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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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Shuaishuai W, Tongtong Z, Dapeng W, Mingran Z, Xukai W, Yue Y, Hengliang D, Guangzhi W, Minglei Z. Implantable biomedical materials for treatment of bone infection. Front Bioeng Biotechnol 2023; 11:1081446. [PMID: 36793442 PMCID: PMC9923113 DOI: 10.3389/fbioe.2023.1081446] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Accepted: 01/18/2023] [Indexed: 01/31/2023] Open
Abstract
The treatment of bone infections has always been difficult. The emergence of drug-resistant bacteria has led to a steady decline in the effectiveness of antibiotics. It is also especially important to fight bacterial infections while repairing bone defects and cleaning up dead bacteria to prevent biofilm formation. The development of biomedical materials has provided us with a research direction to address this issue. We aimed to review the current literature, and have summarized multifunctional antimicrobial materials that have long-lasting antimicrobial capabilities that promote angiogenesis, bone production, or "killing and releasing." This review provides a comprehensive summary of the use of biomedical materials in the treatment of bone infections and a reference thereof, as well as encouragement to perform further research in this field.
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Affiliation(s)
- Wang Shuaishuai
- Department of Orthopedics, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Zhu Tongtong
- Department of Orthopedics, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Wang Dapeng
- Department of Orthopedics, Siping Central Hospital, Siping, China
| | - Zhang Mingran
- Department of Orthopedics, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Wang Xukai
- Department of Orthopedics, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Yu Yue
- Department of Orthopedics, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Dong Hengliang
- Department of Orthopedics, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Wu Guangzhi
- Department of Orthopedics, China-Japan Union Hospital of Jilin University, Changchun, China,*Correspondence: Wu Guangzhi, ; Zhang Minglei,
| | - Zhang Minglei
- Department of Orthopedics, China-Japan Union Hospital of Jilin University, Changchun, China,*Correspondence: Wu Guangzhi, ; Zhang Minglei,
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3
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Bettencourt AF, Costa J, Ribeiro IAC, Gonçalves L, Arias-Moliz MT, Dias JR, Franco M, Alves NM, Portugal J, Neves CB. Development of a chlorhexidine delivery system based on dental reline acrylic resins. Int J Pharm 2023; 631:122470. [PMID: 36516927 DOI: 10.1016/j.ijpharm.2022.122470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 11/18/2022] [Accepted: 12/04/2022] [Indexed: 12/14/2022]
Abstract
The high recurrence rate of common denture stomatitis after antifungal treatment is still concerning. This condition is caused by low patient compliance and incomplete local elimination of the main etiological factor - Candida albicans, often associated with other microorganisms, such as Streptococcus species. Impregnating denture materials with antimicrobials for local delivery is a strategy that can overcome the side effects and improve the efficacy of conventional treatments (topical and/or systemic). In this work, we describe the development of three hard autopolymerizing reline acrylic resins (Kooliner, Ufi Gel Hard, and Probase Cold) loaded with different percentages of chlorhexidine (CHX). The novel formulations were characterized based on their antimicrobial activity, mechanical, morphological and surface properties, in-vitro drug release profiles, and cytotoxicity. The addition of CHX in all resins did not change their chemical and mechanical structure. Among all the tested formulations, Probase Cold loaded with 5 wt% CHX showed the most promising results in terms of antimicrobial activity and lack of serious detrimental mechanical, morphological, surface, and biological properties.
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Affiliation(s)
- Ana F Bettencourt
- Research Institute for Medicines (iMed.ULisboa), Faculdade de Farmácia, Universidade de Lisboa, 1649-003 Lisboa, Portugal.
| | - Joana Costa
- Unidade de Investigação em Ciências Orais e Biomédicas (UICOB), Faculdade de Medicina Dentária, Universidade de Lisboa, 1600-277 Lisboa, Portugal
| | - Isabel A C Ribeiro
- Research Institute for Medicines (iMed.ULisboa), Faculdade de Farmácia, Universidade de Lisboa, 1649-003 Lisboa, Portugal
| | - Lídia Gonçalves
- Research Institute for Medicines (iMed.ULisboa), Faculdade de Farmácia, Universidade de Lisboa, 1649-003 Lisboa, Portugal
| | | | - Juliana R Dias
- Center for Rapid and Sustainable Product Development (CDRsp), Polytechnic Institute of Leiria, 2030-028 Marinha Grande, Portugal
| | - Margarida Franco
- Center for Rapid and Sustainable Product Development (CDRsp), Polytechnic Institute of Leiria, 2030-028 Marinha Grande, Portugal
| | - Nuno M Alves
- Center for Rapid and Sustainable Product Development (CDRsp), Polytechnic Institute of Leiria, 2030-028 Marinha Grande, Portugal
| | - Jaime Portugal
- Unidade de Investigação em Ciências Orais e Biomédicas (UICOB), Faculdade de Medicina Dentária, Universidade de Lisboa, 1600-277 Lisboa, Portugal
| | - Cristina B Neves
- Unidade de Investigação em Ciências Orais e Biomédicas (UICOB), Faculdade de Medicina Dentária, Universidade de Lisboa, 1600-277 Lisboa, Portugal.
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Clinical Efficacy and Safety Analysis of Levofloxacin for the Prevention of Infection after Traumatic Osteoarthrosis and Internal Fixation: Systematic Review and Meta-Analysis. Emerg Med Int 2022; 2022:8788365. [PMID: 36213001 PMCID: PMC9537031 DOI: 10.1155/2022/8788365] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 08/28/2022] [Accepted: 09/13/2022] [Indexed: 11/22/2022] Open
Abstract
Objective Levofloxacin has been widely used in clinical anti-infection treatment; however, its adverse reactions to levofloxacin were also obvious in patients. Herein we aimed to systematically evaluate the clinical efficacy and safety of systemic administration of levofloxacin in the prevention of postoperative infection after traumatic osteoarthrosis and internal fixation. Methods PubMed, Cochrane Library, OVID, EBSCO, CNKI, VIP database, and Wanfang Database were searched from December 1993 to December 2021. Meanwhile, China ADR Information Bulletin and WHO Pharmaceutical were searched manually. Newsletter and FDA Drug Safety Newsletter, also to retrieve the Websites of Chinese, Chinese, and drug regulatory authorities; To obtain data on adverse events in children with systemic administration of levofloxacin. The literature was screened according to inclusion and exclusion criteria. The risk of bias was evaluated for the included RCT literature. Results There was a statistical difference in the comparison of the incidence of fever between the experimental group and the control group (OR = 2.29, 95% CI (1.75,2.98),P < 0.00001, I2 = 0%, Z = 6.11); elevated white blood cell count (OR = 1.82, 95% CI (1.31,2.52),P=0.0003, I2 = 0%, Z = 3.60); incidence of wound infection (OR = 2.11, 95% CI (1.54,2.90),P < 0.00001, I2 = 0%, Z = 4.64); adverse drug reaction (OR = 1.82, 95% CI (1.21,2.74),P=0.004, I2 = 0%, Z = 2.86). Conclusion In the clinical use of levofloxacin, adverse drug reactions including fever, elevated white blood cell count, and wound infection should be concerned.
