Targeted release of tobramycin from a pH-responsive grafted bilayer challenged with S. aureus

Controlling spatial distribution of functional lipids in a supported lipid bilayer prepared from vesicles

Conjugating biomolecules, such as antibodies, to bioconjugate moieties on lipid surfaces is a powerful tool for engineering the surface of diverse biomaterials, including cells and nanoparticles. We developed supported lipid bilayers (SLBs) presenting well-defined spatial distributions of functional moieties as models for precisely engineered functional biomolecular-lipid surfaces. We used quartz crystal microbalance with dissipation (QCM-D) and atomic force microscopy (AFM) to determine how vesicles containing a mixture of 1,2-dipalmitoyl-sn-glycero-3-phosphatidylcholine (DPPC) and 1,2-distearoyl-sn-glycero-3-phosphoethanolamine-N-[azido(polyethylene glycol)-2000] (DSPE-PEG-N3) form SLBs as a function of the lipid phase transition temperature (Tm). Above the DPPC Tm, DPPC/DSPE-PEG-N3 vesicles form SLBs with functional azide moieties on SiO2 substrates via vesicle fusion. Below this Tm, DPPC/DSPE-PEG-N3 vesicles attach to SiO2 intact. Intact DPPC/DSPE-PEG-N3 vesicles on the SiO2 surfaces fuse and rupture to form SLBs when temperature is brought above the DPPC Tm. AFM studies show uniform and complete DPPC/DSPE-PEG-N3 SLB coverage of SiO2 surfaces for different DSPE-PEG-N3 concentrations. As the DSPE-PEG-N3 concentration increases from 0.01 to 6 mol%, the intermolecular spacing of DSPE-PEG-N3 in the SLBs decreases from 4.6 to 1.0 nm. The PEG moiety undergoes a mushroom to brush transition as DSPE-PEG-N3 concentration varies from 0.1 to 2.0 mol%. Via copper-free click reaction, IgG was conjugated to SLB surfaces with 4.6 nm or 1.3 nm inter-DSPE-PEG-N3 spacing. QCM-D and AFM data show; 1) uniform and complete IgG layers of similar mass and thickness on the two types of SLB; 2) a higher-viscosity/less rigid IgG layer on the SLB with 4.6 nm inter-DSPE-PEG-N3 spacing. Our studies provide a blueprint for SLBs modeling spatial control of functional macromolecules on lipid surfaces, including surfaces of lipid nanoparticles and cells.

Recent Advances in Nanomedicine for Ocular Fundus Neovascularization Disease Management

As an indispensable part of the human sensory system, visual acuity may be impaired and even develop into irreversible blindness due to various ocular pathologies. Among ocular diseases, fundus neovascularization diseases (FNDs) are prominent etiologies of visual impairment worldwide. Intravitreal injection of anti-vascular endothelial growth factor drugs remains the primary therapy but is hurdled by common complications and incomplete potency. To renovate the current therapeutic modalities, nanomedicine emerged as the times required, which is endowed with advanced capabilities, able to fulfill the effective ocular fundus drug delivery and achieve precise drug release control, thus further improving the therapeutic effect. This review provides a comprehensive summary of advances in nanomedicine for FND management from state-of-the-art studies. First, the current therapeutic modalities for FNDs are thoroughly introduced, focusing on the key challenges of ocular fundus drug delivery. Second, nanocarriers are comprehensively reviewed for ocular posterior drug delivery based on the nanostructures: polymer-based nanocarriers, lipid-based nanocarriers, and inorganic nanoparticles. Thirdly, the characteristics of the fundus microenvironment, their pathological changes during FNDs, and corresponding strategies for constructing smart nanocarriers are elaborated. Furthermore, the challenges and prospects of nanomedicine for FND management are thoroughly discussed.

Multifunctional modifications of polyetheretherketone implants for bone repair: A comprehensive review

Polyetheretherketone (PEEK) has emerged as a highly promising orthopedic implantation material due to its elastic modulus which is comparable to that of natural bone. This polymer exhibits impressive properties for bone implantation such as corrosion resistance, fatigue resistance, self-lubrication and chemical stability. Significantly, compared to metal-based implants, PEEK implants have mechanical properties that are closer to natural bone, which can mitigate the "stress shielding" effect in bone implantation. Nevertheless, PEEK is incapable of inducing osteogenesis due to its bio-inert molecular structure, thereby hindering the osseointegration process. To optimize the clinical application of PEEK, researchers have been working on promoting its bioactivity and endowing this polymer with beneficial properties, such as antibacterial, anti-inflammatory, anti-tumor, and angiogenesis-promoting capabilities. Considering the significant growth of research on PEEK implants over the past 5 years, this review aims to present a timely update on PEEK's modification methods. By highlighting the latest advancements in PEEK modification, we hope to provide guidance and inspiration for researchers in developing the next generation bone implants and optimizing their clinical applications.

pH-Responsive Cobalt(II)-Coordinated Assembly Containing Quercetin for Antimicrobial Applications

The development of novel drug delivery systems (DDSs) with promising antibacterial properties is essential for facing the emergency of increasing resistance to antimicrobial agents. The antibacterial features of quercetin and its metal complexes have been broadly investigated. However, several drawbacks affect their activity and effectiveness. In this work, we propose a DDS based on a pH-responsive cobalt(II)-coordinated assembly containing quercetin and polyacrylic acid. This system is suggested to trigger the release of the model drug in a pH-dependent mode by exploiting the localized acidic environment at the bacterial infection sites under anaerobic conditions. The delivery system has been designed by accurately examining the species and the multiple equilibria occurring in solution among the assembly components. The formation of cobalt(II) complexes with quercetin in the absence or presence of the pH-responsive polyacrylic acid was investigated in buffered aqueous solution at pH 7.4 using spectrophotometric (UV-Vis) and calorimetric (ITC) techniques. The determined binding affinities and thermodynamic parameters that resulted are essential for the development of a DDS with improved binding and release capabilities. Furthermore, the affinity of the polymer-cobalt(II) complex toward the model antimicrobial flavonoid was explored at the solid-liquid interface by quartz crystal microbalance (QCM-D) experiments, which provided marked evidence for drug loading and release under pH control.

