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Sabater-Martos M, Verdejo MA, Morata L, Muñoz-Mahamud E, Guerra-Farfan E, Martinez-Pastor JC, Soriano A. Antimicrobials in polymethylmethacrylate: from prevention to prosthetic joint infection treatment: basic principles and risk of resistance. ARTHROPLASTY 2023; 5:12. [PMID: 36864538 PMCID: PMC9983184 DOI: 10.1186/s42836-023-00166-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Accepted: 01/16/2023] [Indexed: 03/04/2023] Open
Abstract
BACKGROUND Excellent revisions about antibiotic-loaded bone cement (ALBC) have been recently published. In the present article, we review the principles and limitations of local antibiotic delivery in the context of recent advances in the pathogenesis of prosthetic joint infections (PJI), with particular attention paid to the potential association between ALBC and antimicrobial resistance. MAIN BODY Recalcitrance of PJI is related to the ability of pathogens to adapt to particular environments present in bone tissue and protect themselves from host immunity in different ways. Accordingly, delivery of high local antimicrobial concentrations using ALBC is needed. Most relevant clinical data showing the efficacy of ALBC for PJI prophylaxis and treatment are reviewed, and we dissected the limitations on the basis of the recent findings from animal models and suggested that aminoglycosides, in particular, could not be the best option. One of the major concerns associated with ALBC is the emergence of resistance because of theoretical prolonged exposure to low antibiotic concentrations. We summarize the mechanisms for the selection of resistant microorganisms, and we critically reviewed the evidence from animal models and clinical data from observational and registry studies and concluded that there is no evidence to support this association. CONCLUSION While waiting for better evidence from well-designed clinical trials, ALBC shows a beneficial effect as a prophylaxis in arthroplasty, and to avoid the colonization of spacers used for two-stage revision in patients with PJI. Experimental models and clinical evidence suggest the need to achieve high local antimicrobial concentrations to obtain the highest prophylactic and therapeutic effect. The current evidence does not support the risk of increasing resistance with use of ALBC. In the future, it is necessary to evaluate new carriers and different antimicrobials to improve clinical outcomes.
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Affiliation(s)
- Marta Sabater-Martos
- Department of Orthopedics and Traumatology, Hospital Clínic of Barcelona, Carrer Villarroel 170, 08036, Barcelona, Spain.
| | - Miguel A. Verdejo
- grid.410458.c0000 0000 9635 9413Department of Infectious Diseases, Hospital Clínic of Barcelona, Carrer Villarroel 170, 08036 Barcelona, Spain
| | - Laura Morata
- grid.410458.c0000 0000 9635 9413Department of Infectious Diseases, Hospital Clínic of Barcelona, Carrer Villarroel 170, 08036 Barcelona, Spain
| | - Ernesto Muñoz-Mahamud
- grid.410458.c0000 0000 9635 9413Department of Orthopedics and Traumatology, Hospital Clínic of Barcelona, Carrer Villarroel 170, 08036 Barcelona, Spain
| | - Ernesto Guerra-Farfan
- grid.411083.f0000 0001 0675 8654Department of Orthopedics and Traumatology, Hospital Vall d’Hebron of Barcelona, Passeig de la Vall d’Hebron 119, 08035 Barcelona, Spain
| | - Juan C. Martinez-Pastor
- grid.410458.c0000 0000 9635 9413Department of Orthopedics and Traumatology, Hospital Clínic of Barcelona, Carrer Villarroel 170, 08036 Barcelona, Spain
| | - Alex Soriano
- Department of Infectious Diseases, Hospital Clínic of Barcelona, Carrer Villarroel 170, 08036, Barcelona, Spain. .,University of Barcelona, CIBERINF, Carrer Casanova 143, 08036, Barcelona, Spain.
