1
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Zheng G, Li R, Wu P, Zhang L, Qin Y, Wan S, Pei J, Yu P, Fu K, Meyerhoff ME, Liu Y, Zhou Y. Controllable release of nitric oxide from an injectable alginate hydrogel. Int J Biol Macromol 2023; 252:126371. [PMID: 37595726 DOI: 10.1016/j.ijbiomac.2023.126371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 07/18/2023] [Accepted: 08/15/2023] [Indexed: 08/20/2023]
Abstract
Currently, the controlled release of nitric oxide (NO) plays a crucial role in various biomedical applications. However, injectable NO-releasing materials remain an underexplored research field to date. In this study, via the incorporation of S-nitroso-N-acetyl-penicillamine (SNAP) as an NO donor, a family of NO-releasing injectable hydrogels was synthesized through the in situ cross-linking between sodium alginate and calcium ion induced by D-(+)-gluconate δ-lactone as an initiator. Initially, the organic functional groups and the corresponding morphologies of the resulting injectable hydrogels were characterized by IR and SEM spectroscopies, respectively. The NO release times of hydrogels with different SNAP loading amounts could reach up to 36-47 h. Due to the release of NO, the highest antibacterial rates of these injectable hydrogels against Escherichia coli (E. coli) and Staphylococcus aureus (S. aureus) were up to 95 %, respectively. Furthermore, the matrix of these hydrogels demonstrated great water absorption ability, swelling behavior, and degradation performance. Finally, we expect that these NO-releasing injectable hydrogels could have great potential applications various biomedical material fields.
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Affiliation(s)
- Guangbin Zheng
- Key Laboratory of Advanced Materials of Tropical Island Resources of Ministry of Education and School of Chemical Engineering and Technology, Hainan University, Haikou, Hainan 570228, China
| | - Rulin Li
- Department of Spinal Surgery, The Qionghai People's Hospital, Qionghai 571400, China
| | - Peixuan Wu
- Key Laboratory of Advanced Materials of Tropical Island Resources of Ministry of Education and School of Chemical Engineering and Technology, Hainan University, Haikou, Hainan 570228, China
| | - Lei Zhang
- College of Animal Science and Technology, Hainan University, Haikou 570228, China
| | - Yao Qin
- College of Animal Science and Technology, Hainan University, Haikou 570228, China
| | - Shungang Wan
- Key Laboratory of Advanced Materials of Tropical Island Resources of Ministry of Education and School of Chemical Engineering and Technology, Hainan University, Haikou, Hainan 570228, China
| | - Jie Pei
- Department of Joint Surgery, The First Affiliated Hospital of Hainan Medical University, Haikou 570102, China
| | - Peng Yu
- Department of Joint Surgery, The First Affiliated Hospital of Hainan Medical University, Haikou 570102, China
| | - Kun Fu
- Department of Joint Surgery, The First Affiliated Hospital of Hainan Medical University, Haikou 570102, China
| | - Mark E Meyerhoff
- Department of Chemistry, University of Michigan, Ann Arbor, MI 48109, USA
| | - Yuanyuan Liu
- Key Laboratory of Advanced Materials of Tropical Island Resources of Ministry of Education and School of Chemical Engineering and Technology, Hainan University, Haikou, Hainan 570228, China.
| | - Yang Zhou
- Key Laboratory of Advanced Materials of Tropical Island Resources of Ministry of Education and School of Chemical Engineering and Technology, Hainan University, Haikou, Hainan 570228, China.
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2
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Manivasagam VK, Popat KC. Improved Hemocompatibility on Superhemophobic Micro-Nano-Structured Titanium Surfaces. BIOENGINEERING (BASEL, SWITZERLAND) 2022; 10:bioengineering10010043. [PMID: 36671615 PMCID: PMC9855096 DOI: 10.3390/bioengineering10010043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 12/21/2022] [Accepted: 12/26/2022] [Indexed: 12/31/2022]
Abstract
Blood-contacting titanium-based implants such as endovascular stents and heart valve casings are prone to blood clotting due to improper interactions at the surface level. In complement, the current clinical demand for cardiovascular implants is at a new apex. Hence, there is a crucial necessity to fabricate an implant with optimal mechanical properties and improved blood compatibility, while simultaneously interacting differentially with cells and other microbial agents. The present study intends to develop a superhydrophobic implant surface with the novel micro-nano topography, developed using a facile thermochemical process. The surface topography, apparent contact angle, and crystal structure are characterized on different surfaces. The hemo/blood compatibility on different surfaces is assessed by evaluating hemolysis, fibrinogen adsorption, cell adhesion and identification, thrombin generation, complement activation, and whole blood clotting kinetics. The results indicate that the super-hemo/hydrophobic micro-nano titanium surface improved hemocompatibility by significantly reducing fibrinogen adsorption, platelet adhesion, and leukocyte adhesion. Thus, the developed surface has high potential to be used as an implant. Further studies are directed towards analyzing the mechanisms causing the improved hemocompatibility of micro/nano surface features under dynamic in vitro and in vivo conditions.