Recent nanotechnology-based strategies for interfering with the life cycle of bacterial biofilms

Biofilm formation plays an important role in the resistance development in bacteria to conventional antibiotics. Different properties of the bacterial strains within biofilms compared with their planktonic states and the protective effect of extracellular polymeric substances contribute to the insusceptibility of bacterial cells to conventional antimicrobials. Although great effort has been devoted to developing novel antibiotics or synthetic antibacterial compounds, their efficiency is overshadowed by the growth of drug resistance. Developments in nanotechnology have brought various feasible strategies to combat biofilms by interfering with the biofilm life cycle. In this review, recent nanotechnology-based strategies for interfering with the biofilm life cycle according to the requirements of different stages are summarized. Additionally, the importance of strategies that modulate the bacterial biofilm microenvironment is also illustrated with specific examples. Lastly, we discussed the remaining challenges and future perspectives on nanotechnology-based strategies for the treatment of bacterial infection.

Infection-responsive long-term antibacterial bone plates for open fracture therapy

The infections in open fracture induce high morbidity worldwide. Thus, developing efficient anti-infective orthopedic devices is of great significance. In this work, we designed a kind of infection-responsive long-term antibacterial bone plates. Through a facile and flexible volatilization method, a multi-aldehyde polysaccharide derivative, oxidized sodium alginate, was crosslinked with multi-amino compounds, gentamycin and gelatin, to fabricate a uniform coating on Ti bone plates via Schiff base reaction, which was followed by a secondary crosslinking process by glutaraldehyde. The double-crosslinked coating was stable under normal condition, and could responsively release gentamycin by the triggering of the acidic microenvironment caused by bacterial metabolism, owning to the pH-responsiveness of imine structure. The thickness of the coating was ranging from 22.0 μm to 63.6 μm. The coated bone plates (Ti-GOGs) showed infection-triggered antibacterial properties (>99%) and high biocompatibility. After being soaked for five months, it still possessed efficient antibacterial ability, showing its sustainable antibacterial performance. The in vivo anti-infection ability was demonstrated by an animal model of infection after fracture fixation (IAFF). At the early stage of IAFF, Ti-GOGs could inhibit the bacterial infection (>99%). Subsequently, Ti-GOGs could promote recovery of fracture of IAFF. This work provides a convenient and universal strategy for fabrication of various antibacterial orthopedic devices, which is promising to prevent and treat IAFF.

Research progress of stimulus-responsive antibacterial materials for bone infection

Infection is one of the most serious complications harmful to human health, which brings a huge burden to human health. Bone infection is one of the most common and serious complications of fracture and orthopaedic surgery. Antibacterial treatment is the premise of bone defect healing. Among all the antibacterial strategies, irritant antibacterial materials have unique advantages and the ability of targeted therapy. In this review, we focus on the research progress of irritating materials, the development of antibacterial materials and their advantages and disadvantages potential applications in bone infection.

Composing On-Program Triggers and On-Demand Stimuli into Biosensor Drug Carriers in Drug Delivery Systems for Programmable Arthritis Therapy

Medication in arthritis therapies is complex because the inflammatory progression of rheumatoid arthritis (RA) and osteoarthritis (OA) is intertwined and influenced by one another. To address this problem, drug delivery systems (DDS) are composed of four independent exogenous triggers and four dependent endogenous stimuli that are controlled on program and induced on demand, respectively. However, the relationships between the mechanisms of endogenous stimuli and exogenous triggers with pathological alterations remain unclear, which results in a major obstacle in terms of clinical translation. Thus, the rationale for designing a guidance system for these mechanisms via their key irritant biosensors is in high demand. Many approaches have been applied, although successful clinical translations are still rare. Through this review, the status quo in historical development is highlighted in order to discuss the unsolved clinical difficulties such as infiltration, efficacy, drug clearance, and target localisation. Herein, we summarise and discuss the rational compositions of exogenous triggers and endogenous stimuli for programmable therapy. This advanced active pharmaceutical ingredient (API) implanted dose allows for several releases by remote controls for endogenous stimuli during lesion infections. This solves the multiple implantation and local toxic accumulation problems by using these flexible desired releases at the specified sites for arthritis therapies.

Oxidized Chitosan-Tobramycin (OCS-TOB) Submicro-Fibers for Biomedical Applications

Chitosan (CS) is a biodegradable, biocompatible, and non-toxic natural amino-poly-saccharide with antibacterial ability, owing to its positively charged amino groups. However, the low charge density leads to poor antibacterial efficiency which cannot meet the biomedical application requirements. In this study, Tobramycin (TOB) was grafted onto the backbone of oxidized chitosan (OCS) to synthesize oxidized chitosan-tobramycin (OCS-TOB). FTIR, ¹H NMR and elemental analysis results demonstrated that OCS-TOB was successfully synthesized. OCS-TOB/PEO composite fibrous materials were produced by a self-made centrifugal spinning machine. In vitro experiments showed that cells proliferated on the submicro-fibrous OCS-TOB/PEO of appropriate concentration, and the antibacterial ability of OCS-TOB was much improved, compared with pristine CS. The results demonstrated that OCS-TOB/PEO nanofibrous materials could potentially be used for biomedical applications.

Stimuli-Responsive Antibacterial Materials: Molecular Structures, Design Principles, and Biomedical Applications

Infections are regarded as the most severe complication associated with human health, which are urgent to be solved. Stimuli-responsive materials are appealing therapeutic platforms for antibacterial treatments, which provide great potential for accurate theranostics. In this review, the advantages, the response mechanisms, and the key design principles of stimuli-responsive antibacterial materials are highlighted. The biomedical applications, the current challenges, and future directions of stimuli-responsive antibacterial materials are also discussed. First, the categories of stimuli-responsive antibacterial materials are comprehensively itemized based on different sources of stimuli, including external physical environmental stimuli (e.g., temperature, light, electricity, salt, etc.) and bacterial metabolites stimuli (e.g., acid, enzyme, redox, etc.). Second, structural characteristics, design principles, and biomedical applications of the responsive materials are discussed, and the underlying interrelationships are revealed. The molecular structures and design principles are closely related to the sources of stimuli. Finally, the challenging issues of stimuli-responsive materials are proposed. This review will provide scientific guidance to promote the clinical applications of stimuli-responsive antibacterial materials.

