Chapter 20 Future directions and therapeutic approaches

Procedure for quantification of platelet adhesion to biomaterials by radioscintigraphy

Detection of adhered platelets on biomaterial surface that has blood-contacting application is an important test to assess its thrombogenicity. Usually, for measurement of platelet adhesion, after exposure to platelet-rich plasma (PRP) under standardized conditions the test surface is rinsed to remove non-adherent cells and is analyzed under scanning electron microscopy (SEM) to detect morphology of adhered cell and degree of aggregate formation. However, being a qualitative test it is unlikely to give an accurate estimate of platelets adhered to the surface. On the other hand, use of radiolabels enables quantification of platelets deposited on a material or device. Because of high gamma emission of (111)In, it can be used for radioscintigraphy, however, its short half life (2.5 days) is a major hurdle in using it for quantification of platelet adhesion. (125)I is a relatively strong radiolabel that is easily tagged to most of the proteins and has a relatively long half-life (60 days). The major objectives of this study are to standardize the labeling conditions to get good (125)I activity on platelets, while maintaining normal cell function after they are labeled. Considering all possible uncertainties, quantity of isotope and platelets to be used and the conditions of iodination reaction are established to get repeatable and reproducible labeling of platelets. Further, it is demonstrated that (125)I-platelets can be used to determine total number of cells adhered to titanium surface, which is known to be used as a blood-contacting biomaterial.

Photoimmobilisation of poly(N-vinylpyrrolidinone) as a means to improve haemocompatibility of polyurethane biomaterials

A novel method to improve the haemocompatibility of polymeric biomaterials (in particular: polyurethane elastomers) is reported. The new approach essentially rests upon photochemical immobilisation of the highly biocompatible polymer poly(N-vinylpyrrolidinone) (poly(NVP)) onto the biomaterial's surface. One of the key steps in the surface modification procedure is the preparation of a copolymer of NVP and the photoreactive building block 4-[4'-azidobenzoyl]-oxo-n-butylmethacrylate (1). This copolymer is first dissolved in a volatile solvent, then sprayed onto the biomaterial's surface, and subsequently immobilised via irradiation with ultraviolet light. The paper describes: (i) preparation of 1, (ii) preparation of the copolymer (NVP + 1), (iii) physico-chemical characterisation of the modified surfaces, and (iv) results of two in vitro haemocompatibility assays (i.e. thrombin generation and adhesion of blood platelets from recalcified human platelet-rich plasma). Furthermore, the surface modification was performed with a microporous polyurethane vascular graft (Chronoflex), which is already in clinical use. The in vitro experiments revealed that significant improvement of the haemocompatibility of polyurethanes can be achieved through this method.

Improving endothelial cell adhesion to vascular graft surfaces: clinical need and strategies

Synthetic vascular grafts do not spontaneously endothelialize in humans and require some form of anticoagulation to maintain patency. Preseeding synthetic graft materials such as expanded polytetrafluoroethylene (ePTFE) and polyethylene terephthalate (PET) with endothelial cells (EC) has been examined in various in vitro and in vivo models. Although various studies provide encouraging results, clinical trials for EC seeding on synthetic grafts have not been equally successful. This paper provides a brief review of the various reports on EC seeding in animal and clinical studies. We discuss the inefficiencies associated with the EC seeding process and examine plasma protein treatment of the graft surfaces as a viable option for improving EC attachment, retention and spreading. As an alternative to existing therapies we present data on a heterogeneous ligand treatment of fibronectin (Fn) and avidin-biotin for enhanced human umbilical vein endothelial cell (HUVEC) adhesion to ePTFE graft surfaces. Control consisted of HUVECs seeded on Fn treated ePTFE graft surfaces. Functionality of HUVECs was assessed by measuring prostacyclin production of cells on both homogeneous and heterogeneous ligand treated surfaces. Laminar flow studies with a variable width flow chamber and scanning electron microscopy were used to measure initial cell retention and observe initial cell spreading on ePTFE surfaces, respectively. HUVEC retention on heterogeneous ligand treated graft surface was significantly (p < 0.001) higher compared to homogeneous ligand treated surfaces for shear stress in the range of 10-30 dyn cm(-2). HUVEC showed more cellular spreading on the heterogeneous ligand treated surface after seeding for 1-2 h. In vivo experimentation was performed in immune deficient (nude) rats by replacing a section of both the femoral arteries with 8 mnm long, 1 mm internal diameter denucleated ePTFE grafts treated with homogeneous and heterogeneous ligands respectively. Both grafts were seeded with similar cell density for 15 min prior to implantation. EC attachment and retention was measured by staining EC with hematoxylin and counting the cells before and after flow using light microscopy. The results indicate that a heterogeneous ligand treatment of graft surfaces using avidin-biotin and Fn-integrin attachment mechanisms increase cell seeding efficiency, initial cell retention and cellular spreading.

