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Sharma Y, Shankar V. Technologies for the fabrication of crosslinked polysaccharide-based hydrogels and its role in microbial three-dimensional bioprinting - A review. Int J Biol Macromol 2023; 250:126194. [PMID: 37562476 DOI: 10.1016/j.ijbiomac.2023.126194] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 07/22/2023] [Accepted: 08/05/2023] [Indexed: 08/12/2023]
Abstract
Three-Dimensional bioprinting has recently gained more attraction among researchers for its wide variety of applicability. This technology involving in developing structures that mimic the natural anatomy, and also aims in developing novel biomaterials, bioinks which have a better printable ability. Different hydrogels (cross-linked polysaccharides) can be used and optimized for good adhesion and cell proliferation. Manufacturing hydrogels with adjustable characteristics allows for fine-tuning of the cellular microenvironment. Different printing technologies can be used to create hydrogels on a micro-scale which will allow regular, patterned integration of cells into hydrogels. Controlling tissue constructions' structural architecture is the important key to ensuring its function as it is designed. The designed tiny hydrogels will be useful in investigating the cellular behaviour within the environments. Three-Dimensional designs can be constructed by modifying their shape and behaviour analogous concerning pressure, heat, electricity, ultraviolet radiation or other environmental elements. Yet, its application in in vitro infection models needs more research and practical study. Microbial bioprinting has become an advancing field with promising potential to develop various biomedical as well as environmental applications. This review elucidates the properties and usage of different hydrogels for Three-Dimensional bioprinting.
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Affiliation(s)
- Yamini Sharma
- School of Biosciences and Technology, Vellore Institute of Technology, Vellore - 14, India
| | - Vijayalakshmi Shankar
- CO(2) Research and Green Technologies Centre, Vellore Institute of Technology, Vellore - 14, India.
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Chen X, Zhou J, Qian Y, Zhao L. Antibacterial coatings on orthopedic implants. Mater Today Bio 2023; 19:100586. [PMID: 36896412 PMCID: PMC9988588 DOI: 10.1016/j.mtbio.2023.100586] [Citation(s) in RCA: 21] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 02/01/2023] [Accepted: 02/14/2023] [Indexed: 02/17/2023] Open
Abstract
With the aging of population and the rapid improvement of public health and medical level in recent years, people have had an increasing demand for orthopedic implants. However, premature implant failure and postoperative complications frequently occur due to implant-related infections, which not only increase the social and economic burden, but also greatly affect the patient's quality of life, finally restraining the clinical use of orthopedic implants. Antibacterial coatings, as an effective strategy to solve the above problems, have been extensively studied and motivated the development of novel strategies to optimize the implant. In this paper, a variety of antibacterial coatings recently developed for orthopedic implants were briefly reviewed, with the focus on the synergistic multi-mechanism antibacterial coatings, multi-functional antibacterial coatings, and smart antibacterial coatings that are more potential for clinical use, thereby providing theoretical references for further fabrication of novel and high-performance coatings satisfying the complex clinical needs.
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Affiliation(s)
- Xionggang Chen
- Institute of Physics & Optoelectronics Technology, Baoji Advanced Titanium Alloys and Functional Coatings Cooperative Innovation Center, Baoji University of Arts and Sciences, Baoji, 721016, PR China
| | - Jianhong Zhou
- Institute of Physics & Optoelectronics Technology, Baoji Advanced Titanium Alloys and Functional Coatings Cooperative Innovation Center, Baoji University of Arts and Sciences, Baoji, 721016, PR China
| | - Yu Qian
- Institute of Physics & Optoelectronics Technology, Baoji Advanced Titanium Alloys and Functional Coatings Cooperative Innovation Center, Baoji University of Arts and Sciences, Baoji, 721016, PR China
| | - LingZhou Zhao
- Department of Stomatology, Air Force Medical Center, The Fourth Military Medical University, Beijing, 100142, PR China
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Serrano-Aroca Á, Cano-Vicent A, Sabater i Serra R, El-Tanani M, Aljabali A, Tambuwala MM, Mishra YK. Scaffolds in the microbial resistant era: Fabrication, materials, properties and tissue engineering applications. Mater Today Bio 2022; 16:100412. [PMID: 36097597 PMCID: PMC9463390 DOI: 10.1016/j.mtbio.2022.100412] [Citation(s) in RCA: 27] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 08/23/2022] [Accepted: 08/24/2022] [Indexed: 11/08/2022] Open
Abstract
Due to microbial infections dramatically affect cell survival and increase the risk of implant failure, scaffolds produced with antimicrobial materials are now much more likely to be successful. Multidrug-resistant infections without suitable prevention strategies are increasing at an alarming rate. The ability of cells to organize, develop, differentiate, produce a functioning extracellular matrix (ECM) and create new functional tissue can all be controlled by careful control of the extracellular microenvironment. This review covers the present state of advanced strategies to develop scaffolds with antimicrobial properties for bone, oral tissue, skin, muscle, nerve, trachea, cardiac and other tissue engineering applications. The review focuses on the development of antimicrobial scaffolds against bacteria and fungi using a wide range of materials, including polymers, biopolymers, glass, ceramics and antimicrobials agents such as antibiotics, antiseptics, antimicrobial polymers, peptides, metals, carbon nanomaterials, combinatorial strategies, and includes discussions on the antimicrobial mechanisms involved in these antimicrobial approaches. The toxicological aspects of these advanced scaffolds are also analyzed to ensure future technological transfer to clinics. The main antimicrobial methods of characterizing scaffolds’ antimicrobial and antibiofilm properties are described. The production methods of these porous supports, such as electrospinning, phase separation, gas foaming, the porogen method, polymerization in solution, fiber mesh coating, self-assembly, membrane lamination, freeze drying, 3D printing and bioprinting, among others, are also included in this article. These important advances in antimicrobial materials-based scaffolds for regenerative medicine offer many new promising avenues to the material design and tissue-engineering communities. Antibacterial, antifungal and antibiofilm scaffolds. Antimicrobial scaffold fabrication techniques. Antimicrobial biomaterials for tissue engineering applications. Antimicrobial characterization methods of scaffolds. Bone, oral tissue, skin, muscle, nerve, trachea, cardiac, among other applications.
