Optimizing the tensile properties of polyvinyl alcohol hydrogel for the construction of a bioprosthetic heart valve stent

The design and characterisation of sinusoidal toolpaths using sub-zero bioprinting of polyvinyl alcohol

Sub-zero (°C) additive manufacturing (AM) systems present a promising solution for the fabrication of hydrogel structures with complex external geometry or a heterogeneous internal structure. Polyvinyl alcohol cryogels (PVA-C) are promising tissue-mimicking materials, with mechanical properties that can be designed to satisfy a wide variety of soft tissues. However, the design of more complex mechanical properties into additively manufactured PVA-C samples, which can be enabled using the toolpath, is a largely unstudied area. This research project will investigate the effect of toolpath variation on the elastic and viscoelastic properties of PVA-C samples fabricated using a sinusoidal toolpath. Samples were fabricated using parametric variation of a sinusoidal toolpath, whilst retaining the same overall cross-sectional area, using a sub-zero AM system. To mechanically characterise the samples, they were tested under tension in uniaxial ramp tests, and through dynamic mechanical analysis (DMA). The elastic and viscoelastic moduli of the samples are presented. No correlations between the parametric variation of the design and the Young's modulus were observed. Analysis of the data shows high intra-sample repeatability, demonstrated robust testing protocols, and variable inter-sample repeatability, indicating differences in the printability and consistency of fabrication between sample sets. DMA of the wavelength samples, show a frequency-dependent loss moduli. The storage modulus demonstrates frequency independence, and a large increase in magnitude as the sample increases to 3 wavelengths.

Study of chondrogenesis of umbilical cord mesenchymal stem cells in curdlan- poly(vinyl alcohol) composite hydrogels and its mechanical properties of freezing-thawing treatments

The curdlan gel is a natural material produced by bacteria. It utilizes chemical cross-linking reactions to form a 3D porous composite hydrogel, increasing its porosity and water content, and improving its mechanical properties. It can be used in tissue repair and regenerative medicine. Curdlan-Poly(vinyl alcohol) (PVA) composite hydrogel can rapidly swell within 1 min due to its porous structure. Compression tests confirmed that it still maintains its original mechanical strength, even after five repeated freeze-thaw (FT) processes, making it suitable for long-term cryopreservation. The purpose of this study is to transplant umbilical cord mesenchymal stem cells (UC-MSCs) on Curdlan-PVA composite hydrogel and observe the chondrocytes on the material. The results of using 4',6-diamidino-2-phenylindole (DAPI), hematoxylin and eosin (H&E), calcein-acetoxymethyl ester (calcein AM), and Collagen type II-Fluorescein isothiocyanate (FITC) staining, confirmed that UC-MSCs can attach and differentiate into chondrocytes on 3D Curdlan-PVA composite hydrogel.

Preparation and Characterization of Self-Healing PVA-H2SO4 Hydrogel for Flexible Energy Storage

In the past decade, hydrogels have attracted growing interest for emerging applications in flexible electronic devices, human-machine interactions, energy supply, or energy storage. Developing a multifunctional gel architecture with superior ionic conductivity and good mechanical flexibility is a bottleneck to overcome. Herein, poly(vinyl alcohol)/sulfuric acid (PVA-H2SO4) hydrogels were prepared via a freeze-thaw method. With the aim of tuning the formulation in view of a possible application in energy storage, the effects of different combinations in terms of the molecular weight (MW) of PVA and PVA-H2SO4 weight ratio were investigated. Moreover, exploiting the self-healing properties of these hydrogels and the easy possibility of functionalizing them, i.e., introducing a conducting polymer such as poly(2-acrylamido-2-methyl-1-propane) sulfonic acid doped polyaniline (PANI_PAMPSA), a sandwiched all-in-one double-layer hydrogel (electrode/electrolyte configuration) was prepared (PVA-H2SO4-PANI_PAMPSA/PVA-H2SO4). Results showed that the water content is independent of the PVA amount and MW; the polymer concentration has a significant effect on the formation of crystalline domains and therefore on swelling degree, whereas the cross-linking degree depends on the MW. The PVA MW has the maximum effect on the swelling percentage normalized with respect to the polymer fraction and the tensile properties of the hydrogel. The assembled all-in-one electrode/electrolyte shows promising ionic conductivity (439.7 mS cm-1) and specific capacitance performance (0.297 mF cm-2 at a current density of 0.025 mA cm-2), as well as excellent flexibility and considerable self-healing properties. These results will promote the development of self-healing symmetrical supercapacitors for storage devices in wearable electronics.

Hydrogel Loaded with Components for Therapeutic Applications in Hypertrophic Scars and Keloids

Hypertrophic scars and keloids are common fibroproliferative diseases following injury. Patients with pathologic scars suffer from impaired quality of life and psychological health due to appearance disfiguration, itch, pain, and movement disorders. Recently, the advancement of hydrogels in biomedical fields has brought a variety of novel materials, methods and therapeutic targets for treating hypertrophic scars and keloids, which exhibit broad prospects. This review has summarized current research on hydrogels and loaded components used in preventing and treating hypertrophic scars and keloids. These hydrogels attenuate keloid and hypertrophic scar formation and progression by loading organic chemicals, drugs, or bioactive molecules (such as growth factors, genes, proteins/peptides, and stem cells/exosomes). Among them, smart hydrogels (a very promising method for loading many types of bioactive components) are currently favoured by researchers. In addition, combining hydrogels and current therapy (such as laser or radiation therapy, etc.) could improve the treatment of hypertrophic scars and keloids. Then, the difficulties and limitations of the current research and possible suggestions for improvement are listed. Moreover, we also propose novel strategies for facilitating the construction of target multifunctional hydrogels in the future.

Progress on a Novel, 3D-Printable Heart Valve Prosthesis

(1) Background: Polymeric heart valves are prostheses constructed out of flexible, synthetic materials to combine the advantageous hemodynamics of biological valves with the longevity of mechanical valves. This idea from the early days of heart valve prosthetics has experienced a renaissance in recent years due to advances in polymer science. Here, we present progress on a novel, 3D-printable aortic valve prosthesis, the TIPI valve, removing the foldable metal leaflet restrictor structure in its center. Our aim is to create a competitive alternative to current valve prostheses made from flexible polymers. (2) Methods: Three-dimensional (3D) prototypes were designed and subsequently printed in silicone. Hemodynamic performance was measured with an HKP 2.0 hemodynamic testing device using an aortic valve bioprosthesis (BP), a mechanical prosthesis (MP), and the previously published prototype (TIPI 2.2) as benchmarks. (3) Results: The latest prototype (TIPI 3.4) showed improved performance in terms of regurgitation fraction (TIPI 3.4: 15.2 ± 3.7%, TIPI 2.2: 36.6 ± 5.0%, BP: 8.8 ± 0.3%, MP: 13.2 ± 0.7%), systolic pressure gradient (TIPI 3.4: 11.0 ± 2.7 mmHg, TIPI 2.2: 12.8 ± 2.2 mmHg, BP: 8.2 ± 0.9 mmHg, MP: 10.5 ± 0.6 mmHg), and effective orifice area (EOA, TIPI 3.4: 1.39 cm2, TIPI 2.2: 1.28 cm2, BP: 1.58 cm2, MP: 1.38 cm2), which was equivalent to currently used aortic valve prostheses. (4) Conclusions: Removal of the central restrictor structure alleviated previous concerns about its potential thrombogenicity and significantly increased the area of unobstructed opening. The prototypes showed unidirectional leaflet movement and very promising performance characteristics within our testing setup. The resulting simplicity of the shape compared to other approaches for polymeric heart valves could be suitable not only for 3D printing, but also for fast and easy mass production using molds and modern, highly biocompatible polymers.

