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Martins GM, da Silva Braz JKF, de Macedo MF, de Oliveira Vitoriano J, Alves Júnior C, Santos CS, Feijó FMC, de Oliveira MF, de Moura CEB. Enhancing Titanium Disk Performance through In-Pack Cold Atmospheric Plasma Treatment. ACS Biomater Sci Eng 2024; 10:1765-1773. [PMID: 38357873 DOI: 10.1021/acsbiomaterials.3c01388] [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] [Indexed: 02/16/2024]
Abstract
While titanium dental implants have already been clinically established, ongoing research is continuously being conducted to advance the fields of osseointegration and bacterial resistance, seeking further improvements in these areas. In this study, we introduce an innovative method for treating titanium surfaces within tightly sealed packaging. Specifically, titanium discs, enclosed in surgical-grade packaging, underwent treatment using cold atmospheric plasma (CAP). The surfaces were thoroughly characterized in terms of wettability, crystalline structure, and chemical composition. Hemocompatibility analyses were conducted using blood diluted in sodium citrate (1:9) exposed to titanium discs for 30 min inside a CO2 incubator at 37 °C. Subsequently, various blood parameters were evaluated, including prothrombin time (PT), activated partial thromboplastin time (APTT), and platelet adhesion. Microbiological analyses were also performed using Pseudomonas aeruginosa (ATCC 27853) for 4 h at 37 °C. The treatment with CAP Jet resulted in a reduction in contact angle without causing any changes in the crystalline structure. No statistically significant differences were observed in the blood parameters. The plasma-treated samples exhibited lower PT and APTT values compared to those of the control group. The surfaces treated with CAP Jet showed increased platelet activation, platelet density, and thrombus formation when compared with the untreated samples. Moreover, the treated surfaces demonstrated lower bacterial colony formation compared with other surfaces.
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Affiliation(s)
- Gabriel Moura Martins
- Department of Health Sciences, Federal University of Rio Grande do Norte (UFRN), Campus Universitário UFRN, Lagoa Nova, 9078-970 Natal, RN, Brazil
| | | | - Michelly Fernandes de Macedo
- Department of Animal Sciences, Federal Rural University of Semi-Arid Region (UFERSA), Av. Francisco Mota, 572, Costa e Silva, 59625-900 Mossoró, RN, Brazil
| | - Jussier de Oliveira Vitoriano
- Plasma Laboratory Applied to Agriculture, Health and Environment, UFERSA, Av. Francisco Mota, 572, Costa e Silva, 59625-900 Mossoró, RN, Brazil
| | - Clodomiro Alves Júnior
- Department of Health Sciences, Federal University of Rio Grande do Norte (UFRN), Campus Universitário UFRN, Lagoa Nova, 9078-970 Natal, RN, Brazil
- Aeronautics Institute of Technology, Praça Marechal Eduardo Gomes, 50 - Vila das Acacias, 12228-900 São José dos Campos, SP, Brazil
- Plasma Laboratory Applied to Agriculture, Health and Environment, UFERSA, Av. Francisco Mota, 572, Costa e Silva, 59625-900 Mossoró, RN, Brazil
| | - Caio Sérgio Santos
- Laboratory of Veterinary Microbiology, Center of Agrarian Sciences, Federal Rural, UFERSA, 59625-900 Mossoró, Brazil
| | | | - Moacir Franco de Oliveira
- Department of Animal Sciences, Federal Rural University of Semi-Arid Region (UFERSA), Av. Francisco Mota, 572, Costa e Silva, 59625-900 Mossoró, RN, Brazil
| | - Carlos Eduardo Bezerra de Moura
- Department of Animal Sciences, Federal Rural University of Semi-Arid Region (UFERSA), Av. Francisco Mota, 572, Costa e Silva, 59625-900 Mossoró, RN, Brazil
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2
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Miao B, Liu Y, Zhang A, Cao Y, Zhong R, Liu J, Shao Z. An in situ grown ultrathin and robust protein nanocoating for mitigating thromboembolic issues associated with cardiovascular medical devices. Biomater Sci 2023; 11:7655-7662. [PMID: 37850341 DOI: 10.1039/d3bm01188g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2023]
Abstract
Thromboembolism, arising from the utilization of cardiovascular medical devices, remains a prevalent issue entailing substantial morbidity and mortality. Despite the proposal of various surface modification strategies, each approach possesses inherent limitations and drawbacks. Herein, we propose a novel approach for the in situ growth of nanocoatings on various material surfaces through the cooperative assembly of silk fibroin (SF) and lysozyme. The intrinsic in situ growth characteristic enables the nanocoatings to achieve stable and uniform adherence to diverse substrate surfaces, including the inner surface of intravascular catheters, to redefine the surface properties of the material. The features of the hydrophilic and negatively charged nanocoating contribute to its antithrombotic properties, as evidenced by the reduced likelihood of platelet adhesion upon modification of the ultrathin and mechanically robust coating. In vitro assessment confirms a significant reduction in blood clot formation along with the promotion of anticoagulation. Such a SF/Ly nanocoating holds substantial promise as a surface modification strategy to enhance the hemocompatibility of medical devices and other materials that come into contact with blood, particularly in situations where medical-grade materials are temporarily unavailable, thus providing a feasible alternative.
