Evaluation of soft tissue response to a poly(urethane urea)

Triton X-100 pretreatment of LR-white thin sections improves immunofluorescence specificity and intensity

The staining of intracellular antigenic sites in postembedded samples is a challenging problem. Deterioration of antigenicity and limited antibody accessibility to the antigen are commonly encountered on account of processing steps. In this study preservation of the antigen was achieved by fixing the tissues with mild fixatives, performing partial dehydration, and embedding in a low crosslinked hydrophilic acrylic resin, LR-White. Permeabilization of cell membranes with Triton X-100 is well documented but can affect some antigen conformations. We tested the effect of Triton X-100 on the ED1 antigen present in the lysosomal membrane of the macrophage in cell culture. The ED1 antigen in the lysosome was resistant to extraction by Triton X-100. Interestingly pretreating the LR-White sections of macrophage pellets with Triton X-100 improved the staining intensity of ED1. The most intense and clear specific fluorescent staining was observed when sections were pretreated with 0.2% Triton X-100 for 2 min. Longer exposure of sections to 0.2% Triton or 2 min exposure to 2% Triton lead to reduced ED1 labeling. SEM observations indicated that the detergent extracted a component from the cells and not the resin and was determined to be lipid. This novel technique could be applied in many research areas where postembedding fluorescent immunolabeling with higher labeling intensity is desired.

Effects of sterilisation method on surface topography and in-vitro cell behaviour of electrostatically spun scaffolds

Electrostatic spinning is a potentially significant technique for scaffold production within the field of tissue engineering; however, the effect of sterilisation upon these structures is not known. This research investigated the extent of any topographical alteration to electrostatically spun scaffolds post-production through sterilisation, and examined any subsequent effect on contacting cells. Scaffolds made from Tecoflex SG-80A polyurethane were sterilised using ethylene oxide and UV-ozone. Scaffold topography was characterized in terms of inter-fibre separation (ifs), fibre diameter (f.dia) and surface roughness. Cell culture was performed over 7 days with both mouse L929 and human embryonic lung fibroblasts, the results of which were assessed using SEM, image analysis and confocal microscopy. Sterilisation by UV-ozone and ethylene oxide decreased ifs and increased f.dia; surface roughness was decreased by UV-ozone but increased by ethylene oxide. Possible mechanisms to explain these observations are discussed, namely photo-oxidative degradation in the case of UV-ozone and process-induced changes in surface roughness. UV-ozone sterilised scaffolds showed greater cell coverage than those treated with ethylene oxide, but lower coverage than all the controls. Changes in cell attachment and morphology were thought to be due to the changes in topography brought about by the sterilisation process. We conclude that surface modification by sterilisation could prove to be a useful tool at the final stage of scaffold production to enhance cell contact, phenotype or function.

Tissue reaction and biodegradation of implanted cross-linked high amylose starch in rats

The biocompatibility and degradation characteristics of cross-linked high amylose starch (Contramid were investigated in rats over 4 months. Contramid pellets (3-mm diameter and thickness) obtained by direct compression, were implanted subcutaneously and intramuscularly. On sequential time points, macroscopic observations of implantation sites were performed and tissue samples were removed, fixed, and histologically evaluated. No macroscopic inflammatory reaction was observed with Contramid.. Upon histologic examination, inflammatory reaction produced by Contramid was moderate and restricted to implantation sites. The sequence of inflammatory events with Contramid was similar regardless of implantation site. Degradation of Contramid pellets was characterized by fragmentation with formation of fibrovascular septa and phagocytosis by macrophages. Finally Contramid was mostly absorbed by the end of the 4-month period and substituted by adipocytes. It has been demonstrated that Contramid is a biocompatible and absorbable material.

Impact of polymer pore size on the interface scar formation in a rat model

BACKGROUND

The surgical therapy of hernias is increasingly based on reinforcement with alloplastic material, in particular surgical meshes. The biological response to these foreign bodies largely depends on the selected material and its structure. In comparison to the physiological scar process following a simple abdominal wall incision, the chronic inflammation at the interface to the polymers lead to specific morphological alterations.

