Biocompatibility of sulphonated polyurethane surfaces

2022 Update of the Consensus on the Rational Use of Antithrombotics and Thrombolytics in Veterinary Critical Care (CURATIVE) Domain 1- Defining populations at risk

OBJECTIVES

To expand the number of conditions and interventions explored for their associations with thrombosis in the veterinary literature and to provide the basis for prescribing recommendations.

DESIGN

A population exposure comparison outcome format was used to represent patient, exposure, comparison, and outcome. Population Exposure Comparison Outcome questions were distributed to worksheet authors who performed comprehensive searches, summarized the evidence, and created guideline recommendations that were reviewed by domain chairs. The revised guidelines then underwent the Delphi survey process to reach consensus on the final guidelines. Diseases evaluated in this iteration included heartworm disease (dogs and cats), immune-mediated hemolytic anemia (cats), protein-losing nephropathy (cats), protein-losing enteropathy (dogs and cats), sepsis (cats), hyperadrenocorticism (cats), liver disease (dogs), congenital portosystemic shunts (dogs and cats) and the following interventions: IV catheters (dogs and cats), arterial catheters (dogs and cats), vascular access ports (dogs and cats), extracorporeal circuits (dogs and cats) and transvenous pacemakers (dogs and cats).

RESULTS

Of the diseases evaluated in this iteration, a high risk for thrombosis was defined as heartworm disease or protein-losing enteropathy. Low risk for thrombosis was defined as dogs with liver disease, cats with immune-mediated hemolytic anemia, protein-losing nephropathy, sepsis, or hyperadrenocorticism.

CONCLUSIONS

Associations with thrombosis are outlined for various conditions and interventions and provide the basis for management recommendations. Numerous knowledge gaps were identified that represent opportunities for future studies.

Surface and Hemocompatibility Studies of Bi-Soft Segment Polyurethane Membranes

Cross-linked urethane/urea membranes with two soft segments were prepared by extending a poly(propylene oxide) based tri-isocyanate-terminated prepolymer (PUR) with polybutadiene diol (PBDO). The ratio of prepolymer and polybutadiene diol was varied to yield cross-linked membranes with different compositions, exhibiting different degrees of phase-separation of the PBDO segments in the bulk and of surface enrichment in PUR. In this work, surface energy and hemocompatibility aspects (hemolysis and thrombosis) of the PUR/PBDO membranes were evaluated. The results showed that the membrane surface energy increased with the PBDO content until 25% of PBDO, and decreased thereafter. The introduction of the second, more hydrophobic, soft segment (PBDO) in the PUR membranes turned hemolytic into non-hemolytic membranes and, for a blood-material contact time of 10 minutes, decreased the thrombogenicity significantly. The 10% PBDO membrane was the least thrombogenic and was also non-hemolytic. The hemolysis degree did not vary significantly with the PBDO content while, for blood-material contact times of 10 minutes, the thrombogenicity increased with an increase in PBDO content above 10%. Membrane thrombogenicity varied with the blood-material contact time. For blood contact times of 10 minutes, all membranes tested were less thrombogenic than glass.

Development of oxidized sulfur polymer films through a combination of plasma polymerization and oxidative plasma treatment

A novel two-step process consisting of plasma polymerization and oxidative plasma treatment is introduced in this article for the first time for the fabrication of -SO(x)(H)-functionalized surfaces. Plasma-polymerized thiophene (PPT) was initially deposited onto silicon wafers and subsequently SO(x)(H)-functionalized using air or oxygen plasma. The effectiveness of both air and oxygen plasma treatments in introducing sulfur-oxygen groups into the PPT film was investigated as the plasma input specific energy and treatment time were varied. The surface chemistries of untreated and treated PPT coatings were analyzed by X-ray photoelectron spectroscopy (XPS) and time-of-flight secondary ion mass spectroscopy (ToF-SIMS), whereas spectroscopic ellipsometry was used to evaluate the film thickness and ablation rate. Surface chemistry analyses revealed that high concentrations of -SO(x)(H) functionalities were generated on the surface upon either air or oxygen plasma treatment. It was found that, at low plasma input energies, the oxidation process was dominant whereas, at higher energies, ablation of the film became more pronounced. The combination of thiophene plasma polymerization and air/oxygen plasma treatment was found to be a successful approach to the fabrication of -SO(x)(H)-functionalized surfaces.

