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Suchý T, Vištejnová L, Šupová M, Klein P, Bartoš M, Kolinko Y, Blassová T, Tonar Z, Pokorný M, Sucharda Z, Žaloudková M, Denk F, Ballay R, Juhás Š, Juhásová J, Klapková E, Horný L, Sedláček R, Grus T, Čejka Z, Čejka Z, Chudějová K, Hrabák J. Vancomycin-Loaded Collagen/Hydroxyapatite Layers Electrospun on 3D Printed Titanium Implants Prevent Bone Destruction Associated with S. epidermidis Infection and Enhance Osseointegration. Biomedicines 2021; 9:biomedicines9050531. [PMID: 34068788 PMCID: PMC8151920 DOI: 10.3390/biomedicines9050531] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Revised: 04/13/2021] [Accepted: 05/04/2021] [Indexed: 12/14/2022] Open
Abstract
The aim of the study was to develop an orthopedic implant coating in the form of vancomycin-loaded collagen/hydroxyapatite layers (COLHA+V) that combine the ability to prevent bone infection with the ability to promote enhanced osseointegration. The ability to prevent bone infection was investigated employing a rat model that simulated the clinically relevant implant-related introduction of bacterial contamination to the bone during a surgical procedure using a clinical isolate of Staphylococcus epidermidis. The ability to enhance osseointegration was investigated employing a model of a minipig with terminated growth. Six weeks following implantation, the infected rat femurs treated with the implants without vancomycin (COLHA+S. epidermidis) exhibited the obvious destruction of cortical bone as evinced via a cortical bone porosity of up to 20% greater than that of the infected rat femurs treated with the implants containing vancomycin (COLHA+V+S. epidermidis) (3%) and the non-infected rat femurs (COLHA+V) (2%). The alteration of the bone structure of the infected COLHA+S. epidermidis group was further demonstrated by a 3% decrease in the average Ca/P molar ratio of the bone mineral. Finally, the determination of the concentration of vancomycin released into the blood stream indicated a negligible systemic load. Six months following implantation in the pigs, the quantified ratio of new bone indicated an improvement in osseointegration, with a two-fold bone ingrowth on the COLHA (47%) and COLHA+V (52%) compared to the control implants without a COLHA layer (27%). Therefore, it can be concluded that COLHA+V layers are able to significantly prevent the destruction of bone structure related to bacterial infection with a minimal systemic load and, simultaneously, enhance the rate of osseointegration.
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Affiliation(s)
- Tomáš Suchý
- Department of Composites and Carbon Materials, Institute of Rock Structure and Mechanics, Czech Academy of Sciences, 18209 Prague 8, Czech Republic; (M.Š.); (Z.S.); (M.Ž.); (F.D.)
- Faculty of Mechanical Engineering, Czech Technical University in Prague, 16000 Prague 6, Czech Republic; (L.H.); (R.S.)
- Biomedical Center, Faculty of Medicine in Pilsen, Charles University, 30100 Pilsen, Czech Republic; (L.V.); (P.K.); (M.B.); (Y.K.); (T.B.); (Z.T.); (K.C.); (J.H.)
- Correspondence: ; +420-777-608-280
| | - Lucie Vištejnová
- Biomedical Center, Faculty of Medicine in Pilsen, Charles University, 30100 Pilsen, Czech Republic; (L.V.); (P.K.); (M.B.); (Y.K.); (T.B.); (Z.T.); (K.C.); (J.H.)
- Department of Histology and Embryology, Faculty of Medicine in Pilsen, Charles University, 301 00 Pilsen, Czech Republic
| | - Monika Šupová
- Department of Composites and Carbon Materials, Institute of Rock Structure and Mechanics, Czech Academy of Sciences, 18209 Prague 8, Czech Republic; (M.Š.); (Z.S.); (M.Ž.); (F.D.)
| | - Pavel Klein
- Biomedical Center, Faculty of Medicine in Pilsen, Charles University, 30100 Pilsen, Czech Republic; (L.V.); (P.K.); (M.B.); (Y.K.); (T.B.); (Z.T.); (K.C.); (J.H.)
| | - Martin Bartoš
- Biomedical Center, Faculty of Medicine in Pilsen, Charles University, 30100 Pilsen, Czech Republic; (L.V.); (P.K.); (M.B.); (Y.K.); (T.B.); (Z.T.); (K.C.); (J.H.)
- Institute of Dental Medicine, First Faculty of Medicine, Charles University and General University Hospital in Prague, 12000 Prague 2, Czech Republic
- Institute of Anatomy, First Faculty of Medicine, Charles University, 12000 Prague 2, Czech Republic
| | - Yaroslav Kolinko
- Biomedical Center, Faculty of Medicine in Pilsen, Charles University, 30100 Pilsen, Czech Republic; (L.V.); (P.K.); (M.B.); (Y.K.); (T.B.); (Z.T.); (K.C.); (J.H.)
- Department of Histology and Embryology, Faculty of Medicine in Pilsen, Charles University, 301 00 Pilsen, Czech Republic
| | - Tereza Blassová
- Biomedical Center, Faculty of Medicine in Pilsen, Charles University, 30100 Pilsen, Czech Republic; (L.V.); (P.K.); (M.B.); (Y.K.); (T.B.); (Z.T.); (K.C.); (J.H.)
- Department of Histology and Embryology, Faculty of Medicine in Pilsen, Charles University, 301 00 Pilsen, Czech Republic
| | - Zbyněk Tonar
- Biomedical Center, Faculty of Medicine in Pilsen, Charles University, 30100 Pilsen, Czech Republic; (L.V.); (P.K.); (M.B.); (Y.K.); (T.B.); (Z.T.); (K.C.); (J.H.)
- Department of Histology and Embryology, Faculty of Medicine in Pilsen, Charles University, 301 00 Pilsen, Czech Republic
| | - Marek Pokorný
- R&D Department, Contipro Inc., 56102 Dolni Dobrouc, Czech Republic;
| | - Zbyněk Sucharda
- Department of Composites and Carbon Materials, Institute of Rock Structure and Mechanics, Czech Academy of Sciences, 18209 Prague 8, Czech Republic; (M.Š.); (Z.S.); (M.Ž.); (F.D.)
| | - Margit Žaloudková
- Department of Composites and Carbon Materials, Institute of Rock Structure and Mechanics, Czech Academy of Sciences, 18209 Prague 8, Czech Republic; (M.Š.); (Z.S.); (M.Ž.); (F.D.)
| | - František Denk
- Department of Composites and Carbon Materials, Institute of Rock Structure and Mechanics, Czech Academy of Sciences, 18209 Prague 8, Czech Republic; (M.Š.); (Z.S.); (M.Ž.); (F.D.)
