Multifunctional, Low Friction, Antimicrobial Approach for Biomaterial Surface Enhancement

Comparing an Integrated Amphiphilic Surfactant to Traditional Hydrophilic Coatings for the Reduction of Catheter-Associated Urethral Microtrauma

Hydrophilic-coated intermittent catheters have improved the experience of intermittent urinary catheterization for patients compared to conventional gel-lubricated uncoated catheters. However, the incorporation of polyvinylpyrrolidone (PVP) within hydrophilic coatings can lead to significant issues with coating dry-out. Consequently, increased force on catheter withdrawal may cause complications, including urethral microtrauma and pain. Standard methods of evaluating catheter lubricity lack physiological relevance and an understanding of the surface interaction with the urethra. The tribological performance and urethral interaction of commercially available hydrophilic PVP-coated catheters and a coating-free integrated amphiphilic surfactant (IAS) catheter were evaluated by using a biomimetic urethral model designed from a modified coefficient of friction (CoF) assay. T24 human urothelial cells were cultured on customized silicone sheets as an alternate countersurface for CoF testing. Hydrophilic PVP-coated and coating-free IAS catheters were hydrated and the CoF obtained immediately following hydration, or after 2 min, mimicking in vivo indwell time for urine drainage. The model was observed for urethral epithelial cell damage postcatheterization. The majority of hydrophilic PVP-coated catheters caused significantly greater removal of cells from the monolayer after 2 min indwell time, compared to the IAS catheter. Hydrophilic PVP-coated catheters were shown to cause more cell damage than the coating-free IAS catheter. A biomimetic urethral model provides a more physiologically relevant model for understanding the factors that govern the frictional interface between a catheter surface and urethral tissue. From these findings, the use of coating-free IAS catheters instead of hydrophilic PVP-coated catheters may help reduce urethral microtrauma experienced during catheter withdrawal from the bladder, which may lead to a lower risk of infection.

Comparative Study on the Lubrication Mechanism and Performance of Two Representative Ionic and Nonionic Self-Adhesive Polymer Coatings

Surface modification of lubricating coatings on biomedical devices is a pivotal strategy to improve the overall performance and clinical efficacy, significantly reducing friction between devices and human tissues and mitigating tissue damage during intervention and long-term implantation. Recently, various hydrophilic polymeric materials have been used for achieving surface functionalization, endowing the biomedical device with excellent superlubrication performance. N-Vinylpyrrolidone (NVP) and 2-methacryloyloxyethyl phosphorylcholine (MPC) are two typical representatives of nonionic and zwitterionic materials. However, there is still a research gap in a comparative study of the lubrication mechanisms and properties between them. In this study, a bioinspired and dopamine-assisted codeposition technique was used to fabricate biomimetic hydrophilic coatings, including P(DMA-NVP) and P(DMA-MPC), on polyurethane. To achieve a thorough comparative analysis of the self-adhesive coating performance, 3 M ratios of the copolymers were synthesized and comprehensive material evaluations were conducted. Additionally, surface morphology, hydrophilicity, and lubrication at both the microscale and macroscale were performed. It was found that both hydrophilic coatings exhibited good stability. The P(DMA-MPC) coating, due to the ability to attract and bind a large number of water molecules, demonstrated superior lubrication effects compared to the P(DMA-NVP) coating. The study provides an in-depth understanding of the lubrication behavior of the self-adhesive coatings to enhance the functionality and application in biomedical engineering.

Tackling catheter-associated urinary tract infections with next-generation antimicrobial technologies

Urinary catheters and other medical devices associated with the urinary tract such as stents are major contributors to nosocomial urinary tract infections (UTIs) as they provide an access path for pathogens to enter the bladder. Considering that catheter-associated urinary tract infections (CAUTIs) account for approximately 75% of UTIs and that UTIs represent the most common type of healthcare-associated infections, novel anti-infective device technologies are urgently required. The rapid rise of antimicrobial resistance in the context of CAUTIs further highlights the importance of such preventative strategies. In this review, the risk factors for pathogen colonization in the urinary tract are dissected, taking into account the nature and mechanistics of this unique environment. Moreover, the most promising next-generation preventative strategies are critically assessed, focusing in particular on anti-infective surface coatings. Finally, emerging approaches in this field and their likely clinical impact are examined.

