A practical model of osteomyelitis-induced bone pain by intra-tibial injection of Staphylococcus aureus in rats

Progress of stimulus responsive nanosystems for targeting treatment of bacterial infectious diseases

In recent decades, due to insufficient concentration at the lesion site, low bioavailability and increasingly serious resistance, antibiotics have become less and less dominant in the treatment of bacterial infectious diseases. It promotes the development of efficient drug delivery systems, and is expected to achieve high absorption, targeted drug release and satisfactory therapy effects. A variety of endogenous stimulation-responsive nanosystems have been constructed by using special infection microenvironments (pH, enzymes, temperature, etc.). In this review, we firstly provide an extensive review of the current research progress in antibiotic treatment dilemmas and drug delivery systems. Then, the mechanism of microenvironment characteristics of bacterial infected lesions was elucidated to provide a strong theoretical basis for bacteria-targeting nanosystems design. In particular, the discussion focuses on the design principles of single-stimulus and dual-stimulus responsive nanosystems, as well as the use of endogenous stimulus-responsive nanosystems to deliver antimicrobial agents to target locations for combating bacterial infectious diseases. Finally, the challenges and prospects of endogenous stimulus-responsive nanosystems were summarized.

Celecoxib for Management of Refractory Back Pain Secondary to Vertebral Osteomyelitis: A Case Report

Back pain is the most common symptom of vertebral osteomyelitis and can be difficult to manage. Pain may persist despite appropriate antibiotic medications and may be refractory to common analgesic treatments. We present a case of a 53-year-old man with acute onset severe low back pain. Clinical evaluation and diagnostic workup were consistent with L1 osteomyelitis. The patient continued to report pain following treatment with intravenous antibiotics and typical analgesic therapy. Opioids were discontinued and low-dose celecoxib was initiated with appreciable improvement in pain and activity tolerance. Celecoxib may be a good option and alternative to opioids in the pain management of this population.

An intravenous application of magnetic nanoparticles for osteomyelitis treatment: An efficient alternative

The infection of bone and bone marrow is called osteomyelitis. Treatment is difficult since antibiotics can not reach with enough concentration to the infected area. For the first time in this study, we have developed gentamicin-loaded magnetic gelatin nanoparticles (GMGNPs) for nanocarrier-mediated and magnetically targeted osteomyelitis therapy. Gelatin, genipin, and magnetite were used for preparation of that novel carrier system due to their biodegradable and biocompatible properties. Cross-linking degree of gelatin nanoparticles, concentration of magnetite nanoparticles, and adsorbed drug amount were optimized. Furthermore, nanoparticles were characterized and the drug release profile was determined. The osteomyelitis model was constituted in the proximal tibia of rats. The therapeutic potential of GMGNPs on rats was monitored via X-Ray radiography and hematological and histopathological analyses were performed. According to the results, 110.3 ± 8.2 µg gentamicin/mg GMGNPs were used, hydrodynamic size was measured as 253.7 ± 11.8 nm, and GMGNPs have controlled drug release profile. Based on in vivo and ex vivo studies, after six doses of GMGNPs treatment, abscess began to heal and the integrity of periost and bone began to reconstruct. In conclusion, it can be suggested that GMGNPs could provide efficient therapy for osteomyelitis.

Antimicrobial Peptides and Nanotechnology, Recent Advances and Challenges

Antimicrobial peptides are sequences of amino acids, which present activity against microorganisms. These peptides were discovered over 70 years ago, and are abundant in nature from soil bacteria, insects, amphibians to mammals and plants. They vary in amino acids number, the distance between amino acids within individual peptide structure, net charge, solubility and other physical chemical properties as well as differ in mechanism of action. These peptides may provide an alternative treatment to conventional antibiotics, which encounter resistance such as the peptide nisin applied in treating methicillin resistant Staphylococcus aureus (MRSA) or may behave synergistically with known antibiotics against parasites for instance, nisin Z when used in synergy with ampicillin reported better activity against Pseudomonas fluorescens than when the antibiotic was alone. AMPs are known to be active against viruses, bacteria, fungi and protozoans. Nanotechnology is an arena which explores the synthesis, characterization and application of an array of delivery systems at a one billionth of meter scale. Such systems are implemented to deliver drugs, proteins, vaccines, and peptides. The role of nanotechnology in delivering AMPs is still at its early development stage. There are challenges of incorporating AMPs into drug delivery system. This review intends to explore in depth, the role of nanotechnology in delivering AMPs as well as presenting the current advances and accompanying challenges of the technology.

