Influence of fibronectin on the adherence of Staphylococcus epidermidis to coated and uncoated intraocular lenses

The role of plasma, albumin, and fibronectin in Staphylococcus epidermidis adhesion to polystyrene surface

The influence of soluble and immobilized plasma, albumin, and fibronectin (Fn) on the adhesion of three Staphylococcus epidermidis strains to polystyrene was investigated. Both soluble and immobilized plasma and albumin cause to 7-fold reduction of the amounts of adhered cells, regardless of the strain used. The soluble Fn exhibited the adhesion for one strain and did not affect the bacterial sorption for remaining strains, whereas on Fn-coated polystyrene two of the three strains showed about 1.5-fold increase in the number of adsorbed bacteria. The plasma- and albumin-coated surfaces became much more hydrophilic as the contact angle changed from 78 ± 2° for control to 18 ± 2° for plasma and 21 ± 3° for albumin. The ligand-receptor specific interactions strains S. epidermidis with Fn-coated surfaces were proved by measuring the adhesion forces between cell surface and Fn-coated AFM tip. The surface roughness measured using AFM after the plasma and proteins immobilization was changed within 10 nm and not correlate with changes in bacterial adhesion.

Adhesion of Staphylococcus epidermidis to biomaterials is inhibited by fibronectin and albumin

Decades of contradictory results have obscured the exact role of adsorbed fibronectin in the adhesion of the bacterium, Staphylococcus epidermidis, to biomaterials. Here, the ability of adsorbed fibronectin (FN) or bovine serum albumin (BSA) to modulate S. epidermidis adhesion to various biomaterials is reported. FN or BSA was adsorbed in increasing surface densities up to saturated monolayer coverage onto various common biomaterials, including poly(ethylene terephthalate), fluorinated ethylene propylene, poly(ether urethane), silicone, and borosilicate glass. Despite the wide range of surface characteristics represented, adsorption isotherms varied only subtly between materials for the two proteins considered. S. epidermidis adhesion to the various protein-coated biomaterials was quantified in a static-fluid batch adhesion assay. Although slight differences in overall adherent cell numbers were observed between the various protein-coated substrata, all materials exhibited significant dose-dependent decreases in S. epidermidis adhesion with increasing adsorption of either protein (FN, BSA) to all surfaces. Results here indicate that S. epidermidis adhesion to FN-coated surfaces is not a specific adhesion (i.e., receptor: ligand) mediated process, as no significant difference in adhesion was found between FN- and BSA-coated materials. Rather, results indicate that increasing surface density of either FN or BSA actually inhibited S. epidermidis adhesion to all biomaterials examined.

[Early in-the-bag spontaneous intraocular lens dislocation of hydrophilic acryl single piece lenses following uncomplicated phacoemulsification]

BACKGROUND

As techniques for cataract surgery have evolved, spontaneous intraocular lens (IOL) dislocation in patients with no ocular pathology arises less frequently. We present seven consecutive cases of uncomplicated cataract surgery with early in-the-bag spontaneous intraocular lens dislocation for which the same type of hydrophilic single piece lens was used.

MATERIAL AND METHODS

A retrospective analysis was conducted on seven cases involving patients with IOL dislocation who underwent uncomplicated cataract surgery within a period of 4 months (October 2010 to January 2011) using the same type of single piece IOL. The median age of the 7 patients was 73 years and IOL repositioning was performed after an average of 10 weeks.

RESULTS

Sulcus repositioning could be carried out in only five of the seven patients and IOL repositioning within the capsule was achieved in one patient. A second patient exhibited IOL dislocation after yttrium aluminium garnet (YAG) laser capsulotomy. Explantation of the IOL and sulcus implantation of another IOL type (Acrysof MA50 MB) was necessary for a third patient. A fourth case presented an angled IOL haptic and dislocation of the IOL in the sulcus position.

