Inflammatory cell recruitment, distribution, and chemiluminescence response at IgG precoated- and thiol functionalized gold surfaces

Avoiding implant-related complications in medically compromised patients with or without unhealthy lifestyle/Elevated oxidative stress

Increased human life expectancy broadens the alternatives for missing teeth and played a role in the widespread use of dental implants and related augmentation procedures for the aging population. Though, many of these patients may have one or more diseases. These systemic conditions may directly lead to surgical complications, compromise implant/bone healing, or influence long-term peri-implant health and its response to biologic nuisances. Offering patients credible expectations regarding intra- and postoperative complications and therapeutic prognosis is an ethical and legal obligation. Clear identification of potential types of adverse effects, complications, or errors is important for decision-making processes as they may be related to different local, systemic, and technical aspects. Therefore, the present review structures the underlying biological mechanisms, clinical evidence, and clinical recommendations for the most common systemic risk factors for implant-related complications.

Applications of Antioxidants in Dental Procedures

As people are paying more and more attention to dental health, various dental treatment procedures have emerged, such as tooth bleaching, dental implants, and dental restorations. However, a large number of free radicals are typically produced during the dental procedures. When the imbalance in distribution of reactive oxygen species (ROS) is induced, oxidative stress coupled with oxidative damage occurs. Oral inflammations such as those in periodontitis and pulpitis are also unavoidable. Therefore, the applications of exogenous antioxidants in oral environment have been proposed. In this article, the origin of ROS during dental procedures, the types of antioxidants, and their working mechanisms are reviewed. Additionally, antioxidants delivery in the complicated dental procedures and their feasibility for clinical applications are also covered. Finally, the importance of safety assessment of these materials and future work to take the challenge in antioxidants development are proposed for perspective.

Characterization of the foreign body response of titanium implants modified with polyphenolic coatings

The foreign body response is dictating the outcome of wound healing around any implanted materials. Patients who suffer from chronic inflammatory diseases and impaired wound healing often face a higher risk for implant failure. Therefore, functional surfaces need to be developed to improve tissue integration. For this purpose, we evaluated the impact of surface coatings made of antioxidant polyphenolic molecules tannic acid (TA) and pyrogallol (PG) on the host response in human blood. Our results showed that although the polyphenolic surface modifications impact the initial blood protein adsorption compared to Ti, the complement and coagulation systems are triggered. Despite complement activation, monocytes and granulocytes remained inactivated, which was manifested in a low pro-inflammatory cytokine expression. Under oxidative stress, both coatings were able to reduce intracellular reactive oxygen species in human gingival fibroblasts (hGFs). However, no anti-inflammatory effects of polyphenolic coatings could be verified in hGFs stimulated with lipopolysaccharide and IL-1β. Although polyphenols reportedly inhibit the NF-κB signaling pathway, phosphorylation of NF-κB p65 was observed. In conclusion, our results indicated that TA and PG coatings improved the hemocompatibility of titanium surfaces and have the potential to reduce oxidative stress during wound healing.

The blood compatibility challenge. Part 2: Protein adsorption phenomena governing blood reactivity

The adsorption of proteins is the initiating event in the processes occurring when blood contacts a "foreign" surface in a medical device, leading inevitably to thrombus formation. Knowledge of protein adsorption in this context has accumulated over many years but remains fragmentary and incomplete. Moreover, the significance and relevance of the information for blood compatibility are not entirely agreed upon in the biomaterials research community. In this review, protein adsorption from blood is discussed under the headings "agreed upon" and "not agreed upon or not known" with respect to: protein layer composition, effects on coagulation and complement activation, effects on platelet adhesion and activation, protein conformational change and denaturation, prevention of nonspecific protein adsorption, and controlling/tailoring the protein layer composition. STATEMENT OF SIGNIFICANCE: This paper is part 2 of a series of 4 reviews discussing the problem of biomaterial associated thrombogenicity. The objective was to highlight features of broad agreement and provide commentary on those aspects of the problem that were subject to dispute. We hope that future investigators will update these reviews as new scholarship resolves the uncertainties of today.

