Recent Advances in Research on Antibacterial Metals and Alloys as Implant Materials

Enhanced antibacterial and corrosion resistance performance of fluorine-doped diamond-like carbon coatings on 316 L stainless steel

Biomedical materials must meet increasingly stringent standards for antibacterial efficacy and corrosion resistance. This study investigates the enhancement of these properties in 316 L stainless steel through the application of fluorine-doped diamond-like carbon (F-DLC) coatings. A series of F-DLC coatings with varying fluorine (F) concentrations were fabricated using plasma-enhanced chemical vapour deposition (PECVD). Fluorine doping increased the sp2/sp3 ratio (0.65-0.93) and enhanced surface hydrophobicity, as indicated by an increase in the contact angle from 63.1° to 79.7°. The impact of F concentration on bacterial adhesion was investigated using Escherichia coli (E. coli) and Staphylococcus aureus (S. aureus). DLC coatings with higher F concentrations and sp2/sp3 ratios exhibited a notable reduction in bacterial adhesion - up to 74 % for E. coli and 77 % for S. aureus - compared to uncoated stainless steel. The extended Derjaguin-Landau-Verwey-Overbeek (XDLVO) theory was employed to model bacteria-surface interactions, revealing the role of F in bacterial adhesion behaviour. Furthermore, the F-DLC coatings achieved a significant corrosion inhibition rate of 98.3 % in Hanks' balanced salt solution at 37 °C. Overall, higher F concentrations in the DLC coatings promote antibacterial and anti-corrosion performance by shifting the carbon structure from a three-dimensional sp3-dominated configuration to a two-dimensional sp2-rich structure.

Research Progress in Medical Biomaterials for Bone Infections

Bone infection is a debilitating condition characterized by inflammation of the bone and its marrow. It poses significant challenges in clinical practice due to its recalcitrant nature and difficulty in eradicating the infecting microorganisms. Recent advancements in the field of medical biomaterials have shown hope in the treatment of bone infections. This article reviews the research progress of medical biomaterials for anti-osteomyelitis in recent years, focusing on the mechanism of action, unique advantages, and application backgrounds of various materials. At the same time, we pay attention to the need for materials used in the treatment of osteomyelitis to promote bone healing.

Investigation of Pore Size Effect on the Infiltration Process of Ti6Al4V/xAg Metal Matrix Composites

This work investigates the fabrication of Ti6Al4V composites manufactured by powder metallurgy through pressureless infiltration. Porous Ti6Al4V alloy compacts with different particle sizes were fabricated by sintering and then, liquid Ag was infiltrated to obtain composites. Computed microtomography was used to analyze the samples before and after infiltration. Numerical flow simulations and dilatometry tests evaluated the kinetics of Ag infiltration into porous Ti6Al4V compacts. Microstructure was observed by SEM and mechanical strength was evaluated by compression tests. Results showed that the pore properties play a crucial role in the infiltration timing and the distribution of the Ag's liquid. In particular, large pores allowed the infiltration to start a few °C degrees earlier than samples with smaller pores. Three-dimensional images after infiltration showed that most of the pores were filled and the remaining ones were isolated. The resulting microstructure was composed of Ti2Ag, α-Ti and Ag phases, indicating that the Ag diffusion occurred. Furthermore, the mechanical strength depends on the interparticle neck sizes and the Ag improves the plastic deformation reached during compression tests. The best results were obtained for the samples with larger pore sizes because the resulting mechanical properties (E = 23 GPa and σy = 403 MPa) are close to that of human bones, making it the best candidate as an antibacterial material for biomedical use.

Phase-transformed lactoferrin/strontium-doped nanocoatings enhance antibacterial, anti-inflammatory and vascularised osteogenesis of titanium

Failure of orthopedic implants due to localized bacterial infections, inflammation and insufficient blood supply is always problematic. In this study, strontium-doped titanium dioxide nanotubes (STN) were firstly prepared on titanium surface, and then lactoferrin (LF) was loaded into strontium-doped nanotubes (STN) by the phase transition method, eventually the LF/TCEP-STN composite coating was successfully prepared. With the innate antimicrobial properties of LF, LF/TCEP-STN was effected against E. coli and S. aureus. Cellular assays showed that RAW264.7 (immune), HUVEC (angiogenic) and MC3T3-E1 (osteogenic) exhibited good adhesion and proliferative activity on the surface of LF/TCEP-STN. At the molecular level, LF/TCEP-STN modulated RAW264.7 polarization toward M2-type while promoting MC3T3-E1 differentiation toward osteogenesis. Meanwhile LF/TCEP-STN coating effectively promoted angiogenesis. The results of the bone defect model with or without infection demonstrated that the LF/TCEP-STN material had good anti-inflammatory, antibacterial, and vascularization-promoting osteogenesis. In addition, LF/TCEP-STN offered excellent blood compatibility and biosafety. As a multifunctional coating on implant surfaces, the study's results highlighted the viability of LF/TCEP-STN and offered fresh concepts for the clinical design of next-generation artificial bone implants with antibacterial, anti-inflammatory, and osteogenic properties.

