Development of a Shape-Memory Tube to Prevent Vascular Stenosis

Recent advances in shape memory polymeric nanocomposites for biomedical applications and beyond

Shape memory polymers (SMPs), which initiate shape transformation in response to environmental stimuli, have attracted significant attention in both academic research and technological innovation. The combination of functional nanomaterials and SMPs has led to the emergence of a variety of shape memory polymeric nanocomposites (SMPNs) with multifunctional properties. This has injected new vitality and vigor into fields such as tissue engineering, biomedicine, optical sensing, aerospace and mechanical engineering. In this review article, we present a brief introduction to the fundamentals of SMPs and SMPNs, followed by a discussion of the recent advances in their multifunctional applications in biomedical manufacturing, drug delivery devices, mechanical sensing, micro-engines, etc. The opportunities and challenges in the future development of SMPs are also discussed.

Shape-Configurable Mesh for Hernia Repair by Synchronizing Anisotropic Body Motion

Continuous progress has been made in elucidating the relationship between material property, device design, and body function to develop surgical meshes. However, an unmet need still exists wherein the surgical mesh can handle the body motion and thereby promote the repair process. Here, the hernia mesh design and the advanced polymer properties are tailored to synchronize with the anisotropic abdominal motion through shape configuration. The thermomechanical property of shape configurable polymer enables molding of mesh shape to fit onto the abdominal structure upon temperature shift, followed by shape fixing with the release of the heat energy. The microstructural design of mesh is produced through finite element modeling to handle the abdominal motion efficiently through the anisotropic longitudinal and transverse directions. The design effects are validated through in vitro, ex vivo, and in vivo mechanical analyses using a self-configurable, body motion responsive (BMR) mesh. The regenerative function of BMR mesh leads to effective repair in a rat hernioplasty model by effectively handling the anisotropic abdomen motion. Subsequently, the device-tissue integration is promoted by promoting healthy collagen synthesis with fibroblast-to-myofibroblast differentiation. This study suggests a potential solution to promote hernia repair by fine-tuning the relationship between material property and mesh design.

In vivo self-assembled shape-memory polyurethane for minimally invasive delivery and therapy

Advanced elastomers are highly in demand for the fabrication of medical devices for minimally invasive surgery (MIS). Herein, a shape memory and self-healing polyurethane (PCLUSe) composed of semi-crystalline poly(ε-caprolactone) (PCL) segments and interchangeable and antioxidative diselenide bonds was designed and synthesized. The excellent shape memory of PCLUSe contributed to the smooth MIS operation, leading to less surgical wounds than in the case of sternotomy. The diselenide bonds of PCLUSe contributed to the rapid self-healing under 405 nm irradiation within 60 s, and the alleviation of tissue oxidation post injury. After being delivered through a 10 mm diameter trocar onto a beating canine heart by MIS, two shape-recovered PCLUSe films self-assembled (self-healing) into a larger single patch (20 × 10 × 0.2 mm3) under the trigger of laser irradiation in situ, which could efficiently overcome the limited-size problem within MIS and meet a larger treatment area. The diselenide bonds in the PCLUSe cardiac patches protected the myocardium under oxidative stress post myocardial infarction (MI), and significantly maintained the cardiac functions.

Hygroscopic Tunable Multishape Memory Effect in Cellulosic Macromolecular Networks with a Supramolecular Mesophase

Tunable multishape memory polymers offer intriguing opportunities for memorizing multiple temporary shapes with tunable transition temperatures from one material composition. However, such multishape memory effects have been exclusively correlated with the thermomechanical behaviors of polymers, significantly limiting their applications in heat-sensitive scenarios. Here we report a nonthermal tunable multishape memory effect in covalently cross-linked cellulosic macromolecular networks, which spontaneously organize into supramolecular mesophases by water evaporation induced self-assembly. The supramolecular mesophase endows the network with a broad, reversible hygromechanical response combined with a unique moisture memory effect at ambient temperature, enabling diverse multishape memory behaviors (dual-, triple-, and quadruple-shape memory) under highly tunable and independent control of relative humidity (RH) alone. Significantly, such a hygroscopic tunable multishape memory effect readily extends the implications of shape memory polymers beyond the conventional thermomechanical regimes with potential advantages for biomedical applications.

