Glutaraldehyde as a fixative in bioprostheses and drug delivery matrices

One-Step Physical and Chemical Dual-Reinforcement with Hydrophobic Drug Delivery in Gelatin Hydrogels for Antibacterial Wound Healing

Gelatin-based bioadhesives, especially methacrylated gelatin (GelMA), have emerged as superior alternatives to sutureless wound closure. Nowadays, their mechanical improvement and therapeutic delivery, particularly for hydrophobic antibiotics, have received ever-increasing interest. Herein, a reinforced gelatin-based hydrogel with a hydrophobic drug delivery property for skin wound treatment was reported. First, photosensitive monomers of N'-(2-nitrobenzyl)-N-acryloyl glycinamide (NBNAGA) were grafted onto GelMA via Michael addition, namely, GelMA-NBNAGA. Second, gelation of the GelMA-NBNAGA solution was accomplished in a few seconds under one step of ultraviolet (UV) light irradiation. Multiple effects were realized simultaneously, including chemical cross-linking initiated by lithium phenyl-2,4,6-trimethylbenzoylphosphinate (LAP), physical cross-linking of uncaged dual hydrogen bonding, and hydrophobic drug release along with o-NB group disintegration. The mechanical properties of the dual-reinforcement hydrogels were verified to be superior to those only with a chemical or physical single-cross-linked network. The hydrophobic anticancer doxorubicin (DOX) and antibiotic rifampicin (Rif) were successfully charged into the hydrogels, separately. The in vitro antimicrobial tests confirmed the antibacterial activity of the hydrogels against Gram-negative (Escherichia coli) and Gram-positive (Staphylococcus aureus) bacteria. The in vivo wound-healing assessment in mice further assured their drug release and efficacy. Therefore, this NBNAGA-modified GelMA hydrogel has potential as a material in skin wound dressing with a hydrophobic antibiotic on-demand delivery.

Swim bladder-derived biomaterials: structures, compositions, properties, modifications, and biomedical applications

Animal-derived biomaterials have been extensively employed in clinical practice owing to their compositional and structural similarities with those of human tissues and organs, exhibiting good mechanical properties and biocompatibility, and extensive sources. However, there is an associated risk of infection with pathogenic microorganisms after the implantation of tissues from pigs, cattle, and other mammals in humans. Therefore, researchers have begun to explore the development of non-mammalian regenerative biomaterials. Among these is the swim bladder, a fish-derived biomaterial that is rapidly used in various fields of biomedicine because of its high collagen, elastin, and polysaccharide content. However, relevant reviews on the biomedical applications of swim bladders as effective biomaterials are lacking. Therefore, based on our previous research and in-depth understanding of this field, this review describes the structures and compositions, properties, and modifications of the swim bladder, with their direct (including soft tissue repair, dural repair, cardiovascular repair, and edible and pharmaceutical fish maw) and indirect applications (including extracted collagen peptides with smaller molecular weights, and collagen or gelatin with higher molecular weights used for hydrogels, and biological adhesives or glues) in the field of biomedicine in recent years. This review provides insights into the use of swim bladders as source of biomaterial; hence, it can aid biomedicine scholars by providing directions for advancements in this field.

Using cryopreserved allogeneic pericardium to repair congenital heart defects in children

Patches prepared from autologous, allogeneic, or xenogeneic tissues are widely used in the repair of congenital heart defects in children. Since 2002, cryopreserved allogeneic pericardial patches have been prepared in our institution as an alternative to commercially available patches. This study retrospectively reviewed donor and patient data concerning cryopreservation time and the clinical use of the pericardium in 382 children who were operated on at a single center between 2004 and 2021. There were 177 donors: 98 males and 79 females. The median donor age was 13 years (range: 1 month to 53 years) and the median cryopreservation time was 72 days (range: 3-685). There were 382 pediatric patients: 224 males and 158 females. The median patient age was 1 month (range: 3 days to 17.8 years). The patches were used for primary surgeries in 228 patients and for reoperations in 154. The patches were implanted into the right heart or venous circulation in 209 patients, the left heart or arterial circulation in 246 patients, and both sides of the circulatory system in 73. Extracardiac patch implantation was performed in 339 patients, intracardiac in 79 patients, and both intracardiac and extracardiac in 36 patients. Our study presents a single-center experience in the use of cryopreserved allogeneic pericardium. The pericardium can be used on the systemic and pulmonary sides of the circulatory system, in either extracardiac or intracardiac positions. However, there is no uniform strategy for selecting the "patch of choice" for correcting congenital heart defects in children, especially since there are few studies comparing several types of patches.

Age-dependent loss of HAPLN1 erodes vascular integrity via indirect upregulation of endothelial ICAM1 in melanoma

Melanoma, the most lethal form of skin cancer, often has worse outcomes in older patients. We previously demonstrated that an age-related decrease in the secreted extracellular matrix (ECM) protein HAPLN1 has a role in slowing melanoma progression. Here we show that HAPLN1 in the dermal ECM is sufficient to maintain the integrity of melanoma-associated blood vessels, as indicated by increased collagen and VE-cadherin expression. Specifically, we show that HAPLN1 in the ECM increases hyaluronic acid and decreases endothelial cell expression of ICAM1. ICAM1 phosphorylates and internalizes VE-cadherin, a critical determinant of vascular integrity, resulting in permeable blood vessels. We found that blocking ICAM1 reduces tumor size and metastasis in older mice. These results suggest that HAPLN1 alters endothelial ICAM1expression in an indirect, matrix-dependent manner. Targeting ICAM1 could be a potential treatment strategy for older patients with melanoma, emphasizing the role of aging in tumorigenesis.

Bacterial cellulose nanocrystal as drug delivery system for overcoming the biological barrier of cyano-phycocyanin: a biomedical application of microbial product

Phycocyanin, produced by Spirulina platensis, has been reported as an anti-inflammatory, anti-hyperalgesia, antioxidant, anti-tumor, and anti-cancer agent. However, the ingestion of phycocyanin in the body is often hindered by its instability against gastric pH conditions. The nano-drug delivery system has developed as a promising platform for efficient drug delivery and improvement as well as drug efficacy. Bacterial cellulose nanocrystal (BCNC) has it superiority as DDS due to its inherent properties such as nanoscale dimension, large surface area, - biocompatibility, and non-toxic. To improve its mechanical properties, BCNC was crosslinked with glutaraldehyde and was analyzed as a potential candidate for DDS. The Fourier transform infrared analysis of the BCNC suggested that hydrolysis did not alter the chemical composition. The index of crystallinity of the BCNC was 18.31% higher than that of the original BC, suggesting that crystalline BC has been successfully isolated. The BCNC particle also showed a needle-like morphology which is 25 ± 10 nm in diameter and a mean length of 626 ± 172 nm. Crosslinked BCNC also had larger pores than the original BCNC along with higher thermal stability. Optimum phycocyanin adsorption on crosslinked BCNC reached 65.3% in 3 h. The release study shows that the crosslinked BCNC can protect the phycocyanin retardation by gastric fluid until phycocyanin reaches the targeted sites. This study provides an alternative potential DDS derived from natural bioresources with less expenses and better properties to promote the application of BCNC as functional nanomaterials in biomedical science.

Review paper: The importance of consideration of collagen cross-links in computational models of collagen-based tissues

Collagen as the main protein in Extra Cellular Matrix (ECM) is the main load-bearing component of fibrous tissues. Nanostructure and architecture of collagen fibrils play an important role in mechanical behavior of these tissues. Extensive experimental and theoretical studies have so far been performed to capture these properties, but none of the current models realistically represent the complexity of network mechanics because still less is known about the collagen's inner structure and its effect on the mechanical properties of tissues. The goal of this review article is to emphasize the significance of cross-links in computational modeling of different collagen-based tissues, and to reveal the need for continuum models to consider cross-links properties to better reflect the mechanical behavior observed in experiments. In addition, this study outlines the limitations of current investigations and provides potential suggestions for the future work.

