Utilization of a highly adaptable murine air pouch model for minimally invasive testing of the inflammatory potential of biomaterials.

Introduction: The biocompatibility of an implanted material strongly determines the subsequent host immune response. After insertion into the body, each medical device causes tissue reactions. How intense and long-lasting these are is defined by the material properties. The so-called foreign body reaction is a reaction leading to the inflammation and wound healing process after implantation. The constantly expanding field of implant technology and the growing areas of application make optimization and adaptation of the materials used inevitable. Methods: In this study, modified liquid silicone rubber (LSR) and two of the most commonly used thermoplastic polyurethanes (TPU) were compared in terms of induced inflammatory response in the body. We evaluated the production of inflammatory cytokines, infiltration of inflammatory cells and encapsulation of foreign bodies in a subcutaneous air-pouch model in mice. In this model, the material is applied in a minimally invasive procedure via a cannula and in one piece, which allows material testing without destroying or crushing the material and thus studying an intact implant surface. The study design includes short-term (6 h) and long-term (10 days) analysis of the host response to the implanted materials. Air-pouch-infiltrating cells were determined by flow cytometry after 6 h and 10 days. Inflammation, fibrosis and angiogenesis markers were analyzed in the capsular tissue by qPCR after 10 days. Results: The foreign body reaction was investigated by macroscopic evaluation and scanning electron microscopy (SEM). Increased leukocyte infiltration was observed in the air-pouch after 6 h, but it markedly diminished after 10 days. After 10 days, capsule formations were observed around the materials without visible inflammatory cells. Discussion: For biocompatibility testing materials are often implanted in muscle tissue. These test methods are not sufficiently conclusive, especially for materials that are intended to come into contact with blood. Our study primarily shows that the presented model is a highly adaptable and minimally invasive test system to test the inflammatory potential of and foreign body reaction to candidate materials and offers more precise analysis options by means of flow cytometry.

Melt blending of poly(lactic acid) with biomedically relevant polyurethanes to improve mechanical performance.

Minimally invasive surgery procedures are of utmost relevance in clinical practice. However, the associated mechanical stress on the material poses a challenge for new implant developments. In particular PLLA, one of the most widely used polymeric biomaterials, is limited in its application due to its high brittleness and low elasticity. In this context, blending is a conventional method of improving the performance of polymer materials. However, in implant applications and development, material selection is usually limited to the use of medical grade polymers. The focus of this work was to investigate the extent to which blending poly-l-lactide (PLLA) with low contents of a selection of five commercially available medical grade polyurethanes leads to enhanced material properties. The materials obtained by melt blending were characterized in terms of their morphology and thermal properties, and the mechanical performance of the blends was evaluated taking into account physiological conditions. From these data, we found that mixing PLLA with Pellethane 80A is a promising approach to improve the material's performance, particularly for stent applications. It was found that PLLA/Pellethane blend with 10% polyurethane exhibits considerable plastic deformation before fracture, while pure PLLA fractures with almost no deformation. Furthermore, the addition of Pellethane only leads to a moderate reduction in elongation at yield and yield stress. In addition, dynamic mechanical analysis for three different PLLA/Pellethane ratios was performed to investigate thermally induced shape retention and shape recovery of the blends.

Fetuin A functionalisation of biodegradable PLLA-co-PEG nonwovens towards enhanced biomineralisation and osteoblastic growth behaviour.

Therapy for large-scale bone defects remains a major challenge in regenerative medicine. In this context, biodegradable electrospun nonwovens are a promising material to be applied as a temporary implantable scaffold as their fibre diameters are in the micro- and nanometre range and possess a high surface-to-volume ratio paired with high porosity. In this work, in vitro assessment of biodegradable PLLA-co-PEG nonwovens with fetuin A covalently anchored to the surface has been performed in terms of biomineralisation and the influence on MG-63 osteoblast cell metabolic activity, biosynthesis of type I collagen propeptide and inflammatory potential. Our finding was that covalent fetuin A funtionalisation of the nonwoven material leads to a distinct increase in calcium affinity, thus enhancing biomineralisation while maintaining the distinct fibre morphology of the nonwoven. The cell seeding experiments showed that the fetuin A functionalised and subsequently in vitro biomineralised PLLA-co-PEG nonwovens did not show negative effects on MG-63 growth. Fetuin A funtionalisation and enhanced biomineralisation supported cell attachment, leading to improved cell morphology, spreading and infiltration into the material. Furthermore, no signs of increase in the inflammatory potential of the material have been detected by flow cytometry experiments. Overall, this study provides a contribution towards the development of artificial scaffolds for guided bone regeneration with the potential to enhance osteoinduction and osteogenesis.

