Abstract P2-12-15: ReFilx- synthetic biodegradable soft tissue fillers for breast conserving surgery in breast cancer

Introduction: Breast conserving surgery (BCS) is the most common procedure performed in breast cancers, but it can often result in breast deformities that can have negative impacts on quality of life. With better treatments, more breast cancer survivors are expected to live longer, the demand for achieving optimal cosmetic outcomes has also increased accordingly. Currently, oncoplastic techniques involving local tissue rearrangement with or without contralateral balancing procedures are used in specialized centers to achieve breast symmetry in some patients. When a breast deformity occurs, corrective options include: fat grafting, autologous flap procedures and completion mastectomy with immediate reconstruction. These techniques have long operative times, longer length of hospital stay and higher complication rates. Commercially-available synthetic implants are fabricated in pre-determined sizes and thus are not suitable to reconstruct partial breast deformities of varying size and shape. We explored the use of amino-acid based biodegradable polyurethanes as tissue fillers for BCS due to their chemical versatility, superior mechanical properties and tailored biocompatibility. Objective: To evaluate novel biodegradable polymer constructs, referred to as ReFilx, as soft tissue fillers for BCS defects. Hypothesis: Implantation of ReFilx during BCS will maintain breast shape and size and promote tissue regeneration in and around the biodegradable biomaterial, in contrast to sham controls. Methods: Two ReFilx formulations with high porosity, mechanical properties (compressive modulus=45±6 kPa and 31±9 kPa) comparable to native breast tissue and a moderate degree of swelling (202±6% and 248±6%) were selected for implantation in porcine BCS defects. Three female Yucatan Minipigs (age=4 years, weight=100-120 kg, 12 breasts per pig) received BCS to remove normal breast tissue of approximately 2 cm diameter, after which the defects were filled with ReFilx Formulation A, ReFilx Formulation B, or no filler (sham control). At 6, 12, 24, and 36 weeks post-implantation (n=3 per group), ultrasound breast examinations and mastectomies of each selected group of breasts were performed. Samples were fixed in 10% buffered formalin and stained with H&E, Masson's Trichrome and immunohistomchemistry using CD31. Results: ReFilx formulations maintained breast size and shape, with similar stiffness to native breast tissue, while sham controls collapsed over 36 weeks. The ReFilx fillers supported cell and tissue infiltration and neovascularization, as indicated by Masson's Trichrome and CD31 staining, respectively, without eliciting foreign body giant cell formation, fibrosis, or chronic inflammation, commonly associated with implanted medical devices. Conclusions: ReFilx are promising soft tissue fillers for breast volume restoration, representing a simple, versatile, permanent, and aesthetically superior solution to prevent soft tissue deformities. Acknowledgements: MaRS PoP fund, grant # MI 2011-170, NSERC # SYN 430828. Haynes Connell Foundation Breast Cancer Fund.

Citation Format: Leong WL, Sharifpoor S, Battiston K, Charleton D, Corrigan M, McCready DR, Done SJ, Santerre JP. ReFilx- synthetic biodegradable soft tissue fillers for breast conserving surgery in breast cancer [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P2-12-15.

Salivary Esterase Activity and Its Association with the Biodegradation of Dental Composites

Pseudocholinesterase (PCE) and cholesterol esterase (CE) can hydrolyze bisphenylglycidyl dimethacrylate (bisGMA) and triethylene glycol dimethacrylate (TEGDMA) monomers. This study will test the hypothesis that enzyme activities showing CE and PCE character are found in human saliva at levels sufficient to hydrolyze ester-containing composites important to restorative denstistry. The study also seeks to ask if the active sites of CE and PCE with respect to composite could be inhibited. Photo-polymerized model composite resin was incubated in PCE and CE solutions, in the presence and absence of a specific esterase inhibitor, phenylmethylsulfonyl fluoride (PMSF). Incubation solutions were analyzed for resin degradation products by high-performance liquid chromatography (HPLC), UV spectroscopy, and mass spectrometry. Saliva was found to contain both hydrolase activities at levels that could degrade composite resins. PMSF inhibited the composite degradation, indicating a material hydrolysis mechanism similar to the enzymes’ common function.

Immunomodulatory polymeric scaffold enhances extracellular matrix production in cell co-cultures under dynamic mechanical stimulation

Despite the importance of immune cells in regulating the wound healing process following injury, there are few examples of synthetic biomaterials that have the capacity to push the body's immune cells toward pro-regeneration phenotypes, and fewer still that are designed with the intention of achieving this immunomodulatory character. While monocytes and their derived macrophages have been recognized as important contributors to tissue remodeling in vivo, this is primarily believed to be due to their ability to regulate other cell types. The ability of monocytes and macrophages to generate tissue products themselves, however, is currently not well appreciated within the field of tissue regeneration. Furthermore, while monocytes/macrophages are found in remodeling tissue that is subjected to mechanical loading, the effect this biomechanical strain on monocytes/macrophages and their ability to regulate tissue-specific cellular activity has not been understood due to the complexity of the many factors involved in the in vivo setting, hence necessitating the use of controlled in vitro culture platforms to investigate this phenomenon. In this study, human monocytes were co-cultured with human coronary artery smooth muscle cells (VSMCs) on a tubular (3mm ID) degradable polyurethane scaffold, with a unique combination of non-ionic polar, hydrophobic and ionic chemistry (D-PHI). The goal was to determine if such a synthetic matrix could be used in a co-culture system along with dynamic biomechanical stimulus (10% circumferential strain, 1Hz) conditions in order to direct monocytes to enhance tissue generation, and to better comprehend the different ways in which monocytes/macrophages may contribute to new tissue production. Mechanical strain and monocyte co-culture had a complementary and non-mitigating effect on VSMC growth. Co-culture samples demonstrated increased deposition of sulphated glycosaminoglycans (GAGs) and elastin, as well as increases in the release of FGF-2, a growth factor that can stimulate VSMC growth, while dynamic culture supported increases in collagen I and III as well as increased mechanical properties (elastic modulus, tensile strength) vs. static controls. Macrophage polarization toward an M1 state was not promoted by the biomaterial or culture conditions tested. Monocytes/macrophages cultured on D-PHI were also shown to produce vascular extracellular matrix components, including collagen I, collagen III, elastin, and GAGs. This study highlights the use of synthetic biomaterials having immunomodulatory character in order to promote cell and tissue growth when used in tissue engineering strategies, and identifies ECM deposition by monocytes/macrophages as an unexpected source of this new tissue.

STATEMENT OF SIGNIFICANCE

The ability of biomaterials to regulate macrophage activation towards a wound healing phenotype has recently been shown to support positive tissue regeneration. However, the ability of immunomodulatory biomaterials to harness monocyte/macrophage activity to support tissue engineering strategies in vitro holds enormous potential that has yet to be investigated. This study used a monocyte co-culture on a degradable polyurethane (D-PHI) to regulate the response of VSMCs in combination with biomechanical strain in a vascular tissue engineering context. Results demonstrate that immunomodulatory biomaterials, such as D-PHI, that support a desirable macrophage activation state can be combined with biomechanical strain to augment vascular tissue production in vitro, in part due to the novel and unexpected contribution of monocytes/macrophages themselves producing vascular ECM proteins.

Cariogenic bacteria degrade dental resin composites and adhesives

A major reason for dental resin composite restoration replacement is related to secondary caries promoted by acid production from bacteria including Streptococcus mutans (S. mutans). We hypothesized that S. mutans has esterase activities that degrade dental resin composites and adhesives. Standardized specimens of resin composite (Z250), total-etch (Scotchbond Multipurpose, SB), and self-etch (Easybond, EB) adhesives were incubated with S. mutans UA159 or uninoculated culture medium (control) for up to 30 days. Quantification of the BisGMA-derived biodegradation by-product, bishydroxy-propoxy-phenyl-propane (BisHPPP), was performed by high-performance liquid chromatography. Surface analysis of the specimens was performed by scanning electron microscopy (SEM). S. mutans was shown to have esterase activities in levels comparable with those found in human saliva. A trend of increasing BisHPPP release throughout the incubation period was observed for all materials and was more elevated in the presence of bacteria vs. control medium for EB and Z250, but not for SB (p < .05). SEM confirmed the increased degradation of all materials with S. mutans UA159 vs. control. S. mutans has esterase activities at levels that degrade resin composites and adhesives; degree of degradation was dependent on the material's chemical formulation. This finding suggests that the resin-dentin interface could be compromised by oral bacteria that contribute to the progression of secondary caries.