MATERIALS AND METHODS

In the present study two meshes with different pore sizes were implanted into rats: a heavy-weight and small-pore-sized mesh (hw-mesh) made of nonabsorbable polypropylene monofilaments and a low-weight large-pore-sized mesh consisting of polypropylene and of absorbable polyglactin multifilaments (lw-mesh). A suture repair of a laparotomy served as control. After 7, 14, 21, and 90 days the mesh area was analyzed with regard to tissue and cellular response.

RESULTS

Over the whole observation period morphometric analysis indicated an improved integration of the lw-mesh with reduction of both inflammation and fibrosis, whereas the hw-mesh induced an intense chronic inflammation concomitant with an intensified bridging scar reaction. On the cellular level these findings correspond to an elevated cell turnover, characterized by increased rates of apoptotic and proliferating cells. In contrast, the tissue reaction to the lw-mesh achieved levels almost similar to those of the physiological scaring process in the control group.

CONCLUSION

In conclusion, the present data confirm the development of a chronic inflammatory foreign body reaction at the interface to both hw-meshes and lw-meshes; however, the use of lw-meshes showed superior tissue integration. With regard to the quite similar polymer surface the pore size appears to be of major importance in tissue reaction and for the biocompatibility of mesh structures.

Tissue reactions evoked by porous and plane surfaces made out of silicon and titanium

Square-shaped silicon or titanium implants with plane or porous surfaces surrounded by a rim of silicone were implanted in the rat abdominal wall for evaluation of the tissue response after one, six, or 12 weeks. Cell damage was identified as increased membrane permeability using fluorescence microscopy by injection of propidium iodide prior to the killing of the rats. Capsule thickness and immunohistochemical quantification of macrophages were used as a further measure of the foreign-body reaction. There were no significant differences in capsular cell densities for macrophages, total cells (macrophages, fibroblasts, and other cells), or necrotic cells at the different time points for the four surfaces studied. However, significant differences in the kinetics of the response were found between plane surfaces compared with porous ones. Both types of plane surfaces developed a significant increase in capsule thickness over time in contrast to the porous implants. Porous silicon displayed a significant decrease in total cells in the reactive capsule over time. Furthermore, porous silicon and titanium surfaces displayed a significant decrease in total cell numbers at the implant interface between six and 12 weeks. The present study demonstrated that implanted silicon elicited soft-tissue reactions comparable to that of titanium.

Characterization of subcutaneous Contramid implantation: host response and delivery of a potent analog of the growth hormone-releasing factor

Cross-linked high amylose starch (Contramid) was investigated as a solid implant for evaluation of host response in mice and as a possible delivery system for a human growth hormone-releasing factor analog (Hex-hGRF) release profile in pigs. Seventy mice were administered subcutaneously one 3 mm diameter Contramid pellet and host reaction was evaluated over 6 months. Thirty pigs were divided into four groups. All animals of the three implanted groups were administered subcutaneously 15 mg Hex-hGRF, (1) one pure Hex-hGRF implant; (2) four 30/70 w/w Hex-hGRF/Contramid implants; or (3) eight 15/85 w/w Hex-hGRF/Contramid implants. The fourth group (n=6) was injected subcutaneously twice daily with 10 microg/kg of Hex-hGRF over 5 consecutive days. Serum insulin-like growth factor-I (IGF-I) was monitored over 1 month. In mice, no adverse reaction occurred after implantation. Macroscopic and microscopic inflammatory reactions were always localized. Polymorphonuclear cells (PMNs) and macrophages predominated within and around the pellets, respectively. Thin fibrovascular septas eventually subdivided Contramid pellets which were progressively phagocytosed by macrophages. In pigs, serum IGF-I concentrations were increased over a 10 day period in all implanted groups. The initial IGF-I peak observed in the daily injected group was avoided in both Contramid implant groups but not in the pure Hex-hGRF implant group. These encouraging results warrant the development of Contramid implants as a sustained delivery system for peptidic drugs.

