Biomedical applications of engineered heparin-based materials

Heparin is a negatively charged polysaccharide with various chain lengths and a hydrophilic backbone. Due to its fascinating chemical and physical properties, nontoxicity, biocompatibility, and biodegradability, heparin has been extensively used in different fields of medicine, such as cardiovascular and hematology. This review highlights recent and future advancements in designing materials based on heparin for various biomedical applications. The physicochemical and mechanical properties, biocompatibility, toxicity, and biodegradability of heparin are discussed. In addition, the applications of heparin-based materials in various biomedical fields, such as drug/gene delivery, tissue engineering, cancer therapy, and biosensors, are reviewed. Finally, challenges, opportunities, and future perspectives in preparing heparin-based materials are summarized.

Commercial and novel anticoagulant ECMO coatings: a review

Extracorporeal membrane oxygenation (ECMO) is an invasive and last-resort treatment for circulatory and respiratory failure. Prolonged ECMO support can disrupt the coagulation and anticoagulation systems in a patient, leading to adverse consequences, such as bleeding and thrombosis. To address this problem, anticoagulation coatings have been developed for use in ECMO circuits. This article reviews commonly used commercial and novel anticoagulant coatings developed in recent years and proposes a new classification of coatings based on the current state. While commercial coatings have been used clinically for decades, this review focuses on comparing the effectiveness and stability of coatings to support clinical selections. Furthermore, novel anticoagulation coatings often involve complex mechanisms and elaborate design strategies, and this review summarises representative studies on mainstream anticoagulation coatings to provide a point of reference for future studies.

Supramolecular self-assembly of glycosaminoglycan mimetic nanostructures for cell proliferation and 3D cell culture application

Glycosaminoglycans (GAGs), such as heparin, heparan sulfate and chondroitin sulfate, are playing important roles in various biological processes. Due to the laborious work of organic or enzymatic total synthesis of GAGs, different approaches, including glycopolymers, dendrimers, etc., have been developed to mimic the structures and bioactivities of GAGs, but the syntheses can still be difficult. In the current study, a new format of GAG mimetic structure, supramolecularly assembled polymers, have been easily prepared by mixing fluorenylmethoxycarbonyl-diphenylalanine (Fmoc-FF) and sulfated glyco-modified fluorenylmethoxy derivatives (FGS and FG3S). The self-assembly behavior of these polymers into different structural formats of nanoparticles, nanofibers and macroscopic hydrogels upon adjusted concentrations and composite ratios have been detailed studied. The nanofibers modified with highly sulfated glycol groups (FG3S/Fmoc-FF) showed strong promotion effect for cell proliferation, which efficiency was even similar to that of natural heparin, higher than nanoparticles or non-/low-sulfated glyco-modified nanofibers. Moreover, the supramolecular polymers were further made into hydrogels that capable of 3D cell culture. This study provided a novel and efficient approach for GAG mimicking, showing great potential for tissue engineering related applications.

Bilirubin Removal by Polymeric Adsorbents for Hyperbilirubinemia Therapy

Hyperbilirubinemia, presenting as jaundice, is a life-threatening critical illness in newborn babies and acute severe hepatic failure patients. Over the past few decades, extracorporeal hemoadsorption by adsorbent therapy has been widely applied in the treatment of hyperbilirubinemia. The capability of hemoadsorption depends on the adsorbents. Most of the clinically used bilirubin adsorbents are made up of styrene/divinylbenzene copolymer and quaternary ammonium salt, which usually have poor biocompatibility and weak mechanical strength. To overcome the drawbacks of commercial polymer adsorbents, advanced synthetic and natural polymers with/without nanomaterials have been designed, and novel adsorbent fabrication technologies have also been developed. In this review, the adsorption mechanism of bilirubin adsorbents has been summarized, which is the basic criterion in adsorbent development. Furthermore, the preparation method, adsorption mechanism, relative merits and practicability of the emerging bilirubin adsorbents have been evaluated. Based on the existing studies, this work highlights the future direction of the efforts on how to design and develop bilirubin adsorbents with good overall clinical performance. Perhaps this study can change traditional perspectives and propose new strategies for bilirubin clearance from the aspects of pathogenic mechanisms, metabolic pathways, and material-based innovation.

