Biocompatibility of the Dialysis System

Fumagall, Giordano; Panichi, Vincenzo

doi:10.1016/b978-0-323-44942-7.00151-5

Cited by 4 publications

(3 citation statements)

References 59 publications

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“…More hydrophobic membranes generally display reduced adsorption of proteins whereas others such as polymethylmethacrylate (PMMA) are recognized as protein-adsorbing membranes [ 61 , 62 ]. The protein layer deposits (‘pseudo membrane’) not only affect the polymer surface but could seep into the pores as well, resulting in narrowing of the pores thereby lowering the sieving properties and hence reducing solute removal particularly for larger solutes [ 63 , 64 ]. The effects are amplified with sub-optimal heparin levels that enhance blood coagulation and at higher ultrafiltration fractions when the phenomenon of polarization thickens the protein deposit on the membrane surface [ 65 ].…”

Section: Blood–materials Interactions: the Specific Case Of Dialysis Membranesmentioning

confidence: 99%

“…Any significant removal of uraemic toxins through an adsorption mechanism is unlikely as the adsorption phenomenon is highly non-specific, poorly defined and extremely difficult to quantify reliably [ 67 ]. The ‘secondary membrane’ in HD is influenced by several factors related to blood composition, chemical properties of proteins, physicochemical membrane characteristics (surface roughness, thickness, porosity, composition, hydrophobicity and charge) and operating conditions within the dialyser (blood flow dynamics and temperature) [ 53 , 63 , 64 , 68 , 69 ]. The impairment of either diffusive and convective transport by secondary membrane formation increases the resistance to mass transfer; this is undesirable and contrary to the core prerequisite of biocompatibility, viz., the nature of blood–material interactions should be such as not to diminish or impair the functioning of the device in its intended use [ 70 ].…”

Section: Blood–materials Interactions: the Specific Case Of Dialysis Membranesmentioning

confidence: 99%

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Blood-incompatibility in haemodialysis: alleviating inflammation and effects of coagulation

Bowry¹,

Kırçelli

Himmele

et al. 2021

Clinical Kidney Journal

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Blood-incompatibility is an inevitability of all blood-contacting device applications and therapies, including haemodialysis (HD). Blood leaving the environment of blood vessels and the protection of the endothelium is confronted with several stimuli of the extracorporeal circuit (ECC), triggering the activation of blood cells and various biochemical pathways of plasma. Prevention of blood coagulation, a major obstacle that needed to be overcome to make HD possible, remains an issue to contend with. While anticoagulation (mainly with heparin) successfully prevents clotting within the ECC to allow removal of uraemic toxins across the dialysis membrane wall, it is far from ideal, triggering heparin-induced thrombocytopenia in some instances. Soluble fibrin can form even in the presence of heparin and depending on the constitution of the patient and activation of platelets, could result in physical clots within the ECC (e.g. bubble trap chamber) and, together with other plasma and coagulation proteins, result in increased adsorption of proteins on the membrane surface. The buildup of this secondary membrane layer impairs the transport properties of the membrane to reduce the clearance of uraemic toxins. Activation of complement system-dependent immune response pathways leads to leukopenia, formation of platelet–neutrophil complexes and expression of tissue factor contributing to thrombotic processes and a procoagulant state, respectively. Complement activation also promotes recruitment and activation of leukocytes resulting in oxidative burst and release of pro-inflammatory cytokines and chemokines, thereby worsening the elevated underlying inflammation and oxidative stress condition of chronic kidney disease patients. Restricting all forms of blood-incompatibility, including potential contamination of dialysis fluid with endotoxins leading to inflammation, during HD therapies is thus still a major target towards more blood-compatible and safer dialysis to improve patient outcomes. We describe the mechanisms of various activation pathways during the interaction between blood and components of the ECC and describe approaches to mitigate the effects of these adverse interactions. The opportunities to develop improved dialysis membranes as well as implementation strategies with less potential for undesired biological reactions are discussed.

