1
|
Li S, Sharaf MG, Zhang L, Wishart DS, Tonelli M, Unsworth LD. Adsorption Dynamics of Uremic Toxins to Novel Modified Magnetic Nanoparticles. Macromol Biosci 2024; 24:e2300133. [PMID: 37728207 DOI: 10.1002/mabi.202300133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 08/25/2023] [Indexed: 09/21/2023]
Abstract
Kidney dysfunction leads to the retention of metabolites in the blood compartment, some of which reach toxic levels. Uremic toxins are associated with the progression of kidney disease and other symptoms of kidney failure (i.e., nausea, itchiness, and hypertension). Toxin removal ameliorates symptoms and reduces further organ damage, but membrane-based methods are inadequate for this purpose. Engineered adsorbents may facilitate enhanced removal of retained toxins, especially those bound strongly by proteins. Poly 2-(methacryloyloxy)ethyl phosphorylcholine-co-β-cyclodextrin (p(MPC-co-PMβCD)) coated magnetic nanoparticles are synthesized, characterized for their physicochemical properties (Fourier-transform infrared spectroscopy (FTIR), nuclear magnetic resonance (NMR), thermogravimetric analysis(TGA), gel permeation chromatography (GPC), and transmission electron microscope (TEM), and evaluated toxin adsorption from a complex solution for the first time to quantify the effects of film chemistry and incubation time on the adsorbed toxinome (the collection of toxins). Uremic toxins are bound by even "low-fouling" polymer films themselves; providing further insight into how small molecule interactions with "low-fouling" films may affect protein-surface interactions. These results suggest a dynamic interaction between toxins and surfaces that is not driven by solution concentration alone. This knowledge will help advance the design of novel adsorbent films for clearing uremic toxins.
Collapse
Affiliation(s)
- Shuhui Li
- Department of Chemical and Materials Engineering, University of Alberta, Edmonton, AB, T6G 1H9, Canada
| | - Mehdi Ghaffari Sharaf
- Department of Chemical and Materials Engineering, University of Alberta, Edmonton, AB, T6G 1H9, Canada
| | - Lun Zhang
- Department of Biological Sciences, University of Alberta, Edmonton, AB, T6G 2E8, Canada
| | - David S Wishart
- Department of Biological Sciences, University of Alberta, Edmonton, AB, T6G 2E8, Canada
- Department of Computing Science, University of Alberta, Edmonton, AB, T6G 2E9, Canada
| | - Marcello Tonelli
- Department of Medicine, University of Calgary, Calgary, AB, T2N 1N4, Canada
| | - Larry D Unsworth
- Department of Chemical and Materials Engineering, University of Alberta, Edmonton, AB, T6G 1H9, Canada
| |
Collapse
|
2
|
Seshadri H, Saraf R, Barchha S. Radiological findings and endovascular management of internal carotid artery pseudoaneurysm in the setting of mucormycosis and COVID-19. BJR Case Rep 2024; 10:uaad006. [PMID: 38352267 PMCID: PMC10860580 DOI: 10.1093/bjrcr/uaad006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 07/21/2022] [Accepted: 11/14/2023] [Indexed: 02/16/2024] Open
Abstract
The coronavirus pandemic is now a public health emergency and has spread to nearly 206 countries across the globe. This novel disease has shaken the psycho-social, economic, and medical infrastructure of India. This has become even more challenging, considering the country's huge population. With the increase in the number of coronavirus disease (COVID) cases, our country has seen an unforeseen, unprecedented rise in a potential life and organ-threatening disease-mucormycosis. Mucormycosis is a deadly, extremely morbid, possibly life-threatening, and most feared complication of the coronavirus, caused by environmental molds belonging to the order Mucorales. Here, we report 2 cases of massive epistaxis due to internal carotid artery (ICA) pseudoaneurysm secondary to mucormycosis, post-COVID-19 pneumonia, which was managed by the endovascular route. To the best of our knowledge, there is very sparse literature available describing endovascular treatment of intracranial ICA pseudoaneurysm in a patient with COVID-induced mucormycosis.
Collapse
Affiliation(s)
| | - Rashmi Saraf
- Division of Interventional Neuroradiology, Department of Radiology, KEM Hospital, Mumbai 400012, India
| | - Satyam Barchha
- Department of Radiology, KEM Hospital, Mumbai 400012, India
| |
Collapse
|
3
|
Zoppo CT, Mocco J, Manning NW, Bogdanov AA, Gounis MJ. Surface modification of neurovascular stents: from bench to patient. J Neurointerv Surg 2023:jnis-2023-020620. [PMID: 37793794 DOI: 10.1136/jnis-2023-020620] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 09/19/2023] [Indexed: 10/06/2023]
Abstract
Flow-diverting stents (FDs) for the treatment of cerebrovascular aneurysms are revolutionary. However, these devices require systemic dual antiplatelet therapy (DAPT) to reduce thromboembolic complications. Given the risk of ischemic complications as well as morbidity and contraindications associated with DAPT, demonstrating safety and efficacy for FDs either without DAPT or reducing the duration of DAPT is a priority. The former may be achieved by surface modifications that decrease device thrombogenicity, and the latter by using coatings that expedite endothelial growth. Biomimetics, commonly achieved by grafting hydrophilic and non-interacting polymers to surfaces, can mask the device surface with nature-derived coatings from circulating factors that normally activate coagulation and inflammation. One strategy is to mimic the surfaces of innocuous circulatory system components. Phosphorylcholine and glycan coatings are naturally inspired and present on the surface of all eukaryotic cell membranes. Another strategy involves linking synthetic biocompatible polymer brushes to the surface of a device that disrupts normal interaction with circulating proteins and cells. Finally, drug immobilization can also impart antithrombotic effects that counteract normal foreign body reactions in the circulatory system without systemic effects. Heparin coatings have been explored since the 1960s and used on a variety of blood contacting surfaces. This concept is now being explored for neurovascular devices. Coatings that improve endothelialization are not as clinically mature as anti-thrombogenic coatings. Coronary stents have used an anti-CD34 antibody coating to capture circulating endothelial progenitor cells on the surface, potentially accelerating endothelial integration. Similarly, coatings with CD31 analogs are being explored for neurovascular implants.
Collapse
Affiliation(s)
- Christopher T Zoppo
- New England Center for Stroke Research, Department of Radiology, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
| | - J Mocco
- Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Nathan W Manning
- The MIRI Centre, Ingham Institute for Applied Medical Science, Sydney, New South Wales, Australia
- Department of Interventional Radiology, Liverpool Hospital, Sydney, New South Wales, Australia
| | - Alexei A Bogdanov
- New England Center for Stroke Research, Department of Radiology, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
| | - Matthew J Gounis
- New England Center for Stroke Research, Department of Radiology, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
| |
Collapse
|
4
|
Arai S, Fujii T, Teranishi K, Nonaka S, Kitamura T, Mitome-Mishima Y, Kondo A, Oishi H. Pipeline Flex with Shield Technology Placement for Small- and Medium-sized Aneurysms Achieves Early Complete Occlusion. Neurol Med Chir (Tokyo) 2023; 63:58-64. [PMID: 36543205 PMCID: PMC9995145 DOI: 10.2176/jns-nmc.2022-0217] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
The flow diverter has been shown to be a safe and effective device for large cerebral aneurysms in the proximal internal carotid artery (ICA). Recently, its indication has been expanded to small- and medium-sized cerebral aneurysms in the distal segment of the ICA. In this study, we report a single-center, retrospective investigation of the safety and efficacy of the Pipeline Flex device to treat these aneurysms. Of the patients who underwent Pipeline implantation for small- and medium-sized ICA aneurysms (≤12 mm) at our hospital between July 2013 and October 2021, 102 patients with 104 aneurysms were included in this study. The mean age of the patients was 57.7 ± 12.1 years, and 94 (90.4%) were female. The mean aneurysmal dome diameter was 9.2 ± 2.3 mm, the mean neck diameter was 5.3 ± 1.6 mm, and the mean dome-to-neck ratio was 1.8 ± 0.5. Twenty-five patients (24.0%) had incorporated vessels from the aneurysm. Complete occlusion of the aneurysms was obtained in 96 patients (92.3%). There were no cases of parent artery stenosis or major stroke after the procedure. Absence of incorporated vessel from the aneurysm dome and adjunctive coil embolization are statistically significant factors indicating complete occlusion in multivariate analysis. The time to complete occlusion was determined earlier with the use of the Pipeline Shield (p = 0.0386) and with adjunctive coils (p = 0.0025). We showed that Pipeline implantation for small- and medium-sized aneurysms was safe and highly effective.
Collapse
Affiliation(s)
- Sho Arai
- Department of Neurosurgery, Graduate School of Medicine, Juntendo University
| | - Takashi Fujii
- Department of Neuroendovascular Therapy, Graduate School of Medicine, Juntendo University
| | - Kohsuke Teranishi
- Department of Neurosurgery, Graduate School of Medicine, Juntendo University
| | - Senshu Nonaka
- Department of Neurosurgery, Graduate School of Medicine, Juntendo University
| | - Takayuki Kitamura
- Department of Neurosurgery, Graduate School of Medicine, Juntendo University
| | | | - Akihide Kondo
- Department of Neurosurgery, Graduate School of Medicine, Juntendo University
| | - Hidenori Oishi
- Department of Neurosurgery, Graduate School of Medicine, Juntendo University.,Department of Neuroendovascular Therapy, Graduate School of Medicine, Juntendo University
| |
Collapse
|
5
|
Li Q, Wen C, Yang J, Zhou X, Zhu Y, Zheng J, Cheng G, Bai J, Xu T, Ji J, Jiang S, Zhang L, Zhang P. Zwitterionic Biomaterials. Chem Rev 2022; 122:17073-17154. [PMID: 36201481 DOI: 10.1021/acs.chemrev.2c00344] [Citation(s) in RCA: 98] [Impact Index Per Article: 49.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
The term "zwitterionic polymers" refers to polymers that bear a pair of oppositely charged groups in their repeating units. When these oppositely charged groups are equally distributed at the molecular level, the molecules exhibit an overall neutral charge with a strong hydration effect via ionic solvation. The strong hydration effect constitutes the foundation of a series of exceptional properties of zwitterionic materials, including resistance to protein adsorption, lubrication at interfaces, promotion of protein stabilities, antifreezing in solutions, etc. As a result, zwitterionic materials have drawn great attention in biomedical and engineering applications in recent years. In this review, we give a comprehensive and panoramic overview of zwitterionic materials, covering the fundamentals of hydration and nonfouling behaviors, different types of zwitterionic surfaces and polymers, and their biomedical applications.
