Experimental evaluation of a gelatin-coated polyester graft used as an arterial substitute

A Bioinspired Gelatin-Amorphous Calcium Phosphate Coating on Titanium Implant for Bone Regeneration

Biocompatible and bio-active coatings can enhance and accelerate osseointegration via chemical binding onto substrates. Amorphous calcium phosphate (ACP) has been shown as a precursor to achieve mineralization in vertebrates and invertebrates under the control of biological macromolecules. This work presents a simple bioinspired Gelatin-CaPO4 (Gel-CaP) composite coating on titanium surfaces to improve osseointegration. The covalently bound Gel-CaP composite is characterized as an ACP-Gel compound via SEM, FT-IR, XRD, and HR-TEM. The amorphous compound coating exhibits a nanometer range thickness and improved elastic modulus, good wettability, and nanometric roughness. The amount of grafted carboxyl groups and theoretical thickness of the coatings are also investigated. More importantly, MC3T3 cells, an osteoblast cell line, show excellent cell proliferation and adhesion on the Gel-CaP coating. The level of osteogenic genes is considerably upregulated on Ti with Gel-CaP coatings compared to uncoated Ti, demonstrating that Gel-CaP coatings possess a unique osteogenic ability. To conclude, this work offers a new perspective on functional, bioactive titanium coatings, and Gel-CaP composites can be a low-cost and promising candidate in bone regeneration.

18-Fluorodeoxyglucose positron emission tomography in the diagnosis of prosthetic aortic graft infection: the difference between open and endovascular repair

OBJECTIVES

18-Fluorodeoxyglucose (18F-FDG) positron emission tomography (PET)/computed tomography (CT) has been reported as useful for diagnosing aortic graft infection. However, 18F-FDG uptake may depend upon various factors including open versus endovascular repair and time from surgery. We aimed to elucidate the factors influencing its uptake and the diagnostic value of 18F-FDG PET/CT after open and endovascular repair.

METHODS

Hospital database of PET/CT (N = 14 490) and our departmental database were cross-checked to identify those who underwent 18F-FDG PET/CT after aortic repair. Patient's data were retrieved from the chart. Images were reviewed by 2 nuclear medicine specialists in consensus, and the presence of increased 18F-FDG uptake was recorded. The maximum standardized uptake value (SUV max) was measured.

RESULTS

Among the 1112 patients who underwent aortic repair between 2011 and 2022, 71 patients were identified. Eighteen patients underwent 18F-FDG PET/CT for suspected graft infection and the remaining 53 patients for other purposes (malignancy, etc.). Fourteen patients were treated as aortic graft infection. They had significantly higher SUV max than those without graft infection [mean 8.64 (standard deviation 2.78) vs 3.40 (standard deviation 0.84); P < 0.01]. In the non-infected grafts, SUV max was higher early after open surgical repair, while it remained low after endovascular repair.

CONCLUSIONS

After endovascular aortic repair, a constant cut-off value of 'SUV max = 4.5' seems appropriate for diagnosing graft infection, since it remains low and stable from the early postoperative period. After open surgical repair, it seems acceptable to have 'stepwise cut-off value' depending on the time from surgery.

Emulsion electrospun nanofibers as substrates for cardiomyogenic differentiation of mesenchymal stem cells

The potential of cardiomyogenic differentiation of human mesenchymal stem cells (hMSCs) on emulsion electrospun scaffold containing poly(L-lactic acid)-co-poly-(ε-caprolactone), gelatin and vascular endothelial growth factor (PLCL/GV) was investigated in this study. The characterizations of the scaffold were carried out using scanning electron microscope (SEM), transmission electron microscope, water contact angle and porometer. The proliferation of hMSCs showed that 73.4% higher cell proliferation on PLCL/GV scaffolds than that on PLCL scaffold after 20 days of cell culture. Results of 5-chloromethylfluorescein diacetate staining and SEM morphology analysis indicated that hMSCs differentiated on PLCL/GV scaffolds showed irregular morphology of cardiomyocyte phenotype compared to the typical long and thin hMSC phenotype. Immunostaining results showed the expression of alpha actinin and myosin heavy chain. Our studies identified emulsion electrospinning as a method for fabrication of core-shell fibers suitable for the differentiation of stem cells to cardiac cells, with potential application in cardiac regeneration.

