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Capuani S, Malgir G, Chua CYX, Grattoni A. Advanced Strategies to Thwart Foreign Body Response to Implantable Devices. Bioeng Transl Med 2022; 7:e10300. [PMID: 36176611 PMCID: PMC9472022 DOI: 10.1002/btm2.10300] [Citation(s) in RCA: 27] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Revised: 01/21/2022] [Accepted: 01/24/2022] [Indexed: 11/10/2022] Open
Abstract
Mitigating the foreign body response (FBR) to implantable medical devices (IMDs) is critical for successful long‐term clinical deployment. The FBR is an inevitable immunological reaction to IMDs, resulting in inflammation and subsequent fibrotic encapsulation. Excessive fibrosis may impair IMDs function, eventually necessitating retrieval or replacement for continued therapy. Therefore, understanding the implant design parameters and their degree of influence on FBR is pivotal to effective and long lasting IMDs. This review gives an overview of FBR as well as anti‐FBR strategies. Furthermore, we highlight recent advances in biomimetic approaches to resist FBR, focusing on their characteristics and potential biomedical applications.
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Affiliation(s)
- Simone Capuani
- Department of Nanomedicine Houston Methodist Research Institute Houston TX USA
- University of Chinese Academy of Science (UCAS) 19 Yuquan Road Beijing China
| | - Gulsah Malgir
- Department of Nanomedicine Houston Methodist Research Institute Houston TX USA
- Department of Biomedical Engineering University of Houston Houston TX USA
| | | | - Alessandro Grattoni
- Department of Nanomedicine Houston Methodist Research Institute Houston TX USA
- Department of Surgery Houston Methodist Hospital Houston TX USA
- Department of Radiation Oncology Houston Methodist Hospital Houston TX USA
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Joseph JI. Review of the Long-Term Implantable Senseonics Continuous Glucose Monitoring System and Other Continuous Glucose Monitoring Systems. J Diabetes Sci Technol 2021; 15:167-173. [PMID: 32345047 PMCID: PMC7783000 DOI: 10.1177/1932296820911919] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
The article published by Kevin Cowart in this issue of the Journal of Diabetes Science and Technology (JDST) is a detailed overview of the clinical trial data and analysis used to demonstrate the safety and effectiveness of the Eversense continuous glucose monitoring (CGM) System for regulatory approval and clinical acceptance. The article describes the published study results for safety, accuracy, reliability, ease of insertion/removal, adverse events, and ease of diabetes patient-use for controlling their glucose levels short and long term. The author nicely compares Eversense CGM System safety and performance with the short-term subcutaneous tissue CGM systems being commercialized by Dexcom, Medtronic Diabetes, and Abbott Diabetes. This comparison may help the clinician define which type of patient with diabetes might benefit the most from the long-term implantable CGM system. The majority of studied patients describe a positive experience managing their diabetes with the Eversense CGM System and request implantation of a new sensor 90 or 180 days later.
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Affiliation(s)
- Jeffrey I. Joseph
- Jeffrey I. Joseph, DO, Department of Anesthesiology, Sidney Kimmel Medical College, Jefferson Artificial Pancreas Center, Thomas Jefferson University, 1020 Locust Street, JAH # 565, Philadelphia, PA 19072, USA.