3D Printed Polymer Piezoelectric Materials: Transforming Healthcare through Biomedical Applications

Three-dimensional (3D) printing is a promising manufacturing platform in biomedical engineering. It offers significant advantages in fabricating complex and customized biomedical products with accuracy, efficiency, cost-effectiveness, and reproducibility. The rapidly growing field of three-dimensional printing (3DP), which emphasizes customization as its key advantage, is actively searching for functional materials. Among these materials, piezoelectric materials are highly desired due to their linear electromechanical and thermoelectric properties. Polymer piezoelectrics and their composites are in high demand as biomaterials due to their controllable and reproducible piezoelectric properties. Three-dimensional printable piezoelectric materials have opened new possibilities for integration into biomedical fields such as sensors for healthcare monitoring, controlled drug delivery systems, tissue engineering, microfluidic, and artificial muscle actuators. Overall, this review paper provides insights into the fundamentals of polymer piezoelectric materials, the application of polymer piezoelectric materials in biomedical fields, and highlights the challenges and opportunities in realizing their full potential for functional applications. By addressing these challenges, integrating 3DP and piezoelectric materials can lead to the development of advanced sensors and devices with enhanced performance and customization capabilities for biomedical applications.

Fabrication and performance evaluation of PLCL-hCOLIII small-diameter vascular grafts crosslinked with procyanidins

Cardiovascular disease has become one of the main causes of death. It is the common goal of researchers worldwide to develop small-diameter vascular grafts to meet clinical needs. Collagen is a valuable biomaterial that has been used in the preparation of vascular grafts and has shown good results. Recombinant humanized collagen (RHC) has the advantages of clear chemical structure, batch stability, no virus hazard and low immunogenicity compared with animal-derived collagen, which can be developed as vascular materials. In this study, Poly (l-lactide- ε-caprolactone) with l-lactide/ε-caprolactone (PLCL) and type III recombinant humanized collagen (hCOLIII) were selected as raw materials to prepare vascular grafts, which were prepared by the same-nozzle electrospinning apparatus. Meanwhile, procyanidin (PC), a plant polyphenol, was used to cross-link the vascular grafts. The physicochemical properties and biocompatibility of the fabricated vascular grafts were investigated by comparing with glutaraldehyde (GA) crosslinked vascular grafts and pure PLCL grafts. Finally, the performance of PC cross-linked PLCL-hCOLIII vascular grafts were evaluated by rabbit carotid artery transplantation model. The results indicate that the artificial vascular grafts have good cell compatibility, blood compatibility, and anti-calcification performance, and can remain unobstructed after 30 days carotid artery transplantation in rabbits. The grafts also showed inhibitory effects on the proliferation of SMCs and intimal hyperplasia, demonstrating its excellent performance as small diameter vascular grafts.

Synthesis of Mesoporous Lanthanum-Doped SnO2 Spheres for Sensitive and Selective Detection of the Glutaraldehyde Disinfectant

Glutaraldehyde disinfectant has been widely applied in aquaculture, farming, and medical treatment. Excessive concentrations of glutaraldehyde in the environment can lead to serious health hazards. Therefore, it is extremely important to develop high-performance glutaraldehyde sensors with low cost, high sensitivity, rapid response, fabulous selectivity, and low limit of detection. Herein, mesoporous lanthanum (La) doped SnO2 spheres with high specific surface area (52-59 m2 g-1), uniform mesopores (with a pore size concentrated at 5.7 nm), and highly crystalline frameworks are designed to fabricate highly sensitive gas sensors toward gaseous glutaraldehyde. The mesoporous lanthanum-doped SnO2 spheres exhibit excellent glutaraldehyde-sensing performance, including high response (13.5@10 ppm), rapid response time (28 s), and extremely low detection limit of 0.16 ppm. The excellent sensing performance is ascribed to the high specific surface area, high contents of chemisorbed oxygen species, and lanthanum doping. DFT calculations suggest that lanthanum doping in the SnO2 lattice can effectively improve the adsorption energy toward glutaraldehyde compared to pure SnO2 materials. Moreover, the fabricated gas sensors can effectively detect commercial glutaraldehyde disinfectants, indicating a potential application in aquaculture, farming, and medical treatment.

A composite hydrogel membrane with shape and water retention for corneal tissue engineering

Tissue engineering (TE) cornea is one of the most potential alternatives to the shortage of corneal donors in cornea transplantation. Sodium alginate (SA) hydrogel is commonly used as scaffold in TE. Herein, we present an approach to construct a composite hydrogel, which with SA fiber skeleton structure for shape retention and gelatin surface modification for water retention. The light transmittance, water retention rate, and swelling rate of hydrogels were characterized, and the tensile mechanical properties were also investigated. Keratinocytes were treated with material extract liquor and the results showed that the gelatin modified SA hydrogel has good cytocompatibility. Furthermore, human corneal stromal fibroblasts (HCSFs) from the lenticules were implanted on the surface of gels, and the SA-gelatin hydrogel significantly improved the adhesion and spreading of HCSFs. Finally, we discussed the improvement and application prospect of the composite hydrogel as cornea equivalents.

Small-Caliber Vascular Grafts Engineered from Decellularized Leaves and Cross-Linked Gelatin

Despite advances in vascular replacement and repair, fabricating small-diameter vascular grafts with low thrombogenicity and appropriate tissue mechanics remains a challenge. A wide range of platforms have been developed to use plant-derived scaffolds for various applications. Unlike animal tissue, plants are primarily composed of cellulose which can offer a promising, nonthrombogenic alternative capable of promoting cell attachment and redirecting blood flow. By taking advantage of the biocompatibility and mechanical properties of cellulose, we developed small-diameter vascular grafts using decellularized leatherleaf viburnum and cross-linked gelatin. Different terrestrial plant leaves (leatherleaf, spinach, and parsley) were decellularized with sodium dodecyl sulfate, egtazic acid and/or Tergitol, followed by a bleach and Triton X-100 clearing solution, and then evaluated for decellularization efficiency, mechanical integrity, and recellularization potential. Hematoxylin and eosin staining and DNA quantification revealed successful removal of cells in all leatherleaf conditions. Methods of 3D graft fabrication were evaluated, and leatherleaf scaffolds maintained suitable tensile and rupture strength properties. 2D scaffolds and 3D grafts were seeded with rat endothelial cells. Cells remained viable for over 14 days with cell densities comparable to other natural and synthetic scaffolds. This study demonstrates the potential of cost effective and readily available decellularized plants to generate small-diameter vascular grafts capable of recellularization and with suitable mechanical properties. Impact statement Due to the prevalence of coronary heart disease in the United States, small-caliber vascular grafts for coronary bypass surgery are in high demand. We evaluate decellularized plant leaves as potential candidates for small-diameter vascular grafts with appropriate mechanical properties and recellularization potential.

A self-indicating and antibacterial gelatine-chitosan blended hydrogel enabling real-time quality control and sustained bioactive agent delivery

Hydrogels are one type of materials that are widely exploited for bioactive agent delivery, partly owing to their high biocompatibility and low toxicity. When hydrogels are used as carriers, their performance in agent loading and sustained agent release are predominately determined by the gel structure, which can be largely affected by variations during gel preparation. Till now, effective and easy methods to enable monitoring of such variations in real time have been lacking, making quality control of the generated gel-based carrier technically challenging. To address this technical gap, in this study we take advantage of the clusteroluminogenic properties of gelatine and chitosan to generate a crosslinked blended hydrogel which not only shows intrinsic antibacterial properties and high tunability in delivery performance but also shows a self-indicating capacity to enable quality control during hydrogel preparation. Upon fitting the curves of agent release into different kinetic models, the release profiles of the agent-loaded gels have been found to follow the Higuchi model well, with the non-Fickian mechanism being the major mechanism of the release process. Along with their high efficiency in agent loading, our gels warrant further exploitation for use in bioactive agent delivery and related biomedical applications.

