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Biodegradation is the chemical breakdown of materials by the action of living organisms that leads to changes in physical properties. It is a concept of vast scope, ranging from decomposition of environmental waste involving microorganisms to host-induced deterioration of biomaterials in implanted medical devices. This chapter, while grounded in biodegradation, addresses other processes that contribute to the often complex mechanisms of polymer degradation. Its focus is the unintended chemical breakdown in the body of synthetic solid-phase polymers. The factors impacting the undesired biodegradation of polymeric implants are largely well-defined, although some recent progress (to be noted) has been made in mitigating such degradation.

In this article, an expansive interpretation of “Tissue Engineering” is proposed which is in congruence with classical and recent published definitions. I further simplify the definition of tissue engineering as: “Exerting systematic control of the body’s cells, matrices and fluids.” As a consequence, many medical therapies not commonly considered tissue engineering are placed in this category because of their effect on the body’s responses. While the progress of tissue engineering strategies is inexorable and generally positive, it has been subject to setbacks as have many important medical therapies. Medical practice is currently undergoing a transition on several fronts (academics, start-up companies, going concerns) from the era of “replacement medicine” where body parts and functions are replaced by mechanical, electrical or chemical therapies to the era of tissue engineering where health is restored by regeneration generation or limitation of the body’s tissues and functions by exploiting our expanding knowledge of the body’s biological processes to produce natural, healthy outcomes.

Graphical abstract Image 1, Highlights • The US/China Workshop: Regulation, Standards, and Innovation IV, organized by the Chinese Society for Biomaterials (CSBM) and the US Society for Biomaterials (SFB) was held in Minneapolis on April 5th, 2017 during the SFB 2017 Annual Meeting. • The series of workshop started in 2013 and has become a platform to communicate and collaborate between US and China on innovation and regulation of biomaterial and medical devices.

The article summarizes the collective views expressed at the fourth session of the workshop Tissue Engineering--the Next Generation, which was devoted to the translation of results of tissue engineering research into applications. Ernst Hunziker described the paradigm of a dual translational approach, and argued that tissue engineering should be guided by the dimensions and physiological setting of the bodily compartment to be repaired. Myron Spector discussed collagen-glycosaminoglycan (GAG) scaffolds for musculoskeletal tissue engineering. Jeanette Libera focused on the biological and clinical aspects of cartilage tissue engineering, and described a completely autologous procedure for engineering cartilage using the patient's own chondrocytes and blood serum. Arthur Gertzman reviewed the applications of allograft tissues in orthopedic surgery, and outlined the potential of allograft tissues as models for biological and medical studies. Savio Woo discussed a list of functional tissue engineering approaches designed to restore the biochemical and biomechanical properties of injured ligaments and tendons to be closer to that of the normal tissues. Specific examples of using biological scaffolds that have chemoattractants as well as growth factors with unique contact guidance properties to improve their healing process were shown. Anthony Ratcliffe discussed the translation of the results of research into products that are profitable and meet regulatory requirements. Michael Lysaght challenged the proposition that commercial and clinical failures of early tissue engineering products demonstrate a need for more focus on basic research. Arthur Coury described the evolution of tissue engineering products based on the example of Genzyme, and how various definitions of success and failure can affect perceptions and policies relative to the status and advancement of the field of tissue engineering.

The treatment of diseased vasculature remains challenging, in part because of the difficulty in implanting drug-eluting devices without subjecting vessels to damaging mechanical forces. Implanting materials using adhesive forces could overcome this challenge, but materials have previously not been shown to durably adhere to intact endothelium under blood flow. Marine mussels secrete strong underwater adhesives that have been mimicked in synthetic systems. Here we develop a drug-eluting bioadhesive gel that can be locally and durably glued onto the inside surface of blood vessels. In a mouse model of atherosclerosis, inflamed plaques treated with steroid-eluting adhesive gels had reduced macrophage content and developed protective fibrous caps covering the plaque core. Treatment also lowered plasma cytokine levels and biomarkers of inflammation in the plaque. The drug-eluting devices developed here provide a general strategy for implanting therapeutics in the vasculature using adhesive forces and could potentially be used to stabilize rupture-prone plaques.

