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Recent Strategies to Combat Infections from Biofilm-Forming Bacteria on Orthopaedic Implants. Int J Mol Sci 2021; 22:ijms221910243. [PMID: 34638591 PMCID: PMC8549706 DOI: 10.3390/ijms221910243] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2021] [Revised: 09/19/2021] [Accepted: 09/20/2021] [Indexed: 12/26/2022] Open
Abstract
Biofilm-related implant infections (BRII) are a disastrous complication of both elective and trauma orthopaedic surgery and occur when an implant becomes colonised by bacteria. The definitive treatment to eradicate the infections once a biofilm has established is surgical excision of the implant and thorough local debridement, but this carries a significant socioeconomic cost, the outcomes for the patient are often poor, and there is a significant risk of recurrence. Due to the large volumes of surgical procedures performed annually involving medical device implantation, both in orthopaedic surgery and healthcare in general, and with the incidence of implant-related infection being as high as 5%, interventions to prevent and treat BRII are a major focus of research. As such, innovation is progressing at a very fast pace; the aim of this study is to review the latest interventions for the prevention and treatment of BRII, with a particular focus on implant-related approaches.
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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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3
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Sabaté Brescó M, Harris LG, Thompson K, Stanic B, Morgenstern M, O'Mahony L, Richards RG, Moriarty TF. Pathogenic Mechanisms and Host Interactions in Staphylococcus epidermidis Device-Related Infection. Front Microbiol 2017; 8:1401. [PMID: 28824556 PMCID: PMC5539136 DOI: 10.3389/fmicb.2017.01401] [Citation(s) in RCA: 117] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2017] [Accepted: 07/11/2017] [Indexed: 12/25/2022] Open
Abstract
Staphylococcus epidermidis is a permanent member of the normal human microbiota, commonly found on skin and mucous membranes. By adhering to tissue surface moieties of the host via specific adhesins, S. epidermidis is capable of establishing a lifelong commensal relationship with humans that begins early in life. In its role as a commensal organism, S. epidermidis is thought to provide benefits to human host, including out-competing more virulent pathogens. However, largely due to its capacity to form biofilm on implanted foreign bodies, S. epidermidis has emerged as an important opportunistic pathogen in patients receiving medical devices. S. epidermidis causes approximately 20% of all orthopedic device-related infections (ODRIs), increasing up to 50% in late-developing infections. Despite this prevalence, it remains underrepresented in the scientific literature, in particular lagging behind the study of the S. aureus. This review aims to provide an overview of the interactions of S. epidermidis with the human host, both as a commensal and as a pathogen. The mechanisms retained by S. epidermidis that enable colonization of human skin as well as invasive infection, will be described, with a particular focus upon biofilm formation. The host immune responses to these infections are also described, including how S. epidermidis seems to trigger low levels of pro-inflammatory cytokines and high levels of interleukin-10, which may contribute to the sub-acute and persistent nature often associated with these infections. The adaptive immune response to S. epidermidis remains poorly described, and represents an area which may provide significant new discoveries in the coming years.
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Affiliation(s)
- Marina Sabaté Brescó
- Musculoskeletal Infection, AO Research Institute DavosDavos, Switzerland.,Molecular Immunology, Swiss Institute of Allergy and Asthma Research, University of ZurichDavos, Switzerland
| | - Llinos G Harris
- Microbiology and Infectious Diseases, Institute of Life Science, Swansea University Medical SchoolSwansea, United Kingdom
| | - Keith Thompson
- Musculoskeletal Infection, AO Research Institute DavosDavos, Switzerland
| | - Barbara Stanic
- Musculoskeletal Infection, AO Research Institute DavosDavos, Switzerland
| | - Mario Morgenstern
- Department of Orthopedic and Trauma Surgery, University Hospital BaselBasel, Switzerland
| | - Liam O'Mahony
- Molecular Immunology, Swiss Institute of Allergy and Asthma Research, University of ZurichDavos, Switzerland
| | - R Geoff Richards
- Musculoskeletal Infection, AO Research Institute DavosDavos, Switzerland
| | - T Fintan Moriarty
- Musculoskeletal Infection, AO Research Institute DavosDavos, Switzerland
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4
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Zapata-Cornelio FY, Day GA, Coe RH, Sikora SNF, Wijayathunga VN, Tarsuslugil SM, Mengoni M, Wilcox RK. Methodology to Produce Specimen-Specific Models of Vertebrae: Application to Different Species. Ann Biomed Eng 2017; 45:2451-2460. [PMID: 28744839 PMCID: PMC5622177 DOI: 10.1007/s10439-017-1883-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2017] [Accepted: 07/07/2017] [Indexed: 11/23/2022]
Abstract
Image-based continuum-level finite element models have been used for bones to evaluate fracture risk and the biomechanical effects of diseases and therapies, capturing both the geometry and tissue mechanical properties. Although models of vertebrae of various species have been developed, an inter-species comparison has not yet been investigated. The purpose of this study was to derive species-specific modelling methods and compare the accuracy of image-based finite element models of vertebrae across species. Vertebral specimens were harvested from porcine (N = 12), ovine (N = 13) and bovine (N = 14) spines. The specimens were experimentally loaded to failure and apparent stiffness values were derived. Image-based finite element models were generated reproducing the experimental protocol. A linear relationship between the element grayscale and elastic modulus was calibrated for each species matching in vitro and in silico stiffness values, and validated on independent sets of models. The accuracy of these relationships were compared across species. Experimental stiffness values were significantly different across species and specimen-specific models required species-specific linear relationship between image grayscale and elastic modulus. A good agreement between in vitro and in silico values was achieved for all species, reinforcing the generality of the developed methodology.
