Antibacterial and Cytocompatible Nanoengineered Silk-Based Materials for Orthopedic Implants and Tissue Engineering

Bioinspired Nanotopography for Combinatory Osseointegration and Antibacterial Therapy

The ongoing global health has highlighted the critical issue of secondary infections, particularly antibiotic-resistant bacterial infections, which have been significant contributors to mortality rates. Orthopedic implants, while essential for trauma and orthopedic surgeries, are particularly susceptible to these infections, leading to severe complications and economic burdens. The traditional use of antibiotics in treating these infections poses further challenges including the risk of developing antibiotic-resistant bacteria. This study introduces a novel approach to combat this issue by developing nanostructured surfaces for orthopedic implants using target ion-induced plasma sputtering. Inspired by the natural design of dragonfly wings, these surfaces aim to prevent bacterial adhesion while promoting preosteoblast activity, offering a dual-function solution to the problems of bacterial infection and implant integration without relying on antibiotics. The in vitro results demonstrate the effectiveness of these bioinspired surfaces in eradicating bacteria and supporting cell proliferation and differentiation, presenting a promising alternative for the development of biomedical implants.

Interdisciplinary-Inspired Smart Antibacterial Materials and Their Biomedical Applications

The discovery of antibiotics has saved millions of lives, but the emergence of antibiotic-resistant bacteria has become another problem in modern medicine. To avoid or reduce the overuse of antibiotics in antibacterial treatments, stimuli-responsive materials, pathogen-targeting nanoparticles, immunogenic nano-toxoids, and biomimetic materials are being developed to make sterilization better and smarter than conventional therapies. The common goal of smart antibacterial materials (SAMs) is to increase the antibiotic efficacy or function via an antibacterial mechanism different from that of antibiotics in order to increase the antibacterial and biological properties while reducing the risk of drug resistance. The research and development of SAMs are increasingly interdisciplinary because new designs require the knowledge of different fields and input/collaboration from scientists in different fields. A good understanding of energy conversion in materials, physiological characteristics in cells and bacteria, and bactericidal structures and components in nature are expected to promote the development of SAMs. In this review, the importance of multidisciplinary insights for SAMs is emphasized, and the latest advances in SAMs are categorized and discussed according to the pertinent disciplines including materials science, physiology, and biomimicry.

Diffusion-driven fabrication of calcium and phosphorous-doped zinc oxide heterostructures on titanium to achieve dual functions of osteogenesis and preventing bacterial infections

Conventional Ti-based implants are vulnerable to postsurgical infection and improving the antibacterial efficiency without compromising the osteogenic ability is one of the key issues in bone implant design. Although zinc oxide (ZnO) nanorods grown on Ti substrates hydrothermally can improve the antibacterial properties, but cannot meet the stringent requirements of bone implants, as rapid degradation of ZnO and uncontrolled leaching of Zn2+ are detrimental to peri-implant cells and tissues. To solve these problems, a lattice-damage-free method is adopted to modify the ZnO nanorods with thin calcium phosphate (CaP) shells. The Ca and P ions from the CaP shells diffuse thermally into the ZnO lattice to prevent the ZnO nanorods from rapid degradation and ensure the sustained release of Zn2+ ions as well. Furthermore, the designed heterostructural nanorods not only induce the osteogenic performances of MC3T3-E1 cells but also exhibit excellent antibacterial ability against S. aureus and E. coli bacteria via physical penetration. In vivo studies also reveal that hybrid Ti-ZnO@CaP5 can not only eradicates bacteria in contact, but also provides sufficient biocompatibility without causing excessive inflammation response. Our study provides insights into the design of multifunctional biomaterials for bone implants. STATEMENT OF SIGNIFICANCE: • A lattice-damage-free method is adopted to modify the ZnO nanorods with thin calcium phosphate (CaP) shells. • The dynamic process of Ca and P diffusion into the ZnO lattice is analyzed by experimental verification and theoretical calculation. • The degradation rate of ZnO nanorods is significantly decreased after CaP deposition. • The ZnO nanorods after CaP deposition can not only sterilize bacteria in contact via physical penetration, but also provide sufficient biocompatibility and osteogenic capability without causing excessive inflammation response..

