Anticoagulation and endothelial cell behaviors of heparin-loaded graphene oxide coating on titanium surface

Emergence of graphene as a novel nanomaterial for cardiovascular applications

Cardiovascular diseases (CDs) are the foremost cause of death worldwide. Several promising therapeutic methods have been developed for this approach, including pharmacological, surgical intervention, cell therapy, or biomaterial implantation since heart tissue is incapable of regenerating and healing on its own. The best treatment for heart failure to date is heart transplantation and invasive surgical intervention, despite their invasiveness, donor limitations, and the possibility of being rejected by the patient's immune system. To address these challenges, research is being conducted on less invasive and efficient methods. Consequently, graphene-based materials (GBMs) have attracted a great deal of interest in the last decade because of their exceptional mechanical, electrical, chemical, antibacterial, and biocompatibility properties. An overview of GBMs' applications in the cardiovascular system has been presented in this article. Following a brief explanation of graphene and its derivatives' properties, the potential of GBMs to improve and restore cardiovascular system function by using them as cardiac tissue engineering, stents, vascular bypass grafts,and heart valve has been discussed.

Fabrication and Characterization of a Multifunctional Coating to Promote the Osteogenic Properties of Orthopedic Implants

Titanium-based alloys are used in orthopedic applications as fixation elements, hard tissue replacements in artificial bones, and dental implants. Despite their wide range of applications, metallic implant defects and failures arise due to inadequate mechanical bonding, postoperative clotting problems, aseptic loosening, and infections. To improve the surface bioactivity and reduce the corrosion rate of the Ti6Al4V alloy, multi-layered coatings (HAp, BG, Cs, and Hep) were applied via electrophoretic deposition (EPD). XRD images showed the presence of HAp within the coating. In vitro investigation: cell line NIH-3T3 fibroblasts were seeded on the non-coated and coated Ti6Al4V substrates, and their cellular behavior was evaluated. The results indicated that the HApBGCsHep coating could enhance the adhesion and proliferation of NIH 3T3 cells. In addition, the potentiodynamic polarization results are compatible with the in vitro outcome.

Regulation of astrocyte activity and immune response on graphene oxide-coated titanium by electrophoretic deposition

Introduction: Astrocytes play crucial role in modulating immune response in the damaged central nervous system. Numerous studies have investigated the relationship between immune responses in astrocytes and brain diseases. However, the potential application of nanomaterials for alleviating neuroinflammation induced by astrocytes remains unexplored. Method: In this study, we utilized electrophoretic deposition (EPD) to coat graphene oxide (GO) onto titanium (Ti) to enhance the bioactivity of Ti. Results: We confirmed that GO-Ti could improve cell adhesion and proliferation of astrocytes with upregulated integrins and glial fibrillary acidic protein (GFAP) expression. Moreover, we observed that astrocytes on GO-Ti exhibited a heightened immune response when exposed to lipopolysaccharide (LPS). Although pro-inflammatory cytokines increased, anti-inflammatory cytokines and brain-derived neurotrophic factors involved in neuroprotective effects were also augmented through nuclear localization of the yes-associated protein (YAP) and nuclear factor kappa B (NF-κB). Discussion: Taken together, GO-Ti could enhance the neuroprotective function of astrocytes by upregulating the expression of anti-inflammatory cytokines and neuroprotective factors with improved cell adhesion and viability. Consequently, our findings suggest that GO-Ti has the potential to induce neuroprotective effects by regulating cell activity.

Controlled drug delivery from chitosan-coated heparin-loaded nanopores anodically grown on nitinol shape-memory alloy

Nitinol (NiTi shape-memory alloy) is an interesting candidate in various medical applications like dental, orthopedic, and cardiovascular devices, owing to its unique mechanical behaviors and proper biocompatibility. The aim of this work is the local controlled delivery of a cardiovascular drug, heparin, loaded onto nitinol treated by electrochemical anodizing and chitosan coating. In this regard, the structure, wettability, drug release kinetics, and cell cytocompatibility of the specimens were analyzed in vitro. The two-stage anodizing process successfully developed a regular nanoporous layer of Ni-Ti-O on nitinol, which considerably decreased the sessile water contact angle and induced hydrophilicity. The application of the chitosan coatings controlled the release of heparin mainly by a diffusional mechanism, where the drug release mechanisms were evaluated by the Higuchi, first-order, zero-order, and Korsmeyer-Pepass models. Human umbilical cord endothelial cells (HUVECs) viability assay also showed the non-cytotoxicity of the samples, so that the best performance was found for the chitosan-coated samples. It is concluded that the designed drug delivery systems are promising for cardiovascular, particularly stent applications.