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Affiliation(s)
- Bianliang Miao
- State Key Laboratory of Molecular Engineering of Polymers, Laboratory of Advanced Materials and Department of Macromolecular Science, Fudan University, Shanghai 200433, China.
| | - Yi Liu
- State Key Laboratory of Molecular Engineering of Polymers, Laboratory of Advanced Materials and Department of Macromolecular Science, Fudan University, Shanghai 200433, China.
| | - Along Zhang
- Institute of Blood Transfusion, Chinese Academy of Medical Sciences & Peking Union Medical College, Chengdu 610052, China
| | - Ye Cao
- Institute of Blood Transfusion, Chinese Academy of Medical Sciences & Peking Union Medical College, Chengdu 610052, China
| | - Rui Zhong
- Institute of Blood Transfusion, Chinese Academy of Medical Sciences & Peking Union Medical College, Chengdu 610052, China
| | - Jiaxin Liu
- Institute of Blood Transfusion, Chinese Academy of Medical Sciences & Peking Union Medical College, Chengdu 610052, China
| | - Zhengzhong Shao
- State Key Laboratory of Molecular Engineering of Polymers, Laboratory of Advanced Materials and Department of Macromolecular Science, Fudan University, Shanghai 200433, China.
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3
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Bonde R, Bonde P. Futuristic perspectives: novel MCS devices. Indian J Thorac Cardiovasc Surg 2023; 39:190-197. [PMID: 37525706 PMCID: PMC10387008 DOI: 10.1007/s12055-023-01519-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 04/06/2023] [Accepted: 04/11/2023] [Indexed: 08/02/2023] Open
Abstract
Treatment of heart failure needs a firm understanding of anatomy and physiology of the circulatory system and the heart. Ancient India takes credit for the "modern concepts" of human circulation. This short review encompasses futuristic perspectives on mechanical circulatory devices (MCS). The heart is a complex structure which has evolved over millennia both in its structure and mechanical functionality. Evolving from a simple tube with peristaltic action such as in annelids, it evolved rapidly to form a more complexity as animals evolved from oceanic to terrestrial adaptation. The major advance is the innovation of placing the actuation mechanism within the blood flow path, such as in continuous flow technology (axial or centrifugal) when contrasted to the positive displacement pumps. We present novel concepts but also touch upon what we would consider as fundamental problems or paradigms that need to be addressed to move this field ahead. Finally, we propose what would be termed a "futuristic" MCS device.
