Decoration of heparin and bovine serum albumin on polysulfone membrane assisted via polydopamine strategy for hemodialysis

Renal failure brings about abnormality of waste and toxins and deposition in the body. In clinic, the waste and toxins in vitro are eliminated by hemodialysis device with polysulfone (PSF) porous membranes. In the work, decoration of heparin (Hep) and bovine serum albumin (BSA) on PSF membranes would be beneficial to improve the hemocompatibility and reduce the anaphylatoxin formation during hemodialysis. The PSF porous membranes are surface-modified by simply dipping them into dopamine aqueous solution for 8 h. Then, Hep and BSA are immobilized covalently onto the resultant membrane. Attenuated total reflectance Fourier transform infrared spectra (ATR-FTIR) confirms that Hep and BSA are successfully introduced onto the surface of PSF membranes. Scanning electronic microscopy (SEM) and atomic force microscopy (AFM) display the changes of surface morphologies after modification. The result of water contact angle measurement shows that the hydrophilicity of PSF membranes is remarkably improved after coating polydopamine (pDA) and binding Hep and BSA. The experiments of hemocompatibility indicate that Hep and BSA grafted onto membranes suppress the adhesion of platelet and enhance the anticoagulation ability of PSF membranes. Furthermore, the protein adsorption tests reveal that Hep and BSA immobilized onto membranes depress the protein absorption and develop antifouling-protein ability of pristine membrane. This study proves a convenient and simple approach to graft two functional organic polymers which, respectively, play a vital role and then improve the hemocompatibility and biocompatibility of PSF membranes for their biomedical and blood-contacting applications.     

Hemocompatibility of polyacrylonitrile dialysis membrane immobilized with chitosan and heparin conjugate

Chitosan (CS)/heparin (HEP) polyelectrolyte complex (PEC) was covalently immobilized onto the surface of polyacrylonitrile (PAN) membrane. The effect of surface modification on the protein adsorption and platelet adhesion, metabolites permeation and anticoagulation activity of the resulting membrane was investigated. Surface characterization such as water contact angle, and X-ray photoelectron spectroscope were performed. The immobilization of PEC caused the water contact angle to reduce, thereby indicating the increase in the hydrophilicity. Protein adsorption, platelet adhesion, and thrombus formation were all reduced by the immobilization of HEP. Anticoagulant activity was evaluated with activated partial thrombin time (APTT), prothrombin time (PT), fibrinogen time, and thrombin time (TT). The results revealed that PEC-immobilizing membrane can improve antithrombogenicity of PAN membrane. In addition, the PEC-immobilized membranes can suppress the proliferation of Pseudomonas aeruginosa. In vitro cytotoxicity test showed leachable substance released was below cytotoxic level. The pure water permeability results show little variation due to PEC-immobilization. Thus PEC-immobilization can endow the PAN membrane hemocompatibility and antibacterial activity while retaining the original permeability.     

Effect of dialyzer membranes on in vitro generation of eicosanoids

Eicosanoids are potent substances released from blood cells after contact with foreign materials. Eicosanoid generation, in addition to complement fragment formation, may be a valuable indicator of the biocompatibility of dialyzer membranes. In the present in vitro study, eicosanoid generation induced by several different flat dialyzer membranes [polyacrylonitrile (PAN), cuprammonium cellulose (CC), and polycarbonate (PC)] was evaluated and compared using blood from non-uremic healthy volunteers. Generation of prostaglandin E2 (PGE2) and thromboxane B2 (TXB2) was greatest with PC followed by PAN and CC. The formation of C3a des arg with PAN was less than with either CC or PC. Our results suggest that dialyzer membranes affect complement activation and eicosanoid generation differently; biocompatibility as expressed by a low level of complement fragment formation does not necessarily translate into biocompatibility when considering eicosanoid generation.     

