Dialysis and nanotechnology: now, 10 years, or never?

Is there a future for electrochemically assisted hemodialysis? Focus on the application of polypyrrole–nanocellulose composites

This work summarizes the various aspects of using electrochemically assisted solute removal techniques in hemodialysis with a focus on blood electrodialysis and electrochemically controlled uremic retention solute removal using polypyrrole. In particular, the feasibility of using highly porous conductive polypyrrole–Cladophora cellulose membranes for hemodialysis are overviewed as a part of our dedicated research efforts during the past 4 years. The potential benefits and the current limitations associated with using the electrochemically controlled uremic retention solute removal techniques are discussed in detail.

Theoretical Application of Irreversible (Nonequilibrium) Thermodynamic Principles to Enhance Solute Fluxes across Nanofabricated Hemodialysis Membranes

Objective. Nanotechnology has the potential to improve hemodialysis membrane technology. Thus, a major objective is to understand how to enhance toxic solute fluxes across these membranes. The aim of this concept building study is to review the application of irreversible thermodynamic (IT) to solute fluxes. Methods. We expanded the application of the Nernst-Planck equation to include the Kedem-Katchalsky equation, pH, membrane thickness, pore size, and electric potential as variables. Results. (1) Reducing the membrane's thickness from 25 μm to 25 nm increased the flux of creatinine, β₂-microglobulin, and tumor necrosis factor-α (TNF-α) by a thousand times but prevented completely albumin flux, (2) applying an electric potential of 50–400 mV across the membrane enhanced the flux of the respective molecules by 71.167 × 10⁻³, 38.7905 × 10⁻⁸, and 0.595 × 10⁻¹³ mol/s, and (3) changing the pH from 7.35 to 7.42 altered the fluxes minimally. Conclusions. The results supported an argument to investigate the application of IT to study forces of fluxes across membranes. Reducing the membrane's thickness—together with the application of an electrical potential—qualities achievable by nanotechnology, can enhance the removal of uremic toxins by many folds. However, changing the pH at a specific membrane thickness does not affect the flux significantly.

NANOPOROUS MEMBRANE FOR BIOSENSING APPLICATIONS

Synthetic nanoporous membranes have been used in numerous biosensing applications, such as glucose detection, nucleic acid detection, bacteria detection, and cell-based sensing. The increased surface affinity area and enhanced output sensing signals make the nanoporous membranes increasingly attractive as biosensing platforms. Surface modification techniques can be used to improve surface properties for realizable bioanalyte immobilization, conjugation, and detection. Combined with realizable detection techniques such as electrochemical and optical detection methods, nanoporous membrane–based biosensors have advantages, including rapid response, high sensitivity, and low cost. In this paper, an overview of nanoporous membranes for biosensing application is given. Types of nanoporous membranes including polymer membranes, inorganic membranes, membranes with nanopores fabricated using nanolithography, and nanotube-based membranes are introduced. The fabrication techniques of nanoporous membranes are also discussed. The key requirements of nanoporous membranes for biosensing applications include surface functionality for bioanalyte immobilization, biocompatibility, mechanical and chemical stability, and anti-biofouling capability. The recent advances and development of nanoporous membrane–based biosensors are discussed, especially for the sensing mechanism and surface functionalization strategies. Finally, the challenges and future development of nanoporous membrane for biosensing applications are discussed.

An experimental and theoretical analysis of molecular separations by diffusion through ultrathin nanoporous membranes

Diffusion based separations are essential for laboratory and clinical dialysis processes. New molecularly thin nanoporous membranes may improve the rate and quality of separations achievable by these processes. In this work we have performed protein and small molecule separations with 15 nm thick porous nanocrystalline silicon (pnc-Si) membranes and compared the results to 1- and 3- dimensional models of diffusion through ultrathin membranes. The models predict the amount of resistance contributed by the membrane by using pore characteristics obtained by direct inspection of pnc-Si membranes in transmission electron micrographs. The theoretical results indicate that molecularly thin membranes are expected to enable higher resolution separations at times before equilibrium compared to thicker membranes with the same pore diameters and porosities. We also explored the impact of experimental parameters such as porosity, pore distribution, diffusion time, and chamber size on the sieving characteristics. Experimental results are found to be in good agreement with the theory, and ultrathin membranes are shown to impart little overall resistance to the diffusion of molecules smaller than the physical pore size cutoff. The largest molecules tested experience more hindrance than expected from simulations indicating that factors not incorporated in the models, such as molecule shape, electrostatic repulsion, and adsorption to pore walls, are likely important.

Integration of in silico and in vitro platforms for pharmacokinetic-pharmacodynamic modeling

IMPORTANCE OF THE FIELD

Pharmacokinetic-pharmacodynamic (PK-PD) modeling enables quantitative prediction of the dose-response relationship. Recent advances in microscale technology enabled researchers to create in vitro systems that mimic biological systems more closely. Combination of mathematical modeling and microscale technology offers the possibility of faster, cheaper and more accurate prediction of the drug's effect with a reduced need for animal or human subjects.

