Biomaterials: Antimicrobial Surfaces in Biomedical Engineering and Healthcare

Anti-Biofilm Strategies: A Focused Review on Innovative Approaches

Biofilm (BF) can give rise to systemic infections, prolonged hospitalization times, and, in the worst case, death. This review aims to provide an overview of recent strategies for the prevention and destruction of pathogenic BFs. First, the main phases of the life cycle of BF and maturation will be described to identify potential targets for anti-BF approaches. Then, an approach acting on bacterial adhesion, quorum sensing (QS), and the extracellular polymeric substance (EPS) matrix will be introduced and discussed. Finally, bacteriophage-mediated strategies will be presented as innovative approaches against BF inhibition/destruction.

Synergistic Effect of Nano Strontium Titanate Coating and Ultraviolet C Photofunctionalization on Osteogenic Performance and Soft Tissue Sealing of poly(ether-ether-ketone)

This study aimed to evaluate the bioactivity of poly(ether ether ketone) (PEEK) after surface modification by persistent photoconductive strontium titanate (SrTiO3) magnetron sputtering and ultraviolet (UV) C irradiation. According to the different modifications, the PEEK specimens were randomly divided into five groups (n = 38/group): PEEK, Sr100-PEEK, Sr200-PEEK, UV/PEEK, and UV/Sr200-PEEK. Then, the specimens of Sr100-PEEK and Sr200-PEEK groups were, respectively, coated with 100 and 200 nm thickness photocatalyst SrTiO3 on the PEEK surface by magnetron sputtering. Subsequently, UV-C light photofunctionalized the specimens of PEEK and Sr200-PEEK groups to form UV/PEEK and UV/Sr200-PEEK groups. The specimens were characterized by a step meter, scanning electron microscopy (SEM), atomic force microscopy (AFM), energy dispersive X-ray spectroscopy (EDX), and a water contact angle meter. The release test of the Sr ion was performed by inductively coupled plasma mass spectrometry (ICP-MS). In vitro study, osteogenic activity (MC3T3-E1 osteoblast-like cells) and epithelial and connective tissue attachment (gingival epithelial cells GE1 and fibroblasts NIH3T3) were analyzed in five groups. Surface morphology of the specimens was changed after coating, and the Sr content on the Sr-PEEK surface was increased with increasing coating thickness. In addition, the contact angle was increased significantly after magnetron sputtering. After UV-C photofunctionalization, the content of surface elements changed and the contact angle was decreased. The release of Sr ion was sustained, and the final cumulative release amount did not exceed the safety limit. In vitro experiments showed that SrTiO3 improved the cell activity of MC3T3-E1 and UV-C irradiation further enhanced the osteogenic performance of PEEK. Besides, UV-C irradiation also significantly promoted the cell viability, development, and expression of adhesion proteins of GE1 and NIH3T3 on PEEK. The present investigation demonstrated that nano SrTiO3 coating with UV-C photofunctionalization synergistically enhanced the osteogenic properties and soft tissue sealing function of PEEK in vitro.

Novel Antibacterial Materials and Coatings-A Perspective by the Editors

The fight between humans and bacteria has escalated to a new level.

Rational design of antimicrobial peptide conjugated graphene-silver nanoparticle loaded chitosan wound dressing

Wound dressing with poor antibacterial properties, the tendency to adhere to the wound site, poor mechanical strength, and lack of porosity and flexibility are the major cause of blood loss, delayed wound repair, and sometimes causes death during the trauma or injury. In such cases, hydrogel-based antibacterial wound dressing would be a boon to the existing dressing as the moist environment will maintain the cooling temperate and proper exchange of atmosphere around the wound. In the present study, the multifunctional graphene with silver and ε-Poly-l-lysine reinforced into the chitosan matrix (CGAPL) was prepared as a nanobiocomposite wound dressing. The contact angle measurement depicted the hydrophilic property of CGAPL nanobiocomposite dressing (water contact angle 42°), while the mechanical property was 78.9 MPa. The antibacterial and cell infiltration study showed the antimicrobial property of CGAPL nanobiocomposite wound dressing. It also demonstrated no cytotoxicity to the L929 fibroblast cells. Chorioallantoic Membrane (CAM) assay showed the pro-angiogenic potential of CGAPL nanobiocomposite wound dressing. In-vitro scratch wound assay confirmed the migration of cells and increased cell adhesion and proliferation within 18 h of culture on the surface of CGAPL nanobiocomposite dressing. Later, the in-vivo study in the Wistar rat model showed that CGAPL nanobiocomposite dressing significantly enhanced the wound healing process as compared to the commercially available wound dressing Tegaderm (p-value <0.01) and Fibroheal@Ag (p-value <0.005) and obtained complete wound closure in 14 days. Histology study further confirmed the complete healing process, re-epithelization, and thick epidermis tissue formation. The proposed CGAPL nanobiocomposite wound dressing thus offers a novel wound dressing material with an efficient and faster wound healing property.

