Falling Leaves Inspired ZnO Nanorods-Nanoslices Hierarchical Structure for Implant Surface Modification with Two Stage Releasing Features

Review on Additives in Hydrogels for 3D Bioprinting of Regenerative Medicine: From Mechanism to Methodology

The regeneration of biological tissues in medicine is challenging, and 3D bioprinting offers an innovative way to create functional multicellular tissues. One common way in bioprinting is bioink, which is one type of the cell-loaded hydrogel. For clinical application, however, the bioprinting still suffers from satisfactory performance, e.g., in vascularization, effective antibacterial, immunomodulation, and regulation of collagen deposition. Many studies incorporated different bioactive materials into the 3D-printed scaffolds to optimize the bioprinting. Here, we reviewed a variety of additives added to the 3D bioprinting hydrogel. The underlying mechanisms and methodology for biological regeneration are important and will provide a useful basis for future research.

Current Advances and Applications of Tantalum Element in Infected Bone Defects

Infected bone defects (IBDs) cause significant economic and psychological burdens, posing a huge challenge to clinical orthopedic surgeons. Traditional approaches for managing IBDs possess inevitable shortcomings; therefore, it is necessary to develop new functionalized scaffolds. Tantalum (Ta) has been widely used in load-bearing orthopedic implants due to its good biocompatibility and corrosion resistance. However, undecorated Ta could only structurally repair common bone defects, which failed to meet the clinical needs of bacteriostasis for IBDs. Researchers have made great efforts to functionalize Ta scaffolds to enhance their antibacterial activity through various methods, including surface coating, alloying, and micro- and nanostructure modifications. Additionally, several studies have successfully utilized Ta to modify orthopedic scaffolds for enhanced antibacterial function. These studies remarkably extended the application range of Ta. Therefore, this review systematically outlines the advances in the fundamental and clinical application of Ta in the treatment of IBDs, focusing on the antibacterial properties of Ta, its functionalization for bacteriostasis, and its applications in the modification of orthopedic scaffolds. This study provides researchers with an overview of the application of Ta in the treatment of IBDs.

Fabrication, bacteriostasis and osteointegration properties researches of the additively-manufactured porous tantalum scaffolds loading vancomycin

Infected bone defects (IBDs) remains a challenging problem for orthopedists. Clinically, routine management for IBDs has two stages: debridement and systematic antibiotics administration to control infection, and secondary grafting to repair bone defects. Whereas the efficacy is not satisfactory, because the overuse of antibiotics may lead to systemic toxicity, and the emergence of drug-resistant bacteria, as well as the secondary surgery would cause additional trauma and economic burden to the patients. Therefore, it is imperative to develop a novel scaffold for one-stage repair of IBDs. In this study, vancomycin (Van) was encapsulated into poly(lactic co-glycolic acid) (PLGA) microspheres through the double emulsion method, which were then loaded into the additively-manufactured porous tantalum (AM-Ta) through gelatin methacryloyl (GelMA) hydrogel to produce the composite Ta/GelMA hydrogel (Gel)/PLGA/vancomycin(Van) scaffolds for repairing IBDs. Physiochemical characterization of the newly-developed scaffold indicated that the releasing duration of Van was over 2 weeks. Biological experiments indicated good biocompatibility of the composite scaffold, as well as bacteriostasis and osteointegration properties, which showed great potential for clinical application. The construction of this novel scaffold would provide new sight into the development of orthopaedic implants, shedding a novel light on the treatment of IBDs.

A review: strategies to reduce infection in tantalum and its derivative applied to implants

Implant-associated infection is the main reasons for implant failure. Titanium and titanium alloy are currently the most widely used implant materials. However, they have limited antibacterial performance. Therefore, enhancing the antibacterial ability of implants by surface modification technology has become a trend of research. Tantalum is a potential implant coating material with good biological properties. With the development of surface modification technology, tantalum coating becomes more functional through improvement. In addition to improving osseointegration, its antibacterial performance has also become the focus of attention. In this review, we provide an overview of the latest strategies to improve tantalum antibacterial properties. We demonstrate the potential of the clinical application of tantalum in reducing implant infections by stressing its advantageous properties.

