Moran Haim Zada1, Awanish Kumar1, Omar Elmalak1, Guy Mechrez2, Abraham J Domb1. 1. Institute of Drug Research, Alex Grass Center for Drug Design and Novel Therapeutics, School of Pharmacy-Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem 91120, Israel. 2. Department of Food Quality and Safety, Institute for Postharvest and Food Sciences, Volcani Center, ARO, 68 HaMaccabim Road, Rishon LeZion 7505101, Israel.
Abstract
Poly-l-lactide-co-ε-caprolactone (PLCL) is a unique polymer containing both polylactic acid and poly-ε-caprolactone (PCL) chain units, and thus it has better flexible and biodegradable properties. Based on these unique properties of PLCL, we have developed balloons that are now widely used in treating major medical problems [Biomaterials 2016, 105, 109-116]. One of the most important considerations needed for balloons is to ensure that the material properties remain similar after undergoing ethylene oxide (EtO) or gamma (γ-) sterilization treatments. From the biotechnological point of view, we focused on analyzing the vital molecular properties of the PLCL material after sterilization, such as changes in crystallinity, molecular weight distributions (M w, M n, and polydispersity index), and inherent viscosity (η). Analysis of the data reveals that EtO sterilization does not engender any change in crystallinity, melting temperature (T m), molecular weights, and η of the polymer. On the contrary, γ-radiations induce chain scission and consequential decrease of ∼33 and ∼15% in molecular weights and η values, respectively. Based on our observations, we recommend EtO sterilization instead of γ-radiation for PLCL. This ensures prolonged stability of the polymer against degradation in a biological environment, long-shelf life, and absolute assurance that balloon failures do not occur after implantation.
Poly-l-lactide-co-ε-caprolactone (PLCL) is a unique polymer containing both polylactic acid and poly-ε-caprolactone (PCL) chain units, and thus it has better flexible and biodegradable properties. Based on these unique properties of PLCL, we have developed balloons that are now widely used in treating major medical problems [Biomaterials 2016, 105, 109-116]. One of the most important considerations needed for balloons is to ensure that the material properties remain similar after undergoing ethylene oxide (EtO) or gamma (γ-) sterilization treatments. From the biotechnological point of view, we focused on analyzing the vital molecular properties of the PLCL material after sterilization, such as changes in crystallinity, molecular weight distributions (M w, M n, and polydispersity index), and inherent viscosity (η). Analysis of the data reveals that EtO sterilization does not engender any change in crystallinity, melting temperature (T m), molecular weights, and η of the polymer. On the contrary, γ-radiations induce chain scission and consequential decrease of ∼33 and ∼15% in molecular weights and η values, respectively. Based on our observations, we recommend EtO sterilization instead of γ-radiation for PLCL. This ensures prolonged stability of the polymer against degradation in a biological environment, long-shelf life, and absolute assurance that balloon failures do not occur after implantation.
In recent years, biodegradable
polymers have become one of the
most frequently used materials for the development of a variety of
biodegradable polymer-based medical devices. One example is poly-l-lactide-co-ε-caprolactone (PLCL) balloons
used widely by orthopedic surgeons for rotor-cuff muscular injury.[1−4] These balloons are inflated with a phosphate buffer to their required
shape and thickness. Flexibility in inflated balloons to withhold
extreme muscular pressures relies on the physical properties of PLCL
materials.[5,6] The composition of the PLCL consists of
a soft matrix of a poly-ε-caprolactone (PCL) chain that provides
a stable environment for the cellular matrix surrounding the balloons.[7−9] This helps to create a smooth balloon surface that reduces friction
between the joints, providing improved shoulder movements and guaranteed
pain reduction.[10] The elastic mechano-property
of the PLCL material is also expected to prevent premature failure
of the balloons.Because of the inherent flexible and biocompatible
properties,
PLCL is a highly valued material used for medical applications. Examples
of success because of PLCL are[11,12] bone regeneration and
bone xenografts,[13,14] implants for pancreatic islet
transplantation,[15−17] and carriers for immunosuppressive drugs.[18]Despite the wide variety of PLCL biomedical
applications, physical
aging is a common drawback that reduces shelf-life and efficiency.
According to Hutchinson, physical aging is a change in the physical
properties in polymers as a function of storage time at constant temperature,
at zero stress, and without influence from any other external condition.[19] During physical aging, the physical properties
of the polymer material modify the chain conformation of the polymer.
