Inhibition of monocyte adhesion and fibrinogen adsorption on glow discharge plasma deposited tetraethylene glycol dimethyl ether

Fibrin polymer on the surface of biomaterial implants drives the foreign body reaction

Implantation of biomaterials and medical devices in the body triggers the foreign body reaction (FBR) which is characterized by macrophage fusion at the implant surface leading to the formation of foreign body giant cells and the development of the fibrous capsule enveloping the implant. While adhesion of macrophages to the surface is an essential step in macrophage fusion and implanted biomaterials are known to rapidly acquire a layer of host proteins, a biological substrate that is responsible for this process in vivo is unknown. Here we show that mice with genetically imposed fibrinogen deficiency display a dramatic reduction of macrophage fusion on biomaterials implanted intraperitoneally and subcutaneously and are protected from the formation of the fibrin-containing fibrous capsule. Furthermore, macrophage fusion on biomaterials implanted in Fib^AEK mice that express a mutated form of fibrinogen incapable of thrombin-mediated polymerization was strongly reduced. Despite the lack of fibrin, the capsule was formed in Fib^AEK mice, although it had a different composition and distinct mechanical properties than that in wild-type mice. Specifically, while mononuclear α-SMA-expressing macrophages embedded in the capsule of both strains of mice secreted collagen, the amount of collagen and its density in the tissue of Fib^AEK mice was reduced. These data identify fibrin polymer as a key biological substrate driving the development of the FBR.

Polysiloxane Nanofilaments Infused with Silicone Oil Prevent Bacterial Adhesion and Suppress Thrombosis on Intranasal Splints

Like all biofluid-contacting medical devices, intranasal splints are highly prone to bacterial adhesion and clot formation. Despite their widespread use and the numerous complications associated with infected splints, limited success has been achieved in advancing their safety and surface biocompatibility, and, to date, no surface-coating strategy has been proposed to simultaneously enhance the antithrombogenicity and bacterial repellency of intranasal splints. Herein, we report an efficient, highly stable lubricant-infused coating for intranasal splints to render their surfaces antithrombogenic and repellent toward bacterial cells. Lubricant-infused intranasal splints were prepared by creating superhydrophobic polysiloxane nanofilament (PSnF) coatings using surface-initiated polymerization of n-propyltrichlorosilane (n-PTCS) and further infiltrating them with a silicone oil lubricant. Compared with commercially available intranasal splints, lubricant-infused, PSnF-coated splints significantly attenuated plasma and blood clot formation and prevented bacterial adhesion and biofilm formation for up to 7 days, the typical duration for which intranasal splints are kept. We further demonstrated that the performance of our engineered biointerface is independent of the underlying substrate and could be used to enhance the hemocompatibility and repellency properties of other medical implants such as medical-grade catheters.

Controlling Experimental Parameters to Improve Characterization of Biomaterial Fouling

Uncontrolled protein adsorption and cell binding to biomaterial surfaces may lead to degradation, implant failure, infection, and deleterious inflammatory and immune responses. The accurate characterization of biofouling is therefore crucial for the optimization of biomaterials and devices that interface with complex biological environments composed of macromolecules, fluids, and cells. Currently, a diverse array of experimental conditions and characterization techniques are utilized, making it difficult to compare reported fouling values between similar or different biomaterials. This review aims to help scientists and engineers appreciate current limitations and conduct fouling experiments to facilitate the comparison of reported values and expedite the development of low-fouling materials. Recent advancements in the understanding of protein-interface interactions and fouling variability due to experiment conditions will be highlighted to discuss protein adsorption and cell adhesion and activation on biomaterial surfaces.

Single and multi-functional coating strategies for enhancing the biocompatibility and tissue integration of blood-contacting medical implants

Device-associated clot formation and poor tissue integration are ongoing problems with permanent and temporary implantable medical devices. These complications lead to increased rates of mortality and morbidity and impose a burden on healthcare systems. In this review, we outline the current approaches for developing single and multi-functional surface coating techniques that aim to circumvent the limitations associated with existing blood-contacting medical devices. We focus on surface coatings that possess dual hemocompatibility and biofunctionality features and discuss their advantages and shortcomings to providing a biocompatible and biodynamic interface between the medical implant and blood. Lastly, we outline the newly developed surface modification techniques that use lubricant-infused coatings and discuss their unique potential and limitations in mitigating medical device-associated complications.

Blood-Compatible Surfaces with Phosphorylcholine-Based Polymers for Cardiovascular Medical Devices

For the acquisition of blood-compatible materials, various hydrophilic polymers for surface modification have been examined. Among them, polymers with a representative phospholipid polar group, the phosphorylcholine (PC) group, are a successful example. These polymers were designed from inspiration of the cell membrane surface and provide protein adsorption resistance even following contact with plasma. This important property is based on the unique hydration state of water molecules surrounding hydrated polymer; in other words, water molecules weakly interact with the polymers and maintain their favorable cluster structure through hydrogen bonding. These polymers are not only hydrophilic, but also electrically neutral, important characteristics which make hydrogen bonding with water molecules less likely to occur and avoid hydrophobic interactions. Phosphorylcholine groups and other zwitterionic structures are significant as hydrophilic functional groups meeting these important requirements. In this review, blood compatibility of a polymer having a PC group is introduced in relation to its hydration structure, followed by a description of the applications of this polymer to cardiovascular medical devices.

