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Ren H, Wang P, Huang H, Huang J, Lu Y, Wu Y, Xie Z, Tang Y, Cai Z, Shen H. N-Halaminated spermidine-containing polymeric coating enables titanium to achieve dual functions of antibacterial and osseointegration. Biomater Sci 2024; 12:2648-2659. [PMID: 38573023 DOI: 10.1039/d4bm00061g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2024]
Abstract
Titanium (Ti) and its alloys have been widely employed in the treatment of orthopedics and other hard tissue diseases. However, Ti-based implants are bioinert and suffer from bacterial infections and poor osseointegration in clinical applications. Herein, we successfully modified Ti with a porous N-halaminated spermidine-containing polymeric coating (Ti-SPD-Cl) through alkali-heat treatment, surface grafting and chlorination, and it has both excellent antibacterial and osteogenic abilities to significantly enhance osseointegration. The as-obtained Ti-SPD-Cl contains abundant N-Cl groups and demonstrates effective antibacterial ability against S. aureus and E. coli. Meanwhile, due to the presence of the spermidine component and construction of a porous hydrophilic surface, Ti-SPD-Cl is also beneficial for maintaining cell membrane homeostasis and promoting cell adhesion, exhibiting good biocompatibility and osteogenic ability. The rat osteomyelitis model demonstrates that Ti-SPD-Cl can effectively suppress bacterial infection and enhance bone-implant integration. Thus, Ti-SPD-Cl shows promising clinical applicability in the prevention of orthopedic implant infections and poor osseointegration.
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Affiliation(s)
- Hang Ren
- The Eighth Affiliated Hospital Sun Yat-sen University Shenzhen 518033, P.R. China.
| | - Peng Wang
- The Eighth Affiliated Hospital Sun Yat-sen University Shenzhen 518033, P.R. China.
| | - Hanwen Huang
- The Eighth Affiliated Hospital Sun Yat-sen University Shenzhen 518033, P.R. China.
| | - Junshen Huang
- The Eighth Affiliated Hospital Sun Yat-sen University Shenzhen 518033, P.R. China.
| | - Yuheng Lu
- The Eighth Affiliated Hospital Sun Yat-sen University Shenzhen 518033, P.R. China.
| | - Yanfeng Wu
- The Eighth Affiliated Hospital Sun Yat-sen University Shenzhen 518033, P.R. China.
| | - Zhongyu Xie
- The Eighth Affiliated Hospital Sun Yat-sen University Shenzhen 518033, P.R. China.
| | - Youchen Tang
- The Eighth Affiliated Hospital Sun Yat-sen University Shenzhen 518033, P.R. China.
| | - Zhaopeng Cai
- The Eighth Affiliated Hospital Sun Yat-sen University Shenzhen 518033, P.R. China.
| | - Huiyong Shen
- The Eighth Affiliated Hospital Sun Yat-sen University Shenzhen 518033, P.R. China.
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Kaspiris A, Vasiliadis E, Pantazaka E, Lianou I, Melissaridou D, Savvidis M, Panagopoulos F, Tsalimas G, Vavourakis M, Kolovos I, Savvidou OD, Pneumaticos SG. Current Progress and Future Perspectives in Contact and Releasing-Type Antimicrobial Coatings of Orthopaedic Implants: A Systematic Review Analysis Emanated from In Vitro and In Vivo Models. Infect Dis Rep 2024; 16:298-316. [PMID: 38667751 PMCID: PMC11050497 DOI: 10.3390/idr16020025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Revised: 03/05/2024] [Accepted: 03/19/2024] [Indexed: 04/28/2024] Open
Abstract
Background: Despite the expanding use of orthopedic devices and the application of strict pre- and postoperative protocols, the elimination of postoperative implant-related infections remains a challenge. Objectives: To identify and assess the in vitro and in vivo properties of antimicrobial-, silver- and iodine-based implants, as well as to present novel approaches to surface modifications of orthopedic implants. Methods: A systematic computer-based review on the development of these implants, on PubMed and Web of Science databases, was carried out according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Results: Overall, 31 in vitro and 40 in vivo entries were evaluated. Regarding the in vitro studies, antimicrobial-based coatings were assessed in 12 entries, silver-based coatings in 10, iodine-based in 1, and novel-applied coating technologies in 8 entries. Regarding the in vivo studies, antimicrobial coatings were evaluated in 23 entries, silver-coated implants in 12, and iodine-coated in 1 entry, respectively. The application of novel coatings was studied in the rest of the cases (4). Antimicrobial efficacy was examined using different bacterial strains, and osseointegration ability and biocompatibility were examined in eukaryotic cells and different animal models, including rats, rabbits, and sheep. Conclusions: Assessment of both in vivo and in vitro studies revealed a wide antimicrobial spectrum of the coated implants, related to reduced bacterial growth, inhibition of biofilm formation, and unaffected or enhanced osseointegration, emphasizing the importance of the application of surface modification techniques as an alternative for the treatment of orthopedic implant infections in the clinical settings.
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Affiliation(s)
- Angelos Kaspiris
- Third Department of Orthopaedic Surgery, School of Medicine, National and Kapodistrian University of Athens, “KAT” General Hospital, Nikis 2, 14561 Athens, Greece; (E.V.); (G.T.); (M.V.); (I.K.); (S.G.P.)
| | - Elias Vasiliadis
- Third Department of Orthopaedic Surgery, School of Medicine, National and Kapodistrian University of Athens, “KAT” General Hospital, Nikis 2, 14561 Athens, Greece; (E.V.); (G.T.); (M.V.); (I.K.); (S.G.P.)
| | - Evangelia Pantazaka
- Synthetic Organic Chemistry Laboratory, Department of Chemistry, University of Patras, 26504 Patras, Greece;
| | - Ioanna Lianou
- Department of Orthopedic Surgery, “Rion” University Hospital and Medical School, School of Health Sciences, University of Patras, 26504 Patras, Greece; (I.L.); (F.P.)
| | - Dimitra Melissaridou
- First Department of Orthopaedic Surgery, School of Medicine, National and Kapodistrian University of Athens, “ATTIKON” University Hospital, Rimini 1, 12462 Athens, Greece; (D.M.); (O.D.S.)
| | - Matthaios Savvidis
- Second Orthopedic Department, 424 General Military Hospital, 56429 Thessaloniki, Greece;
| | - Fotios Panagopoulos
- Department of Orthopedic Surgery, “Rion” University Hospital and Medical School, School of Health Sciences, University of Patras, 26504 Patras, Greece; (I.L.); (F.P.)
| | - Georgios Tsalimas
- Third Department of Orthopaedic Surgery, School of Medicine, National and Kapodistrian University of Athens, “KAT” General Hospital, Nikis 2, 14561 Athens, Greece; (E.V.); (G.T.); (M.V.); (I.K.); (S.G.P.)
| | - Michail Vavourakis
- Third Department of Orthopaedic Surgery, School of Medicine, National and Kapodistrian University of Athens, “KAT” General Hospital, Nikis 2, 14561 Athens, Greece; (E.V.); (G.T.); (M.V.); (I.K.); (S.G.P.)
| | - Ioannis Kolovos
- Third Department of Orthopaedic Surgery, School of Medicine, National and Kapodistrian University of Athens, “KAT” General Hospital, Nikis 2, 14561 Athens, Greece; (E.V.); (G.T.); (M.V.); (I.K.); (S.G.P.)
| | - Olga D. Savvidou
- First Department of Orthopaedic Surgery, School of Medicine, National and Kapodistrian University of Athens, “ATTIKON” University Hospital, Rimini 1, 12462 Athens, Greece; (D.M.); (O.D.S.)
| | - Spiros G. Pneumaticos
- Third Department of Orthopaedic Surgery, School of Medicine, National and Kapodistrian University of Athens, “KAT” General Hospital, Nikis 2, 14561 Athens, Greece; (E.V.); (G.T.); (M.V.); (I.K.); (S.G.P.)
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Wang M, Zheng Y, Yin C, Dai S, Fan X, Jiang Y, Liu X, Fang J, Yi B, Zhou Q, Wang T. Recent Progress in antibacterial hydrogel coatings for targeting biofilm to prevent orthopedic implant-associated infections. Front Microbiol 2023; 14:1343202. [PMID: 38188584 PMCID: PMC10768665 DOI: 10.3389/fmicb.2023.1343202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Accepted: 12/12/2023] [Indexed: 01/09/2024] Open
Abstract
The application of orthopedic implants for bone tissue reconstruction and functional restoration is crucial for patients with severe bone fractures and defects. However, the abiotic nature of orthopedic implants allows bacterial adhesion and colonization, leading to the formation of bacterial biofilms on the implant surface. This can result in implant failure and severe complications such as osteomyelitis and septic arthritis. The emergence of antibiotic-resistant bacteria and the limited efficacy of drugs against biofilms have increased the risk of orthopedic implant-associated infections (OIAI), necessitating the development of alternative therapeutics. In this regard, antibacterial hydrogels based on bacteria repelling, contact killing, drug delivery, or external assistance strategies have been extensively investigated for coating orthopedic implants through surface modification, offering a promising approach to target biofilm formation and prevent OIAI. This review provides an overview of recent advancements in the application of antibacterial hydrogel coatings for preventing OIAI by targeting biofilm formation. The topics covered include: (1) the mechanisms underlying OIAI occurrence and the role of biofilms in exacerbating OIAI development; (2) current strategies to impart anti-biofilm properties to hydrogel coatings and the mechanisms involved in treating OIAI. This article aims to summarize the progress in antibacterial hydrogel coatings for OIAI prevention, providing valuable insights and facilitating the development of prognostic markers for the design of effective antibacterial orthopedic implants.
