Tailoring of the Titanium Surface by Immobilization of Heparin/Fibronectin Complexes for Improving Blood Compatibility and Endothelialization: An in Vitro Study

Surface modification of polyvinyl chloride with sodium alginate/carboxymethyl chitosan and heparin for realizing the anticoagulation

Thrombosis of extracorporeal circuits causes significant morbidity and mortality worldwide. In this study, plasma treatment technology and chemical grafting method were used to construct heparinized surfaces on the PVC substrate, which could not only reduce thrombosis but also decrease the side effects of the direct injection of anticoagulants. The PVC substrate was modified by plasma treatment technology firstly to obtain the active surface with the hydroxyl groups used for grafting. Then, heparin was grafted onto the modified PVC surface using different grafting strategies to prepare different heparinized surfaces. The experimental results indicated that the sodium alginate (SA) and carboxymethyl chitosan (CCS) used as interlayers could significantly increase the graft density of heparin to improve the anticoagulant effects and hemocompatibility of heparinized surfaces. In addition, the modification of heparin can further improve the anticoagulant effects. The CCS/low-molecular-weight heparin (LWMH) surface has the best anticoagulant properties, which can prolong the activated partial thromboplastin time (APTT) values of human plasma for about 35 s, reduce the hemolysis rates to <0.3 %, and perform well in the in-vitro blood circulation test. The heparinized surfaces prepared in this work have great application potential in anticoagulant treatment for medical devices.

Titanium Surface-Grafted Zwitterionic Polymers with an Anti-Polyelectrolyte Effect Enhances Osteogenesis

Zwitterionic polymers have attracted considerable attention because of their anti-adsorption and unique anti-polyelectrolyte effects and was widely used in surface modification. In this study, zwitterionic copolymers (poly (sulfobetaine methacrylate-co-butyl acrylate) (pSB) coating on the surface of a hydroxylated titanium sheet using surface-initiated atom transfer radical polymerization (SI-ATRP) was successfully constructed. X-ray photoelectron spectroscopy (XPS), Fourier transform infrared spectroscopy (FT-IR) and Water contact angle (WCA) analysis proved the successful preparation of the coating. The swelling effect caused by the anti-polyelectrolyte effect was reflected in the simulation experiment in vitro, and this coating can promote the proliferation and osteogenesis of MC3T3-E1. Therefore, this study provides a new strategy for designing multifunctional biomaterials for implant surface modifications.

Multimodal effects of asymmetric coating of coronary stents by electrospinning and electrophoretic deposition

Drug-eluting stents (DESs) are drug-coated vascular implants that inhibit smooth muscle cell proliferation and limit in-stent re-stenosis. However, traditional DESs release a single drug into the blood and cannot cope with complex mechanisms in atherosclerosis and body responses. The present study aimed to develop a novel multimodal stent by fabricating asymmetric coating with electrophoretic deposition and electrospinning. Herein, we use heparin-loaded alginate (Hep/Alg) and atorvastatin calcium-loaded polyurethane (AtvCa/PU) coatings on the stent luminal and abluminal surfaces, respectively. Scanning electron microscopy (SEM) micrographs showed that the alginate coatings had uniformity and thin thickness. Meanwhile, the PU fibers were formed without beads, with an acceptable diameter and suitable mechanical properties. PU nanofiber revealed minimal degradation in a 1-month study. The release of AtvCa and Hep continued for 8 days without a significant initial burst release. None of the stent coatings were cytotoxic or hemolytic, and PU nanofibers supported the survival of human umbilical endothelial cells (HUVEC) with high adhesion and flattened morphologies. The results indicate that electrophoretic deposition and electrospinning have significant potential for achieving asymmetric coating on stents and a promising approach for dual drug release for multimodal effects in vascular stent applications.

Hemocompatibility challenge of membrane oxygenator for artificial lung technology

The artificial lung (AL) technology is one of the membrane-based artificial organs that partly augments lung functions, i.e. blood oxygenation and CO₂ removal. It is generally employed as an extracorporeal membrane oxygenation (ECMO) device to treat acute and chronic lung-failure patients, and the recent outbreak of the COVID-19 pandemic has re-emphasized the importance of this technology. The principal component in AL is the polymeric membrane oxygenator that facilitates the O₂/CO₂ exchange with the blood. Despite the considerable improvement in anti-thrombogenic biomaterials in other applications (e.g., stents), AL research has not advanced at the same rate. This is partly because AL research requires interdisciplinary knowledge in biomaterials and membrane technology. Some of the promising biomaterials with reasonable hemocompatibility - such as emerging fluoropolymers of extremely low surface energy - must first be fabricated into membranes to exhibit effective gas exchange performance. As AL membranes must also demonstrate high hemocompatibility in tandem, it is essential to test the membranes using in-vitro hemocompatibility experiments before in-vivo test. Hence, it is vital to have a reliable in-vitro experimental protocol that can be reasonably correlated with the in-vivo results. However, current in-vitro AL studies are unsystematic to allow a consistent comparison with in-vivo results. More specifically, current literature on AL biomaterial in-vitro hemocompatibility data are not quantitatively comparable due to the use of unstandardized and unreliable protocols. Such a wide gap has been the main bottleneck in the improvement of AL research, preventing promising biomaterials from reaching clinical trials. This review summarizes the current state-of-the-art and status of AL technology from membrane researcher perspectives. Particularly, most of the reported in-vitro experiments to assess AL membrane hemocompatibility are compiled and critically compared to suggest the most reliable method suitable for AL biomaterial research. Also, a brief review of current approaches to improve AL hemocompatibility is summarized. STATEMENT OF SIGNIFICANCE: The importance of Artificial Lung (AL) technology has been re-emphasized in the time of the COVID-19 pandemic. The utmost bottleneck in the current AL technology is the poor hemocompatibility of the polymer membrane used for O₂/CO₂ gas exchange, limiting its use in the long-term. Unfortunately, most of the in-vitro AL experiments are unsystematic, irreproducible, and unreliable. There are no standardized in-vitro hemocompatibility characterization protocols for quantitative comparison between AL biomaterials. In this review, we tackled this bottleneck by compiling the scattered in-vitro data and suggesting the most suitable experimental protocol to obtain reliable and comparable hemocompatibility results. To the best of our knowledge, this is the first review paper focusing on the hemocompatibility challenge of AL technology.