Fibrinogen adsorption to biomaterials

Fibrinogen (Fg) adsorption is an important mechanism underlying cell adhesion to biomaterials and was the major focus of the author's research career. This article summarizes our work on Fg adsorption, with citations of related work as appropriate. The molecular properties of Fg that promote adsorption and cell adhesion will be described. In addition, the adsorption behavior of Fg from buffer, binary solutions with other proteins, and blood plasma will be discussed, including the Vroman effect. Studies of platelet adhesion to surfaces preadsorbed with blood plasmas selectively deficient in Fg, vitronectin (Vn), fibronectin (Fn), or von Willebrand's factor (vWf) will be reviewed. These studies clearly showed a major role for Fg in platelet adhesion under static conditions and both Fg and vWf for adhesion from flowing suspensions, but no significant role for Vn or Fn. However, it was also shown that platelet adhesion was poorly correlated with the total amount of adsorbed Fg, but very well correlated with the binding of antibodies specific to the cell binding domains of Fg. A brief overview of nonfouling surfaces for prevention of Fg adsorption will be given. A more extensive discussion of structural changes in Fg after its adsorption is included, including changes detected with both physicochemical and biological methods. A short discussion of the state of the art of structural determination of adsorbed proteins with computational methods is also given. A final section identifies Fg adsorption as the single most important event determining the biocompatibility of implants in soft tissue and in blood. © 2018 Wiley Periodicals, Inc. J Biomed Mater Res Part A: 106A: 2777-2788, 2018.

Enhanced antibacterial efficacy of nitric oxide releasing thermoplastic polyurethanes with antifouling hydrophilic topcoats

Surface fouling is one of the leading causes of infection associated with implants, stents, catheters, and other medical devices. The surface chemistry of medical device coatings is important in controlling and/or preventing fouling. In this study, we have shown that a combination of nitric oxide releasing hydrophobic polymer with a hydrophilic polymer topcoat can significantly reduce protein attachment and subsequently reduce bacterial adhesion as a result of the synergistic effect. Nitric oxide (NO) is a well-known potent antibacterial agent due to its adverse reactions on microbial cell components. Owing to the surface chemistry of hydrophilic polymers, they are suitable as antifouling topcoats. In this study, four biomedical grade polymers were compared for protein adhesion and NO-release behavior: CarboSil 2080A, silicone rubber, SP60D60, and SG80A. SP60D60 was found to resist protein adsorption up to 80% when compared to the other polymers while CarboSil 2080A maintained a steady NO flux even after 24 hours (∼0.50 × 10-10 mol cm-2 min-1) of soaking in buffer solution with a loss of less than 3% S-nitroso-N-acetylpenicillamine (SNAP), the NO donor molecule, in the leaching analysis. Therefore, CarboSil 2080A incorporated with SNAP and top-coated with SP60D60 was tested for antibacterial efficacy after exposure to fibrinogen, an abundantly found protein in blood. The NO-releasing CarboSil 2080A with the SP60D60 top-coated polymer showed a 96% reduction in Staphylococcus aureus viable cell count compared to the control samples. Hence, the study demonstrated that a hydrophilic polymer topcoat, when applied to a polymer with sustained NO release from an underlying SNAP incorporated hydrophobic polymer, can reduce bacterial adhesion and be used as a highly efficient antifouling, antibacterial polymer for biomedical applications.

Plasma-Treated Microplates with Enhanced Protein Recoveries and Minimized Extractables

SiO₂ Medical Products, Inc. (SiO) has developed a proprietary technology that greatly enhances protein recoveries and reduces extractables from commercial microplates used for bioanalytical assays and storage of biologics. SiO technology is based on plasma treatment that chemically modifies the surface of polypropylene with predominantly hydrogen-bond-acceptor uncharged polar groups. The resultant surface resists nonspecific protein adsorption over a wide range of protein concentrations, thereby eliminating the need to passivate (and hence potentially contaminate) the microplates with blocking proteins. High shelf-life stability and cleanliness of the plasma-treated microplates have been demonstrated using five different proteins for two common microplate formats. The protein recovery performance of plasma-treated microplates is found to be higher compared with commercial low-protein-binding microplates.

Integrin-directed modulation of macrophage responses to biomaterials

Macrophages are the primary mediator of chronic inflammatory responses to implanted biomaterials, in cases when the material is either in particulate or bulk form. Chronic inflammation limits the performance and functional life of numerous implanted medical devices, and modulating macrophage interactions with biomaterials to mitigate this response would be beneficial. The integrin family of cell surface receptors mediates cell adhesion through binding to adhesive proteins nonspecifically adsorbed onto biomaterial surfaces. In this work, the roles of integrin Mac-1 (αMβ2) and RGD-binding integrins were investigated using model systems for both particulate and bulk biomaterials. Specifically, the macrophage functions of phagocytosis and inflammatory cytokine secretion in response to a model particulate material, polystyrene microparticles were investigated. Opsonizing proteins modulated microparticle uptake, and integrin Mac-1 and RGD-binding integrins were found to control microparticle uptake in an opsonin-dependent manner. The presence of adsorbed endotoxin did not affect microparticle uptake levels, but was required for the production of inflammatory cytokines in response to microparticles. Furthermore, it was demonstrated that integrin Mac-1 and RGD-binding integrins influence the in vivo foreign body response to a bulk biomaterial, subcutaneously implanted polyethylene terephthalate. A thinner foreign body capsule was formed when integrin Mac-1 was absent (~30% thinner) or when RGD-binding integrins were blocked by controlled release of a blocking peptide (~45% thinner). These findings indicate integrin Mac-1 and RGD-binding integrins are involved and may serve as therapeutic targets to mitigate macrophage inflammatory responses to both particulate and bulk biomaterials.