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Affiliation(s)
- Riya Bonde
- Bonde Artificial Heart Lab, Division of Cardiac Surgery, Yale School of Medicine, 204 Boardman 330 Cedar Street, New Haven, CT 06510 USA
| | - Pramod Bonde
- Bonde Artificial Heart Lab, Division of Cardiac Surgery, Yale School of Medicine, 204 Boardman 330 Cedar Street, New Haven, CT 06510 USA
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4
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Walle L, Sudhoff H, Frerichs O, Todt I. Intraluminal Monitoring of Micro Vessels. A Surgical Feasibility Study. Front Surg 2021; 8:681797. [PMID: 34368216 PMCID: PMC8333698 DOI: 10.3389/fsurg.2021.681797] [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] [Received: 03/17/2021] [Accepted: 06/28/2021] [Indexed: 11/13/2022] Open
Abstract
Objective: Monitoring of vessel perfusion is of high clinical importance in vascular anastomosis of free flaps. Current sensor systems are based on different principles and show limitations in validity and accuracy. Fiber optic pressure sensors exhibit high accuracy and are small in size. The aim of the present study was to evaluate the surgical feasibility of intraluminal pressure (ILP) measurements with a fiber optic pressure sensor in an animal model. Methods: In a microsurgical setting we sedated 10 Wistar rats with weight adapted phenobarbital, xylazine, and fentanyl. We performed a surgical approach to A. carotis communis and V. jugularis and introduced a 600 μm fiber optic pressure sensor into the vessels followed by measuring the ILP. The sensor was stabilized by the surrounding tissue, and the vessels were closed. Results: In all cases, surgical placement was uneventful. Measurement of intra-venous and intra-arterial pressure was possible and stable over the whole measurement period of an hour. Conclusion: Fiber optic pressure measurement in microvessels is possible and surgically feasible. An application to monitor the perfusion of free flaps seems possible.
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Affiliation(s)
- Leonard Walle
- Department of Otolaryngology, Head and Neck Surgery, Medical School OWL, Bielefeld University, Bielefeld, Germany
| | - Holger Sudhoff
- Department of Plastic Surgery, Medical School OWL, Bielefeld University, Bielefeld, Germany
| | - Onno Frerichs
- Department of Otolaryngology, Head and Neck Surgery, Medical School OWL, Bielefeld University, Bielefeld, Germany
| | - Ingo Todt
- Department of Plastic Surgery, Medical School OWL, Bielefeld University, Bielefeld, Germany
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5
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Lu Q, Nehrer JM, Li J, Jamiolkowski MA, Rinaldi JE, Malinauskas RA. Platelet and leukocyte count assay for thrombogenicity screening of biomaterials and medical devices: Evaluation and improvement of ASTM F2888 test standard. J Biomed Mater Res B Appl Biomater 2021; 109:2259-2267. [PMID: 34106517 DOI: 10.1002/jbm.b.34887] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 04/14/2021] [Accepted: 05/28/2021] [Indexed: 11/09/2022]
Abstract
An appropriate preclinical thrombogenicity evaluation of a blood-contacting device is important to reduce thrombosis and thromboembolism risks to patients. The in vitro platelet and leukocyte count assay, as described in the ASTM F2888 test standard, aims to assess thrombogenic potentials of blood-contacting materials. The goals of this study were to evaluate whether this standardized test method can effectively differentiate materials with different thrombogenic potentials and to investigate the impact of anticoagulation conditions on test sensitivity. Using human blood with various anticoagulation conditions, we performed the platelet and leukocyte count assays on four biomaterials and three positive control materials. We found that the use of sodium citrate anticoagulation as stipulated in the 2013 version of the ASTM F2888 standard cannot differentiate materials with different thrombogenic potentials. The modification to use low-concentration heparin, either with recalcified citrated blood or with direct heparinization, substantially improved the test sensitivity and enabled the assay to distinguish platelet count reduction between the positive controls and commonly used biomaterials. Leukocyte count was shown to be a much less sensitive indicator than platelet count for thrombogenicity evaluations of biomaterials. The findings from this study have been incorporated in the recent 2019 version of the ASTM F2888 standard.
