Uc Biomaterials Quiz 3: Cell/biomaterial Interaction And Biocompatibility

Front 1

What are five elements of the foreign body reaction.

Back 1

1. Multinucleated foreign body giant cells

2. Macrophages

3. Fibroblasts

4. Capillaries

5. Multinucleated foreign body giant cellsform upon coalescence of macrophages.

Front 2

What are three inflammatory stimuli that lead to chronic inflammation?

Back 2

1. Chemical and Physical properties of biomaterial

2. Motion in the implant site

3. Confined to the implant site

Front 3

What are two types of cells that merge to become foreign body giant cells?

Back 3

1. Macrophages

2. Monocytes

Front 4

What are three types of surfaces found in biomaterials?

Back 4

1. Flat and smooth surfaces

2. Relatively rough surfaces

3. Rough surfaces

Front 5

What is a foreign body reaction to a flat and smooth surface?

Back 5

A layer of macrophages one or two cells in thickness.

Front 6

What is a foreign body reaction to a relatively rough surface.

Back 6

Composed of multiple layers of macrophages and foreign body giant cells at the surface.

Front 7

What is a foreign body reaction to rough surfaces?

Back 7

Composed of macrophages and foreign body giant cells with varying degrees of granulation tissue.

Front 8

What is the end stage of the healing process usually extending four or more weeks after implantation?

Back 8

Fibrous Encapsulation

Front 9

What does the presence of neutrophils during the fibrous encapsulation stage of healing suggest?

Back 9

Persisiting Inflammatory Challenge

Front 10

What does the presence of macrophages likely suggest during fibrous encapsulation?

Back 10

Production of small particles by corrosion, depolymerization, dissolution or wear.

Front 11

What does the presence of lymphocytes likely suggest during fibrous encapsulation?

Back 11

Specific Immune Response

Front 12

What are three factors that determine the wall thickness of a fibrous capsule?

Back 12

1. Chemical Activity Rate of the material.

2. Motion between implant and tissue

3. Shape of implant (Thicker over sharp edges)

Front 13

What are the three possible outcomes for an implant?

Back 13

1. Resorption

2. Integration

3. Encapsulation

Front 14

What are the 7 steps that follow implantation which ultimately end in scar formation or capsule development?

Back 14

1. Injury

2. Hemostasis

3. Inflammation

4. Acute Inflammation

5. Proliferation

6. Remodelling

7. Scar Tissue or Fibrous Capsule Development

Front 15

What are the 7 steps that follow implantation which ultimately end in Foreign Body Giant Cell Formation?

Back 15

1. Injury

2. Hemostasis

3. Inflammation

4. Acute Inflammation

5. Chronic Inflammation

6. Proliferation

7. Foreign Body Giant Cell Formation

Front 16

Describe neutrophil activity levels during host response to implant?

Back 16

They are the first cells to arrive on the site.

Peak hours after injury (During acute stage) and decline in number after that.

Front 17

Describe Macrophage activity levels during host response to implant?

Back 17

Second type of cell on site.

Begin to appear hours after injury during the acute stage and gradually grow and peak during the granulation tissue stage

Front 18

Describe Foreign Body Giant Cell activity levels during host response to implant?

Back 18

Third cell type to appear.

Start to appear days after injury during the chronic phase and peak during the granulation tissue stage

Front 19

Describe fibroblasts activity levels during host response to implant?

Back 19

Fourth cells type to appear.

Start to appear between days and weeks after injury and peak during the granulation tissue stage.

Front 20

What are 3 serious complications that can occur as a result of presence of biomaterials in the body?

Back 20

1. Hypersensitivity

2. Infection

3. Tumorigenesis

Front 21

This term is also known as an allergic reaction. It is an undesired immune response mediated by the adaptive immune response. It is typically defined as unusual, excessive, or uncontrolled.

Back 21

Hypersensitivity

Front 22

This type of complication associated with implants typically displays at least one of the following characteristics: Presence of biomaterial, Bacterial colonization of tissue, Resistance to host defence mechanisms and antibiotic treatment, presence of multiple bacteria species, absence of integration of biomaterial with the host, presence of cell damage.

Back 22

Infection

Front 23

What are 6 signs of infection as a result of implantation?

Back 23

1. Presence of biomaterial

2. Bacterial colonization of tissue

3. Resistance to host defence mechanisms and antibiotic treatment

4. Presence of multiple bacteria species

5. Absence of integration of biomaterial with the host

6. Presence of cell damage

Front 24

What are the 4 stages of the development of implant associated infection?

Back 24

1. Attachment

2. Adhesion

3. Aggregation

4. Dispersion

Front 25

Which stage of infection involves bacterial attachment to surface through nonspecific interaction between pathogen and surface?

Back 25

Attachment

Front 26

Which stage of infection involves the preliminary attachments becoming permanent through the formation of receptor-ligand interaction?

