Immobilization of antibacterial chlorhexidine on stainless steel using crosslinking polydopamine film: Towards infection resistant medical devices

Co-immobilization of Ciprofloxacin and Chlorhexidine as a Broad-Spectrum Antimicrobial Dual-Drug Coating for Poly(vinyl chloride) (PVC)-Based Endotracheal Tubes

The endotracheal tube (ETT) affords support for intubated patients, but the increasing incidence of ventilator-associated pneumonia (VAP) is jeopardizing its application. ETT surfaces promote (poly)microbial colonization and biofilm formation, with a heavy burden for VAP. Devising safe, broad-spectrum antimicrobial materials to tackle the ETT bioburden is needful. Herein, we immobilized ciprofloxacin (CIP) and/or chlorhexidine (CHX), through polydopamine (pDA)-based functionalization, onto poly(vinyl chloride) (PVC) surfaces. These surfaces were characterized regarding physicochemical properties and challenged with single and polymicrobial cultures of VAP-relevant bacteria (Pseudomonas aeruginosa, Acinetobacter baumannii, Klebsiella pneumoniae, Staphylococcus aureus, Staphylococcus epidermidis) and fungi (Candida albicans). The coatings imparted PVC surfaces with a homogeneous morphology, varied wettability, and low roughness. The antimicrobial immobilization via pDA chemistry was still evidenced by infrared spectroscopy. Coated surfaces exhibited sustained CIP/CHX release, retaining prolonged (10 days) activity. CIP/CHX-coated surfaces evidencing no A549 lung cell toxicity displayed better antibiofilm outcomes than CIP or CHX coatings, preventing bacterial attachment by 4.1-7.2 Log10 CFU/mL and modestly distressingC. albicans. Their antibiofilm effectiveness was endured toward polymicrobial consortia, substantially inhibiting the adhesion of the bacterial populations (up to 8 Log10 CFU/mL) within the consortia in dual- and even inP. aeruginosa/S. aureus/C. albicans triple-species biofilms while affecting fungal adhesion by 2.7 Log10 CFU/mL (dual consortia) and 1 Log10 CFU/mL (triple consortia). The potential of the dual-drug coating strategy in preventing triple-species adhesion and impairing bacterial viability was still strengthened by live/dead microscopy. The pDA-assisted CIP/CHX co-immobilization holds a safe and robust broad-spectrum antimicrobial coating strategy for PVC-ETTs, with the promise laying in reducing VAP incidence.

Immobilization of blood coagulant factor VII on polycaprolactone membrane through polydopamine grafting

Postoperative bleeding following cardiac surgeries is still an issue that deranges the medical resources and cost. The oral and injection administrations of blood coagulation protein, Factor VII (FVII), is effective to stop the bleeding. However, its short half-life has limited the effectiveness of this treatment and frequent FVII intake may distress the patients. Instead, incorporating FVII into synthetic biodegradable polymers such as polycaprolactone (PCL) that is commonly used in drug delivery applications should provide a solution. Therefore, this study aimed to immobilize FVII on PCL membranes through a cross-linkage polydopamine (PDA) grafting as an intermediate layer. These membranes are intended to provide a solution for cardiac bleeding in coagulating blood and sealing the sutured region. The membranes were evaluated in terms of its physio-chemical properties, thermal behavior, FVII release profile and biocompatibility properties. The ATR-FTIR was used to analyze the chemical functionalities of the membranes. Further validation was done with XPS where the appearances of 0.45 ± 0.06% sulfur composition and C-S peak have confirmed the immobilization of FVII on the PCL membranes. The cross-linked FVIIs were viewed in spherical immobilization on the PCL membranes with a size range between 30 and 210 nm. The surface roughness and hydrophilicity of the membranes were enhanced with a slight shift of melting temperature. The PCL-PDA-FVII0.03 and PCL-PDA-FVII0.05 membranes, with wide area of FVII immobilization released approximately only 22% of FVII into the solution within 60 days period and, it is found that the PCL-PDA-FVIIx membranes projected the Higuchi release model with non-Fickian anomalous transport. While the cytotoxic and hemocompatibility analyses showed advance cell viability, identical coagulation time and low hemolysis ratio on the PCL-PDA-FVIIx membranes. The erythrocytes were viewed in polyhedrocyte coagulated structure under SEM visualization. These results validate the biocompatibility of the membranes and its ability to prolong blood coagulation, thus highlighting its potential application as cardiac bleeding sealant.