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Affiliation(s)
- Mengxuan Wang
- Department of Orthopaedic Surgery, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Yawen Zheng
- Department of Orthopaedic Surgery, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Chuqiang Yin
- Department of Orthopaedic Surgery, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Shiyou Dai
- Department of Bone Joint and Sports Medicine, Qingdao Hospital, University of Health and Rehabilitation Sciences (Qingdao Municipal Hospital), Qingdao, China
| | - Xiao Fan
- Department of Bone Joint and Sports Medicine, Qingdao Hospital, University of Health and Rehabilitation Sciences (Qingdao Municipal Hospital), Qingdao, China
| | - Ying Jiang
- Department of Orthopaedic Surgery, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Xuequan Liu
- Department of Anesthesiology, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Junqiang Fang
- Shandong Key Laboratory of Carbohydrate Chemistry and Glycobiology, Shandong University, Qingdao, China
| | - Bingcheng Yi
- Qingdao Key Laboratory of Materials for Tissue Repair and Rehabilitation, School of Rehabilitation Sciences and Engineering, University of Health and Rehabilitation Sciences, Qingdao, China
| | - Qihui Zhou
- Qingdao Key Laboratory of Materials for Tissue Repair and Rehabilitation, School of Rehabilitation Sciences and Engineering, University of Health and Rehabilitation Sciences, Qingdao, China
- Hubei Key Laboratory of Biomass Fibers and Eco-Dyeing and Finishing, Wuhan Textile University, Wuhan, China
| | - Ting Wang
- Department of Orthopaedic Surgery, The Affiliated Hospital of Qingdao University, Qingdao, China
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Chen S, Jiang Y, Wang W, Chen J, Zhu J. The effect and mechanism of iodophors on the adhesion and virulence of Staphylococcus aureus biofilms attached to artificial joint materials. J Orthop Surg Res 2023; 18:756. [PMID: 37798766 PMCID: PMC10557172 DOI: 10.1186/s13018-023-04246-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Accepted: 09/28/2023] [Indexed: 10/07/2023] Open
Abstract
BACKGROUND Iodophors are known to be a treatment for biofilm-related periprosthetic joint infection. However, the efficacy and mechanism of eradicating biofilms from different artificial joint materials after iodophor treatment are unknown. This study was conducted to understand the effect and mechanism of iodophors with respect to the adhesion and virulence of Staphylococcus aureus biofilms attached to artificial joint materials. METHODS Biofilms of Staphylococcus aureus strains were grown on titanium alloy, cobalt chromium molybdenum and polyethylene coupons, which are commonly used materials for artificial joints, for 24 h. Afterward, all coupons were divided into experimental and control groups: (1) exposed to a 0.5 ± 0.05% iodophor for 5 min and (2) exposed to phosphate-buffered saline for 5 min. To gauge the level of biofilm, colony forming units (CFU), live/dead staining confocal microscopy and crystal violet staining were used. Meanwhile, the expression of icaACDR and clfA, which are related to virulence and adhesion, was examined in both the experimental and control groups. RESULTS A roughly three-log decrease in CFU/cm2 was seen in the viable plate count compared to the control group. Confocal imaging and crystal violet staining verified the CFU data. Moreover, the expression of icaACDR was reduced on three different orthopaedic implant materials, and the expression of clfA was also inhibited on titanium alloy coupons exposed to the iodophor. CONCLUSIONS Our results indicated that exposure to an iodophor for 5 min could significantly eliminate biofilms. When Staphylococcus aureus that had adhered to these three materials, which were used for artificial joints, was treated with an iodophor for 5 min, the expression of icaACDR was significantly reduced. This provides strong evidence for clinically clearing periprosthetic joint infections without removing the artificial joints.
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Affiliation(s)
- Sihui Chen
- Department of Orthopaedics, First Hospital of Jiaxing, South Central Avenue No. 1882, Jiaxing, 314000, People's Republic of China
- College of Medicine, Jiaxing University, Guangqiong Avenue No. 899, Jiaxing, 314000, People's Republic of China
| | - Yi Jiang
- Department of Orthopaedics, First Hospital of Jiaxing, South Central Avenue No. 1882, Jiaxing, 314000, People's Republic of China
- College of Medicine, Jiaxing University, Guangqiong Avenue No. 899, Jiaxing, 314000, People's Republic of China
| | - Wei Wang
- College of Medicine, Jiaxing University, Guangqiong Avenue No. 899, Jiaxing, 314000, People's Republic of China
- Department of Clinical Laboratory, First Hospital of Jiaxing, South Central Avenue No. 1882, Jiaxing, 314000, People's Republic of China
| | - Junjie Chen
- Zhejiang Chinese Medical University Master Degree Cultivation Base in Jiaxing University, South Central Avenue No. 1882, Jiaxing, 314000, People's Republic of China
| | - Jinyu Zhu
- Department of Orthopaedics, First Hospital of Jiaxing, South Central Avenue No. 1882, Jiaxing, 314000, People's Republic of China.
- College of Medicine, Jiaxing University, Guangqiong Avenue No. 899, Jiaxing, 314000, People's Republic of China.
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Shirai T, Tsuchiya H, Terauchi R, Tsuchida S, Shimomura S, Kajino Y, Takahashi K. Iodine-supported implants in prevention and treatment of surgical site infections for compromised hosts: a prospective study. J Orthop Surg Res 2023; 18:388. [PMID: 37245049 DOI: 10.1186/s13018-023-03868-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 05/21/2023] [Indexed: 05/29/2023] Open
Abstract
BACKGROUND Surgical site infection (SSI) is a common complication following orthopedic implantation. We developed an iodine coating for titanium implants to reduce implant-related infections and conducted a prospective clinical study to evaluate the efficacy and potential drawbacks of iodine-supported implants. PATIENTS AND METHODS Between July 2008 and July 2017, 653 patients (377 male and 27 female patients; mean age, 48.6) with postoperative infection or a compromised status were treated using iodine-loaded titanium implants. The mean follow-up period was 41.7 months. In 477 patients, iodine-supported implants were used to prevent infection and in 176 patients, to treat active infection (one-stage surgery, 89 patients; two-stage surgery, 87 patients). In the limbs and pelvis, the primary diagnoses included the following: 161 tumors, 92 deformities/shortening, 47 pseudarthrosis, 42 fractures, 32 infected TKA, 25 osteoarthritis, 21 pyogenic arthritis, 20 infected THA, and 6 osteomyelitis. In the spinal cases, there were 136 cases of tumors, 36 cases of pyogenic spondylitis, and 35 cases of degeneration. Five modes of implant failure were identified and classified as follows: soft tissue failure (type 1), aseptic loosening (type 2), structural failure (type 3), infection (type 4), and tumor progression (type 5). RESULTS The overall failure rate in our series was 26.3% (172/653). There were 101 mechanical failures, including 22 type 1, 20 type 2, and 59 type 3 failures. Non-mechanical causes accounted for 71 failures, including 45 type 4 and 26 type 5 failures. The overall incidence of infections was 6.8%. The mean time to the onset of infection after implantation was 9.1 months. The overall infection rate was 3.7% in the prevention cases and 15.3% in the treatment cases. There was no difference between one-stage replacement (14.6%) and two-stage replacement (16.0%). There were 11 cases of treatment for SSI of spine surgery, and the re-infection rate was 0% using iodine-coated instruments. CONCLUSIONS The five modes of failure of the iodine-supported implant were satisfactory compared with previous reports. In particular, because the infection rate of iodine-coated implants used for compromised hosts is low compared with other methods, postoperative infection is more easily controlled. It can be considered highly effective for spinal infections that require one-stage revision surgery. LEVEL OF EVIDENCE IV Trial registration Prospective, Observation study.
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Affiliation(s)
- Toshiharu Shirai
- Department of Orthopaedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kamigyo-Ku, Kyoto, 602-8566, Japan.
- Department of Orthopaedic Surgery, Graduate School of Medical Science, Kanazawa University, 13-1 Takaramachi, Kanazawa, 920-8641, Japan.
| | - Hiroyuki Tsuchiya
- Department of Orthopaedic Surgery, Graduate School of Medical Science, Kanazawa University, 13-1 Takaramachi, Kanazawa, 920-8641, Japan
| | - Ryu Terauchi
- Department of Orthopaedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kamigyo-Ku, Kyoto, 602-8566, Japan
| | - Shinji Tsuchida
- Department of Orthopaedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kamigyo-Ku, Kyoto, 602-8566, Japan
| | - Seiji Shimomura
- Department of Orthopaedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kamigyo-Ku, Kyoto, 602-8566, Japan
| | - Yoshitomo Kajino
- Department of Orthopaedic Surgery, Graduate School of Medical Science, Kanazawa University, 13-1 Takaramachi, Kanazawa, 920-8641, Japan
| | - Kenji Takahashi
- Department of Orthopaedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kamigyo-Ku, Kyoto, 602-8566, Japan
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Choi S, Lee H, Hong R, Jo B, Jo S. Application of Multi-Layered Temperature-Responsive Polymer Brushes Coating on Titanium Surface to Inhibit Biofilm Associated Infection in Orthopedic Surgery. Polymers (Basel) 2022; 15:polym15010163. [PMID: 36616511 PMCID: PMC9823637 DOI: 10.3390/polym15010163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 12/25/2022] [Accepted: 12/28/2022] [Indexed: 12/31/2022] Open
Abstract
Infection associated with biomedical implants remains the main cause of failure, leading to reoperation after orthopedic surgery. Orthopedic infections are characterized by microbial biofilm formation on the implant surface, which makes it challenging to diagnose and treat. One potential method to prevent and treat such complications is to deliver a sufficient dose of antibiotics at the onset of infection. This strategy can be realized by coating the implant with thermoregulatory polymers and triggering the release of antibiotics during the acute phase of infection. We developed a multi-layered temperature-responsive polymer brush (MLTRPB) coating that can release antibiotics once the temperature reaches a lower critical solution temperature (LCST). The coating system was developed using copolymers composed of diethylene glycol methyl ether methacrylate and 2-hydroxyethyl methacrylate by alternatively fabricating monomers layer by layer on the titanium surface. LCST was set to the temperature of 38-40 °C, a local temperature that can be reached during infection. The antibiotic elution characteristics were investigated, and the antimicrobial efficacy was tested against S. aureus species (Xen29 ATCC 29 213) using one to four layers of MLTRPB. Both in vitro and in vivo assessments demonstrated preventive effects when more than four layers of the coating were applied, ensuring promising antibacterial effects of the MLTRPB coating.
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Affiliation(s)
- Sookyung Choi
- School of Medicine, Chosun University Medical School, Gwangju 61452, Republic of Korea
| | - Hyeonjoon Lee
- Department of Orthopedic Surgery, Chosun University Hospital, Gwangju 61453, Republic of Korea
| | - Ran Hong
- School of Medicine, Chosun University Medical School, Gwangju 61452, Republic of Korea
- Department of Pathology, Chosun University Hospital, Gwangju 61453, Republic of Korea
| | - Byungwook Jo
- School of Engineering, Chosun University, Gwangju 61452, Republic of Korea
| | - Suenghwan Jo
- School of Medicine, Chosun University Medical School, Gwangju 61452, Republic of Korea
- Department of Orthopedic Surgery, Chosun University Hospital, Gwangju 61453, Republic of Korea
- Correspondence: ; Tel.: +82-62-220-3147
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Gu K, Ouyang P, Hong Y, Dai Y, Tang T, He C, Shu G, Liang X, Tang H, Zhu L, Xu Z, Yin L. Geraniol inhibits biofilm formation of methicillin-resistant Staphylococcus aureus and increase the therapeutic effect of vancomycin in vivo. Front Microbiol 2022; 13:960728. [PMID: 36147840 PMCID: PMC9485828 DOI: 10.3389/fmicb.2022.960728] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Accepted: 08/16/2022] [Indexed: 12/04/2022] Open
Abstract
Methicillin-resistant Staphylococcus aureus (MRSA) is among the common drug resistant bacteria, which has gained worldwide attention due to its high drug resistance and infection rates. Biofilms produced by S. aureus are known to increase antibiotic resistance, making the treatment of S. aureus infections even more challenging. Hence, inhibition of biofilm formation has become an alternative strategy for controlling persistent infections. In this study, we evaluated the efficacy of geraniol as a treatment for MRSA biofilm infection. The results of crystal violet staining indicated that 256 μg/mL concentration of geraniol inhibited USA300 biofilm formation by 86.13% and removed mature biofilms by 49.87%. Geraniol exerted its anti-biofilm effect by influencing the major components of the MRSA biofilm structure. We found that geraniol inhibited the synthesis of major virulence factors, including staphyloxanthin and autolysins. The colony count revealed that geraniol inhibited staphyloxanthin and sensitized USA300 cells to hydrogen peroxide. Interestingly, geraniol not only reduced the release of extracellular nucleic acids (eDNA) but also inhibited cell autolysis. Real-time polymerase chain reaction data revealed the downregulation of genes involved in biofilm formation, which verified the results of the phenotypic analysis. Geraniol increased the effect of vancomycin in eliminating USA300 biofilms in a mouse infection model. Our findings revealed that geraniol effectively inhibits biofilm formation in vitro. Furthermore, in combination with vancomycin, geraniol can reduce the biofilm adhesion to the implant in mice. This suggests the potential of geraniol as an anti-MRSA biofilm drug and can provide a solution for the clinical treatment of biofilm infection.
