Synthese und Charakterisierung von Polymeren mit peptidischen Seitenketten

Die Forschung im Bereich der Drug Delivery-Systeme konzentriert sich auf biokompatible und wenig immunogene Trägermoleküle. Eine Klasse vielversprechender Trägersysteme stellen Peptid basierte Polymere dar, die neben einer hohen Biokompatibilität auch eine Sensitivität gegenüber externen Einflüssen aufweisen. Der zwitterionische Charakter von Aminosäuren und Peptiden verhindert die Adsorption von Serumproteinen und ein „antifouling“ Verhalten kann festgestellt werden, sodass diese Moleküle für den Einsatz als Wirkstoffträgersystem sehr geeignet scheinen. In Kombination mit einer bürstenartigen Struktur entstehen Systeme mit einer einzigartigen Peptidarchitektur, die sich durch eine hohe Dichte funktioneller Gruppen für Konjugationsreaktionen auszeichnen und deren formabhängige Zellaufnahme sie besonders attraktiv für die Anwendung als „Nanocarrier“ macht.rnrnDas zwitterionische Poly-(ε-N-Methacryloyl-L-Lysin) (Mw = 721,000 g∙mol 1) wurde durch freie radikalische Polymerisation dargestellt und seine Konformation in Abhängigkeit von Ionenstärke und pH-Wert untersucht. Die Biokompatibilität des Systems konnte durch Toxizitätstests und dynamische Lichtstreuung in humanem Blutserum nachgewiesen werden. Zusammen mit der vernachlässigbaren unspezifischen Aufnahme in dendritische Zellen aus Knochenmark erfüllt das System damit alle Bedingungen, die an ein polymeres Wirkstoffträgersystem gestellt werden. Darüber hinaus können Komplexe des Polymers mit DNA in Gegenwart von divalenten Metallionen für die Gentransfektion verwendet werden.rnrnDurch Kopplung von ε-N-Methacryloyl-L-Lysin mit der Elastin-ähnlichen Polypeptid Pentasequenz Valin-Prolin-Glycin-Glycin-Glycin konnte ein Hexapeptid-Makromonomer dargestellt werden, welches anschließend mittels „grafting through“ Polymerisation zur Polymerbürste umgesetzt wurde. Die wurmartige Struktur der Polymerbürsten wurde in AFM-Aufnahmen gezeigt und eine hohe Kettensteifigkeit der Polymerbürsten über dynamische und statische Lichtstreuung nachgewiesen. Zirkulardichroismus-Messungen lieferten Informationen über struktur-, salz- und temperaturabhängige Veränderungen der Konformation. Toxizitätstests und dynamische Lichtstreuung in humanem Blutserum bestätigten die erwartete Biokompatibilität.rnrnBasierend auf zwei Elastin-ähnlichen Polypeptiden mit ähnlicher Peptidsequenz wurden insgesamt vier unterschiedliche Makromonomere mit jeweils 20 Pentapeptid-Wiederholungseinheiten dargestellt. Über anschließende „grafting through“ Polymerisation entstanden molekulare Bürstenmoleküle mit variierenden externen funktionellen Gruppen, die für zukünftige Konjugationsreaktionen verwendet werden können. Der Einfluss von Ionenstärke und Temperatur auf die Konformation der Makromonomere und Polymere wurde mittels Zirkulardichroismus- und Trübungskurven-Messungen untersucht und ein starker Einfluss der hohen Seitenkettendichte auf das Verhalten der Polymerbürsten wurde festgestellt. Über dynamische Lichtstreuung konnte ein von den externen funktionellen Gruppen abhängiges Aggregationsverhalten in humanem Blutserum nachgewiesen werden.rnrnDie in dieser Arbeit synthetisierten Polymerbürsten mit peptidischen Seitenketten stellen damit biokompatible und vielversprechende Trägersysteme für die Konjugation mit Biomolekülen dar, die zukünftig als Drug Delivery-Systeme ihren Einsatz finden können.rn

Poly(lactide): from hyperbranched copolyesters to new block copolymers with functional methacrylates

