The antiplatelet activity of immobilized prostacyclin

Sung Wan Kim - Early events in blood/material interactions

Sung Wan Kim's initial efforts as an independent investigator were focused on improving the understanding of the early events in blood/material interactions with the goal to develop blood compatible materials for application in medical devices and prostheses. These initial efforts were centered around blood protein adsorption on biomaterials and related mechanisms of thrombus formation (thrombosis). Ultimately, Sung Wan's efforts were expanded to studies of the non-thrombogenic nature of heparinized biomaterials, prostaglandin biomaterials, and block copolymer systems. These studies were supported by two NIH grants for 22 and 19 years, respectively, and a NIH Career Development Award. Moreover, these studies resulted in over 140 peer-reviewed publications and training of many students and postdoctoral scientists. The intent of this paper is to identify key concepts, papers, and contributions by Sung Wan and his colleagues that fall within the four aforementioned research categories. In this context, many of Sung Wan's early efforts contributed directly to Utah's biomaterials efforts and the Total Artificial Heart program at the time, while providing the foundation for the productive international Triangle Collaboration as well as his following work in polymer-controlled drug releasing systems.

Antithrombogenic Poly(vinyl chloride) with Heparin- and/or Prostaglandin I2-Immobilized in Hydrogels

Poly(vinyl chloride) (PVC) with heparin- and/or prostaglandin I2 (PGI2)- immobilized on crosslinked polyacrylamide hydrogels were prepared by the ad dition of the dry hydrogels to a PVC tetrahydrofuran solution. Immobilized heparin was found to be continuously released from the PVC matrix at 37 ° C in a physiological saline. Antithrombogenic activity of PVCs with heparin and/or PGI2 was evaluated by activated partial thromboplastin time (aPTT), whole blood clotting time, and inhibition of platelet aggregation. The heparin- immobilized PVC's exhibited excellent anticoagulant activity and the PGI2 immobilized PVC's completely inhibit platelet aggregation of human blood after sitting for 46 h in a physiological saline.

Improvement of blood compatibility on polysulfone-polyvinylpyrrolidone blend films as a model membrane of dialyzer by physical adsorption of recombinant soluble human thrombomodulin (ART-123)

ART-123 is a recombinant soluble human thrombomodulin (hTM) with potent anticoagulant activity, and is available for developing antithrombogenic surfaces by immobilization. We focused on improving blood compatibility on the dialyzer surface by the physical adsorption of ART-123 as a safe yet simple method without using chemical reagents. The physical adsorption mechanism and anticoagulant activities of adsorbed hTM on the surface of a polysulfone (PSF) membrane containing polyvinylpyrrolidone (PVP) as a model dialyzer were investigated in detail. The PVP content of the PSF-PVP films was saturated at 20 wt% after immersion in Tris-HCl buffer, even with the addition of over 20 wt% PVP. The surface morphology of the PSF-PVP films was strongly influenced by the PVP content, because PVP covered the outermost surface of the PSF-PVP films. The adsorption speed of hTM slowed dramatically with increasing PVP content up to 10 wt%, but the maximum adsorption amount of hTM onto the PSF-PVP film surface was almost the same, regardless of the PVP content. The PSF-PVP film with the physically adsorbed hTM showed higher protein C activity as compared to the PSF film, it showed excellent blood compatibility due to the protein C activity and the inhibition properties of platelet adhesion. The physical adsorption of hTM can be useful as a safe yet simple method to improve the blood compatibility of a dialyzer surface.

Nitric oxide-releasing/generating polymers for the development of implantable chemical sensors with enhanced biocompatibility

The development of reliable in vivo chemical sensors for real-time clinical monitoring of blood gases, electrolytes, glucose, etc. in critically ill and diabetic patients remains a great challenge owing to inherent biocompatibility problems that can cause errant analytical results upon sensor implantation (e.g., cell adhesion, thrombosis, inflammation). Nitric oxide (NO) is a well-known inhibitor of platelet activation and adhesion, and also a potent inhibitor of smooth muscle cell proliferation. In addition, NO mediates inflammatory response and promotes angiogenesis. Polymers that release or generate NO at their surfaces have been shown to exhibit greatly enhanced thromboresistance in vivo when in contact with flowing blood, as well as reduce inflammatory response when placed subcutaneously, and thus have the potential to improve the biocompatibility of implanted chemical sensors. Locally elevated NO levels at the surface of implanted devices can be achieved by using polymers that incorporate NO donor species that can decompose and release NO spontaneously when in contact with physiological fluids, or NO-generating polymers that possess an immobilized catalyst that decompose endogenous S-nitrosothiols to generate NO in situ. The potential use of such NO-releasing/generating materials for preparing in vivo sensors implanted either intravascularly or subcutaneously, is examined in this review.