Immobilisation of heparin on bacterial cellulose-chitosan nano-fibres surfaces via the cross-linking technique

In recent years, bacterial cellulose (BC) has been fabricated in tubular shape as scaffold for vascular tissue engineering. However, in order to improve the blood compatibility and regenerative ability of BC, BC nano-fibres should be cross-linked with some materials which can prevent the formation of blood clot. In this work, a novel BC-chitosan (CS)/heparin (Hep) composite was prepared. Scanning electron microscopy (SEM), transmission electron microscopy (TEM), X-ray diffraction (XRD) and Fourier-transformed infrared spectroscopy (FTIR) were used to analyse the obtained samples. It is observed by SEM and TEM that the obtained composites remain the three-dimensional (3D) network and porous structure. The results of XRD reveal that the curve of BC-CS/Hep composite assumes the characteristic absorption peaks of BC, CS and Hep. The FTIR results also confirm the presence of CS and Hep on the surface of BC nano-fibres. In conclusion, BC-CS/Hep composites were obtained by the co-synthesis technique and the cross-linking method, respectively. Furthermore, the MC3T3-E1 cells were seeded on the obtained samples to test the cell compatibility. The 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide results indicated that the BC-CS/Hep composites were suitable for cell proliferation and ingrowth.

Sub-micron tailoring of bi-soft segment asymmetric polyurethane membrane surfaces with enhanced hemocompatibility properties

Enhancement of membrane hemocompatibility is achieved through the control of the surface morphology. Bi-soft segment integrally skinned poly(ester urethane urea) (PEUU) membranes containing polycaprolactone (PCL) as a second soft segment are synthesized with PCL-diol ranging from 0% to 15% (w/w). Scanning electron microscopy and atomic force microscopy characterized membrane asymmetry and sub-micron roughnesses, R(a), of top dense surfaces as major assets to the development of platelet/membrane surface interactions. Here we show that the top dense surfaces of asymmetric PEUU membranes can be tailored with different morphologies when the ratio of the two soft segments PPO/PCL varies. A strong correlation between the top surface roughnesses, R(a) and platelet deposition is identified. The membrane with 15% (w/w) of PCL-diol, PEUU 85, shows the smoothest top dense layer with a R(a) as low as 1 nm which is 5 times below the characteristic value of the PEUU membrane with a single soft segment. The PEUU 85 asymmetric membrane displayed minimal platelet deposition and inhibition of extreme stages of platelet activation.

Spatial variation of the charge and sulfur oxidation state in a surface gradient affects plasma protein adsorption

A gradient of negative surface charge based on the 1D spatial variation from surface sulfhydryl to mixed sulfhydryl-sulfonate moieties was prepared by the controlled UV oxidation of a 3-mercaptopropylsilane monolayer on fused silica. The adsorption of three human plasma proteins--albumin (HSA), immunoglobulin G (IgG), and fibrinogen (Fgn)--onto such a surface gradient was studied using spatially resolved total internal reflection fluorescence (TIRF) and autoradiography. Adsorption was measured from dilute solutions equivalent to 1/100 (TIRF, autoradiography), 1/500, and 1/1000 (autoradiography) of protein physiological concentrations in plasma. All three proteins adsorbed more to the nonoxidized sulfhydryl region than to the oxidized, mixed sulfhydryl-sulfonate region of the gradient. In the case of HSA, the adsorption contrast along the gradient was largest when the adsorption took place from more dilute protein solutions. Increasing the concentration to 1/100 of the protein plasma concentration eliminated the effect of the gradient on HSA adsorption and, to the lesser extent, on IgG adsorption. In the case of Fgn, the greatest adsorption contrast was observed at the highest concentration used. On the basis of adsorption kinetics, the estimated binding affinity of HSA for the sulfhydryl region was twice the affinity for the mixed sulfhydryl-sulfonate region of the gradient. For IgG and Fgn, the initial adsorption was transport-limited and the initial adsorption rates approached the computed flux of the protein to the surface.