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Kankilic B, Bayramli E, Korkusuz P, Eroglu H, Sener B, Mutlu P, Korkusuz F. Vancomycin Containing PDLLA and PLGA/β-TCP Inhibit Biofilm Formation but Do Not Stimulate Osteogenic Transformation of Human Mesenchymal Stem Cells. Front Surg 2022; 9:885241. [PMID: 35846965 PMCID: PMC9283789 DOI: 10.3389/fsurg.2022.885241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Accepted: 06/09/2022] [Indexed: 11/13/2022] Open
Abstract
Aims Chronic osteomyelitis, including implant-related prosthetic joint infection, is extremely difficult to cure. We develop vancomycin containing release systems from poly(d,l-lactide) (PDLLA) and poly(d,l-lactide-co-glycolide) (PLGA) composites with beta-tricalcium phosphate (β-TCP) to treat methicillin-resistant Staphylococcus aureus osteomyelitis. We ask whether vancomycin containing PDLLA/β-TCP and PLGA/β-TCP composites will prevent early biofilm formation, allow cell proliferation and osteogenic differentiation, and stimulate osteogenic signaling molecules in the absence of an osteogenic medium. Methods Composites were produced and characterized with scanning electron microscopy. In vitro vancomycin release was assessed for 6 weeks. Biofilm prevention was calculated by crystal violet staining. Human bone marrow-derived mesenchymal stem cells (hBM-MSCs) and osteosarcoma cell (SaOS-2) proliferation and differentiation were assessed with water soluble tetrazolium salt and alkaline phosphatase (ALP) staining. Real-time quantitative polymerase chain reaction defined osteogenic signaling molecules for hBM-MSCs. Results Totally, 3.1 ± 0.2 mg and 3.4 ± 0.4 mg vancomycin released from PDLLA/β-TCP and the PLGA/β-TCP composites, respectively, and inhibited early biofilm formation. hBM-MSCs and SaOS-2 cells proliferated on the composites and stimulated ALP activity of cells. Runt-related transcription factor 2 (RUNX2) and SRY-Box transcription Factor 9 (SOX9) expressions were, however, lower with composites when compared with control. Conclusion Vancomycin containing PDLLA/β-TCP and PLGA/β-TCP composites inhibited early biofilm formation and proliferated and differentiated hBM-MSCs and SaOS-2 cells, but osteogenesis-related RUNX2 and SOX9 transcription factors were not strongly expressed in the absence of an osteogenic medium for 14 days.
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Affiliation(s)
- Berna Kankilic
- Graduate School of Natural and Applied Sciences, Middle East Technical University, Ankara, Turkey
- Correspondence: Berna Kankilic
| | - Erdal Bayramli
- Department of Chemistry, Faculty of Arts and Sciences, Middle East Technical University, Ankara, Turkey
| | - Petek Korkusuz
- Department of Histology and Embryology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Hakan Eroglu
- Department of Pharmaceutical Technology, Faculty of Pharmacy, Hacettepe University, Ankara, Turkey
| | - Burcin Sener
- Department of Medical Microbiology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Pelin Mutlu
- Central Laboratory, Molecular Biology and Biotechnology R&D, Middle East Technical University, Ankara, Turkey
| | - Feza Korkusuz
- Department of Sports Medicine, Faculty of Medicine, Hacettepe University, Ankara, Turkey
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A two-phase and long-lasting multi-antibacterial coating enables titanium biomaterials to prevent implants-related infections. Mater Today Bio 2022; 15:100330. [PMID: 35789634 PMCID: PMC9250043 DOI: 10.1016/j.mtbio.2022.100330] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2022] [Revised: 06/10/2022] [Accepted: 06/11/2022] [Indexed: 01/08/2023] Open
Abstract
In clinical work, the main challenges for titanium (Ti) implantation are bacterial infection and aseptic loosening, which severely affect the survival rate of implants. The first 4 weeks post-operation is the infection peak phase of implants. Inhibiting implant infection caused by bacteria adhesion and proliferation during the early phase as well as promoting subsequent osteointegration is essential for implant success. Herein, we constructed a quaternary ammonium carboxymethyl chitosan (QCMC), collagen (COL Ⅰ) and hydroxyapatite (HAP) multilayers coating on Ti substrates via a modified layer-by-layer (LBL) technique and polymerization of dopamine. The QCMC/COL/HAP coating exhibited a multi-antibacterial property with a two-phase function: (1) At the first 4 weeks post-operation, the covalently bonded QCMC could be slowly degraded and demonstrated both contact-killing and release-killing properties during the infection peak phase; (2) At the second phase, osteogenesis and osseointegration-promotion capabilities were enhanced by HAP under the effective control of infection. The multifilm coating was degraded for more than 45 days under the action of collagenase Ⅰ, and displayed good biocompatibility in vivo and in vitro. Most importantly, the coating exhibited a long-lasting antibacterial activity for more than 3 months, against the main pathogenic bacteria of peri-implant infections. Both in vitro studies and in vivo animal models revealed a desirable osteogenic differentiation capacity of Ti-CCH. Therefore, our study reports a two-phase, long-lasting multi-antibacterial coating on Ti-CCH and indicates potential applications of the modified LBL strategy in orthopaedic fields, which is enlightening for developing practical implant and scaffold materials. Developing a QCMC/COL/HAP multifilm coating via modified layer-by-layer technique and self-polymerization of dopamine. The QCMC/COL/HAP coating exhibited desirable mechanical properties and excellent biocompatibility. The release kinetics endowed the QCMC/COL/HAP coating with multi-antibacterial activity at the first phase after operation. The QCMC/COL/HAP coating could improve osseointegration at the second phase of post-operation.
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Costa RC, Bertolini M, Costa Oliveira BE, Nagay BE, Dini C, Benso B, Klein MI, Barāo VAR, Souza JGS. Polymicrobial biofilms related to dental implant diseases: unravelling the critical role of extracellular biofilm matrix. Crit Rev Microbiol 2022; 49:370-390. [PMID: 35584310 DOI: 10.1080/1040841x.2022.2062219] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Biofilms are complex tri-dimensional structures that encase microbial cells in an extracellular matrix comprising self-produced polymeric substances. The matrix rich in extracellular polymeric substance (EPS) contributes to the unique features of biofilm lifestyle and structure, enhancing microbial accretion, biofilm virulence, and antimicrobial resistance. The role of the EPS matrix of biofilms growing on biotic surfaces, especially dental surfaces, is largely unravelled. To date, there is a lack of a broad overview of existing literature concerning the relationship between the EPS matrix and the dental implant environment and its role in implant-related infections. Here, we discuss recent advances in the critical role of the EPS matrix on biofilm growth and virulence on the dental implant surface and its effect on the etiopathogenesis and progression of implant-related infections. Similar to other biofilms associated with human diseases/conditions, EPS-enriched biofilms on implant surfaces promote microbial accumulation, microbiological shift, cross-kingdom interaction, antimicrobial resistance, biofilm virulence, and, consequently, peri-implant tissue damage. But intriguingly, the protagonism of EPS role on implant-related infections and the development of matrix-target therapeutic strategies has been neglected. Finally, we highlight the need for more in-depth analyses of polymicrobial interactions within EPS matrix and EPS-targeting technologies' rationale for disrupting the complex biofilm microenvironment with more outstanding translation to implant applications in the near future.
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Affiliation(s)
- Raphael C Costa
- Department of Prosthodontics and Periodontology, Piracicaba Dental School, University of Campinas (UNICAMP), Piracicaba, Brazil
| | - Martinna Bertolini
- Department of Oral Health and Diagnostic Sciences, University of Connecticut Health Center, Farmington, CT, USA
| | | | - Bruna E Nagay
- Department of Prosthodontics and Periodontology, Piracicaba Dental School, University of Campinas (UNICAMP), Piracicaba, Brazil
| | - Caroline Dini
- Department of Prosthodontics and Periodontology, Piracicaba Dental School, University of Campinas (UNICAMP), Piracicaba, Brazil
| | - Bruna Benso
- School of Dentistry, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, CA, Chile
| | - Marlise I Klein
- Department of Dental Materials and Prosthodontics, São Paulo State University, São Paulo, Brazil
| | - Valentim A R Barāo
- Department of Prosthodontics and Periodontology, Piracicaba Dental School, University of Campinas (UNICAMP), Piracicaba, Brazil
| | - Joāo Gabriel S Souza
- Department of Prosthodontics and Periodontology, Piracicaba Dental School, University of Campinas (UNICAMP), Piracicaba, Brazil.,Dental Science School (Faculdade de Ciências Odontológicas - FCO), Montes Claros, Brazil.,Dental Research Division, Guarulhos University, Sāo Paulo, Brazil
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11
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Fitting pieces into the puzzle: The impact of titanium-based dental implant surface modifications on bacterial accumulation and polymicrobial infections. Adv Colloid Interface Sci 2021; 298:102551. [PMID: 34757285 DOI: 10.1016/j.cis.2021.102551] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Revised: 10/09/2021] [Accepted: 10/17/2021] [Indexed: 12/12/2022]
Abstract
Polymicrobial infection is the main cause of dental implant failure. Although numerous studies have reported the ability of titanium (Ti) surface modifications to inhibit microbial adhesion and biofilm accumulation, the majority of solutions for the utilization of Ti antibacterial surfaces have been testedin in vitro and animal models, with only a few developed surfaces progressing into clinical research. Motivated by this huge gap, we critically reviewed the scientific literature on the existing antibacterial Ti surfaces to help understand these surfaces' impact on the "puzzle" of undesirable dental implant-related infections. This manuscript comprises three main sections: (i) a narrative review on topics related to oral biofilm formation, bacterial-implant surface interactions, and on how implant-surface modifications can influence microbial accumulation; (ii) a critical evidence-based review to summarize pre-clinical and clinical studies in an attempt to "fit pieces into the puzzle" to unveil the best way to reduce microbial loads and control polymicrobial infection around dental implants showed by the current in vivo evidence; and (iii) discussion and recommendations for future research testing emerging antibacterial implant surfaces, connecting basic science and the requirements for future clinical translation. The findings of the present review suggest no consensus regarding the best available Ti surface to reduce bacterial colonization on dental implants. Smart release or on-demand activation surface coatings are a "new piece of the puzzle", which may be the most effective alternative for reducing microbial colonization on Ti surfaces, and future studies should focus on these technologies.