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Affiliation(s)
- Qijin Lu
- Center for Devices and Radiological Health, U.S. Food and Drug Administration, Silver Spring, Maryland, USA
| | - Joshua M Nehrer
- Center for Devices and Radiological Health, U.S. Food and Drug Administration, Silver Spring, Maryland, USA
| | - Jiaming Li
- Center for Devices and Radiological Health, U.S. Food and Drug Administration, Silver Spring, Maryland, USA
| | - Megan A Jamiolkowski
- Center for Devices and Radiological Health, U.S. Food and Drug Administration, Silver Spring, Maryland, USA
| | - Jean E Rinaldi
- Center for Devices and Radiological Health, U.S. Food and Drug Administration, Silver Spring, Maryland, USA
| | - Richard A Malinauskas
- Center for Devices and Radiological Health, U.S. Food and Drug Administration, Silver Spring, Maryland, USA
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6
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Ashcraft M, Douglass M, Chen Y, Handa H. Combination strategies for antithrombotic biomaterials: an emerging trend towards hemocompatibility. Biomater Sci 2021; 9:2413-2423. [PMID: 33599226 PMCID: PMC8035307 DOI: 10.1039/d0bm02154g] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Surface-induced thrombosis is a frequent, critical issue for blood-contacting medical devices that poses a serious threat to patient safety and device functionality. Antithrombotic material design strategies including the immobilization of anticoagulants, alterations in surface chemistries and morphology, and the release of antithrombotic compounds have made great strides in the field with the ultimate goal of circumventing the need for systemic anticoagulation, but have yet to achieve the same hemocompatibility as the native endothelium. Given that the endothelium achieves this state through the use of many mechanisms of action, there is a rising trend in combining these established design strategies for improved antithrombotic actions. Here, we describe this emerging paradigm, highlighting the apparent advantages of multiple antithrombotic mechanisms of action and discussing the demonstrated potential of this new direction.
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Affiliation(s)
- Morgan Ashcraft
- School of Chemical, Materials and Biomedical Engineering, College of Engineering, University of Georgia, Athens, Georgia 30602, USA.
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7
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Jamiolkowski MA, Snyder TA, Perkins IL, Malinauskas RA, Lu Q. Preclinical Device Thrombogenicity Assessments: Key Messages From the 2018 FDA, Industry, and Academia Forum. ASAIO J 2021; 67:214-219. [PMID: 33512917 DOI: 10.1097/mat.0000000000001226] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Device-related thrombosis and thromboembolic complications remain a major clinical concern and often impact patient morbidity and mortality. Thus, improved preclinical thrombogenicity assessment methods that better predict clinical outcomes and enhance patient safety are needed. However, there are several challenges and limitations associated with developing and performing preclinical thrombogenicity assessments on the bench and in animals (e.g., the clinical relevance of most in vitro tests has not been established, animal studies may not accurately predict clinical thrombotic events). To facilitate a discussion on how to overcome some of these challenges and to promote collaboration between the Food and Drug Administration (FDA), industry, and academia for the development of more reliable test methods, a scientific forum was organized by FDA and held in Washington, DC, on June 15, 2018 at the ASAIO 64th Annual Conference. Three subject matter experts from the medical device industry and FDA presented their perspectives at this forum, and several audience experts provided input during the open dialogue session. This article summarizes the key messages from the forum regarding the current status and challenges of preclinical thrombogenicity testing, important areas of needed research, and mechanisms for working with FDA to further improve thrombogenicity evaluations of medical devices.
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Affiliation(s)
| | | | | | | | - Qijin Lu
- From the U.S. Food and Drug Administration, Silver Spring, Maryland
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8
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Parada G, Yu Y, Riley W, Lojovich S, Tshikudi D, Ling Q, Zhang Y, Wang J, Ling L, Yang Y, Nadkarni S, Nabzdyk C, Zhao X. Ultrathin and Robust Hydrogel Coatings on Cardiovascular Medical Devices to Mitigate Thromboembolic and Infectious Complications. Adv Healthc Mater 2020; 9:e2001116. [PMID: 32940970 DOI: 10.1002/adhm.202001116] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 08/21/2020] [Indexed: 01/10/2023]
Abstract
Thromboembolic and infectious complications stemming from the use of cardiovascular medical devices are still common and result in significant morbidity and mortality. There is no strategy to date that effectively addresses both challenges at the same time. Various surface modification strategies (e.g., silver, heparin, and liquid-impregnated surfaces) are proposed yet each has several limitations and shortcomings. Here, it is shown that the incorporation of an ultrathin and mechanically robust hydrogel layer reduces bacterial adhesion to medical-grade tubing by 95%. It is additionally demonstrated, through a combination of in vitro and in vivo tests, that the hydrogel layer significantly reduces the formation and adhesion of blood clots to the tubing without affecting the blood's intrinsic clotting ability. The adhesion of clots to the tubing walls is reduced by over 90% (in vitro model), which results in an ≈60% increase in the device occlusion time (time before closure due to clot formation) in an in vivo porcine model. The advantageous properties of this passive coating make it a promising surface material candidate for medical devices interfacing with blood.
