Plasma protein adsorbed biomedical polymers: activation of human monocytes and induction of interleukin 1

A portable multi-sensor module for monitoring external ventricular drains

External ventricular drains (EVDs) are used clinically to relieve excess fluid pressure in the brain. However, EVD outflow rate is highly variable and typical clinical flow tracking methods are manual and low resolution. To address this problem, we present an integrated multi-sensor module (IMSM) containing flow, temperature, and electrode/substrate integrity sensors to monitor the flow dynamics of cerebrospinal fluid (CSF) drainage through an EVD. The impedimetric sensors were microfabricated out of biocompatible polymer thin films, enabling seamless integration with the fluid drainage path due to their low profile. A custom measurement circuit enabled automated and portable sensor operation and data collection in the clinic. System performance was verified using real human CSF in a benchtop EVD model. Impedimetric flow sensors tracked flow rate through ambient temperature variation and biomimetic pulsatile flow, reducing error compared with previous work by a factor of 6.6. Detection of sensor breakdown using novel substrate and electrode integrity sensors was verified through soak testing and immersion in bovine serum albumin (BSA). Finally, the IMSM and measurement circuit were tested for 53 days with an RMS error of 61.4 μL/min.

Rapid Manufacturing of Multilayered Microfluidic Devices for Organ on a Chip Applications

Microfabrication and Polydimethylsiloxane (PDMS) soft-lithography techniques became popular for microfluidic prototyping at the lab, but even after protocol optimization, fabrication is yet a long, laborious process and partly user-dependent. Furthermore, the time and money required for the master fabrication process, necessary at any design upgrade, is still elevated. Digital Manufacturing (DM) and Rapid-Prototyping (RP) for microfluidics applications arise as a solution to this and other limitations of photo and soft-lithography fabrication techniques. Particularly for this paper, we will focus on the use of subtractive DM techniques for Organ-on-a-Chip (OoC) applications. Main available thermoplastics for microfluidics are suggested as material choices for device fabrication. The aim of this review is to explore DM and RP technologies for fabrication of an OoC with an embedded membrane after the evaluation of the main limitations of PDMS soft-lithography strategy. Different material options are also reviewed, as well as various bonding strategies. Finally, a new functional OoC device is showed, defining protocols for its fabrication in Cyclic Olefin Polymer (COP) using two different RP technologies. Different cells are seeded in both sides of the membrane as a proof of concept to test the optical and fluidic properties of the device.

Antibacterial infection and immune-evasive coating for orthopedic implants

Bacterial infection and infection-induced immune response have been a life-threatening risk for patients having orthopedic implant surgeries. Conventional biomaterials are vulnerable to biocontamination, which causes bacterial invasion in wounded areas, leading to postoperative infection. Therefore, development of anti-infection and immune-evasive coating for orthopedic implants is urgently needed. Here, we developed an advanced surface modification technique for orthopedic implants termed lubricated orthopedic implant surface (LOIS), which was inspired by slippery surface of Nepenthes pitcher plant. LOIS presents a long-lasting, extreme liquid repellency against diverse liquids and biosubstances including cells, proteins, calcium, and bacteria. In addition, we confirmed mechanical durability against scratches and fixation force by simulating inevitable damages during surgical procedure ex vivo. The antibiofouling and anti-infection capability of LOIS were thoroughly investigated using an osteomyelitis femoral fracture model of rabbits. We envision that the LOIS with antibiofouling properties and mechanical durability is a step forward in infection-free orthopedic surgeries.

Mitigation of monocyte driven thrombosis on cobalt chrome surfaces in contact with whole blood by thin film polar/hydrophobic/ionic polyurethane coatings

Monocytes are active at the crossroads between inflammation and coagulation processes since they can secrete pro-inflammatory cytokines and express tissue factor (TF), a major initiator of coagulation. Cobalt-chrome (CoCr), a metal alloy, used as a biomaterial for vascular stents, has been shown to be potentially pro-thrombotic and pro-inflammatory. Research work with a polymer from a family of degradable-polar hydrophobic ionic polyurethanes (D-PHI), called HHHI, has been shown to exhibit anti-inflammatory responses from human monocytes. We have generated multifunctional polyurethane thin films (MPTF) based on the HHHI chemistry, as a thin coating for CoCr and have evaluated the reactivity of blood with MPTF-coated CoCr. The results showed that the coating of CoCr with MPTF derived from HHHI prevents thrombin generation, reduces coagulation activation, and suppresses fibrin formation in whole blood. Activation of monocytes was also suppressed at the surface of MPTF-coated CoCr and specifically the decrease in thrombin generation was accompanied by a significant decrease in TF and pro-inflammatory cytokine levels. Mass spectroscopy of the adsorbed proteins showed lower levels of fibrinogen, fibronectin and complement C3, C4, and C8 when compared to CoCr. We can conclude that MPTFs reduce the pro-thrombotic and pro-inflammatory phenotype of monocytes and macrophages on CoCr, and prevent clotting in whole blood.

Toll-like Receptor 2-Dependent NF-κB/AP-1 Activation by Damage-Associated Molecular Patterns Adsorbed on Polymeric Surfaces

The foreign body reaction is a chronic inflammatory response to an implanted biomaterial that ultimately leads to fibrous encapsulation of the implant. It is widely accepted that the host response to implanted biomaterials is largely dependent on the species and conformations of proteins adsorbed onto the material surface due to the adsorbate's role in mediating cellular interactions with the implanted material. While the cellular response to adsorbed serum-derived proteins has been studied extensively, the presence of endogenous, matrix- and cell-derived mediators of inflammation within the adsorbed protein layer and their impact on cell-material interactions is not well-understood. Damage associated molecular patterns (DAMPs) are endogenous ligands released by stressed or damaged tissues to stimulate sterile inflammatory responses via Toll-like receptors (TLRs) and other pattern recognition receptors. The present study investigated the potential role of tissue-derived, pro-inflammatory stimuli in macrophage responses to biomaterials using cell lysate as a complex source of cell-derived DAMPs and poly(methyl methacrylate) (PMMA) and polydimethylsiloxane (PDMS) films as model biomaterials. We show that lysate-adsorbed PMMA and PDMS surfaces strongly induced NF-κB/AP-1 transcription factor activity and pro-inflammatory cytokine secretion in the RAW-Blue macrophage cell line compared to serum-adsorbed surfaces. Lysate-dependent NF-κB/AP-1 activation and cytokine expression were strongly attenuated by TLR2 neutralizing antibodies, while TLR4 inhibition resulted in a modest reduction. These data suggest that DAMPs, in their adsorbed conformations on material surfaces, may play a significant role in macrophage activation through TLR signaling, and that TLR pathways, particularly TLR2, merit further investigation as potential therapeutic targets to modulate host responses to implanted biomaterials.