Collapse
Affiliation(s)
- Qingsi Li
- Department of Biochemical Engineering, Frontier Science Center for Synthetic Biology and Key Laboratory of Systems Bioengineering (MOE), School of Chemical Engineering and Technology, Tianjin University, Tianjin, 300350, China
| | - Chiyu Wen
- Department of Biochemical Engineering, Frontier Science Center for Synthetic Biology and Key Laboratory of Systems Bioengineering (MOE), School of Chemical Engineering and Technology, Tianjin University, Tianjin, 300350, China
| | - Jing Yang
- Department of Biochemical Engineering, Frontier Science Center for Synthetic Biology and Key Laboratory of Systems Bioengineering (MOE), School of Chemical Engineering and Technology, Tianjin University, Tianjin, 300350, China
| | - Xianchi Zhou
- MOE Key Laboratory of Macromolecule Synthesis and Functionalization, Department of Polymer Science and Engineering, Zhejiang University, Hangzhou, 310027, China
| | - Yingnan Zhu
- Institute of Drug Discovery and Development, School of Pharmaceutical Sciences, Center for Drug Safety Evaluation and Research, Zhengzhou University, Zhengzhou 450001, China
| | - Jie Zheng
- Department of Chemical, Biomolecular, and Corrosion Engineering, The University of Akron, Akron, Ohio 44325, United States
| | - Gang Cheng
- Department of Chemical Engineering, The University of Illinois at Chicago, Chicago, Illinois 60607, United States
| | - Jie Bai
- College of Chemical Engineering, Inner Mongolia University of Technology, Hohhot, Inner Mongolia 010051, China
| | - Tong Xu
- College of Chemical Engineering, Inner Mongolia University of Technology, Hohhot, Inner Mongolia 010051, China
| | - Jian Ji
- MOE Key Laboratory of Macromolecule Synthesis and Functionalization, Department of Polymer Science and Engineering, Zhejiang University, Hangzhou, 310027, China
| | - Shaoyi Jiang
- Meinig School of Biomedical Engineering, Cornell University, Ithaca, New York 14853, United States
| | - Lei Zhang
- Department of Biochemical Engineering, Frontier Science Center for Synthetic Biology and Key Laboratory of Systems Bioengineering (MOE), School of Chemical Engineering and Technology, Tianjin University, Tianjin, 300350, China
| | - Peng Zhang
- MOE Key Laboratory of Macromolecule Synthesis and Functionalization, Department of Polymer Science and Engineering, Zhejiang University, Hangzhou, 310027, China
| |
Collapse
|
6
|
Luo C, Jin L, Dong J, Fu Z, Liu E, Yin S, Jian L, Luo P, Liu B, Huang W, Zhou S. Clinical outcomes of pipeline embolization devices with shield technology for treating intracranial aneurysms. Front Neurol 2022; 13:971664. [PMID: 36452166 PMCID: PMC9702813 DOI: 10.3389/fneur.2022.971664] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Accepted: 10/24/2022] [Indexed: 08/05/2023] Open
Abstract
INTRODUCTION As a common endovascular treatment for intracranial aneurysms, the pipeline embolization device (PED) is considered a standard treatment option, especially for large, giant, wide-necked, or dissecting aneurysms. A layer of phosphorylcholine biocompatible polymer added to the surface of the PED can substantially improve this technology. This PED with shield technology (pipeline shield) is relatively novel; its early technical success and safety have been reported. We conducted a systematic literature review with the aim of evaluating the efficacy and safety of the pipeline shield. METHODS We searched the PubMed, Embase, and Cochrane databases, following the preferred reporting items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. RESULTS We selected five prospective and two retrospective studies for review. A total of 572 aneurysms were included; of these, 506 (88.5%) were unruptured. The antiplatelet regimens were heterogeneous. The rate of perioperative and postoperative complications was 11.1% [95% confidence interval (CI): 6.5-18.9%]. The adequate occlusion rate at 6 months was 73.9% (95% CI: 69.1-78.7%). The adequate occlusion rate of more than 12 months was 80.9% (95% CI: 75.1-86.1%). The mortality rate was 0.7% (95% CI: 0.2-1.5%). Subgroup analyses showed that aneurysm rupture status had no effect on aneurysm occlusion rate, patient morbidity, or mortality. CONCLUSION This review demonstrates the safety and efficacy of the pipeline shield for treating intracranial aneurysms. However, direct comparisons of the pipeline shield with other flow diverters are needed to better understand the relative safety and effectiveness of different devices.
Collapse
Affiliation(s)
- Chao Luo
- Department of Neurosurgery, The Affiliated Hospital of Kunming University of Science and Technology, Kunming, China
| | - Lide Jin
- Department of Neurosurgery, The Affiliated Hospital of Kunming University of Science and Technology, Kunming, China
| | - Jigen Dong
- Department of Neurosurgery, The Affiliated Hospital of Kunming University of Science and Technology, Kunming, China
| | - Zaixiang Fu
- Department of Neurosurgery, School of Medicine, Second Affiliated Hospital, Zhejiang University, Hangzhou, China
| | - Erheng Liu
- Department of Neurosurgery, The Affiliated Hospital of Kunming University of Science and Technology, Kunming, China
| | - Shi Yin
- Department of Neurosurgery, The Affiliated Hospital of Kunming University of Science and Technology, Kunming, China
| | - Lipeng Jian
- Department of Neurosurgery, The Affiliated Hospital of Kunming University of Science and Technology, Kunming, China
| | - Pengren Luo
- Department of Neurosurgery, The Affiliated Hospital of Kunming University of Science and Technology, Kunming, China
| | - Bo Liu
- College of Clinical Medicine, Jilin University, Changchun, China
| | - Wei Huang
- Department of Neurosurgery, The Affiliated Hospital of Kunming University of Science and Technology, Kunming, China
| | - Shuai Zhou
- Department of Neurosurgery, The Affiliated Hospital of Kunming University of Science and Technology, Kunming, China
- Medical Faculty, Kunming University of Science and Technology, Kunming, China
| |
Collapse
|
7
|
Ishihara K. Biomimetic materials based on zwitterionic polymers toward human-friendly medical devices. SCIENCE AND TECHNOLOGY OF ADVANCED MATERIALS 2022; 23:498-524. [PMID: 36117516 PMCID: PMC9481090 DOI: 10.1080/14686996.2022.2119883] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Revised: 08/26/2022] [Accepted: 08/28/2022] [Indexed: 06/01/2023]
Abstract
This review summarizes recent research on the design of polymer material systems based on biomimetic concepts and reports on the medical devices that implement these systems. Biomolecules such as proteins, nucleic acids, and phospholipids, present in living organisms, play important roles in biological activities. These molecules are characterized by heterogenic nature with hydrophilicity and hydrophobicity, and a balance of positive and negative charges, which provide unique reaction fields, interfaces, and functionality. Incorporating these molecules into artificial systems is expected to advance material science considerably. This approach to material design is exceptionally practical for medical devices that are in contact with living organisms. Here, it is focused on zwitterionic polymers with intramolecularly balanced charges and introduce examples of their applications in medical devices. Their unique properties make these polymers potential surface modification materials to enhance the performance and safety of conventional medical devices. This review discusses these devices; moreover, new surface technologies have been summarized for developing human-friendly medical devices using zwitterionic polymers in the cardiovascular, cerebrovascular, orthopedic, and ophthalmology fields.
Collapse
Affiliation(s)
- Kazuhiko Ishihara
- Division of Materials and Manufacturing Science, Graduate School of Engineering, Osaka University, Osaka, Japan
| |
Collapse
|
8
|
Monteiro A, Khan A, Donnelly BM, Kuo CC, Burke SM, Waqas M, Housley SB, Cappuzzo JM, Davies JM, Snyder KV, Levy EI, Siddiqui AH. Treatment of ruptured intracranial aneurysms using the novel generation of flow-diverters with surface modification: A systematic review and meta-analysis. Interv Neuroradiol 2022:15910199221117921. [PMID: 35929825 DOI: 10.1177/15910199221117921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Surface modification of flow diverters (FDs) has been explored as a solution for reducing thrombotic risk of these devices, without necessarily using dual antiplatelet therapy (DAPT). If effective, this could pose a promising alternative for treatment of ruptured aneurysms not amenable to other modalities. METHODS We performed a comprehensive search of PubMed, MEDLINE, and Embase databases following Preferred Reporting Items for Systematic reviews and Meta-analyzes guidelines. We included articles reporting use of surface-modified FDs for treatment of ruptured aneurysms. Demographics, subarachnoid hemorrhage (SAH) severity, aneurysm characteristics, devices used, periprocedural complications, angiographic outcomes, and mortality were extracted for sample size-based weighted analysis. RESULTS Six studies comprising 59 patients with 64 aneurysms were included. Mean patient age was 56.6 ± 6.3 years and 60.6% (95% confidence interval [CI], 46.7-72.9%) were women. The anterior circulation was the location in 60.4% (95%CI, 45.5-73.5%) of aneurysms; 41.8% of the aneurysms were saccular (95%CI, 29.3-55.4%), 16.7% were fusiform (95%CI, 8.3-30.8%), 29.9% were dissecting (95%CI, 12.8-55.4%), 24.4% were blood-blister (95%CI, 15.2-36.7%), and 5.7% were mycotic (95%CI, 2-15.1%). Poor SAH grade was reported in 46.9% (95%CI, 33.3-60.9%). Adjunctive coiling was used in 33.2% (95%CI, 12.4-63.6%). Periprocedural thromboembolic and hemorrhagic complications occurred in 20% (95%CI, 7.1-45.1%) and 8.8% (95%CI, 3.7-19.5%), respectively. Complete occlusion was achieved in 76.4% (95%CI, 58.1-88.3%); no retreatments during follow-up were reported. Overall mortality was 15.1% (95%CI, 7.7-27.6%). There were no differences between single antiplatelet therapy (SAPT) and DAPT regimens with respect to periprocedural thromboembolic complications (P = 0.09), hemorrhagic (P = 0.834) complications, and mortality (P = 0.312). CONCLUSION Surface-modified FD treatment of ruptured aneurysms resulted in high rates of thromboembolic complications and acceptable rates of hemorrhagic complications. A considerable proportion of aneurysms were nonsaccular. Rates of complete occlusion were high and retreatment were low. Importantly, no statistically significant difference was found between SAPT and DAPT with respect to complications and mortality.
Collapse
Affiliation(s)
- Andre Monteiro
- Department of Neurosurgery, 12291Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA
- Department of Neurosurgery, 23564Gates Vascular Institute at Kaleida Health, Buffalo, NY, USA
| | - Asham Khan
- Department of Neurosurgery, 12291Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA
- Department of Neurosurgery, 23564Gates Vascular Institute at Kaleida Health, Buffalo, NY, USA
| | - Brianna M Donnelly
- Department of Neurosurgery, 23564Gates Vascular Institute at Kaleida Health, Buffalo, NY, USA
| | - Cathleen C Kuo
- Jacobs School of Medicine, University at Buffalo, Buffalo, NY, USA
| | - Samantha M Burke
- Department of Neurosurgery, 23564Gates Vascular Institute at Kaleida Health, Buffalo, NY, USA
| | - Muhammad Waqas
- Department of Neurosurgery, 12291Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA
- Department of Neurosurgery, 23564Gates Vascular Institute at Kaleida Health, Buffalo, NY, USA
| | - Steven B Housley
- Department of Neurosurgery, 12291Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA
- Department of Neurosurgery, 23564Gates Vascular Institute at Kaleida Health, Buffalo, NY, USA
| | - Justin M Cappuzzo
- Department of Neurosurgery, 12291Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA
- Department of Neurosurgery, 23564Gates Vascular Institute at Kaleida Health, Buffalo, NY, USA
| | - Jason M Davies
- Department of Neurosurgery, 12291Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA
- Department of Neurosurgery, 23564Gates Vascular Institute at Kaleida Health, Buffalo, NY, USA
- Department of Bioinformatics, 12291Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA
- 573848Canon Stroke and Vascular Research Center, University at Buffalo, Buffalo, NY, USA
- Jacobs Institute, Buffalo, NY, USA
| | - Kenneth V Snyder
- Department of Neurosurgery, 12291Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA
- Department of Neurosurgery, 23564Gates Vascular Institute at Kaleida Health, Buffalo, NY, USA
- 573848Canon Stroke and Vascular Research Center, University at Buffalo, Buffalo, NY, USA
- Jacobs Institute, Buffalo, NY, USA
| | - Elad I Levy
- Department of Neurosurgery, 12291Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA
- Department of Neurosurgery, 23564Gates Vascular Institute at Kaleida Health, Buffalo, NY, USA
- 573848Canon Stroke and Vascular Research Center, University at Buffalo, Buffalo, NY, USA
- Jacobs Institute, Buffalo, NY, USA
- Department of Radiology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA
| | - Adnan H Siddiqui
- Department of Neurosurgery, 12291Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA
- Department of Neurosurgery, 23564Gates Vascular Institute at Kaleida Health, Buffalo, NY, USA
- 573848Canon Stroke and Vascular Research Center, University at Buffalo, Buffalo, NY, USA
- Jacobs Institute, Buffalo, NY, USA
- Department of Radiology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA
| |
Collapse
|
9
|
Sarvari R, Naghili B, Agbolaghi S, Abbaspoor S, Bannazadeh Baghi H, Poortahmasebi V, Sadrmohammadi M, Hosseini M. Organic/polymeric antibiofilm coatings for surface modification of medical devices. INT J POLYM MATER PO 2022. [DOI: 10.1080/00914037.2022.2066668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Raana Sarvari
- Infectious and Tropical Diseases Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Behrooz Naghili
- Infectious and Tropical Diseases Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Samira Agbolaghi
- Chemical Engineering Department, Faculty of Engineering, Azarbaijan Shahid Madani University, Tabriz, Iran
| | | | - Hossein Bannazadeh Baghi
- Infectious and Tropical Diseases Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
- Immunology Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Vahdat Poortahmasebi
- Infectious and Tropical Diseases Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
- Department of Bacteriology and Virology, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mehdi Sadrmohammadi
- Infectious and Tropical Diseases Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
- Student Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Maryam Hosseini
- Chemical Engineering Department, Faculty of Engineering, Azarbaijan Shahid Madani University, Tabriz, Iran
| |
Collapse
|
10
|
Guo H, Wen C, Tian S, Zhang X, Ma Y, Liu X, Yang J, Zhang L. Universal Intraductal Surface Antifouling Coating Based on an Amphiphilic Copolymer. ACS APPLIED MATERIALS & INTERFACES 2021; 13:21051-21059. [PMID: 33929824 DOI: 10.1021/acsami.1c04579] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Surface modification on the inner wall of medical or industrial polymeric catheters with a high length/diameter ratio is highly desired. Herein, a universal and facile method based on an amphiphilic copolymer was developed to immobilize an intraductal surface antifouling coating for a variety of polymeric catheters. A fouling-repelled thin layer was formed by swelling-driven adsorption via directly perfusing an amphiphilic copolymer [polyvinylpyrrolidone-polydimethylsiloxane-polyvinylpyrrolidone (PVP-PDMS-PVP)] solution into catheters. In this copolymer, hydrophobic PDMS was embedded into a shrinking cross-linked network of catheters; also, PVP segments migrated to the surface under driving water to form a hydrophilic antifouling coating. Moreover, because of the coordination between I2 and pyrrolidone of PVP, the copolymer-modified intraductal surface was then infused with aqueous I2 to form the PVP-I2 complex, endowing this coating with bactericidal activity. Notably, diverse catheters with arbitrary shapes (circular, rectangular, triangular, and hexagonal) and different components (silicone, polyurethane, and polyethylene) were also verified to work using this interfacial interpenetration strategy. The findings in this work provide a new avenue toward facile and universal fabrication of intraductal surface antifouling catheters, creating a superior option for decreasing the consumable costs in industrial production and alleviating the pain of replacing catheters for patients.