Antiblood Cell Adhesion of Mussel-Inspired Chondroitin Sulfate- and Caffeic Acid-Modified Polycarbonate Membranes

We fabricated a mussel-inspired hemocompatible polycarbonate membrane (PC) modified by the cross-linking of chondroitin sulfate and caffeic acid polymer using CA-CS via a Schiff base and Michael addition reaction and named it CA-CS-PC. The as-fabricated CA-CS-PC membrane shows excellent hydrophilicity with a water contact angle of 0° and a negative surface charge with a zeta potential of -32 mV. The antiadhesion property of the CA-CS-modified PC membrane was investigated by enzyme-linked immunosorbent assay (ELISA), using human plasma protein fibrinogen adsorption studies, and proved to have excellent antiadhesion properties, because of the lower fibrinogen adsorption. In addition, the CA-CS-PC membrane also shows enhanced hemocompatibility. Finally, blood cell attachment tests of the CA-CS-PC membrane were observed by CLSM and SEM, and the obtained results proved that CA-CS-PC effectively resisted cell adhesion, such as platelets and leucocytes. Therefore, this work disclosed a new way to design a simple and versatile modification of the membrane surface by caffeic acid and chondroitin sulfate and apply it for cell adhesion.

Impact of Membrane Modification and Surface Immobilization Techniques on the Hemocompatibility of Hemodialysis Membranes: A Critical Review

Despite significant research efforts, hemodialysis patients have poor survival rates and low quality of life. Ultrafiltration (UF) membranes are the core of hemodialysis treatment, acting as a barrier for metabolic waste removal and supplying vital nutrients. So, developing a durable and suitable membrane that may be employed for therapeutic purposes is crucial. Surface modificationis a useful solution to boostmembrane characteristics like roughness, charge neutrality, wettability, hemocompatibility, and functionality, which are important in dialysis efficiency. The modification techniques can be classified as follows: (i) physical modification techniques (thermal treatment, polishing and grinding, blending, and coating), (ii) chemical modification (chemical methods, ozone treatment, ultraviolet-induced grafting, plasma treatment, high energy radiation, and enzymatic treatment); and (iii) combination methods (physicochemical). Despite the fact that each strategy has its own set of benefits and drawbacks, all of these methods yielded noteworthy outcomes, even if quantifying the enhanced performance is difficult. A hemodialysis membrane with outstanding hydrophilicity and hemocompatibility can be achieved by employing the right surface modification and immobilization technique. Modified membranes pave the way for more advancement in hemodialysis membrane hemocompatibility. Therefore, this critical review focused on the impact of the modification method used on the hemocompatibility of dialysis membranes while covering some possible modifications and basic research beyond clinical applications.

Artificial Extracellular Matrix Composed of Heparin-Mimicking Polymers for Efficient Anticoagulation and Promotion of Endothelial Cell Proliferation

Heparin-mimicking polymers have emerged as an alternative to heparin to construct effective and safe anticoagulant surfaces. However, the present heparin-mimicking polymers are usually limited to the combinations of glucose and sulfonic acid units, and the structure origin of their anticoagulant properties remains vague. Inspired by the structure of natural heparin, we synthesized a series of novel heparin-mimicking polymers (named GSAs) composed of three units, glucose, sulfonic acid, and carboxylic acid. Then, we constructed artificial extracellular matrices composed of GSAs and two typical cationic polymers, polyethyleneimine and chitosan, to investigate the anticoagulation and endothelialization of GSAs. By changing the ratio of the three units, their functions in the matrices were studied systematically. We found that an increase in the sulfonic acid content enhanced surface anticoagulant activity, an increase in glucose and sulfonic acid content promoted the proliferation of human umbilical vein vascular endothelial cells, and an increase in the carboxylic acid content inhibited the adherence of human umbilical vein vascular smooth muscle cells. This work uncovers the important role of the GSAs structure to the anticoagulation properties, which sheds new light on the design and preparation of heparin-mimicking polymers for practical engineering applications.

Anticoagulation polyvinyl chloride extracorporeal circulation catheters for heparin-free treatment

Extracorporeal circulation (ECC) catheters have potential to be blood compatible and could be used to prevent thrombotic occlusion. Here, we produced heparin-mimicking anticoagulation PVC tubing on a large scale by synthesizing a heparin-mimicking polymer (HMP) and co-extruding. The PVC@HMP catheter was evaluated using whole human blood in vitro, which indicated it could prevent plasma protein attachment, reduce platelet adhesion and activation, and inhibit coagulation factors (XII, XI, IX, and VIII). Moreover, the anticoagulation PVC tubing was assembled into extracorporeal circulation with a New Zealand rabbit model, manifesting excellent real-time antithrombogenic properties without systemic heparin anticoagulation in vivo. The rapid recovery of coagulation factors after operation further confirmed its superiority over heparin, which would not completely inactivate the activity of those coagulation factors (XII, XI, IX and VIII). In addition, the PVC@HMP-1 catheters remain patent after being implanted in rats for 28 days without apparent inflammation and mortality complications. The anticoagulation PVC tubes could be used to construct various systemic and integrative anticlotting biomedical devices, which would dramatically reduce the introduction of heparin into blood circulation, thus preventing side effects and promoting the development of heparin-free treatment.

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.

