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Suda AJ, Miethke T, Landua N, Obertacke U. Advantages in orthopaedic implant infection diagnostics by additional analysis of explants. INTERNATIONAL ORTHOPAEDICS 2025; 49:997-1005. [PMID: 39969590 PMCID: PMC12003479 DOI: 10.1007/s00264-025-06424-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/23/2024] [Accepted: 01/20/2025] [Indexed: 02/20/2025]
Abstract
PURPOSE Implant-associated infections are the most challenging complication in orthopaedics and trauma surgery as they often lead to long courses of illness and are a financial burden for the healthcare system. There is a need for fast, simple, and cheap identification of pathogens but the ideal detection method was not found yet. The work aims to test whether the detection of pathogens culturing the removed implant is more successful than from simultaneously taken tissue samples or punction fluid. METHODS Implants were removed due to infection, irritation, or loosening. Tissue samples and joint fluids were processed for bacterial growth in sterile conditions. Samples were incubated and checked for growth. Bacterial identification and antibiotic sensitivity testing were performed. Data were anonymized, and statistical analysis was done using Excel and SAS, employing tests like Shapiro-Wilk, Mann-Whitney-U, and Kruskal-Wallis. Ethical approval was obtained for this study. RESULTS Between February 2018 and April 2019, a total of 163 patients (175 cases) underwent orthopaedic implant removal for various reasons. 30 cases were not usable or analyzable due to missing or damaged reference material, so 145 cases could be evaluated due to study protocol. The range of detected bacteria was as expected and included low-virulent bacteria such as Micrococcus luteus and Corynebacteria. Pathogen detection by culture of the the explant´s was more sensitive (84.83%) than pathogen detection from tissue samples and punction fluid (64.14%, p<0.0001). Comorbidities did not play any role in the quality of detection but prior antibiotic treatment did influence the results of tissue diagnostics. CONCLUSION This study showed with a higher frequency of bacterial detection of orthopedic explant´s surface compared to tissue samples or punction fluid. This may reduce the number of samples and cost but enhances the quality of orthopaedic implant-related infection diagnostics.
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Affiliation(s)
- Arnold J Suda
- Department of Orthopaedics and Trauma Surgery, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany.
| | - Thomas Miethke
- Institute of Medical Microbiology and Hygiene, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Nadine Landua
- Department of Orthopaedics and Trauma Surgery, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Udo Obertacke
- Department of Orthopaedics and Trauma Surgery, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
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2
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Mishchenko O, Volchykhina K, Maksymov D, Manukhina O, Pogorielov M, Pavlenko M, Iatsunskyi I. Advanced Strategies for Enhancing the Biocompatibility and Antibacterial Properties of Implantable Structures. MATERIALS (BASEL, SWITZERLAND) 2025; 18:822. [PMID: 40004345 PMCID: PMC11857362 DOI: 10.3390/ma18040822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/20/2024] [Revised: 01/27/2025] [Accepted: 01/29/2025] [Indexed: 02/27/2025]
Abstract
This review explores the latest advancements in enhancing the biocompatibility and antibacterial properties of implantable structures, with a focus on titanium (Ti) and its alloys. Titanium implants, widely used in dental and orthopedic applications, demonstrate excellent mechanical strength and biocompatibility, yet face challenges such as peri-implantitis, a bacterial infection that can lead to implant failure. To address these issues, both passive and active surface modification strategies have been developed. Passive modifications, such as altering surface texture and chemistry, aim to prevent bacterial adhesion, while active approaches incorporate antimicrobial agents for sustained infection control. Nanotechnology has emerged as a transformative tool, enabling the creation of nanoscale materials and coatings like TiO2 and ZnO that promote osseointegration and inhibit biofilm formation. Techniques such as plasma spraying, ion implantation, and plasma electrolytic oxidation (PEO) show promising results in improving implant integration and durability. Despite significant progress, further research is needed to refine these technologies, optimize surface properties, and address the clinical challenges associated with implant longevity and safety. This review highlights the intersection of surface engineering, nanotechnology, and biomedical innovation, paving the way for the next generation of implantable devices.
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Affiliation(s)
- Oleg Mishchenko
- Department of Dentistry of Postgraduate Education, Zaporizhzhia State Medical and Pharmaceutical University, 26 Marii Prymachenko Blvd., 69035 Zaporizhzhia, Ukraine; (K.V.); (D.M.); (O.M.)
| | - Kristina Volchykhina
- Department of Dentistry of Postgraduate Education, Zaporizhzhia State Medical and Pharmaceutical University, 26 Marii Prymachenko Blvd., 69035 Zaporizhzhia, Ukraine; (K.V.); (D.M.); (O.M.)
| | - Denis Maksymov
- Department of Dentistry of Postgraduate Education, Zaporizhzhia State Medical and Pharmaceutical University, 26 Marii Prymachenko Blvd., 69035 Zaporizhzhia, Ukraine; (K.V.); (D.M.); (O.M.)
| | - Olesia Manukhina
- Department of Dentistry of Postgraduate Education, Zaporizhzhia State Medical and Pharmaceutical University, 26 Marii Prymachenko Blvd., 69035 Zaporizhzhia, Ukraine; (K.V.); (D.M.); (O.M.)
| | - Maksym Pogorielov
- Insitute of Atomic Physics and Spectroscopy, University of Latvia, 3 Jelgavas Str., LV-1004 Riga, Latvia;
| | - Mykola Pavlenko
- NanoBioMedical Centre, Adam Mickiewicz University, Wszechnicy Piastowskiej Str. 3, 61-614 Poznan, Poland;
| | - Igor Iatsunskyi
- NanoBioMedical Centre, Adam Mickiewicz University, Wszechnicy Piastowskiej Str. 3, 61-614 Poznan, Poland;
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3
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Dini C, Borges MHR, Malheiros SS, Piazza RD, van den Beucken JJJP, de Avila ED, Souza JGS, Barão VAR. Progress in Designing Therapeutic Antimicrobial Hydrogels Targeting Implant-associated Infections: Paving the Way for a Sustainable Platform Applied to Biomedical Devices. Adv Healthc Mater 2025; 14:e2402926. [PMID: 39440583 DOI: 10.1002/adhm.202402926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2024] [Revised: 09/19/2024] [Indexed: 10/25/2024]
Abstract
Implantable biomedical devices have found widespread use in restoring lost functions or structures within the human body, but they face a significant challenge from microbial-related infections, which often lead to implant failure. In this context, antimicrobial hydrogels emerge as a promising strategy for treating implant-associated infections owing to their tunable physicochemical properties. However, the literature lacks a comprehensive analysis of antimicrobial hydrogels, encompassing their development, mechanisms, and effect on implant-associated infections, mainly in light of existing in vitro, in vivo, and clinical evidence. Thus, this review addresses the strategies employed by existing studies to tailor hydrogel properties to meet the specific needs of each application. Furthermore, this comprehensive review critically appraises the development of antimicrobial hydrogels, with a particular focus on solving infections related to metallic orthopedic or dental implants. Then, preclinical and clinical studies centering on providing quantitative microbiological results associated with the application of antimicrobial hydrogels are systematically summarized. Overall, antimicrobial hydrogels benefit from the tunable properties of polymers and hold promise as an effective strategy for the local treatment of implant-associated infections. However, future clinical investigations, grounded on robust evidence from in vitro and preclinical studies, are required to explore and validate new antimicrobial hydrogels for clinical use.
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Affiliation(s)
- Caroline Dini
- Department of Prosthodontics and Periodontology, Piracicaba Dental School, Universidade Estadual de Campinas (UNICAMP), Piracicaba, São Paulo, 13414-903, Brazil
| | - Maria Helena Rossy Borges
- Department of Prosthodontics and Periodontology, Piracicaba Dental School, Universidade Estadual de Campinas (UNICAMP), Piracicaba, São Paulo, 13414-903, Brazil
| | - Samuel Santana Malheiros
- Department of Prosthodontics and Periodontology, Piracicaba Dental School, Universidade Estadual de Campinas (UNICAMP), Piracicaba, São Paulo, 13414-903, Brazil
| | - Rodolfo Debone Piazza
- Physical Chemistry Department, Institute of Chemistry, São Paulo State University (UNESP), Araraquara, São Paulo, 14800-900, Brazil
| | | | - Erica Dorigatti de Avila
- Department of Dental Materials and Prosthodontics, School of Dentistry at Araçatuba, São Paulo State University (UNESP), Araçatuba, São Paulo, 16015-050, Brazil
| | - João Gabriel S Souza
- Dental Research Division, Guarulhos University (UNG), Guarulhos, São Paulo, 07023-070, Brazil
| | - Valentim A R Barão
- Department of Prosthodontics and Periodontology, Piracicaba Dental School, Universidade Estadual de Campinas (UNICAMP), Piracicaba, São Paulo, 13414-903, Brazil
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Hamilton A, Wongcharoenwatana J, Hoellwarth J, Fragomen A, Rozbruch S, Reif T. The immediate ex vivo covering and filling characteristics of antibiotic-loaded resorbable calcium sulfate paste around intramedullary nails. J Bone Jt Infect 2024; 9:261-270. [PMID: 40308333 PMCID: PMC12042201 DOI: 10.5194/jbji-9-261-2024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 04/08/2024] [Indexed: 05/02/2025] Open
Abstract
Background: Antibiotic-laden polymethyl methacrylate (PMMA)-coated intramedullary nails (IMNs) are an effective treatment for osteomyelitis, but they pose multiple disadvantages. Antibiotic-loaded resorbable calcium sulfate (ARCS) paste is an alternative option to deliver a local antibiotic depot around IMNs, but such use has been minimally investigated. This study aimed to define the immediate covering and filling characteristics of ARCS around IMNs by using anatomic bone models. Method: Five tibia models (foam with cortical shell) were prepared by reaming a uniform 13 mm cylindrical path. Three 40 cc kits of ARCS (STIMULAN, Biocomposites Ltd, Keele, UK) were mixed with 3 g vancomycin and 1.2 g tobramycin powder and injected into the intramedullary canal while wet, completely filling the canal. A 10 mm × 345 mm tibial IMN was immediately inserted without interlocking screws and allowed to completely cure for 2 h. The models were then longitudinally cut without disrupting the dry ARCS covering on the nail. The ARCS was removed from the nail at five equidistant locations along the nail. The thickness of the ARCS was measured with a caliper. A repeated-measures ANOVA test was used to compare the mean width of each segment for each model. Results: In all five trials, the tibial canal volume surrounding the nail remained completely filled. The ARCS paste was confluent along the length of the IMN. There were no gaps or air pockets between the paste and reamed model bone. There was no statistically significant difference among the five samples at each location ( p = 0.913 ) or among the five locations along the bone ( p = 0.210 ). Conclusion: In a model setting, ARCS fully fills the intramedullary canal of a tibia and covers an IMN uniformly. Study of the in vivo material properties of ARCS may further elucidate the bone penetration as well as the clinical utility of this antibiotic depot technique.
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Affiliation(s)
- Amber A. Hamilton
- Limb Lengthening and Complex Reconstruction Service, Hospital for Special Surgery, New York, NY 10021, USA
- Department of Orthopedic Surgery, Weill Cornell Medical College, New York, NY 10021, USA
| | - Jidapa Wongcharoenwatana
- Limb Lengthening and Complex Reconstruction Service, Hospital for Special Surgery, New York, NY 10021, USA
| | - Jason S. Hoellwarth
- Limb Lengthening and Complex Reconstruction Service, Hospital for Special Surgery, New York, NY 10021, USA
- Department of Orthopedic Surgery, Weill Cornell Medical College, New York, NY 10021, USA
| | - Austin T. Fragomen
- Limb Lengthening and Complex Reconstruction Service, Hospital for Special Surgery, New York, NY 10021, USA
- Department of Orthopedic Surgery, Weill Cornell Medical College, New York, NY 10021, USA
| | - S. Robert Rozbruch
- Limb Lengthening and Complex Reconstruction Service, Hospital for Special Surgery, New York, NY 10021, USA
- Department of Orthopedic Surgery, Weill Cornell Medical College, New York, NY 10021, USA
| | - Taylor J. Reif
- Limb Lengthening and Complex Reconstruction Service, Hospital for Special Surgery, New York, NY 10021, USA
- Department of Orthopedic Surgery, Weill Cornell Medical College, New York, NY 10021, USA
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5
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Ma Z, Zhao Y, Xu Z, Zhang Y, Han Y, Jiang H, Sun P, Feng W. 3D-printed porous titanium rods equipped with vancomycin-loaded hydrogels and polycaprolactone membranes for intelligent antibacterial drug release. Sci Rep 2024; 14:21749. [PMID: 39294268 PMCID: PMC11411058 DOI: 10.1038/s41598-024-72457-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2024] [Accepted: 09/06/2024] [Indexed: 09/20/2024] Open
Abstract
Implant-related infections pose significant challenges to orthopedic surgeries due to the high risk of severe complications. The widespread use of bioactive prostheses in joint replacements, featuring roughened surfaces and tight integration with the bone marrow cavity, has facilitated bacterial proliferation and complicated treatment. Developing antibacterial coatings for orthopedic implants has been a key research focus in recent years to address this critical issue. Researchers have designed coatings using various materials and antibacterial strategies. In this study, we fabricated 3D-printed porous titanium rods, incorporated vancomycin-loaded mPEG750-b-PCL2500 gel, and coated them with a PCL layer. We then evaluated the antibacterial efficacy through both in vitro and in vivo experiments. Our coating passively inhibits bacterial biofilm formation and actively controls antibiotic release in response to bacterial growth, providing a practical solution for proactive and sustained infection control. This study utilized 3D printing technology to produce porous titanium rod implants simulating bioactive joint prostheses. The porous structure of the titanium rods was used to load a thermoresponsive gel, mPEG750-b-PCL2500 (PEG: polyethylene glycol; PCL: polycaprolactone), serving as a novel drug delivery system carrying vancomycin for controlled antibiotic release. The assembly was then covered with a PCL membrane that inhibits bacterial biofilm formation early in infection and degrades when exposed to lipase solutions, mimicking enzymatic activity during bacterial infections. This setup provides infection-responsive protection and promotes drug release. We investigated the coating's controlled release, antibacterial capability, and biocompatibility through in vitro experiments. We established a Staphylococcus aureus infection model in rabbits, implanting titanium rods in the femoral medullary cavity. We evaluated the efficacy and safety of the composite coating in preventing implant-related infections using imaging, hematology, and pathology. In vitro experiments demonstrated that the PCL membrane stably protects encapsulated vancomycin during PBS immersion. The PCL membrane rapidly degraded at a lipase concentration of 0.2 mg/mL. The mPEG750-b-PCL2500 gel ensured stable and sustained vancomycin release, inhibiting bacterial growth. We investigated the antibacterial effect of the 3D-printed titanium material, coated with PCL and loaded with mPEG750-b-PCL2500 hydrogel, using a rabbit Staphylococcus aureus infection model. Imaging, hematology, and histopathology confirmed that our composite antibacterial coating exhibited excellent antibacterial effects and infection prevention, with good safety in trials. Our results indicate that the composite antibacterial coating effectively protects vancomycin in the hydrogel from premature release in the absence of bacterial infection. The outer PCL membrane inhibits bacterial growth and prevents biofilm formation. Upon contact with bacterial lipase, the PCL membrane rapidly degrades, releasing vancomycin for antibacterial action. The mPEG750-b-PCL2500 gel provides stable and sustained vancomycin release, prolonging its antibacterial effects. Our composite antibacterial coating demonstrates promising potential for clinical application.
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Affiliation(s)
- Zheru Ma
- Department of Bone and Joint Surgery, Orthopedic Center, The First Hospital of Jilin University, 72 Xinmin Street, Changchun, 130021, Jilin, China
| | - Yao Zhao
- Department of Bone and Joint Surgery, Orthopedic Center, The First Hospital of Jilin University, 72 Xinmin Street, Changchun, 130021, Jilin, China
| | - Zhe Xu
- Department of Bone and Joint Surgery, Orthopedic Center, The First Hospital of Jilin University, 72 Xinmin Street, Changchun, 130021, Jilin, China
- Weifang Traditional Chinese Hospital, Weifang, China
| | - Yao Zhang
- Department of Bone and Joint Surgery, Orthopedic Center, The First Hospital of Jilin University, 72 Xinmin Street, Changchun, 130021, Jilin, China
- Affiliated Hospital of Yangzhou University, Yangzhou, China
| | - Yu Han
- Department of Bone and Joint Surgery, Orthopedic Center, The First Hospital of Jilin University, 72 Xinmin Street, Changchun, 130021, Jilin, China
| | - Haozhuo Jiang
- Department of Bone and Joint Surgery, Orthopedic Center, The First Hospital of Jilin University, 72 Xinmin Street, Changchun, 130021, Jilin, China
| | - Peng Sun
- Department of Bone and Joint Surgery, Orthopedic Center, The First Hospital of Jilin University, 72 Xinmin Street, Changchun, 130021, Jilin, China
| | - Wei Feng
- Department of Bone and Joint Surgery, Orthopedic Center, The First Hospital of Jilin University, 72 Xinmin Street, Changchun, 130021, Jilin, China.
