Abstract

The biocompatibility of medical devices, such as implants and prostheses, is strongly determined by the host’s immune response to the implanted material. Monocytes and macrophages are main actors of the so-called foreign body reaction. The innate immune system macrophages (M) can be broadly classified into the pro-inflammatory M1-type and the anti-inflammatory, pro-healing M2-type. While a transient inflammatory initial state can be helpful during an infection, persistent inflammation interferes with proper healing and subsequent regeneration. The functional orientation of the immune response, mirrored by monocyte polarization, during interaction with different biomaterials has not yet been sufficiently explored. In implant manufacturing, thermoplastic polyurethane (TPU) represents the state-of-the-art material. The constantly growing areas of application and the associated necessary adaptations make the optimization of these materials indispensable. In the present study, modified liquid silicone rubber (LSR) were compared with two of the most commonly used TPUs, in terms of monocyte adhesion and M1/M2 polarization in vitro. Human monocytes isolated from venous blood were evaluated for their ability to adhere to various biomaterials, their gene expression profile, and their cytokine release. Based on the results, the different polymers exhibit different potential to bias monocytes with respect to early pro-inflammatory cytokine production and gene transcription. Furthermore, none of our test materials showed a clear trend towards M1 or M2 polarization. However, we were able to evaluate the inflammatory potential of the materials, with the classic TPUs appearing to be the most unreactive compared to the silicone-based materials.

Highlights

  • Implant materials used in the cardiovascular system consist of modified biological substances, metals, and polymers

  • Monocytes are instrumental in this host inflammatory and foreign body reaction to biomaterials [3,4]

  • The increased expression of M1-associated cytokines, such as IL6 and TNF-α, by monocytes/macrophages on the silicone-based materials shown here is an important indication that the innate immune system responds to these materials, as IL-1b, and CCLs [23,24,25]

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Summary

Introduction

Implant materials used in the cardiovascular system consist of modified biological substances, metals, and polymers. Polymer materials have a very high value in cardiac surgery. Owing to their good biocompatibility and adaptable mechanical properties (e.g., high ductility, good resistance to abrasion or chemicals, high flexibility), they can be used as prostheses, e.g., for artificial vessels, heart valves, and heart support systems [1]. Cardiovascular implant materials are in contact with blood and in close contact with tissue. Foreign body reactions between the material surface and surrounding stressed tissue and recruited immune cells can decisively determine the success or failure of an implant [2]. Monocytes are instrumental in this host inflammatory and foreign body reaction to biomaterials [3,4]

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