1
|
Farag A, Koung Ngeun S, Kaneda M, Aboubakr M, Tanaka R. Optimizing Cardiomyocyte Differentiation: Comparative Analysis of Bone Marrow and Adipose-Derived Mesenchymal Stem Cells in Rats Using 5-Azacytidine and Low-Dose FGF and IGF Treatment. Biomedicines 2024; 12:1923. [PMID: 39200387 PMCID: PMC11352160 DOI: 10.3390/biomedicines12081923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2024] [Revised: 08/09/2024] [Accepted: 08/19/2024] [Indexed: 09/02/2024] Open
Abstract
Mesenchymal stem cells (MSCs) exhibit multipotency, self-renewal, and immune-modulatory properties, making them promising in regenerative medicine, particularly in cardiovascular treatments. However, optimizing the MSC source and induction method of cardiac differentiation is challenging. This study compares the cardiomyogenic potential of bone marrow (BM)-MSCs and adipose-derived (AD)-MSCs using 5-Azacytidine (5-Aza) alone or combined with low doses of Fibroblast Growth Factor (FGF) and Insulin-like Growth Factor (IGF). BM-MSCs and AD-MSCs were differentiated using two protocols: 10 μmol 5-Aza alone and 10 μmol 5-Aza with 1 ng/mL FGF and 10 ng/mL IGF. Morphological, transcriptional, and translational analyses, along with cell viability assessments, were performed. Both the MSC types exhibited similar morphological changes; however, AD-MSCs achieved 70-80% confluence faster than BM-MSCs. Surface marker profiling confirmed CD29 and CD90 positivity and CD45 negativity. The differentiation protocols led to cell flattening and myotube formation, with earlier differentiation in AD-MSCs. The combined protocol reduced cell mortality in BM-MSCs and enhanced the expression of cardiac markers (MEF2c, Troponin I, GSK-3β), particularly in BM-MSCs. Immunofluorescence confirmed cardiac-specific protein expression in all the treated groups. Both MSC types exhibited the expression of cardiac-specific markers indicative of cardiomyogenic differentiation, with the combined treatment showing superior efficiency for BM-MSCs.
Collapse
Affiliation(s)
- Ahmed Farag
- Veterinary Teaching Hospital, Faculty of Agriculture, Tokyo University of Agriculture and Technology, Tokyo 183-8509, Japan
- Department of Surgery, Anesthesiology, and Radiology, Faculty of Veterinary Medicine, Zagazig University, Zagazig 44519, Egypt
| | - Sai Koung Ngeun
- Laboratory of Veterinary Diagnostic Imaging, Faculty of Agriculture, Tokyo University of Agriculture and Technology, Tokyo 183-8509, Japan;
| | - Masahiro Kaneda
- Laboratory of Veterinary Anatomy, Division of Animal Life Science, Tokyo University of Agriculture and Technology, Tokyo 183-8509, Japan;
| | - Mohamed Aboubakr
- Department of Pharmacology, Faculty of Veterinary Medicine, Benha University, Toukh 13736, Egypt;
| | - Ryou Tanaka
- Veterinary Teaching Hospital, Faculty of Agriculture, Tokyo University of Agriculture and Technology, Tokyo 183-8509, Japan
| |
Collapse
|
2
|
Andrianopoulou A, Sokolowski K, Wenzler E, Bulman ZP, Gemeinhart RA. Assessment of antibiotic release and antibacterial efficacy from pendant glutathione hydrogels using ex vivo porcine skin. J Control Release 2024; 365:936-949. [PMID: 38070603 PMCID: PMC10843833 DOI: 10.1016/j.jconrel.2023.12.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 11/22/2023] [Accepted: 12/03/2023] [Indexed: 12/22/2023]
Abstract
Acute bacterial skin and skin structure infections (ABSSSIs) confer a substantial burden on the healthcare system. Local antibiotic delivery systems can provide controlled drug release directly to the site of infection to maximize efficacy and minimize systemic toxicity. The purpose of this study was to examine the antibacterial activity of antibiotic-loaded glutathione-conjugated poly(ethylene glycol) hydrogels (GSH-PEG) against ABSSSIs utilizing an ex vivo porcine dermal explant model. Vancomycin- or meropenem-loaded GSH-PEG hydrogels at 3 different dose levels were loaded over 1 h. Drug release was monitored in vitro under submerged conditions, by the Franz cell diffusion method, and ex vivo utilizing a porcine dermis model. Antibacterial activity was assessed ex vivo on porcine dermis explants inoculated with Staphylococcus aureus or Pseudomonas aeruginosa isolates treated with vancomycin- or meropenem-loaded GSH-PEG hydrogels, respectively. Histological assessment of the explants was conducted to evaluate tissue integrity and viability in the context of the experimental conditions. A dose-dependent release was observed from vancomycin and meropenem hydrogels, with in vitro Franz cell diffusion data closely representing ex vivo vancomycin release, but not high dose meropenem release. High dose vancomycin-loaded hydrogels resulted in a >3 log10 clearance against all S. aureus isolates at 48 h. High dose meropenem-loaded hydrogels achieved 6.5, 4, and 2 log10 reductions in CFU/ml against susceptible, intermediate, and resistant P. aeruginosa isolates, respectively. Our findings demonstrate the potential application of GSH-PEG hydrogels for flexible, local antibiotic delivery against bacterial skin infections.