Investigation of heparin-loaded poly(ethylene glycol)-based hydrogels as anti-thrombogenic surface coatings for extracorporeal membrane oxygenation

Extracorporeal membrane oxygenation (ECMO), a critical life-sustaining tool, faces significant challenges for the maintenance of normal haemostasis due to the large volume of circulating blood continuously in contact with artificial surfaces, hyperoxia and excessive shear stresses of the extracorporeal circuit. From a biomaterials perspective, it has been hypothesised that drug eluting coatings composed of haemocompatible hydrogels loaded with an anticoagulant drug could potentially enhance the haemocompatibility of the circuit. Poly(ethylene glycol) (PEG) has been well established as a biocompatible and anti-fouling material with wide biomedical application. Unfractionated heparin is the most commonly used anticoagulant for ECMO. In the present study, the feasibility of using heparin-loaded PEG-based hydrogels as anti-thrombogenic surface coatings for ECMO was investigated. The hydrogels were synthesised by photopolymerisation using poly(ethylene glycol) diacrylate (PEGDA) as the crosslinking monomer and poly(ethylene glycol) methacrylate (PEGMA) as the hydrophilic monomer, with heparin loaded into the pre-gel solution. Factors which could affect the release of heparin were investigated, including the ratio of PEGDA/PEGMA, water content, loading level of heparin and the flow of fluid past the hydrogel. Our results showed that increased crosslinker content and decreased water content led to slower heparin release. The hydrogels with water contents of 60 wt% and 70 wt% could achieve a sustained heparin release by adjusting the ratio of PEGDA/PEGMA. The anticoagulation efficacy of the released heparin was evaluated by measuring the activated clotting time of whole blood. The hydrogels with desirable heparin release profiles were prepared onto poly(4-methyl-1-pentene) (PMP) films with the same chemical composition as the PMP ECMO membranes. The coatings showed sustained heparin release with a cumulative release of 70-80% after 7 days. Haemocompatibility tests demonstrated that PEG hydrogel coatings significantly reduced platelet adhesion and prolonged plasma recalcification time. These results suggest that heparin-loaded PEG hydrogels are potential anti-thrombogenic coatings for ECMO.

Tunable Properties of Polydopamine Nanoparticles and Coated Surfaces

Polydopamine (PDA) nanoparticles and PDA-coated surfaces have wide applications due to PDA's unique reactivity and efficient coating ability on nearly any surface. However, challenges in manipulating and controlling dopamine polymerization and thus the PDA nanoparticle formations and surface coatings still exist. Here, dopamine with a tetraborate (borax)-protected catechol group was utilized to tune the properties of PDA nanoparticles and PDA coatings. This method allows us to (1) synthesize PDA nanoparticles with a narrow size distribution and low aggregation and (2) create surface coating with the desired PDA layer thickness and varying water contact angles. PDA nanoparticles and PDA-coated surfaces of varying but tunable chemical and physical properties will find wide applications. For example, such PDA-coated surfaces were successfully used to construct Ag nanoparticle patterned surfaces with varying Ag particle sizes and densities.

Zein-induced immune response and modulation by size, pore structure and drug-loading: Application for sciatic nerve regeneration

Zein is a biodegradable material with great potential in biomedical applications. However, as a plant-derived protein material, body's immune response is the key factor to determine its clinical performance. Herein, for the first time, the zein-induced immune response is evaluated systemically and locally, comparing with typical materials including alginate (ALG), poly(lactic-co-glycolic) acid (PLGA) and polystyrene (PS). Zein triggers an early inflammatory response consistent with the non-degradable PS, but this response decreases to the same level of the biosafe ALG and PLGA with zein degradation. Changing sphere sizes, pore structure and encapsulating dexamethasone can effectively modulate the zein-induced immune response, especially the pore structure which also inhibits neutrophil recruitment and promotes macrophages polarizing towards M2 phenotype. Thus, porous zein conduits with high and low porosity are further fabricated for the 15 mm sciatic nerve defect repair in rats. The conduits with high porosity induce more M2 macrophages to accelerate nerve regeneration with shorter degradation period and better nerve repair efficacy. These findings suggest that the pore structure in zein materials can alleviate the zein-induced early inflammation and promote M2 macrophage polarization to accelerate nerve regeneration. STATEMENT OF SIGNIFICANCE: Zein is a biodegradable material with great potential in biomedical applications. However, as a plant protein, its possible immune response in vivo is always the key issue. Until now, the systemic study on the immune responses of zein in vivo is still very limited, especially as an implant. Herein, for the first time, the zein-induced immune response was evaluated systemically and locally, comparing with typical biomaterials including alginate, poly(lactic-co-glycolic) acid and polystyrene. Changing sphere sizes, pore structure and encapsulating dexamethasone could effectively modulate the zein-induced immune response, especially the pore structure which also inhibited neutrophil recruitment and promoted macrophages polarizing towards M2 phenotype. Furthermore, the pore structure in zein nerve conduits was proved to alleviate the early inflammation and promote M2 macrophage polarization to accelerate nerve regeneration.

A Well-Designed Two-Fold Crosslinked Biological Valve Leaflets with Heparin-Loaded Hydrogel Coating for Enhancing Anticoagulation, Endothelialization, and Anticalcification

Commercial biological valve leaflets (BVLs) crosslinked with Glutaraldehyde (GA) are at risk of accelerating damage and even failure, owing to high cell toxicity of GA, acute thrombosis, and calcification in...

Surface engineering and the application of laser-based processes to stents - A review of the latest development

Late in-stent thrombus and restenosis still represent two major challenges in stents’ design. Surface treatment of stent is attracting attention due to the increasing importance of stenting intervention for coronary artery diseases. Several surface engineering techniques have been utilised to improve the biological response in vivo on a wide range of biomedical devices. As a tailorable, precise, and ultra-fast process, laser surface engineering offers the potential to treat stent materials and fabricate various 3D textures, including grooves, pillars, nanowires, porous and freeform structures, while also modifying surface chemistry through nitridation, oxidation and coatings. Laser-based processes can reduce the biodegradable materials' degradation rate, offering many advantages to improve stents’ performance, such as increased endothelialisation rate, prohibition of SMC proliferation, reduced platelet adhesion and controlled corrosion and degradation. Nowadays, adequate research has been conducted on laser surface texturing and surface chemistry modification. Laser texturing on commercial stents has been also investigated and a promotion of performance of laser-textured stents has been proved.

In this critical review, the influence of surface texture and surface chemistry on stents performance is firstly reviewed to understand the surface characteristics of stents required to facilitate cellular response. This is followed by the explicit illustration of laser surface engineering of stents and/or related materials. Laser induced periodic surface structure (LIPSS) on stent materials is then explored, and finally the application of laser surface modification techniques on latest generation of stent devices is highlighted to provide future trends and research direction on laser surface engineering of stents.

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Compared conventional surface engineering with laser-based methods for biomedical devices.

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Explained the influence of texture geometry and surface chemistry on stents biological response.