Characterization of the annulus fibrosus-vertebral body interface: identification of new structural features

Current surgical treatments for degenerative intervertebral disc disease do not restore full normal spinal movement. Tissue engineering a functional disc replacement may be one way to circumvent this limitation, but will require an integration of the different tissues making up the disc for this approach to be successful. Hence, an in-depth characterization of the native tissue interfaces, including annulus insertion into bone is necessary, as knowledge of this interface is limited. The objective of this study was to characterize the annulus fibrosus-vertebral bone (AF-VB) interface in immature (6-9 months old) and mature (18-24 months old) bovine discs, as well as to define these structures for normal adult human (22 and 45 years old) discs. Histological assessment showed that collagen fibers in the inner annulus, which are predominantly type II collagen, all appear to insert into the mineralized endplate zone. In contrast, some of the collagen fibers of the outer annulus, predominantly type I collagen, insert into this endplate, while other fibers curve laterally, at an ∼ 90° angle, to the outer aspect of the bone, and merge with the periosteum. This is seen in both human and bovine discs. Where the AF inserts into the calcified zone of the AF-VB interface, it passes through a chondroid region, rich in type II collagen and proteoglycans. Annulus cells (elongated cells that are not surrounded by proteoglycans) are present at this interface. This cartilage zone is evident in both human and bovine discs. Type X collagen and alkaline phosphatase are localized to the interface region. Age-associated differences in bovine spines are observed when examining the interface thickness and the matrix composition of the cartilaginous endplate, as well as the thickness of the mineralized endplate. These findings will assist with the design of the AF-VB interface in the tissue engineered disc.

Biodegradation of resin-dentin interfaces increases bacterial microleakage

Bis-GMA-containing resin composites and adhesives undergo biodegradation by human-saliva-derived esterases, yielding Bis-hydroxy-propoxy-phenyl-propane (Bis-HPPP). The hypothesis of this study is that the exposure of dental restorations to saliva-like esterase activities accelerates marginal bacterial microleakage. Resin composites (Scotchbond, Z250, 3M) bonded to human dentin were incubated in either buffer or dual-esterase media (pseudocholinesterase/cholesterol-esterase; PCE+CE), with activity levels simulating those of human saliva, for up to 90 days. Incubation solutions were analyzed for Bis-HPPP by high-performance liquid chromatography. Post-incubation, specimens were suspended in a chemostat-based biofilm fermentor cultivating Streptococcus mutans NG8, a primary species associated with dental caries, for 7 days. Bacterial microleakage was assessed by confocal laser scanning microscopy. Bis-HPPP production and depth and spatial volume of bacterial cell penetration within the interface increased with incubation time and were higher for 30- and 90-day PCE+CE vs. buffer-incubated groups, suggesting that biodegradation can contribute to the formation of recurrent decay.

Effect of phorbol esters on the macrophage-mediated biodegradation of polyurethanes via protein kinase C activation and other pathways

It was previously found that re-seeding monocyte-derived macrophages (MDM) on polycarbonate-based polyurethanes (PCNUs) in the presence of the protein kinase C (PKC) activator phorbol myristate acetate (PMA) inhibited MDM-mediated degradation of PCNUs synthesized with 1,6-hexane diisocyanate (HDI), as well as esterase activity and monocyte-specific esterase (MSE) protein. However, no effect on the degradation of a 4,4'-methylene bisphenyl (MDI)-derived PCNU (MDI321) occurred. This finding suggested that oxidation, a process linked to the PKC pathway, was not activated in the same manner for all PCNUs. In the current study MDM were re-seeded onto the above PCNU surfaces with PMA, PKC-inactive 4alphaPMA and the PKC inhibitor bisindolylmaleimide I hydrochloride (BIM) for 48 h before assaying for PCNU degradation, esterase activity, MSE protein, DNA, cell viability and cell morphology. 4alphaPMA did not alter MDM-mediated HDI PCNU degradation but MDI321 degradation increased in this condition. BIM alone had no effect on any parameter; however, when BIM and PMA were added together, the PMA inhibition of biodegradation, esterase activity and MSE protein was partially reversed for MDM on HDI PCNUs only. Adding PMA to MDM on HDI PCNUs increased intercellular connections, whereas 4alphaPMA or BIM+PMA increased cell size. Although this study demonstrated a role for oxidation via a PKC-activated pathway in MDM-mediated PCNU degradation, phorbol esters appear to also activate non-PKC pathways that have roles in biodegradation. Moreover, the sensitivity to material surface chemistry in the MDM response to each PCNU dictates a multi-factorial degradative process involving alternate material specific oxidative and hydrolytic mechanisms.

Influence of silanated filler content on the biodegradation of bisGMA/TEGDMA dental composite resins

It has been shown that an increase in the content of nonsilanated submicron colloidal silica filler particles within dental composites resulted in the release of more bis-phenol-A diglycidyl dimethacrylate (bisGMA)-derived product, bis-hydroxy-propoxyphenyl propane, following incubation with cholesterol esterase (CE). This work further investigates the enzyme-catalyzed biodegradation of fine composite resin systems, containing silanated micron-size irregular glass fillers, commonly used in clinical restorations. Model composite resin samples (10 or 60% weight fraction silanated barium glass filler, 1 mum average particle size) based on bisGMA/triethylene glycol dimethacrylate (TEGDMA) were incubated in buffer or buffer with CE (pH = 7.0, 37 degrees C) solutions for 32 days. The incubation solutions were analyzed using high-performance liquid chromatography, UV spectroscopy, and mass spectrometry. Both groups were characterized by Fourier transform infrared spectroscopy, scanning electron microscopy, and X-ray photoelectron spectroscopy. In contrast with previous findings for nonsilanated submicron filler systems, the higher filler containing composite showed an increase in its stability with time, following exposure to esterase and when compared to the lower filler content material. As well, the 60% filler composite leached less unreacted monomer TEGDMA. Since the model composite resins studied here were identical and only the filler content varied, the differences in biostability could be specifically associated with the relative amount of resin/filler distribution. The clinical use of different materials in varied dental applications (ranging from fissure sealant to tooth-colored highly filled materials) must consider the potential for different degradation profiles to occur as a function of filler content.

Fibrinogen adsorption and platelet lysis characterization of fluorinated surface-modified polyetherurethanes

A polyetherurethane (PU) was modified using fluorinated surface-modifying macromolecules (SMMs). A double radiolabel method was used simultaneously to measure the number of adhered platelets ((51)Cr) and the quantity of adsorbed Fg ((125)I), in a cone-and-plate instrument. The objectives were to determine if adsorbed Fg levels correlated to platelet adhesion on the surfaces, and to assess if any reductions in platelet adhesion for the SMM-treated surfaces resulted from surface-induced platelet lysis, rather than changes directly related to lower platelet activation and attachment on the novel surfaces. Platelet lysis was determined from lactate dehydrogenase (LDH) and unbound (51)Cr released into plasma isolated from whole blood exposed to test materials. The corresponding Fg adsorption, evaluated under the same platelet adhesion conditions, did not account for the reduced platelet adhesion on the treated surfaces. LDH and (51)Cr platelet release were very low and indicated no statistically significant differences between the materials. It was therefore concluded that platelet lysis did not contribute to the reduction in platelet adhesion characteristic observed on the SMM-treated surfaces. More importantly, the work emphasizes that the platelet activation cannot be inferred to by assessing the quantity of fibrinogen as is commonly done in the literature. The finding suggests a much more complex mechanism of action for the SMM surface modifiers. On-going work is investigating other Fg parameters such as protein binding affinity and protein conformational state in order to establish the mechanism by which the fluorinated surface modifiers may be reducing platelet adhesion via intermediary changes in initial protein adsorption.

Understanding the biodegradation of polyurethanes: from classical implants to tissue engineering materials

After almost half a century of use in the health field, polyurethanes (PUs) remain one of the most popular group of biomaterials applied for medical devices. Their popularity has been sustained as a direct result of their segmented block copolymeric character, which endows them with a wide range of versatility in terms of tailoring their physical properties, blood and tissue compatibility, and more recently their biodegradation character. While they became recognized in the 1970s and 1980s as the blood contacting material of choice in a wide range of cardiovascular devices their application in long-term implants fell under scrutiny with the failure of pacemaker leads and breast implant coatings containing PUs in the late 1980s. During the next decade PUs became extensively researched for their relative sensitivity to biodegradation and the desire to further understand the biological mechanisms for in vivo biodegradation. The advent of molecular biology into mainstream biomedical engineering permitted the probing of molecular pathways leading to the biodegradation of these materials. Knowledge gained throughout the 1990s has not only yielded novel PUs that contribute to the enhancement of biostability for in vivo long-term applications, but has also been translated to form a new class of bioresorbable materials with all the versatility of PUs in terms of physical properties but now with a more integrative nature in terms of biocompatibility. The current review will briefly survey the literature, which initially identified the problem of PU degradation in vivo and the subsequent studies that have led to the field's further understanding of the biological processes mediating the breakdown. An overview of research emerging on PUs sought for use in combination (drug + polymer) products and tissue regeneration applications will then be presented.