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Affiliation(s)
- Fernando Y Zapata-Cornelio
- School of Mechanical Engineering, Institute of Medical and Biological Engineering, University of Leeds, Leeds, LS2 9JT, UK.
| | - Gavin A Day
- School of Mechanical Engineering, Institute of Medical and Biological Engineering, University of Leeds, Leeds, LS2 9JT, UK
| | - Ruth H Coe
- School of Mechanical Engineering, Institute of Medical and Biological Engineering, University of Leeds, Leeds, LS2 9JT, UK
| | - Sebastien N F Sikora
- School of Mechanical Engineering, Institute of Medical and Biological Engineering, University of Leeds, Leeds, LS2 9JT, UK
| | - Vithanage N Wijayathunga
- School of Mechanical Engineering, Institute of Medical and Biological Engineering, University of Leeds, Leeds, LS2 9JT, UK
| | - Sami M Tarsuslugil
- School of Mechanical Engineering, Institute of Medical and Biological Engineering, University of Leeds, Leeds, LS2 9JT, UK
| | - Marlène Mengoni
- School of Mechanical Engineering, Institute of Medical and Biological Engineering, University of Leeds, Leeds, LS2 9JT, UK
| | - Ruth K Wilcox
- School of Mechanical Engineering, Institute of Medical and Biological Engineering, University of Leeds, Leeds, LS2 9JT, UK
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5
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Horváthy DB, Simon M, Schwarz CM, Masteling M, Vácz G, Hornyák I, Lacza Z. Serum albumin as a local therapeutic agent in cell therapy and tissue engineering. Biofactors 2017; 43:315-330. [PMID: 27859738 DOI: 10.1002/biof.1337] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2016] [Revised: 09/05/2016] [Accepted: 10/03/2016] [Indexed: 12/15/2022]
Abstract
Albumin is a major plasma protein that has become ubiquitous in regenerative medicine research. As such, many studies have examined its structure and advantageous properties. However, a systematic and comprehensive understanding of albumin's role, capabilities and therapeutic potential still eludes the field. In the present work, we review how albumin is applied in tissue engineering, including cell culture and storage, in vitro fertilization and transplantation. Furthermore, we discuss how albumin's physiological role extends beyond a carrier for metal ions, fatty acids, pharmacons and growth factors. Albumin acts as a bacteriostatic coating that simultaneously promotes attachment and proliferation of eukaryotic cells. These properties with the combination of free radical scavenging, neutrophil activation and as a buffer molecule already make the albumin protein beneficial in healing processes supporting functional tissue remodeling. Nevertheless, recent data revealed that albumin can be synthesized by osteoblasts and its local concentration is raised after bone trauma. Interestingly, by increasing the local albumin concentration in vivo, faster bone healing is achieved, possibly because albumin recruits endogenous stem cells and promotes the growth of new bone. These data also suggest an active role of albumin, even though a specific receptor has not yet been identified. Together, this discussion sheds light on why the extravascular use of the albumin molecule is in the scope of scientific investigations and why it should be considered as a local therapeutic agent in regenerative medicine. © 2016 BioFactors, 43(3):315-330, 2017.
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Affiliation(s)
- Dénes B Horváthy
- Institute of Clinical Experimental Research, Semmelweis University, Budapest, Hungary
| | - Melinda Simon
- Institute of Clinical Experimental Research, Semmelweis University, Budapest, Hungary
| | - Charlotte M Schwarz
- Institute of Clinical Experimental Research, Semmelweis University, Budapest, Hungary
| | - Mariana Masteling
- Institute of Clinical Experimental Research, Semmelweis University, Budapest, Hungary
| | - Gabriella Vácz
- Institute of Clinical Experimental Research, Semmelweis University, Budapest, Hungary
| | - István Hornyák
- Institute of Clinical Experimental Research, Semmelweis University, Budapest, Hungary
| | - Zsombor Lacza
- Institute of Clinical Experimental Research, Semmelweis University, Budapest, Hungary
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Activity of Tedizolid in Methicillin-Resistant Staphylococcus epidermidis Experimental Foreign Body-Associated Osteomyelitis. Antimicrob Agents Chemother 2017; 61:AAC.01644-16. [PMID: 27855069 DOI: 10.1128/aac.01644-16] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2016] [Accepted: 10/22/2016] [Indexed: 12/19/2022] Open
Abstract
We developed a rat model of methicillin-resistant Staphylococcus epidermidis (MRSE) foreign body-associated osteomyelitis and used it to compare tedizolid alone and in combination with rifampin against rifampin alone, vancomycin plus rifampin, and vancomycin alone. A clinical strain of MRSE was inoculated into the proximal tibia, and a stainless steel wire with a precolonized MRSE biofilm was implanted. Following a 1-week infection period, 92 rats received either no treatment (n = 17) or 14 days of intraperitoneal tedizolid (n = 15), tedizolid plus rifampin (n = 15), rifampin (n = 15), vancomycin plus rifampin (n = 15), or vancomycin (n = 15). Quantitative bone and wire cultures were performed after treatment completion and also 1 week after infection in a separate group of five rats. The median quantity of staphylococci in bone after the 1-week infection period was 4.89 log10 CFU/g bone (interquartile range, 3.83 to 5.33 log10 CFU/g bone); staphylococci were recovered from all associated wires. A median quantity of staphylococci of 3.70 log10 CFU/g bone was detected in bones of untreated control rats after 3 weeks. Quantities of staphylococci in bones of all treatment groups except the group receiving vancomycin alone (2.78 log10 CFU/g) were significantly lower than those for untreated controls, with no staphylococci being detected in the groups receiving rifampin monotherapy, tedizolid-plus-rifampin combination therapy, and vancomycin-plus-rifampin combination therapy. Quantities of staphylococci on wires from all treatment groups that included rifampin were significantly lower than those for untreated controls. No resistance to rifampin, tedizolid, or vancomycin was detected. Tedizolid combined with rifampin was active in a rat model of MRSE foreign body-associated osteomyelitis.
