Surface modification of a biodegradable magnesium alloy with phosphorylcholine (PC) and sulfobetaine (SB) functional macromolecules for reduced thrombogenicity and acute corrosion resistance

Control of Blood Coagulation by Hemocompatible Material Surfaces-A Review

Hemocompatibility of biomaterials in contact with the blood of patients is a prerequisite for the short- and long-term applications of medical devices such as cardiovascular stents, artificial heart valves, ventricular assist devices, catheters, blood linings and extracorporeal devices such as artificial kidneys (hemodialysis), extracorporeal membrane oxygenation (ECMO) and cardiopulmonary bypass. Although lower blood compatibility of materials and devices can be handled with systemic anticoagulation, its side effects, such as an increased bleeding risk, make materials that have a better hemocompatibility highly desirable, particularly in long-term applications. This review provides a short overview on the basic mechanisms of blood coagulation including plasmatic coagulation and blood platelets, as well as the activation of the complement system. Furthermore, a survey on concepts for tailoring the blood response of biomaterials to improve the hemocompatibility of medical devices is given which covers different approaches that either inhibit interaction of material surfaces with blood components completely or control the response of the coagulation system, blood platelets and leukocytes.

In vitro and in vivo degradation assessment and preventive measures of biodegradable Mg alloys for biomedical applications

Magnesium (Mg) and its alloys have been widely explored as a potential biodegradable implant material. However, the fast degradation of Mg-based alloys under physiological environment has hindered their widespread use for implant applications till date. The present review focuses on in vitro and in vivo degradation of biodegradable Mg alloys, and preventive measures for biomedical applications. Initially, the corrosion assessment approaches to predict the degradation behavior of Mg alloys are discussed along with the measures to control rapid corrosion. Furthermore, this review attempts to explore the correlation between in vitro and in vivo corrosion behavior of different Mg alloys. It was found that the corrosion depends on experimental conditions, materials and the results of different assessment procedures hardly matches with each other. It has been demonstrated the corrosion rate of magnesium can be tailored by alloying elements, surface treatments and heat treatments. Various researches also studied different biocompatible coatings such as dicalcium phosphate dihydrate (DCPD), β-tricalcium phosphate (β-TCP), hydroxyapatite (HA), polycaprolactone (PCL), polylactic acid (PLA), and so on, on Mg alloys to suppress rapid degradation and examine their influence on new bone regeneration as well. This review shows the need for a standard method of corrosion assessment to predict the in vivo corrosion rate based on in vitro data, and thus reducing the in vivo experimentation.

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.

Degradation and interaction with bone of magnesium alloy WE43 implants: A long-term follow-up in vivo rat tibia study

The aim of this in vivo study was to examine the degradation and biocompatibility of the WE43 magnesium alloy containing magnesium yttrium, rare earth elements, and zirconium over a one-year long-term follow-up period. Additionally, we compared anodized WE43 implants with monolithic ones and clarified the effect of the anodization. WE43 cylindrical implants with and without anodization (length, 10 mm; diameter, 0.3 mm) were transplanted into the rat tibia. In both groups, the development of corrosion and the change in implant volume were evaluated by in vivo micro-computed tomography until 12 months, and the bone tissue reaction was observed histologically. In the monolithic WE43 implants, hydrogen gas was evident until 14 days and the volume loss was 36.3% after 12 months. In the anodized WE43 implants, the development of hydrogen gas was inhibited and the volume loss was 27.7% after 12 months. The anodized WE43 implants showed a significantly slower corrosion process in the early phase. Therefore, these implants may require a prolonged period to degrade completely and may even resist complete degradation. At one year post surgery, bone maturation progressed and lamellar bone structure developed around the implant in both groups. In conclusion, the WE43 implants showed good long-term stability and biocompatibility in bone tissue.