These modifications accompany changes in molecular weight distribution
and intrinsic viscosity. This shortcoming is primarily associated
with a decrease in the viscoelasticity of the polymer material, thus
reducing product stability/durability, reliability, and safety.[20−22] In this context, PLCL has been reported to be unstable, undergoing
changes in its physical properties such as ductile deformation.[23] Supporting this, Tsuji et al.[24] and Saha and Tsuji[25] have demonstrated
that the ductile properties of the PLCL material are due to changes
in crystalline properties during storage.Factors that are mainly
responsible for changes in the polymer
material include process conditions and sterilization methods. The
most widely used sterilization techniques for biodegradable polymers
include treatment with ethylene oxide (EtO) and γ-irradiation.[26,27] These sterilization conditions increase stiffness of the polymer.[28] Farrar and Gillson[29] show that decrease in the strength of the polymer material is due
to the decrease in its polymer molecular weight. The drawbacks of
EtO sterilization are that the EtO gas can induce chemical reactions
potentially damaging the polymer structure.[30−32] On the other
hand, γ-irradiation induces changes in the polymer structure
through chain scission reactions.[33] Valente
et al.[34] and Pietrzak[35] show that after sterilization, the changes in the molecular
properties of the bioabsorbable polymers can completely impact biodegradation
kinetics and performance time of the polymer device.The decrease
in the polymer molecular weight during sterilization
hydrolyzes the device, making it be reabsorbed faster than predicted.
Changes in the molecular weight of the polymer also disturb chain
segment mobility in the polymer microstructure.[36] Thus, any change in the molecularity of the polymer changes
the life span, and efficiency of the device affects its mechanical
properties. Changes in the dimension of the polymer device may also
occur.[37] It is, therefore, extremely necessary
to examine and determine suitable sterilization methods for polymeric
bioimplants.[38]Predicting the consequences
of sterilization methods on the polymer
material is complex. Alteration of PLCL material over time is obvious,
and the analysis of the device performance in real-time is probably
impractical. Before end-use, the balloons need to be sterilized and
subjected to long-term shelf-storage under varying conditions. Given
these difficulties, a fundamental understanding of polymer structure
and behavior is essential, examining physical properties such as crystallinity,
thermal behavior, molecular weight, and inherent viscosity (η)
of the final product before and after the manufacture processes. This
offers the possibility to obtain the most reliable predictions of
device or polymer-based scaffold performances in biomedical tissue
engineering.[39,40] In this report, we examine the
changes in the structural properties of the PLCL that may occur in
the balloon material during the sterilization processes. Focus is
on determining properties such as crystallinity, thermal properties,
molecular weight distribution, and η before and after EtO and
γ-sterilization.
Results and Discussion
The aim of the
experiments is to screen commonly used procedures
for polymer sterilization such as EtO and gamma (γ-) sterilization
on PLCL balloons. Our goal is to determine whether any of the sterilization
methods can cause undesired alterations in the PLCL material. The
effect of EtO and γ-sterilization on the weight of balloons,
molecular weight, and η of PLCL material is examined in Table .
Table 1
Average Weight, Molecular Weight Distribution,
and Inherent Viscosity (η) of the PLCL Material in Balloons
before and after Sterilizationa
sterilization method
average weight [g]
Mw [g/mol]
Mn [g/mol]
PDI
viscosity (η) [dL/g]
control
1.319 ± 0.388
133 000 ± 4900
81 000 ± 2400
1.65 ± 0.05
1.23 ± 0.06
EtO
cycle 1
1.065 ± 0.160
147 000 ± 6700
93 000 ± 5400
1.58 ± 0.01
1.20 ± 0.06
cycle 2
1.253 ± 0.027
138 000 ± 6500
86 000 ± 5000
1.60 ± 0.02
1.25 ± 0.02
cycle 3
1.268 ± 0.022
136 000 ± 7000
83 000 ± 4600
1.63 ± 0.01
1.24 ± 0.02
β-radiation
19.5 kGy
1.220 ± 0.032
110 000 ± 1700
65 000 ± 1900
1.68 ± 0.03
1.09 ± 0.04
21.5 kGy
1.236 ± 0.049
128 000 ± 1300
82 000 ± 2900
1.54 ± 0.04
1.08 ± 0.02
25 kGy
1.291 ± 0.036
89 000 ± 6500
45 000 ± 4900
1.96 ± 0.07
1.05 ± 0.06
Mw =
weight average molecular weight; Mn =
number average molecular weight; PDI = polydispersity index.