Collapse
Affiliation(s)
- Hongshuang Guo
- Department of Biochemical Engineering, Frontier Science Center for Synthetic Biology and Key Laboratory of Systems Bioengineering (MOE), School of Chemical Engineering and Technology, Tianjin University, Tianjin 300350, China
- Qingdao Institute for Marine Technology of Tianjin University, Qingdao 266235, China
| | - Chiyu Wen
- Department of Biochemical Engineering, Frontier Science Center for Synthetic Biology and Key Laboratory of Systems Bioengineering (MOE), School of Chemical Engineering and Technology, Tianjin University, Tianjin 300350, China
- Qingdao Institute for Marine Technology of Tianjin University, Qingdao 266235, China
| | - Shu Tian
- Department of Biochemical Engineering, Frontier Science Center for Synthetic Biology and Key Laboratory of Systems Bioengineering (MOE), School of Chemical Engineering and Technology, Tianjin University, Tianjin 300350, China
- Qingdao Institute for Marine Technology of Tianjin University, Qingdao 266235, China
| | - Xiangyu Zhang
- Department of Biochemical Engineering, Frontier Science Center for Synthetic Biology and Key Laboratory of Systems Bioengineering (MOE), School of Chemical Engineering and Technology, Tianjin University, Tianjin 300350, China
- Qingdao Institute for Marine Technology of Tianjin University, Qingdao 266235, China
| | - Yiming Ma
- Department of Biochemical Engineering, Frontier Science Center for Synthetic Biology and Key Laboratory of Systems Bioengineering (MOE), School of Chemical Engineering and Technology, Tianjin University, Tianjin 300350, China
- Qingdao Institute for Marine Technology of Tianjin University, Qingdao 266235, China
| | - Xinmeng Liu
- Department of Biochemical Engineering, Frontier Science Center for Synthetic Biology and Key Laboratory of Systems Bioengineering (MOE), School of Chemical Engineering and Technology, Tianjin University, Tianjin 300350, China
- Qingdao Institute for Marine Technology of Tianjin University, Qingdao 266235, China
| | - Jing Yang
- Department of Biochemical Engineering, Frontier Science Center for Synthetic Biology and Key Laboratory of Systems Bioengineering (MOE), School of Chemical Engineering and Technology, Tianjin University, Tianjin 300350, China
- Qingdao Institute for Marine Technology of Tianjin University, Qingdao 266235, China
| | - Lei Zhang
- Department of Biochemical Engineering, Frontier Science Center for Synthetic Biology and Key Laboratory of Systems Bioengineering (MOE), School of Chemical Engineering and Technology, Tianjin University, Tianjin 300350, China
- Qingdao Institute for Marine Technology of Tianjin University, Qingdao 266235, China
| |
Collapse
|
11
|
Cohen JE, Gomori JM, Moscovici S, Kaye AH, Shoshan Y, Spektor S, Leker RR. Flow-diverter stents in the early management of acutely ruptured brain aneurysms: effective rebleeding protection with low thromboembolic complications. J Neurosurg 2021; 135:1394-1401. [PMID: 33862594 DOI: 10.3171/2020.10.jns201642] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Accepted: 10/05/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Flow-diverter stents (FDSs) are not generally used for the management of acutely ruptured aneurysms with associated subarachnoid hemorrhage (SAH). Herein, the authors present their experience with FDSs in this scenario, focusing on the antiplatelet regimen, perioperative management, and outcome. METHODS The authors retrospectively reviewed their institutional database for the treatment and outcomes of all patients with acutely ruptured aneurysms and associated SAH from July 2010 to September 2018 who had received an FDS implant as stand-alone treatment within 4 days after diagnosis. The protocol with the use of flow diversion in these patients includes a low threshold for placement of external ventricular drains before stenting, followed by the administration of aspirin and clopidogrel with platelet testing before stent implantation. With this approach, the risk of hemorrhage and stent-related thrombus formation is limited. Demographic, clinical, technical, and imaging data were analyzed. RESULTS Overall, 76 patients (61% females, mean age 42.8 ± 11.3 years) met the inclusion criteria. FDS implantation was performed a median of 2 days after diagnosis. On average, 1.05 devices were used per procedure. There was no procedural mortality directly attributed to the endovascular intervention. Procedural device-related clinical complications were recorded in a total of 6 cases (7.9%) and resulted in permanent neurological morbidity in 2 cases (2.6%). There was complete immediate aneurysm occlusion in 11 patients (14.5%), and persistent aneurysm filling was seen in 65 patients (85.5%). Despite this, no patient presented with rebleeding from the target aneurysm. There was an excellent clinical outcome in 62 patients (81.6%), who had a 90-day modified Rankin Scale score of 0-2. Among the 71 survivors, total or near-total occlusion was observed in 64/67 patients (95.5%) with a 3- to 6-month angiographic follow-up and in all cases evaluated at 12 months. Five patients (6.6%) died during follow-up for reasons unrelated to the procedure or new hemorrhage. CONCLUSIONS Flow diversion is an effective therapeutic strategy for the management of select acutely ruptured aneurysms. Despite low rates of immediate aneurysm occlusion after FDS implantation, the device exerts an important protective effect. The authors' experience confirmed no aneurysm rerupture, high rates of delayed complete occlusion, and complication rates that compare favorably with the rates obtained using other techniques.
Collapse
Affiliation(s)
| | | | | | - Andrew H Kaye
- Departments of1Neurosurgery
- 3Division of Surgery, Neurosurgery Department, University of Melbourne, Parkville, Victoria, Australia
| | | | | | - Ronen R Leker
- 4Neurology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel; and
| |
Collapse
|
12
|
BOLAT A, SURER S, GÜLBAHAR Ö, BOLAT E, GÜLTEKİN Y, KUTSAL A. The effect of phosphorolcoline-coated cardiopulmonary by-pass circuits on morbidity and mortality in patients with congenital open cardiac surgery. JOURNAL OF HEALTH SCIENCES AND MEDICINE 2021. [DOI: 10.32322/jhsm.854196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
|
13
|
Pomeraniec IJ, Mastorakos P, Raper D, Park MS. Rerupture Following Flow Diversion of a Dissecting Aneurysm of the Vertebral Artery: Case Report and Review of the Literature. World Neurosurg 2020; 143:171-179. [PMID: 32730963 DOI: 10.1016/j.wneu.2020.07.149] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 07/20/2020] [Accepted: 07/21/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Dissecting aneurysms of the posterior cerebral circulation can wield significant treatment challenges with devastating clinical outcomes. Despite an expanded therapeutic armamentarium, these vascular lesions remain relatively difficult to diagnose and portend high associated morbidity and mortality. METHODS A ruptured, fusiform, dissecting aneurysm of the mid V4 segment of the right vertebral artery (VA) distal to the posterior inferior cerebellar artery origin resulted in a Hunt and Hess grade 5, Fisher scale score 4 subarachnoid hemorrhage. The lesion incorporated 360 degrees of the vessel wall and extended across an area measuring 11 mm in length and 6.8 mm in width at maximum dimension. The vascular lesion was treated with 2 overlapping Pipeline Embolization Devices. RESULTS Digital subtraction angiography demonstrated an origin of the right posterior inferior cerebellar artery mildly stenosed by the dissecting aneurysm. The left VA was markedly hypoplastic. After deployment of 2 overlapping Pipeline Embolization Devices, the aneurysm neck was well covered with appropriate positioning of the stent construct with good apposition to the vessel wall. There was contrast stasis within the aneurysm. The patient was managed with dual antiplatelet therapy. He demonstrated initial clinical and radiographic improvement. However, on the night of the second postprocedure day, the patient succumbed to rerupture of the aneurysm. CONCLUSIONS The literature posits that nonsaccular, fusiform, and dissecting aneurysms of the vertebrobasilar circulation can be occluded with consistency and success using flow diversion techniques. Endovascular treatment of a ruptured dissecting aneurysm of the VA is technically feasible and can be performed with or without parent artery occlusion. Outcomes following flow diversion of the posterior circulation may depend on the location of the dissection and viability of collateral circulation. In the present case, adequate coverage of the aneurysm did not portend a positive outcome.
Collapse
Affiliation(s)
- I Jonathan Pomeraniec
- Department of Neurosurgery, University of Virginia Health Science Center, Charlottesville, Virginia, USA
| | - Panagiotis Mastorakos
- Department of Neurosurgery, University of Virginia Health Science Center, Charlottesville, Virginia, USA
| | - Daniel Raper
- Department of Neurosurgery, University of Virginia Health Science Center, Charlottesville, Virginia, USA
| | - Min S Park
- Department of Neurosurgery, University of Virginia Health Science Center, Charlottesville, Virginia, USA; Department of Interventional Neuroradiology, University of Virginia Health Science Center, Charlottesville, Virginia, USA.
| |
Collapse
|
14
|
Oushy S, Rinaldo L, Brinjikji W, Cloft H, Lanzino G. Recent advances in stent-assisted coiling of cerebral aneurysms. Expert Rev Med Devices 2020; 17:519-532. [PMID: 32500761 DOI: 10.1080/17434440.2020.1778463] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
INTRODUCTION Stent-assisted coiling (SAC) of intracranial aneurysms paved the way for endovascular coiling of wide-neck and bifurcation aneurysms, improving rates of aneurysm obliteration and recurrence. In this review, we provide a comprehensive review of the most recent advances related to stent-assisted coiling of intracranial aneurysm. AREAS COVERED The authors have made an attempt to cover the inception, applications, and limitations of SAC of intracranial aneurysms. Special focus is given to 1) the current and recently introduced SAC techniques, 2) most recent advances in device technology, and 3) outcome data for the discussed techniques and devices. The authors also discuss the potential future direction of SAC. EXPERT OPINION technical refinements in the field of SAC should continue to focus on device development and addressing the limitations of SAC, namely aneurysm recurrence and need of antiplatelet agents. Although the recurrence rate of SAC has not been shown to be inferior to flow diverters, the use of intrasaccular and intravascular flow diverters are likely to expand in the future at the expense of SAC.