Advances in Research on Titanium and Titanium Alloys with Antibacterial Functionality for Medical Use—A Review

Materials based on titanium and its alloys are widely used in the medical and dental fields because of their excellent physical properties such as hardness, ductility and elastic modulus, etc. However, because commonly used titanium alloy internal plants do not have antibacterial properties, when these implants are implanted into the human body, there is a certain risk of infection. Such infections are extremely painful for the patient and problematic for the attending physician. In the past, infections of implants were usually treated with systemic antibiotics in combination with thorough debridement or implant replacement. However, these are passive treatments and typically cause huge physical and economic burdens on the patient. Therefore, attempts towards the development of implants with antibacterial functionality have been increasing, with the combination of titanium alloys with antibiotics, antibacterialmetals, and antibacterial peptides being the main research direction. Therefore, this paper will discuss the latest research progress in the preparation of titanium alloys with antibacterial strategies such as combining antibiotics or antimicrobial peptides, adding antimicrobial metals, and the antibacterial properties and biocompatibility of proposed systems are summarised and discussed herein. This review should serve as a reference for further research on antibacterial titanium alloy implants.

Nanoparticles as Next-Generation Tooth-Whitening Agents: Progress and Perspectives

Whitening agents, such as hydrogen peroxide and carbamide peroxide, are currently used in clinical applications for dental esthetic and dental care. However, the free radicals generated by whitening agents cause pathological damage; therefore, their safety issues remain controversial. Furthermore, whitening agents are known to be unstable and short-lived. Since 2001, nanoparticles (NPs) have been researched for use in tooth whitening. Importantly, nanoparticles not only function as abrasives but also release reactive oxygen species and help remineralization. This review outlines the historical development of several NPs based on their whitening effects and side effects. NPs can be categorized into metals or metal oxides, ceramic particles, graphene oxide, and piezoelectric particles. Moreover, the status quo and future prospects are discussed, and recent progress in the development of NPs and their applications in various fields requiring tooth whitening is examined. This review promotes the research and development of next-generation NPs for use in tooth whitening.

Formation of a ZnO nanorods-patterned coating with strong bactericidal capability and quantitative evaluation of the contribution of nanorods-derived puncture and ROS-derived killing

To endow Ti-based orthopedic implants with strong bactericidal activity, a ZnO nanorods-patterned coating (namely ZNR) was fabricated on Ti utilizing a catalyst- and template-free method of micro-arc oxidation (MAO) and hydrothermal treatment (HT). The coating comprises an outer layer of ZnO nanorods and a partially crystallized inner layer with nanocrystalline TiO₂ and Zn₂TiO₄ embedded amorphous matrix containing Ti, O and Zn. During HT, Zn²⁺ ions contained in amorphous matrix of the as-MAOed layer migrate to surface and react with OH⁻ in hydrothermal solution to form ZnO nuclei growing in length at expense of the migrated Zn²⁺. ZNR exhibits intense bactericidal activity against the adhered and planktonic S. aureus in vitro and in vivo. The crucial contributors to kill the adhered bacteria are ZnO nanorods derived mechano-penetration and released reactive oxygen species (ROS). Within 30 min of S. aureus incubation, ROS is the predominant bactericidal contributor with quantitative contribution value of ∼20%, which transforms into mechano-penetration with prolonging time to reach quantitative contribution value of ∼96% at 24 h. In addition, the bactericidal contributor against the planktonic bacteria of ZNR is relied on the released Zn²⁺. This work discloses an in-depth bactericidal mechanism of ZnO nanorods.

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A templates and catalysts-free method is used to fabricate ZnO nanorods on Ti

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ZnO nanorods-arrayed coating shows intense broad-spectrum bactericidal activity

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Main bactericidal contributor of ZnO nanorods to adhered bacteria is mechano-puncture

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Main bactericidal contributor of ZnO nanorods to planktonic bacteria is released Zn²⁺

NanoZnO-modified titanium implants for enhanced anti-bacterial activity, osteogenesis and corrosion resistance

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.