Body-Shaping Membrane to Regenerate Breast Fat by Elastic Structural Holding

Tissue regeneration requires structural holding and movement support using tissue-type-specific aids such as bone casts, skin bandages, and joint protectors. Currently, an unmet need exists in aiding breast fat regeneration as the breast moves following continuous body motion by exposing the breast fat to dynamic stresses. Here, the concept of elastic structural holding is applied to develop a shape-fitting moldable membrane for breast fat regeneration ("adipoconductive") after surgical defects are made. The membrane has the following key characteristics: (a) It contains a panel of honeycomb structures, thereby efficiently handling motion stress through the entire membrane; (b) a strut is added into each honeycomb in a direction perpendicular to gravity, thereby suppressing the deformation and stress concentration upon lying and standing; and (c) thermo-responsive moldable elastomers are used to support structural holding by suppressing large deviations of movement that occur sporadically. The elastomer became moldable upon a temperature shift above T_m. The structure can then be fixed as the temperature decreases. As a result, the membrane promotes adipogenesis by activating mechanotransduction in a fat miniature model with pre-adipocyte spheroids under continuous shaking in vitro and in a subcutaneous implant placed on the motion-prone back areas of rodents in vivo.

Vascular Cast to Program Antistenotic Hemodynamics and Remodeling of Vein Graft

The structural stability of medical devices is established by managing stress distribution in response to organ movement. Veins abruptly dilate upon arterial grafting due to the mismatched tissue property, resulting in flow disturbances and consequently stenosis. Vascular cast is designed to wrap the vein-artery grafts, thereby adjusting the diameter and property mismatches by relying on the elastic fixity. Here, a small bridge connection in the cast structure serves as an essential element to prevent stress concentrations due to the improved elastic fixity. Consequently, the vein dilation is efficiently suppressed, healthy (laminar and helical) flow is induced effectively, and the heathy functions of vein grafting are promoted, as indicated by the flow directional alignment of endothelial cells with arterialization, muscle expansion, and improved contractility. Finally, collaborative effects of the bridge drastically suppress stenosis with patency improvement. As a key technical point, the advantages of the bridge addition are validated via the computational modeling of fluid-structure interaction, followed by a customized ex vivo set-up and analyses. The calculated effects are verified using a series of cell, rat, and canine models towards translation. The bridge acted like "Little Dutch boy" who saved the big mass using one finger by supporting the cast function.

Intelligent Eucommia ulmoides Rubber/Ionomer Blends with Thermally Activated Shape Memory and Self-Healing Properties

Intelligent Eucommia ulmoides rubber (EUR) and ionomer Surlyn resin (SR) blends were prepared and studied in this manuscript. This is the first paper to combine EUR with SR to prepare blends with both the shape memory effect and self-healing capability. The mechanical, curing, thermal, shape memory and self-healing properties were studied by a universal testing machine, differential scanning calorimetry (DSC) and dynamic mechanical analysis (DMA), respectively. Experimental results showed that the increase in ionomer content not only improved mechanical and shape memory properties but also endowed the compounds with excellent self-healing ability under the appropriate environmental conditions. Notably, the self-healing efficiency of the composites reached 87.41%, which is much higher than the efficiency of other covalent cross-linking composites. Therefore, these novel shape memory and self-healing blends can expand the use of natural Eucommia ulmoides rubber, such as in special medical devices, sensors and actuators.

Solid-State Crosslinkable, Shape-Memory Polyesters Serving Tissue Engineering

Acrylate-endcapped urethane-based precursors constituting a poly(D,L-lactide)/poly(ε-caprolactone) (PDLLA/PCL) random copolymer backbone are synthesized with linear and star-shaped architectures and various molar masses. It is shown that the glass transition and thus the actuation temperature could be tuned by varying the monomer content (0-8 wt% ε-caprolactone, T_{g,crosslinked} = 10-42 °C) in the polymers. The resulting polymers are analyzed for their physico-chemical properties and viscoelastic behavior (G'_max = 9.6-750 kPa). The obtained polymers are subsequently crosslinked and their shape-memory properties are found to be excellent (R_r = 88-100%, R_f = 78-99.5%). Moreover, their potential toward processing via various additive manufacturing techniques (digital light processing, two-photon polymerization and direct powder extrusion) is evidenced with retention of their shape-memory effect. Additionally, all polymers are found to be biocompatible in direct contact in vitro cell assays using primary human foreskin fibroblasts (HFFs) through MTS assay (up to ≈100% metabolic activity relative to TCP) and live/dead staining (>70% viability).

