Photochemical coatings for the prevention of bacterial colonization

Healthcare costs and resource utilization in patients with severe aplastic anemia in the US

Purpose: This study aimed to evaluate the healthcare resource utilization (HCRU) and costs for patients with severe aplastic anemia (SAA) using US claims data. Methods: This retrospective, observational database study analyzed claims data from the Truven MarketScan databases. SAA patients aged ≥2 years identified between 2014 and 2017 who were continuously enrolled for 6 months before their first SAA treatment or blood transfusion, with a ≥6-month follow-up, were included. Baseline demographics and comorbidities were evaluated. Monthly all-cause and SAA-related HCRU and direct costs in the follow-up period were analyzed and differences were presented for all patients and across age groups. Results: With an average follow-up period of 21.5 months, 939 patients were included in the study. Monthly all-cause and SAA-related HCRU [mean (SD)] were 1.65 days (2.61 days) and 0.18 days (0.70 days) for length of stay, 0.18 (0.23) and 0.01 (0.04) for hospital admissions, 0.25 (0.30) and 0.02 (0.07) for ER visits, 2.24 (1.40) and 0.46 (0.99) for office visits, and 2.90 (2.64) and 0.55 (1.31) for outpatient visits, respectively. On average, SAA patients received 0.15 (0.57) blood transfusions per month. Mean monthly all-cause direct costs were $28,280 USD ($36,127) [US dollars, mean (SD)]. Direct costs related to admissions were $11,433 USD (SD $25,040), followed by $624 USD ($1,703) for ER visits, $528 USD ($694) for office visits, $7,615 USD ($13,273) for outpatient visits, and $5,998 USD ($11,461) for pharmacy expenses. Monthly SAA-related direct costs averaged $7,884 USD (SD $16,254); of these costs, $1,608 USD ($7,774) were from admissions, $47 USD ($257) from ER visits, $127 USD ($374) from office visits, $1,462 USD ($4,994) from outpatient visits, and $4,451 USD ($10,552) from pharmacy expenses. Conclusion: SAA is associated with high economic burden, with costs comparable to blood malignancies, implying that US health plans should consider appropriately managing SAA while constraining the total healthcare costs when making formulary decisions.

Modern Strategies in the Prevention of Implant-Associated Infections

The application of medical devices either for temporary or permanent use has become an indispensible part of almost all fields of medicine. However, foreign bodies are associated with a substantial risk of bacterial and fungal infections. Implant-associated infections significantly contribute to the still increasing problem of nosocomial infections.

To reduce the incidence of such infections, specific guidelines providing evidence-based recommendations and comprising both technological and nontechnological strategies for prevention have been established. Strict adherence to hygienic rules during insertion or implantation of the device are aspects of particular importance. Besides such basic and indispensable aspects, the development of new materials which could withstand microbial adherence and colonization has become a major topic in recent years. Modification of surface by primarily physico-chemical methods may lead to a change in specific and unspecific interactions with microorganisms and, thus, to a reduction in microbial adherence. Medical devices made out of a material that would be ideally antiadhesive or at least colonization-resistant would be the most suitable candidates to avoid colonization and subsequent infection. However, it appears impossible to create a surface with an absolute “zero”-adherence due to thermodynamical reasons and due to the fact that a modified material surface is in vivo rapidly covered by plasma and connective tissue proteins. Therefore, another concept for the prevention of implant-associated infections involves the impregnation of devices with various antimicrobial substances such as antibiotics, antiseptics, and/or metals.

In fact, already commercially available materials for clinical use such as antimicrobial catheters have been introduced, in part with considerable impact on subsequent infections. However, future studies are warranted to translate the knowledge on the pathogenesis of device-associated infections into applicable prevention strategies.

Review: Antimicrobial efficacy validation using in vitro and in vivo testing methods

Pre-clinical antimicrobial validation testing for single and combination products, and parameters that should be considered when testing the antimicrobial performance of a medical device, are discussed. Guidance is provided on key elements required for in vitro and in vivo antimicrobial validation, including validation of microbial growth, microbial recovery, neutralization, and antimicrobial activity. An important consideration, both in terms of practicality and economics, is designing in vitro studies that bridge to in vivo testing: A representative in vitro model is used to generate data on many clinically relevant microorganisms, and then one microorganism is selected for use in in vivo testing. If the in vivo results correlate to the in vitro results, it can reasonably be extrapolated that the same would be true for the remaining microorganisms tested in vitro. Thus, the selection of relevant in vitro models for testing is critical for successful antimicrobial validation testing.

