Strategy forin vitro evaluation of the interactions between biomaterials and complement system

In vitro Blood Compatibility Evaluation of Hollow Fibre Membrane Using a Controlled Flow System: A Comparative Study

A procedure has been established for the in vitro assessment of hollow fibre haemodialysis membranes. A 30 ml syringe containing 20 ml of fresh non-anticoagulated blood was mounted onto a non-pulsatile syringe pump and blood was perfused through minimodules constructed from 80 fibres retrieved from Cuprophan (Baxter ST15), cellulose acetate (M57-12, JMS Co Ltd, Hiroshima, Japan), and AN69HF (Filtral 20, Hospal, France) dialysers. Samples were collected before perfusion, 3, 6, 9 and 12 minutes. The modules were clamped vertically to minimise the effect of red cell pooling and the dialysate compartment was filled with 0.9% saline to minimise ultrafiltration. After sample processing, complement C3a, thrombin-antithrombin III complexes, prothrombin F1 + 2, and factor XII-like activity were evaluated. The results indicated that the system could discriminate between the membranes evaluated and therefore was a relevant procedure for the assessment of hollow fibre haemodialysis membranes.

Biocompatibility of polymer-based biomaterials and medical devices – regulations,in vitroscreening and risk-management

Biomaterials play an increasing role in modern health care systems.

Screening biomaterials for functional complement activation in serum

Complement plays an important role in the immune attack against invading microorganisms. However, blood-contacting medical device biomaterials lacking specific complement inhibitors, with free hydroxyl and/or amino groups, or with absorbed antibodies, may inappropriately activate complement. Inappropriate activation by either the antibody-mediated classical or the antibody-independent alternative pathway may have well-known acute or poorly understood chronic effects on the host or device. This article describes methods for screening biomaterials for functional whole complement activation using normal human serum, or specifically for alternative pathway activation using C4-deficient guinea pig serum, or for classical pathway activation using both sera in combination. Detailed protocols are available as standard methodologies from the American Society for Testing and Materials (ASTM F1984, ASTM F2065, and ASTM F2567). Results obtained with these functional tests are confirmed by detection of classical and alternative pathway-specific markers C4d and Bb, respectively. These methods demonstrate dose and time-course activation of complement to beaded agarose, cellulose acetate, and purified alginate as examples of biomaterials. Significant difference in a functional endpoint denoting specific complement pathways is an appropriate screening method for complement activation by medical device biomaterials which might result in adverse events when the device is implanted or contacts human blood.

Positively-charged, porous, polysaccharide nanoparticles loaded with anionic molecules behave as 'stealth' cationic nanocarriers

PURPOSE

Stealth nanoparticles are generally obtained after modifying their surface with hydrophilic polymers, such as PEG. In this study, we analysed the effect of a phospholipid (DG) or protein (BSA) inclusion in porous cationic polysaccharide (NP(+)) on their physico-chemical structure and the effect on complement activation.

METHODS

NP(+)s were characterised in terms of size, zeta potential (zeta) and static light scattering (SLS). Complement consumption was assessed in normal human serum (NHS) by measuring the residual haemolytic capacity of the complement system.

RESULTS

DG loading did not change their size or zeta, whereas progressive BSA loading lightly decreased their zeta. An electrophoretic mobility analysis study showed the presence of two differently-charged sublayers at the NP(+) surface which are not affected by DG loading. Complement system activation, studied via a CH50 test, was suppressed by DG or BSA loading. We also demonstrated that NP(+)s could be loaded by a polyanionic molecule, such as BSA, after their preliminary filling by a hydrophobic molecule, such as DG.

CONCLUSION

These nanoparticles are able to absorb large amounts of phospholipids or proteins without change in their size or zeta potential. Complement studies showed that stealth behaviour is observed when they are loaded and saturated either with anionic phospholipid or proteins.

In situ complement activation by polyethylene wear debris

A frequent long-term complication of total joint arthroplasty is aseptic loosening, the end result of wear debris accumulation, synovitis, and osteolysis about the implant-bone or cement-bone interface. Complement, an effector system in plasma, synovial fluid, and tissue, has powerful chemotactic, inflammatory, and osteoclast-activating potentials. This study explored the complement-activating ability of polyethylene, a material used in joint implants. In vitro hemolytic assays using sheep red blood cells (E(sh)), human serum, and particulate polyethylene suggested alternative pathway complement activation, as well as polyethylene adsorption of activated complement components. These results were confirmed by enzyme-linked immunosorbent assay (ELISA) quantification of activated complement factors Bb and C3b. In situ double antibody immunoperoxidase staining for factors Bb, C3a, iC3b, and SC5-9 in synovial tissue from revision hip specimens showed localized alternative pathway activation and component adsorption. These results introduce a likely role for complement activation in particle-mediated recruitment, proliferation, and activation of macrophages during early events in osteolysis and implant loosening.