Composite Nanocoatings of Biomedical Magnesium Alloy Implants: Advantages, Mechanisms, and Design Strategies

The rapid degradation of magnesium (Mg) alloy implants erodes mechanical performance and interfacial bioactivity, thereby limiting their clinical utility. Surface modification is among the solutions to improve corrosion resistance and bioefficacy of Mg alloys. Novel composite coatings that incorporate nanostructures create new opportunities for their expanded use. Particle size dominance and impermeability may increase corrosion resistance and thereby prolong implant service time. Nanoparticles with specific biological effects may be released into the peri-implant microenvironment during the degradation of coatings to promote healing. Composite nanocoatings provide nanoscale surfaces to promote cell adhesion and proliferation. Nanoparticles may activate cellular signaling pathways, while those with porous or core-shell structures may carry antibacterial or immunomodulatory drugs. Composite nanocoatings may promote vascular reendothelialization and osteogenesis, attenuate inflammation, and inhibit bacterial growth, thus increasing their applicability in complex clinical microenvironments such as those of atherosclerosis and open fractures. This review combines the physicochemical properties and biological efficiency of Mg-based alloy biomedical implants to summarize the advantages of composite nanocoatings, analyzes their mechanisms of action, and proposes design and construction strategies, with the purpose of providing a reference for promoting the clinical application of Mg alloy implants and to further the design of nanocoatings.

A breakthrough trial of an artificial liver without systemic heparinization in hyperbilirubinemia beagle models

The development of wearable artificial livers was restricted to device miniaturization and bleeding risk with water-soluble anticoagulants. Herein, a double-deck column filled with solid anticoagulant microspheres and Kevlar porous microspheres (KPMs, bilirubin adsorbents) was connected with the principle machine of wearable artificial liver (approximately 9 kg) to treat hyperbilirubinemia beagles for the first time. With the initial normal dose of heparin, the double-deck column could afford 3 h hemoperfusion in whole blood without thrombus formation. The removal efficiency of the double-deck column for total bilirubin (TBIL) was 31.4%. Interestingly, the excessive amounts of hepatocyte metabolites were also decreased by approximately 25%. The “anticoagulant + column” realized safe and effective whole blood hemoperfusion without the plasma separation system and heparin pump; however, the proposed principle machine of wearable artificial liver and “anticoagulant + column” cannot completely replace the bio-liver now. The intelligence of the device and the versatility of the adsorbent need to be improved; moreover, advanced experimental techniques need to be developed to validate the survival rates in animals. Overall, this study is a meaningful trial for the development of wearable artificial livers in the future.

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This is a breakthrough trial of a wearable artificial liver to perform in hyperbilirubinemia beagle models without systemic heparinization treatment.

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We proposed the “solid anticoagulant microspheres” to supersede water-soluble anticoagulant medications in the artificial liver, which could reduce the bleeding risks for patients and supersede heparin pump to further reduce the weight of wearable artificial liver.

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The “anticoagulant + column” could provide a safe, efficient and low-cost blood purification method, which will be a milestone in the clinical development of wearable artificial livers.

Surface Coating of Polyurethane Films with Gelatin, Aspirin and Heparin to Increase the Hemocompatibility of Artificial Vascular Grafts

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.

Zinc Ion-crosslinked polycarbonate/heparin composite coatings for biodegradable Zn-alloy stent applications

Zinc and its alloys are the best candidates for biodegradable cardiovascular stents due to their good corrosion rate and biocompatibility in vasculature. However, the cytotoxicity caused by the rapid release of zinc ions during the initial degradation stage and the lack of an anticoagulant function are huge challenges for their practical clinical applications. In this work, we developed a zinc ion-crosslinked polycarbonate/heparin composite coating via electrophoretic deposition (EPD) to improve the biocompatibility and provide anticoagulant functions for Zn-alloy stents. Both electrochemical tests and in vitro immersion tests demonstrated an enhanced corrosion resistance and lower Zn ion release rate of the coated Zn alloys. Enhanced adhesion and proliferation of endothelial cells on coated Zn alloys were also observed, indicating faster reendothelialization than that on bare Zn alloys. Moreover, the surface erosion of the composite coating led to the uniform and long-term release of heparin, which remarkably inhibited the adhesion and activation of platelets, and may have endowed the coated Zn-alloy stents with long-term anticoagulant functions.