Adherence of proteins, cells, and microorganisms to the surface of venous catheters contributes to catheter occlusion, venous thrombosis, thrombotic embolism, and infections. These complications lengthen hospital stays and increase patient morbidity and mortality. Current technologies for inhibiting these complications are limited in duration of efficacy and may induce adverse side effects. To prevent complications over the life span of a device without using active drugs, we modified a catheter with the nonleaching polymeric sulfobetaine (polySB), which coordinates water molecules to the catheter surface. The modified surface effectively reduced protein, mammalian cell, and microbial attachment in vitro and in vivo. Relative to commercial catheters, polySB-modified catheters exposed to human blood in vitro had a >98% reduction in the attachment and a significant reduction in activation of platelets, lymphocytes, monocytes, and neutrophils. Additionally, the accumulation of thrombotic material on the catheter surface was reduced by >99% even after catheters were exposed to serum in vitro for 60 days. In vivo, in a highly thrombogenic canine model, device- and vessel-associated thrombus was reduced by 99%. In vitro adherence of a broad spectrum of microorganisms was reduced on both the external and the internal surfaces of polySB-modified catheters compared to unmodified catheters. When unmodified and polySB-modified catheters were exposed to the same bacterial challenge and implanted into animals, 50% less inflammation and fewer bacteria were associated with polySB-modified catheters. This nonleaching, polySB-modified catheter could have a major impact on reducing thrombosis and infection, thus improving patient health.

This chapter addresses fabrication variables that affect the intrinsic blood compatibility of biomaterial test specimens. The primary focus, therefore, is on surface chemical composition, which can vary instantaneously with processing conditions and environmental changes. The relevance of blood compatibility testing is dependent on the control of applicable variables and an understanding of the state of the biomaterial at the time of testing. An appropriate fabrication protocol includes rigorous planning for and execution of quality control measures in collaboration with those who will design, run, and interpret the actual tests. Adequate documentation, quality monitoring, operator training, and safe laboratory practices contribute to a valid test outcome. Controllable environmental variables include air composition and flow, light composition and intensity, temperature, electrostatic charge, and particulates. To minimize particulate contamination, handling and processing of biomaterials should take place in clean spaces. Substrate effects involving the contact of biomaterials with processing tools, handling implements, or packaging materials must be controlled to minimize mechanical damage or the transfer of contaminants to test specimens. In preparing the test specimen, different primary fabrication processes and subsequent treatments can produce widely divergent properties in the same biomaterial. Therefore a detailed understanding of the physical and chemical consequences of the chosen process (e.g., thermal, solution, reactive, mechanical) is necessary. Secondary procedures such as cleaning, extraction, surface modification, prehydration, and storage will affect important surface and bulk properties of the biomaterial. Commitment to the quality of a study from design through test execution is necessary to provide assurance of validity and reproducibility.

A series of poly(ethylene glycol)-co-poly(lactide) diacrylate macromers was synthesized with variable PEG molecular weights (10 or 20 kDa) and lactate contents (0 or 6 lactates per end group). These macromers were polymerized to form hydrogels by free radical polymerization using either redox or photochemical initiators. The extent of polymerization was determined by monitoring the compressive modulus of the resulting hydrogels and by quantitative determination of unreacted acrylate after exhaustive hydrolysis of the gel. Polymerization efficiency was found to depend on the lactate content of the macromer, with higher lactate macromers giving more efficient polymerization. For redox-initiated polymerization using ferrous gluconate/t-butyl hydroperoxide initiator, macromers containing approximately six lactate repeats per end group required lower concentrations of initiator to reach high conversion than lactate-free macromers. Photochemical polymerization with α,α-dimethoxy-α-phenylacetophenone (Irgacure 651(®)) was found to be less efficient than redox polymerization, requiring the addition of N-vinyl-2- pyrrolidone (NVP) as a co-monomer to achieve conversions comparable with redox polymerization. When conditions were optimized to provide near complete conversion for all gels, the presence of lactate repeat units in the hydrogel was generally found to reduce swelling and increase the compressive modulus. Calculated values of molecular weight between cross-links (M(c)) and mesh size using Flory-Rehner theory showed that macromer molecular weight had the greatest impact on the network structure of the gel.

A series of segmented polyurethanes (SPUs) with various polyol soft segments was prepared and their hydrolytic degradation and degradation due to lipid sorption was investigated. The hydrolytic degradation of the SPUs was investigated in a papain solution, where it was shown that the SPU based on poly(ethyleneoxide) (PEO) soft segment was susceptible to hydrolytic degradation. X-ray photoelectron spectroscopic (XPS) data suggest dissociation of the urethane linkage by enzymatic degradation. Degradation by lipid sorption was observed for the SPU based on a poly(dimethylsiloxane) (PDMS) soft segment. This is ascribed to the high solubility of lipid in the PDMS segment of the SPU.

