Design of an electrospun tubular construct combining a mechanical and biological approach to improve tendon repair.

Hand tendon injuries represent a major clinical problem and might dramatically diminish a patient's life quality. In this study, a targeted solution for flexor tendon repair was developed by combining a mechanical and biological approach. To this end, a novel acrylate-endcapped urethane-based polymer (AUP) was synthesized and its physico-chemical properties were characterized. Next, tubular repair constructs were developed using electrospinning of the AUP material with incorporated naproxen and hyaluronic acid (i.e. anti-inflammatory and anti-adhesion compounds, respectively), and with a tubular braid as mechanical reinforcement. Tensile testing of the repair constructs using ex vivo sheep tendons showed that the developed repair constructs fulfilled the required mechanical properties for tendon repair (i.e. minimal ultimate stress of 4 MPa), with an ultimate stress of 6.4 ± 0.6 MPa. Moreover, in vitro biological assays showed that the developed repair tubes and the incorporated bioactive components were non-cytotoxic. In addition, when equine tenocytes and mesenchymal stem cells were co-cultured with the repair tubes, an increased production of collagen and non-collagenous proteins was observed. In conclusion, this novel construct in which a mechanical approach (fulfilling the required mechanical properties) was combined with a biological approach (incorporation of bioactive compounds), shows potential as flexor tendon repair application. Graphical abstract.

Polysaccharide-based layer-by-layer nanoarchitectonics with sulfated chitosan for tuning anti-thrombogenic properties.

The development of blood-interacting surfaces is critical to fabricate biomaterials for medical use, such as prostheses, implants, biosensors, and membranes. For instance, thrombosis is one of the leading clinical problems when polymer-based materials interact with blood. To overcome this limitation is necessary to develop strategies that limit platelets adhesion and activation. In this work, hyaluronan (HA)/chitosan (Chi) based-films, recently reported in the literature as platforms for tumor cell capture, were developed and, subsequently, functionalized with sulfated chitosan (ChiS) using a layer-by-layer technique. ChiS, when compared to native Chi, presents the unique abilities to confer anti-thrombogenic properties, to reduce protein adsorption, and also to limit calcification. Film physicochemical characterization was carried out using FTIR and XPS for chemical composition assessment, AFM for the surface morphology, and contact angle for hydrophilicity evaluation. The deposition of ChiS monolayer promoted a decrease in both roughness and hydrophilicity of the HA/Chi films. In addition, the appearance of sulfur in the chemical composition of ChiS-functionalized films confirmed the film modification. Biological assay indicated that the incorporation of sulfated groups limited platelet adhesion, mainly because a significant reduction of platelets adhesion to ChiS-functionalized films was observed compared to HA/Chi films. On balance, this work provides a new insight for the development of novel antithrombogenic biomaterials, opening up new possibilities for devising blood-interaction surfaces.

The mechanical characterization of blood vessels and their substitutes in the continuous quest for physiological-relevant performances. A critical review.

During the last 50 years, novel biomaterials and tissue engineering techniques have been investigated to produce alternative vascular substitutes that recapitulate the unique elastic mechanical features of blood vessels. A large variation in mechanical characterization, including the test type, protocol, and data analysis, is present in literature which complicates the comparison among studies and prevents the blooming and the advancement of this field. In addition, a limited mechanical assessment of the substitute for the intended application is often provided. In this light, this review presents the mechanical environment of blood vessels, discusses their mechanical behavior responsible for the suited blood flow into the body (non-linearity, anisotropy, hysteresis, and compliance), and compares the mechanical properties reported in literature (obtained with compression, tensile, stress-relaxation, creep, dynamic mechanical analysis, burst pressure, and dynamic compliance tests). This perspective highlights that the mechanical properties extracted through conventional tests are not always suitable indicators of the mechanical performance during the working life of a vascular substitute. The available tests can be then strategically used at different stages of the substitute development, prioritizing the simplicity of the method at early stages, and the physiological pertinence at later stages, following as much as possible ISO standards in the field. A consistent mechanical characterization focused on the behavior to which they will be subdued during real life is one key and missing element in the quest for physiological-like mechanical performance of vascular substitutes.

Real-Time Study of the Adsorption and Grafting Process of Biomolecules by Means of Bloch Surface Wave Biosensors.

