Nitric Oxide Releasing Titanium Surfaces for Antimicrobial Bone-Integrating Orthopedic Implants

Abstract

Titanium implants in orthopedic applications can fail due to infection and impaired integration into the host. Most research efforts that facilitate osseointegration of the implant have not considered infection, and vice versa. Moreover, most infection control measures involve the use of conventional antibiotics which contributes to the global epidemic of antimicrobial resistance. Nitric oxide (NO) is a promising alternative to antibiotics, and while researchers have investigated NO releasing coatings, there are few reports on the function/robustness or the mechanism of NO release. Our comprehensive mechanistic study has allowed us to design, characterize, and optimize NO releasing coatings to achieve maximum antimicrobial efficacy toward bacteria with minimum cytotoxicity to human primary osteoblasts in vitro. As the antibiotic era is coming to an end and the future of infection control continues to demand new alternatives, the coatings described herein represent a promising therapeutic strategy for use in orthopedic surgeries.

Dairy-Inspired Coatings for Bone Implants from Whey Protein Isolate-Derived Self-Assembled Fibrils

“…Substrates were rinsed with Milli-Q to remove non-adhered fibrils, air-dried and autoclaved (121 • C, 15 min). SEM, CA measurements and fibrillar yield quantification were performed as described previously [5,7,31,32].…”

Impact of Healthcare-Associated Infections Connected to Medical Devices—An Update

“…Another important strategy is surface modification using anti-adhesive polymer, nanopatterned surface, hydrogels, biosurfactants, silver ions, and antimicrobial peptides either for the prevention of microbial attachment or the eradication of attached microorganisms [146]. Li et al (2020) designed alternative strategies to avoid the infection and rejection of titanium implants. They developed titanium implants modified with nitric oxide, and the material demonstrated antimicrobial effectivity by reducing the infection rate of S. aureus and P. aeruginosa [147].…”

“…Li et al (2020) designed alternative strategies to avoid the infection and rejection of titanium implants. They developed titanium implants modified with nitric oxide, and the material demonstrated antimicrobial effectivity by reducing the infection rate of S. aureus and P. aeruginosa [147].…”

Recent Developments in Nitric Oxide Donors and Delivery for Antimicrobial and Anti-Biofilm Applications

“…The xerogels display high material stability with no change in surface properties after high pressure NO treatment [174]. NO flux from xerogels is easily tunable via the use of different ratios of different silane monomers or application of a topcoat [141,150]. In general, a higher reduction in bacterial and fungal adhesion is observed with xerogels with higher NO flux [141,142,175].…”