Controlled Release of Small Molecules from Elastomers for Reducing Epidermal Downgrowth in Percutaneous Devices

Junctional epithelium and hemidesmosomes: Tape and rivets for solving the "percutaneous device dilemma" in dental and other permanent implants

The percutaneous device dilemma describes etiological factors, centered around the disrupted epithelial tissue surrounding non-remodelable devices, that contribute to rampant percutaneous device infection. Natural percutaneous organs, in particular their extracellular matrix mediating the "device"/epithelium interface, serve as exquisite examples to inspire longer lasting long-term percutaneous device design. For example, the tooth's imperviousness to infection is mediated by the epithelium directly surrounding it, the junctional epithelium (JE). The hallmark feature of JE is formation of hemidesmosomes, cell/matrix adhesive structures that attach surrounding oral gingiva to the tooth's enamel through a basement membrane. Here, the authors survey the multifaceted functions of the JE, emphasizing the role of the matrix, with a particular focus on hemidesmosomes and their five main components. The authors highlight the known (and unknown) effects dental implant - as a model percutaneous device - placement has on JE regeneration and synthesize this information for application to other percutaneous devices. The authors conclude with a summary of bioengineering strategies aimed at solving the percutaneous device dilemma and invigorating greater collaboration between clinicians, bioengineers, and matrix biologists.

Tapping basement membrane motifs: Oral junctional epithelium for surface-mediated soft tissue attachment to prevent failure of percutaneous devices

Teeth, long-lasting percutaneous organs, feature soft tissue attachment through adhesive structures, hemidesmosomes, in the junctional epithelium basement membrane adjacent to teeth. This soft tissue attachment prevents bacterial infection of the tooth despite the rich - and harsh - microbial composition of the oral cavity. Conversely, millions of percutaneous devices (catheters, dental, and orthopedic implants) fail from infection yearly. Standard of care antibiotic usage fuels antimicrobial resistance and is frequently ineffective. Infection prevention strategies, like for dental implants, have failed in generating durable soft tissue adhesion - like that seen with the tooth - to prevent bacterial colonization at the tissue-device interface. Here, inspired by the impervious natural attachment of the junctional epithelium to teeth, we synthesized four cell adhesion peptide (CAPs) nanocoatings, derived from basement membranes, to promote percutaneous device soft tissue attachment. The two leading nanocoatings upregulated integrin-mediated hemidesmosomes, selectively increased keratinocyte proliferation compared to fibroblasts, which cannot form hemidesmosomes, and expression of junctional epithelium adhesive markers. CAP nanocoatings displayed marked durability under simulated clinical conditions and the top performer CAP nanocoating was validated in a percutaneous implant murine model. Basement membrane CAP nanocoatings, inspired by the tooth and junctional epithelium, may provide an alternative anti-infective strategy for percutaneous devices to mitigate the worldwide threat of antimicrobial resistance. STATEMENT OF SIGNIFICANCE: Prevention and management of medical device infection is a significant healthcare challenge. Overzealous antibiotic use has motivated alternative material innovations to prevent infection. Here, we report implant cell adhesion peptide nanocoatings that mimic a long-lasting, natural "medical device," the tooth, through formation of cell adhesive structures called hemidesmosomes. Such nanocoatings sidestep the use of antimicrobial or antibiotic elements to form a soft-tissue seal around implants. The top performing nanocoatings prompted expression of hemidesmosomes and defensive factors to mimic the tooth and was validated in an animal model. Application of cell adhesion peptide nanocoatings may provide an alternative to preventing, rather that necessarily treating, medical device infection across a range of device indications, like dental implants.

Dual keratinocyte-attachment and anti-inflammatory coatings for soft tissue sealing around transmucosal oral implants

Unlike the attachment of soft epithelial skin tissue to penetrating solid natural structures like fingernails and teeth, sealing around percutaneous/permucosal devices such as dental implants is hindered by inflammation and epidermal down growth. Here, we employed a dual keratinocyte-adhesive peptide and anti-inflammatory biomolecule coating on titanium to promote oral epithelial tissue attachment. For minimizing inflammation-triggered epidermal down growth, we coated pristine and oxygen plasma pre-treated polished titanium (pTi) with conjugated linoleic acid (CLA). Further, in order to aid in soft tissue attachment via the formation of hemidesmosomes, adhesive structures by oral keratinocytes, we coated the anionic linoleic acid (LA) adsorbed titanium with cationic cell adhesive peptides (CAP), LamLG3, a peptide derived from Laminin 332, the major extracellular matrix component of the basement membrane in skin tissue and Net1, derived from Netrin-1, a neural chemoattractant capable of epithelial cell attachment via α6β4 integrins. The dual CLA-CAP coatings on pTi were characterized by X-ray photoelectron spectroscopy and dynamic water contact angle measurements. The proliferation of human oral keratinocytes (TERT-2/OKF6) was accelerated on the peptide coated titanium while also promoting the expression of Col XVII and β-4 integrin, two markers for hemidesmosomes. Simultaneously, CLA coating suppressed the production of inducible nitric oxide synthase (anti-iNOS); a pro-inflammatory M1 marker expressed in lipopolysaccharide (LPS) stimulated murine macrophages (RAW 264.7) and elevated expression of anti-CD206, associated to an anti-inflammatory M2 macrophage phenotype. Taken together, the dual keratinocyte-adhesive peptide and anti-inflammatory biomolecule coating on titanium can help reduce inflammation and promote permucosal/peri-implant soft tissue sealing.

