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Fan D, Liu X, Chen H. Endothelium-Mimicking Materials: A "Rising Star" for Antithrombosis. ACS APPLIED MATERIALS & INTERFACES 2024. [PMID: 39344055 DOI: 10.1021/acsami.4c12117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/01/2024]
Abstract
The advancement of antithrombotic materials has significantly mitigated the thrombosis issue in clinical applications involving various medical implants. Extensive research has been dedicated over the past few decades to developing blood-contacting materials with complete resistance to thrombosis. However, despite these advancements, the risk of thrombosis and other complications persists when these materials are implanted in the human body. Consequently, the modification and enhancement of antithrombotic materials remain pivotal in 21st-century hemocompatibility studies. Previous research indicates that the healthy endothelial cells (ECs) layer is uniquely compatible with blood. Inspired by bionics, scientists have initiated the development of materials that emulate the hemocompatible properties of ECs by replicating their diverse antithrombotic mechanisms. This review elucidates the antithrombotic mechanisms of ECs and examines the endothelium-mimicking materials developed through single, dual-functional and multifunctional strategies, focusing on nitric oxide release, fibrinolytic function, glycosaminoglycan modification, and surface topography modification. These materials have demonstrated outstanding antithrombotic performance. Finally, the review outlines potential future research directions in this dynamic field, aiming to advance the development of antithrombotic materials.
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Affiliation(s)
- Duanqi Fan
- State and Local Joint Engineering Laboratory for Novel Functional Polymeric Materials, College of Chemistry, Chemical Engineering and Materials Science, Soochow University, Suzhou 215123, P. R. China
| | - Xiaoli Liu
- State and Local Joint Engineering Laboratory for Novel Functional Polymeric Materials, College of Chemistry, Chemical Engineering and Materials Science, Soochow University, Suzhou 215123, P. R. China
| | - Hong Chen
- State and Local Joint Engineering Laboratory for Novel Functional Polymeric Materials, College of Chemistry, Chemical Engineering and Materials Science, Soochow University, Suzhou 215123, P. R. China
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2
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Li R, Xu J, Li Y, Yi P, Sun C, Yang Q, Wang Q, Mao Y, Mei Z, Zhou G, Ruan F, Shi S, Zhang M, Gong YK. An endothelium membrane mimetic antithrombotic coating enables safer and longer extracorporeal membrane oxygenation application. Acta Biomater 2024; 186:185-200. [PMID: 39103136 DOI: 10.1016/j.actbio.2024.07.058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Revised: 07/25/2024] [Accepted: 07/30/2024] [Indexed: 08/07/2024]
Abstract
Thrombosis and plasma leakage are two of the most frequent dysfunctions of polypropylene (PP) hollow fiber membrane (PPM) used in extracorporeal membrane oxygenation (ECMO) therapy. In this study, a superhydrophilic endothelial membrane mimetic coating (SEMMC) was constructed on polydopamine-polyethyleneimine pre-coated surfaces of the PPM oxygenator and its ECMO circuit to explore safer and more sustainable ECMO strategy. The SEMMC is fabricated by multi-point anchoring of a phosphorylcholine and carboxyl side chained copolymer (PMPCC) and grafting of heparin (Hep) to form PMPCC-Hep interface, which endows the membrane superior hemocompatibility and anticoagulation performances. Furthermore, the modified PPM reduces protein adsorption amount to less than 30 ng/cm2. More significantly, the PMPCC-Hep coated ECMO system extends the anti-leakage and non-clotting oxygenation period to more than 15 h in anticoagulant-free animal extracorporeal circulation, much better than the bare and conventional Hep coated ECMO systems with severe clots and plasma leakage in 4 h and 8 h, respectively. This SEMMC strategy of grafting bioactive heparin onto bioinert zwitterionic copolymer interface has great potential in developing safer and longer anticoagulant-free ECMO systems. STATEMENT OF SIGNIFICANCE: A superhydrophilic endothelial membrane mimetic coating was constructed on surfaces of polypropylene hollow fiber membrane (PPM) oxygenator and its ECMO circuit by multi-point anchoring of a phosphorylcholine and carboxyl side chain copolymer (PMPCC) and grafting of heparin (Hep). The strong antifouling nature of the PMPCC-Hep coating resists the adsorption of plasma bio-molecules, resulting in enhanced hemocompatibility and anti-leakage ability. The grafted heparin on the zwitterionic PMPCC interface exhibits superior anticoagulation property. More significantly, the PMPCC-Hep coating achieves an extracorporeal circulation in a pig model for at least 15 h without any systemic anticoagulant. This endothelial membrane mimetic anticoagulation strategy shows great potential for the development of safer and longer anticoagulant-free ECMO systems.
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Affiliation(s)
- Rong Li
- Key Laboratory of Synthetic and Natural Functional Molecule Chemistry of Ministry of Education, College of Chemistry and Materials Science, Northwest University, Xian 710127, Shaanxi, China
| | - Jiefeng Xu
- Department of Emergency Medicine, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China; Key Laboratory of The Diagnosis and Treatment of Severe Trauma and Burn of Zhejiang Province, Hangzhou, China; Zhejiang Provincial Clinical Research Center for Emergency and Critical Care Medicine, Hangzhou, China
| | - Yin Li
- Key Laboratory of Synthetic and Natural Functional Molecule Chemistry of Ministry of Education, College of Chemistry and Materials Science, Northwest University, Xian 710127, Shaanxi, China
| | - Panpan Yi
- Key Laboratory of Synthetic and Natural Functional Molecule Chemistry of Ministry of Education, College of Chemistry and Materials Science, Northwest University, Xian 710127, Shaanxi, China
| | - Chenwei Sun
- Key Laboratory of Synthetic and Natural Functional Molecule Chemistry of Ministry of Education, College of Chemistry and Materials Science, Northwest University, Xian 710127, Shaanxi, China
| | - Qiankun Yang
- Key Laboratory of Synthetic and Natural Functional Molecule Chemistry of Ministry of Education, College of Chemistry and Materials Science, Northwest University, Xian 710127, Shaanxi, China
| | - Qianqian Wang
- Department of Intensive Care Unit, The First Hospital of Jiaxing, Jiaxing, China
| | - Yi Mao
- Department of Emergency Medicine, The First People's Hospital of Wenling, Taizhou, China
| | - Zhihan Mei
- Department of Emergency Medicine, Tiantai Country People's Hospital, Taizhou, China
| | - Guangju Zhou
- Department of Emergency Medicine, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China; Key Laboratory of The Diagnosis and Treatment of Severe Trauma and Burn of Zhejiang Province, Hangzhou, China; Zhejiang Provincial Clinical Research Center for Emergency and Critical Care Medicine, Hangzhou, China
| | - Feng Ruan
- Department of Emergency Medicine, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China; Key Laboratory of The Diagnosis and Treatment of Severe Trauma and Burn of Zhejiang Province, Hangzhou, China; Zhejiang Provincial Clinical Research Center for Emergency and Critical Care Medicine, Hangzhou, China
| | - Suqing Shi
- Key Laboratory of Synthetic and Natural Functional Molecule Chemistry of Ministry of Education, College of Chemistry and Materials Science, Northwest University, Xian 710127, Shaanxi, China.
| | - Mao Zhang
- Department of Emergency Medicine, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China; Key Laboratory of The Diagnosis and Treatment of Severe Trauma and Burn of Zhejiang Province, Hangzhou, China; Zhejiang Provincial Clinical Research Center for Emergency and Critical Care Medicine, Hangzhou, China.
| | - Yong-Kuan Gong
- Key Laboratory of Synthetic and Natural Functional Molecule Chemistry of Ministry of Education, College of Chemistry and Materials Science, Northwest University, Xian 710127, Shaanxi, China; Institute of Materials Science and New Technology, Northwest University, Xian 710127, Shaanxi, China.
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3
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Li R, Li Y, Bai Y, Yi P, Sun C, Shi S, Gong YK. Achieving superior anticoagulation of endothelial membrane mimetic coating by heparin grafting at zwitterionic biocompatible interfaces. Int J Biol Macromol 2024; 257:128574. [PMID: 38052281 DOI: 10.1016/j.ijbiomac.2023.128574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2023] [Revised: 11/16/2023] [Accepted: 11/30/2023] [Indexed: 12/07/2023]
Abstract
Thrombosis and bleeding are common complications of blood-contacting medical device therapies. In this work, an endothelium membrane mimetic coating (PMPCC/Hep) has been created to address these challenges. The coating is fabricated by multi-point anchoring of a phosphorylcholine copolymer (poly-MPC-co-MSA, PMPCC) with carboxylic side chains and end-group grafting of unfractionated heparin (Hep) onto polydopamine precoated blood-contacting material surfaces. The PMPCC coating forms an ultrathin cell outer membrane mimetic layer to resist protein adsorption and platelet adhesion. The tiny defects/pores of the PMPCC layer provide entrances for heparin end-group to be inserted and grafted onto the sub-layer amino groups. The combination of the PMPCC cell membrane mimetic anti-fouling nature with the grafted heparin bioactivity further enhances the anticoagulation performance of the formed endothelium membrane mimetic PMPCC/Hep coating. Compared to conventional Hep coating, the PMPCC/Hep coating further decreases protein adsorption and platelet adhesion by 50 % and 90 %, respectively. More significantly, the PMPCC/Hep coating shows a superior anticoagulation activity, even significantly higher than that of an end-point-attached heparin coating. Furthermore, the blood coagulation function is well preserved in the PMPCC/Hep coating anticoagulation strategy. All the results support that the PMPCC/Hep coating strategy has great potential in developing more efficient and safer blood-contacting medical devices.
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Affiliation(s)
- Rong Li
- Key Laboratory of Synthetic and Natural Functional Molecule Chemistry of Ministry of Education, College of Chemistry and Materials Science, Northwest University, Xian 710127, Shaanxi, PR China
| | - Yin Li
- Key Laboratory of Synthetic and Natural Functional Molecule Chemistry of Ministry of Education, College of Chemistry and Materials Science, Northwest University, Xian 710127, Shaanxi, PR China
| | - Yunjie Bai
- Key Laboratory of Synthetic and Natural Functional Molecule Chemistry of Ministry of Education, College of Chemistry and Materials Science, Northwest University, Xian 710127, Shaanxi, PR China
| | - Panpan Yi
- Key Laboratory of Synthetic and Natural Functional Molecule Chemistry of Ministry of Education, College of Chemistry and Materials Science, Northwest University, Xian 710127, Shaanxi, PR China
| | - Chenwei Sun
- Key Laboratory of Synthetic and Natural Functional Molecule Chemistry of Ministry of Education, College of Chemistry and Materials Science, Northwest University, Xian 710127, Shaanxi, PR China
| | - Suqing Shi
- Key Laboratory of Synthetic and Natural Functional Molecule Chemistry of Ministry of Education, College of Chemistry and Materials Science, Northwest University, Xian 710127, Shaanxi, PR China; Institute of Materials Science and New Technology, Northwest University, Xian 710127, Shaanxi, China
| | - Yong-Kuan Gong
- Key Laboratory of Synthetic and Natural Functional Molecule Chemistry of Ministry of Education, College of Chemistry and Materials Science, Northwest University, Xian 710127, Shaanxi, PR China; Institute of Materials Science and New Technology, Northwest University, Xian 710127, Shaanxi, China.
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4
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Rao J, Mou X, Mo Y, Bei HP, Wang L, Tang CY, Yiu KH, Yang Z, Zhao X. Gas station in blood vessels: An endothelium mimicking, self-sustainable nitric oxide fueling stent coating for prevention of thrombosis and restenosis. Biomaterials 2023; 302:122311. [PMID: 37677916 DOI: 10.1016/j.biomaterials.2023.122311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 08/30/2023] [Indexed: 09/09/2023]
Abstract
Stenting is the primary treatment for vascular obstruction-related cardiovascular diseases, but it inevitably causes endothelial injury which may lead to severe thrombosis and restenosis. Maintaining nitric oxide (NO, a vasoactive mediator) production and grafting endothelial glycocalyx such as heparin (Hep) onto the surface of cardiovascular stents could effectively reconstruct the damaged endothelium. However, insufficient endogenous NO donors may impede NO catalytic generation and fail to sustain cardiovascular homeostasis. Here, a dopamine-copper (DA-Cu) network-based coating armed with NO precursor L-arginine (Arg) and Hep (DA-Cu-Arg-Hep) is prepared using an organic solvent-free dipping technique to form a nanometer-thin coating onto the cardiovascular stents. The DA-Cu network adheres tightly to the surface of stents and confers excellent NO catalytic activity in the presence of endogenous NO donors. The immobilized Arg functions as a NO fuel to generate NO via endothelial nitric oxide synthase (eNOS), while Hep works as eNOS booster to increase the level of eNOS to decompose Arg into NO, ensuring a sufficient supply of NO even when endogenous donors are insufficient. The synergistic interaction between Cu and Arg is analogous to a gas station to fuel NO production to compensate for the insufficient endogenous NO donor in vivo. Consequently, it promotes the reconstruction of natural endothelium, inhibits smooth muscle cell (SMC) migration, and suppresses cascading platelet adhesion, preventing stent thrombosis and restenosis. We anticipate that our DA-Cu-Arg-Hep coating will improve the quality of life of cardiovascular patients through improved surgical follow-up, increased safety, and decreased medication, as well as revitalize the stenting industry through durable designs.