Inhibition of experimental neointimal hyperplasia by recombinant human thrombomodulin coated ePTFE stent grafts

OBJECTIVES

The goal of this study was to evaluate the ability of recombinant human thrombomodulin (rTM) to inhibit neointimal hyperplasia when bound to expanded polytetrafluoroethylene (ePTFE) stent grafts placed in a porcine balloon injured carotid artery model.

METHODS

The left carotid artery of male pigs, weighing 25 to 30 Kg, was injured with an angioplasty balloon. Two weeks later either a non-coated standard ePTFE stent graft (Viabahn, 6 x 25 mm, W. L. Gore & Associates) or a rTM coated stent graft was implanted into the balloon-injured segment using an endovascular technique. Carotid angiography was performed at the time of the balloon injury, two weeks later and then at 4 weeks to assess the degree of luminal stenosis. One month after stent graft deployment, the grafts were explanted following in situ perfusion fixation for histological analysis. The specimens were then cross-sectioned into proximal, middle and distal segments, and the residual arterial lumen and intimal to media (I/M) ratios were calculated with computerized planimetry.

RESULTS

rTM binding onto ePTFE-grafts was confirmed by functional activation of protein C and histopathology with immuno-scanning electron microscopy, backscatter electron emission imaging and x-ray microanalysis. All seven of the rTM coated stent grafts and six of the seven uncoated stent grafts were patent at the time of explantation. The mean luminal diameter of the rTM coated stents was 93% +/- 2.0% of the original diameter, compared with 67% +/- 23% (P = .006) in the control group. Histological analysis demonstrated that the area obliterated by intimal hyperplasia at the proximal portion of the rTM stent was -27% compared with the control group: (2.73 +/- 0.69 mm(2), vs 3.47 +/- 0.67 mm(2), P <.05).

CONCLUSIONS

Neointimal hyperplasia is significantly inhibited in ePTFE stent grafts coated with rTM compared with uncoated grafts, as documented by improved luminal diameter by angiography and by computerized planimetry measurements of residual lumen area. These findings suggest that binding of recombinant human thrombomodulin onto ePTFE grafts may improve the long-term patency of covered stents grafts.

CLINICAL RELEVANCE

Decrease of neointimal hyperplasia of the magnitude observed in this study could significantly improve blood flow and patency of small caliber prosthetic grafts. If the durability of these results can be confirmed by long-term studies, this technique may prove useful in preventing graft stenosis and arterial thrombosis following angioplasty or vascular bypass procedures.

Fabrication and characterization of heparin functionalized membrane-mimetic assemblies

A membrane-mimetic assembly incorporating surface bound heparin was fabricated as a system to improve the hemocompatibility of blood-contacting devices. As a model system, heparin was chemically modified by end-point conjugation to biotin and immobilized onto membrane-mimetic thin films via biotin-streptavidin interactions. Heparin surface density, determined by radiochemical titration, confirmed that surface density was directly related to the molar concentration of biotinylated lipid within the assembled membrane-mimetic film. The capacity of surface bound heparin to promote ATIII-mediated thrombin inactivation was investigated in a parallel plate flow chamber under simulated venous and arterial wall shear rates of 50 and 500 s(-1), respectively. Significantly, we observed that the rate of thrombin inactivation approached a maximum at a heparin surface concentration greater than 4.4 pmol/cm(2) (61 ng/cm(2)). In the process, mass transport limited regimes were identified for heparin potentiated thrombin inactivation under both simulated venous and arterial conditions.

Preparation and characterization of polymeric coatings with combined nitric oxide release and immobilized active heparin

A new dual acting polymeric coating is described that combines nitric oxide (NO) release with surface-bound active heparin, with the aim of mimicking the nonthrombogenic properties of the endothelial cell (EC) layer that lines the inner wall of healthy blood vessels. A trilayer membrane configuration is employed to create the proposed blood compatible coating. A given polymeric substrate (e.g., the outer surface of a catheter sleeve, etc.) is first coated with a dense polymer layer, followed by a plasticized poly(vinyl chloride) (PVC) or polyurethane (PU) layer doped with a lipophilic N-diazeniumdiolate as the NO donor species. Finally, an outer aminated polymer layer is applied. Porcine heparin is then covalently linked to the outer layer via formation of amide bonds. The surface-bound heparin is shown to possess anti-coagulant activity in the range of 4.80-6.39 mIU/cm2 as determined by a chromogenic anti-Factor Xa assay. Further, the surface NO flux from the underlying polymer layer containing the diazeniumdiolate species can be controlled and maintained at various levels (from 0.5 to 60 x 10(-10) mol cm(-2)min(-1)) for at least 24 h and up to 1 week (depending on the flux level desired) by changing the chemical/polymer composition of the NO release layer. The proposed polymeric coatings are capable of functioning by two complementary anti-thrombotic mechanisms, one based on the potent anti-platelet activity of NO, and the other the result of the ability of immobilized heparin to inhibit Factor Xa and thrombin (Factor IIa). Thus, the proposed polymeric coatings are expected to exhibit greatly enhanced thromboresistivity compared to polymers that utilize either immobilized heparin or NO release alone.