Investigation of Stent Prototypes for the Eustachian Tube in Human Donor Bodies.

Chronic otitis media is often connected to Eustachian tube dysfunction. As successful treatment cannot be guaranteed with the currently available options, the aim is to develop a stent for the Eustachian tube (ET). Over the course of this development, different prototypes were generated and tested in ex vivo experiments. Four different prototypes of an ET stent and one commercially available coronary stent were implanted in the ET of seven human donor bodies. The position of the stents was verified by cone beam CT. The implanted ETs were harvested, embedded in resin and ground at 200 µm steps. Resulting images of the single steps were used to generate 3D models. The 3D models were then evaluated regarding position of the stent in the ET, its diameters, amount of squeezing, orientation of the axes and other parameters. Virtual reconstruction of the implanted ET was successful in all cases and revealed one incorrect stent placement. The cross-section increased for all metal stents in direction from the isthmus towards the pharyngeal orifice of the ET. Depending on the individual design of the metal stents (open or closed design), the shape varied also between different positions along a single stent. In contrast, the cross-section area and shape remained constant along the polymeric prototype. With the current investigation, insight into the behavior of different prototypes of ET stents was gained, which can help in defining the specifications for the intended ET stent.

Micro Injection Molding of Drug-Loaded Round Window Niche Implants for an Animal Model Using 3D-Printed Molds.

A novel approach for the long-term medical treatment of the inner ear is the diffusion of drugs through the round window membrane from a patient-individualized, drug-eluting implant, which is inserted in the middle ear. In this study, drug-loaded (10 wt% Dexamethasone) guinea pig round window niche implants (GP-RNIs, ~1.30 mm × 0.95 mm × 0.60 mm) were manufactured with high precision via micro injection molding (µIM, Tmold = 160 °C, crosslinking time of 120 s). Each implant has a handle (~3.00 mm × 1.00 mm × 0.30 mm) that can be used to hold the implant. A medical-grade silicone elastomer was used as implant material. Molds for µIM were 3D printed from a commercially available resin (TG = 84 °C) via a high-resolution DLP process (xy resolution of 32 µm, z resolution of 10 µm, 3D printing time of about 6 h). Drug release, biocompatibility, and bioefficacy of the GP-RNIs were investigated in vitro. GP-RNIs could be successfully produced. The wear of the molds due to thermal stress was observed. However, the molds are suitable for single use in the µIM process. About 10% of the drug load (8.2 ± 0.6 µg) was released after 6 weeks (medium: isotonic saline). The implants showed high biocompatibility over 28 days (lowest cell viability ~80%). Moreover, we found anti-inflammatory effects over 28 days in a TNF-α-reduction test. These results are promising for the development of long-term drug-releasing implants for human inner ear therapy.

Revisiting SFA stent technology: an updated overview on mechanical stent performance.

OBJECTIVES: The study investigated mechanical parameters of stent systems indicated for treatment of femoropopliteal (FP) arterial disease to support interpretation of clinical results and the related causalities. METHODS: Eight stent system types of same dimensions were investigated (n=2). Parameters were the profile of stent delivery system (SDS), radiopacity, trackability and pushability, bending stiffness (flexibility) and axial stiffness of expanded stents, length change during expansion, radial force, crush resistance, strut thickness and general surface condition. RESULTS: The trackability ranged from 0.237 to 0.920 N and the pushability was 47.9-67.6 %. The bending stiffness of SDS was between 108.42 and 412.68 N mm2. The length change during stent release to 5 mm was low, with one exception. The bending stiffness of the expanded stents was 2.73-41.67 N mm2. The normalized radial forces at 5 mm diameter ranged from 0.133 N/mm to 0.503 N/mm. During non-radial compression by 50 %, the forces were 3.07-8.42 N, with one exception (58.7 N). The strut thickness was 153-231 µm. CONCLUSIONS: Large differences occurred for flexibility, radial force and length change during expansion. The data should be used when choosing the proper device for restoring vascular function.

