Mechanisms for Reduced Fibrin Clot Formation on Liquid-Infused Surfaces.

Biomedical devices are prone to blood clot formation (thrombosis), and liquid-infused surfaces (LIS) are effective in reducing the thrombotic response. However, the mechanisms that underpin this performance, and in particular the role of the lubricant, are not well understood. In this work, it is investigated whether the mechanism of LIS action is related to i) inhibition of factor XII (FXII) activation and the contact pathway; ii) reduced fibrin density of clots formed on surfaces; iii) increased mobility of proteins or cells on the surface due to the interfacial flow of the lubricant. The chosen LIS is covalently tethered, nanostructured layers of perfluorocarbons, infused with thin films of medical-grade perfluorodecalin (tethered-liquid perfluorocarbon), prepared with chemical vapor deposition previously optimized to retain lubricant under flow. Results show that in the absence of external flow, interfacial mobility is inherently higher at the liquid-blood interface, making it a key contributor to the low thrombogenicity of LIS, as FXII activity and fibrin density are equivalent at the interface. The findings of this study advance the understanding of the anti-thrombotic behavior of LIS-coated biomedical devices for future coating design. More broadly, enhanced interfacial mobility may be an important, underexplored mechanism for the anti-fouling behavior of surface coatings.

Biomaterial Wettability Affects Fibrin Clot Structure and Fibrinolysis.

Thrombosis on blood-contacting medical devices can cause patient fatalities through device failure and unstable thrombi causing embolism. The effect of material wettability on fibrin network formation, structure, and stability is poorly understood. Under static conditions, fibrin fiber network volume and density increase in clots formed on hydrophilic compared to hydrophobic polystyrene surfaces. This correlates with reduced plasma clotting time and increased factor XIIa (FXIIa) activity. These structural differences are consistent up to 50 µm away from the material surface and are FXIIa dependent. Fibrin forms fibers immediately at the material interface on hydrophilic surfaces but are incompletely formed in the first 5 µm above hydrophobic surfaces. Additionally, fibrin clots on hydrophobic surfaces have increased susceptibility to fibrinolysis compared to clots formed on hydrophilic surfaces. Under low-flow conditions, clots are still denser on hydrophilic surfaces, but only 5 µm above the surface, showing the combined effect of the surface wettability and coagulation factor dilution with low flow. Overall, wettability affects fibrin fiber formation at material interfaces, which leads to differences in bulk fibrin clot density and susceptibility to fibrinolysis. These findings have implications for thrombus formed in stagnant or low-flow regions of medical devices and the design of nonthrombogenic materials.

Evaluating medical device and material thrombosis under flow: current and emerging technologies.

Although blood-contacting medical devices are used widely, blood clot formation (thrombosis) leads to device failure and potentially catastrophic adverse thrombotic events for patients, such as stroke or pulomonary embolism. Systemic anti-thrombotic drugs aimed at reducing these complications do not always prevent device thrombosis and can cause increased bleeding risks. Therefore, our understanding of material thrombosis mechanisms needs to be improved in order to develop next generation blood-contacting medical devices and materials. Medical device development requires material thrombogenicity evaluation according to the International Standards 10993-4 Biological evaluation of medical devices-Selection of tests for interactions with blood, which highlights that one of the key aspects for testing is a clinically relevant flow system. In this review, we first provide an overview of the current knowledge regarding material thrombosis and important physical and biological aspects of blood flow in relation to thrombus formation. We then examine commonly used in vitro flow systems to evaluate material and medical device thrombosis, focusing on their capabilities, advantages and disadvantages. Finally, we explore recent advances in technology that will aid in improving the design and fabrication of flow systems, mechanistic analysis and computational modelling.

Hypoxic postconditioning enhances functional recovery following endothelin-1 induced middle cerebral artery occlusion in conscious rats.

Stroke is a leading cause of death and a major contributor to neurological disability in adults. Tissue plasminogen activator is the only approved treatment. However, due to its narrow therapeutic window, <5% of patients receive treatment. Recently, hypoxic postconditioning (HPC) was shown to reduce stroke induced-injury in mice, but the mechanisms and functional outcomes are still unknown. In the current study, male Sprague Dawley rats were subjected to endothelin-1 induced stroke. HPC (8% O2, 1 h/d for 5d) or normoxia treatments were started 24 h after stroke. Behavioural tests were performed at various time-points (pre- and post-surgery, 1 and 6 days post stroke) and brains were collected 6 days after stroke for histological and immunoblotting analysis. HPC improved deficits in neurological score, motor and sensory function after stroke. Furthermore, HPC reduced infarct volume and neuronal loss in the cortex, while it increased the number of astrocytes and of Fluoro-Jade-positive cells in the injured hemisphere. We observed a mild increase in HIF-1 and its target gene, glucose transporter-1. Our data suggest that HPC-induced neuroprotection was mediated by enhanced astrocyte function, which may have contributed to functional recovery after stroke.