Phosphonate/quaternary ammonium copolymers as high-efficiency antibacterial coating for metallic substrates

Designing a coating material with efficient bactericidal property to cope with bacterial associated infections is highly desirable for metallic implants and devices. Here, we report phosphonate/quaternary ammonium copolymers, p(DEMMP-co-TMAEMA), as the new type of metal anchorable high-efficiency antibacterial coating. Seven p(DEMMP-co-TMAEMA) polymers with varied cationic components were precisely prepared via random radical polymerization. Copolymers were constructed on titanium alloy (TC4) substrates based on strong covalent bonding between the phosphonate group and metallic substrates through a one-step process as evidenced by XPS and water contact angle tests. A robust relationship between the composition of the copolymers and the bactericidal ability endowed to TC4 substrates was established. Results showed that the copolymer, with the pDEMMP content even as low as 6.3%, was able to anchor onto TC4 substrates. With the increase of cationic pTMAEMA content from 4.0 to 93.7% in the coating copolymer, the bactericidal ability endowed to the TC4 substrates was steadily increased from 39.4 to 98.8% for S. aureus and from 70.0 to 99.4% for E. coli after 8 h's of contacting. All p(DEMMP-co-TMAEMA) coating on TC4 substrates showed limited cytotoxicity to C2C12 cells. Notably, the phosphonate/quaternary amine copolymers can be easily constructed on diverse biomedical metals such as titanium (Ti), stainless steel (SS), and Ni/Cr alloys with significantly increased antibacterial performance, demonstrating the potency of the copolymer as the general high-efficiency antibacterial coating for diverse bio-metals.

High special surface area and "warm light" responsive ZnO: Synthesis mechanism, application and optimization

In this study, a new series of zinc oxide (ZnO) with high specific surface area and narrow energy band gap are prepared using a facile microwave-induced method. The corresponding formation mechanism is also discussed for the first time. Due to the introduction of C, these ZnO can be excited by long wave temperature light without harmful short wave radiation, and play an efficient photocatalytic activity. This valuable property fundamentally improves the biological safety of its photocatalytic application. Herein, taking teeth whitening as an example, the photocatalytic performance of ZnO is evaluated. The “pure” yellow light-emitting diode (PYLED) with high biological safety is used as the excitation source. It is found that this method could effectively remove pigment on the tooth surface through physical adsorption. In addition, these ZnO could generate active oxygen to degrade the pigment on the tooth surface under the irradiation of yellow light. Some further optimization of these “warm light” responsive ZnO is also discussed in this systematical study, which could open up new opportunities in biomedical field.

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A series of ZnO (PZCs, ZnO-BC) with high specific surface area and low band gap were synthesized by simple microwave-induced synthesis.

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The introduction of C or BC can effectively reduce the band gap of ZnO.

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Long wavelength warm light can effectively stimulate the photocatalytic activity of PZCs and ZnO-BC.

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Under the yellow light, ZnO can effectively decompose the pigment on the tooth surface.

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Warm light whitening, from the light source and material two levels to reduce the stimulation of teeth, and no obvious damage to enamel.

The Clinical Application of Porous Tantalum and Its New Development for Bone Tissue Engineering

Porous tantalum (Ta) is a promising biomaterial and has been applied in orthopedics and dentistry for nearly two decades. The high porosity and interconnected pore structure of porous Ta promise fine bone ingrowth and new bone formation within the inner space, which further guarantee rapid osteointegration and bone-implant stability in the long term. Porous Ta has high wettability and surface energy that can facilitate adherence, proliferation and mineralization of osteoblasts. Meanwhile, the low elastic modulus and high friction coefficient of porous Ta allow it to effectively avoid the stress shield effect, minimize marginal bone loss and ensure primary stability. Accordingly, the satisfactory clinical application of porous Ta-based implants or prostheses is mainly derived from its excellent biological and mechanical properties. With the advent of additive manufacturing, personalized porous Ta-based implants or prostheses have shown their clinical value in the treatment of individual patients who need specially designed implants or prosthesis. In addition, many modification methods have been introduced to enhance the bioactivity and antibacterial property of porous Ta with promising in vitro and in vivo research results. In any case, choosing suitable patients is of great importance to guarantee surgical success after porous Ta insertion.