Mw =
weight average molecular weight; Mn =
number average molecular weight; PDI = polydispersity index.
EtO Sterilization
The weight of the
balloons was measured before and after each EtO sterilization cycle.
Gel permeation chromatography (GPC) was performed to determine if
sterilization by EtO influences the molecular weight of PLCL material
compared to the balloons not treated with EtO. GPC data were always
obtained in triplicate and for samples from three different balloons.
We also examined the effect of repetitive EtO sterilization (up to
three continuous sterilization cycles) conditions on the balloons.No significant changes in the weight of the balloons were observed
(Figure ). Visual
appearance of EtO-treated balloon samples remained unchanged. It is
interesting to note that even the repetitive sterilization cycles
have an insignificant effect on the balloon weights. This means that
EtO is not absorbed within the PLCL material during sterilization.
Figure 1
Effect
of EtO sterilization on the (A) weight, (B) intrinsic viscosity,
and (C) molecular weight (Mw) of the PLCL
material in balloons. The effect of β-radiation on the (D) weight,
(E) intrinsic viscosity, and (F) molecular weight (Mw) of the PLCL material in balloons.
Effect
of EtO sterilization on the (A) weight, (B) intrinsic viscosity,
and (C) molecular weight (Mw) of the PLCL
material in balloons. The effect of β-radiation on the (D) weight,
(E) intrinsic viscosity, and (F) molecular weight (Mw) of the PLCL material in balloons.Changes in molecular weight [Mw, Mn, and polydispersity
index (PDI)] for samples
sterilized by EtO are shown in Table . We also analyzed changes in the molecular weight
of the PLCL material, when the balloons were treated with multiple
cycles of EtO. The molecular weight data indicate that the EtO sterilization
processes have no significant influence on the molecular integrity
of PLCL material. As represented in Table and Figure , no significant difference between the Mw and Mn of the control and
EtO-sterilized balloons is observed. Following the first sterilization
cycles, the Mw shows a slight increase
with a difference of less than 10% (Table ) from the nonsterile PLCL material. However,
the PDI values for the treated and untreated samples are nearly constant
to ∼1.6. This indicates that EtO does not promote chain scission
nor does it cause any chemical changes in the PLCL material.The η measurements support the GPC data that the physical
and chemical integrity of the PLCL material after EtO sterilization
is not compromised, and that sterilization due to EtO does not cause
any changes in the chain conformation of the PLCL material. The variations
in η of neat and sterilized samples are provided in Figure . No change in the
η was observed in the PLCL material for the balloons that were
treated with EtO.These results coincide with the results of
Horakova et al.,[41] who report that EtO
does not interact with the
PLCL material. This also confirms that EtO does not interact with
parent polymeric chains such as of PCL. No difference in the Fourier
transform infrared (FTIR) spectra of the native polymer with the EtO-treated
balloon was observed (Figure ). Therefore, we focused on determining the changes in the
melting point (Tm) and changes in the
crystalline properties (X) of the sterilized samples.
The results are provided in the sections below.
Figure 2
FTIR spectra of nonsterilized
(black) and three cycle EtO-sterilized
(red) PLCL balloon material.
FTIR spectra of nonsterilized
(black) and three cycle EtO-sterilized
(red) PLCL balloon material.
γ-Sterilization
Radiation sterilization
was performed at 19.5, 21.5, and 25 kGy for balloons. The average
weight of the balloons did not change after the sterilization process.
GPC data indicate that γ-irradiation breaks PLCLpolymer chains.
γ-Sterilization markedly decreases the molecular weight and
η of the PLCL in the balloons. An approximately 33% decrease
in the Mw of the balloons was observed
under 25 kGy. As presented in Table , both Mw and Mn in PLCL are decreased after radiation sterilization.
Undoubtedly, the γ-radiation induces the chain scission in the
PLCL, which is also reflected in the increase in the PDI from 1.5
to 2.0. The result is consistent with observations in the literature,
where exposure of radiation during the sterilization process induces
reduction in the polymer chains.[42] Chaochanchaikul
and Harnnarongchai[42] show that γ-irradiation
decreases the Mw and Mn in the polylactic acid (PLA) material. Obviously, Table shows that the changes
in the molecular weights of the polymer material are dependent on
the amount of radiation exposure.[43] Nugroho
et al.[44] illustrate that a chain degradation
in PLA can occur in any atmosphere, whether in air or in vacuum during
γ-sterilization.The η of the PLCL material significantly
decreases to ∼15% after a radiation exposure of 25 kGy. The
η values in sterilized balloons decrease from 1.23 (control)
to 1.09 and 1.08 for radiation strengths of 19.5 and 21.5 kGy, respectively.
