Biocompatibility and degradation of poly(ether-ester) microspheres: in vitro and in vivo evaluation.

Microspheres of a hydrophobic and a hydrophilic poly(ether-ester) copolymer were evaluated for their in vitro and in vivo biocompatibility and degradation. The microspheres prior to and after sterilization were tested for in vitro cytotoxicity. The in vivo biocompatibility of the poly(ethylene glycol) terephthalate and poly(butylene terephthalate) (PEGT/PBT) microspheres was evaluated subcutaneously and intramuscularly for 24 weeks in rabbits. The in vivo degradation of the microspheres was studied microscopically and compared to the in vitro degradation. The in vitro and in vivo studies showed the biocompatibility of the microspheres of both the hydrophobic and the hydrophilic PEGT/PBT copolymer. Extracts of these microspheres showed no cytotoxic reactivity in the in vitro cytotoxicity test. Sterilization of the microspheres by gamma irradiation did not affect the cytotoxicity. PEGT/PBT microspheres injected subcutaneously and intramuscularly in rabbits showed a mild tissue response in vivo, in terms of the inflammatory response, the foreign body reaction and the granulation tissue response. Although an in vitro degradation experiment showed a decrease in molecular weight due to hydrolysis, the in vivo degradation of the microspheres was slower than previously published.

Effect of implantation site on phagocyte/polymer interaction and fibrous capsule formation.

Implants of Silastic, Estane, polypropylene oxide and an HPOE/PBT segmented polyether polyester copolymer were qualitatively and quantitatively evaluated, with respect to interaction with mononuclear and multinucleated phagocytes as well as fibrous capsule formation, after implantation at three sites in the rat middle ear. The volume of the phagocyte exudate surrounding the implants, the degree of implant degradation and fragmentation and the thickness of the fibrous capsules were found to be correlated with the implantation site. From these findings, it can be concluded that it is important to assess the biological performance of a biomaterial at carefully chosen implantation sites.

Reactions of cells at implant surfaces.

The surface of implants is an important parameter in host-implant integration. Several strategies can be used to obtain integration, such as the application of grooves or pores at the implant surface. Most of these surface alterations, however, will lead to an increase of total implant surface area which might influence the inflammatory response to an implant. As far as integration with bone is concerned several biomaterials have been successful in mimicking this material, by having similar crystals at their surface (calcium phosphate ceramics) or by containing a certain amount of calcium and phosphorus. Polyactive, a poly(ethylene oxide)-poly(butylene terephthalate) segmented copolymer, also possesses favourable integration properties with bone, but initially lacks calcium and phosphorus. It is proposed that the application of hydrogels as biomaterial may add a new dimension to integration capacity.

Cellular reaction on the intraperitoneal injection of four types of polylactide particulates.

Four types of polylactide particulates, P-L-LA 100, 250, 550 KD and a P-DL-LA 400 KD were injected into the peritoneal cavity of mice. The inflammatory reaction showed an increase in cell number (mainly neutrophilic granulocytes) up to 48 h after which the cell numbers decreased below the control (phosphate-buffered saline). All four polylactide particulates aggregated and intermingled with inflammatory cells. The aggregates remained throughout the investigation period of 6 months. Quantitative measurements showed that standardization of the particle form and size is essential. From this study and other experiments in which calcium phosphates and asbestos were injected intraperitoneally, it is concluded that the inflammatory response observed in the peritoneal cavity is related to the type of material injected and probably to form and size of the individual particles, but not to molecular weight.

Bone growth in biomimetic apatite coated porous Polyactive 1000PEGT70PBT30 implants.

We recently, developed a simple one-day one-step incubation method to obtain bone-like apatite coating on flexible and biodegradable Polyactive 1000PEGT70PBT30. The present study reports a preliminary biological evaluation on the coated polymer after implantation in rabbit femurs. The porous cylindrical implants were produced from a block fabricated by injection molding and salt leaching. This technique provided the block necessary mechanical integrity to make small cylinders (diameter 3.5 x 5 mm2) that were suitable for implantation in rabbits. The coating continuously covered the surface of the polymer, preserving the porous architecture of outer contour of the cylinders. Two defects with a diameter of 3.5 or 4 mm were drilled in the proximal and distal part of femur diaphysis. The implants were inserted as press-fit or undersized into the cortex as well as in the marrow cavity. The polymer swelled after implantation due to hydration, leading to a tight contact with the surrounding bone in both defects. The adherence of the coating on the polymer proved to be sufficient to endure a steam sterilization process as well as the 15% swelling of the polymer in vivo. The coated Polyactive 1000PEGT70PBT30 has a good osteoconductive property, as manifested by abundant bone growth into marrow cavity along the implant surface during 4-week implantation. A favorable bioactive effect of the coating with an intimate bone contact and extensive bone bonding with this polymer was qualitatively confirmed. Concerning the bone ingrowth into the porous implant in the defect of 4 mm diameter, only marginal bone formation was observed up to 8 weeks with a maximal penetration depth of about 1 mm. The pore interconnectivity is important not only for producing a coating inside the porous structure but also for bone ingrowth into this biodegradable material. This preliminary study provided promising evidence for a further study using a bigger animal model.

