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Cytocompatible 3D chitosan/hydroxyapatite composites endowed with antibacterial properties: toward a self-sterilized bone tissue engineering scaffold. Sci Bull (Beijing) 2015. [DOI: 10.1007/s11434-015-0838-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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102
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Antifouling coatings for dental implants: Polyethylene glycol-like coatings on titanium by plasma polymerization. Biointerphases 2015; 10:029505. [DOI: 10.1116/1.4913376] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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103
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Metsemakers WJ, Emanuel N, Cohen O, Reichart M, Potapova I, Schmid T, Segal D, Riool M, Kwakman PHS, de Boer L, de Breij A, Nibbering PH, Richards RG, Zaat SAJ, Moriarty TF. A doxycycline-loaded polymer-lipid encapsulation matrix coating for the prevention of implant-related osteomyelitis due to doxycycline-resistant methicillin-resistant Staphylococcus aureus. J Control Release 2015; 209:47-56. [PMID: 25910578 DOI: 10.1016/j.jconrel.2015.04.022] [Citation(s) in RCA: 56] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2015] [Revised: 04/17/2015] [Accepted: 04/19/2015] [Indexed: 11/19/2022]
Abstract
Implant-associated bone infections caused by antibiotic-resistant pathogens pose significant clinical challenges to treating physicians. Prophylactic strategies that act against resistant organisms, such as methicillin-resistant Staphylococcus aureus (MRSA), are urgently required. In the present study, we investigated the efficacy of a biodegradable Polymer-Lipid Encapsulation MatriX (PLEX) loaded with the antibiotic doxycycline as a local prophylactic strategy against implant-associated osteomyelitis. Activity was tested against both a doxycycline-susceptible (doxy(S)) methicillin-susceptible S. aureus (MSSA) as well as a doxycycline-resistant (doxy(R)) methicillin-resistant S. aureus (MRSA). In vitro elution studies revealed that 25% of the doxycycline was released from the PLEX-coated implants within the first day, followed by a 3% release per day up to day 28. The released doxycycline was highly effective against doxy(S) MSSA for at least 14days in vitro. A bolus injection of doxycycline mimicking a one day release from the PLEX-coating reduced, but did not eliminate, mouse subcutaneous implant-associated infection (doxy(S) MSSA). In a rabbit intramedullary nail-related infection model, all rabbits receiving a PLEX-doxycycline-coated nail were culture negative in the doxy(S) MSSA-group and the surrounding bone displayed a normal physiological appearance in both histological sections and radiographs. In the doxy(R) MRSA inoculated rabbits, a statistically significant reduction in the number of culture-positive samples was observed for the PLEX-doxycycline-coated group when compared to the animals that had received an uncoated nail, although the reduction in bacterial burden did not reach statistical significance. In conclusion, the PLEX-doxycycline coating on titanium alloy implants provided complete protection against implant-associated MSSA osteomyelitis, and resulted in a significant reduction in the number of culture positive samples when challenged with a doxycycline-resistant MRSA.
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Affiliation(s)
- Willem-Jan Metsemakers
- AO Research Institute Davos, AO Foundation, Clavadelerstrasse 8, Davos Platz CH7270, Switzerland
| | - Noam Emanuel
- PolyPid Ltd., 18 Hasivim St., Petach-Tikva 4959376, Israel
| | - Or Cohen
- PolyPid Ltd., 18 Hasivim St., Petach-Tikva 4959376, Israel
| | - Malka Reichart
- PolyPid Ltd., 18 Hasivim St., Petach-Tikva 4959376, Israel
| | - Inga Potapova
- AO Research Institute Davos, AO Foundation, Clavadelerstrasse 8, Davos Platz CH7270, Switzerland
| | - Tanja Schmid
- AO Research Institute Davos, AO Foundation, Clavadelerstrasse 8, Davos Platz CH7270, Switzerland
| | - David Segal
- PolyPid Ltd., 18 Hasivim St., Petach-Tikva 4959376, Israel
| | - Martijn Riool
- Department of Medical Microbiology, Center for Infection and Immunity Amsterdam (CINIMA), Academic Medical Center, University of Amsterdam, Meibergdreef 15, 1105 AZ Amsterdam, The Netherlands
| | - Paulus H S Kwakman
- Department of Medical Microbiology, Center for Infection and Immunity Amsterdam (CINIMA), Academic Medical Center, University of Amsterdam, Meibergdreef 15, 1105 AZ Amsterdam, The Netherlands
| | - Leonie de Boer
- Department of Medical Microbiology, Center for Infection and Immunity Amsterdam (CINIMA), Academic Medical Center, University of Amsterdam, Meibergdreef 15, 1105 AZ Amsterdam, The Netherlands
| | - Anna de Breij
- Department of Infectious Diseases, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands
| | - Peter H Nibbering
- Department of Infectious Diseases, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands
| | - R Geoff Richards
- AO Research Institute Davos, AO Foundation, Clavadelerstrasse 8, Davos Platz CH7270, Switzerland
| | - Sebastian A J Zaat
- Department of Medical Microbiology, Center for Infection and Immunity Amsterdam (CINIMA), Academic Medical Center, University of Amsterdam, Meibergdreef 15, 1105 AZ Amsterdam, The Netherlands
| | - T Fintan Moriarty
- AO Research Institute Davos, AO Foundation, Clavadelerstrasse 8, Davos Platz CH7270, Switzerland.
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Dlaska CE, Andersson G, Brittberg M, Suedkamp NP, Raschke MJ, Schuetz MA. Clinical Translation in Tissue Engineering—The Surgeon’s View. ACTA ACUST UNITED AC 2015. [DOI: 10.1007/s40610-015-0013-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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105
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Qin H, Zhao Y, An Z, Cheng M, Wang Q, Cheng T, Wang Q, Wang J, Jiang Y, Zhang X, Yuan G. Enhanced antibacterial properties, biocompatibility, and corrosion resistance of degradable Mg-Nd-Zn-Zr alloy. Biomaterials 2015; 53:211-20. [PMID: 25890720 DOI: 10.1016/j.biomaterials.2015.02.096] [Citation(s) in RCA: 91] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2014] [Revised: 02/15/2015] [Accepted: 02/21/2015] [Indexed: 12/28/2022]
Abstract
Magnesium (Mg), a potential biodegradable material, has recently received increasing attention due to its unique antibacterial property. However, rapid corrosion in the physiological environment and potential toxicity limit clinical applications. In order to improve the corrosion resistance meanwhile not compromise the antibacterial activity, a novel Mg alloy, Mg-Nd-Zn-Zr (Hereafter, denoted as JDBM), is fabricated by alloying with neodymium (Nd), zinc (Zn), zirconium (Zr). pH value, Mg ion concentration, corrosion rate and electrochemical test show that the corrosion resistance of JDBM is enhanced. A systematic investigation of the in vitro and in vivo antibacterial capability of JDBM is performed. The results of microbiological counting, CLSM, SEM in vitro, and microbiological cultures, histopathology in vivo consistently show JDBM enhanced the antibacterial activity. In addition, the significantly improved cytocompatibility is observed from JDBM. The results suggest that JDBM effectively enhances the corrosion resistance, biocompatibility and antimicrobial properties of Mg by alloying with the proper amount of Zn, Zr and Nd.
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Affiliation(s)
- Hui Qin
- Department of Orthopedics, Shanghai Sixth People's Hospital, Shanghai Jiao Tong University, Shanghai 200233, China
| | - Yaochao Zhao
- Department of Orthopedics, Shanghai Sixth People's Hospital, Shanghai Jiao Tong University, Shanghai 200233, China
| | - Zhiquan An
- Department of Orthopedics, Shanghai Sixth People's Hospital, Shanghai Jiao Tong University, Shanghai 200233, China
| | - Mengqi Cheng
- Department of Orthopedics, Shanghai Sixth People's Hospital, Shanghai Jiao Tong University, Shanghai 200233, China
| | - Qi Wang
- Department of Orthopedics, Shanghai Sixth People's Hospital, Shanghai Jiao Tong University, Shanghai 200233, China
| | - Tao Cheng
- Department of Orthopedics, Shanghai Sixth People's Hospital, Shanghai Jiao Tong University, Shanghai 200233, China
| | - Qiaojie Wang
- Department of Orthopedics, Shanghai Sixth People's Hospital, Shanghai Jiao Tong University, Shanghai 200233, China
| | - Jiaxing Wang
- Department of Orthopedics, Shanghai Sixth People's Hospital, Shanghai Jiao Tong University, Shanghai 200233, China
| | - Yao Jiang
- Department of Orthopedics, Shanghai Sixth People's Hospital, Shanghai Jiao Tong University, Shanghai 200233, China.
| | - Xianlong Zhang
- Department of Orthopedics, Shanghai Sixth People's Hospital, Shanghai Jiao Tong University, Shanghai 200233, China.
| | - Guangyin Yuan
- National Engineering Research Center of Light Alloys Net Forming, Shanghai Jiao Tong University, Shanghai 200240, China; State Key Laboratory of Metal Matrix Composite, Shanghai Jiao Tong University, Shanghai 200240, China.
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106
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Tran N, Kelley MN, Tran PA, Garcia DR, Jarrell JD, Hayda RA, Born CT. Silver doped titanium oxide-PDMS hybrid coating inhibits Staphylococcus aureus and Staphylococcus epidermidis growth on PEEK. MATERIALS SCIENCE & ENGINEERING. C, MATERIALS FOR BIOLOGICAL APPLICATIONS 2014; 49:201-209. [PMID: 25686940 DOI: 10.1016/j.msec.2014.12.072] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/16/2014] [Revised: 11/18/2014] [Accepted: 12/20/2014] [Indexed: 02/08/2023]
Abstract
Bacterial infection remains one of the most serious issues affecting the successful installation and retention of orthopedic implants. Many bacteria develop resistance to current antibiotics, which complicates or prevents traditional antibiotic-dependent eradication therapy. In this study, a hybrid coating of titanium dioxide and polydimethylsiloxane (PDMS) was synthesized to regulate the release of silver. The coatings were benefited from the antimicrobial activity of silver ion, the biocompatibility of titanium dioxide, and the flexibility of the polymer. Three studied silver doped coatings with different titanium dioxide-PDMS ratios effectively inhibited the attachment and growth of Staphylococcus aureus and Staphylococcus epidermidis in a dose-dependent manner. The coatings were successfully applied on the discs of polyether ether ketone (PEEK), a common spinal implant material and antibacterial property of these coatings was assessed via Kirby Bauer assay. More importantly, these selected coatings completely inhibited biofilm formation. The release study demonstrated that the release rate of silver from the coating depended on doping levels and also the ratios of titanium dioxide and PDMS. This result is crucial for designing coatings with desired silver release rate on PEEK materials for antimicrobial applications.
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Affiliation(s)
- Nhiem Tran
- Department of Orthopaedic Surgery, Alpert Medical School, Brown University, Providence, RI, USA; Weiss Center for Orthopaedic Trauma Research, Rhode Island Hospital, Providence, RI, USA
| | - Michael N Kelley
- Department of Orthopaedic Surgery, Alpert Medical School, Brown University, Providence, RI, USA; Weiss Center for Orthopaedic Trauma Research, Rhode Island Hospital, Providence, RI, USA
| | - Phong A Tran
- Department of Orthopaedic Surgery, Alpert Medical School, Brown University, Providence, RI, USA; Weiss Center for Orthopaedic Trauma Research, Rhode Island Hospital, Providence, RI, USA
| | - Dioscaris R Garcia
- Department of Orthopaedic Surgery, Alpert Medical School, Brown University, Providence, RI, USA; Weiss Center for Orthopaedic Trauma Research, Rhode Island Hospital, Providence, RI, USA
| | - John D Jarrell
- Department of Orthopaedic Surgery, Alpert Medical School, Brown University, Providence, RI, USA; BioIntraface Inc., North Kingstown, RI, USA
| | - Roman A Hayda
- Department of Orthopaedic Surgery, Alpert Medical School, Brown University, Providence, RI, USA; Weiss Center for Orthopaedic Trauma Research, Rhode Island Hospital, Providence, RI, USA
| | - Christopher T Born
- Department of Orthopaedic Surgery, Alpert Medical School, Brown University, Providence, RI, USA; Weiss Center for Orthopaedic Trauma Research, Rhode Island Hospital, Providence, RI, USA; BioIntraface Inc., North Kingstown, RI, USA.
