Development of a standardized and safe airborne antibacterial assay, and its evaluation on antibacterial biomimetic model surfaces

An in vitro model of microbial contamination in the operating room

Infection associated with tissue-contacting biomedical devices is a compelling clinical problem initiated by the microbial colonization of the device surface. Among the possible sources of contaminating bacteria is the operating room (OR) itself, where viable bacteria in the atmosphere can sediment onto a device surface intraoperatively. We have developed an aerosolizing system that can reproducibly spray small quantities of aerosolized bacteria onto a surface to mimic OR contamination. This paper describes the design of the system and characterizes key aspects associated with its operation. The area density of sprayed bacteria is on the order of 10² /cm² . Using titanium (Ti) alloy coupons as test substrates contaminated by staphylococci, we quantify the fraction of bacteria that are well adhered to the substrate, those that can be removed by sonication, and those that are not recovered after spraying. Despite the relatively low levels of surface contamination, we furthermore show that such a model is able to demonstrate a statistically significant reduction in colonization of Ti coupons modified by antimicrobial quaternary ammonium compounds relative to unmodified controls.

Degradable Polymer Films Made from Poly(salicylic-acid-co-sebacic acid) and Poly(sebacic anhydride)/Poly(adipic anhydride) Blends: Degradation Kinetics and Use as Sacrificial Layers for Polymer Multilayer Systems

Two approaches to obtain fast-degrading polymer films based on poly(sebacic anhydride) (PSA) are presented, both of which target polymer films with a lower degree of crystallinity than pure PSA homopolymer: first, thin films were prepared from poly(adipic anhydride)/poly(sebacic anhydride) blends at different ratios, and second, films were made from the copolymer poly(salicylic acid-co-sebacic acid). These films are intended as sacrificial layers for self-regenerating functional coatings, for example to regenerate antimicrobial surface activity. The degradation kinetics of these films were analyzed by surface plasmon resonance spectroscopy (SPR). The results of the blends approach indicate that the blend degradation rate was accelerated only in the initial degradation phase (compared to PSA). The degradation kinetics study of the poly(salicylic-acid-co-sebacic acid) film shows that this copolymer degraded faster than poly(sebacic anhydride) initially, releasing antimicrobial salicylic acid in the process. However, its degradation rate slowed down at a mass loss > 60% and approached the PSA degradation curve at longer degradation times. When tested as sacrificial layer in self-regenerating antimicrobial polymer stacks, it was found that the degradation rate was too low for successful layer shedding.

Stimulus-Responsive Polyzwitterionic Surfaces Made from Itaconic Acid: Self-Triggered Antimicrobial Activity, Protein Repellency, and Cell Compatibility

A functional monomer carrying a carboxylate and a protected primary ammonium group is synthesized from itaconic acid. When copolymerized with dimethyl acrylamide and 4-methacryloyloxybenzophenone, cross-linkable polyzwitterions are obtained. These are converted to surface-attached polyzwitterion networks by simultaneous UV-triggered C,H insertion reactions. The resulting polyzwitterion-coated substrates were studied by surface plasmon resonance spectroscopy measurements, ζ potential and various biological assays. They were (expectedly) protein repellent, yet at the same time (and unexpectedly) cell-adhesive and antimicrobially active. This was attributed to stimulus-responsiveness of the polyzwitterion (confirmed by the ζ potential measurements), which enables charge adjustment at different pH values. When protonated, the polyzwitterions become amphiphilic polycations and, in this state, kill bacteria upon contact like their parent structures (polymer-based synthetic mimics of antimicrobial peptides, SMAMPs).

