A pharmacological and toxicological profile of silver as an antimicrobial agent in medical devices

Mechano-Bactericidal Titanium Surfaces for Bone Tissue Engineering

Despite advances in the development of bone substitutes and strict aseptic procedures, the majority of failures in bone grafting surgery are related to nosocomial infections. Development of biomaterials combining both osteogenic and antibiotic activity is, therefore, a crucial public health issue. Herein, two types of intrinsically bactericidal titanium supports were fabricated by using commercially scalable techniques: plasma etching or hydrothermal treatment, which display two separate mechanisms of mechano-bactericidal action. Hydrothermal etching produces a randomly nanostructured surface with sharp nanosheet protrusions killing bacteria via cutting of the cell membrane, whereas plasma etching of titanium produces a microscale two-tier hierarchical topography that both reduce bacterial attachment and rupture those bacteria that encounter the surface. The adhesion, growth, and proliferation of human adipose-derived stem cells (hASCs) on the two mechano-bactericidal topographies were assessed. Both types of supports allowed the growth and proliferation of the hASCs in the same manner and cells retained their stemness and osteogenic potential. Furthermore, these supports induced osteogenic differentiation of hASCs without the need of differentiation factors, demonstrating their osteoinductive properties. This study proves that these innovative mechano-bactericidal titanium surfaces with both regenerative and bactericidal properties are a promising solution to improve the success rate of reconstructive surgery.

Dermatologic reactions to disinfectant use during the COVID-19 pandemic

Infection preventive practice of using disinfectants against SARS-CoV-2 has become the new normal due to the COVID-19 pandemic. Although disinfectants may not be applied directly to the human body, it remains at high risk of exposure including close skin contact on disinfected surfaces or during handling. This dermal contact, on a regular basis, can induce hazardous skin reactions like irritation, inflammation, and burning in severe conditions. Disinfectants are germicide chemicals that can penetrate the skin and create skin reactions that are usually regarded as irritant and allergic contact dermatitis. More importantly, disinfectants can react with skin components (proteins and lipids) to facilitate their skin penetration and disrupt the skin barrier function. Whereas the antimicrobial actions of disinfectants are well understood, much less is known regarding their dermatologic reactions, including but not limited to irritation and hypersensitivity. We reviewed the skin reactions created by those disinfectants against SARS-CoV-2 approved by the European Chemical Agency and the US Environmental Protection Agency.

Antibacterial activity and mechanism of three isomeric terpineols of Cinnamomum longepaniculatum leaf oil

α-Terpineol, terpinen-4-ol, and δ-terpineol, isomers of terpineol, are among the compounds that give Cinnamomum longepaniculatum leaf oil its distinguished pleasant smell. The objective of this study was to evaluate the antimicrobial activity of these three isomeric terpineols. The determination of antibacterial activity was based on the minimum inhibition concentration (MIC) and minimum bactericide concentration (MBC). Changes in time-kill curve, alkaline phosphatase (AKP), UV-absorbing material, membrane potential, and scanning electron microscopy (SEM) were measured to elucidate the possible antimicrobial mechanism. α-Terpineol, terpinen-4-ol, and δ-terpineol demonstrated good inhibitory effects against several gram-negative bacteria, particularly Shigella flexneri. MIC and MBC of α-terpineol and terpinen-4-ol were similar (0.766 mg/mL and 1.531 mg/mL, respectively) for S. flexneri, while the MIC and MBC values of δ-terpineol were 0.780 mg/mL and 3.125 mg/mL, respectively. Time-kill curves showed that the antibacterial activities of the tested compounds were in a concentration-dependent manner. Release of nucleic acids and proteins along with a decrease in membrane potential proved that α-terpineol, terpinen-4-ol, and δ-terpineol could increase the membrane permeability of Shigella flexneri. Additionally, the release of AKP suggested that the cell wall was destroyed. SEM analysis further confirmed that S. flexneri cell membranes were damaged by α-terpineol, terpinen-4-ol, and δ-terpineol. Our research suggests that these three isomeric terpineols have the potential of being used as natural antibacterial agents by destroying the cell membrane and wall, resulting in cell death. However, the specific antibacterial activity differences need further investigation.

Silver-coated megaprosthesis in prevention and treatment of peri-prosthetic infections: a systematic review and meta-analysis about efficacy and toxicity in primary and revision surgery

AIM

Prosthetic joint infection (PJI) is a common complication following orthopedic megaprosthetic implantations (EPR), estimated up to 50%. Silver coatings were introduced in order to reduce the incidence of PJI, by using the antibacterial activity of silver. Three different silver coatings are available: MUTARS^® (Implantcast), Agluna^® (Accentus Medical), PorAg^® (Waldemar Link). The aim of this review is to provide an overview on efficacy and safety of silver-coated EPR both in primary and revision surgery, comparing infection rate according to the type of implant.

METHODS

Through an electronic systematic search, we reviewed the articles concerning silver-coated EPRs. Infection rate, silver-related complications, local and blood concentrations of the silver were evaluated. Meta-analyses were performed to compare results from each study included.

RESULTS

Nineteen studies were included. The overall infection rate in patients with silver-coated implants was 17.6% (133/755). Overall infection rate in primary silver-coated EPR was been 9.2% (44/445), compared to 11.2% (57/507) of non-silver-coated implants. The overall infection rate after revisions was 13.7% (25/183) in patients with silver-coated EPR and 29.2% (47/161) when uncoated EPR were used, revealing a strength statistically significative utility of silver coatings in preventing infections in this group (p: 0.019). Generally, the use of MUTARS^® EPR had produced an almost constant decrease in the incidence of primary PJI but there are few data on the effectiveness in revisions. The results from the use of Agluna^® in both primary and revisions implants are inconstant. Conversely, PorAg^® had proven to be effective both in PJI prevention but, especially, when used in PJI revision settings. Local argyria was reported in 8 out of 357 patients (2.2%), while no systemic complications were described. Local and blood concentrations of silver were always reported very far to the threshold of toxicity, with the lowest concentration found using PorAg^®.

CONCLUSIONS

Silver-coated EPRs are safe and effective in reduction in PJI and re-infection rate, in particular when used in higher risk patients and after two-stage revisions to fight PJI.