Poly(Glycerol sebacate)/gelatin core/shell fibrous structure for regeneration of myocardial infarction

Heart failure remains the leading cause of death in many industrialized nations owing to the inability of the myocardial tissue to regenerate. The main objective of this work was to develop a cardiac patch that is biocompatible and matches the mechanical properties of the heart muscle for myocardial infarction. The present study was to fabricate poly (glycerol sebacate)/gelatin (PGS/gelatin) core/shell fibers and gelatin fibers alone by electrospinning for cardiac tissue engineering. PGS/gelatin core/shell fibers, PGS used as a core polymer to impart the mechanical properties and gelatin as a shell material to achieve favorable cell adhesion and proliferation. These core/shell fibers were characterized by scanning electron microscopy, contact angle, Fourier transform infrared spectroscopy, and tensile testing. The cell-scaffold interactions were analyzed by cell proliferation, confocal analysis for the expression of marker proteins like actinin, troponin-T, and platelet endothelial cell adhesion molecule, and scanning electron microscopy to analyze cell morphology. Dual immunofluorescent staining was performed to further confirm the cardiogenic differentiation of mesenchymal stem cells by employing mesenchymal stem cell-specific marker protein CD 105 and cardiac-specific marker protein actinin. The results observed that PGS/gelatin core/shell fibers have good potential biocompatibility and mechanical properties for fabricating nanofibrous cardiac patch and would be a prognosticating device for the restoration of myocardium.

Factors of osteogenesis influencing various human stem cells on third-generation gelatin/β-tricalcium phosphate scaffold material

Human bone marrow-derived stem cells (hBMSCs) and adipose-derived stem cells (hASCs) have been used to regenerate bone. Both sources are claimed to have comparable osteogenic potential, but few comparative studies are available. Third-generation biomaterials have been developed to reduce steps in regenerating tissues. For osteogenesis gelatin/β-tricalcium phosphate (β-TCP) scaffolds with incorporated controlled-release bone morphogenetic protein-2 (BMP-2) as third-generation biomaterials were recently developed. So far, few studies on protein-induced osteogenesis versus chemical-induced osteogenesis have been performed. This study evaluates the osteogenic potential of hBMSCs versus hASCs derived on gelatin/β-TCP scaffolds in vitro under four different conditions. Gelatin/β-TCP scaffolds with and without incorporated controlled-release BMP-2 were seeded with hBMSCs or hASCs under oscillating fluid conditions in osteogenic (OS) medium or growth medium (GM). All were evaluated radiologically (computed tomography [CT] scan), histologically, biomechanically, and for gene expression at 1, 2, 4, and 6 weeks. The highest radiological densities were seen in specimens at 6 weeks with controlled-release BMP-2, close to native bone. HBMSCs, hASCs, OS, and GM conditions resulted in similar bone formation with gelatin/β-TCP scaffolds and incorporated controlled-release BMP-2. This was confirmed histologically by Toluidine Blue and van Kossa staining and biomechanically. Gene expression studies of these specimens showed the presence of preosteoblasts, transitory osteoblasts, and secretory osteoblasts. Specimens comprised of gelatin/β-TCP scaffolds without incorporated controlled release BMP-2 in OS medium showed lesser bone formation. hASCs and hBMSCs have similar osteogenic potential. hASCs are an attractive alternative to hBMSCs for bone regeneration using third-generation gelatin/β-TCP scaffolds with incorporated controlled-release BMP-2.

Electrospinning of collagen/biopolymers for regenerative medicine and cardiovascular tissue engineering

The process of electrospinning has seen a resurgence of interest in the last few decades which has led to a rapid increase in the amount of research devoted to its use in tissue engineering applications. Of this research, the area of cardiovascular tissue engineering makes up a large percentage, with substantial resources going towards the creation of bioresorbable vascular grafts composed of electrospun nanofibers of collagen and other biopolymers. These bioresorbable grafts have compositions that allow for the in situ remodeling of the structure, with the eventual replacement of the graft with completely autologous tissue. This review will highlight some of the work done in the field of electrospinning for cardiovascular applications, with an emphasis on the use of biopolymers such as collagens, elastin, gelatin, fibrinogen, and silk fibroin, as well as biopolymers used in combination with resorbable synthetic polymers.

