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Jiang C, Zhu G, Liu Q. Current application and future perspectives of antimicrobial degradable bone substitutes for chronic osteomyelitis. Front Bioeng Biotechnol 2024; 12:1375266. [PMID: 38600942 PMCID: PMC11004352 DOI: 10.3389/fbioe.2024.1375266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Accepted: 03/19/2024] [Indexed: 04/12/2024] Open
Abstract
Chronic osteomyelitis remains a persistent challenge for the surgeons due to its refractory nature. Generally, treatment involves extensive debridement of necrotic bone, filling of dead space, adequate antimicrobial therapy, bone reconstruction, and rehabilitation. However, the optimal choice of bone substitute to manage the bone defect remains debatable. This paper reviewed the clinical evidence for antimicrobial biodegradable bone substitutes in the treatment of osteomyelitis in recent years. Indeed, this combination was proved to eradicate infection and facilitate bone reconstruction, which might reduce the cost and hospital stay. Handling was associated with increased risk of unwanted side effect to affect bone healing. The study provides some valuable insights into the clinical evaluation of treatment outcomes in the aspects of infection eradication, bone reconstruction, and complications caused by materials. However, achieving complete infection eradication and subsequently perfect bone reconstruction remains challenging in compromised conditions, hence advanced innovative bone substitutes are imperative. In this review, we mainly focus on the desired functional effects of advanced bone substitutes on infection eradication and bone reconstruction from the future perspective. Handling property was optimized to simplify surgery process. It is expected that this review will provide an important opportunity to enhance the understanding of the design and application of innovative biomaterials to synergistically eradicate infection and restore integrity and function of bone.
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Affiliation(s)
- Chenxi Jiang
- Department of Stomatology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- School of Stomatology, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Hubei Province Key Laboratory of Oral and Maxillofacial Development and Regeneration, Wuhan, China
| | - Guangxun Zhu
- School of Stomatology, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Hubei Province Key Laboratory of Oral and Maxillofacial Development and Regeneration, Wuhan, China
- Department of Stomatology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Qian Liu
- Department of Stomatology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- School of Stomatology, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Hubei Province Key Laboratory of Oral and Maxillofacial Development and Regeneration, Wuhan, China
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2
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Gatti SD, Gaddi D, Turati M, Leone G, Arts JJ, Pessina F, Carminati M, Zatti G, De Rosa L, Bigoni M. Clinical outcomes and complications of S53P4 bioactive glass in chronic osteomyelitis and septic non-unions: a retrospective single-center study. Eur J Clin Microbiol Infect Dis 2024; 43:489-499. [PMID: 38195783 DOI: 10.1007/s10096-023-04737-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Accepted: 12/11/2023] [Indexed: 01/11/2024]
Abstract
INTRODUCTION Dead space management following debridement surgery in chronic osteomyelitis or septic non-unions is one of the most crucial and discussed steps for the success of the surgical treatment of these conditions. In this retrospective clinical study, we described the efficacy and safety profile of surgical debridement and local application of S53P4 bioactive glass (S53P4 BAG) in the treatment of bone infections. METHODS A consecutive single-center series of 38 patients with chronic osteomyelitis (24) and septic non-unions (14), treated with bioactive glass S53P4 as dead space management following surgical debridement between May 2015 and November 2020, were identified and evaluated retrospectively. RESULTS Infection eradication was reached in 22 out of 24 patients (91.7%) with chronic osteomyelitis. Eleven out of 14 patients (78.6%) with septic non-union achieved both fracture healing and infection healing in 9.1 ± 4.9 months. Three patients (7.9%) developed prolonged serous discharge with wound dehiscence but healed within 2 months with no further surgical intervention. Average patient follow-up time was 19.8 months ± 7.6 months. CONCLUSION S53P4 bioactive glass is an effective and safe therapeutic option in the treatment of chronic osteomyelitis and septic non-unions because of its unique antibacterial properties, but also for its ability to generate a growth response in the remaining healthy bone at the bone-glass interface.
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Affiliation(s)
| | - Diego Gaddi
- Department of Orthopedic Surgery, Policlinico San Pietro, Ponte San Pietro, Italy
| | - Marco Turati
- School of Medicine and Surgery, University of Milano, Bicocca, Monza, Italy.
- Orthopedic Department, IRCCS San Gerardo dei Tintori, Via Pergolesi, 33, 20900, Monza, Italy.
- Transalpine Center of Pediatric Sports Medicine and Surgery, University of Milano-Bicocca - Hospital Couple Enfant, Monza (Italy), Grenoble, France.
- Department of Paediatric Orthopedic Surgery, Hospital Couple Enfants, Grenoble Alpes University, Grenoble, France.