Nanoengineering and green chemistry-oriented strategies toward nanocelluloses for protein sensing

As one of the most important functional organic macromolecules of life, proteins not only participate in the cell metabolism and gene regulation, they also earnestly protect the body's immunity system, leading to a powerful biological shield and homeostasis. Advances in nanomaterials are boosting the significant progress in various applications, including the sensing and examination of proteins in trace amount. Nanocellulose-oriented protein sensing is at the forefront of this revolution. The inherent feature of high biocompatibility, low cytotoxicity, high specific area, good durability and marketability endow nanocellulose with great superiority in protein sensing. Here, we highlight the recent progress of protein sensing using nanocellulose as the biosensor in trace amount. Besides, various kinds of construction strategies for nanocelluloses-based biosensors are discussed in detail, to enhance the agility and accuracy of clinical/medical diagnostics. Finally, several challenges in the approbatory identification of new approaches for the marketization of biomedical sensing that need further expedition in the future are highlighted.

One step preparation of multifunctional poly (ether sulfone) thin films with potential for wound dressing

The increasing demand for higher-quality medical care has resulted in the obsolescence of traditional biomaterials. Medical care is currently transitioning from an era depending on single-functional biomaterials to one that is supported by multifunctional and stable biomaterials. Herein, long-lasting multifunctional poly(ether sulfone) thin films (MPFs) containing heparin-mimic groups and a quaternary ammonium compound (QAC) were prepared via semi-interpenetrating polymer network (SIPN) strategy. The MPFs, with rough surface and inner finger-like macrovoid, had better hydrophilicity and anti-protein fouling ability, as revealed by scanning electron microscopy (SEM), atomic force microscope (AFM) and water contact angle (WCA) and protein adsorption tests. The results of platelet adhesion and activation, and clotting time confirmed that the hemocompatibility of the MPFs was significantly improved. From cell culture and germ-culture test, it was noted that the overall trend of human umbilical vein endothelial cell (HUVEC) proliferation was enhanced by a combination of heparin-mimic groups and QAC, whereas the growth of Escherichia coli (E. coli) and Staphylococcus aureus (S. aureus) was significantly prohibited. In addition, the MPFs were capable of modulating the expression level of basic fibroblast growth factor (bFGF) and transforming growth factor-beta1 (TGF-β1) in fibroblast, which was beneficial to controlling the formation of hypertrophic scar. In summary, the MPFs had potential to be used in the field of wound management and the study might help guide the design of surface structure of wound dressing.

Manufacturing and Separation Characteristics of Hemodialysis Membranes to Improve Toxin Removal Rate

With the recently growing interest in health care, hemodialysis is being performed not only to treat patients with renal disease but also to improve blood circulation. At present, filters used for hemodialysis are manufactured only in certain countries, and all other countries must rely on imports. In this study, polyethersulfone (PES), which has excellent blood compatibility, was used as the main material to develop hemodialysis membranes for hemodialysis filters, and these hemodialysis membranes were prepared by adding a hydrophilic polymer, polyvinylpyrrolidone (PVP), and varying the type of nonsolvent during the manufacturing process to improve the toxin removal rate and biocompatibility. The addition of PVP was confirmed through attenuated total reflection Fourier transform infrared (ATR-FTIR), and the structure of the membranes depending on the nonsolvent was analyzed through scanning electron microscopy (SEM) and atomic force microscopy (AFM) images. The contact angle results indicated that the hydrophilicity of the membrane surface was improved as the concentration of PVP increased. The results of the toxin filtration efficiency experiment using urea, creatinine, and bovine serum albumin (BSA) confirmed removal rates of 58.8% and 56.87%, respectively, and a protein loss of less than 8%. Also, cell viability was over 90% at the PVP concentration of 2% or higher. A preliminary study was conducted on the improvement of toxin filtration efficiency and the development potential of these hemodialysis membranes with excellent biocompatibility.

Hierarchical Shish-Kebab Structures Functionalizing Nanofibers for Controlled Drug Release and Improved Antithrombogenicity

The functionalization of the fibrous scaffolds including drug loading and release is of significance in tissue engineering and regenerative medicine. Our previous results have shown that the shish-kebab structure-modified fibrous scaffold shows a completely different microenvironment that mimics the topography of the collagen fibers, which interestingly facilitates the cell adhesion and migration. However, the functionalization of the unique structure needs to be further investigated. In this study, we modified the heparin-loaded fiber with a shish-kebab structure and tuned the kebab structure as the barrier for the sustained release of heparin. The introduction of the kebab structure increases the diffusion energy barrier by extending the diffusion distance. Moreover, the discontinued surface topography of the shish-kebab structure altered the surface chemistry from hydrophobic for the original poly(ε-caprolactone) (PCL) nanofibers to hydrophilic for the PCL nanofibers with the shish-kebab structure, which might have inhibited the activation of fibrinogen and thus improved the anticoagulant ability. This synergistic effect of heparin and the kebab structure significantly promotes the endothelial cell affinity and antithrombogenicity. This method might be a viable and versatile drug delivery strategy in vascular tissue engineering.