Fibrinogen surface distribution correlates to platelet adhesion pattern on fluorinated surface-modified polyetherurethane

In previous work, it had been shown that platelet adhesion could be reduced by fluorinating surfaces with oligomeric fluoropolymers, referred to as surface-modifying macromolecules (SMMs). In the current study, two in vitro blood-contacting experiments were carried out on a polyetherurethane modified with three different SMMs in order to determine if altered platelet adhesion levels could be related to the pattern of adsorbed protein and more specifically to the manner in which fibrinogen (Fg) distribution occurs at the surface. In the first experiment, the materials were placed in whole human blood and the adherent platelets were viewed with high-resolution scanning electron microscopy (SEM). In a second experiment, the materials were incubated with human plasma with the absence of platelets. The plasma contained 5% fluorescent-Fg. The materials were then viewed with a fluorescence microscope and images were collected to define the distribution of high-density fluorescent-Fg areas. The SEM and fluorescent-Fg images were imported to Image Pro Plus imaging software to measure the area, length and circularity and a bivariate correlation test was conducted between the two sets of data. For area and length morphology parameters, there were high and significant correlations (r > 0.9, p < 0.05) between the platelets and Fg aggregates. The data suggest that the Fg distribution may serve as a predictor of platelet morphology/activation and provides insight into the non-thrombogenic character of biomaterials containing the fluorinated SMMs.

The influence of resin chemistry on a dental composite's biodegradation

Previous work reported that commercial dental composite resins containing a urethane-modified bisGMA (bisphenylglycidyl dimethacrylate)/TEGDMA (triethylene glycol dimethacrylate) (ubis) based monomer system showed a 10-fold reduction in the release of a bisGMA-derived product, bishydroxypropoxyphenyl propane (bisHPPP), as compared with that found for bisGMA/TEGDMA (bis) based composites after incubation with cholesterol esterase (CE). Unfortunately, these materials also differed substantially in filler type and content, making it impossible to directly relate any specific parameter to the differences in biodegradation levels. By controlling for filler content and type, the current study will seek to probe the biomolecular interactions between composite resin chemistry and esterase activity in order to help explain the observed differences in biodegradation levels between the ubis and bis resin systems. After 32 days of incubation, buffer and CE solutions were analyzed for degradation products using high-performance liquid chromatography, UV spectroscopy, and mass spectrometry. Both materials were characterized by Fourier transform infrared spectroscopy, scanning electron microscopy, and X-ray photoelectron spectroscopy. In the CE groups, the ubis system showed a 2.6- to 86-fold reduction (dependent on the product) in the amount of isolated products relative to the bis system (p < 0.01). Scanning electron microscopy data also demonstrated the relative stability of the ubis system and X-ray photoelectron spectroscopy analysis showed a higher content of the ester bond at the surface of the bis samples. Fourier transform infrared data showed that both resins had similar conversions. Because both systems were identical except for their monomer systems, it was concluded that changes in biostability were associated with chemistry. Crosslinking, hydrophobicity, and solubility all relate to ubis's pro-stability.

Effect of composite resin biodegradation products on oral streptococcal growth

Hydrolytic degradation by-products associated with the constitutive monomers 2,2-bis [4-(2-hydroxy-3-methacryloxypropoxy) phenyl] propane (bis-GMA), bisphenol A polyethylene glycol diether dimethacrylate (bis-EMA), and triethylene glycol dimethacrylate (TEDGMA) used in dental restorative composites include bis-hydroxy-propoxyphenyl propane (bis-HPPP), ethoxylated bisphenol A (E-bisPA), methacrylic acid (MA), and triethylene glycol (TEG). These products are generated from the interaction of human salivary esterases with the composites. Recent findings have indicated that TEGDMA has the ability to modulate oral bacteria but it is unclear which components of TEGDMA are related to the observed effects. The objective of the current study was to investigate the influence of TEGDMA derived degradation products MA and TEG on the growth of three strains of oral bacteria: S. mutans strains NG8 and JH1005, and S. salivarius AT2. Bacterial growth rates were measured at 37 degrees C, and pH values of 5.5 (representative of cariogenic state) or 7.0 at concentrations of 0-50mmol/l for MA (Sigma, US) and 0-100mmol/l for TEG (Sigma, US). It was found that at pH 5.5 TEG significantly stimulated the growth of both S. mutans strains ( p<0.05 ) in the concentration range of 0.5-10.0mmol/l and stimulated the growth of S. salivarius AT2 for the entire concentration range tested (p<0.05). TEG (above 50mmol/1) did not significantly affect the doubling times of S. salivarius at pH of 7.0 and it inhibited the growth of both S. mutans strains above 50mmol/l at the same pH value. At pH 5.5 MA inhibited the growth of all three strains with increasing concentration. At neutral pH, the growth of S. mutans NG8 strain was significantly reduced by MA ( p<0.05 ) above 10mmol/l. In summary, these results indicate that TEG and MA modulate the growth rate of important oral bacteria in a concentration and pH dependent manner.

Mutual influence of cholesterol esterase and pseudocholinesterase on the biodegradation of dental composites

It has been demonstrated that human saliva contains cholesterol esterase (CE)- and pseudocholinesterase (PCE)-like hydrolase activities. While PCE has been shown to preferentially degrade triethylene glycol dimethacrylate (TEGDMA) and its derivatives, CE has a greater catalytic effect on the breakdown of bis-phenol-A-diglycidyl dimethacrylate (bisGMA) components in composite dental resins. The current study seeks to determine if there is a mutual influence between the different esterases with respect to the biodegradation of resin composite. Photopolymerized model composite resin samples (containing 60% by weight fraction of silanated barium glass filler) based on bisGMA/TEGDMA (bis) or urethane-modified bisGMA/TEGDMA/bisEMA (ubis) monomers were incubated in buffer, CE and/or PCE solutions (pH=7.0, 37 degrees C) for 8 and 16 days. The incubation solutions were analyzed for degradation products using high-performance liquid chromatography, UV spectroscopy and mass spectrometry. In the bis system, higher amounts (p<0.05) of a bisGMA derived product, bishydroxy-propoxyphenyl-propane (bisHPPP), were detected in the combined enzyme group as compared to the sum of the two individual enzyme groups. In the ubis system, similar comparisons showed that higher levels (p<0.05) of bisHPPP were detected in the combined group at 8 days while higher amounts (p<0.05) of a bisEMA derived product, ethoxylated bis-phenol A, were detected in the combined group at 16 days. The study concluded that CE and PCE act synergistically to increase the biodegradation of both composite resin materials.

Modulation of collagen proteolysis by chemical modification of amino acid side-chains in acellularized arteries

In this study, we have examined the effects of specific chemical modifications of amino acid side-chains on the in vitro degradation of "native" collagen obtained from acellular matrix (ACM)-processed arteries. Two monofunctional epoxides of different size and chemistry were used to modify lysine, with or without methylglyoxal modification of arginine. Biochemical, thermomechanical, tensile mechanical, and multi-enzymatic (collagenase, cathepsin B, acetyltrypsin, and trypsin) degradation analyses were used to determine the effects of modifications.Collagen solubilization by enzymes was found to depend upon the size and chemistry of epoxides used to modify lysine residues. In general, the solubilization of native ACM collagen by collagenase, cathepsin B, trypsin, and acetyltrypsin was either unaltered or decreased after modification with glycidol. In contrast, n-butylglycidylether (n-B) treatment increased solubilization by all enzymes. Subsequent arginine modification significantly reduced collagen solubilization by acetyltrypsin for glycidol-treated ACM arteries, whereas increased collagen solubilization was observed for n-B-treated ACM arteries with all enzymes. Gel chromatographic analyses of collagen fragments solubilized by trypsin revealed that both the amount and sites of cleavage were altered after lysine and arginine modification. The ability to modulate the enzymatic degradation of tissue-derived materials as demonstrated in this study may facilitate the design of novel engineering scaffolds for tissue regeneration or collagen-based drug delivery systems.

