Thermosensitive hybrid hydrogels for the controlled release of bioactive vancomycin in the treatment of orthopaedic implant infections

Unlocking the Potential of Hybrid Nanocomposite Hydrogels: Design, Mechanical Properties and Biomedical Performances

Hybrid nanocomposite hydrogels consist of the homogeneous incorporation of nano‐objects in a hydrogel matrix. The latter, whether made of natural or synthetic materials, possesses a microporous, soft structure that makes it an ideal host for a variety of polymer and lipid‐based nano‐objects as well as metal‐ and silica‐based ones. By carefully choosing the composition and the proportions of the different constituents, hybrid hydrogels can display a wide array of properties, from simple enhancement of mechanical characteristics to specific bioactivity. This review aims to provide an overview of the state of the art in hybrid hydrogels highlighting key aspects that make them a promising choice for a variety of biomedical applications. Strategies for the preparation of hybrid hydrogels are discussed by covering the selection of individual components. The review will also explore the physico‐chemical and rheological characterization of these materials, which is essential for understanding their structure and function, ultimately satisfying specifications for the intended use. Successful examples of biomedical applications will also be presented, and the main challenges to be met will be discussed, with the aim of stimulating the research community to exploit the full potential of these materials.

In-situ synthesis and evaluation of anti-bacterial efficacy and angiogenesis of curcumin encapsulated lipogel dermal patch for wound healing applications

The development of synthetic hydrogels as a dermal patch offers unique advantage of providing moist environment around the wound site. The incorporation of curcumin in hydrogel plays a significant role in the healing process of chronic wounds. The present investigation aims to develop nano-formulated curcumin-fused lipogel to impart the dual advantages of sustained drug release and enhanced wound healing ability. The wound healing behaviour of the prepared lipogel has been assessed through series of techniques namely DPPH assay and bacterial inhibitory efficacy through the Kirby Bauer assay against E. coli and S. aureus. Further, the promotion of angiogenesis has been determined through an in-ovo CAM assay. The results obtained from the investigation revealed the enhanced solubility of curcumin in liposome formulation. Moreover, the encapsulation of curcumin in liposomes facilitated prolonged drug release and better antibacterial efficacy against the tested bacterial stains. The developed hydrogel also displayed good adhesion and water retention ability, which is an important prerequisite for better wound healing ability.

Vancomycin-Loaded in situ Gelled Hydrogel as an Antibacterial System for Enhancing Repair of Infected Bone Defects

Purpose

During treatment of infected bone defects, control of infection is necessary for effective bone repair, and hence controlled topical application of antibiotics is required in clinical practice. In this study, a biodegradable drug delivery system with in situ gelation at the site of infection was prepared by integrating vancomycin into a polyethylene glycol/oxidized dextran (PEG/ODEX) hydrogel matrix.

Methods

In this work, PEG/ODEX hydrogels were prepared by Schiff base reaction, and vancomycin was loaded into them to construct a drug delivery system with controllable release and degradability. We first examined the microstructure, degradation time and drug release of the hydrogels. Then we verified the biocompatibility and in vitro ability of the release system. Finally, we used a rat infected bone defect model for further experiments.

Results

The results showed that this antibacterial system could be completely biodegradable in vivo for 56 days, and its degradation products did not cause specific inflammatory response. The cumulative release of vancomycin from the antibacterial system was 58.3% ± 3.8% at 14 days and 78.4% ± 3.2% at 35 days. The concentration of vancomycin in the surrounding environment was about 1.2 mg/mL, which can effectively remove bacteria. Further studies in vivo showed that the antibacterial system cleared the infection and accelerated repair of infected bone defects in the femur of rats. There was no infection in rats after 8 weeks of treatment. The 3D image analysis of the experimental group showed that the bone volume fraction (BV/TV) was 1.39-fold higher (p < 0.001), the trabecular number (Tb.N) was 1.31-fold higher (p < 0.05), and the trabecular separation (Tb.Sp) was 0.58-fold higher than those of the control group (p < 0.01).

Conclusion

In summary, this study clearly demonstrates that a clinical strategy based on biological materials can provide an innovative and effective approach to treatment of infected bone defects.

