Glass wool-H2O2/CoCl2 test system for in vitro evaluation of biodegradative stress cracking in polyurethane elastomers

The Development of a SIBS Shunt to Treat Glaucoma

Many pharmaceutical and medical device start-up companies share similar goals. Each experience is different and offers important lessons for companies seeking Food and Drug Administration approval. This article offers important advice for budding entrepreneurs as it discusses some career-altering decisions, lessons learned in the start-up world, the technology leading up to innovation, the relevant science, medicine, chemistry, and engineering, the need to develop novel biomaterials, the regulatory path, and the business process culminating in the development of a Poly(styrene-block-isobutylene-block-Styrene)-based microshunt to treat glaucoma that led to the founding of InnFocus, Inc. (Miami, FL) in 2004, and then the acquisition of InnFocus by Santen Pharmaceuticals (Osaka, Japan) in 2016.

Increased Elasticity Modulus of Polymeric Materials Is a Source of Surface Alterations in the Human Body

The introduction of alloplastic materials (meshes) in hernia surgery has improved patient outcome by a radical reduction of hernia recurrence rate, but discussion about the biocompatibility of these implanted materials continues since observations of surface alterations of polypropylene and other alloplastic materials were published. This study intends to investigate if additives supplemented to alloplastic mesh materials merge into the solution and become analyzable. Four polypropylene and one polyester alloplastic material were incubated in different media for three weeks: distilled water, saline solution, urea solution, formalin, and hydrogen peroxide. No swelling or other changes were observed. Infrared spectroscopy scanning of incubated alloplastic materials and NMR studies of extracted solutions were performed to investigate loss of plasticizers. The surface of the mesh materials did not show any alterations independent of the incubation medium. FT-IR spectra before and after incubation did not show any differences. NMR spectra showed leaching of different plasticizers (PEG, sterically hindered phenols, thioester), of which there was more for polypropylene less for polyester. This could be the reason for the loss of elasticity of the alloplastic materials with consecutive physically induced surface alterations. A mixture of chemical reactions (oxidative stress with additive leaching from polymer fiber) in connection with physical alterations (increased elasticity modulus by loss of plasticizers) seem to be a source of these PP and PE alterations.

In vitro oxidative stability of high strength siloxane poly(urethane-urea) elastomers based on linked-macrodiol

In vitro oxidative stability of two siloxane poly(urethane urea)s synthesized using 4,4'-methylenediphenyl diisocyanate (in SiPUU-1) and Isophorone diisocyanate (in SiPUU-2) linked soft segment was evaluated using 20% H₂ O₂ and 0.1 mol/L CoCl₂ solution at 37°C under 150% strain. Commercially available siloxane polyurethane (Elast-Eon™ 2A) and polyether polyurethane (ChronoThane P™ 80A) were used as negative and positive controls, respectively. ChronoSil™ 80A was included as another commercially available polycarbonate polyurethane. Scanning electron microscopic (SEM) examinations, attenuated total reflectance-Fourier transform infrared (ATR-FTIR) spectroscopy, and molecular weight reduction revealed the extensive degradation of ChronoThane P™ 80A after 90 days while SiPUU-1, SiPUU-2 and Elast-Eon™ 2A showed no noticeable surface degradation. ChronoSil™ 80A showed degradation in both soft and hard segments. Tensile testing was carried out only on unstrained polyurethanes for 90 days. ChronoThane P™ 80A showed 35% loss in ultimate tensile strength and it was only 13-14% for SiPUU-1 and Elast-Eon™ 2A. However, the tensile strength of ChronoSil™ 80A was not significantly affected. The results of this study proved that SiPUU-1 possess oxidative stability comparable with Elast-Eon™ 2A. © 2019 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater 107B:2557-2565, 2019.

Oxidatively Stable Polyolefin Thermoplastics and Elastomers for Biomedical Applications

Statistical copolymers were prepared by the Ring Opening Metathesis coPolymerization (ROMP) of (Z)-5,5-dimethylcyclooct-1-ene and cis-cyclooctene. Subsequent hydrogenation yielded poly(ethylene-co-isobutylene) (PEIB) materials. The feed ratio of the comonomers controls the degree of branching and resulting thermal and mechanical properties of the PEIB samples. Oxidative degradation studies, conducted under accelerated in vitro conditions were used to assess and predict their long-term biostability. Relative to commercial poly(ether urethanes) and a structurally similar polyolefin, poly(ethylene-co-1-butylene), the PEIB samples showed much better oxidative resistance. The facile synthesis, improved stability, and excellent mechanical performance of these PEIB materials bode well for their use in biomedical applications that require long-term biostability.