Collagen-PVA Films Plasticized with Choline Acetate Ionic Liquid for Sustained Drug Release: UV Shielding, Mechanical, Antioxidant, and Antibacterial Properties

Collagen and poly(vinyl alcohol) films as topical drug delivery systems were developed by plasticization with glycerol and different concentrations of choline acetate ([Cho]Ac) ionic liquid (IL). The results showed that [Cho]Ac improved the performance of the materials and can serve as an alternative to synthetic plasticizers such as glycerol. Ciprofloxacin (CIP) was used as a model drug to study its release behavior. Ready-to-use films were characterized for their optical opacity, solubility, swelling, mechanical properties, water contact angle, surface morphology, surface roughness, antioxidant, and antimicrobial activities. Moreover, X-ray diffraction and Fourier Transform Infrared (FTIR) studies were carried out for molecular characterization of the films. [Cho]Ac used as a plasticizing agent showed excellent antioxidant properties, mechanical strength, and UV shielding properties. Further, [Cho]Ac improves the roughness and decreases the solubility of films. The in vitro release behavior of CIP was investigated at physiological pH (7.4), and the results showed that CIP was released in a more controlled manner due to the incorporation of [Cho]Ac into the films' matrix, while the films constructed with glycerol exhibited burst release of CIP. Moreover, the films loaded with CIP showed excellent antibacterial activity against Gram-negative (Escherichia coli) as well as Gram-positive (Staphylococcus aureus) bacteria. This study provides insight into the use of choline-based ILs as plasticizing agents for the fabrication of protein-polymer composite films for wound dressing and many other applications.

Bifunctional conducting polymer matrices with antibacterial and neuroprotective effects

Current trends in the field of neural tissue engineering include the design of advanced biomaterials combining excellent electrochemical performance with versatile biological characteristics. The purpose of this work was to develop an antibacterial and neuroprotective coating based on a conducting polymer - poly(3,4-ethylenedioxypyrrole) (PEDOP), loaded with an antibiotic agent - tetracycline (Tc). Employing an electrochemical technique to immobilize Tc within a growing polymer matrix allowed to fabricate robust PEDOP/Tc coatings with a high charge storage capacity (63.65 ± 6.05 mC/cm2), drug release efficiency (629.4 µg/cm2 ± 62.7 µg/cm2), and low charge transfer resistance (2.4 ± 0.1 kΩ), able to deliver a stable electrical signal. PEDOP/Tc were found to exhibit strong antimicrobial effects against Gram-negative bacteria Escherichia coli, expressed through negligible adhesion, reduction in viability, and a characteristic elongation of bacterial cells. Cytocompatibility and neuroprotective effects were evaluated using a rat neuroblastoma B35 cell line, and were analyzed using MTT, cell cycle, and Annexin-V apoptosis assays. The presence of Tc was found to enhance neural cell viability and neurite outgrowth. The results confirmed that PEDOP/Tc can serve as an efficient neural electrode coating able to enhance charge transfer, as well as to exhibit bifunctional biological characteristics, different for eukaryotic and prokaryotic cells.