Bone formation after 4 weeks around blood-plasma-modified titanium implants with varying surface topographies: an in vivo study

The aim of the present study was to investigate and compare the stability and bone ingrowth capacity to screw-shaped titanium implants with five different surface treatments. The implants were: (1) standard turned with a thin blood plasma coat (TP), (2) NaOH-etched dito with pore size 0.2-0.3 microm (E), (3) NaOH-etched with pore size 0.2-0.3 microm and a thin blood plasma coat (EP), (4) electrochemically oxidised with pore size 1-2 microm (O), (5) electrochemically oxidised with pore size 1-2 microm and a thin blood plasma coat (OP). A total of 66 implants were divided into the above-described five groups and inserted for 4 weeks into tibia and femur of 11 rabbits. The implants were evaluated by resonance frequency (RF) measurements at the time of insertion and removal, and analysed histomorphometrically at removal. The RF measurements showed that the implant stability was lower in soft bone compared to dense and increased with time. No significant differences were observed between the different surface modifications. The histomorphometric analysis revealed no statistically significant differences between the implants regarding bone-to-metal contact (BMC) and bone area inside the threads (BA). The above results indicate that thin blood plasma-coated and non-coated screw-shaped titanium implants with turned, NaOH-etched and electrochemically etched surface profiles integrate similarly to bone at 1 month of implantation.

Studies of a novel human thrombomodulin immobilized substrate: surface characterization and anticoagulation activity evaluation

Immobilization of the anticoagulative or antithrombogenic biomolecule has been considered as one of the important methods to improve the blood compatibility of artificial biomaterials. In this study, a novel immobilization reaction scheme was utilized to incorporate the human thrombomodulin, an endothelial cell associated glycoprotein, onto the cover glass surface with an aim to develop an anticoagulative substrate. Trichlorotriazine and amino-terminated silane were employed as the coupling agents, while the polyethylene glycol with a molecular weight of 1500 was used as the spacer in this reaction scheme. Protein C activation assay indicated the immobilized human thrombomodulin still has this coenzymatic activity but is lower, possibly due to the conformation variation by the coupling agents. In vitro platelet adhesion assay has demonstrated the surface with immobilized human thrombomodulin is much less platelet-activating than others. Therefore, the novel reaction scheme proposed here is very promising for future development of an anticoagulative silicon or cover glass substrate (e.g. implantable sensor or biochip) by the immobilization of antithrombogenic protein, such as the human thrombomodulin in this study.

Immobilization of human thrombomodulin to expanded polytetrafluoroethylene

BACKGROUND

The success of synthetic grafts for vascular reconstruction remains limited by thrombosis and intimal hyperplasia. In addition to the well-described antithrombotic effects of thrombomodulin, we have demonstrated that recombinant human thrombomodulin (rTM) inhibits arterial smooth muscle cell proliferation induced by thrombin. This study investigated the binding of functional rTM to expanded polytetrafluoroethylene (ePTFE).

METHODS

Immobilization of rTM was achieved by either (1) a direct coating or (2) a two-step binding process using a water-soluble condensing cross-reaction agent EDAC to modify the ePTFE surface followed by binding of rTM. The samples were then subjected to a tangential shaken wash. The evidence of bound rTM was evaluated by both morphologic and functional studies.

RESULTS

SEM, BSI, and X-ray microanalysis identified that the two-step binding method resulted in significantly greater binding of rTM molecules to ePTFE pre- and post a 7-h wash than the direct coating method. With the two-step binding method rTM ranging from 0.25 to 12.5 microg immobilized to ePTFE-activated protein C (APC) in a concentration-dependent manner by more than 6000-fold compared to the buffer control (P < 0.04) and 50-85% more than direct coating (P < 0.004). With direct coating, the level of APC dropped significantly to near 40% of the preshaken level at 2 h and diminished to 26% at 7 h. Whereas, the level of APC with the two-step binding stabilized at 51 and 49% after being shaken 2 and 7 h, respectively.