Heavy metal pollution in the environment and their toxicological effects on humans

Environmental pollution of heavy metals is increasingly becoming a problem and has become of great concern due to the adverse effects it is causing around the world. These inorganic pollutants are being discarded in our waters, soils and into the atmosphere due to the rapidly growing agriculture and metal industries, improper waste disposal, fertilizers and pesticides. This review shows how pollutants enter the environment together with their fate. Some metals affect biological functions and growth, while other metals accumulate in one or more different organs causing many serious diseases such as cancer. The pharmacokinetics and toxicological processes in humans for each metal is described. In summary, the review shows the physiological and biochemical effects of each heavy metal bioaccumulation in humans and the level of gravity and disquieting factor of the disease.

Assessment of Silver Levels in a Closed-Incision Negative Pressure Therapy Dressing: In Vitro and In Vivo Study

Objective: In recent years, reticulated open-cell foam-based closed-incision negative pressure therapy (ROCF-ciNPT) has shown effectiveness in management of various postoperative incisions. These dressings consist of a skin interface layer that absorbs fluid from the skin surface and reduces the potential for microbial colonization within the dressing by means of ionic silver. This study examines the ability of silver to reduce the bioburden within the dressing as well as the localized effect due to potential silver mobility.

Approach: Ability of silver to reduce bioburden within the ROCF-ciNPT dressing was assessed using Staphylococcus aureus, Pseudomonas aeruginosa, and Candida spp. Furthermore, silver mobility was assessed using an in vitro skin model to study the zone of inhibition along with released silver quantification. Using a porcine model, diffusion of silver into blood and tissue was studied using emission spectrometry and histology.

Results: Microbial growth in the ROCF-ciNPT dressing was significantly reduced (∼2.7–4.9 log reduction) compared to a silver-free negative control. No zone of inhibition was observed for microbial colonies for up to 7 days with minimal localized silver release (<5.5 ppm release). In vivo studies demonstrated no measurable concentration (<0.2 μg/g) of silver in the blood, urine, feces, kidney, and liver tissue biopsy.

Innovation: This study provides an important insight into silver concentration and mobility within the ROCF-ciNPT dressing, given emerging concerns associated with potential silver cytotoxicity.

Conclusion: These results indicate the concentration of silver (0.019% silver by weight) in the ROCF-ciNPT dressings has been adequate to reduce bioburden within the skin interface layer, while severely limiting the amount of silver leaching out.

Titanium Alloys for Dental Implants: A Review

The topic of titanium alloys for dental implants has been reviewed. The basis of the review was a search using PubMed, with the large number of references identified being reduced to a manageable number by concentrating on more recent articles and reports of biocompatibility and of implant durability. Implants made mainly from titanium have been used for the fabrication of dental implants since around 1981. The main alloys are so-called commercially pure titanium (cpTi) and Ti-6Al-4V, both of which give clinical success rates of up to 99% at 10 years. Both alloys are biocompatible in contact with bone and the gingival tissues, and are capable of undergoing osseointegration. Investigations of novel titanium alloys developed for orthopaedics show that they offer few advantages as dental implants. The main findings of this review are that the alloys cpTi and Ti-6Al-4V are highly satisfactory materials, and that there is little scope for improvement as far as dentistry is concerned. The conclusion is that these materials will continue to be used for dental implants well into the foreseeable future.

Silver Sulfadiazine's Effect on Keratin-19 Expression as Stem Cell Marker in Burn Wound Healing

BACKGROUND

Burn wounds are one of the causes of cutaneous injury that involve both epidermal and dermal layers of skin. Silver sulfadiazine (SSD) has been widely used to treat burn wounds, however recent studies have found the treatment to have some drawbacks, such as cellular toxicity effects. Cutaneous wound regeneration is known to start from the basal layer of the epidermal epithelial cells, which are enriched with highly proliferative cells. Keratin-19 (K19) is one of the epidermal stem cell biomarkers found in the skin. This study aims to explore the expression of K19 in burn wound tissue and to investigate the effect of SSD on its expression.

METHODS

We created a burn wound model in Sprague Dawley rats and randomly divided them into control and SSD groups. Wound closure was evaluated (visitrak) overtime series followed by histological evaluation of K19 expression in the wound tissue (immunohistochemistry staining).

RESULTS

Our model successfully represents full-thickness damage caused by a burn wound. The SSD group showed a faster reduction of wound surface area (wound closure) compared to the control group with the peak at day 18 post wounding (p < 0.05). K19 expression was found in both groups and was distributed on epidermal layers, hair follicles and dermis of granulation tissue showing similar patterns.

CONCLUSION

Topical application of SSD on burn wounds showed superiority in wound closure and is likely to have no harmful effect on epidermal stem cells. However, further study is required to investigate the effect of silver species on cell viability and toxicity effects during long term treatment.

Clinical efficacy and the antimicrobial potential of silver formulations in arresting dental caries: a systematic review

Background

The use of silver-formulation as microbicide to arrest dentinal caries is gaining popularity. The primary objective of the present appraisal was to systematically review the clinical (in vivo) applications and antimicrobial potential of silver-containing formulations in arresting dentinal caries. Our secondary aim was to sum up the available in vitro applications of silver-containing formulations against cariogenic microbes isolated from dentine lesions.

Methods

Ovid MEDLINE, EBSCO host, Web of Science, and Cochrane Library databases was searched between January 2009–May 2019.

Results

In vivo: We observed conflicting evidence of antimicrobial efficacy of SDF on a diverse array of microbial taxa present in carious dentine of primary and permanent teeth. Moreover, there is insufficient evidence on the application of AgNP-fluoride as an effective microbicidal against cariogens of dentine lesions.

In vitro: We found a good evidence of microbicidal efficacy of silver diamine fluoride (SDF) on selective cariogenic microbes in human dentine model. Additionally, a good evidence was noted of in vitro application of silver nanoparticles (AgNPs) as a useful microbicidal against S. mutans adhesion, growth and subsequent biofilm formation in human dentine models.

Conclusions

Taken together, in vitro evidence indicates the promising antimicrobial potential of silver-based formulations (SDF and nanosilver) against the predominant cariogenic flora, particularly from dentine lesions. Post-treatment clinical data of either the bactericidal and bacteriostatic effects of SDF or nanosilver are sparse. Furthermore, the current understanding of the specific size, concentration, antimicrobial mechanisms, and toxicological aspects of nano-silver compounds is inadequate to draw firm conclusions on their clinical utility.

