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Bujda M, Klíma K. Enhancing Guided Bone Regeneration with a Novel Carp Collagen Scaffold: Principles and Applications. J Funct Biomater 2024; 15:150. [PMID: 38921524 PMCID: PMC11205119 DOI: 10.3390/jfb15060150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2024] [Revised: 05/21/2024] [Accepted: 05/29/2024] [Indexed: 06/27/2024] Open
Abstract
Bone defects resulting from trauma, surgery, and congenital, infectious, or oncological diseases are a functional and aesthetic burden for patients. Bone regeneration is a demanding procedure, involving a spectrum of molecular processes and requiring the use of various scaffolds and substances, often yielding an unsatisfactory result. Recently, the new collagen sponge and its structural derivatives manufactured from European carp (Cyprinus carpio) were introduced and patented. Due to its fish origin, the novel scaffold poses no risk of allergic reactions or transfer of zoonoses and additionally shows superior biocompatibility, mechanical stability, adjustable degradation rate, and porosity. In this review, we focus on the basic principles of bone regeneration and describe the characteristics of an "ideal" bone scaffold focusing on guided bone regeneration. Moreover, we suggest several possible applications of this novel material in bone regeneration processes, thus opening new horizons for further research.
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Affiliation(s)
- Michele Bujda
- Department of Oral and Maxillofacial Surgery, 1st Faculty of Medicine and General University Hospital in Prague, Charles University, 12108 Prague, Czech Republic
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2
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Eikani C, Hoyt A, Cho E, Levack AE. The State of Local Antibiotic Use in Orthopedic Trauma. Orthop Clin North Am 2024; 55:207-216. [PMID: 38403367 DOI: 10.1016/j.ocl.2023.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/27/2024]
Abstract
Fracture-related infections are a challenging complication in orthopedic trauma that often necessitates multiple surgeries. Early administration of systemic antibiotics and surgical intervention remains the gold standard of care, but despite these measures, treatment failures can be as high as 35%. For these reasons, the introduction of local antibiotics at the site of at-risk fractures has increased over the past decade. This review looks at the various measures being used clinically including local antibiotic powder, polymethylmethacrylate, biodegradable substances, antibiotic-coated implants, and novel methods such as hydrogels and nanoparticles that have the potential for use in the future.
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Affiliation(s)
- Carlo Eikani
- Loyola University Stritch School of Medicine; Department of Orthopaedic Surgery & Rehabilitation, Loyola University Medical Center, 2160 South 1st Avenue, Maguire Suite 1700, Maywood, IL, USA.
| | - Aaron Hoyt
- Department of Orthopaedic Surgery & Rehabilitation, Loyola University Medical Center, 2160 South 1st Avenue, Maguire Suite 1700, Maywood, IL, USA
| | - Elizabeth Cho
- Department of Orthopaedic Surgery & Rehabilitation, Loyola University Medical Center, 2160 South 1st Avenue, Maguire Suite 1700, Maywood, IL, USA
| | - Ashley E Levack
- Loyola University Stritch School of Medicine; Department of Orthopaedic Surgery & Rehabilitation, Loyola University Medical Center, 2160 South 1st Avenue, Maguire Suite 1700, Maywood, IL, USA
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3
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Akay S, Yaghmur A. Recent Advances in Antibacterial Coatings to Combat Orthopedic Implant-Associated Infections. Molecules 2024; 29:1172. [PMID: 38474684 DOI: 10.3390/molecules29051172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Revised: 03/02/2024] [Accepted: 03/03/2024] [Indexed: 03/14/2024] Open
Abstract
Implant-associated infections (IAIs) represent a major health burden due to the complex structural features of biofilms and their inherent tolerance to antimicrobial agents and the immune system. Thus, the viable options to eradicate biofilms embedded on medical implants are surgical operations and long-term and repeated antibiotic courses. Recent years have witnessed a growing interest in the development of robust and reliable strategies for prevention and treatment of IAIs. In particular, it seems promising to develop materials with anti-biofouling and antibacterial properties for combating IAIs on implants. In this contribution, we exclusively focus on recent advances in the development of modified and functionalized implant surfaces for inhibiting bacterial attachment and eventually biofilm formation on orthopedic implants. Further, we highlight recent progress in the development of antibacterial coatings (including self-assembled nanocoatings) for preventing biofilm formation on orthopedic implants. Among the recently introduced approaches for development of efficient and durable antibacterial coatings, we focus on the use of safe and biocompatible materials with excellent antibacterial activities for local delivery of combinatorial antimicrobial agents for preventing and treating IAIs and overcoming antimicrobial resistance.
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Affiliation(s)
- Seref Akay
- Department of Pharmacy, Faculty of Health and Medical Sciences, University of Copenhagen, 2100 Copenhagen, Denmark
| | - Anan Yaghmur
- Department of Pharmacy, Faculty of Health and Medical Sciences, University of Copenhagen, 2100 Copenhagen, Denmark
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Zhao Y, Guo P, Li D, Liu M, Zhang J, Yuan K, Zheng H, Liu L. Preparation and evaluation of oxidized-dextran based on antibacterial hydrogel for synergistic photodynamic therapy. Int J Biol Macromol 2023; 253:127648. [PMID: 37890748 DOI: 10.1016/j.ijbiomac.2023.127648] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Revised: 10/13/2023] [Accepted: 10/22/2023] [Indexed: 10/29/2023]
Abstract
Skin trauma is a widespread, extremely susceptible health issue that affects people all over the world. In this study, an innovative antibacterial hydrogel (ODAA hydrogel) with photosensitizer and antibiotics was developed. Oxidized dextran (ODEX) was used as a carrier to prepare a pH-responsive hydrogel by loading the antibiotic amikacin (AMK) and the photosensitizer hexyl 5-aminolevulinate (HAL) via imine bonds. The ODAA hydrogel has a uniformly distributed cavity structure. The cumulative release rates of HAL and AMK in a simulated inflammatory environment at pH 5.0 were approximately 62.3 % and 71.9 % during 15 days. These results demonstrate the ODAA hydrogel's ability to deliver antibiotics on demand, where the antibiotic content is reduced within the effective range. Regarding the in vitro antibacterial behavior, the combination of HAL and AMK synergistically destroyed the majority of Gram-positive and Gram-negative bacteria through several pathways with broad-spectrum antibacterial effects. ODAA hydrogel has been shown to be biocompatible, nearly non-cytotoxic, and capable of promoting wound healing. It is anticipated that the simultaneous targeted delivery of multiple drugs to lesions in the same carrier at ideal dose ratios for particular therapeutic combinations will produce the most synergistic effects.
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Affiliation(s)
- Yuting Zhao
- School of Chemistry, Chemical Engineering and Life Sciences, Wuhan University of Technology, Wuhan 430070, China
| | - Peiyong Guo
- School of Chemistry, Chemical Engineering and Life Sciences, Wuhan University of Technology, Wuhan 430070, China
| | - Dan Li
- School of Chemistry, Chemical Engineering and Life Sciences, Wuhan University of Technology, Wuhan 430070, China
| | - Mengjie Liu
- School of Chemistry, Chemical Engineering and Life Sciences, Wuhan University of Technology, Wuhan 430070, China
| | - Junhao Zhang
- School of Chemistry, Chemical Engineering and Life Sciences, Wuhan University of Technology, Wuhan 430070, China
| | - Kai Yuan
- School of Chemistry, Chemical Engineering and Life Sciences, Wuhan University of Technology, Wuhan 430070, China
| | - Hua Zheng
- School of Chemistry, Chemical Engineering and Life Sciences, Wuhan University of Technology, Wuhan 430070, China; School of Materials Science and Engineering, Wuhan University of Technology, Wuhan 430070, China.
| | - Liang Liu
- School of Traditional Chinese Medicine, Inner Mongolia Medical University, Huhehot 010010, China.
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Smolle MA, Murtezai H, Niedrist T, Amerstorfer F, Hörlesberger N, Leitner L, Klim SM, Glehr R, Ahluwalia R, Leithner A, Glehr M. Vancomycin Elution Kinetics of Four Antibiotic Carriers Used in Orthopaedic Surgery: In Vitro Study over 42 Days. Antibiotics (Basel) 2023; 12:1636. [PMID: 37998838 PMCID: PMC10669465 DOI: 10.3390/antibiotics12111636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Revised: 11/11/2023] [Accepted: 11/15/2023] [Indexed: 11/25/2023] Open
Abstract
This study aimed to analyse and compare the vancomycin elution kinetics of four biodegradable, osteoconductive antibiotic carriers used in clinical practice within a 42-day in vitro setting. Carriers A and D already contained vancomycin (1.1 g and 0.247 g), whereas carriers B and C were mixed with vancomycin according to the manufacturer's recommendations (B: 0.83 g and C: 0.305 g). At nine time points, 50% (4.5 mL) of the elution sample was removed and substituted with the same amount of PBS. Probes were analysed with a kinetic microparticle immunoassay. Time-dependent changes in vancomycin concentrations for each carrier and differences between carriers were analysed. Mean initial antibiotic levels were highest for carrier A (37.5 mg/mL) and lowest for carrier B (5.4 mg/mL). We observed time-dependent, strongly negative linear elution kinetics for carriers A (-0.835; p < 0.001), C (-0.793; p < 0.001), and D (-0.853; p < 0.001). Vancomycin concentrations increased from 48 h to 7 d and dropped thereafter in carriers C and D whilst constantly decreasing at any time point for carrier A. Carrier B showed a shallower decrease. Mean antibiotics levels at 42 d were 1.5 mg/mL, 2.6 mg/mL, 0.1 mg/mL, and 0.1 mg/mL for carriers A, B, C, and D. Differences in mean initial and final vancomycin concentrations for carrier A were significantly larger in comparison to C (p = 0.040). A carrier consisting of allogenic bone chips showed the highest vancomycin-to-carrier ratio and the largest elution over the study period. Whilst vancomycin concentrations were still measurable at 42 days for all carriers, carrier A provided a higher drug-to-carrier ratio and a more consistent antibiotic-releasing profile.
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Affiliation(s)
- Maria Anna Smolle
- Department of Orthopaedics and Trauma, Medical University of Graz, 8036 Graz, Austria
| | - Hana Murtezai
- Department of Orthopaedics and Trauma, Medical University of Graz, 8036 Graz, Austria
- Institute of Pharmaceutical Sciences, University of Graz, 8010 Graz, Austria
| | - Tobias Niedrist
- Clinical Institute of Medical and Chemical Laboratory Diagnostics, Medical University of Graz, 8036 Graz, Austria
| | - Florian Amerstorfer
- Department of Orthopaedics and Trauma, Medical University of Graz, 8036 Graz, Austria
| | - Nina Hörlesberger
- Department of Orthopaedics and Trauma, Medical University of Graz, 8036 Graz, Austria
| | - Lukas Leitner
- Department of Orthopaedics and Trauma, Medical University of Graz, 8036 Graz, Austria
| | - Sebastian Martin Klim
- Department of Orthopaedics and Trauma, Medical University of Graz, 8036 Graz, Austria
| | - Reingard Glehr
- Institute of General Practice and Evidence-Based Health Services Research, Medical University of Graz, 8036 Graz, Austria
| | - Raju Ahluwalia
- Orthopaedics, Kings College Hospital NHS Foundation Trust, London SE5 9RS, UK
| | - Andreas Leithner
- Department of Orthopaedics and Trauma, Medical University of Graz, 8036 Graz, Austria
| | - Mathias Glehr
- Department of Orthopaedics and Trauma, Medical University of Graz, 8036 Graz, Austria
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6
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Guarch-Pérez C, Riool M, de Boer L, Kloen P, Zaat SAJ. Bacterial reservoir in deeper skin is a potential source for surgical site and biomaterial-associated infections. J Hosp Infect 2023; 140:62-71. [PMID: 37544367 DOI: 10.1016/j.jhin.2023.07.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Revised: 07/22/2023] [Accepted: 07/24/2023] [Indexed: 08/08/2023]
Abstract
BACKGROUND The origin of surgical site and biomaterial-associated infection is still elusive. Micro-organisms contaminating the wound may come from the air in the operating theatre, the surgical team or the skin of the patient. The skin of patients is disinfected prior to surgery, but bacteria deeper in the skin (e.g. in sweat glands or sebaceous glands) may not be reached. METHODS A preliminary cohort study was performed to study the origin of surgical site and biomaterial-associated infection between May 2020 and February 2021. In order to investigate whether cutaneous microbiota colonize the wound when released from the skin upon cutting, aerobic and anaerobic bacteria were isolated, quantified and identified from the skin of 99 patients undergoing trauma surgery, before and after skin disinfection, from knife blades and from the wound directly after the first cut. RESULTS Ninety-nine percent of the patients were culture-positive before disinfection with chlorhexidine. Of these, 40% were still culture-positive after disinfection. Of these, 54% had a positive culture of the wound after cutting the skin. Twenty percent of the patients with a negative culture after disinfection had a positive wound culture after cutting the skin. Staphylococcus epidermidis and Cutibacterium acnes were the most commonly cultured bacterial species. In 9% of cases, more than 100 bacterial colonies were cultured from the wound; this may cause biomaterial-associated infection. CONCLUSION Bacteria residing in the skin and not eradicated by disinfection may enter the surgical wound upon cutting, resulting in contamination which may cause biomaterial-associated infection.
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Affiliation(s)
- C Guarch-Pérez
- Department of Medical Microbiology and Infection Prevention, Amsterdam Institute for Infection and Immunity, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - M Riool
- Department of Medical Microbiology and Infection Prevention, Amsterdam Institute for Infection and Immunity, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - L de Boer
- Department of Medical Microbiology and Infection Prevention, Amsterdam Institute for Infection and Immunity, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - P Kloen
- Department of Orthopaedic Surgery and Sports Medicine, Amsterdam Movement Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - S A J Zaat
- Department of Medical Microbiology and Infection Prevention, Amsterdam Institute for Infection and Immunity, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.
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7
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Pressato D, Battista A, Govoni M, Vivarelli L, Dallari D, Pellegrini A. The Intraoperative Use of Defensive Antibacterial Coating (DAC ®) in the Form of a Gel to Prevent Peri-Implant Infections in Orthopaedic Surgery: A Clinical Narrative Review. MATERIALS (BASEL, SWITZERLAND) 2023; 16:5304. [PMID: 37570009 PMCID: PMC10420205 DOI: 10.3390/ma16155304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 07/21/2023] [Accepted: 07/26/2023] [Indexed: 08/13/2023]
Abstract
Periprosthetic joint infections (PJIs) in arthroplasty and osteosynthesis-associated infections (OAIs) in reconstructive surgery still represent a challenging complication in orthopaedics and traumatology causing a burden worsening the patient's quality of life, for caregiver and treating physicians, and for healthcare systems. PJIs and OAIs are the result of bacterial adhesion over an implant surface with subsequent biofilm formation. Therefore, the clinical pathological outcome is a difficult-to-eradicate persistent infection. Strategies to treat PJIs and OAIs involve debridement, the replacement of internal fixators or articular prostheses, and intravenous antibiotics. However, long treatments and surgical revision cause discomfort for patients; hence, the prevention of PJIs and OAIs represents a higher priority than treatment. Local antibiotic treatments through coating-release systems are becoming a smart approach to prevent this complication. Hydrophilic coatings, loaded with antibiotics, simultaneously provide a barrier effect against bacterial adhesion and allow for the local delivery of an antibiotic. The intraoperative use of a hyaluronan (HY)-derivative coating in the form of a gel, loaded with antibiotics to prevent PJI, has recently raised interest in orthopaedics. Current evidence supports the use of this coating in the prophylaxis of PJI and IRIs in terms of clinical outcomes and infection reduction. Thus, the purpose of this narrative review is to assess the use of a commercially available HY derivative in the form of a gel, highlighting the characteristics of this biomaterial, which makes it attractive for the management of PJIs and IRIs in orthopaedics and traumatology.
