Toxicological aspects of topical silver pharmaceuticals

Enhanced transparency, mechanical durability, and antibacterial activity of zinc nanoparticles on glass substrate

Homogeneously distributed zinc nanoparticles (NPs) on the glass substrate were investigated for the transmittance, mechanical durability, and antibacterial effect. The buffered Ti NPs between Zn NPs and glass substrate were studied for an enhancement of the transmittance and mechanical endurance. The Ti NPs buffered Zn NPs showed a high transmittance of approximately 91.5% (at a wavelength of 550 nm) and a strong antibacterial activity for Staphylococcus aureus and Escherichia coli bacteria. The buffered Ti NPs are attractive for an excellent mechanical endurance of the Zn NPs. The Zn NPs did not require the protection layer to prevent the degradation of the performance for both the antibacterial effect and the transmittance.

Green synthesis of Kocuran-functionalized silver glyconanoparticles for use as antibiofilm coatings on silicone urethral catheters

Microbial infections due to biofilm formation on medical implants are serious complications arising after surgery which can be prevented by using antimicrobial coatings on biomaterial surfaces. We developed a simple, rapid and green chemistry approach for synthesis of silver glyconanoparticles (AgNPs) using Kocuran, an exopolysaccharide produced by Kocuria rosea strain BS-1. Kocuran-capped AgNPs exhibited a characteristic surface plasmon resonance (SPR) peak around 435 nm. They were mono-dispersed, spherical with an average particle size of 12 nm. XRD and SAED studies suggested that AgNPs were crystalline in nature. AgNPs had a zeta potential of -33.9 mV and were anionic charged. They showed colloidal stability at different pH (6 to 10), temperatures (30 °C to 100 °C), in NaCl, NaNO3 and BSA solutions. Kocuran-capped AgNPs exhibited effective antimicrobial activity against Staphylococcus aureus and Escherichia coli and cell death was mainly due to hydroxyl radical induction and depletion of NADH. They also inhibited the biofilm development by S. aureus and E. coli and confocal scanning laser microscopic images revealed the damage of intact cell architecture. In vitro evaluation of Kocuran-capped silver glyconanoparticles on human gingival fibroblasts demonstrated good cell proliferation as compared to commercial AgNPs suggesting that they are biocompatible and non-toxic in nature. This is a first report on Kocuran-functionalized AgNPs exhibiting potential antibacterial and antiadhesive properties for use as antimicrobial coatings against bacterial adhesion and biofilm formation on silicone urethral catheters.

Review: emerging developments in the use of bioactive glasses for treating infected prosthetic joints

Bacterial contamination of implanted orthopedic prostheses is a serious complication that requires prolonged systemic antibiotic therapy, major surgery to remove infected implants, bone reconstruction, and considerable morbidity. Local delivery of high doses of antibiotics using poly(methyl methacrylate) (PMMA) cement as the carrier, along with systemic antibiotics, is the standard treatment. However, PMMA is not biodegradable, and it can present a surface on which secondary bacterial infection can occur. PMMA spacers used to treat deep implant infections must be removed after resolution of the infection. Alternative carrier materials for antibiotics that could also restore deficient bone are therefore of interest. In this article, the development of bioactive glass-based materials as a delivery system for antibiotics is reviewed. Bioactive glass is osteoconductive, converts to hydroxyapatite, and heals to hard and soft tissues in vivo. Consequently, bioactive glass-based carriers can provide the combined functions of controlled local antibiotic delivery and bone restoration. Recently-developed borate bioactive glasses are of particular interest since they have controllable degradation rates coupled with desirable properties related to osteogenesis and angiogenesis. Such glasses have the potential for providing a new class of biomaterials, as substitutes for PMMA, in the treatment of deep bone infections.

Anti-infection trauma devices with drug release and nonfouling surface modification

OBJECTIVES

By coupling an antimicrobial release with a highly nonfouling betaine modification on titanium, this approach innovatively addresses the initial bacterial challenge and the longer term biofilm formation on trauma devices.

