The effect of dynamic culture conditions on endothelial cell seeding and retention on small diameter polyurethane vascular grafts

Due to the limited number of cells available in endothelial cell (EC) seeding of small diameter vascular grafts, high seeding rate and ideal proliferation are normally required and can be achieved by optimizing the EC seeding and culture procedures. In this study, by using rotational seeding at 0.16 rpm for 12 h in an incubator, 90% cells were successfully seeded on the polyurethane vascular grafts. Following a period of 72 h of static culture, the cell retention after 6 h of flushing could reach 90%. The retention was further enhanced after perfuse culture (9 cm/s). The optimal procedures to prepare a polyurethane vascular graft (4-mm i.d., 4 cm long) populated with firmly attached EC were therefore: (1) seeding the graft with 0.5 ml of cell suspension containing approximately 10(5) cells rotated at 0.16 rpm for 12 h; (2) culturing the seeded graft in static for 72 h; and (3) culturing the graft by perfusion (9 cm/s) for another 72 h to 7 days. These procedures consistently resulted in a graft covered with confluent vein EC that fully retained on the surface after 6 h of in vitro flushing.     

Steady unidirectional laminar flow inhibits monolayer formation by human and rat microvascular endothelial cells.

Endothelialization of artificial vascular grafts is rapid and complete in numerous animal models, including dogs and rats, but not in human patients. One possible explanation for this well-known, yet puzzling observation might be that monolayer formation of human endothelial cells (ECs), and of canine or rodent ECs, is affected differently by flow-induced shear stress. To begin testing this hypothesis, the authors wounded confluent monolayers of cultured rat and human ECs and exposed these cultures for 20 h to unidirectional steady laminar shear stress of 10 dyn/cm(2) induced by fluid flow perpendicular to the wound boundaries. In comparison to experimental control cultures simultaneously maintained under static (no-flow) conditions, flow-induced shear stress attenuated the monolayer formation (sheet migration) in both human and rat ECs. In brief, compared to control, the average human EC monolayer formation under shear was reduced by 33% whereas the average rat EC monolayer formation was reduced by 34%. Furthermore, the cell responses showed a dependence on fluid flow direction that differed per species. When exposed to shear stress, human EC monolayer formation was reduced by 16% in the upstream direction (opposing the direction of flow) and reduced by 50% in the downstream direction (with the direction of flow), whereas rat EC monolayer formation was reduced by 64% upstream and showed no change downstream. These findings suggest that although overall monolayer formation is inhibited by fluid-induced shear stress to the same extent in both species, there are cell type- and/or species-dependent migration responses to fluid-induced shear stress, and that different flow conditions possibly contribute to species-specific patterns of endothelialization.     

Endothelial cell attachment and shear response on biomimetic polymer-coated vascular grafts

Endothelial cell (EC) adhesion, shear retention, morphology, and hemostatic gene expression on fibronectin (FN) and RGD fluorosurfactant polymer (FSP)-coated expanded polytetrafluoroethylene grafts were investigated using an in vitro perfusion system. ECs were sodded on both types of grafts and exposed to 8 dyn/cm(2) of shear stress. After 24 h, the EC retention on RGD-FSP-coated grafts was 59 ± 14%, which is statistically higher than the 36 ± 11% retention measured on FN grafts (p < 0.02). Additionally, ECs on RGD-FSP exhibited a more spread morphology and oriented in the direction of shear stress, as demonstrated by actin fiber staining. This spread morphology has been observed earlier in cells that are adapting to shear stress. Real-time PCR for vascular cell adhesion molecule 1, tissue factor, tissue plasminogen activator, and inducible nitric oxide synthase indicated that the RGD-FSP material did not activate the cells and that shear stress appears to induce a more vasoprotective phenotype, as shown by a significant decrease in VCAM-1 expression, compared with sodded grafts. RGD-FSP-coating allows for a cell layer that is more resistant to physiological shear stress, as shown by the increased cell retention over FN. This shear stable EC layer is necessary for in vivo endothelialization of the graft material, which shows promise to increase the patency of synthetic small diameter vascular grafts.     