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Affiliation(s)
- German Parada
- Chemical Engineering Department Massachusetts Institute of Technology Cambridge MA 02139 USA
- Mechanical Engineering Department Massachusetts Institute of Technology Cambridge MA 02139 USA
| | - Yan Yu
- Mechanical Engineering Department Massachusetts Institute of Technology Cambridge MA 02139 USA
- School of Optical and Electronic Information Huazhong University of Science and Technology Wuhan Hubei 430064 China
| | - William Riley
- Perfusion Services Massachusetts General Hospital Boston MA 02114 USA
| | - Sarah Lojovich
- Perfusion Services Massachusetts General Hospital Boston MA 02114 USA
| | - Diane Tshikudi
- Wellman Center for Photomedicine Massachusetts General Hospital Boston MA 02114 USA
| | - Qing Ling
- Tongji Medical School Huazhong University of Science and Technology Wuhan Hubei 430064 China
| | - Yefang Zhang
- Tongji Medical School Huazhong University of Science and Technology Wuhan Hubei 430064 China
| | - Jiaxin Wang
- Tongji Medical School Huazhong University of Science and Technology Wuhan Hubei 430064 China
| | - Lei Ling
- Tongji Medical School Huazhong University of Science and Technology Wuhan Hubei 430064 China
| | - Yueying Yang
- Mechanical Engineering Department Massachusetts Institute of Technology Cambridge MA 02139 USA
- School of Optical and Electronic Information Huazhong University of Science and Technology Wuhan Hubei 430064 China
| | - Seemantini Nadkarni
- Wellman Center for Photomedicine Massachusetts General Hospital Boston MA 02114 USA
| | - Christoph Nabzdyk
- Department of Anesthesia Critical Care and Pain Medicine Massachusetts General Hospital Boston MA 02114 USA
- Department of Anesthesiology and Perioperative Medicine Mayo Clinic Rochester Rochester MN 55902 USA
| | - Xuanhe Zhao
- Mechanical Engineering Department Massachusetts Institute of Technology Cambridge MA 02139 USA
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9
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Gupta A, Johnston CM, Hinds MT, Anderson DEJ. Quantifying Physical Thrombus Characteristics on Cardiovascular Biomaterials Using MicroCT. Methods Protoc 2020; 3:E29. [PMID: 32295060 PMCID: PMC7359709 DOI: 10.3390/mps3020029] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 04/08/2020] [Accepted: 04/09/2020] [Indexed: 12/15/2022] Open
Abstract
Hemocompatibility is a critical consideration when designing cardiovascular devices. Methods of assessing hemocompatibility range from in vitro protein adsorption and static platelet attachment to in vivo implantation. A standard preclinical assessment of biomaterial hemocompatibility is ex vivo quantification of thrombosis in a chronic arteriovenous shunt. This technique utilizes flowing blood and quantifies platelet accumulation and fibrin deposition. However, the physical parameters of the thrombus have remained unknown. This study presents the development of a novel method to quantify the 3D physical properties of the thrombus on different biomaterials: expanded polytetrafluoroethylene and a preclinical hydrogel, poly(vinyl alcohol). Tubes of 4-5 mm inner diameter were exposed to non-anticoagulated blood flow for 1 hour and fixed. Due to differences in biomaterial water absorption properties, unique methods, requiring either the thrombus or the lumen to be radiopaque, were developed to quantify average thrombus volume within a graft. The samples were imaged using X-ray microcomputed tomography (microCT). The methodologies were strongly and significantly correlated to caliper-measured graft dimensions (R2 = 0.994, p < 0.0001). The physical characteristics of the thrombi were well correlated to platelet and fibrin deposition. MicroCT scanning and advanced image analyses were successfully applied to quantitatively measure 3D physical parameters of thrombi on cardiovascular biomaterials under flow.
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Affiliation(s)
| | | | | | - Deirdre E. J. Anderson
- Department of Biomedical Engineering, Oregon Health & Science University, Portland, OR 97239, USA (M.T.H.)