组织因子途径抑制因子对生物材料表面血小板粘附的影响

组织因子途径抑制因子（tissue factor pathway inhibitor,TFPI）是组织因子凝血途径的主要抑制因子，具有抑制组织因子、凝血因子VIIa、和Xa的功能。我们以前的研究显示TFPI在体外可以明显延长被修饰材料表面的凝血时间，在体内显著减少材料表面的血栓形成。本文观察了TFPI包被对聚乙烯和聚氯乙烯材料表面血小板粘附的影响。结果显示，通过TFPI处理后，上述两种材料表面的血小板粘附数目较对照组明显减少，提示TFPI可通过抑制血小板在材料表面的粘附起到改善生物材料血液相容性的作用。     

Effect of hirudin versus heparin on hemocompatibility of blood contacting biomaterials: an in vitro study

Hirudin serves as an alternative anticoagulant for extracorporeal blood circulation. Comparing anticoagulation with hirudin (2.5 or 5.0 microg/mL) and heparin (2.0 or 4.0 IU/mL) human blood was circulated in a modified 'Chandler System' using PVC-tubes for 2 hours at 37 degrees C. Activation of coagulation (thrombin-antithrombin III-complex, prothrombin fragment 1+2 and D-Dimer), platelet (platelet factor 4 - PF4) and complement systems was analyzed. Both heparin concentrations and 5.0 microg/dL hirudin led to as significantly less activated plasmatic coagulation as 2.5 microg/dL hirudin. Decreased levels of PF4 and anaphylatoxin C5a (p<0.05) as well as terminal complement complex demonstrated improved hemocompatibility after anticoagulation with heparin in contrast to hirudin. Because initial coagulation cascade, platelet activation and complement activation is less influenced by hirudin than by heparin, hemocompatibility is more dependent on the characteristics of the biomaterials used. This predestines hirudin as anticoagulant for in vitro studies analyzing hemocompatibility of biomaterials or surface modifications.     

Polymer surfaces structured with random or aligned electrospun nanofibers to promote the adhesion of blood platelets

Fibrous membranes (nonwoven meshes) prepared via electrospinning technique have great potential in tissue engineering. This work is the first study on the behaviors of blood platelets at the nanostructured surface generated by electrospinning. Poly[acrylonitrile-co-(N-vinyl-2-pyrrolidone)] (PANCNVP) that shows excellent antiplatelet adhesion ability was directly electrospun onto its dense membrane surface. Polyacrylonitrile (PAN) samples were used as controls. The depth as well as the density of the nanofibers can be easily controlled. The results showed that the PANCNVP dense membrane certainly suppressed the activation and adhesion of platelets. However, whether the nanofibers and underlying membranes were composed of PAN or PANCNVP, the nanostructured surfaces promoted the activation, adhesion, and orientation of platelets. It was also found that, if the space between fibers was too large or the depth of fibers was too small, the nanostructured surface did not change the property of antiplatelet adhesion of PANCNVP. The promotion of activation and adhesion of platelets was obviously due to the presence of nanofibers, which induced the changes of surface topography and charge.     

Adsorption of low molecular weight proteins to hemodialysis membranes: experimental results and simulations.

Adsorption of alpha-lactalbumin and Cytochrome C on different hollow-fiber hemodialysis modules, whose main membrane constituent was polyacrylonitrile (PAN), polymethylmethacrylate (PMMA) or polysulfone (PS), were compared under different pH and flow rate conditions. These proteins were chosen as models of small scarce proteins like beta2-microglobulin from which the patient's blood should be epurated. Influence of pH suggests the importance of electrostatic interactions on a charged membrane since adsorption greatly decreases at pH 10.9 for Cytochrome C (pI = 10.6) and at pH 7.4 for alpha-lactalbumin (pI = 5). The difference in adsorbance between different membranes is most probably due to their different microstructures. However, the chemical nature of the support plays a non-negligible role since PMMA membranes have smaller initial adsorption rates than PAN membranes. This is correlated with the density of membrane surface charge showing the importance of electrostatic interactions. The influence of the wall shear rate on adsorption kinetics is analyzed through numerical simulations, in terms of transport limitation in the liquid phase and interfacial reaction.     

In vitro activation of human complement by polyacrilonitrile dialyzer membrane assayed by complement binding to bystander red cells.

