Manfred F. Maitz

Current strategies towards hemocompatible coatings

A wide range of biomedical devices is applied clinically in contact with blood. Tailoring the surface properties of the involved biomaterials is a common approach to enhance performance and to limit adverse reactions. This review summarizes current trends in coating technologies developed for that purpose. Inorganic coatings were shown to substantially improve the durability and inertness of biomaterials while a number of advanced polymer coatings were demonstrated to be very effective by targeting specific biochemical pathways. However, to fully utilize the power of these bioactive coatings safety issues need to be thoroughly addressed in future studies.

The effect of coimmobilizing heparin and fibronectin on titanium on hemocompatibility and endothelialization

Currently available cardiovascular implants, such as heart valves and stents, exhibit suboptimal biocompatibility because of the incomplete endothelialization and sequential thrombosis formation especially after a long-term implantation. To improve the blood compatibility and endothelialization simultaneously and ensure the long-term effect of the cardiovascular implants, a technique of combining electrostatic interaction and coimmobilization was developed to form heparin and fibronectin (Hep/Fn) films on aminosilanized titanium (Ti) surfaces. The Hep/Fn coimmobilized films were stable after immersion in PBS for five days, probed by wettability studies and by the release kinetics of heparin and fibronectin. Blood compatibility tests showed that the coimmobilized Hep/Fn films displayed lower hemolysis rate, prolonged blood coagulation time, higher AT III binding density, less platelets activation and aggregation, and less fibrinogen conformational change compared with Ti surface. Endothelial cells (ECs) seeding and fibronectin bioactivity results showed more attached and proliferated ECs and exposed cell-binding sites on the Hep/Fn immobilized samples than that on Ti surfaces. Thus, the Hep/Fn coimmobilized films kept excellent bioactivity even after immersion in PBS for five days. Systemic evaluation suggests that the coimmobilization of Hep/Fn complex improves the blood compatibility and promotes the endothelialization simultaneously. We envisage that this method will provide a potential and effective selection for biomaterials surface modification of cardiovascular implants.

The covalent immobilization of heparin to pulsed-plasma polymeric allylamine films on 316L stainless steel and the resulting effects on hemocompatibility

For an improved hemocompatibility of 316L stainless steel (SS), we develop a facile and effective approach to fabricating a pulsed-plasma polymeric allylamine (P-PPAm) film that possesses a high cross-linking degree and a high density of amine groups, which is used for subsequent bonding of heparin. The P-PPAm film as a stent coating shows good resistance to the deformation behavior of compression and expansion of a stent. Using deionized water as an aging medium, it is demonstrated that the heparin-immobilized P-PPAm (Hep-P-PPAm) surface has a good retention of heparin. The systematic in vitro hemocompatibility evaluation reveals lower platelet adhesion, platelet activation and fibrinogen activation on the Hep-P-PPAm surface, and the activated partial thromboplastin time prolongs for about 15 s compared with 316L SS. The P-PPAm surface significantly promotes adhesion and proliferation of endothelial cells (ECs). For the Hep-P-PPAm, although EC adhesion and proliferation is slightly suppressed initially, after cultivation for 3 days, the growth behavior of ECs is remarkably improved over 316L SS. In vivo results indicate that the Hep-P-PPAm surface successfully restrain thrombus formation by growing a homogeneous and intact shuttle-like endothelium on its surface. The Hep-P-PPAm modified 316L SS shows a promising application for vascular devices.