Human endothelial cells hollow fiber membrane bioreactor as a model of the blood vessel for in vitro studies

Human endothelial cells are used in experimental models for studying in vitro pathophysiological mechanisms of different diseases. We developed an original bioreactor, which can simulate human blood vessel, with capillary polysulfone membranes covered with the human umbilical vein endothelial cells (HUVECs) and we characterized its properties. The elaborated cell seeding and culturing procedures ensured formation of a confluent cell monolayer on the inside surface of capillaries within 24 h of culturing under the shear stress of 6.6 dyn/cm². The optimal density of cells to be seeded was 60,000 cells/cm². Labeling HUVECs with carboxyfluorescein succinimidyl ester (CFSE) did not influence cells’ metabolism. Flow cytometry-based analysis of HUVECs stained with CFSE demonstrated that in a presence of the shear stress cells’ proliferation was much inhibited (after 72 h proliferation index was equal to 1.9 and 6.2 for cultures with and without shear stress, respectively) and the monolayer was formed mainly due to migration and spreading of cells that were physiologically elongated in a direction of the flow. Monitoring of cells’ metabolism showed that HUVECs cultured in a presence of the shear stress preferred anaerobic metabolism and they consumed 1.5 times more glucose and produced 2.3 times more lactate than the cells cultured under static conditions. Daily von Willebrand factor production by HUVECs was near 2 times higher in a presence of the shear stress. The developed model can be used for at least 3 days in target studies under conditions mimicking the in vivo state more closely than the static HUVEC cultures.     

不同条件培养的内皮细胞耐受流体剪切力的比较研究

为提高内皮细胞（EC）与移植间的粘附,研究其可能的机制,我们采用改进的流室装置比较流动培养的EC与静态培养的EC对剪切力的耐受强度,预铺纤维粘连蛋白,层粘连蛋白对其对其粘附的影响,并研究2了EC骨架成分肌动蛋白丝的分布及在剪切力作用下的变化,结果显示流动培养组的细胞残留明显多于相应静态培养组,预辅纤维连接蛋白可显著提高静态培养EC的残留,加入纤维连接蛋白和层粘连蛋白效应更明显,而预铺的基质对流动培养组结果影响较小,剪切力作用下EC的肌动蛋白丝有序排列,并形成张力纤维,提示流动培养可显著提高EC对剪切力的耐受,其机制与剪切力诱导肌动蛋白丝重建,张力纤维形成,细胞形态的变化有关。     

The effect of gradually graded shear stress on the morphological integrity of a huvec-seeded compliant small-diameter vascular graft

The premature endothelialization of tissue-engineered grafts had often induced cellular detachment at an early period of implantation in arterial circulation, resulting in occlusion at an early period of implantation. This study was aimed to determine whether gradually increased shear stress applied ex vivo improves cell retention and tissue morphological integrity including cell shape and alignment, actin fiber alignment and expression of vascular endothelial (VE) cadherin. Tissue-engineered grafts used for this study were human umbilical vein endothelial cell (HUVEC)-seeded compliant small-diameter grafts made of poly(L-lactide-co-epsilon-caprolactone) fiber meshes fabricated by electrospinning. The shear stresses applied to grafts, generated using a custom-designed mock circulatory apparatus, were 3.2, 8.7 and 19.6 dyn/cm(2). The grafts completely monolayered prior to shear stress exposure exhibited a polygonal cobblestone morphology with randomly distributed actin fibers and VE cadherin at the continuous peripheral region of adjacent cells. The 24-h-loading of high shear stresses (8.7 and 19.6 dyn/cm(2)) equivalent to those of the arterial circulatory system resulted in severe cellular damage resulting in the complete loss of cells. However, a gradually increased graded exposure from a low (3.2 dyn/cm(2)) to a high shear stress (19.6 dyn/cm(2)) resulted in a markedly reduced cell detachment, a highly elongated cell shape, and orientation or alignment of both cells and actin fibers, which were parallel to the direction of flow. Although VE-cadherin expression was not detected yet, a higher degree of tissue integrity was achieved, which may greatly improve the performance particularly at an early period of implantation.     

Endothelial cell seeding: coating Dacron and expanded polytetrafluoroethylene vascular grafts with a biological glue allows adhesion and growth of human saphenous vein endothelial cells