CONCLUSION

Functional rTM binding to ePTFE was significantly improved with a new two-step binding method.

Understanding and controlling the bone-implant interface

A goal of current implantology research is to design devices that induce controlled, guided, and rapid healing. In addition to acceleration of normal wound healing phenomena, endosseous implants should result in formation of a characteristic interfacial layer and bone matrix with adequate biomechanical properties. To achieve these goals, however, a better understanding of events at the interface and of the effects biomaterials have on bone and bone cells is needed. Such knowledge is essential for developing strategies to optimally control osseointegration. This paper reviews current knowledge of the bone-biomaterial interface and methods being investigated for controlling it. Morphological studies have revealed the heterogeneity of the bone-implant interface. One feature often reported, regardless of implant material, is an afibrillar interfacial zone, comparable to cement lines and laminae limitantes at natural bone interfaces. These electron-dense interfacial layers are rich in noncollagenous proteins, such as osteopontin and bone sialoprotein. Several approaches, involving alteration of surface physicochemical, morphological, and/or biochemical properties, are being investigated in an effort to obtain a desirable bone-implant interface. Of particular interest are biochemical methods of surface modification, which immobilize molecules on biomaterials for the purpose of inducing specific cell and tissue responses or, in other words, to control the tissue-implant interface with biomolecules delivered directly to the interface. Although still in its infancy, early studies indicate the value of this methodology for controlling cell and matrix events at the bone-implant interface.

Extracorporeal circulation, hemocompatibility, and biomaterials

BACKGROUND

Performance of a majority of cardiac surgical procedures requires the use of extracorporeal circulation. Contact of the patients' blood with the nonendothelial surface of the cardiopulmonary bypass circuit is responsible for several, potentially harmful systemic reactions.

METHODS

The patients' response to extracorporeal circulation is reviewed briefly. The interactions between patient and circuit are discussed not only as they relate to blood-material contact, but also from a mechanical and rheologic standpoint. The theoretic benefits of the newer, more hemocompatible materials are presented, along with a review of published clinical experience with heparinized cardiopulmonary bypass circuits.

RESULTS

The response to extracorporeal circulation extends far beyond a simple derangement of hemostasis. This inflammatory response is strongly influenced by the rheologic design of the circuit and by the physical and chemical properties of the surface. Heparinized circuits decrease inflammation, but the clinical benefits of this reduction remain unclear, except for extended cardiopulmonary support. The safe use of these circuits requires full heparinization and does not reduce allogeneic transfusions.

CONCLUSIONS

Clinicians are still in the search of the ideal material and the ideal extracorporeal circuit design. Newer, heparinized materials offer real but limited clinical benefits.

Heparin immobilized chitosan--poly ethylene glycol interpenetrating network: antithrombogenicity

This work deals with the synthesis and blood compatibility studies of Heparin immobilized chitosan--polyethyleneglycol (Chit-PEG) hydrogels for various biomedical applications. Chit-PEG interpenetrating net work (IPN) had been synthesised by crosslinking different ratios of chitosan with glutaraldehyde using schiffs base reaction mechanism and interpenetrating polyethyleneglycol (PEG) to form hydrogen bonding between the amino hydrogen in chitosan and polyether oxygen. An optimum gel combination was selected from the IPN of Chit-PEG and used for bonding heparin. This modified gel had dramatically improved its blood compatibility. The antithrombotic function of this gel and the release profile of heparin had been investigated using coagulation assays, and spectrophotometric quantitation. Recalcification times of plasma exposed to heparin immobilized Chit-PEG hydrogel were markedly increased as compared to heparin free gels. The anticoagulant function of this gel matrix may be due to partially released heparin and bonded heparin.

Heparin surface immobilization through hydrophilic spacers: thrombin and antithrombin III binding kinetics

The immobilization of heparin onto polymeric surfaces using hydrophilic spacer groups has been effective in curtailing surface induced thrombus formation. In this study, the effect of hydrophilic spacers (PEO) on the binding kinetics of immobilized heparin with antithrombin III (ATIII) and thrombin was investigated. Monodispersed, low molecular weight heparin was fractionated on an ATIII affinity column to isolate high-ATIII affinity heparin. This high-ATIII affinity fraction was immobilized onto a styrene/p-amino styrene random copolymer surface using hydrophilic poly(ethylene oxide) (PEO) spacer groups. Styrene/p-amino styrene random copolymer was chosen as the model surface to provide quantitative and reproducible surface concentrations of available amine groups, grafted PEO spacers, and immobilized heparin. The polymer substrate was coated onto glass beads, tolylene diisocyanate modified PEO was covalently coupled to the surface, followed by heparin immobilization. The bioactivity of immobilized heparin was 16.2%, relative to free heparin, and a 1:1 binding ratio between heparin and PEO was achieved. The binding of ATIII and thrombin to control surfaces (no heparin), soluble heparin, heparin immobilized directly onto the surface, and heparin immobilized via spacer groups, were compared. Soluble heparin bound both thrombin and ATIII, while heparin immobilized directly onto the surface bound only thrombin. Spacer-immobilized heparin bound both ATIII and thrombin, although to a lesser extent than soluble heparin. Thus, the enhanced bioactivity of spacer-immobilized heparin, compared to direct-immobilization, may be attributed to the retention of ATIII binding.