Addressing the Needs of the Rapidly Aging Society through the Development of Multifunctional Bioactive Coatings for Orthopedic Applications

The unprecedented aging of the world's population will boost the need for orthopedic implants and expose their current limitations to a greater extent due to the medical complexity of elderly patients and longer indwelling times of the implanted materials. Biocompatible metals with multifunctional bioactive coatings promise to provide the means for the controlled and tailorable release of different medications for patient-specific treatment while prolonging the material's lifespan and thus improving the surgical outcome. The objective of this work is to provide a review of several groups of biocompatible materials that might be utilized as constituents for the development of multifunctional bioactive coatings on metal materials with a focus on antimicrobial, pain-relieving, and anticoagulant properties. Moreover, the review presents a summary of medications used in clinical settings, the disadvantages of the commercially available products, and insight into the latest development strategies. For a more successful translation of such research into clinical practice, extensive knowledge of the chemical interactions between the components and a detailed understanding of the properties and mechanisms of biological matter are required. Moreover, the cost-efficiency of the surface treatment should be considered in the development process.

Analytical Techniques for the Characterization of Bioactive Coatings for Orthopaedic Implants

The development of bioactive coatings for orthopedic implants has been of great interest in recent years in order to achieve both early- and long-term osseointegration. Numerous bioactive materials have been investigated for this purpose, along with loading coatings with therapeutic agents (active compounds) that are released into the surrounding media in a controlled manner after surgery. This review initially focuses on the importance and usefulness of characterization techniques for bioactive coatings, allowing the detailed evaluation of coating properties and further improvements. Various advanced analytical techniques that have been used to characterize the structure, interactions, and morphology of the designed bioactive coatings are comprehensively described by means of time-of-flight secondary ion mass spectrometry (ToF-SIMS), X-ray photoelectron spectroscopy (XPS), Fourier transform infrared spectroscopy (FTIR), atomic force microscopy (AFM), scanning electron microscopy (SEM), transmission electron microscopy (TEM), 3D tomography, quartz crystal microbalance (QCM), coating adhesion, and contact angle (CA) measurements. Secondly, the design of controlled-release systems, the determination of drug release kinetics, and recent advances in drug release from bioactive coatings are addressed as the evaluation thereof is crucial for improving the synthesis parameters in designing optimal bioactive coatings.

Graphene Oxide Coating Improves the Mechanical and Biological Properties of Decellularized Umbilical Cord Arteries

The lack of small-diameter vascular grafts (inner diameter <5 mm) to substitute autologous grafts in arterial bypass surgeries has a massive impact on the prognosis and progression of cardiovascular diseases, the leading cause of death globally. Decellularized arteries from different sources have been proposed as an alternative, but their poor mechanical performance and high collagen exposure, which promotes platelet and bacteria adhesion, limit their successful application. In this study, these limitations were surpassed for decellularized umbilical cord arteries through the coating of their lumen with graphene oxide (GO). Placental and umbilical cord arteries were decellularized and perfused with a suspension of GO (C/O ratio 2:1) with ∼1.5 μm lateral size. A homogeneous GO coating that completely covered the collagen fibers was obtained for both arteries, with improvement of mechanical properties being achieved for umbilical cord decellularized arteries. GO coating increased the maximum force in 27%, the burst pressure in 29%, the strain in 25%, and the compliance in 10%, compared to umbilical cord decellularized arteries. The achieved theoretical burst pressure (1960 mmHg) and compliance (13.9%/100 mmHg) are similar to the human saphenous vein and mammary artery, respectively, which are used nowadays as the gold standard in coronary and peripheral artery bypass surgeries. Furthermore, and very importantly, coatings with GO did not compromise the endothelial cell adhesion but decreased platelet and bacteria adhesion to decellularized arteries, which will impact on the prevention of thrombosis and infection, until full re-endothetialization is achieved. Overall, our results reveal that GO coating has an effective role in the improvement of decellularized umbilical cord artery performance, which is a huge step toward their application as a small-diameter vascular graft.

Blood biocompatibility enhancement of biomaterials by heparin immobilization: a review

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.

