Developing bone cement implants impregnated with bacteriocins for prevention of infections

[摘要] ENGLISH ABSTRACT: Infection is one of the major causes of increased morbidity and the escalating costs associated with orthopedic surgery. The areas that are infected are often difficult to reach and thus difficult to treat. In some surgeries antibiotic-loaded bone cements are used to control infection. Polymethylmethacrylate (PMMA) and calcium phosphate-based bone cements (CPC) are usually used as bone fillers. CPC are bioresorbable and biocompatible (unlike PMMA cements), but can only be used in non- or low-load bearing areas and are thus more applicable in cranio-and maxilla-facial surgeries. Several in vitro and in vivo trials have been conducted on the incorporation of antibiotics and other therapeutic agents into CPC and the release of these agents. As with any solid matrix, release is defined by specific parameters, i.e. matrix porosity, solubility of the drug and interaction of the drug with the cement.The increase in antibiotic-resistant pathogens, mainly as a result of overuse of antibiotics, has a major impact on the choice of antibiotics that are used in the treatment of bacterial infections. The search for alternative antimicrobial compounds that are active against resistant pathogens, is thus of utmost importance.Antimicrobial peptides (bacteriocins) produced by lactic acid bacteria may pose a possible alternative to antibiotics. Some of these peptides are active against antibiotic-resistant pathogens. Bacteriocins are small cationic, hydrophobic, or amphiphilic peptides active against a narrow range of target organisms. Most of these peptides are active in the nanomolar range. It may then be advantageous to incorporate bacteriocins into CPC to evaluate if they may be used as an alternative to antibiotics.The aim of the project was to evaluate if bacteriocins could be successfully incorporated into self seting brushite bone cement and remain effective in vivo without altering basic cement characteristics. Incorporation of bacteriocins into CPC is a novel concept. The low setting temperature and pH of CPC renders it the ideal matrix for incorporation of antimicrobial peptides. In this study, peptide ST4SA, a class IIa broad-spectrum bacteriocin, has been incorporated into brushite bone cement and characterized in vitro. Incorporation of the peptide did not have a significant effect on the crystal entanglement or setting reaction of the cement. Peptide ST4SA was rapidly released and inhibited the growth of the target strain effectively. In another experiment, peptide ST4SA was suspended in poly (lactide-co-glycolide) and electrosprayed to form micro particles that were entrapped in brushite cement. Association of the peptide with microparticles resulted in a delayed release from the cement, followed by a constant release.Nisin F, a class Ia bacteriocin was also incorporated into brushite cement and its activity studied in vitro and in vivo. Similar results were observed in vitro as recorded with peptide ST4SA incorporated into brushite cement. Small cylinders of brushite cement loaded with nisin F were implanted into subcutaneous pockets in mice and each pocket infected with a bioluminescent strain of Staphylococcus aureus (Xen 36). Nisin F in the bone cement prevented the growth of S. aureus in the wound and controlled infection.With this study we have shown that antimicrobial peptides that differ in structure (classes I and II) could be incorporated into bone cement and control the growth of S. aureus in vivo and in vitro. The mode of action of these peptides differs from antibiotics in that they form a permanent pore in the cell membrane of the target organism. This minimizes the chance of a strain becoming resistant to the peptide. Incorporation of antimicrobial peptides into bone cement may be a possible alternative to antibiotics in the control of bacterial infections associated with implants.

[发布机构] Stellenbosch University