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107
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Kankilic B, Bilgic E, Korkusuz P, Korkusuz F. Vancomycin containing PLLA/β-TCP controls experimental osteomyelitis in vivo. J Orthop Surg Res 2014; 9:114. [PMID: 25407446 PMCID: PMC4243329 DOI: 10.1186/s13018-014-0114-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2014] [Accepted: 10/31/2014] [Indexed: 11/10/2022] Open
Abstract
Background Implant-related osteomyelitis (IRO) is recently controlled with local antibiotic delivery systems to overcome conventional therapy disadvantages. In vivo evaluation of such systems is however too little. Questions/purposes We asked whether vancomycin (V)-containing poly-l-lactic acid/β-tricalcium phosphate (PLLA/β-TCP) composites control experimental IRO and promote bone healing in vivo. Methods Fifty-six rats were distributed to five groups in this longitudinal controlled study. Experimental IRO was established at tibiae by injecting methicillin-resistant Staphylococcus aureus (MRSA) suspensions with titanium particles in 32 rats. Vancomycin-free PLLA/β-TCP composites were implanted into the normal and infected tibiae, whereas V-PLLA/β-TCP composites and coated (C)-V-PLLA/β-TCP composites were implanted into IRO sites. Sham-operated tibiae established the control group. Radiological and histological scores were quantified with microbiological findings on weeks 1 and 6. Results IRO is resolved in the CV- and the V-PLLA/β-TCP groups but not in the PLLA/β-TCP group. MRSA was not isolated in the CV- and the V-PLLA/β-TCP groups at all times whereas the bacteria were present in the PLLA/β-TCP group. Radiological signs secondary to infection are improved from 10.9 ± 0.9 to 3.0 ± 0.3 in the V-PLLA/β-TCP group but remained constant in the PLLA/β-TCP group. Histology scores are improved from 24.7 ± 6.5 to 17.6 ± 4.8 and from 27.6 ± 7.9 to 32.4 ± 8.9 in the CV-PLLA/β-TCP and the V-PLLA/β-TCP groups, respectively. New bone was formed in all the PLLA/β-TCP group at weeks 1 and 6. Conclusions CV- and V-PLLA/β-TCP composites controlled experimental IRO and promoted bone healing. Clinical relevance CV- and V-PLLA/β-TCP composites have the potential of controlling experimental IRO and promoting bone healing.
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Affiliation(s)
- Berna Kankilic
- Department of Biotechnology, Institute of Applied Sciences, Middle East Technical University, Çankaya, Ankara, 06800, Turkey.
| | - Elif Bilgic
- Department of Histology and Embryology, Hacettepe University Faculty of Medicine, Sihhiye, Ankara, 06100, Turkey.
| | - Petek Korkusuz
- Department of Histology and Embryology, Hacettepe University Faculty of Medicine, Sihhiye, Ankara, 06100, Turkey.
| | - Feza Korkusuz
- Department of Sports Medicine, Hacettepe University Faculty of Medicine, Sihhiye, Ankara, 06100, Turkey.
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108
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Fölsch C, Federmann M, Kuehn KD, Kittinger C, Kogler S, Zarfel G, Kerwat M, Braun S, Fuchs-Winkelmann S, Paletta JRJ, Roessler PP. Coating with a novel gentamicinpalmitate formulation prevents implant-associated osteomyelitis induced by methicillin-susceptible Staphylococcus aureus in a rat model. INTERNATIONAL ORTHOPAEDICS 2014; 39:981-8. [PMID: 25380688 DOI: 10.1007/s00264-014-2582-9] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/21/2014] [Accepted: 10/22/2014] [Indexed: 02/06/2023]
Abstract
PURPOSE Implant-associated osteomyelitis still represents a demanding challenge due to unfavourable biological conditions, bacterial properties and incremental resistance to antibiotic treatment. Therefore different bactericide or bacteriostatic implant coatings have been developed recently to control local intramedullary infections. Controlled local release of gentamicin base from a highly lipophilic gentamicin palmitate compound achieves extended intramedullary retention times and thus may improve its bactericide effect. METHODS Forty male Sprague-Dawley rats were divided into two groups receiving an intramedullary femoral injection of 10(2) colony-forming units (CFU) of a common methicillin susceptible Staphylococcus aureus strain (MSSA Rosenbach) and either an uncoated femur nail (Group I) or a nail coated with gentamicin palmitate (Group II). Animals were observed for 28 and 42 days. Serum haptoglobin and relative weight gain were assessed as well as rollover cultures of explanted femur nails and histological scores of periprosthetic infection in dissected femurs. RESULTS Implants coated with gentamicin palmitate significantly reduced periprosthetic bacterial growth as well as signs of systemic inflammation compared with uncoated implants. CONCLUSIONS Gentamicin palmitate appears to be a viable coating for the prevention of implant-associated infections. These findings will have to be confirmed in larger animal models as well as in clinical trials.
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Affiliation(s)
- Christian Fölsch
- Department of Orthopaedics and Rheumatology, University Hospital Marburg, Marburg, Germany
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109
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Antimicrobial GL13K peptide coatings killed and ruptured the wall of Streptococcus gordonii and prevented formation and growth of biofilms. PLoS One 2014; 9:e111579. [PMID: 25372402 PMCID: PMC4221044 DOI: 10.1371/journal.pone.0111579] [Citation(s) in RCA: 76] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2014] [Accepted: 10/06/2014] [Indexed: 12/14/2022] Open
Abstract
Infection is one of the most prevalent causes for dental implant failure. We have developed a novel antimicrobial peptide coating on titanium by immobilizing the antimicrobial peptide GL13K. GL13K was developed from the human salivary protein BPIFA2. The peptide exhibited MIC of 8 µg/ml against planktonic Pseudonomas aeruginosa and their biofilms were reduced by three orders of magnitude with 100 µg/ml GL13K. This peptide concentration also killed 100% of Streptococcus gordonii. At 1 mg/ml, GL13K caused less than 10% lysis of human red blood cells, suggesting low toxicity to mammalian cells. Our GL13K coating has also previously showed bactericidal effect and inhibition of biofilm growth against peri-implantitis related pathogens, such as Porphyromonas gingivalis. The GL13K coating was cytocompatible with human fibroblasts and osteoblasts. However, the bioactivity of antimicrobial coatings has been commonly tested under (quasi)static culture conditions that are far from simulating conditions for biofilm formation and growth in the oral cavity. Oral salivary flow over a coating is persistent, applies continuous shear forces, and supplies sustained nutrition to bacteria. This accelerates bacteria metabolism and biofilm growth. In this work, the antimicrobial effect of the coating was tested against Streptococcus gordonii, a primary colonizer that provides attachment for the biofilm accretion by P. gingivalis, using a drip-flow biofilm bioreactor with media flow rates simulating salivary flow. The GL13K peptide coatings killed bacteria and prevented formation and growth of S. gordonii biofilms in the drip-flow bioreactor and under regular mild-agitation conditions. Surprisingly the interaction of the bacteria with the GL13K peptide coatings ruptured the cell wall at their septum or polar areas leaving empty shell-like structures or exposed protoplasts. The cell wall rupture was not detected under regular culture conditions, suggesting that cell wall rupture induced by GL13K peptides also requires media flow and possible attendant biological sequelae of the conditions in the bioreactor.
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110
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Antibacterial properties of magnesium in vitro and in an in vivo model of implant-associated methicillin-resistant Staphylococcus aureus infection. Antimicrob Agents Chemother 2014; 58:7586-91. [PMID: 25288077 DOI: 10.1128/aac.03936-14] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Periprosthetic infection remains a challenging clinical complication. We investigated the antibacterial properties of pure (99.9%) magnesium (Mg) in vitro and in an in vivo rat model of implant-related infection. Mg was highly effective against methicillin-resistant Staphylococcus aureus-induced osteomyelitis and improved new peri-implant bone formation. Bacterial icaA and agr RNAIII transcription levels were also assessed to characterize the mechanism underlying the antibacterial properties of the Mg implant.
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111
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Alt V, Kirchhof K, Seim F, Hrubesch I, Lips KS, Mannel H, Domann E, Schnettler R. Rifampicin-fosfomycin coating for cementless endoprostheses: antimicrobial effects against methicillin-sensitive Staphylococcus aureus (MSSA) and methicillin-resistant Staphylococcus aureus (MRSA). Acta Biomater 2014; 10:4518-24. [PMID: 24948548 DOI: 10.1016/j.actbio.2014.06.013] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2014] [Revised: 05/07/2014] [Accepted: 06/09/2014] [Indexed: 01/08/2023]
Abstract
New strategies to decrease infection rates in cementless arthroplasty are needed, especially in the context of the growing incidence of methicillin-resistant Staphylococcus aureus (MRSA) infections. The purpose of this study was to investigate the antimicrobial activity of a rifampicin-fosfomycin coating against methicillin-sensitive Staphylococcus aureus (MSSA) and MRSA in a rabbit infection prophylaxis model. Uncoated or rifampicin-fosfomycin-coated K-wires were inserted into the intramedullary canal of the tibia in rabbits and contaminated with an inoculation dose of 10(5) or 10(6) colony-forming units of MSSA EDCC 5055 in study 1 and MRSA T6625930 in study 2, respectively. After 28days the animals were killed and clinical, histological and microbiological assessment, including pulse-field gel electrophoresis, was conducted. Positive culture growth in agar plate testing and/or clinical signs and/or histological signs were defined positive for infection. Statistical evaluation was performed using Fisher's exact test. Both studies showed a statistically significant reduction of infection rates for rifampicin-fosfomycin-coated implants compared to uncoated K-wires (P=0.015). In both studies none of the 12 animals that were treated with a rifampicin-fosfomycin-coated implant showed clinical signs of infection or a positive agar plate testing result. In both studies, one animal of the coating group showed the presence of sporadic bacteria with concomitant inflammatory signs in histology. The control groups in both studies exhibited an infection rate of 100% with clear clinical signs of infection and positive culture growth in all animals. In summary, the rifampicin-fosfomycin-coating showed excellent antimicrobial activity against both MSSA and MRSA, and therefore warrants further clinical testing.
