Antibacterial nanohydroxyapatite/polyurethane composite scaffolds with silver phosphate particles for bone regeneration

Biological Effects, Applications and Design Strategies of Medical Polyurethanes Modified by Nanomaterials

Polyurethane (PU) has wide application and popularity as medical apparatus due to its unique structural properties relationship. However, there are still some problems with medical PUs, such as a lack of functionality, insufficient long-term implantation safety, undesired stability, etc. With the rapid development of nanotechnology, the nanomodification of medical PU provides new solutions to these clinical problems. The introduction of nanomaterials could optimize the biocompatibility, antibacterial effect, mechanical strength, and degradation of PUs via blending or surface modification, therefore expanding the application range of medical PUs. This review summarizes the current applications of nano-modified medical PUs in diverse fields. Furthermore, the underlying mechanisms in efficiency optimization are analyzed in terms of the enhanced biological and mechanical properties critical for medical use. We also conclude the preparation schemes and related parameters of nano-modified medical PUs, with discussions about the limitations and prospects. This review indicates the current status of nano-modified medical PUs and contributes to inspiring novel and appropriate designing of PUs for desired clinical requirements.

Scaffolds in the microbial resistant era: Fabrication, materials, properties and tissue engineering applications

Due to microbial infections dramatically affect cell survival and increase the risk of implant failure, scaffolds produced with antimicrobial materials are now much more likely to be successful. Multidrug-resistant infections without suitable prevention strategies are increasing at an alarming rate. The ability of cells to organize, develop, differentiate, produce a functioning extracellular matrix (ECM) and create new functional tissue can all be controlled by careful control of the extracellular microenvironment. This review covers the present state of advanced strategies to develop scaffolds with antimicrobial properties for bone, oral tissue, skin, muscle, nerve, trachea, cardiac and other tissue engineering applications. The review focuses on the development of antimicrobial scaffolds against bacteria and fungi using a wide range of materials, including polymers, biopolymers, glass, ceramics and antimicrobials agents such as antibiotics, antiseptics, antimicrobial polymers, peptides, metals, carbon nanomaterials, combinatorial strategies, and includes discussions on the antimicrobial mechanisms involved in these antimicrobial approaches. The toxicological aspects of these advanced scaffolds are also analyzed to ensure future technological transfer to clinics. The main antimicrobial methods of characterizing scaffolds’ antimicrobial and antibiofilm properties are described. The production methods of these porous supports, such as electrospinning, phase separation, gas foaming, the porogen method, polymerization in solution, fiber mesh coating, self-assembly, membrane lamination, freeze drying, 3D printing and bioprinting, among others, are also included in this article. These important advances in antimicrobial materials-based scaffolds for regenerative medicine offer many new promising avenues to the material design and tissue-engineering communities.

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Antibacterial, antifungal and antibiofilm scaffolds.

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Antimicrobial scaffold fabrication techniques.

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Antimicrobial biomaterials for tissue engineering applications.

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Antimicrobial characterization methods of scaffolds.

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Bone, oral tissue, skin, muscle, nerve, trachea, cardiac, among other applications.

Is Silver the New Gold? A Systematic Review of the Preclinical Evidence of Its Use in Bone Substitutes as Antiseptic

Antibiotic-laden bone substitutes represent a viable option in the treatment of bone and joint infections with bone defects. In particular, the addition of silver ions or silver nanoparticles to bone substitutes to achieve local antiseptic activity could represent a further contribution, also helping to prevent bacterial resistance to antibiotics. An in-depth search of the main scientific databases was performed regarding the use of silver compounds for bone substitution. The available evidence is still limited to the preclinical level: 22 laboratory studies, 2 animal models, and 3 studies, with both in vitro and in vivo analysis, were found on the topic. Numerous biomaterials have been evaluated. In vitro studies confirmed that silver in bone substitutes retains the antibacterial activity already demonstrated in coatings materials. Cytotoxicity was generally found to be low and only related to silver concentrations higher than those sufficient to achieve antibacterial activity. Instead, there are only a few in vivo studies, which appear to confirm antibacterial efficacy, although there is insufficient evidence on the pharmacokinetics and safety profile of the compounds investigated. In conclusion, research on bone substitutes doped with silver is in its early stages, but the preliminary findings seem promising.

