Graphene Oxide-Silver-Coated Sulfonated Polyetheretherketone (Ag/GO-SPEEK): A Broad-Spectrum Antibacterial Artificial Bone Implants

Polyetheretherketone (PEEK), particularly its sulfonated form (SPEEK), has emerged as a promising synthetic biomaterial for artificial bone implants, providing an alternative to conventional titanium metal. However, postoperative infections pose a critical challenge, driven by diverse and antibiotic-resistant bacteria. To address this issue, we propose the modification of the SPEEK surface using a thin graphene oxide (GO) film containing silver (Ag) ions. The resulting coating exhibits substantial antibacterial effects against various pathogens, including Staphylococcus aureus, Escherichia coli, Pseudomonas aeruginosa, Klebsiella pneumoniae, and Candida albicans. Experimental assessments elucidate the coating's impact on bacterial adhesion, biofilm formation, and morphology. The results suggest that hindered bacterial growth stems from reduced biofilm production and the controlled release of Ag ions facilitated by the GO coating. The Ag/GO-SPEEK material holds promise as a bioactive implant, addressing the challenges associated with bacterial targeting in bone tissue engineering applications.

Methods to improve antibacterial properties of PEEK: A review

As a thermoplastic and bioinert polymer, polyether ether ketone (PEEK) serves as spine implants, femoral stems, cranial implants, and joint arthroplasty implants due to its mechanical properties resembling the cortical bone, chemical stability, and radiolucency. Although there are standards and antibiotic treatments for infection control during and after surgery, the infection risk is lowered but can not be eliminated. The antibacterial properties of PEEK implants should be improved to provide better infection control. This review includes the strategies for enhancing the antibacterial properties of PEEK in four categories: immobilization of functional materials and functional groups, forming nanocomposites, changing surface topography, and coating with antibacterial material. The measuring methods of antibacterial properties of the current studies of PEEK are explained in detail under quantitative, qualitative, andin vivomethods. The mechanisms of bacterial inhibition by reactive oxygen species generation, contact killing, trap killing, and limited bacterial adhesion on hydrophobic surfaces are explained with corresponding antibacterial compounds or techniques. The prospective analysis of the current studies is done, and dual systems combining osteogenic and antibacterial agents immobilized on the surface of PEEK are found the promising solution for a better implant design.

Recent Development and Applications of Polydopamine in Tissue Repair and Regeneration Biomaterials

The various tissue damages are a severe problem to human health. The limited human tissue regenerate ability requires suitable biomaterials to help damage tissue repair and regeneration. Therefore, many researchers devoted themselves to exploring biomaterials suitable for tissue repair and regeneration. Polydopamine (PDA) as a natural and multifunctional material which is inspired by mussel has been widely applied in different biomaterials. The excellent properties of PDA, such as strong adhesion, photothermal and high drug-loaded capacity, seem to be born for tissue repair and regeneration. Furthermore, PDA combined with different materials can exert unexpected effects. Thus, to inspire researchers, this review summarizes the recent and representative development of PDA biomaterials in tissue repair and regeneration. This article focuses on why apply PDA in these biomaterials and what PDA can do in different tissue injuries.

A dual-functional strontium-decorated titanium implants that guides the immune response for osseointegration of osteoporotic rats

Due to the dynamic imbalance between osteogenesis and osteoclasis and the abnormal inflammatory microenvironment in situ, osteoporosis hampers the early osseointegration between implants and bones. To improve osseointegration with the osteoporosis, we first coated the titanium implants (Ti) with polydopamine (PDA) coating (Ti-PDA), followed by modification with strontium (Sr) to prepare the Ti-PDA-Sr implants. An osteoporotic rat model with femoral bone defect was verified to estimate the osseointegration of the implants. The Ti-PDA-Sr implants exhibited good biocompatibility with continuous release of Sr ions for up to 21 days. Ti-PDA-Sr implants promoted the osteogenesis of BMSCs and the polarization of BMMs to M2 phenotype compared to that of Ti and Ti-PDA implants, revealing the double-regulated effects in bone induction and immune regulation. According to the Micro-CT and histopathology results, Ti-PDA-Sr implants exhibited the most stable osseointegration between bone tissues and implants. According to the immunohistochemistry results, the Ti-PDA-Sr implants differentiated the BMMs to M2 phenotype, alleviating the abnormal inflammation in osteoporosis and preventing the consistent bone destruction between the implants and bone tissues. This study provides a practical and effective strategy in preparing bi-functional implants that can promote osseointegration with osteoporosis.

Latest advances: Improving the anti-inflammatory and immunomodulatory properties of PEEK materials

Excellent biocompatibility, mechanical properties, chemical stability, and elastic modulus close to bone tissue make polyetheretherketone (PEEK) a promising orthopedic implant material. However, biological inertness has hindered the clinical applications of PEEK. The immune responses and inflammatory reactions after implantation would interfere with the osteogenic process. Eventually, the proliferation of fibrous tissue and the formation of fibrous capsules would result in a loose connection between PEEK and bone, leading to implantation failure. Previous studies focused on improving the osteogenic properties and antibacterial ability of PEEK with various modification techniques. However, few studies have been conducted on the immunomodulatory capacity of PEEK. New clinical applications and advances in processing technology, research, and reports on the immunomodulatory capacity of PEEK have received increasing attention in recent years. Researchers have designed numerous modification techniques, including drug delivery systems, surface chemical modifications, and surface porous treatments, to modulate the post-implantation immune response to address the regulatory factors of the mechanism. These studies provide essential ideas and technical preconditions for the development and research of the next generation of PEEK biological implant materials. This paper summarizes the mechanism by which the immune response after PEEK implantation leads to fibrous capsule formation; it also focuses on modification techniques to improve the anti-inflammatory and immunomodulatory abilities of PEEK. We also discuss the limitations of the existing modification techniques and present the corresponding future perspectives.