Protein Adsorption and Cellular Adhesion and Activation on Biomedical Polymers

The design and development of new biomedical polymers for clinical application in devices, prostheses, and artificial organs requires a basic and fundamental understanding of biological interactions with biomedical polymers. Efforts in our laboratory have been directed towards appreciating the humoral and cellular interactions which govern protein adsorption and cellular adhesion and activation on biomedical polymers. Information and data are presented on protein adsorption from whole human blood, complement activation and receptors, and monocyte/macrophage adhesion and activation with growth factor release. Supported by experimental evidence, concepts regarding protein/polymer, cell/ polymer, cell/protein/polymer, and cell/cell interactions as they are related to in vivo events are presented.

An immobilized liquid interface prevents device associated bacterial infection in vivo

Virtually all biomaterials are susceptible to biofilm formation and, as a consequence, device-associated infection. The concept of an immobilized liquid surface, termed slippery liquid-infused porous surfaces (SLIPS), represents a new framework for creating a stable, dynamic, omniphobic surface that displays ultralow adhesion and limits bacterial biofilm formation. A widely used biomaterial in clinical care, expanded polytetrafluoroethylene (ePTFE), infused with various perfluorocarbon liquids generated SLIPS surfaces that exhibited a 99% reduction in S. aureus adhesion with preservation of macrophage viability, phagocytosis, and bactericidal function. Notably, SLIPS modification of ePTFE prevents device infection after S. aureus challenge in vivo, while eliciting a significantly attenuated innate immune response. SLIPS-modified implants also decrease macrophage inflammatory cytokine expression in vitro, which likely contributed to the presence of a thinner fibrous capsule in the absence of bacterial challenge. SLIPS is an easily implementable technology that provides a promising approach to substantially reduce the risk of device infection and associated patient morbidity, as well as health care costs.

Integrin-directed modulation of macrophage responses to biomaterials

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

Nanoporosity of alumina surfaces induces different patterns of activation in adhering monocytes/macrophages

The present study shows that alumina nanotopography affects monocyte/macrophage behavior. Human mononuclear cells cultured on alumina membranes with pore diameters of 20 and 200 nm were evaluated in terms of cell adhesion, viability, morphology, and release of proinflammatory cytokines. After 24 hours, cell adhesion was assessed by means of light microscopy and cell viability by measuring LDH release. The inflammatory response was evaluated by quantifying interleukin-1β and tumour necrosis factor-α. Finally, scanning electron microscopy was used to study cell morphology. Results showed pronounced differences in cell number, morphology, and cytokine release depending on the nanoporosity. Few but highly activated cells were found on the 200 nm porous alumina, while relatively larger number of cells were found on the 20 nm porous surface. However, despite their larger number, the cells adhering on the 20 nm surface exhibited reduced pro-inflammatory activity. The data of this paper implies that nanotopography could be exploited for controlling the inflammatory response to implants.

Mitigation of reactive human cell adhesion on poly(dimethylsiloxane) by immobilized trypsin

Occlusion or blockage of silicone shunts utilized in the treatment of hydrocephalus is a major challenge that is currently addressed by multiple shunt replacements. Shunt occlusion is caused by the adhesion and proliferation of reactive cells, such as glial and vascular cells, into the lumen of the catheter and on valve components. This in vitro study describes how the adhesive behavior of four human cell types on poly(dimethylsiloxane) (PDMS) surfaces can be suppressed by functionalization with trypsin, a proteolytic enzyme. The covalently conjugated trypsin retained its proteolytic activity and acted in a dose-dependent manner. Trypsin-modified PDMS surfaces supported significantly lower adhesion of normal human astrocytes, human microglia, human dermal fibroblasts, and human umbilical vein endothelial cells compared to unmodified PDMS surfaces (p < 0.0001). Immunofluorescence imaging of cellular fibronectin and quantitative adsorption experiments with serum components indicated that the PDMS surfaces immobilized with trypsin inhibited surface remodeling by all cell types and resisted protein adsorption. The impact of this work lies in the recognition that the well-known proteolytic characteristics of trypsin can be harnessed by covalent surface immobilization to suppress cell adhesion and protein adsorption.

Foreign body reaction to biomaterials

The foreign body reaction composed of macrophages and foreign body giant cells is the end-stage response of the inflammatory and wound healing responses following implantation of a medical device, prosthesis, or biomaterial. A brief, focused overview of events leading to the foreign body reaction is presented. The major focus of this review is on factors that modulate the interaction of macrophages and foreign body giant cells on synthetic surfaces where the chemical, physical, and morphological characteristics of the synthetic surface are considered to play a role in modulating cellular events. These events in the foreign body reaction include protein adsorption, monocyte/macrophage adhesion, macrophage fusion to form foreign body giant cells, consequences of the foreign body response on biomaterials, and cross-talk between macrophages/foreign body giant cells and inflammatory/wound healing cells. Biomaterial surface properties play an important role in modulating the foreign body reaction in the first two to four weeks following implantation of a medical device, even though the foreign body reaction at the tissue/material interface is present for the in vivo lifetime of the medical device. An understanding of the foreign body reaction is important as the foreign body reaction may impact the biocompatibility (safety) of the medical device, prosthesis, or implanted biomaterial and may significantly impact short- and long-term tissue responses with tissue-engineered constructs containing proteins, cells, and other biological components for use in tissue engineering and regenerative medicine. Our perspective has been on the inflammatory and wound healing response to implanted materials, devices, and tissue-engineered constructs. The incorporation of biological components of allogeneic or xenogeneic origin as well as stem cells into tissue-engineered or regenerative approaches opens up a myriad of other challenges. An in depth understanding of how the immune system interacts with these cells and how biomaterials or tissue-engineered constructs influence these interactions may prove pivotal to the safety, biocompatibility, and function of the device or system under consideration.

