In vitro action of a combination of selected antimicrobial agents and chondroitin sulfate

Comparative Analysis of Antioxidant, Anticholinesterase, and Antibacterial Activity of Microbial Chondroitin Sulfate and Commercial Chondroitin Sulfate

Chondroitin synthesis was performed using the recombinant Escherichia coli(C2987) strain created by transforming the plasmid pETM6-PACF-vgb, which carries the genes responsible for chondroitin synthesis, kfoA, kfoC, kfoF, and the Vitreoscilla hemoglobin gene (vgb). Then, Microbial chondroitin sulfate (MCS)'s antioxidant, anticholinesterase, and antibacterial activity were compared with commercial chondroitin sulfate (CCS). The antioxidant studies revealed that the MCS and CCS samples could be potential targets for scavenging radicals and cupric ion reduction. MCS demonstrated better antioxidant properties in the ABTS assay with the IC50 value of 0.66 mg than CCS. MCS showed 2.5-fold for DPPH and almost 5-fold for ABTS⋅+ (with a value of 3.85 mg/mL) better activity than the CCS. However, the compounds were not active for cholinesterase enzyme inhibitions. In the antibacterial assay, the Minimum inhibitory concentration (MIC) values of MCS against S. aureus, E. aerogenes, E. coli, P. aeruginosa, and K. pneumoniae (0.12, 0.18, 0.12, 0.18, and 0.18 g/mL, respectively) were found to be greater than that of CCS (0.42, 0.48, 0.36, 0.36, and 0.36 g/mL, respectively). This study demonstrates that MCS is a potent pharmacological agent due to its physicochemical properties, and its usability as a therapeutic-preventive agent will shed light on future studies.

Antimicrobial stewardship of antiseptics that are pertinent to wounds: the need for a united approach

Long before the nature of infection was recognized, or the significance of biofilms in delayed healing was understood, antimicrobial agents were being used in wound care. In the last 70 years, antibiotics have provided an effective means to control wound infection, but the continued emergence of antibiotic-resistant strains and the documented antibiotic tolerance of biofilms has reduced their effectiveness. A range of wound dressings containing an antimicrobial (antibiotic or non-antibiotic compound) has been developed. Whereas standardized methods for determining the efficacy of non-antibiotic antimicrobials in bacterial suspension tests were developed in the early twentieth century, standardized ways of evaluating the efficacy of antimicrobial dressings against microbial suspensions and biofilms are not available. Resistance to non-antibiotic antimicrobials and cross-resistance with antibiotics has been reported, but consensus on breakpoints is absent and surveillance is impossible. Antimicrobial stewardship is therefore in jeopardy. This review highlights these difficulties and in particular the efficacy of current non-antibiotic antimicrobials used in dressings, their efficacy, and the challenges of translating in vitro efficacy data to the efficacy of dressings in patients. This review calls for a unified approach to developing standardized methods of evaluating antimicrobial dressings that will provide an improved basis for practitioners to make informed choices in wound care.

Extensively-drug-resistant Klebsiella pneumoniae ST307 outbreak strain from north-eastern Germany does not show increased tolerance to quaternary ammonium compounds and chlorhexidine

BACKGROUND

An outbreak of extensively-drug-resistant Klebsiella pneumoniae strain ST307 in a cluster of hospitals in north-east Germany gave rise to the assumption that the epidemiological success of the strain could be based on increased tolerance to biocides.

METHODS

The tolerance of the outbreak strain was compared with epidemiologically unrelated clinical isolates of K. pneumoniae, and reference strains of Pseudomonas aeruginosa (ATCC 15442) and Escherichia coli K12 (NCTC 10538). Tests were performed in a miniaturized assay based on European Standard EN 1040. The widely used biocides benzalkonium chloride (BAC) and didecyl dimethyl ammonium chloride (DDAC), their commercial formulation Descosept spezial (DS), and the antiseptic agent chlorhexidine digluconate (CHG) were selected as test substances. These biocides are used regularly in the hospitals involved in the outbreak.

FINDINGS

All biocides had a bactericidal effect against all tested strains in the quantitative suspension test within 5 min at typically used concentrations and dilutions. The effectiveness of BAC and DDAC alone and in combination, and CHG antisepsis were not impaired under tested conditions.

CONCLUSION

The outbreak strain did not show significantly increased tolerance towards biocides regarding the antiseptic. Thus, the epidemiological success of the strain has to be ascribed to other causes, such as inadequate hand hygiene of visitors.