Influence of PEGDA Molecular Weight and Concentration on the In Vitro Release of the Model Protein BSA-FITC from Photo Crosslinked Systems.

Novel 3D printing techniques enable the development of medical devices with drug delivery systems that are tailored to the patient in terms of scaffold shape and the desired pharmaceutically active substance release. Gentle curing methods such as photopolymerization are also relevant for the incorporation of potent and sensitive drugs including proteins. However, retaining the pharmaceutical functions of proteins remains challenging due to the possible crosslinking between the functional groups of proteins, and the used photopolymers such as acrylates. In this work, the in vitro release of the model protein drug, albumin-fluorescein isothiocyanate conjugate (BSA-FITC) from differently composed, photopolymerized poly(ethylene) glycol diacrylate (PEGDA), an often employed, nontoxic, easily curable resin, was investigated. Different PEGDA concentrations in water (20, 30, and 40 wt %) and their different molecular masses (4000, 10,000, and 20,000 g/mol) were used to prepare a protein carrier with photopolymerization and molding. The viscosity measurements of photomonomer solutions revealed exponentially increasing values with increasing PEGDA concentration and molecular mass. Polymerized samples showed increasing medium uptake with an increasing molecular mass and decreasing uptake with increasing PEGDA content. Therefore, the modification of the inner network resulted in the most swollen samples (20 wt %) also releasing the highest amount of incorporated BSA-FITC for all PEGDA molecular masses.

Development of a Novel Valve-Controlled Drug-Elutable Microstent for Microinvasive Glaucoma Surgery: In Vitro and Preclinical In Vivo Studies.

Purpose: Microinvasive glaucoma surgery (MIGS) has become an important treatment approach for primary open-angle glaucoma, although the safe and long-term effective lowering of intraocular pressure with currently available implants for MIGS is not yet achieved to a satisfactory extent. The study focusses on the development and in vitro and in vivo testing of a novel microstent for MIGS. Methods: A silicone elastomer-based microstent was developed. Implants were manufactured using dip coating, fs-laser cutting, and spray coating. Within the current study no antifibrotic drug was loaded into the device. Sterilized microstents were analyzed in vitro regarding pressure-flow characteristics and biocompatibility. Six New Zealand white rabbits were implanted with a microstent draining the aqueous humor from the anterior chamber into the subconjunctival space. Drainage efficacy was evaluated using oculopressure tonometry as a transient glaucoma model. Noninvasive imaging was performed. Results: Microstents were manufactured successfully and characterized in vitro. Implantation in vivo was successful for four animals with additional device fixation. Without additional fixation, dislocation of microstents was found in two animals. Safe and effective intraocular pressure reduction was observed for the four eyes with correctly implanted microstent during the 6-month trial period. Conclusions: The described microstent represents an innovative treatment approach for MIGS. The incorporation of a selectively antifibrotic drug into the microstent drug-elutable coating will be addressed in future investigations. Translational Relevance: The current preclinical study successfully provided proof of concept for our microstent for MIGS which is suitable for safe and effective intraocular pressure reduction and offers promising perspectives for the clinical management of glaucoma.

Detection of acoustic emission from nanofiber nonwovens under tensile strain - An ultrasonic test setup for critical medical device components.

