Inflammatory potential of cotton-based surgically invasive devices: Implications for cardiac surgery
Stefan Trunk
Clinical Research Laboratory, Department of Thoracic, Cardiac and Vascular Surgery, University Hospital Tuebingen, Tuebingen University, Tuebingen, 72076 Germany
Search for more papers by this authorPia Müllerbader
Clinical Research Laboratory, Department of Thoracic, Cardiac and Vascular Surgery, University Hospital Tuebingen, Tuebingen University, Tuebingen, 72076 Germany
Search for more papers by this authorUlrike Hennig
Clinical Research Laboratory, Department of Thoracic, Cardiac and Vascular Surgery, University Hospital Tuebingen, Tuebingen University, Tuebingen, 72076 Germany
Search for more papers by this authorMartin Abel
Clinical Regulatory Affairs, Lohmann & Rauscher GmbH &Co KG, Neuwied, Germany
Search for more papers by this authorAnnette Koggel
Clinical Regulatory Affairs, Lohmann & Rauscher GmbH &Co KG, Neuwied, Germany
Search for more papers by this authorKatharina Stang
Clinical Research Laboratory, Department of Thoracic, Cardiac and Vascular Surgery, University Hospital Tuebingen, Tuebingen University, Tuebingen, 72076 Germany
Search for more papers by this authorYvonne Altreuter
Clinical Research Laboratory, Department of Thoracic, Cardiac and Vascular Surgery, University Hospital Tuebingen, Tuebingen University, Tuebingen, 72076 Germany
Search for more papers by this authorVolker Steger
Clinical Research Laboratory, Department of Thoracic, Cardiac and Vascular Surgery, University Hospital Tuebingen, Tuebingen University, Tuebingen, 72076 Germany
Search for more papers by this authorChristian Schlensak
Clinical Research Laboratory, Department of Thoracic, Cardiac and Vascular Surgery, University Hospital Tuebingen, Tuebingen University, Tuebingen, 72076 Germany
Search for more papers by this authorHans P. Wendel
Clinical Research Laboratory, Department of Thoracic, Cardiac and Vascular Surgery, University Hospital Tuebingen, Tuebingen University, Tuebingen, 72076 Germany
Search for more papers by this authorCorresponding Author
Sandra Stoppelkamp
Clinical Research Laboratory, Department of Thoracic, Cardiac and Vascular Surgery, University Hospital Tuebingen, Tuebingen University, Tuebingen, 72076 Germany
Correspondence to: S. Stoppelkamp; e-mail: [email protected]Search for more papers by this authorStefan Trunk
Clinical Research Laboratory, Department of Thoracic, Cardiac and Vascular Surgery, University Hospital Tuebingen, Tuebingen University, Tuebingen, 72076 Germany
Search for more papers by this authorPia Müllerbader
Clinical Research Laboratory, Department of Thoracic, Cardiac and Vascular Surgery, University Hospital Tuebingen, Tuebingen University, Tuebingen, 72076 Germany
Search for more papers by this authorUlrike Hennig
Clinical Research Laboratory, Department of Thoracic, Cardiac and Vascular Surgery, University Hospital Tuebingen, Tuebingen University, Tuebingen, 72076 Germany
Search for more papers by this authorMartin Abel
Clinical Regulatory Affairs, Lohmann & Rauscher GmbH &Co KG, Neuwied, Germany
Search for more papers by this authorAnnette Koggel
Clinical Regulatory Affairs, Lohmann & Rauscher GmbH &Co KG, Neuwied, Germany
Search for more papers by this authorKatharina Stang
Clinical Research Laboratory, Department of Thoracic, Cardiac and Vascular Surgery, University Hospital Tuebingen, Tuebingen University, Tuebingen, 72076 Germany
Search for more papers by this authorYvonne Altreuter
Clinical Research Laboratory, Department of Thoracic, Cardiac and Vascular Surgery, University Hospital Tuebingen, Tuebingen University, Tuebingen, 72076 Germany
Search for more papers by this authorVolker Steger
Clinical Research Laboratory, Department of Thoracic, Cardiac and Vascular Surgery, University Hospital Tuebingen, Tuebingen University, Tuebingen, 72076 Germany
Search for more papers by this authorChristian Schlensak
Clinical Research Laboratory, Department of Thoracic, Cardiac and Vascular Surgery, University Hospital Tuebingen, Tuebingen University, Tuebingen, 72076 Germany
Search for more papers by this authorHans P. Wendel
Clinical Research Laboratory, Department of Thoracic, Cardiac and Vascular Surgery, University Hospital Tuebingen, Tuebingen University, Tuebingen, 72076 Germany
Search for more papers by this authorCorresponding Author
Sandra Stoppelkamp
Clinical Research Laboratory, Department of Thoracic, Cardiac and Vascular Surgery, University Hospital Tuebingen, Tuebingen University, Tuebingen, 72076 Germany
Correspondence to: S. Stoppelkamp; e-mail: [email protected]Search for more papers by this authorAbstract
Cotton-based surgical invasive devices with their desired hemostyptic properties have been used for decades in the surgical field. However, in cardiac surgery using the heart–lung machine with direct retransfusion of suction blood, activated blood may re-enter the circulation without filtration and may trigger a cascade reaction leading to systemic inflammation and thrombosis. We therefore set out to evaluate the inflammatory potential of untreated and pyrogen-impregnated cotton-based surgical invasive medical devices. After incubation of the swabs with whole blood or PBMC, the cell-free supernatant was investigated for IL1β and IL6. While the reaction of human whole blood toward cotton swabs could not be influenced by any sterilization technique, dry heat and gamma-irradiation were able to diminish the inflammatory reaction of PBMC toward the material and the used pyrogens. In conclusion, using PBMC in direct contact to cotton we are the first to establish a suitable test method for quantification of the pyrogenic/inflammatory activity of this material. The unaltered reaction of whole blood, however, suggests a crosstalk of cells and plasma proteins in the inflammation activation that is not prevented by sterilization of the swabs. This new in vitro testing methodology may help to better display the clinical situation during development of new materials. © 2018 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater 107B: 1877–1888, 2019.
Supporting Information
| Filename | Description |
|---|---|
| JBMB34280-sup-0001-FigS1.tifTIFF image, 403.3 KB | Figure S1. Comparison of cell viability after incubation with γ-irradiated and plasma treated cotton swabs. Whole blood without material contact was used as control and set to 100% viability. The viability of the blood cells after contact with -irradiated and plasma treated swabs was expressed in relation to the blood cells without cotton. |
| JBMB34280-sup-0001-FigS2.tifTIFF image, 608.8 KB | Figure S2. Zymosan concentration response curves. Zymosan was diluted to final concentrations of 0.625; 1.25; 2.5; 5; 20; 50; 100; 200; 400 ng/mL and incubated with whole blood (A) and PBMC (B, C) for 18 h at 37°C from three different donor pools (n1–n3; of n ≥ 4 single donors). Pyrogen-free water served as control (0 ng/mL). After the incubation, cytokine responses (IL1β – A, B and IL6, C) were determined from the cell-free supernatant. |
| JBMB34280-sup-0001-TableS1.docxWord 2007 document , 34.2 KB | Table S1. Interaction of macrophages and particles |
Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.
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