Advances in Enhancing Hemocompatibility of Hemodialysis Hollow-Fiber Membranes

Hemodialysis, the most common modality of renal replacement therapy, is critically required to remove uremic toxins from the blood of patients with end-stage kidney disease. However, the chronic inflammation, oxidative stress as well as thrombosis induced by the long-term contact of hemoincompatible hollow-fiber membranes (HFMs) contribute to the increase in cardiovascular diseases and mortality in this patient population. This review first retrospectively analyzes the current clinical and laboratory research progress in improving the hemocompatibility of HFMs. Details on different HFMs currently in clinical use and their design are described. Subsequently, we elaborate on the adverse interactions between blood and HFMs, involving protein adsorption, platelet adhesion and activation, and the activation of immune and coagulation systems, and the focus is on how to improve the hemocompatibility of HFMs in these aspects. Finally, challenges and future perspectives for improving the hemocompatibility of HFMs are also discussed to promote the development and clinical application of new hemocompatible HFMs.

Graphical Abstract

A self-cleaning zwitterionic nanofibrous membrane for highly efficient oil-in-water separation

The oil and bacteria adhesion during membrane separation process brings great challenges to the operation costs and membrane service life. Meantime, the strong chemical corrosion in sewage seriously limits the durability of membrane as well. Herein, a facile strategy is developed for fabricating highly stable and efficient zwitterionic nanofibrous membrane (NFM) with self-cleaning feature via the combination of in-situ cross-linking of poly (sulfobetaine methacrylate) (PSBMA) and electrospun poly (ether sulfone) (PES) nanofibers. Owing to the introduction of zwitterionic functional groups, the PSBMA/PES NFM exhibits superior antifouling ability (over 3 cycles of crude oil fouling/self-cleaning and up to 7 days of bacteria adhesion/repelling tests). Moreover, the membrane also presents remarkable chemical stability in acidic, alkaline and salty environments; and exhibits excellent separation performance for both layered oil/water mixture and oil-in-water emulsion as well. Furthermore, the membrane is capable to remove bacteria during the continuous oil/water mixture separation. Overall, the proposed strategy provides a new perspective into developing long-term antifouling membrane materials for complicated oily wastewater remediation in various corrosive environments.

Hemocompatible magnetic particles with broad-spectrum bacteria capture capability for blood purification

Pathogen capture and removal from whole blood is a new strategy for extracorporeal blood purification, especially in initial treatment of sepsis before pathogen identification. Herein, hemocompatible magnetic particles with broad-spectrum bacteria capture capability were proposed for pathogen removal from whole blood, omitting the necessity of pathogen identification. Firstly, we designed and synthesized a new kind of imidazolium-based ionic liquid with good antibacterial activity, and polydopamine coating was utilized as a hemocompatible platform to immobilize ionic liquids on Fe₃O₄ nanoparticles, forming the hemocompatible magnetic particles (Fe₃O₄@PDA-IL). The magnetic particles exhibited good hemocompatibility and performed well in the removal of various species of clinically significant pathogens from human whole blood, including S. aureus, E. coli, and the hard-to-treat bacteria of P. aeruginosa and Methicillin-resistant S. aureus, which are the most common pathogens in bloodstream infections. Besides, the Fe₃O₄@PDA-IL particles were also capable to remove bacterial endotoxins from blood, inhibiting further aggravation of sepsis. Overall, we demonstrated the application of hemocompatible magnetic particles in the removal of pathogens and bacterial endotoxins from whole blood via electrostatic and hydrophobic interactions, without significant effects on blood cells or the activation of coagulation and complement, addressing the feasibility of using imidazolium-based ionic liquids for bacteria capture and removal from whole blood. It would contribute to the development of magnetic separation-based approaches to remove bacteria and bacterial endotoxin for extracorporeal blood purification, especially in initial sepsis therapy before pathogen identification.

Green Fabrication of Tannic Acid-Inspired Magnetic Composite Nanoparticles toward Cationic Dye Capture and Selective Degradation

An environmental strategy for developing sustainable materials presents an attractive prospect for wastewater remediation. Herein, a facile, green, and economical strategy is proposed to fabricate magnetic composite nanoparticles (NPs) toward cationic dye adsorption and selective degradation. To prepare the composite TiO2-PEI-TA@Fe3O4 NPs, tannic acid (TA) and polyethyleneimine (PEI) were first used to decorate Fe3O4 NPs at aqueous solution, and then TiO2 NPs were anchored onto the surfaces of Fe3O4 NPs based on the catecholamine chemistry. The chemical composition and microstructure of the obtained NPs were systematically characterized. The NPs not only exhibited adsorption ability for the cationic dye of methylene blue (MB) but also responded to ultraviolet light to selectively degrade the adsorbed MB, and the removal (adsorption and/or degradation) ratio for MB could reach 95%. In addition, cyclic experiments showed that the removal ratio of the composite NPs for MB could still be maintained more than 85% even after five cycles. Given by the above-mentioned advantages, such a green and facile strategy for combining the adsorption and degradation methods to construct magnetic nanocomposites exhibits potential applications in cationic dye selective removal and sustainable wastewater remediation.