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Kern C, Pauli A, Rohnke M. Determination of Sr 2+ mobility in viscous bovine bone marrow by cryo-time-of-flight secondary ion mass spectrometry. RAPID COMMUNICATIONS IN MASS SPECTROMETRY : RCM 2022; 36:e9300. [PMID: 35312121 DOI: 10.1002/rcm.9300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 03/17/2022] [Accepted: 03/18/2022] [Indexed: 06/14/2023]
Abstract
RATIONALE In osteoporosis research, strontium ions (Sr2+ ) have emerged as promising therapeutic agent in modified bone cements for better fracture healing. Modeling of Sr2+ dispersion in bone could be used as a predictive tool for the evaluation of functionalized biomaterials in future. Therefore, determination of experimental parameters for Sr2+ transport in bone is essential. In this study, we focus on the determination of Sr2+ diffusion in viscous bovine bone marrow by time-of-flight secondary ion mass spectrometry (ToF-SIMS). METHODS For this comparatively fast diffusion (FD) experiment, a specific experimental protocol of ToF-SIMS depth profiling under cryogenic conditions was developed. The validity of our experimental approach is proven by a time-dependent experimental series. Furthermore, 2D and 3D mass spectrometric imaging analysis was used to study Sr2+ surface and bulk distribution within bovine bone marrow. RESULTS Detailed 2D and 3D mass spectrometric imaging analysis revealed that Sr2+ diffusion is slower in bone marrow areas with high intensity of lipid and fatty acid signals than in areas with less lipid content. The Sr2+ transport within this passive model can be described by Fickian diffusion. Average diffusion coefficients of Sr2+ in bovine bone marrow were obtained from diffusion profiles in FD areas (Dbovine,FD = [2.09 ± 2.39]·10-9 cm2 s-1 ), slow diffusion areas (Dbovine,SD = [1.52 ± 1.80]·10-10 cm2 s-1 ), and total area diffusion (Dbovine,TA = [1.94 ± 2.40]·10-9 cm2 s-1 ). CONCLUSIONS We were able to show that cryo-ToF-SIMS is a useful tool for the characterization of rapid diffusion in water-containing highly viscous media. To the best of our knowledge, this is the first reported experimental approach for the investigation of the distribution of low concentrated therapeutic agents in bone marrow. Overall, our results provide important insights about Sr2+ diffusion in bovine bone marrow.
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Affiliation(s)
- Christine Kern
- Institute of Physical Chemistry, Justus Liebig University Giessen, Giessen, Germany
| | - Anna Pauli
- Institute of Physical Chemistry, Justus Liebig University Giessen, Giessen, Germany
| | - Marcus Rohnke
- Institute of Physical Chemistry, Justus Liebig University Giessen, Giessen, Germany
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Kern C, Jamous R, El Khassawna T, Rohnke M. Characterisation of Sr 2+ mobility in osteoporotic rat bone marrow by cryo-ToF-SIMS and cryo-OrbiSIMS. Analyst 2022; 147:4141-4157. [DOI: 10.1039/d2an00913g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Mass spectrometric imaging approach for ex vivo monitoring of drug transport in bone sections. Cryo-ToF-SIMS depth profiling and high-resolution imaging as well as OrbiSIMS analysis revealed inhomogeneous Sr2+ transport in rat bone marrow.
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Affiliation(s)
- Christine Kern
- Institute of Physical Chemistry, Justus Liebig University Giessen, Heinrich-Buff-Ring 17, 35392 Giessen, Germany
| | - Reem Jamous
- Experimental Trauma Surgery, Faculty of Medicine, Justus Liebig University Giessen, Aulweg 128, 35392 Giessen, Germany
| | - Thaqif El Khassawna
- Experimental Trauma Surgery, Faculty of Medicine, Justus Liebig University Giessen, Aulweg 128, 35392 Giessen, Germany
| | - Marcus Rohnke
- Institute of Physical Chemistry, Justus Liebig University Giessen, Heinrich-Buff-Ring 17, 35392 Giessen, Germany
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4
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Development of Bisphosphonate-Conjugated Antibiotics to Overcome Pharmacodynamic Limitations of Local Therapy: Initial Results with Carbamate Linked Sitafloxacin and Tedizolid. Antibiotics (Basel) 2021; 10:antibiotics10060732. [PMID: 34204351 PMCID: PMC8235690 DOI: 10.3390/antibiotics10060732] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Revised: 06/10/2021] [Accepted: 06/14/2021] [Indexed: 12/24/2022] Open
Abstract
The use of local antibiotics to treat bone infections has been questioned due to a lack of clinical efficacy and emerging information about Staphylococcus aureus colonization of the osteocyte-lacuno canalicular network (OLCN). Here we propose bisphosphonate-conjugated antibiotics (BCA) using a “target and release” approach to deliver antibiotics to bone infection sites. A fluorescent bisphosphonate probe was used to demonstrate bone surface labeling adjacent to bacteria in a S. aureus infected mouse tibiae model. Bisphosphonate and hydroxybisphosphonate conjugates of sitafloxacin and tedizolid (BCA) were synthesized using hydroxyphenyl and aminophenyl carbamate linkers, respectively. The conjugates were adequately stable in serum. Their cytolytic activity versus parent drug on MSSA and MRSA static biofilms grown on hydroxyapatite discs was established by scanning electron microscopy. Sitafloxacin O-phenyl carbamate BCA was effective in eradicating static biofilm: no colony formation units (CFU) were recovered following treatment with 800 mg/L of either the bisphosphonate or α-hydroxybisphosphonate conjugated drug (p < 0.001). In contrast, the less labile tedizolid N-phenyl carbamate linked BCA had limited efficacy against MSSA, and MRSA. CFU were recovered from all tedizolid BCA treatments. These results demonstrate the feasibility of BCA eradication of S. aureus biofilm on OLCN bone surfaces and support in vivo drug development of a sitafloxacin BCA.