Stretchable Conductive Fabric for Cardiac Electrophysiology Applications

Stretchable conductive fabric (SCF) is a durable nontoxic textile material coated or blended with conductive metals. Unlike solid metal, SCF effectively conducts electricity with low resistance and maintains conductance when stretched. Thus, we hypothesized that SCF electrodes are more suitable for cardiac electrophysiology applications in beating hearts than traditional solid metal electrodes. Accordingly, we developed a straightforward protocol for fabricating customized SCF electrodes and then assessed their ability to electrically stimulate and record electrical signals from beating hearts. Compared to flexible copper electrodes, SCF electrodes had similar electrical resistance (112.50 ± 25.81 vs 157.85 ± 17.06 Ω, p = 0.09), activated cardiac tissue with lower stimulus strength (27.25 ± 3.52 vs 15.35 ± 2.15 mA, p = 0.0001), recorded stable electrograms with a higher signal-to-noise ratio (20.54 ± 1.09 vs 13.35 ± 1.46 dB, p = 0.04), and were noncorrosive and harmless to cardiac tissue or vasculature. These results support the use of SCF over metal electrodes for a wide range of cardiac electrophysiology applications in the beating heart.

Co-incorporation of graphene oxide/silver nanoparticle into poly-L-lactic acid fibrous: A route toward the development of cytocompatible and antibacterial coating layer on magnesium implants

Magnesium (Mg) alloys present great potential for the development of orthopedic implants, whereas, their high degradation rate and poor antibacterial performance have restricted orthopedic applications. In this work, PLLA/GO-AgNP (poly-L-lactic acid/graphene oxide- silver nanoparticle) with different concentration of GO-AgNPs were deposited on Mg alloy via electrospinning method for enhancement of corrosion resistance and antibacterial performance. The result revealed that incorporation of GO into PLLA fibrous considerably slowed down the degradation rate of Mg alloy substrate and reduced the H₂ release rate from the substrate. Also, co-incorporation of GO and AgNPs into PLLA fibrous resulted in substantial escalate in compressive strength after immersion in simulated body fluid (SBF). Antibacterial activity test exhibited that Mg alloy and neat PLLA fibrous presented minimal inhibition area toward Escherichia coli (E. coli) and Staphylococcus aureus (S. aureus). In contrast, using PLLA/GO-AgNPs fibrous improved antibacterial performance against both bacteria. Cytocompatibility results indicated that PLLA/GO-AgNPs fibrous with a low amount of GO-AgNPs enhanced cell proliferation and growth while high co-incorporation of GO-AgNPs showed a negative effect on cell proliferation. Taken together, PLLA/1GO-AgNPs fibrous coating shows suitable corrosion resistance, cytocompatibility, and antibacterial function for use in orthopedic applications.

(Amino)cyclophosphazenes as Multisite Ligands for the Synthesis of Antitumoral and Antibacterial Silver(I) Complexes

The reactivity of the multisite (amino)cyclotriphosphazene ligands, [N₃P₃(NHCy)₆] and [N₃P₃(NHCy)₃(NMe₂)₃], has been explored in order to obtain silver(I) metallophosphazene complexes. Two series of cationic silver(I) metallophosphazenes were obtained and characterized: [N₃P₃(NHCy)₆{AgL}_n](TfO)_n [n = 2, L = PPh₃ (2), PPh₂Me (4); n = 3, L = PPh₃ (3), PPh₂Me (5), TPA (TPA = 1,3,5-triaza-7-phosphaadamantane, 6)] and nongem-trans-[N₃P₃(NHCy)₃(NMe₂)₃{AgL}_n](TfO)_n [n = 2, L = PPh₃ (7), PPh₂Me (9); n = 3, L = PPh₃ (8), PPh₂Me (10)]. 5, 7, and 9 have also been characterized by single-crystal X-ray diffraction, thereby allowing key bonding information to be obtained. Compounds 2-6, 9, and 10 were screened for in vitro cytotoxic activity against two tumor human cell lines, MCF7 (breast adenocarcinoma) and HepG2 (hepatocellular carcinoma), and for antimicrobial activity against five bacterial species including Gram-positive, Gram-negative, and Mycobacteria strains. Both the IC₅₀ and MIC values revealed excellent biological activity for these metal complexes, compared with their precursors and cisplatin and also AgNO₃ and silver sulfadiazine, respectively. Both IC₅₀ and MIC values are among the lowest values found for any silver derivatives against the cell lines and bacterial strains used in this work. The structure-activity relationships were clear. The most cytotoxic and antimicrobial derivatives were those with the triphenylphosphane and [N₃P₃(NHCy)₆] ligands. A significant improvement in the activity was also observed upon a rise in the number of silver atoms linked to the phosphazene ring.

The Pulsed Electron Deposition Technique for Biomedical Applications: A Review

The “pulsed electron deposition” (PED) technique, in which a solid target material is ablated by a fast, high-energy electron beam, was initially developed two decades ago for the deposition of thin films of metal oxides for photovoltaics, spintronics, memories, and superconductivity, and dielectric polymer layers. Recently, PED has been proposed for use in the biomedical field for the fabrication of hard and soft coatings. The first biomedical application was the deposition of low wear zirconium oxide coatings on the bearing components in total joint replacement. Since then, several works have reported the manufacturing and characterization of coatings of hydroxyapatite, calcium phosphate substituted (CaP), biogenic CaP, bioglass, and antibacterial coatings on both hard (metallic or ceramic) and soft (plastic or elastomeric) substrates. Due to the growing interest in PED, the current maturity of the technology and the low cost compared to other commonly used physical vapor deposition techniques, the purpose of this work was to review the principles of operation, the main applications, and the future perspectives of PED technology in medicine.

Pharmacokinetics of 38% topical silver diamine fluoride in healthy adult volunteers

BACKGROUND

Silver diamine fluoride (SDF) is used topically to prevent or arrest caries. The authors' aim was to characterize the kinetics of silver and fluoride after topical application of SDF.

METHODS

Sixteen adults participated in a pharmacokinetics study after the application of 38% SDF to 5 teeth (approximately 50 microliters, estimated 4-11 milligrams per participant). Serum and urine samples were collected over 24 hours after application and were analyzed for silver and fluoride.