The establishment of an endothelial lining on vascular grafts to obtain a highly thromboresistant surface in a clinical situation requires optimization of cell collection, quality, adhesion and growth. We have studied the conditions for collection, seeding and growth of human saphenous vein endothelial cells (HSVEC), on Dacron or Gore-Tex expanded polytetrafluoroethylene (PTFE) vascular grafts. Carefully handled veins, as opposed to veins obtained using the usual procedures for coronary bypass graft preparation, yielded a higher rate of successful culture (94% vs 43%) and reached confluence in primary culture sooner (9.4 +/- 3 days vs 13.4 +/- 4.5 days). HSVEC were seeded at a density of 6 x 10(3) cells/cm2 on graft fragments coated with fibronectin (FN) or Transglutine (TGL), a biological glue. There was no HSVEC adhesion on Dacron or PTFE without protein pretreatment of the artificial surface. FN improved HSVEC adhesion but there was no cell growth. Adhesion, doubling time and cell density at confluence on PTFE pretreated with TGL were similar to those on conventional tissue culture polystyrene (TCP) pretreated with TGL or FN. HSVEC adhesion on Dacron pretreated with TGL was lower than on TCP pretreated with TGL; the doubling time was similar but the density at confluence was 40% lower. We conclude that pretreatment of vascular grafts with TGL, besides being an alternative to preclotting of the Dacron graft, allows adhesion and growth to confluence of HSVEC on these surfaces.     

流体切应力梯度对血管内皮细胞排列和形状的影响

目的研究不同梯度切应力作用下,血管内皮细胞(endothelial cells,ECs)排列和形状变化,旨在了解流体切应力梯度对ECs形态的影响,为进一步探讨其功能变化提供实验基础。方法建立可对体外培养ECs施加梯度切应力的流动腔装置,并应用该装置对人脐静脉ECs加载了大小在15dyn/cm2～6.6dyn/cm2(1dyn=10-5N)范围、梯度分别为1.5dyn/cm2和3dyn/cm2的切应力,加载时间均为6h。比较这两种不同切应力梯度对ECs的细胞方向角、细胞宽长比和细胞形态指数的影响。结果在不同切应力梯度作用下,ECs的细胞方向角分布散乱,细胞无排列规律。与3dyn/cm2相比,1.5dyn/cm2切应力梯度下ECs的宽长比和细胞形态指数明显减少,趋向于拉伸状态。结论在不同切应力梯度作用下,ECs均排列紊乱,无规律可循。然而,在相对较小的切应力梯度作用下,细胞容易被拉伸,细胞形状趋向于伸长,而较大切应力梯度作用下,细胞形状则趋向于圆形。     

一种骨种子细胞体外应力培养系统的建立

目的建立体外应力培养系统，观察应力刺激对骨种子细胞成骨分化的影响。方法选择具有明确成骨分化潜能的间充质干细胞(MSCs)作为种子细胞，以脱细胞骨基质为支架材料，以流体切应力作为对种子细胞的体外应力刺激。建立一种骨种子细胞体外三维应力培养系统——流动腔灌流体系，并利用该系统对MSCs的碱性磷酸酶(ALP)活性和骨钙素产物的影响进行评价。结果该系统可以明显促进ALP活性和骨钙素产物的表达，而细胞计数无明显改变。结论本系统为骨组织工程研究提供了一种有效的体外培养模型。     

Perfusion of medium with supplemented growth factors changes metabolic activities and cell morphology of hepatocyte-nonparenchymal cell coculture

To develop a feasible perfusion-type bioartificial liver device, perfusion of hepatocyte-nonparenchymal cell (NPC) cocultures with medium supplemented with hepatocyte growth factor (HGF) and heparin-binding epidermal growth factor-like growth factor (HB-EGF) was carried out. On day 1 of culture, perfusion at a constant shear stress of 1.3 dyn/cm2 enhanced ammonia metabolic and urea synthetic activities of hepatocytes. These enhanced activities were sustained up to day 7 only when growth factors were present. In contrast, no beneficial effects of growth factors on these activities were observed in static cultures. In perfusion cultures, three-dimensional cell aggregates were formed. On the surface of these aggregates, flattened cell layers composed mainly of NPCs were found, and the central cluster of cell aggregates was composed of round-shaped hepatocytes and reticulin fibrils. These observations strongly suggested that the reconstruction of different types of liver cells and connective tissues formed tissue-mimicking cell aggregates in the perfusion culture that was able to modulate the liver-specific functions of hepatocytes. Thus, perfusion culture conditions of the hepatocyte--NPC coculture system should be appropriately designed to induce suitable reconstruction of the cultured cells for use as a bioartificial liver device.     