A novel titanium alloy for load-bearing biomedical implants: Evaluating the antibacterial and biocompatibility of Ti536 produced via electron beam powder bed fusion additive manufacturing process

Additive manufacturing (AM) of Ti-based biomedical implants is a pivotal research topic because of its ability to produce implants with complicated geometries. Despite desirable mechanical properties and biocompatibility of Ti alloys, one major drawback is their lack of inherent antibacterial properties, increasing the risk of postoperative infections. Hence, this research focuses on the Ti536 (Ti5Al3V6Cu) alloy, developed through Electron Beam Powder Bed Fusion (EB-PBF), exploring bio-corrosion, antibacterial features, and cell biocompatibility. The microstructural characterization revealed grain refinement and the formation of Ti2Cu precipitates with different morphologies and sizes in the Ti matrix. Electrochemical tests showed that Cu content minimally influenced the corrosion current density, while it slightly affected the stability, defect density, and chemical composition of the passive film. According to the findings, the Ti536 alloy demonstrated enhanced antibacterial properties without compromising its cell biocompatibility and corrosion behavior, thanks to Ti2Cu precipitates. This can be attributed to both the release of Cu ions and the Ti2Cu precipitates. The current study suggests that the EB-PBF fabricated Ti536 sample is well-suited for use in load-bearing applications within the medical industry. This research also offers an alloy design roadmap for novel biomedical Ti-based alloys with superior biological performance using AM methods.

Various Antibacterial Strategies Utilizing Titanium Dioxide Nanotubes Prepared via Electrochemical Anodization Biofabrication Method

Currently, titanium and its alloys have emerged as the predominant metallic biomaterials for orthopedic implants. Nonetheless, the relatively high post-operative infection rate (2-5%) exacerbates patient discomfort and imposes significant economic costs on society. Hence, urgent measures are needed to enhance the antibacterial properties of titanium and titanium alloy implants. The titanium dioxide nanotube array (TNTA) is gaining increasing attention due to its topographical and photocatalytic antibacterial properties. Moreover, the pores within TNTA serve as excellent carriers for chemical ion doping and drug loading. The fabrication of TNTA on the surface of titanium and its alloys can be achieved through various methods. Studies have demonstrated that the electrochemical anodization method offers numerous significant advantages, such as simplicity, cost-effectiveness, and controllability. This review presents the development process of the electrochemical anodization method and its applications in synthesizing TNTA. Additionally, this article systematically discusses topographical, chemical, drug delivery, and combined antibacterial strategies. It is widely acknowledged that implants should possess a range of favorable biological characteristics. Clearly, addressing multiple needs with a single antibacterial strategy is challenging. Hence, this review proposes systematic research into combined antibacterial strategies to further mitigate post-operative infection risks and enhance implant success rates in the future.

Biomaterials science and surface engineering strategies for dental peri-implantitis management

Peri-implantitis is a bacterial infection that causes soft tissue inflammatory lesions and alveolar bone resorption, ultimately resulting in implant failure. Dental implants for clinical use barely have antibacterial properties, and bacterial colonization and biofilm formation on the dental implants are major causes of peri-implantitis. Treatment strategies such as mechanical debridement and antibiotic therapy have been used to remove dental plaque. However, it is particularly important to prevent the occurrence of peri-implantitis rather than treatment. Therefore, the current research spot has focused on improving the antibacterial properties of dental implants, such as the construction of specific micro-nano surface texture, the introduction of diverse functional coatings, or the application of materials with intrinsic antibacterial properties. The aforementioned antibacterial surfaces can be incorporated with bioactive molecules, metallic nanoparticles, or other functional components to further enhance the osteogenic properties and accelerate the healing process. In this review, we summarize the recent developments in biomaterial science and the modification strategies applied to dental implants to inhibit biofilm formation and facilitate bone-implant integration. Furthermore, we summarized the obstacles existing in the process of laboratory research to reach the clinic products, and propose corresponding directions for future developments and research perspectives, so that to provide insights into the rational design and construction of dental implants with the aim to balance antibacterial efficacy, biological safety, and osteogenic property.