Silver-Containing Biomaterials for Biomedical Hard Tissue Implants

Bacterial infection caused by biomaterials is a very serious problem in the clinical treatment of implants. The emergence of antibiotic resistance has prompted other antibacterial agents to replace traditional antibiotics. Silver is rapidly developing as an antibacterial candidate material to inhibit bone infections due to its significant advantages such as high antibacterial timeliness, high antibacterial efficiency, and less susceptibility to bacterial resistance. However, silver has strong cytotoxicity, which can cause inflammatory reactions and oxidative stress, thereby destroying tissue regeneration, making the application of silver-containing biomaterials extremely challenging. In this paper, the application of silver in biomaterials is reviewed, focusing on the following three issues: 1) how to ensure the excellent antibacterial properties of silver, and not easy to cause bacterial resistance; 2) how to choose the appropriate method to combine silver with biomaterials; 3) how to make silver-containing biomaterials in hard tissue implants have further research. Following a brief introduction, the discussion focuses on the application of silver-containing biomaterials, with an emphasis on the effects of silver on the physicochemical properties, structural properties, and biological properties of biomaterials. Finally, the review concludes with the authors' perspectives on the challenges and future directions of silver in commercialization and in-depth research.

Enhancing cell adhesive and antibacterial activities of glass-fibre-reinforced polyetherketoneketone through Mg and Ag PIII

Glass-fibre-reinforced polyetherketoneketone (PEKK-GF) shows great potential for application as a dental implant restoration material; however, its surface bioinertness and poor antibacterial properties limit its integration with peri-implant soft tissue, which is critical in the long-term success of implant restoration. Herein, functional magnesium (Mg) and silver (Ag) ions were introduced into PEKK-GF by plasma immersion ion implantation (PIII). Surface characterization confirmed that the surface morphology of PEKK-GF was not visibly affected by PIII treatment. Further tests revealed that PIII changed the wettability and electrochemical environment of the PEKK-GF surface and enabled the release of Mg²⁺ and Ag⁺ modulated by Giavanni effect. In vitro experiments showed that Mg/Ag PIII-treated PEKK-GF promoted the proliferation and adhesion of human gingival fibroblasts and upregulated the expression of adhesion-related genes and proteins. In addition, the treated samples inhibited the metabolic viability and adhesion of Streptococcus mutans and Porphyromonas gingivalis on their surfaces, distorting bacterial morphology. Mg/Ag PIII surface treatment improved the soft tissue integration and antibacterial activities of PEKK-GF, which will further support and broaden its adoption in dentistry.

Polyetheretherketone development in bone tissue engineering and orthopedic surgery

Polyetheretherketone (PEEK) has been widely used in the medical field as an implant material, especially in bone tissue engineering and orthopedic surgery, in recent years. This material exhibits superior stability at high temperatures and is biosecured without harmful reactions. However, the chemical and biological inertness of PEEK still limits its applications. Recently, many approaches have been applied to improve its performance, including the modulation of physical morphology, chemical composition and antimicrobial agents, which advanced the osteointegration as well as antibacterial properties of PEEK materials. Based on the evolution of PEEK biomedical devices, many studies on the use of PEEK implants in spine surgery, joint surgery and trauma repair have been performed in the past few years, in most of which PEEK implants show better outcomes than traditional metal implants. This paper summarizes recent studies on the modification and application of biomedical PEEK materials, which provides further research directions for PEEK implants.

A dual-functional PEEK implant coating for anti-bacterial and accelerated osseointegration

Polyetheretherketone (PEEK) has been widely applied in biomedical engineering. However, the unsatisfactory bioactivity essentially limits the clinical application of PEEK. In this study, a simply immersing method was proposed to fabricate a dual-functional PEEK with antibacterial properties and enhanced bone integration. Firstly, the surface of PEEK was modified with a polydopamine (PDA) coating by incubating at dopamine solution. Afterward, the PEEK-PDA was modified with manganese (Mn) and silver (Ag) ions by the soaking method to fabricate the PEEK-PDA-Mn/Ag. The physicochemical capabilities of PEEK-PDA-Mn/Ag were further explored in the ions release, wettability, morphology, and element distributions. PEEK-PDA-Mn/Ag obviously accelerated the adhesion and distribution of MC3T3-E1 cells, indicating favorable biosafety in vitro. Meanwhile, the osteogenic properties of PEEK-PDA-Mn and PEEK-PDA-Mn/Ag were proved by the increased expression of osteogenic genes, alkaline phosphatase (ALP), and mineralization in vitro. Additionally, the wide antibacterial capabilities of PEEK-PDA-Mn/Ag were proved in both Staphylococcus aureus (S. aureus) and Escherichia coli (E. coli) in vitro. Furthermore, the PEEK-PDA-Mn/Ag was antibacterial with capability in enhancing osseointegration in vivo. Overall, the simply immersing method can modify the surface of PEEK, giving the bioactivity, biocompatibility, and antibacterial ability to the composited PEEK, which could be applied as an orthopedic implant in clinical.

Surface competition between osteoblasts and bacteria on silver-doped bioactive titanium implant

The rapid integration in the bone tissue and the prevention of bacterial infection are key for the success of the implant. In this regard, a silver (Ag)-doped thermochemical treatment that generate an Ag-doped calcium titanate layer on titanium (Ti) implants was previously developed by our group to improve the bone-bonding ability and provide antibacterial activity. In the present study, the biological and antibacterial potential of this coating has been further studied. In order to prove that the Ag-doped layer has an antibacterial effect with no detrimental effect on the bone cells, the behavior of osteoblast-like cells in terms of cell adhesion, morphology, proliferation and differentiation was evaluated, and the biofilm inhibition capacity was assessed. Moreover, the competition by the surface between cell and bacteria was carried out in two different co-culture methods. Finally, the treatment was applied to porous Ti implants to study in vivo osteointegration. The results show that the incorporation of Ag inhibits the biofilm formation and has no effect on the performance of osteoblast-like cells. Therefore, it can be concluded that the Ag-doped surface is capable of preventing bone bacterial infection and providing suitable osseointegration.