The prologue of this thesis (Chapter 1.0) gives a general overview on lactone based poly(ester) chemistry with a focus on advanced synthetic strategies for ring-opening polymerization, including the emerging field of organo catalysis. This section is followed by a presentation of the state-of the art regarding the two central fields of the thesis: (i) polyfunctional and branched poly(ester)s in Chapter 1.1 as well as (ii) the development of new poly(ester) based block copolymers with functional methacrylates (Chapter 1.2). Chapter 2 deals with the synthesis of new, non-linear poly(ester) structures. In Chapter 2.1, the synthesis of poly(lactide)-based multiarm stars, prepared via a grafting-from method, is described. The hyperbranched poly(ether)-poly(ol) poly(glycerol) is employed as a hydrophilic core molecule. The resulting star block copolymers exhibit potential as phase transfer agents and can stabilize hydrophilic dyes in a hydrophobic environment. In Chapter 2.2, this approach is expanded to poly(glycolide) multiarm star polymers. The problem of the poor solubility of linear poly(glycolide)s in common organic solvents combined with an improvement of the thermal properties has been approached by the reduction of the total chain length. In Chapter 2.3, the first successful synthesis of hyperbranched poly(lactide)s is presented. The ring-opening, multibranching copolymerization of lactide with the “inimer” 5HDON (a hydroxyl-functional lactone monomer) was carefully examined. Besides a precise molecular characterization involving the determination of the degree of branching, we were able to put forward a reaction model for the formation of branching during polymerization. Several innovative approaches to amphiphilic poly(ester)/poly(methacrylate)-based block copolymers are presented in the third part of the thesis (Chapter 3). Block copolymer build-up especially relies on the combination of ring-opening and living radical polymerization. Atom transfer radical polymerization has been successfully combined with lactide ring-opening, using a “double headed” initiator. This strategy allowed for the realization of poly(lactide)-block-poly(2-hydroxyethyl methacrylate) copolymers, which represent promising materials for tissue engineering scaffolds with anti-fouling properties (Chapter 3.1). The two-step/one-pot approach forgoes the use of protecting groups for HEMA by a careful selection of the reaction conditions. A series of potentially biocompatible and partially biodegradable homo- and block copolymers is described in Chapter 3.2. In order to create a block copolymer with a comparably strong hydrophilic character, a new acetal-protected glycerol monomethacrylate monomer (cis-1,3- benzylidene glycerol methacrylate/BGMA) was designed. The hydrophobic poly(BGMA) could be readily transformed into the hydrophilic and water-soluble poly(iso-glycerol methacrylate) (PIGMA) by mild acidic hydrolysis. Block copolymers of PIGMA and poly(lactide) exhibited interesting spherical aggregates in aqueous environment which could be significantly influenced by variation of the poly(lactide)s stereo-structure. In Chapter 3.3, pH-sensitive poly(ethylene glycol)-b-PBGMA copolymers are described. At slightly acidic pH values (pH 4/37°C), they decompose due to a polarity change of the BGMA block caused by progressing acetal cleavage. This stimuli-responsive behavior renders the system highly attractive for the targeted delivery of anti-cancer drugs. In Chapter 3.4, which was realized in cooperation, the concept of biocompatible, amphiphilic poly(lactide) based polymer drug conjugates, was pursued. This was accomplished in the form of fluorescently labeled poly(HPMA)-b-poly(lactide) copolymers. Fluorescence correlation spectroscopy (FCS) of partially biodegradable block copolymer aggregates exhibited fast cellular uptake by human cervix adenocarcinoma cells without showing toxic effects in the examined concentration range (Chapter 4.1). The current state of further projects which will be pursued in future studies is addressed in Chapter 4. This covers the synthesis of biocompatible star block copolymers (Chapter 4.2) and the development of new methacrylate monomers for biomedical applications (Chapters 4.3 and 4.4). Finally, the further investigation of hydroxyl-functional lactones and carbonates which are promising candidates for the synthesis of new hydrophilic linear or hyperbranched biopolymers, is addressed in Chapter 4.5.