Enhancing the anti-biofouling property of solar evaporator through the synergistic antibacterial effect of lignin and nano silver

Solar desalination is an effective solution to address the global water scarcity issue. However, biofouling poses a significant challenge for solar evaporators due to the presence of bacteria in seawater. In this study, an anti-biofouling evaporator was constructed using the synergistic antibacterial effect of lignin and silver nanoparticles (AgNPs). The AgNPs were easily synthesized using lignin as reductant under mild reaction conditions. Subsequently, the Lignin-AgNPs solution was integrated into polyacrylamide hydrogel (PAAm) without any purification steps, resulting in the formation of Lignin/AgNPs-PAAm (LAg-PAAm). Under the combined action of AgNPs and the hydroquinone groups present in oxidized lignin, LAg-PAAm achieved over 99 % disinfection efficiency within 1 h, effectively preventing biofilm formation in pore channels of solar evaporators. The anti-biofouling solar evaporator demonstrated an evaporation rate of 1.85 kg m-2 h-1 under 1 sun irradiation, and maintained stable performance for >30 days due to its high efficient bactericidal effect. Furthermore, it also exhibited exceptional salt-rejection capability attributed to its superior hydrophilicity.

Self-controllable proteinic antibacterial coating with bacteria-triggered antibiotic release for prevention of periprosthetic infection

Periprosthetic infection is a devastating postimplantation complication in which a biofilm layer harboring invasive microorganisms forms around orthopedic implants, leading to severe implant failure and patient morbidity. Despite the development of several infection-triggered antibiotic release approaches, most current antibacterial coatings are susceptible to undesired antibiotic leakage or mechanical disintegration during prosthesis installation. Herein, we propose a self-controllable proteinic antibacterial coating capable of both long-lasting adherence onto titanium implant substrates over the implant fixation period and instantaneous bacterial eradication. Importantly, the pH-dependent reversible metal coordination of mussel adhesive protein (MAP) enabled bacterial concentration-dependent antibiotic delivery in response to infection-induced acidification. In addition, the MAP coating exhibited superior self-healable adhesive properties and scratch resistance, which enabled to avert issues associated with mechanical damages, including peeling and cracking, often occurring in conventional implant coating systems. The gentamicin-loaded MAP coating exhibited complete inhibition of bacterial growth in vivo against Staphylococcus aureus penetrations during implantation surgery (immediate infection) and even 4 weeks after implantation (delayed infection). Thus, our antibiotic-loaded MAP hydrogel coating can open new avenues for self-defensive antibiotic prophylaxis to achieve instant and sustainable bacteriocidal activity in orthopedic prostheses. © 2017 Elsevier Inc. All rights reserved.

Inherent Antibacterial Properties of Biodegradable FeMnC(Cu) Alloys for Implant Application

Implant-related infections or inflammation are one of the main reasons for implant failure. Therefore, different concepts for prevention are needed, which strongly promote the development and validation of improved material designs. Besides modifying the implant surface by, for example, antibacterial coatings (also implying drugs) for deterring or eliminating harmful bacteria, it is a highly promising strategy to prevent such implant infections by antibacterial substrate materials. In this work, the inherent antibacterial behavior of the as-cast biodegradable Fe69Mn30C1 (FeMnC) alloy against Gram-negative Pseudomonas aeruginosa and Escherichia coli as well as Gram-positive Staphylococcus aureus is presented for the first time in comparison to the clinically applied, corrosion-resistant AISI 316L stainless steel. In the second step, 3.5 wt % Cu was added to the FeMnC reference alloy, and the microbial corrosion as well as the proliferation of the investigated bacterial strains is further strongly influenced. This leads for instance to enhanced antibacterial activity of the Cu-modified FeMnC-based alloy against the very aggressive, wild-type bacteria P. aeruginosa. For clarification of the bacterial test results, additional analyses were applied regarding the microstructure and elemental distribution as well as the initial corrosion behavior of the alloys. This was electrochemically investigated by a potentiodynamic polarization test. The initial degraded surface after immersion were analyzed by glow discharge optical emission spectrometry and transmission electron microscopy combined with energy-dispersive X-ray analysis, revealing an increase of degradation due to Cu alloying. Due to their antibacterial behavior, both investigated FeMnC-based alloys in this study are attractive as a temporary implant material.