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Dardouri M, Bettencourt A, Martin V, Carvalho FA, Colaço B, Gama A, Ramstedt M, Santos NC, Fernandes MH, Gomes PS, Ribeiro IAC. Assuring the Biofunctionalization of Silicone Covalently Bonded to Rhamnolipids: Antibiofilm Activity and Biocompatibility. Pharmaceutics 2022; 14:pharmaceutics14091836. [PMID: 36145584 PMCID: PMC9501004 DOI: 10.3390/pharmaceutics14091836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 08/10/2022] [Accepted: 08/25/2022] [Indexed: 12/05/2022] Open
Abstract
Silicone-based medical devices composed of polydimethylsiloxane (PDMS) are widely used all over the human body (e.g., urinary stents and catheters, central venous catheters stents) with extreme clinical success. Nevertheless, their abiotic surfaces, being prone to microorganism colonization, are often involved in infection occurrence. Improving PDMS antimicrobial properties by surface functionalization with biosurfactants to prevent related infections has been the goal of different works, but studies that mimic the clinical use of these novel surfaces are missing. This work aims at the biofunctional assessment of PDMS functionalized with rhamnolipids (RLs), using translational tests that more closely mimic the clinical microenvironment. Rhamnolipids were covalently bonded to PDMS, and the obtained surfaces were characterized by contact angle modification assessment, ATR-FTIR analysis and atomic force microscopy imaging. Moreover, a parallel flow chamber was used to assess the Staphylococcus aureus antibiofilm activity of the obtained surfaces under dynamic conditions, and an in vitro characterization with human dermal fibroblast cells in both direct and indirect characterization assays, along with an in vivo subcutaneous implantation assay in the translational rabbit model, was performed. A 1.2 log reduction in S. aureus biofilm was observed after 24 h under flow dynamic conditions. Additionally, functionalized PDMS lessened cell adhesion upon direct contact, while supporting a cytocompatible profile, within an indirect assay. The adequacy of the biological response was further validated upon in vivo subcutaneous tissue implantation. An important step was taken towards biofunctional assessment of RLs-functionalized PDMS, reinforcing their suitability for medical device usage and infection prevention.
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Affiliation(s)
- Maïssa Dardouri
- Research Institute for Medicines (iMed.ULisboa), Faculty of Pharmacy, Universidade de Lisboa, Avenida Prof. Gama Pinto, 1649-003 Lisboa, Portugal
| | - Ana Bettencourt
- Research Institute for Medicines (iMed.ULisboa), Faculty of Pharmacy, Universidade de Lisboa, Avenida Prof. Gama Pinto, 1649-003 Lisboa, Portugal
| | - Victor Martin
- BoneLab—Laboratory for Bone Metabolism and Regeneration, Faculty of Dental Medicine, University of Porto, Rua Dr. Manuel Pereira da Silva, 4200-393 Porto, Portugal
- LAQV/REQUIMTE, University of Porto, Praça Coronel Pacheco, 4050-453 Porto, Portugal
| | - Filomena A. Carvalho
- Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Av. Prof. Egas Moniz, 1649-028 Lisbon, Portugal
| | - Bruno Colaço
- Animal and Veterinary Research Centre (CECAV), Associate Laboratory for Animal and Veterinary Science–AL4AnimalS, University of Trás-os-Montes and Alto Douro (UTAD), 5000-801 Vila Real, Portugal
| | - Adelina Gama
- Animal and Veterinary Research Centre (CECAV), Associate Laboratory for Animal and Veterinary Science–AL4AnimalS, University of Trás-os-Montes and Alto Douro (UTAD), 5000-801 Vila Real, Portugal
| | | | - Nuno C. Santos
- Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Av. Prof. Egas Moniz, 1649-028 Lisbon, Portugal
| | - Maria H. Fernandes
- BoneLab—Laboratory for Bone Metabolism and Regeneration, Faculty of Dental Medicine, University of Porto, Rua Dr. Manuel Pereira da Silva, 4200-393 Porto, Portugal
- LAQV/REQUIMTE, University of Porto, Praça Coronel Pacheco, 4050-453 Porto, Portugal
| | - Pedro S. Gomes
- BoneLab—Laboratory for Bone Metabolism and Regeneration, Faculty of Dental Medicine, University of Porto, Rua Dr. Manuel Pereira da Silva, 4200-393 Porto, Portugal
- LAQV/REQUIMTE, University of Porto, Praça Coronel Pacheco, 4050-453 Porto, Portugal
- Correspondence: (P.S.G.); (I.A.C.R.); Tel.: +351-220-910-100 (P.S.G.); +351-217-946-400 (I.A.C.R.); Fax: +351-220-910-101 (P.S.G.); +351-217-946-470 (I.A.C.R.)
| | - Isabel A. C. Ribeiro
- Research Institute for Medicines (iMed.ULisboa), Faculty of Pharmacy, Universidade de Lisboa, Avenida Prof. Gama Pinto, 1649-003 Lisboa, Portugal
- Correspondence: (P.S.G.); (I.A.C.R.); Tel.: +351-220-910-100 (P.S.G.); +351-217-946-400 (I.A.C.R.); Fax: +351-220-910-101 (P.S.G.); +351-217-946-470 (I.A.C.R.)