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Affiliation(s)
- Jingdong Rao
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong SAR, China; The Hong Kong Polytechnic University Shenzhen Research Institute, Shenzhen, China
| | - Xiaohui Mou
- Dongguan Key Laboratory of Smart Biomaterials and Regenerative Medicine, The Tenth Affiliated Hospital of Southern Medical University, Dongguan, Guangdong 523000, China; Guangdong Provincial Key Laboratory of Cardiac Function and Microcirculation, Guangzhou, Guangdong, China
| | - Yongyi Mo
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong SAR, China; The Hong Kong Polytechnic University Shenzhen Research Institute, Shenzhen, China
| | - Ho-Pan Bei
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong SAR, China
| | - Li Wang
- Department of Civil Engineering, The University of Hong Kong, Pokfulam Road, Hong Kong Island, Hong Kong SAR, China
| | - Chuyang Y Tang
- Department of Civil Engineering, The University of Hong Kong, Pokfulam Road, Hong Kong Island, Hong Kong SAR, China
| | - Kai-Hang Yiu
- Cardiology Division, Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Pokfulam Road, Hong Kong Island, Hong Kong SAR, China
| | - Zhilu Yang
- Dongguan Key Laboratory of Smart Biomaterials and Regenerative Medicine, The Tenth Affiliated Hospital of Southern Medical University, Dongguan, Guangdong 523000, China; Guangdong Provincial Key Laboratory of Cardiac Function and Microcirculation, Guangzhou, Guangdong, China.
| | - Xin Zhao
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong SAR, China; The Hong Kong Polytechnic University Shenzhen Research Institute, Shenzhen, China; Department of Applied Biology and Chemical Technology, the Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong SAR, China.
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5
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Newman G, Leclerc A, Arditi W, Calzuola ST, Feaugas T, Roy E, Perrault CM, Porrini C, Bechelany M. Challenge of material haemocompatibility for microfluidic blood-contacting applications. Front Bioeng Biotechnol 2023; 11:1249753. [PMID: 37662438 PMCID: PMC10469978 DOI: 10.3389/fbioe.2023.1249753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 08/07/2023] [Indexed: 09/05/2023] Open
Abstract
Biological applications of microfluidics technology is beginning to expand beyond the original focus of diagnostics, analytics and organ-on-chip devices. There is a growing interest in the development of microfluidic devices for therapeutic treatments, such as extra-corporeal haemodialysis and oxygenation. However, the great potential in this area comes with great challenges. Haemocompatibility of materials has long been a concern for blood-contacting medical devices, and microfluidic devices are no exception. The small channel size, high surface area to volume ratio and dynamic conditions integral to microchannels contribute to the blood-material interactions. This review will begin by describing features of microfluidic technology with a focus on blood-contacting applications. Material haemocompatibility will be discussed in the context of interactions with blood components, from the initial absorption of plasma proteins to the activation of cells and factors, and the contribution of these interactions to the coagulation cascade and thrombogenesis. Reference will be made to the testing requirements for medical devices in contact with blood, set out by International Standards in ISO 10993-4. Finally, we will review the techniques for improving microfluidic channel haemocompatibility through material surface modifications-including bioactive and biopassive coatings-and future directions.
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Affiliation(s)
- Gwenyth Newman
- Department of Medicine and Surgery, Università degli Studi di Milano-Bicocca, Milan, Italy
- Eden Tech, Paris, France
| | - Audrey Leclerc
- Institut Européen des Membranes, IEM, UMR 5635, Univ Montpellier, ENSCM, Centre National de la Recherche Scientifique (CNRS), Place Eugène Bataillon, Montpellier, France
- École Nationale Supérieure des Ingénieurs en Arts Chimiques et Technologiques, Université de Toulouse, Toulouse, France
| | - William Arditi
- Eden Tech, Paris, France
- Centrale Supélec, Gif-sur-Yvette, France
| | - Silvia Tea Calzuola
- Eden Tech, Paris, France
- UMR7648—LadHyx, Ecole Polytechnique, Palaiseau, France
| | - Thomas Feaugas
- Department of Medicine and Surgery, Università degli Studi di Milano-Bicocca, Milan, Italy
- Eden Tech, Paris, France
| | | | | | | | - Mikhael Bechelany
- Institut Européen des Membranes, IEM, UMR 5635, Univ Montpellier, ENSCM, Centre National de la Recherche Scientifique (CNRS), Place Eugène Bataillon, Montpellier, France
- Gulf University for Science and Technology (GUST), Mubarak Al-Abdullah, Kuwait
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6
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Zhao CY, Sheng KJ, Bao T, Shi T, Liu PN, Yan Y, Zheng XL. Commercial and novel anticoagulant ECMO coatings: a review. J Mater Chem B 2023. [PMID: 37183615 DOI: 10.1039/d3tb00471f] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
Extracorporeal membrane oxygenation (ECMO) is an invasive and last-resort treatment for circulatory and respiratory failure. Prolonged ECMO support can disrupt the coagulation and anticoagulation systems in a patient, leading to adverse consequences, such as bleeding and thrombosis. To address this problem, anticoagulation coatings have been developed for use in ECMO circuits. This article reviews commonly used commercial and novel anticoagulant coatings developed in recent years and proposes a new classification of coatings based on the current state. While commercial coatings have been used clinically for decades, this review focuses on comparing the effectiveness and stability of coatings to support clinical selections. Furthermore, novel anticoagulation coatings often involve complex mechanisms and elaborate design strategies, and this review summarises representative studies on mainstream anticoagulation coatings to provide a point of reference for future studies.
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Affiliation(s)
- Chang-Ying Zhao
- Department of Cardiovascular Surgery, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710061, China.
| | - Kang-Jia Sheng
- School of Pharmacy, Health Science Center, Xi'an Jiaotong University, Xi'an 710061, China
| | - Tao Bao
- School of Pharmacy, Health Science Center, Xi'an Jiaotong University, Xi'an 710061, China
| | - Tao Shi
- Department of Cardiovascular Surgery, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710061, China.
| | - Pei-Nan Liu
- Department of Oncology, Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710004, China
| | - Yang Yan
- Department of Cardiovascular Surgery, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710061, China.
| | - Xing-Long Zheng
- Department of Cardiovascular Surgery, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710061, China.
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Hosseinzadeh S, Shams F, Fattahi R, Nuoroozi G, rostami E, Shahghasempour L, Salehi-Nik N, Bohlouli M, Khojasteh A, Ghasemi N, Peiravi H. Surface Coating of Polyurethane Films with Gelatin, Aspirin and Heparin to Increase the Hemocompatibility of Artificial Vascular Grafts. Adv Pharm Bull 2023; 13:123-133. [PMID: 36721809 PMCID: PMC9871267 DOI: 10.34172/apb.2023.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Revised: 10/14/2021] [Accepted: 12/31/2021] [Indexed: 02/03/2023] Open
Abstract
Purpose: A hemocompatible substrate can offer a wonderful facility for nitric oxide (NO) production by vascular endothelial cells in reaction to the inflammation following injuries. NO inhibits platelet aggregation this is especially critical in small-diameter vessels. Methods: The substrate films were made of polyurethane (PU) in a casting process and after plasma treatments, their surface was chemically decorated with polyethylene glycol (PEG) 2000, gelatin, gelatin-aspirin, gelatin-heparin and gelatin-aspirin-heparin. The concentrations of these ingredients were optimized in order to achieve the biocompatible values and the resulting modifications were characterized by water contact angle and Fourier transform infra-red (FTIR) assays. The values of NO production and platelet adhesion were then examined. Results: The water contact angle of the modified surface was reduced to 26±4∘ and the newly developed hydrophilic chemical groups were confirmed by FTIR. The respective concentrations of 0.05 mg/ml and 100 mg/mL were found to be the IC50 values for aspirin and heparin. However, after the surface modification with aspirin, the bioactivity of the substrate increased in compared to the other experimental groups. In addition, there was a synergistic effect between these reagents for NO synthesis. While, heparin inhibited platelet adhesion more than aspirin. Conclusion: Because of the highly hydrophilic nature of heparin, this reagent was hydrolyzed faster than aspirin and therefore its influence on platelet aggregation and cell growth was greater. Taken together, the results give the biocompatible concentrations of both biomolecules that are required for endothelial cell proliferation, NO synthesis and platelet adhesion.
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Affiliation(s)
- Simzar Hosseinzadeh
- Medical Nanotechnology and Tissue Engineering Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.,Department of Tissue Engineering and Applied Cell Sciences, School of Advanced Technologies in Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran.,Corresponding Authors: Simzar Hosseinzadeh and Nasim Salehi-Nik, ,
| | - Forough Shams
- Department of Medical Biotechnology, School of Advanced Technologies in Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Roya Fattahi
- Department of Tissue Engineering and Applied Cell Sciences, School of Advanced Technologies in Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Ghader Nuoroozi
- Department of Tissue Engineering and Applied Cell Sciences, School of Advanced Technologies in Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Elnaz rostami
- Department of Animal Sciences and Biotechnology, Faculty of Life Sciences and Biotechnology, Shahid Beheshti University, Tehran, Iran
| | - lida Shahghasempour
- Department of Microbiology, Karaj Branch, Islamic Azad University, Karaj, Iran
| | - Nasim Salehi-Nik
- Department of Tissue Engineering and Applied Cell Sciences, School of Advanced Technologies in Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran.,Corresponding Authors: Simzar Hosseinzadeh and Nasim Salehi-Nik, ,
| | - Mahboubeh Bohlouli
- Department of Tissue Engineering and Applied Cell Sciences, School of Advanced Technologies in Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Arash Khojasteh
- Department of Tissue Engineering and Applied Cell Sciences, School of Advanced Technologies in Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Nazanin Ghasemi
- Department of Immunology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Habibollah Peiravi
- Department of Tissue Engineering and Applied Cell Sciences, School of Advanced Technologies in Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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8
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Roberts TR, Garren MRS, Wilson SN, Handa H, Batchinsky AI. Development and In Vitro Whole Blood Hemocompatibility Screening of Endothelium-Mimetic Multifunctional Coatings. ACS APPLIED BIO MATERIALS 2022; 5:2212-2223. [PMID: 35404571 DOI: 10.1021/acsabm.2c00073] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Multifunctional antithrombotic surface modifications for blood-contacting medical devices have emerged as a solution for foreign surface-mediated coagulation disturbance. Herein, we have developed and evaluated an endothelium-inspired strategy to reduce the thrombogenicity of medical plastics by imparting nitric oxide (NO) elution and heparin immobilization on the material surface. This dual-action approach (NO+Hep) was applied to polyethylene terephthalate (PET) blood incubation vials and compared to isolated modifications. Vials were characterized to evaluate NO surface flux as well as heparin density and activity. Hemocompatibility was assessed in vitro using whole blood from human donors. Compared to unmodified surfaces, blood incubated in the NO+Hep vials exhibited reduced platelet aggregation (15% decrease AUC, p = 0.040) and prolonged plasma clotting times (aPTT = 147% increase, p < 0.0001, prothrombin time = 5% increase, p = 0.0002). Prolongation of thromboelastography reaction time and elevated antifactor Xa levels in blood from NO+Hep versus PET vials suggests some heparin leaching from the vial surface, confirmed by post-blood incubation heparin density assessment. Results suggest NO+Hep surface modification is a promising approach for blood-contacting plastics; however, careful tuning of NO flux and heparin stabilization are essential and require assessment using human blood as performed here.
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Affiliation(s)
- Teryn R Roberts
- Autonomous Reanimation and Evacuation Research Program, The Geneva Foundation, 2509 Kennedy Circle Bldg 125, San Antonio, Texas 78235, United States
| | - Mark R S Garren
- School of Chemical, Materials and Biomedical Engineering, College of Engineering, University of Georgia, Athens, Georgia 30602, United States
| | - Sarah N Wilson
- School of Chemical, Materials and Biomedical Engineering, College of Engineering, University of Georgia, Athens, Georgia 30602, United States
| | - Hitesh Handa
- School of Chemical, Materials and Biomedical Engineering, College of Engineering, University of Georgia, Athens, Georgia 30602, United States.,Department of Pharmaceutical and Biomedical Sciences, College of Pharmacy, University of Georgia, Athens, Georgia 30602, United States
| | - Andriy I Batchinsky
- Autonomous Reanimation and Evacuation Research Program, The Geneva Foundation, 2509 Kennedy Circle Bldg 125, San Antonio, Texas 78235, United States
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9
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Zhang M, Pauls JP, Bartnikowski N, Haymet AB, Chan CHH, Suen JY, Schneider B, Ki KK, Whittaker AK, Dargusch MS, Fraser JF. Anti-thrombogenic Surface Coatings for Extracorporeal Membrane Oxygenation: A Narrative Review. ACS Biomater Sci Eng 2021; 7:4402-4419. [PMID: 34436868 DOI: 10.1021/acsbiomaterials.1c00758] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Extracorporeal membrane oxygenation (ECMO) is used in critical care to manage patients with severe respiratory and cardiac failure. ECMO brings blood from a critically ill patient into contact with a non-endothelialized circuit which can cause clotting and bleeding simultaneously in this population. Continuous systemic anticoagulation is needed during ECMO. The membrane oxygenator, which is a critical component of the extracorporeal circuit, is prone to significant thrombus formation due to its large surface area and areas of low, turbulent, and stagnant flow. Various surface coatings, including but not limited to heparin, albumin, poly(ethylene glycol), phosphorylcholine, and poly(2-methoxyethyl acrylate), have been developed to reduce thrombus formation during ECMO. The present work provides an up-to-date overview of anti-thrombogenic surface coatings for ECMO, including both commercial coatings and those under development. The focus is placed on the coatings being developed for oxygenators. Overall, zwitterionic polymer coatings, nitric oxide (NO)-releasing coatings, and lubricant-infused coatings have attracted more attention than other coatings and showed some improvement in in vitro and in vivo anti-thrombogenic effects. However, most studies lacked standard hemocompatibility assessment and comparison studies with current clinically used coatings, either heparin coatings or nonheparin coatings. Moreover, this review identifies that further investigation on the thrombo-resistance, stability and durability of coatings under rated flow conditions and the effects of coatings on the function of oxygenators (pressure drop and gas transfer) are needed. Therefore, extensive further development is required before these new coatings can be used in the clinic.