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12
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Hu Y, Zhou W, Zhu C, Zhou Y, Guo Q, Huang X, Yang B, Ren B, Cheng L. The Synergistic Effect of Nicotine and Staphylococcus aureus on Peri-Implant Infections. Front Bioeng Biotechnol 2021; 9:658380. [PMID: 34589469 PMCID: PMC8473630 DOI: 10.3389/fbioe.2021.658380] [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: 02/04/2021] [Accepted: 07/30/2021] [Indexed: 12/02/2022] Open
Abstract
Smoking is considered a key risk factor for implant survival; however, how it interacts with the pathogens in peri-implant infections is not clear. Here, we identified that nicotine, the key component of cigarette smoking, can interact with Staphylococcus aureus and synergistically induce peri-implant infections in a rat osteolysis model. The nicotine–S. aureus combination group increased the gross bone pathology, osteolysis, periosteal reactions, and bone resorption compared to the nicotine or S. aureus single treated group (p < 0.05). Nicotine did not promote the proliferation of S. aureus both in vitro and in vivo, but it can significantly upregulate the expression of staphylococcal protein A (SpA), a key virulence factor of S. aureus. The nicotine–S. aureus combination also synergistically activated the expression of RANKL (receptor activator of nuclear factor-kappa B ligand, p < 0.05) to promote the development of peri-implant infections. The synergistic effects between nicotine and S. aureus infection can be a new target to reduce the peri-implant infections.
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Affiliation(s)
- Yao Hu
- State Key Laboratory of Oral Diseases and West China School of Stomatology and National Clinical Research Center for Oral Diseases, Sichuan University, Chengdu, China
| | - Wen Zhou
- State Key Laboratory of Oral Diseases and West China School of Stomatology and National Clinical Research Center for Oral Diseases, Sichuan University, Chengdu, China.,Fujian Key Laboratory of Oral Diseases and Fujian Provincial Engineering Research Center of Oral Biomaterial and Stomatological Key Laboratory of Fujian College and University, School of Stomatology, Fujian Medical University, Fuzhou, China
| | - Chengguang Zhu
- State Key Laboratory of Oral Diseases and West China School of Stomatology and National Clinical Research Center for Oral Diseases, Sichuan University, Chengdu, China
| | - Yujie Zhou
- State Key Laboratory of Oral Diseases and West China School of Stomatology and National Clinical Research Center for Oral Diseases, Sichuan University, Chengdu, China
| | - Qiang Guo
- State Key Laboratory of Oral Diseases and West China School of Stomatology and National Clinical Research Center for Oral Diseases, Sichuan University, Chengdu, China
| | - Xiaoyu Huang
- State Key Laboratory of Oral Diseases and West China School of Stomatology and National Clinical Research Center for Oral Diseases, Sichuan University, Chengdu, China
| | - Bina Yang
- State Key Laboratory of Oral Diseases and West China School of Stomatology and National Clinical Research Center for Oral Diseases, Sichuan University, Chengdu, China
| | - Biao Ren
- State Key Laboratory of Oral Diseases and West China School of Stomatology and National Clinical Research Center for Oral Diseases, Sichuan University, Chengdu, China
| | - Lei Cheng
- State Key Laboratory of Oral Diseases and West China School of Stomatology and National Clinical Research Center for Oral Diseases, Sichuan University, Chengdu, China
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Ueoka K, Kabata T, Tokoro M, Kajino Y, Inoue D, Takagi T, Ohmori T, Yoshitani J, Ueno T, Yamamuro Y, Taninaka A, Tsuchiya H. Antibacterial Activity in Iodine-coated Implants Under Conditions of Iodine Loss: Study in a Rat Model Plus In Vitro Analysis. Clin Orthop Relat Res 2021; 479:1613-1623. [PMID: 33847603 PMCID: PMC8208413 DOI: 10.1097/corr.0000000000001753] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 03/08/2021] [Indexed: 01/31/2023]
Abstract
BACKGROUND We developed iodine-coated titanium implants to suppress microbial activity and prevent periprosthetic joint infection (PJI); their efficacy was demonstrated in animal and in vitro models. The iodine content in iodine-coated implants naturally decreases in vivo. However, to our knowledge, the effect of reduced iodine content on the implant's antimicrobial activity has not been evaluated to date. QUESTIONS/PURPOSES (1) How much does the iodine content on the implant surface decrease after 4 and 8 weeks in vivo in a rat model? (2) What effect does the reduced iodine content have on the antimicrobial effect of the implant against multiple bacteria in an in vitro model? METHODS This experiment was performed in two parts: an in vivo experiment to determine attenuation of iodine levels over time in rats, and an in vitro experiment in which we sought to assess whether the reduced iodine content observed in the in vivo experiment was still sufficient to deliver antimicrobial activity against common pathogens seen in PJI. For the in vivo experiment, three types of titanium alloy washers were implanted in rats: untreated (Ti), surface-anodized to produce an oxide film (Ti-O), and with an iodine layer on the oxidation film (Ti-I). The attenuation of iodine levels in rats was measured over time using inductively coupled plasma-mass spectrometry. Herein, only the Ti-I washer was used, with five implanted in each rat that were removed after 4 or 8 weeks. For the 4- and 8-week models, two rats and 15 washers were used. For the in vitro study, to determine the antibacterial effect, three types of washers (Ti, Ti-O, and Ti-I) (nine washers in total) were implanted in each rat. Then, the washers were removed and the antibacterial effect of each washer was examined on multiple bacterial species using the spread plate method and fluorescence microscopy. For the spread plate method, six rats were used, and five rats were used for the observation using fluorescence microscopy; further, 4- and 8-week models were made for each method. Thus, a total of 22 rats and 198 washers were used. Live and dead bacteria in the biofilm were stained, and the biofilm coverage percentage for quantitative analysis was determined using fluorescence microscopy in a nonblinded manner. Ti-I was used as the experimental group, and Ti and Ti-O were used as control groups. The total number of rats and washers used throughout this study was 24 and 213, respectively. RESULTS Iodine content in rats implanted with Ti-I samples decreased to 72% and 65% after the in vivo period of 4 and 8 weeks, respectively (p = 0.001 and p < 0.001, respectively). In the in vitro experiment, the Ti-I implants demonstrated a stronger antimicrobial activity than Ti and Ti-O implants in the 4- and 8-week models. Both the median number of bacterial colonies and the median biofilm coverage percentage with live bacteria on Ti-I were lower than those on Ti or Ti-O implants for each bacterial species in the 4- and 8-week models. There was no difference in the median biofilm coverage percentage of dead bacteria. In the 8-week model, the antibacterial activity using the spread plate method had median (interquartile range) numbers of bacteria on the Ti, Ti-O, and Ti-I implants of 112 (104 to 165) × 105, 147 (111 to 162) × 105, and 55 (37 to 67) × 105 of methicillin-sensitive Staphylococcus aureus (Ti-I versus Ti, p = 0.026; Ti-I versus Ti-O, p = 0.009); 71 (39 to 111) × 105, 50 (44 to 62) × 105, and 26 (9 to 31)× 105 CFU of methicillin-resistant S. aureus (Ti-I versus Ti, p = 0.026; Ti-I versus Ti-O, p = 0.034); and 77 (74 to 83) × 106, 111 (95 to 117) × 106, and 30 (21 to 45) × 106 CFU of Pseudomonas aeruginosa (Ti-I versus Ti, p = 0.004; Ti-I versus Ti-O, p = 0.009). Despite the decrease in the iodine content of Ti-I after 8 weeks, it demonstrated better antibacterial activity against all tested bacteria than the Ti and Ti-O implants. CONCLUSION Iodine-coated implants retained their iodine content and antibacterial activity against methicillin-sensitive S. aureus, methicillin-resistant S. aureus, and P. aeruginosa for 8 weeks in vivo in rats. To evaluate the longer-lasting antibacterial efficacy, further research using larger infected animal PJI models with implants in the joints of both males and females is desirable. CLINICAL RELEVANCE Iodine-coated titanium implants displayed an antibacterial activity for 8 weeks in rats in vivo. Although the findings in a rat model do not guarantee efficacy in humans, they represent an important step toward clinical application.
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Affiliation(s)
- Ken Ueoka
- Department of Orthopedic Surgery, Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Japan
| | - Tamon Kabata
- Department of Orthopedic Surgery, Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Japan
| | - Masaharu Tokoro
- Department of Parasitology, Advanced Preventive Medical Sciences Research Center, Kanazawa University, Kanazawa, Japan
| | - Yoshitomo Kajino
- Department of Orthopedic Surgery, Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Japan
| | - Daisuke Inoue
- Department of Orthopedic Surgery, Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Japan
| | - Tomoharu Takagi
- Department of Orthopedic Surgery, Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Japan
| | - Takaaki Ohmori
- Department of Orthopedic Surgery, Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Japan
| | - Junya Yoshitani
- Department of Orthopedic Surgery, Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Japan
| | - Takuro Ueno
- Department of Orthopedic Surgery, Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Japan
| | - Yuki Yamamuro
- Department of Orthopedic Surgery, Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Japan
| | - Atsushi Taninaka
- Department of Orthopedic Surgery, Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Japan
| | - Hiroyuki Tsuchiya
- Department of Orthopedic Surgery, Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Japan
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Ueoka K, Kajino Y, Kabata T, Inoue D, Yoshitani J, Ueno T, Yamamuro Y, Shirai T, Tsuchiya H. The feasibility of iodine-supported processing for titanium with different surfaces. J Orthop Sci 2020; 25:1095-1100. [PMID: 32143853 DOI: 10.1016/j.jos.2019.12.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Revised: 12/04/2019] [Accepted: 12/05/2019] [Indexed: 11/18/2022]
Abstract
BACKGROUND The reduction of microbial infections can substantially improve the success of implant surgery. The iodine-supported implants that were developed by us for infection prevention were featured at the recent International Consensus Meeting on Musculoskeletal Infection and were partly incorporated into the consensus guidelines. For future clinical application, we examined (1) whether iodine can be added to metals with different surface roughness, (2) differences in surface roughness before and after processing, and (3) the effect of sterilization on the iodine content. METHODS Four Ti-6Al-4V metals were prepared with different surface roughness values by polishing, blasting and plasma spraying. Before and after processing, the surface structure of metals was observed using a scanning electron microscope and stylus instruments. Before and after sterilization, iodine contents were measured by X-ray fluorescence spectroscopy. RESULTS After processing, sufficient iodine contents with an antimicrobial effect were detected for each metal. These iodine contents decreased after sterilization but were higher than the lowest content of iodine observed to have an antimicrobial effect in a previous study, indicating that the antimicrobial effect persists even after sterilization. After processing, surface roughness was greater for polishing metal. With general surface processing, iodine processing was possible. CONCLUSIONS Our results indicated that surface roughness is affected by the processing method and that the iodine content should be set according to the sterilization method. Considering these factors, iodine processing can be used for clinical applications.