Harmonizing Thickness and Permeability in Bone Tissue Engineering: A Novel Silk Fibroin Membrane Inspired by Spider Silk Dynamics

Guided bone regeneration gathers significant interest in the realm of bone tissue engineering; however, the interplay between membrane thickness and permeability continues to pose a challenge that can be addressed by the water-collecting mechanism of spider silk, where water droplets efficiently move from smooth filaments to rough conical nodules. Inspired by the natural design of spider silk, an innovative silk fibroin membrane is developed featuring directional fluid transportation via harmoniously integrating a smooth, dense layer with a rough, loose layer; conical microchannels are engineered in the smooth and compact layer. Consequently, double-layered membranes with cone-shaped microporous passageways (CSMP-DSF membrane) are designed for in situ bone repair. Through extensive in vitro testing, it is noted that the CSMP-DSF membrane guides liquid flow from the compact layer's surface to the loose layer, enabling rapid diffusion. Remarkably, the CSMP-DSF membrane demonstrates superior mechanical properties and resistance to bacterial adhesion. When applied in vivo, the CSMP-DSF membrane achieves results on par with the commercial Bio-Gide collagen membranes. This innovative integration of a cross-thickness wetting gradient structure offers a novel solution, harmonizing the often-conflicting requirements of material transport, mechanical strength, and barrier effectiveness, while also addressing issues related to tissue engineering scaffold perfusion.

Quantifiable Relationship Between Antibacterial Efficacy and Electro-Mechanical Intervention on Nanowire Arrays

Physical disruption is an important antibacterial means as it is lethal to bacteria without spurring antimicrobial resistance. However, it is very challenging to establish a quantifiable relationship between antibacterial efficacy and physical interactions such as mechanical and electrical forces. Herein, titanium nitride (TN) nanowires with adjustable orientations and capacitances are prepared to exert gradient electro-mechanical forces on bacteria. While vertical nanowires show the strongest mechanical force resulting in an antibacterial efficiency of 0.62 log reduction (vs 0.22 for tiled and 0.36 for inclined nanowires, respectively), the addition of electrical charges maximizes the electro-mechanical interactions and elevates the antibacterial efficacy to more than 3 log reduction. Biophysical and biochemical analyses indicate that electrostatic attraction by electrical charge narrows the interface. The electro-mechanical intervention more easily stiffens and rips the bacteria membrane, disturbing the electron balance and generating intracellular oxidative stress. The antibacterial ability is maintained in vivo and bacteria-challenged rats are protected from serious infection. The physical bacteria-killing process demonstrated here can be controlled by adjusting the electro-mechanical interactions. Overall, these results revealed important principles for rationally designing high-performance antibacterial interfaces for clinical applications.

A Review on Nano Ti-Based Oxides for Dark and Photocatalysis: From Photoinduced Processes to Bioimplant Applications

Catalysis on TiO₂ nanomaterials in the presence of H₂O and oxygen plays a crucial role in the advancement of many different fields, such as clean energy technologies, catalysis, disinfection, and bioimplants. Photocatalysis on TiO₂ nanomaterials is well-established and has advanced in the last decades in terms of the understanding of its underlying principles and improvement of its efficiency. Meanwhile, the increasing complexity of modern scientific challenges in disinfection and bioimplants requires a profound mechanistic understanding of both residual and dark catalysis. Here, an overview of the progress made in TiO₂ catalysis is given both in the presence and absence of light. It begins with the mechanisms involving reactive oxygen species (ROS) in TiO₂ photocatalysis. This is followed by improvements in their photocatalytic efficiency due to their nanomorphology and states by enhancing charge separation and increasing light harvesting. A subsection on black TiO₂ nanomaterials and their interesting properties and physics is also included. Progress in residual catalysis and dark catalysis on TiO₂ are then presented. Safety, microbicidal effect, and studies on Ti-oxides for bioimplants are also presented. Finally, conclusions and future perspectives in light of disinfection and bioimplant application are given.