Decrease in the η in PLCL material after radiation treatment
is a direct indication of polymer chain scission. It is known that
the concept of η relates directly to polymer molecular weight.[45] Based on our observations, it is obvious that
for a bioabsorbable polymerPLCL, reduction in the molecular weight
is reflected in the decrease in its η.The obtained results
are consistent with Nuutinen et al.,[46] who
illustrate that the η of the PLApolymer
decreases to 64% with γ-sterilization. Similarly, Suuronen et
al.[47] report a decrease in the η
of PLA after a sterilization dose of 25 kGy. Additionally, we observed
that the decrease in the η is dependent on the strength of the
radiation. The η of PLCL decreases gradually with an increase
in radiation strength from 1.97 to 2.57 kGy. The answer lies in the
observations of Nugroho et al.[48] that with
an increase in radiation strength, the polymer is more susceptible
and easily undergoes oxidative chain-scission.
Thermal Analysis and Crystallinity after Sterilization
The PLCL material crystalline properties were measured before and
after the sterilization treatments using differential scanning calorimetry
(DSC) (Figure ). The
relationship between enthalpy of fusion (ΔH) of polymers with its crystallinity is provided in eq . Generally, an increase in the
crystalline properties of the polymer leads to an increase in the
ΔH. We observed that the melting temperature
(Tm) of the raw PLCL material (Resomer
LC703S) is 168 °C, whereas the Tm of the solvent-casted balloon films was reduced to 160 °C.
The reason for such variation is totally dependent on the crystallization
properties of the polymer and the method of preparing the polymer
films. The literature illustrates that the crystallinity of the polymer
films is widely affected by solvent-induced conformational changes.[49,50] Apart from the type of solvent used in the polymer film preparation,
Runt and Rim[51] emphasize that processing
conditions such as polymer film thickness, casting temperature, evaporation
rate, and solvent retention time are the additional factors that control
the crystalline properties of the polymer.
Figure 3
DSC curve of, PLCL raw
material (Resomer LC703S) (black), balloon
films: nonsterilized (red), EtO treated [cycle 1 (blue), cycle 2 (green),
cycle 3 (magenta)], and 25 kGy treated (dark yellow).
DSC curve of, PLCL raw
material (Resomer LC703S) (black), balloon
films: nonsterilized (red), EtO treated [cycle 1 (blue), cycle 2 (green),
cycle 3 (magenta)], and 25 kGy treated (dark yellow).It should be noted from Figure that samples treated with EtO and 25 kGy
radiation
also exhibited the Tm of 160 °C.
Because the ratio of monomers (PLA and PCL) in PLCL is 70:30, the
observation of Tm at 160 °C for all
the balloons is because of randomization of the PLA with the PCL blocks
in the polymer. Han et al.[52] illustrate
that when the PLA segment is the major component within the PLCL,
it is possible that during polymerization, PLA chains become bonded
to the PCL chains, hence being in excess, only the crystalline part
of the PLA appears in DSC. This is an indication that the crystallinity
of the PCL is drastically reduced in the presence of PLA chains in
PLCL. Patel et al.[53] provide bibliographic
references reporting covalent conjugation between PLA and PCL significantly
reducing the crystallinity of the PCL. The crystallinity in PCL is
far less than the PLA. Possibly, the earlier crystallization of the
PLA chains strongly restricts the crystallization of the PCL segments,
which remain undetectable in DSC.[54,55]The
degree of crystallinity was determined from the enthalpy of
fusion (ΔH) which was calculated from the area
under the endotherm (eq ).where X is the extent of
crystallinity, ΔH is the enthalpy of fusion
measured at the melting point (Tm), and
ΔH0 is the enthalpy of fusion of
the completely crystalline polymer measured at equilibrium melting
temperature (Tm0). The presence of PCL in PLCL makes it a semicrystalline
material. We, therefore, determined the percentage crystallinity in
PLCL using the reported values of PLA. A literature value of 95 J
g–1 for ΔH0 was
considered, assuming 100% crystalline form of the PLA as determined
by Sosnowski.[56] The ΔH and crystallinity of the nonsterilized balloons were −24.5
J g–1 and ∼26%, respectively. This value
is comparatively lower than the value of 65% crystallinity for the
pure PLCL reported in the literature.[73] This decrease in the crystallinity, as stated earlier, is because
of the solvent medium chosen for the balloon film preparation. In
support, Byun et al.[57] observe a decrease
in the crystallinity of the PLA films treated with dichloromethane
(DCM) using DSC measurements. This is in agreement with our observed
crystallinity for nonsterilized PLCL films in balloons casted using
DCM. The ΔH value for the PLCL after up to
three continuous EtO sterilization cycles almost remains constant
compared to the untreated balloon sample (−24.5 J g–1). The average ΔH values were −24.3,
−24.4, and −24.0 for balloons exposed under 1, 2, and
3 EtO cycles. The insignificant changes in the ΔH after EtO treatment are an indication that the polymer properties
remain unaffected after sterilization. The crystallinity of the PLCL
after EtO sterilization cycles remained constant at ∼26%. This
indicates that EtO sterilization has no effect on the polymer properties
of the balloon films.On the other hand, an increase in the
ΔH of the polymer is seen after treatment with
a 25 kGy radiation dose.