Endothelial barrier function under laminar fluid shear stress

It has been suggested that increasing levels of shear stress could modify endothelial permeability. This might be critical in venous grafting and in the pathogenesis of certain vascular diseases. We present a novel setup based on impedance spectroscopy that allows online investigation of the transendothelial electrical resistance (TER) under pure laminar shear stress. Shear stress-induced change in TER was associated with changes in cell motility and cell shape as a function of time (morphodynamics) and accompanied by a reorganization of catenins that regulate endothelial adherens junctions. Confluent cultures of porcine pulmonary trunk endothelial cells typically displayed a TER between 6 and 15 ohms cm2 under both resting conditions and low shear stress levels (0.5 dyn/cm2). Raising shear stress to the range of 2 to 50 dyn/cm2 caused a transient 2% to 15% increase in TER within 15 minutes that was accompanied by a reduction in cell motility. Subsequently, TER slowly decreased to a minimum of 20% below the starting value. During this period, acceleration of shape change occurred. In the ensuing period, TER values recovered, reaching control levels within hours and associated with an entire deceleration of shape change. A heterogeneous distribution of alpha-, beta-, and gamma-catenin, main components of the endothelial adherens type junctions, was also observed, indicating a differentiated regulation of shear stress-induced junction rearrangement. Additionally, catenins were partly colocalized with beta-actin at the plasma membrane, indicating migration activity of these subcellular parts. Shear stress, even at peak levels of 50 dyn/cm2, did not cause intercellular gap formation. These data show that endothelial monolayers exposed to increased levels of laminar shear stress respond with a shear stress-dependent regulation of permeability and a reorganization of junction-associated proteins, whereas monolayer integrity remains unaffected.     

The effects of pore size and endothelial cell seeding upon the performance of small-diameter e-PTFE vascular grafts under controlled flow conditions

The purpose of this study was to determine the effects of endothelial cell seeding and graft internodal distance upon the performance of 4-mm-ID e-PTFE grafts during acute reduced blood flow conditions. PTFE grafts especially manufactured with three different mean internodal distances (28, 40, and 52 microns) were evaluated. Fifteen dogs (n = 5 for each design of PTFE graft) underwent bilateral carotid artery replacements with 6 cm lengths of 4-mm-ID PTFE grafts. In each dog one graft was seeded with enzymatically derived endothelial cells; the contralateral graft was nonseeded. All grafts were evaluated 5 weeks postoperatively. Dogs with bilaterally patent grafts were subsequently subjected to flow conditions through the graft that were maintained at 30% of the initial flow rates for 4 hr. Following controlled low flows the grafts were excised and assessed for patency, thrombus-free surface area, inner capsule thickness and prostacyclin production. Endothelial cell seeding of these small-diameter e-PTFE vascular grafts improved patency and thrombus-free surface areas in grafts of all pore sizes, with these parameters being greatest in the 40-microns grafts. Inner-capsule healing in these grafts was controlled and related to the pore size. PGI2 production was improved in endothelial cell seeded grafts of all pore sizes. However, neither endothelial cell seeding nor graft pore size affected the performance of these e-PTFE grafts under conditions of reduced blood flows.     

Improved endothelialization of postfixation treated biological vascular grafts.

Preliminary in vitro and in vivo studies have shown that endothelialization is improved by a detoxifying postfixation treatment of glutaraldehyde (GA) fixed bovine pericardial patches and grafts. To test whether this is also true for GA tanned human vein (HUV) grafts, patches of commercially available HUV grafts (MHUV), postfixation treated HUV grafts (PTHUV) and GA fixed HUV granfts (GAHUV) were endothelialized in vitro. Eight pairs of MHUV and PTHUV grafts were implanted as femoropopliteal grafts in eight sheep. Endothelial cell adherence was significantly better on PTHUV (11910 +/- 4413 cells/cm2) than on MHUV (6545 +/- 2835 cells/mm2; p = 0.0007) and on GAHUV (3563 +/- 1638; p = 0.0001) one day after cell seeding. After eight days of culture significantly more cells spread on PTHUV material than on MHUV (p = 0.0002), but none of the cultures on GAHUV remained viable. Four PTHUV grafts occluded in the femoropopliteal position, mostly because of kinking, so that only in four pairs of grafts could the thrombus-free surface be compared by planimetry. Again PTHUV material was covered more by endothelial cells than was MHUV material. On PTHUV endothelial cells spread directly on the graft material while on MHUV these cells spread on a layer of fibrin and macrophages. Postfixation treatment of GA-fixed biological graft material by amino-acid solutions improves the biocompatibility of the material and enhances in vitro as well as spontaneous in vivo endothelialization.     