A quality by design approach to optimise disulfide-linked hyaluronic acid hydrogels

In this study, the disulfide-linked hyaluronic acid (HA) hydrogels were optimised for potential application as a scaffold in tissue engineering through the Quality by Design (QbD) approach. For this purpose, HA was first modified by incorporating the cysteine moiety into the HA backbone, which promoted the formation of disulfide cross-linked HA hydrogel at physiological pH. Utilising a Design of Experiments (DoE) methodology, the critical factors to achieve stable biomaterials, i.e. the degree of HA substitution, HA molecular weight, and coupling agent ratio, were explored. To establish a design space, the DoE was performed with 65 kDa, 138 kDa and 200 kDa HA and variable concentrations of coupling agent to optimise conditions to obtain HA hydrogel with improved rheological properties. Thus, HA hydrogel with a 12 % degree of modification, storage modulus of ≈2321 Pa and loss modulus of ≈15 Pa, was achieved with the optimum ratio of coupling agent. Furthermore, biocompatibility assessments in C28/I2 chondrocyte cells demonstrated the non-toxic nature of the hydrogel, underscoring its potential for tissue regeneration. Our findings highlight the efficacy of the QbD approach in designing HA hydrogels with tailored properties for biomedical applications.

An injectable magnesium-coordinated phosphate chitosan-based hydrogel loaded with vancomycin for antibacterial and osteogenesis in the treatment of osteomyelitis

Microbial infections of bones, particularly after joint replacement surgery, are a common occurrence in clinical settings and often lead to osteomyelitis (OM). Unfortunately, current treatment approaches for OM are not satisfactory. To address this issue, this study focuses on the development and evaluation of an injectable magnesium oxide (MgO) nanoparticle (NP)-coordinated phosphocreatine-grafted chitosan hydrogel (CMPMg-VCM) loaded with varying amounts of vancomycin (VCM) for the treatment of OM. The results demonstrate that the loading of VCM does not affect the formation of the injectable hydrogel, and the MgO-incorporated hydrogel exhibits anti-swelling properties. The release of VCM from the hydrogel effectively kills S.aureus bacteria, with CMPMg-VCM (50) showing the highest antibacterial activity even after prolonged immersion in PBS solution for 12 days. Importantly, all the hydrogels are non-toxic to MC3T3-E1 cells and promote osteogenic differentiation through the early secretion of alkaline phosphatase and calcium nodule formation. Furthermore, in vivo experiments using a rat OM model reveal that the CMPMg-VCM hydrogel effectively kills and inhibits bacterial growth, while also protecting the infected bone from osteolysis. These beneficial properties are attributed to the burst release of VCM, which disrupts bacterial biofilm, as well as the release of Mg ions and hydroxyl by the degradation of MgO NPs, which inhibits bacterial growth and prevents osteolysis. Overall, the CMPMg-VCM hydrogel exhibits promising potential for the treatment of microbial bone infections.

3D printed scaffolds based on hyaluronic acid bioinks for tissue engineering: a review

Hyaluronic acid (HA) is widely distributed in human connective tissue, and its unique biological and physicochemical properties and ability to facilitate biological structure repair make it a promising candidate for three-dimensional (3D) bioprinting in the field of tissue regeneration and biomedical engineering. Moreover, HA is an ideal raw material for bioinks in tissue engineering because of its histocompatibility, non-immunogenicity, biodegradability, anti-inflammatory properties, anti-angiogenic properties, and modifiability. Tissue engineering is a multidisciplinary field focusing on in vitro reconstructions of mammalian tissues, such as cartilage tissue engineering, neural tissue engineering, skin tissue engineering, and other areas that require further clinical applications. In this review, we first describe the modification methods, cross-linking methods, and bioprinting strategies for HA and its derivatives as bioinks and then critically discuss the strengths, shortcomings, and feasibility of each method. Subsequently, we reviewed the practical clinical applications and outcomes of HA bioink in 3D bioprinting. Finally, we describe the challenges and opportunities in the development of HA bioink to provide further research references and insights.

