Lubricity, wear prevention, and anti-biofouling properties of macromolecular coatings for endotracheal tubes

Macromolecular coatings can improve the surface properties of many medical devices by enhancing their wetting behavior, tribological performance, and anti-biofouling properties - and covalent coatings produced from mucin glycoproteins have been shown to be very powerful in all those aspects. However, obtaining highly functional mucin glycoproteins is, at the moment, still a time-consuming process, which renders mucins rather expensive compared to other biomacromolecules. Here, we study a set of commercially available macromolecules that have the potential of substituting mucins in coatings for endotracheal tubes (ETTs). We present an overview of the different properties these macromolecular coatings establish on the ETT surface and whether they withstand storage or sterilization processes. Our study pinpoints several strategies of how to enhance the lubricity of ETTs by applying macromolecular coatings but also demonstrates the limited anti-biofouling abilities of well-established macromolecules such as hyaluronic acid, polyethylene glycol, and dextran. Based on the obtained results, we discuss to what extent those coatings can be considered equivalent alternatives to mucin coatings for applications on medical devices - their applicability does not have to be limited to ETTs, but could be broadened to catheters and endoscopes as well. Macromolecular coatings on endotracheal tubes are tested regarding their lubricity, anti-biofouling activity towards cells and molecules, and stability towards sterilization and storage.