- Faculty of Mechanical Engineering, Czech Technical University in Prague, 16000 Prague 6, Czech Republic; (L.H.); (R.S.)
| | - Rastislav Ballay
- 1st Department of Orthopedics, First Faculty of Medicine, Charles University in Prague and Motol University Hospital, 150 06 Prague 5, Czech Republic;
| | - Štefan Juhás
- PIGMOD Centre, Laboratory of Cell Regeneration and Plasticity, Institute of Animal Physiology and Genetics, Czech Academy of Sciences, 27721 Libechov, Czech Republic; (Š.J.); (J.J.)
| | - Jana Juhásová
- PIGMOD Centre, Laboratory of Cell Regeneration and Plasticity, Institute of Animal Physiology and Genetics, Czech Academy of Sciences, 27721 Libechov, Czech Republic; (Š.J.); (J.J.)
| | - Eva Klapková
- Department of Medical Chemistry and Clinical Biochemistry, Charles University, 2nd Medical School and University Hospital Motol, 15006 Prague 5, Czech Republic;
| | - Lukáš Horný
- Faculty of Mechanical Engineering, Czech Technical University in Prague, 16000 Prague 6, Czech Republic; (L.H.); (R.S.)
- Biomedical Center, Faculty of Medicine in Pilsen, Charles University, 30100 Pilsen, Czech Republic; (L.V.); (P.K.); (M.B.); (Y.K.); (T.B.); (Z.T.); (K.C.); (J.H.)
| | - Radek Sedláček
- Faculty of Mechanical Engineering, Czech Technical University in Prague, 16000 Prague 6, Czech Republic; (L.H.); (R.S.)
- Biomedical Center, Faculty of Medicine in Pilsen, Charles University, 30100 Pilsen, Czech Republic; (L.V.); (P.K.); (M.B.); (Y.K.); (T.B.); (Z.T.); (K.C.); (J.H.)
| | - Tomáš Grus
- 2nd Department of Cardiovascular Surgery, First Faculty of Medicine, Charles University and General University Hospital in Prague, 12000 Prague 2, Czech Republic;
| | - Zdeněk Čejka
- ProSpon Ltd., 27201 Kladno, Czech Republic; (Z.Č.J.); (Z.Č.)
| | - Zdeněk Čejka
- ProSpon Ltd., 27201 Kladno, Czech Republic; (Z.Č.J.); (Z.Č.)
| | - Kateřina Chudějová
- Biomedical Center, Faculty of Medicine in Pilsen, Charles University, 30100 Pilsen, Czech Republic; (L.V.); (P.K.); (M.B.); (Y.K.); (T.B.); (Z.T.); (K.C.); (J.H.)
| | - Jaroslav Hrabák
- Biomedical Center, Faculty of Medicine in Pilsen, Charles University, 30100 Pilsen, Czech Republic; (L.V.); (P.K.); (M.B.); (Y.K.); (T.B.); (Z.T.); (K.C.); (J.H.)
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Mooney JA, Pridgen EM, Manasherob R, Suh G, Blackwell HE, Barron AE, Bollyky PL, Goodman SB, Amanatullah DF. Periprosthetic bacterial biofilm and quorum sensing. J Orthop Res 2018; 36:2331-2339. [PMID: 29663554 DOI: 10.1002/jor.24019] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2017] [Accepted: 04/04/2018] [Indexed: 02/04/2023]
Abstract
Periprosthetic joint infection (PJI) is a common complication after total joint arthroplasty leading to severe morbidity and mortality. With an aging population and increasing prevalence of total joint replacement procedures, the burden of PJI will be felt not only by individual patients, but in increased healthcare costs. Current treatment of PJI is inadequate resulting in incredibly high failure rates. This is believed to be largely mediated by the presence of bacterial biofilms. These polymicrobial bacterial colonies form within secreted extracellular matrices, adhering to the implant surface and local tissue. The biofilm architecture is believed to play a complex and critical role in a variety of bacterial processes including nutrient supplementation, metabolism, waste management, and antibiotic and immune resistance. The establishment of these biofilms relies heavily on the quorum sensing communication systems utilized by bacteria. Early stage research into disrupting bacterial communication by targeting quorum sensing show promise for future clinical applications. However, prevention of the biofilm formation via early forced induction of the biofilm forming process remains yet unexplored. © 2018 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 36:2331-2339, 2018.
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Affiliation(s)
- Jake A Mooney
- Stanford University, School of Medicine, Stanford, California
| | - Eric M Pridgen
- Department of Orthopaedic Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Robert Manasherob
- Department of Orthopaedic Surgery, Stanford Hospitals and Clinics, Broadway Street, Redwood City, Stanford 94063, California
| | - Gina Suh
- Department of Medicine, Stanford School of Medicine, Stanford, California
| | - Helen E Blackwell
- Department of Chemistry, University of Wisconsin-Madison, Madison, Wisconsin
| | - Annelise E Barron
- Department of Bioengineering, School of Medicine, Stanford University, Stanford, California
| | - Paul L Bollyky
- Division of Infectious Diseases, Department of Medicine, Stanford University School of Medicine, Stanford, California
| | - Stuart B Goodman
- Department of Orthopaedic Surgery, Stanford Hospitals and Clinics, Broadway Street, Redwood City, Stanford 94063, California
| | - Derek F Amanatullah
- Department of Orthopaedic Surgery, Stanford Hospitals and Clinics, Broadway Street, Redwood City, Stanford 94063, California
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Nandi SK, Shivaram A, Bose S, Bandyopadhyay A. Silver nanoparticle deposited implants to treat osteomyelitis. J Biomed Mater Res B Appl Biomater 2018; 106:1073-1083. [PMID: 28508595 PMCID: PMC5685947 DOI: 10.1002/jbm.b.33910] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2016] [Revised: 04/18/2017] [Accepted: 04/22/2017] [Indexed: 01/11/2023]
Abstract
In this study, electrolytically deposited strongly adherent silver nanoparticles on stainless-steel (SS) implants were used for in situ osteomyelitis treatment. Samples were heat treated to enhance adhesion of silver on 316 L SS. Ex vivo studies were performed to measure silver-release profiles from the 316 L SS screws inserted in equine cadaver bones. No change in the release profiles of silver ions were observed in vitro between the implanted screws and the control. In vivo studies were performed using osteomyelitic rabbit model with 3 mm diameter silver-deposited 316 L SS pins at two different doses of silver: high and low. Infection control ability of the pins for treating osteomyelitis in a rabbit model was measured using bacteriologic, radiographic, histological, and scanning electron microscopic studies. Silver-coated pins, especially high dose, offered a promising result to treat infection in animal osteomyelitis model without any toxicity to major organs. © 2017 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater, 106B: 1073-1083, 2018.