Simvastatin-hydroxyapatite coatings prevent biofilm formation and improve bone formation in implant-associated infections

Implant-associated infections (IAIs) caused by biofilm formation are the most devastating complications of orthopedic surgery. Statins have been commonly and safely used drugs for hypercholesterolemia for many years. Here, we report that simvastatin-hydroxyapatite-coated titanium alloy prevents biofilm-associated infections. The antibacterial properties of simvastatin against Staphylococcus aureus and Staphylococcus epidermidis biofilms in vitro was confirmed by crystal violet staining and live-dead bacterial staining. We developed a simvastatin-and hydroxyapatite (Sim-HA)-coated titanium alloy via electrochemical deposition. Sim-HA coatings inhibited Staphylococcus aureus biofilm formation and improved the biocompatibility of the titanium alloy. Sim-HA coatings effectively prevented Staphylococcus aureus IAI in rat femurs, as confirmed by radiological assessment and histological examination. The antibacterial effects of the Sim-HA coatings were attributed to their inhibitory effects on biofilm formation, as verified by scanning electron microscopic observations and bacterial spread plate analysis. In addition, the Sim-HA coatings enhanced osteogenesis and osteointegration, as verified by micro-CT, histological evaluation, and biomechanical pull-out tests. In summary, Sim-HA coatings are promising implant materials for protection against biofilm-associated infections.

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Simvastatin-hydroxyapatite coatings were prepared on Ti6Al4V by electrochemical deposition process.

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The Simvastatin-hydroxyapatite coatings inhibited S. aureus biofilm formation and improved biocompatibility in vitro.

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The coatings exhibited antibacterial effects and improved bone formation in a rat femur IAI model.

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Simvastatin coatings are promising for application in orthopedic implants.

Recent advances in engineered polymeric materials for efficient photodynamic inactivation of bacterial pathogens

Nowadays, infectious diseases persist as a global crisis by causing significant destruction to public health and the economic stability of countries worldwide. Especially bacterial infections remain a most severe concern due to the prevalence and emergence of multi-drug resistance (MDR) and limitations with existing therapeutic options. Antibacterial photodynamic therapy (APDT) is a potential therapeutic modality that involves the systematic administration of photosensitizers (PSs), light, and molecular oxygen (O₂) for coping with bacterial infections. Although the existing porphyrin and non-porphyrin PSs were effective in APDT, the poor solubility, limited efficacy against Gram-negative bacteria, and non-specific distribution hinder their clinical applications. Accordingly, to promote the efficiency of conventional PSs, various polymer-driven modification and functionalization strategies have been adopted to engineer multifunctional hybrid phototherapeutics. This review assesses recent advancements and state-of-the-art research in polymer-PSs hybrid materials developed for APDT applications. Further, the key research findings of the following aspects are considered in-depth with constructive discussions: i) PSs-integrated/functionalized polymeric composites through various molecular interactions; ii) PSs-deposited coatings on different substrates and devices to eliminate healthcare-associated infections; and iii) PSs-embedded films, scaffolds, and hydrogels for regenerative medicine applications.

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Synthetic strategies of engineered polymer-based hybrid materials integrated with photosensitizers for APDT.

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Utilization of photosensitizer-incorporated polymeric materials in health care applications.

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Challenges and opportunities in the future development of polymeric biomaterials with improved photo-bactericidal properties.

A critical review on polydopamine surface-modified scaffolds in musculoskeletal regeneration

Increasing concern about age-related diseases, particularly musculoskeletal injuries and orthopedic conditions, highlights the need for strategies such as tissue engineering to address them. Surface modification has been developed to create pro-healing interfaces, personalize scaffolds and provide novel medicines. Polydopamine, a mussel-inspired adhesive polymer with highly reactive functional groups that adhere to nearly all substrates, has gained attention in surface modification strategies for biomaterials. Polydopamine was primarily developed to modify surfaces, but its effectiveness has opened up promising approaches for further applications in bioengineering as carriers and nanoparticles. This review focuses on the recent discoveries of the role of polydopamine as a surface coating material, with focus on the properties that make it suitable for tackling musculoskeletal disorders. We report the evolution of using it in research, and discuss papers involving the progress of this field. The current research on the role of polydopamine in bone, cartilage, muscle, nerve, and tendon regeneration is discussed, thus giving comprehensive overview about the function of polydopamine both in-vitro and in-vivo. Finally, the report concludes presenting the critical challenges that must be addressed for the clinical translation of this biomaterial while exploring future perspectives and research opportunities in this area.

Treatment methods toward improving the anti-infection ability of poly(etheretherketone) implants for medical applications

Due to its favorable chemical stability, biocompatibility, and mechanical properties, Poly(etheretherketone) (PEEK) is a promising material for repairing bone and dental hard tissue defects. However, there are critical disadvantages: PEEK is biologically and chemically inert, which influences osseointegration of implants and bonding strength of prostheses, and its mechanical properties still cannot meet the requirements for some medical applications. Furthermore, bacterial infections and inflammatory reactions often accompany bone defects caused by trauma or inflammation or teeth loss caused by periodontitis. Previous studies mainly focused on enhancing PEEK's bioactivity and mechanical performance, but PEEK also lacks effective anti-infection ability. Thus, it is necessary to improve its anti-infection ability, and this is considered in this paper from two aspects. The first is to inhibit the attachment and growth of bacteria on the material, and the second is to endow the material with immunoregulatory ability, which means mobilizing the host immune system to protect tissue from inflammation. In this review, we analyze and discuss the existing treatment methods to improve the antibacterial and immunomodulatory abilities of PEEK addressing their limitations, relevant future challenges, and required research efforts.