Additive manufacturing of sustainable biomaterials for biomedical applications

Biopolymers are promising environmentally benign materials applicable in multifarious applications. They are especially favorable in implantable biomedical devices thanks to their excellent unique properties, including bioactivity, renewability, bioresorbability, biocompatibility, biodegradability and hydrophilicity. Additive manufacturing (AM) is a flexible and intricate manufacturing technology, which is widely used to fabricate biopolymer-based customized products and structures for advanced healthcare systems. Three-dimensional (3D) printing of these sustainable materials is applied in functional clinical settings including wound dressing, drug delivery systems, medical implants and tissue engineering. The present review highlights recent advancements in different types of biopolymers, such as proteins and polysaccharides, which are employed to develop different biomedical products by using extrusion, vat polymerization, laser and inkjet 3D printing techniques in addition to normal bioprinting and four-dimensional (4D) bioprinting techniques. This review also incorporates the influence of nanoparticles on the biological and mechanical performances of 3D-printed tissue scaffolds. This work also addresses current challenges as well as future developments of environmentally friendly polymeric materials manufactured through the AM techniques. Ideally, there is a need for more focused research on the adequate blending of these biodegradable biopolymers for achieving useful results in targeted biomedical areas. We envision that biopolymer-based 3D-printed composites have the potential to revolutionize the biomedical sector in the near future.

Demonstrating the In Vitro and In Situ Antimicrobial Activity of Oxide Mineral Microspheres: An Innovative Technology to Be Incorporated into Porous and Nonporous Materials

The antimicrobial activity of surfaces treated with zinc and/or magnesium mineral oxide microspheres is a patented technology that has been demonstrated in vitro against bacteria and viruses. This study aims to evaluate the efficiency and sustainability of the technology in vitro, under simulation-of-use conditions, and in situ. The tests were undertaken in vitro according to the ISO 22196:2011, ISO 20473:2013, and NF S90-700:2019 standards with adapted parameters. Simulation-of-use tests evaluated the robustness of the activity under worst-case scenarios. The in situ tests were conducted on high-touch surfaces. The in vitro results show efficient antimicrobial activity against referenced strains with a log reduction of >2. The sustainability of this effect was time-dependent and detected at lower temperatures (20 ± 2.5 °C) and humidity (46%) conditions for variable inoculum concentrations and contact times. The simulation of use proved the microsphere's efficiency under harsh mechanical and chemical tests. The in situ studies showed a higher than 90% reduction in CFU/25 cm² per treated surface versus the untreated surfaces, reaching a targeted value of <50 CFU/cm². Mineral oxide microspheres can be incorporated into unlimited surface types, including medical devices, to efficiently and sustainably prevent microbial contamination.

Double-Network Chitosan-Based Hydrogels with Improved Mechanical, Conductive, Antimicrobial, and Antibiofouling Properties

In recent years, the antimicrobial activity of chitosan-based hydrogels has been at the forefront of research in wound healing and the prevention of medical device contamination. Anti-infective therapy is a serious challenge given the increasing prevalence of bacterial resistance to antibiotics as well as their ability to form biofilms. Unfortunately, hydrogel resistance and biocompatibility do not always meet the demands of biomedical applications. As a result, the development of double-network hydrogels could be a solution to these issues. This review discusses the most recent techniques for creating double-network chitosan-based hydrogels with improved structural and functional properties. The applications of these hydrogels are also discussed in terms of tissue recovery after injuries, wound infection prevention, and biofouling of medical devices and surfaces for pharmaceutical and medical applications.

