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Li B, Thebault P, Labat B, Ladam G, Alt V, Rupp M, Brochausen C, Jantsch J, Ip M, Zhang N, Cheung WH, Leung SYS, Wong RMY. Implants coating strategies for antibacterial treatment in fracture and defect models: A systematic review of animal studies. J Orthop Translat 2024; 45:24-35. [PMID: 38495742 PMCID: PMC10943307 DOI: 10.1016/j.jot.2023.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 12/20/2023] [Accepted: 12/28/2023] [Indexed: 03/19/2024] Open
Abstract
Objective Fracture-related infection (FRI) remains a major concern in orthopaedic trauma. Functionalizing implants with antibacterial coatings are a promising strategy in mitigating FRI. Numerous implant coatings have been reported but the preventive and therapeutic effects vary. This systematic review aimed to provide a comprehensive overview of current implant coating strategies to prevent and treat FRI in animal fracture and bone defect models. Methods A literature search was performed in three databases: PubMed, Web of Science and Embase, with predetermined keywords and criteria up to 28 February 2023. Preclinical studies on implant coatings in animal fracture or defect models that assessed antibacterial and bone healing effects were included. Results A total of 14 studies were included in this systematic review, seven of which used fracture models and seven used defect models. Passive coatings with bacteria adhesion resistance were investigated in two studies. Active coatings with bactericidal effects were investigated in 12 studies, four of which used metal ions including Ag+ and Cu2+; five studies used antibiotics including chlorhexidine, tigecycline, vancomycin, and gentamicin sulfate; and the other three studies used natural antibacterial materials including chitosan, antimicrobial peptides, and lysostaphin. Overall, these implant coatings exhibited promising efficacy in antibacterial effects and bone formation. Conclusion Antibacterial coating strategies reduced bacterial infections in animal models and favored bone healing in vivo. Future studies of implant coatings should focus on optimal biocompatibility, antibacterial effects against multi-drug resistant bacteria and polymicrobial infections, and osseointegration and osteogenesis promotion especially in osteoporotic bone by constructing multi-functional coatings for FRI therapy. The translational potential of this paper The clinical treatment of FRI is complex and challenging. This review summarizes novel orthopaedic implant coating strategies applied to FRI in preclinical studies, and offers a perspective on the future development of orthopaedic implant coatings, which can potentially contribute to alternative strategies in clinical practice.
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Affiliation(s)
- Baoqi Li
- Department of Orthopaedics & Traumatology, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Pascal Thebault
- Univ Rouen Normandie, INSA Rouen Normandie, CNRS, Normandie Univ, PBS UMR 6270, F-76000, Rouen, France
| | - Béatrice Labat
- Univ Rouen Normandie, INSA Rouen Normandie, CNRS, Normandie Univ, PBS UMR 6270, F-76000, Rouen, France
| | - Guy Ladam
- Univ Rouen Normandie, INSA Rouen Normandie, CNRS, Normandie Univ, PBS UMR 6270, F-76000, Rouen, France
| | - Volker Alt
- Department of Trauma Surgery, University Hospital Regensburg, Germany
| | - Markus Rupp
- Department of Trauma Surgery, University Hospital Regensburg, Germany
| | | | - Jonathan Jantsch
- Institute for Medical Microbiology, Immunology, and Hygiene, and Center for Molecular Medicine Cologne (CMMC), University of Cologne, Cologne, Germany
| | - Margaret Ip
- Department of Microbiology, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Ning Zhang
- Department of Orthopaedics & Traumatology, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Wing-Hoi Cheung
- Department of Orthopaedics & Traumatology, The Chinese University of Hong Kong, Hong Kong SAR, China
| | | | - Ronald Man Yeung Wong
- Department of Orthopaedics & Traumatology, The Chinese University of Hong Kong, Hong Kong SAR, China
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Choi V, Rohn JL, Stoodley P, Carugo D, Stride E. Drug delivery strategies for antibiofilm therapy. Nat Rev Microbiol 2023; 21:555-572. [PMID: 37258686 DOI: 10.1038/s41579-023-00905-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/28/2023] [Indexed: 06/02/2023]
Abstract
Although new antibiofilm agents have been developed to prevent and eliminate pathogenic biofilms, their widespread clinical use is hindered by poor biocompatibility and bioavailability, unspecific interactions and insufficient local concentrations. The development of innovative drug delivery strategies can facilitate penetration of antimicrobials through biofilms, promote drug dispersal and synergistic bactericidal effects, and provide novel paradigms for clinical application. In this Review, we discuss the potential benefits of such emerging techniques for improving the clinical efficacy of antibiofilm agents, as well as highlighting the existing limitations and future prospects for these therapies in the clinic.
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Affiliation(s)
- Victor Choi
- Department of Engineering Science, Institute of Biomedical Engineering, University of Oxford, Oxford, UK
| | - Jennifer L Rohn
- Department of Renal Medicine, Centre for Urological Biology, Division of Medicine, University College London, London, UK
| | - Paul Stoodley
- Departments of Microbial Infection and Immunity, Microbiology and Orthopaedics, The Ohio State University, Columbus, OH, USA
- Department of Mechanical Engineering, National Centre for Advanced Tribology at Southampton (nCATS) and National Biofilm Innovation Centre (NBIC), University of Southampton, Southampton, UK
| | - Dario Carugo
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Eleanor Stride
- Department of Engineering Science, Institute of Biomedical Engineering, University of Oxford, Oxford, UK.
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK.
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Bandyopadhyay A, Mitra I, Goodman SB, Kumar M, Bose S. Improving Biocompatibility for Next Generation of Metallic Implants. PROGRESS IN MATERIALS SCIENCE 2023; 133:101053. [PMID: 36686623 PMCID: PMC9851385 DOI: 10.1016/j.pmatsci.2022.101053] [Citation(s) in RCA: 19] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
The increasing need for joint replacement surgeries, musculoskeletal repairs, and orthodontics worldwide prompts emerging technologies to evolve with healthcare's changing landscape. Metallic orthopaedic materials have a shared application history with the aerospace industry, making them only partly efficient in the biomedical domain. However, suitability of metallic materials in bone tissue replacements and regenerative therapies remains unchallenged due to their superior mechanical properties, eventhough they are not perfectly biocompatible. Therefore, exploring ways to improve biocompatibility is the most critical step toward designing the next generation of metallic biomaterials. This review discusses methods of improving biocompatibility of metals used in biomedical devices using surface modification, bulk modification, and incorporation of biologics. Our investigation spans multiple length scales, from bulk metals to the effect of microporosities, surface nanoarchitecture, and biomolecules such as DNA incorporation for enhanced biological response in metallic materials. We examine recent technologies such as 3D printing in alloy design and storing surface charge on nanoarchitecture surfaces, metal-on-metal, and ceramic-on-metal coatings to present a coherent and comprehensive understanding of the subject. Finally, we consider the advantages and challenges of metallic biomaterials and identify future directions.
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Affiliation(s)
- Amit Bandyopadhyay
- W. M. Keck Biomedical Materials Research Laboratory, School of Mechanical and Materials Engineering, Washington State University, Pullman, WA 99164-2920
| | - Indranath Mitra
- W. M. Keck Biomedical Materials Research Laboratory, School of Mechanical and Materials Engineering, Washington State University, Pullman, WA 99164-2920
| | - Stuart B. Goodman
- Department of Orthopedic Surgery, Stanford University Medical Center, Redwood City, CA 94063
| | | | - Susmita Bose
- W. M. Keck Biomedical Materials Research Laboratory, School of Mechanical and Materials Engineering, Washington State University, Pullman, WA 99164-2920
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4
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Duda-Chodak A, Tarko T, Petka-Poniatowska K. Antimicrobial Compounds in Food Packaging. Int J Mol Sci 2023; 24:ijms24032457. [PMID: 36768788 PMCID: PMC9917197 DOI: 10.3390/ijms24032457] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Revised: 01/22/2023] [Accepted: 01/25/2023] [Indexed: 01/31/2023] Open
Abstract
This review presents current knowledge on antimicrobial agents that are already used in the food packaging industry. At the beginning, innovative ways of food packaging were discussed, including how smart packaging differs from active packaging, and what functions they perform. Next, the focus was on one of the groups of bioactive components that are used in these packaging, namely antimicrobial agents. Among the antimicrobial agents, we selected those that have already been used in packaging and that promise to be used elsewhere, e.g., in the production of antimicrobial biomaterials. Main groups of antimicrobial agents (i.e., metals and metal oxides, organic acids, antimicrobial peptides and bacteriocins, antimicrobial agents of plant origin, enzymes, lactoferrin, chitosan, allyl isothiocyanate, the reuterin system and bacteriophages) that are incorporated or combined with various types of packaging materials to extend the shelf life of food are described. The further development of perspectives and setting of new research directions were also presented.
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Affiliation(s)
- Aleksandra Duda-Chodak
- Department of Fermentation Technology and Microbiology, Faculty of Food Technology, University of Agriculture in Krakow, ul. Balicka 122, 30-149 Kraków, Poland
- Correspondence: ; Tel.: +48-12-662-4792
| | - Tomasz Tarko
- Department of Fermentation Technology and Microbiology, Faculty of Food Technology, University of Agriculture in Krakow, ul. Balicka 122, 30-149 Kraków, Poland
| | - Katarzyna Petka-Poniatowska
- Department of Plant Products Technology and Nutrition Hygiene, Faculty of Food Technology, University of Agriculture in Krakow, ul. Balicka 122, 30-149 Kraków, Poland
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Samuel MS, Moghaddam ST, Shang M, Niu J. A Flexible Anti-Biofilm Hygiene Coating for Water Devices. ACS APPLIED BIO MATERIALS 2022; 5:3991-3998. [PMID: 35912797 DOI: 10.1021/acsabm.2c00538] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Biofilm is a microbiome complex comprising different bacterial colonies that typically adhere to device surfaces in water, which causes serious medical issues such as indwelling infections and outbreaks. Here, we developed a non-nanoparticle, flexible anti-biofilm hygiene coating consisting of lithocholic acid (LCA), zinc pyrithione (Zn), and cinnamaldehyde (Cn) (named as LCA-Zn-Cn) that largely prevents the bacteria adhesion to various water device surfaces such as stainless steel and glass through a synergistic mechanism. The existing chelated groups on LCA and Cn attract plenty of bacteria via hydrophobic interaction. Both the bactericidal reaction by grafting biocidal groups from both LCA and Cn and the bacteriostatic reaction by inhibiting cell division via zinc ions (Zn) lead to a largely improved bacteria/biofilm prevention. The antibacterial performance was assessed by using the JIS Z 2801/ISO 22196 method. The designed LCA-Zn-Cn coating displayed log10 reduction of 4.23 (99.9% reduction) of E. coli and log10 reduction of 3.51 (99.8% reduction) of E. faecalis on stainless steel, which are much higher than the control samples, demonstrating a promising colonization inhibition. In parallel, the polysulfone encapsulated beads also showed >99% reduction efficiency in batch and >97-98% reduction efficiency in continuous column tests using the Lake Michigan water. Due to the strong cross-linked configuration, the coating still showed >90.9% bacterial reduction after 3000 abrasion cycles and over 99.9% bacteria reduction after a high flow velocity of 1.99 m/s test, which confirmed the enhanced mechanical durability. By applying either spray or dip-coating, the designed polymer composite can be coated on a variety of irregular water devices with mass production using an auto-controlled robot arm.