Bioactive technologies for hemocompatibility

The contact of any biomaterial with blood gives rise to multiple pathophysiologic defensive mechanisms such as activation of the coagulation cascade, platelet adhesion and activation of the complement system and leukocytes. The reduction of these events is of crucial importance for the successful clinical performance of a cardiovascular device. This can be achieved by improving the hemocompatibility of the device materials or by pharmacologic inhibition of the key enzymes responsible for the activation of the cascade reactions, or a combination of both. Different strategies have been developed during the last 20 years, and this article attempts to review the most significant, by dividing them into three main categories: bioinert or biopassive, biomimetic and bioactive strategies. With regard to bioactive strategies, particular attention is given to heparin immobilization and recent related technologies. References from both scientific literature and commercial sites are provided. Future development and studies are suggested.

A hydrazide-anchored dendron scaffold for chemoselective ligation strategies

We report the design and synthesis of a dendron scaffold, enabling the chemoselective decoration of target molecules with multiple copies of functional species, such as peptides, via a hydrazone bond.

Photocatalytic nanolithography of self-assembled monolayers and proteins

Self-assembled monolayers of alkylthiolates on gold and alkylsilanes on silicon dioxide have been patterned photocatalytically on sub-100 nm length-scales using both apertured near-field and apertureless methods. Apertured lithography was carried out by means of an argon ion laser (364 nm) coupled to cantilever-type near-field probes with a thin film of titania deposited over the aperture. Apertureless lithography was carried out with a helium-cadmium laser (325 nm) to excite titanium-coated, contact-mode atomic force microscope (AFM) probes. This latter approach is readily implementable on any commercial AFM system. Photodegradation occurred in both cases through the localized photocatalytic degradation of the monolayer. For alkanethiols, degradation of one thiol exposed the bare substrate, enabling refunctionalization of the bare gold by a second, contrasting thiol. For alkylsilanes, degradation of the adsorbate molecule provided a facile means for protein patterning. Lines were written in a protein-resistant film formed by the adsorption of oligo(ethylene glycol)-functionalized trichlorosilanes on glass, leading to the formation of sub-100 nm adhesive, aldehyde-functionalized regions. These were derivatized with aminobutylnitrilotriacetic acid, and complexed with Ni(2+), enabling the binding of histidine-labeled green fluorescent protein, which yielded bright fluorescence from 70-nm-wide lines that could be imaged clearly in a confocal microscope.

On the effect of monomer chemistry on growth mechanisms of nonfouling PEG-like plasma polymers

It has been shown that both ions and neutral species may contribute to plasma polymer growth. However, the relative contribution from these mechanisms remains unclear. We present data elucidating the importance of considering monomer structure with respect to which the growth mechanism dominates for nonfouling PEG-like plasma polymers. The deposition rate for saturated monomers is directly linked with ion flux to the substrate. For unsaturated monomers, the neutral flux also plays a role, particularly at low power. Increased fragmentation of the monomer at high power reduces the ability of unsaturated monomers to grow via neutral grafting. Chemical characterization by X-ray photoelectron spectroscopy (XPS) and time-of-flight secondary ion mass spectrometry (ToF-SIMS) confirm the role that plasma phase fragmentation plays in determining the deposition rate and surface chemistry of the deposited film. The simple experimental method used here may also be used to determine which mechanisms dominate plasma deposition for other monomers. This knowledge may enable significant improvement in future reactor design and process control.

Elucidation of adhesion-dependent spontaneous apoptosis in macrophages using phase separated PEG/polyurethane films

Circulating monocytes undergo spontaneous apoptosis when there is no activation stimulus, which is critical to population control for proper host response to implants. As activation and apoptosis of monocytes/macrophages are regulated by cell-cell and cell-matrix interactions, their regulatory mechanism was investigated in this study using polyethylene glycol (PEG)-containing polyurethane films in which PEG-rich and polyester-rich domains were phase separated. Human blood monocyte-derived macrophages (HBMs) preferentially adhered to PEG domains (cell-matrix interaction) due to the low molecular weight (600 g mol⁻¹), resulting in increased HBM density (cell-cell interaction). As both cell-cell and cell-matrix interactions were promoted, HBM apoptosis increased, while their activation as measured by phagocytosis, intracellular reactive oxygen species (ROS) level and matrix metalloproteinase-9 production decreased compared to PEG-free films. When cell seeding density and cell-adhesive gelatin coating on silicone films were controlled, a cooperative role of cell-matrix (adhesion) and cell-cell (density) interactions in inducing HBM apoptosis was observed. Expression of the macrophage adhesion molecule CD11b caused apoptosis in this context, which was mediated by tissue necrosis factor-α signaling but down-regulated by the ROS inhibitor diphenylene iodonium and the anti-inflammatory peptide Ac-SDKP, suggesting a new concept for the design of biomaterials that allows for cell adhesion without excessive inflammatory activation.