Ionic interaction-driven switchable bactericidal surfaces

Bacteria in the external environment inevitably invade the wound and subsequently colonize the wound surface during surgery and biomedical operations, which slows down the process of wound healing and tissue repair; this poses a significant threat to human health. Therefore, the development of an intelligent antibacterial surface has become the focus of research in the field of antimicrobial strategies, which has important social and economic significance. Here, we present a simple approach of producing an ionic interaction-driven anionic activation substratum which is then functionalized with cationic molecules through coulombic interactional immobilization. The switchable multifunctional antibacterial surface can decrease bacterial attachment and inactivate the attached microorganisms, thus overcoming the conventional challenge for antibacterial surfaces. Briefly, poly (3-sulfopropyl methacrylate potassium salt) (PSPMA) brushes were constructed by surface-initiated atom transfer radical polymerization on silicon or cotton fabric substrates, and a positive-charged component, namely lysozyme (LYZ), hexadecyl trimethyl ammonium bromide (CTAB) or chitosan (CS), was loaded on negative-charged sulfonate groups through electrostatic interactions. The resultant brush-grafted surfaces exhibited more than ∼95.5% bactericidal efficacy and ∼92.8% release rate after the introduction of an adequate amount of contra-ions (1.0 M; Na⁺ & Cl^-) against both Gram-negative Escherichia coli and Gram-positive Staphylococcus aureus, thus achieving a regenerated surface through the cyclic process of "assembly-dissociation". Smart cotton fabric (Fabric-PSPMA/LYZ and Fabric-PSPMA/CS) surfaces were constructed, which were found to promote wound epidermal tissue regeneration with a higher efficiency after 7-day in vivo studies. This ionic interaction-driven method used in the present work is simple and can reversibly renew antibacterial surfaces, which will help in the wider utilization of switchable antibacterial materials with a more ecologic and economic significance. STATEMENT OF SIGNIFICANCE: Smart antibacterial surfaces with renewable characteristics have attracted considerable interests over the past few years. Here, we used ionic interaction-driven force to manipulate dynamic conformational changes in PSPMA surface brushes, accompanied by highly switchable bacteria killing and bacteria releasing behaviors. Different cationic molecules were also designed for assembly/dissociation on the PSPMA-modified surfaces, and the essential parameters, including chemical structures, molecular weight, and cationic charge density, were investigated. With the refined structural combinations and the balance of bacteria killing/bacteria releasing behaviors, smart cotton fabrics (e.g., Fabric-PSPMA/lysozyme and Fabric-PSPMA/chitosan) were designed that could promote wound healing and tissue repair. These results contribute to the fundamental understanding of a switchable cationic-anionic pair design and the corresponding practical, renewable, highly antibacterial fabric.

Challenges and solutions in polymer drug delivery for bacterial biofilm treatment: A tissue-by-tissue account

To tackle the emerging antibiotic resistance crisis, novel antimicrobial approaches are urgently needed. Bacterial communities (biofilms) are a particular concern in this context. Biofilms are responsible for most human infections and are inherently less susceptible to antibiotic treatments. Biofilms have been linked with several challenging chronic diseases, including implant-associated osteomyelitis and chronic wounds. The specific local environments present in the infected tissues further contribute to the rise in antibiotic resistance by limiting the efficacy of systemic antibiotic therapies and reducing drug concentrations at the infection site, which can lead to reoccurring infections. To overcome the shortcomings of systemic drug delivery, encapsulation within polymeric carriers has been shown to enhance antimicrobial efficacy, permeation and retention at the infection site. In this Review, we present an overview of current strategies for antimicrobial encapsulation within polymeric carriers, comparing challenges and solutions on a tissue-by-tissue basis. We compare challenges and proposed drug delivery solutions from the perspective of the local environments for biofilms found in oral, wound, gastric, urinary tract, bone, pulmonary, vaginal, ocular and middle/inner ear tissues. We will also discuss future challenges and barriers to clinical translation for these therapeutics. The following Review demonstrates there is a significant imbalance between the research focus being placed on different tissue types, with some targets (oral and wound biofims) being extensively more studied than others (vaginal and otitis media biofilms and endocarditis). Furthermore, the importance of the local tissue environment when selecting target therapies is demonstrated, with some materials being optimal choices for certain sites of bacterial infection, while having limited applicability in others.

Electrochemical immunosensor based on mussel inspired coating for simultaneous detection and elimination of Staphylococcus aureus in drinks

Staphylococcus aureus (S. aureus) is one of the most commonly isolated foodborne pathogens, and is considered as a major cause of foodborne illnesses worldwide. However, the development of smart and accurate analytical methods for the simultaneous detection and elimination of S. aureus in matrices of food or drinks remains challenging. In the present work, a mussel-inspired material, ε-poly-l-lysine-3,4-dihydroxy benzaldehyde (EPD), was designed and fabricated based on its Schiff base structure. Owing to the robust ability of the material to adhere onto wet electrode surfaces and the pH-responsive properties of EPD, the prepared immunosensor exhibited an excellent detection limit and linear range with on-demand antibacterial activity. In real milk samples, the average values obtained from the immunosensor were approximate to the standard results obtained from the plate count method, and the relative standard deviation was 3.16–6.54%, suggesting the good accuracy of the developed method. Moreover, it exhibited good selectivity, reproducibility, and stability, thus demonstrating the potential significant applications of the electrochemical immunosensor in drinks safety monitoring.

A smart electrochemical immunosensor for the detection and elimination of Staphylococcus aureus in food with on-demand antibacterial activity.