Effect of HA-1A monoclonal IgM antibody on endotoxin-induced proliferation of cultured rat middle ear epithelium.

The effect of human monoclonal antibody HA-1A (Centoxin) on the effect of endotoxin on cultured rat middle ear epithelium was investigated. The addition of endotoxin to the standard culture medium revealed a concentration-related proliferative effect on cultured rat middle ear epithelium, leading to cobblestone cells, cell tracks, and stratification of epithelium, whereas rat middle ear epithelium cultured in standard medium grew as a monolayer composed of flat polygonal cells. Addition of HA-1A to standard medium supplemented with endotoxin gave rise to a statistically significant suppression of the proliferative effects of endotoxin on these cells. The morphology of rat middle ear epithelium cultured in the presence of HA-1A and endotoxin showed that these cells still had a tendency to form cobblestone-like cells and cell tracks, but to a substantially lower degree. The present results support the hypothesis that HA-1A suppresses the proliferative and morphological effects of endotoxin on rat middle ear epithelium and may play an important role in the pathogenesis of otitis media.

Cytokeratin patterns of tissues related to cholesteatoma pathogenesis.

Specimens of cholesteatoma matrix, meatal epidermis, and middle ear epithelium were removed during surgery, and immunohistochemical techniques were used to investigate cytokeratin expression. The use of five chain-specific anticytokeratin monoclonal antibodies and one broad specific anticytokeratin monoclonal antibody showed the divergent behavior of middle ear epithelium compared with the cytokeratin expression of the other two types of epithelium. Middle ear epithelium was characterized by the presence of cytokeratins 4, 8, 18, and 19, whereas in both cholesteatoma and meatal epidermis cytokeratin 10 predominated. Furthermore, cholesteatoma showed an infrequent focal presence of cytokeratins 4, 18, and 19. The similarity between cholesteatoma and meatal epidermis with respect to morphology, and the presence of cytokeratin 10 support an epidermal origin of cholesteatoma. However, a metaplastic origin cannot be excluded, because of the infrequent occurrence of a small amount of cytokeratins 4, 18, and 19 in cholesteatoma matrix that was not found in meatal epidermis but was a component of the cytokeratin pattern of middle ear epithelium.

The effect of external stimuli on cultured rat middle ear epithelium. I. Extracellular calcium concentration.

The effect of the extracellular calcium concentration on serially cultured rat middle ear epithelium was investigated with phase contrast microscopy, scanning electron microscopy, and transmission electron microscopy, as well as by a method to induce cornified envelope formation with a calcium ionophore. The results show that calcium concentration affects cell morphology and terminal differentiation. Furthermore, a role in the proliferation rate, secretory activity and migration seems likely. Since the extracellular calcium concentration may fluctuate locally during osteoresorption or osteodeposition, both of which occur during otitis media, this concentration might be an important factor in the pathogenesis of both acute and chronic otitis media.

Effect of endotoxin on the advancing front between cultured middle ear mucosa and epidermis. A preliminary study.

The formation of Cholesteatoma is often accompanied by infection, and is very likely to be influenced by inflammatory mediators. Endotoxin, a strong inflammatory mediator, may play an important role in cholesteatoma pathogenesis. It has been demonstrated in middle ear effusions, and it causes marked reactions in middle ear epithelium and epidermis, both in vivo and in vitro. The effect of endotoxin on a simulation of the advancing front of cholesteatoma was investigated in this study. We developed a co-culture model composed of a simultaneous culture of rat middle ear mucosa and rat meatal epidermis in one culture dish, to which endotoxin was added. During the culture period the addition of endotoxin to the co-culture delayed take-over of the meatal epidermis by the middle ear mucosa, in comparison with control cultures. Morphological changes included the clustering of microvilli in co-cultures exposed to endotoxin. Although these results are preliminary, they suggest that endotoxin disturbs the normal healing process of the middle ear cavity.