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Affiliation(s)
- Ken Ueoka
- Department of Orthopaedic Surgery, Graduate School of Medical Science, Kanazawa University, Kanazawa, Japan
| | - Yoshitomo Kajino
- Department of Orthopaedic Surgery, Graduate School of Medical Science, Kanazawa University, Kanazawa, Japan.
| | - Tamon Kabata
- Department of Orthopaedic Surgery, Graduate School of Medical Science, Kanazawa University, Kanazawa, Japan
| | - Daisuke Inoue
- Department of Orthopaedic Surgery, Graduate School of Medical Science, Kanazawa University, Kanazawa, Japan
| | - Junya Yoshitani
- Department of Orthopaedic Surgery, Graduate School of Medical Science, Kanazawa University, Kanazawa, Japan
| | - Takuro Ueno
- Department of Orthopaedic Surgery, Graduate School of Medical Science, Kanazawa University, Kanazawa, Japan
| | - Yuki Yamamuro
- Department of Orthopaedic Surgery, Graduate School of Medical Science, Kanazawa University, Kanazawa, Japan
| | - Toshiharu Shirai
- Department of Orthopaedic Surgery, Graduate School of Medical Science, Kanazawa University, Kanazawa, Japan
| | - Hiroyuki Tsuchiya
- Department of Orthopaedic Surgery, Graduate School of Medical Science, Kanazawa University, Kanazawa, Japan
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15
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Tsikopoulos K, Sidiropoulos K, Kitridis D, Hassan A, Drago L, Mavrogenis A, McBride D. Is coating of titanium implants effective at preventing Staphylococcus aureus infections? A meta-analysis of animal model studies. INTERNATIONAL ORTHOPAEDICS 2020; 45:821-835. [PMID: 32761434 DOI: 10.1007/s00264-020-04660-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/31/2019] [Accepted: 06/11/2020] [Indexed: 12/25/2022]
Abstract
AIM OF THE STUDY To assess the effects of the available coating methods against methicillin-resistant Staphylococcus aureus (MRSA) and methicillin-susceptible S. aureus (MSSA) biofilm development on titanium implants. METHODS We searched the MEDLINE, Embase, and CENTRAL databases until May 18, 2019, for studies that used animal models of infections to evaluate various titanium implant coating methods to prevent S. aureus infection. Twenty-seven studies were eligible for inclusion in qualitative synthesis. Of those, twenty-three were considered in pair-wise meta-analysis. In addition, subgroup analysis of implant protection strategies relative to uncoated controls was performed, and any adverse events stemming from the coating applications were reported. Quality assessment was performed using SYRCLE's risk of bias tool for animal studies. RESULTS Meta-analysis showed that active coating with antibiotics was favoured over uncoated controls (standardised mean differences [SMD] for MRSA and MSSA were - 2.71 [95% CI, - 4.24 to - 1.18], p = 0.0005, and - 2.5 [- 3.79 to - 1.22], p = 0.0001, respectively). Likewise, large effect sizes were demonstrated when a combination of active and conventional non-degradable passive coatings was compared with controls (SMDs for MRSA and MSSA were - 0.62 [95% CI, - 1.15 to - 0.08], p = 0.02, and - 1.93 [95% CI, - 2.87 to - 0.98], p < 0.001, respectively). DISCUSSION/CONCLUSION As a standalone prevention method, active titanium coating with antibiotics yielded promising results against both MSSA and MRSA. Combinations between active and non-degradable passive coatings, potentially allowing for sustained antimicrobial substance release, provided consistent hardware infection protection. Thus, we recommend that future research efforts focus on combined coating modalities against S. aureus biofilm infections in the presence of titanium implants. SYSTEMATIC REVIEW REGISTRATION CRD42019123462.
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Affiliation(s)
| | | | - Dimitrios Kitridis
- 1st Orthopaedic Department of Aristotle University, G. Papanikolaou General Hospital, Exohi, Thessaloniki, Greece
| | - Anas Hassan
- Orthopaedic Department, Lister Hospital, Stevenage, East and North Hertfordshire, UK
| | - Lorenzo Drago
- Laboratory of Clinical Microbiology, Department of Biochemical Sciences for Health, University of Milan, Milan, Italy
| | - Andreas Mavrogenis
- Orthopaedic Department, National and Kapodistrian University of Athens, Athens, Greece
| | - Donald McBride
- Orthopaedic Department, University Hospitals of North Midlands, Stoke-on-Trent, UK
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Combinational therapy with antibiotics and antibiotic-loaded adipose-derived stem cells reduce abscess formation in implant-related infection in rats. Sci Rep 2020; 10:11182. [PMID: 32636453 PMCID: PMC7341734 DOI: 10.1038/s41598-020-68184-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2020] [Accepted: 06/19/2020] [Indexed: 02/06/2023] Open
Abstract
Implant-related infection is difficult to treat without extended antibiotic courses. However, the long-term use of antibiotics has led to the development of multidrug- and methicillin-resistant Staphylococcusaureus. Thus, alternatives to conventional antibiotic therapy are needed. Recently, mesenchymal stem cells have been shown to have antimicrobial properties. This study aimed to evaluate the antimicrobial activity and therapeutic effect of local treatment with antibiotic-loaded adipose-derived stem cells (ADSCs) plus an antibiotic in a rat implant-associated infection model. Liquid chromatography/tandem mass spectrometry revealed that ADSCs cultured in the presence of ciprofloxacin for 24 h showed time-dependent antibiotic loading. Next, we studied the therapeutic effects of ADSCs and ciprofloxacin alone or in combination in an implant-related infection rat model. The therapeutic effects of ADSCs plus antibiotics, antibiotics, and ADSCs were compared with no treatment as a control. Rats treated with ADSCs plus ciprofloxacin had the lowest modified osteomyelitis scores, abscess formation, and bacterial burden on the implant among all groups (P < 0.05). Thus, local treatment with ADSCs plus an antibiotic has an antimicrobial effect in implant-related infection and decrease abscess formation. Thus, our findings indicate that local administration of ADSCs with antibiotics represents a novel treatment strategy for implant-associated osteomyelitis.
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Surface Modifications for Implants Lifetime extension: An Overview of Sol-Gel Coatings. COATINGS 2020. [DOI: 10.3390/coatings10060589] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
The limited lifetime of implants entails having patients undergo replacement surgeries, several times throughout life in young patients, with significant risks for them and extensive cost for healthcare service. The overcoming of such inconvenience is still today a hard challenge for the scholars of the biomedical and biomaterial fields. The improvement of the currently employed implants through surface modification by coatings application is the main strategy proposed to avoid implants failure, and the sol-gel coating is an ideal technology to achieve this goal. Therefore, the present review aims to provide an overview of the most important problems leading to implant failure, the sol-gel coating technology, and its use as a strategy to overcome such issues.
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Ota T, Demura S, Kato S, Yoshioka K, Hayashi H, Inoue K, Shinmura K, Yokogawa N, Shirai T, Murakami H, Tsuchiya H. A comparison of bone conductivity on titanium screws inserted into the vertebra using different surface processing. J Exp Orthop 2020; 7:29. [PMID: 32405666 PMCID: PMC7221053 DOI: 10.1186/s40634-020-00250-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Accepted: 05/08/2020] [Indexed: 11/10/2022] Open
Abstract
PURPOSE Antibacterial iodine-supported titanium has an anodized oxide layer; thus, it can be expected to have a higher osteoconductivity than untreated titanium. This study aimed to compare the osteoconductivity between untreated titanium (Ti), anodically oxidized titanium (AO-Ti), and iodine-supported titanium (I-Ti) screws. METHODS The screws were inserted into the vertebral bodies of 30 dogs (12 for the biomechanical, and 18 for the histological examination). The vertebral bodies were analyzed at 4 or 8 weeks after screw insertion. Biomechanically, rotational torque of the screw was measured. Histologically, bone formation index (ratio of the length of the part where the bone directly contacts with the length of the screw) and bone volume density (ratio of the area of the bone tissue to the area between the threads of the screw) were measured. RESULT At 4 weeks, the torque value was significantly higher in the AO-Ti (0.59 ± 0.16 Nm) and I-Ti (0.72 ± 0.14 Nm) groups than in the Ti group (0.39 ± 0.12 Nm), with the AO-Ti and I-Ti groups showing no significant difference. Bone formation index was significantly higher in the AO-Ti (72.5% ± 0.8%) and I-Ti (73.4% ± 1.5%) groups than in the Ti group (64.6% ±1.7%), with the AO-Ti and I-Ti groups showing no significant difference. Bone volume density did not show a significant difference. At 8 weeks, the results were similar to those at 4 weeks. CONCLUSIONS I-Ti had a higher osteoconductivity than Ti, indicating that iodine coating did not adversely affect osteoconductivity.
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Affiliation(s)
- Takashi Ota
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, 13-1, Takara-machi, Kanazawa, 920-8641, Japan
| | - Satoru Demura
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, 13-1, Takara-machi, Kanazawa, 920-8641, Japan.
| | - Satoshi Kato
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, 13-1, Takara-machi, Kanazawa, 920-8641, Japan
| | - Katsuhito Yoshioka
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, 13-1, Takara-machi, Kanazawa, 920-8641, Japan
| | - Hiroyuki Hayashi
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, 13-1, Takara-machi, Kanazawa, 920-8641, Japan
| | - Kei Inoue
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, 13-1, Takara-machi, Kanazawa, 920-8641, Japan
| | - Kazuya Shinmura
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, 13-1, Takara-machi, Kanazawa, 920-8641, Japan
| | - Noriaki Yokogawa
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, 13-1, Takara-machi, Kanazawa, 920-8641, Japan
| | - Toshiharu Shirai
- Department of Orthopaedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan
| | - Hideki Murakami
- Department of Orthopaedic Surgery, Nagoya City University Medical School, 1-Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, 467-8602, Japan
| | - Hiroyuki Tsuchiya
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, 13-1, Takara-machi, Kanazawa, 920-8641, Japan
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A Portable Device for the Generation of Drug-Loaded Three-Compartmental Fibers Containing Metronidazole and Iodine for Topical Application. Pharmaceutics 2020; 12:pharmaceutics12040373. [PMID: 32325670 PMCID: PMC7238112 DOI: 10.3390/pharmaceutics12040373] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Revised: 04/13/2020] [Accepted: 04/13/2020] [Indexed: 11/16/2022] Open
Abstract
The use of combination therapies for the treatment of a range of conditions is now well established, with the component drugs usually being delivered either as distinct medicaments or combination products that contain physical mixes of the two active ingredients. There is, however, a compelling argument for the development of compartmentalised systems whereby the release, stability and incorporation environment of the different drugs may be tailored. Here we outline the development of polymeric fine fiber systems whereby two drugs used for the treatment of wounds may be separately incorporated. Fibers were delivered using a newly developed handheld electrospinning device that allows treatment at the site of need. Crucially, the delivery system is portable and may be used for the administration of drug-loaded fibers directly into the wound in situ, thereby potentially allowing domiciliary or site-of-trauma administration. The three-layered fiber developed in this study has polyethylene glycol as the outermost layer, serving as a structural support for the inner layers. The inner layers comprised iodine complexed with polyvinylpyrrolidone (PVP) and metronidazole dispersed in polycaprolactone (PCL) as a slow release core. The systems were characterized in terms of structure and architecture using scanning electron microscopy, transmission electron microscopy, attenuated total reflection Fourier transform infrared spectroscopy and diffractometry. As antibacterial creams are still used for managing infected wounds, the performance of our trilayered fiber was studied in comparison with creams containing similar active drugs. Drug release was measured by UV analysis, while antimicrobial efficiency was measured using agar diffusion and suspension methods. It was found that the trilayered systems, averaging 3.16 µm in diameter, released more drug over the study period and were confirmed by the microbacterial studies to be more effective against P. aeruginosa, a bacterium commonly implicated in infected wounds. Overall, the portable system has been shown to be capable of not only incorporating the two drugs in distinct layers but also of delivering adequate amounts of drugs for a more effective antibacterial activity. The portability of the device and its ability to generate distinct layers of multiple active ingredients make it promising for further development for wound healing applications in terms of both practical applicability and antimicrobial efficacy.
