Nanomaterial-based therapeutics for antibiotic-resistant bacterial infections

Antibiotic-resistant bacterial infections arising from acquired resistance and/or through biofilm formation necessitate the development of innovative 'outside of the box' therapeutics. Nanomaterial-based therapies are promising tools to combat bacterial infections that are difficult to treat, featuring the capacity to evade existing mechanisms associated with acquired drug resistance. In addition, the unique size and physical properties of nanomaterials give them the capability to target biofilms, overcoming recalcitrant infections. In this Review, we highlight the general mechanisms by which nanomaterials can be used to target bacterial infections associated with acquired antibiotic resistance and biofilms. We emphasize design elements and properties of nanomaterials that can be engineered to enhance potency. Lastly, we present recent progress and remaining challenges for widespread clinical implementation of nanomaterials as antimicrobial therapeutics.

Validation of Three Different Sterilization Methods of Tilapia Skin Dressing: Impact on Microbiological Enumeration and Collagen Content

Tilapia fish skin has demonstrated promise as a stable and practical biological dressing to be used in wound and burn management. However, the appropriate sterilization technique of the Tilapia fish skin is crucial before its clinical application. The standard sterilization technique must eliminate harmful pathogens but maintain the structural and biochemical properties that could compromise the dressing function. This study investigated and compared the efficiency of three sterilizing agents; chlorhexidine gluconate 4% (CHG), povidone iodine 10% (PVP-I), and silver nanoparticles (25 μg/mL) (AgNPs), at three different times (5, 10, and 15 min) on Tilapia fish skin based on the microbial count, histological and collagen properties. Among the sterilization procedures, AgNPs showed rapid and complete antimicrobial activity, with a 100% reduction in microbial growth of the fish skin throughout the treated times. Furthermore, AgNPs did not impair the cellular structure or collagen fibers content of the fish skin. However, CHG and PVP-I caused alterations in the collagen content. This study demonstrated that the AgNPs treatment of Tilapia fish skin provided sterile skin while preserving the histological properties and structural integrity. These findings provide an efficient and quick sterilization method suitable for Tilapia fish skin that could be adopted as a biological dressing.

Inorganic ions in the skin: Allies or enemies?

Skin constitutes a barrier protecting the organism against physical and chemical factors. Therefore, it is constantly exposed to the xenobiotics, including inorganic ions that are ubiquitous in the environment. Some of them play important roles in homeostasis and regulatory functions of the body, also in the skin, while others can be considered dangerous. Many authors have shown that inorganic ions could penetrate inside the skin and possibly induce local effects. In this review, we give an account of the current knowledge on the effects of skin exposure to inorganic ions. Beneficial effects on skin conditions related to the use of thermal spring waters are discussed together with the application of aluminium in underarm hygiene products and silver salts in treatment of difficult wounds. Finally, the potential consequences of dermal exposure to topical sensitizers and harmful heavy ions including radionuclides are discussed.

The Effect of pH on the Size of Silver Nanoparticles Obtained in the Reduction Reaction with Citric and Malic Acids

In colloidal methods, the morphology of nanoparticles (size and shape) as well as their stability can be controlled by changing the concentration of the substrate, stabilizer, adding inorganic salts, changing the reducer/substrate molar ratio, and changing the pH and reaction time. The synthesis of silver nanoparticles was carried out according to the modified Lee and Meisel method in a wide pH range (from 2.0 to 11.0) using citric acid and malic acid, without adding any additives or stabilizers. Keeping the same reaction conditions as the concentration of acid and silver ions, temperature, and heating time, it was possible to determine the relationship between the reaction pH, the type of acid, and the size of the silver nanoparticles formed. Obtained colloids were analyzed by UV-Vis spectroscopy and investigated by means of Transmission Electron Microscope (TEM). The study showed that the colloids reduced with citric acid and malic acid are stable over time for a minimum of seven weeks. We observed that reactions occurred for citric acid from pH 6.0 to 11.0 and for malic acid from pH 7.0 to 11.0. The average size of the quasi-spherical nanoparticles changed with pH due to the increase of reaction rate.

Tissue reaction and anti-biofilm action of new biomaterial composed of latex from Hancornia speciosa Gomes and silver nanoparticles

In this work, the natural latex extracted from Harconia speciosa was incorporated with silver nanoparticles (AgNP) to compose a functional biomaterial associating the intrinsic angiogenic activity of the latex and the antimicrobial activity of AgNP. Tissue reaction after subcutaneous implantation in dorsum of rats of membranes without AgNP and with 0.05%, 0.4% AgNP was compared at 3, 7 and 25 days. No statistically significant difference in the tissue response of the different biomaterials was observed, indicating that AgNP did not interfere with the inflammatory reaction (p > 0.05) or with the angiogenic activity of latex. Biomembranes were also tested against bacterial biofilm formation by Staphylococcus aureus and the antimicrobial activity of the new biomaterial can be found with bacteria crenation (0.05% AgNP) and no biofilm deposition (0.4% AgNP). Therefore, this biomaterial has interesting properties for the tissue repair process and may be feasible for future applications as dressing.

Applicability of QCM-D for Quantitative Measurements of Nano- and Microparticle Deposition Kinetics: Theoretical Modeling and Experiments

A new theoretical model is formulated for the quantitative analysis of quartz crystal microbalance (QCM) response for heterogeneous loads consisting of nano- and microparticles. The influence of particle coverage and structure is described using a universal correction function in an ab initio manner. Explicit analytical expressions for the frequency and dissipation shifts are derived for the entire range of particle size under the rigid contact regime. The solvent coupling functions are also calculated to determine the dry coverage using the QCM measurements. These expressions furnish the upper limit of the QCM signal, which can be attained for a sensor providing perfect adhesion of particles. Correction functions accounting for the finite adhesion strength (soft contact regime) are also derived. The theoretical results are confronted with QCM and atomic force microscopy measurements of positively charged polymer particle deposition on silica sensors. The main features of the theoretical model are confirmed, especially the abrupt decrease in the QCM wet mass with the particle coverage and the overtone number. The latter effect is especially pronounced for microparticles under the soft contact regime, where the higher-number overtones produce a negligible QCM signal. These results represent a useful reference data for the interpretation of protein and bioparticles, for example, virus and bacteria attachment processes to various substrates.

A Concise Review on Multidimensional Silver Nanoparticle Health Aids and Threats

Benefits and Risk:

AgNps have beneficial approaches for cancer treatment and angiogenesisrelated diseases like rheumatoid arthritis, atherosclerosis, diabetic psoriasis, retinopathy, endometriosis, and adiposity.

Result:

The advancing nanotechnology-based therapy needs to be devised better, and it should offload the hitches of prevailing treatment approaches. Essential studies are required to explain the synergistic effect of two different cytotoxic agents.