Moderating cellular inflammation using 2-dimensional titanium carbide MXene and graphene variants

The effective control of microbial and metabolically derived biological toxins which negatively impact physical health remains a key challenge for the 21st century. 2-Dimensional graphene and MXene nanomaterials are relatively new additions to the field of biomedical materials with superior external surface areas suited to adsorptive remediation of biological toxins. However, relatively little is known about their physiological interactions with biological systems and, to date, no comparative biological studies have been done. This study compares titanium carbide MXene (Ti3C2Tx) in multilayered and delaminated forms with graphene variants to assess the impact of variable physical properties on cellular inflammatory response to endotoxin stimulus. No significant impact on cell metabolism or induction of inflammatory pathways leading to cell death was observed. No significant increase in markers of blood cell activation and haemolysis occurred. Whilst graphene nanoplatelets (GNP), graphene oxide (GO) and Ti3C2Tx showed insignificant antibacterial activity towards Escherichia coli, silver nanoparticle-modified GO (GO-Ag) induced bacterial cell death and at a lower dose than silver nanoparticles. All nanomaterials significantly reduced bacterial endotoxin induced THP-1 monocyte IL-8, IL-6 and TNF-α cytokine production by >99%, >99% and >80% respectively, compared to control groups. This study suggests the utility of these nanomaterials as adsorbents in blood contacting medical device applications for removal of inflammatory cytokines linked to poor outcome in patients with life-threatening infection.

Incorporation of heparin/BMP2 complex on GOCS-modified magnesium alloy to synergistically improve corrosion resistance, anticoagulation, and osteogenesis

The in vivo fast degradation and poor biocompatibility are two major challenges of the magnesium alloys in the field of artificial bone materials. In this study, graphene oxide (GO) was first functionalized by chitosan (GOCS) and then immobilized on the magnesium alloy surface, finally the complex of heparin and bone morphogenetic protein 2 was incorporated on the modified surface to synergistically improve the corrosion resistance, anticoagulation, and osteogenesis. Apart from an excellent hydrophilicity after the surface modification, a sustained heparin and BMP2 release over 14 days was achieved. The corrosion resistance of the modified magnesium alloy was significantly better than that of the control according to the results of electrochemical tests. Moreover, the corrosion rate was also significantly reduced in contrast to the control. The modified magnesium alloy not only had excellent anticoagulation, but also can significantly promote osteoblast adhesion and proliferation, upregulate the expression of alkaline phosphatase and osteocalcin, and enhance mineralization. Therefore, the method of the present study can be used to simultaneously improve the corrosion resistance and biocompatibility of the magnesium alloys targeted for the orthopedic applications.

Novel Copper Nanoparticles Intercalated Polyurethane Heparin/Poly-L-Lysine Chelates Coated Stents: Viability Study for Coronary Vascular Cells and Aneurysms Treatments

Continuous delayed endothelium regeneration and continues thrombosis development designate a task for coronary artery stent rehabilitation. To progress the direct vascular cell behavior, aneurysms treatments and compatibility of cardiovascular implants novel copper intercalated polyurethane heparin/poly-L-lysine chelates treated stent has established in this report. The functional group modifications, structural characteristics, and stability of the chelates have investigated for polyurethane heparin: poly-L-lysine, copper intercalated polyurethane heparin/poly-L-lysine coated stents. The FTIR results showed the copper intercalation at 446 cmr and the Cu 2s peak at 932 eV from XPS also indicated that the successful coating of copper, polyurethane heparin, poly-L-lysine. The relative surface geomorphology of the chelates displayed the uniform Cu coating consisting of multilayer poly-L-lysine on the substrate. The stability and biocompatibility studies indicated the significantly enhanced performance with clot the APTT and TT periods as clotting and cell proliferation assessments. This type of composite proposes a stage on a stent external area for discerning track of vascular cell performance and aneurysms treatments with low side effects.

Multifunctional surfaces through synergistic effects of heparin and nitric oxide release for a highly efficient treatment of blood-contacting devices

Thrombosis and inflammation after implantation remain unsolved problems associated with various medical devices with blood-contacting applications. In this study, we develop a multifunctional biomaterial with enhanced hemocompatibility and anti-inflammatory effects by combining the anticoagulant activity of heparin with the vasodilatory and anti-inflammatory properties of nitric oxide (NO). The co-immobilization of these two key molecules with distinct therapeutic effects is achieved by simultaneous conjugation of heparin (HT) and copper nanoparticles (Cu NPs), an NO-generating catalyst, via a simple tyrosinase (Tyr)-mediated reaction. The resulting immobilized surface showed long-term, stable and adjustable NO release for 14 days. Importantly, the makeup of the material endows the surface with the ability to promote endothelialization and to inhibit coagulation, platelet activation and smooth muscle cell proliferation. In addition, the HT/Cu NP co-immobilized surface enhanced macrophage polarization towards the M2 phenotype in vitro, which can reduce the inflammatory response and improve the adaptation of implants in vivo. This study demonstrated a simple but efficient method of developing a multifunctional surface for blood-contacting devices.