Is cell culture stressful? Effects of degradable and nondegradable culture surfaces on U937 cell function

In vitro cell culture has become one of the most widely used techniques in biological and health sciences research, with the most common culture supports being either tissue culture grade polystyrene (TCPS) or polydimethylsiloxane (PDMS). It has previously been shown that monocyte-derived macrophages (MDMs) respond to material surface chemistry, synthesizing and releasing degradative activities that could produce products, which alter the cell's response. In this study, functional parameters of differentiated U937 macrophage-like cells were compared when cultured on nondegradable standard control surfaces versus models of biomaterials (polycarbonate-based polyurethanes) used in the manufacture of medical devices previously shown to degrade and/or elicit pathways of inflammation. Although the influence of PDMS and TCPS on cell function is often underappreciated by investigators, both surfaces elicited enzyme markers of inflammation. Cells on TCPS had the highest intracellular and released esterase activities and protein levels. Cells on PDMS had the most released acid phosphatase activity and protein (P<0.001), as well as de novo 57− and 59− kDa released proteins. The criteria for defining an activated cell phenotype become critically important when materials such as PDMS and TCPS are used as standard control surfaces whether in experiments for research in elucidating metabolic pathways or in screening drugs and materials for therapeutic uses.

Bacterial adhesion to phosphorylcholine-based polymers with varying cationic charge and the effect of heparin pre-adsorption

The steady increase in the use of medical implants and the associated rise of medical device infections has fuelled the need for the production of biomaterials with improved biocompatibility. 2-(methacryloyloxyethyl phosphorylcholine) (MPC) based coatings have been used to improve the biocompatibility of a number of different medical devices. Recent studies have investigated the use of a phosphorylcholine modified with cationic charge to encourage specific bio-interaction. Until now the affect of cationic charge incorporation in MPC copolymers on bacterial adhesion has not been investigated. This study attempts to address this by investigating the affect of charge on four different strains of bacteria commonly associated with medical device infections. In addition, the affect of pre-incubating these MPC-copolymers in heparin is also evaluated as this has previously been shown to improve biocompatibility and reduce bacterial adhesion. Bacterial adhesion was assessed by ATP bioluminescence and Scanning Electron Microscopy (SEM). Results suggest that bacterial adhesion generally increased with increasing cationic charge. When samples were however, pre-incubated with heparin a significant reduction in bacterial adhesion to the MPC-based samples was observed. The heparin remained bound and effective at reducing bacterial adhesion to the cationic MPC-based samples even after three weeks incubation in PBS. To conclude, the MPC-based cationic polymer coatings complexed with heparin may provide a promising solution to reduce medical device related infections.

The recognition of adsorbed and denatured proteins of different topographies by β2 integrins and effects on leukocyte adhesion and activation

Leukocyte beta2 integrins Mac-1 and p150,95 are promiscuous cell-surface receptors that recognise and mediate cell adhesion to a variety of adsorbed and denatured proteins. We used albumin as a model protein to study whether leukocyte adhesion and activation depended on the nm-scale topography of a protein adlayer. Albumin adsorbed from the native conformation gave rise to different adlayer topographies and different amounts of adsorbed protein on hydrophobic and relatively hydrophilic polystyrene and silanised silicon-wafer surfaces, whereas adsorption of pre-denatured Alb resulted in similar adlayer topographies and similar amounts of adsorbed protein on these surfaces. All three distinct protein-adlayer topographies supported adhesion of in vitro differentiated, macrophage-like U937 and THP-1 cells, but did not support adhesion of their promonocytic precursors. Human monocytes freshly isolated from peripheral blood did not adhere to adsorbed albumin, not even in the presence of monocyte chemoattractant protein-1 and macrophage inflammatory protein-1alpha chemokines. Adhesion of the macrophage-like cells to albumin in any of the three topographies was inhibited by antibodies against beta2 integrins, but not by antibodies against beta1 integrins, and did not induce secretion of the proinflammatory cytokine tumour necrosis factor-alpha.

Biological responses to cationically charged phosphorylcholine-based materials in vitro

Phosphorylcholine (PC)-based polymers have been used in a variety of medical device applications to improve biocompatibility. The use of PC-based materials for biomaterials is associated with low protein adsorption, reduced complement activation, low inflammatory response and cell adhesion. For some medical device applications however, materials that support cell adhesion are also beneficial, allowing host interaction and encouraging full incorporation within the body. As previous studies have suggested that cell adhesion to materials is enhanced by the addition of charge, PC-based polymers have therefore been modified to incorporate various concentrations of cationic charge. In this study, the affect of cationic charge on a range of biological responses was investigated. In vitro assays have been used to assess the adsorption of protein onto the materials surface, the adhesion of mouse fibroblasts and rabbit corneal epithelial cells and the adhesion of human mononuclear cells and granulocytes. The results corroborate previous work showing that PC without charge significantly reduces protein adsorption, cell adhesion and inflammatory cell activation. The addition of cationic charge to PC polymers however, resulted in an increase in all of the above responses. This increase did not however, increase linearly with cationic monomer concentration. The differences in cell adhesion are discussed in terms of differences in protein adsorption, cytotoxicity and/or stability of the different cationic polymer coatings.