Organic and inorganic antibacterial approaches in combating bacterial infection for biomedical application

In spite of antibiotics, antibacterial agents or specifically known as antiseptics are actively explored for the prevention of infection-associated medical devices. Antibacterial agents are introduced to overcome the complication of bacterial resistance which devoted by antibiotics. It can be classified into inorganic and organic, that prominently have impacted bacterial retardation in their own killing mechanism patterns. Therefore, this review paper aimed to provide information on most common used inorganic and organic antibacterial agents which have potential to be utilized in biomedical applications, thus, classifying the trends of antibacterial mechanism on Gram-negative and Gram-positive bacteria. In the beginning, infectious diseases and associated biomedical infections were stated to expose current infection scenarios on medical devices. The general view, application, susceptible bacteria and activation mechanism of inorganic (silver, copper, gold and zinc) and organic (chlorhexidine, triclosan, polyaniline and polyethylenimine) antibacterial agents that are widely proposed for biomedical area, were then gathered and reviewed. In the latter part of the study, the intact mechanisms of inorganic and organic antibacterial agents in retarding bacterial growth were classified and summarized based on its susceptibility on Gram-negative and Gram-positive bacteria. Most of inorganic antibacterial agents are in the form of metal, which release its ions to retard prominently Gram-negative bacteria. While organic antibacterial agents are susceptible to Gram-positive bacteria through organelle modification and disturbance of bio-chemical pathway. However, the antibacterial effects of each antibacterial agent are also depending on its effective mechanism and the species of bacterial strain. These compilation reviews and classification mechanisms are beneficial to assist the selection of antibacterial agents to be incorporated on/within biomaterials, based on its susceptible bacteria. Besides, the combination of several antibacterial agents with different susceptibilities will cover a wide range of antibacterial spectrum.

A human skin equivalent burn model to study the effect of a nanocrystalline silver dressing on wound healing

In this study, a deep burn wound model was established using a 3D human skin equivalent (HSE) model and this was compared to native skin. HSEs were constructed from dermis derived from abdominoplasty/breast surgery and this dermal template was seeded with primary keratinocytes and fibroblasts. The HSE model was structurally similar to native skin with a stratified and differentiated epidermis. A contact burn (60 °C, 80 °C, 90 °C) was applied with a modified soldering iron and wounds were observed at day 1 and 7 after burn. The HSEs demonstrated re-growth with keratinocyte proliferation and formation of a neo-epidermis after burn injury, whereas the ex vivo native skin did not. To assess the suitability of the 3D HSE model for penetration and toxicity studies, a nanocrystalline silver dressing was applied to the model for 7 days, with and without burn injury. The effect of silver on skin re-growth and its penetration and subcellular localization was assessed in HSEs histologically and with laser ablation-inductively coupled plasma mass spectrometry (LA-ICPMS). The silver treatment delayed or reduced skin re-growth, and silver particles were detected on the top of the epidermis, and within the papillary dermis. This novel in vitro 3D multicellular deep burn wound model is effective for studying the pathology and treatment of burn wound injury and is suitable for penetration and toxicity studies of wound healing treatments.

Antibacterial Properties of Nano-Ag Coating on Healing Abutment: An In Vitro and Clinical Study

Peri-implantitis is an inflammatory disease with a relevant focus on the long-term success of dental implants and implant-supported prostheses. The present study focuses on the antibacterial effect of the silver nanoparticle and investigated the suppression of dental plaque adhesion on implant abutment and/or superstructure by micro-wave assistant nanosilver coating in vivo and in vitro. Nanosilver coating on pure titanium was prepared by microwave-assisted synthesis, and characterized by scanning electron microscopy and energy-dispersive X-ray spectroscopy. In vitro studies were conducted to analyze biocompatibility using MTS assay and fluorescence microscopy with human gingival fibroblasts to evaluate antibacterial activity. During the in vivo study, nanosilver coating was applied to the healing abutments, and the prevention of plaque accumulation on nanosilver coating was confirmed by a split-mouth randomized clinical trial. The aggregation of nano-sized particles was found on the titanium surface with an antibacterial effect. The coating had no cytotoxic effect on human gingival fibroblasts. The result of the clinical trial showed that the coating suppressed the dental plaque adhesion on the healing abutments. Nanosilver coating is a promising material with antibacterial properties and can be used for implant abutments and prostheses for preventing peri-implantitis.

Enhanced Healing and Antimicrobial Efficacy of Chitosan-g-Polyacrylamide in a Rat Model of Gingival Ulcers

Patients in dental hospitals often experience oral ulcerative lesions, which lead to pain and affect the patient's quality of life. At present, the goal of treating oral ulcerative lesions with drugs is to reduce inflammation and promote ulcer healing. However, very few antibacterial and hemostatic drugs are designed to be suitable for the microenvironment of gingival ulcers. Based on this, we have designed a natural therapeutic agent for oral ulcerative lesions that meets the various requirements of oral ulcerative lesion medication. The chitosan-g-polyacrylamide (CP) copolymer is composed of chitosan as the main chain and polyacrylamide polymers as the side chains. Antibacterial experiments show that this polymer can effectively inhibit the proliferation of Gram-negative (Escherichia coli) and Gram-positive bacteria (Staphylococcus aureus). In vitro cell experiments also show that the CP copolymer is non-toxic, which is conducive to ulcer wound healing. Coagulation experiments prove that the CP copolymer can accelerate blood coagulation to stop bleeding. In experiments using a Wistar rat gingival ulcer model, the CP copolymer significantly promoted ulcer healing and shortened the healing time. These results indicate that the CP copolymer may serve as a potential therapeutic agent for oral ulcerative lesions.

Electrospun Fibers and Sorbents as a Possible Basis for Effective Composite Wound Dressings

Skin burns and ulcers are considered hard-to-heal wounds due to their high infection risk. For this reason, designing new options for wound dressings is a growing need. The objective of this work is to investigate the properties of poly (ε-caprolactone)/poly (vinyl-pyrrolidone) (PCL/PVP) microfibers produced via electrospinning along with sorbents loaded with Argovit™ silver nanoparticles (Ag-Si/Al2O3) as constituent components for composite wound dressings. The physicochemical properties of the fibers and sorbents were characterized using scanning electron microscopy (SEM), differential scanning calorimetry (DSC), Fourier transform infrared spectroscopy (FTIR) and inductively coupled plasma optical emission spectroscopy (ICP-OES). The mechanical properties of the fibers were also evaluated. The results of this work showed that the tested fibrous scaffolds have melting temperatures suitable for wound dressings design (58-60 °C). In addition, they demonstrated to be stable even after seven days in physiological solution, showing no macroscopic damage due to PVP release at the microscopic scale. Pelletized sorbents with the higher particle size demonstrated to have the best water uptake capabilities. Both, fibers and sorbents showed antimicrobial activity against Gram-negative bacteria Pseudomona aeruginosa and Escherichia coli, Gram-positive Staphylococcus aureus and the fungus Candida albicans. The best physicochemical properties were obtained with a scaffold produced with a PCL/PVP ratio of 85:15, this polymeric scaffold demonstrated the most antimicrobial activity without affecting the cell viability of human fibroblast. Pelletized Ag/Si-Al2O3-3 sorbent possessed the best water uptake capability and the higher antimicrobial activity, over time between all the sorbents tested. The combination of PCL/PVP 85:15 microfibers with the chosen Ag/Si-Al2O3-3 sorbent will be used in the following work for creation of wound dressings possessing exudate retention, biocompatibility and antimicrobial activity.