Synthese und Charakterisierung von polymerbasierten Trägersystemen für biomedizinische Anwendungen

Polymer-Therapeutika spielen im Bereich der Arzneimittelforschung eine immerrngrößere Rolle. Benötigt werden dafür Trägersysteme für die gewünschten Wirkstoffe.rnDurch den Einsatz von wasserlöslichen biokompatiblen Polymeren werden mehrerernentscheidende Vorteile erhalten. Beispielsweise verlängert sich durch die höherernMolmasse die Zirkulationszeit im Blutkreislauf. Zudem ermöglicht die Anbindung vonrnTargetmolekülen den gezielten Wirkstofftransport zum Zielort.rnDie vorliegende Arbeit behandelt die Synthese und Charakterisierung von polymerbasiertenrnTrägersystemen für biomedizinische Anwendungen.rnAls erstes Teilprojekt wurde die Synthese einer Polymerbürste gewählt, derenrnSeitenketten aus Polymer-Oligonucleotid (ODN)-Konjugaten bestehen. Als Polymerrnwurde Poly(N-Isopropylacrylamid) gewählt, welches per RAFT-Polymerisationrnsynthetisiert wurde. Die Bürste sollte mittels „Grafting Through“-Technik hergestelltrnwerden. Dafür wurden zuerst das Polymer-Oligonucleotid-Konjugat und darausrnanschließend das entsprechende Makromonomer gebildet. Die Synthese undrnCharakterisierung des Konjugats sowie des Makromonomers wurden erfolgreichrndurchgeführt, jedoch war die Aufreinigung des Makromonomers nicht möglich.rnIm zweiten Teilprojekt war das Ziel Polyion-Komplex-Mizellen als Trägersystemernherzustellen. Benötigt wurden dazu ein Polymer bestehend aus einem kationischenrnund einem biokompatiblen Block sowie eine ODN-Sequenz zur Komplexierung desrnkationischen Blocks. Im ersten Ansatz wurde als Polymerisationsmethode die RAFTPolymerisationrnund Mono-N-boc-1,3-diaminopropanmethylmethacrylat als kationischesrnMonomer sowie α- bzw. ε-Lysinmethylmethacrylat als zwitterionischesrnMonomer verwendet. Jedoch war die Herstellung der Blockcopolymere nicht möglich.rnIm zweiten Ansatz wurde deshalb Poly-2-oxazolin als biokompatibler Block gewählt.rnMit Poly-L-lysin als kationischen Block und CpG war eine Bildung und Charakterisierungrnvon Polyion-Komplex-Mizellen in 15mM PBS-Puffer möglich.rnIm dritten Teilprojekt wurden biomedizinisch relevante Verbindungen mittelsrnkupferfreier Clickchemie an eine ELP-Bürste gebunden und charakterisiert.

Synthese und Charakterisierung von zylindrischen Bürsten mit polypept(o)idischen Seitenketten als nanopartikuläre Trägersysteme

Zylindrische Polymerbürsten mit pept(o)idischen Seitenketten sind auf Grund ihrer elongierten Topologie, Bioverträglichkeit und hohen Dichte an funktionellen Gruppen vielversprechende Kandidaten für Anwendungen im Bereich des kontrollierten Wirkstoff- bzw. Gentransportes.In dieser Arbeit wurden Polylysin und Polysarkosin als Bestandteile der Seitenketten verwendet. Polylysin dient als positiv geladener Polypeptidblock für die Komplexierung von Polynukleotiden. Polysarkosin reduziert mit seinem „Stealth“-Effekt die Toxizität des Trägersystems und vermindert Wechselwirkungen mit dem Immunsystem. Über den „grafting from“-Ansatz und mit Hilfe der ringöffnenden NCA-Polymerisation konnten erstmals zylindrische Bürsten mit reinen Polysarkosin-Seitenketten sowie mit amphiphilen Seitenketten aus einem Polylysinkern und einer Polysarkosinschale hergestellt werden. Die Bürsten wurden mittels Lichtstreuung, GPC, CD-Spektroskopie und AFM charakterisiert. Die hohe Biokompatibilität beider Bürsten konnte durch Toxizitätstests und dynamische Lichtstreuung in humanem Blutserum nachgewiesen werden.Die Polysarkosin-Bürsten konnten zusätzlich an den Seitenkettenenden mit Azidgruppen funktionalisiert werden, welche eine effektive Biokonjugation ermöglichen. Die zylindrischen Bürsten zeigten nach ihrer Modifikation keine unspezifische Aufnahme in dendritische Zellen und könnten somit als Ausgangssubstanzen für die Synthese polymerbasierter Antikörper-Antigen-Konjugate in der Krebsimmuntherapie verwendet werden.Die Kern-Schale-Bürsten konnten erfolgreich mit siRNA komplexiert werden, ohne dass dabei eine Aggregation auftrat. In ersten Gen-Knockdown-Experimenten zeigten ihre Komplexe eine signifikante Verminderung der ApoB100-Proteinexpression in AML-12 Hepatozyten und könnten daher zukünftig als Transfektionsmittel in der Gentherapie ihren Einsatz finden.

