Thermal spray processes influencing surface chemistry and in-vitro hemocompatibility of hydroxyapatite-based orthopedic implants

Orthopedic implants made from titanium are a popular choice in the medical field because of their remarkable strength-to-weight ratio. Nevertheless, they may not interact well with human blood, resulting in thrombosis and hemolysis. In fact, non-hemocompatibility is believed to be responsible for about 31 % of medical device failures in the US alone, requiring painful and expensive revision surgery. To address this issue, bioactive hydroxyapatite coatings are applied to Ti-6Al-4V implants using thermal spray techniques. However, the temperature used during thermal processing impacts the coating's surface properties, affecting the mechanical and biological properties. Furthermore, the effectiveness of HA coatings on titanium for orthopedic applications has not been validated by biocompatibility tests, particularly hemocompatibility. In this study, we aimed to investigate the relative efficacy of three thermal spray processes of different temperature ranges: Atmospheric plasma spray (APS) (high temperature), Flame spray (FS) (moderate temperature), and High-Velocity Oxy-Fuel spray (HVOF) (low temperature), and study their impact on coating's surface properties, affecting blood components and implant's strength. The crystallinity of the HA coating increased by 32 % with a decrease in the operating temperature (APS < FS < HVOF). HVOF coating exhibited a ~ 34 % and ~ 120 % improvement in adhesion strength and ~ 31 % and 59 % increment in hardness compared to APS and FS coating, respectively, attributed to its low porosity, low coating thickness (~55 μm), and high degree of crystallinity. The HVOF coating showcased a significant increase in non-hemolytic behavior, with hemolysis rates ~8 and ~ 11 times lower than APS and FS coatings, respectively, owing to its smooth texture and high degree of crystallinity (p < 0.05). Furthermore, the HVOF coating exhibited minimal blood clotting based on the whole blood clotting assay, again confirmed by PT and aPTT assays showing delayed clotting time, indicating its non-thrombogenic behavior. The number of platelets adhered to the three coatings showed no significant difference compared to Ti-6Al-4V. APS and FS coatings showed low platelet activation, unlike HVOF coating and titanium, which revealed round platelets, similar to the negative control. Neither titanium nor HA coatings exhibited antibacterial properties, which may be due to their high affinity for organic substances, which promotes bacterial adhesion and replication. Among the three thermal processes, HVOF coating displayed good apatite growth, non-hemolytic, and non-thrombogenicity with no platelet activation owing to its low processing temperature, high degree of crystallinity (89.7 %), hydrophilicity, smooth (~4 μm) and dense (~97 %) microstructural properties. The results demonstrated that the HVOF-HA coating presented in this work meets the hemocompatible requirements and shows promise for prospective application as an orthopedic implant. Furthermore, this study has the potential to significantly reduce the use of animals in in-vivo research and improve their welfare while also cutting costs.

Developing a synthetic composite membrane for cleft palate repair

An oronasal fistula is a passage between the oral and nasal cavity. Currently, surgical procedures use mucosal flaps or collagen grafts to make a barrier between oral and nasal cavities. Our aim was to develop a cell-free synthetic repair material for closure of nasal fistulas. We surface functionalized electrospun polyurethane (PU) and poly-L-lactic acid (PLLA) and composite polymer (PU-PLLA) membranes with acrylic acid through plasma polymerization. Membranes were treated in a layer-by-layer approach to develop highly charged electrostatic layer that could bind heparin as a pro-angiogenic glycosaminoglycan. The properties were evaluated through physical, chemical, and mechanical characterization techniques. Cytotoxicity was tested with MC3T3 pre-osteoblast cell lines for 3, 7, and 14 days, and vasculogenesis was assessed by implantation into the chorio-allantoic membrane in chick embryos for 7 days. In vivo biocompatibility was assessed by subcutaneous implantation in rats for 1, 3, and 6 weeks. The membranes consisted of random fibers of PLLA-PU with fiber diameters of 0.47 and 0.12 μm, respectively. Significantly higher cell proliferation and migration of MC3T3 cells at 3, 7, and 14 days were shown on plasma-coated membranes compared with uncoated membranes. Further, it was found that plasma-coated membranes were more angiogenic than controls. In vivo implantation of membranes in rats did not reveal any gross toxicity to the materials, and wound healing was comparable with the native tissue repair (sham group). We therefore present a plasma-functionalized electrospun composite polymer membrane for use in the treatment of fistulas. These membranes are flexible, non-cytotoxic, and angiogenic, and we hope it should lead to permanent closure of oronasal fistula.

