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Zhang J, Liu Y, Wu P. An elastic piezoelectric nanomembrane with double noise reduction for high-quality bandpass acoustics. Nat Commun 2024; 15:8920. [PMID: 39414797 PMCID: PMC11484958 DOI: 10.1038/s41467-024-52787-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2024] [Accepted: 09/18/2024] [Indexed: 10/18/2024] Open
Abstract
Polymer piezoelectrics with high electromechanical energy conversion (HEEC) are very promising for flexible acoustoelectric devices. However, reducing thickness and improving ordered polarization and ferroelectricity while maintaining high mechanical strength pose enormous fabrication challenges for polymer piezoelectric membranes-additionally, noise management in the acoustoelectric conversion remains an open issue. Here, we present a hydro-levitation superspreading approach for fabricating polymer nanomembranes with ordered crystalline phases and sub-nanostructures on the water surface. The elastic piezoelectric nanomembrane (EPN) is only 335 nanometers thick and consists of a conductance-stable piezoelectric layer sandwiched between two elastic damping layers. Such an all-in-one EPN can reduce background noise with low autocorrelation in the environment, suppress spurious noise caused by poor circuit contact, and achieve bandpass filtering of acoustic signals at human voice frequencies. This nanomembrane holds promise in repairing the auditory system of patients with tympanic membrane perforation and in a wide range of other acoustoelectric conversion fields.
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Affiliation(s)
- Jialin Zhang
- State Key Laboratory for Modification of Chemical Fibers and Polymer Materials, College of Chemistry and Chemical Engineering, Donghua University, 2999 North Renmin Road, Shanghai, 201620, China
| | - Yanjun Liu
- State Key Laboratory for Modification of Chemical Fibers and Polymer Materials, College of Chemistry and Chemical Engineering, Donghua University, 2999 North Renmin Road, Shanghai, 201620, China.
| | - Peiyi Wu
- State Key Laboratory for Modification of Chemical Fibers and Polymer Materials, College of Chemistry and Chemical Engineering, Donghua University, 2999 North Renmin Road, Shanghai, 201620, China.
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2
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Xue H, Chen S, Hu Y, Huang J, Shen Y. Advances in 3D printing for the repair of tympanic membrane perforation: a comprehensive review. Front Bioeng Biotechnol 2024; 12:1439499. [PMID: 39188376 PMCID: PMC11345550 DOI: 10.3389/fbioe.2024.1439499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2024] [Accepted: 07/19/2024] [Indexed: 08/28/2024] Open
Abstract
Tympanic membrane perforation (TMP) is one of the most common conditions in otolaryngology worldwide, and hearing damage caused by inadequate or prolonged healing can be distressing for patients. This article examines the rationale for utilizing three-dimensional (3D) printing to produce scaffolds for repairing TMP, compares the advantages and disadvantages of 3D printed and bioprinted grafts with traditional autologous materials and other tissue engineering materials in TMP repair, and highlights the practical and clinical significance of 3D printing in TMP repair while discussing the current progress and promising future of 3D printing and bioprinting. There is a limited number of reviews specifically dedicated to 3D printing for TMP repair. The majority of reviews offer a general overview of the applications of 3D printing in the broader realm of tissue regeneration, with some mention of TMP repair. Alternatively, they explore the biopolymers, cells, and drug molecules utilized for TMP repair. However, more in-depth analysis is needed on the strategies for selecting bio-inks that integrate biopolymers, cells, and drug molecules for tympanic membrane repair.
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Affiliation(s)
- Hao Xue
- Ningbo Institute of Innovation for Combined Medicine and Engineering, The Affiliated Lihuili Hospital of Ningbo University, Ningbo, Zhejiang, China
- School of Medicine, Ningbo University, Ningbo, Zhejiang, China
| | - Shengjia Chen
- Ningbo Institute of Innovation for Combined Medicine and Engineering, The Affiliated Lihuili Hospital of Ningbo University, Ningbo, Zhejiang, China
- School of Medicine, Ningbo University, Ningbo, Zhejiang, China
| | - Yi Hu
- Ningbo Institute of Innovation for Combined Medicine and Engineering, The Affiliated Lihuili Hospital of Ningbo University, Ningbo, Zhejiang, China
| | - Juntao Huang
- Ningbo Institute of Innovation for Combined Medicine and Engineering, The Affiliated Lihuili Hospital of Ningbo University, Ningbo, Zhejiang, China
| | - Yi Shen
- Ningbo Institute of Innovation for Combined Medicine and Engineering, The Affiliated Lihuili Hospital of Ningbo University, Ningbo, Zhejiang, China
- School of Medicine, Ningbo University, Ningbo, Zhejiang, China
- Centre for Medical Research, Ningbo No.2 Hospital, Ningbo, Zhejiang, China
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3
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Anand S, Fusco A, Günday C, Günday-Türeli N, Donnarumma G, Danti S, Moroni L, Mota C. Tunable ciprofloxacin delivery through personalized electrospun patches for tympanic membrane perforations. Bioact Mater 2024; 38:109-123. [PMID: 38699239 PMCID: PMC11063525 DOI: 10.1016/j.bioactmat.2024.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Revised: 03/17/2024] [Accepted: 04/01/2024] [Indexed: 05/05/2024] Open
Abstract
Approximately 740 million symptomatic patients are affected by otitis media every year. Being an inflammatory disease affecting the middle ear, it is one of the primary causes of tympanic membrane (TM) perforations, often resulting in impaired hearing abilities. Antibiotic therapy using broad-spectrum fluoroquinolones, such as ciprofloxacin (CIP), is frequently employed and considered the optimal route to treat otitis media. However, patients often get exposed to high dosages to compensate for the low drug concentration reaching the affected site. Therefore, this study aims to integrate tissue engineering with drug delivery strategies to create biomimetic scaffolds promoting TM regeneration while facilitating a localized release of CIP. Distinct electrospinning (ES) modalities were designed in this regard either by blending CIP into the polymer ES solution or by incorporating nanoparticles-based co-ES/electrospraying. The combination of these modalities was investigated as well. A broad range of release kinetic profiles was achieved from the fabricated scaffolds, thereby offering a wide spectrum of antibiotic concentrations that could serve patients with diverse therapeutic needs. Furthermore, the incorporation of CIP into the TM patches demonstrated a favorable influence on their resultant mechanical properties. Biological studies performed with human mesenchymal stromal cells confirmed the absence of any cytotoxic or anti-proliferative effects from the released antibiotic. Finally, antibacterial assays validated the efficacy of CIP-loaded scaffolds in suppressing bacterial infections, highlighting their promising relevance for TM applications.