No-Observed-Effect Level of Silver Phosphate in Carbonate Apatite Artificial Bone on Initial Bone Regeneration

Fracture-related infections require both treatments for bacteria removal and bone reconstruction. The use of combined broad-spectrum antibacterial silver compounds and artificial bone with high osteogenic activity is considered to be an effective strategy for achieving these treatments in one surgery. However, silver compounds are toxic for living tissues even at low concentrations. Herein, we investigated the no-observed-effect level (NOEL) of silver phosphate (Ag₃PO₄) in a bone substitute composed of carbonate apatite (CO₃Ap), a bone mineral, using in vitro and in vivo experiments. In vitro experiments demonstrated that the CO₃Ap artificial bone containing ≥0.1 wt % Ag₃PO₄ exerted antibacterial effects against Staphylococcus epidermidis, while those containing ≤0.3 wt % Ag₃PO₄ did not affect cellular adhesion, proliferation, differentiation, and calcification of osteoblast-like MC3T3-E1 cells. In vivo experiments demonstrated that the CO₃Ap artificial bone containing ≤0.3 wt % Ag₃PO₄ replaced a new bone to the same levels as those without Ag₃PO₄ 4 weeks after implantation into the bone defect of the rabbit femur condyle. However, the CO₃Ap artificial bone containing 0.3 wt % Ag₃PO₄ caused an inflammatory reaction, whereas those containing ≤0.1 wt % Ag₃PO₄ did not. Thus, both bone regeneration and infection control without any adverse effects were achieved using the CO₃Ap artificial bone containing 0.1 wt % Ag₃PO₄, indicating that the NOEL of Ag₃PO₄ was 0.1 wt %. Our results provide an effective strategy for the treatments of fracture-related infections.

Metallic Nanoscaffolds as Osteogenic Promoters: Advances, Challenges and Scope

Bone injuries and fractures are often associated with post-surgical failures, extended healing times, infection, a lack of return to a normal active lifestyle, and corrosion associated allergies. In this regard, this review presents a comprehensive report on advances in nanotechnology driven solutions for bone tissue engineering. The fabrication of metals such as copper, gold, platinum, palladium, silver, strontium, titanium, zinc oxide, and magnetic nanoparticles with tunable physico-chemical and opto-electronic properties for osteogenic scaffolds is discussed here in detail. Furthermore, the rational selection of a polymeric base such as chitosan, collagen, poly (L-lactide), hydroxyl-propyl-methyl cellulose, poly-lactic-co-glycolic acid, polyglucose-sorbitol-carboxymethy ether, polycaprolactone, natural rubber latex, and silk fibroin for scaffold preparation is also discussed. These advanced materials and fabrication strategies not only provide for appropriate mechanical strength but also render integrity, making them appealing for orthopedic applications. Further, such scaffolds can be functionalized with ligands or biomolecules such as hydroxyapatite, polypyrrole (PPy), magnesium, zinc dopants, and growth factors to stimulate osteogenic differentiation, mineralization, and neovascularization to aid in rapid healing. Future directions to co-incorporate bioceramics, biogenic nanoparticles, and fourth generation biomaterials to enhance biocompatibility, mechanical properties, and rapid recovery are also included in this review. Hence, the further development of such biomimetic metal-based nano-scaffolds at a lower cost with reduced risks and greater efficacy at regrowing bone can revolutionize the future of orthopedics.

Electrospun Scaffolds Containing Silver-Doped Hydroxyapatite with Antimicrobial Properties for Applications in Orthopedic and Dental Bone Surgery

Preventing the development of osteomyelitis while enhancing bone regeneration is challenging, with relatively little progress to date in translating promising technologies to the clinic. Nanoscale hydroxyapatite (nHA) has been employed as a bone graft substitute, and recent work has shown that it may be modified with silver to introduce antimicrobial activity against known pathogens. The aim of this study was to incorporate silver-doped nHA into electrospun scaffolds for applications in bone repair. Silver-doped nHA was produced using a modified, rapid mixing, wet precipitation method at 2, 5, 10 mol.% silver. The silver-doped nHA was added at 20 wt.% to a polycaprolactone solution for electrospinning. Bacteria studies demonstrated reduced bacterial presence, with Escherichia coli and Staphylococcus aureus undetectable after 96 h of exposure. Mesenchymal stem cells (MSCs) were used to study both toxicity and osteogenicity of the scaffolds using PrestoBlue^® and alkaline phosphatase (ALP) assays. Innovative silver nHA scaffolds significantly reduced E. coli and S. aureus bacterial populations while maintaining cytocompatibility with mammalian cells and enhancing the differentiation of MSCs into osteoblasts. It was concluded that silver-doped nHA containing scaffolds have the potential to act as an antimicrobial device while supporting bone tissue healing for applications in orthopedic and dental bone surgery.