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Affiliation(s)
- Vignesh K. Manivasagam
- Department of Mechanical Engineering, Colorado State University, Fort Collins, CO 80523, USA
| | - Ketul C. Popat
- Department of Mechanical Engineering, Colorado State University, Fort Collins, CO 80523, USA
- School of Biomedical Engineering, Colorado State University, Fort Collins, CO 80523, USA
- School of Advanced Materials Discovery, Colorado State University, Fort Collins, CO 80523, USA
- Correspondence:
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3
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Seyrek A, Günal G, Aydin HM. Development of Antithrombogenic ECM-Based Nanocomposite Heart Valve Leaflets. ACS APPLIED BIO MATERIALS 2022; 5:3883-3895. [PMID: 35839464 PMCID: PMC9382671 DOI: 10.1021/acsabm.2c00423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
![]()
Thrombogenicity, which is commonly encountered in artificial
heart
valves after replacement surgeries, causes valvular failure. Even
life-long anticoagulant drug use may not be sufficient to prevent
thrombogenicity. In this study, it was aimed to develop a heart valve
construct with antithrombogenic properties and suitable mechanical
strength by combining multiwalled carbon nanotubes within a decellularized
bovine pericardium. In this context, the decellularization process
was performed by using the combination of freeze–thawing and
sodium dodecyl sulfate (SDS). Evaluation of decellularization efficiency
was determined by histology (Hematoxylin and Eosin, DAPI and Masson’s
Trichrome) and biochemical (DNA, sGAG and collagen) analyses. After
the decellularization process of the bovine pericardium, composite
pericardial tissues were prepared by incorporating −COOH-modified
multiwalled carbon nanotubes (MWCNTs). Characterization of MWCNT incorporation
was performed by ATR-FTIR, TGA, and mechanical analysis, while SEM
and AFM were used for morphological evaluations. Thrombogenicity assessments
were studied by platelet adhesion test, Calcein-AM staining, kinetic
blood clotting, hemolysis, and cytotoxicity analyses. As a result
of this study, the composite pericardial material revealed improved
mechanical and thermal stability and hemocompatibility in comparison
to decellularized pericardium, without toxicity. Approximately 100%
success is achieved in preventing platelet adhesion. In addition,
kinetic blood-coagulation analysis demonstrated a low rate and slow
coagulation kinetics, while the hemolysis index was below the permissible
limit for biomaterials.
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Affiliation(s)
- Ahsen Seyrek
- Nanotechnology and Nanomedicine Division, Institute of Science, Hacettepe University, Beytepe, 06800, Ankara, Turkey
| | - Gülçin Günal
- Bioengineering Division, Institute of Science, Hacettepe University, Beytepe, 06800, Ankara, Turkey
| | - Halil Murat Aydin
- Bioengineering Division, Institute of Science, Hacettepe University, Beytepe, 06800, Ankara, Turkey.,Centre for Bioengineering, Hacettepe University, Beytepe, 06800, Ankara, Turkey
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4
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Griffin L, Douglass M, Goudie M, Hopkins SP, Schmiedt C, Handa H. Improved Polymer Hemocompatibility for Blood-Contacting Applications via S-Nitrosoglutathione Impregnation. ACS APPLIED MATERIALS & INTERFACES 2022; 14:11116-11123. [PMID: 35225600 PMCID: PMC9793915 DOI: 10.1021/acsami.1c24557] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
Blood-contacting medical devices (BCMDs) are inevitably challenged by thrombi formation, leading to occlusion of flow and device failure. Ideal BCMDs seek to mimic the intrinsic antithrombotic properties of the human vasculature to locally prevent thrombotic complications, negating the need for systemic anticoagulation. An emerging category of BCMD technology utilizes nitric oxide (NO) as a hemocompatible agent, as the vasculature's endothelial layer naturally releases NO to inhibit platelet activation and consumption. In this paper, we report for the first time the novel impregnation of S-nitrosoglutathione (GSNO) into polymeric poly(vinyl chloride) (PVC) tubing via an optimized solvent-swelling method. Material testing revealed an optimized GSNO-PVC material that had adequate GSNO loading to achieve NO flux values within the physiological endothelial NO flux range for a 4 h period. Through in vitro hemocompatibility testing, the optimized material was deemed nonhemolytic (hemolytic index <2%) and capable of reducing platelet activation, suggesting that the material is suitable for contact with whole blood. Furthermore, an in vivo 4 h extracorporeal circulation (ECC) rabbit thrombogenicity model confirmed the blood biocompatibility of the optimized GSNO-PVC. Platelet count remained near 100% for the novel GSNO-impregnated PVC loops (1 h, 91.08 ± 6.27%; 2 h, 95.68 ± 0.61%; 3 h, 97.56 ± 8.59%; 4 h, 95.11 ± 8.30%). In contrast, unmodified PVC ECC loops occluded shortly after the 2 h time point and viable platelet counts quickly diminished (1 h, 85.67 ± 12.62%; 2 h, 54.46 ± 10.53%; 3 h, n/a; 4 h, n/a). The blood clots for GSNO-PVC loops (190.73 ± 72.46 mg) compared to those of unmodified PVC loops (866.50 ± 197.98 mg) were significantly smaller (p < 0.01). The results presented in this paper recommend further investigation in long-term animal models and suggest that GSNO-PVC has the potential to serve as an alternative to systemic anticoagulation in BCMD applications.