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Mantz A, Rosenthal A, Farris E, Kozisek T, Bittrich E, Nazari S, Schubert E, Schubert M, Stamm M, Uhlmann P, Pannier AK. Free Polyethylenimine Enhances Substrate-Mediated Gene Delivery on Titanium Substrates Modified With RGD-Functionalized Poly(acrylic acid) Brushes. Front Chem 2019; 7:51. [PMID: 30792979 PMCID: PMC6374293 DOI: 10.3389/fchem.2019.00051] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Accepted: 01/18/2019] [Indexed: 01/08/2023] Open
Abstract
Substrate mediated gene delivery (SMD) is a method of immobilizing DNA complexes to a substrate via covalent attachment or nonspecific adsorption, which allows for increased transgene expression with less DNA compared to traditional bolus delivery. It may also increase cells receptivity to transfection via cell-material interactions. Substrate modifications with poly(acrylic) acid (PAA) brushes may improve SMD by enhancing substrate interactions with DNA complexes via tailored surface chemistry and increasing cellular adhesion via moieties covalently bound to the brushes. Previously, we described a simple method to graft PAA brushes to Ti and further demonstrated conjugation of cell adhesion peptides (i.e., RGD) to the PAA brushes to improve biocompatibility. The objective of this work was to investigate the ability of Ti substrates modified with PAA-RGD brushes (PAA-RGD) to immobilize complexes composed of branched polyethyleneimine and DNA plasmids (bPEI-DNA) and support SMD in NIH/3T3 fibroblasts. Transfection in NIH/3T3 cells cultured on bPEI-DNA complexes immobilized onto PAA-RGD substrates was measured and compared to transfection in cells cultured on control surfaces with immobilized complexes including Flat Ti, PAA brushes modified with a control peptide (RGE), and unmodified PAA. Transfection was two-fold higher in cells cultured on PAA-RGD compared to those cultured on all control substrates. While DNA immobilization measured with radiolabeled DNA indicated that all substrates (PAA-RGD, unmodified PAA, Flat Ti) contained nearly equivalent amounts of loaded DNA, ellipsometric measurements showed that more total mass (i.e., DNA and bPEI, both complexed and free) was immobilized to PAA and PAA-RGD compared to Flat Ti. The increase in adsorbed mass may be attributed to free bPEI, which has been shown to improve transfection. Further transfection investigations showed that removing free bPEI from the immobilized complexes decreased SMD transfection and negated any differences in transfection success between cells cultured on PAA-RGD and on control substrates, suggesting that free bPEI may be beneficial for SMD in cells cultured on bPEI-DNA complexes immobilized on PAA-RGD grafted to Ti. This work demonstrates that substrate modification with PAA-RGD is a feasible method to enhance SMD outcomes on Ti and may be used for future applications such as tissue engineering, gene therapy, and diagnostics.
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Affiliation(s)
- Amy Mantz
- Department of Biological Systems Engineering, University of Nebraska-Lincoln, Lincoln, NE, United States
- Center for Nanohybrid Functional Materials, University of Nebraska-Lincoln, Lincoln, NE, United States
| | - Alice Rosenthal
- Leibniz-Institut für Polymerforschung Dresden e.V., Dresden, Germany
- Institute of Polymeric Materials, Technische Universität Dresden, Dresden, Germany
| | - Eric Farris
- Department of Biological Systems Engineering, University of Nebraska-Lincoln, Lincoln, NE, United States
| | - Tyler Kozisek
- Department of Biological Systems Engineering, University of Nebraska-Lincoln, Lincoln, NE, United States
| | - Eva Bittrich
- Leibniz-Institut für Polymerforschung Dresden e.V., Dresden, Germany
| | - Saghar Nazari
- Leibniz-Institut für Polymerforschung Dresden e.V., Dresden, Germany
| | - Eva Schubert
- Center for Nanohybrid Functional Materials, University of Nebraska-Lincoln, Lincoln, NE, United States
- Department of Electrical and Computer Engineering, University of Nebraska-Lincoln, Lincoln, NE, United States
| | - Mathias Schubert
- Center for Nanohybrid Functional Materials, University of Nebraska-Lincoln, Lincoln, NE, United States
- Leibniz-Institut für Polymerforschung Dresden e.V., Dresden, Germany
- Department of Electrical and Computer Engineering, University of Nebraska-Lincoln, Lincoln, NE, United States
- Department of Physics, Chemistry, and Biology, Linkoping University, Linkoping, Sweden
- Terahertz Materials Analysis Center (THeMAC), Linkoping University, Linkoping, Sweden
| | - Manfred Stamm
- Leibniz-Institut für Polymerforschung Dresden e.V., Dresden, Germany
- Institute of Polymeric Materials, Technische Universität Dresden, Dresden, Germany
| | - Petra Uhlmann
- Leibniz-Institut für Polymerforschung Dresden e.V., Dresden, Germany
- Department of Chemistry, University of Nebraska-Lincoln, Lincoln, NE, United States
| | - Angela K. Pannier
- Department of Biological Systems Engineering, University of Nebraska-Lincoln, Lincoln, NE, United States