One-Step Preparation of an AgNP-nHA@RGO Three-Dimensional Porous Scaffold and Its Application in Infected Bone Defect Treatment

Background

Bactericidal capacity, durable inhibition of biofilm formation, and a three-dimensional (3D) porous structure are the emphases of infected bone defect (IBD) treatment via local scaffold implantation strategy.

Purpose

In this study, silver nanoparticle (AgNP)-loaded nano-hydroxyapatite (nHA)@ reduced graphene oxide (RGO) 3D scaffolds (AHRG scaffolds) were designed to alleviate bone infection, inhibit biofilm formation, and promote bone repair through the synergistic effects of AgNPs, RGO, and nHA.

Materials and Methods

AHRGs were prepared using a one-step preparation method, to create a 3D porous scaffold to facilitate a uniform distribution of AgNPs and nHA. Methicillin-resistant Staphylococcus aureus (MRSA) was used as a model-resistant bacterium, and the effects of different silver loadings on the antimicrobial activity and cytocompatibility of materials were evaluated. Finally, a rabbit IBD model was used to evaluate the therapeutic effect of the AHRG scaffold in vivo.

Results

The results showed successful synthesis of the AHRG scaffold. The ideal 3D porous structure was verified using scanning electron microscopy and transmission electron microscopy, and X-ray photoelectron spectroscopy and selected area electron diffraction measurements revealed uniform distributions of AgNP and nHA. In vitro antibacterial and cytocompatibility indicated that the 4% AHRG scaffolds possessed the most favorable balance of bactericidal properties and cytocompatibility. In vivo evaluation of the IBD model showed promising treatment efficacy of AHRG scaffolds.

Conclusion

The as-fabricated AHRG scaffolds effectively eliminated infection and inhibited biofilm formation. IBD repair was facilitated by the bactericidal properties and 3D porous structure of the AHRG scaffold, suggesting its potential in the treatment of IBDs.

Antibacterial cotton fabrics via immobilizing silver phosphate nanoparticles onto the chitosan nanofiber coating

Development of chitosan nanofiber (CNF)/nano‑silver phosphate (Ag3PO4) coatings is reported for the fabrication of antibacterial cotton fabrics. The surface morphology and chemical composition were evaluated by scanning electron microscopy (SEM) and X-ray photoelectron spectroscopy (XPS), respectively. SEM results revealed that Ag3PO4 have formed micron-scale clusters and were not completely deposited on the fabric's surface whereas CNFs properly coated the fabric. However, once the hybrid of CNFs and Ag3PO4 was utilized, nanoparticles were better deposited on the fabric. The porous and nano-fibrous structure of CNFs provided an ideal substrate to which nanoparticles tightly adhered. The antibacterial activity of the as-synthesized Ag3PO4 nanoparticles was demonstrated by measuring the minimum inhibitory concentration (MIC). Moreover, the antibacterial property of the coated fabrics was demonstrated by colony counting method and zone of inhibition (ZOI). The bacterial adhesion reductions for CNF/Ag3PO4 coated fabrics were obtained as 100 and 99.8% against S. aureus and E. coli, respectively. Moreover, ZOI was highly increased in the case of the hybrid coating. The results demonstrated the promising potential of CNF/Ag3PO4 coatings for the fabrication of antibacterial cotton fabrics to be used as antibacterial garments for clinical environments.

Shape-Depended Biological Properties of Ag3PO4 Microparticles: Evaluation of Antimicrobial Properties and Cytotoxicity in In Vitro Model-Safety Assessment of Potential Clinical Usage