Back 26

Adhesion

Front 27

Which stage of infection involves the formation of a biofilm which protects the micro organisms from phagocytosis and provide a favorible environment for the microbes to grow?

Back 27

Aggregation

Front 28

Which stage of infection involves the bacteria travelling away from the colony to otherr areas of the body.

Back 28

Dispersion

Front 29

This type of complication associated with implants typically presents as the formation of a mass of uncontrolled proliferating cells.

Back 29

Tumorigenesis

Front 30

What are three stages of tumorigenesis?

Back 30

1. Initiation

2. Latency

3. Promotion

Front 31

This stage of tumorigenesis involves the implantation of the biomaterial which leads to a malignant transformation of DNA.

Back 31

Initiation

Front 32

This stage of tumorigenesis invlves the obvious presence of tumor growth around the implant.

Back 32

Promotion

Front 33

What are two main pathways for malignant transformations?

Back 33

1. Chemical Carcinogenesis

2. Foreign Body Carcinogenesis

Front 34

This type of malignant transformation is possible near the biomaterial since the tumors are likely a result of substance being leached from the implant.

Back 34

Chemcal Carcinogenesis

Front 35

This type of malignant transformation may be related to surface or bulk properties of the implant or alterations in the local environment?

Back 35

Foreign Body Carcinogenesis

Front 36

What are five possible causes of foreign body carcinogenesis?

Back 36

1. Bulk chemical properties of the implant

2. Physiochemical surface properties of the implant

3. Viral contamination of the implant

4. Interruption of cellular communication due to the presence of the implant

5. Local tissue damage leading to insufficient nutrient exchange

Front 37

This type of tumor is a neoplasm of glandular epithelium and can be benign or melignant.

Back 37

Adenoma

Front 38

This type of tumor is a cancer arising in an epithelium and account for 90 percent of human cancers.

Back 38

Carcinoma

Front 39

This type of tumor is a cancer arising in mesenchyme derived tissue (i.e. connective tissue and muscle).

Back 39

Sarcoma

Front 40

Why has the definiton of biocompatibly materials been changed from inert material to include material with minimal interaction with their environment.

Back 40

It is unlikely to find a material that is totally inert, but the physiological response to any biomaterial is kept within acceptable bounds.

Front 41

What type of materials will produce a higher ratio of macrophages and foreign body giant cells than smooth components?

Back 41

High surface area to volume ratio fabrics and porous structures

Front 42

Provide 3 examples of bulk properties.

Back 42

1. Chemical properties

2. Structure

3. Purity and presence of leachables

Front 43

Provide 4 examples of surface properties

Back 43

1. Smoothness

2. Geometry

3. Hydrophilicity

4. Surface Charge

Front 44

Provide 3 examples of mechanical properties of biomaterials.

Back 44

1. Elastic Modulus

2. Stability

3. Fixation

Front 45

Provide 4 examples of long-term structural integrity properties to design for in biomaterials.

Back 45

1. Fatigue and fracture loading

2. Wear

3. Creep

4. Stress corrosion cracking

Front 46

Provide 4 examples of systemic effects caused by implants.

Back 46

1. Embolization (Leading to blood vessel occlusion)

2. Hypersensitivity

3. Implant elements in blood

4. Lymphatic particle transport

Front 47

Provide 4 ways that a host can physically affect an implant.

Back 47

1. Abrasive, adhesive, and delamination wear

2. Fatigue and fracture

3. Stress corrosion cracking

4. General corrosion

Front 48

Proved 3 ways that a host can biologically affect an implant.

Back 48

1. Absorption of substances from the tissue

2. Enzymatic degredation

3. Calcification

Front 49

What are 3 host factors that determine the success of an implant.

Back 49

1. Age and health status of patient

2. Immunological/metaboloc status of host

3. Effectiveness of surgeon

Front 50

What are 7 components of biocompatibility testing that help characterize and evaluate the structure and response relationship of the biomaterial as well as the reproducability of the results?

Back 50

1. Cell toxicity

2. Thrombogenecity

3. Inflammatory Response

4. Animal Tests

5. Clinical Trials

6. FDA Regulations

7. ASTM/ISO standard

Front 51

What is the main goal of level I biocompatibility testing? What are four elements that help accomplish this?

Back 51

Bulk-characterization tests to identify the polymer and confirm it meets specifications

Elements involve tests for:

1. Surface topography

2. Cleanliness

3. Chemical structure and composition

4. Toxixity

Front 52

What is the main goal of level II biocompatibility testing? What are three elements that help accomplish this?

Back 52

Gathering detailed information of specific elements of structural and functional behavior that may relate to performance.

Elements involve tests for:

1. Surface chemistry

2. Morphology

3. Interfacial properties

Front 53

What is the first event in blood-surface interactions and is crucial in understanding surface-induced thrombosis?

Back 53

Adsorption of plasma proteins

Front 54

What are four types of In Vitro tests for estimating biocompatibility?

