Heparin coatings for improving blood compatibility of medical devices.

Blood contact with biomaterials triggers activation of multiple reactive mechanisms that can impair the performance of implantable medical devices and potentially cause serious adverse clinical events. This includes thrombosis and thromboembolic complications due to activation of platelets and the coagulation cascade, activation of the complement system, and inflammation. Numerous surface coatings have been developed to improve blood compatibility of biomaterials. For more than thirty years, the anticoagulant drug heparin has been employed as a covalently immobilized surface coating on a variety of medical devices. This review describes the fundamental principles of non-eluting heparin coatings, mechanisms of action, and clinical applications with focus on those technologies which have been commercialized. Because of its extensive publication history, there is emphasis on the CARMEDA® BioActive Surface (CBAS® Heparin Surface), a widely used commercialized technology for the covalent bonding of heparin.

Heparin surfaces: Impact of immobilization chemistry on hemocompatibility and protein adsorption.

Immobilization of heparin to surfaces has been used for decades to reduce the thrombogenicity of blood contacting devices. This study evaluates how the mode of covalent heparin bonding affects the hemocompatibility and uptake of antithrombin on surfaces in whole blood. End-point attached (EPA) heparin, using the proprietary Carmeda Bioactive Surface (CBAS Surface), was compared with other methods of covalent heparin bonding that typically yield multiple covalent linkages (using reductive amination of periodate oxidized native heparin or EDC coupling of native heparin). All heparin surfaces were immobilized on flexible polyvinyl chloride tubing and exposed to fresh non-anticoagulated blood in an in vitro recirculating Chandler loop blood model. After exposure, biomarkers for coagulation and platelet activation were analyzed in the solution phase, and adsorbed plasma proteins were eluted from the heparin surfaces and measured for surface concentration of antithrombin and total adsorbed protein. Only the EPA-heparin surface conferred thromboresistance, as observed by the absence of clotting. Attachment and activation of platelets as well as activation of the clotting cascade was significantly lower on the EPA-heparin surface when compared with the other heparin surfaces. In addition, antithrombin constituted ∼40% of the total adsorbed plasma protein concentration on the EPA-heparin surfaces.

Characterization of microglial attachment and cytokine release on biomaterials of differing surface chemistry.

The clinical usefulness of central nervous system recording electrodes is currently limited by inconsistent long-term performance that is believed to be governed by the brain tissue response to the implant. In this study, we observed persistent macrophage biomarker expression at the biotic-abiotic interface surrounding implanted electrodes over a 12-week indwelling period. Using the cell type-specific marker CD11b to examine the cells attached to electrodes retrieved over the indwelling period, we found that most of the cells were activated microglia, the resident macrophage of brain tissue, indicating that the implanted electrodes behave as a persistent inflammatory stimulus. To determine the potential usefulness of different materials as coatings for implanted electrodes, we examined brain-derived microglial cell attachment and cytokine release on a number of medically relevant materials. Our results suggest that activated microglia attach to many of the materials used as external coatings for electrode manufacture, and likely serve as a source of pro-inflammatory and neurotoxic cytokines that may be responsible for reducing the biocompatibility of such implants. Our results also indicate that low protein-binding coatings may be useful in reducing microglial attachment upon implantation in brain tissue and may provide a means of improving electrode biocompatibility.

The brain tissue response to implanted silicon microelectrode arrays is increased when the device is tethered to the skull.

The influence of tethering silicon microelectrode arrays on the cortical brain tissue reaction was compared with that of untethered implants placed in the same location by identical means using immunoflourescent methods and cell type specific markers over indwelling periods of 1-4 weeks. Compared with untethered, freely floating implants, tethered microelectrodes elicited significantly greater reactivity to antibodies against ED1 and GFAP over time. Regardless of implantation method or indwelling time, retrieved microelectrodes contained a layer of attached macrophages identified by positive immunoreactivity against ED1. In the tethered condition and in cases where the tissue surrounding untethered implants had the highest levels of ED1+ and GFAP+ immunoreactivity, the neuronal markers for neurofilament 160 and NeuN were reduced. Although the precise mechanisms are unclear, the present study indicates that simply tethering silicon microelectrode arrays to the skull increases the cortical brain tissue response in the recording zone immediately surrounding the microelectrode array, which signals the importance of identifying this important variable when evaluating the tissue response of different device designs, and suggests that untethered or wireless devices may elicit less of a foreign body response.

Neuronal cell loss accompanies the brain tissue response to chronically implanted silicon microelectrode arrays.

Implantable silicon microelectrode array technology is a useful technique for obtaining high-density, high-spatial resolution sampling of neuronal activity within the brain and holds promise for a wide range of neuroprosthetic applications. One of the limitations of the current technology is inconsistent performance in long-term applications. Although the brain tissue response is believed to be a major cause of performance degradation, the precise mechanisms that lead to failure of recordings are unknown. We observed persistent ED1 immunoreactivity around implanted silicon microelectrode arrays implanted in adult rat cortex that was accompanied by a significant reduction in nerve fiber density and nerve cell bodies in the tissue immediately surrounding the implanted silicon microelectrode arrays. Persistent ED1 up-regulation and neuronal loss was not observed in microelectrode stab controls indicating that the phenotype did not result from the initial mechanical trauma of electrode implantation, but was associated with the foreign body response. In addition, we found that explanted electrodes were covered with ED1/MAC-1 immunoreactive cells and that the cells released MCP-1 and TNF-alpha under serum-free conditions in vitro. Our findings suggest a potential new mechanism for chronic recording failure that involves neuronal cell loss, which we speculate is caused by chronic inflammation at the microelectrode brain tissue interface.