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10
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Maitz MF, Martins MCL, Grabow N, Matschegewski C, Huang N, Chaikof EL, Barbosa MA, Werner C, Sperling C. The blood compatibility challenge. Part 4: Surface modification for hemocompatible materials: Passive and active approaches to guide blood-material interactions. Acta Biomater 2019; 94:33-43. [PMID: 31226481 DOI: 10.1016/j.actbio.2019.06.019] [Citation(s) in RCA: 65] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Revised: 05/29/2019] [Accepted: 06/13/2019] [Indexed: 12/22/2022]
Abstract
Biomedical devices in the blood flow disturb the fine-tuned balance of pro- and anti-coagulant factors in blood and vessel wall. Numerous technologies have been suggested to reduce coagulant and inflammatory responses of the body towards the device material, ranging from camouflage effects to permanent activity and further to a responsive interaction with the host systems. However, not all types of modification are suitable for all types of medical products. This review has a focus on application-oriented considerations of hemocompatible surface fittings. Thus, passive versus bioactive modifications are discussed along with the control of protein adsorption, stability of the immobilization, and the type of bioactive substance, biological or synthetic. Further considerations are related to the target system, whether enzymes or cells should be addressed in arterial or venous system, or whether the blood vessel wall is addressed. Recent developments like feedback controlled or self-renewing systems for drug release or addressing cellular regulation pathways of blood platelets and endothelial cells are paradigms for a generation of blood contacting devices, which are hemocompatible by cooperation with the host system. STATEMENT OF SIGNIFICANCE: This paper is part 4 of a series of 4 reviews discussing the problem of biomaterial associated thrombogenicity. The objective was to highlight features of broad agreement and provide commentary on those aspects of the problem that were subject to dispute. We hope that future investigators will update these reviews as new scholarship resolves the uncertainties of today.
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Affiliation(s)
- Manfred F Maitz
- Institute Biofunctional Polymer Materials, Max Bergmann Center of Biomaterials, Leibniz-Institut für Polymerforschung Dresden e.V., Dresden, Germany; Key Laboratory of Advanced Technology for Materials of Education Ministry, School of Materials Science and Engineering, Southwest Jiaotong University, Chengdu 610031, China.
| | - M Cristina L Martins
- i3S, Instituto de Investigação e Inovação em Saúde, Portugal; INEB, Instituto de Engenharia Biomédica, Rua Alfredo Allen, 208, 4200-135 Porto, Portugal; ICBAS, Instituto de Ciências Biomédicas Abel Salazar, Universidade do Porto, Porto, Portugal
| | - Niels Grabow
- Institut für Biomedizinische Technik, Universitätsmedizin Rostock, Friedrich-Barnewitz-Str. 4, 18119 Rostock, Germany
| | - Claudia Matschegewski
- Institut für Biomedizinische Technik, Universitätsmedizin Rostock, Friedrich-Barnewitz-Str. 4, 18119 Rostock, Germany; Institute for ImplantTechnology and Biomaterials (IIB) e.V., Friedrich-Barnewitz-Str. 4, 18119 Rostock, Germany
| | - Nan Huang
- Key Laboratory of Advanced Technology for Materials of Education Ministry, School of Materials Science and Engineering, Southwest Jiaotong University, Chengdu 610031, China
| | - Elliot L Chaikof
- Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, Boston, MA 02115, United States; Wyss Institute for Biologically Inspired Engineering at Harvard University, 3 Blackfan Circle, Boston, MA 02115, United States; Harvard-MIT Division of Health Sciences and Technology, 77 Massachusetts Avenue, Cambridge, MA 02139, United States
| | - Mário A Barbosa
- i3S, Instituto de Investigação e Inovação em Saúde, Portugal; INEB, Instituto de Engenharia Biomédica, Rua Alfredo Allen, 208, 4200-135 Porto, Portugal; ICBAS, Instituto de Ciências Biomédicas Abel Salazar, Universidade do Porto, Porto, Portugal
| | - Carsten Werner
- Institute Biofunctional Polymer Materials, Max Bergmann Center of Biomaterials, Leibniz-Institut für Polymerforschung Dresden e.V., Dresden, Germany
| | - Claudia Sperling
- Institute Biofunctional Polymer Materials, Max Bergmann Center of Biomaterials, Leibniz-Institut für Polymerforschung Dresden e.V., Dresden, Germany
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