| | - Giulio Leone
- Orthopedic Department, IRCCS San Gerardo dei Tintori, Via Pergolesi, 33, 20900, Monza, Italy
| | - Jacobus J Arts
- Department Orthopaedic Biomechanics, Faculty Biomedical Engineering, Eindhoven University of Technology TU/e, Eindhoven, Netherlands
- Department Orthopaedic Surgery, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - Fabio Pessina
- School of Medicine and Surgery, University of Milano, Bicocca, Monza, Italy
| | - Mattia Carminati
- School of Medicine and Surgery, University of Milano, Bicocca, Monza, Italy
| | - Giovanni Zatti
- School of Medicine and Surgery, University of Milano, Bicocca, Monza, Italy
- Orthopedic Department, IRCCS San Gerardo dei Tintori, Via Pergolesi, 33, 20900, Monza, Italy
| | - Laura De Rosa
- School of Medicine and Surgery, University of Milano, Bicocca, Monza, Italy
- Orthopedic Department, IRCCS San Gerardo dei Tintori, Via Pergolesi, 33, 20900, Monza, Italy
| | - Marco Bigoni
- School of Medicine and Surgery, University of Milano, Bicocca, Monza, Italy
- Department of Orthopedic Surgery, Policlinico San Pietro, Ponte San Pietro, Italy
- Transalpine Center of Pediatric Sports Medicine and Surgery, University of Milano-Bicocca - Hospital Couple Enfant, Monza (Italy), Grenoble, France
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Epstein G, Ferreira N. Dead space management strategies in the treatment of chronic osteomyelitis: a retrospective review. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2023; 33:565-570. [PMID: 36112226 DOI: 10.1007/s00590-022-03392-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/16/2022] [Accepted: 09/02/2022] [Indexed: 10/14/2022]
Abstract
PURPOSE Dead space management is critically important during the treatment of chronic osteomyelitis. Many dead space management strategies are available, each with their respective advantages and shortcomings. This study aims to present the outcomes and complications of dead space management strategies employed in the treatment of chronic osteomyelitis at a single tertiary level musculoskeletal unit. METHODS A retrospective review of dead space management strategies employed at a tertiary-level musculoskeletal infection unit was conducted. Patients of any age treated for chronic osteomyelitis of the appendicular skeleton with a minimum follow-up of 6 months were included in the study. Data were collected regarding patient demographics, aetiology and site of infection, dead space management strategy employed, follow-up period and outcome in terms of resolution of infection. RESULTS A final cohort of 132 patients underwent surgical treatment with a dedicated dead space management strategy for chronic osteomyelitis of the appendicular skeleton. Eleven patients (8%) experienced a recurrence of infection. Seven patients (63%) with recurrence were type B hosts, while four patients (37%) were type A hosts. CONCLUSION Dead space management is an integral part of treating chronic osteomyelitis; however, no guidelines currently exist regarding the most appropriate strategy. Favourable results are achievable in low to middle-income countries, and it is evident that no dead space management strategy is superior to another. The pursuit for the ideal void filler is ongoing. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Gadi Epstein
- Division of Orthopaedic Surgery, Department of Surgical Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Nando Ferreira
- Division of Orthopaedic Surgery, Department of Surgical Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.
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Shearer A, Montazerian M, Sly JJ, Hill RG, Mauro JC. Trends and perspectives on the commercialization of bioactive glasses. Acta Biomater 2023; 160:14-31. [PMID: 36804821 DOI: 10.1016/j.actbio.2023.02.020] [Citation(s) in RCA: 16] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 02/08/2023] [Accepted: 02/09/2023] [Indexed: 02/18/2023]
Abstract
At least 25 bioactive glass (BG) medical devices have been approved for clinical use by global regulatory agencies. Diverse applications include monolithic implants, bone void fillers, dentin hypersensitivity agents, wound dressing, and cancer therapeutics. The morphology and delivery systems of bioactive glasses have evolved dramatically since the first devices based on 45S5 Bioglass®. The particle size of these devices has generally decreased with the evolution of bioactive glass technology but primarily lies in the micron size range. Morphologies have progressed from glass monoliths to granules, putties, and cements, allowing medical professionals greater flexibility and control. Compositions of these commercial materials have primarily relied on silicate-based systems with varying concentrations of sodium, calcium, and phosphorus. Furthermore, therapeutic ions have been investigated and show promise for greater control of biological stimulation of genetic processes and increased bioactivity. Some commercial products have exploited the borate and phosphate-based compositions for soft tissue repair/regeneration. Mesoporous BGs also promise anticancer therapies due to their ability to deliver drugs in combination with radiotherapy, photothermal therapy, and magnetic hyperthermia. The objective of this article is to critically discuss all clinically approved bioactive glass products. Understanding essential regulatory standards and rules for production is presented through a review of the commercialization process. The future of bioactive glasses, their promising applications, and the challenges are outlined. STATEMENT OF SIGNIFICANCE: Bioactive glasses have evolved into a wide range of products used to treat various medical conditions. They are non-equilibrium, non-crystalline materials that have been designed to induce specific biological activity. They can bond to bone and soft tissues and contribute to their regeneration. They are promising in combating pathogens and malignancies by delivering drugs, inorganic therapeutic ions, and heat for magnetic-induced hyperthermia or laser-induced phototherapy. This review addresses each bioactive glass product approved by regulatory agencies for clinical use. A review of the commercialization process is also provided with insight into critical regulatory standards and guidelines for manufacturing. Finally, a critical evaluation of the future of bioactive glass development, applications, and challenges are discussed.
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Affiliation(s)
- Adam Shearer
- Department of Materials Science and Engineering, The Pennsylvania State University, University Park, PA, USA
| | - Maziar Montazerian
- Northeastern Laboratory for Evaluation and Development of Biomaterials, Department of Materials Engineering, Federal University of Campina Grande, PB, Brazil
| | - Jessica J Sly
- Department of Materials Science and Engineering, The Pennsylvania State University, University Park, PA, USA
| | - Robert G Hill
- Institute of Dentistry, Dental Physical Sciences Unit, Queen Mary University of London, London, United Kingdom
| | - John C Mauro
- Department of Materials Science and Engineering, The Pennsylvania State University, University Park, PA, USA.