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Schwarz EM, McLaren AC, Sculco TP, Brause B, Bostrom M, Kates SL, Parvizi J, Alt V, Arnold WV, Carli A, Chen AF, Choe H, Coraça‐Huber DC, Cross M, Ghert M, Hickok N, Jennings JA, Joshi M, Metsemakers W, Ninomiya M, Nishitani K, Oh I, Padgett D, Ricciardi B, Saeed K, Sendi P, Springer B, Stoodley P, Wenke JC. Adjuvant antibiotic-loaded bone cement: Concerns with current use and research to make it work. J Orthop Res 2021; 39:227-239. [PMID: 31997412 PMCID: PMC7390691 DOI: 10.1002/jor.24616] [Citation(s) in RCA: 57] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Revised: 01/07/2020] [Accepted: 01/13/2020] [Indexed: 02/04/2023]
Abstract
Antibiotic-loaded bone cement (ALBC) is broadly used to treat orthopaedic infections based on the rationale that high-dose local delivery is essential to eradicate biofilm-associated bacteria. However, ALBC formulations are empirically based on drug susceptibility from routine laboratory testing, which is known to have limited clinical relevance for biofilms. There are also dosing concerns with nonstandardized, surgeon-directed, hand-mixed formulations, which have unknown release kinetics. On the basis of our knowledge of in vivo biofilms, pathogen virulence, safety issues with nonstandardized ALBC formulations, and questions about the cost-effectiveness of ALBC, there is a need to evaluate the evidence for this clinical practice. To this end, thought leaders in the field of musculoskeletal infection (MSKI) met on 1 August 2019 to review and debate published and anecdotal information, which highlighted four major concerns about current ALBC use: (a) substantial lack of level 1 evidence to demonstrate efficacy; (b) ALBC formulations become subtherapeutic following early release, which risks induction of antibiotic resistance, and exacerbated infection from microbial colonization of the carrier; (c) the absence of standardized formulation protocols, and Food and Drug Administration-approved high-dose ALBC products to use following resection in MSKI treatment; and (d) absence of a validated assay to determine the minimum biofilm eradication concentration to predict ALBC efficacy against patient specific micro-organisms. Here, we describe these concerns in detail, and propose areas in need of research.
