Cytotoxicity of medical materials sterilized with vapour-phase hydrogen peroxide

A 3D Printed Device for In Vitro Generation of Stratified Epithelia at the Air-Liquid Interface

Air-liquid interface (ALI) cultures are used to produce stratified epithelial tissues in vitro, notably for the production of oral mucosal equivalents. Currently, there are few purpose-built devices which aim to enhance the ease and reproducibility of generating such tissue. Most ALI cultures utilise stainless steel grids or cell culture inserts to elevate the matrix or scaffold to the surface of the culture media. Here, a novel buoyant epithelial culture device (BECD) was designed to both contain a fibroblast-seeded collagen hydrogel and float in culture media, thereby automatically maintaining the ALI without further user intervention. BECDs aim to mitigate several issues associated with ALI culture; reducing the chance of media flooding the epithelial layer from physical disturbance, reducing technique-sensitivity for less experienced users, and improving the reproducibility of the epithelia generated. H400 oral squamous cell carcinoma cells cultured in BECDs for 7, 14 and 21 days showed continuous increase in epithelial tissue thickness with expected localisation of epithelial differentiation markers: cytokeratin 5, involucrin and E-cadherin. Fused filament fabrication 3D printing with polypropylene used in BECD production allows for rapid turnover and design iteration, presenting a versatile, adaptable and useful tool for application in in vitro cell culture.

Evaluation of Low-Temperature Sterilization using Hydrogen Peroxide Gas Containing Peracetic Acid

In low-temperature sterilization for the medical field, hydrogen peroxide sterilization is widely used for its safety. However, its low penetrability and residual amount of sterilant are major concerns. Recently, the combination of hydrogen peroxide and peracetic acid has been found to enforce sporicidal effect, with low concentration in hydrogen peroxide. The application of this finding in medical sterilization is still very limited. To elucidate the combination effect, we compare peracetic acid containing hydrogen peroxide gas sterilizer and conventional hydrogen peroxide gas (plasma) sterilizers. The sterilant penetrability was examined in hollow load process challenge devices with inner diameters of 1 and 2 mm and lengths of 1, 2, and 3 m. As a result, peracetic acid containing hydrogen peroxide gas sterilizer demonstrated total inactivation with all diameters and lengths and achieved the highest sterilant penetrability in this study. The amount of residual sterilant on the surface of the sterilized object was 4.2 μg/cm², which corresponds to half amount of those of conventional hydrogen peroxide gas sterilizers. These results suggest that the addition of peracetic acid to hydrogen peroxide gas sterilizer can enhance sterilization efficiency and safety.

Viability evaluation of layered cell sheets after ultraviolet light irradiation of 222 nm

Introduction

The objective of this study was to evaluate the cell viability of layered cell sheets, irradiated with 222 nm UV light.

Methods

UV transmittance of 222 nm and 254 nm was evaluated when the cell sheets of NCTC Clone 929 cells were irradiated UV light. Cell viability was evaluated after irradiation of 222 nm using 3-(4,5-Dimethyl-2-thiazolyl)-2,5-diphenyltetrazolium bromide (MTT) assay. Following irradiation of two layered cell sheets at 500 mJ/cm², the cell damage of lower layers was evaluated by a colony formation and MTT assays.

Results

The UV transmittance of 222 nm was 10 times less than that of 254 nm. A MTT assay revealed that cells of cell sheets irradiated at 222 nm was less damaged than those at 254 nm, when irradiated at 5 mJ/cm². Cell colonies were formed for cells of lower layers irradiated at 222 nm whereas no colony formation was observed for those irradiated at 254 nm. Significantly higher MTT activity was observed for cells of lower layers irradiated at 222 nm than at 254 nm.

Conclusions

It is concluded that 222 nm irradiation is biologically safe for cell viability.

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The cell viability of two-layered cell sheets was evaluated after irradiation of UV light at 222 nm.

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UV light at 222 nm is safer to the lower layer than the conventional UV light at 254 nm.

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The reason can be attributed to the lower transmission of UV light at 222 nm through cell sheets.

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UV light at 222 nm could be one of promising tools to be required for the sterilization in the field of regenerative therapy.