The development of a micro-shunt made from poly(styrene-block-isobutylene-block-styrene) to treat glaucoma

Glaucoma is the second leading cause of blindness with ∼70 million people worldwide who are blind from this disease. The currently practiced trabeculectomy surgery, the gold standard treatment used to stop the progression of vision loss, is rather draconian, traumatic to the patient and requires much surgical skill to perform. This article summarizes the more than 10‐year development path of a novel device called the InnFocus MicroShunt®, which is a minimally invasive glaucoma drainage micro‐tube used to shunt aqueous humor from the anterior chamber of the eye to a flap formed under the conjunctiva and Tenon's Capsule. The safety and clinical performance of this device approaches that of trabeculectomy. The impetus to develop this device stemmed from the invention of a new biomaterial called poly(styrene‐block‐isobutylene‐block‐styrene), or “SIBS.” SIBS is ultra‐stable with virtually no foreign body reaction in the body, which manifests in the eye as clinically insignificant inflammation and capsule formation. The quest for an easier, safer, and more effective method of treating glaucoma led to the marriage of SIBS with this glaucoma drainage micro‐tube. This article summarizes the development of SIBS and the subsequent three iterations of design and four clinical trials that drove the one‐year qualified success rate of the device from 43% to 100%. © 2015 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater, 105B: 211–221, 2017.

Rapid evaluation of the durability of cortical neural implants using accelerated aging with reactive oxygen species

OBJECTIVE

A challenge for implementing high bandwidth cortical brain-machine interface devices in patients is the limited functional lifespan of implanted recording electrodes. Development of implant technology currently requires extensive non-clinical testing to demonstrate device performance. However, testing the durability of the implants in vivo is time-consuming and expensive. Validated in vitro methodologies may reduce the need for extensive testing in animal models.

APPROACH

Here we describe an in vitro platform for rapid evaluation of implant stability. We designed a reactive accelerated aging (RAA) protocol that employs elevated temperature and reactive oxygen species (ROS) to create a harsh aging environment. Commercially available microelectrode arrays (MEAs) were placed in a solution of hydrogen peroxide at 87 °C for a period of 7 days. We monitored changes to the implants with scanning electron microscopy and broad spectrum electrochemical impedance spectroscopy (1 Hz-1 MHz) and correlated the physical changes with impedance data to identify markers associated with implant failure.

MAIN RESULTS

RAA produced a diverse range of effects on the structural integrity and electrochemical properties of electrodes. Temperature and ROS appeared to have different effects on structural elements, with increased temperature causing insulation loss from the electrode microwires, and ROS concentration correlating with tungsten metal dissolution. All array types experienced impedance declines, consistent with published literature showing chronic (>30 days) declines in array impedance in vivo. Impedance change was greatest at frequencies <10 Hz, and smallest at frequencies 1 kHz and above. Though electrode performance is traditionally characterized by impedance at 1 kHz, our results indicate that an impedance change at 1 kHz is not a reliable predictive marker of implant degradation or failure.

SIGNIFICANCE

ROS, which are known to be present in vivo, can create structural damage and change electrical properties of MEAs. Broad-spectrum electrical impedance spectroscopy demonstrates increased sensitivity to electrode damage compared with single-frequency measurements. RAA can be a useful tool to simulate worst-case in vivo damage resulting from chronic electrode implantation, simplifying the device development lifecycle.

Degradability of polymers for implantable biomedical devices

Many key components of implantable medical devices are made from polymeric materials. The functions of these materials include structural support, electrical insulation, protection of other materials from the environment of the body, and biocompatibility, as well as other things such as delivery of a therapeutic drug. In such roles, the stability and integrity of the polymer, over what can be a very long period of time, is very important. For most of these functions, stability over time is desired, but in other cases, the opposite–the degradation and disappearance of the polymer over time is required. In either case, it is important to understand both the chemistry that can lead to the degradation of polymers as well as the kinetics that controls these reactions. Hydrolysis and oxidation are the two classes of reactions that lead to the breaking down of polymers. Both are discussed in detail in the context of the environmental factors that impact the utility of various polymers for medical device applications. Understanding the chemistry and kinetics allows prediction of stability as well as explanations for observations such as porosity and the unexpected behavior of polymeric composite materials in some situations. In the last part, physical degradation such interfacial delamination in composites is discussed.

In vitro biostability evaluation of polyurethane composites in acidic, basic, oxidative, and neutral solutions

New and improved properties can often be achieved by compounding two or more different but compatible materials. But, can failure possibility also be increased by such a compounding strategy? In this article, we compared the in vitro biostability of composites with that of the pure polymer. We tested three model composites in oxidative, acidic, basic, and neutral solutions. We found that oxidation degradation was much more profound in the composites than in the corresponding pure polymer. This degradation seemed to be an intrinsic property of composite materials. We also observed the well documented interfacial debonding between filler and matrix and its effects on the mechanical reinforcement of the hydrated composites. The improvements in acid and base resistance were also observed.