Skin adhesion to the percutaneous component of direct bone anchored systems: systematic review on preclinical approaches and biomaterials

Nowadays, direct bone anchored systems are an increasingly adopted approach in the therapeutic landscape for amputee patients. However, the percutaneous nature of these devices poses a major challenge to obtain a stable and lasting proper adhesion between the implant surface and the skin. A systematic review was carried out in three databases (PubMed, Scopus, Web of Science) to provide an overview of the innovative strategies tested with preclinical models (in vitro and in vivo) in the last ten years to improve the skin adhesion of direct bone anchored systems. Fifty five articles were selected after screening, also employing PECO question and inclusion criteria. A modified Cochrane RoB 2.0 tool for the in vitro studies and the SYRCLE tool for in in vivo studies were used to assess the risk of bias. The evidence collected suggests that the implementation of porous percutaneous structures could be one of the most favorable approach to improve proper skin adhesion, especially in association with bioactive coatings, as hydroxyapatite, and exploiting the field of nanostructure. Some issues still remain open as (a) the identification and characterization of the best material/coating association able to limit the shear stresses at the interface and (b) the role of keratinocyte turnover on the skin/biomaterial adhesion and integration processes.

Injectable Poly(ethylene glycol) Hydrogels Cross-Linked by Metal-Phenolic Complex and Albumin for Controlled Drug Release

Injectable hydrogel is advantageous as a drug reservoir for controlled drug release since its injectability provides minimally invasive access to internal tissues and irregular-shaped target sites. Herein, we fabricated pH-responsive injectable hydrogels constructed of a supramolecular cross-link network, which contained tannic acid (TA), Fe(III), poly(ethylene glycol) (PEG), and bovine serum albumin (BSA) for controlled drug release. The hydrogel precursors rapidly turned into a gel when co-injected with NaOH in a time scale of seconds. The hydrogel properties and drug release profiles are all tunable by adjusting the concentrations of BSA, NaOH, and doxorubicin (DOX). The Young's moduli range from 3.19 ± 0.93 to 43.24 ± 1.37 kPa that match internal soft tissues. The hydrogel lasts more than 3 weeks and gradually releases doxorubicin up to 123.6 ± 1.7 μg at pH 6.4. The results of the physical properties and drug release suggest supramolecular interactions that correspond to Fourier transform infrared (FTIR) results. In vitro cytotoxicity was also assessed using L929 cells, and the results demonstrated the material biocompatibility. The tunable properties, controlled release profiles, and biocompatibility of injectable poly(ethylene glycol) hydrogels support that they have great potential as a drug-releasing material for localized treatments.

Formation of highly elastomeric and property-tailorable poly(glycerol sebacate)-co-poly(ethylene glycol) hydrogels through thiol–norbornene photochemistry

Nor_PGS-co-PEG is a new type of hydrophilic PGS-based copolymer with definable properties for scaffold manufacturing as well as for biomedical applications.

BioMEMS for biosensors and closed-loop drug delivery

The efficacy of pharmaceutical treatments can be greatly enhanced by physiological feedback from the patient using biosensors, though this is often invasive or infeasible. By adapting microelectromechanical systems (MEMS) technology to miniaturize such biosensors, previously inaccessible signals can be obtained, often from inside the patient. This is enabled by the device's extremely small footprint which minimizes both power consumption and implantation trauma, as well as the transport time for chemical analytes, in turn decreasing the sensor's response time. MEMS fabrication also allows mass production which can be easily scaled without sacrificing its high reproducibility and reliability, and allows seamless integration with control circuitry and telemetry which is already produced using the same materials and fabrication steps. By integrating these systems with drug delivery devices, many of which are also MEMS-based, closed loop drug delivery can be achieved. This paper surveys the types of signal transduction devices available for biosensing-primarily electrochemical, optical, and mechanical-looking at their implementation via MEMS technology. The impact of MEMS technology on the challenges of biosensor development, particularly safety, power consumption, degradation, fouling, and foreign body response, are also discussed.

Norbornene-modified poly(glycerol sebacate) as a photocurable and biodegradable elastomer

Photocurable norbornene-functionalized poly(glycerol sebacate) (Nor-PGS) has been developed to fabricate cytocompatible, biodegradable and elastomeric scaffolds for tissue engineering applications.