In vitro hemocompatibility screening of a slippery liquid impregnated surface coating for extracorporeal organ support applications

INTRODUCTION

Clot formation, infection, and biofouling are unfortunate but frequent complications associated with the use of blood-contacting medical devices. The challenge of blood-foreign surface interactions is exacerbated during medical device applications involving substantial blood contact area and extended duration of use, such as extracorporeal life support (ECLS). We investigated a novel surface modification, a liquid-impregnated surface (LIS), designed to minimize protein adsorption and thrombus development on medical plastics.

METHODS

The hemocompatibility and efficacy of LIS was investigated first in a low-shear model with LIS applied to the lumen of blood incubation vials and exposed to human whole blood. Additionally, LIS was evaluated in a 6 h ex vivo circulation model with swine blood using full-scale ECLS circuit tubing and centrifugal pumps with clinically relevant flow rate (1.5 L/min) and shear conditions for extracorporeal carbon dioxide removal.

RESULTS

Under low-shear, LIS preserved fibrinogen concentration in blood relative to control polymers (+40 ± 6 mg/dL vs polyvinyl chloride, p < .0001), suggesting protein adsorption was minimized. A fibrinogen adhesion assay demonstrated a dramatic reduction in protein adsorption under low shear (87% decrease vs polyvinyl chloride, p = .01). Thrombus deposition and platelet adhesion visualized by scanning electron microscopy were drastically reduced. During the 6 h ex vivo circulation, platelets in blood exposed to LIS tubing did not become significantly activated or procoagulant, as occurred with control tubing; and again, thrombus deposition was visually reduced.

CONCLUSIONS

A LIS coating demonstrated potential to reduce thrombus formation on medical devices. Further testing is needed specialized to clinical setting and duration of use for specific medical target applications.

Construction of Hierarchical Micro/Nanostructured ZnO/Cu-ZnMOFs@SA Superhydrophobic Composite Coatings with Excellent Multifunctionality of Anticorrosion, Blood-Repelling, and Antimicrobial Properties

Naked medical devices are often damaged by blood, bacteria, and other extreme environmental conditions (heat, humidity, acid, alkali, salts, and others), causing device failure and increasing difficulty for the operator. They can also cause inflammation and coagulation resulting in severe complications and even death. In this work, the superhydrophobic ZnO/copper-zinc metal-organic frameworks@stearic acid (ZnO/Cu-ZnMOFs@SA) composite coatings with hierarchical micro/nanostructures were fabricated on Zn substrates via a one-step hydrothermal method. The effects of hierarchical micro/nanostructures on surface wettability, physicochemical stability, and biological properties have been studied in this manuscript. The structure not only provided the coatings with robust waterproofing, abrasive resistance, durability, and thermal and light irradiation stability but also successfully recovered their superhydrophobicity by remodifying the surface with SA, showing excellent repeatability. In addition, the coating demonstrates excellent corrosion resistance and self-cleaning ability and rejects various solid and liquid contaminants. The superhydrophobic ZnO/Cu-ZnMOFs@SA composite coatings also exhibited excellent antibacterial and thrombosis resistance. The findings indicated that the superhydrophobic composite coatings have a strong potential for application in medical instruments for exhibiting multifunctional properties in various extreme environments.

Superhydrophobic Biological Fluid-Repellent Surfaces: Mechanisms and Applications

Superhydrophobic biological fluid-repellent surfaces (SBFRSs) have attracted great attention in the treatment of blood and urine-related diseases because of their unique wettability and compatibility, which creates a new path for the development of medical apparatus and instruments, and are expected to create advances in various fields. Here, this review provides an up-to-date summary of research progress on the repellent mechanism and application of SBFRSs. The underlying physical and chemical principles for designing superhydrophobic surfaces are first introduced. Then, the dialectical influences of solid-liquid interactions between superhydrophobic surfaces and biological fluids on the wettability and compatibility are emphatically expounded. Subsequently, attention is drawn to the recent applications of SBFRSs in biomedical fields, such as surgical medical apparatus, implant materials, extracorporeal circulation devices, and biological fluid detection. Finally, the outlook and challenges in terms of employing SBFRSs are also discussed. This review is expected to provide a comprehensive guidance for the preparation of SBFRSs with compatibility and long-term superhydrophobic stability that is closely related to clinical applications.