In the biomedical field, nanofiber materials are gaining increasing application. For material characterization of nanofiber fabrics, tensile testing and scanning electron microscopy (SEM) are established standards. However, tensile tests provide information about the entire sample without information about single fibers. Conversely, SEM images examine individual fibers, but cover only a small section near the surface of the sample. To gain information on failure at the fiber level under tensile stress, recording of acoustic emission (AE) is a promising method, but challenging due to weak signal intensity. Using AE recording, beneficial findings can be obtained even on "invisible" material failure without affecting tensile tests. In this work, a technology for recording weak ultrasonic AE of tearing nanofiber nonwovens is presented, which uses a highly sensitive sensor. Functional proof of the method using biodegradable PLLA nonwoven fabrics is provided. The potential benefit is demonstrated by unmasking significant AE intensity in an almost imperceptible bend in the stress-strain curve of a nonwoven fabric. AE recording has not yet been performed on standard tensile tests of unembedded nanofiber material intended for safety-related medical applications. The technology has the potential to enrich the spectrum of testing methods, even those not confined to medical field.

Novel dalbavancin-PLLA implant coating prevents hematogenous Staphylococcus aureus infection in a minimally invasive mouse tail vein model.

Infective/bacterial endocarditis is a rare but life-threatening disease with a hospital mortality rate of 22.7% and a 1-year mortality rate of 40%. Therefore, continued research efforts to develop efficient anti-infective implant materials are of the utmost importance. Equally important is the development of test systems that allow the performance of new materials to be comprehensively evaluated. In this study, a novel antibacterial coating based on dalbavancin was tested in comparison to rifampicin/minocycline, and the suitability of a recently developed mouse tail vein model for testing the implant coatings was validated. Small polymeric stent grafts coated with a poly-L-lactic acid (PLLA) layer and incorporated antibiotics were colonized with Staphylococcus (S.) aureus before implantation into the tail vein of mice. The main assessment criteria were the hematogenous spread of the bacteria and the local tissue reaction to the contaminated implant. For this purpose, colony-forming units (CFU) in the blood, spleen and kidneys were determined. Tail cross sections were prepared for histological analysis, and plasma cytokine levels and expression values of inflammation-associated genes were examined. Both antibiotic coatings performed excellently, preventing the onset of infection. The present study expands the range of available methods for testing the anti-infectivity of cardiovascular implants, and the spectrum of agents for effective surface coating.

Mimicking critical environment factors for a static in vitro biofilm formation model on blood-contact implant materials.

The prevention of implant infections is a major challenge for implant developers and clinicians. Understanding biofilm dynamics and favorable implant or environmental characteristics will help to prevent biofilm formation. Blood-contact implants, such as cardiovascular implants, are particularly susceptible to infections as the blood provides a favorable growth environment for bacteria due to its rich supply of micro- and macro substances, such as glucose and plasma proteins. In this context, Staphylococcus aureus, Staphylococcus epidermidis and Enterococcus faecalis are the most reported causes accompanying foreign body-associated infections, mainly due to their ability to form an adherent, multilayered bacterial biofilm on a wide variety of surfaces. The present study demonstrates that the provision of glucose and human plasma to the growth medium or coating of the flask with human plasma differentially affects the biofilm formation of these three bacterial species, with human plasma being the most effective regulator. However, glucose supplementation promoted and stabilized biofilm formation of S. aureus and E. faecalis, while an opposite effect was observed for additional plasma. These findings highlight the urgent need to intensify studies on the impact of host soluble factors as risk factors promoting fitness and persistence of bacterial biofilms.

GIFT: An ImageJ macro for automated fiber diameter quantification.

This paper details the development and testing of the GIFT macro, which is a freely available program for ImageJ for the automated measurement of fiber diameters in SEM images of electrospun materials. The GIFT macro applies a validated method which distinguishes fiber diameters based on distance frequencies within an image. In this work, we introduce an applied version of the GIFT method which has been designed to be user-friendly while still allowing complete control over the various parameters involved in the image processing steps. The macro quickly processes large data sets and creates results that are reproducible and accurate. The program outputs both raw data and fiber diameter averages, so that the user can quickly assess the results and has the opportunity for further analysis if desired. The GIFT macro was compared directly to other software designed for fiber diameter measurements and was found to have comparable or lower average error, especially when measuring very small fibers, and reduced processing times per image. The macro, detailed instructions for use, and sample images are freely available online (https://github.com/IBMTRostock/GIFT). We believe that the GIFT macro is a valuable new tool for researchers looking to quickly, easily and reliably assess fiber diameters in electrospun materials.