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Reviewed state of the art in laser surface engineering of stents for improved biological response.

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Reviewed state of the art in laser surface engineering to control degradation of bioresorbable stents.

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Highlighted novel laser surface engineering designs for improved stents'performance.

Surface modification strategies to improve titanium hemocompatibility: a comprehensive review

Titanium and its alloys are widely used in different biomaterial applications due to their remarkable mechanical properties and bio-inertness. However, titanium-based materials still face some challenges, with an emphasis on hemocompatibility. Blood-contacting devices such as stents, heart valves, and circulatory devices are prone to thrombus formation, restenosis, and inflammation due to inappropriate blood-implant surface interactions. After implantation, when blood encounters these implant surfaces, a series of reactions takes place, such as protein adsorption, platelet adhesion and activation, and white blood cell complex formation as a defense mechanism. Currently, patients are prescribed anticoagulant drugs to prevent blood clotting, but these drugs can weaken their immune system and cause profound bleeding during injury. Extensive research has been done to modify the surface properties of titanium to enhance its hemocompatibility. Results have shown that the modification of surface morphology, roughness, and chemistry has been effective in reducing thrombus formation. The main focus of this review is to analyze and understand the different modification techniques on titanium-based surfaces to enhance hemocompatibility and, consequently, recognize the unresolved challenges and propose scopes for future research.

Hemocompatibility of polyzwitterion-modified titanium dioxide nanotubes

Titanium dioxide nanotubes (TNTs) have attracted increasing interest as implantable materials due to their many desirable properties. However, their blood compatibility remains an issue. In this paper, TNTs of different diameters were modified with two types of zwitterionic polymers, poly(sulfobetaine methacrylate) (pSBMA) and poly(carboxybetaine methacrylate) (pCBMA), which were grafted onto the TNTs using ARGET-ATRP (activators regenerated by electron transfer atom transfer radical polymerization) method. Both pSBMA and pCBMA brushes coatings were found to greatly reduce adsorption of bovine serum albumin (BSA) and fibrinogen (Fib) onto the TNTs, showing excellent protein resistance. Moreover, the effects of the surface topography on the amount of protein adsorption were largely suppressed by the polyzwitterion coatings. The conformation of the protein adsorbed to the substrates was analyzed at the molecular level by Fourier-transform infrared reflection spectroscopy (FT-IR), which revealed that the BSA adsorbed on the polyzwitterion-modified TNTs adopted significantly different secondary structures from that on the virgin TNTs, whereas the conformation of the adsorbed Fib remained basically the same. The polyzwitterion-modified TNTs were found to be non-hemolytic, and platelet adhesion and activation was significantly reduced, showing excellent blood compatibility.

Epigallocatechin gallate mediated sandwich-like coating for mimicking endothelium with sustained therapeutic nitric oxide generation and heparin release

In-stent restenosis after stenting is generally characterized by an inflammatory response, excessive proliferation of smooth muscle cells, and delayed healing of the endothelium layer. In this study, inspired by catechol/gallol surface chemistry, a sandwich-like layer-by-layer (LBL) coating was developed using chitosan and heparin as polyelectrolytes, along with the embedding of an epigallocatechin gallate/copper (EGCG/Cu) complex. The embedding of EGCG stabilized the coating by various intermolecular interactions in the LBL coating (e.g., π-π stacking, weak intermolecular crosslinking, and enriched hydrogen bonding) and supported the sustained release of the cargo heparin over 90 days. This design enabled a biomimetic endothelium function in terms of the sustained release of heparin and continuous in situ generation of nitric oxide, driven by the catalytic decomposition of endogenous S-nitrostothiols by copper ions. The result showed enhanced durability of anticoagulation and suppressed inflammatory response. Moreover, the "sandwich-like" coating supported the growth of endothelial cells and up-regulated the protein expression of vascular endothelial growth factor, while effectively suppressing the proliferation and migration of smooth muscle cells (SMCs) via the up-regulation of cyclic guanosine monophosphate. Ex vivo and in vivo experiments demonstrated the effectiveness of the sandwich-like coating in preventing thrombosis formation, suppressing the growth of SMCs, reducing the infiltration and activation of inflammatory cells, and ultimately achieving rapid in situ endothelialization. Hence, the EGCG-assisted sandwich-like coating might be used as a robust and versatile surface modification strategy for implantable cardiovascular devices.

Endothelialization of cardiovascular devices

Blood-contacting surfaces of cardiovascular devices are not biocompatible for creating an endothelial layer on them. Numerous research studies have mainly sought to modify these surfaces through physical, chemical and biological means to ease early endothelial cell (EC) adhesion, migration and proliferation, and eventually to build an endothelial layer on the surfaces. The first priority for surface modification is inhibition of protein adsorption that leads to inhibition of platelet adhesion to the device surfaces, which may favor EC adhesion. Surface modification through surface texturing, if applicable, can bring some hopeful outcomes in this regard. Surface modifications through chemical and/or biological means may play a significant role in easy endothelialization of cardiovascular devices and inhibit smooth muscle cell proliferation. Cellular engineering of cells relevant to endothelialization can boost the positive outcomes obtained through surface engineering. This review briefly summarizes recent developments and research in early endothelialization of cardiovascular devices. STATEMENT OF SIGNIFICANCE: Endothelialization of cardiovascular implants, including heart valves, vascular stents and vascular grafts is crucial to solve many problems in our health care system. Numerous research efforts have been made to improve endothelialization on the surfaces of cardiovascular implants, mainly through surface modifications in three ways - physically, chemically and biologically. This review is intended to highlight comprehensive research studies to date on surface modifications aiming for early endothelialization on the blood-contacting surfaces of cardiovascular implants. It also discusses future perspectives to help guide endothelialization strategies and inspire further innovations.

Construction of Biofunctionalized Anisotropic Hydrogel Micropatterns and Their Effect on Schwann Cell Behavior in Peripheral Nerve Regeneration

Hydrogels have promising application in tissue regeneration due to their excellent physicochemical and biocompatible properties, whereas anisotropic micropatterns are been proven to directionally induce cell alignment and accelerate cell migration. However, an effect of biofunctionalized anisotropic hydrogel micropatterns on nerve regeneration has rarely been reported. In this study, the anisotropic polyacrylamide (PAM) hydrogel micropatterns with aligned ridge/groove structures were first prepared via in situ free radical polymerization and micromolding, and then biofunctionalized using YIGSR peptide for better promoting cell growth. The morphology, swelling ratio, wettability, mechanical properties, and stability of the prepared hydrogel were characterized. The successful immobilization of YIGSR peptide on the PAM hydrogel was monitored using FTIR, immunofluorescence staining, and ELISA. The effects on adhesion, directional growth, and biological function of Schwann cells were evaluated. The results displayed that the anisotropic PAM hydrogel micropatterns with inner porous structure possessed good stability, swelling, and mechanical properties. The YIGSR peptide could be well immobilized on hydrogel micropatterns with a percentage of 62.6%. The biofunctionalized anisotropic hydrogel micropatterns could effectively regulate the orientation growth of Schwann cells, and obviously up-regulate BDNF (40%) and β-actin (50%) expression compared with single hydrogel micropatterns, without negatively affecting the normal secretion of neurotropic factors by Schwann cells. To the best of our knowledge, this is the first time to study the construction and effect of biofunctionalized anisotropic hydrogel micropatterns on nerve regeneration, which may provide an experimental and theoretical basis for the design and development of artificial implants for nerve regeneration application.