Quantitation of complement activation by polyacrilonitrile (PAN) dialyzer membrane is complicated by the high adsorptive capacity of the membrane for fluid phase anaphylotoxins. Assays for these anaphylotoxins, therefore, underestimate the degree of complement activation produced by this membrane. Alternative methods of measuring in vitro complement activation by the PAN and Cuprophan membranes were explored by incubating normal human erythrocytes with the membranes in the presence of serum. This led to deposition of C3d on these "innocent bystander" red cells, and provided an independent parameter for measuring complement activation. The PAN membrane caused significantly more C3d deposition on red cells, and thus more complement activation than Cuprophan. The possible significance of complement activation by PAN membrane, in consideration of its property of binding the resultant anaphylotoxins, is discussed.     

Anaphylatoxin formation by contact activation of plasma. I. Activation by zymosan without participation of antibody

By incubation with human plasma at 37°C zymosan is coated with factors forming a complex which liberates anaphylatoxin from rat anaphylatoxinogen. This complex is formel equally well in plasma which has been preabsorbed with zymosan at 0°C. In contrast to fresh plasma, preabsorbed plasma did not contain detectable antibodies to zymosan. Furthermore, precoating of zymosan with rabbit anti-zymosan antibody did not increase its capability to fix anaphylatoxin-forming factors from preabsorbed human plasma. Anaphylatoxin formation in rat plasma by incubation with zymosan or Sephadex proceeded equally well regardless of whether the respective antibodies had been eliminated by preabsorption or not. Glycogen proved to be an effective contact agent, inducing anaphylatoxin formation in rat plasma which is unlikely to contain anti-glycogen antibodies. The findings suggest that natural antibodies to the mentioned polysaccharides are not involved in anaphylatoxin formation induced by contact with plasma. This makes it unlikely that the anaphylatoxin-forming system fixed on zymosan, etc. is represented simply by the complement complex C1423. Sheep red blood cells can be coated with anaphylatoxin-forming serum factors only when previously loaded with amboceptor. This suggests that two different pathways of anaphylatoxin formation exist: one is by use of the classical complement reaction, operating when e.g. erythrocyte-antibody complexes are incubated with serum; the other pathway is involved when polysaccarides are used for induction of anaphylatoxin liberation.     

Antifouling blood purification membrane composed of cellulose acetate and phospholipid polymer

The ideal surface of an artificial blood purification membrane needs hemocompatibility and durability of high performance; it should not adsorb any proteins or cells but should still have high permeability in the desired range of solute size. To improve the anti-fouling property of cellulose acetate (CA) membranes, a CA membrane blended with poly(2-methacryloyloxyethyl phosphorylcholine (MPC)-co-n-butyl methacrylate (BMA)) (PMB30) was designed as a blood purification membrane. The polymer solutions for preparing the membrane were prepared using a solvent mixture composed of N, N-dimethylformamide, acetone, 2-propanol or water. The CA and CA/PMB30 blend membranes with an asymmetric and porous structure were prepared by a phase inversion process.The characteristics of the CA/PMB30 blend membrane, such as structural properties, mechanical properties, and solute permeability were examined with attention to changes in the preparation conditions of the membrane. The CA/PMB30 blend membrane had good water and solute permeability and a sharp molecular weight cut-off property. Moreover, the amount of proteins adsorbed on the CA/PMB30 blend membrane surface was less than that of the original CA membrane and a conventional polysulfone membrane. Adhesion and activation of platelets on the CA/PMB30 blend membrane were reduced compared with that on a CA membrane. In addition, the CA/PMB30 blend membrane showed good permselectivity and an antifouling property during a long time ultrafiltration experiment with protein solutions.     