Past and Current Progress in the Development of Antiviral/Antimicrobial Polymer Coating towards COVID-19 Prevention: A Review

The astonishing outbreak of SARS-CoV-2 coronavirus, known as COVID-19, has attracted numerous research interests, particularly regarding fabricating antimicrobial surface coatings. This initiative is aimed at overcoming and minimizing viral and bacterial transmission to the human. When contaminated droplets from an infected individual land onto common surfaces, SARS-CoV-2 coronavirus is able to survive on various surfaces for up to 9 days. Thus, the possibility of virus transmission increases after touching or being in contact with contaminated surfaces. Herein, we aim to provide overviews of various types of antiviral and antimicrobial coating agents, such as antimicrobial polymer-based coating, metal-based coating, functional nanomaterial, and nanocomposite-based coating. The action mode for each type of antimicrobial agent against pathogens is elaborated. In addition, surface properties of the designed antiviral and antimicrobial polymer coating with their influencing factors are discussed in this review. This paper also exhibits several techniques on surface modification to improve surface properties. Various developed research on the development of antiviral/antimicrobial polymer coating to curb the COVID-19 pandemic are also presented in this review.

Bacterial disinfection and cell assessment post ultraviolet-C LED exposure for wound treatment

Ultraviolet-C sourced LED (UVC-LED) has been widely used for disinfection purposes due to its germicidal spectrum. In this study, the efficiencies of UVC-LED for Pseudomonas aeruginosa (P. aeruginosa) and Staphylococcus aureus (S. aureus) disinfections were investigated at three exposure distances (1, 1.5, and 2 cm) and two exposure times (30 and 60 s). The respective bacterial inhibition zones were measured, followed by a morphological analysis under SEM. The viabilities of human skin fibroblast cells were further evaluated under the treatment of UVC-LED with the adoption of aforesaid exposure parameters. The inhibition zones were increased with the increment of exposure distances and times. The highest records of 5.40 ± 0.10 cm P. aeruginosa inhibition and 5.43 ± 0.11 cm S. aureus inhibition were observed at the UVC-LED distance of 2 cm and 60-s exposure. Bacterial physical damage with debris formation and reduction in size were visualized following the UVC-LED exposures. The cell viability percentages were in a range of 75.20-99.00% and 82-100.00% for the 30- and 60-s exposures, respectively. Thus, UVC-LED with 275-nm wavelength is capable in providing bacterial disinfection while maintaining accountable cell viability which is suitable to be adopted in wound treatment. Bacterial disinfection and human skin fibroblast cell assessment using UVC-LED.

Bioinspired and eco-friendly high efficacy cinnamaldehyde antibacterial surfaces

Antimicrobial essential oils are incorporated into mussel-inspired and natural plant polyphenol coatings as part of a single-step fabrication process. Polydopamine-cinnamaldehyde, polyethyleneimine-cinnamaldehyde, and tannic acid-cinnamaldehyde coatings exhibit strong antibacterial activities against both Gram-negative Escherichia coli and Gram-positive Staphylococcus aureus (with the polydopamine- and tannic acid-based systems displaying log₁₀ Reduction = 8). Cinnamaldehyde impregnation into porous non-woven polypropylene cloth, polytetrafluoroethylene membrane, and knitted cotton cloth also gives rise to high levels of antibacterial activity (log₁₀ Reduction = 8). No loss in antibacterial efficacy is observed for non-woven polypropylene cloth impregnated with cinnamaldehyde over 17 recycle tests.

Electrically-responsive antimicrobial coatings based on a tetracycline-loaded poly(3,4-ethylenedioxythiophene) matrix

The growth of bacteria and the formation of complex bacterial structures on biomedical devices is a major challenge in modern medicine. The aim of this study was to develop a biocompatible, conducting and antibacterial polymer coating applicable in biomedical engineering. Since conjugated polymers have recently aroused strong interest as controlled delivery systems for biologically active compounds, we decided to employ a poly(3,4-ethylenedioxythiophene) (PEDOT) matrix to immobilize a powerful, first-line antibiotic: tetracycline (Tc). Drug immobilization was carried out simultaneously with the electrochemical polymerization process, allowing to obtain a polymer coating with good electrochemical behaviour (charge storage capacity of 19.15 ± 6.09 mC/cm²) and high drug loading capacity (194.7 ± 56.2 μg/cm²). Biological activity of PEDOT/Tc matrix was compared with PEDOT matrix and a bare Pt surface against a model Gram-negative bacteria strain of Escherichia coli with the use of LIVE/DEAD assay and SEM microscopy. Finally, PEDOT/Tc was shown to serve as a robust electroactive coating exhibiting antibacterial activity.