Sulfonate Groups and Saccharides as Essential Structural Elements in Heparin-Mimicking Polymers Used as Surface Modifiers: Optimization of Relative Contents for Antithrombogenic Properties

Blood compatibility is a long sought-after goal in biomaterials research, but remains an elusive one, and in spite of extensive work in this area, there is still no definitive information on the relationship between material properties and blood responses such as coagulation and thrombus formation. Materials modified with heparin-mimicking polymers have shown promise and indeed may be seen as comparable to materials modified with heparin itself. In this work, heparin was conceptualized as consisting of two major structural elements: saccharide- and sulfonate-containing units, and polymers based on this concept were developed. Copolymers of 2-methacrylamido glucopyranose, containing saccharide groups, and sodium 4-vinylbenzenesulfonate, containing sulfonate groups, were graft-polymerized on vinyl-functionalized polyurethane (PU) surfaces by free radical polymerization. This graft polymerization method is simple, and the saccharide and sulfonate contents are tunable by regulating the feed ratio of the monomers. Homopolymer-grafted materials, containing only sulfonate or saccharide groups, showed different effects on cell-surface interactions including platelet adhesion, adhesion and proliferation of vascular endothelial cells, and adhesion and proliferation of smooth muscle cells. The copolymer-grafted materials showed effects due to both sulfonate and saccharide elements with respect to blood responses, and the optimum composition was obtained at a 2:1 ratio of sulfonate to saccharide units (material designated as PU-PS1M1). In cell adhesion experiments, this material showed the lowest platelet and human umbilical vein smooth muscle cell density and the highest human umbilical vein endothelial cell density. Among the materials investigated, PU-PS1M1 also had the longest plasma clotting time. This material was thus shown to be multifunctional with a combination of properties, suggesting thromboresistant behavior in blood contact.

2-methoxyethylacrylate modified polyurethane membrane and its blood compatibility

Hydrophilic material 2-methoxyethylacrylate (MEA) was grafted onto polyurethane (PU) membrane via Michael addition reaction. Fourier transform infrared spectroscope (FTIR) and X-ray photoelectron spectroscopy (XPS) characterizations of the modified membrane proved that MEA was successfully grafted onto PU membrane surface. The water contact angle of the modified PU membrane decreased from 86° to 48° compared with unmodified PU membrane, which means that the hydrophilicity of the modified membrane was greatly improved. A series of blood compatibility tests including bovine serum protein adsorption, platelet adhesion, hemolysis assay, plasma recalacification time, prothrombin time (PT), partial thromboplastin time (APTT) and thrombin time (TT) were carried out on PU membrane and the modified PU membrane with highest grafted density of MEA. The combined results indicate that MEA plays an important role in improving the blood compatibility of PU membrane.

A hemocompatible polyurethane surface having dual fibrinolytic and nitric oxide generating functions