METHODS

Titanium substrates were modified to obtain a polymer reservoir for chlorhexidine (CHX) and a polybetaine surface layer. The surface was characterized by infrared spectroscopy, scanning electron microscopy, laser confocal scanning microscopy, and a radiolabeled fibrinogen assay. The in vitro drug release profiles were measured using an ultraviolet-visible spectroscopy and a high-performance liquid chromatography. The efficacy to inhibit surface biofilm formation was determined by a bacterial adherence assay. The surface modification's bonding strength to the titanium substrate was measured, and its resistance to abrasion was tested ex vivo. Additionally, the biocompatibility was tested after ISO 10993 procedures.

RESULTS

Titanium surfaces were successfully modified with a conformal and strongly bound polymer layer. No scratches were observed when inserting the modified titanium wires into porcine femur, and preservation of modification was confirmed by infrared spectroscopy. Controlled release of CHX was demonstrated for more than 8 weeks, and different formulations were tailored for different release rates. Greater than 3 log (99.9%) reductions in bacterial adherence were achieved after serum exposure. Additionally, the nonfouling properties were retained after several weeks of CHX release. Modified materials passed ISO 10993 testing for permanent implant devices.

CONCLUSIONS

By innovatively addressing the initial bacterial challenge and longer term biofilm formation on trauma devices, this approach may be a superior solution to the current biofilm control technology.

Acute and subacute toxicity in vivo of thermal-sprayed silver containing hydroxyapatite coating in rat tibia

To reduce the incidence of implant-associated infection, we previously developed a novel coating technology using hydroxyapatite (HA) containing silver (Ag). This study examined in vivo acute and subacute toxicity associated with the Ag-HA coating in rat tibiae. Ten-week-old rats received implantation of HA-, 2% Ag-HA-, or 50% Ag-HA-coated titanium rods. Concentrations of silver in serum, brain, liver, kidneys, and spleen were measured in the acute phase (2-4 days after treatment) and subacute phase (4-12 weeks after treatment). Biochemical and histological examinations of those organs were also performed. Mean serum silver concentration peaked in the acute phase and then gradually decreased. Mean silver concentrations in all examined organs from the 2% Ag-HA coating groups showed no significant differences compared with the HA coating group. No significant differences in mean levels of glutamic-oxaloacetic transaminase, glutamic-pyruvic transaminase, lactate dehydrogenase, creatinine, or blood urea nitrogen were seen between the three groups and controls. Histological examinations of all organs revealed no abnormal pathologic findings. No acute or subacute toxicity was seen in vivo for 2% Ag-HA coating or HA coating. Ag-HA coatings on implants may represent biologically safe antibacterial biomaterials and may be of value for reducing surgical-site infections related to implantation.

Nanosilver cytotoxicity in rainbow trout (Oncorhynchus mykiss) erythrocytes and hepatocytes

Silver nanoparticles (AgNPs) are present in a multitude of consumer and medical products; however, the toxicity of AgNPs is not fully understood. This research aimed to elucidate the relationship between AgNP cytotoxicity and oxidative stress and damage in rainbow trout (Oncorhynchus mykiss) hepatocytes and erythrocytes in comparison to silver ions (Ag(+)). Generally the cytotoxicity of AgNPs and Ag(+) was similar, such that both silver types generated reactive oxygen species, decreased glutathione levels, and decreased activities of glutathione reductase and glutathione-S-transferase. Nonetheless, the two silver types had different cellular targets; AgNPs increased lipid peroxidation without apparent uptake into the cells whereas Ag(+) increased DNA damage. Furthermore, the toxicity of both silver types was generally decreased in cells treated with cysteine while treatment with buthionine sulfoximine increased the toxicity of both silver types.

A multifunctional composite of an antibacterial higher-valent silver metallopharmaceutical and a potent wound healing polypeptide: a combined killing and healing approach to wound care

A histatin-1 and silver(ii) polydiguanide complex composite demonstrated both antibacterial and wound healing promoting activity.

The use of 111Ag as a tool for studying biological distribution of silver-based antimicrobials

Recently, there has been an emergence of significant interest in silver-based antimicrobials. Our goal was to develop a radioactive tracer for investigating the biological fate of such compounds. Purified 111Ag was incorporated into the methylated caffeine analogue, IC1 to yield the silver carbene complex designated as [111Ag]SCC1 and investigated in biodistribution studies.