Laminar Biomaterial Composite of PVA Cryogel with Amnion as Potential Wound Dressing

Gel dressings, composed of polymers both natural and synthetic, are successfully used in the treatment of burn wounds. They protect the burn wound site against adverse external factors, ensure an adequate level of tissue hydration, have soothing and pain-relieving properties, and also support the healing process and reduce the risk of pathological scars. Another promising material that can be used in the wound-healing process is an amnion membrane. Due to its valuable properties such as protecting the body against bacterial infections and permeability to nutrition, it has found usage in different brands of medicine. In this work, we have combined the beneficial properties of hydrogels and amnion in order to make the laminar dressing that may serve for wound healing. For that purpose, the physically crosslinked cryogel of poly(vinyl alcohol) (PVA) was covered with an amnion membrane. Subsequently, gamma irradiation was performed, leading to the simultaneous internal crosslinking of the hydrogel, its permanent bonding with the amnion, and dressing sterilization. The physicochemical properties of the dressing including gel fraction, swelling, and hardness were studied. Biological tests such as the MTT assay, antimicrobial activity, and histopathological examination confirmed that the obtained material constituted a promising candidate for further, more in-depth studies aiming at wound dressing application.

Polyvinyl Alcohol-Chitosan Scaffold for Tissue Engineering and Regenerative Medicine Application: A Review

Tissue engineering and regenerative medicine (TERM) holds great promise for addressing the growing need for innovative therapies to treat disease conditions. To achieve this, TERM relies on various strategies and techniques. The most prominent strategy is the development of a scaffold. Polyvinyl alcohol-chitosan (PVA-CS) scaffold emerged as a promising material in this field due to its biocompatibility, versatility, and ability to support cell growth and tissue regeneration. Preclinical studies showed that the PVA-CS scaffold can be fabricated and tailored to fit the specific needs of different tissues and organs. Additionally, PVA-CS can be combined with other materials and technologies to enhance its regenerative capabilities. Furthermore, PVA-CS represents a promising therapeutic solution for developing new and innovative TERM therapies. Therefore, in this review, we summarized the potential role and functions of PVA-CS in TERM applications.

Polymeric Heart Valves Will Displace Mechanical and Tissue Heart Valves: A New Era for the Medical Devices

The development of a novel artificial heart valve with outstanding durability and safety has remained a challenge since the first mechanical heart valve entered the market 65 years ago. Recent progress in high-molecular compounds opened new horizons in overcoming major drawbacks of mechanical and tissue heart valves (dysfunction and failure, tissue degradation, calcification, high immunogenic potential, and high risk of thrombosis), providing new insights into the development of an ideal artificial heart valve. Polymeric heart valves can best mimic the tissue-level mechanical behavior of the native valves. This review summarizes the evolution of polymeric heart valves and the state-of-the-art approaches to their development, fabrication, and manufacturing. The review discusses the biocompatibility and durability testing of previously investigated polymeric materials and presents the most recent developments, including the first human clinical trials of LifePolymer. New promising functional polymers, nanocomposite biomaterials, and valve designs are discussed in terms of their potential application in the development of an ideal polymeric heart valve. The superiority and inferiority of nanocomposite and hybrid materials to non-modified polymers are reported. The review proposes several concepts potentially suitable to address the above-mentioned challenges arising in the R&D of polymeric heart valves from the properties, structure, and surface of polymeric materials. Additive manufacturing, nanotechnology, anisotropy control, machine learning, and advanced modeling tools have given the green light to set new directions for polymeric heart valves.

Unidirectional Nanopore Dehydration Induces an Anisotropic Polyvinyl Alcohol Hydrogel Membrane with Enhanced Mechanical Properties

As a biocompatible, degradable polymer material, polyvinyl alcohol (PVA) can have a wide range of applications in the biomedical field. PVA aqueous solutions at room temperature can be cast into very thin films with poor mechanical strength via water evaporation. Here, we describe a novel dehydration method, unidirectional nanopore dehydration (UND). The UND method was used to directly dehydrate a PVA aqueous solution to form a water-stable, anisotropic, and mechanically robust PVA hydrogel membrane (PVAHM), whose tensile strength, elongation at break, and swelling ratio reached values of up to ~2.95 MPa, ~350%, and ~350%, respectively. The film itself exhibited an oriented arrangement of porous network structures with an average pore size of ~1.0 μm. At 70 °C, the PVAHMs formed were even more mechanically robust, with a tensile strength and elongation at break of 10.5 MPa and 891%, almost 3.5 times and 2 times greater than the PVAHM prepared at 25 °C, respectively. The processing temperature affects the velocity at which the water molecules flow unidirectionally through the nanopores, and could, thus, alter the overall transformation of the PVA chains into a physically crosslinked 3D network. Therefore, the temperature setting during UND can control the mechanical properties of the hydrogel membrane to meet the requirements of various biomaterial applications. These results show that the UND can induce the ordered rearrangement of PVA molecular chains, forming a PVAHM with superior mechanical properties and exhibiting a greater number of stronger hydrogen bonds. Therefore, the novel dehydration mode not only induces the formation of a mechanically robust and anisotropic PVA hydrogel membrane with a porous network structure and an average pore size of ~1.0 μm, but also greatly enhances the mechanical properties by increasing the temperature. It may be applied for the processing of water-soluble polymers, including proteins, as novel functional materials.

