Hemocompatibility challenge of membrane oxygenator for artificial lung technology

Mytilus edulis foot protein mimics for tailoring long-acting endothelium-mimicking anti-thrombotic surfaces

Surfaces with enduring and superior antithrombotic properties are essential for long-term blood-contacting devices. While current surface engineering strategies integrating anticoagulants and antiplatelet agents show promise in mimicking the non-thrombogenic properties of the endothelium, their long-term effectiveness remains limited. Here, we report an easy-to-perform, dual-biomimetic surface engineering strategy for tailoring long-acting endothelium-mimicking anti-thrombotic surfaces. We first designed a Mytilus edulis foot protein-5 (Mefp-5) mimic rich in amine and clickable alkynyl groups to polymerize-deposit a chemical robust coating onto the surface through a mussel-inspired adhesion mechanism. Then, a clickable nitric oxide (NO, an antiplatelet agent)-generating enzyme and the anticoagulant heparin were sequentially co-grafted onto the chemical robust coatings via click chemistry and carbodiimide chemistry. Our results demonstrate that this engineered surface achieved an impressive NO catalytic release efficiency of up to 88 %, while heparin retained 86 % of its bioactivity even after one month of exposure to PBS containing NO donor. Both in vitro and in vivo experiments confirmed that this robust endothelium-mimicking coating substantially reduces thrombosis formation. Overall, our long-acting endothelium-mimicking anti-thrombotic coatings present a promising and feasible strategy to address thrombosis-related challenges associated with blood-contacting devices.

Agarose modification on PDMS/PES composite membrane for improved hemocompatibility and anti-fouling performance

Agarose, the natural hydrophilic polysaccharide with good biocompatibility, low immunogenicity and low cost which has been widely used in tissue engineering and regenerative medicine but not in biomedical equipment, was employed to modify the potential oxygenation membrane, the core component for blood oxygenation ex vivo in the artificial lung machine. The oxidized agarose was successfully coated onto the hydrophobic polydimethylsiloxane (PDMS) surface forming a hydrophilic layer via intermolecular chemical bonding as well as physical interactions based on characterization and analyses from SEM, HNMR, FTIR, XPS and water contact angle measurement. The agarose modification significantly improved the hemocompatibility, reducing protein adsorption by 50-60 % and hemolysis rate from ∼0.45 % to ∼0.2 %, elongating the plasma recalcification time and blood clotting time, as well as alleviating platelet adhesion, and the antibacterial performance of the membrane, which would reduce the contamination of the membrane thus prolonging the membrane service life as well as blood clotting, blood damage and blood fouling. Meanwhile, the CO2/O2 gas selectivity was promoted to ∼9, an 64 % increase in comparison to that of unmodified membranes, which would significantly enhance the gas exchange efficiency of the oxygenation membrane. Moreover, the membrane modified with agarose exhibited long-term stability against platelet adhesion and blood leakage. This agarose modification strategy is simple yet effective, providing new ideas for oxygenation membrane synthesis and improvement.

Anticoagulant Sulfonate Polyamide/Poly(ether sulfone) Membrane Barrier for Efficient Blood Oxygenation

Extracorporeal membrane oxygenation (ECMO) is the most important support for patients with severe cardiopulmonary failure. As the key component, the oxygenation membrane has suffered the risk of blood coagulation and plasma leakage in the long term. Herein, we prepare a sulfonate polyamide film on poly(ether sulfone) (PES) support via interfacial polymerization modulated by a sulfonate amine monomer. The pore diameter of the prepared polyamide film is ∼3.67 Å (exactly a little smaller than the water molecule, the base of plasma). By such size repulsion effect, the polyamide film demonstrates remarkable plasma leakage resistance (confirmed by human plasma circulation). Moreover, the introduction of the sulfonate amine monomer effectively enhances the anticoagulation performance (activated partial thromboplastin time (aPTT) prolongation >10 s). In addition, the PES support used for interfacial polymerization is modified and realizes improved porosity, hydrophilicity, and positive charge potential, resulting in lower mass transfer resistance and improved interfacial strength between the support and polyamide film. ECMO-simulated circulation tests prove the facilitation effect on gas exchange derived from the support modification and interfacial polymerization modulation. This work provides a composite membrane simultaneously with significant plasma leakage resistance and anticoagulation properties for efficient blood oxygenation.