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Affiliation(s)
- Daniele Pressato
- Clinical and Scientific Affairs, Novagenit S.r.l., 38017 Mezzolombardo, Italy
| | - Angela Battista
- Quality Assurance and Regulatory Affairs, Novagenit S.r.l., 38017 Mezzolombardo, Italy;
| | - Marco Govoni
- Reconstructive Orthopaedic Surgery and Innovative Techniques—Musculoskeletal Tissue Bank, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy; (L.V.); (D.D.)
| | - Leonardo Vivarelli
- Reconstructive Orthopaedic Surgery and Innovative Techniques—Musculoskeletal Tissue Bank, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy; (L.V.); (D.D.)
| | - Dante Dallari
- Reconstructive Orthopaedic Surgery and Innovative Techniques—Musculoskeletal Tissue Bank, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy; (L.V.); (D.D.)
| | - Antonio Pellegrini
- Reconstructive Surgery and Septic Complications Surgery Center, IRCCS Istituto Ortopedico Galeazzi, 20161 Milan, Italy;
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Chakraborty S, Katsifis G, Roohani I, Boyer C, McKenzie D, Willcox MDP, Chen R, Kumar N. Electrostatic and Covalent Binding of an Antibacterial Polymer to Hydroxyapatite for Protection against Escherichia coli Colonization. MATERIALS (BASEL, SWITZERLAND) 2023; 16:5045. [PMID: 37512322 PMCID: PMC10385198 DOI: 10.3390/ma16145045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 07/12/2023] [Accepted: 07/13/2023] [Indexed: 07/30/2023]
Abstract
Orthopedic-device-related infections are notorious for causing physical and psychological trauma to patients suffering from them. Traditional methods of treating these infections have relied heavily on antibiotics and are becoming ineffectual due to the rise of antibiotic-resistant bacteria. Mimics of antimicrobial peptides have emerged as exciting alternatives due to their favorable antibacterial properties and lack of propensity for generating resistant bacteria. In this study, the efficacy of an antibacterial polymer as a coating material for hydroxyapatite and glass surfaces, two materials with wide ranging application in orthopedics and the biomedical sciences, is demonstrated. Both physical and covalent modes of attachment of the polymer to these materials were explored. Polymer attachment to the material surfaces was confirmed via X-ray photoelectron spectroscopy and contact angle measurements. The modified surfaces exhibited significant antibacterial activity against the Gram-negative bacterium E. coli, and the activity was retained for a prolonged period on the surfaces of the covalently modified materials.
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Affiliation(s)
| | - Georgio Katsifis
- School of Physics, University of Sydney, Sydney, NSW 2006, Australia
| | - Iman Roohani
- School of Chemistry, UNSW Sydney, Sydney, NSW 2052, Australia
- Charles Perkins Centre, University of Sydney, Sydney, NSW 2006, Australia
- School of Life and Environmental Sciences, University of Sydney, Sydney, NSW 2006, Australia
| | - Cyrille Boyer
- School of Chemical Engineering, UNSW Sydney, Sydney, NSW 2052, Australia
| | - David McKenzie
- School of Physics, University of Sydney, Sydney, NSW 2006, Australia
- Charles Perkins Centre, University of Sydney, Sydney, NSW 2006, Australia
| | - Mark D P Willcox
- School of Optometry and Vision Science, UNSW Sydney, Sydney, NSW 2052, Australia
| | - Renxun Chen
- School of Chemistry, UNSW Sydney, Sydney, NSW 2052, Australia
| | - Naresh Kumar
- School of Chemistry, UNSW Sydney, Sydney, NSW 2052, Australia
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9
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Khan SA, Shakoor A. Recent Strategies and Future Recommendations for the Fabrication of Antimicrobial, Antibiofilm, and Antibiofouling Biomaterials. Int J Nanomedicine 2023; 18:3377-3405. [PMID: 37366489 PMCID: PMC10290865 DOI: 10.2147/ijn.s406078] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Accepted: 05/06/2023] [Indexed: 06/28/2023] Open
Abstract
Biomaterials and biomedical devices induced life-threatening bacterial infections and other biological adverse effects such as thrombosis and fibrosis have posed a significant threat to global healthcare. Bacterial infections and adverse biological effects are often caused by the formation of microbial biofilms and the adherence of various biomacromolecules, such as platelets, proteins, fibroblasts, and immune cells, to the surfaces of biomaterials and biomedical devices. Due to the programmed interconnected networking of bacteria in microbial biofilms, they are challenging to treat and can withstand several doses of antibiotics. Additionally, antibiotics can kill bacteria but do not prevent the adsorption of biomacromolecules from physiological fluids or implanting sites, which generates a conditioning layer that promotes bacteria's reattachment, development, and eventual biofilm formation. In these viewpoints, we highlighted the magnitude of biomaterials and biomedical device-induced infections, the role of biofilm formation, and biomacromolecule adhesion in human pathogenesis. We then discussed the solutions practiced in healthcare systems for curing biomaterials and biomedical device-induced infections and their limitations. Moreover, this review comprehensively elaborated on the recent advances in designing and fabricating biomaterials and biomedical devices with these three properties: antibacterial (bacterial killing), antibiofilm (biofilm inhibition/prevention), and antibiofouling (biofouling inhibition/prevention) against microbial species and against the adhesion of other biomacromolecules. Besides we also recommended potential directions for further investigations.
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Affiliation(s)
- Shakeel Ahmad Khan
- Department of Applied Biology and Chemical Technology, the Hong Kong Polytechnic University, Hung Hom, Kowloon, 999077, Hong Kong
| | - Adnan Shakoor
- Department of Control and Instrumentation Engineering, King Fahd University of Petroleum & Minerals, Dhahran, Saudi Arabia
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Haonga BT, O'Marr JM, Ngunyale P, Ngahyoma J, Kessey J, Sasillo I, Rodarte P, Belaye T, Berhaneselase E, Eliezer E, Porco TC, Morshed S, Shearer DW. GO-Tibia: a masked, randomized control trial evaluating gentamicin versus saline in open tibia fractures. Trials 2023; 24:406. [PMID: 37322521 PMCID: PMC10268448 DOI: 10.1186/s13063-023-07410-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 05/24/2023] [Indexed: 06/17/2023] Open
Abstract
BACKGROUND The rate of open tibia fractures is rapidly increasing across the globe due to a recent rise in road traffic accidents, predominantly in low- and low-middle-income countries. These injuries are orthopedic emergencies associated with infection rates as high as 40% despite the use of systemic antibiotics and surgical debridement. The use of local antibiotics has shown some promise in reducing the burden of infection in these injuries due to increasing local tissue availability; however, no trial has yet been appropriately powered to evaluate for definitive evidence and the majority of current studies have taken place in a high-resource countries where resources and the bio-burden may be different. METHODS This is a prospective randomized, masked, placebo-controlled superiority trial designed to evaluate the efficacy of locally administered gentamicin versus placebo in the prevention of fracture-related infection in adults (age > 18 years) with primarily closeable Gustillo-Anderson class I, II, and IIIA open tibia fractures. Eight hundred ninety patients will be randomized to receive an injection of either gentamicin (treatment group) or saline (control group) at the site of their primarily closed open fracture. The primary outcome will be the occurrence of a fracture-related infection occurring during the course of the 12-month follow-up. DISCUSSION This study will definitively assess the effectiveness of local gentamicin for the prevention of fracture-related infections in adults with open tibia fractures in Tanzania. The results of this study have the potential to demonstrate a low-cost, widely available intervention for the reduction of infection in open tibia fractures. TRIAL REGISTRATION Clinicaltrials.gov NCT05157126. Registered on December 14, 2021.
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Affiliation(s)
- Billy T Haonga
- Muhimbili Orthopaedic Institute, Muhimbili University of Health and Allied Sciences, Dar Es Salaam, Tanzania
| | - Jamieson M O'Marr
- Department of Orthopaedic Surgery, Institute for Global Orthopaedics and Traumatology, University of California San Francisco School of Medicine, 2550 23rd Street, Building 9, 2nd Floor, San Francisco, CA, 94110, USA
| | - Patrick Ngunyale
- Muhimbili Orthopaedic Institute, Muhimbili University of Health and Allied Sciences, Dar Es Salaam, Tanzania
| | - Joshua Ngahyoma
- Muhimbili Orthopaedic Institute, Muhimbili University of Health and Allied Sciences, Dar Es Salaam, Tanzania
| | - Justin Kessey
- Muhimbili Orthopaedic Institute, Muhimbili University of Health and Allied Sciences, Dar Es Salaam, Tanzania
| | - Ibrahim Sasillo
- Muhimbili Orthopaedic Institute, Muhimbili University of Health and Allied Sciences, Dar Es Salaam, Tanzania
| | - Patricia Rodarte
- Muhimbili Orthopaedic Institute, Muhimbili University of Health and Allied Sciences, Dar Es Salaam, Tanzania
| | - Tigist Belaye
- Department of Orthopaedic Surgery, Institute for Global Orthopaedics and Traumatology, University of California San Francisco School of Medicine, 2550 23rd Street, Building 9, 2nd Floor, San Francisco, CA, 94110, USA
| | - Eleni Berhaneselase
- Department of Orthopaedic Surgery, Institute for Global Orthopaedics and Traumatology, University of California San Francisco School of Medicine, 2550 23rd Street, Building 9, 2nd Floor, San Francisco, CA, 94110, USA
| | - Edmund Eliezer
- Muhimbili Orthopaedic Institute, Muhimbili University of Health and Allied Sciences, Dar Es Salaam, Tanzania
| | - Travis C Porco
- F.I. Proctor Foundation, University of California San Francisco, 513 Parnassus Avenue, San Francisco, CA, 94122, USA
- Department of Ophthalmology, University of California San Francisco, 10 Koret Way, San Francisco, CA, 94143, USA
- Department of Epidemiology and Biostatistics, University of California San Francisco, 550 16th St. 2nd Floor, San Francisco, CA, 94158, USA
| | - Saam Morshed
- Department of Orthopaedic Surgery, Institute for Global Orthopaedics and Traumatology, University of California San Francisco School of Medicine, 2550 23rd Street, Building 9, 2nd Floor, San Francisco, CA, 94110, USA
| | - David W Shearer
- Department of Orthopaedic Surgery, Institute for Global Orthopaedics and Traumatology, University of California San Francisco School of Medicine, 2550 23rd Street, Building 9, 2nd Floor, San Francisco, CA, 94110, USA.
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11
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Biomimetic AgNPs@antimicrobial peptide/silk fibroin coating for infection-trigger antibacterial capability and enhanced osseointegration. Bioact Mater 2023; 20:64-80. [PMID: 35633877 PMCID: PMC9127278 DOI: 10.1016/j.bioactmat.2022.05.015] [Citation(s) in RCA: 19] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Revised: 05/13/2022] [Accepted: 05/13/2022] [Indexed: 11/24/2022] Open
Abstract
Endowing implant surfaces with combined antibacterial and osteogenic properties by drug-loaded coatings has made great strides, but how to achieve the combined excellence of infection-triggered bactericidal and in vivo-proven osteogenic activities without causing bacterial resistance still remains a formidable challenge. Herein, antimicrobial peptides (AMPs) with osteogenic fragments were designed and complexed on the surface of silver nanoparticle (AgNP) through hydrogen bonding, and the collagen structure-bionic silk fibroin (SF) was applied to carry AgNPs@ AMPs to achieve infection-triggered antibacterial and osteointegration. As verified by TEM, AMPs contributed to the dispersion and size-regulation of AgNPs, with a particle size of about 20 nm, and a clear protein corona structure was observed on the particle surface. The release curve of silver ion displayed that the SF-based coating owned sensitive pH-responsive properties. In the antibacterial test against S.aureus for up to 21 days, the antibacterial rate had always remained above 99%. Meanwhile, the underlying mechanism was revealed, originating from the destruction of the bacterial cell membranes and ROS generation. The SF-based coating was conducive to the adhesion, diffusion, and proliferation of bone marrow stem cells (BMSCs) on the surface, and promoted the expression of osteogenic genes and collagen secretion. The in vivo implantation results showed that compared with the untreated Ti implants, SF-based coating enhanced osseointegration at week 4 and 8. Overall, the AgNPs@AMPs-loaded SF-based coating presented the ability to synergistically inhibit bacteria and promote osseointegration, possessing tremendous potential application prospects in bone defects and related-infection treatments. AMPs and AgNPs were complexed through hydrogen bonds to form a protein crowns structure. Silk fibroin matrix was able to maintain the activity of AMPs over 21 d and endow with the infection-trigger release. The functional coating achieved synergistic antibacterial properties by damaging membrane structure and generating ROS. The coating displayed acceptable osteogenic properties in vitro and observably promoted osteointegration in vivo.
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12
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Dong Y, Yao L, Cai L, Jin M, Forouzanfar T, Wu L, Liu J, Wu G. Antimicrobial and Pro-Osteogenic Coaxially Electrospun Magnesium Oxide Nanoparticles-Polycaprolactone /Parathyroid Hormone-Polycaprolactone Composite Barrier Membrane for Guided Bone Regeneration. Int J Nanomedicine 2023; 18:369-383. [PMID: 36700148 PMCID: PMC9869899 DOI: 10.2147/ijn.s395026] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Accepted: 12/24/2022] [Indexed: 01/21/2023] Open
Abstract
Introduction An antibacterial and pro-osteogenic coaxially electrospun nanofiber guided bone regeneration (GBR) membrane was fabricated to satisfy the complicated and phased requirements of GBR process. Methods In this study, we synthesize dual-functional coaxially electrospun nanofiber GBR membranes by encapsulating parathyroid hormone (PTH) in the core layer and magnesium oxide nanoparticles (MgONPs) in the shell layer (MgONPs-PCL/PTH-PCL). Herein, the physicochemical characterization of MgONPs-PCL/PTH-PCL, the release rates of MgONPs and PTH, and antibacterial efficiency of the new membrane were evaluated. Furthermore, the pro-osteogenicity of the membranes was assessed both in-vitro and in-vivo. Results We successfully fabricated a coaxially electrospun nanofiber MgONPs-PCL/PTH-PCL membrane with the majority of nanofibers (>65%) ranged from 0.40~0.60μm in diameter. MgONPs-PCL/PTH-PCL showed outstanding antibacterial potential against Escherichia coli (E. coli) and Staphylococcus aureus (S. aureus) through the release of MgONPs. We also discovered that the incorporation of MgONPs significantly prolonged the release of PTH. Furthermore, both the in-vivo and in-vitro studies demonstrated that high dosage of PTH promoted pro-osteogenicity of the membrane to improve bone regeneration efficacy with the presence of MgONPs. Conclusion The new composite membrane is a promising approach to enhance bone regeneration in periodontitis or peri-implantitis patients with large-volume bone defects.