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6
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Mandell JB, Gish C, Cappellini AJ, Parker DM, Brothers KM, Ma D, Urish KL. Methicillin resistant Staphylococcus aureus mazEF expression promotes infections by influencing cellular growth, antibiotic sensitivity, and formation of biofilms. Sci Rep 2024; 14:21269. [PMID: 39261496 PMCID: PMC11390869 DOI: 10.1038/s41598-024-70829-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2024] [Accepted: 08/21/2024] [Indexed: 09/13/2024] Open
Abstract
Staphylococcus aureus infections are hard to treat due to the emergence of antibiotic resistant strains, as well as their ability to form biofilms. The MazEF toxin-antitoxin system is thought play a role in bacterial biofilm phenotype as well as antibiotic resistance. In S. aureus, the physiologic function of the mazEF gene in the disease transition from acute to chronic infection is not well understood. In methicillin resistant S. aureus (MRSA), loss of mazF expression results in loss of resistance to first generation cephalosporins. mazF::tn displayed sensitivity while the isogenic wild type (WT) remained resistant. mazF::tn displayed significantly increased growth of biofilms on metal implants over 48 h compared to WT and the complemented transposon mutant. mazF::tn biofilms displayed significantly decreased antibiotic tolerance to vancomycin and cefazolin in comparison to WT and complement biofilms. Mice given mazF::tn in a sepsis model displayed less abscess burden and increased survival (100%) when treated with cefazolin compared to WT bacteremia treated with cefazolin (20%). mazF::tn periprosthetic joint infections displayed increased biofilm burden at acute time points and decreased biofilm burden at chronic time points. Our data suggests MazEF in MRSA is responsible for controlling growth of biofilms, antibiotic tolerance, and influence chronic infections in vivo.
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Affiliation(s)
- Jonathan B Mandell
- Arthritis and Arthroplasty Design Laboratory, Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Ophthalmology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Charles Gish
- Arthritis and Arthroplasty Design Laboratory, Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, PA, USA
| | - Alex J Cappellini
- Arthritis and Arthroplasty Design Laboratory, Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, PA, USA
| | - Dana M Parker
- Arthritis and Arthroplasty Design Laboratory, Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, PA, USA
| | - Kimberly M Brothers
- Arthritis and Arthroplasty Design Laboratory, Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, PA, USA
| | - Dongzhu Ma
- Arthritis and Arthroplasty Design Laboratory, Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, PA, USA
| | - Kenneth L Urish
- Arthritis and Arthroplasty Design Laboratory, Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, PA, USA.
- The Bone and Joint Center, Magee Womens Hospital, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, USA.
- Clinical and Translational Science Institute, University of Pittsburgh, Pittsburgh, PA, USA.
- Department of Biomedical Engineering, Carnegie Mellon University, Pittsburgh, PA, USA.
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7
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Mannala GK, Rupp M, Walter N, Youf R, Bärtl S, Riool M, Alt V. Repetitive combined doses of bacteriophages and gentamicin protect against Staphylococcus aureus implant-related infections in Galleria mellonella. Bone Joint Res 2024; 13:383-391. [PMID: 39089687 PMCID: PMC11293943 DOI: 10.1302/2046-3758.138.bjr-2023-0340.r1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/04/2024] Open
Abstract
Aims Bacteriophages infect, replicate inside bacteria, and are released from the host through lysis. Here, we evaluate the effects of repetitive doses of the Staphylococcus aureus phage 191219 and gentamicin against haematogenous and early-stage biofilm implant-related infections in Galleria mellonella. Methods For the haematogenous infection, G. mellonella larvae were implanted with a Kirschner wire (K-wire), infected with S. aureus, and subsequently phages and/or gentamicin were administered. For the early-stage biofilm implant infection, the K-wires were pre-incubated with S. aureus suspension before implantation. After 24 hours, the larvae received phages and/or gentamicin. In both models, the larvae also received daily doses of phages and/or gentamicin for up to five days. The effect was determined by survival analysis for five days and quantitative culture of bacteria after two days of repetitive doses. Results In the haematogenous infection, a single combined dose of phages and gentamicin, and repetitive injections with gentamicin or in combination with phages, resulted in significantly improved survival rates. In the early-stage biofilm infection, only repetitive combined administration of phages and gentamicin led to a significantly increased survival. Additionally, a significant reduction in number of bacteria was observed in the larvae after receiving repetitive doses of phages and/or gentamicin in both infection models. Conclusion Based on our results, a single dose of the combination of phages and gentamicin is sufficient to prevent a haematogenous S. aureus implant-related infection, whereas gentamicin needs to be administered daily for the same effect. To treat early-stage S. aureus implant-related infection, repetitive doses of the combination of phages and gentamicin are required.
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Affiliation(s)
- Gopala K. Mannala
- Department of Trauma Surgery, University Hospital Regensburg, Regensburg, Germany
| | - Markus Rupp
- Department of Trauma Surgery, University Hospital Regensburg, Regensburg, Germany
| | - Nike Walter
- Department of Trauma Surgery, University Hospital Regensburg, Regensburg, Germany
- Department for Psychosomatic Medicine, University Hospital Regensburg, Regensburg, Germany
| | - Raphaelle Youf
- Department of Trauma Surgery, University Hospital Regensburg, Regensburg, Germany
| | - Susanne Bärtl
- Department of Trauma Surgery, University Hospital Regensburg, Regensburg, Germany
| | - Martijn Riool
- Department of Trauma Surgery, University Hospital Regensburg, Regensburg, Germany
| | - Volker Alt
- Department of Trauma Surgery, University Hospital Regensburg, Regensburg, Germany
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Ward SA, Habibi AA, Ashkenazi I, Arshi A, Meftah M, Schwarzkopf R. Innovations in the Isolation and Treatment of Biofilms in Periprosthetic Joint Infection: A Comprehensive Review of Current and Emerging Therapies in Bone and Joint Infection Management. Orthop Clin North Am 2024; 55:171-180. [PMID: 38403364 DOI: 10.1016/j.ocl.2023.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/27/2024]
Abstract
Periprosthetic joint infections (PJIs) are a devastating complication of joint arthroplasty surgeries that are often complicated by biofilm formation. The development of biofilms makes PJI treatment challenging as they create a barrier against antibiotics and host immune responses. This review article provides an overview of the current understanding of biofilm formation, factors that contribute to their production, and the most common organisms involved in this process. This article focuses on the identification of biofilms, as well as current methodologies and emerging therapies in the management of biofilms in PJI.
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Affiliation(s)
- Spencer A Ward
- NYU Langone Orthopedic Hospital, NYU Langone Health, 301 East 17th Street, Room 1402, New York, NY 10003, USA
| | - Akram A Habibi
- NYU Langone Orthopedic Hospital, NYU Langone Health, 301 East 17th Street, Room 1402, New York, NY 10003, USA
| | - Itay Ashkenazi
- NYU Langone Orthopedic Hospital, NYU Langone Health, 301 East 17th Street, Room 1402, New York, NY 10003, USA
| | - Armin Arshi
- NYU Langone Orthopedic Hospital, NYU Langone Health, 301 East 17th Street, Room 1402, New York, NY 10003, USA
| | - Morteza Meftah
- NYU Langone Orthopedic Hospital, NYU Langone Health, 301 East 17th Street, Room 1402, New York, NY 10003, USA
| | - Ran Schwarzkopf
- NYU Langone Orthopedic Hospital, NYU Langone Health, 301 East 17th Street, Room 1402, New York, NY 10003, USA.
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9
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MacConnell AE, Levack AE, Brown NM. Biofilm and How It Relates to Prosthetic Joint Infection. Orthop Clin North Am 2024; 55:161-169. [PMID: 38403363 DOI: 10.1016/j.ocl.2023.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/27/2024]
Abstract
Prosthetic joint infection following total joint arthroplasty is a devastating complication, resulting in increased morbidity and mortality for the patient. The formation of a biofilm on implanted hardware contributes to the difficulty in successful identification and eradication of the infection. Antibiotic therapy and surgical intervention are necessary for addressing this condition; we present a discussion on different treatment options, including those that are not yet routinely utilized in the clinical setting or are under investigation, to highlight the present and future of PJI management.
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Affiliation(s)
- Ashley E MacConnell
- Department of Orthopaedic Surgery and Rehabilitation, Loyola University Medical Center, 2160 South First Avenue, Suite 1700, Maywood, IL 60153, USA.
| | - Ashley E Levack
- Department of Orthopaedic Surgery and Rehabilitation, Loyola University Medical Center, 2160 South First Avenue, Suite 1700, Maywood, IL 60153, USA
| | - Nicholas M Brown
- Department of Orthopaedic Surgery and Rehabilitation, Loyola University Medical Center, 2160 South First Avenue, Suite 1700, Maywood, IL 60153, USA
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10
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Xiu W, Li X, Li Q, Ding M, Zhang Y, Wan L, Wang S, Gao Y, Mou Y, Wang L, Dong H. Ultrasound-Stimulated "Exocytosis" by Cell-Like Microbubbles Enhances Antibacterial Species Penetration and Immune Activation Against Implant Infection. ADVANCED SCIENCE (WEINHEIM, BADEN-WURTTEMBERG, GERMANY) 2024; 11:e2307048. [PMID: 38109089 PMCID: PMC10933665 DOI: 10.1002/advs.202307048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 11/18/2023] [Indexed: 12/19/2023]
Abstract
Host immune systems serving as crucial defense lines are vital resisting mechanisms against biofilm-associated implant infections. Nevertheless, biofilms hinder the penetration of anti-bacterial species, inhibit phagocytosis of immune cells, and frustrate host inflammatory responses, ultimately resulting in the weakness of the host immune system for biofilm elimination. Herein, a cell-like construct is developed through encapsulation of erythrocyte membrane fragments on the surface of Fe3 O4 nanoparticle-fabricated microbubbles and then loaded with hydroxyurea (EMB-Hu). Under ultrasound (US) stimulation, EMB-Hu undergoes a stable oscillation manner to act in an "exocytosis" mechanism for disrupting biofilm, releasing agents, and enhancing penetration of catalytically generated anti-bacterial species within biofilms. Additionally, the US-stimulated "exocytosis" by EMB-Hu can activate pro-inflammatory macrophage polarization and enhance macrophage phagocytosis for clearance of disrupted biofilms. Collectively, this work has exhibited cell-like microbubbles with US-stimulated "exocytosis" mechanisms to overcome the biofilm barrier and signal macrophages for inflammatory activation, finally achieving favorable therapeutic effects against implant infections caused by methicillin-resistant Staphylococcus aureus (MRSA) biofilms.
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Affiliation(s)
- Weijun Xiu
- Nanjing Stomatological HospitalAffiliated Hospital of Medical SchoolNanjing University30 Zhongyang RoadNanjing210008P. R. China
- Key Laboratory for Organic Electronics and Information DisplaysJiangsu Key Laboratory for BiosensorsInstitute of Advanced MaterialsJiangsu National Synergetic Innovation Centre for Advanced MaterialsNanjing University of Posts and Telecommunications9 Wenyuan RoadNanjing210023P. R. China
| | - Xiaoye Li
- Nanjing Stomatological HospitalAffiliated Hospital of Medical SchoolNanjing University30 Zhongyang RoadNanjing210008P. R. China
| | - Qiang Li
- Nanjing Stomatological HospitalAffiliated Hospital of Medical SchoolNanjing University30 Zhongyang RoadNanjing210008P. R. China
| | - Meng Ding
- Nanjing Stomatological HospitalAffiliated Hospital of Medical SchoolNanjing University30 Zhongyang RoadNanjing210008P. R. China
| | - Yu Zhang
- Nanjing Stomatological HospitalAffiliated Hospital of Medical SchoolNanjing University30 Zhongyang RoadNanjing210008P. R. China
| | - Ling Wan
- Key Laboratory for Organic Electronics and Information DisplaysJiangsu Key Laboratory for BiosensorsInstitute of Advanced MaterialsJiangsu National Synergetic Innovation Centre for Advanced MaterialsNanjing University of Posts and Telecommunications9 Wenyuan RoadNanjing210023P. R. China
| | - Siyu Wang
- Key Laboratory for Organic Electronics and Information DisplaysJiangsu Key Laboratory for BiosensorsInstitute of Advanced MaterialsJiangsu National Synergetic Innovation Centre for Advanced MaterialsNanjing University of Posts and Telecommunications9 Wenyuan RoadNanjing210023P. R. China
| | - Yu Gao
- Key Laboratory for Organic Electronics and Information DisplaysJiangsu Key Laboratory for BiosensorsInstitute of Advanced MaterialsJiangsu National Synergetic Innovation Centre for Advanced MaterialsNanjing University of Posts and Telecommunications9 Wenyuan RoadNanjing210023P. R. China
| | - Yongbin Mou
- Nanjing Stomatological HospitalAffiliated Hospital of Medical SchoolNanjing University30 Zhongyang RoadNanjing210008P. R. China
| | - Lianhui Wang
- Key Laboratory for Organic Electronics and Information DisplaysJiangsu Key Laboratory for BiosensorsInstitute of Advanced MaterialsJiangsu National Synergetic Innovation Centre for Advanced MaterialsNanjing University of Posts and Telecommunications9 Wenyuan RoadNanjing210023P. R. China
| | - Heng Dong
- Nanjing Stomatological HospitalAffiliated Hospital of Medical SchoolNanjing University30 Zhongyang RoadNanjing210008P. R. China
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11
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Datta S, Nag S, Roy DN. Biofilm-producing antibiotic-resistant bacteria in Indian patients: a comprehensive review. Curr Med Res Opin 2024; 40:403-422. [PMID: 38214582 DOI: 10.1080/03007995.2024.2305241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 01/10/2024] [Indexed: 01/13/2024]
Abstract
For the past few years, microbial biofilms have been emerging as a significant threat to the modern healthcare system, and their prevalence and antibiotic resistance threat gradually increase daily among the human population. The biofilm has a remarkable impact in the field of infectious diseases, in particular healthcare-associated infections related to indwelling devices such as catheters, implants, artificial heart valves, and prosthetic joints. Bacterial biofilm potentially adheres to any biotic or abiotic surfaces that give specific shelter to the microbial community, making them less susceptible to many antimicrobial agents and even resistant to the immune cells of animal hosts. Around thirty clinical research reports available in PUBMED have been considered to establish the occurrence of biofilm-forming bacteria showing resistance against several regular antibiotics prescribed against infection by clinicians among Indian patients. After the extensive literature review, our observation exhibits a high predominance of biofilm formation among bacteria such as Escherichia sp., Streptococcus sp., Staphylococcus sp., and Pseudomonas sp., those are the most common biofilm-producing antibiotic-resistant bacteria among Indian patients with urinary tract infections and/or catheter-related infections, respiratory tract infections, dental infections, skin infections, and implant-associated infections. This review demonstrates that biofilm-associated bacterial infections constantly elevate in several pathological conditions along with the enhancement of the multi-drug resistance phenomenon.
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Affiliation(s)
- Susmita Datta
- Department of Chemical Engineering, National Institute of Technology, Agartala, Tripura, India
| | - Soma Nag
- Department of Chemical Engineering, National Institute of Technology, Agartala, Tripura, India
| | - Dijendra Nath Roy
- Department of Biotechnology, National Institute of Technology, Raipur, Chhattisgarh, India
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12
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Hussaini IM, Oyewole OA, Sulaiman MA, Dabban AI, Sulaiman AN, Tarek R. Microbial anti-biofilms: types and mechanism of action. Res Microbiol 2024; 175:104111. [PMID: 37844786 DOI: 10.1016/j.resmic.2023.104111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2023] [Revised: 07/27/2023] [Accepted: 08/01/2023] [Indexed: 10/18/2023]
Abstract
Biofilms have been recognized as a serious threat to public health as it protects microbes from antimicrobials, immune defence mechanisms, chemical treatments and nutritional stress. Biofilms are also a source of concern in industries and water treatment because their presence compromises the integrity of equipment. To overcome these problems, it is necessary to identify novel anti-biofilm compounds. Products of microorganisms have been identified as promising broad-spectrum anti-biofilm agents. These natural products include biosurfactants, antimicrobial peptides, enzymes and bioactive compounds. Anti-biofilm products of microbial origin are chemically diverse and possess a broad spectrum of activities against biofilms. The objective of this review is to give an overview of the different types of microbial anti-biofilm products and their mechanisms of action.
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Affiliation(s)
| | - Oluwafemi Adebayo Oyewole
- Department of Microbiology, School of Life Sciences, Federal University of Technology, Minna, Nigeria; African Center of Excellence for Mycotoxin and Food Safety, Federal University of Technology Minna, Nigeria.
| | | | | | - Asmau Nna Sulaiman
- Department of Microbiology, Faculty of Life Sciences, Ahmadu Bello University, Zaria, Nigeria
| | - Reham Tarek
- Department of Biotechnology, Cairo University, Egypt
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13
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Li H, Hao J, Liu X. Research progress and perspective of metallic implant biomaterials for craniomaxillofacial surgeries. Biomater Sci 2024; 12:252-269. [PMID: 38170634 DOI: 10.1039/d2bm01414a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2024]
Abstract
Craniomaxillofacial bone serves a variety of functions. However, the increasing number of cases of craniomaxillofacial bone injury and the use of selective rare implants make the treatment difficult, and the cure rate is low. If such a bone injury is not properly treated, it can lead to a slew of complications that can seriously disrupt a patient's daily life. For example, premature closure of cranial sutures or skull fractures can lead to increased intracranial pressure, which can lead to headaches, vomiting, and even brain hernia. At present, implant placement is one of the most common approaches to repair craniomaxillofacial bone injury or abnormal closure, especially with biomedical metallic implants. This review analyzes the research progress in the design and development of degradable and non-degradable metallic implants in craniomaxillofacial surgery. The mechanical properties, corrosion behaviours, as well as in vitro and in vivo performances of these materials are summarized. The challenges and future research directions of metallic biomaterials used in craniomaxillofacial surgery are also identified.