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Yuan Z, Dai Y, Ouyang P, Rehman T, Hussain S, Zhang T, Yin Z, Fu H, Lin J, He C, Lv C, Liang X, Shu G, Song X, Li L, Zou Y, Yin L. Thymol Inhibits Biofilm Formation, Eliminates Pre-Existing Biofilms, and Enhances Clearance of Methicillin-Resistant Staphylococcus aureus (MRSA) in a Mouse Peritoneal Implant Infection Model. Microorganisms 2020; 8:microorganisms8010099. [PMID: 31936809 PMCID: PMC7023310 DOI: 10.3390/microorganisms8010099] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Revised: 01/08/2020] [Accepted: 01/09/2020] [Indexed: 12/19/2022] Open
Abstract
Methicillin-resistant Staphylococcus aureus (MRSA) is a common human pathogen that causes several difficult-to-treat infections, including biofilm-associated infections. The biofilm-forming ability of S. aureus plays a pivotal role in its resistance to most currently available antibiotics, including vancomycin, which is the first-choice drug for treating MRSA infections. In this study, the ability of thymol (a monoterpenoid phenol isolated from plants) to inhibit biofilm formation and to eliminate mature biofilms, was assessed. We found that thymol could inhibit biofilm formation and remove mature biofilms by inhibiting the production of polysaccharide intracellular adhesin (PIA) and the release of extracellular DNA (eDNA). However, cotreatment with thymol and vancomycin was more effective at eliminating MRSA biofilms, in a mouse infection model, than monotherapy with vancomycin. Comparative histopathological analyses revealed that thymol reduced the pathological changes and inflammatory responses in the wounds. Assessments of white blood cell counts and serum TNF-α and IL-6 levels showed reduced inflammation and an increased immune response following treatment with thymol and vancomycin. These results indicate that combinatorial treatment with thymol and vancomycin has the potential to serve as a more effective therapy for MRSA biofilm-associated infections than vancomycin monotherapy.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Lizi Yin
- Correspondence: ; Tel.: +86-170-9284-8186
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21
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Shirai T, Tsuchiya H, Terauchi R, Tsuchida S, Mizoshiri N, Mori Y, Takeuchi A, Hayashi K, Yamamoto N, Ikoma K, Kubo T. A retrospective study of antibacterial iodine-coated implants for postoperative infection. Medicine (Baltimore) 2019; 98:e17932. [PMID: 31702678 PMCID: PMC6855576 DOI: 10.1097/md.0000000000017932] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
Postoperative infection is one of the most serious complications in orthopedic surgery. We have developed and use iodine-coated implants to prevent and treat postoperative infection in compromised hosts. This study evaluated outcomes using iodine-coated implants for postoperative infections.We treated 72 postoperative infected patients using iodine-coated implants. Of these, 38 were males and 34 were females, with a mean age of 59.3 years. The mean follow-up period was 5.6 years. The patients included 23 with an infection following total knee arthroplasty, 20 following total hip arthroplasty, 11 following osteosynthesis, 11 following spine surgery, 6 following tumor excision, and 1 following osteotomy. Of these, 37 underwent single-stage surgery and 35 underwent staged revision surgery. We performed staged surgery in any case with active infection. The survival of iodine-coated implants was determined using Kaplan-Meier analysis. White blood cell (WBC) and C-reactive protein (CRP) levels were measured pre- and postoperatively. To evaluate the systemic effects of iodine, serum thyroid hormone levels were examined.Five patients underwent re-revision surgery. In 3 patients, periprosthetic infection recurred at an average of 18 months after surgery. The reinfection rate was 4.2%. These patients recovered following reimplantation of iodine-coated prostheses. No patients required amputation. The survival rate of iodine-coated implants was 91%. There were no signs of infection at the latest follow-up. The median WBC level was nearly in the normal range, and CRP levels returned to normal within 4 weeks after surgery. No abnormalities of thyroid gland function were detected.Iodine-coated titanium implants can be very effective in the treatment of postoperative infections. An iodine coating can be safely applied to infected regions.
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Affiliation(s)
- Toshiharu Shirai
- Department of Orthopedics, Graduate School of Medical Science, Kyoto prefectural University of Medicine, 465 Kajiicho Kyoto
- Department of Orthopaedic Surgery, Graduate School of Medical Science, Kanazawa University, 13-1 Takaramachi Kanazawa, Japan
| | - Hiroyuki Tsuchiya
- Department of Orthopaedic Surgery, Graduate School of Medical Science, Kanazawa University, 13-1 Takaramachi Kanazawa, Japan
| | - Ryu Terauchi
- Department of Orthopedics, Graduate School of Medical Science, Kyoto prefectural University of Medicine, 465 Kajiicho Kyoto
| | - Shinji Tsuchida
- Department of Orthopedics, Graduate School of Medical Science, Kyoto prefectural University of Medicine, 465 Kajiicho Kyoto
| | - Naoki Mizoshiri
- Department of Orthopedics, Graduate School of Medical Science, Kyoto prefectural University of Medicine, 465 Kajiicho Kyoto
| | - Yuki Mori
- Department of Orthopedics, Graduate School of Medical Science, Kyoto prefectural University of Medicine, 465 Kajiicho Kyoto
| | - Akihiko Takeuchi
- Department of Orthopaedic Surgery, Graduate School of Medical Science, Kanazawa University, 13-1 Takaramachi Kanazawa, Japan
| | - Katsuhiro Hayashi
- Department of Orthopaedic Surgery, Graduate School of Medical Science, Kanazawa University, 13-1 Takaramachi Kanazawa, Japan
| | - Norio Yamamoto
- Department of Orthopaedic Surgery, Graduate School of Medical Science, Kanazawa University, 13-1 Takaramachi Kanazawa, Japan
| | - Kazuya Ikoma
- Department of Orthopedics, Graduate School of Medical Science, Kyoto prefectural University of Medicine, 465 Kajiicho Kyoto
| | - Toshikazu Kubo
- Department of Orthopedics, Graduate School of Medical Science, Kyoto prefectural University of Medicine, 465 Kajiicho Kyoto
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22
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Nagao R, Esaki D, Shibata Y, Ikawa S, Kitano K, Ayukawa Y, Matsushita Y, Takeshita T, Yamashita Y, Matsuzaki M, Koyano K. Investigation of a novel sterilization method for biofilms formed on titanium surfaces. Dent Mater J 2019; 38:654-662. [PMID: 31189796 DOI: 10.4012/dmj.2018-274] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
The development of effective methods to disinfect biofilms on dental materials is medically important. This study evaluated the bactericidal effects of peroxynitric acid (HOONO2; PNA) on biofilms formed on titanium surfaces. Streptococcus gordonii was cultured on either machined or rough titanium discs that were then used to evaluate the bactericidal effects of seven reagents, i.e., normal saline, benzalkonium chloride disinfectant solution, chlorhexidine digluconate solution, three concentration types of PNA, and inactivated PNA. Using low concentration of PNA, the bacterial count based on a CFU assay reached an undetectable level within 10 s; this bactericidal effect was the strongest observed for the seven tested reagents. Thus, PNA may be more useful than other disinfectants for sterilizing biofilms on titanium surfaces that have been contaminated with bacteria.
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Affiliation(s)
- Rei Nagao
- Section of Implant and Rehabilitative Dentistry, Division of Oral Rehabilitation, Faculty of Dental Science, Kyushu University
| | - Daisuke Esaki
- Section of Implant and Rehabilitative Dentistry, Division of Oral Rehabilitation, Faculty of Dental Science, Kyushu University
| | - Yukie Shibata
- Section of Preventive and Public Health Dentistry, Division of Oral Health, Growth and Development, Faculty of Dental Science, Kyushu University
| | - Satoshi Ikawa
- Osaka Research Institute of Industrial Science and Technology
| | - Katsuhisa Kitano
- Center for Atomic and Molecular Technologies, Graduate School of Engineering, Osaka University
| | - Yasunori Ayukawa
- Section of Implant and Rehabilitative Dentistry, Division of Oral Rehabilitation, Faculty of Dental Science, Kyushu University
| | - Yasuyuki Matsushita
- Section of Implant and Rehabilitative Dentistry, Division of Oral Rehabilitation, Faculty of Dental Science, Kyushu University
| | - Toru Takeshita
- Section of Preventive and Public Health Dentistry, Division of Oral Health, Growth and Development, Faculty of Dental Science, Kyushu University
| | - Yoshihisa Yamashita
- Section of Preventive and Public Health Dentistry, Division of Oral Health, Growth and Development, Faculty of Dental Science, Kyushu University
| | - Masaaki Matsuzaki
- Section of Implant and Rehabilitative Dentistry, Division of Oral Rehabilitation, Faculty of Dental Science, Kyushu University
| | - Kiyoshi Koyano
- Section of Implant and Rehabilitative Dentistry, Division of Oral Rehabilitation, Faculty of Dental Science, Kyushu University
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23
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Abstract
Implant-related infection is one of the leading reasons for failure in orthopaedics and trauma, and results in high social and economic costs. Various antibacterial coating technologies have proven to be safe and effective both in preclinical and clinical studies, with post-surgical implant-related infections reduced by 90% in some cases, depending on the type of coating and experimental setup used. Economic assessment may enable the cost-to-benefit profile of any given antibacterial coating to be defined, based on the expected infection rate with and without the coating, the cost of the infection management, and the cost of the coating. After reviewing the latest evidence on the available antibacterial coatings, we quantified the impact caused by delaying their large-scale application. Considering only joint arthroplasties, our calculations indicated that for an antibacterial coating, with a final user's cost price of €600 and able to reduce post-surgical infection by 80%, each year of delay to its large-scale application would cause an estimated 35 200 new cases of post-surgical infection in Europe, equating to additional hospital costs of approximately €440 million per year. An adequate reimbursement policy for antibacterial coatings may benefit patients, healthcare systems, and related research, as could faster and more affordable regulatory pathways for the technologies still in the pipeline. This could significantly reduce the social and economic burden of implant-related infections in orthopaedics and trauma. Cite this article: C. L. Romanò, H. Tsuchiya, I. Morelli, A. G. Battaglia, L. Drago. Antibacterial coating of implants: are we missing something? Bone Joint Res 2019;8:199-206. DOI: 10.1302/2046-3758.85.BJR-2018-0316.