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7
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Du H, Qian X. The hydration properties of carboxybetaine zwitterion brushes. J Comput Chem 2015; 37:877-85. [DOI: 10.1002/jcc.24234] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2015] [Revised: 09/30/2015] [Accepted: 10/04/2015] [Indexed: 01/23/2023]
Affiliation(s)
- Hongbo Du
- Department of Biomedical Engineering; University of Arkansas; Fayetteville Arkansas 72701
| | - Xianghong Qian
- Department of Biomedical Engineering; University of Arkansas; Fayetteville Arkansas 72701
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Romanò CL, Scarponi S, Gallazzi E, Romanò D, Drago L. Antibacterial coating of implants in orthopaedics and trauma: a classification proposal in an evolving panorama. J Orthop Surg Res 2015; 10:157. [PMID: 26429342 PMCID: PMC4591707 DOI: 10.1186/s13018-015-0294-5] [Citation(s) in RCA: 168] [Impact Index Per Article: 18.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2015] [Accepted: 09/16/2015] [Indexed: 02/07/2023] Open
Abstract
Implanted biomaterials play a key role in current success of orthopedic and trauma surgery. However, implant-related infections remain among the leading reasons for failure with high economical and social associated costs. According to the current knowledge, probably the most critical pathogenic event in the development of implant-related infection is biofilm formation, which starts immediately after bacterial adhesion on an implant and effectively protects the microorganisms from the immune system and systemic antibiotics. A rationale, modern prevention of biomaterial-associated infections should then specifically focus on inhibition of both bacterial adhesion and biofilm formation. Nonetheless, currently available prophylactic measures, although partially effective in reducing surgical site infections, are not based on the pathogenesis of biofilm-related infections and unacceptable high rates of septic complications, especially in high-risk patients and procedures, are still reported.In the last decade, several studies have investigated the ability of implant surface modifications to minimize bacterial adhesion, inhibit biofilm formation, and provide effective bacterial killing to protect implanted biomaterials, even if there still is a great discrepancy between proposed and clinically implemented strategies and a lack of a common language to evaluate them.To move a step forward towards a more systematic approach in this promising but complicated field, here we provide a detailed overview and an original classification of the various technologies under study or already in the market. We may distinguish the following: 1. Passive surface finishing/modification (PSM): passive coatings that do not release bactericidal agents to the surrounding tissues, but are aimed at preventing or reducing bacterial adhesion through surface chemistry and/or structure modifications; 2. Active surface finishing/modification (ASM): active coatings that feature pharmacologically active pre-incorporated bactericidal agents; and 3. Local carriers or coatings (LCC): local antibacterial carriers or coatings, biodegradable or not, applied at the time of the surgical procedure, immediately prior or at the same time of the implant and around it. Classifying different technologies may be useful in order to better compare different solutions, to improve the design of validation tests and, hopefully, to improve and speed up the regulatory process in this rapidly evolving field.
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Affiliation(s)
- Carlo Luca Romanò
- Department of Reconstructive Surgery of Osteo-articular Infections C.R.I.O. Unit, IRCCS Galeazzi Orthopaedic Institute, Via R. Galeazzi 4, 20161, Milan, Italy.
| | - Sara Scarponi
- Department of Reconstructive Surgery of Osteo-articular Infections C.R.I.O. Unit, IRCCS Galeazzi Orthopaedic Institute, Via R. Galeazzi 4, 20161, Milan, Italy.
| | - Enrico Gallazzi
- Department of Reconstructive Surgery of Osteo-articular Infections C.R.I.O. Unit, IRCCS Galeazzi Orthopaedic Institute, Via R. Galeazzi 4, 20161, Milan, Italy.
| | - Delia Romanò
- Department of Reconstructive Surgery of Osteo-articular Infections C.R.I.O. Unit, IRCCS Galeazzi Orthopaedic Institute, Via R. Galeazzi 4, 20161, Milan, Italy.
| | - Lorenzo Drago
- Laboratory of Clinical Chemistry and Microbiology, I.R.C.C.S. Galeazzi Orthopaedic Institute, Milan, Italy.
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9
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Horváthy DB, Vácz G, Szabó T, Szigyártó IC, Toró I, Vámos B, Hornyák I, Renner K, Klára T, Szabó BT, Dobó-Nagy C, Doros A, Lacza Z. Serum albumin coating of demineralized bone matrix results in stronger new bone formation. J Biomed Mater Res B Appl Biomater 2015; 104:126-32. [DOI: 10.1002/jbm.b.33359] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2014] [Revised: 10/30/2014] [Accepted: 12/09/2014] [Indexed: 11/12/2022]
Affiliation(s)
- Dénes B. Horváthy
- Institute of Human Physiology and Clinical Experimental Research, Semmelweis University; Budapest Hungary
- Department of Orthopedics; Semmelweis University; Budapest Hungary
| | - Gabriella Vácz
- Institute of Human Physiology and Clinical Experimental Research, Semmelweis University; Budapest Hungary
| | - Tamás Szabó
- Department of Interfaces and Surface Modification; Institute of Materials and Environmental Chemistry, Research Centre for Natural Sciences, Hungarian Academy of Sciences; Budapest Hungary
| | - Imola C. Szigyártó
- Department of Biological Nanochemistry; Institute of Molecular Pharmacology, Research Centre for Natural Sciences, Hungarian Academy of Sciences; Budapest Hungary
| | - Ildikó Toró
- Institute of Human Physiology and Clinical Experimental Research, Semmelweis University; Budapest Hungary
| | - Boglárka Vámos
- Institute of Human Physiology and Clinical Experimental Research, Semmelweis University; Budapest Hungary
| | - István Hornyák
- Institute of Human Physiology and Clinical Experimental Research, Semmelweis University; Budapest Hungary
| | - Károly Renner
- Department of Physical Chemistry and Material Science; Budapest University of Technology and Economics; Budapest Hungary
| | - Tamás Klára
- Department of Orthopedics; Semmelweis University; Budapest Hungary
| | - Bence T. Szabó
- Department of Oral Diagnostics; Semmelweis University; Budapest Hungary
| | - Csaba Dobó-Nagy
- Department of Oral Diagnostics; Semmelweis University; Budapest Hungary
| | - Attila Doros
- Department of Transplantation and Surgery; Semmelweis University; Budapest Hungary
| | - Zsombor Lacza
- Institute of Human Physiology and Clinical Experimental Research, Semmelweis University; Budapest Hungary
- Department of Orthopedics; Semmelweis University; Budapest Hungary
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10
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Antibacterial surface treatment for orthopaedic implants. Int J Mol Sci 2014; 15:13849-80. [PMID: 25116685 PMCID: PMC4159828 DOI: 10.3390/ijms150813849] [Citation(s) in RCA: 169] [Impact Index Per Article: 16.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2013] [Revised: 06/06/2014] [Accepted: 06/13/2014] [Indexed: 02/07/2023] Open
Abstract
It is expected that the projected increased usage of implantable devices in medicine will result in a natural rise in the number of infections related to these cases. Some patients are unable to autonomously prevent formation of biofilm on implant surfaces. Suppression of the local peri-implant immune response is an important contributory factor. Substantial avascular scar tissue encountered during revision joint replacement surgery places these cases at an especially high risk of periprosthetic joint infection. A critical pathogenic event in the process of biofilm formation is bacterial adhesion. Prevention of biomaterial-associated infections should be concurrently focused on at least two targets: inhibition of biofilm formation and minimizing local immune response suppression. Current knowledge of antimicrobial surface treatments suitable for prevention of prosthetic joint infection is reviewed. Several surface treatment modalities have been proposed. Minimizing bacterial adhesion, biofilm formation inhibition, and bactericidal approaches are discussed. The ultimate anti-infective surface should be “smart” and responsive to even the lowest bacterial load. While research in this field is promising, there appears to be a great discrepancy between proposed and clinically implemented strategies, and there is urgent need for translational science focusing on this topic.