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Xiong Y, Wang L, Xu W, Li L, Tang Y, Shi C, Li X, Niu Y, Sun C, Ren C. Electrostatic induced peptide hydrogel containing PHMB for sustained antibacterial activity. J Drug Deliv Sci Technol 2022. [DOI: 10.1016/j.jddst.2022.103717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Andersen C, Madsen J, Daugaard AE. A Synthetic Overview of Preparation Protocols of Nonmetallic, Contact-Active Antimicrobial Quaternary Surfaces on Polymer Substrates. Macromol Rapid Commun 2021; 42:e2100437. [PMID: 34491589 DOI: 10.1002/marc.202100437] [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: 07/09/2021] [Revised: 08/27/2021] [Indexed: 11/07/2022]
Abstract
Antibacterial surfaces have been researched for more than 30 years and remain highly desirable. In particular, there is an interest in providing antimicrobial properties to commodity plastics, because these, in their native state, are excellent substrates for pathogens to adhere and proliferate on. Therefore, efficient strategies for converting surfaces of commodity plastics into contact-active antimicrobial surfaces are of significant interest. Many systems have been prepared and tested for their efficacy. Here, the synthetic approaches to such active surfaces are reviewed, with the restriction to only include systems with tested antibacterial properties. The review focuses on the synthetic approach to surface functionalization of the most common materials used and tested for biomedical applications, which effectively has limited the study to quaternary materials. For future developments in the field, it is evident that there is a need for development of simple methods that permit scalable production of active surfaces. Furthermore, in terms of efficacy, there is an outstanding concern of a lack of universal antimicrobial action as well as rapid deactivation of the antibacterial effect through surface fouling.
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Affiliation(s)
- Christian Andersen
- Department of Chemical and Biochemical Engineering, Technical University of Denmark, DTU, Søltofts Plads, building 229, Kgs. Lyngby, 2800, Denmark.,Coloplast A/S, Holtedam 1-3, Humlebaek, 3050, Denmark
| | - Jeppe Madsen
- Department of Chemical and Biochemical Engineering, Technical University of Denmark, DTU, Søltofts Plads, building 229, Kgs. Lyngby, 2800, Denmark
| | - Anders E Daugaard
- Department of Chemical and Biochemical Engineering, Technical University of Denmark, DTU, Søltofts Plads, building 229, Kgs. Lyngby, 2800, Denmark
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Zanocco M, Boschetto F, Zhu W, Marin E, McEntire BJ, Bal BS, Adachi T, Yamamoto T, Kanamura N, Ohgitani E, Yamamoto K, Mazda O, Pezzotti G. 3D-additive deposition of an antibacterial and osteogenic silicon nitride coating on orthopaedic titanium substrate. J Mech Behav Biomed Mater 2019; 103:103557. [PMID: 32090951 DOI: 10.1016/j.jmbbm.2019.103557] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2019] [Revised: 11/07/2019] [Accepted: 11/25/2019] [Indexed: 12/29/2022]
Abstract
A 3D-additive manufacturing approach produced a dense Si3N4 ceramic coating on a biomedical grade commercially pure titanium (cp-Ti) substrate by an automatic laser-sintering procedure. Si3N4 coatings could be prepared with thicknesses from the single to the tens of microns. A coating thickness, t = 15 ± 5 μm, was selected for this study, based on projections of homogeneity and scratching resistance. The Si3N4 coating met the 20 N threshold required for biomaterial applications, according to the standard scratch testing (ASTM C1624-05). The Si3N4 coating imparted both the antibacterial and osteogenic properties of bulk Si3N4 to the cp-Ti substrate. Both properties were comparable to those previously described for bulk Si3N4 biomedical implants. The newly developed Si3N4-coating was applied to commercially available Ti-alloy acetabular shells for total hip arthroplasty. A "glowing" test based on luciferase gene transformation was applied to visualize the colonization of gram-negative Escherichia coli on Si3N4-coated and uncoated Ti-alloy acetabular shells. The results showed that the coating technology conferred resistance to Staphylococcus epidermidis and Escherichia coli adhesion onto the bulk acetabular sockets.