A Biocompatible 4D Printing Shape Memory Polymer as Emerging Strategy for Fabrication of Deployable Medical Devices

The rapid development of 4D printing provides a potential strategy for the fabrication of deployable medical devices (DMD). The minimally invasive surgery to implant the DMD into the body is critical, 4D printing DMD allows the well-defined device to be implanted with a high-compacted shape and transformed into their designed shape to meet the requirement. Herein, a 4D printing tissue engineering material is developed with excellent biocompatibility and shape memory effect based on the photocrosslinked polycaprolactone (PCL). The fast thiol-acrylate click reaction is applied for photocrosslinking of the acrylates capped star polymer (s-PCL-MA) with poly-thiols, that enable the 3D printing for the DMD fabrication. The cell viability, erythrocyte hemolysis, and platelet adhesion results indicate the excellent biocompatibility of the 4D printing polymer, especially the biological subcutaneous implantation results confirm the promote tissue growth and good histocompatibility. A 4D printing stent with deformable shape and recovery at a temperature close to human body temperature demonstrated the potential application as DMD. In addition, the everolimus is loaded to the polymer (ps1-PCL) through host-guest coordination with β-cyclodextrin as the core of the star polymer, which shows sustained drug release and improved body's inflammatory response.

Research Progress of Shape Memory Polymer and 4D Printing in Biomedical Application

As a kind of smart material, shape memory polymer (SMP) shows great application potential in the biomedical field. Compared with traditional metal-based medical devices, SMP-based devices have the following characteristics: 1) The adaptive ability allows the biomedical device to better match the surrounding tissue after being implanted into the body by minimally invasive implantation; 2) it has better biocompatibility and adjustable biodegradability; 3) mechanical properties can be regulated in a large range to better match with the surrounding tissue. 4D printing technology is a comprehensive technology based on smart materials and 3D printing, which has great application value in the biomedical field. 4D printing technology breaks through the technical bottleneck of personalized customization and provides a new opportunity for the further development of the biomedical field. This paper summarizes the application of SMP and 4D printing technology in the field of bone tissue scaffolds, tracheal scaffolds, and drug release, etc. Moreover, this paper analyzes the existing problems and prospects, hoping to provide a preliminary discussion and useful reference for the application of SMP in biomedical engineering.

4D Printing: A Cutting-edge Platform for Biomedical Applications

Nature's materials have evolved over time to be able to respond to environmental stimuli by generating complex structures that can change their functions in response to distance, time, and direction of stimuli. A number of technical efforts are currently being made to improve printing resolution, shape fidelity, and printing speed to mimic the structural design of natural materials with three-dimensional (3D) printing. Unfortunately, this technology is limited by the fact that printed objects are static and cannot be reshaped dynamically in response to stimuli. In recent years, several smart materials have been developed that can undergo dynamic morphing in response to a stimulus, thus resolving this issue. Four-dimensional (4D) printing refers to a manufacturing process involving additive manufacturing, smart materials, and specific geometries. It has become an essential technology for biomedical engineering and has the potential to create a wide range of useful biomedical products. This paper will discuss the concept of 4D bioprinting and the recent developments in smart matrials, which can be actuated by different stimuli and be exploited to develop biomimetic materials and structures, with significant implications for pharmaceutics and biomedical research, as well as prospects for the future.

Emerging 4D Printing Strategies for Next-Generation Tissue Regeneration and Medical Devices

The rapid development of 3D printing has led to considerable progress in the field of biomedical engineering. Notably, 4D printing provides a potential strategy to achieve a time-dependent physical change within tissue scaffolds or replicate the dynamic biological behaviors of native tissues for smart tissue regeneration and the fabrication of medical devices. The fabricated stimulus-responsive structures can offer dynamic, reprogrammable deformation or actuation to mimic complex physical, biochemical, and mechanical processes of native tissues. Although there is notable progress made in the development of the 4D printing approach for various biomedical applications, its more broad-scale adoption for clinical use and tissue engineering purposes is complicated by a notable limitation of printable smart materials and the simplistic nature of achievable responses possible with current sources of stimulation. In this review, the recent progress made in the field of 4D printing by discussing the various printing mechanisms that are achieved with great emphasis on smart ink mechanisms of 4D actuation, construct structural design, and printing technologies, is highlighted. Recent 4D printing studies which focus on the applications of tissue/organ regeneration and medical devices are then summarized. Finally, the current challenges and future perspectives of 4D printing are also discussed.

Shape-Memory Polymers Hallmarks and Their Biomedical Applications in the Form of Nanofibers

Shape-Memory Polymers (SMPs) are considered a kind of smart material able to modify size, shape, stiffness and strain in response to different external (heat, electric and magnetic field, water or light) stimuli including the physiologic ones such as pH, body temperature and ions concentration. The ability of SMPs is to memorize their original shape before triggered exposure and after deformation, in the absence of the stimulus, and to recover their original shape without any help. SMPs nanofibers (SMPNs) have been increasingly investigated for biomedical applications due to nanofiber’s favorable properties such as high surface area per volume unit, high porosity, small diameter, low density, desirable fiber orientation and nanoarchitecture mimicking native Extra Cellular Matrix (ECM). This review focuses on the main properties of SMPs, their classification and shape-memory effects. Moreover, advantages in the use of SMPNs and different biomedical application fields are reported and discussed.

