Selecting valid in vitro biocompatibility tests that predict the in vivo healing response of synthetic vascular prostheses

Effect of compatibilizers on in vitro biocompatibility of PLA–HA bioscaffold

This paper exclusively describes the biocompatibility evaluation of biodegradable PLA–HA-based composites as temporary bone scaffolds for bone tissue engineering in orthopaedic applications. For that purpose, a set of composites were prepared using 3D melt-deposition method that comprises a biopolymer namely polylactic acid (PLA), and a bioceramic filler, namely hydroxyapatite (HA) 10 wt%, and compatibilizers, namely poly acrylic acid (PAA) 2 wt% and maleic anhydirde (MAH) 2 wt%. The composite samples were evaluated by in vitro assays and biodegradability tests were conducted in phosphate-buffered saline (PBS). For the in vitro analysis, osteogenic-induced stem cells were seeded onto the composite scaffold. An inverted optical microscope with computerised image analysis system was used to obtain data regarding cell attachment and contact characteristics after seeding for 48 h. Results showed that the PLA–HA-based composites did not induce adverse reactions from the cells, which in addition to their bone-matching mechanical properties makes them promising materials for bone scaffold applications.

Alternative methods for assessing biocompatibility and function of implant materials

Biocompatibility testing is used to evaluate the host response to implantable materials and to assess their ability to perform in applications in which they are intended to interact with biological systems. In compliance with international and/or national standards, such assessment is based mainly on the results of experimental implantation into animal tissues. However, the development of in vitro experimental techniques creates new opportunities to observe and to understand the interaction of biomaterials with host tissue. The state-of-the-art application of alternative methods in biocompatibility testing is presented in this review article. It is discussed with respect to the Three Rs concept (reduction, refinement, replacement) of Russell & Burch. Perspectives on alternative methods in biocompatibility studies are discussed with regard to the possible role of biomaterials in tissue engineering.

Comparison of murine fibroblast cell response to fluor-hydroxyapatite composite, fluorapatite and hydroxyapatite by eluate assay

Fluorapatite (FA) is one of the inorganic constituents of bone or teeth used for hard tissue repairs and replacements. Fluor-hydroxyapatite (FHA) is a new synthetic composite that contains the same molecular concentration of OH(-) groups and F(-) ions. The aim of this experiment was to evaluate the cellular responses of murine fibroblast NIH-3T3 cells in vitro to solid solutions of FHA and FA and to compare them with the effect of hydroxyapatite (HA). We studied 24, 48 and 72 h effects of biomaterials on cell morphology, proliferation and cell cycle of NIH-3T3 cells by eluate assay. Furthermore, we examined the ability of FHA, FA and HA to induce cell death and DNA damage. Our cytotoxic/antiproliferative studies indicated that any of tested biomaterials did not cause the total inhibition of cell division. Biomaterials induced different antiproliferative effects increasing in the order HA < FHA < FA which were time- and concentration-dependent. None of the tested biomaterials induced necrotic/apoptotic death of NIH-3T3 cells. On the other hand, after 72 h we found that FHA and FA induced G0/G1 arrest of NIH-3T3 cells, while HA did not affect any cell cycle phases. Comet assay showed that while HA demonstrated weaker genotoxicity, DNA damage induced by FHA and FA caused G0/G1 arrest of NIH-3T3 cells. Fluoridation of hydroxyapatite and different FHA and FA structure caused different cell response of NIH-3T3 cells to biomaterials.

Multiplexed cytokine detection of interstitial fluid collected from polymeric hollow tube implants--a feasibility study

Cytokines are important cellular signaling proteins involved in inflammation, wound healing and are thought to direct the foreign body response to implanted materials. In this work, polyurethane tubes (25 mm length, 1.02 mm i.d., and 1.65 mm o.d.) were implanted into subcutaneous tissue of male Sprague-Dawley rats. The tubes served as the biomaterial and a means to collect the interstitial fluid that would be exchanged within the tube lumen and the surrounding tissue. After 3 and 7 days, the tubes were explanted and cytokines in the fluid were quantified with a multiplexed cytokine immunoassay. Six cytokines, interleukin-1beta (IL-1beta), IL-4, IL-6, IL-10, macrophage chemoattractant protein-1 (MCP-1), and tumor necrosis factor-alpha (TNF-alpha), were simultaneously quantified. All cytokine concentrations with the exception of IL-4 and TNF-alpha ranged between low pg/mL to mid ng/mL levels. Neither TNF-alpha nor IL-4 was detected from any sample. These results illustrate the potential of using the tube materials combined with bead-based immunoassays as a direct method for in vivo collection of multiple cytokines in low microliter sample volumes for fixed day biomaterial implant studies.