Biodegradable Zwitterionic Polymer Coatings for Magnesium Alloy Stents

Degradable metallic stents, most commonly composed of Mg-based alloys, are of interest as an alternative to traditional metallic stents for application in cardiac and peripheral vasculature. Two major design challenges with such stents are control of the corrosion rate and acute presentation of a nonthrombogenic surface to passing blood. In this study, several types of sulfobetaine (SB)-bearing biodegradable polyurethanes were developed and assessed as physical, chemical, and combination-type coatings for a model degradable Mg alloy, AZ31. For physical coatings, poly(ester sulfobetaine)urethane ureas, PESBUUs were synthesized using variable monomers that allowed the incorporation of a varying extent of carboxyl groups. Introduction of the carboxyl groups was associated with faster polymer degradation time. Simple physical coating of PESBUUs reduced macro- and microscopic thrombogenic deposition together with good stability of the coating attachment compared to a control coating of polylactic- co-glycolic acid. For PESBUUs incorporating carboxyl groups (PESBUUs-COOH), these groups could be converted to siloxane groups (PESBUUs-Si), thus creating polymers that could be surface reacted with the oxidized or phytic acid treated AZ31 surface. Chemical (silanization) attachment of these polymers reduced underlying alloy corrosion rates, but following the salination reaction with physical coating most reduced corrosion rates and protected the surface better from the consequences of oxidation occurring under the coating, such as blistering. The application of a multilayered coating approach using a sulfobetaine-based biodegradable elastomer thus offers options for degradable metallic stent design where thromboresistance is desired in combination with a means to control both polymeric coating degradation rates and underlying alloy corrosion rates.

Treatment of intracranial aneurysms using the pipeline flex embolization device with shield technology: angiographic and safety outcomes at 1-year follow-up

PURPOSE

The Pipeline Embolization Device (PED) is a routine first-line treatment option for intracranial aneurysms (IAs). The Pipeline Flex Embolization Device with Shield Technology (Pipeline Shield) is an updated version of the PED which has been modified to include a surface phosphorylcholine biocompatible polymer. Its early technical success and safety have been reported previously. Here, we assessed the long-term safety and efficacy of the Pipeline Shield for the treatment of IAs.

MATERIALS AND METHODS

The Pipeline Flex Embolization Device with Shield Technology (PFLEX) study was a prospective, single-arm, multicenter study for the treatment of unruptured IAs using the Pipeline Shield. The primary endpoint was a major stroke in the territory supplied by the treated artery or neurologic death at 1-year post-procedure. Angiographic outcomes were also assessed by an independent radiology laboratory at 6 months and 1 year.

RESULTS

Fifty patients (mean age, 53 years; 82% female) with 50 unruptured IAs were treated. Mean aneurysm diameter was 8.82±6.15 mm. Of the target aneurysms, 38/50 (76%) were small (<10 mm), 11/50 (22%) were large (≥10 and<25 mm), and 1/50 (2%) was giant (≥25 mm). Forty-seven (94%) were located in the internal carotid artery and three (6%) in the vertebral artery. At 1-year post-procedure, no major strokes or neurologic deaths were reported, and complete occlusion was achieved in 27/33 (81.8%). There were no instances of aneurysm recurrence or retreatment.

CONCLUSIONS

Our 1-year follow-up concerning angiographic and safety outcomes corroborate previous evidence that the Pipeline Shield is a safe and effective treatment for IAs.

TRIAL REGISTRATION NUMBER

NCT02390037.

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.

Self-Propulsion and Shape Restoration of Aqueous Drops on Sulfobetaine Silane Surfaces

The motion of droplets on typical surfaces is generally halted by contact line pinning associated with contact angle hysteresis. In this study, it was shown that, on a zwitterionic sulfobetaine silane (SBSi)-coated surface, aqueous drops with appropriate solutes can demonstrate hysteresis-free behavior, whereas a pure water drop shows spontaneous spreading. By adding solutes such as polyethylene glycol, 2(2-butoxy ethoxy) ethanol, or sodium n-dodecyl sulfate, an aqueous drop with a small contact angle (disappearance of spontaneous spreading) was formed on SBSi surfaces. The initial drop shape was readily relaxed back to a circular shape (hysteresis-free behavior), even upon severe disturbances. Moreover, it was interesting to observe the self-propulsion of such a drop on horizontal SBSi surfaces in the absence of externally provided stimuli. The self-propelled drop tends to follow a random trajectory, and the continuous movement can last for at least 10 min. This self-propelled random motion can be attributed to the combined effects of the hysteresis-free surface and the Marangoni stress. The former comes from the total wetting property of the surface, while the latter originates from surface tension gradient due to fluctuating evaporation rates along the drop border.