Antibacterial activity profile of miramistin in in vitro and in vivo models

BACKGROUND

Miramistin is a widely used antiseptic, disinfectant and preservative, and one of the most popular antimicrobial agents on pharmaceutical market of the Russian Federation (http://www.dsm.ru/en/news/385/). However, there is a lack of reported systematic data on antibacterial efficacy of this agent obtained in accordance with the international standards.

AIM

This paper represents a systematic study of antibacterial properties of miramistin. Another objective of this work is to evaluate and compare the exploratory performance of in vitro and in vivo protocols of antiseptics' efficacy testing using miramistin as the reference antiseptic.

METHODS

Antibacterial activity of 0.1% and 0.2% aqueous solutions of miramistin against two museum strains of S. aureus (ATCC 209p) and E. coli (CDC F-50) was studied. Three standard in vitro laboratory tests (microdilution test, suspension test, and metal surface test), and one in vivo test (on rat's skin) were used. The study was conducted in accordance with the international regulatory documents.

RESULTS

Miramistin showed high bactericidal activity against the studied bacterial pathogens in the standard in vitro tests. Thus, in the microdilution test it showed expressed activity against S. aureus (MIC 8 μg/ml, MBC 16 μg/ml) and E. coli (MIC 32 μg/ml, MBC 128 μg/ml). In the suspension test, miramistin decreased the amount of colony forming units by at least 6 log10 units for S. aureus, and by at least 4.5 log10 units for E. coli. Transition to the metal surface test led to significant decrease of antibacterial activity by 1-3 log10 units as compared to the suspension test. Further dramatic reduction of antiseptic activity (by 3-4 log10 units) was observed in in vivo rat skin test. Addition of a protein contaminant (bovine serum albumin) led to a general decrease in the effectiveness of miramistin against the test pathogens (typically, by 1-2 log10 units). An interesting effect of exposure time-dependent reversal of miramistin's specificity to the studied Gram-positive S. aureus and the Gram-negative E. coli organisms was observed in the metal surface test.

CONCLUSIONS

The results of this work provide systematic data on antibacterial efficacy of miramistin. They also underscore the need in relevant in vivo models for evaluation of antiseptics' efficacy. While the existing in vitro methods can be successfully applied at the discovery stages, it is necessary to use more realistic in vivo models at more advanced development stages. The observed selectivity reversal effect should be taken into account when carrying out the antiseptics' efficacy testing and surface disinfection procedures.

SPS-neutralization in tissue samples for efficacy testing of antimicrobial peptides

Background

Accurate determination of the efficacy of antimicrobial agents requires neutralization of residual antimicrobial activity in the samples before microbiological assessment of the number of surviving bacteria. Sodium polyanethol sulfonate (SPS) is a known neutralizer for the antimicrobial activity of aminoglycosides and polymyxins. In this study, we evaluated the ability of SPS to neutralize residual antimicrobial activity of antimicrobial peptides [SAAP-148 and pexiganan; 1% (wt/v) in PBS], antibiotics [mupirocin (Bactroban) and fusidic acid (Fucidin) in ointments; 2% (wt/wt))] and disinfectants [2% (wt/wt) silver sulfadiazine cream (SSD) and 0.5% (v/v) chlorhexidine in 70% alcohol].

Methods

Homogenates of human skin models that had been exposed to various antimicrobial agents for 1 h were pipetted on top of Methicillin-resistant Staphylococcus aureus (MRSA) on agar plates to determine whether the antimicrobial agents display residual activity.

To determine the optimal concentration of SPS for neutralization, antimicrobial agents were mixed with PBS or increasing doses of SPS in PBS (0.05–1% wt/v) and then 10⁵ colony forming units (CFU)/mL MRSA were added. After 30 min incubation, the number of viable bacteria was assessed. Next, the in vitro efficacy of SAAP-148 against various gram-positive and gram-negative bacteria was determined using PBS or 0.05% (wt/v) SPS immediately after 30 min incubation of the mixture. Additionally, ex vivo excision wound models were inoculated with 10⁵ CFU MRSA for 1 h and exposed to SAAP-148, pexiganan, chlorhexidine or PBS for 1 h. Subsequently, samples were homogenized in PBS or 0.05% (wt/v) SPS and the number of viable bacteria was assessed.

Results

All tested antimicrobials displayed residual activity in tissue samples, resulting in a lower recovery of surviving bacteria on agar. SPS concentrations at ≥0.05% (wt/v) were able to neutralize the antimicrobial activity of SAAP-148, pexiganan and chlorhexidine, but not of SSD, Bactroban and Fucidin. Finally, SPS-neutralization in in vitro and ex vivo efficacy tests of SAAP-148, pexiganan and chlorhexidine against gram-positive and gram-negative bacteria resulted in significantly higher numbers of CFU compared to control samples without SPS-neutralization.