Tailoring Materials with Specific Wettability in Biomedical Engineering

As a fundamental feature of solid surfaces, wettability is playing an increasingly important role in our daily life. Benefitting from the inspiration of biological paradigms and the development in manufacturing technology, numerous wettability materials with elaborately designed surface topology and chemical compositions have been fabricated. Based on these advances, wettability materials have found broad technological implications in various fields ranging from academy, industry, agriculture to biomedical engineering. Among them, the practical applications of wettability materials in biomedical-related fields are receiving remarkable researches during the past decades because of the increasing attention to healthcare. In this review, the research progress of materials with specific wettability is discussed. After briefly introducing the underlying mechanisms, the fabrication strategies of artificial materials with specific wettability are described. The emphasis is put on the application progress of wettability biomaterials in biomedical engineering. The prospects for the future trend of wettability materials are also presented.

Enhancement of the anticoagulant capacity of polyvinyl chloride tubing for cardiopulmonary bypass circuit using aluminum oxide nanoscale coating applied through atomic layer deposition

For cardiopulmonary bypass, the polyvinyl chloride (PVC) circuit which can initiate the activation of platelets and the coagulation cascade after blood cell contacting is the possible detrimental effect. Surface coating of the PVC tubing system can be an effective approach to enhance circuit's hemocompatibility. In this study, aluminum oxide (Al₂ O₃ ) thin films were deposited through thermal atomic layer deposition (T-ALD) or plasma-enhanced ALD (PE-ALD) on PVC samples, and the anticoagulation of the Al₂ O₃ -coated PVC samples was demonstrated. The results revealed that Al₂ O₃ deposition through ALD increased surface roughness, whereas T-ALD had a relative hydrophilicity compared with blank PVC and PE-ALD. Whole blood immersion tests showed that blood clots formed on blank PVC and that a large amount of red blood cells was found on PE-ALD substrates, whereas less blood cells were noted in T-ALD samples. Both T-ALD and PE-ALD Al₂ O₃ films did not cause activation of blood cells, as evidenced in CD3⁺ /CD4⁺ /CD8⁺ , CD61⁺ /CD62P⁺ , and CD45⁺ /CD42b⁺ populations. Analysis of serum coagulation factors showed that a lower amount of prothrombin was absorbed on T-ALD Al₂ O₃ samples than that on blank PVC. For albumin and fibrinogen immersion tests, immunostaining and scanning electron microscopy further revealed that a thin albumin layer was absorbed on T-ALD Al₂ O₃ substrates but not on PVC samples. This study revealed that deposition of Al₂ O₃ films by T-ALD can improve anticoagulation of the PVC tubing system.

Potential of Superhydrophobic Surface for Blood-Contacting Medical Devices

Medical devices are indispensable in the healthcare setting, ranging from diagnostic tools to therapeutic instruments, and even supporting equipment. However, these medical devices may be associated with life-threatening complications when exposed to blood. To date, medical device-related infections have been a major drawback causing high mortality. Device-induced hemolysis, albeit often neglected, results in negative impacts, including thrombotic events. Various strategies have been approached to overcome these issues, but the outcomes are yet to be considered as successful. Recently, superhydrophobic materials or coatings have been brought to attention in various fields. Superhydrophobic surfaces are proposed to be ideal blood-compatible biomaterials attributed to their beneficial characteristics. Reports have substantiated the blood repellence of a superhydrophobic surface, which helps to prevent damage on blood cells upon cell-surface interaction, thereby alleviating subsequent complications. The anti-biofouling effect of superhydrophobic surfaces is also desired in medical devices as it resists the adhesion of organic substances, such as blood cells and microorganisms. In this review, we will focus on the discussion about the potential contribution of superhydrophobic surfaces on enhancing the hemocompatibility of blood-contacting medical devices.