Enhanced antibacterial activity and superior biocompatibility of cobalt-deposited titanium discs for possible use in implant dentistry

The clinical success of implants depends on rapid osseointegration, and new materials are being developed considering the increasing demand. Considering cobalt (Co) antibacterial characteristics, we developed Co-deposited titanium (Ti) using direct current (DC) sputtering and investigated it as a new material for implant dentistry. The material was characterized using atomic absorption spectroscopy, scanning electron microscopy-energy dispersive X-ray spectroscopy, and X-ray photoelectron spectroscopy. The material's surface topography, roughness, surface wettability, and hardness were also analyzed. The Co thin film (Ti-Co15) showed excellent antibacterial effects against microbes implicated in peri-implantitis. Furthermore, Ti-Co15 was compatible and favored the attachment and spreading of MG-63 cells. The alkaline phosphatase and calcium mineralization activities of MG-63 cells cultured on Ti-Co15 remained unaltered compared to Ti. These data correlated well with the time-dependent expression of ALP, RUNX-2, and BMP-2 genes involved in osteogenesis. The results demonstrate that Co-deposited Ti could be a promising material in implant dentistry.

Additively manufactured Ti-Ta-Cu alloys for the next-generation load-bearing implants

Bacterial colonization of orthopedic implants is one of the leading causes of failure and clinical complexities for load-bearing metallic implants. Topical or systemic administration of antibiotics may not offer the most efficient defense against colonization, especially in the case of secondary infection, leading to surgical removal of implants and in some cases even limbs. In this study, laser powder bed fusion was implemented to fabricate Ti3Al2V alloy by a 1:1 weight mixture of CpTi and Ti6Al4V powders. Ti-Tantalum (Ta)-Copper (Cu) alloys were further analyzed by the addition of Ta and Cu into the Ti3Al2V custom alloy. The biological, mechanical, and tribo-biocorrosion properties of Ti3Al2V alloy were evaluated. A 10 wt.% Ta (10Ta) and 3 wt.% Cu (3Cu) were added to the Ti3Al2V alloy to enhance biocompatibility and impart inherent bacterial resistance. Additively manufactured implants were investigated for resistance against Pseudomonas aeruginosa and Staphylococcus aureus strains of bacteria for up to 48 h. A 3 wt.% Cu addition to Ti3Al2V displayed improved antibacterial efficacy, i.e. 78%-86% with respect to CpTi. Mechanical properties for Ti3Al2V-10Ta-3Cu alloy were evaluated, demonstrating excellent fatigue resistance, exceptional shear strength, and improved tribological and tribo-biocorrosion characteristics when compared to Ti6Al4V. In vivo studies using a rat distal femur model revealed improved early-stage osseointegration for alloys with 10 wt.% Ta addition compared to CpTi and Ti6Al4V. The 3 wt.% Cu-added compositions displayed biocompatibility and no adverse inflammatory response in vivo. Our results establish the Ti3Al2V-10Ta-3Cu alloy's synergistic effect on improving both in vivo biocompatibility and microbial resistance for the next generation of load-bearing metallic implants.

Nanobiotics and the One Health Approach: Boosting the Fight against Antimicrobial Resistance at the Nanoscale

Antimicrobial resistance (AMR) is a growing public health concern worldwide, and it poses a significant threat to human, animal, and environmental health. The overuse and misuse of antibiotics have contributed significantly and others factors including gene mutation, bacteria living in biofilms, and enzymatic degradation/hydrolyses help in the emergence and spread of AMR, which may lead to significant economic consequences such as reduced productivity and increased health care costs. Nanotechnology offers a promising platform for addressing this challenge. Nanoparticles have unique properties that make them highly effective in combating bacterial infections by inhibiting the growth and survival of multi-drug-resistant bacteria in three areas of health: human, animal, and environmental. To conduct an economic evaluation of surveillance in this context, it is crucial to obtain an understanding of the connections to be addressed by several nations by implementing national action policies based on the One Health strategy. This review provides an overview of the progress made thus far and presents potential future directions to optimize the impact of nanobiotics on AMR.