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Campoccia D, Visai L, Renò F, Cangini I, Rizzi M, Poggi A, Montanaro L, Rimondini L, Arciola CR. Bacterial adhesion to poly-(D,L)lactic acid blended with vitamin E: toward gentle anti-infective biomaterials. J Biomed Mater Res A 2014; 103:1447-58. [PMID: 25046271 DOI: 10.1002/jbm.a.35284] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2014] [Revised: 06/28/2014] [Accepted: 07/18/2014] [Indexed: 12/23/2022]
Abstract
Anti-infective properties of biomedical materials are often achieved by loading or coating them with powerful bactericides. Undesirably, these bioactive molecules can damage the host cells at the biomaterial-tissues interface and, sometimes, even determine systemic toxic effects. The search for biomaterials able to actively resist infection while displaying a safe cytocompatibility profile toward eukaryotic cells is being progressively developed. Poly-(D,L)lactic acid (PLA) is a broadly used resorbable material with established biocompatibility properties. The dissolving surfaces of a biodegradable material tend to be per se elusive for bacteria. Here, films of pristine PLA, of PLA blended with vitamin E (VitE) and PLA blended with vitamin E acetate (VitE ac) were challenged in vitro with the biofilm-producers Staphylococcus epidermidis RP62A and Staphylococcus aureus ATCC25923. The bacterial adhesion properties of the different materials were investigated on small film disc specimens by a method based on microtiter plates. Adherent bacteria were quantified by both CFU plating and bioluminescence. Significant decrease in bacterial adhesion and biofilm accumulation was found on the surface of both the enriched polymers. These findings, together with the favorable intrinsic properties of PLA and the desirable bioactivities conferred by VitE, point up the VitE-blended PLA polymers as gentle anti-infective biomaterials.
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Affiliation(s)
- Davide Campoccia
- Research Unit on Implant Infections, Rizzoli Orthopaedic Institute, Bologna, Italy
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12
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Odekerken JCE, Arts JJC, Surtel DAM, Walenkamp GHIM, Welting TJM. A rabbit osteomyelitis model for the longitudinal assessment of early post-operative implant infections. J Orthop Surg Res 2013; 8:38. [PMID: 24188807 PMCID: PMC3828396 DOI: 10.1186/1749-799x-8-38] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2013] [Accepted: 10/17/2013] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND Implant infection is one of the most severe complications within the field of orthopaedic surgery, associated with an enormous burden for the healthcare system. During the last decades, attempts have been made to lower the incidence of implant-related infections. In the case of cemented prostheses, the use of antibiotic-containing bone cement can be effective. However, in the case of non-cemented prostheses, osteosynthesis and spinal surgery, local antibacterial prophylaxis is not a standard procedure. For the development of implant coatings with antibacterial properties, there is a need for a reliable animal model to evaluate the preventive capacity of such coatings during a specific period of time. Existing animal models generally present a limited follow-up, with a limited number of outcome parameters and relatively large animal numbers in multiple groups. METHODS To represent an early post-operative implant infection, we established an acute tibial intramedullary nail infection model in rabbits by contamination of the tibial nail with 3.8 × 10⁵ colony forming units of Staphylococcus aureus. Clinical, haematological and radiological parameters for infection were weekly assessed during a 6-week follow-up with post-mortem bacteriological and histological analyses. RESULTS S. aureus implant infection was confirmed by the above parameters. A saline control group did not develop osteomyelitis. By combining the clinical, haematological, radiological, bacteriological and histological data collected during the experimental follow-up, we were able to differentiate between the control and the infected condition and assess the severity of the infection at sequential timepoints in a parameter-dependent fashion. CONCLUSION We herein present an acute early post-operative rabbit implant infection model which, in contrast to previously published models, combines improved in-time insight into the development of an implant osteomyelitis with a relatively low amount of animals.
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Affiliation(s)
| | | | | | | | - Tim J M Welting
- Laboratory for Experimental Orthopaedics, Department of Orthopaedic Surgery, CAPHRI School for Public Health and Primary Care, Maastricht University Medical Centre, P,O, Box 5800, Maastricht 6202 AZ, the Netherlands.
