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Wang M, Li J, Geng M, Yang Z, Xi A, Yu Y, Liu B, Tay FR, Gou Y. Mussel-inspired Bifunctional Coating for Long-Term Stability of Oral Implants. Acta Biomater 2024:S1742-7061(24)00526-9. [PMID: 39299623 DOI: 10.1016/j.actbio.2024.09.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2024] [Revised: 08/31/2024] [Accepted: 09/10/2024] [Indexed: 09/22/2024]
Abstract
Peri-implantitis and osseointegration failure present considerable challenges to the prolonged stability of oral implants. To address these issues, there is an escalating demand for a resilient implant surface coating that seamlessly integrates antimicrobial features to combat bacteria-induced peri-implantitis, and osteogenic properties to promote bone formation. In the present study, a bio-inspired poly(amidoamine) dendrimer (DA-PAMAM-NH2) is synthesized by utilizing a mussel protein (DA) known for its strong adherence to various materials. Conjugating DA with PAMAM-NH2, inherently endowed with antibacterial and osteogenic properties, results in a robust and multifunctional coating. Robust adhesion between DA-PAMAM-NH2 and the titanium alloy surface is identified using confocal laser scanning microscopy (CLSM) and attenuated total reflectance-infrared (ATR-IR) spectroscopy. Following a four-week immersion of the coated titanium alloy surface in simulated body fluid (SBF), the antimicrobial activity and superior osteogenesis of the DA-PAMAM-NH2-coated surface remain stable. In contrast, the bifunctional effects of the PAMAM-NH2-coated surface diminish after the same immersion period. In vivo animal experiments validate the enduring antimicrobial and osteogenic properties of DA-PAMAM-NH2-coated titanium alloy implants, significantly enhancing the long-term stability of the implants. This innovative coating holds promise for addressing the multifaceted challenges associated with peri-implantitis and osseointegration failure in titanium-based implants. STATEMENT OF SIGNIFICANCE: Prolonged stability of oral implants remains a clinically-significant challenge. Peri-implantitis and osseointegration failure are two important contributors to the poor stability of oral implants. The present study developed a mussel-bioinspired poly(amidoamine) dendrimer (DA-PAMAM-NH2) for a resilient implant surface coating that seamlessly integrates antimicrobial features to combat bacteria-induced peri-implantitis, and osteogenic properties to promote bone formation to extend the longevity of oral implants.
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Affiliation(s)
- Mengmeng Wang
- School/Hospital of Stomatology, Lanzhou University; Key Laboratory of Dental Maxillofacial Reconstruction and Biological Intelligence Manufacturing of Gansu Province, Lanzhou, 730000, Gansu Province, China
| | - Jie Li
- School/Hospital of Stomatology, Lanzhou University; Key Laboratory of Dental Maxillofacial Reconstruction and Biological Intelligence Manufacturing of Gansu Province, Lanzhou, 730000, Gansu Province, China
| | - Mengqian Geng
- School/Hospital of Stomatology, Lanzhou University; Key Laboratory of Dental Maxillofacial Reconstruction and Biological Intelligence Manufacturing of Gansu Province, Lanzhou, 730000, Gansu Province, China
| | - Zhen Yang
- School/Hospital of Stomatology, Lanzhou University; Key Laboratory of Dental Maxillofacial Reconstruction and Biological Intelligence Manufacturing of Gansu Province, Lanzhou, 730000, Gansu Province, China
| | - Aiwen Xi
- School/Hospital of Stomatology, Lanzhou University; Key Laboratory of Dental Maxillofacial Reconstruction and Biological Intelligence Manufacturing of Gansu Province, Lanzhou, 730000, Gansu Province, China
| | - Yingying Yu
- School/Hospital of Stomatology, Lanzhou University; Key Laboratory of Dental Maxillofacial Reconstruction and Biological Intelligence Manufacturing of Gansu Province, Lanzhou, 730000, Gansu Province, China
| | - Bin Liu
- School/Hospital of Stomatology, Lanzhou University; Key Laboratory of Dental Maxillofacial Reconstruction and Biological Intelligence Manufacturing of Gansu Province, Lanzhou, 730000, Gansu Province, China
| | - Franklin R Tay
- The Dental College of Georgia, Augusta University, Augusta, GA, USA.
| | - Yaping Gou
- School/Hospital of Stomatology, Lanzhou University; Key Laboratory of Dental Maxillofacial Reconstruction and Biological Intelligence Manufacturing of Gansu Province, Lanzhou, 730000, Gansu Province, China
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Xu H, Li S, Liu S, Li S, Yin Z, Du Y, Weng X, Qian W. The presence of a sinus tract is associated with reinfection after two-stage revision surgery for prosthetic hip joint infection: a case-control study. BMC Musculoskelet Disord 2024; 25:721. [PMID: 39244574 PMCID: PMC11380202 DOI: 10.1186/s12891-024-07840-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2024] [Accepted: 08/30/2024] [Indexed: 09/09/2024] Open
Abstract
BACKGROUND Reinfection rates after two-stage revision (TSR) for prosthetic joint infection (PJI) range from 7.9 to 14%. Many factors, including sinus tracts, are associated with reinfection after this procedure. This study aimed to delineate whether the presence of sinus tract could increase reinfection rate after TSR and to investigate other potential risk factors for reinfection after TSR. METHODS We conducted a case-control study by retrospectively reviewing patients who underwent TSR for prosthetic hip joint infection from 2002 to 2022. The case group included patients who developed reinfection after TSR, while the control group consisted of patients who did not experience reinfection. PJI and reinfection after TSR were defined based on Delphi-based international consensus criteria. Patient demographics, past medical history, clinical manifestations, laboratory results, interval between stages, microbiological culture results were collected. Univariate analyses were utilized to assess the effect of sinus tract on reinfection and to identify other risk factors for reinfection after TSR. RESULTS Six patients with reinfection after TSR were included as the case group and 32 patients without reinfection were in the control group. Significant difference was observed in percentage of patients with sinus tracts between the two groups (67% in the case group versus 19% in the control group, p = 0.031, OR = 8.7). Significant difference was also found in percentage of patients with positive cultures of synovial fluid and synovium harvested during the first-stage revision between the two groups (100% in the case group versus 50% in the control group, p = 0.030). Additionally, patients in the case group had a significantly higher C-reactive protein (CRP) level prior to the second stage revision than that of patients in the control group (8.80 mg/L versus 2.36 mg/L, p = 0.005), despite normal CRP levels in all patients. CONCLUSIONS Our study revealed that the presence of sinus tracts could significantly increase risk of postoperative reinfection after TSR. Positive cultures during the first stage revision and elevated CRP level prior to the second stage revision could also increase the risk of reinfection after TSR. Further studies with a larger sample size are required. TRIAL REGISTRATION Retrospectively registered.
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Affiliation(s)
- Hongjun Xu
- Department of Orthopedic Surgery, Peking Union Medical College, Peking Union Medical College Hospital, Chinese Academy of Medical Science, Beijing, 100730, China
| | - Songlin Li
- Department of Orthopedic Surgery, Peking Union Medical College, Peking Union Medical College Hospital, Chinese Academy of Medical Science, Beijing, 100730, China
| | - Sen Liu
- Department of Orthopedic Surgery, Peking Union Medical College, Peking Union Medical College Hospital, Chinese Academy of Medical Science, Beijing, 100730, China
| | - Shanni Li
- Department of Orthopedic Surgery, Peking Union Medical College, Peking Union Medical College Hospital, Chinese Academy of Medical Science, Beijing, 100730, China
| | - Zhaojing Yin
- Department of Orthopedic Surgery, Peking Union Medical College, Peking Union Medical College Hospital, Chinese Academy of Medical Science, Beijing, 100730, China
| | - Yiyang Du
- Department of Orthopedic Surgery, Peking Union Medical College, Peking Union Medical College Hospital, Chinese Academy of Medical Science, Beijing, 100730, China
| | - Xisheng Weng
- Department of Orthopedic Surgery, Peking Union Medical College, Peking Union Medical College Hospital, Chinese Academy of Medical Science, Beijing, 100730, China
| | - Wenwei Qian
- Department of Orthopedic Surgery, Peking Union Medical College, Peking Union Medical College Hospital, Chinese Academy of Medical Science, Beijing, 100730, China.
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Cometta S, Hutmacher DW, Chai L. In vitro models for studying implant-associated biofilms - A review from the perspective of bioengineering 3D microenvironments. Biomaterials 2024; 309:122578. [PMID: 38692146 DOI: 10.1016/j.biomaterials.2024.122578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Revised: 04/01/2024] [Accepted: 04/13/2024] [Indexed: 05/03/2024]
Abstract
Biofilm research has grown exponentially over the last decades, arguably due to their contribution to hospital acquired infections when they form on foreign body surfaces such as catheters and implants. Yet, translation of the knowledge acquired in the laboratory to the clinic has been slow and/or often it is not attempted by research teams to walk the talk of what is defined as 'bench to bedside'. We therefore reviewed the biofilm literature to better understand this gap. Our search revealed substantial development with respect to adapting surfaces and media used in models to mimic the clinical settings, however many of the in vitro models were too simplistic, often discounting the composition and properties of the host microenvironment and overlooking the biofilm-implant-host interactions. Failure to capture the physiological growth conditions of biofilms in vivo results in major differences between lab-grown- and clinically-relevant biofilms, particularly with respect to phenotypic profiles, virulence, and antimicrobial resistance, and they essentially impede bench-to-bedside translatability. In this review, we describe the complexity of the biological processes at the biofilm-implant-host interfaces, discuss the prerequisite for the development and characterization of biofilm models that better mimic the clinical scenario, and propose an interdisciplinary outlook of how to bioengineer biofilms in vitro by converging tissue engineering concepts and tools.
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Affiliation(s)
- Silvia Cometta
- Max Planck Queensland Centre, Queensland University of Technology, Brisbane, QLD 4000, Australia; Faculty of Engineering, School of Mechanical, Medical and Process Engineering, Queensland University of Technology, Brisbane, QLD 4000, Australia; Australian Research Council (ARC) Training Centre for Multiscale 3D Imaging, Modelling, and Manufacturing (M3D Innovation), Queensland University of Technology, Brisbane, QLD 4000, Australia.
| | - Dietmar W Hutmacher
- Max Planck Queensland Centre, Queensland University of Technology, Brisbane, QLD 4000, Australia; Faculty of Engineering, School of Mechanical, Medical and Process Engineering, Queensland University of Technology, Brisbane, QLD 4000, Australia; Australian Research Council (ARC) Training Centre for Multiscale 3D Imaging, Modelling, and Manufacturing (M3D Innovation), Queensland University of Technology, Brisbane, QLD 4000, Australia; Australian Research Council Training Centre for Cell and Tissue Engineering Technologies, Queensland University of Technology, Brisbane, QLD 4059, Australia.
| | - Liraz Chai
- Max Planck Queensland Centre, Queensland University of Technology, Brisbane, QLD 4000, Australia; The Hebrew University of Jerusalem, Institute of Chemistry, Jerusalem, 91904, Israel; The Harvey M. Krueger Family Center for Nanoscience and Nanotechnology, The Hebrew University of Jerusalem, Jerusalem, 9190401, Israel.
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Previ L, Iorio R, Solmone M, Mazza D, Marzilli F, Di Niccolo R, Corsetti F, Viglietta E, Carrozzo A, Maffulli N. Worrying Presence of Asymptomatic Bacterial Colonisation on Implanted Orthopedic Devices. Cureus 2024; 16:e68126. [PMID: 39347164 PMCID: PMC11438488 DOI: 10.7759/cureus.68126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/29/2024] [Indexed: 10/01/2024] Open
Abstract
Background Bacterial infection after hardware implantation in orthopedic and trauma surgery is devastating, resulting in increased hospital costs and stays, multiple revision surgeries, and prolonged use of antibiotics. The present study aims to determine whether a symbiotic relationship between the human organism and bacteria in hardware implantation may be present, without clinically evident infection. Materials and methods We studied explanted devices for microbiological analysis, using the sonication technique, from patients who underwent surgical removal of musculoskeletal hardware for mechanical reasons. None of the patients included in the study had clinical or biochemical signs of infection. Results Forty-nine patients were enrolled. Cultures tested positive for bacteria in 42.8% of the 49 patients (21 of 49). In 13 patients, Gram-positive bacteria were isolated, while Gram-negative bacteria were isolated from nine patients. The most frequent bacterial species found was Pseudomonas aeruginosa, with six positive cultures (28.5%). Coagulase-negative staphylococci were isolated from ten implants (47%). Conclusion A pacific coexistence between humans and bacteria is possible following the implantation of metallic devices for trauma or orthopedic ailments. It is still unclear how strong or unstable this equilibrium is.
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Affiliation(s)
- Leonardo Previ
- Orthopedics and Traumatology, Ospedale Sant'Andrea, Rome, ITA
| | - Raffaele Iorio
- Orthopedics and Traumatology, Ospedale Sant'Andrea, Rome, ITA
| | | | - Daniele Mazza
- Orthopedics and Traumatology, Ospedale Sant'Andrea, Rome, ITA
| | - Fabio Marzilli
- Orthopedics and Trauma, Ospedale Santo Spirito, Pescara, ITA
| | | | | | | | | | - Nicola Maffulli
- Trauma and Orthopaedic Surgery, University of Rome, Rome, ITA
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Roscetto E, Di Gennaro D, Ascione T, Galdiero U, Aversa M, Festa E, Catania MR, Balato G. Antiseptics' Concentration, Combination, and Exposure Time on Bacterial and Fungal Biofilm Eradication. Arthroplast Today 2024; 28:101468. [PMID: 39139360 PMCID: PMC11320471 DOI: 10.1016/j.artd.2024.101468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2024] [Revised: 05/20/2024] [Accepted: 06/10/2024] [Indexed: 08/15/2024] Open
Abstract
Background This study aims to assess the activity of solutions containing povidone-iodine (PI) and hydrogen peroxide (H2O2) alone or combined on the biofilm of microbial species in the contest of periprosthetic joint infection (PJI). Methods Different antiseptic solutions were tested on 2-day-old biofilms of Gram-positive and Gram-negative bacteria and fungi at 1 and 3 minutes of exposure. The efficacy of these solutions was evaluated by measuring the biofilm metabolic activity by methoxynitrosulfophenyl-tetrazolium carboxanilide (XTT) reduction assay. The anti-biofilm effect of 5% PI and 0.3% PI + 0.5% H2O2 was tested on a 5-day-old biofilm using colony-forming unit counts and an XTT reduction assay. Results PI and H2O2 solutions showed concentration-dependent anti-biofilm activity except for E. faecalis. PI at 5% was the most active solution against the 2-day-old biofilm of all test microorganisms. The 0.3% PI + 0.5% H₂O₂ solution had a significant effect only at 3 minutes. The 5% PI and 0.3% PI + 0.5% H₂O₂ effect was evaluated on 5-day-old biofilms. PI at 5% produced a significant reduction in metabolic activity at both 1 and 3 minutes; 0.3% PI + 0.5% H₂O₂ caused a significant activity against all Gram-positive strains after 3 minutes, with a greater metabolic activity reduction than 5% PI. Conclusions In the case of PJI caused by Gram-positive bacteria, 0.3% PI + 0.5% H₂O₂ could be used for wound irrigation for 3 minutes of exposure. In the case of PJI with a different etiological agent or PJI with an unknown etiology, it is advisable to use 5% PI for 1 minute of exposure.