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Lazzeri S, Montagnani C, Zanardi A, Beltrami G, Galli L. Bioactive glass in the treatment of chronic osteomyelitis in children: Description of four consecutive cases and literature review. Injury 2022; 53:3317-3321. [PMID: 35817607 DOI: 10.1016/j.injury.2022.07.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 06/20/2022] [Accepted: 07/02/2022] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Chronic osteomyelitis in children is a rare condition. Debridement surgery, along with appropriate antibiotic therapy, is widely agreed to represent the best procedure in the treatment of chronic osteomyelitis but can result in an extensive dead space formation. In this study, we evaluated the use of bioactive glass to address dead space management. METHODS Four consecutive cases of chronic osteomyelitis treated with antibiotic therapy, one stage- surgical debridement and bioglass implantation between September 2016 and February 2017 were prospectively followed for a minimum of three years. Two cases followed acute hematogenous osteomyelitis, two cases followed fracture fixation. Clinical, histology, laboratory and radiographic findings were recorded. Primary endpoint was eradication of infection. Possible complication related to bioglass application were investigated. RESULTS All patients achieved healing at the latest follow-up of minimum three years. No successive surgical treatments were required at any time. No complications related to the bioglass were detected. Radiographic reconstruction of normal anatomy progressed through the years. CONCLUSIONS Bioglass for the treatment of dead space after surgical debridement appears a viable option in the treatment of chronic osteomyelitis in children.
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Affiliation(s)
- Simone Lazzeri
- Department of Orthopaedics and Traumatology, Meyer Children's Hospital, Viale Pieraccini, 24, Firenze, Italy.
| | | | - Alessandro Zanardi
- Department of Orthopaedics and Traumatology, Meyer Children's Hospital, Viale Pieraccini, 24, Firenze, Italy
| | - Giovanni Beltrami
- Department of Orthopaedics and Traumatology, Meyer Children's Hospital, Viale Pieraccini, 24, Firenze, Italy
| | - Luisa Galli
- Infectious Disease Unit, Meyer Children's Hospital, Firenze, Italy
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Wickramasinghe ML, Dias GJ, Premadasa KMGP. A novel classification of bone graft materials. J Biomed Mater Res B Appl Biomater 2022; 110:1724-1749. [DOI: 10.1002/jbm.b.35029] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2021] [Revised: 01/20/2022] [Accepted: 01/21/2022] [Indexed: 12/19/2022]
Affiliation(s)
- Maduni L. Wickramasinghe
- Department of Biomedical Engineering General Sir John Kotelawala Defense University Ratmalana Sri Lanka
| | - George J. Dias
- Department of Anatomy, School of Medical Sciences University of Otago Dunedin New Zealand
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Bioactive glass S53P4 to fill-up large cavitary bone defect after acute and chronic osteomyelitis treated with antibiotic-loaded cement beads: A prospective case series with a minimum 2-year follow-up. Injury 2021; 52 Suppl 3:S23-S28. [PMID: 34116851 DOI: 10.1016/j.injury.2021.05.030] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Revised: 05/03/2021] [Accepted: 05/05/2021] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Bioactive glass S53P4 (BAG-S53P4) has been used in the treatment of osteomyelitis with excellent results. The aim of this study was to evaluate the clinical and radiographic results of patients treated with use of antibiotic-loaded cement beads, followed by bone defects filling using bioglass. METHODS We treated a prospective series of patients presenting with acute or chronic osteomyelitis of a long bone of the upper or lower limb. The first-stage procedure involved debridement and filling of cavitary defects with antibiotic-loaded polymethylmethacrylate (PMMA) beads. When signs of infection subsided, the defects were filled with BAG-S53P4. The main outcomes assessed were the reinfection rate, need for reoperation, radiographic and functional evaluations (DASH and Lysholm scores). RESULTS Ten patients were included, aged between 4 and 66 years (mean 25.4 years). The source of infection was hematogenic in five cases and post-traumatic in the other five. Hematogenic infections required two debridements before filling with bioglass, whereas post-traumatic cases required only one. The time between the first debridement and the application of bioglass varied from 1 to 63 weeks (average of 17 weeks). All patients showed a favorable evolution after bioglass procedure, with no need for reoperation or relevant wound problems. The radiographic evaluation showed partial incorporation of the material and adequate bone formation, and functional scores were satisfactory in all cases. CONCLUSION The treatment of osteomyelitis with surgical debridement and PMMA beads, followed by filling of bone defect with BAG-S53P4, was effective in all patients evaluated, with adequate infectious control and bone regeneration. No cases required reoperation after bioglass implantation. Patients with hematogenous osteomyelitis required a greater number of debridements before filling with bioglass.
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8
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Ziegenhain F, Neuhaus V, Pape HC. Bioactive glass in the treatment of chronic osteomyelitis-a valid option? OTA Int 2021; 4:e105(1-4). [PMID: 37609479 PMCID: PMC10441679 DOI: 10.1097/oi9.0000000000000105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 11/10/2020] [Accepted: 12/11/2020] [Indexed: 08/24/2023]
Abstract
Chronic osteomyelitis continues to represent a challenge both for patients and the treating physician, especially in the presence of multiple germs. We performed a literature review assessing the current role of the indications of bioactive glass. We included studies about patients with chronic osteomyelitis that were treated with S53P4. A literature review of Medline via PubMed was performed. After the exclusion of case reports, 7 studies were included in the narrative review. Recurrence of infection was defined as the main outcome parameter. Six of 7 studies were retrospective, or case studies with a relatively small sample size (total patient number N = 274). The overall recurrence rate was 10.6%. Studies that compared the outcome of the treatment with S53P4 versus antibiotic-loaded polymethyl methacrylate (PMMA) revealed no significant difference. The data reviewed indicate that in cases of multiple bacteria and resistance to antibiotic treatment, bioglass may be a valuable treatment alternative to other forms of spacers (e.g., PMMA). This statement is limited by the fact that the number of described cases is very low. Therefore, a definitive statement of its effectiveness cannot be made at this point.