A New Multifunction Oxygenator With a Dual-Chamber Gas Exchanger to Reduce Dependence on Oxygen Supply

Although extracorporeal membrane oxygenation (ECMO) systems have been used to provide temporary support for patients with severe respiratory or cardiac failure, they are often bedridden, in part because of their bulky size which relies solely on an unlimited source of wall oxygen. However, there is an unmet clinical need for ambulatory ECMO which necessitates downsizing the ECMO system. We sought to develop a new oxygenator to reduce the dependence on the oxygen supply source. The proposed oxygenator features a dual-chamber gas exchangers, with one chamber primarily responsible for carbon dioxide removal using ambient air and a subsequent chamber primarily responsible for oxygen transfer using pure oxygen. Computational fluid dynamics was used to analyze the blood flow field to avoid adverse stagnation and optimize gas exchange performance. Bovine blood was used for in vitro gas transfer test. This new oxygenator demonstrated the capability to provide adequate respiratory support (both carbon dioxide removal and oxygen transfer) to adult patients at blood rate of 4-6 L/min with an oxygen supply of only 2 L/min. The reduced use of oxygen with this new oxygenator may pave the way for the development of potable ECMO systems.

Heparin-modified polyether ether ketone hollow fiber membrane with improved hemocompatibility and air permeability used for extracorporeal membrane oxygenation

To expand the selection of raw material for fabricating extracorporeal membrane oxygenation (ECMO) and promote its application in lung disease therapy, polyether ether ketone hollow fiber membrane (PEEK-HFM) with designable pore characteristics, desired mechanical performances, and excellent biocompatibility was selected as the potential substitute for existing poly (4-methyl-1-pentene) hollow fiber membrane (PMP-HFM). To address the platelet adhesion and plasma leakage issues with PEEK-HFM, a natural anticoagulant heparin was grafted onto the surface using ultraviolet irradiation. Additionally, to explore the substitutability of the heparin layer while considering cost and scalability, a heparin-like layer composed of copolymers of acrylic acid and sodium p-styrenesulfonate was also constructed on the surface of PEEK-HFM Even though the successful grafting of heparin and heparin-like layers on the PEEK-HFM surface reduced the pore parameters, improvements in surface hydrophilicity also prevented the platelet-adhesion phenomenon and improved the anticoagulant behaviour, making it a viable alternative for commercial PMP-HFMs in ECMO production. Furthermore heparin-modified and heparin-like modified PEEK-HFMs demonstrated similar performance, indicating that synthetic layers can effectively replace natural heparin. This study holds practical and instructive significance for future research and the application of membranes in the development of oxygenators.

An endothelium membrane mimetic antithrombotic coating enables safer and longer extracorporeal membrane oxygenation application

Thrombosis and plasma leakage are two of the most frequent dysfunctions of polypropylene (PP) hollow fiber membrane (PPM) used in extracorporeal membrane oxygenation (ECMO) therapy. In this study, a superhydrophilic endothelial membrane mimetic coating (SEMMC) was constructed on polydopamine-polyethyleneimine pre-coated surfaces of the PPM oxygenator and its ECMO circuit to explore safer and more sustainable ECMO strategy. The SEMMC is fabricated by multi-point anchoring of a phosphorylcholine and carboxyl side chained copolymer (PMPCC) and grafting of heparin (Hep) to form PMPCC-Hep interface, which endows the membrane superior hemocompatibility and anticoagulation performances. Furthermore, the modified PPM reduces protein adsorption amount to less than 30 ng/cm2. More significantly, the PMPCC-Hep coated ECMO system extends the anti-leakage and non-clotting oxygenation period to more than 15 h in anticoagulant-free animal extracorporeal circulation, much better than the bare and conventional Hep coated ECMO systems with severe clots and plasma leakage in 4 h and 8 h, respectively. This SEMMC strategy of grafting bioactive heparin onto bioinert zwitterionic copolymer interface has great potential in developing safer and longer anticoagulant-free ECMO systems. STATEMENT OF SIGNIFICANCE: A superhydrophilic endothelial membrane mimetic coating was constructed on surfaces of polypropylene hollow fiber membrane (PPM) oxygenator and its ECMO circuit by multi-point anchoring of a phosphorylcholine and carboxyl side chain copolymer (PMPCC) and grafting of heparin (Hep). The strong antifouling nature of the PMPCC-Hep coating resists the adsorption of plasma bio-molecules, resulting in enhanced hemocompatibility and anti-leakage ability. The grafted heparin on the zwitterionic PMPCC interface exhibits superior anticoagulation property. More significantly, the PMPCC-Hep coating achieves an extracorporeal circulation in a pig model for at least 15 h without any systemic anticoagulant. This endothelial membrane mimetic anticoagulation strategy shows great potential for the development of safer and longer anticoagulant-free ECMO systems.