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Affiliation(s)
- Emanuela Roscetto
- Department Molecular Medicine and Medical Biotechnology, “Federico II” University, Naples, Italy
| | - Donato Di Gennaro
- Section of Orthopaedic Surgery, Department of Public Health, “Federico II” University, Naples, Italy
| | - Tiziana Ascione
- Department of Medicine, Service of Infectious Disease, Cardarelli Hospital Naples, Naples, Italy
| | - Umberto Galdiero
- Department Molecular Medicine and Medical Biotechnology, “Federico II” University, Naples, Italy
| | - Martina Aversa
- Department Molecular Medicine and Medical Biotechnology, “Federico II” University, Naples, Italy
| | - Enrico Festa
- Section of Orthopaedic Surgery, Department of Public Health, “Federico II” University, Naples, Italy
| | - Maria Rosaria Catania
- Department Molecular Medicine and Medical Biotechnology, “Federico II” University, Naples, Italy
| | - Giovanni Balato
- Section of Orthopaedic Surgery, Department of Public Health, “Federico II” University, Naples, Italy
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Jaekel C, Windolf CD, Bieler D, Oezel L, Seiler LF, Lakomek FN, Beyersdorf C, Mertens J, Steuwe A, Windolf J, Grassmann JP. Efficacy of lysostaphin-coated titanium plates on implant-associated MRSA osteitis in minipigs. Eur J Trauma Emerg Surg 2024; 50:887-895. [PMID: 38265442 PMCID: PMC11249774 DOI: 10.1007/s00068-024-02448-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2023] [Accepted: 01/12/2024] [Indexed: 01/25/2024]
Abstract
PURPOSE The growing incidence of implant-associated infections (IAIs) caused by biofilm-forming Staphylococcus aureus in combination with an increasing resistance to antibiotics requires new therapeutic strategies. Lysostaphin has been shown to eliminate this biofilm. Own studies confirm the effectiveness in a murine model. The current study characterizes the effects of lysostaphin-coated plates in an IAI minipig model. METHODS The femur of 30 minipigs was stabilized with a five-hole plate, a bone defect was created, and in 20 cases methicillin-resistant Staphylococcus aureus was applied. Ten animals served as control group. After 14 days, local debridement, lavage, and plate exchange (seven-hole plate) were performed. Ten of the infected minipigs received an uncoated plate and 10 a lysostaphin-coated plate. On day 84, the minipigs were again lavaged, followed by euthanasia. Bacterial load was quantified by colony-forming units (CFU). Immunological response was determined by neutrophils, as well as interleukins. Fracture healing was assessed radiologically. RESULTS CFU showed significant difference between infected minipigs with an uncoated plate and minipigs with a lysostaphin-coated plate (p = 0.0411). The infection-related excessive callus formation and calcification was significantly greater in the infected animals with an uncoated plate than in animals with a lysostaphin-coated plate (p = 0.0164/p = 0.0033). The analysis of polymorphonuclear neutrophils and interleukins did not reveal any pioneering findings. CONCLUSION This study confirms the minipig model for examining IAI. Furthermore, coating of plates using lysostaphin could be a promising tool in the therapeutic strategies of IAI. Future studies should focus on coating technology of implants and on translation into a clinical model.
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Affiliation(s)
- Carina Jaekel
- Department of Orthopaedics and Trauma Surgery, Medical Faculty and University Hospital, Heinrich Heine University Düsseldorf, Moorenstraße 5, 40225, Düsseldorf, Germany.
| | - Ceylan D Windolf
- Department of Orthopaedics and Trauma Surgery, Medical Faculty and University Hospital, Heinrich Heine University Düsseldorf, Moorenstraße 5, 40225, Düsseldorf, Germany
| | - Dan Bieler
- Department of Orthopaedics and Trauma Surgery, Medical Faculty and University Hospital, Heinrich Heine University Düsseldorf, Moorenstraße 5, 40225, Düsseldorf, Germany
- Department of Trauma Surgery and Orthopedics, Reconstructive Surgery, Hand Surgery and Burn Medicine, German Armed Forces Central Hospital Koblenz, Koblenz, Germany
| | - Lisa Oezel
- Department of Orthopaedics and Trauma Surgery, Medical Faculty and University Hospital, Heinrich Heine University Düsseldorf, Moorenstraße 5, 40225, Düsseldorf, Germany
| | - Lars F Seiler
- Department of Orthopaedics and Trauma Surgery, Medical Faculty and University Hospital, Heinrich Heine University Düsseldorf, Moorenstraße 5, 40225, Düsseldorf, Germany
| | - Felix N Lakomek
- Department of Orthopaedics and Trauma Surgery, Medical Faculty and University Hospital, Heinrich Heine University Düsseldorf, Moorenstraße 5, 40225, Düsseldorf, Germany
| | - Christoph Beyersdorf
- Department of Orthopaedics and Trauma Surgery, Medical Faculty and University Hospital, Heinrich Heine University Düsseldorf, Moorenstraße 5, 40225, Düsseldorf, Germany
| | - Jann Mertens
- Department of Trauma Surgery, Orthopaedics and Hand Surgery, Städtisches Klinikum Solingen, Solingen, Germany
| | - Andrea Steuwe
- Department of Diagnostic and Interventional Radiology, Medical Faculty and University Hospital, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Joachim Windolf
- Department of Orthopaedics and Trauma Surgery, Medical Faculty and University Hospital, Heinrich Heine University Düsseldorf, Moorenstraße 5, 40225, Düsseldorf, Germany
| | - Jan P Grassmann
- Department of Trauma, Hand and Reconstructive Surgery, Klinikum Osnabrück GmbH, Osnabrück, Germany
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Ul Haq I, Khan TA, Krukiewicz K. Etiology, pathology, and host-impaired immunity in medical implant-associated infections. J Infect Public Health 2024; 17:189-203. [PMID: 38113816 DOI: 10.1016/j.jiph.2023.11.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 10/20/2023] [Accepted: 11/21/2023] [Indexed: 12/21/2023] Open
Abstract
Host impaired immunity and pathogens adhesion factors are the key elements in analyzing medical implant-associated infections (MIAI). The infection chances are further influenced by surface properties of implants. This review addresses the medical implant-associated pathogens and summarizes the etiology, pathology, and host-impaired immunity in MIAI. Several bacterial and fungal pathogens have been isolated from MIAI; together, they form cross-kingdom species biofilms and support each other in different ways. The adhesion factors initiate the pathogen's adherence on the implant's surface; however, implant-induced impaired immunity promotes the pathogen's colonization and biofilm formation. Depending on the implant's surface properties, immune cell functions get slow or get exaggerated and cause immunity-induced secondary complications resulting in resistant depression and immuno-incompetent fibro-inflammatory zone that compromise implant's performance. Such consequences lead to the unavoidable and straightforward conclusion for the downstream transformation of new ideas, such as the development of multifunctional implant coatings.
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Affiliation(s)
- Ihtisham Ul Haq
- Department of Physical Chemistry and Technology of Polymers, Silesian University of Technology, M. Strzody 9, 44-100 Gliwice, Poland; Joint Doctoral School, Silesian University of Technology, Akademicka 2A, 44-100 Gliwice, Poland; Programa de Pós-graduação em Inovação Tecnológica, Universidade Federal de Minas Gerais, Belo Horizonte 31270-901, MG, Brazil.
| | - Taj Ali Khan
- Division of Infectious Diseases & Global Medicine, Department of Medicine, University of Florida, Gainesville, FL, United States; Institute of Pathology and Diagnostic Medicine, Khyber Medical University, Peshawar, Pakistan.
| | - Katarzyna Krukiewicz
- Department of Physical Chemistry and Technology of Polymers, Silesian University of Technology, M. Strzody 9, 44-100 Gliwice, Poland; Centre for Organic and Nanohybrid Electronics, Silesian University of Technology, Konarskiego 22B, 44-100 Gliwice, Poland.
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Burger L, Conzelmann A, Ulrich S, Mozaffari-Jovein H. Process Development of a Generative Method for Partial and Controlled Integration of Active Substances into Open-Porous Matrix Structures. MATERIALS (BASEL, SWITZERLAND) 2023; 16:6985. [PMID: 37959583 PMCID: PMC10647568 DOI: 10.3390/ma16216985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/19/2023] [Revised: 10/23/2023] [Accepted: 10/29/2023] [Indexed: 11/15/2023]
Abstract
A special generative manufacturing (AM) process was developed for the partial integration of active ingredients into open-porous matrix structures. A mixture of a silver-containing solution as an antibacterial material with an alginate hydrogel as a carrier system was produced as the active ingredient. The AM process developed was used to introduce the active ingredient solution into an open-porous niobium containing a β-titanium matrix structure, thus creating a reproducible active ingredient delivery system. The matrix structure had already been produced in a separate AM process by means of selective laser melting (SLM). The main advantage of this process is the ability to control porosity with high precision. To determine optimal surface conditions for the integration of active ingredients into the matrix structure, different surface conditions of the titanium substrate were tested for their impact on wetting behaviour of a silver-containing hydrogel solution. The solution-substrate contact angle was measured and evaluated to determine the most favourable surface condition. To develop the generative manufacturing process, an FDM printer underwent modifications that permitted partial application of the drug solution to the structure in accordance with the bioprinting principle. The modified process enabled flexible control and programming of both the position and volume of the applied drug. Furthermore, the process was able to fill up to 95% of the titanium matrix body pore volume used. The customised application of drug carriers onto implants as a drug delivery system can be achieved via the developed process, providing an alternative to established methods like dip coating that lack this capability.
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Affiliation(s)
- Lena Burger
- Institute of Materials Science and Engineering Tuttlingen (IWAT), Campus Tuttlingen, Furtwangen University, 78532 Tuttlingen, Germany
- Institute for Applied Materials-Applied Materials Physics (IAM-AWP), Karlsruhe Institute of Technology, 76131 Karlsruhe, Germany
| | - Achim Conzelmann
- Institute of Materials Science and Engineering Tuttlingen (IWAT), Campus Tuttlingen, Furtwangen University, 78532 Tuttlingen, Germany
- Institute for Applied Materials-Applied Materials Physics (IAM-AWP), Karlsruhe Institute of Technology, 76131 Karlsruhe, Germany
| | - Sven Ulrich
- Institute of Materials Science and Engineering Tuttlingen (IWAT), Campus Tuttlingen, Furtwangen University, 78532 Tuttlingen, Germany
- Institute for Applied Materials-Applied Materials Physics (IAM-AWP), Karlsruhe Institute of Technology, 76131 Karlsruhe, Germany
| | - Hadi Mozaffari-Jovein
- Institute of Materials Science and Engineering Tuttlingen (IWAT), Campus Tuttlingen, Furtwangen University, 78532 Tuttlingen, Germany
- Department of Microsystems Engineering, University of Freiburg, Georges-Köhler-Allee 103, 79110 Freiburg, Germany
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9
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Limantoro C, Das T, He M, Dirin D, Manos J, Kovalenko MV, Chrzanowski W. Synthesis of Antimicrobial Gallium Nanoparticles Using the Hot Injection Method. ACS MATERIALS AU 2023; 3:310-320. [PMID: 38090131 PMCID: PMC10347687 DOI: 10.1021/acsmaterialsau.2c00078] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Revised: 03/13/2023] [Accepted: 03/14/2023] [Indexed: 09/03/2024]
Abstract
Antibiotic resistance continues to be an ongoing problem in global public health despite interventions to reduce antibiotic overuse. Furthermore, it threatens to undo the achievements and progress of modern medicine. To address these issues, the development of new alternative treatments is needed. Metallic nanoparticles have become an increasingly attractive alternative due to their unique physicochemical properties that allow for different applications and their various mechanisms of action. In this study, gallium nanoparticles (Ga NPs) were tested against several clinical strains of Pseudomonas aeruginosa (DFU53, 364077, and 365707) and multi-drug-resistant Acinetobacter baumannii (MRAB). The results showed that Ga NPs did not inhibit bacterial growth when tested against the bacterial strains using a broth microdilution assay, but they exhibited effects in biofilm production in P. aeruginosa DFU53. Furthermore, as captured by atomic force microscopy imaging, P. aeruginosa DFU53 and MRAB biofilms underwent morphological changes, appearing rough and irregular when they were treated with Ga NPs. Although Ga NPs did not affect planktonic bacterial growth, their effects on both biofilm formation and established biofilm demonstrate their potential role in the race to combat antibiotic resistance, especially in biofilm-related infections.