RESULTS

Silver serum peak was 0.67 (standard deviation [SD], 0.49) nanograms per milliliter; median time to peak was 3 hours. The estimated elimination half-life of silver was 46 (SD, 26) hours. No silver was recovered in urine. Baseline fluoride serum levels ranged from less than 10 through 50 ng/mL (< 0.01-0.05 parts per million) and fluctuated around baseline after SDF. The 24-hour urinary fluoride was 1.29 (SD, 0.81) mg.

CONCLUSIONS

SDF was well tolerated in this study, and no adverse events related to SDF were reported.

PRACTICAL IMPLICATIONS

This clinical study confirmed that topical application of 38% SDF, in growing use in the United States, is safe and well tolerated in healthy adults.

Synthesis and biological characterization of silver nanoparticles derived from the cyanobacterium Oscillatoria limnetica

Using aqueous cyanobacterial extracts in the synthesis of silver nanoparticle is looked as green, ecofriendly, low priced biotechnology that gives advancement over both chemical and physical methods. In the current study, an aqueous extract of Oscillatoria limnetica fresh biomass was used for the green synthesis of Ag-NPs, since O. limnetica extract plays a dual part in both reducing and stabilizing Oscillatoria-silver nanoparticles (O-AgNPs). The UV-Visible absorption spectrum, Fourier transforms infrared (FT-IR), transmission electron microscopy (TEM) and scanning electron microscope (SEM) were achieved for confirming and characterizing the biosynthesized O-AgNPs. TEM images detected the quasi-spherical Ag-NPs shape with diverse size ranged within 3.30-17.97 nm. FT-IR analysis demonstrated the presence of free amino groups in addition to sulfur containing amino acid derivatives acting as stabilizing agents as well as the presence of either sulfur or phosphorus functional groups which possibly attaches silver. In this study, synthesized Ag-NPs exhibited strong antibacterial activity against multidrug-resistant bacteria (Escherichia coli and Bacillus cereus) as well as cytotoxic effects against both human breast (MCF-7) cell line giving IC50 (6.147 µg/ml) and human colon cancer (HCT-116) cell line giving IC50 (5.369 µg/ml). Hemolytic activity of Ag-NPs was investigated and confirmed as being non- toxic to human RBCs in low concentrations.

Anemia and leukopenia following intravenous colloidal silver infusions-Clinical and hematological features, unique peripheral blood film appearance and effective therapy with supplemental oral copper and apheresis

Alternative medical therapy with multiple intravenous colloidal silver infusions may cause severe illness, including profound copper deficiency-induced anemia and hepatic toxicity. No chelating agent for silver poisoning exists and effective therapy requires apheresis in combination with continuous administration of oral copper.

Safety Assessment of Nanomaterials to Eyes: An Important but Neglected Issue

The production and application of nanomaterials have grown tremendously during last few decades. The widespread exposure of nanoparticles to the public is provoking great concerns regarding their toxicity to the human body. However, in comparison with the extensive studies carried out to examine nanoparticle toxicity to the human body/organs, one especially vulnerable organ, the eye, is always neglected. Although it is a small part of the body, 90% of outside information is obtained via the ocular system. In addition, eyes usually directly interact with the surrounding environment, which may get severer damage from toxic nanoparticles compared to inner organs. Therefore, the study of assessing the potential nanoparticle toxicity to the eyes is of great importance. Here, the recent advance of some representative manufactured nanomaterials on ocular toxicity is summarized. First, a brief introduction of ocular anatomy and disorders related to particulate matter exposure is presented. Following, the factors that may influence toxicity of nanoparticles to the eye are emphasized. Next, the studies of representative manufactured nanoparticles on eye toxicity are summarized and classified. Finally, the limitations that are associated with current nanoparticle-eye toxicity research are proposed.

Antifungal activity of silver nanoparticles in combination with ketoconazole against Malassezia furfur

Malassezia furfur is lipophilic and lipid-dependent yeast, inhabitant of human skin microbiota associated with several dermal disorders. In recent years, along with the advances in nanotechnology and the incentive to find new antimicrobial drugs, there has been a growing interest in the utilization of nanoparticles for the treatment of skin microbial infections. This work aimed to study the in vitro inhibitory activity of silver nanoparticles (AgNP) against 41 M. furfur clinical isolates, visualize the interaction between AgNP-Malassezia, evaluate the synergism with ketoconazole (KTZ) and to produce an antimicrobial gel of AgNP–KTZ. The synthesized AgNP were randomly distributed around the yeast surface and showed a fungicidal action with low minimal inhibitory concentration values. AgNP showed no antagonistic effect with KTZ. The broad-spectrum antimicrobial property with fungicidal action of AgNP and its accumulation in affected areas with a sustained release profile, added to the great antifungal activity of KTZ against Malassezia infections and other superficial mycoses, allowed us to obtain a gel based on carbopol formulated with AgNP–KTZ with the potential to improve the topical therapy of superficial malasseziosis, reduce the number of applications and, also, prevent the recurrence.

Silver in Wound Care-Friend or Foe?: A Comprehensive Review

Due to its strong antimicrobial activity, silver is a commonly used adjunct in wound care. However, it also has the potential to impair healing by exerting toxic effects on keratinocytes and fibroblasts. The published literature on the use of silver in wound care is very heterogeneous, making it difficult to generate useful treatment guidelines.

METHODS

A search of high-quality studies on the use of silver in wound care was performed on PubMed. A detailed qualitative analysis of published articles was performed to evaluate the evidence for the use of silver in infected wounds, clean wounds, burns, and over closed surgical incisions.

RESULTS

Fifty-nine studies were included in this qualitative analysis. We found that, overall, the quality of the published research on silver is poor. While there is some evidence for short-term use of dressings containing nanocrystalline silver in infected wounds, the use of silver-containing dressings in clean wounds and over closed surgical incisions is not indicated. Negative-pressure wound therapy accelerates the healing of contaminated wounds, especially when silver is used as an adjunct. For burns, silver sulfadiazine slows healing and should not be used. Instead, nanocrystalline silver, or alternatives such as octenidine and polyhexanide, lead to less infection and faster healing.

CONCLUSIONS

In infected wounds, silver is beneficial for the first few days/weeks, after which nonsilver dressings should be used instead. For clean wounds and closed surgical incisions, silver confers no benefit. The ideal silver formulations are nanocrystalline silver and silver-coated polyurethane sponge for negative-pressure wound therapy. Silver sulfadiazine impairs wound healing. Proper use of silver-containing dressings is essential to optimize wound healing.

