Cardiopulmonary bypass technology transfer: musings of a cardiac surgeon

In Vitro Endothelialization Test of Biomaterials Using Immortalized Endothelial Cells

Functionalizing biomaterials with peptides or polymers that enhance recruitment of endothelial cells (ECs) can reduce blood coagulation and thrombosis. To assess endothelialization of materials in vitro, primary ECs are generally used, although the characteristics of these cells vary among the donors and change with time in culture. Recently, primary cell lines immortalized by transduction of simian vacuolating virus 40 large T antigen or human telomerase reverse transcriptase have been developed. To determine whether immortalized ECs can substitute for primary ECs in material testing, we investigated endothelialization on biocompatible polymers using three lots of primary human umbilical vein endothelial cells (HUVEC) and immortalized microvascular ECs, TIME-GFP. Attachment to and growth on polymer surfaces were comparable between cell types, but results were more consistent with TIME-GFP. Our findings indicate that TIME-GFP is more suitable for in vitro endothelialization testing of biomaterials.

Adhesion and proliferation of human periodontal ligament cells on poly(2-methoxyethyl acrylate)

Human periodontal ligament (PDL) cells obtained from extracted teeth are a potential cell source for tissue engineering. We previously reported that poly(2-methoxyethyl acrylate) (PMEA) is highly biocompatible with human blood cells. In this study, we investigated the adhesion, morphology, and proliferation of PDL cells on PMEA and other types of polymers to design an appropriate scaffold for tissue engineering. PDL cells adhered and proliferated on all investigated polymer surfaces except for poly(2-hydroxyethyl methacrylate) and poly[(2-methacryloyloxyethyl phosphorylcholine)-co-(n-butyl methacrylate)]. The initial adhesion of the PDL cells on PMEA was comparable with that on polyethylene terephthalate (PET). In addition, the PDL cells on PMEA spread well and exhibited proliferation behavior similar to that observed on PET. In contrast, platelets hardly adhered to PMEA. PMEA is therefore expected to be an excellent scaffold for tissue engineering and for culturing tissue-derived cells in a blood-rich environment.

Currently available biomaterials for use in cardiopulmonary bypass

Cardiopulmonary bypass (CPB) represents one of the most important technical innovations in healthcare history, yet the systemic responses to CPB remain a fundamentally unresolved problem. Study of the blood-biomaterial interaction and development of biocompatible materials is intimately related to efforts to optimize patient outcome following CPB. This article reviews the design innovations in biomaterial surfaces that have been introduced into clinical practice in an attempt to ameliorate the detrimental consequences of CPB, contrasting the actual clinical improvements and patient benefits achieved against those predicted on the basis of theory and in vitro testing. Some discussion of the underlying mechanisms of action as presently understood is provided and the current limitations of biomaterial-dependent strategies to improve outcome following CPB are addressed.

Development of soft nanocomposite materials and their applications in cell culture and tissue engineering

Novel soft nanocomposite materials with unique organic/inorganic network structures have been developed by extending the strategy of “organic/inorganic nanocomposites” to the field of soft materials. The structures described here were synthesized by in-situ free-radical polymerization of various monomers in the presence of exfoliated clay (hectorite) in aqueous media. The nanocomposite hydrogels (NC gels) and soft nanocomposites (M-NCs) obtained were flexible and transparent soft materials, regardless of the clay content, that could be prepared in various shapes and surface forms, each consisting of individually different polymer/clay network structures. Owing to these unique network structures, both NC gels and M-NCs showed extraordinary mechanical properties such as ultrahigh elongation at break and widely controlled modulus and strength, which could overcome the problems (e.g., mechanical fragility, optical turbidity, poor processing ability) associated with conventional chemically crosslinked materials. In addition, the NC gels and M-NCs exhibited a number of new characteristics related to optical anisotropy, morphology, biocompatibility, stimulus sensitivity and cell culture. In the present review, we outline the novel features of these soft nanocomposites, and demonstrate their potential as soft culture substrates useful for tissue engineering as well as soft, transparent, absorbing, and mechanically tough biomaterials for many bio-applications.