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Affiliation(s)
- Meili Zhang
- Innovative Cardiovascular Engineering and Technology Laboratory, Critical Care Research Group, The Prince Charles Hospital, Brisbane, Queensland 4032, Australia.,School of Mechanical and Mining Engineering, The University of Queensland, Brisbane, Queensland 4072,Australia
| | - Jo P Pauls
- Innovative Cardiovascular Engineering and Technology Laboratory, Critical Care Research Group, The Prince Charles Hospital, Brisbane, Queensland 4032, Australia.,School of Engineering and Built Environment, Griffith University, Southport, Queensland 4222, Australia
| | - Nicole Bartnikowski
- Innovative Cardiovascular Engineering and Technology Laboratory, Critical Care Research Group, The Prince Charles Hospital, Brisbane, Queensland 4032, Australia.,School of Mechanical, Medical and Process Engineering, Queensland University of Technology, Brisbane, Queensland 4000, Australia
| | - Andrew B Haymet
- Innovative Cardiovascular Engineering and Technology Laboratory, Critical Care Research Group, The Prince Charles Hospital, Brisbane, Queensland 4032, Australia
| | - Chris H H Chan
- Innovative Cardiovascular Engineering and Technology Laboratory, Critical Care Research Group, The Prince Charles Hospital, Brisbane, Queensland 4032, Australia.,School of Engineering and Built Environment, Griffith University, Southport, Queensland 4222, Australia
| | - Jacky Y Suen
- Scientific and Translational Research Laboratory, Critical Care Research Group, The Prince Charles Hospital, Brisbane, Queensland 4032, Australia.,Faculty of Medicine, The University of Queensland, Brisbane, Queensland 4072, Australia
| | - Bailey Schneider
- Scientific and Translational Research Laboratory, Critical Care Research Group, The Prince Charles Hospital, Brisbane, Queensland 4032, Australia
| | - Katrina K Ki
- Scientific and Translational Research Laboratory, Critical Care Research Group, The Prince Charles Hospital, Brisbane, Queensland 4032, Australia
| | - Andrew K Whittaker
- Australian Institute for Bioengineering and Nanotechnology and ARC Center of Excellence in Convergent Bio-Nano Science and Technology, The University of Queensland, Brisbane, Queensland 4072, Australia
| | - Matthew S Dargusch
- School of Mechanical and Mining Engineering, The University of Queensland, Brisbane, Queensland 4072,Australia
| | - John F Fraser
- Innovative Cardiovascular Engineering and Technology Laboratory, Critical Care Research Group, The Prince Charles Hospital, Brisbane, Queensland 4032, Australia.,Scientific and Translational Research Laboratory, Critical Care Research Group, The Prince Charles Hospital, Brisbane, Queensland 4032, Australia.,Faculty of Medicine, The University of Queensland, Brisbane, Queensland 4072, Australia.,School of Medicine, Griffith University, Southport, Queensland 4222, Australia
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10
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Zhang Q, Meyerhoff ME. Nitric Oxide Release for Enhanced Biocompatibility and Analytical Performance of Implantable Electrochemical Sensors. ELECTROANAL 2021. [DOI: 10.1002/elan.202100174] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
- Qi Zhang
- Department of Chemistry University of Michigan Ann Arbor MI 48109 USA
| | - Mark E. Meyerhoff
- Department of Chemistry University of Michigan Ann Arbor MI 48109 USA
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11
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Patel H. Blood biocompatibility enhancement of biomaterials by heparin immobilization: a review. Blood Coagul Fibrinolysis 2021; 32:237-247. [PMID: 33443929 DOI: 10.1097/mbc.0000000000001011] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Blood contacting materials are concerned with biocompatibility including thrombus formation, decrease blood coagulation time, hematology, activation of complement system, platelet aggression. Interestingly, recent research suggests that biocompatibility is increasing by incorporating various materials including heparin using different methods. Basic of heparin including uses and complications was mentioned, in which burst release of heparin is major issue. To minimize the problem of biocompatibility and unpredictable heparin release, present review article potentially reviews the reported work and investigates the various immobilization methods of heparin onto biomaterials, such as polymers, metals, and alloys. Detailed explanation of different immobilization methods through different intermediates, activation, incubation method, plasma treatment, irradiations and other methods are also discussed, in which immobilization through intermediates is the most exploitable method. In addition to biocompatibility, other required properties of biomaterials like mechanical and corrosion resistance properties that increase by attachment of heparin are reviewed and discussed in this article.
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Affiliation(s)
- Himanshu Patel
- Department of Applied Science and Humanities, Pacific School of Engineering, Surat, Gujarat
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12
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Devine R, Douglass M, Ashcraft M, Tayag N, Handa H. Development of Novel Amphotericin B-Immobilized Nitric Oxide-Releasing Platform for the Prevention of Broad-Spectrum Infections and Thrombosis. ACS APPLIED MATERIALS & INTERFACES 2021; 13:19613-19624. [PMID: 33904311 PMCID: PMC9683085 DOI: 10.1021/acsami.1c01330] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
Indwelling medical devices currently used to diagnose, monitor, and treat patients invariably suffer from two common clinical complications: broad-spectrum infections and device-induced thrombosis. Currently, infections are managed through antibiotic or antifungal treatment, but the emergence of antibiotic resistance, the formation of recalcitrant biofilms, and difficulty identifying culprit pathogens have made treatment increasingly challenging. Additionally, systemic anticoagulation has been used to manage device-induced thrombosis, but subsequent life-threatening bleeding events associated with all available therapies necessitates alternative solutions. In this study, a broad-spectrum antimicrobial, antithrombotic surface combining the incorporation of the nitric oxide (NO) donor S-nitroso-N-acetylpenicillamine (SNAP) with the immobilization of the antifungal Amphotericin B (AmB) on polydimethylsiloxane (PDMS) was developed in a two-step process. This novel strategy combines the key advantages of NO, a bactericidal agent and platelet inhibitor, with AmB, a potent antifungal agent. We demonstrated that SNAP-AmB surfaces significantly reduced the viability of adhered Staphylococcus aureus (99.0 ± 0.2%), Escherichia coli (89.7 ± 1.0%), and Candida albicans (93.5 ± 4.2%) compared to controls after 24 h of in vitro exposure. Moreover, SNAP-AmB surfaces reduced the number of platelets adhered by 74.6 ± 3.9% compared to controls after 2 h of in vitro porcine plasma exposure. Finally, a cytotoxicity assay validated that the materials did not present any cytotoxic side effects toward human fibroblast cells. This novel approach is the first to combine antifungal surface functionalization with NO-releasing technology, providing a promising step toward reducing the rate of broad-spectrum infection and thrombosis associated with indwelling medical devices.
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Affiliation(s)
- Ryan Devine
- School of Chemical, Materials and Biomedical Engineering, College of Engineering, University of Georgia, Athens, Georgia 30602, United States
| | - Megan Douglass
- School of Chemical, Materials and Biomedical Engineering, College of Engineering, University of Georgia, Athens, Georgia 30602, United States
| | - Morgan Ashcraft
- School of Chemical, Materials and Biomedical Engineering, College of Engineering, University of Georgia, Athens, Georgia 30602, United States
- Pharmaceutical and Biomedical Sciences Department, College of Pharmacy, University of Georgia, Athens, Georgia 30602, United States
| | - Nicole Tayag
- School of Chemical, Materials and Biomedical Engineering, College of Engineering, University of Georgia, Athens, Georgia 30602, United States
| | - Hitesh Handa
- School of Chemical, Materials and Biomedical Engineering, College of Engineering, University of Georgia, Athens, Georgia 30602, United States
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13
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Ashcraft M, Douglass M, Chen Y, Handa H. Combination strategies for antithrombotic biomaterials: an emerging trend towards hemocompatibility. Biomater Sci 2021; 9:2413-2423. [PMID: 33599226 PMCID: PMC8035307 DOI: 10.1039/d0bm02154g] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Surface-induced thrombosis is a frequent, critical issue for blood-contacting medical devices that poses a serious threat to patient safety and device functionality. Antithrombotic material design strategies including the immobilization of anticoagulants, alterations in surface chemistries and morphology, and the release of antithrombotic compounds have made great strides in the field with the ultimate goal of circumventing the need for systemic anticoagulation, but have yet to achieve the same hemocompatibility as the native endothelium. Given that the endothelium achieves this state through the use of many mechanisms of action, there is a rising trend in combining these established design strategies for improved antithrombotic actions. Here, we describe this emerging paradigm, highlighting the apparent advantages of multiple antithrombotic mechanisms of action and discussing the demonstrated potential of this new direction.
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Affiliation(s)
- Morgan Ashcraft
- School of Chemical, Materials and Biomedical Engineering, College of Engineering, University of Georgia, Athens, Georgia 30602, USA.
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14
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Vlcek JR, Hedayati M, Melvin AC, Reynolds MM, Kipper MJ. Blood-Compatible Materials: Vascular Endothelium-Mimetic Surfaces that Mitigate Multiple Cell-Material Interactions. Adv Healthc Mater 2021; 10:e2001748. [PMID: 33448158 DOI: 10.1002/adhm.202001748] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Indexed: 12/17/2022]
Abstract
When flowing whole blood contacts medical device surfaces, the most common blood-material interactions result in coagulation, inflammation, and infection. Many new blood-contacting biomaterials have been proposed based on strategies that address just one of these common modes of failure. This study proposes to mitigate unfavorable biological reactions that occur with blood-contacting medical devices by designing multifunctional surfaces, with features optimized to meet multiple performance criteria. These multifunctional surfaces incorporate the release of the small molecule hormone nitric oxide (NO) with surface chemistry and nanotopography that mimic features of the vascular endothelial glycocalyx. These multifunctional surfaces have features that interact with coagulation components, inflammatory cells, and bacterial cells. While a single surface feature alone may not be sufficient to achieve multiple functions, the release of NO from the surfaces along with their modification to mimic the endothelial glycocalyx synergistically improves platelet-, leukocyte-, and bacteria-surface interactions. This work demonstrates that new blood-compatible materials should be designed with multiple features, to better address the multiple modes of failure of blood-contacting medical devices.
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Affiliation(s)
- Jessica R. Vlcek
- School of Biomedical Engineering Colorado State University Fort Collins CO 80523 USA
| | - Mohammadhasan Hedayati
- Department of Chemical and Biological Engineering Colorado State University Fort Collins CO 80523 USA
| | - Alyssa C. Melvin
- Department of Chemistry Colorado State University Fort Collins CO 80532 USA
| | - Melissa M. Reynolds
- Department of Chemistry Department of Chemical and Biological Engineering, and School of Biomedical Engineering Colorado State University Fort Collins CO 80523 USA
| | - Matt J. Kipper
- Department of Chemical and Biological Engineering School of Biomedical Engineering, and School of Advanced Materials Discovery Colorado State University Fort Collins CO 80523 USA
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15
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Lyu N, Du Z, Qiu H, Gao P, Yao Q, Xiong K, Tu Q, Li X, Chen B, Wang M, Pan G, Huang N, Yang Z. Mimicking the Nitric Oxide-Releasing and Glycocalyx Functions of Endothelium on Vascular Stent Surfaces. ADVANCED SCIENCE (WEINHEIM, BADEN-WURTTEMBERG, GERMANY) 2020; 7:2002330. [PMID: 33173746 PMCID: PMC7610264 DOI: 10.1002/advs.202002330] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/20/2020] [Revised: 07/27/2020] [Indexed: 05/29/2023]
Abstract
Endothelium can secrete vasoactive mediators and produce specific extracellular matrix, which contribute jointly to the thromboresistance and regulation of vascular cell behaviors. From a bionic point of view, introducing endothelium-like functions onto cardiovascular stents represents the most effective means to improve hemocompatibility and reduce late stent restenosis. However, current surface strategies for vascular stents still have limitations, like the lack of multifunctionality, especially the monotony in endothelial-mimic functions. Herein, a layer-by-layer grafting strategy to create endothelium-like dual-functional surface on cardiovascular scaffolds is reported. Typically, a nitric oxide (NO, vasoactive mediator)-generating compound and an endothelial polysaccharide matrix molecule hyaluronan (HA) are sequentially immobilized on allylamine-plasma-deposited stents through aqueous amidation. In this case, the stents could be well-engineered with dual endothelial functions capable of remote and close-range regulation of the vascular microenvironment. The synergy of NO and endothelial glycocalyx molecules leads to efficient antithrombosis, smooth muscle cell (SMC) inhibition, and perfect endothelial cell (EC)-compatibility of the stents in vitro. Moreover, the dual-functional stents show efficient antithrombogenesis ex vivo, rapid endothelialization, and long-term prevention of restenosis in vivo. Therefore, this study will provide new solutions for not only multicomponent surface functionalization but also the bioengineering of endothelium-mimic vascular scaffolds with improved clinical outcomes.