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.

Fluorescent genipin cross-linked REDV-conjugated polymeric microbubbles for human vascular endothelial cell (HVEC) targeting

Fluorescent polymeric microbubbles conjugated with REDV peptides were fabricated to achieve HVECs active targeting. The degradation, cytotoxicity and targeting features endowed them potential candidates in early molecular diagnosis for cardiovascular diseases.

Enhanced bioactivity of Mg-Nd-Zn-Zr alloy achieved with nanoscale MgF2 surface for vascular stent application

Magnesium (Mg) alloys have revolutionized the application of temporary load-bearing implants as they meet both engineering and medical requirements. However, rapid degradation of Mg alloys under physiological conditions remains the major obstacle hindering the wider use of Mg-based implants. Here we developed a simple method of preparing a nanoscale MgF2 film on Mg-Nd-Zn-Zr (denoted as JDBM) alloy, aiming to reduce the corrosion rate as well as improve the biological response. The corrosion rate of JDBM alloy exposed to artificial plasma is reduced by ∼20% from 0.337 ± 0.021 to 0.269 ± 0.043 mm·y(-1) due to the protective effect of the MgF2 film with a uniform and dense physical structure. The in vitro cytocompatibility test of MgF2-coated JDBM using human umbilical vein endothelial cells indicates enhanced viability, growth, and proliferation as compared to the naked substrate, and the MgF2 film with a nanoscale flakelike feature of ∼200-300 nm presents a much more favorable environment for endothelial cell adhesion, proliferation, and alignment. Furthermore, the animal experiment via implantation of MgF2-coated JDBM stent to rabbit abdominal aorta confirms excellent tissue compatibility of the well re-endothelialized stent with no sign of thrombogenesis and restenosis in the stented vessel.

Hollow fiber membrane modification with functional zwitterionic macromolecules for improved thromboresistance in artificial lungs

Respiratory assist devices seek optimized performance in terms of gas transfer efficiency and thromboresistance to minimize device size and reduce complications associated with inadequate blood biocompatibility. The exchange of gas with blood occurs at the surface of the hollow fiber membranes (HFMs) used in these devices. In this study, three zwitterionic macromolecules were attached to HFM surfaces to putatively improve thromboresistance: (1) carboxyl-functionalized zwitterionic phosphorylcholine (PC) and (2) sulfobetaine (SB) macromolecules (mPC or mSB-COOH) prepared by a simple thiol-ene radical polymerization and (3) a low-molecular weight sulfobetaine (SB)-co-methacrylic acid (MA) block copolymer (SBMAb-COOH) prepared by reversible addition-fragmentation chain transfer (RAFT) polymerization. Each macromolecule type was covalently immobilized on an aminated commercial HFM (Celg-A) by a condensation reaction, and HFM surface composition changes were analyzed by X-ray photoelectron spectroscopy. Thrombotic deposition on the HFMs was investigated after contact with ovine blood in vitro. The removal of CO2 by the HFMs was also evaluated using a model respiratory assistance device. The HFMs conjugated with zwitterionic macromolecules (Celg-mPC, Celg-mSB, and Celg-SBMAb) showed expected increases in phosphorus or sulfur surface content. Celg-mPC and Celg-SBMAb experienced rates of platelet deposition significantly lower than those of unmodified (Celg-A, >95% reduction) and heparin-coated (>88% reduction) control HFMs. Smaller reductions were seen with Celg-mSB. The CO2 removal rate for Celg-SBMAb HFMs remained comparable to that of Celg-A. In contrast, the rate of removal of CO2 for heparin-coated HFMs was significantly reduced. The results demonstrate a promising approach to modifying HFMs using zwitterionic macromolecules for artificial lung devices with improved thromboresistance without degradation of gas transfer.

Facile syntheses of alkoxysilanated phosphorylcholines as surface modifiers: CuAAC and thiol-ene “click” reactions

Alkoxysilanated PCs were synthesizedviaCuAAC and thiol-ene “click” reactions and used as surface modifiers on silica beads.

Controlled release and corrosion protection by self-assembled colloidal particles electrodeposited onto magnesium alloys

Self-assembled nanoparticles loaded with bioactive agents were electrodeposited to provide the magnesium alloy with controlled release and corrosion resistance properties.