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Ribeiro M, Monteiro FJ, Ferraz MP. Infection of orthopedic implants with emphasis on bacterial adhesion process and techniques used in studying bacterial-material interactions. BIOMATTER 2012; 2:176-94. [PMID: 23507884 PMCID: PMC3568104 DOI: 10.4161/biom.22905] [Citation(s) in RCA: 420] [Impact Index Per Article: 35.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Staphylococcus comprises up to two-thirds of all pathogens in orthopedic implant infections and they are the principal causative agents of two major types of infection affecting bone: septic arthritis and osteomyelitis, which involve the inflammatory destruction of joint and bone. Bacterial adhesion is the first and most important step in implant infection. It is a complex process influenced by environmental factors, bacterial properties, material surface properties and by the presence of serum or tissue proteins. Properties of the substrate, such as chemical composition of the material, surface charge, hydrophobicity, surface roughness and the presence of specific proteins at the surface, are all thought to be important in the initial cell attachment process. The biofilm mode of growth of infecting bacteria on an implant surface protects the organisms from the host immune system and antibiotic therapy. The research for novel therapeutic strategies is incited by the emergence of antibiotic-resistant bacteria. This work will provide an overview of the mechanisms and factors involved in bacterial adhesion, the techniques that are currently being used studying bacterial-material interactions as well as provide insight into future directions in the field.
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Affiliation(s)
- Marta Ribeiro
- Instituto de Engenharia Biomédica, Universidade do Porto, Porto, Portugal.
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14
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Del Prado G, Terriza A, Ortiz-Pérez A, Molina-Manso D, Mahillo I, Yubero F, Puértolas JA, Manrubia-Cobo M, Gómez Barrena E, Esteban J. DLC coatings for UHMWPE: Relationship between bacterial adherence and surface properties. J Biomed Mater Res A 2012; 100:2813-20. [DOI: 10.1002/jbm.a.34220] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2012] [Revised: 03/25/2012] [Accepted: 04/04/2012] [Indexed: 01/25/2023]
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15
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Effects of gentamicin and gentamicin-RGD coatings on bone ingrowth and biocompatibility of cementless joint prostheses: an experimental study in rabbits. Acta Biomater 2011; 7:1274-80. [PMID: 21081183 DOI: 10.1016/j.actbio.2010.11.012] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2010] [Revised: 11/04/2010] [Accepted: 11/10/2010] [Indexed: 02/04/2023]
Abstract
Antimicrobial coatings are of interest as a means to improve infection prophylaxis in cementless joint arthroplasty. However, those coatings must not interfere with the essential bony integration of the implants. Gentamicin-hydroxyapatite (gentamicin-HA) and gentamicin-RGD (arginine-glycine-aspartate)-HA coatings have recently been shown to significantly reduce infection rates in a rabbit infection prophylaxis model. The purpose of the current study was to investigate the in vitro elution kinetics and in vivo effects of gentamicin-HA and gentamicin-RGD-HA coatings on new bone formation, implant integration and biocompatibility in a rabbit model. In vitro elution testing showed that 95% and 99% of the gentamicin was released after 12 and 24 h, respectively. The in vivo study comprised 45 rabbits in total, with six animals for each of the gentamicin-HA, gentamicin-RGD-HA group and control pure HA coating groups for the 4 week time period, and nine animals for each of the three groups for the 12 week observation period. A 2.0 mm steel K-wire with one of the coatings under test was placed in the intramedullary canal of the tibia. After 4 and 12 weeks the tibiae were harvested and three different areas (proximal metaphysis, shaft area, distal metaphysis) were assessed by quantitative and qualitative histology for new bone formation, direct implant-bone contact and the formation of multinucleated giant cells. The results exhibited high standard deviations in all subgroups. There was a trend towards better bone formation and better direct implant contact in the pure HA coating group compared with both gentamicin coatings after 4 and 12 weeks, which was, however, not statistically significant. The number of multinucleated giant cells did not differ significantly between the three groups at both time points. In summary, both gentamicin coatings with 99% release of gentamicin within 24 h revealed good biocompatibility and bony integration, which was not statistically significant different compared with pure HA coating. Limitations of the study are the high standard deviation of the results and the limited number of animals per time point.
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Banerjee I, Pangule RC, Kane RS. Antifouling coatings: recent developments in the design of surfaces that prevent fouling by proteins, bacteria, and marine organisms. ADVANCED MATERIALS (DEERFIELD BEACH, FLA.) 2011; 23:690-718. [PMID: 20886559 DOI: 10.1002/adma.201001215] [Citation(s) in RCA: 1554] [Impact Index Per Article: 119.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/05/2010] [Revised: 06/06/2010] [Indexed: 05/21/2023]
Abstract
The major strategies for designing surfaces that prevent fouling due to proteins, bacteria, and marine organisms are reviewed. Biofouling is of great concern in numerous applications ranging from biosensors to biomedical implants and devices, and from food packaging to industrial and marine equipment. The two major approaches to combat surface fouling are based on either preventing biofoulants from attaching or degrading them. One of the key strategies for imparting adhesion resistance involves the functionalization of surfaces with poly(ethylene glycol) (PEG) or oligo(ethylene glycol). Several alternatives to PEG-based coatings have also been designed over the past decade. While protein-resistant coatings may also resist bacterial attachment and subsequent biofilm formation, in order to overcome the fouling-mediated risk of bacterial infection it is highly desirable to design coatings that are bactericidal. Traditional techniques involve the design of coatings that release biocidal agents, including antibiotics, quaternary ammonium salts (QAS), and silver, into the surrounding aqueous environment. However, the emergence of antibiotic- and silver-resistant pathogenic strains has necessitated the development of alternative strategies. Therefore, other techniques based on the use of polycations, enzymes, nanomaterials, and photoactive agents are being investigated. With regard to marine antifouling coatings, restrictions on the use of biocide-releasing coatings have made the generation of nontoxic antifouling surfaces more important. While considerable progress has been made in the design of antifouling coatings, ongoing research in this area should result in the development of even better antifouling materials in the future.