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Affiliation(s)
- Melvin S Samuel
- Department of Materials Science and Engineering, CEAS, University of Wisconsin-Milwaukee, Milwaukee, Wisconsin 53211, United States
| | - Sahebeh Tamaddoni Moghaddam
- Department of Materials Science and Engineering, CEAS, University of Wisconsin-Milwaukee, Milwaukee, Wisconsin 53211, United States
| | - Mingwei Shang
- Department of Materials Science and Engineering, CEAS, University of Wisconsin-Milwaukee, Milwaukee, Wisconsin 53211, United States
| | - Junjie Niu
- Department of Materials Science and Engineering, CEAS, University of Wisconsin-Milwaukee, Milwaukee, Wisconsin 53211, United States
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6
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Chen Y, An Q, Teng K, Zhang Y, Zhao Y. Latest development and versatile applications of highly integrating drug delivery patch. Eur Polym J 2022. [DOI: 10.1016/j.eurpolymj.2022.111164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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7
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Lex JR, Koucheki R, Stavropoulos NA, Michele JD, Toor JS, Tsoi K, Ferguson PC, Turcotte RE, Papagelopoulos PJ. Megaprosthesis anti-bacterial coatings: A comprehensive translational review. Acta Biomater 2022; 140:136-148. [PMID: 34879295 DOI: 10.1016/j.actbio.2021.11.045] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Revised: 11/29/2021] [Accepted: 11/30/2021] [Indexed: 12/15/2022]
Abstract
Periprosthetic joint infections (PJI) are catastrophic complications for patients with implanted megaprostheses and pose significant challenges in the management of orthopaedic oncology patients. Despite various preventative strategies, with the increasing rate of implanted orthopaedic prostheses, the number of PJIs may be increasing. PJIs are associated with a high rate of amputation. Therefore, novel strategies to combat bacterial colonization and biofilm formation are required. A promising strategy is the utilization of anti-bacterial coatings on megaprosthetic implants. In this translational review, a brief overview of the mechanism of bacterial colonization of implants and biofilm formation will be provided, followed by a discussion and classification of major anti-bacterial coatings currently in use and development. In addition, current in vitro outcomes, clinical significance, economic importance, evolutionary perspectives, and future directions of anti-bacterial coatings will also be discussed. Megaprosthetic anti-bacterial coating strategies will help reduce infection rates following the implantation of megaprostheses and would positively impact sarcoma care. STATEMENT OF SIGNIFICANCE: This review highlights the clinical challenges and a multitude of potential solutions to combating peri-prosthetic join infections in megaprotheses using anti-bacterial coatings. Reducing infection rates following the implantation of megaprostheses would have a major impact on sarcoma care and major trauma surgeries that require reconstruction of large skeletal defects.
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Affiliation(s)
- Johnathan R Lex
- Division of Orthopaedic Surgery, Department of Surgery, University of Toronto, Toronto, Canada
| | - Robert Koucheki
- Temerty Faculty of Medicine, University of Toronto, Toronto, Canada; Institute of Biomedical Engineering, University of Toronto, Toronto, Canada
| | | | - Joseph Di Michele
- Division of Orthopaedic Surgery, Department of Surgery, University of Toronto, Toronto, Canada
| | - Jay S Toor
- Division of Orthopaedic Surgery, Department of Surgery, University of Toronto, Toronto, Canada
| | - Kim Tsoi
- Division of Orthopaedic Surgery, Department of Surgery, University of Toronto, Toronto, Canada; Institute of Biomedical Engineering, University of Toronto, Toronto, Canada; University Musculoskeletal Oncology Unit, Mount Sinai Hospital, Toronto, Canada
| | - Peter C Ferguson
- Division of Orthopaedic Surgery, Department of Surgery, University of Toronto, Toronto, Canada; University Musculoskeletal Oncology Unit, Mount Sinai Hospital, Toronto, Canada
| | - Robert E Turcotte
- Division of Orthopedic Surgery, McGill University Health Centre, Montreal, Canada
| | - Panayiotis J Papagelopoulos
- 1st Department of Orthopaedic Surgery, School of Medicine, National and Kapodistrian University of Athens, Greece
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8
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Thorn CR, Howell PL, Wozniak DJ, Prestidge CA, Thomas N. Enhancing the therapeutic use of biofilm-dispersing enzymes with smart drug delivery systems. Adv Drug Deliv Rev 2021; 179:113916. [PMID: 34371086 DOI: 10.1016/j.addr.2021.113916] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 07/27/2021] [Accepted: 08/02/2021] [Indexed: 12/18/2022]
Abstract
Biofilm-dispersing enzymes degrade the extracellular polymeric matrix surrounding bacterial biofilms, disperse the microbial community and increase their susceptibility to antibiotics and immune cells. Challenges for the clinical translation of biofilm-dispersing enzymes involve their susceptibility to denaturation, degradation, and clearance upon administration in vivo. Drug delivery systems aim to overcome these limitations through encapsulation, stabilization and protection from the exterior environment, thereby maintaining the enzymatic activity. Smart drug delivery systems offer target specificity, releasing payloads at the site of infection while minimizing unnecessary systemic exposure. This review highlights critical advances of biofilm-dispersing enzymes as a novel therapeutic approach for biofilm-associated infections. We explore how smart, bio-responsive delivery systems overcome the limiting factors of biofilm-dispersing enzymes and summarize the key systems designed. This review will guide future developments, focusing on utilizing selective and specific therapies in a targeted fashion to meet the unmet therapeutic needs of biofilm infections.
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Affiliation(s)
- Chelsea R Thorn
- University of South Australia, Clinical and Health Sciences, North Tce, Adelaide, SA 5000, Australia; The Basil Hetzel Institute for Translational Health Research, Woodville, SA 5011, Australia; ARC Centre for Excellence in Bio-Nano Science and Technology, Adelaide, SA 5000, Australia; Biofilm Test Facility, Cancer Research Institute, University of South Australia, North Tce, Adelaide, SA 5000, Australia
| | - P Lynne Howell
- Program in Molecular Medicine, The Hospital for Sick Children, Toronto, ON M5G 1X8, Canada; Department of Biochemistry, University of Toronto, Toronto, ON M5S 1A8, Canada
| | - Daniel J Wozniak
- Departments of Microbial Infection and Immunity, Ohio State University, Columbus, OH 43210, USA
| | - Clive A Prestidge
- University of South Australia, Clinical and Health Sciences, North Tce, Adelaide, SA 5000, Australia; ARC Centre for Excellence in Bio-Nano Science and Technology, Adelaide, SA 5000, Australia
| | - Nicky Thomas
- University of South Australia, Clinical and Health Sciences, North Tce, Adelaide, SA 5000, Australia; The Basil Hetzel Institute for Translational Health Research, Woodville, SA 5011, Australia; ARC Centre for Excellence in Bio-Nano Science and Technology, Adelaide, SA 5000, Australia; Biofilm Test Facility, Cancer Research Institute, University of South Australia, North Tce, Adelaide, SA 5000, Australia.
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9
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Liu Z, Zhao Z, Zeng K, Xia Y, Xu W, Wang R, Guo J, Xie H. Functional Immobilization of a Biofilm-Releasing Glycoside Hydrolase Dispersin B on Magnetic Nanoparticles. Appl Biochem Biotechnol 2021; 194:737-747. [PMID: 34524634 DOI: 10.1007/s12010-021-03673-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Accepted: 09/08/2021] [Indexed: 11/26/2022]
Abstract
Dispersin B (DspB) is a member of glycoside hydrolase family 20 (GH20) and catalyzes degradation of biofilms forming by pathogenic bacteria such as Staphylococcus aureus. Magnetoreceptor (MagR) is a magnetic protein that can be used as a fusion partner for functionally immobilizing proteins on magnetic surfaces. In the present study, a recombinant protein DspB-MagR was constructed by fusing MagR to the C-terminus of DspB and expressed in Escherichia coli. Magnetic immobilization of purified DspB-MagR on magnetic core-shell structured Fe3O4@SiO2 nanoparticles was achieved and characterized by means of various techniques including SDS-PAGE, Fourier transform infrared spectroscopy, thermogravimetric analysis, zeta potential measurement, and scanning electron microscopy. It was evaluated the influence of temperature, pH, and storage time on the performance of immobilized DspB-MagR on Fe3O4@SiO2 nanoparticles. Removal of biofilms forming by Staphylococcus aureus and other medical sourced bacterial species was achieved by using Fe3O4@SiO2 nanoparticles loading with DspB-MagR. This work promoted potential applications of DspB and similar enzymes for medical purposes.
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Affiliation(s)
- Zewen Liu
- School of Chemistry, Chemical Engineering, and Life Science, Wuhan University of Technology, Wuhan, 430070, China
| | - Zisong Zhao
- School of Chemistry, Chemical Engineering, and Life Science, Wuhan University of Technology, Wuhan, 430070, China
| | - Kai Zeng
- School of Chemistry, Chemical Engineering, and Life Science, Wuhan University of Technology, Wuhan, 430070, China
| | - Yue Xia
- School of Chemistry, Chemical Engineering, and Life Science, Wuhan University of Technology, Wuhan, 430070, China
| | - Weihua Xu
- Department of Orthopaetics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Ruoyu Wang
- Department of Orthopaetics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Junhui Guo
- School of Chemistry, Chemical Engineering, and Life Science, Wuhan University of Technology, Wuhan, 430070, China.
| | - Hao Xie
- School of Chemistry, Chemical Engineering, and Life Science, Wuhan University of Technology, Wuhan, 430070, China.
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10
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Li P, Gao Z, Tan Z, Xiao J, Wei L, Chen Y. New developments in anti-biofilm intervention towards effective management of orthopedic device related infections (ODRI's). BIOFOULING 2021; 37:1-35. [PMID: 33618584 DOI: 10.1080/08927014.2020.1869725] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/23/2020] [Revised: 12/15/2020] [Accepted: 12/20/2020] [Indexed: 06/12/2023]
Abstract
Orthopedic device related infections (ODRI's) represent a difficult to treat situation owing to their biofilm based nature. Biofilm infections once established are difficult to eradicate even with an aggressive treatment regimen due to their recalcitrance towards antibiotics and immune attack. The involvement of antibiotic resistant pathogens as the etiological agent further worsens the overall clinical picture, pressing on the need to look into alternative treatment strategies. The present review highlightes the microbiological challenges associated with treatment of ODRI's due to biofilm formation on the implant surface. Further, it details the newer anti-infective modalities that work either by preventing biofilm formation and/or through effective disruption of the mature biofilms formed on the medical implant. The study, therefore aims to provide a comprehensive insight into the newer anti-biofilm interventions (non-antibiotic approaches) and a better understanding of their mechanism of action essential for improved management of orthopedic implant infections.
