The Influence of Comorbidities on Chemokine and Cytokine Profile in Obstructive Sleep Apnea Patients: Preliminary Results.

INTRODUCTION: Obstructive sleep apnea (OSA) is frequently associated with a chronic inflammatory state and cardiovascular/metabolic complications. The aim of this study was to evaluate the influence of certain comorbidities on a panel of 45 chemokines and cytokines in OSA patients with special regard to their possible association with cardiovascular diseases. MATERIAL AND METHODS: This cross-sectional study was performed on 61 newly diagnosed OSA patients. For the measurement of the plasma concentration of chemokines and cytokines, the magnetic bead-based multiplex assay for the Luminex® platform was used. RESULTS: In the patients with concomitant COPD, there were increased levels of pro-inflammatory cytokines (CCL11, CD-40 ligand) and decreased anti-inflammatory cytokine (IL-10), while in diabetes, there were increased levels of pro-inflammatory cytokines (IL-6, TRIAL). Obesity was associated with increased levels of both pro-inflammatory (IL-13) and anti-inflammatory (IL-1RA) cytokines. Hypertension was associated with increased levels of both pro-inflammatory (CCL3) and anti-inflammatory (IL-10) cytokines. Increased daytime pCO2, low mean nocturnal SaO2, and the oxygen desaturation index were associated with increased levels of pro-inflammatory cytokines (CXCL1, PDGF-AB, TNF-α, and IL-15). CONCLUSIONS: In OSA patients with concomitant diabetes and COPD, elevated levels of certain pro-inflammatory and decreased levels of certain anti-inflammatory cytokines may favor the persistence of a chronic inflammatory state with further consequences. Nocturnal hypoxemia, frequent episodes of desaturation, and increased daytime pCO2 are factors contributing to the chronic inflammatory state in OSA patients.

VDR Polymorphic Variants Are Related to Improvements in CRP and Disease Activity in Patients with Axial Spondyloarthritis That Undergo Anti-TNF Treatment.

Vitamin D deficiency is related with susceptibility or progression of various autoimmune diseases. The aim of the study was to assess potential relations between single nucleotide polymorphisms (SNPs) in the vitamin D receptor-coding gene (VDR): rs1544410 (BsmI), rs2228570 (FokI), rs731236 (TaqI), rs7975232 (ApaI), and disease activity in patients with axial spondyloarthritis (axSpA) undergoing anti-TNF therapy. The VDR rs731236 CT genotype was statistically more common among female patients (p = 0.027). An improvement of CRP equal to or higher than 50% after 3 months of anti-TNF therapy was observed for rs2228570 T allele (p = 0.002). After 6 months, CRP improvement equal to or higher than 75% was related to presence of the rs1544410 AA genotype (p = 0.027) and the rs731236 CC homozygotes (p = 0.047). Baseline BASDAI values were lower in individuals with the rs2228570 TT genotype (p = 0.036) and rs7975232 C allele (p = 0.029). After 6 months of treatment, lower BASDAI values were observed in AC heterozygotes (p = 0.005). The same AC genotype was more frequently detected in patients with remission (BASDAI ≤ 2) (p = 0.001) and in those achieving BASDAI improvement equal to or higher than 75% (p = 0.006). In conclusion, VDR SNPs were found to relate to CRP and BASDAI values at different time points of anti-TNF therapy.

The use of long-chain plant polyprenols as a means to modify the biological properties of new biodegradable polyurethane scaffolds for tissue engineering. A pilot study.

Microporous membranes for tissue engineering were produced from new biodegradable polyurethane based on hexamethylene diisocyanate, poly(epsilon-caprolactone) diol and 1,4:3,6-dianhydro-D-sorbitol. The interconnected pores had an average size in the range of 5-100 microm. The tensile strength at break, the Young's modulus and elongation at break of the membranes were 3.2+/-0.3 MPa, 25.2+/-1.5 MPa and 190+/-12%, respectively, while nonporous foils from the same polymers had a tensile strength at break of 40+/-2 MPa, a Young's modulus of 91+/-6 MPa, and an elongation at break of 370+/-10%. The membranes were incubated for 10 days in a 2.65 vol% solution of long-chain plant polyprenol in n-hexane to promote their interaction with cells and tissues. The polyprenol was isolated from leaves of Magnolia cobus and was a mixture of prenol-10 and prenol-11. The prenol-impregnated membranes and nonimpregnated membranes (control) were tested in cell culture to assess whether impregnation has a beneficial effect on cell-material interaction. The cells used in the test were chondrocytes isolated from the articular-epiphyseal cartilage of leg bones of 5-day-old inbred LEW rats. The time of culture was 2 and 5 weeks. Both, the nonimpregnated and impregnated polyurethane membranes supported attachment and growth of rat chondrocytes. The cells firmly attached to the surface of the microporous membranes, invaded the pores and maintained the round shape characteristic for chondrocyte-like-morphology. Abundant fibrillar extracellular matrix produced by the cells resembled the network formed by chondrocytes in vivo. The cells produced relatively more extracellular matrix in the membranes impregnated with polyprenol than in the control membranes. Impregnation of polyurethane scaffolds with biologically active amphiphilic polyprenols may be a route to facilitate the cell-material interaction.