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Affiliation(s)
- Yiwen Dong
- School and Hospital of Stomatology, Wenzhou Medical University, Wenzhou, People’s Republic of China,Department of Oral and Maxillofacial Surgery/Pathology, Amsterdam UMC and Academic Center for Dentistry Amsterdam (ACTA), Vrije Universiteit Amsterdam, Amsterdam Movement Science, Amsterdam, Amsterdam, the Netherlands,Department of Oral Cell Biology, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam (UvA) and Vrije Universiteit Amsterdam (VU), Amsterdam, the Netherlands
| | - Litao Yao
- Department of Oral and Maxillofacial Surgery/Pathology, Amsterdam UMC and Academic Center for Dentistry Amsterdam (ACTA), Vrije Universiteit Amsterdam, Amsterdam Movement Science, Amsterdam, Amsterdam, the Netherlands,Department of Oral Cell Biology, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam (UvA) and Vrije Universiteit Amsterdam (VU), Amsterdam, the Netherlands,Department of Dentistry, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, People’s Republic of China,Correspondence: Litao Yao, Department of Dentistry, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, People’s Republic of China, Zhejiang, Email
| | - Lei Cai
- School and Hospital of Stomatology, Wenzhou Medical University, Wenzhou, People’s Republic of China
| | - Mi Jin
- School and Hospital of Stomatology, Wenzhou Medical University, Wenzhou, People’s Republic of China
| | - Tymour Forouzanfar
- Department of Oral and Maxillofacial Surgery/Pathology, Amsterdam UMC and Academic Center for Dentistry Amsterdam (ACTA), Vrije Universiteit Amsterdam, Amsterdam Movement Science, Amsterdam, Amsterdam, the Netherlands,Department of Oral Cell Biology, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam (UvA) and Vrije Universiteit Amsterdam (VU), Amsterdam, the Netherlands
| | - Lianjun Wu
- School and Hospital of Stomatology, Wenzhou Medical University, Wenzhou, People’s Republic of China
| | - Jinsong Liu
- School and Hospital of Stomatology, Wenzhou Medical University, Wenzhou, People’s Republic of China,Jinsong Liu, School and Hospital of Stomatology, Wenzhou Medical University, Wenzhou, 325027, People’s Republic of China, Email
| | - Gang Wu
- Department of Oral and Maxillofacial Surgery/Pathology, Amsterdam UMC and Academic Center for Dentistry Amsterdam (ACTA), Vrije Universiteit Amsterdam, Amsterdam Movement Science, Amsterdam, Amsterdam, the Netherlands,Department of Oral Cell Biology, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam (UvA) and Vrije Universiteit Amsterdam (VU), Amsterdam, the Netherlands
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13
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Bottagisio M, Palombella S, Lopa S, Sangalli F, Savadori P, Biagiotti M, Sideratou Z, Tsiourvas D, Lovati AB. Vancomycin-nanofunctionalized peptide-enriched silk fibroin to prevent methicillin-resistant Staphylococcus epidermidis-induced femoral nonunions in rats. Front Cell Infect Microbiol 2023; 12:1056912. [PMID: 36683682 PMCID: PMC9851397 DOI: 10.3389/fcimb.2022.1056912] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 12/19/2022] [Indexed: 01/06/2023] Open
Abstract
Introduction Implant-related infections and infected fractures are significant burdens in orthopedics. Staphylococcus epidermidis is one of the main causes of bone infections related to biofilm formation upon implants. Current antibiotic prophylaxis/therapy is often inadequate to prevent biofilm formation and results in antibiotic resistance. The development of bioactive materials combining antimicrobial and osteoconductive properties offers great potential for the eradication of microorganisms and for the enhancement of bone deposition in the presence of infections. The purpose of this study is to prevent the development of methicillin-resistant S. epidermidis (MRSE)-infected nonunion in a rat model. Methods To this end, a recently developed in our laboratories bioactive material consisting of antibiotic-loaded nanoparticles based on carboxylic acid functionalized hyperbranched aliphatic polyester (CHAP) that are integrated into peptide-enriched silk fibroin sponges with osteoconductive properties (AFN-PSF) was employed, whose biocompatibility and microbiological tests provided proof of its potential for the treatment of both orthopedic and dental infections. In particular, non-critical femoral fractures fixed with plates and screws were performed in Wistar rats, which were then randomly divided into three groups: 1) the sham control (no infection, no treatment); 2) the control group, infected with MRSE and treated with peptide-enriched silk fibroin sponges incorporating non-drug-loaded functionalized nanoparticles (PSF); 3) the treated group, infected with MRSE and treated with peptide-enriched silk fibroin sponges incorporating vancomycin-loaded functionalized nanoparticles (AFN-PSF). After 8 weeks, bone healing and osteomyelitis were clinically assessed and evaluated by micro-CT, microbiological and histological analyses. Results The sham group showed no signs of infection and complete bone healing. The PSF group failed to repair the infected fracture, displaying 75% of altered bone healing and severe signs of osteomyelitis. The AFN-PSF treated group reached 70% of fracture healing in the absence of signs of osteomyelitis, such as abscesses in the cortical and intraosseous compartments and bone necrosis with sequestra. Discussion AFN-PSF sponges have proven effective in preventing the development of infected nonunion in vivo. The proposed nanotechnology for local administration of antibiotics can have a significant impact on patient health in the case of orthopedic infections.
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Affiliation(s)
- Marta Bottagisio
- IRCCS Istituto Ortopedico Galeazzi, Laboratory of Clinical Chemistry and Microbiology, Milan, Italy
| | - Silvia Palombella
- IRCCS Istituto Ortopedico Galeazzi, Cell and Tissue Engineering Laboratory, Milan, Italy
| | - Silvia Lopa
- IRCCS Istituto Ortopedico Galeazzi, Cell and Tissue Engineering Laboratory, Milan, Italy
| | - Fabio Sangalli
- IRCCS Istituto di Ricerche Farmacologiche Mario Negri, Laboratory of Renal Biophysics, Department of Biomedical Engineering, Bergamo, Italy
| | - Paolo Savadori
- IRCCS Istituto Ortopedico Galeazzi, Department of Endodontics, Milan, Italy
| | | | - Zili Sideratou
- National Centre for Scientific Research "Demokritos", Institute of Nanoscience and Nanotechnology, Aghia Paraskevi, Greece
| | - Dimitris Tsiourvas
- National Centre for Scientific Research "Demokritos", Institute of Nanoscience and Nanotechnology, Aghia Paraskevi, Greece
| | - Arianna B Lovati
- IRCCS Istituto Ortopedico Galeazzi, Cell and Tissue Engineering Laboratory, Milan, Italy
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Effect of Local Antibiotic Prophylaxis on Postoperative Deep Infection in Fracture Surgery: A Systematic Review and Meta-Analysis. J Orthop Trauma 2023; 37:e28-e35. [PMID: 36084224 DOI: 10.1097/bot.0000000000002487] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/02/2022] [Indexed: 02/02/2023]
Abstract
OBJECTIVES Despite the use of systemic antibiotic prophylaxis, postoperative infection after fracture surgery remains an issue. The purpose of this systematic review and meta-analysis was to evaluate the effect of locally applied antibiotics on deep infection in fracture surgery in both the open and closed fractures. DATA SOURCES A comprehensive search of MEDLINE, Embase, and PubMed was performed from the date of inception to April 15, 2021, and included studies in all languages. STUDY SELECTION Cohort studies were eligible if they investigated the effect on the infection rate of local antibiotic prophylaxis on deep infection after fracture surgery. DATA EXTRACTION This study was conducted according to the Cochrane Handbook for Systematic Reviews and reported as per the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Risk of bias was assessed using version 2 of the Cochrane risk-of-bias tool for randomized trials and the Methodological Index for Nonrandomized Studies tool where applicable. DATA SYNTHESIS An inverse variance random-effects model was the primary analysis model because of the anticipated diversity in the evaluated populations. Univariate models were used when a single outcome was of interest. CONCLUSIONS The risk of deep infection was significantly reduced when local antibiotics were applied compared with the control group receiving systemic prophylaxis only. This beneficial effect was observed in open fractures but failed to reach statistical significance in closed fractures. This meta-analysis suggests that there may be a significant risk reduction in deep infection rate after fracture surgery when local antibiotics are added to standard systemic prophylaxis, particularly in open fractures. Further high-powered Level I studies are needed to support these findings. LEVEL OF EVIDENCE Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
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15
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Dhillon MS, Hooda A, Moriarty TF, Sharma S. Biofilms-What Should the Orthopedic Surgeon know? Indian J Orthop 2023; 57:44-51. [PMID: 36660477 PMCID: PMC9789254 DOI: 10.1007/s43465-022-00782-6] [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: 11/07/2022] [Accepted: 11/18/2022] [Indexed: 12/24/2022]
Abstract
Background Musculoskeletal infections are a major source of morbidity for orthopedic and trauma patients, are associated with prolonged treatment times, and, unfortunately, suffer from poor functional outcomes. Further complicating the issue, antimicrobial resistance (AMR) is increasingly impacting the treatment of musculoskeletal infections with a diminishing repertoire of effective antibiotic agents for some highly resistant pathogens. Most orthopedic surgical procedures involve implants, and the formation of bacterial biofilms on these implants is now recognized as a major factor contributing to the failure of antibiotic therapy in orthopedic surgery. Methods This review presents an overview of the types, structure, formation, and pathogenesis of biofilms as they pertain to musculoskeletal infections. Furthermore, it describes the key concepts in the management of biofilms and future perspectives for the better treatment of patients with biofilm-related musculoskeletal infections. Results A bacterial biofilm is a dynamic, living conglomerate of bacteria encased in an extracapsular polysaccharide matrix (EPS). Biofilms are a natural mode of survival for virtually all bacterial species, including both Grampositive and Gram-negative bacteria, as well as fungi. The biofilm model of growth confers resistance by several well-defined mechanisms regardless of the species of the microorganism. In most cases, biofilm management often necessitates radical measures to ensure eradication including both surgical and medical interventions. Conclusions Orthopedic surgeons should be aware of the key concepts pertaining to biofilms, and the impact that these can have on clinical practice.
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Affiliation(s)
- Mandeep Singh Dhillon
- Foot & Ankle Biomechanics, Experimentation and Research Laboratory, Department of Orthopedics, Postgraduate Institute of Medical Education & Research, Chandigarh, India
| | - Aman Hooda
- Department of Emergency Medicine (Orthopedics), Ambedkar Institute of Medical Sciences, Mohali, Punjab India
| | | | - Siddhartha Sharma
- Foot & Ankle Biomechanics, Experimentation and Research Laboratory, Department of Orthopedics, Postgraduate Institute of Medical Education & Research, Chandigarh, India
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16
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Wittmann C, Vanvelk N, Fürst AE, Moriarty TF, Zeiter S. Development and Characterization of a Subcutaneous Implant-Related Infection Model in Mice to Test Novel Antimicrobial Treatment Strategies. Biomedicines 2022; 11:biomedicines11010040. [PMID: 36672548 PMCID: PMC9855336 DOI: 10.3390/biomedicines11010040] [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: 11/21/2022] [Revised: 12/19/2022] [Accepted: 12/21/2022] [Indexed: 12/29/2022] Open
Abstract
Orthopedic-device-related infection is one of the most severe complications in orthopedic surgery. To reduce the associated morbidity and healthcare costs, new prevention and treatment modalities are continuously under development. Preclinical in vivo models serve as a control point prior to clinical implementation. This study presents a mouse model of subcutaneously implanted titanium discs, infected with Staphylococcus aureus, to fill a gap in the early-stage testing of antimicrobial biomaterials. Firstly, three different inocula were administered either pre-adhered to the implant or pipetted on top of it following implantation to test their ability to reliably create an infection. Secondly, the efficacy of low-dose (25 mg/kg) and high-dose (250 mg/kg) cefazolin administered systemically in infection prevention was assessed. Lastly, titanium implants were replaced by antibiotic-loaded bone cement (ALBC) discs to investigate the efficacy of local antibiotics in infection prevention. The efficacy in infection prevention of the low-dose perioperative antibiotic prophylaxis (PAP) depended on both the inoculum and inoculation method. Bacterial counts were significantly lower in animals receiving the high dose of PAP. ALBC discs with or without the additional PAP proved highly effective in infection prevention and provide a suitable positive control to test other prevention strategies.
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Affiliation(s)
| | - Niels Vanvelk
- AO Research Institute Davos, 7270 Davos, Switzerland
| | - Anton E. Fürst
- Equine Department–Vetsuisse Faculty, University of Zurich, 8057 Zurich, Switzerland
| | | | - Stephan Zeiter
- AO Research Institute Davos, 7270 Davos, Switzerland
- Correspondence: ; Tel.: +41-81-414-2311
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17
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Watson AL, Eckhart KE, Wolf ME, Sydlik SA. Hyaluronic Acid-Based Antibacterial Hydrogels for Use as Wound Dressings. ACS APPLIED BIO MATERIALS 2022; 5:5608-5616. [PMID: 36383154 DOI: 10.1021/acsabm.2c00647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Wound dressings have been shifting toward a more active role in the wound-healing process. Hydrated environments with additives to aid in the healing process are currently being explored through the application of hydrocolloid dressings. However, these moist healing environments are also ideal for bacterial growth, leading to the widespread use of antibiotics with concerns of antibiotic resistance and toxicity. To overcome this concern, we present a hydrogel wound dressing consisting of hyaluronic acid (HA) cross-linked with gentamicin. This hydrogel treats bacterial infection locally, lowering the effective dose and reducing the concerns of antibiotic resistance and systemic exposure. Changing the cross-linking density, by using varied amounts of a cross-linker, created gels that provided a sustained release of gentamicin for up to 9 days with a range of adhesive and cohesive properties. Overall, this HA hydrogel could provide an important solution in treating local infection in burns and other dermal injuries.
