Preparation and characterization of injectable fibrillar type I collagen and evaluation for pseudoaneurysm treatment in a pig model  Paul J. Geutjes,

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Preparation and characterization of injectable fibrillar type I collagen and evaluation for pseudoaneurysm treatment in a pig model  Paul J. Geutjes, MSc, J. Adam van der Vliet, MD, PhD, Kaeuis A. Faraj, PhD, Noes de Vries, MPharm, Herman T.B. van Moerkerk, BSc, Ronnie G. Wismans, MSc, Thijs Hendriks, PhD, Willeke F. Daamen, PhD, Toin H. van Kuppevelt, PhD  Journal of Vascular Surgery  Volume 52, Issue 5, Pages 1330-1338 (November 2010) DOI: 10.1016/j.jvs.2010.05.118 Copyright © 2010 Society for Vascular Surgery Terms and Conditions

Fig 1 Morphology and length of purified type I collagen fibrils. Scanning and transmission electron micrograph of purified type I collagen fibrils (A) and (B), respectively, and the distribution of fibril length (μm) in the collagen preparation (C). Results are mean ± SD of three separate experiments. Bar in (A) is 1 μm and inset is 0.2 μm. Bar in (B) is 0.2 μm. Journal of Vascular Surgery 2010 52, 1330-1338DOI: (10.1016/j.jvs.2010.05.118) Copyright © 2010 Society for Vascular Surgery Terms and Conditions

Fig 2 Effect of sterilization procedure on the integrity of collagen. SDS-PAGE under reducing conditions of fibrillar type I collagen before (lane 1) and after (lanes 2-4) sterilization, viz.: ethylene oxide gas sterilization (lane 2), hydrogen peroxide (H2O2) gas sterilization (lane 3), or gamma irradiation (lane 4). The low molecular weight marker is visualized in lane 5. This is a combined image taken from two separate gels (lanes 1, 2, and 4 are from one gel). Note that especially after gamma sterilization, collagen degradation products are observed. Journal of Vascular Surgery 2010 52, 1330-1338DOI: (10.1016/j.jvs.2010.05.118) Copyright © 2010 Society for Vascular Surgery Terms and Conditions

Fig 3 Effect of sterilization on platelet aggregation of fibrillar collagen. Collagen before sterilization was set on 1 arbitrary unit (AU). Results are mean ± SD for three separate experiments. Sterilized collagen showed no statistical significant differences in comparison to nonsterilized collagen (P > .05). EtO, Ethylene oxide gas sterilization; Gamma, gamma irradiation; H2O2, hydrogen peroxide sterilization. Journal of Vascular Surgery 2010 52, 1330-1338DOI: (10.1016/j.jvs.2010.05.118) Copyright © 2010 Society for Vascular Surgery Terms and Conditions

Fig 4 Evaluation of injectability. Macroscopic image of the displacement test set up with type I collagen suspension in a 1 mL syringe (A). Graph of displacement test (1.8 mm/s with maximal distance 44 mm) of 3%, 4%, and 5% (w/v) type I collagen suspension in a 1 mL syringe with a 2F (0.7 mm) needle (B). On the Y-axis, force is given in Newton, and on the X-axis displacement is shown in mm. Results are mean ± SD of three separate experiments. The white arrow and white dashed line indicate the 1 mL syringe in the displacement set up. The black arrow and dashed circle indicate the pressure plate. Journal of Vascular Surgery 2010 52, 1330-1338DOI: (10.1016/j.jvs.2010.05.118) Copyright © 2010 Society for Vascular Surgery Terms and Conditions

Fig 5 Aggregation of injectable collagen under physiologic conditions. Macroscopic images of 4% (w/v) type I collagen suspension in MilliQ water (A) and the network that was formed directly after injection of the type I collagen in pre-heated (37°C) phosphate buffered saline (PBS, pH 7.4) (B). Scanning electron microscopic images after applying a 0.5% (w/v) collagen suspension in MilliQ water or in PBS, resulting in an open fibril network (C) and an aggregated fibril network (D), respectively. Under physiologic conditions (PBS, 37°C), the collagen fibrils formed a dense network. Arrows in (A) and (B) indicate the aggregated type I collagen suspension. Arrowheads for (D) indicate the aggregated collagen fibrils. Bar is 10 μm in (C) and (D). Journal of Vascular Surgery 2010 52, 1330-1338DOI: (10.1016/j.jvs.2010.05.118) Copyright © 2010 Society for Vascular Surgery Terms and Conditions

Fig 6 Angiograms of the porcine femoral pseudoaneurysm (PSA) (animal no. 6) at day 4 before collagen injection (A) and at day 10 (6 days after collagen injection) (B). Tweezers were positioned on the PSA segment (white arrowheads). In (A), the PSA was open. In (B), it was closed after collagen injection. White arrows indicate the direction of arterial blood flow in the femoral artery (FA). Journal of Vascular Surgery 2010 52, 1330-1338DOI: (10.1016/j.jvs.2010.05.118) Copyright © 2010 Society for Vascular Surgery Terms and Conditions

Fig 7 Macroscopic image of cross-sectioned pseudoaneurysm (PSA) model, 6 days after collagen injection (animal no. 1, day 10). FA, Femoral artery; PSA, pseudoaneurysm model with thrombus; c, injected type I collagen suspension (4% [w/v] in MilliQ water). The white dashed lines indicate the boundary of the PSA wall. Bar indicates 5 mm. Journal of Vascular Surgery 2010 52, 1330-1338DOI: (10.1016/j.jvs.2010.05.118) Copyright © 2010 Society for Vascular Surgery Terms and Conditions

Fig 8 Microscopic images of coagulated pseudoaneurysm (PSA) model (luminal site) 6 days after type I collagen injection. Hematoxylin-eosin stained sections showed a clotted PSA filled with type I collagen (c) and coagulated blood cells (black arrows) (A) and (B). The wall of the PSA is indicated by dashed line (A). Leukocytes were found within the collagen network (white arrows) (B). c, Collagen network. Bar indicates 500 μm in (A) and 50 μm in (B). Journal of Vascular Surgery 2010 52, 1330-1338DOI: (10.1016/j.jvs.2010.05.118) Copyright © 2010 Society for Vascular Surgery Terms and Conditions