Bioengineering of improved biomaterials coatings for extracorporeal circulation requires extended observation of blood-biomaterial interaction under flow

Extended use of cardiopulmonary bypass (CPB) systems is often hampered by thrombus formation and infection. Part of these problems relates to imperfect hemocompatibility of the CPB circuitry. The engineering of biomaterial surfaces with genuine long-term hemocompatibility is essentially virgin territory in biomaterials science. For example, most experiments with the well-known Chandler loop model, for evaluation of blood-biomaterial interactions under flow, have been described for a maximum duration of 2 hours only. This study reports a systematic evaluation of two commercial CPB tubings, each with a hemocompatible coating, and one uncoated control. The experiments comprised (i) testing over 5 hours under flow, with human whole blood from 4 different donors; (ii) measurement of essential blood parameters of hemocompatibility; (iii) analysis of the luminal surfaces by scanning electron microscopy and thrombin generation time measurements. The dataset indicated differences in hemocompatibility of the tubings. Furthermore, it appeared that discrimination between biomaterial coatings can be made only after several hours of blood-biomaterial contact. Platelet counting, myeloperoxidase quantification, and scanning electron microscopy proved to be the most useful methods. These findings are believed to be relevant with respect to the bioengineering of extracorporeal devices that should function in contact with blood for extended time.

Relationship between blood compatibility and water structure—Comparative study between 2-methoxyethylacrylate- and 2-methoxyethylmethacrylate-based random copolymers

We have proposed that the excellent blood compatibility of poly(2-methoxyethylacrylate (MEA)) is caused by freezing bound water contained in it on the basis of results on platelet activation (Tanaka and Mochizuki, J Biomed Mater Res A 2004; 68:684-695). To clarify the applicability of this mechanism to other indexes for blood compatibility, the relationship between complement activation and water structure was investigated by using two copolymers, poly(MEA-2-hydroxyethylmethacrylate (HEMA)) and poly(2-methoxyethylmethacrylate (MEMA)-HEMA), where HEMA content was varied from 25 to 90 mol %. ESCA analysis revealed that the surface compositions of these copolymers (dry state) agreed with the compositions determined by (1)H NMR. However, analysis by water contact angle (wet state) showed that their surfaces were quite different. The contact angle of poly(MEMA-HEMA) depended on the monomer composition, whereas the angle of poly(MEA-HEMA) was close to that of polyHEMA regardless of the monomer composition. The effect of HEMA content in the copolymers on complement activation (production of C3a) was investigated in an in vitro test. The activation by poly(MEMA-HEMA) was enhanced according to the HEMA content, while the activation by poly(MEA-HEMA) with 0-40 mol % of HEMA was weak and did not depend on the HEMA content. These properties are discussed from the viewpoints of the water structure observed by DSC and the surface structure.

Study on blood compatibility with poly(2-methoxyethylacrylate)—relationship between surface structure, water structure, and platelet compatibility in 2-methoxyethylacrylate/2-hydroxyethylmethacrylate diblock copolymer

Diblock copolymers composed of 2-methoxyethylacrylate (MEA) and 2-hydroxyethylmethacrylate (HEMA) were firstly prepared (the composition ratio = 90/10, 79/21, 66/34, and 48/52 mol/mol) by anion living polymerization. ESCA analysis of their surface structures (dry state) revealed that PMEA segment was segregated to the top surface in all of the polymers, whereas the results of contact angle of water (wet state) showed that the surfaces were covered with PHEMA segment. In vitro platelet adhesion test showed that these polymers had the excellent compatibility with platelet compared to PHEMA homopolymer. Water structure in the hydrated copolymers was investigated by DSC and freezing bound water was observed for all the polymers like PMEA homopolymer, whereas it was not found in PHEMA homopolymer. Further investigation of water structure based on the results of DSC and EWCMS (equilibrium water content by moisture sorption) suggested that freezing bound water existed in PHEMA segment in addition to PMEA segment. We have proposed that the water plays a key role in the appearance of good blood compatibility of the copolymer, according to our previous works (Tanaka et al. Biomacromolecules 2002;3:36-41, Tanaka et al. J Biomed Mater Res A 2004;68:684-695).

Effect of water structure on blood compatibility? thermal analysis of water in poly(meth)acrylate

The purpose of this study is to clarify the main factor causing excellent blood compatibility of poly(2-methoxyethyl acrylate)(PMEA) by the comparison between PMEA and seven PMEA analogous polymers. The polymers have a typical functional group as ester side chains such as methoxyethyl, hydroxyethyl, phenoxyethyl, and alkyl groups. The properties of the polymers relating to water were investigated in terms of contact angle, equilibrium water content (EWC), and thermal analysis by differential scanning calorimetry. The water in PMEA could be classified into three types: nonfreezing water, freezing bound water, and free water while the water in the analogous polymers was classified into just two types: free and nonfreezing waters, regardless of the chemical structure of the side chain. The surface property represented by the contact angle of water corresponded to the content of the bound water (nonfreezing water + freezing bound water). The platelet compatibility in vitro did not depend on the contents of these waters, or on the contact angle. On the basis of the results of this work and the previous work on the platelet compatibility of poly(MEA-co-HEMA) (Tanaka et al. Biomacromolecules 2002;3;36-41), the main factor causing the excellent compatibility of PMEA is discussed.