Recent Progress on Bioinspired Antibacterial Surfaces for Biomedical Application

Surface bacterial fouling has become an urgent global challenge that calls for resilient solutions. Despite the effectiveness in combating bacterial invasion, antibiotics are susceptible to causing microbial antibiotic resistance that threatens human health and compromises the medication efficacy. In nature, many organisms have evolved a myriad of surfaces with specific physicochemical properties to combat bacteria in diverse environments, providing important inspirations for implementing bioinspired approaches. This review highlights representative natural antibacterial surfaces and discusses their corresponding mechanisms, including repelling adherent bacteria through tailoring surface wettability and mechanically killing bacteria via engineering surface textures. Following this, we present the recent progress in bioinspired active and passive antibacterial strategies. Finally, the biomedical applications and the prospects of these antibacterial surfaces are discussed.

Prodigiosin-Loaded Poly(lactic acid) to Combat the Biofilm-Associated Infections

Poly(lactic acid) (PLA) is an emerging biobased implant material. Despite its biocompatibility and the aseptic procedures followed during orthopedic surgery, bacterial infection remains an obstacle to implementing PLA-based implants. To tackle this issue, prodigiosin-incorporated PLA has been developed, which possesses improved hydrophobicity with a contact angle of 111 ± 1.5°. The degradation temperature of the prodigiosin is 215 °C, which is more than the melting temperature of PLA, which supports the processability and sterilization of the PLA-based implants without any toxic gases. Further, prodigiosin improves the transparency of PLA and acts as a nucleation site. The spherulite density increases three times compared to that of neat PLA. The inherent methoxy group of prodigiosin is an active site responsible for the inhibition of bacterial attack and biofilm formation. The in vitro study on biofilm formation shows excellent inhibition activity against implant-associated pathogens such as Klebsiella aerogenes and Staphylococcus aureus.

A Review on Antibacterial Silk Fibroin-based Biomaterials: Current State and Prospects

Bacterial contamination of biomaterials is a common problem and a serious threat to human health worldwide. Therefore, the development of multifunctional biomaterials that possess antibacterial properties and can resist infection is a continual goal for biomedical applications. Silk fibroin (SF), approved by U.S. Food and Drug Administration (FDA) as a biomaterial, is one of the most widely studied natural polymers for biomedical applications due to its unique mechanical properties, biocompatibility, tunable biodegradation, and versatile material formats. In the last decade, many methods have been employed for the development of antibacterial SF-based biomaterials (SFBs) such as physical loading or chemical functionalization of SFBs with different antibacterial agents and bio-inspired surface modifications. In this review, we first describe the current understanding of the composition and structure-properties relationship of SF as a leading-edge biomaterial. Then we demonstrate the different antibacterial agents and methods implemented for the development of bactericidal SFBs, their mechanisms of action, and different applications. We briefly address their fabrication methods, advantages, and limitations, and finally discuss the emerging technologies and future trends in this research area.

Surface Design for Antibacterial Materials: From Fundamentals to Advanced Strategies

Healthcare-acquired infections as well as increasing antimicrobial resistance have become an urgent global challenge, thus smart alternative solutions are needed to tackle bacterial infections. Antibacterial materials in biomedical applications and hospital hygiene have attracted great interest, in particular, the emergence of surface design strategies offer an effective alternative to antibiotics, thereby preventing the possible development of bacterial resistance. In this review, recent progress on advanced surface modifications to prevent bacterial infections are addressed comprehensively, starting with the key factors against bacterial adhesion, followed by varying strategies that can inhibit biofilm formation effectively. Furthermore, "super antibacterial systems" through pre-treatment defense and targeted bactericidal system, are proposed with increasing evidence of clinical potential. Finally, the advantages and future challenges of surface strategies to resist healthcare-associated infections are discussed, with promising prospects of developing novel antimicrobial materials.