A versatile modification strategy for functional non-glutaraldehyde cross-linked bioprosthetic heart valves with enhanced anticoagulant, anticalcification and endothelialization properties

Valvular heart disease is a major threat to human health and transcatheter heart valve replacement (THVR) has emerged as the primary treatment option for severe heart valve disease. Bioprosthetic heart valves (BHVs) with superior hemodynamic performance and compressibility have become the first choice for THVR, and more BHVs have been requested for clinical use in recent years. However, several drawbacks remain for the commercial BHVs cross-linked by glutaraldehyde, including calcification, thrombin, poor biocompatibility and difficulty in endothelialization, which would further reduce the BHVs' lifetime. This study developed a dual-functional non-glutaraldehyde crosslinking reagent OX-VI, which can provide BHV materials with reactive double bonds (CC) for further bio-function modification in addition to the crosslinking function. BHV material PBAF@OX-PP was developed from OX-VI treated porcine pericardium (PP) after the polymerization with 4-vinylbenzene boronic acid and the subsequent modification of poly (vinyl alcohol) and fucoidan. Based on the functional anti-coagulation and endothelialization strategy and dual-functional crosslinking reagent, PBAF@OX-PP has better anti-coagulation and anti-calcification properties, higher biocompatibility, and improved endothelial cells proliferation when compared to Glut-treated PP, as well as the satisfactory mechanical properties and enhanced resistance effect to enzymatic degradation, making it a promising candidate in the clinical application of BHVs. STATEMENT OF SIGNIFICANCE: Transcatheter heart valve replacement (THVR) has become the main solution for severe valvular heart disease. However, bioprosthetic heart valves (BHVs) used in THVR exhibit fatal drawbacks such as calcification, thrombin and difficulty for endothelialization, which are due to the glutaraldehyde crosslinking, resulting in a limited lifetime to 10-15 years. A new non-glutaraldehyde cross-linker OX-VI has been designed, which can not only show great crosslinking ability but also offer the BHVs with reactive double bonds (CC) for further bio-function modification. Based on the dual-functional crosslinking reagent OX-VI, a versatile modification strategy was developed and the BHV material (PBAF@OX-PP) has been developed and shows significantly enhanced anticoagulant, anti-calcification and endothelialization properties, making it a promising candidate in the clinical application of BHVs.

Developing small-diameter vascular grafts with human amniotic membrane: long-term evaluation of transplantation outcomes in a small animal model

While current clinical utilization of large vascular grafts for vascular transplantation is encouraging, tissue engineering of small grafts still faces numerous challenges. This study aims to investigate the feasibility of constructing a small vascular graft from decellularized amniotic membranes (DAMs). DAMs were rolled around a catheter and each of the resulting grafts was crosslinked with (a) 0.1% glutaraldehyde; (b) 1-ethyl-3-(3-dimethylaminopropyl) crbodiimidehydro-chloride (20 mM)-N-hydroxy-succinimide (10 mM); (c) 0.5% genipin; and (d) no-crosslinking, respectively. Our results demonstrated the feasibility of using a rolling technique followed by lyophilization to transform DAM into a vessel-like structure. The genipin-crosslinked DAM graft showed an improved integrated structure, prolonged stability, proper mechanical property, and superior biocompatibility. After transplantation in rat abdominal aorta, the genipin-crosslinked DAM graft remained patent up to 16 months, with both endothelial and smooth muscle cell regeneration, which suggests that the genipin-crosslinked DAM graft has great potential to beimplementedas a small tissue engineered graft for futurevasculartransplantation.

Collagen and Silk Fibroin as Promising Candidates for Constructing Catalysts

A catalyst determines the mechanism of an organic chemical reaction, thus enabling the commercially viable formation of desired material products. Biopolymers offer new opportunities for the construction of catalysts by virtue of their biocompatibility, environmental benignity, and sustainability, as well as their low cost. Biopolymers are especially useful as carriers and precursors in catalysis application. The employment of biocompatible and biosustainable collagen and silk fibroin materials will revolutionize state-of-the-art electronic devices and systems that currently rely on conventional technologies. In this review, we first consider the ordered hierarchical structure, origin, and processing methods of collagen and silk fibroin. Then, the unique advantages and applicability of collagen and silk fibroin for constructing catalysts are summarized. Moreover, a summary of the state-of-the-art design, fabrication, and application of collagen- and silk fibroin-based catalysts, as well as the application of collagen- and silk-based catalysts, is presented by focusing on their roles as carriers and precursors, respectively. Finally, challenges and prospects are assessed for the construction and development of collagen and silk fibroin-based catalysts.

Dual-crosslinked bioprosthetic heart valves prepared by glutaraldehyde crosslinked pericardium and poly-2-hydroxyethyl methacrylate exhibited improved antithrombogenicity and anticalcification properties

Bioprosthetic heart valves (BHVs) have been widely used due to the revolutionary transcatheter aortic valve replacement (TAVR) techniques but suffer from a limited lifespan. Previous modification methods of BHVs mainly rely on glutaraldehyde precrosslinking and subsequent modification. In this study, we have engineered a Poly-2-Hydroxyethyl methacrylate (pHEMA) coated BHV based on co-crosslinking and co-polymerization strategies. Our BHV overcomes previous limitations of glutaraldehyde prefixation by introducing free molecules before crosslinking to achieve the crosslinking and allyl moiety immobilization simultaneously. Decellularized porcine pericardium and 2-Amino-4-pentenoic acid (APA) are firstly co-crosslinked by glutaraldehyde to obtain alkenylated porcine pericardium (APA-PP), then APA-PP is copolymerized with hydrophilic monomer 2-Hydroxyethyl methacrylate (HEMA) to prepare pHEMA grafted porcine pericardium (HEMA-PP). Compared with traditional glutaraldehyde crosslinked pericardium (GA), HEMA-PP exhibits decreased cytotoxicity and significantly increased endothelialial cells proliferation (7-folds higher than GA after 3-day incubation). In vitro and ex vivo hemocompatibility studies demonstrate the superiority of HEMA-PP in anti-thrombogenicity, where the platelet adhesion decreased by levels of approximately 89% compared to GA. Moreover, HEMA-PP maintains structurally stable with a low level of calcification in the subcutaneous model. The hydrodynamic performance and durability are proven to meet the requirements of ISO 5840-3. Altogether, HEMA-PP may have the potential for future clinical application. STATEMENT OF SIGNIFICANCE: Currently, bioprosthetic heart valves (BHVs) have drawbacks including cytotoxicity, calcification and thrombosis, which would accelerate structural valvular degeneration and limit the service life of BHVs. We developed a new modification strategy that could simultaneously improve the biocompatibility, anti-calcification and anti-thrombotic properties of BHVs. Moreover, the appropriate durability and hydrodynamic property demonstrated the potential of our strategy for clinical application. This work will potentially prolong the service life of BHVs and provide new insight for the modification of BHVs.

