Anticoagulant and antiplatelet agents: their clinical and device application(s) together with usages to engineer surfaces

Investigating the Interactions of Hyaluronan Derivatives with Biomolecules. The Use of Diffusional NMR Techniques

[Chemical structure: see text] The interactions between a biomaterial and biomolecules present in body fluids often determine the fate of the biomaterial. This paper presents a study on hyaluronan (HA)-containing materials (in soluble or colloidal form) that focuses on their interactions with lipids and proteins and for the first time uses PFG NMR as an analytical technique for probing these events. The interactions of HA-based polymers with phospholipids (DPPC and DPPG liposomes) are shown to depend both on charge and hydrophobicity factors. Despite the difference in behavior between albumin (substantially non-adhesive) and fibrinogen (adhesive), the interactions of the polymers with proteins do not seem to be based on hydrophobic effects but on surface polar interactions.

Nanocomposite Containing Bioactive Peptides Promote Endothelialisation by Circulating Progenitor Cells: An In vitro Evaluation

OBJECTIVE

The formation of an endothelial cell layer on the luminal surface of cardiovascular devices, especially bypass grafts, is an important attribute in order to improve their patency. Endothelial progenitor cells (EPCs) have a potential role in the endothelialisation of bypass grafts. We hypothesised that a novel approach to improve endothelialisation of bypass grafts by EPCs would be the creation on the graft lumen of a microenvironment that supports EPC adhesion and differentiation.

METHODS

A new generation of nanocomposite based on silsesquioxane in the form of polyhedral oligomeric silsesquioxane (POSS) nanocages which incorporate bioactive peptides (RGD) was made into sheets. Peripheral blood mononuclear cells (PBMCs) containing EPCs isolated from six consenting young, healthy, adult volunteers were then plated both on (1) sheets of the nanocomposite with the bioactive peptide, (2) sheets of the nanocomposite without the bioactive peptide, (3) culture dishes as control and then cultured in presence of vascular endothelial growth factor (VEGF). Confirmation of endothelial and EPCs markers was carried out using fluorescence-activated cell sorter (FACS) analysis, reverse transcription polymerase chain reaction (RT-PCR) and immunostaining.

RESULTS

One to two percent of PBMCs expressed CD34 as determined by FACS analysis. Cells were demonstrated to express mRNA for the EPC markers CD34, platelet-endothelial cell adhesion molecule-1 (CD31), CD133 and vascular endothelial growth factor receptor-2(FlK-1/KDR). Endothelial cell-colony forming units were formed between day 5 and day 7 after plating. Colonies were confirmed to be endothelial like cells by immunostaining. There were significantly greater numbers of EPC colonies on the bioactive nanocomposites as compared to the nanocomposite alone and the uncoated dishes.

CONCLUSION

We report a new nanocomposite based biomaterial that has been demonstrated, in vitro, to promote endothelialisation from PBMCs containing EPCs.

Effects of a cinnamon extract on plasma glucose, HbA, and serum lipids in diabetes mellitus type 2

BACKGROUND

According to previous studies, cinnamon may have a positive effect on the glycaemic control and the lipid profile in patients with diabetes mellitus type 2. The aim of this trial was to determine whether an aqueous cinnamon purified extract improves glycated haemoglobin A1c (HbA1c), fasting plasma glucose, total cholesterol, low-density lipoprotein (LDL), high-density lipoprotein (HDL) and triacylglycerol concentrations in patients with type 2 diabetes.

METHODS

A total of 79 patients with diagnosed diabetes mellitus type 2 not on insulin therapy but treated with oral antidiabetics or diet were randomly assigned to take either a cinnamon extract or a placebo capsule three times a day for 4 months in a double-blind study. The amount of aqueous cinnamon extract corresponded to 3 g of cinnamon powder per day.

RESULTS

The mean absolute and percentage differences between the pre- and post-intervention fasting plasma glucose level of the cinnamon and placebo groups were significantly different. There was a significantly higher reduction in the cinnamon group (10.3%) than in the placebo group (3.4%). No significant intragroup or intergroup differences were observed regarding HbA1c, lipid profiles or differences between the pre- and postintervention levels of these variables. The decrease in plasma glucose correlated significantly with the baseline concentrations, indicating that subjects with a higher initial plasma glucose level may benefit more from cinnamon intake. No adverse effects were observed.

CONCLUSIONS

The cinnamon extract seems to have a moderate effect in reducing fasting plasma glucose concentrations in diabetic patients with poor glycaemic control.