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Affiliation(s)
- Shivesh Anand
- Department of Complex Tissue Regeneration, MERLN Institute for Technology-Inspired Regenerative Medicine, Maastricht University, 6229 ER, Maastricht, the Netherlands
| | - Alessandra Fusco
- Interuniversity National Consortiums of Materials Science and Technology (INSTM), 50121, Firenze, Italy
- Department of Experimental Medicine, University of Campania “Luigi Vanvitelli”, 80138, Naples, Italy
| | - Cemre Günday
- MyBiotech GmbH, Industriestraße 1B, 66802, Uberherrn, Germany
| | | | - Giovanna Donnarumma
- Interuniversity National Consortiums of Materials Science and Technology (INSTM), 50121, Firenze, Italy
- Department of Experimental Medicine, University of Campania “Luigi Vanvitelli”, 80138, Naples, Italy
| | - Serena Danti
- Interuniversity National Consortiums of Materials Science and Technology (INSTM), 50121, Firenze, Italy
- Department of Civil and Industrial Engineering, University of Pisa, 56122, Pisa, Italy
| | - Lorenzo Moroni
- Department of Complex Tissue Regeneration, MERLN Institute for Technology-Inspired Regenerative Medicine, Maastricht University, 6229 ER, Maastricht, the Netherlands
| | - Carlos Mota
- Department of Complex Tissue Regeneration, MERLN Institute for Technology-Inspired Regenerative Medicine, Maastricht University, 6229 ER, Maastricht, the Netherlands
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4
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Kim S, Goo W, Karima G, Lee JH, Kim HD. Polyacrylamide/Gel-Based Self-Healing Artificial Tympanic Membrane for Drug Delivery of Otitis Treatment. Biomater Res 2024; 28:0049. [PMID: 38952716 PMCID: PMC11214819 DOI: 10.34133/bmr.0049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Accepted: 05/26/2024] [Indexed: 07/03/2024] Open
Abstract
One of the bacterial infections caused by tympanic membrane perforation is otitis media (OM). Middle ear inflammation causes continuous pain and can be accompanied by aftereffects such as facial nerve paralysis if repeated chronically. Therefore, it is necessary to develop an artificial tympanic membrane (TM) that can effectively regenerate the eardrum due to the easy implantation and removal of OM inflammation. In this study, we synthesized hydrogel by mixing gelatin and polyacrylamide. Cefuroxime sodium salt was then incorporated into this hydrogel to both regenerate the TM and treat OM. Cytotoxicity experiments confirmed the biocompatibility of hydrogels equipped with antibiotics, and we conducted drug release and antibacterial experiments to examine continuous drug release. Through experiments, we have verified the excellent biocompatibility, drug release ability, and antibacterial effectiveness of hydrogel. It holds the potential to serve as an effective strategy for treating OM and regenerating TM as a drug delivery substance.
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Affiliation(s)
- Sujin Kim
- Department of IT Convergence (Brain Korea Plus 21),
Korea National University of Transportation, Chungju, 27469, Republic of Korea
| | - Woonhoe Goo
- Department of Otorhinolaryngology-Head and Neck Surgery,
Seoul National University Hospital, Seoul, 03080, Republic of Korea
| | - Gul Karima
- Department of Polymer Science and Engineering,
Korea National University of Transportation, Chungju, 27469, Republic of Korea
| | - Jun Ho Lee
- Department of Otorhinolaryngology-Head and Neck Surgery,
Seoul National University Hospital, Seoul, 03080, Republic of Korea
| | - Hwan D. Kim
- Department of IT Convergence (Brain Korea Plus 21),
Korea National University of Transportation, Chungju, 27469, Republic of Korea
- Department of Polymer Science and Engineering,
Korea National University of Transportation, Chungju, 27469, Republic of Korea
- Department of Biomedical Engineering,
Korea National University of Transportation, Chungju, 27469, Republic of Korea
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5
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Azimi B, Rasti A, Fusco A, Macchi T, Ricci C, Hosseinifard MA, Guazzelli L, Donnarumma G, Bagherzadeh R, Latifi M, Roy I, Danti S, Lazzeri A. Bacterial Cellulose Electrospun Fiber Mesh Coated with Chitin Nanofibrils for Eardrum Repair. Tissue Eng Part A 2024; 30:340-356. [PMID: 37962275 DOI: 10.1089/ten.tea.2023.0242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2023] Open
Abstract
In this study, we develop a bio-based and bioactive nanofibrous patch based on bacterial cellulose (BC) and chitin nanofibrils (CNs) using an ionic liquid as a solvent for BC, aimed at tympanic membrane (TM) repair. Electrospun BC nanofiber meshes were produced via electrospinning, and surface-modified with CNs using electrospray. The rheology of the BC/ionic liquid system was investigated. The obtained CN/BC meshes underwent comprehensive morphological, physicochemical, and mechanical characterization. Cytotoxicity tests were conducted using L929 mouse fibroblasts, revealing a cell viability of 97.8%. In vivo tests on rabbit skin demonstrated that the patches were nonirritating. Furthermore, the CN/BC fiber meshes were tested in vitro using human dermal keratinocytes (HaCaT cells) and human umbilical vein endothelial cells as model cells for TM perforation healing. Both cell types demonstrated successful growth on these scaffolds. The presence of CNs resulted in improved indirect antimicrobial activity of the electrospun fiber meshes. HaCaT cells exhibited an upregulated mRNA expression at 6 and 24 h of key proinflammatory cytokines crucial for the wound healing process, indicating the potential benefits of CNs in the healing response. Overall, this study presents a natural and eco-sustainable fiber mesh with great promise for applications in TM repair, leveraging the synergistic effects of BC and CNs to possibly enhance tissue regeneration and healing. Impact statement Repair of tympanic membrane perforations following chronic otitis media is a main clinical issue in otologic surgery, where the underlying infection obstacles self-healing. To address this challenge, our study proposes a bio-based patch made of nanoscale carbohydrate materials (i.e., bacterial cellulose electrospun fibers and chitin nanofibrils) processed via green solvents. The scaffold is nonirritating in vivo, and cytocompatible with fibroblasts, endothelial cells, and keratinocytes. In epithelial cells, it stimulates the expression of the antimicrobial peptide human beta defensin 2, with a pathway of cytokine expression compatible with the wound healing process. Therefore, it could be applied with unsolved infective pathology.