Delivery of silver sulfadiazine and adipose derived stem cells using fibrin hydrogel improves infected burn wound regeneration

Infection control is necessary for improved burn wound regeneration. In this study contact burn wounds were induced on the dorsum of the rats and were infected with Pseudomonas aeruginosa (107cfu/ml of saline) and left overnight (12-14 hours) to establish the infection. After 12 hours, the wounds were treated with PEGylated fibrin hydrogel containing 50 mgs of silver sulfadiazine (SSD) loaded chitosan microsphere (SSD-CSM-FPEG). On day 9, SSD-CSM-FPEG treated burn wounds further received adipose derived stem cell (5×104 ASCs cells/ml) embedded in PEGylated fibrin hydrogel. Wounds were assessed for the healing outcomes such as neovascularization, granulation tissue formation, wound closure and collagen maturation. Analysis of bacterial load in the burn wound biopsies, demonstrated that SSD-CSM-FPEG significantly reduced bacterial infection, while overt infection was still observed in the untreated groups on day 14. Sequential treatment of infected wounds with SSD-CSM-FPEG followed by ASC-FPEGs (SSD-CSM-ASC-FPEG) significantly reduced bacterial colonization (9 log reduction) and pro-inflammatory cytokine (TNF-α) expression. A significant increase in neovascularization markers; NG2 and vWF was also observed. Histological analysis indicated the wounds treated with SSD-CSM-ASC-FPEG increased amount of dermal collagen matrix deposition, a thicker granulation tissue on day 21 and more mature collagen on day 28. This work demonstrates that the sequential treatment of infected burn wounds with SSD-CSM-FPEG followed by ASC-FPEG reduces bacterial infection as well as promotes neo-vascularization with improved matrix remodeling.

Colloidal Silver Induces Cytoskeleton Reorganization and E-Cadherin Recruitment at Cell-Cell Contacts in HaCaT Cells

Up until the first half of the 20th century, silver found significant employment in medical applications, particularly in the healing of open wounds, thanks to its antibacterial and antifungal properties. Wound repair is a complex and dynamic biological process regulated by several pathways that cooperate to restore tissue integrity and homeostasis. To facilitate healing, injuries need to be promptly treated. Recently, the interest in alternatives to antibiotics has been raised given the widespread phenomenon of antibiotic resistance. Among these alternatives, the use of silver appears to be a valid option, so a resurgence in its use has been recently observed. In particular, in contrast to ionic silver, colloidal silver, a suspension of metallic silver particles, shows antibacterial activity displaying less or no toxicity. However, the human health risks associated with exposure to silver nanoparticles (NP) appear to be conflicted, and some studies have suggested that it could be toxic in different cellular contexts. These potentially harmful effects of silver NP depend on various parameters including NP size, which commonly range from 1 to 100 nm. In this study, we analyzed the effect of a colloidal silver preparation composed of very small and homogeneous nanoparticles of 0.62 nm size, smaller than those previously tested. We found no adverse effect on the cell proliferation of HaCaT cells, even at high NP concentration. Time-lapse microscopy and indirect immunofluorescence experiments demonstrated that this preparation of colloidal silver strongly increased cell migration, re-modeled the cytoskeleton, and caused recruitment of E-cadherin at cell-cell junctions of human cultured keratinocytes.

Biofilm Forming Antibiotic Resistant Gram-Positive Pathogens Isolated From Surfaces on the International Space Station

The International Space Station (ISS) is a closed habitat in a uniquely extreme and hostile environment. Due to these special conditions, the human microflora can undergo unusual changes and may represent health risks for the crew. To address this problem, we investigated the antimicrobial activity of AGXX®, a novel surface coating consisting of micro-galvanic elements of silver and ruthenium along with examining the activity of a conventional silver coating. The antimicrobial materials were exposed on the ISS for 6, 12, and 19 months each at a place frequently visited by the crew. Bacteria that survived on the antimicrobial coatings [AGXX® and silver (Ag)] or the uncoated stainless steel carrier (V2A, control material) were recovered, phylogenetically affiliated and characterized in terms of antibiotic resistance (phenotype and genotype), plasmid content, biofilm formation capacity and antibiotic resistance transferability. On all three materials, surviving bacteria were dominated by Gram-positive bacteria and among those by Staphylococcus, Bacillus and Enterococcus spp. The novel antimicrobial surface coating proved to be highly effective. The conventional Ag coating showed only little antimicrobial activity. Microbial diversity increased with increasing exposure time on all three materials. The number of recovered bacteria decreased significantly from V2A to V2A-Ag to AGXX®. After 6 months exposure on the ISS no bacteria were recovered from AGXX®, after 12 months nine and after 19 months three isolates were obtained. Most Gram-positive pathogenic isolates were multidrug resistant (resistant to more than three antibiotics). Sulfamethoxazole, erythromycin and ampicillin resistance were most prevalent. An Enterococcus faecalis strain recovered from V2A steel after 12 months exposure exhibited the highest number of resistances (n = 9). The most prevalent resistance genes were ermC (erythromycin resistance) and tetK (tetracycline resistance). Average transfer frequency of erythromycin, tetracycline and gentamicin resistance from selected ISS isolates was 10⁻⁵ transconjugants/recipient. Most importantly, no serious human pathogens such as methicillin resistant Staphylococcus aureus (MRSA) or vancomycin-resistant Enterococci (VRE) were found on any surface. Thus, the infection risk for the crew is low, especially when antimicrobial surfaces such as AGXX® are applied to surfaces prone to microbial contamination.