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Affiliation(s)
- Christina Limantoro
- Sydney
Pharmacy School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2006, Australia
- Sydney
Nano Institute, The University of Sydney, Sydney, NSW 2006, Australia
| | - Theerthankar Das
- Department
of Infectious Diseases and Immunology, School of Medical Sciences, The University of Sydney, Camperdown, NSW 2006, Australia
| | - Meng He
- Department
of Chemistry and Applied Biosciences, ETH
Zürich—Swiss Federal Institute of Technology Zürich, Vladimir Prelog Weg 1, CH-8093 Zürich, Switzerland
- Empa-Swiss
Federal Laboratories for Materials Science and Technology, Überlandstrasse 129, CH-8600 Dübendorf, Switzerland
| | - Dmitry Dirin
- Department
of Chemistry and Applied Biosciences, ETH
Zürich—Swiss Federal Institute of Technology Zürich, Vladimir Prelog Weg 1, CH-8093 Zürich, Switzerland
- Empa-Swiss
Federal Laboratories for Materials Science and Technology, Überlandstrasse 129, CH-8600 Dübendorf, Switzerland
| | - Jim Manos
- Department
of Infectious Diseases and Immunology, School of Medical Sciences, The University of Sydney, Camperdown, NSW 2006, Australia
| | - Maksym V. Kovalenko
- Department
of Chemistry and Applied Biosciences, ETH
Zürich—Swiss Federal Institute of Technology Zürich, Vladimir Prelog Weg 1, CH-8093 Zürich, Switzerland
- Empa-Swiss
Federal Laboratories for Materials Science and Technology, Überlandstrasse 129, CH-8600 Dübendorf, Switzerland
| | - Wojciech Chrzanowski
- Sydney
Pharmacy School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2006, Australia
- Sydney
Nano Institute, The University of Sydney, Sydney, NSW 2006, Australia
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10
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Porous surface with fusion peptides embedded in strontium titanate nanotubes elevates osteogenic and antibacterial activity of additively manufactured titanium alloy. Colloids Surf B Biointerfaces 2023; 224:113188. [PMID: 36773409 DOI: 10.1016/j.colsurfb.2023.113188] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 01/30/2023] [Accepted: 01/31/2023] [Indexed: 02/04/2023]
Abstract
It is still a big challenge in orthopedics to treat infected bone defects properly using medical metals. The use of three-dimensional (3D) scaffold materials that simultaneously mimic the skeletal hierarchy and induce sustainable osteogenic and antibacterial functions are a promising solution with an increasing appeal. In this study, we first designed a bifunctional fusion peptide (HHC36-RGD, HR) by linking antimicrobial peptide (HHC36) and arginine-glycine-aspartate (RGD) peptide via 6-aminohexanoic acid. Then the 3D scaffold was fabricated by additive manufacturing, and the strontium titanate nanotube structure (3D-STN) was constructed on its surface. Finally, the HR was anchored to the 3D-STN with the aid of polydopamine (PDA, P), forming the 3D-STN-P-HR scaffold. The results showed that the scaffold exhibited an ordered 3D porous structure, and that the surface was covered by a dense HHC36-RGD layer. Expectedly, the adsorption of PDA effectively slowed down the release of HR. Moreover, the functionalized scaffold had a significant inhibitory effect on Staphylococcus aureus and Escherichia coli, and its antibacterial rate could reach more than 95%. The results of in vitro cell culture experiments demonstrated that the 3D-STN-P-HR scaffold possessed excellent cytocompatibility and could promote the transcription of osteogenic differentiation-related genes and the expression of related proteins. In conclusion, the functionally modified 3D porous titanium alloy scaffold (3D-STN-P-HR) has a balanced antibacterial and osteogenic function, which bodes well for future potential in the customized functional reconstruction of complex-shaped infected bone defects.
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11
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Antimicrobial-Loaded Polyacrylamide Hydrogels Supported on Titanium as Reservoir for Local Drug Delivery. Pathogens 2023; 12:pathogens12020202. [PMID: 36839473 PMCID: PMC9962340 DOI: 10.3390/pathogens12020202] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 01/11/2023] [Accepted: 01/24/2023] [Indexed: 02/03/2023] Open
Abstract
Arthroplasty is a highly successful treatment to restore the function of a joint. The contamination of the implant via bacterial adhesion is the first step toward the development of device-associated infections. The emerging concern about antimicrobial resistance resulted in a growing interest to develop alternative therapeutic strategies. Thus, the increment in the incidence of bacterial periprosthetic infections, the complexity of treating infections caused by organisms growing in biofilms, together with the rise in antibiotic resistant bacteria, expose the need to design novel surfaces that provide innovative solutions to these rising problems. The aim of this work is to develop a coating on titanium (Ti) suitable for inhibiting bacterial adhesion and proliferation, and hence, biofilm formation on the surface. We have successfully prepared polyacrylamide hydrogels containing the conventional antibiotic ampicillin (AMP), silver nanoparticles (AgNPs), and both, AMP and AgNPs. The release of the antibacterial agents from the gelled to aqueous media resulted in an excellent antibacterial action of the loaded hydrogels against sessile S. aureus. Moreover, a synergic effect was achieved with the incorporation of both AMP and AgNPs in the hydrogel, which highlights the importance of combining antimicrobial agents having different targets. The polyacrylamide hydrogel coating on the Ti surface was successfully achieved, as it was demonstrated by FTIR, contact angle, and AFM measurements. The modified Ti surfaces having the polyacrylamide hydrogel film containing AgNPs and AMP retained the highest antibacterial effect against S. aureus as it was found for the unsupported hydrogels. The modified surfaces exhibit an excellent cytocompatibility, since healthy, flattened MC3T3-E1 cells spread on the surfaces were observed. In addition, similar macrophage RAW 264.7 adhesion was found on all the surfaces, which could be related to a low macrophage activation. Our results indicate that AMP and AgNP-loaded polyacrylamide hydrogel films on Ti are a good alternative for designing efficient antibacterial surfaces having an excellent cytocompatibility without inducing an exacerbated immune response. The approach emerges as a superior alternative to the widely used direct adsorption of therapeutic agents on surfaces, since the antimicrobial-loaded hydrogel coatings open the possibility of modulating the concentration of the antimicrobial agents to enhance bacterial killing, and then, reducing the risk of infections in implantable materials.
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12
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Emerging nanosonosensitizers augment sonodynamic-mediated antimicrobial therapies. Mater Today Bio 2023; 19:100559. [PMID: 36798535 PMCID: PMC9926023 DOI: 10.1016/j.mtbio.2023.100559] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 01/07/2023] [Accepted: 01/19/2023] [Indexed: 01/22/2023] Open
Abstract
With the widespread prevalence of drug-resistant pathogens, traditional antibiotics have limited effectiveness and do not yield the desired outcomes. Recently, alternative antibacterial therapies based on ultrasound (US) have been explored to overcome the crisis of bacterial pathogens. Antimicrobial sonodynamic therapy (aSDT) offers an excellent solution that relies on US irradiation to produce reactive oxygen species (ROS) and achieve antibiotic-free mediated antimicrobial effects. In addition, aSDT possesses the advantage of superior tissue penetrability of US compared to light irradiation, demonstrating great feasibility in treating deep infections. Although existing conventional sonosensitizers can produce ROS for antimicrobial activity, some limitations, such as low penetration rate, nonspecific distribution and poor ROS production under hypoxic conditions, result in suboptimal sterilization in aSDT. Recently, emerging nanosonosensitizers have enormous advantages as high-performance agents in aSDT, which overcome the deficiencies of conventional sonosensitizers as described above. Thus, nanosonosensitizer-mediated aSDT has a bright future for the management of bacterial infections. This review classifies the current available nanosonosensitizers and provides an overview of the mechanisms, biomedical applications, recent advances and perspectives of aSDT.
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Gamaletsou MN, Rammaert B, Brause B, Bueno MA, Dadwal SS, Henry MW, Katragkou A, Kontoyiannis DP, McCarthy MW, Miller AO, Moriyama B, Pana ZD, Petraitiene R, Petraitis V, Roilides E, Sarkis JP, Simitsopoulou M, Sipsas NV, Taj-Aldeen SJ, Zeller V, Lortholary O, Walsh TJ. Osteoarticular Mycoses. Clin Microbiol Rev 2022; 35:e0008619. [PMID: 36448782 PMCID: PMC9769674 DOI: 10.1128/cmr.00086-19] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Osteoarticular mycoses are chronic debilitating infections that require extended courses of antifungal therapy and may warrant expert surgical intervention. As there has been no comprehensive review of these diseases, the International Consortium for Osteoarticular Mycoses prepared a definitive treatise for this important class of infections. Among the etiologies of osteoarticular mycoses are Candida spp., Aspergillus spp., Mucorales, dematiaceous fungi, non-Aspergillus hyaline molds, and endemic mycoses, including those caused by Histoplasma capsulatum, Blastomyces dermatitidis, and Coccidioides species. This review analyzes the history, epidemiology, pathogenesis, clinical manifestations, diagnostic approaches, inflammatory biomarkers, diagnostic imaging modalities, treatments, and outcomes of osteomyelitis and septic arthritis caused by these organisms. Candida osteomyelitis and Candida arthritis are associated with greater events of hematogenous dissemination than those of most other osteoarticular mycoses. Traumatic inoculation is more commonly associated with osteoarticular mycoses caused by Aspergillus and non-Aspergillus molds. Synovial fluid cultures are highly sensitive in the detection of Candida and Aspergillus arthritis. Relapsed infection, particularly in Candida arthritis, may develop in relation to an inadequate duration of therapy. Overall mortality reflects survival from disseminated infection and underlying host factors.
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Affiliation(s)
- Maria N. Gamaletsou
- Laiko General Hospital of Athens and Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Blandine Rammaert
- Université de Poitiers, Faculté de médecine, CHU de Poitiers, INSERM U1070, Poitiers, France
| | - Barry Brause
- Hospital for Special Surgery, Weill Cornell Medicine, New York, New York, USA
| | - Marimelle A. Bueno
- Far Eastern University-Dr. Nicanor Reyes Medical Foundation, Manilla, Philippines
| | | | - Michael W. Henry
- Hospital for Special Surgery, Weill Cornell Medicine, New York, New York, USA
| | - Aspasia Katragkou
- Nationwide Children’s Hospital, Columbus, Ohio, USA
- The Ohio State University School of Medicine, Columbus, Ohio, USA
| | | | - Matthew W. McCarthy
- Weill Cornell Medicine of Cornell University, New York, New York, USA
- New York Presbyterian Hospital, New York, New York, USA
| | - Andy O. Miller
- Hospital for Special Surgery, Weill Cornell Medicine, New York, New York, USA
| | | | - Zoi Dorothea Pana
- Hippokration General Hospital, Aristotle University School of Health Sciences, Thessaloniki, Greece
- Faculty of Medicine, Aristotle University School of Health Sciences, Thessaloniki, Greece
| | - Ruta Petraitiene
- Weill Cornell Medicine of Cornell University, New York, New York, USA
| | | | - Emmanuel Roilides
- Hippokration General Hospital, Aristotle University School of Health Sciences, Thessaloniki, Greece
- Faculty of Medicine, Aristotle University School of Health Sciences, Thessaloniki, Greece
| | | | - Maria Simitsopoulou
- Hippokration General Hospital, Aristotle University School of Health Sciences, Thessaloniki, Greece
- Faculty of Medicine, Aristotle University School of Health Sciences, Thessaloniki, Greece
| | - Nikolaos V. Sipsas
- Laiko General Hospital of Athens and Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | | | - Valérie Zeller
- Groupe Hospitalier Diaconesses-Croix Saint-Simon, Paris, France
| | - Olivier Lortholary
- Université de Paris, Faculté de Médecine, APHP, Hôpital Necker-Enfants Malades, Paris, France
- Institut Pasteur, Unité de Mycologie Moléculaire, CNRS UMR 2000, Paris, France
| | - Thomas J. Walsh
- Hospital for Special Surgery, Weill Cornell Medicine, New York, New York, USA
- Weill Cornell Medicine of Cornell University, New York, New York, USA
- New York Presbyterian Hospital, New York, New York, USA
- Center for Innovative Therapeutics and Diagnostics, Richmond, Virginia, USA
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14
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Xu LC, Siedlecki CA. Surface Texturing and Combinatorial Approaches to Improve Biocompatibility of Implanted Biomaterials. FRONTIERS IN PHYSICS 2022; 10:994438. [PMID: 38250242 PMCID: PMC10798815 DOI: 10.3389/fphy.2022.994438] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/23/2024]
Abstract
Biomaterial associated microbial infection and blood thrombosis are two of the barriers that inhibit the successful use of implantable medical devices in modern healthcare. Modification of surface topography is a promising approach to combat microbial infection and thrombosis without altering bulk material properties necessary for device function and without contributing to bacterial antibiotic resistance. Similarly, the use of other antimicrobial techniques such as grafting poly(ethylene glycol) (PEG) and nitric oxide (NO) release also improve the biocompatibility of biomaterials. In this review, we discuss the development of surface texturing techniques utilizing ordered submicron-size pillars for controlling bacterial adhesion and biofilm formation, and we present combinatorial approaches utilizing surface texturing in combination with poly(ethylene glycol) (PEG) grafting and NO release to improve the biocompatibility of biomaterials. The manuscript also discusses efforts towards understanding the molecular mechanisms of bacterial adhesion responses to the surface texturing and NO releasing biomaterials, focusing on experimental aspects of the approach.