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Affiliation(s)
- Samit Kumar Nandi
- Department of Veterinary Surgery and Radiology, West Bengal University of Animal and Fishery Sciences, Kolkata, 700037, India
| | - Anish Shivaram
- W. M. Keck Biomedical Materials Research Laboratory, School of Mechanical and Materials Engineering, Washington State University, Pullman, Washington, 99164-2920, USA
| | - Susmita Bose
- W. M. Keck Biomedical Materials Research Laboratory, School of Mechanical and Materials Engineering, Washington State University, Pullman, Washington, 99164-2920, USA
| | - Amit Bandyopadhyay
- W. M. Keck Biomedical Materials Research Laboratory, School of Mechanical and Materials Engineering, Washington State University, Pullman, Washington, 99164-2920, USA
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Klinger-Strobel M, Makarewicz O, Pletz MW, Stallmach A, Lautenschläger C. TiO 2-containing and ZnO-containing borosilicate glass-a novel thin glass with exceptional antibiofilm performances to prevent microfouling. J Mater Sci Mater Med 2016; 27:175. [PMID: 27752973 DOI: 10.1007/s10856-016-5792-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/04/2016] [Accepted: 10/05/2016] [Indexed: 06/06/2023]
Abstract
Biofilm formation, also known as microfouling, on indwelling medical devices such as catheters or prosthetic joints causes difficult to treat and recurrent infections. It is also the initial step for biocorrosion of surfaces in aquatic environment. An efficient prevention of microfouling is preferable but the development of antibiofilm surfaces is enormously challenging. Therefore, soda-lime, aluminosilicate, and three borosilicate glasses with different TiO2 and ZnO compositions were investigated on their feasibility to prevent biofilm formation by standardized in vitro biofilm assays using different pathogenic bacteria. Furthermore, the biocompatibility of these glasses was evaluated using eukaryotic cell lines end erythrocytes. Only two borosilicate glasses, containing TiO2 and ZnO, showed an increased antibiofilm performance inhibiting biofilm adhesion and formation. The biofilm thickness and area were significantly reduced by over 90 % and characterized by diffuse structures. All tested glass types showed neither cytotoxicity nor hemotoxicity. Therefore, the antibiofilm borosilicate-thin glasses are qualified for surface coatings where biofilms are not desirable such as on medical devices.
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Affiliation(s)
- Mareike Klinger-Strobel
- Center for Infectious Diseases and Infection Control, Jena University Hospital, Jena, 07747, Germany.
- Center for Sepsis Control and Care, Jena University Hospital, Jena, 07747, Germany.
| | - Oliwia Makarewicz
- Center for Infectious Diseases and Infection Control, Jena University Hospital, Jena, 07747, Germany
- Center for Sepsis Control and Care, Jena University Hospital, Jena, 07747, Germany
| | - Mathias W Pletz
- Center for Infectious Diseases and Infection Control, Jena University Hospital, Jena, 07747, Germany
- Center for Sepsis Control and Care, Jena University Hospital, Jena, 07747, Germany
| | - Andreas Stallmach
- Center for Sepsis Control and Care, Jena University Hospital, Jena, 07747, Germany
- Department of Internal Medicine IV, Jena University Hospital, Jena, 07747, Germany
| | - Christian Lautenschläger
- Center for Sepsis Control and Care, Jena University Hospital, Jena, 07747, Germany
- Department of Internal Medicine IV, Jena University Hospital, Jena, 07747, Germany
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Affiliation(s)
- Arvind Nana
- University of North Texas Health Science Center, Fort Worth, Texas
| | - Sandra B Nelson
- Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Alex McLaren
- Orthopaedic Surgery Residency, University of Arizona College of Medicine, Phoenix, Arizona
| | - Antonia F Chen
- Rothman Institute at Thomas Jefferson University, Sidney Kimmel Medical College, Philadelphia, Pennsylvania
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Abstract
The number of arthroplasties being undertaken is expected to grow year on year, and periprosthetic joint infections will be an increasing socioeconomic burden. The challenge to prevent and eradicate these infections has resulted in the emergence of several new strategies, which are discussed in this review. Cite this article: Bone Joint J 2015;97-B:1162-9.
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Affiliation(s)
- D A George
- University College London Hospitals, 235 Euston Road, London, NW1 2BU, UK
| | - V Gant
- University College London Hospitals, 235 Euston Road, London, NW1 2BU, UK
| | - F S Haddad
- University College London Hospitals, 235 Euston Road, London, NW1 2BU, UK
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Davidson H, Poon M, Saunders R, Shapiro IM, Hickok NJ, Adams CS. Tetracycline tethered to titanium inhibits colonization by Gram-negative bacteria. J Biomed Mater Res B Appl Biomater 2014; 103:1381-9. [PMID: 25389082 DOI: 10.1002/jbm.b.33310] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2014] [Revised: 08/14/2014] [Accepted: 10/18/2014] [Indexed: 11/07/2022]
Abstract
As peri-prosthetic infection is one of the most devastating complications associated with implant placement, we have reasoned that such infection can be largely subverted by development of antibacterial implants. Our previous work demonstrated that covalent coupling of vancomycin to titanium alloy prevented colonization by the Gram-positive pathogens, Staphylococcus aureus and Staphylococcus epidermidis. Some orthopedic devices, including permanent prosthesis anchors, and most dental implants are transcutaneous or transmucosal and can be prone to colonization by Gram-negative pathogens. We report here the successful covalent coupling of the broad-spectrum antibiotic, tetracycline (TET), to titanium surfaces (Ti-TET) to retard Gram-negative colonization. Synthetic progress was followed by changes in water contact angle, while the presence of TET was confirmed by immunofluorescence. Ti-TET actively prevented colonization in the presence of bathing Escherichia coli, both by fluorescence microscopy and direct counting. Finally, the Ti-TET surface supported osteoblastic cell adhesion and proliferation over a 72-h period. Thus, this new surface offers a powerful means to protect transcutaneous implants from adhesion of Gram-negative pathogens, decreasing the need for replacement of this hardware.