Zinc chloride is effective as an antibiotic in biofilm prevention following septoplasty

Biofilm-state bacterial infections associated with inserted medical devices constitute a massive health and financial problem worldwide. Although bacteria exhibit significantly lower susceptibility to antibiotics in the biofilm state, the most common treatment approach still relies on antibiotics, exacerbating the phenomenon of antibiotic-resistant bacteria. In this study, we aimed to assess whether ZnCl₂ coating of intranasal silicone splints (ISSs) can reduce the biofilm infections associated with the insertion of these devices and prevent the overuse of antibiotics while minimizing waste, pollution and costs. We tested the ability of ZnCl₂ to prevent biofilm formation on ISS both in vitro and in vivo by using the microtiter dish biofilm formation assay, crystal violet staining, and electron and confocal microscopy. We found a significant decrease in biofilm formation between the treatment group and the growth control when ZnCl₂-coated splints were placed in patients' nasal flora. According to these results, infections associated with ISS insertion may be prevented by using ZnCl₂ coating, thereby obviating the overuse and abuse of antibiotics.

Host Immune Regulation in Implant-Associated Infection (IAI): What Does the Current Evidence Provide Us to Prevent or Treat IAI?

The number of orthopedic implants for bone fixation and joint arthroplasty has been steadily increasing over the past few years. However, implant-associated infection (IAI), a major complication in orthopedic surgery, impacts the quality of life and causes a substantial economic burden on patients and societies. While research and study on IAI have received increasing attention in recent years, the failure rate of IAI has still not decreased significantly. This is related to microbial biofilms and their inherent antibiotic resistance, as well as the various mechanisms by which bacteria evade host immunity, resulting in difficulties in diagnosing and treating IAIs. Hence, a better understanding of the complex interactions between biofilms, implants, and host immunity is necessary to develop new strategies for preventing and controlling these infections. This review first discusses the challenges in diagnosing and treating IAI, followed by an extensive review of the direct effects of orthopedic implants, host immune function, pathogenic bacteria, and biofilms. Finally, several promising preventive or therapeutic alternatives are presented, with the hope of mitigating or eliminating the threat of antibiotic resistance and refractory biofilms in IAI.

Vapor-Induced Pore-Forming Atmospheric-Plasma-Sprayed Zinc-, Strontium-, and Magnesium-Doped Hydroxyapatite Coatings on Titanium Implants Enhance New Bone Formation-An In Vivo and In Vitro Investigation

OBJECTIVES

Titanium implants are regarded as a promising treatment modality for replacing missing teeth. Osteointegration and antibacterial properties are both desirable characteristics for titanium dental implants. The aim of this study was to create zinc (Zn)-, strontium (Sr)-, and magnesium (Mg)-multidoped hydroxyapatite (HAp) porous coatings, including HAp, Zn-doped HAp, and Zn-Sr-Mg-doped HAp, on titanium discs and implants using the vapor-induced pore-forming atmospheric plasma spraying (VIPF-APS) technique.

METHODS

The mRNA and protein levels of osteogenesis-associated genes such as collagen type I alpha 1 chain (COL1A1), decorin (DCN), osteoprotegerin (TNFRSF11B), and osteopontin (SPP1) were examined in human embryonic palatal mesenchymal cells. The antibacterial effects against periodontal bacteria, including Porphyromonas gingivalis and Prevotella nigrescens, were investigated. In addition, a rat animal model was used to evaluate new bone formation via histologic examination and micro-computed tomography (CT).

RESULTS

The ZnSrMg-HAp group was the most effective at inducing mRNA and protein expression of TNFRSF11B and SPP1 after 7 days of incubation, and TNFRSF11B and DCN after 11 days of incubation. In addition, both the ZnSrMg-HAp and Zn-HAp groups were effective against P. gingivalis and P. nigrescens. Furthermore, according to both in vitro studies and histologic findings, the ZnSrMg-HAp group exhibited the most prominent osteogenesis and concentrated bone growth along implant threads.

SIGNIFICANCE

A porous ZnSrMg-HAp coating using VIPF-APS could serve as a novel technique for coating titanium implant surfaces and preventing further bacterial infection.

Implantable biomedical materials for treatment of bone infection

The treatment of bone infections has always been difficult. The emergence of drug-resistant bacteria has led to a steady decline in the effectiveness of antibiotics. It is also especially important to fight bacterial infections while repairing bone defects and cleaning up dead bacteria to prevent biofilm formation. The development of biomedical materials has provided us with a research direction to address this issue. We aimed to review the current literature, and have summarized multifunctional antimicrobial materials that have long-lasting antimicrobial capabilities that promote angiogenesis, bone production, or "killing and releasing." This review provides a comprehensive summary of the use of biomedical materials in the treatment of bone infections and a reference thereof, as well as encouragement to perform further research in this field.