One-Pot but Two-Step Vapor-Based Amine- and Fluorine-Bearing Dual-Layer Coating for Improving Anticorrosion and Biocompatibility of Magnesium Alloy

Hydrophobic coating is of great interest to enhance the corrosion resistance of magnesium alloy implants, which always suffer from rapid corrosion that leads to the failing application under physiological conditions. Plasma-polymerized fluorocarbon (C-F) coating has been widely studied as a substrate protection layer; however, the precise control of the deposition rate of C-F coating with fluorinated alkanes has been a challenge. In this study, a thin, uniform, pinhole-free, polymerlike, and hydrophobic C-F coating was successfully prepared using acetylene (C₂H₂) as a cross-linking agent, which endows the coating with tunable properties of deposition rate by incorporation of unsaturated bonds. Electrochemical corrosion and in vitro immersion test demonstrated that the C-F coating significantly slows down the corrosion rate of MgZnMn in phosphate-buffered saline solution at 37 °C. Furthermore, an additional layer of PPAam was deposited on the C-F coating to eliminate the adverse effect of C-F surface on cytocompatibility. Thus, such a stacked coating imparts MgZnMn with a significantly improved corrosion resistance and promotes cell adhesion and viability. Therefore, the strategy of acetylene-mediated C-F-based coating shows a great potential for tailoring ideal surface functionalities of magnesium-based medical devices.

TiO2 Coating and UV Photofunctionalization Enhance Blood Coagulation on Zirconia Surfaces

This in vitro study was designed to evaluate the effect of sol-gel derived TiO₂ coating on blood coagulation, blood protein adsorption, and platelet response on zirconia surfaces. Square-shaped zirconia (n=96) (10x10x2 mm) was cut, ground, sintered, and finally cleansed ultrasonically in each of acetone and ethanol for 5 minutes. Three experimental groups (n=32) were fabricated: (a) zirconia coated with sol-gel derived TiO₂, (b) zirconia coated with sol-gel derived TiO₂ and treated with ultraviolet (UV) irradiation for 1 hour, and (c) non-coated zirconia as control. The coatings were prepared from tetraisopropyl orthotitanate solution by dip-coating. The thrombogenicity of the specimens was evaluated using a whole blood kinetic clotting time method where the extent of blood clotting was evaluated at 10, 20, 30, 40, 50, and 60 minutes (n=4/time point, total n=24/group). Scanning electron microscope images were taken to observe platelet morphologies after 1-hour incubation with platelet-rich plasma (PRP) (n=5/group). Surface characteristics were visualized using atomic force microscopy (n=1/group). Adsorption of plasma proteins and fibronectin on each surface was studied by gel electrophoresis (n=2/group). Significant differences were observed in blood coagulation between the test groups at 20-, 30-, 40-, and 50-minute time points (p<0.005). UV treated TiO₂ coated specimens showed fastest blood coagulation followed by TiO₂ coated and non-coated specimens. Furthermore, platelets appeared at a higher activation state on coated specimens. Gel electrophoresis revealed no difference in protein adsorption among the experimental groups. In summary, TiO₂ coatings promoted blood coagulation, and it was further enhanced by UV treatment, which has the potential to hasten the wound healing process in vivo.

Immobilization of heparin on decellularized kidney scaffold to construct microenvironment for antithrombosis and inducing reendothelialization

In recent years, rapid development of tissue engineering technology provides possibilities for the construction of artificial tissues or organs. In construction of engineered kidneys, researchers used native decellularized extracellular matrix (ECM) as the scaffolds to recellularization. However, thrombosis has been a great issue that hinders the progress of transplantation in vivo. In this study, heparin was immobilized to the collagen part of decellularized scaffold with collagen-binding peptide (CBP). Through the anticoagulant and endothelial cell reperfusion experiments, it can be demonstrated that the heparinized scaffolds absorbed less platelets and red blood cells which can effectively reduce the formation of thrombosis. Moreover, it is conducive to long-term adhesion of endothelial cells which is important for the formation of subsequent vascularization. Taken together, our results reveal that the whole kidney can be modified by CBP-heparin composite to reduce the thrombosis and provide the better conditions for neovascularization.

Cardiovascular stents: overview, evolution, and next generation

Compared to bare-metal stents (BMSs), drug-eluting stents (DESs) have been regarded as a revolutionary change in coronary artery diseases (CADs). Releasing pharmaceutical agents from the stent surface was a promising progress in the realm of cardiovascular stents. Despite supreme advantages over BMSs, in-stent restenosis (ISR) and long-term safety of DESs are still deemed ongoing concerns over clinically application of DESs. The failure of DESs for long-term clinical use is associated with following factors including permanent polymeric coating materials, metallic stent platforms, non-optimal drug releasing condition, and factors that have recently been supposed as contributory factors such as degradation products of polymers, metal ions due to erosion and degradation of metals and their alloys utilizing in some stents as metal frameworks. Discovering the direct relation between stent materials and associating adverse effects is a complicated process, and yet it has not been resolved. For clinical success it is of significant importance to optimize DES design and explore novel strategies to overcome all problems including inflammatory response, delay endothelialization, and sub-acute stent thrombosis (ST) simultaneously. In this work, scientific reports are reviewed particularly focusing on recent advancements in DES design which covers both potential improvements of existing and recently novel prototype stent fabrications. Covering a wide range of information from the BMSs to recent advancement, this study mostly sheds light on DES's concepts, namely stent composition, drug release mechanism, and coating techniques. This review further reports different forms of DES including fully biodegradable DESs, shape-memory ones, and polymer-free DESs.