Contact-Active Layer-by-Layer Grafted TPU/PDMS Blends as an Antiencrustation and Antibacterial Platform for Next-Generation Urological Biomaterials: Validation in Artificial and Human Urine

Urinary tract infections and urinary encrustation impede the long-term clinical performance of urological implants and medical devices. Together, biofilm formation and encrustation constitute serious complications, driving the development of next-generation urological biomaterials. The currently available bioengineered solutions have limited success during long-term usage in the urinary environment. In addressing this unmet clinical challenge, contact-active, antiencrustation surface grafting were conceived onto a dynamically cross-linked polydimethylsiloxane (PDMS) modified thermoplastic polyurethane (TPU) blend using the layer-by-layer (LbL) assembly route. To the best of the authors' knowledge, the present study is the first to investigate the LbL grafting in developing an antiencrustation platform. These multilayered assemblies strategically employed covalent cross-linking and electrostatic interaction-assisted progressive depositions of branched polyethyleneimine and poly(2-ethyl-2-oxazoline). While polyethyleneimine conferred the contact-killing bactericidal activity, the much-coveted antiencrustation properties were rendered by incorporating a partially hydrolyzed derivative of poly(2-ethyl-2-oxazoline). The performance of the resultant surface-modified TPU/PDMS blends was benchmarked against the conventional urological alloplasts, in a customized lab-scale bioreactor-based dynamic encrustation study and in human urine. After 6 weeks of exposure to an artificial urine medium, simulating urease-positive bacterial infection, the surface-modified blends exhibited a remarkable ability to suppress Ca and Mg encrustation. In addition, these blends also displayed superior grafting stability and antibacterial efficacy against common uropathogens. As high as 4-fold log reduction in the planktonic growth of Gram-negative P. mirabilis and Gram-positive MRSA was recorded with the LbL platform vis-à-vis medical-grade TPU. In conjunction, the in vitro cellular assessment with human keratinocytes (HaCaT) and human embryonic kidney cells (HEK) established the uncompromised cytocompatibility of the multilayered grafted blends. Finally, the physiologically relevant functionality of the LbL grafting has been validated using clinical samples of human urine collected from 129 patients with a broad spectrum of disease conditions. The phase-I pre-clinical study, entailing 6 week-long incubation in human urine, demonstrated significantly improved encrustation resistance of the blends. The collective findings of the present work clearly establish the success of LbL strategies in the development of stable, multifunctional new-generation urological biomaterials.

Compatibility and Durability of the Gel Stent Material

INTRODUCTION

The XEN Gel Stent (AbbVie Pharmaceuticals) is a device made from Gelatin; a well-known material in the medical field that is firm enough to hold its shape and soft enough to conform to tissues and reduce the risk of erosion. The Gel Stent creates a permanent outflow connection between the anterior chamber and subconjunctival space.

AREAS COVERED

Validation testing done on the Gel Stent to evaluate biocompatibility and durability of the material as well as real-world experience are included and discussed in this paper.

EXPERT OPINION

Correlating the results of the preclinical testing, study outcomes available in the published literature, and the surgeons' experiences, the device and materials have shown to have an acceptable biocompatibility and durability profile, with a stable, nondegradable, and permanent implant.

Cross-Linking Agents for Electrospinning-Based Bone Tissue Engineering

Electrospun nanofibers are promising bone tissue scaffolds that support bone healing due to the body’s structural similarity to the extracellular matrix (ECM). However, the insufficient mechanical properties often limit their potential in bone tissue regeneration. Cross-linking agents that chemically interconnect as-spun electrospun nanofibers are a simple but effective strategy for improving electrospun nanofibers’ mechanical, biological, and degradation properties. To improve the mechanical characteristic of the nanofibrous bone scaffolds, two of the most common types of cross-linking agents are used to chemically crosslink electrospun nanofibers: synthetic and natural. Glutaraldehyde (GTA) is a typical synthetic agent for electrospun nanofibers, while genipin (GP) is a natural cross-linking agent isolated from gardenia fruit extracts. GP has gradually gained attention since GP has superior biocompatibility to synthetic ones. In recent studies, much more progress has been made in utilizing crosslinking strategies, including citric acid (CA), a natural cross-linking agent. This review summarizes both cross-linking agents commonly used to improve electrospun-based scaffolds in bone tissue engineering, explains recent progress, and attempts to expand the potential of this straightforward method for electrospinning-based bone tissue engineering.

A PEGylation method of fabricating bioprosthetic heart valves based on glutaraldehyde and 2-amino-4-pentenoic acid co-crosslinking with improved antithrombogenicity and cytocompatibility

With the development of diagnostic techniques, the incidence of bioprosthetic heart valve thrombosis (BHVT) is found to be seriously underestimated. Developing bioprosthetic heart valves (BHVs) that have good hemocompatibility without sacrificing other properties such as hydrodynamics and durability will be an effective strategy to alleviate BHVT. In this study, we developed a PEGylation method by co-crosslinking and subsequent radical polymerization. 2-amino-4-pentenoic acid was used to introduce carbon-carbon double bonds for glutaraldehyde crosslinked pericardia. Then poly (ethylene glycol) diacrylate (PEGDA) was immobilized on pericardia by radical polymerization. A comprehensive evaluation of the modified pericardia was performed including structural characterization, hemocompatibility, cytocompatibility, mechanical properties, component stability, hydrodynamic performance and durability of the BHVs. The modified pericardia significantly reduced platelet adhesion by more than 75% compared with traditional glutaraldehyde crosslinked pericardia. Cell viability in the modified pericardia group was nearly 5-fold higher than that in glutaraldehyde crosslinked pericardia. The hydrodynamic performance met the requirements of ISO 5840-3 under physiological aortic valve conditions and its durability was proved after 200 million cycles of accelerated fatigue test. In conclusion, PEGDA modified pericardia exhibited improved antithrombogenicity and cytocompatibility properties compared with glutaraldehyde crosslinked pericardia. STATEMENT OF SIGNIFICANCE: Bioprosthetic valve (BHV) implantation requires BHV to be structurally stable as well as biocompatible in vivo. Traditional glutaraldehyde crosslinking method prepared BHV suffers from severe cytotoxicity, thrombosis, and calcification. BHV modification methods that have simultaneously improved structural stability and biocompatibility were rarely reported. Here, we proposed a PEGylation method for BHV based on co-crosslinking strategy that could improve its structural stability as well as hemocompatibility. We take the advantage of high efficiency of glutaraldehyde crosslinking and demonstrate the feasibility and superiority of the PEGylated strategy, offering a promising option in glutaraldehyde-based BHV fabrication in the future.

Smart piezoelectric biomaterials for tissue engineering and regenerative medicine: a review

Due to the presence of electric fields and piezoelectricity in various living tissues, piezoelectric materials have been incorporated into biomedical applications especially for tissue regeneration. The piezoelectric scaffolds can perfectly mimic the environment of natural tissues. The ability of scaffolds which have been made from piezoelectric materials in promoting cell proliferation and regeneration of damaged tissues has encouraged researchers in biomedical areas to work on various piezoelectric materials for fabricating tissue engineering scaffolds. In this review article, the way that cells of different tissues like cardio, bone, cartilage, bladder, nerve, skin, tendon, and ligament respond to electric fields and the mechanism of tissue regeneration with the help of piezoelectric effect will be discussed. Furthermore, all of the piezoelectric materials are not suitable for biomedical applications even if they have high piezoelectricity since other properties such as biocompatibility are vital. Seen in this light, the proper piezoelectric materials which are approved for biomedical applications are mentioned. Totally, the present review introduces the recent materials and technologies that have been used for tissue engineering besides the role of electric fields in living tissues.

Direct Ink Writing of Biocompatible Nanocellulose and Chitosan Hydrogels for Implant Mesh Matrices

Direct ink writing via single or multihead extrusion is used to synthesize layer-by-layer (LbL) meshes comprising renewable polysaccharides. The best mechanical performance (683 ± 63 MPa modulus and 2.5 ± 0.4 MPa tensile strength) is observed for 3D printed structures with full infill density, given the role of electrostatic complexation between the oppositely charged components (chitosan and cellulose nanofibrils). The LbL structures develop an unexpectedly high wet stability that undergoes gradual weight loss at neutral and slightly acidic pH. The excellent biocompatibility and noncytotoxicity toward human monocyte/macrophages and controllable shrinkage upon solvent exchange make the cellular meshes appropriate for use as biomedical implants.