Interactions of gold nanoparticles with polymeric membranes

This thesis focuses on the interactions of nanoparticles with artificial membranes. The synthesis of the block copolymer poly(dimethylsiloxane)-block-poly(2-methyloxazoline) (PDMS-b-PMOXA) is described, as well as the formation of polymersomes in water. These polymersomes act as minimal cell models, consisting of an artificial bilayer membrane only, allowing the study of the interactions between nanoparticles and polymeric membranes. Both spherical and rod-shaped gold nanoparticles (AuNPs) were used in this study and they were characterized using light scattering (PCS), transmission electron microscopy (TEM), UV/Vis spectroscopy, and polarization anisotropy measurements. The polymer grafting on the spherical cores is asymmetric (shell asphericity) but is parallel to the inherent, due to polycrystallinity, core anisotropy, resulting in a characteristic scattering of the AuNPs in PCS.rnInteractions of polymersomes and AuNPs were investigated by PCS, cryo-TEM and UV/Vis. Three possible scenarios upon mixing of polymersomes and AuNPs can be distinguished by using only PCS: (i) no interactions between particles and vesicles, (ii) attachment of the particles to the outer side of the vesicles (decoration), and (iii) uptake of particles into the vesicles. It is shown that all three scenarios are possible, solely depending on the particle’s surface functionalization. In addition, it was revealed that the AuNPs need to be attached to the inner side of the membrane instead of diffusing freely within the vesicle. The present experimental findings essentially help with the understanding of the interactions of nanoparticles with membranes and show that the process of endocytosis can be attributed to physical processes only. rn

Computer simulation of rod-coil block copolymers and tetrapod,polymer mixtures

In this thesis I present a new coarse-grained model suitable to investigate the phase behavior of rod-coil block copolymers on mesoscopic length scales. In this model the rods are represented by hard spherocylinders, whereas the coil block consists of interconnected beads. The interactions between the constituents are based on local densities. This facilitates an efficient Monte-Carlo sampling of the phase space. I verify the applicability of the model and the simulation approach by means of several examples. I treat pure rod systems and mixtures of rod and coil polymers. Then I append coils to the rods and investigate the role of the different model parameters. Furthermore, I compare different implementations of the model. I prove the capability of the rod-coil block copolymers in our model to exhibit typical micro-phase separated configurations as well as extraordinary phases, such as the wavy lamellar state, percolating structuresrnand clusters. Additionally, I demonstrate the metastability of the observed zigzag phase in our model. A central point of this thesis is the examination of the phase behavior of the rod-coil block copolymers in dependence of different chain lengths and interaction strengths between rods and coil. The observations of these studies are summarized in a phase diagram for rod-coil block copolymers. Furthermore, I validate a stabilization of the smectic phase with increasing coil fraction.rnIn the second part of this work I present a side project in which I derive a model permitting the simulation of tetrapods with and without grafted semiconducting block copolymers. The effect of these polymers is added in an implicit manner by effective interactions between the tetrapods. While the depletion interaction is described in an approximate manner within the Asakura-Oosawa model, the free energy penalty for the brush compression is calculated within the Alexander-de Gennes model. Recent experiments with CdSe tetrapods show that grafted tetrapods are clearly much better dispersed in the polymer matrix than bare tetrapods. My simulations confirm that bare tetrapods tend to aggregate in the matrix of excess polymers, while clustering is significantly reduced after grafting polymer chains to the tetrapods. Finally, I propose a possible extension enabling the simulation of a system with fluctuating volume and demonstrate its basic functionality. This study is originated in a cooperation with an experimental group with the goal to analyze the morphology of these systems in order to find the ideal morphology for hybrid solar cells.