- Center for Nanohybrid Functional Materials, University of Nebraska-Lincoln, Lincoln, NE, United States
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Reduction of measurement noise in a continuous glucose monitor by coating the sensor with a zwitterionic polymer. Nat Biomed Eng 2018; 2:894-906. [PMID: 30931173 PMCID: PMC6436621 DOI: 10.1038/s41551-018-0273-3] [Citation(s) in RCA: 97] [Impact Index Per Article: 16.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Continuous glucose monitors (CGMs), used by patients with diabetes mellitus, can autonomously track fluctuations in blood glucose over time. However, the signal produced by CGMs during the initial recording period following sensor implantation contains substantial noise, requiring frequent recalibration via fingerprick tests. Here, we show that coating the sensor with a zwitterionic polymer, found via a combinatorial-chemistry approach, significantly reduces signal noise and improves CGM performance. We evaluated the polymer-coated sensors in mice as well as in healthy and diabetic non-human primates, and show that the sensors accurately record glucose levels without the need for recalibration. We also show that the polymer-coated sensors significantly abrogated immune responses to the sensor, as indicated by histology, fluorescent whole-body imaging of inflammation-associated protease activity, and gene expression of inflammation markers. The polymer coating may allow CGMs to become standalone measuring devices.
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Joseph JI, Eisler G, Diaz D, Khalf A, Loeum C, Torjman MC. Glucose Sensing in the Subcutaneous Tissue: Attempting to Correlate the Immune Response with Continuous Glucose Monitoring Accuracy. Diabetes Technol Ther 2018; 20:321-324. [PMID: 29792751 PMCID: PMC6110119 DOI: 10.1089/dia.2018.0106] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Affiliation(s)
- Jeffrey I Joseph
- Department of Anesthesiology, Jefferson Artificial Pancreas Center, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania
- Address correspondence to:Jeffrey I Joseph, DODepartment of AnesthesiologyJefferson Artificial Pancreas CenterSidney Kimmel Medical CollegeThomas Jefferson UniversityJefferson Alumni Hall # 5651020 Locust StreetPhiladelphia, PA 19107
| | - Gabriella Eisler
- Department of Anesthesiology, Jefferson Artificial Pancreas Center, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - David Diaz
- Department of Anesthesiology, Jefferson Artificial Pancreas Center, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Abdurizzagh Khalf
- Department of Anesthesiology, Jefferson Artificial Pancreas Center, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania
| | | | - Marc C. Torjman
- Department of Anesthesiology, Jefferson Artificial Pancreas Center, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania
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Rigla M, Pons B, Rebasa P, Luna A, Pozo FJ, Caixàs A, Villaplana M, Subías D, Bella MR, Combalia N. Human Subcutaneous Tissue Response to Glucose Sensors: Macrophages Accumulation Impact on Sensor Accuracy. Diabetes Technol Ther 2018; 20:296-302. [PMID: 29470128 DOI: 10.1089/dia.2017.0321] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Subcutaneous (s.c.) glucose sensors have become a key component in type 1 diabetes management. However, their usability is limited by the impact of foreign body response (FBR) on their duration, reliability, and accuracy. Our study gives the first description of human acute and subacute s.c. response to glucose sensors, showing the changes observed in the sensor surface, the inflammatory cells involved in the FBR and their relationship with sensor performance. METHODS Twelve obese patients (seven type 2 diabetes) underwent two abdominal biopsies comprising the surrounding area where they had worn two glucose sensors: the first one inserted 7 days before and the second one 24 h before biopsy procedure. Samples were processed and studied to describe tissue changes by two independent pathologists (blind regarding sensor duration). Macrophages quantification was studied by immunohistochemistry methods in the area surrounding the sensor (CD68, CD163). Sensor surface changes were studied by scanning electron microscopy. Seven-day continuous glucose monitoring records were considered inaccurate when mean absolute relative difference was higher than 10%. RESULTS Pathologists were able to correctly classify all the biopsies regarding sensor duration. Acute response (24 h) was characterized by the presence of neutrophils while macrophages were the main cell involved in subacute inflammation. The number of macrophages around the insertion hole was higher for less accurate sensors compared with those performing more accurately (32.6 ± 14 vs. 10.6 ± 1 cells/0.01 mm2; P < 0.05). CONCLUSION The accumulation of macrophages at the sensor-tissue interface is related with decrease in accuracy of the glucose measure.