Adhesion Behavior of Peritoneal Cells on the Surface of Self-Assembled Triblock Copolymer Hydrogels

Adhesion behavior of cells to the surface of physical hydrogel membranes prepared by water-induced self-organization of precisely synthesized ABA-triblock copolymers comprised of poly(beta-benzyl L-aspartate) (PBLA) as A segment and poly(ethylene oxide) (PEO, molecular weight = 20 000) as the B segment were investigated. The cast film from the methylenechloride solution of these copolymers swelled in water very rapidly forming hydrogels (100-400% water content of total weight). The content of PBLA affected the strength, the hydrophobicity, and the amount of water involved in the hydrogel surface. During the early stage of cultivation with murine peritoneal cells, cell adhesion on the hydrogels of PEO and PBLA with 18 (20K18) and 25 (20K25) monomeric units was not observed, while adhesion on the hydrogels of PEO and PBLA with 32 (20K32) and 55 (20K55) monomeric units was successful, suggesting more than 12 mol % in PBLA content is necessary for adhesion of these cells. Although cell spreading on the hydrogels of 20K18, 20K25, and 20K32 was not sufficient, the hydrogel of 20K55 allowed cell adhesion and spreading to be bipolar with leading edge whose raffling is active with pseudopodium and lamellipodium as well as PBLA homopolymer, suggesting active motility of these cells. Remarkably, prolonged incubation restored adhesiveness onto the films at 20K18 in contrast to adhesion with 20K25 despite low hydrophobicity. It is conceivable that adaptation of proteins and chemical changes to the surface during the culture period may participate in these phenomena. Mechanical properties and interaction between cell and these copolymer hydrogels could be controlled by composition of block segments, and optimization for implants could also be attainable.

Effects of adsorbed proteins and surface chemistry on foreign body giant cell formation, tumor necrosis factor alpha release and procoagulant activity of monocytes

The adhesion and activation of monocytes and macrophages are thought to affect the foreign body response to implanted medical devices. However, these cells interact with devices indirectly, because of the prior adsorption of proteins. Therefore, we preadsorbed several "model" biomaterial surfaces with proteins and then measured foreign body giant cell (FBGC) formation, tumor necrosis factor alpha (TNFalpha) release, and procoagulant activity. The model surfaces were tissue culture polystyrene (TCPS), untreated polystyrene (PS), and Primaria, whereas the proteins used were albumin, fibronectin, fibrinogen, and immunoglobulin. FBGC formation, TNFalpha release, and procoagulant activity of monocytes were the highest for surfaces preadsorbed with IgG. FBGC formation was lower on surfaces with adsorbed fibrinogen and fibronectin than on uncoated surfaces. TNFalpha release and procoagulant activity of monocytes were similar on surface adsorbed with fibrinogen, fibronectin, or albumin. Monocyte activation was also affected by the surface chemistry of the substrates, because FBGC formation was the highest on PS and the lowest on TCPS. Monocyte procoagulant activity was the highest on Primaria. Adsorbed proteins and surface chemistry were found to have strong effects on FBGC formation, monocyte TNFalpha release, and procoagulant activity in vitro, providing support for the idea that these same variables could affect macrophage-mediated foreign body response to biomaterials in vivo.

Force spectroscopy study of the adhesion of plasma proteins to the surface of a dialysis membrane: role of the nanoscale surface hydrophobicity and topography

A mechanochemical study of the process of adhesion of plasma proteins to the surface of dialysis membranes was carried out with a scanning force microscope (SFM) in the force spectroscopy mode. Three representative blood plasma proteins (fibronectin, fibrinogen, and albumin) covalently were grafted to a SFM probe, and the adhesion forces of these proteins to cellulosic and synthetic dialysis membranes were measured. The experiment was tailored to apply a controlled load on the protein molecules adsorbed onto the surface in order to simulate the squeezing forces exerted on them during blood filtration. The de-adhesion forces, measured using this new approach for studying the interaction between a protein and dialysis membranes, suggest that the membrane's topography, at a nanometer scale, plays a critical role in the adhesion process. This result was strongly supported by parallel experiments performed on a flattened glass surface with the same dominant hydrophilic character as dialysis membranes. In contrast, a hydrophobic polystyrene surface led to de-adhesion forces at least one order of magnitude greater, overwhelming any possible shape recognition process between the protein molecules and the surface.

Reduction of surface-induced inflammatory reaction on PLGA/MPC polymer blend

Poly(lactide-co-glycolide) (PLGA) has been believed to be a good biocompatible material for tissue engineering due to its biodegradability and non-toxicity of the monomer. However, the inflammatory reaction of adherent cells on the surface has not been discussed sufficiently. We hypothesized that the inflammatory reaction of adherent cells on PLGA might occur and could be reduced by blending a 2-methacryloyloxyethyl phosphorylcholine (MPC) polymer (PMEH) with the PLGA. PLGA/PMEH blend membranes were prepared by a solvent evaporation technique. The thermal properties of the PLGA/PMEH membrane were determined using a differential scanning calorimeter. The glass transition temperature of the PLGA/PMEH membranes was slightly decreased compared to that of a PLGA membrane. X-ray photoelectron spectrum analysis revealed that the MPC unit was exposed on the PLGA/PMEH membrane and that the surface concentration of the MPC unit on the membrane was increased with an increase in the concentration of the PMEH in the blended membrane. NIH-3T3 mouse fibroblast cells were cultured on the PLGA/ PMEH membrane for 2 days. The number of adherent cells on the PLGA/PMEH membrane was decreased with an increase in the concentration of the PMEH. Using the RT-PCR method, the amount of an inflammatory cytokine, IL-1beta, mRNA expressed from adherent human premyelocytic leukemia cells on PLGA and PLGA/PMEH membranes were determined. On a PLGA/PMEH membrane containing 0.2 wt% of PMEH, the expression of IL-1beta mRNA was significantly lower than that on PLGA, but no difference in the number of adherent cells was found. Therefore, the MPC polymer was a useful additive for reducing the inflammatory reaction of adherent cells on PLGA.

Study of cell-material interaction by estimating NF-kappaB activation in HeLa S3 cells adhered onto hydrophilic substrates

In order to interpret how cells recognize biomaterials, nucleic factor-kappa B (NF-kappaB) activation in the attached HeLa S3 cells on various substrates was evaluated. As substrates, materials of hydrophilic nature (cellulose, poly(acrylamide)-grafted poly(ethylene) (PAAm-g-PE), and lipids films) were used. The contemporary assay method for NF-kappaB was modified to fit our system. As a result, NF-kappaB activation varied depending on the substrates. The NF-kappaB outcome was induced significantly in the HeLa S3 cells that had adhered onto the lipid films in a short time. On the other hand, high levels of NF-kappaB induction were observed in the HeLa cells adhered to the celluose and PAAm-g-PE after a 24 h incubation period. The induction of NF-kappaB by cell-material interaction is discussed from the point of view of biocompatibility.