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9
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Steinhausen E, Lefering R, Glombitza M, Brinkmann N, Vogel C, Mester B, Dudda M. Reply to McNally's comment on "Bioactive glass S53P4 vs. autologous bone graft for filling defects in patients with chronic osteomyelitis and infected non-unions - a single center experience" by Steinhausen et al. (2021). J Bone Jt Infect 2021; 6:203-205. [PMID: 34123710 PMCID: PMC8188879 DOI: 10.5194/jbji-6-203-2021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Accepted: 05/04/2021] [Indexed: 11/11/2022] Open
Affiliation(s)
- Eva Steinhausen
- Department of Orthopedic and Trauma Surgery, BG Klinikum Duisburg, University of Duisburg-Essen, 47249 Duisburg, Germany.,Department of Trauma, Hand and Reconstructive Surgery, University Hospital Essen, University of Duisburg Essen, Essen, Germany
| | - Rolf Lefering
- Institute for Research in Operative Medicine (IFOM), University of Witten/Herdecke, Cologne, Germany
| | - Martin Glombitza
- Department of Orthopedic and Trauma Surgery, BG Klinikum Duisburg, University of Duisburg-Essen, 47249 Duisburg, Germany
| | - Nikolaus Brinkmann
- Department of Orthopedic and Trauma Surgery, BG Klinikum Duisburg, University of Duisburg-Essen, 47249 Duisburg, Germany
| | - Carsten Vogel
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Essen, University of Duisburg Essen, Essen, Germany
| | - Bastian Mester
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Essen, University of Duisburg Essen, Essen, Germany
| | - Marcel Dudda
- Department of Orthopedic and Trauma Surgery, BG Klinikum Duisburg, University of Duisburg-Essen, 47249 Duisburg, Germany.,Department of Trauma, Hand and Reconstructive Surgery, University Hospital Essen, University of Duisburg Essen, Essen, Germany
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McNally M. Comment on "Bioactive glass S53P4 vs. autologous bone graft for filling defects in patients with chronic osteomyelitis and infected non-unions - a single center experience" by Steinhausen et al. (2021). J Bone Jt Infect 2021; 6:199-201. [PMID: 34123709 PMCID: PMC8188880 DOI: 10.5194/jbji-6-199-2021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Accepted: 05/04/2021] [Indexed: 12/22/2022] Open
Affiliation(s)
- Martin McNally
- Oxford Bone Infection Unit, Nuffield Orthopaedic Centre, Oxford University Hospitals, Oxford, UK
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11
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Bagne L, Oliveira MA, Pereira AT, Caetano GF, Oliveira CA, Aro AA, Chiarotto GB, Santos GMT, Mendonça FAS, Santamaria-Jr M. Electrical therapies act on the Ca 2+ /CaM signaling pathway to enhance bone regeneration with bioactive glass [S53P4] and allogeneic grafts. J Biomed Mater Res B Appl Biomater 2021; 109:2104-2116. [PMID: 34008329 DOI: 10.1002/jbm.b.34858] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 04/12/2021] [Accepted: 04/24/2021] [Indexed: 12/26/2022]
Abstract
This study aimed to investigate the application of low-intensity electrostimulation (ES) and electromagnetic stimulation (EM) associated with bioactive glass (BG) or allogeneic grafts (BB) in bone regeneration. A cell viability test on osteoblasts (UMR-106) was performed in the presence of BB and BG grafts associated with ES (10 μA/5 min) and EM (500 Hz/2 min). Critical defects (25 mm2 ) in calvaria were generated in male Wistar rats, and bone regeneration was evaluated on the 30th, 60th, and 120th days after surgery. Cell proliferation increased with the application of ES in both grafts and after EM with BG. Bone remodeling was more effective using the allogeneic graft in both therapies, with increased angiogenesis, osteoblast proliferation, and OPN expression in the BB + EM group. A higher number of osteoblasts and osteoclasts, and an increase in bone sialoprotein, Runx-2, and Opn gene expression were found in the BB + ES group. The BG graft associated with EM therapy had an increased proliferation of osteoblasts and increased expression of Runx-2 and Opn. Groups that had BG and ES therapy had increased numbers of osteoblasts, osteoclasts, and increased OPN expression. The expression of voltage-gated calcium channels increased in groups with ES, while calmodulin expression increased in therapies without grafting. ES and EM therapies favored the repair of bone defects upon grafting by improving angiogenesis, osteogenic gene expression, and tissue reorganization. Despite activating different pathways, both therapies increased the intracellular concentrations of calmodulin, leading to cell proliferation and bone regeneration.