Back 54

1. Cytotoxicity

2. Hemocompatibility

3. Mutagenicity

4. Hypersensitivity

Front 55

What are three examples of cytotoxicity test?

Back 55

1. Elution or extraction test

2. Agar or agarose test

3. Direct contact test

Front 56

What are two examples of hemocompatibility tests?

Back 56

1. Hemolysis test

2. Clotting and complement activation

Front 57

Provide an example of a Mutagenecity test

Back 57

Ames Test

Front 58

Provide two examples of hypersensitivity test.

Back 58

1. Lymphocyte transformation test

2. Leukocyte migration inhibition test

Front 59

The abilty to cause death or damage at the cellular level by direct cell lysis or by fatally altering cellular metabolism?

Back 59

Cytotoxicity

Front 60

Which cytotoxicity test aims to determine toxic doses and changes in cell growth or proliferation by comparing to non treated cells over a 24 to 72 hour period?

Back 60

Elution Test

Front 61

Which cytotoxicity test is performed by placing the the material over a layer of agar/agarose and covering cells for 24 hours. Components of the material diffuse through the layer to the cell and the cytotoxicity of the diffusable materials is measured.

Back 61

Agar Overlay Test

Front 62

Which cytotoxicity test is performed by measuring changes in cell growth or proliferation in a manner similar to the elution test?

Back 62

Direct contacct test.

Front 63

What type of test is used to evaluate the effect of material on blood coagulation processes, thrombus formation, and hemolysis (Destruction of RBCs)?

Back 63

Hemocompatibility Tests

Front 64

What is a material called that modifies the genome of a host (Also called genotoxic).

Back 64

Mutagenes

Front 65

Which genotoxicity test uses a mutant line of bacteria (Usually salmonella or E. Coli) that must be supplied with histadine to grow and are cultured in a histadine free environment. This test checks for materials that that mutate the bacteria back to a histadine independant state.

Back 65

Ames Test

Front 66

The leukocyte migration inhibition and lymphocyte transformational test which estimate delayed hypersensitivity reaction to implant materials and their released components are examples of what type of test?

Back 66

Hypersensitivity test

Front 67

What are four types of in vivo tests?

Back 67

1. Short-term implantation tests

2. Long-term functional tests

3. Sensitization tests

4. Irritation tests

Front 68

Which type of in vivo test involves subcutaneous, intramuscular and intraperitoneal implantation tests to evluate general tissue necrosis, fibrosis and inflammation.

Back 68

Short-term implantation tests

Front 69

Which type of in vivo test uses the device or compositionally identical prototypes to simulate intended end-use in an animal model and then test for functionality and histopathological evaluation.

Back 69

Long-term functional test

Front 70

Which in vivo test invovles guinea pigs, occluded patch tests, and open epicutaneous tests?

Back 70

Sensitization

Front 71

Which in vivo test checks for skin, ocular, and mucosal irritation?

Back 71

Irritation test

Front 72

What are 5 types of animal tests?

Back 72

1. Nonfunctional tests

2. Function tests

3. Genotoxicity tests

4. Cancerogenity tests

5. Irritation test

Front 73

What are the negative systemic effect of animal testing with regards to implantion?

Back 73

Chemicals released from implant materials are distributed by blood and lymphatic system and damage organs and tissues.

Front 74

What are the 4 categories of the systemic effects that result from animal testing?

Back 74

1. Acute (24 hrs)

2. Sub-Acute (14-28 days)

3. Sub-Chronic (10% of animal's life span)

4. Chronic (Longer than 10% of an animmal's life span)

Front 75

What is the standard practice for running a clinical trial for a new drug.

Back 75

A double-blind study in which a placebo is randomly distributed.

Front 76

Why is the standard practice for drug related clinical trials not possible to be used for implants?

Back 76

It is not possible to conceal an implant (Or lack thereof) from the patient and/or the surgeon (Double blind practice is not possible).

Front 77

How many phases are in a typical clinical trial.

Back 77

Three

Front 78

What does Phase 1 of a clinical trial usually involve?

Back 78

Biomaterial being tested on a small group (60-80 people)

Front 79

What does Phase 2 of a clinical trial usually involve?

Back 79

Biomaterial being tested on large group (100-300 people)

Front 80

What does Phase 3 of a clinical trial usually involve?

Back 80

Comparison of the effectiveness of the new treatment with a standard of management (1000-3000)

Front 81

Which animal test looks for alterations in DNA or chromosomal structure or other DNA or gene damage that results in permanent inheritable changes in cell function.

Back 81

Genotoxicity Test

Front 82

What type of animal is usually used to harvest opthalmological materials for an Ocular irritation test?

Back 82

Rabbit

Front 83

Which type of animal test involves determining whether chemicals or compounds that may be released from biomaterials elicit sensitization reactions (i.e. redness and swelling).

Back 83

Cancergenity Test