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Xu H, Feng J, Dai N, Han Q, Zhou B, Yang G, Hu R. Self-assembling peptide hydrogel scaffold integrating stem cell-derived exosomes for infected bone defects. JOURNAL OF BIOMATERIALS SCIENCE. POLYMER EDITION 2024; 35:1511-1522. [PMID: 38574263 DOI: 10.1080/09205063.2024.2336316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Accepted: 02/19/2024] [Indexed: 04/06/2024]
Abstract
Infected bone defect (IBD) is a great challenge in orthopedics, which involves in bone loss and infection. Here, a self-assembling hydrogel scaffold (named AMP-RAD/EXO), integrating antimicrobial peptides(AMPs), RADA16 and BMSCs exosomes with an innovative strategy, is developed and applied in IBD treatment for sustained antimicrobial ability, accelerating osteoblasts proliferation and promoting bone regeneration. AMPs present an excellent ability to inhibit infection, RADA16 is a self-assembling peptide hydrogel for AMPs delivery, and BMSCs exosomes can promote the bone regeneration. The prepared AMP-RAD/EXO exhibited a polyporous 3D structure for imbibition of BMSCs exosomes and migration of osteoblasts. In vitro studies indicate AMP-RAD/EXO can inhibit the growth of Staphylococcus aureus, accelerate the proliferation and migration of BMSCs. More importantly, in vivo results also prove that AMP-RAD/EXO exhibit an excellent effect on IBD treatment. Thus, the prepared AMP-RAD/EXO provides a multifunctional scaffold concept for bone tissue engineering technology.
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Affiliation(s)
- Haiyan Xu
- Orthopaedics, Wuhan Fourth Hospital, Wuhan, Hubei Province, P.R. China
| | - Jing Feng
- Nursing Department, Wuhan Fourth Hospital, Wuhan, Hubei Province, P.R. China
| | - Ning Dai
- Nursing Department, Wuhan Fourth Hospital, Wuhan, Hubei Province, P.R. China
| | - Qiong Han
- Orthopaedics, Wuhan Fourth Hospital, Wuhan, Hubei Province, P.R. China
| | - Bei Zhou
- Nursing Department, Wuhan Fourth Hospital, Wuhan, Hubei Province, P.R. China
| | - Guiyun Yang
- Nursing Department, Wuhan Fourth Hospital, Wuhan, Hubei Province, P.R. China
| | - Rui Hu
- Orthopaedics, Wuhan Fourth Hospital, Wuhan, Hubei Province, P.R. China
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Graff C, Mathur T. Antibiotic impregnated cement coated intramedullary nail (ACCIN) using bronchoscopy tubing: technical tips, case series and a review of the literature. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2024; 34:683-688. [PMID: 37639005 PMCID: PMC10771592 DOI: 10.1007/s00590-023-03668-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/06/2022] [Accepted: 08/02/2023] [Indexed: 08/29/2023]
Abstract
Antibiotic impregnated cement coated intramedullary nails (ACCINs) have been used in clinical practice for many years and have been shown to help eradicate infection in tibial osteomyelitis while providing stability. We present a novel technique for preparation using bronchoscopy tubing, as well as technical tips and a review of the literature, for ease of preparation and potential subsequent retrieval.
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Affiliation(s)
- Christy Graff
- The University of Adelaide, Adelaide, SA, Australia.
- Department of Orthopaedics, Royal Adelaide Hospital, Adelaide, SA, Australia.
- Department of Orthopaedics, Women's and Children's Hospital, Adelaide, SA, Australia.
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Wassif RK, Elkheshen SA, Shamma RN, Amer MS, Elhelw R, El-Kayal M. Injectable systems of chitosan in situ forming composite gel incorporating linezolid-loaded biodegradable nanoparticles for long-term treatment of bone infections. Drug Deliv Transl Res 2024; 14:80-102. [PMID: 37542190 PMCID: PMC10746766 DOI: 10.1007/s13346-023-01384-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/11/2023] [Indexed: 08/06/2023]
Abstract
The objective of the current study was to create an efficient, minimally invasive combined system comprising in situ forming hydrogel loaded with both spray-dried polymeric nanoparticles encapsulating linezolid and nanohydroxyapatite for local injection to bones or their close vicinity. The developed system was designed for a dual function namely releasing the drug in a sustained manner for long-term treatment of bone infections and supporting bone proliferation and new tissues generation. To achieve these objectives, two release sustainment systems for linezolid were optimized namely a composite in situ forming chitosan hydrogel and spray-dried PLGA/PLA solid nanoparticles. The composite, in situ forming hydrogel of chitosan was prepared using two different gelling agents namely glycerophosphate (GP) and sodium bicarbonate (NaHCO3) at 3 different concentrations each. The spray-dried linezolid-loaded PLGA/PLA nanoparticles were developed using a water-soluble carrier (PVP K30) and a lipid soluble one (cetyl alcohol) along with 3 types of DL-lactide and/or DL-lactide-co-glycolide copolymer using nano-spray-drying technique. Finally, the optimized spray-dried linezolid nanoparticles were incorporated into the optimized composite hydrogel containing nanohydroxy apatite (nHA). The combined hydrogel/nanoparticle systems displayed reasonable injectability with excellent gelation time at 37 °C. The optimum formulae sustained the release of linezolid for 7-10 days, which reveals its ability to reduce the frequency of injection during the course of treatment of bones infections and increase the patients' compliance. They succeeded to alleviate the bone infections and the associated clinical, biochemical, radiological, and histopathological changes within 2-4 weeks of injection. As to the state of art in this study and to the best of our knowledge, no such complete and systematic study on this type of combined in situ forming hydrogel loaded with spray-dried nanoparticles of linezolid is available yet in literatures.
