Mitigation of Staphylococcus aureus-mediated surgical site infections with ir photoactivated TiO2 coatings on Ti implants

Review of Antimicrobial Nanocoatings in Medicine and Dentistry: Mechanisms of Action, Biocompatibility Performance, Safety, and Benefits Compared to Antibiotics

This review discusses topics relevant to the development of antimicrobial nanocoatings and nanoscale surface modifications for medical and dental applications. Nanomaterials have unique properties compared to their micro- and macro-scale counterparts and can be used to reduce or inhibit bacterial growth, surface colonization and biofilm development. Generally, nanocoatings exert their antimicrobial effects through biochemical reactions, production of reactive oxygen species or ionic release, while modified nanotopographies create a physically hostile surface for bacteria, killing cells via biomechanical damage. Nanocoatings may consist of metal nanoparticles including silver, copper, gold, zinc, titanium, and aluminum, while nonmetallic compounds used in nanocoatings may be carbon-based in the form of graphene or carbon nanotubes, or composed of silica or chitosan. Surface nanotopography can be modified by the inclusion of nanoprotrusions or black silicon. Two or more nanomaterials can be combined to form nanocomposites with distinct chemical or physical characteristics, allowing combination of different properties such as antimicrobial activity, biocompatibility, strength, and durability. Despite their wide range of applications in medical engineering, questions have been raised regarding potential toxicity and hazards. Current legal frameworks do not effectively regulate antimicrobial nanocoatings in matters of safety, with open questions remaining about risk analysis and occupational exposure limits not considering coating-based approaches. Bacterial resistance to nanomaterials is also a concern, especially where it may affect wider antimicrobial resistance. Nanocoatings have excellent potential for future use, but safe development of antimicrobials requires careful consideration of the "One Health" agenda, appropriate legislation, and risk assessment.

Recent Advances in the Evaluation of Antimicrobial Materials for Resolution of Orthopedic Implant-Associated Infections In Vivo

While orthopedic implant-associated infections are rare, revision surgeries resulting from infections incur considerable healthcare costs and represent a substantial research area clinically, in academia, and in industry. In recent years, there have been numerous advances in the development of antimicrobial strategies for the prevention and treatment of orthopedic implant-associated infections which offer promise to improve the limitations of existing delivery systems through local and controlled release of antimicrobial agents. Prior to translation to in vivo orthopedic implant-associated infection models, the properties (e.g., degradation, antimicrobial activity, biocompatibility) of the antimicrobial materials can be evaluated in subcutaneous implant in vivo models. The antimicrobial materials are then incorporated into in vivo implant models to evaluate the efficacy of using the material to prevent or treat implant-associated infections. Recent technological advances such as 3D-printing, bacterial genomic sequencing, and real-time in vivo imaging of infection and inflammation have contributed to the development of preclinical implant-associated infection models that more effectively recapitulate the clinical presentation of infections and improve the evaluation of antimicrobial materials. This Review highlights the advantages and limitations of antimicrobial materials used in conjunction with orthopedic implants for the prevention and treatment of orthopedic implant-associated infections and discusses how these materials are evaluated in preclinical in vivo models. This analysis serves as a resource for biomaterial researchers in the selection of an appropriate orthopedic implant-associated infection preclinical model to evaluate novel antimicrobial materials.