Biological stability of polyurethane modified with covalent attachment of di-tert-butyl-phenol

Polyurethane cardiovascular implants are subject to oxidation initiated surface degradation, which is mediated by monocyte-derived macrophages (MDM); this often leads to surface cracking and device failure. The present studies examined the hypothesis that covalently attaching antioxidant, di-tert-butylphenol (DBP), to the urethane nitrogens of a polyether polyurethane (PU) via bromo-alkylation reactions could prevent this problem. PU was configured with two dosages of DBP, 0.14 mM DBP/g PU of DBP (PU-DBP) and a more highly modified (HM) 0.40 mM DBP/g PU (PU-DBP-HM). THP-1 cells, a human MDM cell line, stimulated with phorbol ester and seeded on PU, PU-DBP, and PU-DBP-HM films were assessed for reactive oxygen species (ROS) production via a fluorescent based dihydrorhodamine-123 assay. Results from these studies showed a significant dose-dependent reduction of ROS levels for THP-1 cells seeded on PU-DBP versus unmodified PU. PU, PU-DBP, or PU-DBP-HM films were implanted into subdermal pouches of Sprague-Dawley rats. Films were explanted after 10 weeks and assessed for oxidative degradation via light and scanning electron microscopy (SEM) and Fourier transformation infrared spectroscopy (FTIR). Light microscopy showed extensive surface cracking, which was confirmed via SEM, on unmodified PU surfaces that was absent in both PU-DBP and PU-DBP-HM explanted films. FTIR analysis showed reduction in oxidation-induced ether crosslinking that was directly related to DBP dosages. It is concluded that modifying PU with the covalent attachment of an antioxidant confers biodegradation resistance in vivo in a dose dependent manner; this effect is likely due to quenching of the ROS generated by the adherent macrophages.

Prevention of oxidative degradation of polyurethane by covalent attachment of di-tert-butylphenol residues

Polyurethane (PU) components of cardiovascular devices are subjected to oxidation-initiated surface degradation, which leads to cracking and ultimately device failure. In the present study, we investigated a novel bromoalkylation chemical strategy to covalently attach the antioxidant, di-tert-butylphenol (DBP), and/or cholesterol (Chol) to the PU urethane nitrogen groups to hypothetically prevent oxidative degradation. These experiments compared PU, PU-DBP, PU-Chol, and PU-Chol-DBP. A series of comparative oxidative degradation studies involved exposing PU samples (modified and unmodified) to H2O2-CoCl2 for 15 days at 37 degrees C, to cause accelerated oxidative degradation. The extent and effects of degradation were assessed by attenuated total reflectance Fourier transformation infrared spectroscopy (FTIR), scanning electron microscopy (SEM), surface contact angle measurements, and mechanical testing. Both the Chol and DBP modification conferred significant resistance to oxidation related changes compared to unmodified PU per FTIR and SEM results. SEM demonstrated cavitation only in unmodified PU. However, contact angle analysis showed significant oxidation-induced changes only in the Chol-modified PU formulations. Most importantly, uniaxial stress-strain testing revealed that only PU-DBP demonstrated bulk elastomeric properties that were minimally affected by oxidation; PU, PU-Chol, PU-Chol-DBP showed marked deterioration of their stress-strain properties following oxidation. In conclusion, these results demonstrate that derivatizing PU with DBP confers significant resistance to oxidative degradation compared with unmodified PU.

Effect of processing route and acetone pre-treatment on the biostability of pellethane materials used in medical device applications

Thermoplastic polyurethanes, such as Pellethane 2363 80A (Pel80A) and Pellethane 2363 55D (Pel55D) are widely used in the medical device industry because of their biological and mechanical properties. However, premature failure in such devices has been observed and attributed to environmental stress cracking (ESC). The current work investigates the possibility of reducing ESC via bulk morphology manipulation. This can be achieved through various processing routes such as solvent-casting (SC) and hot-press quenching (HPQ). The effect of stress on the bulk morphology of Pel55D and Pel80A was evaluated using small-angle X-ray scattering (SAXS) in conjunction with tensile testing. SC samples exhibited greater phase separation compared with HPQ samples. Alignment of hard segment domains became apparent around the point of yield. Onset of ESC with respect to SC and HPQ routines was determined using the Zhao-Stokes glass-wool test with optical (OM) and environment scanning electron microscopy (ESEM). Improvement in biostability of Pel80A was found in HPQ samples compared to those that were SC. A secondary objective of this work was to investigate the effect of acetone pre-treatment on surface morphology. High resolution imaging of acetone treated and untreated SC Pel80A showed significant differences in surface morphology.

Analysis and evaluation of a biomedical polycarbonate urethane tested in an in vitro study and an ovine arthroplasty model. Part I: materials selection and evaluation

The polyurethane elastomer (PU) Corethane 80A (Corvita) is being considered as the acetabular bearing material in a novel total replacement hip joint. The biostability of Corethane 80A was investigated in vitro (this work) and in vivo (reported separately) in a fully functioning ovine total hip arthroplasty (THA) model, with the PU as the bearing layer in a prototype compliant layer acetabular cup. The in vitro studies assessed the resistance of Corethane 80A to the main degradation mechanisms observed in PUs: hydrolysis, environmental stress cracking (ESC), metal ion oxidation (MIO) and calcification. The performance of the polycarbonate PU Corethane 80A was assessed alongside three other commercially available biomedical PUs: polyether PUs Pellethane 2363-80A (DOW Chemical) and PHMO-PU (CSIRO, not supplied as a commercial material) as well as polycarbonate PU ChronoFlex AL-80A (CardioTech). Chemical and structural variables that affect the properties of the materials were analysed with particular attention to the nature of the material's hard and soft segments. PU degradation was probed using a range of analytical tools and physical-testing methods, including mechanical testing, differential scanning calorimetry (DSC), Fourier transform infrared spectroscopy (FTIR) and environmental scanning microscopy (ESEM). Corethane 80A displayed the best overall resistance to hydrolysis, ESC, MIO and calcification, followed by ChronoFlex 80A and PHMO-PU. Pellethane 80A was the least stable. This study provides compelling evidence for the biostability and effectiveness of Corethane 80A and points to its suitability for use as a compliant bearing layer in hip arthroplasty, and possibly also other joints.