Active Packaging Coatings

Active food packaging involves the packaging of foods with materials that provide an enhanced functionality, such as antimicrobial, antioxidant or biocatalytic functions. This can be achieved through the incorporation of active compounds into the matrix of the commonly used packaging materials, or by the application of coatings with the corresponding functionality through surface modification. The latter option offers the advantage of preserving the packaging materials’ bulk properties nearly intact. Herein, different coating technologies like embedding for controlled release, immobilization, layer-by-layer deposition, and photografting are explained and their potential application for active food packaging is explored and discussed.

Biofilm formation on coated silicone tympanostomy tubes

OBJECTIVES

Tympanostomy tube (TT) surface modifications have been promoted as a means of reducing biofilm formation, otorrhea, and occlusion. The goal of this study was to determine if biofilm formation on silicone TTs could be prevented by commercially available surface coatings.

METHODS

Silicone TTs with and without polyvinylpyrrolidone (PVP) or/and silver oxide were exposed to human plasma and cultured with Pseudomonas aeruginosa or Staphylococcus aureus (22 TTs per group). After 4 days, antibiotics were added to kill planktonic bacteria. Biofilm formation was assessed by quantitative bacterial counts and scanning electron microscopy.

RESULTS

PVP, silver, and PVP-silver coatings reduced P. aeruginosa biofilm formation relative to silicone by over 1 log (p<0.0001). PVP was superior to silver (p=0.04) and PVP-silver (p<0.0001). PVP and PVP-silver coatings increased S. aureus biofilm formation nominally (p=0.01 & 0.003).

CONCLUSION

PVP and silver coatings reduce P. aeruginosa biofilm formation on silicone TTs. Combining PVP and silver coatings does not further improve biofilm resistance. TT surface coatings warrant further study through clinical trials.

Effect of tympanostomy tube surface on occlusion

OBJECTIVE

Premature tympanostomy tube (TT) occlusion frequently leads to TT replacement surgery. TT surface preparations have been suggested as a means of reducing TT occlusion. The purpose of this study is to determine if commercial TT compositions or surface preparations impact the rate of TT occlusion using an in vitro model.

METHODS

Commercial TTs composed of titanium, fluoroplastic, and silicone, as well as human serum albumin coated titanium, phosphorylcholine coated fluoroplastic, and polyvinylpyrrolidone coated silicone TTs, were tested for occlusion development in a previously validated in vitro model that simulates middle ear air and mucus flow.

RESULTS

Time to occlusion was longer with all coated TTs relative to all uncoated TTs (p=0.038). Polyvinylpyrrolidone coated silicone TTs had the lowest rate of occlusion and improvement relative to silicone (36% vs. 70%). Time to occlusion was longer in all coated TTs, but individually, none reached statistical significance.

CONCLUSION

TT composition and surface preparations do not dramatically impact the development of TT occlusion. All tested surface coatings seem to delay TT occlusion in this in vitro model. In vivo testing will be necessary to validate these findings.

Contact killing antimicrobial acrylic bone cements: preparation and characterization

Novel antimicrobial poly(methyl methacrylate) (PMMA)-based bone cement was synthesized by co-polymerizing PMMA/MMA with various percentages of quaternary amine dimethacrylate (QADMA) by free radical bulk polymerization technique at room temperature using benzoyl peroxide and N,N-dimethyl-p-toulidine (DMPT) as a redox initiator. The modified bone cement was characterized by FT-IR and 1H-NMR spectral studies. The thermal and physical properties of the bone cements of varying composition of QADMA were evaluated by thermogravimetric analysis (TGA), differential calorimetry (DSC) and contact angle measurements. Peak exothermic temperature was observed to decrease, while setting time increased with increase in QADMA content in the bone cement formulations. The antibacterial activity of the synthesized bone cement containing quaternary amine dimethacrylate against Escherichia coli and Staphylococcus aureus was studied by zone of inhibition, colony count method and scanning electron microscopy (SEM). QADMA containing acrylic bone cement showed a broad spectrum of contact killing antimicrobial properties. Retention of E. coli onto the surface of PMMA bone cement was observed, whereas there was complete prevention of retention of E. coli onto the modified PMMA bone cement with 15% QADMA. The studies were compared with the acrylic bone cement synthesized using 15% N-vinyl-2-pyrrolidone (NVP) in place of QADMA to which iodine was added as an antimicrobial agent during co-polymerization.