Effects of Nanowire Length and Surface Roughness on the Electrochemical Sensor Properties of Nafion-Free, Vertically Aligned Pt Nanowire Array Electrodes

In this paper, vertically aligned Pt nanowire arrays (PtNWA) with different lengths and surface roughnesses were fabricated and their electrochemical performance toward hydrogen peroxide (H₂O₂) detection was studied. The nanowire arrays were synthesized by electroplating Pt in nanopores of anodic aluminum oxide (AAO) template. Different parameters, such as current density and deposition time, were precisely controlled to synthesize nanowires with different surface roughnesses and various lengths from 3 μm to 12 μm. The PtNWA electrodes showed better performance than the conventional electrodes modified by Pt nanowires randomly dispersed on the electrode surface. The results indicate that both the length and surface roughness can affect the sensing performance of vertically aligned Pt nanowire array electrodes. Generally, longer nanowires with rougher surfaces showed better electrochemical sensing performance. The 12 μm rough surface PtNWA presented the largest sensitivity (654 μA·mM⁻¹·cm⁻²) among all the nanowires studied, and showed a limit of detection of 2.4 μM. The 12 μm rough surface PtNWA electrode also showed good anti-interference property from chemicals that are typically present in the biological samples such as ascorbic, uric acid, citric acid, and glucose. The sensing performance in real samples (river water) was tested and good recovery was observed. These Nafion-free, vertically aligned Pt nanowires with surface roughness control show great promise as versatile electrochemical sensors and biosensors.

Effects of low-temperature hydrogen peroxide gas plasma sterilization on in vitro cytotoxicity of poly(ϵ-caprolactone) (PCL)

Our objective was to determine whether low-temperature hydrogen peroxide (H2O2) gas plasma sterilization of porous three-dimensional poly(ϵ-caprolactone) (PCL) constructs significantly inhibits cellular metabolism of canine chondrocytes. Porous cylindrical constructs were fabricated using fused deposition modeling and divided into four sterilization groups. Two groups were sterilized with low-temperature H2O2 gas plasma (LTGP) and constructs from one of those groups were subsequently rinsed with Dulbecco's Modified Essential Media (LTGPDM). Constructs in the other two groups were disinfected with either 70% isopropyl alcohol or exposure to UV light. Canine chondrocytes were seeded in 6-well tissue-culture plates and allowed to adhere prior to addition of PCL. Cellular metabolism was assessed by adding resazurin to the tissue-culture wells and assessing conversion of this substrate by viable cells to the fluorescent die resorufin. This process was performed at three times prior to addition of PCL and at four times after addition of PCL to the tissue-culture wells. Metabolism was not significantly different among the different tissue-culture wells at any of the 3 times prior to addition of PCL. Metabolism was significantly different among the treatment groups at 3 of 4 times after addition of PCL to the tissue culture wells. Metabolism was significantly lower with constructs sterilized by LTGP than all other treatment groups at all 3 of these times. We conclude that LTGP sterilization of PCL constructs resulted in significant cytotoxicity to canine chondrocytes when compared to PCL constructs disinfected with either UV light exposure or 70% isopropyl alcohol.

An Evaluation of Sterilisation Processes

A sterile environment is one of the basic elements of in vitro cell culture. When choosing an appropriate sterilisation method, the possibility that the physical and chemical properties of the sterilised material could be altered by the sterilisation process itself, should be considered. Avoiding any potential problems of toxicity arising as a consequence of the sterilisation process is essential, not only in in vitro cell culture procedures, but especially in the case of the sterilisation of medical devices which come into contact with human tissue (e.g. catheters, surgical tools, and containers used for transplant preparation and storage). As it is not possible to predict the potential effects of every combination of test material and sterilisation process, we have designed a simple test, which can be easily performed to ensure the absence of cytotoxicity. The test involves the culturing of a non-adherent cell line in direct contact with the test material, in micro-wells attached to the surface of the test device. By using this novel test method, three sterilisation procedures were compared for each material. The results indicated that, neither ionising irradiation nor ethylene oxide left toxic residues on the surface of polystyrene; and that, in the case of steel, neither steam sterilisation nor ethylene oxide left toxic residues on the metal. The cold plasma system, which left toxic residues on the surface of both materials, required a post-sterilisation period of 24 hours in the case of steel, and 10 days in the case of polystyrene, in order to eliminate toxic residues prior to their use.

