A Facile Composite Strategy to Prepare a Biodegradable Polymer Based Radiopaque Raw Material for "Visualizable" Biomedical Implants

Enabling a biodegradable polymer radiopaque under X-ray is much desired for many medical devices. Physical blending of a present biodegradable polymer and a commercialized medical contrast agent is convenient yet lacks comprehensive fundamental research. Herein, we prepared a biodegradable polymer-based radiopaque raw material by blending poly(l-lactic acid) (PLLA or simply PLA) and iohexol (IHX), where PLA constituted the continuous phase and IHX particles served as the dispersed phase. The strong X-ray adsorption of IHX enabled the composite radiopaque; the hydrolysis of the polyester and the water solubility of the contrast agent enabled the composite biodegradable in an aqueous medium. The idea was confirmed by in vitro characterizations of the resultant composite, in vivo subcutaneous implantation in rats up to 6 months, and the clear visualization of a part of a biodegradable occluder in a Bama piglet under X-ray. We also found that the crystallization of PLA was significantly enhanced in the presence of the solid particles, which should be taken into consideration in the design of an appropriate biomaterial composite because crystallization degree influences the biodegradation rate and mechanical property of a material to a large extent. We further tried to introduce a small amount of poly(vinylpyrrolidone) into the blend of PLA and IHX. Compared to the bicomponent composite, the tricomponent one exhibited decreased modulus and increased elongation at break and tensile strength. This paves more ways for researchers to select appropriate raw materials according to the regenerated tissue and the application site.

Intrinsically radiopaque biomaterial assortments: a short review on the physical principles, X-ray imageability, and state-of-the-art developments

X-ray attenuation ability, otherwise known as radiopacity of a material, could be indisputably tagged as the central and decisive parameter that produces contrast in an X-ray image. Radiopaque biomaterials are vital in the healthcare sector that helps clinicians to track them unambiguously during pre and post interventional radiological procedures. Medical imaging is one of the most powerful resources in the diagnostic sector that aids improved treatment outcomes for patients. Intrinsically radiopaque biomaterials enable themselves for visual targeting/positioning as well as to monitor their fate and further provide the radiologists with critical insights about the surgical site. Moreover, the emergence of advanced real-time imaging modalities is a boon to the contemporary healthcare systems that allow to perform minimally invasive surgical procedures and thereby reduce the healthcare costs and minimize patient trauma. X-ray based imaging is one such technologically upgraded diagnostic tool with many variants like digital X-ray, computed tomography, digital subtraction angiography, and fluoroscopy. In light of these facts, this review is aimed to briefly consolidate the physical principles of X-ray attenuation by a radiopaque material, measurement of radiopacity, classification of radiopaque biomaterials, and their recent advanced applications.

Organic Compound with Potential for X-ray Imaging Applications

A radiopaque compound, namely, 4,4-bis(4-hydroxy-3,5-diiodophenyl)pentanoic acid, was synthesized by the electrophilic aromatic iodination of 4,4-bis(4-hydroxyphenyl)pentanoic acid using sodium iodide and sodium hypochlorite. The active iodines created by hypochlorite were selectively bound to the ortho positions of the diphenolic acid and obtained a tetraiodo compound. Characterization of this iodinated compound was accomplished by routine methods such as Fourier transform infrared (FTIR) spectroscopy, ¹H nuclear magnetic resonance (NMR) spectroscopy, energy-dispersive X-ray spectroscopy, mass spectroscopy, UV-Vis spectroscopy, and thermogravimetry. The iodine content in the compound was as high as 64% by weight and therefore expected to possess substantial radiopacity. A 5% solution of the compound in dimethyl sulfoxide exhibited radiopacity of 885 ± 7 Hounsfield Units when tested with computed tomography (CT) scanner. In vitro cytotoxicity test performed using 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) assay demonstrated that the compound was noncytotoxic to L929 fibroblast cells up to the level of 0.8 mg/mL concentration. Overall results indicate that this highly radiopaque compound has the potential to be used for X-ray imaging in the clinical scenario.

PEG-based thermosensitive and biodegradable hydrogels

Injectable thermosensitive hydrogels are free-flowing polymer solutions at low or room temperature, making them easy to encapsulate the therapeutic payload or cells via simply mixing. Upon injection into the body, in situ forming hydrogels triggered by body temperature can act as drug-releasing reservoirs or cell-growing scaffolds. Finally, the hydrogels are eliminated from the administration sites after they accomplish their missions as depots or scaffolds. This review outlines the recent progress of poly(ethylene glycol) (PEG)-based biodegradable thermosensitive hydrogels, especially those composed of PEG-polyester copolymers, PEG-polypeptide copolymers and poly(organophosphazene)s. The material design, performance regulation, thermogelation and degradation mechanisms, and corresponding applications in the biomedical field are summarized and discussed. A perspective on the future thermosensitive hydrogels is also highlighted. STATEMENT OF SIGNIFICANCE: Thermosensitive hydrogels undergoing reversible sol-to-gel phase transitions in response to temperature variations are a class of promising biomaterials that can serve as minimally invasive injectable systems for various biomedical applications. Hydrophilic PEG is a main component in the design and fabrication of thermoresponsive hydrogels due to its excellent biocompatibility. By incorporating hydrophobic segments, such as polyesters and polypeptides, into PEG-based systems, biodegradable and thermosensitive hydrogels with adjustable properties in vitro and in vivo have been developed and have recently become a research hotspot of biomaterials. The summary and discussion on molecular design, performance regulation, thermogelation and degradation mechanisms, and biomedical applications of PEG-based thermosensitive hydrogels may offer a demonstration of blueprint for designing new thermogelling systems and expanding their application scope.