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Affiliation(s)
- Edward M. Schwarz
- Department of Orthopaedics, Center for Musculoskeletal Research University of Rochester Rochester New York
| | - Alex C. McLaren
- Department of Orthopaedic Surgery, College of Medicine‐Phoenix University of Arizona Phoenix Arizona
| | - Thomas P. Sculco
- Department of Orthopaedic Surgery, Weill Cornell Medicine Hospital for Special Surgery New York New York
| | - Barry Brause
- Department of Infectious Diseases, Weill Cornell Medicine Hospital for Special Surgery New York New York
| | - Mathias Bostrom
- Department of Orthopaedic Surgery, Weill Cornell Medicine Hospital for Special Surgery New York New York
| | - Stephen L. Kates
- Department of Orthopaedic Surgery Virginia Commonwealth University Richmond Virginia
| | - Javad Parvizi
- Department of Orthopaedics Rothman Institute at Thomas Jefferson University Hospital Philadelphia Pennsylvania
| | - Volker Alt
- Department of Trauma Surgery University Medical Centre Regensburg Regensburg Germany
| | - William V. Arnold
- Department of Orthopaedics Rothman Institute at Thomas Jefferson University Hospital Philadelphia Pennsylvania
| | - Alberto Carli
- Department of Orthopaedic Surgery, Weill Cornell Medicine Hospital for Special Surgery New York New York
| | - Antonia F. Chen
- Department of Orthopaedics, Brigham and Women's Hospital Harvard Medical School Boston Massachusetts
| | - Hyonmin Choe
- Department of Orthopaedic Yokohama City University Yokohama Japan
| | - Débora C. Coraça‐Huber
- Department of Orthopaedic Surgery, Experimental Orthopedics, Research Laboratory for Biofilms and Implant Associated Infections Medical University of Innsbruck Innsbruck Austria
| | - Michael Cross
- Department of Orthopaedic Surgery, Weill Cornell Medicine Hospital for Special Surgery New York New York
| | - Michelle Ghert
- Division of Orthopaedic Surgery, Department of Surgery McMaster University Hamilton Ontario Canada
| | - Noreen Hickok
- Department of Orthopaedic Surgery, Department of Biochemistry & Molecular Biology Thomas Jefferson University Philadelphia Pennsylvania
| | | | - Manjari Joshi
- Division of Infectious Diseases, R Adams Cowley Shock Trauma Center University of Maryland Baltimore Maryland
| | | | - Mark Ninomiya
- Department of Orthopaedics, Center for Musculoskeletal Research University of Rochester Rochester New York
| | - Kohei Nishitani
- Department of Orthopaedic Surgery Graduate School of Medicine, Kyoto University Sakyo Kyoto Japan
| | - Irvin Oh
- Department of Orthopaedics, Center for Musculoskeletal Research University of Rochester Rochester New York
| | - Douglas Padgett
- Department of Orthopaedic Surgery, Weill Cornell Medicine Hospital for Special Surgery New York New York
| | - Benjamin Ricciardi
- Department of Orthopaedics, Center for Musculoskeletal Research University of Rochester Rochester New York
| | - Kordo Saeed
- Southampton University Hospitals NHS Foundation Trust, Department of Microbiology, Microbiology and Innovation Research Unit (MIRU) and University of Southampton, School of Medicine Southampton UK
| | - Parham Sendi
- Institute for Infectious Diseases University of Bern, Bern and Department of Infectious Diseases, Hospital Epidemiology and Department of Orthopaedics and Traumatology, University of Basel Basel Switzerland
- Department of Orthopaedics and Traumatology University Hospital Basel Basel Switzerland
| | - Bryan Springer
- Department of Orthopaedic Surgery, OrthoCarolina Hip and Knee Center Atrium Musculoskeletal Institute Charlotte North Carolina
| | - Paul Stoodley
- Department of Microbial Infection and Immunity and Orthopaedics The Ohio State University Columbus Ohio
| | - Joseph C. Wenke
- Orthopaedic Trauma Department U.S. Army Institute of Surgical Research Fort Sam Houston Texas
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Anagnostakos K, Sahan I. Are Cement Spacers and Beads Loaded with the Correct Antibiotic(s) at the Site of Periprosthetic Hip and Knee Joint Infections? Antibiotics (Basel) 2021; 10:antibiotics10020143. [PMID: 33535704 PMCID: PMC7912871 DOI: 10.3390/antibiotics10020143] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 01/26/2021] [Accepted: 01/29/2021] [Indexed: 01/22/2023] Open
Abstract
The optimal impregnation of antibiotic-loaded bone cement in the treatment of periprosthetic hip and knee joint infection is unknown. It is also unclear, whether a suboptimal impregnation might be associated with a higher persistence of infection. A total of 93 patients (44 knee, 49 hip) were retrospectively evaluated, and the most common organism was a methicillin-resistant Staphylococcus epidermidis, followed by methicillin-susceptible Staphylococcus aureus. Of all the organisms, 37.1% were resistant against gentamicin and 54.2% against clindamycin. All organisms were susceptible against vancomycin. In 41 cases, gentamicin-loaded beads were inserted and in 52 cases, spacers: (2 loaded only with gentamicin, 18 with gentamicin + vancomycin, 19 with gentamicin + clindamycin, and 13 with gentamicin + vancomycin + clindamycin). The analysis of each antibiotic impregnation showed that complete susceptibility was present in 38.7% of the cases and partial susceptibility in 28%. In the remaining 33.3%, no precise statement can be made because either there was a culture-negative infection or the antibiotic(s) were not tested against the specific organism. At a mean follow-up of 27.9 months, treatment failure was observed in 6.7% of the cases. Independent of which antibiotic impregnation was used, when the organism was susceptible against the locally inserted antibiotics or not tested, reinfection or persistence of infection was observed in the great majority of cases. Future studies about the investigation of the optimal impregnation of antibiotic-loaded bone cement are welcome.