Chitosan decorated essential oil nanoemulsions for enhanced antibacterial activity using a microfluidic device and response surface methodology

In this work, the antibacterial activity of Satureja Khuzestanica essential oil nanoemulsions improved by employing chitosan (ch/SKEO NE) against E. coli bacterium. The optimum ch/SKEO NE with mean droplet size of 68 nm was attained at 1.97, 1.23, and 0.10%w/w of surfactant, essential oil and chitosan, using Response Surface Methodology (RSM). Applying microfluidic platform, the ch/SKEO NE resulted in improved antibacterial activity owing to the modification of surface properties. The nanoemulsion samples showed a significant rupturing effect on the E. coli bacterial cell membrane which resulted in a rapid release of cellular contents. This action was remarkably intensified by executing microfluidic chip in parallel to the conventional method. Having treated the bacteria in the microfluidic chip for 5 min with a 8 μg/mL concentration of ch/SKEO NE, the bacterial integrity disrupted quickly, and the activity was totally lost in a 10-min period at 37 μg/mL, while it took 5 h for a complete inhibition in the conventional method using the same concentration of ch/SKEO NE. It can be concluded that nanoemulsification of EOs using chitosan coating can intensify the interaction of nanodroplets with the bacterial membrane, especially within the microfluidic chips which provides high contact surface area.

New frontiers in healthcare environmental hygiene: thoughts from the 2022 healthcare cleaning forum

Healthcare environmental hygiene (HEH) has become recognized as being increasingly important for patient safety and the prevention of healthcare-associated infections. At the 2022 Healthcare Cleaning Forum at Interclean in Amsterdam, the academic lectures focused on a series of main areas of interest. These areas are indicative of some of the main trends and avenues for research in the coming years. Both industry and academia need to take steps to continue the momentum of HEH as we transition out of the acute phase of the Covid-19 pandemic. There is a need for new ways to facilitate collaboration between the academic and private sectors. The Clean Hospitals® network was presented in the context of the need for both cross-disciplinarity and evidence-based interventions in HEH. Governmental bodies have also become more involved in the field, and both the German DIN 13603 standard and the UK NHS Cleaning Standards were analyzed and compared. The challenge of environmental pathogens was explored through the example of how P. aeruginosa persists in the healthcare environment. New innovations in HEH were presented, from digitalization to tracking, and automated disinfection to antimicrobial surfaces. The need for sustainability in HEH was also explored, focusing on the burden of waste, the need for a circular economy, and trends towards increasingly local provision of goods and services. The continued focus on and expansion of these areas of HEH will result in safer patient care and contribute to better health systems.

Antimicrobial Compounds in Food Packaging

This review presents current knowledge on antimicrobial agents that are already used in the food packaging industry. At the beginning, innovative ways of food packaging were discussed, including how smart packaging differs from active packaging, and what functions they perform. Next, the focus was on one of the groups of bioactive components that are used in these packaging, namely antimicrobial agents. Among the antimicrobial agents, we selected those that have already been used in packaging and that promise to be used elsewhere, e.g., in the production of antimicrobial biomaterials. Main groups of antimicrobial agents (i.e., metals and metal oxides, organic acids, antimicrobial peptides and bacteriocins, antimicrobial agents of plant origin, enzymes, lactoferrin, chitosan, allyl isothiocyanate, the reuterin system and bacteriophages) that are incorporated or combined with various types of packaging materials to extend the shelf life of food are described. The further development of perspectives and setting of new research directions were also presented.

Hyaluronic acid association with bacterial, fungal and viral infections: Can hyaluronic acid be used as an antimicrobial polymer for biomedical and pharmaceutical applications?

The relationships between hyaluronic acid (HA) and pathological microorganisms incite new understandings on microbial infection, tissue penetration, disease progression and lastly, potential treatments. These understandings are important for the advancement of next generation antimicrobial therapeutical strategies for the control of healthcare-associated infections. Herein, this review will focus on the interplay between HA, bacteria, fungi, and viruses. This review will also comprehensively detail and discuss the antimicrobial activity displayed by various HA molecular weights for a variety of biomedical and pharmaceutical applications, including microbiology, pharmaceutics, and tissue engineering.