Collapse
Affiliation(s)
- Soliman Oushy
- Department of Neurosurgery, Mayo Clinic , Rochester, MN, USA
| | - Lorenzo Rinaldo
- Department of Neurosurgery, Mayo Clinic , Rochester, MN, USA
| | - Waleed Brinjikji
- Department of Neurosurgery, Mayo Clinic , Rochester, MN, USA.,Department of Radiology, Mayo Clinic , Rochester, MN, USA
| | - Harry Cloft
- Department of Neurosurgery, Mayo Clinic , Rochester, MN, USA.,Department of Radiology, Mayo Clinic , Rochester, MN, USA
| | - Giuseppe Lanzino
- Department of Neurosurgery, Mayo Clinic , Rochester, MN, USA.,Department of Radiology, Mayo Clinic , Rochester, MN, USA
| |
Collapse
|
15
|
Mohammaden MH, English SW, Stapleton CJ, Khedr E, Shoyb A, Hegazy A, Elbassiouny A. Safety and efficacy of ticagrelor as single antiplatelet therapy in prevention of thromboembolic complications associated with the Pipeline Embolization Device (PED): multicenter experience. J Neurointerv Surg 2020; 12:1113-1116. [PMID: 32471826 DOI: 10.1136/neurintsurg-2020-015978] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2020] [Revised: 04/08/2020] [Accepted: 04/10/2020] [Indexed: 11/04/2022]
Abstract
BACKGROUND Flow diversion (FD) is a common treatment modality for complex intracranial aneurysms. A major concern regarding the use of FD is thromboembolic events (TEE). There is debate surrounding the optimal antiplatelet regimen to prevent TEE. We aim to evaluate the safety and efficacy of ticagrelor as a single antiplatelet therapy (SAPT) for the prevention of TEE following FD for complex aneurysm treatment. METHODS A retrospective review of a prospectively maintained neuroendovascular database at three endovascular centers was performed. Patients were included if they had an intracranial aneurysm that was treated with FD between January 2018 and September 2019 and were treated with ticagrelor as SAPT. Primary outcomes included early (within 72 hours post-procedure) and late (within 6 months) ischemic events. RESULTS A total of 24 patients (mean age 47.7 years) with 36 aneurysms were eligible for analysis, including 15 (62.5%) females. 14 (58.3%) patients presented with subarachnoid hemorrhage. 35 aneurysms arose from the anterior circulation and 1 from the posterior circulation. 23 aneurysms had a saccular morphology, whereas 7 were fusiform and 6 were blister. For the treatment of all 36 aneurysms, 30 procedures were performed with 32 FD devices. Procedural in-stent thrombosis occurred in 2 cases and was treated with intra-arterial tirofiban without complications. Aneurysm re-bleeding was reported in 1 (4.2%) patient. There were no reported early or late TEE. Three patients discontinued ticagrelor due to systemic side effects. CONCLUSION Ticagrelor is a safe and effective SAPT for the prevention of TEE after FD. Large multicenter prospective studies are warranted to validate our findings.
Collapse
Affiliation(s)
- Mahmoud H Mohammaden
- Department of Neurology, Faculty of Medicine, South Valley University, Qena, Egypt.,Department of Neurology, Marcus Stroke & Neuroscience Center, Grady Memorial Hospital, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Stephen W English
- Department of Neurology, Marcus Stroke & Neuroscience Center, Grady Memorial Hospital, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Christopher J Stapleton
- Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Eman Khedr
- Department of Neurology, Assiut University Faculty of Medicine, Assiut, Egypt
| | - Ahmed Shoyb
- Department of Neurology, Faculty of Medicine, Aswan University, Sahary City, Egypt
| | - Ahmed Hegazy
- Department of Neurosurgery, Cairo University Kasr Alainy Faculty of Medicine, Cairo, Egypt
| | - Ahmed Elbassiouny
- Department of Neurology, Ain Shams University Faculty of Medicine, Cairo, Egypt
| |
Collapse
|
16
|
Mahmoud M, Farag A, Farid M, Elserwi A, Abdelsamad A, Guergues W, Hassan F. Application of flow diverters in the treatment of aneurysms in the internal carotid artery bifurcation region. Neuroradiol J 2020; 33:297-305. [PMID: 32419609 DOI: 10.1177/1971400920924840] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
INTRODUCTION The treatment of aneurysms in the internal carotid bifurcation region (ICABR), including aneurysms of the true internal carotid artery (ICA) terminus, those inclined on the proximal A1 or M1 segments or at the most distal pre-bifurcation (ICA) segment, is often challenging in microsurgical clipping and endovascular surgery. Few reports had discussed flow diversion as a therapeutic option for this group. METHODS This was a retrospective study analysing flow diversion in treating ICABR aneurysms. Seven patients harbouring eight aneurysms in the ICABR were treated with flow diversion. Five aneurysms were inclined on the proximal A1 segment, and three were located at the most distal pre-bifurcation segment. Patients' demographics, presentation, procedure technical description, angiographic and clinical follow-up were recorded. PubMed and Ovid MEDLINE were also reviewed for articles published in English, including case series or case reports, for ICABR aneurysms treated with flow diverters. RESULTS All patients except one underwent angiographic follow-up. The Karman-Byrne occlusion scale was used to determine the occlusion rate. All six patients with documented angiographic follow-up had a class IV occlusion score. No permanent or transient neurological or non-neurological complications were encountered in this study. CONCLUSION Treating ICABR aneurysms using flow diversion is feasible, with a promising angiographic occlusion rate. Further studies are needed to analyse long-term clinical and angiographic results.
Collapse
Affiliation(s)
| | - Ahmed Farag
- Radiology Department, Ain Shams University Hospital, Egypt
| | - Mostafa Farid
- Radiology Department, Ain Shams University Hospital, Egypt
| | - Ahmed Elserwi
- Radiology Department, Ain Shams University Hospital, Egypt
| | - Amr Abdelsamad
- Radiology Department, Ain Shams University Hospital, Egypt
| | | | | |
Collapse
|
17
|
Sefton MV, Gorbet MB. Nonthrombogenic Treatments and Strategies. Biomater Sci 2020. [DOI: 10.1016/b978-0-12-816137-1.00035-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
18
|
Lenz-Habijan T, Bhogal P, Bannewitz C, Hannes R, Monstadt H, Simgen A, Mühl-Benninghaus R, Reith W, Henkes H. Prospective study to assess the tissue response to HPC-coated p48 flow diverter stents compared to uncoated devices in the rabbit carotid artery model. Eur Radiol Exp 2019; 3:47. [PMID: 31807964 PMCID: PMC6895370 DOI: 10.1186/s41747-019-0128-z] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Accepted: 10/10/2019] [Indexed: 01/08/2023] Open
Abstract
Background Flow diverters (FDs) are widely used in the treatment of intracranial aneurysms, but the required medication increases the risk of haemorrhagic complications and limits their use in the acute setting. Surface modified FDs may limit the need for dual antiplatelet therapy (DAPT). Hydrophilic polymer coating (HPC) may reduce the need of medication. Methods This explorative study, approved by the local authorities and the local welfare committee, compared stent behaviour and overall tissue response between HPC-coated FDs and uncoated FDs, both implanted into the common carotid arteries of eight New Zealand white rabbits. Endothelialisation, inflammatory response, and performance during implantation were assessed. Angiographic follow-up was performed to observe the patency of the devices after implantation and after 30 days. Histological examinations were performed at 30 days to assess foreign body reaction and endothelialisation. Kruskal-Wallis and Wilcoxon tests were used to compare non-parametric variables. Results Angiography showed that both coated and uncoated FDs performed well during implantation. All devices remained patent during immediate follow-up and after 30 days. Histopathology showed no significant difference in inflammation within the vessel wall between the two cohorts (2.12 ± 0.75 vs. 1.96 ± 0.79, p = 0.7072). Complete endothelialisation of the stent struts was seen with very similar (0.04 ± 0.02 mm vs. 0.04 ± 0.03 mm, p = 0.892) neoendothelial thickness between the two cohorts after 30 days. Conclusion Taking into account the limitation in sample size, non-significant differences between the HPC-coated and uncoated FDs regarding implantation, foreign body response, and endothelialisation were found.
Collapse
Affiliation(s)
| | - Pervinder Bhogal
- Department of Interventional Neuroradiology, The Royal London Hospital, Whitechapel Road, London, E1 1BB, UK.
| | | | | | | | - Andreas Simgen
- Department of Neuroradiology, Saarland University, Homburg, Saar, Germany
| | | | - Wolfgang Reith
- Department of Neuroradiology, Saarland University, Homburg, Saar, Germany
| | - Hans Henkes
- Neuroradiological Clinic, Klinikum Stuttgart, Stuttgart, Germany.,Medical Faculty, University Duisburg-Essen, Essen, Germany
| |
Collapse
|
19
|
Comparison of the Thrombogenicity of a Bare and Antithrombogenic Coated Flow Diverter in an In Vitro Flow Model. Cardiovasc Intervent Radiol 2019; 43:140-146. [PMID: 31410532 PMCID: PMC6940313 DOI: 10.1007/s00270-019-02307-5] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Accepted: 08/05/2019] [Indexed: 12/25/2022]
Abstract
BACKGROUND Dual antiplatelet therapy is a pre-requisite for flow diverter (FD) implantation. The purpose of this study was to assess the thrombogenicity of the p48 FD, coated with the newly developed phenox Hydrophilic Polymer Coating (p48_HPC, phenox GmbH, Germany) in comparison with uncoated p48 FDs in an in vitro flow model (Chandler Loop). METHODS p48 and p48_HPC FDs were implanted into silicon tubes filled with whole human blood and incubated at 37 °C under pulsating flow. After 120 min, platelet count was determined in the blood. Platelet activation markers (PAR1) and formation of microparticles were analyzed in a flow cytometer. Fluorescence microscopy of CD42a positive cells and scanning electron microscopy was used to detect adherent platelets on the wire surface. RESULTS Platelets in contact with the uncoated p48 FDs are significantly more activated than those incubated with p48_HPC (73 ± 9% vs. 65 ± 6%, p < 0.05) and release more microparticles (1.8 ± 0.5 vs. 1.4 ± 0.4, p < 0.05). The platelet count after 120-min circulation in the Chandler Loop was significantly lower for the uncoated p48 compared to the p48_HPC indicating significantly greater adherence of the platelets to the p48 (71 ± 8% vs. 87 ± 5%, p < 0.05). SEM and fluorescent antibody imaging revealed minimal platelet adherence to the surface of the p48_HPC compared to the uncoated p48. CONCLUSION The pHPC coating significantly reduces thrombogenicity of the p48 FD. This may help to reduce the risk of thromboembolic complications when using these devices. A reduction in antiplatelet therapy may be possible.
Collapse
|
20
|
Ishihara K. Revolutionary advances in 2‐methacryloyloxyethyl phosphorylcholine polymers as biomaterials. J Biomed Mater Res A 2019; 107:933-943. [DOI: 10.1002/jbm.a.36635] [Citation(s) in RCA: 124] [Impact Index Per Article: 24.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Accepted: 01/24/2019] [Indexed: 12/19/2022]
Affiliation(s)
- Kazuhiko Ishihara
- Department of Materials Engineering The University of Tokyo 7‐3‐1 Hongo, Bunkyo‐ku, Tokyo 113‐8656 Japan
| |
Collapse
|
21
|
Martínez Moreno R, Bhogal P, Lenz-Habijan T, Bannewitz C, Siddiqui A, Lylyk P, Hannes R, Monstadt H, Henkes H. In vivo canine study of three different coatings applied to p64 flow-diverter stents: initial biocompatibility study. Eur Radiol Exp 2019; 3:3. [PMID: 30671686 PMCID: PMC6342750 DOI: 10.1186/s41747-018-0084-z] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Accepted: 12/27/2018] [Indexed: 11/26/2022] Open
Abstract
Background Flow-diverter stents (FDSs) have revolutionised the treatment of intracranial aneurysms. However, associated dual antiplatelet treatment is mandatory. We investigated the biocompatibility of three proprietary antithrombogenic coatings applied to FDSs. Methods After Institutional Animal Care and Use Committee approval, four domestic juvenile female dogs (weight 19.9 ± 0.9 kg, mean ± standard deviation) were commenced on three different oral antiplatelet regimes: no medication (n = 1), acetylsalicylic acid (n = 2), and acetylsalicylic acid and clopidogrel (n = 1). Four p64 FDSs were randomly implanted into the subclavian, common carotid, and external carotid arteries of each dog, including both uncoated p64 stents and p64 stents coated with three different antithrombogenic hydrophilic coating (HPC). Angiography and histological examinations were performed. Wilcoxon/Kruskal-Wallis and ANOVA were used with p value < 0.05 considered as significant. Results Minimal inflammatory cell infiltration and no device-associated granulomatous cell inflammation were observed. No significant difference in adventitial inflammation (p = 0.522) or neointimal/medial inflammation (p = 0.384) between coated and uncoated stents as well as between the different stent groups regarding endothelial cell loss, surface fibrin/platelet deposition, medial smooth muscle cell loss, or adventitial fibrosis were found. Acute self-limiting thrombus formed on 6/16 implants (37.5%), and all of the thrombi were noted on devices implanted in the common or external carotid artery irrespective of the surface coating. Two of 12 p64 HPC-coated stents (16.7%) and 1/4 uncoated p64 stents (25%) showed severe or complete stenosis at delayed angiography. Conclusions In these preliminary in vivo experiments, HPC-coated p64 FDSs appeared to be biocompatible, without acute inflammation.