Cell Type-Specific Adhesion and Migration on Laser-Structured Opaque Surfaces

Cytocompatibility is essential for implant approval. However, initial in vitro screenings mainly include the quantity of adherent immortalized cells and cytotoxicity. Other vital parameters, such as cell migration and an in-depth understanding of the interaction between native tissue cells and implant surfaces, are rarely considered. We investigated different laser-fabricated spike structures using primary and immortalized cell lines of fibroblasts and osteoblasts and included quantification of the cell area, aspect ratio, and focal adhesions. Furthermore, we examined the three-dimensional cell interactions with spike topographies and developed a tailored migration assay for long-term monitoring on opaque materials. While fibroblasts and osteoblasts on small spikes retained their normal morphology, cells on medium and large spikes sank into the structures, affecting the composition of the cytoskeleton and thereby changing cell shape. Up to 14 days, migration appeared stronger on small spikes, probably as a consequence of adequate focal adhesion formation and an intact cytoskeleton, whereas human primary cells revealed differences in comparison to immortalized cell lines. The use of primary cells, analysis of the cell-implant structure interaction as well as cell migration might strengthen the evaluation of cytocompatibility and thereby improve the validity regarding the putative in vivo performance of implant material.

On the Interaction between 1D Materials and Living Cells

One-dimensional (1D) materials allow for cutting-edge applications in biology, such as single-cell bioelectronics investigations, stimulation of the cellular membrane or the cytosol, cellular capture, tissue regeneration, antibacterial action, traction force investigation, and cellular lysis among others. The extraordinary development of this research field in the last ten years has been promoted by the possibility to engineer new classes of biointerfaces that integrate 1D materials as tools to trigger reconfigurable stimuli/probes at the sub-cellular resolution, mimicking the in vivo protein fibres organization of the extracellular matrix. After a brief overview of the theoretical models relevant for a quantitative description of the 1D material/cell interface, this work offers an unprecedented review of 1D nano- and microscale materials (inorganic, organic, biomolecular) explored so far in this vibrant research field, highlighting their emerging biological applications. The correlation between each 1D material chemistry and the resulting biological response is investigated, allowing to emphasize the advantages and the issues that each class presents. Finally, current challenges and future perspectives are discussed.

Oxidative Stress-Generating Antimicrobials, a Novel Strategy to Overcome Antibacterial Resistance

Antimicrobial resistance is becoming one of the most important human health issues. Accordingly, the research focused on finding new antibiotherapeutic strategies is again becoming a priority for governments and major funding bodies. The development of treatments based on the generation of oxidative stress with the aim to disrupt the redox defenses of bacterial pathogens is an important strategy that has gained interest in recent years. This approach is allowing the identification of antimicrobials with repurposing potential that could be part of combinatorial chemotherapies designed to treat infections caused by recalcitrant bacterial pathogens. In addition, there have been important advances in the identification of novel plant and bacterial secondary metabolites that may generate oxidative stress as part of their antibacterial mechanism of action. Here, we revised the current status of this emerging field, focusing in particular on novel oxidative stress-generating compounds with the potential to treat infections caused by intracellular bacterial pathogens.

Promising Recent Strategies with Potential Clinical Translational Value to Combat Antibacterial Resistant Surge

Multiple drug resistance (MDR) for the treatment of bacterial infection has been a significant challenge since the beginning of the 21st century. Many of the small molecule-based antibiotic treatments have failed on numerous occasions due to a surge in MDR, which has claimed millions of lives worldwide. Small particles (SPs) consisting of metal, polymer or carbon nanoparticles (NPs) of different sizes, shapes and forms have shown considerable antibacterial effect over the past two decades. Unlike the classical small-molecule antibiotics, the small particles are less exposed so far to the bacteria to trigger a resistance mechanism, and hence have higher chances of fighting the challenge of the MDR process. Until recently, there has been limited progress of clinical treatments using NPs, despite ample reports of in vitro antibacterial efficacy. In this review, we discuss some recent and unconventional strategies that have explored the antibacterial efficacy of these small particles, alone and in combination with classical small molecules in vivo, and demonstrate possibilities that are favorable for clinical translations in near future.

Usos terapéuticos de nanomateriales y nanopartículas

La síntesis de nanomateriales y nanopartículas para usos médicos ha llevado a la generación de la nanomedicina, rama de la nanotecnología que permite diagnosticar, tratar y prevenir enfermedades y traumatismos, aliviar el dolor, preservar y mejorar la salud humana utilizando herramientas y conocimientos moleculares del cuerpo humano. Este artículo revisa las aplicaciones actuales y futuras de los nanomateriales en áreas biomédicas y presenta los riesgos de toxicidad que se podrían generar por su usoindiscriminado.