Effectively improved 3-dimensional structural stability of atelocollagen-gelatin sponge biomaterial by heat treatment

Atelocollagen-gelatin (ACG) sponge was fabricated from atelocollagen and gelatin by lyophilization without introducing toxic substances. This study aimed to investigate the effects of heat treatment on the 3-dimensional structural stability of ACG sponge biomaterial. ACG sponge samples were fabricated and heat treated at 125^oC for 12 h in the vacuum. The results revealed that heat treatment did not affect porosity, pore size and mechanical compressive strength. Heat-treated ACG sponge showed decreased absorbance and peak shift of amid I (C=O) stretches, slightly higher water uptake degree and significantly decreased in vitro degradation rate. Moreover, heat-treated ACG sponge maintained good 3-dimensional surface morphology and porous microstructure throughout 7 days, while non-heat-treated ACG sponge collapsed in less than 24 h. The human mesenchymal stromal cells (hMSCs) were shown to adhere and grow well on heat-treated ACG sponges. These results indicate that heat treatment is effective and safe to stabilize 3-dimensional ACG sponge biomaterial for tissue engineering.

A comprehensive review on methods for promotion of mechanical features and biodegradation rate in amniotic membrane scaffolds

Amniotic membrane (AM) is a biological tissue that surrounds the fetus in the mother's womb. It has pluripotent cells, immune modulators, collagen, cytokines with anti-fibrotic and anti-inflammatory effect, matrix proteins, and growth factors. In spite of the biological characteristics, some results have been released in preventing the adhesion on traumatized surfaces. Application of the AM as a scaffold is limited due to its low biomechanical resistance and rapid biodegradation. Therefore, for using the AM during surgery, its modification by different methods such as cross-linking of the membrane collagen is necessary, because the cross-linking is an effective way to reduce the rate of biodegradation of the biological materials. In addition, their cross-linking is likely an efficient way to increase the tensile properties of the material, so that they can be easily handled or sutured. In this regard, various methods related to cross-linking of the AM subsuming the composite materials, physical cross-linking, and chemical cross-linking with the glutraldehyde, carbodiimide, genipin, aluminum sulfate, etc. are reviewed along with its advantages and disadvantages in the current work.

Advantages of decellularized bovine pericardial scaffolds compared to glutaraldehyde fixed bovine pericardial patches demonstrated in a 180-day implant ovine study

Glutaraldehyde (GA)-fixed bovine pericardial patches remain the cardiovascular industry standard despite reports of degradation, thickening, inflammation, calcification and lack of tissue remodelling. Decellularization provides the opportunity to attenuate some of these immune-mediated processes. This study compared the mechanical and morphological integrity of bovine pericardium that is GA-fixated (Glycar® patches) or decellularized (BPS), using a proprietary protocol, following implantation in an ovine model. The impact of the processing methods on tissue strength and morphology was assessed prior to implantation. Pericardial patches were then implanted in the descending aorta and main pulmonary artery of juvenile sheep (n = 6 per group) for 180 days, and clinically evaluated using echocardiography. At explanation, patches were evaluated for strength, calcification and biological interaction. Histology demonstrated a wave-like appearance of well-separated collagen fibers for BPS scaffolds that provided pore sizes adequate to promote fibroblast infiltration. The collagen of the Glycar® patches showed loss of collagen fiber integrity, making the collagen densely compacted, contributing to insignificant recipient cell infiltration. The clinical performance of both groups was excellent, and echocardiography confirmed the absence of aneurysm formation, calcification and degeneration. Explanted Glycar® patches demonstrated cells in abundance within the fibrous encapsulation that separated the implant from the host tissue. More importantly, the fibrous encapsulation also contributed to patch thickening of both the explanted aorta and pulmonary patches. The decellularized pericardial scaffolds demonstrated recellularization, resistance to calcification, re-endothelialization and adequate strength after 180-day implantation. The proprietary decellularization protocol produced pericardial scaffolds that could be considered as an alternative to GA-fixed pericardial patches.

Structural and Biochemical Changes in Pericardium upon Genipin Cross-Linking Investigated Using Nondestructive and Label-Free Imaging Techniques

Tissue cross-linking represents an important and often used technique to enhance the mechanical properties of biomaterials. For the first time, we investigated biochemical and structural properties of genipin (GE) cross-linked equine pericardium (EP) using optical imaging techniques in tandem with quantitative atomic force microscopy (AFM). EP was cross-linked with GE at 37 °C, and its biochemical and biomechanical properties were observed at various time points up to 24 h. GE cross-linked EP was monitored by the normalized ratio between its second-harmonic generation (SHG) and two-photon autofluorescence emissions and remained unchanged for untreated EP; however, a decreasing ratio due to depleted SHG and elevated autofluorescence and a fluorescence band at 625 nm were found for GE cross-linked EP. The mean autofluorescence lifetime of GE cross-linked EP also decreased. The biochemical signature of GE cross-linker and shift in collagen bands were detected and quantified using shifted excitation Raman difference spectroscopy as an innovative approach for tackling artifacts with high fluorescence backgrounds. AFM images indicated a higher and increasing Young's modulus correlated with cross-linking, as well as collagen structural changes in GE cross-linked EP, qualitatively explaining the observed decrease in the second-harmonic signal. In conclusion, we obtained detailed information about the biochemical, structural, and biomechanical effects of GE cross-linked EP using a unique combination of optical and force microscopy techniques in a nondestructive and label-free manner.

Characterization and properties of singly and dually modified hydrogen peroxide oxidized and glutaraldehyde crosslinked biodegradable starch films

Poor properties of native cassava starch film such as low mechanical properties and high water uptake are the limitations of biodegradable starch films. Dual modification is an alternative way to improve the properties. Characteristics and properties of oxidized, crosslinked and dually modified starch films by hydrogen peroxide oxidation and glutaraldehyde crosslinking were examined. Sequence of the dual modification was also studied. All starch films were prepared by casting technique using glycerol plasticizer. The oxidation and crosslinking of modified starch were confirmed by carbonyl and carboxyl contents as well as degree of crosslinking. The lowest and highest molecular weights of the modified starch were observed for the oxidized starch and crosslinked starch, respectively. Moreover, swelling power and moisture absorption of dually modified starch films was clearly lower than those of singly modified films. Additionally, both good stiffness and extensibility was also obtained from the dually modified films especially for the crosslinked-oxidized film. Moreover, thermal property and biodegradability were also determined.

Collagen- and hyaluronic acid-based hydrogels and their biomedical applications

Hydrogels have been widely investigated in biomedical fields due to their similar physical and biochemical properties to the extracellular matrix (ECM). Collagen and hyaluronic acid (HA) are the main components of the ECM in many tissues. As a result, hydrogels prepared from collagen and HA hold inherent advantages in mimicking the structure and function of the native ECM. Numerous studies have focused on the development of collagen and HA hydrogels and their biomedical applications. In this extensive review, we provide a summary and analysis of the sources, features, and modifications of collagen and HA. Specifically, we highlight the fabrication, properties, and potential biomedical applications as well as promising commercialization of hydrogels based on these two natural polymers.

Long-Term Stability and Biocompatibility of Pericardial Bioprosthetic Heart Valves

The use of bioprostheses for heart valve therapy has gradually evolved over several decades and both surgical and transcatheter devices are now highly successful. The rapid expansion of the transcatheter concept has clearly placed a significant onus on the need for improved production methods, particularly the pre-treatment of bovine pericardium. Two of the difficulties associated with the biocompatibility of bioprosthetic valves are the possibilities of immune responses and calcification, which have led to either catastrophic failure or slow dystrophic changes. These have been addressed by evolutionary trends in cross-linking and decellularization techniques and, over the last two decades, the improvements have resulted in somewhat greater durability. However, as the need to consider the use of bioprosthetic valves in younger patients has become an important clinical and sociological issue, the requirement for even greater longevity and safety is now paramount. This is especially true with respect to potential therapies for young people who are afflicted by rheumatic heart disease, mostly in low- to middle-income countries, for whom no clinically acceptable and cost-effective treatments currently exist. To extend longevity to this new level, it has been necessary to evaluate the mechanisms of pericardium biocompatibility, with special emphasis on the interplay between cross-linking, decellularization and anti-immunogenicity processes. These mechanisms are reviewed in this paper. On the basis of a better understanding of these mechanisms, a few alternative treatment protocols have been developed in the last few years. The most promising protocol here is based on a carefully designed combination of phases of tissue-protective decellularization with a finely-titrated cross-linking sequence. Such refined protocols offer considerable potential in the progress toward superior longevity of pericardial heart valves and introduce a scientific dimension beyond the largely disappointing 'anti-calcification' treatments of past decades.