The AGXX® Antimicrobial Coating Causes a Thiol-Specific Oxidative Stress Response and Protein S-bacillithiolation in Staphylococcus aureus

Multidrug-resistant pathogens, such as methicillin-resistant Staphylococcus aureus (MRSA) pose an increasing health burden and demand alternative antimicrobials to treat bacterial infections. The surface coating AGXX® is a novel broad-spectrum antimicrobial composed of two transition metals, silver and ruthenium that can be electroplated on various surfaces, such as medical devices and implants. AGXX® has been shown to kill nosocomial and waterborne pathogens by production of reactive oxygen species (ROS), but the effect of AGXX® on the bacterial redox balance has not been demonstrated. Since treatment options for MRSA infections are limited, ROS-producing agents are attractive alternatives to combat multi-resistant strains. In this work, we used RNA-seq transcriptomics, redox biosensor measurements and phenotype analyses to study the mode of action of AGXX® microparticles in S. aureus USA300. Using growth and survival assays, the growth-inhibitory amount of AGXX® microparticles was determined as 5 μg/ml. In the RNA-seq transcriptome, AGXX® caused a strong thiol-specific oxidative stress response and protein damage as revealed by the induction of the PerR, HypR, QsrR, MhqR, CstR, CtsR, and HrcA regulons. The derepression of the Fur, Zur, and CsoR regulons indicates that AGXX® also interferes with the metal ion homeostasis inducing Fe²⁺- and Zn²⁺-starvation responses as well as export systems for toxic Ag⁺ ions. The induction of the SigB and GraRS regulons reveals also cell wall and general stress responses. AGXX® stress was further shown to cause protein S-bacillithiolation, protein aggregation and an oxidative shift in the bacillithiol (BSH) redox potential. In phenotype assays, BSH and the HypR-controlled disulfide reductase MerA were required for protection against ROS produced under AGXX® stress in S. aureus. Altogether, our study revealed a strong thiol-reactive mode of action of AGXX® in S. aureus USA300 resulting in an increased BSH redox potential and protein S-bacillithiolation.

The Management of Critically Colonized and Locally Infected Leg Ulcers with an Acid-Oxidizing Solution: A Pilot Study

OBJECTIVE:

Critical colonization or local infection is very common in chronic wounds, but clinically problematic. Because therapeutic options for these conditions are limited in number and efficacy, the study authors tested a new acid-oxidizing solution (AOS [Nexodyn]; APR Applied Pharma Research S.A., Balerna, Switzerland) to determine its ancillary antimicrobial properties and potential support for wound healing.

DESIGN AND SETTING:

This open-label clinical case series was conducted with a prospective, single-arm design at the Federal County Hospital in Bregenz, Austria.

PATIENTS:

In the study, 30 patients with critically colonized or locally infected chronic leg ulcers of any origin were included.

INTERVENTIONS:

The AOS was applied on each leg ulcer at every dressing change for 35 days.

MAIN OUTCOME MEASURES:

The tolerability and performance of the AOS were assessed by evaluating the ulcer characteristics and comparing them with those at baseline. The clinical course of wounds was analyzed using standard measures for bioburden, local infection, pain, pH, and wound healing.

MAIN RESULTS:

Application of the solution was well tolerated, and no adverse events were recorded. In all patients, local infection was overcome, and wound bed pH and wound area decreased significantly. In addition, patient pain levels decreased to a level where interventions were not required after study day 7. In 37% of all patients, a complete resolution of chronic ulcers was achieved by the end of the study period.

CONCLUSION:

According to these results, the AOS seems to be a valid and highly tolerable treatment to support wound healing in locally infected ulcers. Nevertheless, larger controlled cohort studies are needed to substantiate these findings.

A Hybrid Textile Electrode for Electrocardiogram (ECG) Measurement and Motion Tracking

Wearable sensors have great potential uses in personal health monitoring systems, in which textile-based electrodes are particularly useful because they are comfortable to wear and are skin and environmentally friendly. In this paper, a hybrid textile electrode for electrocardiogram (ECG) measurement and motion tracking was introduced. The hybrid textile electrode consists of two parts: A textile electrode for ECG monitoring, and a motion sensor for patient activity tracking. In designing the textile electrodes, their performance in ECG measurement was investigated. Two main influencing factors on the skin-electrode impedance of the electrodes were found: Textile material properties, and electrode sizes. The optimum textile electrode was silver plated, made of a high stitch density weft knitted conductive fabric and its size was 20 mm × 40 mm. A flexible motion sensor circuit was designed and integrated within the textile electrode. Systematic measurements were performed, and results have shown that the hybrid textile electrode is capable of recording ECG and motion signals synchronously, and is suitable for ambulatory ECG measurement and motion tracking applications.

A critical review of multifunctional titanium surfaces: New frontiers for improving osseointegration and host response, avoiding bacteria contamination

Evolution of metal implants progressively shifted the focus from adequate mechanical strength to improved biocompatibility and absence of toxicity and, finally, to fast osseointegration. Recently, new frontiers and challenges of Ti implants have been addressed to improvement of bioactivity, fighting of bacterial infection and biofilm formation, as well as modulation of inflammation. This is closely related to the clinical demand of multifunctional implants able to simultaneously have a number of specific responses with respect to body fluids, cells (osteoblasts, fibroblasts, macrophages) and pathogenic agents (bacteria, viruses). This complex system of multiple biological stimuli and surface responses is a major arena of the current research on biomaterials and biosurfaces. This review covers the strategies explored to this purpose since 2010 in the case of Ti and Ti alloys, considering that the number of related papers doubled about in the last seven years and no review has comprehensively covered this engaging research area yet. The different approaches followed for producing multifunctional Ti-based surfaces involve the use of thick and thin inorganic coatings, chemical surface treatments, and functionalization strategies coupled with organic coatings.

STATEMENT OF SIGNIFICANCE

According to the clinical demand of multifunctional implants able to simultaneously have a number of specific responses with respect to body fluids, cells and pathogenic agents, new frontiers of Ti implants have been addressed to improvement of bioactivity, fighting of bacterial infection and biofilm formation, as well as modulation of inflammation. Literature since 2010 is here reviewed. Several strategies for getting bioactive and antibacterial actions on Ti surfaces have been suggested, but they still need to be optimized with respect to several concerns. A further step will be to combine on the same surface a proven ability of modulation of inflammatory response. The achievement of multifunctional surfaces able to modulate inflammation and to promote osteogenesis is a grand challenge.

Silver and Antibiotic, New Facts to an Old Story

The therapeutic arsenal against bacterial infections is rapidly shrinking, as drug resistance spreads and pharmaceutical industry are struggling to produce new antibiotics. In this review we cover the efficacy of silver as an antibacterial agent. In particular we recall experimental evidences pointing to the multiple targets of silver, including DNA, proteins and small molecules, and we review the arguments for and against the hypothesis that silver acts by enhancing oxidative stress. We also review the recent use of silver as an adjuvant for antibiotics. Specifically, we discuss the state of our current understanding on the potentiating action of silver ions on aminoglycoside antibiotics.