Synthesis, characterization and crystallization of bionanocomposites based on PLLA, PCL and nanocellulose

In recent years, environmental concerns and the expected shortage in the fossil reserves have increased further development of biomaterials. Among them, poly(lactide) PLA possess some potential properties such as good ability process, excellent tensile strength and stiffness equivalent to some commercial petroleum-based polymers (PP, PS, PET, etc.). This biobased polymer is also biodegradable and biocompatible However, one great disadvantage of commercial PLA is slow crystallization rate, which restricts its use in many fields. Using of nanofillers is viewed as an efficient strategy to overcome this problem. In this thesis, the effect of bionanofillers in neat PLA and in blends of poly (L-lactide)(PLA)/poly(ε-Caprolactone) (PCL) has been investigated. The used nanofillers are: poly(L-lactide-co-ε-caprolactone) and poly(L-lactide-b-ε-caprolactone) grafted on cellulose nanowhiskers and neat cellulose nanowhiskers (CNW). The grafting reaction of poly(L-lactide-co-caprolactone) and poly (L-lactide-b-caprolactone) on the nanocellulose has been performed by the grafting from technique. In this way the polymerization reaction it is directly initiated on the substrate surface. The condition of the reaction were chosen after a temperature and solvent screening. By non-isothermal an isothermal DSC analysis the effect of bionanofillers on PLA and 80/20 PLA/PCL was evaluated. Non-isothermal DSC scans show a nucleating effect of the bionanofillers on PLA. This effect is detectable during PLA crystallization from the glassy state. Cold crystallization temperature is reduced upon the addition of the poly(L-lactide-b-caprolactone) grafted on cellulose nanowhiskers that is most performing bionanofiller in acting as a nucleating agent. On the other hand, DSC isothermal analysis on the overall crystallization rate indicate that cellulose nanowhiskers are best nucleating agents during isothermal crystallization from the melt state. In conclusion, nanofillers have different behavior depending on the processing conditions. However, the efficiency of our nanofillers as nucleating agent was clearly demonstrated in both isothermal as in non-isothermal condition.

Bionanocomposites based on Plla, Pcl and montmorillonite: synthesis, characterization and crystallization

Poly(lactide) is one of the best candidate to replace conventional petroleum-based polymers, since it is biobased, biocompatible and biodegradable. However, commercial PLA materials typically have low crystallization rate resulting in long processing time and low production efficiency. In this work the effects of two nanofillers MMT30B and MMT30B-g-P(LA-co-CL) on the crystallization rate of neat PLA and PLA/PCL blend were investigated. MMT30B-g-P(LA-co-CL) was synthetized by in situ grafting reaction. The synthesis was carried in xylene at 140°C, upon the results of a screening. The grafted copolymers were evaluated by 1H-NMR ,ATR–IR and TGA. Solvent casted films were obtained by mixing MMT30B-g-P(LA-co-CL) at 5% (w/w) with neat PLA and PLA/PCL blend, comparing the properties with the corresponding blends with and without a 5% of (w/w) unmodified clay. SEM images on PLA based blends shows that MMT30B is aggregated into larger particles compared to MMT30B-g-P(LLA-co-CL). This behavior is correlated to the better exfoliation of MMT30B-g-P(LA-co-CL) clay layers. SEM images on PLA/PCL based blends exhibit the typical sea-island morphology, characteristic of immiscible blends. PLA is the matrix while PCL is finely dispersed in droplets. MMT30B does not reduce PCL droplets size, while MMT30B-g-P(LA-co-CL) reduces the size of PCL droplets. This means that MMT30B-g-P(LA-co-CL) can migrate to the PLA-PCL interface, acting as a compatibilizer. Non-isothermal DSC cooling scans show a fractionated crystallization of the PCL phase in PLA/PCL/MMT30B-g-P(LA-co-CL), confirming the compatibilizer effect of MMT30B-g-P(LA-co-CL). At the same timeMMT30B-g-P(LA-co-CL) can better nucleate the PLA phase, both in neat PLA and PLA/PCL blend, promoting the crystallization during the heating scans. In isothermal condition, both the nanofillers increase the crystallization rate of PLA phase in neat PLA, while in PLA/PCL blends the effect is covered by the nucleating effect of PCL.