The ΔH and the crystallinity in the radiation-treated
balloon sample were 27.5 J g–1 and ∼29%,
respectively. This increase in the crystallinity in PLCL is attributed
to the mobility and rearrangement of the smaller chain segments upon
radiation. In support to our observation, Mansouri et al.[58] observe an increase in the crystallinity of
the PLA upon radiation treatment to 45 kGy, which they ascribe to
the reorientation of shorter polymer chains. Suljovrujić et
al.[59] suggested that during the radiation
treatment scission of the PLA molecules occur, leading to the growth
of thin-crystal structures. Possibly, the formation of low molecular
weight degradation products nucleates together internally, exaggerating
crystallinity of the polymer material. This formation of the thin
crystal structures induces an overall increase in polymer crystallinity.
However, Walo et al.[60] illustrate that
there is no advantageous relationship between the radiation-induced
increased crystallinity with the stability of the polymers. They explored
the phenomenon that the increase in the crystallinity is not only
observed in PLA but also with PCL. However, this increase in crystallinity
in both the PLA and PCL is temporary and decreases with time. We believe
that the observed increase in the crystallinity in PLCL when treated
with 25 kGy radiation is simply because of the early stage self-nucleation
of the degraded byproducts such as short polymer chains.
Discussion
It has been widely observed
that bioabsorbable polymers are more
susceptible to degradation because of their hydrolytic instability
during sterilization.[61−63] The polymer undergoes chain scission when treated
under 25 kGy radiation. However, the short chain-fragmented macromolecule
initially tends to reorient itself over the already existing polymer
crystals, resulting in a more crystalline form of the polymer. With
an increase in the radiation dose, this reorientation is destroyed
because of the recombination of free radicals within crystalline regions.[60] Such changes were detected by DSC while analyzing
our balloons. Experiments showed an increase in the ΔH of the radiation-treated samples. On the other hand, EtO
treatment did not promote any chain mobilization or reorientation,
therefore no change in the ΔH and the degree
of crystallinity was obtained in the balloons.We presume that
the wide difference between the EtO and γ-sterilization
results for PLCL is because of the sensitivity of its PLA and PCL
chain components. A comparative analysis confirms that radiation sterilization
initiates degradation in both polymers, however the effect in PCL
is smaller than in PLA.[60] Several studies
report that γ-radiation causes chain scission in PLA, leading
to a decrease in molecular weight and mechanical properties.[64,65] This effect has been studied using a mathematical model, which reveals
that sterilization hydrolysis of PLCL after radiation is about 3.5
times faster than polymer samples without sterilization.[73]It is interesting that EtO sterilization
does not alter the molecular
structure or molecular weight of the polymers.[66] These results are in agreement with Steripro[67] and Tipnis,[68] who
report that EtO sterilization is considered compatible with polymers
used in implantable medical devices. Middleton et al.[69] studied the effects of γ- and EtO-sterilization on
the intrinsic viscosities of molded PLA parts. They report that physical
properties of the material sterilized using γ-radiation are
considerably less than material sterilized by EtO.It is now
clear that the PLA chain segment in PLCL is the major
component sensitive to γ-ration treatment. Because 70% of the
total chain segments in PLCL are composed of PLA chains, it is obvious
that any change in the PLA segment is sufficient to cause major changes
in the physical properties of the PLCL material during sterilization.