Application of Ag@SiO2 nanoparticles within PVA to reduce growth of E. coli and S. aureus in beef patties

To overcome defects of polyvinyl alcohol (PVA) and expand its applications in food preservation, PVA/Ag@SiO₂ nanocomposite films were prepared using the solution intercalation film-casting method. Transmission electron microscopy, X-ray diffraction, and UV-visible absorption spectra were applied to confirm the synthesis of the nanoparticles (NPs). Effects of Ag@SiO₂ NPs on physicochemical characteristics of films like viscosity, swelling ratio, tensile strength, elongation at break, as well as antibacterial activity were also evaluated. Results indicate that Ag@SiO₂ NPs could be synthesized successfully, and the increasing concentration of Ag@SiO₂ NPs led to the decrease in viscosity and the swelling ratio of the PVA/Ag@SiO₂ NPs nanocomposite films. PVA/Ag@SiO₂ nanocomposite films exhibited increased tensile strength and strong antibacterial activity against Escherichia coli and Staphylococcus aureus. The films had higher antibacterial activity toward E. coli compared with S. aureus. Beef patties were applied to verify the practicality of PVA/Ag@SiO₂ films. PVA/Ag@SiO₂ NPs nanocomposite films act as an active food packaging system showing great potential in retaining food safety and prolonging the shelf-life of packaged foods. PRACTICAL APPLICATION: During the storage of fresh meat, the microbial count on the meat surface increased with increasing storage time; meat proteins could be broken down by microorganisms, causing the tissue structure to be destroyed, leading to loose muscle fibers and loss of nutrient-containing juices. In this paper, by improving the PVA film, a new antibacterial membrane was prepared, which can be used for fresh meat sold in supermarkets, as a lining at the bottom of the meat or directly covering the meat. The method can significantly decrease the number of microorganisms and extend the shelf-life of fresh meat.

Hydrogels: Properties and Applications in Biomedicine

Hydrogels are crosslinked polymer chains with three-dimensional (3D) network structures, which can absorb relatively large amounts of fluid. Because of the high water content, soft structure, and porosity of hydrogels, they closely resemble living tissues. Research in recent years shows that hydrogels have been applied in various fields, such as agriculture, biomaterials, the food industry, drug delivery, tissue engineering, and regenerative medicine. Along with the underlying technology improvements of hydrogel development, hydrogels can be expected to be applied in more fields. Although not all hydrogels have good biodegradability and biocompatibility, such as synthetic hydrogels (polyvinyl alcohol, polyacrylamide, polyethylene glycol hydrogels, etc.), their biodegradability and biocompatibility can be adjusted by modification of their functional group or incorporation of natural polymers. Hence, scientists are still interested in the biomedical applications of hydrogels due to their creative adjustability for different uses. In this review, we first introduce the basic information of hydrogels, such as structure, classification, and synthesis. Then, we further describe the recent applications of hydrogels in 3D cell cultures, drug delivery, wound dressing, and tissue engineering.

Criteria for the design of tissue-mimicking phantoms for the standardization of biophotonic instrumentation

A lack of accepted standards and standardized phantoms suitable for the technical validation of biophotonic instrumentation hinders the reliability and reproducibility of its experimental outputs. In this Perspective, we discuss general criteria for the design of tissue-mimicking biophotonic phantoms, and use these criteria and state-of-the-art developments to critically review the literature on phantom materials and on the fabrication of phantoms. By focusing on representative examples of standardization in diffuse optical imaging and spectroscopy, fluorescence-guided surgery and photoacoustic imaging, we identify unmet needs in the development of phantoms and a set of criteria (leveraging characterization, collaboration, communication and commitment) for the standardization of biophotonic instrumentation.

Hydrogels as Corneal Stroma Substitutes for In Vitro Evaluation of Drug Ocular Permeation

Hydrogels are complex hydrophilic structures, consisting of crosslinked homopolymers or copolymers insoluble in water. Due to their controllable bio-physicochemical properties mimicking the morphology of the native extracellular matrix, they are a key part of a lot of research fields, including medicine, pharmaceutics, and tissue engineering. This paper was focused on the preparation and characterization of hydrogels from different blends of polyvinyl alcohol (PVA) with microcrystalline cellulose (MCC) and gelatin (GEL) at various ratios, and from gelatin and chitosan alone to understand their feasibility of utilizing as corneal stroma substitutes in permeability tests for drug candidate molecules in early stages of their development. The characterization was carried out by differential scanning calorimetry, electron microscopy (SEM), water content, mass loss, water permeability, wettability, and tensile stress–strain tests. After the physicochemical characterization, PVA/MCC blend and chitosan proved to be the most promising constructs, showing negligible mass loss after immersion in aqueous medium for two weeks and low hydrodynamic permeability. They were then employed in drug molecules permeation studies and these data were compared to that obtained through excised tissues. The results obtained showed that PVA/MCC hydrogels have similar mechanical and permeability properties to corneal stroma.

The dynamic viscoelastic characterisation and magnetic resonance imaging of poly(vinyl alcohol) cryogel: Identifying new attributes and opportunities

Poly(vinyl alcohol) (PVA) cryogel is a biocompatible, synthetic hydrogel, compatible with magnetic resonance (MR) imaging. It is widely used as a biomaterial in tissue scaffolds and mimics to test various diagnostic techniques. The aim of this study is to characterise the effect of varying PVA concentration, molecular weight (MW) and manufacturing protocol on the viscoelastic mechanical properties and MR T₂ relaxation time. Further to this MR imaging (MRI) was investigated as a method to quantify material homogeneity. Cylindrical samples of PVA, of varying MW, concentration and number of freeze thaw cycles (FTCs), were manufactured. Dynamic mechanical analysis was performed to evaluate the storage and loss moduli between frequencies of 0.5 and 10 Hz. MR T₂ relaxation maps were imaged using a 7 T MRI instrument. Storage and loss moduli were shown to increase with MW, concentration, or the number of FTCs; with storage modulus ranging from 55 kPa to 912 kPa and loss modulus ranging from 6 kPa to 103 kPa. MR T₂ relaxation time was shown to increase linearly with PVA concentration. The qualitative and quantitative heterogeneity of the PVA sample were identified through MR T₂ relaxation time maps. Excitingly, PVA demonstrated a composition-dependent casual correlation between the viscoelastic mechanical properties and MR T₂ relaxation time. In conclusion, this research thoroughly characterised the viscoelastic mechanical properties of PVA to support its extensive use as a biomaterial, and demonstrated the use of MRI to non-invasively identify sample heterogeneity and to predict the composition-dependent viscoelastic properties of PVA.

The orthotropic viscoelastic characterisation of sub-zero 3D-printed poly(vinyl alcohol) cryogel

Abstract

Poly(vinyl alcohol) cryogel (PVA) is a versatile biomaterial used to replicate the biomechanics of tissues. Additive manufacture (AM) at sub-zero (°C) temperatures enables the manufacture of PVA with complex geometry; however, the effect of processing parameters on the mechanical properties of PVA has not been evaluated. The aim of this study is to understand the impact of print nozzle diameter and orientation on the viscoelastic mechanical properties of PVA. Samples of sub-zero AM PVA, with different filament thicknesses, were tested under tension relative to the print direction, to calculate the storage and loss moduli. As the nozzle size was decreased, AM PVA exhibited more pronounced orthotropic properties; the smallest size showed a 33% decrease in storage moduli when tested perpendicular to the print direction, as opposed to parallel. This study has demonstrated the ability of sub-zero AM to tailor the orthotropic properties of PVA.