Collapse
Affiliation(s)
| | - Karol Sokolowski
- Department of Pharmaceutical Sciences, University of Illinois Chicago, Chicago, IL, USA
| | - Eric Wenzler
- Department of Pharmacy Practice, University of Illinois Chicago, Chicago, IL, USA
| | - Zackery P Bulman
- Department of Pharmacy Practice, University of Illinois Chicago, Chicago, IL, USA
| | - Richard A Gemeinhart
- Department of Pharmaceutical Sciences, University of Illinois Chicago, Chicago, IL, USA; Department of Biomedical Engineering, University of Illinois Chicago, Chicago, IL, USA; Department of Chemical Engineering, University of Illinois Chicago, Chicago, IL, USA; Department of Ophthalmology and Visual Sciences, University of Illinois Chicago, Chicago, IL, USA.
| |
Collapse
|
3
|
Thierbach M, Müller M, Stange R, Kronenberg D, Aurich M, Wildemann B. Wrap It! Preventive Antimicrobial Treatment Shows No Negative Effects on Tenocytes and Tendons-A Comprehensive Approach. J Clin Med 2023; 12:4104. [PMID: 37373797 DOI: 10.3390/jcm12124104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Revised: 06/12/2023] [Accepted: 06/14/2023] [Indexed: 06/29/2023] Open
Abstract
Although the rate of infection after the reconstruction of a ruptured anterior cruciate ligament (ACL) is low, prophylactic incubation of the graft with vancomycin (Vanco-wrap or vancomycin soaking) is routinely performed. A cytotoxic effect of vancomycin is reported for several cell types, and the prophylactic treatment might prevent infection but harm the tissue and cells. AIM A comprehensive study was performed to investigate the effect of vancomycin on tendon tissue and isolated tenocytes using cell viability, molecular and mechanical analysis. MATERIAL AND METHODS Rat tendons or isolated tenocytes were incubated in increasing concentrations of vancomycin (0-10 mg/mL) for different times, and cell viability, gene expression, histology and Young's modulus were analyzed. RESULTS The clinically used concentration of vancomycin (5 mg/mL for 20 min) had no negative effect on cell viability in the tendons or the isolated tenocytes, while incubation with the toxic control significantly reduced cell viability. Increasing the concentration and prolonging the incubation time had no negative effect on the cells. The expression of Col1a1, Col3a1 and the tenocyte markers mohawk, scleraxis and tenomodulin was not affected by the various vancomycin concentrations. The structural integrity as measured through histological and mechanical testing was not compromised. CONCLUSION The results proved the safe application of the Vanco-wrap on tendon tissue. LEVEL OF EVIDENCE IV.
Collapse
Affiliation(s)
- Manuela Thierbach
- Experimental Trauma Surgery, Department of Trauma, Hand and Reconstructive Surgery, Jena University Hospital/Friedrich Schiller University Jena, 07747 Jena, Germany
| | - Michelle Müller
- Experimental Trauma Surgery, Department of Trauma, Hand and Reconstructive Surgery, Jena University Hospital/Friedrich Schiller University Jena, 07747 Jena, Germany
| | - Richard Stange
- Department of Regenerative Musculoskeletal Medicine, Institute for Musculoskeletal Medicine, Westfälische Wilhelms-Universität Münster, 48149 Münster, Germany
| | - Daniel Kronenberg
- Department of Regenerative Musculoskeletal Medicine, Institute for Musculoskeletal Medicine, Westfälische Wilhelms-Universität Münster, 48149 Münster, Germany
| | - Matthias Aurich
- Experimental Trauma Surgery, Department of Trauma, Hand and Reconstructive Surgery, Jena University Hospital/Friedrich Schiller University Jena, 07747 Jena, Germany
- DOUW-Section of Trauma and Reconstructive Surgery, University Hospital Halle (Saale), 06120 Halle, Germany
- BG Trauma Center Bergmannstrost, 06112 Halle, Germany
| | - Britt Wildemann
- Experimental Trauma Surgery, Department of Trauma, Hand and Reconstructive Surgery, Jena University Hospital/Friedrich Schiller University Jena, 07747 Jena, Germany
| |
Collapse
|
4
|
Lv L, Cheng W, Wang S, Lin S, Dang J, Ran Z, Zhu H, Xu W, Huang Z, Xu P, Xu H. Poly(β-amino ester) Dual-Drug-Loaded Hydrogels with Antibacterial and Osteogenic Properties for Bone Repair. ACS Biomater Sci Eng 2023; 9:1976-1990. [PMID: 36881921 DOI: 10.1021/acsbiomaterials.2c01524] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/09/2023]
Abstract
In this study, we developed a poly(β-amino ester) (PBAE) hydrogel for the double release of vancomycin (VAN) and total flavonoids of Rhizoma Drynariae (TFRD). VAN was covalently bonded to PBAE polymer chains and was released to enhance the antimicrobial effect first. TFRD chitosan (CS) microspheres were physically dispersed in the scaffold, TFRD was released from the microspheres, and osteogenesis was induced subsequently. The scaffold had good porosity (90.12 ± 3.27%), and the cumulative release rate of the two drugs in PBS (pH 7.4) solution exceeded 80%. In vitro antimicrobial assays demonstrated the antibacterial properties of the scaffold against Staphylococcus aureus (S. aureus) and Escherichia coli (E. coli). Besides these, cell viability assays indicated that the scaffold had good biocompatibility. Moreover, alkaline phosphatase and matrix mineralization were expressed more than in the control group. Overall, cell experiments confirmed that the scaffolds have enhanced osteogenic differentiation capabilities. In conclusion, the dual-drug-loaded scaffold with antibacterial and bone regeneration effects is promising in the field of bone repair.