We conclude that for PLCL balloons, sterilization treatment using
EtO is much more beneficial, as it has an insignificant effect on
molecular properties. Undoubtedly, EtO-sterilized PLCL balloons will
have self-stability and high performance as polymer implants compared
to the balloons treated with γ-radiation.To evaluate
the mechanical stability of PLCL balloon implants after
EtO sterilization, we examined the stability of the balloons under
external loading using an INSTRON fatigue testing machine. Saline-filled
balloons were immersed into a buffer medium for 1, 3, 6, and 13 weeks
and then taken out from the aqueous medium to check their mechanical
stability. The load on the balloons was increased until the balloon
leaked. Figure summarizes
the mean of the maximum loads until the balloon ruptured or started
leaking. Balloon resistance to external loads: the test reveals that
at least until week 6 (42 days in the incubator), there was no statistically
significant difference between the external loads applied on the balloons
until failure. At week 13 (91 days), the balloons sprang a leak under
external loads. External loading tests demonstrate that EtO-sterilized
balloons withstand higher loads of more than 900 N. Variability of
the results was high within each group, but no statistically significant
difference was found between the groups from 0 to 6 weeks. Although
it appears that there is a slight decrease in the maximum load applied
on the balloons until failure, the correlation is not good (R2 = 0.56), and analysis of variance tests using
Excel reveal that there is no statistically significant difference
between the results of any of the groups 2, 4, 6, and 8 (0, 1, 3,
and 6 weeks, respectively) (min. p value was 0.11).
When considering week 6 versus week 13, there is a significant difference
(F(1,8) = 6.317, p = 0.0362). The
results demonstrate that the mechanical properties of the balloons
are not influenced by exposure to EtO. This also correlates with results
from the in vitro fatigue test, which shows that the mechanical properties
of the balloons remain the same when subjected under a constant cyclic
loading for more than 8 weeks.[70]
Figure 4
Maximum load
applied on the balloons until failure. The balloons
were kept in closed glass containers (separate container per balloons),
and pH levels were monitored to be 7.4 ± 0.2 throughout the test
period. After a certain time period, the balloons were taken out from
the aqueous medium and further examined under applied loading.
Maximum load
applied on the balloons until failure. The balloons
were kept in closed glass containers (separate container per balloons),
and pH levels were monitored to be 7.4 ± 0.2 throughout the test
period. After a certain time period, the balloons were taken out from
the aqueous medium and further examined under applied loading.
Conclusions
Our study clarifies the
impacts of EtO and γ-radiation sterilization
on the safety and performance of absorbable PLCL-based balloon implants.
γ-Radiation sterilization results in a change in the material
properties in balloons. Apparently, the molecular weight (Mw, Mn, and PDI)
and η for the PLCL material decrease significantly after radiation
sterilization. Because most medical devices are constructed from biodegradable
polymers, a decrease in the molecular weight distribution increases
the risk of early degradation after γ-sterilization. On the
other hand, EtO sterilization does not disturb polymer material properties.
No change in the molecular weight distribution and η was observed
for EtO-treated PLCL.In conclusion, we recommend EtO sterilization
for PLCL-based medical
devices because it has been compatible with the polymer in this experimental
study. These considerations are critical to balloon performance because
complete assurance that failures will not occur during the defined
time-period is a major concern.
Material and Methods
Materials
PLCL (70:30) (Resomer LC703S)
was obtained from Evonik, Germany. Water and DCM HPLC grade were purchased
from Bio-Lab, Jerusalem, Israel. Agarose was obtained from Merck,
Israel.
Balloon Preparation
PLCL balloons
were prepared using a multicycle dip-coating process.[1] As shown in Scheme , the balloons were prepared by dipping a balloon-shaped agarose
template into 14% w/v PLCL (70:30) in DCM solution and drying the
polymer-coated template under a nitrogen atmosphere. The agar was
then removed by immersing the coated cast into hot water and drying
again. The final balloons were kept under sealed dry conditions.
Scheme 1
Steps Involved in the Preparation of PLCL Balloons
Methods
PLCL balloons were tested
for their molecular stability using different terminal sterilization
methods. In this study, the control balloons were those without sterilization.EtO sterilization
is a low-temperature sterilization procedure that can be applied to
a wide range of materials. It is the preferred alternative to irradiation
for heat-labile medical devices and pharmaceutical-packaging components.