Stress Communication between the Chain Movement and the Shape Transformation from 2D to 3D

Shape memory polymers can change their initial shape under the stimulation of the external environment, but most of the stimulations require not only an external force but also a high temperature, which limits their application to a certain extent. Inspired by the unmatched elongation of cells on both sides of the mimosa petiole in nature, which leads to leaf closure, we designed a new type of shape transformation polymer, which can transform between 2D and 3D by simple stretching and releasing steps at room temperature. Surface patterning on one side of the sample film was realized via a coordination network of Fe³⁺-COOH to achieve different coordination gradients along its thickness. By this way, different movements of polymer chains along the thickness would lead to 2D-3D transformation upon releasing the stretched sample. Using this method, we obtained a series of transformations from customized 2D materials to complex 3D shapes and explored their potential application in information encryption transmission.

4D Printing of Shape Memory Vascular Stent Based on βCD-g-Polycaprolactone

The 4D-printing technology is applied to fabricate a shape memory peripheral stent with good biocompatibility, which sustains long-term drug release. The star polymer s-PCL is prepared by ring opening polymerization of ε-caprolactone with the -OH of β-cyclodextrin (βCD) as initiator, and then the s-PCL is modified with acrylate endgroup which allows the polymerization under UV light to form the crosslinking network c-PCL. Attributed to the feature of the high crosslinked structure and chemical nature of polycaprolactone (PCL) and βCD, the composite exhibits appropriate tensile strength and sufficient elasticity and bursting pressure, and it is comparable with great saphenous vein in human body. The radial support of the 4D-printed stent is 0.56 ± 0.11 N and is equivalent to that of commercial stent. The cell adhesion and proliferation results show a good biocompatibility of the stent with human umbilical vein endothelial cells. Due to the presence of βCD, the wettability and biocompatibility of the materials are improved, and the sustained paclitaxel release based on the host-guest complexion shows the potential of the drug-loaded stent for long-term release. This study provides a new strategy to solve the urgent need of small-diameter scaffolds to treat critical limb ischemia.

Dilation-Responsive Microshape Programing Prevents Vascular Graft Stenosis

Shape memory materials have been successfully applied to minimally invasive implantation of medical devices. However, organ-movement-specific shape programing at a microscale level has never been demonstrated despite significant unmet needs. As vein-to-artery grafting induces vein dilation and stenosis, a polymeric self-enclosable external support (SES) is designed to wrap the vascular out-wall. Its micropores are programmed to increase sizes and interconnections upon dilation. Vessel dilation promotes venous maturation, but overdilation induces stenosis by disturbed blood flow. Therefore, the unique elastic shape-fixity of SES provides a foundation to enable a stable microscale shape transition by maintaining the vein dilation. The shape transition of micropore architecture upon dilation induces beneficial inflammation, thereby regenerating vasa vasorum and directing smooth muscle cell migration toward adventitia with the consequent muscle reinforcement of veins. This game-changer approach prevents the stenosis of vein-to-artery grafting by rescuing ischemic disorders and promoting arterial properties of veins.

Hormone autocrination by vascularized hydrogel delivery of ovary spheroids to rescue ovarian dysfunctions

The regeneration potential of implantable organ model hydrogels is applied to treat a loss of ovarian endocrine function in women experiencing menopause and/or cancer therapy. A rat ovariectomy model is used to harvest autologous ovary cells while subsequently producing a layer-by-layer form of follicle spheroids. Implantation of a microchannel network hydrogel with cell spheroids [vascularized hydrogel with ovarian spheroids (VHOS)] into an ischemic hindlimb of ovariectomized rats significantly aids the recovery of endocrine function with hormone release, leading to full endometrium regeneration. The VHOS implantation effectively suppresses the side effects observed with synthetic hormone treatment (i.e., tissue overgrowth, hyperplasia, cancer progression, deep vein thrombosis) to the normal levels, while effectively preventing the representative aftereffects of menopause (i.e., gaining fatty weight, inducing osteoporosis). These results highlight the unprecedented therapeutic potential of an implantable VHOS against menopause and suggest that it may be used as an alternative approach to standard hormone therapy.