Recent trends in therapeutic application of engineered blood purification materials for kidney disease

Blood purification is a commonly used method to remove excess metabolic waste in the blood in renal replacement therapy. The sufficient removal of these toxins from blood can reduce complications and improve survival lifetime in dialysis patients. However, the current biological blood purification materials in clinical practice are not ideal, where there is an unmet need for producing novel materials that have better biocompatibility, reduced toxicity, and, in particular, more efficient toxin clearance rates and a lower cost of production. Given this, this review has carefully summarized newly developed engineered different structural biomedical materials for blood purification in terms of types and structure characteristics of blood purification materials, the production process, as well as interfacial chemical adsorption properties or mechanisms. This study may provide a valuable reference for fabricating a user-friendly purification device that is more suitable for clinical blood purification applications in dialysis patients.

Preliminary Results on Heparin-Modified Double-Layered PCL and PLA-Based Scaffolds for Tissue Engineering of Small Blood Vessels

Low-diameter blood vessels are challenging to replace with more traditional synthetic vascular grafts. Therefore, the obvious choice is to try to regenerate small veins and arteries through tissue-engineering approaches. However, the layered structure of native vessels and blood compatibility issues make this a very challenging task. The aim of this study is to create double-layered tubular scaffolds with enhanced anticoagulant properties for the tissue engineering of small blood vessels. The scaffolds were made of a polycaprolactone-based porous outer layer and a polylactide-based electrospun inner layer modified with heparin. The combination of thermally induced phase separation and electrospinning resulted in asymmetric scaffolds with improved mechanical properties. The release assay confirmed that heparin is released from the scaffolds. Additionally, anticoagulant activity was shown through APTT (activated partial thromboplastin time) assay. Interestingly, the endothelial cell culture test revealed that after 14 days of culture, HAECs (human aortic endothelial cell lines) tended to organize in chain-like structures, typical for early stages of vascular formation. In the longer culture, HAEC viability was higher for the heparin-modified scaffolds. The proposed scaffold design and composition have great potential for application in tissue engineering of small blood vessels.

CaCO3-based carriers with prolonged release property for antifungal drug delivery to hair follicles

Superficial fungal infections are of serious concern worldwide due to their morbidity and increasing distribution across the globe in this era of growing antimicrobial resistance. Delivery of antifungals to target...

Fluorescent polydopamine based molecularly imprinted sensor for ultrafast and selective detection of p-nitrophenol in drinking water

A highly effective fluorescent molecularly imprinted sensor (F-PDA-MIS) based on fluorescent polydopamine (F-PDA) was successfully synthesized for selective and ultrafast detection of p-nitrophenol (P-NP) in drinking water. F-PDA with abundant surface functional groups has been artfully modified to firstly serve as both fluorescent monomer and functional monomer in the synthesis of a uniform luminous F-PDA-MIS, which can greatly improve the detection efficiency. As expected, F-PDA-MIS had an obvious emission wavelength of 535 nm with the optimal excitation wavelength at 400 nm. Specially, F-PDA-MIS could detect P-NP in the range 100 to 1100 nM with much lower detection limit of 24.2 nM within 120 s compared with other conventional imprinted fluorescent sensors based on pure quantum dots (QDs) or dyes. This excellent test phenomenon is mainly ascribed to the rapid electron transfer between F-PDA and P-NP. Satisfactory recovery of 98.0-104% for mineral water and 98.6-106% for boiling water were obtained with relative standard deviations (RSDs) of 2.7-3.4% and 2.6-3.5% respectively. The detection reliability of F-PDA-MIS was verified by the comparison with high-performance liquid chromatography (HPLC-UV). Consequently, F-PDA as a fluorescence functional monomer has been shown to be a possible strategy to effectively improve the detection limit and shorten response time of the target determination in water..