Assessing the residual antibacterial activity of clinical materials disinfected with glutaraldehyde, o-phthalaldehyde, hydrogen peroxide or 2-bromo-2-nitro-1,3-propanediol by means of a bacterial toxicity assay

This study investigated the use of a rapid bacterial toxicity test for detecting disinfectant residues released by disinfected materials. The test substances included an environmental disinfectant used in hospitals in high-risk areas, such as critical care units or emergency services, and three disinfectants used on clinical devices when a high level of disinfection is required. The test materials were polyurethane, polypropylene, glass, latex and cotton from different instruments and utensils used in hospitals. Of the four test disinfectants, o-phthalaldehyde (OPA) and 2-bromo-2-nitro-1,3-propanediol (BNP) showed the greatest inhibitory activity (as much as 300-fold greater than hydrogen peroxide in the case of OPA) according to the toxicity text. However, with the exception of hydrogen peroxide on latex, it was the most porous test materials, namely latex and cotton, that accumulated the least residue. BNP was the disinfectant that left the least residue on the five test materials, while the greatest residual concentration was left by hydrogen peroxide on latex (as much as 5 microg/cm2). The biotest used in this study permitted the detection of disinfectant residues released by different types of previously disinfected clinical materials, and can be adapted to simulate elution conditions similar to those existing in routine hospital practice.

Safety issue of re-sterilization of polyurethane electrophysiology catheters: a cytotoxicity study

The reuse of electrophysiology catheters could result in significant cost savings. However, re-sterilization of catheters could lead to several adverse consequences, including toxicity related to potential chemical reactions that occur during sterilization due to toxic residues remaining on the surface of catheters. The objective of this study was to investigate in vitro cytotoxicity of polyurethane (PU)-based catheter extracts on macrophages after their re-sterilization. We have compared three sterilization methods: steam autoclave, ethylene oxide (EtO) and hydrogen peroxide plasma (Sterrad system). Our results showed that the viability of cells varied from 90% to 99% as a function of incubation time and number of sterilization cycle. While there was no statistical difference based on the sterilization procedure, the number of sterilization cycles (up to 10 cycles) presents a statistically significant effect on the viability of J774 macrophages. However, extract obtained after resterilization of PU-based catheters had a low cytotoxic effect on J774 macrophages, since the overall cell mortality remained under 10%. An inhibitory effect on cell growth was also observed, which was not significant either as a function of incubation time, sterilization technique or the number of sterilization cycles. Finally, extracts of PU-based catheters had no statistically significant effect on TNF-alpha release by J774 macrophage. Even though there were some statistically significant differences between the control and processed samples, and among processed samples, our data suggest that one single reprocessing of PU-based catheters may not induce clinically significant changes in their cytotoxicity behaviour.

Sterilization of elastic ligatures for intraoperative mandibulomaxillary immobilization

Sterilization can influence the mechanical properties of elastic ligatures used for mandibulomaxillary immobilization. The aim of this study was to compare different sterilization protocols (ethylene oxide, autoclave, irradiation, plasma sterilization, povidone-iodine for 24 hours and 70% isopropyl alcohol for 24 hours) of three elastomers (natural rubber, silicone rubber, and polyurethane). Three mechanical variables were assessed in a testing machine: breaking strength, tensile strength and tensile strength after a 24-hour load (material fatigue). Natural rubber was most susceptible to mechanical alteration by sterilization and lost 46% of its breaking strength and 43% of its tensile strength after autoclaving. Polyurethane was more resistant (multiple comparison, Tukey-Kramer), but polyurethane ligatures stuck together after autoclaving. The protocols for low-temperature sterilization, ethylene oxide, irradiation, and plasma were superior to autoclaving and the disinfecting solutions. These data suggest that polyurethane sterilized with ethylene oxide is the material of choice.

Effect of gas composition on spore mortality and etching during low-pressure plasma sterilization

The aim of this work was to investigate possible mechanisms of sterilization by low-temperature gas plasma: spore destruction by plasma is compared with etching of synthetic polymers. Bacillus subtilis spores were inoculated at the bottom of glass vials and subjected to different plasma gas compositions (O(2), O(2)/Ar, O(2)/H(2), CO(2), and O(2)/CF(4)), all known to etch polymers. O(2)/CF(4) plasma exhibited much higher efficacy than all other gases or gas mixtures tested, with a more than 5 log decrease in 7.5 min, compared with a 2 log decrease with pure oxygen. Examination by scanning electron microscopy showed that spores were significantly etched after 30 min of plasma exposure, but not completely. We speculate about their etch resistance compared with that of synthetic polymers on the basis of their morphology and complex coating structure. In contrast to so-called in-house plasma, sterilization by Sterrad(R) tended to increase the observed spores' size; chemical modification (oxidation), rather than etching, is believed to be the sterilization mechanism of Sterrad(R).