Blood coagulation on biomaterials requires the combination of distinct activation processes

The rational design of hemocompatible materials requires a mechanistic understanding of activation processes induced at the blood-material interface. Binary self-assembled monolayers of alkyl thiols (SAMs) with various ratios of -CH3 and -COOH terminations were used to study the relevance of hydrophobic and negatively charged surfaces for the initiation of blood coagulation. Platelet adhesion and activation of the intrinsic coagulation pathway scaled with the surface composition: the numbers of adherent platelets were highest on the 100%-CH3 surface whereas the greatest contact activation was seen on 100%-COOH surfaces. In vitro whole blood incubation assays showed, however, that the surfaces exposing either -CH3 or -COOH groups induced comparably low levels of thrombin formation while the surfaces with intermediate contents of both terminating groups had significantly higher values. These results reveal that contact activation and platelet adhesion have a strong synergistic effect on coagulation on blood-contacting materials even though these events in isolation are not sufficient to induce substantial thrombin formation. Successful surface design strategies for hemocompatible materials therefore need to carefully consider the interplay of both processes.

Blood Compatibility of Titanium Oxides with Various Crystal Structure and Element Doping

BACKGROUND: Titanium oxides are known to be good hemocompatible, therefore they are suggested as coatings for blood contacting implants. But little is known about the influence of physical characteristics like crystal structure, roughness and electronic state on the activation of blood platelets and the blood clotting cascade. METHODS: Titanium oxide films were produced by metal plasma deposition and implantation in the form of rutile, crystalline and nanocrystalline anatase + brookite and amorphous TiO2. The redox potential was reduced by implantation of chromium ions, the Fermi level of the semiconductive oxide was shifted by ion implantation of the electron donor phosphorous. Hemocompatibility was determined by measuring the adhesion of blood platelets, their P-selectine expression, and of the blood clotting time on these samples. RESULTS: The crystalline titanium oxides had a slightly higher activation of the clotting cascade but lower platelet adhesion than nanocrystalline and amorphous titanium oxides. The surface roughness below 50 nm had no obvious effect. Both, implantation of phosphorous or chromium ions, strongly reduced the activation of the clotting cascade, but only the phosphorous implanted surface also showed a reduced platelet activation, whereas platelet adhesion and activation was strongly increased on the chromium implanted surfaces. CONCLUSION: Phosphorous doping of rutile TiO2 can increase its hemocompatibility, both concerning blood platelets and blood clotting cascade, but the biochemical mechanism has to be worked out.

Mussel‐Inspired Coating of Polydopamine Directs Endothelial and Smooth Muscle Cell Fate for Re‐endothelialization of Vascular Devices

Polydopamine (PDAM), a mussel adhesive protein inspired coating that can be easily deposited onto a wide range of metallic, inorganic, and organic materials, gains interest also in the field of biomaterials. In this work, PDAM is applied as coating on 316L stainless steel (SS) stents and the response of cells of the blood vessel wall, human umbilical vein endothelial cell (HUVEC), and human umbilical artery smooth muscle cell (HUASMC) as predictors for re-endothelialization is tested. It is found that the PDAM-modified surface significantly enhances HUVEC adhesion, proliferation, and migration, release of nitric oxide (NO), and secretion of prostaglandin I(2) (PGI(2) ). Additionally, the PDAM-modified surface shows a remarkable ability to decrease the adhesion and proliferation of HUASMCs. As a blood-contacting material, the PDAM tends to improve the hemocompatibility compared with the substrate 316L SS. It is noteworthy that the PDAM coating shows good resistance to the deformation behavior of compression and expansion of a stent. These data suggest the potential of PDAM as a blood-contacting material for the application in vascular stents or grafts.

Bio-responsive polymer hydrogels homeostatically regulate blood coagulation

Bio-responsive polymer architectures can empower medical therapies by engaging molecular feedback-response mechanisms resembling the homeostatic adaptation of living tissues to varying environmental constraints. Here we show that a blood coagulation-responsive hydrogel system can deliver heparin in amounts triggered by the environmental levels of thrombin, the key enzyme of the coagulation cascade, which—in turn—becomes inactivated due to released heparin. The bio-responsive hydrogel quantitatively quenches blood coagulation over several hours in the presence of pro-coagulant stimuli and during repeated incubation with fresh, non-anticoagulated blood. These features enable the introduced material to provide sustainable, autoregulated anticoagulation, addressing a key challenge of many medical therapies. Beyond that, the explored concept may facilitate the development of materials that allow the effective and controlled application of drugs and biomolecules.