State-of-the-Art, and Perspectives of, Silver/Plasma Polymer Antibacterial Nanocomposites

Urgent need for innovative and effective antibacterial coatings in different fields seems to have triggered the development of numerous strategies for the production of such materials. As shown in this short overview, plasma based techniques arouse considerable attention that is connected with the possibility to use these techniques for the production of advanced antibacterial Ag/plasma polymer coatings with tailor-made functional properties. In addition, the plasma-based deposition is believed to be well-suited for the production of novel multi-functional or stimuli-responsive antibacterial films.

Optimized laser-induced breakdown spectroscopy for determination of xenobiotic silver in monosodium glutamate and its verification using ICP-AES

Laser-induced breakdown spectroscopy (LIBS) was applied as a potential tool for the determination of xenobiotic metal in monosodium glutamate (MSG). In order to achieve a high-sensitivity LIBS system required to determine trace amounts of metallic silver in MSG and to attain the best detection limit, the parameters used in our experiment (impact of focusing laser energy on the intensity of LIBS emission signals, the influence of focusing lens distance on the intensity of LIBS signals, and time responses of the plasma emissions) were optimized. The spectra of MSG were obtained in air using a suitable detector with an optical resolution of 0.06 nm, covering a spectral region from 220 to 720 nm. Along with the detection of xenobiotic silver, other elements such as Ca, Mg, S, and Na were also detected in MSG. To determine the concentration of xenobiotic silver in MSG, the calibration curve was plotted by preparing standard samples having different silver abundances in an MSG matrix. The LIBS results of each sample were cross-verified by analyzing with a standard analytical technique such as inductively coupled plasma-atomic emission spectroscopy (ICP-AES). Both (LIBS and ICP-AES) results were in mutual agreement. The limit of detection of the LIBS setup was found to be 0.57 ppm for silver present in MSG samples.

A Novel Antimicrobial Coating Represses Biofilm and Virulence-Related Genes in Methicillin-Resistant Staphylococcus aureus

Methicillin-resistant Staphylococcus aureus (MRSA) has become an important cause of hospital-acquired infections worldwide. It is one of the most threatening pathogens due to its multi-drug resistance and strong biofilm-forming capacity. Thus, there is an urgent need for novel alternative strategies to combat bacterial infections. Recently, we demonstrated that a novel antimicrobial surface coating, AGXX®, consisting of micro-galvanic elements of the two noble metals, silver and ruthenium, surface-conditioned with ascorbic acid, efficiently inhibits MRSA growth. In this study, we demonstrated that the antimicrobial coating caused a significant reduction in biofilm formation (46%) of the clinical MRSA isolate, S. aureus 04-02981. To understand the molecular mechanism of the antimicrobial coating, we exposed S. aureus 04-02981 for different time-periods to the coating and investigated its molecular response via next-generation RNA-sequencing. A conventional antimicrobial silver coating served as a control. RNA-sequencing demonstrated down-regulation of many biofilm-associated genes and of genes related to virulence of S. aureus. The antimicrobial substance also down-regulated the two-component quorum-sensing system agr suggesting that it might interfere with quorum-sensing while diminishing biofilm formation in S. aureus 04-02981.

Synergistic mechanism of Ag+-Zn2+ in anti-bacterial activity against Enterococcus faecalis and its application against dentin infection

Background

Ag⁺ and Zn²⁺ have already been used in combinations to obtain both enhanced antibacterial effect and low cytotoxicity. Despite this, it is still unclear how the Zn²⁺ co-works with Ag⁺ in the synergistic antibacterial activity. The main purposes of this study were to investigate the co-work pattern and optimum ratio between Ag⁺ and Zn²⁺ in their synergistic antibacterial activity against E. faecalis, the possible mechanisms behind this synergy and the primary application of optimum Ag⁺–Zn²⁺ co-work pattern against the E. faecalis biofilm on dentin. A serial of Ag⁺–Zn²⁺ atomic combination ratios were tested on both planktonic and biofilm-resident E. faecalis on dentin, their antibacterial efficiency was calculated and optimum ratio determined. And the cytotoxicity of various Ag⁺–Zn²⁺ atomic ratios was tested on MC3T3-E1 Cells. The role of Zn²⁺ in Ag⁺–Zn²⁺co-work was evaluated using a Zn²⁺ pretreatment study and membrane potential—permeability measurement.

Results

The results showed that the synergistically promoted antibacterial effect of Ag⁺–Zn²⁺ combinations was Zn²⁺ amount-dependent with the 1:9 and 1:12 Ag⁺–Zn²⁺ atomic ratios showing the most powerful ability against both planktonic and biofilm-resident E. faecalis. This co-work could likely be attributed to the depolarization of E. faecalis cell membrane by the addition of Zn²⁺. The cytotoxicity of the Ag⁺–Zn²⁺ atomic ratios of 1:9 and 1:12 was much lower than 2% chlorhexidine.

Conclusions

The Ag⁺–Zn²⁺ atomic ratios of 1:9 and 1:12 demonstrated similar strong ability against E. faecalis biofilm on dentin but much lower cytotoxicity than 2% chlorhexidine. New medications containing optimum Ag⁺–Zn²⁺ atomic ratios higher than 1:6, such as 1:9 or 1:12, could be developed against E. faecalis infection in root canals of teeth or any other parts of human body.

Stable PEG-coated silver nanoparticles - A comprehensive toxicological profile

The present study was purported to assess the toxicological profile of bare and polyethylene glycol (PEG) coated spherical silver nanoparticles (AgNPs) by means of in vitro (on human keratinocytes - HaCat cells) and in vivo non-invasive tests (after intraperitoneal - i.p. administration to mice). Bare and PEG-coated AgNPs were synthesized by applying Turkevich's method slightly modified. The physico-chemical characterization revealed the formation of stable, spherical AgNPs and PEG-AgNPs, with narrow size distributions and mean hydrodynamic sizes in the range of 19 nm and 50 nm, respectively. Toxicity data revealed a dose-dependent safe profile for low concentrations of test compounds (<10 μM) in terms of cell viability, whereas higher concentrations were associated with a high rate of cell mortality. In vivo acute/subacute toxicity data showed no denotive changes in mice health status after i.p. administration. Histological observations of internal organs and the biochemical parameters analyzed together with the other biological observations showed a low toxicity level with no major differences related to control, albeit at skin level a reduced number of mast cells was detected. All these observations provide strong support for the idea that coated silver nanoparticles could be applied as targeted nanocarriers for skin pathologies and diagnostic.