Conclusions

SPS was successfully used to neutralize residual activity of SAAP-148, pexiganan and chlorhexidine and this prevented an overestimation of their efficacy.

Antibacterial activity of polihexanide formulations in a co-culture of HaCaT keratinocytes and Staphylococcus aureus and at different pH levels

Complex stalled wounds feature an alkaline milieu that favors tissue destruction and microbial growth. The presence of bacteria in turn perpetuates the inflammatory response. However, only limited knowledge exists of pH dependency on the antibacterial efficacy of polyhexamethylene biguanide (PHMB) or the influence of surfactants or delivery vehicle used in antiseptic formulations. So far, PHMB alone has been shown to protect the keratinocytes from bacterial damage in such a co-culture system as well as exhibiting increased antimicrobial activity at higher pH values. Here, the interaction of PHMB with the surfactants macrogolum and undecylenamidopropyl betaine that are most commonly used as additives in antiseptics and rinsing solutions such as Lavasept and Prontosan has been explored in addition to the PHMB-containing biocellulose dressing Suprasorb X + PHMB. Undecylenamidopropyl betaine was found to lower the antimicrobial activity of polihexanide in the co-culture system, while macrogolum and the biocellulose increased polihexanide efficiency to reduce Staphylococcus aureus especially in the presence of serum. The increasing antibacterial efficacy of PHMB with rising pH was not altered by undecylenamidopropyl betaine, macrogolum, or the biocellulose. The results suggest that application of PHMB with macrogolum or by delivery through a biocellulose dressing might be advantageous for management of wound infections.

Cytotoxic Effects of Polyhexanide on Cellular Repopulation and Calcification of Decellularized Equine Carotids in vitro and in vivo

Purpose

Disinfection of biological implants is indispensable for clinical safety. Here, decellularized equine carotid arteries (dECAs) were disinfected by polyhexanide (PHX), an effective, well-tolerated and nontoxic wound disinfectant and evaluated as vascular grafts for their repopulation and local biocompatibility in vivo.

Methods

dECAs were terminally disinfected by a combination of 0.1% PHX and 70% ethanol (dECA_PHX-ET) or exclusively ethanol (dECA-ET) and subsequently implanted as arteriovenous shunts in sheep for 14 weeks. Repopulation was determined by immunohistochemistry for endothelial- (ECs) or smooth muscle cells (SMCs) using antibodies against CD31 and smooth muscle actin. Histological evaluation was performed on HE-stained sections. Cytotoxicity of dECAs was measured directly by seeding the scaffolds with L-929 fibroblasts, which were visualized by calcein staining. Indirect cytotoxicity was determined by WST-8 viability assay by incubation of L-929 with dECA extracts.

Results

dECA_PHX-ET completely lacked repopulation with ECs and SMCs, showed leukocyte infiltration, strong calcification and poor neovascularization indicating insufficient biocompatibility and inflammatory graft degeneration. PHX-treatment reduced cell viability to 33.2 ± 12.6% and disturbed cell growth at direct contact. In contrast, dECA_ET had no direct cytotoxic effect and only slightly influenced cell viability (82.9 ± 12.5%), showed a substantial repopulation by ECs and SMCs including neovascularization, and were only slightly calcified.

Conclusion

The disinfectant polyhexanide seems to exert severe cytotoxic effects when used for the processing of decellularized matrices and may result in degenerative graft deterioration. In contrast, dECAs exclusively disinfected with ethanol were well integrated. Thus, ethanol seems to be a more suitable tool for graft processing than polyhexanide.

Substantivity of chlorhexidine to human dentin

OBJECTIVES

To better comprehend the role of CHX in the preservation of resin-dentin bonds, this study investigated the substantivity of CHX to human dentin.

MATERIAL AND METHODS

Dentin disks (n=45) were obtained from the mid-coronal portion of human third molars. One-third of dentin disks were kept mineralized (MD), while the other two-thirds had one of the surfaces partially demineralized with 37% phosphoric acid for 15 s (PDD) or they were totally demineralized with 10% phosphoric acid (TDD). Disks of hydroxyapatite (HA) were also prepared. Specimens were treated with: (1) 10 microL of distilled water (controls), (2) 10 microL of 0.2% chlorhexidine diacetate (0.2% CHX) or (3) 10 microL of 2% chlorhexidine diacetate (2% CHX). Then, they were incubated in 1 mL of PBS (pH 7.4, 37 degrees C). Substantivity was evaluated as a function of the CHX-applied dose after: 0.5 h, 1 h, 3 h, 6 h, 24 h, 168 h (1 week), 672 h (4 weeks) and 1344 h (8 weeks) of incubation. CHX concentration in eluates was spectrophotometrically analyzed at 260 nm.