Infections associated with medical devices: pathogenesis, management and prophylaxis

The insertion or implantation of foreign bodies has become an indispensable part in almost all fields of medicine. However, medical devices are associated with a definitive risk of bacterial and fungal infections. Foreign body-related infections (FBRIs), particularly catheter-related infections, significantly contribute to the increasing problem of nosocomial infections. While a variety of micro-organisms may be involved as pathogens, staphylococci account for the majority of FBRIs. Their ability to adhere to materials and to promote formation of a biofilm is the most important feature of their pathogenicity. This biofilm on the surface of colonised foreign bodies is regarded as the biological correlative for the clinical experience with FBRI, that is, that the host defence mechanisms often seem to be unable to handle the infection and, in particular, to eliminate the micro-organisms from the infected device. Since antibacterial chemotherapy is also frequently not able to cure these infections despite the use of antibacterials with proven in vitro activity, removal of implanted devices is often inevitable and has been standard clinical practice. However, in specific circumstances, such as infections of implanted medical devices with coagulase-negative staphylococci, a trial of salvage of the device may be justified. All FBRIs should be treated with antibacterials to which the pathogens have been shown to be susceptible. In addition to systemic antibacterial therapy, an intraluminal application of antibacterial agents, referred to as the 'antibiotic-lock' technique, should be considered to circumvent the need for removal, especially in patients with implanted long-term catheters. To reduce the incidence of intravascular catheter-related bloodstream infections, specific guidelines comprising both technological and nontechnological strategies for prevention have been established. Quality assurance, continuing education, choice of the catheter insertion site, hand hygiene and aseptic techniques are aspects of particular interest. Furthermore, all steps in the pathogenesis of biofilm formation may represent targets against which prevention strategies may be directed. Alteration of the foreign body material surface may lead to a change in specific and nonspecific interactions with micro-organisms and, thus, to a reduced microbial adherence. Medical devices made out of a material that would be antiadhesive or at least colonisation resistant would be the most suitable candidates to avoid colonisation and subsequent infection. Another concept for the prevention of FBRIs involves the impregnation of devices with various substances such as antibacterials, antiseptics and/or metals. Finally, further studies are needed to translate the knowledge on the mechanisms of biofilm formation into applicable therapeutic and preventive strategies.

Plasma deposition and surface characterization of oligoglyme, dioxane, and crown ether nonfouling films

Plasma-deposited PEG-like films are emerging as promising materials for preventing protein and bacterial attachment to surfaces. To date, there has not been a detailed surface analysis to examine the chemistry and molecular structure of these films as a function of both precursor size and structure. In this paper, we describe radio-frequency plasma deposition of a series of short-chain oligoglymes, dioxane, and crown ethers onto glass cover slips to create poly(ethylene glycol)-like coatings. The resultant films were characterized by X-ray photoelectron spectroscopy (XPS), time-of-flight secondary ion mass spectrometry (TOF-SIMS), dynamic contact angle goniometry, and radiolabeled fibrinogen adsorption. Detailed analysis of the high-mass (120-300 m/z) TOF-SIMS oligoglyme film spectra revealed six classes of significant fragments. Two new models are proposed to describe how these fragments could be formed by distinct film-building processes: incorporation of intact and fragmented precursor molecules. The models also provide for the incorporation of hydrocarbon--a species that is not present in the precursors but is evidenced in XPS C(1s) spectra of these films. Two additional models describe the effects of incorporating intact and fragmented cyclic precursors.

