Nitric oxide-releasing dextran surface with enhanced albumin affinity mitigates infection and foreign body reaction

Medical device surfaces often lack the blood compatibility and features of native endothelium, leading to issues from blood-material interactions and infection. Procoagulant plasma proteins rapidly adsorb to these surfaces, triggering the coagulation cascade. Concurrently, bacteria may adhere to these foreign surfaces, developing biofilms. To address these issues, we developed a hybrid nitric oxide (NO)-releasing material by integrating the NO donor S-nitroso-N-acetylpenicillamine into polydimethylsiloxane (PDMS), followed by its surface functionalization with blue dextran (NOBD). Blue dextran preferentially binds albumin, reducing adsorption of other plasma proteins as well as its selective displacement, thereby minimizing coagulation cascade activation. Simultaneously, NO release inhibits platelet activation and enables antimicrobial protection. Surface characterization confirmed the stability of the NOBD technology over 24 h under physiological conditions. In kinetics studies, NO release rates remained within vascular levels (0.5-4.0 × 10^-10 mol cm^-2 min^-1). NOBD materials showed both biocompatibility with mouse fibroblasts and hemocompatibility with porcine erythrocytes. Compared to unmodified control materials, NOBD reduced fibrinogen adsorption and platelet attachment by over 80 %. Additionally, NOBD surfaces eradicated >80 % Escherichia coli and >97 % Staphylococcus aureus adherent bacteria compared to controls. These findings suggest that the NOBD technology offers a promising strategy for enhancing the biocompatibility and antimicrobial performance of blood-contacting medical devices.