Influence of surface morphology and chemistry on the enzyme catalyzed biodegradation of polycarbonate-urethanes

Polycarbonate based polyurethanes were synthesized with varying hard segment content as well as hard segment chemistry based on three different diisocyanates,1,6-hexane diisocyanate (HDI), 4.4'-methylene bisphenyl diisocyanate (MDI) and 4,4-methylene biscyclohexyl diisocyanate (HMDI). The surface chemistry and morphology were characterized using X-ray photoelectron spectroscopy (XPS) and atomic force microscopy (AFM). The polymers were incubated with cholesterol esterase (CE) in a phosphate buffer solution at 37 degrees C over 10 weeks. XPS results showed that the surface chemistry changed as the size and chemistry of the hard segment varied within the materials. AFM images exhibited distinctive surface morphologies for all polymers, and this was particularly apparent with changes in the hard segment chemistry. The results showed that the surface of HDI polymers consisted of relatively stiff rod-like structures, which corresponded to the soft segment domains. Polymers with a higher HDI content exhibited a dense top layer containing a relatively higher hard segment component, covering the sub-surface matrix of rod like structures. The MDI based polyurethane had large aggregates on its top surface, which corresponded to the aggregation of harder components. The HMDI based polycarbonate-urethane presented a relatively homogeneous surface where no phase separation could be detected. The relative differences in hard and soft segment content in their surface structure was supported by XPS findings. The analysis of the biodegradation results, concluded that enzyme catalyzed biodegradation within these materials was initiated in amorphous soft segment regions located in the region of the interface between hard and soft segments. A higher hard segment content at the surface contributed significantly to an increase in biostability. The findings provided an enhanced understanding for the role of surface molecular structure in the enzyme catalyzed biodegradation of polyurethanes.

Isolation of methylene dianiline and aqueous-soluble biodegradation products from polycarbonate-polyurethanes

Polycarbonate-polyurethanes (PCNUs) have provided the medical device industry with practical alternatives to oxidation-sensitive polyether-urethanes (PEUs). To date, many studies have focused on PCNUs synthesized with 4,4'-methylene diphenyl-diisocyanate (MDI). The relative hydrolytic stability of this class of polyurethanes is actually quite surprising given the inherent hydrolytic potential of the aliphatic carbonate group. Yet, there has been little information reporting on the rationale for the material's demonstrated hydrolytic stability. Recent work has shown that PCNU materials have a strong sensitivity towards hydrolysis when changes are made to their hard segment content and/or chemistry. However, knowledge is specifically lacking in regards of the identification of cleavage sites and the specific nature of the biodegradation products. Using high-performance liquid chromatography, radiolabel tracers and mass spectrometry, the current study provides insight into the distribution of biodegradation products from the enzyme-catalyzed hydrolysis of five different PCNUs. The hydrolytic sensitivity of the materials is shown to be related to the distribution of products, which itself is a direct consequence of unique micro-structures formed within the different materials. While an MDI-based polymer was shown to be the most hydrolytically stable material, it was the only PCNU that produced its diamine analog, in this case 4,4'-methylene dianiline (MDA), as a degradation product. Given the concern over aromatic diamine toxicity, this finding is important and highlights the fact that relative biostability is a distinct issue from that of degradation product toxicity, and that both must be considered separately when assessing the impact of biodegradation on biomaterial in vivo compatibility.

Enzyme induced biodegradation of polycarbonate-polyurethanes: dose dependence effect of cholesterol esterase

The current study has investigated the influence of esterase activity (80-400units/ml) on the biodegradation of polycarbonate-urethanes (PCNUs) by cholesterol esterase (CE), with a particular interest in studying the influence of different hard segment structures and their contribution to sensitizing the polymer towards enzyme catalyzed hydrolysis. Polycarbonate based polyurethanes were synthesized with varying hard segment content as well as hard segment chemistry based on three different diisocyanates, 1,6-hexane diisocyanate (HDI), 4,4'-methylene bisphenyl diisocyanate (MDI) and 4,4-methylene biscyclohexyl diisocyanate (HMDI). The effect of different chemistry on surface contact angle was measured in order to define the relative chemical nature of the surfaces. The enzyme dose response was found to be lower when hard segment content in the polymer was high. There was a very strong dependence on enzyme concentration for polyurethanes with different hard segment chemistry, despite the fact that the nature of the hydrolysable polycarbonate segment remained the same. The PCNU which showed the most dramatic dependence on enzyme concentration was synthesized with HMDI. At low enzyme concentration (80units/ml) this material was the most stable of the polymers while at elevated CE concentration (400units/ml) the polymer underwent a catastrophic breakdown. The findings suggested that protein binding on the surfaces was saturated even though enzyme degradation did not achieve saturation on any of the surfaces. The role of protein binding in modulating the hydrolytic action of the enzymes at different activity levels highlights a need for further study in this area.

Identification of biodegradation products formed by L-phenylalanine based segmented polyurethaneureas

The degradation of novel biodegradable segmented polyurethanes was investigated with a view to determining the cleavage points within the polymer backbones targeted by the enzyme chymotrypsin. While the materials were developed with specific enzyme cleavage sites designed into the polymer chains, the nature of their degradation had not yet been determined. In this work, two segmented polyurethaneureas containing L-phenylalanine residues in the chain extender and two control polymers were subjected to degradation in the presence of chymotrypsin. Samples were collected for analysis over a time period from 1 day to 8 weeks. The degradation products from these materials were isolated using solid phase extraction and reversed phase high pressure liquid chromatography, and identified using mass and tandem mass spectrometry. Three hard segment related degradation products were identified and provide important insight into the polyurethane backbone cleavage sites. Cleavage of urea, ester and urethane bonds were observed. The results confirmed that chymotrypsin was able to cleave ester bonds adjacent to phenylalanine residues contained within the novel chain extender.

Surface modification of a polycarbonate-urethane using a vitamin-E-derivatized fluoroalkyl surface modifier

Fluorinated surface-modifying macromolecules (SMMs) have been previously reported on and shown to limit the hydrolytic degradation of polyurethanes. The SMM molecules achieve this effect by allowing for the selective migration of terminal fluorinated groups to the polymer's surface, which may then shield more hydrolytically-sensitive groups in the base polyurethane backbone. A further extension of the SMM concept would be to utilize the migration of the fluorine tails to simultaneously deliver biologically active moieties to the surface. This study explored the synthesis and characterization of a vitamin-E (natural anti-oxidant) coupled surface modifier, as a model for the bioactive SMM concept. The SMM was synthesized using lysine diisocyanate (LDI), polycarbonate diol (PCN), and a fluoroalcohol. By derivatizing the LDI pendant ester, vitamin E was coupled to the SMM. The vitamin-E SMM was physically characterized using gel-permeation chromatography (GPC) and its anti-oxidant activity was assessed in the presence of 0.1 mM NaOCl. Polymer degradation experiments were carried out using 10 mM NaOCl incubation solutions, and the relative material breakdown was assessed using GPC and scanning electron microscopy (SEM). The results indicate that while the fluoro-component reduced damage of the PU, the bioactive component achieved a further deactivating effect. A similar action may also be effective against superoxide anions generated by human macrophages.

Biodegradation of a dental composite by esterases: dependence on enzyme concentration and specificity

Studies have shown that inflammatory (cholesterol esterase, CE) and salivary (pseudo-cholinesterase, PCE) enzymes can cause the breakdown of bisphenol-A diglycidyl dimethacrylate (bisGMA) and triethylene glycol dimethacrylate (TEGDMA) components from composite resins. Based on the above consideration, it was desired to show how CE- and PCE-catalyzed hydrolysis of resin components was dependent on the enzymes' concentration and to determine their distinct specificities (if any) towards resin components. Photopolymerized model composite resin samples (60% weight fraction silanated barium glass filler) based on bisGMA and TEGDMA monomers (55/45 weight ratio of the matrix, respectively) were incubated with PBS and either 0.01, 0.05, 0.1 or 1 unit/ml of CE or PCE for 16 days (pH 7.0, 37 degrees C). Incubation solutions were analyzed by high-performance liquid chromatography (HPLC), UV spectroscopy and mass spectrometry. The composite samples were characterized by scanning electron microscopy (SEM). Degradation rates of bisGMA and TEGDMA monomers were assessed. The results showed that CE had a greater specificity towards cleaving bisGMA while PCE showed a greater specificity towards TEGDMA. A strong enzyme concentration dependence was observed which suggests that the level of degradation products generated for a material will depend on the esterase make-up of an individual's saliva in combination with the specific formulation of monomer components used.