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Affiliation(s)
- Mercedes Rigla
- 1 Endocrinology Department, Parc Taulí Sabadell University Hospital, Institut d'Investigacio i Innovació Parc Taulí, Autonomous University of Barcelona , Barcelona, Spain
| | - Belén Pons
- 1 Endocrinology Department, Parc Taulí Sabadell University Hospital, Institut d'Investigacio i Innovació Parc Taulí, Autonomous University of Barcelona , Barcelona, Spain
| | - Pere Rebasa
- 2 General Surgery Department, Parc Taulí Sabadell University Hospital, Institut d'Investigacio i Innovació Parc Taulí, Autonomous University of Barcelona , Barcelona, Spain
| | - Alexis Luna
- 2 General Surgery Department, Parc Taulí Sabadell University Hospital, Institut d'Investigacio i Innovació Parc Taulí, Autonomous University of Barcelona , Barcelona, Spain
| | - Francisco Javier Pozo
- 3 Pathology Department, Parc Taulí Sabadell University Hospital, Institut d'Investigacio i Innovació Parc Taulí, Autonomous University of Barcelona , Barcelona, Spain
| | - Assumpta Caixàs
- 1 Endocrinology Department, Parc Taulí Sabadell University Hospital, Institut d'Investigacio i Innovació Parc Taulí, Autonomous University of Barcelona , Barcelona, Spain
| | - Maria Villaplana
- 1 Endocrinology Department, Parc Taulí Sabadell University Hospital, Institut d'Investigacio i Innovació Parc Taulí, Autonomous University of Barcelona , Barcelona, Spain
| | - David Subías
- 1 Endocrinology Department, Parc Taulí Sabadell University Hospital, Institut d'Investigacio i Innovació Parc Taulí, Autonomous University of Barcelona , Barcelona, Spain
| | - Maria Rosa Bella
- 3 Pathology Department, Parc Taulí Sabadell University Hospital, Institut d'Investigacio i Innovació Parc Taulí, Autonomous University of Barcelona , Barcelona, Spain
| | - Neus Combalia
- 3 Pathology Department, Parc Taulí Sabadell University Hospital, Institut d'Investigacio i Innovació Parc Taulí, Autonomous University of Barcelona , Barcelona, Spain
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Klueh U, Czajkowski C, Ludzinska I, Qiao Y, Frailey J, Kreutzer DL. Impact of CCL2 and CCR2 chemokine/receptor deficiencies on macrophage recruitment and continuous glucose monitoring in vivo. Biosens Bioelectron 2016; 86:262-269. [PMID: 27376197 DOI: 10.1016/j.bios.2016.06.026] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2016] [Revised: 05/26/2016] [Accepted: 06/10/2016] [Indexed: 01/11/2023]
Abstract
The accumulation of macrophages (MΦ) at the sensor-tissue interface is thought to be a major player in controlling tissue reactions and sensor performance in vivo. Nevertheless until recently no direct demonstration of the causal relationship between MΦ aggregation and loss of sensor function existed. Using a Continuous Glucose Monitoring (CGM) murine model we previously demonstrated that genetic deficiencies of MΦ or depletion of MΦ decreased MΦ accumulation at sensor implantation sites, which led to significantly enhanced CGM performance, when compared to normal mice. Additional studies in our laboratories have also demonstrated that MΦ can act as "metabolic sinks" by depleting glucose levels at the implanted sensors in vitro and in vivo. In the present study we extended these observations by demonstrating that MΦ chemokine (CCL2) and receptor (CCR2) knockout mice displayed a decrease in inflammation and MΦ recruitment at sensor implantation sites, when compared to normal mice. This decreased MΦ recruitment significantly enhanced CGM performance when compared to control mice. These studies demonstrated the importance of the CCL2 family of chemokines and related receptors in MΦ recruitment and sensor performance and suggest chemokine targets for enhancing CGM in vivo.