Structure-property relations and cytotoxicity of isosorbide-based biodegradable polyurethane scaffolds for tissue repair and regeneration.

Microporous scaffolds with potential applications for tissue engineering were produced from the biodegradable aliphatic isosorbide-based polyurethane using a combined salt leaching-solvent evaporation-coagulation process. Alkaline sodium phosphate heptahydrate crystals were used as a solid porogene, and acetone-water mixture was used as a nonsolvent-coagulant. The scaffolds used in this study had interconnected pores with sizes in the range of 70-120 microm and a pore-to-volume ratio of 87%. The XPS measurements showed that the residence of the scaffold in an aqueous solution of the alkaline porogene changed its surface atomic composition, that is increased the surface concentration of oxygen and nitrogen and reduced the surface concentration of hydrocarbons relative to the control material. This also enhanced the hydrophilicity of the scaffold's surfaces as assessed from contact angle measurements. The alkaline porogene did not affect the polymer's molecular weight. The MTT cytotoxicity assay showed that the isosorbide-based polyurethane scaffold is noncytotoxic. The amounts of interleukin-6 and interleukin-8 proinflammatory cytokines released from human blood leukocytes exposed to the polyurethane scaffolds in vitro were comparable and/or lower than the amount of the cytokines released by leukocytes exposed to the culture-grade polystyrene control.

Bioinspired mineralization of inorganics from aqueous media controlled by synthetic polymers.

The formation of inorganic structures in nature is commonly controlled by biogenic macromolecules. The understanding of mineralization phenomena and the nucleation and growth mechanisms involved is still a challenge in science but also of great industrial interest. This article focuses on the formation and mineralization of two archetypical inorganic materials: zinc oxide and amorphous calcium carbonate (ACC). Zinc oxide is selected as a model compound to investigate the role that polymers play in mineralization. Most of the effort has been devoted to the investigation of the effects of double-hydrophilic block and graft copolymers. Recent work has demonstrated that latex particles synthesized by miniemulsion polymerization, properly functionalized by various chemical groups, have similar effects to conventional block copolymers and are excellently suited for morphology control of ZnO crystals. Latex particles might serve as analogues of natural proteins in biomineralization. The second example presented, ACC, addresses the issue of whether this amorphous phase is an intermediate in the biomineralization of calcite, vaterite, or aragonite. Conditions under which amorphous calcium carbonate can be obtained as nanometer-sized spheres as a consequence of a liquid-liquid phase segregation are presented. Addition of specific block copolymers allows control of the particle size from the micrometer to the submicrometer length scale. The physical properties of novel materials synthesized from concentrated solution and their potential applications as a filler of polymers are also discussed.

Biodegradable polyurethane cancellous bone graft substitutes in the treatment of iliac crest defects.

Porous scaffolds were produced from newly designed biodegradable, segmented aliphatic polyurethanes of various chemical compositions and hydrophilic-to-hydrophobic segment ratios. The scaffolds were implanted into monocortical defects in the iliac crest of healthy sheep for 6 months. The resected cortex was not repositioned. The ilium defects, which were not implanted with polyurethane scaffolds, were used as controls. In none of the control defects was there bone regeneration at the time of euthanasia. The defects implanted with porous scaffolds from polyurethanes were healed to varying extents with cancellous bone. The structure of the regenerated cancellous bone was radiographically denser than the structure of native bone. New bone that was formed in the scaffolds with a higher amount of hydrophilic component contained more calcium phosphate deposit than the bone formed in the scaffolds with a lower amount of the hydrophilic component. There was no new cortex formed over the defect, but a thin layer of soft tissue covered the newly formed cancellous bone.

Biodegradable elastomeric polyurethane membranes as chondrocyte carriers for cartilage repair.