Tailoring the immobilization and release of chlorhexidine using dopamine chemistry to fight infections associated to orthopedic devices

A crucial factor in the pathogenesis of orthopedics associated infections is that bacteria do not only colonize the implant surface but also the surrounding tissues. This study aimed to engineer an antimicrobial release coating for stainless steel (SS) surfaces, to impart them with the ability to prevent Staphylococci colonization. Chlorhexidine (CHX) was immobilized using two polydopamine (pDA)-based approaches: a one-pot synthesis, where CHX is dissolved together with dopamine before its polymerization; and a two-step methodology, comprising the deposition of a pDA layer to which CHX is immobilized. To modulate CHX release, an additional layer of pDA was also added for both strategies. Immobilization of CHX using a one-step approach yielded surfaces with a more homogenous coating and less roughness than the other strategies. The amount of released CHX was lower for the one-step approach, as opposed to the two-step approach yielding the higher release, which could be decreased by applying an outward layer of pDA. Both one and two-step approaches provided the surfaces with the ability to prevent bacterial colonization of the surface itself and kill most of bacteria in the bulk phase up to 10 days. This long-term antimicrobial performance alluded a stable and enduring immobilization of CHX. In terms of biocompatibility, the amount of CHX released from the one-step approach did not compromise the growth of mammalian cells, contrary to the two-step strategy. Additionally, the few bacteria that managed to adhere to surfaces modified with one-step approach did not show evidence of resistance towards CHX. Overall data underline that one-step immobilization of CHX holds great potential to be further applied in the fight against orthopedic devices associated infections.

Synthesis of multifunctional chlorhexidine-doped thin films for titanium-based implant materials

Our goal was to create bio-functional chlorhexidine (CHX)-doped thin films on commercially pure titanium (cpTi) discs using the glow discharge plasma approach. Different plasma deposition times (50, 35 and 20 min) were used to create bio-functional surfaces based on silicon films with CHX that were compared to the control groups [no CHX and bulk cpTi surface (machined)]. Physico-chemical and biological characterizations included: 1. Morphology, roughness, elemental chemical composition, film thickness, contact angle and surface free energy; 2. CHX-release rate; 3. Antibacterial effect on Streptococcus sanguinis biofilms at 24, 48 and 72 h; 4. Cytotoxicity and metabolic activity using fibroblasts cell culture (NIH-F3T3 cells) at 1, 2, 3 and 4 days; 5. Protein expression by NIH-F3T3 cells at 1, 2, 3 and 4 days; and 6. Co-culture assay of fibroblasts cells and S. sanguinis to assess live and dead cells on the confocal laser scanning microscopy, mitochondrial activity (XTT), membrane leakage (LDH release), and metabolic activity (WST-1 assay) at 1, 2 and 3 days of co-incubation. Data analysis showed that silicon films, with or without CHX coated cpTi discs, increased surface wettability and free energy (p < 0.05) without affecting surface roughness. CHX release was maintained over a 22-day period and resulted in a significant inhibition of biofilm growth (p < 0.05) at 48 and 72 h of biofilm formation for 50 min and 20 min of plasma deposition time groups, respectively. In general, CHX treatment did not significantly affect NIH-F3T3 cell viability (p > 0.05), whereas cell metabolism (MTT assay) was affected by CHX, with the 35 min of plasma deposition time group displaying the lowest values as compared to bulk cpTi (p < 0.05). Moreover, data analysis showed that films, with or without CHX, significantly affected the expression profile of inflammatory cytokines, including IL-4, IL-6, IL-17, IFN-y and TNF-α by NIH-F3T3 cells (p < 0.05). Co-culture demonstrated that CHX-doped film did not affect the metabolic activity, cytotoxicity and viability of fibroblasts cells (p > 0.05). Altogether, the findings of the current study support the conclusion that silicon films added with CHX can be successfully created on titanium discs and have the potential to affect bacterial growth and inflammatory markers without affecting cell viability/proliferation rates.