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Dardouri M, Aljnadi IM, Deuermeier J, Santos C, Costa F, Martin V, Fernandes MH, Gonçalves L, Bettencourt A, Gomes PS, Ribeiro IA. Bonding antimicrobial rhamnolipids onto medical grade PDMS: A strategy to overcome multispecies vascular catheter-related infections. Colloids Surf B Biointerfaces 2022; 217:112679. [DOI: 10.1016/j.colsurfb.2022.112679] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 05/30/2022] [Accepted: 06/28/2022] [Indexed: 01/06/2023]
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7
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Zegre M, Barros J, Ribeiro IAC, Santos C, Caetano LA, Gonçalves L, Monteiro Resource FJ, Ferraz MP, Bettencourt A. Poly(DL-lactic acid) scaffolds as a bone targeting platform for the co-delivery of antimicrobial agents against S. aureus-C. albicans mixed biofilms. Int J Pharm 2022; 622:121832. [PMID: 35595042 DOI: 10.1016/j.ijpharm.2022.121832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 05/11/2022] [Accepted: 05/12/2022] [Indexed: 10/18/2022]
Abstract
New strategies for the treatment of polymicrobial bone infections are required. In this study, the co-delivery of two antimicrobials by poly(D,L-lactic acid) (PDLLA) scaffolds was investigated in a polymicrobial biofilm model. PDLLA scaffolds were prepared by solvent casting/particulate leaching methodology, incorporating minocycline and voriconazole as clinically relevant antimicrobial agents. The scaffolds presented a sponge-like appearance, suitable to support cell proliferation and drug release. Single- and dual-species biofilm models of Staphylococcus aureus and Candida albicans were developed and characterized. S. aureus presented a higher ability to form single-species biofilms, compared to C. albicans. Minocycline and voriconazole-loaded PDLLA scaffolds showed activity against S. aureus and C. albicans single- and dual-biofilms. Ultimately, the cytocompatibility/functional activity of PDLLA scaffolds observed in human MG-63 osteosarcoma cells unveil their potential as a next-generation co-delivery system for antimicrobial therapy in bone infections.
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Affiliation(s)
- M Zegre
- Research Institute for Medicines (iMed.ULisboa), Faculdade de Farmácia, Universidade de Lisboa, Av. Prof. Gama Pinto, 1649-003, Lisboa, Portugal; H&TRC - Centro de Investigação em Saúde e Tecnologia, ESTeSL - Escola Superior de Tecnologia da Saúde de Lisboa, IPL - Instituto Politécnico de Lisboa, Av. D. João II, Lote 4.69.01, 1990-096, Lisboa, Portugal
| | - J Barros
- i3S - Instituto de Investigação e Inovação em Saúde - Associação, Universidade do Porto, R. Alfredo Allen 208, 4200-135, Porto, Portugal; INEB - Instituto de Engenharia Biomédica, Universidade do Porto, R. Alfredo Allen 208, 4200-135, Porto, Portugal
| | - I A C Ribeiro
- Research Institute for Medicines (iMed.ULisboa), Faculdade de Farmácia, Universidade de Lisboa, Av. Prof. Gama Pinto, 1649-003, Lisboa, Portugal
| | - C Santos
- CQE - Instituto Superior Técnico, Universidade de Lisboa, Av. Rovisco Pais 1049-001,Lisboa, Portugal; EST Setúbal, CDP2T, Instituto Politécnico de Setúbal, Campus IPS, 2910 Setúbal,Portugal
| | - L A Caetano
- Research Institute for Medicines (iMed.ULisboa), Faculdade de Farmácia, Universidade de Lisboa, Av. Prof. Gama Pinto, 1649-003, Lisboa, Portugal; H&TRC - Centro de Investigação em Saúde e Tecnologia, ESTeSL - Escola Superior de Tecnologia da Saúde de Lisboa, IPL - Instituto Politécnico de Lisboa, Av. D. João II, Lote 4.69.01, 1990-096, Lisboa, Portugal
| | - L Gonçalves
- Research Institute for Medicines (iMed.ULisboa), Faculdade de Farmácia, Universidade de Lisboa, Av. Prof. Gama Pinto, 1649-003, Lisboa, Portugal
| | - F J Monteiro Resource
- i3S - Instituto de Investigação e Inovação em Saúde - Associação, Universidade do Porto, R. Alfredo Allen 208, 4200-135, Porto, Portugal; INEB - Instituto de Engenharia Biomédica, Universidade do Porto, R. Alfredo Allen 208, 4200-135, Porto, Portugal; FEUP/DEMM - Departamento de Engenharia Metalúrgica e de Materiais, Faculdade de Engenharia da Universidade do Porto, 4200-465 Porto, Portugal
| | - M P Ferraz
- i3S - Instituto de Investigação e Inovação em Saúde - Associação, Universidade do Porto, R. Alfredo Allen 208, 4200-135, Porto, Portugal; INEB - Instituto de Engenharia Biomédica, Universidade do Porto, R. Alfredo Allen 208, 4200-135, Porto, Portugal; FEUP/DEMM - Departamento de Engenharia Metalúrgica e de Materiais, Faculdade de Engenharia da Universidade do Porto, 4200-465 Porto, Portugal.
| | - A Bettencourt
- Research Institute for Medicines (iMed.ULisboa), Faculdade de Farmácia, Universidade de Lisboa, Av. Prof. Gama Pinto, 1649-003, Lisboa, Portugal.
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Mendes RM, Francisco AP, Carvalho FA, Dardouri M, Costa B, Bettencourt AF, Costa J, Gonçalves L, Costa F, Ribeiro IAC. Fighting S. aureus catheter-related infections with sophorolipids: Electing an antiadhesive strategy or a release one? Colloids Surf B Biointerfaces 2021; 208:112057. [PMID: 34464911 DOI: 10.1016/j.colsurfb.2021.112057] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 07/31/2021] [Accepted: 08/16/2021] [Indexed: 02/08/2023]
Abstract
Staphylococcus aureus medical devices related-infections, such as blood stream catheter are of major concern. Their prevention is compulsory and strategies, not prone to the development of resistance, to prevent S. aureus biofilms on catheter surfaces (e.g. silicone) are needed. In this work two different approaches using sophorolipids were studied to prevent S. aureus biofilm formation on medical grade silicone: i) an antiadhesive strategy through covalent bond of sophorolipids to the surface; ii) and a release strategy using isolated most active sophorolipids. Sophorolipids produced by Starmerella bombicola, were characterized by UHPLC-MS and RMN, purified by automatic flash chromatography and tested for their antimicrobial activity towards S. aureus. Highest antimicrobial activity was observed for C18:0 and C18:1 diacetylated lactonic sophorolipids showing a MIC of 50 μg mL-1. Surface modification with acidic or lactonic sophorolipids when evaluating the anti-adhesive or release strategy, respectively, was confirmed by contact angle, FTIR-ATR and AFM analysis. When using a mixture of acidic sophorolipids covalently bonded to silicone surface as antiadhesive strategy cytocompatible surfaces were obtained and a reduction of 90 % on biofilm formation was observed. Nevertheless, if a release strategy is adopted with purified lactonic sophorolipids a higher effect is achieved. Most promising compound was C18:1 diacateylated lactonic sophorolipid that showed no cellular viability reduction when a concentration of 1.5 mg mL-1 was selected and a reduction on biofilm around 5 log units. Results reinforce the applicability of these antimicrobial biosurfactants on preventing biofilms and disclose that their antimicrobial effect is imperative when comparing to their antiadhesive properties.