The relationship between surface, bulk and ex vivo blood-contacting properties of segmented polyurethanes with various polyol soft segment was investigated. The polyols used in this study were poly(ethylene oxide), poly(tetramethylene oxide), hydrogenated poly(butadiene), poly(butadiene) and poly(dimethylsiloxane). The hard segment of these segmented polyurethanes was composed of 4,4' diphenylmethane diisocyanate and 1,4 butanediol, present at 50 wt%. An experimental polyurethane, Biostable PUR, which has shown excellent biostability, was used in this study. The segmented polyurethanes based on the hydrophobic polyols such as poly(dimethylsiloxane) and hydrogenated poly(butadiene) showed distinct microphase separation between hard and soft segments. X-ray photoelectron spectroscopy revealed the surface enrichment of the hydrophobic component at the air-solid interface. Dynamic contact angle measurements indicated that the poly(dimethylsiloxane)-based segmented polyurethane possessed a hydrophobic surface in water. The poly(dimethylsiloxane)-based segmented polyurethane had the lowest platelet adhesion among the segmented polyurethanes investigated in this study, whilst the platelet deposition on the poly(ethylene oxide)-based polymer increased with time.

Publisher Summary This chapter introduces biodegradation issues for a number of classes of materials. Biodegradation is the chemical breakdown of materials by the action of living organisms that leads to changes in physical properties. It is a concept of vast scope, ranging from the decomposition of environmental waste involving microorganisms to the host-induced deterioration of biomaterials in implanted medical devices. The calcification of biomaterial implants is an important pathologic process affecting a variety of tissue-derived biomaterials as well as synthetic polymers in various functional configurations. The pathophysiology has been partially characterized with a number of useful animal models; a key common feature is the involvement of devitalized cells and cellular debris. To understand the biological degradation of implant materials, synergistic pathways should be considered. Degradation products can alter the local pH, stimulating further reaction. The hydrolysis of polymers can generate more hydrophilic species leading to polymer swelling and entry of degrading species into the bulk of the polymer.

A series of segmented polyurethanes (SPUs) containing various polyol soft segments was prepared and their resistance to oxidative degradation was investigated after aging in AgNO3 solution. The SPU with the polyether soft segment showed a large reduction in mechanical strength after exposure to the oxidative environment. Surface cracking was often observed for these specimens. XPS measurements revealed that scission of the ether linkage occurs upon oxidation. The oxidative resistance of SPUs containing aliphatic hydrocarbon soft segments was significantly improved over the poly(tetramethylene oxide) (PTMO) based polyurethane.

A series of segmented polyurethanes (SPU’s) containing various polyol soft segments was prepared and their resistance to oxidative degradation, hydrolysis, and lipid sorption was investigated. The SPU with the polyether soft segment showed a large reduction in mechanical strength after exposure to the oxidative environment. Surface cracking was often observed in these specimens. X-ray photoelection spectroscopy (XPS) and Fourier transform attenuated total reflection infrared spectroscopy (FT ATR-IR) measurements revealed that scission of the ether linkage occurs upon oxidation. The stability of SPU’s against hydrolysis depended on the hydrophilicity of the soft segment component. The SPU with a poly(dimethylsiloxane) soft segment showed extensive reduction in strength after lipid sorption.

Polyurethanes offer the greatest versatility in compositions and properties of any family of polymers. For implantable medical devices, a few specific elastomeric polyurethane compositions have demonstrated a combination of toughness, durability, biocompatibility and biostability not achieved by any other available material. Because of the complex behavior of implantable polyurethanes in the body environment, designers and fabricators of polyurethane-containing devices must pay particular attention to the choice of composition and design of components. Subsequent treatment during qualification, fabrication, sterilization, storage, implantation, in vivo operation and explantation also determine the performance and provide the means for assessing the efficacy of the polyurethane in the implanted device.

While certain polyether polyurethanes have been shown to be biostable, undesirable interactions between polymer, the body environment and device can occur. For example, the corrosion products of metallic parts can cause relatively rapid autooxidation of polyether soft segments. This phenomenon was first demonstrated in our laboratories by immersing polyurethane test specimens in metal ion solutions of different oxidation potentials. Subsequently, the mechanism was reasonably duplicated by immersing Pellethane 2363-80A insulated cardiac pacing leads in 3%, 37°C hydrogen peroxide. In vivo studies after 1 year show that corrosion products from pure Co and Fe produce the most rapid degradation of the polyurethane.