Immobilization of human thrombomodulin on biomaterials: evaluation of the activity of immobilized human thrombomodulin

Thrombomodulin (TM) is a newly described endothelial cell associated protein that functions as a potent natural anticoagulant by converting thrombin from a procoagulant protease to an anticoagulant. In this study, the immobilization of hTM was investigated in detail using surface modified polymers. As the basis of immobilization, poly(acrylic acid) (PAAc) surface-grafted poly(ethylene) (PAAc-g-PE) film was used with the expectation of increasing the immobilization amount of hTM. The effect of the immobilization reaction on the hTM activities, and the comparison of the activities of the immobilized hTM with the free hTM, were studied.

Immobilization of human thrombomodulin onto poly(ether urethane urea) for developing antithrombogenic blood-contacting materials

Thrombomodulin (TM) is a newly described endothelial cell-associated protein that functions as a potent natural anticoagulant by converting thrombin from a procoagulant protease to an anticoagulant. In this study, focussing on the application of TM for biomedical materials, recombinant human TM (hTM) was immobilized onto the polymers for medical use, and the evaluation of their antithrombogenicity and the interaction with platelets were investigated. As the base polymer for immobilization reaction, poly(ether urethane urea) (PEUU), which was reported to have good blood compatibility, was used. hTM-immobilized PEUU showed superior antithrombogenic activity, such as the prolongation of plasma recalcification time and the inhibition of thrombin-induced platelet aggregation, though the amount of immobilized hTM was very small (i.e. less than 1 microgram/cm2). Platelet adhesions onto hTM-immobilized PEUU were not observed. These results show that the immobilization of hTM does not change the native good blood compatibility of PEUU, but provides excellent anticoagulant activity.

Effect of controlled local acetylsalicylic acid release on in vitro platelet adhesion to vascular grafts

Thrombosis is the most serious acute problem for small diameter arterial bypass grafts. In this research, small diameter expanded polytetrafluoroethylene (e-PTFE) vascular grafts were coated with acetylsalicylic acid (ASA) loaded poly (d,l-lactide) (PLA) by a solvent casting method. The feasibility and efficacy of this approach were evaluated by ASA release studies and platelet adhesion tests. First, the ASA release kinetics were evaluated from the ASA/PLA coated vascular grafts in an in vitro steady flow loop model. ASA release was measured by a spectrophotometric technique. Finally, the efficacy of local ASA release to reduce in vitro canine platelet adhesion to grafts was determined with epifluorescent video microscopy and quantitative image analysis. The steady state release rates from the 5%, 10%, and 15% ASA/PLA coated grafts were 13.2 x 10(-5), 32.0 x 10(-5), and 41.5 x 10(-5) micrograms/cm2.sec, respectively. Platelet adhesion to 10% and 15% ASA/PLA coated grafts was reduced with respect to the control and 5% grafts for 10 days. Platelet adhesion to 5% ASA/PLA coated grafts was reduced with respect to controls at 2 and 10 days, but not initially.

New challenges in biomaterials

Significant opportunities and challenges exist in the creation and characterization of biomaterials. Materials have been designed for contact with blood, as replacements for soft and hard tissues, as adhesives, and as dental materials. Current methods of synthesis and characterization of these materials are outlined. Approaches for controlling the interface between tissue and biomaterials and ways in which the engineered materials may contribute to medicine are considered.

Influence of molecular structure on the synergistic action of theophylline or dipyridamole derivatives in the prostaglandin-type inhibition of platelet aggregation

Approximately 30 new derivatives of theophylline and dipyridamole have been prepared and examined as potentiators of the inhibition of platelet aggregation induced by the prostaglandin analogue BW 245C. Potentiating activity has been found to be sensitive to molecular size and also to the presence of specific groups. Polymeric adducts based on dextran, poly(ethylene glycol) or poly(N-vinyl pyrrolidone), and aliphatic esters with alkyl chain-lengths greater than 7 are inactive in potentiation. Derivatives containing carboxyl groups are also inactive. Potentiation is discussed in terms of platelet membrane penetration and extra- and intra-cellular processes. The latter are invoked to account for the enhanced potentiation shown by dipyridamole and derivatives when aggregation is induced by PAF-acether rather than ADP. One derivative of particular interest is the adduct of theophylline with 1,2,5,6-diisopropylidene-D-glucose, containing a furanose ring. This is a more active potentiator than theophylline itself, possibly owing to its molecular resemblance to cAMP. On conversion to the pyranose form all activity is removed.