Current Advances and Applications of Tantalum Element in Infected Bone Defects

Infected bone defects (IBDs) cause significant economic and psychological burdens, posing a huge challenge to clinical orthopedic surgeons. Traditional approaches for managing IBDs possess inevitable shortcomings; therefore, it is necessary to develop new functionalized scaffolds. Tantalum (Ta) has been widely used in load-bearing orthopedic implants due to its good biocompatibility and corrosion resistance. However, undecorated Ta could only structurally repair common bone defects, which failed to meet the clinical needs of bacteriostasis for IBDs. Researchers have made great efforts to functionalize Ta scaffolds to enhance their antibacterial activity through various methods, including surface coating, alloying, and micro- and nanostructure modifications. Additionally, several studies have successfully utilized Ta to modify orthopedic scaffolds for enhanced antibacterial function. These studies remarkably extended the application range of Ta. Therefore, this review systematically outlines the advances in the fundamental and clinical application of Ta in the treatment of IBDs, focusing on the antibacterial properties of Ta, its functionalization for bacteriostasis, and its applications in the modification of orthopedic scaffolds. This study provides researchers with an overview of the application of Ta in the treatment of IBDs.

A review: strategies to reduce infection in tantalum and its derivative applied to implants

Implant-associated infection is the main reasons for implant failure. Titanium and titanium alloy are currently the most widely used implant materials. However, they have limited antibacterial performance. Therefore, enhancing the antibacterial ability of implants by surface modification technology has become a trend of research. Tantalum is a potential implant coating material with good biological properties. With the development of surface modification technology, tantalum coating becomes more functional through improvement. In addition to improving osseointegration, its antibacterial performance has also become the focus of attention. In this review, we provide an overview of the latest strategies to improve tantalum antibacterial properties. We demonstrate the potential of the clinical application of tantalum in reducing implant infections by stressing its advantageous properties.

The progress in titanium alloys used as biomedical implants: From the view of reactive oxygen species

Titanium and Titanium alloys are widely used as biomedical implants in oral and maxillofacial surgery, due to superior mechanical properties and biocompatibility. In specific clinical populations such as the elderly, diabetics and patients with metabolic diseases, the failure rate of medical metal implants is increased significantly, putting them at increased risk of revision surgery. Many studies show that the content of reactive oxygen species (ROS) in the microenvironment of bone tissue surrounding implant materials is increased in patients undergoing revision surgery. In addition, the size and shape of materials, the morphology, wettability, mechanical properties, and other properties play significant roles in the production of ROS. The accumulated ROS break the original balance of oxidation and anti-oxidation, resulting in host oxidative stress. It may accelerate implant degradation mainly by activating inflammatory cells. Peri-implantitis usually leads to a loss of bone mass around the implant, which tends to affect the long-term stability and longevity of implant. Therefore, a great deal of research is urgently needed to focus on developing antibacterial technologies. The addition of active elements to biomedical titanium and titanium alloys greatly reduce the risk of postoperative infection in patients. Besides, innovative technologies are developing new biomaterials surfaces conferring anti-infective properties that rely on the production of ROS. It can be considered that ROS may act as a messenger substance for the communication between the host and the implanted material, which run through the entire wound repair process and play a role that cannot be ignored. It is necessary to understand the interaction between oxidative stress and materials, the effects of oxidative stress products on osseointegration and implant life as well as ROS-induced bactericidal activity. This helps to facilitate the development of a new generation of well-biocompatible implant materials with ROS responsiveness, and ultimately prolong the lifespan of implants.

Complexes of Cu-Polysaccharide of a Marine Red Microalga Produce Spikes with Antimicrobial Activity

Metal-polysaccharides have recently raised significant interest due to their multifunctional bioactivities. The antimicrobial activity of a complex of Cu₂O with the sulfated polysaccharide (PS) of the marine red microalga Porphyridium sp. was previously attributed to spikes formed on the complex surface (roughness). This hypothesis was further examined here using other Cu-PS complexes (i.e., monovalent-Cu₂O, CuCl and divalent-CuO, CuCl₂). The nanostructure parameters of the monovalent complexes, namely, longer spikes (1000 nm) and greater density (2000-5000 spikes/µm²) were found to be related to the superior inhibition of microbial growth and viability and biofilm formation. When Escherichia coli TV1061, used as a bioluminescent test organism, was exposed to the monovalent Cu-PS complexes, enhanced bioluminescence accumulation was observed, probably due to membrane perforation by the spikes on the surface of the complexes and consequent cytoplasmic leakage. In addition, differences were found in the surface chemistry of the monovalent and divalent Cu-PS complexes, with the monovalent Cu-PS complexes exhibiting greater stability (ζ-potential, FTIR spectra, and leaching out), which could be related to spike formation. This study thus supports our hypothesis that the spikes protruding from the monovalent Cu-PS surfaces, as characterized by their aspect ratio, are responsible for the antimicrobial and antibiofilm activities of the complexes.