Surface modification of polytetrafluoroethylene (PTFE) with a heparin-immobilized extracellular matrix (ECM) coating for small-diameter vascular grafts applications

Intimal hyperplasia, thrombosis formation, and delayed endothelium regeneration are the main causes that restrict the clinical applications of PTFE small-diameter vascular grafts (inner diameter < 6 mm). An ideal strategy to solve such problems is to facilitate in situ endothelialization. Since the natural vascular endothelium adheres onto the basement membrane, which is a specialized form of extracellular matrix (ECM) secreted by endothelial cells (ECs) and smooth muscle cells (SMCs), functionalizing PTFE with an ECM coating was proposed. However, besides ECs, the ECM-modified PTFE improved SMC growth as well, thereby increasing the risk of intimal hyperplasia. In the present study, heparin was immobilized on the ECM coating at different densities (4.89 ± 1.02 μg/cm2, 7.24 ± 1.56 μg/cm2, 15.63 ± 2.45 μg/cm2, and 26.59 ± 3.48 μg/cm2), aiming to develop a bio-favorable environment that possessed excellent hemocompatibility and selectively inhibited SMC growth while promoting endothelialization. The results indicated that a low heparin density (4.89 ± 1.02 μg/cm2) was not enough to restrict platelet adhesion, whereas a high heparin density (26.59 ± 3.48 μg/cm2) resulted in decreased EC growth and enhanced SMC proliferation. Therefore, a heparin density at 7.24 ± 1.56 μg/cm2 was the optimal level in terms of antithrombogenicity, endothelialization, and SMC inhibition. Collectively, this study proposed a heparin-immobilized ECM coating to modify PTFE, offering a promising means to functionalize biomaterials for developing small-diameter vascular grafts.

Heparin-Eluting Tissue-Engineered Bioabsorbable Vascular Grafts

The creation of small-diameter tissue-engineered vascular grafts using biodegradable materials has the potential to change the quality of cardiovascular surgery in the future. The implantation of these tissue-engineered arterial grafts has yet to reach clinical application. One of the reasons for this is thrombus occlusion of the graft in the acute phase. In this paper, we first describe the causes of accelerated thrombus formation and discuss the drugs that are thought to inhibit thrombus formation. We then review the latest research on methods to locally bind the anticoagulant heparin to biodegradable materials and methods to extend the duration of sustained heparin release. We also discuss the results of studies using large animal models and the challenges that need to be overcome for future clinical applications.

The role of carboxylic groups in heparin-mimicking polymer-functionalized surfaces for blood compatibility: Enhanced vascular cell selectivity

Blood compatibility is an eternal topic of biomedical materials. The effect of heparin-mimicking polymers (HMPs) on blood compatibility has been well studied, especially the synergistic effect of sugar unit and sulfonate/sulfate unit. However, carboxylic groups also play an important role in HMPs. In this work, copolymers of sodium 4-vinyl-benzenesulfonate (SS) and 2-methacrylamido glucopyranose (MAG) (poly(SS-co-MAG)) and poly(acrylate acid) (PAA) were self-assembled on Au surfaces with different feed ratios. When self-assembly of poly(SS-co-MAG) alone, the optimized feed ratio of SS and MAG for vascular cell selectivity was 1:1 (PS1M1); at this ratio the Au-PS1M1 surface showed the highest human umbilical vein endothelial cells (HUVECs) density and the lowest human umbilical vein smooth muscle cells (HUVSMCs) density. When self-assembly of PAA alone (surface designated as Au-PAA), the proliferation of both HUVECs and HUVSMCs was inhibited. Compared with either PS1M1 or PAA alone, the surfaces modified with both PAA and PS1M1 at the feed ratio of 1:1 (material designated as Au-PSM/PAA-2) showed enhanced promoting effect on HUVECs as well as enhanced inhibiting effect on HUVSMCs, indicating stronger vascular cell selectivity of carboxylic groups in the presence of sugar and sulfonate units.

Elimination of Uremic Toxins by Functionalized Graphene-Based Composite Beads for Direct Hemoperfusion

Conventional absorbents for hemoperfusions suffer from low efficiency and slow absorption with numerous side effects. In this research, we developed cellulose acetate (CA) functionalized graphene oxide (GO) beads (∼1.5-2 mm) that can be used for direct hemoperfusion, aiming at the treatment of kidney dysfunction. The CA-functionalized GO bead facilitates adsorption of toxins with high biocompatibility and high-efficiency of hemoperfusion while maintaining high retention for red blood cell, white blood cells, and platelets. Our in vitro results show that the toxin concentration for creatinine reduced from 0.21 to 0.12 μM (p < 0.005), uric acid from 0.31 to 0.15 mM (p < 0.005), and bilirubin from 0.36 to 0.09 mM (p < 0.005), restoring to normal levels within 2 h. Our in vivo study on rats (Sprague-Dawley, n = 30) showed that the concentration for creatinine reduced from 83.23 to 54.87 μmol L^-1 (p < 0.0001) and uric acid from 93.4 to 54.14 μmol L^-1 (p < 0.0001), restoring to normal levels within 30 min. Results from molecular dynamics (MD) simulations using free-energy calculations reveal that the presence of CA on GO increases the surface area for adsorption and enhances penetration of toxins in the binding cavities because of the increased electrostatic and van der Waals force (vdW) interactions. These results provide critical insight to fabricate graphene-based beads for hemoperfusion and to have the potential for the treatment of blood-related disease.