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Affiliation(s)
- Rita M Mendes
- Research Institute for Medicines (iMed.ULisboa), Faculty of Pharmacy, Universidade de Lisboa, Avenida Prof. Gama Pinto, 1649-003, Lisboa, Portugal
| | - Ana P Francisco
- Research Institute for Medicines (iMed.ULisboa), Faculty of Pharmacy, Universidade de Lisboa, Avenida Prof. Gama Pinto, 1649-003, Lisboa, Portugal
| | - Filomena A Carvalho
- Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Av. Prof. Egas Moniz, 1649-028, Lisbon, Portugal
| | - Maissa Dardouri
- Research Institute for Medicines (iMed.ULisboa), Faculty of Pharmacy, Universidade de Lisboa, Avenida Prof. Gama Pinto, 1649-003, Lisboa, Portugal
| | - Bruna Costa
- i3S - Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Rua Alfredo Allen, 208, 4200-135, Porto, Portugal; INEB - Instituto de Engenharia Biomédica, Universidade do Porto, Rua Alfredo Allen, 208, 4200-135, Porto, Portugal
| | - Ana F Bettencourt
- Research Institute for Medicines (iMed.ULisboa), Faculty of Pharmacy, Universidade de Lisboa, Avenida Prof. Gama Pinto, 1649-003, Lisboa, Portugal
| | - Judite Costa
- Research Institute for Medicines (iMed.ULisboa), Faculty of Pharmacy, Universidade de Lisboa, Avenida Prof. Gama Pinto, 1649-003, Lisboa, Portugal
| | - Lidia Gonçalves
- Research Institute for Medicines (iMed.ULisboa), Faculty of Pharmacy, Universidade de Lisboa, Avenida Prof. Gama Pinto, 1649-003, Lisboa, Portugal
| | - Fabíola Costa
- i3S - Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Rua Alfredo Allen, 208, 4200-135, Porto, Portugal; INEB - Instituto de Engenharia Biomédica, Universidade do Porto, Rua Alfredo Allen, 208, 4200-135, Porto, Portugal
| | - Isabel A C Ribeiro
- Research Institute for Medicines (iMed.ULisboa), Faculty of Pharmacy, Universidade de Lisboa, Avenida Prof. Gama Pinto, 1649-003, Lisboa, Portugal.
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9
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Sun J, Liu X, Lyu C, Hu Y, Zou D, He YS, Lu J. Synergistic antibacterial effect of graphene-coated titanium loaded with levofloxacin. Colloids Surf B Biointerfaces 2021; 208:112090. [PMID: 34507071 DOI: 10.1016/j.colsurfb.2021.112090] [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: 07/20/2021] [Revised: 08/26/2021] [Accepted: 08/30/2021] [Indexed: 11/17/2022]
Abstract
In this study, graphene coating was introduced to the modified titanium surface to prevent bacterial infection in oral implants. We modified the titanium surface through SLA and silanization treatment and then coated the surface with graphene. The structure and surface properties were characterized by XPS and SEM. Graphene-coated titanium sheet was incubated with bacteria to test the antibacterial property, which was enhanced by adsorption and release of levofloxacin. We further implanted the graphene-coated titanium sheet loaded with levofloxacin into rabbits to test the antibacterial properties in vivo. The graphene coating exhibited inherent antibacterial properties through membrane stress and the generation of reactive oxygen species (ROS). When loaded with levofloxacin, the graphene coating exhibited a synergistic antibacterial effect and effectively prevented bacterial infections following the implantation. The graphene coating is promising to improve the antibacterial functions of oral implant surfaces to prevent bacterial infection.
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Affiliation(s)
- Jiayue Sun
- Department of Stomatology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, 200233, China
| | - Xuling Liu
- Department of Stomatology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, 200233, China
| | - Chengqi Lyu
- Department of Stomatology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, 200233, China
| | - Yinghan Hu
- Department of Stomatology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, 200233, China
| | - Derong Zou
- Department of Stomatology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, 200233, China
| | - Yu-Shi He
- Shanghai Electrochemical Energy Devices Research Center, School of Chemistry and Chemical Engineering, Shanghai Jiao Tong University, Shanghai, 200240, China.
| | - Jiayu Lu
- Department of Stomatology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, 200233, China.