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Affiliation(s)
- Matteo Zanocco
- Ceramic Physics Laboratory, Kyoto Institute of Technology, Sakyo-ku, Matsugasaki, Kyoto, 606-8585, Japan; Department of Immunology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kamigyo-ku, 465 Kajii-cho, Kyoto, 602-8566, Japan
| | - Francesco Boschetto
- Ceramic Physics Laboratory, Kyoto Institute of Technology, Sakyo-ku, Matsugasaki, Kyoto, 606-8585, Japan; Department of Immunology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kamigyo-ku, 465 Kajii-cho, Kyoto, 602-8566, Japan
| | - Wenliang Zhu
- Ceramic Physics Laboratory, Kyoto Institute of Technology, Sakyo-ku, Matsugasaki, Kyoto, 606-8585, Japan
| | - Elia Marin
- Ceramic Physics Laboratory, Kyoto Institute of Technology, Sakyo-ku, Matsugasaki, Kyoto, 606-8585, Japan; Department of Dental Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kamigyo-ku, Kyoto, 602-8566, Japan
| | - Bryan J McEntire
- SINTX Technologies Corporation, 1885 West 2100 South, Salt Lake City, UT, 84119, USA
| | - B Sonny Bal
- SINTX Technologies Corporation, 1885 West 2100 South, Salt Lake City, UT, 84119, USA
| | - Tetsuya Adachi
- Department of Dental Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kamigyo-ku, Kyoto, 602-8566, Japan
| | - Toshiro Yamamoto
- Department of Dental Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kamigyo-ku, Kyoto, 602-8566, Japan
| | - Narisato Kanamura
- Department of Dental Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kamigyo-ku, Kyoto, 602-8566, Japan
| | - Eriko Ohgitani
- Department of Immunology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kamigyo-ku, 465 Kajii-cho, Kyoto, 602-8566, Japan
| | - Kengo Yamamoto
- Department of Orthopedic Surgery, Tokyo Medical University, 6-7-1 Nishi-Shinjuku, Shinjuku-ku, 160-0023, Tokyo, Japan
| | - Osam Mazda
- Department of Immunology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kamigyo-ku, 465 Kajii-cho, Kyoto, 602-8566, Japan
| | - Giuseppe Pezzotti
- Ceramic Physics Laboratory, Kyoto Institute of Technology, Sakyo-ku, Matsugasaki, Kyoto, 606-8585, Japan; Department of Immunology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kamigyo-ku, 465 Kajii-cho, Kyoto, 602-8566, Japan; Department of Orthopedic Surgery, Tokyo Medical University, 6-7-1 Nishi-Shinjuku, Shinjuku-ku, 160-0023, Tokyo, Japan; The Center for Advanced Medical Engineering and Informatics, Osaka University, 2-2 Yamadaoka, Suita, Osaka, 565-0854, Japan.
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Pan C, Zhou Z, Yu X. Coatings as the useful drug delivery system for the prevention of implant-related infections. J Orthop Surg Res 2018; 13:220. [PMID: 30176886 PMCID: PMC6122451 DOI: 10.1186/s13018-018-0930-y] [Citation(s) in RCA: 59] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2017] [Accepted: 08/22/2018] [Indexed: 12/13/2022] Open
Abstract
Implant-related infections (IRIs) which led to a large amount of medical expenditure were caused by bacteria and fungi that involve the implants in the operation or in ward. Traditional treatments of IRIs were comprised of repeated radical debridement, replacement of internal fixators, and intravenous antibiotics. It needed a long time and numbers of surgeries to cure, which meant a catastrophe to patients. So how to prevent it was more important than to cure it. As an excellent local release system, coating is a good idea by its local drug infusion and barrier effect on resisting biofilms which were the main cause of IRIs. So in this review, materials used for coatings and evidences of prevention were elaborated.