Collapse
Affiliation(s)
| | - Pervinder Bhogal
- Department of Interventional Neuroradiology, The Royal London Hospital, Whitechapel Road, London, E1 1BB, UK.
| | | | | | - Adnan Siddiqui
- Jacobs School of Medicine and Biomedical Science, University of Buffalo, Buffalo, NY, USA
| | - Pedro Lylyk
- Clinica Sagrada Familia, ENERI, Buenos Aires, Argentina
| | | | | | - Hans Henkes
- Neurozentrum, Klinikum Stuttgart, Stuttgart, Germany.,Medical Faculty, University Duisburg-Essen, Essen, Germany
| |
Collapse
|
22
|
Manning NW, Cheung A, Phillips TJ, Wenderoth JD. Pipeline shield with single antiplatelet therapy in aneurysmal subarachnoid haemorrhage: multicentre experience. J Neurointerv Surg 2018; 11:694-698. [PMID: 30552166 PMCID: PMC6582735 DOI: 10.1136/neurintsurg-2018-014363] [Citation(s) in RCA: 86] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Revised: 11/14/2018] [Accepted: 11/19/2018] [Indexed: 11/18/2022]
Abstract
Background The Pipeline Embolisation Device with Shield technology (PED-Shield) is suggested to have reduced thrombogenicity. This reduced thrombogenicity may make it possible to use safely in the acute treatment of aneurysmal subarachnoid haemorrhage (aSAH) on single antiplatelet therapy (SAPT). Objective To evaluate the safety and efficacy of the off-label use of PED-Shield with SAPT for the acute treatment of aSAH. Methods Patients who underwent acute treatment of ruptured intracranial aneurysms with the PED-Shield with SAPT were retrospectively identified from prospectively maintained databases at three Australian neurointerventional centres. Patient demographics, aneurysm characteristics, clinical and imaging outcomes were reviewed. Results Fourteen patients were identified (12 women), median age 64 (IQR 21.5) years. Aneurysm morphology was saccular in seven, fusiform in five, and blister in two. Aneurysms arose from the anterior circulation in eight patients (57.1%). Six (42.9%) patients were poor grade (World Federation of Neurological Societies grade ≥IV) SAH. Median time to treatment was 1 (IQR 0.5) day. Complete or near complete aneurysm occlusion (Raymond-Roy <3) was achieved in 12 (85.7%) patients at the end of early-acute follow-up (median day 7 after SAH). Permanent, treatment-related morbidity occurred in one (7.1%) patient and one (7.1%) treatment-related death occurred. The use of a postoperative heparin infusion (n=5) was associated with a higher rate of all complications (80.0% vs 11.1%, p=0.023) and symptomatic complications (60% vs 0.0%, p=0.028). No symptomatic ischaemic or haemorrhagic complications were observed in the patients who did not receive a post-operative heparin infusion. Nine (64.3%) patients were functionally independent on discharge from the treatment centre. Conclusion The PED-Shield may be safe to use in the acute treatment of ruptured intracranial aneurysms with SAPT. Further investigation with a formal treatment registry is needed.
Collapse
Affiliation(s)
- Nathan W Manning
- Institute of Neurological Sciences, Prince of Wales Hospital, Randwick, New South Wales, Australia.,Department of Interventional Neuroradiology, Liverpool Hospital, Liverpool, New South Wales, Australia.,Ingham Institute for Applied Medical Research, Sydney, New South Wales, Australia.,Prince of Wales Clinical School, University of New South Wales, Sydney, New South Wales, Australia.,Florey Institute of Neuroscience, Parkville, Victoria, Australia
| | - Andrew Cheung
- Institute of Neurological Sciences, Prince of Wales Hospital, Randwick, New South Wales, Australia.,Department of Interventional Neuroradiology, Liverpool Hospital, Liverpool, New South Wales, Australia.,Ingham Institute for Applied Medical Research, Sydney, New South Wales, Australia
| | - Timothy J Phillips
- Neurological Intervention and Imaging Service Western Australia (W.A.), Sir Charles Gairdner Hospital, Perth, Western Australia, Australia
| | - Jason D Wenderoth
- Institute of Neurological Sciences, Prince of Wales Hospital, Randwick, New South Wales, Australia.,Department of Interventional Neuroradiology, Liverpool Hospital, Liverpool, New South Wales, Australia.,Ingham Institute for Applied Medical Research, Sydney, New South Wales, Australia.,Prince of Wales Clinical School, University of New South Wales, Sydney, New South Wales, Australia
| |
Collapse
|
23
|
Hydrophilic Stent Coating Inhibits Platelet Adhesion on Stent Surfaces: Initial Results In Vitro. Cardiovasc Intervent Radiol 2018; 41:1779-1785. [PMID: 30039502 PMCID: PMC6182755 DOI: 10.1007/s00270-018-2036-7] [Citation(s) in RCA: 50] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Accepted: 05/20/2018] [Indexed: 11/30/2022]
Abstract
Background Endovascular stents and flow diverter stents (FDS) have revolutionized the treatment of intradural aneurysms; however, the need for dual anti-platelet treatment (DAPT) limits their use and can cause additional issues. Therefore, there is a need to develop stent coatings that negate the need for DAPT. Methods Two different hydrophilic polymer coatings (HPC-I and HPC-II) were used to coat small nickel titanium plates to initially test the hydrophilic properties of these coatings when applied to nickel titanium. The plates were subsequently incubated with non-medicated whole blood from healthy volunteers for 10 min and stained with a CD61 immunofluorescent antibody that allows detection of adherent platelets. The coatings were applied to FDS wires and were again incubated with non-medicated whole blood from the same volunteers. Scanning electron microscopy was used to detect adherent platelets on the wire surface. Results The HPC-II coating (1.12 ± 0.4%) showed a significantly lower CD61 +ve cell count (p ≤ 0.001) compared to both uncoated NiTi plates (48.61 ± 7.3%) and those with the HPC-I coating (mean 40.19 ± 8.9%). Minimal adherent platelets were seen on the FDS nickel titanium wires coated with the HPC-II compared to uncoated FDS under electron microscopy. Conclusion There is a significant decrease in the number of adherent CD61 +ve platelets on nickel titanium surfaces coated with the HPC-II coating compared to uncoated surfaces. The coating can be successfully applied to the wires of flow diverters. The results of this study are promising with regard to the development of new anti-thrombogenic endovascular devices.
Collapse
|
24
|
Matsuda Y, Jang DK, Chung J, Wainwright JM, Lopes D. Preliminary outcomes of single antiplatelet therapy for surface-modified flow diverters in an animal model: analysis of neointimal development and thrombus formation using OCT. J Neurointerv Surg 2018; 11:74-79. [PMID: 29804090 PMCID: PMC6327918 DOI: 10.1136/neurintsurg-2018-013935] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Revised: 04/19/2018] [Accepted: 04/26/2018] [Indexed: 11/09/2022]
Abstract
Objective To evaluate the rate of neointimal development and thrombus formation of surface-modified flow diverters in single antiplatelet therapy (SAPT) using optical coherence tomography (OCT) in a porcine model. Methods We divided 10 experimental pigs into two groups. One group (n=6) received dual antiplatelet therapy (DAPT) and the other group (n=4) received SAPT. Four stents (two per carotid artery) were implanted in both groups. The stents used were the Pipeline Flex embolization device (PED Flex), Pipeline Flex with Shield technology (PED Shield), and the Solitaire AB stent. All animals underwent weekly angiography and OCT. The OCT data were analyzed using the following measurements: neointimal ratio ((stent – lumen area)/stent area), stent-coverage ratio (number of stent struts covered by neointima/total stent struts), and the presence or absence of thrombus formation per 1 mm cross-section. Results PED Flex and Shield in the SAPT group had higher neointimal ratios than in the DAPT group (P<0.001, respectively). In the DAPT group, the speed of endothelial growth on day 7 in the PED Shield group was higher than that in the PED Flex group (P<0.001). In the SAPT group, PED Flex demonstrated significantly more thrombus formation on day 7 than PED Shield (P<0.001). Conclusions The PED Shield stent showed faster endothelial growth than the other devices and comparable neointimal volume. There was significantly less thrombus formation on PED Shield than PED Flex when using SAPT in a porcine model.
Collapse
Affiliation(s)
- Yoshikazu Matsuda
- Department of Neurological Surgery, Rush University Medical Center, Chicago, Illinois, USA.,Department of Neurosurgery, Wakayama Medical University, Wakayama City, Japan
| | - Dong-Kyu Jang
- Department of Neurological Surgery, Rush University Medical Center, Chicago, Illinois, USA.,Department of Neurosurgery, Incheon St Mary's Hospital, College of Medicine, The Catholic University of Korea, Incheon, Republic of Korea
| | - Joonho Chung
- Department of Neurological Surgery, Rush University Medical Center, Chicago, Illinois, USA.,Department of Neurosurgery, Stroke Center, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | | | - Demetrius Lopes
- Department of Neurological Surgery, Rush University Medical Center, Chicago, Illinois, USA
| |
Collapse
|
25
|
Abstract
Purpose of Review There are three technological parameters that play a key role on the performance of an ideal stent. These are its material, design and surface coating. This article highlights some fundamental developments that took place in these three areas of stent’s technology, in order to contribute to the identification of an ideal stent. Recent Findings In addition to technological developments concerning stent’s material, design and surface coating, the flow dynamic performance of stents has recently attracted increasing attention. Notably, it has been postulated that the local flow field in a stent is correlated with the deposition of crystals and microorganisms. These findings could potentially revolutionise future stent’s designs, and complement developments made on materials and coatings. Summary The most relevant changes in materials, designs and surface coatings of ureteric stents are reviewed in this article. These are described in the context of a specific cause of stent’s failure they aim to address, with a particular focus on encrustation and biofilm formation.
Collapse
Affiliation(s)
- Ali Mosayyebi
- Bioengineering Science Research Group, Faculty of Engineering and the Environment, University of Southampton, Southampton, UK. .,Institute for Life Sciences (IfLS), University of Southampton, Southampton, UK.
| | - Costantino Manes
- Department of Environment, Land and Infrastructure Engineering, Politecnico di Torino, Turin, Italy
| | - Dario Carugo
- Bioengineering Science Research Group, Faculty of Engineering and the Environment, University of Southampton, Southampton, UK.,Institute for Life Sciences (IfLS), University of Southampton, Southampton, UK
| | - Bhaskar K Somani
- Department of Urology, University Hospital Southampton NHS Trust, Southampton, UK
| |
Collapse
|
26
|
Salehi-Nik N, Malaie-Balasi Z, Amoabediny G, Banikarimi SP, Zandieh-Doulabi B, Klein-Nulend J. Sustained release of growth hormone and sodium nitrite from biomimetic collagen coating immobilized on silicone tubes improves endothelialization. MATERIALS SCIENCE & ENGINEERING. C, MATERIALS FOR BIOLOGICAL APPLICATIONS 2017; 77:1204-1215. [PMID: 28531997 DOI: 10.1016/j.msec.2017.03.172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/19/2016] [Revised: 12/28/2016] [Accepted: 03/20/2017] [Indexed: 10/19/2022]
Abstract
Biocompatibility of biomedical devices can be improved by endothelialization of blood-contacting parts mimicking the vascular endothelium's function. Improved endothelialization might be obtained by using biomimetic coatings that allow local sustained release of biologically active molecules, e.g. anti-thrombotic and growth-inducing agents, from nanoliposomes. We aimed to test whether incorporation of growth-inducing nanoliposomal growth hormone (nGH) and anti-thrombotic nanoliposomal sodium nitrite (nNitrite) into collagen coating of silicone tubes enhances endothelialization by stimulating endothelial cell proliferation and inhibiting platelet adhesion. Collagen coating stably immobilized on acrylic acid-grafted silicone tubes decreased the water contact angle from 102° to 56°. Incorporation of 50 or 500nmol/ml nNitrite and 100 or 1000ng/ml nGH into collagen coating decreased the water contact angle further to 48°. After 120h incubation, 58% nitrite and 22% GH of the initial amount of sodium nitrite and GH in nanoliposomes were gradually released from the nNitrite-nGH-collagen coating. Endothelial cell number was increased after surface coating of silicone tubes with collagen by 1.6-fold, and with nNitrite-nGH-collagen conjugate by 1.8-3.9-fold after 2days. After 6days, endothelial cell confluency in the absence of surface coating was 22%, with collagen coating 74%, and with nNitrite-nGH-collagen conjugate coating 83-119%. In the absence of endothelial cells, platelet adhesion was stimulated after collagen coating by 1.3-fold, but inhibited after nNitrite-nGH-collagen conjugate coating by 1.6-3.7-fold. The release of anti-thrombotic prostaglandin I2 from endothelial cells was stimulated after nNitrite-nGH-collagen conjugate coating by 1.7-2.2-fold compared with collagen coating. Our data shows improved endothelialization and blood compatibility using nNitrite-nGH-collagen conjugate coating on silicone tubes suggesting that these coatings are highly suitable for use in blood-contacting parts of biomedical devices.