The influence of protein adsorption and surface modifying macromolecules on the hydrolytic degradation of a poly(ether-urethane) by cholesterol esterase

Previous investigations have demonstrated that the inflammatory cell derived enzyme, cholesterol esterase (CE) could degrade polyurethanes (PUs) by hydrolyzing ester and urethane bonds. Studies that have investigated the development of protective coatings for PUs have reported that the polymer degradation of polyester-urethanes (PESUs) can be reduced with the use of fluorine containing surface modifying macromolecules (SMMs). Since these latter studies were carried out in the presence of relatively pure enzyme, it has not been shown if SMMs would still provide an enhanced inhibitory effect if surfaces were pre-exposed to plasma proteins. This would be more representative of the in vivo scenario since protein adsorption would occur before the appearance of monocyte-derived macrophages which would be a primary source of esterase activities. The current investigation has focused on studying the influence of fibrinogen (Fg) as a simple model of protein adsorption in order to assess the effect of CE in combination with protein on polyether-urethane (PEU) surfaces. The materials were prepared with and without SMMs, and were pre-coated with Fg prior to carrying out biodegradation studies. The pre-adsorption of Fg onto the modified and non-modified surfaces provided a significant delay in the hydrolytic action of CE onto the PEU substrates. However, the effect was gone by 70 days and by the 126th day of incubation, both Fg coated and non-Fg coated groups had the same level of degradation. The difference between Fg coated and non-coated substrates was much smaller for materials containing SMMs. In addition, the pre-adsorption of Fg did not alter the SMMs' ability to provide a more biostable surface over the 4 month incubation period.

Utilization of quinolone drugs as monomers: characterization of the synthesis reaction products for poly(norfloxacin diisocyanatododecane polycaprolactone)

A broad spectrum antimicrobial agent, 1-ethyl-6-fluoro-1,4-dihydro-4-oxo-7-(1-piperazinyl)-3-quinolinecarboxylic acid (norfloxacin), has been successfully incorporated as a monomer into a polyurethane backbone structure via a three-step polymerization of norfloxacin, diisocyanatododecane (DDI), and polycaprolactone diol (PCL). The reaction was catalyzed by dibutyltin dilaurate and carried out in dimethyl sulfoxide. The sequential order of monomer feeding had a strong influence on the polymerization behavior and final polymer structure. In the preferred reaction scheme norfloxacin is initially reacted with DDI to form an oligomer. This is followed by a second reaction where PCL is introduced in order to produce a drug polymer chain with higher molecular weight and degradable segments. Cross-linking of urea linkages between the norfloxacin and DDI segments was a particular concern and was minimized by feeding PCL into the reaction system immediately following the completion of the first step. Chain extension by 1,4-butanediol or ethylenediamine was shown to be an effective approach for increasing the molecular weight of the polymers.

The effect of polyethylene particle phagocytosis on the viability of mature human macrophages

Macrophages are the major cell type observed in the inflammatory membrane retrieved at implant revision surgery. In this study, mature human monocyte-derived macrophages (MDM) were adapted to a previously established in vitro model to examine the influence of high-density polyethylene (HDPE) particulate (4-10 microm) on MDM viability. HDPE particles were suspended in soluble type I collagen, which subsequently was solidified on glass coverslips. Mature human macrophages, derived from differentiating peripheral blood monocytes on polystyrene for 10 days, were incubated in culture media on collagen controls and collagen-particle substrata for 31 days. Histologic analysis demonstrated that MDMs were in contact with the particles at 2 h. The majority of the particles were associated with the cells within 24 h. Based on electron microscopy, those cells associated with the particles appeared to be morphologically activated rather than necrotic or apoptotic. Assessment of cell viability revealed no differences among the groups at 24 h, but at 31 days significantly more viable cells and higher DNA values were found associated with the particle groups versus the collagen controls. The histologic results validate human mature MDMs as a clinically relevant cell type for study of the role of polyethylene particulate in aseptic loosening. The cell viability results indicate that phagocytosis of HDPE is not toxic to MDMs but in fact prolongs MDM survival. The long-lived MDMs may play a role in perpetuating chronic inflammation surrounding implants.

Fluorinated surface-modifying macromolecules: modulating adhesive protein and platelet interactions on a polyether-urethane

Polyether-urethanes (PEUs) have been the materials of choice for the manufacture of conventional blood-contacting devices. Nevertheless, biostability and blood compatibility are still among the principal limitations in their long-term application. Studies investigating the development of protective coatings for PEUs have shown that degradation can be reduced with the use of fluorinated surface-modifying macromolecules (SMMs). It has also been hypothesized that SMM-modified PEU surfaces may exhibit improved blood compatibility because other studies have shown a modulation in fibrinogen adsorption onto these surfaces. To determine the blood compatibility of a PEU-containing fluorinated SMMs, a series of in vitro experiments were designed to study the pattern of protein adsorption from plasma and then to assess the nature of platelet adhesion and activation on each substrate. Western blot analysis as well as single protein studies revealed that the dominant "adhesive proteins" [fibrinogen (Fg), fibronectin (Fnc), and vitronectin (Vnc)] were adsorbed on two of the SMM-containing PEUs in lower amounts relative to unmodified base. Platelet adhesion and activation data further highlighted the differences among the various substrates. It was shown that the unmodified base had a higher number of adhered platelets relative to the SMM-modified surfaces, and that of the SMM-containing substrates, which showed the lowest levels of adhesive proteins also, exhibited significantly lower platelet densities. Close morphological examination further revealed that platelets residing on these latter substrates were not appreciably activated. Based on the current evidence, it is believed that the fluorinated SMMs demonstrate good potential for the development of surfaces with minimal thrombogenic character in in vivo applications.

Interactions between resin monomers and commercial composite resins with human saliva derived esterases

Cholesterol esterase (CE) and pseudocholinesterase (PCE) have been reported to degrade commercial and model composite resins containing bisphenylglycidyl dimethacrylate (BisGMA), triethylene glycol dimethacrylate (TEGDMA) or the latter in combination with urethane modified BisGMA monomer systems. In addition, human saliva has been shown to contain esterase like activities similar to CE and PCE. Hence, it was the aim of the current study to determine to what extent human saliva could degrade two common commercial composite resins (Z250 from 3M Inc. and Spectrum TPH from L.D. Caulk) which contain the above monomer systems. Saliva samples from different volunteers were collected, processed, pooled, and freeze-dried. TEGDMA and BisGMA monomers were incubated with human saliva derived esterase activity (HSDEA) and their respective hydrolysis was monitored using high performance liquid chromatography (HPLC). Both monomers were completely hydrolyzed within 25 h by HSDEA. Photopolymerized composites were incubated with buffer or human saliva (pH 7.0 and 37 C) for 2, 8 and 16 days. The incubation solutions were analyzed using HPLC and mass spectrometry. Surface morphology characterization was carried out using scanning electron microscopy. Upon biodegradation, the Z250 composite yielded higher amounts of BisGMA and TEGDMA related products relative to the TPH composite. However, there were higher amounts of ethoxylated bis-phenol A released from the TPH material. In terms of total mass of products released, human saliva demonstrated a greater ability to degrade Z250. In summary, HSDEA has been shown to contain esterase activities that can readily catalyze the biodegradation of current commercial composite resins.

Biological characterization of a novel biodegradable antimicrobial polymer synthesized with fluoroquinolones

Biomaterial-related infections continue to represent a significant challenge to the medical community. Several approaches have been utilized to incorporate antimicrobial agents at the surface of implant devices in attempts to delay or eliminate the formation of biofilms. To date, most of these strategies have focused on drug conjugation or diffusion-limited systems for the delivery of such pharmaceutical agents. More recently, work has been presented on the feasibility of incorporating drugs into the backbone of polymers as a main-chain monomer. When sequenced into the backbone of the polymer with other monomers that are hydrolytically sensitive to enzyme-catalyzed breakdown, it is thought that drugs may be able to be selectively released. Specifically, degradable polyurethanes have been synthesized with fluoroquinolone antibiotics and have shown an ability to kill bacteria when released following degradation of the polymer chains by the macrophage-derived enzyme cholesterol esterase. However, specificity of the cleavage sites in the polymer was difficult to control. Since cholesterol esterase has specificity for hydrophobic moieties, it is desirable to alter the formulation of the polyurethanes to incorporate long hydrophobic monomers immediately adjacent to the ciprofloxacin molecule. Hence, the current study focuses on evaluating the enzyme-catalyzed degradation of a degradable polyurethane synthesized with 1,12 diisocyanatododecane as a substitute for 1,6 diisocyanatohexane, which was used in previous work. Validation of specific ciprofloxacin release and the generation of antimicrobial are shown. A preliminary cell study to assess the cytotoxicity of this biodegradable antibiotic polymer shows that the material has no observable effects on cell proliferation or cell membrane structure.