Bacterial Adhesion and Biofilm Formation of Enterococcus faecalis on Zwitterionic Methylmethacrylat and Polysulfones.

Biofilm-associated implant infections represent a major challenge for healthcare systems around the world due to high patient burden and enormous costs incurred. Enterococcus faecalis (E. faecalis) is the most prevalent enterococcal species identified in biofilm-associated infections. The steadily growing areas of application of implants demand a solution for the control of bacterial infections. Therefore, the development of modified anti-microbial implant materials and the testing of the behavior of different relevant bacterial strains towards them display an indispensable task. Recently, we demonstrated an anti-microbial effect of zwitterionic modified silicone rubber (LSR) against Staphylococcus aureus. The aim of this study was to evaluate bacterial colonization and biofilm formation of another clinically relevant strain, E. faecalis, on this material in comparison to two of the most commonly used thermoplastic polyurethanes (TPUs) and other modified LSR surfaces. By generating growth curves, crystal violet, and fluorescence staining, as well as analyzing the expression of biofilm-associated genes, we demonstrated no anti-microbial activity of the investigated materials against E. faecalis. These results point to the fact that anti-microbial effects of novel implant materials do not always apply across the board to all bacterial strains.

A PLLA Coating Does Not Affect the Insertion Pressure or Frictional Behavior of a CI Electrode Array at Higher Insertion Speeds.

To prevent endocochlear insertion trauma, the development of drug delivery coatings in the field of CI electrodes has become an increasing focus of research. However, so far, the effect of a polymer coating of PLLA on the mechanical properties, such as the insertion pressure and friction of an electrode array, has not been investigated. In this study, the insertion pressure of a PLLA-coated, 31.5-mm long standard electrode array was examined during placement in a linear cochlear model. Additionally, the friction coefficients between a PLLA-coated electrode array and a tissue simulating the endocochlear lining were acquired. All data were obtained at different insertion speeds (0.1, 0.5, 1.0, 1.5, and 2.0 mm/s) and compared with those of an uncoated electrode array. It was shown that both the maximum insertion pressure generated in the linear model and the friction coefficient of the PLLA-coated electrode did not depend on the insertion speed. At higher insertion speeds above 1.0 mm/s, the insertion pressure (1.268 ± 0.032 mmHg) and the friction coefficient (0.40 ± 0.15) of the coated electrode array were similar to those of an uncoated array (1.252 ± 0.034 mmHg and 0.36 ± 0.15). The present study reveals that a PLLA coating on cochlear electrode arrays has a negligible effect on the electrode array insertion pressure and the friction when higher insertion speeds are used compared with an uncoated electrode array. Therefore, PLLA is a suitable material to be used as a coating for CI electrode arrays and can be considered for a potential drug delivery system.

Thermal, Mechanical and Biocompatibility Analyses of Photochemically Polymerized PEGDA250 for Photopolymerization-Based Manufacturing Processes.

Novel fabrication techniques based on photopolymerization enable the preparation of complex multi-material constructs for biomedical applications. This requires an understanding of the influence of the used reaction components on the properties of the generated copolymers. The identification of fundamental characteristics of these copolymers is necessary to evaluate their potential for biomaterial applications. Additionally, knowledge of the properties of the starting materials enables subsequent tailoring of the biomaterials to meet individual implantation needs. In our study, we have analyzed the biological, chemical, mechanical and thermal properties of photopolymerized poly(ethyleneglycol) diacrylate (PEGDA) and specific copolymers with different photoinitiator (PI) concentrations before and after applying a post treatment washing process. As comonomers, 1,3-butanediol diacrylate, pentaerythritol triacrylate and pentaerythritol tetraacrylate were used. The in vitro studies confirm the biocompatibility of all investigated copolymers. Uniaxial tensile tests show significantly lower tensile strength (82% decrease) and elongation at break (76% decrease) values for washed samples. Altered tensile strength is also observed for different PI concentrations: on average, 6.2 MPa for 1.25% PI and 3.1 MPa for 0.5% PI. The addition of comonomers lowers elongation at break on average by 45%. Moreover, our observations show glass transition temperatures (Tg) ranging from 27 °C to 56 °C, which significantly increase with higher comonomer content. These results confirm the ability to generate biocompatible PEGDA copolymers with specific thermal and mechanical properties. These can be considered as resins for various additive manufacturing-based applications to obtain personalized medical devices, such as drug delivery systems (DDS). Therefore, our study has advanced the understanding of PEGDA multi-materials and will contribute to the future development of tools ensuring safe and effective individual therapy for patients.