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Affiliation(s)
- Lauren Griffin
- School of Chemical, Materials and Biomedical Engineering, College of Engineering, University of Georgia, 220 Riverbend Road, Athens, Georgia 30602, United States
| | - Megan Douglass
- School of Chemical, Materials and Biomedical Engineering, College of Engineering, University of Georgia, 220 Riverbend Road, Athens, Georgia 30602, United States
| | - Marcus Goudie
- School of Chemical, Materials and Biomedical Engineering, College of Engineering, University of Georgia, 220 Riverbend Road, Athens, Georgia 30602, United States
| | - Sean P Hopkins
- School of Chemical, Materials and Biomedical Engineering, College of Engineering, University of Georgia, 220 Riverbend Road, Athens, Georgia 30602, United States
| | - Chad Schmiedt
- Department of Small Animal Medicine and Surgery, College of Veterinary Medicine, University of Georgia, 220 Riverbend Road, Athens, Georgia 30602, United States
| | - Hitesh Handa
- School of Chemical, Materials and Biomedical Engineering, College of Engineering, University of Georgia, 220 Riverbend Road, Athens, Georgia 30602, United States
- Department of Pharmaceutical and Biomedical Sciences, College of Pharmacy, University of Georgia, 220 Riverbend Road, Athens, Georgia 30602, United States
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5
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Madike LN, Pillay M, Popat KC. Antithrombogenic properties of Tulbaghia violacea aqueous leaf extracts: assessment of platelet activation and whole blood clotting kinetics. RSC Adv 2021; 11:30455-30464. [PMID: 35480283 PMCID: PMC9041137 DOI: 10.1039/d1ra00926e] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Accepted: 08/28/2021] [Indexed: 12/17/2022] Open
Abstract
Tulbaghia violacea plant extracts have been investigated for their potential therapeutic effects in the management of various ailments, among which are cardiovascular diseases, due to the wide range of phytocompounds that the plant possesses. One of the major challenges in clinical practice is the inability to control platelet activation and clotting caused by cardiovascular disease interventions. Current treatment methods to inhibit platelet aggregation and thromboxane formation have been associated with major undesirable side effects. This has led to increased research studies on the development of newer and more effective antiplatelet agents. In particular, there has been a growing interest on the potential antiplatelet activity of plant-derived extracts. Hence this study methodically evaluates the anticlotting and antiplatelet properties of T. violacea aqueous leaf extracts. The platelet activity of the plant extracts was assessed using total platelet adhesion, platelet morphology and whole blood clotting kinetics. The 0.1 mg ml−1T. violacea extract mixed with blood plasma demonstrated the lowest platelet adhesion and activation and also reduced whole blood clotting kinetics. There was a reduction of about 70% in platelet adhesion for the 0.1 mg ml−1 treatment compared to the control in the first 15 min which was supported by morphological characterization under SEM. These observations suggest that T. violacea may be a potential antiplatelet therapeutic agent to inhibit the initial step of platelet adhesion and ultimately reduce the incidence of cardiovascular events. Tulbaghia violacea plant extracts have been investigated for their potential therapeutic effects in the management of various ailments, among which are cardiovascular diseases, due to the wide range of phytocompounds that the plant possesses.![]()
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Affiliation(s)
- Lerato N Madike
- Department of Biotechnology, Faculty of Applied and Computer Sciences, Vaal University of Technology Andries Potgieter Blvd Vanderbijlpark 1911 South Africa
| | - M Pillay
- Department of Biotechnology, Faculty of Applied and Computer Sciences, Vaal University of Technology Andries Potgieter Blvd Vanderbijlpark 1911 South Africa
| | - Ketul C Popat
- Department of Mechanical Engineering, School of Biomedical Engineering, Colorado State University Fort Collins Colorado 80523 USA
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6
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Manivasagam V, Popat KC. In Vitro Investigation of Hemocompatibility of Hydrothermally Treated Titanium and Titanium Alloy Surfaces. ACS OMEGA 2020; 5:8108-8120. [PMID: 32309720 PMCID: PMC7161035 DOI: 10.1021/acsomega.0c00281] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Accepted: 03/25/2020] [Indexed: 06/01/2023]
Abstract
For decades, titanium and its alloys have been established as a biocompatible material for cardiovascular medical devices such as heart valves, stents, vascular grafts, catheters, etc. However, thrombosis is one of the reasons for implant failure, where blood clot forms on the implant surface, thus obstructing the flow of the blood and that leads to some serious complications. Various surface modification techniques such as heparin modification, albumin coating, surface anodization, plasma etching, and hydrothermal treatments have been explored to improve the hemocompatibility of titanium-based materials. However, there are several limitations related to the robustness of the surfaces and long-term efficacy in vivo. In this study, titanium and its alloy Ti-6Al-4V were hydrothermally treated to form nanostructured surfaces with the aim to enhance their hemocompatibility. These modified surfaces were characterized for their wettability, surface morphology, surface chemistry, and crystallinity. The hemocompatibility of these surfaces was characterized by evaluating blood plasma protein adsorption, platelet adhesion and activation, platelet-leukocyte complex formation, and whole blood clotting. The results indicate lower fibrinogen adsorption, cell adhesion, platelet activation, and whole blood clotting on hydrothermally treated surfaces. Thus, these surfaces may be a promising approach to prevent thrombosis for several titanium blood-contacting medical devices.
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Affiliation(s)
- Vignesh
K. Manivasagam
- Department
of Mechanical Engineering, Colorado State
University, Fort Collins, Colorado 80523, United States
| | - Ketul C. Popat
- Department
of Mechanical Engineering, Colorado State
University, Fort Collins, Colorado 80523, United States
- School
of Biomedical Engineering, Colorado State
University, Fort Collins, Colorado 80523, United States
- School
of Advanced Materials Discovery, Colorado
State University, Fort Collins, Colorado 80523, United States
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7
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Madike LN, Pillay M, Popat KC. Antithrombogenic properties of Tulbaghia violacea–loaded polycaprolactone nanofibers. J BIOACT COMPAT POL 2020. [DOI: 10.1177/0883911520903748] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
A broad range of polymers have been utilized for the development of blood-contacting implantable medical devices; however, their rate of failure has raised the need for developing more hemocompatible biomaterial surfaces. In this study, a novel scaffold based on polycaprolactone incorporated with 10% and 15% (w/w) Tulbaghia violacea plant extracts were fabricated using electrospinning technique. The fabricated scaffolds were then treated with T. violacea aqueous plant extracts (100 and 1000 µg/mL) to investigate their use as interfaces for blood-contacting implants. The 10% Tvio scaffold produced the lowest mean fibre diameter (193 ± 30 nm), whereas the 15% Tvio scaffold produces the highest mean fibre diameter (538 ± 236 nm) when compared with the control polycaprolactone (275 ± 61 nm) scaffold. The number of adhered platelets was directly linked to fibre diameter and concentration of plant extract in such a way that the lowest fibre diameter scaffold (10% Tvio) inhibited platelet adhesion, whereas more platelets adhered to the scaffold with the highest fibre diameter (15% Tvio scaffolds). There was also an increase in platelet adhesion as the concentration of T. violacea was increased from 100 to 1000 µg/mL for all designed scaffolds. The improved blood compatibility demonstrated by the 10% Tvio scaffold suggests that the plant possesses antithrombogenic properties, particularly at lower concentrations.