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Affiliation(s)
- Helen Davidson
- Department of Orthopaedic Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Martin Poon
- Department of Orthodontics, School of Dental Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Ray Saunders
- Department of Biological Science, University of the Sciences, Philadelphia, Pennsylvania
| | - Irving M Shapiro
- Department of Orthopaedic Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Noreen J Hickok
- Department of Orthopaedic Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania
- Department of Biochemistry and Molecular Biology, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Christopher S Adams
- Department of Bio-Medical Sciences, Philadelphia College of Osteopathic Medicine, Philadelphia, Pennsylvania
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Palchesko RN, Buckholtz GA, Romeo JD, Gawalt ES. Co-immobilization of active antibiotics and cell adhesion peptides on calcium based biomaterials. Mater Sci Eng C Mater Biol Appl 2014; 40:398-406. [PMID: 24857508 DOI: 10.1016/j.msec.2014.04.017] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/21/2013] [Revised: 02/20/2014] [Accepted: 04/06/2014] [Indexed: 10/25/2022]
Abstract
Two bioactive molecules with unrelated functions, vancomycin and a cell adhesion peptide, were immobilized on the surface of a potential bone scaffold material, calcium aluminum oxide. In order to accomplish immobilization and retain bioactivity three sequential surface functionalization strategies were compared: 1.) vancomycin was chemically immobilized before a cell adhesion peptide (KRSR), 2.) vancomycin was chemically immobilized after KRSR and 3.) vancomycin was adsorbed after binding the cell adhesion peptide. Both molecules remained on the surface and active using all three reaction sequences and after autoclave sterilization based on osteoblast attachment, bacterial turbidity and bacterial zone inhibition test results. However, the second strategy was superior at enhancing osteoblast attachment and significantly decreasing bacterial growth when compared to the other sequences.
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Affiliation(s)
- Rachelle N Palchesko
- Duquesne University, Department of Chemistry and Biochemistry, 600 Forbes Avenue, Pittsburgh, PA 15282, USA
| | - Gavin A Buckholtz
- Duquesne University, Department of Chemistry and Biochemistry, 600 Forbes Avenue, Pittsburgh, PA 15282, USA
| | - Jared D Romeo
- Duquesne University, Department of Chemistry and Biochemistry, 600 Forbes Avenue, Pittsburgh, PA 15282, USA
| | - Ellen S Gawalt
- Duquesne University, Department of Chemistry and Biochemistry, 600 Forbes Avenue, Pittsburgh, PA 15282, USA; McGowan Institute for Regenerative Medicine, University of Pittsburgh, Pittsburgh, PA 15219, USA.
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Diaz-Ledezma C, Parvizi J, Zhou Y, Antoci V, Ducheyne P, Freiberg A, Garcia Rangel G, Han SB, Hickok N, Higuera C, Ketonis C, Korkusuz F, Kruczynski J, Macule F, Markuszewski J, Marín-Peña O, Nathwani D, Noble P, Ong K, Ono N, Parvizi MS, Post Z, Rivero-Boschert S, Schaer T, Shapiro I. Prosthesis selection. J Arthroplasty 2014; 29:71-6. [PMID: 24360496 DOI: 10.1016/j.arth.2013.09.039] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
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Diaz-Ledezma C, Parvizi J, Zhou Y, Antoci V, Ducheyne P, Freiberg A, Rangel GG, Han SB, Hickok N, Higuera C, Ketonis C, Korkusuz F, Kruczynski J, Macule F, Markuszewski J, Marín-Peña O, Nathwani D, Noble P, Ong K, Ono N, Parvizi MS, Post Z, Rivero-Boschert S, Schaer T, Shapiro I. Prosthesis selection. J Orthop Res 2014; 32 Suppl 1:S90-7. [PMID: 24464902 DOI: 10.1002/jor.22552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
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Ghani Y, Coathup MJ, Hing KA, Blunn GW. Antibacterial effect of incorporating silver ions in electrochemically deposited hydroxyapatite coating: An experimental study. JRSM Short Rep 2013; 4:2042533313481212. [PMID: 24040499 PMCID: PMC3767068 DOI: 10.1177/2042533313481212] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Yaser Ghani
- The John Scales Centre for Biomedical Engineering, Institute of Orthopaedics and Musculoskeletal Science, Division of Surgery and Interventional Science, University College London, The Royal National Orthopaedic Hospital Trust, Brockley Hill, Stanmore, Middlesex, HA7 4LP, UK; Department of Materials and IRC in Biomedical Materials, School of Engineering and Materials, Queen Mary University of London, Mile End Road, London E1 4NS, UK
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Rottman M, Goldberg J, Hacking SA. Titanium-tethered vancomycin prevents resistance to rifampicin in Staphylococcus aureus in vitro. PLoS One 2012; 7:e52883. [PMID: 23285213 PMCID: PMC3527614 DOI: 10.1371/journal.pone.0052883] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2012] [Accepted: 11/23/2012] [Indexed: 11/29/2022] Open
Abstract
Rifampicin is currently recognized as the most potent drug against Gram positive implant related infections. The use of rifampicin is limited by the emergence of bacterial resistance, which is often managed by coadministration of a second antibiotic. The purpose of this study was to determine the effectiveness of soluble rifampicin in combination with vancomycin tethered to titanium metal as a means to control bacterial growth and resistance in vitro. Bacterial growth was inhibited when the vancomycin-tethered titanium discs were treated with Staphylococcus aureus inocula of ≤2×106 CFU, however inocula greater than 2×106 CFU/disc adhered and survived. The combination of surface-tethered vancomycin with soluble rifampicin enhanced the inhibitory effect of rifampicin for an inoculum of 106 CFU/cm2 by one dilution (combination MIC of 0.008 mg/L versus 0.015 mg/L for rifampicin alone). Moreover, surface tethered vancomycin prevented the emergence of a rifampicin resistant population in an inoculum of 2×108 CFU.
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Affiliation(s)
- Martin Rottman
- Laboratory for Musculoskeletal Research and Innovation, Department of Orthopaedics, Harvard Medical School and Massachusetts General Hospital, Boston, Massachusetts, United States of America
- The Wyss Institute at Harvard Medical School, Boston, Massachusetts, United States of America
- EA 3647 Physiopathologie et Diagnostic des Infections Microbiennes, Université Versailles St Quentin, and Laboratoire de Microbiologie, Hôpital Raymond Poincaré, AP-HP, Garches, France
| | - Joel Goldberg
- Laboratory for Musculoskeletal Research and Innovation, Department of Orthopaedics, Harvard Medical School and Massachusetts General Hospital, Boston, Massachusetts, United States of America
| | - S. Adam Hacking
- Laboratory for Musculoskeletal Research and Innovation, Department of Orthopaedics, Harvard Medical School and Massachusetts General Hospital, Boston, Massachusetts, United States of America
- * E-mail:
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13
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Hickok NJ, Shapiro IM. Immobilized antibiotics to prevent orthopaedic implant infections. Adv Drug Deliv Rev 2012; 64:1165-76. [PMID: 22512927 DOI: 10.1016/j.addr.2012.03.015] [Citation(s) in RCA: 179] [Impact Index Per Article: 14.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2011] [Revised: 03/08/2012] [Accepted: 03/20/2012] [Indexed: 12/17/2022]
Abstract
Many surgical procedures require the placement of an inert or tissue-derived implant deep within the body cavity. While the majority of these implants do not become colonized by bacteria, a small percentage develops a biofilm layer that harbors invasive microorganisms. In orthopaedic surgery, unresolved periprosthetic infections can lead to implant loosening, arthrodeses, amputations and sometimes death. The focus of this review is to describe development of an implant in which an antibiotic tethered to the metal surface is used to prevent bacterial colonization and biofilm formation. Building on well-established chemical syntheses, studies show that antibiotics can be linked to titanium through a self-assembled monolayer of siloxy amines. The stable metal-antibiotic construct resists bacterial colonization and biofilm formation while remaining amenable to osteoblastic cell adhesion and maturation. In an animal model, the antibiotic modified implant resists challenges by bacteria that are commonly present in periprosthetic infections. While the long-term efficacy and stability is still to be established, ongoing studies support the view that this novel type of bioactive surface has a real potential to mitigate or prevent the devastating consequences of orthopaedic infection.