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7
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Inceoglu S, Botimer G, Maskiewicz VK. Novel microcomposite implant for the controlled delivery of antibiotics in the treatment of osteomyelitis following total joint replacement. J Orthop Res 2021; 39:365-375. [PMID: 33222231 DOI: 10.1002/jor.24919] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 11/11/2020] [Accepted: 11/19/2020] [Indexed: 02/04/2023]
Abstract
The objective of this study was to develop a novel microcomposite implant to be used in the treatment of osteomyelitis following total joint arthroplasty, with the dual purpose of releasing high local concentrations of antibiotic to eradicate the infection while providing adequate mechanical strength to maintain the dynamic or static spacer. Vancomycin-loaded microcomposite implants were fabricated by incorporating drug-loaded microparticles comprised of mesoporous silica into commonly employed polymethylmethacrylate (PMMA) bone cement, to yield a final drug loading of 10% w/w. In vitro release kinetics at 37°C were monitored by reverse-phase high-performance liquid chromatography, and compared to the release kinetics of current therapy implants consisting of drug alone incorporated at 10% w/w directly into PMMA bone cement. Results demonstrated a sevenfold improvement in the elution profile of microcomposite systems over current therapy implants. In vivo delivery of vancomycin to bone from microcomposite implants (70% of payload) was significantly higher than that from current therapy implants (approx. 22% of payload) and maintained significantly higher bone concentrations for up to 2 weeks duration. The elastic modulus showed no statistical difference between microcomposite implants and current standard therapy implants before drug elution, and maintenance of acceptable strength of microcomposite implants postdrug elution. These results demonstrate that we have developed a novel microcomposite spacer that will release continuously high antibiotic concentrations over a prolonged period of time, offering the possibility to eliminate infection and avoid the emergence of new resistant bacterial strains, while maintaining the requisite mechanical properties for proper space maintenance and joint fixation.
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Affiliation(s)
- Serkan Inceoglu
- Department of Orthopaedic Surgery, Loma Linda University School of Medicine, Loma Linda, California, USA
| | - Gary Botimer
- Department of Orthopaedic Surgery, Loma Linda University School of Medicine, Loma Linda, California, USA
| | - Victoria K Maskiewicz
- Department of Pharmaceutical Sciences, Loma Linda University School of Pharmacy, Loma Linda, California, USA
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8
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Li T, Fu L, Wang J, Shi Z. High dose of vancomycin plus gentamicin incorporated acrylic bone cement decreased the elution of vancomycin. Infect Drug Resist 2019; 12:2191-2199. [PMID: 31410038 PMCID: PMC6645360 DOI: 10.2147/idr.s203740] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Accepted: 07/03/2019] [Indexed: 12/23/2022] Open
Abstract
Purpose Low doses of vancomycin and gentamicin were commonly incorporated into acrylic bone cement (antibiotic-impregnated bone cement, AIBC) during revision arthroplasty. Previous studies showed that only a very small amount of antibiotics could be eluted from AIBC. Given the fact that a high dose of antibiotic would elute high concentration of antibiotic, this study investigated the influence of a high dose of dual-antibiotic loading on the properties of cement. Methods A total of 8 groups of AIBC containing either gentamicin or vancomycin or both with different amounts of antibiotics (1 g, 2 g and 4 g) were tested on material properties, elution profiles, antibacterial activity and cytological toxicity. Results A high dose of gentamicin and vancomycin AIBC (with 2 g gentamicin and 2 g vancomycin loaded) regiment showed acceptable compressive strength of 74.25±0.72 MPa. No cytotoxicity or antibacterial activity reduction was observed in any group tested in this study. The elution profiles indicated that incorporating 2 g vancomycin resulted in 4.77% (1049.57±3.74 μg) released after 28 days. However, after 2 g gentamicin was added, the vancomycin released was significantly reduced to 2.42% (532.24±1.77 μg) (p<0.001), approximately 50% reduction. No significant influence of vancomycin on gentamicin was observed. Conclusion These findings suggest that the addition of 2 g vancomycin and 2 g gentamicin into acrylic bone cement was preferred while considering this dual-antibiotic AIBC regiment with acceptably material properties and effective antibacterial activity. However, special attention should be drawn to the reduction of vancomycin elution when incorporated with gentamicin.