In vitro investigation of the blood response to medical grade PVC and the effect of heparin on the blood response

This paper reports the results of an investigation into the blood response of polymers in vitro, using non-anticoagulated and heparinised blood and plasma. The materials studied were regenerated cellulose, (Cuprophan), an acrylonitrile-allyl sulphonate copolymer (AN69S), and medical grade polyvinyl chloride plasticised with di-2-ethyl-hexyl-phthalate (PVC/DEHP). Blood-material or plasma-material contact was achieved using a parallel plate flow cell, and C3a generation and FXII-like activity measured. The results of the study with non-anticoagulated human blood show that PVC/DEHP is a high complement activator. C3a concentration in the blood was higher after contact with PVC/DEHP than after contact with regenerated cellulose. The introduction of heparin in the blood induced complex alterations in the blood response. C3a generation could be elevated, decreased, or remain the same, depending on the material. The FXII-like activity on the surface of the PVC/DEHP after contact with plasma was also higher than the other two polymers. The introduction of heparin could increase or decrease FXII-like activity, depending on material. The patterns of response obtained with non-anticoagulated blood in vitro for AN69S and Cuprophan bore a strong resemblance with patterns of response obtained in the clinic, whereas those obtained with heparinised blood in vitro did not.

Complement activation by model drug carriers for intravenous application: determination by two-dimensional electrophoresis

The interactions of intravenously injected drug carriers with blood proteins are considered as an important factor for the fate of the particles after their administration. Protein adsorption on latex particles applied as model for intravenous drug carriers was analysed using two-dimensional electrophoresis (2-DE). The particles were incubated in citrated plasma, serum and heat-inactivated serum, respectively. Incubation in the various media resulted in clear differences in the protein adsorption patterns. Two characteristic protein spots were determined to be enriched on the 2-DE gels only after incubation of the particles in serum. Employing N-terminal microsequencing these protein spots were identified to be fragments of the complement protein C3. Enrichment of these particular spots was most likely a result of complement activation by the particles. Mechanism of C3 binding to the particle surface and subsequent inactivation by cleavage are discussed in order to explain the results. It could be demonstrated that 2-DE analysis provides the possibility to distinguish between adsorption and covalent attachment of C3 to particulate surfaces. The findings indicate that complement activation was caused by covalent binding of the C3 component C3b to the particles' surface. The influence of the incubation medium on the in vitro protein adsorption of particulate drug carriers has to be considered when a correlation between the protein adsorption pattern and the in vivo behaviour of the particles is approached.

Polyethylene glycol (PEG) modified bovine pericardium as a biomaterial: a comparative study on immunogenicity

Bioprosthetic heart valves made from glutaraldehyde (GA)-fixed porcine aortic valves or bovine pericardium (BP) are having some advantages over mechanical valves. However, their durability is low due to the calcification and immunological rejection. Study on immunogenicity is an important part in understanding the biocompatibility of materials. Polyethylene glycol (PEG) on pericardium can control biodegradation and calcification. Also, PEG exhibits low immunogenicity. We have studied the complement activation potential and the contribution of complement factors (biologic factors) on the calcification of PEG grafted pericardium samples and compared with standard (control) glutaraldehyde-treated pericardium samples. PEG-grafted BP activated using GA and carbodiimide (EDC) could be selected for further studies since complement activation and calcification observed on these samples has been relatively low.

Interactions of nanoparticles bearing heparin or dextran covalently bound to poly(methyl methacrylate) with the complement system

The efficient uptake of injected nanoparticles by cells of the mononuclear phagocyte system (MPS) limits the development of long-circulating colloidal drug carriers. The complement system plays a major role in the opsonization and recognition processes of foreign materials. Since heparin is an inhibitor of complement activation, nanoparticles bearing heparin covalently bound to poly(methyl methacrylate) (PMMA) have been prepared and their interactions with complement evaluated. The particles retained the complement-inhibiting properties of soluble heparin. Nanoparticles bearing covalently bound dextran instead of heparin were weak activators of complement as compared with crosslinked dextran (Sephadex) or bare PMMA nanoparticles. In addition to the specific activity of bound heparin, the protective effect of both polysaccharides is hypothesized to be due to the presence of a dense brush-like layer on the surface of the particles. Such properties are expected to reduce the uptake by MPS in vivo.