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Ayre WN, Scully N, Elford C, Evans BA, Rowe W, Rowlands J, Mitha R, Malpas P, Manti P, Holt C, Morgan-Jones R, Birchall JC, Denyer SP, Evans SL. Alternative radiopacifiers for polymethyl methacrylate bone cements: Silane-treated anatase titanium dioxide and yttria-stabilised zirconium dioxide. J Biomater Appl 2021; 35:1235-1252. [PMID: 33573445 PMCID: PMC8058833 DOI: 10.1177/0885328220983797] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Poly (methyl methacrylate) (PMMA) bone cement is widely used for anchoring joint arthroplasties. In cement brands approved for these procedures, micron-sized particles (usually barium sulphate, BaSO4) act as the radiopacifier. It has been postulated that these particles act as sites for crack initiation and subsequently cement fatigue. This study investigated whether alternative radiopacifiers, anatase titanium dioxide (TiO2) and yttria-stabilised zirconium dioxide (ZrO2), could improve the in vitro mechanical, fatigue crack propagation and biological properties of polymethyl methacrylate (PMMA) bone cement and whether their coating with a silane could further enhance cement performance. Cement samples containing 0, 5, 10, 15, 20 and 25%w/w TiO2 or ZrO2 and 10%w/w silane-treated TiO2 or ZrO2 were prepared and characterised in vitro in terms of radiopacity, compressive and bending strength, bending modulus, fatigue crack propagation, hydroxyapatite forming ability and MC3T3-E1 cell attachment and viability. Cement samples with greater than 10%w/w TiO2 and ZrO2 had a similar radiopacity to the control 10%w/w BaSO4 cement and commercial products. The addition of TiO2 and ZrO2 to bone cement reduced the bending strength and fracture toughness and increased fatigue crack propagation due to the formation of agglomerations and voids. Silane treating TiO2 reversed this effect, enhancing the dispersion and adhesion of particles to the PMMA matrix and resulted in improved mechanical properties and fatigue crack propagation resistance. Silane-treated TiO2 cements had increased nucleation of hydroxyapatite and MC3T3-E1 cell attachment in vitro, without significantly compromising cell viability. This research has demonstrated that 10%w/w silane-treated anatase TiO2 is a promising alternative radiopacifier for PMMA bone cement offering additional benefits over conventional BaSO4 radiopacifiers.
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Affiliation(s)
| | | | | | | | - Wendy Rowe
- School of Dentistry, Cardiff University, Cardiff, UK
| | - Jeff Rowlands
- School of Engineering, Cardiff University, Cardiff, UK
| | - Ravi Mitha
- School of Engineering, Cardiff University, Cardiff, UK
| | - Paul Malpas
- School of Engineering, Cardiff University, Cardiff, UK
| | | | - Cathy Holt
- School of Engineering, Cardiff University, Cardiff, UK
| | - Rhidian Morgan-Jones
- Department of Trauma & Orthopaedics, Cardiff & Vale University Health Board, Cardiff, UK
| | - James C Birchall
- School of Pharmacy and Pharmaceutical Sciences, Cardiff University, Cardiff, UK
| | - Stephen P Denyer
- School of Pharmacy and Biomolecular Sciences, University of Brighton, Brighton, UK
| | - Sam L Evans
- School of Engineering, Cardiff University, Cardiff, UK
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11
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Ferreira M, Aguiar S, Bettencourt A, Gaspar MM. Lipid-based nanosystems for targeting bone implant-associated infections: current approaches and future endeavors. Drug Deliv Transl Res 2020; 11:72-85. [PMID: 32514703 DOI: 10.1007/s13346-020-00791-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Bone infections caused by Staphylococcus aureus are a major concern in medical care, particularly when associated with orthopedic-implant devices. The ability of the bacteria to form biofilms and their capacity to invade and persist within osteoblasts turn the infection eradication into a huge challenge. The reduction of antibiotic penetration through bacterial biofilms associated with the presence of persistent cells, ability to survive in the host, and high tolerance to antibiotics are some of the reasons for the difficult treatment of these infections. Effective therapeutic approaches are urgently needed. In this sense, lipid-based nanosystems, such as liposomes, have been investigated as an innovative and alternative strategy for the treatment of implant-associated S. aureus infections, due to their preferential accumulation at infected sites and interaction with S. aureus. This review highlights the recent advances on antibiotic-loaded liposome formulations both in vitro and in vivo and how the interaction with S. aureus biofilms may be improved by modulating the liposomal external surface. Graphical Abstract.
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Affiliation(s)
- Magda Ferreira
- Research Institute for Medicines (iMed.ULisboa), Faculty of Pharmacy, Universidade de Lisboa, Av. Prof. Gama Pinto, 1649-003, Lisbon, Portugal
- Centre for Interdisciplinary Research in Animal Health (CIISA), Faculty of Veterinary Medicine, Universidade de Lisboa, Av. Universidade Técnica, 1300-477, Lisbon, Portugal
| | - Sandra Aguiar
- Centre for Interdisciplinary Research in Animal Health (CIISA), Faculty of Veterinary Medicine, Universidade de Lisboa, Av. Universidade Técnica, 1300-477, Lisbon, Portugal
| | - Ana Bettencourt
- Research Institute for Medicines (iMed.ULisboa), Faculty of Pharmacy, Universidade de Lisboa, Av. Prof. Gama Pinto, 1649-003, Lisbon, Portugal.
| | - Maria Manuela Gaspar
- Research Institute for Medicines (iMed.ULisboa), Faculty of Pharmacy, Universidade de Lisboa, Av. Prof. Gama Pinto, 1649-003, Lisbon, Portugal.
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12
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Silva T, Silva JC, Colaco B, Gama A, Duarte-Araújo M, Fernandes MH, Bettencourt A, Gomes P. In vivo tissue response and antibacterial efficacy of minocycline delivery system based on polymethylmethacrylate bone cement. J Biomater Appl 2019; 33:380-391. [PMID: 30223730 DOI: 10.1177/0885328218795290] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
This study aims the in vivo biological characterization of an innovative minocycline delivery system, based on polymethylmethacrylate bone cement. Bone cements containing 1% or 2.5% (w/w) minocycline were formulated and evaluated through solid-state characterization. Biological evaluation was conducted in vivo, within a rat model, following the subcutaneous and bone tissue implantation, and tissue implantation associated with Staphylococcus aureus is challenging. The assessment of the tissue/biomaterial interaction was conducted by histologic, histomorphometric and microtomographic techniques. Minocycline addition to the composition of the polymethylmethacrylate bone cement did not modify significantly the cement properties. Drug release profile was marked by an initial burst release followed by a low-dosage sustained release. Following the subcutaneous tissue implantation, a reduced immune-inflammatory reaction was verified, with diminished cell recruitment and a thinner fibro-connective capsule formation. Minocycline-releasing cements were found to enhance the bone-to-implant contact and bone tissue formation, following the tibial implantation. Lastly, an effective antibacterial activity was mediated by the implanted cement following the tissue challenging with S. aureus. Kinetic minocycline release profile, attained with the developed polymethylmethacrylate system, modulated adequately the in vivo biological response, lessening the immune-inflammatory activation and enhancing bone tissue formation. Also, an effective in vivo antibacterial activity was established. These findings highlight the adequacy and putative application of the developed system for orthopedic applications.