UV/ozone irradiation manipulates immune response for antibacterial activity and bone regeneration on titanium

The immunomodulatory antibacterial activity and osteoimmunomodulatory properties of implantable biomaterials significantly influence bone regeneration. Various types of ultraviolet (UV) instrument are currently in use to greatly enhance the antibacterial activity and osteoconductive capability of titanium, it remains unclear how UV treatment modulates immune response. Compared to traditional UV treatment, the combination of low-dose ozone with UV irradiation is considered a new option to give benefits to surface modification and reduce the drawbacks of UV and ozone individually. Herein, the aim of this study was to elucidate the immune-modulatory properties of macrophages on UV/ozone-irradiated titanium that serve as defense against S. aureus and the crosstalk between immune cells and osteoblasts. Three different cell and bacteria co-culture systems were developed in order to investigate the race between host cells and bacteria to occupy the surface. In vitro immunological experiments indicated that UV/ozone irradiation significantly enhanced the phagocytic and bactericidal activity of macrophages against S. aureus. Further, in vitro and in vivo studies evidenced the favorable osteoimmune environment for osteogenic differentiation and bone formation. This research suggests vital therapeutic potential of UV/ozone irradiation for preventing the biomaterial-associated infections and achieving favorable bone formation simultaneously.

Enhanced corrosion resistance and reduced cytotoxicity of the AZ91 Mg alloy by plasma nitriding and a hierarchical structure composed of ciprofloxacin-loaded polymeric multilayers and calcium phosphate coating

Much effort has made to lessen the cytotoxicity and enhance the corrosion resistance of biodegradable magnesium alloys, for example, by depositing multilayered polymeric coatings containing hydroxyapatite. In this work, a hierarchical structure composed of ciprofloxacin (Cip)-loaded on polyacrylic acid (PAA) and poly (ethyleneimine) (PEI) as biocompatible polymeric multilayers and calcium phosphate coating as the top layer is formed by the sol-gel method on the AZ91 Mg alloy with an intermediate layer formed by nitrogen plasma immersion ion implantation. The thicknesses of the multilayered coating and nitrided layer (Mg₃ N₂ ) are 10 μm and 140 nm, respectively. The corrosion current density decreases by 95.6% and the corrosion potential in the polarization curve shifts to the positive direction by 23%. The passivation process which occurs at defects by deposition of corrosion products mitigates both galvanic and localized corrosion. Slight increase in the contact angle and surface free energy, enhanced corrosion resistance, and reduced cytotoxicity are observed from the multilayered structure. The better corrosion resistance enables better control of release of Cip. Biological assessment indicates that the antibacterial activity against Escherichia coli is improved by 100% after culturing for 24 hr and the cell viability and noncytotoxic behavior of the coated AZ91 are enhanced as well. The corrosion behavior and biological results suggest that the strategy of using a hierarchical structure composed of Cip-loaded polymeric multilayers in conjunction with an intermediate plasma nitrided layer has large potential in the development of biodegradable orthopedic implants made of Mg alloys.

Corrosion resistance, nano-mechanical properties, and biocompatibility of Mg-plasma-implanted and plasma-etched Ta/TaN hierarchical multilayered coatings on the nitrided AZ91 Mg alloy