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Affiliation(s)
- Indrani Banerjee
- Howard P. Isermann Department of Chemical and Biological Engineering, Rensselaer Polytechnic Institute, Troy, NY 12180, USA
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Terriza A, Del Prado G, Pérez AO, Martínez MJ, Puértolas JA, Manso DM, González-Elipe AR, Yubero F, Barrena EG, Esteban J. Bacterial adherence on fluorinated carbon based coatings deposited on polyethylene surfaces. ACTA ACUST UNITED AC 2010. [DOI: 10.1088/1742-6596/252/1/012013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Baillif S, Hartmann D, Freney J, Kodjikian L. [Intraocular lens and bacterial adhesion: influence of the environmental factors, the characteristics of the bacteria, and the target material surface]. J Fr Ophtalmol 2010; 33:210-21. [PMID: 20202716 DOI: 10.1016/j.jfo.2010.01.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2009] [Accepted: 12/22/2009] [Indexed: 10/19/2022]
Abstract
Adhesion of bacteria to intraocular lenses is an important step in the pathogenesis of postoperative endophthalmitis. It can be described as a two-phase process including an initial, instantaneous, and reversible phase followed by a time-dependant and irreversible molecular and cellular phase. The binding of bacteria is affected by many factors including environmental factors such as medium composition, presence of proteins and flow conditions, the bacterial cell surface characteristics, and the material's surface properties. This article reviews all these factors affecting the adhesion of bacteria to intraocular lenses. A better understanding of these mechanisms would make it possible to reduce the bacterial adhesion process and thus could help decrease the incidence of postoperative endophthalmitis.
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Affiliation(s)
- S Baillif
- Département d'Ophtalmologie, Centre hospitalo-universitaire Saint Roch, Nice, France; Laboratoire "Réparation Tissulaire, Interactions Biologiques et Biomatériaux", UPSP 2007.03.135 RTI2B, Lyon, France
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Saldarriaga Fernández IC, van der Mei HC, Lochhead MJ, Grainger DW, Busscher HJ. The inhibition of the adhesion of clinically isolated bacterial strains on multi-component cross-linked poly(ethylene glycol)-based polymer coatings. Biomaterials 2007; 28:4105-12. [PMID: 17573108 DOI: 10.1016/j.biomaterials.2007.05.023] [Citation(s) in RCA: 79] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2007] [Accepted: 05/25/2007] [Indexed: 11/24/2022]
Abstract
This study examined bacterial adhesion to a new multi-component cross-linked poly(ethylene glycol)-based polymer coating that can be applied by spin-coating or spraying onto diverse biomaterials. Adhesion of five clinically isolated bacterial strains involved in biomaterial-centered infections were studied in a parallel-plate flow chamber at different shear rates and after exposure of the coating to different physiological fluids. The new chemistry inhibits non-specific biomolecular and cell binding interactions. Relative to glass, the coating reduced adhesion of all strains used in this study by more than 80%, with the exception of Escherichia coli O2K2. Reductions in adhesion of Staphylococcus epidermidis 3,399 persisted beyond 168h exposure of the coatings to phosphate buffered saline or urine, but not after exposure to protein-rich fluids as saliva and blood plasma, despite evidence from X-ray photoelectron spectroscopy that the coating integrity was not affected by exposure to these fluids. We conclude that this new coating chemistry provides beneficial properties to prevent or hinder bacterial adhesion and colonization in applications where low protein-conditions prevail.
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Affiliation(s)
- Isabel C Saldarriaga Fernández
- Department of BioMedical Engineering, University Medical Center Groningen, University of Groningen, Antonius Deusinglaan 1, 9713 AV Groningen, The Netherlands
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Peltonen LI, Kinnari TJ, Aarnisalo AA, Kuusela P, Jero J. Comparison of bacterial adherence to polylactides, silicone, and titanium. Acta Otolaryngol 2007; 127:587-93. [PMID: 17503227 DOI: 10.1080/00016480600987792] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
CONCLUSIONS Less bacterial adherence occurred on uncoated polylactide and silicone than on uncoated titanium surfaces. Albumin coating was an effective method to inhibit bacterial adherence to all these surfaces. As regards bacterial adherence, polylactides are at least as safe implant materials as silicone and titanium. OBJECTIVES We compared adherence of Staphylococcus aureus and Pseudomonas aeruginosa to four implant materials and studied the inhibitory effect of albumin on adherence. The aims were to discover any differences between materials and to study the effectiveness of albumin coating. MATERIALS AND METHODS Eight plates of polylactide A and B, silicone, and titanium were exposed to S. aureus and P. aeruginosa. Four of these plates were uncoated and four were coated with albumin. A total of 64 plates were included in the study. The bacteria were stained with acridine orange, and 10 photomicrographs of each plate allowed quantification of the surface area covered with bacteria. RESULTS The most adherence occurred on titanium without coating. Albumin coating of the surface significantly reduced bacterial adherence to each material. Differences between materials with albumin coating were relatively small. Of the bacteria, P. aeruginosa had the greater capacity to adhere to a surface.
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Affiliation(s)
- Lauri I Peltonen
- Department of Otorhinolaryngology, Helsinki University Central Hospital, Helsinki, Finland
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Craig MR, Poelstra KA, Sherrell JC, Kwon MS, Belzile EL, Brown TE. A novel total knee arthroplasty infection model in rabbits. J Orthop Res 2005; 23:1100-4. [PMID: 15927441 DOI: 10.1016/j.orthres.2005.03.007] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2004] [Revised: 11/15/2004] [Accepted: 03/15/2005] [Indexed: 02/04/2023]
Abstract
Infection of biomaterial implants is an expensive and devastating complication of orthopaedic surgery historically ranging from less than 1% in primary total knee arthroplasty (TKA) to 10% in revision TKA. An in vivo animal model was developed to test the efficacy of innovative therapies for the prevention of biomaterial centered infections caused by methicillin-resistant Staphylococcus aureus bacteria (MRSA). Twenty-two New Zealand White rabbits were used in this study. After proper anesthesia, a stainless-steel screw with a high molecular weight polyethylene (UHMWPE) washer was cemented in a defect created in the intra-articular, non-articulating portion of the lateral femoral condyle of each knee. After closure of the joint capsule, each knee was inoculated with 0, 10(2), 10(3), or 10(4) colony forming units (CFU) of MRSA. Animals were sacrificed after 7 days at which time joint aspirate, tissues and biomaterial samples were examined for evidence of infection. A total of 42 knees were used for analysis. When saline was injected into the knee, 0/10 of the knees demonstrated evidence of biomaterial centered infection (with the contralateral knee receiving 10(4)CFU MRSA). Four of 10 knees developed a biomaterial centered infection when 10(2)CFU MRSA was introduced. Seven out of 10 knees developed a biomaterial centered infection when either 10(3) or 10(4)CFU MRSA was injected. No evidence of septicemia (positive blood cultures) was found in any animal. This rabbit knee model utilizes commonly employed inexpensive orthopaedic implant materials in an in vivo milieu and provides an effective method for the evaluation of treatments for biomaterial centered infections.