Collapse
Affiliation(s)
- Lu Lv
- Department of Biological Science and Technology, School of Chemistry, Chemical Engineering and Life Sciences, Wuhan University of Technology, Wuhan 430070, China
| | - Wanting Cheng
- Department of Biological Science and Technology, School of Chemistry, Chemical Engineering and Life Sciences, Wuhan University of Technology, Wuhan 430070, China
| | - Sining Wang
- Department of Biological Science and Technology, School of Chemistry, Chemical Engineering and Life Sciences, Wuhan University of Technology, Wuhan 430070, China
| | - Sihui Lin
- Department of Biological Science and Technology, School of Chemistry, Chemical Engineering and Life Sciences, Wuhan University of Technology, Wuhan 430070, China
| | - Jiarui Dang
- Department of Biological Science and Technology, School of Chemistry, Chemical Engineering and Life Sciences, Wuhan University of Technology, Wuhan 430070, China
| | - Zhihui Ran
- Department of Biological Science and Technology, School of Chemistry, Chemical Engineering and Life Sciences, Wuhan University of Technology, Wuhan 430070, China
| | - Hong Zhu
- Department of Biological Science and Technology, School of Chemistry, Chemical Engineering and Life Sciences, Wuhan University of Technology, Wuhan 430070, China
| | - Wenjin Xu
- Department of Biological Science and Technology, School of Chemistry, Chemical Engineering and Life Sciences, Wuhan University of Technology, Wuhan 430070, China
| | - Zhijun Huang
- Department of Biological Science and Technology, School of Chemistry, Chemical Engineering and Life Sciences, Wuhan University of Technology, Wuhan 430070, China
| | - Peihu Xu
- Department of Biological Science and Technology, School of Chemistry, Chemical Engineering and Life Sciences, Wuhan University of Technology, Wuhan 430070, China
| | - Haixing Xu
- Department of Biological Science and Technology, School of Chemistry, Chemical Engineering and Life Sciences, Wuhan University of Technology, Wuhan 430070, China
| |
Collapse
|
5
|
Hernandez A, Rahman O, Kadkoy Y, Lauritsen KL, Sanchez A, Innella K, Lin A, Lopez J, O'Connor JP, Benevenia J, Paglia DN, Lin SS, Cottrell J. Effect of Vancomycin Applied to the Surgical Site on Fracture Healing in a Diabetic Rat Model. Foot Ankle Int 2023; 44:232-242. [PMID: 36859796 DOI: 10.1177/10711007231153354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/03/2023]
Abstract
BACKGROUND Prophylactic vancomycin treatment decreases the prevalence of surgical site and deep infections by >70% in diabetic patients undergoing reconstructive foot and ankle surgery. Thus, determining whether clinically relevant local vancomycin doses affect diabetic fracture healing is of medical interest. We hypothesized that application of vancomycin powder to the fracture site during surgery would not affect healing outcomes, but continuous exposure of vancomycin would inhibit differentiation of osteoblast precursor cells and their osteogenic activity in vitro. METHODS The vancomycin dose used to treat the diabetic rats was a modest increase to routine surgical site vancomycin application of 1 to 2 g for a 70-kg adult (21 mg/kg). After femur fracture in BB-Wistar type 1 diabetic rats, powdered vancomycin (25 mg/kg) was administered to the fracture site. Bone marrow and periosteal cells isolated from diabetic bones were cultured and treated with increasing levels of vancomycin (0, 5, 50, 500, or 5000 µg/mL). RESULTS Radiographic scoring, micro-computed tomography (µCT) analysis, and torsion mechanical testing failed to identify any statistical difference between the vancomycin-treated and the untreated fractured femurs 6 weeks postfracture. Low to moderate levels of vancomycin treatment (5 and 50 µg/mL) did not impair cell viability, osteoblast differentiation, or calcium deposition in either the periosteum or bone marrow-derived cell cultures. In contrast, high doses of vancomycin (5000 µg/mL) did impair viability, differentiation, and calcium deposition. CLINICAL RELEVANCE In this diabetic rodent fracture model, vancomycin powder application at clinically relevant doses did not affect fracture healing or osteogenesis.
Collapse
Affiliation(s)
- Alexis Hernandez
- Department of Biological Sciences, Seton Hall University, South Orange, NJ, USA
| | - Ohidur Rahman
- Department of Orthopaedics, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Yazan Kadkoy
- Department of Orthopaedics, Rutgers New Jersey Medical School, Newark, NJ, USA
| | | | - Alexandra Sanchez
- Department of Orthopaedics, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Kevin Innella
- Department of Orthopaedics, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Anthony Lin
- Department of Orthopaedics, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Jonathan Lopez
- Department of Orthopaedics, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - J Patrick O'Connor
- Department of Orthopaedics, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Joseph Benevenia
- Department of Orthopaedics, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - David N Paglia
- Department of Orthopaedics, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Sheldon S Lin
- Department of Orthopaedics, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Jessica Cottrell
- Department of Biological Sciences, Seton Hall University, South Orange, NJ, USA
| |
Collapse
|
6
|
Jacob B, Wassilew G, von Eisenhart-Rothe R, Brodt S, Matziolis G. Topical vancomycin powder does not affect patella cartilage degeneration in primary total knee arthroplasty and conversion rate for secondary patella resurfacing. Arch Orthop Trauma Surg 2022:10.1007/s00402-022-04721-w. [PMID: 36538161 PMCID: PMC10374468 DOI: 10.1007/s00402-022-04721-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2022] [Accepted: 11/22/2022] [Indexed: 12/24/2022]
Abstract
INTRODUCTION Vancomycin powder (VP) is an antibiotic first introduced in pediatric spinal surgery to prevent surgical site infections (SSI). Recently its topical application was expanded to total hip and knee arthroplasty (THA, TKA) and anterior cruciate ligament reconstruction (ACLR). Toxicity to cartilage is the subject of current research. The aim of this study was to prove the hypothesis that topical application of VP in TKA does not result in a degeneration of patella cartilage. We propagate that the conversion rate for secondary patella resurfacing is not influenced by its use. MATERIALS AND METHODS Between 2014 and 2021, 4292 joints were included in this monocentric retrospective cohort study. All patients underwent TKA without primary patella resurfacing. After a change of the procedure in the hospital, one group (VPG) was administered VP intraoperatively. The other group (nVPG) received no VP during surgery (nVPG). The remaining perioperative procedure was constant over the investigation period. Conversion rates for secondary patella resurfacing for both groups were determined without making distinctions in the indication. A second cohort was composed of patients presenting for follow-up examination 12 months after TKA and included 210 joints. Retrospective radiographic evaluations were performed preoperatively, before discharge and at follow-up examination. Patella axial radiographs were analyzed for patella tracking (lateral patellar tilt, patellar displacement) and patella degeneration (Sperner classification, patellofemoral joint space). RESULTS There was no significant difference in the conversion rate for secondary patella resurfacing (4.24% VPG, 4.97% nVPG). Patella tracking and patella degeneration did not differ significantly between both groups. CONCLUSIONS The topical application of VP does not influence the conversion rate for secondary patella resurfacing. Moreover, it does not result in a degeneration of patella cartilage in TK. LEVEL OF EVIDENCE Retrospective case series, Level III.