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Affiliation(s)
- Anna L Watson
- Department of Chemistry, Carnegie Mellon University, 4400 Fifth Avenue, Pittsburgh, Pennsylvania15213, United States
| | - Karoline E Eckhart
- Department of Chemistry, Carnegie Mellon University, 4400 Fifth Avenue, Pittsburgh, Pennsylvania15213, United States
| | - Michelle E Wolf
- Department of Chemistry, Carnegie Mellon University, 4400 Fifth Avenue, Pittsburgh, Pennsylvania15213, United States
| | - Stefanie A Sydlik
- Department of Chemistry, Carnegie Mellon University, 4400 Fifth Avenue, Pittsburgh, Pennsylvania15213, United States
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18
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Strategies to Mitigate and Treat Orthopaedic Device-Associated Infections. Antibiotics (Basel) 2022; 11:antibiotics11121822. [PMID: 36551479 PMCID: PMC9774155 DOI: 10.3390/antibiotics11121822] [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: 11/11/2022] [Revised: 12/03/2022] [Accepted: 12/10/2022] [Indexed: 12/23/2022] Open
Abstract
Orthopaedic device implants play a crucial role in restoring functionality to patients suffering from debilitating musculoskeletal diseases or to those who have experienced traumatic injury. However, the surgical implantation of these devices carries a risk of infection, which represents a significant burden for patients and healthcare providers. This review delineates the pathogenesis of orthopaedic implant infections and the challenges that arise due to biofilm formation and the implications for treatment. It focuses on research advancements in the development of next-generation orthopaedic medical devices to mitigate against implant-related infections. Key considerations impacting the development of devices, which must often perform multiple biological and mechanical roles, are delineated. We review technologies designed to exert spatial and temporal control over antimicrobial presentation and the use of antimicrobial surfaces with intrinsic antibacterial activity. A range of measures to control bio-interfacial interactions including approaches that modify implant surface chemistry or topography to reduce the capacity of bacteria to colonise the surface, form biofilms and cause infections at the device interface and surrounding tissues are also reviewed.
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19
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Rotman S, Post V, Foster A, Lavigne R, Wagemans J, Trampuz A, Moreno MG, Metsemakers WJ, Grijpma D, Richards R, Eglin D, Moriarty T. Alginate chitosan microbeads and thermos-responsive hyaluronic acid hydrogel for phage delivery. J Drug Deliv Sci Technol 2022. [DOI: 10.1016/j.jddst.2022.103991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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20
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Buckman SA, Forrester JD, Bessoff KE, Parli SE, Evans HL, Huston JM. Surgical Infection Society Guidelines: 2022 Updated Guidelines for Antibiotic Use in Open Extremity Fractures. Surg Infect (Larchmt) 2022; 23:817-828. [DOI: 10.1089/sur.2022.206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Affiliation(s)
- Sara A. Buckman
- Division of Acute and Critical Care Surgery, Department of Surgery, Washington University School of Medicine in St. Louis, St. Louis, Missouri, USA
| | - Joseph D. Forrester
- Division of General Surgery, Department of Surgery, Stanford University, Stanford, California, USA
| | - Kovi E. Bessoff
- Division of General Surgery, Department of Surgery, Stanford University, Stanford, California, USA
| | - Sara E. Parli
- Department of Pharmacy Services, University of Kentucky, Lexington, Kentucky, USA
| | - Heather L. Evans
- Division of General and Acute Care Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Jared M. Huston
- Departments of Surgery and Science Education, Zucker School of Medicine, Northwell Health, Manhasset, New York, USA
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21
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Sliepen J, Corrigan RA, Dudareva M, Wouthuyzen-Bakker M, Rentenaar RJ, Atkins BL, Govaert GAM, McNally MA, IJpma FFA. Does the Use of Local Antibiotics Affect Clinical Outcome of Patients with Fracture-Related Infection? Antibiotics (Basel) 2022; 11:1330. [PMID: 36289989 PMCID: PMC9598690 DOI: 10.3390/antibiotics11101330] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 09/22/2022] [Accepted: 09/28/2022] [Indexed: 10/14/2023] Open
Abstract
This international, multi-center study evaluated the effect of antibiotic-loaded carriers (ALCs) on outcome in patients with a fracture-related infection (FRI) and evaluated whether bacterial resistance to the implanted antibiotics influences their efficacy. All patients who were retrospectively diagnosed with FRI according to the FRI consensus definition, between January 2015 and December 2019, and who underwent surgical treatment for FRI at any time point after injury, were considered for inclusion. Patients were followed-up for at least 12 months. The primary outcome was the recurrence rate of FRI at follow-up. Inverse probability for treatment weighting (IPTW) modeling and multivariable regression analyses were used to assess the relationship between the application of ALCs and recurrence rate of FRI at 12 months and 24 months. Overall, 429 patients with 433 FRIs were included. A total of 251 (58.0%) cases were treated with ALCs. Gentamicin was the most frequently used antibiotic (247/251). Recurrence of infection after surgery occurred in 25/251 (10%) patients who received ALCs and in 34/182 (18.7%) patients who did not (unadjusted hazard ratio (uHR): 0.48, 95% CI: [0.29-0.81]). Resistance of cultured microorganisms to the implanted antibiotic was not associated with a higher risk of recurrence of FRI (uHR: 0.75, 95% CI: [0.32-1.74]). The application of ALCs in treatment of FRI is likely to reduce the risk of recurrence of infection. The high antibiotic concentrations of ALCs eradicate most pathogens regardless of susceptibility test results.
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Affiliation(s)
- Jonathan Sliepen
- Department of Trauma Surgery, University Medical Center Groningen, University of Groningen, 9712 CP Groningen, The Netherlands
| | - Ruth A. Corrigan
- Department of Infectious Diseases, Nuffield Orthopaedic Centre, Oxford University Hospitals, Oxford OX3 9DU, UK
| | - Maria Dudareva
- Department of Infectious Diseases, Nuffield Orthopaedic Centre, Oxford University Hospitals, Oxford OX3 9DU, UK
| | - Marjan Wouthuyzen-Bakker
- Department of Medical Microbiology and Infection Prevention, University Medical Center Groningen, University of Groningen, 9712 CP Groningen, The Netherlands
| | - Rob J. Rentenaar
- Department of Medical Microbiology, University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands
| | - Bridget L. Atkins
- Department of Infectious Diseases, Nuffield Orthopaedic Centre, Oxford University Hospitals, Oxford OX3 9DU, UK
| | - Geertje A. M. Govaert
- Department of Trauma Surgery, University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands
| | - Martin A. McNally
- The Bone Infection Unit, Nuffield Orthopaedic Centre, Oxford University Hospitals, Oxford OX3 9DU, UK
| | - Frank F. A. IJpma
- Department of Trauma Surgery, University Medical Center Groningen, University of Groningen, 9712 CP Groningen, The Netherlands
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22
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Polymer–Metal Composite Healthcare Materials: From Nano to Device Scale. JOURNAL OF COMPOSITES SCIENCE 2022. [DOI: 10.3390/jcs6080218] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Metals have been investigated as biomaterials for a wide range of medical applications. At nanoscale, some metals, such as gold nanoparticles, exhibit plasmonics, which have motivated researchers’ focus on biosensor development. At the device level, some metals, such as titanium, exhibit good physical properties, which could allow them to act as biomedical implants for physical support. Despite these attractive features, the non-specific delivery of metallic nanoparticles and poor tissue–device compatibility have greatly limited their performance. This review aims to illustrate the interplay between polymers and metals, and to highlight the pivotal role of polymer–metal composite/nanocomposite healthcare materials in different biomedical applications. Here, we revisit the recent plasmonic engineered platforms for biomolecules detection in cell-free samples and highlight updated nanocomposite design for (1) intracellular RNA detection, (2) photothermal therapy, and (3) nanomedicine for neurodegenerative diseases, as selected significant live cell–interactive biomedical applications. At the device scale, the rational design of polymer–metallic medical devices is of importance for dental and cardiovascular implantation to overcome the poor physical load transfer between tissues and devices, as well as implant compatibility under a dynamic fluidic environment, respectively. Finally, we conclude the treatment of these innovative polymer–metal biomedical composite designs and provide a future perspective on the aforementioned research areas.
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Yu KE, Kwon HK, Dussik CM, Cahill SV, Back J, Alder KD, Lee FY. Enhancement of Impaired MRSA-Infected Fracture Healing by Combinatorial Antibiotics and Modulation of Sustained Inflammation. J Bone Miner Res 2022; 37:1352-1365. [PMID: 35616626 DOI: 10.1002/jbmr.4570] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Revised: 04/19/2022] [Accepted: 05/08/2022] [Indexed: 11/07/2022]
Abstract
Fracture healing is impaired in the setting of infection, which begets protracted inflammation. The most problematic causative agent of musculoskeletal infection is methicillin-resistant Staphylococcus aureus (MRSA). We hypothesized that modulation of excessive inflammation combined with cell-penetrating antibiotic treatments facilitates fracture healing in a murine MRSA-infected femoral fracture model. Sterile and MRSA-contaminated open transverse femoral osteotomies were induced in 10-week-old male C57BL/6 mice and fixed via intramedullary nailing. In the initial therapeutic cohort, empty, vancomycin (V), rifampin (R), vancomycin-rifampin (VR), or vancomycin-rifampin-trametinib (VRT) hydrogels were applied to the fracture site intraoperatively. Rifampin was included because of its ability to penetrate eukaryotic cells to target intracellular bacteria. Unbiased screening demonstrated ERK activation was upregulated in the setting of MRSA infection. As such, the FDA-approved mitogen-activated protein kinase kinase (MEK)1-pERK1/2 inhibitor trametinib was evaluated as an adjunctive therapeutic agent to selectively mitigate excessive inflammation after infected fracture. Two additional cohorts were created mimicking immediate and delayed postoperative antibiotic administration. Systemic vancomycin or VR was administered for 2 weeks, followed by 2 weeks of VRT hydrogel or oral trametinib therapy. Hematologic, histological, and cytokine analyses were performed using serum and tissue isolates obtained at distinct postoperative intervals. Radiography and micro-computed tomography (μCT) were employed to assess fracture healing. Pro-inflammatory cytokine levels remained elevated in MRSA-infected mice with antibiotic treatment alone, but increasingly normalized with trametinib therapy. Impaired callus formation and malunion were consistently observed in the MRSA-infected groups and was partially salvaged with systemic antibiotic treatment alone. Mice that received VR alongside adjuvant MEK1-pERK1/2 inhibition displayed the greatest restoration of bone and osseous union. A combinatorial approach involving adjuvant cell-penetrating antibiotic treatments alongside mitigation of excessive inflammation enhanced healing of infected fractures. © 2022 American Society for Bone and Mineral Research (ASBMR).
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Affiliation(s)
- Kristin E Yu
- Department of Orthopaedics and Rehabilitation, Yale University, School of Medicine, New Haven, CT, USA
| | - Hyuk-Kwon Kwon
- Department of Orthopaedics and Rehabilitation, Yale University, School of Medicine, New Haven, CT, USA
| | - Christopher M Dussik
- Department of Orthopaedics and Rehabilitation, Yale University, School of Medicine, New Haven, CT, USA
| | - Sean V Cahill
- Department of Orthopedic Surgery, Washington University, School of Medicine, St. Louis, MO, USA
| | - Jungho Back
- Department of Orthopaedics and Rehabilitation, Yale University, School of Medicine, New Haven, CT, USA
| | - Kareme D Alder
- Department of Orthopaedics and Rehabilitation, Yale University, School of Medicine, New Haven, CT, USA.,Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
| | - Francis Y Lee
- Department of Orthopaedics and Rehabilitation, Yale University, School of Medicine, New Haven, CT, USA
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24
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Navrátil O, Lizoňová D, Slonková K, Mašková L, Zadražil A, Sedmidubský D, Štěpánek F. Antibiotic depot system with radiofrequency controlled drug release. Colloids Surf B Biointerfaces 2022; 217:112618. [PMID: 35738076 DOI: 10.1016/j.colsurfb.2022.112618] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Revised: 04/20/2022] [Accepted: 06/06/2022] [Indexed: 11/28/2022]
Abstract
Drug depot systems have traditionally relied on the spontaneous dissolution and diffusion of drugs or prodrugs from a reservoir with constant exposure to the surrounding physiological fluids. While this is appropriate for clinical scenarios that require constant plasma concentration of the drug over time, there are also situations where multiple bursts of the drug at well-defined time intervals are preferred. This work presents a drug depot system that enables repeated on-demand release of antibiotics in precise doses, controlled by an external radiofrequency magnetic field. The remotely controlled depot system consists of composite microcapsules with a core-shell structure. The core contains micronized drug particles embedded in a low-melting hydrophobic matrix. The shell is formed by a hydrogel with immobilised magnetic nanoparticles that facilitate local heat dissipation after exposure to a radiofrequency magnetic field. When the melting point of the core material is locally exceeded, the embedded drug particles are mobilised and their surface is exposed to the external aqueous phase. It is shown that drug release can be controlled in an on/off manner by a chosen sequence and duration of radiofrequency pulses. The capacity of the depot system is shown to be significantly higher than that of purely diffusion-controlled systems containing a pre-dissolved drug. The functionality of the depot system is demonstrated in vitro for the specific case of norfloxacin acting on E. coli.
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Affiliation(s)
- Ondřej Navrátil
- Department of Chemical Engineering, University of Chemistry and Technology Prague, Technická 5, 166 28 Prague 6, Czech Republic
| | - Denisa Lizoňová
- Department of Chemical Engineering, University of Chemistry and Technology Prague, Technická 5, 166 28 Prague 6, Czech Republic
| | - Karolína Slonková
- Department of Chemical Engineering, University of Chemistry and Technology Prague, Technická 5, 166 28 Prague 6, Czech Republic
| | - Lucie Mašková
- Department of Chemical Engineering, University of Chemistry and Technology Prague, Technická 5, 166 28 Prague 6, Czech Republic
| | - Aleš Zadražil
- Department of Chemical Engineering, University of Chemistry and Technology Prague, Technická 5, 166 28 Prague 6, Czech Republic
| | - David Sedmidubský
- Department of Inorganic Chemistry, University of Chemistry and Technology Prague, Technická 5, 166 28 Prague 6, Czech Republic
| | - František Štěpánek
- Department of Chemical Engineering, University of Chemistry and Technology Prague, Technická 5, 166 28 Prague 6, Czech Republic.
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Xin W, Gao Y, Yue B. Recent Advances in Multifunctional Hydrogels for the Treatment of Osteomyelitis. Front Bioeng Biotechnol 2022; 10:865250. [PMID: 35547176 PMCID: PMC9081433 DOI: 10.3389/fbioe.2022.865250] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Accepted: 04/04/2022] [Indexed: 11/13/2022] Open
Abstract
Osteomyelitis (OM), a devastating disease caused by microbial infection of bones, remains a major challenge for orthopedic surgeons. Conventional approaches for prevention and treatment of OM are unsatisfactory. Various alternative strategies have been proposed, among which, hydrogel-based strategies have demonstrated potential due to their unique properties, including loadable, implantable, injectable, printable, degradable, and responsive to stimuli. Several protocols, including different hydrogel designs, selection of antimicrobial agent, co-administration of bone morphogenetic protein 2 (BMP 2), and nanoparticles, have been shown to improve the biological properties, including antimicrobial effects, osteo-induction, and controlled drug delivery. In this review, we describe the current and future directions for designing hydrogels and their applications to improve the biological response to OM in vivo.