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112
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Morawska-Chochół A, Domalik-Pyzik P, Chłopek J, Szaraniec B, Sterna J, Rzewuska M, Boguń M, Kucharski R, Mielczarek P. Gentamicin release from biodegradable poly-l-lactide based composites for novel intramedullary nails. MATERIALS SCIENCE & ENGINEERING. C, MATERIALS FOR BIOLOGICAL APPLICATIONS 2014; 45:15-20. [PMID: 25491796 DOI: 10.1016/j.msec.2014.08.059] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/16/2014] [Revised: 07/18/2014] [Accepted: 08/29/2014] [Indexed: 11/26/2022]
Abstract
One of the major problems in orthopedic surgery is infection associated with implantation. The treatment is a very difficult and long-term process. A solution to this issue can be the use of implants which additionally constitute an antibiotic carrier preventing the development of an infection. Prototypes of biodegradable intramedullary nails made of three different composites with a poly(L-lactide) matrix were designed. The nails served as gentamicin sulfate (GS) carrier - an antibiotic commonly used in the treatment of osteomyelitis. The matrix was reinforced with carbon fibers (CF), alginate fibers (Alg) and magnesium alloy wires (Mg), as well as modified with bioactive particles of tricalcium phosphate (TCP) in various systems. In this way, novel, multi-phase and multifunctional degradable intramedullary nails were obtained. The tests demonstrated strong dependence between the type of the modifying phase introduced into the composite, and the rate of drug release. Introduction of gentamicin into the nail structure strengthened and prolonged antibacterial activity of the nails.
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Affiliation(s)
- Anna Morawska-Chochół
- AGH University of Science and Technology, Faculty of Materials Science and Ceramics, Department of Biomaterials, al. A. Mickiewicza 30, 30-059 Krakow, Poland.
| | - Patrycja Domalik-Pyzik
- AGH University of Science and Technology, Faculty of Materials Science and Ceramics, Department of Biomaterials, al. A. Mickiewicza 30, 30-059 Krakow, Poland
| | - Jan Chłopek
- AGH University of Science and Technology, Faculty of Materials Science and Ceramics, Department of Biomaterials, al. A. Mickiewicza 30, 30-059 Krakow, Poland
| | - Barbara Szaraniec
- AGH University of Science and Technology, Faculty of Materials Science and Ceramics, Department of Biomaterials, al. A. Mickiewicza 30, 30-059 Krakow, Poland
| | - Jacek Sterna
- Warsaw University of Life Sciences - SGGW, Faculty of Veterinary Medicine, Department of Small Animal Diseases with Clinic, ul. Nowoursynowska 159c, 02-776 Warszawa, Poland
| | - Magdalena Rzewuska
- Warsaw University of Life Sciences - SGGW, Faculty of Veterinary Medicine, Department of Preclinical Sciences, ul. Ciszewskiego 8, 02-786 Warszawa, Poland
| | - Maciej Boguń
- Lodz University of Technology, Faculty of Material Technologies and Textile Design, Department of Material and Commodity Sciences and Textile Metrology, ul. Żeromskiego 116, 90-924 Lodz, Poland
| | - Rafael Kucharski
- CJS Sp. z o. o., Gen. Jankego 134/1, 40-617 Katowice, Poland; IEE Group, Hannover, Germany
| | - Przemysław Mielczarek
- AGH University of Science and Technology, Faculty of Materials Science and Ceramics, Department of Biochemistry and Neurobiology, al. A. Mickiewicza 30, 30-059 Krakow, Poland
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Qin H, Cao H, Zhao Y, Zhu C, Cheng T, Wang Q, Peng X, Cheng M, Wang J, Jin G, Jiang Y, Zhang X, Liu X, Chu PK. In vitro and in vivo anti-biofilm effects of silver nanoparticles immobilized on titanium. Biomaterials 2014; 35:9114-25. [PMID: 25112937 DOI: 10.1016/j.biomaterials.2014.07.040] [Citation(s) in RCA: 185] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2014] [Accepted: 07/23/2014] [Indexed: 01/09/2023]
Abstract
Prevention of periprosthetic infection (PPI) by inhibiting biofilm formation on prostheses is crucial to orthopedic surgery. In this work, silver nanoparticles (Ag NPs) are fabricated in situ and immobilized on titanium by silver plasma immersion ion implantation (PIII). The anti-biofilm activity rendered by the immobilized Ag NPs is assessed using Staphylococcus epidermidis, a biofilm producing strain, in vitro and in vivo. The immobilized Ag NPs show no apparent cytotoxicity but reduce biofilm formation in vitro by inhibiting bacteria adhesion and icaAD transcription. The immobilized Ag NPs offer a good defense against multiple cycles of bacteria attack in vitro, and the mechanism is independent of silver release. Radiographic assessment, microbiological cultures, and histopathological results demonstrate the ability of the functionalized surface against bacterial infection to reduce the risk of implant-associated PPI.
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Affiliation(s)
- Hui Qin
- Department of Orthopedics, Shanghai Sixth People's Hospital, Shanghai Jiao Tong University, Shanghai 200233, China
| | - Huiliang Cao
- State Key Laboratory of High Performance Ceramics and Superfine Microstructure, Shanghai Institute of Ceramics, Chinese Academy of Sciences, Shanghai 200050, China
| | - Yaochao Zhao
- Department of Orthopedics, Shanghai Sixth People's Hospital, Shanghai Jiao Tong University, Shanghai 200233, China
| | - Cheng Zhu
- Department of Orthopedics, Shanghai Sixth People's Hospital, Shanghai Jiao Tong University, Shanghai 200233, China
| | - Tao Cheng
- Department of Orthopedics, Shanghai Sixth People's Hospital, Shanghai Jiao Tong University, Shanghai 200233, China
| | - Qiaojie Wang
- Department of Orthopedics, Shanghai Sixth People's Hospital, Shanghai Jiao Tong University, Shanghai 200233, China
| | - Xiaochun Peng
- Department of Orthopedics, Shanghai Sixth People's Hospital, Shanghai Jiao Tong University, Shanghai 200233, China
| | - Mengqi Cheng
- Department of Orthopedics, Shanghai Sixth People's Hospital, Shanghai Jiao Tong University, Shanghai 200233, China
| | - Jiaxin Wang
- Department of Orthopedics, Shanghai Sixth People's Hospital, Shanghai Jiao Tong University, Shanghai 200233, China
| | - Guodong Jin
- State Key Laboratory of High Performance Ceramics and Superfine Microstructure, Shanghai Institute of Ceramics, Chinese Academy of Sciences, Shanghai 200050, China
| | - Yao Jiang
- Department of Orthopedics, Shanghai Sixth People's Hospital, Shanghai Jiao Tong University, Shanghai 200233, China
| | - Xianlong Zhang
- Department of Orthopedics, Shanghai Sixth People's Hospital, Shanghai Jiao Tong University, Shanghai 200233, China.
| | - Xuanyong Liu
- State Key Laboratory of High Performance Ceramics and Superfine Microstructure, Shanghai Institute of Ceramics, Chinese Academy of Sciences, Shanghai 200050, China.
| | - Paul K Chu
- Department of Physics & Materials Science, City University of Hong Kong, Tat Chee Avenue, Kowloon, Hong Kong, China
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In vivo effect of quaternized chitosan-loaded polymethylmethacrylate bone cement on methicillin-resistant Staphylococcus epidermidis infection of the tibial metaphysis in a rabbit model. Antimicrob Agents Chemother 2014; 58:6016-23. [PMID: 25070107 DOI: 10.1128/aac.03489-14] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Infection of open tibial fractures with contamination remains a challenge for orthopedic surgeons. Local use of antibiotic-impregnated polymethylmethacrylate (PMMA) beads and blocks is a widely used procedure to reduce the risk of infection. However, the development of antibiotic-resistant organisms make the management of infection more difficult. Our in vitro study demonstrated that quaternized chitosan (hydroxypropyltrimethyl ammonium chloride chitosan [HACC])-loaded PMMA bone cement exhibits strong antibacterial activity toward antibiotic-resistant bacteria. Therefore, the present study aimed to investigate the in vivo antibacterial activity of quaternized chitosan-loaded PMMA. Twenty-four adult female New Zealand White rabbits were used in this study. The right proximal tibial metaphyseal cavity was prepared, 10(7) CFU of methicillin-resistant Staphylococcus epidermidis was inoculated, and PMMA-only, gentamicin-loaded PMMA (PMMA-G), chitosan-loaded PMMA (PMMA-C), or HACC-loaded PMMA (PMMA-H) bone cement cylinders were inserted. During the follow-up period, the infections were evaluated using X rays on days 21 and 42 and histopathological and microbiological analyses on day 42 after surgery. Radiographic indications of bone infections, including bone lysis, periosteal reactions, cyst formation, and sequestral bone formation, were evident in the PMMA, PMMA-G, and PMMA-C groups but not in the PMMA-H group. The radiographic scores and gross bone pathological and histopathological scores were significantly lower in the PMMA-H group than in the PMMA, PMMA-G, and PMMA-C groups (P < 0.05). Explant cultures also indicated significantly less bacterial growth in the PMMA-H group than in the PMMA, PMMA-G, and PMMA-C groups (P < 0.01). We concluded that PMMA-H bone cement can inhibit the development of bone infections in this animal model inoculated with antibiotic-resistant bacteria, thereby demonstrating its potential application for treatment of local infections in open fractures.
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Synergistic effects of dual Zn/Ag ion implantation in osteogenic activity and antibacterial ability of titanium. Biomaterials 2014; 35:7699-713. [PMID: 24947228 DOI: 10.1016/j.biomaterials.2014.05.074] [Citation(s) in RCA: 230] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2014] [Accepted: 05/25/2014] [Indexed: 01/01/2023]
Abstract
Zinc (Zn) and silver (Ag) are co-implanted into titanium by plasma immersion ion implantation. A Zn containing film with Ag nanoparticles (Ag NPs) possessing a wide size distribution is formed on the surface and the corrosion resistance is improved due to the micro-galvanic couples formed by the implanted Zn and Ag. Not only are the initial adhesion, spreading, proliferation and osteogenic differentiation of rBMSCs observed from the Zn/Ag implanted Ti in vitro, but also bacteria killing is achieved both in vitro and in vivo. Electrochemical polarization and ion release measurements suggest that the excellent osteogenic activity and antibacterial ability of the Zn/Ag co-implanted titanium are related to the synergistic effect resulting from the long-range interactions of the released Zn ions and short-range interactions of the embedded Ag NPs. The Zn/Ag co-implanted titanium offers both excellent osteogenic activity and antibacterial ability and has large potential in orthopedic and dental implants.
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Shirai T, Tsuchiya H, Nishida H, Yamamoto N, Watanabe K, Nakase J, Terauchi R, Arai Y, Fujiwara H, Kubo T. Antimicrobial megaprostheses supported with iodine. J Biomater Appl 2014; 29:617-23. [PMID: 24913616 DOI: 10.1177/0885328214539365] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Deep infection associated with implants remains a serious complication of orthopedic surgery. We developed iodine coating for titanium implants. In this study, we performed a clinical trial of iodine-coated megaprostheses to evaluate its safety and antibacterial effects. Forty-seven patients with malignant bone tumor or pyogenic arthritis were treated using iodine-supported titanium megaprostheses between July 2008 and May 2013. The mean age was 53.6 years (range, 15-85 years). Twenty-six patients were males and 21 were females. The diagnoses included malignant bone tumor in 29 cases, infected total knee arthroplasty in 11 cases, chronic osteomyelitis due to pyogenic arthritis in six cases and loosening of total knee arthroplasty in one case. The iodine-supported implants used were 42 Kyocera Limb Salvage System and five KOBELCO K-MAX K-3. These megaprostheses were used to prevent infection in 21 patients, treat active infections in 26 patients. The mean follow-up period was 30.1 months (range, 8-50). Infection was prevented in 20 out of 21 patients. Only one patient had surgical site infection caused by Pseudomonas aeruginosa and was cured by intravenous administration of antibiotics alone without removal of the implant. In 26 treatment cases involving one- or two-stage revision surgery, infection subsided without any additional surgery. In all cases, there were no signs of infection at the time of the last follow-up. White blood cell and C-reactive protein levels returned to normal within four weeks after surgery. To confirm systemic effects of iodine, thyroid hormone levels in the blood were examined. Abnormalities of thyroid gland function were not detected. Loosening of the implants was not observed. Excellent bone ingrowth and ongrowth were found around iodine-supported megaprostheses. The iodine-supported titanium megaprostheses are highly effective and show promise for the prevention and treatment of infections in large bone defects. No cytotoxicity or adverse effects were detected with this treatment.