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Affiliation(s)
- Nan Lyu
- Key Lab of Advanced Technology of Materials of Education MinistrySchool of Materials Science and EngineeringSouthwest Jiaotong UniversityChengduSichuan610031China
| | - Zeyu Du
- Key Lab of Advanced Technology of Materials of Education MinistrySchool of Materials Science and EngineeringSouthwest Jiaotong UniversityChengduSichuan610031China
| | - Hua Qiu
- Key Lab of Advanced Technology of Materials of Education MinistrySchool of Materials Science and EngineeringSouthwest Jiaotong UniversityChengduSichuan610031China
| | - Peng Gao
- Key Lab of Advanced Technology of Materials of Education MinistrySchool of Materials Science and EngineeringSouthwest Jiaotong UniversityChengduSichuan610031China
| | - Qin Yao
- Department of UrologyAffiliated Hospital of Jiangsu University438 Jiefang RoadZhenjiangJiangsu212001China
| | - Kaiqin Xiong
- Key Lab of Advanced Technology of Materials of Education MinistrySchool of Materials Science and EngineeringSouthwest Jiaotong UniversityChengduSichuan610031China
| | - Qiufen Tu
- Key Lab of Advanced Technology of Materials of Education MinistrySchool of Materials Science and EngineeringSouthwest Jiaotong UniversityChengduSichuan610031China
| | - Xiangyang Li
- Key Lab of Advanced Technology of Materials of Education MinistrySchool of Materials Science and EngineeringSouthwest Jiaotong UniversityChengduSichuan610031China
| | - Binghai Chen
- Department of UrologyAffiliated Hospital of Jiangsu University438 Jiefang RoadZhenjiangJiangsu212001China
| | - Miao Wang
- Institute for Advanced MaterialsSchool of Materials Science and EngineeringJiangsu University301 Xuefu RoadZhenjiangJiangsu212013China
| | - Guoqing Pan
- Institute for Advanced MaterialsSchool of Materials Science and EngineeringJiangsu University301 Xuefu RoadZhenjiangJiangsu212013China
| | - Nan Huang
- Key Lab of Advanced Technology of Materials of Education MinistrySchool of Materials Science and EngineeringSouthwest Jiaotong UniversityChengduSichuan610031China
| | - Zhilu Yang
- Key Lab of Advanced Technology of Materials of Education MinistrySchool of Materials Science and EngineeringSouthwest Jiaotong UniversityChengduSichuan610031China
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16
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Thompson AJ, Ma LJ, Major T, Jeakle M, Lautner-Csorba O, Goudie MJ, Handa H, Rojas-Peña A, Potkay JA. Assessing and improving the biocompatibility of microfluidic artificial lungs. Acta Biomater 2020; 112:190-201. [PMID: 32434076 PMCID: PMC10168296 DOI: 10.1016/j.actbio.2020.05.008] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Revised: 05/05/2020] [Accepted: 05/07/2020] [Indexed: 02/08/2023]
Abstract
Microfluidic artificial lungs (µALs) have the potential to improve the treatment and quality of life for patients with acute or chronic lung injury. In order to realize the full potential of this technology (including as a destination therapy), the biocompatibility of these devices needs to be improved to produce long-lasting devices that are safe for patient use with minimal or no systemic anticoagulation. Many studies exist which probe coagulation and thrombosis on polydimethyl siloxane (PDMS) surfaces, and many strategies have been explored to improve surface biocompatibility. As the field of µALs is young, there are few studies which investigate biocompatibility of functioning µALs; and even fewer which were performed in vivo. Here, we use both in vitro and in vivo models to investigate two strategies to improve µAL biocompatibility: 1) a hydrophilic surface coating (polyethylene glycol, PEG) to prevent surface fouling, and 2) the addition of nitric oxide (NO) to the sweep gas to inhibit platelet activation locally within the µAL. In this study, we challenge µALs with clottable blood or platelet-rich plasma (PRP) and monitor the resistance to blood flow over time. Device lifetime (the amount of time the µAL remains patent and unobstructed by clot) is used as the primary indicator of biocompatibility. This study is the first study to: 1) investigate the effect of NO release on biocompatibility in a microfluidic network; 2) combine a hydrophilic PEG coating with NO release to improve blood compatibility; and 3) perform extended in vivo biocompatibility testing of a µAL. We found that µALs challenged in vitro with PRP remained patent significantly longer when the sweep gas contained NO than without NO. In the in vivo rabbit model, neither approach alone (PEG coating nor NO sweep gas) significantly improved biocompatibility compared to controls (though with larger sample size significance may become apparent); while the combination of a PEG coating with NO sweep gas resulted in significant improvement of device lifetime. STATEMENT OF SIGNIFICANCE: The development of microfluidic artificial lungs (µALs) can potentially have a massive impact on the treatment of patients with acute and chronic lung impairments. Before these devices can be deployed clinically, the biocompatibility of µALs must be improved and more comprehensively understood. This work explores two strategies for improving biocompatibility, a hydrophilic surface coating (polyethylene glycol) for general surface passivation and the addition of nitric oxide (NO) to the sweep gas to quell platelet and leukocyte activation. These two strategies are investigated separately and as a combined device treatment. Devices are challenged with clottable blood using in vitro testing and in vivo testing in rabbits. This is the first study to our knowledge that allows statistical comparisons of biocompatible µALs in animals, a key step towards eventual clinical use.
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Affiliation(s)
- Alex J Thompson
- VA Ann Arbor Healthcare System, 2215 Fuller Road, Ann Arbor, MI, USA, 48105; University of Michigan, 1150 W. Medical Center Drive, Ann Arbor, MI, USA, 48109.
| | - Lindsay J Ma
- VA Ann Arbor Healthcare System, 2215 Fuller Road, Ann Arbor, MI, USA, 48105; University of Michigan, 1150 W. Medical Center Drive, Ann Arbor, MI, USA, 48109
| | - Terry Major
- University of Michigan, 1150 W. Medical Center Drive, Ann Arbor, MI, USA, 48109
| | - Mark Jeakle
- University of Michigan, 1150 W. Medical Center Drive, Ann Arbor, MI, USA, 48109
| | | | - Marcus J Goudie
- University of Georgia, College of Engineering, 220 Riverbend Road, Athens, GA, USA, 30602
| | - Hitesh Handa
- University of Georgia, College of Engineering, 220 Riverbend Road, Athens, GA, USA, 30602
| | - Alvaro Rojas-Peña
- University of Michigan, 1150 W. Medical Center Drive, Ann Arbor, MI, USA, 48109
| | - Joseph A Potkay
- VA Ann Arbor Healthcare System, 2215 Fuller Road, Ann Arbor, MI, USA, 48105; University of Michigan, 1150 W. Medical Center Drive, Ann Arbor, MI, USA, 48109
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17
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Devine R, Goudie MJ, Singha P, Schmiedt C, Douglass M, Brisbois EJ, Handa H. Mimicking the Endothelium: Dual Action Heparinized Nitric Oxide Releasing Surface. ACS APPLIED MATERIALS & INTERFACES 2020; 12:20158-20171. [PMID: 32271542 PMCID: PMC7962625 DOI: 10.1021/acsami.9b22277] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
The management of thrombosis and bacterial infection is critical to ensure the functionality of medical devices. While administration of anticoagulants is the current antithrombotic clinical practice, a variety of complications, such as uncontrolled hemorrhages or heparin-induced thrombocytopenia, can occur. Additionally, infection rates remain a costly and deadly complication associated with use of these medical devices. It has been hypothesized that if a synthetic surface could mimic the biochemical mechanisms of the endothelium of blood vessels, thrombosis could be reduced, anticoagulant use could be avoided, and infection could be prevented. Herein, the interfacial biochemical effects of the endothelium were mimicked by altering the surface of medical grade silicone rubber (SR). Surface modification was accomplished via heparin surface immobilization (Hep) and the inclusion of a nitric oxide (NO) donor into the SR polymeric matrix to achieve synergistic effects (Hep-NO-SR). An in vitro bacteria adhesion study revealed that Hep-NO-SR exhibited a 99.46 ± 0.17% reduction in viable bacteria adhesion compared to SR. An in vitro platelet study revealed Hep-NO-SR reduced platelet adhesion by 84.12 ± 6.19% compared to SR, while not generating a cytotoxic response against fibroblast cells. In a 4 h extracorporeal circuit model without systemic anticoagulation, all Hep-NO-SR samples were able to maintain baseline platelet count and device patency; whereas 66% of SR samples clotted within the first 2 h of study. Results indicate that Hep-NO-SR creates a more hemocompatible and antibacterial surface by mimicking two key biochemical functions of the native endothelium.
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Affiliation(s)
- Ryan Devine
- School of Chemical, Materials and Biomedical Engineering, College of Engineering, University of Georgia, Athens, GA USA
| | - Marcus J. Goudie
- School of Chemical, Materials and Biomedical Engineering, College of Engineering, University of Georgia, Athens, GA USA
| | - Priyadarshini Singha
- School of Chemical, Materials and Biomedical Engineering, College of Engineering, University of Georgia, Athens, GA USA
| | - Chad Schmiedt
- Department of Small Animal Medicine and Surgery, College of Veterinary Medicine, University of Georgia, Athens, GA USA
| | - Megan Douglass
- School of Chemical, Materials and Biomedical Engineering, College of Engineering, University of Georgia, Athens, GA USA
| | - Elizabeth J. Brisbois
- Department of Materials Science & Engineering, College of Engineering and Computer Science, University of Central Florida, Orlando, FL USA
| | - Hitesh Handa
- School of Chemical, Materials and Biomedical Engineering, College of Engineering, University of Georgia, Athens, GA USA
- Corresponding author Dr. Hitesh Handa, College of Engineering, University of Georgia, 220 Riverbend Road, Athens, GA 30602, Telephone: (706) 542-8109,
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18
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Yang L, Li L, Wu H, Zhang B, Luo R, Wang Y. Catechol-mediated and copper-incorporated multilayer coating: An endothelium-mimetic approach for blood-contacting devices. J Control Release 2020; 321:59-70. [DOI: 10.1016/j.jconrel.2020.02.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Revised: 01/25/2020] [Accepted: 02/02/2020] [Indexed: 10/25/2022]
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19
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Sniderman J, Monagle P, Annich GM, MacLaren G. Hematologic concerns in extracorporeal membrane oxygenation. Res Pract Thromb Haemost 2020; 4:455-468. [PMID: 32548547 PMCID: PMC7292669 DOI: 10.1002/rth2.12346] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Revised: 03/27/2020] [Accepted: 03/31/2020] [Indexed: 12/16/2022] Open
Abstract
This ISTH "State of the Art" review aims to critically evaluate the hematologic considerations and complications in extracorporeal membrane oxygenation (ECMO). ECMO is experiencing a rapid increase in clinical use, but many questions remain unanswered. The existing literature does not address or explicitly state many pertinent details that may influence hematologic complications and, ultimately, patient outcomes. This review aims to broadly introduce modern ECMO practices, circuit designs, circuit materials, hematologic complications, transfusion-related considerations, age- and size-related differences, and considerations for choosing outcome measures. Relevant studies from the 2019 ISTH Congress in Melbourne, which further advanced our understanding of these processes, will also be highlighted.
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Affiliation(s)
| | - Paul Monagle
- Department of PaediatricsDepartment of HaematologyUniversity of MelbourneThe Royal Children's HospitalHaematology Research Murdoch Children’s Research InstituteMelbourneVic.Australia
| | - Gail M. Annich
- Department of Critical Care MedicineThe Hospital for Sick ChildrenUniversity of TorontoTorontoOntarioCanada
| | - Graeme MacLaren
- Paediatric ICURoyal Children’s HospitalMelbourneVic.Australia
- Department of PaediatricsUniversity of MelbourneParkvilleVic.Australia
- Cardiothoracic ICUNational University Health SystemSingapore CitySingapore
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20
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Ploetz E, Zimpel A, Cauda V, Bauer D, Lamb DC, Haisch C, Zahler S, Vollmar AM, Wuttke S, Engelke H. Metal-Organic Framework Nanoparticles Induce Pyroptosis in Cells Controlled by the Extracellular pH. ADVANCED MATERIALS (DEERFIELD BEACH, FLA.) 2020; 32:e1907267. [PMID: 32182391 DOI: 10.1002/adfm.201909062] [Citation(s) in RCA: 114] [Impact Index Per Article: 28.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Revised: 03/01/2020] [Accepted: 03/02/2020] [Indexed: 05/23/2023]
Abstract
Ion homeostasis is essential for cellular survival, and elevated concentrations of specific ions are used to start distinct forms of programmed cell death. However, investigating the influence of certain ions on cells in a controlled way has been hampered due to the tight regulation of ion import by cells. Here, it is shown that lipid-coated iron-based metal-organic framework nanoparticles are able to deliver and release high amounts of iron ions into cells. While high concentrations of iron often trigger ferroptosis, here, the released iron induces pyroptosis, a form of cell death involving the immune system. The iron release occurs only in slightly acidic extracellular environments restricting cell death to cells in acidic microenvironments and allowing for external control. The release mechanism is based on endocytosis facilitated by the lipid-coating followed by degradation of the nanoparticle in the lysosome via cysteine-mediated reduction, which is enhanced in slightly acidic extracellular environment. Thus, a new functionality of hybrid nanoparticles is demonstrated, which uses their nanoarchitecture to facilitate controlled ion delivery into cells. Based on the selectivity for acidic microenvironments, the described nanoparticles may also be used for immunotherapy: the nanoparticles may directly affect the primary tumor and the induced pyroptosis activates the immune system.