Hierarchically hybrid biocoatings on Ti implants for enhanced antibacterial activity and osteogenesis

Titanium (Ti) is widely applied as bone-anchoring implants in dental and orthopedic applications owing to its superior mechanical characteristics, high corrosion resistance, and excellent biocompatibility. Nevertheless, Ti-based implants with the deficiencies of insufficient osteoinduction and associated infections can result in implant failure, which significantly limits its applications in some cases. In this work, hierarchically hybrid biocoatings on Ti implants are developed by gradual incorporation of polydopamine (PDA), ZnO nanoparticles (nZnO), and chitosan (CS)/nanocrystal hydroxyapatite (nHA) via oxidative self-polymerization, nanoparticle deposition, solvent casting and evaporation methods for enhancing their antibacterial activity and osteogenesis. The modification of PDA on porous reticular Ti substrates greatly reduces the surface roughness, wettability, protein adsorption, and provides high adhesion to the deposited nZnO. Further, incorporating nZnO on PDA-coated Ti surfaces affects the surface structure and wettability, significantly inhibits the growth of both Staphylococcus aureus and Escherichia coli. Moreover, the CS/nHA-doped coating on the nZnO-modified Ti surfaces remarkably improves cytocompatibility and enhances the osteogenic differentiation of MC3T3-E1 cells by upregulating the protein expression of alkaline phosphatase. This work offers a promising alternative for developing Ti implants with long-lifetime bioactivity to achieve strong antibacterial ability and enhanced bone formation for potential dental/orthopedic applications.

Fabrication and Potential Applications of Highly Durable Superhydrophobic Polyethylene Terephthalate Fabrics Produced by In-Situ Zinc Oxide (ZnO) Nanowires Deposition and Polydimethylsiloxane (PDMS) Packaging

Considerable attention has been devoted to the in-situ deposition of zinc oxide (ZnO) nanowires (ZnO-NWs) on the surface of organic supports, due to their very wide applications in superhydrophobicity, UV shielding, and nanogenerators. However, the poor interfacial bond strength between ZnO-NWs and its support limits their applications. Herein, we developed a facile process to grow robust ZnO-NWs on a polyethylene terephthalate (PET) fabric surface through simultaneous radiation-induced graft polymerization, hydrothermal processing, and in-situ nano-packaging; the obtained materials were denoted as PDMS@ZnO-NWs@PET. The introduction of an adhesion and stress relief layer greatly improved the attachment of the ZnO-NWs to the support, especially when the material was subjected to extreme environment conditions of external friction forces, strong acidic or alkaline solutions, UV-irradiation and even washing with detergent for a long time. The PDMS@ZnO-NWs@PET material exhibited excellent UV resistance, superhydrophobicity, and durability. The ZnO-NWs retained on the fabric surface even after 30 cycles of accelerated washing. Therefore, this process can be widely applied as a universal approach to overcome the challenges associated with growing inorganic nanowires on polymeric support surfaces.

Tremella-Like ZnO@Col-I-Decorated Titanium Surfaces with Dual-Light-Defined Broad-Spectrum Antibacterial and Triple Osteogenic Properties

The growing population of peri-implant diseases (PIDs) has become a public obsession, mainly due to the lack of antibacterial ability and osteogenic promotion of titanium (Ti) implants. Herein, inspired by tremella, we reported zinc oxide (ZnO)@collagen type I (Col-I)-decorated Ti for PIDs treatments. Compared with pure Ti implants, ZnO@Col-I-decorated Ti could be activated by a safe visible yellow light and showed excellent broad-spectrum antibacterial properties. The proliferation and osteogenic gene expression of bone marrow mesenchymal stem cells (BMSCs) indicated that the triple osseointegration of implants was realized through (I) the remarkedly improved surface hydrophilicity of ZnO@Col-I-decorated Ti, (II) the function of Col-I, and (III) the excellent near-infrared (NIR)-induced photothermal performance of ZnO. Collectively, the proposed dual-light-defined ZnO@Col-I coating was a promising implant surface modification system to provide customized treatments for each PID patient.