Biological and Physicochemical Assessment of Middle Ear Prosthesis

Polymers modified with bioactive nanoparticles are a promising solution for patients who need a tissue replacement. Modern implants, thanks to bioactive and bactericidal functions, facilitate the healing and regeneration process of the replaced tissue. The aim of this study was to assess whether silver nanoparticles (AgNPs) could support antibacterial function without cytotoxic effect and deterioration of biostability. This article describes biological and physiochemical aspects concerning a new polymeric middle ear implant (Otoimplant) enriched with silver nanoparticles. This kind of prosthesis is a promising implant for the reconstruction of ossicles in ossiculoplasty. We found that incorporation of silver nanoparticles into a polymeric matrix resulted in bactericidal efficacy against Gram-positive and Gram-negative bacteria, both resistant to antibiotics and basic strains. Our prostheses do not show cytotoxic effect and are a suitable biomaterial platform for effective culture of Saos2 and NHOst osteoblastic cells. The in vitro incubation of the samples in distilled water revealed that surface parameters, such as roughness, may slightly increase as a result of unveiling nanoparticles. However, the prolonged immersion does not change mechanical parameters. During one-year incubation, the prosthesis proved to retain stable values of Young's modulus, tensile strength, propagation of longitudinal ultrasonic waves, pH, and conductivity.

Mechanical, bactericidal and osteogenic behaviours of hydrothermally synthesised TiO2 nanowire arrays

The application of orthopaedic implants is associated with risks of bacterial infection and long-term antibiotic therapy. This problem has led to the study of implants with nano-textured surfaces as a method of inhibiting bacterial adhesion and reducing implant failure due to infection. In this research, various nano-textured surfaces of TiO₂ were synthesised using hydrothermal synthesis, by varying NaOH concentration, reaction time and reaction temperature. Their correlations to mechanical, morphological, bactericidal and osteogenic properties of the surfaces were investigated. It was found that high alkaline concentrations produced large nanowire mesh arrays, while short reaction time and low temperature produced comparatively smaller arrays. The highly dense morphology formed at higher NaOH concentrations has resulted in high elastic modulus and hardness values, compared to surfaces produced at lower NaOH concentrations. Viability tests of the TiO₂ nanowire array against gram-positive Staphylococcus aureus cells showed a bactericidal efficiency of 54% and 33% after 3 and 18 h, respectively. This nano-textured surface produces an osteoblast cellular metabolic activity of 71% after 24 h, compared to 67% when exposed to a flat Ti control surface. This preliminary work demonstrates an excellent outcome in producing bactericidal surfaces that promoted metabolic activity of human osteoblast cells for potential use in orthopaedic implants.

Atomic layer deposition of nano-TiO2 thin films with enhanced biocompatibility and antimicrobial activity for orthopedic implants

Titanium (Ti) and its alloys have been extensively used as implant materials in orthopedic applications. Nevertheless, implants may fail due to a lack of osseointegration and/or infection. The aim of this in vitro study was to endow an implant surface with favorable biological properties by the dual modification of surface chemistry and nanostructured topography. The application of a nanostructured titanium dioxide (TiO2) coating on Ti-based implants has been proposed as a potential way to enhance tissue-implant interactions while inhibiting bacterial colonization simultaneously due to its chemical stability, biocompatibility, and antimicrobial properties. In this paper, temperature-controlled atomic layer deposition (ALD) was introduced for the first time to provide unique nanostructured TiO2 coatings on Ti substrates. The effect of nano-TiO2 coatings with different morphology and structure on human osteoblast and fibroblast functions and bacterial activities was investigated. In vitro results indicated that the TiO2 coating stimulated osteoblast adhesion and proliferation while suppressing fibroblast adhesion and proliferation compared to uncoated materials. In addition, the introduction of nano-TiO2 coatings was shown to inhibit gram-positive bacteria (Staphylococcus aureus), gram-negative bacteria (Escherichia coli), and antibiotic-resistant bacteria (methicillin-resistant Staphylococcus aureus), all without resorting to the use of antibiotics. Our results suggest that the increase in nanoscale roughness and greater surface hydrophilicity (surface energy) together could contribute to increased protein adsorption selectively, which may affect the cellular and bacterial activities. It was found that ALD-grown TiO2-coated samples with a moderate surface energy at 38.79 mJ/m2 showed relatively promising antibacterial properties and desirable cellular functions. The ALD technique provides a novel and effective strategy to produce TiO2 coatings with delicate control of surface nanotopography and surface energy to enhance the interfacial biocompatibility and mitigate bacterial infection, and could potentially be used for improving numerous orthopedic implants.