Thermosensitive injectable dual drug-loaded chitosan-based hybrid hydrogel for treatment of orthopedic implant infections

A myriad of therapeutic agents and drug delivery systems are available to the surgeons for treating orthopedic implant-associated infections (OIAI), but only very few have demonstrated their effectiveness in preventing bacteria colonization and biofilm formation due to challenges in the local and sustainable therapeutic release. To address this issue, in this work, a thermosensitive injectable hydrogel based on chitosan (CH)-integrated hydroxyapatite nanoparticles (HAP NPs) containing vancomycin (Van) and quercetin (QC)-loaded in F127 micelles (CH-HAP-FQ-Van hydrogel) was fabricated with potential application in the treatment of OIAI. This dual drug delivery system demonstrated a pH-sensitive drug release pattern. In addition, 100 % growth inhibition of Staphylococcus aureus for a duration of 14 days was observed. Apart from the strong antioxidant activities owing to the co-administration of QC even after 432 h, this composite hydrogel revealed 95.88 ± 2.8 % S. aureus biofilm eradication. By consideration of degradation stability (53.52 ± 4.24 %) during 60 days along with smart gelation within 10 min at 37 °C and easy injectability, CH-HAP-FQ-Van hydrogel could be used as a promising ideal local drug delivery system for implant-related infections.

Hyaluronic Acid as Bioink and Hydrogel Scaffolds for Tissue Engineering Applications

Bioprinting is an additive manufacturing technique that focuses on developing living tissue constructs using bioinks. Bioink is crucial in determining the stability of printed patterns, which remains a major challenge in bioprinting. Thus, the choices of bioink composition, modifications, and cross-linking methods are being continuously researched to augment the clinical translation of bioprinted constructs. Hyaluronic acid (HA) is a naturally occurring polysaccharide with the repeating unit of N-acetyl-glucosamine and d-glucuronic acid disaccharides. It is present in the extracellular matrix (ECM) of tissues (skin, cartilage, nerve, muscle, etc.) with a wide range of molecular weights. Due to the nature of its chemical structure, HA could be easily subjected to chemical modifications and cross-linking that would enable better printability and stability. These interesting properties have made HA an ideal choice of bioinks for developing tissue constructs for regenerative medicine applications. In this Review, the physicochemical properties, reaction chemistry involved in various cross-linking strategies, and biomedical applications of HA have been elaborately discussed. Further, the features of HA bioinks, emerging strategies in HA bioink preparations, and their applications in 3D bioprinting have been highlighted. Finally, the current challenges and future perspectives in the clinical translation of HA-based bioinks are outlined.

Local Antibiotic Delivery Options in Prosthetic Joint Infection

Prosthetic Joint Infection (PJI) causes significant morbidity and mortality for patients globally. Delivery of antibiotics to the site of infection has potential to improve the treatment outcomes and enhance biofilm eradication. These antibiotics can be delivered using an intra-articular catheter or combined with a carrier substance to enhance pharmacokinetic properties. Carrier options include non-resorbable polymethylmethacrylate (PMMA) bone cement and resorbable calcium sulphate, hydroxyapatite, bioactive glass, and hydrogels. PMMA allows for creation of structural spacers used in multi-stage revision procedures, however it requires subsequent removal and antibiotic compatibility and the levels delivered are variable. Calcium sulphate is the most researched resorbable carrier in PJI, but is associated with wound leakage and hypercalcaemia, and clinical evidence for its effectiveness remains at the early stage. Hydrogels provide a versatile combability with antibiotics and adjustable elution profiles, but clinical usage is currently limited. Novel anti-biofilm therapies include bacteriophages which have been used successfully in small case series.

Anionic polysaccharides for stabilization and sustained release of antimicrobial peptides