Effect of Compressive Modulus of Porous PVA Hydrogel Coating on the Preventing Adhesion of Polypropylene Mesh

PP mesh is a widely used prosthetic material in hernia repair. However, visceral adhesion is one of the worst complications of this operation. Hence, an anti-adhesive PP mesh is developed by coating porous polyvinyl alcohol (PVA) hydrogel on PP surface via freezing-thawing process method. The compressive modulus of porous PVA hydrogel coating is first regulated by the addition of porogen sodium bicarbonate (NaHCO3) at various quality ratios with PVA. As expected, the porous hydrogel coating displayed modulus more closely resembling that of native abdominal wall tissue. In vitro tests demonstrate the modified PP mesh show superior coating stability, excellent hemocompatibility, and good cytocompatibility. In vivo experiments illustrate that PP mesh coated by the PVA4 hydrogel that mimicked the modulus of native abdominal wall could prevent adhesion effectively. Based on this, the rapamycin (RPM) is loaded into the porous PVA4 hydrogel coating to further improve anti-adhesive property of PP mesh. The Hematoxylin and eosin (H&E) and Masson trichrome (MT) staining results verified that the resulting mesh could alleviate the inflammation response and reduce the deposition of collagen around the implantation zone. The biomimetic mechanical property and anti-adhesive property of modified PP mesh make it a valuable candidate for application in hernioplasty.

Preparation of Time-Sequential Functionalized ZnS-ZnO Film for Modulation of Interfacial Behavior of Metals in Biological Service Environments

Blood-contact devices are prone to inflammation, endothelial dysfunction, coagulation, and the uncontrolled release of metal ions during implantation and service. Therefore, it is essential to make these multifunctional. Herein, a superhydrophobic DE@ZnS-ZnO@SA film (composed of dabigatran ester, zinc sulfite, zinc oxide, and stearic acid, respectively) is produced. The prepared film has non-adhesion and antibacterial properties, superior mechanical stability, durability, corrosion resistance, and is self-cleaning and blood-repellent. The results of the hemolysis, cytotoxicity, and other anticoagulant experiments revealed that the film had good blood compatibility, no cytotoxicity, and excellent anticoagulant properties. The film displays anticoagulant properties even after being immersed in Phosphate-Buffered Saline (PBS) for 7 days. Furthermore, the film can spontaneously release H2S gas for 90 h after soaking in an acidic environment (pH = 6) for 90 h. This property improves the acidic microenvironment of the lesion and promotes the proliferation of endothelial cells by using H2S gas. In addition, the film can inhibit the uncontrollable release of Zn2+ ions, avoiding its toxicity even when immersed in an acid environment for 35 days. This time-sequential functionalized surface has the potential to typify the future of blood-contacting scaffolds for long-lasting use.

Biomimetic nanoporous oxygenation membranes with high hemocompatibility and fast gas transport property

Membrane technology holds great potential for separation applications and also finds critical needs in biomedical fields, such as blood oxygenation. However, the bottlenecks in gas permeation, plasma leakage, and especially hemocompatibility hamper the development of membrane oxygenation. It remains extremely challenging to design efficient membranes and elucidate underlying principles. In this study, we report biomimetic decoration of asymmetric nanoporous membranes by ultrathin FeIII-tannic acid metal-ligand networks to realize fast gas exchange with on plasma leakage and substantially enhance hemocompatibility. Because the intrinsic nanopores facilitate gas permeability and the FeIII-catechol layers enable superior hydrophilicity and electronegativity to original surfaces, the modified membranes exhibit high transport properties for gases and great resistances to protein adsorption, platelet activation, coagulation, thrombosis, and hemolysis. Molecular docking and density functional theory simulations indicate that more preferential adsorption of metal-ligand networks with water molecules than proteins is critical to anticoagulation. Moreover, benefiting from the better antiaging property gave by biomimetic decoration, the membranes after four-month aging present gas permeances similar to or even larger than those of pristine ones, despite the initial permeation decline. Importantly, for blood oxygenation, the designed membranes after aging show fast O2 and CO2 exchange processes with rates up to 28-17 and 97-47 mL m-2 min-1, respectively, accompanied with no detectable thrombus and plasma leakage. We envisage that the biomimetic decoration of nanoporous membranes provide a feasible route to achieve great biocompatibility and transport capability for various applications.