Reduction of hepatitis C virus by dialysis membrane

Recently, it has been reported that hepatitis C virus (HCV) RNA levels in blood are reduced after a hemodialysis procedure and that HCV RNA levels in blood are significantly lower in hemodialysis patients than in nonuremic subjects. The present study was designed to examine whether there were differences in the reduction of HCV RNA levels in blood between different dialysis membranes used in a hemodialysis procedure in maintenance hemodialysis patients with HCV. Dialyzers made of polysulfone, ethylenevinylalcohol, polyacrylonitril, polymethylmethacrylate, cellulose diacetate, and cellulose triacetate were used. We took an aliquot of blood from blood tubing at the inlet and the outlet of each dialyzer to measure serum HCV RNA levels. Furthermore, the filtrate was concurrently collected to measure its HCV RNA level at the dialysis outlet. We found that serum HCV RNA levels were reduced when dialyzers made of polysulfone, polyacrylonitril, polymethylmethacrylate, cellulose diacetate, and cellulose triacetate were used. Particularly, serum HCV RNA levels were reduced significantly when dialyzers made of polymethylmethacrylate (P<0.05) and cellulose diacetate (P<0.1) were used. No HCV RNA was detected in the filtrate of any dialysis membrane. These results suggest that the reduction of hepatitic C viral particles in blood is different in each dialysis membrane used in a hemodialysis procedure, and that viral particles may be adsorbed onto the inner surface of the dialysis membranes. This work was presented at the Annual Meeting of the Japanese Society of Dialysis Therapy in Fukuoka, Japan, in 2000     

Redistribution of P-selectin ligands on neutrophil cell membranes and the formation of platelet-neutrophil complex induced by hemodialysis membranes

The formation of platelet-neutrophil microaggregates and successive activation of neutrophils are closely related to hemodialysis-associated complications. The microaggregate is mediated primarily by the interaction between P-selectin (CD62P) expressed on activated platelets and P-selectin glycoprotein ligand-1 (PSGL-1, CD162) expressed on neutrophils. We previously reported that the clustered distribution of PSGL-1 on the cell membranes of chemokine-treated neutrophils caused upregulation of the microaggregate formation. In this study, we found that neutrophils treated with human plasma that had been incubated with hemodialysis membranes greatly enhanced the microaggregate formation. The membrane-treated plasma also induced PSGL-1 to form a cap-like cluster on the neutrophil surface. Analysis of several hemodialysis membranes with different materials indicated that the inducibility for the cap-like cluster formation of PSGL-1 parallels their ability to activate the complement system. Both the enhancement of microaggregate formation and the redistribution of PSGL-1 induced by the hemodialysis membrane-treated plasma were almost completely abrogated in the presence of a specific antagonist for the complement component C5a receptor, W-54011. These results strongly suggest that the generation of anaphylatoxin C5a through complement activation induced by hemodialysis membranes is responsible for the clustered redistribution of PSGL-1 in neutrophils leading to the increase in the platelet-neutrophil microaggregate formation. The present study indicates the importance of synergistic exacerbation of complement activation and platelet-neutrophil microaggregate formation in developing hemodialysis-associated complications.     

Membranes for biohybrid liver support systems--investigations on hepatocyte attachment,morphology and growth

The biological properties of four different membranes were studied regarding their possible application in biohybrid liver support systems. Two of them, one made of polyetherimide (PEI), and a second based on polyacrylonitrile-N-vinylpyrollidone co-polymer (P(AN-NVP)), were recently developed in our lab and studied for the first time. Together with pure polyacrylonitrile (PAN) membranes, the three preparations were characterised as ultra-filtration membranes. Their ability to support cell attachment, morphology, proliferation and function of human hepatoblastoma C3A cells was studied. The role of surface morphology for the interaction with hepatocytes was highlighted using a commercial, moderately wettable polyvinylidendifluoride (PVDF) membrane with micro-filtration properties. Comparative investigations showed strongest interaction of C3A cells with PAN membranes, as the focal adhesion contacts were more expressed and cell growth was also high. However, the functional activity in terms of albumin synthesis was reduced. Very similar results were obtained with the most hydrophobic PEI membrane. In contrast, the most hydrophilic membrane P(AN-NVP) was found to provoke stronger homotypic adhesion (E-cadherin expression) of C3A cells and less substratum attachment (focal adhesions), but enhanced albumin secretion. However, proliferation of C3A cells was lowered. Micro-porous PVDF membrane showed very good initial attachment, but the resulting cell material and cell-cell interaction were relatively poor developed. Among four membranes tested, PEI seems to be the most attractive membrane for biohybrid liver devices, as it provides good surface properties for hepatocytes interaction, but in addition it is highly thermostable, which would permit steam sterilisation. No simple relationship, however, between the wettability of the membranes and their ability to support hepatocyte adhesion and function was found in this study.     