Comparison of Superhydrophilic, Liquid-Like, Liquid-Infused, and Superhydrophobic Surfaces in Preventing Catheter-Associated Urinary Tract Infection and Encrustation

Over the past decade, superhydrophilic zwitterionic surfaces, slippery liquid-infused porous surfaces, covalently attached liquid-like surfaces, and superhydrophobic surfaces have emerged as the most promising strategies to prevent biofouling on biomedical devices. Despite working through different mechanisms, they have demonstrated superior efficacy in preventing the adhesion of biomolecules (e.g., proteins and bacteria) compared with conventional material surfaces. However, their potential in combating catheter-associated urinary tract infection (CAUTI) remains uncertain. In this research, we present the fabrication of these four coatings for urinary catheters and conduct a comparative assessment of their antifouling properties through a stepwise approach. Notably, the superhydrophilic zwitterionic coating demonstrated the highest antifouling activity, reducing 72.3% of fibrinogen deposition and over 75% of bacterial adhesion (Escherichia coli and Staphylococcus aureus) when compared with an uncoated polyvinyl chloride (PVC) surface. The zwitterionic coating also exhibited robust repellence against blood and improved surface lubricity, decreasing the dynamic coefficient of friction from 0.63 to 0.35 as compared with the PVC surface. Despite the fact that the superhydrophilic zwitterionic and hydrophobic liquid-like surfaces showed great promise in retarding crystalline biofilm formation in the presence of Proteus mirabilis, it is worth noting that their long-term antifouling efficacy may be compromised by the proliferation and migration of colonized bacteria as they are unable to kill them or inhibit their swarming. These findings underscore both the potential and limitations of these ultralow fouling materials as urinary catheter coatings for preventing CAUTI.

Supplementation of Polymeric Reservoirs with Redox-Responsive Metallic Nanoparticles as a New Concept for the Smart Delivery of Insulin in Diabetes

Type 1 diabetes is caused by the inability of the pancreatic beta cells to produce sufficient amounts of insulin, an anabolic hormone promoting the absorption of the blood glucose by various cells in the body, primarily hepatocytes and skeletal muscle cells. This form of impaired metabolism has been traditionally treated with subcutaneous insulin injections. However, because one such method of administration does not directly correspond to the glucose concentrations in the blood and may fail to reduce hyperglycemia or cause hypoglycemia, the delivery of insulin in a glucose-dependent manner has been researched intensely in the present and past. This study tested the novel idea that the supplementation of polymeric reservoirs containing insulin with metallic nanoparticle precursors responsive to the redox effect of glucose could be used to create triggers for the release of insulin in direct response to the concentration of glucose in the tissue. For that purpose, manganese oxide nanoparticles were dispersed inside a poly(ε-caprolactone) matrix loaded with an insulin proxy and the resulting composite was exposed to different concentrations of glucose. The release of the insulin proxy occurred in direct proportion to the concentration of glucose in the medium. Mechanistically, as per the central hypothesis of the study, glucose reduced the manganese cations contained within the metal oxide phase, forming finer and more dissipative zero-valent metallic nanoparticles, thus disrupting the polymeric network, opening up pores in the matrix and facilitating the release of the captured drug. The choice of manganese for this study over other metals was justified by its use as a supplement for protection against diabetes. Numerical analysis of the release mechanism revealed an increasingly nonlinear and anomalous release accompanied by a higher diffusion rate at the expense of chain rigidity as the glucose concentration increased. Future studies should focus on rendering the glucose-controlled release (i) feasible within the physiological pH range and (ii) sensitive to physiologically relevant glucose concentrations. These technical improvements of the fundamental new concept proven here may bring it closer to a real-life application for the mitigation of symptoms of hyperglycemia in patients with diabetes.

Tetrasodium EDTA for the prevention of urinary catheter infections and blockages

Long-term catheterised individuals are at significant risk of developing catheter-associated urinary tract infections (CAUTIs), with up to 50% of patients experiencing recurrent episodes of catheter encrustation and blockage. Catheter blockage is a result of accumulation of carbonate apatite and struvite formed upon precipitation of ions within urine due to an infection-induced rise in pH. The aim of this study was to investigate the antimicrobial and anti-encrustation activities of tetrasodium ethylenediaminetetraacetic acid (tEDTA) to evaluate its potential efficacy in preventing CAUTIs and catheter blockages. The antimicrobial activity of tEDTA against uropathogens was assessed using time kill assays performed in artificial urine (AU). Crystallisation studies and in vitro bladder model assays were conducted to investigate the effect of tEDTA on struvite crystallisation and catheter blockage. tEDTA displayed bacteriostatic activity against Proteus mirabilis and prevented precipitation of ions in the AU. Crystallisation studies confirmed tEDTA inhibits struvite nucleation and growth via Mg²⁺ chelation with 7.63 mM tEDTA, equimolar to the concentration of divalent cations in AU, preventing the formation of crystalline deposits and blockage of Foley catheters for ≥168 h. The promising chelating abilities of low tEDTA concentrations could be exploited to inhibit encrustation and blockage of indwelling catheters. The fundamental research presented will inform our future development of an effective tEDTA-eluting catheter coating aimed at preventing catheter encrustation.

