REACTIONS OF FORMED ELEMENTS OF BLOOD WITH PLASMA PROTEINS AT INTERFACES

Biocompatibility in Hemapheresis: Blood Coagulation

Hemapheresis may influence the coagulation system with effects of activation and dilution. Dilution can lead to reduced levels of platelets, fibrinogen and antithrombin III. Activation initially causes increased clotting activity, but the consumption of the activated factors generally induces a subsequent phase of hypocoagulability. In the donor, apheresis diminishes platelet count and function, as well as the levels of many other clotting factors. Depletion of fibrinogen and antithrombin III are less transient than others because their rates of synthesis are lower. In spite of the wide variety in hemapheretic procedures, all of them (or at least, those that are the most commonly used) are associated with similar activation phenomena, that appear to be mediated by the formation of a fibrinogen layer on the artificial surfaces of the circuitry.

Identification of proteins involved in the adhesionof Candida species to different medical devices

Adhesion is the first step for Candida species to form biofilms on medical devices implanted in the human host. Both the physicochemical nature of the biomaterial and cell wall proteins (CWP) of the pathogen play a determinant role in the process. While it is true that some CWP have been identified in vitro, little is known about the CWP of pathogenic species of Candida involved in adhesion. On this background, we considered it important to investigate the potential role of CWP of C. albicans, C. glabrata, C. krusei and C. parapsilosis in adhesion to different medical devices. Our results indicate that the four species strongly adher to polyvinyl chloride (PVC) devices, followed by polyurethane and finally by silicone. It was interesting to identify fructose-bisphosphate aldolase (Fba1) and enolase 1 (Eno1) as the CWP involved in adhesion of C. albicans, C. glabrata and C. krusei to PVC devices whereas phosphoglycerate kinase (Pgk) and Eno1 allow C. parapsilosis to adher to silicone-made implants. Results presented here suggest that these CWP participate in the initial event of adhesion and are probably followed by other proteins that covalently bind to the biomaterial thus providing conditions for biofilm formation and eventually the onset of infection.

Platelet preservation during coronary bypass surgery with bubble and membrane oxygenators: effect of albumin priming

Sixty-three patients admitted for routine coronary bypass operations were randomized to cardiopulmonary bypass (CPB) with a membrane oxygenator (Capiox- CA) or a bubbler (Polystan or William Harvey- WH), and in the Polystan group to prime with or without albumin (P+ or P-). Platelets were counted and blood loss from the mediastinal drains during the first 12 postoperative hours was measured. The reduction in platelet numbers from baseline to closure of the sternum was significantly larger in the P- group (121 x 109/l, median) than in the CA group (55 x 109/l) (p <0.001), with intermediate reductions in the P+ (87 x 109/l) and WH (90 x 109/l) groups. The reduced platelet loss in the P+ group compared with P- was accompanied by a significant reduction in early postoperative chest tube drainage (480 versus 728 ml). Thus, precirculation of the CPB circuit with prime containing a low dose of albumin was a simple and inexpensive means of increasing platelet function with a bubble oxygenator.

Investigation of platelet responses and clotting characteristics of in situ albumin binding surfaces

The response of biomaterial surfaces when exposed to blood is in part dependent upon the nature and composition of the adsorbed layer of proteins. Surfaces passivated with albumin have been shown to reduce platelet adhesion and activation. In an attempt to develop surfaces that can selectively and specifically bind albumin, silicon-based surfaces were functionalized with linear peptides and chemical ligands that displayed an affinity for albumin. Peptide functionalized surfaces were observed to preferentially bind albumin when compared to human immunoglobulin and human fibrinogen, which possess low densities of surface adsorbed platelets. The platelet morphology was noted to be discoid on the peptide modified surface. Both the unmodified control and SCL functionalized surfaces had high densities of surface adhered platelets with spread out morphology. The peptide and SCL functionalized surfaces were noted to have no impact on PTT and PT clotting times, indicating that the extrinsic and intrinsic pathways were unperturbed by the surfaces generated.

Influence of nanoscale surface roughness on neural cell attachment on silicon

The adherence and viability of neural cells (primary cortical cells) from rat embryo on silicon wafers with varying surface roughness (10 to 250 nm) at the nano scale were investigated. The roughnesses were achieved by using chemical etching. Atomic force microscopy was utilized to determine surface roughness. We examined the adherence and viability of neural cells by using scanning electron microscopy and fluorescence immunoassaying. Antineuron-specific enolase antibody was used for immunostaining. Results from this investigation show that for these specific neural cells, there is an optimum surface roughness range, R(a) = 20 to 100 nm, that promotes cell adhesion and longevity. For silicon-based devices, this optimum surface roughness will be desirable as a suitable material/neuron interface.

Protein adsorption and smooth muscle cell adhesion on biodegradable agmatine-modified poly(propylene fumarate-co-ethylene glycol) hydrogels

We synthesized positively charged biodegradable hydrogels from poly(propylene fumarate-co-ethylene glycol) block copolymer and agmatine-modified poly(ethylene glycol)-tethered fumarate by radical crosslinking, and investigated the effect of the guanidino group of agmatine on vascular smooth muscle cell adhesion and protein adsorption to the hydrogels. In the presence of serum, the number of adherent smooth muscle cells per unit surface area increased dose-dependently from 15 to 75% of the initial seeding density at 20 h as the initial agmatine-modified monomer content increased from 0 to 200 mg/g. Cell spreading also depended on the initial monomer content. In the absence of serum, the number of adherent cells per unit surface area increased slightly from 10 to 17% of the initial seeding density as the initial monomer content increased from 0 to 200 mg/g. Cell adhesion increased significantly by adding exogenous vitronectin to serum-free medium, whereas exogenous fibronectin addition did not enhance cell adhesion. The enzyme-linked immunosorbent assay of fibronectin and vitronectin adsorbed onto the hydrogels revealed that the incorporation of positive charges into the hydrogels enhanced vitronectin, but not fibronectin, adsorption significantly. These results suggest that the guanidino group of agmatine enhanced cell adhesion by promoting the adsorption of serum components, and vitronectin may be one of the components.