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Li Y, Chen R, Wang F, Cai X, Wang Y. Antimicrobial peptide GL13K immobilized onto SLA-treated titanium by silanization: antibacterial effect against methicillin-resistant Staphylococcus aureus (MRSA). RSC Adv 2022; 12:6918-6929. [PMID: 35424597 PMCID: PMC8981691 DOI: 10.1039/d1ra04974g] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Accepted: 02/22/2022] [Indexed: 02/03/2023] Open
Abstract
Infection is the main reason for implant failure, and the incidence of drug-resistant bacterial infection has increased in recent years. Further, methicillin-resistant Staphylococcus aureus (MRSA)-related implant infection has become a serious worldwide threat. New strategies, other than antibiotics, to tackle drug-resistance, are of high clinical significance. Antimicrobial peptides show clear superiority over conventional antibiotics in inhibiting drug-resistant bacteria. In the present study, we combined the antimicrobial peptide, GL13K, with sandblasting and acid-etching (SLA)-treated titanium using a silane coupling agent. Field emission scanning electron microscopy images showed the morphology of the coating. Attenuated total reflectance Fourier transform infrared spectroscopy and X-ray photoelectron spectroscopy results confirmed loading of GL13K, and the hydrophilicity of the SLA-GL13K coating was evaluated by water contact angle analysis. The releasing study of samples showed that the coating has a sustained releasing profile. SLA-GL13K coating exhibited strong contact- and release-killing abilities against MRSA, E. coli, and S. aureus. Meanwhile, Cell Counting Kit 8 analysis and examination of cell morphology demonstrated that the SLA-GL13K coating had good cytocompatibility at antibacterial concentrations. Overall, all these results suggest that SLA-GL13K coating can be successfully fabricated using silanization, and is a promising candidate for controlling MRSA-induced implant-related infection.
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Affiliation(s)
- Yusang Li
- The State Key Laboratory Breeding Base of Basic Science of Stomatology (Hubei-MOST) and Key Laboratory of Oral Biomedicine Ministry of Education, School and Hospital of Stomatology, Wuhan University Wuhan China
| | - Ruiying Chen
- Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, College of Stomatology, Shanghai Jiao Tong University, Department of Implant Dentistry Shanghai China
| | - Fushi Wang
- The State Key Laboratory Breeding Base of Basic Science of Stomatology (Hubei-MOST) and Key Laboratory of Oral Biomedicine Ministry of Education, School and Hospital of Stomatology, Wuhan University Wuhan China
- Hospital of Stomatology Wuhan University, Department of Cariology and Endodontics Wuhan China
| | - Xinjie Cai
- The State Key Laboratory Breeding Base of Basic Science of Stomatology (Hubei-MOST) and Key Laboratory of Oral Biomedicine Ministry of Education, School and Hospital of Stomatology, Wuhan University Wuhan China
- Hospital of Stomatology Wuhan University, Department of Prosthodontics Wuhan China
| | - Yining Wang
- The State Key Laboratory Breeding Base of Basic Science of Stomatology (Hubei-MOST) and Key Laboratory of Oral Biomedicine Ministry of Education, School and Hospital of Stomatology, Wuhan University Wuhan China
- Hospital of Stomatology Wuhan University, Department of Prosthodontics Wuhan China
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Role of Implantable Drug Delivery Devices with Dual Platform Capabilities in the Prevention and Treatment of Bacterial Osteomyelitis. Bioengineering (Basel) 2022; 9:bioengineering9020065. [PMID: 35200418 PMCID: PMC8869141 DOI: 10.3390/bioengineering9020065] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Revised: 02/01/2022] [Accepted: 02/03/2022] [Indexed: 11/26/2022] Open
Abstract
As medicine advances and physicians are able to provide patients with innovative solutions, including placement of temporary or permanent medical devices that drastically improve quality of life of the patient, there is the persistent, recurring problem of chronic bacterial infection, including osteomyelitis. Osteomyelitis can manifest as a result of traumatic or contaminated wounds or implant-associated infections. This bacterial infection can persist as a result of inadequate treatment regimens or the presence of biofilm on implanted medical devices. One strategy to mitigate these concerns is the use of implantable medical devices that simultaneously act as local drug delivery devices (DDDs). This classification of device has the potential to prevent or aid in clearing chronic bacterial infection by delivering effective doses of antibiotics to the area of interest and can be engineered to simultaneously aid in tissue regeneration. This review will provide a background on bacterial infection and current therapies as well as current and prospective implantable DDDs, with a particular emphasis on local DDDs to combat bacterial osteomyelitis.
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Thorn CR, Howell PL, Wozniak DJ, Prestidge CA, Thomas N. Enhancing the therapeutic use of biofilm-dispersing enzymes with smart drug delivery systems. Adv Drug Deliv Rev 2021; 179:113916. [PMID: 34371086 DOI: 10.1016/j.addr.2021.113916] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 07/27/2021] [Accepted: 08/02/2021] [Indexed: 12/18/2022]
Abstract
Biofilm-dispersing enzymes degrade the extracellular polymeric matrix surrounding bacterial biofilms, disperse the microbial community and increase their susceptibility to antibiotics and immune cells. Challenges for the clinical translation of biofilm-dispersing enzymes involve their susceptibility to denaturation, degradation, and clearance upon administration in vivo. Drug delivery systems aim to overcome these limitations through encapsulation, stabilization and protection from the exterior environment, thereby maintaining the enzymatic activity. Smart drug delivery systems offer target specificity, releasing payloads at the site of infection while minimizing unnecessary systemic exposure. This review highlights critical advances of biofilm-dispersing enzymes as a novel therapeutic approach for biofilm-associated infections. We explore how smart, bio-responsive delivery systems overcome the limiting factors of biofilm-dispersing enzymes and summarize the key systems designed. This review will guide future developments, focusing on utilizing selective and specific therapies in a targeted fashion to meet the unmet therapeutic needs of biofilm infections.
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Affiliation(s)
- Chelsea R Thorn
- University of South Australia, Clinical and Health Sciences, North Tce, Adelaide, SA 5000, Australia; The Basil Hetzel Institute for Translational Health Research, Woodville, SA 5011, Australia; ARC Centre for Excellence in Bio-Nano Science and Technology, Adelaide, SA 5000, Australia; Biofilm Test Facility, Cancer Research Institute, University of South Australia, North Tce, Adelaide, SA 5000, Australia
| | - P Lynne Howell
- Program in Molecular Medicine, The Hospital for Sick Children, Toronto, ON M5G 1X8, Canada; Department of Biochemistry, University of Toronto, Toronto, ON M5S 1A8, Canada
| | - Daniel J Wozniak
- Departments of Microbial Infection and Immunity, Ohio State University, Columbus, OH 43210, USA
| | - Clive A Prestidge
- University of South Australia, Clinical and Health Sciences, North Tce, Adelaide, SA 5000, Australia; ARC Centre for Excellence in Bio-Nano Science and Technology, Adelaide, SA 5000, Australia
| | - Nicky Thomas
- University of South Australia, Clinical and Health Sciences, North Tce, Adelaide, SA 5000, Australia; The Basil Hetzel Institute for Translational Health Research, Woodville, SA 5011, Australia; ARC Centre for Excellence in Bio-Nano Science and Technology, Adelaide, SA 5000, Australia; Biofilm Test Facility, Cancer Research Institute, University of South Australia, North Tce, Adelaide, SA 5000, Australia.
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Munir MU, Salman S, Javed I, Bukhari SNA, Ahmad N, Shad NA, Aziz F. Nano-hydroxyapatite as a delivery system: overview and advancements. ARTIFICIAL CELLS, NANOMEDICINE, AND BIOTECHNOLOGY 2021; 49:717-727. [PMID: 34907839 DOI: 10.1080/21691401.2021.2016785] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Nano-hydroxyapatite is being investigated as vital components of implants and dental and tissue engineering devices. It is found as a bone replacement due to its non-toxicity and cytocompatibility with dental tissues and bone. The reality that nanocrystalline hydroxyapatite can be made of porous granules and scaffolds. Additionally, it has a massive loading potential indicating its use as a transporter for drugs or a regulated drug release mechanism in pharmaceutical research. This review aims to present existing nano-hydroxyapatite research developments as a drug carrier employed in bone tissue disorders locally and deliver poorly soluble drugs with reduced bioavailability. We have discussed the nano-hydroxyapatite role in the delivery of drugs (i.e. anti-resorptive, anti-cancer, and antibiotics), proteins, genetic material, and radionuclides.
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Affiliation(s)
- Muhammad Usman Munir
- Department of Pharmaceutical Chemistry, College of Pharmacy, Jouf University, Sakaka, Saudi Arabia
| | - Sajal Salman
- Faculty of Pharmacy, University of Central Punjab, Lahore, Pakistan
| | - Ibrahim Javed
- Australian Institute for Bioengineering and Nanotechnology, University of Queensland, Brisbane, Australia
| | - Syed Nasir Abbas Bukhari
- Department of Pharmaceutical Chemistry, College of Pharmacy, Jouf University, Sakaka, Saudi Arabia
| | - Naveed Ahmad
- Department of Pharmaceutics, College of Pharmacy, Jouf University, Sakaka, Saudi Arabia
| | - Naveed Akhter Shad
- National Institute of Biotechnology and Genetic Engineering, Faisalabad, Pakistan
| | - Farooq Aziz
- Department of Physics, University of Sahiwal, Sahiwal, Pakistan
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Costa B, Martínez-de-Tejada G, Gomes PAC, L. Martins MC, Costa F. Antimicrobial Peptides in the Battle against Orthopedic Implant-Related Infections: A Review. Pharmaceutics 2021; 13:1918. [PMID: 34834333 PMCID: PMC8625235 DOI: 10.3390/pharmaceutics13111918] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 11/04/2021] [Accepted: 11/05/2021] [Indexed: 02/06/2023] Open
Abstract
Prevention of orthopedic implant-related infections is a major medical challenge, particularly due to the involvement of biofilm-encased and multidrug-resistant bacteria. Current therapies, based on antibiotic administration, have proven to be insufficient, and infection prevalence may rise due to the dissemination of antibiotic resistance. Antimicrobial peptides (AMPs) have attracted attention as promising substitutes of conventional antibiotics, owing to their broad-spectrum of activity, high efficacy at very low concentrations, and, importantly, low propensity for inducing resistance. The aim of this review is to offer an updated perspective of the development of AMPs-based preventive strategies for orthopedic and dental implant-related infections. In this regard, two major research strategies are herein addressed, namely (i) AMP-releasing systems from titanium-modified surfaces and from bone cements or beads; and (ii) AMP immobilization strategies used to graft AMPs onto titanium or other model surfaces with potential translation as coatings. In overview, releasing strategies have evolved to guarantee higher loadings, prolonged and targeted delivery periods upon infection. In addition, avant-garde self-assembling strategies or polymer brushes allowed higher immobilized peptide surface densities, overcoming bioavailability issues. Future research efforts should focus on the regulatory demands for pre-clinical and clinical validation towards clinical translation.
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Affiliation(s)
- Bruna Costa
- i3S–Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Rua Alfredo Allen, 208, 4200-135 Porto, Portugal; (B.C.); (F.C.)
- INEB–Instituto de Engenharia Biomédica, Universidade do Porto, Rua Alfredo Allen, 208, 4200-135 Porto, Portugal
- FEUP–Faculdade de Engenharia, Universidade do Porto, Rua Dr. Roberto Frias, 4200-465 Porto, Portugal
| | - Guillermo Martínez-de-Tejada
- Department of Microbiology and Parasitology, University of Navarra, Irunlarrea, 1, 31008 Pamplona, Spain;
- Navarra Institute for Health Research (IdiSNA), 31008 Pamplona, Spain
| | - Paula A. C. Gomes
- CIQ-UP e Centro de Investigação em Química da Universidade do Porto, Departamento de Química e Bioquímica, Faculdade de Ciências, Universidade do Porto, 4169-007 Porto, Portugal;
| | - M. Cristina L. Martins
- i3S–Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Rua Alfredo Allen, 208, 4200-135 Porto, Portugal; (B.C.); (F.C.)
- INEB–Instituto de Engenharia Biomédica, Universidade do Porto, Rua Alfredo Allen, 208, 4200-135 Porto, Portugal
- ICBAS–Instituto de Ciências Biomédicas Abel Salazar, Universidade do Porto, Rua Jorge de Viterbo Ferreira 228, 4050-313 Porto, Portugal
| | - Fabíola Costa
- i3S–Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Rua Alfredo Allen, 208, 4200-135 Porto, Portugal; (B.C.); (F.C.)
- INEB–Instituto de Engenharia Biomédica, Universidade do Porto, Rua Alfredo Allen, 208, 4200-135 Porto, Portugal
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Wong Wei Kang N, Tan WPJ, Phua YMC, Min ATG, Naidu K, Umapathysivam K, Smitham PJ. Intramedullary nail: the past, present and the future - a review exploring where the future may lead us. Orthop Rev (Pavia) 2021; 13:25546. [PMID: 34745479 DOI: 10.52965/001c.25546] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Accepted: 07/02/2021] [Indexed: 11/06/2022] Open
Abstract
Background Intramedullary nails (IMNs) are the current gold standard treatment for long bone diaphyseal and selected metaphyseal fractures. The design of IMNs has undergone many revisions since its invention in the 16th century, with a dramatic increase in novel designs in recent years aiming to further improve intramedullary fixation techniques. Aims To map the evolution of IMNs in orthopedic surgery, discuss the limitations and complications of current IMNs and identify novel IMNs that may influence future design innovations. Methods We undertook a scoping review on the status of orthopedic IMNs by reviewing Google Scholar with the following keywords. Publications and patents selected for retrieval were initially assessed on the title and abstract by five independent reviewers. 52 papers were retrieved for complete text examination, and secondary references were checked from these papers. The results were discussed within the research group and consensus was obtained describing novel IMNs. Results Novel IMN designs include growth factor and/or antimicrobial coatings targeting fracture healing and perioperative infection risk, respectively; minimally invasive expandable IMNs to avoid the need for interlocking screws; and novel materials such as carbon fiber for their theoretically superior biomechanical properties and avoidance of artifact on CT and MRI imaging. Conclusion The novel IMNs proposed in recent years collectively aim to improve intramedullary fixation techniques by reducing operative time and radiation exposure, improving fracture healing or monitoring bone cancer progression. However, more research and development are necessary to solve these complex problems.
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Affiliation(s)
| | | | | | | | | | | | - Peter Jonathan Smitham
- Adelaide Medical School; Department of Orthopedics and Trauma, Royal Adelaide Hospital & Discipline of Orthopedics & Trauma, The University of Adelaide
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Wang B, Guo W, Li T, Wang R, Song P, He Y, Cheng X. Synthesis of antibacterial Janus sheets containing dual-active centers by quaternization fracture. Colloids Surf A Physicochem Eng Asp 2021. [DOI: 10.1016/j.colsurfa.2021.127276] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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Lauroyl hyaluronan films for local drug delivery: Preparation and factors influencing the release of small molecules. Int J Pharm 2021; 608:121111. [PMID: 34547392 DOI: 10.1016/j.ijpharm.2021.121111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 09/12/2021] [Accepted: 09/14/2021] [Indexed: 11/21/2022]
Abstract
Lauroyl derivatives of hyaluronan are safe and biodegradable materials that seem promising for application in medicine. However, their potential in the field of drug delivery was not yet explored. We thus prepared lauroyl hyaluronan films loaded with various drugs and studied the effects of lauroyl hyaluronan properties, drug hydrophobicity and medium composition on the drug release. Since biomolecules will always be present in real clinical applications, media supplemented by albumin were also included. The amphiphilic character of lauroyl hyaluronan enabled convenient loading of the films by both hydrophilic and hydrophobic drugs. Dominant factors influencing drug release were drug hydrophobicity and the presence of albumin. Hydrophilic diclofenac was released rapidly in all cases, while triclosan with medium hydrophobicity exhibited slower release sensitive to other parameters, reaching equilibrium values in the used experimental setup. The release of hydrophobic octenidine into pure buffer was almost negligible, but the addition of albumin did promote its release. The strong effect of albumin highlights the importance of considering biomolecules in the design of release experiments.