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Affiliation(s)
- Ping Li
- Department of Orthopedics, Ya'an People's Hospital, Yaan City, China
| | - Zhenwu Gao
- Department of Orthopedics, Shanxi Bethune Hospital, Taiyuan City, China
| | - Zhenwei Tan
- Department of Orthopedics, Western Theater Air Force Hospital of PLA, Chengdu, China
| | - Jun Xiao
- Department of Orthopedics, Ya'an People's Hospital, Yaan City, China
| | - Li Wei
- Nursing Department, Three Gorges Hospital Affiliated to Chongqing University, Chongqing, China
| | - Yirui Chen
- Department of Orthopedics, Three Gorges Hospital Affiliated to Chongqing University, Chongqing, China
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11
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Ricardo SIC, Anjos IIL, Monge N, Faustino CMC, Ribeiro IAC. A Glance at Antimicrobial Strategies to Prevent Catheter-Associated Medical Infections. ACS Infect Dis 2020; 6:3109-3130. [PMID: 33245664 DOI: 10.1021/acsinfecdis.0c00526] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Urinary and intravascular catheters are two of the most used invasive medical devices; however, microbial colonization of catheter surfaces is responsible for most healthcare-associated infections (HAIs). Several antimicrobial-coated catheters are available, but recurrent antibiotic therapy can decrease their potential activity against resistant bacterial strains. The aim of this Review is to question the actual effectiveness of currently used (coated) catheters and describe the progress and promise of alternative antimicrobial coatings. Different strategies have been reviewed with the common goal of preventing biofilm formation on catheters, including release-based approaches using antibiotics, antiseptics, nitric oxide, 5-fluorouracil, and silver as well as contact-killing approaches employing quaternary ammonium compounds, chitosan, antimicrobial peptides, and enzymes. All of these strategies have given proof of antimicrobial efficacy by modifying the physiology of pathogens or disrupting their structural integrity. The aim for synergistic approaches using multitarget processes and the combination of both antifouling and bactericidal properties holds potential for the near future. Despite intensive research in biofilm preventive strategies, laboratorial studies still present some limitations since experimental conditions usually are not the same and also differ from biological conditions encountered when the catheter is inserted in the human body. Consequently, in most cases, the efficacy data obtained from in vitro studies is not properly reflected in the clinical setting. Thus, further well-designed clinical trials and additional cytotoxicity studies are needed to prove the efficacy and safety of the developed antimicrobial strategies in the prevention of biofilm formation at catheter surfaces.
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Affiliation(s)
- Susana I. C. Ricardo
- Faculty of Pharmacy, Universidade de Lisboa, Avenida Prof. Gama Pinto, 1649-003 Lisboa, Portugal
| | - Inês I. L. Anjos
- Research Institute for Medicines (iMed.ULisboa), Faculty of Pharmacy, Universidade de Lisboa, Avenida Prof. Gama Pinto, 1649-003 Lisboa, Portugal
| | - Nuno Monge
- Centro Interdisciplinar de Estudos Educacionais (CIED), Escola Superior de Educação de Lisboa, Instituto Politécnico de Lisboa, Campus de Benfica do IPL, 1549-003 Lisboa, Portugal
| | - Célia M. C. Faustino
- Faculty of Pharmacy, Universidade de Lisboa, Avenida Prof. Gama Pinto, 1649-003 Lisboa, Portugal
- Research Institute for Medicines (iMed.ULisboa), Faculty of Pharmacy, Universidade de Lisboa, Avenida Prof. Gama Pinto, 1649-003 Lisboa, Portugal
| | - Isabel A. C. Ribeiro
- Faculty of Pharmacy, Universidade de Lisboa, Avenida Prof. Gama Pinto, 1649-003 Lisboa, Portugal
- Research Institute for Medicines (iMed.ULisboa), Faculty of Pharmacy, Universidade de Lisboa, Avenida Prof. Gama Pinto, 1649-003 Lisboa, Portugal
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Baidamshina DR, Koroleva VA, Trizna EY, Pankova SM, Agafonova MN, Chirkova MN, Vasileva OS, Akhmetov N, Shubina VV, Porfiryev AG, Semenova EV, Sachenkov OA, Bogachev MI, Artyukhov VG, Baltina TV, Holyavka MG, Kayumov AR. Anti-biofilm and wound-healing activity of chitosan-immobilized Ficin. Int J Biol Macromol 2020; 164:4205-4217. [DOI: 10.1016/j.ijbiomac.2020.09.030] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Revised: 09/01/2020] [Accepted: 09/03/2020] [Indexed: 01/08/2023]
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13
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Van der Gucht M, Aktan MK, Hendrix H, Velde GV, Paeshuyse J, Braem A, Lavigne R. qDNase assay: A quantitative method for real-time assessment of DNase activity on coated surfaces. Biochem Biophys Res Commun 2020; 534:1003-1006. [PMID: 33121680 DOI: 10.1016/j.bbrc.2020.10.050] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Accepted: 10/17/2020] [Indexed: 11/17/2022]
Abstract
DNase coatings show great potential to prevent biofilm formation in various applications of the medical implant, food and marine industry. However, straightforward and quantitative methods to characterize the enzymatic activity of these coatings are currently not available. We here introduce the qDNase assay, a quantitative, real-time method to characterize the activity of DNase coatings. The assay combines (1) the use of an oligonucleotide probe, which fluoresces upon cleavage by coated DNases, and (2) the continuous read-out of the fluorescent signal within a microplate fluorometer format. The combination of these two properties results in a real-time fluorescent signal that is used to directly quantify the activity of DNase coatings. As a proof of concept, bovine DNase I coatings were immobilized on titanium by means of chemical grafting and their activity was estimated at 3.87 × 10-4 U. To our knowledge, the qDNase assay provides the first approach to report the activity of a DNase coating in absolute DNase activity units. This assay will not only serve to compare existing DNase coating methods more accurately, but will also enable the rational design of new DNase coating methods in the future.
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Affiliation(s)
- Marie Van der Gucht
- KU Leuven, Department of Biosystems, Laboratory of Gene Technology, Kasteelpark Arenberg 21 - box 2462, B-3001, Leuven, Belgium
| | - Merve Kübra Aktan
- KU Leuven, Department of Materials Engineering (MTM), Biomaterials and Tissue Engineering Research Group, Kasteelpark Arenberg 44 - box 2450, B-3001, Leuven, Belgium
| | - Hanne Hendrix
- KU Leuven, Department of Biosystems, Laboratory of Gene Technology, Kasteelpark Arenberg 21 - box 2462, B-3001, Leuven, Belgium
| | - Greetje Vande Velde
- KU Leuven, Department of Imaging & Pathology, Biomedical MRI / MoSAIC, Herestraat 49, building O&N1 - box 505, B-3000, Leuven, Belgium
| | - Jan Paeshuyse
- KU Leuven, Department of Biosystems, Laboratory of Host Pathogen Interaction in Livestock, Kasteelpark Arenberg 30 - box 2472, B-3001, Leuven, Belgium
| | - Annabel Braem
- KU Leuven, Department of Materials Engineering (MTM), Biomaterials and Tissue Engineering Research Group, Kasteelpark Arenberg 44 - box 2450, B-3001, Leuven, Belgium
| | - Rob Lavigne
- KU Leuven, Department of Biosystems, Laboratory of Gene Technology, Kasteelpark Arenberg 21 - box 2462, B-3001, Leuven, Belgium.
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14
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Schilcher K, Horswill AR. Staphylococcal Biofilm Development: Structure, Regulation, and Treatment Strategies. Microbiol Mol Biol Rev 2020. [PMID: 32792334 DOI: 10.1128/mmbr.00026-19/asset/e] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/15/2023] Open
Abstract
In many natural and clinical settings, bacteria are associated with some type of biotic or abiotic surface that enables them to form biofilms, a multicellular lifestyle with bacteria embedded in an extracellular matrix. Staphylococcus aureus and Staphylococcus epidermidis, the most frequent causes of biofilm-associated infections on indwelling medical devices, can switch between an existence as single free-floating cells and multicellular biofilms. During biofilm formation, cells first attach to a surface and then multiply to form microcolonies. They subsequently produce the extracellular matrix, a hallmark of biofilm formation, which consists of polysaccharides, proteins, and extracellular DNA. After biofilm maturation into three-dimensional structures, the biofilm community undergoes a disassembly process that leads to the dissemination of staphylococcal cells. As biofilms are dynamic and complex biological systems, staphylococci have evolved a vast network of regulatory mechanisms to modify and fine-tune biofilm development upon changes in environmental conditions. Thus, biofilm formation is used as a strategy for survival and persistence in the human host and can serve as a reservoir for spreading to new infection sites. Moreover, staphylococcal biofilms provide enhanced resilience toward antibiotics and the immune response and impose remarkable therapeutic challenges in clinics worldwide. This review provides an overview and an updated perspective on staphylococcal biofilms, describing the characteristic features of biofilm formation, the structural and functional properties of the biofilm matrix, and the most important mechanisms involved in the regulation of staphylococcal biofilm formation. Finally, we highlight promising strategies and technologies, including multitargeted or combinational therapies, to eradicate staphylococcal biofilms.
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Affiliation(s)
- Katrin Schilcher
- Department of Immunology and Microbiology, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Alexander R Horswill
- Department of Immunology and Microbiology, University of Colorado School of Medicine, Aurora, Colorado, USA
- Department of Veterans Affairs Eastern Colorado Health Care System, Denver, Colorado, USA
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15
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Staphylococcal Biofilm Development: Structure, Regulation, and Treatment Strategies. Microbiol Mol Biol Rev 2020; 84:84/3/e00026-19. [PMID: 32792334 DOI: 10.1128/mmbr.00026-19] [Citation(s) in RCA: 279] [Impact Index Per Article: 69.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
In many natural and clinical settings, bacteria are associated with some type of biotic or abiotic surface that enables them to form biofilms, a multicellular lifestyle with bacteria embedded in an extracellular matrix. Staphylococcus aureus and Staphylococcus epidermidis, the most frequent causes of biofilm-associated infections on indwelling medical devices, can switch between an existence as single free-floating cells and multicellular biofilms. During biofilm formation, cells first attach to a surface and then multiply to form microcolonies. They subsequently produce the extracellular matrix, a hallmark of biofilm formation, which consists of polysaccharides, proteins, and extracellular DNA. After biofilm maturation into three-dimensional structures, the biofilm community undergoes a disassembly process that leads to the dissemination of staphylococcal cells. As biofilms are dynamic and complex biological systems, staphylococci have evolved a vast network of regulatory mechanisms to modify and fine-tune biofilm development upon changes in environmental conditions. Thus, biofilm formation is used as a strategy for survival and persistence in the human host and can serve as a reservoir for spreading to new infection sites. Moreover, staphylococcal biofilms provide enhanced resilience toward antibiotics and the immune response and impose remarkable therapeutic challenges in clinics worldwide. This review provides an overview and an updated perspective on staphylococcal biofilms, describing the characteristic features of biofilm formation, the structural and functional properties of the biofilm matrix, and the most important mechanisms involved in the regulation of staphylococcal biofilm formation. Finally, we highlight promising strategies and technologies, including multitargeted or combinational therapies, to eradicate staphylococcal biofilms.