Healing of complement activating Ti implants compared with non-activating Ti in rat tibia

Recent studies have revealed that ozone ultraviolet (UVO) illumination of titanium (Ti) implants improves bone-implant anchorage by altering the physico-chemical and immune activating properties of the titanium dioxide (TiO(2)) layer. In the present rat tibia model, the authors compared the early events of inflammation and bone formation around UVO-treated Ti and complement activating immunoglobin g (IgG)-coated Ti. Machined Ti and machined Ti coated with a physical vapour-deposited Ti layer were used as references. Screw-shaped test and reference implants were implanted into rat tibia and harvested after 1, 7 and 28 days. Messenger RNA expression of implant adhered cells and peri-implant tissue ~250 μm from the surface were subsequently analysed with regard to IL-1β, TNF-α, osteocalcin, cathepsin K, BMP-2 and PDGF. Separate implants were retrieved after 7 and 28 days for removal torque measurements, and histological staining and histomorphometric analysis of bone area and bone-to-implant contact. While enhanced expression of inflammatory markers, TNF-α and IL-1β, was observed on IgG-coated surfaces throughout the observation time, UVO-treated surfaces indicated a significantly lower early inflammatory response. In the early phases (1 and 7 days), the UVO-treated surfaces displayed a significantly higher expression of osteoblast markers BMP-2 and osteocalcin. In summary, complement activating Ti implants elicited a stronger inflammatory response than UVO-treated Ti, with low complement activation during the first week of healing. In spite of this, the UVO-treated Ti induced only marginally more bone growth outside the implants.

Vitamin E triggers poly(2-hydroxyethyl methacrylate) (PHEMA) embolic potential: a proposed application for endovascular surgery

Poly(2-hydroxyethyl methacrylate) (PHEMA) is a biocompatible polymer used as embolizing agent for endovascular surgery. Blending of PHEMA with a hydrophobic and anti-oxidant agent, Vitamin E (Vit.E, 0.1-10%, w/v), modified PHEMA's haemocombatibility, evaluated measuring wettability, plasma protein adsorption along with whole blood coagulation time. The presence of Vit.E increases PHEMA's hydrophobicity and plasma protein adsorption (in particular albumin and Immunoglobulin G), while it also accelerates blood clot formation. These effects are developed due to a combination of issues such as surface hydrophobicity and plasma protein adsorption induced by the presence of Vit.E, suggesting that Vit.E blending could improve the use of PHEMA as embolizing agent.

Quartz crystal microbalance-with dissipation monitoring (QCM-D) for real time measurements of blood coagulation density and immune complement activation on artificial surfaces

A recently developed variant of quartz crystal microbalance (QCM) called QCM-with dissipation monitoring (QCM-D) allows simultaneous and simple measurements of changes in adsorbed mass as well as the viscoelastic property (D-factor) of deposited protein layers on the sensor surface. We have taken the QCM-D technology a step further and demonstrated its advantages in the study of protein assembly as a consequence of surface induced immune complement activation, or contact activated blood coagulation. In the present study we have continued our QCM-D investigations of surface assembly of fibrin clot formation and complement activation and incubated differently modified quartz sensor surfaces in blood plasma and sera. Polymer surfaces used were spin-coated polyethylene, poly(ethylene terephtalate), poly(methylmetacrylate) and poly(dimethylsiloxane). Also used were sputtered titanium and heparin grafted surfaces. In this investigation we found that we could describe the surface induced coagulation with four independent parameters: (1) Time of onset of coagulation, (2) fibrin deposition rate, (3) total frequency shift at stable plateau, and (4) fibrin clot density. The most important finding was that the blood plasma clot density can be assessed with the use of D determinations and that the clot density varied significantly with the chemical composition of the surface. However, the D-factor did not give any new analytical information about the possible complement activation mechanisms. Nevertheless, the QCM-D was found to be a reliable tool for the analysis of surface induced complement activation. We also compared the QCM-D technique with traditional enzyme immuno assay (EIA) measurements of soluble products from the surface activation of the complement and coagulation systems. We found that the results from EIA and QCM-D measurements corresponded well for the complement activation but not for the coagulation, probably due to the biological complexity of the coagulation system.