Surface modification and drug delivery for biointegration

Biointegration refers to the interconnection between a biomedical device and the recipient tissue. In many implant devices, the lack of proper biointegration can cause device failure and potentially serious medical problems. This review summarizes the recent progress in surface chemistry, drug delivery and antifouling methods to improve the biointegration of implants. Much progress has been made as our understanding of biological systems and material properties expands and as new technologies become available. This article addresses methods of enhancing biointegration by means of modifying implant surface chemistry and by drug-delivery approaches.

Stable low-fouling plasma polymer coatings on polydimethylsiloxane

Polydimethylsiloxane (DMS) is a popular material for microfluidics, but it is hydrophobic and is prone to non-specific protein adsorption. In this study, we explore methods for producing stable, protein resistant, tetraglyme plasma polymer coatings on PDMS by combining extended baking processes with multiple plasma polymer coating steps. We demonstrate that by using this approach, it is possible to produce a plasma polymer coatings that resist protein adsorption (<10 ng/cm(2)) and are stable to storage over at least 100 days. This methodology can translate to any plasma polymer system, enabling the introduction of a wide range of surface functionalities on PDMS surfaces.

Modulation of fibroblast inflammatory response by surface modification of a perfluorinated ionomer

An ideal surface for implantable glucose sensors would be able to evade the events leading to chronic inflammation and fibrosis, thereby extending its utility in an in vivo environment. Nafion™, a perfluorinated ionomer, is the membrane material preferred for in situ glucose sensors. Unfortunately, the surface properties of Nafion™ promote random protein adsorption and eventual foreign body encapsulation, thus leading to loss of glucose signal over time. Details of the techniques to render Nafion™ nonprotein fouling are given in a previous article [T. I. Valdes et al., Biomaterials 29, 1356 (2008)]. Once random protein adsorption is prevented, a biologically active peptide can be covalently bonded to the treated Nafion™ to induce cellular adhesion. Cellular responses to these novel decorated Nafion™ surfaces are detailed here, including cell viability, cell spreading, and type I collagen synthesis. Normal human dermal fibroblasts (NHDFs) were cultured on control and modified Nafion™ surfaces. Findings indicate that Nafion™ modified with 10% 2-hydroxyethyl methacrylate and 90% tetraglyme created a nonfouling surface that was subsequently decorated with the YRGDS peptide. NHDFs were shown to have exhibited decreased type I collagen production in comparison to NHDF cells on unmodified Nafion™ surfaces. Here, the authors report evidence that proves that optimizing conditions to prevent protein adsorption and enhance cellular adhesion may eliminate fibrous encapsulation of an implant.

Immune responses to implants - a review of the implications for the design of immunomodulatory biomaterials

A key for long-term survival and function of biomaterials is that they do not elicit a detrimental immune response. As biomaterials can have profound impacts on the host immune response the concept emerged to design biomaterials that are able to trigger desired immunological outcomes and thus support the healing process. However, engineering such biomaterials requires an in-depth understanding of the host inflammatory and wound healing response to implanted materials. One focus of this review is to outline the up-to-date knowledge on immune responses to biomaterials. Understanding the complex interactions of host response and material implants reveals the need for and also the potential of "immunomodulating" biomaterials. Based on this knowledge, we discuss strategies of triggering appropriate immune responses by functional biomaterials and highlight recent approaches of biomaterials that mimic the physiological extracellular matrix and modify cellular immune responses.

The role of complement C3 and fibrinogen in monocyte adhesion to PEO-like plasma deposited tetraglyme

The role of complement C3 in mediating adhesion of monocytes to plasma deposited tetraglyme surfaces was studied. Although fibrinogen (Fg) is usually considered the main factor in mediating phagocyte attachment, plasma deposited PEO-like tetraethylene glycol dimethyl ether (tetraglyme) coatings that have ultra-low Fg adsorption (<10 ng cm(-2)) from low concentration solutions and low monocyte adhesion in vitro still show high phagocyte adhesion after short implantations and later become encapsulated when tested in vivo. To test whether higher Fg adsorption under in vivo conditions could explain the higher in vivo reactivity, we again measured the resistance of tetraglyme films to Fg adsorption. We found a surprising and previously unreported increased amount of adsorbed Fg on tetraglyme surfaces from higher concentration protein solutions. However, monocyte adhesion to tetraglyme did not markedly increase despite the increased Fg adsorption. We thus suspected proteins other than Fg must be responsible for the increased in vivo reactivity. We found that on tetraglyme preadsorbed with C3-depleted serum, monocyte adhesion was greatly reduced as compared to samples adsorbed with normal serum. Addition of exogenous pure C3 to the serum used to preadsorb the surfaces restored monocyte adhesion to tetraglyme coatings. While Fg clearly plays an important role in mediating monocyte adhesion to tetraglyme surfaces, the results show an additional role for adsorbed C3 in monocyte adhesion.