Enhanced osteoinduction by controlled release of bone morphogenetic protein-2 from biodegradable sponge composed of gelatin and β-tricalcium phosphate

Biodegradable gelatin sponges at different contents of beta-tricalcium phosphate (beta-TCP) were fabricated to allow bone morphogenetic protein (BMP)-2 to incorporate into them. The in vivo osteoinduction activity of the sponges incorporating BMP-2 was investigated, while their in vivo profile of BMP-2 release was evaluated. The sponges prepared had an interconnected pore structure with an average pore size of 200 microm, irrespective of the beta-TCP content. The in vivo release test revealed that BMP-2 was released in vivo at a similar time profile, irrespective of the beta-TCP content. The in vivo time period of BMP-2 retention was longer than 28 days. When the osteoinduction activity of gelatin or gelatin-beta-TCP sponges incorporating BMP-2 was studied following the implantation into the back subcutis of rats in terms of histological and biochemical examinations, homogeneous bone formation was histologically observed throughout the sponges, although the extent of bone formation was higher in the sponges with the lower contents of beta-TCP. On the other hand, the level of alkaline phosphatase activity and osteocalcin content at the implanted sites of sponges decreased with an increase in the content of beta-TCP. The gelatin sponge exhibited significantly higher osteoinduction activity than that of any gelatin-beta-TCP sponge, although every sponge with or without beta-TCP showed a similar in vivo profile of BMP-2 release. In addition, the in vitro collagenase digestion experiments revealed that the gelatin-beta-TCP sponge collapsed easier than the gelatin sponge without beta-TCP incorporation. These results suggest that the maintenance of the intrasponge space necessary for the osteoinduction is one factor contributing to the osteoinduction extent of BMP-2-incorporating sponges.

Osteogenic differentiation of mesenchymal stem cells in biodegradable sponges composed of gelatin and β-tricalcium phosphate

Biodegradable gelatin sponges incorporating various amounts of beta-tricalcium phosphate (betaTCP) (gelatin-betaTCP) were fabricated and the in vitro osteogenic differentiation of mesenchymal stem cells (MSC) isolated from the rat bone marrow in the sponges was investigated. The gelatin sponges incorporating betaTCP have an interconnected pore structure with the average size of 180-200 microm, irrespective of the betaTCP amount. The stiffness of the sponges became higher with an increase in the amount of betaTCP. When seeded into the sponges by an agitated method, MSC were homogeneously distributed throughout the sponge. The morphology of cells attached got more spreaded with the increased betaTCP amount. The rate of MSC proliferation depended on the betaTCP amount and culture method: the higher the betaTCP amount in the stirring culture, the higher the proliferation rate. The deformed extent of gelatin-betaTCP sponges was suppressed with the increased amount of betaTCP. When measured to evaluate the osteogenic differentiation of MSC, the alkaline phosphatase activity and osteocalcin content became maximum for the sponge with a betaTCP amount of 50 wt%, although both the values were significantly high in the stirring culture compared with those in the static culture. We concluded that the attachment, proliferation, and osteogenic differentiation of MSC were influenced by sponge composition of gelatin and betaTCP as the cell scaffold.

Use of plasma glow for surface-engineering biomolecules to enhance bloodcompatibility of Dacron and PTFE vascular prosthesis

The search for a nonthrombogenic material having patency to be used for small diameter vascular graft applications continues to be a field of extensive investigation. The purpose of the present study was to examine whether surface modification of polytetra fluoroethylene (PTFE, Teflon) and polyethylene-terephthalate (Dacron) vascular grafts might extend graft biocompatibility without modifying the graft structure. A series of surface coatings were prepared by modifying the argon plasma-treated PTFE and Dacron grafts with collagen IV and laminin and subsequently immobilizing bioactive molecules like PGE1, heparin or phosphatidyl choline via the carbodiimide functionalities. Surface analysis by Fourier transform infrared spectroscopy-attenuated total reflectance revealed the presence of new functional groups on the modified graft surfaces. In vitro studies showed that fibrinogen adsorption and platelet adhesion on modified grafts were significantly reduced. This study proposes that surface grafting of matrix components (collagen-type IV and laminin) and subsequent immobilization of bioactive molecules (PGE1, heparin or phosphatidyl choline) changed the surface conditioning of vascular grafts and subsequently improved their biocompatibility. However, more detailed in vivo studies are needed to confirm these observations.

Impregnated polyester arterial prostheses: performance and prospects

Impregnated polyester arterial prostheses have gained wide acceptance by most vascular surgery teams, probably because these prostheses are easy to use, without any preclotting. We offer here a synthesis of the main studies that have appraised the experimental and clinical performance of these prostheses, and we delineate their major prospects.

Implantable bioelectric interfaces for lost nerve functions

Neuronal cells are unique within the organism. In addition to forming long-distance connections with other nerve cells and non-neuronal targets, they lose the ability to regenerate their neurites and to divide during maturation. Consequently, external violations like trauma or disease frequently lead to their disappearance and replacement by non-neuronal, and thus not properly functioning cells. The advent of microtechnology and construction of artificial implants prompted to create particular devices for specialised regions of the nervous system, in order to compensate for the loss of function. The scope of the present work is to review the current devices in connection with their applicability and functional perspectives. (1) Successful implants like the cochlea implant and peripherally implantable stimulators are discussed. (2) Less developed and not yet applicable devices like retinal or cortical implants are introduced, with particular emphasis given to the reasons for their failure to replace very complex functions like vision. (3) Material research is presented both from the technological aspect and from their biocompatibility as prerequisite of any implantation. (4) Finally, basic studies are presented, which deal with methods of shaping the implants, procedures of testing biocompatibility and modification of improving the interfaces between a technical device and the biological environment. The review ends by pointing to future perspectives in neuroimplantation and restoration of interrupted neuronal pathways.