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16
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Zhang K, Li X, Yu C, Wang Y. Promising Therapeutic Strategies Against Microbial Biofilm Challenges. Front Cell Infect Microbiol 2020; 10:359. [PMID: 32850471 PMCID: PMC7399198 DOI: 10.3389/fcimb.2020.00359] [Citation(s) in RCA: 64] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Accepted: 06/10/2020] [Indexed: 12/17/2022] Open
Abstract
Biofilms are communities of microorganisms that are attached to a biological or abiotic surface and are surrounded by a self-produced extracellular matrix. Cells within a biofilm have intrinsic characteristics that are different from those of planktonic cells. Biofilm resistance to antimicrobial agents has drawn increasing attention. It is well-known that medical device- and tissue-associated biofilms may be the leading cause for the failure of antibiotic treatments and can cause many chronic infections. The eradication of biofilms is very challenging. Many researchers are working to address biofilm-related infections, and some novel strategies have been developed and identified as being effective and promising. Nevertheless, more preclinical studies and well-designed multicenter clinical trials are critically needed to evaluate the prospects of these strategies. Here, we review information about the mechanisms underlying the drug resistance of biofilms and discuss recent progress in alternative therapies and promising strategies against microbial biofilms. We also summarize the strengths and weaknesses of these strategies in detail.
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Affiliation(s)
- Kaiyu Zhang
- Department of Infectious Diseases, First Hospital of Jilin University, Changchun, China
| | - Xin Li
- Department of Infectious Diseases, First Hospital of Jilin University, Changchun, China
| | - Chen Yu
- Department of Infectious Diseases, First Hospital of Jilin University, Changchun, China
| | - Yang Wang
- Department of Infectious Diseases, First Hospital of Jilin University, Changchun, China.,Department of Pediatrics, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States
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17
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Hu X, Tian J, Li C, Su H, Qin R, Wang Y, Cao X, Yang P. Amyloid-Like Protein Aggregates: A New Class of Bioinspired Materials Merging an Interfacial Anchor with Antifouling. ADVANCED MATERIALS (DEERFIELD BEACH, FLA.) 2020; 32:e2000128. [PMID: 32346929 DOI: 10.1002/adma.202000128] [Citation(s) in RCA: 70] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Revised: 03/24/2020] [Accepted: 04/02/2020] [Indexed: 06/11/2023]
Abstract
Surfaces that resist nonspecific protein adsorption in a complex biological milieu are required for a variety of applications. However, few strategies can achieve a robust antifouling coating on a surface in an easy and reliable way, regardless of material type, morphology, and shape. Herein, the preparation of an antifouling coating by one-step aqueous supramolecular assembly of bovine serum albumin (BSA) is reported. Based on fast amyloid-like protein aggregation through the rapid reduction of the intramolecular disulfide bonds of BSA by tris(2-carboxyethyl)phosphine, a dense proteinaceous nanofilm with controllable thickness (≈130 nm) can be covered on virtually arbitrary material surfaces in tens of minutes by a simple dipping or spraying. The nanofilm shows strong stability and adhesion with the underlying substrate, exhibiting excellent resistance to the nonspecific adsorption of a broad-spectrum of contaminants including proteins, serum, cell lysate, cells, and microbes, etc. In vitro and in vivo experiments show that the nanofilm can prevent the adhesion of microorganisms and the formation of biofilm. Compared with native BSA, the proteinaceous nanofilm coating exposes a variety of functional groups on the surface, which have more-stable adhesion with the surface and can maintain the antifouling in harsh conditions including under ultrasound, surfactants, organic solvents, and enzymatic digestion.
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Affiliation(s)
- Xinyi Hu
- Key Laboratory of Applied Surface and Colloid Chemistry, Ministry of Education, School of Chemistry and Chemical Engineering, Shaanxi Normal University, Xi'an, 710119, China
| | - Juanhua Tian
- Department of Urology, The Second Affiliated Hospital of Xi'an Jiaotong University, West Five Road, No. 157, Xi'an, 710004, China
| | - Chen Li
- Key Laboratory of Applied Surface and Colloid Chemistry, Ministry of Education, School of Chemistry and Chemical Engineering, Shaanxi Normal University, Xi'an, 710119, China
| | - Hao Su
- Key Laboratory of Applied Surface and Colloid Chemistry, Ministry of Education, School of Chemistry and Chemical Engineering, Shaanxi Normal University, Xi'an, 710119, China
| | - Rongrong Qin
- Key Laboratory of Applied Surface and Colloid Chemistry, Ministry of Education, School of Chemistry and Chemical Engineering, Shaanxi Normal University, Xi'an, 710119, China
| | - Yifan Wang
- State Key Laboratory of Eco-hydraulics in Northwest Arid Region, Xi'an University of Technology, Xi'an, 710048, China
| | - Xin Cao
- State Key Laboratory of Eco-hydraulics in Northwest Arid Region, Xi'an University of Technology, Xi'an, 710048, China
| | - Peng Yang
- Key Laboratory of Applied Surface and Colloid Chemistry, Ministry of Education, School of Chemistry and Chemical Engineering, Shaanxi Normal University, Xi'an, 710119, China
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18
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Piarali S, Marlinghaus L, Viebahn R, Lewis H, Ryadnov MG, Groll J, Salber J, Roy I. Activated Polyhydroxyalkanoate Meshes Prevent Bacterial Adhesion and Biofilm Development in Regenerative Medicine Applications. Front Bioeng Biotechnol 2020; 8:442. [PMID: 32671021 PMCID: PMC7326089 DOI: 10.3389/fbioe.2020.00442] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2020] [Accepted: 04/17/2020] [Indexed: 12/13/2022] Open
Abstract
Regenerative medicine has become an extremely valuable tool offering an alternative to conventional therapies for the repair and regeneration of tissues. The re-establishment of tissue and organ functions can be carried out by tissue engineering strategies or by using medical devices such as implants. However, with any material being implanted inside the human body, one of the conundrums that remains is the ease with which these materials can get contaminated by bacteria. Bacterial adhesion leads to the formation of mature, alive and complex three-dimensional biofilm structures, further infection of surrounding tissues and consequent development of complicated chronic infections. Hence, novel tissue engineering strategies delivering biofilm-targeted therapies, while at the same time allowing tissue formation are highly relevant. In this study our aim was to develop surface modified polyhydroxyalkanoate-based fiber meshes with enhanced bacterial anti-adhesive and juvenile biofilm disrupting properties for tissue regeneration purposes. Using reactive and amphiphilic star-shaped macromolecules as an additive to a polyhydroxyalkanoate spinning solution, a synthetic antimicrobial peptide, Amhelin, with strong bactericidal and anti-biofilm properties, and Dispersin B, an enzyme promoting the disruption of exopolysaccharides found in the biofilm matrix, were covalently conjugated to the fibers by addition to the solution before the spinning process. Staphylococcus epidermidis is one of the most problematic pathogens responsible for tissue-related infections. The initial antibacterial screening showed that Amhelin proved to be strongly bactericidal at 12 μg/ml and caused >50% reductions of biofilm formation at 6 μg/ml, while Dispersin B was found to disperse >70% of pre-formed biofilms at 3 μg/ml. Regarding the cytotoxicity of the agents toward L929 murine fibroblasts, a CC50 of 140 and 115 μg/ml was measured for Amhelin and Dispersin B, respectively. Optimization of the electrospinning process resulted in aligned fibers. Surface activated fibers with Amhelin and Dispersin B resulted in 83% reduction of adhered bacteria on the surface of the fibers. Additionally, the materials developed were found to be cytocompatible toward L929 murine fibroblasts. The strategy reported in this preliminary study suggests an alternative approach to prevent bacterial adhesion and, in turn biofilm formation, in materials used in regenerative medicine applications such as tissue engineering.
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Affiliation(s)
- Sheila Piarali
- Department of Surgery, Universitätsklinikum Knappschaftskrankenhaus Bochum, Ruhr-University, Bochum, Germany
- Applied Biotechnology Research Group, School of Life Sciences, College of Liberal Arts and Sciences, University of Westminster, London, United Kingdom
| | | | - Richard Viebahn
- Department of Surgery, Universitätsklinikum Knappschaftskrankenhaus Bochum, Ruhr-University, Bochum, Germany
| | - Helen Lewis
- National Physical Laboratory, Teddington, United Kingdom
| | | | - Jürgen Groll
- Department for Functional Materials in Medicine and Dentistry and Bavarian Polymer Institute, University of Würzburg, Würzburg, Germany
| | - Jochen Salber
- Department of Surgery, Universitätsklinikum Knappschaftskrankenhaus Bochum, Ruhr-University, Bochum, Germany
| | - Ipsita Roy
- Department of Material Science and Engineering, Faculty of Engineering, University of Sheffield, Sheffield, United Kingdom
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19
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Francolini I, Hall-Stoodley L, Stoodley P. Biofilms, Biomaterials, and Device-Related Infections. Biomater Sci 2020. [DOI: 10.1016/b978-0-12-816137-1.00054-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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20
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Ghiorghita CA, Bucatariu F, Dragan ES. Influence of cross-linking in loading/release applications of polyelectrolyte multilayer assemblies. A review. MATERIALS SCIENCE & ENGINEERING. C, MATERIALS FOR BIOLOGICAL APPLICATIONS 2019; 105:110050. [DOI: 10.1016/j.msec.2019.110050] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/25/2018] [Revised: 07/31/2019] [Accepted: 08/02/2019] [Indexed: 10/26/2022]
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21
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Weldrick PJ, Hardman MJ, Paunov VN. Enhanced Clearing of Wound-Related Pathogenic Bacterial Biofilms Using Protease-Functionalized Antibiotic Nanocarriers. ACS APPLIED MATERIALS & INTERFACES 2019; 11:43902-43919. [PMID: 31718141 DOI: 10.1021/acsami.9b16119] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Biofilms are prevalent in chronic wounds and once formed are very hard to remove, which is associated with poor outcomes and high mortality rates. Biofilms are comprised of surface-attached bacteria embedded in an extracellular polymeric substance (EPS) matrix, which confers increased antibiotic resistance and host immune evasion. Therefore, disruption of this matrix is essential to tackle the biofilm-embedded bacteria. Here, we propose a novel nanotechnology to do this, based on protease-functionalized nanogel carriers of antibiotics. Such active antibiotic nanocarriers, surface coated with the protease Alcalase 2.4 L FG, "digest" their way through the biofilm EPS matrix, reach the buried bacteria, and deliver a high dose of antibiotic directly on their cell walls, which overwhelms their defenses. We demonstrated their effectiveness against six wound biofilm-forming bacteria, Staphylococcus aureus, Pseudomonas aeruginosa, Staphylococcus epidermidis, Klebsiella pneumoniae, Escherichia coli, and Enterococcus faecalis. We confirmed a 6-fold decrease in the biofilm mass and a substantial reduction in bacterial cell density using fluorescence, atomic force, and scanning electron microscopy. Additionally, we showed that co-treatments of ciprofloxacin and Alcalase-coated Carbopol nanogels led to a 3-log reduction in viable biofilm-forming cells when compared to ciprofloxacin treatments alone. Encapsulating an equivalent concentration of ciprofloxacin into the Alcalase-coated nanogel particles boosted their antibacterial effect much further, reducing the bacterial cell viability to below detectable amounts after 6 h of treatment. The Alcalase-coated nanogel particles were noncytotoxic to human adult keratinocyte cells (HaCaT), inducing a very low apoptotic response in these cells. Overall, we demonstrated that the Alcalase-coated nanogels loaded with a cationic antibiotic elicit very strong biofilm-clearing effects against wound-associated biofilm-forming pathogenic bacteria. This nanotechnology approach has the potential to become a very powerful treatment of chronically infected wounds with biofilm-forming bacteria.