In vitro investigation of an intracranial flow diverter with a fibrin-based, hemostasis mimicking, nanocoating

Flow diversion aims at treatment of intracranial aneurysms via vessel remodeling mechanisms, avoiding the implantation of foreign materials into the aneurysm sack. However, complex implantation procedure, high metal surface and hemodynamic disturbance still pose a risk for thromboembolic complications in the clinical praxis. A novel fibrin and heparin based nano coating considered as a hemocompatible scaffold for neointimal formation was investigated regarding thrombogenicity and endothelialization. The fibrin-heparin coating was compared to a bare metal as well as fibrin- or heparin-coated flow diverters. The implants were tested separately in regard to inflammation and coagulation markers in two different in vitro hemocompatibility models conducted with human whole blood (n = 5). Endothelialization was investigated through a novel dynamic in vitro cell seeding model containing primary human cells with subsequent viability assay. It was demonstrated that platelet loss and platelet activation triggered by presence of a bare metal stent could be significantly reduced by applying the fibrin-heparin, fibrin and heparin coating. Viability of endothelial cells after proliferation was similar in fibrin-heparin compared to bare metal implants, with a slight, non-significant improvement observed in the fibrin-heparin group. The results suggest that the presented nanocoating has the potential to reduce thromboembolic complications in a clinical setting. Though the new model allowed for endothelial cell proliferation under flow conditions, a higher number of samples is required to assess a possible effect of the coating.

Synergetic effect of growth factor and topography on fibroblast proliferation

An innovative basic fibroblast growth factor (bFGF)-loaded polycaprolactone (PCL) fibrous membrane with highly aligned structure is developed for guided tissue regeneration (GTR). The aligned membrane is fabricated by electrospinning. In order to make efficient use of bFGF, PCL electrospun fibrous membrane is firstly surface-coated by self-polymerization of dopamine, and followed by immobilization of heparin via covalent conjugation to the polydopamine (PDA) layer. Subsequently, bFGF is loaded by binding to heparin. The loading yield of bFGF on heparin-immobilized PDA-coated PCL membrane significantly increases to around 7 times as compared with that of pure PCL membrane. NIH-3T3 cells show an enhanced proliferation and exhibit a stretched morphology aligned along the direction of the fibers on the aligned membranes. However, aligned bFGF-loaded PCL membrane exhibit a similar morphology but a highest cell density prolonged till 9 days. The synergetic effect of growth factor and topography would effectively regulate cell proliferation.

Graphene Surfaces Interaction with Proteins, Bacteria, Mammalian Cells, and Blood Constituents: The Impact of Graphene Platelet Oxidation and Thickness

Graphene-based materials (GBMs) have been increasingly explored for biomedical applications. However, interaction between GBMs-integrating surfaces and bacteria, mammalian cells, and blood components, that is, the major biological systems in our body, is still poorly understood. In this study, we systematically explore the features of GBMs that most strongly impact the interactions of GBMs films with plasma proteins and biological systems. Films produced by vacuum filtration of GBMs with different oxidation degree and thickness depict different surface features: graphene oxide (GO) and few-layer GO (FLGO) films are more oxidized, smoother, and hydrophilic, while reduced GO (rGO) and few-layer graphene (FLG) are less or nonoxidized, rougher, and more hydrophobic. All films promote glutathione oxidation, although in a lower extent by rGO, indicating their potential to induce oxidative stress in biological systems. Human plasma proteins, which mediate most of the biological interactions, adsorb less to oxidized films than to rGO and FLG. Similarly, clinically relevant bacteria, Staphylococcus epidermidis, Staphylococcus aureus, Pseudomonas aeruginosa, and Escherichia coli, adhere less to GO and FLGO films, while rGO and FLG favor bacterial adhesion and viability. Surface features caused by the oxidation degree and thickness of the GBMs powders within the films have less influence toward human foreskin fibroblasts; all materials allow cell adhesion, proliferation and viability up to 14 days, despite less on rGO surfaces. Blood cells adhere to all films, with higher numbers in less or nonoxidized surfaces, despite none having caused hemolysis (<5%). Unlike thickness, oxidation degree of GBMs platelets strongly impact surface morphology/topography/chemistry of the films, consequently affecting protein adsorption and thus bacteria, fibroblasts and blood cells response. Overall, this study provides useful guidelines regarding the choice of the GBMs to use in the development of surfaces for an envisioned application. Oxidized materials appear as the most promising for biomedical applications that require low bacterial adhesion without being cytotoxic to mammalian cells.