A hybrid lipid membrane coating "shape-locks" silver nanoparticles to prevent surface oxidation and silver ion dissolution

The controlled synthesis of stable silver nanoparticles (AgNPs), that do not undergo surface oxidation and Ag+ ion dissolution, continues to be a major challenge. Here the synthesis of robust hybrid lipid-coated AgNPs, comprised of l-α-phosphatidylcholine (PC) membranes anchored by a stoichiometric amount of long-chained hydrophobic thiols and sodium oleate (SOA) as hydrophobic binding partners, that do not undergo surface oxidation and Ag+ ion dissolution, is described. UV-Visible (UV-Vis) spectroscopy, transmission electron microscopy (TEM), and inductively coupled plasma mass spectrometry (ICP-MS) demonstrate that in the presence of strong oxidants, such as potassium cyanide (KCN), the hybrid lipid-coated AgNPs are stable and do not undergo surface oxidation even in the presence of membrane destabilizing surfactants. UV-Vis studies show that the stability of hybrid lipid-coated AgNPs of various sizes and shapes is dependent on the length of the thiol hydrocarbon chain and can be ranked in the order of increasing stability as follows: propanethiol (PT) < hexanethiol (HT) ≤ decanethiol (DT). UV-Vis and ICP-MS studies show that the hybrid lipid-coated AgNPs do not change in size or shape confirming that the AgNPs do not undergo surface oxidation and Ag+ ion dissolution when placed in the presence of strong oxidants, chlorides, thiols, and low pH. Long-term stability studies, over 21 days, show that the hybrid lipid-coated AgNPs do not release Ag+ ions and are more stable. Overall, these studies demonstrate hybrid membrane encapsulation of nanomaterials is a viable method for stabilizing AgNPs in a "shape-locked" form that is unable to undergo surface oxidation, Ag+ ion release, aging, or shape conversion. More importantly, this design strategy is a simple approach to the synthesis and stabilization of AgNPs for a variety of biomedical and commercial applications where Ag+ ion release and toxicity is a concern. With robust and shielded AgNPs, investigators can now evaluate and correlate how the physical features of AgNPs influence toxicity without the confounding factor of Ag+ ions present in samples. This design strategy also provides an opportunity where the membrane composition can be tuned to control the release rate of Ag+ ions for optimizing antimicrobial activity.

Wound healing of nanofiber comprising Polygalacturonic/Hyaluronic acid embedded silver nanoparticles: In-vitro and in-vivo studies

The current study is pertaining to develop a novel wound dressing, comprising natural biologically absorbable materials for wound healing In-vivo. Wound dressing is composed of Polygalacturonic acid, Hyaluronic acid embedded silver nanoparticles, which is further fabricated to form nanofibrous mat, using electrospinning. Silver nanoparticles was prepared using PGA. AgNPs in this formula will serve as an antioxidant and anti-inflammatory that protect cells from destructive effect of elevated ROS and accelerate wound healing. The physical performance and water contact angle for nanofiber was evaluated. The produced nanofiber was characterized by Fourier-transform infrared (FTIR), scanning electron microscopy and thermal analysis. Also, the embedded AgNPs was also characterized by UV-vis spectroscopy and TEM. The nanofiber mates embedded AgNPs was applied to the wounded site of albino rats in-vivo. Histopathological assessment for the wound was fully performed. Also, the antimicrobial activity for the fabricated wound dressing was evaluated against gram+ve and gram -ve bacteria.

Silver nanoparticle uptake in the human lung assessed through in-vitro and in-silico methods

Silver nanoparticles (AgNP) are commonly used in medical, cosmetics, clothing, and industrial applications for their antibacterial and catalytic properties. As AgNP become more prevalent, the doses to which humans are exposed may increase and pose health risks, particularly through incidental inhalation. This exposure was evaluated through in-vitro methods simulating lung fluids and lung epithelium, and through computational fluid dynamics (CFD) methods of AgNP transport. A high-dose scenario simulated a short-term inhalation of 10 μg AgNP/m³, based on an exposure limit recommended by the National Institute of Occupational Safety and Health for the case of a health-care worker who handles AgNP-infused wound dressings, and regularly wears AgNP-imbedded clothing. Bioaccessibility tests were followed by a Parallel Artificial Membrane Permeability Assay (PAMPA) and supported by CFD models of the lung alveoli, membrane, pores, and blood capillaries. Results indicate that such exposure produces an average and maximum AgNP flux of approximately 4.7 × 10^-21 and 6.5 × 10^-19 mol m^-2·s^-1 through lung tissue, respectively, yielding a blood-silver accumulation of 0.46-64 mg per year, which may exceed the lowest adverse effect level of 25 mg for an adult male. Results from in-silico simulations were consistent with values estimated in vitro (within an order of magnitude), which suggest that CFD models may be used effectively to predict silver exposure from inhaled AgNP. Although the average short-term exposure concentrations are 3 orders of magnitude smaller than the reported threshold for mammalian cytotoxicity effects (observed at 5000 ppb), cumulative effects resulting from constant exposure to AgNP may pose risks to human health in the long-term, with predicted bioaccumulation reaching potential toxic effects after only five months of exposure, based on maximum flux.

Electrospun Nanocomposites Containing Cellulose and Its Derivatives Modified with Specialized Biomolecules for an Enhanced Wound Healing

Wound healing requires careful, directed, and effective therapies to prevent infections and accelerate tissue regeneration. In light of these demands, active biomolecules with antibacterial properties and/or healing capacities have been functionalized onto nanostructured polymeric dressings and their synergistic effect examined. In this work, various antibiotics, nanoparticles, and natural extract-derived products that were used in association with electrospun nanocomposites containing cellulose, cellulose acetate and different types of nanocellulose (cellulose nanocrystals, cellulose nanofibrils, and bacterial cellulose) have been reviewed. Renewable, natural-origin compounds are gaining more relevance each day as potential alternatives to synthetic materials, since the former undesirable footprints in biomedicine, the environment, and the ecosystems are reaching concerning levels. Therefore, cellulose and its derivatives have been the object of numerous biomedical studies, in which their biocompatibility, biodegradability, and, most importantly, sustainability and abundance, have been determinant. A complete overview of the recently produced cellulose-containing nanofibrous meshes for wound healing applications was provided. Moreover, the current challenges that are faced by cellulose acetate- and nanocellulose-containing wound dressing formulations, processed by electrospinning, were also enumerated.