Accelerated Endothelialization of Nanofibrous Scaffolds for Biomimetic Cardiovascular Implants.

Nanofiber nonwovens are highly promising to serve as biomimetic scaffolds for pioneering cardiac implants such as drug-eluting stent systems or heart valve prosthetics. For successful implant integration, rapid and homogeneous endothelialization is of utmost importance as it forms a hemocompatible surface. This study aims at physicochemical and biological evaluation of various electrospun polymer scaffolds, made of FDA approved medical-grade plastics. Human endothelial cells (EA.hy926) were examined for cell attachment, morphology, viability, as well as actin and PECAM 1 expression. The appraisal of the untreated poly-L-lactide (PLLA L210), poly-ε-caprolactone (PCL) and polyamide-6 (PA-6) nonwovens shows that the hydrophilicity (water contact angle > 80°) and surface free energy (<60 mN/m) is mostly insufficient for rapid cell colonization. Therefore, modification of the surface tension of nonpolar polymer scaffolds by plasma energy was initiated, leading to more than 60% increased wettability and improved colonization. Additionally, NH3-plasma surface functionalization resulted in a more physiological localization of cell−cell contact markers, promoting endothelialization on all polymeric surfaces, while fiber diameter remained unaltered. Our data indicates that hydrophobic nonwovens are often insufficient to mimic the native extracellular matrix but also that they can be easily adapted by targeted post-processing steps such as plasma treatment. The results achieved increase the understanding of cell−implant interactions of nanostructured polymer-based biomaterial surfaces in blood contact while also advocating for plasma technology to increase the surface energy of nonpolar biostable, as well as biodegradable polymer scaffolds. Thus, we highlight the potential of plasma-activated electrospun polymer scaffolds for the development of advanced cardiac implants.

PLLA Coating of Active Implants for Dual Drug Release.

Cochlear implants, like other active implants, rely on precise and effective electrical stimulation of the target tissue but become encapsulated by different amounts of fibrous tissue. The current study aimed at the development of a dual drug release from a PLLA coating and from the bulk material to address short-term and long-lasting release of anti-inflammatory drugs. Inner-ear cytocompatibility of drugs was studied in vitro. A PLLA coating (containing diclofenac) of medical-grade silicone (containing 5% dexamethasone) was developed and release profiles were determined. The influence of different coating thicknesses (2.5, 5 and 10 µm) and loadings (10% and 20% diclofenac) on impedances of electrical contacts were measured with and without pulsatile electrical stimulation. Diclofenac can be applied to the inner ear at concentrations of or below 4 × 10-5 mol/L. Release of dexamethasone from the silicone is diminished by surface coating but not blocked. Addition of 20% diclofenac enhances the dexamethasone release again. All PLLA coatings serve as insulator. This can be overcome by using removable masking on the contacts during the coating process. Dual drug release with different kinetics can be realized by adding drug-loaded coatings to drug-loaded silicone arrays without compromising electrical stimulation.

Vascular Response Toward an Absorbable Sirolimus-eluting Polymeric Scaffold for Vascular Application in a Model of Normal Porcine Carotid Arteries.