AREAS COVERED IN THIS REVIEW

This article discusses combining in vitro microscale systems and PK-PD models for improved prediction of drug's efficacy and toxicity. First, we describe the concept of PK-PD modeling and its applications. Different classes of PK-PD models are described. Microscale technology offers an opportunity for building physical systems that mimic PK-PD models. Recent progress in this approach during the last decade is summarized.

WHAT THE READER WILL GAIN

This article is intended to review how microscale technology combined with cell cultures, also known as 'cells-on-a-chip', can confer a novel aspect to current PK-PD modeling. Readers will gain a comprehensive knowledge of PK-PD modeling and 'cells-on-a-chip' technology, with the prospect of how they may be combined for synergistic effect.

TAKE HOME MESSAGE

The combination of microscale technology and PK-PD modeling should contribute to the development of a novel in vitro/in silico platform for more physiologically-realistic drug screening.

A robust nanofluidic membrane with tunable zero-order release for implantable dose specific drug delivery

This manuscript demonstrates a mechanically robust implantable nanofluidic membrane capable of tunable long-term zero-order release of therapeutic agents in ranges relevant for clinical applications. The membrane, with nanochannels as small as 5 nm, allows for the independent control of both dosage and mechanical strength through the integration of high-density short nanochannels parallel to the membrane surface with perpendicular micro- and macrochannels for interfacing with the ambient solutions. These nanofluidic membranes are created using precision silicon fabrication techniques on silicon-on-insulator substrates enabling exquisite control over the monodispersed nanochannel dimensions and surface roughness. Zero-order release of analytes is achieved by exploiting molecule to surface interactions which dominate diffusive transport when fluids are confined to the nanoscale. In this study we investigate the nanofluidic membrane performance using custom diffusion and gas testing apparatuses to quantify molecular release rate and process uniformity as well as mechanical strength using a gas based burst test. The kinetics of the constrained zero-order release is probed with molecules presenting a range of sizes, charge states, and structural conformations. Finally, an optimal ratio of the molecular hydrodynamic diameter to the nanochannel dimension is determined to assure zero-order release for each tested molecule.

Silicon induces minimal thromboinflammatory response during 28-day intravascular implant testing

Microelectromechanical systems (MEMS) are used to machine miniaturized implantable medical devices. Our group has used MEMS technology to develop hemofiltration membranes for use in renal replacement therapy, which possess enhanced selectivity and permeability. The use of silicon in blood-contacting environments may be limited, however, due to contact activation of the coagulation cascade by silicon, which forms the surface oxides in atmospheric conditions. As well, the reports of long-term biocompatibility of blood- contacting silicon devices are lacking. The aims of this pilot study were as follows: 1) to develop a model for investigating the effects of intravascular implants and 2) to characterize the degree of thrombosis and tissue inflammation incited by prolonged implantation of silicon materials. Silicon implants with and without polyethylene glycol (PEG) coatings were surgically implanted transluminally through rat femoral veins. Gore-Tex and stainless steel implants served as controls. The implants were left in vivo for 4 weeks. All femoral veins remained patent. The veins associated with silicon implants exhibited rare thrombi and occasional mild perivascular inflammation. In contrast, Gore-Tex and stainless steel controls caused moderate vein thrombosis and provoked a moderate to marked cellular infiltrate. Under scanning electron microscopy, bare silicon implants were found to have significant adherent microthrombi, whereas PEG-treated implants showed no evidence of thrombi. PEG-treated silicon seems to be biocompatible and holds potential as an excellent material with which to construct an implantable, miniaturized hemofiltration membrane.

Cell culture on MEMS platforms: a review

Microfabricated systems provide an excellent platform for the culture of cells, and are an extremely useful tool for the investigation of cellular responses to various stimuli. Advantages offered over traditional methods include cost-effectiveness, controllability, low volume, high resolution, and sensitivity. Both biocompatible and bio-incompatible materials have been developed for use in these applications. Biocompatible materials such as PMMA or PLGA can be used directly for cell culture. However, for bio-incompatible materials such as silicon or PDMS, additional steps need to be taken to render these materials more suitable for cell adhesion and maintenance. This review describes multiple surface modification strategies to improve the biocompatibility of MEMS materials. Basic concepts of cell-biomaterial interactions, such as protein adsorption and cell adhesion are covered. Finally, the applications of these MEMS materials in Tissue Engineering are presented.