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Affiliation(s)
- Bahareh Azimi
- Department of Civil and Industrial Engineering, University of Pisa, Pisa, Italy
| | - Atefeh Rasti
- Department of Textile Engineering, Amirkabir University of Technology, Tehran, Iran
| | - Alessandra Fusco
- Department of Experimental Medicine, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Teresa Macchi
- Department of Translational Researches and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Claudio Ricci
- Department of Civil and Industrial Engineering, University of Pisa, Pisa, Italy
| | | | | | - Giovanna Donnarumma
- Department of Experimental Medicine, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Roohollah Bagherzadeh
- Institute for Advanced Textile Materials and Technologies (ATMT), Amirkabir University of Technology, Tehran, Iran
| | - Masoud Latifi
- Department of Textile Engineering, Amirkabir University of Technology, Tehran, Iran
| | - Ipsita Roy
- Department of Materials Science and Engineering, University of Sheffield, Sheffield, United Kingdom
| | - Serena Danti
- Department of Civil and Industrial Engineering, University of Pisa, Pisa, Italy
| | - Andrea Lazzeri
- Department of Civil and Industrial Engineering, University of Pisa, Pisa, Italy
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Lou Z, Li C, Yu D, Wang J, Chen Z, Yin S. Comparison of healing of acute total tympanic membrane perforation between rats with and without excision of the mallear handle. Laryngoscope Investig Otolaryngol 2023; 8:1648-1656. [PMID: 38130269 PMCID: PMC10731538 DOI: 10.1002/lio2.1175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 09/15/2023] [Accepted: 10/06/2023] [Indexed: 12/23/2023] Open
Abstract
Objective We compared the histological changes and hearing restoration during the healing of acute total tympanic membrane (TM) perforations between Sprague-Dawley (SD) rats with and without excision of the mallear handle. Materials and methods Bilateral, acute, and total TM perforations were created in 36 male SD rats. The mallear handle was preserved in the left ear (handle-preserved ear [HPE]) and excised from the right ear (handle-excised ear [HEE]). Endoscopical examination, auditory brainstem response (ABR) thresholds, histopathological, and scanning electron microscope (SEM) analysis were performed. Results Endoscopic photographs showed that all perforations in the 18 SD rats were closed. The mean closure times were 6.83 ± 0.85 and 8.50 ± 0.71 days in the HPE and HEE groups, respectively (p < .001). SEM images showed radial arrangement of fiber bundles in a single direction in HPEs, although normal arrangement was not achieved. In contrast, HEEs showed disorganized arrangement. At 1 month after perforation closure, the ABR thresholds at high frequencies were significantly higher in the HEE group than in the HPE group (p = .029 and p = .017 for 16 and 32 kHz, respectively). Additionally, the changes in ABR threshold were significantly different at high frequencies (p = .011 and p = .017 for 16 and 32 kHz, respectively) before and 1 month after perforation closure between the HPE and HEE groups, although the differences were not statistically significant at the remaining frequencies. Conclusion Although the malleus handle may not affect the closure of total perforation in SD rats, it contributes to accelerate the perforation closure by possible guide the migration of proliferative epithelial cell on the upper halves of the annulus. Additionally, resection of the malleus handle impairs high frequency hearing recovery following spontaneous closure of the TM.