Cellular interactions and degradation of aliphatic poly(ester amide)s derived from glycine and/or 4-amino butyric acid

A series of poly(ester amide)s derived from amino acid (glycine or 4-amino butyric acid), diol (1,6-hexanediol or 1,4-butanediol) and sebacoyl chloride were prepared by interfacial polymerization. FT-IR analysis indicated that for poly(ester amide)s derived from glycine, only amide-amide hydrogen bonds and hydrogen-bonded C=O ester groups were established, whereas the poly(ester amide)s derived from 4-amino butyric acid contained amide-amide hydrogen bonds and amide-ester hydrogen bonds, including NH groups and C=O ester groups in free state. The biodegradability was estimated by weight residue of poly(ester amide) films in pH 6 buffer solution with papain at 37 degrees C. The poly(ester amide) films derived from glycine demonstrated significantly improved degradability compared to the poly(ester amide) films derived from 4-amino butyric acid. This difference of degradation rate could be explained by the bonding state in C=O ester groups. The cellular interaction of the poly(ester amide)s was studied by measuring the proliferation of human dermal fibroblasts on the polymer films. The cells proliferated significantly faster on poly(ester amide) films derived from 4-amino butyric acid than on poly(ester amide) films derived from glycine. These results suggest that the poly(ester amide) prepared in this study may serve as a potential cell-compatible biomedical material.

The biocompatibility of novel starch-based polymers and composites: in vitro studies

Studies with biodegradable starch-based polymers have recently demonstrated that these materials have a range of properties. which make them suitable for use in several biomedical applications, ranging from bone plates and screws to drug delivery carriers and tissue engineering scaffolds. The aim of this study was to screen the cytotoxicity and evaluate starch-based polymers and composites as potential biomaterials. The biocompatibility of two different blends of corn-starch, starch ethylene vinyl alcohol (SEVA-C) and starch cellulose acetate (SCA) and their respective composites with hydroxyapatite (HA) was assessed by cytotoxicity and cell adhesion tests. The MTT assay was performed with the extracts of the materials in order to evaluate the short-term effect of the degradation products. The cell morphology of L929 mouse fibroblast cell line was also analysed after direct contact with polymers and composites for different time periods and the number of cells adhered to the surface of the polymers was determined by quantification of the cytosolic lactate dehydrogenase (LDH) activity. Both types of starch-based polymers exhibit a cytocompatibility that might allow for their use as biomaterials. SEVA-C blends were found to be the less cytotoxic for the tested cell line, although cells adhere better to SCA surface. The cytotoxicity test also revealed that SCA and SEVA-C composites have a similar response to the one obtained for SCA polymer. Scanning electron microscopy (SEM) analysis showed that cells were much more spread on the SCA polymer and LDH measurements showed a higher number of cells on this surface.

Effect of surface treatment on the biocompatibility of microbial polyhydroxyalkanoates

The biocompatibility of microbial polyesters polyhydroxybutyrate (PHB) and poly(hydroxybutyrate-co-hydroxyhexanoate) (PHBHHx) were evaluated in vitro. The mouse fibroblast cell line L929 was inoculated on films made of PHB, PHBHHx and their blends, polylactic acid (PLA) as control. It was found that the growth of the cells L929 was poor on PHB and PLA films. The viable cell number ranged from 8.8 x 10(2) to 1.8 x 10(4)/cm2 only. Cell growth on the films made by blending PHB and PHBHHx showed a dramatic improvement. The viable cell number observed increased from 9.7 x 10(2) to 1.9 x 10(5) on a series of PHB/PHBHHx blended film in ratios of 0.9/0.1:0/1, respectively, indicating a much better biocompatibility in the blends contributed by PHBHHx. Biocompatibility was also strongly improved when these polymers were treated with lipases and NaOH, respectively. However, the effects of treatment were weakened when PHBHHx content increased in the blends. It was found that lipase treatment had more increased biocompatibility than NaOH. After the treatment biocompatibility of PHB was approximately the same as PLA, while PHBHHx and its dominant blends showed improved biocompatibility compared to PLA.

