Noninvasively Imaging pH at the Surface of Implanted Orthopedic Devices with X-ray Excited Luminescence Chemical Imaging

Functionalized orthopaedic implant as pH electrochemical sensing tool for smart diagnosis of hardware infection

In the orthopaedic surgery field, the use of medical implants to treat a patient's bone fracture is nowadays a common practice, nevertheless, it is associated with possible cases of infection. The consequent hardware infection can lead to implant failure and systemic infections, with prolonged hospitalization, time-consuming rehabilitation treatments, and extended antibiotic therapy. Hardware infections are strictly related to bacterial adhesion to the implant, leading to infection occurrence and consequent pH decreasing from physiological level to acid pH. Here, we demonstrate the new strategy to use an orthopaedic implant functionalized with iridium oxide film as the working electrode for the potentiometric monitoring of pH in hardware infection diagnosis. A functional investigation was focused on selecting the implant material, namely titanium, titanium alloy, and stainless steel, and the component, namely screws and implants. After selecting the titanium-based implant as the working electrode and a silver wire as the reference electrode in the final configuration of the smart sensing orthopaedic implant, a calibration curve was performed in standard solutions. An equation equal to y = (0.76 ± 0.02) - (0.068 ± 0.002) x, R2 = 0.996, was obtained in the pH range of 4-8. Subsequently, hysteresis, interference, matrix effect, recovery study, and storage stability were investigated to test the overall performance of the sensing device, demonstrating the tremendous potential of electrochemical sensors to deliver the next generation of smart orthopaedic implants.

The colorful world of sulfonephthaleins: Current applications in analytical chemistry for "old but gold" molecules

Sulfonephthaleins represent one of the most common and widely employed reactive dyes in analytical chemistry, thanks to their stability, low-cost, well-visible colors, reactivity and possibilities of chemical modification. Despite being first proposed in 1916, nowadays, these molecules play a fundamental role in biological and medical applications, environmental analyses, food quality monitoring and other fields, with a particular focus on low-cost and disposable devices or methods for practical applications. Since up to our knowledge, no reviews or book chapters focused explicitly on sulfonephthaleins have ever been published, in this review, we will briefly describe sulfonephthaleins history, their acid-base properties will be discussed, and the most recent applications in different fields will be presented, focusing on the last ten years literature (2014-2023). Finally, safety and environmental issues will be briefly discussed, despite being quite controversial.

Finite element-based feasibility study on utilizing heat flux sensors for early detection of vascular graft infections

Aortic vascular graft infections have high morbidity and mortality rate, however, patients often do not show symptoms. Continuous implant surface monitoring will allow for early detection of infections on implant surfaces, which allows for antibiotic treatment prior to biofilm formation. We explore the possibility of using heat flux sensors mounted on an aortic vascular graft to sense the localized heat production at the onset of infectious growth. We apply Finite Element Model simulations to demonstrate changes of the heat transfer coefficient depending on different pulsatile flow parameters. We determine various differences, the main influence being the distance travelled from the inlet of the simulation with the highest heat transfer coefficient closest to the inlet and decreasing along the direction of travel of the fluid. The determined range of heat transfer coefficients of 200 to 4800 W/m2 was applied to a second simulation of the thermal environment of the implant. We determined the heat transfer efficiency of the aortic graft system depending on different graft materials and thicknesses. We are further able to determine that the early detection of infection is possible by comparing the simulated amount of heat flux produced locally with the resolution of a commercial heat flux sensor.