Chemical and enzymatic in vivo degradation of antimicrobial peptides represents a major challenge for their therapeutic use to treat bacterial infections. In this work, anionic polysaccharides were investigated for their ability to increase the chemical stability and achieve sustained release of such peptides. The investigated formulations comprised a combination of antimicrobial peptides (vancomycin (VAN) and daptomycin (DAP)) and anionic polysaccharides (xanthan gum (XA), hyaluronic acid (HA), propylene glycol alginate (PGA) and alginic acid (ALG)). VAN dissolved in buffer of pH 7.4 and incubated at 37 °C showed first order degradation kinetics with a reaction rate constant k_obs of 5.5 × 10^-2 day^-1 corresponding with a half-life of 13.9 days. However, once VAN was present in a XA, HA or PGA-based hydrogel, k_obs decreased to (2.1-2.3) × 10^-2 day^-1 while k_obs was not affected in an alginate hydrogel and a dextran solution (5.4 × 10^-2 and 4.4 × 10^-2 day^-1). Under the same conditions, XA and PGA also effectively decreased k_obs for DAP (5.6 × 10^-2 day^-1), whereas ALG had no effect and HA even increased the degradation rate. These results demonstrate that the investigated polysaccharides (except ALG for both peptides and HA for DAP) slowed down the degradation of VAN and DAP. DSC analysis was used to investigate on polysaccharide ability to bind water molecules. Rheological analysis highlighted that the polysaccharides containing VAN displayed an increase in G' of their formulations, pointing that the peptides interaction act as crosslinker of the polymer chains. The obtained results suggest that the mechanism of stabilization of VAN and DAP against hydrolytic degradation is conferred by electrostatic interactions between the ionizable amine groups of the drugs and the anionic carboxylate groups of the polysaccharides. This, in turn, results in a close proximity of the drugs to the polysaccharide chain, where the water molecules have a lower mobility and, therefore, a lower thermodynamic activity.

Development of responsive chitosan-based hydrogels for the treatment of pathogen-induced skin infections

Vancomycin (Van) remains one of the first-line drugs for the treatment of wound infections caused by methicillin-resistant Staphylococcus aureus (MRSA). However, the unsatisfactory bioavailability of vancomycin alone has greatly limited its potential health benefits. Here a responsive chitosan-based hydrogel was developed as the delivery system which not only would reduce this side effect but also increase efficacy of vancomycin. The hydrogel was prepared by grafting chitosan and cinnamaldehyde-based thioacetal (CTA) together with ginipin (G) as the crosslinker. Upon exposure to reactive oxygen species which were enriched in the bacterial wound, the hydrogel can locally degrade and sustainably release the loaded vancomycin near the lesion to compete with the troubling MRSA. Compared with vancomycin alone, the chitosan-based hydrogel loaded with vancomycin demonstrated accelerated acute wound healing. This achievement reveals that this multi-functional hydrogel may be a promising drug-delivery device for improving the efficacy of local antibiotic therapy.

Application of Porous Polyetheretherketone Scaffold/ Vancomycin-Loaded Thermosensitive Hydrogel Composites for Antibacterial Therapy in Bone Repair

Polyetheretherketone (PEEK) has been widely used in bone repair, but it often fails due to bacterial infection. Herein, a high-strength porous polyetheretherketone scaffold (ps-PK) loaded with antibacterial drug-loaded hydrogel strategy is proposed. The prepared ps-PK possesses high porosity (30.8%-64.7%) and the compression modulus is between 0.4-0.98 GPa. The interconnected pore-type structure endows it with a drug loading capacity. Poly(_D,L -lactic acid-co-glycolic acid)-b-Poly(ethylene glycol)-b-Poly(_D,L -lactic acid-co-glycolic acid) (PLGA-PEG-PLGA) thermoresponsive hydrogels loaded with vancomycin are used as the drug sustained-release system. The vancomycin-loaded hydrogels in the solution state at a low temperature were filled into a porous polyetheretherketone scaffold (ps-PK-VGel) and formed a gel state after implantation in vivo. The antibacterial rate of ps-PK-VGel against methicillin-resistant staphylococcus aureus (MRSA) in vitro was 99.7% and histological observation in vivo demonstrates that the ps-PK-VGel shows obvious antibacterial activity. Given its excellent antibacterial ability and mechanical properties, the porous PEEK scaffold composite drug-loaded thermosensitive hydrogel has great potential in bone repair surgery applications. This article is protected by copyright. All rights reserved.

Toward Designing of Anti-infective Hydrogels for Orthopedic Implants: From Lab to Clinic

An alarming increase in implant failure incidence due to microbial colonization on the administered orthopedic implants has become a horrifying threat to replacement surgeries and related health concerns. In essence, microbial adhesion and its subsequent biofilm formation, antibiotic resistance, and the host immune system's deficiency are the main culprits. An advanced class of biomaterials termed anti-infective hydrogel implant coatings are evolving to subdue these complications. On this account, this review provides an insight into the significance of anti-infective hydrogels for preventing orthopedic implant associated infections to improve the bone healing process. We briefly discuss the clinical course of implant failure, with a prime focus on orthopedic implants. We identify the different anti-infective coating strategies and hence several anti-infective agents which could be incorporated in the hydrogel matrix. The fundamental design criteria to be considered while fabricating anti-infective hydrogels for orthopedic implants will be discussed. We highlight the different hydrogel coatings based on the origin of the polymers involved in light of their antimicrobial efficacy. We summarize the relevant patents reported in the prevention of implant infections, including orthopedics. Finally, the challenges concerning the clinical translation of the aforesaid hydrogels are described, and considerable solutions for improved clinical practice and better future prospects are proposed.