Protein adsorption on blood-contacting surfaces: A thermodynamic perspective to guide the design of antithrombogenic polymer coatings

Blood-contacting medical devices often succumb to thrombosis, limiting their durability and safety in clinical applications. Thrombosis is fundamentally initiated by the nonspecific adsorption of proteins to the material surface, which is strongly governed by thermodynamic factors established by the nature of the interaction between the material surface, surrounding water molecules, and the protein itself. Along these lines, different surface materials (such as polymeric, metallic, ceramic, or composite) induce different entropic and enthalpic changes at the surface-protein interface, with material wettability significantly impacting this behavior. Consequently, protein adsorption on medical devices can be modulated by altering their wettability and surface energy. A plethora of polymeric coating modifications have been utilized for this purpose; hydrophobic modifications may promote or inhibit protein adsorption determined by van der Waals forces, while hydrophilic materials achieve this by mainly relying on hydrogen bonding, or unbalanced/balanced electrostatic interactions. This review offers a cohesive understanding of the thermodynamics governing these phenomena, to specifically aid in the design and selection of hemocompatible polymeric coatings for biomedical applications. STATEMENT OF SIGNIFICANCE: Blood-contacting medical devices often succumb to thrombosis, limiting their durability and safety in clinical applications. A plethora of polymeric coating modifications have been utilized for addressing this issue. This review offers a cohesive understanding of the thermodynamics governing these phenomena, to specifically aid in the design and selection of hemocompatible polymeric coatings for biomedical applications.

Immobilization of carbonic anhydrase on modified PES membranes for artificial lungs

The introduction of carbonic anhydrase (CA) onto an extracorporeal membrane oxygenation (ECMO) membrane can improve the permeability of carbon dioxide (CO2). However, existing CA-grafting methods have limitations, and the hemocompatibility of current substrate membranes of commercial ECMO is not satisfactory. In this study, a 1-(3-dimethylaminopropyl)-3-ethylcarbodiimide hydrochloride (EDC)/N-hydroxy succinimide (NHS) activation method is adopted to graft CA with CO2-catalyzed conversion activity onto a polyethersulfone (PES) membrane, which is prepared by a phase inversion technique after in situ crosslinking polymerization of 1-vinyl-2-pyrrolidone (VP) and acrylic acid (AA) in PES solution. The characterization results reveal that CA has been grafted onto the modified PES membrane successfully and exhibits catalytic activity. The kinetic parameters of esterase activity verify that the grafted amount of active CA increases with an increase in the concentration of the CA incubation solution. The CA-grafted membrane (CA-M) can accelerate the conversion of bicarbonate to CO2 in water and blood, which demonstrates the special catalytic activity towards bicarbonate of CA. Finally, blood compatibility tests prove that the CA-M does not lead to hemolysis, shows suppressed protein adsorption and increased coagulation time, and is suitable for application in ECMO. This work demonstrates a green and efficient method for preparing bioactive materials and has practical guiding significance for subsequent pulmonary membrane research and ECMO applications.

Achieving superior anticoagulation of endothelial membrane mimetic coating by heparin grafting at zwitterionic biocompatible interfaces

Thrombosis and bleeding are common complications of blood-contacting medical device therapies. In this work, an endothelium membrane mimetic coating (PMPCC/Hep) has been created to address these challenges. The coating is fabricated by multi-point anchoring of a phosphorylcholine copolymer (poly-MPC-co-MSA, PMPCC) with carboxylic side chains and end-group grafting of unfractionated heparin (Hep) onto polydopamine precoated blood-contacting material surfaces. The PMPCC coating forms an ultrathin cell outer membrane mimetic layer to resist protein adsorption and platelet adhesion. The tiny defects/pores of the PMPCC layer provide entrances for heparin end-group to be inserted and grafted onto the sub-layer amino groups. The combination of the PMPCC cell membrane mimetic anti-fouling nature with the grafted heparin bioactivity further enhances the anticoagulation performance of the formed endothelium membrane mimetic PMPCC/Hep coating. Compared to conventional Hep coating, the PMPCC/Hep coating further decreases protein adsorption and platelet adhesion by 50 % and 90 %, respectively. More significantly, the PMPCC/Hep coating shows a superior anticoagulation activity, even significantly higher than that of an end-point-attached heparin coating. Furthermore, the blood coagulation function is well preserved in the PMPCC/Hep coating anticoagulation strategy. All the results support that the PMPCC/Hep coating strategy has great potential in developing more efficient and safer blood-contacting medical devices.

