Comparable biocompatibility of Phisio- and Bioline-coated cardiopulmonary bypass circuits indicated by the inflammatory response

Thiara, Amrik S.; Andersen, V Y; Videm, Vibeke; Te, Mollnes; Svennevig, Katja; Hoel, Terje; Fiane, AE

doi:10.1177/0267659110362822

Cited by 37 publications

(34 citation statements)

References 27 publications

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“…Some high-flow dialysis treatments can be carried out without heparin in subsets of patients with high bleeding risks, but even in this patient population, half are forced to switch to heparin bolus dialysis within the first year of treatment 2 . Due to these limitations, other non-thrombogenic, hydrophilic material coatings have been explored, including PHISIO (Sorin) 13 , Trillium (Medtronic) 14 , PMEA polymer 15 , and sulfobetaine 16 . Extensive human clinical evaluation of these various alternative surface coatings is currently underway; however, no benefit has been shown to date when compared to existing heparin-coated materials 17,18 .…”

Section: ____________________________________________________________mentioning

confidence: 99%

A bioinspired omniphobic surface coating on medical devices prevents thrombosis and biofouling

et al. 2014

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________________________________________________________________Countless lives have been saved by implantable medical devices (e.g., total artificial hearts, ventricular assist devices, pacemakers, cardioverterdefibrillators, and central lines) and extracorporeal devices that flow whole human blood outside the body through indwelling catheters and external circuits, during cardiopulmonary bypass (CPB), hemodialysis, and extracorporeal membrane oxygenation (ECMO) 1,2 . However, the need to co-administer soluble anticoagulant drugs, such as heparin, with many of these procedures, significantly reduces their safety and hampers their effectiveness 3,4 . Without systemic anticoagulation, these extracorporeal and indwelling devices can rapidly occlude due to thrombosis because clots form when fibrin and platelets in the flowing blood adhere to the surfaces of these artificial materials 5 . Unfortunately, heparin causes significant morbidity and mortality including post-operative bleeding, thrombocytopenia, hypertriglyceridemia, hyperkalemia and hypersensitivity 6 , and its use is contraindicated in several patient populations 7 . In fact, the majority of drug-related deaths from adverse clinical events in the UnitedStates are due to systemic anticoagulation 8 .This need to prevent blood clotting while minimizing administration of anticoagulant drugs has led to the search for biomaterial surface coatings that can directly suppress blood clot formation. The most successful approach to date has been to chemically immobilize heparin on blood-contacting surfaces to reduce thrombosis and lower anticoagulant administration 9,10 . Although this approach has been widely adopted, major limitations persist because the surface-bound heparin leaches, resulting in a progressive loss of anticoagulation 24,25 . Importantly, the TP continues to retain the free LP as a thin mobile liquid layer even when the surface is challenged with a flowing immiscible fluid, such as blood (Fig. 1a). We refer to this unique anti-thrombogenic bilayer composed of the TP and LP coating as a Tethered-Liquid Perfluorocarbon (TLP) surface. RESULTS A generic blood repellent surface coatingTo test the anti-adhesive properties of the TLP coating method, we examined surface adhesion of fresh whole human blood on an acrylic surface sloped at an angle of 30 degrees, with or without a TLP coating composed of tethered perfluorohexane and liquid perfluorodecalin. Blood droplets immediately adhered to the control uncoated acrylic surface and left a trail of blood components over the course of 5 sec (Fig. 1b, top, Supplementary Fig. 1 and Supplementary Movie 1).In contrast, when the same surface was coated with TLP, the blood droplet almost immediately slid off the surface (< 0.3 sec), and remarkably, there was no evidence of any residual blood trail (Fig. 1b, Supplementary Fig. 1 and Supplementary Movie 2). We quantified blood adhesion to surfaces by measuring the minimum angle required to cause a droplet to slide ("sliding angle") ( Fig. 1c). Control uncoated s...

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Section: ____________________________________________________________mentioning

confidence: 99%

A bioinspired omniphobic surface coating on medical devices prevents thrombosis and biofouling

et al. 2014

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“…Non-fouling surfaces prepared with poly(ethylene glycol) (PEG) and zwitterionic polymeric materials have proved to be very effective in preventing blood coagulation around implants 11 . Similarly, heparin-coated dialysis catheters and cardiopulmonary bypass (CPB) surfaces showed a greater reduction in thrombosis and infection, and superior cumulative survival compared to non-coated controls 12, 13 . However, implant failures due to coating delamination have been observed in several clinical trials and the irreversible platelet activation events remain problematic 14 .…”

Section: Introductionmentioning

confidence: 99%

Antithrombogenic properties of a nitric oxide-releasing dextran derivative: evaluation of platelet activation and whole blood clotting kinetics

Damodaran¹,

Leszczak²,

Wold³

et al. 2013

RSC Adv.