Cytotoxicity of silver dressings on diabetic fibroblasts

A large number of silver-based dressings are commonly used in the management of chronic wounds that are at risk of infection, including diabetic foot ulcers. However, there are still controversies regarding the toxicity of silver dressings on wound healing. The purpose of this study was to objectively test the cytotoxicity of silver dressings on human diabetic fibroblasts. Human diabetic fibroblasts were obtained from the foot skin of four diabetic foot ulcer patients and cultured. The effect of five silver-containing dressing products (Aquacel Ag, Acticoat*Absorbent, Medifoam Ag, Biatain Ag and PolyMem Ag) and their comparable silver-free dressing products on morphology, proliferation and collagen synthesis of the cultured human diabetic fibroblasts were compared in vitro. In addition, extracts of each dressing were tested in order to examine the effect of other chemical components found in the dressings on cytotoxicity. The diabetic fibroblasts cultured with each silver-free dressing adopted the typical dendritic and fusiform shape. On the other hand, the diabetic fibroblasts did not adopt this typical morphology when treated with the different silver dressings. All silver dressings tested in the study reduced the viability of the diabetic fibroblasts and collagen synthesis by 54-70 and 48-68%, respectively, when compared to silver-free dressings. Silver dressings significantly changed the cell morphology and decreased cell proliferation and collagen synthesis of diabetic fibroblasts. Therefore, silver dressings should be used with caution when treating diabetic wounds.

Earthworms and humans in vitro: characterizing evolutionarily conserved stress and immune responses to silver nanoparticles

Little is known about the potential threats of silver nanoparticles (AgNPs) to ecosystem health, with no detailed report existing on the stress and immune responses of soil invertebrates. Here we use earthworm primary cells, cross-referencing to human cell cultures with a particular emphasis on the conserved biological processes, and provide the first in vitro analysis of molecular and cellular toxicity mechanisms in the earthworm Eisenia fetida exposed to AgNPs (83 ± 22 nm). While we observed a clear difference in cytotoxicity of dissolved silver salt on earthworm coelomocytes and human cells (THP-1 cells, differentiated THP-1 cells and peripheral blood mononuclear cells), the coelomocytes and differentiated (macrophage-like) THP-1 cells showed a similar response to AgNPs. Intracellular accumulation of AgNPs in the coelomocytes, predominantly in a phagocytic population, was evident by several methods including transmission electron microscopy. Molecular signatures of oxidative stress and selected biomarker genes probed in a time-resolved manner suggest early regulation of oxidative stress genes and subsequent alteration of immune signaling processes following the onset of AgNP exposure in the coelomocytes and THP-1 cells. Our findings provide mechanistic clues on cellular innate immunity toward AgNPs that is likely to be evolutionarily conserved across the animal kingdom.

Infected tumor prostheses

Infection of tumor prostheses has been a major concern because of the extensive soft tissue dissection, long operating times, and patients' immunosuppression by cancer and adjuvant treatments. Infections most often present within 2 years postoperatively, with approximately 70% of postoperative deep infections presenting within 12 months after surgery. They are typically low organism burden infections, the pathogenesis of which is related to bacteria growing in biofilms. Staphylococci are the most common pathogens involved in prosthetic joint infections, accounting for approximately 50% of infections overall, followed by streptococci, enterococci, Enterobacteriaceae species, Pseudomonas aeruginosa, and anaerobe species. Multiple pathogens may be isolated in approximately 25% of cases, with the most common combination being coagulase-negative Staphylococcus and group-D Streptococcus. Early diagnosis and appropriate treatment are necessary. However, diagnosis may be challenging because clinical symptoms are highly variable and numerous preoperative and intraoperative diagnostic laboratory tests are nonspecific. In most cases, a 1- or 2-stage revision surgery is necessary for eradicating the megaprosthetic infection. Prevention of infection is important. The future will see technical advances for infections of tumor prostheses in areas such as microbiological diagnostics and biofilm-resistant prostheses.