Polydopamine, harness of the antibacterial potentials-A review

Antibiotic resistance is one of the major causes of morbidity and mortality, triggered by the adhesion of microbes and to some extent the formation of biofilms. This condition has been quite challenging in the health and industrial sector. Conditions and processes required to foil these infectious and resistance are of much concern. The synthesis of PDA material, inspired by the Mytilus edulis foot protein (MEFP)5 possesses unique characteristics that allow for, adhesion, photothermal therapy, synergistic effects with other materials, biocompatibility process, etc. Therefore, their usage holds great potential for dealing with both the infectious nature and the antibiotic resistance processes. Hence, this review provides an overview of the mechanism involved in accomplishing and eradicating bacteria, the recently harnessed antibacterial effect of the PDA through other properties they possess, a way forward in tapping the benefit embedded in the PDA, and the future perspective.

Approaches to Biofunctionalize Polyetheretherketone for Antibacterial: A Review

Due to excellent mechanical properties and similar elastic modulus compared with human cortical bone, polyetheretherketone (PEEK) has become one of the most promising orthopedic implant materials. However, implant-associated infections (IAIs) remain a challenging issue since PEEK is bio-inert. In order to fabricate an antibacterial bio-functional surface, modifications of PEEK had been widely investigated. This review summarizes the modification strategies to biofunctionalize PEEK for antibacterial. We will begin with reviewing different approaches, such as surface-coating modifications and controlled release of antimicrobials. Furthermore, blending modifications and 3D printing technology were discussed. Finally, we compare the effects among different approaches. We aimed to provide an in-depth understanding of the antibacterial modification and optimize the design of the PEEK orthopedic implant.

Systematic Approach to Mimic Phenolic Natural Polymers for Biofabrication

In nature, phenolic biopolymers are utilized as functional tools and molecular crosslinkers to control the mechanical properties of biomaterials. Of particular interest are phenolic proteins/polysaccharides from living organisms, which are rich in catechol and/or gallol groups. Their strong underwater adhesion is attributed to the representative phenolic molecule, catechol, which stimulates intermolecular and intramolecular crosslinking induced by oxidative polymerization. Significant efforts have been made to understand the underlying chemistries, and researchers have developed functional biomaterials by mimicking the systems. Owing to their unique biocompatibility and ability to transform their mechanical properties, phenolic polymers have revolutionized biotechnologies. In this review, we highlight the bottom-up approaches for mimicking polyphenolic materials in nature and recent advances in related biomedical applications. We expect that this review will contribute to the rational design and synthesis of polyphenolic functional biomaterials and facilitate the production of related applications.

Synthesis Monitoring, Characterization and Cleanup of Ag-Polydopamine Nanoparticles Used as Antibacterial Agents with Field-Flow Fractionation

Advances in nanotechnology have opened up new horizons in nanomedicine through the synthesis of new composite nanomaterials able to tackle the growing drug resistance in bacterial strains. Among these, nanosilver antimicrobials sow promise for use in the treatment of bacterial infections. The use of polydopamine (PDA) as a biocompatible carrier for nanosilver is appealing; however, the synthesis and functionalization steps used to obtain Ag-PDA nanoparticles (NPs) are complex and require time-consuming cleanup processes. Post-synthesis treatment can also hinder the stability and applicability of the material, and dry, offline characterization is time-consuming and unrepresentative of real conditions. The optimization of Ag-PDA preparation and purification together with well-defined characterization are fundamental goals for the safe development of these new nanomaterials. In this paper, we show the use of field-flow fractionation with multi-angle light scattering and spectrophotometric detection to improve the synthesis and quality control of the production of Ag-PDA NPs. An ad hoc method was able to monitor particle growth in a TLC-like fashion; characterize the species obtained; and provide purified, isolated Ag-PDA nanoparticles, which proved to be biologically active as antibacterial agents, while achieving a short analysis time and being based on the use of green, cost-effective carriers such as water.

Enhanced osteogenic activity and antibacterial performance in vitro of polyetheretherketone by plasma-induced graft polymerization of acrylic acid and incorporation of zinc ions

Polyetheretherketone (PEEK) has been widely used in the fields of orthopedics and trauma, but weak osteointegration and bacterial infection affect its long-term stability and repair effects. Surface modification is an effective way to improve the osteogenic and antibacterial activity of PEEK implants. In the present study, a layer of acrylic acid (AA) polymer coating loaded with zinc ions (Zn²⁺) was constructed on the surface of PEEK (PEEK-AA-Zn) using a strategy of combining plasma-induced graft polymerization with a chemical immersion technique. Successful construction of the AA coating remarkably enhanced the hydrophilicity of PEEK, and effectively loaded and released Zn²⁺. In vitro cell culture using MC3T3-E1 preosteoblasts showed that the Zn²⁺ released from PEEK-AA-Zn promoted cell proliferation and elevated gene expression levels of alkaline phosphatase (ALP), osteocalcin (OCN) and bone sialoprotein (BSP). Antibacterial tests revealed that PEEK-AA-Zn efficiently inhibited the proliferation of Staphylococcus aureus (S. aureus). These results suggest that the combined method of graft polymerization and ion incorporation endows PEEK with excellent osteogenic and antibacterial activity, which provides a wide range of possibilities for developing PEEK implants with multifunctional properties for bone tissue repair.

Polydopamine antibacterial materials

Recently, the development of polydopamine (PDA) has demonstrated numerous excellent performances in free radical scavenging, UV shielding, photothermal conversion, and biocompatibility. These unique properties enable PDA to be widely used as efficient antibacterial materials for various applications. Accordingly, PDA antibacterial materials mainly include free-standing PDA materials and PDA-based composite materials. In this review, an overview of PDA antibacterial materials is provided to summarize these two types of antibacterial materials in detail, including the fabrication strategies and antibacterial mechanisms. The future development and challenges of PDA in this field are also presented. It is hoped that this review will provide an insight into the future development of antibacterial functional materials based on PDA.