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Affiliation(s)
- Chenhao Pan
- Department of Orthopaedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai, 200233 China
| | - Zubin Zhou
- Department of Orthopaedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai, 200233 China
| | - Xiaowei Yu
- Department of Orthopaedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai, 200233 China
- Department of Orthopaedic Surgery, Shanghai Sixth People’s Hospital East Campus, Shanghai University of Medicine and Health Sciences, Shanghai, 201306 China
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Zhang J, Allardyce BJ, Rajkhowa R, Zhao Y, Dilley RJ, Redmond SL, Wang X, Liu X. 3D Printing of Silk Particle-Reinforced Chitosan Hydrogel Structures and Their Properties. ACS Biomater Sci Eng 2018; 4:3036-3046. [DOI: 10.1021/acsbiomaterials.8b00804] [Citation(s) in RCA: 61] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Affiliation(s)
- Jun Zhang
- Deakin University, Institute for Frontier Materials, Geelong, 75 Pigdons Road, Waurn Ponds, Victoria 3216, Australia
| | - Benjamin J. Allardyce
- Deakin University, Institute for Frontier Materials, Geelong, 75 Pigdons Road, Waurn Ponds, Victoria 3216, Australia
| | - Rangam Rajkhowa
- Deakin University, Institute for Frontier Materials, Geelong, 75 Pigdons Road, Waurn Ponds, Victoria 3216, Australia
| | - Yan Zhao
- College of Textile and Clothing Engineering, Soochow University, Suzhou 215123, China
| | - Rodney J. Dilley
- Ear Science Institute Australia, 8 Verdun Street, Nedlands, Western Australia 6009, Australia
| | - Sharon L. Redmond
- Ear Science Institute Australia, 8 Verdun Street, Nedlands, Western Australia 6009, Australia
| | - Xungai Wang
- Deakin University, Institute for Frontier Materials, Geelong, 75 Pigdons Road, Waurn Ponds, Victoria 3216, Australia
| | - Xin Liu
- Deakin University, Institute for Frontier Materials, Geelong, 75 Pigdons Road, Waurn Ponds, Victoria 3216, Australia
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Mi G, Shi D, Wang M, Webster TJ. Reducing Bacterial Infections and Biofilm Formation Using Nanoparticles and Nanostructured Antibacterial Surfaces. Adv Healthc Mater 2018; 7:e1800103. [PMID: 29790304 DOI: 10.1002/adhm.201800103] [Citation(s) in RCA: 101] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2018] [Revised: 03/29/2018] [Indexed: 02/02/2023]
Abstract
With the rapid spreading of resistance among common bacterial pathogens, bacterial infections, especially antibiotic-resistant bacterial infections, have drawn much attention worldwide. In light of this, nanoparticles, including metal and metal oxide nanoparticles, liposomes, polymersomes, and solid lipid nanoparticles, have been increasingly exploited as both efficient antimicrobials themselves or as delivery platforms to enhance the effectiveness of existing antibiotics. In addition to the emergence of widespread antibiotic resistance, of equal concern are implantable device-associated infections, which result from bacterial adhesion and subsequent biofilm formation at the site of implantation. The ineffectiveness of conventional antibiotics against these biofilms often leads to revision surgery, which is both debilitating to the patient and expensive. Toward this end, micro- and nanotopographies, especially those that resemble natural surfaces, and nonfouling chemistries represent a promising combination for long-term antibacterial activity. Collectively, the use of nanoparticles and nanostructured surfaces to combat bacterial growth and infections is a promising solution to the growing problem of antibiotic resistance and biofilm-related device infections.
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Affiliation(s)
- Gujie Mi
- Department of Chemical Engineering; 313 Snell Engineering Center; Northeastern University; 360 Huntington Avenue Boston MA 02115 USA
| | - Di Shi
- Department of Chemical Engineering; 313 Snell Engineering Center; Northeastern University; 360 Huntington Avenue Boston MA 02115 USA
| | - Mian Wang
- Department of Chemical Engineering; 313 Snell Engineering Center; Northeastern University; 360 Huntington Avenue Boston MA 02115 USA
| | - Thomas J. Webster
- Department of Chemical Engineering; 313 Snell Engineering Center; Northeastern University; 360 Huntington Avenue Boston MA 02115 USA
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Zhang Y, Zhai D, Xu M, Yao Q, Zhu H, Chang J, Wu C. 3D-printed bioceramic scaffolds with antibacterial and osteogenic activity. Biofabrication 2017. [PMID: 28631614 DOI: 10.1088/1758-5090/aa6ed6] [Citation(s) in RCA: 70] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Bacterial infection poses a significant risk with the wide application of bone graft materials. Designing bone grafts with good antibacterial performance and excellent bone-forming activity is of particular significance for bone tissue engineering. In our study, a 3D printing method was used to prepare β-tricalcium phosphate (β-TCP) bioceramic scaffolds. Silver (Ag) nanoparticles were uniformly dispersed on graphene oxide (GO) to form a homogeneous nanocomposite (named Ag@GO) with different Ag-to-graphene oxide mass ratios, with this being synthesized via the liquid chemical reduction approach. Ag@GO nanocomposites were successfully modified on the β-TCP scaffolds by a simple soaking method to achieve bifunctional biomaterials with antibacterial and osteogenic activity. The prepared scaffolds possessed a connected network with triangle pore morphology and the surfaces of the β-TCP scaffolds were uniformly modified by the Ag@GO nanocomposite layers. The Ag content in the scaffolds was controlled by changing the coating times and concentration of the Ag@GO nanocomposites. The antibacterial activity of the scaffolds was assessed with Gram-negative bacteria (Escherichia coli, E. coli). The results demonstrated that the scaffolds with Ag@GO nanocomposites presented excellent antibacterial activity. In addition, the scaffolds coated with Ag@GO nanocomposites conspicuously accelerated the osteogenic differentiation of rabbit bone marrow stromal cells by improving their alkaline phosphatase activity and bone-related gene expression (osteopontin, runt-related transcription factor 2, osteocalcin and bone sialoprotein). This study demonstrates that bifunctional scaffolds with a combination of antibacterial and osteogenic activity can be achieved for the reconstruction of large-bone defects while preventing or treating infections.