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Abstract
BACKGROUND Total hip arthroplasty (THA) is one of the most successful surgical interventions devised in modern times. Attempts to change the current THA procedure with unproven innovations bring the risk of increased failure rates while trying to improve the benefit of the surgery. QUESTIONS/PURPOSES This manuscript examines the evolution of THA at the Rothman Institute illustrating the key elements that lead the success of this procedure at this institution. These key elements include femoral stem design, use of highly crossed-linked polyethylene and use of pain and rehabilitation protocols. We attempted to describe the long-term results regarding safety, effectiveness, and durability of specific THA implant designs used at this institution drawing on reported evidence in the literature. METHODS The authors performed a review of peer-reviewed articles related to the Rothman Institute's experience with THA. RESULTS Total hip arthroplasty is an efficient, safe, and durable procedure. It is a highly successful operation to restore function and improve pain. The survivorship of THA procedures at the Rothman Institute is higher than 99% at 10 years based on mechanical failure. The use of collarless, tapered wedge femoral stem, highly crossed-linked polyethylene, and improved pain rehabilitation protocols have contributed to this success. CONCLUSIONS There is a well-documented long-term survivorship after THA. Future innovation in THA should address new challenges with younger and more demanding patients, rather than change current methods that have a proven good survivorship. This innovation depends mainly upon improvements in the bearing surfaces and advances in pain control and rehabilitation.
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Ghani Y, Coathup MJ, Hing KA, Blunn GW. Development of a hydroxyapatite coating containing silver for the prevention of peri-prosthetic infection. J Orthop Res 2012; 30:356-63. [PMID: 21901753 DOI: 10.1002/jor.21543] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2011] [Accepted: 08/11/2011] [Indexed: 02/04/2023]
Abstract
We hypothesized that the electrochemical deposition of hydroxyapatite (EHA) can be used to incorporate silver (Ag), providing a controlled and sustained release of Ag ions at a bactericidal concentration. Six groups were investigated: electrochemical co-precipitation of HA and Ag (EHA/Ag); EHA pre-coated discs treated in AgN0(3) (EHA/AgN0(3)); plasma sprayed HA (PHA) pre-coated discs treated in AgN0(3) (PHA/AgN0(3)); EHA with 2 "layers" of Ag (EHA/Ag/2 layers); EHA coating only; and PHA coating only. Scanning electron microscopy (SEM) and energy dispersive X-ray (EDX) and X-ray diffraction (XRD) analyses quantified coating thickness, calcium/phosphorous ratio, and % atomic silver content, respectively. Inductively coupled plasma-mass spectrometry quantified the amount of Ag released in phosphate-buffered saline, and zone of inhibition tests on agar plates using a lawn of Staph aureus were quantified in each group. XRD and EDX analysis confirmed the presence of Ag in all coatings. EHA coated discs with two layers of Ag and the EHA discs soaked in AgN0(3) showed significantly higher zones of inhibition at all time points when compared with all other groups (except PHA/AgN0(3) on day 0). This study demonstrated that Ag ions can be incorporated into a HA coating using an electrochemical technique.
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Affiliation(s)
- Yaser Ghani
- The John Scales Centre for Biomedical Engineering, Institute of Orthopaedics and Musculoskeletal Science, Division of Surgery and Interventional Science, University College London, The Royal National Orthopaedic Hospital Trust, Brockley Hill, Stanmore, Middlesex HA7 4LP, United Kingdom
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Abstract
The local delivery of antibiotics in the treatment of osteomyelitis has been used safely and effectively for decades. Multiple methods of drug delivery have been developed for the purposes of both infection treatment and prophylaxis. The mainstay of treatment in this application over the past 20 years has been non-biodegradable polymethylmethacrylate, which has the advantages of excellent elution characteristics and structural support properties. Biodegradable materials such as calcium sulfate and bone graft substitutes have been used more recently for this purpose. Other biodegradable implants, including synthetic polymers, are not yet approved for use but have demonstrated potential in laboratory investigations. Antibiotic-impregnated metal, a recent development, holds great promise in the treatment and prophylaxis of osteomyelitis in the years to come.
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Affiliation(s)
- Jaspaul S Gogia
- Department of Orthopaedic Surgery, UC Davis Medical Center, Sacramento, California
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Palchesko RN, Mcgowan KA, Gawalt ES. Surface immobilization of active vancomycin on calcium aluminum oxide. Materials Science and Engineering: C 2011; 31:637-42. [DOI: 10.1016/j.msec.2010.12.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Fadeeva E, Truong VK, Stiesch M, Chichkov BN, Crawford RJ, Wang J, Ivanova EP. Bacterial retention on superhydrophobic titanium surfaces fabricated by femtosecond laser ablation. Langmuir 2011; 27:3012-9. [PMID: 21288031 DOI: 10.1021/la104607g] [Citation(s) in RCA: 171] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
Two-tier micro- and nanoscale quasi-periodic self-organized structures, mimicking the surface of a lotus Nelumbo nucifera leaf, were fabricated on titanium surfaces using femtosecond laser ablation. The first tier consisted of large grainlike convex features between 10 and 20 μm in size. The second tier existed on the surface of these grains, where 200 nm (or less) wide irregular undulations were present. The introduction of the biomimetic surface patterns significantly transformed the surface wettabilty of the titanium surface. The original surface possessed a water contact angle of θ(W) 73 ± 3°, whereas the laser-treated titanium surface became superhydrophobic, with a water contact angle of θ(W) 166 ± 4°. Investigations of the interaction of S. aureus and P. aeruginosa with these superhydrophobic surfaces at the surface-liquid interface revealed a highly selective retention pattern for two pathogenic bacteria. While S. aureus cells were able to successfully colonize the superhydrophobic titanium surfaces, no P. aeruginosa cells were able to attach to the surface (i.e., any attached bacterial cells were below the estimated lower detection limit).