Bioinspired Self-Adhesive Lubricated Coating for the Surface Functionalization of Implanted Biomedical Devices

The lubrication property of implanted biomedical devices is of great significance as it affects the clinical performance owing to direct contact with soft tissues. In the present study, a bioinspired copolymer with dual functions of both self-adhesion and lubrication was synthesized with N-(3-aminopropyl) methacrylamide hydrochloride, gallic acid, and 3-[dimethyl-[2-(2-methylprop-2-enoyloxy) ethyl] azaniumyl] propane-1-sulfonate by free radical polymerization and a carbodiimide coupling reaction. The copolymer was further modified on the surface of poly(vinyl chloride) (PVC) samples using a simple dip-coating method and was characterized by different evaluations including Fourier transform infrared spectroscopy, the water contact angle, X-ray photoelectron spectroscopy, optical interferometry, and atomic force microscopy. Additionally, the results of a series of tribological tests at the microscopic level demonstrated that the friction coefficient of the copolymer-coated PVC samples was significantly reduced compared to that of the bare PVC samples. Furthermore, the pull out test at the macroscopic level was performed using copolymer-coated PVC catheters on a poly(dimethylsiloxane)-based test rig, and the result showed that the copolymer-coated PVC catheters were endowed with a greatly decreased and much more stable pull out force compared with that of the bare PVC catheters. In conclusion, the bioinspired self-adhesive lubricated coating developed herein may be applied as a universal and versatile method to enhance the lubrication performance of implanted biomedical devices.

A review of advances in tribology in 2020–2021

Around 1,000 peer-reviewed papers were selected from 3,450 articles published during 2020–2021, and reviewed as the representative advances in tribology research worldwide. The survey highlights the development in lubrication, wear and surface engineering, biotribology, high temperature tribology, and computational tribology, providing a show window of the achievements of recent fundamental and application researches in the field of tribology.

A Bioinspired Hydrogel-Elastomer Hybrid Surface for Enhanced Mechanical Properties and Lubrication

Developing surfaces that realize lubrication and durable wear resistance under high pressure has great implications in areas ranging from electromechanical systems to advanced biomedical devices but has proven challenging. Inspired by the zonal and transitional structure of articular cartilage, we fabricate a hydrogel-elastomer hybrid surface, where the hydrogel interpenetrates into the polymer elastomer substrate as a transitional and bonding zone, that exhibits a low coefficient of friction and wear resistance under a high load. First, we entrap benzophenone within the surface of polymer substrates such as polydimethylsiloxane, polyvinylchloride, and polyurethane. The hybrid surface is then achieved through initiating polymerization of the acrylamide monomer on the polymer surface upon ultraviolet irradiation. We observe an interpenetration area of the hydrogel and the polymer substrate. The hybrid surface shows a low coefficient of friction (∼0.05) under a very high load (over 100 atm contact pressure). It conserves the lubrication property over 100,000 cycles under a 10.9 MPa pressure and shows slight wear. This work brings a new perspective on designing surfaces with a lubrication property and wear resistance, showing broad applications.

Infection-Triggered, Self-Cleaning Surfaces with On-Demand Cleavage of Surface-Localized Surfactant Moieties

Biofouling of surfaces is a major cause of infection and leads to significant patient morbidity and mortality within healthcare settings. With ever-increasing concerns over antibiotic resistance and associated challenges in eradicating surface-attached biofilm communities, efficacious antifouling materials are urgently required. We herein describe the development of an inherently antiadherent polymer system with the capacity for on-demand cleavage of surface-localized surfactant moieties. The nonionic surfactant, Triton X-100, was linked to hydrogel monomers via hydrolytically labile ester bonds. Synthesized copolymers exhibited pH-dependent switching of surfactant release, with elution triggered under the alkaline conditions characteristic of catheter-associated urinary tract infections and subsequently slowed down as the pH decreased, representing eradication of infection. In addition, the materials demonstrated complete resistance to adherence of Staphylococcus aureus following 24 h incubation in infected artificial urine, with reductions in adherence of Proteus mirabilis of up to 89% also observed. This dual-pronged approach with active, infection-responsive cleavage of surfactant to enhance the antiadherent properties of the surfactant-modified surfaces represents a promising self-cleaning strategy without associated concerns over bacterial resistance.