Immersed multilayer biodegradable ureteral stent with reformed biodegradation: An in vitro experiment

Contact-Active Layer-by-Layer Grafted TPU/PDMS Blends as an Antiencrustation and Antibacterial Platform for Next-Generation Urological Biomaterials: Validation in Artificial and Human Urine

Urinary tract infections and urinary encrustation impede the long-term clinical performance of urological implants and medical devices. Together, biofilm formation and encrustation constitute serious complications, driving the development of next-generation urological biomaterials. The currently available bioengineered solutions have limited success during long-term usage in the urinary environment. In addressing this unmet clinical challenge, contact-active, antiencrustation surface grafting were conceived onto a dynamically cross-linked polydimethylsiloxane (PDMS) modified thermoplastic polyurethane (TPU) blend using the layer-by-layer (LbL) assembly route. To the best of the authors' knowledge, the present study is the first to investigate the LbL grafting in developing an antiencrustation platform. These multilayered assemblies strategically employed covalent cross-linking and electrostatic interaction-assisted progressive depositions of branched polyethyleneimine and poly(2-ethyl-2-oxazoline). While polyethyleneimine conferred the contact-killing bactericidal activity, the much-coveted antiencrustation properties were rendered by incorporating a partially hydrolyzed derivative of poly(2-ethyl-2-oxazoline). The performance of the resultant surface-modified TPU/PDMS blends was benchmarked against the conventional urological alloplasts, in a customized lab-scale bioreactor-based dynamic encrustation study and in human urine. After 6 weeks of exposure to an artificial urine medium, simulating urease-positive bacterial infection, the surface-modified blends exhibited a remarkable ability to suppress Ca and Mg encrustation. In addition, these blends also displayed superior grafting stability and antibacterial efficacy against common uropathogens. As high as 4-fold log reduction in the planktonic growth of Gram-negative P. mirabilis and Gram-positive MRSA was recorded with the LbL platform vis-à-vis medical-grade TPU. In conjunction, the in vitro cellular assessment with human keratinocytes (HaCaT) and human embryonic kidney cells (HEK) established the uncompromised cytocompatibility of the multilayered grafted blends. Finally, the physiologically relevant functionality of the LbL grafting has been validated using clinical samples of human urine collected from 129 patients with a broad spectrum of disease conditions. The phase-I pre-clinical study, entailing 6 week-long incubation in human urine, demonstrated significantly improved encrustation resistance of the blends. The collective findings of the present work clearly establish the success of LbL strategies in the development of stable, multifunctional new-generation urological biomaterials.

Design and Analysis of a Biodegradable Polycaprolactone Flow Diverting Stent for Brain Aneurysms

The flow diverting stent (FDS) has become a promising endovascular device for the treatment of aneurysms. This research presents a novel biodegradable and non-braided Polycaprolactone (PCL) FDS. The PCL FDS was designed and developed using an in-house fabrication unit and coated on two ends with BaSO₄ for angiographic visibility. The mechanical flexibility and quality of FDS surfaces were examined with the UniVert testing machine, scanning electron microscope (SEM), and 3D profilometer. Human umbilical vein endothelial cell (HUVEC) adhesion, proliferation, and cell morphology studies on PCL FDS were performed. The cytotoxicity and NO production by HUVECs with PCL FDS were also conducted. The longitudinal tensile, radial, and bending flexibility were found to be 1.20 ± 0.19 N/mm, 0.56 ± 0.11 N/mm, and 0.34 ± 0.03 N/mm, respectively. The FDS was returned to the original shape and diameter after repeated compression and bending without compromising mechanical integrity. Results also showed that the proliferation and adhesion of HUVECs on the FDS surface increased over time compared to control without FDS. Lactate dehydrogenase (LDH) release and NO production showed that PCL FDS were non-toxic and satisfactory. Cell morphology studies showed that HUVECs were elongated to cover the FD surface and developed an endothelial monolayer. This study is a step forward toward the development and clinical use of biodegradable flow diverting stents for endovascular treatment of the aneurysm.

A new hydrophilic biodegradable ureteral stent restrain encrustation both in vitro and in vivo

Ureteral stents have been widely used as biomedical devices to treat some urological diseases for several decades. However, the encrustation complications hamper the long-time clinical use of the ureteral stents. In this work, a new type of biodegradable material for the ureteral stents, methoxypoly(ethylene glycol)-block-poly(L-lactide-ran-Ɛ-caprolactone) (mPEG-PLACL), is evaluated to overcome this problem. The results show that the hydrophilicity and degradation rate in artificial urine of mPEG-PLACL are both significantly increased. It is worth noting that the mPEG-PLACL shows a lower amount of encrustation after immersing the stents in the dynamic urinary extracorporeal circulation (DUEC) model for 7 days. In addition, 71% Ca and 92% Mg are inhibited in vivo by quantitative analysis. Pathological analysis exhibit that the mPEG-PLACL cause less diffuse mucosal hyperplasia after 7 weeks of implantation. All the results indicate that this new type of biodegradable material had an excellent potential for the ureteral stents in the future.

Prospects for the research and application of biodegradable ureteral stents: from bench to bedside

Ureteral stents are commonly used in urological practices but are frequently associated with patient discomfort, encrustation and stent-related infection. And a second procedure is needed to remove the stent. New biomaterials and designs have been attempted to solve these problems. The development of biodegradable ureteral stent shows promising prospects in future clinical applications. This article reviews the biomaterials and preparation methods commonly used in the present study of biodegradable ureteral stents. To date, none of the technological developments has lead to the 'ideal' biodegradable ureteral stent, but much progress has been made in the stent design by improving the physical characteristics and biocompatibility of the biomaterials. The controllability of degradation, the biggest problem faced currently, still needs to be further improved. In the future, the nanotechnology and chemical modification of biomaterials may be able to further optimize the properties of degradation.