Silver-doped calcium phosphate cements with antimicrobial activity

There is a current need for the localised delivery of antibiotics in order to treat implant-based bacterial infections. Existing treatments use non-resorbable materials such as poly(methyl methacrylate) beads loaded with antibiotics; unfortunately, as they are not resorbable, these beads require secondary surgery for removal. Calcium phosphate cements have considerable potential for the localised delivery of drugs since they can be resorbed to some extent within the body, eliminating the need for a secondary surgical procedure. Therefore, in this study, the efficacy of both hydroxyapatite and brushite cements in the delivery of silver ions has been investigated. The activity of the Ag(+) released from the cements was assessed against the growth of both Staphylococcus aureus and Staphylococcus epidermidis; the brushite cement exhibited excellent antibacterial properties and also showed an increase in compressive strength of over 30%. In this study we have found that with a few changes in Ag(+) concentration it should be possible to produce a fully resorbable bone replacement material that is combined with an antibacterial scaffold with controlled release over a period of time, which is likely to inhibit bacterial infections associated with implantation procedures.

The influence of elementary silver versus titanium on osteoblasts behaviour in vitro using human osteosarcoma cell lines

Purpose. The antimicrobial effect of a silver-coated tumor endoprosthesis has been proven in clinical and experimental trials. However, in the literature there are no reports concerning the effect of elementary silver on osteoblast behaviour. Therefore, the prosthetic stem was not silver-coated because of concerns regarding a possible inhibition of the osseointegration. The aim of the present study was to investigate the effect of 5–25 mg of elementary silver in comparison to Ti-6Al-4V on human osteosarcoma cell lines (HOS-58, SAOS). Methods. Cell viability was determined by measuring the MTT proliferation rate. Cell function was studied by measuring alkaline phosphatase (AP) activity and osteocalcine production. Results. In the HOS-58 cells, the AP activity was statistically significant (P < 0.05) higher at a supplement of 5–10 mg of silver than of Ti-6 Al-4V at the same doses. For both cell lines, a supplement above 10 mg of silver resulted in a reduced AP activity in comparision to the Ti-6 Al-4V group, but a statistically significant difference (P < 0.05) was observed at a dose of 25 mg for the SAOS cells only. At doses of 20–25 mg in the HOS-58 cells and 10–25 mg in the SAOS cells, the reduction of the proliferation rate by silver was statistically significant (P < 0.05) compared to the Ti-6 Al-4V supplement. Discussion. In conclusion, elementary silver exhibits no cytotoxicity at low concentrations. In contrast, it seems to be superior to Ti-6 Al-4V concerning the stimulation of osteogenic maturation at these concentrations, whereas at higher doses it causes the known cytotoxic properties.

In vitro assessment of silver effect on porcine ovarian granulosa cells

The general objective of this in vitro study was to examine the secretory activity (insulin-like growth factor I, IGF-I) of porcine ovarian granulosa cells after Ag addition and to outline the potential intracellular mediators (cyclin B1 and caspase-3) of its effects. Ovarian granulosa cells were incubated with silver nitrate (AgNO(3)) at the doses 0.09, 0.17, 0.33, 0.5 and 1.0 mg/mL for 18 h and compared to the control group without metal addition. The release of IGF-I by granulosa cells was assessed by RIA and expression of cyclin B1 and caspase-3 immunocytochemistry. Our observations show that IGF-I release by granulosa cells was significantly (P<0.05) stimulated by AgNO(3) addition at the doses (0.09-1.0 mg/mL). Similarly to IGF-I the cyclin B1 and caspase-3 expression in ovarian granulosa cells was stimulated by Ag addition (0.09-1.0 mg/mL). In conclusion, the present results indicate, a direct effect of Ag on (1) secretion of growth factor IGF-I, (2) expression of markers of proliferation (cyclin B1) and apoptosis (caspase-3) of porcine ovarian granulosa cells and (3) that the effect of Ag on ovarian cell proliferation could be mediated by IGF-I and cyclin B1. Obtained data indicate the interference of Ag in the pathways of proliferation and apoptosis of porcine ovarian granulosa cells through hormonal and intracellular peptides such as are cyclin B1 and caspase-3.