Hydrogen peroxide for prevention of bacterial growth on polymer biomaterials

BACKGROUND

Despite widespread use of potent antibiotics, infections of artificial implants and catheters are of increasing concern. We tested whether local treatment with 3% hydrogen peroxide (H2O2), long known as an inexpensive wound disinfectant, could prevent or reduce bacterial growth on polymer biomaterials.

METHODS

Two-centimeter-long pieces of polyurethane and silicone tubing were contaminated with a standardized solution of Staphylococcus epidermidis (10(5)/mL) and then rinsed and wiped with saline (0.9%) solution. Bacterial growth was assessed after incubation at 37 degrees C for 24 hours. Bacterial colonies were compared for the following treatments: wiping only with saline; wiping with 1.5%, 2%, or 3% H2O2; pretreating biomaterials with 3% H2O2 and subsequent contamination for 2 and 4 hours without treatment after contamination; and contamination of tubings 1 month after pretreatment with 3% H2O2. The effect of 3% H2O2 was also assessed on contamination with Escherichia coli.

RESULTS

Bacterial growth was reduced by more than 99% when the contaminated tubes were treated with 3% H2O2 compared with saline control (p < 0.001). Lower concentrations of H2O2 were less effective. The length of the contamination period had no influence on the effectiveness of H2O2 when used on polyurethane but did with silicone tubings. Pretreatment with H2O2 1 month before contamination still reduced bacterial growth rate by 90% on polyurethane and by 75% on silicone tubings. Comparable effects on bacterial growth rate were observed for staphylococci (-90%, p < 0.001) and escherichiae (-90%, p < 0.001).

CONCLUSIONS

Local treatment with 3% H2O2 significantly reduced bacterial growth on polymer biomaterials even for 1 month after treatment. This finding might influence clinical strategies of prevention of foreign body infection.

Cytotoxicity of polymerized commercial cyanoacrylate adhesive on cultured human oral fibroblasts

Cyanoacrylate (CA) has been used as both a commercial and tissue adhesive. Dentists may have had the experience of patients repairing their own acrylic-based dentures using a cyanoacrylate (CA) adhesive known as 'super glue'. This study evaluated the cytotoxicity of commercial CA adhesives when fully polymerized, as well as the toxicity of substances released from polymerized commercial CA adhesives after incubation of these materials for various periods of time. Toxicity was tested on cultured oral fibroblasts. Dead cells found around the various CA-coated filter papers constituted inhibitory zones which varied from 200-1000 microns and which persisted for two weeks. Control oral fibroblasts grew to approach the wax-coated filter paper. Cell viability testing using MTT and crystal violet staining methods supported the conclusion that polymerized CA-coated filter paper released substances that are toxic to cells, while wax-coated filter paper gave the same result as the control. The crystal violet staining method was also used to investigate the cytotoxicity of various CA materials after incubation for one, three, seven and 14 days and showed that CA continued to release cytotoxic substances at about the same level for at least two weeks. It can be concluded that, if CA adhesive is used for repair of broken dentures, it will release substances which are toxic to human oral fibroblast cells. This release of substances may persist for at least two weeks.

Elastomers for biomedical applications

Current topics in elastomers for biomedical applications are reviewed. Elastomeric biomaterials, such as silicones, thermoplastic elastomers, polyolefin and polydiene elastomers, poly(vinyl chloride), natural rubber, heparinized polymers, hydrogels, polypeptides elastomers and others are described. In addition biomedical applications, such as cardiovascular devices, prosthetic devices, general medical care products, transdermal therapeutic systems, orthodontics, and ophthalmology are reviewed as well. Elastomers will find increasing use in medical products, offering biocompatibility, durability, design flexibility, and favorable performance/cost ratios. Elastomers will play a key role in medical technology of the future.