Advanced surface engineering of titanium materials for biomedical applications: From static modification to dynamic responsive regulation

Titanium (Ti) and its alloys have been widely used as orthopedic implants, because of their favorable mechanical properties, corrosion resistance and biocompatibility. Despite their significant success in various clinical applications, the probability of failure, degradation and revision is undesirably high, especially for the patients with low bone density, insufficient quantity of bone or osteoporosis, which renders the studies on surface modification of Ti still active to further improve clinical results. It is discerned that surface physicochemical properties directly influence and even control the dynamic interaction that subsequently determines the success or rejection of orthopedic implants. Therefore, it is crucial to endow bulk materials with specific surface properties of high bioactivity that can be performed by surface modification to realize the osseointegration. This article first reviews surface characteristics of Ti materials and various conventional surface modification techniques involving mechanical, physical and chemical treatments based on the formation mechanism of the modified coatings. Such conventional methods are able to improve bioactivity of Ti implants, but the surfaces with static state cannot respond to the dynamic biological cascades from the living cells and tissues. Hence, beyond traditional static design, dynamic responsive avenues are then emerging. The dynamic stimuli sources for surface functionalization can originate from environmental triggers or physiological triggers. In short, this review surveys recent developments in the surface engineering of Ti materials, with a specific emphasis on advances in static to dynamic functionality, which provides perspectives for improving bioactivity and biocompatibility of Ti implants.

Surface-Doped Zinc Gallate Colloidal Nanoparticles Exhibit pH-Dependent Radioluminescence with Enhancement in Acidic Media

As abnormal acidic pH symbolizes dysfunctions of cells, it is highly desirable to develop pH-sensitive luminescent materials for diagnosing disease and imaging-guided therapy using high-energy radiation. Herein, we explored near-infrared-emitting Cr-doped zinc gallate ZnGa₂O₄ nanoparticles (NPs) in colloidal solutions with different pH levels under X-ray excitation. Ultrasmall NPs were synthesized via a facile hydrothermal method by controlling the addition of ammonium hydroxide precursor and reaction time, and structural characterization revealed Cr dopants on the surface of NPs. The synthesized NPs exhibited different photoluminescence and radioluminescence mechanisms, confirming the surface distribution of activators. It was observed that the colloidal NPs emit pH-dependent radioluminescence in a linear relationship, and the enhancement reached 4.6-fold when pH = 4 compared with the colloidal NPs in the neutral solution. This observation provides a strategy for developing new biomaterials by engineering activators on the nanoparticle surfaces for potential pH-sensitive imaging and imaging-guided therapy using high-energy radiation.

Advancing X-ray Luminescence for Imaging, Biosensing, and Theragnostics

X-ray luminescence is an optical phenomenon in which chemical compounds known as scintillators can emit short-wavelength light upon the excitation of X-ray photons. Since X-rays exhibit well-recognized advantages of deep penetration toward tissues and a minimal autofluorescence background in biological samples, X-ray luminescence has been increasingly becoming a promising optical tool for tackling the challenges in the fields of imaging, biosensing, and theragnostics. In recent years, the emergence of nanocrystal scintillators have further expanded the application scenarios of X-ray luminescence, such as high-resolution X-ray imaging, autofluorescence-free detection of biomarkers, and noninvasive phototherapy in deep tissues. Meanwhile, X-ray luminescence holds great promise in breaking the depth dependency of deep-seated lesion treatment and achieving synergistic radiotherapy with phototherapy.In this Account, we provide an overview of recent advances in developing advanced X-ray luminescence for applications in imaging, biosensing, theragnostics, and optogenetics neuromodulation. We first introduce solution-processed lead halide all-inorganic perovskite nanocrystal scintillators that are able to convert X-ray photons to multicolor X-ray luminescence. We have developed a perovskite nanoscintillator-based X-ray detector for high-resolution X-ray imaging of the internal structure of electronic circuits and biological samples. We further advanced the development of flexible X-ray luminescence imaging using solution-processable lanthanide-doped nanoscintillators featuring long-lived X-ray luminescence to image three-dimensional irregularly shaped objects. We also outline the general principles of high-contrast in vivo X-ray luminescence imaging which combines nanoscintillators with functional biomolecules such as aptamers, peptides, and antibodies. High-quality X-ray luminescence nanoprobes were engineered to achieve the high-sensitivity detection of various biomarkers, which enabled the avoidance of interference from the biological matrix autofluorescence and photon scattering. By marrying X-ray luminescence probes with stimuli-responsive materials, multifunctional theragnostic nanosystems were constructed for on-demand synergistic gas radiotherapy with excellent therapeutic effects. By taking advantage of the capability of X-rays to penetrate the skull, we also demonstrated the development of controllable, wireless optogenetic neuromodulation using X-ray luminescence probes while obviating damage from traditional optical fibers. Furthermore, we discussed in detail some challenges and future development of X-ray luminescence in terms of scintillator synthesis and surface modification, mechanism studies, and their other potential applications to provide useful guidance for further advancing the development of X-ray luminescence.

