2S0

6 DEGRADATION OF MATERIALS IN THE BIOLOGICAL ENVIRONMENT

TABLE 4 Prevention of Calcification

Swamp
Detergent mareatinnx
Al" or tc" pr ...raiment
Ammodtphowhonwe oe ethistehydromdipiwaphonate
covalent bonding
Dphomhownes kennelled akin.;

Application

Mechanism

Glsearaldeitydepreterand blomatmals

(large modificancen or photpholipd

Glouraldehyde.pretreated

biomaterials

Gluwaldehyde.pectreated biomaterials
and Pohorettane
All implants

AI" [controlled rekawl

Ghturaddode.pretteated biomateriah

aim of more than 30 years by using formulations containing

the slighdy soluble calcium salt of EHDP in the mattices. Di.
phosphonates outlet* bonded to polyurethane also prevent
implant calcification.
Another potentially useful approach for preventing cakifi
cation involves the me of specific metal ions that are calcific'.
don inhibitors. Pretreatment of booprosthetic heart valve cusps
with Al" has also ban shown to prevent implant mineraliza.
don without generalized side effects. This approach was tuggentd by the observations that patients with kidney disease,
aim are exposed to trace-level Alf', have insufficiendy calcified

bona. The medunisin of action of Al" inhibition of calofication has been shown to be due, at kart in part, to the inhibition
of hydroxyapatite crystal growth. Other metallic canons that
have been shown to inhibit hydroxyapante crystallization in
vitro, such as Fel% Gas', and

caz,

may also be useful in

preventing calcification.
Charge modificanon of &Nearside-twat-pretreated bovine
pericardium with covalent binding of pnxamme has also inhibited calcification of this bionaterial experimentally. Protamine
is a highly positively charged proton that may inhibit v akificanon by repelling calcium ions. thus blocking the formation of
calcium phosphate.

CONCLUSIONS

Calcificanon of biomattrial implants is an important

packer process affecting a variety of tissue-derived blotterteriaLs as well as synthetic polymers in various functional
configurations. The pathophysiology has been partially chap
aetenzed with a number of useful animal models; a key
common feature is the involvement of devitalized cells and
cellular debris. Although no clinically makl preventive ap.
puma, is yet available, several strategies based on either
modifying biornaterials or local drug administration appear
to he promising.
Agthentigdellatagg

Rama growth of mineral plan

Rennet growth of mineral phase

All implants
Pnwanane pretreatment

alti4:1100

Raffia growth 04 atonal phase

Ranter growth of mineral phase

Charge modification

The audios+ thank Mn. Catherine Wontatteen for preparing dos

litantatalpl. This work was ,upported in pan by MINGrants H1311118

and HI 36574,

BINIcrgraphy

Gmerel Ware
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