A combined label-free and fluorescence surface optical technique was used to quantify the mass deposited in binary biomolecular coatings. These coatings were constituted by fibronectin (FN), to stimulate endothelialization, and phosphorylcholine (PRC), for its hemocompatibility, which are two properties of relevance for cardiovascular applications. One-dimensional photonic crystals sustaining a Bloch surface wave were used to characterize different FN/PRC coatings deposited by a combination of adsorption and grafting processes. In particular, the label-free results permitted to quantitatively assess the mass deposited in FN adsorbed (185 ng/cm2) and grafted (160 ng/cm2). PRC binding to grafted FN coatings was also quantified, showing a coverage as low as 10 and 12 ng/cm2 for adsorbed and grafted PRC, respectively. Moreover, desorption of FN deposited by adsorption was detected and quantified upon the addition of PRC. The data obtained by the surface optical technique were complemented by water contact angle and X-ray photoelectron spectroscopy (XPS) analyses. The results were in accordance with those obtained previously by qualitative and semiquantitative techniques (XPS, time-of-flight secondary ion mass spectrometry) on several substrates (PTFE and stainless steel), confirming that grafted FN coatings show higher stability than those obtained by FN adsorption.

Prediction of circumferential compliance and burst strength of polymeric vascular grafts.

The circumferential compliance and burst strength of vascular grafts are predicted through the conically modified von Mises and elasticity theories, providing an analytical closed form solution for both parameters. Besides the graft's radii, the model for circumferential compliance depends solely on the elastic modulus and Poisson's ratio of the polymer material, and its accuracy was verified by finite element analysis and measurements. The analytical expression of the burst strength requires accurate determination of the material's tensile and compressive yield stress, which were carefully obtained by using digital image correlation measurements in uniaxial tensile and compressive tests of the constitutive material. The average measured circumferential compliance and burst strength of an 8mm graft made of a commonly used biomaterial, Tecoflex® SG-80A, are 1.05%/100mmHg-1 and 34.1psi (1763mmHg) and the proposed analytical predictions fall within the experimental scattering. Thus, it is shown that the circumferential compliance and burst strength of vascular grafts can be analytically predicted by knowing the elastic and yield material properties accurately, without needing to actually test the graft under radial pressure. This is a major advantage which can aid in the design and tailoring of vascular grafts.

Incrementing the Frequency of Dynamic Strain on SMC-Cellularised Collagen-Based Scaffolds Affects Extracellular Matrix Remodeling and Mechanical Properties.

Notwithstanding the efforts injected in vascular tissue engineering in the past 30 years, the clinical translation of engineered artery constructs is far from being successful. One common approach to improve artery regeneration is the use of cyclic mechanical stimuli to guide cellular remodeling. However, there is a lack of information on the effect of cyclic strain on cells within a 3D environment. To this end, this work explored the effect of gradual increase in stimulation frequency on the response of human umbilical artery smooth muscle cells (HUASMCs) embedded in a 3D collagen matrix. The results demonstrate that, with an applied strain of 5%, the gradual increase of frequency from 0.1 to 1 Hz improved collagen remodeling by HUASMCs compared to samples constantly stimulated at 1 Hz. The expression of collagen, elastin and matrix metalloproteinase-2 (MMP-2) genes was similar at 7 days for gradual and 1 Hz samples which showed lower amounts than static counterparts. Interestingly the mechanical properties of the constructs, specifically the amplitude of the time constants and the elastic equilibrium modulus, were enhanced by gradual increase of frequency. Taken together, these results show an increase in collagen remodeling by the HUASMCs overtime under incremental cyclic mechanical strain. This work suggests that only the in-depth investigation of the effects of stimulation parameters on the behavior of vSMC under cyclic strain in a 3D environment could lead to the design of optimized control strategies for enhanced vascular tissue generation and maturation in bioreactors.

Long-term in vitro degradation behaviour of Fe and Fe/Mg2Si composites for biodegradable implant applications.