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Affiliation(s)
- Zihan Lou
- Department of Otolaryngology‐Head and Neck SurgeryShanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of MedicineShanghaiChina
- Department of Otolaryngology‐Head and Neck Surgery & Center of Sleep MedicineShanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of MedicineShanghaiChina
- Otolaryngological Institute of Shanghai Jiao Tong UniversityShanghaiChina
- Shanghai Key Lab Sleep Disordered BreathingShanghaiChina
| | - Chunyan Li
- Department of Otolaryngology‐Head and Neck SurgeryShanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of MedicineShanghaiChina
- Department of Otolaryngology‐Head and Neck Surgery & Center of Sleep MedicineShanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of MedicineShanghaiChina
- Otolaryngological Institute of Shanghai Jiao Tong UniversityShanghaiChina
- Shanghai Key Lab Sleep Disordered BreathingShanghaiChina
| | - Dongzhen Yu
- Department of Otolaryngology‐Head and Neck SurgeryShanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of MedicineShanghaiChina
- Department of Otolaryngology‐Head and Neck Surgery & Center of Sleep MedicineShanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of MedicineShanghaiChina
- Otolaryngological Institute of Shanghai Jiao Tong UniversityShanghaiChina
- Shanghai Key Lab Sleep Disordered BreathingShanghaiChina
| | - Jingjing Wang
- Department of Otolaryngology‐Head and Neck SurgeryShanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of MedicineShanghaiChina
- Department of Otolaryngology‐Head and Neck Surgery & Center of Sleep MedicineShanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of MedicineShanghaiChina
- Otolaryngological Institute of Shanghai Jiao Tong UniversityShanghaiChina
- Shanghai Key Lab Sleep Disordered BreathingShanghaiChina
| | - Zhengnong Chen
- Department of Otolaryngology‐Head and Neck SurgeryShanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of MedicineShanghaiChina
- Department of Otolaryngology‐Head and Neck Surgery & Center of Sleep MedicineShanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of MedicineShanghaiChina
- Otolaryngological Institute of Shanghai Jiao Tong UniversityShanghaiChina
- Shanghai Key Lab Sleep Disordered BreathingShanghaiChina
| | - Shankai Yin
- Department of Otolaryngology‐Head and Neck SurgeryShanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of MedicineShanghaiChina
- Department of Otolaryngology‐Head and Neck Surgery & Center of Sleep MedicineShanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of MedicineShanghaiChina
- Otolaryngological Institute of Shanghai Jiao Tong UniversityShanghaiChina
- Shanghai Key Lab Sleep Disordered BreathingShanghaiChina
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Steuer S, Morgenstern J, Kirsten L, Bornitz M, Neudert M, Koch E, Golde J. In vivo microstructural investigation of the human tympanic membrane by endoscopic polarization-sensitive optical coherence tomography. JOURNAL OF BIOMEDICAL OPTICS 2023; 28:121203. [PMID: 37007626 PMCID: PMC10050973 DOI: 10.1117/1.jbo.28.12.121203] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Accepted: 02/27/2023] [Indexed: 06/19/2023]
Abstract
SIGNIFICANCE Endoscopic optical coherence tomography (OCT) is of growing interest for in vivo diagnostics of the tympanic membrane (TM) and the middle ear but generally lacks a tissue-specific contrast. AIM To assess the collagen fiber layer within the in vivo TM, an endoscopic imaging method utilizing the polarization changes induced by the birefringent connective tissue was developed. APPROACH An endoscopic swept-source OCT setup was redesigned and extended by a polarization-diverse balanced detection unit. Polarization-sensitive OCT (PS-OCT) data were visualized by a differential Stokes-based processing and the derived local retardation. The left and right ears of a healthy volunteer were examined. RESULTS Distinct retardation signals in the annulus region of the TM and near the umbo revealed the layered structure of the TM. Due to the TM's conical shape and orientation in the ear canal, high incident angles onto the TM's surface, and low thicknesses compared to the axial resolution limit of the system, other regions of the TM were more difficult to evaluate. CONCLUSIONS The use of endoscopic PS-OCT is feasible to differentiate birefringent and nonbirefringent tissue of the human TM in vivo. Further investigations on healthy as well as pathologically altered TMs are required to validate the diagnostic potential of this technique.
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Affiliation(s)
- Svea Steuer
- TU Dresden, Department of Medical Physics and Biomedical Engineering, Faculty of Medicine, Dresden, Germany
- TU Dresden, Anesthesiology and Intensive Care Medicine, Clinical Sensoring and Monitoring, Faculty of Medicine, Dresden, Germany
| | - Joseph Morgenstern
- TU Dresden, Otorhinolaryngology, Ear Research Center Dresden, Faculty of Medicine, Dresden, Germany
- TU Dresden, Else Kröner-Fresenius Center for Digital Health, Dresden, Germany
| | - Lars Kirsten
- TU Dresden, Department of Medical Physics and Biomedical Engineering, Faculty of Medicine, Dresden, Germany
| | - Matthias Bornitz
- TU Dresden, Otorhinolaryngology, Ear Research Center Dresden, Faculty of Medicine, Dresden, Germany
| | - Marcus Neudert
- TU Dresden, Otorhinolaryngology, Ear Research Center Dresden, Faculty of Medicine, Dresden, Germany
- TU Dresden, Else Kröner-Fresenius Center for Digital Health, Dresden, Germany
| | - Edmund Koch
- TU Dresden, Anesthesiology and Intensive Care Medicine, Clinical Sensoring and Monitoring, Faculty of Medicine, Dresden, Germany
- TU Dresden, Else Kröner-Fresenius Center for Digital Health, Dresden, Germany
| | - Jonas Golde
- TU Dresden, Department of Medical Physics and Biomedical Engineering, Faculty of Medicine, Dresden, Germany
- TU Dresden, Else Kröner-Fresenius Center for Digital Health, Dresden, Germany
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von Witzleben M, Stoppe T, Zeinalova A, Chen Z, Ahlfeld T, Bornitz M, Bernhardt A, Neudert M, Gelinsky M. Multimodal additive manufacturing of biomimetic tympanic membrane replacements with near tissue-like acousto-mechanical and biological properties. Acta Biomater 2023; 170:124-141. [PMID: 37696412 DOI: 10.1016/j.actbio.2023.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 08/08/2023] [Accepted: 09/05/2023] [Indexed: 09/13/2023]
Abstract
The three additive manufacturing techniques fused deposition modeling, gel plotting and melt electrowriting were combined to develop a mimicry of the tympanic membrane (TM) to tackle large TM perforations caused by chronic otitis media. The mimicry of the collagen fiber orientation of the TM was accompanied by a study of multiple funnel-shaped mimics of the TM morphology, resulting in mechanical and acoustic properties similar to those of the eardrum. For the different 3D printing techniques used, the process parameters were optimized to allow reasonable microfiber arrangements within the melt electrowriting setup. Interestingly, the fiber pattern was less important for the acousto-mechanical properties than the overall morphology. Furthermore, the behavior of keratinocytes and fibroblasts is crucial for the repair of the TM, and an in vitro study showed a high biocompatibility of both primary cell types while mimicking the respective cell layers of the TM. A simulation of the in vivo ingrowth of both cell types resulted in a cell growth orientation similar to the original collagen fiber orientation of the TM. Overall, the combined approach showed all the necessary parameters to support the growth of a neo-epithelial layer with a similar structure and morphology to the original membrane. It therefore offers a suitable alternative to autologous materials for the treatment of chronic otitis media. STATEMENT OF SIGNIFICANCE: Millions of people worldwide suffer from chronic middle ear infections. Although the tympanic membrane (TM) can be reconstructed with autologous materials, the grafts used for this purpose require extensive manual preparation during surgery. This affects not only the hearing ability but also the stability of the reconstructed TM, especially in the case of full TM reconstruction. The synthetic alternative presented here mimicked not only the fibrous structure of the TM but also its morphology, resulting in similar acousto-mechanical properties. Furthermore, its high biocompatibility supported the migration of keratinocytes and fibroblasts to form a neo-epithelial layer. Overall, this completely new TM replacement was achieved by combining three different additive manufacturing processes.