In vitro and in vivo biocompatibility of chitosan-xanthan polyionic complex

A novel hydrogel, CHITOXAN(TM) (CH-X), has potential as a vehicle for controlled drug delivery. The hydrogel is obtained by complexation of two polysaccharides, chitosan and xanthan. In the present work we investigated the biocompatibility of the complex using in vitro and in vivo models. The cytotoxic effects of CH-X microspheres as well as their degradation products at different concentrations were assessed on fibroblasts (fibroblast cell line L-929) using 3-(4,5-dimethylthiazole-2yl)-2,5-triphenyl tetrazolium) (MTT). The test is based on mitochondrial dehydrogenase cell activity as an indicator of cell viability. Interleukin-1beta (IL-1beta) and tumor necrosis factor-alpha (TNF-alpha) cytokines as well as nitric oxide (NO) production by macrophages (macrophage cell line J-774) were examined as indicators of cell activation. In vivo biocompatibility assessment was performed for 1 to 12 weeks. This study was performed using tablets obtained after compression of CH-X particles implanted at the subcutaneous level in male Wistar rats. CH-X biocompatibility and degradation were investigated using histological studies. Light and transmission electron microscopy (TEM) analyses were used to determine the foreign-body reaction and phagocytosis of the implants by macrophages. Fibroblast exposition to CH-X particles and degradation products did not show cytotoxic effects as measured by MTT test. TNF-alpha production was dependent on CH-X particles concentration, whereas IL-1beta production was found to be dose independent. CH-X extract products stimulated TNF-alpha secretion when used at the highest concentration (10 mg/mL), notably after 28 days' degradation time. No effect was observed on IL-1beta production when CH-X extracts were used in comparison to the control. The effects of CH-X particles on NO secretion were similar as on TNF-alpha. Histological studies showed that CH-X tablets broke down into particles which progressively degraded into smaller fragments. A significant fraction of the fragments was ingested by the macrophages after 12 weeks of implantation. Light microscopy studies showed a weak foreign-body reaction as a function of time and the fibrous layer thickness decreased with time of implantation.

Different kinetics of the respiratory burst response in granulocytes, induced by serum from blood coagulated in contact with polymer materials

Tubes of different polymer materials were filled with blood collected by venous puncture. The blood was allowed to clot for 10 min, and the serum was collected. Complement activation was demonstrated through assessment of the C3-level by radial immunodiffusion. Phospholipid fingerprints were made after lipid extraction of serum and separation by thin-layer chromatography. The granulocyte fraction of venous blood was separated on a Percoll gradient and the cells were either loaded with a calcium probe, or incubated with luminol. These cells were used as a biological test for inflammatory mediators. Serum from blood coagulated in contact with different materials was added to the test cells. The intracellular calcium level was recorded by Calcium Green-1 fluorescence and the respiratory burst of the test cells was recorded by luminol-amplified chemiluminescence. Serum from blood coagulated in contact with glass tubes, methylised glass tubes and teflon (PTFE) tubes induced a transient increase of the cellular calcium level, indicating a G protein-coupled activation of the test cells. Serum from blood coagulated in contact with glass tubes, methylised glass tubes, and PTFE tubes primed the test cells for a subsequent f-MLP response. Serum from blood coagulated in contact with polyurethane and polypropylene induced a direct biphasic respiratory burst response in the test cells and serum from blood coagulated in contact with methylised glass induced a direct monophasic respiratory burst response in the test cells. Complement activation was demonstrated after blood contact with hydrophobic glass and PTFE. Different fingerprints of phospholipid content were found in sera after blood contact with different materials. The data show that different inflammatory mediators are released during blood coagulation in contact with different materials. The method may be valuable as a screening test for blood compatibility of materials.

In vivo cell recruitment, cytokine release and chemiluminescence response at gold, and thiol functionalized surfaces

Hydroxylated and methylated surfaces were prepared by the self-assembled monolayer technique (SAM) of alkane thiols on gold. The surfaces were used to evaluate the influence of implant surface chemistry on protein deposition and inflammatory cell response. Implants were inserted subcutaneously in the rat for 3 and 24 h. The surface chemical properties influenced the in vitro rat plasma protein adsorption (ellipsometry/antibody) with few exceptions (albumin not found and fibrinogen always found). The number of recruited cells and their distribution (DNA from implant versus from exudate) was influenced by the different chemistries at 24 h, but not at 3 h. HIS48+, ED1+, ED2+ and small numbers of CD5+ cells were present in the exudate at both time periods (flow cytometry). The cellular oxidative metabolism was low, although cells on -OH surfaces responded with the highest phorbol ester-stimulated chemiluminescence (CL)/DNA. The levels of cytokines IL-1alpha, IL-1beta and TNFalpha (ELISA) were not influenced by material surface chemistry. Sham operated sites had a higher cytokine concentration/DNA compared with exudates from an implant milieu. The results of this study show that surface chemical functionalization modifies specific events in the inflammatory response around implants in soft tissues.

Tissue reactions to polypyrrole-coated polyesters: A magnetic resonance relaxometry study

The electrically conductive properties of polypyrrole (PPy) as a coating on polyester material are very attractive for the manufacture of small diameter blood conduits. However, before these PPy-coated materials can be investigated for their capacity to generate endothelialized luminal surfaces, they must first be studied for their innocuousness in a living environment. The specific goal of the present study was to investigate the in vivo interactions of PPy-coated and noncoated woven polyester materials implanted subcutaneously in rats for prescheduled periods of 2, 5, 10, 20, and 30 days. The in vivo magnetic resonance (MR) relaxation times were computed for a small area of muscle tissue adjacent to the implants. A correlation was concurrently attempted with blood monocyte activation studies as well as histological observations of the tissue-material interface. The progressive pattern of the slower transversal relaxation time (T2s) values revealed a more persistent tissue reaction for the most conductive PPy-coated materials and a shorter acute tissue response as the surface resistivity increased. Similarly, the blood monocyte activation studies indicated that the thickness of the PPy coating, which correlated with the conductivity, was directly related to tissue response. Furthermore, both the MR and biological studies showed that the PPy-coated material with a high surface resistivity displayed the lowest tissue reaction over the entire period of implantation. The results obtained from the blood monocyte activation studies and histological observations correlate well with the noninvasive MR measurements of the body's healing process. The conductive materials with high surface resistivities must be further investigated. Finally, the noninvasive nature of MR relaxometry reveals its outstanding potential for future in vivo investigations of the body's tissue interactions with polymers and nonferromagnetic biomaterials.

