Comparative evaluation of cell types for endothelialization in cardiovascular tissue engineering

Tissue engineering represents a promising approach to overcome the limitations of current vascular grafts by promoting endothelialization. However, the successful fabrication of small-diameter (<6 mm) tissue-engineered vascular grafts (TEVGs) that maintain the desired mechanical strength, biocompatibility, and long-term patency of native vessels remains a significant challenge. The development of an ideal TEVG depends largely on achieving complete endothelial coverage using appropriate autologous cells that can mimic the functional properties of native endothelium. Several studies have highlighted various autologous and stem cell sources with potential for graft endothelialization, including endothelial progenitor cells (EPCs), embryonic stem cells (ESCs), human umbilical vein endothelial cells (HUVECs), mesenchymal stem cells (MSCs), and induced pluripotent stem cells (iPSCs). Despite extensive preclinical progress, the most suitable cell source for generating stable and functional endothelium in small-diameter TEVGs remains unclear, representing a key gap in current knowledge. This review therefore evaluates the principal cell types investigated in cardiovascular tissue engineering, outlining their main advantages, limitations, and translational potential. Overall, a critical comparison of these cell sources highlights the need for further research to determine their long-term safety, durability, and suitability for clinical application in the construction of functional and durable TEVGs.