Hybrid silver-gold nanoparticles suppress drug resistant polymicrobial biofilm formation and intracellular infection

Over decades bacteria have evolved multiple mechanisms to fight antibiotics. Biofilm formation by bacteria is one such mechanism as it forms a barrier and creates an acidic environment that reduces the efficiency of antimicrobials. Bacteria have also developed the ability to persist intracellularly within mammalian cells, causing recurrent infections. Many antibiotics are rendered ineffective due to poor penetration across biofilms and within mammalian cells. In this study, silver-gold hybrid nanoparticles were developed as anti-microbial agents to combat biofilm formation and intracellular infections. Biogenic hybrid silver gold nanoparticles were developed in an organic solvent free single reaction mixture using quercetin, a flavonoid, as the reducing and stabilizing agent. Silver-gold nanoparticles of 40 ± 10 nm diameter were effective against a broad spectrum of bacteria with minimum bactericidal concentrations of 10 μg ml-1 and 20 μg ml-1 for Gram negative and Gram-positive organisms, respectively. These nanoparticles were also effective against mixed infections at 20 μg ml-1. Their mode of action involves generating intracellular oxidative stress in both Gram negative and Gram-positive bacteria, which causes damage to the cell wall. Polymicrobial biofilm formation was suppressed and intracellular infection was reduced by 70% to 90% in fibroblast and monocyte cell lines. These results indicate that hybrid silver gold nanoparticles are promising agents to suppress biofilm formation and tackle intracellular infections.

Polymers with Hemiaminal Ether Linkages for pH-Responsive Antibacterial Materials

Antibacterial materials containing biocides suffer from the fact that biocides are usually quickly released and hence display a limited antibacterial ability over a long period of time. To overcome this problem, the antibacterial agent 6-chloropurine is conjugated to a monomer via a hemiaminal ether linkage. The functional monomer is then reacted with a urethane acrylate by photopolymerization to yield thin polymer coatings. The release of the antibacterial agent from the coatings is sustained due to the slow kinetics of the hydrolysis of the hemiaminal ether linkage. Antibacterial performance is achieved against S. aureus and E. coli bacteria. This simple strategy can be applied for the rapid preparation of antibacterial coatings on various substrates and other applications such as antifouling or anticorrosion coatings.

Antibacterial activity of an NIR-induced Zn ion release film

Photothermal therapy originated from using gold nanorods (GNRs) and near-infrared (NIR) irradiation has been widely used in the antibacterial field. Zn element exhibits antimicrobial activity against various bacterial and fungal strains. In this study, a bilayer film, consisting of GNRs as the inner layer and a polydopamine layer containing Zn element (PDA@Zn) as the outer layer, was deposited on the Ti surface. The results testified that all the GNR-modified surfaces had the same photothermal conversion efficiency. The Ti surface modified with GNR and PDA@Zn layers had better antibacterial activity against E. coli and S. aureus due to the GNR-induced photothermal effect and the antibacterial Zn element. Moreover, the accelerated release of Zn ions from the PDA@Zn layer was attributed to the GNR-induced high temperature under the NIR irradiation, which caused the concentration of Zn ions to be high enough to kill the surrounding bacteria. This study illustrates that a composite surface possessing both the contact and heat-responsive antibacterial property was constructed on titanium for potential clinical applications.

Polymeric Nitric Oxide Delivery Nanoplatforms for Treating Cancer, Cardiovascular Diseases, and Infection

The shortened Abstract is as follows: Therapeutic gas nitric oxide (NO) has demonstrated the unique advances in biomedical applications due to its prominent role in regulating physiological/pathophysiological activities in terms of vasodilation, angiogenesis, chemosensitizing effect, and bactericidal effect. However, it is challenging to deliver NO, due to its short half-life (<5 s) and short diffusion distances (20-160 µm). To address these, various polymeric NO delivery nanoplatforms (PNODNPs) have been developed for cancer therapy, antimicrobial and cardiovascular therapeutics, because of the important advantages of polymeric delivery nanoplatforms in terms of controlled release of therapeutics and the extremely versatile nature. This reviews highlights the recent significant advances made in PNODNPs for NO storing and targeting delivery. The ideal and unique criteria that are required for PNODNPs for treating cancer, cardiovascular diseases and infection, respectively, are summarized. Hopefully, effective storage and targeted delivery of NO in a controlled manner using PNODNPs could pave the way for NO-sensitized synergistic therapy in clinical practice for treating the leading death-causing diseases.

New Smart Antimicrobial Hydrogels, Nanomaterials, and Coatings: Earlier Action, More Specific, Better Dosing?

To fight against antibiotic-resistant bacteria adhering and developing on medical devices, which is a growing problem worldwide, researchers are currently developing new "smart" materials and coatings. They consist in delivery of antimicrobial agents in an intelligent way, i.e., only when bacteria are present. This requires the use of new and sophisticated tools combining antimicrobial agents with lipids or polymers, synthetic and/or natural. In this review, three classes of innovative materials are described: hydrogels, nanomaterials, and thin films. Moreover, smart antibacterial materials can be classified into two groups depending on the origin of the stimulus used: those that respond to a nonbiological stimulus (light, temperature, electric and magnetic fields) and those that respond to a biological stimulus related to the presence of bacteria, such as changes in pH or bacterial enzyme secretion. The bacteria presence can induce a pH change that constitutes a first potential biological trigger allowing the system to become active. A second biological trigger signal consists in enzymes produced by bacteria themselves. A complete panel of recent studies will be given focusing on the design of such innovative smart materials that are sensitive to biological triggers.

Extracellular matrix scaffold crosslinked with vancomycin for multifunctional antibacterial bone infection therapy

The treatment of acute and chronic bone infections remains a major clinical challenge. The various factors released by the bacteria, acidic environment, and bacterial colonies in the bone grooves and implanted synthetic materials collectively promote the formation of biofilms. Dormant bacteria and biofilms cause infections that are difficult to cure and that can develop chronically. Therefore, a new antibacterial material was synthesized in the present study for multifunctional bone infection therapy and consists of specific demineralized extracellular cancellous bone (SDECM) crosslinked with vancomycin (Van) by means of electrostatic interactions and chemical bonds. It was verified in vitro that the new material (Van-SDECM) not only has pH-sensitive release and biofilm inhibition properties, but also maintains sustained bactericidal ability accompanied by the degradation of the scaffold, which does not affect its favorable osteogenic performance. The infectious bone defect in vivo model further confirms the comprehensive anti-infective and osteogenic ability of the Van-SDECM. Further, these favorable properties are due to the pH-sensitive sustained release sterilization and scaffold contact antibacterial properties, accompanied by osteoclast activity inhibition, osteogenesis promotion and immunoregulation effects. This study provides a new drug-scaffold composite preparation method based on a native-derived extracellular matrix scaffold.