RESULTS

Significant amounts of CHX remained retained in dentin substrates (MD, PPD or TDD), independent on the CHX-applied dose or time of incubation (p<0.05). High amounts of retained CHX onto HA were observed only for specimens treated with the highest concentration of CHX (2%) (p<0.05).

CONCLUSION

The outstanding substantivity of CHX to dentin and its reported effect on the inhibition of dentinal proteases may explain why CHX can prolong the durability of resin-dentin bonds.

The effects of toxicological agents on the optics and mitochondria of the lens and the mitochondria of the corneal epithelium

This review describes how the morphology and distribution of the mitochondria of the epithelium and the superficial fibre layers of the lens were studied using confocal scanning laser microscopy. This research was correlated with an effort to use the optical properties of the intact lens in culture as a proxy for the cornea in measuring ocular toxicity. In turn, this work led to the confocal study of the in vitro and then the in vivo cornea and their possible use in using confocal microscopy to evaluate the effect of various treatments on the integrity of the surface of the eye. Finally, confocal examination of the mitochondria of the lens has provided an avenue to the study of mitochondrial dynamics.

The comparative clinical performance of a new polyhexamethylene biguanide- vs a polyquad-based contact lens care regime with two silicone hydrogel contact lenses

PURPOSE

To compare the clinical performance of a new polyhexamethylene-biguanide (PHMB)- vs a polyquad-based contact lens care regime with two silicone hydrogel contact lenses.

METHODS

This study was a randomised, controlled and investigator-masked (to the lens regimen) clinical study where the clinical performance of two multipurpose contact lens solutions was compared at a single site. Forty-one existing contact lens wearers were recruited and fitted randomly with either galyfilcon A or lotrafilcon A contact lenses. Subjects wore the same lens type for a period of 2 months but used a different care regime (PHMB- and polyquad-based) in a crossover manner, each for a period of 1 month. The primary outcome measure was the difference in corneal staining. Corneal staining was graded in five different locations: central, superior, inferior, temporal and nasal. Measurements of conjunctival redness, limbal redness, conjunctival staining and papillary conjunctivitis were also carried out throughout the study. Biomicroscopic measures were graded using the Efron grading scales. A variety of symptoms were also measured using a visual analogue scale.

RESULTS

There was no statistically significant difference in overall corneal staining between lens types (p = 0.16) or care regimens (p = 0.60). Central corneal staining was significantly greater for the polyquad-based care regimen when compared with the PHMB-based care regimen (p = 0.04). Lotrafilcon A lenses showed greater superior corneal staining (p = 0.0004) and papillary conjunctivitis (p = 0.02), and lower comfort on insertion (p = 0.03) when compared with galyfilcon A lenses regardless of the care regime used. There were no statistically significant differences in the other biomicrosopic signs and symptoms between the lens types and the care regimes.

CONCLUSIONS

Both care regimes performed in a similar clinical manner and are valid for use with the two silicone hydrogel contact lenses used in this study.

Cytotoxicity and antimicrobial activity of six multipurpose soft contact lens disinfecting solutions1

OBJECTIVES

To assess and compare the cytotoxicity and antimicrobial activity of six multipurpose disinfecting contact lens solutions (MPDS).

METHOD

Six MPDS were assessed and compared: MeniCare Soft, Complete Moisture Plus, Solo-Care Aqua, Opti-Free Express, ReNu MultiPlus and ReNuMoistureLoc. Cytotoxicity was evaluated by means of the colony-forming assay (ISO 10993-5) using one cell line. One hundred Chinese hamster's fibroblast V79 cells in 2 mL of medium were inoculated into 6-well plates and cultured for 24 h. After incubation, the medium was removed and 2 mL of each MPDS was diluted with physiological saline and medium and added individually into wells at 1.25, 2.5, 5 and 10% concentrations. After an additional 6 days of incubation, cells were fixed and stained with Giemsa solution. Subsequently, the number of colonies was counted. Cytotoxicity was expressed in terms of the concentration of the MPDS that suppresses colony formation. Antimicrobial activity was evaluated by means of the stand-alone contact lens disinfection test (ISO 14729).