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Affiliation(s)
- Lerato N Madike
- Department of Biotechnology, Faculty of Applied and Computer Sciences, Vaal University of Technology, Vanderbijlpark, South Africa
| | - Michael Pillay
- Department of Biotechnology, Faculty of Applied and Computer Sciences, Vaal University of Technology, Vanderbijlpark, South Africa
| | - Ketul C Popat
- Department of Mechanical Engineering, School of Biomedical Engineering, Colorado State University, Fort Collins, CO, USA
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8
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Sabino RM, Popat KC. Evaluating Whole Blood Clotting in vitro on Biomaterial Surfaces. Bio Protoc 2020; 10:e3505. [PMID: 33654732 DOI: 10.21769/bioprotoc.3505] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2019] [Revised: 12/16/2019] [Accepted: 12/26/2019] [Indexed: 11/02/2022] Open
Abstract
Biomaterial-associated thrombosis is still a major concern for blood-contacting implants. After the medical device is implanted and comes in contact with blood, several complex reactions occur, which may lead to thrombus formation and failure of the device. Therefore, it is essential to evaluate the biomaterial interaction with the whole blood. Several studies have been reported in the literature that evaluate different steps in the coagulation cascade, such as protein adsorption, plasma activation, and platelet adhesion in vitro, however, evaluation of whole blood clotting on biomaterial surfaces is not widely reported. Here, a protocol to evaluate whole blood clotting in vitro on 2D biomaterials surfaces via a simple and fast hemolysis assay is presented. Whole human blood is placed onto the biomaterial surfaces and is allowed to clot for different time periods. After the specific time intervals, the surfaces are transferred into deionized (DI) water to release the free hemoglobin and the absorbance of this solution is measured. The absorbance value is proportional to the free hemoglobin concentration in the DI water due to lysis of red blood cells and gives an indirect correlation to the extent of blood clotting on the biomaterial surfaces. This protocol provides a fast, facile and effective method to measure the anti-thrombogenic properties of biomaterials.
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Affiliation(s)
- Roberta M Sabino
- School of Advanced Materials Discovery, Colorado State University, Fort Collins, USA
| | - Ketul C Popat
- School of Advanced Materials Discovery, Colorado State University, Fort Collins, USA.,School of Biomedical Engineering, Colorado State University, Fort Collins, USA.,Department of Mechanical Engineering, Colorado State University, Fort Collins, USA
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9
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Sabino RM, Kauk K, Movafaghi S, Kota A, Popat KC. Interaction of blood plasma proteins with superhemophobic titania nanotube surfaces. NANOMEDICINE : NANOTECHNOLOGY, BIOLOGY, AND MEDICINE 2019; 21:102046. [PMID: 31279063 PMCID: PMC6814547 DOI: 10.1016/j.nano.2019.102046] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Revised: 06/12/2019] [Accepted: 06/12/2019] [Indexed: 10/26/2022]
Abstract
The need to improve blood biocompatibility of medical devices is urgent. As soon as blood encounters a biomaterial implant, proteins adsorb on its surfaces, often leading to several complications such as thrombosis and failure of the device. Therefore, controlling protein adsorption plays a major role in developing hemocompatible materials. In this study, the interaction of key blood plasma proteins with superhemophobic titania nanotube substrates and the blood clotting responses was investigated. The substrate stability was evaluated and fibrinogen adsorption and thrombin formation from plasma were assessed using ELISA. Whole blood clotting kinetics was also investigated, and Factor XII activation on the substrates was characterized by an in vitro plasma coagulation time assay. The results show that superhemophobic titania nanotubes are stable and considerably decrease surface protein adsorption/Factor XII activation as well as delay the whole blood clotting, and thus can be a promising approach for designing blood contacting medical devices.
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Affiliation(s)
- Roberta Maia Sabino
- School of Advanced Materials Discovery, Colorado State University, Fort Collins, CO, USA
| | - Kirsten Kauk
- School of Biomedical Engineering, Colorado State University, Fort Collins, CO, USA
| | - Sanli Movafaghi
- Department of Mechanical Engineering, Colorado State University, Fort Collins, CO, USA
| | - Arun Kota
- School of Advanced Materials Discovery, Colorado State University, Fort Collins, CO, USA; School of Biomedical Engineering, Colorado State University, Fort Collins, CO, USA; Department of Mechanical Engineering, Colorado State University, Fort Collins, CO, USA
| | - Ketul C Popat
- School of Advanced Materials Discovery, Colorado State University, Fort Collins, CO, USA; School of Biomedical Engineering, Colorado State University, Fort Collins, CO, USA; Department of Mechanical Engineering, Colorado State University, Fort Collins, CO, USA.
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10
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Bui HT, Friederich ARW, Li E, Prawel DA, James SP. Hyaluronan enhancement of expanded polytetrafluoroethylene cardiovascular grafts. J Biomater Appl 2018; 33:52-63. [DOI: 10.1177/0885328218776807] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Heart disease continues to be the leading cause of death in the United States. The demand for cardiovascular bypass procedures increases annually. Expanded polytetrafluoroethylene is a popular material for replacement implants, but it does have drawbacks such as high thrombogenicity and low patency, particularly in small diameter grafts. Hyaluronan, a naturally occurring polysaccharide in the human body, is known for its wound healing and anticoagulant properties. In this work, we demonstrate that treating the luminal surface of expanded polytetrafluoroethylene grafts with hyaluronan improves hemocompatibility without notably changing its mechanical properties and without significant cytotoxic effects. Surface characterization such as ATR-FTIR and contact angle goniometry demonstrates that hyaluronan treatment successfully changes the surface chemistry and increases hydrophilicity. Tensile properties such as elastic modulus, tensile strength, yield stress and ultimate strain are unchanged by hyaluronan enhancement. Durability data from flow loop studies demonstrate that hyaluronan is durable on the expanded polytetrafluoroethylene inner lumen. Hemocompatibility tests reveal that hyaluronan-treated expanded polytetrafluoroethylene reduces blood clotting and platelet activation. Together our results indicate that hyaluronan-enhanced expanded polytetrafluoroethylene is a promising candidate material for cardiovascular grafts.