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Affiliation(s)
- Evelyn Ploetz
- Department of Chemistry and Center for NanoScience (CeNS), LMU Munich, Munich, 81377, Germany
- Nanosystems Initiative Munich (NIM), LMU Munich, Munich, 81377, Germany
- Center for Integrated Protein Science Munich (CiPSM), LMU Munich, Munich, 81377, Germany
| | - Andreas Zimpel
- Department of Chemistry and Center for NanoScience (CeNS), LMU Munich, Munich, 81377, Germany
| | - Valentina Cauda
- Department of Applied Science and Technology, Politecnico di Torino, Torino, 10129, Italy
| | - David Bauer
- Department of Chemistry, TU Munich, Munich, 81377, Germany
| | - Don C Lamb
- Department of Chemistry and Center for NanoScience (CeNS), LMU Munich, Munich, 81377, Germany
- Nanosystems Initiative Munich (NIM), LMU Munich, Munich, 81377, Germany
- Center for Integrated Protein Science Munich (CiPSM), LMU Munich, Munich, 81377, Germany
| | | | - Stefan Zahler
- Department of Pharmacy, LMU Munich, Munich, 81377, Germany
| | | | - Stefan Wuttke
- BCMaterials, Basque Center for Materials, UPV/EHU Science Park, Leioa, 48940, Spain
- Ikerbasque, Basque Foundation for Science, Bilbao, 48013, Spain
| | - Hanna Engelke
- Department of Chemistry and Center for NanoScience (CeNS), LMU Munich, Munich, 81377, Germany
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21
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Jeakle MM, Major TC, Meyerhoff ME, Bartlett RH. Comparison of Diazeniumdiolated Dialkylhexanediamines as Nitric Oxide Release Agents on Nonthrombogenicity in an Extracorporeal Circulation Model. ACS APPLIED BIO MATERIALS 2020; 3:466-476. [PMID: 35019463 DOI: 10.1021/acsabm.9b00924] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
When blood from a patient is circulated through extracorporeal circuits (ECCs), such as in cardiopulmonary bypass or extracorporeal life support, platelets in the blood are activated and form a thrombus. This is prevented clinically with a range of different systemic anticoagulation agents (e.g., heparin); however, this increases a patient's risk of hemorrhage. Previous work with nitric oxide (NO) releasing materials using the combined diazeniumdiolated diamine, N-N-di-N'-butyl-1,6-hexanediamine (DBHD), and a polymer-linked thrombin inhibitor, argatroban (AG), showed significant nonthrombogenicity in ECCs using a 4 h rabbit model. Herein, we evaluated if diazeniumdiolated N-N-di-N'-propyl-1,6-hexanediamine (DPHDN2O2), which has a slightly lower degree of lipophilicity compared to DBHDN2O2, would provide similar nonthrombogenicity as the AG/DBHDN2O2-polymer-coated circuits. While DPHDN2O2 releases NO at a higher flux rate than DBHDN2O2 when coated (within CarboSil polymer) on the inner wall of polyvinyl chloride tubing, neither coated circuit significantly affected animal hemodynamics. Both diazeniumdiolated diamines, in combination with immobilized AG or alone, significantly reduced thrombus formation similarly in the 4 h rabbit model (vs uncoated control): AG/DBHDN2O2: 0.12 ± 0.03 cm2; DBHDN2O2: 2.57 ± 0.82 cm2; AG/DPHDN2O2: 0.68 ± 0.22 cm2; DPHDN2O2: 1.87 + 1.26 cm2; uncoated control: 6.95 ± 0.82 cm2. AG/DPHDN2O2 was no different than AG/DBHDN2O in preserving platelet count and function. In addition, AG did not leach into the systemic circulation as the total clotting times were insignificantly different from the baseline values (AG/DPHDN2O2: 12.7 + 0.5 s (n = 3); AG/DBHDN2O2: 12.3 + 0.7 s (n = 3); baseline: 13.9 + 0.3 s (n = 13)). Based on these results, both DPHDN2O2 and DPHDN2O2 are good candidates as NO donor molecules for creating nonthrombogenic polymer coatings for ECCs.
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Affiliation(s)
- Mark M Jeakle
- Department of Surgery, University of Michigan Medical Center, Ann Arbor, Michigan 48109, United States
| | - Terry C Major
- Department of Surgery, University of Michigan Medical Center, Ann Arbor, Michigan 48109, United States
| | - Mark E Meyerhoff
- Department of Chemistry, University of Michigan, Ann Arbor, Michigan 48109, United States
| | - Robert H Bartlett
- Department of Surgery, University of Michigan Medical Center, Ann Arbor, Michigan 48109, United States
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22
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Yang T, Du Z, Qiu H, Gao P, Zhao X, Wang H, Tu Q, Xiong K, Huang N, Yang Z. From surface to bulk modification: Plasma polymerization of amine-bearing coating by synergic strategy of biomolecule grafting and nitric oxide loading. Bioact Mater 2020; 5:17-25. [PMID: 31956732 PMCID: PMC6957870 DOI: 10.1016/j.bioactmat.2019.12.006] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Accepted: 12/23/2019] [Indexed: 12/19/2022] Open
Abstract
Integration of two or more biomolecules with synergetic and complementary effects on a material surface can help to obtain multi-functions for various biomedical applications. However, the amounts of biomolecules integrated and their physiological functions are compromised due to the limited surface anchoring sites. Herein, we propose a novel concept of film engineering strategy “from surface to bulk synergetic modification”. This new concept is realized by employing the surface amine groups of plasma polymerized allylamine (PPAm) film for grafting a molecule e.g., thrombin inhibitor, bivalirudin (BVLD), meanwhile its bulk amine groups is used as a universal depot for storing and releasing therapeutic nitric oxide (NO) gas as supplement to the functions of BVLD. It is demonstrated that such a “from surface to bulk synergetic modification” film engineering can impart the modified-substrates with anti-platelet and anti-coagulant dual functions, giving rise to a highly endothelium-mimetic thromboresistant property. We believe that our research provides a very promising strategy to deliver multifunctional surface versatilely that require NO release in combination with other properties, which will find broad biomedical applications in blood-contacting devices, and et al. Moreover, it also provides a brand-new film engineering strategy for tailoring surface multi-functionalities of a wide range of materials. A concept of “from surface to bulk synergetic modification” is proposed for tailoring surface multi-functionalities. The surface amine groups of plasma polymerized allylamine (PPAm) film were used for grafting bivalirudin. The bulk amine groups of PPAm film is utilized as the universal depots for storing and releasing nitric oxide.
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Affiliation(s)
- Tong Yang
- Key Laboratory of Advanced Technology for Materials of the Education Ministry, School of Materials Science and Engineering, Southwest Jiaotong University, Chengdu, 610031, China
| | - Zeyu Du
- Key Laboratory of Advanced Technology for Materials of the Education Ministry, School of Materials Science and Engineering, Southwest Jiaotong University, Chengdu, 610031, China
| | - Hua Qiu
- Key Laboratory of Advanced Technology for Materials of the Education Ministry, School of Materials Science and Engineering, Southwest Jiaotong University, Chengdu, 610031, China
| | - Peng Gao
- Key Laboratory of Advanced Technology for Materials of the Education Ministry, School of Materials Science and Engineering, Southwest Jiaotong University, Chengdu, 610031, China
| | - Xin Zhao
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Hung Hom, Hong Kong, China
| | - Huaiyu Wang
- Institute of Biomedicine and Biotechnology, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, 518055, China
| | - Qiufen Tu
- Key Laboratory of Advanced Technology for Materials of the Education Ministry, School of Materials Science and Engineering, Southwest Jiaotong University, Chengdu, 610031, China
| | - Kaiqin Xiong
- Key Laboratory of Advanced Technology for Materials of the Education Ministry, School of Materials Science and Engineering, Southwest Jiaotong University, Chengdu, 610031, China
| | - Nan Huang
- Key Laboratory of Advanced Technology for Materials of the Education Ministry, School of Materials Science and Engineering, Southwest Jiaotong University, Chengdu, 610031, China
| | - Zhilu Yang
- Key Laboratory of Advanced Technology for Materials of the Education Ministry, School of Materials Science and Engineering, Southwest Jiaotong University, Chengdu, 610031, China
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Yang Y, Gao P, Wang J, Tu Q, Bai L, Xiong K, Qiu H, Zhao X, Maitz MF, Wang H, Li X, Zhao Q, Xiao Y, Huang N, Yang Z. Endothelium-Mimicking Multifunctional Coating Modified Cardiovascular Stents via a Stepwise Metal-Catechol-(Amine) Surface Engineering Strategy. RESEARCH (WASHINGTON, D.C.) 2020; 2020:9203906. [PMID: 32405627 PMCID: PMC7196174 DOI: 10.34133/2020/9203906] [Citation(s) in RCA: 53] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Accepted: 03/22/2020] [Indexed: 12/14/2022]
Abstract
Stenting is currently the major therapeutic treatment for cardiovascular diseases. However, the nonbiogenic metal stents are inclined to trigger a cascade of cellular and molecular events including inflammatory response, thrombogenic reactions, smooth muscle cell hyperproliferation accompanied by the delayed arterial healing, and poor reendothelialization, thus leading to restenosis along with late stent thrombosis. To address prevalence critical problems, we present an endothelium-mimicking coating capable of rapid regeneration of a competently functioning new endothelial layer on stents through a stepwise metal (copper)-catechol-(amine) (MCA) surface chemistry strategy, leading to combinatorial endothelium-like functions with glutathione peroxidase-like catalytic activity and surface heparinization. Apart from the stable nitric oxide (NO) generating rate at the physiological level (2.2 × 10-10 mol/cm2/min lasting for 60 days), this proposed strategy could also generate abundant amine groups for allowing a high heparin conjugation efficacy up to ∼1 μg/cm2, which is considerably higher than most of the conventional heparinized surfaces. The resultant coating could create an ideal microenvironment for bringing in enhanced anti-thrombogenicity, anti-inflammation, anti-proliferation of smooth muscle cells, re-endothelialization by regulating relevant gene expressions, hence preventing restenosis in vivo. We envision that the stepwise MCA coating strategy would facilitate the surface endothelium-mimicking engineering of vascular stents and be therefore helpful in the clinic to reduce complications associated with stenosis.
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Affiliation(s)
- Ying Yang
- Key Laboratory of Advanced Technologies of Materials, Ministry of Education, School of Materials Science and Engineering, Southwest Jiaotong University, Chengdu 610031, China
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane 4059, Australia
- Australia-China Centre for Tissue Engineering and Regenerative Medicine, Queensland University of Technology, Brisbane 4059, Australia
| | - Peng Gao
- Key Laboratory of Advanced Technologies of Materials, Ministry of Education, School of Materials Science and Engineering, Southwest Jiaotong University, Chengdu 610031, China
| | - Juan Wang
- Key Laboratory of Advanced Technologies of Materials, Ministry of Education, School of Materials Science and Engineering, Southwest Jiaotong University, Chengdu 610031, China
| | - Qiufen Tu
- Key Laboratory of Advanced Technologies of Materials, Ministry of Education, School of Materials Science and Engineering, Southwest Jiaotong University, Chengdu 610031, China
| | - Long Bai
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane 4059, Australia
- Australia-China Centre for Tissue Engineering and Regenerative Medicine, Queensland University of Technology, Brisbane 4059, Australia
| | - Kaiqin Xiong
- Key Laboratory of Advanced Technologies of Materials, Ministry of Education, School of Materials Science and Engineering, Southwest Jiaotong University, Chengdu 610031, China
| | - Hua Qiu
- Key Laboratory of Advanced Technologies of Materials, Ministry of Education, School of Materials Science and Engineering, Southwest Jiaotong University, Chengdu 610031, China
| | - Xin Zhao
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong, China
| | - Manfred F. Maitz
- Key Laboratory of Advanced Technologies of Materials, Ministry of Education, School of Materials Science and Engineering, Southwest Jiaotong University, Chengdu 610031, China
- Max Bergmann Center of Biomaterials, Leibniz Institute of Polymer Research Dresden, Hohe Strasse 6, 01069 Dresden, Germany
| | - Huaiyu Wang
- Institute of Biomedicine and Biotechnology, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen 518055, China
| | - Xiangyang Li
- Key Laboratory of Advanced Technologies of Materials, Ministry of Education, School of Materials Science and Engineering, Southwest Jiaotong University, Chengdu 610031, China
| | - Qiang Zhao
- State Key Laboratory of Medicinal Chemical Biology, Key Laboratory of Bioactive Materials, Ministry of Education, College of Life Sciences, Nankai University, Tianjin, China
| | - Yin Xiao
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane 4059, Australia
- Australia-China Centre for Tissue Engineering and Regenerative Medicine, Queensland University of Technology, Brisbane 4059, Australia
| | - Nan Huang
- Key Laboratory of Advanced Technologies of Materials, Ministry of Education, School of Materials Science and Engineering, Southwest Jiaotong University, Chengdu 610031, China
| | - Zhilu Yang
- Key Laboratory of Advanced Technologies of Materials, Ministry of Education, School of Materials Science and Engineering, Southwest Jiaotong University, Chengdu 610031, China
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24
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Poly-ε-caprolactone/polysulfhydrylated polyester blend: A platform for topical and degradable nitric oxide-releasing materials. Eur Polym J 2018. [DOI: 10.1016/j.eurpolymj.2018.09.046] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
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25
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Ontaneda A, Annich GM. Novel Surfaces in Extracorporeal Membrane Oxygenation Circuits. Front Med (Lausanne) 2018; 5:321. [PMID: 30525038 PMCID: PMC6256321 DOI: 10.3389/fmed.2018.00321] [Citation(s) in RCA: 59] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Accepted: 10/30/2018] [Indexed: 01/01/2023] Open
Abstract
The balance between systemic anticoagulation and clotting is challenging. In normal hemostasis, the endothelium regulates the balance between anticoagulant and prothrombotic systems. It becomes particularly more challenging to maintain this physiologic hemostasis when we are faced with extracorporeal life support therapies, where blood is continuously in contact with a foreign extracorporeal circuit surface predisposing a prothrombotic state. The blood-surface interaction during extracorporeal life support therapies requires the use of systemic anticoagulation to decrease the risk of clotting. Unfractionated heparin is the most common anticoagulant agent widely used in this setting. New trends include the use of direct thrombin inhibitor agents for systemic anticoagulation; and surface modifications that aim to overcome the blood-biomaterial surface interaction by modifying the hydrophilicity or hydrophobicity of the polymer surface; and coating the circuit with substances that will mimic the endothelium or anti-thrombotic agents. To improve hemocompatibility in an extracorporeal circuit, replication of the anti-thrombotic and anti-inflammatory properties of the endothelium is ideal. Surface modifications can be classified into three major groups: biomimetic surfaces (heparin, nitric oxide, and direct thrombin inhibitors); biopassive surfaces [phosphorylcholine, albumin, and poly- 2-methoxyethylacrylate]; and endothelialization of blood contacting surface. The focus of this paper will be to review both present and future novel surface modifications that can obviate the need for systemic anticoagulation during extracorporeal life support therapies.