Fibronectin and avidin-biotin as a heterogeneous ligand system for enhanced endothelial cell adhesion

A preadsorbed layer of "heterogeneous" integrin-dependent and -independent protein was used to enhance initial integrin-mediated endothelial cell attachment and spreading. Glass substrates were treated with fibronectin (Fn) and avidin coupled through adsorbed biotinylated bovine serum albumin (b-BSA). The slides then were seeded with biotinylated BAEC. Control "homogeneous" surfaces were slides adsorbed with either Fn or avidin coupled to b-BSA. The cells were incubated for 0.5 h in serum-containing media and exposed to a range of shear stresses in a laminar flow variable-height flow chamber. The critical shear stress to detach 50% of the seeded cells on the heterogeneous ligand surface was significantly greater than for either of the control homogeneous ligand systems (p < 0.001). Cellular spreading during the initial period of 0-2 h also was higher (p < 0.05) on the heterogeneous ligand-treated surface than on the surface of either of the homogeneous controls. The close contact area of the cell membrane with the substrate 1 h after seeding in serum-containing media was measured using TIRFM. Cells attached onto the heterogeneous ligand-treated surfaces had a significantly (p < 0.01) higher area of close contact with the substrate, which is consistent with a greater degree of attachment and spreading. The results indicate that the combination of integrin-dependent and -independent adhesion systems using heterogeneous ligands further enhances initial endothelial cell attachment and spreading.

Using avidin-mediated binding to enhance initial endothelial cell attachment and spreading

Binding between the protein avidin and the vitamin biotin was used as an extrinsic, high affinity receptor-ligand system to augment the intrinsic integrin-dependent cellular adhesion mechanism. Glass substrates were coupled with avidin receptors through an adsorbed film of biotinylated bovine serum albumin (b-BSA). The avidin-treated slides then were seeded with biotinylated bovine aortic endothelial cells (BAEC). A 3:1 ratio of BSA:b-BSA provided the best results in terms of specific cellular attachment, growth, and spreading. Control surfaces consisted of bare glass or glass with adsorbed BSA. Attachment of unmodified BAEC to glass decreased in the presence of anti-beta 1 integrin antibody. Adhesion of biotinylated BAEC to avidin-treated slides was not affected by anti-beta 1 integrin antibody, consistent with integrin-independent avidin-mediated adhesion. The initial rate of cell spreading was greatest for avidin-biotin-mediated adhesion (80.0 +/- 25.6 microns2/h), followed by integrin-dependent cellular adhesion on plain glass (35.7 +/- 7.7 microns2/h) and, finally, by adhesion on BSA-coated protein surfaces (10.2 +/- 0.3 microns2/h). Biotinylated and unmodified BAEC, cultured for 1 h in serum-containing media, were subjected to laminar flow in a variable-height flow chamber that provided a range of shear stresses from 0.2 to 75 dynes/cm2. The critical shear stress required to detach 50% of the cells in serum-containing media increased from 4.6 +/- 0.8 dynes/cm2 for integrin-dependent adhesion to 12.6 +/- 1.2 dynes/cm2 for avidin-biotin-mediated adhesion. Avidin-mediated attachment for biotinylated BAEC increased initial cellular spreading rates and strength of attachment (i.e., at 1 h) by a factor of two and three, respectively. These results support the hypothesis that integrin-mediated cell attachment and spreading can be enhanced using high affinity integrin-independent binding.

Blood anesthesia for cardiopulmonary bypass

Cardiopulmonary bypass (CPB) causes bleeding and thrombotic complications, fluid retention and temporary dysfunction of every organ system. This morbidity of CPB is primarily do to activation of blood proteins and cells by contact with nonendothelial cell surfaces of the wound and biomaterials of the extracorporeal perfusion circuit. CPB is not possible without heparin, yet heparin is not an ideal anticoagulant and does not prevent activation of at least five plasma protein systems and five blood cells. Stimulation of these blood elements produces over 25 vasoactive substances that alter vascular tone, capillary permeability, and cardiac myocyte contractility. In addition, CPB produces showers of microemboli that pass filters to obstruct arterioles and precapillaries to produce necrosis of widely dispersed, small groups of cells. Attempts to develop nonthrombogenic synthetic materials have failed; only the endothelial cell is nonthrombogenic and achieves this property by active metabolic processes. Although some biomaterials are less thrombogenic than others, all activate blood elements to initiate clotting and the body's defense reaction. The concept of "blood anesthesia" envisions the use of reversible inhibitors of key blood reactions to temporarily prevent activation of blood elements during CPB. If the initial reactions of blood with nonendothelial surfaces are blocked, production of many vasoactive substances and microemboli by CPB is suppressed. This conserves blood elements that are normally consumed during CPB and makes them available after the inhibitor is reversed. Effective, reversible inhibitors of platelets are entering clinical trials; reversible inhibitors of other key blood relations are being developed and tested at a rapid rate.(ABSTRACT TRUNCATED AT 250 WORDS)