The major drawback of Fe-based materials for biodegradable implant applications is their slow degradation rate. Addition of second phase particles into the Fe matrix can increase the degradation rate at the beginning of the corrosion process. However, so far, there is neither quantitative data on in vitro degradation nor direct experimental evidence for long-term dissolution of Fe-based biodegradable composites. Here, a series of immersion tests at different exposure intervals (20, 50 and 100 days) to modified Hanks' solution were performed to study the degradation behavior of Fe and Fe/Mg2Si composites prepared by different powder metallurgy techniques. The results revealed the role of Mg2Si in the composition and stability of the protective films formed during the static corrosion experiments. Fe/Mg2Si composites showed higher degradation rates than those of pure Fe at all stages of immersion. Degradation rates at distinct exposure intervals strongly depended on the composition and stability of formed oxide, hydroxide, carbonate and phosphate protective films on the degraded surfaces. The release of Fe ions into the solution at later stages of the experiment was limited due to the barrier effect of the insoluble deposit. This fundamental study provided a basis for the processes of protective film formation in modified Hanks' solution, which enables a detailed identification of its characteristic features.

Synthesis, mechanical properties and corrosion behavior of powder metallurgy processed Fe/Mg2Si composites for biodegradable implant applications.

Recently, Fe and Fe-based alloys have shown their potential as degradable materials for biomedical applications. Nevertheless, the slow corrosion rate limits their performance in certain situations. The shift to iron matrix composites represents a possible approach, not only to improve the mechanical properties, but also to accelerate and tune the corrosion rate in a physiological environment. In this work, Fe-based composites reinforced by Mg2Si particles were proposed. The initial powders were prepared by different combinations of mixing and milling processes, and finally consolidated by hot rolling. The influence of the microstructure on mechanical properties and corrosion behavior of Fe/Mg2Si was investigated. Scanning electron microscopy and X-ray diffraction were used for the assessment of the composite structure. Tensile and hardness tests were performed to characterize the mechanical properties. Potentiodynamic and static corrosion tests were carried out to investigate the corrosion behavior in a pseudo-physiological environment. Samples with smaller Mg2Si particles showed a more homogenous distribution of the reinforcement. Yield and ultimate tensile strength increased when compared to those of pure Fe (from 400MPa and 416MPa to 523MPa and 630MPa, respectively). Electrochemical measurements and immersion tests indicated that the addition of Mg2Si could increase the corrosion rate of Fe even twice (from 0.14 to 0.28mm·year-1). It was found that the preparation method of the initial composite powders played a major role in the corrosion process as well as in the corrosion mechanism of the final composite.

Fabrication, mechanical properties and in vitro degradation behavior of newly developed ZnAg alloys for degradable implant applications.

Zn and Zn-based alloys have been recognized as highly promising biodegradable materials for orthopedic implants and cardiovascular stents, due to their proved biocompatibility and, more importantly, lower corrosion rates compared to Mg alloys. However, pure Zn has poor mechanical properties. In this study, Ag is used as a promising alloying element to improve the mechanical properties of the Zn matrix as well as its biocompatibility and antibacterial properties. Accordingly, we design three ZnAg alloys with Ag content ranging from 2.5 to 7.0wt% and investigate the influence of the Ag content on mechanical and corrosion behavior of the alloys. The alloys are developed by casting process and homogenized at 410°C for 6h and 12h, followed by hot extrusion at 250°C with extrusion ratio of 14:1. Degradation behavior is assessed by electrochemical and static immersion tests in Hank's modified solution. Microstructural analysis reveals that hot extrusion significantly reduces the grain size of the alloys. Zn-7.0%Ag alloy shows a reasonably equiaxed and considerably refined microstructure with mean grain size of 1.5µm. Tensile tests at room temperature suggest that increasing the Ag content steadily enhances the tensile strength, while it does not affect the tensile ductility significantly. Zn-7.0%Ag shows high yield strength and ultimate tensile strength of 236MPa and 287MPa, respectively, which is due to the grain refinement and high volume fraction of fine AgZn3 particles precipitating along the grain boundaries during the extrusion process. Among all these alloys, Zn-7.0%Ag displayed superplasticity over a wide range of strain rates (from 5×10-4s-1 to 1.0×10-2s-1) providing the possibility of exploiting forming processes at rapid rates and/or even at lower temperatures. In addition, extruded alloys exhibit slightly faster degradation rate than pure Zn. X-ray diffraction results show the presence of ZnO and Zn(OH)2 on the degraded surfaces. Moreover, scanning electron microscopy imaging reveals that micro-galvanic corrosion is more pronounced on the alloys with higher Ag content due to the higher volume fraction of AgZn3 particles.