Implant-related infections are an emerging clinical and economic problem. Therefore, we decided to assess potential clinical usefulness and safety of silver orthophosphate microparticles (SOMPs) regarding their shape. We synthesized and then assessed antimicrobial properties and potential cytotoxicity of six shapes of SOMPs (tetrapod, cubes, spheres, tetrahedrons, branched, and rhombic dodecahedron). We found that SOMPs had a high antimicrobial effect; they were more efficient against fungi than bacteria. SOMPs exerted an antimicrobial effect in concentrations not toxic to mammalian cells: human fetal osteoblast (hFOB1.19), osteosarcoma (Saos-2), mouse preosteoblasts (MC3T3-E1), skin fibroblast (HDF), and mouse myoblast (C2C12). At higher concentration SOMPs, induced shape- and concentration-dependent cytotoxicity (according to MTT and BrdU assays). Tetrapod SOMPs had the smallest effect, whereas cubical SOMPs, the highest on cell viability. hFOB1.19 were the most resistant cells and C2C12, the most susceptible ones. We have proven that the induction of oxidative stress and inflammation is involved in the cytotoxic mechanism of SOMPs. After treatment with microparticles, we observed changes in levels of reactive oxygen species, first-line defense antioxidants-superoxide dismutase (SOD1, SOD3), and glutathione peroxidase (GPX4), metalloproteinase (MMP1, MMP3), and NF-κB protein. Neither cell cycle distribution nor ultrastructure was altered as determined by flow cytometry and transmission electron microscopy, respectively. In conclusion, silver orthophosphate may be a safe and effective antimicrobial agent on the implant surface. Spherical-shaped SOMPs are the most promising for biomedical application.

Local extraction and detection of early stage breast cancers through a microneedle and nano-Ag/MBL film based painless and blood-free strategy

Early diagnosis is the key to the good prognosis of breast cancer. At present, clinical tumor diagnosis is mainly through serum analysis, which is painful and can only detect relatively advanced tumors that have already metastasized from the glands into the blood circulation. Here, we developed an earlier diagnostic method (before tumor cells entering the blood) of breast cancers through a convenient and painless process with blood-free samples. The microneedles were utilized to insert into the animals' testing areas, while the tissue fluid was collected through our synthesized breathable thin film. The obtained tissue fluid sample was then incubated to form blue products. In the area where tumors occurred, the blue changes were more obvious than the healthy area, a semi-localization and semi-quantitative detection of the tumorous area thus could be realized. The results of corresponding animal experiments showed that, after the injection of tumor cells, the proposed nano-Ag based colorimetric method can detect the occurrence of breast cancers in 7 days. What is more, these early tumors could be effectively suppressed through classical DOX treatment. For comparison, the classical blood test needed 14 days to validate the occurrence of breast cancers. The subsequent human tests further demonstrated the feasibility of the present method. The development of this work could provide a more convenient, accurate and comfortable technology to support for the early screening and diagnosis of cancer patients, so as to fundamentally reduce the mortality of the breast cancers.

Nanoantibiotics: A Novel Rational Approach to Antibiotic Resistant Infections

Background:

The main drawbacks for using conventional antimicrobial agents are the development of multiple drug resistance due to the use of high concentrations of antibiotics for extended periods. This vicious cycle often generates complications of persistent infections, and intolerable antibiotic toxicity. The problem is that while all new discovered antimicrobials are effective and promising, they remain as only short-term solutions to the overall challenge of drug-resistant bacteria.

Objective:

Recently, nanoantibiotics (nAbts) have been of tremendous interest in overcoming the drug resistance developed by several pathogenic microorganisms against most of the commonly used antibiotics. Compared with free antibiotic at the same concentration, drug delivered via a nanoparticle carrier has a much more prominent inhibitory effect on bacterial growth, and drug toxicity, along with prolonged drug release. Additionally, multiple drugs or antimicrobials can be packaged within the same smart polymer which can be designed with stimuli-responsive linkers. These stimuli-responsive nAbts open up the possibility of creating multipurpose and targeted antimicrobials. Biofilm formation still remains the leading cause of conventional antibiotic treatment failure. In contrast to conventional antibiotics nAbts easily penetrate into the biofilm, and selectively target biofilm matrix constituents through the introduction of bacteria specific ligands. In this context, various nanoparticles can be stabilized and functionalized with conventional antibiotics. These composites have a largely enhanced bactericidal efficiency compared to the free antibiotic.

Conclusion:

Nanoparticle-based carriers deliver antibiotics with better biofilm penetration and lower toxicity, thus combating bacterial resistance. However, the successful adaptation of nanoformulations to clinical practice involves a detailed assessment of their safety profiles and potential immunotoxicity.