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Section: Blood–materials Interactions: the Specific Case Of Dialysis Membranesmentioning

confidence: 99%

Section: Blood–materials Interactions: the Specific Case Of Dialysis Membranesmentioning

confidence: 99%

Blood-incompatibility in haemodialysis: alleviating inflammation and effects of coagulation

Bowry¹,

Kırçelli

Himmele

et al. 2021

Clinical Kidney Journal

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“…42 While not directly related to nanoparticles, corona formation on dialysis membranes discussed by Fumagalli and Panichi (2019) is relevant in the context of nanodevices. 43 According to these authors, there is the competitive deposition of high molecular weight proteins on the membrane surface in the first step. Subsequently, proteins of lower molecular weights, which can enter the membrane pores, show dynamic adsorption inside the membranes.…”

Section: ■ Vroman Effectmentioning

confidence: 99%

How Corona Formation Impacts Nanomaterials as Drug Carriers

Gupta

Roy

2020

Mol. Pharmaceutics

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As drugs/drug carriers, upon encountering physiological fluids, nanoparticles adsorb biological molecules almost immediately to form a biocorona, which is often simply called a corona. Once the corona is formed, it dictates the subsequent fate of the drug nanoparticle as a therapeutic agent. Protein adsorption on micron-size or even bigger particles was originally described by the Vroman effect. It has served as a useful framework to understand the corona formation. Proteins that are irreversibly adsorbed on nanoparticles form what is called a hard corona. Beyond that is the exchangeable population of proteins, which constitute the dynamic structure called a soft corona. More than the abundance, the affinity of the proteins toward the nanoparticles decides which ones end up in the corona. For example, the more common serum albumin, which is deposited initially, is displaced by fibrinogen, which has a higher affinity for gold nanoparticles. The curvature of the particle is a crucial parameter with bigger particles generally able to bind a more diverse population of proteins from the physiological milieu. The earlier perception of the corona formation being a challenge for drug targeting, etc. has been turned into an opportunity by engineering corona to manipulate properties like circulating half-lives, capacity to evade the immune system, and targeting or even overcoming the blood−brain barrier. The most commonly used techniques for particle characterization, including dynamic light scattering (DLS), differential sedimentation centrifugation, transmission electron microscopy (TEM), and SDS-PAGE, have been adopted to study corona formation in the past. Many newer tools, for example, a combination of capillary electrophoresis with mass spectrometry, are being used to study the corona composition. The comparison of interlaboratory results is a problem because of the lack of standard protocols. This has hindered the ability to obtain more precise information about the corona composition. That, in turn, affects our prospects to use nanoparticles as drugs/drug carriers. This overview is an attempt to assess our understanding of corona formation critically and to outline the complexities involved in gaining precise information. The discussion is largely focused on findings of the last year or so.

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Understanding the Influence of Serum Proteins Adsorption on the Mechano‐Bactericidal Efficacy and Immunomodulation of Nanostructured Titanium

Martins de Sousa,

Linklater,

Baulin

et al. 2024

Adv Materials Inter

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Nanostructured surfaces are effective at physically killing bacterial cells, highlighting their prospective application as biomaterials. The benefits of application of mechano‐bactericidal nanostructures as an alternative to chemical functionalisation are well documented, however, the effects of protein adsorption are not well understood. In this work, theoretical and experimental analyses are conducted by studying the adsorption of human serum proteins (HSP) to nanosheet titanium (Ti) and its subsequent effect on the mechano‐bactericidal efficacy toward Staphylococcus aureus and Pseudomonas aeruginosa cells. The nanosheet pattern exhibits enhanced antibiofouling behaviour mantaining high bactericidal efficiency toward both Gram‐negative and Gram‐positive cells in the presence of adsorbed HSP. To ascertain the immunomodulatory response, S. aureus cells are introduced to protein‐conditioned Ti nanosheet surfaces prior to introducing RAW 264.7 macrophages. On the pre‐infected nanostructured surfaces, macrophages exhibit wound healing behaviour with superior activation of M2‐like macrophage polarization and secretion of anti‐inflammatory cytokines. By contrast, macrophages attached to infected smooth surfaces activated the M1‐like polarized phenotype via the high expression of pro‐inflammatory cytokines, indicating persistent inflammation. The outcomes of this work demonstrate the suitability of Ti nanosheets as a potential biomaterial surface whereby the mechano‐bactericidal activity is not compromised by HSP adsorption and, furthermore, positively influenced an anti‐inflammatory immune response.

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Biocompatibility of the Dialysis System

Cited by 4 publications

References 59 publications

Blood-incompatibility in haemodialysis: alleviating inflammation and effects of coagulation

Blood-incompatibility in haemodialysis: alleviating inflammation and effects of coagulation

How Corona Formation Impacts Nanomaterials as Drug Carriers

Understanding the Influence of Serum Proteins Adsorption on the Mechano‐Bactericidal Efficacy and Immunomodulation of Nanostructured Titanium

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