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Affiliation(s)
- Max von Witzleben
- Technische Universität Dresden, Faculty of Medicine Carl Gustav Dresden, Centre for Translational Bone, Joint and Soft Tissue Research, Fetscherstr. 74, 01307 Dresden, Germany
| | - Thomas Stoppe
- Technische Universität Dresden, Faculty of Medicine Carl Gustav Carus, Department of Otorhinolaryngology, Head and Neck Surgery, Ear Research Center Dresden (ERCD), Fetscherstr. 74, 01307 Dresden, Germany
| | - Alina Zeinalova
- Technische Universität Dresden, Faculty of Medicine Carl Gustav Dresden, Centre for Translational Bone, Joint and Soft Tissue Research, Fetscherstr. 74, 01307 Dresden, Germany
| | - Zhaoyu Chen
- Technische Universität Dresden, Faculty of Medicine Carl Gustav Carus, Department of Otorhinolaryngology, Head and Neck Surgery, Ear Research Center Dresden (ERCD), Fetscherstr. 74, 01307 Dresden, Germany
| | - Tilman Ahlfeld
- Technische Universität Dresden, Faculty of Medicine Carl Gustav Dresden, Centre for Translational Bone, Joint and Soft Tissue Research, Fetscherstr. 74, 01307 Dresden, Germany
| | - Matthias Bornitz
- Technische Universität Dresden, Faculty of Medicine Carl Gustav Carus, Department of Otorhinolaryngology, Head and Neck Surgery, Ear Research Center Dresden (ERCD), Fetscherstr. 74, 01307 Dresden, Germany
| | - Anne Bernhardt
- Technische Universität Dresden, Faculty of Medicine Carl Gustav Dresden, Centre for Translational Bone, Joint and Soft Tissue Research, Fetscherstr. 74, 01307 Dresden, Germany
| | - Marcus Neudert
- Technische Universität Dresden, Faculty of Medicine Carl Gustav Carus, Department of Otorhinolaryngology, Head and Neck Surgery, Ear Research Center Dresden (ERCD), Fetscherstr. 74, 01307 Dresden, Germany
| | - Michael Gelinsky
- Technische Universität Dresden, Faculty of Medicine Carl Gustav Dresden, Centre for Translational Bone, Joint and Soft Tissue Research, Fetscherstr. 74, 01307 Dresden, Germany.
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Chitin nanofibrils modulate mechanical response in tympanic membrane replacements. Carbohydr Polym 2023; 310:120732. [PMID: 36925264 DOI: 10.1016/j.carbpol.2023.120732] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 02/02/2023] [Accepted: 02/18/2023] [Indexed: 02/25/2023]
Abstract
The tympanic membrane (TM), is a thin tissue lying at the intersection of the outer and the middle ear. TM perforations caused by traumas and infections often result in a conductive hearing loss. Tissue engineering has emerged as a promising approach for reconstructing the damaged TM by replicating the native material characteristics. In this regard, chitin nanofibrils (CN), a polysaccharide-derived nanomaterial, is known to exhibit excellent biocompatibility, immunomodulation and antimicrobial activity, thereby imparting essential qualities for an optimal TM regeneration. This work investigates the application of CN as a nanofiller for poly(ethylene oxide terephthalate)/poly(butylene terephthalate) (PEOT/PBT) copolymer to manufacture clinically suitable TM scaffolds using electrospinning and fused deposition modelling. The inclusion of CN within the PEOT/PBT matrix showed a three-fold reduction in the corresponding electrospun fiber diameters and demonstrated a significant improvement in the mechanical properties required for TM repair. Furthermore, in vitro biodegradation assay highlighted a favorable influence of CN in accelerating the scaffold degradation over a period of one year. Finally, the oto- and cytocompatibility response of the nanocomposite substrates corroborated their biological relevance for the reconstruction of perforated eardrums.
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10
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Del Toro Runzer C, Anand S, Mota C, Moroni L, Plank C, van Griensven M, Balmayor ER. Cellular uptake of modified mRNA occurs via caveolae-mediated endocytosis, yielding high protein expression in slow-dividing cells. MOLECULAR THERAPY. NUCLEIC ACIDS 2023; 32:960-979. [PMID: 37305166 PMCID: PMC10250585 DOI: 10.1016/j.omtn.2023.05.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Accepted: 05/17/2023] [Indexed: 06/13/2023]
Abstract
Nucleic acids have clear clinical potential for gene therapy. Plasmid DNA (pDNA) was the first nucleic acid to be pursued as a therapeutic molecule. Recently, mRNA came into play as it offers improved safety and affordability. In this study, we investigated the uptake mechanisms and efficiencies of genetic material by cells. We focused on three main variables (1) the nucleic acid (pDNA, or chemically modified mRNA), (2) the delivery vector (Lipofectamine 3000 or 3DFect), and (3) human primary cells (mesenchymal stem cells, dermal fibroblasts, and osteoblasts). In addition, transfections were studied in a 3D environment using electrospun scaffolds. Cellular internalization and intracellular trafficking were assessed by using enhancers or inhibitors of endocytosis and endosomal escape. The polymeric vector TransIT-X2 was included for comparison purposes. While lipoplexes utilized several entry routes, uptake via caveolae served as the main route for gene delivery. pDNA yielded higher expression levels in fast-dividing fibroblasts, whereas, in slow-dividing osteoblasts, cmRNA was responsible for high protein production. In the case of mesenchymal stem cells, which presented an intermediate doubling time, the combination vector/nucleic acid seemed more relevant than the nucleic acid per se. In all cases, protein expression was higher when the cells were seeded on 3D scaffolds.