Response of Human Macrophages to Clinically Applied Wound Dressings Loaded With Silver

Wound infections constitute an increasing clinical problem worldwide. To reverse this trend, several wound dressings with antimicrobial properties have been developed. Considering the increasing presence of antibiotic-resistant microorganisms, product developers have been focusing their efforts in introducing antibiotic-free antibacterial wound dressings to the market, with silver being the most commonly incorporated antimicrobial agent. In this scenario, gaining information about the microbial and eukaryotic cells' response to these dressings is needed for a proper selection of antimicrobial dressings for the different cases of infected wounds. In particular, one insufficiently explored parameter is the effect of the dressings on the immunomodulation of macrophages, the main immune cell population participating in the repair process, because of their pivotal role in the transition of the inflammation to the proliferation phase of wound healing. In this work, three different clinically applied antimicrobial, silver impregnated wound dressings were selected: Atrauman® Ag, Biatain® Alginate Ag and PolyMem WIC Silver® Non-adhesive. Antimicrobial susceptibility tests (disk diffusion and broth dilution), cell viability evaluation (CellTiter-Blue®) and experiments to determine macrophage polarization (e.g., flow cytometry, ELISA and glucose uptake) were performed after 24 h of incubation. Among all products tested, Biatain® Alginate Ag induced the most evident bactericidal effect on Gram-positive and Gram-negative bacteria, followed by PolyMem WIC Silver® Non-adhesive, but did not show good cytocompatibility in vitro. On the other hand, Atrauman® Ag showed excellent cytocompatibility on L929 fibroblasts, HaCaT keratinocytes and THP-1 derived macrophages, but no significant antimicrobial activity was observed. Overall, it was confirmed that macrophages initiate, in fact, an alteration of their metabolism and phenotype in response to wound dressings of different composition in a short period of contact (24 h). M0 resting state macrophages common response to all silver-containing dressings used in this study was to increase the production of the anti-inflammatory cytokine TGF-β, which indicates an acquisition of M2-like macrophages characteristics.

Role of pH Value in Clinically Relevant Diagnosis

As a highly influential physiological factor, pH may be leveraged as a tool to diagnose physiological state. It may be especially suitable for diagnosing and assessing skin structure and wound status. Multiple innovative and elegant smart wound dressings combined with either pH sensors or drug control-released carriers have been extensively studied. Increasing our understanding of the role of pH value in clinically relevant diagnostics should assist clinicians and improve personal health management in the home. In this review, we summarized a number of articles and discussed the role of pH on the skin surface as well as the factors that influence skin pH and pH-relevant skin diseases, but also the relationship of skin pH to the wound healing process, including its influence on the activity of proteases, bacterial enterotoxin, and some antibacterial agents. A great number of papers discussing physiological pH value have been published in recent decades, far too many to be included in this review. Here, we have focused on the impact of pH on wounds and skin with an emphasis on clinically relevant diagnosis toward effective treatment. We have also summarized the differences in skin structure and wound care between adults and infants, noting that infants have fragile skin and poor skin barriers, which makes them more vulnerable to skin damage and compels particular care, especially for wounds.

New Antibacterial Paper Made of Silver Phosphate Cellulose Fibers: A Preliminary Study on the Elimination of Staphylococcus aureus Involved in Diabetic Foot Ulceration

AIM

To evaluate in vitro the antibacterial effect of a paper made of silver phosphate cellulose fibers (SPCF) on Staphylococcus aureus, the most common diabetic foot ulceration (DFU) pathogen when compared with other common commercial products.

METHODS

The antibacterial activity of SPCF samples was evaluated through time with cell counting on agar plates. SPCF samples were then compared with commercial wound care products currently in use in DFU treatments (Silvercel™, Acticoat 7, and Aquacel Ag ExtraTM) through time on agar plates (growth inhibition zones).

RESULTS

After 6 hours, there was no viable bacterial cell detected on either plate (p < 0.05). There was a net growth inhibition zone for SPCF samples but no significant difference between the two silver concentrations. Compared with common commercial products, SPCF paper provides results equal to Acticoat 7 (p < 0.05). There was a net growth inhibition zone for SPCF samples but no significant difference between the two silver concentrations. Compared with common commercial products, SPCF paper provides results equal to Acticoat 7 (p < 0.05). There was a net growth inhibition zone for SPCF samples but no significant difference between the two silver concentrations. Compared with common commercial products, SPCF paper provides results equal to Acticoat 7 (.

CONCLUSIONS

These results have shown the efficiency of SPCF paper to eliminate Staphylococcus aureus in these conditions. SPCF papers are effective when compared with other common commercial products and could have an industrial potential in wound care. Infected DFU could benefit from the antibacterial effectiveness of SPCF, but more relevant experimentations related to foot ulcers are needed.Staphylococcus aureus, the most common diabetic foot ulceration (DFU) pathogen when compared with other common commercial products.

Classification of Metal-based Drugs According to Their Mechanisms of Action

Metal-based drugs and imaging agents are extensively used in the clinic for the treatment and diagnosis of cancers and a wide range of other diseases. The current clinical arsenal of compounds operate via a limited number of mechanisms, whereas new putative compounds explore alternative mechanisms of action, which could potentially bring new chemotherapeutic approaches into the clinic. In this review, metal-based drugs and imaging agents are characterized according to their primary mode of action and the key properties and features of each class of compounds are defined, wherever possible. A better understanding of the roles played by metal compounds at a mechanistic level will help to deliver new metal-based therapies to the clinic, by providing an alternative, targeted and rational approach, to supplement non-targeted screening of novel chemical entities for biological activity.

Current status and future outlook of nano-based systems for burn wound management

Wound healing process is a natural and intricate response of the body to its injuries and includes a well-orchestrated sequence of biochemical and cellular phenomena to restore the integrity of skin and injured tissues. Complex nature and associated complications of burn wounds lead to an incomplete and prolonged recovery of these types of wounds. Among different materials and systems which have been used in treating the wounds, nanotechnology driven therapeutic systems showed a great opportunity to improvement and enhancement of the healing process of different type of wounds. The aim of this study is to provide an overview of the recent studies about the various nanotechnology-based management of burn wounds and the future outlook of these systems in this area. Laboratory and animal models for assessing the efficacy of these systems in burn wound management also discussed.