DISCUSSION

Even after uncomplicated cataract surgery, spontaneous in-the-bag IOL dislocation in patients with no ocular pathology may occur due to a hydrophilic lens material which induces stronger anterior capsular phimosis (ACP) in comparison to alternative materials. In combination with a thin lens design this may result in angled IOL haptics and IOL dislocation.

CONCLUSIONS

Careful selection of suitable lens design and material according to individual predisposing factors is necessary. This retrospective case study demonstrates that the combination of hydrophilic lens material and a thin lens design may result in early spontaneous IOL dislocation. Furthermore, as established in one case, YAG laser capsulotomy may induce IOL dislocation if the lens design cannot withstand capsular fibrosis.

[Subluxation of hydrophilic acrylate intraocular lenses due to massive capsular fibrosis]

BACKGROUND

Compared with other biomaterials, hydrophilic acrylate provides better uveal biocompatibility, lower adhesion rates of bacteria and silicone oil, and less glare. Because of reduced capsular biocompatibility, increased fibrosis may initiate dislocation of the intraocular lens (IOL).

PATIENTS

In six eyes of four patients, enhanced fibroses led to IOL dislocation, leading to an IOL exchange an average of 40 weeks after implantation of the same hydrophilic acrylate lens type.

DISCUSSION

Predisposing factors were found in 90% of all reported cases of IOL dislocation in the literature, but not in the cases described here. The lens type that was implanted was unable to adapt to the massive fibrosis induced by its hydrophilic biomaterial.

CONCLUSIONS

The pattern of lens opacification should receive attention when one is choosing an IOL type. Eyes showing pseudoexfoliation syndrome as well as post-uveitis eyes might require a hydrophilic IOL for less cellular reaction, whereas a posterior subcapsular cataract might need a hydrophobic IOL to prevent a massive capsular fibrosis. In the case of increased capsular contraction, unreflected YAG laser capsulotomy may result in IOL subluxation when the lens design cannot handle capsule shrinkage, as demonstrated here.

[Intraocular lens and bacterial adhesion: influence of the environmental factors, the characteristics of the bacteria, and the target material surface]

Adhesion of bacteria to intraocular lenses is an important step in the pathogenesis of postoperative endophthalmitis. It can be described as a two-phase process including an initial, instantaneous, and reversible phase followed by a time-dependant and irreversible molecular and cellular phase. The binding of bacteria is affected by many factors including environmental factors such as medium composition, presence of proteins and flow conditions, the bacterial cell surface characteristics, and the material's surface properties. This article reviews all these factors affecting the adhesion of bacteria to intraocular lenses. A better understanding of these mechanisms would make it possible to reduce the bacterial adhesion process and thus could help decrease the incidence of postoperative endophthalmitis.

Impact of fibronectin on surface properties of intraocular lenses

PURPOSE

Physical properties of intraocular lens (IOL) surfaces determine biocompatibility. IOL hydrophobicity of commercially available IOLs with and without fibronectin (FN) coating can be determined by surface contact angle (SCA) measurements. SCA data of IOLs may allow for a rational selection of an IOL type as a function of underlying eye disease.

SETTING

University Hospital of Saarland, Homburg (Saar), Germany

METHODS

Thirteen IOL types were tested. IOLs were made of poly(methyl methacrylate)(PMMA), acrylate, or silicone. Select IOLs were surface modified by the manufacturer with heparin or a polysaccharide coating. SCA values of IOLs, either uncoated or precoated with FN, were determined using the sessile water drop method.

RESULTS

SCA values ranged from 61.3 to 116.1 degrees for unmodified IOLs, with PMMA IOLs being more hydrophilic (median SCA, 74.1 degrees ), silicone IOLs more hydrophobic (median SCA, 113.3 degrees ), and acrylate IOLs intermediate (median SCA, 86.6 degrees ). Upon FN coating, all genuine acrylate lenses became significantly more hydrophilic while this effect was either nonsignificant or opposite on some PMMA and silicon IOLs. Heparin or polysaccharide surface modification resulted in significantly reduced SCA values. On acrylate IOLs, SCA values did not correlate with the aqueous content of the material.