Long-term in vivo biostability of poly(dimethylsiloxane)/poly(hexamethylene oxide) mixed macrodiol-based polyurethane elastomers

The long-term biostability of a novel thermoplastic polyurethane elastomer (Elast-Eon 2 80A) synthesized using poly(hexamethylene oxide) (PHMO) and poly(dimethylsiloxane) (PDMS) macrodiols has been studied using an in vivo ovine model. The material's biostability was compared with that of three commercially available control materials, Pellethane 2363-80A, Pellethane 2363-55D and Bionate 55D, after subcutaneous implantation of strained compression moulded flat sheet dumbbells in sheep for periods ranging from 3 to 24 months. Scanning electron microscopy, attenuated total reflectance-Fourier transform infrared spectroscopy, and X-ray photoelectron spectroscopy were used to assess changes in the surface chemical structure and morphology of the materials. Gel permeation chromatography, differential scanning calorimetry and tensile testing were used to examine changes in bulk characteristics of the materials. The results showed that the biostability of the soft flexible PDMS-based test polyurethane was significantly better than the control material of similar softness, Pellethane 80A, and as good as or better than both of the harder commercially available negative control polyurethanes, Pellethane 55D and Bionate 55D. Changes observed in the surface of the Pellethane materials were consistent with oxidation of the aliphatic polyether soft segment and hydrolysis of the urethane bonds joining hard to soft segment with degradation in Pellethane 80A significantly more severe than that observed in Pellethane 55D. Very minor changes were seen on the surfaces of the Elast-Eon 2 80A and Bionate 55D materials. There was a general trend of molecular weight decreasing with time across all polymers and the molecular weights of all materials decreased at a similar relative rate. The polydispersity ratio, Mw/Mn, increased with time for all materials. Tensile tests indicated that UTS increased in Elast-Eon 2 80A and Bionate 55D following implantation under strained conditions. However, ultimate strain decreased and elastic modulus increased in the explanted specimens of all three materials when compared with their unimplanted unstrained counterparts. The results indicate that a soft, flexible PDMS-based polyurethane synthesized using 20% PHMO and 80% PDMS macrodiols has excellent long-term biostability compared with commercially available polyurethanes.

In vitro stability of a novel compliant poly(carbonate-urea)urethane to oxidative and hydrolytic stress

Poly(ester)urethane and poly(ether)urethane vascular grafts fail in vivo because of hydrolytic and oxidative degradative mechanisms. Studies have shown that poly(carbonate)urethanes have enhanced resistance. There is still a need for a viable, nonrigid, small-diameter, synthetic vascular graft. In this study, we sought to confirm this by exposing a novel formulation of compliant poly(carbonate-urea)urethane (CPU) manufactured by an innovative process, resulting in a stress-free. Small-diameter prosthesis, and a conventional poly(ether)urethane Pulse-Tec graft known to readily undergo oxidation in a variety of degradative solutions, and we assessed them for the development of oxidative and hydrolytic degradation, changes in elastic properties, and chemical stability. To simulate the in vivo environment, we used buffered solutions of phospholipase A(2) and cholesterol esterase; solutions of H(2)O(2)/CoCl(2), t-butyl peroxide/CoCl(2) (t-but/CoCl(2)), and glutathione/t-butyl peroxide/CoCl(2) (Glut/t-but/CoCl(2)); and plasma fractions I-IV, which were derived from fresh human plasma centrifuged in poly(ethylene glycol). To act as a negative control, both graft types were incubated in distilled water. Samples of both graft types (100 mm with a 5.0-mm inner diameter) were incubated in these solutions at 37 degrees C for 70 days before environmental scanning electron microscopy, radial tensile strength and quality control, gel permeation chromatography, and in vitro compliance assessments were performed. Oxidative degradation was ascertained from significant changes in molecular weight with respect to a control on all Pulse-Tec grafts treated with t-but/CoCl(2), Glut/t-but/CoCl(2), and plasma fractions I-III. Pulse-Tec grafts exposed to the H(2)O(2)/CoCl(2) mixture had significantly greater compliance than controls incubated in distilled water (p < 0.001 at 50 mmHg). No changes in molecular weight with respect to the control were observed for the CPU samples; only those immersed in t-but/CoCl(2) and Glut/t-but/CoCl(2) showed an 11% increase in molecular weight to 108,000. Only CPU grafts treated with the Glut/t-but/CoCl(2) mixture exhibited significantly greater compliance (p < 0.05 at 50 mmHg). Overall, results from this study indicate that CPU presents a far greater chemical stability than poly(ether)-urethane grafts do.

