Surface modification of a titanium alloy with a phospholipid polymer prepared by a plasma-induced grafting technique to improve surface thromboresistance

Bio-inspired hemocompatible surface modifications for biomedical applications

When blood first encounters the artificial surface of a medical device, a complex series of biochemical reactions is triggered, potentially resulting in clinical complications such as embolism/occlusion, inflammation, or device failure. Preventing thrombus formation on the surface of blood-contacting devices is crucial for maintaining device functionality and patient safety. As the number of patients reliant on blood-contacting devices continues to grow, minimizing the risk associated with these devices is vital towards lowering healthcare-associated morbidity and mortality. The current standard clinical practice primarily requires the systemic administration of anticoagulants such as heparin, which can result in serious complications such as post-operative bleeding and heparin-induced thrombocytopenia (HIT). Due to these complications, the administration of antithrombotic agents remains one of the leading causes of clinical drug-related deaths. To reduce the side effects spurred by systemic anticoagulation, researchers have been inspired by the hemocompatibility exhibited by natural phenomena, and thus have begun developing medical-grade surfaces which aim to exhibit total hemocompatibility via biomimicry. This review paper aims to address different bio-inspired surface modifications that increase hemocompatibility, discuss the limitations of each method, and explore the future direction for hemocompatible surface research.

Surface Coatings for Rotary Ventricular Assist Devices: A Systematic Review

Rotary ventricular assist devices (VADs) are frequently used to provide mechanical circulatory support to patients suffering from end-stage heart failure. Therefore, these devices and especially their pump impeller and housing components have stringent requirements on wear resistance and hemocompatibility. Various surface coatings have been investigated to improve the wear resistance or hemocompatibility of these devices. The aim of the present systematic review was to build a comprehensive understanding of these coatings and provide potential future research directions. A Boolean search for peer-reviewed studies was conducted in online databases (Web of Science, Scopus, PubMed, and ScienceDirect), and a preferred reporting items for systematic reviews and meta-analyses (PRISMA) process was followed for selecting relevant papers for analysis. A total of 45 of 527 publications were included for analysis. Eighteen coatings were reported to improve wear resistance or hemocompatibility of rotary VADs with the most common coatings being diamond-like carbon (DLC), 2-methacryloyloxyethyl phosphorylcholine (MPC), and heparin. Ninety-three percent of studies focused on hemocompatibility, whereas only 4% of studies focused on wear properties. Thirteen percent of studies investigated durability. This review provides readers with a systematic catalogue and critical review of surface coatings for rotary VADs. The review has identified that more comprehensive studies especially investigations on wear properties and durability are needed in future work.

Safety and Effectiveness of the Pipeline Flex Embolization Device With Shield Technology for the Treatment of Intracranial Aneurysms: Midterm Results From a Multicenter Study

BACKGROUND

The safety and efficacy of the first generation of the Pipeline Embolization Device (PED; Medtronic Inc) have been proven in large case series. Ischemic events are one of the most common complications following treatment of aneurysms with flow diverters. The new PED Flex with Shield technology (PED Shield; Medtronic Inc) was introduced to minimize the rate of complications.

OBJECTIVE

To evaluate the outcomes of patients harboring aneurysms treated with the PED Shield.

METHODS

This was an observational, prospective, single-arm multicenter study of patients treated with the PED Shield. The primary safety endpoint was the absence of major neurological complications and death. The secondary effectiveness endpoint was angiographic occlusion at 6 and 12 mo. Technical complications were also reported.

RESULTS

Between November 2017 and December 2018, 151 patients from 7 centers with 182 aneurysms were enrolled. The mean aneurysm size was 7.0 mm; 27 (14.8%) aneurysms were large, and 7 (3.8%) were giant. In 141 of 151 patients (93.4%), the primary endpoint was reached. The overall rate of periprocedural complications was 7.3%. Of the aneurysms, 79.7% met the study's secondary endpoint of complete occlusion at 6 mo and 85.3% at 12 mo.