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Affiliation(s)
- Yongliang Zhang
- State Key Laboratory of High Performance Ceramics and Superfine Microstructure, Shanghai Institute of Ceramics, Chinese Academy of Sciences, Shanghai 200050, People's Republic of China. Shanghai Engineering Research Center of Single Crystal Silicon Carbide, Shanghai Institute of Ceramics, Chinese Academy of Sciences, Shanghai 200050, People's Republic of China
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Malizos K, Blauth M, Danita A, Capuano N, Mezzoprete R, Logoluso N, Drago L, Romanò CL. Fast-resorbable antibiotic-loaded hydrogel coating to reduce post-surgical infection after internal osteosynthesis: a multicenter randomized controlled trial. J Orthop Traumatol 2017; 18:159-169. [PMID: 28155060 PMCID: PMC5429256 DOI: 10.1007/s10195-017-0442-2] [Citation(s) in RCA: 64] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2016] [Accepted: 12/31/2016] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Infection is one of the main reasons for failure of orthopedic implants. Antibacterial coatings may prevent bacterial adhesion and biofilm formation, according to various preclinical studies. The aim of the present study is to report the first clinical trial on an antibiotic-loaded fast-resorbable hydrogel coating (Defensive Antibacterial Coating, DAC®) to prevent surgical site infection, in patients undergoing internal osteosynthesis for closed fractures. MATERIALS AND METHODS In this multicenter randomized controlled prospective study, a total of 256 patients in five European orthopedic centers who were scheduled to receive osteosynthesis for a closed fracture, were randomly assigned to receive antibiotic-loaded DAC or to a control group (without coating). Pre- and postoperative assessment of laboratory tests, wound healing, clinical scores and X-rays were performed at fixed time intervals. RESULTS Overall, 253 patients were available with a mean follow-up of 18.1 ± 4.5 months (range 12-30). On average, wound healing, clinical scores, laboratory tests and radiographic findings did not show any significant difference between the two groups. Six surgical site infections (4.6%) were observed in the control group compared to none in the treated group (P < 0.03). No local or systemic side-effects related to the DAC hydrogel product were observed and no detectable interference with bone healing was noted. CONCLUSIONS The use of a fast-resorbable antibiotic-loaded hydrogel implant coating provides a reduced rate of post-surgical site infections after internal osteosynthesis for closed fractures, without any detectable adverse event or side-effects. LEVEL OF EVIDENCE 2.
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Affiliation(s)
- Kostantinos Malizos
- Orthopaedic Surgery and Trauma, Medical School, University of Thessaly, Larissa, Greece
| | - Michael Blauth
- Department for Trauma Surgery, Medical University, Innsbruck, Austria
| | - Adrian Danita
- Department for Trauma Surgery, Medical University, Innsbruck, Austria
| | - Nicola Capuano
- Department for Orthopaedics, San Luca Hospital, Vallo Della Lucania, Italy
| | | | - Nicola Logoluso
- Department of Reconstructive Surgery of Osteo-articular Infections CRIO Unit, IRCCS Galeazzi Orthopaedic Institute, Via R. Galeazzi 4, 20161 Milan, Italy
| | - Lorenzo Drago
- Laboratory of Clinical Chemistry and Microbiology, IRCCS Galeazzi Orthopaedic Institute, Milan, Italy
- Laboratory of Medical Technical Sciences, Department of Biochemical Sciences for Health, University of Milano, Milan, Italy
| | - Carlo Luca Romanò
- Department of Reconstructive Surgery of Osteo-articular Infections CRIO Unit, IRCCS Galeazzi Orthopaedic Institute, Via R. Galeazzi 4, 20161 Milan, Italy
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Romanò CL, Malizos K, Capuano N, Mezzoprete R, D'Arienzo M, Van Der Straeten C, Scarponi S, Drago L. Does an Antibiotic-Loaded Hydrogel Coating Reduce Early Post-Surgical Infection After Joint Arthroplasty? J Bone Jt Infect 2016; 1:34-41. [PMID: 28529851 PMCID: PMC5423565 DOI: 10.7150/jbji.15986] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2016] [Accepted: 07/02/2016] [Indexed: 01/17/2023] Open
Abstract
Background: Infection remains among the main reasons for joint prosthesis failure. Preclinical reports have suggested that antibacterial coatings of implants may prevent bacterial adhesion and biofilm formation. This study presents the results of the first clinical trial on an antibiotic-loaded fast-resorbable hydrogel coating (Defensive Antibacterial Coating, DAC®) in patients undergoing hip or knee prosthesis. Methods: In this multicenter, randomized prospective study, a total of 380 patients, scheduled to undergo primary (n=270) or revision (n=110) total hip (N=298) or knee (N=82) joint replacement with a cementless or a hybrid implant, were randomly assigned, in six European orthopedic centers, to receive an implant either with the antibiotic-loaded DAC coating (treatment group) or without coating (control group). Pre- and postoperative assessment of clinical scores, wound healing, laboratory tests, and x-ray exams were performed at fixed time intervals. Results: Overall, 373 patients were available at a mean follow-up of 14.5 ± 5.5 months (range 6 to 24). On average, wound healing, laboratory and radiographic findings showed no significant difference between the two groups. Eleven early surgical site infections were observed in the control group and only one in the treatment group (6% vs. 0.6%; p=0.003). No local or systemic side effects related to the DAC hydrogel coating were observed, and no detectable interference with implant osteointegration was noted. Conclusions: The use of a fast-resorbable, antibiotic-loaded hydrogel implant coating can reduce the rate of early surgical site infections, without any detectable adverse events or side effects after hip or knee joint replacement with a cementless or hybrid implant.