ZnO@ZnS nanorod-array coated titanium: Good to fibroblasts but bad to bacteria

Cell-selective toxic titanium is highly desired in clinical dental practice. Herein, based on the in situ conversion of ZnO to ZnO@ZnS, nanorod-array structured coatings with a controllable release features of zinc (Zn), has been successfully fabricated by a two-step hydrothermal method to endow titanium surface with cell-selectivity, i.e. boosting the functions (attachment and migration) of human gingival fibroblasts (HGnFs) while acting against the invasion of pathogenic bacteria. The improved functions of HGnFs over the ZnO@ZnS nanorod-array were attributed to the material's optimized zinc release, which was decreased from an order of 3.5 mg L^-1 to about 0.3 mg L^-1 (within the first week). But more importantly, this concentration still had a high antibacterial efficacy up to 100% (against both the S. aureus and E. coli, 10⁷ CFU mL^-1). This study demonstrated that a ZnO@ZnS nanorod-array coating could be a promising strategy to endow titanium dental implants with improved soft tissue sealing and effectively reduce peri-implantitis.

Silver-Laden Black Phosphorus Nanosheets for an Efficient In Vivo Antimicrobial Application

Nanobactericides represent one of the most efficient and promising strategies for eliminating bacterial infection considering the increasing resistance threats of conventional antibiotics. Black phosphorus (BP) is the most exciting postgraphene layered 2D nanomaterial with convincing physiochemical properties, yet the study of BP-based antibiotics is still in its infancy. Here, a compact silver nanoparticle (AgNP)-doped black phosphorus nanosheet (BPN) is constructed to synergistically enhance solar disinfection through the promoted reactive oxygen species (ROS) photogeneration, which is attributed to the improved electron-hole separation and recombination of BPNs as revealed from the systematic experimental studies. An in-depth density functional theory (DFT) calculation confirms that the integrated AgNPs provide a preferred site for facilitating the adsorption and activation of O₂ , thus promoting the more efficient and robust ROS generation on BPN-AgNP nanohybrids. Besides the enhanced photoinduced ROS, the anchored AgNPs simultaneously lead to a dramatically increased affinity toward bacteria, which facilitates a synergetic pathogen inactivation. Significantly, the convincing antimicrobial BPN-AgNP contributes to the prominent wound healing and antimicrobial ability in vivo with minimized biological burden. This sophisticated design of new 2D nanohybrids opens a new avenue for further exploiting BP-based nanohybrids in portable bandage and broad-spectrum disinfection applications.

Antibacterial Properties of Bilayer Biomimetic Nano-ZnO for Dental Implants

Dental implant surgery has a relatively high incidence of peri-implantitis. In this research, ZnO nanorods and ZnO nanospheres were synthesized by a hydrothermal method. ZnO nanorods first covered the surface of Ti or Ti-Zr, and ZnO nanospheres were then modified as the outermost layer. By these means a dual antibacterial effect could be realized by the rapid release of ZnO nanospheres and the sustained release of ZnO nanorods. Subsequent studies implied that this ZnO nanorods-nanospheres hierarchical structure (NRS) could be stably loaded on the surface of roughened Ti and Ti-Zr slices. The modified materials not only showed excellent antibacterial activities against both Escherichia coli and Staphylococcus aureus but also showed low cellular cytotoxicity. This ZnO NRS structure is thus expected to be used as a general antimicrobial coating on the surface of Ti (Ti-Zr) in dental implant surgery.