Early inflammatory response after elective abdominal aortic aneurysm repair: a comparison between endovascular procedure and conventional surgery

OBJECTIVE

To determine the nature of and to compare the inflammatory responses induced by (1) endovascular and (2) conventional abdominal aortic aneurysm (AAA) repair.

MATERIAL AND METHODS

Twelve consecutive patients undergoing elective infrarenal AAA repair were prospectively studied. Seven patients were selected for endovascular procedures (the EAAA group); five patients underwent open surgery (the OAAA group). Three control patients undergoing carotid thromboendarterectomy were also included. Serial peripheral venous blood samples were collected preoperatively, immediately after declamping or placement of the endograft, and at hours 1, 3, 6, 12, 24, 48, and 72. Acute phase response expression of peripheral T lymphocyte and monocyte activation markers and adhesion molecules (flow cytometry), soluble levels of cell adhesion molecules (enzyme-linked immunosorbent assay), cytokine (tumor necrosis factor alpha, interleukin-6, and interleukin-8) release (enzyme-linked immunosorbent assay), and liberation of complement products (nephelometry) were measured.

RESULTS

Regarding acute phase response, the EAAA and OAAA groups showed significant increases in C-reactive protein (P <.001 and P =.001), body temperature (P =.035 and P =.048), and leukocyte count (P <.001 and P <.001). Similar time course patterns were observed with respect to body temperature (P =.372). Statistically significant different patterns were demonstrated for C-reactive protein (P =.032) and leukocyte count (P =.002). Regarding leukocyte activation, a significant upregulation of peripheral T lymphocyte CD38 expression was observed in the OAAA group only (P =.001). Analysis of markers such as CD69, CD40L, CD25, and CD54 revealed no perioperative fluctuations in any group. Regarding circulating cell adhesion molecules, the EAAA and OAAA groups displayed significant increases in soluble intercellular adhesion molecule-1 (P =.003 and P =.001); there was no intergroup difference (P =.193). All groups demonstrated high soluble von Willebrand factor levels (P =.018, P =. 007, and P =.027), there being no differences in the patterns (P =. 772). Otherwise, soluble vascular cell adhesion molecule-1, soluble E-selectin, and soluble P-selectin did not appear to vary in any group. Regarding cytokine release, although a tendency toward high tumor necrosis factor alpha and interleukin-8 levels was noticed in the EAAA group, global time course effects failed to reach statistical significance (P =.543 and P =.080). In contrast, interleukin-6 showed elevations in all groups (P =.058, P <.001, and P =.004). Time course patterns did not differ between the EAAA and OAAA groups (P =.840). Regarding complement activation, the C3d/C3 ratio disclosed significant postoperative elevations in the EAAA and OAAA groups (P =.013 and P =.009). This complement product release was reduced in the EAAA group (P <.001).

CONCLUSIONS

The current study indicated that both endovascular and coventional AAA repair induced significant inflammatory responses. Our findings showed that there were no large differences between the procedures with respect to circulating cell adhesion molecule and cytokine release. Moreover, the endoluminal approach produced a limited response in terms of acute phase reaction, T lymphocyte activation, and complement product liberation. This might support the concept that endovascular AAA repair represents an attractive alternative to open surgery. Given the relatively small sample size, further larger studies are required for confirmation of our observations.