Recent Advances in Surface Nanoengineering for Biofilm Prevention and Control. Part II: Active, Combined Active and Passive, and Smart Bacteria-Responsive Antibiofilm Nanocoatings

The second part of our review describing new achievements in the field of biofilm prevention and control, begins with a discussion of the active antibiofilm nanocoatings. We present the antibiofilm strategies based on antimicrobial agents that kill pathogens, inhibit their growth, or disrupt the molecular mechanisms of biofilm-associated increase in resistance and tolerance. These agents of various chemical structures act through a plethora of mechanisms targeting vital bacterial metabolic pathways or cellular structures like cell walls and cell membranes or interfering with the processes that underlie different stages of the biofilm life cycle. We illustrate the latter action mechanisms through inhibitors of the quorum sensing signaling pathway, inhibitors of cyclic-di-GMP signaling system, inhibitors of (p)ppGpp regulated stringent response, and disruptors of the biofilm extracellular polymeric substances matrix (EPS). Both main types of active antibiofilm surfaces, namely non-leaching or contact killing systems, which rely on the covalent immobilization of the antimicrobial agent on the surface of the coatings and drug-releasing systems in which the antimicrobial agent is physically entrapped in the bulk of the coatings, are presented, highlighting the advantages of each coating type in terms of antibacterial efficacy, biocompatibility, selective toxicity, as well as drawbacks and limitations. Developments regarding combined strategies that join in a unique platform, both passive and active elements are not omitted. In such platforms with dual functionality, passive and active strategies can be applied either simultaneously or sequentially. We especially emphasize those systems that can be reversely and repeatedly switched between the non-fouling status and the bacterial killing status, thereby allowing several bacteria-killing/surface regeneration cycles to be performed without significant loss of the initial bactericidal activity. Eventually, smart antibiofilm coatings that release their antimicrobial payload on demand, being activated by various triggers such as changes in local pH, temperature, or enzymatic triggers, are presented. Special emphasis is given to the most recent trend in the field of anti-infective surfaces, specifically smart self-defensive surfaces for which activation and switch to the bactericidal status are triggered by the pathogens themselves.

Poly-l-lysine/Sodium Alginate Coating Loading Nanosilver for Improving the Antibacterial Effect and Inducing Mineralization of Dental Implants

In recent years, antibacterial surface modification of titanium (Ti) implants has been widely studied in preventing implant-associated infection for dental and orthopedic applications. The purpose of this study was to prepare a composite coating on a porous titanium surface for infection prevention and inducing mineralization, which was initialized by deposition of a poly-l-lysine (PLL)/sodium alginate(SA)/PLL self-assembled coating, followed by dopamine deposition, and finally in situ reduction of silver nanoparticles (AgNPs) by dopamine. The surface zeta potential, SEM, XPS, UV-vis, and water contact angle analyses demonstrate that each coating was successfully prepared after the respective steps and that the average sizes of AgNPs were 20-30 nm. The composite coating maintained Ag⁺ release for more than 27 days in PBS and induced mineralization when incubated in SBF. The antibacterial results showed that the composite coating inhibited/killed bacteria on the material surface and killed bacteria around them. In addition, although this coating inhibited the initial adhesion of osteoblasts, the mineralized surface greatly enhanced the cytocompatibility. Thus, we concluded that the composite coating could prevent bacterial infections and facilitate mineralization in vivo in the early postoperative period, and then, the mineralized surface could enhance the cytocompatibility.

