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Mechanistic Investigation of a Hemostatic Keratin Biomaterial

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Mechanistic Investigation of a Hemostatic Keratin Biomaterial MECHANISTIC INVESTIGATION OF A HEMOSTATIC KERATIN BIOMATERIAL By MARIA BAHAWDORY RAHMANY A Dissertation Submitted to the Graduate Faculty of WAKE FOREST UNIVERSITY GRADUATE SCHOOL OF ARTS AND SCIENCES in Partial Fulfillment of the Requirements for the degree of DOCTOR OF PHILOSOPHY Molecular Medicine and Translational Science May 2013 Winston-Salem, North Carolina Approved By: Mark Van Dyke, Ph.D Advisor Justin M. Saul, Ph.D Chair Roy R. Hantgan, Ph.D. Jason Hoth, M.D., Ph.D Daniel Kim-Shapiro, Ph.D. [i] ACKNOWLEDGMENTS The last five years at Wake have been the filled with friendships, challenges and opportunities, all of which were a result of the many amazing people I crossed paths with while doing my graduate studies. I would first like to thank the Molecular Medicine & Translational Science program for taking a chance and accepting me into the program less than a month before classes were to begin. Thank you to the program faculty members for providing constant support for students as we navigate our way through graduate school. I am thankful for the MMTS program for bringing together Bailey, Jessica, Jasmin and I, we have developed a lifelong friendship and continue to support each other through personal and professional endeavors. To my advisor Mark Van Dyke (MVD), your first words to me were “are you afraid of blood?” and I’m pretty lucky that you believed me when I said “No”. Thank you for being a wonderful mentor, advisor, life coach, filter and all of the other roles you have taken in the past 4 years to ensure my success. I am fortunate to have an advisor with such strong moral and ethical values as I develop my own moral compass that will guide me through my career in science and business. Thank you for providing an environment where students feel comfortable disagreeing with you, because a two- way conversation about science is always better than one. You have not only taught me to how to be a good scientist but also taught me valuable management skills. I am in awe of how you have efficiently managed so many people, projects and budgets, while still making your students a priority. Finally, thank you for including me in the work that you do with keratin! We discover something new about this material every month and I look forward to sponsoring an International Meeting on Keratin Research one day. [ii] I have been very fortunate to have a committee made up of diverse scientific expertise and personalities which I have truly enjoyed. Justin, thank you for agreeing to be my committee chair and always being available to give me honest advice whether in your office in NC or through email from Ohio. Dr. Hantgan, thank you for introducing me to the world of platelets and hemostasis. Dr. Jason Hoth, your success as a surgeon and researcher is inspirational, thank you for taking time to answer my questions and allowing me to shadow you during surgeries so that I am always aware of the ultimate goal of biomedical research. Finally, Dr. Daniel Kim-Shapiro, thank you for providing guidance as a member of my committee but also as our MMTS class advisor. I am grateful for the time I spent at WFIRM and the wonderful people I met while in lab. The environment at WFIRM is one where friendships and scientific collaborations can be formed over coffee. Thank you to the Department of Orthopaedics for taking us in with open arms and ensuring that we have everything we need to continue our research at the medical center. To Luke, Todd and Kim, thank you for taking the time to show me a little bit of the business side of science. I have learned a lot during my time as an intern at KeraNetics and it has been a joy to see the company grow over the last 5 years. I’m sure our paths will cross again in this small world of biotechnology. Mark has developed an incredible team of graduate students, technicians, researchers, post-docs and undergraduate students that I am grateful to call colleagues and friends. To current and past members of the Van Dyke group – Paulina Hill, Luke Burnett, Jill Richter, Mary Ellenburg, Heather Bradbury-Coan, Carmen Gaines, Deepika Poranki, Alana Sampson, Olga Roberts, Michelle Merrill, Rawad Hamzi, Fiesky Nunez, Bailey Fearing, Lauren Pace, Roche De Guzman, [iii] Thalia Teli, and Barbara Summerlin- it has been so much fun to work with each of you in different capacities throughout my time at Wake. Coming to lab everyday was a delight because I was able to work with such amazing people. There a few that I would like to mention specifically: Jill, I am thankful that I wore that red coat on the first day I met you because that is what started it all! I have never seen you waiver in your beliefs and opinions which demonstrates the strong woman you are. I love your determination to “get things done” even if it meant staying in lab until 4 am. Roche, I am so lucky to have you as a friend and colleague. Not only are you an extremely talented researcher but you always provide a unique perspective to any situation that arises. Thank you for being the one that supports big dreams and big ideas, I can’t wait to see your future success. Catherine Ward, I thank you for you friendship over the last few years! I appreciate you always taking time to read my emails about how much I dislike an experiment one week and how much I love it the next. I know that no matter how much distance is between us, you will always be my BFF because honestly, “people always more fun with us around”. I thank my family for showing me the meaning of hard work. My favorite memories are times spent with my brother and sisters, so thank you to my siblings for your constant encouragement- even if you are never really sure what it is I do. I would also like to thank my in-laws for their support, I am so lucky to be the aroos to such amazing women. [iv] And finally, thank you to Khalid for going through this journey through undergrad and grad school with me for the past 9 years. You are my best friend and soulmate. Thank you for never letting me waiver from my goals when stress got the best of me, thank you for always taking time to listen to me when I need to vent and being the most patient person I know. You always take time to listen to me practice presentations through the phone or skype and stayed awake even though I fall asleep when you talk about philosophy or economics. I’m so lucky to be married to such a loving, patient and kind person that sacrifices his own time and energy to help others. I’m excited to put on our grown-up pants and see what the future holds for us! [v] DEDICATION To the Afghan families that left behind their own degrees and professional successes and came to a new country so that their children may have better opportunities [vi] TABLE OF CONTENTS ACKNOWLEDGMENTS ...................................................................................................................... ii DEDICATION .................................................................................................................................... vi TABLE OF CONTENTS...................................................................................................................... vii LIST OF ILLUSTRATIONS AND TABLES............................................................................................ viii LIST OF ABBREVIATIONS ................................................................................................................. xi ABSTRACT ....................................................................................................................................... xii CHAPTER I ........................................................................................................................................ 1 CHAPTER II ..................................................................................................................................... 14 CHAPTER III .................................................................................................................................... 42 CHAPTER IV .................................................................................................................................... 66 CHAPTER V ..................................................................................................................................... 98 CHAPTER VI .................................................................................................................................. 126 CHAPTER VII ................................................................................................................................. 144 CURRICULUM VITAE ..................................................................................................................... 153 [vii] LIST OF ILLUSTRATIONS AND TABLES Chapter I : Introduction Figure 1 Schematic of Coagulation Cascade……………………………………………...3 Table 1 Description of Platelet Integrins ………………………………………………...5 Table 2 Description of Current Hemostatic Agents…………….………………………..6 Chapter II : Introduction to Biomimetic Approaches to Modulate Cellular Adhesion to Biomaterials Figure 1 Methods of Modulating Receptor-Ligand Interactions………………………...18 Figure 2 Schematic of Integrin Activation……………………………………………….22 Chapter III : Novel Keratin and Polyurethane Biomaterials are Hemostatic in Porcine Lethal Extremity Hemorrhage Model Table 1 Description of Dressings……………………………………………………….46 Figure 1 Images of Nanosan-Sorb, Kerastat and Hemcon Hemostats…………….….…47 Table 2 Baseline Parameters Pre- and Post -Injury………………………….………....49
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