A Review of Shape Memory Polymers and Composites: Mechanisms, Materials, and Applications

Over the past decades, interest in shape memory polymers (SMPs) has persisted, and immense efforts have been dedicated to developing SMPs and their multifunctional composites. As a class of stimuli-responsive polymers, SMPs can return to their initial shape from a programmed temporary shape under external stimuli, such as light, heat, magnetism, and electricity. The introduction of functional materials and nanostructures results in shape memory polymer composites (SMPCs) with large recoverable deformation, enhanced mechanical properties, and controllable remote actuation. Because of these unique features, SMPCs have a broad application prospect in many fields covering aerospace engineering, biomedical devices, flexible electronics, soft robotics, shape memory arrays, and 4D printing. Herein, a comprehensive analysis of the shape recovery mechanisms, multifunctionality, applications, and recent advances in SMPs and SMPCs is presented. Specifically, the combination of functional, reversible, multiple, and controllable shape recovery processes is discussed. Further, established products from such materials are highlighted. Finally, potential directions for the future advancement of SMPs are proposed.

Shape Memory Tube Plug for Fine-control of Intraocular Pressure by Glaucoma Devices

As a standard approach to treating glaucoma, a silicone tube device is inserted into the eye to drain water and thereby lower the intraocular pressure (IOP). However, the fixed diameter of the tube often results in too much initial water drain. Suture-sheaving of the outer tube wall also leads to random IOP drops over time. In this study, self-expansion of the inner tube diameter was achieved by inserting a shape memory tube into the silicone tube. The difference in controlling small to large IOP drops before and after tube diameter expansion was demonstrated via computational modeling, a flow pumping system, and rabbit experiments.

Microchannel network hydrogel induced ischemic blood perfusion connection

Angiogenesis induction into damaged sites has long been an unresolved issue. Local treatment with pro-angiogenic molecules has been the most common approach. However, this approach has critical side effects including inflammatory coupling, tumorous vascular activation, and off-target circulation. Here, the concept that a structure can guide desirable biological function is applied to physically engineer three-dimensional channel networks in implant sites, without any therapeutic treatment. Microchannel networks are generated in a gelatin hydrogel to overcome the diffusion limit of nutrients and oxygen three-dimensionally. Hydrogel implantation in mouse and porcine models of hindlimb ischemia rescues severely damaged tissues by the ingrowth of neighboring host vessels with microchannel perfusion. This effect is guided by microchannel size-specific regenerative macrophage polarization with the consequent functional recovery of endothelial cells. Multiple-site implantation reveals hypoxia and neighboring vessels as major causative factors of the beneficial function. This technique may contribute to the development of therapeutics for hypoxia/inflammatory-related diseases.

Nasolacrimal stent with shape memory as an advanced alternative to silicone products

Epiphora is the overflow of tears typically caused by obstruction or occlusion of the nasolacrimal duct. More attention is required to address this global health issue owing to the increase in air pollution. Implantation of a silicone stent is the preferred treatment for epiphora; however, introducing a silicone stent into a narrow duct with complex geometry is challenging as it requires guidance by a sharp metal needle. Additionally, silicone can cause adverse reactions such as biofilm formation and tear flow resistance due to its extreme hydrophobicity. To overcome these problems, in this study we developed a new type of biocompatible shape memory polymer (SMP) stent with elasticity capacity for self-expansion. First, SMPs in the form of x%poly(ε-caprolactone)-co-y%poly(glycidyl methacrylate) (x%PCL-y%PGMA) were synthesized via ring opening polymerization by varying the molar ratio of PCL (x%) and PGMA (y%). Second, the shape memory and mechanical properties were tuned by controlling the crosslinking degree and concentration of x%PCL-y%PGMA solution to produce a test type of SMP stent. Lastly, this 94%PCL-06%PGMA stent exhibited more standout critical functions in a series of in vitro and in vivo experiments such as a cell growth-supporting level of biocompatibility with nasal epithelial cells without significant inflammatory responses, better resistance to biofilm formation, and more efficient capacity to drain tear than the silicone control. Overall, 94%PCL-06%PGMA can be suggested as a superior alternative to the currently used materials for nasolacrimal stents. STATEMENT OF SIGNIFICANCE: Silicone intubation (stenting) has been widely used to treat nasolacrimal duct obstruction, however, it can cause adverse clinical effects such as bacterial infection; presents procedural challenges because of the curved nasolacrimal duct structure; and shows poor drainage efficiency stemming from the highly hydrophobic nature of silicone. In this work, we describe an innovative shape memory polymer (SMP) as a superior alternative to conventional silicone-based materials for nasolacrimal duct intubation. We demonstrate the clear advantages of the SMP over conventional silicone, including a much higher drainage capacity and superior resistance to bacterial infection.