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Affiliation(s)
- Tao Li
- Department of Orthopedics, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, People's Republic of China
| | - Lilan Fu
- Nanfang PET Center, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, People's Republic of China
| | - Jian Wang
- Department of Orthopedics, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, People's Republic of China
| | - Zhanjun Shi
- Department of Orthopedics, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, People's Republic of China
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9
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Kern C, Quade M, Ray S, Thomas J, Schumacher M, Gemming T, Gelinsky M, Alt V, Rohnke M. Investigation of strontium transport and strontium quantification in cortical rat bone by time-of-flight secondary ion mass spectrometry. J R Soc Interface 2019; 16:20180638. [PMID: 30958183 PMCID: PMC6408337 DOI: 10.1098/rsif.2018.0638] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Accepted: 01/16/2019] [Indexed: 02/07/2023] Open
Abstract
Next-generation bone implants will be functionalized with drugs for stimulating bone growth. Modelling of drug release by such functionalized biomaterials and drug dispersion into bone can be used as predicting tool for biomaterials testing in future. Therefore, the determination of experimental parameters to describe and simulate drug release in bone is essential. Here, we focus on Sr2+ transport and quantification in cortical rat bone. Sr2+ dose-dependently stimulates bone-building osteoblasts and inhibits bone-resorbing osteoclasts. It should be preferentially applied in the case of bone fracture in the context of osteoporotic bone status. Transport properties of cortical rat bone were investigated by dipping experiments of bone sections in aqueous Sr2+ solution followed by time-of-flight secondary ion mass spectrometry (ToF-SIMS) depth profiling. Data evaluation was carried out by fitting a suitable mathematical diffusion equation to the experimental data. An average diffusion coefficient of D = (1.68 ± 0.57) · 10-13 cm2 s-1 for healthy cortical bone was obtained. This value differed only slightly from the value of D = (4.30 ± 1.43) · 10-13 cm2 s-1 for osteoporotic cortical bone. Transmission electron microscopy investigations revealed a comparable nano- and ultrastructure for both types of bone status. Additionally, Sr2+-enriched mineralized collagen standards were prepared for ToF-SIMS quantification of Sr2+ content. The obtained calibration curve was used for Sr2+ quantification in cortical and trabecular bone in real bone sections. The results allow important insights regarding the Sr2+ transport properties in healthy and osteoporotic bone and can ultimately be used to perform a simulation of drug release and mobility in bone.
