Abstract Background Atherosclerosis is a complex inflammatory vascular disease characterized by lipid and immune cells accumulation in the vessel wall, leading to lumen narrowing. Although several 3D in vitro microfluidic systems were previously described, a realistic reconstruction of the in vivo human atherosclerotic environment requires co-culture of different cell types arranged in atherosclerotic vessel-like structures with exposure to flow and circulating cells, creating challenges for disease modelling. In this study we developed a 3D tubular microfluidic model with quadruple coculture of human aortic smooth muscle cells (hAoSMCs), human umbilical cord vein endothelial cells (HUVECs) and foam cells to re-create a complex human atherosclerotic vessel in vitro to study the effect of flow and circulating immune cells. Methods &amp; Results Our new co-culture protocol with BFP-labelled hAoSMCs, GFP-labelled HUVECs and THP-1 macrophages-derived, Dil-labelled Oxidized Low-Density Lipoprotein (Dil-Ox-LDL) foam cells in a fibrinogen-collagen-I based 3D extracellular matrix (ECM) resulted in vessels with an early lesion morphology, showing a layered vessel-like composition with an endothelium and media, with foam cells accumulating in the sub-endothelial space. Perfusion for 24 hours of atherosclerotic and “healthy” vessels (BFP hAoSMCs and GFP HUVECs without foam cells) showed that the layered wall composition remained stable. Perfusion with circulating THP-1 monocytes demonstrated cell extravasation into the atherosclerotic vessel wall and recruitment of THP-1 cells to the foam cell core. QPCR analysis revealed increased expression of atherosclerosis markers in the atherosclerotic vessels and adaptation in VSMCs migration to flow and the plaque microenvironment, compared to control vessels. Conclusion We present a 3D tubular microfluidic model of a complex early atherosclerotic human vessel that can be exposed to flow and circulating THP-1 monocytes to study hemodynamic changes and immune cell recruitment under live confocal imaging. This novel atherosclerosis-on-a-chip model offers a humanized platform for in-depth mechanistic in vitro studies and drug testing.

A complex three-dimensional microfluidic model that mimics the early stage events in the human atherosclerotic artery