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Affiliation(s)
- Andrea Ontaneda
- Department of Critical Care Medicine, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Gail M Annich
- Department of Critical Care Medicine, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
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26
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Luo R, Zhang J, Zhuang W, Deng L, Li L, Yu H, Wang J, Huang N, Wang Y. Multifunctional coatings that mimic the endothelium: surface bound active heparin nanoparticles with in situ generation of nitric oxide from nitrosothiols. J Mater Chem B 2018; 6:5582-5595. [PMID: 32254968 DOI: 10.1039/c8tb00596f] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Multifunctional coatings that mimic the endothelial function in terms of nitric oxide generation and membrane-bound active heparin species are prepared via the immobilization of cystamine-modified heparin/polyethyleneimine (Hep-Cys/PEI) nanoparticles. Fourier transform infrared spectra (FTIR) and X-ray photoelectron spectroscopy (XPS) were conducted to confirm the coating formation. Functions of active heparin release and nitric oxide (NO) generation are obtained on the material surface after the immobilization of Hep-Cys/PEI nanoparticles. Moreover, a nanoparticle-immobilized coating is sufficiently flexible to resist the deformation of a 316L SS stent without any destruction. With the introduction of heparin, the antithrombin III (AT-III) binding ability was significantly enhanced with prolonged APTT time. Besides, a Hep-Cys/PEI nanoparticle immobilized coating surface not only significantly suppressed the platelet adhesion and activation, but also promoted EC proliferation and inhibited SMC proliferation. Besides, a milder tissue response was observed on the NP immobilized surface. With the synergistic effect of heparin and nitric oxide generating moieties, such multifunctional coatings presented potential for the modification of vascular materials.
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Affiliation(s)
- Rifang Luo
- National Engineering Research Center for Biomaterials, Sichuan University, Chengdu 610064, China.
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27
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Cha KH, Wang X, Meyerhoff ME. Nitric Oxide Release for Improving Performance of Implantable Chemical Sensors - A Review. APPLIED MATERIALS TODAY 2017; 9:589-597. [PMID: 29520370 PMCID: PMC5837052 DOI: 10.1016/j.apmt.2017.10.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Over the last three decades, there has been extensive interest in developing in vivo chemical sensors that can provide real-time measurements of blood gases (oxygen, carbon dioxide, and pH), glucose/lactate, and potentially other critical care analytes in the blood of hospitalized patients. However, clot formation with intravascular sensors and foreign body response toward sensors implanted subcutaneously can cause inaccurate analytical results. Further, the risk of bacterial infection from any sensor implanted in the human body is another major concern. To solve these issues, the release of an endogenous gas molecule, nitric oxide (NO), from the surface of such sensors has been investigated owing to NO's ability to inhibit platelet activation/adhesion, foreign body response and bacterial growth. This paper summarizes the importance of NO's therapeutic potential for this application and reviews the publications to date that report on the analytical performance of NO release sensors in laboratory testing and/or during in vivo testing.
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Affiliation(s)
- Kyoung Ha Cha
- Department of Chemistry, University of Michigan, 930 N. University Ave., Ann Arbor, MI 48109-1055, USA
| | - Xuewei Wang
- Department of Chemistry, University of Michigan, 930 N. University Ave., Ann Arbor, MI 48109-1055, USA
| | - Mark E Meyerhoff
- Department of Chemistry, University of Michigan, 930 N. University Ave., Ann Arbor, MI 48109-1055, USA
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28
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Li J, Zhang K, Huang N. Engineering Cardiovascular Implant Surfaces to Create a Vascular Endothelial Growth Microenvironment. Biotechnol J 2017; 12. [PMID: 28941232 DOI: 10.1002/biot.201600401] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2016] [Revised: 09/14/2017] [Indexed: 12/16/2022]
Abstract
Cardiovascular disease (CVD) is generally accepted as the leading cause of morbidity and mortality worldwide, and an increasing number of patients suffer from atherosclerosis and thrombosis annually. To treat these disorders and prolong the sufferers' life, several cardiovascular implants have been developed and applied clinically. Nevertheless, thrombosis and hyperplasia at the site of cardiovascular implants are recognized as long-term problems in the practice of interventional cardiology. Here, we start this review from the clinical requirement of the implants, such as anti-hyperplasia, anti-thrombosis, and pro-endothelialization, wherein particularly focus on the natural factors which influence functional endothelialization in situ, including the healthy smooth muscle cells (SMCs) environment, blood flow shear stress (BFSS), and the extracellular matrix (ECM) microenvironment. Then, the currently available strategies on surface modification of cardiovascular biomaterials to create vascular endothelial growth microenvironment are introduced as the main topic, e.g., BFSS effect simulation by surface micro-patterning, ECM rational construction and SMCs phenotype maintain. Finally, the prospects for extending use of the in situ construction of endothelial cells growth microenvironment are discussed and summarized in designing the next generation of vascular implants.
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Affiliation(s)
- Jingan Li
- School of Materials Science and Engineering, Zhengzhou University, 100 Science Road, Zhengzhou 450001, PR China.,Key Lab. for Advanced Technologies of Materials, Ministry of Education, School of Material Science and Engineering, Southwest Jiaotong University, Chengdu 610031, PR China
| | - Kun Zhang
- Key Lab. for Advanced Technologies of Materials, Ministry of Education, School of Material Science and Engineering, Southwest Jiaotong University, Chengdu 610031, PR China.,School of Life Science, Zhengzhou University, 100 Science Road, Zhengzhou 450001, PR China
| | - Nan Huang
- Key Lab. for Advanced Technologies of Materials, Ministry of Education, School of Material Science and Engineering, Southwest Jiaotong University, Chengdu 610031, PR China
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29
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Salehi-Nik N, Malaie-Balasi Z, Amoabediny G, Banikarimi SP, Zandieh-Doulabi B, Klein-Nulend J. Sustained release of growth hormone and sodium nitrite from biomimetic collagen coating immobilized on silicone tubes improves endothelialization. MATERIALS SCIENCE & ENGINEERING. C, MATERIALS FOR BIOLOGICAL APPLICATIONS 2017; 77:1204-1215. [PMID: 28531997 DOI: 10.1016/j.msec.2017.03.172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/19/2016] [Revised: 12/28/2016] [Accepted: 03/20/2017] [Indexed: 10/19/2022]
Abstract
Biocompatibility of biomedical devices can be improved by endothelialization of blood-contacting parts mimicking the vascular endothelium's function. Improved endothelialization might be obtained by using biomimetic coatings that allow local sustained release of biologically active molecules, e.g. anti-thrombotic and growth-inducing agents, from nanoliposomes. We aimed to test whether incorporation of growth-inducing nanoliposomal growth hormone (nGH) and anti-thrombotic nanoliposomal sodium nitrite (nNitrite) into collagen coating of silicone tubes enhances endothelialization by stimulating endothelial cell proliferation and inhibiting platelet adhesion. Collagen coating stably immobilized on acrylic acid-grafted silicone tubes decreased the water contact angle from 102° to 56°. Incorporation of 50 or 500nmol/ml nNitrite and 100 or 1000ng/ml nGH into collagen coating decreased the water contact angle further to 48°. After 120h incubation, 58% nitrite and 22% GH of the initial amount of sodium nitrite and GH in nanoliposomes were gradually released from the nNitrite-nGH-collagen coating. Endothelial cell number was increased after surface coating of silicone tubes with collagen by 1.6-fold, and with nNitrite-nGH-collagen conjugate by 1.8-3.9-fold after 2days. After 6days, endothelial cell confluency in the absence of surface coating was 22%, with collagen coating 74%, and with nNitrite-nGH-collagen conjugate coating 83-119%. In the absence of endothelial cells, platelet adhesion was stimulated after collagen coating by 1.3-fold, but inhibited after nNitrite-nGH-collagen conjugate coating by 1.6-3.7-fold. The release of anti-thrombotic prostaglandin I2 from endothelial cells was stimulated after nNitrite-nGH-collagen conjugate coating by 1.7-2.2-fold compared with collagen coating. Our data shows improved endothelialization and blood compatibility using nNitrite-nGH-collagen conjugate coating on silicone tubes suggesting that these coatings are highly suitable for use in blood-contacting parts of biomedical devices.
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Affiliation(s)
- Nasim Salehi-Nik
- School of Chemical Engineering, College of Engineering, University of Tehran,111554563, Enqelab Avenue, Tehran, Iran; Department of Oral Cell Biology, Academic Centre for Dentistry Amsterdam, University of Amsterdam and VU University Amsterdam, MOVE Research Institute Amsterdam, Gustav Mahlerlaan 3008, 1081 LA Amsterdam, The Netherlands; Department of Tissue Engineering, School of Advanced Technologies in Medicine, Shahid Beheshti University of Medical Sciences, 1985717443, Velenjak, Shahid Chamran Highway, Tehran, Iran.
| | - Zahra Malaie-Balasi
- Research Center for New Technologies in Life Science Engineering, University of Tehran,143951374, Enqelab Avenue, Tehran, Iran.
| | - Ghassem Amoabediny
- School of Chemical Engineering, College of Engineering, University of Tehran,111554563, Enqelab Avenue, Tehran, Iran; Research Center for New Technologies in Life Science Engineering, University of Tehran,143951374, Enqelab Avenue, Tehran, Iran.
| | - Seyedeh Parnian Banikarimi
- School of Chemical Engineering, College of Engineering, University of Tehran,111554563, Enqelab Avenue, Tehran, Iran; Research Center for New Technologies in Life Science Engineering, University of Tehran,143951374, Enqelab Avenue, Tehran, Iran.
| | - Behrouz Zandieh-Doulabi
- Department of Oral Cell Biology, Academic Centre for Dentistry Amsterdam, University of Amsterdam and VU University Amsterdam, MOVE Research Institute Amsterdam, Gustav Mahlerlaan 3008, 1081 LA Amsterdam, The Netherlands; Department of Tissue Engineering, School of Advanced Technologies in Medicine, Shahid Beheshti University of Medical Sciences, 1985717443, Velenjak, Shahid Chamran Highway, Tehran, Iran.
| | - Jenneke Klein-Nulend
- Department of Oral Cell Biology, Academic Centre for Dentistry Amsterdam, University of Amsterdam and VU University Amsterdam, MOVE Research Institute Amsterdam, Gustav Mahlerlaan 3008, 1081 LA Amsterdam, The Netherlands; Department of Tissue Engineering, School of Advanced Technologies in Medicine, Shahid Beheshti University of Medical Sciences, 1985717443, Velenjak, Shahid Chamran Highway, Tehran, Iran.
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30
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Singha P, Pant J, Goudie MJ, Workman CD, Handa H. Enhanced antibacterial efficacy of nitric oxide releasing thermoplastic polyurethanes with antifouling hydrophilic topcoats. Biomater Sci 2017; 5:1246-1255. [PMID: 28466898 PMCID: PMC5503190 DOI: 10.1039/c6bm00948d] [Citation(s) in RCA: 57] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Surface fouling is one of the leading causes of infection associated with implants, stents, catheters, and other medical devices. The surface chemistry of medical device coatings is important in controlling and/or preventing fouling. In this study, we have shown that a combination of nitric oxide releasing hydrophobic polymer with a hydrophilic polymer topcoat can significantly reduce protein attachment and subsequently reduce bacterial adhesion as a result of the synergistic effect. Nitric oxide (NO) is a well-known potent antibacterial agent due to its adverse reactions on microbial cell components. Owing to the surface chemistry of hydrophilic polymers, they are suitable as antifouling topcoats. In this study, four biomedical grade polymers were compared for protein adhesion and NO-release behavior: CarboSil 2080A, silicone rubber, SP60D60, and SG80A. SP60D60 was found to resist protein adsorption up to 80% when compared to the other polymers while CarboSil 2080A maintained a steady NO flux even after 24 hours (∼0.50 × 10-10 mol cm-2 min-1) of soaking in buffer solution with a loss of less than 3% S-nitroso-N-acetylpenicillamine (SNAP), the NO donor molecule, in the leaching analysis. Therefore, CarboSil 2080A incorporated with SNAP and top-coated with SP60D60 was tested for antibacterial efficacy after exposure to fibrinogen, an abundantly found protein in blood. The NO-releasing CarboSil 2080A with the SP60D60 top-coated polymer showed a 96% reduction in Staphylococcus aureus viable cell count compared to the control samples. Hence, the study demonstrated that a hydrophilic polymer topcoat, when applied to a polymer with sustained NO release from an underlying SNAP incorporated hydrophobic polymer, can reduce bacterial adhesion and be used as a highly efficient antifouling, antibacterial polymer for biomedical applications.
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Affiliation(s)
- Priyadarshini Singha
- School of Chemical, Materials and Biomedical Engineering, College of Engineering, University of Georgia, Athens, GA, USA.
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31
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Lukas K, Stadtherr K, Gessner A, Wehner D, Schmid T, Wendel HP, Schmid C, Lehle K. Effect of Immobilized Antithrombin III on the Thromboresistance of Polycarbonate Urethane. MATERIALS 2017; 10:ma10040335. [PMID: 28772696 PMCID: PMC5506919 DOI: 10.3390/ma10040335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/17/2017] [Revised: 02/28/2017] [Accepted: 03/21/2017] [Indexed: 11/16/2022]
Abstract
The surface of foils and vascular grafts made from a thermoplastic polycarbonate urethanes (PCU) (Chronoflex AR) were chemically modified using gas plasma treatment, binding of hydrogels—(1) polyethylene glycol bisdiamine and carboxymethyl dextran (PEG-DEX) and (2) polyethyleneimine (PEI)—and immobilization of human antithrombin III (AT). Their biological impact was tested in vitro under static and dynamic conditions. Static test methods showed a significantly reduced adhesion of endothelial cells, platelets, and bacteria, compared to untreated PCU. Modified PCU grafts were circulated in a Chandler-Loop model for 90 min at 37 °C with human blood. Before and after circulation, parameters of the hemostatic system (coagulation, platelets, complement, and leukocyte activation) were analyzed. PEI-AT significantly inhibited the activation of both coagulation and platelets and prevented the activation of leukocytes and complement. In conclusion, both modifications significantly reduce coagulation activation, but only PEI-AT creates anti-bacterial and anti-thrombogenic functionality.