CONCLUSION

The PED Shield is a safe and effective treatment for intracranial aneurysms. The results regarding total occlusion and ischemic complications did not differ from those obtained in case series using previous versions of the PED. Long-term follow-up and comparative studies are required to provide stronger conclusions regarding the reduced thrombogenicity of this device.

Osteoblast Biocompatibility and Antibacterial Effects Using 2-Methacryloyloxyethyl Phosphocholine-Grafted Stainless-Steel Composite for Implant Applications

Poor osteogenesis and bacterial infections lead to an implant failure, so the enhanced osteogenic and antimicrobial activity of the implantable device is of great importance in orthopedic applications. In this study, 2-methacryloyloxyethyl phosphocholine (MPC) was grafted onto 316L stainless steel (SS) using a facile photo-induced radical graft polymerization method via a benzophenone (BP) photo initiator. Atomic force microscopy (AFM) was employed to determine the nanoscale morphological changes on the surface. The grafted BP-MPC layer was estimated to be tens of nanometers thick. The SS-BP-MPC composite was more hydrophilic and smoother than the untreated and BP-treated SS samples. Staphylococcus aureus (S. aureus) bacteria binding onto the SS-BP-MPC composite film surface was significantly reduced compared with the pristine SS and SS-BP samples. Mouse pre-osteoblast (MC3T3-E1) cells showed good adhesion on the MPC-modified samples and better proliferation and metabolic activity (73% higher) than the pristine SS sample. Biological studies revealed that grafting MPC onto the SS substrate enhanced the antibacterial efficiency and also retained osteoblast biocompatibility. This proposed procedure is promising for use with other implant materials.

Electrochemical Strategies for Titanium Implant Polymeric Coatings: The Why and How

Among the several strategies aimed at polymeric coatings deposition on titanium (Ti) and its alloys, metals commonly used in orthopaedic and orthodontic prosthesis, electrochemical approaches have gained growing interest, thanks to their high versatility. In this review, we will present two main electrochemical procedures to obtain stable, low cost and reliable polymeric coatings: electrochemical polymerization and electrophoretic deposition. Distinction should be made between bioinert films—having mainly the purpose of hindering corrosive processes of the underlying metal—and bioactive films—capable of improving biological compatibility, avoiding inflammation or implant-associated infection processes, and so forth. However, very often, these two objectives have been pursued and achieved contemporaneously. Indeed, the ideal coating is a system in which anti-corrosion, anti-infection and osseointegration can be obtained simultaneously. The ultimate goal of all these coatings is the better control of properties and processes occurring at the titanium interface, with a special emphasis on the cell-coating interactions. Finally, advantages and drawbacks of these electrochemical strategies have been highlighted in the concluding remarks.

Designs of Zwitterionic Interfaces and Membranes

Zwitterionic materials are the latest generation of materials for nonfouling interfaces and membranes. They outperform poly(ethylene glycol) derivatives because they form tighter bonds with water molecules and can trap more water molecules. This feature article summarizes our laboratory's fundamental developments related to the functionalization of interfaces and membranes using zwitterionic materials. Our molecular designs of zwitterionic polymers and copolymers, sulfobetaine-based, carboxybetaine-based, or phosphobetaine-based, are first reviewed. Then, the strategies used to functionalize surfaces/membranes by coating, grafting onto, grafting from, or in situ modification are examined and discussed, and the third part of this article shifts the focus to key applications of zwitterionic materials. Finally, some potential future directions for molecular designs, functionalization processes, and applications are presented.