Blood compatible aspects of DNA-modified polysulfone membrane-protein adsorption and platelet adhesion

DNA was used as a biomaterial to modify the polysulfone (PSf) membrane by blending it with PSf. The blood compatibility of the membranes was then investigated. The water contact angle decreased, and the hydrophilicity increased when a single strand DNA was blended with PSf. Because of the hydrophilic surface, the DNA-blended PSf membranes had a lower protein adsorption than the PSf membrane, but it was not significantly decreased due to the interaction between the DNA and proteins. Circular dichroism (CD) spectroscopy was used to examine the changes in the secondary structure of the proteins after adsorption onto the polymer surface and desorption from the polymer surface into the SDS solution. The conformation of the proteins adsorbed onto the PSf membrane and desorbed from the PSf membrane significantly changed, but that of the proteins for the DNA-blended PSf membranes differed only slightly from the native one. The number of platelets that adhered on the surface of the DNA-blended PSf membranes was reduced compared to that on the PSf membrane. This suggested that DNA can be regarded as a biopolymer to modify PSf, and contributes to the hydrophilic and hemocompatible wipers on the surface of the hydrophobic PSf membranes.     

Effect of different dialyzer membranes on serum angiotensin-converting enzyme during hemodialysis

The effects of different dialyzer membranes on serum concentration of angiotension-converting enzyme (ACE) and white blood cells during hemodialysis were examined on a cross-over basis in 20 chronically uremic patients. Hemodialysis with cuprophane membranes was associated with a significant (p less than 0.001) fall in the mean leukocyte count during the 1st hour of treatment. The use of polymethylmethacrylate membranes resulted in a more attenuated form of leukopenia and with polyacrylonitrile membranes no change was observed during hemodialysis. Hemodialysis with each membrane caused a comparable, significant (p less than 0.005) increase in serum ACE, independent of the degree of leukopenia but significantly (p less than 0.001) correlated with the increases in serum proteins. We conclude that this increase in serum ACE concentration after hemodialysis does not reflect acute damage of the pulmonary vascular endothelium during treatment and most probably is a result of hemoconcentration. Therefore, serum ACE analysis is not an indicator of dialyzer membrane biocompatibility.     

Biocompatibility of different hemodialysis membranes: activation of complement and leukopenia

The ability of three hollow-fiber dialyzers (Cuprophane [CU], polymethylmethacrylate [PMMA], and polyacrylonitrile [PAN]) to activate complement and to induce leukopenia was studied prospectively in six patients on long-term hemodialysis. CU membranes caused the most intense complement activation with C3a, C3d, and C5a levels peaking 15 min after beginning dialysis. Total white blood cell (WBC) counts dropped simultaneously by 76%, and the decrease in leukocytes was inversely correlated with the levels of C3a and C5a. In contrast, PMMA membranes led only to slight complement activation with an associated fall in WBC counts of 29%, and PAN membranes induced very little complement activation without leukopenia. In vitro studies involving incubation of normal human plasma with each of the three membranes corroborated these findings. The results suggest that the biocompatibility of PMMA and PAN dialyzers is superior to CU.     

Biocompatibility of blood tubings

We studied hemocompatibility of various blood tubings with C3a anaphylatoxin measurement and comparative electron scanning microscopy. The following tubing materials were tested: polyvinylchloride (PVC) plasticised with phthalate (PVC), pvc plasticised with phthalate coextruded with polyurethane (PIV), and two phthalate-free lines: pvc plasticised with trimellitate coextruded with polyurethane (TRI) and pvc plasticised with LT 360 (LTP). Results of C3a generation rate showed a significant activation by all blood tubings, with a reduced rate with PIV when compared to all others. Electron scanning microscopy showed marked alterations of PIV surface on tubings stored for 6 months. Protein deposits on internal surfaces after dialysis were similar whatever tubing material was tested, but adhesive cell number was greater with TRI when compared to PVC and LTP. Hemocompatibility is unchanged with phthalate-free tubings when compared to phthalate plasticised ones. In contrast with phthalate plasticised PVC there is no beneficial effect of polyurethane coextrusion with trimellitate plasticised PVC in regard to C3a generation.     