Construction of bioartificial renal tubule assist device in vitro and its function of transporting sodium and glucose

To explore a new way of constructing bioartificial renal tubule assist device (RAD) in vitro and its function of transporting sodium (Na(+)) and glucose and to evaluate the application of atomic force microscope in the RAD construction, rat renal tubular epithelial cell line NRK-52E was cultured in vitro, seeded onto the outer surfaces of hollow fibers in a bioreactor, and then cultured for two weeks to construct RAD. Bioreactor hollow fibers without NRK-52E cells were used as control. The morphologies of attached cells were observed with scanning electron microscope, and the junctions of cells and polysulfone membrane were observed with atomic force microscope. Transportation of Na(+) and glucose was measured. Oubaine and phlorizin were used to inhibit the transporting property. The results showed that NRK-52E cells and polysulfone membrane were closely linked, as observed under atomic force microscope. After exposure to oubaine and phlorizin, transporting rates of Na(+) and glucose were decreased significantly in the RAD group as compared with that in the control group (P<0.01). Furthermore, when the inhibitors were removed, transportation of Na(+) and glucose was restored. It is concluded that a new RAD was constructed successfully in vitro, and it is able to selectively transport Na(+) and glucose.

The effect of three different miniaturized blood purification devices on plasma cytokine concentration in an ex vivo model of endotoxinemia

PURPOSE

A novel type of adsorptive plasma filtering device (ETX-A) capable of removing endotoxin from blood in a single step has recently been developed using nanotechnology.

METHODS

In a miniaturized, ex vivo model of extracorporeal circuits, we tested the capacity to reduce plasma cytokine concentration of ETX-A filters in comparison to standard high-flux (HF) filters, high cut-off (HCO) filters and a control. Blood from six healthy volunteers was spiked with endotoxin and then circulated through closed (ETX-A, control) or open (HF, HCO) circuits. Blood flow was set at 16 ml/min and filtration flow at 1 ml/min. Samples for measurement of IL-1ra and IL-6 were taken at baseline and at 4 hours.

RESULTS

Compared to control (703.3 [850.6] pg/mL), in HCO (383.5 [1144.1] pg/mL) and ETX-A (490.1 [683.2] pg/mL) filters, plasma IL-1ra pooled pre- and postfilter concentrations were lower at the end of the experiment (P=0.002; P=0.050, respectively) whereas, in standard HF filters, IL-1ra concentration was higher than control. HCO showed a trend toward a reduced relative increase in IL-6 concentration from commencement to end of experiment compared to control (P=0.07). After pooling end-of-experiment plasma cytokine values of novel blood purification devices, we found HCO + ETX-A superior to H with regard to reduction of IL-1ra (-27.0 [-20.5]% vs. 8.1 [18.9]%; p<0.001) and IL-6 (-18.0 [38.3]% vs. -1.1 [24.3]%; P=0.050) compared to control.

CONCLUSIONS

HCO and ETX-A appeared to significantly reduce plasma IL-1ra and, when combined, plasma IL-6 concentration as well. It appears desirable to manufacture full-size blood purification devices using this technology and to explore their effect on cytokine removal.

The future of extracorporeal support

Extracorporeal therapy has expanded significantly over the past few decades from solely artificial renal replacement therapy. In patients with multiple organ dysfunction syndrome, it becomes necessary to provide multiple organ support therapy. Technological advances have opened the door to a multifaceted intervention directed at supporting the function of multiple organs through the treatment of blood. Indications for "old" therapies such as hemofiltration and adsorption have been expanded, and using these therapies in combination further enhances blood detoxification capabilities. Furthermore, new devices are constantly in development. Nanotechnology allows us to refine membrane characteristics and design innovative monitoring/biofeedback devices. Miniaturization is leading down the path of wearable/implantable devices. With the incorporation of viable cells within medical devices, these instruments become capable not only of detoxification but synthetic functions as well, bringing us closer to the holy grail of complete replacement of organ function. This article provides a brief overview of current and future direction in extracorporeal support in the critical care setting.

Membranes for dialysis: can we do without them?

Over the past five decades, membranes used for the treatment of chronic kidney disease have continuously evolved. In the course of this evolution, the use of classical non-modified cellulose membranes has declined in favor of cellulose-based membranes in which the basic structure has been modified to improve the biocompatibility profile of the material as well as membranes based on synthetic polymers. In addition to providing improved biocompatibility, manufacturing methods have been innovatively adapted to produce membranes with optimized pore size and pore size distribution. This has led to the more effective removal of molecules involved in the development of complications associated with dialysis treatment. More recently, the approach has been move membranes beyond being just selective barriers with a high performance and to incorporate biological function. Despite these advances, membranes in current clinical use represent a compromise: while efficient in their removal of water soluble compounds, they are non selective, retain some bioreactivity and differ in their ability to adsorb endotoxins or bacterial fragments that may be present in the dialysis fluid. In this paper, an overview of the membranes used in current clinical practice and their limitations are discussed, together with approaches to solute transport in which no membranes are used.