The effect of treatment temperature on corrosion resistance and hydrophilicity of an ionic liquid coating for Mg-based stents

Mg alloys are attractive candidate materials for biodegradable stents. However, there are few commercially available Mg-based stents in clinical use because Mg alloys generally undergo rapid localized corrosion in the body. In this study, we report a new surface coating for Mg alloy AZ31 based on a low-toxicity ionic liquid (IL), tributyl(methyl)phosphonium diphenyl phosphate (P1,4,4,4 dpp), to control its corrosion rate. Emphasis is placed on the effect of treatment temperature. We showed that enhancing the treatment temperature provided remarkable improvements in the performances of both corrosion resistance and biocompatibility. Increasing treatment temperature resulted in a thicker (although still nanometer scale) and more homogeneous IL film on the surface. Scanning electron microscopy and optical profilometry observations showed that there were many large, deep pits formed on the surface of bare AZ31 after 2 h of immersion in simulated body fluid (SBF). The IL coating (particularly when formed at 100 °C for 1 h) significantly suppressed the formation of these pits on the surface, making corrosion occur more uniformly. The P1,4,4,4 dpp IL film formed at 100 °C was more hydrophilic than the bare AZ31 surface, which was believed to be beneficial for avoiding the deposition of the proteins and cells on the surface and therefore improving the biocompatibility of AZ31 in blood. The interaction mechanism between this IL and AZ31 was also investigated using ATR-FTIR, which showed that both anion and cation of this IL were present in the film, and there was a chemical interaction between dpp(-) anion and the surface of AZ31 during the film formation.

Blood compatible materials: state of the art

Devices that function in contact with blood are ubiquitous in clinical medicine and biotechnology. These devices include vascular grafts, coronary stents, heart valves, catheters, hemodialysers, heart-lung bypass systems and many others. Blood contact generally leads to thrombosis (among other adverse outcomes), and no material has yet been developed which remains thrombus-free indefinitely and in all situations: extracorporeally, in the venous circulation and in the arterial circulation. In this article knowledge on blood-material interactions and "thromboresistant" materials is reviewed. Current approaches to the development of thromboresistant materials are discussed including surface passivation; incorporation and/or release of anticoagulants, antiplatelet agents and thrombolytic agents; and mimicry of the vascular endothelium.

Synergistic effect on corrosion resistance of Phynox substrates grafted with surface-initiated ATRP (co)polymerization of 2-methacryloyloxyethyl phosphorylcholine (MPC) and 2-hydroxyethyl methacrylate (HEMA)

Phynox is of high interest for biomedical applications due to its biocompatibility and corrosion resistance. However, some Phynox applications require specific surface properties. These can be imparted with suitable surface functionalizations of its oxide layer. The present work investigates the surface-initiated atom transfer radical polymerization (ATRP) of 2-methacryloyoxyethyl phosphorylcholine (MPC), 2-hydroxyethyl methacrylate (HEMA), and ATRP copolymerization of (HEMA-co-MPC) (block and statistic copolymerization with different molar ratios) on grafted Phynox substrates modified with 11-(2-bromoisobutyrate)-undecyl-1-phosphonic acid (BUPA) as initiator. It is found that ATRP (co)polymerization of these monomers is feasible and forms hydrophilic layers, while improving the corrosion resistance of the system.

Optimization of cell adhesion on mg based implant materials by pre-incubation under cell culture conditions

Magnesium based implants could revolutionize applications where orthopedic implants such as nails, screws or bone plates are used because they are load bearing and degrade over time. This prevents a second surgery to remove conventional implants. To improve the biocompatibility we studied here if and for how long a pre-incubation of the material under cell culture conditions is favorable for cell attachment and proliferation. For two materials, Mg and Mg10Gd1Nd, we could show that 6 h pre-incubation are already enough to form a natural protective layer suitable for cell culture.

Thiol–ene “click” reactions and recent applications in polymer and materials synthesis: a first update

This contribution serves as an update to a previous review (Polym. Chem.2010,1, 17–36) and highlights recent applications of thiol–ene ‘click’ chemistry as an efficient tool for both polymer/materials synthesis as well as modification.