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Affiliation(s)
- Paul J Weldrick
- Department of Chemistry and Biochemistry , University of Hull , Hull HU6 7RX , U.K
| | - Matthew J Hardman
- Centre for Atherothrombosis and Metabolic Disease , Hull York Medical School , Hull HU6 7RX , U.K
| | - Vesselin N Paunov
- Department of Chemistry and Biochemistry , University of Hull , Hull HU6 7RX , U.K
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22
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Hoque J, Ghosh S, Paramanandham K, Haldar J. Charge-Switchable Polymeric Coating Kills Bacteria and Prevents Biofilm Formation in Vivo. ACS APPLIED MATERIALS & INTERFACES 2019; 11:39150-39162. [PMID: 31550124 DOI: 10.1021/acsami.9b11453] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
Preventing bacterial biofilm formation on medical devices and implants in vivo still remains a daunting task. Current antibacterial coatings to combat implant-associated infections are generally composed of toxic metals or nondegradable polymers and involve multistep surface modifications. Here, we present a charge-switchable antibacterial and antibiofilm coating based on water-insoluble cationic hydrophobic polymers that are soluble in organic solvents and can be noncovalently coated onto different surfaces. Toward this, a library of quaternary polyethylenimine (QPEI) polymers with an amide or ester group in their pendant alkyl chain was developed. These QPEIs are shown to hydrolyze from active cationic to nontoxic zwitterionic polymers under acidic or enzymatic conditions. Notably, polymers with both zwitterionic and cationic groups, obtained upon partial hydrolysis of QPEIs, are shown to retain their antibacterial activity with much lower toxicity toward mammalian cells. Furthermore, the zwitterionic polymer, a fully hydrolyzed product of the QPEIs, is shown to be nontoxic to mammalian cells in vitro as well as in vivo. The QPEIs, when coated onto surfaces, kill bacteria and prevent formation of biofilms. In an in vivo mice model, the QPEI-coated medical grade catheter is shown to reduce methicillin-resistant Staphylococcus aureus contamination both on the catheter surface and in the adjacent tissues (99.99% reduction compared to a noncoated catheter). Additionally, biofilm formation is inhibited on the catheter surface with negligible inflammation in the adjacent tissue. The above results thus highlight the importance of these polymers to be used as effective antibacterial coatings in biomedical applications.
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Affiliation(s)
| | | | - Krishnamoorthy Paramanandham
- National Institute of Veterinary Epidemiology and Disease Informatics (NIVEDI) Ramagondanahalli , Yelahanka, Bengaluru 560064 , India
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23
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Bou Haidar N, Marais S, Dé E, Schaumann A, Barreau M, Feuilloley MGJ, Duncan AC. Chronic wound healing: A specific antibiofilm protein-asymmetric release system. MATERIALS SCIENCE & ENGINEERING. C, MATERIALS FOR BIOLOGICAL APPLICATIONS 2019; 106:110130. [PMID: 31753364 DOI: 10.1016/j.msec.2019.110130] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Revised: 08/02/2019] [Accepted: 08/23/2019] [Indexed: 02/06/2023]
Abstract
Chronic infection is a major cause of delayed wound-healing. It is recognized to be associated with infectious bacterial communities called biofilms. Currently used conventional antibiotics alone often reveal themselves ineffective, since they do not specifically target the wound biofilm. Here, we report a new conceptual tool aimed at overcoming this drawback: an antibiofilm drug delivery system targeting the bacterial biofilm as a whole, by inhibiting its formation and/or disrupting it once it is formed. The system consists of a micro/nanostructured poly(butylene-succinate-co-adipate) (PBSA)-based asymmetric membrane (AM) with controlled porosity. By the incorporation of hydrophilic porogen agents, polyvinylpyrrolidone (PVP) and polyethylene glycol (PEG), we were able to obtain AMs with high levels of porosity, exhibiting interconnections between pores. The PBSA-PEG membrane presented a dense upper layer with pores small enough to block bacteria penetration. Upon using such porogen agents, under dry and wet conditions, membrane's integrity and mechanical properties were maintained. Using bovine serum albumin (BSA) as a model protein, we demonstrated that protein loading and release from PBSA membranes were affected by the membrane structure (porosity) and the presence of residual porogen. Furthermore, the release curve profile consisted of a fast initial slope followed by a second slow phase approaching a plateau within 24 h. This can be highly beneficial for the promotion of wound healing. Cross-sectional confocal laser scanning microscopy (CLSM) images revealed a heterogeneous distribution of fluorescein isothiocyanate (FITC) labeled BSA throughout the entire membrane. PBSA membranes were loaded with dispersin B (DB), a specific antibiofilm matrix enzyme. Studies using a Staphylococcus epidermidis model, indicate significant efficiency in both inhibiting or dispersing preformed biofilm (up to 80 % eradication). The asymmetric PBSA membrane prepared with the PVP porogen (PBSA-PVP) displayed highest antibiofilm activity. Moreover, in vitro cytotoxicity assays using HaCaT and reconstructed human epidermis (RHE) models revealed that unloaded and DB-loaded PBSA-PVP membranes had excellent biocompatibility suitable for wound dressing applications.
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Affiliation(s)
- Naila Bou Haidar
- Normandie Univ, UNIRouen Normandie, INSA Rouen, CNRS, PBS, 76000 Rouen, France
| | - Stéphane Marais
- Normandie Univ, UNIRouen Normandie, INSA Rouen, CNRS, PBS, 76000 Rouen, France
| | - Emmanuelle Dé
- Normandie Univ, UNIRouen Normandie, INSA Rouen, CNRS, PBS, 76000 Rouen, France
| | - Annick Schaumann
- Normandie Univ, UNIRouen Normandie, INSA Rouen, CNRS, PBS, 76000 Rouen, France
| | - Magalie Barreau
- Normandie Univ, UNIRouen Normandie, LMSM EA4312, 27000 Evreux, France
| | | | - Anthony C Duncan
- Normandie Univ, UNIRouen Normandie, INSA Rouen, CNRS, PBS, 76000 Rouen, France.
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24
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Albright V, Palanisamy A, Zhou Q, Selin V, Sukhishvili SA. Functional Surfaces through Controlled Assemblies of Upper Critical Solution Temperature Block and Star Copolymers. LANGMUIR : THE ACS JOURNAL OF SURFACES AND COLLOIDS 2019; 35:10677-10688. [PMID: 30346775 DOI: 10.1021/acs.langmuir.8b02535] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Endowing surfaces with multiple advanced functionalities, such as temperature-controlled swelling or the triggered release of functional small molecules, is attractive for a large variety of applications ranging from smart textiles to advanced biomedical applications. This Invited Feature Article summarizes recent advances in the development of upper critical solution temperature (UCST) behavior of copolymers in aqueous solutions and compares the fundamental differences between lower critical solution temperature (LCST) and UCST transitions. The effect of polymer chemistry and architecture on UCST transitions is discussed for block copolymer micelles (BCMs) and star polymers in solution and assembled at surfaces. The inclusion of such nanocontainers (i.e., BCMs and star polymers) in layer-by-layer (LbL) coatings and how to control their responsive behavior through deposition conditions and binding partners is explored. Finally, the inclusion and temperature-triggered release of functional small molecules is explored for nanocontainers in LbL coatings. Taken together, UCST nanocontainers containing LbL films are promising building blocks for the development of new generations of practical, functional surface coatings.
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Affiliation(s)
- Victoria Albright
- Department of Materials Science and Engineering , Texas A&M University , 575 Ross Street , College Station , Texas 77843 , United States
| | - Anbazhagan Palanisamy
- Department of Materials Science and Engineering , Texas A&M University , 575 Ross Street , College Station , Texas 77843 , United States
| | - Qing Zhou
- Department of Materials Science and Engineering , Texas A&M University , 575 Ross Street , College Station , Texas 77843 , United States
| | - Victor Selin
- Department of Materials Science and Engineering , Texas A&M University , 575 Ross Street , College Station , Texas 77843 , United States
| | - Svetlana A Sukhishvili
- Department of Materials Science and Engineering , Texas A&M University , 575 Ross Street , College Station , Texas 77843 , United States
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25
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A Review on Surface Modifications and Coatings on Implants to Prevent Biofilm. REGENERATIVE ENGINEERING AND TRANSLATIONAL MEDICINE 2019. [DOI: 10.1007/s40883-019-00116-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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26
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Alvarez-Lorenzo C, Concheiro A. Smart Drug Release from Medical Devices. J Pharmacol Exp Ther 2019; 370:544-554. [DOI: 10.1124/jpet.119.257220] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Accepted: 04/01/2019] [Indexed: 12/23/2022] Open
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27
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Xia Q, Pan S, Zhang Y, An Q, Zhang Q, Zhang Y. Preparation of Highly Loaded PAA/PAH Layer-by-layer Films by Combining Acid Transformation and Templating Methods. Chem Res Chin Univ 2019. [DOI: 10.1007/s40242-019-8203-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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28
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Bavya MC, Vimal Rohan K, Gaurav GB, Srivasatava R. Synergistic treatment strategies to combat resistant bacterial infections using Schiff base modified nanoparticulate - hydrogel system. MATERIALS SCIENCE & ENGINEERING. C, MATERIALS FOR BIOLOGICAL APPLICATIONS 2018; 95:226-235. [PMID: 30573245 DOI: 10.1016/j.msec.2018.10.080] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Revised: 10/04/2018] [Accepted: 10/23/2018] [Indexed: 01/22/2023]
Abstract
Antibiotic resistance is of much prevalence and is one of the alarming realities for the rise in morbidity and mortality. Antibiotics; once regarded as wonder drugs have lost its credit of combating bacteria due to the rapid rise in variety of nosocomial pathogens. The underlying cause for the resistance spread is due to sudden drift in genetic mutation and the recalcitrant behavior of bacterial species. On the other hand, illegal and overconsumption of drugs fuels up the issue, wherein resistance development is directly proportional to the rate of drug consumption. Our pursuit was in reviving antibiotic, and further repurposing them into more potent formulation with reduced side effects to completely deplete resistant bacteria. In this work we present gentamicin encapsulated zein nanoparticle modified with Schiff base incorporated in immobilized chitosan-polyvinyl alcohol gel matrix([GM-ZNP]PG CsPVA) resulting in synergistic antibacterial activity. Schiff base modified zein nanoparticle exhibited an average diameter of 240 ± 8 nm and stability of -29.85 ± 2 mV. The nanocomposite system exhibited enhanced penetration rate when applied to dermis eliciting combinatorial antibacterial activity. Gentamicin in combination with Schiff base was found to lyse bacteria by ruining its cell integrity as depicted by SEM analysis. The formulation upon application stays intact to the impaired dermal tissues and releases drug in a sustained manner without the need of recurrent administration. The gel system was extremely biocompatible towards L929 cells without any toxicity. Overall, the work reports use of [GM-ZNP]PG CsPVA for resistant bacterial infections.