Polyvinyl alcohol and pectin blended films: Preparation, characterization, and mesenchymal stem cells attachment

The design of novel wound dressings for chronic wound treatment is still of great importance. One of the promising approaches is application of mesenchymal stem cells (MSCs), immobilized on a flexible polymer film, for healing. In this study, blended films based on polyvinyl alcohol (PVA) and pectin with different component ratio have been prepared by solution casting method and evaluated. Physicochemical properties of the formed PVA/pectin films, including their morphology, wettability, swelling, stability, mechanical characteristics, have been studied. We demonstrated that the surface of PVA/pectin films could be modified by ultraviolet or dielectric barrier discharge plasma exposure. After both ultraviolet and plasma treatment, the hydrophilicity of PVA/pectin films increased. It has been shown that additional crosslinking of PVA/pectin films with glutaraldehyde resulted in reinforcement of their structure. MSCs were cultured on neat and modified PVA/pectin samples to evaluate the effects of film characteristics and composition on cell behavior. It has been determined that MSCs effectively adhered to glutaraldehyde-crosslinked PVA/pectin films and formed on them the monolayer culture of fibroblast-like cells. The additional modification of PVA/pectin films with collagen resulted in enhancement of MSCs adhesion. Our results show that the obtained PVA/pectin films with adhered MSCs can be suggested for potential application as a part of novel complex wound dressings.

Parietal Peritoneum as a Novel Substitute for Middle Hepatic Vein Reconstruction During Living Donor Liver Transplantation

BACKGROUND

Although autologous, cryopreserved, or artificial vascular grafts can be used as interpositional vascular substitutes for middle hepatic vein (MHV) reconstruction during living donor liver transplantation (LDLT), they are not always available, are limited in size and length, and are associated with risks of infection. This study aimed to evaluate the parietal peritoneum as a novel substitute for MHV reconstruction during LDLT.

METHODS

Prospectively collected data of 15 patients who underwent LDLT using the right liver with reconstruction of MHV using the recipients' own parietal peritoneum graft were retrospectively reviewed.

RESULTS

The 1-, 2-, 3-, and 5-mo patency rates were 57.1%, 57.1%, 57.1%, and 28.6%, respectively. Among the 15 cases assessed, the most recent 6 cases showed patent graft flow until discharge with 1-, 2-, 3-, and 5-mo patency rates of 80.0%, 80.0%, 80.0%, and 20.0%, respectively. All patients survived with tolerable liver function tests. There were no significant congestion-related problems, except for 1 patient who experienced MHV thrombosis requiring aspiration thrombectomy and stent insertion. There were no infection-related complications. All patients survived to the final follow-up, with a minimum follow-up duration of 8 mo. When comparing the latter 6 cases of peritoneal grafts and the recent 28 cases of conventional polytetrafluorethylene graft, the overall patency rate of the polytetrafluorethylene group was higher (P = 0.002). There were no major differences other than long-term patency rate.

CONCLUSIONS

Parietal peritoneum may be a novel autologous substitute for MHV reconstruction during LDLT.

Feasibility of using the homologous parietal peritoneum as a vascular substitute for venous reconstruction during abdominal surgery: An animal model

BACKGROUND

The interest in vascular substitutes has recently increased. We evaluated the feasibility of using a homologous parietal peritoneum as a vascular substitute for venous reconstruction during abdominal surgery.

METHODS

The inferior vena cava was replaced with a homologous parietal peritoneum after cross-linking with glutaraldehyde in 36 rabbits. At 7, 14, and 28 days, the patency rate, outer and inner graft diameters, histology, and immunohistochemistry were evaluated.

RESULTS

Both the 7- and 14-day groups maintained vascular patency. Vascular patency was maintained in 3 rabbits in the 28-day group. The inner diameters of the anastomotic sites were 6.23 ± 0.18, 5.64 ± 0.16, and 2.34 ± 0.21 mm in the 7-day, 14-day, and 28-day groups, respectively. The midpoint inner diameters of the homologous parietal peritoneum grafts were 624 ± 0.46, 5.74 ± 0.26, and 2.14 ± 0.28 mm in each group, respectively. Endothelial cell proliferation on the homologous parietal peritoneum graft surfaces in all groups was based on the histological findings from the first group. Multiple neovascularizations of the homologous parietal peritoneum graft were found in the 14- and 28-day groups, indicating neo-media formation. Acute inflammation appeared to progress to the entire layer of the homologous parietal peritoneum graft without an intraluminal thrombus, but the graft was patent in the 14-day group. In the 28-day group, 6 rabbits showed near-total occlusion and a thrombus formed in the homologous parietal peritoneum graft at the anastomosis site with severe stricture; however, the rabbits were alive and had collateral vessel formation.

CONCLUSION

Using homologous parietal peritoneum is feasible for venous reconstruction in abdominal surgery.

Collagen hydrogels with controllable combined cues of elasticity and topography to regulate cellular processes

The elasticity, topography, and chemical composition of cell culture substrates influence cell behavior. However, the cellular responses toin vivoextracellular matrix (ECM), a hydrogel of proteins (mainly collagen) and polysaccharides, remain unknown as there is no substrate that preserves the key features of native ECM. This study introduces novel collagen hydrogels that can combine elasticity, topography, and composition and reproduce the correlation between collagen concentration (C) and elastic modulus (E) in native ECM. A simple reagent-free method based on radiation-cross-linking altered ECM-derived collagen I and hydrolyzed collagen (gelatin or collagen peptide) solutions into hydrogels with tunable elastic moduli covering a broad range of soft tissues (E= 1-236 kPa) originating from the final collagen density in the hydrogels (C= 0.3%-14%) and precise microtopographies (⩾1 μm). The amino acid composition ratio was almost unchanged by this method, and the obtained collagen hydrogels maintained enzyme-mediated degradability. These collagen hydrogels enabled investigation of the responses of cell lines (fibroblasts, epithelial cells, and myoblasts) and primary cells (rat cardiomyocytes) to soft topographic cues such as thosein vivounder the positive correlation betweenCandE. These cells adhered directly to the collagen hydrogels and chose to stay atop or spontaneously migrate into them depending onE, that is, the density of the collagen network,C. We revealed that the cell morphology and actin cytoskeleton organization conformed to the topographic cues, even when they are as soft asin vivoECM. The stiffer microgrooves on collagen hydrogels aligned cells more effectively, except HeLa cells that underwent drastic changes in cell morphology. These collagen hydrogels may not only reducein vivoandin vitrocell behavioral disparity but also facilitate artificial ECM design to control cell function and fate for applications in tissue engineering and regenerative medicine.