Self-Adaptive Antibacterial Coating for Universal Polymeric Substrates Based on a Micrometer-Scale Hierarchical Polymer Brush System

Surface-tethered hierarchical polymer brushes find wide applications in the development of antibacterial surfaces due to the well-defined spatial distribution and the separate but complementary properties of different blocks. Existing methods to achieve such polymer brushes mainly focused on inorganic material substrates, precluding their practical applications on common medical devices. In this work, a hierarchical polymer brush system is proposed and facilely constructed on polymeric substrates via light living graft polymerization. The polymer brush system with micrometer-scale thickness exhibits a unique hierarchical architecture consisting of a poly(hydroxyethyl methacrylate) (PHEMA) outer layer and an anionic inner layer loading with cationic antimicrobial peptide (AMP) via electrostatic attraction. The surface of this system inhibits the initial adhesion of bacteria by the PHEMA hydration outer layer under neutral pH conditions; when bacteria adhere and proliferate on this surface, the bacterially induced acidification triggers the cleavage of labile amide bonds within the inner layer to expose the positively charged amines and vigorously release melittin (MLT), allowing the surface to timely kill the adhering bacteria. The hierarchical surface employs multiple antibacterial mechanisms to combat bacterial infection and shows high sensitiveness and responsiveness to pathogens. A new paradigm is supplied by this modular hierarchical polymer brushes system for the progress of intelligent surfaces on universal polymer substrates, showing great potential to a promising strategy for preventing infection related to medical devices.

Self-defensive antimicrobial biomaterial surfaces

Self-defensive biomaterial surfaces are being developed in order to mitigate infection associated with tissue-contacting biomedical devices. Such infection occurs when microbes colonize the surface of a device and proliferate into a recalcitrant biofilm. A key intervention point centers on preventing the initial colonization. Incorporating antimicrobials within a surface coating can be very effective, but the traditional means of antimicrobial delivery by continuous elution can often be counterproductive. If there is no infection, continuous elution creates conditions that promote the development of resistant microbes throughout the patient. In contrast, a self-defensive coating releases antimicrobial only when and only where there is a microbial challenge to the surface. Otherwise, the antimicrobial remains sequestered within the coating and does not contribute to the development of resistance. A self-defensive surface requires a local trigger that signals the microbial challenge. Three such triggers have been identified as: (1) local pH lowering; (2) local enzyme release; and (3) direct microbial-surface contact. This short review highlights the need for self-defensive surfaces in the general context of the device-infection problem and then reviews key biomaterials developments associated with each of these three triggering mechanisms.

Recent advances in pH-responsive nanomaterials for anti-infective therapy

The design and synthesis of pH-responsive antibacterial nanomaterials and their applications in anti-infective therapy.

Responsive Assembly of Silver Nanoclusters with a Biofilm Locally Amplified Bactericidal Effect to Enhance Treatments against Multi-Drug-Resistant Bacterial Infections

Bacterial biofilms pose a major threat to public health because they are resistant to most current therapeutics. Conventional antibiotics exhibit limited penetration and weakened activity in the acidic microenvironment of a biofilm. Here, the development of biofilm-responsive nanoantibiotics (rAgNAs) composed of self-assembled silver nanoclusters and pH-sensitive charge reversal ligands, whose bactericidal activity can be selectively boosted in the biofilm microenvironment, is reported. Under neutral physiological conditions, the bactericidal activity of rAgNAs is self-quenched because the toxic silver ions' release is largely inhibited; however, upon entry into the acidic biofilm microenvironment, the rAgNAs not only exhibit charge reversal to facilitate local accumulation and retention but also disassemble into small silver nanoclusters, thus enabling deep penetration and accelerated silver ions release for dramatically amplified bactericidal activity. The superior antibiofilm activity of rAgNAs is demonstrated both in vitro and in vivo, and the mortality rate of mice with multi-drug-resistant biofilm-induced severe pyomyositis can be significantly reduced by rAgNAs treatment, indicating the immense potential of rAgNAs as highly efficient nanoscale antibacterial agents to combat resistant bacterial biofilm-associated infections.

Biomaterial surfaces self-defensive against bacteria by contact transfer of antimicrobials

Despite extensive engineering of tissue-contacting biomedical devices to control healing, these devices remain susceptible to bacterial colonization, biofilm formation, and chronic infection. The threat of selecting for resistance genes largely precludes sustained antimicrobial elution as a wide-spread clinical solution. In response, self-defensive surfaces have been developed where antimicrobial is released only when and where there is a bacterial challenge. We explore a new self-defensive approach using anionic microgels into which small-molecule cationic antimicrobials are loaded by complexation. We identify conditions where antimicrobial remains sequestered within the microgels for periods as long as weeks. However, bacterial contact triggers release and leads to local bacterial killing. We speculate that the close proximity of bacteria alters the local thermodynamic environment and interferes with the microgel-antimicrobial complexation. The contact-transfer approach does not require bacterial metabolism but instead appears to be driven by differences between the microgels and the bacterial cell envelope where there is a high concentration of negative charge and hydrophobicity. Contact with metabolizing macrophages or osteoblasts is, however, insufficient to trigger antimicrobial release, indicating that contact transfer can be specific to bacteria and suggesting an avenue to biomedical device surfaces that can simultaneously promote healing and resist infection.

Enhanced of antibacterial activity of antibiotic-functionalized silver nanocomposites with good biocompatibility

Antimicrobial resistance to traditional antibiotics leads to a serious concern for medical care owing to ineffective antibiotic therapies. This study focused on the preparation of silver nanocomposites (AgNPs@Tob&PAGA) by modifying AgNPs with tobramycin (Tob) and carbohydrate polymer of poly(2-(acrylamido) glucopyranose) (PAGA). The enhanced antibacterial activities of nanocomposites against common pathogens of Escherichia coli (E. coli) and Staphylococcus aureus (S. aureus) were explored. The introduction of PAGA onto silver nanocomposites improved both citocompatibility and antibacterial activity. Compared with nude Tob, AgNPs@Tob&PAGA showed more fascinating antimicrobial effect against E. coli and S. aureus with about 20-fold increase in the antibacterial activity, simultaneously no detectable resistance was observed. Consequently, the silver nanocomposite as an antimicrobial agent presents promising prospects in the treatment of bacterial infections caused by antimicrobial resistant bacteria.