Stress response of a clinical Enterococcus faecalis isolate subjected to a novel antimicrobial surface coating

Emerging antibiotic resistance among pathogenic bacteria, paired with their ability to form biofilms on medical and technical devices, represents a serious problem for effective and long-term decontamination in health-care environments and gives rise to an urgent need for new antimicrobial materials. Here we present the impact of AGXX^®, a novel broad-spectrum antimicrobial surface coating consisting of micro-galvanic elements formed by silver and ruthenium, on the transcriptome of Enterococcus faecalis. A clinical E. faecalis isolate was subjected to metal stress by growing it for different periods in presence of the antimicrobial coating or silver-coated steel meshes. Subsequently, total RNA was isolated and next-generation RNA sequencing was performed to analyze variations in gene expression in presence of the antimicrobial materials with focus on known stress genes. Exposure to the antimicrobial coating had a large impact on the transcriptome of E. faecalis. After 24min almost 1/5 of the E. faecalis genome displayed differential expression. At each time-point the cop operon was strongly up-regulated, providing indirect evidence for the presence of free Ag⁺-ions. Moreover, exposure to the antimicrobial coating induced a broad general stress response in E. faecalis. Genes coding for the chaperones GroEL and GroES and the Clp proteases, ClpE and ClpB, were among the top up-regulated heat shock genes. Differential expression of thioredoxin, superoxide dismutase and glutathione synthetase genes indicates a high level of oxidative stress. We postulate a mechanism of action where the combination of Ag⁺-ions and reactive oxygen species generated by AGXX^® results in a synergistic antimicrobial effect, superior to that of conventional silver coatings.

Role of slough and biofilm in delaying healing in chronic wounds

The management of biofilms with maintenance desloughing and antimicrobial therapy is fast becoming the accepted treatment strategy for chronic wounds.

Silver-Functionalized Bacterial Cellulose as Antibacterial Membrane for Wound-Healing Applications

Bacterial cellulose (BC) functionalized with silver nanoparticles (AgNPs) is evaluated as an antimicrobial membrane for wound-healing treatment. A facile green synthesis of silver nanoparticles inside the porous three-dimensional weblike BC network has been obtained by UV light irradiation. AgNPs were photochemically deposited onto the BC gel network as well as they were chemically bonded to the cellulose fiber surfaces. AgNPs with a narrow size distribution along with some aggregates in the BC network were evidenced from the morphological analyses. A highly crystalline nature of the BC membranes was observed in X-ray diffraction measurements, and the presence of metallic silver confirmed the photochemical reduction of Ag+ → Ag0 in Ag/BC composites. Antibacterial activity of the hybrid composites, such as pellicles, performed against the Gram-negative bacteria (Escherichia coli) by disk diffusion and growth dynamics methods showed high bacteria-killing performance. No significant amount of silver release was observed from the Ag/BC pellicles even after a long soaking time. As composite pellicles are preserved in a moist environment that also favors wound recovery, by combining all of these properties the material could be useful in wound-healing treatments.

Influence of the Microstructure and Silver Content on Degradation, Cytocompatibility, and Antibacterial Properties of Magnesium-Silver Alloys In Vitro

Implantation is a frequent procedure in orthopedic surgery, particularly in the aging population. However, it possesses the risk of infection and biofilm formation at the surgical site. This can cause unnecessary suffering to patients and burden on the healthcare system. Pure Mg, as a promising metal for biodegradable orthopedic implants, exhibits some antibacterial effects due to the alkaline pH produced during degradation. However, this antibacterial effect may not be sufficient in a dynamic environment, for example, the human body. The aim of this study was to increase the antibacterial properties under harsh and dynamic conditions by alloying silver metal with pure Mg as much as possible. Meanwhile, the Mg-Ag alloys should not show obvious cytotoxicity to human primary osteoblasts. Therefore, we studied the influence of the microstructure and the silver content on the degradation behavior, cytocompatibility, and antibacterial properties of Mg-Ag alloys in vitro. The results indicated that a higher silver content can increase the degradation rate of Mg-Ag alloys. However, the degradation rate could be reduced by eliminating the precipitates in the Mg-Ag alloys via T4 treatment. By controlling the microstructure and increasing the silver content, Mg-Ag alloys obtained good antibacterial properties in harsh and dynamic conditions but had almost equivalent cytocompatibility to human primary osteoblasts as pure Mg.

Widespread and Indiscriminate Nanosilver Use: Genuine Potential for Microbial Resistance

In this era of increasing antibiotic resistance, the use of alternative antimicrobials such as silver has become more widespread. Superior antimicrobial activity has been provided through fabrication of silver nanoparticles or nanosilver (NAg), which imparts cytotoxic actions distinct from those of bulk silver. In the wake of the recent discoveries of bacterial resistance to NAg and its rising incorporation in medical and consumer goods such as wound dressings and dietary supplements, we argue that there is an urgent need to monitor the prevalence and spread of NAg microbial resistance. In this Perspective, we describe how the use of NAg in commercially available products facilitates prolonged microorganism exposure to bioavailable silver, which underpins the development of resistance. Furthermore, we advocate for a judicial approach toward NAg use in order to preserve its efficacy and to avoid environmental disruption.

Calcium Phosphate Bioceramics: A Review of Their History, Structure, Properties, Coating Technologies and Biomedical Applications

Calcium phosphate (CaP) bioceramics are widely used in the field of bone regeneration, both in orthopedics and in dentistry, due to their good biocompatibility, osseointegration and osteoconduction. The aim of this article is to review the history, structure, properties and clinical applications of these materials, whether they are in the form of bone cements, paste, scaffolds, or coatings. Major analytical techniques for characterization of CaPs, in vitro and in vivo tests, and the requirements of the US Food and Drug Administration (FDA) and international standards from CaP coatings on orthopedic and dental endosseous implants, are also summarized, along with the possible effect of sterilization on these materials. CaP coating technologies are summarized, with a focus on electrochemical processes. Theories on the formation of transient precursor phases in biomineralization, the dissolution and reprecipitation as bone of CaPs are discussed. A wide variety of CaPs are presented, from the individual phases to nano-CaP, biphasic and triphasic CaP formulations, composite CaP coatings and cements, functionally graded materials (FGMs), and antibacterial CaPs. We conclude by foreseeing the future of CaPs.