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Affiliation(s)
- Reem Khaled Wassif
- Department of Pharmaceutics and Pharmaceutical Technology, Faculty of Pharmacy, Future University in Egypt, Cairo, Egypt
| | - Seham A Elkheshen
- Department of Pharmaceutics and Industrial Pharmacy, Faculty of Pharmacy, Cairo University, Kasr Elini Street, Cairo, 11562, Egypt.
| | - Rehab Nabil Shamma
- Department of Pharmaceutics and Industrial Pharmacy, Faculty of Pharmacy, Cairo University, Kasr Elini Street, Cairo, 11562, Egypt
| | - Mohammed S Amer
- Department of Surgery, Anaesthesiology and Radiology, Faculty of Veterinary Medicine, Cairo University, Cairo, Egypt
| | - Rehab Elhelw
- Department of Microbiology and Immunology, Faculty of Veterinary Medicine, Cairo University, Cairo, Egypt
| | - Maha El-Kayal
- Department of Pharmaceutics and Pharmaceutical Technology, Faculty of Pharmacy, Future University in Egypt, Cairo, Egypt
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Wang L, Lu S, Luo W, Wang G, Zhu Z, Liu Y, Gao H, Fu C, Ren J, Zhang Y, Zhang Y. Efficacy comparison of antibiotic bone cement-coated implants and external fixations for treating infected bone defects. INTERNATIONAL ORTHOPAEDICS 2023; 47:1171-1179. [PMID: 36862164 PMCID: PMC10079742 DOI: 10.1007/s00264-023-05727-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Accepted: 01/30/2023] [Indexed: 03/03/2023]
Abstract
PURPOSE This study aimed to investigate the clinical efficacy of antibiotic bone cement-coated implants compared with external fixations for treating infected bone defects. METHODS We retrospectively enrolled 119 patients with infected bone defects in our hospital from January 2010 to June 2021, of which 56 were treated with antibiotic bone cement-coated implants and 63 were with external fixation. RESULTS The pre-operative and post-operative haematological indexes were tested to assess the infection control; the post-operative CRP level in the internal fixation group was lower than that in the external fixation group. No statistical significance was found in the rate of infection recurrence, loosening and rupture of the fixation, and amputation between the two groups. Twelve patients in the external fixation group had pin tract infection. In the evaluation of the Paley score scale, bone healing aspect revealed no significant difference between the two groups, while in the limb function aspect, antibiotic cement-coated implant group showed a much better score than the external fixation group (P = 0.002). The anxiety evaluation scale result also showed lower score in the antibiotic cement implant group (P < 0.001). CONCLUSIONS Compared with external fixation, antibiotic bone cement-coated implant had the same effect on controlling infection and was more effective in recovering limb function and mental health in the first-stage treatment of infected bone defects after debridement.
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Affiliation(s)
- Linhu Wang
- Department of Orthopaedics, Second Affiliated Hospital, Air Force Medical University, 1 Xinsi Rd, Xi’an, 710038 Shaanxi China
| | - Shuaikun Lu
- Department of Orthopaedics, Second Affiliated Hospital, Air Force Medical University, 1 Xinsi Rd, Xi’an, 710038 Shaanxi China
| | - Wen Luo
- Department of Ultrasound, Xijing Hospital, Air Force Medical University, 169 Changlexi Rd, Xi’an, 710032 Shaanxi China
| | - Guoliang Wang
- Department of Orthopaedics, Second Affiliated Hospital, Air Force Medical University, 1 Xinsi Rd, Xi’an, 710038 Shaanxi China
| | - Zhenfeng Zhu
- Department of Orthopaedics, Second Affiliated Hospital, Air Force Medical University, 1 Xinsi Rd, Xi’an, 710038 Shaanxi China
| | - Yunyan Liu
- Department of Orthopaedics, Second Affiliated Hospital, Air Force Medical University, 1 Xinsi Rd, Xi’an, 710038 Shaanxi China
| | - Hao Gao
- Department of Orthopaedics, Second Affiliated Hospital, Air Force Medical University, 1 Xinsi Rd, Xi’an, 710038 Shaanxi China
| | - Congxiao Fu
- Department of Orthopaedics, Second Affiliated Hospital, Air Force Medical University, 1 Xinsi Rd, Xi’an, 710038 Shaanxi China
| | - Jun Ren
- Department of Orthopaedics, Second Affiliated Hospital, Air Force Medical University, 1 Xinsi Rd, Xi’an, 710038 Shaanxi China
| | - Yunfei Zhang
- Department of Orthopaedics, Second Affiliated Hospital, Air Force Medical University, 1 Xinsi Rd, Xi’an, 710038 Shaanxi China
| | - Yong Zhang
- Department of Orthopaedics, Second Affiliated Hospital, Air Force Medical University, 1 Xinsi Rd, Xi’an, 710038 Shaanxi China
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Liu Y, Li X, Liang A. Current research progress of local drug delivery systems based on biodegradable polymers in treating chronic osteomyelitis. Front Bioeng Biotechnol 2022; 10:1042128. [PMID: 36507256 PMCID: PMC9729283 DOI: 10.3389/fbioe.2022.1042128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Accepted: 11/14/2022] [Indexed: 11/25/2022] Open