Bio-mimicking nano and micro-structured surface fabrication for antibacterial properties in medical implants

Orthopaedic and dental implants have become a staple of the medical industry and with an ageing population and growing culture for active lifestyles, this trend is forecast to continue. In accordance with the increased demand for implants, failure rates, particularly those caused by bacterial infection, need to be reduced. The past two decades have led to developments in antibiotics and antibacterial coatings to reduce revision surgery and death rates caused by infection. The limited effectiveness of these approaches has spurred research into nano-textured surfaces, designed to mimic the bactericidal properties of some animal, plant and insect species, and their topographical features. This review discusses the surface structures of cicada, dragonfly and butterfly wings, shark skin, gecko feet, taro and lotus leaves, emphasising the relationship between nano-structures and high surface contact angles on self-cleaning and bactericidal properties. Comparison of these surfaces shows large variations in structure dimension and configuration, indicating that there is no one particular surface structure that exhibits bactericidal behaviour against all types of microorganisms. Recent bio-mimicking fabrication methods are explored, finding hydrothermal synthesis to be the most commonly used technique, due to its environmentally friendly nature and relative simplicity compared to other methods. In addition, current proposed bactericidal mechanisms between bacteria cells and nano-textured surfaces are presented and discussed. These models could be improved by including additional parameters such as biological cell membrane properties, adhesion forces, bacteria dynamics and nano-structure mechanical properties. This paper lastly reviews the mechanical stability and cytotoxicity of micro and nano-structures and materials. While the future of nano-biomaterials is promising, long-term effects of micro and nano-structures in the body must be established before nano-textures can be used on orthopaedic implant surfaces as way of inhibiting bacterial adhesion.

The antimicrobial activity of nanoparticles: present situation and prospects for the future

Nanoparticles (NPs) are increasingly used to target bacteria as an alternative to antibiotics. Nanotechnology may be particularly advantageous in treating bacterial infections. Examples include the utilization of NPs in antibacterial coatings for implantable devices and medicinal materials to prevent infection and promote wound healing, in antibiotic delivery systems to treat disease, in bacterial detection systems to generate microbial diagnostics, and in antibacterial vaccines to control bacterial infections. The antibacterial mechanisms of NPs are poorly understood, but the currently accepted mechanisms include oxidative stress induction, metal ion release, and non-oxidative mechanisms. The multiple simultaneous mechanisms of action against microbes would require multiple simultaneous gene mutations in the same bacterial cell for antibacterial resistance to develop; therefore, it is difficult for bacterial cells to become resistant to NPs. In this review, we discuss the antibacterial mechanisms of NPs against bacteria and the factors that are involved. The limitations of current research are also discussed.