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Affiliation(s)
- Toshiharu Shirai
- Department of Orthopaedic Surgery, Graduate School of Medical Science, Kanazawa University, Kanazawa, Japan Department of Orthopaedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, Japan
| | - Hiroyuki Tsuchiya
- Department of Orthopaedic Surgery, Graduate School of Medical Science, Kanazawa University, Kanazawa, Japan
| | - Hideji Nishida
- Department of Orthopaedic Surgery, Graduate School of Medical Science, Kanazawa University, Kanazawa, Japan
| | - Norio Yamamoto
- Department of Orthopaedic Surgery, Graduate School of Medical Science, Kanazawa University, Kanazawa, Japan
| | - Koji Watanabe
- Department of Orthopaedic Surgery, Graduate School of Medical Science, Kanazawa University, Kanazawa, Japan
| | - Junsuke Nakase
- Department of Orthopaedic Surgery, Graduate School of Medical Science, Kanazawa University, Kanazawa, Japan
| | - Ryu Terauchi
- Department of Orthopaedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, Japan
| | - Yuji Arai
- Department of Orthopaedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, Japan
| | - Hiroyoshi Fujiwara
- Department of Orthopaedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, Japan
| | - Toshikazu Kubo
- Department of Orthopaedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, Japan
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Mattioli-Belmonte M, Cometa S, Ferretti C, Iatta R, Trapani A, Ceci E, Falconi M, De Giglio E. Characterization and cytocompatibility of an antibiotic/chitosan/cyclodextrins nanocoating on titanium implants. Carbohydr Polym 2014; 110:173-82. [PMID: 24906744 DOI: 10.1016/j.carbpol.2014.03.097] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2013] [Revised: 03/24/2014] [Accepted: 03/26/2014] [Indexed: 10/25/2022]
Abstract
A novel ciprofloxacin loaded chitosan nanoparticle-based coating onto titanium substrates has been developed and characterized to obtain an orthopaedic implant surface able to in situ release the antibiotic for the prevention of post-operative infections. Ciprofloxacin loaded chitosan nanoparticles were obtained using the combination of sulfobutyl ether-beta-cyclodextrin and gamma-cyclodextrin. The resulting nanoparticulate system was characterized by TEM, HPLC and XPS. Particle size was in the range 426-552 nm and zeta potential values were around +30 mV. This antibacterial coating was able to in vitro inhibit two nosocomial Staphylococcus aureus strains growth, with a reduction of about 20 times compared to controls. No impairment in MG63 osteoblast-like cells viability, adhesion and gene expression were detected at 48 h, 7 and 14 days of culture. Overall, the investigated coating represents a promising candidate for the development of a new antibiotic carrier for titanium implants.
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Affiliation(s)
- Monica Mattioli-Belmonte
- Department of Clinical and Molecular Sciences, Università Politecnica delle Marche, Via Tronto 10/A, 60126 Ancona, Italy.
| | | | - Concetta Ferretti
- Department of Clinical and Molecular Sciences, Università Politecnica delle Marche, Via Tronto 10/A, 60126 Ancona, Italy.
| | - Roberta Iatta
- Department of Veterinary Medicine, University of Bari Aldo Moro, Str. Prov. per Casamassima Km 3, Valenzano (BA), Italy.
| | - Adriana Trapani
- Department of Pharmacy-Drug Sciences, University of Bari Aldo Moro, Via E. Orabona 4, 70126 Bari, Italy.
| | - Edmondo Ceci
- Department of Veterinary Medicine, University of Bari Aldo Moro, Str. Prov. per Casamassima Km 3, Valenzano (BA), Italy.
| | - Mirella Falconi
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Via Irnerio 48, 40126 Bologna, Italy.
| | - Elvira De Giglio
- Department of Chemistry, University of Bari Aldo Moro, Via E. Orabona 4, 70126 Bari, Italy.
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Reizner W, Hunter J, O’Malley N, Southgate R, Schwarz E, Kates S. A systematic review of animal models for Staphylococcus aureus osteomyelitis. Eur Cell Mater 2014; 27:196-212. [PMID: 24668594 PMCID: PMC4322679 DOI: 10.22203/ecm.v027a15] [Citation(s) in RCA: 87] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
Staphylococcus aureus (S. aureus) osteomyelitis is a significant complication for orthopaedic patients undergoing surgery, particularly with fracture fixation and arthroplasty. Given the difficulty in studying S. aureus infections in human subjects, animal models serve an integral role in exploring the pathogenesis of osteomyelitis, and aid in determining the efficacy of prophylactic and therapeutic treatments. Animal models should mimic the clinical scenarios seen in patients as closely as possible to permit the experimental results to be translated to the corresponding clinical care. To help understand existing animal models of S. aureus, we conducted a systematic search of PubMed and Ovid MEDLINE to identify in vivo animal experiments that have investigated the management of S. aureus osteomyelitis in the context of fractures and metallic implants. In this review, experimental studies are categorised by animal species and are further classified by the setting of the infection. Study methods are summarised and the relevant advantages and disadvantages of each species and model are discussed. While no ideal animal model exists, the understanding of a model's strengths and limitations should assist clinicians and researchers to appropriately select an animal model to translate the conclusions to the clinical setting.
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Affiliation(s)
| | | | | | | | | | - S.L. Kates
- Address for correspondence: Stephen L. Kates, 601 Elmwood Ave, Box 665, Rochester, NY 14642, USA,
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119
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Kaur S, Harjai K, Chhibber S. Local delivery of linezolid from poly-D,L-lactide (PDLLA)-linezolid-coated orthopaedic implants to prevent MRSA mediated post-arthroplasty infections. Diagn Microbiol Infect Dis 2014; 79:387-92. [PMID: 24809862 DOI: 10.1016/j.diagmicrobio.2014.01.026] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2013] [Revised: 11/25/2013] [Accepted: 01/27/2014] [Indexed: 10/25/2022]
Abstract
The present study focuses on the use of linezolid as local delivery agent for direct administration of the drug at the orthopaedic implant site. Local drug delivery system with linezolid added to the Poly D, L-(Lactide) polymer solution was used to coat the orthopaedic grade K-wires. Bacterial adherence on K-wires was then determined to evaluate the effect of the coated drug on the adherence of MRSA. A significant decrease in bacterial adherence as compared to naked wires was observed on all the coated K-wires (2.5, 5 and 10% w/w linezolid coated) with maximum decrease of 60%. This represents an aggressive early approach to prevent initial adherence of bacterial population. With the rise in MRSA mediated orthopaedic device related infections, the use of linezolid loaded polymer coated implants is definitely an attractive strategy against drug resistant strains of S. aureus.
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Affiliation(s)
- Sandeep Kaur
- Department of Microbiology, Panjab University, Chandigarh 160014, India
| | - Kusum Harjai
- Department of Microbiology, Panjab University, Chandigarh 160014, India
| | - Sanjay Chhibber
- Department of Microbiology, Panjab University, Chandigarh 160014, India.
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120
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Lyndon JA, Boyd BJ, Birbilis N. Metallic implant drug/device combinations for controlled drug release in orthopaedic applications. J Control Release 2014; 179:63-75. [PMID: 24512924 DOI: 10.1016/j.jconrel.2014.01.026] [Citation(s) in RCA: 87] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2013] [Revised: 01/25/2014] [Accepted: 01/27/2014] [Indexed: 10/25/2022]
Abstract
The study of metallic drug/device combinations for controlled drug release in orthopaedic applications has gained significant momentum in the past decade, particularly for the prevention and reduction of implant associated infection. Such combinations are commonly based upon a permanent metallic implant (such as stainless steel or titanium) and are then coated with a drug-eluting polymer or ceramic system. Drug elution is also possible from the implant itself by utilising metallic foams, porous architectures and bioresorbable metals. This review will explore the current research into metallic implant drug/device combinations via a critical review of the relevant literature.
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Affiliation(s)
- Jessica A Lyndon
- Department of Materials Engineering, Monash University, Wellington Road, Clayton, Victoria 3800, Australia
| | - Ben J Boyd
- Drug Delivery, Disposition and Dynamics, Monash institute of Pharmaceutical Sciences, Monash University Parkville Campus, 381 Royal Pde, Parkville, Victoria 3052, Australia
| | - Nick Birbilis
- Department of Materials Engineering, Monash University, Wellington Road, Clayton, Victoria 3800, Australia.
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121
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Jennison T, McNally M, Pandit H. Prevention of infection in external fixator pin sites. Acta Biomater 2014; 10:595-603. [PMID: 24076071 DOI: 10.1016/j.actbio.2013.09.019] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2013] [Revised: 09/15/2013] [Accepted: 09/18/2013] [Indexed: 12/19/2022]
Abstract
Infection in external fixator pins is known to be a significant problem, with incidences between 3% and 80% reported in the literature. An infection occurs when planktonic bacteria adhere to external fixator pins and subsequently produce a biofilm which protects the bacteria from host defences. The most commonly implicated organisms are Staphylococcus aureus and Staphylococcus epidermidis. Once an infection occurs, treatment is difficult. Systemic antibiotics have limited benefits and considerable side-effects. The only definitive management is removal of the pin. This review will consider the current and potential future strategies for reducing pin site infection. Techniques to prevent infection must prevent bacterial adhesion, allow good osteointegration and have a low toxicity. Current areas of interest reviewed are titanium-copper alloys, nanosilver coatings, nitric oxide coatings, chitosan coatings, chlorhexidine and iodine, hydroxyapatite and antibiotic coatings. At present there is no consensus on the prevention of pin site infection, and there is a paucity of randomized controlled trials on which to draw a conclusion. Whilst a number of these strategies have potential future use, many of the above strategies need further studies in animal models to ensure no cytotoxicity and prevention of osteointegration. Following this, well-designed randomized controlled clinical trials are required to give future ways to prevent external fixator pin site infections.
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122
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Zhu C, Wang J, Cheng T, Li Q, Shen H, Qin H, Cheng M, Zhang X. The potential role of increasing the release of mouse β- defensin-14 in the treatment of osteomyelitis in mice: a primary study. PLoS One 2014; 9:e86874. [PMID: 24489798 PMCID: PMC3904979 DOI: 10.1371/journal.pone.0086874] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2013] [Accepted: 12/17/2013] [Indexed: 11/18/2022] Open
Abstract
Mammalian β-defensins are small cationic peptides that have been implicated in mediating innate immune defenses against microbial infection. Mouse β-defensin-14 (MBD-14), based on structural and functional similarities, appears to be an ortholog of human β-defensin-3 (HBD-3). Previous studies identified signaling pathway p38 mitogen-activated protein kinase (MAPK) that contributed to the expression of MBD-14 in mouse osteoblasts upon contacted with methicillin-resistance Staphylococcus aureus (MRSA) supernatant, which provided a theoretical basis as a promising therapeutic target in the treatment of intramedullary infection with MRSA in vivo. In this study, the medullary cavities of tibiae were contaminated with MRSA 10(3) colony forming units and different doses of p38 MAPK agonists anisomycin were followed as group III or IV in 30 mice. Fifteen animals that received phosphate- buffered saline served as group II and 15 mice were not contaminated with MRSA and received phosphate-buffered saline served as controls (group I). Follow-up was 7 days. In day 1, day 4 and day 7 postoperatively, infection was evaluated by blood routine, microbiological and histological analyses after sacrifice. All animals of group II developed microbiological and histological signs of infection. Histological signs of infection, white blood counts and cultures of group III and IV showed significantly reduced bacterial growth compared to cultures of group II. Simultaneously, different doses of anisomycin significantly induced the expression of osteoblast-associated genes, including alkaline phosphatase, osteocalcin and collagen type I. In addition, the expression of HBD-3 in human interfacial membranes around infected periprosthetic joint by staphylococcus contaminated was evaluated, and the expression pattern changed with significant induction of HBD-3 in infected periprosthetic joint compared with aseptic loosening under inflammatory conditions. Our primary study indicated that the potential antibacterial role of increased MBD-14 in the osteomyelitis mouse model.