The Effects of Subcellular Nanograting Geometry on the Formation and Growth of Bacterial Biofilms

Biofilm formation by bacteria protects them against environmental stresses such as desiccation, shear forces and antimicrobial agents, making them much harder to remove and increasing their virulence and persistence in industrial water systems and biomedical equipment. One promising method of disrupting biofilm formation and growth is to employ passive surface structures to inhibit bacterial adhesion and aggregation. However, most studies thus far have mainly focused on the early stages of biofilm formation and it is unclear if the influence of surface topography in the early phase will propagate to later stages. Here, we attempt to address this with an investigation into the biofilm formation of Pseudomonas aeruginosa on 25 different nanograting geometries, with dimensions that were systematically varied from subcellular to cellular sizes. The biofilms were characterized from the exponential growth phase to the decline phase, in intervals of 24 H over 4 days, using confocal scanning laser microscopy. Comparing the maximum volume of biofilm formed on each surface over 96 H, it was found that approximately 1/3 of the nanograting geometries exhibited 72 ± 16 % lower biovolume density than a flat surface. Bacteria on these nanogratings were also observed to form 40 ± 11 % smaller microcolonies that were 17 ± 6 % less compact than that found on the control surface. The majority of these nanogratings had deep trenches (i.e. depth ≥ 70% of the cell diameter). Furthermore, P. aeruginosa cells were observed to multiply at approximately twice the rate on almost all the nanogratings compared to flat surfaces, but these cell populations also began to decline 24 H earlier than those on a flat surface. Using available literature on P. aeruginosa, a qualitative model was put forth, attributing the results to increased cell motility, decreased exopolysaccharide formation and disrupted psl adhesin/signal trails on nanogratings. These factors, together, led to the net effects of reduced attachment, increased scattering of cells and rapid decline of the biofilms on nanogratings. The insights derived from this study suggest that passive surface geometries can be designed and optimized to successfully control/inhibit biofilm formation and growth.

Hemocompatibility of Super-Repellent surfaces: Current and Future

Virtually all blood-contacting medical implants and devices initiate immunological events in the form of thrombosis and inflammation. Typically, patients receiving such implants are also given large doses of anticoagulants, which pose a high risk and a high cost to the patient. Thus, the design and development of surfaces with improved hemocompatibility and reduced dependence on anticoagulation treatments is paramount for the success of blood-contacting medical implants and devices. In the past decade, the hemocompatibility of super-repellent surfaces (i.e., surfaces that are extremely repellent to liquids) has been extensively investigated because such surfaces greatly reduce the blood-material contact area, which in turn reduces the area available for protein adsorption and blood cell or platelet adhesion, thereby offering the potential for improved hemocompatibility. In this review, we critically examine the progress made in characterizing the hemocompatibility of super-repellent surfaces, identify the unresolved challenges and highlight the opportunities for future research on developing medical implants and devices with super-repellent surfaces.

Durable, flexible, superhydrophobic and blood-repelling surfaces for use in medical blood pumps

A new sand-casting method for fabricating superhydrophobic materials gives highly durable, flexible, and blood-repelling surfaces useful for cardiovascular medical devices.

Water and Blood Repellent Flexible Tubes

A top-down scalable method to produce flexible water and blood repellent tubes is introduced. The method is based on replication of overhanging nanostructures from an aluminum tube template to polydimethylsiloxane (PDMS) via atomic layer deposition (ALD) assisted sacrificial etching. The nanostructured PDMS/titania tubes are superhydrophobic with water contact angles 163 ± 1° (advancing) and 157 ± 1° (receding) without any further coating. Droplets are able to slide through a 4 mm (inner diameter) tube with low sliding angles of less than 10° for a 35 µL droplet. The superhydrophobic tube shows up to 5,000 times increase in acceleration of a sliding droplet compared to a control tube depending on the inclination angle. Compared to a free falling droplet, the superhydrophobic tube reduced the acceleration by only 38.55%, as compared to a 99.99% reduction for a control tube. The superhydrophobic tubes are blood repellent. Blood droplets (35 µL) roll through the tubes at 15° sliding angles without leaving a bloodstain. The tube surface is resistant to adhesion of activated platelets unlike planar control titania and smooth PDMS surfaces.