Graphic abstract

Transcatheter Heart Valves: A Biomaterials Perspective

Heart valve disease is prevalent throughout the world, and the number of heart valve replacements is expected to increase rapidly in the coming years. Transcatheter heart valve replacement (THVR) provides a safe and minimally invasive means for heart valve replacement in high-risk patients. The latest clinical data demonstrates that THVR is a practical solution for low-risk patients. Despite these promising results, there is no long-term (>20 years) durability data on transcatheter heart valves (THVs), raising concerns about material degeneration and long-term performance. This review presents a detailed account of the materials development for THVRs. It provides a brief overview of THVR, the native valve properties, the criteria for an ideal THV, and how these devices are tested. A comprehensive review of materials and their applications in THVR, including how these materials are fabricated, prepared, and assembled into THVs is presented, followed by a discussion of current and future THVR biomaterial trends. The field of THVR is proliferating, and this review serves as a guide for understanding the development of THVs from a materials science and engineering perspective.

3D printed ascending aortic simulators with physiological fidelity for surgical simulation

Introduction

Three-dimensional (3D) printed multimaterial ascending aortic simulators were created to evaluate the ability of polyjet technology to replicate the distensibility of human aortic tissue when perfused at physiological pressures.

Methods

Simulators were developed by computer-aided design and 3D printed with a Connex3 Objet500 printer. Two geometries were compared (straight tube and idealised aortic aneurysm) with two different material variants (TangoPlus pure elastic and TangoPlus with VeroWhite embedded fibres). Under physiological pressure, β Stiffness Index was calculated comparing stiffness between our simulators and human ascending aortas. The simulators’ material properties were verified by tensile testing to measure the stiffness and energy loss of the printed geometries and composition.

Results

The simulators’ geometry had no effect on measured β Stiffness Index (p>0.05); however, β Stiffness Index increased significantly in both geometries with the addition of embedded fibres (p<0.001). The simulators with rigid embedded fibres were significantly stiffer than average patient values (41.8±17.0, p<0.001); however, exhibited values that overlapped with the top quartile range of human tissue data suggesting embedding fibres can help replicate pathological human aortic tissue. Biaxial tensile testing showed that fiber-embedded models had significantly higher stiffness and energy loss as compared with models with only elastic material for both tubular and aneurysmal geometries (stiffness: p<0.001; energy loss: p<0.001). The geometry of the aortic simulator did not statistically affect the tensile tested stiffness or energy loss (stiffness: p=0.221; energy loss: p=0.713).

Conclusion

We developed dynamic ultrasound-compatible aortic simulators capable of reproducing distensibility of real aortas under physiological pressures. Using 3D printed composites, we are able to tune the stiffness of our simulators which allows us to better represent the stiffness variation seen in human tissue. These models are a step towards achieving better simulator fidelity and have the potential to be effective tools for surgical training.

Design of heart phantoms for ultrasound imaging of ventricular septal defects

PURPOSE

Ventricular septal defects (VSDs) are common congenital heart malformations. Echocardiography used during VSD hybrid cardiac procedures requires extensive training for image acquisition and interpretation. Cardiac surgery simulators with heart phantoms have shown usefulness for such training, but they are limited in visualization and characterization of complex VSD. This study explores a new method to build patient-specific heart phantoms with VSD, with proper tissue echogenicity for ultrasound imaging.

METHODS

Heart phantoms were designed from preoperative imaging of three patients with complex VSDs. Each whole heart phantom, including atrial and ventricular septums, was obtained by manual segmentation and by surface reconstruction, then by molding and by casting in different materials. Heart phantoms in silicone and polyvinyl alcohol cryogel (PVA-C) were considered, and they were reconstructed in 3-D using 2-D freehand ultrasound imaging.

RESULTS

An electromagnetic measurement system was used to measure the mean VSD diameters from the heart phantoms. Errors were evaluated below 1.0 mm for mean VSD diameters between 6.2 and 7.5 mm.

CONCLUSION

Patient-specific heart phantoms promise for representing complex heart malformations such as VSDs. PVA-C showed better tissue echogenicity than silicone for VSDs visualization and characterization.

Study on Structure, Thermal Behavior and Viscoelastic Properties of Nanodiamond-Reinforced Poly (vinyl alcohol) Nanocomposites

In this work, advanced polymer nanocomposites comprising of polyvinyl alcohol (PVA) and nanodiamonds (NDs) were developed using a single-step solution-casting method. The properties of the prepared PVA/NDs nanocomposites were investigated using Raman spectroscopy, small- and wide-angle X-ray scattering (SAXS/WAXS), scanning electron microscopy (SEM), transmission electron microscopy (TEM), thermogravimetric analysis (TGA), differential scanning calorimetry (DSC), and dynamic mechanical analysis (DMA). It was revealed that the tensile strength improved dramatically with increasing ND content in the PVA matrix, suggesting a strong interaction between the NDs and the PVA. SEM, TEM, and SAXS showed that NDs were present in the form of agglomerates with an average size of ~60 nm with primary particles of diameter ~5 nm. These results showed that NDs could act as a good nanofiller for PVA in terms of improving its stability and mechanical properties.

A novel assessment of microstructural and mechanical behaviour of bilayer silica-reinforced nanocomposite hydrogels as a candidate for artificial cartilage

The complex structure of healthy articular cartilage facilitates the joint withstanding the imposed pressures and retaining interstitial fluid to lessen stresses on its soft tissue, while easing the locomotion and minimising friction between cartilage mates. Avascular nature of this tissue results in unrecoverable damaged lesions and severe pain over time. Polymeric hydrogels are promising candidate materials for the replacement of the damaged cartilage. Hence, a tough bilayer nanocomposite acrylamide-acrylic acid hydrogel reinforced with silica nanoparticles (SNPs) was designed and synthesised. The mechanical characterisations showed a significant increase in compressive strength up to 1.4 MPa and doubled elastic modulus (240 kPa) by utilising only 0.6 wt% SNPs compared to the non-reinforced hydrogel. The optimum amounts of monomers and SNPs resulted in the compression of samples up to 85% strain without failure. Viscoelastic responses improved as the stress relaxation lessened to half in all nanocomposite hydrogels. Diffusion rate theory was applied, and the results showed to what extent elastic modulus results in an improvement in stress relaxation. The proposed hydrogel formulation exhibited the poroelastic relaxation occurred before viscoelastic relaxation at the time elapses under stress relaxation tests. SEM images showed uniform funnel-like porosity with 570 μm thick lubricious layer, which is an important feature to retain interstitial fluid. Energy-dispersive X-ray spectroscopy was conducted to characterise the elemental composition within the polymeric macrostructure.