Collapse
Affiliation(s)
- Benjamin Jacob
- Orthopaedic Department Waldkliniken Eisenberg, University Hospital Jena, Campus Eisenberg, Klosterlausnitzer Straße 81, 07607, Eisenberg, Germany.
| | - Georgi Wassilew
- Department of Orthopaedic Surgery, University Hospital Greifswald, Greifswald, Germany
| | - Rüdiger von Eisenhart-Rothe
- Department of Orthopaedics and Sports Orthopaedics, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Steffen Brodt
- Orthopaedic Department Waldkliniken Eisenberg, University Hospital Jena, Campus Eisenberg, Klosterlausnitzer Straße 81, 07607, Eisenberg, Germany
| | - Georg Matziolis
- Orthopaedic Department Waldkliniken Eisenberg, University Hospital Jena, Campus Eisenberg, Klosterlausnitzer Straße 81, 07607, Eisenberg, Germany
| |
Collapse
|
7
|
He JW, Wang J, Cao L, Zhang XG, Li GQ, Xu BY, Ji BC, Ge SY, Yang JH. Serum and Synovial Vancomycin Concentrations in Patients with Prosthetic Joint Infection after Intra-articular Infusion. Eur J Drug Metab Pharmacokinet 2021; 46:637-643. [PMID: 34275127 DOI: 10.1007/s13318-021-00705-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/29/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND OBJECTIVES Vancomycin is one of the most commonly used antibiotics for intra-articular (IA) infusion in the treatment of prosthetic joint infection (PJI). This study aimed to preliminarily investigate the serum and synovial vancomycin concentrations in patients with PJI after IA infusion. METHODS In total, 16 patients who developed PJI were enrolled in this study; 14 of the patients were treated with IA infusion of vancomycin postoperatively, while the other 2 patients received intravenous (IV) infusion of vancomycin alone. Chemiluminescent immunoassay assay (CLIA) and high-performance liquid chromatography (HPLC) were used to determine the serum and synovial vancomycin concentrations, respectively. RESULTS Administration of vancomycin 0.5 g once daily (qd) IA maintained a high vancomycin trough concentration in synovial fluid before the next IA dose, regardless of whether it was given in combination with IV administration. The combination vancomycin 0.5 g qd IA + vancomycin 1 g every 12 h (q12h) IV yielded relatively good trough concentrations of vancomycin in both serum and synovial fluid. The mean trough serum vancomycin concentration of patients who used vancomycin 1 g q12h IV therapy was above 10 μg/mL; however, no vancomycin was detected in their synovial fluid. CONCLUSIONS The rational use of IA vancomycin infusion may help to achieve effective therapeutic concentrations of vancomycin in the serum and synovial fluid of patients with PJI.
Collapse
Affiliation(s)
- Jia-Wei He
- Department of Pharmacy, The First Affiliated Hospital of Xinjiang Medical University, No. 137 South Liyu Mountain Road, Urumqi, 830054, Xinjiang, China
| | - Jing Wang
- Department of Pharmacy, The Eighth Affiliated Hospital of Xinjiang Medical University, Urumqi, 830054, Xinjiang, China
| | - Li Cao
- Department of Orthopaedics, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, 830054, Xinjiang, China
| | - Xiao-Gang Zhang
- Department of Orthopaedics, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, 830054, Xinjiang, China
| | - Guo-Qing Li
- Department of Orthopaedics, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, 830054, Xinjiang, China
| | - Bo-Yong Xu
- Department of Orthopaedics, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, 830054, Xinjiang, China
| | - Bao-Chao Ji
- Department of Orthopaedics, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, 830054, Xinjiang, China
| | - Si-Ya Ge
- College of Pharmacy, Xinjiang Medical University, Urumqi, 830054, Xinjiang, China
| | - Jian-Hua Yang
- Department of Pharmacy, The First Affiliated Hospital of Xinjiang Medical University, No. 137 South Liyu Mountain Road, Urumqi, 830054, Xinjiang, China.