Characterization of carotid endothelial cell proliferation on Au, Au/GO, and Au/rGO surfaces by electrical impedance spectroscopy

To the best of the authors' knowledge, testing the biocompatibility of graphene coatings can be considered as the first to demonstrate human carotid endothelial cell (HCtAEC) proliferation on Au, graphene oxide-coated Au (Au/GO), and reduced graphene oxide-coated Au (Au/rGO) surfaces. We hypothesized that stent material modified with graphene (G)-based coatings could be used as electrodes for electrical impedance spectroscopy (EIS) in monitoring cell cultures, i.e., endothelialization. Alamar Blue cell viability assay and cell staining and cell counting with optical images were performed. For EIS analysis, an EIS sensor consisting of Au surface electrodes was produced by the photolithographic technique. Surface characterizations were performed by considering scanning electron microscope (SEM) and water contact angle analyses. Results showed that GO and rGO coatings did not prevent neither the electrical measurements nor the cell proliferation and that rGO had a positive effect on HCtAEC proliferation. The rate of increase of impedance change from day 1 to day 10 was nearly fivefold for all electrode surfaces. Alamar Blue assay performed to monitor cell proliferation rates between groups, and rGO has shown the highest Alamar Blue reduction value of 43.65 ± 8.79%. Graphical abstract.

Fabrication of chitosan/heparinized graphene oxide multilayer coating to improve corrosion resistance and biocompatibility of magnesium alloys

Due to its good biodegradability and mechanical properties, magnesium alloys are considered as the ideal candidate for the cardiovascular stents. However, the rapid degradation in human physiological environment and the poor biocompatibility seriously limit its application for biomaterials. In the present study, a chitosan/heparinized graphene oxide (Chi/HGO) multilayer coating was constructed on the AZ31B magnesium alloy surface using layer-by-layer (LBL) method to improve the corrosion resistance and biocompatibility. The results of attenuated total reflectance Fourier transform infrared spectroscopy (ATR-FTIR), Raman spectrum (RAMAN), scanning electron microscopy (SEM) and energy dispersive spectroscopy (EDS) showed that a dense and compact Chi/HGO multilayer coating was fabricated on the magnesium alloy surface. The results of potentiodynamic polarization, electrochemical impedance spectroscopy (EIS), pH value changes and magnesium ion release suggested that the multilayer coating can significantly enhance the corrosion resistance of the magnesium alloy. Moreover, the Chi/HGO multilayer coating could not only significantly reduce the hemolysis rate and platelet adhesion, but also promote the adhesion and proliferation of endothelial cells. Therefore, the Chi/HGO multilayer coating can simultaneously improve the corrosion resistance and biocompatibility of the magnesium alloys.

Anti-thrombogenic coatings for devices in neurointerventional surgery: Case report and review of the literature

BACKGROUND

Stent-assisted coiling and extra-saccular flow diversion require dual anti-platelet therapy due to the thrombogenic properties of the implants. While both methods are widely accepted, thromboembolic complications and the detrimental effects of dual anti-platelet therapy remain a concern. Anti-thrombogenic surface coatings aim to solve both of these issues. Current developments are discussed within the framework of an actual clinical case.

CASE DESCRIPTION

A 33-year-old male patient lost consciousness while doing sport and was administered 500 mg acetylsalicylic acid on site. Computed tomography revealed a massive subarachnoid haemorrhage, and digital subtraction angiography showed an aneurysm of the right middle cerebral artery. Stent-assisted coiling using a neck bridging device with a hydrophilic coating (pCONUS_HPC) was considered as an appropriate approach. Another 500 mg acetylsalicylic acid IV was given. After the single anti-platelet therapy was seen to be effective, a pCONUS_HPC was implanted, and the aneurysm sac subsequently fully occluded using coils. No thrombus formation was encountered. During the following days, 2 × 500 mg acetylsalicylic acid IV daily were required to maintain single anti-platelet therapy, monitored by frequent response testing. Follow-up digital subtraction angiography after 13 days confirmed the occlusion of the aneurysm and the patency of the middle cerebral artery.