Characterization of the in vitro macrophage response and in vivo host response to poly(ethylene glycol)-based hydrogels

Photopolymerizable poly(ethylene glycol) (PEG)- based hydrogels have great potential as in vivo cell delivery vehicles for tissue engineering. However, their success in vivo will be dependent on the host response. The objectives for this study were to explore the in vivo host response and in vitro macrophage response to commonly used PEG-based hydrogels, PEG and PEG containing RGD. Acellular hydrogels were implanted subcutaneously into c57bl/6 mice and the foreign body response (FBR) was compared to medical grade silicone. Our findings demonstrated PEG-RGD hydrogels resulted in a FBR similar to silicone, while PEG-only hydrogels resulted in a robust inflammatory reaction characterized by a thick layer of macrophages at the material surface with evidence of gel degradation. In vitro, bone marrow-derived primary macrophages adhered well and similarly to PEG-based hydrogels, silicone, and tissue culture polystyrene when cultured for 4 days. Significantly higher gene expressions of the proinflammatory cytokines, TNF-alpha and Il-1beta, were found in macrophages seeded onto PEG compared to PEG-RGD and silicone at 1 and 2 days. PEG hydrogels were also shown to be susceptible to oxidative biodegradation. Our findings indicate that PEG-only hydrogels are proinflammatory while RGD attenuates this negative reaction leading to a moderate FBR.

Assembly and structure of alpha-helical peptide films on hydrophobic fluorocarbon surfaces

The structure, orientation, and formation of amphiphilic alpha-helix model peptide films on fluorocarbon surfaces has been monitored with sum frequency generation (SFG) vibrational spectroscopy, near-edge x-ray absorption fine structure (NEXAFS) spectroscopy, and x-ray photoelectron spectroscopy (XPS). The alpha-helix peptide is a 14-mer of hydrophilic lysine and hydrophobic leucine residues with a hydrophobic periodicity of 3.5. This periodicity yields a rigid amphiphilic peptide with leucine and lysine side chains located on opposite sides. XPS composition analysis confirms the formation of a peptide film that covers about 75% of the surface. NEXAFS data are consistent with chemically intact adsorption of the peptides. A weak linear dichroism of the amide pi( *) is likely due to the broad distribution of amide bond orientations inherent to the alpha-helical secondary structure. SFG spectra exhibit strong peaks near 2865 and 2935 cm(-1) related to aligned leucine side chains interacting with the hydrophobic surface. Water modes near 3200 and 3400 cm(-1) indicate ordering of water molecules in the adsorbed-peptide fluorocarbon surface interfacial region. Amide I peaks observed near 1655 cm(-1) confirm that the secondary structure is preserved in the adsorbed peptide. A kinetic study of the film formation process using XPS and SFG showed rapid adsorption of the peptides followed by a longer assembly process. Peptide SFG spectra taken at the air-buffer interface showed features related to well-ordered peptide films. Moving samples through the buffer surface led to the transfer of ordered peptide films onto the substrates.

Pursuing "zero" protein adsorption of poly(carboxybetaine) from undiluted blood serum and plasma

Human blood serum and plasma pose significant challenges to blood-contacting devices and implanted materials because of their high nonspecific adsorption onto surfaces. In this work, we investigated nonspecific protein adsorption from single protein solutions and complex media such as undiluted human blood serum and plasma onto poly(carboxybetaine acrylamide) (polyCBAA)-grafted surfaces at different temperatures. The polyCBAA grafting was done via atom-transfer radical polymerization (ATRP) with varying film thicknesses. The objective is to create a surface that experiences "zero" protein adsorption from complex undiluted human blood serum and plasma. Results show that protein adsorption from undiluted human blood serum, plasma, and aged serum on the polyCBAA-grafted surface is undetectable at both 25 and 37 degrees C by a surface plasmon resonance (SPR) sensor. This was achieved with a film thickness of approximately 21 nm. Furthermore, it is demonstrated that the polyCBAA surfaces after antibody immobilization maintain undetectable protein adsorption from undiluted human blood serum. This is the first time that an effective nonfouling material suitable for applications in complex blood media has been demonstrated.

Tetraglyme coatings reduce fibrinogen and von Willebrand factor adsorption and platelet adhesion under both static and flow conditions