Glycidyl acrylate plasma glow discharged polymers

A homogeneous glycidyl acrylate polymer (GAP) has been grafted on to polytetrafluoroethylene (PTFE) and polyethylene (PE) using a modified plasma glow discharge technique with glycidyl acrylate. The polymeric layer appears to be extremely stable to acidic media and to common organic solvents. The modified surface can be derivatized via epoxy groups with hydroxy and amino compounds including sugars and amino sugars. These derivatized surfaces have been characterized by Fourier transform infrared (FTIR) spectroscopy and contact angle measurements. The wide variety of compounds which can be attached provides flexibility in the design of surfaces for the study of a range of biological interactions.

Surface Modification of Polystyrene — Platelet Adhesion

Indomethacine is an analgesic and antiinflammatory drug which has antiplatelet and antithrombotic properties. In our work, we have tried to immobilize the same onto a polymer surface covalently. Surface parameters like water contact angle and platelet adhesion are studied. Similar studies are conducted on heparin immobilized surfaces, for relative comparison.

Antithrombogenic surfaces: characterization and bioactivity of surface immobilized PGE1-heparin conjugate

A covalently bonded conjugate of commercial grade heparin and prostaglandin E1 (PGE1) was synthesized to prevent both fibrin formation and platelet aggregation during thrombus formation. The PGE1-heparin conjugate was immobilized on an imidazole carbamate derivatized sepharose bead surface through hydrophilic spacer groups (diamino-terminated polyethylene oxides). One end of the spacer group was coupled to the derivatized surface through a urethane bond between the amine group of the spacer and the derivatized surface. The free amine group of the immobilized spacers was coupled to a carboxylic group of the PGE1-heparin conjugate through an amide bond. Bioactivity of the immobilized conjugate (heparin activity) was measured in terms of increased clotting times (thrombin time assay) and for the inactivation of Factor Xa. Bioactivity of the immobilized compound (PGE1 activity) was analyzed by platelet adhesion and platelet release reactions using C14-5-hydroxytryptamine (5-HT). The conjugate immobilized via the C2 spacer showed the highest incidence of platelet adhesion, 5-HT released and the lowest activity for coagulation factors. In contrast, the 1000 and 4000 immobilized systems showed a significant reduction in platelet activation, while having the greatest effect on coagulation factors. The results of these experiments imply that the immobilized conjugate is active in preventing both pathways of thrombus formation, and the efficacy is improved through the use of long-chain hydrophilic spacer groups.

Synthesis and non-thrombogenicity of polyurethanes with poly(oxyethylene) side chains in soft segment regions

Epoxidized polybutadiene-urethanes were synthesized and grafted with poly(oxyethylene)s. The non-thrombogenicity of the graft polyurethanes was investigated in relation to the content of poly(oxyethylene). The grafting of poly(oxyethylene) to polyurethane suppressed adsorption and denaturation of plasma proteins and platelet adhesion. It was also found that there exists an optimum content of poly(oxyethylene) for the graft polyurethane to attain the highest non-thrombogenicity.

Surface modification for improved blood compatibility

Several surface modification techniques are currently being used to improve the biocompatibility of blood-contacting devices. These include the immobilization of bioactive materials to prevent thrombus generation and platelet activation, the incorporation of hydrophilic grafts onto practical hydrophobic surfaces (polyurethanes) to reduce protein adsorption, and the concept of microdomain-phase separated surfaces to regulate cellular and protein adhesion.

Immobilization of prostaglandin PGF2 alpha on poly(vinyl alcohol)

Prostaglandin PGF2 alpha was immobilized onto a poly(vinyl alcohol) hydrogel (PVA) by reaction of a PGF2 alpha-polylysine adduct with glutaraldehyde. The PGF2 alpha-polylysine adduct was prepared by carbodiimide activation of the carboxyl group of PGF2 alpha followed by coupling to the lysine. The adduct was separated from the unreacted PGF2 alpha by dialysis and the purified product was found to contain congruent to 44 mol of PGF2 alpha/mol of adduct involving congruent to 40% of the amines of the polylysine. The adduct was bound to PVA by reacting with an excess of glutaraldehyde at 0 degrees C, followed by cross-linking of the PVA to a gel at 35-37 degrees C. The PGF2 alpha of the adduct was found to retain congruent to 40% of its biological activity on a molar basis in a smooth muscle cell contraction assay, but its activity immobilized to PVA was not determined. Spectroscopically, infrared nuclear magnetic resonance (IR/NMR), the PGF2 alpha appeared identical to the native molecule, except for the amide bond at its carboxylic acid, suggesting that the reactions were very gentle and that other biomolecules could be incorporated into the gel without loss of activity.