Effect of carbon-coated polyethylene terephthalate on prostacyclin release by endothelial cells stimulated with arachidonic acid in vitro

The production of 6-keto prostaglandin F1alpha (6-keto-PGF1alpha), stable metabolyte of prostacyclin, by cultured human endothelial cells in contact with carbon- and collagen-coated polyethylene terephthalate (PC), was assessed by enzyme immunoassay. As control material, tissue culture-treated polystyrene was used. The cultures were put in contact with the materials for 48 h and then were stimulated with 0.1 mM arachidonic acid for 3 h. The stimulation induced a highly significant increase of 6-keto-PGF1alpha in the cultures in contact with the control material. PC induced only insignificant variations in stimulated cultures compared to unstimulated ones. In conclusion, PC determined a decrease in the endothelial cell response to stimulation with arachidonic acid.

In vitro cellular response to polypyrrole-coated woven polyester fabrics: potential benefits of electrical conductivity

Electrically conducting polypyrrole-treated films have recently been shown to influence the morphology and function of mammalian cells in vitro. This type of polymer represents a possible alternative biomaterial for use in vascular implantation. The present study compared the in vitro biocompatibility of the five different polyester woven fabrics having increasing levels of electrical conductivity ranging from 4.5 x 10(4) to 123 omega/square with that of low density polyethylene and polydimethylsiloxane primary reference materials. Biocompatibility was measured in terms of four different types of in vitro cellular response, including (a) an indirect and (b) a direct control organotypic culture assay using endothelial cells, (c) a polymorphonuclear (PMN) cell activation study using flow-cytometric measurements of CD11/CD18 integrin molecule expression, and (d) a semiquantification of interleukin (IL)-6 mRNA expression on monocytes/macrophages using reverse-transcriptase polymerase chain reaction. The organotypic culture study revealed that the fabrics with high levels of conductivity exhibited lower cell migration, proliferation, and viability. The PMN activation study of blood from 10 healthy adult donors demonstrated that the two most conductive fabrics were able to identify the more reactive donors. The levels of IL-6 mRNA expression by monocytes/macrophages decreased as the conductivity level of the fabrics increased. The results of the present study therefore indicate that high levels of conductivity (< 200 omega/square) on polyester fabrics are detrimental to the growth, migration, and viability of endothelial cells; induce elevated PMN activation; and affect the intracellular metabolism of monocytes. They also point to a specific range of conductivity (10(3) < 10(4) omega/square) which is associated with an optimum in vitro cellular response.

Bacterial products primarily mediate fibroblast inhibition in biomaterial infection

PURPOSE

The stimulation of fibroblast growth is essential for the normal healing and tissue integration of biomaterials. The local elevation of proinflammatory mediators in infected perigraft fluid (PGF) may inhibit this growth. We sought to determine whether infected PGF inhibited fibroblast growth, and, if so, whether this was primarily dependent on the biomaterial, bacteria, or host.

METHODS

In vivo Dacron or expandable polytetra-fluoroethylene (ePTFE) grafts, sterile or colonized with slime-producing (RP-62A, viable or formalin-killed) or nonslime-producing (RP-62NA) Staphylococcus epidermidis (1 x 10(7) CFU/cm2), were implanted in Swiss Webster mice, and the PGF was harvested at 7 and 28 days. Antibodies to tumor necrosis factor alpha, interleukin 1 alpha, interferon gamma (7 micrograms/day), and indomethacin (50 micrograms/day) were administered by microinfusion pumps for 7 days and the PGF was harvested. Inhibition of the proinflammatory mediators was confirmed by enzyme-linked immunosorbant assay. The nontreated, heat-treated, or trypsin-digested in vivo PGF was incubated with an in vitro [3H]thymidine murine fibroblast (ATCC CCL-12) proliferation assay.

RESULTS

Fibroblast inhibition was significant at 7 and 28 days with infected PGF incubation compared with sterile and was not dependent on bacterial slime production or viability. Dacron sterile PGF did not significantly inhibit fibroblasts compared with control, whereas sterile ePTFE stimulated (P < 0.05) fibroblasts. Treatment of the PGF with proinflammatory cytokines, heat, and trypsin failed to reverse fibroblast inhibition in the infected state.

CONCLUSION

Biomaterial infection is associated with fibroblast inhibition that is dependent primarily on bacterial products and not the host or biomaterial. Conservative intervention strategies for graft infection need to address the problem of poor healing as well as bacterial clearance.