Tympanic membrane structure during a Staphylococcus aureus-induced middle ear infection. A study in the rat middle ear.

In response to a Staphylococcus aureus-induced middle ear infection the tympanic membrane showed infiltration of polymorphonuclear granulocytes, lymphocytes, and macrophages and increased areas covered by ciliary and secretory epithelium. These reactions, which were comparable to the cellular and mucociliary responses seen in the middle ear mucosa during infection, were restricted to the pars flaccida and to predominantly the annular and manubrial regions of the pars tensa. This showed that the greater part of the tympanic membrane, where the lamina propria is composed of collagenous bundles and only very thin layers of loose connective tissue, is hardly affected by or barely responds to the inflammatory stimulus.

New alloplastic tympanic membrane material.

For patients with a totally empty middle ear a total alloplastic middle ear prosthesis (TAM) has been developed consisting of a macroporous hydroxyapatite canal-wall segment as a foundation system from which a dense hydroxyapatite ossicular chain is suspended. To connect the ossicular chain, we developed an alloplastic tympanic membrane made from a polymer. Light microscopy, morphometry, and autoradiography as well as various electron microscopy techniques were used in this study to evaluate the biocompatibility of Polyactive, a polyether polyester copolymer, after implantation in the rat middle ear. After between 2 and 4 weeks, implants were completely covered by tympanic-membrane epidermis and epithelium. Polyactive provoked a mild foreign-body reaction, showed a degradation rate of 54 percent after 1 year, and was nontoxic. Growth of fibrous tissue and bone into Polyactive copolymer indicated appropriate implant fixation by mechanical interlocking. The fixation of Polyactive by ingrowth of bone is promising, not only in terms of the amount of bone but also in terms of the bone/polymer interface. The latter is indicative of bonding osteogenesis in a way similar to that reported for hydroxyapatite implants. The results of this study showed that Polyactive copolymer is suitable as a degradable alloplastic tympanic membrane, both as a temporary scaffolding for the repair of tympanic membrane perforations and as a tympanic membrane in the TAM.

DNA measurements of cervical epithelial cells in combination with scanning electron microscopy.

A method is described in which the surface morphology of benign and malignant cervical cells is investigated with a combined light microscope-scanning electron microscope, after the measurement of the DNA content of each individual cell in the same instrument. The suspect cells can thus be identified by an increased aneuploid DNA content (greater than 5C) and not primarily by morphology. The DNA content was measured, after a quantitative acriflavine-Feulgen staining, by using a microphotometer attached to the combined microscope. It was found that the suspect cells show a different surface morphology compared to normal cells from a benign specimen.

The competence of transformed keratinocytes to differentiate is accompanied by amplification of the LDL- and EGF-receptor genes but not of the insulin receptor gene.

The possible relationship between cell surface receptor numbers, receptor gene expression for low density lipoprotein (LDL), insulin and epidermal growth factor (EGF), and differentiation capacity has been studied in normal and SV40 transformed (SVK14) keratinocytes, various squamous carcinoma cell (SCC) lines and A431 cells. Our recent studies demonstrated that an inverse relationship exists between LDL- and EGF-receptor binding and the ability to differentiate of both normal and transformed keratinocytes. In the present study cloned LDL- and EGF-receptor complementary DNAs were used as probes to identify both LDL and EGF receptor gene fragments on genomic DNA blots. The extent of hybridisation was found to be increased to the highest extent in A431 cells and decreased in other cells in the following order SCC-4 greater than SCC-15. In SCC-12F2, SVK14 and normal keratinocytes no increase has been observed. The increased hybridisation of LDL- and EGF-receptors in A431, SCC-4 and SCC-15 cells was found to be due to gene amplification and not to aneuploidy. In contrast to the LDL- and EGF-receptor binding, no correlation has been found between insulin receptor binding and ability of cells to differentiate. Furthermore, no amplification of insulin receptor gene has been observed in any of the cells under study.

The biocompatibility of hydroxyapatite ceramic: a study of retrieved human middle ear implants.

