Toxicity of polyhexanide and hydrogen peroxide on human chondrocytes in vitro

Antiseptic Irrigation Solutions Used in Total Joint Arthroplasty: A Critical Analysis Review

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There are limited data that directly compare the efficacy of antiseptic irrigation solutions used for the prevention and treatment of periprosthetic joint infections in orthopaedic procedures; there is a notable lack of prospective data.

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For prevention of periprosthetic joint infections, the strongest evidence supports the use of low-pressure povidone-iodine.

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For the treatment of periprosthetic joint infections, delivering multiple solutions sequentially may be beneficial.

Engineering osteoarthritic cartilage model through differentiating senescent human mesenchymal stem cells for testing disease-modifying drugs

Significant cellular senescence has been observed in cartilage harvested from patients with osteoarthritis (OA). In this study, we aim to develop a senescence-relevant OA-like cartilage model for developing disease-modifying OA drugs (DMOADs). Specifically, human bone marrow-derived mesenchymal stromal cells (MSCs) were expanded in vitro up to passage 10 (P10-MSCs). Following their senescent phenotype formation, P10-MSCs were subjected to pellet culture in chondrogenic medium. Results from qRT-PCR, histology, and immunostaining indicated that cartilage generated from P10-MSCs displayed both senescent and OA-like phenotypes without using other OA-inducing agents, when compared to that from normal passage 4 (P4)-MSCs. Interestingly, the same gene expression differences observed between P4-MSCs and P10-MSC-derived cartilage tissues were also observed between the preserved and damaged OA cartilage regions taken from human samples, as demonstrated by RNA Sequencing data and other analysis methods. Lastly, the utility of this senescence-initiated OA-like cartilage model in drug development was assessed by testing several potential DMOADs and senolytics. The results suggest that pre-existing cellular senescence can induce the generation of OA-like changes in cartilage. The P4- and P10-MSCs derived cartilage models also represent a novel platform for predicting the efficacy and toxicity of potential DMOADs on both preserved and damaged cartilage in humans.

Role of hydrogen peroxide in intra-operative wound preparation based on an in vitro fibrin clot degradation model

Three per cent hydrogen peroxide (H₂O₂) is widely used to irrigate acute and chronic wounds in the surgical setting and clinical experience tells us that it is more effective at removing dried-on blood than normal saline alone. We hypothesise that this is due to the effect of H₂O₂ on fibrin clot architecture via fibrinolysis. We investigate the mechanisms and discuss the clinical implications using an in vitro model. Coagulation assays with normal saline (NaCl), 1% and 3% concentrations of H₂O₂ were performed to determine the effect on fibrin clot formation. These effects were confirmed by spectrophotometry. The effects of 1%, 3% and 10% H₂O₂ on the macroscopic and microscopic features of fibrin clots were assessed at set time intervals and compared to a NaCl control. Quantitative analysis of fibrin networks was undertaken to determine the fibre length, diameter, branch point density and pore size. Fibrin clots immersed in 1%, 3% and 10% H₂O₂ demonstrated volume losses of 0.09-0.25mm³/min, whereas those immersed in the normal saline gained in volume by 0.02±0.13 mm³/min. Quantitative analysis showed that H₂O₂ affects the structure of the fibrin clot in a concentration-dependent manner, with the increase in fibre length, diameter and consequently pore sizes. Our results support our hypothesis that the efficacy of H₂O₂ in cleaning blood from wounds is enhanced by its effects on fibrin clot architecture in a concentration- and time-dependent manner. The observed changes in fibre size and branch point density suggest that H₂O₂ is acting on the quaternary structure of the fibrin clot, most likely via its effect on cross-linking of the fibrin monomers and may therefore be of benefit for the removal of other fibrin-dependent structures such as wound slough.

The Evidence Behind Peroxide in Orthopedic Surgery

Peroxide is a strong oxidizing agent and disinfectant frequently used in orthopedic surgery. The authors conducted a systematic literature review of peroxide in orthopedic surgery, evaluating use, complications, efficacy, and appropriate concentrations. One hundred seventy-five reports were identified, with 24 being eligible for analysis. Orthopedic surgeons used peroxide for irrigation and bacterial reduction in various procedures. Complications included cytotoxicity, allergic reactions, suture damage, and inflammation. Use of the standard concentration of 3% peroxide and standard time in situ are without evidence. Laboratory studies suggest that diluted concentrations retain the benefit of bacterial decolonization without increasing the risk for complications. [Orthopedics. 2018; 41(6):e756-e764.].