Previous studies have showed that radio-frequency plasma deposited tetraglyme coatings greatly reduced fibrinogen adsorption (Gamma(Fg)) from highly diluted plasmas (0.1 and 1%) and subsequent platelet adhesion under static conditions. In this study, the protein resistant properties of tetraglyme were re-examined with high-concentration plasma, and subsequent platelet adhesion was measured under both static and flow conditions. The resistance of tetraglyme to vWf adsorption (Gamma(vWf)) and the role of vWf in platelet adhesion under flow were also investigated. Gamma(Fg) and Gamma(vWf) were measured with (125)I radiolabeled proteins. Flow studies were done at shear rates of 50 or 500 s(-1) by passing a platelet/red cell suspension through a GlycoTech flow chamber. When adsorbed from a series of increasing plasma concentrations, the adsorption of both proteins to tetraglyme increased steadily, and did not show a peak at intermediate dilutions, i.e., there was no Vroman effect. When plasma concentration was less than 10%, the tetraglyme surface was highly nonfouling, exhibiting ultralow Gamma(Fg) (less than 5 ng/cm(2)) and extremely low platelet adhesion under both static and flow conditions. However, when the adsorption was done from 100% plasma, Gamma(Fg) was much higher ( approximately 85 ng/cm(2)), indicating that tetraglyme surface may not be sufficiently protein-resistant in the physiological environment. To correlate platelet adhesion under flow with Gamma(Fg) and Gamma(vWf), a series of tetraglyme surfaces varying in ether content and protein adsorption was created by varying deposition power. On these surfaces, platelet adhesion at low shear rate depended only on the amount of Gamma(Fg), but under high shear, both Gamma(Fg) and Gamma(vWf) affected platelet adhesion. In particular, it was found that Gamma(vWf) must be reduced to less than 0.4 ng/cm(2) to achieve ultra low platelet adhesion under high shear.

Anti-inflammatory polymeric coatings for implantable biomaterials and devices

Synthetic polymer coatings are used extensively in modern medical devices and implants because of their material versatility and processability. These coatings are designed for specific applications by controlling composition and physical and chemical properties, and they can be formed into a variety of complex structures and shapes. However, implantation of these materials into the body elicits a strong inflammatory host response that significantly limits the integration and biological performance of devices. Biomaterial-mediated inflammation is a complex reaction involving protein adsorption, leukocyte recruitment and activation, secretion of inflammatory mediators, and fibrous encapsulation of the implant. Significant research efforts have focused on modifying material properties using various anti-inflammatory polymeric surface coatings to generate more biocompatible implants. This minireview provides a brief background on the events of biomaterial-mediated inflammation and highlights various approaches used for modifying material surfaces to modulate inflammatory responses. These include both passive and active strategies, such as nonfouling surface treatments and delivery of anti-inflammatory agents, respectively. Novel approaches will be needed to extend the in vivo lifetime and performance of devices and reduce the need for multiple implantation surgeries.

Reduced acute inflammatory responses to microgel conformal coatings

Implantation of synthetic materials into the body elicits inflammatory host responses that limit medical device integration and biological performance. This inflammatory cascade involves protein adsorption, leukocyte recruitment and activation, cytokine release, and fibrous encapsulation of the implant. We present a coating strategy based on thin films of poly(N-isopropylacrylamide) hydrogel microparticles (i.e. microgels) cross-linked with poly(ethylene glycol) diacrylate. These particles were grafted onto a clinically relevant polymeric material to generate conformal coatings that significantly reduced in vitro fibrinogen adsorption and primary human monocyte/macrophage adhesion and spreading. These microgel coatings also reduced leukocyte adhesion and expression of pro-inflammatory cytokines (TNF-alpha, IL-1beta, MCP-1) in response to materials implanted acutely in the murine intraperitoneal space. These microgel coatings can be applied to biomedical implants as a protective coating to attenuate biofouling, leukocyte adhesion and activation, and adverse host responses for biomedical and biotechnological applications.

A review of the foreign-body response to subcutaneously-implanted devices: the role of macrophages and cytokines in biofouling and fibrosis

The biological response to implanted biomaterials in mammals is a complex series of events that involves many biochemical pathways. Shortly after implantation, fibrinogen and other proteins bind to the device surface, a process known as biofouling. Macrophages then bind to receptors on the proteins, join into multinucleated giant cells, and release transforming growth factor beta and other inflammatory cytokines. In response to these signals, quiescent fibroblasts are transformed into myofibroblasts, which synthesize procollagen via activation of Smad mediators. The procollagen becomes crosslinked after secretion into the extracellular space. Mature crosslinked collagen and other extracellular matrix proteins gradually contribute to formation of a hypocellular dense fibrous capsule that becomes impermeable or hypopermeable to many compounds. Porous substrates and angiogenic growth factors can stimulate formation of microvessels, which to some extent can maintain analyte delivery to implanted sensors. However, stimulation by vascular endothelial growth factor alone may lead to formation of leaky, thin-walled, immature vessels. Other growth factors are most probably needed to act upon these immature structures to create more robust vessels.During implantation of foreign bodies, the foreign-body response is difficult to overcome, and thousands of biomaterials have been tested. Biomimicry (i.e., creating membranes whose chemical structure mimics natural cellular compounds) may diminish the response, but as of this writing, it has not been possible to create a stealth material that circumvents the ability of the mammalian surveillance systems to distinguish foreign from self.

Species and density of implant surface chemistry affect the extent of foreign body reactions

Implant-associated fibrotic capsule formation presents a major challenge for the development of long-term drug release microspheres and implantable sensors. Since material properties have been shown to affect in vitro cellular responses and also to influence short-term in vivo tissue responses, we have thus assumed that the type and density of surface chemical groups would affect the degree of tissue responses to microsphere implants. To test this hypothesis, polypropylene particles with different surface densities of -OH and -COOH groups, along with the polypropylene control (-CH2 groups) were utilized. The influence of functional groups and their surface densities on fibrotic reactions were analyzed using a mice subcutaneous implantation model. Our comparative studies included determination and correlation of the extents of fibrotic capsule formation, cell infiltration into the particles, and recruitment of CD11b+ inflammatory cells for all of the substrates employed. We have observed major differences among microspheres coated with different surface functionalities. Surfaces with -OH surface groups trigger the strongest responses, while -COOH-rich surfaces prompt the least tissue reactions. However, variation of the surface density of either functional group has a relatively minor influence on the extent of fibrotic tissue reactions. The present results show that surface functionality can be used as a powerful tool to alter implant-associated fibrotic reactions and, potentially, to improve the efficacy and function of drug-delivery microspheres, implantable sensors, and tissue-engineering scaffolds.