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Affiliation(s)
- Carlo Luca Romanò
- Department of Reconstructive Surgery of Osteo-articular Infections C.R.I.O. Unit, I.R.C.C.S. Galeazzi Orthopaedic Institute, Milano, Italy
| | - Kostantinos Malizos
- Orthopaedic Surgery & Trauma, Medical School, University of Thessaly, Larissa, Greece
| | - Nicola Capuano
- Department of Orthopaedics, San Luca Hospital - Vallo della Lucania, Italy
| | | | | | - Catherine Van Der Straeten
- Department of Orthopaedics, Medical University Ghent, Belgium.,MSK Lab, Department of Surgery and Cancer, Imperial College London, London, United Kingdom
| | - Sara Scarponi
- Department of Reconstructive Surgery of Osteo-articular Infections C.R.I.O. Unit, I.R.C.C.S. Galeazzi Orthopaedic Institute, Milano, Italy
| | - Lorenzo Drago
- Clinical Chemistry and Microbiology Laboratory, I.R.C.C.S. Galeazzi Orthopaedic Institute, Milano, Italy.,Laboratory of Medical Technical Sciences, Department of Biochemical Sciences for Health, University of Milano, Italy
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Controlling cell adhesion using layer-by-layer approaches for biomedical applications. MATERIALS SCIENCE & ENGINEERING. C, MATERIALS FOR BIOLOGICAL APPLICATIONS 2016; 70:1163-1175. [PMID: 27772718 DOI: 10.1016/j.msec.2016.03.074] [Citation(s) in RCA: 71] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/11/2016] [Revised: 03/16/2016] [Accepted: 03/21/2016] [Indexed: 12/11/2022]
Abstract
Controlling the adhesion of mammalian and bacterial cells at the interfaces between synthetic materials and biological environments is a real challenge in the biomedical fields such as tissue engineering, antibacterial coating, implantable biomaterials and biosensors. The surface properties of materials are known to profoundly influence the adhesion processes. To mediate the adhesion processes, polymeric coatings have been used to functionalize surfaces to introduce diverse physicochemical properties. The polyelectrolyte multilayer films built via the layer-by-layer (LbL) method, introduced by Moehwald, Decher, and Lvov 20years ago, has led to significant developments ranging from the fundamental understanding of cellular processes to controlling cell adhesion for biomedical applications. In this review, we focus our attention on the modification of surface physicochemical properties, using the LbL approach, to construct films which can either promote or inhibit mammalian/bacterial cell adhesion. We also discuss the emerging field of multifunctional surfaces capable of responding to specific cellular activity but being inert to the others.
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Gentile P, Carmagnola I, Nardo T, Chiono V. Layer-by-layer assembly for biomedical applications in the last decade. NANOTECHNOLOGY 2015; 26:422001. [PMID: 26421916 DOI: 10.1088/0957-4484/26/42/422001] [Citation(s) in RCA: 81] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
In the past two decades, the design and manufacture of nanostructured materials has been of tremendous interest to the scientific community for their application in the biomedical field. Among the available techniques, layer-by-layer (LBL) assembly has attracted considerable attention as a convenient method to fabricate functional coatings. Nowadays, more than 1000 scientific papers are published every year, tens of patents have been deposited and some commercial products based on LBL technology have become commercially available. LBL presents several advantages, such as (1): a precise control of the coating properties; (2) environmentally friendly, mild conditions and low-cost manufacturing; (3) versatility for coating all available surfaces; (4) obtainment of homogeneous film with controlled thickness; and (5) incorporation and controlled release of biomolecules/drugs. This paper critically reviews the scientific challenge of the last 10 years--functionalizing biomaterials by LBL to obtain appropriate properties for biomedical applications, in particular in tissue engineering (TE). The analysis of the state-of-the-art highlights the current techniques and the innovative materials for scaffold and medical device preparation that are opening the way for the preparation of LBL-functionalized substrates capable of modifying their surface properties for modulating cell interaction to improve substitution, repair or enhancement of tissue function.