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Qiu G, Wu H, Huang M, Ma T, Schneider A, Oates TW, Weir MD, Xu HHK, Zhao L. Novel calcium phosphate cement with biofilm-inhibition and platelet lysate delivery to enhance osteogenesis of encapsulated human periodontal ligament stem cells. MATERIALS SCIENCE & ENGINEERING. C, MATERIALS FOR BIOLOGICAL APPLICATIONS 2021; 128:112306. [PMID: 34474857 DOI: 10.1016/j.msec.2021.112306] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 07/02/2021] [Accepted: 07/05/2021] [Indexed: 01/09/2023]
Abstract
Osteomyelitis is caused by Staphylococcus aureus (S. aureus), with associated progressive bone loss. This study developed for the first time a calcium phosphate cement (CPC) for delivery of doxycycline (DOX) and human platelet lysate (hPL) to fight against S. aureus infection and enhance the osteogenesis of human periodontal ligament stem cells (hPDLSCs). Chitosan-containing CPC scaffolds were fabricated in the absence (CPCC) or presence of DOX (CPCC+DOX). In addition, hPL was encapsulated in alginate microbeads and incorporated into CPCC+DOX (CPCC+DOX+ hPL). Flexural strength of CPCC+DOX + hPL was (5.56 ± 0.55) MPa, lower than (8.26 ± 1.6) MPa of CPCC+DOX (p < 0.05), but exceeding the reported strength of cancellous bone. CPCC+DOX and CPCC+DOX + hPL exhibited strong antibacterial activity against S. aureus, reducing biofilm CFU by 4 orders of magnitude. The hPDLSCs encapsulated in microbeads were co-cultured with the CPCs. The hPDLSCs were able to be released from the microbeads and showed a high proliferation rate, increasing by about 8 folds at 14 days for all groups. The hPL was released from the scaffold and promoted the osteogenic differentiation of hPDLSCs. ALP activity was 28.07 ± 5.15 mU/mg for CPCC+DOX + hPL, higher than 17.36 ± 2.37 mU/mg and 1.34 ± 0.37 mU/mg of CPCC+DOX and CPCC, respectively (p < 0.05). At 7 days, osteogenic genes (ALP, RUNX2, COL-1, and OPN) in CPCC+DOX + hPL were 3-10 folds those of control. The amount of hPDLSC-synthesized bone mineral with CPCC+DOX + hPL was 3.8 folds that of CPCC (p < 0.05). In summary, the novel CPC + DOX + hPL-hPDLSCs scaffold exhibited strong antibacterial activity, excellent cytocompatibility and hPDLSC osteogenic differentiation, showing a promising approach for treatment and prevention of bone infection and enhancement of bone regeneration.
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Affiliation(s)
- Gengtao Qiu
- Department of Trauma and Joint Surgery, Shunde Hospital, Southern Medical University, Foshan, Guangdong, China; Department of Advanced Oral Sciences and Therapeutics, University of Maryland Dental School, Baltimore, MD 21201, USA; Department of Orthopaedic Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China
| | - Hansen Wu
- General Administration Office, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong, China
| | - Mingguang Huang
- Department of Trauma and Joint Surgery, Shunde Hospital, Southern Medical University, Foshan, Guangdong, China
| | - Tao Ma
- Department of Oncology and Diagnostic Sciences, University of Maryland School of Dentistry, Baltimore, MD 21201, USA
| | - Abraham Schneider
- Department of Oncology and Diagnostic Sciences, University of Maryland School of Dentistry, Baltimore, MD 21201, USA; Member, Marlene and Stewart Greenebaum Comprehensive Cancer Center, University of Maryland School of Medicine, Baltimore, MD 21201, USA.
| | - Thomas W Oates
- Department of Advanced Oral Sciences and Therapeutics, University of Maryland Dental School, Baltimore, MD 21201, USA
| | - Michael D Weir
- Department of Advanced Oral Sciences and Therapeutics, University of Maryland Dental School, Baltimore, MD 21201, USA.
| | - Hockin H K Xu
- Department of Advanced Oral Sciences and Therapeutics, University of Maryland Dental School, Baltimore, MD 21201, USA; Member, Marlene and Stewart Greenebaum Comprehensive Cancer Center, University of Maryland School of Medicine, Baltimore, MD 21201, USA; Center for Stem Cell Biology & Regenerative Medicine, University of Maryland School of Medicine, Baltimore, MD 21201, USA
| | - Liang Zhao
- Department of Trauma and Joint Surgery, Shunde Hospital, Southern Medical University, Foshan, Guangdong, China; Department of Orthopaedic Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China.
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Hazra RS, Dutta D, Mamnoon B, Nair G, Knight A, Mallik S, Ganai S, Reindl K, Jiang L, Quadir M. Polymeric Composite Matrix with High Biobased Content as Pharmaceutically Relevant Molecular Encapsulation and Release Platform. ACS APPLIED MATERIALS & INTERFACES 2021; 13:40229-40248. [PMID: 34423963 DOI: 10.1021/acsami.1c03805] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Drug delivery systems (DDS) that can temporally control the rate and extent of release of therapeutically active molecules find applications in many clinical settings, ranging from infection control to cancer therapy. With an aim to design a locally implantable, controlled-release DDS, we demonstrated the feasibility of using cellulose nanocrystal (CNC)-reinforced poly (l-lactic acid) (PLA) composite beads. The performance of the platform was evaluated using doxorubicin (DOX) as a model drug for applications in triple-negative breast cancer. A facile, nonsolvent-induced phase separation (NIPS) method was adopted to form composite beads. We observed that CNC loading within these beads played a critical role in the mechanical stability, porosity, water uptake, diffusion, release, and pharmacological activity of the drug from the delivery system. When loaded with DOX, composite beads significantly controlled the release of the drug in a pH-dependent pattern. For example, PLA/CNC beads containing 37.5 wt % of CNCs showed a biphasic release of DOX, where 41 and 82% of the loaded drug were released at pH 7.4 and pH 5.5, respectively, over 7 days. Drug release followed Korsmeyer's kinetics, indicating that the release mechanism was mostly diffusion and swelling-controlled. We showed that DOX released from drug-loaded PLA/CNC composite beads locally suppressed the growth and proliferation of triple-negative breast cancer cells, MBA-MB-231, via the apoptotic pathway. The efficacy of the DDS was evaluated in human tissue explants. We envision that such systems will find applications for designing biobased platforms with programmed stability and drug delivery functions.
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Affiliation(s)
- Raj Shankar Hazra
- Department of Mechanical Engineering, North Dakota State University, Fargo, North Dakota 58108, United States
- Materials and Nanotechnology Program, North Dakota State University, Fargo, North Dakota 58108, United States
| | - Debasmita Dutta
- Department of Coatings and Polymeric Materials, North Dakota State University, Fargo, North Dakota 58108, United States
| | - Babak Mamnoon
- Department of Pharmaceutical Sciences, North Dakota State University, Fargo, North Dakota 58108, United States
| | - Gauthami Nair
- Department of Biological Sciences, North Dakota State University, Fargo, North Dakota 58108, United States
| | - Austin Knight
- Department of Mechanical Engineering, North Dakota State University, Fargo, North Dakota 58108, United States
| | - Sanku Mallik
- Department of Pharmaceutical Sciences, North Dakota State University, Fargo, North Dakota 58108, United States
| | - Sabha Ganai
- Division of Surgical Oncology, Sanford Research, Fargo, North Dakota 58122, United States
| | - Katie Reindl
- Department of Biological Sciences, North Dakota State University, Fargo, North Dakota 58108, United States
| | - Long Jiang
- Department of Mechanical Engineering, North Dakota State University, Fargo, North Dakota 58108, United States
- Materials and Nanotechnology Program, North Dakota State University, Fargo, North Dakota 58108, United States
| | - Mohiuddin Quadir
- Department of Coatings and Polymeric Materials, North Dakota State University, Fargo, North Dakota 58108, United States
- Materials and Nanotechnology Program, North Dakota State University, Fargo, North Dakota 58108, United States
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Wang X, Ning B, Pei X. Tantalum and its derivatives in orthopedic and dental implants: Osteogenesis and antibacterial properties. Colloids Surf B Biointerfaces 2021; 208:112055. [PMID: 34438295 DOI: 10.1016/j.colsurfb.2021.112055] [Citation(s) in RCA: 41] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 07/11/2021] [Accepted: 08/16/2021] [Indexed: 02/08/2023]
Abstract
Implant-associated infections and aseptic loosening are some of the main reasons for implant failure. Therefore, there is an urgent need to improve the osseointegration and antibacterial capabilities of implant materials. In recent years, a large number of breakthroughs in the biological application of tantalum and its derivatives have been achieved. Owing to their corrosion resistance, biocompatibility, osseointegration ability, and antibacterial properties, they have shown considerable potential in orthopedic and dental implant applications. In this review, we provide the latest progress and achievements in the research on osseointegration and antibacterial properties of tantalum as well as its derivatives, and summarize the surface modification methods to enhance their osseointegration and antibacterial properties.
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Affiliation(s)
- Xu Wang
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Department of Prosthodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, 610041, China
| | - Boyu Ning
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Department of Prosthodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, 610041, China
| | - Xibo Pei
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Department of Prosthodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, 610041, China.
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Jensen LK. Implant-associated osteomyelitis: Development, characterisation, and application of a porcine model. APMIS 2021; 129 Suppl 141:1-44. [PMID: 34129250 DOI: 10.1111/apm.13125] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- Louise Kruse Jensen
- Department of Veterinary and Animal Sciences, Faculty of Health and Medical Science, University of Copenhagen, Copenhagen, Denmark
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Zhang B, Chai Y, Huang K, Wei X, Mei Z, Wu X, Dai H. Vancomycin Hydrochloride Loaded Hydroxyapatite Mesoporous Microspheres with Micro/Nano Surface Structure to Increase Osteogenic Differentiation and Antibacterial Ability. J Biomed Nanotechnol 2021; 17:1668-1678. [PMID: 34544543 DOI: 10.1166/jbn.2021.3128] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
As infection induced by the implant will lead to operation failure, the implant material must be endowed with certain antibacterial properties. Hydroxyapatite (HA) mesoporous microspheres have been widely used in bone repair due to their advantages, including simple synthesis, good osteogenic properties and drug loading capacity. In this study, vancomycin hydrochloride-loaded mesoporous hydroxyapatite microspheres with micro/nanosurface structures were synthesized to increase osteogenic differentiation and antibacterial ability. Phytic acid (IP6) was used as a template to prepare mesoporous hydroxyapatite microspheres composed of fibres, flakes and smooth surfaces by the hydrothermal homogeneous precipitation method, and the corresponding specific surface areas were 65.20 m²/g, 75.13 m²/g and 71.27 m²/g, respectively. Vancomycin hydrochloride (Van) was used as the drug model to study the drug loading and release characteristics of the microspheres, as well as the in vitro antibacterial properties after treatment. In addition, during cocultivation with MC3T3-E1 preosteoblasts, HA microspheres assembled via flakes exhibited better cell compatibility, which promoted cell proliferation, alkaline phosphatase (ALP) activity, and the formation of calcium nodules and increased the expression of osteogenic differentiation-related proteins such as Runx-2, osteopontin (OPN) and collagen I (COL I). These results indicated that the HA microspheres prepared in this experiment have broad application prospects in drug delivery systems and bone repair.
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Affiliation(s)
- Beizhi Zhang
- State Key Laboratory of Advanced Technology for Materials Synthesis and Processing, Wuhan University of Technology, Biomedical Materials and Engineering Research Center of Hubei Province, Wuhan 430070, PR China
| | - Yunhui Chai
- State Key Laboratory of Advanced Technology for Materials Synthesis and Processing, Wuhan University of Technology, Biomedical Materials and Engineering Research Center of Hubei Province, Wuhan 430070, PR China
| | - Kai Huang
- State Key Laboratory of Advanced Technology for Materials Synthesis and Processing, Wuhan University of Technology, Biomedical Materials and Engineering Research Center of Hubei Province, Wuhan 430070, PR China
| | - Xuejie Wei
- State Key Laboratory of Advanced Technology for Materials Synthesis and Processing, Wuhan University of Technology, Biomedical Materials and Engineering Research Center of Hubei Province, Wuhan 430070, PR China
| | - Zhiqing Mei
- State Key Laboratory of Advanced Technology for Materials Synthesis and Processing, Wuhan University of Technology, Biomedical Materials and Engineering Research Center of Hubei Province, Wuhan 430070, PR China
| | - Xiaopei Wu
- State Key Laboratory of Advanced Technology for Materials Synthesis and Processing, Wuhan University of Technology, Biomedical Materials and Engineering Research Center of Hubei Province, Wuhan 430070, PR China
| | - Honglian Dai
- State Key Laboratory of Advanced Technology for Materials Synthesis and Processing, Wuhan University of Technology, Biomedical Materials and Engineering Research Center of Hubei Province, Wuhan 430070, PR China
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Hasan R, Schaner K, Mulinti P, Brooks A. A Bioglass-Based Antibiotic (Vancomycin) Releasing Bone Void Filling Putty to Treat Osteomyelitis and Aid Bone Healing. Int J Mol Sci 2021; 22:7736. [PMID: 34299362 PMCID: PMC8304857 DOI: 10.3390/ijms22147736] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Revised: 07/06/2021] [Accepted: 07/09/2021] [Indexed: 11/16/2022] Open
Abstract
While the infection rate after primary total joint replacements (TJR) sits at 1-2%, for trauma-related surgery, it can be as high as 3.6 to 21.2% based on the type of trauma; the risk of reinfection after revision surgery is even higher. Current treatments with antibiotic-releasing PMMA-based bone cement/ beads and/or systemic antibiotic after surgical debridement do not provide effective treatment due to fluctuating antibiotic levels at the site of infection, leading to insufficient local antibiotic concentration. In addition, non-biodegradable PMMA does not support bone regrowth in the debrided void spaces and often must be removed in an additional surgery. Here, we report a bioactive glass or bioglass (BG) substrate-based biodegradable, easy to fabricate "press fitting" antibiotic-releasing bone void filling (ABVF-BG) putty to provide effective local antibiotic release at the site of infection along with support for bone regeneration. The ABVF-BG putty formulation had homogenously distributed BG particles, a porous structure, and showed putty-like ease of handling. Furthermore, the ABVF-BG putty demonstrated in vitro antibacterial activity for up to 6 weeks. Finally, the ABVF-BG putty was biodegradable in vivo and showed 100% bacterial eradication (as shown by bacterial cell counts) in the treatment group, which received ABVF-BG putty, compared to the infection control group, where all the rats had a high bacterial load (4.63 × 106 ± 7.9 × 105 CFU/gram bone) and sustained osteomyelitis. The ABVF-BG putty also supported bone growth in the void space as indicated by a combination of histology, µCT, and X-ray imaging. The potential for simultaneous infection treatment and bone healing using the developed BG-based ABVF-BG putty is promising as an alternative treatment option for osteomyelitis.