Two-Sided Antibacterial Cellulose Combining Probiotics and Silver Nanoparticles

The constant increase of antibiotic-resistant bacteria demands the design of novel antibiotic-free materials. The combination of antibacterials in a biocompatible biomaterial is a very promising strategy to treat infections caused by a broader spectrum of resistant pathogens. Here, we combined two antibacterials, silver nanoparticles (AgNPs) and living probiotics (Lactobacillus fermentum, Lf), using bacterial cellulose (BC) as scaffold. By controlling the loading of each antibacterial at opposite BC sides, we obtained a two-sided biomaterial (AgNP-BC-Lf) with a high density of alive and metabolically active probiotics on one surface and AgNPs on the opposite one, being probiotics well preserved from the killer effect of AgNPs. The resulting two-sided biomaterial was characterized by Field-Emission Scanning Electron Microscopy (FESEM) and Confocal Laser Scanning Microscopy (CLSM). The antibacterial capacity against Pseudomonas aeruginosa (PA), an opportunistic pathogen responsible for a broad range of skin infections, was also assessed by agar diffusion tests in pathogen-favorable media. Results showed an enhanced activity against PA when both antibacterials were combined into BC (AgNP-BC-Lf) with respect to BC containing only one of the antibacterials, BC-Lf or AgNP-BC. Therefore, AgNP-BC-Lf is an antibiotic-free biomaterial that can be useful for the therapy of topical bacterial infections.

Recent Advances in a Polydopamine-Mediated Antimicrobial Adhesion System

The drug resistance developed by bacteria during antibiotic treatment has been a call to action for researchers and scientists across the globe, as bacteria and fungi develop ever increasing resistance to current drugs. Innovative antimicrobial/antibacterial materials and coatings to combat such infections have become a priority, as many infections are caused by indwelling implants (e.g., catheters) as well as improving postsurgical function and outcomes. Pathogenic microorganisms that can exist either in planktonic form or as biofilms in water-carrying pipelines are one of the sources responsible for causing water-borne infections. To combat this, researchers have developed nanotextured surfaces with bactericidal properties mirroring the topographical features of some natural antibacterial materials. Protein-based adhesives, secreted by marine mussels, contain a catecholic amino acid, 3,4-dihydroxyphenylalanine (DOPA), which, in the presence of lysine amino acid, empowers with the ability to anchor them to various surfaces in both wet and saline habitats. Inspired by these features, a novel coating material derived from a catechol derivative, dopamine, known as polydopamine (PDA), has been designed and developed with the ability to adhere to almost all kinds of substrates. Looking at the immense potential of PDA, this review article offers an overview of the recent growth in the field of PDA and its derivatives, especially focusing the promising applications as antibacterial nanocoatings and discussing various antimicrobial mechanisms including reactive oxygen species-mediated antimicrobial properties.

Enhanced Osseointegration of Titanium Implants by Surface Modification with Silicon-doped Titania Nanotubes

Introduction

Despite great progress made in developing orthopedic implants, the development of titanium (Ti) implants with ideal early osseointegration remains a big challenge. Our pilot study has demonstrated that Si-TiO₂ nanotubes on the surface of Ti substrates could enhance their osteogenic activity. Hence, in this study, we aim to comprehensively evaluate the effects of silicon-doped titania (Si-TiO₂) nanotubes on the osseointegration property of Ti implants.

Materials and Methods

The Ti implants were surface modified with Si-TiO₂ nanotubes through in situ anodization and Si plasma immersion ion implantation (PIII) method. Three groups were divided as Ti implants (Ti), Ti modified with TiO₂ nanotubes (TiO₂-NTs) and Ti modified with Si-TiO₂ nanotubes (Si-TiO₂-NTs). The morphology of Si-TiO₂ nanotubes was observed by scanning electron microscope. The growth and osteogenic differentiation of MC3T3-E1 cells on the Ti implants were evaluated. Further, the pull-out tests and in vivo osseointegration ability evaluation were performed after implanting the screws in the femur of Sprague Dawley rats.

Results

The Si-TiO₂ nanotubes could be seen on the surface of Ti implants. The MC3T3-E1 cells could grow on the surface of Ti, TiO₂-NTs and Si-TiO₂-NTs, and showed fast proliferation rate on the Si-TiO₂-NTs. Moreover, the production of some osteogenesis-related proteins (ALP and Runx2) at one week and calcium deposition at four week was also enhanced in Si-TiO₂-NTs rather than other groups. In vivo osseointegration results showed that Si-TiO₂ nanotube-modified Ti screws had higher pullout force at two and four weeks as well as enhanced new bone formation at six weeks compared to bare Ti screws and Ti screws modified with TiO₂ nanotubes alone.

Discussion

The modification of Si-TiO₂-NTs on the Ti substrate could generate a nanostructured and hydrophilic surface, which can promote cell growth. Moreover, the existence of the TiO₂ nanotubes and Si element also can improve the in vitro osteogenic differentiation of MC3T3-E1 cells and early bone formation around the implanted screws. Together, findings from this study show that surface modification of Ti implants with Si-TiO₂ nanotubes could enhance early osseointegration and therefore has the potential for clinical applications.

Endowing polyetheretherketone with anti-inflammatory ability and improved osteogenic ability

Both osteogenesis and anti-inflammatory bioactive materials play a vital role in the regeneration of skeletal defects. Bone inflammation is hard to cure and can lead to malformation or amputation. The purpose of this study is to use anti-inflammatory drugs to endow polyetheretherketone (PEEK) with the dual ability to achieve anti-inflammatory effects while maintaining favorable biocompatibility. In this experiment, the porous PEEK was immersed in an aspirin (ASP) solution after sulfonation, and the obtained porous PEEK had significantly improved the anti-inflammatory abilities. Additionally, grafting the bone forming peptide (BFP) onto the porous PEEK can distinctly enchance the osteogenesis capability. The effects of the BFP polypeptide on the proliferation of MC3T3-E1 cells and ALP activity, and the effects of aspirin on inflammation were systematically investigated. The modified material showed favorable biocompatibility and osteogenic ability. The results suggest that the combination of the BFP polypeptide with aspirin may lead to a synergetic effect on the stimulation of osteogenesis and on the reduction of inflammation.