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Affiliation(s)
- Leonardo Bagne
- Graduate Program in Biomedical Sciences, University Center of Hermínio Ometto Foundation - FHO, Araras, Brazil
| | - Maraiara A Oliveira
- Graduate Program in Biomedical Sciences, University Center of Hermínio Ometto Foundation - FHO, Araras, Brazil
| | - Amanda T Pereira
- Graduate Program in Biomedical Sciences, University Center of Hermínio Ometto Foundation - FHO, Araras, Brazil
| | - Guilherme F Caetano
- Graduate Program in Biomedical Sciences, University Center of Hermínio Ometto Foundation - FHO, Araras, Brazil
| | - Camila A Oliveira
- Graduate Program in Biomedical Sciences, University Center of Hermínio Ometto Foundation - FHO, Araras, Brazil
| | - Andréa A Aro
- Graduate Program in Biomedical Sciences, University Center of Hermínio Ometto Foundation - FHO, Araras, Brazil
| | - Gabriela B Chiarotto
- Graduate Program in Biomedical Sciences, University Center of Hermínio Ometto Foundation - FHO, Araras, Brazil
| | - Glaucia M T Santos
- Graduate Program in Biomedical Sciences, University Center of Hermínio Ometto Foundation - FHO, Araras, Brazil
| | - Fernanda A S Mendonça
- Graduate Program in Biomedical Sciences, University Center of Hermínio Ometto Foundation - FHO, Araras, Brazil
| | - Milton Santamaria-Jr
- Graduate Program in Biomedical Sciences, University Center of Hermínio Ometto Foundation - FHO, Araras, Brazil
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Steinhausen E, Lefering R, Glombitza M, Brinkmann N, Vogel C, Mester B, Dudda M. Bioactive glass S53P4 vs. autologous bone graft for filling defects in patients with chronic osteomyelitis and infected non-unions - a single center experience. J Bone Jt Infect 2021; 6:73-83. [PMID: 34084694 PMCID: PMC8132459 DOI: 10.5194/jbji-6-73-2021] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Accepted: 12/17/2020] [Indexed: 11/29/2022] Open
Abstract
Introduction:
The goals of osteomyelitis therapy are successful control of infection and
reconstruction of the bone. The gold standard for filling defects is the
autologous bone graft. Bioactive glass S53P4 is an inorganic bone
substitute. We compared the outcome of using bioactive glass (BAG) versus
autologous bone graft (AB) in patients with infected non-union.
Methods:
Patients with chronic osteomyelitis and infected non-union who received
either bioactive glass or autologous bone grafts between 2013 and 2017 were
analyzed retrospectively. The primary endpoint was successful control of
infection during follow-up. Secondary endpoints were bone healing,
functional outcome, and occurrence of complications.
Results:
Eighty-three patients were analyzed (BAG n=51, AB n=32). Twenty-one
patients experienced reinfection (BAG n=15, 29 %; AB n=6, 19 %).
Seventy-eight patients achieved full weight bearing (BAG n=47, 92 %; AB
n=31, 97 %). Sixty-four patients had complete bone healing at the end of
the follow-up period (BAG n=39, 77 %; AB n=25, 78 %). There were no
significant differences between the groups with respect to the primary or
secondary endpoints. Patients with multidrug-resistant pathogens had a
significantly higher rate of incomplete bone healing (p=0.033) and a 3-fold
higher risk of complications in both groups.
Conclusions:
Bioactive glass appears to be a suitable bone substitute not only for
successful control of infection and defect filling but also for bone healing
in cases of infected non-union. In our study, bioactive glass was neither
superior nor inferior to autologous bone graft with regard to the primary
and secondary endpoints. Further studies with larger numbers of patients are
required.
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Affiliation(s)
- Eva Steinhausen
- Department of Orthopedic and Trauma Surgery, BG Klinikum Duisburg, University of Duisburg-Essen, 47249 Duisburg, Germany.,Department of Trauma, Hand and Reconstructive Surgery, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Rolf Lefering
- Institute for Research in Operative Medicine (IFOM), University of Witten/Herdecke, Cologne, Germany
| | - Martin Glombitza
- Department of Orthopedic and Trauma Surgery, BG Klinikum Duisburg, University of Duisburg-Essen, 47249 Duisburg, Germany
| | - Nikolaus Brinkmann
- Department of Orthopedic and Trauma Surgery, BG Klinikum Duisburg, University of Duisburg-Essen, 47249 Duisburg, Germany
| | - Carsten Vogel
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Bastian Mester
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Marcel Dudda
- Department of Orthopedic and Trauma Surgery, BG Klinikum Duisburg, University of Duisburg-Essen, 47249 Duisburg, Germany.,Department of Trauma, Hand and Reconstructive Surgery, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
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13
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Thijssen EGJ, van Gestel NAP, Bevers R, Hofmann S, Geurts J, van Loo IHM, Arts JJ. Assessment of Growth Reduction of Five Clinical Pathogens by Injectable S53P4 Bioactive Glass Material Formulations. Front Bioeng Biotechnol 2020; 8:634. [PMID: 32676498 PMCID: PMC7333246 DOI: 10.3389/fbioe.2020.00634] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Accepted: 05/22/2020] [Indexed: 11/13/2022] Open
Abstract
The one-stage treatment of chronic osteomyelitis with S53P4 bioactive glass (BAG) granules has shown excellent results. However, these granules possess suboptimal handling properties. Therefore, new injectable S53P4 putty materials have been developed by the incorporation of a synthetic binder to contain glass granules. The goal of the current study was to assess their potential to eradicate five clinically relevant pathogens: methicillin sensitive Staphylococcus aureus (MSSA), methicillin resistant Staphylococcus aureus (MRSA), Enterococcus coli (E. coli), Enterococcus faecalis (E. faecalis), and Pseudomonas aeruginosa (P. aeruginosa). As a control, S53P4 granules (500–800 μm) and S66 glass (< 45 μm) were used. To evaluate the antimicrobial properties, the materials were cultured with the pathogens in a Müller-Hinton II broth for a week with daily colony forming unit (CFU) counting. One of the tested putty formulations was observed to reduce the number of CFU/mL compared to a negative control (no material, only pathogen in broth) for E. coli, E. faecalis and P. aeruginosa. However, none of the tested putty formulations was able to completely eradicate the pathogens in the broths, which would be needed for safe infection treatment. The results obtained for the control materials were unexpected. S66 glass showed full eradication of P. aeruginosa and reduced the number of CFUs of other pathogens, while the S53P4 granules did not show eradication. The observations on the loose S53P4 granules in this study contradict available literature, which needs further investigation. The results obtained in this study also stretch the importance for a better understanding of the underlying antimicrobial mechanism of S53P4 BAG and how this is related to the dosage. In addition, it should be elucidated how these antimicrobial properties are affected by changes in the material formulation, for example by addition of binders to improve the handling properties or by changing the surface area.