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Affiliation(s)
- Claudia Del Toro Runzer
- Department of Cell Biology-Inspired Tissue Engineering, MERLN Institute for Technology-Inspired Regenerative Medicine, 6229 ER Maastricht, the Netherlands
| | - Shivesh Anand
- Department of Complex Tissue Regeneration, MERLN Institute for Technology-Inspired Regenerative Medicine, 6229 ER Maastricht, the Netherlands
| | - Carlos Mota
- Department of Complex Tissue Regeneration, MERLN Institute for Technology-Inspired Regenerative Medicine, 6229 ER Maastricht, the Netherlands
| | - Lorenzo Moroni
- Department of Complex Tissue Regeneration, MERLN Institute for Technology-Inspired Regenerative Medicine, 6229 ER Maastricht, the Netherlands
| | | | - Martijn van Griensven
- Department of Cell Biology-Inspired Tissue Engineering, MERLN Institute for Technology-Inspired Regenerative Medicine, 6229 ER Maastricht, the Netherlands
- Musculoskeletal Gene Therapy Laboratory, Rehabilitation Medicine Research Center, Mayo Clinic, Rochester, MN 55905, USA
| | - Elizabeth R. Balmayor
- Musculoskeletal Gene Therapy Laboratory, Rehabilitation Medicine Research Center, Mayo Clinic, Rochester, MN 55905, USA
- Experimental Orthopaedics and Trauma Surgery, Department of Orthopaedic, Trauma, and Reconstructive Surgery, RWTH Aachen University Hospital, 52074 Aachen, Germany
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11
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Hu H, Chen J, Li S, Xu T, Li Y. 3D printing technology and applied materials in eardrum regeneration. JOURNAL OF BIOMATERIALS SCIENCE, POLYMER EDITION 2022; 34:950-985. [PMID: 36373498 DOI: 10.1080/09205063.2022.2147350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Tympanic membrane perforation is a common condition in clinical otolaryngology. Although some eardrum patients can self-heal, a long period of non-healing perforation leads to persistent otitis media, conductive deafness, and poor quality of life. Tympanic membrane repair with autologous materials requires a second incision, and the sampling site may get infected. It is challenging to repair tympanic membranes while maintaining high functionality, safety, affordability, and aesthetics. 3D bioprinting can be used to fabricate tissue patches with materials, factors, and cells in a design manner. This paper reviews 3D printing technology that is being used widely in recent years to construct eardrum stents and the utilized applied materials for tympanic membrane repair. The paper begins with an introduction of the physiological structure of the tympanic membrane, briefly reviews the current clinical method thereafter, highlights the recent 3D printing-related strategies in tympanic membrane repair, describes the materials and cells that might play an important role in 3D printing, and finally provides a perspective of this field.
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Affiliation(s)
- Haolei Hu
- Department of Otolaryngology, the 988th Hospital of the Joint Support Force of the Chinese People’s Liberation Army, Zhengzhou City 450042, Henan Province, China
| | - Jianwei Chen
- Bio-intelligent Manufacturing and Living Matter Bioprinting Center, Research Institute of Tsinghua University in Shenzhen, Tsinghua University, Shenzhen, 518057, People’s Republic of China
| | - Shuo Li
- Xinxiang Medical College, Xinxiang,453003, Henan Province, China
| | - Tao Xu
- Bio-intelligent Manufacturing and Living Matter Bioprinting Center, Research Institute of Tsinghua University in Shenzhen, Tsinghua University, Shenzhen, 518057, People’s Republic of China
| | - Yi Li
- Department of Otolaryngology, the 988th Hospital of the Joint Support Force of the Chinese People’s Liberation Army, Zhengzhou City 450042, Henan Province, China
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12
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Li C, Xiong Z, Zhou L, Huang W, He Y, Li L, Shi H, Lu J, Wang J, Li D, Yin S. Interfacing Perforated Eardrums with Graphene-Based Membranes for Broadband Hearing Recovery. Adv Healthc Mater 2022; 11:e2201471. [PMID: 35899802 PMCID: PMC11469052 DOI: 10.1002/adhm.202201471] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2022] [Indexed: 01/28/2023]
Abstract
Eardrum perforation and associated hearing loss is a global health problem. Grafting perforated eardrum with autologous tissues in clinic can restore low-frequency hearing but often leaves poor recovery of high-frequency hearing. In this study, the potential of incorporating a thin multilayered graphene membrane (MGM) into the eardrum for broadband hearing recovery in rats is examined. The MGM shows good biocompatibility and biostability to promote the growth of eardrum cells in a regulated manner with little sign of tissue rejection and inflammatory response. After three weeks of implantation, the MGM is found to be encapsulated by a thin layer of newly grown tissue on both sides without a significant folded overgrowth that is often seen in natural healing. The perforation is well sealed, and broadband hearing recovery (1-32 kHz) is enabled and maintained for at least 2 months. Mechanical simulations show that the high elastic modulus of MGM and thin thickness of the reconstructed eardrum play a critical role in the recovery of high-frequency hearing. This work demonstrates the promise of the use of MGM as a functional graft for perforated eardrum to recover hearing in the broadband frequency region and suggests a new acoustics-related medical application for graphene-related 2D materials.