Reactivity of human platelets with immobilized fibrinogen is dictated by the chemical character of the surface

Quiescent platelets readily adhere to surface-immobilized fibrinogen. In contrast, platelets exposed to soluble fibrinogen do not demonstrate such activity. As part of an effort to characterize this phenomenon, a solid-phase reagent was prepared by adsorbing human fibrinogen to polystyrene-divinylbenzene microparticles. Using a suspension of human platelets, phase-contrast microscopy was used to quantitate directly platelets bound to fibrinogen-coated beads. This method is fast, straightforward, and requires minimal amounts of reagents and sample. An existing turbidimetric assay was modified to monitor optically the rate and extent of platelet-fibrinogen binding. When platelet-rich plasma was added to a stirred suspension of fibrinogen-coated beads, the rate of aggregation was related directly to the concentration of fibrinogen on the bead surface. This response could not be mitigated by the thrombin inhibitor, hirudin, indicating that any thrombin generated in the reaction has no role in bead aggregation. Conversely, the alpha(IIb)beta(3) antagonist, abciximab (ReoPro), completely prevented aggregation, implicating specific fibrinogen-alpha(IIb)beta(3) interactions as responsible for the observed effect. Beads coated with either albumin or a densely packed, pure film of the neutral phospholipid, phosphatidylcholine (lecithin), do not aggregate under identical conditions, nor do fibrinogen-coated beads aggregate when platelet-depleted plasma is added. When fibrinogen was coated to beads as a mixed film with lecithin, a striking increase in reactivity toward platelets was demonstrated, compared to unmodified beads. These studies indicate that the observed adhesion of platelets to beads is a direct result of platelet-fibrinogen interactions and platelets respond differently to fibrinogen when presented as a mixed film with lipid, compared to the protein alone at an interface.

Influence of steroid hormones on bovine pericardial calcification

Calcification is a frequent cause of the clinical failure of bioprosthetic heart valves fabricated from glutaraldehyde pretreated bovine pericardium (GABP). The present investigation describes the influence of steroid hormones in the mineralization of GABP, in an extra-circulatory environment. Calcification was studied on GABP incubation in a metastable solution of calcium phosphate containing steroid hormones such as estrone, progesterone, 7(OH) progesterone, testosterone and beta-estradiol. It is interesting to note that certain steroids can variably increase the GABP calcification. Further, the effect of these steroids in an in vitro hydroxyapatite (HA) formation was investigated. In addition, we observed these steroids alter the calcium transport through GABP in diffusion experiments and also in HA formation. Therefore, it is conceivable that prolonged use of steroids or steroids containing oral contraceptive agents may not be advisable for patients having bioprosthetic implants in contact with blood. A better understanding of the mechanism of these drugs under in vivo conditions is needed to develop applications.

Inhibition of bioprosthesis calcification due to synergistic effect of Fe/Mg ions to polyethylene glycol grafted bovine pericardium

Calcification has limited the durability of bioprosthetic heart valves fabricated from glutaraldehyde pretreated porcine aortic valves or bovine pericardium (BP). The present study describes calcium antagonistic effect of polyethylene glycol grafted bovine pericardium (PEG-GABP) with Fe2+/Mg2+ delivery from a co-matrix system in rat subcutaneous model. Retrieved samples were biochemically evaluated for calcification and alkaline phosphate (AP) activity. Scanning electron micrographs of 21-day explants had shown excessive calcification with glutaraldehyde treated BP (control). However, the PEG grafting and Fe/Mg release had substantially inhibited the deposition of calcium on BP. The extractable alkaline phosphatase activity was also reduced with PEG grafting and metal ion release to BP. The extractable AP had shown peak activity at 72 h [for GATBP--250.5 +/- 1.2 nm pnp/mg protein/min enzyme activity (unit), PEG-GABP--165.2 +/- 16.6 units], but markedly reduced after 21 days (22.1 +/- 1.8 and 12.0 +/- 1.5 units, respectively). The initial high levels may be due to tissue injury via surgery, which mitigated with time. It is assumed that ferric ions may slow down or retard the calcification process by the inhibition of proper formation of hydroxy apatite while magnesium ions disrupt the growth of these crystals by replacing Ca2+. In addition it maybe hypothesized that these metal ions may inhibit the key element alkaline phosphatase, which acts as the substrate for mineralization. Hence, it is conceivable that a combination therapy via surface grafting of PEG and local delivery of low levels of ferric and magnesium ions may prevent the bioprosthesis associated calcification.