Surface modification of a perfluorinated ionomer using a glow discharge deposition method to control protein adsorption

Nafion is the membrane material preferred for in situ glucose sensors. Unfortunately, surface properties of Nafion promote random protein adsorption and eventual foreign body encapsulation thus leading to loss of glucose signal over time. Here we detail surface modifications made by RF plasma deposition to Nafion with the intent to prevent random protein adsorption while providing enough functional sites (hydroxyl groups) to bind a biologically active peptide known to induce cellular adhesion (YRGDS). Nafion surfaces were modified by RF plasma polymerizing five different combinations of (1) tetraethylene glycol dimethyl ether (tetraglyme) and (2) 2-hydroxyethyl methacrylate (HEMA): pure tetraglyme, 2.5% HEMA with 97.5% tetraglyme, 5% HEMA with 95% tetraglyme, 10% HEMA with 90% tetraglyme, and pure HEMA. Resultant surfaces were characterized by XPS (low and high resolution), dynamic contact angle, and atomic force microscopy. Protein adsorption and retention was determined and correlated to surface layer composition. The ability to bind a cell adhesion peptide was also determined and correlated well with surface layer composition.

Monocyte activation in response to polyethylene glycol hydrogels grafted with RGD and PHSRN separated by interpositional spacers of various lengths

Polyethylene glycol (PEG) is often cited as a "stealth" polymer, capable of resisting both protein adsorption and cell adhesion. By extension, PEG would then be expected to limit the host response. Monocyte-derived macrophages play an integral role in inflammation, and thus their response to a material can potentially dictate the overall host response to a biomaterial. In the present study, monocyte responses following interaction with a photopolymerized PEG hydrogel were compared with those from standard tissue culture polystyrene (TCPS). Additionally, the effect of the spacing between RGD and PHSRN, the corresponding synergy sequence on fibronectin (FN), was evaluated using peptides with differing spacer lengths grafted to the PEG hydrogel. Monocyte adherent density on the PEG-only hydrogel was comparable with that of TCPS; however, the secretion of the proinflammatory molecules interleukin-1beta (IL-1beta), tumor necrosis factor-alpha (TNF-alpha), and granulocyte-macrophage colony stimulating factor (GM-CSF) increased dramatically following monocyte interaction with PEG-only hydrogels as compared with TCPS. The matrix metalloproteinase-2 (MMP-2) concentration was similar for all surfaces, while both the matrix metalloproteinase-9 (MMP-9) and FN concentrations were above the range of the assay for all substrates. Cell density was higher on the PHSRNG(13)RGD grafted substrate as compared with PHSRNG(6)RGD, but neither sequence increased cell density versus RGD alone. Although protein concentration did sometimes vary with different peptides, this variation was minimal in comparison with the surface effects between TCPS and the PEG-only hydrogel. This study explores the roles of PEG and FN-derived peptides on monocyte activation.

Biological principals and clinical potentials of limbal epithelial stem cells

In this review, we describe a population of adult stem cells that are currently being successfully used in the clinic to treat blinding ocular surface disease, namely limbal epithelial stem cells (LESC). The function and characteristics of LESC and the challenges faced in making use of their therapeutic potential will be examined. The cornea on the front surface of the eye provides our window on the world. The consistency and functionality of the outer-most corneal epithelium is essential for vision. A population of LESC are responsible for replenishing the epithelium throughout life by providing a constant supply of daughter cells that replace those constantly removed from the ocular surface during normal wear and tear and following injury. LESC deficiency results in corneal inflammation, opacification, vascularisation and severe discomfort. The transplantation of cultured LESC is one of only a few examples of the successful use of adult stem cell therapy in patients. The clinical precedence for the use of stem cell therapy and the ready accessibility of a transparent stem cell niche make the cornea a unique model for the study of adult stem cells in health and disease.

Plasma-deposited tetraglyme surfaces greatly reduce total blood protein adsorption, contact activation, platelet adhesion, platelet procoagulant activity, and in vitro thrombus deposition

The ability of tetraethylene glycol dimethyl ether (tetraglyme) plasma deposited coatings exhibiting ultralow fibrinogen adsorption to reduce blood activation was studied with six in vitro methods, namely fibrinogen and von Willebrand's factor adsorption, total protein adsorption, clotting time in recalcified plasma, platelet adhesion and procoagulant activity, and whole blood thrombosis in a disturbed flow catheter model. Surface plasmon resonance results showed that tetraglyme surfaces strongly resisted the adsorption of all proteins from human plasma. The clotting time in the presence of tetraglyme surfaces was lengthened compared with controls, indicating a lower activation of the intrinsic coagulation cascade. Platelet adhesion and thrombin generation by adherent platelets were greatly reduced on tetraglyme-coated materials, compared with uncoated and Biospan-coated glass slides. In the in vitro disturbed blood flow model, tetraglyme plasma coated catheters had 50% less thrombus than did the uncoated catheters. Tetraglyme-coated materials thus had greatly reduced blood interactions as measured with all six methods. The improved blood compatibility of plasma-deposited tetraglyme is thus not only due to their reduced platelet adhesion and activation, but also to a generalized reduction in blood interactions.