[Research progress of self-assembled monolayer in biomedical metallic materials]

Because of the excellent mechanical properties, biocompatibility and reasonable prices, biomedical metallic materials are widely used in the manufacture of vascular stents, heart valve membrane, artificial joints and other body implants. However, the physiological environment in the body is very complex, the long-term embedding of the metal implants may result in corrosion or some nonspecific effects. The properties of medical metal surfaces may decay, which can cause serious injury to human body. By means of the self-assembled monolayer(SAM) technology, the physical and chemical properties of the medical metal surfaces can be modified, and through the SAM medium, some functional materials can be grafted on the metal surfaces, which can largely improve the stability and compatibility of implants in the body, and find wide applications in promoting cell adhesion, improving hemocompatibility, inhibiting bacteria growth, and constructing drug delivery coatings. This paper reviews the progress in the application of SAM in biomedical metallic materials.

Biologizing titanium alloy implant material with morphogenetically active polyphosphate

As a further step towards a new generation of bone implant materials, we developed a procedure for biological functionalization of titanium alloy surfaces with inorganic calcium polyphosphate (Ca-polyP).

Surface zwitterionization of titanium for a general bio-inert control of plasma proteins, blood cells, tissue cells, and bacteria

Surface coating of antifouling materials on the substrates offers convenient strategies and great opportunities to improve their biocompatibility and functions of host substrates for wide biomedical applications. In this work, we present a general surface zwitterionization strategy to improve surface biocompatibility and antifouling properties of titanium (Ti) by grafting zwitterionic poly(sulfobetaine methacrylate) (polySBMA). This method also demonstrates its general applicability to graft polySBMA onto Ti surface using different anchoring agents of dopamine and silane. The resulting polySBMA grafted from dopamine- (pTi-D-pSBMA) and silane-anchored titanium surfaces (pTi-Si-pSBMA) surfaces exhibit superlow fouling ability to highly resist the adhesions of plasma proteins, platelets, erythrocytes, leukocytes, human fibroblast (HT1080), E. coli, and S. epidermidis. The interfacial properties of the surface-modified Ti surfaces are analyzed and correlated with their antifouling properties. The new method and materials provide a more general, flexible, and robust way to produce an excellent nonfouling surface with adjustable interfacial structures of grafted polymers, which hopefully can be expanded to wider applications based on both the structure and surface superiorities.

Surface modification of a biodegradable magnesium alloy with phosphorylcholine (PC) and sulfobetaine (SB) functional macromolecules for reduced thrombogenicity and acute corrosion resistance

Siloxane functionalized phosphorylcholine (PC) or sulfobetaine (SB) macromolecules (PCSSi or SBSSi) were synthesized to act as surface modifying agents for degradable metallic surfaces to improve acute blood compatibility and slow initial corrosion rates. The macromolecules were synthesized using a thiol-ene radical photopolymerization technique and then utilized to modify magnesium (Mg) alloy (AZ31) surfaces via an anhydrous phase deposition of the silane functional groups. X-ray photoelectron spectroscopy surface analysis results indicated successful surface modification based on increased nitrogen and phosphorus or sulfur composition on the modified surfaces relative to unmodified AZ31. In vitro acute thrombogenicity assessment after ovine blood contact with the PCSSi and SBSSi modified surfaces showed a significant decrease in platelet deposition and bulk phase platelet activation compared with the control alloy surfaces. Potentiodynamic polarization and electrochemical impedance spectroscopy data obtained from electrochemical corrosion testing demonstrated increased corrosion resistance for PCSSi- and SBSSi-modified AZ31 versus unmodified surfaces. The developed coating technique using PCSSi or SBSSi showed promise in acutely reducing both the corrosion and thrombotic processes, which would be attractive for application to blood contacting devices, such as vascular stents, made from degradable Mg alloys.