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Affiliation(s)
- Eline G J Thijssen
- Laboratory for Experimental Orthopedics, Department of Orthopedic Surgery, Research School CAPHRI, Maastricht University Medical Centre, Maastricht, Netherlands
| | - Nicole A P van Gestel
- Orthopaedic Biomechanics, Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, Netherlands.,Institute for Complex Molecular Systems, Eindhoven University of Technology, Eindhoven, Netherlands
| | - Raymond Bevers
- Laboratory for Experimental Orthopedics, Department of Orthopedic Surgery, Research School CAPHRI, Maastricht University Medical Centre, Maastricht, Netherlands
| | - Sandra Hofmann
- Orthopaedic Biomechanics, Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, Netherlands.,Institute for Complex Molecular Systems, Eindhoven University of Technology, Eindhoven, Netherlands
| | - Jan Geurts
- Laboratory for Experimental Orthopedics, Department of Orthopedic Surgery, Research School CAPHRI, Maastricht University Medical Centre, Maastricht, Netherlands
| | - Inge H M van Loo
- Department of Medical Microbiology, Research School CAPHRI, Maastricht University Medical Centre, Maastricht, Netherlands
| | - J J Arts
- Laboratory for Experimental Orthopedics, Department of Orthopedic Surgery, Research School CAPHRI, Maastricht University Medical Centre, Maastricht, Netherlands.,Orthopaedic Biomechanics, Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, Netherlands
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Ma J, Yang F. [Advances in clinical diagnosis and treatment of chronic osteomyelitis in adults]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2020; 34:651-655. [PMID: 32410435 DOI: 10.7507/1002-1892.201909032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Objective To review the progress of clinical diagnosis and treatment of chronic osteomyelitis in adults. Methods The literature related to chronic osteomyelitis in recent years was extensively reviewed, and the clinical diagnosis and treatment methods were summarized. Results Clinical characteristics and laboratory examination can help to diagnose chronic osteomyelitis in adults. Pathogenic identification is the basis for choosing antibiotics. Diagnostic imaging is specific. The treatment includes systemic treatment and local treatment, and the local treatment is the key to radical cure. Conclusion The diagnosis of chronic osteomyelitis in adults should be made as early as possible. According to the anatomical and physiological classification of the patients, the appropriate treatment plan should be made.
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Affiliation(s)
- Jinglong Ma
- Department of Trauma and Hand Surgery, the First Affiliated Hospital of Guangxi Medical University, Nanning Guangxi, 530021, P.R.China
| | - Fuchun Yang
- Department of Trauma and Hand Surgery, the First Affiliated Hospital of Guangxi Medical University, Nanning Guangxi, 530021, P.R.China
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15
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Malik QUA, Iftikhar S, Zahid S, Safi SZ, Khan AF, Nawshad M, Ghafoor S, Khan AS, Tufail Shah A. Smart injectable self-setting bioceramics for dental applications. MATERIALS SCIENCE & ENGINEERING. C, MATERIALS FOR BIOLOGICAL APPLICATIONS 2020; 113:110956. [PMID: 32487378 DOI: 10.1016/j.msec.2020.110956] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/30/2019] [Revised: 03/29/2020] [Accepted: 04/10/2020] [Indexed: 10/24/2022]
Abstract
A thermo-responsive injectable bioactive glass (BAG) that has the ability to set at body temperature was prepared using pluronic F127 and hydroxypropyl methylcellulose as the carrier. The injectable composite has the advantage to fill irregular shape implantation sites and quick setting at body temperature. The structural and morphological analysis of injectable BAG before and after setting was done by using Fourier Transform Infrared spectroscopy (FTIR), and Scanning Electron Microscope (SEM). The effect of an ultrasonic scaler for a quick setting of injectable BAG was also investigated. The ultrasonic scaler sets the BAG formulation three-folds faster than at body temperature and homogenized the dispersion. The in vitro bio-adhesion was studied in the bovine tooth in both artificial saliva and deionized water for periodic time intervals, i.e., day 7, 30, 90, and 180, which confirmed the apatite layer formation. The mineral density analysis was used to differentiate the newly formed apatite with tooth apatite. In the MTT assay, the experimental material showed continuous proliferation and cell growth. This indicated that injectable hydrogel promoted cell growth, facilitated proliferation, and had no cytotoxic effect. The SEM and micro-CT results (performed after in vitro bioactivity testing) showed that the injectable BAG had the ability to regenerate dentin, hence this material has the potential to be used for dental and biomedical applications including tooth and bone regeneration in minimally invasive procedures in future.
