In an era of increased cardiovascular disease burden in the ageing population, there is great demand for devices that come in to contact with the blood such as heart valves, stents, and bypass grafts that offer life saving treatments. Nitric oxide (NO) elution from healthy endothelial tissue that lines the vessels maintains haemostasis throughout the vasculature. Surgical devices that release NO are desirable treatment options and N-diazeniumdiolates and S-nitrosothiols are recognized as preferred donor molecules. There is a keen interest to investigate newer methods by which NO donors can be retained within biomaterials so that their release and kinetic profiles can be optimized. A range of polymeric scaffolds incorporating microparticles and nanomaterials are presenting solutions to current challenges, and have been investigated in a range of clinical applications. This review outlines the application of NO donors for cardiovascular therapy using biomaterials that release NO locally to prevent thrombosis and intimal hyperplasia (IH) and enhance endothelialization in the fabrication of next generation cardiovascular device technology.

Cardiovascular implants must resist thrombosis and intimal hyperplasia, but they are prone to such patency limiting conditions during graft implantation and prior to endothelialisation. Nitric oxide (NO) released from the endothelium has a complex protective role in the cardiovascular system, and this study has addressed: (1) in situ NO release profiles from S-nitrosothiols ((S-Nitroso-N-acetylpenicillamine (SNAP) and (S-Nitrosoglutathione (GSNO)) incorporated into polyhedral oligomeric silsesquioxanepoly(carbonate-urea)urethane (POSS-PCU) coronary artery bypass grafts (CABG) in a physiological pulsatile flow, and (2) the determination of their interaction with endothelial progenitor cells (EPCs), smooth muscle cells, platelets, whole blood kinetics. It was found that 1, 2, and 3 wt% SNAP/GSNO incorporated into POSS-PCU-CABG successfully eluted NO, but optimal elution was evident with 2 %-SNAP-POSS-PCU. NO release determined under static conditions using the Griess assay, and in situ measurements under pulsatile flow using amperometric probe was found to differ, thus confirming the significance of monitoring NO-elution under haemodynamic conditions. 2 %-SNAP-POSS-PCU demonstrated anti-thrombogenic kinetics through thromboelastography measurements, while metabolic activity using Alamar Blue™ assay and scanning electron microscopy demonstrated greater adhesion of EPCs and reduced adhesion of platelets.

Background: There is a great potential for nitric oxide (NO) eluting biomaterials in biomedical applications. These include the development of cardiovascular implants, wound healing products, or applications in cancer and respiratory therapy. While the potential of these materials as a therapy is becoming clearer, the real-time monitoring of NO is not easy and the success in the development of such materials depends on the accurate quantification of NO release. Method: To emphasize on the importance of a measurement technique on the outcome of an experiment, we compared total NO released from S-nitroso-N-acetyl-d-penicillamine (SNAP) incorporated nanocomposite polymer in the form of bypass grafts under simulated physiological conditions using amperometric and chemiluminescence techniques. Results: We found that the total amount of NO measured by the amperometric technique was 35.8% of the theoretical amount. Similarly, on measuring NO release from the bypass grafts, we demonstrated that the chemiluminesence technique detected NO at a relatively higher level. Conclusions:The results of this study clearly demonstrate the relative difference between analysis techniques for accurate NO detection that can be applied to distinct experimental models associated with NO-eluting cardiovascular implants.

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