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Affiliation(s)
- Huafang Li
- School of Materials Science and Engineering, University of Science and Technology Beijing, Beijing, 100083, China.
| | - Jiaqi Hao
- School of Materials Science and Engineering, University of Science and Technology Beijing, Beijing, 100083, China.
| | - Xiwei Liu
- Lepu Medical Technology Co., Ltd, Beijing 102200, China
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14
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Chen C, Xiao Q, Xiao L, Feng M, Liu F, Yao K, Cui Y, Zhang T, Zhang Y. Drug delivery nanoparticles for preventing implant bacterial infections based on the bacteria and immunity mechanisms. Biomater Sci 2024; 12:413-424. [PMID: 38010155 DOI: 10.1039/d3bm01584j] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2023]
Abstract
Implant dysfunction and failure during medical treatment can be attributed to bacterial infection with Staphylococcus aureus and Enterococcus faecalis, which are the prevalent strains responsible for implant infections. Currently, antibiotics are primarily used either locally or systemically to prevent and treat bacterial infections in implants. However, the effectiveness of this approach is unsatisfactory. Therefore, the development of new antimicrobial medications is crucial to address the clinical challenges associated with implant infections. In this study, a nanoparticle (ICG+RSG) composed of indocyanine green (ICG) and rosiglitazone (RSG), and delivered using 1,2-dipalmitoyl-snglycero-3-phosphocholine (DPPC) was prepared. ICG+RSG has photothermal and photodynamic properties to eliminate bacteria at the infection site by releasing reactive oxygen species and increasing the temperature. Additionally, it regulates phagocytosis and macrophage polarization to modulate the immune response in the body. ICG+RSG kills bacteria and reduces tissue inflammation, showing potential for preventing implant infections.
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Affiliation(s)
- Chen Chen
- State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, Key Laboratory of Oral Biomedicine Ministry of Education, Hubei Key Laboratory of Stomatology, School & Hospital of Stomatology, Wuhan University, Wuhan University, Wuhan 430079, China.
| | - Qi Xiao
- State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, Key Laboratory of Oral Biomedicine Ministry of Education, Hubei Key Laboratory of Stomatology, School & Hospital of Stomatology, Wuhan University, Wuhan University, Wuhan 430079, China.
| | - Leyi Xiao
- State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, Key Laboratory of Oral Biomedicine Ministry of Education, Hubei Key Laboratory of Stomatology, School & Hospital of Stomatology, Wuhan University, Wuhan University, Wuhan 430079, China.
| | - Mengge Feng
- State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, Key Laboratory of Oral Biomedicine Ministry of Education, Hubei Key Laboratory of Stomatology, School & Hospital of Stomatology, Wuhan University, Wuhan University, Wuhan 430079, China.
| | - Fangzhe Liu
- State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, Key Laboratory of Oral Biomedicine Ministry of Education, Hubei Key Laboratory of Stomatology, School & Hospital of Stomatology, Wuhan University, Wuhan University, Wuhan 430079, China.
| | - Ke Yao
- State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, Key Laboratory of Oral Biomedicine Ministry of Education, Hubei Key Laboratory of Stomatology, School & Hospital of Stomatology, Wuhan University, Wuhan University, Wuhan 430079, China.
| | - Yu Cui
- State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, Key Laboratory of Oral Biomedicine Ministry of Education, Hubei Key Laboratory of Stomatology, School & Hospital of Stomatology, Wuhan University, Wuhan University, Wuhan 430079, China.
| | - Tiange Zhang
- State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, Key Laboratory of Oral Biomedicine Ministry of Education, Hubei Key Laboratory of Stomatology, School & Hospital of Stomatology, Wuhan University, Wuhan University, Wuhan 430079, China.
| | - Yufeng Zhang
- State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, Key Laboratory of Oral Biomedicine Ministry of Education, Hubei Key Laboratory of Stomatology, School & Hospital of Stomatology, Wuhan University, Wuhan University, Wuhan 430079, China.
- Frontier Science Center for Immunology and Metabolism, Wuhan University, Wuhan 430071, China
- TaiKang Center for Life and Medical Sciences, Wuhan University, Wuhan 430071, China
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15
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Peng M, Chuan JL, Zhao GP, Fu Q. Construction of silver-coated high translucent zirconia implanting abutment material and its property of antibacterial. ARTIFICIAL CELLS, NANOMEDICINE, AND BIOTECHNOLOGY 2023; 51:441-452. [PMID: 37594201 DOI: 10.1080/21691401.2023.2244013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Revised: 07/13/2023] [Accepted: 07/29/2023] [Indexed: 08/19/2023]
Abstract
High translucent zirconia (HTZ) has excellent mechanical properties, biocompatibility, and good semi-translucency making it an ideal material for aesthetic anterior dental implant abutments without antibacterial properties. In the oral environment, the surface of the abutment material is susceptible to microbial adhesion and biofilm formation, which can lead to infection or peri-implantitis and even implant failure. This study aims to promote the formation of a biological seal at the implant-soft tissue interface by modifying the HTZ surface, using the load-bearing capacity of the aluminosilicate porous structure and the broad-spectrum antibacterial effect of silver nanoparticles to prevent peri-implant bacterial infection and inflammation and to improve the success rate and prolong the use of the implant. FE-SEM (field emission scanning electron microscopes), EDS (energy dispersive spectroscopy), and XPS (X-ray photoelectron spectroscopy) results showed that aluminosilicate non-vacuum sintering can form open micro- and nanoporous structures on HTZ surfaces, and that porous aluminosilicate coatings obtain a larger number, smaller size, and more uniformly shaped silver nanoparticles than smooth aluminosilicate coatings, and could be deposited deeper in the coating. The ICP-AES (inductively coupled plasma-atomic emission spectroscopy) results showed that the early silver ion release of both the smooth silver coating and the porous silver coating was obvious, the silver ion concentration released by the former was higher than that of the latter. However, the silver ion concentration released by the porous silver coating was higher than that of the smooth coating when the release slowed down. Both smooth and porous silver coatings both inhibited E. coli (Escherichia coli), S. aureus (Staphylococcus aureus), and L. acidophilus (L. acidophilus), and porous silver coatings had stronger antibacterial properties. The silver coating was successfully constructed on the surface of HTZ, through aluminium silicate sintering and silver nitrate solution impregnation. It was found that the high concentration environment of silver nitrate solution was more advantageous for nano-Ag deposition, and the non-vacuum sintered porous surface was able to obtain a larger number of nano-Ag particles with smaller sizes. The porous Ag coating exhibited superior antibacterial properties. It was suggested that the HTZ with silver coating had clinical application, and good antibacterial properties that can improve the survival rate and service life of implants.
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Affiliation(s)
- Min Peng
- Department of Stomatology, Sichuan Academy of Medical Sciences and Sichuan Provincial People's Hospital, Chengdu, Sichuan, China
- School of Medicine, University of Electronic Science and Technology of Chengdu, Sichuan, China
| | - Jun-Lan Chuan
- Department of Pharmacy, Sichuan Academy of Medical Sciences and Sichuan Provincial People's Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, Sichuan, China
| | - Gao-Ping Zhao
- Department of Gastroinstestinal Surgery, Sichuan Academy of medical sciences and Sichuan Provincial People's Hospital, University of Medical sciences and technology of China, Chengdu, Sichuan, China
| | - Qiang Fu
- Organ Transplantation Center, Sichuan Provincial People's Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
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Arciola CR, Ravaioli S, Mirzaei R, Dolzani P, Montanaro L, Daglia M, Campoccia D. Biofilms in Periprosthetic Orthopedic Infections Seen through the Eyes of Neutrophils: How Can We Help Neutrophils? Int J Mol Sci 2023; 24:16669. [PMID: 38068991 PMCID: PMC10706149 DOI: 10.3390/ijms242316669] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Revised: 11/13/2023] [Accepted: 11/16/2023] [Indexed: 12/18/2023] Open
Abstract
Despite advancements in our knowledge of neutrophil responses to planktonic bacteria during acute inflammation, much remains to be elucidated on how neutrophils deal with bacterial biofilms in implant infections. Further complexity transpires from the emerging findings on the role that biomaterials play in conditioning bacterial adhesion, the variety of biofilm matrices, and the insidious measures that biofilm bacteria devise against neutrophils. Thus, grasping the entirety of neutrophil-biofilm interactions occurring in periprosthetic tissues is a difficult goal. The bactericidal weapons of neutrophils consist of the following: ready-to-use antibacterial proteins and enzymes stored in granules; NADPH oxidase-derived reactive oxygen species (ROS); and net-like structures of DNA, histones, and granule proteins, which neutrophils extrude to extracellularly trap pathogens (the so-called NETs: an allusive acronym for "neutrophil extracellular traps"). Neutrophils are bactericidal (and therefore defensive) cells endowed with a rich offensive armamentarium through which, if frustrated in their attempts to engulf and phagocytose biofilms, they can trigger the destruction of periprosthetic bone. This study speculates on how neutrophils interact with biofilms in the dramatic scenario of implant infections, also considering the implications of this interaction in view of the design of new therapeutic strategies and functionalized biomaterials, to help neutrophils in their arduous task of managing biofilms.
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Affiliation(s)
- Carla Renata Arciola
- Laboratory of Immunorheumatology and Tissue Regeneration, Laboratory of Pathology of Implant Infections, IRCCS Istituto Ortopedico Rizzoli, Via di Barbiano 1/10, 40136 Bologna, Italy;
- Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Via San Giacomo 14, 40126 Bologna, Italy
| | - Stefano Ravaioli
- Laboratorio di Patologia delle Infezioni Associate all’Impianto, IRCCS Istituto Ortopedico Rizzoli, Via di Barbiano 1/10, 40136 Bologna, Italy; (S.R.); (D.C.)
| | - Rasoul Mirzaei
- Venom and Biotherapeutics Molecules Laboratory, Medical Biotechnology Department, Biotechnology Research Center, Pasteur Institute of Iran, Tehran 1316943551, Iran;
| | - Paolo Dolzani
- Laboratorio di Immunoreumatologia e Rigenerazione Tissutale, IRCCS Istituto Ortopedico Rizzoli, Via di Barbiano 1/10, 40136 Bologna, Italy;
| | - Lucio Montanaro
- Laboratory of Immunorheumatology and Tissue Regeneration, Laboratory of Pathology of Implant Infections, IRCCS Istituto Ortopedico Rizzoli, Via di Barbiano 1/10, 40136 Bologna, Italy;
- Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Via San Giacomo 14, 40126 Bologna, Italy
| | - Maria Daglia
- Department of Pharmacy, University of Napoli Federico II, Via D. Montesano 49, 80131 Naples, Italy;
| | - Davide Campoccia
- Laboratorio di Patologia delle Infezioni Associate all’Impianto, IRCCS Istituto Ortopedico Rizzoli, Via di Barbiano 1/10, 40136 Bologna, Italy; (S.R.); (D.C.)
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17
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Jaramillo-Correa C, Posada VM, Nashed J, Civantos A, Allain JP. Analysis of Antibacterial Efficacy and Cellular Alignment Regulation on Plasma Nanotextured Chitosan Surfaces. LANGMUIR : THE ACS JOURNAL OF SURFACES AND COLLOIDS 2023; 39:14573-14585. [PMID: 37797266 DOI: 10.1021/acs.langmuir.3c01808] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/07/2023]
Abstract
To address implant-related infections, antibacterial solutions specific to biomaterials are required to prevent bacterial proliferation. Traditional antibiotic usage has been found insufficient, motivating researchers to investigate alternative strategies such as surface modification and the application of antifouling or infection-resistant properties. A developing interest lies in designing surfaces that mimic natural antibacterial nanotopographies. In this study, we conducted a quantitative analysis of the outcomes from plasma nanotexturing, with particular emphasis on how the organization of topography influences antibacterial efficacy and the regulation of cell alignment. Plasma nanotexturing was applied to chitosan surfaces, which gradually transformed from nanopores to pillars and eventually into tilted pillars, as the plasma parameters (fluence and angle) increased. We used directed plasma nanosynthesis, a plasma-based technique that primarily induces topographical alterations on the surfaces. The surfaces were systematically characterized, incorporating methods such as scanning electron microscopy (SEM), atomic force microscopy (AFM), and X-ray photoelectron spectroscopy (XPS). A comprehensive comparison of the nanotextures was executed by utilizing a trapezoidal method to calculate aspect ratios and assess texture orientation by examining the gaps in the nanostructures. We evaluated antibacterial properties against E. coli and S. aureus strains and assessed the survival and alignment of human bone marrow mesenchymal stem cells. Our findings reveal a significant reduction in bacterial adhesion (>80%) and growth on nanotextured surfaces, underscoring their potential for clinical applications. Moreover, we measured cell alignment, presenting the results in both a color-coded and numerical format to demonstrate the preferential alignment orientation induced specially by the tilted nanotexture. These insights highlight the profound impacts of plasma nanotexturing, indicating its potential for innovative biomedical applications such as advanced wound healing and tissue engineering.
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Affiliation(s)
- Camilo Jaramillo-Correa
- Ken and Mary Alice Lindquist Department of Nuclear Engineering, Pennsylvania State University, University Park, Pennsylvania 16082, United States
- Nuclear, Plasma & Radiological Engineering Department, University of Illinois at Urbana-Champaign, Urbana, Illinois 61801, United States
- Materials Research Laboratory, University of Illinois at Urbana-Champaign, Urbana, Illinois 61801, United States
| | - Viviana M Posada
- Ken and Mary Alice Lindquist Department of Nuclear Engineering, Pennsylvania State University, University Park, Pennsylvania 16082, United States
| | - Jordan Nashed
- Ken and Mary Alice Lindquist Department of Nuclear Engineering, Pennsylvania State University, University Park, Pennsylvania 16082, United States
| | - Ana Civantos
- Nuclear, Plasma & Radiological Engineering Department, University of Illinois at Urbana-Champaign, Urbana, Illinois 61801, United States
| | - Jean Paul Allain
- Ken and Mary Alice Lindquist Department of Nuclear Engineering, Pennsylvania State University, University Park, Pennsylvania 16082, United States
- Nuclear, Plasma & Radiological Engineering Department, University of Illinois at Urbana-Champaign, Urbana, Illinois 61801, United States
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18
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Chang Y, Li Y, Fan T, Jiang K, Lv J, Huang J. Pathogenic bacteria characteristics and drug resistance in acute, delayed, and chronic periprosthetic joint infection: A retrospective analysis of 202 patients. Int Wound J 2023; 20:3315-3323. [PMID: 37186450 PMCID: PMC10502290 DOI: 10.1111/iwj.14212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 04/13/2023] [Accepted: 04/13/2023] [Indexed: 05/17/2023] Open
Abstract
To assist orthopaedic surgeons in choosing appropriate antibiotics, this study attempted to identify the common microorganisms that cause periprosthetic joint infection (PJI) and their respective drug resistance spectrums. The clinical data of 202 patients with PJI after primary hip and knee arthroplasty between January 2017 and December 2021 were retrospectively analysed. There were 84 males and 118 females, aged (63.03 ± 13.10) years (range: 24-89 years). A total of 102 and 100 patients underwent total hip and total knee arthroplasty, respectively. Based on the time of postoperative infection, the patients were divided into acute (25 cases), delayed (91 cases), and chronic (86 cases) PJI groups. The results of pathogen species, composition ratio, and drug susceptibility tests were collected. Gram-positive bacteria were the primary causative pathogens of PJI (58.91%, 119/202), and their culture-positive rates in patients with acute, delayed, and chronic PJI were 32.00% (8/25), 62.64% (57/91), and 62.79% (54/86), respectively. Staphylococcus epidermidis and Staphylococcus aureus were the major gram-positive bacteria detected, followed by gram-negative bacteria (29/202, 14.36%), and fungi (4/202, 1.98%). Gram-positive bacteria showed higher resistance to penicillin (81.25%), oxacillin (63.33%), erythromycin (61.17%), and clindamycin (48.35%) and 100% sensitivity to linezolid, vancomycin, daptomycin, and tigecycline. In gram-negative bacteria, the drug resistance rates to cefazolin, gentamicin, furantoin, cefuroxime, ticacillin/clavulanic acid, ceftriaxone, ciprofloxacin, and tobramycin were >50%. However, no vancomycin-resistant bacteria were discovered in the current study. The drug resistance rate to carbapenems was low, ranging from 0% to 3.57%. Gram-positive bacteria are the main causative pathogens of PJI, and the resistance rate of pathogens of chronic PJI is higher than those of delayed and acute PJI. Use of cefuroxime and clindamycin in patients with PJIs should proceed with caution because of the high drug resistance rate. Vancomycin can be used as a first-line antibiotic against gram-positive bacteria. Carbapenems can be used as the first choice against gram-negative bacteria because of to their high sensitivity.
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Affiliation(s)
- Yu Chang
- Department of Clinical PharmacyHonghui Hospital, Xi'an Jiaotong UniversityXi'anShaanxiPeople's Republic of China
| | - Yongsheng Li
- Department of Clinical PharmacyHonghui Hospital, Xi'an Jiaotong UniversityXi'anShaanxiPeople's Republic of China
| | - Ting Fan
- Department of Clinical PharmacyHonghui Hospital, Xi'an Jiaotong UniversityXi'anShaanxiPeople's Republic of China
| | - Kai Jiang
- Department of Clinical PharmacyHonghui Hospital, Xi'an Jiaotong UniversityXi'anShaanxiPeople's Republic of China
| | - Jing Lv
- Department of Clinical LaboratoryHonghui Hospital, Xi'an Jiaotong UniversityXi'anShaanxiPeople's Republic of China
| | - Jing Huang
- Department of Clinical PharmacyHonghui Hospital, Xi'an Jiaotong UniversityXi'anShaanxiPeople's Republic of China
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19
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Elfarargy RG, Sedki M, Samhan FA, Hassan RYA, El-Sherbiny IM. Surface grafting of polymeric catheters and stents to prevent biofilm formation of pathogenic bacteria. J Genet Eng Biotechnol 2023; 21:92. [PMID: 37707582 PMCID: PMC10501021 DOI: 10.1186/s43141-023-00545-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Accepted: 09/01/2023] [Indexed: 09/15/2023]
Abstract
BACKGROUND Tecothane (medical grade of polyurethane) is strongly involved in the fabrication of metallic and polymeric-based medical devices (e.g., catheters and stents) as they can withstand cardiac cycle-related forces without deforming or failing, and they can mimic tissue behavior. The main problem is microbial contamination and formation of pathogenic biofilms on such solid surfaces within the human body. Accordingly, our hypothesis is the coating of tecothane outer surfaces with antibacterial agents through the electro-deposition or chemical grafting of anti-biofilm agents onto the stent and catheter surfaces. RESULTS Tecothane is grafted with itaconic acid for cross-linking the polyethyleneimine (PEI) as the protective-active layer. Accordingly, the grafting of poly-itaconic acid onto the Tecothane was achieved by three different methods: wet-chemical approach, electro-polymerization, or by using plasma treatment. The successful modifications were verified using Fourier Transform Infrared (FTIR) spectroscopy, grafting percentage calculations, electrochemical, and microscopic monitoring of biofilm formation. The grafting efficiency of itaconic acid was over 3.2% (w/w) at 60 ℃ after 6 h of the catheter chemical modification. Bio-electrochemical signals of biofilms have been seriously reduced after chemical modification because of the inhibition of biofilm formation (for both Pseudomonas aeruginosa and Staphylococcus aureus) over a period of 9 days. CONCLUSION Chemical functionalization of the polyurethane materials with the antimicrobial and anti-biofilm agents led to a significant decrease in the formation of pathogenic biofilms. This promising proof-concept will open the door to explore further surface protection with potential anti-biofilm agents providing better and sustainable productions of stents and catheters biomaterials.