| |
Collapse
|
8
|
Sathish M, Girinivasan C. Is Use of Topical Vancomycin in Pediatric Spine Surgeries a Safe Option in the Prevention of Surgical Site Infections? A Meta-analysis and Systematic Review of the Literature. Global Spine J 2021; 11:774-781. [PMID: 32677529 PMCID: PMC8165936 DOI: 10.1177/2192568220937286] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
STUDY DESIGN Systematic review and meta-analysis. OBJECTIVE To systematically review the available articles on topical vancomycin powder (TVP) use in pediatric spine surgeries exploring the usefulness and safety of such practice. METHODS We conducted an independent and duplicate electronic database search in PubMed, EMBASE, and Cochrane Library till March 2020 to identify all relevant literature on the use of TVP for pediatric spine surgeries. Surgical site infection (SSI) rate, specific reported complications, reoperation rate, microbial flora pattern in reported SSIs, and safety profile were the outcomes analyzed. Analysis was performed with the R platform using OpenMeta[Analyst] software. RESULTS No prospective studies were available to evaluate the use of TVP in pediatric spine surgeries for the prevention of SSIs. Neither standardized protocol, nor drug dosage, nor safety profile was established for pediatric use. Three retrospective cohort studies including 824 patients (TVP/control: 400/424) were included in the meta-analysis. There was low-quality evidence suggesting no significant difference between the 2 groups in SSI rate (RR = 0.474; 95% CI = [0.106,2.112]; P = .327) with significant heterogeneity (I2 = 70.14; P = .035). The TVP group showed a significant benefit on cost analysis in one of the included studies. However, TVP did not prevent gram-negative coinfection on SSI in the TVP group. CONCLUSION From the literature available at present, TVP does not qualify to be recommended as a safe and useful option to prevent SSI following pediatric spine surgeries. High-quality prospective interventional studies are needed to arrive at a consensus on its use along with appropriate dosage and method of application.
Collapse
Affiliation(s)
- Muthu Sathish
- Government Hospital Velayuthampalayam, Karur, Tamil Nadu, India
- A Researcher, Orthopaedic Research Group, India
- Muthu Sathish, Government Hospital Velayuthampalayam, Karur, Tamil Nadu, and Researcher, Orthopaedic Research Group, India.
| | - Chellamuthu Girinivasan
- Ganga Hospitals, Coimbatore, Tamil Nadu, India
- A Researcher, Orthopaedic Research Group, India
| |
Collapse
|
9
|
Schwarz EM, McLaren AC, Sculco TP, Brause B, Bostrom M, Kates SL, Parvizi J, Alt V, Arnold WV, Carli A, Chen AF, Choe H, Coraça‐Huber DC, Cross M, Ghert M, Hickok N, Jennings JA, Joshi M, Metsemakers W, Ninomiya M, Nishitani K, Oh I, Padgett D, Ricciardi B, Saeed K, Sendi P, Springer B, Stoodley P, Wenke JC. Adjuvant antibiotic-loaded bone cement: Concerns with current use and research to make it work. J Orthop Res 2021; 39:227-239. [PMID: 31997412 PMCID: PMC7390691 DOI: 10.1002/jor.24616] [Citation(s) in RCA: 69] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Revised: 01/07/2020] [Accepted: 01/13/2020] [Indexed: 02/04/2023]
Abstract
Antibiotic-loaded bone cement (ALBC) is broadly used to treat orthopaedic infections based on the rationale that high-dose local delivery is essential to eradicate biofilm-associated bacteria. However, ALBC formulations are empirically based on drug susceptibility from routine laboratory testing, which is known to have limited clinical relevance for biofilms. There are also dosing concerns with nonstandardized, surgeon-directed, hand-mixed formulations, which have unknown release kinetics. On the basis of our knowledge of in vivo biofilms, pathogen virulence, safety issues with nonstandardized ALBC formulations, and questions about the cost-effectiveness of ALBC, there is a need to evaluate the evidence for this clinical practice. To this end, thought leaders in the field of musculoskeletal infection (MSKI) met on 1 August 2019 to review and debate published and anecdotal information, which highlighted four major concerns about current ALBC use: (a) substantial lack of level 1 evidence to demonstrate efficacy; (b) ALBC formulations become subtherapeutic following early release, which risks induction of antibiotic resistance, and exacerbated infection from microbial colonization of the carrier; (c) the absence of standardized formulation protocols, and Food and Drug Administration-approved high-dose ALBC products to use following resection in MSKI treatment; and (d) absence of a validated assay to determine the minimum biofilm eradication concentration to predict ALBC efficacy against patient specific micro-organisms. Here, we describe these concerns in detail, and propose areas in need of research.