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Affiliation(s)
- M C Bavya
- Nanobios Lab, Department of Bioscience and Bioengineering, Indian Institute of Technology Bombay, Mumbai 400076, India
| | - K Vimal Rohan
- Academy of Medical Sciences, Pariyaram, Kerala 670503, India
| | - G B Gaurav
- Nanobios Lab, Department of Bioscience and Bioengineering, Indian Institute of Technology Bombay, Mumbai 400076, India
| | - R Srivasatava
- Nanobios Lab, Department of Bioscience and Bioengineering, Indian Institute of Technology Bombay, Mumbai 400076, India.
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29
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Chen KJ, Lee CK. Twofold enhanced dispersin B activity by N-terminal fusion to silver-binding peptide for biofilm eradication. Int J Biol Macromol 2018; 118:419-426. [DOI: 10.1016/j.ijbiomac.2018.06.066] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2018] [Revised: 06/12/2018] [Accepted: 06/12/2018] [Indexed: 12/27/2022]
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30
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Wang M, Tang T. Surface treatment strategies to combat implant-related infection from the beginning. J Orthop Translat 2018; 17:42-54. [PMID: 31194031 PMCID: PMC6551355 DOI: 10.1016/j.jot.2018.09.001] [Citation(s) in RCA: 66] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Revised: 08/13/2018] [Accepted: 09/04/2018] [Indexed: 02/08/2023] Open
Abstract
Orthopaedic implants are recognised as important therapeutic devices in the successful clinical management of a wide range of orthopaedic conditions. However, implant-related infections remain a challenging and not uncommon issue in patients with implanted instrumentation or medical devices. Bacterial adhesion and formation of biofilm on the surface of the implant represent important processes towards progression of infection. Given the intimate association between infection and the implant surface, adequate treatment of the implant surface may help mitigate the risk of infection. This review summarises the current surface treatment technologies and their role in prevention of implant-related infection from the beginning. Translational potential of this article Despite great technological advancements, the prevalence of implant-related infections remains high. Four main challenges can be identified. (i) Insufficient mechanical stability can cause detachment of the implant surface coating, altering the antimicrobial ability of functionalized surfaces. (ii) Regarding drug-loaded coatings, a stable drug release profile is of vital importance for achieving effective bactericidal effect locally; however, burst release of the loaded antibacterial agents remains common. (iii) Although many coatings and modified surfaces provide superior antibacterial action, such functionalisation of surfaces sometimes has a detrimental effect on tissue biocompatibility, impairing the integration of the implants into the surrounding tissue. (iv) Biofilm eradication at the implant surface remains particularly challenging. This review summarised the recent progress made to address the aforementioned problems. By providing a perspective on state-of-the-art surface treatment strategies for medical implants, we hope to support the timely adoption of modern materials and techniques into clinical practice.
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Affiliation(s)
- Minqi Wang
- Shanghai Key Laboratory of Orthopaedic Implants, Department of Orthopaedic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Tingting Tang
- Shanghai Key Laboratory of Orthopaedic Implants, Department of Orthopaedic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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31
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Cattò C, Villa F, Cappitelli F. Recent progress in bio-inspired biofilm-resistant polymeric surfaces. Crit Rev Microbiol 2018; 44:633-652. [DOI: 10.1080/1040841x.2018.1489369] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Cristina Cattò
- Department of Food Environmental and Nutritional Sciences, Università degli Studi di Milano, Milano, Italy
| | - Federica Villa
- Department of Food Environmental and Nutritional Sciences, Università degli Studi di Milano, Milano, Italy
| | - Francesca Cappitelli
- Department of Food Environmental and Nutritional Sciences, Università degli Studi di Milano, Milano, Italy
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32
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An Q, Huang T, Shi F. Covalent layer-by-layer films: chemistry, design, and multidisciplinary applications. Chem Soc Rev 2018; 47:5061-5098. [PMID: 29767189 DOI: 10.1039/c7cs00406k] [Citation(s) in RCA: 75] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Covalent layer-by-layer (LbL) assembly is a powerful method used to construct functional ultrathin films that enables nanoscopic structural precision, componential diversity, and flexible design. Compared with conventional LbL films built using multiple noncovalent interactions, LbL films prepared using covalent crosslinking offer the following distinctive characteristics: (i) enhanced film endurance or rigidity; (ii) improved componential diversity when uncharged species or small molecules are stably built into the films by forming covalent bonds; and (iii) increased structural diversity when covalent crosslinking is employed in componential, spacial, or temporal (labile bonds) selective manners. In this review, we document the chemical methods used to build covalent LbL films as well as the film properties and applications achievable using various film design strategies. We expect to translate the achievement in the discipline of chemistry (film-building methods) into readily available techniques for materials engineers and thus provide diverse functional material design protocols to address the energy, biomedical, and environmental challenges faced by the entire scientific community.
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Affiliation(s)
- Qi An
- Beijing Key Laboratory of Materials Utilization of Nonmetallic Minerals and Solid Wastes, National Laboratory of Mineral Materials, School of Materials Science and Technology, China University of Geosciences, Beijing, 100083, China.
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Albright V, Xu M, Palanisamy A, Cheng J, Stack M, Zhang B, Jayaraman A, Sukhishvili SA, Wang H. Micelle-Coated, Hierarchically Structured Nanofibers with Dual-Release Capability for Accelerated Wound Healing and Infection Control. Adv Healthc Mater 2018; 7:e1800132. [PMID: 29683273 PMCID: PMC6347427 DOI: 10.1002/adhm.201800132] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2018] [Revised: 03/03/2018] [Indexed: 12/18/2022]
Abstract
Tailoring nanofibrous matrices-a material with much promise for wound healing applications-to simultaneously mitigate bacterial colonization and stimulate wound closure of infected wounds is highly desirable. To that end, a dual-releasing, multiscale system of biodegradable electrospun nanofibers coated with biocompatible micellar nanocarriers is reported. For wound healing, transforming growth factor-β1 is incorporated into polycaprolactone/collagen (PCL/Coll) nanofibers via electrospinning and the myofibroblastic differentiation of human dermal fibroblasts is locally stimulated. To prevent infection, biocompatible nanocarriers of polypeptide-based block copolymer micelles are deposited onto the surfaces of PCL/Coll nanofibers using tannic acid as a binding partner. Micelle-modified fibrous scaffolds are favorable for wound healing, not only supporting the attachment and spreading of fibroblasts comparable to those on noncoated nanofibers, but also significantly enhancing fibroblast migration. Micellar coatings can be loaded with gentamicin or clindamycin and exhibit antibacterial activity as measured by Petrifilm and zone of inhibition assays as well as time-dependent reduction of cellular counts of Staphylococcus aureus cultures. Moreover, delivery time of antibiotic dosage is tunable through the application of a novel modular approach. Altogether, this system holds great promise as an infection-mitigating, cell-stimulating, biodegradable skin graft for wound management and tissue engineering.
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Affiliation(s)
- Victoria Albright
- Department of Materials Science and Engineering, Texas A&M University, 575 Ross Street, College Station, TX 77843, USA
| | - Meng Xu
- Department of Chemistry and Chemical Biology, Stevens Institute of Technology, 1 Castle Point on the Hudson, Hoboken, NJ 07030, USA
| | - Anbazhagan Palanisamy
- Department of Materials Science and Engineering, Texas A&M University, 575 Ross Street, College Station, TX 77843, USA
| | - Jun Cheng
- Department of Chemistry and Chemical Biology, Stevens Institute of Technology, 1 Castle Point on the Hudson, Hoboken, NJ 07030, USA
| | - Mary Stack
- Department of Biomedical Engineering, Stevens Institute of Technology, 1 Castle Point on the Hudson, Hoboken, NJ 07030, USA
| | - Beilu Zhang
- Department of Chemistry and Chemical Biology, Stevens Institute of Technology, 1 Castle Point on the Hudson, Hoboken, NJ 07030, USA
| | - Arul Jayaraman
- Department of Chemical Engineering, Department of Biomedical Engineering, Texas A&M University
| | - Svetlana A. Sukhishvili
- Department of Materials Science and Engineering, Texas A&M University, 575 Ross Street, College Station, TX 77843, USA,
| | - Hongjun Wang
- Department of Chemistry and Chemical Biology, Stevens Institute of Technology, 1 Castle Point on the Hudson, Hoboken, NJ 07030, USA,
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34
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Non-eluting, surface-bound enzymes disrupt surface attachment of bacteria by continuous biofilm polysaccharide degradation. Biomaterials 2018; 167:168-176. [DOI: 10.1016/j.biomaterials.2018.03.016] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Revised: 02/28/2018] [Accepted: 03/12/2018] [Indexed: 11/19/2022]
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Bassegoda A, Ivanova K, Ramon E, Tzanov T. Strategies to prevent the occurrence of resistance against antibiotics by using advanced materials. Appl Microbiol Biotechnol 2018; 102:2075-2089. [PMID: 29392390 DOI: 10.1007/s00253-018-8776-0] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Revised: 01/04/2018] [Accepted: 01/06/2018] [Indexed: 01/26/2023]
Abstract
Drug resistance occurrence is a global healthcare concern responsible for the increased morbidity and mortality in hospitals, time of hospitalisation and huge financial loss. The failure of the most antibiotics to kill "superbugs" poses the urgent need to develop innovative strategies aimed at not only controlling bacterial infection but also the spread of resistance. The prevention of pathogen host invasion by inhibiting bacterial virulence and biofilm formation, and the utilisation of bactericidal agents with different mode of action than classic antibiotics are the two most promising new alternative strategies to overcome antibiotic resistance. Based on these novel approaches, researchers are developing different advanced materials (nanoparticles, hydrogels and surface coatings) with novel antimicrobial properties. In this review, we summarise the recent advances in terms of engineered materials to prevent bacteria-resistant infections according to the antimicrobial strategies underlying their design.
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Affiliation(s)
- Arnau Bassegoda
- Group of Molecular and Industrial Biotechnology, Department of Chemical Engineering, Universitat Politècnica de Catalunya, Terrassa, Spain
| | - Kristina Ivanova
- Group of Molecular and Industrial Biotechnology, Department of Chemical Engineering, Universitat Politècnica de Catalunya, Terrassa, Spain
| | - Eva Ramon
- Group of Molecular and Industrial Biotechnology, Department of Chemical Engineering, Universitat Politècnica de Catalunya, Terrassa, Spain
| | - Tzanko Tzanov
- Group of Molecular and Industrial Biotechnology, Department of Chemical Engineering, Universitat Politècnica de Catalunya, Terrassa, Spain.