Reactive capsule formation around soft-tissue implants is related to cell necrosis

Low-density polethylene disks with smooth or course surfaces were implanted in the abdominal wall of rats, and the tissue response was evaluated after 1, 6, or 12 weeks. Cell damage was detected by two different methods. Cells with increased membrane permeability could be identified using fluorescence microscopy by injection of propidium iodide prior to the killing of the rats. Second, cell death was verified by detection of DNA fragmentation. At 1 week a considerable number of the interfacial cells was stained with propidium iodide. Propidium-iodide-positive cells also were enriched at the edges of the disks irrespective of surface texture. The numbers of positive interfacial cells decreased markedly over time. Cells with DNA fragmentation initially displayed a scattered distribution; at later time points they appeared mainly in the outer portion of the enveloping capsule. The reactive capsule was thicker for the smooth surface, and there was a positive correlation between capsule thickness and propidium-iodide-positive cells at earlier implantation periods. The results suggest that the thickness of the reactive capsule is related to the extent of cell necrosis. It is suggested that the major initiator for this cell necrosis is mechanical shear since cell necrosis was found mainly in areas where mechanical shear could be expected.

The modulation of cellular responses to poly(2-hydroxyethyl methacrylate) hydrogel surfaces: phosphorylation decreases macrophage collagenase production in vitro

We examined the regulation of collagenase production by the monocyte/macrophage THP-1 cell line when these cells were exposed to poly(2-hydroxyethyl methacrylate) (PHEMA) hydrogel surfaces with different chemistries and morphologies. Tissue culture modified polystyrene (TCP), used as a control surface, induced the maximum collagenase response. Copolymer hydrogels containing 2-ethoxyethyl methacrylate (EMA) or methyl methacrylate (MMA) also induced a high response, while PHEMA hydrogels induced a low level response and the phosphorylated hydrogel induced no response. This pattern was altered when the morphology of the hydrogels was changed to that of a sponge. The overall enzyme response to the sponge hydrogels was lower than that to the homogeneous hydrogels. Sponges containing EMA and MMA produced low level response relative to the TCP control. PHEMA and phosphorylated sponges produced little and no response respectively. The dramatically reduced enzyme response to phosphorylated surfaces was not a consequence of cell death, and may be a phenomenon related to changes in cell surface charge.

Macrophage subpopulation differentiation by stimulation with biomaterials

Macrophages were elicited by the subcutaneous implantation of ultra high molecular weight polyethylene (UHMWPE) for periods of 2, 7, and 14 days in rats. Exudates of varying volumes were produced that was comprised of granulocytes, monocytes, immature and mature macrophages, and T-lymphocytes. No B-lymphocytes were observed at any time periods. Cell types were identified by their granularity and positivity to the following antibodies: leucocyte common antigen (LCA, pan leucocyte); CD11b/c (macrophage/monocyte); CD5 (T-lymphocyte); CD45RA (B-lymphocyte); HIS48 (granulocyte); ED2 (mature macrophage); and MCP-1 (monocyte chemoattractant protein 1). Monocytes isolated from control rat blood demonstrated a size slightly larger than that of granulocytes but with less granularity. Their size and granularity were followed over increasing time periods. The macrophages elicited by UHMWPE showed a similar pattern, with the exception of an apparently highly granular subpopulation with volumes similar to that of granulocytes but significantly more granular. The granular macrophage subset had a very high degree of ED2 and MCP-1 positivity, and their proportion, compared with other macrophages, was greatest at 2 days. The high MCP-1 expression was accounted for by MCP-1 molecules bound to the surface of a small proportion of macrophages that were activated. It is postulated that this subpopulation was responsible for the synthesis of the MCP-1 and could indicate a mechanism by which monocytes are attracted to the site of an implanted material.

Techniques to investigate cellular and molecular interactions in the host response to implanted biomaterials

Evaluation of the host response to implanted materials requires systematic, objective investigations of responses at both the cellular and molecular levels. This article explains the basis behind two technologies: antibody and molecular techniques, which will give valuable information when applied to investigations of cells and molecules involved in the host biomaterial interaction. Such investigations are well underway, and a number of groups are now studying well characterised cell markers or molecules to evaluate the host response to biomaterials. Here we outline current technologies for the development of antibodies as tools to study cell markers or molecules, including those for which reagents are not yet available and DNA based technologies, whose continued application should prove an invaluable adjunct to existing approaches. These technologies may be particularly valuable to investigations focusing on newly characterised cytokines, receptors or cell adhesion molecules and subsequently provide a way forward for the production of advanced biomaterials.