RESULTS

Cytotoxicity--MeniCare Soft and Complete Moisture Plus were not cytotoxic at any of the concentrations tested. The cytotoxicity ranking of the other MPDS was as follows: Solo-Care Aqua approximately equal to Opti-Free Express < ReNu MultiPlus < ReNu MoistureLoc. Antimicrobial activity--All MPDS met the primary criteria of the stand-alone test for bacterial species. ReNu MoistureLoc showed borderline values for Serratia marcescens and Staphylococcus aureus. Complete Moisture Plus failed to meet the stand-alone test criteria for Fusarium solani.

CONCLUSIONS

Large differences in cytotoxicity and antimicrobial activity were found among the MPDS under investigation. Multipurpose disinfecting contact lens solutions with identical concentrations of polyhexamethylene biguanide can behave differently depending on solution formulation. The new MeniCare Soft showed effective antimicrobial activity and minimal cytotoxicity.

Effect of selected wound antiseptics on adult articular cartilage (bovine sesamoid bone) in the presence of Escherichia coli and Staphylococcus aureus

After removing an inoculum of 10(8)-10(9) cfu of Escherichia coli (E. coli) or Staphylococcus aureus (S. aureus) effectively within 2 h from bovine sesamoid bones (bsb) using the iodophore Betaisodona [0.5 and 1.0% (v/v) PVP-I], the biguanide polihexanide (PHMB) [0.005 and 0.01% (v/v)], and the bispyridinamine Octenidine (Oct) [0.005 and 0.01% (v/v)] the metabolic effect on proteoglycans (PG) in bsb was investigated by subsequent culture of bsb for 7 d and biosynthetically labeling with (35)S-sulfate for a period of 24 h. The treatment with the iodophore stimulates the incorporation of (35)S-sulfate into PG, whereas that of Oct was toxic. The PHMB treatment was both tolerated and effective only when it was used at low concentrations (0.005%). The antiseptic treatment did not result in an increase of catabolism of PG. This in vitro study clearly demonstrates that irrigation of cartilage with an antiseptic should be limited to an effective concentration and treatment time compatible with antiseptic function. Iodophores have no negative feedback on cartilage metabolism, moreover, they stimulate chondrocytes in vitro. Cationic antiseptics are not suited as irrigating solutions.

Cytoprotective properties of carboxymethyl cellulose (CMC) when used prior to wearing contact lenses treated with cationic disinfecting agents

PURPOSE

Disinfecting agents found in current multipurpose solutions (MPS) may produce low-grade ocular surface insults. This study investigates the potential for carboxymethylcellulose (CMC) to chemically complex residual disinfectants in situ.

METHODS

The chemical availability of the MPS disinfectant polyhexamethylene biguanide (PHMB) was examined using a spectrophotometric assay. PHMB bioactivity was assessed by survival of bacteria in the presence of MPS with varying amounts of added CMC.

RESULTS

Chemical availability of PHMB in water or MPS was reduced within 10 minutes of adding CMC. With the addition of CMC to MPS, survival rates for bacteria improved substantially, depending on the bacterial species, concentration, and exposure time.

CONCLUSIONS

Carboxymethylcellulose rapidly binds PHMB and reduces its chemical availability and bioactivity. These results suggest a potential cytoprotective effect of CMC on the ocular surface when used before lens insertion.

In vitro action of combinations of selected antimicrobial agents and adult bovine articular cartilage (sesamoid bone)

Anatomically intact articular cartilage in form of sesamoid bones from metacarpophalangeal joints of 2-year-old cows was tested for its influence on the microbicidal effect of the iodophore Betaisodona, the bispyridinamine Octenisept, and the biguanide Lavasept. Comparisons were carried out in Ham's F12 medium with and without 0.2% bovine serum albumin as organic matter loading. The expected abolition of the microbicidal effect of these antiseptics against the test organisms Escherichia coli or Staphylococcus aureus in the presence of sesamoid bone was not evident. Furthermore, sesamoid bone alone demonstrated antibacterial activity against Staphylococcus aureus, which may involve adherence of bacteria to surface constituents of articular cartilage. Final concentrations of 2.5-5% Betaisodona, 5% Octenisept as well as 0.025% Lavasept are effective in killing of 10(8)-10(9) cfu/ml Escherichia coli or Staphylococcus aureus in the presence of sesamoid bone without the reduction of antimicrobial activity expected from binding to CS, which has previously been demonstrated for CS in solution.