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Affiliation(s)
- Li-Chong Xu
- Department of Surgery, The Pennsylvania State University, College of Medicine, Hershey, PA 17033
| | - Christopher A. Siedlecki
- Department of Surgery, The Pennsylvania State University, College of Medicine, Hershey, PA 17033
- Department of Biomedical Engineering, The Pennsylvania State University, College of Medicine, Hershey, PA 17033
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Yu X, Du H, Huang Y, Yin X, Liu Y, Li Y, Liu H, Wang X. Selective adsorption of antibiotics on aged microplastics originating from mariculture benefits the colonization of opportunistic pathogenic bacteria. ENVIRONMENTAL POLLUTION (BARKING, ESSEX : 1987) 2022; 313:120157. [PMID: 36126771 DOI: 10.1016/j.envpol.2022.120157] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 08/22/2022] [Accepted: 09/07/2022] [Indexed: 06/15/2023]
Abstract
Microplastics and antibiotics widely coexist in the aquatic environment, especially in mariculture regions. However, antibiotics adsorbed on microplastics and their role in the colonization of microorganisms on microplastics are poorly understood. Therefore, in-situ aging experiments were conducted to investigate the impact of antibiotics and microplastics co-occurrence on microorganisms and assess their potential risks to human health. Results showed that antibiotics were adsorbed selectively on microplastics, with 29 investigated antibiotics (n = 40) detected in surrounding water but only 6 investigated antibiotics were adsorbed on microplastics. The concentration of antibiotics accumulated on microplastics was controlled by microplastic types and environmental conditions. For example, aged polypropylene (PP) had more developed pore structures resulting in higher adsorption of antibiotics than other microplastic types. High-throughput sequencing showed higher diversity and distinct composition of microorganisms attached to the microplastics than the surrounding water. Opportunistic pathogenic bacteria such as Mycobacterium possessed positive relationships with tetracycline and doxycycline on aged microplastics, which showed adsorbed antibiotics on aged microplastics could benefit some specific pathogens colonized on the microplastics and spread into unaffected ecosystems, marine organisms even humans. The health risk quotient (HQ) implied the potential human health risk of consuming commercial seafood polluted by antibiotics and microplastic loaded with antibiotics. This study revealed the interaction of antibiotics and microorganisms with aged microplastics in aquaculture systems, providing a novel insight into their synergistic effects on ecological and human health.
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Affiliation(s)
- Xiaoxuan Yu
- State Key Laboratory of Marine Environmental Science, College of the Environment & Ecology, Xiamen University, Xiamen, 361102, China
| | - Huihong Du
- State Key Laboratory of Marine Environmental Science, College of the Environment & Ecology, Xiamen University, Xiamen, 361102, China
| | - Yuhong Huang
- State Key Laboratory of Marine Environmental Science, College of the Environment & Ecology, Xiamen University, Xiamen, 361102, China
| | - Xiaohan Yin
- State Key Laboratory of Marine Environmental Science, College of the Environment & Ecology, Xiamen University, Xiamen, 361102, China
| | - Yawen Liu
- State Key Laboratory of Marine Environmental Science, College of the Environment & Ecology, Xiamen University, Xiamen, 361102, China
| | - Yongyu Li
- State Key Laboratory of Marine Environmental Science, College of the Environment & Ecology, Xiamen University, Xiamen, 361102, China
| | - Huatai Liu
- State Key Laboratory of Marine Environmental Science, College of the Environment & Ecology, Xiamen University, Xiamen, 361102, China
| | - Xinhong Wang
- State Key Laboratory of Marine Environmental Science, College of the Environment & Ecology, Xiamen University, Xiamen, 361102, China.
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Brigmon MM, Brigmon RL. Infectious Diseases Impact on Biomedical Devices and Materials. BIOMEDICAL MATERIALS & DEVICES (NEW YORK, N.Y.) 2022; 1:1-8. [PMID: 38625309 PMCID: PMC9616421 DOI: 10.1007/s44174-022-00035-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Accepted: 09/01/2022] [Indexed: 11/07/2022]
Abstract
Infectious diseases and nosocomial infections may play a significant role in healthcare issues associated with biomedical materials and devices. Many current polymer materials employed are inadequate for resisting microbial growth. The increase in microbial antibiotic resistance is also a factor in problematic biomedical implants. In this work, the difficulty in diagnosing biomedical device-related infections is reviewed and how this leads to an increase in microbial antibiotic resistance. A conceptualization of device-related infection pathogenesis and current and future treatments is made. Within this conceptualization, we focus specifically on biofilm formation and the role of host immune and antimicrobial therapies. Using this framework, we describe how current and developing preventative strategies target infectious disease. In light of the significant increase in antimicrobial resistance, we also emphasize the need for parallel development of improved treatment strategies. We also review potential production methods for manufacturing specific nanostructured materials with antimicrobial functionality for implantable devices. Specific examples of both preventative and novel treatments and how they align with the improved care with biomedical devices are described.
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Affiliation(s)
- Matthew M. Brigmon
- Department of Infectious Diseases and Pulmonary Critical Care, Long School of Medicine, UT Health San Antonio, San Antonio, USA
| | - Robin L. Brigmon
- Savannah River National Laboratory, Bldg 999W, Aiken, SC 29808 USA
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Lu Y, Cai WJ, Ren Z, Han P. The Role of Staphylococcal Biofilm on the Surface of Implants in Orthopedic Infection. Microorganisms 2022; 10:1909. [PMID: 36296183 PMCID: PMC9612000 DOI: 10.3390/microorganisms10101909] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Revised: 09/11/2022] [Accepted: 09/20/2022] [Indexed: 08/27/2023] Open
Abstract
Despite advanced implant sterilization and aseptic surgical techniques, implant-associated infection remains a major challenge for orthopedic surgeries. The subject of bacterial biofilms is receiving increasing attention, probably as a result of the wide acknowledgement of the ubiquity of biofilms in the clinical environment, as well as the extreme difficulty in eradicating them. Biofilm can be defined as a structured microbial community of cells that are attached to a substratum and embedded in a matrix of extracellular polymeric substances (EPS) that they have produced. Biofilm development has been proposed as occurring in a multi-step process: (i) attachment and adherence, (ii) accumulation/maturation due to cellular aggregation and EPS production, and (iii) biofilm detachment (also called dispersal) of bacterial cells. In all these stages, characteristic proteinaceous and non-proteinaceous compounds are expressed, and their expression is strictly controlled. Bacterial biofilm formation around implants shelters the bacteria and encourages the persistence of infection, which could lead to implant failure and osteomyelitis. These complications need to be treated by major revision surgeries and extended antibiotic therapies, which could lead to high treatment costs and even increase mortality. Effective preventive and therapeutic measures to reduce risks for implant-associated infections are thus in urgent need.
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Affiliation(s)
| | | | | | - Pei Han
- Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
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18
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Porous thermosensitive coating with water-locking ability for enhanced osteogenic and antibacterial abilities. Mater Today Bio 2022; 14:100285. [PMID: 35647512 PMCID: PMC9130111 DOI: 10.1016/j.mtbio.2022.100285] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 05/01/2022] [Accepted: 05/08/2022] [Indexed: 11/22/2022] Open
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Combined sterilization and fabrication of drug-loaded scaffolds using supercritical CO 2 technology. Int J Pharm 2022; 612:121362. [PMID: 34896562 DOI: 10.1016/j.ijpharm.2021.121362] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 12/03/2021] [Accepted: 12/04/2021] [Indexed: 01/16/2023]
Abstract
The access of biodegradable scaffolds to the clinical arena is constrained by the absence of a suitable sterilization technique for the processing of advanced polymeric materials. Sterilization with supercritical CO2 (scCO2) may circumvent some technological limitations (e.g., low temperature, no chemical residues on the material), although scCO2 can plasticize the polymer depending on the processing conditions used. In this latter case, the integration of the manufacturing and sterilization processes is of particular interest to obtain sterile and customized scaffolds in a single step. In this work, scCO2 was exploited as a concomitantly foaming and sterilizing agent for the first time, developing a one-step process for the production of vancomycin-loaded poly(ε-caprolactone) (PCL) bone scaffolds. The effect of the CO2 contact time on the sterility levels of the procedure was investigated, and the sterilization efficiency was evaluated against dry spores (Bacillus stearothermophilus, Bacillus pumilus and Bacillus atrophaeus). Vancomycin-loaded PCL scaffolds had relevant sustained release profiles for the prophylaxis of infections at the grafted area, even those caused by methicillin-resistant Staphylococcus aureus (MRSA). The biological performance of the scaffolds was evaluated in vitro regarding human mesenchymal stem cells (hMSCs) attachment and growth. Finally, the biocompatibility and angiogenic response of the manufactured sterile scaffolds was assessed in ovo through chick chorioallantoic membrane (CAM) assays.
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20
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Risk Factors of Coexisting Septic Spondylitis and Arthritis: A Case-Control Study in a Tertiary Referral Hospital. J Clin Med 2021; 10:jcm10225345. [PMID: 34830626 PMCID: PMC8622201 DOI: 10.3390/jcm10225345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2021] [Revised: 11/12/2021] [Accepted: 11/15/2021] [Indexed: 01/08/2023] Open
Abstract
Introduction: In patients under immunosuppression or severe sepsis, it is sometimes manifested as coexisting septic arthritis and spondylitis. The aim of this study is to evaluate and investigate the risk factors of infectious spondylitis associated with septic arthritis. Methods: The study retrospectively reviewed the patients diagnosed with infectious spondylitis between January 2010 and September 2018 for risk factors of coexisting major joint septic arthritis. Results: A total of 10 patients with infectious spondylitis and coexisting septic arthritis comprised the study group. Fifty matched patients with solely infectious spondylitis were selected as the control group. Major risk factors include preoperative C-reactive protein (p = 0.001), hypoalbuminemia (p = 0.011), history of total joint replacement (p < 0.001), duration of preoperative antibiotics treatment (p = 0.038) and psoas muscle abscess (p < 0.001). Conclusion: Infectious spondylitis and septic arthritis are thought of as medical emergencies due to their high mortality and morbidity. Our study evaluated 5 risk factors as significant major findings: hypoalbuminemia (<3.4 g/dL), higher preoperative CRP (>130 mg/L), psoas muscle abscess, longer preoperative antibiotics treatment (>8 days) and history of total joint replacement. Clinicians should pay attention to the patients with those five factors to detect the coexisting infections as early as possible.
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21
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Hersh A, Young R, Pennington Z, Ehresman J, Ding A, Kopparapu S, Cottrill E, Sciubba DM, Theodore N. Removal of instrumentation for postoperative spine infection: systematic review. J Neurosurg Spine 2021; 35:376-388. [PMID: 34243152 DOI: 10.3171/2020.12.spine201300] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Accepted: 12/14/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Currently, no consensus exists as to whether patients who develop infection of the surgical site after undergoing instrumented fusion should have their implants removed at the time of wound debridement. Instrumentation removal may eliminate a potential infection nidus, but removal may also destabilize the patient's spine. The authors sought to summarize the existing evidence by systematically reviewing published studies that compare outcomes between patients undergoing wound washout and instrumentation removal with outcomes of patients undergoing wound washout alone. The primary objectives were to determine 1) whether instrumentation removal from an infected wound facilitates infection clearance and lowers morbidity, and 2) whether the chronicity of the underlying infection affects the decision to remove instrumentation. METHODS PRISMA guidelines were used to review the PubMed/MEDLINE, Embase, Cochrane Library, Scopus, Web of Science, and ClinicalTrials.gov databases to identify studies that compared patients with implants removed and patients with implants retained. Outcomes of interest included mortality, rate of repeat wound washout, and loss of correction. RESULTS Fifteen articles were included. Of 878 patients examined in these studies, 292 (33%) had instrumentation removed. Patient populations were highly heterogeneous, and outcome data were limited. Available data suggested that rates of reoperation, pseudarthrosis, and death were higher in patients who underwent instrumentation removal at the time of initial washout. Three studies recommended that instrumentation be uniformly removed at the time of wound washout. Five studies favored retaining the original instrumentation. Six studies favored retention in early infections but removal in late infections. CONCLUSIONS The data on this topic remain heterogeneous and low in quality. Retention may be preferred in the setting of early infection, when the risk of underlying spine instability is still high and the risk of mature biofilm formation on the implants is low. However, late infections likely favor instrumentation removal. Higher-quality evidence from large, multicenter, prospective studies is needed to reach generalizable conclusions capable of guiding clinical practice.
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22
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Supercritical CO 2 technology for one-pot foaming and sterilization of polymeric scaffolds for bone regeneration. Int J Pharm 2021; 605:120801. [PMID: 34139307 DOI: 10.1016/j.ijpharm.2021.120801] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 06/09/2021] [Accepted: 06/11/2021] [Indexed: 12/21/2022]
Abstract
Sterilization is a quite challenging step in the development of novel polymeric scaffolds for regenerative medicine since conventional sterilization techniques may significantly alter their morphological and physicochemical properties. Supercritical (sc) sterilization, i.e. the use of scCO2 as a sterilizing agent, emerges as a promising sterilization method due to the mild operational conditions and excellent penetration capability. In this work, a scCO2 protocol was implemented for the one-pot preparation and sterilization of poly(ε-caprolactone) (PCL)/poly(lactic-co-glycolic acid) (PLGA) scaffolds. The sterilization conditions were established after screening against both Gram-positive (Staphylococcus aureus) and Gram-negative (Escherichia coli, Pseudomonas aeruginosa) vegetative bacteria and spores of Bacillus stearothermophilus, Bacillus pumilus and Bacillus atrophaeus. The transition from the sterilization conditions (140 bar, 39 °C) to the compressed foaming (60 bar, 26 °C) was performed through controlled depressurization (3.2 bar/min) and CO2 liquid flow. Controlled depressurization/pressurization cycles were subsequently applied. Using this scCO2 technology toolbox, sterile scaffolds of well-controlled pore architecture were obtained. This sterilization procedure successfully achieved not only SAL-6 against well-known resistant bacteria endospores but also improved the scaffold morphologies compared to standard gamma radiation sterilization procedures.
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Khalid S, Gao A, Wang G, Chu PK, Wang H. Tuning surface topographies on biomaterials to control bacterial infection. Biomater Sci 2021; 8:6840-6857. [PMID: 32812537 DOI: 10.1039/d0bm00845a] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Microbial contamination and subsequent formation of biofilms frequently cause failure of surgical implants and a good understanding of the bacteria-surface interactions is vital to the design and safety of biomaterials. In this review, the physical and chemical factors that are involved in the various stages of implant-associated bacterial infection are described. In particular, topographical modification strategies that have been employed to mitigate bacterial adhesion via topographical mechanisms are summarized and discussed comprehensively. Recent advances have improved our understanding about bacteria-surface interactions and have enabled biomedical engineers and researchers to develop better and more effective antibacterial surfaces. The related interdisciplinary efforts are expected to continue in the quest for next-generation medical devices to attain the ultimate goal of improved clinical outcomes and reduced number of revision surgeries.