Study of the Relationship Between Chlorhexidine-Grafted Amount and Biological Performances of Micro/Nanoporous Titanium Surfaces

Biomaterial-associated infection and lack of sufficient osseointegration contribute to a large proportion of implant failures. Therefore, antibacterial and osseointegration-accelerating properties are important in implant surface design. In this study, a micro/nanoporous titanium surface was prepared through alkaline and heat treatments, covalently conjugated with aminosilane. Then, varying amounts of chlorhexidine (CHX) were covalently grafted onto the aminosilane-modified surface via glutaraldehyde to obtain different CHX-grafted surfaces. These as-prepared surfaces were evaluated in terms of their surface chemical composition, surface topography, CHX grafting amount, antibacterial activity, and osteoblast compatibility. The results showed that the CHX grafting amount increased with increasing CHX concentrations, leading to better antibacterial activity. CHX (1 mg/mL) resulted in the best antibacterial surface, which still retained good osteoblast compatibility. Meanwhile, competitive bacterial-cell adhesion analysis demonstrated that this surface has great value for osteoblast adhesion at the implant-bone interface even in the presence of bacteria. This effortless, easily performed, and eco-friendly technique holds huge promise for clinical applications.

Study of the Structure and Antimicrobial Activity of Ca-Deficient Ceramics on Chlorhexidine Nanoclay Substrate

Novel biomedical composites, based on organically modified vermiculite and montmorillonite with deposited Ca-deficient hydroxyapatite (CDH), were prepared. The monoionic sodium forms of vermiculite and montmorillonite were intercalated with chlorhexidine diacetate (CA). The surfaces of organoclays were used for the precipitation of Ca-deficient hydroxyapatite. The composites with Ca-deficient hydroxyapatite showed very good antibacterial effects, similar to the antimicrobial activity of pure organoclay samples. Better antibacterial activity was shown in the organically modified montmorillonite sample with Ca-deficient hydroxyapatite compared with the vermiculite composite, but, in the case of Staphylococcus aureus, both composites showed the same minimum inhibitory concentration (MIC) value. The antimicrobial effect of composites against bacteria and fungi increased with the time of exposure. The structural characterization of all the prepared materials, performed using X-ray diffraction and FT infrared spectroscopy analysis, detected no changes in the original clay or CDH during the intercalation or precipitation process, therefore we expect the strength of the compounds to be in the original power.

Polydopamine-assisted chlorhexidine immobilization on medical grade stainless steel 316L: Apatite formation and in vitro osteoblastic evaluation

Immobilization of chlorhexidine (CHX) on stainless steel 316L (SS316L), assisted by a polydopamine film as an intermediate layer is projected as an approach in combating infection while aiding bone regeneration for coating development on orthopedic and dental implants. This study aimed to investigate the ability of CHX coating to promote apatite layer, osteoblast cells viability, adhesion, osteogenic differentiation and mineralization. Stainless steel 316L disks were pre-treated, grafted with a polydopamine film and immobilized with different concentrations of CHX (10-30mM). The apatite layer formation was determined through an in vitro simulated body fluid (SBF) test by ATR-FTIR and SEM-EDX analyses. The osteoblastic evaluations including cells viability, cells adhesion, osteogenic differentiation and mineralization were assessed with human fetal osteoblast cells through MTT assay, morphology evaluation under FESEM, ALP enzyme activity and Alizarin Red S assay. The apatite layer was successfully formed on the CHX coated disks, demonstrating potential excellent bioactivity property. The CHX coatings were biocompatible with the osteoblast cells at low CHX concentration (<20mM) with good adhesion on the metal surfaces. The increment of ALP activity and calcium deposition testified that the CHX coated disks able to support osteoblastic maturation and mineralization. These capabilities give a promising value to the CHX coating to be implied in bone regeneration area.

Polydopamine films change their physicochemical and antimicrobial properties with a change in reaction conditions

The present finding provides insight into the different chemistry, morphologies and properties of the designed polydopamine films with controlled antibacterial/antifouling properties.