Thrombus formation remains a serious problem in developing blood compatible materials. Despite continuous, intensive efforts over many years to prepare surfaces that prevent clotting, such surfaces have not been achieved; indeed it seems that surface-induced clotting is inevitable. An alternative approach is to accept that clotting will occur and to design surfaces so that small, nascent clots will be lysed before they can cause harm. The generation of plasmin, as in the fibrinolytic system, may be adopted for this purpose. The vascular endothelium (the inner surface of intact blood vessels) releases nitric oxide (NO) on a continuous basis. NO protects against platelet activation and aggregation, and also has an anti-proliferative effect on smooth muscle cells (SMCs). Based on these two important functions of the vascular system, the approach of constructing a fibrinolytic surface that generates NO is developed in the present work. Poly(oligo(ethylene glycol) methyl ether methacrylate-co-6-amino-2-(2-methacylamido)-hexanoic acid) (poly(OEGMA-co-LysMA)) was attached to a vinyl-functionalized polyurethane (PU) surface by graft polymerization giving a surface (PU-POL) with protein-resistant properties (via poly(OEGMA)) and clot lysing properties (via poly(LysMA)). Selenocystamine, which catalyzes S-nitrosothiol decomposition to generate NO in the vasculature, was then immobilized on the PU-POL surface via covalent attachment. A dual functioning surface with fibrinolytic activity (lysis of nascent clots) and NO releasing ability (inhibition of platelet adhesion and SMC adhesion as well as proliferation) was thereby constructed.

A multifunctional surface for blood contact with fibrinolytic activity, ability to promote endothelial cell adhesion and inhibit smooth muscle cell adhesion

A multifunctional surface with fibrinolytic activity, the ability to promote endothelial cell and inhibit smooth muscle cell adhesion was realized.

A versatile approach towards multi-functional surfaces via covalently attaching hydrogel thin layers

In this study, a robust and straightforward method to covalently attach multi-functional hydrogel thin layers onto substrates was provided. In our strategy, double bonds were firstly introduced onto substrates to provide anchoring points for hydrogel layers, and then hydrogel thin layers were prepared via surface cross-linking copolymerization of the immobilized double bonds with functional monomers. Sulfobetaine methacrylate (SBMA), sodium allysulfonate (SAS), and methyl acryloyloxygen ethyl trimethyl ammonium chloride (METAC) were selected as functional monomers to form hydrogel layers onto polyether sulfone (PES) membrane surfaces, respectively. The thickness of the formed hydrogel layers could be controlled, and the layers showed excellent long-term stability. The PSBMA hydrogel layer exhibited superior antifouling property demonstrated by undetectable protein adsorption and excellent bacteria resistant property; after attaching PSAS hydrogel layer, the membrane showed incoagulable surface property when contacting with blood confirmed by the activated partial thromboplastin time (APTT) value exceeding 600s; while, the PMETAC hydrogel thin layer could effectively kill attached bacteria. The proposed method provides a new platform to directly modify material surfaces with desired properties, and thus has great potential to be widely used in designing materials for blood purification, drug delivery, wound dressing, and intelligent biosensors.

APTES assisted surface heparinization of polylactide porous membranes for improved hemocompatibility

The Hep-APTES/PLA was synthesized through the amidation reaction and results showed that surface heparinization significantly improved the hemocompatibility of PLA porous membrane.

Well-defined polyurethane-graft-poly(N,N-dimethylacrylamide) copolymer with a controlled graft density and grafted chain length: synthesis and its application as a Pickering emulsion

Well-defined PU-g-PDMA graft copolymers with controlled graft densities and grafted chain lengths could be facilely synthesized by combining the polyaddition reaction with the RAFT polymerization.

Substrate-independent, Schiff base interactions to fabricate lysine-functionalized surfaces with fibrinolytic activity

We demonstrated a simple, substrate-independent approach for the fabrication of lysine-ligand functionalized surfaces with fibrinolytic activity under physiological conditions.

Graphene as a chain extender of polyurethanes for biomedical applications

Chemically tagged graphene nanohybrid for a controlled drug delivery vehicle.