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Affiliation(s)
- Saud Khalid
- Center for Human Tissues and Organs Degeneration, Institute of Biomedicine and Biotechnology, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, 518055, China.
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Jeyanathan A, Ramalhete R, Blunn G, Gibbs H, Pumilia CA, Meckmongkol T, Lovejoy J, Coathup MJ. Lactobacillus cell-free supernatant as a novel bioagent and biosurfactant against Pseudomonas aeruginosa in the prevention and treatment of orthopedic implant infection. J Biomed Mater Res B Appl Biomater 2021; 109:1634-1643. [PMID: 33634961 DOI: 10.1002/jbm.b.34821] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Revised: 01/13/2021] [Accepted: 02/14/2021] [Indexed: 01/09/2023]
Abstract
The hypothesis was that probiotic Lactobacillus species (spp.) or their cell-free supernatant (CFS) are effective in inhibiting (a) planktonic growth of Pseudomonas aeruginosa (PA), (b) its adhesion to a Ti6Al4V-alloy surface, and (c) in dispersing biofilm once formed. (a) A planktonic co-culture containing PA(104 colony-forming unit [CFU]/ml) was combined with either Lactobacillus acidophilus, Lactobacillus plantarum (LP), or Lactobacillus fermentum (LF) at a suspension of 104 (1:1) or 108 CFU/ml (1:2). Lactobacillus and PA CFUs were then quantified. (b) Ti-6Al-4V discs were inoculated with PA followed by supplementation with CFS and adherent PA quantified. (c) Biofilm covered discs were supplemented with Lactobacillus CFS and remaining PA activity quantified. Results showed that whole-cell cultures were ineffective in preventing PA growth; however, the addition of CFS resulted in a 99.99 ± 0.003% reduction in adherent PA in all Lactobacillus groups (p < .05 in all groups) with no viable PA growth measured in the LF and LP groups. Following PA biofilm formation, CFS resulted in a significant reduction in PA activity in all Lactobacillus groups (p ≤ .05 in all groups) with a 29.75 ± 15.98% increase measured in control samples. Supplementation with CFS demonstrated antiadhesive, antibiofilm, and toxic properties to PA.
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Affiliation(s)
- Augustina Jeyanathan
- Institute of Orthopaedics and Musculoskeletal Science, Division of Surgery and Interventional Science, Royal National Orthopaedic Hospital, University College London, Stanmore, UK
| | - Rita Ramalhete
- Institute of Orthopaedics and Musculoskeletal Science, Division of Surgery and Interventional Science, Royal National Orthopaedic Hospital, University College London, Stanmore, UK
| | - Gordon Blunn
- Institute of Orthopaedics and Musculoskeletal Science, Division of Surgery and Interventional Science, Royal National Orthopaedic Hospital, University College London, Stanmore, UK.,School of Pharmacy and Biomedical Sciences, University of Portsmouth, Portsmouth, UK
| | - Hannah Gibbs
- Biionix (Bionic Materials, Implants & Interfaces) Cluster, Department of Internal Medicine, College of Medicine, University of Central Florida, Orlando, Florida, USA
| | - Cyrus Anthony Pumilia
- Biionix (Bionic Materials, Implants & Interfaces) Cluster, Department of Internal Medicine, College of Medicine, University of Central Florida, Orlando, Florida, USA
| | - Teerin Meckmongkol
- Biionix (Bionic Materials, Implants & Interfaces) Cluster, Department of Internal Medicine, College of Medicine, University of Central Florida, Orlando, Florida, USA.,Department of General Surgery, Nemours Children's Hospital, Orlando, Florida, USA
| | - John Lovejoy
- Biionix (Bionic Materials, Implants & Interfaces) Cluster, Department of Internal Medicine, College of Medicine, University of Central Florida, Orlando, Florida, USA.,Department of Orthopaedics, Sports Medicine and Physical Medicine and Rehabilitation, Nemours Children's Hospital, Orlando, Florida, USA
| | - Melanie J Coathup
- Institute of Orthopaedics and Musculoskeletal Science, Division of Surgery and Interventional Science, Royal National Orthopaedic Hospital, University College London, Stanmore, UK.,Biionix (Bionic Materials, Implants & Interfaces) Cluster, Department of Internal Medicine, College of Medicine, University of Central Florida, Orlando, Florida, USA
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Tanner MC, Fischer C, Schmidmaier G, Haubruck P. Evidence-based uncertainty: do implant-related properties of titanium reduce the susceptibility to perioperative infections in clinical fracture management? A systematic review. Infection 2021; 49:813-821. [PMID: 33586124 PMCID: PMC8476472 DOI: 10.1007/s15010-021-01583-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Accepted: 02/02/2021] [Indexed: 11/28/2022]
Abstract
Background Implant-associated infections (IAI) remain a challenging complication in osteosynthesis. There is no consensus or clear evidence whether titanium offers a relevant clinical benefit over stainless steel. Purpose In this systematic review, we sought to determine whether the implant properties of titanium reduce the susceptibility to IAI compared to stainless steel in fracture management. Methods A systematic literature search in German and English was performed using specific search terms and limits. Studies published between 1995 and 1st June 2020 in the Cochrane library, MEDLINE and Web of Science databases were included. Only clinical studies comparing titanium and stainless steel implants regarding the susceptibility to infections were selected for detailed review. Results Five studies out of 384 papers were identified and reviewed. From the studies meeting inclusion criteria one study was a systematic review, two studies were randomized controlled studies (RCT) and two studies were of retrospective comparative nature of level IV evidence. Conclusion Our results show that currently, no proven advantage for titanium implants in respect to IAI can be seen in contemporary literature. Implants preserving periosteal blood-flow and minimising soft-tissue trauma show statistically significant benefits in reducing the incidence of IAI. Clinical studies providing reliable evidence regarding the influence of titanium implants on IAI and investigating the susceptibility of titanium to infection are necessary
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Affiliation(s)
- Michael C Tanner
- HTRG-Heidelberg Trauma Research Group, Center for Orthopedics, Trauma Surgery and Spinal Cord Injury, Trauma and Reconstructive Surgery, Heidelberg University Hospital, 69118, Heidelberg, Germany.
| | - Christian Fischer
- HTRG-Heidelberg Trauma Research Group, Center for Orthopedics, Trauma Surgery and Spinal Cord Injury, Trauma and Reconstructive Surgery, Heidelberg University Hospital, 69118, Heidelberg, Germany
| | - Gerhard Schmidmaier
- HTRG-Heidelberg Trauma Research Group, Center for Orthopedics, Trauma Surgery and Spinal Cord Injury, Trauma and Reconstructive Surgery, Heidelberg University Hospital, 69118, Heidelberg, Germany
| | - Patrick Haubruck
- HTRG-Heidelberg Trauma Research Group, Center for Orthopedics, Trauma Surgery and Spinal Cord Injury, Trauma and Reconstructive Surgery, Heidelberg University Hospital, 69118, Heidelberg, Germany
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26
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Sanders D, Grunden A, Dunn RR. A review of clothing microbiology: the history of clothing and the role of microbes in textiles. Biol Lett 2021; 17:20200700. [PMID: 33435848 PMCID: PMC7876606 DOI: 10.1098/rsbl.2020.0700] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Accepted: 12/14/2020] [Indexed: 12/11/2022] Open
Abstract
Humans have worn clothing for thousands of years, and since its invention, clothing has evolved from its simple utilitarian function for survival to become an integral part of society. While much consideration has been given to the broad environmental impacts of the textile and laundering industries, little is known about the impact wearing clothing has had on the human microbiome, particularly that of the skin, despite our long history with clothing. This review discusses the history of clothing and the evolution of textiles, what is and is not known about microbial persistence on and degradation of various fibres, and what opportunities for the industrial and environmental application of clothing microbiology exist for the future.
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Affiliation(s)
- Deaja Sanders
- Department of Plant and Microbial Biology, North Carolina State University, Raleigh, NC 27695, USA
| | - Amy Grunden
- Department of Plant and Microbial Biology, North Carolina State University, Raleigh, NC 27695, USA
| | - Robert R. Dunn
- Department of Applied Ecology, North Carolina State University, Raleigh, NC 27695, USA
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27
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Lin F, Yuan S, Han W. Effective prevention of Escherichia coli biofilm on materials by nano-vibration. Colloids Surf A Physicochem Eng Asp 2021. [DOI: 10.1016/j.colsurfa.2020.125610] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
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28
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Prabakaran S, Rajan M. The osteogenic and bacterial inhibition potential of natural and synthetic compound loaded metal–ceramic composite coated titanium implant for orthopedic applications. NEW J CHEM 2021. [DOI: 10.1039/d1nj02363b] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Schematic illustration of the preparation, electrophoretic deposition, antibacterial and osteogenic bone regeneration abilities of the MHAP/ChN/GGe/GTN composite. Where, the green colored shape with red, yellow and blue spheres indicates the GGe.
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Affiliation(s)
- Selvakani Prabakaran
- Biomaterials in Medicinal Chemistry Laboratory, Department of Natural Products Chemistry, School of Chemistry, Madurai Kamaraj University, Madurai 625021, India
| | - Mariappan Rajan
- Biomaterials in Medicinal Chemistry Laboratory, Department of Natural Products Chemistry, School of Chemistry, Madurai Kamaraj University, Madurai 625021, India
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29
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Raj A, Dhandia N, Balani K. Adhesin Protein Interaction of Staphylococcus Aureus Bacteria with Various Biomaterial Surfaces. ACS Biomater Sci Eng 2020; 6:6161-6172. [PMID: 33449661 DOI: 10.1021/acsbiomaterials.0c01285] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The primary stage of adhesion during implant infection is dominated by interactions of the surface proteins of the bacteria with the substrate atoms. In the current work, molecular dynamics (MD) simulations have been utilized to investigate the mechanics of the associated adhesion forces of bacteria on different surfaces. The unfolding of these adhesion proteins is investigated in order to map these events to earlier experiments on bacterial de-adhesion (using single cell force spectroscopy) with real-life substrates (i.e., ultrahigh molecular weight polyethylene, hydroxyapatite, Ti alloy, and stainless steel). The adhesion of Staphylococcus aureus adhesin (i.e., SpA) is observed by altering their orientation on the silica substrate through MD simulations, followed by capturing unfolding events of three adhesins (SpA, ClfA, and SraP) of variable lengths possessing different secondary structures. The output long-range and short-range interaction forces and consequent visualization of changes in the secondary structure of protein segments are presented during the de-adhesion process. Simulation results are correlated with extracted short-range forces (using Poisson regression) from real-life bacterial de-adhesion experiments. Insights into such protein-substrate interactions may allow for engineering of biomaterials and designing of nonbiofouling surfaces.
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Affiliation(s)
- Arindam Raj
- Materials Science and Engineering, Indian Institute of Technology Kanpur, Kanpur208016, India.,Mechanical Engineering and Materials Science, Yale University, New Haven06520-8292, Connecticut, United States
| | - Neeraj Dhandia
- Materials Science and Engineering, Indian Institute of Technology Kanpur, Kanpur208016, India
| | - Kantesh Balani
- Materials Science and Engineering, Indian Institute of Technology Kanpur, Kanpur208016, India
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30
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Antimicrobial nanoparticle coatings for medical implants: Design challenges and prospects. Biointerphases 2020; 15:060801. [DOI: 10.1116/6.0000625] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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31
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Sosa BR, Niu Y, Turajane K, Staats K, Suhardi V, Carli A, Fischetti V, Bostrom M, Yang X. 2020 John Charnley Award: The antimicrobial potential of bacteriophage-derived lysin in a murine debridement, antibiotics, and implant retention model of prosthetic joint infection. Bone Joint J 2020; 102-B:3-10. [DOI: 10.1302/0301-620x.102b7.bjj-2019-1590.r1] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Aims Current treatments of prosthetic joint infection (PJI) are minimally effective against Staphylococcus aureus biofilm. A murine PJI model of debridement, antibiotics, and implant retention (DAIR) was used to test the hypothesis that PlySs2, a bacteriophage-derived lysin, can target S. aureus biofilm and address the unique challenges presented in this periprosthetic environment. Methods The ability of PlySs2 and vancomycin to kill biofilm and colony-forming units (CFUs) on orthopaedic implants were compared using in vitro models. An in vivo murine PJI model of DAIR was used to assess the efficacy of a combination of PlySs2 and vancomycin on periprosthetic bacterial load. Results PlySs2 treatment reduced 99% more CFUs and 75% more biofilm compared with vancomycin in vitro. A combination of PlySs2 and vancomycin in vivo reduced the number of CFUs on the surface of implants by 92% and in the periprosthetic tissue by 88%. Conclusion PlySs2 lysin was able to reduce biofilm, target planktonic bacteria, and work synergistically with vancomycin in our in vitro models. A combination of PlySs2 and vancomycin also reduced bacterial load in periprosthetic tissue and on the surface of implants in a murine model of DAIR treatment for established PJI. Cite this article: Bone Joint J 2020;102-B(7 Supple B):3–10.
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Affiliation(s)
| | - YingZhen Niu
- Hospital for Special Surgery, New York, New York, USA
- Hebei Medical University Third Affiliated Hospital, Department of Joint Surgery, Hebei Medical University Third Affiliated Hospital, Shijiazhuang, China
| | | | - Kevin Staats
- Hospital for Special Surgery, Department of Orthopedics and Trauma Surgery, New York, New York, USA
- Medical University of Vienna, Department of Orthopedics and Trauma Surgery, Vienna, Austria
| | | | - Alberto Carli
- Hospital for Special Surgery, New York, New York, USA
| | | | | | - Xu Yang
- Hospital for Special Surgery, New York, New York, USA
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32
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The Impact of EBM-Manufactured Ti6Al4V ELI Alloy Surface Modifications on Cytotoxicity toward Eukaryotic Cells and Microbial Biofilm Formation. MATERIALS 2020; 13:ma13122822. [PMID: 32585940 PMCID: PMC7344637 DOI: 10.3390/ma13122822] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 06/19/2020] [Accepted: 06/19/2020] [Indexed: 11/17/2022]
Abstract
Electron beam melting (EBM) is an additive manufacturing technique, which allows forming customized implants that perfectly fit the loss of the anatomical structure of bone. Implantation efficiency depends not only on the implant's functional or mechanical properties but also on its surface properties, which are of great importance with regard to such biological processes as bone regeneration or microbial contamination. This work presents the impact of surface modifications (mechanical polishing, sandblasting, and acid-polishing) of EBM-produced Ti6Al4V ELI implants on essential biological parameters. These include wettability, cytotoxicity toward fibroblast and osteoblast cell line, and ability to form biofilm by Staphylococcus aureus, Pseudomonas aeruginosa, and Candida albicans. Obtained results indicated that all prepared surfaces exhibited hydrophilic character and the highest changes of wettability were obtained by chemical modification. All implants displayed no cytotoxicity against osteoblast and fibroblast cell lines regardless of the modification type. In turn, the quantitative microbiological tests and visualization of microbial biofilm by means of electron microscopy showed that type of implant's modification correlated with the species-specific ability of microbes to form biofilm on it. Thus, the results of the presented study confirm the relationship between such technological aspects as surface modification and biological properties. The provided data are useful with regard to applications of the EBM technology and present a significant step towards personalized, customized implantology practice.
