On the function of biosynthesized cellulose as barrier against bacterial colonization of VAD drivelines

Abstract

Bacterial colonization of drivelines represents a major adverse event in the implantation of left ventricular assist devices (L-VADs) for the treatment of congestive heart failure. From the external driveline interface and through the skin breach, pathogens can ascend to the pump pocket, endangering the device function and the patient’s life. Surface Micro-Engineered Biosynthesized cellulose (BC) is an implantable biomaterial, which minimizes fibrotic tissue deposition and promotes healthy tissue regeneration. The topographic arrangement of cellulose fibers and the typical material porosity support its potential protective function against bacterial permeation; however, this application has not been tested in clinically relevant animal models. Here, a goat model was adopted to evaluate the barrier function of BC membranes. The external silicone mantle of commercial L-VAD drivelines was implanted percutaneously with an intervening layer of BC to separate them from the surrounding soft tissue. End-point evaluation at 6 and 12 weeks of two separate animal groups revealed the local bacterial colonization at the different interfaces in comparison with unprotected driveline mantle controls. The results demonstrate that the BC membranes established an effective barrier against the bacterial colonization of the outer driveline interface. The containment of pathogen infiltration, in combination with the known anti-fibrotic effect of BC, may promote a more efficient immune clearance upon driveline implantation and support the efficacy of local antibiotic treatments, therefore mitigating the risk connected to their percutaneous deployment.

LVAD as a Bridge to Transplantation—Current Status and Future Perspectives

“…In a small study, merbromin used for local irrigation showed a significant reduction in the development of infection, with all 31 patients treated being free of infection after LVAD implantation [ 81 ]. Other approaches, such as wrapping the silicone driveline with biosynthesized cellulose, have shown a reduction in local bacterial colonization, which, together with the known anti-fibrotic effect of biosynthesized cellulose, may promote more efficient immune clearance after driveline implantation and support the efficacy of local antibiotic treatments [ 82 ].…”

Bacterial Cellulose as Drug Delivery System for Optimizing Release of Immune Checkpoint Blocking Antibodies

“…As a gel-like product, for instance, it soothes the skin and does not engraft with the skin. A recent study just reported the promising results of BC as a biomaterial implant, in which BC was tested as a cardiac implant to mimic the function as a left ventricular assist device for the treatment of congestive heart failure [ 16 ]. Recent drug delivery research has further demonstrated various other advantages of BC, including its promising effects on controlling drug release, biocompatibility, low immunogenicity and ease of production/handling.…”