Biomaterials in Valvular Heart Diseases

Valvular heart disease (VHD) occurs as the result of valvular malfunction, which can greatly reduce patient's quality of life and if left untreated may lead to death. Different treatment regiments are available for management of this defect, which can be helpful in reducing the symptoms. The global commitment to reduce VHD-related mortality rates has enhanced the need for new therapeutic approaches. During the past decade, development of innovative pharmacological and surgical approaches have dramatically improved the quality of life for VHD patients, yet the search for low cost, more effective, and less invasive approaches is ongoing. The gold standard approach for VHD management is to replace or repair the injured valvular tissue with natural or synthetic biomaterials. Application of these biomaterials for cardiac valve regeneration and repair holds a great promise for treatment of this type of heart disease. The focus of the present review is the current use of different types of biomaterials in treatment of valvular heart diseases.

Bimodal microwave and ultrasound phantoms for non-invasive clinical imaging

A precise and thorough methodology is presented for the design and fabrication of bimodal phantoms to be used in medical microwave and ultrasound applications. Dielectric and acoustic properties of human soft tissues were simultaneously mimicked. The phantoms were fabricated using polyvinyl alcohol cryogel (PVA-C) as gelling agent at a 10% concentration. Sucrose was employed to control the dielectric properties in the microwave spectrum, whereas cellulose was used as acoustic scatterer for ultrasound. For the dielectric properties at microwaves, a mathematical model was extracted to calculate the complex permittivity of the desired mimicked tissues in the frequency range from 500 MHz to 20 GHz. This model, dependent on frequency and sucrose concentration, was in good agreement with the reference Cole-Cole model. Regarding the acoustic properties, the speed of sound and attenuation coefficient were employed for validation. In both cases, the experimental data were consistent with the corresponding theoretical values for soft tissues. The characterization of these PVA-C phantoms demonstrated a significant performance for simultaneous microwave and ultrasound operation. In conclusion, PVA-C has been validated as gelling agent for the fabrication of complex multimodal phantoms that mimic soft tissues providing a unique tool to be used in a range of clinical applications.

Cartilage tissue engineering using injectable functionalized Demineralized Bone Matrix scaffold with glucosamine in PVA carrier, cultured in microbioreactor prior to study in rabbit model

Using 3D model of injectable scaffolds for cartilage tissue engineering is one of the challenges that should be addressed to avoid invasive surgery for treatment. For this purpose, chondrocytes on Demineralized Bone Matrix (DBM) scaffolds functionalized with glucosamine in 20% polyvinyl alcohol (PVA) as a carrier was applied to the micro-bioreactor in-vitro, then the study was continued on in-vivo stage. Scaffold biocompatibility tests were performed and the mechanical and physicochemical properties were studied showing the fact that DBM was functionalized by Glucosamine, scaffold degradation rate was 53% after 720 h and swelling ratio was 2.5 times after 16 h, injectable scaffold demonstrated better mechanical characteristics (P < 0.05) than other concentrations of PVA. Consequently, in-vitro tests, including live-dead imaging resulting in 99% viability after 14 days (P < 0.001), DAPI staining and scanning electron microscope imaging were performed to determine the number and viability of the cells on the scaffold, showing a cells proliferation property of this group compared with the control after 14 days (P < 0.0001), then relative gene expression was evaluated and protein expression was assessed. The overall chondrogenic gene expression improved (P < 0.05) compared to the control (2D culture). Subsequently, the scaffold were loaded with chondrocytes and injected into the cartilage lesion part After 24 weeks of surgery, MRI and immunocytochemistry were performed. Then all outputs proved that the scaffold plus cell group had a significantly higher topological score (P < 0.0001) than other groups compared to normal cartilage. Finally, studies have shown that transplantation of chondrocytes in DBM, polyvinyl alcohol and glucosamine scaffold through one surgical stage improves cartilage lesion and it can be considered as a breakthrough in tissue engineering.

Tough pNAGA hydrogel hybridized porcine pericardium for the pre-mounted TAVI valve with improved anti-tearing properties and hemocompatibility

The rate of adoption of transcatheter aortic valve implantation (TAVI) is increasing rapidly, due to the procedure being less invasive. However, TAVI still faces problems relating to durability, the potential incidence of thrombosis, and the inconvenience of storage in glutaraldehyde (Glut) solution. In this work, a tough hydrogel poly(N-acryloyl glycinamide) (pNAGA) is hybridized with Glut-crosslinked porcine pericardium (Glut-PP) via in situ polymerization and glycerolization, so as to obtain dry leafet material for the fabrication of a pre-mounted bioprosthetic heart valve (BHV). The tensile strength, anti-shearing, and anti-tearing properties of the valve are significantly improved by the process of hydrogel hybridization. Following a period of dry-state compression as a simulation for the crimping process of pre-mounted TAV, pNAGA/Glut-PP showed full recovery without structural damage when fully rehydrated. The introduction of pNAGA also improved the blood compatibility of the tissue, with less clot formation and fewer blood cells adhering to the surface of pNAGA/Glut-PP than is found with Glut-PP. Subcutaneous implantation in rats showed that pNAGA/Glut-PP induced a decreased inflammatory response compared with Glut-PP. These results indicate that the strategy for hybridization with hydrogel could be a potential method for preparing pre-mounted TAVs with an improved performance.

Fabrication of polyvinyl alcohol hydrogels with excellent shape memory and ultraviolet-shielding behavior via the introduction of tea polyphenols

Shape-memory hydrogels are expected to be used not only in an ordinary environment, but also in some special environments, such as under ultraviolet (UV) irradiation. Developing novel shape-memory polyvinyl alcohol (PVA)/tea polyphenol (TP) hydrogels with UV shielding performance is realistically important in application fields. Herein, we designed functional PVA/TP hydrogels with excellent UV-shielding ability and improved the shape memory on hot water stimuli. This study shows that the abundant hydrogen bonds between PVA and TP are the source of shape memory. The PVA hydrogels with 8 wt% TP loading could approximately recover their original shape after deformation when immersed in water at 50 °C for 30 s. Meanwhile, the hydrogels also had excellent UV shielding capacity. After ageing under UV for 16 days, the observed shape of the hydrogel with 8 wt% TP loading retained 74.7% of the original, and the hydrogel could effectively protect the skin of mice from damage under 10 mW cm-2 UV irradiation. With the understanding of the UV-shielding behavior of hydrogels, this study has been able to generate biomedical materials for human skin protection, specifically skin covering the joint areas, where shape memory of the applied materials is essential.

Experimental model standardizing polyvinyl alcohol hydrogel to simulate endoscopic ultrasound and endoscopic ultrasound-elastography

BACKGROUND

Endoscopic ultrasound (EUS) and endoscopic ultrasound elastography (EUS-E) simulation lessens the learning curve; however, models lack realism, diminishing competitiveness.

AIM

To standardize the mechanical properties of polyvinyl alcohol (PVA) hydrogel for simulating organs and digestive lesions.