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33
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The Impact of Engineered Silver Nanomaterials on the Immune System. NANOMATERIALS 2020; 10:nano10050967. [PMID: 32443602 PMCID: PMC7712063 DOI: 10.3390/nano10050967] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 05/04/2020] [Accepted: 05/05/2020] [Indexed: 01/07/2023]
Abstract
Over the last decades there has been a tremendous volume of research efforts focused on engineering silver-based (nano)materials. The interest in silver has been mostly driven by the element capacity to kill pathogenic bacteria. In this context, the main area of application has been medical devices that are at significant risk of becoming colonized by bacteria and subsequently infected. However, silver nanomaterials have been incorporated in a number of other commercial products which may or may not benefit from antibacterial protection. The rapid expansion of such products raises important questions about a possible adverse influence on human health. This review focuses on examining currently available literature and summarizing the current state of knowledge of the impact of silver (nano)materials on the immune system. The review also looks at various surface modification strategies used to generate silver-based nanomaterials and the immunomodulatory potential of these materials. It also highlights the immune response triggered by various silver-coated implantable devices and provides guidance and perspective towards engineering silver nanomaterials for modulating immunological consequences.
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34
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Su K, Tan L, Liu X, Cui Z, Zheng Y, Li B, Han Y, Li Z, Zhu S, Liang Y, Feng X, Wang X, Wu S. Rapid Photo-Sonotherapy for Clinical Treatment of Bacterial Infected Bone Implants by Creating Oxygen Deficiency Using Sulfur Doping. ACS NANO 2020; 14:2077-2089. [PMID: 31990179 DOI: 10.1021/acsnano.9b08686] [Citation(s) in RCA: 122] [Impact Index Per Article: 30.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/07/2023]
Abstract
Periprosthetic infection is considered the main cause of implant failure, which is expected to be solved by fabricating an antibacterial coating on the surface of the implant. Nevertheless, systemic antibiotic treatment still represents the mainstream method for preventing infection, and few antibacterial coatings are applied clinically. This is because the externally introduced traditional antibacterial coatings suffer from the risk of invalidation and tissue toxicity induced by the consumption of antibacterial agents, degradation, and shedding. In this work, we proposed a rapid photo-sonotherapy by creating an oxygen deficiency on a titanium (Ti) implant through sulfur (S)-doping (Ti-S-TiO2-x), which endowed the implants with great sonodynamic and photothermal ability. Without introducing an external antibacterial coating, it reached a high antibacterial efficiency of 99.995% against Staphylococcus aureus under 15 min near-infrared light and ultrasound treatments. Furthermore, bone infection was successfully treated after combination treatments, and improved osseointegration was observed. Importantly, the S-doped Ti implant immersed in water for 6 months showed an unchanged structure and properties, suggesting that the Ti implant with intrinsic modification showed stable antibacterial performance under exogenous stimuli with a high antibacterial performance in vivo. This photo-sonotherapy based on sulfur doping is also promising for cancer therapy with biosafety.
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Affiliation(s)
- Kun Su
- Ministry-of-Education Key Laboratory for the Green Preparation and Application of Functional Materials, Hubei Key Laboratory of Polymer Materials, School of Materials Science & Engineering , Hubei University , Wuhan 430062 , China
| | - Lei Tan
- Ministry-of-Education Key Laboratory for the Green Preparation and Application of Functional Materials, Hubei Key Laboratory of Polymer Materials, School of Materials Science & Engineering , Hubei University , Wuhan 430062 , China
| | - Xiangmei Liu
- Ministry-of-Education Key Laboratory for the Green Preparation and Application of Functional Materials, Hubei Key Laboratory of Polymer Materials, School of Materials Science & Engineering , Hubei University , Wuhan 430062 , China
| | - Zhenduo Cui
- School of Materials Science & Engineering, the Key Laboratory of Advanced Ceramics and Machining Technology by the Ministry of Education of China , Tianjin University , Tianjin 300072 , China
| | - Yufeng Zheng
- State Key Laboratory for Turbulence and Complex System and Department of Materials Science and Engineering, College of Engineering , Peking University , Beijing 100871 , China
| | - Bo Li
- State Key Laboratory for Mechanical Behavior of Materials, School of Materials Science and Engineering , Xi'an Jiaotong University , Xi'an , Shaanxi 710049 , China
| | - Yong Han
- State Key Laboratory for Mechanical Behavior of Materials, School of Materials Science and Engineering , Xi'an Jiaotong University , Xi'an , Shaanxi 710049 , China
| | - Zhaoyang Li
- School of Materials Science & Engineering, the Key Laboratory of Advanced Ceramics and Machining Technology by the Ministry of Education of China , Tianjin University , Tianjin 300072 , China
| | - Shengli Zhu
- School of Materials Science & Engineering, the Key Laboratory of Advanced Ceramics and Machining Technology by the Ministry of Education of China , Tianjin University , Tianjin 300072 , China
| | - Yanqin Liang
- School of Materials Science & Engineering, the Key Laboratory of Advanced Ceramics and Machining Technology by the Ministry of Education of China , Tianjin University , Tianjin 300072 , China
| | - Xiaobo Feng
- Department of Orthopaedics, Union Hospital, Tongji Medical College , Huazhong University of Science and Technology , Wuhan 430022 , China
| | - Xianbao Wang
- Ministry-of-Education Key Laboratory for the Green Preparation and Application of Functional Materials, Hubei Key Laboratory of Polymer Materials, School of Materials Science & Engineering , Hubei University , Wuhan 430062 , China
| | - Shuilin Wu
- School of Materials Science & Engineering, the Key Laboratory of Advanced Ceramics and Machining Technology by the Ministry of Education of China , Tianjin University , Tianjin 300072 , China
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35
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El‐Chami MF, Mayotte J, Bonner M, Holbrook R, Stromberg K, Sohail MR. Reduced bacterial adhesion with parylene coating: Potential implications for Micra transcatheter pacemakers. J Cardiovasc Electrophysiol 2020; 31:712-717. [DOI: 10.1111/jce.14362] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Revised: 01/08/2020] [Accepted: 01/14/2020] [Indexed: 12/27/2022]
Affiliation(s)
- Mikhael F. El‐Chami
- Division of Cardiology, Section of ElectrophysiologyEmory UniversityAtlanta Georgia
| | | | | | | | | | - Muhammad Rizwan Sohail
- Department of Medicine and Department of Cardiovascular DiseasesMayo Clinic College of Medicine and ScienceRochester Minnesota
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Abstract
Prosthetic joint infection (PJI) is associated with poor clinical outcomes and is expensive to treat.Although uncommon overall (affecting between 0.5% and 2.2% of cases), PJI is one of the most commonly encountered complications of joint replacement and its incidence is increasing, putting a significant burden on healthcare systems.Once established, PJI is extremely difficult to eradicate as bacteria exist in biofilms which protect them from antibiotics and the host immune response.Improved understanding of the microbial pathology in PJI has generated potential new treatment strategies for prevention and eradication of biofilm associated infection including modification of implant surfaces to prevent adhesion of bacteria.Much research is currently ongoing looking at different implant surface coatings and modifications, and although most of this work has not translated into clinical medicine there has been some early clinical success. Cite this article: EFORT Open Rev 2019;4:633-639. DOI: 10.1302/2058-5241.4.180095.
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Affiliation(s)
- Donald J Davidson
- Research Department of Orthopaedics and Musculoskeletal Sciences, University College London, London, UK.,Department of Microbial Diseases, UCL Eastman Dental Institute, University College London, London, UK
| | - David Spratt
- Department of Microbial Diseases, UCL Eastman Dental Institute, University College London, London, UK
| | - Alexander D Liddle
- Department of Microbial Diseases, UCL Eastman Dental Institute, University College London, London, UK.,MSK Lab, Imperial College London, London, UK
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37
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Sprio S, Preti L, Montesi M, Panseri S, Adamiano A, Vandini A, Pugno NM, Tampieri A. Surface Phenomena Enhancing the Antibacterial and Osteogenic Ability of Nanocrystalline Hydroxyapatite, Activated by Multiple-Ion Doping. ACS Biomater Sci Eng 2019; 5:5947-5959. [PMID: 33405685 DOI: 10.1021/acsbiomaterials.9b00893] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
The present work describes a novel nanocrystalline, multidoped hydroxyapatite featuring excellent eukaryotic versus prokaryotic cell selectivity, attested by excellent osteoinductive character and evaluated with human stem cells, and anti-infective ability, tested against different pathogens. Physicochemical analysis and transmission electron microscopy (TEM)/scanning STEM observations highlighted that such enhanced biological features are related to the lower crystallinity level and increased surface charge of hydroxyapatite, both induced by multiple-ion doping. Specifically, the lattice substitution of Ca2+ with Zn2+ promotes the segregation of Ca2+ and doping Mg2+ cations to a less-ordered surface layer, thus promoting dynamic ion absorption/release acting as bioactive signals for cells and exerting an antiproliferative effect on all tested pathogens. These findings open the design of new biodevices, combining regenerative ability and effective microbial inhibition without using any antibiotic drugs. This is extremely important to circumvent bacterial resistance to antibiotics, which is today considered as one of the biggest threats to global health.
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Affiliation(s)
- Simone Sprio
- Institute of Science and Technology for Ceramics-National Research Council (ISTEC-CNR), Faenza 48018, Italy
| | - Lorenzo Preti
- Institute of Science and Technology for Ceramics-National Research Council (ISTEC-CNR), Faenza 48018, Italy.,Laboratory of Bio-inspired & Graphene Nanomechanics, Department of Civil, Environmental and Mechanical Engineering, University of Trento, Via Mesiano 77, 38123 Trento, Italy
| | - Monica Montesi
- Institute of Science and Technology for Ceramics-National Research Council (ISTEC-CNR), Faenza 48018, Italy
| | - Silvia Panseri
- Institute of Science and Technology for Ceramics-National Research Council (ISTEC-CNR), Faenza 48018, Italy
| | - Alessio Adamiano
- Institute of Science and Technology for Ceramics-National Research Council (ISTEC-CNR), Faenza 48018, Italy
| | - Alberta Vandini
- Institute of Microbiology, University of Ferrara, Ferrara 44121, Italy
| | - Nicola M Pugno
- Laboratory of Bio-inspired & Graphene Nanomechanics, Department of Civil, Environmental and Mechanical Engineering, University of Trento, Via Mesiano 77, 38123 Trento, Italy.,School of Engineering and Materials Science, Queen Mary University of London, Mile End Road, London E1 4NS, U.K.,Ket-Lab, Edoardo Amaldi Foundation, Via del Politecnico, 00133 Rome, Italy
| | - Anna Tampieri
- Institute of Science and Technology for Ceramics-National Research Council (ISTEC-CNR), Faenza 48018, Italy
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Croes M, van der Wal BCH, Vogely HC. Impact of Bacterial Infections on Osteogenesis: Evidence From In Vivo Studies. J Orthop Res 2019; 37:2067-2076. [PMID: 31329305 PMCID: PMC6771910 DOI: 10.1002/jor.24422] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Accepted: 07/15/2019] [Indexed: 02/04/2023]
Abstract
The clinical impact of bacterial infections on bone regeneration has been incompletely quantified and documented. As a result, controversy exists about the optimal treatment strategy to maximize healing of a contaminated defect. Animal models are extremely useful in this respect, as they can elucidate how a bacterial burden influences quantitative healing of various types of defects relative to non-infected controls. Moreover, they may demonstrate how antibacterial treatment and/or bone grafting techniques facilitate the osteogenic response in the harsh environment of a bacterial infection. Finally, it a well-known contradiction that osteomyelitis is characterized by uncontrolled bone remodeling and bone loss, but at the same time, it can be associated with excessive new bone apposition. Animal studies can provide a better understanding of how osteolytic and osteogenic responses are related to each other during infection. This review discusses the in vivo impact of bacterial infection on osteogenesis by addressing the following questions (i) How does osteomyelitis affect the radiographic bone appearance? (ii) What is the influence of bacterial infection on histological bone healing? (iii) How do bacterial infections affect quantitative bone healing? (iv) What is the effect of antibacterial treatment on the healing outcome during infection? (v) What is the efficacy of osteoinductive proteins in infected bones? (vi) What is the balance between the osteoclastic and osteoblastic response during bacterial infections? (vii) What is the mechanism of the observed pro-osteogenic response as observed in osteomyelitis? © 2019 The Authors. Journal of Orthopaedic Research© published by Wiley Periodicals, Inc. on behalf of Orthopaedic Research Society. J Orthop Res 37:2067-2076, 2019.
