Effect of phthalate plasticizer on blood compatibility of polyvinyl chloride

DEHP Nanodroplets Leached From Polyvinyl Chloride IV Bags Promote Aggregation of IVIG and Activate Complement in Human Serum

Concerns regarding the impact of subvisible particulate impurities on the safety and efficacy of therapeutic protein products have led manufacturers to implement strategies to minimize protein aggregation and particle formation during manufacturing, storage, and shipping. However, once these products are released, manufacturers have limited control over product handling. In this work, we investigated the effect of di(2-ethylhexyl) phthalate (DEHP) nanodroplets generated in polyvinyl chloride (PVC) bags of intravenous (IV) saline on the stability and immunogenicity of IV immunoglobulin (IVIG) formulations. We showed that PVC IV bags containing saline can release DEHP droplets into the solution when agitated or transported using a pneumatic tube transportation system in a clinical setting. We next investigated the effects of emulsified DEHP nanodroplets on IVIG stability and immunogenicity. IVIG adsorbed strongly to DEHP nanodroplets, forming a monolayer. In addition, DEHP nanodroplets accelerated IVIG aggregation in agitated samples. The immunogenicity of DEHP nanodroplets and IVIG aggregates generated in these formulations were evaluated using an in vitro assay of complement activation in human serum. The results suggested DEHP nanodroplets shed from PVC IV bags could reduce protein stability and induce activation of the complement system, potentially contributing to adverse immune responses during the administration of therapeutic proteins.

Plasticizer endocrine disruption: Highlighting developmental and reproductive effects in mammals and non-mammalian aquatic species

Due to their versatility, robustness, and low production costs, plastics are used in a wide variety of applications. Plasticizers are mixed with polymers to increase flexibility of plastics. However, plasticizers are not covalently bound to plastics, and thus leach from products into the environment. Several studies have reported that two common plasticizers, bisphenol A (BPA) and phthalates, induce adverse health effects in vertebrates; however few studies have addressed their toxicity to non-mammalian species. The aim of this review is to compare the effects of plasticizers in animals, with a focus on aquatic species. In summary, we identified three main chains of events that occur in animals exposed to BPA and phthalates. Firstly, plasticizers affect development by altering both the thyroid hormone and growth hormone axes. Secondly, these chemicals interfere with reproduction by decreasing cholesterol transport through the mitochondrial membrane, leading to reduced steroidogenesis. Lastly, exposure to plasticizers leads to the activation of peroxisome proliferator-activated receptors, the increase of fatty acid oxidation, and the reduction in the ability to cope with the augmented oxidative stress leading to reproductive organ malformations, reproductive defects, and decreased fertility.

Effect of low molecular weight additives on immobilization strength, activity, and conformation of protein immobilized on PVC and UHMWPE

Horseradish peroxidase (HRP) was immobilized onto both plasticized and unplasticized polyvinylchloride (PVC) and ultrahigh molecular weight polyethylene (UHMWPE). Plasma immersion ion implantation (PIII) in a nitrogen plasma with 20 kV bias was used to facilitate covalent immobilization and to improve the wettability of the surfaces. The surfaces and immobilized protein were studied using attenuated total reflection infrared (ATR-IR) spectroscopy and water contact angle measurements. Protein elution on exposure to repeated sodium dodecyl sulfate (SDS) washing was used to assess the strength of HRP immobilization. The presence of low molecular weight components (plasticizer, additives in solvent, unreacted monomers, adsorbed molecules on surface) was found to have a major influence on the strength of immobilization and the conformation of the protein on the samples not exposed to the PIII treatment. A phenomenological model considering interactions between the low molecular weight components, the protein molecule, and the surface is developed to explain these observations.

Biocompatibility of adenoviral vectors in poly(vinyl chloride) tubing catheters with presence or absence of plasticizer di-2-ethylhexyl phthalate

Adenoviral (Ad) vectors feature attractive characteristics for gene therapy of a wide variety of diseases. In many cases, the Ad vector must be administered using catheters and other plastic medical devices. Although poly(vinyl chloride) is one of the most frequently used catheter materials, it is relatively rigid and requires the addition of a plasticizer such as di-2-ethylhexyl phthalate (DEHP) to increase its flexibility. In this study, we demonstrated that exposure to a DEHP-containing catheter decreased the infectivity of Ad vectors but not the total particle number of the vector. Loss of Ad vector infectivity was directly related to the time of exposure to the DEHP-containing catheter, but it was not due to simple leaching of the chemical from the plastic. The loss of Ad vector infectivity could be prevented by preflushing the tube with albumin. Careful consideration of the compatibility between gene therapy vectors and medical delivery devices will be critical to the success of human gene therapy applications.

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

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

Influence on blood of plasticized polyvinyl chloride: significance of the plasticizer

An investigation has been made of the significance of the level of the plasticizer di-(2-ethylhexyl)phthalate at the surface of plasticized polyvinyl chloride for interactions with blood components. Plasticized polyvinyl chloride before and after treatment with methanol to reduce the plasticizer surface level was assessed in terms of fibrinogen and albumin adsorption with unplasticized polyvinyl chloride acting as a control. As the plasticizer surface level decreased, fibrinogen adsorption decreased almost linearly while albumin adsorption increased initially before decreasing slightly. The investigation indicates that reduction in the amount of plasticizer at the surface improves the blood compatibility of plasticized polyvinyl chloride, and the influence on blood is due primarily to the plasticizer rather than the polyvinyl chloride itself.