A review on surface modification methods of poly(arylsulfone) membranes for biomedical applications

Considerable methods have so far been used for the surface modification of biomedical membranes. Several reviews and articles have been published on the improvements achieved in the field of poly(arylsulfone) membranes subjected to various surface modification methods and used in biomedical applications. This review concentrates on the surface modification, biological applications and future perspective of the poly(arylsulfone) biomedical membranes. Different surface modification procedures employed for the poly(arylsulfone) membranes have been classified, studied and compared. Diverse surface modification techniques include surface coating, chemical modification and immobilization/cross-linking, grafting, surface zwitterionicalization, mussel-inspired coating and layer-by-layer assembly. Furthermore, we review the recent research studies performed on the surface modification of the poly(arylsulfone) biomedical membranes. Meanwhile, the properties of biomedical membranes are also discussed in each section. At last, the future perspective and challenges of the strategies utilized for the surface modification of poly(arylsulfone) biomedical membranes are presented.

Electrospun fibers based on botanical, seaweed, microbial, and animal sourced biomacromolecules and their multidimensional applications

This review summarizes and broadly classifies all of the major sustainable natural carbohydrate bio-macromolecular manifestations in nature - from botanical (cellulose, starch, and pectin), seaweed (alginate, carrageenan, and agar), microbial (bacterial cellulose, dextran, and pullulan), and animal (hyaluronan, heparin, chitin, and chitosan) sources - that have been contrived into electrospun fibers. Furthermore, a relative study of these biomaterials for the fabrication of nanofibers by electrospinning and their characteristics viz. solution behavior, blending nature, as well as rheological and fiber attributes are discussed. The potential multidimensional applications of nanofibers (filtration, antimicrobial, biosensor, gas sensor, energy storage, catalytic, and tissue engineering) originating from these polysaccharides and their major impacts on the properties, functionalities, and uses of these electrospun fibers are compared and critically examined.

Antithrombin III-mediated blood coagulation inhibitory activity of chitosan sulfate derivatized with different functional groups

Acylated chitosan sulfate (ChS1), a sulfated polysaccharide with high anticoagulant activity, was chemically synthesized and structurally characterized using FT-IR analysis. The beneficial structural properties and high availability of the sulfate group in ChS1 led to greater anticoagulant activity through both the intrinsic and common pathways with antithrombin III (AT III)-mediated inhibition, particularly involving coagulation factors FXa and FIIa. The analysis of the binding affinities using surface plasma resonance found that the equilibrium dissociation constant (K_D) of ChS1 for FXa and FIIa in the presence of AT III was 67.4 nM and 112.6 nM, respectively, indicating the stronger interaction of the AT III/ChS1 complex with the ligands and the inhibition of activated FX and FII. The results of amidolytic assays further demonstrated the stronger inhibition of the proteolytic conversion of factor X by the intrinsic FXase complex and of FII by the prothrombinase complex. Molecular docking analysis further validated the protein-ligand interactions of ChS1 with AT III and their binding affinity.

Vascular cell responses to silicone surfaces grafted with heparin-like polymers: surface chemical composition vs. topographic patterning

Heparin-like polymers are promising synthetic materials with biological functionalities, such as anticoagulant ability, growth factor binding to regulate cellular functions, and inflammation mediation, similar to heparin. The biocompatibility of heparin-like polymers with well-defined chemical structures has inspired many researchers to design heparin-like surfaces to explore their biological applications. The concept of the recombination of functional heparin structural units (sulfonate- and glyco-containing units) was proven to be successful in designing heparin-mimicking surfaces. However, besides surface structural units, topographic patterning is also an important contributor to the biological activity of the surfaces modified with heparin-like polymers. In this work, both surface structural units and topographic patterning were taken into account to investigate the vascular cell behaviors on the silicone surfaces. A facile method for the production of patterned bromine-containing polydimethylsiloxane surface (PDMS-Br) was developed from a one-step multicomponent thermocuring procedure and replica molding using a nanohole-arrayed silicon template. Different structural units of heparin-like polymers, i.e. homopolymer of sulfonate-containing sodium 4-vinylbenzenesulfonate (pSS), homopolymer of glyco-containing 2-(methacrylamido)glucopyranose (pMAG), and copolymers of MAG and SS (pSG), were then introduced on the flat and patterned PDMS-Br surface using visible light-induced graft polymerization. For the flat surfaces, compared with the PDMS-Br surface, pSS-grafted and pSG-grafted surfaces significantly increased cell densities of both human umbilical vein endothelial cells (HUVECs) and human umbilical vein smooth muscle cells (HUVSMCs), indicating that they are "vascular cell-friendly". In contrast, the pMAG-grafted surface showed decreased cell attachment of both HUVECs and HUVSMCs, indicating that the pMAG-grafted surface is "vascular cell-resistant". Moreover, surface topographic patterning enhanced the cell responses to the corresponding flat surfaces. That is to say, surface patterning can make the "vascular cell-friendly" surface still friendly, and the "vascular cell-resistant" surface much more resistant. The combination of surface structural units and topographic patterning shows promise in the preparation of new heparin-like surfaces with improved cell compatibility that is suitable for blood-compatible biomaterials.