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Affiliation(s)
- Michiel Croes
- Department of OrthopaedicsUniversity Medical Center UtrechtHeidelberglaan 1003508 GAUtrechtThe Netherlands
| | - Bart C. H. van der Wal
- Department of OrthopaedicsUniversity Medical Center UtrechtHeidelberglaan 1003508 GAUtrechtThe Netherlands
| | - H. Charles Vogely
- Department of OrthopaedicsUniversity Medical Center UtrechtHeidelberglaan 1003508 GAUtrechtThe Netherlands
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Saeed K, McLaren AC, Schwarz EM, Antoci V, Arnold WV, Chen AF, Clauss M, Esteban J, Gant V, Hendershot E, Hickok N, Higuera CA, Coraça-Huber DC, Choe H, Jennings JA, Joshi M, Li WT, Noble PC, Phillips KS, Pottinger PS, Restrepo C, Rohde H, Schaer TP, Shen H, Smeltzer M, Stoodley P, Webb JCJ, Witsø E. 2018 international consensus meeting on musculoskeletal infection: Summary from the biofilm workgroup and consensus on biofilm related musculoskeletal infections. J Orthop Res 2019; 37:1007-1017. [PMID: 30667567 DOI: 10.1002/jor.24229] [Citation(s) in RCA: 101] [Impact Index Per Article: 20.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Accepted: 01/14/2019] [Indexed: 02/04/2023]
Abstract
Biofilm-associated implant-related bone and joint infections are clinically important due to the extensive morbidity, cost of care and socioeconomic burden that they cause. Research in the field of biofilms has expanded in the past two decades, however, there is still an immense knowledge gap related to many clinical challenges of these biofilm-associated infections. This subject was assigned to the Biofilm Workgroup during the second International Consensus Meeting on Musculoskeletal Infection held in Philadelphia USA (ICM 2018) (https://icmphilly.com). The main objective of the Biofilm Workgroup was to prepare a consensus document based on a review of the literature, prepared responses, discussion, and vote on thirteen biofilm related questions. The Workgroup commenced discussing and refining responses prepared before the meeting on day one using Delphi methodology, followed by a tally of responses using an anonymized voting system on the second day of ICM 2018. The Working group derived consensus on information about biofilms deemed relevant to clinical practice, pertaining to: (1) surface modifications to prevent/inhibit biofilm formation; (2) therapies to prevent and treat biofilm infections; (3) polymicrobial biofilms; (4) diagnostics to detect active and dormant biofilm in patients; (5) methods to establish minimal biofilm eradication concentration for biofilm bacteria; and (6) novel anti-infectives that are effective against biofilm bacteria. It was also noted that biomedical research funding agencies and the pharmaceutical industry should recognize these areas as priorities. © 2019 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res.
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Affiliation(s)
- Kordo Saeed
- Department of Microbiology Hampshire Hospitals NHS Foundation Trust, Winchester and Basingstoke, UK and University of Southampton, School of Medicine, Southampton, UK
| | - Alex C McLaren
- Department of Orthopaedic Surgery, University of Arizona, College of Medicine-Phoenix, Phoenix, Arizona
| | - Edward M Schwarz
- Department of Orthopaedics, University of Rochester, Rochester, New York
| | - Valentin Antoci
- Department of Orthopaedics, University Orthopedics Rhode Island, Providence, Rhode Island
| | - William V Arnold
- Department of Orthopaedics, Rothman Institute at Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Antonia F Chen
- Department of Orthopaedics, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Martin Clauss
- Department for Orthopaedics and Trauma Surgery Kantonsspital Baselland, Liestal and University Hospital Basel Department for Orthopaedics and Trauma Surgery, Basel, CH
| | - Jaime Esteban
- Department of Clinical Microbiology, IIS-Fundacion Jimenez Diaz, UAM, Av. Reyes Catolicos 2., 28040-Madrid, Spain
| | - Vanya Gant
- College Hospital, Hospital for Tropical Diseases, National Hospital for Neurology and Neurosurgery at University College London Hospitals, London, UK
| | - Edward Hendershot
- Department of Internal Medicine and Infectious Diseases at Duke University Hospital, Durham, North Carolina
| | - Noreen Hickok
- Department of Orthopaedic Surgery, Department of Biochemistry & Molecular Biology Thomas Jefferson University, 1015 Walnut St., Philadelphia, 19107, Pennsylvania
| | - Carlos A Higuera
- Levitetz Department of Orthopaedic Surgery, Cleveland Clinic Florida, Weston, Florida
| | - Débora C Coraça-Huber
- Research Laboratory for Implant Associated Infections (Biofilm Lab) - Experimental Orthopaedics, Department of Orthopaedic Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - Hyonmin Choe
- Yokohama City University Orthopaedic Department, Fukuura-3-9, Kanazawa-ku, Yokohama, Japan
| | - Jessica A Jennings
- Department of Biomedical Engineering, The University of Memphis, 303B Engineering Technology Building, Memphis, Tennessee
| | - Manjari Joshi
- Department of Internal Medicine and Infectious Diseases at University of Mryland, School of Medicine, R Adams Cowley Shock Trauma Center Baltimore, Baltimore, Maryland
| | - William T Li
- Sydney Kimmel Medical College at Philadelphia University and Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Philip C Noble
- Institute of Orthopaedic Research and Education, Houston, Texas.,Baylor College of Medicine Department of Orthopaedic Surgery, Houston, Texas
| | - K Scott Phillips
- Division of Biology, Chemistry, and Materials Science, Office of Science and Engineering Laboratories, Center for Devices and Radiological Health, Office of Medical Products and Tobacco, US Food and Drug Administration, Silver Spring, Maryland
| | - Paul S Pottinger
- Department of Medicine, Division of Allergy and Infectious Diseases, University of Washington, Seattle, Washington
| | - Camilo Restrepo
- Department of Orthopaedics, Rothman Institute at Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Holger Rohde
- Institute for Medical Microbiology, Virology and Hygiene, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Thomas P Schaer
- Department of Clinical Studies New Bolton Center, University of Pennsylvania School of Veterinary Medicine, Kennett Square, Pennsylvania
| | - Hao Shen
- Department of Orthopaedics, Shanghai Jiao Tong University Affiliated Sixth People' s Hospital, Shanghai, P. R. China
| | - Mark Smeltzer
- Department of Microbiology and Immunology, Department of Orthopaedic Surgery, Center for Microbial Pathogenesis and Host Inflammatory Responses, University of Arkansas for Medical Sciences 4301 W. Markham, Slot 511, Little Rock, 72205, Arkansas
| | - Paul Stoodley
- Department Microbial Infection and Immunity, College of Medicine, The Ohio State University, Columbus, Ohio.,Department Orthopaedics, College of Medicine, The Ohio State University, Columbus, Ohio.,Department National Centre for Advanced Tribology at Southampton (nCATS), Mechanical Engineering, University of Southampton, Southampton, UK
| | - Jason C J Webb
- Department of Orthopaedic Surgery, Avon Orthopaedic Centre, Southmead Hospital, Bristol, UK
| | - Eivind Witsø
- Department of Orthopaedic Surgery at St. Olavs Hospital, Trondheim, Norway
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Moon GH, Cho JW, Kim BS, Yeo DH, Oh JK. Analysis of Risk Factors for Infection in Orthopedic Trauma Patients. JOURNAL OF TRAUMA AND INJURY 2019. [DOI: 10.20408/jti.2018.023] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Affiliation(s)
- Gi Ho Moon
- Department of Orthopedic Surgery, Guro Hospital, Korea University Medical Center, Seoul, Korea
| | - Jae-Woo Cho
- Department of Orthopedic Surgery, Guro Hospital, Korea University Medical Center, Seoul, Korea
| | - Beom Soo Kim
- Department of Orthopedic Surgery, Guro Hospital, Korea University Medical Center, Seoul, Korea
| | - Do Hyun Yeo
- Department of Orthopedic Surgery, Guro Hospital, Korea University Medical Center, Seoul, Korea
| | - Jong-Keon Oh
- Department of Orthopedic Surgery, Guro Hospital, Korea University Medical Center, Seoul, Korea
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41
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Costoya A, Velázquez Becerra LE, Meléndez-Ortiz HI, Díaz-Gómez L, Mayer C, Otero A, Concheiro A, Bucio E, Alvarez-Lorenzo C. Immobilization of antimicrobial and anti-quorum sensing enzymes onto GMA-grafted poly(vinyl chloride) catheters. Int J Pharm 2019; 558:72-81. [DOI: 10.1016/j.ijpharm.2018.12.075] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Revised: 12/04/2018] [Accepted: 12/29/2018] [Indexed: 11/30/2022]
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Mas-Moruno C, Su B, Dalby MJ. Multifunctional Coatings and Nanotopographies: Toward Cell Instructive and Antibacterial Implants. Adv Healthc Mater 2019; 8:e1801103. [PMID: 30468010 DOI: 10.1002/adhm.201801103] [Citation(s) in RCA: 117] [Impact Index Per Article: 23.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Revised: 10/15/2018] [Indexed: 01/02/2023]
Abstract
In biomaterials science, it is nowadays well accepted that improving the biointegration of dental and orthopedic implants with surrounding tissues is a major goal. However, implant surfaces that support osteointegration may also favor colonization of bacterial cells. Infection of biomaterials and subsequent biofilm formation can have devastating effects and reduce patient quality of life, representing an emerging concern in healthcare. Conversely, efforts toward inhibiting bacterial colonization may impair biomaterial-tissue integration. Therefore, to improve the long-term success of medical implants, biomaterial surfaces should ideally discourage the attachment of bacteria without affecting eukaryotic cell functions. However, most current strategies seldom investigate a combined goal. This work reviews recent strategies of surface modification to simultaneously address implant biointegration while mitigating bacterial infections. To this end, two emerging solutions are considered, multifunctional chemical coatings and nanotopographical features.
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Affiliation(s)
- Carlos Mas-Moruno
- Biomaterials, Biomechanics and Tissue Engineering Group; Department of Materials Science and Engineering & Center in Multiscale Science and Engineering; Universitat Politècnica de Catalunya (UPC); Barcelona 08019 Spain
| | - Bo Su
- Bristol Dental School; University of Bristol; Bristol BS1 2LY UK
| | - Matthew J. Dalby
- Centre for Cell Engineering; University of Glasgow; Glasgow G12 UK
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43
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Yang Y, Chu L, Yang S, Zhang H, Qin L, Guillaume O, Eglin D, Richards RG, Tang T. Dual-functional 3D-printed composite scaffold for inhibiting bacterial infection and promoting bone regeneration in infected bone defect models. Acta Biomater 2018; 79:265-275. [PMID: 30125670 DOI: 10.1016/j.actbio.2018.08.015] [Citation(s) in RCA: 87] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Revised: 07/29/2018] [Accepted: 08/16/2018] [Indexed: 12/20/2022]
Abstract
Infection is one of the pivotal causes of nonunion in large bone defect after trauma or tumor resection. Three-dimensional (3D) composite scaffold with multifunctional-therapeutic properties offer many advantages over allogenic or xenogenic bone grafting for the restoration of challenging infected bone defects. In the previous study, we demonstrated that quaternized chitosan (HACC)-grafted polylactide-co-glycolide (PLGA)/hydroxyapatite (HA) scaffold (PLGA/HA/HACC) via 3D-printing technique exhibited significantly improved antimicrobial and osteoconductive property in vitro, together with good biocompatibility in vivo. Hence, the present study further investigated whether such an innovative bone substitute could effectively inhibit the bacterial biofilm formation and promote bone regeneration in vivo. To evaluate the bone repairing effects of the 3D-printed scaffolds on infected cortical and cancellous bone defects scenarios, eighty female Sprague Dawley rats and thirty-six female New Zealand white rabbits were used to establish infected femoral shaft defect and condyle defect model, respectively. X-ray, micro-CT, microbiological and histopathological analyses were used to assess the anti-infection and bone repairing potential of the dual-functional porous scaffolds. We observed that HACC-grafted PLGA/HA scaffolds exhibited significantly enhanced anti-infection and bone regeneration capability in different infected bone defect models. In addition, the degradation rate of the scaffolds appeared to be closely related to the progress of infection, influencing the bone repairing potential of the scaffolds in infected bone defects models. In general, this investigation is of great significance as it demonstrates promising applications of the 3D-printed dual-functional PLGA/HA/HACC scaffold for repairing different types of bone defect under infection. STATEMENT OF SIGNIFICANCE Currently, it is clinically urgent to exploit bone substitutes with potential of bacterial inhibition and bone regeneration. However, bone scaffolds with relatively low risks of bacterial resistance and tissue toxicity used for combating infected bone defects remain to be developed. We have reported that quaternized chitosan (HACC)-grafted 3D-printed PLGA/HA composite scaffold had enhanced in vitro antimicrobial and osteoconductive property, and well cytocompatibility in our published study. This continuing study further confirmed that HACC-grafted PLGA/HA scaffolds exhibited significantly enhanced anti-infection and bone regeneration efficacy in both cortical bone defect in rat and cancellous bone defect in rabbit under infection. Meanwhile, we also found that the degradation rate of the scaffolds seemed to be closely related to the progress of infection, influencing the bone repairing potential of the scaffolds in infected bone defects models. In conclusion, this study provides significant opportunities to develop a 3D-printed bone scaffold with dual functions used for infected bone defects in future plastic and orthopaedic surgery.
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44
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Real-time analysis of nanopore-based metagenomic sequencing from infected orthopaedic devices. BMC Genomics 2018; 19:714. [PMID: 30261842 PMCID: PMC6161345 DOI: 10.1186/s12864-018-5094-y] [Citation(s) in RCA: 84] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Accepted: 09/19/2018] [Indexed: 01/02/2023] Open
Abstract
Background Prosthetic joint infections are clinically difficult to diagnose and treat. Previously, we demonstrated metagenomic sequencing on an Illumina MiSeq replicates the findings of current gold standard microbiological diagnostic techniques. Nanopore sequencing offers advantages in speed of detection over MiSeq. Here, we report a real-time analytical pathway for Nanopore sequence data, designed for detecting bacterial composition of prosthetic joint infections but potentially useful for any microbial sequencing, and compare detection by direct-from-clinical-sample metagenomic nanopore sequencing with Illumina sequencing and standard microbiological diagnostic techniques. Results DNA was extracted from the sonication fluids of seven explanted orthopaedic devices, and additionally from two culture negative controls, and was sequenced on the Oxford Nanopore Technologies MinION platform. A specific analysis pipeline was assembled to overcome the challenges of identifying the true infecting pathogen, given high levels of host contamination and unavoidable background lab and kit contamination. The majority of DNA classified (> 90%) was host contamination and discarded. Using negative control filtering thresholds, the species identified corresponded with both routine microbiological diagnosis and MiSeq results. By analysing sequences in real time, causes of infection were robustly detected within minutes from initiation of sequencing. Conclusions We demonstrate a novel, scalable pipeline for real-time analysis of MinION sequence data and use of this pipeline to show initial proof of concept that metagenomic MinION sequencing can provide rapid, accurate diagnosis for prosthetic joint infections. The high proportion of human DNA in prosthetic joint infection extracts prevents full genome analysis from complete coverage, and methods to reduce this could increase genome depth and allow antimicrobial resistance profiling. The nine samples sequenced in this pilot study have shown a proof of concept for sequencing and analysis that will enable us to investigate further sequencing to improve specificity and sensitivity. Electronic supplementary material The online version of this article (10.1186/s12864-018-5094-y) contains supplementary material, which is available to authorized users.