METHODS

PVA hydrogel (Sigma Aldrich, degree of hydrolysis 99%) for simulating EUS/EUS-E lesions was investigated in Unidad de Investigación y Desarrollo Tecnológico at Hospital General de México “Dr. Eduardo Liceaga”, Mexico City. We evaluated physical, contrast, elasticity and deformation coefficient characteristics in lesions, applying Kappa’s concordance and satisfaction questionnaire (Likert 4-points).

RESULTS

PVA hydrogel showed stable mechanical properties. Density depended on molecular weight (MW) and concentration (C). PVA bblocks with the greatest density showed lowest tensile strength (r = -0.8, P = 0.01). Lesions were EUS-graphically visible. Homogeneous and heterogeneous examples were created from PVA blocks or PVA phantoms, exceeding (MW₂ = 146000-186000, C₉ = 15% and C₁₀ = 20%) with a density under (MW₁ = 85000-124000, C₁ = 7% and C₂ = 9%). We calculated elasticity and deformation parameters of solid (blue) areas, contrasting with the norm (Kappa = 0.8; high degree of satisfaction).

CONCLUSION

PVA hydrogels were appropriate for simulating organs and digestive lesions using EUS/EUS-E, facilitating practice and reducing risk. Repetition amplified skills, while reducing the learning curve.

Mechanical characterization of PVA hydrogels' rate-dependent response using multi-axial loading

The time-dependent properties of rubber-like synthesized and biological materials are crucial for their applications. Currently, this behavior is mainly measured using axial tensile test, compression test, or indentation. Limited studies performed on using multi-axial loading measurements of time-dependent material behavior exist in the literature. Therefore, the aim of this study is to investigate the viscoelastic response of rubber-like materials under multi-axial loading using cavity expansion and relaxation tests. The tests were performed on PVA hydrogel specimens. Three hyperelasitc models and one term Prony series were used to characterize the viscoelastic response of the hydrogels. Finite element (FE) simulations were performed to verify the validity of the calibrated material coefficients by reproducing the experimental results. The excellent agreement between the experimental, analytical and numerical data proves the capability of the cavity expansion technique to measure the time-dependent behavior of viscoelastic materials.

Dynamic Left Atrioventricular Phantom Test Bed Emulating Mitral Valve Motion

Novel catheter-based medical procedures targeting heart valve structures are currently under development. These techniques entail installing a prosthetic implant on valves inside a beating heart. The development of these approaches requires a simple and effective validation test bed. Current early process testing methods rely on both static and dynamically pressurized excised porcine hearts. The variability between excised-tissue mechanical properties poses problems of reproducibility. In addition, these test beds do not emulate annulus motion, which affects the implant installation. A reproducible phantom of the left atrioventricular chambers was developed. The system consists of a hydraulic constant flow arrangement and a polyvinyl alcohol phantom heart with material properties that mimic passive myocardium mechanical properties and annulus motion. The system was then used to emulate blood flow through an actual heart. The building process starts by obtaining an accurate computer-aided design (CAD) model of a human heart, from which, a mold is produced using a novel rapid-freezing prototyping method and computer numerical control machining. The phantom is then cast-out of polyvinyl alcohol (PVA), a hydrogel, whose mechanical properties are set by subjecting the phantom to freeze and thaw cycles. Subsequently, blood flow is emulated at a constant volumetric rate at the atrial pressure observed in a healthy adult human heart at rest. The annulus motion is implemented by suturing the outside of the phantom to a one-degree-of-freedom cam-follower mechanism reproducing valve motion. Such test beds could play a significant role in future development of medical devices.

Investigation of Gel Properties of Novel Cryo-Clay-Silica Polymer Networks

Several methods to increase the mechanical and swelling properties of Poly(N-isopropylacrylamide) gels are known. In this study different methods were combined to systematically alter the gel properties. The combination of nanocomposite and cryo gels as well as silica post modification was used to modulate the gel strength. This new cryo-clay-silica gel based on N-isopropylacrylamide was investigated in respect to degree of swelling, kinetic of thermo responsive behavior and tensile strength. Here, the properties of new cryo-clay-silica gel were compared with properties of clay-, silica-clay and cryo-clay gels.

Anthropomorphic and biomechanical mockup for abdominal aortic aneurysm

Abdominal aortic aneurysm (AAA) is an asymptomatic condition due to the dilation of abdominal aorta along with progressive wall degeneration, where rupture of AAA is life-threatening. Failures of AAA endovascular repair (EVAR) reflect our inadequate knowledge about the complex interaction between the aortic wall and medical devices. In this regard, we are presenting a hydrogel-based anthropomorphic mockup (AMM) to better understand the biomechanical constraints during EVAR. By adjusting the cryogenic treatments, we tailored the hydrogel to mimic the mechanical behavior of human AAA wall, thrombus and abdominal fat. A specific molding sequence and a pressurizing system were designed to reproduce the geometrical and diseased characteristics of AAA. A mechanically, anatomically and pathologically realistic AMM for AAA was developed for the first time, EVAR experiments were then performed with and without the surrounding fat. Substantial displacements of the aortic centerlines and vessel expansion were observed in the case without surrounding fat, revealing an essential framework created by the surrounding fat to account for the interactions with medical devices. In conclusion, the importance to consider surrounding tissue for the global deformation of AAA during EVAR was highlighted. Furthermore, potential use of this AMM for medical training was also suggested.

Novel high-strength thromboresistant poly(vinyl alcohol)-based hydrogel for vascular access applications

Adherence of proteins, cells, and microorganisms to the surface of biomaterials used for vascular access contribute to device failure by thrombosis, occlusions, and infections. Current technologies for inhibiting these complications are limited to coatings and additives that are limited in duration of efficacy and often induce adverse side effects. In this work, we developed a novel composite hydrogel structure comprising of a porous poly(vinyl alcohol) (PVA) that is impregnated with poly(acrylic acid) (PAA) and heat treated to create a physically cross-linked high-strength hydrogel material. The swelling and mechanical properties can be controlled by the temperature and duration of heat treatment to increase the cross-link density of the matrix. The heat treated composite PVA/PAA hydrogel exhibits both the mechanical strength and durability of thermoplastic polyurethanes (TPUs) and the inherently non-thrombogenic surface functionality of PVA-based hydrogels without the use of chemical cross-linking agents. The composite hydrogels were found to maintain their mechanical integrity and surface functionality after accelerated aging in a simulated-use in vitro model for 162.5 days real-time equivalent. Relative to commercial catheter materials, the composite PVA/PAA hydrogel exhibited up to an average of 97% reduction in platelet adhesion when exposed to an in vitro blood loop model and a lower rate of tip occlusion due to thrombosis. This high-strength thromboresistant hydrogel could have a major impact as a novel biomaterial for use in vascular access applications to improve patient health.