Shear stress and VEGF enhance endothelial differentiation of human adipose-derived stem cells

Abstract

Herein we combine chemical and mechanical stimulation to investigate the effects of vascular endothelial growth factor (VEGF) and physiological shear stress in promoting the differentiation human adipose derived stem cells (ADSCs) into endothelial cells. ADSCs were isolated and characterized; endothelial differentiation was promoted by culturing confluent cells in 50?ng/ml VEGF under physiological shear stress for up to 14 days. Afterwards, endothelial cells were seeded onto collagen or acellular aortic valve matrices and exposed to four culture conditions: shear stress + VEGF; shear stress ? VEGF; static + VEGF and static ? VEGF. After 7 days, phenotype was investigated. ADSCs subjected to shear stress and VEGF express a comprehensive range of specific endothelial markers (vWF, eNOS and FLT-1 after 7 days and CD31, FLk-1 and VE-cadherin after 14 days) and maintain the phenotype when seeded onto scaffolds. Our protocol proved to be an efficient source of endothelial-like cells for tissue engineering based on autologous ADSC.     

Down-regulation of endothelial ephrinB2 expression by laminar shear stress.

The EphB receptors and their ephrinB ligands are involved in vascular assembly and differentiation. In this study, the authors analyzed the regulation of ephrinB2 and EphB4 in response to laminar shear stress in human endothelial cells. In order to simulate different flow conditions in vitro, human endothelial cells were exposed to laminar shear stress (1 to 50 dyn/cm2 for up to 24 h) in a cone-and-plate viscometer. EphrinB2 mRNA expression is down-regulated by arterial, but not by venous, laminar shear stress in a dose-dependent manner in primary cultures of human umbilical vein endothelial cells (HUVECs) (maximum at 30 dyn/cm2, 24 h: 46% +/- 4%of internal control without shear stress, n = 16, p < .05). The down-regulation of ephrinB2 by arterial shear stress is blocked by the protein kinase C inhibitor RO-31-8220. A similar shear stress-dependent down-regulation of ephrin-B2 can be found in human coronary artery endothelial cells (HCAECs). Chronic application of laminar shear stress does not affect EphB4 expression in venous and arterial endothelial cells. The down-regulation of ephrinB2 in response to laminar shear stress may contribute to the differentiation of endothelial cells into a nonactivated phenotype.     

The use of mild trypsinization conditions in the detachment of endothelial cells to promote subsequent endothelialization on synthetic surfaces

A necessary condition for endothelialization of small diameter grafts is rapid and firm adhesion of endothelial cells upon exposure to flow. To retain integrins on the cell surface, we assessed the effects of trypsin concentration, the duration of trypsin incubation, and trypsin neutralization methods on endothelial cell adhesion. Human umbilical vein endothelial cells which were detached using 0.025% trypsin for 5 min and seeded onto glass pretreated with fibronectin had close to 100% cell retention when shear stresses as high as 200 dyn/cm2 were applied for 2 min. An equivalent level of cell retention was observed on fibronectin coated Teflon-AF for shear stresses up to 60 dyn/cm2 applied for 4h. Using 0.025% trypsin, initial cell spreading and cell surface alpha5beta1 integrins were increased relative to cells treated with 0.5% trypsin. After 1h of attachment, focal adhesions formed when low trypsin concentrations were used but were less evident with high trypsin concentrations. These results showed that low trypsin concentrations produced faster spreading, a higher number of intact integrins, and rapid focal adhesion formation.     

Shear stress responses of adult blood outgrowth endothelial cells seeded on bioartificial tissue

Human blood outgrowth endothelial cells (HBOECs) are expanded from circulating endothelial progenitor cells in peripheral blood and thus could provide a source of autologous endothelial cells for tissue-engineered vascular grafts. To examine the suitability of adult HBOECs for use in vascular tissue engineering, the shear stress responsiveness of these cells was examined on bioartificial tissue formed from dermal fibroblasts entrapped in tubular fibrin gels. HBOECs adhered to this surface, deposited collagen IV and laminin, and remained adherent when exposed to 15 dyn/cm(2) shear stress for 24 h. The shear stress responses of HBOECs were compared to human umbilical vein endothelial cells (HUVECs). As with HUVECs, HBOECs upregulated vascular cell adhesion molecule-1 and intercellular adhesion molecule-1 when exposed to tumor necrosis factor (TNF)-α and shear stress decreased the expression of these adhesion molecules on TNF-α-activated monolayers. Nitric oxide production was elevated by shear stress, but did not vary between cell types. Both cell types decreased platelet adhesion to the bioartificial tissue, whereas pre-exposing the cells to flow decreased platelet adhesion further. These results illustrate the potential utility for HBOECs in vascular tissue engineering, as not only do the cells adhere to bioartificial tissue and remain adherent under physiological shear stress, they are also responsive to shear stress signaling.     