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Controlling platelet activation and clotting initiated by cardiovascular interventions remains a major challenge in clinical practice. In this work, the anti-thrombotic properties of a polysaccharide-based nitric oxide (NO)-releasing dextran derivative are presented. Total platelet adhesion, platelet morphology and whole blood clotting kinetics were used as indicators to evaluate the anti-clotting properties of this material. With a total NO delivery of 0.203±0.003 μmol, the NO-releasing dextran derivative (Dex-SNO) mixed with blood plasma demonstrated a significantly lower amount of platelet adhesion and activation onto a surface and reduced whole blood clotting kinetics. Nearly 75% reduction in platelet adhesion and a significant retention of platelet morphology were observed with blood plasma treated with Dex-SNO, suggesting this to be a potential anti-platelet therapeutic agent for preventing thrombosis that does not have an adverse effect on circulating platelets.

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“…sTCC was measured in a sandwich ELISA with a monoclonal capture antibody against the neoepitope on C9 when built-in to the C5b-9 complex and a biotinylated anti-C6 as detection antibody. These results were mentioned briefly by Thiara et al [13] but were not presented in detail, which is thus reported in the present paper.…”

Section: C3a and Soluble Tccmentioning

confidence: 39%

“…These results were mentioned briefly by Thiara et al . but were not presented in detail, which is thus reported in the present paper.…”

Section: Methodsmentioning

confidence: 73%

Heparin-coated cardiopulmonary bypass circuits selectively deplete the pattern recognition molecule ficolin-2 of the lectin complement pathway in vivo

Hein

Munthe-Fog

Thiara

et al. 2015

Clinical and Experimental Immunology

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SummaryThe complement system can be activated via the lectin pathway by the recognition molecules mannose-binding lectin (MBL) and the ficolins. Ficolin-2 exhibits binding against a broad range of ligands, including biomaterials in vitro, and low ficolin-2 levels are associated with increased risk of infections. Thus, we investigated the biocompatibility of the recognition molecules of the lectin pathway in two different types of cardiopulmonary bypass circuits. Bloods were drawn at five time-points before, during and postoperatively from 30 patients undergoing elective cardiac surgery. Patients were randomized into two groups using different coatings of cardiopulmonary bypass circuits, Phisio® (phosphorylcholine polymer coating) and Bioline® (albumin-heparin coating). Concentrations of MBL, ficolin-1, −2 and −3 and soluble C3a and terminal complement complex (TCC) in plasma samples were measured. Ficolin-3-mediated complement activation potential was evaluated with C4, C3 and TCC as output. There was no significant difference between the two circuit materials regarding MBL, ficolin-1 and −3. In the Bioline® group the ficolin-2 levels decreased significantly after initiation of surgery (P < 0·0001) and remained reduced throughout the sampling period. This was not seen for Phisio®-coated circuits. Ficolin-3-mediated complement activation potential was reduced significantly in both groups after start of operation (P < 0·0001), whereas soluble C3a and TCC in the samples were increased (P < 0·0001). Ficolin-2 was depleted from plasma during cardiac surgery when using heparin-coated bypass circuits and did not reach baseline level 24 h postoperation. These findings may have implications for the postoperative susceptibility to infections in patients undergoing extracorporeal circulation procedures.

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Comparable biocompatibility of Phisio- and Bioline-coated cardiopulmonary bypass circuits indicated by the inflammatory response

Abstract: The two circuits exhibited a comparable degree of in vivo biocompatibility.

Cited by 37 publications

References 27 publications

A bioinspired omniphobic surface coating on medical devices prevents thrombosis and biofouling

A bioinspired omniphobic surface coating on medical devices prevents thrombosis and biofouling

Antithrombogenic properties of a nitric oxide-releasing dextran derivative: evaluation of platelet activation and whole blood clotting kinetics

Heparin-coated cardiopulmonary bypass circuits selectively deplete the pattern recognition molecule ficolin-2 of the lectin complement pathway in vivo

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