pH variation in medical implant biofilms: Causes, measurements, and its implications for antibiotic resistance

The advent of implanted medical devices has greatly improved the quality of life and increased longevity. However, infection remains a significant risk because bacteria can colonize device surfaces and form biofilms that are resistant to antibiotics and the host's immune system. Several factors contribute to this resistance, including heterogeneous biochemical and pH microenvironments that can affect bacterial growth and interfere with antibiotic biochemistry; dormant regions in the biofilm with low oxygen, pH, and metabolites; slow bacterial growth and division; and poor antibody penetration through the biofilm, which may also be regions with poor acid product clearance. Measuring pH in biofilms is thus key to understanding their biochemistry and offers potential routes to detect and treat latent infections. This review covers the causes of biofilm pH changes and simulations, general findings of metabolite-dependent pH gradients, methods for measuring pH in biofilms, effects of pH on biofilms, and pH-targeted antimicrobial-based approaches.

Synovial fluid pH sensor for early detection of prosthetic hip infections

We describe an implantable sensor developed to measure synovial fluid pH for noninvasive early detection and monitoring of hip infections using standard-of-care plain radiography. The sensor was made of a pH responsive polyacrylic acid-based hydrogel, which expands at high pH and contracts at low pH. A radiodense tantalum bead and a tungsten wire were embedded in the two ends of the hydrogel in order to monitor the change in length of the hydrogel sensor in response to pH via plain radiography. The effective pKa of the hydrogel-based pH sensor was 5.6 with a sensitivity of 3 mm/pH unit between pH 4 and 8. The sensor showed a linear response and reversibility in the physiologically relevant pH range of pH 6.5 and 7.5 in both buffer and bovine synovial fluid solutions with a 30-minute time constant. The sensor was attached to an explanted prosthetic hip and the pH response determined from the X-ray images by measuring the length between the tantalum bead and the radiopaque wire. Therefore, the developed sensor would enable noninvasive detection and studying of implant hip infection using plain radiography.

Review of in vivo optical molecular imaging and sensing from x-ray excitation

SIGNIFICANCE

Deep-tissue penetration by x-rays to induce optical responses of specific molecular reporters is a new way to sense and image features of tissue function in vivo. Advances in this field are emerging, as biocompatible probes are invented along with innovations in how to optimally utilize x-ray sources.

AIM

A comprehensive review is provided of the many tools and techniques developed for x-ray-induced optical molecular sensing, covering topics ranging from foundations of x-ray fluorescence imaging and x-ray tomography to the adaptation of these methods for sensing and imaging in vivo.

APPROACH

The ways in which x-rays can interact with molecules and lead to their optical luminescence are reviewed, including temporal methods based on gated acquisition and multipoint scanning for improved lateral or axial resolution.

RESULTS

While some known probes can generate light upon x-ray scintillation, there has been an emergent recognition that excitation of molecular probes by x-ray-induced Cherenkov light is also possible. Emission of Cherenkov radiation requires a threshold energy of x-rays in the high kV or MV range, but has the advantage of being able to excite a broad range of optical molecular probes. In comparison, most scintillating agents are more readily activated by lower keV x-ray energies but are composed of crystalline inorganic constituents, although some organic biocompatible agents have been designed as well. Methods to create high-resolution structured x-ray-optical images are now available, based upon unique scanning approaches and/or a priori knowledge of the scanned x-ray beam geometry. Further improvements in spatial resolution can be achieved by careful system design and algorithm optimization. Current applications of these hybrid x-ray-optical approaches include imaging of tissue oxygenation and pH as well as of certain fluorescent proteins.

CONCLUSIONS

Discovery of x-ray-excited reporters combined with optimized x-ray scan sequences can improve imaging resolution and sensitivity.