Hydrogel Dressings for Advanced Wound Management

BACKGROUND

Composed in a large extent of water and due to their nonadhesiveness, hydrogels found their way to the wound dressing market as materials that provide a moisture environment for healing while being comfortable to the patient. Hydrogels' exploitation is constantly increasing after evidences of their even broader therapeutic potential due to resemblance to dermal tissue and ability to induce partial skin regeneration. The innovation in advanced wound care is further directed to the development of so-called active dressings, where hydrogels are combined with components that enhance the primary purpose of providing a beneficial environment for wound healing.

OBJECTIVE

The objective of this review is to concisely describe the relevance of hydrogel dressings as platforms for delivery of active molecules for improved management of difficult- to-treat wounds. The emphasis is on the most recent advances in development of stimuli- responsive hydrogels, which allow for control over wound healing efficiency in response to different external modalities. Novel strategies for monitoring of the wound status and healing progress based on incorporation of sensor molecules into the hydrogel platforms are also discussed.

The future application of nanomedicine and biomimicry in plastic and reconstructive surgery

Plastic surgery encompasses a broad spectrum of reconstructive challenges and prides itself upon developing and adopting new innovations. Practice has transitioned from microsurgery to supermicrosurgery with a possible future role in even smaller surgical frontiers. Exploiting materials on a nanoscale has enabled better visualization and enhancement of biological processes toward better wound healing, tumor identification and viability of tissues, all cornerstones of plastic surgery practice. Recent advances in nanomedicine and biomimicry herald further reconstructive progress facilitating soft and hard tissue, nerve and vascular engineering. These lay the foundation for improved biocompatibility and tissue integration by the optimization of engineered implants or tissues. This review will broadly examine each of these technologies, highlighting areas of progress that reconstructive surgeons may not be familiar with, which could see adoption into our armamentarium in the not-so-distant future.

Ag(I) camphor complexes: antimicrobial activity by design

Eleven new complexes of general formula [Ag(NO₃)(L-Y)₂] corresponding to Ag(I) camphorimine complexes [Ag(NO₃)(OC₁₀H₁₄NY)₂] (Y=NMe₂ (1); OH (2); C₆H₅ (3); 4-MeC₆H₄, (4); 3,5-(CH₃)₂C₆H₃ (5); 3-OHC₆H₄, (6); 3-ClC₆H₄ (7); 4-ClC₆H₄ (8); 4-FC₆H₄ (9); 4-CF₃C₆H₄ (10)) and the camphor sulfonylimine complex [Ag(NO₃)(O₂SNC₁₀H₁₄NY)₂] (Y=NH₂) were synthesized/characterized and their structural properties and antibacterial activity studied to gain insights into the structure-antimicrobial activity relationships. Five of the complexes were selected as representative examples and structures were optimized by Density Functional Theory calculations. The results show that the imine substituents (Y) at the camphor ligands drive the structure of the complexes from distorted octahedral to trigonal prismatic or linear ionic while the effect of the sulfonylimine ring does not appreciably affects the geometry of the complex. The lipophilicity and polarity which are important parameters concerning the biological activity of the complexes are also high dependent of the characteristics of the camphor ligands. The redox properties of the complexes studied by cyclic voltammetry showed that their reduction potentials are essentially independent of their electronic and steric properties. The antibacterial activity of all the complexes, against Gram-positive (S. aureus Newman) and Gram-negative (Escherichia coli ATCC25922, Pseudomonas aeruginosa 477, Burkholderia contaminans IST408) strains was evaluated through calculation of MIC values. Results show that complexes with camphor imine ligands (1-10) that combine high lipophilicity with low dipolar moment (3-5) exhibit enhanced antibacterial activity. The ability to establish hydrogen bonding emerged as an important contribution to the antibacterial activity of the camphor sulphonylimine complex 11 (Y=NH₂).

Comparative proteomic analysis reveals drug resistance of Staphylococcus xylosus ATCC700404 under tylosin stress

Background

As a kind of opportunist pathogen, Staphylococcus xylosus (S. xylosus) can cause mastitis. Antibiotics are widely used for treating infected animals and tylosin is a member of such group. Thus, the continuous use of antibiotics in dairy livestock enterprise will go a long way in increasing tylosin resistance. However, the mechanism of tylosin-resistant S. xylosus is not clear. Here, isobaric tag for relative and absolute quantitation (iTRAQ)-based quantitative proteomics methods was used to find resistance-related proteins.

Results

We compared the differential expression of S. xylosus in response to tylosin stress by iTRAQ. A total of 155 proteins (59 up-regulated, 96 down-regulated) with the fold-change of >1.2 or <0.8 (p value ≤0.05) were observed between the S. xylosus treated with 1/2 MIC (0.25 μg/mL) tylosin and the untreated S. xylosus. Bioinformatic analysis revealed that these proteins play important roles in stress-response and transcription. Then, in order to verify the relationship between the above changed proteins and mechanism of tylosin-resistant S. xylosus, we induced the tylosin-resistant S. xylosus, and performed quantitative PCR analysis to verify the changes in the transcription proteins and the stress-response proteins in tylosin-resistant S. xylosus at the mRNA level. The data displayed that ribosomal protein L23 (rplw), thioredoxin(trxA) and Aldehyde dehydrogenase A(aldA-1) are up-regulated in the tylosin-resistant S. xylosus, compared with the tylosin-sensitive strains.

Conclusion

Our findings demonstrate the important of stress-response and transcription in the tylosin resistance of S. xylosus and provide an insight into the prevention of this resistance, which would aid in finding new medicines .

Electronic supplementary material

The online version of this article (10.1186/s12917-019-1959-9) contains supplementary material, which is available to authorized users.