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Affiliation(s)
- Chen Zhu
- Department of Orthopaedic Surgery, Shanghai Sixth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Department of Orthopaedic Surgery, Anhui Provincial Hospital of Anhui Medical University, Hefei, China
| | - Jiaxing Wang
- Department of Orthopaedic Surgery, Shanghai Sixth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Tao Cheng
- Department of Orthopaedic Surgery, Shanghai Sixth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Qingtian Li
- Department of Medical Microbiology and Parasitology, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Hao Shen
- Department of Orthopaedic Surgery, Shanghai Sixth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Hui Qin
- Department of Orthopaedic Surgery, Shanghai Sixth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Mengqi Cheng
- Department of Orthopaedic Surgery, Shanghai Sixth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xianlong Zhang
- Department of Orthopaedic Surgery, Shanghai Sixth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- * E-mail:
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123
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Antimicrobial peptides. Pharmaceuticals (Basel) 2013; 6:1543-75. [PMID: 24287494 PMCID: PMC3873676 DOI: 10.3390/ph6121543] [Citation(s) in RCA: 835] [Impact Index Per Article: 75.9] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2013] [Revised: 11/21/2013] [Accepted: 11/25/2013] [Indexed: 12/20/2022] Open
Abstract
The rapid increase in drug-resistant infections has presented a serious challenge to antimicrobial therapies. The failure of the most potent antibiotics to kill “superbugs” emphasizes the urgent need to develop other control agents. Here we review the history and new development of antimicrobial peptides (AMPs), a growing class of natural and synthetic peptides with a wide spectrum of targets including viruses, bacteria, fungi, and parasites. We summarize the major types of AMPs, their modes of action, and the common mechanisms of AMP resistance. In addition, we discuss the principles for designing effective AMPs and the potential of using AMPs to control biofilms (multicellular structures of bacteria embedded in extracellular matrixes) and persister cells (dormant phenotypic variants of bacterial cells that are highly tolerant to antibiotics).
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124
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Fassbender M, Minkwitz S, Kronbach Z, Strobel C, Kadow-Romacker A, Schmidmaier G, Wildemann B. Local gentamicin application does not interfere with bone healing in a rat model. Bone 2013; 55:298-304. [PMID: 23631877 DOI: 10.1016/j.bone.2013.04.018] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2013] [Revised: 04/16/2013] [Accepted: 04/17/2013] [Indexed: 01/16/2023]
Abstract
For the prophylaxis and treatment of bony infections antibiotics are locally used. Since several decades antibiotics mixed with bone cement (methylmethacrylate) are successfully used in prosthetic surgery and a gentamicin coated tibial nail is approved in Europe for fracture stabilization. The goal of the present study was to investigate if gentamicin, locally applied from a polymeric coating of intramedullary nails, might interfere with the bone healing process. Female Sprague Dawley rats (n = 72) were used and the tibiae were intramedullary stabilized with Kirschner-wires (k-wires) after osteotomy. This model was established earlier and shows a delayed healing with a prolonged inflammatory reaction. The open approach is clinically more relevant compared to a closed one because it mimics the clinically critical case of an open fracture, which has a higher risk of infection. The k-wire was either coated with the polymer poly(d,l-lactide) (control group) or with 10% gentamicin incorporated into the polymer (gentamicin group). In vivo μCT analyses were performed at days 10, 28, 42, and 84 after osteotomy. Mechanical torsional testing and histological evaluation were done at the days of sacrifice: 28, 42, and 84. The μCT analyses revealed an increase in tissue mineral density (TMD) over the healing period in both groups. In the control group, the torsional stiffness and maximum load did not reach the values of the intact contralateral side at any time point. At day 84 the gentamicin treated tibiae, however, showed significantly better maximum load compared to the control group. The histology showed no bony bridging in the control, whereas in 2 of 5 calluses of the gentamicin group mineralized bridging occurred. Significantly more mineralized tissue was measured in the gentamicin group. This study shows that the local gentamicin application does not negatively interfere with the long term healing process. Local infection prophylaxis is effective without negative effects on bone healing.
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Affiliation(s)
- M Fassbender
- Julius Wolff Institute, Berlin-Brandenburg Center for Regenerative Therapies, Charité-Universitätsmedizin Berlin, Augustenburger Platz 1, 13353 Berlin, Germany.
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125
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Kumeria T, Gulati K, Santos A, Losic D. Real-time and in situ drug release monitoring from nanoporous implants under dynamic flow conditions by reflectometric interference spectroscopy. ACS APPLIED MATERIALS & INTERFACES 2013; 5:5436-5442. [PMID: 23731441 DOI: 10.1021/am4013984] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Herein, we present an innovative approach to monitoring in situ drug release under dynamic flow conditions from aluminum implants featuring nanoporous anodic alumina (NAA) covers used as a model of drug-releasing implants. In this method, reflectometric interference spectroscopy (RIfS) is used to monitor in real-time the diffusion of drug from these nanoporous implants. The release process is carried out in a microfluidic device, which makes it possible to analyze drug release under dynamic flow conditions with constant refreshing of eluting medium. This setup mimics the physiological conditions of biological milieu at the implant site inside the host body. The release of a model drug, indomethacin, is established by measuring the optical thickness change with time under four different flow rates (i.e. 0, 10, 30, and 50 μL min(-1)). The obtained data are fitted by a modified Higuchi model, confirming the diffusion-controlled release mechanism. The obtained release rate constants demonstrate that the drug release depends on the flow rate and the faster the flow rate the higher the drug release from the nanoporous covers. In particular, the rate constants increase from 2.23 ± 0.02 to 12.47 ± 0.04 μg min(-1/2) when the flow rate is increased from 10 to 50 μL min(-1), respectively. Therefore, this method provides more reliable and relevant information than conventional in vitro drug release methods performed under static conditions.
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Affiliation(s)
- Tushar Kumeria
- School of Chemical Engineering, The University of Adelaide, Adelaide, SA 5005, Australia
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Sanders D, Lambie J, Bond P, Moate R, Steer JA. An in vitro study assessing the effect of mesh morphology and suture fixation on bacterial adherence. Hernia 2013; 17:779-89. [PMID: 23780573 DOI: 10.1007/s10029-013-1124-5] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2012] [Accepted: 06/08/2013] [Indexed: 11/29/2022]
Abstract
PURPOSE Prosthetic infections, although relatively uncommon in hernia surgery, are a source of considerable morbidity and cost. The aims of this experimental study were to assess the influence of the morphological properties of the mesh on bacterial adherence in vitro. The morphological properties assessed were the polymer type, filament type, filament diameter, mesh weight, mean pore size, and the addition of silver chlorhexidine and titanium coatings. In addition, the study assessed the effect on bacterial adherence of adding a commonly used suture to the mesh and compared adherence rates to self-gripping mesh that does not require suture fixation. METHODS Eight commercially sourced flat hernia meshes with different material characteristics were included in the study. These were Prolene(®) (Ethicon(®)), DualMesh(®) (Gore(®)), DualMesh(®) Plus (Gore(®)), Parietex™ ProGrip (Covidien™), TiMesh(®) Light (GfE Medical), Bard(®) Soft Mesh (Bard(®)), Vypro(®) (Ethicon(®)), and Omyra(®) (Braun(®)). Individual meshes were inoculated with Staphylococcus epidermidis and Staphylococcus aureus with a bacterial inoculum of 10(2) bacteria. To assess the effect of suture material on bacterial adhesion, a sterile piece of commonly used monofilament suture material (2.0 Prolene(®), ZB370 Ethicon(®)) was sutured to selected meshes (chosen to represent different commonly used polymers and/or the presence of an antibacterial coating). Inoculated meshes were incubated for 18 h in tryptone soy broth and then analysed using scanning electron microscopy. A previously validated method for enumeration of bacteria using automated stage movement electron microscopy was used for direct bacterial counting. The final fraction of the bacteria adherent to the mesh was compared between the meshes and for each morphological variable. One-way analysis of variance (ANOVA) was performed on the bacterial counts. Tukey's test was used to determine the difference between the different biomaterials in the event the ANOVA was significant. RESULTS Properties that significantly increased the mean bacterial adherence were the expanded polytetrafluoroethylene polymer (P < 0.001); multifilament meshes (P < 0.001); increased filament diameter (P < 0.001); increased mesh weight (P < 0.001); and smaller mean pore size (P < 0.001). In contrast, mesh coating with antibacterial silver chlorhexidine significantly reduced bacterial adhesion (S. epidermidis mean bacterial count 140.7 ± 19.1 SE with DualMesh(®) vs. 2.3 ± 1.2 SE with DualMesh(®) Plus, P < 0.001; S. aureus mean bacterial count 371.7 ± 22.7 SE with DualMesh(®) vs. 19.3 ± 4.7 SE with DualMesh(®) Plus, P = 0.002). The addition of 2.0 Prolene suture material significantly increased the mean number of adherent bacteria independent of the mesh polymer or mesh coating (P = 0.04 to <0.001). CONCLUSION The present study demonstrates the significant influence of the prosthetic load on bacterial adherence. In patients at increased risk of infection, low prosthetic load materials, i.e., lightweight meshes with large pores, may be beneficial. Furthermore self-fixing meshes, which avoid increasing the prosthetic load and antibacterial impregnated meshes, may have an advantage in this setting.
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Affiliation(s)
- D Sanders
- Peninsula College of Medicine and Dentistry, John Bull Building, Tamar Science Park, Plymouth, PL6 8BU, UK,
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Wu T, Zhang Q, Ren W, Yi X, Zhou Z, Peng X, Yu X, Lang M. Controlled release of gentamicin from gelatin/genipin reinforced beta-tricalcium phosphate scaffold for the treatment of osteomyelitis. J Mater Chem B 2013; 1:3304-3313. [PMID: 32261039 DOI: 10.1039/c3tb20261e] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Infection of the bone (osteomyelitis) remains one of the most challenging problems in the field of orthopedic surgery. The limitations of systemic antibiotics administration include undesired side effects, systemic toxicity, patient discomfort, and development of bacterial resistance. In this study, we developed a bactericidal gentamicin-doped beta-tricalcium phosphate (TCP) scaffold reinforced with a gelatin/genipin hydrogel (G-TCP). Our data showed that the gentamicin-doped G-TCP had a much longer drug releasing period, while the gentamicin was completely released from pure TCP cements (B-TCP) within one day. In addition, the release profile of G-TCP exhibited an initial burst followed by a zero-order release. One standard strain, Staphylococcus aureus (S. aureus, ATCC25923) was selected to evaluate the antibacterial activity and therapeutic effect of this scaffold. G-TCP significantly inhibited growth of S. aureus both in vitro and in vivo. In a rat osteomyelitis model, osteomyelitis could be totally cured after implantation of G-TCP for three weeks. We propose that the gelatin/genipin-gentamicin TCP scaffold represents one of the promising gentamicin releasing bone scaffolds in treating osteomyelitis.