Autologous chondrocyte implantation in combination with an autologous periosteal patch has become a clinically accepted procedure for the treatment of articular cartilage defects. The use of periosteum has, however, several drawbacks. We have been able to fabricate thin elastomeric biodegradable polyurethane (PU) membranes that may possibly have an application as a tissue-engineered substitute for the periosteal patch. Three types of membranes varying in pore size and surface texture were used as substrates for bovine chondrocytes in culture. The membranes, marked as P-I, P-II, and P-R, had average pore sizes of 10 to 20 microm, 40 to 60 microm, and less than 5 microm, respectively. A poly(L/DL-lactide) 80/ 20% micro-porous membrane (PLA) with an average pore size in the range of 10 to 70 microm was used as a control. There was no difference in the cell proliferation profile among the 4 membranes. In terms of proteoglycan and collagen production, P-I, P-R, and PLA performed similarly to one another. The rate of matrix production appears to be greater in the PU membranes than in the PLA membrane in the first 10 days, although by day 30, the PLA membrane had caught up. In all comparisons, the performance of P-II lagged behind those of the other materials. In conclusion, this preliminary study supports the potential use of this novel group of PUs as a periosteal flap substitute or perhaps as a chondrocyte carrier for matrix-assisted chondrocyte implantation and related techniques. Further studies will be necessary to better define their role in clinical applications for cartilage repair.

Biodegradable porous polyurethane scaffolds for tissue repair and regeneration.

Critical-size bone defects usually require the insertion of autogenous bone graft to heal. Harvesting of bone is traumatic and results in high morbidity at the donor site. A potential alternative to bone graft may be a bone substitute with adequate biocompatibility and biological properties produced from ceramics or bioresorbable/biodegradable polymers. In the present study, new elastomeric biodegradable polyurethanes with an enhanced affinity toward cells and tissues were synthesized using aliphatic diisocyanate, poly(epsilon-caprolactone) diol, and biologically active 1,4:3,6-dianhydro-D-sorbitol (isosorbide diol) as chain extender. The polymers were processed into 3D porous scaffolds by applying a combined salt leaching-phase inverse process. The critical parameters controlling pore size and geometry were the solvents and nonsolvents used for scaffold preparation and the sizes of the solid porogen crystals. Scaffolds prepared from the polymer solution in solvents such as dimethylsulfoxide or methyl-2-pyrrolidone did not have a homogenous pore structure. Many pores were interconnected, but numerous pores were closed. Irrespective of the high pore-to-volume ratio (75%), the scaffolds showed poor water permeability. The best solvent for the preparation of scaffolds from the polyurethane used in the study was dimethylformamide (DMF). The type of nonsolvent admixed to the polymer solution in DMF strongly affected the scaffolds' pore structure. The elastomeric polyurethane scaffold prepared from the optimal solvent-nonsolvent mixture had regular interconnected pores, high water permeability, and a pore-to-volume ratio of 90%. The osteoconductive properties of the 3D porous polyurethane scaffolds can be additionally promoted by loading them with calcium phosphate salts such as hydroxyapatite or tricalcium phosphate, thus making them promising candidates for bone graft substitutes.

Regeneration of bicortical defects in the iliac crest of estrogen-deficient sheep, using new biodegradable polyurethane bone graft substitutes.

Porous scaffolds for cancellous bone graft substitutes were prepared from new experimental biodegradable aliphatic polyurethane elastomers with varying hydrophilicity. The ratios of the hydrophilic-to-hydrophobic content in the polymers were 30-70, 50-50, and 70-30%, respectively. The hydrophilic component consisted of poly(ethylene oxide) diol and the hydrophobic component of poly(epsilon-caprolactone) diol. To promote the materials' biological performance, the calcium complexing moiety, the polysaccharide, and vitamin D(3) were incorporated into the polymer chain upon synthesis. The scaffolds had an interconnected porous structure with an average pore size in the range of 300-2,000 microm and pore-to-volume ratios of (85 +/- 5)%. The bone substitutes were implanted (press-fit) in biocortical 10 x 10 mm(2) defects created in the tuber coxae of 21 skeletally mature Warhill ewes, which were ovariectomized 12 months prior to implantation. At the time of euthanasia at 18 and 25 months, all the defects in the ilium implanted with polyurethane bone substitutes had healed with new bone. The extent of bone healing depended on the chemical composition of the polymer from which the implant was made, although for the same material there were animal-related differences in healing. The structure of the newly formed cancellous bone was radiographically and histologically similar to the native bone. The implants from polymers with the incorporated calcium-complexing additive were the most effective promoters of bone healing, followed by those with vitamin D(3) and polysaccharide-containing polymer. There was no bone healing in the control defects.