The antithrombogenic potential of a polyhedral oligomeric silsesquioxane (POSS) nanocomposite

We have developed a nanocomposite using a silica nanocomposite polyhedral oligomeric silsesquioxane (POSS) and poly(carbonate-urea)urethane (PCU) for potential use in cardiovascular bypass grafts and the microvascular component of artificial capillary beds. In this study, we sought to compare its antithrombogenicity to that of conventional polymers used in vascular bypass grafts so as to improve upon current patency rates, particularly in the microvascular setting. Using atomic force microscopy (AFM) and transmission electron microscopy (TEM), surface topography and composition were studied, respectively. The ability of the nanocomposite surface to repel both proteins and platelets in vitro was assessed using thromboelastography (TEG), fibrinogen ELISA assays, antifactor Xa assays, scanning electron microscopy (SEM), and platelet adsorption tests. TEG analysis showed a significant decrease in clot strength (one-way ANOVA, p < 0.001) and increase in clot lysis (one-way ANOVA, p < 0.0001) on the nanocomposite when compared to both poly(tetrafluoroethylene) (PTFE) and PCU. ELISA assays indicate lower adsorption of fibrinogen to the nanocomposite compared to PTFE (one-way ANOVA, p < 0.01). Interestingly, increasing the concentration of POSS nanocages within these polymers was shown to proportionately inhibit factor X activity. Platelet adsorption at 120 min was also lower compared to PTFE and PCU (two-way ANOVA, p < 0.05). SEM images showed a "speckled" morphologic pattern with Cooper grades I platelet adsorption morphology on the nanocomposite compared to PTFE with grade IV morphology. On the basis of these results, we concluded that POSS nanocomposites possess greater thromboresistance than PTFE and PCU, making it an ideal material for the construction of both bypass grafts and microvessels.

Heparin-coupled poly(poly(ethylene glycol) monomethacrylate)-Si(111) hybrids and their blood compatible surfaces

Well-defined (nearly monodispersed) poly(poly(ethylene glycol)monomethacrylate)-Si hybrids were prepared via surface-initiated atom transfer radical polymerization (ATRP) of the poly(ethylene glycol)monomethacrylate (PEGMA) macromonomer on the hydrogen-terminated Si(111) surface (Si-H surface). Both the active chloride groups at the chain ends (from the ATRP process) and the chloride groups converted from some ( approximately 32%) of the -OH groups of the Si-C bonded PEGMA polymer, or P(PEGMA), brushes were used as leaving groups for the covalent coupling of heparin. For the heparinized P(PEGMA)-Si hybrid surfaces, protein adsorption and platelet adhesion were significantly suppressed. The well-defined and dense P(PEGMA) brushes, prepared from surface-initiated ATRP, had allowed the immobilization of a relatively high concentration of heparin (about 14 mug/cm(2)). The resulting silicon surface exhibited significantly improved antithrombogenecity with a plasma recalcification time (PRT) of about 150 min. The persistence of high bioactivity for the immobilized heparin on the hybrid surfaces can be attributed to the biocompatibility of the PEGMA units, as well as their role as spacers in providing the immobilized heparin with a higher degree of conformational freedom in a more hydrophilic environment. Thus, the heparin-coupled P(PEGMA)-Si hybrids with anti-fouling and antithrombogenic surfaces are potentially useful in silicon-based implantable devices and tissue engineering.

In vivo regeneration of small‐diameter (2 mm) arteries using a polymer scaffold

The difficulty of obtaining significant long-term patency and good wall mechanical strength in vivo has been a significant obstacle in achieving small-diameter vascular prostheses. The aim of the present study was to develop a prosthetic graft that could perform as a small-diameter vascular conduit. Tubular structures of hyaluronan (HYAFF-11 tubules, 2 mm diameter, 1 cm length) were grafted in the abdominal aorta of 30 rats as temporary absorbable guides to promote regeneration of vascular structures. Performance was assessed by histology, immunohistochemistry, and ultra-structural analysis. These experiments resulted in three novel findings: 1) complete endothelialization of the tube's luminal surface occurred; 2) sequential regeneration of vascular components led to complete vascular wall regeneration 15 days after surgery; and 3) the biomaterial used created the ideal environment for the delicate regeneration process during the critical initial phases, yet its biodegradability allowed for complete degradation of the construct four months after implantation, at which time, a new artery remained to connect the artery stumps. This study assesses the feasibility to create a completely biodegradable vascular regeneration guide in vivo, able to sequentially orchestrate vascular regeneration events needed for very small artery reconstruction.

Polyhedral oligomeric silsesquioxane nanocomposites: the next generation material for biomedical applications

The unique properties of nanocomposites have seen them creating the next revolution in materials science. Their quantal properties as a result of their size have given them unique physical characteristics, previously not possible because of classical physical laws. There is now evidence that these may also extend into the world of biology and medicine. In this Account, we look at the birth of a new generation of silica nanocomposites using polyhedral oligomeric silsesquioxanes, a promising nanoscale silica particle with particular use in cardiovascular interventional devices.

Engineering of bypass conduits to improve patency

For patients with severe coronary artery and distal peripheral vascular disease not amenable to angioplasty and lacking sufficient autologous vessels there is a pressing need for improvements to current surgical bypass options. It has been decades since any real progress in bypass material has reached mainstream surgical practice. This review looks at possible remedies to this situation. Options considered are methods to reduce prosthetic graft thrombogenicity, including endothelial cell seeding and developments of new prosthetic materials. The promise of tissue-engineered blood vessels is examined with a specific look at how peptides can improve cell adhesion to scaffolds.