel. 

TC: What motivated you to work on the project?

JL: I’m a vascular surgeon. I fix blood vessels all the time, that’s my day job. We fix them all over the body all different ways, in legs for people who have a blockage in their leg, in the neck for people who have something wrong in their brain. We do a lot of reconstruction of blood vessels, and in this particular case, we reconstruct blood vessels in a very unique way.

In this case, for dialysis, if your kidneys don’t work, you have to be able to clean your blood with a machine three times a week. If you move a blood vessel close to skin, a dialysis team can access it more easily. That’s a great model—it’s a great clinical area to test new technologies, because if it doesn’t work well, we haven’t put a heart or brain at risk of having a  heart attack or stroke. And so the replacement blood vessel was in the arm of a patient who needed a blood vessel placed close to the skin to get dialysis.

I’m a vascular surgeon but also a vascular scientist, with a Ph.D in cell and molecular biology, studying how blood moves through tubes, through your blood vessels and how to make those blood vessels work better. To team up and work to make blood move better is something I’ve been doing my whole career.

In 1998 when I met Dr. Niklason, we were both interested in this and we started working together. After about 15 years of work, of research, of writing, of grants, we finally got it. She formed a company, Humacyte, to work with it—it’s a Duke spinoff, manufacturing biotech tissue engineering right here in the Triangle. 

TC: Will other groups pursue the technology and tissue engineered blood vessels?

JF: The technology that Humacyte has is proprietary—when you make the company, other companies might try to make similar prototypes and deal with the licensing technology. What’s more likely, if this is successful, and so far it has been—it’s been implanted in a number of animals, and we started implanting them in Europe six months ago, before the one we did two weeks ago, which was the first one in the U.S.—Humacyte will have to make a decision whether to stay a biotechnology company or to be acquired by bigger company. To be truly commercial would involve scaling up manufacturing and scaling up distribution, and the company will ultimately decide.

TC: Anything else you’d like to say about how your research came together? 

JF: This really highlights a long standing interdepartmental collaboration among a bunch of scientists, postdocs, trainees, other people who worked on this. I’ve gotten credit as the person who did the implant, but it wouldn’t have happened if not for the Department of Surgery, the Department of Anesthesiology and biomedical engineering. It really highlights the collaboration and resources of the institution over a long period of time to pull off a project like this.