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Affiliation(s)
- Reham G Elfarargy
- Center for Materials Science, Zewail City of Science and Technology, 6Th October City, Giza, 12578, Egypt
| | - Mohamed Sedki
- Center for Materials Science, Zewail City of Science and Technology, 6Th October City, Giza, 12578, Egypt
| | - Farag A Samhan
- Water Pollution Research Department, National Research Centre (NRC), Giza, Egypt
| | - Rabeay Y A Hassan
- Center for Materials Science, Zewail City of Science and Technology, 6Th October City, Giza, 12578, Egypt.
| | - Ibrahim M El-Sherbiny
- Center for Materials Science, Zewail City of Science and Technology, 6Th October City, Giza, 12578, Egypt.
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20
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Hong S, Jiang W, Ding Q, Lin K, Zhao C, Wang X. The Current Progress of Tetrahedral DNA Nanostructure for Antibacterial Application and Bone Tissue Regeneration. Int J Nanomedicine 2023; 18:3761-3780. [PMID: 37457798 PMCID: PMC10348378 DOI: 10.2147/ijn.s403882] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Accepted: 06/19/2023] [Indexed: 07/18/2023] Open
Abstract
Recently, programmable assembly technologies have enabled the application of DNA in the creation of new nanomaterials with unprecedented functionality. One of the most common DNA nanostructures is the tetrahedral DNA nanostructure (TDN), which has attracted great interest worldwide due to its high stability, simple assembly procedure, high predictability, perfect programmability, and excellent biocompatibility. The unique spatial structure of TDN allows it to penetrate cell membranes in abundance and regulate cellular biological properties as a natural genetic material. Previous studies have demonstrated that TDNs can regulate various cellular biological properties, including promoting cells proliferation, migration and differentiation, inhibiting cells apoptosis, as well as possessing anti-inflammation and immunomodulatory capabilities. Furthermore, functional molecules can be easily modified at the vertices of DNA tetrahedron, DNA double helix structure, DNA tetrahedral arms or DNA tetrahedral cage structure, enabling TDN to be used as a nanocarrier for a variety of biological applications, including targeted therapies, molecular diagnosis, biosensing, antibacterial treatment, antitumor strategies, and tissue regeneration. In this review, we mainly focus on the current progress of TDN-based nanomaterials for antimicrobial applications, bone and cartilage tissue repair and regeneration. The synthesis and characterization of TDN, as well as the biological merits are introduced. In addition, the challenges and prospects of TDN-based nanomaterials are also discussed.
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Affiliation(s)
- Shebin Hong
- Department of Oral & Cranio-Maxillofacial Surgery, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People’s Republic of China
- College of Stomatology, Shanghai Jiao Tong University, Shanghai, People’s Republic of China
- National Center for Stomatology, National Clinical Research Center for Oral Diseases, Shanghai Key Laboratory of Stomatology, Shanghai, People’s Republic of China
| | - Weidong Jiang
- Department of Oral & Cranio-Maxillofacial Surgery, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People’s Republic of China
- College of Stomatology, Shanghai Jiao Tong University, Shanghai, People’s Republic of China
- National Center for Stomatology, National Clinical Research Center for Oral Diseases, Shanghai Key Laboratory of Stomatology, Shanghai, People’s Republic of China
| | - Qinfeng Ding
- Department of Oral & Cranio-Maxillofacial Surgery, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People’s Republic of China
- College of Stomatology, Shanghai Jiao Tong University, Shanghai, People’s Republic of China
- National Center for Stomatology, National Clinical Research Center for Oral Diseases, Shanghai Key Laboratory of Stomatology, Shanghai, People’s Republic of China
| | - Kaili Lin
- Department of Oral & Cranio-Maxillofacial Surgery, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People’s Republic of China
- College of Stomatology, Shanghai Jiao Tong University, Shanghai, People’s Republic of China
- National Center for Stomatology, National Clinical Research Center for Oral Diseases, Shanghai Key Laboratory of Stomatology, Shanghai, People’s Republic of China
| | - Cancan Zhao
- Department of Oral & Cranio-Maxillofacial Surgery, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People’s Republic of China
- College of Stomatology, Shanghai Jiao Tong University, Shanghai, People’s Republic of China
- National Center for Stomatology, National Clinical Research Center for Oral Diseases, Shanghai Key Laboratory of Stomatology, Shanghai, People’s Republic of China
| | - Xudong Wang
- Department of Oral & Cranio-Maxillofacial Surgery, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People’s Republic of China
- College of Stomatology, Shanghai Jiao Tong University, Shanghai, People’s Republic of China
- National Center for Stomatology, National Clinical Research Center for Oral Diseases, Shanghai Key Laboratory of Stomatology, Shanghai, People’s Republic of China
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21
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Hollyer I, Ivanov D, Kappagoda S, Lowenberg DW, Goodman SB, Amanatullah DF. Selecting a high-dose antibiotic-laden cement knee spacer. J Orthop Res 2023; 41:1383-1396. [PMID: 37127938 DOI: 10.1002/jor.25570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 04/17/2023] [Indexed: 05/03/2023]
Abstract
Prosthetic joint infection [PJI] after total knee arthroplasty (TKA) remains a common and challenging problem for joint replacement surgeons and patients. Once the diagnosis of PJI has been made, patient goals and characteristics as well as the infection timeline dictate treatment. Most commonly, this involves a two-stage procedure with the removal of all implants, debridement, and placement of a static or dynamic antibiotic spacer. Static spacers are commonly indicated for older, less healthy patients that would benefit from soft tissue rest after initial debridement. Mobile spacers are typically used in younger, healthier patients to improve quality of life and reduce soft-tissue contractures during antibiotic spacer treatment. Spacers are highly customizable with regard to antibiotic choice, cement variety, and spacer design, each with reported advantages, drawbacks, and indications that will be covered in this article. While no spacer is superior to any other, the modern arthroplasty surgeon must be familiar with the available modalities to optimize treatment for each patient. Here we propose a treatment algorithm to assist surgeons in deciding on treatment for PJI after TKA.
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Affiliation(s)
- Ian Hollyer
- Department of Orthopaedic Surgery, Stanford University, Redwood City, California, USA
| | - David Ivanov
- Department of Orthopaedic Surgery, Stanford University, Redwood City, California, USA
| | - Shanthi Kappagoda
- Division of Infectious Diseases and Geographic Medicine, Stanford Univeristy, Stanford, California, USA
| | - David W Lowenberg
- Department of Orthopaedic Surgery, Stanford University, Redwood City, California, USA
| | - Stuart B Goodman
- Department of Orthopaedic Surgery, Stanford University, Redwood City, California, USA
| | - Derek F Amanatullah
- Department of Orthopaedic Surgery, Stanford University, Redwood City, California, USA
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22
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Li M, Yu J, Guo G, Shen H. Interactions between Macrophages and Biofilm during Staphylococcus aureus-Associated Implant Infection: Difficulties and Solutions. J Innate Immun 2023; 15:499-515. [PMID: 37011602 PMCID: PMC10315156 DOI: 10.1159/000530385] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2022] [Accepted: 03/16/2023] [Indexed: 04/05/2023] Open
Abstract
Staphylococcus aureus (S. aureus) biofilm is the major cause of failure of implant infection treatment that results in heavy social and economic burden on individuals, families, and communities. Planktonic S. aureus attaches to medical implant surfaces where it proliferates and is wrapped by extracellular polymeric substances, forming a solid and complex biofilm. This provides a stable environment for bacterial growth, infection maintenance, and diffusion and protects the bacteria from antimicrobial agents and the immune system of the host. Macrophages are an important component of the innate immune system and resist pathogen invasion and infection through phagocytosis, antigen presentation, and cytokine secretion. The persistence, spread, or clearance of infection is determined by interplay between macrophages and S. aureus in the implant infection microenvironment. In this review, we discuss the interactions between S. aureus biofilm and macrophages, including the effects of biofilm-related bacteria on the macrophage immune response, roles of myeloid-derived suppressor cells during biofilm infection, regulation of immune cell metabolic patterns by the biofilm environment, and immune evasion strategies adopted by the biofilm against macrophages. Finally, we summarize the current methods that support macrophage-mediated removal of biofilms and emphasize the importance of considering multi-dimensions and factors related to implant-associated infection such as immunity, metabolism, the host, and the pathogen when developing new treatments.
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Affiliation(s)
- Mingzhang Li
- Department of Orthopaedics, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jinlong Yu
- Department of Orthopaedics, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Geyong Guo
- Department of Orthopaedics, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Hao Shen
- Department of Orthopaedics, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
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23
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Yang X, Wang Q, Zhang Y, He H, Xiong S, Chen P, Li C, Wang L, Lu G, Xu Y. A dual-functional PEEK implant coating for anti-bacterial and accelerated osseointegration. Colloids Surf B Biointerfaces 2023; 224:113196. [PMID: 36764204 DOI: 10.1016/j.colsurfb.2023.113196] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2022] [Revised: 02/01/2023] [Accepted: 02/02/2023] [Indexed: 02/05/2023]
Abstract
Polyetheretherketone (PEEK) has been widely applied in biomedical engineering. However, the unsatisfactory bioactivity essentially limits the clinical application of PEEK. In this study, a simply immersing method was proposed to fabricate a dual-functional PEEK with antibacterial properties and enhanced bone integration. Firstly, the surface of PEEK was modified with a polydopamine (PDA) coating by incubating at dopamine solution. Afterward, the PEEK-PDA was modified with manganese (Mn) and silver (Ag) ions by the soaking method to fabricate the PEEK-PDA-Mn/Ag. The physicochemical capabilities of PEEK-PDA-Mn/Ag were further explored in the ions release, wettability, morphology, and element distributions. PEEK-PDA-Mn/Ag obviously accelerated the adhesion and distribution of MC3T3-E1 cells, indicating favorable biosafety in vitro. Meanwhile, the osteogenic properties of PEEK-PDA-Mn and PEEK-PDA-Mn/Ag were proved by the increased expression of osteogenic genes, alkaline phosphatase (ALP), and mineralization in vitro. Additionally, the wide antibacterial capabilities of PEEK-PDA-Mn/Ag were proved in both Staphylococcus aureus (S. aureus) and Escherichia coli (E. coli) in vitro. Furthermore, the PEEK-PDA-Mn/Ag was antibacterial with capability in enhancing osseointegration in vivo. Overall, the simply immersing method can modify the surface of PEEK, giving the bioactivity, biocompatibility, and antibacterial ability to the composited PEEK, which could be applied as an orthopedic implant in clinical.
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Affiliation(s)
- Xin Yang
- Department of Orthopaedics, The First Affiliated Hospital of Soochow University, No. 188 Shizi Street, Suzhou, Jiangsu 215006, China; Department of Orthopedics, The First Affiliated Hospital of Wannan Medical College, Wuhu 241001, Anhui, China
| | - Qiang Wang
- Department of Orthopedics, The First Affiliated Hospital of Wannan Medical College, Wuhu 241001, Anhui, China
| | - Yinchang Zhang
- Department of Orthopedics, The First Affiliated Hospital of Wannan Medical College, Wuhu 241001, Anhui, China
| | - Huazheng He
- Department of Orthopedics, The First Affiliated Hospital of Wannan Medical College, Wuhu 241001, Anhui, China
| | - Shouliang Xiong
- Department of Orthopedics, The First Affiliated Hospital of Wannan Medical College, Wuhu 241001, Anhui, China
| | - Pingbo Chen
- Department of Orthopedics, The First Affiliated Hospital of Wannan Medical College, Wuhu 241001, Anhui, China
| | - Congming Li
- Department of Orthopedics, The First Affiliated Hospital of Wannan Medical College, Wuhu 241001, Anhui, China
| | - Lei Wang
- Department of Orthopedics, The First Affiliated Hospital of Wannan Medical College, Wuhu 241001, Anhui, China.
| | - Guohai Lu
- Department of orthopedics, Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou 215500, Jiangsu, China.
| | - Yaozeng Xu
- Department of Orthopaedics, The First Affiliated Hospital of Soochow University, No. 188 Shizi Street, Suzhou, Jiangsu 215006, China.
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24
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Brar B, Marwaha S, Poonia AK, Koul B, Kajla S, Rajput VD. Nanotechnology: a contemporary therapeutic approach in combating infections from multidrug-resistant bacteria. Arch Microbiol 2023; 205:62. [PMID: 36629918 DOI: 10.1007/s00203-023-03404-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 12/24/2022] [Accepted: 01/02/2023] [Indexed: 01/12/2023]
Abstract
In the 20th century, the discovery of antibiotics played an essential role in the fight against infectious diseases, including meningitis, typhoid fever, pneumonia and Mycobacterium tuberculosis. The development of multidrug resistance in microflora due to improper antibiotic use created significant public health issues. Antibiotic resistance has increased at an alarming rate in the past few decades. Multidrug-resistant bacteria (superbugs) such as methicillin-resistant Staphylococcus aureus (MRSA) as well as drug-resistant tuberculosis pose serious health implications. Despite the continuous increase in resistant microbes, the discovery of novel antibiotics is constrained by the cost and complexities of discovery of drugs. The nanotechnology has given new hope in combating this problem. In the present review, recent developments in therapeutics utilizing nanotechnology for novel antimicrobial drug development are discussed. The nanoparticles of silver, gold and zinc oxide have proved to be efficient antimicrobial agents against multidrug-resistant Klebsiella, Pseudomonas, Escherichia Coli and MRSA. Using nanostructures as carriers for antimicrobial agents provides better bioavailability, less chances of sub-therapeutic drug accumulation and less drug-related toxicity. Nanophotothermal therapy using fullerene and antibody functionalized nanostructures are other strategies that can prove to be helpful.
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Affiliation(s)
- Basanti Brar
- HABITAT, Genome Improvement Primary Producer Company Ltd. Centre of Biofertilizer Production and Technology, HAU, Hisar, 125004, India
| | - Sumnil Marwaha
- ICAR-National Research Centre On Camel, Bikaner, 334001, Rajasthan, India
| | - Anil Kumar Poonia
- Department of Botany, School of Bioengineering and Biosciences, Lovely Professional University, Phagwara, 144411, Punjab, India. .,Department of Molecular Biology &Biotechnology, CCSHAU, Hisar, 125004, Haryana, India.
| | - Bhupendra Koul
- Department of Botany, School of Bioengineering and Biosciences, Lovely Professional University, Phagwara, 144411, Punjab, India.
| | - Subhash Kajla
- Department of Molecular Biology &Biotechnology, CCSHAU, Hisar, 125004, Haryana, India.
| | - Vishnu D Rajput
- Academy of Biology and Biotechnology, Southern Federal University, Rostov-On-Don, 344090, Russia.
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25
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Campoccia D, Montanaro L, Ravaioli S, Mariani V, Bottau G, De Donno A, Arciola CR. Antibacterial Activity on Orthopedic Clinical Isolates and Cytotoxicity of the Antimicrobial Peptide Dadapin-1. Int J Mol Sci 2023; 24:ijms24010779. [PMID: 36614222 PMCID: PMC9821071 DOI: 10.3390/ijms24010779] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Revised: 12/26/2022] [Accepted: 12/30/2022] [Indexed: 01/04/2023] Open
Abstract
In orthopedic surgery, biomaterial-associated infections represent a complication of serious concern. Most promising strategies to prevent these infections currently rely on the use of anti-infective biomaterials. Desirably, in anti-infective biomaterials, the antibacterial properties should be achieved by doping, grafting, or coating the material surfaces with molecules that are alternative to conventional antibiotics and exhibit a potent and highly specific activity against bacteria, without altering the biocompatibility. Antimicrobial peptides (AMPs) are among the most interesting candidate molecules for this biomaterial functionalization. Here, the potential expressed by the recently discovered peptide Dadapin-1 was explored by assaying its MIC, MBIC and MBC on clinical strains of relevant bacterial species isolated from orthopedic infections and by assessing its cytotoxicity on the human osteoblast-like MG63 cells. When appropriately tested in diluted Mueller Hinton Broth II (MHB II), Dadapin-1 exhibited significant antibacterial properties. MIC values were in the range of 3.1-6.2 µM for the gram-positive bacteria Staphylococcus aureus, Staphylococcus epidermidis, and Staphylococcus warneri, and 12.4-24.9 µM for the gram-negative bacteria Escherichia coli and Pseudomonas aeruginosa. Interestingly, the peptide was found non-cytotoxic, with an IC50 exceeding the highest concentration tested of 179 µM. Overall, Dadapin-1 expresses considerable potential for future application in the production of anti-infective biomaterials.