Inflammatory reaction dependence on implant localization in rat soft tissue models

This study compares two different implantation models in soft tissue in rat abdominal wall with regard to inflammatory reactions. Titanium rods and discs, penetrating or not penetrating the peritoneal wall respectively, were implanted. After 3, 10 or 30 days the distribution of monocytes/macrophages and cytokines (interleukin-1 and transforming growth factor-beta) in the tissue adjacent to the implants was investigated under immunohistochemistry. The macrophage-specific antibody, ED1, was used for the identification of newly recruited macrophages and the ED2 antibody was used for the mature tissue macrophages. After 10 days the non-penetrating implants had a larger number of cells close to the implant than the penetrating implants. The opposite was seen after 30 days implantation, with a larger number of cells around the penetrating implants. At all time intervals the penetrating implants had a thicker reactive capsule. The cytokines interleukin-1beta and transforming growth factor-beta could be detected in the reactive tissue adjacent to both types of implants, without obvious differences for the two implant situations. The biocompatibility of a material appears to be influenced by the localization of the implant. In addition, it seems to be of importance to extend the follow-up periods further, as we cannot assume that steady state is reached at 30 days implantation.

Quantitative assessment of the tissue response to films of hyaluronan derivatives

The aim of this study was to evaluate the in vivo response following implantation into a rat model of three innovative hyaluronan derivatives for clinical use: HYAFF 7, HYAFF 11 and HYAFF 11p75 (respectively, the 100% ethyl ester, 100% and 75% benzyl esters). The tissue reaction evoked by films of these new biomaterials implanted into the dorsolumbar musculature of rats was assessed quantitatively using a well established technique based upon an image analysis system. The number of inflammatory cells present and the patterns of cell distribution around the implant up to a distance of 642 microns were examined at different time periods after implantation. Since a well-delineated tissue-material interface was needed for this type of investigation, it was not possible to apply image analysis to sections once dissolution of the implanted materials had begun. Films of both the total esters, HYAFF 7 and HYAFF 11, were found to undergo a slow dissolution process and, after a month, films of these materials were still present at the site of implantation. Differences in response to the two materials were observed only during the first two weeks, particularly with respect to neutrophil distribution and total cellularity. HYAFF 7 was found to be more reactive, with higher numbers of neutrophils near the surface of the implant than HYAFF 11. Thereafter, the differences between the two materials were minimal and owing mainly to a faster dissolution of HYAFF 7 films. After 3 and 5 months, considerable degradation of films of both total esters had occurred. Significant quantities of material appeared inside numerous macrophages with an ED1-positive phenotype. Only a very thin layer of fibrous connective tissue, indicative of low reactivity, was found to surround the site of implantation, separating the dissolved material and the phagocytic cells from healthy muscular tissue. ED2-positive macrophages were primarily confined within the lining connective tissue. The partial benzyl ester, HYAFF 11p75, showed a different behaviour. In fact, evidence of film dissolution was already present a week after the implantation. After two weeks, the implanted films were completely dissolved and numerous ED1-positive macrophages phagocytosing the material were observed at the site of implantation. Therefore, in agreement with previous in vitro studies, which showed a greater susceptibility to degradation of hyaluronan derivatives with lower percentage of esterification, HYAFF 11p75 underwent resorption faster than the corresponding total ester.

Quantifying the soft tissue response to implanted materials

As the diversity of biomaterials increases, new developments are aimed at these materials becoming interactive rather than passive with respect to the environment they are placed in. The need accurately and reproducibly to assess the response of the body to these materials increases. Historically, quantification of tissue responses has taken many forms but with the continuing development of powerful computers, our ability to quantify the tissue response to implanted materials has become a reality. Computer systems can now analyse sections automatically and then go on to sort the huge quantities of data created, into in depth patterns and cross comparisons so that subtle changes in tissue responses can be detected and understood.