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Affiliation(s)
- Hieu T Bui
- School of Biomedical Engineering, Colorado State University, Fort Collins, CO, USA
| | - Aidan RW Friederich
- School of Biomedical Engineering, Colorado State University, Fort Collins, CO, USA
- Department of Mechanical Engineering, Colorado State University, Fort Collins, CO, USA
| | - Emily Li
- Department of Biomedical Sciences, Colorado State University, Fort Collins, CO, USA
| | - David A Prawel
- School of Biomedical Engineering, Colorado State University, Fort Collins, CO, USA
- Department of Mechanical Engineering, Colorado State University, Fort Collins, CO, USA
| | - Susan P James
- School of Biomedical Engineering, Colorado State University, Fort Collins, CO, USA
- Department of Mechanical Engineering, Colorado State University, Fort Collins, CO, USA
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11
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Annich GM, Zaulan O, Neufeld M, Wagner D, Reynolds MM. Thromboprophylaxis in Extracorporeal Circuits: Current Pharmacological Strategies and Future Directions. Am J Cardiovasc Drugs 2017; 17:425-439. [PMID: 28536932 DOI: 10.1007/s40256-017-0229-0] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
The development of extracorporeal devices for organ support has been a part of medical history and progression since the late 1900s. These types of technology are primarily used and developed in the field of critical care medicine. Unfractionated heparin, discovered in 1916, has really been the only consistent form of thromboprophylaxis for attenuating or even preventing the blood-biomaterial reaction that occurs when such technologies are initiated. The advent of regional anticoagulation for procedures such as continuous renal replacement therapy and plasmapheresis have certainly removed the risks of systemic heparinization and heparin effect, but the challenges of the blood-biomaterial reaction and downstream effects remain. In addition, regional anticoagulation cannot realistically be applied in a system such as extracorporeal membrane oxygenation because of the high blood flow rates needed to support the patient. More recently, advances in the technology itself have resulted in smaller, more compact extracorporeal life support (ECLS) systems that can-at certain times and in certain patients-run without any form of anticoagulation. However, the majority of patients on ECLS systems require some type of systemic anticoagulation; therefore, the risks of bleeding and thrombosis persist, the most devastating of which is intracranial hemorrhage. We provide a concise overview of the primary and alternate agents and monitoring used for thromboprophylaxis during use of ECLS. In addition, we explore the potential for further biomaterial and technologic developments and what they could provide when applied in the clinical arena.
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Affiliation(s)
- Gail M Annich
- Department of Critical Care Medicine, The Hospital for Sick Children, University of Toronto, 555 University Avenue, M5G 1X8, Toronto, ON, Canada.
| | - Oshri Zaulan
- Department of Critical Care Medicine, The Hospital for Sick Children, University of Toronto, 555 University Avenue, M5G 1X8, Toronto, ON, Canada
| | - Megan Neufeld
- Department of Chemistry, Colorado State University, Fort Collins, Colorado, USA
| | - Deborah Wagner
- Departments of Pharmacology and Anesthesia, University of Michigan, Ann Arbor, Michigan, USA
| | - Melissa M Reynolds
- Department of Chemistry, School of Biomedical Engineering, Chemical and Biological Engineering, Colorado State University, Fort Collins, Colorado, USA
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12
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Movafaghi S, Leszczak V, Wang W, Sorkin JA, Dasi LP, Popat KC, Kota AK. Response to "Correspondence Concerning Hemocompatibility of Superhemophobic Titania Surfaces". Adv Healthc Mater 2017; 6. [PMID: 28703490 DOI: 10.1002/adhm.201700647] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Indexed: 12/26/2022]
Affiliation(s)
- S. Movafaghi
- Department of Mechanical Engineering; Colorado State University; Fort Collins CO 80523 USA
| | - V. Leszczak
- Department of Mechanical Engineering; Colorado State University; Fort Collins CO 80523 USA
| | - W. Wang
- Department of Mechanical Engineering; Colorado State University; Fort Collins CO 80523 USA
| | - J. A. Sorkin
- Department of Mechanical Engineering; Colorado State University; Fort Collins CO 80523 USA
| | - L. P. Dasi
- Department of Mechanical Engineering; Colorado State University; Fort Collins CO 80523 USA
- School of Biomedical Engineering; Colorado State University; Fort Collins CO 80523 USA
- Department of Biomedical Engineering; Dorothy Davis Heart and Lung Research Institute; Ohio State University; Columbus OH 43210 USA
| | - K. C. Popat
- Department of Mechanical Engineering; Colorado State University; Fort Collins CO 80523 USA
- School of Biomedical Engineering; Colorado State University; Fort Collins CO 80523 USA
| | - A. K. Kota
- Department of Mechanical Engineering; Colorado State University; Fort Collins CO 80523 USA
- School of Biomedical Engineering; Colorado State University; Fort Collins CO 80523 USA
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13
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Sukavaneshvar S. Device thrombosis and pre-clinical blood flow models for assessing antithrombogenic efficacy of drug-device combinations. Adv Drug Deliv Rev 2017; 112:24-34. [PMID: 27496706 DOI: 10.1016/j.addr.2016.07.009] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2016] [Revised: 05/31/2016] [Accepted: 07/26/2016] [Indexed: 12/20/2022]
Abstract
Thrombosis associated with blood-contacting devices is a complex process involving several component interactions that have eluded precise definition. Extensive investigations of individual biological modules such as protein adsorption, coagulation cascade activation and platelet activation/adhesion/aggregation have provided an initial foundation for developing biomaterials for blood-contacting devices, but a material that is intrinsically non-thrombogenic is yet to be developed. The well-recognized association between fluid dynamics parameters such as shear stress, vortices, stagnation and thrombotic processes such as platelet aggregation and coagulation aggravate thrombosis on most device geometries that elicit these flow disturbances. Thus, antithrombotic drugs that were developed to treat thrombosis associated with vascular diseases such as atherosclerosis have also been adapted to mitigate the risk of device thrombosis. However, balancing the risk of bleeding with the antithrombotic efficacy of these drugs continues to be a challenge, and surface modification of devices with these drug molecules to mitigate device thrombosis locally has been explored. Pre-clinical blood flow models to test the effectiveness of these drug-device combinations have also evolved and several in-vitro, ex-vivo, and in-vivo test configurations are available with their attendant merits and limitations. Despite considerable efforts toward iterative design and testing of blood contacting devices and antithrombogenic surface modifications, device thrombosis remains an unsolved problem.