Vascularised fibula grafts for early tibia reconstruction in infants with congenital pseudarthrosis

Congenital pseudarthrosis of the tibia (CPT) is caused by an ill-defined, segmental disturbance of periosteal bone formation leading to spontaneous bowing, followed by fracture and subsequent pseudarthrosis in the first 2 years of life. The results of conventional treatment modalities (e.g., bracing, internal and external fixation and bone grafting) are associated with high failure rates in terms of persisting pseudarthrosis, malunion and impaired growth. As a more promising alternative, a more aggressive approach, including wide resection of the affected bone, reconstruction with free vascularised fibula grafts from the healthy contralateral leg and stable external fixation at a very early stage has been suggested. Between 1995 and 2007, 10 children (age 12-31 months, median 20 months) suffering from CPT were treated at our institutions according to this principle. Two patients were treated before a fracture had occurred. The length of the fibula graft was 7-9cm. End-to-end anastomoses were performed at the level of the distal tibia stump. The follow-up was 80 months (median, range 12 months to 12 years). Radiologic examination at 6 weeks postoperatively showed normal bone density and structure of the transplanted fibula in all cases and osseous consolidation at 19 of the 20 graft/tibia junctions. One nonunion was sucessfully treated with bone grafting and plate osteosynthesis. Pin-tract infection occurred in three patients. Five children sustained graft fractures that were successfully treated with internal or external fixation. Two patients developed diminished growth of the affected limb or foot; all others had equal limb length and shoe size. At long-term follow-up, tibialisation of the transplant had occurred, and normal gait and physical activities were possible in all children. We conclude that in spite of a relatively high complication rate and the reluctance to perform free flap surgery in infants at this young age, the present concept may successfully prevent the imminent severe sequelae associated with CPT.

Prognosis of Atrial Fibrillation in Patients with Symptomatic Peripheral Arterial Disease: Data from the REduction of Atherothrombosis for Continued Health (REACH) Registry

BACKGROUND: Atrial fibrillation (AF) is a significant risk factor for cardiovascular (CV) mortality. This study aims to evaluate the prognostic implication of AF in patients with peripheral arterial disease (PAD). METHODS: The International Reduction of Atherothrombosis for Continued Health (REACH) Registry included 23,542 outpatients in Europe with established coronary artery disease, cerebrovascular disease (CVD), PAD and/or >/=3 risk factors. Of these, 3753 patients had symptomatic PAD. CV risk factors were determined at baseline. Study end point was a combination of cardiac death, non-fatal myocardial infarction (MI) and stroke (CV events) during 2 years of follow-up. Cox regression analysis adjusted for age, gender and other risk factors (i.e., congestive heart failure, coronary artery re-vascularisation, coronary artery bypass grafting (CABG), MI, hypertension, stroke, current smoking and diabetes) was used. RESULTS: Of 3753 PAD patients, 392 (10%) were known to have AF. Patients with AF were older and had a higher prevalence of CVD, diabetes and hypertension. Long-term CV mortality occurred in 5.6% of patients with AF and in 1.6% of those without AF (p<0.001). Multivariable analyses showed that AF was an independent predictor of late CV events (hazard ratio (HR): 1.5; 95% confidence interval (CI): 1.09-2.0). CONCLUSION: AF is common in European patients with symptomatic PAD and is independently associated with a worse 2-year CV outcome.

The Influence of PRP on Early Bone Formation in Membrane Protected Defects. A Histological and Histomorphometric Study in the Rabbit Calvaria

Platelet rich plasma (PRP) has been proposed to be a useful adjunct to bone grafting.

The role of the interplay between polymer architecture and bacterial surface properties on the microbial adhesion to polyoxazoline-based ultrathin films