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Affiliation(s)
- Christine Kern
- Institute of Physical Chemistry, Justus-Liebig-University Giessen, Heinrich-Buff-Ring 17, 35392 Giessen, Germany
| | - Mandy Quade
- Centre for Translational Bone, Joint and Soft Tissue Research, Medical Faculty and University Hospital, Technische Universität Dresden, Fetscherstrasse 74, 01307 Dresden, Germany
| | - Seemun Ray
- Experimental Trauma Surgery, Justus-Liebig University Giessen, Aulweg 128, 35392 Giessen, Germany
| | - Jürgen Thomas
- IFW Dresden, Institute for Complex Materials, Helmholtzstrasse 20, 01069 Dresden, Germany
| | - Matthias Schumacher
- Centre for Translational Bone, Joint and Soft Tissue Research, Medical Faculty and University Hospital, Technische Universität Dresden, Fetscherstrasse 74, 01307 Dresden, Germany
| | - Thomas Gemming
- IFW Dresden, Institute for Complex Materials, Helmholtzstrasse 20, 01069 Dresden, Germany
| | - Michael Gelinsky
- Centre for Translational Bone, Joint and Soft Tissue Research, Medical Faculty and University Hospital, Technische Universität Dresden, Fetscherstrasse 74, 01307 Dresden, Germany
| | - Volker Alt
- Experimental Trauma Surgery, Justus-Liebig University Giessen, Aulweg 128, 35392 Giessen, Germany
| | - Marcus Rohnke
- Institute of Physical Chemistry, Justus-Liebig-University Giessen, Heinrich-Buff-Ring 17, 35392 Giessen, Germany
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Rohnke M, Pfitzenreuter S, Mogwitz B, Henß A, Thomas J, Bieberstein D, Gemming T, Otto SK, Ray S, Schumacher M, Gelinsky M, Alt V. Strontium release from Sr 2+-loaded bone cements and dispersion in healthy and osteoporotic rat bone. J Control Release 2017; 262:159-169. [PMID: 28757358 DOI: 10.1016/j.jconrel.2017.07.036] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Revised: 07/25/2017] [Accepted: 07/25/2017] [Indexed: 12/15/2022]
Abstract
Drug functionalization of biomaterials is a modern and popular approach in biomaterials research. Amongst others this concept is used for the functionalization of bone implants to locally stimulate the bone healing process. For example strontium ions (Sr2+) are administered in osteoporosis therapy to stimulate bone growth and have recently been integrated into bone cements. Based on results of different analytical experiments we developed a two-phase model for the transport of therapeutically active Sr2+-ions in bone in combination with Korsmeyer-Peppas kinetics for the Sr2+ release from bone cement. Data of cement dissolution experiments into water in combination with inductively coupled plasma mass spectrometry (ICP-MS) analysis account for dissolution kinetics following Noyes-Whitney rule. For dissolution in α-MEM cell culture media the process is kinetically hindered and can be described by Korsmeyer-Peppas kinetics. Time of flight secondary ion mass spectrometry (ToF-SIMS) was used to determine the Sr2+ diffusion coefficient in healthy and osteoporotic trabecular rat bone. Therefore, bone sections were dipped in aqueous Sr2+-solution by one side and the Sr2+-profile was measured by classical SIMS depth profiling. The Sr2+ mobility can be described by a simple diffusion model and we obtained diffusion coefficients of (2.28±2.97)⋅10-12cm2/s for healthy and of (1.55±0.93)⋅10-10cm2/s for osteoporotic bone. This finding can be explained by a different bone nanostructure, which was observed by focused ion beam scanning electron microscopy (FIB-SEM) and transmission electron microscopy (TEM). Finally, the time and spatially resolved drug transport was calculated by finite element method for the femur of healthy and osteoporotic rats. The obtained results were compared to mass images that were obtained from sections of in vivo experiments by ToF-SIMS. The simulated data fits quite well to experimental results. The successfully applied model for the description of drug dispersion can help to reduce the number of animal experiments in the future.
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Affiliation(s)
- Marcus Rohnke
- Institute of Physical Chemistry, Justus-Liebig-University Giessen, Heinrich-Buff-Ring 17, 35392 Giessen, Germany.