Endothelial cells cultured on engineered vascular grafts are able to transduce shear stress

In vitro endothelialization of small-diameter vascular prostheses confluently lined with cultured autologous endothelial cells (ECs) before clinical implantation improves their patency. Many authors have studied the effects of shear stress on ECs seeded on various substrates showing activation of mitogen-activated protein (MAP) kinases. Very few studies have reported any functional EC response to shear stress when they are seeded on vascular grafts. The purpose of this in vitro study was to investigate whether ECs were able to transduce shear stress. Human saphenous vein ECs were seeded on 6 mm fibrin-glue-coated grafts, then submitted to 15 dyn/cm(2) for 10, 30, and 120 min. Cell lysates were submitted to Western blot analysis to detect phosphorylated ERK 1/2 and p38. ERK 1/2 activation was observed at 10 min (1.6 fold) followed by a lower activation than under static conditions at 30 and 120 min. Shear stress induced a significant increase in p38 phosphorylation (2.5 fold) at 10 and 30 min, decreasing at 120 min. Thus, ECs are able to transduce shear stress in an in vitro model in closed clinical conditions, but the ERK 1/2 and p38 temporal activation profile is different. We provide new insights into the validity of the vascular tissue engineering approach.     

Adhesion and Function of Human Endothelial Cells Co-cultured on Smooth Muscle Cells

To evaluate interactions between human endothelial cells (ECs) and smooth muscle cells (SMCs) for the development of tissue-engineered vessels, we examined the adhesion and key cell properties of human ECs grown on quiescent human aortic SMCs. ECs attached to SMCs spread more slowly than ECs attached to fibronectin surfaces, and ECs aligned along the direction of the SMCs. ECs attached firmly and less than 5% of the cells were removed by shear stresses as high as 300 dyn cm⁻². Unlike porcine SMCs and co-cultures, human SMCs or co-cultures do not contract under flow, and the human ECs and SMCs in co-culture align toward the direction of flow. A confluent endothelium could be maintained in co-culture for over 30 days, and some of the ECs reoriented perpendicular to the SMCs after 9 days in static culture. Surface tissue factor levels in ECs and SMCs were less in co-culture than in monoculture. Co-culture induced an increase in calponin expression in SMCs. These findings show that human co-cultures can be maintained for long culture periods, where the endothelium remains confluent and responds to long-term exposure to flow, and EC–SMC interactions lead to an increase in SMC differentiation and an EC surface that is less thrombotic.     

Hydrodynamic shear-stress-dependent retention of endothelial and endothelial progenitor cells adhered to vascular endothelial growth factor-fixed surfaces

The luminal surfaces of small-diameter artificial vascular grafts must be fully endothelialized to be nonthrombogenic following implantation. To achieve this goal, we have attempted to capture circulating endothelial progenitor cells (EPCs) in situ on the luminal surfaces of implanted grafts. We examined potential receptor-ligand pairs that promote selective and tight adhesion of EPCs using a radial flow chamber comprising three regions, each containing a specific protein-bound substrate: fibronectin (FN) for integrin, and vascular endothelial growth factor (VEGF) and anti-Flk-1 antibody for VEGF receptor. In the presence of shear stress, the greatest retention of endothelial cells and EPCs was observed with FN followed by VEGF and then anti-Flk-1 antibody. Regardless of the bound protein, cell adhesion increased with larger areas of cell adhesion and enhanced cell spreading; the latter was also greatest with FN followed by VEGF and then anti-Flk-1 antibody. The distribution of vinculin-a key protein in focal adhesion plaques-in adherent endothelial cells was examined using total internal reflection fluorescence microscopy; FN-bound surfaces resulted in larger areas of adhesion and more focal adhesion plaques compared with surfaces bound with VEGF. On the other hand, examining these parameters relative to the area of cell adhesion revealed that VEGF-bound surfaces resulted in larger focal adhesion areas and greater fluorescence signals, both of which indicate increased resistance to shear stress. We also discuss in situ capturing of EPCs on surfaces bound with VEGF or anti-Flk-1 antibody, with the goal of creating endothelialized small-diameter vascular grafts.