Surface thiocyanation of plasticized poly(vinyl chloride) and its effect on bacterial adhesion

Thiocyanates, especially bis-alkylthiocyanates are highly effective in killing a number of bacterial strains and are reported to be potent biocides at ppm concentrations. In order to examine whether a covalently bound and immobilized thiocyanate group on a biomaterial surface is still effective as a bactericide, plasticized poly(vinyl chloride) (PVC) was thiocyanated using sodium thiocyanate in the presence of a phase transfer catalyst in aqueous media leading to the nucleophilic substitution of chlorine by thiocyanate on the PVC surface. Thiocyanation imparted hydrophilicity to the surface in comparison with bare PVC. Control and thiocyanated PVC surfaces were exposed to two strains of bacteria commonly implicated in device-associated infections, such as Staphylococcus aureus and Staphylococcus epidermidis. Bacterial adhesion and colonization was quantitated by counting the viable organisms on the adhered surface as well as by optical and scanning electron microscopy. Significantly reduced retention of S. epidermidis and S. aureus was seen on the thiocyanated PVC surface. Immobilized thiocyanate was non-cytotoxic in a preliminary cell culture assay. The study thus showed that even though an immobilized thiocyanate moiety on the polymer surface was not as effective as a bactericide unlike soluble thiocyanates, it prevented the retention and colonization of the bacteria to a considerable extent.

Bacterial adhesion onto azidated poly(vinyl chloride) surfaces

A plasticized poly(vinyl chloride) surface was modified by azidation using sodium azide in the presence of a phase transfer catalyst in aqueous media. Subsequent to azidation, the surface was crosslinked using ultraviolet radiation. Contact angle measurements showed that the surface became hydrophilic on azidation whereas photoirradiation did not have any further effect on the hydrophilicity of the azidated surface. Control, azidated, and photocrosslinked surfaces were exposed to two strains of bacteria commonly implicated in device infection such as Staphylococcus aureus and Escherichia coli. Whereas the control and photocrosslinked surfaces showed no significant difference in bacterial adhesion, the azidated surface showed significantly reduced adhesion to both strains. Data obtained indicate that the presence of an intact azide function on the polymer surface is responsible for the reduced bacterial adherence and the surface hydrophobicity/hydrophilicity did not exert any effect in the present case. Although azides are known to be effective only against Gram-negative species, surprising was the observation that the azidated polymer surface was equally effective against a Gram-positive species such as S. aureus. Because sodium azide is routinely used as a preservative to prevent bacterial and fungal growth in many microbiology reagents and diagnostic kits, covalent binding of the azide onto a polymer surface or synthesizing azide containing polymers may be an interesting method to investigate in tackling the problem of bacterial adhesion and colonization of medical devices.

In vitro study of blood-contacting properties and effect on bacterial adhesion of a polymeric surface with immobilized heparin and sulphated hyaluronic acid

The blood-contacting properties and the effect on bacterial adhesion of a material based on polyurethane and poly(amido-amine) (PUPA), both in its native form and with the anticoagulant molecules heparin or sulphated hyaluronic acid (HyalS3.5) electrostatically bonded to its surface, were evaluated and compared in vitro. The presence of the biological molecules on the surface was revealed by a dye test and ATR/FTIR analysis. Bound heparin was found to maintain its physiological action, in terms of thrombin inactivation, as well as did free heparin. Moreover, it reduced the degree of platelet adhesion. On the contrary, bound HyalS3.5 lost its anticoagulant activity, though it reduced platelet adhesion. The number of platelets on both modified surfaces was low. Their shape distribution, as determined by SEM, did not differ significantly on the two modified surfaces or with respect to the bare PUPA surface. HyalS3.5 and heparin also inhibited adhesion of Staphylococcus epidermidis to the material. A possible relationship between the platelet and bacterial adhesion is ascribed to the mediating role of plasma proteins.

Surface modification of poly(ethylene terephthalate) angioplasty balloons with a hydrophilic poly(acrylamide-co-ethylene glycol) interpenetrating polymer network coating

An interpenetrating polymer network (IPN) of poly(acrylamide-co-ethylene glycol) (p(AAm-co-EG)) hydrogel was covalently grafted to polyethylene terephthalate (PET) angioplasty balloons to increase surface hydrophilicity and improve lubricity. A 2-step graft polymerization protocol was followed to first polymerize and cross-link acrylamide onto the substrate with a photosensitizer and/or oxygen plasma pretreatment. The effects of varying photo-initiation and plasma exposure times were investigated separately and conjunctively using water contact angles to obtain optimal coating deposition parameters. A poly(ethylene glycol) network was then grafted by swelling the preexisting polyacrylamide network to allow inter-diffusion of the monomer and cross-linker, which were then polymerized by photo-initiation. When the photo-initiation time was long enough to reach near gelation, pretreatment of PET with oxygen plasma did not offer significant benefit. X-ray photoelectron spectroscopy confirmed the presence of both polymer layers, and composition depth profiles supported the assessment that an interpenetrating network was formed. Tensile testing and application of Weibull statistics on unmodified and modified films indicated that the surface modification approach did not significantly alter the mechanical integrity of the material. These findings indicate that a p(AAm-co-EG) coating can be effectively deposited on PET surfaces without compromising the structural integrity of the substrate.