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Affiliation(s)
- Matthew R Craig
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, VA 22908, USA
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Savarino L, Baldini N, Tarabusi C, Pellacani A, Giunti A. Diagnosis of infection after total hip replacement. J Biomed Mater Res B Appl Biomater 2005; 70:139-45. [PMID: 15199594 DOI: 10.1002/jbm.b.30030] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Subclinical infection in patients with pain following total hip replacement (THR) is an underestimated condition that needs consideration because it mimics aseptic loosening, contributes to periprosthetic osteolysis, and necessitates proper treatment. We aimed to define the reliability of diagnostic parameters that are routinely used before revision surgery for the assessment of infection. A continuous series of 26 subjects who underwent THR revision surgery was considered, including 21 cases diagnosed as aseptic loosening (group A) and 5 hip revisions with a clinical diagnosis for infection (group B). Seven subjects at the time of the primary arthroplasty were used as negative controls (group C). Technetium-99m labeled hydroxymethylene diphosphonate [(99m)Tc-HDP]- and technetium-99m hexamethylpropyleneamine oxide [(99m)Tc-HMPAO)]-labeled granulocyte scintigraphy, histology of peri-implant tissues, laboratory tests for inflammation, and microbiology were performed. Scintigraphy was positive for loosening [positive (99m)Tc-HDP scan] but negative for infection [negative (99m)Tc-HMPAO-labeled granulocyte scan] in all group A patients, whereas in 11 cases (52%) a positive culture was unexpectedly obtained. Histology showed conflicting results: Polymorphonuclear cells (PMNs) were found only in 5 of 11 culture-positive patients, whereas in 2 cases the presence of PMNs did not correspond to a positive culture. In group B patients, both isotope scans and microbiology were found to be positive. All control subjects (group C) had negative cultures. In our opinion, smoldering infection could be present in a significant proportion of cases of failed hip implants currently diagnosed as "nonseptic." The inflammatory response to wear debris and the presence of superimposed, slowly growing bacteria could act synergically, both contributing to the pathogenesis of periprosthetic osteolysis.
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Affiliation(s)
- L Savarino
- Laboratory for Pathophysiology of Orthopaedic Implants, and 7th Division of Orthopaedic Surgery, Istituti Ortopedici Rizzoli, Via di Barbiano 1/10, 40136 Bologna, Italy.
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Kinnari TJ, Rihkanen H, Laine T, Salonen EM, Jero J. Albumin-Coated Tympanostomy Tubes: Prospective, Double-Blind Clinical Study. Laryngoscope 2004; 114:2038-43. [PMID: 15510039 DOI: 10.1097/01.mlg.0000147944.20676.17] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Coating an implant with albumin prevents adhesion of proteins, bacteria, and platelets and thus may lead to its improved and prolonged function. Previously, we have demonstrated the inhibition of binding of fibronectin, one of the most adhesive glycoproteins, on human serum albumin (HSA)-coated tympanostomy tubes and the durability of this binding inhibition in a 8-month trial. We have also demonstrated that the HSA coating inhibits the binding of Staphylococcus aureus and Pseudomonas aeruginosa to titanium plates. This prospective study evaluated the effect of albumin coating on tympanostomy tube sequelae and on the outcome of tympanostomized patients. STUDY DESIGN Double-blind, prospective, randomized clinical trial. METHODS Two otolaryngological centers in southern Finland enrolled 179 pediatric patients. Number of tube occlusions and otorrhea and tube ventilation time in the ears with HSA-coated titanium tympanostomy tubes were compared with the contralateral ear with its uncoated, otherwise identical titanium tube during a 9-month follow-up period. RESULTS In HSA-coated tubes, average ventilation time was slightly longer and the number of early tube occlusions significantly less (P < .05). Moreover, in patients with perioperative bleeding, the coating prolonged average ventilation time of tympanostomy tubes significantly (P < .05). CONCLUSIONS HSA coating reduces early tube occlusions by preventing adherence of blood and secretion.
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Affiliation(s)
- Teemu J Kinnari
- Department of Otolaryngology, Helsinki University Central Hospital and the Haartman Institute, Helsinki, Finland.
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Kinnari TJ, Salonen EM, Jero J. Durability of the binding inhibition of albumin coating on tympanostomy tubes. Int J Pediatr Otorhinolaryngol 2003; 67:157-64. [PMID: 12623152 DOI: 10.1016/s0165-5876(02)00364-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Occlusion and prolonged otorrhea are typical problems associated with the use of middle-ear ventilation tubes. Albumin coating of ventilation tubes has been introduced to prevent tube occlusions by granulation tissue, blood clot, or pus. In this study, the durability of the binding inhibition (BI) of fibronectin was examined on the tube surface in albumin-coated tubes in different environments during an 8-month trial. METHODS Human serum albumin (HSA) was used to coat silicone tympanostomy tubes. Fibronectin, a typical adhesive protein in serum and exudates, was used as a model representative of exudates of the ear. The durability of BI of this glue protein on the tube surface was tested in different time periods with radiolabelled fibronectin. Scanning electron microscopy (SEM) was performed on the tubes. RESULTS The BI of fibronectin, achieved with the albumin coating, was still strong after 8 months of storage at +4 degrees C. A slight decline in BI was noted between the first and third months of storage at +37 degrees C. A significant difference between HSA-coated and uncoated tympanostomy tubes was noted in SEM. The uncoated surface generally appeared to be rougher than that of HSA-coated tubes when either titanium or silicone tubes were tested. CONCLUSIONS Albumin coating markedly inhibits the binding of fibronectin on tube surfaces in vitro. A clear BI achieved by albumin coating on tube surfaces was shown to persist throughout an 8-month trial, although some reduction of the BI was seen over time. The result emphasizes the role of albumin coating in preventing the adherence of foreign material on tympanostomy tubes. No advantage was achieved by using a cross-linking chemical in the albumin coating.