Optimization of Collagen Chemical Crosslinking to Restore Biocompatibility of Tissue-Engineered Scaffolds

Collagen scaffolds, one of the most used biomaterials in corneal tissue engineering, are frequently crosslinked to improve mechanical properties, enzyme tolerance, and thermal stability. Crosslinkers such as 1-ethyl-3-(3-dimethylaminopropyl) carbodiimide hydrochloride (EDC) are compatible with tissues but provide low crosslinking density and reduced mechanical properties. Conversely, crosslinkers such as glutaraldehyde (GTA) can generate mechanically more robust scaffolds; however, they can also induce greater toxicity. Herein, we evaluated the effectivity of double-crosslinking with both EDC and GTA together with the capability of sodium metabisulfite (SM) and sodium borohydride (SB) to neutralize the toxicity and restore biocompatibility after crosslinking. The EDC-crosslinked collagen scaffolds were treated with different concentrations of GTA. To neutralize the free unreacted aldehyde groups, scaffolds were treated with SM or SB. The chemistry involved in these reactions together with the mechanical and functional properties of the collagen scaffolds was evaluated. The viability of the cells grown on the scaffolds was studied using different corneal cell types. The effect of each type of scaffold treatment on human monocyte differentiation was evaluated. One-way ANOVA was used for statistical analysis. The addition of GTA as a double-crosslinking agent significantly improved the mechanical properties and enzymatic stability of the EDC crosslinked collagen scaffold. GTA decreased cell biocompatibility but this effect was reversed by treatment with SB or SM. These agents did not affect the mechanical properties, enzymatic stability, or transparency of the double-crosslinked scaffold. Contact of monocytes with the different scaffolds did not trigger their differentiation into activated macrophages. Our results demonstrate that GTA improves the mechanical properties of EDC crosslinked scaffolds in a dose-dependent manner, and that subsequent treatment with SB or SM partially restores biocompatibility. This novel manufacturing approach would facilitate the translation of collagen-based artificial corneas to the clinical setting.

Natural bio-based monomers for biomedical applications: a review

In recent years, synthetic and semi-synthetic polymer materials have been widely used in various applications. Especially concerning biomedical applications, their biocompatibility, biodegradability, and non-toxicity have increased the interest of researchers to discover and develop new products for the well-being of humanity. Among the synthetic and semi-synthetic materials, the use of natural bio-based monomeric materials presents a possible novel avenue for the development of new biocompatible, biodegradable, and non-toxic products. The purpose of this article is to review the information on the role of natural bio-based monomers in biomedical applications. Increased eco-friendliness, biocompatibility, biodegradability, non-toxicity, and intrinsic biological activity are some of the attributes which make itaconic, succinic, citric, hyaluronic, and glutamic acids suitable potential materials for biomedical applications. Herein, we summarize the most recent advances in the field over the past ten years and specifically highlight new and interesting discoveries in biomedical applications. Natural origin acid-based bio-monomers for biomedical applications.

An In Vitro Model to Study Endothelialization of Cardiac Graft Tissues Under Flow

Pulmonary valve replacement is performed with excellent resultant hemodynamics in patients that have underlying congenital or acquired heart valve defects. Despite recent advancements in right ventricular outflow tract reconstruction, an increased risk of developing infective endocarditis remains, which has a more common occurrence for conduits of bovine jugular vein (BJV) origin compared with cryopreserved homografts. The reason for this is unclear although it is hypothesized to be associated with an aberrant phenotypic state of cells that reendothelialize the graft tissue postimplantation. The aim of this study was to develop an in vitro model that enables the analysis of endothelial cell (EC) attachment to cardiac graft tissues under flow. In the experiments, EC attachment was optimized on bovine pericardium (BP) patch using human umbilical vein ECs. Different biological coatings, namely gelatin, fibronectin, plasma, or a combination of fibronectin and plasma were tested. After cell adaptation, graft tissues were exposed to laminar flow in a parallel-plate flow chamber. Cell retention to the tissue was analyzed after nuclear staining with YO-PRO-1 and a membranous localization of VE-cadherin. Experiments showed that combined coating with fibronectin and blood plasma together with a two-phased shear pattern resulted in a relevant cell monolayer on BP patch and cryopreserved homograft. For BJV tissue, no adherent cells under both static and shear conditions were initially observed. In conclusion, having established the new flow chamber system we could obtain EC layers on the surface of BP patch and cryopreserved pulmonary homograft tissues. The presented in vitro system can serve as a competent model to study cell phenotypes on cardiac grafts in the close-to-physiologic environment. Moreover, this approach allows broad applications and enables further development by testing more complex conditions.

Recent Advances in Scaffolding from Natural-Based Polymers for Volumetric Muscle Injury

Volumetric Muscle Loss (VML) is associated with muscle loss function and often untreated and considered part of the natural sequelae of trauma. Various types of biomaterials with different physical and properties have been developed to treat VML. However, much work remains yet to be done before the scaffolds can pass from the bench to the bedside. The present review aims to provide a comprehensive summary of the latest developments in the construction and application of natural polymers-based tissue scaffolding for volumetric muscle injury. Here, the tissue engineering approaches for treating volumetric muscle loss injury are highlighted and recent advances in cell-based therapies using various sources of stem cells are elaborated in detail. An overview of different strategies of tissue scaffolding and their efficacy on skeletal muscle cells regeneration and migration are presented. Furthermore, the present paper discusses a wide range of natural polymers with a special focus on proteins and polysaccharides that are major components of the extracellular matrices. The natural polymers are biologically active and excellently promote cell adhesion and growth. These bio-characteristics justify natural polymers as one of the most attractive options for developing scaffolds for muscle cell regeneration.

Freeze-Drying of Decellularized Heart Valves for Off-the-Shelf Availability

Malfunctioning heart valves can cause severe health problems, which if left untreated can lead to death. One of the treatment options is to replace a diseased heart valve with a decellularized valve construct prepared from human or animal material. Decellularized tissue scaffolds closely resemble properties of native tissue, while lacking immunogenic factors of cellular components. After transplantation, circulating stem and progenitor cells of the patient adhere to the scaffold resulting in in vivo tissue regeneration of the valve. Decellularized heart valve scaffold implants need to be stored to be readily available whenever needed, which can be done by freeze-drying. The advantage of freeze-drying is that it does not require bulky and energy-consuming freezing equipment for storage and allows easy transport. This chapter outlines the entire process from decellularization to freeze-drying to obtain dry decellularized heart valves, which after a simple rehydration step, can be used as implants. The protocol is described for porcine heart valves, but procedures can easily be adapted for material obtained from other species.

Poly(ethylene glycol)-Based Coatings for Bioprosthetic Valve Tissues: Toward Restoration of Physiological Behavior

Bioprosthetic valves (BPVs) have a limited lifespan in the body necessitating repeated surgeries to replace the failed implant. Early failure of these implants has been linked to various surface properties of the valve. Surface properties of BPVs are significantly different from physiological valves because of the fixation process used when processing the xenograft tissue. To improve the longevity of BPVs, efforts need to be taken to improve the surface properties and shield the implant from the bodily interactions that degrade it. Toward this goal, we evaluated the use of hydrogel coatings to attach to the BPV tissue and impart surface properties that are close to physiological. Hydrogels are well characterized for their biocompatibility and highly tunable surface characteristics. Using a previously published coating method, we deposited hydrogel coatings of poly(ethylene glycol)diacrylate (PEGDA) and poly(ethylene glycol)diacrylamide (PEGDAA) atop BPV samples. Coated samples were evaluated against the physiological tissue and uncoated glutaraldehyde-fixed tissue for deposition of hydrogel, surface adherence, mechanical properties, and fixation properties. Results showed both PEGDA- and PEGDAA-deposited coatings were nearly continuous across the valve leaflet surface. Further, the PEGDA- and PEGDAA-coated samples showed restoration of physiological levels of protein adhesion and mechanical stiffness. Interestingly, the coating process rather than the coating itself altered the material behavior yet did not alter the cross-linking from fixation. These results show that the PEG-based coatings for BPVs can successfully alter surface properties of BPVs and help promote physiological characteristics without interfering with the necessary fixation.

Long-term Results Using Glutaraldehyde-treated Homograft Pericardium in Congenital Heart Surgery

BACKGROUND

This study reports the long-term outcomes using glutaraldehyde-treated cryopreserved homograft pericardium (CPH) in neonates, infants, children, and young adults undergoing congenital cardiac surgery.

METHODS

A retrospective review was performed of all patients at a single institution (Rady Children's Hospital, San Diego, CA) who had undergone surgical implantation with CPH between 2006 and 2016. The study identified 134 consecutive patients who underwent implantation of a total of 276 patches. The baseline demographic characteristics, primary cardiac diagnosis, surgical characteristics, operative reports, and postoperative catheterization and reoperation reports were analyzed. The use of CPH was categorized by specific anatomic insertion site.