Collapse
Affiliation(s)
- Edward M. Schwarz
- Department of Orthopaedics, Center for Musculoskeletal Research University of Rochester Rochester New York
| | - Alex C. McLaren
- Department of Orthopaedic Surgery, College of Medicine‐Phoenix University of Arizona Phoenix Arizona
| | - Thomas P. Sculco
- Department of Orthopaedic Surgery, Weill Cornell Medicine Hospital for Special Surgery New York New York
| | - Barry Brause
- Department of Infectious Diseases, Weill Cornell Medicine Hospital for Special Surgery New York New York
| | - Mathias Bostrom
- Department of Orthopaedic Surgery, Weill Cornell Medicine Hospital for Special Surgery New York New York
| | - Stephen L. Kates
- Department of Orthopaedic Surgery Virginia Commonwealth University Richmond Virginia
| | - Javad Parvizi
- Department of Orthopaedics Rothman Institute at Thomas Jefferson University Hospital Philadelphia Pennsylvania
| | - Volker Alt
- Department of Trauma Surgery University Medical Centre Regensburg Regensburg Germany
| | - William V. Arnold
- Department of Orthopaedics Rothman Institute at Thomas Jefferson University Hospital Philadelphia Pennsylvania
| | - Alberto Carli
- Department of Orthopaedic Surgery, Weill Cornell Medicine Hospital for Special Surgery New York New York
| | - Antonia F. Chen
- Department of Orthopaedics, Brigham and Women's Hospital Harvard Medical School Boston Massachusetts
| | - Hyonmin Choe
- Department of Orthopaedic Yokohama City University Yokohama Japan
| | - Débora C. Coraça‐Huber
- Department of Orthopaedic Surgery, Experimental Orthopedics, Research Laboratory for Biofilms and Implant Associated Infections Medical University of Innsbruck Innsbruck Austria
| | - Michael Cross
- Department of Orthopaedic Surgery, Weill Cornell Medicine Hospital for Special Surgery New York New York
| | - Michelle Ghert
- Division of Orthopaedic Surgery, Department of Surgery McMaster University Hamilton Ontario Canada
| | - Noreen Hickok
- Department of Orthopaedic Surgery, Department of Biochemistry & Molecular Biology Thomas Jefferson University Philadelphia Pennsylvania
| | | | - Manjari Joshi
- Division of Infectious Diseases, R Adams Cowley Shock Trauma Center University of Maryland Baltimore Maryland
| | | | - Mark Ninomiya
- Department of Orthopaedics, Center for Musculoskeletal Research University of Rochester Rochester New York
| | - Kohei Nishitani
- Department of Orthopaedic Surgery Graduate School of Medicine, Kyoto University Sakyo Kyoto Japan
| | - Irvin Oh
- Department of Orthopaedics, Center for Musculoskeletal Research University of Rochester Rochester New York
| | - Douglas Padgett
- Department of Orthopaedic Surgery, Weill Cornell Medicine Hospital for Special Surgery New York New York
| | - Benjamin Ricciardi
- Department of Orthopaedics, Center for Musculoskeletal Research University of Rochester Rochester New York
| | - Kordo Saeed
- Southampton University Hospitals NHS Foundation Trust, Department of Microbiology, Microbiology and Innovation Research Unit (MIRU) and University of Southampton, School of Medicine Southampton UK
| | - Parham Sendi
- Institute for Infectious Diseases University of Bern, Bern and Department of Infectious Diseases, Hospital Epidemiology and Department of Orthopaedics and Traumatology, University of Basel Basel Switzerland
- Department of Orthopaedics and Traumatology University Hospital Basel Basel Switzerland
| | - Bryan Springer
- Department of Orthopaedic Surgery, OrthoCarolina Hip and Knee Center Atrium Musculoskeletal Institute Charlotte North Carolina
| | - Paul Stoodley
- Department of Microbial Infection and Immunity and Orthopaedics The Ohio State University Columbus Ohio
| | - Joseph C. Wenke
- Orthopaedic Trauma Department U.S. Army Institute of Surgical Research Fort Sam Houston Texas
| | | |
Collapse
|
10
|
Xu H, Yang J, Xie J, Huang Z, Huang Q, Cao G, Pei F. Efficacy and safety of intrawound vancomycin in primary hip and knee arthroplasty. Bone Joint Res 2020; 9:778-788. [PMID: 33135425 PMCID: PMC7649508 DOI: 10.1302/2046-3758.911.bjr-2020-0190.r2] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Aims The efficacy and safety of intrawound vancomycin for preventing surgical site infection in primary hip and knee arthroplasty is uncertain. Methods A systematic review of the literature was conducted, indexed from inception to March 2020 in PubMed, Web of Science, Cochrane Library, Embase, and Google Scholar databases. All studies evaluating the efficacy and/or safety of intrawound vancomycin in patients who underwent primary hip and knee arthroplasty were included. Incidence of periprosthetic joint infection (PJI), superficial infection, aseptic wound complications, acute kidney injury, anaphylactic reaction, and ototoxicity were meta-analyzed. Results were reported as odds ratios (ORs) and 95% confidence intervals (CIs). The quality of included studies was assessed using the risk of bias in non-randomized studies of interventions (ROBINS-I) assessment tool. Results Nine studies involving 4,607 patients were included. Intrawound vancomycin was associated with lower incidence of PJI (30 patients (1.20%) vs 58 control patients (2.75%); OR 0.44, 95% CI 0.28 to 0.69) and simultaneous acute kidney injury (four patients (0.28%) vs four control patients (0.35%), OR 0.71, 95% CI 0.19 to 2.55). However, it did not reduce risk of superficial infection (four patients (0.67%) vs six control patients (1.60%), OR 0.60, 95% CI 0.17 to 2.12) and was associated with higher incidence of aseptic wound complications (23 patients (2.15%) vs eight in control patients (0.96%), OR 2.39, 95% CI 1.09 to 5.23). Four studies reported no anaphylactic reactions and three studies reported no ototoxicity in any patient group. Conclusion The current literature suggests that intrawound vancomycin used in primary hip and knee arthroplasty may reduce incidence of PJI, but it may also increase risk of aseptic wound complications. Cite this article: Bone Joint Res 2020;9(11):778–788.