Enzyme-induced biodegradation of polycarbonate-polyurethanes: dependence on hard-segment chemistry

Polycarbonate urethanes (PCNUs) have been used as a replacement for traditional biomedical polyether-urethanes due to their reported resistance to oxidative biodegradation. However, relatively little is known about their hydrolytic stability in the presence of inflammatory derived enzymes. This has in part motivated the current study relating to the effect of hard segment chemistry and the microdomain structures generated by such chemistry, on the cholesterol esterase (CE) catalyzed hydrolysis of PCNUs. The bulk structures of the studied materials were characterized using gel permeation chromatography (GPC), differential scanning calorimetry (DSC), small-angle X-ray scattering (SAXS), Fourier transform infrared spectroscopy (FTIR) for their bulk structures, and attenuated total reflectance Fourier transform infrared spectroscopy (ATR-FTIR) for their subsurface structures. 14C-labeled PCNUs were incubated with CE (400 units/mL), for a period of 10 weeks (pH 7.0 at 37 degrees C), and radiolabel release was used to monitor the degradation. The results showed that all of the polymers synthesized in this study were susceptible to CE-catalyzed hydrolytic degradation, and that the extent of degradation was highly dependent on the nature of hard segment interactions within the polymer and at the surface. More specifically, the degree of phase separation and soft segment crystallinity were found to be less important in comparison to the hydrogen bonding among the carbonate and urethane linkages. The rank of the different chemical groups' susceptibility to hydrolysis was as follows: nonhydrogen bonded carbonate > nonhydrogen bonded urethane > hydrogen bonded carbonate > hydrogen bonded urethane. The findings suggest that the degree of hydrogen bonding, when processed into a polyurethane material could be an important parameter to consider in the design of new biostable polyurethane products.

Hydrolytic degradation of poly(carbonate)-urethanes by monocyte-derived macrophages

Polycarbonate (PCN)-based polyurethanes (PCNU) are rapidly becoming the chosen polyurethane (PU) for long-term implantation since they have shown decreased susceptibility to oxidation. However, monocyte-derived macrophages (MDM), the cell implicated in biodegradation, also contain hydrolytic activities. Hence, in this study, an activated human MDM cell system was used to assess the biostability of a PCNU, synthesized with 14C-hexane diisocyanate (HDI) and butanediol (BD), previously shown to be susceptible to hydrolysis by cholesterol esterase (CE). Monocytes, isolated from whole blood and cultured for 14 days on polystyrene (PS) to mature MDM, were gently trypsinized and seeded onto 14C-PCNU. Radiolabel release and esterase activity, as measured with p-nitrophenylbutyrate, increased for almost 2 weeks. At 1 week, the increase in radiolabel release and esterase activity were diminished by more than 50% when the protein synthesis inhibitor, cycloheximide, or the serine esterase/protease inhibitor, phenylmethylsulfonylfluoride was added to the medium. This strongly suggests that in part, it was MDM esterase activity which contributed to the PU degradation. In an effort to simulate the potential combination of oxidative and hydrolytic activities of inflammatory cells. 14C-PCNU was exposed to HOCl and then CE. Interestingly, the release of radiolabeled products by CE was significantly inhibited by the pre-treatment of PCNU with HOCl. The results of this study show that while the co-existing roles of oxidation and hydrolysis in the biodegradation of PCNUs remains to be elucidated, a clear relationship is drawn for PCNU degradation to the hydrolytic degradative activities which increase in MDM during differentiation from monocytes, and during activation in the chronic phase of the inflammatory response.

Enzyme-induced biodegradation of polycarbonate polyurethanes: dependence on hard-segment concentration

Polycarbonate-based polyurethanes with varying hard segment contents were synthesized. The physical and chemical structures were characterized by using gel permeation chromatography, differential scanning calorimetry, water uptake testing, Fourier transform infrared, and attenuated total reflectance--Fourier transform infrared. The polymers were incubated with cholesterol esterase in a phosphate buffer solution at 37 degrees C over 10 weeks. A higher resistance to hydrolytic degradation was observed in polycarbonate-based urethanes with higher hard segment content. The analysis of the material structures revealed that the degradation of polycarbonate-based urethanes was preferentially initiated at non-hydrogen-bonded carbonates and urethanes. Although the crystallinity of the polycarbonate soft segment may contribute to reducing the hydrolytic degradation catalyzed by cholesterol esterase, it was found to be relatively minor in comparison to the importance of hydrogen bonding between the carbonate and urethane groups. These observations suggest that the biostability of polyurethanes and specifically polycarbonate-based polyurethanes can be improved by manipulating the degree of hydrogen bonding within the materials.

Relation of dental composite formulations to their degradation and the release of hydrolyzed polymeric-resin-derived products

This article reviews the principal modes of dental composite material degradation and relates them to the specific components of the composites themselves. Particular emphasis is placed on the selection of the monomer resins, the filler content, and the degree of monomer conversion after the clinical materials are cured. Loss of mechanical function and leaching of components from the composites are briefly described, while a more detailed description is provided of studies that have considered the chemical breakdown of materials by agents that are present in the oral cavity, or model the latter. Specific attention will be given to the hydrolysis process of monomer and composite components, i.e., the scission of condensation-type bonds (esters, ethers, amides, etc.) that make up the monomer resins, following reaction of the resins with water and salivary enzymes. A synopsis of enzyme types and their sources is outlined, along with a description of the work that supports their ability to attack and degrade specific types of monomer systems. The methods for the study of biodegradation effects are compared in terms of sensitivity and the information that they provide. The impact of biodegradation on the ultimate biocompatibility of current materials is discussed from the perspective of what is known to date and what remains to be studied. The findings of the past decade clearly indicate that there are many reasons to probe the issue of biochemical stability of composite resins in the oral cavity. The challenge will now be to have both industry and government agencies take a pro-active approach to fund research in this area, with the expectation that these studies will lead to a more concise definition of biocompatibility issues related to dental composites. In addition, the acquired information from such studies will generate the development of alternate polymeric chemistries and composite formulations that will require further investigation for use as the next generation of restorative materials with enhanced biostability.

The effect of fluorinated surface modifying macromolecules on the surface morphology of polyethersulfone membranes

Polyethersulfone (PES) has been recently adopted for membrane materials in applications such as ultrafiltration and haemodialysis. As a biomaterial, the factors which affect the blood compatibility of PES membranes include surface energetics, hydrophobicity, and surface morphology. Surface fluorination of materials has been found to create surfaces with improved blood compatibility and chemical stability. One novel approach to generating fluorinated polymer surfaces has included the use of fluorinated surface modifying macromolecules (SMMs). These macromolecules have been reported to establish fluorinated functional groups at surfaces of polymeric materials without significantly affecting the physical properties of the base polymer. However, to date there has been relatively little information published on the nature of the surface structure for PES materials containing these SMMs. In this study, synthesized SMMs with varying chemical compositions were characterized and blended with PES, and fabricated into flat sheet membranes. The bulk thermal transitions of PES materials were not significantly altered by the addition of 4 wt% SMMs. Contact angle data showed that the addition of SMMs in PES created more hydrophobic surfaces, accompanied by an increase in surface heterogeneity. X-ray photoelectron spectroscopy studies confirmed the presence of elemental fluorine at the surface. Through microscopy studies, it was shown that surface modification was achieved by the migration of SMM concentrated microdomains to the air-membrane interface. The generated microdomains (approximately 1-2 microm in diameter) are dispersed within the top 8 microm of the surface. The concentration of microdomains was gradually depleted from the surface to the bulk of the membrane. A schematic of the morphology for SMMs within the PES membrane surface was proposed.