Cytocompatibility testing of cyclodextrin-functionalized antimicrobial textiles-a comprehensive approach

Functionalized textiles can be used in wound management to reduce the microbial burden in the wound area, to prevent wound infections, and to avoid cross-contamination between patients. In the present study, a comprehensive in vitro approach to enable the assessment of antibacterial activity of functionalized textiles and cytotoxicity of cyclodextrin (CD)-complexes with chlorhexidine diacetate (CHX), iodine (IOD), and polihexanide (PHMB) is suggested to evaluate their properties for supporting optimal conditions for wound healing. For all β-CD-antiseptic functionalized cotton samples a strong antibacterial effect on the Gram-positive bacteria Staphylococcus aureus and Staphylococcus epidermidis as well as on the Gram-negative bacteria Klebsiella pneumoniae and Escherichia coli was proven. In addition, β-CD-CHX and β-CD-PHMB were effective against the yeast Candida albicans. The growth of Pseudomonas aeruginosa could be reduced significantly by β-CD-IOD and β-CD-PHMB. The established comprehensive testing system for determination of biocompatibility on human HaCaT keratinocytes is suitable for obtaining robust data on cell viability, cytotoxicity and mode of cell death of the β-CD-antiseptic-complexes. The promising results of the high antimicrobial activity of these functionalized textiles show the high potential of such materials in medical applications.

Study of epigenetic properties of Poly(HexaMethylene Biguanide) hydrochloride (PHMB)

Poly(HexaMethylene Biguanide) hydrochloride (PHMB) CAS No. [32289-58-0] is a particularly effective member of the biguanides antiseptic chemical group, and has been in use since the early fifties in numerous applications. It has been proposed that PHMB be classified as a category 3 carcinogen although PHMB is not genotoxic. It has been hypothesized that PHMB may have epigenetic properties effects, including non-genotoxic modifications of DNA bases, DNA methylation and mitogenic cytokine production. These properties have been assessed in vitro using 3 cell types: Caco-2 cells (from a human colon adenocarcinoma) with a non-functional p53 gene. (∆p53: mut p53), N2-A (Neuro-2A cells, mouse neural cells), the brain being a possible target organ in rodents and HepG2 cells (human hepatocellular carcinoma) with functional p53 gene. From the concentration 1 μg/mL up to 20 μg/mL of PHMB, no effect was observed, either growth stimulation or inhibition. Viability testing using neutral red led to an IC 50 of 20–25 μg/mL after treatment with PHMB for 3 h, whereas the MTT test led to IC50 values of 80 μg/mL, 160 μg/mL and 160 μg/mL respectively for HepG2 cells, Neuro-2A cells and Caco-2 cells. PHMB does not induce significant oxidative stress (production of MDA or lipoperoxidation, nor does it induce hydroxylation of DNA (8-OH-dG) and/or its hypermethylation (m5dC), the latter being strongly implicated in DNA replication and regulation and cell division. PHMB does not induce significant production of mitogenic cytokines such as TNF-α (tumor necrosis factor), interleukins (IL-1 alpha), and the transcription factor nuclear factor kappa B (NF-κB) which can cause either apoptosis or stimulate the growth of transformed cells or tumors. Instead, from concentrations of 20 to 100 μg/mL, PHMB kills cells of all types in less than 3 h. The expression of genes involved in the mechanisms of cell death induced by PHMB, including p53, the pro apoptotic gene bax and others, the anti-apoptotic bcl-2 and caspase-3 has been evaluated by RT-PCR. Finally, the status of GAP-junctions (GJIC) in the presence of PHMB has been determined and appeared to not be significantly affected. Taken together the data show that in vitro PHMB does not exhibit clear and remarkable epigenetic properties except a slight increase of some cytokines and transcription factor at higher concentrations at which cell lysis occurs rapidly.

Preferred use of polyhexanide in orthopedic surgery

In orthopedic and trauma surgery, the most frequently used antiseptic is polyhexanide. Its favored application is based on prepossessing tissue compatibility in contrast to various antiseptics and a high antimicrobiological effect. Recent studies showed toxic effects of this antiseptic on human chondrocytes. The aim of this study was to further analyze the toxic and apoptotic effects of polyhexanide on primary human chondrocytes. The hypothesis of this study was that polyhexanide induces apoptosis on human chondrocytes. Primary human chondrocytes were isolated and cultured from human donors with osteoarthritis of the knee who underwent total arthroplasty and had no indication of infection. Polyhexanide at a standard concentration of 0.04% was added to the monolayer cultures. Early and late apoptotic cells were analyzed by flow cytometric detection of annexin V, active caspases, and 7AAD, and by fluorescence microscopy using annexin V and propidium iodide staining. Flow cytometric analysis demonstrated an increase of annexin V and active caspases expression of human chondrocytes after incubation with polyhexanide. Fluorescence microscopy demonstrated a high number of annexin V positive and propidium iodide negative early apoptotic cells. The data show that polyhexanide promotes apoptosis on primary human chondrocytes in vitro, which may indicate the use of polyhexanide in septic joint surgery.