Selective potassium uptake via biocompatible zeolite-polymer hybrid microbeads as promising binders for hyperkalemia

Patients with chronic kidney disease are at high risk of hyperkalemia that is associated with various life-threatening complications. Treatments primarily rely on orally administered potassium binding agents, along with low curative effects and various side effects. Herein, direct serum potassium uptake was realized via zeolite–heparin-mimicking-polymer hybrid microbeads. The preparation process involved the synthesis of the heparin-mimicking polymer via the in situ cross-linking polymerization of acrylic acid and N-vinylpyrrolidone in polyethersulfone solution, the fabrication of microbeads via zeolite-mixing, electro-spraying and phase-inversion, and the subsequent aqueous-phase modifications based on ion-exchange and metal-leaching. An ultra-high (about 88%) amount of zeolite could be incorporated and well locked inside the polymer matrix. Potassium uptake capability was verified in water, normal saline and human serum, showing high selectivity and fast adsorption. The microbeads exhibited satisfying blood compatibility, negligible hemolysis ratio, prolonged clotting time, inhibited contact activation, and enhanced antifouling property toward serum proteins and cells. The proposed approach toward zeolite–heparin-mimicking-polymer hybrid microbeads provided a cheap, efficient and safe treatment protocol of hyperkalemia for the high-risk patients.

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Zeolite–heparin-mimicking-polymer hybrid microbeads were prepared for potassium uptake.

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An ultra-high (~88%) amount of zeolite could be well locked inside the polymer matrix.

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Potassium uptake by microbeads exhibited high selectivity and fast adsorption.

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The microbeads exhibited excellent blood compatibility.

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The proposed method is cheap, efficient and safe to treat hyperkalemia.

Heparin mimics and fibroblast growth factor-2 fabricated nanogold composite in promoting neural differentiation of mouse embryonic stem cells

The replacement therapy or transplantation using neural cells, which differentiated from stem cells, has emerged as a promising strategy for repairing damaged neural tissues and helping functional recovery in the treatment of neural system diseases. The challenge, however, is how to control embryonic stem cell fate so that neural differentiation can be efficiently directed to enrich a neuron cell population, and meanwhile to maintain their bioactivities. This is a key question and has a very significant impact in regenerative medicine. Here we proposed a new neural-differentiation inductive nanocomposite, containing gold nanoparticles (AuNPs), poly(2-methacrylamido glucopyranose-co-3-sulfopropyl acrylate) (PMS), and basic fibroblast growth factor (FGF2), for the high efficient directional neural-specific differentiation of mouse embryonic stem cells (mESCs). In this AuNP-PMS/FGF2 composite, PMS, playing as the high-active mimic of heparin/heparan sulfate (HS), is covalently anchored to AuNPs and bound with FGF2 on the surface of nanoparticles, forming a HS/FGF2 complex nanomimics to facilitate its binding to FGF receptor (FGFR) and promote high neural-inductive activity of mESCs. The stability, bioactivity and biocompatibility of the composite are investigated in this study. The results showed that the AuNP-PMS/FGF2 composite could maintain a long-term stability at room temperature for at least 8 days, and greatly promote the neural differentiation of mESCs. Compared with the other materials, the AuNP-PMS/FGF2 composite could significantly stimulate the expression of the specific neural differentiation markers (nestin and β3-tubulin), while obviously down-regulate the mRNA production of pluripotency marker Oct-4 in mESCs. Moreover, the promotion effect of the composite on neuronal maturation marker β3-tubulin expression achieved maximally at the low concentration of FGF2 (4 ng/mL), which suggested the high efficiency of AuNP-PMS/FGF2 composite in neural differentiation of mESCs. Meanwhile, both mESCs and L929 cells showed desirable growth during the incubation with AuNP-PMS/FGF2 composite. The AuNP-PMS/FGF2 system presents a new way to achieve HS/FGF2 complex nanomimics efficiently for the neural differentiation of mESCs.