Abstract
Chronic osteomyelitis is one of the most challenging diseases in orthopedic treatment. It is usually treated with intravenous antibiotics and debridement in clinical practice, which also brings systemic drug side effects and bone defects. The local drug delivery system of antibiotics has the characteristics of targeted slow release to the lesion site, replacing systemic antibiotics and reducing the toxic and side effects of drugs. It can also increase the local drug concentration, achieve sound bacteriostatic effects, and promote bone healing and formation. Currently, PMMA beads are used in treating chronic osteomyelitis at home and abroad, but the chain beads need to be removed after a second operation, inconveniences patients. Biodegradable materials have been extensively studied as optimal options for antibiotic encapsulation and delivery, bringing new hope for treating chronic osteomyelitis. This article reviews the research progress of local drug delivery systems based on biodegradable polymers, including natural and synthetic ones, in treating chronic osteomyelitis.
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Affiliation(s)
- Yixiu Liu
- Department of Orthopaedics, The Central Hospital Affiliated to Shenyang Medical College, Shenyang, China,Shenyang Clinical Research Center for Hand and Foot, Shenyang, China
| | - Xu Li
- Department of Orthopaedics, The Central Hospital Affiliated to Shenyang Medical College, Shenyang, China,Shenyang Clinical Research Center for Hand and Foot, Shenyang, China
| | - A. Liang
- Department of Orthopaedics, The Central Hospital Affiliated to Shenyang Medical College, Shenyang, China,Shenyang Clinical Research Center for Hand and Foot, Shenyang, China,*Correspondence: A. Liang,
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Wassif RK, Elkayal M, Shamma RN, Elkheshen SA. Recent advances in the local antibiotics delivery systems for management of osteomyelitis. Drug Deliv 2021; 28:2392-2414. [PMID: 34755579 PMCID: PMC8583938 DOI: 10.1080/10717544.2021.1998246] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Chronic osteomyelitis is a challenging disease due to its serious rates of mortality and morbidity while the currently available treatment strategies are suboptimal. In contrast to the adopted systemic treatment approaches after surgical debridement in chronic osteomyelitis, local drug delivery systems are receiving great attention in the recent decades. Local drug delivery systems using special carriers have the pros of enhancing the feasibility of penetration of antimicrobial agents to bone tissues, providing sustained release and localized concentrations of the antimicrobial agents in the infected area while avoiding the systemic side effects and toxicity. Most important, the incorporation of osteoinductive and osteoconductive materials in these systems assists bones proliferation and differentiation, hence the generation of new bone materials is enhanced. Some of these systems can also provide mechanical support for the long bones during the healing process. Most important, if the local systems are designed to be injectable to the affected site and biodegradable, they will reduce the level of invasion required for implantation and can win the patients’ compliance and reduce the healing period. They will also allow multiple injections during the course of therapy to guard against the side effect of the long-term systemic therapy. The current review presents different available approaches for delivering antimicrobial agents for the treatment of osteomyelitis focusing on the recent advances in researches for local delivery of antibiotics.HIGHLIGHTS Chronic osteomyelitis is a challenging disease due to its serious mortality and morbidity rates and limited effective treatment options. Local drug delivery systems are receiving great attention in the recent decades. Osteoinductive and osteoconductive materials in the local systems assists bones proliferation and differentiation Local systems can be designed to provide mechanical support for the long bones during the healing process. Designing the local system to be injectable to the affected site and biodegradable will reduces the level of invasion and win the patients’ compliance.
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Affiliation(s)
- Reem Khaled Wassif
- Department of Pharmaceutics and Pharmaceutical Technology, Faculty of Pharmacy, Future University in Egypt, Cairo, Egypt
| | - Maha Elkayal
- Department of Pharmaceutics and Pharmaceutical Technology, Faculty of Pharmacy, Future University in Egypt, Cairo, Egypt
| | - Rehab Nabil Shamma
- Department of Pharmaceutics and Industrial Pharmacy, Faculty of Pharmacy, Cairo University, Cairo, Egypt
| | - Seham A Elkheshen
- Department of Pharmaceutics and Industrial Pharmacy, Faculty of Pharmacy, Cairo University, Cairo, Egypt
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