Gellan gum incorporating titanium dioxide nanoparticles biofilm as wound dressing: Physicochemical, mechanical, antibacterial properties and wound healing studies

In this work, the potential of titanium dioxide nanoparticles incorporated gellan gum (GG + TiO₂-NPs) biofilm as wound dressing material was investigated. The GG + TiO₂-NPs biofilm was prepared via evaporative casting technique and was characterized using FTIR, XRD, and SEM to study their physiochemical properties. The mechanical properties, swelling and water vapor transmission rate (WVTR) of biofilm was determined to comply with an ideal wound dressing material. In vitro and in vivo wound healing studies was carried out to evaluate the performance of GG + TiO₂-NPs biofilm. In vitro wound healing was studied on 3 T3 mouse fibroblast cells for cell viability, cell proliferation, and scratch assay. The acridine orange/propidium iodide (AO/PI) staining and 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) assay were used to evaluate the viability of cell and cell proliferation. Cell migration assay was analyzed using Essen BioScience IncuCyteTM Zoom system. In vivo wound healing via open excision wounds model on Sprague Dawley rat was studied within 14 days. The FT-IR spectra of GG + TiO₂-NPs biofilm show main bands assigned to OH stretching, OH deformation, and TiO stretching modes. XRD pattern of GG + TiO₂-NPs biofilm suggesting that TiO₂-NPs was successfully incorporated in biofilm and well distributed on the surface as proved by SEM analysis. The GG + TiO₂-NPs biofilm shows higher mechanical strength and swelling (3.76 ± 0.11 MPa and 1061 ± 6%) as compared to pure GG film (3.32 ± 0.08 Mpa and 902 ± 6%), respectively. GG + TiO₂-NPs biofilm shows good antibacterial properties as 9 ± 0.25 mm and 11 ± 0.06 mm exhibition zone was observed against Staphylococcus aureus and Escherichia coli bacteria, respectively. While no exhibition zone was obtained for pure GG biofilm. GG + TiO₂-NPs biofilm also demonstrated better cell-to-cell interaction properties, as it's promoted cell proliferation and cell migration to accelerate open excision wound healing on Sprague Dawley rat. The wound treated with GG + TiO₂-NPs biofilm was healed within 14 days, on the other hand, the wound is still can be seen when it was treated with GG. However, GG and GG + TiO₂-NPs biofilm show no cytotoxicity effects on mouse fibroblast cells.

Aspects of Nanomaterials in Wound Healing

Wound infections impose a remarkable clinical challenge that has a considerable influence on morbidity and mortality of patients, influencing the cost of treatment. The unprecedented advancements in molecular biology have come up with new molecular and cellular targets that can be successfully applied to develop smarter therapeutics against diversified categories of wounds such as acute and chronic wounds. However, nanotechnology-based diagnostics and treatments have achieved a new horizon in the arena of wound care due to its ability to deliver a plethora of therapeutics into the target site, and to target the complexity of the normal wound-healing process, cell type specificity, and plethora of regulating molecules as well as pathophysiology of chronic wounds. The emerging concepts of nanobiomaterials such as nanoparticles, nanoemulsion, nanofibrous scaffolds, graphene-based nanocomposites, etc., and nano-sized biomaterials like peptides/proteins, DNA/RNA, oligosaccharides have a vast application in the arena of wound care. Multi-functional, unique nano-wound care formulations have acquired major attention by facilitating the wound healing process. In this review, emphasis has been given to different types of nanomaterials used in external wound healing (chronic cutaneous wound healing); the concepts of basic mechanisms of wound healing process and the promising strategies that can help in the field of wound management.

Silver nanoparticles as an effective disinfectant: A review

The paradigm modifications in the metallic crystals from bulky to micro-size to nano-scale have resulted in excellent and amazing properties; which have been the remarkable interests in a wider range of applications. Particularly, Ag NPs have much attention owing to their distinctive optical, chemical, electrical and catalytic properties that can be tuned with surface nature, size, shapes, etc. and hence these crystals have been used in various fields such as catalysis, sensor, electronic components, antimicrobial agents in the health industry etc. Among them, Ag NPs based disinfectants have paid attention due to the practical applications in our daily life. Therefore the Ag NPs have been used in different sectors such as silver-based air/water filters, textile, animal husbandry, biomedical and food packaging etc. In this review, the Ag NPs as a disinfectant in different sectors have been included in detail.

Induction of 8-hydroxydeoxyguanosine and ultrastructure alterations by silver nanoparticles attributing to placental transfer in pregnant rats and fetuses

A quantitative assessment of the genotoxicity of silver nanoparticles (AgNPs) ascribed to its transplacental transfer and tissue distribution in pregnant rats was carried out in this study. A single intravenous (i.v.) injection of AgNPs with a size range from 4.0 to 17.0 nm was administered to pregnant rats at a dose of 2 mg/kg b.w. on the 19th day of gestation. Five groups beside control, each of the five rats were euthanized after 10 min, 1, 6, 12, or 24 h, respectively. The accumulation of nanoparticles (NPs) in mother and fetal tissues was quantified by inductively coupled plasma optical emission spectroscopy, where the highest accumulation level was recorded in maternal blood (0.523 µg/ml) after 24 h of administration. AgNPs induced accumulation in spleen tissue higher than placenta and fetal tissue homogenates. The data showed significantly detected levels of 8-hydroxydeoxyguanosine in all collected samples from administered animals compared with untreated individuals. Level of 8-OHdG in amniotic fluid exhibited the greatest values followed by maternal spleen, kidneys, and liver, respectively. Investigation by transmission electron microscope showed that the transfer of AgNPs through placental wall caused indentation of nuclei, clumped chromatin, pyknotic nuclei, and focal necrotic areas, while AgNPs appeared mainly accumulated in the macrophages of the spleen. Therefore, the data assume that the genotoxicity studies of AgNPs must be recommended during a comprehensive assessment of the safety of novel types of NPs and nanomaterials. Additionally, exposure to AgNPs must be prevented or minimized during pregnancy or prenatal periods.

Imaging of Ag NP transport through collagen-rich microstructures in fibroblast multicellular spheroids by high-resolution laser ablation inductively coupled plasma time-of-flight mass spectrometry

We investigated the penetration of silver nanoparticles (Ag NPs) into a three-dimensional in vitro tissue analog using NPs with various sizes and surface coatings, and with different incubation times. A high-resolution laser ablation inductively coupled plasma mass spectrometry (LA-ICP-MS) time-of-flight (TOF) instrument was applied for imaging the distributions of elements in thin sample sections (20 μm thick). A fibroblast multicellular spheroid (MCS) was selected as the model system and cultured for more than 8 days to produce a natural barrier formed by the extracellular matrix containing collagen. The MCS was then exposed for up to 48 h to one of four types of Ag NPs (∅ 5 nm citrate coated, ∅ 20 nm citrate coated, ∅ 20 nm polyvinylpyrrolidone coated, and ∅ 50 nm citrate coated). Imaging showed that the penetration pathway was strongly related to steric networks formed by collagen fibrils, and Ag NPs with a hydrodynamic diameter of more than 41 nm were completely trapped in an outer rim of the MCSs even after incubation for 48 h. In addition, we examined the impact of these NPs on essential elements (P, Fe, Cu, and Zn) in areas of Ag NP accumulation. We observed a linear increase at the sub-femtogram level in the total concentration of Cu (fg per pixel) in samples treated with small or large Ag NPs (∅ 5 nm or ∅ 50 nm) for 48 h.

