Calcification is a frequent cause of the clinical failure of bioprosthetic heart valves fabricated from glutaraldehyde pretreated bovine pericardium (GABP). The present investigation describes the influence of steroid hormones in the mineralization of GABP, in an extra-circulatory environment. Calcification was studied on GABP incubation in a metastable solution of calcium phosphate containing steroid hormones such as estrone, progesterone, 7(OH) progesterone, testosterone and β-estradiol. It is interesting to note that certain steroids can variably increase the GABP calcification. Further, the effect of these steroids in an in vitro hydroxyapatite (HA) formation was investigated. In addition, we observed these steroids alter the calcium transport through GABP in diffusion experiments and also in HA formation. Therefore, it is conceivable that prolonged use of steroids or steroids containing oral contraceptive agents may not be advisable for patients having bioprosthetic implants in contact with blood. A better understanding of the mechanism of these drugs under in vivo conditions is needed to develop applications.
1. Levy, R.J., Schoen F.J., Flowers W.B. and Staelin, S.T.1991. “Inhibition of mineralization in bioprosthetic heart valves: Studies of alkaline phosphatase activity and its inhibition by AlCl3 or FeCl3 pre-incubation.”J. Biomed. Mater. Res., 23: 905–935.
2.
2. Levy, R.J., Schoen F.J. and Golomb G.1986. “Bioprosthetic heart valve calcification: Clinical features, pathobiology and prospects for prevention.”CRC Crit. Rev. Biocompat., 2: 147–187.
3.
3. Schoen F.J.1987. “Biomaterial-associated infection neoplasia and calcification—clinicopathologic features, and pathophysiologic concepts.”Trans. Am. Soc. Artif. Intern. Organs, 33: 8–18.
4.
4. Schoen F.J., Tsao J. and Levy R.J.1986. “Calcification of bovine pericardium used in cardiac valve prostheses: role of glutaraldehyde modified structural components in bioprosthetic tissue mineralization.”Am. J. Pathol. 123: 134–145.
5.
5. Vroman L., Adams A., Klings M., Fisher C., Munos P. and Solensky R.1977. “Reaction of formed elements of blood with plasma proteins at interfaces.”Ann NY Acad. Sci.283: 65–76.
6.
6. Ambrus, C.M, Niswander, K.R., Courey, N.G. and Minkl, B.1970. “Effect of contraceptive drugs on the blood coagulation system.”Hacmatol Rev. 21: 163–181.
7.
7. Hahn, T.J.1989. “Steroid hormones and the skeleton” in Metabolic Bone Disease: Cellular and Tissue Mechanism, Tam C.S., Heersche J.N.M. and Murray T.M. Eds., CRC Press, Boca Raton, FL, pp 223-223.
8.
8. Chandy T. and Sharma, C.P.1986. “Antibiotic reversal of surface fibrinogen interaction changes with lymphocytes”, Edited by Nose, Y., Kjellstrand, C. and Ivanovich, P., Progress in artificial organs, Cleveland: ISAO Press, 969–974.
9.
9. Chandy, T. and Sharma, C.P.1988. “Changes in albumin/platelet interaction with an artificial surface due to antibiotics pyridoxal phosphate and lymphocytes.”Artif. Organs, 12: 143-151.
10.
10. Sharma, C.P. and Hari, P.R.1991. “The effect of anesthetics and analgesis on protein adsorption, platelet adhesion and plasma recalcification time at blood polymer interface.”Artif. Organs, 15: 498-506.
11.
11. Chandy, T., Vasudev, S.C. and Sharma, C.P.1996. “Changes in polyurethane calcification due to antibiotics.”Artif. Organs, 20(7): 752–760.
12.
12. Chandy, T. and Sharma, C.P.1991. “Influence of antihypertensive drugs and steroid hormones on protein adsorption/desorption of polycarbonate.”Artif. Organs, 15(3): 198–205.
13.
13. Pasquino, E., Pascale, S., Anderson, M., Pinaldi, S., Laborde, F. and Galloni, M.1992. “Bovine pericardium for heart valve bioprostheses in vitro and in vivo characterization of new chemical treatments.”J. Mater. Sci. Mater. Med., 3: 272–277.
14.
14. Courtman, D.W, Pereira, C.A, Kashef, V, McComb, D., Lee, J.M. and Wilson, G.J.1994. “Development of a pericardial acellular matrix biomaterial, biochemical and mechanical effects of cell extraction.”J. Biomed. Matrix. Res., 28: 655–666.
15.
15. Golomb, G. and Wagner, D.1991. “Development of a new in vitro model for studying implantable polyurethane calcification.”Biomaterials, 12: 397–405.
16.
16. Vasudev, S.C. and Chandy T.1997. “ Effect of alternative crosslinking techniques on the enzymatic degradation of bovine pericardium and their calcification.”J. Biomed. Mater. Res., 35: 357–369.
17.
17. Varley, H., Gowenlock, A.H. and Bell, M.1980. Practical clinical chemistry. Vol. 1. London, UK, Heinemann Medical Books, 858-858.
18.
18. Kim, S.W., Wisniewski, S., Lee, E.S. and Winn, M.L.1977. “Role of protein and fatty acid adsorption on platelet adhesion and aggregation at the blood polymer interfaces.”J. Biomed. Mater. Res., 11: 23–31.
19.
19. Donnelly, R. and Boskey, A.1989. “The effect of gallium on seeded hydroxyapatite growth.”Calcif. Tissue Int., 44: 138–142.
20.
20. Gelder, J.M.V., Breuer, E., Ornoy, A., Schlossman, A., Patlas, N. and Golomb, G.1995. “Anticalcification and antiresorption effects of Bisacyl phosphonates.”Bone, 16(5): 511–520.
21.
21. Chen, W., Schoen, F.J. and Levy, R.J.1994. “Mechanism of efficacy of 2-amino oleic acid for inhibition of calcification of glutaraldehyde—pretreated porcine bioprosthetic heart valves.”Circulation, 90: 323–329.
22.
22. Thoma, R.J.1987. “Poly (ether) urethane reactivity with metal ion in calcification and environmental stress cracking.”J. Biomater. Appl., 11: 449–486.
23.
23. Wouters, L.H.G., Rousseau, E.P.M., Van Steenhoven, A.A. and German, A.L. 1986. “An experimental set up for the in vitro analysis of polyurethane calcification.” Preprint from: Proceedings of 2nd International Conference on Polyurethane in Biomedical Engineering, Germany: Fellbach/Stuttgart, Germany.
24.
24. Chandy, T. and Sharma, C.P.1994. “Anesthetic and ferric-magnesium ion combinations as calcium antagonists for glutaraldehyde-treated pericardial tissues.”Clinical Materials, 17: 165–172.