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Affiliation(s)
- Raquib Hasan
- Department of Pharmaceutical Sciences, North Dakota State University, Fargo, ND 58102, USA;
| | - Kambri Schaner
- Department of Biological Sciences, North Dakota State University, Fargo, ND 58102, USA;
| | - Pranothi Mulinti
- Department of Pharmaceutical Sciences, North Dakota State University, Fargo, ND 58102, USA;
| | - Amanda Brooks
- Department of Pharmaceutical Sciences, North Dakota State University, Fargo, ND 58102, USA;
- Department of Research and Scholarly Activity, Rocky Vista University, Ivins, UT 84734, USA
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Ge SM, Harvey EJ. Collagen fleece in orthopaedic infections. OTA Int 2021; 4:e111(1-5). [PMID: 37609481 PMCID: PMC10441674 DOI: 10.1097/oi9.0000000000000111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 11/05/2020] [Accepted: 12/11/2020] [Indexed: 08/24/2023]
Abstract
Collagen fleece is a relatively new development. It represents another option in the battle against infection. It is a cheap, biocompatible, and resorbable local antibiotic delivery mechanism with favorable drug release kinetics and low risk of adverse effects or toxicity. Benefit may be conferred when used in contaminated cases. Significantly more research is still needed before the adoption of collagen fleece as the standard of care. However, we can likely conclude that there are no major adverse effects and it can be safely used as an adjunct in addition to conventional therapies for the prophylaxis and treatment of infections.
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Jacobs A, Renaudin G, Charbonnel N, Nedelec JM, Forestier C, Descamps S. Copper-Doped Biphasic Calcium Phosphate Powders: Dopant Release, Cytotoxicity and Antibacterial Properties. MATERIALS 2021; 14:ma14092393. [PMID: 34064435 PMCID: PMC8124198 DOI: 10.3390/ma14092393] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 04/19/2021] [Accepted: 05/02/2021] [Indexed: 11/25/2022]
Abstract
Cytotoxicity and antibacterial properties associated with the dopant release of Cu-doped Biphasic Calcium Phosphate (BCP) powders, mainly composed of hydroxyapatite mixed with β-tricalcium phosphate powders, were investigated. Twelve BCP ceramics were synthesized at three different sintering temperatures (600 °C, 900 °C and 1200 °C) and four copper doping rates (x = 0.0, 0.05, 0.10 and 0.20, corresponding to the stoichiometric amount of copper in Ca10Cux(PO4)6(OH)2-2xO2x). Cytotoxicity assessments of Cu-doped BCP powders, using MTT assay with human-Mesenchymal Stem Cells (h-MSCs), indicated no cytotoxicity and the release of less than 12 ppm of copper into the biological medium. The antibacterial activity of the powders was determined against both Gram-positive (methicillin-sensitive (MS) and methicillin resistant (MR) Staphylococcus aureus) and Gram-negative (Escherichia coli and Pseudomonas aeruginosa) bacteria. The Cu-doped biomaterials exhibited a strong antibacterial activity against MSSA, MRSA and E. coli, releasing approximatively 2.5 ppm after 24 h, whereas 10 ppm were required to induce an antibacterial effect against P. aeruginosa. This study also demonstrated that the culture medium used during experiments can directly impact the antibacterial effect observed; only 4 ppm of Cu2+ were effective for killing all the bacteria in a 1:500 diluted TS medium, whereas 20 ppm were necessary to achieve the same result in a rich, non-diluted standard marrow cell culture medium.
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Affiliation(s)
- Aurélie Jacobs
- Université Clermont Auvergne, Clermont Auvergne INP, CNRS, ICCF, F-63000 Clermont-Ferrand, France; (A.J.); (J.-M.N.)
| | - Guillaume Renaudin
- Université Clermont Auvergne, Clermont Auvergne INP, CNRS, ICCF, F-63000 Clermont-Ferrand, France; (A.J.); (J.-M.N.)
- Correspondence:
| | - Nicolas Charbonnel
- Université Clermont Auvergne, CNRS, Laboratoire Microorganismes: Genome et Environnement, F-63000 Clermont-Ferrand, France; (N.C.); (C.F.)
| | - Jean-Marie Nedelec
- Université Clermont Auvergne, Clermont Auvergne INP, CNRS, ICCF, F-63000 Clermont-Ferrand, France; (A.J.); (J.-M.N.)
| | - Christiane Forestier
- Université Clermont Auvergne, CNRS, Laboratoire Microorganismes: Genome et Environnement, F-63000 Clermont-Ferrand, France; (N.C.); (C.F.)
| | - Stéphane Descamps
- Université Clermont Auvergne, Clermont Auvergne INP, CNRS, CHU Clermont, ICCF, F-63000 Clermont-Ferrand, France;
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Current concepts in the prevention, diagnosis and treatment of fracture-related infection (FRI). EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2021; 31:957-966. [PMID: 33778904 DOI: 10.1007/s00590-021-02956-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Accepted: 03/21/2021] [Indexed: 12/24/2022]
Abstract
Fracture-related infection (FRI) is one of the most challenging complications following operative management of fractures. It can have profound implications for the patient, can be associated with considerable morbidity and often lead to impaired outcomes. There are significant healthcare-related costs. In recent years, there has been significant progress towards developing preventative strategies. Furthermore, diagnostic algorithms and management protocols have recently been reported. Lack of a strong evidence base has previously hindered efforts to implement these and develop established standards of care. There are multiple aspects of care that need to be considered and a multi-disciplinary approach is recommended. In this narrative review, we present the most up-to-date recommendations in the prevention, diagnosis and management of FRI.
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Chaudhry H, Hennedige A, Patel M. Review of prophylactic prescribing of antibiotics during the management of fractured mandibles. Surgeon 2021; 19:e519-e525. [PMID: 33582055 DOI: 10.1016/j.surge.2020.12.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 12/14/2020] [Accepted: 12/25/2020] [Indexed: 11/15/2022]
Abstract
OBJECTIVES To provide evidence based guidance on the optimum prophylactic antibiotic prescribing regimens in the treatment of fractured mandibles to protect against surgical site infections. MATERIAL AND METHODS OVID and Pubmed databases were searched for articles published between 1946 and 2020. Inclusion criteria was for articles to be in English, involve adult patients aged 14 and over, and involve patients treated with oral or IV antibiotics preoperatively, perioperatively or postoperatively during treatment of open or closed fractures of the mandible. Exclusion criteria included infected fractures on presentation, immunocompromised patients, fractures resulting from gunshot and pathological fractures. RESULTS A number of retrospective and prospective, randomised, double blind placebo-controlled trials were identified as suitable for inclusion. The age range within these trials was 14-77 years old. The numbers of patients contained within each trial ranged from 30 to 642. The most commonly prescribed antibiotics were penicillin, administered orally or intravenously. Duration of administration ranged from hospital admission to five days postoperatively. Analysis of these studies failed to demonstrate a statistical difference on the number of surgical site infections and the duration of antibiotic course. CONCLUSIONS The available evidence reveals no statistical difference in infection rates whether antibiotics are prescribed pre, peri, or postoperatively. The duration of antibiotics therapy also appears not to be important. Current evidence does not support the recommendation of an optimum antibiotic prescribing regimen. Additional prospective studies looking at the duration and timing of antibiotics during the management of fractured mandibles are required to identify the optimum prescribing regimen.
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Affiliation(s)
- Hiba Chaudhry
- Department of Oral and Maxillofacial Surgery, University Hospital South Manchester, Manchester, United Kingdom.
| | - Anusha Hennedige
- Department of Craniofacial Surgery, Alder Hey Children's Hospital, Liverpool, United Kingdom
| | - Manu Patel
- Department of Oral and Maxillofacial Surgery, University Hospital South Manchester, Manchester, United Kingdom
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Sun CK, Ke CJ, Lin YW, Lin FH, Tsai TH, Sun JS. Transglutaminase Cross-Linked Gelatin-Alginate-Antibacterial Hydrogel as the Drug Delivery-Coatings for Implant-Related Infections. Polymers (Basel) 2021; 13:polym13030414. [PMID: 33525449 PMCID: PMC7866112 DOI: 10.3390/polym13030414] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2021] [Revised: 01/17/2021] [Accepted: 01/25/2021] [Indexed: 02/07/2023] Open
Abstract
Implant-related infection may be catastrophic and result in poor functional outcome, chronic osteomyelitis, implant failure or even sepsis and death. Based on a transglutaminase (TGase) cross-linked/antibiotics-encapsulated gelatin-alginate hydrogel, the main aim of this study is to establish an effective antibiotic slow-release system. The second aim is to evaluate the efficacy of a hydrogel-encapsulated antibiotic-containing titanium pin in preventing implant-related infections in a rat model. The prepared gelatin/alginate/gentamicin or vancomycin hydrogel was covalently cross-linked with transglutaminase (TGase). Its drug release profile and cytotoxicity were determined and the Wistar rat animal model was performed to validate its efficacy by radiographic examination, Micro-CT (computed tomography) evaluation and histo-morphological analysis at 12 weeks after surgery. When gelatin and alginate were thoroughly mixed with TGase, both 0.5% and 1.0% TGase can effectively cross link the hydrogel; the release of antibiotic is slowed down with higher degree of TGase concentration (from 20 min to more than 120 h). In the animal study, antibiotic-impregnated hydrogel is effective in alleviating the implant-related infections. Relative to that of a positive control group, the experimental group (vancomycin treatment group) showed significant higher bone volume, more intact bony structure with only mild inflammatory cell infiltration. This newly designed hydrogel can effectively deliver antibiotics to reduce bacterial colonization and biofilm formation on the implant surface. The remaining challenges will be to confer different potent antibacterial medications with good biocompatibility and fulfill the safety, practical and economic criteria for future clinical translation.
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Affiliation(s)
- Chung-Kai Sun
- Institute of Traditional Medicine, School of Medicine, National Yang Ming Chiao Tung University, No. 155, Sec. 2, Linong Street, Taipei 11221, Taiwan; or
| | - Cherng-Jyh Ke
- Biomaterials Translational Research Center, China Medical University Hospital, No. 2, Yude Rd., Taichung City 40447, Taiwan;
| | - Yi-Wen Lin
- Institute of Biomedical Engineering, College of Medicine, National Taiwan University, No. 1, Sec. 4, Roosevelt Rd., Taipei 10617, Taiwan; (Y.-W.L.); (F.-H.L.)
- Institute of Biomedical Engineering, College of Engineering, National Taiwan University, No. 1, Sec. 4, Roosevelt Rd., Taipei 10617, Taiwan
| | - Feng-Huei Lin
- Institute of Biomedical Engineering, College of Medicine, National Taiwan University, No. 1, Sec. 4, Roosevelt Rd., Taipei 10617, Taiwan; (Y.-W.L.); (F.-H.L.)
- Institute of Biomedical Engineering, College of Engineering, National Taiwan University, No. 1, Sec. 4, Roosevelt Rd., Taipei 10617, Taiwan
- Division of Biomedical Engineering and Nanomedicine Research, National Health Research Institutes, No. 35, Keyan Road, Zhunan, Miaoli County 35053, Taiwan
| | - Tung-Hu Tsai
- Institute of Traditional Medicine, School of Medicine, National Yang Ming Chiao Tung University, No. 155, Sec. 2, Linong Street, Taipei 11221, Taiwan; or
- Correspondence: (T.-H.T.); (J.-S.S.); Tel.: +886-2-2826-7115 (T.-H.T.); Fax: +886-2-2822-5044 (T.-H.T.)
| | - Jui-Sheng Sun
- Department of Orthopedic Surgery, College of Medicine, China Medical University, No. 2, Yu-Der Rd., Taichung City 40447, Taiwan
- Department of Orthopedic Surgery, National Taiwan University Hospital, No. 7, Chung-Shan South Road, Taipei 10002, Taiwan
- Correspondence: (T.-H.T.); (J.-S.S.); Tel.: +886-2-2826-7115 (T.-H.T.); Fax: +886-2-2822-5044 (T.-H.T.)
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Myakinin A, Turlybekuly A, Pogrebnjak A, Mirek A, Bechelany M, Liubchak I, Oleshko O, Husak Y, Korniienko V, Leśniak-Ziółkowska K, Dogadkin D, Banasiuk R, Moskalenko R, Pogorielov M, Simka W. In vitro evaluation of electrochemically bioactivated Ti6Al4V 3D porous scaffolds. MATERIALS SCIENCE & ENGINEERING. C, MATERIALS FOR BIOLOGICAL APPLICATIONS 2021; 121:111870. [PMID: 33579496 DOI: 10.1016/j.msec.2021.111870] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Revised: 12/28/2020] [Accepted: 01/03/2021] [Indexed: 12/21/2022]
Abstract
Triply periodic minimal surfaces (TPMS) are known for their advanced mechanical properties and are wrinkle-free with a smooth local topology. These surfaces provide suitable conditions for cell attachment and proliferation. In this study, the in vitro osteoinductive and antibacterial properties of scaffolds with different minimal pore diameters and architectures were investigated. For the first time, scaffolds with TPMS architecture were treated electrochemically by plasma electrolytic oxidation (PEO) with and without silver nanoparticles (AgNPs) to enhance the surface bioactivity. It was found that the scaffold architecture had a greater impact on the osteoblast cell activity than the pore size. Through control of the architecture type, the collagen production by osteoblast cells increased by 18.9% and by 43.0% in the case of additional surface PEO bioactivation. The manufactured scaffolds demonstrated an extremely low quasi-elastic modulus (comparable with trabecular and cortical bone), which was 5-10 times lower than that of bulk titanium (6.4-11.4 GPa vs 100-105 GPa). The AgNPs provided antibacterial properties against both gram-positive and gram-negative bacteria and had no significant impact on the osteoblast cell growth. Complex experimental results show the in vitro effectiveness of the PEO-modified TPMS architecture, which could positively impact the clinical applications of porous bioactive implants.