Collapse
Affiliation(s)
- Nasim Salehi-Nik
- School of Chemical Engineering, College of Engineering, University of Tehran,111554563, Enqelab Avenue, Tehran, Iran; Department of Oral Cell Biology, Academic Centre for Dentistry Amsterdam, University of Amsterdam and VU University Amsterdam, MOVE Research Institute Amsterdam, Gustav Mahlerlaan 3008, 1081 LA Amsterdam, The Netherlands; Department of Tissue Engineering, School of Advanced Technologies in Medicine, Shahid Beheshti University of Medical Sciences, 1985717443, Velenjak, Shahid Chamran Highway, Tehran, Iran.
| | - Zahra Malaie-Balasi
- Research Center for New Technologies in Life Science Engineering, University of Tehran,143951374, Enqelab Avenue, Tehran, Iran.
| | - Ghassem Amoabediny
- School of Chemical Engineering, College of Engineering, University of Tehran,111554563, Enqelab Avenue, Tehran, Iran; Research Center for New Technologies in Life Science Engineering, University of Tehran,143951374, Enqelab Avenue, Tehran, Iran.
| | - Seyedeh Parnian Banikarimi
- School of Chemical Engineering, College of Engineering, University of Tehran,111554563, Enqelab Avenue, Tehran, Iran; Research Center for New Technologies in Life Science Engineering, University of Tehran,143951374, Enqelab Avenue, Tehran, Iran.
| | - Behrouz Zandieh-Doulabi
- Department of Oral Cell Biology, Academic Centre for Dentistry Amsterdam, University of Amsterdam and VU University Amsterdam, MOVE Research Institute Amsterdam, Gustav Mahlerlaan 3008, 1081 LA Amsterdam, The Netherlands; Department of Tissue Engineering, School of Advanced Technologies in Medicine, Shahid Beheshti University of Medical Sciences, 1985717443, Velenjak, Shahid Chamran Highway, Tehran, Iran.
| | - Jenneke Klein-Nulend
- Department of Oral Cell Biology, Academic Centre for Dentistry Amsterdam, University of Amsterdam and VU University Amsterdam, MOVE Research Institute Amsterdam, Gustav Mahlerlaan 3008, 1081 LA Amsterdam, The Netherlands; Department of Tissue Engineering, School of Advanced Technologies in Medicine, Shahid Beheshti University of Medical Sciences, 1985717443, Velenjak, Shahid Chamran Highway, Tehran, Iran.
| |
Collapse
|
27
|
Abstract
Atherosclerotic disease of the cerebral vasculature is a major cause of stroke worldwide. Atherosclerosis that is refractory to best medical management may require revascularization. In these instances, endovascular treatment provides a popular and safe alternative to open surgical techniques. The authors provide an overview of stent technology in the treatment of ischemic stroke, discussing the major studies evaluating stenting for extracranial carotid artery, vertebral artery, and intracranial atherosclerotic disease. The authors describe the commonly used stents with respect to their individual characteristics and technical limitations. Current and future developments in stent technology are also discussed, with areas for further innovation and clinical research.
Collapse
Affiliation(s)
- Nam K Yoon
- Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah
| | - Al-Wala Awad
- Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah
| | - M Yashar S Kalani
- Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah
| | - Philipp Taussky
- Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah
| | - Min S Park
- Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah
| |
Collapse
|
28
|
Biomimetic Principles to Develop Blood Compatible Surfaces. Int J Artif Organs 2017; 40:22-30. [DOI: 10.5301/ijao.5000559] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/27/2017] [Indexed: 12/11/2022]
Abstract
Functionalized biomaterial surface patterns capable of resisting nonspecific adsorption while retaining their bioactivity are crucial in the advancement of biomedical technologies, but currently available biomaterials intended for use in whole blood frequently suffer from nonspecific adsorption of proteins and cells, leading to a loss of activity over time. In this review, we address two concepts for the design and modification of blood compatible biomaterial surfaces, zwitterionic modification and surface functionalization with glycans – both of which are inspired by the membrane structure of mammalian cells – and discuss their potential for biomedical applications.
Collapse
|
29
|
Rubens FD, Mesana T. The inflammatory response to cardiopulmonary bypass: a therapeutic overview. Perfusion 2016; 19 Suppl 1:S5-12. [PMID: 15161059 DOI: 10.1191/0267659104pf717oa] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The demographic of cardiac surgery patients continues to evolve to include older, sicker candidates, all the while maintaining an expectation of excellent outcomes. These latter results can only be achieved by the parallel advancement and re-examination of the technology of cardiopulmonary bypass (CPB); the key tool used daily by surgical teams worldwide. In this review, we will provide an overview of integrated therapeutic strategies that can be utilized to minimize the complex and myriad changes related to inflammation after CPB with the understanding that this may abrogate the detrimental end-organ and systemic effects of blood activation. Therapeutic strategies specifically related to the technology can be classified into those targeting biomaterial dependent or independent processes. The former can be addressed by the utilization of currently available biocompatible surfaces such as with heparin-coated circuits, phosphorylcholine-coated circuits (‘biomembrane mimicry’) and circuits composed of copolymers containing surface-modifying additives. The most important strategies related to biomaterial independent activation include the modification of techniques related to cardiotomy blood management and blood filtration. Finally, all of these strategies must be integrated and tailored with complementary pharmacologic agents such as aprotinin and steroids to optimize anti-inflammatory synergism. Only if we are armed with a comprehensive knowledge of the molecular and cellular basis for these strategies will we be able to continue to evolve our treatment in parallel with our patients to achieve these goals.
Collapse
Affiliation(s)
- F D Rubens
- Division of Cardiac Surgery, University of Ottawa Heart Institute, Ottawa, Ontario, Canada.
| | | |
Collapse
|
30
|
Hagen MW, Girdhar G, Wainwright J, Hinds MT. Thrombogenicity of flow diverters in an ex vivo shunt model: effect of phosphorylcholine surface modification. J Neurointerv Surg 2016; 9:1006-1011. [PMID: 27799376 PMCID: PMC5629931 DOI: 10.1136/neurintsurg-2016-012612] [Citation(s) in RCA: 58] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2016] [Revised: 08/25/2016] [Accepted: 08/29/2016] [Indexed: 11/03/2022]
Abstract
BACKGROUND Flow diverters offer a promising treatment for cerebral aneurysms. However, they have associated thromboembolic risks, mandating chronic dual antiplatelet therapy (DAPT). Shield Technology is a phosphorylcholine surface modification of the Pipeline Embolization Device (PED) flow diverter, which has shown significant reductions in material thrombogenicity in vitro. OBJECTIVE To compare the thrombogenicity of PED, PED with Shield Technology (PED+Shield), and the Flow-Redirection Endoluminal Device (FRED)-with and without single antiplatelet therapy and DAPT-under physiological flow. METHODS An established non-human primate ex vivo arteriovenous shunt model of stent thrombosis was used. PED, PED+Shield, and FRED were tested without antiplatelet therapy, with acetylsalicylic acid (ASA) monotherapy, and with DAPT. Radiolabeled platelet deposition was quantified over 1 hour for each device and total fibrin deposition was also quantified. RESULTS Cumulative statistical analysis showed significantly lower platelet deposition on PED compared with FRED. The same statistical model showed significant decreases in platelet deposition when ASA, clopidogrel, or Shield Technology was used. Direct comparisons of device performances within antiplatelet conditions showed consistent significant decreases in platelet accumulation on PED+Shield relative to FRED. PED+Shield showed significant reductions in platelet deposition compared with unmodified PED without antiplatelet therapy and with DAPT. PED accumulated minimal fibrin with and without Shield Technology. CONCLUSIONS In this preclinical model, we have shown that the Shield Technology phosphorylcholine modification reduces the platelet-specific thrombogenicity of a flow diverter under physiologically relevant flow with and without DAPT. We have further identified increased fibrin-driven thrombogenicity associated with FRED relative to PED.
Collapse
Affiliation(s)
- Matthew W Hagen
- Department of Biomedical Engineering, Oregon Health & Science University, Portland, Oregon, USA
| | | | | | - Monica T Hinds
- Department of Biomedical Engineering, Oregon Health & Science University, Portland, Oregon, USA
| |
Collapse
|
31
|
Consolo F, Valerio L, Brizzola S, Rota P, Marazzato G, Vincoli V, Reggiani S, Redaelli A, Fiore G. On the Use of the Platelet Activity State Assay for the In Vitro Quantification of Platelet Activation in Blood Recirculating Devices for Extracorporeal Circulation. Artif Organs 2016; 40:971-980. [DOI: 10.1111/aor.12672] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Affiliation(s)
- Filippo Consolo
- Dipartimento di Elettronica, Informazione e Bioingegneria; Politecnico di Milano; Milano Italy
| | - Lorenzo Valerio
- Dipartimento di Elettronica, Informazione e Bioingegneria; Politecnico di Milano; Milano Italy
| | - Stefano Brizzola
- Dipartimento di Scienze Veterinarie per la Salute, la Produzione Animale e la Sicurezza Alimentare, Facoltà di Medicina Veterinaria; Università di Milano; Milano Italy
| | - Paolo Rota
- Dipartimento di Elettronica, Informazione e Bioingegneria; Politecnico di Milano; Milano Italy
| | - Giulia Marazzato
- Dipartimento di Elettronica, Informazione e Bioingegneria; Politecnico di Milano; Milano Italy
| | - Valentina Vincoli
- Dipartimento di Elettronica, Informazione e Bioingegneria; Politecnico di Milano; Milano Italy
| | | | - Alberto Redaelli
- Dipartimento di Elettronica, Informazione e Bioingegneria; Politecnico di Milano; Milano Italy
| | - Gianfranco Fiore
- Dipartimento di Elettronica, Informazione e Bioingegneria; Politecnico di Milano; Milano Italy
| |
Collapse
|
32
|
Stickler DJ. Clinical complications of urinary catheters caused by crystalline biofilms: something needs to be done. J Intern Med 2014; 276:120-9. [PMID: 24635559 DOI: 10.1111/joim.12220] [Citation(s) in RCA: 103] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
This review is largely based on a previous paper published in the journal Spinal Cord. The care of many patients undergoing long-term bladder catheterization is complicated by encrustation and blockage of their Foley catheters. This problem stems from infection by urease-producing bacteria, particularly Proteus mirabilis. These organisms colonize the catheter forming an extensive biofilm; they also generate ammonia from urea, thus elevating the pH of urine. As the pH rises, crystals of calcium and magnesium phosphates precipitate in the urine and in the catheter biofilm. The continued development of this crystalline biofilm blocks the flow of urine through the catheter. Urine then either leaks along the outside of the catheter and the patient becomes incontinent or is retained causing painful distension of the bladder and reflux of urine to the kidneys. The process of crystal deposition can also initiate stone formation. Most patients suffering from recurrent catheter encrustation develop bladder stones. P. mirabilis establishes stable residence in these stones and is extremely difficult to eliminate from the catheterized urinary tract by antibiotic therapy. If blocked catheters are not identified and changed, serious symptomatic episodes of pyelonephritis, septicaemia and endotoxic shock can result. All types of Foley catheters including silver- or nitrofurazone-coated devices are vulnerable to this problem. In this review, the ways in which biofilm formation on Foley catheters is initiated by P. mirabilis will be described. The implications of understanding these mechanisms for the development of an encrustation-resistant catheter will be discussed. Finally, the way forward for the prevention and control of this problem will be considered.