A review of the biostability and carcinogenicity of polyurethanes in medicine and the new generation of 'biostable' polyurethanes

Polyurethanes are very versatile materials which have been used in the body for over 20 years. In fact, there are probably more scientific papers describing these materials and modifications of these materials for medical use than any other material to date. Unfortunately, some formulations of these polymers are subject to biodegradation and have limited their application in the body. Extensive investigation of the biodegradation mechanisms of these polymers by many researchers in the field has led to the development of a new generation of what are now called 'biostable' polyurethanes. This article reviews the history of polyurethane in medicine, polyurethane nomenclature, the biodegradation of these materials, the proposed mechanisms of its degradation as well as the carcinogenicity associated with these materials. Included in the discussion are the polyurethanes used as pacemaker lead insulators as well as those used to coat breast implants. The article concludes with a review of the new generation of 'biostable' polyurethanes and their proposed formulations.

Theoretical analysis of in vivo macrophage adhesion and foreign body giant cell formation on strained poly(etherurethane urea) elastomers

Quantitative description of foreign body giant cell (FBGC) formation on poly(etherurethane urea) (PEUU) surfaces as a function of time can conceivably predict the effects of polymer characteristics on cellular responses in vivo. In the present study, the formation of FBGCs on strained and unstrained PEUUs was quantified with two parameters: the density of adherent macrophages present initially that participate in FBGC formation (d(o)) and the rate constant for cell fusion (k); both kinetic parameters were used to calculate the time-dependent FBGC density (dfc). Relationships were sought between results of the cellular analysis and the extent of environmental stress cracking (ESC), as characterized by scanning electron microscopy. Surface degradation was semiquantified with percent light transmittance. The materials used were: base PEUU, base PEUU with 1% Santowhite antioxidant powder, base PEUU with 5% Methacrol 2138F antifume agent, and base PEUU with both 1% Santowhite and 5% Methacrol 2138F. A comparison of unstrained base PEUU with base PEUU strained to 400% elongation indicated that the rate of cell fusion, but not d(o) and dfc, increased in the presence of strain. In all strained samples, additives that strongly affected the ESC also influenced FBGC kinetic parameters. Strained PEUU containing Santowhite had the lowest d(o), the slowest rate of cell fusion, and lowest dfc, and the least incidence of ESC. The results suggest that the incidence of ESC in PEUU was decreased in the presence of Santowhite, which also lowered the number of adherent macrophages participating in FBGC formation, the rate of FBGC formation and the subsequent FBGC density. These studies also indicate that strain in PEUUs does not directly modulate the adherent macrophage and FBGC density. Further studies are necessary to delineate the relationship between PEUU strain and adherent macrophage and FBGC activation, which leads to the exocytosis of degrading agents and the observed incidence of biodegradation.

Theoretical analysis of in vivo macrophage adhesion and foreign body giant cell formation on polydimethylsiloxane, low density polyethylene, and polyetherurethanes

Quantitative description of foreign body giant cell (FBGC) formation on implanted polymer surfaces as a function of time can conceivably correlate cell adhesion with polymer properties and possibly predict the behavior of the polymer in vivo. In the present study, the formation of FBGCs on various biomedical polymers was quantified by two parameters: the density of adherent macrophages present initially that participate in FBGC formation (d0) and the rate constant for cell fusion (k); both kinetic parameters were used to calculate the time-dependent FBGC density (dfc). The materials used were: three Pellethane poly(etherurethanes) (PEUs) varying in weight percent of hard segment, one poly(etherurethane urea) (PEUU), and NHLBI-DTB primary reference materials: low density polyethylene (LDPE), silica-free polydimethylsiloxane (PDMS). The results indicated that up to 5 weeks of implantation, FBGCs were formed from the fusion of one population of adherent macrophages present by 3 days post-implantation. Furthermore, only a small fraction (< 8%) of this initial adherent macrophage population participated in FBGC formation. Based on the results of previous studies and the current study, it was concluded that increase in PEU hard segment weight percent, surface hardness and hydrophobicity increased total protein adsorption and effectively increased d0 and dfc. No further correlations between the material properties of all polymers and the cell kinetics can be made at this time. However, this study demonstrated that macrophage adhesion and FBGC formation can be quantified with the cell fusion model, and are modulated by various polymer properties.