A tantalum/tantalum nitride (Ta/TaN) multilayered coating is deposited on plasma-nitridedAZ91 Mg alloy. The top TaN layer undergoes O₂+ Ar plasma etching to improve the antibacterial properties and Mg plasma immersion ion implantation (MgPIII) is performed to enhance the biocompatibility and wound healing capability. A uniform, compact, homogeneous, and columnar nanostructured MgPIII and plasma-etched TaN layer with a cluster size of about 17 nm, surface roughness of 0.28 nm, and needle morphology is observed. Although, plasma etching increases the corrosion current density (i_corr) from 0.02 to 0.19 µA cm^-2due to larger surface roughness and different potentials between sharp points and smooth points, MgPIII decreasesi_corrfrom 0.19 to 0.02 µA cm^-2besides a more positive corrosion potential. The amounts of Mg⁺²released to the simulated body fluid (SBF) diminishes from 89.63 ± 0.54 to 60.30 ± 0.47 mg l^-1cm^-2indicating improved corrosion resistance. Under fever conditions (40 °C),i_corrdecreases by 63%, but the open circuit potential does not change due to the constant chemical composition of the surface as well as thicker double layer and less defects, as confirmed by the larger amount of Mg⁺²of 71.49 ± 0.22 mg l^-1cm^-2leached to the SBF. In the self-healing process which occurs via the reactions between the tantalum intermediate layer and electrolytes and penetrating ions through the defects as well as formation of oxide compounds, creation and propagation of defects are deterred as shown the 24 h destructive polarization test in SBF. The combination of plasma etching and MgPIII enhance not only the bacterial resistance and biocompatibility of the super-hard TaN layer by providing the rougher surface on TaN-P-Mg, but also the nano-mechanical properties and anticorrosion properties. As a result, the hardness increases by 7%, elastic modulus decreases by 19%, and the stiffness increases by 21%.

Tuning surface topographies on biomaterials to control bacterial infection

Microbial contamination and subsequent formation of biofilms frequently cause failure of surgical implants and a good understanding of the bacteria-surface interactions is vital to the design and safety of biomaterials. In this review, the physical and chemical factors that are involved in the various stages of implant-associated bacterial infection are described. In particular, topographical modification strategies that have been employed to mitigate bacterial adhesion via topographical mechanisms are summarized and discussed comprehensively. Recent advances have improved our understanding about bacteria-surface interactions and have enabled biomedical engineers and researchers to develop better and more effective antibacterial surfaces. The related interdisciplinary efforts are expected to continue in the quest for next-generation medical devices to attain the ultimate goal of improved clinical outcomes and reduced number of revision surgeries.

A Biomimetic Nano-Engineered Platform for Functional Tissue Engineering of Cartilage Superficial Zone

Articular cartilage has limited regeneration capacity because of its acellular and avascular nature. Although tissue engineering has been shown to be life-saving, reforming cartilage zones required by the appropriate tissue functions are challenging. Herein, the need is addressed by designing and producing a nano-engineered structure mimicking the superficial zone (SZ) of articular cartilage. The substrate is based on silk with good mechanical properties in conjunction with nano-topographical and biochemical cues. Nanopillar arrays are produced on the silk surface to regulate the stem cell morphology rendering them with a flattened ellipsoidal shape that is similar to that of chondrocytes in the SZ of natural cartilage. The cell interactions are enhanced by nitrogen ion implantation and the biomolecule, kartogenin (KGN), is loaded to promote chondrogenesis of the stem cells and furthermore, a thermosensitive chitosan hydrogel is formed on the nanopatterned silk to produce rheological properties similar to those of a synovial fluid. Based on the in vitro results and mechanical properties, it is a desirable implantable smart structure mimicking the cartilage SZ with the ability of continuous drug release for cartilage regeneration.