Molecular basis of biomaterial-mediated foreign body reactions

Despite being inert and nontoxic, implanted biomaterials often trigger adverse foreign body reactions such as inflammation, fibrosis, infection, and thrombosis. With regard to the inflammatory responses to biomaterial implants, it was previously found that a crucial precedent event was the spontaneous adsorption and denaturation of fibrinogen on implant surfaces. It was further found that interactions between the phagocyte integrin Mac-1 (CD11b/CD18) and one short sequence within the fibrinogen D domain (gamma 190-202; P1) at least partially explained phagocyte accumulation on implant surfaces. However, the reason that adsorbed fibrinogen is proinflammatory--while soluble fibrinogen clearly is not--remained obscure. In this study, therefore, the question of how fibrinogen is converted to a proinflammatory state when adsorbed to biomaterial surfaces is investigated. In soluble fibrinogen, the 13 amino acid P1 sequence was found to be hidden. However, the adsorption and denaturation of fibrinogen on the surfaces of commonly used biomaterials lead to the exposure of P1 and a second neo-epitope, gamma 377-395 (P2), which also interacts with Mac-1 and is similarly occult in the soluble protein. The extent of biomaterial-mediated P1 and P2 exposure appears directly related to the severity of inflammatory responses to a test panel of biomaterials. Finally, thrombin-mediated conversion of fibrinogen to fibrin also exposes both P1 and P2 epitopes. These observations may help explain both the inflammation caused by many types of implanted biomaterials and that which occurs naturally following thrombotic events. (Blood. 2001;98:1231-1238)

Initial events at the bioactive glass surface in contact with protein-containing solutions

Upon implantation, bioactive glass undergoes a series of reactions that leads to the formation of a calcium phosphate-rich layer. Most in vitro studies of the changes that occur on the surface of bioactive glass have employed the use of buffer solutions with compositions reflecting the ionic composition of interstitial fluid. Although these studies have documented the physical and chemical changes associated with bioactive glass immersed in aqueous media, they do not reveal the effect of serum proteins and cells that are present at the implantation site. In the present study, we document, using atomic force microscopy (AFM) and Rutherford backscattering spectrometry (RBS), significant differences in the reaction layer composition, thickness, morphology, and kinetics of formation arising from the presence of serum proteins. The data reveal that the uniform and rapid adsorption of serum proteins on the surface may serve to protect the surface from further direct interaction with the aqueous media, slowing down the transformation reactions. This finding is in agreement with previous studies that have shown that the presence of serum proteins significantly delays the formation of hydroxyapatite at the surface of bioactive glass. These data also support the hypothesis that initial reaction layers in vivo interact with cells in order to produce the tissue-bioactive glass interface typically observed on ex vivo specimens.

Characterization of plasma proteins adsorbed onto biomaterials. By MALDI-TOFMS

The analysis of plasma proteins adsorbed onto a polyurethane (PU) biomaterial was performed using matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOFMS). This article marks the first study on MALDI-TOFMS analysis of multiple proteins adsorbed from plasma, in vitro, onto the surface of a biomaterial to easily enable their characterization. Plasma standards from three different hosts were placed in contact with non-porous PU, a model biomaterial. Following the use of washing protocols developed in our laboratory, the biomaterial was analyzed, directly, with MALDI-TOFMS. Proteins with molecular weights (Mr) ranging from ca. 6.5 to 150 kDa were observed in the mass spectra and characterized upon comparison with proteins of known Mr. The proteins observed were tentatively identified as those known to adsorb onto PU, both in vitro and in vivo. In an attempt to model in vivo sorption, the PU biomaterial was exposed to freshly collected canine plasma, in vitro, for different lengths of time. Corresponding MALDI-TOFMS spectra displayed increasing protein signal for a number of different proteins with increasing times of exposure to plasma. This method provided qualitative and semi-quantitative analysis of the proteins adsorbed onto the biomaterial surface.

Different kinetics of the respiratory burst response in granulocytes, induced by serum from blood coagulated in contact with polymer materials

Tubes of different polymer materials were filled with blood collected by venous puncture. The blood was allowed to clot for 10 min, and the serum was collected. Complement activation was demonstrated through assessment of the C3-level by radial immunodiffusion. Phospholipid fingerprints were made after lipid extraction of serum and separation by thin-layer chromatography. The granulocyte fraction of venous blood was separated on a Percoll gradient and the cells were either loaded with a calcium probe, or incubated with luminol. These cells were used as a biological test for inflammatory mediators. Serum from blood coagulated in contact with different materials was added to the test cells. The intracellular calcium level was recorded by Calcium Green-1 fluorescence and the respiratory burst of the test cells was recorded by luminol-amplified chemiluminescence. Serum from blood coagulated in contact with glass tubes, methylised glass tubes and teflon (PTFE) tubes induced a transient increase of the cellular calcium level, indicating a G protein-coupled activation of the test cells. Serum from blood coagulated in contact with glass tubes, methylised glass tubes, and PTFE tubes primed the test cells for a subsequent f-MLP response. Serum from blood coagulated in contact with polyurethane and polypropylene induced a direct biphasic respiratory burst response in the test cells and serum from blood coagulated in contact with methylised glass induced a direct monophasic respiratory burst response in the test cells. Complement activation was demonstrated after blood contact with hydrophobic glass and PTFE. Different fingerprints of phospholipid content were found in sera after blood contact with different materials. The data show that different inflammatory mediators are released during blood coagulation in contact with different materials. The method may be valuable as a screening test for blood compatibility of materials.