CONCLUSION

A variety of ways to reduce the thrombogenicity of neurovascular stents is discussed. Hydrophilic surface coatings are a valid concept to improve the haemocompatibility of neurovascular implants while avoiding the use of dual anti-platelet therapy. Phosphorylcholine and phenox hydrophilic polymer coating are currently the most promising candidates. This concept is supported by anecdotal experience. However, formalised registries and randomised trials are currently being established.

Inhibition of in-stent restenosis after graphene oxide double-layer drug coating with good biocompatibility

In this study, we designed a double layer-coated vascular stent of 316L stainless steel using an ultrasonic spray system to achieve both antiproliferation and antithrombosis. The coating included an inner layer of graphene oxide (GO) loaded with docetaxel (DTX) and an outer layer of carboxymethyl chitosan (CMC) loaded with heparin (Hep). The coated surface was uniform without aggregation and shedding phenomena before and after stent expanded. The coating treatment was able to inhibit the adhesion and activation of platelets and the proliferation and migration of smooth muscle cells, indicating the excellent biocompatibility and antiproliferation ability. The toxicity tests showed that the GO/DTX and CMC/Hep coating did not cause deformity and organ abnormalities in zebrafish under stereomicroscope. The stents with GO double-layer coating were safe and could effectively prevent thrombosis and in-stent restenosis after the implantation into rabbit carotid arteries for 4–12 weeks.

Engineering Approaches to Prevent Blood Clotting from Medical Implants

Injectable and/or Implantable medical devices are widely used in the treatment of diseases. Among them, vascular stents provide the medical solution to treat blood clotting. However, traditional metallic stents, even with current improvements in anticoagulation properties, have potential drawbacks in local inflammation when first implanted into the body and undesirable protein adsorption and cell adhesion after a prolonged period of time in the body. In this perspective, we discuss several engineering approaches, including drug-eluting materials, polymeric and non-polymeric coatings, and surface modifications to coating materials that can be applied to the surface of medical implants to significantly improve the hemocompatibility. These coatings are expected to have a slow degradation rate with the ability to either load drugs or attach biomacromolecules to form an architecture that mimics the surrounding cells. In general, our perspective provides a current view on the achievements of hemo-compatible coatings and future trends in coating materials that will extend the life of the medical implants.

Recent advances to accelerate re-endothelialization for vascular stents

Cardiovascular diseases are considered as one of the serious diseases that leads to the death of millions of people all over the world. Stent implantation has been approved as an easy and promising way to treat cardiovascular diseases. However, in-stent restenosis and thrombosis remain serious problems after stent implantation. It was demonstrated in a large body of previously published literature that endothelium impairment represents a major factor for restenosis. This discovery became the driving force for many studies trying to achieve an optimized methodology for accelerated re-endothelialization to prevent restenosis. Thus, in this review, we summarize the different methodologies opted to achieve re-endothelialization, such as, but not limited to, manipulation of surface chemistry and surface topography.

Generating Aptamers Interacting with Polymeric Surfaces for Biofunctionalization

Common strategies for biofunctionalization of surfaces comprise the immobilization of bioactive molecules used as cell-binding ligands for cell recruitment. Besides covalent binding, multivalent noncovalent physical forces between substrate and ligand are an alternative way to equip surfaces with biomacromolecules. In this study, polymer binding ligands are screened by means of a DNA-based in vitro selection process. As candidate biomaterials poly(ether imide) (PEI), polystyrene, and poly[ethylene-co-(vinyl acetate)] are selected, due to their different chemical structure, but similar macroscopic interface properties, allowing physical interaction with nucleotide bases by varying valences. Multivalent interacting aptamers are successfully enriched by SELEX method and an area-wide surface functionalization is achieved, which can be used for further binding of bioactive molecules. In vitro selection against the polymers result in thymine-dominated aptamer binding motifs. The preferential interaction with thymine is attributed to its chemical structure, connected with a decreased electrostatic repulsion of the π-system and the hydrophobic character maximizing entropy. The aptamer binding stability correlates with available valences for interaction, resulting in a more stable functionalization of PEI.