Efficacy of novel nano-hydroxyapatite/polyurethane composite scaffolds with silver phosphate particles in chronic osteomyelitis

Recently, chronic osteomyelitis is still a challenging surgical problem. Unfortunately, the traditional clinical method using bone cement loaded antibiotics is restricted due to its non-biodegradability and limited release of antibiotics. Hydroxyapatite is a good adsorbent with good biocompatibility, an ideal bone repair material, and can avert the requirement for the secondary surgical procedure of removal. In this study, nano-hydroxyapatite combined with a polyurethane containing 3% silver (Ag/n-HA/PU) was synthesized, and investigated for its efficacy of treating chronic bone infection with bone defects. To clarify its silver ions release characteristics, the concentration of the Ag⁺ in the elution was analyzed every day after in vitro deionized water immersion. A chronic osteomyelitis of tibia in rabbit model was established, and 70 New Zealand rabbits were divided into 4 groups, including the blank control group, nano-hydroxyapatite combined with polyurethane (n-HA/PU) implant group, 3% Ag/n-HA/PU group and 10% Ag/n-HA/PU group after debridement. Routine blood tests, radiography, Micro-CT, and histological staining were conducted at 4 days, 3, 6 and 12 weeks post-treatment. The results showed that the released silver from the 3% Ag/n-HA/PU and 10% Ag/n-HA/PU exhibited an initial burst release and followed by a slow controlled release up to 39 days and 42 days respectively. A good repair of bone defects, an appropriate rate of degradation of scaffolds and no significant toxicity were observed in the 3% Ag/n-HA/PU group, indicating the advantages of this novel synthetic scaffold to be a potential option for the treatment of chronic osteomyelitis. A novel nano-composite, nano-hydroxyapatite combined with a polyurethane containing 3% silver (Ag/n-HA/PU) provide controlled release of Ag⁺, illustrated by its abilities of biodegradation, antimicrobial activity, and favorable repair of bone defects in the treatment of chronic osteomyelitis.

Three-Dimensional Printing of Drug-Loaded Scaffolds for Antibacterial and Analgesic Applications

Pneumatic extrusion-based three-dimensional (3D) printing can be used to fabricate custom-made scaffolds to restore irregular bone defects. During the 3D printing process, therapeutic agents can be added to the scaffolds. This study aimed to develop a polycaprolactone (PCL) scaffold loaded with Ag₃PO₄ to prevent infections and lidocaine for pain relief by one-step 3D printing. We hypothesized that the drug release could be controlled by varying the filament diameter of the 3D printed scaffolds. To this end, PCL slurry mixed with different amounts of silver phosphate and lidocaine was printed via differently sized nozzles. The obtained cylindric scaffolds displayed a porous interconnected microstructure with high fidelity. The Ag₃PO₄ and lidocaine were distributed homogeneously. The lidocaine release could be controlled by adjusting the filament diameter while the silver release is correlated with the Ag₃PO₄ loading amount. The released medium from silver-loaded scaffolds exhibited an obvious inhibition zone against Staphylococcus aureus and Escherichia coli upon loading with 1% Ag₃PO₄ for up to 6 days and with 3% Ag₃PO₄ for at least 7 days. Cytotoxicity of all scaffolds was screened by cell assay. In conclusion, the pneumatic extrusion-based 3D printing provides a practical technique to fabricate drug-loaded scaffolds. The Ag₃PO₄ and lidocaine loaded PCL scaffolds showed the potential for infection prevention and pain relief.

Three-dimensional graphene oxide-coated polyurethane foams beneficial to myogenesis

The development of three dimensional (3D) scaffolds for promoting and stimulating cell growth is one of the greatest concerns in biomedical and tissue engineering. In the present study, novel biomimetic 3D scaffolds composed of polyurethane (PU) foam and graphene oxide (GO) nanosheets were designed, and their potential as 3D scaffolds for skeletal tissue regeneration was explored. The GO-coated PU foams (GO-PU foams) were characterized by scanning electron microscopy and Raman spectroscopy. It was revealed that the 3D GO-PU foams consisted of an interconnected foam-like network structure with an approximate 300 μm pore size, and the GO was uniformly distributed in the PU foams. On the other hand, the myogenic stimulatory effects of GO on skeletal myoblasts were also investigated. Moreover, the cellular behaviors of the skeletal myoblasts within the 3D GO-PU foams were evaluated by immunofluorescence analysis. Our findings showed that GO can significantly promote spontaneous myogenic differentiation without any myogenic factors, and the 3D GO-PU foams can provide a suitable 3D microenvironment for cell growth. Furthermore, the 3D GO-PU foams stimulated spontaneous myogenic differentiation via the myogenic stimulatory effects of GO. Therefore, this study suggests that the 3D GO-PU foams are beneficial to myogenesis, and can be used as biomimetic 3D scaffolds for skeletal tissue engineering.