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Affiliation(s)
- Davide Campoccia
- Laboratorio di Patologia delle Infezioni Associate all’Impianto, IRCCS Istituto Ortopedico Rizzoli, Via di Barbiano 1/10, 40136 Bologna, Italy
- Correspondence: (D.C.); (C.R.A.); Tel.: +39-0516-366-666 (D.C.); +39-0516-366-599 (C.R.A.)
| | - Lucio Montanaro
- Laboratorio di Patologia delle Infezioni Associate all’Impianto, IRCCS Istituto Ortopedico Rizzoli, Via di Barbiano 1/10, 40136 Bologna, Italy
| | - Stefano Ravaioli
- Laboratorio di Patologia delle Infezioni Associate all’Impianto, IRCCS Istituto Ortopedico Rizzoli, Via di Barbiano 1/10, 40136 Bologna, Italy
| | - Valentina Mariani
- Laboratorio di Patologia delle Infezioni Associate all’Impianto, IRCCS Istituto Ortopedico Rizzoli, Via di Barbiano 1/10, 40136 Bologna, Italy
| | - Giulia Bottau
- Laboratorio di Patologia delle Infezioni Associate all’Impianto, IRCCS Istituto Ortopedico Rizzoli, Via di Barbiano 1/10, 40136 Bologna, Italy
| | - Andrea De Donno
- Laboratorio di Patologia delle Infezioni Associate all’Impianto, IRCCS Istituto Ortopedico Rizzoli, Via di Barbiano 1/10, 40136 Bologna, Italy
| | - Carla Renata Arciola
- Laboratorio di Patologia delle Infezioni Associate all’Impianto, IRCCS Istituto Ortopedico Rizzoli, Via di Barbiano 1/10, 40136 Bologna, Italy
- Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Via San Giacomo 14, 40126 Bologna, Italy
- Correspondence: (D.C.); (C.R.A.); Tel.: +39-0516-366-666 (D.C.); +39-0516-366-599 (C.R.A.)
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26
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Afshar M, Møllebjerg A, Minero GA, Hollensteiner J, Poehlein A, Himmelbach A, Lange J, Meyer RL, Brüggemann H. Biofilm formation and inflammatory potential of Staphylococcus saccharolyticus: A possible cause of orthopedic implant-associated infections. Front Microbiol 2022; 13:1070201. [DOI: 10.3389/fmicb.2022.1070201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Accepted: 11/09/2022] [Indexed: 11/29/2022] Open
Abstract
Staphylococcus saccharolyticus, a coagulase-negative staphylococcal species, has some unusual characteristics for human-associated staphylococci, such as slow growth and its preference for anoxic culture conditions. This species is a relatively abundant member of the human skin microbiota, but its microbiological properties, as well as the pathogenic potential, have scarcely been investigated so far, despite being occasionally isolated from different types of infections including orthopedic implant-associated infections. Here, we investigated the growth and biofilm properties of clinical isolates of S. saccharolyticus and determined host cell responses. Growth assessments in anoxic and oxic conditions revealed strain-dependent outcomes, as some strains can also grow aerobically. All tested strains of S. saccharolyticus were able to form biofilm in a microtiter plate assay. Strain-dependent differences were determined by optical coherence tomography, revealing that medium supplementation with glucose and sodium chloride enhanced biofilm formation. Visualization of the biofilm by confocal laser scanning microscopy revealed the role of extracellular DNA in the biofilm structure. In addition to attached biofilms, S. saccharolyticus also formed bacterial aggregates at an early stage of growth. Transcriptome analysis of biofilm-grown versus planktonic cells revealed a set of upregulated genes in biofilm-embedded cells, including factors involved in adhesion, colonization, and competition such as epidermin, type I toxin-antitoxin system, and phenol-soluble modulins (beta and epsilon). To investigate consequences for the host after encountering S. saccharolyticus, cytokine profiling and host cell viability were assessed by infection experiments with differentiated THP-1 cells. The microorganism strongly triggered the secretion of the tested pro-inflammatory cyto- and chemokines IL-6, IL-8, and TNF-alpha, determined at 24 h post-infection. S. saccharolyticus was less cytotoxic than Staphylococcus aureus. Taken together, the results indicate that S. saccharolyticus has substantial pathogenic potential. Thus, it can be a potential cause of orthopedic implant-associated infections and other types of deep-seated infections.
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27
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Xie H, Liu Y, An H, Yi J, Li C, Wang X, Chai W. Recent advances in prevention, detection and treatment in prosthetic joint infections of bioactive materials. Front Bioeng Biotechnol 2022; 10:1053399. [PMID: 36440438 PMCID: PMC9685530 DOI: 10.3389/fbioe.2022.1053399] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Accepted: 10/31/2022] [Indexed: 11/07/2023] Open
Abstract
Prosthetic joint infection (PJI) is often considered as one of the most common but catastrophic complications after artificial joint replacement, which can lead to surgical failure, revision, amputation and even death. It has become a worldwide problem and brings great challenges to public health systems. A small amount of microbe attaches to the graft and forms a biofilm on its surface, which lead to the PJI. The current standard methods of treating PJI have limitations, but according to recent reports, bioactive materials have potential research value as a bioactive substance that can have a wide range of applications in the field of PJI. These include the addition of bioactive materials to bone cement, the use of antibacterial and anti-fouling materials for prosthetic coatings, the use of active materials such as bioactive glasses, protamine, hydrogels for prophylaxis and detection with PH sensors and fluorescent-labelled nanoparticles, and the use of antibiotic hydrogels and targeting delivery vehicles for therapeutic purposes. This review focus on prevention, detection and treatment in joint infections with bioactive materials and provide thoughts and ideas for their future applications.
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Affiliation(s)
- Hongbin Xie
- Senior Department of Orthopedics, Fourth Medical Center of People’s Liberation Army General Hospital, Beijing, China
- School of Medicine, Nankai University, Tianjin, China
- National Clinical Research Center for Orthopaedics, Sports Medicine & Rehabilitation, Beijing, China
| | - Yubo Liu
- Senior Department of Orthopedics, Fourth Medical Center of People’s Liberation Army General Hospital, Beijing, China
- School of Medicine, Nankai University, Tianjin, China
- National Clinical Research Center for Orthopaedics, Sports Medicine & Rehabilitation, Beijing, China
| | - Haoming An
- Senior Department of Orthopedics, Fourth Medical Center of People’s Liberation Army General Hospital, Beijing, China
- School of Medicine, Nankai University, Tianjin, China
- National Clinical Research Center for Orthopaedics, Sports Medicine & Rehabilitation, Beijing, China
| | - Jiafeng Yi
- Senior Department of Orthopedics, Fourth Medical Center of People’s Liberation Army General Hospital, Beijing, China
- School of Medicine, Nankai University, Tianjin, China
- National Clinical Research Center for Orthopaedics, Sports Medicine & Rehabilitation, Beijing, China
| | - Chao Li
- Senior Department of Orthopedics, Fourth Medical Center of People’s Liberation Army General Hospital, Beijing, China
- National Clinical Research Center for Orthopaedics, Sports Medicine & Rehabilitation, Beijing, China
| | - Xing Wang
- Beijing National Laboratory for Molecular Sciences, Institute of Chemistry, Chinese Academy of Sciences, Beijing, China
- University of Chinese Academy of Sciences, Beijing, China
| | - Wei Chai
- Senior Department of Orthopedics, Fourth Medical Center of People’s Liberation Army General Hospital, Beijing, China
- National Clinical Research Center for Orthopaedics, Sports Medicine & Rehabilitation, Beijing, China
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28
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Putra NE, Leeflang MA, Ducret V, Patrulea V, Fratila-Apachitei LE, Perron K, Ye H, Zhou J, Apachitei I, Zadpoor AA. Preventing Antibiotic-Resistant Infections: Additively Manufactured Porous Ti6Al4V Biofunctionalized with Ag and Fe Nanoparticles. Int J Mol Sci 2022; 23:13239. [PMID: 36362029 PMCID: PMC9654018 DOI: 10.3390/ijms232113239] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2022] [Revised: 10/24/2022] [Accepted: 10/28/2022] [Indexed: 08/20/2024] Open
Abstract
Implant-associated infections are highly challenging to treat, particularly with the emergence of multidrug-resistant microbials. Effective preventive action is desired to be at the implant site. Surface biofunctionalization of implants through Ag-doping has demonstrated potent antibacterial results. However, it may adversely affect bone regeneration at high doses. Benefiting from the potential synergistic effects, combining Ag with other antibacterial agents can substantially decrease the required Ag concentration. To date, no study has been performed on immobilizing both Ag and Fe nanoparticles (NPs) on the surface of additively manufactured porous titanium. We additively manufactured porous titanium and biofunctionalized its surface with plasma electrolytic oxidation using a Ca/P-based electrolyte containing Fe NPs, Ag NPs, and the combinations. The specimen's surface morphology featured porous TiO2 bearing Ag and Fe NPs. During immersion, Ag and Fe ions were released for up to 28 days. Antibacterial assays against methicillin-resistant Staphylococcus aureus and Pseudomonas aeruginosa showed that the specimens containing Ag NPs and Ag/Fe NPs exhibit bactericidal activity. The Ag and Fe NPs worked synergistically, even when Ag was reduced by up to three times. The biofunctionalized scaffold reduced Ag and Fe NPs, improving preosteoblasts proliferation and Ca-sensing receptor activation. In conclusion, surface biofunctionalization of porous titanium with Ag and Fe NPs is a promising strategy to prevent implant-associated infections and allow bone regeneration and, therefore, should be developed for clinical application.
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Affiliation(s)
- Niko E. Putra
- Department of Biomechanical Engineering, Faculty of Mechanical, Maritime, and Materials Engineering, Delft University of Technology, Mekelweg 2, 2628 CD Delft, The Netherlands
| | - Marius A. Leeflang
- Department of Biomechanical Engineering, Faculty of Mechanical, Maritime, and Materials Engineering, Delft University of Technology, Mekelweg 2, 2628 CD Delft, The Netherlands
| | - Verena Ducret
- Microbiology Unit, Department of Botany and Plant Biology, University of Geneva, 30 Quai Ernest-Ansermet, 1211 Geneva, Switzerland
| | - Viorica Patrulea
- Institute of Biomedical Engineering, Department of Engineering Science, University of Oxford, Oxford OX3 7DQ, UK
| | - Lidy E. Fratila-Apachitei
- Department of Biomechanical Engineering, Faculty of Mechanical, Maritime, and Materials Engineering, Delft University of Technology, Mekelweg 2, 2628 CD Delft, The Netherlands
| | - Karl Perron
- Microbiology Unit, Department of Botany and Plant Biology, University of Geneva, 30 Quai Ernest-Ansermet, 1211 Geneva, Switzerland
- Institute of Pharmaceutical Sciences of Western Switzerland, University of Geneva, 1 Rue Michel Servet, 1211 Geneva, Switzerland
- Section of Pharmaceutical Sciences, University of Geneva, 1 Rue Michel Servet, 1211 Geneva, Switzerland
| | - Hua Ye
- Institute of Biomedical Engineering, Department of Engineering Science, University of Oxford, Oxford OX3 7DQ, UK
| | - Jie Zhou
- Department of Biomechanical Engineering, Faculty of Mechanical, Maritime, and Materials Engineering, Delft University of Technology, Mekelweg 2, 2628 CD Delft, The Netherlands
| | - Iulian Apachitei
- Department of Biomechanical Engineering, Faculty of Mechanical, Maritime, and Materials Engineering, Delft University of Technology, Mekelweg 2, 2628 CD Delft, The Netherlands
| | - Amir A. Zadpoor
- Department of Biomechanical Engineering, Faculty of Mechanical, Maritime, and Materials Engineering, Delft University of Technology, Mekelweg 2, 2628 CD Delft, The Netherlands
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29
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Chang Y, Li Y, Jiang K, Lv J, Huang J. Pathogen distrbution and drug resistance in acute, delayed and chronic periprosthetic joint infection: a retrospective analysis of 202 patients.. [DOI: 10.21203/rs.3.rs-2111407/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Abstract
Introduction To assist orthopedic surgeons to select appropriate antibiotics, this study identified the common microorganisms that caused PJI and their drug-resistant spectrum.
Methods. The clinical data of 202 patients with PJI after primary knee and hip arthroplasty from January 2017 to December 2021 were retrospectively analyzed. According to the time of postoperative infection, the patients were divided into acute PJI group (25 cases), delayed PJI group (91 cases), and chronic PJI group (86 cases). The results of pathogen species, composition ratio, drug susceptibility tests were collected.
Results.The main pathogens of PJI were Gram-positive bacteria (58.91%, 119/202), and the positive rates of culture in patients with acute PJI, delayed PJI and chronic PJI were 32.00% (8/25), 62.64% (57/91) and 62.79% (54/86), followed by gram-negative bacteria (29/202, 14.36%) and fungus (4/202, 1.98%). Staphylococcus epidermidis and Staphylococcus aureus played an important role as well, followed by gram-negative bacteria (29/202, 14.36%) and fungus (4/202, 1.98%). Penicillin (81.25%), oxacillin (63.33%), erythromycin (61.17%) and clindamycin (48.35%) showed high antibiotic resistance rate in gram-positive bacteria. The drug-sensitivity to linezolid, vancomycin, daptomycin and tigecycline was 100%. The drug resistance rate to carbapenems was low, ranging from 0 to 3.57%.
Conclusions. The main pathogens of PJI are Gram-positive bacteria, and the drug resistance rate of chronic PJI is higher than that of delayed and acute PJI.
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Affiliation(s)
- Yu Chang
- Honghui Hospital, Xi'an Jiaotong University
| | | | - Kai Jiang
- Honghui Hospital, Xi'an Jiaotong University
| | - Jing Lv
- Honghui Hospital, Xi'an Jiaotong University
| | - Jing Huang
- Honghui Hospital, Xi'an Jiaotong University
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30
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Melicherčík P, Kotaška K, Jahoda D, Landor I, Čeřovský V. Antimicrobial peptide in polymethylmethacrylate bone cement as a prophylaxis of infectious complications in orthopedics-an experiment in a murine model. Folia Microbiol (Praha) 2022; 67:785-791. [PMID: 35612699 DOI: 10.1007/s12223-022-00979-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Accepted: 05/18/2022] [Indexed: 12/29/2022]
Abstract
Polymethylmethacrylate (PMMA) bone cement mixed with antibiotics is used in orthopedic surgery to cope with implant-related infections which are typically associated with the formation of bacterial biofilms. Taking into account the growing bacterial resistance to current antibiotics, we examined here the efficacy of a selected antimicrobial peptide (AMP) mixed into the bone cement to inhibit bacterial adhesion and the consequent biofilm formation on its surface. In particular, we followed the formation of bacterial biofilms of methicillin-resistant Staphylococcus aureus (MRSA) on implants made from PMMA bone cement loaded with AMP composed of 12 amino acid residues. This was evaluated by CFU counting of bacteria released by sonication from the biofilms formed on their surfaces after these implants were retrieved from the infected murine femoral canals. The AMP loaded in these model implants prevented adhesion of MRSA and the subsequent formation of MRSA biofilm on the surfaces of more than 80% of these implants, whereas biofilms did form on control implants made from the plain cement. The results of our experiments performed in the murine femoral canal indicate the potential for this murine osteomyelitis model to mimic actual operations in orthopedics.
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Affiliation(s)
- Pavel Melicherčík
- Department of Orthopaedics, First Faculty of Medicine, Charles University in Prague and Motol University Hospital, V Úvalu 84, Prague 5, 150 06, Czech Republic
| | - Karel Kotaška
- Department of Medical Chemistry and Clinical Biochemistry, Second Faculty of Medicine, Charles University in Prague and Motol University Hospital, V Úvalu 84, Prague 5, 150 06, Czech Republic
| | - David Jahoda
- Department of Orthopaedics, First Faculty of Medicine, Charles University in Prague and Motol University Hospital, V Úvalu 84, Prague 5, 150 06, Czech Republic
| | - Ivan Landor
- Department of Orthopaedics, First Faculty of Medicine, Charles University in Prague and Motol University Hospital, V Úvalu 84, Prague 5, 150 06, Czech Republic
| | - Václav Čeřovský
- Institute of Organic Chemistry and Biochemistry of the Czech Academy of Sciences, Flemingovo nám. 2, Prague 6, 166 10, Czech Republic.
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Role of RNAIII in Resistance to Antibiotics and Antimicrobial Agents in Staphylococcus epidermidis Biofilms. Int J Mol Sci 2022; 23:ijms231911094. [PMID: 36232391 PMCID: PMC9569910 DOI: 10.3390/ijms231911094] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Revised: 08/29/2022] [Accepted: 09/16/2022] [Indexed: 11/17/2022] Open
Abstract
Staphylococcus epidermidis is a known opportunistic pathogen and is one of the leading causes of chronic biofilm-associated infections. Biofilm formation is considered as a main strategy to resist antibiotic treatment and help bacteria escape from the human immune system. Understanding the complex mechanisms in biofilm formation can help find new ways to treat resistant strains and lower the prevalence of nosocomial infections. In order to examine the role of RNAIII regulated by the agr quorum sensing system and to what extent it influences biofilm resistance to antimicrobial agents, deletion mutant S. epidermidis RP62a-ΔRNAIII deficient in repressor domains with a re-maining functional hld gene was created. A deletion strain was used to examine the influence of oxacillin in combination with vanillin on biofilm resistance and cell survival was determined. Utilizing real-time qPCR, confocal laser scanning microscopy (CLSM), and crystal violet staining analyses, we found that the RNAIII-independent controlled phenol soluble modulins (PSMs) and RNAIII effector molecule have a significant role in biofilm resistance to antibiotics and phenolic compounds, and it protects the integrity of biofilms. Moreover, a combination of antibiotic and antimicrobial agents can induce methicillin-resistant S. epidermidis biofilm formation and can lead to exceedingly difficult medical treatment.
