Urinary tract infections and urinary
encrustation impede the long-term
clinical performance of urological implants and medical devices. Together,
biofilm formation and encrustation constitute serious complications,
driving the development of next-generation urological biomaterials.
The currently available bioengineered solutions have limited success
during long-term usage in the urinary environment. In addressing this
unmet clinical challenge, contact-active, antiencrustation surface
grafting were conceived onto a dynamically cross-linked polydimethylsiloxane
(PDMS) modified thermoplastic polyurethane (TPU) blend using the layer-by-layer
(LbL) assembly route. To the best of the authors’ knowledge,
the present study is the first to investigate the LbL grafting in
developing an antiencrustation platform. These multilayered assemblies
strategically employed covalent cross-linking and electrostatic interaction-assisted
progressive depositions of branched polyethyleneimine and poly(2-ethyl-2-oxazoline).
While polyethyleneimine conferred the contact-killing bactericidal
activity, the much-coveted antiencrustation properties were rendered
by incorporating a partially hydrolyzed derivative of poly(2-ethyl-2-oxazoline).
The performance of the resultant surface-modified TPU/PDMS blends
was benchmarked against the conventional urological alloplasts, in
a customized lab-scale bioreactor-based dynamic encrustation study
and in human urine. After 6 weeks of exposure to an artificial urine
medium, simulating urease-positive bacterial infection, the surface-modified
blends exhibited a remarkable ability to suppress Ca and Mg encrustation.
In addition, these blends also displayed superior grafting stability
and antibacterial efficacy against common uropathogens. As high as
4-fold log reduction in the planktonic growth of Gram-negative P. mirabilis and Gram-positive MRSA was recorded with the LbL platform vis-à-vis medical-grade
TPU. In conjunction, the in vitro cellular assessment
with human keratinocytes (HaCaT) and human embryonic kidney cells
(HEK) established the uncompromised cytocompatibility of the multilayered
grafted blends. Finally, the physiologically relevant functionality
of the LbL grafting has been validated using clinical samples of human
urine collected from 129 patients with a broad spectrum of disease
conditions. The phase-I pre-clinical study, entailing 6 week-long
incubation in human urine, demonstrated significantly improved encrustation
resistance of the blends. The collective findings of the present work
clearly establish the success of LbL strategies in the development
of stable, multifunctional new-generation urological biomaterials.