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Affiliation(s)
- P Gentile
- School of Clinical Dentistry, University of Sheffield, 19 Claremont Crescent, Sheffield S10 2TA, UK
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Romanò CL, Scarponi S, Gallazzi E, Romanò D, Drago L. Antibacterial coating of implants in orthopaedics and trauma: a classification proposal in an evolving panorama. J Orthop Surg Res 2015; 10:157. [PMID: 26429342 PMCID: PMC4591707 DOI: 10.1186/s13018-015-0294-5] [Citation(s) in RCA: 168] [Impact Index Per Article: 18.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2015] [Accepted: 09/16/2015] [Indexed: 02/07/2023] Open
Abstract
Implanted biomaterials play a key role in current success of orthopedic and trauma surgery. However, implant-related infections remain among the leading reasons for failure with high economical and social associated costs. According to the current knowledge, probably the most critical pathogenic event in the development of implant-related infection is biofilm formation, which starts immediately after bacterial adhesion on an implant and effectively protects the microorganisms from the immune system and systemic antibiotics. A rationale, modern prevention of biomaterial-associated infections should then specifically focus on inhibition of both bacterial adhesion and biofilm formation. Nonetheless, currently available prophylactic measures, although partially effective in reducing surgical site infections, are not based on the pathogenesis of biofilm-related infections and unacceptable high rates of septic complications, especially in high-risk patients and procedures, are still reported.In the last decade, several studies have investigated the ability of implant surface modifications to minimize bacterial adhesion, inhibit biofilm formation, and provide effective bacterial killing to protect implanted biomaterials, even if there still is a great discrepancy between proposed and clinically implemented strategies and a lack of a common language to evaluate them.To move a step forward towards a more systematic approach in this promising but complicated field, here we provide a detailed overview and an original classification of the various technologies under study or already in the market. We may distinguish the following: 1. Passive surface finishing/modification (PSM): passive coatings that do not release bactericidal agents to the surrounding tissues, but are aimed at preventing or reducing bacterial adhesion through surface chemistry and/or structure modifications; 2. Active surface finishing/modification (ASM): active coatings that feature pharmacologically active pre-incorporated bactericidal agents; and 3. Local carriers or coatings (LCC): local antibacterial carriers or coatings, biodegradable or not, applied at the time of the surgical procedure, immediately prior or at the same time of the implant and around it. Classifying different technologies may be useful in order to better compare different solutions, to improve the design of validation tests and, hopefully, to improve and speed up the regulatory process in this rapidly evolving field.
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Affiliation(s)
- Carlo Luca Romanò
- Department of Reconstructive Surgery of Osteo-articular Infections C.R.I.O. Unit, IRCCS Galeazzi Orthopaedic Institute, Via R. Galeazzi 4, 20161, Milan, Italy.
| | - Sara Scarponi
- Department of Reconstructive Surgery of Osteo-articular Infections C.R.I.O. Unit, IRCCS Galeazzi Orthopaedic Institute, Via R. Galeazzi 4, 20161, Milan, Italy.
| | - Enrico Gallazzi
- Department of Reconstructive Surgery of Osteo-articular Infections C.R.I.O. Unit, IRCCS Galeazzi Orthopaedic Institute, Via R. Galeazzi 4, 20161, Milan, Italy.
| | - Delia Romanò
- Department of Reconstructive Surgery of Osteo-articular Infections C.R.I.O. Unit, IRCCS Galeazzi Orthopaedic Institute, Via R. Galeazzi 4, 20161, Milan, Italy.
| | - Lorenzo Drago
- Laboratory of Clinical Chemistry and Microbiology, I.R.C.C.S. Galeazzi Orthopaedic Institute, Milan, Italy.
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Abstract
The addition of specific proteins or growth factors onto sutures would provide a direct application of exogenous factors to promote tissue repair. The higher levels of growth factors and cytokines may optimize the healing environment and promote tissue recovery. Despite this proposed benefit, the current orthopedic literature on the use of coated sutures is limited. Although several of the published studies investigating healing improvement by coated sutures have shown promising results, these data are only based on in vitro or small animal experiments. Recent meta-analyses have reported positive effects of triclosan-coated antimicrobial sutures in regards to reduction of surgical site complications. However, biologically coated sutures are not yet widely accepted due to several unanswered questions (concentration, release kinematics, tissue reactions, etc.) in addition to the high costs of such products. Further studies are needed to demonstrate the efficacy of coated sutures in orthopedic surgery.
