Endothelial and smooth muscle cell interaction with hydrothermally treated titanium surfaces

Cardiovascular diseases (CVDs) remain the leading cause of death worldwide, and the most common form is coronary artery disease (CAD). Treatment options include coronary artery bypass surgery (CABG) or percutaneous heart intervention (PCI), but both have drawbacks. Bare metal stents (BMS) are commonly used to treat CAD; however, they lead to restenosis. Drug-eluting stents (DES) were developed to overcome this limitation; however, they lead to late thrombosis. Hence, there is an urgent need to engineer stent surfaces that selectively prevents smooth muscle cell adhesion and proliferation (restenosis), while promoting endothelial cell adhesion and differentiation (endothelialization), thus enhancing hemocompatibility. In this study, hydrothermal treatment with either sodium hydroxide or sulfuric acid was used to modify the surface of titanium. Titanium surface treated with sulfuric acid led to a micro-nano-surface morphology that selectively promoted endothelial cell adhesion and differentiation while prevented smooth muscle cell proliferation.