J Extra Corpor Technol 2024 , 56 , 37 – 44 Ó The Author ( s ), published by EDP Sciences , 2024 https :// doi . org / 10.1051 / ject / 2024003
Available online at : ject . edpsciences . org
ORIGINAL ARTICLE
Designing an experimental method for assessing biocompatibility of circuit coatings using biomarkers for platelet activation during cardiopulmonary bypass
Meghal Sancheti ( BS ) 1 , Mitchell Rentschler ( BA ) 1 , Charlotte Bolch ( PhD ) 2 , Weidang Li ( PhD ) 3 , Katelyn Necco ( MSc ) 4 , Thomas Rath ( MPS ) 5 , Mitra Esfandiarei ( PhD ) 4 , 6 , and Nathaniel Darban ( PhD ) 5 ,*
1 Arizona College of Osteopathic Medicine , Midwestern University , 19555 N . 59th Avenue , Glendale , AZ 85308 , USA 2 Office of Research & Sponsored Program , Midwestern University , 19555 N . 59th Avenue , Glendale , AZ 85308 , USA 3 College of Veterinary Medicine , Midwestern University , 19555 N . 59th Avenue , Glendale , AZ 85308 , USA 4 College of Graduate Studies , Midwestern University , 19555 N . 59th Avenue , Glendale , AZ 85308 , USA 5 College of Health Sciences , Midwestern University , 19555 N . 59th Avenue , Glendale , AZ 85308 , USA 6 College of Medicine Phoenix , University of Arizona , 19555 N . 59th Avenue , Glendale , AZ 85308 , USA 7 Faculty of Medicine , University of British Columbia , 2176 Health Sciences Mall , Vancouver , BC V6T 2A1 , Canada
Received 2 February 2023 , Accepted 10 February 2024
Abstract – Introduction : Cardiopulmonary bypass is an essential component of cardiothoracic surgeries . However , significant complications such as systemic inflammatory response syndrome ( SIRS ) resulting from cardiopulmonary bypass ( CPB ) are a common occurrence due to contact between circulating blood and foreign surfaces that leads to platelet activation . It is suggested that different available CPB circuit coatings can potentially reduce platelet activation . However , there have been no published evidence-based reports confirming these claims . In addition , there is no well-established protocol for studying platelet activation biomarkers during CPB in vitro in a laboratory setting . Methods : CPB was simulated in the laboratory using bovine blood in two different types of coated CPB circuits : Trillium Ò Biosurface by Medtronic , and Xcoating TM Surface by Terumo . Fresh bovine blood samples were collected and circulated through the CPB circuit following the standard protocol used in the operation rooms . Blood samples were then collected at 5 min , 30 min , and 55 min during the circulation . Blood plasmas were separated and subjected to enzyme-linked immunosorbent assay to measure most established platelet activation markers P-selectin , Platelet Factor 4 ( PF4 ), Glycoprotein IIb / IIIa ( GPIIb / IIIa ), and b-thromboglobulin ( b-TG ) at different time points . Results : The biomarker values at 30 min and 55 min were compared to the base values at 5 min for each type of CPB circuit . The results of the means from all measured biomarkers showed data measurements that indicated no significant variability within each coating . All collected data points fell within ± 2 SD of the means , which was considered acceptable variations across technical replicates . Conclusion : In this study , we were able to establish an in vitro protocol in the laboratory setting that is precise and reliable with minimum intra-variability . This established protocol will allow for future studies in which different coated CPB circuits can be compared for their effectiveness in blocking platelet activation during the CPB .
Key words : Cardiopulmonary bypass , Platelets , Biomarkers , Platelet activation , ELISA , Circuit coating .
Introduction
Cardiopulmonary bypass ( CPB ) provides a bloodless , motionless field for the surgeon to operate . While this has facilitated many advances in the field , it does pose significant complications , such as platelet activation and dysfunction , as well as abnormal bleeding [ 1 ]. Serious manifestations of these complications can lead to systemic inflammatory response
* Corresponding authors : ndarba @ midwestern . edu ; mesfan @ midwestern . edu syndrome ( SIRS ) and sepsis , leading to organ failure [ 2 ]. Most of these complications can be traced back to platelet activation in contact with a foreign body , such as the coating of circuits used in CPB . During the bypass , platelets bind to these artificial surfaces , leading to the release of inflammatory cytokines and activation of coagulation-fibrinolysis systems [ 3 ]. The surface markers of platelets such as platelet factor 4 ( PF4 ), b-thromboglobulin ( b-TG ), glycoprotein IIb / IIIa ( GPIIb / IIIa ), and soluble P-selectin are released during the coagulation cascade and are considered as reliable markers for platelet activation during CPB [ 4 ].
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