Surface platforms were engineered from poly(L-lysine)-graft-poly(2-methyl-2-oxazoline) (PLL-g-PMOXA) copolymers to study the mechanisms involved in the non-specific adhesion of Escherichia coli (E. coli) bacteria. Copolymers with three different grafting densities (PMOXA chains/Lysine residue of 0.09, 0.33 and 0.56) were synthesized and assembled on niobia (Nb O ) surfaces. PLL-modified and bare niobia surfaces served as controls. To evaluate the impact of fimbriae expression on the bacterial adhesion, the surfaces were exposed to genetically engineered E. coli strains either lacking, or constitutively expressing type 1 fimbriae. The bacterial adhesion was strongly influenced by the presence of bacterial fimbriae. Non-fimbriated bacteria behaved like hard, charged particles whose adhesion was dependent on surface charge and ionic strength of the media. In contrast, bacteria expressing type 1 fimbriae adhered to the substrates independent of surface charge and ionic strength, and adhesion was mediated by non-specific van der Waals and hydrophobic interactions of the proteins at the fimbrial tip. Adsorbed polymer mass, average surface density of the PMOXA chains, and thickness of the copolymer films were quantified by optical waveguide lightmode spectroscopy (OWLS) and variable-angle spectroscopic ellipsometry (VASE), whereas the lateral homogeneity was probed by time-of-flight secondary ion mass spectrometry (ToF-SIMS). Streaming current measurements provided information on the charge formation of the polymer-coated and the bare niobia surfaces. The adhesion of both bacterial strains could be efficiently inhibited by the copolymer film only with a grafting density of 0.33 characterized by the highest PMOXA chain surface density and a surface potential close to zero.

Results of the randomized, placebo-controlled clopidogrel and acetylsalicylic acid in bypass surgery for peripheral arterial disease (CASPAR) trial

OBJECTIVE: Dual antiplatelet therapy with clopidogrel plus acetylsalicylic acid (ASA) is superior to ASA alone in patients with acute coronary syndromes and in those undergoing percutaneous coronary intervention. We sought to determine whether clopidogrel plus ASA conferred benefit on limb outcomes over ASA alone in patients undergoing below-knee bypass grafting. METHODS: Patients undergoing unilateral, below-knee bypass graft for atherosclerotic peripheral arterial disease (PAD) were enrolled 2 to 4 days after surgery and were randomly assigned to clopidogrel 75 mg/day plus ASA 75 to 100 mg/day or placebo plus ASA 75 to 100 mg/day for 6 to 24 months. The primary efficacy endpoint was a composite of index-graft occlusion or revascularization, above-ankle amputation of the affected limb, or death. The primary safety endpoint was severe bleeding (Global Utilization of Streptokinase and Tissue plasminogen activator for Occluded coronary arteries [GUSTO] classification). RESULTS: In the overall population, the primary endpoint occurred in 149 of 425 patients in the clopidogrel group vs 151 of 426 patients in the placebo (plus ASA) group (hazard ratio [HR], 0.98; 95% confidence interval [CI], 0.78-1.23). In a prespecified subgroup analysis, the primary endpoint was significantly reduced by clopidogrel in prosthetic graft patients (HR, 0.65; 95% CI, 0.45-0.95; P = .025) but not in venous graft patients (HR, 1.25; 95% CI, 0.94-1.67, not significant [NS]). A significant statistical interaction between treatment effect and graft type was observed (P(interaction) = .008). Although total bleeds were more frequent with clopidogrel, there was no significant difference between the rates of severe bleeding in the clopidogrel and placebo (plus ASA) groups (2.1% vs 1.2%). CONCLUSION: The combination of clopidogrel plus ASA did not improve limb or systemic outcomes in the overall population of PAD patients requiring below-knee bypass grafting. Subgroup analysis suggests that clopidogrel plus ASA confers benefit in patients receiving prosthetic grafts without significantly increasing major bleeding risk.

Autotransfusion system or integrated automatic suction device in minimized extracorporeal circulation: influence on coagulation and inflammatory response

To measure surrogate markers of coagulation activation as well as of the systemic inflammatory response in patients undergoing primary elective coronary artery bypass grafting (CABG) using either the so-called Smart suction device or a continuous autotransfusion system (C.A.T.S.®).

Reactive oxygen species mediate functional differences in human radial and internal thoracic arteries from smokers

Smoking not only increases the risk that coronary heart disease will develop but also morbidity and mortality in patients with known coronary atherosclerosis and after coronary artery bypass grafting. Excessive generation of reactive oxygen species (ROS) has been implicated as the final common pathway for the development of endothelial dysfunction in various cardiovascular risk factors. This study assessed the influence of smoking on two different human arteries routinely used as coronary artery bypass graft conduits.