Immunohistochemical analysis of vascular prostheses implanted with the left ventricular assist system

BACKGROUND

Dacron vascular prostheses are associated with thromboembolic complications and inflammatory responses; impregnation with bovine collagen reportedly stimulates additional inflammatory/immunologic complications. The Novacor (Baxter Healthcare Corp., Oakland, CA, USA) left ventricular assist system uses Dacron inflow and collagen-impregnated Dacron outflow prostheses.

METHODS

Explanted inflow and outflow prostheses were evaluated for inflammatory/immunologic, hemostatic, anticoagulant, and fibrinolytic pathways. Non-implanted prostheses immersed in whole blood or plasma were used as controls.

RESULTS

Immunoglobulins and complement components were observed in all prostheses with activated macrophages being present only in implanted prostheses. Antithrombin III was observed in all prostheses whereas fibrin, tissue plasminogen activator, and alpha-2 plasmin inhibitor were present only in implanted prostheses. Endothelial and smooth muscle cells associated with vascular structures containing collagen type IV and laminin were observed solely in implanted prostheses.

CONCLUSION

An inflammatory response occurs and key components of hemostatic, anticoagulant, and fibrinolytic pathways are present within implanted prostheses. These processes are accompanied by endothelial and smooth muscle cell infiltration which appear to lay the foundation for neovessel development.

Correlation of cytokine elaboration with mononuclear cell adhesion to platelet storage bag plastic polymers: a pilot study

The basis for many febrile nonhemolytic transfusion reactions associated with platelet transfusion therapy is cytokine elaboration and accumulation in the storage bag, which correlate with the leukocyte content and the length of platelet storage. We propose that a possible additional variable in the elaboration and accumulation of cytokines is the differential adhesion of mononuclear cells to the plastic substrate of the platelet storage bag. We hypothesize that mononuclear cell adhesion-induced cytokine release is greater in random-donor platelet bags composed of the polyolefin polymer compared to the single-donor apheresis platelet bags composed of the polyvinyl chloride polymer with the tri-(2-ethylhexyl) trimellitate (TEHTM) plasticizer. For four blood donors, we demonstrate preferential mononuclear cell adhesion, in vitro, to discs of polyolefin polymer versus discs of polyvinyl chloride polymer with the TEHTM plasticizer. Scanning electron microscopy corroborates this. In addition, proinflammatory cytokine (interleukin 1beta [IL-1beta] and tumor necrosis factor alpha [TNF-alpha]) levels are greater in culture wells containing discs of polyolefin polymer than in those containing discs of polyvinyl chloride polymer with the TEHTM plasticizer, and even more so in storage bags containing polyolefin polymer versus polyvinyl chloride polymer with the TEHTM plasticizer (IL-1beta, TNF-alpha, IL-6, and IL-8). This study suggests, for the first time, that differential plastic substrate mononuclear cell adhesion may contribute to cytokine release during platelet storage. This may represent an additional variable in the pathophysiology of febrile nonhemolytic transfusion reactions in patients receiving stored platelet units.

Biological reactions to cerebrospinal fluid shunt devices: a review of the cellular pathology

OBJECTIVE

To understand the interaction between cerebrospinal fluid shunt components and the brain and other tissues.

METHODS

A systematic review of the medical literature directly pertaining to shunt complications, and that dealing with tissues' reactions to implants in general, was conducted.

RESULTS

Vascularized pedicles of glial tissue or choroid plexus grow into ventricular catheters, primarily as a mechanical phenomenon. Cellular debris or blood can cause dysfunction of valve components. Chronic inflammation, which is nonspecific, might contribute to degradation of the components.

CONCLUSION

Care must be taken to prevent early entry of debris or blood into the shunt system. Ventricular collapse onto the shunt must be avoided. Refinement of manufacturing methods or modification of shunt materials could reduce the susceptibility of shunts to infection and improve longevity of the apparatus.

Cell and soft tissue interactions with methyl- and hydroxyl-terminated alkane thiols on gold surfaces

In order to evaluate the biological response induced by true methyl and hydroxyl surfaces, alkane thiols were immobilized onto gold. Initial protein adsorption from human plasma was measured in vitro by ellipsometry-antibody techniques and in vivo surface-cell interactions were evaluated in rat subcutaneous tissues for time periods ranging between 1 and 28 days. Rat mononuclear cells were studied after culturing (24 h) on the surfaces. Plasma protein experiments revealed deposition of fibrinogen onto the pure gold and the methylated surface. The hydroxylated surface tended to release the surface-associated proteins tested for by antibodies. None of the in vivolin vitro models used showed differences between the hydroxyl and methyl surfaces for spontaneous or augmented cell hydrogen peroxide and interleukin-1 alpha secretions. However, the different surface chemistries markedly affected the distribution of the cells that were recruited to the interfaces (cells in the fluid space and surface-associated DNA content on the retrieved implants) at late and early time periods. The results indicate that different implant surface properties, such as chemical functionality and hydrophobicity, influence specific events in the inflammatory cell response, and ultimately the wound healing around implantable materials.

Monocyte activation on titanium-sputtered polystyrene surfaces in vitro: the effect of culture conditions on interleukin-1 release

The release of interleukin-1 alpha (IL-1 alpha) by human peripheral blood monocytes cultured for 24 and 48 h on polystyrene (PS) and titanium-sputtered polystyrene (Ti) was evaluated. Magnetron sputtering of the PS surfaces resulted in a formation of a 50-nm-thick coat, consisting of an outer layer of TiO2. Monocytes released IL-1 alpha without the addition of exogenous stimuli. A doubling of the culture time from 24 to 48 h did not have a major effect on the amount of IL-1 alpha released. The IL-1 alpha levels were increased by addition of lipopolysaccharide (LPS). High concentrations of PS particles (1 and 3 microns diameter) were equally effective stimuli for IL-1 alpha release as LPS. Preadsorption of fibronectin to culture plates augmented LPS-stimulated IL-1 alpha secretion, whereas preadsorbed fibrinogen had an inhibitory effect. Our observation indicate a direct activation of monocytes by PS and Ti, resulting in IL-1 alpha secretion, which is modified by protein adsorption and exogenous stimuli.