Antibacterial surfaces by adsorptive binding of polyvinyl-sulphonate-stabilized silver nanoparticles

This paper presents a novel and facile method for the generation of efficient antibacterial coatings which can be applied to practically any type of substrate. Silver nanoparticles were stabilized with an adsorbed surface layer of polyvinyl sulphonate (PVS). This steric layer provided excellent colloidal stability, preventing aggregation over periods of months. PVS-coated silver nanoparticles were bound onto amine-containing surfaces, here produced by deposition of an allylamine plasma polymer thin film onto various substrates. SEM imaging showed no aggregation upon surface binding of the nanoparticles; they were well dispersed on amine surfaces. Such nanoparticle-coated surfaces were found to be effective in preventing attachment of Staphylococcus epidermidis bacteria and also in preventing biofilm formation. Combined with the ability of plasma polymerization to apply the thin polymeric binding layer onto a wide range of materials, this method appears promising for the fabrication of a wide range of infection-resistant biomedical devices.

Real-time measurements of coagulation on bacterial cellulose and conventional vascular graft materials

The search for a functional, small diameter (<5mm) vascular graft has been ongoing for over 30 years, but yet there is no consistently reliable synthetic graft. The primary mechanisms of graft failure are intimal hyperplasia, poor blood flow and surface thrombogenicity. Bacterial cellulose (BC) became therefore a proposed new biosynthetic vascular graft material. Since conventional methods are not suited for coagulation measurements on BC, we have adapted the automated calibrated thrombin generation method for measurements of biomaterial-induced coagulation of BC as compared with clinically used graft materials i.e., expanded poly(tetrafluoroethylene) (ePTFE) and poly(ethyleneterephtalat) (PET). We have also visualized the coagulation propagation at the material surfaces. Thrombin generation experiments revealed dramatic differences between the materials tested. Both ePTFE and BC were found to generate longer lag times and ttpeak values than PET. Most importantly, BC was found to generate the lowest "peak", indicating a slower coagulation process at the surface. These results are also supported by the measurements of factor XIIa generation and analysis of surface coagulation times, which were detected in the following increasing order (mean + or - SD): PET (27 + or - 8 min)<BC (46 + or - 9 min)<ePTFE (61 + or - 21 min). Real-time measurement of coagulation seems to have the potential for becoming a powerful tool for evaluation of biomaterials for blood-contacting devices.

Multiscale analysis of surface thrombosis in vivo in a left ventricular assist system

Thrombosis limits the success of ventricular assist devices as the demand for alternatives to heart transplants is increasing. This study mapped the occurrence of thrombosis in a left ventricular assist system (LVAS) to better understand the biologic response to these devices. Nine calves divided into two groups were implanted with LVAS for 28 to 30 days. One group was anticoagulated, whereas the second group received no long-term anticoagulation. The blood-contacting poly(urethane urea) surfaces of blood sacs in the LVAS were examined for macroscopic thrombi upon retrieval. The sac was partitioned into eight sections and imaged for thrombi by scanning electron microscopy. No difference in thrombosis was observed macroscopically between the groups. Anticoagulation appeared to result in reduction of platelet-like structures, but the presence of fibrin-like structures remained similar between groups. Regional differences correlating with high and low shear stress regions were observed. At the macroscale, fewer thrombi were recorded in the high shear stress ports. At the microscale, features resembling fibrin were observed primarily in the ports and platelet-like features were common in lower shear stress regions. These variations in thrombosis with anticoagulation and location are likely due to varied fluid dynamics within the LVAS blood sac.

A scanning electron microscopic study on thrombogenicity of intraarterial catheters for chemotherapeutic treatment in head and neck cancer

BACKGROUND

The purpose of this study was to assess the impact of standard anticoagulation and intermittent catheter irrigation on clot formation on intraarterial chemotherapeutical catheters.