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Affiliation(s)
- Elena Fadeeva
- Laser Zentrum Hannover e.V., Hollerithallee 8, D-30419 Hannover, Germany
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Affiliation(s)
- Wadih Y Matar
- Division of Orthopaedic Surgery, Department of Surgery, CSSS Gatineau-Hull Hospital, Gatineau, QC, Canada
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van Brakel R, Cune MS, van Winkelhoff AJ, de Putter C, Verhoeven JW, van der Reijden W. Early bacterial colonization and soft tissue health around zirconia and titanium abutments: an in vivo study in man. Clin Oral Implants Res 2010; 22:571-7. [PMID: 21054554 DOI: 10.1111/j.1600-0501.2010.02005.x] [Citation(s) in RCA: 91] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
AIM To compare the early bacterial colonization and soft tissue health of mucosa adjacent to zirconia (ZrO(2)) and titanium (Ti) abutment surfaces in vivo. MATERIALS AND METHODS Twenty edentulous subjects received two endosseous mandibular implants. The implants were fitted with either a ZrO(2) or a Ti abutment (non-submerged implant placement, within-subject comparison, left-right randomization). Sulcular bacterial sampling and the assessment of probing pocket depth, recession and bleeding on probing were performed at 2 weeks and 3 months post-surgery. Wilcoxon matched-pairs, sign-rank tests were applied to test differences in the counts of seven marker bacteria and the clinical parameters that were associated with the ZrO(2) and Ti abutments, at the two observation time points. RESULTS ZrO(2) and Ti abutments harboured similar counts of Aggregatibacter actinomycetemcomitans, Porphyromonas gingivalis, Prevotella intermedia, Tannerella forsythia, Peptostreptococcus micros, Fusobacterium nucleatum and Treponema denticola at 2 weeks and 3 months. Healthy clinical conditions were seen around both ZrO(2) and Ti abutments at all times, without significant differences in most clinical parameters of peri-implant soft tissue health. Mean probing depths around Ti abutments were slightly deeper than around ZrO(2) abutments after 3 months (2.2 SD 0.8 mm vs. 1.7 SD 0.7 mm, P=0.03). CONCLUSIONS No difference in health of the soft tissues adjacent to ZrO(2) and Ti abutment surfaces or in early bacterial colonization could be demonstrated, although somewhat shallower probing depths were observed around ZrO(2) abutments after 3 month.
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Affiliation(s)
- Ralph van Brakel
- Department of Oral-Maxillofacial Surgery, Prosthodontics and Special, Dental Care, University Medical Centre Utrecht, Utrecht, The Netherlands.
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Abstract
BACKGROUND Biofilm formation on indwelling medical devices is a ubiquitous problem causing considerable patient morbidity and mortality. In orthopaedic surgery, this problem is exacerbated by the large number and variety of material types that are implanted. Metallic hardware in conjunction with polymethylmethacrylate (PMMA) bone cement is commonly used. QUESTIONS/PURPOSES We asked whether polymerizable derivatives of vancomycin might be useful to (1) surface modify Ti-6Al-4V alloy and to surface/bulk modify PMMA bone cement to prevent Staphylococcus epidermidis biofilm formation and (2) whether the process altered the compressive modulus, yield strength, resilience, and/or fracture strength of cement copolymers. METHODS A Ti-6Al-4V alloy was silanized with methacryloxypropyltrimethoxysilane in preparation for subsequent polymer attachment. Surfaces were then coated with polymers formed from PEG(375)-acrylate or a vancomycin-PEG(3400)-PEG(375)-acrylate copolymer. PMMA was loaded with various species, including vancomycin and several polymerizable vancomycin derivatives. To assess antibiofilm properties of these materials, initial bacterial adherence to coated Ti-6Al-4V was determined by scanning electron microscopy (SEM). Biofilm dry mass was determined on PMMA coupons; the compressive mechanical properties were also determined. RESULTS SEM showed the vancomycin-PEG(3400)-acrylate-type surface reduced adherent bacteria numbers by approximately fourfold when compared with PEG(375)-acrylate alone. Vancomycin-loading reduced all mechanical properties tested; in contrast, loading a vancomycin-acrylamide derivative restored these deficits but demonstrated no antibiofilm properties. A polymerizable, PEGylated vancomycin derivative reduced biofilm attachment but resulted in inferior cement mechanical properties. CLINICAL RELEVANCE The approaches presented here may offer new strategies for developing biofilm-resistant orthopaedic materials. Specifically, polymerizable derivatives of traditional antibiotics may allow for direct polymerization into existing materials such as PMMA bone cement while minimizing mechanical property compromise. Questions remain regarding ideal monomer structure(s) that confer biologic and mechanical benefits.
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Affiliation(s)
- McKinley C. Lawson
- Department of Chemical and Biological Engineering, University of Colorado, Boulder, CO USA
- Medical Scientist Training Program (MD/PhD Program), University of Colorado School of Medicine, Denver, CO USA
- University of Colorado School of Medicine, UCHSC MSTP Mailstop B176, Academic Office One, Room L15-2601, 12631 E 17th Avenue, Aurora, CO 80045 USA
| | - Kevin C. Hoth
- Department of Chemical and Biological Engineering, University of Colorado, Boulder, CO USA
| | - Cole A. DeForest
- Department of Chemical and Biological Engineering, University of Colorado, Boulder, CO USA
| | - Christopher N. Bowman
- Department of Chemical and Biological Engineering, University of Colorado, Boulder, CO USA
| | - Kristi S. Anseth
- Department of Chemical and Biological Engineering, Howard Hughes Medical Institute, University of Colorado, 424 UCB, Boulder, CO 80309 USA
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Lawson MC, Shoemaker R, Hoth KB, Bowman CN, Anseth KS. Polymerizable vancomycin derivatives for bactericidal biomaterial surface modification: structure-function evaluation. Biomacromolecules 2009; 10:2221-34. [PMID: 19606854 PMCID: PMC2936007 DOI: 10.1021/bm900410a] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
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Surface modification of implantable biomaterials with biologically active functionalities, including antimicrobials, has wide potential for addressing implant-related design problems. Here, four polymerizable vancomycin derivatives bearing either acrylamide or poly(ethylene glycol) (PEG)-acrylate were synthesized and then polymerized through a surface-mediated reaction. Functionalization of vancomycin at either the V3 or the X1 position decreased monomeric activity by 6−75-fold depending on the modification site and the nature of the adduct (P < 0.08 for all comparisons). A 5000 Da PEG chain showed an order of magnitude decrease in activity relative to a 3400 Da counterpart. Molecular dynamics computational simulations were used to explore the mechanisms of this decreased activity. Assays were also conducted to demonstrate the utility of a living radical photopolymerization to create functional, polymeric surfaces with these monomers and to demonstrate surface-based activity against Staphylococcus epidermidis. In particular, the vancomycin−PEG-acrylate derivatives demonstrated a 7−8 log reduction in bacterial colony forming units (CFU) with respect to nonfunctionalized control surfaces.