A Dual-Mode Bioreactor System for Tissue Engineered Vascular Models.

In the past decades, vascular tissue engineering has made great strides towards bringing engineered vascular tissues to the clinics and, in parallel, obtaining in-lab tools for basic research. Herein, we propose the design of a novel dual-mode bioreactor, useful for the fabrication (construct mode) and in vitro stimulation (culture mode) of collagen-based tubular constructs. Collagen-based gels laden with smooth muscle cells (SMCs) were molded directly within the bioreactor culture chamber. Based on a systematic characterization of the bioreactor culture mode, constructs were subjected to 10% cyclic strain at 0.5 Hz for 5 days. The effects of cyclic stimulation on matrix re-arrangement and biomechanical/viscoelastic properties were examined and compared vs. statically cultured constructs. A thorough comparison of cell response in terms of cell localization and expression of contractile phenotypic markers was carried out as well. We found that cyclic stimulation promoted cell-driven collagen matrix bi-axial compaction, enhancing the mechanical strength of strained samples with respect to static controls. Moreover, cyclic strain positively affected SMC behavior: cells maintained their contractile phenotype and spread uniformly throughout the whole wall thickness. Conversely, static culture induced a noticeable polarization of cell distribution to the outer rim of the constructs and a sharp reduction in total cell density. Overall, coupling the use of a novel dual-mode bioreactor with engineered collagen-gel-based tubular constructs demonstrated to be an interesting technology to investigate the modulation of cell and tissue behavior under controlled mechanically conditioned in vitro maturation.

Controlled Distribution and Clustering of Silver in Ag-DLC Nanocomposite Coatings Using a Hybrid Plasma Approach.

Incorporation of selected metallic elements into diamond-like carbon (DLC) has emerged as an innovative approach to add unique functional properties to DLC coatings, thus opening up a range of new potential applications in fields as diverse as sensors, tribology, and biomaterials. However, deposition by plasma techniques of metal-containing DLC coatings with well-defined structural properties and metal distribution is currently hindered by the limited understanding of their growth mechanisms. We report here a silver-incorporated diamond-like carbon coating (Ag-DLC) prepared in a hybrid plasma reactor which allowed independent control of the metal content and the carbon film structure and morphology. Morphological and chemical analyses of Ag-DLC films were performed by atomic force microscopy, scanning electron microscopy, and X-ray photoelectron spectroscopy. The vertical distribution of silver from the surface toward the coating bulk was found to be highly inhomogeneous due to top surface segregation and clustering of silver nanoparticles. Two plasma parameters, the sputtered Ag flux and ion energy, were shown to influence the spatial distribution of silver particles. On the basis of these findings, a mechanism for Ag-DLC growth by plasma was proposed.

Novel Zn-based alloys for biodegradable stent applications: Design, development and in vitro degradation.

The search for a degradable metal simultaneously showing mechanical properties equal or higher to that of stainless steel and uniform degradation is still an open challenge. Several magnesium-based alloys have been studied, but their degradation rate has proved to be too fast and rarely homogeneous. Fe-based alloys show appropriate mechanical properties but very low degradation rate. In the present work, four novel Zn-Mg and two Zn-Al binary alloys were investigated as potential biodegradable materials for stent applications. The alloys were developed by casting process and homogenized at 350°C for 48h followed by hot extrusion at 250°C. Tube extrusion was performed at 300°C to produce tubes with outer/inner diameter of 4/1.5mm as precursors for biodegradable stents. Corrosion tests were performed using Hanks׳ modified solution. Extruded alloys exhibited slightly superior corrosion resistance and slower degradation rate than those of their cast counterparts, but all had corrosion rates roughly half that of a standard purity Mg control. Hot extrusion of Zn-Mg alloys shifted the corrosion regime from localized pitting to more uniform erosion, mainly due to the refinement of second phase particles. Zn-0.5Mg is the most promising material for stent applications with a good combination of strength, ductility, strain hardening exponent and an appropriate rate of loss of mechanical integrity during degradation. An EBSD analysis in the vicinity of the laser cut Zn-0.5Mg tube found no grain coarsening or texture modification confirming that, after laser cutting, the grain size and texture orientation of the final stent remains unchanged. This work shows the potential for Zn alloys to be considered for stent applications.