Preparation of multifunctional poly(l-lactic acid) film using heparin-mimetic polysaccharide multilayers: Hemocompatibility, cytotoxicity, antibacterial and drug loading/releasing properties

Poly(l-lactic acid) (PLLA) has been the most commonly used polymer for making bioresorbable vascular scaffolds (BVS). Despite owning remarkable properties, BVS made from PLLA are facing higher rates of early thrombosis compared with permanent metallic scaffolds. To solve this issue, we modified the PLLA film surface with heparin-mimetic polysaccharide multilayers consisting of sulfated Chinese yam polysaccharide (SCYP) and chitosan (CS) through layer-by-layer (LBL) assembly. The surface chemical compositions, morphologies and growth manner of SCYP/CS multilayers were investigated using X-ray photoelectron spectroscopy, scanning electron microscopy, atomic force microscopy and UV-vis spectroscopy. The relevant hemocompatibility results showed that multilayer-modified PLLA could effectively resist protein adsorption, suppress the platelet adhesion, prolong clotting time, prevent contact and complement activation as well as reduce hemolysis rate. Moreover, the multilayer-modified PLLA exhibited non-cytotoxicity, good antibacterial ability against E. coli and S. aureus, and drug loading/sustained releasing behavior. Overall, the multifunctional PLLA film with integrated properties of hemocompatibility, non-cytotoxicity, antibacterial and drug loading/releasing behavior could be successfully achieved by deposition of SCYP/CS multilayers, which will have potential application in blood-contacting biomedical materials.

Ascidian-Inspired Heparin-Mimetic Magnetic Nanoparticles with Potential for Application in Hemodialysis as Recycling Anticoagulants

In the present study, heparin-mimetic magnetic nanoparticles (HMNPs), which might be used as recycling anticoagulants, were synthesized by coating heparin-mimetic sodium alginate (HLSA) on the surface of iron oxide magnetic nanoparticles (MNPs), using 3,4,5-trihydroxyphenylalanine (TOPA) as a biological adhesive. HLSA was successfully immobilized on the MNP surface, as revealed by Fourier transform infrared spectroscopy and thermal gravimetric analysis, and the core (MNP)-shell (TOPA, HLSA) structure was confirmed by transmission electron microscopy observations. In addition, in vitro studies of protein adsorption, blood clotting time, and contact activation confirmed that the blood compatibility of the HMNP was significantly enhanced compared with the bare MNP. The improved hemocompatibility was attributed to the introduction of the multiple heparin-mimetic groups (-SO₃Na, -COONa, and -OH). In addition, the HMNP showed outstanding recycle stability and, thus, can be reused if needed. The synthesized HMNP appeared to be a suitable biomaterial to safely replace heparin as an anticoagulant in patients undergoing long-term hemodialysis.

Recent advances in heparinization of polymeric membranes for enhanced continuous blood purification

Continuous blood purification technology such as hemodiafiltration has been used worldwide for saving patients suffering from severe diseases or organ function failure, especially in the intensive care unit and emergency setting. The filters as core devices are commonly made of polymer materials as hollow fiber membranes. However, the membrane is often inductively blocked by blood clot formation due to its interactions with blood components. Heparin is the anticoagulant often used in clinical practice for anti-coagulation. Recently, heparin is also employed to modify the hollow fiber membranes either chemically or physically to improve the filtration performance. This review summarizes recent advances in methodology for surface heparinization of such hollow fiber membranes, and their filtration performance improvement. The review also provides expert opinions for further research in this rapidly expanding field.

Wavy small-diameter vascular graft made of eggshell membrane and thermoplastic polyurethane

In this study, a small-diameter, double-layered eggshell membrane/thermoplastic polyurethane (ESM/TPU) vascular graft with a wavy structure was developed. The avian eggshell membrane, a fibrous structure similar to the extracellular matrix (ECM), has the potential to yield rapid endothelialization in vitro. The dopamine and heparin modification of the ESM surface not only promoted human umbilical vein endothelial cell (HUVEC) proliferation via cytocompatibility assessment, but also improved its anticoagulation properties as verified in platelet adhesion tests. The biomimetic mechanical properties of the vascular graft were provided by the elastic TPU fibers via electrospinning using a wavy cross-section rotating collector. The advantage of combining these two materials is to make use of the bioactivity of ESM as the internal membrane and the tunable mechanical properties of TPU as the external layer. The circumferentially wavy structure of the vascular graft produced a toe region in the non-linear section of the stress-strain curve similar to that of natural blood vessels. The ESM/TPU graft's circumferential ultimate strength was 2.57 MPa, its strain was 339% mm/mm, and its toe region was found to be around 20% mm/mm. Cyclical tension tests showed that the vascular graft could maintain good mechanical properties and showed no structural damage under repeated extension tests.

A chitosan modified asymmetric small-diameter vascular graft with anti-thrombotic and anti-bacterial functions for vascular tissue engineering

Rapid endothelialization and prevention of restenosis are two vital challenges for the preparation of a small-diameter vascular graft (SDVG), while postoperative infection after implantation is often neglected.