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Affiliation(s)
- Tianyi Wu
- Department of Orthopedic Surgery, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiaotong University, Shanghai, 200233, China
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128
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Lebeaux D, Chauhan A, Rendueles O, Beloin C. From in vitro to in vivo Models of Bacterial Biofilm-Related Infections. Pathogens 2013; 2:288-356. [PMID: 25437038 PMCID: PMC4235718 DOI: 10.3390/pathogens2020288] [Citation(s) in RCA: 300] [Impact Index Per Article: 27.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2013] [Revised: 05/01/2013] [Accepted: 05/08/2013] [Indexed: 12/13/2022] Open
Abstract
The influence of microorganisms growing as sessile communities in a large number of human infections has been extensively studied and recognized for 30–40 years, therefore warranting intense scientific and medical research. Nonetheless, mimicking the biofilm-life style of bacteria and biofilm-related infections has been an arduous task. Models used to study biofilms range from simple in vitro to complex in vivo models of tissues or device-related infections. These different models have progressively contributed to the current knowledge of biofilm physiology within the host context. While far from a complete understanding of the multiple elements controlling the dynamic interactions between the host and biofilms, we are nowadays witnessing the emergence of promising preventive or curative strategies to fight biofilm-related infections. This review undertakes a comprehensive analysis of the literature from a historic perspective commenting on the contribution of the different models and discussing future venues and new approaches that can be merged with more traditional techniques in order to model biofilm-infections and efficiently fight them.
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Affiliation(s)
- David Lebeaux
- Institut Pasteur, Unité de Génétique des Biofilms, 25 rue du Dr. Roux, 75724 Paris cedex 15, France.
| | - Ashwini Chauhan
- Institut Pasteur, Unité de Génétique des Biofilms, 25 rue du Dr. Roux, 75724 Paris cedex 15, France.
| | - Olaya Rendueles
- Institut Pasteur, Unité de Génétique des Biofilms, 25 rue du Dr. Roux, 75724 Paris cedex 15, France.
| | - Christophe Beloin
- Institut Pasteur, Unité de Génétique des Biofilms, 25 rue du Dr. Roux, 75724 Paris cedex 15, France.
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129
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Staphylococcus aureus supernatant induces the release of mouse β-defensin-14 from osteoblasts via the p38 MAPK and NF-κB pathways. Int J Mol Med 2013; 31:1484-94. [PMID: 23588388 DOI: 10.3892/ijmm.2013.1346] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2013] [Accepted: 04/03/2013] [Indexed: 11/05/2022] Open
Abstract
Mammalian β-defensins are small cationic peptides of approximately 2-6 kDa that have been implicated in mediating innate immune defenses against microbial infection. Previous studies have reported that mouse β-defensin-14 (MBD‑14), based on structural and functional similarities, appears to be an ortholog of human β-defensin-3 (HBD-3). The aim of this study was to identify the signaling pathways that contribute to the expression of MBD-14 in mouse osteoblasts (OBs) upon contact with methicillin-resistant Staphylococcus aureus (S. aureus) supernatant (SAS) to provide a theoretical basis for the use of MDB-14 as a therapeutic agent in the treatment of intramedullary infection with S. aureus in vivo. The bacterial exoproducts released by S. aureus mainly include a large amount of enterotoxins. Using mouse OBs, the release and regulation of MBD-14 was evaluated by real-time polymerase chain reaction (PCR) and enzyme‑linked immunosorbent assay (ELISA) following exposure to SAS. The activation of the p38 mitogen‑activated protein kinase (MAPK), extracellular signal-regulated kinase (ERK) and nuclear factor-κB (NF-κB) pathways was determined by western blot analysis. OBs treated with lipopolysaccharide (LPS) were used as the positive control. The results revealed that SAS significantly promoted the phosphorylation of p38 MAPK, NF-κB and the inhibitory subunit of NF-κBα (IκBα) in a time-dependent manner. The treatment of OBs with SB203580 (an inhibitor of p38 MAPK) and pyrrolidine dithiocarbamate (PDTC, an inhibitor of NF-κB) prior to stimulation with SAS significantly inhibited the phosphorylation and mRNA expression of p38 MAPK and NF-κB p65, simultaneously reducing the release of MBD-14. Our findings suggest that the release of MBD-14 is mediated at least in part through the activation of p38 MAPK and NF-κB in response to S. aureus‑secreted bacterial exoproducts. Moreover, our data demonstrate the innate immune capacity of OBs under conditions of bacterial challenge to enhance the local expression of this MBD-14, a peptide with anti‑staphylococcal activity.
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130
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Sinclair KD, Pham TX, Williams DL, Farnsworth RW, Loc-Carrillo CM, Bloebaum RD. Model development for determining the efficacy of a combination coating for the prevention of perioperative device related infections: a pilot study. J Biomed Mater Res B Appl Biomater 2013; 101:1143-53. [PMID: 23564717 DOI: 10.1002/jbm.b.32924] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2012] [Revised: 11/29/2012] [Accepted: 01/30/2013] [Indexed: 12/21/2022]
Abstract
Antibiotic resistant bacterial infections are a growing problem in patient care. These infections are difficult to treat and severely affect the patient's quality of life. The goal of this translational experiment was to investigate the antimicrobial potential of cationic steroidal antimicrobial-13 (CSA-13) for the prevention of perioperative device-related infections in vivo. It was hypothesized that when incorporated into a polymeric device coating, the release of CSA-13 could prevent perioperative device-related infection without inhibiting skeletal attachment. To test this hypothesis, 12 skeletally mature sheep received a porous coated titanium implant in the right femoral condyle. Group 1 received the titanium implant and an inoculum of 5 × 10(8) CFU of methicillin-resistant Staphylococcus aureus (MRSA). Group 2 received a CSA-13 coated implant and the MRSA inoculum. Group 3 received only the CSA-13 coated implant and Group 4 received only the implant-without the CSA-13 coating or MRSA inoculum. In conclusion, the CSA-13 combination coating demonstrated bactericidal potential without adversely affecting skeletal attachment. The CSA-13 containing groups exhibited no evidence of bacterial infection at the conclusion of the 12 week study and established skeletal attachment consistent with Group 4. In contrast, all of the Group 1 animals became infected and required euthanasia within 6-10 days. The significance of this finding is that this combination coating could be applied to implanted devices to prevent perioperative device-related infections. This method may facilitate significantly reduced incidences of device-related infections as well as a new method to treat and prevent resistant strain bacterial infections.
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Affiliation(s)
- Kristofer D Sinclair
- Department of Veterans Affairs Salt Lake City Health Care System, Salt Lake City, Utah; Department of Orthopaedics, University of Utah, Salt Lake City, Utah
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131
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Williams DL, Sinclair KD, Jeyapalina S, Bloebaum RD. Characterization of a novel active release coating to prevent biofilm implant-related infections. J Biomed Mater Res B Appl Biomater 2013; 101:1078-89. [DOI: 10.1002/jbm.b.32918] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2012] [Revised: 01/24/2013] [Accepted: 01/30/2013] [Indexed: 01/16/2023]
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132
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Chen X, Sevilla P, Aparicio C. Surface biofunctionalization by covalent co-immobilization of oligopeptides. Colloids Surf B Biointerfaces 2013; 107:189-97. [PMID: 23500730 DOI: 10.1016/j.colsurfb.2013.02.005] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2012] [Revised: 02/07/2013] [Accepted: 02/11/2013] [Indexed: 02/07/2023]
Abstract
Functionalization of implants with multiple bioactivities is desired to obtain surfaces with improved biological and clinical performance. Our objective was developing a simple and reliable method to obtain stable multifunctional coatings incorporating different oligopeptides. We co-immobilized on titanium surface oligopeptides of known cooperative bioactivities with a simple and reliable method. Appropriately designed oligopeptides containing either RGD or PHSRN bioactive sequences were mixed and covalently bonded on CPTES-silanized surfaces. Coatings made of only one of the two investigated peptides and coatings with physisorbed oligopeptides were produced and tested as control groups. We performed thorough characterization of the obtained surfaces after each step of the coating preparation and after mechanically challenging the obtained coatings. Fluorescence labeling of RGD and PHSRN peptides with fluorescence probes of different colors enabled the direct visualization of the co-immobilization of the oligopeptides. We proved that the coatings were mechanically stable. The surfaces with co-immobilized RGD and PHSRN peptides significantly improved osteoblasts response in comparison with control surfaces, which assessed the effectiveness of our coating method to bio-activate the implant surfaces. This same simple method can be used to obtain other multi-functional surfaces by co-immobilizing oligopeptides with different targeted bioactivities--cell recruitment and differentiation, biomineral nucleation, antimicrobial activity--and thus, further improving the clinical performance of titanium implants.
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Affiliation(s)
- Xi Chen
- Minnesota Dental Research Center for Biomaterials and Biomechanics, Department of Restorative Sciences, University of Minnesota School of Dentistry, Minneapolis, MN 55455, USA.
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133
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Koseki H, Asahara T, Shida T, Yoda I, Horiuchi H, Baba K, Osaki M. Clinical and histomorphometrical study on titanium dioxide-coated external fixation pins. Int J Nanomedicine 2013; 8:593-9. [PMID: 23429667 PMCID: PMC3575175 DOI: 10.2147/ijn.s39201] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2013] [Indexed: 11/23/2022] Open
Abstract
Background: Pin site infection is the most common and significant complication of external fixation. In this work, the efficacy of pins coated with titanium dioxide (TiO2) for inhibition of infection was compared with that of stainless steel control pins in an in vivo study. Methods: Pins contaminated with an identifiable Staphylococcus aureus strain were inserted into femoral bone in a rat model and exposed to ultraviolet A light for 30 minutes. On day 14, the animals were sacrificed and the bone and soft tissue around the pin were retrieved. The clinical findings and histological findings were evaluated in 60 samples. Results: Clinical signs of infection were present in 76.7% of untreated pins, but in only 36.7% of TiO2-coated pins. The histological bone infection score and planimetric rate of occupation for bacterial colonies and neutrophils in the TiO2-coated pin group were lower than those in the control group. The bone-implant contact ratio of the TiO2-coated pin group was significantly higher (71.4%) than in the control pin group (58.2%). The TiO2 was successful in decreasing infection both clinically and histomorphometrically. Conclusion: The photocatalytic bactericidal effect of TiO2 is thought to be useful for inhibiting pin site infection after external fixation.
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Affiliation(s)
- Hironobu Koseki
- Department of Orthopedic Surgery, Graduate School of Medicine, Nagasaki University, Nagasaki, Japan.
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134
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Kluin OS, van der Mei HC, Busscher HJ, Neut D. Biodegradable vs non-biodegradable antibiotic delivery devices in the treatment of osteomyelitis. Expert Opin Drug Deliv 2013; 10:341-51. [PMID: 23289645 DOI: 10.1517/17425247.2013.751371] [Citation(s) in RCA: 97] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
INTRODUCTION Chronic osteomyelitis, or bone infection, is a major worldwide cause of morbidity and mortality, as it is exceptionally hard to treat due to patient and pathogen-associated factors. Successful treatment requires surgical debridement together with long-term, high antibiotic concentrations that are best achieved by local delivery devices, either made of degradable or non-degradable materials. AREAS COVERED Non-degradable delivery devices are frequently constituted by polymethylmethacrylate-based carriers. Drawbacks are the need to remove the carrier (as the carrier itself may provide a substratum for bacterial colonization), inefficient release kinetics and incompatibility with certain antibiotics. These drawbacks have led to the quest for degradable alternatives, but also devices made of biodegradable calcium sulphate, collagen sponges, calcium phosphate or polylactic acids have their specific disadvantages. EXPERT OPINION Antibiotic treatment of osteomyelitis with the current degradable and non-degradable delivery devices is effective in the majority of cases. Degradable carriers have an advantage over non-degradable carriers that they do not require surgical removal. Synthetic poly(trimethylene carbonate) may be preferred in the future over currently approved lactic/glycolic acids, because it does not yield acidic degradation products. Moreover, degradable poly(trimethylene carbonate) yields a zero-order release kinetics that may not stimulate development of antibiotic-resistant bacterial strains due to the absence of long-term, low-concentration tail-release.