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Affiliation(s)
- C. L. Romanò
- Studio Medico Associato Cecca-Romanò, Milan, Italy
| | - H. Tsuchiya
- Department of Orthopaedic Surgery, Graduate School of Medical Science, Kanazawa University, Kanazawa, Japan
| | - I. Morelli
- Specialty School of Orthopaedics, University of Milan, Milan, Italy
| | - A. G. Battaglia
- Specialty School of Orthopaedics, University of Milan, Milan, Italy
| | - L. Drago
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
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24
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Inoue D, Kabata T, Kajino Y, Shirai T, Tsuchiya H. Iodine-supported titanium implants have good antimicrobial attachment effects. J Orthop Sci 2019; 24:548-551. [PMID: 30409704 DOI: 10.1016/j.jos.2018.10.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Revised: 09/25/2018] [Accepted: 10/07/2018] [Indexed: 11/17/2022]
Abstract
BACKGROUND We have developed iodine-supported titanium implants, which were shown to have good anti-bacterial effects for Methicillin-sensitive Staphylococcus aureus (MSSA) in our past basic research. However, PJI can be caused by various bacteria including MRSA, Pseudomonas aeruginosa, MSSE, and fungus. The purpose of this study was to investigate whether these implants also have good antibacterial attachment effects for MRSA, P. aeruginosa, MSSE, and fungus. METHODS Ti-6Al-4V titanium plates were either left untreated (Ti), treated with oxide film on the Ti surface by anodization (Ti-O), or treated with an iodine coating on oxidation film (Ti-I). The antibacterial activity of the TiI was measured by experimental methods according to Japanese Industrial Standard (JIS) protocols. Implants in this study were exposed to MRSA (ATCC43300), P. aeruginosa (ATCC27853), MSSE (ATCC35984), and Candida Albicans (ATCC10231). Colonies were counted immediately after the bacteria attached to the metal surface and again after 24 h incubation. The difference in the number of bacteria on each metal plate was statistically investigated and an antibacterial activity value was calculated. An effective antibacterial active value of more than 2.0 was judged to be effective according to JIS protocol. RESULTS No countable viable bacteria were observed on the Ti-I surface. For all bacteria there was a significant difference in the mean number of viable bacteria between Ti-I and Ti or Ti-O. Antibacterial activity value in Ti-I and Ti-O was more than 5.9 and 3.6 respectively for MRSA, more than 2.8 and zero for P. aeruginosa, more than 4.3 and zero for MSSE, and more than 4.7 and zero for C. Albicans. CONCLUSIONS This study showed that iodine-supported titanium implants have good antimicrobial attachment effects for MRSA, P. aeruginosa, MSSE, and C. Albicans. Iodine-supported titanium implants could have great potential as innovative antibacterial implants that can prevent early onset periprosthetic joint infection.
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Affiliation(s)
- Daisuke Inoue
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, Japan.
| | - Tamon Kabata
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, Japan.
| | - Yoshitomo Kajino
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, Japan.
| | - Toshiharu Shirai
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, Japan; Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyoto Prefectural University of Medicine, Japan.
| | - Hiroyuki Tsuchiya
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, Japan.
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25
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Abstract
In part 1 of this article, the authors explore nanoscale modifications of the surfaces of biomaterials, which offer an exciting potential venue for the prevention of bacterial adhesion and growth. Despite advances in the design and manufacture of implants, infection remains an important and often devastating mode of failure. In part 2, additive technologies for tissue engineering, live cell printing (bioprinting), and tissue fabrication are briefly introduced. The similarities and differences between bioprinting and non-bio 3D-printing approaches and requirements are discussed, along with terminological definitions, current processes, requirements, and biomaterial and cell-type selection and sourcing.
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Affiliation(s)
- Felasfa M Wodajo
- Virginia Cancer Specialists, 8503 Arlington Boulevard, Suite 400, Fairfax, VA 22031, USA; Orthopedic Surgery, VCU School of Medicine, Inova Campus, Fairfax, VA 22042, USA; Orthopedic Surgery, Georgetown University Hospital, Washington, DC 20007, USA.
| | - Adam E Jakus
- Dimension Inx LLC, 303 East Superior Street, 11th Floor, Chicago, IL 60611, USA
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26
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Chouirfa H, Bouloussa H, Migonney V, Falentin-Daudré C. Review of titanium surface modification techniques and coatings for antibacterial applications. Acta Biomater 2019; 83:37-54. [PMID: 30541702 DOI: 10.1016/j.actbio.2018.10.036] [Citation(s) in RCA: 434] [Impact Index Per Article: 86.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Revised: 10/09/2018] [Accepted: 10/23/2018] [Indexed: 02/07/2023]
Abstract
Implanted biomaterials play a key role in the current success of orthopedic and dental procedures. Pure titanium and its alloys are the most commonly used materials for permanent implants in contact with bone. However, implant-related infections remain among the leading reasons for failure. The most critical pathogenic event in the development of infection on biomaterials is biofilm formation, which starts immediately after bacterial adhesion. In the last decade, numerous studies reported the ability of titanium surface modifications and coatings to minimize bacterial adhesion, inhibit biofilm formation and provide effective bacterial killing to protect implanted biomaterials. In the present review, the different strategies to prevent infection onto titanium surfaces are reported: surface modification and coatings by antibiotics, antimicrobial peptides, inorganic antibacterial metal elements and antibacterial polymers. STATEMENT OF SIGNIFICANCE: Implanted biomaterials play a key role in the current success of orthopedic and dental procedures. Pure titanium and its alloys are the most commonly used materials for permanent implants in contact with bone. Microbial infection is one of the main causes of implant failure. Currently, the global infection risk is 2-5% in orthopedic surgery. Numerous solutions exist to render titanium surfaces antibacterial. The LBPS team is an expert on the functionalization of titanium surfaces by using bioactive polymers to improve the biologiocal response. In this review, the different strategies to prevent infection are reported onto titanium and titanium alloy surfaces such as surface modification by antibiotics, antimicrobial peptides, inorganic antibacterial metal elements and antibacterial polymers.
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27
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Peeters E, Hooyberghs G, Robijns S, De Weerdt A, Kucharíková S, Tournu H, Braem A, Čeh K, Majdič G, Španič T, Pogorevc E, Claes B, Dovgan B, Girandon L, Impellizzeri F, Erdtmann M, Krona A, Vleugels J, Fröhlich M, Garcia-Forgas J, De Brucker K, Cammue BPA, Thevissen K, Van Dijck P, Vanderleyden J, Van der Eycken E, Steenackers HP. An antibiofilm coating of 5-aryl-2-aminoimidazole covalently attached to a titanium surface. J Biomed Mater Res B Appl Biomater 2018; 107:1908-1919. [PMID: 30549192 DOI: 10.1002/jbm.b.34283] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Revised: 09/21/2018] [Accepted: 09/30/2018] [Indexed: 12/25/2022]
Abstract
Biofilms, especially those formed by Staphylococcus aureus, play a key role in the development of orthopedic implant infections. Eradication of these infections is challenging due to the elevated tolerance of biofilm cells against antimicrobial agents. In this study, we developed an antibiofilm coating consisting of 5-(4-bromophenyl)-N-cyclopentyl-1-octyl-1H-imidazol-2-amine, designated as LC0024, covalently bound to a titanium implant surface (LC0024-Ti). We showed in vitro that the LC0024-Ti surface reduces biofilm formation of S. aureus in a specific manner without reducing the planktonic cells above the biofilm, as evaluated by plate counting and fluorescence microscopy. The advantage of compounds that only inhibit biofilm formation without affecting the viability of the planktonic cells, is that reduced development of bacterial resistance is expected. To determine the antibiofilm activity of LC0024-Ti surfaces in vivo, a biomaterial-associated murine infection model was used. The results indicated a significant reduction in S. aureus biofilm formation (up to 96%) on the LC0024-Ti substrates compared to pristine titanium controls. Additionally, we found that the LC0024-Ti substrates did not affect the attachment and proliferation of human cells involved in osseointegration and bone repair. In summary, our results emphasize the clinical potential of covalent coatings of LC0024 on titanium implant surfaces to reduce the risk of orthopedic implant infections. © 2018 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater 107B: 1908-1919, 2019.