Unraveling the role of mechanical stimulation on smooth muscle cells: A comparative study between 2D and 3D models.

A thorough understanding of cell response to combined culture configuration and mechanical cues is of paramount importance in vascular tissue engineering applications. Herein, we investigated and compared the response of vascular smooth muscle cells (vSMCs) cultured in different culture environments (2D cell monolayers and 3D cellularized collagen-based gels) in combination with mechanical stimulation (7% uniaxial cyclic strain, 1 Hz) for 2 and 5 days. When cyclic strain was applied, two different responses, in terms of cell orientation and expression of contractile-phenotype proteins, were observed in 2D and 3D models. Specifically, in 2D configuration, cyclic strain caused ∼50% of cell population to align nearly perpendicular (80-90 degrees) to the strain direction, while not influencing the contractile-phenotype protein expression, as compared to the 2D static controls. Conversely, the application of uniaxial strain to 3D constructs induced a ∼60% cell alignment almost parallel (0-10 degrees) to the strain direction. Moreover, 3D mechanical stimulation applied for 5 days induced a twofold increase of SM α-actin level and a 14-fold increase of calponin expression as compared to 3D static controls. Altogether these findings provide a new insight into the potential to drive cell behavior by modulating the extracellular matrix and the biomechanical environment. Biotechnol. Bioeng. 2016;113: 2254-2263. © 2016 Wiley Periodicals, Inc.

Antibacterial Coatings: Challenges, Perspectives, and Opportunities.

Antibacterial coatings are rapidly emerging as a primary component of the global mitigation strategy of bacterial pathogens. Thanks to recent concurrent advances in materials science and biotechnology methodologies, and a growing understanding of environmental microbiology, an extensive variety of options are now available to design surfaces with antibacterial properties. However, progress towards a more widespread use in clinical settings crucially depends on addressing the key outstanding issues. We review release-based antibacterial coatings and focus on the challenges and opportunities presented by the latest generation of these materials. In particular, we highlight recent approaches aimed at controlling the release of antibacterial agents, imparting multi-functionality, and enhancing long-term stability.

Degradation behavior of biodegradable Fe35Mn alloy stents.

This article reports a degradation study that was done on stent prototypes made of biodegradable Fe35Mn alloy in a simulated human coronary arterial condition. The stent degradation was observed for a short-term period from 0.5 to 168 h, which simulates the early period of stenting procedure. Potentiodynamic polarization and electrochemical impedance spectroscopy were used to quantify degradation rate and surface property of the stents. Results showed that signs of degradation were visible on both crimped and expanded stents after 1 h of test, mostly located on the stent's curvatures. The degradation rate of stent was higher compared to that of the original alloy, indicating the surface altering effect of stent fabrication processing to degradation. A single oxide layer was formed and detected as a porous structure with capacitive behavior. Expanded stents exhibited lower polarization resistance compared to the nonexpanded ones, indicating the cold work effect of expansion procedure to degradation.

Reduced graphene oxide growth on 316L stainless steel for medical applications.

We report a new method for the growth of reduced graphene oxide (rGO) on the 316L alloy of stainless steel (SS) and its relevance for biomedical applications. We demonstrate that electrochemical etching increases the concentration of metallic species on the surface and enables the growth of rGO. This result is supported through a combination of Raman spectroscopy, X-ray photoelectron spectroscopy (XPS), atomic force microscopy (AFM), scanning electron microscopy (SEM), density functional theory (DFT) calculations and static water contact angle measurements. Raman spectroscopy identifies the G and D bands for oxidized species of graphene at 1595 cm(-1) and 1350 cm(-1), respectively, and gives an ID/IG ratio of 1.2, indicating a moderate degree of oxidation. XPS shows -OH and -COOH groups in the rGO stoichiometry and static contact angle measurements confirm the wettability of rGO. SEM and AFM measurements were performed on different substrates before and after coronene treatment to confirm rGO growth. Cell viability studies reveal that these rGO coatings do not have toxic effects on mammalian cells, making this material suitable for biomedical and biotechnological applications.