Metal-plant frameworks in nanotechnology: An overview

BACKGROUND

Since ancient times, potential of plants in research and medicine have found pronounced applications, due to better therapeutic value. To meet the mounting demands for commercial nanoparticles, novel eco-friendly methods of synthesis has led to a remarkable progress via unfolding a green synthesis protocol towards metallic nanoparticles synthesis.

HYPOTHESIS/PURPOSE

This review highlights the biological synthesis of various metallic nanoparticles as safe, cost effective process, where the phytochemicals present in extract such as flavonoid, phenols, terpenoids act as capping, reducing and stabilizing agents. Moreover, due to their nano size, the nanoparticles directly bind to bacterial strains leading to higher antimicrobial activity.

CONCLUSION

Nano-sized dosage systems have a potential for enhancing the activity and overcoming problems associated with phyto medicines. Hence, synthesis of metallic nanoparticles using various plant extracts, emerge as safe alternative to conventional methods for biomedical applications.

Catalytic, antibacterial and antibiofilm efficacy of biosynthesised silver nanoparticles using Prosopis juliflora leaf extract along with their wound healing potential

The present study focuses on the catalytic, antibacterial and antibiofilm efficacy of silver nanoparticles (AgNPs) in an easy, rapid and eco-friendly pathway. Herein, we have synthesised AgNPs using an aqueous extract of P. juliflora leaf. The bioactive compounds present in the extract are responsible for the reduction of Ag⁺ to Ag⁰. The particle synthesis was first observed by visual color change and then characterized using UV-visible spectroscopy to confirm the formation of AgNPs. The synthesis conditions were then optimised using critical parameters such as reaction time, AgNO₃ concentration, extract to AgNO₃ ratio and temperature of the reaction. The hydrodynamic size of the AgNPs with Dynamic light scattering (DLS) was 55.24 nm, while, was in the range of 10-20 nm as determined through Transmission Electron Microscopy (TEM). Further, Fourier transform infrared spectroscopy (FTIR) studies were conducted to discern the functional groups or compounds responsible for the reduction of silver nitrate as well as the capping of silver nanoparticles. Later, X-ray diffraction (XRD) results showed crystalline nature of the biosynthesized AgNPs. To evaluate their antibacterial potential, AgNPs were assessed through disc-diffusion assay, which resulted in an appreciable dose-dependent activity. The antibacterial potential was investigated through disc-diffusion assay against E. coli and P. aeruginosa. The Congo red agar (CRA) plate assay successfully revealed the anti-biofilm activity against B. subtilis and P. aeruginosa. Further, the catalytic activity of synthesised AgNPs was assessed against azo dyes such a Methylene Blue (MB) and Congo Red (CR) that resulted in its effective degradation of toxic compounds in a short span of time. Further, AgNPs were assessed for their wound healing potential.

Combined antibacterial and osteogenic in situ effects of a bifunctional titanium alloy with nanoscale hydroxyapatite coating

To resolve the problems of bacterial infections and the low efficiency of osteogenesis of implanted titanium alloys in clinical dental and bone therapy, we developed a bifunctional titanium alloy (Ti) with a nano-hydroxyapatite (HA) coating (HBD + BMP/HA-Ti), which enables the sustained release of the natural antimicrobial peptide human β-defensin 3 (HBD-3) and bone morphogenetic protein-2 (BMP-2). Due to the poriferous nano-sized structure of the HA coating with a 20-30 μm thickness, the HBD + BMP/HA-Ti material had a high encapsulation efficiency (>74%) and exhibited synchronized slow release of HBD-3 and BMP-2. In an antibacterial test, HBD + BMP/HA-Ti prevented the growth of bacteria in an inoculated medium, and its surface remained free from viable bacteria after a continuous incubation with Gram-negative and Gram-positive strains for 7 days. Furthermore, good adhesion, proliferation and osteogenic differentiation of hBMSCs in contact with HBD + BMP/HA-Ti were achieved in 7 days. Therefore, the bifunctional titanium alloy HBD + BMP/HA-Ti has a great potential for eventual applications in the protection of implants against bacteria in the orthopaedic and dental clinic.

Antibacterial and biodegradable tissue nano-adhesives for rapid wound closure

BACKGROUND

Although various organic tissue adhesives designed to facilitate would healing are gaining popularity in diverse clinical applications, they present significant inherent limitations, such as rejection, infections, toxicity and/or excessive swelling. It is highly desirable to develop efficient, biocompatible and anti-bacterial tissue adhesives for skin wound healing.

PURPOSE

Inspired by the fact that inorganic nanoparticles can directly glue tissues through the "nanobridging effect", herein disulfide bond-bridged nanosilver-decorated mesoporous silica nanoparticles (Ag-MSNs) was constructed as an effective and safe tissue adhesive with antibacterial and degradable properties for wound closure and healing.

MATERIALS AND METHODS

Ag-MSNs was fabricated by controlled reduce of ultrasmall nanosilvers onto the both surface and large pore of biodegradable MSNs. The obtained MSNs were characterized by transmission electron microscopy, Fourier transform infrared spectroscopy, energy-dispersive X-ray spectroscopy, and measurement of size distribution, zeta potential, and mesopore properties. Furthermore, adhesion strength test, anti-bacterial assessment, mouse skin wound model, and MTT assays were used to investigate the tissue adhesive property, antibacterial effect, biodegradability and biocompatibility of the Ag-MSNs.

RESULTS

Ag-MSNs exhibited not only strong adhesive properties but also excellent antibacterial activities than that of MSNs. Importantly, this antibacterial nano-adhesive achieved rapid and efficient closure and healing of wounds in comparison to sutures or MSNs in a mouse skin wound model. Furthermore, Ag-MSNs with fast degradable behavior caused little cellular toxicity and even less systemic toxicity during wound healing.

CONCLUSION

Our findings suggest that biodegradable Ag-MSNs can be employed as the next generation of nano-adhesives for rapid wound closure and aesthetic wound healing.

Mechanistic approach to study conjugation of nanoparticles for biomedical applications

Interaction of nanoparticles with biological systems turns out to be vibrant for their efficient application in biomedical field. Here, we have shown antibiotic amakicin loaded nanoparticles are responsible for the dual role as reducing and stabilizing the silver nanoparticles without the use of any undesired chemicals. Synthesized nanoparticles are well-dispersed having quasi spherical morphology with an average particle size around 10-11 nm. Crystallinity of nanoparticles was measured using selected area electron diffraction (SAED) and powder XRD analysis which show that particles are perfectly crystalline with cubic phase of geometry. UV-Vis, FTIR and circular dichroism (CD) analysis explained the presence and interaction of antibiotic on the nanoparticle's surface. Amakicin functionalized Ag nanoparticles used in this study have shown enhanced antibacterial activity against E. coli. These studies will help in designing an in-depth understanding that how nanostructures can possibly interact with biological systems.