Fibronectin modified TiO2 nanotubes modulate endothelial cell behavior

Cardiovascular disease has become a great threat to the health of mankind; current titanium (Ti) stents fail due to late stent thrombosis caused by the lack of re-endothelialization of the Ti stent. The objective of this study was to design a novel cardiovascular Ti implant with improved surface biocompatibility. TiO2 nanotubes with a diameter of 110 nm were anodized at a constant voltage of 30 V, and fibronectin was immobilized onto the TiO2 nanotubes using polydopamine. The element composition, morphology, and wettability of the different substrate surfaces were characterized by x-ray photoelectron spectroscopy (XPS), field-emission scanning electron microscopy (FE-SEM), atomic force microscopy (AFM), and contact angle measurements, respectively, confirming the successful immobilization of fibronectin. In vitro experiments including immunofluorescence staining, Cell Counting Kit-8 (CCK-8), and nitric oxide (NO) and prostacyclin (PGI2) release demonstrate that fibronectin modified TiO2 nanotubes supported cell adhesion, proliferation, and normal cellular functions of human umbilical vein endothelial cells (HUVECs). These methodologies can be applied for future fabrication of cardiovascular stents.

Catechol/polyethyleneimine conversion coating with enhanced corrosion protection of magnesium alloys: potential applications for vascular implants

A catechol/polyethyleneimine conversion coating on a MgZnMn alloy possessed good corrosion resistance. Heparin was further grafted on it and this showed the potential for surface modification of magnesium-based vascular implants.

Controlling Molecular Weight of Hyaluronic Acid Conjugated on Amine-rich Surface: Toward Better Multifunctional Biomaterials for Cardiovascular Implants

The molecular weights (MWs) of hyaluronic acid (HA) in extracellular matrix secreted from both vascular endothelial cells (VECs) and vascular smooth muscle cells (VSMCs) play crucial roles in the cardiovascular physiology, as HA with appropriate MW influences important pathways of cardiovascular homeostasis, inhibits VSMC synthetic phenotype change and proliferation, inhibits platelet activation and aggregation, promotes endothelial monolayer repair and functionalization, and prevents inflammation and atherosclerosis. In this study, HA samples with gradients of MW (4 × 10³, 1 × 10⁵, and 5 × 10⁵ Da) were prepared by covalent conjugation to a copolymerized film of polydopamine and hexamethylendiamine (PDA/HD) as multifunctional coatings (PDA/HD-HA) with potential to improve the biocompatibility of cardiovascular biomaterials. The coatings immobilized with high-MW-HA (PDA/HD-HA-2: 1 × 10⁵ Da; PDA/HD-HA-3: 5 × 10⁵ Da) exhibited a remarkable suppression of platelet activation/aggregation and thrombosis under 15 dyn/cm² blood flow and simultaneously suppressed the adhesion and proliferation of VSMC and the adhesion, activation, and inflammatory cytokine release of macrophages. In particular, PDA/HD-HA-2 significantly enhanced VEC adhesion, proliferation, migration, and functional factors release, as well as the captured number of endothelial progenitor cells under dynamic condition. The in vivo results indicated that the multifunctional surface (PDA/HD-HA-2) created a favorable microenvironment of endothelial monolayer formation and functionalization for promoting reendothelialization and reducing restenosis of cardiovascular biomaterials.

Biofunctionalisation of magnesium alloys by successive immobilisation of poly(ethylene glycol), fibronectin and heparin

In the present study, with the aim of improving their corrosion resistance, anticoagulation and cytocompatibility with endothelial cells, a magnesium alloy (AZ31B) was modified by the alkali heat treatment followed by the immobilisation of the dopamine layer. Subsequently, molecules of poly(ethylene glycol) (PEG) and fibronectin or fibronectin–heparin complexes were successively immobilised on the dopamine-modified surface. After the surface modification, the hydrophilicity of magnesium alloy was obviously improved. The corrosion resistance of the magnesium alloy was improved through alkali heat treatment, and the immobilisation of dopamine and PEG can further reduce the corrosion rate. However, the corrosion resistance of the magnesium alloy was slightly reduced by the grafting of fibronectin or fibronectin–heparin complex. Furthermore, the modified samples showed improved hemocompatibility and good cytocompatibility with the endothelial cells on the fibronectin or fibronectin–heparin-modified surfaces. Therefore, the corrosion resistance, anticoagulation and cytocompatibility of the magnesium alloy can be enhanced by alkali heat treatment and subsequent immobilisation of biomolecules. The method of this study can be used for surface modification of magnesium alloys to impart these with better corrosion resistance, blood compatibility and cytocompatibility with endothelial cells simultaneously.

Surface modification of esophageal stent materials by a polyethylenimine layer aiming at anti-cancer function

Esophageal cancer is difficult to cure globally and possesses high mortality rate, and it is generally accepted that palliative care such as stent implantation is the main therapy method for esophageal cancer in later period. However, the restenosis caused by tumor cells and inflammatory cells seriously interferes the stent clinical application and limits its long-term services. To solve this problem, series of drug delivery stents were developed and proven rather effective in the early stage of implantation, but more serious restenosis occurred after the drug delivery was over, which endangered the patients' life. Therefore, endowing the esophageal stent continuous anti-cancer function become an ideal strategy for inhibiting the restenosis. In this contribution, the functional layer composed of polydopamine (PDA) and Poly-ethylenimine (PEI) with series of molecular weights (MW, 1.8 × 10³, 1 × 10⁴, 2.5 × 10⁴ and 7 × 10⁴ Da) were fabricated onto the esophageal stent material 317L stainless steel (317L SS) surface. The surface characterization including amine quantitative, atomic force microscopy (AFM) and water contact angle measurement indicated successful preparation of the PDA/PEI layer. The Eca109 cells culture results proved that the PDA/PEI layers significantly improve Eca109 cells apoptosis and necrosis, suggesting excellent anti-cancer function. In addition, we also found that the anti-cancer function of the PDA/PEI layers was positively correlated to the immobilized PEIs' MW. All the results demonstrated the potential application of the PDA/PEI layers on the surface modification of esophageal stent for continuous anti-cancer function. It is generally accepted that the restenosis caused by tumor cells seriously interferes the esophageal stent clinical application. Thus, endowing the esophageal stent continuous anti-cancer function is the ideal strategy for inhibiting the restenosis. In this work, we fabricated functional layers composed of polydopamine (PDA) and Poly-ethylenimine (PEI) with series of molecular weights (MW, 1.8 × 10³, 1 × 10⁴, 2.5 × 10⁴ and 7 × 10⁴ Da) onto the esophageal stent material 317L stainless steel (317L SS) surface to inhibit the tumor cells growth, and this function was related to the PEIs' molecular weights. The functional PDA/PEI layers were expected potentially applied for surface modification of esophageal stent materials.