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Affiliation(s)
- Karin Lukas
- IMHR, Institute for Medical Microbiology and Hygiene, University of Regensburg, Franz-Josef-Strauss-Allee 11, 93042 Regensburg, Germany.
| | - Karin Stadtherr
- IMHR, Institute for Medical Microbiology and Hygiene, University of Regensburg, Franz-Josef-Strauss-Allee 11, 93042 Regensburg, Germany.
| | - Andre Gessner
- IMHR, Institute for Medical Microbiology and Hygiene, University of Regensburg, Franz-Josef-Strauss-Allee 11, 93042 Regensburg, Germany.
| | - Daniel Wehner
- Dualis Medtech GmbH, Am Technologiepark 8+10, 82229 Seefeld, Germany.
| | - Thomas Schmid
- Dualis Medtech GmbH, Am Technologiepark 8+10, 82229 Seefeld, Germany.
| | - Hans Peter Wendel
- Department of Thoracic, Cardiac, and Vascular Surgery, University Hospital Tübingen, Hoppe-Seyler-Str. 3, 72076 Tübingen, Germany.
| | - Christof Schmid
- Department of Cardiothoracic Surgery, University Medical Center Regensburg, Josef-Strauss-Allee 11, 93042 Regensburg, Germany.
| | - Karla Lehle
- Department of Cardiothoracic Surgery, University Medical Center Regensburg, Josef-Strauss-Allee 11, 93042 Regensburg, Germany.
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32
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Gu H, Chen X, Liu X, Zhan W, Lyu Z, Yu Q, Wu Z, Chen H. A hemocompatible polyurethane surface having dual fibrinolytic and nitric oxide generating functions. J Mater Chem B 2017; 5:980-987. [PMID: 32263876 DOI: 10.1039/c6tb02735k] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Thrombus formation remains a serious problem in developing blood compatible materials. Despite continuous, intensive efforts over many years to prepare surfaces that prevent clotting, such surfaces have not been achieved; indeed it seems that surface-induced clotting is inevitable. An alternative approach is to accept that clotting will occur and to design surfaces so that small, nascent clots will be lysed before they can cause harm. The generation of plasmin, as in the fibrinolytic system, may be adopted for this purpose. The vascular endothelium (the inner surface of intact blood vessels) releases nitric oxide (NO) on a continuous basis. NO protects against platelet activation and aggregation, and also has an anti-proliferative effect on smooth muscle cells (SMCs). Based on these two important functions of the vascular system, the approach of constructing a fibrinolytic surface that generates NO is developed in the present work. Poly(oligo(ethylene glycol) methyl ether methacrylate-co-6-amino-2-(2-methacylamido)-hexanoic acid) (poly(OEGMA-co-LysMA)) was attached to a vinyl-functionalized polyurethane (PU) surface by graft polymerization giving a surface (PU-POL) with protein-resistant properties (via poly(OEGMA)) and clot lysing properties (via poly(LysMA)). Selenocystamine, which catalyzes S-nitrosothiol decomposition to generate NO in the vasculature, was then immobilized on the PU-POL surface via covalent attachment. A dual functioning surface with fibrinolytic activity (lysis of nascent clots) and NO releasing ability (inhibition of platelet adhesion and SMC adhesion as well as proliferation) was thereby constructed.
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Affiliation(s)
- Hao Gu
- State and Local Joint Engineering Laboratory for Novel Functional Polymeric Materials, College of Chemistry, Chemical Engineering and Materials Science, Soochow University, Suzhou 215123, P. R. China.
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33
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Hou L, Udangawa WMRN, Pochiraju A, Dong W, Zheng Y, Linhardt RJ, Simmons TJ. Synthesis of Heparin-Immobilized, Magnetically Addressable Cellulose Nanofibers for Biomedical Applications. ACS Biomater Sci Eng 2016; 2:1905-1913. [DOI: 10.1021/acsbiomaterials.6b00273] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- Lijuan Hou
- Center
for Nanoscience and Nanotechnology, Zhejiang Sci-Tech University, 5 Second Avenue, Xiasha Higher Education Zone, Hangzhou 310018, PR China
| | | | | | - Wenjun Dong
- Center
for Nanoscience and Nanotechnology, Zhejiang Sci-Tech University, 5 Second Avenue, Xiasha Higher Education Zone, Hangzhou 310018, PR China
- School
of Materials Science and Engineering, University of Science and Technology Beijing, 30 Xueyuan Road, Haidian District, Beijing 100083, PR China
| | - Yingying Zheng
- Center
for Nanoscience and Nanotechnology, Zhejiang Sci-Tech University, 5 Second Avenue, Xiasha Higher Education Zone, Hangzhou 310018, PR China
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Wo Y, Brisbois EJ, Bartlett RH, Meyerhoff ME. Recent advances in thromboresistant and antimicrobial polymers for biomedical applications: just say yes to nitric oxide (NO). Biomater Sci 2016; 4:1161-83. [PMID: 27226170 PMCID: PMC4955746 DOI: 10.1039/c6bm00271d] [Citation(s) in RCA: 170] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Biomedical devices are essential for patient diagnosis and treatment; however, when blood comes in contact with foreign surfaces or homeostasis is disrupted, complications including thrombus formation and bacterial infections can interrupt device functionality, causing false readings and/or shorten device lifetime. Here, we review some of the current approaches for developing antithrombotic and antibacterial materials for biomedical applications. Special emphasis is given to materials that release or generate low levels of nitric oxide (NO). Nitric oxide is an endogenous gas molecule that can inhibit platelet activation as well as bacterial proliferation and adhesion. Various NO delivery vehicles have been developed to improve NO's therapeutic potential. In this review, we provide a summary of the NO releasing and NO generating polymeric materials developed to date, with a focus on the chemistry of different NO donors, the polymer preparation processes, and in vitro and in vivo applications of the two most promising types of NO donors studied thus far, N-diazeniumdiolates (NONOates) and S-nitrosothiols (RSNOs).
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Affiliation(s)
- Yaqi Wo
- Department of Chemistry, University of Michigan, Ann Arbor, MI 48109, USA.
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35
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In situ regeneration of bioactive coatings enabled by an evolved Staphylococcus aureus sortase A. Nat Commun 2016; 7:11140. [PMID: 27073027 PMCID: PMC4833859 DOI: 10.1038/ncomms11140] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2015] [Accepted: 02/24/2016] [Indexed: 11/08/2022] Open
Abstract
Surface immobilization of bioactive molecules is a central paradigm in the design of implantable devices and biosensors with improved clinical performance capabilities. However, in vivo degradation or denaturation of surface constituents often limits the long-term performance of bioactive films. Here we demonstrate the capacity to repeatedly regenerate a covalently immobilized monomolecular thin film of bioactive molecules through a two-step stripping and recharging cycle. Reversible transpeptidation by a laboratory evolved Staphylococcus aureus sortase A (eSrtA) enabled the rapid immobilization of an anti-thrombogenic film in the presence of whole blood and permitted multiple cycles of film regeneration in vitro that preserved its biological activity. Moreover, eSrtA transpeptidation facilitated surface re-engineering of medical devices in situ after in vivo implantation through removal and restoration film constituents. These studies establish a rapid, orthogonal and reversible biochemical scheme to regenerate selective molecular constituents with the potential to extend the lifetime of bioactive films. Bioactive coatings offer a strategy to modulate host response to implants, but their translation to the clinic is hampered by their fast in vivo degradation. Here, the authors use an engineered bacterial protein to regenerate an anti-thrombogenic film in vitro and in situ after device implantation.
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36
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Wang L, Jiang R, Wang L, Liu Y, Sun XL. Preparation of chain-end clickable recombinant protein and its bio-orthogonal modification. Bioorg Chem 2016; 65:159-66. [PMID: 26953841 DOI: 10.1016/j.bioorg.2016.02.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2015] [Revised: 02/18/2016] [Accepted: 02/27/2016] [Indexed: 01/21/2023]
Abstract
Introducing unique functional group into protein is an attractive approach for site-selective protein modification applications. In this report, we systemically investigated four site-selective strategies to introduce azide functionality into recombinant thrombomodulin (TM456), via direct recombinant expression with unnatural amino acid, chemical, and enzymatic modification for its bio-orthogonal modification application. First, a straightforward recombinant method to express TM456 with azide functionality near C-terminus by replacing methionine with azidohomoanlanine from methionine auxotroph Escherichia coli cell was investigated. Next, a sortase-mediated ligation (SML) method to incorporate azide functionality into the C-terminus of recombinant TM456 was demonstrated. The third is to add azide functionality to the N-terminal amine of recombinant TM456via amidation chemistry, and the fourth is tyrosine selective three-component Mannich reaction to introduce azide functionality to recombinant TM456. Overall, SML of recombinant protein affords the highest overall yield for incorporating azide functionality into the C-terminus recombinant TM456 since the key protein expression step uses natural amino acids. Also, single site modification facilitates the highest TM456 activity.
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Affiliation(s)
- Lin Wang
- Department of Chemistry, Chemical and Biomedical Engineering and Center for Gene Regulation in Health and Disease (GRHD), Cleveland State University, Cleveland, OH, USA
| | - Rui Jiang
- Department of Chemistry, Chemical and Biomedical Engineering and Center for Gene Regulation in Health and Disease (GRHD), Cleveland State University, Cleveland, OH, USA; College of Life and Health Sciences, Northeastern University, Shenyang 110004, PR China
| | - Lin Wang
- Department of Chemistry, Chemical and Biomedical Engineering and Center for Gene Regulation in Health and Disease (GRHD), Cleveland State University, Cleveland, OH, USA; Department of Medicinal Chemistry, China Medical University, Shenyang, PR China
| | - Yang Liu
- Department of Chemistry, Chemical and Biomedical Engineering and Center for Gene Regulation in Health and Disease (GRHD), Cleveland State University, Cleveland, OH, USA; Key Laboratory of Structure-Based Drugs Design & Discovery of Ministry of Education, School of Pharmaceutical Engineering, Shenyang Pharmaceutical University, Shenyang, PR China
| | - Xue-Long Sun
- Department of Chemistry, Chemical and Biomedical Engineering and Center for Gene Regulation in Health and Disease (GRHD), Cleveland State University, Cleveland, OH, USA.
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37
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Kim YK, Chen EY, Liu WF. Biomolecular strategies to modulate the macrophage response to implanted materials. J Mater Chem B 2015; 4:1600-1609. [PMID: 32263014 DOI: 10.1039/c5tb01605c] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
The material-induced foreign body response is a major challenge for implanted medical devices. This review highlights recent developments in biomimetic approaches to create biomaterials that mitigate the host response to biomaterials. Specifically, we will describe strategies in which biomaterials are decorated with endogenously expressed biomolecules that naturally modulate the function of immune cells. These include molecules that directly bind to and interact with immune cells, as well as molecules that control complement activation or thrombosis and indirectly modulate immune cell function. We provide perspective on how these approaches may impact the design of materials for medical devices and tissue engineering.
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Affiliation(s)
- Yoon Kyung Kim
- Department of Biomedical Engineering, University of California Irvine, 2412 Engineering Hall, Irvine, CA 92697, USA.
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38
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WANG J, ZHU ZW, XU GH, AN Y. [Research progress of self-assembled monolayer in biomedical metallic materials]. Zhejiang Da Xue Xue Bao Yi Xue Ban 2015; 44:589-94. [PMID: 26713537 PMCID: PMC10397081 DOI: 10.3785/j.issn.1008-9292.2015.09.19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2015] [Accepted: 06/22/2015] [Indexed: 06/05/2023]
Abstract
Because of the excellent mechanical properties, biocompatibility and reasonable prices, biomedical metallic materials are widely used in the manufacture of vascular stents, heart valve membrane, artificial joints and other body implants. However, the physiological environment in the body is very complex, the long-term embedding of the metal implants may result in corrosion or some nonspecific effects. The properties of medical metal surfaces may decay, which can cause serious injury to human body. By means of the self-assembled monolayer(SAM) technology, the physical and chemical properties of the medical metal surfaces can be modified, and through the SAM medium, some functional materials can be grafted on the metal surfaces, which can largely improve the stability and compatibility of implants in the body, and find wide applications in promoting cell adhesion, improving hemocompatibility, inhibiting bacteria growth, and constructing drug delivery coatings. This paper reviews the progress in the application of SAM in biomedical metallic materials.