Antibacterial Ti-Cu implants: A critical review on mechanisms of action

Titanium (Ti) has been widely used for manufacturing of bone implants because of its mechanical properties, biological compatibility, and favorable corrosion resistance in biological environments. However, Ti implants are prone to infection (peri-implantitis) by bacteria which in extreme cases necessitate painful and costly revision surgeries. An emerging, viable solution for this problem is to use copper (Cu) as an antibacterial agent in the alloying system of Ti. The addition of copper provides excellent antibacterial activities, but the underpinning mechanisms are still obscure. This review sheds light on such mechanisms and reviews how incorporation of Cu can render Ti-Cu implants with antibacterial activity. The review first discusses the fundamentals of interactions between bacteria and implanted surfaces followed by an overview of the most common engineering strategies utilized to endow an implant with antibacterial activity. The underlying mechanisms for antibacterial activity of Ti-Cu implants are then discussed in detail. Special attention is paid to contact killing mechanisms because the misinterpretation of this mechanism is the root of discrepancies in the literature.

Strontium-doped apatitic bone cements with tunable antibacterial and antibiofilm ability

Injectable calcium phosphate cements (CPCs) represent promising candidates for the regeneration of complex-shape bone defects, thanks to self-hardening ability, bioactive composition and nanostructure offering high specific surface area for cell attachment and conduction. Such features make CPCs also interesting for functionalization with various biomolecules, towards the generation of multifunctional devices with enhanced therapeutic ability. In particular, strontium-doped CPCs have been studied in the last years due to the intrinsic antiosteoporotic character of strontium. In this work, a SrCPC previously reported as osteointegrative and capable to modulate the fate of bone cells was enriched with hydroxyapatite nanoparticles (HA-NPs) functionalized with tetracycline (TC) to provide antibacterial activity. We found that HA-NPs functionalized with TC (NP-TC) can act as modulator of the drug release profile when embedded in SrCPCs, thus providing a sustained and tunable TC release. In vitro microbiological tests on Escherichia coli and Staphylococcus aureus strains proved effective bacteriostatic and bactericidal properties, especially for the NP-TC loaded SrCPC formulations. Overall, our results indicate that the addition of NP-TC on CPC acted as effective modulator towards a tunable drug release control in the treatment of bone infections or cancers.

Gallium containing bioactive materials: A review of anticancer, antibacterial, and osteogenic properties

The incorporation of gallium into bioactive materials has been reported to enhance osteogenesis, to influence blood clotting, and to induce anti-cancer and anti-bacterial activity. Gallium-doped biomaterials prepared by various techniques include melt-derived and sol-gel-derived bioactive glasses, calcium phosphate bioceramics, metals and coatings. In this review, we summarize the recently reported developments in antibacterial, anticancer, osteogenesis, and hemostasis properties of Ga-doped biomaterials and briefly outline the mechanisms leading to Ga biological effects. The key finding is that gallium addition to biomaterials has great potential for treating bone-related diseases since it can be efficiently transferred to the desired region at a controllable rate. Besides, it can be used as a potential substitute for antibiotics for the inhibition of infections during the initial and advanced phases of the wound healing process. Ga is also used as an anticancer agent due to the increased concentration of gallium around excessive cell proliferation (tumor) sites. Moreover, we highlight the possibility to design different therapeutic approaches aimed at increasing the efficiency of the use of gallium containing bioactive materials for multifunctional applications.