Polydopamine Surface Coating Synergizes the Antimicrobial Activity of Silver Nanoparticles

Metal nanoparticles, especially silver nanoparticles (AgNPs), have drawn increasing attention for antimicrobial applications. Most studies have emphasized on the correlations between the antibacterial potency of AgNPs and the kinetics of metallic to ionic Ag conversion, while other antimicrobial mechanisms have been underestimated. In this work, we focused on the surface effects of polydopamine (PDA) coating on the antimicrobial activity of AgNPs. A method of fast deposition of PDA was used to synthesize the PDA-AgNPs with controllable coating thickness ranging from 3 to 25 nm. The antimicrobial activities of the PDA-AgNPs were analyzed by fluorescence-based growth curve assays on Escherichia coli. The results indicated that the PDA-AgNPs exhibited significantly higher antibacterial activities than poly(vinylpyrrolidone)-passivated AgNPs (PVP-AgNPs) and PDA themselves. It was found that the PDA coating synergized with the AgNPs to prominently enhance the potency of the PDA-AgNPs against bacteria. The analysis of X-ray photoelectron spectroscopy and Fourier transform infrared spectroscopy elucidated that the synergistic effects could be originated from the interaction/coordination between Ag and catechol group on the PDA coating. The synergistic effects led to increased generation of reactive oxygen species and the consequent bacterial damage. These findings demonstrated the importance of the surface effects on the antimicrobial properties of AgNPs. The underlying molecular mechanisms have shined light on the future development of more potent metal nanoparticle-based antimicrobial agents.

Gaseous sulfur trioxide induced controllable sulfonation promoting biomineralization and osseointegration of polyetheretherketone implants

Fabricating a desired porous structure on the surface of biomedical polyetheretherketone (PEEK) implants for enhancing biological functions is crucial and difficult due to its inherent chemical inertness. In this study, a porous surface of PEEK implants was fabricated by controllable sulfonation using gaseous sulfur trioxide (SO₃) for different time (5, 15, 30, 60 and 90 min). Micro-topological structure was generated on the surface of sulfonated PEEK implants preserving original mechanical properties. The protein absorption capacity and apatite forming ability was thus improved by the morphological and elemental change with higher degree of sulfonation. In combination of the appropriate micromorphology and bioactive sulfonate components, the cell adhesion, migration, proliferation and extracellular matrix secretion were obviously enhanced by the SPEEK-15 samples which were sulfonated for 15 min. Finding from this study revealed that controllable sulfonation by gaseous SO₃ would be an extraordinarily strategy for improving osseointegration of PEEK implants by adjusting the microstructure and chemical composition while maintaining excellent mechanical properties.

Metal-Containing Polydopamine Nanomaterials: Catalysis, Energy, and Theranostics

Polydopamine (PDA) is a major type of artificial melanin material with many interesting properties such as antioxidant activity, free-radical scavenging, high photothermal conversion efficiency, and strong metal-ion chelation. The high affinity of PDA to a wide range of metals/metal ions has offered a new class of functional metal-containing polydopamine (MPDA) nanomaterials with promising functions and extensive applications. Understanding and controlling the metal coordination environment is vital to achieve desirable functions for which such materials can be exploited. MPDA nanomaterials with metal/metal ions as the active functions are reviewed, including their synthesis and metal coordination environment and their applications in catalysis, batteries, solar cells, capacitors, medical imaging, cancer therapy, antifouling, and antibacterial coating. The current trends, limitations, and future directions of this area are also explored.

Tissue Engineering and Regenerative Medicine: Achievements, Future, and Sustainability in Asia

Exploring innovative solutions to improve the healthcare of the aging and diseased population continues to be a global challenge. Among a number of strategies toward this goal, tissue engineering and regenerative medicine (TERM) has gradually evolved into a promising approach to meet future needs of patients. TERM has recently received increasing attention in Asia, as evidenced by the markedly increased number of researchers, publications, clinical trials, and translational products. This review aims to give a brief overview of TERM development in Asia over the last decade by highlighting some of the important advances in this field and featuring major achievements of representative research groups. The development of novel biomaterials and enabling technologies, identification of new cell sources, and applications of TERM in various tissues are briefly introduced. Finally, the achievement of TERM in Asia, including important publications, representative discoveries, clinical trials, and examples of commercial products will be introduced. Discussion on current limitations and future directions in this hot topic will also be provided.

KR-12 coating of polyetheretherketone (PEEK) surface via polydopamine improves osteointegration and antibacterial activity in vivo

KR-12 was grafted onto the surface of PEEK, which improved the hydrophilicity of the material surface, promoted cell adhesion, osteogenic differentiation and osseointegration, while also endowing the appreciable antibacterial activity on the material surface.

Effects of a Coating of Nano Silicon Nitride on Porous Polyetheretherketone on Behaviors of MC3T3-E1 Cells in Vitro and Vascularization and Osteogenesis in Vivo

To improve the bioperformances of porous polyetheretherketone (PPK) for bone repair, silicon nitride-coated PPK (CSNPPK) was prepared by a method of suspension coating and melt binding. The results revealed that, as compared with PPK, the surface roughness, compressive strength, and water absorption of CSNPPK increased, while the pore size and porosity of CSNPPK exhibited no obvious changes. In addition, the cellular responses (including attachment, proliferation, and differentiation as well as osteogenically related gene expressions) of the MC3T3-E1 cells to CSNPPK were remarkably promoted compared with PPK and dense polyetheretherketone in vitro. Moreover, in the model of rabbit femoral condyle defects, the results of micro computed tomography and histological and mechanical evaluation revealed that the ingrowth of new vessels and bone tissues into CSNPPK was significantly greater than that into PPK in vivo. Furthermore, the load-displacement and push-out loads for CSNPPK with bone tissues were higher than for PPK, indicating good osseointegration. In short, CSNPPK not only promoted vascularization but also enhanced osteogenesis as well as osseointegration in vivo. Therefore, it can be suggested that CSNPPK with good biocompatibility, osteogenic activity, and vascularization might be a promising candidate as an implant for bone substitute and repair.