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Affiliation(s)
- Chunyan Li
- Department of OtorhinolaryngologyShanghai Jiao Tong University Affiliated Sixth People's HospitalShanghai200233China
| | - Zhiyuan Xiong
- Department of Chemical EngineeringThe University of MelbourneMelbourneVictoria3010Australia
| | - Lei Zhou
- Department of Otorhinolaryngology‐Head and Neck SurgeryZhongshan Hospital affiliated to Fudan UniversityShanghai200032China
| | | | - Yushi He
- Shanghai Electrochemical Energy Devices Research CenterSchool of Chemistry and Chemical EngineeringShanghai Jiao Tong UniversityShanghai200240China
| | - Linpeng Li
- Department of OtorhinolaryngologyShanghai Jiao Tong University Affiliated Sixth People's HospitalShanghai200233China
| | - Haibo Shi
- Department of OtorhinolaryngologyShanghai Jiao Tong University Affiliated Sixth People's HospitalShanghai200233China
| | - Jiayu Lu
- Department of StomatologyShanghai Jiao Tong University Affiliated Sixth People's HospitalShanghai200233China
| | - Jian Wang
- School of Communication Science and DisordersDalhousie UniversityHalifaxB3J 1Y6Canada
| | - Dan Li
- Department of Chemical EngineeringThe University of MelbourneMelbourneVictoria3010Australia
| | - Shankai Yin
- Department of OtorhinolaryngologyShanghai Jiao Tong University Affiliated Sixth People's HospitalShanghai200233China
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13
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Benecke L, Chen Z, Zeidler-Rentzsch I, von Witzleben M, Bornitz M, Zahnert T, Neudert M, Cherif C, Aibibu D. Development of electrospun, biomimetic tympanic membrane implants with tunable mechanical and oscillatory properties for myringoplasty. Biomater Sci 2022; 10:2287-2301. [PMID: 35363238 DOI: 10.1039/d1bm01815a] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Most commonly, autologous grafts are used in tympanic membrane (TM) reconstruction. However, apart from the limited availability and the increased surgical risk, they cannot replicate the full functionality of the human TM properly. Hence, biomimetic synthetic TM implants have been developed in our project to overcome these drawbacks. These innovative TM implants are made from synthetic biopolymer polycaprolactone (PCL) and silk fibroin (SF) by electrospinning technology. Static and dynamic experiments have shown that the mechanical and oscillatory behavior of the TM implants can be tuned by adjusting the solution concentration, the SF and PCL mixing ratio and the electrospinning parameters. In addition, candidates for TM implants could have comparable acousto-mechanical properties to human TMs. Finally, these candidates were further validated in in vitro experiments by performing TM reconstruction in human cadaver temporal bones. The reconstructed TM with SF-PCL blend membranes fully recovered the acoustic vibration when the perforation was smaller than 50%. Furthermore, the handling, medium adhesion and transparency of the developed TM implants were similar to those of human TMs.
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Affiliation(s)
- Lukas Benecke
- Technische Universität Dresden, Faculty of Mechanical Science and Engineering, Institute of Textile Machinery and High Performance Material Technology, Breitscheidstraße 78, 01237 Dresden, Germany.
| | - Zhaoyu Chen
- Technische Universität Dresden, Carl Gustav Carus Faculty of Medicine, Department of Otorhinolaryngology, Head and Neck Surgery, Ear Research Center Dresden, Fetscherstraße 74, 01307 Dresden, Germany
| | - Ines Zeidler-Rentzsch
- Technische Universität Dresden, Carl Gustav Carus Faculty of Medicine, Department of Otorhinolaryngology, Head and Neck Surgery, Ear Research Center Dresden, Fetscherstraße 74, 01307 Dresden, Germany
| | - Max von Witzleben
- Technische Universität Dresden, Carl Gustav Carus Faculty of Medicine, Center for Translational Bone, Joint and Soft Tissue Research, Fetscherstraße 74, 01307 Dresden, Germany
| | - Matthias Bornitz
- Technische Universität Dresden, Carl Gustav Carus Faculty of Medicine, Department of Otorhinolaryngology, Head and Neck Surgery, Ear Research Center Dresden, Fetscherstraße 74, 01307 Dresden, Germany
| | - Thomas Zahnert
- Technische Universität Dresden, Carl Gustav Carus Faculty of Medicine, Department of Otorhinolaryngology, Head and Neck Surgery, Ear Research Center Dresden, Fetscherstraße 74, 01307 Dresden, Germany
| | - Marcus Neudert
- Technische Universität Dresden, Carl Gustav Carus Faculty of Medicine, Department of Otorhinolaryngology, Head and Neck Surgery, Ear Research Center Dresden, Fetscherstraße 74, 01307 Dresden, Germany
| | - Chokri Cherif
- Technische Universität Dresden, Faculty of Mechanical Science and Engineering, Institute of Textile Machinery and High Performance Material Technology, Breitscheidstraße 78, 01237 Dresden, Germany.
| | - Dilbar Aibibu
- Technische Universität Dresden, Faculty of Mechanical Science and Engineering, Institute of Textile Machinery and High Performance Material Technology, Breitscheidstraße 78, 01237 Dresden, Germany.