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Affiliation(s)
- Teemu J Kinnari
- Department of Otolaryngology, Helsinki University Central Hospital, PO Box 220, FIN-00029, Helsinki, Finland.
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Bi Y, Seabold JM, Kaar SG, Ragab AA, Goldberg VM, Anderson JM, Greenfield EM. Adherent endotoxin on orthopedic wear particles stimulates cytokine production and osteoclast differentiation. J Bone Miner Res 2001; 16:2082-91. [PMID: 11697805 DOI: 10.1359/jbmr.2001.16.11.2082] [Citation(s) in RCA: 188] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Aseptic loosening of orthopedic implants is thought to be caused primarily by osteoclast differentiation induced by bone resorptive cytokines produced in response to phagocytosis of implant-derived wear particles. This study examined whether adherent endotoxin on the wear particles is responsible for inducing osteoclast differentiation as well as production of interleukin-1beta (IL-1beta), IL-6, and tumor necrosis factor a (TNF-alpha). Removal of adherent endotoxin almost completely inhibited the responses to titanium (Ti) particles by both murine marrow cells and human peripheral blood monocytes. In vivo experiments showed that endotoxin removal reduced particle-induced osteolysis by 50-70%. Addition of lipopolysaccharide (LPS) to the "endotoxin-free" particles restored their ability to induce cytokine production and osteoclast differentiation in vitro. Moreover, marrow cells from mice that are hyporesponsive to endotoxin because of mutation of Toll-like receptor 4 induced significantly less cytokine production and osteoclast differentiation in response to Ti particles with adherent endotoxin than did marrow cells from normoresponsive mice. This mutation also resulted in significantly less particle-induced osteolysis in vivo. Taken together, these results show that adherent endotoxin is involved in many of the biological responses induced by orthopedic wear particles and should stimulate development of new approaches designed to reduce the activity of adherent endotoxin in patients with orthopedic implants.
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Affiliation(s)
- Y Bi
- Department of Orthopedics, Case Western Reserve University, Cleveland, Ohio 44106-5000, USA
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Kinnari TJ, Salonen EM, Jero J. New method for coating tympanostomy tubes to prevent tube occlusions. Int J Pediatr Otorhinolaryngol 2001; 58:107-11. [PMID: 11278018 DOI: 10.1016/s0165-5876(01)00413-x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE tympanostomy tube insertion is currently the most common surgical procedure requiring general anesthesia performed on children. Occlusion of the tube and prolonged otorrhea through the tube are typical problems associated with the use of middle-ear ventilation tubes. In this study, a new method for coating ventilation tubes is introduced that prevents occlusion of the tube lumen by granulation tissue, blood clot or pus. METHODS human serum albumin (HSA) was used to coat standard tympanostomy tubes of different materials. Fibronectin, a typical protein in serum and exudates and one of the most adhesive glycoproteins, was used as a model representative of exudates of the ear. RESULTS when compared with the binding on uncoated tubes, the binding of fibronectin on HSA-coated tubes was inhibited from 59 to 85%, depending on the tube material used. CONCLUSIONS HSA-coating markedly reduced the binding of fibronectin on tube surfaces in vitro. The study shows the potential role of HSA-coating in preventing the adherence of foreign material to tympanostomy tubes and reducing tube occlusions.
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Affiliation(s)
- T J Kinnari
- Department of Otolaryngology, Helsinki University Central Hospital, P.O. Box 220, FIN-00029 HUCH Helsinki, Finland.
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An YH, Friedman RJ. Concise review of mechanisms of bacterial adhesion to biomaterial surfaces. JOURNAL OF BIOMEDICAL MATERIALS RESEARCH 2000; 43:338-48. [PMID: 9730073 DOI: 10.1002/(sici)1097-4636(199823)43:3<338::aid-jbm16>3.0.co;2-b] [Citation(s) in RCA: 662] [Impact Index Per Article: 27.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
This article reviews the mechanisms of bacterial adhesion to biomaterial surfaces and the factors affecting the adhesion. The process of bacterial adhesion includes an initial physicochemical interaction phase (phase one) and a late molecular and cellular interaction phase (phase two), which is a complicated process affected by many factors, including the characteristics of the bacteria themselves, the target material surface, and the environmental factors, such as the presence of serum proteins or bactericidal substances.
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Affiliation(s)
- Y H An
- Department of Orthopaedic Surgery, Medical University of South Carolina, Charleston, USA.
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Abstract
Prosthetic infection following total joint replacement can have catastrophic results both physically and psychologically for patients, leading to complete failure of the arthroplasty, possible amputation, prolonged hospitalization, and even death. Although with the use of prophylactic antibiotics and greatly improved operating room techniques the infection rate has decreased markedly during the years, challenges still remain for better preventive and therapeutic measures. In this review the in vivo experimental methods for studies of prosthetic infection are discussed, concentrating on (1) the animal models that have been established and the use of these animal models for studies of pathogenesis of bacteria, behavior of biofilm, effect of biomaterials on prosthetic infection rate, and the effect of infection on biomaterial surfaces, and (2) how to design and conduct an animal model of orthopedic prosthetic infection including animal selection, implant fabrication, bacterial inoculation, surgical technique, and the methods for evaluating the results.
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Affiliation(s)
- Y H An
- Department of Orthopedic Surgery, Medical University of South Carolina, Charleston 29425, USA.
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