Acute and subchronic dermal toxicity of nanosilver in guinea pig

Silver has been used as an antimicrobial agent for a long time in different forms, but silver nanoparticles (nanosilver) have recently been recognized as potent antimicrobial agents. Although nanosilver is finding diverse medical applications such as silver-based dressings and silver-coated medical devices, its dermal and systemic toxicity via dermal use has not yet been identified. In this study, we analyzed the potential toxicity of colloidal nanosilver in acute and subchronic guinea pigs. Before toxicity assessments, the size of colloidal nanosilver was recorded in sizes <100 nm by X-ray diffraction and transmission electron microscopy. For toxicological assessments, male guinea pigs weighing 350 to 400 g were exposed to two different concentrations of nanosilver (1000 and 10,000 μg/mL) in an acute study and three concentrations of nanosilver (100, 1000, and 10,000 μg/mL) in a subchronic study. Toxic responses were assessed by clinical and histopathologic parameters. In all experimental animals the sites of exposure were scored for any type of dermal toxicity and compared with negative control and positive control groups. In autopsy studies during the acute test, no significant changes in organ weight or major macroscopic changes were detected, but dose-dependent histopathologic abnormalities were seen in skin, liver, and spleen of all test groups. In addition, experimental animals subjected to subchronic tests showed greater tissue abnormalities than the subjects of acute tests. It seems that colloidal nanosilver has the potential to provide target organ toxicities in a dose- and time-dependent manner.

Silver toxicity with the use of silver-impregnated dressing and wound vacuum-assisted closure in an immunocompromised patient

Silver-containing topical agents are used to help prevent infectious complications in wound therapy. Toxicity from topical silver agent exposure was initially reported in 1975 and was clinically characterized by granulocytopenia. Currently, the data regarding potential toxicity associated with silver-impregnated devices are limited. A 23-year-old patient receiving chemotherapy for acute lymphoblastic leukemia presented with necrotizing fasciitis of the abdominal wall and scrotum from a Crohn disease-related psoas-enteric fistula. Surgical debridement of the soft-tissue and abdominal musculature was performed to the peritoneum. Silver-containing foam sponges and wound vacuum-assisted closure were applied directly to the peritoneum 2 weeks after initial debridement. Subsequently, the patient developed leukopenia, and workup revealed the serum silver level was 4 times normal level. Silver-impregnated sponges were discontinued and silver-free sponges and wound vacuum-assisted closure therapy resumed, followed by leukopenia resolution. Silver toxicity associated with routine application of silver-impregnated sponges has not been previously reported.

Covalent layer-by-layer assembly of polyethyleneimine multilayer for antibacterial applications

Polyelectrolyte multilayer film (PMF) is conventionally fabricated by the layer-by-layer (LBL) assembly of a pair of oppositely charged polyelectrolytes on a substrate through electrostatic attractions. However, the lack of long-term stability of PMF under physiological conditions limits its application as antimicrobial coating in medical devices. In this study, a stable PMF composed of only polyethyleneimine (PEI) was constructed by covalent LBL deposition. First, the specific buildup of PEI during covalent LBL assembly was validated by UV-Vis absorption spectroscopy and atomic force microscopy. Second, silver (Ag) nanoparticles were incorporated into PEI multilayers through in situ reduction of Ag(+) by the pre-absorption of NaBH(4). It was also shown that the mass of Ag nanoparticle can be controlled by varying multilayer thickness and loading cycles. Bacterial live/dead assay showed that the PEI multilayers effectively killed Staphylococcus aureus and Escherichia coli upon contact formation. The inclusion of Ag nanoparticles in (PEI) film not only enhanced the antimicrobial property against adherent bacteria but also led to the inhibition of the bacteria growth in suspended culture via the long-term release of Ag(+) into the liquid medium.

A comparative study of the burn wound healing properties of saline-soaked dressing and silver sulfadiazine in rats

The purpose of this study was to further investigate that phenomenon and to explore the effect silver sulfadiazine on wound healing. Full-thickness burn wounds were created on the dorsum of Wistar albino rats under anesthesia. The wounds were treated with silver sulfadiazine and saline-soaked dressing for fourteen days, and then observed until healed. Wound surface area was measured each three days. Time to 50% and 90% healing was compared. No clinical infections occurred. Wound half-life and healing times were shortest in the saline-soaked group (P < 0.0001) in full-thickness burns. Wound contraction was delayed by silver sulfadiazine. These data suggest that silver sulfadiazine retard burn wound healing. Infection control without delay of burn wound healing is most appealing and clinical trials are planned.