Novel electrochemical immune sensor based on Hep-PGA-PPy nanoparticles for detection of α-Fetoprotein in whole blood

A simple and accurate immune sensor for quantitative detection of α-Fetoprotein (AFP) was developed based on the immobilization of antigen on the surface of Hep-PGA-PPy nanoparticles modified glassy carbon electrodes (GCE). The obtained Hep-PGA-PPy nanoparticles were characterized by fourier transform infrared (FT-IR) spectra and transmission electron microscopy (TEM). And the blood compatibility of Hep-PGA-PPy nanoparticles was investigated by in vitro coagulation tests, hemolysis assay and whole blood adhesion tests. Combining the conductive property of polypyrrole (PPy) and the biocompatibility of heparin (Hep), the Hep-PGA-PPy nanoparticles could improve not only the anti-biofouling effect the electrode, but also improved the electrochemical properties of the immune sensor. Under optimal conditions, the proposed immune sensor could detect AFP in a linear range from 0.1 to 100 ng mL^-1 with a detection limit of 0.099 ng mL^-1 at the signal-to-noise ratio of 3, and it also possessed good reproducibility and storage stability. Furthermore, the detection of AFP in five human blood samples also showed satisfactory accuracy with low relative errors. Thus, the developed immune sensor which showed acceptable reproducibility, selectivity, stability and accuracy could be potentially used for the detection of whole blood samples directly.

A sensitive label-free immunosensor for detection α-Fetoprotein in whole blood based on anticoagulating magnetic nanoparticles

Accurate values of tumor markers in blood play an especially important role in the diagnosis of illness. Here, based on the combination of three techniques include anticoagulant technology, nanotechnology and biosensing technology, a sensitive label-free immunosensor with anti-biofouling electrode for detection α-Fetoprotein (AFP) in whole blood was developed by anticoagulating magnetic nanoparticles. The obtained products of Fe₃O₄-ɛ-PL-Hep nanoparticles were characterized by fourier transform infrared (FT-IR) spectra, transmission electron microscopy (TEM), ζ-potential and vibrating sample magnetometry (VSM). Moreover, the blood compatibility of anticoagulating magnetic nanoparticles was characterized by in vitro coagulation tests, hemolysis assay and whole blood adhesion tests. Combining the anticoagulant property of heparin (Hep) and the good magnetism of Fe₃O₄, the Fe₃O₄-ɛ-PL-Hep nanoparticles could improve not only the anti-biofouling property of the electrode surface when they contact with whole blood, but also the stability and reproducibility of the proposed immunosensor. Thus, the prepared anticoagulating magnetic nanoparticles modified immunosensor for the detection of AFP showed excellent electrochemical properties with a wide concentration range from 0.1 to 100ng/mL and a low detection limit of 0.072ng/mL. Furthermore, five blood samples were assayed using the developed immunosensor. The results showed satisfactory accuracy with low relative errors. It indicated that our developed immunoassay was competitive and could be potentially used for the detection of whole blood samples directly.

Reversible Tethering of Polymers onto Catechol-Based Titanium Platforms

In this article, we report on the reversible tethering of end-functionalized polymers onto catechol-based titanium platforms by exploiting the reversible Diels-Alder (DA) cycloaddition reaction. For this purpose, furan and maleimide end-functionalized polymers, prepared via reversible addition-fragmentation chain transfer polymerization, were covalently grafted through a DA reaction onto reactive titanium platforms elaborated from catechol-based anchors incorporating either the furan or the maleimide moiety. As a proof of concept, a hydrophilic poly(oligo(ethylene glycol)acrylate) (POEGA) and a hydrophobic poly(2,2,2-trifluoroethyl acrylate) (PTFEA) were grafted onto titanium surfaces and subsequently detached by exploiting the thermoreversible nature of the DA reaction [i.e., retro Diels-Alder (rDA)]. These polymers were interchanged by performing a second DA reaction, thereby allowing the titanium surface wettability to be switched from hydrophobic to hydrophilic on demand. The grafting of furan/maleimide end-functionalized polymers onto functionalized (maleimide/furan, respectively) catechol-based titanium platforms and the subsequent rDA/DA sequence used for switching the titanium surface were evidenced by attenuated total reflectance-Fourier transform-infrared spectroscopy, X-ray photoelectron spectroscopy, and contact angle measurements.

Tuning cell adhesive properties via layer-by-layer assembly of chitosan and alginate

Understanding the mechanisms controlling cell-multilayer film interactions is crucial to the successful engineering of these coatings for biotechnological and biomedical applications. Herein, we present a strategy to tune the cell adhesive properties of multilayers based on marine polysaccharides with and without cross-linking and/or coating with extracellular matrix proteins. Chemical cross-linking of multilayers improved mechanical properties of the coatings but also elicited changes in surface chemistry that alter the adhesion of human umbilical vein endothelial cells. We evaluated a strategy to decouple the mechanical and chemical properties of these films, enabling the transition from cell-adhesive to cell-resistant multilayers. Addition of chitosan/alginate multilayers on top of cross-linked films decreased endothelial cell adhesion, spreading, and proliferation to similar levels as uncross-linked films. Our findings highlight the key role of surface chemistry in cell-multilayer film interactions, and these engineered nanocoatings represent a tunable model of cell adhesive and non-adhesive multilayered films.

STATEMENT OF SIGNIFICANCE

Multilayered films based on marine-derived polysaccharides were obtained by layer-by-layer (LbL). Biological tests with human umbilical vein endothelial cells (HUVECs) showed the potential of these films to tailor cell adhesion, spreading and proliferation. These multilayered films promise to be versatile and tunable model of cell adhesive and non-adhesive films.

Strong multi-functions based on conjugating chondroitin sulfate onto an amine-rich surface will direct the vascular cell fate for cardiovascular implanted devices

This research may support potential applications for surface modification of cardiovascular implants to achieve improved multi-functions.

Multilayered Hollow Tubes as Blood Vessel Substitutes

The available therapies for cardiovascular pathologies often require the replacement of diseased vascular grafts. However, the current blood vessel substitutes are unsuitable for small-diameter blood vessel replacements. Herein, we propose the creation of multilayered hollow tubes as blood vessel substitutes. Hollow tubes were obtained by building-up multilayers of marine-derived polysaccharides (i.e., chitosan and alginate) on sacrificial tubular templates using layer-by-layer technology and template leaching. A cross-linking degree of ≈59% was achieved using genipin, which is reflected in an increase of the mechanical properties and a decrease of the water uptake. To further improve the cell adhesive properties of the multilayers, fibronectin (FN) was immobilized on the surface of the hollow tubes. The in vitro biological performance of human umbilical vein endothelial cells (HUVECs) and human aortic smooth muscle cells (HASMCs) was assessed. In addition, to perform the culture of HUVECs on the inner side and the HASMCs on the outer side of the tubes, an in-house developed apparatus was created that allowed us to feed cells with their respective culture medium. The developed hollow tubes were shown to be a suitable structure to promote cell adhesion, spreading, and proliferation. It is our belief that the creation of these functional structures will open a new research field in order to develop innovative multilayered tubular structures for cardiovascular TE applications.