In vitro interactions of biomedical polyurethanes with macrophages and bacterial cells

Three commercial medical-grade polyurethanes (PUs), a poly-ether-urethane (Pellethane), and two poly-carbonate-urethanes, the one aromatic (Bionate) and the other aliphatic (Chronoflex), were tested for macrophages and bacterial cells adhesion, in the presence or absence of adhesive plasma proteins. All the experiments were carried out on PUs films obtained by solvent casting. The wettability of these films was analysed by measuring static contact angles against water. The ability of the selected PUs to adsorb human fibronectin (Fn) and fibrinogen (Fbg) was checked by ELISA with biotin-labelled proteins. All PUs were able to adsorb Fn and Fbg (Fn > Fbg). Fn adsorption was in the order: Pellethane > Chronoflex > Bionate, the highest Fbg adsorption being detected onto Bionate (Bionate > Chronoflex > Pellethane). The human macrophagic line J111, and the two main bacterial strains responsible for infection in humans (Staphylococcus aureus Newman and Staphylococcus epidermidis 14852) were incubated in turn with the three PUs, uncoated or coated with plasma proteins. No macrophage or bacterial adhesion was observed onto uncoated PUs. PUs coated with plasma, Fn or Fbg promoted bacterial adhesion (S. aureus > S. epidermidis), whereas macrophage adhered more onto PUs coated with Fn or plasma. The coating with Fbg did not promote cell adhesion. Pellethane showed the highest macrophage activation (i.e. spreading), followed, in the order, by Bionate and Chronoflex.

New methods for the assessment of in vitro and in vivo stress cracking in biomedical polyurethanes

This article describes a new test method for the assessment of the severity of environmental stress cracking of biomedical polyurethanes in a manner that minimizes the degree of subjectivity involved. The effect of applied strain and acetone pre-treatment on degradation of Pellethane 2363 80A and Pellethane 2363 55D polyurethanes under in vitro and in vivo conditions is studied. The results are presented using a magnification-weighted image rating system that allows the semi-quantitative rating of degradation based on distribution and severity of surface damage. Devices for applying controlled strain to both flat sheet and tubing samples are described. The new rating system consistently discriminated between the effects of acetone pre-treatments, strain and exposure times in both in vitro and in vivo experiments. As expected, P80A underwent considerable stress cracking compared with P55D. P80A produced similar stress crack ratings in both in vivo and in vitro experiments, however P55D performed worse under in vitro conditions compared with in vivo. This result indicated that care must be taken when interpreting in vitro results in the absence of in vivo data.

The mechanical behavior of vascular grafts: a review

The development of intimal hyperplasia (IH) near the anastomosis of a vascular graft to artery is directly related to changes in the wall shear rate distribution. Mismatch in compliance and diameter at the end-to-end anastomosis of a compliant artery and rigid graft cause shear rate disturbances that may induce intimal hyperplasia and ultimately graft failure. The principal strategy being developed to prevent IH is based on the design and fabrication of compliant synthetic or innovative tissue-engineered grafts with viscoelastic properties that mirror those of the human artery. The goal of this review is to discuss how mechanical properties including compliance mismatch, diameter mismatch, Young's modulus and impedance phase angle affect graft failure due to intimal hyperplasia.

Selection of a polyurethane membrane for the manufacture of ventricles for a totally implantable artificial heart: blood compatibility and biocompatibility studies

Membranes made from 4 commercial poly(carbonate urethanes): Carbothane (CB), Chronoflex (CF), Corethane 80A (CT80), and Corethane 55D (CT55), and from 2 poly(ether urethanes): Tecoflex (TF) and Tecothane (TT) were prepared by solution casting and sterilized by either ethylene oxide (EO) or gamma radiation. Their biocompatibility was evaluated in vitro in terms of proliferation, cell viability, and adhesion characteristics of human umbilical veins (HUVEC), monocytes (THP-1), and skin fibroblasts, and by measuring complement activation through the generation of the C3a complex. Their hemocompatibility was determined by measuring the level of radiolabeled platelet, neutrophil, and fibrin adhesion in an ex vivo arteriovenous circuit study in piglets as well as via an in vitro hemolysis test. The results of this study showed no endothelial cell proliferation on any of the materials. The cell viability study revealed that the CB, CF, and TF membranes sterilized by EO maintained the highest percentage of monocyte viability after 72 h of incubation (>70%) while none of the gamma-sterilized membranes displayed any cell viability. The fibroblast adhesion and C3a generation assays revealed that none of the materials supported any cell adhesion or activated complement, regardless of the sterilization method. The hemolysis test also confirmed that the 4 poly(carbonate urethanes) were hemolytic while none of the poly(ether urethanes) were. Finally, the ex vivo study revealed that significantly more platelets adhered to the CB and CT55 membranes while the levels of neutrophil and fibrin deposition were observed to be similar for all 6 materials. In conclusion, the study identified the CF and TF membranes as having superior biocompatibility and hemocompatibility compared to the other polyurethanes.