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39
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Yang Y, Qi P, Yang Z, Huang N. Nitric oxide based strategies for applications of biomedical devices. BIOSURFACE AND BIOTRIBOLOGY 2015. [DOI: 10.1016/j.bsbt.2015.08.003] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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40
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Luo R, Liu Y, Yao H, Jiang L, Wang J, Weng Y, Zhao A, Huang N. Copper-Incorporated Collagen/Catechol Film for in Situ Generation of Nitric Oxide. ACS Biomater Sci Eng 2015; 1:771-779. [DOI: 10.1021/acsbiomaterials.5b00131] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
- Rifang Luo
- School of Material Science and
Engineering and §Key Lab of Advanced Technology of
Materials of Education Ministry, Southwest Jiaotong University, Chengdu, 610031, China
| | - Yujie Liu
- School of Material Science and
Engineering and §Key Lab of Advanced Technology of
Materials of Education Ministry, Southwest Jiaotong University, Chengdu, 610031, China
| | - Hang Yao
- School of Material Science and
Engineering and §Key Lab of Advanced Technology of
Materials of Education Ministry, Southwest Jiaotong University, Chengdu, 610031, China
| | - Lang Jiang
- School of Material Science and
Engineering and §Key Lab of Advanced Technology of
Materials of Education Ministry, Southwest Jiaotong University, Chengdu, 610031, China
| | - Jin Wang
- School of Material Science and
Engineering and §Key Lab of Advanced Technology of
Materials of Education Ministry, Southwest Jiaotong University, Chengdu, 610031, China
| | - Yajun Weng
- School of Material Science and
Engineering and §Key Lab of Advanced Technology of
Materials of Education Ministry, Southwest Jiaotong University, Chengdu, 610031, China
| | - Ansha Zhao
- School of Material Science and
Engineering and §Key Lab of Advanced Technology of
Materials of Education Ministry, Southwest Jiaotong University, Chengdu, 610031, China
| | - Nan Huang
- School of Material Science and
Engineering and §Key Lab of Advanced Technology of
Materials of Education Ministry, Southwest Jiaotong University, Chengdu, 610031, China
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41
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Salehi-Nik N, Amoabediny G, Solouk A, Shokrgozar MA, Zandieh-Doulabi B, Klein-Nulend J. Biomimetic modification of silicone tubes using sodium nitrite-collagen immobilization accelerates endothelialization. J Biomed Mater Res B Appl Biomater 2015; 104:1311-21. [DOI: 10.1002/jbm.b.33412] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2014] [Revised: 02/22/2015] [Accepted: 03/09/2015] [Indexed: 11/06/2022]
Affiliation(s)
- Nasim Salehi-Nik
- School of Chemical Engineering; College of Engineering; University of Tehran; Tehran Iran
- Department of Biomedical Engineering; Research Center for New Technologies in Life Science Engineering; University of Tehran; Tehran Iran
| | - Ghassem Amoabediny
- School of Chemical Engineering; College of Engineering; University of Tehran; Tehran Iran
- Department of Biomedical Engineering; Research Center for New Technologies in Life Science Engineering; University of Tehran; Tehran Iran
| | - Atefeh Solouk
- Department of Biomedical Engineering; Amirkabir University of Technology; Tehran Iran
| | | | - Behrouz Zandieh-Doulabi
- Department of Oral Cell Biology; Academic Centre for Dentistry Amsterdam; University of Amsterdam and VU University Amsterdam; MOVE Research Institute Amsterdam; Amsterdam The Netherlands
| | - Jenneke Klein-Nulend
- Department of Oral Cell Biology; Academic Centre for Dentistry Amsterdam; University of Amsterdam and VU University Amsterdam; MOVE Research Institute Amsterdam; Amsterdam The Netherlands
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42
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Frost MC, Meyerhoff ME. Real-Time Monitoring of Critical Care Analytes in the Bloodstream with Chemical Sensors: Progress and Challenges. ANNUAL REVIEW OF ANALYTICAL CHEMISTRY (PALO ALTO, CALIF.) 2015; 8:171-92. [PMID: 26161973 DOI: 10.1146/annurev-anchem-071114-040443] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
We review approaches and challenges in developing chemical sensor-based methods to accurately and continuously monitor levels of key analytes in blood related directly to the status of critically ill hospitalized patients. Electrochemical and optical sensor-based technologies have been pursued to measure important critical care species in blood [i.e., oxygen, carbon dioxide, pH, electrolytes (K(+), Na(+), Cl(-), etc.), glucose, and lactate] in real-time or near real-time. The two main configurations examined to date for achieving this goal have been intravascular catheter sensors and patient attached ex vivo sensors with intermittent blood sampling via an attached indwelling catheter. We discuss the status of these configurations and the main issues affecting the accuracy of the measurements, including cell adhesion and thrombus formation on the surface of the sensors, sensor drift, sensor selectivity, etc. Recent approaches to mitigate these nagging performance issues that have prevented these technologies from clinical use are also discussed.
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Affiliation(s)
- Megan C Frost
- Department of Biomedical Engineering, Michigan Technological University, Houghton, Michigan 49931-1295;
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43
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Liu T, Zhang W, Song T, Yang X, Li C. Hollow double-layered polymer microspheres with pH and thermo-responsive properties as nitric oxide-releasing reservoirs. Polym Chem 2015. [DOI: 10.1039/c5py00001g] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
TheN-diazeniumdiolated hollow double-layered P(AmEMA-co-EGDMA)/P(NIPAAm-co-DMAEMA-co-EGDMA) microspheres (NO as 3.0 μmol mg−1) show a steady NO release behavior in a wide range of pHs (5–9) and temperatures (20–55 °C).
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Affiliation(s)
- Tuanwei Liu
- Key Laboratory of Functional Polymer Materials
- Ministry of Education
- Institute of Polymer Chemistry
- Collaborative Innovation Center of Chemical Science and Engineering (Tianjin)
- Nankai University
| | - Wei Zhang
- Key Laboratory of Functional Polymer Materials
- Ministry of Education
- Institute of Polymer Chemistry
- Collaborative Innovation Center of Chemical Science and Engineering (Tianjin)
- Nankai University
| | - Tao Song
- Key Laboratory of Functional Polymer Materials
- Ministry of Education
- Institute of Polymer Chemistry
- Collaborative Innovation Center of Chemical Science and Engineering (Tianjin)
- Nankai University
| | - Xinlin Yang
- Key Laboratory of Functional Polymer Materials
- Ministry of Education
- Institute of Polymer Chemistry
- Collaborative Innovation Center of Chemical Science and Engineering (Tianjin)
- Nankai University
| | - Chenxi Li
- Key Laboratory of Functional Polymer Materials
- Ministry of Education
- Institute of Polymer Chemistry
- Collaborative Innovation Center of Chemical Science and Engineering (Tianjin)
- Nankai University
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44
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Nitric oxide release from polydimethylsiloxane-based polyurethanes. J Appl Biomater Funct Mater 2014; 12:172-82. [PMID: 24744231 PMCID: PMC6161757 DOI: 10.5301/jabfm.5000192] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/06/2013] [Indexed: 11/26/2022] Open
Abstract
Localized nitric oxide (NO) release from polymeric materials holds much promise for the prevention of coagulation often associated with implantable and extracorporeal blood-contacting devices. Films of polyurethane (PU) containing incorporated polyethyleneimine were thus exposed to NO gas to form diazeniumdiolates (NONOates) in situ. Donor incorporation and NO gas exposure did not affect the mechanical properties of the films. The NO release capacity increased with increasing polydimethylsiloxane (PDMS) content in the soft segment of the PU: total capacity could be more than doubled (P<0.05) from 0.093 ± 0.028 to 0.225 ± 0.004 mmol/g when the PDMS content was increased from 0 to 100%. Release kinetics were best approximated using a modified Korsemeyer-Peppas power law (R2=0.95-0.99). Despite the resultant rapid initial decrease in NO release rates, values above that observed for quiescent endothelial cells (0.83 pmol·cm−2·s−1) were maintained for extended periods of 5-10 days, while rates above that of a stimulated endothelium (2.7-6.8 pmol·cm−2·s−1) were achieved for the first 24 hours. This method of NONOate formation may be advantageous, as potential premature NO release by exposure of diazeniumdiolated donors during incorporation, processing and storage, can be avoided by in situ diazoniumdiolation closer to the time of implantation.
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45
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Butruk-Raszeja B, Trzaskowski M, Ciach T. Cell membrane-mimicking coating for blood-contacting polyurethanes. J Biomater Appl 2014; 29:801-12. [DOI: 10.1177/0885328214549611] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The aim of the present work was to develop simple modification technique for polyurethanes (PUs) intended for use in blood-contacting implants (vascular grafts, heart prosthesis, ventricular assist devices). PU surface was modified with soybean-derived phosphatidylcholine (PC) via one-step dip coating technique. In order to evaluate blood compatibility of the obtained materials, samples were contacted with human blood under static and arterial flow-simulated conditions. The PC-modified surfaces were thoroughly characterized and tested for fibrinogen resistance, the ability to resist platelet adhesion and activation, hemolysis percentage and plasma recalcification time. Results demonstrated significant, more than three-fold reduction in the amount of fibrinogen adsorbed to PC-modified materials as compared to non-modified PU. Analysis of the samples’ surface after incubation with blood showed high reduction in platelet adhesion. The results were confirmed by analysis of blood samples collected after shear-stress tests – the percentage of free (non-aggregated) platelets remaining in blood samples contacted with PC-coated materials exceeded 70%. The same parameter measured for non-modified PU was significantly lower and equaled 28%.
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Affiliation(s)
- Beata Butruk-Raszeja
- Laboratory of Biomedical Engineering, Faculty of Chemical and Process Engineering, Warsaw University of Technology, Warsaw, Poland
| | - Maciej Trzaskowski
- Laboratory of Biomedical Engineering, Faculty of Chemical and Process Engineering, Warsaw University of Technology, Warsaw, Poland
| | - Tomasz Ciach
- Laboratory of Biomedical Engineering, Faculty of Chemical and Process Engineering, Warsaw University of Technology, Warsaw, Poland
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46
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Major TC, Handa H, Annich GM, Bartlett RH. Development and hemocompatibility testing of nitric oxide releasing polymers using a rabbit model of thrombogenicity. J Biomater Appl 2014; 29:479-501. [PMID: 24934500 DOI: 10.1177/0885328214538866] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Hemocompatibility is the goal for any biomaterial contained in extracorporeal life supporting medical devices. The hallmarks for hemocompatibility include nonthrombogenicity, platelet preservation, and maintained platelet function. Both in vitro and in vivo assays testing for compatibility of the blood/biomaterial interface have been used over the last several decades to ascertain if the biomaterial used in medical tubing and devices will require systemic anticoagulation for viability. Over the last 50 years systemic anticoagulation with heparin has been the gold standard in maintaining effective extracorporeal life supporting. However, the biomaterial that maintains effective ECLS without the use of any systemic anticoagulant has remained elusive. In this review, the in vivo 4-h rabbit thrombogenicity model genesis will be described with emphasis on biomaterials that may require no systemic anticoagulation for extracorporeal life supporting longevity. These novel biomaterials may improve extracorporeal circulation hemocompatibility by preserving near resting physiology of the major blood components, the platelets and monocytes. The rabbit extracorporeal circulation model provides a complete assessment of biomaterial interactions with the intrinsic coagulation players, the circulating platelet and monocytes. This total picture of blood/biomaterial interaction suggests that this rabbit thrombogenicity model could provide a standardization for biomaterial hemocompatibility testing.
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Affiliation(s)
- Terry C Major
- Department of Surgery, University of Michigan Health System, Ann Arbor, USA
| | - Hitesh Handa
- Department of Surgery, University of Michigan Health System, Ann Arbor, USA
| | - Gail M Annich
- Department of Pediatrics, University of Michigan Health System, Ann Arbor, USA
| | - Robert H Bartlett
- Department of Surgery, University of Michigan Health System, Ann Arbor, USA
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47
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Major TC, Brisbois EJ, Jones AM, Zanetti ME, Annich GM, Bartlett RH, Handa H. The effect of a polyurethane coating incorporating both a thrombin inhibitor and nitric oxide on hemocompatibility in extracorporeal circulation. Biomaterials 2014; 35:7271-85. [PMID: 24927680 DOI: 10.1016/j.biomaterials.2014.05.036] [Citation(s) in RCA: 63] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2014] [Accepted: 05/15/2014] [Indexed: 01/23/2023]
Abstract
Nitric oxide (NO) releasing (NORel) materials have been extensively investigated to create localized increases in NO concentration by the proton driven diazeniumdiolate-containing polymer coatings and demonstrated to improve extracorporeal circulation (ECC) hemocompatibility. In this work, the NORel polymeric coating composed of a diazeniumdiolated dibutylhexanediamine (DBHD-N2O2)-containing hydrophobic Elast-eon™ (E2As) polyurethane was combined with a direct thrombin inhibitor, argatroban (AG), and evaluated in a 4 h rabbit thrombogenicity model without systemic anticoagulation. In addition, the immobilizing of argatroban to E2As polymer was achieved by either a polyethylene glycol-containing (PEGDI) or hexane methylene (HMDI) diisocyanate linker. The combined polymer film was coated on the inner walls of ECC circuits to yield significantly reduced ECC thrombus formation compared to argatroban alone ECC control after 4 h blood exposure (0.6 ± 0.1 AG/HMDI/NORel vs 1.7 ± 0.2 cm(2) AG/HMDI control). Platelet count (2.8 ± 0.3 AG/HMDI/NORel vs 1.9 ± 0.1 × 10(8)/ml AG/HMDI control) and plasma fibrinogen levels were preserved after 4 h blood exposure with both the NORel/argatroban combination and the AG/HMDI control group compared to baseline. Platelet function as measured by aggregometry remained near normal in both the AG/HMDI/NORel (63 ± 5%) and AG/HMDI control (58 ± 7%) groups after 3 h compared to baseline (77 ± 1%). Platelet P-selectin mean fluorescence intensity (MFI) as measured by flow cytometry also remained near baseline levels after 4 h on ECC to ex vivo collagen stimulation (16 ± 3 AG/HMDI/NORel vs 11 ± 2 MFI baseline). These results suggest that the combined AG/HMDI/NORel polymer coating preserves platelets in blood exposure to ECCs to a better degree than AG/PEGDI/NORel, NORel alone or AG alone. These combined antithrombin, NO-mediated antiplatelet effects were shown to improve thromboresistance of the AG/HMDI/NORel polymer-coated ECCs and move potential nonthrombogenic polymers closer to mimicking vascular endothelium.
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Affiliation(s)
- Terry C Major
- Department of Surgery, University of Michigan Medical Center, Ann Arbor, MI, USA.
| | | | - Anna M Jones
- Department of Surgery, University of Michigan Medical Center, Ann Arbor, MI, USA
| | - Margaux E Zanetti
- Department of Surgery, University of Michigan Medical Center, Ann Arbor, MI, USA
| | - Gail M Annich
- Department of Pediatrics and Communicable Diseases, University of Michigan Medical Center, Ann Arbor, MI, USA
| | - Robert H Bartlett
- Department of Surgery, University of Michigan Medical Center, Ann Arbor, MI, USA
| | - Hitesh Handa
- Department of Surgery, University of Michigan Medical Center, Ann Arbor, MI, USA.
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48
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Na Meng, Zhou NL. Synthesis and properties of PDMS/montmorillonite-cetyltrimethylammonium bromide-heparin films. Carbohydr Polym 2014; 105:70-4. [DOI: 10.1016/j.carbpol.2014.01.052] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2013] [Revised: 12/28/2013] [Accepted: 01/14/2014] [Indexed: 10/25/2022]
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49
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Pawlak M, Bakker E. Chemical Modification of Polymer Ion-Selective Membrane Electrode Surfaces. ELECTROANAL 2014. [DOI: 10.1002/elan.201300449] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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50
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Kim J, Saravanakumar G, Choi HW, Park D, Kim WJ. A platform for nitric oxide delivery. J Mater Chem B 2014; 2:341-356. [DOI: 10.1039/c3tb21259a] [Citation(s) in RCA: 119] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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