Substrate curvature influences the direction of nerve outgrowth.

Nerve outgrowth in the developing nervous system utilizes a variety of attractive and repulsive molecules found in the extracellular environment. In addition, physical cues may play an important regulatory role in determining directional outgrowth of nervous tissue. Here, by culturing nerve cells on filamentous surfaces and measuring directional growth, we tested the hypothesis that substrate curvature is sufficient to influence the directional outgrowth of nerve cells. We found that the mean direction of neurite outgrowth aligned with the direction of minimum principle curvature, and the spatial variance in outgrowth direction was directly related to the maximum principle curvature. As substrate size approached the size of an axon, adherent neurons extended processes that followed the direction of the long axis of the substrate similar to what occurs during development along pioneering axons and radial glial fibers. A simple Boltzmann model describing the interplay between adhesion and bending stiffness of the nerve process was found to be in close agreement with the data suggesting that cell stiffness and substrate curvature can act together in a manner that is sufficient to direct nerve outgrowth in the absence of contrasting molecular cues. The study highlights the potential importance of cellular level geometry as a fidelity-enhancing cue in the developing and regenerating nervous system.

Neurite outgrowth on well-characterized surfaces: preparation and characterization of chemically and spatially controlled fibronectin and RGD substrates with good bioactivity.

Study of axonal growth and ligand-receptor interactions requires specificity and careful characterization of the biomaterial substrates to which the neurons bind. It would be impossible to predict the effects of important variables such as composition, surface density, spatial distribution, and conformation of the ligands on axonal growth of a neuron without highly specific surface characterization. Here, we compare two methods of surface modification (hereafter referred to as "Heterobifunctional Crosslinker" and "Pluronics" methods) used for immobilization of fibronectin (FN) and FN-derived, RGD-containing peptides to the substrates. We also characterized their performance in neurite outgrowth experiments. Various surface analytical techniques such as contact angle measurement, XPS, and time-of-flight secondary ion mass spectrometry (TOF-SIMS) were used for the analysis of the substrates at each step of the two different chemistries involved. FN-patterned surfaces were created by micro-contact printing methods and confirmed by imaging TOF-SIMS, and AFM techniques. After immobilization of FN and/or FN-derived RGD-containing peptide, including the formation of micron-scale patterns of FN, the modified surfaces were plated with neurons from postnatal rat dorsal root ganglia (DRG) and incubated in serum-free medium. Both the peptide- and/or protein-modified substrates supported significantly greater neurite outgrowth than controls, and outgrowth on both substrate chemistries was inhibited by the addition of soluble RGD peptide. Patterned FN surfaces were successful in spatially controlling the neuron attachment and outgrowth.

Directed nerve outgrowth is enhanced by engineered glial substrates.

In the present study, the influence of astrocyte alignment on the direction and length of regenerating neurites was examined in vitro. Astrocytes were experimentally manipulated by different approaches to create longitudinally aligned monolayers. When cultured on the aligned monolayers, dorsal root ganglion neurites grew parallel to the long axis of the aligned astrocytes and were significantly longer than controls. Engineered monolayers expressed linear arrays of fibronectin, laminin, neural cell adhesion molecule, and chondroitin sulfate proteoglycan that were organized parallel to one another, suggesting that a particular spatial arrangement of these molecules on the astrocyte surface may be necessary to direct nerve regeneration in vivo. In contrast, no bias in directional outgrowth was observed for neurites growing on unorganized monolayers. The results suggest that altering the organization of astrocytes and their scar-associated matrix at the lesion site may be used to influence the direction and the length of adjacent regenerating axons in the damaged brain and spinal cord.

Hollow fiber membrane diffusive permeability regulates encapsulated cell line biomass, proliferation, and small molecule release.

Using histological and HPLC methods, we examined the influence of hollow fiber membrane transport properties on encapsulated PC12 cell biomass, proliferation and the release of dopamine over 4 weeks in culture. Our data indicated that encapsulated cell biomass, the number of proliferating cells, and the quantity of dopamine released increased as a function of increasing hollow fiber encapsulation membrane diffusive permeability. Overall the percentage of viable cells and the biomass architecture, however, was not significantly affected by differences in membrane transport. When compared to membrane sieving properties, membrane diffusive transport and membrane hydraulic permeability were better indicators of biomass size, proliferating cell number, and dopamine release from encapsulated cells. Studies examining the sustained release of DA from membranes of differing permeability suggest that membrane diffusive permeability can be used to regulate the quantity of small molecules released per unit time at steady state, and should be considered when dosing is an important determinant of implant efficacy.