| | - Stefanie Pfitzenreuter
- Institute of Physical Chemistry, Justus-Liebig-University Giessen, Heinrich-Buff-Ring 17, 35392 Giessen, Germany
| | - Boris Mogwitz
- Institute of Physical Chemistry, Justus-Liebig-University Giessen, Heinrich-Buff-Ring 17, 35392 Giessen, Germany
| | - Anja Henß
- Institute of Physical Chemistry, Justus-Liebig-University Giessen, Heinrich-Buff-Ring 17, 35392 Giessen, Germany
| | - Jürgen Thomas
- IFW Dresden, Institute for Complex Materials, Helmholtzstrasse 20, 01069 Dresden, Germany
| | - Dina Bieberstein
- IFW Dresden, Institute for Complex Materials, Helmholtzstrasse 20, 01069 Dresden, Germany
| | - Thomas Gemming
- IFW Dresden, Institute for Complex Materials, Helmholtzstrasse 20, 01069 Dresden, Germany
| | - Svenja K Otto
- Institute of Physical Chemistry, Justus-Liebig-University Giessen, Heinrich-Buff-Ring 17, 35392 Giessen, Germany
| | - Seemun Ray
- Laboratory of Experimental Trauma Surgery, Justus-Liebig-University, Aulweg 128, 35392 Giessen, Germany
| | - Matthias Schumacher
- Centre for Translational Bone, Joint and Soft Tissue Research, Medical Faculty and University Hospital, Technische Universität Dresden, Fetscherstrasse 74, 01307 Dresden, Germany
| | - Michael Gelinsky
- Centre for Translational Bone, Joint and Soft Tissue Research, Medical Faculty and University Hospital, Technische Universität Dresden, Fetscherstrasse 74, 01307 Dresden, Germany
| | - Volker Alt
- Laboratory of Experimental Trauma Surgery, Justus-Liebig-University, Aulweg 128, 35392 Giessen, Germany; Department of Trauma Surgery, University Hospital Giessen-Marburg GmbH, Campus Giessen, Rudolf-Buchheim-Strasse 7, 35385 Giessen, Germany
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Jennings JA, Beenken KE, Parker AC, Smith JK, Courtney HS, Smeltzer MS, Haggard WO. Polymicrobial Biofilm Inhibition Effects of Acetate-Buffered Chitosan Sponge Delivery Device. Macromol Biosci 2016; 16:591-8. [DOI: 10.1002/mabi.201500347] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2015] [Revised: 11/04/2015] [Indexed: 12/14/2022]
Affiliation(s)
- Jessica Amber Jennings
- Department of Biomedical Engineering; University of Memphis; 330 Engineering Technology Building Memphis TN 38152 USA
| | - Karen E. Beenken
- Department of Orthopaedics; University of Arkansas for Medical Sciences; 4301 W. Markham St. Little Rock AR 72205 USA
| | - Ashley C. Parker
- Department of Biomedical Engineering; University of Memphis; 330 Engineering Technology Building Memphis TN 38152 USA
| | - James Keaton Smith
- Department of Biomedical Engineering; University of Memphis; 330 Engineering Technology Building Memphis TN 38152 USA
| | - Harry S. Courtney
- Department of Medicine; University of Tennessee Health Science Center; Coleman Building Suite D334, 956 Court Avenue Memphis TN 38163 USA
| | - Mark S. Smeltzer
- Department of Orthopaedics; University of Arkansas for Medical Sciences; 4301 W. Markham St. Little Rock AR 72205 USA
| | - Warren O. Haggard
- Department of Biomedical Engineering; University of Memphis; 330 Engineering Technology Building Memphis TN 38152 USA
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Kargupta R, Bok S, Darr CM, Crist BD, Gangopadhyay K, Gangopadhyay S, Sengupta S. Coatings and surface modifications imparting antimicrobial activity to orthopedic implants. WILEY INTERDISCIPLINARY REVIEWS-NANOMEDICINE AND NANOBIOTECHNOLOGY 2014; 6:475-95. [PMID: 24867883 DOI: 10.1002/wnan.1273] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/23/2013] [Revised: 03/23/2014] [Accepted: 04/06/2014] [Indexed: 12/24/2022]
Abstract
Bacterial colonization and biofilm formation on an orthopedic implant surface is one of the worst possible outcomes of orthopedic intervention in terms of both patient prognosis and healthcare costs. Making the problem even more vexing is the fact that infections are often caused by events beyond the control of the operating surgeon and may manifest weeks to months after the initial surgery. Herein, we review the costs and consequences of implant infection as well as the methods of prevention and management. In particular, we focus on coatings and other forms of implant surface modification in a manner that imparts some antimicrobial benefit to the implant device. Such coatings can be classified generally based on their mode of action: surface adhesion prevention, bactericidal, antimicrobial-eluting, osseointegration promotion, and combinations of the above. Despite several advances in the efficacy of these antimicrobial methods, a remaining major challenge is ensuring retention of the antimicrobial activity over a period of months to years postoperation, an issue that has so far been inadequately addressed. Finally, we provide an overview of additional figures of merit that will determine whether a given antimicrobial surface modification warrants adoption for clinical use.
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Affiliation(s)
- Roli Kargupta
- Department of Bioengineering, University of Missouri, Columbia, MO, USA
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