Responsive and Synergistic Antibacterial Coatings: Fighting against Bacteria in a Smart and Effective Way

Antibacterial coatings that eliminate initial bacterial attachment and prevent subsequent biofilm formation are essential in a number of applications, especially implanted medical devices. Although various approaches, including bacteria-repelling and bacteria-killing mechanisms, have been developed, none of them have been entirely successful due to their inherent drawbacks. In recent years, antibacterial coatings that are responsive to the bacterial microenvironment, that possess two or more killing mechanisms, or that have triggered-cleaning capability have emerged as promising solutions for bacterial infection and contamination problems. This review focuses on recent progress on three types of such responsive and synergistic antibacterial coatings, including i) self-defensive antibacterial coatings, which can "turn on" biocidal activity in response to a bacteria-containing microenvironment; ii) synergistic antibacterial coatings, which possess two or more killing mechanisms that interact synergistically to reinforce each other; and iii) smart "kill-and-release" antibacterial coatings, which can switch functionality between bacteria killing and bacteria releasing under a proper stimulus. The design principles and potential applications of these coatings are discussed and a brief perspective on remaining challenges and future research directions is presented.

Construction of Self-defensive Antibacterial and Osteogenic AgNPs/Gentamicin Coatings with Chitosan as Nanovalves for Controlled release

To solve the Ti implants-associated infection and poor osseointegration problems, we have constructed the AgNPs/gentamicin (Gen)-loaded silk fibroin (SF) coating with acceptable antibacterial and osteogenic aptitude. Nevertheless, due to uncontrollably sustained drug release, this bactericidal coating encountered some tricky problems, such as local high Ag concentration, short life-span and potential cytotoxicity. In this work, a chitosan (CS) barrier layer was constructed to prebuilt the SF-based film by two means, dip-coating (DCS) and spin-coating (SCS). Intriguingly, the CS barrier layer constructed by spin-coating highly improved the hydrophilic and protein-absorbed performances. As verified in the release profile, both coatings showed a prolonged and pH-dependent pattern of Ag⁺ with an accelerated release in acidic condition. Also, the multilayer coating with a SCS barrier layer showed an apparent bacteria-trigged antibacterial and biofilm-inhibited performances, whereas the improvements of antibacterial abilities of DCS coating were limited. The mechanisms could be explained that the pH decrease induced by the attachment and proliferation of bacteria triggered collapse of CS barrier layer, accelerating the release of bactericides. Moreover, benefitted from pH-dependent release behavior of Ag and bioactive SCS layer, functional coatings highly enhanced the initial adhesion, migration and proliferation of preosteoblast MC3T3-E1 cells, and subsequently accelerated osteoblast differentiation (alkaline phosphatase production). A relevant aspect of this work was to demonstrate the essential effect of reasonable construction of self-defensive barrier layer in achieving the balance between the high-efficiency bacterial killing and osteogenic activity, and highlighted its excellent potential in clinical applications.

N-halamine-based multilayers on titanium substrates for antibacterial application

Bacterial infection is one of the most severe postoperative complications leading to clinical orthopedic implants failure. To improve the antibacterial property of titanium (Ti) substrates, a bioactive coating composed of chitosan-1-(hydroxymethyl)- 5,5-dimethylhydantoin (Chi-HDH-Cl) and gelatin (Gel) was fabricated via layer-by-layer (LBL) assembly technique. The results of Fourier transform infrared spectroscopy (FTIR), nuclear magnetic resonance (¹HNMR) and X-ray photoelectron spectroscopy (XPS) showed that Chi-HHD-Cl conjugate was successfully synthesized. Scanning electron microscopy (SEM), atomic force microscope (AFM) and water contact angle measurements were employed to monitor the morphology, roughness changes and surface wettability of Ti substrates, which proved the multilayers coating formation. Antibacterial assay against Escherichia coli (E. coli) and Staphylococcus aureus (S. aureus) revealed that the Gel/Chi-HDH-Cl modified Ti substrates most efficiently inhibited the adhesion and growth of bacteria. Meanwhile, in vitro cellular tests confirmed that Gel/Chi-HDH-Cl multilayers had no obvious cytotoxicity to osteoblasts. The study thus provides a promising method to fabricate antibacterial Ti-based substrates for potential orthopedic application.

A Nanocomposite Hydrogel with Potent and Broad-Spectrum Antibacterial Activity

Local bacterial infection is a challenging task and still remains a serious threat to human health in clinics. Systemic administration of antibiotics has only short-term antibacterial activity and usually causes adverse effects and bacterial resistance. A bioadhesive hydrogel with broad-spectrum and on-demand antibiotic activity is highly desirable. Here, we designed a pH-responsive nanocomposite hydrogel via a Schiff base linkage between oxidized polysaccharides and cationic dendrimers encapsulated with silver nanoparticles. The antibacterial components, both the cationic dendrimers and silver species, could be released in response to the acidity generated by growing bacteria. The released cationic polymer and silver exhibited a synergistic effect in antibacterial activity, and thus, the nanocomposite hydrogel showed potent antibacterial activity against both Gram-negative ( Escherichia coli and Pseudomonas aeruginosa) and Gram-positive bacteria ( Staphylococcus epidermidis and Staphylococcus aureus). The gel showed superior in vivo antibacterial efficacy against S. aureus infection compared with a commercial silver hydrogel at the same silver concentration. In addition, no obvious hemolytic toxicity, cytotoxicity, and tissue and biochemical toxicity were observed for the antibacterial hydrogel after incubation with cells or implantation. This study provides a facile and promising strategy to develop smart hydrogels to treat local bacterial infections.