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36
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Samantaray PK, Madras G, Bose S. PVDF/PBSA membranes with strongly coupled phosphonium derivatives and graphene oxide on the surface towards antibacterial and antifouling activities. J Memb Sci 2018. [DOI: 10.1016/j.memsci.2017.11.018] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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37
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Bioinspired surface functionalization of metallic biomaterials. J Mech Behav Biomed Mater 2018; 77:90-105. [DOI: 10.1016/j.jmbbm.2017.08.035] [Citation(s) in RCA: 111] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Revised: 08/23/2017] [Accepted: 08/29/2017] [Indexed: 12/31/2022]
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38
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Integrating zwitterionic polymer and Ag nanoparticles on polymeric membrane surface to prepare antifouling and bactericidal surface via Schiff-based layer-by-layer assembly. J Colloid Interface Sci 2018; 510:308-317. [DOI: 10.1016/j.jcis.2017.09.071] [Citation(s) in RCA: 53] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2017] [Revised: 09/19/2017] [Accepted: 09/20/2017] [Indexed: 11/23/2022]
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39
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Albright V, Zhuk I, Wang Y, Selin V, van de Belt-Gritter B, Busscher HJ, van der Mei HC, Sukhishvili SA. Self-defensive antibiotic-loaded layer-by-layer coatings: Imaging of localized bacterial acidification and pH-triggering of antibiotic release. Acta Biomater 2017; 61:66-74. [PMID: 28803214 DOI: 10.1016/j.actbio.2017.08.012] [Citation(s) in RCA: 68] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Revised: 07/22/2017] [Accepted: 08/08/2017] [Indexed: 10/19/2022]
Abstract
Self-defensive antibiotic-loaded coatings have shown promise in inhibiting growth of pathogenic bacteria adhering to biomaterial implants and devices, but direct proof that their antibacterial release is triggered by bacterially-induced acidification of the immediate environment under buffered conditions remained elusive. Here, we demonstrate that Staphylococcus aureus and Escherichia coli adhering to such coatings generate highly localized acidification, even in buffered conditions, to activate pH-triggered, self-defensive antibiotic release. To this end, we utilized chemically crosslinked layer-by-layer hydrogel coatings of poly(methacrylic acid) with a covalently attached pH-sensitive SNARF-1 fluorescent label for imaging, and unlabeled-antibiotic (gentamicin or polymyxin B) loaded coatings for antibacterial studies. Local acidification of the coatings induced by S. aureus and E. coli adhering to the coatings was demonstrated by confocal-laser-scanning-microscopy via wavelength-resolved imaging. pH-triggered antibiotic release under static, small volume conditions yielded high bacterial killing efficiencies for S. aureus and E. coli. Gentamicin-loaded films retained their antibacterial activity against S. aureus under fluid flow in buffered conditions. Antibacterial activity increased with the number of polymer layers in the films. Altogether, pH-triggered, self-defensive antibiotic-loaded coatings become activated by highly localized acidification in the immediate environment of an adhering bacterium, offering potential for clinical application with minimized side-effects. STATEMENT OF SIGNIFICANCE Polymeric coatings were created that are able to uptake and selectively release antibiotics upon stimulus by adhering bacteria in order to understand the fundamental mechanisms behind pH-triggered antibiotic release as a potential way to prevent biomaterial-associated infections. Through fluorescent imaging studies, this work importantly shows that adhering bacteria produce highly localized pH changes even in buffer. Accordingly such coatings only demonstrate antibacterial activity by antibiotic release in the presence of adhering bacteria. This is clinically important, because ad libitum releasing antibiotic coatings usually show a burst release and have often lost their antibiotic content when bacteria adhere.
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40
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Samantaray PK, Madras G, Bose S. Antibacterial and Antibiofouling Polymeric Membranes through Immobilization of Pyridine Derivative Leading to ROS Generation and Loss in Bacterial Membrane Integrity. ChemistrySelect 2017. [DOI: 10.1002/slct.201701701] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
| | - Giridhar Madras
- Department of Chemical Engineering; Indian Institute of Science; Bangalore
| | - Suryasarathi Bose
- Department of Materials Engineering; Indian Institute of Science; Bangalore
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41
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Sun B, Wang L, Li Q, He P, Liu H, Wang H, Yang Y, Li J. Bis(pyrene)-Doped Cationic Dipeptide Nanoparticles for Two-Photon-Activated Photodynamic Therapy. Biomacromolecules 2017; 18:3506-3513. [DOI: 10.1021/acs.biomac.7b00780] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
- Bingbing Sun
- Beijing
National Laboratory for Molecular Sciences, CAS Key Laboratory of
Colloid, Interface and Chemical Thermodynamics, Institute of Chemistry, Chinese Academy of Sciences, Beijing 100190, China
| | - Lei Wang
- CAS
Key Laboratory for Biomedical Effects of Nanomaterials and Nanosafety, National Center for Nanoscience and Technology, Beijing 100190, China
| | - Qi Li
- Beijing
National Laboratory for Molecular Sciences, CAS Key Laboratory of
Colloid, Interface and Chemical Thermodynamics, Institute of Chemistry, Chinese Academy of Sciences, Beijing 100190, China
| | - Pingping He
- CAS
Key Laboratory for Biomedical Effects of Nanomaterials and Nanosafety, National Center for Nanoscience and Technology, Beijing 100190, China
| | - Huiling Liu
- CAS
Key Laboratory for Biomedical Effects of Nanomaterials and Nanosafety, National Center for Nanoscience and Technology, Beijing 100190, China
| | - Hao Wang
- CAS
Key Laboratory for Biomedical Effects of Nanomaterials and Nanosafety, National Center for Nanoscience and Technology, Beijing 100190, China
| | - Yang Yang
- CAS
Key Laboratory for Biomedical Effects of Nanomaterials and Nanosafety, National Center for Nanoscience and Technology, Beijing 100190, China
| | - Junbai Li
- Beijing
National Laboratory for Molecular Sciences, CAS Key Laboratory of
Colloid, Interface and Chemical Thermodynamics, Institute of Chemistry, Chinese Academy of Sciences, Beijing 100190, China
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42
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Peng L, Chang L, Liu X, Lin J, Liu H, Han B, Wang S. Antibacterial Property of a Polyethylene Glycol-Grafted Dental Material. ACS APPLIED MATERIALS & INTERFACES 2017; 9:17688-17692. [PMID: 28513133 DOI: 10.1021/acsami.7b05284] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Dental materials often cause bacterial adhesion and promote bacterial biofilm formation, which brings a series of long-standing and significant problems in oral health. However, the current development of antibacterial research in dental devices is limited by the lack of materials endowed with good antibacterial properties against oral bacteria. Here, we present a new strategy for reducing the initial adhesion of bacterial on dental biomaterials by chemically bonding long-chain polyethylene glycol. Our work represents an important step toward solving the problem of bacterial accumulation on dental devices.
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Affiliation(s)
- Liying Peng
- Department of Orthodontics, Peking University School and Hospital of Stomatology, National Engineering Laboratory for Digital and Material Technology of Stomatology, and Beijing Key Laboratory of Digital Stomatology, Peking University , 22 Zhongguancun South Avenue, Haidian District, Beijing 100081, P. R. China
| | - Li Chang
- State Key Laboratory of Applied Organic Chemistry, Key Laboratory of Nonferrous Metal Chemistry and Resources Utilization of Gansu Province and Department of Chemistry, Lanzhou University , Lanzhou 730000, P. R. China
| | - Xi Liu
- CAS Key Laboratory of Bio-inspired Materials and Interfacial Science, CAS Center for Excellence in Nanoscience, Technical Institute of Physics and Chemistry, Chinese Academy of Sciences , Beijing 100190, P. R. China
| | - Jiuxiang Lin
- Department of Orthodontics, Peking University School and Hospital of Stomatology, National Engineering Laboratory for Digital and Material Technology of Stomatology, and Beijing Key Laboratory of Digital Stomatology, Peking University , 22 Zhongguancun South Avenue, Haidian District, Beijing 100081, P. R. China
| | - Hongliang Liu
- CAS Key Laboratory of Bio-inspired Materials and Interfacial Science, CAS Center for Excellence in Nanoscience, Technical Institute of Physics and Chemistry, Chinese Academy of Sciences , Beijing 100190, P. R. China
| | - Bing Han
- Department of Orthodontics, Peking University School and Hospital of Stomatology, National Engineering Laboratory for Digital and Material Technology of Stomatology, and Beijing Key Laboratory of Digital Stomatology, Peking University , 22 Zhongguancun South Avenue, Haidian District, Beijing 100081, P. R. China
| | - Shutao Wang
- CAS Key Laboratory of Bio-inspired Materials and Interfacial Science, CAS Center for Excellence in Nanoscience, Technical Institute of Physics and Chemistry, Chinese Academy of Sciences , Beijing 100190, P. R. China
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43
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Francolini I, Vuotto C, Piozzi A, Donelli G. Antifouling and antimicrobial biomaterials: an overview. APMIS 2017; 125:392-417. [PMID: 28407425 DOI: 10.1111/apm.12675] [Citation(s) in RCA: 159] [Impact Index Per Article: 22.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2016] [Accepted: 01/14/2017] [Indexed: 12/12/2022]
Abstract
The use of implantable medical devices is a common and indispensable part of medical care for both diagnostic and therapeutic purposes. However, as side effect, the implant of medical devices quite often leads to the occurrence of difficult-to-treat infections, as a consequence of the colonization of their abiotic surfaces by biofilm-growing microorganisms increasingly resistant to antimicrobial therapies. A promising strategy to combat device-related infections is based on anti-infective biomaterials that either repel microbes, so they cannot attach to the device surfaces, or kill them in the surrounding areas. In general, such biomaterials are characterized by antifouling coatings, exhibiting low adhesion or even repellent properties towards microorganisms, or antimicrobial coatings, able to kill microbes approaching the surface. In this light, the present overview will address the development in the last two decades of antifouling and antimicrobial biomaterials designed to potentially limit the initial stages of microbial adhesion, as well as the microbial growth and biofilm formation on medical device surfaces.
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Affiliation(s)
| | - Claudia Vuotto
- Microbial Biofilm Laboratory, IRCCS Fondazione Santa Lucia, Rome
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44
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Baidamshina DR, Trizna EY, Holyavka MG, Bogachev MI, Artyukhov VG, Akhatova FS, Rozhina EV, Fakhrullin RF, Kayumov AR. Targeting microbial biofilms using Ficin, a nonspecific plant protease. Sci Rep 2017; 7:46068. [PMID: 28387349 PMCID: PMC5384253 DOI: 10.1038/srep46068] [Citation(s) in RCA: 63] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2016] [Accepted: 03/08/2017] [Indexed: 11/09/2022] Open
Abstract
Biofilms, the communities of surface-attached bacteria embedded into extracellular matrix, are ubiquitous microbial consortia securing the effective resistance of constituent cells to environmental impacts and host immune responses. Biofilm-embedded bacteria are generally inaccessible for antimicrobials, therefore the disruption of biofilm matrix is the potent approach to eradicate microbial biofilms. We demonstrate here the destruction of Staphylococcus aureus and Staphylococcus epidermidis biofilms with Ficin, a nonspecific plant protease. The biofilm thickness decreased two-fold after 24 hours treatment with Ficin at 10 μg/ml and six-fold at 1000 μg/ml concentration. We confirmed the successful destruction of biofilm structures and the significant decrease of non-specific bacterial adhesion to the surfaces after Ficin treatment using confocal laser scanning and atomic force microscopy. Importantly, Ficin treatment enhanced the effects of antibiotics on biofilms-embedded cells via disruption of biofilm matrices. Pre-treatment with Ficin (1000 μg/ml) considerably reduced the concentrations of ciprofloxacin and bezalkonium chloride required to suppress the viable Staphylococci by 3 orders of magnitude. We also demonstrated that Ficin is not cytotoxic towards human breast adenocarcinoma cells (MCF7) and dog adipose derived stem cells. Overall, Ficin is a potent tool for staphylococcal biofilm treatment and fabrication of novel antimicrobial therapeutics for medical and veterinary applications.