High Potential of Bacterial Adhesion on Block Bone Graft Materials

Bone graft infections represent a challenge in daily clinics, resulting in increased patient discomfort and graft removal. The aim of this study was to investigate the initial adhesion of five representative pathogens on three different block bone graft materials (xenogeneic, alloplastic and allogeneic) and to assess if chlorhexidine (CHX) can effectively control the initial bacterial adhesion. Three different block bone grafting materials (Tutobone®, Endobon® and human spongiosa) were incubated with Escherichia coli, Staphylococcus aureus, Streptococcus mutans, Enterococcus faecalis and Pseudomonas aeruginosa in the presence or absence of 0.2% CHX solution. Bacterial adhesion was assessed by the direct counting of the colony-forming units (CFUs) and visualized by scanning electron microscopy (SEM). Overall, the selected bacterial species adhered successfully to all tested bone replacement scaffolds, which showed similar bacterial counts. The lg CFU values ranged from 5.29 ± 0.14 to 5.48 ± 0.72 for E. coli, from 4.37 ± 0.62 to 5.02 ± 0.48 for S. aureus, from 4.92 ± 0.34 to 4.95 ± 0.21 for S. mutans, from 4.97 ± 0.40 to 5.22 ± 0.13 for E. faecalis and from 4.23 ± 0.54 to 4.58 ± 0.26 for P. aeruginosa. CHX did not interfere with initial microbial adhesion, and yet it killed all adhered bacterial cells. Thus, CHX can be used to prevent subsequent biofilm infections.

Thin Degradable Coatings for Optimization of Osteointegration Associated with Simultaneous Infection Prophylaxis

One of the most common causes of implant failure is aseptic prosthesis loosening. Another frequent complication after prosthesis implant is the microbial colonization of the prosthesis surface, which often leads to a replacement of the prosthesis. One approach to reduce these complications is the application of bioactive substances to implant surfaces. Both an antibiotic prophylaxis and a faster osteointegration can be obtained by incorporation of bactericidal active metals in degradable calcium phosphate (CaP) coatings. In this study, thin degradable calcium phosphate ceramic coatings doped with silver (Ag), copper (Cu), and bismuth (Bi) on a titanium substrate were prepared with the aid of the high-velocity suspension flame spraying (HVSFS) coating process. To characterize the samples surface roughness, brightfield microscopy of the coatings, X-ray diffraction (XRD)-analysis for definition of the phase composition of the layers, Raman spectroscopy for determination of the phase composition of the contained metals, element-mapping for Cu-content verification, release kinetics for detection of metal ions and ceramic components of the coatings were carried out. The aim of this study was to evaluate in vitro biocompatibility and antimicrobial activity of the coatings. For biocompatibility testing, growth experiments were performed using the cell culture line MG-63. Cell viability was investigated by Giemsa staining and live/dead assay. The WST-1 kit was used to quantify cell proliferation and vitality in vitro and the lactate dehydrogenase (LDH) kit to quantify cytotoxicity. The formation of hydroxyapatite crystals in simulated body fluid was investigated to predict bioactivity in vivo. The Safe Airborne Antibacterial Assay with Staphylococcus aureus (S. aureus) was used for antimicrobial testing. The results showed good biocompatibility of all the metal doped CaP coatings, furthermore Cu and Ag doped layers showed significant antibacterial effects against S. aureus.

Bifunctional Bioactive Polymer Surfaces with Micrometer and Submicrometer-sized Structure: The Effects of Structure Spacing and Elastic Modulus on Bioactivity

This study presents a comparison of two types of bifunctional structured surface that were made from the same polymer -- an antimicrobial polycation (a synthetic mimic of an antimicrobial peptide, SMAMP) and a protein-repellent polyzwitterion (poly(sulfobetaines), PSB). The first type of bifunctional surface was fabricated by a colloidal lithography (CL) based process where the two polymers were immobilized sequentially onto pre-structured surfaces with a chemical contrast (gold on silicon). This enabled site-selective covalent attachment. The CL materials had a spacing ranging from 200 nm to 2 µm. The second type of structured surface (spacing: 1 - 8.5 µm) was fabricated using a microcontact printing (µCP) process where SMAMP patches were printed onto a PSB network, so that 3D surface features were obtained. The thus obtained materials were studied by quantitative nanomechanical measurements using atomic force microscopy (QNM-AFM). The different architectures led to different local elastic moduli at the polymer-air interface, where the CL surfaces were much stiffer (Derjaguin-Muller-Toporov (DMT) modulus = 20 ± 0.8 GPa) compared to the structured 3D networks obtained by µCP (DMT modulus = 42 ± 1.1 MPa). The effects of the surface topology and stiffness on the antimicrobial activity against Escherichia coli, the protein repellency (using fibrinogen), and the compatibility with human gingival mucosal keratinocytes were investigated. The softer 3D µCP surfaces had simultaneous antimicrobial activity, protein repellency, and cell compatibility at all spacings. For the stiffer CL surfaces, quantitative simultaneous antimicrobial activity and protein repellency was not obtained. However, the cell compatibility could be maintained at all spacings. The optimum spacing for the CL materials was in the range of 500 nm-1 µm, with significantly reduced antimicrobial activity at 2 µm spacing. Thus, the soft polymer network obtained by µCP could be more easily optimized than the stiff CL surface, and had a broader topology range of optimal or near-optimal bioactivity.