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14
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Simon-Walker R, Romero R, Staver JM, Zang Y, Reynolds MM, Popat KC, Kipper MJ. Glycocalyx-Inspired Nitric Oxide-Releasing Surfaces Reduce Platelet Adhesion and Activation on Titanium. ACS Biomater Sci Eng 2016; 3:68-77. [PMID: 33429688 DOI: 10.1021/acsbiomaterials.6b00572] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The endothelial glycocalyx lining the inside surfaces of blood vessels has multiple features that prevent inflammation, blood clot formation, and infection. This surface represents the highest standard in blood compatibility for long-term contact with blood under physiological flow rates. Engineering materials used in blood-contacting biomedical devices, including metals and polymers, have undesirable interactions with blood that lead to failure modes associated with inflammation, blood clotting, and infection. Platelet adhesion and activation are key events governing these undesirable interactions. In this work, we propose a new surface modification to titanium with three features inspired by the endothelial glcyocalyx: First, titanium surfaces are anodized to produce titania nanotubes with high surface area. Second, the nanostructured surfaces are coated with heparin-chitosan polyelectrolyte multilayers to provide glycosaminoglycan functionalization. Third, chitosan is modified with a nitric oxide-donor chemistry to provide an important antithrombotic small-molecule signal. We show that these surfaces are nontoxic with respect to platelets and leukocytes. The combination of glycocalyx-inspired features results in a dramatic reduction of platelet and leukocyte adhesion and platelet activation.
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Affiliation(s)
- Rachael Simon-Walker
- School of Biomedical Engineering, Colorado State University, 1376 Campus Delivery, Fort Collins, Colorado 80523-1376, United States
| | - Raimundo Romero
- School of Biomedical Engineering, Colorado State University, 1376 Campus Delivery, Fort Collins, Colorado 80523-1376, United States
| | - Joseph M Staver
- Department of Chemical and Biological Engineering, Colorado State University, 1370 Campus Delivery, Fort Collins, Colorado 80523-1370, United States
| | - Yanyi Zang
- School of Biomedical Engineering, Colorado State University, 1376 Campus Delivery, Fort Collins, Colorado 80523-1376, United States
| | - Melissa M Reynolds
- School of Biomedical Engineering, Colorado State University, 1376 Campus Delivery, Fort Collins, Colorado 80523-1376, United States.,Department of Chemical and Biological Engineering, Colorado State University, 1370 Campus Delivery, Fort Collins, Colorado 80523-1370, United States.,Department of Chemistry, Colorado State University, 1872 Campus Delivery, Fort Collins, Colorado 80523-1872, United States
| | - Ketul C Popat
- School of Biomedical Engineering, Colorado State University, 1376 Campus Delivery, Fort Collins, Colorado 80523-1376, United States.,Department of Mechanical Engineering, Colorado State University, 1374 Campus Delivery, Fort Collins, Colorado 80523-1374, United States
| | - Matt J Kipper
- School of Biomedical Engineering, Colorado State University, 1376 Campus Delivery, Fort Collins, Colorado 80523-1376, United States.,Department of Chemical and Biological Engineering, Colorado State University, 1370 Campus Delivery, Fort Collins, Colorado 80523-1370, United States
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15
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Damodaran VB, Murthy NS. Bio-inspired strategies for designing antifouling biomaterials. Biomater Res 2016; 20:18. [PMID: 27326371 PMCID: PMC4913429 DOI: 10.1186/s40824-016-0064-4] [Citation(s) in RCA: 179] [Impact Index Per Article: 22.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2016] [Accepted: 06/02/2016] [Indexed: 02/03/2023] Open
Abstract
Contamination of biomedical devices in a biological medium, biofouling, is a major cause of infection and is entirely avoidable. This mini-review will coherently present the broad range of antifouling strategies, germicidal, preventive and cleaning using one or more of biological, chemical and physical techniques. These techniques will be discussed from the point of view of their ability to inhibit protein adsorption, usually the first step that eventually leads to fouling. Many of these approaches draw their inspiration from nature, such as emulating the nitric oxide production in endothelium, use of peptoids that mimic protein repellant peptides, zwitterionic functionalities found in membrane structures, and catechol functionalities used by mussel to immobilize poly(ethylene glycol) (PEG). More intriguing are the physical modifications, creation of micropatterns on the surface to control the hydration layer, making them either superhydrophobic or superhydrophilic. This has led to technologies that emulate the texture of shark skin, and the superhyprophobicity of self-cleaning textures found in lotus leaves. The mechanism of antifouling in each of these methods is described, and implementation of these ideas is illustrated with examples in a way that could be adapted to prevent infection in medical devices.