Enhanced corrosion resistance, antibacterial properties, and biocompatibility by hierarchical hydroxyapatite/ciprofloxacin-calcium phosphate coating on nitrided NiTi alloy

Multi-functional hierarchical coatings are deposited on the nitrided NiTi alloy. The nitrided layer is first deposited by nitrogen plasma immersion ion implantation and a middle layer containing porous hydroxyapatite and ciprofloxacin (Cip) is produced before the top calcium phosphate coating is deposited by the sol-gel method. The thicknesses of the coating and nitrided intermediate layer are about 1.54 μm and 160 nm, respectively and Cip penetrates to a depth of about 530 nm. Calcium phosphate reduces surface defects resulting in a surface roughness of 17 ± 2 nm compared to 34 ± 5 nm of the porous hydroxyapatite coating. The corrosion resistance is improved due to reduced defects and localized corrosion as manifested by the decrease in the Ni²⁺ release rate by 11.6% from 0.0198 to 0.0175 mg L^-1 cm^-2. The bacterial resistance against E. coli is also improved by about 88 times on account of Cip release and good biocompatibility is confirmed by proliferation of MC3T3 cells. This multi-functional hierarchical coating has large potential in orthopedic and dental applications.

Injectable in situ forming kartogenin-loaded chitosan hydrogel with tunable rheological properties for cartilage tissue engineering

Limited regeneration capacity of cartilage can be addressed by tissue engineering approaches including localized delivery of bioactive agents using biomaterials. Although chitosan hydrogels have been considered as appropriate candidates for these purposes, however, their poor mechanical properties limit their real applications. Here, we develop in situ forming chitosan hydrogels with enhanced shear modulus by chemical modification of chitosan using N-(β-maleimidopropyloxy) succinimide ester (BMPS). Moreover, we utilize β-Glycerophosphate (β-GP) in the hydrogels for achieving thermosensitivity. We investigate the effects of BMPS, β-GP and chitosan concentration on rheological and swelling properties of the hydrogels. Accordingly, we generate significant statistical models by response surface method to predict these properties. These models provide us beneficial tools to tune the hydrogel properties depending on the cartilage defect location and properties. Finally, we incorporate a recently discovered small biomolecule, kartogenin (KGN), for promoting chondrogenesis of stem cells into the optimized hydrogel. The hydrogel's shear modulus is 78 ± 5 kPa which covers a wide range of human articular cartilage shear modulus (50-250 kPa). It can be injected to the defects non-invasively at room temperature which gels at 37 °C within minutes. Additionally, it provides a sustained KGN release for ∼40 days that may eliminate the need of multiple injections. In vitro chondrogenic results confirm enhanced chondrogenic differentiation of human adipose mesenchymal stem cells (hAMSCs) treated with KGN-loaded hydrogel, compared to pure KGN. Based on the enhanced hydrogel shear modulus, injectability, gelation behavior, long-term drug release and in vitro results, this thermosensitive hydrogel looks promising for cartilage tissue engineering.

Micro- and Nanopatterned Silk Substrates for Antifouling Applications

A major problem of current biomedical implants is the bacterial colonization and subsequent biofilm formation, which seriously affects their functioning and can lead to serious post-surgical complications. Intensive efforts have been directed toward the development of novel technologies that can prevent bacterial colonization while requiring minimal antibiotics doses. To this end, biocompatible materials with intrinsic antifouling capabilities are in high demand. Silk fibroin, widely employed in biotechnology, represents an interesting candidate. Here, we employ a soft-lithography approach to realize micro- and nanostructured silk fibroin substrates, with different geometries. We show that patterned silk film substrates support mammal cells (HEK-293) adhesion and proliferation, and at the same time, they intrinsically display remarkable antifouling properties. We employ Escherichia coli as representative Gram-negative bacteria, and we observe an up to 66% decrease in the number of bacteria that adhere to patterned silk surfaces as compared to control, flat silk samples. The mechanism leading to the inhibition of biofilm formation critically depends on the microstructure geometry, involving both a steric and a hydrophobic effect. We also couple silk fibroin patterned films to a biocompatible, optically responsive organic semiconductor, and we verify that the antifouling properties are very well preserved. The technology described here is of interest for the next generation of biomedical implants, involving the use of materials with enhanced antibacterial capability, easy processability, high biocompatibility, and prompt availability for coupling with photoimaging and photodetection techniques.