Self-Regenerating Antimicrobial Polymer Surfaces via Multilayer-Design - Sequential and Triggered Layer Shedding under Physiological Conditions

Regeneration of materials properties through surface regeneration could extend the lifetime of devices and is still an emerging field of research. (Self-)regenerating antimicrobial polymer surfaces could help to fight biofilm formation and related bacterial infections. In this paper, four different polymer multilayer designs for the regeneration of antimicrobial surfaces by layer shedding are presented. The multilayer architectures consist of 100-200 nm thick, discrete polymer layers. They are made from poly(guanidinium oxanorbornene) networks as the antimicrobial component, and different interlayers made from degradable poly(adipic anhydrides), depolymerizable poly(ethyl glyoxylate), or water-soluble poly(acrylamide). Layer shedding is designed to occur after hydrolysis, dissolution or depolymerization under simulated physiological conditions. The multilayer fabrication and disassembly is monitored by fluorescence microscopy, ellipsometry FT-IR spectroscopy and atomic force microscopy. By testing the antimicrobial activity of the restored surfaces, their functional integrity after layer shedding is confirmed.

Surface Structuring Combined with Chemical Surface Functionalization: An Effective Tool to Manipulate Cell Adhesion

In this study, we investigate how a surface structure underneath a surface-attached polymer coating affects the bioactivity of the resulting material. To that end, structured surfaces were fabricated using colloidal lithography (lateral dimensions: 200 nm to 1 µm, height ~15 to 50 nm). The surface structures were further functionalized either with antimicrobial, cell-adhesive polycations or with protein-repellent polyzwitterions. The materials thus obtained were compared to non-functionalized structured surfaces and unstructured polymer monolayers. Their physical properties were studied by contact-angle measurements and atomic force microscopy (AFM). Protein adhesion was studied by surface plasmon resonance spectroscopy, and the antimicrobial activity against Escherichia coli bacteria was tested. The growth of human mucosal gingiva keratinocytes on the materials was analyzed using the Alamar blue assay, optical microscopy, and live-dead staining. The data shows that the underlying surface structure itself reduced protein adhesion and also bacterial adhesion, as evidenced by increased antimicrobial activity. It also enhanced cell adhesion to the surfaces. Particularly in combination with the adhesive polycations, the surfaces increased the cell growth compared to the unstructured reference materials. Thus, functionalizing structured surfaces with adhesive polymer could be a valuable tool for improved tissue integration.

Three-Dimensional, Bifunctional Microstructured Polymer Hydrogels Made from Polyzwitterions and Antimicrobial Polymers

Biofilm-associated infections of medical devices are a global problem. For the prevention of such infections, biomaterial surfaces are chemically or topographically modified to slow down the initial stages of biofilm formation. In the bifunctional material here presented, chemical and topographical cues are combined, so that protein and bacterial adhesion as well as bacterial proliferation are effectively inhibited. Upon changes in the surface topography parameters and investigation of the effect of these changes on bioactivity, structure-property relationships are obtained. The target material is obtained by microcontact printing (μCP), a soft lithography method. The antimicrobial component, poly(oxanorbornene)-based synthetic mimics of an antimicrobial peptide (SMAMP), was printed onto a protein-repellent polysulfobetaine hydrogel, so that bifunctional 3D structured polymer surfaces with 1, 2, and 8.5 μm spacing are obtained. These surfaces are characterized with fluorescence microscopy, surface plasmon resonance spectroscopy, atomic force microscopy, and contact angle measurements. Biological studies show that the bifunctional surfaces with 1 and 2 μm spacing are 100% antimicrobially active against Escherichia coli and Staphylococcus aureus, 100% fibrinogen-repellent, and nontoxic to human gingival mucosal keratinocytes. At 8.5 μm spacing, the broad-band antimicrobial activity and the protein repellency are compromised, which indicates that this spacing is above the upper limit for effective simultaneous antimicrobial activity and protein repellency of polyzwitterionic-polycationic materials.