Facile Surface Modification Method for Synergistically Enhancing the Biocompatibility and Bioactivity of Poly(ether ether ketone) That Induced Osteodifferentiation

Poly(ether ether ketone) (PEEK) is a promising material in biomedical engineering due to its suitable mechanical properties and excellent chemical resistance and biocompatibility. However, the biological inertness of PEEK limits its applications. In this study, we developed a facile approach of immersion to generate a biocompatible and bioactive PEEK that induced osteodifferentiation. First, micropores on the surface of PEEK were introduced by concentrated sulfuric acid and subsequent water immersion, followed by the hydrothermal treatment to reduce residual sulfuric acid. Subsequently, the sulfonated PEEK surface was activated by the oxygen plasma treatment and then coated with a poly(dopamine) (PDA) layer by immersion into the dopamine solution. Finally, the tripeptide Arg-Gly-Asp (RGD) was integrated onto the PDA-coated surface of PEEK by immersion into the RGD peptide solution. The surface characteristics (physical chemistry and biological properties) and the ability to form bonelike apatite were systematically investigated by scanning electron microscopy, X-ray photoelectron spectroscopy, water contact angle analysis, the Archimedes' fluid saturation method, ellipsometry, a quartz crystal microbalance with dissipation monitoring, cell proliferation, real-time reverse transcription polymerase chain reaction analysis, alizarin red staining, immunocytochemistry staining, and simulated body fluid immersion. Collectively, the modified PEEK showed a significantly improved ability to promote cell proliferation, osteogenic differentiation, and bonelike apatite formation in vitro as compared to the PEEK control. These results demonstrate that combined facile surface modifications for PEEK enhance its bioactivity and biocompatibility, and induce osteodifferentiation. This study presents a strategy for broadening the use of PEEK in the application of orthopedic implants and could be industrially scalable in future.

Multifunctional Coating to Simultaneously Encapsulate Drug and Prevent Infection of Radiopaque Agent

Poly(methyl methacrylate) (PMMA) bone cements have been widely used in clinical practices. In order to enhance PMMA's imaging performance to facilitate surgical procedures, a supplementation of radiopaque agent is needed. However, PMMA bone cements are still facing problems of loosening and bacterial infection. In this study, a multifunctional coating to simultaneously encapsulate drug and prevent the infection of radiopaque agent has been developed. Barium sulfate (BaSO4), a common radiopaque agent, is used as a substrate material. We successfully fabricated porous BaSO4 microparticles, then modified with hexakis-(6-iodo-6-deoxy)-alpha-cyclodextrin (I-CD) and silver (Ag) to obtain porous BaSO4@PDA/I-CD/Ag microparticles. The porous nature and presence of PDA coating and I-CD on the surface of microparticles result in efficient loading and release of drugs such as protein. Meanwhile, the radiopacity of BaSO4@PDA/I-CD/Ag microparticles is enhanced by this multifunctional coating containing Ba, I and Ag. PMMA bone cements containing BaSO4@PDA/I-CD/Ag microparticles show 99% antibacterial rate against both Staphylococcus aureus (S. aureus) and Escherichia Coli (E. coli), yet without apparently affecting its biocompatibility. Together, this multifunctional coating possessing enhanced radiopacity, controlled drug delivery capability and exceptional antibacterial performance, may be a new way to modify radiopaque agents for bone cements.

Polydopamine-assisted surface modification for orthopaedic implants

Along with the massive use of implants in orthopaedic surgeries in recent few decades, there has been a tremendous demand for the surface modification of the implants to avoid surgery failure and improve their function. Polydopamine (PDA), being able to adhere to almost all kinds of substrates and possessing copious functional groups for covalently immobilizing biomolecules and anchoring metal ions, has been widely used for surface modification of materials since its discovery in the last decade. PDA and its derivatives can be used for the surface modification of orthopaedic implants to modulate cellular responses, including cell spreading, migration, proliferation, and differentiation, and may thereby enhance the function of existing implants. In addition, the osseointegration and antimicrobial properties of orthopaedic implants may also be improved by PDA-based coatings. The aim of this review is to provide a brief overview of current advances of surface modification technologies for orthopaedic implants using PDA and its derivatives as a medium. Given the versatility of PDA-based adhesion, such PDA-assisted surface modification technologies will certainly benefit the development of new orthopaedic implants.

THE TRANSLATIONAL POTENTIAL OF THIS ARTICLE

Surface treatments of orthopaedic implants, which are normally inert materials, are essential for their performance in vivo. This review summarizes recent advances in the surface modification of orthopaedic implants using facile and highly versatile techniques based on the use of polydopamine (PDA) and its derivatives.

A bio-inspired, one-step but versatile coating onto various substrates with strong antibacterial and enhanced osteogenesis

It is of great interest to prepare osteogenic and antibacterial coatings for successful implants. Current coating techniques suffer from being time-consuming, substrate material or shape dependence, expensive equipment, environmental pollution, low stability, processes that are difficult to control, etc. Herein, inspired by mussels, we report a one-step and versatile method to fabricate a dual functional coating. The coating is finished in minutes independently of materials or dimensions of substrates. Thus, our coatings exhibit strong antibacterial ability against both Gram-positive bacteria S. aureus, and Gram-negative bacteria E. coli, support the proliferation of dental pulp stem cells (DPSCs), and are powerful for inducing osteogenic differentiation. The universality, facility, rapidness, and mildness of our coating process, which is also environmentally-friendly and cost-effective, points towards potential applications in bone or dental implants.