Surface characterization, protein adsorption, and initial cell-surface reactions on glutathione and 3-mercapto-1,2,-propanediol immobilized to gold

Monolayers of glutathione (GSH) and 3-mercapto-1,2-propanediol (MG) on gold were tested for their bioreactivity by assessing the degree of inflammatory reaction as manifested by the adherence and activation of platelets and white blood cells (wbc) after exposure to blood ex vivo. Surface composition was characterized by XPS, and noncontact optical profilometry was used to determine surface roughness. The thickness and composition of the adsorbed protein layers were measured by ellipsometry/antibody techniques in vitro. Cell adhesion and activation were quantified by acridine orange staining, fluorescein-diacetate staining, and by specific antibodies against cell membrane antigens. Distinct differences among the surfaces were observed relative to the amounts and composition of adsorbed plasma proteins and the adhesion and activation of platelets (CD62P-exposure) and wbc (CD11b/CD18-exposure). GSH surfaces, which adsorbed the least amount of plasma protein, caused the least adherence and activation of platelets (CD62P), followed by the highest activation of wbc (CD11b/18). The MG surfaces caused a rapid recruitment and activation of platelets (CD62P), followed by a lower activation of wbc (CD11b/18). Thus it appears that measurements of the initial adsorption of plasma protein from anticoagulated plasma and of the adhesion and activation of platelets after 8 min of exposure to whole blood cannot be used to predict accurately the adhesion and activation behavior of inflammatory cells after longer periods (2 h) of exposure on different surfaces.

A turbidimetric assay for quantitating functional fibrin(ogen) using polystyrene-divinylbenzene microparticles

A sensitive assay has been developed to quantitate fibrinogen in plasma or in other aqueous solutions. Microscopic latex particles, modified with a mixed monomolecular film of lecithin and fibrinogen, are used as a solid-phase reagent. These lecithin/fibrinogen-coated beads aggregate when stirred in the presence of thrombin and, when solution-phase fibrinogen is added, the increased rate of aggregation is proportional to the concentration of soluble fibrinogen. Using a sample volume of 200 microl, as little as 15 nM ( approximately 5 microg ml-1) fibrinogen can be measured. Fibrinogen determinations using the bead assay compared favorably with those derived from a standard clinical assay, with a correlation coefficient (r2) of 0.9710 over a range of 2.5 to 28.0 microM. Analytic precision was comparable to available assays, with typical coefficients of variation of 12.7 and 7.1% for fibrinogen concentrations of 30 nM and 15.0 microM, respectively. The method has a dynamic range of 15 nM to over 3.0 microM and offers the advantage of being sensitive to 20-fold lower concentrations of fibrinogen compared to routine clot-based methods. Unlike immunological assays, e.g., ELISA, it measures only the functional protein. This bead method should prove to be of greatest use to investigators measuring low levels of functional fibrin(ogen).

Characterization of cellular response to thiol-modified gold surfaces implanted in mouse peritoneal cavity

The early inflammatory reaction in vivo to three well defined surfaces-gold, gold coated with glutathione (GSH), and 3-mercapto-1, 2-propanediol (MG)-was assessed as manifested by the adherence and activation of inflammatory cells during implantation intraperitoneally in mice. Evaluation of cell adhesion and activation was done by immunohistochemistry using specific monoclonal antibodies directed against cell differentiation antigens CD11b/CD18, CD74, and CD25 or by measurement by chemoluminescence of reactive oxygen radical species produced by adhering cells. Cell recruitment and activation was slow on the GSH-coated gold surfaces. These surfaces also had the highest percentage of adhering cells with an intact cell membrane. The MG-coated surfaces, on the other hand, rapidly recruited and activated cells and also caused cell membrane leakage to propidium iodide, suggesting cell membrane damage or cell death. The respiratory burst of adhering cells was stimulated by phorbol-myristate acetate on the GSH-coated surface but not on the MG-coated surface and by opsonized zymosan on the Mg-coated surface but only to a small degree on the GSH-coated surface. The respiratory burst following zymosan activation of cells adhering to the MG-coated surface was inhibited by treatment with 2. 3-diphosphoglycerate, a phospholipase D inhibitor. The presented data suggest that peritoneal leukocytes adhering to foreign materials may raise a respiratory burst response via a phospholipase D-dependent and protein kinase C-independent pathway.

Mice that lack the angiogenesis inhibitor, thrombospondin 2, mount an altered foreign body reaction characterized by increased vascularity

Disruption of the thrombospondin 2 gene (Thbs2) in mice results in a complex phenotype characterized chiefly by abnormalities in fibroblasts, connective tissues, and blood vessels. Consideration of this phenotype suggested to us that the foreign body reaction (FBR) might be altered in thrombospondin 2 (TSP2)-null mice. To investigate the participation of TSP2 in the FBR, polydimethylsiloxane (PDMS) and oxidized PDMS (ox-PDMS) disks were implanted in TSP2-null and control mice. Growth of TSP2-null and control skin fibroblasts in vitro also was evaluated on both types of disks. Normal fibroblasts grew as a monolayer on both surfaces, but attachment of the cells to ox-PDMS was weak and sensitive to movement. TSP2-null fibroblasts grew as aggregates on both surfaces, and their attachment was further compromised on ox-PDMS. After a 4-week implantation period, both types of PDMS elicited a similar FBR with a collagenous capsule in both TSP2-null and control mice. However, strikingly, the collagenous capsule that formed in TSP2-null mice was highly vascularized and thicker than that formed in normal mice. In addition, abnormally shaped collagen fibers were observed in capsules from mutant mice. These observations indicate that the presence or absence of an extracellular matrix component, TSP2, can influence the nature of the FBR, in particular its vascularity. The expression of TSP2 therefore could represent a molecular target for local inhibitory measures when vascularization of the tissue surrounding an implanted device is desired.