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Affiliation(s)
- McKinley C Lawson
- Department of Chemical and Biological Engineering, University of Colorado, Boulder, CO 80309, USA
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Ewald A, Ihde S. Salt impregnation of implant materials. ACTA ACUST UNITED AC 2009; 107:790-5. [DOI: 10.1016/j.tripleo.2008.12.028] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2008] [Revised: 12/10/2008] [Accepted: 12/17/2008] [Indexed: 11/23/2022]
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Abstract
Infections in the setting of orthopaedic hardware remain a serious complication. Traditional treatment modalities rely on antibiotic-loaded biomaterials and/or prolonged intravenous therapy, both of which suffer major limitations. We hypothesized a derivatized form of the glycopeptide antibiotic vancomycin could be covalently attached to a Ti-6Al-4V implant alloy to form a bactericidal surface capable of killing bacteria relevant to orthopaedic infections. First, a polymerizable poly(ethylene glycol)-acrylate derivative of vancomycin was synthesized. This monomer was characterized by liquid chromatography, 1H NMR spectroscopy, and MIC and MBC determination. The monomer was subsequently photochemically polymerized to implant grade Ti-6Al-4V alloy. The coating was bactericidal against Staphylococcus epidermidis through initial release of unattached antibiotic species followed by continued surface-contact-mediated bacterial killing by covalently tethered vancomycin. Through this surface-contact mechanism, the number of colony forming units dropped by ca. fivefold from an initial inoculum of 1 x 10(6) cfu/mL over 4 hours and by ca. 100-fold with respect to nonbactericidal control surfaces. An inoculum of 1 x 10(4) cfu/mL was reduced to undetectable levels over 17 hours. This coating method allows a loading dose several thousand times larger than that achieved with monolayer vancomycin coupling approaches and holds promise for the treatment of orthopaedic infections.
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Affiliation(s)
- McKinley C Lawson
- Department of Chemical and Biological Engineering, University of Colorado, Boulder, CO 80309, USA
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Abstract
Despite improved strategies for treating periprosthetic infection, current antibiotic delivery approaches are imperfect and can result in bacterial resistance and recalcitrant bio-films. To address the issues, we developed a covalently linked vancomycin-titanium implant interface that prevents and possibly eliminates bacterial colonization. We determined the amount of vancomycin immobilized on the titanium surface and assessed vancomycin stability and activity over time. When incubated with Staphylococcus aureus, the vancomycin-titanium surface showed an almost complete absence of adherent bacteria. To determine if continual exposure to vancomycin-titanium would cause decreased susceptibility to the antibiotic, S. aureus was incubated with vancomycin-titanium for 1 week or 4 weeks; these bacteria did not show an increased minimum inhibitory concentration for vancomycin. We tested the long-term stability of the vancomycin-titanium surface by incubation in phosphate-buffered saline for 11 months and then challenging the surface with S. aureus. Fluorescent staining for bacteria indicated the vancomycin-titanium retained its bactericidal activity. Finally, osteoblasts seeded on the vancomycin-titanium surface exhibited no change in viability, indicating the surface supports bone cell adhesion. Based on these observations, covalent modification of the titanium surface with an antibiotic may be viewed as a potential new tool in preventing or eliminating periprosthetic infection.
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Affiliation(s)
- Valentin Antoci
- Department of Orthopaedic Surgery, Thomas Jefferson University, Philadelphia, PA 19107, USA
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Abstract
A major challenge in treating periprosthetic infection is the predilection of certain bacteria to colonize implants, form biofilms, and resist treatment. We engineered an innovative self-protective implant with covalently bound antibiotics that prevents bacterial colonization and remains stable for extended periods of time. To test this surface in vivo, we developed a rat periprosthetic infection model with an intramedullary implant in S. aureus-infected femora. Using the model, we then evaluated the effect of vancomycin-modified titanium rods on the clinical presentation of bone infection. Finally, assuming delayed and chronic periprosthetic infections originate from biofilms atop contaminated implants, the numbers of surface adherent bacteria were measured to assess the capability of the implant to prevent biofilms. S. aureus (1.5 x 10(3) colony forming units) with no known resistance were injected into the femoral canal of Wistar rats, followed by the implant. Signs of infection were assessed weekly by direct clinical observation of the animals, radiograph, and microCT, and counts of bacteria adherent to the implant. Vancomycin-modified implants showed superior inhibition of bacterial attachment and proliferation compared to control titanium surfaces.
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Affiliation(s)
- Valentin Antoci
- Department of Orthopaedic Surgery, Thomas Jefferson University, Philadelphia, PA, USA
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Abstract
In this review, we discuss current advances leading to an exciting change in implant design for orthopedic surgery. The initial biomaterial approaches in implant design are being replaced by cellular-molecular interactions and nanoscale chemistry. New designs address implant complications, particularly loosening and infection. For infection, local delivery systems are an important first step in the process. Selfprotective 'smart' devices are an example of the next generation of orthopedic implants. If proven to be effective, antibiotics or other active molecules that are tethered to the implant surface through a permanent covalent bond and tethering of antibiotics or other biofactors are likely to transform the practice of orthopedic surgery and other medical specialties. This new technology has the potential to eliminate periprosthetic infection, a major and growing problem in orthopedic practice.
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Affiliation(s)
- Javad Parvizi
- Thomas Jefferson University, Rothman Institute of Orthopedics, 925 Chestnut Street, Philadelphia, PA 19107, USA.