Covalent attachment of multilayers on poly(tetrafluoroethylene) surfaces

These studies demonstrate a new approach of producing multifunctionalized coatings on poly(tetrafluoroethylene) (PTFE) surfaces by covalent attachments of multilayers (CAM) of heparin (HP) and poly(ethylene glycol) (PEG). This process can be universally applied to other covalently bonded species and was facilitated by microwave plasma reactions in the presence of maleic anhydride which, upon ring-opening and hydrolysis, provided covalent attachment of COOH groups to PTFE. These studies showed that alternating layers of PEG and HP can be covalently attached to COOH-PTFE surfaces, and the volume concentration and surface density of PEG and HP on the PTFE surface achieved by the CAM were 7.02-6.04 × 10(-3) g/cm(3) (2.1-1.8 × 10(-7) g/cm(2)) and 9.3-8.7 × 10(-3) g/cm(3) (2.8-2.6 × 10(-7) g/cm(2)), respectively. The CAM process may serve numerous applications when the covalent modification of inert polymeric substrates is required and particularly where the presence of bioactive species for biocompatibility enhancement is desirable.

Biocompatibility assessment of the first generation PediaFlow pediatric ventricular assist device

The PediaFlow pediatric ventricular assist device is a miniature magnetically levitated mixed flow pump under development for circulatory support of newborns and infants (3-15 kg) with a targeted flow range of 0.3-1.5 L/min. The first generation design of the PediaFlow (PF1) was manufactured with a weight of approximately 100 g, priming volume less than 2 mL, length of 51 mm, outer diameter of 28 mm, and with 5-mm blood ports. PF1 was evaluated in an in vitro flow loop for 6 h and implanted in ovines for three chronic experiments of 6, 17, and 10 days. In the in vitro test, normalized index of hemolysis was 0.0087 ± 0.0024 g/100L. Hemodynamic performance and blood biocompatibility of PF1 were characterized in vivo by measurements of plasma free hemoglobin, plasma fibrinogen, total plasma protein, and with novel flow cytometric assays to quantify circulating activated ovine platelets. The mean plasma free hemoglobin values for the three chronic studies were 4.6 ± 2.7, 13.3 ± 7.9, and 8.8 ± 3.3 mg/dL, respectively. Platelet activation was low for portions of several studies but consistently rose along with observed animal and pump complications. The PF1 prototype generated promising results in terms of low hemolysis and platelet activation in the absence of complications. Hemodynamic results validated the magnetic bearing design and provided the platform for design iterations to meet the objective of providing circulatory support for young children with exceptional biocompatibility.

Simple surface modification of a titanium alloy with silanated zwitterionic phosphorylcholine or sulfobetaine modifiers to reduce thrombogenicity

Thrombosis and thromboembolism remain problematic for a large number of blood contacting medical devices and limit broader application of some technologies due to this surface bioincompatibility. In this study we focused on the covalent attachment of zwitterionic phosphorylcholine (PC) or sulfobetaine (SB) moieties onto a TiAl(6)V(4) surface with a single step modification method to obtain a stable blood compatible interface. Silanated PC or SB modifiers (PCSi or SBSi) which contain an alkoxy silane group and either PC or SB groups were prepared respectively from trimethoxysilane and 2-methacryloyloxyethyl phosphorylcholine (MPC) or N-(3-sulfopropyl)-N-(methacryloxyethyl)-N,N-dimethylammonium betaine (SMDAB) monomers by a hydrosilylation reaction. A cleaned and oxidized TiAl(6)V(4) surface was then modified with the PCSi or SBSi modifiers by a simple surface silanization reaction. The surface was assessed with X-ray photoelectron spectroscopy (XPS), attenuated total reflection-Fourier transform infrared spectroscopy (ATR-FTIR) and contact angle goniometry. Platelet deposition and bulk phase activation were evaluated following contact with anticoagulated ovine blood. XPS results verified successful modification of the PCSi or SBSi modifiers onto TiAl(6)V(4) based on increases in surface phosphorous or sulfur respectively. Surface contact angles in water decreased with the addition of hydrophilic PC or SB moieties. Both the PCSi and SBSi modified TiAl(6)V(4) surfaces showed decreased platelet deposition and bulk phase platelet activation compared to unmodified TiAl(6)V(4) and control surfaces. This single step modification with PCSi or SBSi modifiers offers promise for improving the surface hemocompatibility of TiAl(6)V(4) and is attractive for its ease of application to geometrically complex metallic blood contacting devices.