Effect of PEO surface density on long-circulating PLA-PEO nanoparticles which are very low complement activators

The rapid uptake of injected nanoparticles by cells of the mononuclear phagocytes system (MPS) is a major obstacle when a long blood circulation time is needed. Whereas nanoparticles made from PLA and stabilized by surfactants (PLA-F68) are rapidly phagocytized, the rate of phagocytosis is strongly reduced in case of nanoparticles made from a diblock copolymer (PLA-PEO). Because of the role of the complement system in opsonization, this difference of phagocytosis was hypothesized to be related to this system. An important complement consumption was obtained in 5 min in the presence of PLA-F68 particles. In the presence of a higher surface area of PLA-PEO particles possessing a high PEO surface density, the consumption remained very low. When the average PEO surface density was decreased on such particles below a given threshold, a fast and strong complement consumption occurred again. These experimental data support the concept of steric repulsion towards proteins, by surfaces covered with terminally attached PEO chains and emphasize the prime importance of PEO surface density in such an effect. The major, but probably not exclusive, role of complement as an opsonin capable of inducing a fast phagocytosis by MPS should be taken into account concerning the in vitro evaluation of nanoparticles as candidates for a long blood circulation.

A new model for evaluation of biocompatibility: combined determination of neoepitopes in blood and on artificial surfaces demonstrates reduced complement activation by immobilization of heparin

An in vitro technique was developed for assessment of the biocompatibility of materials for use in clinical applications. Artificial materials were exposed to blood, and the resulting complement activation was quantified both in the plasma and on the material surface by enzyme immunoassays based on monoclonal antibodies specific for neoepitopes exposed in complement activation products. Several materials were evaluated, and the effect of surface modifications, including end-point immobilized heparin, was studied. The results revealed widely varying complement activation properties of the different materials and confirmed that heparin markedly improves biocompatibility. The present method is superior to analysis limited to either the fluid phase or solid phase since certain materials adsorb activation products (exemplified by Tecoflex) whereas others do not although activation was evident from fluid-phase assay (silicone). Furthermore, direct determination of activation-specific neoepitopes on the surface represents an improvement compared with previously described methods for detection of adsorbed components.

Permeability and blood compatibility properties of chitosan-poly(ethylene oxide) blend membranes for haemodialysis

Chitosan-poly(ethylene oxide) (PEO) blend membranes, using different molecular weights of PEO, were developed for improved permeability and blood compatibility. The equilibrium hydration increased from 44.7% for chitosan to 62.5% for chitosan-PEO blend membranes when the molecular weight of PEO was 10,000 (10K) or higher. An increase in the hydration of PEO blend membranes was due to intermolecular association between PEO and chitosan chains. Scanning electron microscopy showed that chitosan-PEO membranes were highly porous with size ranging from 50 to 80 nm in diameter observed in membranes made with PEO10K. Electron spectroscopy for chemical analysis suggested an increase in PEO on the membrane surface with increasing molecular weight in the blend. The permeability coefficient of urea increased from 5.47 x 10(-5) cm2 min-1 in chitosan to 9.86 x 10(-5) cm2 min-1 in chitosan-PEO10K membranes. The increase in permeability coefficient could be either due to an increase in the hydrophilicity or the high porosity of the membranes. Although chitosan-PEO membranes did not prevent serum complement activation, platelet adhesion and activation were significantly reduced. Chitosan-PEO blend membranes, therefore, appear to be beneficial in improving the permeability of toxic metabolites and in reducing the thrombogenicity for haemodialysis.

Complement activation by liposome-encapsulated hemoglobin in vitro: the role of endotoxin contamination

Incubation of liposome-encapsulated Hb (LEH) with rat serum at 37 degrees C led to accelerated decay of serum hemolytic complement (C) activity (CH50/ml). Empty liposomes (L) caused less decrease of CH50/ml, whereas free Hb had no effect on C activity. The LEH- and L-induced increases in C consumption were unlikely a consequence of endotoxin (LPS) contamination, as spiking of rat serum with LPS caused reduction in C only at levels significantly higher than those detectable in LEH or L. LPS-induced C consumption was not potentiated by free hemoglobin.