Ctr1 transports silver into mammalian cells

Silver is a non-essential, toxic metal. The use of silver as an antimicrobial agent in many applications and its presence as a contaminant in foods and air can lead to accumulation in tissues. Despite its widespread use, the systems involved in the uptake of silver into mammalian cells are presently unknown. Previous studies have shown that copper uptake at the plasma membrane by copper transporter 1 (Ctr1) is inhibited by an excess of silver, suggesting that Ctr1 may function in importing silver into cells. In this study we examined directly the role of Ctr1 in the accumulation of silver in mammalian cells using over-expression experiments and mouse embryonic fibroblast cells lacking Ctr1. COS-7 cells transfected to express a human Ctr1-green fluorescent protein (hCtr1-GFP) fusion protein hyper-accumulated silver when incubated in medium supplemented with low micromolar concentrations (2.5-10 micromol/L) of AgNO(3). An hCtr1-GFPM150L,M154L variant deficient for copper transport failed to stimulate accumulation of silver. Mouse embryonic fibroblast cells lacking Ctr1 showed approximately a 50% reduction in silver content when incubated in silver-supplemented medium compared to a wild-type isogenic cell line. Collectively, these data demonstrate that Ctr1 transports both copper and silver and suggest that Ctr1 is an important transport protein in the accumulation of silver in mammalian cells.

A review of the in vivo and in vitro toxicity of silver and gold particulates: particle attributes and biological mechanisms responsible for the observed toxicity

This review is concerned with evaluating the toxicity associated with human exposure to silver and gold nanoparticles (NPs), due to the relative abundance of toxicity data available for these particles, when compared to other metal particulates. This has allowed knowledge on the current understanding of the field to be gained, and has demonstrated where gaps in knowledge are. It is anticipated that evaluating the hazards associated with silver and gold particles will ultimately enable risk assessments to be completed, by combining this information with knowledge on the level of human exposure. The quantity of available hazard information for metals is greatest for silver particulates, due to its widespread inclusion within a number of diverse products (including clothes and wound dressings), which primarily arises from its antibacterial behaviour. Gold has been used on numerous occasions to assess the biodistribution and cellular uptake of NPs following exposure. Inflammatory, oxidative, genotoxic, and cytotoxic consequences are associated with silver particulate exposure, and are inherently linked. The primary site of gold and silver particulate accumulation has been consistently demonstrated to be the liver, and it is therefore relevant that a number of in vitro investigations have focused on this potential target organ. However, in general there is a lack of in vivo and in vitro toxicity information that allows correlations between the findings to be made. Instead a focus on the tissue distribution of particles following exposure is evident within the available literature, which can be useful in directing appropriate in vitro experimentation by revealing potential target sites of toxicity. The experimental design has the potential to impact on the toxicological observations, and in particular the use of excessively high particle concentrations has been observed. As witnessed for other particle types, gold and silver particle sizes are influential in dictating the observed toxicity, with smaller particles exhibiting a greater response than their larger counterparts, and this is likely to be driven by differences in particle surface area, when administered at an equal-mass dose. A major obstacle, at present, is deciphering whether the responses related to silver nanoparticulate exposure derive from their small size, or particle dissolution contributes to the observed toxicity. Alternatively, a combination of both may be responsible, as the release of ions would be expected to be greater for smaller particles.

Topical antimicrobial agents for the treatment of chronic wounds

Chronic wounds are commonly observed in acute and community settings. The management of chronic wounds represents a significant proportion of health-care resources and makes up a substantial amount of contact time with community-based nurses spending approximately 25% to 50% of their time treating wounds. Chronic wounds often exhibit increased bacterial burden that can negatively impact upon patients, reduce their quality of life and substantially increase treatment costs for health care providers. Antibiotic resistance has become a major medical and public health problem, and interest has been generated in the use of topical therapies to manage wound infection. This article presents an overview of the historical use of honey, silver and iodine for the treatment of infected wounds progressing through to modern day use and the current evidence base for the use of these antimicrobial agents in the management of infected wounds.