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Affiliation(s)
- Tiago Silva
- 1 Faculty of Dental Medicine, University of Porto, Porto, Portugal
| | - Jose C Silva
- 1 Faculty of Dental Medicine, University of Porto, Porto, Portugal
| | - Bruno Colaco
- 2 University of Trás-os-Montes e Alto Douro, Vila Real, Portugal
| | - Adelina Gama
- 2 University of Trás-os-Montes e Alto Douro, Vila Real, Portugal
| | | | - Maria H Fernandes
- 1 Faculty of Dental Medicine, University of Porto, Porto, Portugal.,4 REQUIMTE/LAQV - University of Porto, Porto, Portugal
| | - Ana Bettencourt
- 5 Research Institute for Medicines (iMed.ULisboa), Faculty of Pharmacy, Universidade de Lisboa, Lisbon, Portugal
| | - Pedro Gomes
- 1 Faculty of Dental Medicine, University of Porto, Porto, Portugal.,4 REQUIMTE/LAQV - University of Porto, Porto, Portugal
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13
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Li T, Fu L, Wang J, Shi Z. High dose of vancomycin plus gentamicin incorporated acrylic bone cement decreased the elution of vancomycin. Infect Drug Resist 2019; 12:2191-2199. [PMID: 31410038 PMCID: PMC6645360 DOI: 10.2147/idr.s203740] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Accepted: 07/03/2019] [Indexed: 12/23/2022] Open
Abstract
Purpose Low doses of vancomycin and gentamicin were commonly incorporated into acrylic bone cement (antibiotic-impregnated bone cement, AIBC) during revision arthroplasty. Previous studies showed that only a very small amount of antibiotics could be eluted from AIBC. Given the fact that a high dose of antibiotic would elute high concentration of antibiotic, this study investigated the influence of a high dose of dual-antibiotic loading on the properties of cement. Methods A total of 8 groups of AIBC containing either gentamicin or vancomycin or both with different amounts of antibiotics (1 g, 2 g and 4 g) were tested on material properties, elution profiles, antibacterial activity and cytological toxicity. Results A high dose of gentamicin and vancomycin AIBC (with 2 g gentamicin and 2 g vancomycin loaded) regiment showed acceptable compressive strength of 74.25±0.72 MPa. No cytotoxicity or antibacterial activity reduction was observed in any group tested in this study. The elution profiles indicated that incorporating 2 g vancomycin resulted in 4.77% (1049.57±3.74 μg) released after 28 days. However, after 2 g gentamicin was added, the vancomycin released was significantly reduced to 2.42% (532.24±1.77 μg) (p<0.001), approximately 50% reduction. No significant influence of vancomycin on gentamicin was observed. Conclusion These findings suggest that the addition of 2 g vancomycin and 2 g gentamicin into acrylic bone cement was preferred while considering this dual-antibiotic AIBC regiment with acceptably material properties and effective antibacterial activity. However, special attention should be drawn to the reduction of vancomycin elution when incorporated with gentamicin.
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Affiliation(s)
- Tao Li
- Department of Orthopedics, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, People's Republic of China
| | - Lilan Fu
- Nanfang PET Center, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, People's Republic of China
| | - Jian Wang
- Department of Orthopedics, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, People's Republic of China
| | - Zhanjun Shi
- Department of Orthopedics, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, People's Republic of China
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14
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Martin V, Ribeiro IA, Alves MM, Gonçalves L, Claudio RA, Grenho L, Fernandes MH, Gomes P, Santos CF, Bettencourt AF. Engineering a multifunctional 3D-printed PLA-collagen-minocycline-nanoHydroxyapatite scaffold with combined antimicrobial and osteogenic effects for bone regeneration. MATERIALS SCIENCE & ENGINEERING. C, MATERIALS FOR BIOLOGICAL APPLICATIONS 2019; 101:15-26. [PMID: 31029308 DOI: 10.1016/j.msec.2019.03.056] [Citation(s) in RCA: 91] [Impact Index Per Article: 18.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Revised: 02/22/2019] [Accepted: 03/17/2019] [Indexed: 01/06/2023]
Abstract
3D-printing and additive manufacturing can be powerful techniques to design customized structures and produce synthetic bone grafts with multifunctional effects suitable for bone repair. In our work we aimed the development of novel multifunctionalized 3D printed poly(lactic acid) (PLA) scaffolds with bioinspired surface coatings able to reduce bacterial biofilm formation while favoring human bone marrow-derived mesenchymal stem cells (hMSCs) activity. For that purpose, 3D printing was used to prepare PLA scaffolds that were further multifunctionalized with collagen (Col), minocycline (MH) and bioinspired citrate- hydroxyapatite nanoparticles (cHA). PLA-Col-MH-cHA scaffolds provide a closer structural support approximation to native bone architecture with uniform macroporous, adequate wettability and an excellent compressive strength. The addition of MH resulted in an adequate antibiotic release profile that by being compatible with local drug delivery therapy was translated into antibacterial activities against Staphylococcus aureus, a main pathogen associated to bone-related infections. Subsequently, the hMSCs response to these scaffolds revealed that the incorporation of cHA significantly stimulated the adhesion, proliferation and osteogenesis-related gene expression (RUNX2, OCN and OPN) of hMSCs. Furthermore, the association of a bioinspired material (cHA) with the antibiotic MH resulted in a combined effect of an enhanced osteogenic activity. These findings, together with the antibiofilm activity depicted strengthen the appropriateness of this 3D-printed PLA-Col-MH-cHA scaffold for future use in bone repair. By targeting bone repair while mitigating the typical infections associated to bone implants, our 3D scaffolds deliver an integrated strategy with the combined effects further envisaging an increase in the success rate of bone-implanted devices.
