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In Vivo Studies of the Foreign Body Reaction to Biomedical IN VIVO STUDIES OF THE FOREIGN BODY REACTION TO BIOMEDICAL POLYMERS by Junghoon Yang Submitted in partial fulfillment of the requirements For the degree of Master of Science Thesis Adviser: Dr. James M. Anderson Department of Biomedical Engineering CASE WESTERN RESERVE UNIVERSITY May, 2013 CASE WESTERN RESERVE UNIVERSITY SCHOOL OF GRADUATE STUDIES We hereby approve the thesis/dissertation of Junghoon Yang candidate for the Master of Science in Biomedical Engineering. Chair of the Committee Dr. James M. Anderson Members of the Committee Dr. Horst von Recum Dr. Roger Marchant Date of Defense: March 7th, 2013 Table of Contents List of Tables………………………………………………………………………..ii List of Figures……………………………………………………………………….iv Abstract……………………………………………………………………………..vii Chapter I: Introduction………………………………………………………………1 Chapter II: Quantitative Versus Qualitative Assessment of the Extent of Foreign Body Reaction (Percent Fusion, Cell Density, and Nuclei Density)……...7 Materials and Methods……………………………………………………….11 Results………………………………………………………………………...31 Discussion……………………………………………………………………..65 References…………………………………………………………………….70 Chapter III: Controlling Fibrous Capsule Formation through Long-Term Down-Regulation of Collagen Type 1 (COL1A1) Expression by Nanofiber- Mediated siRNA Gene Silencing……………………………………………………….73 Materials and Methods…………………………………………………………75 Results…………………………………………………………………………..79 Discussion……………………………………………………………………….84 i List of Tables Chapter II Table 1. Animal Phenotype Table Indicating Strain, General Information, Specific Traits, and References………………………………………………………….9 Table 2. Quantitative Percent Fusion for PEU with Timepoints 14, 21, and 28 Days…..37 Table 3. Average Cell Density for PEU with Timepoints 14, 21, and 28 Days…………39 Table 4. Average Nuclei Density for PEU with Timepoints 14, 21, and 28 Days………41 Table 5. Qualitative Normalized Average Grading for PEU with Timepoints 14, 21, and 28 Days…………………………………………………………43 Table 6. Quantitative Percent Fusion for PET with Timepoints 14, 21, 28 Days ………45 Table 7. Average Cell Density for PET with Timepoints 14, 21, and 28 Days………….47 Table 8. Average Nuclei Density for PET with Timepoints 14, 21, and 28 Days……….49 Table 9. Qualitative Normalized Average Grading for PET with Timepoints 14, 21, and 28 Days…………………………………………………………51 Table 10. One-way ANOVA Testing for Percent Fusion P Values between Two Different Strains for Material PEU…………………………………………………53 Table 11. One-way ANOVA Testing for Percent Fusion P Values between Two Different Strains for Material PET…………………………………………………54 Table 12. One-way ANOVA Testing P Values between the Percent Fusion for the Two Materials, PEU and PET, for Experimental Strain Groups with BALB/cJ Control…………………………………………………………………...55 Table 13. One-way ANOVA Testing P Values between the Percent Fusion for the Two Materials, PEU and PET, for Experimental Strain Groups with c57 Control…………………………………………………………………………55 Table 14. One-way ANOVA Testing P Values between the Cell Density for the Two Materials, PEU and PET, for Experimental Strain Groups with BALB/cJ Control…………………………………………………………………...55 Table 15. One-way ANOVA Testing P Values between the Cell Density for the Two Materials, PEU and PET, for Experimental Strain Groups with c57 Control…………………………………………………………………………55 Table 16. One-way ANOVA Testing P Values between the Nuclei Density for the Two Materials, PEU and PET, for Experimental Strain Groups with BALB/cJ Control…………………………………………………………………...56 ii Table 17. One-way ANOVA Testing P Values between the Nuclei Density for the Two Materials, PEU and PET, for Experimental Strain Groups with c57 Control…………………………………………………………………………56 Table 18. One-way ANOVA Testing P Values between the Normalized Grading for the Two Materials, PEU and PET, for Experimental Strain Groups with BALB Control………………………………………………………56 Table 19. One-way ANOVA Testing P Values between the Normalized Grading for the Two Materials, PEU and PET, for Experimental Strain Groups with c57 Control………………………………………………………….56 Table 20. One-way ANOVA Testing P Values between the Percent Fusion for the Two Time Points with Material PEU…………………………………………….57 Table 21. One-way ANOVA Testing P Values between the Percent Fusion for the Two Time Points with Material PET…………………………………………….58 Table 22. One-way ANOVA Testing P Values between the Cell Density for the Two Time Points with Material PEU……………………………………………59 Table 23. One-way ANOVA Testing P Values between the Cell Density for the Two Time Points with Material PET…………………………………………….60 Table 24. One-way ANOVA Testing P Values between the Nuclei Density for the Two Time Points with Material PEU……………………………………………61 Table 25. One-way ANOVA Testing P Values between the Nuclei Density for the Two Time Points with Material PET…………………………………………….62 Table 26. One-way ANOVA Testing P Values between the Normalized Grading for the Two Time Points with Material PEU…………………………………..63 Table 27. One-way ANOVA Testing P Values between the Normalized Grading for the Two Time Points with Material PET…………………………………...64 