BACKGROUND: Fully absorbable polymeric scaffolds, as a potential alternative to permanent metallic stents, are entering the clinical field. The aim of this study is to assess the in vivo biocompatibility of a novel Sirolimus-eluting (SIR) absorbable scaffold based on poly(L-lactide) (PLLA) and poly(4-hydroxybutyrate) (P4HB) for interventional application. METHODS: Absorbable PLLA/P4HB scaffolds either loaded with SIR coating or unloaded scaffolds were implanted interventionally into common carotid arteries of 14 female. Bare metal stents (BMS) served as control. Peroral dual anti-platelet therapy was administered throughout the study. Stented common carotid arteries segments were explanted after 4 weeks, and assessed histomorphometrically. RESULTS: The absorbable scaffolds showed a decreased residual lumen area and higher stenosis after 4 weeks (PLLA/P4HB: 6.56 ± 0.41 mm² and 37.56 ± 4.67%; SIR-PLLA/P4HB: 6.90 ± 0.58 mm² and 35.60 ± 3.15%) as compared to BMS (15.29 ± 1.86 mm² and 7.65 ± 2.27%). Incorporation of SIR reduced the significantly higher inflammation of unloaded scaffolds however not to a level compared to bare metal stent (PLLA/P4HB: 1.20 ± 0.19; SIR-PLLA/P4HB: 0.96 ± 0.24; BMS: 0.54 ± 0.12). In contrast, the BMS showed a slightly elevated vascular injury score (0.74 ± 0.15), as compared to the PLLA/P4HB (0.54 ± 0.20) and the SIR-PLLA/P4HB (0.48 ± 0.15) groups. CONCLUSION: In this preclinical model, the new absorbable polymeric (SIR-) scaffolds showed similar technical feasability and safety for vascular application as the permanent metal stents. The higher inflammatory propensity of the polymeric scaffolds was slightly reduced by SIR-coating. A smaller strut thickness of the polymeric scaffolds might have been a positive effect on tissue ingrowth between the struts and needs to be addressed in future work on the stent design.

In Vitro Study of the Interaction of Innate Immune Cells with Liquid Silicone Rubber Coated with Zwitterionic Methyl Methacrylate and Thermoplastic Polyurethanes.

The biocompatibility of medical devices, such as implants and prostheses, is strongly determined by the host's immune response to the implanted material. Monocytes and macrophages are main actors of the so-called foreign body reaction. The innate immune system macrophages (M) can be broadly classified into the pro-inflammatory M1-type and the anti-inflammatory, pro-healing M2-type. While a transient inflammatory initial state can be helpful during an infection, persistent inflammation interferes with proper healing and subsequent regeneration. The functional orientation of the immune response, mirrored by monocyte polarization, during interaction with different biomaterials has not yet been sufficiently explored. In implant manufacturing, thermoplastic polyurethane (TPU) represents the state-of-the-art material. The constantly growing areas of application and the associated necessary adaptations make the optimization of these materials indispensable. In the present study, modified liquid silicone rubber (LSR) were compared with two of the most commonly used TPUs, in terms of monocyte adhesion and M1/M2 polarization in vitro. Human monocytes isolated from venous blood were evaluated for their ability to adhere to various biomaterials, their gene expression profile, and their cytokine release. Based on the results, the different polymers exhibit different potential to bias monocytes with respect to early pro-inflammatory cytokine production and gene transcription. Furthermore, none of our test materials showed a clear trend towards M1 or M2 polarization. However, we were able to evaluate the inflammatory potential of the materials, with the classic TPUs appearing to be the most unreactive compared to the silicone-based materials.

Evaluation of a Murine Model for Testing Antimicrobial Implant Materials in the Blood Circulation System.

Medical device-related infections are becoming a steadily increasing challenge for the health care system regarding the difficulties in the clinical treatment. In particular, cardiovascular implant infections, catheter-related infections, as well as infective endocarditis are associated with high morbidity and mortality risks for the patients. Antimicrobial materials may help to prevent medical device-associated infections and supplement the currently available therapies. In this study, we present an easy-to-handle and simplified in vivo model to test antimicrobial materials in the bloodstream of mice. The model system is composed of the implantation of a bacteria-laden micro-stent scaffold into the murine tail vein. Our model enables the simulation of catheter-related infections as well as the development of infective endocarditis specific pathologies in combination with material testing. Furthermore, this in vivo model can cover two phases of the biofilm formation, including both the local tissue response to the bacterial biofilm and the systemic inflammatory response against circulating bacteria in the bloodstream that detached from a mature biofilm.