Polydimethylsiloxane/polyether-mixed macrodiol-based polyurethane elastomers: biostability

A series of four thermoplastic polyurethane elastomers were synthesized with varying proportions of poly(hexamethylene oxide) (PHMO) and poly(dimethylsiloxane) (PDMS) macrodiols. The macrodiol ratios (by weight) employed were (% PDMS:% PHMO) 100:0, 80:20, 50:50 and 20:80. The weight fraction of macrodiol in each polymer was fixed at 60%. The mixed macrodiols were reacted with 4,4'-methylenediphenyl diisocyanate (MDI) and 1,4-butanediol (BDO) chain extender. The biostability of these polymers was assessed by strained subcutaneous implantation in sheep for three months followed by microscopic examination. Pellethane 2363-80A and 2363-55D were employed as control materials. The mechanical properties of the polymers were tested and discussed along with the biostability results. The results showed that soft, flexible PDMS-based polyurethanes with very promising biostability can be successfully produced using the mixed macrodiol approach. The formulation with 80% PDMS macrodiol produced the best result in terms of a combination of flexibility, strength and biostability.

In vitro stability of polyether and polycarbonate urethanes

The in vitro structural stability of poly-ether-urethanes (PEUs) and poly-carbonate-urethanes (PCUs) was examined under strong acidic (HNO3) or alkaline (NaClO) oxidative conditions and in presence of a constant strain state. Polyurethane (PU) samples were represented by sheets solvent-cast from commercial pellets or by tubular specimens cut from commercial catheters. The specimens were strained at 100% uniaxial elongation over appropriate extension devices and completely immersed into the oxidative solutions at 50 degrees C for 7-14 days. The changes induced by the oxidative treatments were then evaluated by molecular weight analysis, tensile mechanical tests, and scanning electron microscopy. In the experiments with solvent-cast samples, the PEU Pellethane was degraded more in the alkaline oxidative conditions and mainly in the absence of an applied uniaxial stress. All the tested PCUs were, on the contrary, more affected by the acidic oxidative agent. All the PCUs proved to have overall better stability than the PEU. The susceptibility to oxidation was also dependent on the shape and bulk/surface organisation acquired by the same polymer during its processing. When the oxidative test was applied to catheters made of a PEU and a PCU, the results confirmed the better stability of poly-carbonate-urethanes.

In vitro modulation of macrophage phenotype and inhibition of polymer degradation by dexamethasone in a human macrophage/Fe/stress system

A new in vitro accelerated biological model, the macrophage-FeCl2-stress system was used for the evaluation of dexamethasone (DEX)-polymer formulations. This model combines the effects of cells (macrophages), transition metal ions (Fe2+), and polymer stress to promote material biodegradation. The cell and material effects of DEX, either in solution or incorporated into a polyetherurethane matrix (DEX/PEU), were monitored. Cell morphology and hydroperoxide formation in the polymer during cell culturing were characterized. After a subsequent treatment with FeCl2 the development of environmental stress cracking in the polymer was evaluated. We attempted to duplicate the biodegradation of PEU in terms of environmental stress cracking (ESC). Our results support the direct involvement of macrophages in polyetherurethane oxidation, probably by inducing hydroperoxide formation in the polymer structure. Under the influence of stress or strain, polymers with sufficient hydroperoxides degrade in the presence of Fe2+ metal ions in a manner that closely resembles the stress cracking that is observed in vivo. By contrast, polymers treated with either agents that inhibit cell activation and/or the oxidative burst, or with cells with no oxidative burst did not show signs of the biodegradative process. We demonstrated a reduction in hydroperoxide formation and no later ESC development in macrophage-cultured PEU in the presence of DEX in solution or in DEX-loaded PEU. We believe the prevention of initial polymer oxidation by reducing the cell's potential to produce oxidative stress at the tissue-biomaterial interface can directly inhibit the ESC degradation of chronically implanted polymers. The in vitro macrophage-Fe-stress system is a valuable tool for reliable assessment and cost-effective evaluation of biomaterials.

Commercial polyurethanes: the potential influence of auxiliary chemicals on the biodegradation process

This investigation elucidates some aspects of auxiliary chemicals on the biodegradation of two commercial polyurethanes (Pellethane and Corethane). The materials were incubated for 28 days with cholesterol esterase and/or with phosphatidylcholine. Extraction studies were carried out on the two materials, using different solvents, chosen on the basis of solvent polarity. FT-IR spectra for the extracted materials indicated the presence of poly(methylene)n oxide moities, silicone oil, bis-ethylene-stearamide, aromatic moities, and alkyd-urea compounds in Pellethane. Corethane materials were shown to contain some fatty acids, hydrocarbon waxes, ester-based species, and chlorinated compounds. Analysis of incubation solutions by high performance liquid chromatography failed to isolate methylene dianiline (MDA) or any of its derivatives from the various polymer incubation solutions. However, a methanol extract of Corethane samples that were incubated for 28 days in cholesterol esterase did show the presence of MDA. The absence of MDA in the Pellethane methanol extracted samples may reflect the differences in surface additives found for this material versus the Corethane. FT-IR/ATR analysis of polymer surfaces exposed to cholesterol esterase/phospholipids mixture showed that there was an increase in the uptake of phospholipids over samples that were incubated in phospholipid dispersion alone. The results of this study show that some of the auxiliary chemicals found in commercial polyurethanes may hinder the specific release of hydrolytic degradation products and delay polymer degradation. However, it should be recognized that the surface layer containing these compounds is susceptible to change following the interaction between the polyurethane-based devices and elements of the host environment (i.e. lipids, enzymes, etc.). Hence, recognition and identification of these changes will ultimately be important in assessing a commercial polymer's blood compatibility characteristics.