The attraction of Mac-1+ phagocytes during acute inflammation by methyl-coated self-assembled monolayers

We have used self-assembled monolayers (SAMs) of alkanethiolates on gold to study the contribution of methyl terminal functional groups in implant-triggered inflammation. The CH3-coated biomaterials were inserted in an air-pouch cavity of the BALB/c mouse and the in situ inflammatory response was monitored 4, 24, 48 and 72 h later. Flow cytometry was applied to define surface expression of the adhesion receptor Mac-1 (CD11b/CD18), a marker of activated leukocytes, and also of CD3 and B220 antigens (T and B lymphocytes). The CH3-coated surfaces caused a significant enhancement in the number of Mac-1+ cells in the implant. The only significant change in T and B lymphocytes was a transient increase in T cells detected 48 h after the implantation. Peak numbers of Mac-1+ phagocytes were observed 24 h after implantation. We conclude that if CH3 is present at the surface of implants, this chemical group will trigger a significant enhancement of activated phagocytes involved in the inflammatory reaction, and this phenomenon may extend the local phlogistic event.

Anti-inflammatory effects of a titanium-peroxy gel: role of oxygen metabolites and apoptosis

Polymorphonuclear neutrophils (PMN) are among the first inflammatory cells to arrive at an implant interface, where they encounter with the foreign material and may produce reactive oxygen species (ROS). During the interaction between titanium and ROS, titanium-peroxy (Ti-peroxy) compounds may be formed. We used a Ti-peroxy gel, made from titanium and hydrogen peroxide, to study the effects of Ti-peroxy compounds on PMN. In the absence of serum, the Ti-peroxy gel decreased the oxidative response of PMN to yeast and PMA and reduced PMN apoptosis without inducing necrosis. These effects could not be ascribed to the release of hydrogen peroxide from the Ti-peroxy gel, because a steady-state hydrogen peroxide producing system failed to mimic the effects of the gel. The effects were similarly unaffected when PMN were preincubated with beta(2)-integrin antibodies, questioning the involvement of adhesion molecules. Nevertheless, when a filter was used to separate the Ti-peroxy gel from the cells, the gel effect on PMN life span was abolished, pointing to a contact-dependent mechanism. In the presence of serum, the Ti-peroxy gel had no effect on the PMN oxidative response and life span, but appeared rather inert. In summary, this study demonstrates that the Ti-peroxy gel has potentially anti-inflammatory properties through a combined peroxide and physical contact effect, supporting the notion that interactions between titanium and inflammatory cells are responsible for the good performance of titanium in vivo.

Adhesion of human leukocytes to biomaterials: an in vitro study using alkanethiolate monolayers with different chemically functionalized surfaces

The adhesion of human leukocytes to self-assembled monolayers of well-defined surface chemistry was investigated in vitro. Polymorphonuclear (PMN) and mononuclear leukocytes were isolated from human blood by centrifugation techniques. The effect on adhesion of cell activation produced by pre-incubation of leukocytes with phytohemagglutinin (PHA) and phorbol 12-myristate 13-acetate (PMA) was also studied. Gold substrates were modified by treatment with alkanethiols with three different terminal chemical groups: COOH, OH, and CH(3). After incubation with the two subpopulations of leukocytes, the monolayers were washed, treated with fixative, stained with a Giemsa method, and observed by light microscopy to quantify the number of attached leukocytes. Comparative quantification of the density of leukocyte adhesion to the three types of self-assembled monolayers was determined. The hydrophobic surface expressing CH(3) was found to be the one that induced the highest adhesion density of leukocytes, both of PMN and mononuclear cells. In vitro activation of both mononuclear and PMN leukocytes further increased cell adhesion to the chemically defined monolayers that were used. This enhancement was higher for PHA-activated than for PMA-stimulated mononuclear cells, whereas PMA treatment of neutrophils resulted in a higher rate of adhesion of these cells than PHA stimulation.