Porous ZnO modified silk sutures with dual light defined antibacterial, healing promotion and controlled self-degradation capabilities

Current sutures have disadvantages such as poor antibacterial activities, low healing effects, and a lack of self-degradation ability.

3D printed zirconia ceramic hip joint with precise structure and broad-spectrum antibacterial properties

Background: Nowadays, zirconia ceramic implants are widely used as a kind of hip prosthesis material because of their excellent biocompatibility and long-term wear resistance. However, the hip joint is one of the major joints with complex 3D morphological structure and greatly individual differences, which usually causes great material waste during the process of surgical selection of prosthesis. Methods: In this paper, by combining ceramic 3D printing technology with antibacterial nano-modification, zirconia ceramic implant material was obtained with precise 3D structure and effective antibacterial properties. Among which, two technical problems (fragile and sintering induced irregular shrinkage) of 3D printed ceramics were effectively minimized by optimizing the reaction conditions and selective area inversing compensation. Through in vivo and in vitro experiments, it was confirmed that the as prepared hip prosthesis could precisely matched the corresponding parts, which also exhibited good biocompatibility and impressive antibacterial activities. Results: 1) Two inherent technical problems (fragile and sintering induced irregular shrinkage) of 3D printed ceramics were effectively minimized by optimizing the reaction conditions and selective area inversing compensation. 2) It could be seen that the surface of the ZrO2 material was covered with a layer of ZnO nano-particles. A universal testing machine was used to measure the tensile, bending and compression experiments of ceramic samples. It could be found that the proposed ZnO modification had no significant effect on the mechanical properties of ZrO2 ceramics. 3) According to the plate counting results, ceramics modified with ZnO exhibited significantly higher antibacterial efficiency than pure ZrO2 ceramics, the ZrO2-ZnO ceramics had a significant killing effect 8 hours. 4) The removed implants and the tissue surrounding the implant were subjected to HE staining. For ZrO2-ZnO ceramics, inflammation was slight, while for pure ZrO2 ceramics, the inflammatory response could be seen that the antibacterial rate of the ZrO2-ZnO ceramics was significantly better than that of the pure ZrO2 ceramics group. 5) It could be seen that the cytotoxicity did not increase proportionally with the increase of concentration, all of viability were still above 80%. This suggested that our materials were safe and could be applied as a type of potential biomaterial in the future. 6) Further animal studies demonstrated that the implant was in good position without dislocation. This resulted implied that the proposed method can achieve accurate 3D printing preparation of ceramic joints. In addition, the femurs and surrounding muscles around the implant were then sectioned and HE stained. Results of muscle tissue sections further showed no significant tissue abnormalities, and the growth of new bone tissue was observed in the sections of bone tissue. Conclusion: 1) The ceramic 3D printing technology combined with antibacterial nano-modification can quickly customize the ideal implant material with precise structure, wear-resistant and effective antibacterial properties. 2) Two inherent technical problems (fragile and sintering induced irregular shrinkage) of 3D printed ceramics were effectively minimized by optimizing the reaction conditions and selective area inversing compensation. 3) ZnO nano-materials were modified on the ceramic surface, which could effectively killing pathogenic bacteria.

ZnO and Hydroxyapatite-Modified Magnesium Implant with a Broad Spectrum of Antibacterial Properties and a Unique Minimally Invasive Defined Degrading Capability

ZnO and hydroxyapatite-based membranes have been proposed to improve the antibacterial properties and anticorrosion capabilities of the magnesium implant, simultaneously. More importantly, the concept of minimally invasive surgery has been introduced to define the degradation timing of the as-modified magnesium implant. With the aid of a Kirschner wire, the as-prepared membrane could immediately change from the "protective layer" to the "degradation accelerator" of the implant material. The subsequent studies have implied that this membrane could be a promising avenue to create a biocompatible and lightweight implant material with a valuable personal customized degradable timing capability.

Latex and a ZnO-based multi-functional material for cardiac implant-related inflammation

A new memory latex foam with ZnO modification was developed to reduce the incidence of both bacteria- and shaking-induced pocket inflammation.