Development of novel thermal sprayed antibacterial coating and evaluation of release properties of silver ions

Several studies have addressed the use of antibacterial coating to reduce implant-associated infections. In this study, novel silver (Ag)-containing calcium-phosphate (CP) coating technology based on the thermal spraying method was developed. The coating's physical and chemical properties, in vitro antibacterial activity, hydroxyapatite (HA)-forming ability, and release of Ag ions were evaluated. An amorphous structure of the coating was confirmed by X-ray diffraction, and Ag residue in the coating was determined by elementary analysis. The coating showed strong antibacterial activity to methicillin-resistant Staphylococcus aureus in fetal bovine serum (FBS) along with HA-forming ability in simulated body fluid. Therefore, it is expected that the coating would confer antibacterial and bone bonding abilities to the implant surface. Time course release testing of Ag ions from the coating on immersion in FBS showed pronounced Ag release for up to 24 h after immersion, with consistent strong antibacterial activity at the early postoperative stage. In repeated testing, the amount of released Ag ions was about 6500 parts per billion (ppb, microg/L) for the first release test, after which it gradually decreased. However, retention of significant release of Ag ions after a sixth repeat implies that Ag release from the coating is slow in FBS.

Interactions of neutrophils with silver-coated vascular polyester grafts

BACKGROUND

In reconstructive vascular surgery, infection is one of the most feared complications because of the high mortality. While the antimicrobial effect of a silver-coated endoprosthesis has been proven in experimental trials, there are no reports on its interactions with granulocytes, the first effector cells in general inflammation and in infection.

MATERIALS AND METHODS

Therefore, we investigated whether silver coating of vascular polyester grafts affects receptor expression, mediator release, and functions of human neutrophils relevant for microbicidal activity and the wound-healing process. Naïve neutrophils were analyzed for their cellular receptors such as cluster of differentiation (CD)62L, CD11b, CXCR2, and fMLP-R, the mediators interleukin 8, granulocyte elastase (human neutrophil elastase), and leukotriene B4 (LTB4) as well as for microbicidal capacity (oxidative burst) in vitro. In addition, the role of plasma coating for receptor expression was addressed.

RESULTS

There was both a decrease of CD62L and CXCR2 expression and an increase of CD11b, fMLP-R expression, elastase release, and LTB4 generation, which were statistically significant (p = 0.04; p = 0.01; p = 0.0; p = 0.0; p = 0.01; p = 0.02, respectively) in the presence of the silver-coated graft compared with non-silver-coated vascular grafts. In addition, microbicidal activity was significantly (p = 0.0) impaired by the silver-coated graft. Coating of the vascular grafts with plasma did not alter the former observations significantly.

CONCLUSION

The results may indicate that silver-coated vascular polyester grafts activate neutrophils chronically which may favor tissue destruction and impaired antimicrobial effects.

The influence of the alloy of megaprostheses on infection rate

We retrospectively reviewed 197 patients who underwent reconstruction with a megaprosthesis of the lower extremity. A cobalt-chrome alloy system was used in 77 patients and a titanium alloy system in 120 patients. The overall infection rate was 20.8% (n = 41). Separated into the 2 prosthesis systems used, an infection rate of 31.2% was found in the patients with a cobalt-chrome-alloy prosthesis and 14.2% in the titanium alloy group of patients (P < .01). Early infection occurred in 5.1% (n = 10) and late infection in 15.7% (n = 31). Selecting 2 identical subgroups for further analysis, the cobalt-chrome alloy prostheses were associated with a significantly higher infection rate, with 5 infections of 26 megaprostheses vs 1 infection of 36 titanium megaprostheses (P < .05).