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Affiliation(s)
- Victor Martin
- Research Institute for Medicines (iMed.ULisboa), Faculdade de Farmácia, Universidade de Lisboa, Avenida Prof. Gama Pinto, 1649-003 Lisboa, Portugal
| | - Isabel A Ribeiro
- Research Institute for Medicines (iMed.ULisboa), Faculdade de Farmácia, Universidade de Lisboa, Avenida Prof. Gama Pinto, 1649-003 Lisboa, Portugal
| | - Marta M Alves
- CQE Instituto Superior Técnico, Universidade de Lisboa, Av. Rovisco Pais, 1049-001, Lisboa, Portugal
| | - Lídia Gonçalves
- Research Institute for Medicines (iMed.ULisboa), Faculdade de Farmácia, Universidade de Lisboa, Avenida Prof. Gama Pinto, 1649-003 Lisboa, Portugal
| | - Ricardo A Claudio
- EST Setúbal, CDP2T, Instituto Politécnico de Setúbal, Campus IPS, 2910 Setúbal, Portugal; IDMEC, Instituto Superior Técnico, Universidade de Lisboa, Av. Rovisco Pais, 1049-001 Lisboa, Portugal
| | - Liliana Grenho
- Laboratory for Bone Metabolism and Regeneration - Faculty of Dental Medicine, U. Porto, Rua Dr. Manuel Pereira da Silva, 4200-393 Porto, Portugal; LAQV/REQUIMTE, U. Porto, Porto 4160-007, Portugal
| | - Maria H Fernandes
- Laboratory for Bone Metabolism and Regeneration - Faculty of Dental Medicine, U. Porto, Rua Dr. Manuel Pereira da Silva, 4200-393 Porto, Portugal; LAQV/REQUIMTE, U. Porto, Porto 4160-007, Portugal
| | - Pedro Gomes
- Laboratory for Bone Metabolism and Regeneration - Faculty of Dental Medicine, U. Porto, Rua Dr. Manuel Pereira da Silva, 4200-393 Porto, Portugal; LAQV/REQUIMTE, U. Porto, Porto 4160-007, Portugal
| | - Catarina F Santos
- CQE Instituto Superior Técnico, Universidade de Lisboa, Av. Rovisco Pais, 1049-001, Lisboa, Portugal; EST Setúbal, CDP2T, Instituto Politécnico de Setúbal, Campus IPS, 2910 Setúbal, Portugal.
| | - Ana F Bettencourt
- Research Institute for Medicines (iMed.ULisboa), Faculdade de Farmácia, Universidade de Lisboa, Avenida Prof. Gama Pinto, 1649-003 Lisboa, Portugal.
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15
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Shen SC, Letchmanan K, Chow PS, Tan RBH. Antibiotic elution and mechanical property of TiO2 nanotubes functionalized PMMA-based bone cements. J Mech Behav Biomed Mater 2019; 91:91-98. [DOI: 10.1016/j.jmbbm.2018.11.020] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Revised: 11/16/2018] [Accepted: 11/19/2018] [Indexed: 11/26/2022]
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16
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Dolci LS, Panzavolta S, Torricelli P, Albertini B, Sicuro L, Fini M, Bigi A, Passerini N. Modulation of Alendronate release from a calcium phosphate bone cement: An in vitro osteoblast-osteoclast co-culture study. Int J Pharm 2019; 554:245-255. [DOI: 10.1016/j.ijpharm.2018.11.023] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2018] [Revised: 11/07/2018] [Accepted: 11/09/2018] [Indexed: 01/12/2023]
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17
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Floating liquid crystalline molecularly imprinted polymer coated carbon nanotubes for levofloxacin delivery. Eur J Pharm Biopharm 2018; 127:150-158. [PMID: 29438726 DOI: 10.1016/j.ejpb.2018.02.012] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2017] [Revised: 12/07/2017] [Accepted: 02/07/2018] [Indexed: 01/12/2023]
Abstract
Liquid crystalline molecularly imprinted polymers (LC-MIPs) were low cross-linking MIPs (5-20 mol%) by introducing a LC monomer into the MIP polymerization system to keep the shape of the imprinted cavities due to additional interactions between the mesogenic groups. The multiwalled carbon nanotubes (MWCNTs) coated LC-MIP (MWCNT@LC-MIP) was the first fabricated as a novel floating interaction-controlled DDS. The synthesis was achieved by adding 9-vinylanthracene to obtain the high-density vinyl group functionalized MWCNTs firstly, and then polymerization of LC MIPs was performed on the surface of MWCNTs using a mixture of methacrylic acid, ethylene glycol dimethacrylate, and 4-methyl phenyl dicyclohexyl ethylene (LC monomer) with levofloxacin (LVF) as model template drug. Both template/functional monomer ratio and levels of crosslinker were optimized to obtain the best imprinting factor. Characterizations of polymer were investigated by the transmission electron microscope, nitrogen adsorption, thermogravimetric analysis, Fourier transform infrared spectra and floating behavior studies. The imprinting effect was confirmed by the adsorption isotherms, adsorption kinetics and effect of selectivity. In vitro release studies were examined by the LVF-loaded MWCNT@LC-MIP and the control samples, MWCNT@LC-NIP, MWCNT@MIP, MWCNT@NIP and the bare MWCNT using acetonitrile as the dissolute medium. The release profiles showed an obvious zero-order release of LVF from MWCNT@LC-MIP, which exhibited 3.8 μg/h of the release rate with duration of about 20 h. In vivo pharmacokinetic study displayed the relative bioavailability of the gastro-floating MWCNT@LC-MIP was 578.9%, whereas only 58.0% of MWCNT@MIP and 11.7% of the bared MWCNT. As a conclusion, MWCNT@LC-MIP showed potentials for oral administration by the innovative combination of floating and controlled release properties.
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18
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Ferreira M, Rzhepishevska O, Grenho L, Malheiros D, Gonçalves L, Almeida AJ, Jordão L, Ribeiro IA, Ramstedt M, Gomes P, Bettencourt A. Levofloxacin-loaded bone cement delivery system: Highly effective against intracellular bacteria and Staphylococcus aureus biofilms. Int J Pharm 2017; 532:241-248. [PMID: 28851574 DOI: 10.1016/j.ijpharm.2017.08.089] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Revised: 08/16/2017] [Accepted: 08/18/2017] [Indexed: 12/31/2022]
Abstract
Staphylococcus aureus is a major pathogen in bone associated infections due to its ability to adhere and form biofilms on bone and/or implants. Moreover, recrudescent and chronic infections have been associated with S. aureus capacity to invade and persist within osteoblast cells. With the growing need of novel therapeutic tools, this research aimed to evaluate some important key biological properties of a novel carrier system composed of acrylic bone cement (polymethylmethacrylate - PMMA), loaded with a release modulator (lactose) and an antibiotic (levofloxacin). Levofloxacin-loaded bone cement (BC) exhibited antimicrobial effects against planktonic and biofilm forms of S. aureus (evaluated by a flow chamber system). Moreover, novel BC formulation showed high anti-bacterial intraosteoblast activity. This fact led to the conclusion that levofloxacin released from BC matrices could penetrate the cell membrane of osteoblasts and be active against S. aureus strains in the intracellular environment. Furthermore, levofloxacin-BC formulations showed no significant in vitro cytotoxicity and no allergic potential (measured by the in vivo chorioallantoic membrane assay). Our results indicate that levofloxacin-loaded BC has potential as a local antibiotic delivery system for treating S. aureus associated bone infections.