Platelet adhesion and prevention at blood-polymer interface

It has been proposed that adsorbed glycoproteins such as fibrinogen and gamma-globulin induce platelet adhesion at blood-polymer interfaces. The importance of oligosaccharide groups in the glycoproteins proved to be responsible for platelet adhesion and aggregation via possible complex formation. Several studies have provided evidence that the proposed mechanism was involved in platelet adhesion on polymer surfaces. To minimize or prevent platelet adhesion on polymers, prostaglandins (PGs), potent inhibitors of platelet aggregation and PG-heparin (HEP) conjugate, were combined with polymers via physical dispersion or chemical immobilization on the surfaces. Albumin-HEP conjugate-adsorbed surfaces also showed significant reduction of platelet adhesion.

Inhibition of platelet adhesion to glow discharge modified surfaces

Plasma glow technique has created much interest in the field of surface modification of polymers due to its versatility of generating active polar groups on the surface without affecting the bulk properties. Here an attempt is made to inter-relate the surface properties and platelet adhesion on various polymeric substrates due to plasma treatments. Initially, a critical review of the process and development of thrombosis upon contact of an artificial surface with blood, has been provided, which has been extended with the need for surface modifications to improve their blood compatibility and the versatility of plasma treatments for such modifications have been emphasized. Phospholipids like phosphoryl choline, phosphatidyl choline and phosphoryl ethanolamine were attached to Angioflex surface by plasma glow. The role of such modified substrates to interact with platelets were investigated using Tyrode washed calf platelets. It seems, glow discharge modified phosphoryl choline bilayers dramatically inhibited the platelet-surface binding, which may be due to their biochemical resemblance with thromboresistant surfaces of human blood cells. Further, the behaviour of all phospholipids towards bloodpolymer interaction is not similar and may change depending on the nature of their functional groups, net charge of the phospholipid adsorbed surface and their interaction with platelets and its activation. It is possible to chemically immobilize lipid bilayers on standard polymers, using plasma glow, to improve their biological performance; by suitably selecting the phospholipid combinations.

Inhibitory effect of immobilized microsomal proteins on platelet aggregation

Bovine aorta microsome was solubilized by 0.5% Triton X-100, and then immobilized on agarose gel (Sepharose 4B). Immobilized microsomal proteins (I-MP) inhibited platelet aggregations induced by ADP, arachidonic acid, collagen, and thrombin. The decrease of free platelet count in sheared whole blood was suppressed by I-MP. The anti-aggregatory activity of I-MP on arachidonic acid-induced aggregation was inhibited by 15-HPETE. This result suggests that I-MP contains PGI2 synthetase activity. It is considered that immobilization of enzymatic systems in aorta microsome which limited platelet aggregation is effective to provide an antithrombogenicity to the artificial polymers for artificial organs, especially used under the conditions which frequently induced platelet aggregation.

Synthesis of novel polyaminoetherurethaneureas and development of antithrombogenic material by their chemical modifications

Novel polyaminoetherurethaneureas containing tertiary amino groups in the main chain were synthesized (PAEUU), quaternized (Q-PAEUU), and heparinized (H-PAEUU). Films of PAEUU showed a microphase separation, which was influenced by the quaternization and the heparinization. With increasing content of amino group, the water content of Q-PAEUU and the heparin content of H-PAEUU increased. The heparin-releasing rate from H-PAEUU into physiological saline solution was slow, but increased with increasing content of quaternary ammonium groups in the polymer. The water content, the heparin adsorption, and the heparin-releasing rate were controlled by the kind of quaternizing agent. The antithrombogenicity of the polyurethaneureas was improved by quaternization and very much by heparinization, and affected by the kind of quaternizing agent. Heparinization was indispensable for achieving antithrombogenicity of the polymer, although the antithrombogenicity of H-PAEUU was affected more strongly by the water content than by the heparin content. The surface free energy of these polymer films was also investigated.