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Affiliation(s)
- Qurat Ul Ain Malik
- Interdisciplinary Research Centre in Biomedical Materials, COMSATS University Islamabad, Lahore Campus, 54000, Pakistan; Department of Oral Biology, University of Health Sciences Lahore, Khayaban-e-Jamia Punjab, Lahore, 54600, Pakistan
| | - Sundus Iftikhar
- Interdisciplinary Research Centre in Biomedical Materials, COMSATS University Islamabad, Lahore Campus, 54000, Pakistan; Department of Oral Biology, University of Health Sciences Lahore, Khayaban-e-Jamia Punjab, Lahore, 54600, Pakistan
| | - Saba Zahid
- Interdisciplinary Research Centre in Biomedical Materials, COMSATS University Islamabad, Lahore Campus, 54000, Pakistan
| | - Sher Zaman Safi
- Interdisciplinary Research Centre in Biomedical Materials, COMSATS University Islamabad, Lahore Campus, 54000, Pakistan
| | - Ather Farooq Khan
- Interdisciplinary Research Centre in Biomedical Materials, COMSATS University Islamabad, Lahore Campus, 54000, Pakistan
| | - Muhammad Nawshad
- Interdisciplinary Research Centre in Biomedical Materials, COMSATS University Islamabad, Lahore Campus, 54000, Pakistan
| | - Sarah Ghafoor
- Department of Oral Biology, University of Health Sciences Lahore, Khayaban-e-Jamia Punjab, Lahore, 54600, Pakistan
| | - Abdul Samad Khan
- Department of Restorative Dental Sciences, College of Dentistry, Imam Abdulrahman Bin Faisal University, P.O. Box 1982, Dammam 31441, Saudi Arabia.
| | - Asma Tufail Shah
- Interdisciplinary Research Centre in Biomedical Materials, COMSATS University Islamabad, Lahore Campus, 54000, Pakistan.
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Oosthuysen W, Venter R, Tanwar Y, Ferreira N. Bioactive glass as dead space management following debridement of type 3 chronic osteomyelitis. INTERNATIONAL ORTHOPAEDICS 2020; 44:421-428. [PMID: 31701158 DOI: 10.1007/s00264-019-04442-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Accepted: 10/21/2019] [Indexed: 01/21/2023]
Abstract
BACKGROUND Chronic osteomyelitis is a challenging condition to treat and although no exact treatment guidelines exist, the surgical management strategy includes wide resection of necrotic and infected bone followed by dead space management. This study evaluates the use of bioactive glass as a single-stage procedure for dead space management following surgical debridement. METHODS A consecutive series of 24 patients with Cierny-Mader type 3 osteomyelitis, treated between March 2016 and June 2018, were identified and evaluated retrospectively. Patients were managed with bioactive glass as dead space management following surgical debridement. RESULTS Of the patients who completed more than 12 months follow-up, all fourteen (100%) showed complete resolution of symptoms. Of the remaining ten patients with less than 12 months follow-up, eight had complete resolution of symptoms. Therefore, a preliminary result of 22 out of 24 patients (91.65%) had resolution of symptoms following debridement and dead space management with bioactive glass. One patient experienced a complication related to the use of bioactive glass. This manifested as prolonged serous wound drainage that resolved with local wound care. CONCLUSION The use of bioactive glass appears to be effective for dead space management following debridement of anatomical type 3 chronic osteomyelitis of the appendicular skeleton.
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Affiliation(s)
- Willem Oosthuysen
- Division of Orthopaedics, Department of Surgical Sciences, Faculty of Medicine and Health Sciences, Tygerberg Hospital, Stellenbosch University, Cape Town, 7505, South Africa
| | - Rudolph Venter
- Division of Orthopaedics, Department of Surgical Sciences, Faculty of Medicine and Health Sciences, Tygerberg Hospital, Stellenbosch University, Cape Town, 7505, South Africa
| | - Yashwant Tanwar
- Division of Orthopaedics, Department of Surgical Sciences, Faculty of Medicine and Health Sciences, Tygerberg Hospital, Stellenbosch University, Cape Town, 7505, South Africa
| | - Nando Ferreira
- Division of Orthopaedics, Department of Surgical Sciences, Faculty of Medicine and Health Sciences, Tygerberg Hospital, Stellenbosch University, Cape Town, 7505, South Africa.
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Gonzalez Moreno M, Butini ME, Maiolo EM, Sessa L, Trampuz A. Antimicrobial activity of bioactive glass S53P4 against representative microorganisms causing osteomyelitis - Real-time assessment by isothermal microcalorimetry. Colloids Surf B Biointerfaces 2020; 189:110853. [PMID: 32058256 DOI: 10.1016/j.colsurfb.2020.110853] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Revised: 01/07/2020] [Accepted: 02/06/2020] [Indexed: 11/30/2022]
Abstract
Bioactive glass (BAG) is a synthetic bone substitute with intrinsic antimicrobial properties, used for bone defect filling. We evaluated the antimicrobial activity of two formulations of BAG S53P4 against representative pathogens of osteomyelitis: Staphylococcus aureus, Staphylococcus epidermidis, Enterococcus faecalis, Escherichia coli and Candida albicans. Antimicrobial activity of BAG S53P4 was assessed by isothermal microcalorimetry, a highly sensitive assay measuring metabolic-related microbial heat production in real-time. Standard CFUs-counting was performed in parallel. BAG granules (diameter 500-800 μm) and powder (<45 μm) were evaluated in two concentrations (400 and 800 mg/ml). Isothermal microcalorimetry was performed in glass ampoules containing growth medium, BAG and test microorganism, heat production was measured for 24 h. BAG S53P4 inhibited heat production of most-tested microorganisms with heat reduction of 60%-98% compared to positive control after 24 h of exposure to the highest-tested concentration (800 mg/ml). BAG S53P4 in powder formulation (<45 μm) inhibited more microbial growth than in granule formulation (500-800 μm), with the exception of C. albicans for which both formulations presented similar inhibition rates ranging between 87 % and 97 %. The BAG inhibitory ratios estimated from the variation in the growth rate constants of each microorganism compared to the growth control ranged between 2.55 % and 100 %. Comparable results were obtained by CFUs-counting, with complete reduction in cell viability of most microorganisms after ≤ 24 h of microbial exposure to BAG S53P4 powder. In summary, BAG S53P4 demonstrated efficient inhibition of microbial growth, especially in powder formulation.