Protein adsorption and macrophage activation on polydimethylsiloxane and silicone rubber

Static and dynamic human blood adsorption studies on polydimethylsiloxane, PDMS, and silicone rubber show that these materials are similar, but not identical, in their protein adsorption behavior. Fibrinogen, immunoglobulin G, and albumin were the predominant proteins identified on the material surfaces with fibronectin, Hageman factor (factor XII), and factor VIII/vWF adsorbing at intermediate levels. While the protein adsorption characteristics for the two materials were similar, higher levels of the respective proteins were identified on silicone rubber compared to PDMS. Monocytes/macrophages incubated on PDMS, silicone rubber and low density polyethylene, LDPE, with or without protein adsorption produced variable levels of IL-1 beta, IL-6 and TNF-alpha dependent on the polymer and adsorbed protein. PDMS showed lower levels of the cytokines when compared to the polystyrene control and polyethylene. Protein preadsorption on the PDMS, polystyrene, and LDPE surfaces showed lower levels of cytokines when compared to the respective quantities produced with no protein adsorption suggesting a passivating effect by the protein adsorption phenomenon on monocyte/macrophage activation. Preadsorption of IgG, fibrinogen or fibronectin decreased the quantitative expression of IL-1 beta but increased the functional activity in the thymocyte proliferation assay indicating the presence of monocyte/macrophage activation products which either downregulated the activity of IL-1 beta or upregulated thymocyte proliferation in an independent fashion.

Plasma protein adsorption to artificial ligament fibers

The adsorption of plasma proteins onto biomedical polymers is an important factor in the biocompatibility of biomaterials. We identified the plasma proteins adsorbed onto four polymeric fibers used for synthetic ligament replacement: polyarylamide, polylactic acid, polyester, and polypropylene. The adsorbed proteins were eluted and analyzed by one-dimensional and two-dimensional gel electrophoresis. Fibrinogen, albumin, IgG, high molecular weight kininogen (HMWK), and lipoproteins ApoA-1 and ApoE were the major proteins adsorbed onto polyarylamide. The three others biomaterials bound albumin, fibrinogen, ApoA-1, and ApoE; however, the proportions of proteins bound to each polymer differed. There was an inverse relationship between ApoA-1 and fibrinogen binding for all four biomaterials; polyarylamide bound a high percentage of fibrinogen, but little ApoA-1; polylactic acid, polyester, and polypropylene bound a high percentage of ApoA-1, but little fibrinogen. These results support suggestions that low fibrinogen adsorption might be due to the preferential adsorption of Apo-1. High fibrinogen binding to polyarylamide ligaments may favor fibroblast adherence, growth, and tissue repair.

Leucocyte accumulation and leukotriene B4 release in response to polyglactin 910 and expanded polytetrafluoroethylene in hollow chambers in the rat

The acute inflammatory reaction elicited after implantation of polymer membranes used clinically to promote bone healing and augmentation was studied in a soft tissue titanium chamber model. The two materials compared were non-degradable expanded polytetrafluoroethylene (ePTFE) and degradable polyglactin 910, a copolymer of 90% polyglycolic acid and 10% polylactic acid. The membranes were implanted in the titanium chamber for 24 h and 6 d. The number of leucocytes increased for both materials, whereas the leukotriene B4 (LTB4) content decreased over time. In both groups polymorphonuclear granulocytes predominated. The number of leucocytes was significantly higher in chambers with polyglactin 910 than ePTFE. In contrast, the LTB4 content was higher in chambers with ePTFE than polyglactin 910. No differences in cell viability were observed between the materials tested. This study shows that both degradable and non-degradable polymers elicit a marked influx and activation of inflammatory cells during early healing in soft tissues.

Mechanisms of biomaterial-induced superoxide release by neutrophils

Biomaterial-centered infection is an important cause of the failure of prosthetic implants and organs. Because neutrophils mediate host defense against infection, the effect of biomaterials on neutrophil superoxide release and the mechanism of that effect were investigated using three materials commonly employed in surgical practice. The graft materials were expanded polytetrafluorethylene (PTFE), polyurethane and woven dacron. Polystyrene, a commonly used laboratory support vessel, was also studied. Both polystyrene and polyurethane were activating, but serum inhibitable, whereas PTFE was nonactivating, and woven dacron was not activating unless serum was present. The signaling mechanisms used by these materials demonstrated time and material dependency. Pertussis toxin inhibition of G protein-dependent activation had little or no effect on biomaterial induced activation, whereas FMLP-induced activation of the same biomaterial-associated cells was inhibited. Protein kinase C inhibition with staurosporine greatly inhibited polystyrene-induced activation, but had only a partial effect with polyurethane and even less effect with the activation associated with serum-treated woven dacron. These studies demonstrated that biomaterial contact-induced neutrophil activation differed from that described for cells in suspension, and showed that activation mechanisms on one material cannot be extrapolated to mechanisms on other materials.

Functional versus quantitative comparison of IL-1 beta from monocytes/macrophages on biomedical polymers

Studies utilizing a quantitative assay, radioimmunoassay, and a biological activity assay, the murine thymocyte proliferation assay, to analyze IL-1 beta cytokine production by monocytes/macrophages on biomedical polymers have been carried out. Results indicate that the quantitative analysis of IL-1 beta on biomedical polymers and protein-adsorbed biomedical polymers is not indicative of and does not correlate with the results of the biological activity assay. IL-1 beta secreted from human monocytes/macrophages on Biomer, polydimethylsiloxane (PDMS), Dacron, polyethylene, expanded polytetrafluoroethylene, and control polystyrene with and without the preadsorption of physiological concentrations of human IgG, fibrinogen, and/or fibronectin was assayed. Quantitative levels of IL-1 beta suggest a greater functional response than that observed in the biological thymocyte proliferation assay when the polymers were studied directly or preadsorbed with IgG. On the other hand, preadsorption with fibrinogen or fibronectin resulted in high functional activity for IL-1 beta with low quantitative levels of IL-1 beta. The lack of correlation between the functional and biological activity assays suggests the presence of other cytokines or antagonists which modulate the biological activity of IL-1 beta.