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Titanium or Biodegradable Osteosynthesis in Maxillofacial Surgery? In Vitro and In Vivo Performances. Polymers (Basel) 2022; 14:polym14142782. [PMID: 35890557 PMCID: PMC9316877 DOI: 10.3390/polym14142782] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 06/30/2022] [Accepted: 07/02/2022] [Indexed: 02/06/2023] Open
Abstract
Osteosynthesis systems are used to fixate bone segments in maxillofacial surgery. Titanium osteosynthesis systems are currently the gold standard. However, the disadvantages result in symptomatic removal in up to 40% of cases. Biodegradable osteosynthesis systems, composed of degradable polymers, could reduce the need for removal of osteosynthesis systems while avoiding the aforementioned disadvantages of titanium osteosyntheses. However, disadvantages of biodegradable systems include decreased mechanical properties and possible foreign body reactions. In this review, the literature that focused on the in vitro and in vivo performances of biodegradable and titanium osteosyntheses is discussed. The focus was on factors underlying the favorable clinical outcome of osteosyntheses, including the degradation characteristics of biodegradable osteosyntheses and the host response they elicit. Furthermore, recommendations for clinical usage and future research are given. Based on the available (clinical) evidence, biodegradable copolymeric osteosyntheses are a viable alternative to titanium osteosyntheses when applied to treat maxillofacial trauma, with similar efficacy and significantly lower symptomatic osteosynthesis removal. For orthognathic surgery, biodegradable copolymeric osteosyntheses are a valid alternative to titanium osteosyntheses, but a longer operation time is needed. An osteosynthesis system composed of an amorphous copolymer, preferably using ultrasound welding with well-contoured shapes and sufficient mechanical properties, has the greatest potential as a biocompatible biodegradable copolymeric osteosynthesis system. Future research should focus on surface modifications (e.g., nanogel coatings) and novel biodegradable materials (e.g., magnesium alloys and silk) to address the disadvantages of current osteosynthesis systems.
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33
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Asare EO, Mun EA, Marsili E, Paunov VN. Nanotechnologies for control of pathogenic microbial biofilms. J Mater Chem B 2022; 10:5129-5153. [PMID: 35735175 DOI: 10.1039/d2tb00233g] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Biofilms are formed at interfaces by microorganisms, which congregate in microstructured communities embedded in a self-produced extracellular polymeric substance (EPS). Biofilm-related infections are problematic due to the high resistance towards most clinically used antimicrobials, which is associated with high mortality and morbidity, combined with increased hospital stays and overall treatment costs. Several new nanotechnology-based approaches have recently been proposed for targeting resistant bacteria and microbial biofilms. Here we discuss the impacts of biofilms on healthcare, food processing and packaging, and water filtration and distribution systems, and summarize the emerging nanotechnological strategies that are being developed for biofilm prevention, control and eradication. Combination of novel nanomaterials with conventional antimicrobial therapies has shown great potential in producing more effective platforms for controlling biofilms. Recent developments include antimicrobial nanocarriers with enzyme surface functionality that allow passive infection site targeting, degradation of the EPS and delivery of high concentrations of antimicrobials to the residing cells. Several stimuli-responsive antimicrobial formulation strategies have taken advantage of the biofilm microenvironment to enhance interaction and passive delivery into the biofilm sites. Nanoparticles of ultralow size have also been recently employed in formulations to improve the EPS penetration, enhance the carrier efficiency, and improve the cell wall permeability to antimicrobials. We also discuss antimicrobial metal and metal oxide nanoparticle formulations which provide additional mechanical factors through externally induced actuation and generate reactive oxygen species (ROS) within the biofilms. The review helps to bridge microbiology with materials science and nanotechnology, enabling a more comprehensive interdisciplinary approach towards the development of novel antimicrobial treatments and biofilm control strategies.
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Affiliation(s)
- Evans O Asare
- Department of Chemistry, School of Sciences and Humanities, Nazarbayev University, 53 Kabanbay Batyr Avenue, Nursultan city, 010000, Kazakhstan.
| | - Ellina A Mun
- Department of Chemistry, School of Sciences and Humanities, Nazarbayev University, 53 Kabanbay Batyr Avenue, Nursultan city, 010000, Kazakhstan.
| | - Enrico Marsili
- Department of Chemical Engineering, School of Engineering and Digital Sciences, Nazarbayev University, 53 Kabanbay Batyr Avenue, Nursultan city, 010000, Kazakhstan
| | - Vesselin N Paunov
- Department of Chemistry, School of Sciences and Humanities, Nazarbayev University, 53 Kabanbay Batyr Avenue, Nursultan city, 010000, Kazakhstan.
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Fritsche T, Schnetz M, Klug A, Fischer S, Ruckes C, Hunfeld KP, Hoffmann R, Gramlich Y. Tissue sampling is non-inferior in comparison to sonication in orthopedic revision surgery. Arch Orthop Trauma Surg 2022; 143:2901-2911. [PMID: 35612616 DOI: 10.1007/s00402-022-04469-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Accepted: 04/24/2022] [Indexed: 02/07/2023]
Abstract
BACKGROUND The aim of this study was to assess the role of sonication fluid cultures in detecting musculoskeletal infections in orthopedic revision surgery in patients suspected of having peri-prosthetic joint infection (PJI), fracture-related infections (FRI), or postoperative spinal implant infections (PSII). METHODS Between 2016 and 2019, 149 cases with a data set including sonication fluid cultures and tissue specimen and histological analysis were included. Accuracy of each diagnostic tool as well as the influence of antibiotic therapy was analyzed. Pathogens identified in the sonication cultures and in the associated tissue samples were compared based on the matching of the antibiograms. Therapeutic benefits were then assessed. RESULTS Of 149 cases, 43.6% (n = 65) were identified as PJI, 2.7% (n = 4) as FRI, 12.8% (n = 19) as PSII, 6.7% (n = 10) as aseptic non-union, and 34.2% (n = 51) as aseptic implant loosening. The sensitivity and specificity of tissue and synovial specimens showed no significant difference with respect to sonication fluid cultures (sensitivity/specificity: tissue: 68.2%/96.7%; sonication fluid cultures: 60.2%/98.4%). The administration of antibiotics over 14 days prior to microbiological sampling (n = 40) resulted in a lower sensitivity of 42.9% each. Histological analysis showed a sensitivity 86.3% and specificity of 97.4%. In 83.9% (n = 125) of the cases, the results of sonication fluid cultures and tissue specimens were identical. Different microorganisms were found in only four cases. In 17 cases, tissue samples (n = 5) or sonication (n = 12) were false-negatives. CONCLUSION Sonication fluid culture showed no additional benefit compared to conventional microbiological diagnostics of tissue and synovial fluid cultures. Preoperative administration of antibiotics had a clearly negative effect on microbiologic test accuracy. In over 83.9% of the cases, sonication fluid and tissue cultures showed identical results. In the other cases, sonication fluid culture did not further contribute to the therapy decision, whereas other factors, such as fistulas, cell counts, or histological analysis, were decisive in determining therapy.
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Affiliation(s)
- Theresa Fritsche
- Department of Trauma and Orthopedic Surgery, Berufsgenossenschaftliche Unfallklinik Frankfurt am Main, Friedberger Landstr. 430, 60389, Frankfurt am Main, Germany
| | - Matthias Schnetz
- Department of Trauma and Orthopedic Surgery, Berufsgenossenschaftliche Unfallklinik Frankfurt am Main, Friedberger Landstr. 430, 60389, Frankfurt am Main, Germany
| | - Alexander Klug
- Department of Trauma and Orthopedic Surgery, Berufsgenossenschaftliche Unfallklinik Frankfurt am Main, Friedberger Landstr. 430, 60389, Frankfurt am Main, Germany
| | - Sebastian Fischer
- Department of Trauma and Orthopedic Surgery, Berufsgenossenschaftliche Unfallklinik Frankfurt am Main, Friedberger Landstr. 430, 60389, Frankfurt am Main, Germany
| | - Christian Ruckes
- Interdisciplinary Center for Clinical Studies, University Medical Center of the Johannes Gutenberg-University Mainz, Langenbeckstrasse 1, Mainz, Germany
| | - K P Hunfeld
- Institute of Laboratory Medicine, Microbiology and Infection Control, Northwest Medical Center, Medical Faculty Goethe University Frankfurt, Steinbacher Hohl 2-26, 60488, Frankfurt am Main, Germany
| | - Reinhard Hoffmann
- Department of Trauma and Orthopedic Surgery, Berufsgenossenschaftliche Unfallklinik Frankfurt am Main, Friedberger Landstr. 430, 60389, Frankfurt am Main, Germany
| | - Yves Gramlich
- Department of Trauma and Orthopedic Surgery, Berufsgenossenschaftliche Unfallklinik Frankfurt am Main, Friedberger Landstr. 430, 60389, Frankfurt am Main, Germany.
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Mo F, Zhang P, Li Q, Yang X, Ma J, Zhang J. Development and Evaluation of a Film Forming System Containing Myricetin and Miconazole Nitrate for Preventing Candida albicans Catheter-Related Infection. Microb Drug Resist 2022; 28:468-483. [PMID: 35451882 DOI: 10.1089/mdr.2021.0242] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: Candida albicans catheter-related infection (CRI) is a great challenge in clinic now, mainly due to the difficulty in eradicating the biofilms. Purpose: In this study, the mechanism of the antibiofilm effect of myricetin (MY) on C. albicans was illustrated. A film forming system (FFS) containing MY and miconazole nitrate (MN) was developed, optimized, and evaluated. The anti-infection effect of MY+MN@FFS against C. albicans CRI was investigated in vivo. Study Design and Methods: To clarify the mechanism of the action of MY, the influence of MY on each key process of the formation of C. albicans biofilms was evaluated. To deliver MY and MN into the skin and form a drug reservoir on the surface of the skin, the FFS was used as a carrier and MY+MN@FFS was developed, optimized, and evaluated. After preliminary confirmation of drug safety, a percutaneously inserted C. albicans CRI mouse model was established to investigate the in vivo anti-infection effect of MY+MN@FFS by fluorescence microscopy and scanning electron microscopy on the outer surface of the catheters, hematoxylin/eosin staining, and periodic acid-Schiff staining of the mice skin tissues. Results: MY was found to inhibit the morphological transition of C. albicans and the secretion of exopolysaccharides, resulting in a reduction in biofilms. MY+MN@FFS exhibited excellent properties and no irritation to mice skin. In an in vivo anti-infection study, MY+MN@FFS exhibited an excellent preventive effect against percutaneously inserted C. albicans CRI. Conclusion: MY+MN@FFS might be a potential approach for effectively preventing percutaneously inserted C. albicans CRI in clinic.
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Affiliation(s)
- Fei Mo
- School of Pharmacy, Health Science Center, Xi'an Jiaotong University, Xi'an, P.R. China
| | - Peipei Zhang
- Biobank, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, P. R. China
| | - Qingqing Li
- School of Pharmacy, Health Science Center, Xi'an Jiaotong University, Xi'an, P.R. China
| | - Xianwei Yang
- School of Pharmacy, Health Science Center, Xi'an Jiaotong University, Xi'an, P.R. China
| | - Jia Ma
- School of Pharmacy, Health Science Center, Xi'an Jiaotong University, Xi'an, P.R. China
| | - Jiye Zhang
- School of Pharmacy, Health Science Center, Xi'an Jiaotong University, Xi'an, P.R. China
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Patiniott P, Jacombs A, Kaul L, Hu H, Warner M, Klosterhalfen B, Karatassas A, Maddern G, Richter K. Are late hernia mesh complications linked to Staphylococci biofilms? Hernia 2022; 26:1293-1299. [PMID: 35286510 PMCID: PMC9525333 DOI: 10.1007/s10029-022-02583-0] [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: 12/21/2021] [Accepted: 02/09/2022] [Indexed: 11/27/2022]
Abstract
Purpose The purpose of this study was to investigate the link between bacterial biofilms and negative outcomes of hernia repair surgery. As biofilms are known to play a role in mesh-related infections, we investigated the presence of biofilms on hernia meshes, which had to be explanted due to mesh failure without showing signs of bacterial infection. Methods In this retrospective observational study, 20 paraffin-embedded tissue sections from explanted groin hernia meshes were analysed. Meshes have been removed due to chronic pain, hernia recurrence or mesh shrinkage. The presence and bacterial composition of biofilms were determined. First, specimens were stained with fluorescence in situ hybridisation (FISH) probes, specific for Staphylococcus aureus and coagulase-negative staphylococci, and visualised by confocal laser scanning microscopy. Second, DNA was extracted from tissue and identified by S. aureus and S. epidermidis specific PCR. Results Confocal microscopy showed evidence of bacterial biofilms on meshes in 15/20 (75.0%) samples, of which 3 were positive for S. aureus, 3 for coagulase-negative staphylococci and 9 for both species. PCR analysis identified biofilms in 17/20 (85.0%) samples, of which 4 were positive for S. aureus, 4 for S. epidermidis and 9 for both species. Combined results from FISH/microscopy and PCR identified staphylococci biofilms in 19/20 (95.0%) mesh samples. Only 1 (5.0%) mesh sample was negative for bacterial biofilm by both techniques. Conclusion Results suggest that staphylococci biofilms may be associated with hernia repair failure. A silent, undetected biofilm infection could contribute to mesh complications, chronic pain and exacerbation of disease.
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Affiliation(s)
- P Patiniott
- Surgery Department, The Queen Elizabeth Hospital and Basil Hetzel Institute for Translational Health Research, The University of Adelaide, Adelaide, Australia
| | - A Jacombs
- Macquarie University Hospital, Macquarie University, Sydney, Australia
| | - L Kaul
- Surgery Department, The Queen Elizabeth Hospital and Basil Hetzel Institute for Translational Health Research, The University of Adelaide, Adelaide, Australia.,Institute of Pharmaceutical Sciences, Department of Pharmaceutical Technology and Biopharmacy, University of Freiburg, Freiburg, Germany
| | - H Hu
- Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, Australia
| | - M Warner
- Microbiology and Infectious Diseases Directorate, SA Pathology, Adelaide, Australia.,Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, Australia.,Infectious Diseases Unit, Central Adelaide Local Health Network, Adelaide, Australia
| | - B Klosterhalfen
- MVZ für Histologie, Zytologie und Molekulare Diagnostik Düren GmbH, Düren, Germany
| | - A Karatassas
- Surgery Department, The Queen Elizabeth Hospital and Basil Hetzel Institute for Translational Health Research, The University of Adelaide, Adelaide, Australia.,Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, Australia
| | - G Maddern
- Surgery Department, The Queen Elizabeth Hospital and Basil Hetzel Institute for Translational Health Research, The University of Adelaide, Adelaide, Australia.,Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, Australia
| | - K Richter
- Surgery Department, The Queen Elizabeth Hospital and Basil Hetzel Institute for Translational Health Research, The University of Adelaide, Adelaide, Australia. .,Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, Australia. .,Institute for Photonics and Advanced Sensing, The University of Adelaide, Adelaide, Australia.
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Geissel FJ, Platania V, Gogos A, Herrmann IK, Belibasakis GN, Chatzinikolaidou M, Sotiriou GA. Antibiofilm activity of nanosilver coatings against Staphylococcus aureus. J Colloid Interface Sci 2022; 608:3141-3150. [PMID: 34815083 DOI: 10.1016/j.jcis.2021.11.038] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 11/05/2021] [Accepted: 11/09/2021] [Indexed: 11/28/2022]
Abstract
Implant infections due to bacterial biofilms constitute a major healthcare challenge today. One way to address this clinical need is to modify the implant surface with an antimicrobial nanomaterial. Among such nanomaterials, nanosilver is arguably the most powerful one, due to its strong and broad antimicrobial activity. However, there is still a lack of understanding on how physicochemical characteristics of nanosilver coatings affect their antibiofilm activity. More specifically, the contributions of silver (Ag)+ ion-mediated vs. contact-based mechanisms to the observed antimicrobial activity are yet to be elucidated. To address this knowledge gap, we produce here nanosilver coatings on substrates by flame aerosol direct deposition that allows for facile control of the coating composition and Ag particle size. We systematically study the effect of (i) nanosilver content in composite Ag silica (SiO2) coatings from 0 (pure SiO2) up to 50 wt%, (ii) the Ag particle size and (iii) the coating thickness on the antibiofilm activity against Staphylococcus aureus (S. aureus), a clinically-relevant pathogen often present on the surface of surgically-installed implants. We show that the Ag+ ion concentration in solution largely drives the observed antibiofilm effect independently of Ag size and coating thickness. Furthermore, co-incubation of both pure SiO2 and nanosilver coatings in the same well also reveals that the antibiofilm effect stems predominantly from the released Ag+ ions, which is especially pronounced for coatings featuring the smallest Ag particle sizes, rather than direct bacterial contact inhibition. We also examine the biocompatibility of the developed nanosilver coatings in terms of pre-osteoblastic cell viability and proliferation, comparing it to that of pure SiO2. This study lays the foundation for the rational design of nanosilver-based antibiofilm implant coatings.
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Affiliation(s)
- Felix J Geissel
- Department of Microbiology, Tumor and Cell Biology, Karolinska Institutet, Stockholm, Sweden
| | - Varvara Platania
- Department of Materials Science and Technology, University of Crete, Heraklion, Greece
| | - Alexander Gogos
- Nanoparticle Systems Engineering Laboratory, Department of Mechanical and Process Engineering, ETH Zurich, Switzerland and Particles Biology Interactions Laboratory, Swiss Federal Laboratories for Materials Science and Technology (Empa), St. Gallen, Switzerland
| | - Inge K Herrmann
- Nanoparticle Systems Engineering Laboratory, Department of Mechanical and Process Engineering, ETH Zurich, Switzerland and Particles Biology Interactions Laboratory, Swiss Federal Laboratories for Materials Science and Technology (Empa), St. Gallen, Switzerland
| | - Georgios N Belibasakis
- Division of Oral Diseases, Department of Dental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Maria Chatzinikolaidou
- Department of Materials Science and Technology, University of Crete, Heraklion, Greece; Institute of Electronic Structure and Laser (IESL), Foundation for Research and Technology Hellas (FORTH), Heraklion, Greece
| | - Georgios A Sotiriou
- Department of Microbiology, Tumor and Cell Biology, Karolinska Institutet, Stockholm, Sweden.