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Affiliation(s)
- Alexandr Myakinin
- D. Serikbayev East Kazakhstan State Technical University, F02K6B2 Oskemen, Kazakhstan
| | | | - Alexander Pogrebnjak
- Sumy State University, Medical Institute, 40018 Sumy, Ukraine; al-Farabi Kazakh National University, 050040 Almaty, Kazakhstan
| | - Adam Mirek
- Institut Européen des Membranes, IEM, UMR-5635, University Montpellier, CNRS, ENSCM, 34095 Montpellier CEDEX 5, France; Nalecz Institute of Biocybernetics and Biomedical Engineering PAS, 02-109 Warsaw, Poland
| | - Mikhael Bechelany
- Institut Européen des Membranes, IEM, UMR-5635, University Montpellier, CNRS, ENSCM, 34095 Montpellier CEDEX 5, France
| | - Iryna Liubchak
- Sumy State University, Medical Institute, 40018 Sumy, Ukraine
| | | | - Yevheniia Husak
- Sumy State University, Medical Institute, 40018 Sumy, Ukraine
| | | | | | - Dmitry Dogadkin
- D. Serikbayev East Kazakhstan State Technical University, F02K6B2 Oskemen, Kazakhstan
| | - Rafał Banasiuk
- NanoWave, 02-676 Warsaw, Poland; Institute of Biotechnology and Molecular Medicine, 80-172 Gdansk, Poland
| | | | - Maksym Pogorielov
- Sumy State University, Medical Institute, 40018 Sumy, Ukraine; NanoPrime, 32-900 Dębica, Poland
| | - Wojciech Simka
- Silesian University of Technology, Faculty of Chemistry, 44-100 Gliwice, Poland; NanoPrime, 32-900 Dębica, Poland.
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Vantucci CE, Ahn H, Fulton T, Schenker ML, Pradhan P, Wood LB, Guldberg RE, Roy K, Willett NJ. Development of systemic immune dysregulation in a rat trauma model of biomaterial-associated infection. Biomaterials 2021; 264:120405. [PMID: 33069135 PMCID: PMC8117743 DOI: 10.1016/j.biomaterials.2020.120405] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 09/09/2020] [Accepted: 09/18/2020] [Indexed: 12/12/2022]
Abstract
Orthopedic biomaterial-associated infections remain a major clinical challenge, with Staphylococcus aureus being the most common pathogen. S. aureus biofilm formation enhances immune evasion and antibiotic resistance, resulting in a local, indolent infection that can persist long-term without symptoms before eventual hardware failure, bone non-union, or sepsis. Immune modulation is an emerging strategy to combat host immune evasion by S. aureus. However, most immune modulation strategies are focused on local immune responses at the site of infection, with little emphasis on understanding the infection-induced and orthopedic-related systemic immune responses of the host, and their role in local infection clearance and tissue regeneration. This study utilized a rat bone defect model to investigate how implant-associated infection affects the systemic immune response. Long-term systemic immune dysregulation was observed with a significant systemic decrease in T cells and a concomitant increase in immunosuppressive myeloid-derived suppressor cells (MDSCs) compared to non-infected controls. Further, the control group exhibited a regulated and coordinated systemic cytokine response, which was absent in the infection group. Multivariate analysis revealed high levels of MDSCs to be most correlated with the infection group, while high levels of T cells were most correlated with the control group. Locally, the infection group had attenuated macrophage infiltration and increased levels of MDSCs in the local soft tissue compared to non-infected controls. These data reveal the widespread impacts of an orthopedic infection on both the local and the systemic immune responses, uncovering promising targets for diagnostics and immunotherapies that could optimize treatment strategies and ultimately improve patient outcomes.
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Affiliation(s)
- Casey E Vantucci
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, GA, USA; Parker H. Petit Institute for Bioengineering and Bioscience, Georgia Institute of Technology, Atlanta, GA, USA
| | - Hyunhee Ahn
- The Atlanta Veterans Affairs Medical Center Atlanta, Decatur, GA, USA; Department of Orthopaedics, Emory University, Atlanta, GA, USA
| | - Travis Fulton
- The Atlanta Veterans Affairs Medical Center Atlanta, Decatur, GA, USA; Department of Orthopaedics, Emory University, Atlanta, GA, USA
| | - Mara L Schenker
- Department of Orthopaedics, Emory University, Atlanta, GA, USA; Grady Memorial Hospital, Atlanta, GA, USA
| | - Pallab Pradhan
- Parker H. Petit Institute for Bioengineering and Bioscience, Georgia Institute of Technology, Atlanta, GA, USA
| | - Levi B Wood
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, GA, USA; Parker H. Petit Institute for Bioengineering and Bioscience, Georgia Institute of Technology, Atlanta, GA, USA; George W. Woodruff School of Mechanical Engineering, Georgia Institute of Technology, Atlanta, GA, USA
| | - Robert E Guldberg
- Knight Campus for Accelerating Scientific Impact, University of Oregon, Eugene, OR, USA
| | - Krishnendu Roy
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, GA, USA; Parker H. Petit Institute for Bioengineering and Bioscience, Georgia Institute of Technology, Atlanta, GA, USA.
| | - Nick J Willett
- The Atlanta Veterans Affairs Medical Center Atlanta, Decatur, GA, USA; Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, GA, USA; Parker H. Petit Institute for Bioengineering and Bioscience, Georgia Institute of Technology, Atlanta, GA, USA; Department of Orthopaedics, Emory University, Atlanta, GA, USA.
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Hasan R, Wohlers A, Shreffler J, Mulinti P, Ostlie H, Schaper C, Brooks B, Brooks A. An Antibiotic-Releasing Bone Void Filling (ABVF) Putty for the Treatment of Osteomyelitis. MATERIALS (BASEL, SWITZERLAND) 2020; 13:E5080. [PMID: 33187199 PMCID: PMC7698155 DOI: 10.3390/ma13225080] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/06/2020] [Revised: 10/27/2020] [Accepted: 10/28/2020] [Indexed: 12/18/2022]
Abstract
The number of total joint replacements (TJR) is on the rise with a corresponding increase in the number of infected TJR, which necessitates revision surgeries. Current treatments with either non-biodegradable, antibiotic-releasing polymethylmethacrylate (PMMA) based bone cement, or systemic antibiotic after surgical debridement do not provide effective treatment due to fluctuating antibiotic levels at the site of infection. Here, we report a biodegradable, easy-to-use "press-fitting" antibiotic-releasing bone void filling (ABVF) putty that not only provides efficient antibiotic release kinetics at the site of infection but also allows efficient osseointegration. The ABVF formulation was prepared using poly (D,L-lactide-co-glycolide) (PLGA), polyethylene glycol (PEG), and polycaprolactone (PCL) as the polymer matrix, antibiotic vancomycin, and osseointegrating synthetic bone PRO OSTEON for bone-growth support. ABVF was homogenous, had a porous structure, was moldable, and showed putty-like mechanical properties. The ABVF putty released vancomycin for 6 weeks at therapeutic level. Furthermore, the released vancomycin showed in vitro antibacterial activity against Staphylococcus aureus for 6 weeks. Vancomycin was not toxic to osteoblasts. Finally, ABVF was biodegradable in vivo and showed an effective infection control with the treatment group showing significantly higher bone growth (p < 0.001) compared to the control group. The potential of infection treatment and osseointegration makes the ABVF putty a promising treatment option for osteomyelitis after TJR.
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Affiliation(s)
- Raquib Hasan
- Department of Pharmaceutical Sciences, North Dakota State University, Fargo, ND 58102, USA; (R.H.); (J.S.); (P.M.)
| | - Abbey Wohlers
- Department of Pharmacy, North Dakota State University, Fargo, ND 58102, USA;
| | - Jacob Shreffler
- Department of Pharmaceutical Sciences, North Dakota State University, Fargo, ND 58102, USA; (R.H.); (J.S.); (P.M.)
| | - Pranothi Mulinti
- Department of Pharmaceutical Sciences, North Dakota State University, Fargo, ND 58102, USA; (R.H.); (J.S.); (P.M.)
| | - Hunter Ostlie
- School of Medicine, St. George’s University, University Centre Grenada, West Indies, Grenada;
| | - Codi Schaper
- College of Veterinary Medicine, Kansas State University, Manhattan, KS 66502, USA;
| | - Benjamin Brooks
- Department of Biomedical Sciences, Rocky Vista University, Ivins, UT 84734, USA;
| | - Amanda Brooks
- Department of Pharmaceutical Sciences, North Dakota State University, Fargo, ND 58102, USA; (R.H.); (J.S.); (P.M.)
- Department of Research and Scholarly Activity, Rocky Vista University, Ivins, UT 84734, USA
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Jacobs A, Renaudin G, Forestier C, Nedelec JM, Descamps S. Biological properties of copper-doped biomaterials for orthopedic applications: A review of antibacterial, angiogenic and osteogenic aspects. Acta Biomater 2020; 117:21-39. [PMID: 33007487 DOI: 10.1016/j.actbio.2020.09.044] [Citation(s) in RCA: 80] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 09/17/2020] [Accepted: 09/21/2020] [Indexed: 12/13/2022]
Abstract
Copper is an essential trace element required for human life, and is involved in several physiological mechanisms. Today researchers have found and confirmed that Cu has biological properties which are particularly useful for orthopedic biomaterials applications such as implant coatings or biodegradable filler bone substitutes. Indeed, Cu exhibits antibacterial functions, provides angiogenic ability and favors osteogenesis; these represent major key points for ideal biomaterial integration and the healing process that follows. The antibacterial performances of copper-doped biomaterials present an interesting alternative to the massive use of prophylactic antibiotics and help to limit the development of antibiotic resistance. By stimulating blood vessel growth and new bone formation, copper contributes to the improved bio-integration of biomaterials. This review describes the bio-functional advantages offered by Cu and focuses on the antibacterial, angiogenic and osteogenic properties of Cu-doped biomaterials with potential for orthopedic applications.
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Wenhao Z, Zhang T, Yan J, Li Q, Xiong P, Li Y, Cheng Y, Zheng Y. In vitro and in vivo evaluation of structurally-controlled silk fibroin coatings for orthopedic infection and in-situ osteogenesis. Acta Biomater 2020; 116:223-245. [PMID: 32889111 DOI: 10.1016/j.actbio.2020.08.040] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 08/20/2020] [Accepted: 08/26/2020] [Indexed: 01/19/2023]
Abstract
Biomedical device-associated infections (BAI) and osteosynthesis are two main complications following the orthopedic implant surgery, especially while infecting bacteria form a mature biofilm, which can protect the organisms from the host immune system and antibiotic therapy. Comparing with the single antibiotics therapeutic method, the combination of silver nanoparticles (AgNPs) and conventional antibiotics exert a high level of antibacterial activity. Nevertheless, one major issue that extremely restricts the potential application of AgNP/antiviotics is the uncontrolled release. Moreover, the lack of osteogenic ability may cause the osteosynthesis. Thus, herein we fabricated a structure-controlled drug-loaded silk fibroin (SF) coating that can achieve the size and release control of AgNPs and high efficient osteogenesis. Three comparative SF-based coatings were fabricated: α-structured coating (α-helices 32.7%,), m-structured coating (β-sheets 28.3%) and β-structured coating (β-sheets 41%). Owning to the high content of α-helices structure and small AgNPs (20 nm), α-structured coating displayed better protein adsorption and hydrophilicity, as well as pH-dependent and long-lasting antibacterial performance. In vitro studies demonstrated that α coating showed biocompatibility (cellular attachment, spreading and proliferation), high ALP expression, collagen secretion and calcium mineralization. Moreover, after one month subcutaneous implantation in vivo, α-structured coating elicited minimal, comparable inflammatory response. Additionally, in a rabbit femoral defect model, α-structured coating displayed a significant improvement on the generation of new-born bone and bonding between the new bone and the tissue, implying a rapid and durable osteointegration. Expectedly, this optimized structure-controlled SF-based coating can be an alternative and prospective solution for the current challenges in orthopedics. STATEMENT OF SIGNIFICANCE: In this study, an AgNPs/Gentamycin-loaded structured-controlled silk fibroin coatings were constructed on Ti implant's surface to guarantee the success of implantation even in the face of bacterial infection. In comparison, the α-structured coating had the lowest content of β-sheets structure (19.0%) and the smallest particle size of AgNPs (~ 20 nm), and owned pH-responsive characteristic due to reversible α-helices structural. Thanks to pH-responsive release of Ag+, the α-structure coating could effectively inhibit adhesive bacteria and kill planktonic bacteria by releasing a large amount of reactive oxygen radicals. Through in vitro biological results (cell proliferation, differentiation and osteogenic gene expression) and in vivo rabbit femur implantation results, the α-structure coating had good biocompatible and osteogenic properties.
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Affiliation(s)
- Zhou Wenhao
- Northwest Institute for Nonferrous Metal Research, Xi'an 710016, China; Academy for Advanced Interdisciplinary Studies, Peking University, Beijing 100871, China
| | - Teng Zhang
- Department of Orthopedics, Peking University Third Hospital, Beijing 100191, China
| | - Jianglong Yan
- Academy for Advanced Interdisciplinary Studies, Peking University, Beijing 100871, China
| | - QiYao Li
- Department of Biomedical Engineering, Materials Research Institute, Huck Institutes of The Life Sciences, The Pennsylvania State University, University Park, PA 16802, United States
| | - Panpan Xiong
- Academy for Advanced Interdisciplinary Studies, Peking University, Beijing 100871, China
| | - Yangyang Li
- Academy for Advanced Interdisciplinary Studies, Peking University, Beijing 100871, China
| | - Yan Cheng
- Academy for Advanced Interdisciplinary Studies, Peking University, Beijing 100871, China.
| | - Yufeng Zheng
- Academy for Advanced Interdisciplinary Studies, Peking University, Beijing 100871, China; Department of Materials Science and Engineering, College of Engineering, Peking University, Beijing 100871, China.
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Allen B, Moore C, Seyler T, Gall K. Modulating antibiotic release from reservoirs in 3D-printed orthopedic devices to treat periprosthetic joint infection. J Orthop Res 2020; 38:2239-2249. [PMID: 32100898 DOI: 10.1002/jor.24640] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Revised: 01/28/2020] [Accepted: 02/19/2020] [Indexed: 02/04/2023]
Abstract
Periprosthetic joint infection is a costly debilitating affliction following total joint arthroplasty. Despite a relatively low incidence rate, periprosthetic joint infection is an increasing problem due to a substantial increase in arthroplasty surgeries over time. The current treatment is replacing the primary implant with a temporary bone cement spacer that releases antibiotics over time. However, the spacer is mechanically weak with an ineffective antibiotic release. Alternatively, three-dimensional (3D)-printed reservoirs in high-strength devices have the potential to release antibiotics long term in a controlled manner. In this study, 3D-printed reservoirs were loaded with calcium sulfate embedded with gentamicin. In vitro antibiotic release is tuned by varying reservoir parameters, such as channel length, diameter, and quantity. In addition, a straightforward computational model effectively predicts antibiotic release curves to rapidly design devices with a preferred release profile. Overall, this study highlights a novel approach to potentially develop high-strength joint implants with the long-term effective release of antibiotics to treat the periprosthetic joint infection.
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Affiliation(s)
- Brian Allen
- Department of Mechanical Engineering and Materials Science, Edmund T. Pratt Jr. School of Engineering, Duke University, Durham, North Carolina
| | - Christina Moore
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina
| | - Thorsten Seyler
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina
| | - Ken Gall
- Department of Mechanical Engineering and Materials Science, Edmund T. Pratt Jr. School of Engineering, Duke University, Durham, North Carolina
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