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Affiliation(s)
- Elien Peeters
- Department of Microbial and Molecular Systems, Centre of Microbial and Plant Genetics (CMPG), KU Leuven, Kasteelpark Arenberg 20 Box 2460, 3001 Leuven, Belgium
| | - Geert Hooyberghs
- Department of Chemistry, Laboratory for Organic and Microwave-Assisted Chemistry (LOMAC), KU Leuven, Celestijnenlaan 200F, 3001 Leuven, Belgium
| | - Stijn Robijns
- Department of Microbial and Molecular Systems, Centre of Microbial and Plant Genetics (CMPG), KU Leuven, Kasteelpark Arenberg 20 Box 2460, 3001 Leuven, Belgium
| | - Ami De Weerdt
- Department of Microbial and Molecular Systems, Centre of Microbial and Plant Genetics (CMPG), KU Leuven, Kasteelpark Arenberg 20 Box 2460, 3001 Leuven, Belgium
| | - Soňa Kucharíková
- Department of Molecular Microbiology, VIB, KU Leuven, Kasteelpark Arenberg 31 Box 2438, 3001 Leuven, Belgium.,Department of Biology, Laboratory of Molecular Cell Biology, KU Leuven, Kasteelpark Arenberg 31 Box 2438, 3001 Leuven, Belgium
| | - Hélène Tournu
- Department of Molecular Microbiology, VIB, KU Leuven, Kasteelpark Arenberg 31 Box 2438, 3001 Leuven, Belgium.,Department of Biology, Laboratory of Molecular Cell Biology, KU Leuven, Kasteelpark Arenberg 31 Box 2438, 3001 Leuven, Belgium
| | - Annabel Braem
- Department of Materials Engineering (MTM), KU Leuven, Kasteelpark Arenberg 44 Box 2450, 3001 Leuven, Belgium
| | - Katerina Čeh
- Center for Animal Genomics, Veterinary Faculty, University of Ljubljana, Gerbiceva 60, 1000 Ljubljana, Slovenia
| | - Gregor Majdič
- Center for Animal Genomics, Veterinary Faculty, University of Ljubljana, Gerbiceva 60, 1000 Ljubljana, Slovenia
| | - Tanja Španič
- Center for Animal Genomics, Veterinary Faculty, University of Ljubljana, Gerbiceva 60, 1000 Ljubljana, Slovenia
| | - Estera Pogorevc
- Center for Animal Genomics, Veterinary Faculty, University of Ljubljana, Gerbiceva 60, 1000 Ljubljana, Slovenia
| | - Birgit Claes
- Centre for Surface Chemistry and Catalysis, KU Leuven, Kasteelpark Arenberg 23, 3001 Leuven, Belgium
| | | | | | | | | | - Annika Krona
- RISE - Research Institutes of Sweden, Bioscience and Materials, Box 5401, 402 29 Gothenburg, Sweden
| | - Jef Vleugels
- Department of Materials Engineering (MTM), KU Leuven, Kasteelpark Arenberg 44 Box 2450, 3001 Leuven, Belgium
| | - Mirjam Fröhlich
- Educell Ltd., Prevale 9, 1236 Trzin, Slovenia.,Faculty of Medicine, Institute of Cell Biology, University of Ljubljana, Vrazov trg 2, 1000 Ljubljana, Slovenia
| | | | - Katrijn De Brucker
- Department of Microbial and Molecular Systems, Centre of Microbial and Plant Genetics (CMPG), KU Leuven, Kasteelpark Arenberg 20 Box 2460, 3001 Leuven, Belgium
| | - Bruno P A Cammue
- Department of Microbial and Molecular Systems, Centre of Microbial and Plant Genetics (CMPG), KU Leuven, Kasteelpark Arenberg 20 Box 2460, 3001 Leuven, Belgium.,VIB Center for Plant Systems Biology, Technologiepark 927, 9052 Ghent, Belgium
| | - Karin Thevissen
- Department of Microbial and Molecular Systems, Centre of Microbial and Plant Genetics (CMPG), KU Leuven, Kasteelpark Arenberg 20 Box 2460, 3001 Leuven, Belgium
| | - Patrick Van Dijck
- Department of Molecular Microbiology, VIB, KU Leuven, Kasteelpark Arenberg 31 Box 2438, 3001 Leuven, Belgium.,Department of Biology, Laboratory of Molecular Cell Biology, KU Leuven, Kasteelpark Arenberg 31 Box 2438, 3001 Leuven, Belgium
| | - Jozef Vanderleyden
- Department of Microbial and Molecular Systems, Centre of Microbial and Plant Genetics (CMPG), KU Leuven, Kasteelpark Arenberg 20 Box 2460, 3001 Leuven, Belgium
| | - Erik Van der Eycken
- Department of Chemistry, Laboratory for Organic and Microwave-Assisted Chemistry (LOMAC), KU Leuven, Celestijnenlaan 200F, 3001 Leuven, Belgium
| | - Hans P Steenackers
- Department of Microbial and Molecular Systems, Centre of Microbial and Plant Genetics (CMPG), KU Leuven, Kasteelpark Arenberg 20 Box 2460, 3001 Leuven, Belgium
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28
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Zagra L, Gallazzi E, Romanò D, Scarponi S, Romanò C. Two-stage cementless hip revision for peri-prosthetic infection with an antibacterial hydrogel coating: results of a comparative series. INTERNATIONAL ORTHOPAEDICS 2018; 43:111-115. [PMID: 30374639 DOI: 10.1007/s00264-018-4206-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/06/2018] [Accepted: 10/12/2018] [Indexed: 02/06/2023]
Abstract
PURPOSE The aim of this study was to investigate the hypothesis that a two-stage exchange procedure, performed with an antibiotic-loaded, fast-resorbable hydrogel coating, may provide better infection cure rate than a two-stage procedure without the coating, in patients affected by peri-prosthetic hip infection. METHODS In this case-control study, 27 patients, treated with a two-stage procedure, using cementless implants coated with an antibiotic-loaded hydrogel (DAC®, "Defensive Antibacterial Coating"), were compared with 27 matched controls, treated with a two-stage cementless revision procedure, without the coating. RESULTS At a mean follow-up of 2.7 (minimum 2.1-maximum 3.5) years, no evidence of infection, implant loosening, or adverse events were observed in the DAC-treated group, compared to four cases of infection recurrence in the control group. CONCLUSIONS Although in a relatively limited series of patients our data show that cementless two-stage hip revision, performed with an antibacterial hydrogel coating, may provide better infection control than two-stage without the coating, with reduced hospitalization time, these findings warrant further studies in the possible applications of antibacterial coating technologies to treat implant-related infections.
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Affiliation(s)
- Luigi Zagra
- Hip Department, IRCCS Istituto Ortopedico Galeazzi, Via R. Galeazzi 4, 20161, Milan, Italy.
| | - Enrico Gallazzi
- Hip Department, IRCCS Istituto Ortopedico Galeazzi, Via R. Galeazzi 4, 20161, Milan, Italy
| | - Delia Romanò
- Department of Reconstructive Surgery of Osteo-articular Infections, IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
| | - Sara Scarponi
- Department of Reconstructive Surgery of Osteo-articular Infections, IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
| | - Carlo Romanò
- Centro Medico, Corso Venezia 2, 20121, Milan, Italy
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29
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Ikebe S, Sonohata M, Kitajima M, Kawano S, Mawatari M. Total hip arthroplasty following Girdlestone arthroplasty. J Orthop Sci 2018; 23:532-537. [PMID: 29459080 DOI: 10.1016/j.jos.2018.01.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2017] [Revised: 01/02/2018] [Accepted: 01/28/2018] [Indexed: 10/18/2022]
Abstract
BACKGROUND Complications associated with re-implantation of total hip arthroplasty (THA) after resection arthroplasty for the treatment of primary septic hip arthritis or infected THA and bipolar hemiarthroplasty (BHA) are not well-documented. Furthermore, no comparison has been made between septic arthritis (SA) and infected THA and BHA. We divided subjects into two groups for evaluation: a SA group and an infected THA or BHA group. METHODS Nineteen hips in 19 patients (12 in the SA group, 7 in the infected THA or BHA group) with an average of 77 months of follow-up from the time of re-implantation THA were retrospectively evaluated. RESULTS The average Japanese Orthopaedic Association hip score improved from 50 points (range, 30 to 73 points) preoperatively to 80 points (range: 64 to 96 points) at the time of the final follow-up (p < 0.01). Intra- and postoperative complications occurred in 11 cases, including intraoperative fracture in 1 hip, deep infection in 6 hips, dislocation in 7 hips, and septic loosening of acetabular component in 2 hips. Following re-implantation, further surgical revision was required in four cases. Two revisions were performed for recurrent infection: one patient had recurrent dislocation of one hip, and one patient had recurrent infection and dislocation. The number of hips with relapsed infection in the infected THA or BHA group (5 hips) was significantly higher than that in the SA group (1 hip) (p < 0.05). CONCLUSIONS Re-implantation after septic hip arthritis or infected THA or BHA was an effective treatment for improving the activity of daily life, especially the gait function. Furthermore, 94.7% of patients were free of infection at the latest follow-up. However, the rate of recurrence of infection was 31.6%, and re-implantation after resection arthroplasty following infected THA or BHA led to a lower rate of infection control than that after primary SA.
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Affiliation(s)
- Satoshi Ikebe
- Department of Orthopaedic Surgery, Faculty of Medicine, Saga University, Nabeshima 5-1-1, Saga, 849-8501, Japan
| | - Motoki Sonohata
- Department of Orthopaedic Surgery, Faculty of Medicine, Saga University, Nabeshima 5-1-1, Saga, 849-8501, Japan.
| | - Masaru Kitajima
- Department of Orthopaedic Surgery, Faculty of Medicine, Saga University, Nabeshima 5-1-1, Saga, 849-8501, Japan
| | - Shunsuke Kawano
- Department of Orthopaedic Surgery, Faculty of Medicine, Saga University, Nabeshima 5-1-1, Saga, 849-8501, Japan
| | - Masaaki Mawatari
- Department of Orthopaedic Surgery, Faculty of Medicine, Saga University, Nabeshima 5-1-1, Saga, 849-8501, Japan
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CORR Insights®: Tantalum Components in Difficult Acetabular Revisions Have Good Survival at 5 to 10 Years: Longer Term Followup of a Previous Report. Clin Orthop Relat Res 2018; 476. [PMID: 29529666 PMCID: PMC6259680 DOI: 10.1007/s11999.0000000000000107] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
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Damiati L, Eales MG, Nobbs AH, Su B, Tsimbouri PM, Salmeron-Sanchez M, Dalby MJ. Impact of surface topography and coating on osteogenesis and bacterial attachment on titanium implants. J Tissue Eng 2018; 9:2041731418790694. [PMID: 30116518 PMCID: PMC6088466 DOI: 10.1177/2041731418790694] [Citation(s) in RCA: 83] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Accepted: 07/03/2018] [Indexed: 01/09/2023] Open
Abstract
Titanium (Ti) plays a predominant role as the material of choice in orthopaedic and dental implants. Despite the majority of Ti implants having long-term success, premature failure due to unsuccessful osseointegration leading to aseptic loosening is still too common. Recently, surface topography modification and biological/non-biological coatings have been integrated into orthopaedic/dental implants in order to mimic the surrounding biological environment as well as reduce the inflammation/infection that may occur. In this review, we summarize the impact of various Ti coatings on cell behaviour both in vivo and in vitro. First, we focus on the Ti surface properties and their effects on osteogenesis and then on bacterial adhesion and viability. We conclude from the current literature that surface modification of Ti implants can be generated that offer both osteoinductive and antimicrobial properties.
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Affiliation(s)
- Laila Damiati
- Centre for the Cellular Microenvironment, University of Glasgow, Glasgow, UK
- Institute of Molecular, Cell and Systems Biology, University of Glasgow, Glasgow, UK
| | - Marcus G Eales
- Bristol Dental School, University of Bristol, Bristol, UK
| | - Angela H Nobbs
- Bristol Dental School, University of Bristol, Bristol, UK
| | - Bo Su
- Bristol Dental School, University of Bristol, Bristol, UK
| | - Penelope M Tsimbouri
- Centre for the Cellular Microenvironment, University of Glasgow, Glasgow, UK
- Institute of Molecular, Cell and Systems Biology, University of Glasgow, Glasgow, UK
| | - Manuel Salmeron-Sanchez
- Centre for the Cellular Microenvironment, University of Glasgow, Glasgow, UK
- Division of Biomedical Engineering, School of Engineering, University of Glasgow, Glasgow, UK
| | - Matthew J Dalby
- Centre for the Cellular Microenvironment, University of Glasgow, Glasgow, UK
- Institute of Molecular, Cell and Systems Biology, University of Glasgow, Glasgow, UK
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