Collapse
Affiliation(s)
- D J Stickler
- Cardiff School of Biosciences, Cardiff University, Cardiff, UK
| |
Collapse
|
33
|
Transcatheter pulmonary valve replacement by hybrid approach using a novel polymeric prosthetic heart valve: proof of concept in sheep. PLoS One 2014; 9:e100065. [PMID: 24926892 PMCID: PMC4057289 DOI: 10.1371/journal.pone.0100065] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2014] [Accepted: 05/21/2014] [Indexed: 11/26/2022] Open
Abstract
Background Since 2000, transcatheter pulmonary valve replacement has steadily advanced. However, the available prosthetic valves are restricted to bioprosthesis which have defects like poor durability. Polymeric heart valve is thought as a promising alternative to bioprosthesis. In this study, we introduced a novel polymeric transcatheter pulmonary valve and evaluated its feasibility and safety in sheep by a hybrid approach. Methods We designed a novel polymeric trileaflet transcatheter pulmonary valve with a balloon-expandable stent, and the valve leaflets were made of 0.1-mm expanded polytetrafluoroethylene (ePTFE) coated with phosphorylcholine. We chose glutaraldehyde-treated bovine pericardium valves as control. Pulmonary valve stents were implanted in situ by a hybrid transapical approach in 10 healthy sheep (8 for polymeric valve and 2 for bovine pericardium valve), weighing an average of 22.5±2.0 kg. Angiography and cardiac catheter examination were performed after implantation to assess immediate valvular functionality. After 4-week follow-up, angiography, echocardiography, computed tomography, and cardiac catheter examination were used to assess early valvular function. One randomly selected sheep with polymeric valve was euthanized and the explanted valved stent was analyzed macroscopically and microscopically. Findings Implantation was successful in 9 sheep. Angiography at implantation showed all 9 prosthetic valves demonstrated orthotopic position and normal functionality. All 9 sheep survived at 4-week follow-up. Four-week follow-up revealed no evidence of valve stent dislocation or deformation and normal valvular and cardiac functionality. The cardiac catheter examination showed the peak-peak transvalvular pressure gradient of the polymeric valves was 11.9±5.0 mmHg, while that of two bovine pericardium valves were 11 and 17 mmHg. Gross morphology demonstrated good opening and closure characteristics. No thrombus or calcification was seen macroscopically. Conclusions This design of the novel ePTFE transcatheter pulmonary valve is safe and effective to deploy in sheep by hybrid approach, and the early valvular functionality is good.
Collapse
|
34
|
Kundu B, Schlimp CJ, Nürnberger S, Redl H, Kundu SC. Thromboelastometric and platelet responses to silk biomaterials. Sci Rep 2014; 4:4945. [PMID: 24824624 PMCID: PMC4018936 DOI: 10.1038/srep04945] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2013] [Accepted: 04/17/2014] [Indexed: 12/02/2022] Open
Abstract
Silkworm's silk is natural biopolymer with unique properties including mechanical robustness, all aqueous base processing and ease in fabrication into different multifunctional templates. Additionally, the nonmulberry silks have cell adhesion promoting tri-peptide (RGD) sequences, which make it an immensely potential platform for regenerative medicine. The compatibility of nonmulberry silk with human blood is still elusive; thereby, restricts its further application as implants. The present study, therefore, evaluate the haematocompatibility of silk biomaterials in terms of platelet interaction after exposure to nonmulberry silk of Antheraea mylitta using thromboelastometry (ROTEM). The mulberry silk of Bombyx mori and clinically used Uni-Graft W biomaterial serve as references. Shortened clotting time, clot formation times as well as enhanced clot strength indicate the platelet mediated activation of blood coagulation cascade by tested biomaterials; which is comparable to controls.
Collapse
Affiliation(s)
- Banani Kundu
- Department of Biotechnology, Indian Institute of Technology, Kharagpur-721302, India
- These authors contributed equally to this work
| | - Christoph J. Schlimp
- Ludwig Boltzmann Institute for Experimental and Clinical Traumatology, AUVA Research Centre, Austrian Cluster for Tissue Regeneration, Vienna, Austria
- These authors contributed equally to this work
| | - Sylvia Nürnberger
- Ludwig Boltzmann Institute for Experimental and Clinical Traumatology, AUVA Research Centre, Austrian Cluster for Tissue Regeneration, Vienna, Austria
| | - Heinz Redl
- Ludwig Boltzmann Institute for Experimental and Clinical Traumatology, AUVA Research Centre, Austrian Cluster for Tissue Regeneration, Vienna, Austria
| | - S. C. Kundu
- Department of Biotechnology, Indian Institute of Technology, Kharagpur-721302, India
| |
Collapse
|
35
|
Belway D, Rubens FD. Currently available biomaterials for use in cardiopulmonary bypass. Expert Rev Med Devices 2014; 3:345-55. [PMID: 16681456 DOI: 10.1586/17434440.3.3.345] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Cardiopulmonary bypass (CPB) represents one of the most important technical innovations in healthcare history, yet the systemic responses to CPB remain a fundamentally unresolved problem. Study of the blood-biomaterial interaction and development of biocompatible materials is intimately related to efforts to optimize patient outcome following CPB. This article reviews the design innovations in biomaterial surfaces that have been introduced into clinical practice in an attempt to ameliorate the detrimental consequences of CPB, contrasting the actual clinical improvements and patient benefits achieved against those predicted on the basis of theory and in vitro testing. Some discussion of the underlying mechanisms of action as presently understood is provided and the current limitations of biomaterial-dependent strategies to improve outcome following CPB are addressed.
Collapse
Affiliation(s)
- Dean Belway
- University of Ottawa Heart Institute, Department of Cardiovascular Perfusion, 40 Ruskin St., Ottawa, Ontario K1Y 4W7, Canada
| | | |
Collapse
|
36
|
Chevalier B, DiMario C, Neumann FJ, Cutlip DE, Williams DO, Ormiston J, Grube E, Whitbourn R, Coe J, Schwartz LB. A randomized, controlled, multicenter trial to evaluate the safety and efficacy of Zotarolimus- vs. Paclitaxel-eluting stents in de novo occlusive lesions in coronary arteries: Five-year results from the ZOMAXX I trial. Catheter Cardiovasc Interv 2013; 82:1039-47. [DOI: 10.1002/ccd.24958] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2012] [Revised: 02/06/2013] [Accepted: 04/07/2013] [Indexed: 11/07/2022]
Affiliation(s)
| | - Carlo DiMario
- Department of Cardiology; Royal Brompton Hospital; London England
| | | | | | - David O. Williams
- Cardiovascular Institute; Rhode Island Hospital, Providence; Rhode Island
| | - John Ormiston
- Department of Cardiology; Auckland City Hospital; Auckland New Zealand
| | | | - Robert Whitbourn
- Cardiac Investigation Unit; St. Vincent's Hospital; Melbourne Australia
| | | | | | | |
Collapse
|
37
|
Pieri M, Turla OG, Calabrò MG, Ruggeri L, Agracheva N, Zangrillo A, Pappalardo F. A new phosphorylcholine-coated polymethylpentene oxygenator for extracorporeal membrane oxygenation: a preliminary experience. Perfusion 2012. [DOI: 10.1177/0267659112469642] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Phosphorylcholine coating has a major role in the improvement of biocompatibility, durability and antihrombogenicity of the circuit for extracorporeal membrane oxygenation (ECMO). Moreover, if heparin-induced thrombocytopenia ensues, removal of all the sources of heparin is challenging if the circuit is coated with heparin. We report our preliminary experience with the new EUROSETS A.L.ONE ECMO oxygenator (Eurosets, Medolla, MO, Italy), which is aimed at providing better biocompatibility thanks to its full coating with phosphorylcholine. We retrospectively collected data on the 16 patients supported with ECMO and with the EUROSETS A.L.ONE ECMO oxygenator at San Raffaele Hospital. Mean ECMO duration was 6 ± 4 days, and 37.5% of the patients died on ECMO. Four episodes of major bleeding and three episodes of minor bleeding were recorded. The oxygenator had an excellent performance in gas exchange and the median pressure drop was 57 (26-85) mmHg at full blood flow (2.5 L/m2/min). The EUROSETS A.L.ONE ECMO oxygenator was an excellent device in our preliminary experience. Further evaluation on a larger sample is encouraged.
Collapse
Affiliation(s)
- M Pieri
- Department of Cardiac Anesthesia and Intensive Care, Vita-Salute San Raffaele University, Milan, Italy
| | - OG Turla
- Department of Cardiac Anesthesia and Intensive Care, Vita-Salute San Raffaele University, Milan, Italy
| | - MG Calabrò
- Department of Cardiac Anesthesia and Intensive Care, Vita-Salute San Raffaele University, Milan, Italy
| | - L Ruggeri
- Department of Cardiac Anesthesia and Intensive Care, Vita-Salute San Raffaele University, Milan, Italy
| | - N Agracheva
- Department of Cardiac Anesthesia and Intensive Care, Vita-Salute San Raffaele University, Milan, Italy
| | - A Zangrillo
- Department of Cardiac Anesthesia and Intensive Care, Vita-Salute San Raffaele University, Milan, Italy
| | - F Pappalardo
- Department of Cardiac Anesthesia and Intensive Care, Vita-Salute San Raffaele University, Milan, Italy
| |
Collapse
|
38
|
Gray WA, Yeung AC, Cutlip DE, Popma JJ, Fitzgerald PJ, Williams DO, Heuer H, O'Shaughnessy CD, Overlie PA, Mann JT, Cannon LA, Hermiller JB, Henry TD, Whitbourn R, Stuckey TD, Midei MG, Coe J, Schwartz LB. A randomized, controlled, multi-center trial comparing the safety and efficacy of zotarolimus-eluting and paclitaxel-eluting stents in de novo lesions in coronary arteries: Final results of the ZoMaxx II trial. Int J Cardiol 2012; 157:96-101. [DOI: 10.1016/j.ijcard.2011.05.061] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2011] [Revised: 04/07/2011] [Accepted: 05/13/2011] [Indexed: 10/18/2022]
|
39
|
|
40
|
Chin-Quee SL, Hsu SH, Nguyen-Ehrenreich KL, Tai JT, Abraham GM, Pacetti SD, Chan YF, Nakazawa G, Kolodgie FD, Virmani R, Ding NN, Coleman LA. Endothelial cell recovery, acute thrombogenicity, and monocyte adhesion and activation on fluorinated copolymer and phosphorylcholine polymer stent coatings. Biomaterials 2010; 31:648-57. [DOI: 10.1016/j.biomaterials.2009.09.079] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2009] [Accepted: 09/21/2009] [Indexed: 11/28/2022]
|
41
|
Schulze CJ, Han L, Ghorpade N, Etches WS, Stang L, Koshal A, Wang SH. Phosphorylcholine-Coated Circuits Improve Preservation of Platelet Count and Reduce Expression of Proinflammatory Cytokines in CABG: A Prospective Randomized Trial. J Card Surg 2009; 24:363-8. [DOI: 10.1111/j.1540-8191.2009.00895.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
|
42
|
Chevalier B, Di Mario C, Neumann FJ, Ribichini F, Urban P, Popma JJ, Fitzgerald PJ, Cutlip DE, Williams DO, Ormiston J, Grube E, Whitbourn R, Schwartz LB. A Randomized, Controlled, Multicenter Trial to Evaluate the Safety and Efficacy of Zotarolimus- Versus Paclitaxel-Eluting Stents in De Novo Occlusive Lesions in Coronary Arteries. JACC Cardiovasc Interv 2008; 1:524-32. [DOI: 10.1016/j.jcin.2008.08.010] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2008] [Revised: 07/21/2008] [Accepted: 08/20/2008] [Indexed: 11/27/2022]
|
43
|
Jaggers J, Lawson JH. Coagulopathy and inflammation in neonatal heart surgery: mechanisms and strategies. Ann Thorac Surg 2007; 81:S2360-6. [PMID: 16731104 DOI: 10.1016/j.athoracsur.2006.02.072] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2005] [Revised: 02/09/2006] [Accepted: 02/13/2006] [Indexed: 10/24/2022]
Affiliation(s)
- James Jaggers
- Department of Pediatric Cardiothoracic Surgery, Duke University Medical Center, Durham, North Carolina 27710, USA.
| | | |
Collapse
|
44
|
Park J, Kurosawa S, Takai M, Ishihara K. Antibody immobilization to phospholipid polymer layer on gold substrate of quartz crystal microbalance immunosensor. Colloids Surf B Biointerfaces 2007; 55:164-72. [PMID: 17207978 DOI: 10.1016/j.colsurfb.2006.11.032] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2006] [Revised: 11/06/2006] [Accepted: 11/29/2006] [Indexed: 11/29/2022]
Abstract
To modify gold electrode for immunosensor to construct an artificial cell membrane structure, water-soluble amphiphilic phospholipid polymer, poly[2-methacryloyloxyehtyl phosphorylcholine-co-n-butyl methacrylate-co-p-nitrophenyloxycarbonyl poly(ethylene glycol) methacrylate (PMBN)] was applied. The polymer had active ester groups for immobilization of biomolecules and it was converted partially to thiol groups for binding to gold substrates. The partially thiolated PMBN was adsorbed on a gold electrode of quartz crystal microbalance (QCM). Surface characterization of adsorbed PMBN layers was thoroughly investigated with reflectance anisotropy spectroscopy, ellipsometry spectroscopy, dynamic contact angle and X-ray photoelectron spectroscopy measurements. Among several PMBN, having different degree of thiolation, it was concluded that 21.5% thiolated PMBN layer had the most well-ordered phosphorylcholine groups in its outer surface. The proteins adsorption test revealed that the phosphorylcholine group on the outer side of PMBN layers, which was substituted their active ester groups by glycine, showed suppress the non-specific adsorption of proteins, such as bovine serum albumin and gamma-globulin. Also, through antigen-antibody binding evaluation, the anti-C-reactive protein antibody immobilized on the PMBN surface worked well and it was confirmed that denaturation of the antibody on the PMBN layers was hardly occurred in spite of 60 days storage at 4 degrees C. The antibody conjugated phospholipid polymer layer with well-ordered phosphorylcholine group could be outstanding functional membrane for biomedical diagnostic devices without non-specific binding and reduction of immunologic activity of immobilized antibody.