Spinal nociceptive transmission by mechanical stimulation of bone marrow

Background

Since bone marrow receives innervation from A-delta and C-fibers and since an increase in intramedullary pressure in bone marrow may induce acute pain in orthopedic patients during surgery and chronic pain in patients with bone marrow edema, skeletal pain may partly originate from bone marrow. Intraosseous lesions, such as osteomyelitis and bone cancer, are also known to produce cutaneous hypersensitivity, which might be referred pain from bone. However, little is known about pain perception in bone marrow and referred pain induced by bone disease. Thus, we carried out an in vivo electrophysiological study and behavioral study to determine whether increased intraosseous pressure of the femur induces acute pain and whether increased intraosseous pressure induces referred pain in the corresponding receptive fields of the skin.

Results

Intraosseous balloon inflation caused spontaneous pain-related behavior and mechanical hyperalgesia and allodynia in the lumbosacral region. Single neuronal activities of spinal dorsal horn neurons were extracellularly isolated, and then evoked responses to non-noxious and noxious cutaneous stimuli and intraosseous balloon inflation were recorded. Ninety-four spinal dorsal horn neurons, which had somatic receptive fields at the lower back and thigh, were obtained. Sixty-two percent of the wide-dynamic-range neurons (24/39) and 86% of the high-threshold neurons (12/14) responded to intraosseous balloon inflation, while none of the low-threshold neurons (0/41) responded to intraosseous balloon inflation. Spinally administered morphine (1 µg) abolished balloon inflation-induced spontaneous pain-related behavior and mechanical hyperalgesia in awake rats and also suppressed evoked activities of wide-dynamic-range neurons to noxious cutaneous stimulation and intraosseous balloon inflation.

Conclusions

The results suggest that mechanical stimulation to bone marrow produces nociception, concomitantly producing its referred pain in the corresponding skin fields. These mechanisms might contribute to pain caused by skeletal diseases.

Animal Models of Implant-Related Low-Grade Infections. A Twenty-Year Review

The demand for joint replacement and surgical treatment is continuously increasing, thus representing a clinical burden and a cost for the healthcare system. Among several pathogens involved in implant-related infections, staphylococci account for the two-thirds of clinically isolated bacteria. Despite most of them are highly virulent microorganisms (Staphylococcus aureus, Escherichia coli, Pseudomonas aeruginosa), low virulent bacteria (Staphylococcus epidermidis, Propionibacterium acnes) are responsible for delayed, low-grade infections without specific clinical signs and hardly distinguishable from aseptic prosthetic failure. Therefore, there is a real need to study the pathogenesis of orthopedic infections through in vivo animal models. The present review of the literature provides a 20-year overview of animal models of acute, subclinical or chronic orthopedic infections according to the pathogen virulence and inocula. Through this analysis, a great variety of conditions in terms of bacterial strains and inocula emerged, thus encouraging the development of more reproducible in vivo studies to provide relevant information for a translational approach to humans.

Chitosan coated vancomycin hydrochloride liposomes: Characterizations and evaluation

The present work evaluated the feasibility of chitosan coated liposomes (c-Lips) for the intravenous delivery of vancomycin hydrochloride (VANH), a water-soluble antibiotic for the treatment of gram-positive bacterial infections like osteomyelitis, arthritis, endocarditis, pneumonia, etc. The objective of this research was to develop a suitable drug delivery system in vivo which could improve therapeutic efficacy and decrease side effects especially nephrotoxicity. Firstly, the vancomycin hydrochloride liposomes (VANH-Lips) were prepared by modified reverse phase evaporation method, then the chitosan wrapped vancomycin hydrochloride liposomes (c-VANH-Lips) nanosuspension was formulated by the method of electrostatic deposition. Based on the optimized results of single-factor screening experiment, the c-VANH-Lips were found to be relatively uniform in size (220.40 ± 3.56 nm) with a narrow polydispersity index (PI) (0.21 ± 0.03) and a positive zeta potential (25.7 ± 1.12 mV). The average drug entrapment efficiency (EE) and drug loading (DL) were 32.65 ± 0.59% and 2.18 ± 0.04%, respectively. The in vitro release profile of c-VANH-Lips possessed a sustained release Characterization and the release behavior was in accordance with the Weibull equation. Hemolysis experiments showed that its intravenous injection had preliminary safety. In vivo, after intravenous injection to mice, c-VANH-Lips showed a longer retention time and higher AUC values compared with the VANH injection (VANH-Inj) and VANH-Lips. In addition, biodistribution results clearly demonstrated that c-VANH-Lips preferentially decreased the drug distribution in kidney of mice after intravenous injection. These results revealed that injectable c-VANH-Lips may serve as a promising carrier for VANH to increase therapeutic efficacy on gram-positive bacterial infections and reduce nephrotoxicity, which provides significantly clinical value for long-term use of VANH.