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Affiliation(s)
- Otto S Kluin
- Department of Biomedical Engineering, W. J. Kolff Institute, University Medical Center Groningen, Antonius Deusinglaan 1, 9713 AV Groningen , The Netherlands
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135
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Chen X, Li Y, Aparicio C. Biofunctional Coatings for Dental Implants. THIN FILMS AND COATINGS IN BIOLOGY 2013. [DOI: 10.1007/978-94-007-2592-8_4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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136
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Abstract
Tremendous advances in quality, reliability, performance, and versatility of surgical instrumentation and devices have been achieved over the past 50 years using biomaterials. The global orthopaedic implant industry is expected to grow to $41.8 billion by 2016, driven primarily by advancements in implant designs, including materials that provide improved biocompatibility, durability, and expanded clinical applications. Biomaterials have evolved through 3 clinical "generations": (1) "bio-inert materials," (2) materials with intrinsic bioactivity and degradability, and (3) biomaterials that stimulate specific biological host responses. In all cases, surface modifications, including coatings, represent a key strategy for improvements in tissue-contacting properties. Surfaces continue to be a focus for many device improvements and for tissue interfacing, especially for many orthopaedic structural implants comprising metal and metal alloys. Progress in implant materials processing, coating technologies, and coating combinations with therapeutic agents provide new properties and functionalities to improve device-tissue integration and reduce foreign body reactions and infections. Performance criteria for these surface modifications success in clinical practice are daunting, and translation of several technologies from in vitro proof-of-concept to in vivo applications has proven challenging.
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137
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Trajkovski B, Petersen A, Strube P, Mehta M, Duda GN. Intra-operatively customized implant coating strategies for local and controlled drug delivery to bone. Adv Drug Deliv Rev 2012; 64:1142-51. [PMID: 22664228 DOI: 10.1016/j.addr.2012.05.016] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2011] [Revised: 04/26/2012] [Accepted: 05/29/2012] [Indexed: 11/30/2022]
Abstract
Bone is one of the few tissues in the human body with high endogenous healing capacity. However, failure of the healing process presents a significant clinical challenge; it is a tremendous burden for the individual and has related health and economic consequences. To overcome such healing deficits, various concepts for a local drug delivery to bone have been developed during the last decades. However, in many cases these concepts do not meet the specific requirements of either surgeons who must use these strategies or individual patients who might benefit from them. We describe currently available methods for local drug delivery and their limitations in therapy. Various solutions for drug delivery to bone focusing on clinical applications and intra-operative constraints are discussed and drug delivery by implant coating is highlighted. Finally, a new set of design and performance requirements for intra-operatively customized implant coatings for controlled drug delivery is proposed. In the future, these requirements may improve approaches for local and intra-operative treatment of patients.
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Affiliation(s)
- Branko Trajkovski
- Julius Wolff Institute, Charité-Universitätsmedizin Berlin, Berlin, Germany.
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138
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Williams DL, Haymond BS, Beck JP, Savage PB, Chaudhary V, Epperson RT, Kawaguchi B, Bloebaum RD. In vivo efficacy of a silicone‒cationic steroid antimicrobial coating to prevent implant-related infection. Biomaterials 2012; 33:8641-56. [PMID: 22940221 DOI: 10.1016/j.biomaterials.2012.08.003] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2012] [Accepted: 08/01/2012] [Indexed: 01/14/2023]
Abstract
Active release antimicrobial coatings for medical devices have been developed to prevent and treat biofilm implant-related infections. To date, only a handful of coatings have been put into clinical use, with limited success. In this study, a novel antimicrobial compound was incorporated into a silicone (polydimethylsiloxane or PDMS) polymer to develop a novel active release coating that addressed several limitations of current device coatings. The efficacy of this coating was optimized using an in vitro flow cells system, then translated to an animal model of a simulated Type IIIB open fracture wherein well-established biofilms were used as initial inocula. Results indicated that the novel coating was able to prevent infection in 100% (9/9) of animals that were treated with biofilms and the novel coating (treatment group). In contrast, 100% (9/9) of animals that were inoculated with biofilms and not treated with the coating (positive control), did develop infection. Nine animals were used as negative controls, i.e., those that were not treated with biofilms, and showed a rate of infection of 11% (1/9). Eight animals were treated with the novel coating only to determine its effect on host tissue. Results indicated that the novel active release coating may have significant promise for future application to prevent biofilm implant-related infections in patients.
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Affiliation(s)
- Dustin L Williams
- George E. Wahlen Department of Veterans Affairs Medical Center, Salt Lake City, UT 84148, USA.
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139
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Abstract
Biointegration refers to the interconnection between a biomedical device and the recipient tissue. In many implant devices, the lack of proper biointegration can cause device failure and potentially serious medical problems. This review summarizes the recent progress in surface chemistry, drug delivery and antifouling methods to improve the biointegration of implants. Much progress has been made as our understanding of biological systems and material properties expands and as new technologies become available. This article addresses methods of enhancing biointegration by means of modifying implant surface chemistry and by drug-delivery approaches.
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140
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Neut D, Dijkstra RJB, Thompson JI, van der Mei HC, Busscher HJ. A gentamicin-releasing coating for cementless hip prostheses-Longitudinal evaluation of efficacy using in vitro bio-optical imaging and its wide-spectrum antibacterial efficacy. J Biomed Mater Res A 2012; 100:3220-6. [PMID: 22733713 DOI: 10.1002/jbm.a.34258] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2012] [Revised: 04/10/2012] [Accepted: 05/02/2012] [Indexed: 12/14/2022]
Abstract
Cementless prostheses are increasingly popular in total hip arthroplasties. Therewith, common prophylactic measures to reduce the risk of postoperative infection like the use of antibiotic-loaded bone cements, will no longer be available. Alternative prophylactic measures may include the use of antibiotic-releasing coatings. Previously, we developed a gentamicin-releasing coating for cementless titanium hip prostheses and derived an appropriate dosing of this coating by adjusting the amount of gentamicin in the coating to match the antibacterial efficacy of clinically employed gentamicin-loaded bone cement. In this manuscript, we investigated two important issues regarding the prophylactic use of this 1 mg cm(-2) bioactive gentamicin-releasing coating in cementless total hip arthroplasty: (1) its ability to prevent bacterial growth in a geometrically relevant set-up and (2) its antibacterial spectrum. A geometrically relevant set-up was developed in which miniature titanium stems were surrounded by agar, contaminated with bioluminescent Staphylococcus aureus. Novel, bio-optical imaging was performed allowing noninvasive, longitudinal monitoring of staphylococcal growth around miniature stems with and without the gentamicin-releasing coating. Furthermore, the antibacterial efficacy of the gentamicin-releasing coating was determined against a wide variety of clinical isolates, including bioluminescent Staphylococcus aureus strains, using traditional zone of inhibition measurements. The gentamicin-releasing coating demonstrated a wide-spectrum of antibacterial efficacy and successfully prevented growth of bioluminescent staphylococci around a miniature stem mounted in bacterially contaminated agar for at least 60 h. This implies that the gentamicin-releasing coating has potential to contribute to the improvement of infection prophylaxis in cementless total hip arthroplasty.
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Affiliation(s)
- Daniëlle Neut
- Department of Biomedical Engineering, University Medical Center Groningen, and University of Groningen, Antonius Deusinglaan 1, 9713 AV Groningen, The Netherlands.
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141
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Williams DL, Haymond BS, Woodbury KL, Beck JP, Moore DE, Epperson RT, Bloebaum RD. Experimental model of biofilm implant-related osteomyelitis to test combination biomaterials using biofilms as initial inocula. J Biomed Mater Res A 2012; 100:1888-900. [PMID: 22492534 DOI: 10.1002/jbm.a.34123] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2011] [Accepted: 02/03/2012] [Indexed: 01/01/2023]
Abstract
Currently, the majority of animal models that are used to study biofilm-related infections use planktonic bacterial cells as initial inocula to produce positive signals of infection in biomaterials studies. However, the use of planktonic cells has potentially led to inconsistent results in infection outcomes. In this study, well-established biofilms of methicillin-resistant Staphylococcus aureus were grown and used as initial inocula in an animal model of a Type IIIB open fracture. The goal of the work was to establish, for the first time, a repeatable model of biofilm implant-related osteomyelitis, wherein biofilms were used as initial inocula to test combination biomaterials. Results showed that 100% of animals that were treated with biofilms developed osteomyelitis, whereas 0% of animals not treated with biofilm developed infection. The development of this experimental model may lead to an important shift in biofilm and biomaterials research by showing that when biofilms are used as initial inocula, they may provide additional insights into how biofilm-related infections in the clinic develop and how they can be treated with combination biomaterials to eradicate and/or prevent biofilm formation.
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Affiliation(s)
- Dustin L Williams
- George E. Wahlen Department of Veterans Affairs Medical Center, Salt Lake City, Utah, USA.
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142
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Matl FD, Zlotnyk J, Obermeier A, Friess W, Vogt S, Büchner H, Schnabelrauch H, Stemberger A, Kühn KD. New Anti-infective Coatings of Surgical Sutures Based on a Combination of Antiseptics and Fatty Acids. JOURNAL OF BIOMATERIALS SCIENCE-POLYMER EDITION 2012; 20:1439-49. [DOI: 10.1163/092050609x12457418973107] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- F. D. Matl
- a Institute of Medical Engineering, Technische Universität München, Boltzmannstrasse 11, 85748 Garching, Germany; Institut für Experimentelle Onkologie und Therapieforschung, Klinikum r. d. Isar, Ismaningerstr. 22, 81675 München, Germany
| | - J. Zlotnyk
- b Institute of Medical Engineering, Technische Universität München, Boltzmannstrasse 11, 85748 Garching, Germany; Institut für Experimentelle Onkologie und Therapieforschung, Klinikum r. d. Isar, Ismaningerstr. 22, 81675 München, Germany
| | - A. Obermeier
- c Institute of Medical Engineering, Technische Universität München, Boltzmannstrasse 11, 85748 Garching, Germany; Institut für Experimentelle Onkologie und Therapieforschung, Klinikum r. d. Isar, Ismaningerstr. 22, 81675 München, Germany
| | - W. Friess
- d Department of Pharmacy-Pharmaceutical Technology, Ludwig-Maximilians-Universität München, München, Germany
| | - S. Vogt
- e Hereaus Medical GmbH, Philipp-Reiss-Strasse 8/13, 61273 Werheim, Germany
| | - H. Büchner
- f Hereaus Medical GmbH, Philipp-Reiss-Strasse 8/13, 61273 Werheim, Germany
| | | | - A. Stemberger
- h Institute of Medical Engineering, Technische Universität München, Boltzmannstrasse 11, 85748 Garching, Germany; Institut für Experimentelle Onkologie und Therapieforschung, Klinikum r. d. Isar, Ismaningerstr. 22, 81675 München, Germany
| | - K.-D. Kühn
- i Hereaus Medical GmbH, Philipp-Reiss-Strasse 8/13, 61273 Werheim, Germany
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143
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Shandley S, Matthews KP, Cox J, Romano D, Abplanalp A, Kalns J. Hyperbaric oxygen therapy in a mouse model of implant-associated osteomyelitis. J Orthop Res 2012; 30:203-8. [PMID: 21815206 DOI: 10.1002/jor.21522] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2011] [Accepted: 07/14/2011] [Indexed: 02/04/2023]
Abstract
Implant associated osteomyelitis (OM) is difficult to treat with antibiotics, and outcomes remain poor. Some reports suggest that hyperbaric oxygen treatment is a safe and effective means of treating OM. We tested this hypothesis in a murine model. Clinical isolates of methicillin-resistant Staphylococcus aureus (MRSA), Pseudomonas aeruginosa, and Klebsiella pneumoniae were used. The mice were infected with each of the three pathogens, treated with 100% oxygen at high pressure, hyperbaric oxygen (HBO), and monitored for the ability of HBO to prevent and/or clear the OM infection. Assessments included bacterial burden of the tibias and lesion scores, as well as receptor activator of NF-κB ligand (RANKL) and myeloperoxidase (MPO) concentrations. HBO resulted in more severe lesion scores and higher RANKL and MPO concentrations for MRSA. A significant positive correlation was found between RANKL concentration and lesion score. No significant difference was found with HBO in P. aeruginosa infections and K. pneumoniae seems to either not infect bone well or get cleared before establishing an infection. The model is useful for studying OM infections caused by MRSA and P. aeruginosa, but HBO does not appear to be an efficacious treatment of an implant-associated OM infection.