Production of monoclonal antibodies against the human anaphylatoxin C5a des Arg and their application in the neoepitope-specific sandwich-ELISA for the quantification of C5a des Arg in plasma.

A panel of ten murine monoclonal antibodies (MAbs) was raised against the human anaphylatoxin C5a des Arg. The MAbs were shown to abrogate or significantly inhibit the chemotactic activity in zymosan activated serum. MAb 4A2E10E2 and MAb 3G3C4 were used as capture and detecting antibody, respectively, in a sandwich enzyme-linked immunosorbent assay (ELISA) for the quantification of C5a des Arg. This ELISA was shown to be very sensitive (detection limit 20 pg/ml) and could be applied directly to plasma/serum samples. The lack of interference by plasma components, in particular C5, suggested specificity for an epitope on C5a (des Arg) which is concealed in native C5 and exposed on the activation fragment only, i.e., a 'neoepitope'. The mean C5a des Arg level in EDTA-plasma from 25 healthy individuals assessed at a 1/20 dilution was 11.2 ng/ml (SD 3.4; range 6.4-16.8 ng/ml). The applicability of the assay was investigated in patients treated with haemodialysis using different membranes. Markedly elevated plasma levels of C5a des Arg were found in blood returning from the dialyzer following contact with cuprophane membranes.     

Grafting of proteins onto polymer surfaces with the use of oxidized starch.

A study has been carried out on the coupling of proteins onto crosslinked poly(vinyl alcohol) hydrogel membranes and ethylene-vinyl alcohol copolymer(EVA) films previously grafted with oxidized starches having many pendant aldehyde groups. The coupling reaction of proteins is based on the Schiff's base formation between the amino groups of proteins and the aldehyde groups of the oxidized starches which have been grafted onto the substrate membrane or film through acetalization of the aldehyde of starch with hydroxyl groups of the substrate polymers. The grafting of oxidized starches onto the EVA films seems to be restricted to the film surface, since no detectable change is observed in the weight and the attenuated total reflection infrared spectrum of the grafted films. The amount of grafted protein, determined by the ninhydrin method, reveals that, at least, plasma proteins such as serum albumin and fibrinogen are grafted to the film surface in a monomolecular layer without undergoing a marked denaturation. The alpha-amylase grafted onto the EVA film showed a distinct enzymatic activity in hydrolysis of amylose and starch, but the activity was very low compared with that of the ungrafted, soluble alpha-amylase.     

The effect of electronegativity and angiotensin-converting enzyme inhibition on the kinin-forming capacity of polyacrylonitrile dialysis membranes

The combination of negatively-charged membranes and angiotensin I-converting enzyme inhibitors (ACEi) evokes hypersensitivity reactions (HSR) during hemodialysis and bradykinin (BK)-related peptides have been hypothesized as being responsible for these complications. In this study, we tested the effects of neutralizing the membrane electronegativity (zeta potential) of polyacrylonitrile AN69 membranes by coating a polyethyleneimine layer (AN69-ST membranes) over the generation of kinins induced by blood contact with synthetic membranes. We used minidialyzers with AN69 or AN69-ST membranes in an ex vivo model of plasma and we showed that plasma dialysis with AN69 membranes led to significant BK and des-Arg(9)-BK release, which was potentiated by ACEi. This kinin formation was dramatically decreased by AN69-ST membranes, even in the presence of an ACEi, and kinin recovery in the dialysates was also significantly lower with these membranes. High molecular weight kininogen and factor XII detection by immunoblotting of the protein layer coating both membranes corroborated the results: binding of these proteins and contact system activation on AN69-ST membranes were reduced. This ex vivo experimental model applied to the plasma, dialysate and dialysis membrane could be used for the characterization of the kinin-forming capacity of any biomaterial potentially used in vivo in combination with drugs which modulate the pharmacological activity of kinins.