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Affiliation(s)
- Vinod B. Damodaran
- New Jersey Center for Biomaterials, Rutgers – The State University of New Jersey, Piscataway, NJ 08854 USA
| | - N. Sanjeeva Murthy
- New Jersey Center for Biomaterials, Rutgers – The State University of New Jersey, Piscataway, NJ 08854 USA
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16
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Bark DL, Vahabi H, Bui H, Movafaghi S, Moore B, Kota AK, Popat K, Dasi LP. Hemodynamic Performance and Thrombogenic Properties of a Superhydrophobic Bileaflet Mechanical Heart Valve. Ann Biomed Eng 2016; 45:452-463. [PMID: 27098219 DOI: 10.1007/s10439-016-1618-2] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2016] [Accepted: 04/13/2016] [Indexed: 10/21/2022]
Abstract
In this study, we explore how blood-material interactions and hemodynamics are impacted by rendering a clinical quality 25 mm St. Jude Medical Bileaflet mechanical heart valve (BMHV) superhydrophobic (SH) with the aim of reducing thrombo-embolic complications associated with BMHVs. Basic cell adhesion is evaluated to assess blood-material interactions, while hemodynamic performance is analyzed with and without the SH coating. Results show that a SH coating with a receding contact angle (CA) of 160° strikingly eliminates platelet and leukocyte adhesion to the surface. Alternatively, many platelets attach to and activate on pyrolytic carbon (receding CA = 47), the base material for BMHVs. We further show that the performance index increases by 2.5% for coated valve relative to an uncoated valve, with a maximum possible improved performance of 5%. Both valves exhibit instantaneous shear stress below 10 N/m2 and Reynolds Shear Stress below 100 N/m2. Therefore, a SH BMHV has the potential to relax the requirement for antiplatelet and anticoagulant drug regimens typically required for patients receiving MHVs by minimizing blood-material interactions, while having a minimal impact on hemodynamics. We show for the first time that SH-coated surfaces may be a promising direction to minimize thrombotic complications in complex devices such as heart valves.
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Affiliation(s)
- David L Bark
- Department of Mechanical Engineering, Colorado State University, Fort Collins, CO, USA.,School of Biomedical Engineering, Colorado State University, Fort Collins, CO, USA
| | - Hamed Vahabi
- Department of Mechanical Engineering, Colorado State University, Fort Collins, CO, USA
| | - Hieu Bui
- School of Biomedical Engineering, Colorado State University, Fort Collins, CO, USA
| | - Sanli Movafaghi
- Department of Mechanical Engineering, Colorado State University, Fort Collins, CO, USA
| | - Brandon Moore
- Department of Mechanical Engineering, Colorado State University, Fort Collins, CO, USA
| | - Arun K Kota
- Department of Mechanical Engineering, Colorado State University, Fort Collins, CO, USA.,School of Biomedical Engineering, Colorado State University, Fort Collins, CO, USA
| | - Ketul Popat
- Department of Mechanical Engineering, Colorado State University, Fort Collins, CO, USA.,School of Biomedical Engineering, Colorado State University, Fort Collins, CO, USA
| | - Lakshmi P Dasi
- Department of Mechanical Engineering, Colorado State University, Fort Collins, CO, USA. .,School of Biomedical Engineering, Colorado State University, Fort Collins, CO, USA. .,Department of Biomedical Engineering, Dorothy Davis Heart and Lung Research Institute, 473 W 12th Avenue, Columbus, OH, 43210, USA.
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17
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Tian JL, Chen Y, Wang YX, Huang XX, Sun X, Liu KC, Song SJ. Microbial transformation of methyl cyperenoate by Cunninghamella elegans AS 3.2028 and the antithrombotic activities of its metabolites. RSC Adv 2016. [DOI: 10.1039/c6ra24332k] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
Microbial transformation is a remarkable tool for the structural modification of bioactive natural compounds converting them into more valuable biologically active derivatives.
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Affiliation(s)
- Jin-Long Tian
- School of Traditional Chinese Materia Medica
- Shenyang Pharmaceutical University
- Shenyang 110016
- People's Republic of China
- Key Laboratory of Structure-Based Drug Design & Discovery
| | - Yu Chen
- School of Life Science and Biopharmaceutics
- Shenyang Pharmaceutical University
- Shenyang 110016
- People's Republic of China
| | - Yu-Xi Wang
- School of Traditional Chinese Materia Medica
- Shenyang Pharmaceutical University
- Shenyang 110016
- People's Republic of China
- Key Laboratory of Structure-Based Drug Design & Discovery
| | - Xiao-Xiao Huang
- School of Traditional Chinese Materia Medica
- Shenyang Pharmaceutical University
- Shenyang 110016
- People's Republic of China
- Key Laboratory of Structure-Based Drug Design & Discovery
| | - Xue Sun
- School of Traditional Chinese Materia Medica
- Shenyang Pharmaceutical University
- Shenyang 110016
- People's Republic of China
- Key Laboratory of Structure-Based Drug Design & Discovery
| | - Ke-Chun Liu
- Biology Institute of Shandong Academy of Sciences
- Jinan
- China
| | - Shao-Jiang Song
- School of Traditional Chinese Materia Medica
- Shenyang Pharmaceutical University
- Shenyang 110016
- People's Republic of China
- Key Laboratory of Structure-Based Drug Design & Discovery
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18
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Major R, Trembecka-Wójciga K, Kot M, Lackner JM, Wilczek P, Major B. In vitro hemocompatibility on thin ceramic and hydrogel films deposited on polymer substrate performed in arterial flow conditions. MATERIALS SCIENCE & ENGINEERING. C, MATERIALS FOR BIOLOGICAL APPLICATIONS 2015; 61:15-22. [PMID: 26838818 DOI: 10.1016/j.msec.2015.12.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/30/2015] [Revised: 11/23/2015] [Accepted: 12/07/2015] [Indexed: 10/22/2022]
Abstract
Hydrogel coatings were stabilized by titanium carbonitride a-C:H:Ti:N buffer layers deposited directly onto the polyurethane (PU) substrate beneath a final hydrogel coating. Coatings of a-C:H:Ti:N were deposited using a hybrid method of pulsed laser deposition (PLD) and magnetron sputtering (MS) under high vacuum conditions. The influence of the buffer a-C:H:Ti:N layer on the hydrogel coating was analysed by means of a multi-scale microstructure study. Mechanical tests were performed at an indentation load of 5 mN using Berkovich indenter geometry. Haemocompatible analyses were performed in vitro using a blood flow simulator. The blood-material interaction was analysed under dynamic conditions. The coating fabrication procedure improved the coating stability due to the deposition of the amorphous titanium carbonitride buffer layer.