Platelets stimulated by IgG-coated surfaces bind and activate neutrophils through a selectin-dependent pathway

Blood platelets bind rapidly to foreign surfaces and interact with adsorbed proteins and neutrophil granulocytes. We demonstrate by use of luminol-amplified chemiluminescence under stirred and non-stirred conditions that platelets at IgG-coated surfaces amplify the neutrophil extracellular release of reactive oxygen species (ROS). The neutrophil response involved tyrosine phosphorylation, but was only in part induced by neutrophil F(c gamma)-receptor stimulation. The platelet mediated effects were contact-dependent since the respiratory burst was inhibited when the IgG-stimulated platelets were removed by filtration, but not when they were fixed in paraformaldehyde. Bodipyphallacidin-staining of filamentous actin (F-actin) revealed that an actin-dependent platelet adhesion supported the subsequent adhesion and spreading of neutrophils. The neutrophil ROS-response was lowered when the interaction between platelet P-selectin (CD62P) and neutrophil P-selectin glycoprotein ligand-l (PSGL-1 or CD162) was inhibited. The blocking of L-selectin (CD62L) or blocking of the interaction between platelet glycoprotein (Gp) IIb/IIIa and neutrophil complement receptor 3 (CR3) showed no effect. We conclude that platelet activation on immobilized IgG trigger a contact-dependent "frustrated" phagocytosis by neutrophils, associated with a release of toxic ROS.

Ex vivo PMA-induced respiratory burst and TNF-alpha secretion elicited from inflammatory cells on machined and porous blood plasma clot-coated titanium

The release of inflammatory mediators around implants and normal wounds may differ due to the presence of the solid surface. In this study, machined and sub-micron porous titanium implants with and without a 100 nm thick blood plasma clot were inserted subcutaneously in rat for 3 or 24 h. The cell recruitment to the interfaces, in vivo secretion of TNF-alpha and the ex vivo PMA-induced production of reactive oxygen species were subsequently investigated. The thin plasma clot coating gave rise to an increased ex vivo PMA-stimulated oxygen radical production by implant-associated cells at both implantation times, and an increased cell recruitment at 24 h. The total TNF-alpha secretion was highest at sham sites and plasma clot-coated porous titanium at 24 h. After 24 h, the cell-type pattern in the exudate around the porous plasma-coated implant was more similar to that found at sham sites than that adjacent to the non-coated implants. No differences were observed between the machined Ti and the machined sub-micron porous Ti.

Ellipsometric in vitro studies on blood plasma and serum adsorption to zirconium

Ellipsometry/antibody techniques were used to study the adsorption of heparinized human blood plasma and serum onto spontaneously oxidized zirconium, and a colorimetric assay measured the formation of kallikrein by the surface in citrated plasma. After 10 min incubation in the blood plasma the protein film thickness was approximately 4.2 nm, and the film bound polyclonal antibodies mainly against high molecular weight kininogen (HMWK), immunoglobulin G (IgG) and fibrinogen. After 5 or 60 min of incubations in whole normal or EGTA sera, antibodies against complement factor 3 (C3) and complement factor 3d (C3d) deposited to the surface. Factor H and complement factor 1q (C1q) were detected similarly after 1 and 5 min of incubation in 1-10% normal serum in veronal buffer, respectively. The indications are that upon contact with blood plasma, zirconium activates the intrinsic pathway of coagulation and is opsonized with C3. The failure to detect properdin and transient presence of factor H at the surface suggest that complement binds to zirconium although the activation becomes quickly down-regulated.