Intestinal and multivisceral transplantation immunosuppression protocols--literature review.

INTRODUCTION: Currently the most used techniques for small bowel transplant are isolated intestinal transplantation, multivisceral transplantation (MVT), and modified multivisceral transplantation. One important factor is early diagnosis of acute cellular rejection (ACR). In addition, improvements in immunosuppression have recently reduced the number and enhanced treatment of ACR episodes, enabling graft recovery. OBJECTIVE: We analyzed immunosuppression protocols of leading transplantation centers in the last 5 years. METHOD: We reviewed papers published in PubMed from major multivisceral and intestinal transplantation centers from 2006 to 2010 in adult recipients. The 211 adults transplanted in seven centers were divided into three groups according to the immunosuppression protocol used: protocol 1: daclizumab induction with tacrolimus and steroid maintenance; protocol 2: alemtuzumab and tacrolimus; and protocol 3: thymoglobulin and rituximab and tacrolimus. RESULTS: Protocol 2 showed the lowest rate of ACR (34%). Protocols 1 and 3 displayed 54% and 48% ACR rates; respectively. However, protocol 1 patients developed only mild ACR, whereas those in protocols 2 and 3 developed moderate ACR in 26.3% and 11.7%, and severe ACR in 7.9% and 47% of cases, respectively. The infection rate was considerably lower in protocol 3 (7.4%). Protocols 1 and 2 showed infection rates of 62.5% and 52%, respectively. One-year patient survival rates were 70%, 79% and 81%, respectively. Three-year patient survival rates were 62%, 56%, and 78% for protocols 1, 2 and 3, respectively. CONCLUSION: Protocol 2 was the strongest immunosuppressive regimen capable of reducing ACR rates when compared with the other protocols, but the strong effect resulted in high infection rate that impacts 1-year patient survival. Protocol 3 seems to be the best available one balancing ACR and infection rates.

A new dextran-graft-polybutylmethacrylate copolymer coated on 316L metallic stents enhances endothelial cell coverage.

Amphiphilic copolymers based on the copolymerization of hydrophilic and hydrophobic moieties offer versatility in various biomedical material applications. Here, a new biocompatible copolymer of dextran-graft-polybutylmethacrylate is synthesized for the coating of metallic endovascular stents. Coating of metallic surfaces is performed and analyzed by X-ray photoelectron spectroscopy, attenuated total reflection Fourier transform infrared spectroscopy, contact angle measurement, atomic force microscopy and scanning electron microscopy before and after deformation corresponding to stent deployment by a balloon catheter. In the conditions described here, the resulting coating is smooth and uniform with neither cracks nor detachment after stent expansion. Interestingly, surfaces coated with the copolymer greatly improve in vitro adhesion and growth of endothelial cells. This copolymer provides new opportunities for implanted biomaterials.

The biological response of poly(L-lactide) films modified by different biomolecules: role of the coating strategy.

The interactions between the surface of synthetic scaffolds and cells play an important role in tissue engineering applications. To improve these interactions, two strategies are generally followed: surface coating with large proteins and surface grafting with small peptides. The proteins and peptides more often used and derived from the extracellular matrix, are fibronectin, laminin, and their active peptides, RGD and SIKVAV, respectively. The aim of this work was to compare the effects of coating and grafting of poly(L-lactide) (PLLA) films on MRC5 fibroblast cells. Grafting reactions were verified by X-ray photoelectron spectroscopy. Cell adhesion and proliferation on coated and grafted PLLA surfaces were measured by cell counting. Vinculin localization and distribution were performed on cell cultured on PLLA samples using a fluorescence microscopy technique. Finally, western blot was performed to compare signals of cell adhesion proteins, such as vinculin, Rac1, and RhoA, as well as cell proliferation, such as PCNA. These tests showed similar results for fibronectin and laminin coated PLLA, while RGD grafting is more effective compared with SIKVAV grafting. Considering the overall view of these results, although coating and grafting can both be regarded as effective methods for surface modification to enhance cell adhesion and proliferation on a biomaterial, RGD grafted PLLA show better cell adhesion and proliferation than coated PLLA, while SIKVAV grafted PLLA show similar adhesion but worse proliferation. These data verified different biological effects depending on the surface modification method used.