Development and characterization of an alginate-impregnated polyester vascular graft

Alignate gels are known to be biocompatible, degradable, and nontoxic. In this study, sodium alginate was impregnated into a porous, knitted polyester graft (Microvel double velour graft) 6 mm in diameter. The alginate-impregnated graft was investigated in vitro and in vivo to evaluate its potential for use as a new vascular graft impervious to blood, while retaining high porosity for tissue ingrowth and biological healing. For in vitro investigation, the coating weight, water permeability, morphology, and mechanical properties of the alginate-impregnated grafts were compared to those of control or commercially available collagen-impregnated (Hemashield) grafts. The water permeability of the controls (1846 mL/min.cm2 at 120 mm Hg) was reduced > 99% by the alginate impregnation, rendering the graft impervious to blood. The coating weight of the alginate was 45 mg/g of graft, producing a much lower value than that of the collagen-impregnated model (310 mg/g). For in vivo investigation, the alginate-impregnated grafts were implanted in the aorta of mongrel dogs without preclotting for scheduled periods ranging from 4 h to 6 months. The control grafts after preclotting and the collagen-impregnated grafts without preclotting were also implanted for 3 and 6 months for comparison. Gross observation of the explanted grafts and histologic examination of the representative sections were conducted for three types of grafts using a light microscope after hematoxylin-eosin staining. No significant differences were observed between the histologic appearance of the alginate-impregnated grafts and that of the preclotted and collagen-impregnated grafts in terms of the degree of inflammation, foreign-body giant cell reaction, and intimal fibrosis. Endothelial-like cells were present on the midsections of all the grafts after 3 months of implantation. The resorption rate of alginate impregnated into the graft was also examined after staining the sections with periodic acid-Schiff reagent, Toluidine blue, and Alcian blue, which are specific for alginates. The staining alginate was partially visible between the graft fabrics up to 1 month after implantation, but was completely resorbed after 3 months. This preliminary study demonstrated that the use of an alginate as a biological sealant instead of proteins such as collagen, gelatin, and albumin may be a feasible approach to developing imprevious textile arterial prostheses, since the proteins have been reported to be generally unstable, hard to obtain in pure forms, not easy to crosslink and control resorption rate, and difficult to render compatible with standard storage and sterilization procedures.

Blood and cell compatibility of gelatin-carrageenan mixtures cross-linked by glutaraldehyde

Mixtures of gelatin and iota-carrageenan cross-linked by glutaraldehyde were prepared and their physical properties and blood and cell compatibility were compared to gelatin as a control material. According to scanning electron microscopic observation of fracture surfaces, the mixtures were composed of dispersed and continuous domains which might be generated by phase separation of carrageenan. The thermal degradation temperature of iota-carrageenan in the mixtures rose with increasing gelatin content. The swelling process in the mixtures proceeded slower than in gelatin. Tensile strengths of the mixtures, except that containing 50% iota-carrageenan, increased with increased amounts of iota-carrageenan in the mixtures. The iota-carrageenan contents at the surfaces of the mixtures were generally higher than those admixed originally. Static friction coefficients of the mixtures were lower than that of gelatin. Plasma recalcification times of the mixtures were longer than that of gelatin. Platelet adhesion of the mixtures was lower than that of gelatin, while cell adhesion and growth assays using Chinese hamster ovary cells showed that cell adhesion and growth were not dependent on adding iota-carrageenan. It was concluded that blood compatibility of the mixtures increased and cell compatibility did not decrease, compared to gelatin.