Pullulan/Poly(Vinyl Alcohol) Composite Hydrogels for Adipose Tissue Engineering

Composite hydrogels based on pullulan (HP) and poly(vinyl alcohol) (PVA) were both prepared by simple chemical crosslinking with sodium trimethaphosphate (STMP) or by dual crosslinking (simultaneously chemical crosslinking with STMP and physical crosslinking by freeze-thaw technique). The resulting hydrogels and cryogels were designed for tissue engineering applications. PVA, with two different molecular weights (47,000 and 125,000 g/mol; PVA₄₇ and PVA₁₂₅, respectively), as well as different P/PVA weight ratios were tested. The physico-chemical characterization of the hydrogels was performed by FTIR spectroscopy and scanning electron microscopy (SEM). The swelling kinetics, dissolution behavior, and degradation profiles in simulated physiological conditions (phosphate buffer at pH 7.4) were investigated. Pullulan concentration and the crosslinking method had significant effects on the pore size, swelling ratio, and degradation profiles. Cryogels exhibit lower swelling capacities than the conventional hydrogels but have better stability against hydrolitic degradation. Biocompatibility of the hydrogels was also investigated by both MTT (3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide) and LDH (lactaten dehydrogenase) assay. The MTT and LDH assays proved that dual crosslinked HP/PVA₁₂₅ (75:25, w/w) scaffolds are more biocompatible and promote to a greater extent the adhesion and proliferation of L929 murine fibroblast cells than chemically crosslinked HP/PVA₄₇ (50/50, w/w) scaffolds. Moreover, the HP/PVA₁₂₅ cryogel had the best ability for the adipogenic differentiation of cells. The overall results demonstrated that the HP/PVA composite hydrogels or cryogels are suitable biomaterials for tissue engineering applications.

Chitosan-Graft-Poly(N-Isopropylacrylamide)/PVA Cryogels as Carriers for Mucosal Delivery of Voriconazole

The objective of this study was to prepare and characterize physically crosslinked gel formulations of chitosan (CS)-graft-poly(N-isopropyl acrylamide) (PNIPAAm) and polyvinyl alcohol (PVA) for smart delivery of an antifungal drug, Voriconazole, for mucosal applications. For this purpose, cryogels of CS-g-PNIPAAm/PVA and CS/PVA were tested by means of texture profile analysis and rheology to determine optimal matrix properties for topical application. The ratio of 75/25 v/v % CS-g-PNIPAAm/PVA was selected to be used for formulation since it gave low compressibility and hardness (1.2 and 0.6 N) as well as high adhesion properties and non-Newtonian flow behavior. The cryogels and formulations were further characterized by means of FTIR spectroscopy, swelling behavior, texture analysis, scanning electron microscopy (SEM), thermal (differential scanning calorimetry (DSC) and TGA), and rheological behavior. The drug loading capacity and in vitro release profile of the drug, storage stability, and cytotoxicity tests were also performed for the gel formulation. The FTIR, DSC, and TGA results verified the successful formation of cryogels. Swelling studies revealed a pH-dependent swelling ability with a maximum swelling degree of 1200% in acid and 990% in phosphate buffer (pH = 7.4). Thermal studies showed that CS-g-PNIPAAm/PVA 75/25 had higher thermal stability proving the structural complexity of the polymer. The loading capacity of Voriconazole was found to be 70% (w/w). The in vitro release profiles of Voriconazole showed Fickian release behavior for CS-g-PNIPAAm/PVA 75/25 gel with an approximate delivery of 38% within 8 h, slower than matrices containing unmodified chitosan. The storage stability test exhibited that the gel formulation was still stable even after aging for two months. Moreover, the cell culture assays revealed a non-toxic character of the polymeric matrix. Overall results showed that the CS-g-PNIPAAm/PVA 75/25 hydrogel has the potential to be used as a smart polymeric vehicle for topical applications.

Impact of Insertion Technique and Iliac Artery Anatomy on Fenestrated Endovascular Aneurysm Repair

Purpose: To develop a mechanically realistic aortoiliac model to evaluate anatomic variables associated with stent-graft rotation and to assess common deployment techniques that may contribute to rotation. Materials and Methods: Idealized aortoiliac geometries were constructed either through direct 3-dimensional (3D) printing (rigid) or through casting with polyvinyl alcohol using 3D-printed molds (flexible). Flexible model bending rigidity was controlled by altering wall thickness. Three flexible patient-specific models were also created based on the preoperative computed tomography angiograms. Zenith infrarenal and fenestrated devices were used in this study. The models were pressurized to 100 mm Hg with normal saline. Deployments were performed under fluoroscopy at 37°C. Rotation was calculated by tracking the change in position of gold markers affixed to the devices. Results: In the rigid idealized models, stent-graft rotation increased with increasing torsion; torsion levels of 1.6, 2.6, and 3.6 mm−1 had mean rotations of 5.2°±0.03°, 11.2°±4.8°, and 27.6°±13.0°, respectively (p<0.001). In the flexible models, the highest rotation (58°±3.0°) was observed in models with high torsion and high rigidity (7.5 mm−1 net torsion and 254 N·m2 flexural rigidity). No rotation was observed in the absence of torsion. Applying torque to the device during insertion significantly increased stent-graft rotation by an average of 28° across all levels of torsion (p<0.01). Multiple device insertions prior to deployment did not change the observed device rotation. The patient-specific models accurately predicted the degree of rotation seen intraoperatively to within 5°. Conclusion: Insertion technique plays an important role in the degree of stent-graft rotation during deployment. Our model suggests that in vivo correction of device orientation can increase the observed rotation and supports the concept of fully removing the device, adjusting the orientation, and subsequently reinserting. Additionally, increasing iliac artery torsion in the presence of increased vessel rigidity results in stent-graft rotation.

Three-dimensional cryogels for biomedical applications

Cryogels are a subset of hydrogels synthesized under sub-zero temperatures: initially solvents undergo active freezing, which causes crystal formation, which is then followed by active melting to create interconnected supermacropores. Cryogels possess several attributes suited for their use as bioscaffolds, including physical resilience, bio-adaptability, and a macroporous architecture. Furthermore, their structure facilitates cellular migration, tissue-ingrowth, and diffusion of solutes, including nano- and micro-particle trafficking, into its supermacropores. Currently, subsets of cryogels made from both natural biopolymers such as gelatin, collagen, laminin, chitosan, silk fibroin, and agarose and/or synthetic biopolymers such as hydroxyethyl methacrylate, poly-vinyl alcohol, and poly(ethylene glycol) have been employed as 3D bioscaffolds. These cryogels have been used for different applications such as cartilage, bone, muscle, nerve, cardiovascular, and lung regeneration. Cryogels have also been used in wound healing, stem cell therapy, and diabetes cellular therapy. In this review, we summarize the synthesis protocol and properties of cryogels, evaluation techniques as well as current in vitro and in vivo cryogel applications. A discussion of the potential benefit of cryogels for future research and their application are also presented.