METHODS

Sixteen nonheparinized catheters were placed in the carotid vessels of 10 patients. Ten catheters were perfused with chemotherapeutic drugs; six catheters were not perfused. Patients received LMWH anticoagulation; catheters were irrigated with boluses of heparinized saline daily. Catheters were retrieved for SEM evaluation after a mean intravessel placement interval of 21 days.

RESULTS

All samples demonstrated accumulation of thrombotic debris on luminal sides and outsides of catheters. Obliteration was seen in three samples. Detachment of thrombus fragments was present in several specimens. No significant dependence of clot formation on placement interval and chemotherapeutic perfusion was calculated.

CONCLUSIONS

Standard anticoagulation was ineffective in clot prevention. Heparinized catheters might potentially reduce the risk of clot formation. A delivery system should be engaged for continuous irrigation of catheters with heparinized saline.

Growth of L929 cells on polymeric films prepared by Langmuir-Blodgett and casting methods

The growth and spreading of fibroblast, L929 cells, on various polymeric films prepared by the Langmuir-Blodgett (LB) and casting methods were investigated. L929 cells, which were cultivated on collagen and synthetic polymeric films prepared by the LB method, adhered and spread much more than those on synthetic films prepared by the casting method. This is explained by the fact that cell growth and cell spreading are suitable for L929 cells on the films having serum proteins that contain a high alpha-helix content, because LB films adsorbed those serum proteins estimated from the circular dichroism measurements of the films immersed in cell culture medium. An exponential relationship was observed from the plot of the cell density vs root mean square of roughness of the films, which is estimated by atomic force microscopy, whereas a linear relationship was observed from the plot of the spreading ratio vs the root mean square of roughness. It is suggested that the correlation between the cell growth or spreading ratio and surface roughness of the films where L929 cells were cultivated is considered to be more important than the correlation between the cell growth or spreading ratio and the contact angle of the films.

Synthesis of cholesterol esterase by monocyte-derived macrophages: a potential role in the biodegradation of poly(urethane)s

Many studies have described the role of monocyte-derived macrophages (MDM) in inflammation leading to atherosclerosis, a process in which alterations in the metabolism of cholesterol esters is well established. On the other hand, the mechanism of MDM activation in response to biomaterial surfaces is still not well understood. Several studies have described the different degrees of activation of monocytes on poly(urethane) surfaces by measuring the release of early markers of differentiation, such as cytokines. It has been possible to decrease MDM activation in contact with materials by modifying the material surface with antioxidants. Therefore, it has been proposed that it is the reactive oxygen species provided by MDM which are responsible for deleterious effects observed in material-derived inflammation. A recent study has shown that one of the markers of the degree of differentiation of MDM is the synthesis of cholesterol esterase (CE), an enzyme demonstrated as causing biodegradation of polyester(urethane)s and more recently polyether- and polycarbonate-poly(urethane)s as well. In this review article, markers used to assess MDM differentiation on material surfaces will be described and related to the activation of MDM. In particular, the CE accumulation in MDM which is associated with atherosclerosis will be related to its degradative potential during chronic inflammation. How this may impact on the biostability of implanted poly(urethane) medical devices is discussed.

Covalent coupling of immunoglobulin G to a poly(vinyl)alcohol-poly(acrylic acid) graft polymer as a method for fabricating the interfacial-recognition layer of a surface plasmon resonance immunosensor

The synthesis of a terminally thiolated poly(vinyl)alcohol (PVA) grafted with Poly (acrylic acid) (PAA) side chains is described. The PVA-PAA graft polymer (PVAg) was end-tethered to silver surfaces via the terminal thiol functionality and the resultant mobile, hydrophilic polymer matrix exploited for the covalent immobilization of large quantities of polyclonal goat (anti-hIgG) antibody (IgG) with low levels of non-specific adsorption. An SPR immunosensor, fabricated with an IgG-PVA-silver interfacial layer proved capable of performing a sensitive label-free assay of human IgG antigen (hIgG) with minimal non-specific binding interference. A detection limit (DL) for hIgG from serum of 0.8 microgram/ml (5 nM) and an assay sensitivity of 0.66 ng hIgG/mm2/nM are reported.