Biomedical Applications of Silver Nanoparticles: An Up-to-Date Overview

During the past few years, silver nanoparticles (AgNPs) became one of the most investigated and explored nanotechnology-derived nanostructures, given the fact that nanosilver-based materials proved to have interesting, challenging, and promising characteristics suitable for various biomedical applications. Among modern biomedical potential of AgNPs, tremendous interest is oriented toward the therapeutically enhanced personalized healthcare practice. AgNPs proved to have genuine features and impressive potential for the development of novel antimicrobial agents, drug-delivery formulations, detection and diagnosis platforms, biomaterial and medical device coatings, tissue restoration and regeneration materials, complex healthcare condition strategies, and performance-enhanced therapeutic alternatives. Given the impressive biomedical-related potential applications of AgNPs, impressive efforts were undertaken on understanding the intricate mechanisms of their biological interactions and possible toxic effects. Within this review, we focused on the latest data regarding the biomedical use of AgNP-based nanostructures, including aspects related to their potential toxicity, unique physiochemical properties, and biofunctional behaviors, discussing herein the intrinsic anti-inflammatory, antibacterial, antiviral, and antifungal activities of silver-based nanostructures.

Silver-Impregnated Dressing Does Not Decrease Incidence of Surgical Site Infection After Adult Cardiac Surgery

OBJECTIVE

Sternal wound infections complicate 1% to 8% of cardiac surgeries and carry significant morbidity. We investigated the utility of silver-impregnated dressing in decreasing sternal wound infections after sternotomy cases.

METHODS

A single-institution cohort study was performed as part of a quality improvement trial of a new sternal dressing. Five hundred fifty-seven sternotomy cases were performed in 2015 with application of a traditional gauze dressing. In 2016, 682 sternotomy cases were performed with the use of a commercially available silver-impregnated dressing. Prospectively identified metrics were analyzed for each patient population along with nursing assessments and structured questionnaires.

RESULTS

Baseline characteristics of patients in traditional gauze and silver-impregnated dressing groups were similar. Morbidity and mortality were similar. Nine (1.6%) and 12 (1.8%) sternal wound infections were reported in traditional gauze and silver-impregnated dressing groups, respectively. There was no difference in the rate of sternal wound infections (P = 0.80). The number of organ space infections (3) and deep sternal wound infections (3) was the same; however, the number of superficial infections was greater in the silver-impregnated dressing cohort (3 vs. 6). Among patients in either group with sternal wound infection, there were no differences in the proportion of superficial infections (44% vs. 50%, P = 0.8) or the organism cultured (67% vs. 50% staphylococcus, P = 0.45). A total of 22% of patients reported "not satisfied" with silver-impregnated dressing.

CONCLUSIONS

Silver dressings did not reduce sternal wound infection after sternotomy for cardiac surgery in a large-cohort study. We discontinued the routine use of silver dressings for adult cardiac surgery based on these results because traditional gauze likely represents an equally effective and less costly alternative.

Bacterial Silver Resistance Gained by Cooperative Interspecies Redox Behavior

Silver has emerged as an important therapeutic option for wound infections in recent years due to its broad-spectrum antimicrobial activity. The silver cation (Ag⁺), but not the bulk metal (Ag⁰), is highly toxic for most microorganisms, although resistance due to genetic modification or horizontal gene transfer does occur. Pseudomonas aeruginosa, however, achieves silver resistance by producing the redox-active metabolite pyocyanin that reduces Ag⁺ to nontoxic Ag⁰ Pyocyanin also possesses broad-spectrum antimicrobial activity. Many microbial species reduce pyocyanin, which reduces molecular oxygen to antimicrobial hydrogen peroxide. In this study, it was hypothesized that both Ag⁺ and oxygen would act as competing terminal electron acceptors for pyocyanin, thus acting as a universal microbial protectant from Ag⁺ while avoiding hydrogen peroxide formation. Escherichia coli and Staphylococcus aureus efficiently reduced pyocyanin and generated hydrogen peroxide, while Ag⁺ markedly reduced the amount of hydrogen peroxide produced. Although unable to reduce directly Ag⁺ to Ag⁰ on their own, E. coli and S. aureus did so when pyocyanin was present, resulting in increased survival when exposed to Ag⁺ Coincubation experiments with either E. coli or S. aureus with P. aeruginosa demonstrated increased survival for those species to Ag⁺, but only if pyocyanin was present. These data demonstrate that microorganisms that display no intrinsic silver resistance may survive and proliferate under potentially toxic conditions, provided their environment contains a suitable redox-active metabolite-producing bacterium. Chronic wounds are often polymicrobial in nature, with pyocyanin-producing P. aeruginosa bacteria frequently being present; therefore, redox-based silver resistance may compromise treatment efforts.

Synergistic antibacterial activity of silver with antibiotics correlating with the upregulation of the ROS production

Thiol-dependent enzymes, including the thioredoxin (Trx) and glutathione (GSH) systems, have recently been found as promising bactericidal targets in multidrug-resistant (MDR) bacteria. We previously discovered that silver acted synergistically with ebselen in the inhibition of the Trx system and also resulted in a fast depletion of GSH in Gram-negative bacteria. Silver has been found by others to improve the sensitivity of bacteria to certain conventional antibiotics. Here, we found that the synergistic antibacterial effects of silver with four conventional antibiotics was correlated with the blockage of bacterial Trx system by silver. The synergistic antibacterial effect came along with the production of reactive oxygen species. All these results suggested that silver primarily enhanced the bactericidal activities of conventional antibiotics towards Gram-negative strains through the upregulation of ROS production.

Wound odor: current methods of treatment and need for objective measures

Chronic wounds are an enormous burden to society, costing billions of dollars annually in the USA alone. Despite the extensive research into methods to heal chronic wounds, many remain unhealed for months to years. There is a need to focus on patient reported outcomes to improve quality of life in patients with non-healing wounds. Wound odor has a significant impact on patient quality of life; however, relatively little information is available on the management of wound odor. We review the current data available on wound odor and discuss the need for standardized objective measures of odor to improve research quality. An independent search of the PubMed and Embase databases was conducted using combinations of the following words or phrases: "wounds," "chronic wounds," "diabetic ulcers," "venous leg ulcers (VLUs)," "malignant ulcers," "odor," "odour," "smell," "malodor," "artificial olfaction," "electronic nose," and "e-nose." Article references were also searched for significance. There are few overall studies on wound odor, and fewer randomized controlled trials. Current trials on odor have consistent weaknesses such as subjective measures and poor methodology. No single odor treatment modality has been demonstrated to be widely effective for wound odor or superior to other methods. Future research should incorporate objective measures of odor such as electronic noses into clinical trials.