Fibrin-polyurethane composites for articular cartilage tissue engineering: a preliminary analysis.

In this study we investigated the use of a fibrin hydrogel to improve the potential of a polyurethane (PU) scaffold-based system for articular cartilage tissue engineering. PU-only ("no-fibrin") and PU-fibrin ("fibrin") composites were cultured for up to 28 days and analyzed for DNA content, glycosaminoglycan (GAG) content, type II collagen content, GAG release, and gene expression of aggrecan, collagen I, and collagen II. The use of fibrin allowed for higher viable cell-seeding efficiency (10% higher DNA content on day 2 in fibrin versus no-fibrin composites) and more even cell distribution on seeding, a more than 3-fold increase in the percentage of newly synthesized GAG retained in the constructs, and 2- to 6-fold higher levels of type II collagen and aggrecan gene expression through day 14. Addition of aprotinin to the medium inhibited fibrin degradation, most noticeably in the center of the constructs, but had little effect on biochemical composition or gene expression. Short-term mechanical compression (0-10% sinusoidal strain at 0.1 Hz for 1 h, applied twice daily for 3 days) doubled the rate of GAG release from the constructs, but had little effect on gene expression, regardless of the presence of fibrin. Although further work is needed to optimize this system, the addition of fibrin hydrogel to encapsulate cells in the stiff, macroporous PU scaffold is a step forward in our approach to articular cartilage tissue engineering.

Surface motion upregulates superficial zone protein and hyaluronan production in chondrocyte-seeded three-dimensional scaffolds.

A cartilage engineering bioreactor has been developed that provides joint-specific kinematics. This study investigated the effect of articular motion on the gene expression of superficial zone protein (SZP) and hyaluronan synthases (HASs) and on the release of SZP and hyaluronan of chondrocytes seeded onto biodegradable scaffolds. Cylindrical (8 x 4 mm) porous polyurethane scaffolds were seeded with bovine articular chondrocytes and subjected to static or dynamic compression, with and without articulation against a ceramic hip ball. After loading, the mRNA expression of SZP and HASs was analyzed, and SZP immunoreactivity and hyaluronan concentration of conditioned media were determined. Surface motion significantly upregulated the mRNA expression of SZP and HASs. Axial compression alone had no effect on SZP and increased HAS mRNA only at high strain amplitude. SZP was immunodetected only in the media of constructs exposed to surface motion. The release of hyaluronan into the culture medium was significantly enhanced by surface motion. These results indicate that specific stimuli that mimic the kinematics of natural joints, such as articular motion, may promote the development of a functional articular surface-synovial interface.

Preparation, degradation, and calcification of biodegradable polyurethane foams for bone graft substitutes.

Autogenous cancellous bone graft is used to heal critical-size segmental long bone defects and defects in the maxillofacial skeleton. Harvesting of bone graft is traumatic, causes morbidity of the donor site, and often results in complications. Thus, there is a need for new biologically functional bone graft substitutes that, instead of autogenous bone graft, could be used to facilitate bone regeneration in critical-size defects. Porous biodegradable elastomeric polyurethane scaffolds combined with the patient's own bone marrow could potentially be such bone substitutes. The elastomeric bone substitute prevents shear forces at the interface between bone and rigid, e.g., ceramic bone substitutes and establishes an intimate contact with the native bone ends, thus facilitating the proliferation of osteogenic cells and bone regeneration. Crosslinked 3D biodegradable polyurethane scaffolds (foams) with controlled hydrophilicity for bone graft substitutes were synthesized from biocompatible reactants. The scaffolds had hydrophilic-to-hydrophobic content ratios of 70:30, 50:50, and 30:70. The reactants used were hexamethylene diisocyanate, poly(ethylene oxide) diol (MW = 600) (hydrophilic component), and poly(epsilon-caprolactone) diol (M(w) = 2000), amine-based polyol (M(w) = 515) or sucrose-based polyol (M(w) = 445) (hydrophobic component), water as the chain extender and foaming agent, and stannous octoate, dibutyltin dilaurate, ferric acetylacetonate, and zinc octoate as catalysts. Citric acid was used as a calcium complexing agent, calcium carbonate, glycerol phosphate calcium salt, and hydroxyapatite were used as inorganic fillers, and lecithin or solutions of vitamin D(3) were used as surfactants. The scaffolds had an open-pore structure with pores whose size and geometry depended on the material's chemical composition. The compressive strengths of the scaffolds were in the range of 4-340 kPa and the compressive moduli in the range of 9-1960 kPa, the values of which increased with increasing content of polycaprolactone. Of the two materials with the same amount of polycaprolactone the compressive strengths and moduli were higher for the one containing inorganic fillers. The scaffolds absorbed water and underwent controlled degradation in vitro. The amount of absorbed water and susceptibility to degradation increased with the increasing content of the polyethylene oxide segment in the polymer chain and the presence in the material of calcium complexing moiety. All polyurethane scaffolds induced the deposition of calcium phosphate crystals, the structure and calcium:phosphorus atomic ratio of which depended on the chemical composition of the polyurethane and varied from 1.52-2.0.