Electrophoretic deposition: a versatile tool against biomaterial associated infections

Biomaterial-associated infections (BAIs) are today considered as one of the most withering complications of orthopedic implant surgery. Even though BAIs occur relatively infrequently in primary joint replacement surgeries (incidence rates around 1-2%), revision arthroplasties carry up to 40% risk of infection recurrence, with devastating consequences for the patient and significant associated cost. Once the responsible pathogens, mainly bacteria, attach to the surface of the biomaterial, they start creating layers of extracellular matrix with complex architectures, called biofilms. These last mentioned, encapsulate and protect bacteria by hindering the immune response and impeding antibiotics from reaching the pathogens. To prevent such an outcome, the surface of the biomaterials, in particular implants, can be modified in order to play the role of inherent drug delivery devices or as substrates for antibacterial/multifunctional coating deposition. This paper presents an overview of novel electrochemically-triggered deposition strategies, with a focus on electrophoretic deposition (EPD), a versatile and cost-effective technique for organic and inorganic material deposition. Other than being a simple deposition tool, EPD has been recently employed to create novel micro/nanostructured surfaces for multi-purpose antibacterial approaches, presented in detail in this review. In addition, a thorough comparison and assessment of the latest antibacterial and multifunctional compounds deposited by means of EPD have been reported, followed by a critical reflection on current and future prospects of the topic. The relative simplicity of EPD's application, has, by some means, undermined the fundamental requirement of rationality of multifunctional coating design. The demanding practical needs for a successful clinical translation in the growing fields of tissue engineering and antibacterial/multifunctional implant coatings, calls for a more systematic in vitro experimental design rationale, in order to make amends for the scarcity of significant in vivo and clinical studies.

Bacterial adaptability of enzyme and pH dual-responsive surface for infection resistance

A major challenge in antibacterial surface preparation is the elaborated implement of controlled antibacterial agent delivery on demand. We present a bacterial hyaluronidase (HAase) and pH dual-responsive antimicrobial surface, with excellent biocompatibility under physiological conditions and releasing vancomycin (Van) once bacteria invade.

Polyelectrolyte multilayers for bio-applications: recent advancements

The synergistic relationship between structure and the bulk properties of polyelectrolyte multilayer (PEM) films has generated tremendous interest in their application for loading and release of bioactive species. Layer-by-layer assembly is the simplest, cost effective process for fabrication of such PEMs films, leading to one of the most widely accepted platforms for incorporating biological molecules with nanometre precision. The bulk reservoir properties of PEM films render them a potential candidate for applications such as biosensing, drug delivery and tissue engineering. Various biomolecules such as proteins, DNA, RNA or other desired molecules can be incorporated into the PEM stack via electrostatic interactions and various other secondary interactions such as hydrophobic interactions. The location and availability of the biological molecules within the PEM stack mediates its applicability in various fields of biomedical engineering such as programmed drug delivery. The development of advanced technologies for biomedical applications using PEM films has seen rapid progress recently. This review briefly summarises the recent successes of PEM being utilised for diverse bio-applications.

Competitive Adsorption of Polyelectrolytes onto and into Pellicle-Coated Hydroxyapatite Investigated by QCM-D and Force Spectroscopy

A current effort in preventive dentistry is to inhibit surface attachment of bacteria using antibacterial polymer coatings on the tooth surface. For the antibacterial coatings, the physisorption of anionic and cationic polymers directly onto hydroxyapatite (HA) and saliva-treated HA surfaces was studied using quartz crystal microbalance, force spectroscopy, and atomic force microscopy. First, single species adsorption is shown to be stronger on HA surfaces than on silicon oxide surfaces for all polymers (i.e., Gantrez, sodium hyaluronate (NaHa), and poly(allylamine-co-allylguanidinium) (PAA-G75)). It is observed through pH dependence of Gantrez, NaHa, and PAA-G75 adsorption on HA surfaces that anionic polymers swell at high pH and collapse at low pH, whereas cationic polymers behave in the opposite fashion. Thicknesses of Gantrez, NaHa, and PAA-G75 are 52 nm (46 nm), 35 nm (11 nm), and 6 nm (54 nm) at pH 7 (3.5), respectively. Second, absorption of charged polymer is followed by absorption of the oppositely charged polymer. Upon exposure of the anionic polymer layers, Gantrez and NaHa, to the cationic polymer, PAA-G75, films collapse from 52 to 8 nm and 35 to 11 nm, respectively. This decrease in film thickness is attributed to the electrostatic cross-linking between anionic and cationic polymers. Third, for HA surfaces pretreated with artificial saliva (AS), the total thickness decreases from 25 to 16 nm upon exposure to PAA-G75. Force spectroscopy is used to further investigate the PAA-G75/AS coating. The results show that the interaction between a negatively charged colloidal bead and the AS surface is strongly repulsive, whereas PAA-G75/AS is attractive but varies across the surface. Additionally, AFM studies show that AS/HA is smooth with a RMS roughness of 1.7 nm, and PAA-G75-treated AS/HA is rough (RMS roughness of 5.4 nm) with patches of polymer distributed across the surface with an underlying coating. The high roughness of PAA-G75 treated AS/HA is attributed to the strong adsorption of the relatively small PAA-G75 onto the heterogeneously distributed negatively charged AS surface. In addition, uptake of PAA-G75 by pellicle layer (saliva-treated HA surface) is observed, and the adsorbed amount of PAA-G75 on/into pellicle layer is ∼2 times more than that on/into AS layer. These studies show that polymer adsorption onto HA and saliva-coated HA depends strongly on the polymer type and size and that there is an electrostatic interaction between polymer and saliva and/or oppositely charged polymers that stabilizes the coatings on HA. Lastly, assessing the viability of the adherent bacteria collected from the PAA-G75-coated surfaces showed a significant reduction (∼93%) in bacterial viability when compared to bacteria collected from untreated and Gantrez-coated HA. These results suggest the potential antimicrobial activity of PAA-G75.