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Cyphert EL, Zhang N, Learn GD, Hernandez CJ, von Recum HA. Recent Advances in the Evaluation of Antimicrobial Materials for Resolution of Orthopedic Implant-Associated Infections In Vivo. ACS Infect Dis 2021; 7:3125-3160. [PMID: 34761915 DOI: 10.1021/acsinfecdis.1c00465] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
While orthopedic implant-associated infections are rare, revision surgeries resulting from infections incur considerable healthcare costs and represent a substantial research area clinically, in academia, and in industry. In recent years, there have been numerous advances in the development of antimicrobial strategies for the prevention and treatment of orthopedic implant-associated infections which offer promise to improve the limitations of existing delivery systems through local and controlled release of antimicrobial agents. Prior to translation to in vivo orthopedic implant-associated infection models, the properties (e.g., degradation, antimicrobial activity, biocompatibility) of the antimicrobial materials can be evaluated in subcutaneous implant in vivo models. The antimicrobial materials are then incorporated into in vivo implant models to evaluate the efficacy of using the material to prevent or treat implant-associated infections. Recent technological advances such as 3D-printing, bacterial genomic sequencing, and real-time in vivo imaging of infection and inflammation have contributed to the development of preclinical implant-associated infection models that more effectively recapitulate the clinical presentation of infections and improve the evaluation of antimicrobial materials. This Review highlights the advantages and limitations of antimicrobial materials used in conjunction with orthopedic implants for the prevention and treatment of orthopedic implant-associated infections and discusses how these materials are evaluated in preclinical in vivo models. This analysis serves as a resource for biomaterial researchers in the selection of an appropriate orthopedic implant-associated infection preclinical model to evaluate novel antimicrobial materials.
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Affiliation(s)
- Erika L. Cyphert
- Department of Biomedical Engineering, Case Western Reserve University, 10900 Euclid Avenue, Cleveland, Ohio 44106, United States
| | - Ningjing Zhang
- Department of Biomedical Engineering, Case Western Reserve University, 10900 Euclid Avenue, Cleveland, Ohio 44106, United States
| | - Greg D. Learn
- Department of Biomedical Engineering, Case Western Reserve University, 10900 Euclid Avenue, Cleveland, Ohio 44106, United States
| | - Christopher J. Hernandez
- Sibley School of Mechanical and Aerospace Engineering, Cornell University, Ithaca, New York 14853, United States
- Hospital for Special Surgery, New York, New York 10021, United States
| | - Horst A. von Recum
- Department of Biomedical Engineering, Case Western Reserve University, 10900 Euclid Avenue, Cleveland, Ohio 44106, United States
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Daskalova A, Filipov E, Angelova L, Stefanov R, Tatchev D, Avdeev G, Sotelo L, Christiansen S, Sarau G, Leuchs G, Iordanova E, Buchvarov I. Ultra-Short Laser Surface Properties Optimization of Biocompatibility Characteristics of 3D Poly-ε-Caprolactone and Hydroxyapatite Composite Scaffolds. MATERIALS (BASEL, SWITZERLAND) 2021; 14:7513. [PMID: 34947106 PMCID: PMC8707740 DOI: 10.3390/ma14247513] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Revised: 11/29/2021] [Accepted: 12/04/2021] [Indexed: 12/17/2022]
Abstract
The use of laser processing for the creation of diverse morphological patterns onto the surface of polymer scaffolds represents a method for overcoming bacterial biofilm formation and inducing enhanced cellular dynamics. We have investigated the influence of ultra-short laser parameters on 3D-printed poly-ε-caprolactone (PCL) and poly-ε-caprolactone/hydroxyapatite (PCL/HA) scaffolds with the aim of creating submicron geometrical features to improve the matrix biocompatibility properties. Specifically, the present research was focused on monitoring the effect of the laser fluence (F) and the number of applied pulses (N) on the morphological, chemical and mechanical properties of the scaffolds. SEM analysis revealed that the femtosecond laser treatment of the scaffolds led to the formation of two distinct surface geometrical patterns, microchannels and single microprotrusions, without triggering collateral damage to the surrounding zones. We found that the microchannel structures favor the hydrophilicity properties. As demonstrated by the computer tomography results, surface roughness of the modified zones increases compared to the non-modified surface, without influencing the mechanical stability of the 3D matrices. The X-ray diffraction analysis confirmed that the laser structuring of the matrices did not lead to a change in the semi-crystalline phase of the PCL. The combinations of two types of geometrical designs-wood pile and snowflake-with laser-induced morphologies in the form of channels and columns are considered for optimizing the conditions for establishing an ideal scaffold, namely, precise dimensional form, mechanical stability, improved cytocompatibility and antibacterial behavior.
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Affiliation(s)
- Albena Daskalova
- Institute of Electronics, Bulgarian Academy of Sciences, 72 Tzarigradsko Shousse Boulevard, 1784 Sofia, Bulgaria; (E.F.); (L.A.)
| | - Emil Filipov
- Institute of Electronics, Bulgarian Academy of Sciences, 72 Tzarigradsko Shousse Boulevard, 1784 Sofia, Bulgaria; (E.F.); (L.A.)
| | - Liliya Angelova
- Institute of Electronics, Bulgarian Academy of Sciences, 72 Tzarigradsko Shousse Boulevard, 1784 Sofia, Bulgaria; (E.F.); (L.A.)
| | - Radostin Stefanov
- Printivo Group JSC, 111 Tsarigradsko Shose Boulevard, 1784 Sofia, Bulgaria;
| | - Dragomir Tatchev
- Institute of Physical Chemistry, Bulgarian Academy of Sciences, Acad. Georgi Bonchev Str. Bld. 11, 1113 Sofia, Bulgaria; (D.T.); (G.A.)
| | - Georgi Avdeev
- Institute of Physical Chemistry, Bulgarian Academy of Sciences, Acad. Georgi Bonchev Str. Bld. 11, 1113 Sofia, Bulgaria; (D.T.); (G.A.)
| | - Lamborghini Sotelo
- Institute for Nanotechnology and Correlative Microscopy GmbH (INAM), Äußere Nürnberger Straße 62, 91301 Forchheim, Germany; (L.S.); (S.C.); (G.S.)
- Institute for Optics, Information and Photonics, Friedrich-Alexander-University, Erlangen-Nürnberg (FAU), Schloßplatz 4, 91054 Erlangen, Germany;
| | - Silke Christiansen
- Institute for Nanotechnology and Correlative Microscopy GmbH (INAM), Äußere Nürnberger Straße 62, 91301 Forchheim, Germany; (L.S.); (S.C.); (G.S.)
| | - George Sarau
- Institute for Nanotechnology and Correlative Microscopy GmbH (INAM), Äußere Nürnberger Straße 62, 91301 Forchheim, Germany; (L.S.); (S.C.); (G.S.)
- Max Planck Institute for the Science of Light, Staudtstraße 2, 91058 Erlangen, Germany
| | - Gerd Leuchs
- Institute for Optics, Information and Photonics, Friedrich-Alexander-University, Erlangen-Nürnberg (FAU), Schloßplatz 4, 91054 Erlangen, Germany;
| | - Ekaterina Iordanova
- Institute of Solid State Physics, Bulgarian Academy of Sciences, 72 Tzarigradsko Shousse Boulevard, 1784 Sofia, Bulgaria;
| | - Ivan Buchvarov
- Faculty of Physics, St. Kliment Ohridski University of Sofia, 5 James Bourchier Boulevard, 1164 Sofia, Bulgaria;
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Anagnostakos K, Thiery A, Sahan I. Retained Negative Pressure Wound Therapy Foams as a Cause of Infection Persistence. Adv Wound Care (New Rochelle) 2021; 10:699-710. [PMID: 32870776 DOI: 10.1089/wound.2019.1088] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Significance: Negative pressure wound therapy (NPWT) has become a valuable adjunct in the treatment of acute and chronic wounds in several surgical disciplines. Retained foams are among its side effects, and they pose a rare but devastating complication at the site of this therapy, which might be associated with wound-healing complications, infection persistence, repeated surgical revisions, and prolonged antibiotic courses. Recent Advances: In the past 15 years, an increasing number of studies have identified this potential problem. Although the exact incidence remains unknown, initial studies have indicated rates of up to 10% in large collectives being treated by NPWT. Critical Issues: The lack of radiopaque markers does not allow for the visual control of retained foams using plain radiographs. Further imaging methods (e.g., CT and MRI) also do not help in adequate differential diagnosis. The lack of routine documentation of the number, type, and localization of the inserted foam(s) and unplanned surgery with a different surgical team pose risk factors for foam retainment. Future Directions: Introducing new documentation records for wounds treated with NPWT is recommended. At foam removal, all dressing materials should be examined for integrity. The development of foams with radiopaque markers by the industry, such as those routinely used in surgical gauze swabs, might also be a useful step to minimize the risk of foam retainment within wounds.
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Affiliation(s)
- Konstantinos Anagnostakos
- Department of Orthopedics, Center for Orthopedic and Trauma Surgery, Klinikum Saarbrücken, Saarbrücken, Germany
| | - Andreas Thiery
- Department of Orthopedics, Center for Orthopedic and Trauma Surgery, Klinikum Saarbrücken, Saarbrücken, Germany
| | - Ismail Sahan
- Department of Orthopedics, Center for Orthopedic and Trauma Surgery, Klinikum Saarbrücken, Saarbrücken, Germany
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Wang Z, Wang X, Wang Y, Zhu Y, Liu X, Zhou Q. NanoZnO-modified titanium implants for enhanced anti-bacterial activity, osteogenesis and corrosion resistance. J Nanobiotechnology 2021; 19:353. [PMID: 34717648 PMCID: PMC8557588 DOI: 10.1186/s12951-021-01099-6] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Accepted: 10/20/2021] [Indexed: 02/08/2023] Open
Abstract
Titanium (Ti) implants are widely used in dentistry and orthopedics owing to their excellent corrosion resistance, biocompatibility, and mechanical properties, which have gained increasing attention from the viewpoints of fundamental research and practical applications. Also, numerous studies have been carried out to fine-tune the micro/nanostructures of Ti and/or incorporate chemical elements to improve overall implant performance. Zinc oxide nanoparticles (nano-ZnO) are well-known for their good antibacterial properties and low cytotoxicity along with their ability to synergize with a variety of substances, which have received increasingly widespread attention as biomodification materials for implants. In this review, we summarize recent research progress on nano-ZnO modified Ti-implants. Their preparation methods of nano-ZnO modified Ti-implants are introduced, followed by a further presentation of the antibacterial, osteogenic, and anti-corrosion properties of these implants. Finally, challenges and future opportunities for nano-ZnO modified Ti-implants are proposed.
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Affiliation(s)
- Zheng Wang
- Institute for Translational Medicine, Department of Orthodontics, The Affiliated Hospital of Qingdao University, Qingdao University, Qingdao, 266003, China
- School of Stomatology, Qingdao University, Qingdao, 266003, China
| | - Xiaojing Wang
- School of Stomatology, Qingdao University, Qingdao, 266003, China
- Department of Oral Implantology, The Affiliated Hospital of Qingdao University, Qingdao, 266003, China
| | - Yingruo Wang
- Shandong University of Science and Technology, Qingdao, 266590, China
| | - Yanli Zhu
- School of Stomatology, Qingdao University, Qingdao, 266003, China
| | - Xinqiang Liu
- Institute for Translational Medicine, Department of Orthodontics, The Affiliated Hospital of Qingdao University, Qingdao University, Qingdao, 266003, China.
- School of Stomatology, Qingdao University, Qingdao, 266003, China.
| | - Qihui Zhou
- Institute for Translational Medicine, Department of Orthodontics, The Affiliated Hospital of Qingdao University, Qingdao University, Qingdao, 266003, China.
- School of Stomatology, Qingdao University, Qingdao, 266003, China.
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Vimalraj S, Sekaran S. Commentary: "Silver Nanoparticles Coated Poly(L-Lactide) Electrospun Membrane for Implant Associated Infections Prevention". Front Pharmacol 2021; 12:759304. [PMID: 34776977 PMCID: PMC8580876 DOI: 10.3389/fphar.2021.759304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Accepted: 09/24/2021] [Indexed: 11/24/2022] Open
Affiliation(s)
- Selvaraj Vimalraj
- Centre for Biotechnology, Anna University, Chennai, India
- Department of Pharmacology, Saveetha Dental College and Hospitals, Saveetha Institute for Medical and Technical Sciences, Chennai, India
| | - Saravanan Sekaran
- Department of Pharmacology, Saveetha Dental College and Hospitals, Saveetha Institute for Medical and Technical Sciences, Chennai, India
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Patient-specific effects of soluble factors from Staphylococcus aureus and Staphylococcus epidermidis biofilms on osteogenic differentiation of primary human osteoblasts. Sci Rep 2021; 11:17282. [PMID: 34446785 PMCID: PMC8390505 DOI: 10.1038/s41598-021-96719-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Accepted: 08/13/2021] [Indexed: 11/08/2022] Open
Abstract
Due to the frequency of biofilm-forming Staphylococcus aureus and Staphylococcus epidermidis in orthopedics, it is crucial to understand the interaction between the soluble factors produced by prokaryotes and their effects on eukaryotes. Our knowledge concerning the effect of soluble biofilm factors (SBF) and their virulence potential on osteogenic differentiation is limited to few studies, particularly when there is no direct contact between prokaryotic and eukaryotic cells. SBF were produced by incubating biofilm from S. aureus and S. epidermidis in osteogenic media. Osteoblasts of seven donors were included in this study. Our results demonstrate that the detrimental effects of these pathogens do not require direct contact between prokaryotic and eukaryotic cells. SBF produced by S. aureus and S. epidermidis affect the metabolic activity of osteoblasts. However, the effect of SBF derived from S. aureus seems to be more pronounced compared to that of S. epidermidis. The influence of SBF of S. aureus and S. epidermidis on gene expression of COL1A1, ALPL, BGLAP, SPP1, RUNX2 is bacteria-, patient-, concentration-, and incubation time dependent. Mineralization was monitored by staining the calcium and phosphate deposition and revealed that the SBF of S. epidermidis markedly inhibits calcium deposition; however, S. aureus shows a less inhibitory effect. Therefore, these new findings support the hypotheses that soluble biofilm factors affect the osteogenic processes substantially, particularly when there is no direct interaction between bacteria and osteoblast.
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44
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Extracellular DNA (eDNA). A Major Ubiquitous Element of the Bacterial Biofilm Architecture. Int J Mol Sci 2021; 22:ijms22169100. [PMID: 34445806 PMCID: PMC8396552 DOI: 10.3390/ijms22169100] [Citation(s) in RCA: 85] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 08/19/2021] [Accepted: 08/20/2021] [Indexed: 12/22/2022] Open
Abstract
After the first ancient studies on microbial slime (the name by which the biofilm matrix was initially indicated), multitudes of studies on the morphology, composition and physiology of biofilms have arisen. The emergence of the role that biofilms play in the pathogenesis of recalcitrant and persistent clinical infections, such as periprosthetic orthopedic infections, has reinforced scientific interest. Extracellular DNA (eDNA) is a recently uncovered component that is proving to be almost omnipresent in the extracellular polymeric substance (EPS) of biofilm. This macromolecule is eliciting unprecedented consideration for the critical impact on the pathogenesis of chronic clinical infections. After a systematic review of the literature, an updated description of eDNA in biofilms is presented, with a special focus on the latest findings regarding its fundamental structural role and the contribution it makes to the complex architecture of bacterial biofilms through interactions with a variety of other molecular components of the biofilm matrix.
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45
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Wang J, Wang L. Novel therapeutic interventions towards improved management of septic arthritis. BMC Musculoskelet Disord 2021; 22:530. [PMID: 34107951 PMCID: PMC8191206 DOI: 10.1186/s12891-021-04383-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Accepted: 05/18/2021] [Indexed: 01/19/2023] Open
Abstract
Septic arthritis (SA) represents a medical emergency that needs immediate diagnosis and urgent treatment. Despite aggressive treatment and rapid diagnosis of the causative agent, the mortality and lifelong disability, associated with septic arthritis remain high as close to 11%. Moreover, with the rise in drug resistance, the rates of failure of conventional antibiotic therapy have also increased. Among the etiological agents frequently isolated from cases of septic arthritis, Staphylococcus aureus emerges as a dominating pathogen, and to worsen, the rise in methicillin-resistant S. aureus (MRSA) isolates in bone and joint infections is worrisome. MRSA associated cases of septic arthritis exhibit higher mortality, longer hospital stay, and higher treatment failure with poorer clinical outcomes as compared to cases caused by the sensitive strain i.e methicillin-sensitive S. aureus (MSSA). In addition to this, equal or even greater damage is imposed by the exacerbated immune response mounted by the patient’s body in a futile attempt to eradicate the bacteria. The antibiotic therapy may not be sufficient enough to control the progression of damage to the joint involved thus, adding to higher mortality and disability rates despite the prompt and timely start of treatment. This situation implies that efforts and focus towards studying/understanding new strategies for improved management of sepsis arthritis is prudent and worth exploring. The review article aims to give a complete insight into the new therapeutic approaches studied by workers lately in this field. To the best of our knowledge studies highlighting the novel therapeutic strategies against septic arthritis are limited in the literature, although articles on pathogenic mechanism and choice of antibiotics for therapy, current treatment algorithms followed have been discussed by workers in the past. The present study presents and discusses the new alternative approaches, their mechanism of action, proof of concept, and work done so far towards their clinical success. This will surely help to enlighten the researchers with comprehensive knowledge of the new interventions that can be used as an adjunct therapy along with conventional treatment protocol for improved success rates.