Model systems to assess the destructive potential of human neutrophils and monocyte-derived macrophages during the acute and chronic phases of inflammation

Isolated cell systems of human neutrophils (PMNs) and monocyte-derived macrophages (MDMs) were used to compare the destructive potential of these cells during the acute and chronic phases of inflammation, respectively. The contrast in the damage to poly(urethane)s (PUs) was monitored by measuring radiolabel release elicited from a (14)C-polyester-urea-urethane (PEUU) during incubation with both cell types. Human PMN were seeded onto polymer-coated glass slips and both radiolabel release as well as serine protease activity [assayed with N-benzyloxycarbonyl lysine thiobenzyl ester (BLT)] were measured 18 h later. Human monocytes were cultured on polystyrene tissue culture plates for 14 days, trypsinized, and seeded onto the polymer-coated glass slips; then, radiolabel release and esterase activity [assayed with p-nitrophenylbutyrate (PNB)] were measured after 18 h. Coverslips with MDM were also incubated for an additional 2 weeks. At 18 h postincubation with the PEUU, MDM elicited 25 times more radiolabel release per 10(6) cells than PMN at 18 h and continued to increase more than sevenfold over the 18-h value during the subsequent 14-day period. The BLT activity in PMN did not increase significantly during the 18-h incubation period, whereas the PNB activity in MDM increased more than fourfold. The MDM, but not the PMN elicited radiolabel release, was inhibited by the protein synthesis inhibitor cycloheximide, as was the increase in PNB activity. The data provide evidence for a hydrolytic role for MDM and, to a lesser extent PMN, in the biodegradation of implanted materials. The full implication of the release of polymer-derived chemical agents from this hydrolytic cleavage of the implanted biomaterials, on the propagation of the inflammatory response, remains to be elucidated.

Neutrophil-mediated biodegradation of medical implant materials

During the acute inflammatory response to implanted medical devices, human neutrophils (PMN) release oxidative and hydrolytic activities which may ultimately contribute to the degradation of the biomaterial. In this study, the biological activities secreted by live PMNs which may contribute to biodegradation were investigated using a 14C label in the monomer unit of a poly(ester-urea-urethane) (PEUU) substrate. By using specific inhibitors, it was possible to propose a mechanism for PMN-mediated biodegradation. PMN, labeled with 3H-arachidonic acid, released significantly more 3H when adherent to PEUU than when adherent to tissue culture grade polystyrene (P<0.05). The phospholipase A2 (PLA2) inhibitors, aristolochic acid (ARIST) and quinacrine (QUIN), decreased the release of 3H and inhibited PEUU biodegradation (>50%, P<0.05). ARIST had no effect on cell viability, whereas QUIN significantly decreased it. The serine protease inhibitor, phenylmethylsulfonylfluoride inhibited biodegradation, but did not decrease cell survival. There is evidence to suggest that activation via the PLA2 pathway caused the release of hydrolytic activities which were able to elicit 14C release from PEUU. The role of oxidative compounds which were released via activation by phorbol myristate acetate (PMA), was not apparent, since PMA inhibited biodegradation and cell survival (>40%, P<0.05). This study has shown that it is possible to find out the differences in PMN activation through the PLA2 pathway when exposed to different material surfaces, making this a model system worthy of further investigation.

The effect of polyethylene particle chemistry on human monocyte-macrophage function in vitro

Osteolysis remains the most important problem in orthopedic implant failure. Wear debris from the implant contains polyethylene (PE) particulate which has been shown to activate monocyte-derived macrophages (MDM). Although the response of MDM has been shown to be influenced by the size, shape, and chemical type of PE, the effect of chemically altered PE on MDM has not been studied. In this study, human MDM were seeded onto glass coverslips coated with virgin high density (HD)PE and chemically modified HDPE (impregnated with ppm levels of CoCl(2) and oxidized by heat) mixed with type I collagen and cultured for 96 h. Light microscopic evaluation demonstrated consistent phagocytosis of the HDPE particulate that was confirmed by scanning electron and transmission electron microscopy with little evidence of cytotoxicity. Evaluation of pro-inflammatory mediator secretion by MDMs in response to the virgin and chemically modified HDPE revealed significant differences in interleukin (IL)-1, tumor necrosis factor (TNF)-alpha, and IL-6 secretion. A significant elevation of IL-1 secretion was observed after initial exposure to virgin HDPE particles compared with controls (p = 0.001). IL-1 secretion was also elevated in the low oxidized particle groups (p = 0.001), whereas the highly oxidized particles were not different than controls. Secretion of both IL-6 (p = 0.03) and TNF-alpha (p = 0.007) were significantly elevated by the low oxidized HDPE particles whereas the virgin and highly oxidized groups showed no difference. The different effects on MDM activation when HDPE surface chemistry was altered, highlight the importance of defining the particle properties when studying the role of MDM activation in in vitro systems and extrapolating these observations to the in vivo situation.

Synthesis and characterization of a novel biodegradable antimicrobial polymer

Bacterial infection is a frequent complication associated with the use of medical devices. In an effort to address this problem, antibacterial agents have been incorporated or applied directly onto the surfaces of numerous types of medical devices. This study assessed the feasibility of using a novel biodegradable polymer to release antibiotic drugs in response to inflammatory related enzymes. A model drug polymer was synthesized using 1,6-hexane diisocyanate (HDI), polycaprolactone diol (PCL), and a fluoroquinolone antibiotic, ciprofloxacin. Polymers were characterized by size-exclusion chromatography (SEC), and elemental analysis. Biodegradation studies were carried out by incubating the polymers with solutions of cholesterol esterase (CE) or phosphate buffer (pH 7.0) for 30 days at 37 degrees C. The degradation was assessed by high-performance liquid chromatography (HPLC), mass spectrometry (MS) and 14C radiolabel release. Subsequently, the activity of the released antibiotic was assessed against a clinical isolate of Pseudomonas aeruginosa. HPLC analysis showed the release of multiple degradation products which were identified, by tandem MS, to include ciprofloxacin and derivatives of ciprofloxacin. The microbiological assessment showed that the released ciprofloxacin possessed antimicrobial activity; 1 microg/ml was measured after 10 days. The results of this study suggest that these novel bioresponsive antimicrobial polymers or similar analogs show promise for use in the control of medical device associated infections.

Analysis of released products from oxidized ultra-high molecular weight polyethylene incubated with hydrogen peroxide and salt solutions

The wear of ultra-high molecular weight polyethylene (UHMWPE) implants generates polymeric and metallic particulate, which can be phagocytosed by human macrophages. The generation of these UHMWPE particles has been attributed to wear mechanisms and oxidation of the material. Many cell/particle studies have focused specifically on investigating particles of virgin materials themselves (i.e. virgin UHMWPE), while in fact, there is a strong likelihood that the oxidation processes encountered by the materials will yield particles with very different surface chemistries. Therefore, it is conceivable that chemical changes in the material would lead to altered cellular responses, as measured in the various cell study models. This paper has focused on the characterization of UHMWPE particulates that have been exposed to various conditions simulating processing steps and some of the oxidative and hydrolytic agents related to inflammatory responses. These include gamma-irradiation, thermal treatment and chemical oxidation by H2O2 and saline solutions. Oxidation of the particles was measured using Fourier transform infrared spectroscopy (FTIR). Degradation products were isolated from the incubation solutions using high-performance liquid chromatography (HPLC). UHMWPE particulates underwent extensive oxidation after gamma-irradiation and thermal treatments. There were marked differences following treatments of film samples taken from bar stock and the virgin particle samples. Polymer-related products, containing alkenes, alkanes and hydroxyl groups, were found in the incubation solutions. The study concluded that future work must consider both the particulates' surface chemistry and the possibility of soluble degradation products when assessing UHMWPE/cellular interactions.

Suppression of bacterial adherence by experimental root canal sealers

To prevent reinfection after root canal treatment, root filling materials should be antimicrobial. This study assessed the antimicrobial efficacy of KT-308, a modified glass ionomer cement sealer, and three formulations of ZUT, a combination of KT-308 and three different concentrations of a silver-containing zeolite. Discs prepared from the test materials and paper controls were incubated in Brain Heart Infusion broth for 12 wk. At 2-wk intervals, 18 discs from each group were inoculated with Enterococcus faecalis and incubated for periods of 1 to 30 h. After further processing, a 200 microliters aliquot of the broth immersing each disc was plated on agar and assessed for bacterial growth. The remaining broth was measured for optical density. All ZUT discs demonstrated no bacterial growth after 15 h of interaction, in contrast to abundant growth with the KT-308 and paper discs. Thus ZUT effectively suppressed adherent E. faecalis after 15 h, irrespective of its concentration and age.