Controlling mesenchymal stem cells differentiate into contractile smooth muscle cells on a TiO2 micro/nano interface: Towards benign pericytes environment for endothelialization

Building healthy and oriented smooth muscle cells (SMCs) environment is an effective method for improving the surface endothelialization of the cardiovascular implants. However, a long-term and stable source of SMCs for implantation without immune rejection and inflammation has not been solved, and mesenchymal stem cells (MSCs) differentiation may be a good choice. In this work, two types of TiO2 micro/nano interfaces were fabricated on titanium surface by photolithography and anodic oxidation. These TiO2 micro/nano interfaces were used to regulate the differentiation of the MSCs. The X-ray diffraction (XRD) detection showed that the TiO2 micro/nano interfaces possessed the anatase crystal structure, suggesting good cytocompatibility. The CCK-8 results indicated the TiO2 micro/nano interfaces improved MSC proliferation, further immunofluorescence staining and calculation of the cell morphology index proved the micro/nano surfaces also elongated MSCs and regulated MSCs oriented growth. The specific staining of α-SMA, CNN-1, vWF, CD44 and CD133 markers revealed that the micro/nano surfaces induced MSCs differentiation to contractile SMCs, and the endothelial cells (ECs) culture experiment indicated that the MSCs induced by micro/nano interfaces contributed to the ECs attachment and proliferation. This method will be further studied and applied for the surface modification of the cardiovascular implants.

Investigation of enhanced hemocompatibility and tissue compatibility associated with multi-functional coating based on hyaluronic acid and Type IV collagen

The biocompatibility of cardiovascular devices has always been considered crucial for their clinical efficacy. Therefore, a biofunctional coating composed of Type IV collagen (CoIV) and hyaluronan (HA) was previously fabricated onto the titanium (Ti) substrate for the application of promoting vascular smooth muscle cell contractile phenotype and improving surface endothelialization. However, the anti-inflammation property, blood compatibility and in vivo tissue compatibility of the HA/CoIV coating, as paramount consideration of cardiovascular materials surface coating, have not been investigated. Thus, in this study, the three crucial properties of the HA/CoIV coating were tested. The platelet adhesion/activation test and the dynamic whole blood experiment implied that the HA/CoIV coating had better blood compatibility compared with Ti substrate and pure CoIV coating. The macrophage adhesion/activation and inflammatory cytokine release (tumor necrosis factor-alpha and interleukin-1) results indicated that the HA/CoIV coating could significantly improve the anti-inflammation property of the Ti substrate. The in vivo implantation of SD rats for 3 weeks' results demonstrated that the HA/CoIV coating caused milder tissue response. All these results suggested that the multi-functional HA/CoIV coating possessed good biocompatibility. This research is anticipated to be potentially applied for the surface modification of cardiovascular stents.

Enhanced in Vitro and in Vivo Performance of Mg-Zn-Y-Nd Alloy Achieved with APTES Pretreatment for Drug-Eluting Vascular Stent Application

Bioabsorbable magnesium alloys are becoming prominent as temporary functional implants, as they avoid the risks generated by permanent metallic implants such as persistent inflammation and late restenosis. Nevertheless, the overfast corrosion of Mg alloys under physiological conditions hinders their wider application as medical implant materials. Here we investigate a simple one-step process to introduce a cross-linked 3-amino-propyltrimethoxysilane (APTES) silane physical barrier layer on the surface of Mg-Zn-Y-Nd alloys prior to electrostatic spraying with rapamycin-eluting poly(lactic-co-glycolic acid) (PLGA) layer. Surface microstructure was characterized by scanning electron microscope and Fourier transform infrared spectroscopy. Nanoscratch test verified the superior adhesion strength of PLGA coating in the group pretreated with APTES. Electrochemical tests combined with long-term immersion results suggested that the preferable in vitro anticorrosion behavior could be achieved by dense APTES barrier. Cell morphology and proliferation data demonstrated that APTES pretreated group resulted in remarkably preferable compatibility for both human umbilical vein endothelial cells and vascular smooth muscle cells. On the basis of excellent in vitro mechenical property, the animal study on the APTES pretreated Mg-Zn-Y-Nd stent implanted into porcine coronary arteries confirmed benign tissue compatibility as well as re-endothelialization without thrombogenesis or in-stent restenosis at six-month followup.

Constructing bio-layer of heparin and type IV collagen on titanium surface for improving its endothelialization and blood compatibility

The modification of cardiovascular stent surface for a better micro-environment has gradually changed to multi-molecule, multi-functional designation. In this study, heparin (Hep) and type IV collagen (IVCol) were used as the functional molecule to construct a bifunctional micro-environment of anticoagulation and promoting endothelialization on titanium (Ti). The surface characterization results (AFM, Alcian Blue 8GX Staining and fluorescence staining of IVCol) indicated that the bio-layer of Hep and IVCol were successfully fabricated on the Ti surface through electrostatic self-assembly. The APTT and platelet adhesion test demonstrated that the bionic layer possessed better blood compatibility compared with Ti surface. The adhesion, proliferation, migration and apoptosis tests of endothelial cells proved that the Hep/IVCol layer was able to enhance the endothelialization of the Ti surface. The in vivo animal implantation results manifested that the bionic surface could encourage new endothelialization. This work provides an important reference for the construction of multifunction micro-environment on the cardiovascular scaffold surface.

Poly(l-Lactic Acid)/Gelatin Fibrous Scaffold Loaded with Simvastatin/Beta-Cyclodextrin-Modified Hydroxyapatite Inclusion Complex for Bone Tissue Regeneration

Recently, the application of nanostructured materials in the field of tissue engineering has garnered attention to mediate treatment and regeneration of bone defects. In this study, poly(l-lactic acid) (PLLA)/gelatin (PG) fibrous scaffolds are fabricated and β-cyclodextrin (βCD) grafted nano-hydroxyapatite (HAp) is coated onto the fibrous scaffold surface via an interaction between βCD and adamantane. Simvastatin (SIM), which is known to promote osteoblast viability and differentiation, is loaded into the remaining βCD. The specimen morphologies are characterized by scanning electron microscopy. The release profile of SIM from the drug loaded scaffold is also evaluated. In vitro proliferation and osteogenic differentiation of human adipose derived stem cells on SIM/HAp coated PG composite scaffolds is characterized by alkaline phosphatase (ALP) activity, mineralization (Alizarin Red S staining), and real time Polymerase chain reaction (PCR). The scaffolds are then implanted into rabbit calvarial defects and analyzed by microcomputed tomography for bone formation after four and eight weeks. These results demonstrate that SIM loaded PLLA/gelatin/HAp-(βCD) scaffolds promote significantly higher ALP activity, mineralization, osteogenic gene expression, and bone regeneration than control scaffolds. This suggests the potential application of this material toward bone tissue engineering.