Complement activation on immunoglobulin G-coated hydrophobic surfaces enhances the release of oxygen radicals from neutrophils through an actin-dependent mechanism

Neutrophil granulocytes are among the first cells to encounter a plasma protein-coated implant and may through frustrated phagocytosis release toxic oxidative species. We used two model surfaces, hydrophobic and hydrophilic glass, to investigate the effects of plasma immunoglobulin G (IgG)-complement interactions for neutrophil adhesion and respiratory burst. The respiratory burst was measured with luminol-amplified chemiluminescence and cell adhesion was determined by labeling neutrophils with 2', 7'-bis-(carboxy-ethyl)-5(6)-carboxyfluorescein. We demonstrate that the IgG-triggered neutrophil adhesion and oxygen radical production is augmented in the presence of normal human serum, in particular on hydrophobic surfaces, indicating that complement factors enhance the neutrophil activation. We propose that the complement factors C3, C5a, and C1q are especially important for this amplification, but factor B is probably not. Disturbance of the actin filament dynamics with cytochalasin B or jasplakinolide blocked the neutrophil radical generation on all surfaces. However, these drugs did not affect the number of adherent neutrophils. We suggest that there is a synergistic interaction between adsorbed IgG, and the complement system, which amplifies the neutrophil acute inflammatory responses through a dynamic actin cytoskeleton on synthetic surfaces.

Secretion of IL-1 and H2O2 by human mononuclear cells in vitro

The secretion of hydrogen peroxide (H2O2) and interleukin-1alpha (IL-1alpha) was evaluated during in vitro culturing of human monocytes. The oxidative metabolism and cytokine secretion were correlated to the cell distribution (number of surface-associated cells), the DNA content and their integrity, evaluated by lactate dehydrogenase (LDH) assay. The differentiation of cultured monocytes was determined by the expression of CD14, 27E10 and RM3/1. After 24 h cultivation, unstimulated cells had a low production of H2O2 and IL-1alpha. A four-fold increase in the production of H2O2 was detected with 5 and 10 microg/ml of lipopolysaccharide (LPS) and polystyrene (PS) particles. PS particles induced a concentration-dependent increase in IL-1alpha after 24 h. In contrast, cultivation for 48 h, did not result in any measurable production of H2O2, irrespective of the type of stimulus. A decreased viability of monocytes was shown after stimulation with PS particles in high concentrations. Our results indicate that the phenotype expression, adhesion, integrity and secretory pattern of human monocytes is dependent on the culture time and the type and concentration of stimulus.

In vivo cell recruitment, cytokine release and chemiluminescence response at gold, and thiol functionalized surfaces

Hydroxylated and methylated surfaces were prepared by the self-assembled monolayer technique (SAM) of alkane thiols on gold. The surfaces were used to evaluate the influence of implant surface chemistry on protein deposition and inflammatory cell response. Implants were inserted subcutaneously in the rat for 3 and 24 h. The surface chemical properties influenced the in vitro rat plasma protein adsorption (ellipsometry/antibody) with few exceptions (albumin not found and fibrinogen always found). The number of recruited cells and their distribution (DNA from implant versus from exudate) was influenced by the different chemistries at 24 h, but not at 3 h. HIS48+, ED1+, ED2+ and small numbers of CD5+ cells were present in the exudate at both time periods (flow cytometry). The cellular oxidative metabolism was low, although cells on -OH surfaces responded with the highest phorbol ester-stimulated chemiluminescence (CL)/DNA. The levels of cytokines IL-1alpha, IL-1beta and TNFalpha (ELISA) were not influenced by material surface chemistry. Sham operated sites had a higher cytokine concentration/DNA compared with exudates from an implant milieu. The results of this study show that surface chemical functionalization modifies specific events in the inflammatory response around implants in soft tissues.