Surfactant polymers designed to suppress bacterial (Staphylococcus epidermidis) adhesion on biomaterials

We describe a series of surfactant polymers designed as surface-modifying agents for the suppression of bacterial adhesion on biomaterials. The surfactant polymers consist of a poly(vinyl amine) backbone with hydrophilic poly(ethylene oxide) (PEO) and hydrophobic hexanal (Hex) side chains (PVAm/PEO:Hex). Surface modification is accomplished by simple dip coating from aqueous solution, from which surfactant polymers undergo spontaneous surface-induced assembly on hydrophobic biomaterials. The stability of PVAm/PEO:Hex on pyrolytic graphite (HOPG) and polyethylene (PE) was demonstrated by the absence of detectable desorption under flow conditions of pure water over a 24-h period. PEO surfactant polymers with four different PEO:Hex ratios (1:1.4, 1:2.5, 1:4.6, and 1:10.7) and a dextran surfactant polymer were compared with respect to S. epidermidis adhesion under dynamic flow conditions. Suppression of S. epidermidis adhesion was achieved for all modified surfaces over the shear range 0-15 dyn/cm(2). The effectiveness depended on the surfactant polymer composition such that S. epidermidis adhesion to modified surfaces decreased significantly with increasing PEO packing density. Modified HOPG was more effective in reducing bacterial adhesion compared with the corresponding modification on PE, which we attribute to the presence of defects in surfactant polymer assembly on PE. Our results are discussed from the perspective of critical factors, such as optimal PEO packing density and hydration thickness, that contribute to the effectiveness of surfactant polymers to shield a biomaterial from adhesive bacterial interactions.

Plasma-deposited membranes for controlled release of antibiotic to prevent bacterial adhesion and biofilm formation

Bacterial infection on implanted medical devices is a significant clinical problem caused by the adhesion of bacteria to the biomaterial surface followed by biofilm formation and recruitment of other cells lines such as blood platelets, leading to potential thrombosis and thromboembolisms. To minimize biofilm formation and potential device-based infections, a polyurethane (Biospan) matrix was developed to release, in a controlled manner, an antibiotic (ciprofloxacin) locally at the implant interface. One material set consisted of the polyetherurethane (PEU) base matrix radiofrequency glow discharge plasma deposited with triethylene glycol dimethyl ether (triglyme); the other set had an additional coating of poly(butyl methyacrylate) (pBMA). Triglyme served as a nonfouling coating, whereas the pBMA served as a controlled porosity release membrane. The pBMA-coated PEU contained and released ciprofloxacin in a controlled manner. The efficacy of the modified PEU polymers against Pseudomonas aeruginosa suspensions was evaluated under flow conditions in a parallel plate flow cell. Bacterial adhesion and colonization, if any, to the test polymers were examined by direct microscopic image analysis and corroborated with destructive sampling, followed by direct cell counting. The rate of initial bacterial cell adhesion to triglyme-coated PEU was 0. 77%, and to the pBMA-coated PEU releasing ciprofloxacin was 6% of the observed adhesion rates for the control PEU. However, the rate of adherent cell accumulation due to cell growth and replication was approximately the same for the triglyme-coated PEU and the PEU controls, but was zero for the pBMA-coated PEU releasing ciprofloxacin.

Photobinding of [gamma-(32)P] ATP gamma-benzophenone to the surface of a polyurethane membrane in the preparation of a beta-particle-emitting balloon catheter

PURPOSE

The goal of this study was to photochemically bind 5'-[gamma-(32)P]-azido-ATP gamma-benzophenone ((32)P-ATP-BPA) to a polyurethane surface. Expandable balloon catheters composed of (32)P-coated polyurethane have the potential for preventing restenosis following percutaneous transluminal coronary angioplasty.