Collapse
Affiliation(s)
- Hong Xu
- Department of Orthopaedic Surgery and National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, China
| | - Jingli Yang
- College of Earth and Environmental Sciences, and School of Public Health, Lanzhou University, Lanzhou, China
| | - Jinwei Xie
- Department of Orthopaedic Surgery and National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, China
| | - Zeyu Huang
- Department of Orthopaedic Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Qiang Huang
- Department of Orthopaedic Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Guorui Cao
- Department of Orthopaedic Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Fuxing Pei
- Department of Orthopaedic Surgery, West China Hospital, Sichuan University, Chengdu, China
| |
Collapse
|
11
|
Xiao M, Leonardi EA, Sharpe O, Sherman SL, Safran MR, Robinson WH, Abrams GD. Soaking of Autologous Tendon Grafts in Vancomycin Before Implantation Does Not Lead to Tenocyte Cytotoxicity. Am J Sports Med 2020; 48:3081-3086. [PMID: 32898431 DOI: 10.1177/0363546520951815] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Surgical site infections (SSIs) after anterior cruciate ligament (ACL) reconstruction procedures are an unfortunate complication. Soaking grafts in vancomycin before implantation has been reported to reduce the incidence of postoperative SSI after ACL reconstruction. There is potential for vancomycin to compromise graft integrity because of tenocyte toxicity. PURPOSE To examine the in vitro toxicity of varying doses of vancomycin on human tenocytes. STUDY DESIGN Controlled laboratory study. METHODS Human patellar tenocytes were isolated and expanded in vitro. Tenocytes in culture were exposed to vancomycin at 5 different concentrations (400, 1600, 3200, 6400, and 12,800 μg/mL) and 3 time intervals (2, 6, and 24 hours). The control for all series was tenocyte exposure to only culture medium for each time interval. After treatment, a 10% Cell Counting Kit-8 solution in cellular growth medium was applied to the cells to examine cytotoxicity. A live/dead assay was used to assess tenocyte viability through fluorescence microscopy and flow cytometry. Results were analyzed statistically using multivariable logistic regression models with Tukey honest significant difference post hoc tests. RESULTS Vancomycin did not cause significant changes in tenocyte viability after 2 and 6 hours of incubation at any concentration between 0 and 12,800 µg/mL. Incubation with vancomycin for 24 hours led to a significant decrease in cell viability at higher concentrations. CONCLUSION Tenocytes derived from human patellar tendons exposed to relatively high concentrations of vancomycin for short periods of time do not demonstrate significant cell death and toxicity. CLINICAL RELEVANCE Exposing tendons to vancomycin for a short period of time, such as before ACL reconstruction, is not likely to cause tenocyte toxicity because of vancomycin administration.
Collapse
Affiliation(s)
- Michelle Xiao
- Department of Orthopaedic Surgery, Stanford University School of Medicine, Palo Alto, California, USA
| | - Erika A Leonardi
- Department of Orthopaedic Surgery, Stanford University School of Medicine, Palo Alto, California, USA
| | - Orr Sharpe
- Veterans Administration Palo Alto Health Care System, Palo Alto, California, USA
| | - Seth L Sherman
- Department of Orthopaedic Surgery, Stanford University School of Medicine, Palo Alto, California, USA
| | - Marc R Safran
- Department of Orthopaedic Surgery, Stanford University School of Medicine, Palo Alto, California, USA
| | - William H Robinson
- Veterans Administration Palo Alto Health Care System, Palo Alto, California, USA.,Department of Medicine, Division of Rheumatology, Stanford University School of Medicine, Palo Alto, California, USA
| | - Geoffrey D Abrams
- Department of Orthopaedic Surgery, Stanford University School of Medicine, Palo Alto, California, USA
| |
Collapse
|
12
|
Abstract
Fracture-related infection (FRI) remains a challenging complication that imposes a heavy burden on orthopaedic trauma patients. The surgical management eradicates the local infectious focus and if necessary facilitates bone healing. Treatment success is associated with debridement of all dead and poorly vascularized tissue. However, debridement is often associated with the formation of a dead space, which provides an ideal environment for bacteria and is a potential site for recurrent infection. Dead space management is therefore of critical importance. For this reason, the use of locally delivered antimicrobials has gained attention not only for local antimicrobial activity but also for dead space management. Local antimicrobial therapy has been widely studied in periprosthetic joint infection, without addressing the specific problems of FRI. Furthermore, the literature presents a wide array of methods and guidelines with respect to the use of local antimicrobials. The present review describes the scientific evidence related to dead space management with a focus on the currently available local antimicrobial strategies in the management of FRI. LEVEL OF EVIDENCE:: Therapeutic Level V. See Instructions for Authors for a complete description of levels of evidence.
Collapse
|
13
|
Raspovic KM, Liu GT, Lalli T, Van Pelt M, Wukich DK. Optimizing Results in Diabetic Charcot Reconstruction. Clin Podiatr Med Surg 2019; 36:469-481. [PMID: 31079611 DOI: 10.1016/j.cpm.2019.02.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Reconstruction of the diabetic Charcot foot can be a challenge even for the most experienced foot and ankle surgeon. The first portion of this article discusses the preoperative evaluation with an emphasis on factors that can be modified before surgical reconstruction to help optimize surgical results. The second portion of the article focuses on intraoperative methods and techniques to help improve postoperative outcomes. Surgeons should strive to provide high-quality, cost-effective care by optimizing patient selection and perioperative care. Objective measures of patient outcomes will become increasingly important with the transition from volume-based to value-based care.
Collapse
Affiliation(s)
- Katherine M Raspovic
- Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center, 1801 Inwood Road, Dallas, TX 75390, USA.