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144
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von Plocki SC, Armbruster D, Klein K, Kämpf K, Zlinszky K, Hilbe M, Kronen P, Gruskin E, von Rechenberg B. Biodegradable sleeves for metal implants to prevent implant-associated infection: an experimental in vivo study in sheep. Vet Surg 2012; 41:410-21. [PMID: 22239648 DOI: 10.1111/j.1532-950x.2011.00943.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVE To evaluate biocompatibility of biodegradable sleeves containing antimicrobial agents, designed for local drug delivery to prevent implant-related infection. STUDY DESIGN Synthetic polyester sleeves (a copolymer of glycolide, caprolactone, trimethylene carbonate, lactide) were cast as thin films. The antimicrobial agents incorporated in the sleeves included gentamicin sulfate, triclosan, or a combination of these drugs. ANIMALS Adult sheep (n = 15). METHODS Two limited contact dynamic compression plates (LC-DCP) with or without sleeves were implanted on tibiae (bilateral) of 15 sheep. Sleeves were placed over the plates before implantation. Beneath half of the plates, 5-mm drill hole defects were made in the near cortex. Samples were harvested 4 weeks later for histology and microradiography. RESULTS Macroscopically, no irritation of bone or adjacent tissue was seen. Small remnants of sleeves were visible on histology, and positively correlated with the presence of macrophages and foreign body cells. Thick sections showed no difference between the test samples and controls in terms of fibrous capsule formation, periosteal remodeling, and defect remodeling. Inflammatory cells, macrophages, and foreign body cells were more prominent in sections with sleeves, but were not statistically significantly different from controls. Cell numbers were within normal physiologic limits normally seen as cellular response to foreign bodies consisting of polymers. CONCLUSION The normal healing response indicated that the biodegradable sleeves demonstrate tissue biocompatibility.
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Affiliation(s)
- Stephanie C von Plocki
- Musculoskeletal Research Unit (MSRU), Equine Department, Vetsuisse Faculty ZH, University of Zurich, Zürich, Switzerland
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Williams DL, Costerton JW. Using biofilms as initial inocula in animal models of biofilm-related infections. J Biomed Mater Res B Appl Biomater 2011; 100:1163-9. [DOI: 10.1002/jbm.b.31979] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2011] [Revised: 09/13/2011] [Accepted: 09/24/2011] [Indexed: 12/23/2022]
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Vancomycin containing PLLA/β-TCP controls MRSA in vitro. Clin Orthop Relat Res 2011; 469:3222-8. [PMID: 21918801 PMCID: PMC3183185 DOI: 10.1007/s11999-011-2082-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2010] [Accepted: 08/31/2011] [Indexed: 01/31/2023]
Abstract
BACKGROUND Osteomyelitis caused by Methicillin-resistant Staphylococcus aureus (MRSA) often requires surgery and prolonged systemic antibiotic treatment. Local antibiotic delivery systems of bioceramics or polymers have been developed to treat osteomyelitis. A disadvantage of biodegradable polymers is the initial burst of antibiotics into the environment; one advantage of bioceramics is its osteoconductivity. We therefore developed a vancomycin-containing poly-l-lactic acid/β-tricalcium phosphate (PLLA/β-TCP) composite to control antibiotic release and stimulate bone formation. QUESTIONS/PURPOSES We (1) characterized these composites, (2) assessed vancomycin release in inhibitory doses, and (3) determined whether they would permit cell adhesion, proliferation, and mineralization in vitro. METHODS We molded 250 vancomycin-containing (VC) and 125 vancomycin-free (VUC) composites using PLLA, β-TCP, and chloroform. One hundred twenty-five VC composites were further dip-coated with PLLA (CVC) to delay antibiotic release. Composites were characterized according to their pore structure, size, volume, density, and surface area. Vancomycin release and bioactivity were determined. Adhesion, proliferation, and mineralization were assessed for two and three replicates on Days 3 and 7 with mesenchymal stem (MSC) and Saos type 2 cells. RESULTS Pore size, volume, apparent density, and surface area of the CVC were 3.5 ± 1.9 μm, 0.005 ± 0.002 cm(3)/g, 1.18 g/cm(3) and 3.68 m(2)/g, respectively. CVC released 1.71 ± 0.13 mg (63.1%) and 2.49 ± 0.64 mg (91.9%) of its vancomycin on Day 1 and Week 6, respectively. MSC and Saos type 2 cells attached and proliferated on composites on Days 3 and 7. CONCLUSIONS Vancomycin-containing PLLA/β-TCP composites release antibiotics in inhibitory doses after dip coating and appeared biocompatible based on adhesion, proliferation, and mineralization. CLINICAL RELEVANCE Vancomycin-containing PLLA/β-TCP composites may be useful for controlling MRSA but will require in vivo confirmation.
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147
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Fuchs T, Stange R, Schmidmaier G, Raschke MJ. The use of gentamicin-coated nails in the tibia: preliminary results of a prospective study. Arch Orthop Trauma Surg 2011; 131:1419-25. [PMID: 21617934 PMCID: PMC3175046 DOI: 10.1007/s00402-011-1321-6] [Citation(s) in RCA: 117] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2010] [Indexed: 02/08/2023]
Abstract
BACKGROUND The use of antibiotic-coated implants may reduce the rate of infection and facilitate fracture healing after surgical treatment of tibial shaft fractures. A new biodegradable gentamicin-loaded coating of an implant (UTN PROtect) was CE-certified in August 2005. In this prospective, non-randomized case series, we investigated the clinical, laboratory and radiological outcomes of 21 patients who underwent surgical treatment in closed or open tibial fractures, as well as revisions with the UTN PROtect gentamicin-coated intramedullary nail. METHODS Of 21 patients (13 men, 8 women), 19 completed the 6-month follow-up. The study population included patients with complex tibial fractures and late revision cases. Clinical outcomes comprised adverse events, including infections and the SF-36 physical score. Laboratory outcomes, including C-reactive protein and leukocyte count as inflammatory markers, haemoglobin and serum gentamicin, were measured at baseline and up to 6 months post operatively. Radiographic assessments of fracture healing and weight-bearing capacity were determined at 5 weeks, 3 and 6 months after surgery. RESULTS No implant-related infections occurred; one patient had superficial wound healing problems. Mean C-reactive protein levels remained below 5 mg/L throughout the study, with a peak at 4-7 days after surgery (4.4 mg/L; range 0.5-16.1 mg/L). Leukocyte counts and haemoglobin levels did not vary over time during the study. The mean SF-36 physical score at 6 months was 42.6 (range 19.4-56.7). Radiographic union defined as three or four bridged cortices was achieved in 11 patients (58%) after 6 months. The remaining eight patients showed partial fracture healing with one or two bridged cortices. Additionally, 13 patients (68%) demonstrated full weight-bearing capacity after 6 months. CONCLUSIONS The use of the UTN PROtect intramedullary nail was associated with good clinical, laboratory and radiological outcomes after 6 months. These preliminary results support the use of gentamicin-coated implants as a new potential treatment option for the prevention of infection in trauma patients and in revision cases. LEVEL OF EVIDENCE Level II.
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Affiliation(s)
- Thomas Fuchs
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital, Münster, Germany.
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Bone Regeneration around Dental Implants as a Treatment for Peri-Implantitis: A Review of the Literature. ACTA ACUST UNITED AC 2011. [DOI: 10.4028/www.scientific.net/jbbte.11.21] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
This manuscript discusses peri-implantitis around dental implants and the current methodologies of surgical and non-surgical approaches towards treating peri-implantitis. Mechanical, chemical cleansing and reactivation of infected implant surface along with recent advances like the use of Laser and Photodynamic therapy (PDT) have also been reviewed in this literature. Bone regenerative treatment methods for the treatment of peri-implantitis using non-resorbable membranes (Guided Bone Regeneration), autogenous bone grafts and bone substitute materials with recombinant human bone morphogenetic protein-2 (rhBMP-2) and other growth factors have also been reviewed in this manuscript.
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Song W, Ren W, Wan C, Esquivel AO, Shi T, Blasier R, Markel DC. A novel strontium-doped calcium polyphosphate/erythromycin/poly(vinyl alcohol) composite for bone tissue engineering. J Biomed Mater Res A 2011; 98:359-71. [DOI: 10.1002/jbm.a.33127] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2010] [Revised: 03/27/2011] [Accepted: 04/08/2011] [Indexed: 11/08/2022]
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Yonekura Y, Miyamoto H, Shimazaki T, Ando Y, Noda I, Mawatari M, Hotokebuchi T. Osteoconductivity of thermal-sprayed silver-containing hydroxyapatite coating in the rat tibia. ACTA ACUST UNITED AC 2011; 93:644-9. [DOI: 10.1302/0301-620x.93b5.25518] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
A silver-containing hydroxyapatite (Ag-HA) coating has been developed using thermal spraying technology. We evaluated the osteoconductivity of this coating on titanium (Ti) implants in rat tibiae in relation to bacterial infection in joint replacement. At 12 weeks, the mean affinity indices of bone formation of a Ti, an HA, a 3%Ag-HA and a 50%Ag-HA coating were 97.3%, 84.9%, 81.0% and 40.5%, respectively. The mean affinity indices of bone contact of these four coatings were 18.8%, 83.7%, 77.2% and 40.5%, respectively. The indices of bone formation and bone contact around the implant of the 3%Ag-HA coating were similar to those of the HA coating, and no significant differences were found between them (bone formation, p = 0.99; bone contact, p = 0.957). However, inhibition of bone formation was observed with the 50%Ag-HA coating. These results indicate that the 3%Ag-HA coating has low toxicity and good osteoconductivity, and that the effect of silver toxicity on osteoconductivity depends on the dose.
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Affiliation(s)
| | - H. Miyamoto
- Department of Pathology and Microbiology, Faculty of Medicine, Saga University, 5-1-1 Nabeshima, Saga 849-8501, Japan
| | | | - Y. Ando
- Research Department, Japan Medical Materials Corporation, 3-3-31 Miyahara, Yodogawa-ku, Osaka, Japan
| | - I. Noda
- Research Department, Japan Medical Materials Corporation, 3-3-31 Miyahara, Yodogawa-ku, Osaka, Japan
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