Plasma deposition of tetraglyme inside small diameter tubing: Optimization and characterization

In this study, a glow discharge plasma deposition system previously used for treating flat substrates was successfully modified and optimized to produce a PEO-like coating on the inner surface of 1-3 mm ID polyethylene tubing by deposition of tetra ethylene glycol dimethyl ether (tetraglyme). The plasma treatment conditions were varied in order to find operating values that would produce coatings with the ultralow (< 5 ng/cm(2)) fibrinogen adsorption (Gamma(Fg)) previously shown necessary to significantly reduce platelet adhesion. The flow rate of gaseous tetraglyme monomer, pressure, and plasma generating power were found to be the most important parameters affecting the uniformity and chemical structure of the coating. The coating uniformity and quality were assessed by measuring Gamma(Fg) at positions 1 cm apart along the entire tube and the fraction of C1s carbon that was in an ether bond (ether-carbon ratio) by electron spectroscopy of chemical analysis. Under optimized conditions, tetraglyme plasma-coated tubes of up to 20 cm in length had ultralow Gamma(Fg). The region of the tube that had ultralow Gamma(Fg) also had C1s ether-carbon ratios that are greater than 50%.

Peri-implant bone formation and implant integration strength of peptide-modified p(AAM-co-EG/AAC) interpenetrating polymer network-coated titanium implants

Interpenetrating polymer networks (IPNs) of poly (acrylamide-co-ethylene glycol/acrylic acid) functionalized with an -Arg-Gly-Asp- (RGD) containing 15 amino acid peptides, derived from rat bone sialoprotein (bsp-RGD(15), were grafted to titanium implants in an effort to modulate bone formation in the peri-implant region in the rat femoral ablation model. Bone-implant contact (BIC) and bone formation within the medullary canal were determined using microcomputed tomography at 2 and 4 weeks postimplantation. BIC for bsp-RGD(15)-IPN implants was enhanced relative to hydroxyapatite tricalcium phosphate (HA-TCP) coated implants, but was similar to all other groups. Aggregate bone formation neither indicated a dose-dependent effect of bsp-RGD(15) nor a meaningful trend. Mechanical testing of implant fixation revealed that only the HA-TCP coated implants supported significant (>1 MPa) interfacial shear strength, despite exhibiting lower overall BIC, an indication that bone ingrowth into the rougher coating was the primary mode of implant fixation. While no evidence was found to support the hypothesis that bsp-RGD(15)-modified IPN coated implants significantly impacted bone-implant bonding, these results point to the lack of correlation between in vitro studies employing primary osteoblasts and in vivo wound healing in the peri-implant region.

A method for characterizing adsorption of flowing solutes to microfluidic device surfaces

We present a method for characterizing the adsorption of solutes in microfluidic devices that is sensitive to both long-lived and transient adsorption and can be applied to a variety of realistic device materials, designs, fabrication methods, and operational parameters. We have characterized the adsorption of two highly adsorbing molecules (FITC-labeled bovine serum albumin (BSA) and rhodamine B) and compared these results to two low adsorbing species of similar molecular weights (FITC-labeled dextran and fluorescein). We have also validated our method by demonstrating that two well-known non-fouling strategies [deposition of the polyethylene oxide (PEO)-like surface coating created by radio-frequency glow discharge plasma deposition (RF-GDPD) of tetraethylene glycol dimethyl ether (tetraglyme, CH(3)O(CH(2)CH(2)O)(4)CH(3)), and blocking with unlabeled BSA] eliminate the characteristic BSA adsorption behavior observed otherwise.

Plasma polymer coated surfaces for serum-free culture of limbal epithelium for ocular surface disease

The potential use of plasma polymer coatings as substrates for serum-free expansion of limbal epithelial cells was investigated. Preliminary studies using a human corneal epithelial cell line showed that acrylic acid-coated surfaces performed better than allyl amine and allyl alcohol coated surfaces in terms of cell metabolic activity and confluence as assessed using the MTT assay. Subsequently, the proliferation and maturity of primary human limbal epithelial cells in co-culture with growth arrested 3T3 fibroblasts on a range of acrylic acid plasma coated surfaces, octadiene plasma coated surfaces and tissue culture plastic was investigated using MTT and cytokeratin 3 immunostaining. The cells performed better in the presence of serum on all surfaces. However, the acrylic acid coated surfaces successfully sustained a serum-free fibroblast/epithelial cell co-culture. The metabolic activity of the epithelial cells was superior on the acrylic acid coated surfaces than on tissue culture plastic in serum-free conditions and their levels of differentiation were not significantly higher than in the presence of serum. These results suggest that these surfaces can be used successfully for the serum-free expansion of human limbal epithelial cells.