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Affiliation(s)
- Jian Wang
- Department of Nursing, The Third Hospital of Jinan, Shandong Province, Jinan, 250132, China.
| | - Liucai Wang
- Hand and Foot Surgery, Shandong Provincial Hospital, Jinan, 250000, China
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46
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Rumyantceva V, Rumyantceva V, Andreeva Y, Tsvetikova S, Radaev A, Vishnevskaya M, Vinogradov V, Drozdov AS, Koshel E. Magnetically Controlled Carbonate Nanocomposite with Ciprofloxacin for Biofilm Eradication. Int J Mol Sci 2021; 22:6187. [PMID: 34201173 PMCID: PMC8229197 DOI: 10.3390/ijms22126187] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 05/31/2021] [Accepted: 06/01/2021] [Indexed: 01/09/2023] Open
Abstract
Biofilms are the reason for a vast majority of chronic inflammation cases and most acute inflammation. The treatment of biofilms still is a complicated task due to the low efficiency of drug delivery and high resistivity of the involved bacteria to harmful factors. Here we describe a magnetically controlled nanocomposite with a stimuli-responsive release profile based on calcium carbonate and magnetite with an encapsulated antibiotic (ciprofloxacin) that can be used to solve this problem. The material magnetic properties allowed targeted delivery, accumulation, and penetration of the composite in the biofilm, as well as the rapid triggered release of the entrapped antibiotic. Under the influence of an RF magnetic field with a frequency of 210 kHz, the composite underwent a phase transition from vaterite into calcite and promoted the release of ciprofloxacin. The effectiveness of the composite was tested against formed biofilms of E. coli and S. aureus and showed a 71% reduction in E. coli biofilm biomass and an 85% reduction in S. aureus biofilms. The efficiency of the composite with entrapped ciprofloxacin was higher than for the free antibiotic in the same concentration, up to 72%. The developed composite is a promising material for the treatment of biofilm-associated inflammations.
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Affiliation(s)
- Viktoriya Rumyantceva
- International Institute Solution Chemistry of Advanced Materials and Technologies, ITMO University, Lomonosova st., 9, 191002 St. Petersburg, Russia; (V.R.); (V.R.); (Y.A.); (S.T.); (V.V.)
| | - Valeriya Rumyantceva
- International Institute Solution Chemistry of Advanced Materials and Technologies, ITMO University, Lomonosova st., 9, 191002 St. Petersburg, Russia; (V.R.); (V.R.); (Y.A.); (S.T.); (V.V.)
| | - Yulia Andreeva
- International Institute Solution Chemistry of Advanced Materials and Technologies, ITMO University, Lomonosova st., 9, 191002 St. Petersburg, Russia; (V.R.); (V.R.); (Y.A.); (S.T.); (V.V.)
| | - Sofia Tsvetikova
- International Institute Solution Chemistry of Advanced Materials and Technologies, ITMO University, Lomonosova st., 9, 191002 St. Petersburg, Russia; (V.R.); (V.R.); (Y.A.); (S.T.); (V.V.)
| | - Anton Radaev
- Chromas Research Resource Center, St. Petersburg State University, 199034 St. Petersburg, Russia; (A.R.); (M.V.)
| | - Maria Vishnevskaya
- Chromas Research Resource Center, St. Petersburg State University, 199034 St. Petersburg, Russia; (A.R.); (M.V.)
| | - Vladimir Vinogradov
- International Institute Solution Chemistry of Advanced Materials and Technologies, ITMO University, Lomonosova st., 9, 191002 St. Petersburg, Russia; (V.R.); (V.R.); (Y.A.); (S.T.); (V.V.)
| | - Andrey S. Drozdov
- International Institute Solution Chemistry of Advanced Materials and Technologies, ITMO University, Lomonosova st., 9, 191002 St. Petersburg, Russia; (V.R.); (V.R.); (Y.A.); (S.T.); (V.V.)
- Laboratory of Nanobiotechnology, Phystech School of Biological and Medical Physics, Moscow Institute of Physics and Technology, 9, 141701 Dolgoprudny, Moscow Region, Russia
| | - Elena Koshel
- International Institute Solution Chemistry of Advanced Materials and Technologies, ITMO University, Lomonosova st., 9, 191002 St. Petersburg, Russia; (V.R.); (V.R.); (Y.A.); (S.T.); (V.V.)
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47
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Leng J, He Y, Yuan Z, Tao B, Li K, Lin C, Xu K, Chen M, Dai L, Li X, Huang TJ, Cai K. Enzymatically-degradable hydrogel coatings on titanium for bacterial infection inhibition and enhanced soft tissue compatibility via a self-adaptive strategy. Bioact Mater 2021; 6:4670-4685. [PMID: 34095624 PMCID: PMC8164017 DOI: 10.1016/j.bioactmat.2021.05.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Revised: 05/02/2021] [Accepted: 05/02/2021] [Indexed: 12/24/2022] Open
Abstract
Ideal percutaneous titanium implants request both antibacterial ability and soft tissue compatibility. ZnO structure constructed on titanium has been widely proved to be helpful to combat pathogen contamination, but the biosafety of ZnO is always questioned. How to maintain the remarkable antibacterial ability of ZnO and efficiently reduce the corresponding toxicity is still challenging. Herein, a hybrid hydrogel coating was constructed on the fabricated ZnO structure of titanium, and the coating was proved to be enzymatically-degradable when bacteria exist. Then the antibacterial activity of ZnO was presented. When under the normal condition (no bacteria), the hydrogel coating was stable and tightly adhered to titanium. The toxicity of ZnO was reduced, and the viability of fibroblasts was largely improved. More importantly, the hydrogel coating provided a good buffer zone for cell ingrowth and soft tissue integration. The curbed Zn ion release was also proved to be useful to regulate fibroblast responses such as the expression of CTGF and COL-I. These results were also validated by in vivo studies. Therefore, this study proposed a valid self-adaptive strategy for ZnO improvement. Under different conditions, the sample could present different functions, and both the antibacterial ability and soft tissue compatibility were finely preserved. Enzymatically-degradable hydrogel coatings are prepared on the ZnO structure of titanium. The degradation of the hydrogel coating is accelerated when S. aureus exists and the remarkable antibacterial activity of ZnO is presented. The hydrogel coating is stable and tightly adhered on ZnO when no bacteria exists and the toxicity of ZnO is largely reduced. The fibroblast responses and soft tissue compatibility are improved.
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Affiliation(s)
- Jin Leng
- Key Laboratory of Biorheological Science and Technology, Ministry of Education, College of Bioengineering, Chongqing University, Chongqing, 400044, China
| | - Ye He
- Key Laboratory of Biorheological Science and Technology, Ministry of Education, College of Bioengineering, Chongqing University, Chongqing, 400044, China.,Thomas Lord Department of Mechanical Engineering & Materials Science, Duke University, Durham, NC, 27708, USA
| | - Zhang Yuan
- Key Laboratory of Biorheological Science and Technology, Ministry of Education, College of Bioengineering, Chongqing University, Chongqing, 400044, China
| | - Bailong Tao
- Key Laboratory of Biorheological Science and Technology, Ministry of Education, College of Bioengineering, Chongqing University, Chongqing, 400044, China
| | - Ke Li
- Key Laboratory of Biorheological Science and Technology, Ministry of Education, College of Bioengineering, Chongqing University, Chongqing, 400044, China
| | - Chuanchuan Lin
- Key Laboratory of Biorheological Science and Technology, Ministry of Education, College of Bioengineering, Chongqing University, Chongqing, 400044, China
| | - Kun Xu
- Key Laboratory of Biorheological Science and Technology, Ministry of Education, College of Bioengineering, Chongqing University, Chongqing, 400044, China
| | - Maowen Chen
- Key Laboratory of Biorheological Science and Technology, Ministry of Education, College of Bioengineering, Chongqing University, Chongqing, 400044, China
| | - Liangliang Dai
- Institute of Medical Research, Northwestern Polytechnical University, Xi'an 710072, China
| | - Xuemin Li
- Innovative Drug Research Centre, School of Pharmaceutical Sciences, Chongqing University, Chongqing, 401331, China
| | - Tony Jun Huang
- Thomas Lord Department of Mechanical Engineering & Materials Science, Duke University, Durham, NC, 27708, USA
| | - Kaiyong Cai
- Key Laboratory of Biorheological Science and Technology, Ministry of Education, College of Bioengineering, Chongqing University, Chongqing, 400044, China.,Chongqing Key Laboratory of Soft-Matter Material Chemistry and Function Manufacturing, Southwest University, Chongqing, 400715, China
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48
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Huang X, Ge Y, Yang B, Han Q, Zhou W, Liang J, Li M, Peng X, Ren B, Yang B, Weir MD, Guo Q, Wang H, Zhou X, Lu X, Oates TW, Xu HHK, Deng D, Zhou X, Cheng L. Novel dental implant modifications with two-staged double benefits for preventing infection and promoting osseointegration in vivo and in vitro. Bioact Mater 2021; 6:4568-4579. [PMID: 34095616 PMCID: PMC8141509 DOI: 10.1016/j.bioactmat.2021.04.041] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 04/24/2021] [Accepted: 04/24/2021] [Indexed: 02/05/2023] Open
Abstract
Peri-implantitis are a major problem causing implant failure these days. Accordingly, anti-infection during the early stage and subsequent promotion of osseointegration are two main key factors to solve this issue. Micro-arc oxidation (MAO) treatment is a way to form an oxidation film on the surface of metallic materials. The method shows good osteogenic properties but weak antibacterial effect. Therefore, we developed combined strategies to combat severe peri-implantitis, which included the use of a novel compound, PD, comprising dendrimers poly(amidoamine) (PAMAM) loading dimethylaminododecyl methacrylate (DMADDM) as well as MAO treatment. Here, we explored the chemical properties of the novel compound PD, and proved that this compound was successfully synthesized, with the loading efficiency and encapsulation efficiency of 23.91% and 31.42%, respectively. We further report the two-stage double benefits capability of PD + MAO: (1) in the first stage, PD + MAO could decrease the adherence and development of biofilms by releasing DMADDM in the highly infected first stage after implant surgery both in vitro and in vivo; (2) in the second stage, PD + MAO indicated mighty anti-infection and osteoconductive characteristics in a rat model of peri-implantitis in vivo. This study first reports the two-staged, double benefits of PD + MAO, and demonstrates its potential in clinical applications for inhibiting peri-implantitis, especially in patients with severe infection risk.
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Affiliation(s)
- Xiaoyu Huang
- State Key Laboratory of Oral Diseases, West China Hospital of Stomatology, National Clinical Research Center for Oral Diseases, Sichuan University, Chengdu, 610041, China.,Department of Operative Dentistry and Endodontics, West China School of Stomatology, Sichuan University, Chengdu, 610041, China
| | - Yang Ge
- State Key Laboratory of Oral Diseases, West China Hospital of Stomatology, National Clinical Research Center for Oral Diseases, Sichuan University, Chengdu, 610041, China.,Department of Operative Dentistry and Endodontics, West China School of Stomatology, Sichuan University, Chengdu, 610041, China.,Stomatological Hospital, Southern Medical University, Guangzhou, 510280, China.,Department of Preventive Dentistry, Academic Center for Dentistry Amsterdam (ACTA), University of Amsterdam and VU University Amsterdam, Amsterdam, the Netherlands
| | - Bina Yang
- State Key Laboratory of Oral Diseases, West China Hospital of Stomatology, National Clinical Research Center for Oral Diseases, Sichuan University, Chengdu, 610041, China.,Department of Operative Dentistry and Endodontics, West China School of Stomatology, Sichuan University, Chengdu, 610041, China
| | - Qi Han
- State Key Laboratory of Oral Diseases, West China Hospital of Stomatology, National Clinical Research Center for Oral Diseases, Sichuan University, Chengdu, 610041, China.,Department of Pathology, West China School of Stomatology, Sichuan University, Chengdu, 610041, China
| | - Wen Zhou
- State Key Laboratory of Oral Diseases, West China Hospital of Stomatology, National Clinical Research Center for Oral Diseases, Sichuan University, Chengdu, 610041, China.,Department of Operative Dentistry and Endodontics, West China School of Stomatology, Sichuan University, Chengdu, 610041, China
| | - Jingou Liang
- State Key Laboratory of Oral Diseases, West China Hospital of Stomatology, National Clinical Research Center for Oral Diseases, Sichuan University, Chengdu, 610041, China.,Department of Pediatrics, West China School of Stomatology, Sichuan University, Chengdu, 610041, China
| | - Mingyun Li
- State Key Laboratory of Oral Diseases, West China Hospital of Stomatology, National Clinical Research Center for Oral Diseases, Sichuan University, Chengdu, 610041, China.,Department of Operative Dentistry and Endodontics, West China School of Stomatology, Sichuan University, Chengdu, 610041, China
| | - Xian Peng
- State Key Laboratory of Oral Diseases, West China Hospital of Stomatology, National Clinical Research Center for Oral Diseases, Sichuan University, Chengdu, 610041, China
| | - Biao Ren
- State Key Laboratory of Oral Diseases, West China Hospital of Stomatology, National Clinical Research Center for Oral Diseases, Sichuan University, Chengdu, 610041, China
| | - Bangcheng Yang
- National Engineering Research Center for Biomaterials, Sichuan University, Chengdu, 610041, China
| | - Michael D Weir
- Department of Advanced Oral Sciences and Therapeutics, University of Maryland School of Dentistry, Baltimore, MD, 21201, USA
| | - Qiang Guo
- State Key Laboratory of Oral Diseases, West China Hospital of Stomatology, National Clinical Research Center for Oral Diseases, Sichuan University, Chengdu, 610041, China
| | - Haohao Wang
- State Key Laboratory of Oral Diseases, West China Hospital of Stomatology, National Clinical Research Center for Oral Diseases, Sichuan University, Chengdu, 610041, China.,Department of Operative Dentistry and Endodontics, West China School of Stomatology, Sichuan University, Chengdu, 610041, China
| | - Xinxuan Zhou
- State Key Laboratory of Oral Diseases, West China Hospital of Stomatology, National Clinical Research Center for Oral Diseases, Sichuan University, Chengdu, 610041, China
| | - Xugang Lu
- National Engineering Research Center for Biomaterials, Sichuan University, Chengdu, 610041, China
| | - Thomas W Oates
- Department of Advanced Oral Sciences and Therapeutics, University of Maryland School of Dentistry, Baltimore, MD, 21201, USA
| | - Hockin H K Xu
- Department of Advanced Oral Sciences and Therapeutics, University of Maryland School of Dentistry, Baltimore, MD, 21201, USA
| | - Dongmei Deng
- Department of Preventive Dentistry, Academic Center for Dentistry Amsterdam (ACTA), University of Amsterdam and VU University Amsterdam, Amsterdam, the Netherlands
| | - Xuedong Zhou
- State Key Laboratory of Oral Diseases, West China Hospital of Stomatology, National Clinical Research Center for Oral Diseases, Sichuan University, Chengdu, 610041, China.,Department of Operative Dentistry and Endodontics, West China School of Stomatology, Sichuan University, Chengdu, 610041, China
| | - Lei Cheng
- State Key Laboratory of Oral Diseases, West China Hospital of Stomatology, National Clinical Research Center for Oral Diseases, Sichuan University, Chengdu, 610041, China.,Department of Operative Dentistry and Endodontics, West China School of Stomatology, Sichuan University, Chengdu, 610041, China
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49
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Research status of biodegradable metals designed for oral and maxillofacial applications: A review. Bioact Mater 2021; 6:4186-4208. [PMID: 33997502 PMCID: PMC8099919 DOI: 10.1016/j.bioactmat.2021.01.011] [Citation(s) in RCA: 50] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2020] [Revised: 01/10/2021] [Accepted: 01/10/2021] [Indexed: 01/08/2023] Open
Abstract
The oral and maxillofacial regions have complex anatomical structures and different tissue types, which have vital health and aesthetic functions. Biodegradable metals (BMs) is a promising bioactive materials to treat oral and maxillofacial diseases. This review summarizes the research status and future research directions of BMs for oral and maxillofacial applications. Mg-based BMs and Zn-based BMs for bone fracture fixation systems, and guided bone regeneration (GBR) membranes, are discussed in detail. Zn-based BMs with a moderate degradation rate and superior mechanical properties for GBR membranes show great potential for clinical translation. Fe-based BMs have a relatively low degradation rate and insoluble degradation products, which greatly limit their application and clinical translation. Furthermore, we proposed potential future research directions for BMs in the oral and maxillofacial regions, including 3D printed BM bone scaffolds, surface modification for BMs GBR membranes, and BMs containing hydrogels for cartilage regeneration, soft tissue regeneration, and nerve regeneration. Taken together, the progress made in the development of BMs in oral and maxillofacial regions has laid a foundation for further clinical translation.
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50
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Benčina M, Resnik M, Starič P, Junkar I. Use of Plasma Technologies for Antibacterial Surface Properties of Metals. Molecules 2021; 26:1418. [PMID: 33808010 PMCID: PMC7961478 DOI: 10.3390/molecules26051418] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Revised: 03/02/2021] [Accepted: 03/02/2021] [Indexed: 02/07/2023] Open
Abstract
Bacterial infections of medical devices present severe problems connected with long-term antibiotic treatment, implant failure, and high hospital costs. Therefore, there are enormous demands for innovative techniques which would improve the surface properties of implantable materials. Plasma technologies present one of the compelling ways to improve metal's antibacterial activity; plasma treatment can significantly alter metal surfaces' physicochemical properties, such as surface chemistry, roughness, wettability, surface charge, and crystallinity, which all play an important role in the biological response of medical materials. Herein, the most common plasma treatment techniques like plasma spraying, plasma immersion ion implantation, plasma vapor deposition, and plasma electrolytic oxidation as well as novel approaches based on gaseous plasma treatment of surfaces are gathered and presented. The latest results of different surface modification approaches and their influence on metals' antibacterial surface properties are presented and critically discussed. The mechanisms involved in bactericidal effects of plasma-treated surfaces are discussed and novel results of surface modification of metal materials by highly reactive oxygen plasma are presented.
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Affiliation(s)
| | | | | | - Ita Junkar
- Department of Surface Engineering, Jožef Stefan Institute, Jamova 39, SI-1000 Ljubljana, Slovenia; (M.B.); (M.R.); (P.S.)
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