Multifunctional Coating Based on Hyaluronic Acid and Dopamine Conjugate for Potential Application on Surface Modification of Cardiovascular Implanted Devices

Surface modification by conjugating biomolecules has been widely proved to enhance biocompatibility of cardiovascular implanted devices. Here, we aimed at developing a multifunctional surface that not only provides good hemocompatibility but also functions well in inducing desirable vascular cell-material interaction. In the present work, the multicoatings of hyaluronic acid (HA) and dopamine (PDA) were prepared onto 316L stainless steel (316L SS) via chemical conjugation (Michael addition, Schiff base reaction, and electrostatic adsorption). The results of platelet adhesion and activation and the whole blood tests indicated that the HA/PDA coatings obtained better hemocompatibility compared with the bare 316L SS and HA or PDA immobilized on 316L SS. The HA/PDA coatings also inhibited the proliferation of smooth muscle cells and adhesion/activation of macrophages effectively, whereas not all the HA/PDA coatings improved surface endothelialization rapidly and the effects of the multifunctional coatings on endothelial cell growth depend on the HA amounts (1.0, 2.0, and 5.0 mg/mL, labeled as PDA-HA-1, PDA-HA-2, and PDA-HA-5 respectively). Herein the PDA-HA-1 and PDA-HA-2 coatings were found to improve endothelial cell adhesion and proliferation significantly. The tissue compatibility of the HA/PDA coatings also depends on the HA amounts, and the PDA-HA-2 coating was proved to cause milder in vivo tissue response. Additionally, the mechanism of the HA molecular weight change and in vivo tissue response was also explored. These results effectively suggested that the HA/PDA coating might be promising when serving as a cardiovascular implanted device coating.

Immobilization of Ophiopogonin D on stainless steel surfaces for improving surface endothelialization

Ophiopogonin D, a traditional Chinese medicine, was immobilized onto the surface of cardiovascular 316L SS material to improve surface endothelialization.

Application Of Phenol/Amine Copolymerized Film Modified Magnesium Alloys: Anticorrosion And Surface Biofunctionalization

Magnesium metal as degradable metallic material is one of the most researched areas, but its rapid degradation rate restricts its development. The current anticorrosion surface modification methods require expensive equipment and complicated operation processes and cannot continue to introduce biofunction on modified surface. In this study, the GAHD conversion coatings were fabricated on the surface of magnesium alloys (MZM) by incubating in the mixture solution of gallic acid (GA) and hexamethylenediamine (HD) to decrease the corrosion rate and provide primary amines (-NH2), carboxyl (-COOH), and quinone groups, which is supposed to introduce biomolecules on MZM. Chemical structures of the MZM-GAHD and MZM-HEP-GAHD were explored by analyzing the results of FTIR and XPS comprehensively. Furthermore, it was proved that the heparin (HEP) molecules were successfully immobilized on MZM-GAHD surface through carbodiimide method. The evaluation of platelet adhesion and clotting time test showed that MZM-HEP-GAHD had higher anticoagulation than MZM-GAHD. Through electrochemical detection (polarization curves and electrochemical impedance spectroscopy Nyquist spectrum) and immersion test (Mg(2+) concentration and weight loss), it was proved that compared to MZM, both the MZM-GAHD and MZM-HEP-GAHD significantly improved the corrosion resistance. Finally, in vivo experimentation indicated that mass loss had no significant difference between MZM-1:1, MZM-HEP-1:1, and MZM. However, the trend still suggested that MZM-1:1 and MZM-HEP-1:1 possessed corrosion resistance property.

Angiogenic tube formation of bovine aortic endothelial cells grown on patterns formed by H2/He plasma treatment of the plasma polymerized hexamethyldisiloxane film

Angiogenesis, the process to generate new vessels, is necessary for normal development in children as well as the wound healing and the tumor growth in adults. Therefore, it is physiologically and/or pathophysiologically significant to monitor angiogenesis. However, classical in vitro methods to evaluate angiogenesis take a long time and are expensive. Here, the authors developed a novel method to analyze the angiogenesis in a simple and economical way, using patterned films. In this study, the authors fabricated a plasma polymerized hexamethyldisiloxane (PPHMDSO) thin film deposited by capacitively coupled plasma chemical vapor deposition system with various plasma powers. The patterned PPHMDSO film was plasma treated by 10:90 H2/He mixture gas through a metal shadow mask. The films were characterized by water contact angle, atomic force microscopy, x-ray photoelectron spectroscopy, and Fourier-transform infrared spectroscopy analyses. Our results show that the PPHMDSO film suppresses the cell adhesion, whereas surface modified PPHMDSO film enhances the cell adhesion and proliferation. From cell culture experiments, the authors found that the patterned film with 300 μm line interval was most efficient to evaluate the tube formation, a sapient angiogenic indicator. This patterned film will provide an effective and promising method for evaluating angiogenesis.

Controlled Slow-Release Drug-Eluting Stents for the Prevention of Coronary Restenosis: Recent Progress and Future Prospects

Drug-eluting stents (DES) have become more widely used by cardiologists than bare metal stents (BMS) because of their better ability to control restenosis. However, recognized negative events, particularly including delayed or incomplete endothelialization and late stent thrombosis, have caused concerns over the long-term safety of DES. Although stent-based drug delivery can facilitate a drug's release directly to the restenosis site, a burst of drug release can seriously affect the pharmacological action and is a major factor accounting for adverse effects. Therefore, the drug release rate has become an important criterion in evaluating DES. The factors affecting the drug release rate include the drug carrier, drug, coating methods, drug storage, elution direction, coating thickness, pore size in the coating, release conditions (release medium, pH value, temperature), and hemodynamics after the stent implantation. A better understanding of how these factors influence drug release is particularly important for the reasonable use of efficient control strategies for drug release. This review summarizes the factors influencing the drug release from DES and presents strategies for enhancing the control of the drug's release, including the stent design, the application of absorbable stents, the development of new polymers, and the application of nanocarriers and improvements in the coating technology. Therefore, this paper provides a reference for the preparation of novel controlled slow-release DES.