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14
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Xiaoli Z, Jian Z, Peiran T, Xiang C. The latest progress of tympanic membrane repair materials. Am J Otolaryngol 2022; 43:103408. [DOI: 10.1016/j.amjoto.2022.103408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Accepted: 02/13/2022] [Indexed: 11/01/2022]
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15
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Danti S, Anand S, Azimi B, Milazzo M, Fusco A, Ricci C, Zavagna L, Linari S, Donnarumma G, Lazzeri A, Moroni L, Mota C, Berrettini S. Chitin Nanofibril Application in Tympanic Membrane Scaffolds to Modulate Inflammatory and Immune Response. Pharmaceutics 2021; 13:pharmaceutics13091440. [PMID: 34575515 PMCID: PMC8468799 DOI: 10.3390/pharmaceutics13091440] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Revised: 09/04/2021] [Accepted: 09/05/2021] [Indexed: 01/25/2023] Open
Abstract
Chitin nanofibrils (CNs) are an emerging bio-based nanomaterial. Due to nanometric size and high crystallinity, CNs lose the allergenic features of chitin and interestingly acquire anti-inflammatory activity. Here we investigate the possible advantageous use of CNs in tympanic membrane (TM) scaffolds, as they are usually implanted inside highly inflamed tissue environment due to underlying infectious pathologies. In this study, the applications of CNs in TM scaffolds were twofold. A nanocomposite was used, consisting of poly(ethylene oxide terephthalate)/poly(butylene terephthalate) (PEOT/PBT) copolymer loaded with CN/polyethylene glycol (PEG) pre-composite at 50/50 (w/w %) weight ratio, and electrospun into fiber scaffolds, which were coated by CNs from crustacean or fungal sources via electrospray. The degradation behavior of the scaffolds was investigated during 4 months at 37 °C in an otitis-simulating fluid. In vitro tests were performed using cell types to mimic the eardrum, i.e., human mesenchymal stem cells (hMSCs) for connective, and human dermal keratinocytes (HaCaT cells) for epithelial tissues. HMSCs were able to colonize the scaffolds and produce collagen type I. The inflammatory response of HaCaT cells in contact with the CN-coated scaffolds was investigated, revealing a marked downregulation of the pro-inflammatory cytokines. CN-coated PEOT/PBT/(CN/PEG 50:50) scaffolds showed a significant indirect antimicrobial activity.
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Affiliation(s)
- Serena Danti
- Interuniversity National Consortiums of Materials Science and Technology (INSTM), 50121 Firenze, Italy; (B.A.); (M.M.); (A.F.); (C.R.); (L.Z.); (G.D.); (A.L.); (S.B.)
- Department of Civil and Industrial Engineering, University of Pisa, 56122 Pisa, Italy
- Correspondence: (S.D.); (C.M.)
| | - Shivesh Anand
- Department of Complex Tissue Regeneration, MERLN Institute for Technology-Inspired Regenerative Medicine, Maastricht University, 6229 ER Maastricht, The Netherlands; (S.A.); (L.M.)
| | - Bahareh Azimi
- Interuniversity National Consortiums of Materials Science and Technology (INSTM), 50121 Firenze, Italy; (B.A.); (M.M.); (A.F.); (C.R.); (L.Z.); (G.D.); (A.L.); (S.B.)
- Department of Civil and Industrial Engineering, University of Pisa, 56122 Pisa, Italy
| | - Mario Milazzo
- Interuniversity National Consortiums of Materials Science and Technology (INSTM), 50121 Firenze, Italy; (B.A.); (M.M.); (A.F.); (C.R.); (L.Z.); (G.D.); (A.L.); (S.B.)
- The BioRobotics Institute, Scuola Superiore Sant’Anna, Viale Rinaldo Piaggio 34, 56025 Pontedera, Italy
| | - Alessandra Fusco
- Interuniversity National Consortiums of Materials Science and Technology (INSTM), 50121 Firenze, Italy; (B.A.); (M.M.); (A.F.); (C.R.); (L.Z.); (G.D.); (A.L.); (S.B.)
- Department of Experimental Medicine, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy
| | - Claudio Ricci
- Interuniversity National Consortiums of Materials Science and Technology (INSTM), 50121 Firenze, Italy; (B.A.); (M.M.); (A.F.); (C.R.); (L.Z.); (G.D.); (A.L.); (S.B.)
- Department of Surgical, Medical, Molecular Pathology and Emergency Medicine, University of Pisa, 56126 Pisa, Italy
| | - Lorenzo Zavagna
- Interuniversity National Consortiums of Materials Science and Technology (INSTM), 50121 Firenze, Italy; (B.A.); (M.M.); (A.F.); (C.R.); (L.Z.); (G.D.); (A.L.); (S.B.)
- Linari Engineering s.r.l., 56121 Pisa, Italy;
| | | | - Giovanna Donnarumma
- Interuniversity National Consortiums of Materials Science and Technology (INSTM), 50121 Firenze, Italy; (B.A.); (M.M.); (A.F.); (C.R.); (L.Z.); (G.D.); (A.L.); (S.B.)
- Department of Experimental Medicine, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy
| | - Andrea Lazzeri
- Interuniversity National Consortiums of Materials Science and Technology (INSTM), 50121 Firenze, Italy; (B.A.); (M.M.); (A.F.); (C.R.); (L.Z.); (G.D.); (A.L.); (S.B.)
- Department of Civil and Industrial Engineering, University of Pisa, 56122 Pisa, Italy
| | - Lorenzo Moroni
- Department of Complex Tissue Regeneration, MERLN Institute for Technology-Inspired Regenerative Medicine, Maastricht University, 6229 ER Maastricht, The Netherlands; (S.A.); (L.M.)
| | - Carlos Mota
- Department of Complex Tissue Regeneration, MERLN Institute for Technology-Inspired Regenerative Medicine, Maastricht University, 6229 ER Maastricht, The Netherlands; (S.A.); (L.M.)
- Correspondence: (S.D.); (C.M.)
| | - Stefano Berrettini
- Interuniversity National Consortiums of Materials Science and Technology (INSTM), 50121 Firenze, Italy; (B.A.); (M.M.); (A.F.); (C.R.); (L.Z.); (G.D.); (A.L.); (S.B.)
- Department of Surgical, Medical, Molecular Pathology and Emergency Medicine, University of Pisa, 56126 Pisa, Italy
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