Comparison of Infectious Agents Susceptibility to Photocatalytic Effects of Nanosized Titanium and Zinc Oxides: A Practical Approach

Nanotechnology contributes towards a more effective eradication of pathogens that have emerged in hospitals, veterinary clinics, and food processing plants and that are resistant to traditional drugs or disinfectants. Since new methods of pathogens eradication must be invented and implemented, nanotechnology seems to have become the response to that acute need. A remarkable achievement in this field of science was the creation of self-disinfecting surfaces that base on advanced oxidation processes (AOPs). Thus, the phenomenon of photocatalysis was practically applied. Among the AOPs that have been most studied in respect of their ability to eradicate viruses, prions, bacteria, yeasts, and molds, there are the processes of TiO2/UV and ZnO/UV. Titanium dioxide (TiO2) and zinc oxide (ZnO) act as photocatalysts, after they have been powdered to nanoparticles. Ultraviolet (UV) radiation is an agent that determines their excitation. Methods using photocatalytic properties of nanosized TiO2 and ZnO prove to be highly efficient in inactivation of infectious agents. Therefore, they are being applied on a growing scale. AOP-based disinfection is regarded as a very promising tool that might help overcome problems in food hygiene and public health protection. The susceptibility of infectious agents to photocatalylic processes can be generally arranged in the following order: viruses > prions > Gram-negative bacteria > Gram-positive bacteria > yeasts > molds.

Chances and limitations of nanosized titanium dioxide practical application in view of its physicochemical properties

Nanotechnology is a field of science that is nowadays developing in a dynamic way. It seems to offer almost endless opportunities of contribution to many areas of economy and human activity, in general. Thanks to nanotechnology, the so-called nanomaterials can be designed. They present structurally altered materials, with their physical, chemical and biological properties entirely differing from properties of the same materials manufactured in microtechnology. Nanotechnology creates a unique opportunity to modify the matter at the level of atoms and particles. Therefore, it has become possible to obtain items displaying new, useful properties, i.e. self-disinfecting and self-cleaning surfaces. Those surfaces are usually covered by a thin layer of a photocatalyst. The role of the photocatalyst is most of the time performed by the nanosized titanium dioxide (nano-TiO2). Excitation of nano-TiO2 by ultraviolet radiation initiates advanced oxidation processes and reactions leading to the creation of oxygen vacancies that bind water particles. As a result, photocatalytic surfaces are given new properties. Those properties can then be applied in a variety of disciplines, such as medicine, food hygiene, environmental protection or building industry. Practically, the applications include inactivation of microorganisms, degradation of toxins, removing pollutants from buildings and manufacturing of fog-free windows or mirrors.

Antimicrobial activity and cytocompatibility of Ag plasma-modified hierarchical TiO2 film on titanium surface

To improve the antimicrobial ability and cytocompatibility of biomedical titanium implants, many efforts have been made to modify their surface topography and chemical composition. In this work, Ag plasma-modified hierarchical TiO2 film was fabricated on titanium surface via acid etching to produce micropit, hydrothermal treatment to generate TiO2 nanorod and subsequent plasma immersion ion implantation process to impregnate Ag into TiO2 surface. In view of the potential clinical applications, their antimicrobial activity, bioactivity and cytocompatibility were systematically evaluated. The hierarchical TiO2 film showed enhanced bioactivity and bacteriostatic effect on both microbes due to more negative zeta potential, constructing the first defense line against microbial adhesion by electrostatic repulsion. Addition of embedded Ag remarkably enhanced the antimicrobial efficiency toward both microbes based on Schottky contact without Ag(+) release, establishing the second defense line targeting microbial membrane. Furthermore, the addition of Ag degraded the bioactivity very little and exerted nearly no adverse or even promoted effect on MG63 cell functions, including adhesion, spreading and proliferation. This work illustrates a two-defense-line antimicrobial activity in darkness with both prior electrostatic repulsion to inhibit most microbes adhesion and posterior biocidal action to kill residual ones that luckily infiltrated through the first defense line, and provide proof of concept using both clinically relevant human pathogens. In conclusion, the Ag-embedded hierarchical TiO2 film with excellent antimicrobial activity, bioactivity and cytocompatibility provides a promising candidate for orthopedic and dental implants.