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Affiliation(s)
- Magda Ferreira
- Research Institute for Medicines (iMed.ULisboa), Faculty of Pharmacy, Universidade de Lisboa, Lisbon, Portugal; Faculdade de Ciências e Tecnologia, Universidade Nova de Lisboa, Lisbon, Portugal
| | | | - Liliana Grenho
- Laboratory for Bone Metabolism and Regeneration - Faculty of Dental Medicine, U. Porto, Porto, Portugal
| | | | - Lídia Gonçalves
- Research Institute for Medicines (iMed.ULisboa), Faculty of Pharmacy, Universidade de Lisboa, Lisbon, Portugal
| | - António J Almeida
- Research Institute for Medicines (iMed.ULisboa), Faculty of Pharmacy, Universidade de Lisboa, Lisbon, Portugal
| | - Luisa Jordão
- National Institute of Health Dr Ricardo Jorge, Department of Environmental Health, Lisbon, Portugal
| | - Isabel A Ribeiro
- Research Institute for Medicines (iMed.ULisboa), Faculty of Pharmacy, Universidade de Lisboa, Lisbon, Portugal
| | | | - Pedro Gomes
- Laboratory for Bone Metabolism and Regeneration - Faculty of Dental Medicine, U. Porto, Porto, Portugal; REQUIMTE/LAQV - Universidade do Porto, Porto, Portugal
| | - Ana Bettencourt
- Research Institute for Medicines (iMed.ULisboa), Faculty of Pharmacy, Universidade de Lisboa, Lisbon, Portugal.
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19
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Zomorodian A, Ribeiro IA, Fernandes JCS, Matos AC, Santos C, Bettencourt AF, Montemor MF. Biopolymeric coatings for delivery of antibiotic and controlled degradation of bioresorbable Mg AZ31 alloys. INT J POLYM MATER PO 2017. [DOI: 10.1080/00914037.2016.1252347] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Affiliation(s)
- A. Zomorodian
- Centro de Química Estrutural, Instituto Superior Técnico, Universidade de Lisboa, Lisboa, Portugal
| | - I. A. Ribeiro
- Research Institute for Medicine (iMed.ULisboa), Faculdade de Farmácia, Universidade de Lisboa, Lisboa, Portugal
| | - J. C. S. Fernandes
- Centro de Química Estrutural, Instituto Superior Técnico, Universidade de Lisboa, Lisboa, Portugal
| | - A. C. Matos
- Research Institute for Medicine (iMed.ULisboa), Faculdade de Farmácia, Universidade de Lisboa, Lisboa, Portugal
| | - C. Santos
- Centro de Química Estrutural, Instituto Superior Técnico, Universidade de Lisboa, Lisboa, Portugal
- Instituto Politécnico de Setúbal, Mechanical Engineering Department, ESTSetúbal, Setúbal, Portugal
| | - A. F. Bettencourt
- Research Institute for Medicine (iMed.ULisboa), Faculdade de Farmácia, Universidade de Lisboa, Lisboa, Portugal
| | - M. F. Montemor
- Centro de Química Estrutural, Instituto Superior Técnico, Universidade de Lisboa, Lisboa, Portugal
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Cao Z, Jiang D, Yan L, Wu J. In vitro and in vivo osteogenic activity of the novel vancomycin-loaded bone-like hydroxyapatite/poly(amino acid) scaffold. J Biomater Appl 2015; 30:1566-77. [PMID: 26686585 DOI: 10.1177/0885328215623735] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND Antibiotic-loaded carriers were developed because of their ability to fill cavities and deliver antibiotics locally following implantation. However, the most commonly used antibiotic carrier, polymethyl methacrylate, has many shortcomings, such as heat production, non-bioresorbable and lack of bone regeneration or conduction. Bone-like hydroxyapatite/poly(amino acid) scaffolds have been shown to have controllable biodegradability, nontoxicity, some osteogenic and osteoconductive properties, which has great potential as a carrier for local delivery of antibiotics. Vancomycin-loaded bone-like hydroxyapatite/poly(amino acid) was successfully fabricated by a homogeneous method using a diffusion control system. In this study, bone regeneration using this scaffold was observed both in vitro and in vivo. METHODS In vitro tests, MG63 cells were incubated with the vancomycin-loaded scaffold to observe its effects on the activation of osteoblasts. In vivo tests, the scaffolds were implanted into rabbit models of chronic osteomyelitis, including regular and methicillin-resistant Staphylococcus aureus. The effects were evaluated by gross observation, X-ray and histological observation. RESULTS After incubating with the scaffold, MG63 cells exhibited good proliferative activity, and increased calcium and alkaline phosphatase synthesis compared with blank control group. In vivo tests, the experimental group showed increased bone growth in infectious bone defects compared with the control groups, regardless of the type of Staphylococcus aureus. CONCLUSION Vancomycin-loaded bone-like hydroxyapatite/poly(amino acid) scaffold has good potential for the repair of infectious bone defects because of its ability to deliver antibiotics and promote bone regeneration.
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Affiliation(s)
- Zhidong Cao
- Department of Orthopedics, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China Department of Orthopedics, The Emergency Medical Center of Chongqing City, Chongqing, China
| | - Dianming Jiang
- Department of Orthopedics, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Ling Yan
- Department of Orthopedics, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Jun Wu
- Department of Orthopedics, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
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21
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Matos AC, Marques CF, Pinto RV, Ribeiro IA, Gonçalves LM, Vaz MA, Ferreira J, Almeida AJ, Bettencourt AF. Novel doped calcium phosphate-PMMA bone cement composites as levofloxacin delivery systems. Int J Pharm 2015; 490:200-8. [DOI: 10.1016/j.ijpharm.2015.05.038] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2015] [Revised: 05/12/2015] [Accepted: 05/13/2015] [Indexed: 11/26/2022]
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