The biocompatibility of 11 hydroxyapatite auditory canal-wall prostheses and 4 hydroxyapatite incus prostheses implanted for 4 to 40 months was evaluated by light microscopy, scanning electron microscopy, transmission electron microscopy, and Röntgen microanalysis. These 15 prostheses representing 4% of 375 prostheses, has been removed because of unresolved chronic middle ear infection, residual cholesteatoma, or poor fit. The findings confirmed earlier reports on the biocompatibility of hydroxyapatite in vitro, in animals, and in man. An electron-dense layer was found at the interface with bone and fibrous tissue, and a firm bond between the ceramic and bone at the hydroxyapatite ceramic/bone interface developed. Macropores became filled with bone and fibrous tissue, and the tissue in the individual pores was interconnected. Furthermore the incus prostheses were covered with an epithelium similar to that found in the human middle ear. Findings diverging from those made in other studies were the relatively large amount of exudate in the pores, an apparent increase of degradation during infection, and the accumulation of trace elements in one of the canal-wall prostheses. In all likelihood these three phenomena may be attributed to the unfavorable conditions to which these prostheses were exposed during implantation.

The behavior of alloplastic tympanic membranes in Staphylococcus aureus-induced middle ear infection. I. Quantitative biocompatibility evaluation.

The biocompatibility of dense Silastic implants and porous implants made of Estane 5714 F1 polyether urethane, polypropylene oxide, and an HPOE/PBT segmented polyether polyester copolymer was evaluated during an induced Staphylococcus aureus middle ear infection. The middle ear response to infection seemed not to be affected by the presence of implants made of either of the polymers. Light microscopical morphometry and transmission electron microscopy showed degradation of the porous implants under study, but not of Silastic implants, which were invariably surrounded by a fibrous capsule. This finding, combined with the degree of porous implant degradation, the composition of the tissues surrounding the implants, and the tissue/biomaterial interface reactions are consistent with the results obtained in the noninfected middle ear. Round-cell infiltrates however, were predominantly associated with implants made of polypropylene oxide and HPOE/PBT copolymer; while the presence of (phagocytosed) microbial debris was associated with copolymer. The present findings indicate that with respect to implant behavior in infected surroundings Estane is the best porous material, whereas the behavior of Silastic implants did not deviate from that in non-infected ears.

Tissue/biomaterial interface characteristics of four elastomers. A transmission electron microscopical study.

The tissue/biomaterial interface reactions of four elastomers--selected as candidates for scaffolding for tympanic membrane tissue in a total alloplastic middle ear prosthesis--were studied at the electron microscopical level after implantation in the rat middle ear. Time-dependent changes in the phagocyte/polymer interface suggested degradation of porous implants made of Estane polyether urethane, polypropylene oxide, and a poly(ethylene oxide hydantoin) and poly(tetramethylene terephthalate) segmented polyether polyester copolymer (HPOE/PBT copolymer), but not of dense Silastic silicone rubber implants. Silastic was always encapsulated in fibrous tissue. Contact between fibrous tissue and HPOE/PBT copolymer or Estane was established in the third month, but fibrous tissue was never seen close to polypropylene oxide. Bone made contact only with Estane and HPOE/PBT copolymer implants. The bone/copolymer interface showed an electron-dense layer morphologically similar to that seen between bone and hydroxyapatite ceramic, suggesting that with respect to bone HPOE/PBT copolymer behaves like a bioactive implant material. The electron-dense layer was absnet at the bone/Estane interface. Estane and especially HPOE/PBT copolymer seem to be suitable as alloplastic tympanic membrane because of their interface behavior with respect to fibrous tissue and bone.

Biocompatibility of a polyether urethane, polypropylene oxide, and a polyether polyester copolymer. A qualitative and quantitative study of three alloplastic tympanic membrane materials in the rat middle ear.

The biocompatibility of porous implants made of Estane 5714 F1 polyether urethane, polypropylene oxide, and a poly(ethylene oxide hydantoin) and poly(tetramethylene terephthalate) segmented polyether polyester copolymer (HPOE/PBT copolymer), which were selected as candidates for an alloplastic tympanic membrane, was assessed after implantation in rat middle ears for periods of up to 1 year. Implantation of the materials led to tissue reactions initially associated with the wound-healing process, whereas after 1 month not only the presence of macrophages and foreign-body giant cells surrounding the implant materials but also implant degradation were characteristic for a foreign-body reaction. Macrophages and foreign-body giant cells dominated the picture of the tissue surrounding polypropylene oxide. The altered morphology of these cells, the persistent infiltration of the implantation sites by exudate cells, and the premature death of five rats in the 1-year group suggest that polypropylene oxide degradation was accompanied by the release of toxic substances. Estane and copolymer degradation did not induce tissue responses reflecting implant toxicity, and tympanic membranes given these alloplasts showed a normal healing pattern. Inclusions in the cytoplasm of macrophages associated with degradation and phagocytosis of all of the polymers under study were found to contain iron, silicon, titanium, and aluminum. Growth of fibrous tissue and bone, the latter into Estane and HPOE/PBT copolymer implants, indicated appropriate implant fixation by tissue, although macrophages and foreign-body giant cells were present as well. Especially the fixation of copolymer by ingrowth of bone seems promising in terms of the amount of bone in the pores and the electron-dense bone/copolymer interface. The latter is indicative for bonding osteogenesis. The HPOE/PBT copolymer is a better candidate for alloplastic tympanic membrane than Estane, and the use of polypropylene oxide cannot be recommended.