Conformal Coating of Orthopedic Plates with X-ray Scintillators and pH Indicators for X-ray Excited Luminescence Chemical Imaging through Tissue

We describe a pH-indicating material that can be directly implanted or coated on orthopedic implant surfaces to provide high-spatial-resolution pH mapping through tissue by X-ray excited luminescence chemical imaging (XELCI). This is especially useful for detecting local pH changes during treatment of implant-associated infections. The material has two layers: an X-ray scintillator layer with Gd₂O₂S:Eu in epoxy, which emits 620 and 700 nm light when irradiated with X-rays, and a pH indicator dye layer, which absorbs some of the 620 nm light in a pH-dependent fashion. To acquire each pixel in the image, a focused X-ray beam irradiates a small region of scintillators and the ratio of 620 to 700 nm light is acquired through the tissue. Scanning the X-ray beam across the implant surface generates high-spatial-resolution chemical measurements. Two associated challenges are (1) to make robust sensors that can be implanted in tissue to measure local chemical concentrations specifically for metal orthopedic implants and (2) to conformally coat the implant surface with scintillators and pH indicator dyes in order to make measurements over a large area. Previously, we have physically pressed or glued a pH-sensitive hydrogel sensor onto the surface of an implant, but this is impractical for imaging over large irregular device areas such as an orthopedic plate with holes and edges. Herein, we describe a chemically sensitive and biocompatible XELCI sensor material that can conformally coat the implant surface. A two-part commercial-grade epoxy resin was mixed with Gd₂O₂S:Eu and adhered to the titanium surface. Sugar and salt particles were added to the surface of the epoxy as it cured to create a roughened surface and increase the surface area. On this roughened surface, a secondary layer of diacrylated polyethylene glycol (PEG) hydrogel, containing a pH sensitive dye, was polymerized. This combination of epoxy-PEG layers was found to adhere well to the metal implant unlike other previously tested polymer surfaces, which delaminated when exposed to water or humidity. The focused X-ray beam enabled 0.5 mm spatial resolution through 1 cm-thick tissue. The pH sensor-coated orthopedic plate was imaged with XELCI, through tissue, with different pH levels to acquire a calibration curve. The plates were also imaged through tissue, with a low pH region on one section due to growth of a Staphylococcus aureus biofilm. A pH sensor-coated stainless-steel rod with two distinct pH regions was inserted in a rabbit tibia specimen, and the pH was imaged through both bone and soft tissue. These studies demonstrate the use of pH sensor-coated orthopedic plates and rods for mapping the local pH through tissue during biofilm formation by XELCI.

Luminescent Spectral Rulers for Noninvasive Displacement Measurement through Tissue

A luminescent spectral ruler was developed to measure micrometer to millimeter displacements through tissue. The spectral ruler has two components: a luminescent encoder patterned with alternating stripes of two spectrally distinct luminescent materials and an analyzer mask with periodic transparent windows the same width as the encoder stripes. The analyzer mask is placed over the encoder and held so that only one type of luminescent stripe is visible through the window; sliding the analyzer over the encoder modulates the luminescence spectrum acquired through the analyzer windows, enabling detection of small displacements without imaging. We prepared two types of spectral rulers, one with a fluorescent encoder and a second with an X-ray excited optical luminescent (XEOL) encoder. The fluorescent ruler used two types of quantum dots to form stripes that were excited with 633 nm light and emitted at 645 and 680 nm, respectively. Each ruler type was covered with chicken breast tissue to simulate implantation. The XEOL ruler generated a strong signal with negligible tissue autofluorescence but used ionizing radiation, while the fluorescence ruler used non-ionizing red light excitation but required spectral fitting to account for tissue autofluorescence. The precision for both types of luminescent spectral rulers (with 1 mm wide analyzer windows, and measured through 6 mm of tissue) was <2 μm, mostly limited by shot noise. The approach enabled high micrometer to millimeter displacement measurements through tissue and has applications in biomechanical and mechanochemical measurements (e.g., tracking postsurgical bone healing and implant-associated infection).