Microporous Coatings of PEKK/SN Composites Integration with PEKK Exhibiting Antibacterial and Osteogenic Activity, and Promotion of Osseointegration for Bone Substitutes

To improve the antibacterial and osteogenic activities of poly(etherketoneketone) (PEKK), concentrated sulfuric acid (H₂SO₄) suspension with silicon nitride (SN) microparticle was utilized to modify PEKK surface. Through sulfonation reaction, microporous coatings of PEKK/SN composites were created on PEKK surface, which were integrated with PEKK substrate. The results showed that the content of SN in the microporous coatings increased with the increase of SN content in H₂SO₄ suspension (PKS without SN, PKSC5 and PKSC10 with 5 and 10 wt % SN content in H₂SO₄) and that the surface roughness and hydrophilicity of microporous coatings on PEKK were significantly improved with the SN content increasing. In addition, the microporous coating of PKSC10 with high SN content exhibited excellent antibacterial activity due to the synergistic action of the presence of amino (-NH₂) and sulfonic acid (-SO₃H) groups as well as the improvement of protein absorption. Moreover, the microporous coating of PKSC10 obviously stimulated adhesion, proliferation, and osteogenic differentiation of rat bone mesenchymal stem cells. Furthermore, histological and push-out load evaluation indicated that the microporous coating of PKSC10 significantly promoted osteogenesis and osseointegration in vivo. The results suggested that the microporous coating of PKSC10 with high SN content display good biocompatibility, antibacterial and osteogenic activities, and osseointegration ability, which would have great potential for bone substitutes.

Bi-functional titanium-polydopamine-zinc coatings for infection inhibition and enhanced osseointegration

The ideal orthopedic implant coating is expected to both inhibit microbial infection and promote osseointegration. In this study, Zn ions were immobilized on a Ti substrate via a polydopamine (PDA) chemical surface modification to prepare Ti-PDA-Zn coatings. Scanning electron microscopy (SEM), atomic force microscopy (AFM), energy-dispersive X-ray spectroscope (EDS), X-ray photoelectron spectroscopy (XPS), contact analysis system, and inductively coupled plasma atomic emission spectrometry (ICP-AES) were used to analyze the morphology, composition, wettability, and zinc ions release of the coatings. The Ti-PDA-Zn coatings demonstrated excellent antibacterial activities in vitro against both Staphylococcus aureus and Escherichia coli. The coatings additionally displayed good biocompatibility, as confirmed by cytoskeletal observations and cell viability assays. Furthermore, the in vivo results confirmed the excellent antibacterial properties and improved osseointegration capability of the Ti-PDA-Zn coating in the presence of S. aureus. The present findings indicate that the Ti-PDA-Zn coatings prepared herein have potential application in orthopedic implantation.

The ideal orthopedic implant coating is expected to both inhibit microbial infection and promote osseointegration.

Strontium/adiponectin co-decoration modulates the osteogenic activity of nano-morphologic polyetheretherketone implant

Polyetheretherketone (PEEK)-based implants have become popular in hard tissue orthopedic and dental field. However, its inherent bio-inertness limited its applications for bone repair/substitution of osteoporosis patients, with poor osteogenesis capability. In order to ameliorate their bioactivity, the 3D porous PEEK substrate was created by sulfonate processing, and the substrate was subsequently incorporated with strontium (Sr) through a hydrothermal reaction in Sr(OH)₂ solutions. The adiponectin (APN) protein membrane was deposited on the substrate via polydopamine-assisted deposition. Surface characterization results disclosed that the nanostructures had been formed on sPEEK-Sr-APN surafces, and APN coatings on the substrates could adjust Sr release rate and further mediate cell-material interactions. in vitro experiments indicated that the cellular effects (proliferation and differentiation) of MC3T3-E1 were significantly increased with Sr/APN coordinated regulation. This study provides bioactive Sr and APN as promising active components for bio-functional bone regeneration/substitution, and optimizes the osteointegration of PEEK implants in clinic.

Antibacterial and immunogenic behavior of silver coatings on additively manufactured porous titanium

Implant-associated infections (IAI) are often recurrent, expensive to treat, and associated with high rates of morbidity, if not mortality. We biofunctionalized the surface of additively manufactured volume-porous titanium implants using electrophoretic deposition (EPD) as a way to eliminate the peri-operative bacterial load and prevent IAI. Chitosan-based (Ch) coatings were incorporated with different concentrations of silver (Ag) nanoparticles or vancomycin. A full-scale in vitro and in vivo study was then performed to evaluate the antibacterial, immunogenic, and osteogenic activity of the developed implants. In vitro, Ch + vancomycin or Ch + Ag coatings completely eliminated, or reduced the number of planktonic and adherent Staphylococcus aureus by up to 4 orders of magnitude, respectively. In an in vivo tibia intramedullary implant model, Ch + Ag coatings caused no adverse immune or bone response under aseptic conditions. Following Staphylococcus aureus inoculation, Ch + vancomycin coatings reduced the implant infection rate as compared to chitosan-only coatings. Ch + Ag implants did not demonstrate antibacterial effects in vivo and even aggravated infection-mediated bone remodeling including increased osteoclast formation and inflammation-induced new bone formation. As an explanation for the poor antibacterial activity of Ch + Ag implants, it was found that antibacterial Ag concentrations were cytotoxic for neutrophils, and that non-toxic Ag concentrations diminished their phagocytic activity. This study shows the potential of EPD coating to biofunctionalize porous titanium implants with different antibacterial agents. Using this method, Ag-based coatings seem inferior to antibiotic coatings, as their adverse effects on the normal immune response could cancel the direct antibacterial effects of Ag nanoparticles. STATEMENT OF SIGNIFICANCE: Implant-associated infections (IAI) are a clinical, societal, and economical burden. Surface biofunctionalization approaches can render complex metal implants with strong local antibacterial action. The antibacterial effects of inorganic materials such as silver nanoparticles (Ag NPs) are often highlighted under very confined conditions in vitro. As a novelty, this study also reports the antibacterial, immunogenic, and osteogenic activity of Ag NP-coated additively-manufactured titanium in vivo. Importantly, it was found that the developed coatings could impair the normal function of neutrophils, the most important phagocytic cells protecting us from IAI. Not surprisingly, the Ag NP-based coatings were outperformed by an antibiotic-based coating. This emphasizes the importance of also targeting implant immune-modulatory functions in future coating strategies against IAI.