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Abstract
BACKGROUND From an ecological viewpoint, the oral cavity, in fact the oro-pharynx, is an 'open growth system'. It undergoes an uninterrupted introduction and removal of both microorganisms and nutrients. In order to survive within the oro-pharyngeal area, bacteria need to adhere either to the soft or hard tissues in order to resist shear forces. The fast turn-over of the oral lining epithelia (shedding 3 x/day) is an efficient defence mechanism as it prevents the accumulation of large masses of microorganisms. Teeth, dentures, or endosseous implants, however, providing non-shedding surfaces, allow the formation of thick biofilms. In general, the established biofilm maintains an equilibrium with the host. An uncontrolled accumulation and/or metabolism of bacteria on the hard surfaces forms, however, the primary cause of dental caries, gingivitis, periodontitis, peri-implantitis, and stomatitis. OBJECTIVES This systematic review aimed to evaluate critically the impact of surface characteristics (free energy, roughness, chemistry) on the de novo biofilm formation, especially in the supragingival and to a lesser extent in the subgingival areas. METHODS An electronic Medline search (from 1966 until July 2005) was conducted applying the following search items: 'biofilm formation and dental/oral implants/surface characteristics', 'surface characteristics and implants', 'biofilm formation and oral', 'plaque/biofilm and roughness', 'plaque/biofilm and surface free energy', and 'plaque formation and implants'. Only clinical studies within the oro-pharyngeal area were included. RESULTS From a series of split-mouth studies, it could be concluded that both an increase in surface roughness above the R(a) threshold of 0.2 microm and/or of the surface-free energy facilitates biofilm formation on restorative materials. When both surface characteristics interact with each other, surface roughness was found to be predominant. The biofilm formation is also influenced by the type (chemical composition) of biomaterial or the type of coating. Direct comparisons in biofilm formation on different transmucosal implant surfaces are scars. CONCLUSIONS Extrapolation of data from studies on different restorative materials seems to indicate that transmucosal implant surfaces with a higher surface roughness/surface free energy facilitate biofilm formation.
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Affiliation(s)
- Wim Teughels
- Department of Periodontology, Faculty of Medicine, School of Dentistry, Oral Pathology & Maxillo-facial Surgery, Catholic University of Leuven, Leuven, Belgium
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Abstract
BACKGROUND Biofilm formation and deep infection of endoprostheses is a recurrent complication in implant surgery. Post-operative infections may be overcome by adjusting antimicrobial properties of the implant surface prior to implantation. In this work we described the development of an antimicrobial titanium/silver hard coating via the physical vapor deposition (PVD) process. METHODS Coatings with a thickness of approximately 2 mum were deposited on titanium surfaces by simultaneous vaporisation of both metals in an inert argon atmosphere with a silver content of approximately 0.7-9% as indicated by energy dispersive X-ray analysis. On these surfaces microorganisms and eukaryotic culture cells were grown. RESULTS The coatings released sufficient silver ions (0.5-2.3 ppb) when immersed in PBS and showed significant antimicrobial potency against Staphylococcus epidermis and Klebsiella pneumoniae strains. At the same time, no cytotoxic effects of the coatings on osteoblast and epithelial cells were found. CONCLUSION Due to similar mechanical performance when compared to pure titanium, the TiAg coatings should be suitable to provide antimicrobial activity on load-bearing implant surfaces.
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Affiliation(s)
- Andrea Ewald
- Department for Functional Materials in Medicine and Dentistry, University of Würzburg, Pleicherwall 2, D-97070 Würzburg, Germany
| | - Susanne K Glückermann
- Department for Functional Materials in Medicine and Dentistry, University of Würzburg, Pleicherwall 2, D-97070 Würzburg, Germany
| | - Roger Thull
- Department for Functional Materials in Medicine and Dentistry, University of Würzburg, Pleicherwall 2, D-97070 Würzburg, Germany
| | - Uwe Gbureck
- Department for Functional Materials in Medicine and Dentistry, University of Würzburg, Pleicherwall 2, D-97070 Würzburg, Germany
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Jose B, Antoci V, Zeiger AR, Wickstrom E, Hickok NJ. Vancomycin covalently bonded to titanium beads kills Staphylococcus aureus. ACTA ACUST UNITED AC 2006; 12:1041-8. [PMID: 16183028 DOI: 10.1016/j.chembiol.2005.06.013] [Citation(s) in RCA: 101] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2005] [Revised: 06/28/2005] [Accepted: 06/30/2005] [Indexed: 11/22/2022]
Abstract
Periprosthetic infections are life-threatening complications that occur in about 6% of medical device insertions. Stringent sterile techniques have reduced the incidence of infections, but many implant patients are at high risk for infection, especially the elderly, diabetic, and immune compromised. Moreover, because of low vascularity at the site of the new implant, antibiotic prophylaxis is often not effective. To address this problem, we designed a covalent modification to titanium implant surfaces to render them bactericidal. Specifically, we aminopropylated titanium, a widely used implant material and extended a tether by solid phase coupling of ethylene glycol linkers, followed by solid phase coupling of vancomycin. Vancomycin covalently attached to titanium still bound soluble bacterial peptidoglycan, reduced Staphylococcus aureus colony-forming units by 88% +/- 16% over 2 hr, and retained antibacterial activity upon a repeated challenge.
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Affiliation(s)
- Binoy Jose
- Department of Biochemistry and Molecular Biology, Thomas Jefferson University, Philadelphia, Pennsylvania 19107, USA
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Stoodley P, Kathju S, Hu FZ, Erdos G, Levenson JE, Mehta N, Dice B, Johnson S, Hall-Stoodley L, Nistico L, Sotereanos N, Sewecke J, Post JC, Ehrlich GD. Molecular and imaging techniques for bacterial biofilms in joint arthroplasty infections. Clin Orthop Relat Res 2005:31-40. [PMID: 16056023 DOI: 10.1097/01.blo.0000175129.83084.d5] [Citation(s) in RCA: 98] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Biofilm formation on surfaces is an ancient and integral strategy for bacterial survival. Billions of years of adaptation provide microbes with the ability to colonize any surface, including those used in orthopaedic surgery. Although remarkable progress has been made in the treatment of orthopaedic diseases with implanted prostheses, infection rates remain between 1% and 2%, and are higher for revision surgeries. The chronic nature of implant infections, their nonresponsiveness to antibiotics, and their frequent culture negativity can be explained by the biofilm paradigm of infectious disease. However, the role of biofilms in orthopaedic implant infections and aseptic loosening is controversial. To address these issues, we developed molecular diagnostic and confocal imaging techniques to identify and characterize biofilms associated with infected implants. We designed PCR and reverse transcription (RT)-PCR-based assays that can be used to detect bacterial infections associated with culture-negative joint effusions that distinguish between physiologically active Staphylococcus aureus and Staphylococcus epidermidis. Using clinical isolates of Pseudomonas aeruginosa, we constructed a series of reporter strains expressing colored fluorescent proteins to observe biofilms growing on 316L stainless steel and titanium orthopaedic screws. Three-dimensional structures of Pseudomonas aeruginosa and staphylococci biofilms growing on the screws were documented using confocal microscopy. The application of these tools for clinical diagnosis and biofilm research in animal and in vitro models is discussed.
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Affiliation(s)
- Paul Stoodley
- Center for Genomic Sciences, Allegheny Singer Research Institute, Pittsburgh, PA 15212, USA
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