Surface-Attached Poly(oxanorbornene) Hydrogels with Antimicrobial and Protein-Repellent Moieties: The Quest for Simultaneous Dual Activity

By copolymerizing an amphiphilic oxanorbornene monomer bearing N- tert-butyloxycarbonyl (Boc) protected cationic groups with an oxanorbornene-functionalized poly(ethylene glycol) (PEG) macromonomer, bifunctional comb copolymers were obtained. Varying the comonomer ratios led to copolymers with PEG contents between 5⁻25 mol %. These polymers were simultaneously surface-immobilized on benzophenone-bearing substrates and cross-linked with pentaerythritoltetrakis(3-mercaptopropionate). They were then immersed into HCl to remove the Boc groups. The thus obtained surface-attached polymer hydrogels (called SMAMP*-co-PEG) were simultaneously antimicrobial and protein-repellent. Physical characterization data showed that the substrates used were homogeneously covered with the SMAMP*-co-PEG polymer, and that the PEG moieties tended to segregate to the polymer⁻air interface. Thus, with increasing PEG content, the interface became increasingly hydrophilic and protein-repellent, as demonstrated by a protein adhesion assay. With 25 mol % PEG, near-quantitative protein-adhesion was observed. The antimicrobial activity of the SMAMP*-co-PEG polymers originates from the electrostatic interaction of the cationic groups with the negatively charged cell envelope of the bacteria. However, the SMAMP*-co-PEG surfaces were only fully active against E. coli, while their activity against S. aureus was already compromised by as little as 5 mol % (18.8 mass %) PEG. The long PEG chains seem to prevent the close interaction of bacteria with the surface, and also might reduce the surface charge density.

Simultaneously Antimicrobial, Protein-repellent and Cell-compatible Polyzwitterion Networks: More Insight on Bioactivity and Physical Properties

A poly(oxanorbornene)-based polyzwitterion with primary ammonium and carboxylate groups (PZI) has been reported previously as the first simultaneously antimicrobial and protein-repellent polyzwitterion. Here, additional physical and biological properties of three poly(oxanorbornene)-based polyzwitterions with different functional groups (PZI, the polycarboxybetaine PCB, and the polysulfobetaine PSB) are compared to understand the molecular origins of this unusual bioactivity. Additionally, the three polyzwitterions and the antimicrobial, polycationic SMAMP are exposed to proteins, bacteria suspensions, human plasma and serum. These interactions are investigated by surface plasmon resonance spectroscopy. In protein adhesion studies, neither fibrinogen nor lysozyme adhere irreversibly to PZI, yet reversible interaction with lysozyme is observed at pH 7 and 8. In the presence of bivalent cations, reversible fibrinogen adhesion on PZI and PSB is observed, but not on PCB. This might explain why mammalian cells grow on PZI and PSB, but not on PCB. PZI does not show human plasma adhesion, while PCB and PSB have 0.27 and 0.48 ng mm^-2 adhered plasma, and SMAMP even 6.3 ng mm^-2. Both PZI and SMAMP show strong serum adhesion, while no serum adhered to PCB, and only little to PSB. This could be related to the pH difference between serum and plasma, to which the pH-responsive primary ammonium groups are susceptible, while the permanently charged NR₄ ⁺ groups are unaffected. Both PZI and PCB showed none or only little bacterial adhesion. PCB is also intrinsically antimicrobial against E. coli and S. aureus bacteria and thus is also simultaneously protein-repellent and antimicrobially active. Thus, while the carboxylate groups of PZI and PCB seems to be a prerequisite for the dual antimicrobial activity and protein-repellency, the pH-responsiveness of the primary ammonium group seems to make the PZI molecule vulnerable for protein adhesion in fluids that are slightly out of the physiological range.