Treatment methods toward improving the anti-infection ability of poly(etheretherketone) implants for medical applications

Due to its favorable chemical stability, biocompatibility, and mechanical properties, Poly(etheretherketone) (PEEK) is a promising material for repairing bone and dental hard tissue defects. However, there are critical disadvantages: PEEK is biologically and chemically inert, which influences osseointegration of implants and bonding strength of prostheses, and its mechanical properties still cannot meet the requirements for some medical applications. Furthermore, bacterial infections and inflammatory reactions often accompany bone defects caused by trauma or inflammation or teeth loss caused by periodontitis. Previous studies mainly focused on enhancing PEEK's bioactivity and mechanical performance, but PEEK also lacks effective anti-infection ability. Thus, it is necessary to improve its anti-infection ability, and this is considered in this paper from two aspects. The first is to inhibit the attachment and growth of bacteria on the material, and the second is to endow the material with immunoregulatory ability, which means mobilizing the host immune system to protect tissue from inflammation. In this review, we analyze and discuss the existing treatment methods to improve the antibacterial and immunomodulatory abilities of PEEK addressing their limitations, relevant future challenges, and required research efforts.

Mg-, Zn-, and Fe-Based Alloys With Antibacterial Properties as Orthopedic Implant Materials

Implant-associated infection (IAI) is one of the major challenges in orthopedic surgery. The development of implants with inherent antibacterial properties is an effective strategy to resolve this issue. In recent years, biodegradable alloy materials have received considerable attention because of their superior comprehensive performance in the field of orthopedic implants. Studies on biodegradable alloy orthopedic implants with antibacterial properties have gradually increased. This review summarizes the recent advances in biodegradable magnesium- (Mg-), iron- (Fe-), and zinc- (Zn-) based alloys with antibacterial properties as orthopedic implant materials. The antibacterial mechanisms of these alloy materials are also outlined, thus providing more basis and insights on the design and application of biodegradable alloys with antibacterial properties as orthopedic implants.

Approaches to Biofunctionalize Polyetheretherketone for Antibacterial: A Review

Due to excellent mechanical properties and similar elastic modulus compared with human cortical bone, polyetheretherketone (PEEK) has become one of the most promising orthopedic implant materials. However, implant-associated infections (IAIs) remain a challenging issue since PEEK is bio-inert. In order to fabricate an antibacterial bio-functional surface, modifications of PEEK had been widely investigated. This review summarizes the modification strategies to biofunctionalize PEEK for antibacterial. We will begin with reviewing different approaches, such as surface-coating modifications and controlled release of antimicrobials. Furthermore, blending modifications and 3D printing technology were discussed. Finally, we compare the effects among different approaches. We aimed to provide an in-depth understanding of the antibacterial modification and optimize the design of the PEEK orthopedic implant.

Application of Nanomaterials in the Prevention, Detection, and Treatment of Methicillin-Resistant Staphylococcus aureus (MRSA)

Due to differences in geographic surveillance systems, chemical sanitization practices, and antibiotic stewardship (AS) implementation employed during the COVID-19 pandemic, many experts have expressed concerns regarding a future surge in global antimicrobial resistance (AMR). A potential beneficiary of these differences is the Gram-positive bacteria MRSA. MRSA is a bacterial pathogen with a high potential for mutational resistance, allowing it to engage various AMR mechanisms circumventing conventional antibiotic therapies and the host’s immune response. Coupled with a lack of novel FDA-approved antibiotics reaching the clinic, the onus is on researchers to develop alternative treatment tools to mitigate against an increase in pathogenic resistance. Mitigation strategies can take the form of synthetic or biomimetic nanomaterials/vesicles employed in vaccines, rapid diagnostics, antibiotic delivery, and nanotherapeutics. This review seeks to discuss the current potential of the aforementioned nanomaterials in detecting and treating MRSA.

Microstructural, Mechanical and Corrosion Characteristics of Degradable PM Biomaterials Made from Copper-Coated Iron Powders

Copper-containing iron-based materials have recently been recognized as potential biomaterials possessing antimicrobial ability. Since then, iron-copper systems have been prepared by different methods and investigated. This article is focused on PM materials made from composite powders. The powders, each particle of which consisted of an iron core and a copper shell, were prepared by electroplating. Test-pieces with copper contents of 0, 3.2, and 8 wt.% were fabricated by pressing and sintering from iron and composite powders. Some microstructural, mechanical, and corrosion characteristics of test-pieces were examined. Microstructures were composed of pores and iron grains with alloyed peripheral regions and copper-free cores. As the copper content in test-pieces was increased, their density and Young’s modulus decreased, and macrohardness, corrosion potential and corrosion current density increased. Likely causes of density and Young’s modulus reduction were higher porosity, low enough copper content, and compliant inclusions in stiff matrix. The increase in macrohardness was attributed to the precipitation hardening which prevailed over softening induced by pores. The increase in corrosion potential and corrosion current density was most likely due to the presence of more noble phase providing surfaces for a faster cathodic reaction.