iii List of Figures Chapter I Figure 1. Macrophage adherent cell density at Days 7 (A), 14 (B), and 21 (C) postimplantation in BALB/c and nude BALB/c mice……………………….2 Figure 2. Percent fusion at Days 14 (A) and 21 (B) post-implantation in BALB/c and nude BALB/c mice……………………………………………………...4 Chapter II Figure 1. Foreign body giant cell formation for BALB/c control on PEU surfaces at (A) 14 days, (B) 21 days, and (C) 28 Days…………………………17 Figure 2. Foreign body giant cell formation for NKT deficient mice on PEU surfaces at (A) 14 days, (B) 21 days, and (C) 28 Days…………………………18 Figure 3. Foreign body giant cell formation for IL-4 receptor alpha deficient mice on PEU surfaces at (A) 14 days, (B) 21 days, and (C) 28 Days…………19 Figure 4. Foreign body giant cell formation for c57 control on PEU surfaces at (A) 14 days, (B) 21 days, and (C) 28 Days…………………………20 Figure 5. Foreign body giant cell formation for NK deficient mice on PEU surfaces at (A) 14 days, (B) 21 days, and (C) 28 Days…………………………21 Figure 6. Foreign body giant cell formation for mast cell deficient mice on PEU surfaces at (A) 14 days, (B) 21 days, and (C) 28 Days…………………………22 Figure 7. Foreign body giant cell formation for SCID mice on PEU surfaces at (A) 14 days, (B) 21 days, and (C) 28 Days…………………………23 Figure 8. Foreign body giant cell formation for BALB/c control on PET surfaces at (A) 14 days, (B) 21 days, and (C) 28 Days………………………….24 Figure 9. Foreign body giant cell formation for NKT deficient mice on PET surfaces at (A) 14 days, (B) 21 days, and (C) 28 Days………………………….25 Figure 10. Foreign body giant cell formation for IL-4 receptor alpha deficient mice on PET surfaces at (A) 14 days, (B) 21 days, and (C) 28 Days………….26 Figure 11. Foreign body giant cell formation for c57 control on PET surfaces at (A) 14 days, (B) 21 days, and (C) 28 Days………………………….27 Figure 12. Foreign body giant cell formation for NK deficient mice on PET surfaces at (A) 14 days, (B) 21 days, and (C) 28 Days………………………….28 iv Figure 13. Foreign body giant cell formation for mast cell deficient mice on PET surfaces at (A) 14 days, (B) 21 days, and (C) 28 Days……………………29 Figure 14. Foreign body giant cell formation for SCID mice on PET surfaces at (A) 14 days, (B) 21 days, and (C) 28 Days………………………….30 Figure 15: Average Quantitative Percent Fusion for PEU with Control and Experimental Groups. Balb/cJ control for NKT Deficient and IL4-ra Deficient. c57 control for NK Deficient, SCID, and Mast Cell Deficient…..38 Figure 16: Average Cell Density for PEU with Control and Experimental Groups. Balb/cJ control for NKT Deficient and IL4-ra Deficient. c57 control for NK Deficient, SCID, and Mast Cell Deficient………………40 Figure 17: Average Nuclei Density for PEU with Control and Experimental Groups. Balb/cJ control for NKT Deficient and IL4-ra Deficient. c57 control for NK Deficient, SCID, and Mast Cell Deficient………………42 Figure 18: Average Normalized Qualitative Grading for PEU with Experimental and Control Groups. Balb/cJ control for NKT Deficient and IL4-ra Deficient. c57 control for NK Deficient, SCID, and Mast Cell Deficient………………………………………………………………………44 Figure 19: Average Quantitative Percent Fusion for PET with Control and Experimental Groups. Balb/cJ control for NKT Deficient and IL4-ra Deficient. c57 control for NK Deficient, SCID, and Mast Cell Deficient. ……………………………………………………………………..46 Figure 20: Average Cell Density for PET with Control and Experimental Groups. Balb/cJ control for NKT Deficient and IL4-ra Deficient. c57 control for NK Deficient, SCID, and Mast Cell Deficient………………48 Figure 21: Average Nuclei Density for PET with Controls and Experimental Groups. Balb/cJ control for NKT Deficient and IL4-ra Deficient. c57 control for NK Deficient, SCID, and Mast Cell Deficient………………50 Figure 22: Average Normalized Qualitative Grading for PET with Experimental and Control Groups. Balb/cJ control for NKT Deficient and IL4-ra Deficient. c57 control for NK Deficient, SCID, and Mast Cell Deficient………………………………………………………………….52 v Chapter III Figure 1. Histological images showing fibrous capsule formation and cell infiltration on aligned nanofibers supported on film at (a–h) week 2 and (i–p) week 4 with hematoxylin & eosin staining (left) and Masson’s Trichrome staining (right)………………………………………………………………..84 Figure 2 Histological images showing the fibrous capsule formation and cell infiltration on aligned nanofibers scaffolds that were supported on films at week 4 with hematoxylin & eosin staining (left) and Masson’s Trichrome staining (right). (a and b) siCOL1A1/CADY and (c and d) PCLEEP samples………………………………………………………….86 Figure 3 Quantitative analysis of (a) fibrous capsule thickness and (b) cell infiltration...87 vi IN VIVO STUDIES OF THE FOREIGN BODY REACTION TO BIOMEDICAL POLYMERS ABSTRACT by JUNGHOON YANG ABSTRACT The in vivo foreign body reaction on biomaterials regarding development of foreign body giant cells and formation of fibrous capsules was studied. The first study (chapter II) discusses the development of foreign body reaction with specific lymphocytic immunodeficient mice mainly targeting IL-4 (interleukin-4) cytokine.
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