ZnO Nanostructures for Drug Delivery and Theranostic Applications

In the last two decades, zinc oxide (ZnO) semiconductor Quantum dots (QDs) have been shown to have fantastic luminescent properties, which together with their low-cost, low-toxicity and biocompatibility have turned these nanomaterials into one of the main candidates for bio-imaging. The discovery of other desirable traits such as their ability to produce destructive reactive oxygen species (ROS), high catalytic efficiency, strong adsorption capability and high isoelectric point, also make them promising nanomaterials for therapeutic and diagnostic functions. Herein, we review the recent progress on the use of ZnO based nanoplatforms in drug delivery and theranostic in several diseases such as bacterial infection and cancer.

Unexpected insights into antibacterial activity of zinc oxide nanoparticles against methicillin resistant Staphylococcus aureus (MRSA)

Zinc oxide nanoparticles (ZnO-NPs) are attractive as broad-spectrum antibiotics, however, their further engineering as antimicrobial agents and clinical translation is impeded by controversial data about their mechanism of activity. It is commonly reported that ZnO-NP's antimicrobial activity is associated with the production of reactive oxygen species (ROS). Here we disprove this concept by comparing the antibacterial potency of ZnO-NPs and their capacity to generate ROS with hydrogen peroxide (H2O2). Then, using gene transcription microarray analysis, we provide evidence for a novel toxicity mechanism. Exposure to ZnO-NPs resulted in over three-log reduction in colonies of methicillin resistant S. aureus with minimal increase in ROS or lipid peroxidation. The amount of ROS required for the same amount of killing by H2O2 was much greater than that generated by ZnO-NPs. In contrast to H2O2, ZnO-NP mediated killing was not mitigated by the antioxidant, N-acetylcysteine. ZnO-NPs caused significant up-regulation of pyrimidine biosynthesis and carbohydrate degradation. Simultaneously, amino acid synthesis in S. aureus was significantly down-regulated indicating a complex mechanism of antimicrobial action involving multiple metabolic pathways. The results of this study point to the importance of specific experimental controls in the interpretation of antimicrobial mechanistic studies and the need for targeted molecular mechanism studies. Continued investigation on the antibacterial mechanisms of biomimetic ZnO-NPs is essential for future clinical translation.

Balancing Bacteria-Osteoblast Competition through Selective Physical Puncture and Biofunctionalization of ZnO/Polydopamine/Arginine-Glycine-Aspartic Acid-Cysteine Nanorods

Bacterial infection and lack of bone tissue integration are two major concerns of orthopedic implants. In addition, osteoinductivity often decreases and toxicity may arise when antibacterial agents are introduced to increase the antibacterial ability. Here hybrid ZnO/polydopamine (PDA)/arginine-glycine-aspartic acid-cysteine (RGDC) nanorod (NR) arrays are designed and prepared on titanium (Ti) implants to not only enhance the osteoinductivity but also effectively kill bacteria simultaneously, which are ascribed to the selective physical puncture and the biofunctionalization of ZnO/PDA/RGDC nanorods during the competition between bacteria and osteoblasts. That is, owing to the much larger size of osteoblasts than bacteria, the hybrid NRs can puncture bacteria but not damage osteoblasts. Meanwhile, the cytocompatibility can be enhanced through the suppression of both reactive oxygen species and higher Zn²⁺ concentration by the covering of PDA and RGDC. The in vitro results confirm the selective puncture of the bacterial membrane and the better osteoinductivity. In vivo tests also show much higher antibacterial efficacy of the hybrid NRs with far less amounts of lobulated neutrophils and adherent bacteria in the surrounding tissues. In addition, the hybrid NRs also accelerate formation of new bone tissues (20.1% higher than pure Ti) and osteointegration between implants and newly formed tissues (32.0% higher than pure Ti) even in the presence of injected bacteria. This work provides a surface strategy for designing implants with desirable ability of osseointegration and infection prevention simultaneously, which will exhibit tremendous clinical potential in orthopedic and dental applications.