The EtO sterilization process utilizes EtO gas that has bactericidal,
sporicidal, and virucidal effects. The basic EtO sterilization cycle
was followed according to the standard guidelines consisting of five
stages: preconditioning and humidification, gas introduction, exposure,
evacuation, and air washes.[71] Mendes et
al.[72] provide detailed guidelines for the
safe and effective use of EtO sterilization for medical devices. In
this study, the EtO sterilizations were performed in Mediplast Israel
Ltd. (Yavne, Israel) following EN ISO-11135:2007, EN ISO-13485, and
ISO-9001:2008 guidelines. ISO 11135 specifies the requirements for
the development, validation, and routine control of the EtO sterilization
process for medical devices in both the industrial and health care
facility settings. Cingolani et al.[73] describe
the details of the EtO sterilization of PLCL material based on the
guidelines of ISO 1135.Briefly, the samples were preconditioned
for 15 h at 45 ± 5 °C in 50–80% of relative humidity
in a separate chamber. Thereafter, the samples were placed in the
EtO sterilization chamber. During the sterilization cycle, inside
the sterilization chamber, preconditioning is done for 3 h at 45 ±
5 °C and a vacuum of −0.8 ± 0.05 bar. Then, the product
is exposed to a gas mixture of 90% EtO and 10% CO2 for
6 h. The quantity of sterilant is 10.04 ± 0.315 kg. The degassing
step is followed by seven cycles of vacuuming to −0.8 to 0.8
± 0.05 bar with each vacuuming cycle involving 10–15 min.
Radiation Sterilization
Radiation
sterilization, a γ-sterilization, is perhaps the most popular
procedure for the terminal sterilization of bioabsorbable polymer-based
medical devices that can occur at low temperature. Radiation sterilization
utilizes ionizing radiation from a cobalt-60 (60Co) isotope
source or machine-generated accelerated electrons. The most commonly
validated dose used to sterilize medical devices is 25 kGy.[74−76] In this study, γ-sterilization was performed at Sorvan Radiation
Ltd. (Yavne, Israel), according to the international standards ISO
11137 and EN 552. The samples were subjected to 60Co γ-irradiation
at a dose of 25 kGy (2.5 Mrad). Details of the radiation sterilization
of PLCL material based on the guidelines of ISO 1137 are provided
elsewhere.[73]
Differential Scanning Calorimetry
The thermal properties of PLCL in the EtO and radiation-treated balloons
were measured by a DSC-1, Mettler Toledo instrument under a nitrogen
atmosphere. Each sample of about 8 mg in an aluminum crucible was
heated from 25 to 200 °C at a scan rate of 10 °C/min. Each
sample was run in triplicate. The results are presented as the average
data.
Gel Permeation Chromatography
Molecular
weight distributions of the PLCL before and after sterilization were
determined by GPC equipped with a Waters 1515 isocratic HPLC pump,
L-7490 refractive index detector (Hitachi), and a Rheodyne (Cotati,
CA) injection valve with a 20 μL loop. Polymer samples (5 mg)
were dissolved in 2 mL chloroform. Samples were tested in triplicate.
Each sample was filtered through a 0.45 μm filter directly into
the GPC vials. Samples were eluted with chloroform (HPLC grade) through
a linear Styragel column, HR4 (Waters, MA) at a flow rate of 1 mL/min.
Molecular weights were determined relative to polystyrene standards
(PolyScience, Warrington, PA). Calibration curve and calculations
were performed using Empower Software (Murrieta, CA, USA).
Inherent Viscosity (η) Measurements
One full-thickness section from each balloon was dissolved in chloroform
to a concentration of 1.0% (w/v). Viscosity was measured using Cannon
Ubbelohde Semi-Micro N223 with 50 μm capillary diameter at 25.0
± 1.0 °C.The η was calculated according to
the following equation (eq )where η = inherent viscosity, ηrel = relative viscosity, and C = mass concentration
of the polymer (g/dL).
Authors: Ji Hoon Park; Bo Keun Lee; Seung Hun Park; Mal Geum Kim; Jin Woo Lee; Hye Yun Lee; Hai Bang Lee; Jae Ho Kim; Moon Suk Kim Journal: Int J Mol Sci Date: 2017-03-21 Impact factor: 5.923