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Affiliation(s)
- Mercedes Gonzalez Moreno
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Center for Musculoskeletal Surgery, Charitéplatz 1, 10117 Berlin, Germany; Berlin-Brandenburg Center for Regenerative Therapies, Charité - Universitätsmedizin Berlin, Augustenburger Platz 1, 13353 Berlin, Germany
| | - Maria Eugenia Butini
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Center for Musculoskeletal Surgery, Charitéplatz 1, 10117 Berlin, Germany; Berlin-Brandenburg Center for Regenerative Therapies, Charité - Universitätsmedizin Berlin, Augustenburger Platz 1, 13353 Berlin, Germany
| | - Elena Maryka Maiolo
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Center for Musculoskeletal Surgery, Charitéplatz 1, 10117 Berlin, Germany; Berlin-Brandenburg Center for Regenerative Therapies, Charité - Universitätsmedizin Berlin, Augustenburger Platz 1, 13353 Berlin, Germany
| | - Laura Sessa
- Department of Medical and Surgical Sciences and Advanced Technologies "GF Ingrassia", University of Catania, Catania, Italy
| | - Andrej Trampuz
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Center for Musculoskeletal Surgery, Charitéplatz 1, 10117 Berlin, Germany; Berlin-Brandenburg Center for Regenerative Therapies, Charité - Universitätsmedizin Berlin, Augustenburger Platz 1, 13353 Berlin, Germany.
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Shahbazi MA, Faghfouri L, Ferreira MPA, Figueiredo P, Maleki H, Sefat F, Hirvonen J, Santos HA. The versatile biomedical applications of bismuth-based nanoparticles and composites: therapeutic, diagnostic, biosensing, and regenerative properties. Chem Soc Rev 2020; 49:1253-1321. [PMID: 31998912 DOI: 10.1039/c9cs00283a] [Citation(s) in RCA: 153] [Impact Index Per Article: 38.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Studies of nanosized forms of bismuth (Bi)-containing materials have recently expanded from optical, chemical, electronic, and engineering fields towards biomedicine, as a result of their safety, cost-effective fabrication processes, large surface area, high stability, and high versatility in terms of shape, size, and porosity. Bi, as a nontoxic and inexpensive diamagnetic heavy metal, has been used for the fabrication of various nanoparticles (NPs) with unique structural, physicochemical, and compositional features to combine various properties, such as a favourably high X-ray attenuation coefficient and near-infrared (NIR) absorbance, excellent light-to-heat conversion efficiency, and a long circulation half-life. These features have rendered bismuth-containing nanoparticles (BiNPs) with desirable performance for combined cancer therapy, photothermal and radiation therapy (RT), multimodal imaging, theranostics, drug delivery, biosensing, and tissue engineering. Bismuth oxyhalides (BiOx, where X is Cl, Br or I) and bismuth chalcogenides, including bismuth oxide, bismuth sulfide, bismuth selenide, and bismuth telluride, have been heavily investigated for therapeutic purposes. The pharmacokinetics of these BiNPs can be easily improved via the facile modification of their surfaces with biocompatible polymers and proteins, resulting in enhanced colloidal stability, extended blood circulation, and reduced toxicity. Desirable antibacterial effects, bone regeneration potential, and tumor growth suppression under NIR laser radiation are the main biomedical research areas involving BiNPs that have opened up a new paradigm for their future clinical translation. This review emphasizes the synthesis and state-of-the-art progress related to the biomedical applications of BiNPs with different structures, sizes, and compositions. Furthermore, a comprehensive discussion focusing on challenges and future opportunities is presented.
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Affiliation(s)
- Mohammad-Ali Shahbazi
- Drug Research Program, Division of Pharmaceutical Chemistry and Technology, Faculty of Pharmacy, FI-00014 University of Helsinki, Helsinki, Finland.
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Tanwar YS, Ferreira N. The role of bioactive glass in the management of chronic osteomyelitis: a systematic review of literature and current evidence. Infect Dis (Lond) 2019; 52:219-226. [PMID: 31774017 DOI: 10.1080/23744235.2019.1695059] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
Background: The increase of orthopaedic surgical interventions has given rise to an increased prevalence of chronic osteomyelitis. The principles of management of chronic osteomyelitis are well defined and include a thorough debridement, dead space management followed by an adequate period of appropriate antibiotics. Bioactive glass has garnered interest in recent years as a potential void filler following debridement. In the present systematic review, we explore the role of bioactive glass as a dead space management agent following debridement of chronic osteomyelitis.Methods: A search was made for all the articles pertaining to the role of bioactive glass in chronic osteomyelitis. The keywords used for search in PUBMED/MEDLINE were 'Bioactive glass' and 'chronic osteomyelitis'. A total of nine publications evaluating the outcome of 206 patients were included for evaluation.Results: The overall cure rate was 86% with 24 patients (11.6%) experiencing recurrence, while five patients were lost to follow-up. Out of the total 24 recurrences or persistent infections, 10 were associated with poor post-operative wound healing which progressed to recurrence.Conclusions: Bioactive glass appears to provide an attractive alternative for bone void filling after debridement of chronic osteomyelitis with good long-term outcomes. Potential advantages include a unique mechanism of anti-microbial action rendering it active against multi-drug resistant bacteria, use as a single stage procedure and gradual replacement by bone.
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Affiliation(s)
- Yashwant Singh Tanwar
- Department of Surgical Sciences, Division of Orthopaedic Surgery, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Nando Ferreira
- Department of Surgical Sciences, Division of Orthopaedic Surgery, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
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