An implantable artificial kidney using a hemofilter constructed from an array of silicon membranes to provide ultrafiltration requires a suitable blood flow path to ensure stable operation in vivo. Two types of flow paths distributing blood to the array of membranes were evaluated: parallel and serpentine. Computational fluid dynamics (CFD) simulations were used to guide the development of the blood flow paths. Pressure data from animal tests were used to obtain pulsatile flow conditions imposed in the transient simulations. A key consideration for stable operation in vivo is limiting platelet stress accumulation to avoid platelet activation and thrombus formation. Platelet stress exposure was evaluated by CFD particle tracking methods through the devices to provide distributions of platelet stress accumulation. The distributions of stress accumulation over the duration of a platelet lifetime for each device revealed that stress accumulation for the serpentine flow path exceeded levels expected to cause platelet activation while the accumulated stress for the parallel flow path was below expected activation levels.

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Background In vitro conversion assays, including real-time quaking-induced conversion (RT-QuIC) and protein misfolding cyclic amplification (PMCA) techniques, were first developed to study the conversion process of the prion protein to its misfolded, disease-associated conformation. The intrinsic property of prion proteins to propagate their misfolded structure was later exploited to detect subfemtogram quantities of the misfolded protein present in tissues and fluids from humans and animals with transmissible spongiform encephalopathies. Currently, conversion assays are used clinically as sensitive and specific diagnostic tools for antemortem diagnosis of prion disease. Content In vitro conversion assays are now being applied to the development of diagnostics for related neurodegenerative diseases, including detection of misfolded α-synuclein in Parkinson disease, misfolded amyloid-β in Alzheimer disease, and misfolded tau in Pick disease. Like the predicate prion protein in vitro conversion diagnostics, these assays exploit the ability of endogenously misfolded proteins to induce misfolding and aggregation of their natively folded counterpart in vitro. This property enables biomarker detection of the underlying protein pathology. Herein, we review RT-QuIC and PMCA for (a) prion-, (b) α-synuclein-, (c) amyloid-β-, and (d) tau-opathies. Summary Although already in routine clinical use for the detection of transmissible spongiform encephalopathies, in vitro conversion assays for other neurodegenerative disorders require further development and evaluation of diagnostic performance before consideration for clinical implementation.

While cross-linked hemoglobin (Hb) tetramers can deliver oxygen as a supplement to red cells, they also cause unacceptable increases in blood pressure, presumably from their penetration of the linings of blood vessels (endothelia) where the internal hemes bind endogenous nitric oxide (NO). This penetration would lower the local concentration of NO that normally induces vasodilation. Enlarging the effective size of the oxygen-carrying protein by coupling two Hbs can prevent their extravasation. Efficient and selective protein-protein coupling to produce those species has been a significant challenge. Introduction of an azide within a protein provides a directionally-oriented reaction site for utilization of the Cu(i)-catalyzed azide-alkyne cycloaddition (CuAAC) in the protein-protein-coupling process based on solubility-directed sequential addition to a bis-alkyne. However, it is known that Hb with an azide-containing cross-link between α-subunits is unreactive in CuAAC. To direct reaction away from the α-subunits of Hb, a specific fumaryl cross-link is installed exclusively between the most reactive sites on those subunits, thereby blocking the α-99 lysyl groups and preventing any further reaction. This modification allows installation of an azide-containing cross-link exclusively between lysine-82 ε-amino groups of the β-subunits of Hb. The multiply interconnected sites establish a geometry that permits initial interfacial interaction of the cross-linked Hb-azide with Cu(i) and a bis-alkyne. After coupling, the protein-linked azide product undergoes CuAAC at the remaining alkyne with a second cross-linked Hb-azide, producing a fully functional cross-linked Hb bis-tetramer whose oxygenation and structural properties include cooperativity and oxygen affinity that should be suitable for testing as an alternative to red cells in transfusions.