Biomedical applications of polyurethanes: a review of past promises, present realities, and a vibrant future

Polyurethanes, having extensive structure/property diversity, are one of the most bio- and blood-compatible materials known today. These materials played a major role in the development of many medical devices ranging from catheters to total artificial heart. Properties such as durability, elasticity, elastomer-like character, fatigue resistance, compliance, and acceptance or tolerance in the body during the healing, became often associated with polyurethanes. Furthermore, propensity for bulk and surface modification via hydrophilic/hydrophobic balance or by attachments of biologically active species such as anticoagulants or biorecognizable groups are possible via chemical groups typical for polyurethane structure. These modifications are designed to mediate and enhance the acceptance and healing of the device or implant. Many innovative processing technologies are used to fabricate functional devices, feeling and often behaving like natural tissue. The hydrolytically unstable polyester polyurethanes were replaced by more resistant but oxidation-sensitive polyether polyols based polyurethanes and their clones containing silicone and other modifying polymeric intermediates. Chronic in vivo instability, however, observed on prolonged implantation, became a major roadblock for many applications. Presently, utilization of more oxidation resistant polycarbonate polyols as soft segments, in combination with antioxidants such as Vitamin E, offer materials which can endure in the body for several years. The applications cover cardiovascular devices, artificial organs, tissue replacement and augmentation, performance enhancing coatings and many others. In situ polymerized, cross-linked systems could extend this biodurability even further. The future will expand this field by revisiting chemically-controlled biodegradation, in combination with a mini-version of RIM technology and minimally invasive surgical procedures, to form, in vivo, a scaffold, by delivery of reacting materials to the specific site in the body and polymerizing the mass in situ. This scaffold will provide anchor for tissue regeneration via cell attachment, proliferation, control of inflammation, and healing.

End-stage renal disease (ESRD) and vascular access grafting: a critical review

End-Stage Renal Disease (ESRD) is a major disease state, costing the U.S. $9.5 billion in 1992, and increasing 10% yearly. The growth in the number of ESRD patients can be attributed principally to demographic trends: the aging of the general population and the improved treatment and increased survival rate of patients with diabetes, hypertension, and other illnesses that lead to ESRD. Moreover, improved dialysis technology has enabled older patients and those who previously could not tolerate dialysis due to other illnesses to benefit from this treatment. Three modalities exist for the treatment of ESRD: hemodialysis, peritoneal dialysis, and kidney transplant. This article reviews the medical treatments and the synthetic polymers used in the manufacture of vascular access grafts. We report on the development of a new, polyurethane-based microporous vascular graft, which displays self-sealing and improved compliance characteristics for use in vascular access grafting.

Synergistic effects of oxidative environments and mechanical stress on in vitro stability of polyetherurethanes and polycarbonateurethanes

The in vitro structural stability of polyetherurethanes (PEUs) and polycarbonateurethanes (PCUs and PCUUs) was examined under strong oxidative conditions (0.5N HNO3, pH 0.3; and NaClO, 4% Cl2 available, pH approximately 13) and in the presence of a constant strain state. Solvent-cast dog-bone shaped specimens were strained at 100% uniaxial elongation over extension devices and completely immersed in the oxidative solutions at 50 degrees C for 15 days. Unstrained polyurethane (PU) samples were treated in the same way for comparison. The modification of the PU molecular structure was determined by DSC, GPC, ATR-FTIR, static contact angle, and surface roughness analyses. The incubation in nitric acid and sodium hypochlorite brought about a greater degradation of samples tested under the applied strain with the exception of PEU treated with nitric acid. PEU was the most affected material, showing bulk deterioration in NaClO and significant modifications in nitric acid, with the appearance of new IR bands, which were assigned to oxidation products. A higher phase separation between soft and hard domains occurred in PCUs upon incubation in nitric acid, the treatment with NaClO gave rise to new bands in the IR spectra, denoting the presence of oxidation products at the surface. The surface roughness greatly increased in strained PCUs with SEM evidence of deep cracks and holes or ragged and stretched fractures perpendicular to the direction of stress. PCUU underwent complex chemical modifications with a marked decrease of N-H and urea IR absorptions and showed a lower degradation than PEU and PCUs under mechanical constraint. From these results, sodium hypochlorite appears to be able to create an ESC-like degradation for PUs that are resistant to other aggressive chemical environments.

Elastomers for biomedical applications

Current topics in elastomers for biomedical applications are reviewed. Elastomeric biomaterials, such as silicones, thermoplastic elastomers, polyolefin and polydiene elastomers, poly(vinyl chloride), natural rubber, heparinized polymers, hydrogels, polypeptides elastomers and others are described. In addition biomedical applications, such as cardiovascular devices, prosthetic devices, general medical care products, transdermal therapeutic systems, orthodontics, and ophthalmology are reviewed as well. Elastomers will find increasing use in medical products, offering biocompatibility, durability, design flexibility, and favorable performance/cost ratios. Elastomers will play a key role in medical technology of the future.