RESULTS

The median age at patch implantation was 1.47 years (range, 1 day to 31.6 years). The numbers and locations of patch use were 124 for pulmonary arterial repair, 57 for repair of the aorta, 49 for septal repair, and 43 at other sites. At a median follow-up of 5.29 years, 9 patients had died (6.7%), but none of those deaths were related to CPH. Twelve patients (8.96%) underwent reoperations, and 18 patients (13.4%) underwent catheter interventions at sites of CPH implantation. The 10-year freedom from patch-induced reoperation and catheter intervention rates were 88.5% and 86.9%, respectively. Overall patch failure-free survival was 85.8% and 79.0% at 5 and 10 years, respectively.

CONCLUSIONS

The use of CPH patch in the surgical correction of congenital heart disease is effective and durable, as evidenced by the low reintervention rates. These results are comparable to the early and midterm outcomes of other similarly used surgical patches..

Enhancement of Podocyte Attachment on Polyacrylamide Hydrogels with Gelatin-Based Polymers

Biological activities of cells such as survival and differentiation processes are mainly maintained by a specific extracellular matrix (ECM). Hydrogels have recently been employed successfully in tissue engineering applications. In particular, scaffolds made of gelatin methacrylate-based hydrogels (GelMA) showed great potential due to their biocompatibility, biofunctionality, and low mechanical strength. The development of a hydrogel having tunable and appropriate mechanical properties as well as chemical and biological cues was the aim of this work. A synthetic and biological hybrid hydrogel was developed to mimic the biological and mechanical properties of native ECM. A combination of gelatin methacrylate and acrylamide (GelMA-AAm)-based hydrogels was studied, and it showed tunable mechanical properties upon changing the polymer concentrations. Different GelMA-AAm samples were prepared and studied by varying the concentrations of GelMA and AAm (AAm_2.5% + GelMA_3%, AAm_5% + GelMA_3%, and AAm_5% + GelMA_5%). The swelling behavior, biodegradability, physicochemical and mechanical properties of GelMA-AAm were also characterized. The results showed a variation of swelling capability and a tunable elasticity ranging from 4.03 to 24.98 kPa depending on polymer concentrations. Moreover, the podocyte cell morphology, cytoskeleton reorganization and differentiation were evaluated as a function of GelMA-AAm mechanical properties. We concluded that the AAm_2.5% + GelMA_3% hydrogel sample having an elasticity of 4.03 kPa can mimic the native kidney glomerular basement membrane (GBM) elasticity and allow podocyte cell attachment without the functionalization of the gel surface with adhesion proteins compared to synthetic hydrogels (PAAm). This work will further enhance the knowledge of the behavior of podocyte cells to understand their biological properties in both healthy and diseased states.

Advances in Engineering Venous Valves: The Pursuit of a Definite Solution for Chronic Venous Disease

Native venous valves enable proper return of blood to the heart. Under pathological conditions (e.g., chronic venous insufficiency), venous valves malfunction and fail to prevent backward flow. Clinically, this can result in painful swelling, varicose veins, edema, and skin ulcerations leading to a chronic wound situation. Surgical correction of venous valves has proven to drastically reduce these symptoms. However, the absence of intact leaflets in many patients limits the applicability of this strategy. In this context, the development of venous valve replacements represents an appealing approach. Despite acceptable results in animal models, no venous valve has succeeded in clinical trials, and so far no single prosthetic venous valve is commercially available. This calls for advanced materials and fabrication approaches to develop clinically relevant venous valves able to restore natural flow conditions in the venous circulation. In this study, we critically discuss the approaches attempted in the last years, and we highlight the potential of tissue engineering to offer new avenues for valve fabrication. Impact statement Venous valves prosthesis offer the potential to restore normal venous flow, and to improve the prospect of patients that suffer from chronic venous disease. Current venous valve replacements are associated with poor outcomes. A deeper understanding of the approaches attempted so far is essential to establish the next steps toward valve development, and importantly, tissue engineering constitutes a unique toolbox to advance in this quest.

Collagen Based Materials in Cosmetic Applications: A Review

This review provides a report on properties and recent advances in the application of collagen in cosmetics. Collagen is a structural protein found in animal organisms where it provides for the fundamental structural support. Most commonly it is extracted from mammalian and fish skin. Collagen has attracted significant academic interest as well as the attention of the cosmetic industry due to its interesting properties that include being a natural humectant and moisturizer for the skin. This review paper covers the biosynthesis of collagen, the sources of collagen used in the cosmetic industry, and the role played by this protein in cosmetics. Future aspects regarding applications of collagen-based materials in cosmetics have also been mentioned.

FLIm and Raman Spectroscopy for Investigating Biochemical Changes of Bovine Pericardium upon Genipin Cross-Linking

Biomaterials used in tissue engineering and regenerative medicine applications benefit from longitudinal monitoring in a non-destructive manner. Label-free imaging based on fluorescence lifetime imaging (FLIm) and Raman spectroscopy were used to monitor the degree of genipin (GE) cross-linking of antigen-removed bovine pericardium (ARBP) at three incubation time points (0.5, 1.0, and 2.5 h). Fluorescence lifetime decreased and the emission spectrum redshifted compared to that of uncross-linked ARBP. The Raman signature of GE-ARBP was resonance-enhanced due to the GE cross-linker that generated new Raman bands at 1165, 1326, 1350, 1380, 1402, 1470, 1506, 1535, 1574, 1630, 1728, and 1741 cm-1. These were validated through density functional theory calculations as cross-linker-specific bands. A multivariate multiple regression model was developed to enhance the biochemical specificity of FLIm parameters fluorescence intensity ratio (R2 = 0.92) and lifetime (R2 = 0.94)) with Raman spectral results. FLIm and Raman spectroscopy detected biochemical changes occurring in the collagenous tissue during the cross-linking process that were characterized by the formation of a blue pigment which affected the tissue fluorescence and scattering properties. In conclusion, FLIm parameters and Raman spectroscopy were used to monitor the degree of cross-linking non-destructively.

FLIm-Guided Raman Imaging to Study Cross-Linking and Calcification of Bovine Pericardium

Bovine pericardium (BP) is a vascular biomaterial used in cardiovascular surgery that is typically cross-linked for masking antigenicity and enhance stability. There is a need for biochemical evaluation of the tissue properties prior to implantation to ensure that quality and reliability standards are met. Here, engineered antigen removed BP (ARBP) that was cross-linked with 0.2% and 0.6% glutaraldehyde (GA), and further calcified in vitro to simulate graft calcifications upon implantation was characterized nondestructively using fluorescence lifetime imaging (FLIm) to identify regions of interest which were then assessed by Raman spectroscopy. We observed that the tissue fluorescence lifetime shortened, and that Raman bands at 856, 935, 1282, and 1682 cm-1 decreased, and at 1032 and 1627 cm-1 increased with increasing GA cross-linking. Independent classification analysis based on fluorescence lifetime and on Raman spectra discriminated between GA-ARBP and untreated ARBP with an accuracy of 91% and 66%, respectively. Pearson's correlation analysis showed a strong correlation between pyridinium cross-links measured with high-performance liquid chromatography and fluorescence lifetime measured at 380-400 nm (R = -0.76, p = 0.00094), as well as Raman bands at 856 cm-1 for hydroxy-proline (R = -0.68, p = 0.0056) and at 1032 cm-1 for hydroxy-pyridinium (R = 0.74, p = 0.0016). Calcified areas of GA cross-linked tissue showed characteristic hydroxyapatite (959 and 1038 cm-1) bands in the Raman spectrum and fluorescence lifetime shortened by 0.4 ns compared to uncalcified regions. FLIm-guided Raman imaging could rapidly identify degrees of cross-linking and detected calcified regions with high chemical specificity, an ability that can be used to monitor tissue engineering processes for applications in regenerative medicine.