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Topuz F, Möller M, Groll J. Covalently layer-by-layer assembled homogeneous nanolayers with switchable wettability. Polym Chem 2015. [DOI: 10.1039/c5py00515a] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
A layer-by-layer growth through alternating chemisorption of isocyanate functional star-shaped polyethers (NCO-sP(EO-stat-PO)) and a linear polymer ((PVFA-co-PVAm)) is described.
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Affiliation(s)
- Fuat Topuz
- DWI-Leibniz Institute for Interactive Materials
- RWTH Aachen University
- 52074 Aachen
- Germany
| | - Martin Möller
- DWI-Leibniz Institute for Interactive Materials
- RWTH Aachen University
- 52074 Aachen
- Germany
| | - Jürgen Groll
- Department of Functional Materials in Medicine and Dentistry
- University of Würzburg
- 97070 Würzburg
- Germany
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Mei Y, Yao C, Li X. A simple approach to constructing antibacterial and anti-biofouling nanofibrous membranes. BIOFOULING 2014; 30:313-322. [PMID: 24558981 DOI: 10.1080/08927014.2013.871540] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
In this work, antibacterial and anti-adhesive polymeric thin films were constructed on polyacrylonitrile (PAN) nanofibrous membranes in order to extend their applications. Polyhexamethylene guanidine hydrochloride (PHGH) as an antibacterial agent and heparin (HP) as an anti-adhesive agent have been successfully coated onto the membranes via a layer-by-layer (LBL) assembly technique confirmed by attenuated total reflectance Fourier transform infrared spectroscopy (ATR-FTIR), energy-dispersive spectroscopy (EDS) and scanning electron microscopy (SEM). The antibacterial properties of LBL-functionalized PAN nanofibrous membranes were evaluated using the Gram-positive bacterium Staphylococcus aureus and the Gram-negative Escherichia coli. Furthermore, the dependence of the antibacterial activity and anti-biofouling performance on the number of layers in the LBL films was investigated quantitatively. It was found that these LBL-modified nanofibrous membranes possessed high antibacterial activities, easy-cleaning properties and stability under physiological conditions, thus qualifying them as candidates for anti-biofouling coatings.
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Affiliation(s)
- Yan Mei
- a School of Chemistry and Chemical Engineering , Southeast University , Nanjing , PR China
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Tang Y, Zhao Y, Wang X, Lin T. Layer-by-layer assembly of silica nanoparticles on 3D fibrous scaffolds: enhancement of osteoblast cell adhesion, proliferation, and differentiation. J Biomed Mater Res A 2013; 102:3803-12. [PMID: 24288259 DOI: 10.1002/jbm.a.35050] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2013] [Revised: 11/25/2013] [Accepted: 11/27/2013] [Indexed: 01/26/2023]
Abstract
Silica nanoparticles were applied onto the fiber surface of an interbonded three-dimensional polycaprolactone fibrous tissue scaffold by an electrostatic layer-by-layer self-assembly technique. The nanoparticle layer was found to improve the fiber wettability and surface roughness. Osteoblast cells were cultured on the fibrous scaffolds to evaluate the biological compatibility. The silica nanoparticle coated scaffold showed enhanced cell attachment, proliferation, and alkaline phosphatase activities. The overall results suggested that interbonded fibrous scaffold with silica nanoparticulate coating could be a promising scaffolding candidate for various applications in bone repair and regeneration.
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Affiliation(s)
- Yanwei Tang
- Institute for Frontier Materials, Deakin University, Geelong, Victoria, 3216, Australia
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Goodman SB, Yao Z, Keeney M, Yang F. The future of biologic coatings for orthopaedic implants. Biomaterials 2013; 34:3174-83. [PMID: 23391496 DOI: 10.1016/j.biomaterials.2013.01.074] [Citation(s) in RCA: 423] [Impact Index Per Article: 38.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2013] [Accepted: 01/20/2013] [Indexed: 12/12/2022]
Abstract
Implants are widely used for orthopaedic applications such as fixing fractures, repairing non-unions, obtaining a joint arthrodesis, total joint arthroplasty, spinal reconstruction, and soft tissue anchorage. Previously, orthopaedic implants were designed simply as mechanical devices; the biological aspects of the implant were a byproduct of stable internal/external fixation of the device to the surrounding bone or soft tissue. More recently, biologic coatings have been incorporated into orthopaedic implants in order to modulate the surrounding biological environment. This opinion article reviews current and potential future use of biologic coatings for orthopaedic implants to facilitate osseointegration and mitigate possible adverse tissue responses including the foreign body reaction and implant infection. While many of these coatings are still in the preclinical testing stage, bioengineers, material scientists and surgeons continue to explore surface coatings as a means of improving clinical outcome of patients undergoing orthopaedic surgery.
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Affiliation(s)
- Stuart B Goodman
- Department of Orthopaedic Surgery, Stanford University, Stanford, CA, USA.
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