Biocompatibility studies on plasma polymerized interface materials encompassing both hydrophobic and hydrophilic surfaces

The biocompatibility of radiofrequency plasma polymerized films (less than 100 nm thick) deposited on biomedical polymer supports has been characterized by in vitro and in vivo methods. The polymer interface materials covered a wide range of elemental composition and surface properties, and were prepared from N-vinyl-2-pyrrolidone, gamma-butyrolactone, n-hexane, and hexamethyldisilazane (PPHMDSZ). The biocompatibility studies showed that the interface materials were noncytotoxic to mouse and human fibroblasts, as shown by morphologic evaluation, and by determination of extracellular LDH; and they did not stimulate interleukin-1-like production from human monocytes, as indicated by a thymocyte proliferation assay. The human fibroblast proliferation assay showed that three of the polymers supported cell growth at levels comparable to, or greater than, polymer controls, while the hydrophobic PPHMDSZ inhibited both cell attachment and proliferation. The response to subcutaneous implantation for all test materials was indicative of biocompatibility, with rapid resolution of the acute phase response and normal wound healing. The wide range of composition and surface properties for the plasma polymerized films evaluated in this study suggest that this general class of materials is likely to exhibit excellent biocompatibility.

Cytokine and growth factor production by monocytes/macrophages on protein preadsorbed polymers

These studies evaluate the effect of biomedical polymers: Biomer, polydimethyl-siloxane (PDMS), polyethylene, expanded polytetrafluoroethylene (ePTFE), Dacron, and the control polystyrene with or without adsorbed proteins IgG, fibrinogen, and fibronectin on the ability of activated human monocytes/macrophages to produce Interleukin 1 Beta (IL-1-B), Interleukin 6 (IL-6), and Tumor Necrosis Factor Alpha (TNF-A). Monocytes/macrophages incubated on biomedical polymers with or without protein preadsorption produce variable levels of IL-1-B, IL-6, and TNF-A dependent on the polymer and adsorbed protein. IL-6 was produced in the greatest quantity and was the most influenced by protein adsorption. ePTFE and PDMS polymers were least stimulating while polystyrene was the most stimulating of monocyte activity. Adsorbed IgG consistently altered the ability of the polymers to activate monocytes/macrophages to produce cytokines. These studies provide important insight into conditions which modulate monocyte/macrophage activity in response to protein preadsorbed biomedical polymers.

TNF and IL-1 generation by human monocytes in response to biomaterials

The biocompatibility of surgically implanted materials may be compromised as a consequence of inflammatory reactions associated with phagocyte activation. Two important mediators of the inflammatory response are Interleukin-1 (IL-1) and tumor necrosis factor (TNF), both of which exert a wide range of biologic effects on many cells. This study was designed to evaluate the release of these cytokines by human monocytes (HM) brought into contact with four biomaterials utilized in clinical practice: polyurethane, expanded polytetrafluorethylene (ePTFE), Dacron velour, and woven Dacron. In vitro cultures for the generation of IL-1 and TNF by HM in the presence of the above biomaterials were established by exposing cells to each biomaterial in the presence and absence of lipopolysaccharide (LPS) with harvest of supernatants after 6 or 18 h. These studies showed that in the absence of LPS, IL-1 was released only by Dacron velour and woven Dacron associated monocytes while TNF was secreted in response to all of the materials. When LPS was present, however, monocytes associated with all of the materials released IL-1; and TNF release was greatly augmented. Further, the quantity of released cytokine was directly related to the duration of the association time. This study demonstrated that HM in association with various biomaterials were activated to produce both TNF and IL-1 and that the addition of nanogram quantities of LPS, such as would be produced if infection were present, greatly increased the amount of cytokines released.

Protein adsorption of biomedical polymers influences activated monocytes to produce fibroblast stimulating factors

The studies presented in this manuscript were based upon the hypothesis that monocytes/macrophages selectively produce cytokines and growth factors due to their interactions with polymers and proteins which are adsorbed to their surfaces. These factors in turn selectively influence the ability of fibroblasts to proliferate. The factors which influence fibroblast proliferation were released from monocytes incubated with polymers: Biomer, polydimethylsiloxane (PDMS), polyethylene (PE), expanded polytetrafluoroethylene (ePTFE), Dacron, and control polystyrene with and without preadsorption with physiological concentrations of IgG, fibrinogen, fibronectin, hemoglobin, or albumin. No simple correlation was found between adsorbed protein, biomedical polymer, and the ability of monocytes to produce growth factors and cytokines which influence fibroblast proliferation. This is evidence for selective protein-polymer interactions which in turn selectively activate monocytes to produce variable cell cycle competence and progression factors controlling fibroblast growth.

Fibroblast stimulation by monocytes cultured on protein adsorbed biomedical polymers. I. Biomer and polydimethylsiloxane

The studies presented in this paper evaluate the modulatory role of protein pre-adsorbed polydimethylsiloxane (PDMS) and Biomer on the secretion of fibroblast stimulating growth factors from human monocytes/macrophages. The results of these studies show that Biomer and PDMS selectively activate human monocytes to produce fibroblast "progression-like" and to a lesser extent "competence-like" stimulating growth factors. Polydimethylsiloxane stimulated the monocytes/macrophages to produce more "progression-like" fibro-blast stimulating growth factors than Biomer. The induction of "competence-like" fibroblast stimulating activity from the monocytes was enhanced by preadsorption of PDMS with human derived fibrinogen, fibronectin, IgG, hemoglobin, or albumin. This phenomenon was not observed with protein pre-adsorbed Biomer. These studies support the hypothesis that protein pre-adsorbed polymers will selectively modulate monocyte/macrophage activation and induction of growth factors which have the potential to participate in tissue-implant interactions in vivo.