Polymer-Based Surfaces Designed to Reduce Biofilm Formation: From Antimicrobial Polymers to Strategies for Long-Term Applications

Contact-active antimicrobial polymer surfaces bear cationic charges and kill or deactivate bacteria by interaction with the negatively charged parts of their cell envelope (lipopolysaccharides, peptidoglycan, and membrane lipids). The exact mechanism of this interaction is still under debate. While cationic antimicrobial polymer surfaces can be very useful for short-term applications, they lose their activity once they are contaminated by a sufficiently thick layer of adhering biomolecules or bacterial cell debris. This layer shields incoming bacteria from the antimicrobially active cationic surface moieties. Besides discussing antimicrobial surfaces, this feature article focuses on recent strategies that were developed to overcome the contamination problem. This includes bifunctional materials with simultaneously presented antimicrobial and protein-repellent moieties; polymer surfaces that can be switched from an antimicrobial, cell-attractive to a cell-repellent state; polymer surfaces that can be regenerated by enzyme action; degradable antimicrobial polymers; and antimicrobial polymer surfaces with removable top layers.

Surface Structuring Meets Orthogonal Chemical Modifications: Toward a Technology Platform for Site-Selectively Functionalized Polymer Surfaces and BioMEMS

A manufacturing process for the site-selective modification of structured (bio)material surfaces with two different polymers/biomolecules is presented. In the first step, a chemical surface contrast is created (e.g., a gold-on-silicon contrast obtained by colloidal lithography), and is combined with two orthogonal surface reactions for polymer/biomolecule immobilization. To demonstrate this, an antimicrobial SMAMP polymer and a protein-repellent polyzwitterion were site-selectively surface-immobilized on the gold-silicon structures. By varying the structure spacing and the surface architecture, structure-property relationships for the interaction of these bifunctional polymer surfaces with bacteria and proteins were obtained (studied by fluorescence microscopy, atomic force microscopy, surface plasmon resonance spectroscopy, and antimicrobial assays). At 1 μm spacing, a fully antimicrobially active bifunctional material was obtained, which also near-quantitatively reduced protein adhesion. As the process is generally applicable to polymers/biomolecules with aliphatic CH-groups, it is an interesting platform technology for site-selectively functionalized bifunctional (Bio)MEMS.

Towards Self-regenerating Antimicrobial Polymer Surfaces

Regeneration of functional polymer surfaces after damage or contamination is an unresolved scientific challenge, and also of practical importance. In this proof-of-concept study, we present a method to regenerate a functional surface property using a polymer multi-layer architecture. This is exemplified using antimicrobially active surfaces. The idea is to shed the top layer of the polymer layer stack, like a reptile shedding its skin. The proof-of-concept stack consists of two antimicrobial layers and a degradable interlayer. Shedding of the top layer is enabled by degrading that interlayer. The shedding process was analyzed by quantitative fluorescence microscopy, ellipsometry, and FTIR spectroscopy. Antimicrobial assays revealed that the functionality of the emerging antimicrobial layer was fully retained after shedding.

Antimicrobial and cell-compatible surface-attached polymer networks - how the correlation of chemical structure to physical and biological data leads to a modified mechanism of action

We present a synthetic platform based on photo-induced thiol-ene chemistry, by which surface-attached networks from antimicrobial poly(oxonorbornene) (so-called polymeric synthetic mimics of antimicrobial peptides, SMAMPs) could be easily obtained. By systematically varying hydrophobicity and charge density, surface-attached polymer networks with high antimicrobial activity and excellent cell compatibility were obtained. For the homopolymer networks with constant charge density, antimicrobial activity increased systematically with increasing hydrophobicity (i.e. decreasing swellability and apparent surface energy). Irrespective of charge density, the antimicrobial activity of all networks correlated with the acid constant pK and the isoelectric point (IEP) - the lower pK and IEP, the higher the antimicrobial activity. The cell compatibility of the networks increased with increasing swellability and apparent surface energy, and decreased with increasing charge density. The data corroborates that the mechanism of action of antimicrobial polymer surfaces depends on at least two mechanistic steps, one of which is hydrophobicity-driven and the other charge related. Therefore, we suggest a modified mechanistic model with a charge-driven and a hydrophobicity-driven step. For antimicrobial networks that only varied in hydrophobicity, the antimicrobial activities on surfaces and in solution also correlated - the higher the activity in solution, the higher the activity on surfaces. Thus, the hydrophobicity-driven step for activity on surfaces may be similar to the one in solution. Cell compatibility of SMAMPs in solution and on surfaces also showed a systematic positive correlation for all polymers, therefore this property also depends on the net hydrophobic balance of the polymer.