In vitro and in vivo biodurability of a compliant microporous vascular graft

Polyurethanes have unique mechanical and biologic properties that make them ideal for many implantable devices. However, certain polyurethanes are affected by some in vivo degradation mechanisms. For example, poly(ester)urethanes are subject to hydrolytic degradation and are no longer used in long-term implanted devices. Poly(ether)urethanes while hydrolytically stable, are subject to oxidative degradation in several forms, including environmental stress cracking and metal ion oxidation. We have developed a second-generation poly(carbonate)urethane with superior biostability. This material has been fabricated by our patented method into small diameter microporous vascular grafts. We evidenced the biodurability of our vascular graft by in vitro qualification tests which compared the poly(carbonate)urethane with a traditional poly(ether)urethane. This poly(carbonate)urethane graft has also proven to be biodurable in in vivo experimental implants up to twenty months duration with no evidence of hydrolysis or environmental stress cracking (ESC).

Bipolar pacemaker leads: new materials, new technology

This commentary is in response to a review published earlier in this journal. It is intended to provide additional information and supplement the original paper. A short review of the failure mechanisms of polyurethane pacing lead materials is provided. Two specific degradation mechanisms, environmental stress cracking and metal ion oxidation, are discussed. Environmental stress cracking has been extensively studied and is a well understood failure mechanism. Methods for reducing the problem have been developed and tested in vivo. As a result, stress cracking failures can be virtually eliminated. Metal ion oxidation failures now dominate pacing lead recalls. Two new materials, polycarbonate urethanes and ethylenetetrafluoroethylene, have been introduced as insulators for pacing leads. These materials do not fail by stress cracking and preliminary test results are very positive.

In-vivo degradation of polyurethanes: transmission-FTIR microscopic characterization of polyurethanes sectioned by cryomicrotomy

A combination of cryomicrotomy and transmission Fourier transform infrared (FTIR) microscopy was used to investigate chemical changes in unstrained sheets of Pellethane 2363-80A, Tecoflex EG80A and Biomer caused by biodegradation (18 month subcutaneous ovine implant). Cryomicrotomy was used to obtain thin sections (ca. 2.5 microm) from the surface into the bulk, parallel to the plane of the surface. FTIR microscopy was then used to obtain infrared absorbance spectra in the range 4000-600 cm(-1). Comparisons between the infrared spectra (by spectral subtraction) from implant surface, implant interior and non-implanted controls were used to detect chemical changes. Scanning electron microscopy was used to assess microstructural changes owing to biodegradation. Biodegradation in Biomer was observed as uniform pitting and superficial fissuring (<2.0 microm depth) over the implant surface. Biodegradation in Pellethane 2363-80A and Tecoflex EG 80A was observed as severe localized embrittlement of the surface with fissures infiltrating up to 40 microm into the bulk. The chemical changes associated with biodegradation were observed as localized oxidation of the soft segment and hydrolysis of the urethane bonds joining hard and soft segments. Tecoflex EG80A was also found to be susceptible to localized hydrolysis of the urethane bond within the aliphatic hard segment. Biomer showed evidence of a significant non-specific degradation in the non-implanted wet control (37 degrees C phosphate buffered saline at pH 7.3) samples and in the implant bulk.

Chemical stability of polyether urethanes versus polycarbonate urethanes

The relative chemical stability of two commercially available polyurethanes-Pellethane, currently used in biomedical devices, and Corethane, considered as a potential biomaterial-was investigated following aging protocols in hydrolytic and oxidative conditions (HOC, water, hydrogen peroxide, and nitric acid) and in physiological media (PHM, phosphate buffer, lipid dispersion, and bile from human donors). The chemical modifications induced on these polymers were characterized using differential scanning calorimetry (DSC), gel permeation chromatography (GPC), and Fourier transform infrared spectroscopy (FTIR). With the exception of nitric acid, all of the aging media promoted a mild hydrolytic reaction leading to a slight molecular weight loss in both polymers. When aged in water and hydrogen peroxide, Pellethane experienced structural modifications through microdomain phase separation along with an increase of the order within the soft-hard segment domains. The incubation of Pellethane in nitric acid also resulted in an important decrease of the melting temperature of its hard segments with chain scission mechanisms. Moreover, incubation in PHM led to an increase of the order within shorter hard-segment domains. FTIR data revealed the presence of aliphatic amide molecules used as additives on the Pellethane's surface. The incubation of Corethane under the same conditions promoted an almost uniform molecular reorganization through a phase separation between the hard and soft segments as well as an increase of the short-range order within the hard-segment domains. Incubation of this polymer in nitric acid also resulted in a chain scission process that was less pronounced than that measured for the Pellethane samples. Finally, lipid adsorption occurred on the Corethane sample incubated in bile for 120 days. Overall data indicate that polycarbonate urethane presents a greater chemical stability than does polyetherurethane.