Injectable and thermosensitive hydrogels mediating a universal macromolecular contrast agent with radiopacity for noninvasive imaging of deep tissues

It is very challenging to visualize implantable medical devices made of biodegradable polymers in deep tissues. Herein, we designed a novel macromolecular contrast agent with ultrahigh radiopacity (iodinate content > 50%) via polymerizing an iodinated trimethylene carbonate monomer into the two ends of poly(ethylene glycol) (PEG). A set of thermosensitive and biodegradable polyester-PEG-polyester triblock copolymers with varied polyester compositions synthesized by us, which were soluble in water at room temperature and could spontaneously form hydrogels at body temperature, were selected as the demonstration materials. The addition of macromolecular contrast agent did not obviously compromise the injectability and thermogelation properties of polymeric hydrogels, but conferred them with excellent X-ray opacity, enabling visualization of the hydrogels at clinically relevant depths through X-ray fluoroscopy or Micro-CT. In a mouse model, the 3D morphology of the radiopaque hydrogels after injection into different target sites was visible using Micro-CT imaging, and their injection volume could be accurately obtained. Furthermore, the subcutaneous degradation process of a radiopaque hydrogel could be non-invasively monitored in a real-time and quantitative manner. In particular, the corrected degradation curve based on Micro-CT imaging well matched with the degradation profile of virgin polymer hydrogel determined by the gravimetric method. These findings indicate that the macromolecular contrast agent has good universality for the construction of various radiopaque polymer hydrogels, and can nondestructively trace and quantify their degradation in vivo. Meanwhile, the present methodology developed by us affords a platform technology for deep tissue imaging of polymeric materials.

Medical imaging of tissue engineering and regenerative medicine constructs

Advancement of tissue engineering and regenerative medicine (TERM) strategies to replicate tissue structure and function has led to the need for noninvasive assessment of key outcome measures of a construct's state, biocompatibility, and function. Histology based approaches are traditionally used in pre-clinical animal experiments, but are not always feasible or practical if a TERM construct is going to be tested for human use. In order to transition these therapies from benchtop to bedside, rigorously validated imaging techniques must be utilized that are sensitive to key outcome measures that fulfill the FDA standards for TERM construct evaluation. This review discusses key outcome measures for TERM constructs and various clinical- and research-based imaging techniques that can be used to assess them. Potential applications and limitations of these techniques are discussed, as well as resources for the processing, analysis, and interpretation of biomedical images.

Water-Dispersible Bismuth-Organic Materials with Computed Tomography Contrast Properties

Two bismuth-organic network polymers were synthesized by means of a one-step polycondensation reaction between an aromatic dithiol/trithiol and triphenylbismuth. The materials were characterized by solid-state UV-vis spectroscopy, Raman spectroscopy, scanning electron microscopy, energy dispersive X-ray spectroscopy, powder X-ray diffraction, elemental microanalysis, and thermogravimetric analysis. Uniform dispersion of the hydrophobic and water-insoluble bismuth-containing polymers in aqueous media was achieved by the addition of 2 kDa poly(ethylene glycol) methyl ether thiol. This enabled quantitative phantom imaging experiments on a clinical computed tomography (CT) scanner, which showed that the coordination polymers possessed strong CT contrast properties. The observed X-ray attenuation properties of each coordination polymer were correlated with its bismuth payload. The X-ray opacity, thermal and chemical stabilities, and aqueous dispersibility of this novel class of bismuth-organic materials make them potentially useful as biomedical CT contrast agents and radiopaque materials.

Well-Defined Selenium-Containing Aliphatic Polycarbonates via Lipase-Catalyzed Ring-Opening Polymerization of Selenic Macrocyclic Carbonate Monomer

The synthesis of well-defined, biodegradable selenium-containing polymers remains a formidable challenge in polymer chemistry. Herein, a selenic cyclic carbonate dimer monomer (M_Se) was developed to generate well-defined, biodegradable aliphatic polycarbonates with selenide functionality on the backbone. The monomer was synthesized via the intermolecular cyclization of di(1-hydroxyethylene) selenide and diphenyl carbonate with lipase CA as catalysts in a mass of anhydrous toluene with very dilute monomer concentration. Then living ring-opening polymerization (ROP) was executed by solution method using the same lipase CA as catalysts. Similarly, the copolymerizations with commercial trimethylene carbonate (TMC) generated random copolymers demonstrated by ¹³C NMR, regulating the density of selenium functional groups. The resulting polymers exhibited a living polymerization characteristic, as evidenced by polymerization kinetics, predictable molecular weights, narrow molecular-weight distribution, and controlled copolymer compositions. Using hydrophilic macroinitiators (PEG), amphiphilic di/triblock copolymers could be obtained, suggesting their potential as controlled drug delivery system (DDS) and hydrogel scaffolds for tissue engineering.