METHODS

After extensive preparation and cleaning of polyurethane disks, 10 microL of the radioactive ATP-BPA reagent (specific activity = 9.4 Ci/mmol) was applied to the surface. After drying, the membrane disks were exposed ultraviolet radiation (254 nm; 6,000 microwatts/cm(2)) for up to 2 h and subsequently washed. The amount of (32)P bound to the membrane disks was determined by Cerenkov counting in a liquid scintillation counter. The effect of the labeling solution composition (solvent, presence of potassium or manganese ions, addition of surfactants, etc.) on photobinding efficiency was determined.

RESULTS

The efficiency of attaching the (32)P-ATP-BPA reagent to the polyurethane surfaces was markedly dependent upon the cleaning and pretreatment conditions. Following detailed washing and rinsing steps, a photobinding efficiency of 36.4+/-3.6% was obtained with 10 min UV exposure time using (32)P-ATP-BPA solutions that were 95/5 methanol/water by vol. Increasing the concentration of the (32)P-ATP-BPA reagent did not improve the photobinding efficiency; however, the total amount of (32)P bound to the disks was increased.

CONCLUSIONS

Photochemical methods can be employed to attach beta(-)-emitting radionuclides to polymers that are employed as balloon catheters. The preparation of the polymeric material (washing, rinsing, and drying) is critically important in maximizing the amount of (32)P-ATP-BPA that can be bound to the polymer.

Inhibition of bacterial adherence to a high-water-content polymer by a water-soluble, nonsteroidal, anti-inflammatory drug

Deposition and aggregation of lachrymal proteins on the contact lens surface can promote bacterial adherence. Lysozyme is the major tear protein and is also mainly responsible for the formation of protein deposits on contact lenses. Nonsteroidal anti-inflammatory drugs (NSAID) prevent protein aggregation. The effect of a water-soluble NSAID drug on bacterial adherence to high-water-content/ionic disposable contact lenses was examined in a radiolabeling study. Dose-related inhibition of adherence of Staphylococcus aureus, S. epidermidis, and Pseudomonas aeruginosa on both pretreated lenses and after adding the drug to the medium was investigated. When the drug was added to the media, maximal inhibition of S. aureus adherence was observed in trypticase soy broth (59-98% at the lower and higher drug concentrations, respectively); inhibition progressively decreased in calf aqueous humor (48-75%), lysozyme (34-63%), and saline (12-20%) solutions. Inhibition of adherence varied with the three bacterial species; it was maximal with S. aureus, intermediate with S. epidermidis, and minimal with P. aeruginosa. When lenses were pretreated with the drug, consistent, and even higher, inhibitory effects were observed. The results suggest that water-soluble NSAIDs could be used in preventive treatments for conjunctivae and corneal infections in contact lens wearers, and may provide a clue as to which compounds might inhibit protein interaction and bacterial adhesion.

Bipolar pacemaker leads: new materials, new technology

This commentary is in response to a review published earlier in this journal. It is intended to provide additional information and supplement the original paper. A short review of the failure mechanisms of polyurethane pacing lead materials is provided. Two specific degradation mechanisms, environmental stress cracking and metal ion oxidation, are discussed. Environmental stress cracking has been extensively studied and is a well understood failure mechanism. Methods for reducing the problem have been developed and tested in vivo. As a result, stress cracking failures can be virtually eliminated. Metal ion oxidation failures now dominate pacing lead recalls. Two new materials, polycarbonate urethanes and ethylenetetrafluoroethylene, have been introduced as insulators for pacing leads. These materials do not fail by stress cracking and preliminary test results are very positive.

A general method for the spatially defined immobilization of biomolecules on glass surfaces using "caged" biotin

A method has been developed to spatially define the immobilization of proteins on surfaces using the classic avidin-biotin link, for which a wide variety of biochemical reagents are commercially available. A derivative of biotin bearing a photoremovable nitrobenzyl group (MeNPOC-biotin) has been prepared in a form suitable for simple linkage to biomolecules and surfaces. It has been used to functionalize bovine serum albumin (BSA) to form MeNPOC-biotin-BSA, which can then be coated onto glass. On photolithographic patterning of the surface, biotins are freed in the irradiated areas, permitting avidin to be localized at the irradiated sites. Subsequent addition of a biotinylated molecule permits its site-specific localization. Patterning of a biotinylated antibody and dye-labeled avidins or streptavidin using this reagent has been demonstrated by fluorescence microscopy.