Multifunctional silane polymers for persistent surface derivatization and their antimicrobial properties

We demonstrate a versatile methodology combining both covalent surface anchoring and polymer cross-linking that is capable of forming long-lasting coatings on reactive and nonreactive surfaces. Polymers containing reactive methoxysilane groups form strong Si-O-Si links to oxide surfaces, thereby anchoring the polymer chains at multiple points. The interchain cross-linking of the methoxysilane groups provides additional durability to the coating and makes the coatings highly resistant to solvents. By tailoring the chemical structure of the polymer, we were able to control the surface energy (wetting) of a variety of surfaces over a wide range of water contact angles of 30-140 degrees . In addition, we synthesized covalently linked layer-by-layer polymeric assemblies from these novel methoxysilane polymers. Finally, antibacterial agents, such as silver bromide nanoparticles and triiodide ions, were introduced into these functional polymers to generate long-lasting and renewable antiseptic coatings on glass, metals, and textiles.

Micro-organism-triggered release of silver nanoparticles from biodegradable oxide carriers allows preparation of self-sterilizing polymer surfaces

The antimicrobial activity of silver has attracted significant research interest and contributes to an exponentially growing use of this noble metal in commodity products. In this investigation, we describe a general approach to increase the antimicrobial activity of a silver-containing surface by two to three orders of magnitude. The use of 1-2-nm silver particles decorating the surface of 20-50-nm carrier particles consisting of a phosphate-based, biodegradable ceramic allows the triggered release of silver in the presence of a growing microorganism. This effect is based on the organism's requirements for mineral uptake during growth creating a flux of calcium, phosphate, and other ions to the organism. The growing micro-organism dissolves the carrier containing these nutrients and thereby releases the silver nanoparticles. Further, we demonstrate the rapid self-sterilization of polymer surfaces containing silver on calcium phosphate nanoparticles using a series of human pathogens. Colony-forming units (viable bacteria or fungi counts) have been routinely reduced below detection limit and suggest application of these self-sterilizing surfaces in hospital environments, food and pharmaceutical processing, and personal care.

Scratching the surface--Managing the itch associated with burns: a review of current knowledge

The problems of itch in burns patients are well recognised, however none of the current standard therapies are very effective. The standard therapies include: antihistamines which are only effective in about 20% of patients and emollients which have limited effects. We review the current literature on the molecular mechanisms of itch and neuronal itch pathways, which supports the predictable lack of effect of anti-histamines. The published studies on therapeutic options to treat itch in burns are discussed and in addition we review the work on the treatment of itch in other pathological states. Finally a treatment algorithm is proposed stratifying possible therapeutic options to assist in the management of burns patients distressed by intractable itch.

The safety of nanocrystalline silver dressings on burns: a study of systemic silver absorption

INTRODUCTION

Wound dressings containing silver have been in widespread use for many years. However, there are few quantitative data on the systemic absorption of silver or whether there is associated clinical risk.

OBJECTIVES

To assess systemic silver levels when Acticoat dressings containing nanocrystalline silver were used, and to determine whether increases in such levels were associated with haematological or biochemical indicators of toxicity.

METHOD

A prospective, single-centre, open-label study of 30 patients with relatively small burns that required skin grafting. Serum silver levels were measured before, during and at discontinuation of the use of the Acticoat dressings, and again at 3 and 6 months following completion of treatment.

RESULTS

The median total postoperative wound size was 12% of the total body surface area. The median time to maximum silver levels was 9 days. The median maximum serum silver level was 56.8 microg/l. The median serum level at 6 months was 0.8 microg/l. There were no haematological or biochemical indicators of toxicity associated with the silver absorption observed in this study.

CONCLUSION

This study has confirmed our view that Acticoat products are safe for use on burns and they remain a standard part of treatment at our centre.

Silver-containing dressings and the need for evidence

PURPOSE

To present the practitioner with detailed information on silver-based dressings, including evidence of their efficacy and current practice related to these dressings.

TARGET AUDIENCE

This continuing education activity is intended for physicians and nurses with an interest in better understanding the evidence for and current use of silver-based dressings.

OBJECTIVES

After reading this article and taking the test, the reader should be able to: 1. Describe the indications, actions, and adverse effects related to silver compounds used in wound care. 2. Review the chemical properties and actions that affect the action of silver compounds. 3. Discuss the limitations of current evidence related to silver-containing dressings, along with some of the rating systems used for evaluating scientific evidence.