Luminal Plasma Treatment for Small Diameter Polyvinyl Alcohol Tubular Scaffolds

Plasma-based surface modification is recognized as an effective way to activate biomaterial surfaces, and modulate their interactions with cells, extracellular matrix proteins, and other materials. However, treatment of a luminal surface of a tubular scaffold remains non-trivial to perform in small diameter tubes. Polyvinyl alcohol (PVA) hydrogel, which has been widely used for medical applications, lacks functional groups to mediate cell attachment. This poses an issue for vascular applications, as endothelialization in a vascular graft lumen is crucial to maintain long term graft patency. In this study, a Radio Frequency Glow Discharges (RFGD) treatment in the presence of NH₃ was used to modify the luminal surface of 3-mm diameter dehydrated PVA vascular grafts. The grafted nitrogen containing functional groups demonstrated stability, and in vitro endothelialization was successfully maintained for at least 30 days. The plasma-modified PVA displayed a higher percentage of carbonyl groups over the untreated PVA control. Plasma treatment on PVA patterned with microtopographies was also studied, with only the concave microlenses topography demonstrating a significant increase in platelet adhesion. Thus, the study has shown the possibility of modifying a small diameter hydrogel tubular scaffold with the RFGD plasma treatment technique and demonstrated stability in ambient storage conditions for up to 30 days.

A Functional Wound Dressing as a Potential Treatment for Cutaneous Leishmaniasis

Cutaneous leishmaniasis (CL) is a parasitic disease characterized by progressive skin sores. Currently, treatments for CL are limited to parenteral administration of the drug, which presents severe adverse effects and low cure rates. Therefore, this study aimed to develop poly(vinyl-alcohol) (PVA) hydrogels containing Amphotericin B (AmB) intended for topical treatment of CL. Hydrogels were evaluated in vitro for their potential to eliminate promastigote forms of Leishmania spp., to prevent secondary infections, to maintain appropriate healing conditions, and to offer suitable biocompatibility. AmB was incorporated into the system in its non-crystalline state, allowing it to swell more and faster than the system without the drug. Furthermore, the AmB release profile showed a continuous and controlled behavior following Higuchi´s kinetic model. AmB-loaded-PVA-hydrogels (PVA-AmB) also showed efficient antifungal and leishmanicidal activity, no cytotoxic potential for VERO cells, microbial impermeability and water vapor permeability compatible with the healthy skin's physiological needs. Indeed, these results revealed the potential of PVA-AmB to prevent secondary infections and to maintain a favorable environment for the healing process. Hence, these results suggest that PVA-AmB could be a suitable and efficient new therapeutic approach for the topical treatment of CL.

Collagen Scaffolds in Cartilage Tissue Engineering and Relevant Approaches for Future Development

BACKGROUND

Cartilage tissue engineering (CTE) aims to obtain a structure mimicking native cartilage tissue through the combination of relevant cells, three-dimensional scaffolds, and extraneous signals. Implantation of 'matured' constructs is thus expected to provide solution for treating large injury of articular cartilage. Type I collagen is widely used as scaffolds for CTE products undergoing clinical trial, owing to its ubiquitous biocompatibility and vast clinical approval. However, the long-term performance of pure type I collagen scaffolds would suffer from its limited chondrogenic capacity and inferior mechanical properties. This paper aims to provide insights necessary for advancing type I collagen scaffolds in the CTE applications.

METHODS

Initially, the interactions of type I/II collagen with CTE-relevant cells [i.e., articular chondrocytes (ACs) and mesenchymal stem cells (MSCs)] are discussed. Next, the physical features and chemical composition of the scaffolds crucial to support chondrogenic activities of AC and MSC are highlighted. Attempts to optimize the collagen scaffolds by blending with natural/synthetic polymers are described. Hybrid strategy in which collagen and structural polymers are combined in non-blending manner is detailed.

RESULTS

Type I collagen is sufficient to support cellular activities of ACs and MSCs; however it shows limited chondrogenic performance than type II collagen. Nonetheless, type I collagen is the clinically feasible option since type II collagen shows arthritogenic potency. Physical features of scaffolds such as internal structure, pore size, stiffness, etc. are shown to be crucial in influencing the differentiation fate and secreting extracellular matrixes from ACs and MSCs. Collagen can be blended with native or synthetic polymer to improve the mechanical and bioactivities of final composites. However, the versatility of blending strategy is limited due to denaturation of type I collagen at harsh processing condition. Hybrid strategy is successful in maximizing bioactivity of collagen scaffolds and mechanical robustness of structural polymer.

CONCLUSION

Considering the previous improvements of physical and compositional properties of collagen scaffolds and recent manufacturing developments of structural polymer, it is concluded that hybrid strategy is a promising approach to advance further collagen-based scaffolds in CTE.

Design, characterization and in vivo performance of synthetic 2 mm-diameter vessel grafts made of PVA-gelatin blends

Since the development of the first vascular grafts, fabrication of vessel replacements with diameters smaller than 6 mm remains a challenge. The present work aimed to develop PVA (poly (vinyl alcohol))-gelatin hybrids as tubes suitable for replacement of very small vessels and to evaluate their performance using a rat abdominal aorta interposition model. PVA-gelatin hybrid tubes with internal and external diameters of 1.4 mm and 1.8 mm, respectively, composed of 4 different gelatin ratios were prepared using a one-step strategy with both chemical and physical crosslinking. By 3D Time of Flight MRI, Doppler-Ultrasound, Computed Tomography angiography and histology, we demonstrated good patency rates with the 1% gelatin composition until the end of the study at 3 months (50% compared to 0% of PVA control grafts). A reduction of the patency rate during the time of implantation suggested some loss of properties of the hybrid material in vivo, further confirmed by mechanical evaluation until one year. In particular, stiffening and reduction of compliance of the PVA-gelatin grafts was demonstrated, which might explain the observed long-term changes in patency rate. These encouraging results confirm the potential of PVA-gelatin hybrids as ready-to-use vascular grafts for very small vessel replacement.

Developing a Clinically Relevant Tissue Engineered Heart Valve-A Review of Current Approaches

Tissue engineered heart valves (TEHVs) have the potential to address the shortcomings of current implants through the combination of cells and bioactive biomaterials that promote growth and proper mechanical function in physiological conditions. The ideal TEHV should be anti-thrombogenic, biocompatible, durable, and resistant to calcification, and should exhibit a physiological hemodynamic profile. In addition, TEHVs may possess the capability to integrate and grow with somatic growth, eliminating the need for multiple surgeries children must undergo. Thus, this review assesses clinically available heart valve prostheses, outlines the design criteria for developing a heart valve, and evaluates three types of biomaterials (decellularized, natural, and synthetic) for tissue engineering heart valves. While significant progress has been made in biomaterials and fabrication techniques, a viable tissue engineered heart valve has yet to be translated into a clinical product. Thus, current strategies and future perspectives are also discussed to facilitate the development of new approaches and considerations for heart valve tissue engineering.