Mechanisms of fibrinogen domains: biomaterial interactions

Spontaneous adsorption of fibrinogen is critical to the pathogenesis of biomaterial-mediated inflammatory responses. However, the mechanism by which adsorbed fibrinogen affects phagocyte responses is still not clear. To investigate the molecular interaction between fibrinogen and biomaterials, fibrinogen fragments (D100 and E50) were generated and used in the present study. The results indicate that biomaterial: D100 interaction is essential to fibrinogen-mediated inflammatory responses, because biomaterials precoated with D100, but not E50, prompt strong inflammatory responses. Furthermore, the results from in vitro studies show that whole molecule fibrinogen and D100 exhibit very similar protein:surface interactions. Specifically: (1) both D100 and fibrinogen have high affinity for biomaterial surfaces; and (2) the retention rates of adsorbed D100 in both in vivo and in vitro environments are as high as that for adsorbed fibrinogen. On the other hand, E50 does bind to biomaterials but with low affinity because, once bound, it is not tightly adherent to the biomaterial surfaces. Taken together, the results suggest that the mechanism of fibrinogen-mediated inflammatory responses may involve the following three consecutive events: (1) after contact with blood or tissue fluid, the D domain tends to interact with biomaterial surfaces and is important in the tight binding of fibrinogen to implant surfaces; (2) the biomaterial surface then promotes conformational changes within the D domain, exposing P1 epitope (gamma 190-202, which interacts with phagocyte Mac-1 integrin); and (3) the engagement of Mac-1 integrin with P1 epitope then triggers subsequent phagocyte adherence and reactions.

Activated charcoal microcapsules and their applications

Activated charcoal, long known to the ancients as a substance of therapeutic value in a variety of maladies, has recently been "rediscovered" to be of great value in medical applications. Activated charcoal hemoperfusion is effective in blood purification for removal of various circulating toxic materials and waste metabolites, directly. However, particulate release and platelet adhesion prevent its continued clinical use. Polymeric coatings or microencapsulation of charcoal within polymers have improved their blood compatibility. Chitosan encapsulated activated charcoal (ACCB) beads have been extensively investigated in our group for the removal of various toxins such as urea, creatinine, uric acid, bilirubin, etc. This article highlights various methods of microencapsulation procedures of activated charcoal and the importance of this novel material for a variety of biomedical applications. Further, this review provides an insight to the future perspectives for using them in clinical practice.

Platelet adhesion and spreading on protein-coated surfaces: variations in behavior in washed cells, PRP, and whole blood

Platelet attachment and spreading were monitored on glass and various protein coated glass, under shear with washed platelets, platelet rich plasma (PRP) and whole blood, using fluorescence Optimas imaging system and software. Results showed that the platelet adhesion and spreading were sensitive to the nature of precoated proteins and the type of medium used for introducing platelet suspension for the study. In general, the cell adhesion and spreading were higher with fibrinogen (Fg), fibronectin (Fn), von Willebrand Factor (vWF), and collagen precoated surfaces. In the presence of albumin on the surface, however, platelets could not attach and spread fully when using washed cells. But, the surface attachment and spreading of the cells were higher on albumin substrates on exposure to PRP or whole blood. This may be due to the replacement of precoated albumin by other plasma proteins, like Fg to facilitate the platelet-surface attachment. The composition of this layer determines the extent of platelet activation and the adhesive strength between platelets and polymer surface. These results indicate that multiple adhesion receptors can mediate platelet adhesion and spread to matrix proteins immobilized on surfaces. Further, these studies combined with some of our earlier observations and suggestions propose the need for developing in vitro tests that resemble in vivo conditions.

125I labelling of human serum albumin and fibrinogen and a study of protein adsorption properties on the surface of titanium oxide film

In order to detect the surface concentration of proteins adsorbed on a solid surface for selecting blood compatible materials, a gentle iodination reagent, Iodogen, was used to label human serum albumin and fibrinogen, and has been applied to the study of protein adsorption properties on a plate of titanium oxide film. The yields of the labelled albumin and fibrinogen are 69.7% and 49.6%. The results of adsorption show that [125I]HSA and [125I]HFG are efficacious at the surface concentration detection and can be used to investigate the protein adsorption properties of a solid material.

Glutaraldehyde treated bovine pericardium: changes in calcification due to vitamins and platelet inhibitors

Cardiovascular calcification, the formation of calcium phosphate deposits in cardiovascular tissue, is a common endstage phenomenon affecting a wide variety of bioprostheses. The purpose of the present paper is to study the possibility that some antiplatelet drugs (aspirin and persantine) and certain vitamins (vitamin C, vitamin B6, and vitamin E) and their combinations might prevent the mineralization of glutaraldehyde treated bovine pericardium (GABP) by modifying the pericardial surface. In this experimental protocol, we used Golomb and Wagner's (1991) in vitro model for studying GABP calcification and a diffusion cell with 2 compartments for evaluating the diffusion of calcium across the GABP. The results showed that a combination of aspirin and vitamins (0.5 mg% aspirin, 1.5 mg% vitamin C, 4 mg% vitamin B6, and 2 mg% vitamin E) in a metastable calcium phosphate solution not only reduced the transport of calcium ions through GABP, but along with the combinations of 0.5 mg% aspirin and 5 mg% persantine also produced significant reductions in GABP calcification. The exact mechanism of these changes in the calcification of GABP are still unknown. From these in vitro findings, it appears that a combined vitamin therapy with low doses of aspirin may be beneficial for platelet suppression and thereby prevent thrombosis. In addition, the vitamins may modify calcium transport and interfere with the adsorption at the surface, thus reducing GABP calcification. However, an important question that remains unanswered is whether this inhibitory effect would continue if the antiplatelet drugs and vitamins were discontinued. For the answer, more in vivo studies are needed to develop applications.