The use of biodegradable polyurethane scaffolds for cartilage tissue engineering: potential and limitations.

The aim of the present study was to evaluate the capability of novel biodegradable polyurethane scaffolds to support attachment, growth and maintenance of differentiated chondrocytes in vitro for up to 42 days. After an initial decrease, although not significant, the DNA content of the constructs remained constant over the culture time. A progressive increase in glycosaminoglycans and collagen was observed during the culture period. However, a significant release of matrix molecules into the culture medium was also noticeable. At the transcriptional level, a decrease in aggrecan and procollagen II mRNA expression was noticeable, whereas procollagen I expression was increased. To conclude, the present data demonstrate that biodegradable polyurethane porous scaffolds seeded with articular chondrocytes support cell attachment and the production of extracellular matrix proteins. The limitations of the system are the diffusion of large amounts of matrix molecules into the culture medium and the dedifferentiation of the chondrocytes with prolonged time in culture. However, due to the favourable mechanical properties of the polyurethane scaffold, stimulation of chondrocytes by mechanical loading can be considered in order to improve the formation of a functional cartilage-like extracellular matrix.

Biodegradable polyurethanes for implants. II. In vitro degradation and calcification of materials from poly(epsilon-caprolactone)-poly(ethylene oxide) diols and various chain extenders.

Linear, biodegradable, aliphatic polyurethanes with various degrees of hydrophilicity were synthesized in bulk at 50-100 degrees C. The ratios between the hydrophilic and hydrophobic segments were 0:100, 30:70, 40:60, 50:50, and 70:30, respectively. The hydrophilic segment consisted of poly(ethylene oxide) (PEO) diol (molecular weight = 600 or 2000) or the poly(ethylene-propylene-ethylene oxide) (PEO-PPO-PEO) diol Pluronic F-68 (molecular weight = 8000). The hydrophobic segment was made of poly(epsilon-caprolactone) diol (molecular weight = 530, 1250, or 2000). The chain extenders were 1,4-butane diol and 2-amino-1-butanol. The diisocyanate was aliphatic hexamethylene diisocyanate. The polymers absorbed water in an amount that increased with the increasing content of the PEO segment in the polymer chain. The total amount of absorbed water did not exceed 2% for the poly(ester urethane)s and was as high as 212% for some poly(ester ether urethane)s that behaved in water like hydrogels. The polymers were subjected to in vitro degradation at 37 +/- 0.1 degrees C in phosphate buffer solutions for up to 76 weeks. The poly(ester urethane)s showed 1-2% mass loss at 48 weeks and 1.1-3.8% mass loss at 76 weeks. The poly(ester ether urethane)s manifested 1.6-76% mass loss at 48 weeks and 1.6-96% mass loss at 76 weeks. The increasing content and molecular weight of the PEO segment enhanced the rate of mass loss. Similar relations were also observed for polyurethanes from PEO-PPO-PEO (Pluronic) diols. Materials obtained with 2-amino-1-butanol as the chain extender degraded at a slower rate than similar materials synthesized with 1,4-butane diol. All the materials already manifested a progressive decrease in the molecular weight in the first month of in vitro aging. The rate of molecular weight loss was higher for poly(ester ether urethane)s than for poly(ester urethane)s. For poly(ester ether urethane)s, the rate of molecular weight loss was higher for materials containing Pluronic than for those containing PEO segments. All polymers calcified in vitro. The susceptibility to calcification increased with material hydrophilicity. The progressive deposition of calcium salt on the film surfaces resulted in the formation of large crystal aggregates, the structure of which depended on the chemical composition of the calcified material. Needle-like aggregates, resembling brushite, formed on the hydrophobic polyurethane, and plate-like crystals formed on the highly hydrophilic material. The calcium-to-phosphorus atomic ratio of the crystals growing on the samples was dependent on the chemical composition of the material and varied from 0.94 to 1.55.