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Affiliation(s)
- Diana R Baidamshina
- Kazan Federal University, Institute of Fundamental Medicine and Biology, Kazan, Republic of Tatarstan, Russian Federation
| | - Elena Y Trizna
- Kazan Federal University, Institute of Fundamental Medicine and Biology, Kazan, Republic of Tatarstan, Russian Federation
| | - Marina G Holyavka
- Voronezh State University, Medicine and Biology Faculty, Voronezh, Russian Federation
| | - Mikhail I Bogachev
- St Petersburg Electrotechnical University, Biomedical Engineering Research Centre, St. Petersburg, Russian Federation
| | - Valeriy G Artyukhov
- Voronezh State University, Medicine and Biology Faculty, Voronezh, Russian Federation
| | - Farida S Akhatova
- Kazan Federal University, Institute of Fundamental Medicine and Biology, Kazan, Republic of Tatarstan, Russian Federation
| | - Elvira V Rozhina
- Kazan Federal University, Institute of Fundamental Medicine and Biology, Kazan, Republic of Tatarstan, Russian Federation
| | - Rawil F Fakhrullin
- Kazan Federal University, Institute of Fundamental Medicine and Biology, Kazan, Republic of Tatarstan, Russian Federation
| | - Airat R Kayumov
- Kazan Federal University, Institute of Fundamental Medicine and Biology, Kazan, Republic of Tatarstan, Russian Federation
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45
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Viola GM, Rosenblatt J, Raad II. Drug eluting antimicrobial vascular catheters: Progress and promise. Adv Drug Deliv Rev 2017; 112:35-47. [PMID: 27496702 DOI: 10.1016/j.addr.2016.07.011] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2016] [Revised: 06/14/2016] [Accepted: 07/26/2016] [Indexed: 12/13/2022]
Abstract
Vascular catheters are critical tools in modern healthcare yet present substantial risks of serious bloodstream infections that exact significant health and economic burdens. Drug-eluting antimicrobial vascular catheters have become important tools in preventing catheter-related bloodstream infections and their importance is expected to increase as significant initiatives are expanded to eliminate and make the occurrence of these infections unacceptable. Here we review clinically significant and emerging drug-eluting antimicrobial catheters within the categories of antibiotic, antiseptic, novel bioactive agents and energy-enhanced drug eluting antimicrobial catheters. Important representatives of each category are reviewed from the standpoints of mechanisms of action, physical-chemical properties, safety, in vitro and clinical effectiveness.
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Affiliation(s)
- George M Viola
- Department of Infectious Diseases, Infection Control, and Employee Health, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Joel Rosenblatt
- Department of Infectious Diseases, Infection Control, and Employee Health, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA.
| | - Issam I Raad
- Department of Infectious Diseases, Infection Control, and Employee Health, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
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46
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Zhang X, Wang Z, Chen M, Liu M, Wu Z. Polyvinylidene fluoride membrane blended with quaternary ammonium compound for enhancing anti-biofouling properties: Effects of dosage. J Memb Sci 2016. [DOI: 10.1016/j.memsci.2016.07.048] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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47
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Hoque J, Akkapeddi P, Ghosh C, Uppu DSSM, Haldar J. A Biodegradable Polycationic Paint that Kills Bacteria in Vitro and in Vivo. ACS APPLIED MATERIALS & INTERFACES 2016; 8:29298-29309. [PMID: 27709890 DOI: 10.1021/acsami.6b09804] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
Bacterial colonization and subsequent formation of biofilms onto surfaces of medical devices and implants is a major source of nosocomial infections. Most antibacterial coatings to combat infections are either metal-based or nondegradable-polymer-based and hence limited by their nondegradability and unpredictable toxicity. Moreover, to combat infections effectively, the coatings are required to display simultaneous antibacterial and antibiofilm activity. Herein we report biocompatible and biodegradable coatings based on organo-soluble quaternary chitin polymers which were immobilized noncovalently onto surfaces as bactericidal paint. The polycationic paint was found to be active against both drug-sensitive and -resistant bacteria such as methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant Enterococcus faecium (VRE), and β-lactam-resistant Klebsiella pneumoniae. The cationic polymers were shown to interact with the negatively charged bacterial cell membrane and disrupt the membrane integrity, thereby causing leakage of intracellular constituents and cell death upon contact. Importantly, surfaces coated with the polymers inhibited formation of biofilms against both Gram-positive S. aureus and Gram-negative E. coli, two of the most clinically important bacteria that form biofilms. Surfaces coated with the polymers displayed negligible toxicity against human erythrocytes and embryo kidney cells. Notably, the polymers were shown to be susceptible toward lysozyme. Furthermore, subcutaneous implantation of polymer discs in rats led to 15-20% degradation in 4 weeks thereby displaying their biodegradability. In a murine model of subcutaneous infection, polymer-coated medical-grade catheter reduced MRSA burden by 3.7 log compared to that of noncoated catheter. Furthermore, no biofilm development was observed on the coated catheters under in vivo conditions. The polycationic materials thus developed herein represent a novel class of safe and effective coating agents for the prevention of device-associated infections.
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Affiliation(s)
- Jiaul Hoque
- Chemical Biology and Medicinal Chemistry Laboratory, New Chemistry Unit, Jawaharlal Nehru Centre for Advanced Scientific Research , Jakkur, Bengaluru 560064, India
| | - Padma Akkapeddi
- Chemical Biology and Medicinal Chemistry Laboratory, New Chemistry Unit, Jawaharlal Nehru Centre for Advanced Scientific Research , Jakkur, Bengaluru 560064, India
| | - Chandradhish Ghosh
- Chemical Biology and Medicinal Chemistry Laboratory, New Chemistry Unit, Jawaharlal Nehru Centre for Advanced Scientific Research , Jakkur, Bengaluru 560064, India
| | - Divakara S S M Uppu
- Chemical Biology and Medicinal Chemistry Laboratory, New Chemistry Unit, Jawaharlal Nehru Centre for Advanced Scientific Research , Jakkur, Bengaluru 560064, India
| | - Jayanta Haldar
- Chemical Biology and Medicinal Chemistry Laboratory, New Chemistry Unit, Jawaharlal Nehru Centre for Advanced Scientific Research , Jakkur, Bengaluru 560064, India
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48
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Ramasamy M, Lee J. Recent Nanotechnology Approaches for Prevention and Treatment of Biofilm-Associated Infections on Medical Devices. BIOMED RESEARCH INTERNATIONAL 2016; 2016:1851242. [PMID: 27872845 PMCID: PMC5107826 DOI: 10.1155/2016/1851242] [Citation(s) in RCA: 118] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/05/2016] [Accepted: 10/13/2016] [Indexed: 11/23/2022]
Abstract
Bacterial colonization in the form of biofilms on surfaces causes persistent infections and is an issue of considerable concern to healthcare providers. There is an urgent need for novel antimicrobial or antibiofilm surfaces and biomedical devices that provide protection against biofilm formation and planktonic pathogens, including antibiotic resistant strains. In this context, recent developments in the material science and engineering fields and steady progress in the nanotechnology field have created opportunities to design new biomaterials and surfaces with anti-infective, antifouling, bactericidal, and antibiofilm properties. Here we review a number of the recently developed nanotechnology-based biomaterials and explain underlying strategies used to make antibiofilm surfaces.
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Affiliation(s)
| | - Jintae Lee
- School of Chemical Engineering, Yeungnam University, Gyeongsan 38541, Republic of Korea
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49
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Alvarez-Lorenzo C, Garcia-Gonzalez CA, Bucio E, Concheiro A. Stimuli-responsive polymers for antimicrobial therapy: drug targeting, contact-killing surfaces and competitive release. Expert Opin Drug Deliv 2016; 13:1109-19. [PMID: 27074830 DOI: 10.1080/17425247.2016.1178719] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
INTRODUCTION Polymers can be designed to modify their features as a function of the level and nature of the surrounding microorganisms. Such responsive polymers can endow drug delivery systems and drug-medical device combination products with improved performance against intracellular infections and biofilms. AREAS COVERED Knowledge on microorganism growth environment outside and inside cells and formation of biofilm communities on biological and synthetic surfaces, together with advances in materials science and drug delivery are prompting strategies with improved efficacy and safety compared to traditional systemic administration of antimicrobial agents. This review deals with antimicrobial strategies that rely on: (i) polymers that disintegrate or undergo phase-transitions in response to changes in enzymes, pH and pO2 associated to microorganism growth; (ii) stimuli-responsive polymers that expose contact-killing groups when microorganisms try to adhere; and (iii) bioinspired polymers that recognize microorganisms for triggered (competitive/affinity-driven) drug release. EXPERT OPINION Prophylaxis and treatment of infections may benefit from polymers that are responsive to the unique changes that microbial growth causes in the surrounding environment or that even recognize the microorganism itself or its quorum sensing signals. These polymers may offer novel tools for the design of macrophage-, bacteria- and/or biofilm-targeted nanocarriers as well as of medical devices with switchable antibiofouling properties.
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Affiliation(s)
- Carmen Alvarez-Lorenzo
- a Departamento de Farmacia y Tecnología Farmacéutica , Universidade de Santiago de Compostela , Santiago de Compostela , Spain
| | - Carlos A Garcia-Gonzalez
- a Departamento de Farmacia y Tecnología Farmacéutica , Universidade de Santiago de Compostela , Santiago de Compostela , Spain
| | - Emilio Bucio
- b Departamento de Química de Radiaciones y Radioquímica , Instituto de Ciencias Nucleares, Universidad Nacional Autónoma de México, Circuito Exterior, Ciudad Universitaria , México DF , Mexico
| | - Angel Concheiro
- a Departamento de Farmacia y Tecnología Farmacéutica , Universidade de Santiago de Compostela , Santiago de Compostela , Spain
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50
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Ribeiro SM, Felício MR, Boas EV, Gonçalves S, Costa FF, Samy RP, Santos NC, Franco OL. New frontiers for anti-biofilm drug development. Pharmacol Ther 2016; 160:133-44. [DOI: 10.1016/j.pharmthera.2016.02.006] [Citation(s) in RCA: 91] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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