Effect of liposome-albumin coatings on ferric ion retention and release from chitosan beads

Ferric chloride was embedded in a chitosan matrix to develop a prolonged-release form. The in vitro release profiles of ferric ions from chitosan beads were monitored in 0.1 M Tris-HCl buffer, pH 7.4, using a UV spectrophotometer. The amount of drug release was much higher initially, followed by a constant slow release profile for a prolonged period. The initial burst release was substantially modified with liposome and albumin coatings. From scanning electron microscope studies, it appears that the ferric ions diffuse out slowly to the dissolution medium through the micropores of the chitosan matrix. Further, the liposome forms a phospholipid membrane layer in the pores of chitosan beads and encapsulates the ferric ions within their vesicles and controls the release profile. The chitosan beads loaded with ferric ions substantially inhibited the polyurethane-associated calcification, in an in vitro model system. The released ferric ions, appeared to alter the protein-surface binding and improved the biocompatibility of the matrix. The results propose the possibility of modifying the polymer matrix to obtain a desired controlled release of the drug for a prolonged period.

Ex vivo analysis of leukocyte hydrogen peroxide production using a bi-plate model in mice

Implantation of artificial materials is followed by inflammation and wound healing, where phagocytic cells play an important role. The mechanisms whereby the implant surface may elicit and modulate leukocyte functions in vivo are not understood, partly due to the technical difficulties of examining the local inflammatory events in vicinity of the material-tissue interface with conventional biochemical and immunological techniques. In the present study a newly developed biplate implant was inserted subcutaneously in the mouse. Leukocytes from the local inflammatory exudate and leukocytes associated to the surface of the implants were retrieved after 1 and 6 days and separately assayed with respect to hydrogen peroxide (H2O2) production ex vivo. Implantation caused a local accumulation of predominantly mononuclear cells in the surrounding subcutaneous tissue. The H2O2 production was found to be low in both the subcutaneous exudate and the implant-associated leukocytes, irrespective of implant material and implantation times. However, ex vivo-stimulation with phorbol myristate acetate (PMA) caused an enhanced H2O2 production. These observations show that biplate implants do not maximally activate the oxidative metabolism of the recruited leukocytes. The exudate leukocytes were more responsive to PMA stimulation in comparison with implant-associated leukocytes, indicating that properties of the implant surface and possibly surface-associated proteins could modify the responsiveness of the phagocytic cells at the implant site. Our results suggest that the present biplate model may be suitable for further studies on local production of oxygen metabolites and function of leukocytes at implanted biomaterials.

Protein adsorption on low temperature isotropic carbon: V. How is it related to its blood compatibility?

Based on our research on blood protein interactions with low temperature isotropic carbon (LTIC) and data from the literature, we propose that the carbon surface has strong interactions with adsorbed proteins. In this paper we focus on how a relatively blood-compatible material interacts with plasma proteins. We present our results on the structure and properties of the LTIC surface utilizing SEM, STM, XPS, and contact angle measurements. We briefly review protein adsorption on LTIC using DSC, impedance, radioisotopes, and two-dimensional gel electrophoresis. LTIC is characterized by a microporous, oxidized, hydrophobic, and domain mosaic structure. Surface polishing smoothens the roughness and removes the porosity, while largely destroying the ordered atomic texture, making the surface more random and more amorphous. The LTIC surface denatures all adsorbed proteins studied. The rate of protein adsorption is high and the surface concentration is large. The LTIC surface adsorbs all proteins without preference. The surface also tenaciously retains proteins such that they cannot be displaced by buffer or exchanged by proteins in solution. We conclude that LTIC accomplishes its blood compatibility through a passivating film of strongly adsorbed bland proteins, which do not interact with platelets nor participate in blood coagulation. We also suggest mechanisms for the production of such a film by the LTIC surface.

Adsorption and coagulability of fibrinogen on atheromatous lipid surfaces

Fibrinogen, the precursor of the blood clot matrix and a major constituent of atherosclerotic lesions, is shown to adsorb with high affinity to hydrophobic beads coated with cholesteryl oleate, cholesterol, or loosely packed lecithin. The quantity of fibrinogen that binds to cholesterol- or lecithin-coated beads decreases as the surface concentration of the lipid increases; densely packed films lecithin bind little,if any, if the protein. In sharp contrast, the appreciable quantity of fibrinogen that binds to cholesteryl oleate-coated beads is indifferent to the surface concentration of that lipid. Not unexpectedly, the quantity of fibrinogen that binds to beads coated with mixtures of cholesteryl oleate and lecithin increases with increasing concentration of the cholesteryl ester. When bound, fibrinogen can be converted by thrombin to fibrin and nucleate clot formation as manifested by the aggregation of stirred beads. These results indicate that hydrophobic, atheromatous lipid surfaces, particularly those rich in cholesteryl esters, may be predisposed to thrombosis by virtue of their inherent capacity to bind functional fibrinogen.