Antibacterial biomaterials in bone tissue engineering

Bone infection is a devastating disease characterized by recurrence, drug-resistance, and high morbidity, that has prompted clinicians and scientists to develop novel approaches to combat it. Currently, although numerous biomaterials that possess excellent biocompatibility, biodegradability, porosity, and mechanical strength have been developed, their lack of effective antibacterial ability substantially limits bone-defect treatment efficacy. There is, accordingly, a pressing need to design antibacterial biomaterials for effective bone-infection prevention and treatment. This review focuses on antibacterial biomaterials and strategies; it presents recently reported biomaterials, including antibacterial implants, antibacterial scaffolds, antibacterial hydrogels, and antibacterial bone cement types, and aims to provide an overview of these antibacterial materials for application in biomedicine. The antibacterial mechanisms of these materials are discussed as well.

Antimicrobial and degradable triazolinedione (TAD) crosslinked polypeptide hydrogels

Hydrogels are perfectly suited to support cell and tissue growth in advanced tissue engineering applications as well as classical wound treatment scenarios. Ideal hydrogel materials for these applications should be easy to produce, biocompatible, resorbable and antimicrobial. Here we report the fabrication of degradable covalent antimicrobial lysine and tryptophan containing copolypeptide hydrogels, whereby the hydrogel properties can be independently modulated by the copolypeptide monomer ratio and chiral composition. Well-defined statistical copolypeptides comprising different overall molecular weights as well as ratios of l- and d-lysine and tryptophan at ratios of 35 : 15, 70 : 30 and 80 : 20 were obtained by N-carboxyanhydride (NCA) polymerisation and subsequently crosslinked by the selective reaction of bifunctional triazolinedione (TAD) with tryptophan. Real-time rheology was used to monitor the crosslinking reaction recording the fastest increase and overall modulus for copolypeptides with the higher tryptophan ratio. Water uptake of cylindrical hydrogel samples was dependent on crosslinking ratio but found independent of chiral composition, while enzymatic degradation proceeded significantly faster for samples containing more l-amino acids. Antimicrobial activity on a range of hydrogels containing different polypeptide chain lengths, lysine/tryptophan composition and l/d enantiomers was tested against reference laboratory strains of Gram-negative Escherichia coli (E. coli; ATCC25922) and Gram-positive, Staphylococcus aureus (S. aureus; ATCC25923). log reductions of 2.8-3.4 were recorded for the most potent hydrogels. In vitro leachable cytotoxicity tests confirmed non-cytotoxicity as per ISO guidelines.

Control of Vancomycin Activity through the Encapsulation and Controlled Release from a Propargyl Acrylate-Poloxamer Nanocomposite System

Vancomycin is a potent antibacterial drug that suffers from poor bioavailability due to its poor water solubility and relatively high molecular weight. Consequently, the application of vancomycin to treat bacteria-induced disease is limited. In this study, the ability of a temperature-stimulated propargyl acrylate-poloxamer nanocomposite (PAPN) system to encapsulate and release vancomycin is investigated. A controllable encapsulation and release system can be used to not only increase and prolong the bioavailability of vancomycin but also activate vancomycin with a temperature change. The PAPN system was prepared using an emulsion polymerization of propargyl acrylate followed by a surface decoration with a poloxamer at a precisely controlled grafting density. The activity of the PAPN system loaded with vancomycin is compared to that of the free drug and unmodified propargyl acrylate nanoparticles. It is shown that the activity of the PAPN system loaded with vancomycin is comparable to that of a freshly prepared, free-floating vancomycin solution. Upon storage, the activity of the free vancomycin in solution decreases, while the PAPN system loaded with vancomycin retains its high activity. Additionally, the PAPN system is able to effectively encapsulate and deactivate vancomycin until heated above a lower critical solution temperature (LCST). At temperatures above the LCST, the PAPN system releases vancomycin restoring the activity of the drug.