Effect of filler content on the profile of released biodegradation products in micro-filled bis-GMA/TEGDMA dental composite resins

This study assesses the effect of the filler content, in a micro-filled composite (0.04 microm), on the liberation of biodegradation products derived from two model composite systems. The materials were based on bis-phenyl glycidyl dimethacrylate (bis-GMA) and triethylenene glycol dimethacrylate (TEGDMA) monomers. The composites were produced using silica filler concentrations of 20 and 40%) by weight. Samples were incubated with either cholesterol esterase (CE) or phosphate buffer solutions (PBS) for 8, 16 and 32 days. Products were isolated by high-performance liquid chromatography (HPLC) and identified by mass spectrometry. The identified products included TEGDMA, 2,2-bis[4(2,3-hydroxypropoxy)-phenyl]propane (bis-HPPP) and triethylene glycol methacrylate (TEGMA). Bis-HPPP was only produced in the presence of enzyme. The amount of isolated TEGMA, in both composite systems, was shown to be significantly higher for materials incubated with enzyme than their buffer counterparts (P < 0.05). Between 0 and 8 days incubation with enzyme, significantly higher amounts of Bis-HPPP and TEGMA were generated with the lower filler model material (composite-20) than the higher filled composite (composite-40), while the opposite effect was observed between 8 and 16 days. The data indicate that biodegradation product release profiles are dependent on the filler/resin ratios, and suggests that this parameter should be considered when assessing product release for biocompatibility issues pertaining to dental composite systems.

Biodegradation of commercial dental composites by cholesterol esterase

The research literature suggests that current dental polymeric composites are not chemically inert at the material/biological interface. Several studies have investigated the process of "biodegradation" on dental composites in the presence of enzymes, by monitoring changes in weight loss and surface hardness properties. However, it is hypothesized that these methods can provide an erroneous measure of biochemically induced degradation, since they are less sensitive to molecular events and lack the ability to provide chemical information. Knowledge of the latter is important because it relates to the biological significance of biodegradation, i.e., the identification and quantification of released compounds that may be capable of influencing cell, bacteria, or enzyme function. It was the objective of this study to compare three methods (weight loss, surface micro-hardness, and liquid chromatography combined with mass spectrometry) for their ability to measure the effect of enzyme-induced biodegradation on three commercial composite resin materials. The enzyme was cholesterol esterase, and the composites were Silux Plus XL, Z100 A2 (3M), and TPH XL (L.D. Caulk). Biodegradation was readily detected by liquid chromatography, and its sensitivity was shown to be substantially greater than that of weight loss or surface hardness measurements, although surface hardness measurements did show some agreement with liquid chromatography data. The data also indicated that the levels and distribution of released degradation products can vary substantially from one product to the next, and that this merits further investigation if the potential impact of different commercial restorative materials on cell and bacteria function is to be assessed.

The biodegradation of poly(urethane)s by the esterolytic activity of serine proteases and oxidative enzyme systems

Biodegradation of poly(urethane)s (PU)s using single enzymes in vitro was assessed by measuring radiolabel release from model poly(ester-urea-urethane) (PESU) and poly(ether-urea-urethane) (PETU) materials synthesized with 14C-labelled monomers. Cholesterol esterase (CE), an enzyme found in monocyte-derived macrophages (MDM), has been reported to cause a significant level of radiolabel release from both of these PUs. Previous work has shown that CE activity could be inhibited by the serine protease/esterase inhibitor, phenylmethylsulfonyl fluoride. Since many serine proteases are present in circulating blood and can be released by cells other than MDM, this study investigated the ability of serine proteases relative to that of CE to cause the degradation of PUs. In addition, the possible role of several oxidative enzymes in the breakdown of PUs was investigated. Proteinase K, chymotrypsin and thrombin, when incubated with PESU, coated on glass slips, caused significant radiolabel release, with proteinase K giving the highest values. However, the highest radiolabel release which proteinase K could elicit was ten times less than CE. Thrombin and then chymotrypsin were progressively worse in their biodegradative activity. Only CE, and not the serine proteases, could elicit a detectable radiolabel release from PETU. Although the release of reactive oxygen species and molecular oxygen occur around an implanted biomaterial, several oxidative systems (peroxidase, xanthine oxidase, catalase), known to produce one or more of these molecular species, were unable to induce radiolabel release from these PUs. The process of biodegradation as assessed by radiolabel release appears to be a specific hydrolytic process, while the role of oxidative enzymes remains less clear.

Commercial polyurethanes: the potential influence of auxiliary chemicals on the biodegradation process

This investigation elucidates some aspects of auxiliary chemicals on the biodegradation of two commercial polyurethanes (Pellethane and Corethane). The materials were incubated for 28 days with cholesterol esterase and/or with phosphatidylcholine. Extraction studies were carried out on the two materials, using different solvents, chosen on the basis of solvent polarity. FT-IR spectra for the extracted materials indicated the presence of poly(methylene)n oxide moities, silicone oil, bis-ethylene-stearamide, aromatic moities, and alkyd-urea compounds in Pellethane. Corethane materials were shown to contain some fatty acids, hydrocarbon waxes, ester-based species, and chlorinated compounds. Analysis of incubation solutions by high performance liquid chromatography failed to isolate methylene dianiline (MDA) or any of its derivatives from the various polymer incubation solutions. However, a methanol extract of Corethane samples that were incubated for 28 days in cholesterol esterase did show the presence of MDA. The absence of MDA in the Pellethane methanol extracted samples may reflect the differences in surface additives found for this material versus the Corethane. FT-IR/ATR analysis of polymer surfaces exposed to cholesterol esterase/phospholipids mixture showed that there was an increase in the uptake of phospholipids over samples that were incubated in phospholipid dispersion alone. The results of this study show that some of the auxiliary chemicals found in commercial polyurethanes may hinder the specific release of hydrolytic degradation products and delay polymer degradation. However, it should be recognized that the surface layer containing these compounds is susceptible to change following the interaction between the polyurethane-based devices and elements of the host environment (i.e. lipids, enzymes, etc.). Hence, recognition and identification of these changes will ultimately be important in assessing a commercial polymer's blood compatibility characteristics.

Synthesis of cholesterol esterase by monocyte-derived macrophages: a potential role in the biodegradation of poly(urethane)s

Many studies have described the role of monocyte-derived macrophages (MDM) in inflammation leading to atherosclerosis, a process in which alterations in the metabolism of cholesterol esters is well established. On the other hand, the mechanism of MDM activation in response to biomaterial surfaces is still not well understood. Several studies have described the different degrees of activation of monocytes on poly(urethane) surfaces by measuring the release of early markers of differentiation, such as cytokines. It has been possible to decrease MDM activation in contact with materials by modifying the material surface with antioxidants. Therefore, it has been proposed that it is the reactive oxygen species provided by MDM which are responsible for deleterious effects observed in material-derived inflammation. A recent study has shown that one of the markers of the degree of differentiation of MDM is the synthesis of cholesterol esterase (CE), an enzyme demonstrated as causing biodegradation of polyester(urethane)s and more recently polyether- and polycarbonate-poly(urethane)s as well. In this review article, markers used to assess MDM differentiation on material surfaces will be described and related to the activation of MDM. In particular, the CE accumulation in MDM which is associated with atherosclerosis will be related to its degradative potential during chronic inflammation. How this may impact on the biostability of implanted poly(urethane) medical devices is discussed.

Differential synthesis of cholesterol esterase by monocyte-derived macrophages cultured on poly(ether or ester)-based poly(urethane)s

Monocytes adherent to implanted biomaterials differentiate into macrophages while synthesizing large amounts of degradative enzymes, including cholesterol esterase (CE), which previously has been shown to degrade poly(urethane)s. Human peripheral blood monocytes were cultured on tissue culture grade polystyrene (PS), and two model poly(urethane)s were synthesized from (1) polycaprolactone (PCL) and (2) polytetramethylene oxide (PTMO), both with 2,4-toluene diisocyanate (TDI) and ethylene diamine (ED). The increase in CE and total protein per cell were measured on days 8 and 28 in culture and normalized to the DNA content per cell. At day 8 there consistently were fewer cells remaining on the PTMO-based polymer than on the PCL-based polymer or the PS (p < 0.05). When comparing day 28 to day 8, there was more CE activity and protein per cell on all materials. However, there was a disproportionate synthesis of CE per mg of total protein on PS and TDI/PCL/ED whereas on PTMO there was not. Significantly, there was more protein and CE per cell on PTMO than on PS or TDI/PCL/ED (p < 0.05). This in vitro model system of the chronic phase of inflammation has shown that it is possible to culture monocytes for a month and assess the material surface itself as a potent activator of the differentiation into macrophages without secondary stimulation. Since CE has been shown to degrade poly(ether and ester)-based poly(urethane)s, the differential production of this enzyme relative to the total protein on different surfaces may impact on the potential long-term biostability of an implanted material.