CONCLUSIONS

This study associates IOL materials, surface modifications, and the role of FN preadsorption with SCA values reflecting surface hydrophobicity versus hydrophilicity. It provides a rationale for specific IOL selection as a function of the clinical setting, and a basis for IOL development using tailored surface physicochemistry to enhance biocompatibility and to reduce susceptibility to implant infection.

[Intraocular lens and cataract surgery: comparison between bacterial adhesion and risk of postoperative endophthalmitis according to intraocular lens biomaterial]

Cataract surgery is a usually successful procedure that restores vision by replacing the natural lens with an intraocular lens (IOL). Acute postoperative endophthalmitis is still one of the most serious complications of cataract surgery. Its incidence has been reported to be between 0.04% and 0.32%. Precisely why bacteria induce endophthalmitis is not entirely understood. Indeed the risk of its development may be influenced by several factors. Among them, bacterial adhesion to the IOL has been recently emphasized in the ophthalmology literature. Indeed, the ability of an organism to adhere to the IOL surface is believed to be associated with a risk of infection at the implantation site. Several studies have demonstrated that bacterial adhesion is influenced by IOL materials. Ever since, numerous studies have investigated the interactions between bacteria and different types of IOLs to determine which biomaterial would be most permissive to bacterial adherence. This article reviews all the epidemiological and experimental data relating to the study of the relationship between bacterial adhesion, IOL material, and risk of developing postoperative endophthalmitis. Even if discrepancies between these studies exist, mainly stemming from the use of different experimental conditions and protocols, it seems that bacterial adhesion is strongly influenced by IOL material. Epidemiological studies suggest that the implantation of silicone IOLs might be associated with increased rates of endophthalmitis. Experimental studies reach similar conclusions showing that hydrophobic IOLs such as silicone or acrylic hydrophobic IOLs are more permissive to bacterial adhesion and growth than hydrophilic IOLs such as acrylic hydrophilic IOLs. Among the interactions that govern bacterial attachment to the IOLs, it seems that hydrophilic-hydrophobic interactions have the greatest influence. Nevertheless, since bacterial adhesion is a complicated process affected by many factors, the conclusions drawn by these results have to be interpreted with care. Further investigations are still needed to understand the connections between IOL material and endophthalmitis.

Peptide modification of polyethersulfone surfaces to improve adipose-derived stem cell adhesion

Polyethersulfone (PES) is a nondegradable, biocompatible, synthetic polymer that is commonly utilized as a membrane material for applications such as hemodialysis, ultrafiltration and bioreactor technology. Various studies have shown surface modification to be a valuable tool in the development of nondegradable materials which promote cell adhesion. Cells of interest include adipose-derived stem cells (ASCs). ASCs are multipotent mesenchymal stem cells that are useful for various regenerative medicine applications. In this study, we hypothesized that PES surfaces modified with a peptide sequence based from fibronectin, such as Arg-Gly-Asp (RGD), Arg-Gly-Asp-Ser and Gly-Arg-Gly-Asp-Ser, would increase ASC adhesion compared to unmodified PES surfaces. The synthetic peptides were covalently bonded to amine-modified PES surfaces using 1-ethyl-3-(dimethylaminopropyl) carbodiimide. The surfaces were characterized using a ninhydrin assay and contact angle measurements. The ninhydrin assay confirmed the presence of amine groups on the surface of peptide-treated PES disks. Advancing water contact angles were analyzed to detect changes in the hydrophilicity of the polymer surfaces, and results indicated our PES membranes had excellent hydrophilicity. The attachment and proliferation of human ASCs was assessed and RGD-treated surfaces resulted in a higher number of attached ASCs after 6 and 48 h, as compared to unmodified PES surfaces. Additionally, varying concentrations of the RGD peptide sequence concentration were examined. These results indicate that PES membranes modified with the RGD peptide sequence can be utilized for enhanced ASC attachment in biomedical applications.