Preparation and characterization of fibrinogen-coated, reversibly adhesive, lecithin/cholesterol vesicles

We have developed a method for producing fibrinogen-coated, reversibly adhesive, lecithin/cholesterol vesicles. In this method, fibrinogen, which is acylated in the presence of preformed vesicles, spontaneously incorporates into vesicular membranes. The degree of incorporation is a function of the extent of acylation of the protein. Fibrinogen-coated vesicles aggregate in the presence of thrombin, a consequence of intervesicular fibrin formation. The rate and extent of thrombin-initiated aggregation depend on the fibrinogen surface concentration. Once aggregated, fibrin-coated vesicles can be dissociated by plasmin and by agents that disrupt intervesicular fibrin dimerization such as heparin and the tetrapeptide Gly-Pro-Arg-Pro. Fibrinogen-coated vesicles can be made to bind avidly to the surface of solution phase fibrin matrices and can be incorporated into solution phase fibrin clots. Fibrinogen-coated vesicles also bind to activated platelets. We propose that fibrinogen-coated vesicles will have practical applications as biomimetic hemostatic agents and as vehicles for the fibrin-specific targeting of drugs and other molecules.

Influence of block copolymers on the adsorption of plasma proteins to microspheres

SDS-PAGE in combination with densitometry has been used to evaluate the adsorption of plasma and serum proteins to polystyrene microspheres (PS) coated with block copolymers of the poloxamer and poloxamine series. The protein-resistant nature of coated PS was demonstrated for these systems when incubated in dilutions of plasma and serum. The total amount of protein and the type of proteins adsorbed were dependent on the plasma and serum incubation concentration used. At 0.3% serum concentrations the total amount of protein adsorbed was found to be related to the polyoxyethylene (PEO) chain length of the block copolymer, whilst at 0.3% or 50% plasma concentrations a relationship was shown between the polyoxypropylene (PPO) chain and the plasma protein adsorption for the range of block copolymers studied. Immunoblotting studies revealed the adsorption of immunoglobulin G, complement C3, transferrin and fibronectin to all microspheres previously incubated in 50% serum and plasma, whilst fibrinogen was also adsorbed after incubation in 50% plasma; with similar quantities of each protein adsorbed to PS and block copolymer-coated PS.

Identification of proteins absorbed to hemodialyser membranes from heparinized plasma

The protein layers formed during contact of plasma with hemodialysis membranes were studied. Dialysers having membranes of cellulose acetate (CA), saponified cellulose ester (SCE), cuprophane (CUP), polymethylmethacrylate (PMMA), and polyacrylonitrile (PAN) were used. Heparinized human plasma was recirculated through the dialysers for four hours. They were then rinsed and the proteins adsorbed to the membranes were eluted with 2% SDS. The yields of protein from the different membranes increased in the order: PMMA < CA < SCE < CUP < PAN. This is the probable order of increasing hydrophilicity. SDS-PAGE and Western blots were performed on the dialyser eluates. The blots were positive for most of the twenty proteins tested for. There were some interesting differences in adsorption patterns among the different membrane materials, notably for high molecular weight kininogen (HMWK), plasminogen and the C3 component of complement. HMWK was intact in the eluates from CA, CUP and SCE, whereas on PMMA and PAN there was evidence of cleavage, suggesting that activation of the contact phase of coagulation was more extensive on the latter two materials. Intact plasminogen was visible on all the blots. However, low molecular weight fragments were visible in the PAN eluates, suggesting activation of the fibrinolytic pathway. Low molecular weight fibrinogen fragments eluted from PAN membranes support this conclusion. C3 was visible in the blots obtained for all membrane materials, and the data suggest that complement is activated by all the membranes. A C3 fragment at about 30 kD (possibly C3d) was seen in the blots for the cellulosic membranes but not for PMMA or PAN.

Adsorption of coagulation proteins from whole blood on to polymer materials: relation to platelet activation

A combination of methods, immunoassays of plasma proteins and platelet release of beta-thromboglobulin and chromogenic substrates for enzymatically active coagulation factors, was used to measure the reactions of coagulation proteins upon contact between whole blood and artificial surfaces as a function of time and surface material. Four types of well-known polymer surfaces, polyvinylchloride, polytetrafluoroethylene, polyurethane and silicone rubber, were investigated to elucidate if a simple and fast in vitro experimental set-up can be of guidance in the selection of materials for use in vivo. Platelets were activated at the polymer surfaces whereas the coagulation enzymes showed little activity on the polymer surfaces tested. There was a correlation between the adsorption of adhesins (fibrinogen, fibronectin and factor VIII-related antigen) at the surfaces and the release of beta-thromboglobulin from platelets, suggesting that adsorption of adhesins is a major determinant of blood compatibility of polymer materials. Significant differences between the surfaces were seen--polyurethane being the surface with the least protein adsorbed and least platelet activation initiated. This study shows that it is possible to make a first in vitro choice of possible blood compatible artificial surfaces before expensive and cumbersome in vivo experiments.

Hydrogel grafted surfaces: protein interaction and platelet adhesion

The blood compatibility of an artificial polymeric implant largely depends on the physicochemical nature of the polymer substrate. In the present study our aim is to develop an understanding of polymer surfaces having similar surface free energy, but different chemical characteristics. We attempted to graft hydrogels onto a silastic polyurethane (Angioflex) material and optimised the surface free energy to about 35.0 ergs/cm2. We compared the protein adsorption and platelet and lymphocyte adhesion on these surfaces. It is observed that there is a relative change in behavior because of the difference in chemical nature.

Ellipsometric studies of plasma protein adsorption on membrane polymers for blood purification

Description of ellipsometric studies on absorption of the human plasma proteins; albumin (HSA), immunoglobulin G (IgG) and fibrinogen (FGN) to polymer surfaces of polyamide, polysulphone, polyetherpolycarbonate and polyacrylonitrile copolymer. Thin layers of the polymers (20-30 nm) were cast onto silicon dioxide/silicon wafers by a spin-coating procedure. The variations observed in surface concentration and adsorption time of the proteins were significant in all four polymers investigated.