Blood-contacting biomaterials: bioengineering viewpoints

The investigation of blood-contacting biomaterials is an important challenge and is relevant for an improvement in the clinical application of biomaterials. With the purpose of improved clinical treatment, bioengineering viewpoints of blood-contacting biomaterials cover the material options and selection, the utilization of materials, the development of materials with better properties, and processing characteristics, and the design of relevant evaluation procedures. The bioengineering objective remains that of achieving an enhanced understanding of the relationship between a biomaterial and the biological response.

Surface characterization of heparin-complexing poly(amido amine) chains grafted on polyurethane and glass surfaces

Poly(amido-amine) chains grafted onto polyurethanes and glass form stable complexes with heparin yielding potential nonthrombogenic surfaces. The characterization of the surfaces, and the product of each chemical reaction including final heparinized surfaces, has been studied by contact angle data and scanning electron microscopy (SEM). Air in water, octane in water, and drop-on-plate contact angle data were used to estimate surface (gamma sv) and interfacial (gamma sw) free energies. Solid-water work of adhesion (Wa) and its dispersive (Wda) and polar (Ipsw) components were calculated for all studied surfaces. It has been found that the viscosity of polyurethane solution used for film casting influences wetting properties of these films. It has also been found that a direct correlation exists between the Ipsw/Wda values and the degree of coverage of the surfaces by cellular deposits after their exposure to platelet-rich plasma. Final heparinized polyurethane and glass materials are hydrophilic, their Ipsw/Wda ratio is high, and little or no cellular deposit is observed on their surfaces.

Biological effects of di-(2-ethylhexyl) phthalate and other phthalic acid esters

Esters of o-phthalic acid are widely distributed in the ecosystem. The phthalate acid esters (PAE's) are used as plasticizers in the manufacture of polyvinylchlorides. They are also used as solvents in certain industrial processes and as vehicles for pesticides. The PAE's are used in enormous quantities for a variety of industrial uses in the formulation of plastics. While there are a number of important PAE's, di-ethylhexyl phthalate has perhaps been used the most extensively in the formulation of plastics used in medical devices and blood bag assemblies. The metabolism, biodistribution and excretion varies to some extent among the various PAE's. There are species differences with respect to the metabolism of the PAE's. The route of administration, and the level and length of exposure, are known to affect the toxicological profile of the various PAE's. There is little evidence of bioaccumulation of the various PAE's, and only at very large doses have there been reports of overt toxicity. Evidence for the carcinogenicity of certain PAE's apparently is related to prolonged exposure to high levels.

Prevention of leakage of Di-(2-ethylhexyl)phthalate from blood bags by glow discharge treatment and its effect on aggregability of stored platelets

Platelets storage in glow discharge treated PVC bags was studied. The amount of leaked di-(2-ethylhexyl) phthalate (DEHP) was 150-200 micrograms/ml/day in the nontreated PVC bags, but only 20-40 micrograms/ml in the treated bags after 48 h. The adhesion of silicone to PVC was much improved, and consequently, uniform coating with silicone became feasible. The decrease of the ability of platelets to aggregate was accelerated by DEHP. When stored platelets were resuspended in fresh plasma, the ability to aggregate was gradually restored. However, the degree of restoration of the ability of platelets which had been incubated with DEHP was low. When platelets were stored in the glow discharge treated and then silicone-coated PVC bags, their adhesion on the surface and the decrease of their function were prevented.

Surface modification and evaluation of some commonly used catheter materials. I. Surface properties

Double catheter systems consisting of a stiff outer catheter and a flexible, buoyant, flow-directed, inner catheter which is often balloon-tipped have been employed with increasing frequency recently in both therapeutic and diagnostic procedures. Their use, however, has been restricted because of the excessive friction generated between the two catheters. In an attempt to decrease friction between polymers commonly used as catheter materials, oxidation of polyethylene, fluorinated ethylene-propylene copolymer, poly(vinyl chloride), silicone rubber, and polystyrene surfaces was induced by exposing the polymers to radio frequency glow discharge (RFGD) in a helium environment. All polymers were surface characterized utilizing x-ray photoelectron spectroscopy (XPS), scanning electron microscopy (SEM), and contact angle measurements before and after oxidation. This article describes the materials and methods used to fabricate and characterize the polymer surfaces and the results of the characterization. The results indicate that increases in oxygen concentration at the surface of the polymers and decreases in air-water contact angles occur with increased RFGD exposure time. Plateau values were usually obtained after 5-30 s exposure time, yet no apparent changes in surface topography were noted by scanning electron microscopy. The hydrophilic surfaces produced were stable for up to three months storage time in air.

Diethylhexyl phthalate as a factor in blood transfusion and haemodialysis

Di-2-ethylhexyl phthalate (DEHP), the most frequently occurring plasticiser in medical equipment manufactured from polymers of vinyl chloride, forms about 40% w/w of tubes and containers used for storing blood and for haemodialysis. The plasticiser leaches out into liquids with lipid contents, although it is very sparingly soluble in purely aqueous solutions. On infusion of 2-3 1 of stored blood, up to 200 mg DEHP may be transferred to the patient, while much higher quantities may be given during dialysis, which is moreover often repeated frequently over long periods. The acute toxicity of DEHP is very low (greater than 20 g/kg as LD50 in rats), and the ester is rapidly metabolised to products which are excreted in the urine and bile; chronic toxicity from the levels of dosage obtaining is thus very improbable. Carcenogenicity has never been demonstrable in animals, while teratological effects are of a very low order. Serious acute results observed after transfusion of neonates have not been proved to be caused by DEHP, and might be ascribable to accompanying foreign substances. Atheroma in chronic dialysis subjects is still unexplained, but hepatitis probably caused by diethylphthalate from plastic was resolved when apparatus plasticised by DEHP alone was substituted. The benefits of DEHP appear vastly to outweigh any risks. The status of DEHP as environmental contaminant is noted.