Biocompatible coatings for luminal and outer surfaces of small-caliber artificial grafts

Luminal and outer surfaces of small-caliber vascular grafts at an early implantation period may require completely opposite cellular responses: minimal cellular adhesion and fibrin formation for a luminal surface versus potent cellular adhesion and migration and matrix generation for an outer surface. Differentiated biocompatible design of luminal and outer surfaces into small-caliber artificial grafts may lead to successful healing. We molecularly designed photocurable extracellular matrices (ECMs): photocurable chondroitin sulfate (CS) and hyaluronic acid (HA) for the luminal surface coating and photocurable gelatin for the outer surface coating. All of them were partially derivatized with photodimerizable groups such as thymine, cinnamate, and coumarin groups and converted to produce water-insoluble gels upon ultraviolet irradiation. In vitro study showed that platelet adhesion on photogelled CS and HA was significantly reduced, whereas endothelial cells adhered well on photogelled gelatin. These materials were individually coated and photogelled onto respective surfaces of artificial grafts (inner diameter [ID], 5 mm). During acute-phase implantation into dogs for up to 1 week, minimal cell adhesion was observed on the luminal surface, which was uniformly covered by photogelled CS or HA. Heparin impregnation of photocured ECM reduced fibrin formation. On the other hand, enhanced tissue ingrowth was noted at the outer surface. Although these ECM-coated grafts need further improvement in molecular design and coating techniques, photocurable ECMs may contribute to successful healing and a high patency rate of small-caliber artificial grafts.

Carbodiimide cross-linked gelatin: a new coating for porous polyester arterial prostheses

The performance of a polyester arterial prosthesis impregnated with gelatin and cross-linked with carbodiimide (Uni-graft) was compared with its porous parent graft (Protegraft) using a canine thoraco-abdominal bypass model. The grafts were investigated in terms of their handling characteristics, imperviousness at implantation, surface thrombogenicity and healing behaviour. Prostheses 30 cm in length were implanted for the following periods: 4, 24 and 48 h, 1, 2 and 4 weeks, 2, 3, 4, 5 and 6 months. Both types of graft had good handling characteristics. The ready-to-use impregnated graft provided satisfactory haemostasis at implantation with no blood permeating through the wall after flow was restored. Both grafts exhibited low surface thrombogenicity, as determined by the uptake of labelled fibrin and platelets, and the healing sequence of the impregnated graft after resorption of the gelatin was equivalent to that of the preclotted control. Biodegradation of the gelatin was complete within 1 month of implantation with the subsequent development of a collagenous internal capsule at both anastomoses. Endothelial cells were observed between 4 and 6 months, but were confined to small islets distributed along the luminal surface. The prostacyclin/thromboxane A2 (PGI2/TXA2) ratio, which gives an indication of the level of endothelial cell activity, was greater than 1.0 after 1 week of implantation for the control graft. For the impregnated graft it reached 1.0 only after 3 months of implantation, but remained above 1.0 for periods of up to 6 months.(ABSTRACT TRUNCATED AT 250 WORDS)

An ex vivo original test using radiotracers for evaluating haemocompatibility of tubular biomaterials

The haemocompatibility of a vascular prosthesis can be estimated as the result of its interaction with blood components. The authors describe an ex vivo canine shunt for evaluating isotopic haemocompatibility in blood-wall interactions. Methods employing radioisotopic tracers can be used to dynamically monitor the adsorption of labelled blood cells and proteins on different biomaterial surfaces. This ex vivo test should enable materials to be assessed for quality according to two thrombogenic criteria: (i) number of adhered platelets mm-2 s-1; (ii) quantity of adsorbed fibrinogen expressed as microgram mm-2 s-1, which would provide the basis for a scale of haemocompatibility.

A canine ex vivo shunt for isotopic hemocompatibility evaluation of a NHLBI DTB primary reference material and of a IUPAC reference material

Factors determining the thrombogenic response to particular artificial surfaces were investigated ex vivo in a canine shunt model. Methods using radioisotopic tracers made it possible to dynamically monitor the deposition of labelled blood cells and proteins on a NHLBI.DTB primary reference material polydimethylsiloxane (PRM.PDMS) and on a IUPAC reference material polyvinyl chloride (IUPAC.PVC). On the one hand, leukocyte affinity tau s(leu) (number of deposited leukocytes mm-2s-1) was not significantly different between IUPAC.PVC (tau s(leu) = 1.2-2.5) and PRM.PDMS (tau s(leu) = 1.5-3.4) and the fibrinogen adsorption rate varied from 33 to 48.10(-5) micrograms mm-2s-1 for both these materials. On the other hand, platelet affinity tau s(plat) (number of deposited platelets mm-2s-1) was significantly different (p < 0.05) for IUPAC.PVC and PRM.PDMS (tau s(plat)PVC = 683 +/- 200 > tau s(plat)PDMS = 327 +/- 80). Scanning electron micrographs of adherent platelets, red cells and leukocytes after blood contact ex vivo were performed after each experiment. This preliminary work contributes not only to quantify the adsorption of different radiotracers, but also to evaluate the superficial distribution of the labelled biological species on the inner surface of the tested biomaterials.