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45
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Wi YM, Patel R. Understanding Biofilms and Novel Approaches to the Diagnosis, Prevention, and Treatment of Medical Device-Associated Infections. Infect Dis Clin North Am 2018; 32:915-929. [PMID: 30241715 DOI: 10.1016/j.idc.2018.06.009] [Citation(s) in RCA: 53] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Treatment of medical device-related infections is challenging and recurrence is common. The main reason for this is that microorganisms adhere to the surfaces of medical devices and enter into a biofilm state in which they display distinct growth rates, structural features, and protection from antimicrobial agents and host immune mechanisms compared with their planktonic counterparts. This article reviews how microorganisms form biofilms and the mechanisms of protection against antimicrobial agents and the host immune system provided by biofilms. Also discussed are innovative strategies for the diagnosis of biofilm-associated infection and novel approaches to treatment and prevention of medical device-associated infections.
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Affiliation(s)
- Yu Mi Wi
- Division of Infectious Diseases, Department of Internal Medicine, Samsung Changwon Hospital, Sungkyunkwan University, 158 palyong-ro, MasanHoiwon-gu, Changwon-si, Gyeongsangnam-do 51353, Korea
| | - Robin Patel
- Division of Clinical Microbiology, Department of Laboratory Medicine and Pathology, Mayo Clinic, 200 First Street Southwest, Rochester, MN 55905, USA; Division of Infectious Diseases, Department of Medicine, Mayo Clinic, 200 First Street Southwest, Rochester, MN 55905, USA.
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46
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von Pfeil DJF, Kowaleski MP, Glassman M, Dejardin LM. Results of a survey of Veterinary Orthopedic Society members on the preferred method for treating cranial cruciate ligament rupture in dogs weighing more than 15 kilograms (33 pounds). J Am Vet Med Assoc 2018; 253:586-597. [DOI: 10.2460/javma.253.5.586] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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47
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Akanda ZZ, Taha M, Abdelbary H. Current review-The rise of bacteriophage as a unique therapeutic platform in treating peri-prosthetic joint infections. J Orthop Res 2018; 36:1051-1060. [PMID: 28971508 DOI: 10.1002/jor.23755] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2017] [Accepted: 09/27/2017] [Indexed: 02/04/2023]
Abstract
Peri-prosthetic joint infection (PJI) is one of the most serious and dreaded complications after total joint replacement (TJR). Due to an aging population and the constant rise in demand for TJR, the incidence of PJI is also increasing. Successful treatment of PJI is challenging and is associated with high failure rates. One of the main causes for treatment failure is bacterial biofilm formation on implant surfaces and the adherence of biofilm bacteria on tissue and bone next to the implant. Biofilms are protective shields to bacterial cells and possess many unique properties that leads to antibiotic resistance. New therapeutic platforms are currently being explored to breakdown biofilm matrix in order to enhance the efficacy of antibiotics. Bacteriophages (phages) is one of these unique therapeutic platforms that can degrade biofilms as well as target the killing of bacterial cells. Preclinical studies of biofilm-mediated infections have demonstrated the ability of phage to eradicate biofilms and clear infections by working synergistically with antibiotics. There is strong preclinical evidence that phage can reduce the concentration of antibiotics required to treat an infection. These findings support a promising role for phages as a future clinical adjunct to antibiotics. In addition, phage therapy can be personalized to target a specific bacterial strain. Clinical studies using phage therapy are limited in Western literature; but phase I studies have established good safety profile with no adverse outcomes reported. In order to translate phage therapy to treat PJI in clinics, further preclinical testing is still required to study optimal delivery methods as well as the interaction between phage and the immune system in vivo. © 2017 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 36:1051-1060, 2018.
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Affiliation(s)
- Zarique Z Akanda
- Department of Surgery, Division of Orthopaedics, The Ottawa Hospital, Ottawa, Canada
| | - Mariam Taha
- Department of Surgery, Division of Orthopaedics, The Ottawa Hospital, Ottawa, Canada
| | - Hesham Abdelbary
- Department of Surgery, Division of Orthopaedics, The Ottawa Hospital, Ottawa, Canada
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48
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Dos Santos Ramos MA, Da Silva PB, Spósito L, De Toledo LG, Bonifácio BV, Rodero CF, Dos Santos KC, Chorilli M, Bauab TM. Nanotechnology-based drug delivery systems for control of microbial biofilms: a review. Int J Nanomedicine 2018; 13:1179-1213. [PMID: 29520143 PMCID: PMC5834171 DOI: 10.2147/ijn.s146195] [Citation(s) in RCA: 152] [Impact Index Per Article: 25.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Since the dawn of civilization, it has been understood that pathogenic microorganisms cause infectious conditions in humans, which at times, may prove fatal. Among the different virulent properties of microorganisms is their ability to form biofilms, which has been directly related to the development of chronic infections with increased disease severity. A problem in the elimination of such complex structures (biofilms) is resistance to the drugs that are currently used in clinical practice, and therefore, it becomes imperative to search for new compounds that have anti-biofilm activity. In this context, nanotechnology provides secure platforms for targeted delivery of drugs to treat numerous microbial infections that are caused by biofilms. Among the many applications of such nanotechnology-based drug delivery systems is their ability to enhance the bioactive potential of therapeutic agents. The present study reports the use of important nanoparticles, such as liposomes, microemulsions, cyclodextrins, solid lipid nanoparticles, polymeric nanoparticles, and metallic nanoparticles, in controlling microbial biofilms by targeted drug delivery. Such utilization of these nanosystems has led to a better understanding of their applications and their role in combating biofilms.
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Affiliation(s)
- Matheus Aparecido Dos Santos Ramos
- São Paulo State University (UNESP), School of Pharmaceutical Sciences, Campus Araraquara, Department of Biological Sciences, Araraquara, SP, Brazil
| | - Patrícia Bento Da Silva
- São Paulo State University (UNESP), School of Pharmaceutical Sciences, Campus Araraquara, Department of Drugs and Medicines. Araraquara, SP, Brazil
| | - Larissa Spósito
- São Paulo State University (UNESP), School of Pharmaceutical Sciences, Campus Araraquara, Department of Biological Sciences, Araraquara, SP, Brazil
| | - Luciani Gaspar De Toledo
- São Paulo State University (UNESP), School of Pharmaceutical Sciences, Campus Araraquara, Department of Biological Sciences, Araraquara, SP, Brazil
| | - Bruna Vidal Bonifácio
- São Paulo State University (UNESP), School of Pharmaceutical Sciences, Campus Araraquara, Department of Biological Sciences, Araraquara, SP, Brazil
| | - Camila Fernanda Rodero
- São Paulo State University (UNESP), School of Pharmaceutical Sciences, Campus Araraquara, Department of Drugs and Medicines. Araraquara, SP, Brazil
| | - Karen Cristina Dos Santos
- São Paulo State University (UNESP), School of Pharmaceutical Sciences, Campus Araraquara, Department of Drugs and Medicines. Araraquara, SP, Brazil
| | - Marlus Chorilli
- São Paulo State University (UNESP), School of Pharmaceutical Sciences, Campus Araraquara, Department of Drugs and Medicines. Araraquara, SP, Brazil
| | - Taís Maria Bauab
- São Paulo State University (UNESP), School of Pharmaceutical Sciences, Campus Araraquara, Department of Biological Sciences, Araraquara, SP, Brazil
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49
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Ishikawa M, de Mesy Bentley KL, McEntire BJ, Bal BS, Schwarz EM, Xie C. Surface topography of silicon nitride affects antimicrobial and osseointegrative properties of tibial implants in a murine model. J Biomed Mater Res A 2017; 105:3413-3421. [PMID: 28865177 DOI: 10.1002/jbm.a.36189] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2017] [Revised: 07/10/2017] [Accepted: 08/16/2017] [Indexed: 12/28/2022]
Abstract
While silicon nitride (Si3 N4 ) is an antimicrobial and osseointegrative orthopaedic biomaterial, the contribution of surface topography to these properties is unknown. Using a methicillin-resistant strain of Staphylococcus aureus (MRSA), this study evaluated Si3 N4 implants in vitro utilizing scanning electron microscopy (SEM) with colony forming unit (CFU) assays, and later in an established in vivo murine tibia model of implant-associated osteomyelitis. In vitro, the "as-fired" Si3 N4 implants displayed significant reductions in adherent bacteria versus machined Si3 N4 (2.6 × 104 vs. 8.7 × 104 CFU, respectively; p < 0.0002). Moreover, SEM imaging demonstrated that MRSA cannot directly adhere to native as-fired Si3 N4 . Subsequently, a cross-sectional study was completed in which sterile or MRSA contaminated as-fired and machined Si3 N4 implants were inserted into the tibiae of 8-week old female Balb/c mice, and harvested on day 1, 3, 5, 7, 10, or 14 post-operatively for SEM. The findings demonstrated that the antimicrobial activity of the as-fired implants resulted from macrophage clearance of the bacteria during biofilm formation on day 1, followed by osseointegration through the apparent recruitment of mesenchymal stem cells on days 3-5, which differentiated into osteoblasts on days 7-14. In contrast, the antimicrobial behavior of the machined Si3 N4 was due to repulsion of the bacteria, a phenomenon that also limited osteogenesis, as host cells were also unable to adhere to the machined surface. Taken together, these results suggest that the in vivo biological behavior of Si3 N4 orthopaedic implants is driven by critical features of their surface nanotopography. © 2017 Wiley Periodicals, Inc. J Biomed Mater Res Part A: 105A: 3413-3421, 2017.
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Affiliation(s)
- Masahiro Ishikawa
- Center for Musculoskeletal Research, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
| | - Karen L de Mesy Bentley
- Center for Musculoskeletal Research, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA.,Department of Pathology and Laboratory Medicine, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA.,Department of Orthopaedics, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
| | | | - B Sonny Bal
- Amedica Corporation, Salt Lake City, Utah, USA.,Department of Orthopaedic Surgery, University of Missouri, Columbia, Missouri, USA
| | - Edward M Schwarz
- Center for Musculoskeletal Research, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA.,Department of Pathology and Laboratory Medicine, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA.,Department of Orthopaedics, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
| | - Chao Xie
- Center for Musculoskeletal Research, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA.,Department of Orthopaedics, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
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50
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Langsteiner A, Loncaric I, Henkel-Odwody AM, Tichy A, Licka TF. Initial adhesion of methicillin-sensitive and methicillin-resistant Staphylococcus aureus strains to untreated and electropolished surgical steel drill bits. Res Vet Sci 2017; 114:474-481. [PMID: 28946121 DOI: 10.1016/j.rvsc.2017.09.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2016] [Revised: 05/22/2017] [Accepted: 09/14/2017] [Indexed: 11/26/2022]
Abstract
Electropolishing of stainless steel has been thoroughly investigated as a prophylactic measure to prevent bacterial colonization of orthopaedic implants and infection. Initial bacterial adhesion onto surgical drill bits as a possible factor for orthopaedic surgical site infections has not yet been documented. The present study investigated the influence of electropolishing on initial staphylococcal adhesion onto AISI 440A stainless steel drill bits. Specifically, one methicillin-susceptible standard laboratory Staphylococcus aureus type strain (DSM 20231T), one methicillin-resistant S. aureus reference strain (DSM 46320) and one methicillin-resistant clinical isolate from an infected orthopaedic implant were used. After standard sterilization, drill bits were immersed in the respective bacterial suspension; bacteria adherent to surface were harvested by vortexing the drill bits in phosphate-buffered saline and viable counts of bacteria transferred from the suspension were made (transferred to log10 for further analysis). Electropolishing significantly reduced adhesion of the clinical S. aureus strain and the S. aureus DSM 20231T. However, electropolishing significantly increased adhesion of the S. aureus DSM 46320. These results show that electropolishing significantly influences initial adhesion of S. aureus strains to surgical drill bits and that the nature of this influence depends on the S. aureus strain examined. For a general recommendation of electropolishing drill bits and guidelines for their handling during surgery, further studies with more strains isolated from infected wounds are suggested.
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Affiliation(s)
- Annemarie Langsteiner
- Department for Companion Animals and Horses, Equine University Clinic, University of Veterinary Medicine, Veterinärplatz 1, 1210 Vienna, Austria
| | - Igor Loncaric
- Department for Pathobiology, Institute of Microbiology, University of Veterinary Medicine, Veterinärplatz 1, 1210 Vienna, Austria.
| | - Anna-Maria Henkel-Odwody
- Department for Companion Animals and Horses, Equine University Clinic, University of Veterinary Medicine, Veterinärplatz 1, 1210 Vienna, Austria
| | - Alexander Tichy
- Department of Biomedical Sciences, Bioinformatics and Biostatistics Platform, University of Veterinary Medicine, Veterinärplatz 1, 1210 Vienna, Austria.
| | - Theresia F Licka
- Department for Companion Animals and Horses, Equine University Clinic, University of Veterinary Medicine, Veterinärplatz 1, 1210 Vienna, Austria; Department of Veterinary Clinical Studies, Royal (Dick) School of Veterinary Studies, University of Edinburgh, Easter Bush Campus, EH25 9RG Edinburgh, United Kingdom.
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