Nanomechanics of pH-Responsive, Drug-Loaded, Bilayered Polymer Grafts

Stimuli-responsive polymer films play an important role in the development of smart antibacterial coatings. In this study, we consider complementary architectures of polyelectrolyte films, including a thin chitosan layer (CH), poly(acrylic acid) (PAA) brushes, and a bilayer structure of CH grafted to PAA brushes (CH/PAA) as possible candidates for targeted drug delivery platforms. Atomic force microscopy (AFM) was employed to study the structure-mechanical property relationship for these mono- and bi-layered polymer grafts at pH 7.4 and 4.0, corresponding to physiological and biofilm formation conditions, respectively. Herein, the surface interactions between polymer grafts and the negatively charged silica colloid attached to an AFM lever are considered as representative interactions between the antibacterial coating and a bacteria/biofilm. The bilayered structure of CH/PAA showed significantly reduced adhesive interactions in comparison to pure CH but slightly higher interactions in comparison to PAA films. Among PAA and CH/PAA films, upon grafting CH over the PAA brushes, the normal stiffness increased by 10-fold at pH 7.4 and 20-fold at pH 4.0. Notably, the study also showed that the addition of an antibiotic drug such as multicationic Tobramycin (TOB) impacts the mechanical properties of the antibacterial coatings. Competition between TOB and water molecules for the PAA chains is shown to determine the structural properties of PAA and CH/PAA films loaded with TOB. At high pH (7.4), the TOB molecules, which remain multicationic, strongly interact with polyanionic PAA, thereby reducing the film's compressibility. On the contrary, at low pH (4.0), the water molecules preferentially interact with TOB in comparison to uncharged PAA chains and, upon TOB release, results in a stronger film collapse together with an increase in adhesive interactions between the probe, the surface, and the elastic modulus of the film. The bacterial proliferation on these platforms when compared to the measured mechanical properties shows a direct correlation; hence, understanding nanomechanical properties can provide insights into designing new antibacterial polymer coatings.

Recent coating developments for combination devices in orthopedic and dental applications: A literature review

Orthopedic and dental implants have been used successfully for decades to replace or repair missing or damaged bones, joints, and teeth, thereby restoring patient function subsequent to disease or injury. However, although device success rates are generally high, patient outcomes are sometimes compromised due to device-related problems such as insufficient integration, local tissue inflammation, and infection. Many different types of surface coatings have been developed to address these shortcomings, including those that incorporate therapeutic agents to provide localized delivery to the surgical site. While these coatings hold enormous potential for improving device function, the list of requirements that an ideal combination coating must fulfill is extensive, and no single coating system today simultaneously addresses all of the criteria. Some of the primary challenges related to current coatings are non-optimal release kinetics, which most often are too rapid, the potential for inducing antibiotic resistance in target organisms, high susceptibility to mechanical abrasion and delamination, toxicity, difficult and expensive regulatory approval pathways, and high manufacturing costs. This review provides a survey of the most recent developments in the field, i.e., those published in the last 2-3years, with a particular focus on technologies that have potential for overcoming the most significant challenges facing therapeutically-loaded coatings. It is concluded that the ideal coating remains an unrealized target, but that advances in the field and emerging technologies are bringing it closer to reality. The significant amount of research currently being conducted in the field provides a level of optimism that many functional combination coatings will ultimately transition into clinical practice, significantly improving patient outcomes.

Multifunctional biomaterial coatings: synthetic challenges and biological activity

A controlled interaction of materials with their surrounding biological environment is of great interest in many fields. Multifunctional coatings aim to provide simultaneous modulation of several biological signals. They can consist of various combinations of bioactive, and bioinert components as well as of reporter molecules to improve cell-material contacts, prevent infections or to analyze biochemical events on the surface. However, specific immobilization and particular assembly of various active molecules are challenging. Herein, an overview of multifunctional coatings for biomaterials is given, focusing on synthetic strategies and the biological benefits by displaying several motifs.

Construction of a temperature-responsive terpolymer coating with recyclable bactericidal and self-cleaning antimicrobial properties

Once a biomedical implant is implanted into a human body, proteins and bacteria can easily colonize the implant, and subsequently, a biofilm can grow on the surface. A biofilm can protect the inhabiting bacteria against macrophages and neutrophil cell attack from the host immune system. The most important issue for artificial antibacterial surfaces is the accumulation of the bacteria corpse after they are killed by contact, which promotes further adhesion of bacteria and biofilm formation. Therefore, we constructed a novel multifunctional bactericidal and fouling release antibacterial surface through the combination of temperature-responsive N-vinylcaprolactam (VCL), hydrophilic 2-methacryloyloxyethyl phosphorylcholine (MPC) and a bactericidal quaternary ammonium salt (2-(dimethylamino)-ethyl methacrylate (DMAEMA+)). The terpolymer coating was prepared through surface-initiated reversible addition-fragmentation chain-transfer (RAFT) polymerization and characterized using water contact angle measurements, atomic force microscopy and spectroscopic ellipsometry. At a temperature above the lower critical solution temperature (LCST), the P(VCL-co-DMAEMA+-co-MPC) terpolymer coating was in a compressed and hydrophobic state with low moisture content, which displayed bactericidal efficiency against Gram-positive Staphylococcus aureus. The coating could be switched into a relatively hydrophilic surface at a temperature below the LCST, which showed self-cleaning properties against both bacteria and bovine serum albumin. The functionalized surface showed good biocompatibility against human lens epithelial cells as evaluated by morphology studies and activity measurements.

Nonleaching Bacteria-Responsive Antibacterial Surface Based on a Unique Hierarchical Architecture

Bacteria-responsive surfaces popularly exert their smart antibacterial activities by bacteria-triggered delivery of antibacterial agents; however, the antibacterial agents should be additionally reloaded for the renewal of these surfaces. Herein, a reversible, nonleaching bacteria-responsive antibacterial surface is prepared by taking advantage of a hierarchical polymer brush architecture. In this hierarchical surface, a pH-responsive poly(methacrylic acid) (PMAA) outer layer serves as an actuator modulating the surface behavior on demand, while antimicrobial peptides (AMP) are covalently immobilized on the inner layer. The PMAA hydration layer renders the hierarchical surface resistant to initial bacterial attachment and biocompatible under physiological conditions. When bacteria colonize the surface, the bacteria-triggered acidification allows the outermost PMAA chains to collapse, therefore exposing the underlying bactericidal AMP to on-demand kill bacteria. In addition, the dead bacteria can be released once the PMAA chains resume their hydrophilicity because of the environmental pH increase. The functionality of the nonleaching surface is reversible without additional reloading of the antibacterial agents. This approach provides a new methodology for the development of smart surfaces in a variety of practical biomedical applications.