Structure and properties of titanium oxide layers prepared by metal plasma immersion ion implantation and deposition

Abstract Coating with titanium oxides is a promising method to improve the blood compatibility of materials to be used for medical implants. Ti oxide layers were deposited on oxidized Si from a plasma produced by cathodic arc evaporation under addition of oxygen to the ambient near the substrate. In dependence on the deposition parameters amorphous and nanocrystalline structures, crystalline layers composed of anatase and brookite as well as layers dominated by the rutile phase have been obtained. The activation of the plasmatic clotting cascade was only minimally influenced by the crystal size and the crystallite structure of the titanium oxide films. As a trend, amorphous, nanocrystalline and fine-grained layers show higher clotting times than well crystallized rutile films. Ion implantation of Cr or P strongly influences the clotting time. Contrasting tendencies in the dependence of clotting time and platelet adhesion on the microstructure of the Ti oxide have been found, however, for P + -doped rutile both, enhanced clotting time and improved platelet adhesion, are observed. Platelet adherence and activation always show similar trends.

Mussel-inspired one-step adherent coating rich in amine groups for covalent immobilization of heparin: hemocompatibility, growth behaviors of vascular cells, and tissue response.

Heparin, an important polysaccharide, has been widely used for coatings of cardiovascular devices because of its multiple biological functions including anticoagulation and inhibition of intimal hyperplasia. In this study, surface heparinization of a commonly used 316L stainless steel (SS) was explored for preparation of a multifunctional vascular stent. Dip-coating of the stents in an aqueous solution of dopamine and hexamethylendiamine (HD) (PDAM/HD) was presented as a facile method to form an adhesive coating rich in primary amine groups, which was used for covalent heparin immobilization via active ester chemistry. A heparin grafting density of about 900 ng/cm(2) was achieved with this method. The retained bioactivity of the immobilized heparin was confirmed by a remarkable prolongation of the activated partial thromboplastin time (APTT) for about 15 s, suppression of platelet adhesion, and prevention of the denaturation of adsorbed fibrinogen. The Hep-PDAM/HD also presented a favorable microenvironment for selectively enhancing endothelial cell (EC) adhesion, proliferation, migration and release of nitric oxide (NO), and at the same time inhibiting smooth muscle cell (SMC) adhesion and proliferation. Upon subcutaneous implantation, the Hep-PDAM/HD exhibited mitigated tissue response, with thinner fibrous capsule and less granulation formation compared to the control 316L SS. This number of unique functions qualifies the heparinized coating as an attractive alternative for the design of a new generation of stents.

Immobilization of heparin/poly-(L)-lysine nanoparticles on dopamine-coated surface to create a heparin density gradient for selective direction of platelet and vascular cells behavior.

Restenosis, thrombosis formation and delayed endothelium regeneration continue to be problematic for coronary artery stent therapy. To improve the hemocompatibility of the cardiovascular implants and selectively direct vascular cell behavior, a novel kind of heparin/poly-l-lysine (Hep/PLL) nanoparticle was developed and immobilized on a dopamine-coated surface. The stability and structural characteristics of the nanoparticles changed with the Hep:PLL concentration ratio. A Hep density gradient was created on a surface by immobilizing nanoparticles with various Hep:PLL ratios on a dopamine-coated surface. Antithrombin III binding quantity was significantly enhanced, and in plasma the APTT and TT times as coagulation tests were prolonged, depending on the Hep density. A low Hep density is sufficient to prevent platelet adhesion and activation. The sensitivity of vascular cells to the Hep density is very different: high Hep density inhibits the growth of all vascular cells, while low Hep density could selectively inhibit smooth muscle cell hyperplasia but promote endothelial progenitor cells and endothelial cell proliferation. These observations provide important guidance for modification of surface heparinization. We suggest that this method will provide a potential means to construct a suitable platform on a stent surface for selective direction of vascular cell behavior with low side effects.