The minimum surface fibrinogen concentration necessary for platelet activation on dimethyldichlorosilane-coated glass

Albumin and fibrinogen were competitively adsorbed onto dimethyldichlorosilane-coated glass (DDS-glass) and platelet activation was examined as a function of the surface fibrinogen concentration. The weight ratio of albumin to fibrinogen in the adsorption solution was varied from 10 to 700. Platelet activation was quantitated by the area and circularity of spread platelets. When the DDS-glass was coated with albumin alone, platelets were only contact adherent and could not spread at all. After competitive adsorption of fibrinogen and albumin, however, platelets were able to spread on the surface. Platelet activation increased linearly as the surface fibrinogen concentration increased up to 0.02 micrograms/cm2. Platelets were able to activate fully if the surface fibrinogen concentration was 0.02 micrograms/cm2 or higher, even though the surface was dominated by albumin. It appears that platelets can activate fully as long as only a small fraction (2-15%) of the surface is covered with tightly bound fibrinogen.

Interactions of proteins in human plasma with modified polystyrene resins

Investigations are reported on the composition of protein layers adsorbed from plasma to various modified polystyrene resins. As well as polystyrene itself, polystyrene bearing sulfonate groups in the benzene rings, and polystyrene sulfonate in which the sulfonate groups were converted to amino acid sulfamide, were investigated. Some of these resins were shown in previous work to have anticoagulant properties. To study the adsorption of proteins from plasma, the resins were exposed to citrate anticoagulated human plasma for 3 h. Adsorbed proteins were then eluted sequentially by 1M Tris buffer and 4% SDS solution, and examined by SDS-PAGE. The gel patterns were similar on all resins except polystyrene. From the MWs of the gel bands, the major protein component appeared to be fibrinogen. Smaller amounts of plasminogen, transferrin, albumin, and IgG were also present. In addition, Ouchterlony immunoassay of the eluates from one resin gave positive identification of complement C3, fibronectin, IgG, and IgM. Many other minor gel bands remain unidentified. A consistent finding for all resins was the presence of plasmin-type fibrinogen degradation products though the amounts varied with resin type. It is concluded from this (and from experiments showing FDP formation when fibrinogen was absorbed to the resins, from buffer containing a trace of plasminogen) that the functional groups in these materials promote the adsorption of plasminogen and its activation to a plasmin-like molecule. It appears from the substantial quantities of fibrinogen adsorbed to these materials after 3 h exposure to plasma that the Vroman effect (giving transient adsorption of fibrinogen) is not operative on these materials. It is hypothesized that specific interactions occur between fibrinogen and sulfonate groups.

Albumin adsorption on to aluminium oxide and polyurethane surfaces

The changes in protein adsorption onto aluminium surfaces coated with different thicknesses of oxide layers were examined. The oxide layers on aluminium substrates were derived by the anodizing technique. Protein adsorption studies were conducted using 125I-labelled albumin and the amount of albumin adsorbed was estimated with the help of a gamma counter. An increase in albumin adsorption was observed on oxide layer coated aluminium surfaces. The effect of anti-Hageman factor on albumin and fibrinogen adsorption on to bare aluminium, oxide layer coated aluminium and bare polyether urethane urea surfaces was also investigated. It was observed that the presence of anti-Hageman factor increased the adsorption of albumin and fibrinogen on to all these substrates.

The influence of vaccines and hyper immune serums on protein/platelet interaction towards an artificial surface

Protein adsorption and platelet adhesion are two important biological processes arising at the blood prosthetic interface. The effect of certain commonly used vaccines and hyper immune serums namely tetanus toxoid, tetanus immunoglobulin, polyvalent anti-snake venum serum and anticholera vaccine to modulate the surface induced platelet adhesion to polycarbonate substrate was investigated using washed calf platelets in presence and absence of fibrinogen. This study also demonstrated the changes in protein-surface binding with few of these vaccines, using SDS - polyacrylamide gel electrophoresis. It seems, the addition of tetanus toxoid to the polymer-protein system increased the level of surface-bound albumin and reduced the fibrinogen-surface attachment. On the other hand, tetanus immunoglobulin reversed the effect. This itself may be one of the parameters for the observed reduction in platelet-surface attachment due to tetanus toxoid. The enhanced platelet adhesion with other vaccines, may be correlated with the availability of more fibrinogen receptors for the platelets to attach. A better understanding of the mechanism of these vaccines is needed in vivo conditions for interrelating these findings.

Influence of steroid hormones on protein-platelet interaction at the blood-polymer interface

To develop artificial materials for prolonged use in the vascular system, the complicated process of surface-induced thrombosis needs to be better understood. Steroidal hormones have a profound role in thrombosis and haemostasis, although adequate studies are not available to demonstrate their part in the thromboembolic phenomena that occur at the blood-foreign material interface. We studied the interfacial phenomena of five steroid hormonal drugs, Sustanon, Menstrogen, Mixogen, Durabolin and Ovral and their interaction with proteins and platelets toward an artificial surface using contact angle, polyacrylamide gel electrophoresis, trace labelling methods, etc. This study demonstrates the effect of these hormones to modulate platelet-surface attachment in the presence of platelet inducers. The addition of steroid hormones to the polymer-protein system can inhibit the level of surface-bound albumin where the fibrinogen binding to an artificial surface has been enhanced or unaltered. Steroids also increase platelet-surface attachment to variable degrees. Prolonged use of steroids or the oestrogen-containing oral contraceptive agents may not be advisable for patients having an artificial implant in contact with blood.