Recent Advances in Copper and Copper-Derived Materials for Antimicrobial Resistance and Infection Control

Antibacterial properties of copper have been known for ages. With the rise of antimicrobial resistance (AMR), hospital-acquired infections, and the current SARS-CoV-2 pandemic, copper and copper-derived materials are being widely researched for healthcare ranging from therapeutics to advanced wound dressing to medical devices. We cover current research that highlights the potential uses of metallic and ionic copper, copper alloys, copper nanostructures, and copper composites as antibacterial, antifungal, and antiviral agents, including those against the SARS-CoV-2 virus. The applications of copper-enabled engineered materials in medical devices, wound dressings, personal protective equipment, and self-cleaning surfaces are discussed. We emphasize the potential of copper and copper-derived materials in combating AMR and efficiently reducing infections in clinical settings.

Chitosan/calcium nanoparticles as advanced antimicrobial coating for paper documents

Preservation of paper-based historical artifacts against deterioration due to the presence of bacteria and fungi colonies has been one of the major issues for the importance of protecting the cultural heritage of humankind. Advances in nanotechnology have enabled the implementation of nanomaterials for this purpose. In this work, calcium/chitosan nanoparticles (Ca/CS NPs) were prepared and well-characterized to investigate their potential as a novel approach for preserving paper-based documents. Following the fundamental characterizations, it was found that Ca/CS NPs are spherical nanoparticles with ~65 nm average size and homogenous dispersion (PdI: 0.2). Besides, minimum inhibition concentration results revealed that Ca/CS NPs show a superior antimicrobial effect against specific bacteria and fungi strains commonly found on paper documents compared to the effect of bare chitosan nanoparticles (CS NPs). After the deposition of Ca/CS NPs onto the paper the pH level was increased and stabilized, and only a limited amount of microbial colony formation was observed for up to 20 days. Moreover, molecular docking analysis provided a better insight into the antibacterial and antifungal activities of these nanoparticles. The antimicrobial activity of CS NPs and Ca/CS NPs was investigated through their interactions with E. coli DNA gyrase B and C. albicans dihydrofolate reductase. The binding modes and all possible interactions of active sites were confirmed by in silico molecular docking method. Collectively, our findings revealed that the formulated Ca/CS NPs are promising candidates for preserving paper documents.

Surface Functionalities of Polymers for Biomaterial Applications

Changes of a material biointerface allow for specialized cell signaling and diverse biological responses. Biomaterials incorporating immobilized bioactive ligands have been widely introduced and used for tissue engineering and regenerative medicine applications in order to develop biomaterials with improved functionality. Furthermore, a variety of physical and chemical techniques have been utilized to improve biomaterial functionality, particularly at the material interface. At the interface level, the interactions between materials and cells are described. The importance of surface features in cell function is then examined, with new strategies for surface modification being highlighted in detail.

Injectable hyaluronic acid hydrogel encapsulated with Si-based NiO nanoflower by visible light cross-linking: Its antibacterial applications

Bacterial infections have become a severe threat to human health and antibiotics have been developed to treat them. However, extensive use of antibiotics has led to multidrug-resistant bacteria and reduction of their therapeutic effects. An efficient solution may be localized application of antibiotics using a drug delivery system. For clinical application, they need to be biodegradable and should offer a prolonged antibacterial effect. In this study, a new injectable and visible-light-crosslinked hyaluronic acid (HA) hydrogel loaded with silicon (Si)-based nickel oxide (NiO) nanoflowers (Si@NiO) as an antibacterial scaffold was developed. Si@NiO nanoflowers were synthesized using chemical bath deposition before encapsulating them in the HA hydrogel under a mild visible-light-crosslinking conditions to generate a Si@NiO-hydrogel. Si@NiO synthesis was confirmed using scanning electron microscopy, transmission electron microscopy, and powder X-ray diffraction. As-prepared Si@NiO-hydrogel exhibited enhanced mechanical properties compared to a control bare hydrogel sample. Moreover, Si@NiO-hydrogel exhibits excellent antibacterial properties against three bacterial strains (P. aeruginosa, K. pneumoniae, and methicillin-resistant Staphylococcus aureus (>99.9% bactericidal rate)) and negligible cytotoxicity toward mouse embryonic fibroblasts. Therefore, Si@NiO-hydrogel has the potential for use in tissue engineering and biomedical applications owing to its injectability, visible-light crosslink ability, degradability, biosafety, and superior antibacterial property.