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Affiliation(s)
- Roman Major
- Institute of Metallurgy and Materials Science, Polish Academy of Sciences, Reymonta St. 25, Krakow, Poland.
| | - Klaudia Trembecka-Wójciga
- Institute of Metallurgy and Materials Science, Polish Academy of Sciences, Reymonta St. 25, Krakow, Poland
| | - Marcin Kot
- AGH University of Science and Technology, Faculty of Mechanical, Engineering and Robotics, Al. Mickiewicza 30, 30-059 Krakow, Poland
| | - Juergen M Lackner
- Joanneum Research Forschungs-GmbH, Materials - Functional Surfaces, Leoben, Austria
| | - Piotr Wilczek
- Heart Prosthesis Institute, Bioengineering Laboratory, Wolnosci 345A, 41-800 Zabrze, Poland
| | - Boguslaw Major
- Institute of Metallurgy and Materials Science, Polish Academy of Sciences, Reymonta St. 25, Krakow, Poland
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19
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Haraguchi K, Takehisa T, Mizuno T, Kubota K. Antithrombogenic Properties of Amphiphilic Block Copolymer Coatings: Evaluation of Hemocompatibility Using Whole Blood. ACS Biomater Sci Eng 2015; 1:352-362. [PMID: 33445240 DOI: 10.1021/acsbiomaterials.5b00079] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Antithrombogenicity is one of the most critical properties required for materials used in biomedical devices, particularly in devices that contact blood. The antithrombogenicity of surfaces coated with amphiphilic block copolymers composed of hydrophobic poly(2-methoxyethyl acrylate) (M) and hydrophilic poly(N,N-dimethylacrylamide) (D) segments was investigated using plasma protein and whole blood with regard to protein adsorption, thrombus formation, platelet activation, and clotting kinetics. Three types of block copolymers and a random copolymer were synthesized using one-pot reversible addition-fragmentation chain-transfer (RAFT) polymerization under conditions of high yield and high molecular weight. Triblock and 4-arm block copolymers with MDM and (MD)4 architecture, respectively, showed good adhesion to both organic and inorganic substrates, including polyvinyl chloride (PVC) tubes, and the resulting coated surfaces showed superior protein repellency and hemocompatibility compared to the diblock or random copolymer coatings and noncoated control. In a Chandler-loop method with whole blood, PVC tubes coated with MDM and (MD)4 showed improved thromboresistance and adsorption resistance to blood-derived proteins. This high hemocompatibility was also confirmed with human whole blood by thrombelastography (suppression of blood-clotting behavior in both intrinsic and extrinsic coagulation pathways) and platelet function analyses (significant reductions in the aggregation activity of platelets under two types of stimulation). The antithrombogenicity has been discussed based on the structural analyses of the MDM-coated surface. The results of this study will enable the development of more effective biomedical and analytical devices with excellent antithrombogenic characteristics by using a simple and environmentally friendly approach.
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Affiliation(s)
- Kazutoshi Haraguchi
- Material Chemistry Laboratory, Kawamura Institute of Chemical Research, Sakura, Chiba 285-0078 Japan.,Department of Applied Molecular Chemistry, College of Industrial Technology, Nihon University, Narashino, Chiba 275-8575 Japan
| | - Toru Takehisa
- Material Chemistry Laboratory, Kawamura Institute of Chemical Research, Sakura, Chiba 285-0078 Japan.,Central Research Laboratories, DIC Co., Sakura, Chiba 285-8668, Japan
| | - Toshihide Mizuno
- Department of Artificial Organs, Research Institute, National Cerebral and Cardiovascular Center, Suita, Osaka, 565-8565, Japan
| | - Kazuomi Kubota
- Material Chemistry Laboratory, Kawamura Institute of Chemical Research, Sakura, Chiba 285-0078 Japan.,Central Research Laboratories, DIC Co., Sakura, Chiba 285-8668, Japan
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20
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Sobolewski P, El Fray M. Cardiac catheterization: consequences for the endothelium and potential for nanomedicine. WILEY INTERDISCIPLINARY REVIEWS-NANOMEDICINE AND NANOBIOTECHNOLOGY 2014; 7:458-73. [PMID: 25429858 DOI: 10.1002/wnan.1316] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/18/2014] [Revised: 09/15/2014] [Accepted: 10/11/2014] [Indexed: 12/19/2022]
Abstract
Cardiac catheterization results in interactions between the catheter and surfaces and the artery lumen, which is lined by the endothelium. These interactions can range from minor rubbing to severe mechanical injury. Further, in the case of radial access, even atraumatic interactions have consequences ranging from clinical complications, such as radial spasm and radial occlusion, to lasting endothelial cell dysfunction. These consequences may be underappreciated; however, endothelial cells play a central role in maintaining vascular homeostasis via nitric oxide production. Existing treatment paradigms do not address endothelial dysfunction or damage and, thus, novel therapeutic approaches are needed. Nanomedicine, in particular, offers great potential in the form of targeted drug delivery, via functionalized coatings or nanocarriers, aimed at increased nitric oxide bioavailability or reduced inflammation.
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Affiliation(s)
- Peter Sobolewski
- Division of Biomaterials and Microbiological Technologies, West Pomeranian University of Technology, Szczecin, Poland
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