In vitro and in vivo anticoagulant activity of heparin-like biomacromolecules and the mechanism analysis for heparin-mimicking activity

Heparin-like biomacromolecules (HepLBm), exhibiting similar chemical structure and biological properties to heparin, can be obtained by modifying either synthetic biopolymers or natural biomacromolecules with physical or chemical methods. In this work, a low-cost and biocompatible sodium alginate was chosen as a model biomacromolecule to design anticoagulant HepLBm with a similar sulfation degree to heparin. FTIR, ¹H NMR, and element analysis data were used to confirm the chemical structure of HepLBm. Hemolysis tests, clotting time, complement activation, and contact activation tests were carried out to determine the in vitro anticoagulant activity of HepLBm. In addition, systematic studies of blood cell count, coagulation function, and histopathology were performed to demonstrate the in vivo anticoagulant activity and toxicity of HepLBm with SD rat experiments. Furthermore, a series of linear molecules containing carboxyl groups, sulfonic groups, and hydroxyl groups were selected and their clotting time was tested to provide a mechanism analysis for the excellent anticoagulant activity of HepLBm. With the excellent in vitro/in vivo anticoagulant activity, good biocompatibility, and low cost, the HepLBm synthesized in this work would have great potential for substitution of heparin in many application fields, such as the surface modification of biomedical devices, extracorporeal anticoagulants, and other clinical fields.

A substrate-independent ultrathin hydrogel film as an antifouling and antibacterial layer for a microfiltration membrane anchored via a layer-by-layer thiol-ene click reaction

Herein, a substrate-independent ultrathin hydrogel film was constructed on a microfiltration membrane through layer-by-layer (LbL) thiol-ene click chemistry to improve the antifouling and antibacterial properties. In our strategy, ene-functionalized dopamine was synthesized and coated onto a model substrate (polyethersulfone membrane) to introduce double bonds as anchoring sites for the hydrogel film; thiol-functionalized poly[oligo(ethylene glycol)mercaptosuccinate] (POEGMS) and ene-functionalized P(SBMA-co-AA) were synthesized as hydrogel precursors. The membrane was alternately immersed in the precursor solutions to form the ultrathin hydrogel film. Finally, Ag nanoparticles (AgNPs) were loaded into the hydrogel layer by adsorption and reduction procedures. By coating the hydrogel films, the loaded AgNPs could kill almost all the contacting bacteria and the bacteria in the surroundings, and the enhanced hydrophilicity of the modified membrane could effectively prevent the attachment of the bacteria. The membrane flux showed no significant decrease, the rejection ratio of BSA increased from 51% to 89%, and the F_RR increased from 36% to 90%. Moreover, the improvement of the hemocompatibility was confirmed by the decline in the plasma protein adsorption, prolonged clotting times, low hemolysis ratio, and prevention of platelet adhesion. Compared with that of other techniques for attaching hydrogel films, the main advantage of the current technique is that the hydrogel film thickness could be well controlled within the nanometer range; thus, it could significantly improve the antifouling and antibacterial properties of the membrane, but without compromising its permeability. Another advantage is that it is versatile for various substrates such as PVDF, PAN, and CA. This study opens up a facile and versatile route for anchoring ultrathin hydrogel film onto polymeric membranes to achieve excellent antifouling, antibacterial and hemocompatible properties.

Design of Carrageenan-Based Heparin-Mimetic Gel Beads as Self-Anticoagulant Hemoperfusion Adsorbents

The currently used hemoperfusion adsorbents such as activated carbon and ion-exchange resin show dissatisfactory hemocompatibility, and a large dose of injected heparin leads to the increasing cost and the risk of systematic bleeding. Natural polysaccharide adsorbents commonly have good biocompatibility, but their application is restricted by the poor mechanical strength and low content of functional groups. Herein, we developed an efficient, self-anticoagulant and blood compatible hemoperfusion adsorbent by imitating the structure and functional groups of heparin. Carrageenan and poly(acrylic acid) (PAA) cross-linked networks were built up by the combination of phase inversion of carrageenan and post-cross-linking of AA, and the formed dual-network structure endowed the beads with improved mechanical properties and controlled swelling ratios. The beads exhibited low protein adsorption amounts, low hemolysis ratios, low cytotoxicity, and suppressed complement activation and contact activation levels. Especially, the activated partial thromboplastin time, prothrombin time, and thrombin time of the gel beads were prolonged over 13, 18, and 4 times than those of the control. The self-anticoagulant and biocompatible beads showed good adsorption capacities toward exogenous toxins (560.34 mg/g for heavy metal ions) and endogenous toxins (14.83 mg/g for creatinine, 228.16 mg/g for bilirubin, and 18.15 mg/g for low density lipoprotein (LDL)), thus, highlighting their potential usage for safe and efficient blood purification.

Hemocompatible poly(lactic acid) membranes prepared by immobilizing carboxylated graphene oxide via mussel-inspired method for hemodialysis

Carboxylated graphene oxide modified PLA membrane via mussel-inspired method exhibited excellent hemocompatibility and dialysis performance.

Polydopamine–polyethylene glycol–albumin antifouling coatings on multiple substrates

Polydopamine–PEG coatings on different substrates: effects of PDA layer properties on PEG grafting and anti-biofouling properties.