| | - George T Liu
- Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center, 1801 Inwood Road, Dallas, TX 75390, USA
| | - Trapper Lalli
- Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center, 1801 Inwood Road, Dallas, TX 75390, USA
| | - Michael Van Pelt
- Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center, 1801 Inwood Road, Dallas, TX 75390, USA
| | - Dane K Wukich
- Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center, 1801 Inwood Road, Dallas, TX 75390, USA
| |
Collapse
|
14
|
Bariteau JT, Kadakia RJ, Traub BC, Viggeswarapu M, Willett NJ. Impact of Vancomycin Treatment on Human Mesenchymal Stromal Cells During Osteogenic Differentiation. Foot Ankle Int 2018; 39:954-959. [PMID: 29620948 DOI: 10.1177/1071100718766655] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Vancomycin is frequently applied locally to the operative site during foot and ankle procedures to help prevent infection. Although the efficacy of locally applied vancomycin has been demonstrated in spine surgery, there is no consensus on dosing and indication within foot and ankle surgery. Osteogenic differentiation of human mesenchymal stromal cells (hMSCs) is key to healing of both fractures and arthrodesis. The purpose of this research was to determine the impact of vancomycin on human hMSCs during the process of osteogenic differentiation. METHODS hMSCs were cultured in osteogenic differentiation media to promote osteogenic differentiation. Cells were treated with vancomycin at differing concentrations of 0, 50, 500, and 5000 µg/mL. Viability and cell growth were assessed via LIVE/DEAD viability/cytotoxicity kit (Invitrogen, Waltham, MA) after 1, 3, and 7 days of vancomycin treatment. Differentiation and mineralization was assessed via alizarin red staining after 21 days of treatment. Mean cell viability, cell number, and mineralization were compared between treatment groups using 1-way analysis of variance and the Tukey-Kramer method for post hoc pairwise comparisons. RESULTS At the highest concentrations of vancomycin, there was a significant reduction in cell viability and proliferation after 3 days compared with all other treatment groups. Mineralization was also significantly decreased with higher doses of vancomycin. CONCLUSION At high concentrations, vancomycin may impair hMSC viability and osteogenic differentiation. CLINICAL RELEVANCE Surgeons should exercise caution and consider the limited soft tissue envelope when applying vancomycin locally during foot and ankle surgery, especially during arthrodesis procedures.
Collapse
Affiliation(s)
- Jason T Bariteau
- 1 Department of Orthopaedic Surgery, Emory University School of Medicine, Atlanta, GA, USA
| | - Rishin J Kadakia
- 1 Department of Orthopaedic Surgery, Emory University School of Medicine, Atlanta, GA, USA
| | - Brian C Traub
- 1 Department of Orthopaedic Surgery, Emory University School of Medicine, Atlanta, GA, USA
| | | | - Nick J Willett
- 1 Department of Orthopaedic Surgery, Emory University School of Medicine, Atlanta, GA, USA.,2 The Atlanta Veterans Affairs Medical Center, Decatur, GA, USA
| |
Collapse
|
15
|
García-González CA, Barros J, Rey-Rico A, Redondo P, Gómez-Amoza JL, Concheiro A, Alvarez-Lorenzo C, Monteiro FJ. Antimicrobial Properties and Osteogenicity of Vancomycin-Loaded Synthetic Scaffolds Obtained by Supercritical Foaming. ACS APPLIED MATERIALS & INTERFACES 2018; 10:3349-3360. [PMID: 29313664 DOI: 10.1021/acsami.7b17375] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Advanced porous synthetic scaffolds are particularly suitable for regeneration of damaged tissues, but there is the risk of infections due to the colonization of microorganisms, forming biofilms. Supercritical foaming is an attractive processing method to prepare bone scaffolds, regulating simultaneously the porosity and loading of bioactive compounds without loss of activity. In this work, scaffolds made of poly-ε-caprolactone (50 kDa), containing chitosan and an antimicrobial agent (vancomycin), were processed by supercritical CO2 foaming for bone regeneration purposes. The obtained scaffolds showed a suitable combination of morphological (porosity, pore size distribution, and interconnectivity), time-dependent in vitro vancomycin release behavior and biological properties (cell viability and proliferation, osteodifferentiation, and tissue-scaffold integration). The scaffolds sustained vancomycin release for more than 2 weeks. Finally, the antimicrobial activity of the scaffolds was tested against Gram-positive (Staphylococcus aureus) and Gram-negative (Escherichia coli) bacteria after 24 h of incubation with full growth inhibition for S. aureus.
Collapse
Affiliation(s)
- Carlos A García-González
- Departamento de Farmacología, Farmacia y Tecnología Farmacéutica, R+D Pharma Group (GI-1645), Facultad de Farmacia and Health Research Institute of Santiago de Compostela (IDIS), Universidade de Santiago de Compostela , E-15782 Santiago de Compostela, Spain
| | - Joana Barros
- FEUP-Faculdade de Engenharia, Universidade do Porto, I3S-Instituto de Investigação e Inovação em Saúde, and INEB-Instituto de Engenharia Biomédica , Porto 4200-135, Portugal
| | - Ana Rey-Rico
- Center of Experimental Orthopaedics, Saarland University Medical Center , Homburg 66421, Germany
| | - Pablo Redondo
- Departamento de Farmacología, Farmacia y Tecnología Farmacéutica, R+D Pharma Group (GI-1645), Facultad de Farmacia and Health Research Institute of Santiago de Compostela (IDIS), Universidade de Santiago de Compostela , E-15782 Santiago de Compostela, Spain
| | - José L Gómez-Amoza
- Departamento de Farmacología, Farmacia y Tecnología Farmacéutica, R+D Pharma Group (GI-1645), Facultad de Farmacia and Health Research Institute of Santiago de Compostela (IDIS), Universidade de Santiago de Compostela , E-15782 Santiago de Compostela, Spain
| | - Angel Concheiro
- Departamento de Farmacología, Farmacia y Tecnología Farmacéutica, R+D Pharma Group (GI-1645), Facultad de Farmacia and Health Research Institute of Santiago de Compostela (IDIS), Universidade de Santiago de Compostela , E-15782 Santiago de Compostela, Spain
| | - Carmen Alvarez-Lorenzo
- Departamento de Farmacología, Farmacia y Tecnología Farmacéutica, R+D Pharma Group (GI-1645), Facultad de Farmacia and Health Research Institute of Santiago de Compostela (IDIS), Universidade de Santiago de Compostela , E-15782 Santiago de Compostela, Spain
| | - Fernando J Monteiro
- FEUP-Faculdade de Engenharia, Universidade do Porto, I3S-Instituto de Investigação e Inovação em Saúde, and INEB-Instituto de Engenharia Biomédica , Porto 4200-135, Portugal
| |
Collapse
|