Performance of small diameter synthetic vascular prostheses with confluent autologous endothelial cell linings

Autologous grafts are superior to their synthetic counter-parts for grafting arteries smaller than 6-mm diameter both in terms of acute thrombogenicity and chronic intimal hyperplasia. Endothelial cell (EC) coating of the blood contacting surface may reduce thrombogenicity of synthetic small diameter vascular prostheses. In this study, the survival of EC monolayers on synthetic 4-mm diameter arterial prostheses over short-term implantations (< or = 6 weeks) was examined. Graft types examined were expanded polytetra-fluoroethylene (ePTFE) and microporous polyurethane (PU). Lumenal coverage with ECs was achieved by culturing ovine ECs on prostheses treated by either physical adsorption or covalent binding of ovine fibronectin (Fn). An ovine carotid interposition model was used to examine the performance of EC coated ePTFE and microporous PU over implantation periods of 1, 3, and 6 weeks. Outcomes assessed at the end of each experiment were graft patency, area covered by ECs, and thrombus free surface area (TFSA). Fn concentration, cell density at the time of coating and prostacyclin production in vitro were similar for both graft types. Occlusion occurred more frequently in unseeded grafts compared with EC coated grafts over 3 and 6 week implantation periods; however, the difference was not significant (p = 0.099). In prostheses precoated with ECs, approximately 40-60% of the surface area remained covered with endothelial-like cells following the first postoperative week. Recovery of EC layers occurred rapidly thereafter with 80-90% coverage at 3 weeks. TFSA remained low in comparison to EC cover in these prostheses until between 3 and 6 weeks postoperatively, suggesting a lag phase in recovery of EC function of seeded cells. In contrast, EC cover of unseeded prostheses only achieved 10-30% at 3 weeks, primarily by pannus EC ingrowth from the adjacent artery. TFSA of unseeded grafts increased in direct proportion to EC cover over time suggesting that there was no lag phase in function of these ingrowing cells.

Kinetics of bone cell organization and mineralization on materials with patterned surface chemistry

Materials with spatially resolved chemistries (i.e. patterned surfaces) have been used to guide and organize the position of mammalian cells in vitro. A common theme in guiding the spatial distribution of cells has been the use of patterned alkylsiloxanes, where one region contains an aminosilane and the other an alkylsilane. The regions of the aminosilane served as preferential sites for cell attachment and spreading, presumably dependent on the association between cell surface proteoglycans the positively charged amine. In this study, experiments were conducted with patterns of N-(2-aminoethyl)-3-aminopropyl-trimethoxysilane (EDS) and dimethyldichlorosilane (DMS) to determine the kinetics of spatial organization of bone-derived cells, and whether initial attachment and spreading affected the rate of matrix mineralization (i.e. bone formation) in extended cultures. The bone cells required the presence of serum or preadsorption of serum proteins to the patterned EDS/DMS surface to organize according to the lithographically defined surface chemistry. Time-lapse video microscopy indicated that cells were randomly distributed over the EDS/DMS surface at the time of plating, but organized on the EDS regions within 30 min. When cultures were extended for 15 and 25 days, the matrix synthesized by the cells was preferentially mineralized on the EDS chemistry. These results demonstrate the ability of surface chemistry modifications to organize cells and form mineralized tissue in vitro. The methods employed should have general value to the engineering of tissues in vitro.

Polymer materials for the prevention of catheter-related infections

Catheter-related infections are major problems in medicine because of severe consequences for the patient, prolongation of hospitalization, and increasing therapy costs. Beside progress in hygienic measures, development of catheters with antiinfective properties seems to be a promising approach to the prevention of such infections. Two approaches for infection-resistant catheter materials have been developed: materials with antiadhesive properties and materials with antimicrobial properties. Antiadhesive polymers shall prevent the adhesion of microorganisms to the medical device. However, up to now there has been no material which would lead to a complete inhibition of adherence ("zero adherence"). Materials with antimicrobial properties contain antimicrobial substances which are incorporated into the biomaterial or bound to the polymer surface. These devices seem to be effective in the prevention of "early onset infections". In this paper, an overview of the development and efficiency of antiadhesive or antimicrobial polymers is given.

Bacterial biofilms

Over the review period, a significant amount of literature has been published documenting the impact of biofilms on engineered and biomedical systems. Reactor systems and analytical techniques have evolved to study the molecular chemistry and microbial ecology within biofilm layers only tens of micrometers thick, and various protocols have been developed to control cell adhesion and biofilm formation.