Epoxy silane sulfobetaine block copolymers for simple, aqueous thromboresistant coating on ambulatory assist lung devices

Developing an ambulatory assist lung (AAL) for patients who need continuous extracorporeal membrane oxygenation has been associated with several design objectives, including the design of compact components, optimization of gas transfer efficiency, and reduced thrombogenicity. In an effort to address thrombogenicity concerns with currently utilized component biomaterials, a low molecular weight water soluble siloxane-functionalized zwitterionic sulfobetaine (SB-Si) block copolymer was coated on a full-scale AAL device set via a one pot aqueous circulation coating. All device parts including hollow fiber bundle, housing, tubing and cannular were successfully coated with increasing atomic compositions of the SB block copolymer and the coated surfaces showed a significant reduction of platelet deposition while gas exchange performance was sustained. However, water solubility of the SB-Si was unstable, and the coating method, including oxygen plasma pretreatment on the surfaces were considered inconsistent with the objective of developing a simple aqueous coating. Addressing these weaknesses, SB block copolymers were synthesized bearing epoxy or epoxy-silane groups with improved water solubility (SB-EP & SB-EP-Si) and no requirement for surface pretreatment (SB-EP-Si). An SB-EP-Si triblock copolymer showed the most robust coating capacity and stability without prior pretreatment to represent a simple aqueous circulation coating on an assembled full-scale AAL device.

Strongly adhesive zwitterionic composite hydrogel paints for surgical sutures and blood-contacting devices

Hydrogels show eminent advantages in biomedical and pharmaceutical fields. However, their application as coating materials for biomedical devices is limited by several key challenges, such as lack of universality, weak mechanical strength, and low adhesion to the substrate. Here we report versatile and tough adhesion composite hydrogel paints (CHPs), which consist of zwitterionic copolymers and microgels, both with reactive groups. The CHPs exhibit tunable rheology and thickness, hydrophilicity, biofouling resistance, durability, and convenient fabrication on metal, polymer, and inorganic surfaces with arbitrary shapes. As a proof-of-concept, the CHP-surgical sutures demonstrate exceptional lubrication, drug delivery, anti-infection, and anti-fibrous capsule properties. Moreover, the CHP-PVC tubing effectively prevents thrombus formation in vitro and ex vivo rabbit blood circulation without anticoagulants. This work provides valuable insights for enhancing and developing integrated hydrogel technologies for biomedical devices. STATEMENT OF SIGNIFICANCE: The combination of hydrogel and biomedical devices can enable numerous existing applications in medicine. In this study, inspired by the principle of microgel reinforcement in industrial paints, we propose a simple and versatile zwitterionic composite hydrogel paints (CHPs) strategy, which can be easily applied to diverse substrates with arbitrary shapes by covalent grafting between complementary groups by brush, dip, or spray. The CHPs integrated universality, tough adhesion, mechanical durability, and anti-biofouling properties because of their unique chemical composition and coating structure design. This strategy provides a simple and versatile route for surface modification of biomedical devices.

Preparation of Hyflon AD/Polypropylene Blend Membrane for Artificial Lung

A high-performance polypropylene hollow fiber membrane (PP-HFM) was prepared by using a binary environmentally friendly solvent of polypropylene as the raw material, adopting the thermally induced phase separation (TIPS) method, and adjusting the raw material ratio. The binary diluents were soybean oil (SO) and acetyl tributyl citrate (ATBC). The suitable SO/ATBC ratio of 7/3 was based on the size change of the L-L phase separation region in PP-SO/ATBC thermodynamic phase diagram. Through the characterization and comparison of the basic performance of PP-HFMs, it was found that with the increase of the diluent content in the raw materials, the micropores of outer surface of the PP-HFM became larger, and the cross section showed a sponge-like pore structure. The fluoropolymer, Hyflon ADx, was deposited on the outer surface of the hollow fiber membrane using a physical modification method of solution dipping. After modification, the surface pore size of the Hyflon AD40L modified membranes decreased; the contact angle increased to around 107°; the surface energy decreased to 17 mN·m^-1; and the surface roughness decreased to 17 nm. Hyflon AD40L/PP-HFMs also had more water resistance properties from the variation of wetting curve. For biocompatibility of the membrane, the adsorption capacity of the modified PP membrane for albumin decreased from approximately 1.2 mg·cm^-2 to 1.0 mg·cm^-2, and the adsorption of platelets decreased under fluorescence microscopy. The decrease in blood cells and protein adsorption in the blood prolonged the clotting time. In addition, the hemolysis rate of modified PP membrane was reduced to within the standard of 5%, and the cell survival rate of its precipitate was above 100%, which also indicated the excellent biocompatibility of fluoropolymer modified membrane. The improvement of hydrophobicity and blood compatibility makes Hyflon AD/PP-HFMs have the potential for application in membrane oxygenators.