Collapse
Affiliation(s)
- Jongwon Park
- Department of Materials Engineering, School of Engineering, Center for NanoBio Integration, The University of Tokyo, Tokyo 113-8656, Japan
| | | | | | | |
Collapse
|
45
|
Tan H, Liu J, Li J, Jiang X, Xie X, Zhong Y, Fu Q. Synthesis and Hemocompatibility of Biomembrane Mimicing Poly(carbonate urethane)s Containing Fluorinated Alkyl Phosphatidylcholine Side Groups. Biomacromolecules 2006; 7:2591-9. [PMID: 16961322 DOI: 10.1021/bm060375y] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
In this article, we designed and synthesized biomembrane mimicing segmented poly(carbonate urethane)s containing fluorinated alkyl phosphatidylcholine (PC) side groups. To obtain these novel poly(carbonate urethane)s, a new diol with a long side chain fluorinated alkyl phosphatidylcholine polar headgroup (2-[2-2,2,3,3,4,4,5,5,6,6,7,7,8,8,9,9-hexadecafluoro-10-ethoxy-decyloxy-N-(2-hydroxy-1-hydroxymethyl-1-methyl-ethyl)-acetamide] phosphatidylcholine, HFDAPC) was first synthesized and characterized. Then a series of poly(carbonate urethane)s containing fluorinated alkyl phosphatidylcholine side groups were synthesized using methylenebis(phenylene isocyanate) (MDI), poly(1,6-hexyl-1,5-pentyl carbonate) diol (PHPCD), 1,4-butandiol (BDO), and HFDAPC. The obtained fluorinated phosphatidylcholine poly(carbonate urethane)s (FPCPCU) possessed high molecular weight, narrower molecular weight distribution, and good mechanical properties as characterized by GPC and Instron, showing an increased hydrophilicity and a possible arrangement of surface structure as characterized by water contact angle. XPS results indicated that the phosphatidylcholine polar headgroups have been indeed pulled out to the surface with the help of the migration of the fluorinated side chain that was directly connected with the phosphatidylcholine polar headgroup. A preliminary result by protein adsorption and platelet adhesion experiments suggested that only 5 approximately 12.5 mol % phosphatidylcholine could be enough for good hemocompatibility. The current work demonstrates a new synthetic approach that can be used to bring the bioactive PC groups to the surface of the PC-containing polyurethanes more effectively.
Collapse
Affiliation(s)
- Hong Tan
- College of Polymer Science and Engineering, State Key Laboratory of Polymer Materials Engineering, Sichuan University, Chengdu 610065, China
| | | | | | | | | | | | | |
Collapse
|
46
|
Pappalardo F, Della Valle P, Crescenzi G, Corno C, Franco A, Torracca L, Alfieri O, Galli L, Zangrillo A, D'Angelo A. Phosphorylcholine Coating May Limit Thrombin Formation During High-Risk Cardiac Surgery: A Randomized Controlled Trial. Ann Thorac Surg 2006; 81:886-91. [PMID: 16488689 DOI: 10.1016/j.athoracsur.2005.09.006] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2004] [Revised: 08/30/2005] [Accepted: 09/01/2005] [Indexed: 10/25/2022]
Abstract
BACKGROUND During cardiopulmonary bypass, blood contact with the large nonendothelial surfaces of the extracorporeal circuit induces activation and consumption of platelets and plasma coagulation factors. Phosphorylcholine (Pc) coating of oxygenators has been designed to improve surface biocompatibility. We evaluated the effects of a Pc-coated oxygenator on blood coagulation in patients undergoing high-risk open heart surgery and receiving tranexamic acid. METHODS Thirty-nine patients undergoing reoperative valvular or combined procedures were randomized to the use of an oxygenator treated with Pc coating (Pc group) or of a standard oxygenator (control group). Platelet count, soluble CD40 ligand, fibrinogen, antithrombin, D-Dimer, prothrombin fragment 1.2 (F1.2), and free plasma hemoglobin levels were measured at baseline, at aortic unclamping, and at arrival in the intensive care unit. RESULTS Postoperative bleeding, need for blood products, and clinical outcomes were similar in the two groups. At unclamping, F1.2, a marker of in vivo thrombin formation, increased to a greater extent in control patients than in Pc patients (p = 0.02), and in the latter group of patients was positively correlated with aortic cross-clamp times (r = 0.70). Relative to baseline values, the percent decrease in platelet count, fibrinogen, and antithrombin levels was not significantly different in Pc patients and in control patients after adjustment for multiple comparisons, but the percent decrease in platelet counts was negatively correlated with F1.2 levels in the entire series of patients (r = -0.62, p < 0.0001). All the evaluated parameters were similar in the two groups of patients at arrival in the intensive care unit. CONCLUSIONS For patients undergoing high-risk open heart surgery and receiving tranexamic acid, a phosphorylcholine-coated oxygenator may reduce intraoperative thrombin formation and the associated consumption of platelets, fibrinogen, and antithrombin.
Collapse
Affiliation(s)
- Federico Pappalardo
- Department of Cardiovascular Anesthesia and Intensive Care, IRCCS San Raffaele Hospital, Milan, Italy.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
47
|
Xu JP, Ji J, Chen WD, Shen JC. Novel biomimetic polymersomes as polymer therapeutics for drug delivery. J Control Release 2006; 107:502-12. [PMID: 16154659 DOI: 10.1016/j.jconrel.2005.06.013] [Citation(s) in RCA: 119] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2004] [Revised: 05/20/2005] [Accepted: 06/14/2005] [Indexed: 11/15/2022]
Abstract
Novel amphiphilic diblock copolymers, cholesterol-end-capped poly(2-methacryloyloxyethyl phosphorylcholine) (CMPC), which have poly(2-methacryloyloxyethyl phosphorylcholine) (poly(MPC)) as hydrophilic segment and cholesterol as hydrophobic segment, was specially designed as drug delivery systems. Fluorescence probe technique and transmission electron microscope (TEM) characterizations indicated that this novel amphiphilic copolymer formed micelles structure in water and the critical micelle concentration (CMC) was determined to be 1.57 x 10(-7) mol/l. A commercial obtained polymeric amphiphiles, Cholesterol end capped PEO (CPEO), which had a similar structure with CMPC, was used as a control in the cytotoxicity test. While CPEO showed obvious cytotoxicity, cytotoxicity of this novel amphiphiles was not observed as indicated by cell culture. Anti-cancer drug adriamycin (ADR) was incorporated into the micelles by oil-in-water method. The size of the drug-containing micelles was less than 200 nm, and the size distribution of the drug-containing micelles showed a narrow and monodisperse unimodal pattern. The release rate of ADR from the nanosphere was slow and the release continued over 7 days and the release rate decreased with the increase of molecular weights of the copolymer and the amount of the drug entrapped. These experimental results suggested that the nanoparticles prepared from CMPC block copolymers could be a good candidate for injectable drug delivery carrier.
Collapse
Affiliation(s)
- Jian-Ping Xu
- Department of Polymer Science and Engineering, Zhejiang University, Hangzhou 310027, P.R. China
| | | | | | | |
Collapse
|
48
|
Chevallier P, Janvier R, Mantovani D, Laroche G. In vitro biological performances of phosphorylcholine-grafted ePTFE prostheses through RFGD plasma techniques. Macromol Biosci 2005; 5:829-39. [PMID: 16134089 DOI: 10.1002/mabi.200500088] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Arterial prostheses made of microporous Teflon (ePTFE) are currently used in vascular surgery as bypasses for small and medium vessels. However, several clinical complications, such as thrombosis, frequently occur in these prostheses when implanted in humans. In this work, an original strategy was developed to improve the hemocompatibility of ePTFE prostheses, based on glow-discharge surface modification followed by chemical grafting of phosphorylcholine, known for its hemocompatible properties. This procedure leads to a covalent attachment of the molecules, therefore preventing their removal by shear stress induced by blood flow at the implant wall. The improvement of the blood compatibility properties of the modified ePTFE arterial prostheses have been investigated by in vitro tests such as thromboelastography, neutrophil adsorption, platelet aggregation, and cell cultures. These in vitro tests put in evidence that thrombogenicity index, platelet aggregation, and neutrophil adhesion were decreased by the molecule grafted on the prostheses. Moreover, the cell growth on the surface of the PRC-grafted prostheses was greatly enhanced in comparison to the virgin prosthesis. Based on these results, it could be concluded that PRC grafting on ePTFE prostheses permit to improve in vitro hemocompatibility and biocompatibility in comparison with their virgin counterpart.
Collapse
Affiliation(s)
- Pascale Chevallier
- Unité de Biotechnologie et de Bioingénierie, Centre de Recherche de l'Hôpital Saint-François d'Assise, CHUQ, 10 rue de l'Espinay, Québec G1L 3L5, Canada
| | | | | | | |
Collapse
|
49
|
Parker AP, Reynolds PA, Lewis AL, Kirkwood L, Hughes LG. Investigation into potential mechanisms promoting biocompatibility of polymeric biomaterials containing the phosphorylcholine moiety. Colloids Surf B Biointerfaces 2005; 46:204-17. [PMID: 16337779 DOI: 10.1016/j.colsurfb.2005.11.009] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2005] [Revised: 10/20/2005] [Accepted: 11/02/2005] [Indexed: 11/18/2022]
Abstract
Phosphorylcholine (PC) moieties were chemically attached to surfaces of polymer microparticles by addition of 2-methylacryloyloxyethyl phosphorylcholine monomer to the seeded, semi-continuous polymerisations of methyl methacrylate (MMA) and butyl acrylate (BA). The surface of the bio-functionalised polymer microparticles was principally characterised using X-ray photoelectron spectroscopy (XPS), dynamic nuclear magnetic resonance (NMR) spectroscopy, scanning electron microscopy (SEM), photon correlation spectroscopy (PCS), acoustophoresis and enzyme-linked immunosorbent assays (ELISA). It was found that the persulphate initiating species are concealed behind the phosphorylcholine containing monomer sequence located on the surface of the microparticles. The combination of analytical techniques showed that the surfaces of the polymer microparticles are extremely mobile above the glass transition temperature of the co-polymer and able to rearrange depending on the environment in which they are placed. This allows the phosphorylcholine moiety to be preferentially expressed at the surface in aqueous media, but not so in the dry state or conditions of ultra-high vacuum. In terms of the nature of the biocompatibility of phosphorylcholine containing polymers, no evidence was found for the irreversible structuring of water molecules around the phosphorylcholine moiety in the wet state. The results of this work suggest that a more likely contributory reason for the protein-resistant nature of phosphorylcholine containing polymers is the mobility of the phosphorylcholine moiety. Increases in biocompatibility correspond with increases in the hydrophilicity of a polymer surface when phosphorylcholine is preferentially expressed. A large free water fraction may be present in the phosphorylcholine containing monomer sequence, as part of a hydrogel structure located at the surface of the polymer microparticles. This, coupled with concomitant modification of the local electrical double-layer very close to the surface may also play a critical role in reducing protein-surface interactions.
Collapse
Affiliation(s)
- Andrew P Parker
- Bristol Colloid Centre, School of Chemistry, University of Bristol, Cantocks Close, UK.
| | | | | | | | | |
Collapse
|
50
|
Rose SF, Okere S, Hanlon GW, Lloyd AW, Lewis AL. Bacterial adhesion to phosphorylcholine-based polymers with varying cationic charge and the effect of heparin pre-adsorption. JOURNAL OF MATERIALS SCIENCE. MATERIALS IN MEDICINE 2005; 16:1003-15. [PMID: 16388382 DOI: 10.1007/s10856-005-4755-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/23/2004] [Accepted: 05/06/2005] [Indexed: 05/06/2023]
Abstract
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.
Collapse
Affiliation(s)
- S F Rose
- Biomedical Materials Research Group, School of Pharmacy and Biomolecular Sciences, University of Brighton, BN2 4GJ, UK
| | | | | | | | | |
Collapse
|