Design of Bio-Conjugated Hydrogels for Regenerative Medicine Applications: From Polymer Scaffold to Biomolecule Choice

Bio-conjugated hydrogels merge the functionality of a synthetic network with the activity of a biomolecule, becoming thus an interesting class of materials for a variety of biomedical applications. This combination allows the fine tuning of their functionality and activity, whilst retaining biocompatibility, responsivity and displaying tunable chemical and mechanical properties. A complex scenario of molecular factors and conditions have to be taken into account to ensure the correct functionality of the bio-hydrogel as a scaffold or a delivery system, including the polymer backbone and biomolecule choice, polymerization conditions, architecture and biocompatibility. In this review, we present these key factors and conditions that have to match together to ensure the correct functionality of the bio-conjugated hydrogel. We then present recent examples of bio-conjugated hydrogel systems paving the way for regenerative medicine applications.

Preparation and characterization of vancomycin-loaded chitosan/PVA/PEG hydrogels for wound dressing

This study describes a drug-loaded porous hydrogel for delivery of vancomycin. Hydrogels based on chitosan (CS), Polyvinyl alcohol (PVA) and Polyethylene glycol (PEG) were prepared by lyophilization. Scanning electron microscopy (SEM), differential scanning calorimetry (DSC), and fourier transform infrared (FTIR) spectroscopy were used to characterize the structures. Water uptake percentage and vancomycin release were also measured. The antibacterial activity against Staphylococcus aureus was investigated. According to the results, mean pore diameter (MPD) was decreased by addition of PEG and reached to 1.3 ± 0.5 μm. On the other hand, 43% decrease in water content of the hydrogels showed along with the incorporation of PEG. The inhibition zone confirmed antibacterial effect of the vancomycin-loaded hydrogels. The porous CS/PVA/PEG hydrogels containing vancomycin could be good candidates to potentially be used as wound dressing.

Steering the Clinical Translation of Delivery Systems for Drugs and Health Products

Besides the feasibility for industrial scale-up, accelerating the translation from bench to bedside of new technological strategies for controlled delivery and targeting of drugs and other actives relevant for health management, such as medical devices and nutraceuticals, would benefit from an even earlier evaluation in pre-clinical models and clinical settings. At the same time, translational medicine also performs in the opposite direction, incorporating clinical needs and observations into scientific hypotheses and innovative technological proposals. With these aims, the sessions proposed for the 2019 CRS Italy Chapter Workshop will introduce the experience of Italian and worldwide researchers on how to foster the actual work in controlled release and drug delivery towards a reliable pre-clinical and clinical assessment.

Interpenetrating Hydrogel Networks Enhance Mechanical Stability, Rheological Properties, Release Behavior and Adhesiveness of Platelet-Rich Plasma

Platelet-rich plasma (PRP) has attracted much attention for the treatment of articular cartilage defects or wounds due to its intrinsic content of growth factors relevant for tissue repair. However, the short residence time of PRP in vivo, due to the action of lytic enzymes, its weak mechanical properties and the consequent short-term release of bioactive factors has restricted its application and efficacy. The present work aimed at designing new formulation strategies for PRP, based on the use of platelet concentrate (PC)-loaded hydrogels or interpenetrating polymer networks, directed at improving mechanical stability and sustaining the release of bioactive growth factors over a prolonged time-span. The interpenetrating hydrogels comprised two polymer networks interlaced on a molecular scale: (a) a first covalent network of thermosensitive and biodegradable vinyl sulfone bearing p(hydroxypropyl methacrylamide-lacate)-polyethylene glycol triblock copolymers, tandem cross-linked by thermal gelation and Michael addition when combined with thiolated hyaluronic acid, and (b) a second network composed of cross-linked fibrin. The PC-loaded hydrogels, instead, was formed only by network (a). All the designed and successfully synthesized formulations greatly increased the stability of PRP in vitro, leading to significant increase in degradation time and storage modulus of PRP gel. The resulting viscoelastic networks showed the ability to controllably release platelet derived growth factor and transforming growth factr β1, and to improve the tissue adhesiveness of PRP. The newly developed hydrogels show great potential for application in the field of wound healing, cartilage repair and beyond.