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Affiliation(s)
- Ulrike Klueh
- Center for Molecular Tissue Engineering, University of Connecticut, School of Medicine, Farmington, CT 06030, USA; Department of Surgery, University of Connecticut, School of Medicine, Farmington, CT 06030, USA.
| | - Caroline Czajkowski
- Center for Molecular Tissue Engineering, University of Connecticut, School of Medicine, Farmington, CT 06030, USA; Department of Surgery, University of Connecticut, School of Medicine, Farmington, CT 06030, USA
| | - Izabela Ludzinska
- Center for Molecular Tissue Engineering, University of Connecticut, School of Medicine, Farmington, CT 06030, USA; Department of Surgery, University of Connecticut, School of Medicine, Farmington, CT 06030, USA
| | - Yi Qiao
- Center for Molecular Tissue Engineering, University of Connecticut, School of Medicine, Farmington, CT 06030, USA; Department of Surgery, University of Connecticut, School of Medicine, Farmington, CT 06030, USA
| | - Jackman Frailey
- Center for Molecular Tissue Engineering, University of Connecticut, School of Medicine, Farmington, CT 06030, USA; Department of Surgery, University of Connecticut, School of Medicine, Farmington, CT 06030, USA
| | - Donald L Kreutzer
- Center for Molecular Tissue Engineering, University of Connecticut, School of Medicine, Farmington, CT 06030, USA; Department of Surgery, University of Connecticut, School of Medicine, Farmington, CT 06030, USA
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Lymphangiogenesis and Inflammation-Looking for the "Missing Pieces" of the Puzzle. Arch Immunol Ther Exp (Warsz) 2015; 63:415-26. [PMID: 26169947 DOI: 10.1007/s00005-015-0349-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2015] [Accepted: 04/27/2015] [Indexed: 10/23/2022]
Abstract
Several papers about lymphangiogenesis and inflammation focused on the detailed and complicated descriptions of the molecular pathways accompanying both non-tumor and tumor inflammatory-induced lymphatic vessel development. Many authors are tempted to present inflammatory-induced lymphangiogenesis in pathologic conditions neglecting the role of inflammatory cells during embryonic lymphatic vessel development. Some of the inflammatory cells are largely characterized in inflammatory-induced lymphangiogenesis, while others as mast cells, eosinophils, or plasma cells are less studied. No phenotypic characterization of inflammation-activated lymphatic endothelial cell is available in this moment. Another paradox is related to the existence of few papers regarding lymphangiogenesis inside lymphoid organs and for their related pathology. There are still several "missing pieces of such a big puzzle" of lymphangiogenesis and inflammation, with a direct impact on the ineffectiveness of the anti-inflammatory therapy as lymphangiogenesis inhibitors. The present paper will focus on the controversial issues of lymphangiogenesis and inflammation.
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Cell based metabolic barriers to glucose diffusion: macrophages and continuous glucose monitoring. Biomaterials 2014; 35:3145-53. [PMID: 24461328 DOI: 10.1016/j.biomaterials.2014.01.001] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2013] [Accepted: 01/01/2014] [Indexed: 12/27/2022]
Abstract
It is assumed that MQ are central to glucose sensor bio-fouling and therefore have a major negative impact on continuous glucose monitoring (CGM) performance in vivo. However to our knowledge there is no data in the literature to directly support or refute this assumption. Since glucose and oxygen (O2) are key to glucose sensor function in vivo, understanding and controlling glucose and O2 metabolic activity of MQ is likely key to successful glucose sensor performance. We hypothesized that the accumulation of MQ at the glucose sensor-tissue interface will act as "Cell Based Metabolic Barriers" (CBMB) to glucose diffusing from the interstitial tissue compartment to the implanted glucose sensor and as such creating an artificially low sensor output, thereby compromising sensor function and CGM. Our studies demonstrated that 1) direct injections of MQ at in vivo sensor implantation sites dramatically decreased sensor output (measured in nA), 2) addition of MQ to glucose sensors in vitro resulted in a rapid and dramatic fall in sensor output and 3) lymphocytes did not affect sensor function in vitro or in vivo. These data support our hypothesis that MQ can act as metabolic barriers to glucose and O2 diffusion in vivo and in vitro.
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