Extracellular Matrix Coatings on Cardiovascular Materials—A Review

Multifunctional hyaluronic acid-based coating to direct vascular cell fate for enhanced vascular tissue healing

Ensuring excellent anticoagulant, anti-inflammatory, and endothelialization properties in vascular stents through coating construction is crucial for their satisfactory performance post-implantation. In this study, we propose a cell-membrane mimetic multifunctional hyaluronic acid (HA)-based coating by combining the aminolyzed methacryloyloxyethyl phosphorylcholine (MPC) copolymer with oxidized hyaluronic acid (Ox-HA) through Schiff base reaction. Compared with traditional anti-fouling design, the composite coating present a stage-specific ability, which can resist the adhesion of blood components, while mediating vascular cell fate with the incorporation of HA. The coating exhibited promoted endothelial cell (EC) growth and inhibited the proliferation of smooth muscle cells (SMCs) by inducing a phenotype change. Besides, the multifunctional HA-based coating can mediate macrophages to a M2 phenotype. The coated stents were implanted in rabbits, and exhibited ideal capabilities in promoting endothelialization and inhibiting inflammation and restenosis in vivo, offering a potential approach to address multifunctionality for vascular implants.

In-Stent Re-Endothelialization Strategies: Cells, Extracellular Matrix, and Extracellular Vesicles

Arterial stenosis caused by atherosclerosis often requires stent implantation to increase the patency of target artery. However, such external devices often lead to in-stent restenosis due to inadequate re-endothelialization and subsequent inflammatory responses. Therefore, re-endothelialization strategies after stent implantation have been developed to enhance endothelial cell recruitment or to capture circulating endothelial progenitor cells. Notably, recent research indicates that coating stent surfaces with biogenic materials enhances the long-term safety of implantation, markedly diminishing the risk of in-stent restenosis. In this review, we begin by describing the pathophysiology of coronary artery disease and in-stent restenosis. Then, we review the characteristics and materials of existing stents used in clinical practice. Lastly, we explore biogenic materials aimed at accelerating re-endothelialization, including extracellular matrix, cells, and extracellular vesicles. This review helps overcome the limitations of current stents for cardiovascular disease and outlines the next phase of research and development.

Coatings for Cardiovascular Stents-An Up-to-Date Review

Cardiovascular diseases (CVDs) increasingly burden health systems and patients worldwide, necessitating the improved awareness of current treatment possibilities and the development of more efficient therapeutic strategies. When plaque deposits narrow the arteries, the standard of care implies the insertion of a stent at the lesion site. The most promising development in cardiovascular stents has been the release of medications from these stents. However, the use of drug-eluting stents (DESs) is still challenged by in-stent restenosis occurrence. DESs' long-term clinical success depends on several parameters, including the degradability of the polymers, drug release profiles, stent platforms, coating polymers, and the metals and their alloys that are employed as metal frames in the stents. Thus, it is critical to investigate new approaches to optimize the most suitable DESs to solve problems with the inflammatory response, delayed endothelialization, and sub-acute stent thrombosis. As certain advancements have been reported in the literature, this review aims to present the latest updates in the coatings field for cardiovascular stents. Specifically, there are described various organic (e.g., synthetic and natural polymer-based coatings, stents coated directly with drugs, and coatings containing endothelial cells) and inorganic (e.g., metallic and nonmetallic materials) stent coating options, aiming to create an updated framework that would serve as an inception point for future research.

Surface Engineering of Bioactive Coatings for Improved Stent Hemocompatibility: A Comprehensive Review

Cardiovascular diseases continue to be a major contributor to illness and death on a global scale, and the implementation of stents has given rise to a revolutionary transformation in the field of interventional cardiology. The thrombotic and restenosis complications associated with stent implantation pose ongoing challenges. In recent years, bioactive coatings have emerged as a promising strategy to enhance stent hemocompatibility and reduce thrombogenicity. This review article provides an overview of the surface engineering techniques employed to improve the hemocompatibility of stents and reduce thrombus formation. It explores the mechanisms underlying thrombosis and discusses the factors influencing platelet activation and fibrin formation on stent surfaces. Various bioactive coatings, including anticoagulant agents, antiplatelet agents, and surface modifications, are discussed in detail, highlighting their potential in reducing thrombogenicity. This article also highlights a multitude of surface modification techniques which can be harnessed to enhance stent hemocompatibility including plasma treatment, physical vapor deposition (PVD), chemical vapor deposition (CVD), and electrodeposition. These techniques offer precise control over surface properties such as roughness, charge, and composition. The ultimate goal is to reduce platelet adhesion, tailor wettability, or facilitate the controlled release of bioactive agents. Evaluation methods for assessing hemocompatibility and thrombogenicity are also reviewed, ranging from in vitro assays to animal models. Recent advances in the field, such as nanotechnology-based coatings and bioactive coatings with controlled drug release systems, are highlighted. Surface engineering of bioactive coatings holds great promise for enhancing the long-term outcomes of stent implantation by enhancing hemocompatibility and reducing thrombogenicity. Future research directions and potential clinical applications are discussed, underscoring the need for continued advancements in this field.

3D cell/scaffold model based on aligned-electrospun-nanofiber film/hydrogel multilayers for construction of anisotropic engineered tissue

Many tissues have a three-dimensional (3D) anisotropic structure compatible with their physiological functions. Engineering an in vitro 3D tissue having the natural structure and functions is a hotspot in tissue engineering with application for tissue regeneration, drug screening, and disease modeling. Despite various designs that have successfully guided the cellular alignment, only a few of them could precisely control the orientation of each layer in a multilayered construct or achieve adequate cell contact between layers. This study proposed a design of a multilayered 3D cell/scaffold model, that is, the cell-loaded aligned nanofiber film/hydrogel (ANF/Gel) model. The characterizations of the 3D cell-loaded ANF/Gel model in terms of design, construction, morphology, and cell behavior were systematically studied. The ANF was produced by efficiently aligned electrospinning using a self-designed, fast-and-easy collector, which was designed based on the parallel electrodes and modified with a larger gap area up to about 100 cm². The nanofibers generated by this simple device presented numerous features like high orientation, uniformity in fiber diameter, and thinness. The ANF/Gel-based cell/scaffold model was formed by encapsulating cell-loaded multilayered poly(lactic-co-glycolic acid)-ANFs in hydrogel. Cells within the ANF/Gel model showed high viability and displayed aligned orientation and elongation in accordance with the nanofiber orientation in each film, forming a multilayered tissue having a layer spacing of 60 μm. This study provides a multilayered 3D cell/scaffold model for the in vitro construction of anisotropic engineered tissues, exhibiting potential applications in cardiac tissue engineering.