Grafting of phosphorylcholine functional groups on polycarbonate urethane surface for resisting platelet adhesion

In order to improve the resistance of platelet adhesion on material surface, 2-methacryloyloxyethyl phosphorylcholine (MPC) was grafted onto polycarbonate urethane (PCU) surface via Michael reaction to create biomimetic structure. After introducing primary amine groups via coupling tris(2-aminoethyl)amine (TAEA) onto the polymer surface, the double bond of MPC reacted with the amino group to obtain MPC modified PCU. The modified surface was characterized by Fourier transform infrared (FTIR) spectroscopy and X-ray photoelectron spectroscopy (XPS). The results verified that MPC was grafted onto PCU surface by Michael reaction method. The MPC grafted PCU surface had a low water contact angle and a high water uptake. This means that the hydrophilic PC functional groups improved the surface hydrophilicity significantly. In addition, surface morphology of MPC grafted PCU film was imaged by atomic force microscope (AFM). The results showed that the grafted surface was rougher than the blank PCU surface. In addition, platelet adhesion study was evaluated by scanning electron microscopy (SEM) observation. The PCU films after treated with platelet-rich plasma demonstrated that much fewer platelets adhered to the MPC-grafted PCU surface than to the blank PCU surface. The antithrombogenicity of the MPC-grafted PCU surface was determined by the activated partial thromboplastin time (APTT). The result suggested that the MPC modified PCU may have potential application as biomaterials in blood-contacting and some subcutaneously implanted devices.

Tissue plasminogen activator-containing polyurethane surfaces for fibrinolytic activity

With the aim of minimizing thrombus formation in blood-contacting devices, tissue plasminogen activator (t-PA)-containing polyurethane (PU) materials have been developed. Cationic PU surfaces were prepared by grafting poly(dimethylaminoethyl methacrylate) and quaternizing the tertiary amino groups with iodomethane or 1,6-diiodohexane or α,α'-dichloro-p-xylene. The surfaces were characterized by water contact angles and X-ray photoelectron spectroscopy. The materials (PU-CH(3)I, PU-I(CH(2))(6)I, PU-Cl) were treated with t-PA in Tris-buffered saline (pH 9.0) to give t-PA-loaded PU surfaces. The t-PA content of the surfaces was determined using radiolabeled t-PA. The quantities of t-PA taken up by the cationic surfaces were significantly greater than on the unmodified PU: approximately 14-fold greater for PU-Cl, 10-fold for PU-CH(3)I and 13-fold for PU-I(CH(2))(6)I. The activity of the bound t-PA, as measured by a plasma clotting-dissolution assay and a chromogenic substrate assay, was similar to that of normal, unbound t-PA. Release of t-PA from these materials in contact with plasma was measured using the labeled protein and was found to be the most rapid on the PU-CH(3)I material. This approach may have potential for the development of surfaces which can lyse clots that begin to form on them.

Lysine-poly(2-hydroxyethyl methacrylate) modified polyurethane surface with high lysine density and fibrinolytic activity

We have developed a potentially fibrinolytic surface in which a bioinert polymer is used as a spacer to immobilize lysine such that the ε-amino group is free to capture plasminogen when in contact with blood. Adsorbed plasminogen can be activated to plasmin and potentially dissolve nascent clots formed on the surface. In previous work lysine was immobilized through a poly(ethylene glycol) (PEG) spacer; however, the graft density of PEG was limited and the resulting adsorbed quantity of plasminogen was insufficient to dissolve clots efficiently. The aim of the present work was to optimize the surface using graft-polymerized poly(2-hydroxyethyl methacrylate) (poly(HEMA)) as a spacer to increase the grafting density of lysine. Such a poly(HEMA)-lysine modified polyurethane (PU) surface is expected to have increased plasminogen binding capacity and clot lysing efficiency compared with PEG-lysine modified PU. A lysine density of 2.81 nmol cm(-2) was measured on the PU-poly(HEMA)-Lys surface vs. 0.76 nmol cm(-2) on a comparable PU-PEG-Lys surface reported previously. The poly(HEMA)-lysine-modified surface was shown to reduce non-specific (fibrinogen) adsorption while binding plasminogen from plasma with high affinity. With increased plasminogen binding capacity these surfaces showed more rapid clot lysis (20 min) in a standard in vitro assay than the corresponding PEG-lysine system (40 min). The data suggest that poly(HEMA) is superior to PEG when used as a spacer in the immobilization of bioactive molecules at high density. This method of modification may also provide a generic approach for preparing bioactive PU surfaces of high activity and low non-specific adsorption of proteins.