The behavior of alloplastic tympanic membranes in Staphylococcus aureus-induced middle ear infection. II. Morphological study of epithelial reactions.

Epithelial reactions to Silastic, Estane polyether urethane, polypropylene oxide, and a poly(ethylene oxide hydantoin) and poly(tetramethylene terephthalate) segmented polyether polyester copolymer were investigated after implantation in tympanic membranes and submucosa of noninfected and Staphylococcus aureus-infected rat middle ears. Porous implants made of Estane and polypropylene oxide were completely covered by tympanic-membrane connective tissue, epidermis, and epithelium in 2 weeks and those made of copolymer in between 2 and 4 weeks postoperatively. Silastic implants, which were dense, were not enveloped by tympanic-membrane tissue but rejected. Starting in the 6th postoperative month the proliferative activity and structure of both the tympanic membrane epithelium and epidermis became normal except for the presence of iron-containing secretory epithelium near polypropylene oxide. After initial swelling caused by the surgical trauma, neither the proliferative activity nor the composition of the epithelium covering submucosal implants was affected by the presence of any of the biomaterials. Infection of middle ears bearing implants induced epithelial reactions similar to those associated with infected middle ears without an implant.

Effect of endotoxin on cultured rat middle ear epithelium, rat meatal epidermis, and human keratinocytes.

Several factors seem to contribute to the series of events in the pathogenesis of otitis media and cholesteatoma. Endotoxin is likely to be one of these factors, since it has been found in human middle ear effusions and since injection of this substance into the middle ear, in animal experiments, gave rise to prominent reactions. Provoking of epithelial cells in vitro with endotoxin led to distinct cell responses that might be associated with cholesteatoma formation. In this study the effect of endotoxin on serially cultured rat middle ear epithelium, rat meatal epidermis, and human keratinocytes was investigated. Endotoxin strongly stimulated the proliferation of middle ear epithelium and human keratinocytes and inhibited that of meatal epidermis. Furthermore, endotoxin affected the morphology of the three types of tissue. Rat middle ear epithelium revealed epithelial cell tracks with interconnecting bridge-like structures protruding above the culture plane, whereas rat meatal epidermis showed increased terminal differentiation expressing large areas of blister-like structures detaching from the culture dish. Cross-linked envelope analysis of human keratinocytes showed an increased terminal differentiation that was morphologically confirmed but was not confirmed by cytokeratin analysis. The results of this study support the hypothesis that endotoxin may play an important role in the pathogenesis of otitis media and cholesteatoma.

Ciliogenesis in human bronchial epithelial cells cultured at the air-liquid interface.

We present a study on modification of culture conditions in serially cultured human bronchial epithelial cells (HBEC), necessary to achieve bronchial epithelial cells similar to the native epithelium. Cells were obtained from bronchial biopsies and serially cultured using a previously described method (In Vitro Cell. Dev. Biol. 1993; 29A:379-387). At the air-liquid interface, the second and the subsequent passages of HBEC cultures were grown 7 to 31 days, in medium containing fetal calf serum, using de-epidermized dermis or collagen discs as substratum. Scanning and transmission electron microscopy revealed ciliogenesis after 7 days and maturation of the cilia up to 31 days, irrespective of whether de-epidermized dermis or collagen membrane was used. The transmission electron microscopy of the developing cilia showed fibrogranular masses, procentrioles, basal bodies, and in the mature cilia a normal ultrastructure of the axoneme, the nine doublets, the central pair, radial spokes, and dynein arms in the ciliary shaft. In contrast, the submerged cultures showed no signs of ciliogenesis in the same time course. Results of experiments, in which cell seeding density, the substrate used, and the manner of nutrient supplementation were modulated, revealed that the air-exposure of the cultured HBEC is a necessary requirement for the ciliogenesis. The development pathway of ciliated cells in air-exposed HBEC cultures was similar to the differentiation and maturation pattern in human fetal tracheal cells. The in vitro model of human bronchial epithelial cells derived from biopsies obtained by fiberoptic bronchoscopy offers an attractive model for future studies on the function of human bronchial epithelial cells under normal and pathologic conditions.