Biomembranes as models for polymer surfaces. IV. ESCA analyses of a phosphorylcholine surface covalently bound to hydroxylated substrates

Using a simple chemical process, phosphorylcholine has been deposited covalently on the surface of a variety of hydroxylated polymers as a stable, monomolecular coating. Our goal was to obtain new biomaterials which, due to the chemical similarity of the modified interfaces to the phospholipid head groups present on the extracellular surfaces of blood cell membranes, should exhibit enhanced haemo- and biocompatibility. Our previous analyses by chemical and spectrophotometric methods indicated that sufficient quantities of phosphorylcholine were deposited on glass and silica surfaces to result in appreciable modification of their interfacial properties. In the present study, we have examined a series of modified hydroxylated substrates by ESCA and demonstrate specific chemical modifications on the molecular surfaces of polymeric substrates.

Polymeric inhibitors of platelet aggregation. Synergistic effects and proposals for a new mechanism

We have studied the inhibition of ADP-induced platelet aggregation in sheep platelet-rich plasma by water-soluble polymers bound to the prostaglandin analogue 5-(6-carboxyhexyl)-1-(3-cyclohexyl-3-hydroxypropyl)hydantoin ('BW 245' C, (I). The use of unambiguous modes of binding this antiplatelet drug to polymers has enabled us to study some structural features which influence inhibitory activity. Evidence is adduced which indicates that the chemical mechanisms responsible for inhibition by free and coupled BW 245 are similar. The most important observation is a remarkable synergism demonstrated by the greatly enhanced activity of a mixture of a polymer coupled to BW 245 with the uncoupled parent polymer. In some cases (e.g., with high-molecular-weight dextran) the effect may reach (and possibly exceed) two orders of magnitude. The influence of polymer molecular weights and 'cross-polymer' effects have both been examined. A mechanism has been proposed to account for these phenomena, involving adsorption of the added (inactive) polymer on to the platelet membranes, facilitating interaction of the polymer-bound drug with receptors, made more accessible by alteration to the surface geometry. This mechanism is based on physical processes, unlike other explanations of synergistic behaviour, e.g., that of prostaglandins used in conjunction with non-polymeric drugs. The observed dependences of synergistic effects upon polymer molecular weight and type and distribution of drug molecules along chains are typical 'polymer' phenomena which are all consistent with the proposed mechanism.

The antithrombotic effect of prostaglandin E1 immobilized on albuminated polymer matrix

For intravascular implantation, a biofunctional surface seems to retard surface thrombosis upon synthetic materials. Prostaglandins, like PGI2, PGE1, and PGD2, etc., are believed to stimulate membrane-bound adenyl cyclase and thereby raise intracellular levels of c-AMP within platelets, which inhibit platelet adhesion and aggregation. A new procedure is suggested for the immobilization of prostaglandin E1 on an albuminated polymer matrix, through glutaraldehyde coupling. Materials thus prepared show dramatic antiplatelet effects, with regard to platelet adhesion, when compared with albumin-immobilized surfaces. The affinity of various modified surfaces toward platelet adhesion is studied, using washed platelets suspended in Tyrode's solution. Octane contact angle studies are used to develop an understanding of the varied nature of bound substrates at equilibrium on polymer surfaces. These are studied at the solid/liquid interface, which is closest to in vivo conditions. The plasma recalcification time demonstrates the anticoagulant properties of various surfaces. A possible role of PGE1 in reducing platelet activity in the presence and absence of vitamin C is discussed. This technique may be used in the development of non-thrombogenic surfaces on existing biomedical polymers. Simultaneous pharmaceutical modification of the blood with vitamin C may enhance the blood compatibility of the surface.

Biomembrane surfaces as models for polymer design: the potential for haemocompatibility

A major restriction in the application of polymeric biomaterials is the propensity of their surfaces to support thrombosis. Theoretical approaches to the design of thromboresistant polymers have been inadequate because of the complexity of surface thrombosis. We have developed a new, practical approach to this problem--the design of polymers which mimic the thromboresistant surfaces of blood cell membranes. Haemostatic processes are mediated by reactions which occur at membrane-plasma interfaces. The extra-cellular surfaces of the plasma membranes of red blood cells and quiescent platelets are thromboresistant; in contrast, their cytoplasmic surfaces are thrombogenic. The simplest common feature among the blood-compatible cellular and model membranes is the high content of the electrically neutral phospholipids which contain the phosphorylcholine head group. We have developed model systems of biological membranes which utilize polymerizable phosphatidylcholines and which mimic nonreactive cell surfaces. Polymeri phospholipids represent a new class of hybrid biomaterials with characteristics both of biomembranes (polar surfaces, nonthrombogenic, low antigenic potential and low permeability) and of synthetic polymers (chemical and physical stability).