Preclinical Bioassay of a Polypropylene Mesh for Hernia Repair Pretreated with Antibacterial Solutions of Chlorhexidine and Allicin: An In Vivo Study

Pérez-Köhler, Bárbara; García-Moreno, Francisca; Brune, T.; Pascual, Gemma; Bellón, Juan M.

doi:10.1371/journal.pone.0142768

Cited by 37 publications

(28 citation statements)

References 47 publications

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“…Furthermore, autografts often cause potential morbidity at the donor site. Synthetic materials, such as polyethylene (PE), polytetrafluoroethylene (PTFE), and polypropylene (PP), are the most commonly used clinical hernia meshes. The main advantages of these materials are that their strength degrades very slowly in vivo, and they are more economically efficient.…”

Section: Introductionmentioning

confidence: 99%

Anti‐Adhesion Mesh for Hernia Repair Based on Modified Bacterial Cellulose

Lai

Wang

et al. 2018

Starch Stärke

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Polypropylene (PP) is the most widely used biomaterial for hernia repair despite its many problems related to over fibrosis. The current study is designed to evaluate and directly compare the biomechanics and antiadhesion properties of the novel, TEMPO(2,2,6,6-tetramethylpyperidine-1oxyl)-mediated modified bacterial cellulose (TBC) mesh and the clinically used PP meshes. Laser perforation generates isotropic, flat and stable structures that prevent deformation under pressure and reduce the risk of potential bacterial colonization. In contrast to the PP mesh, the results of the in vitro study, which involve protein adsorption and cell-material interaction, suggest that TBC preferentially adsorbs bovine serum albumin (BSA) and enhances the expression of type I collagen in fibroblasts. TBC mesh cause less inflammation and is surrounded by newly formed connective tissue composed of type I collagen after implantation in a rabbit model for 1 week, demonstrating that the novel mesh is fully biocompatible and can integrate into surrounding tissues. From this study, TBC mesh may prove to be a viable clinical alternative to existing materials.

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Section: Introductionmentioning

confidence: 99%

Anti‐Adhesion Mesh for Hernia Repair Based on Modified Bacterial Cellulose

Lai

Wang

et al. 2018

Starch Stärke

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“…To address these concerns, engineers have developed a variety of localized delivery approaches ranging from antibiotic-filled bone cement [19] to soft tissue meshes coated with chlorhexidine and silver [20]; however, all patients receiving these antimicrobial devices still receive antimicrobials independent of whether they develop an infection.…”

Section: Introductionmentioning

confidence: 99%

Affinity interactions drive post-implantation drug filling, even in the presence of bacterial biofilm

Cyphert

Zuckerman²,

Korley³

et al. 2017

Acta Biomaterialia

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Current post-operative standard of care for surgical procedures, including device implantations, dictates prophylactic antimicrobial therapy, but a percentage of patients still develop infections. Systemic antimicrobial therapy needed to treat such infections can lead to downstream tissue toxicities and generate drug-resistant bacteria. To overcome issues associated with systemic drug administration, a polymer incorporating specific drug affinity has been developed with the potential to be filled or refilled with antimicrobials, post-implantation, even in the presence of bacterial biofilm. This polymer can be used as an implant coating or stand-alone drug delivery device, and can be translated to a variety of applications, such as implanted or indwelling medical devices, and/or surgical site infections. The filling of empty affinity-based drug delivery polymer was analyzed in an in vitro filling/refilling model mimicking post-implantation tissue conditions. Filling in the absence of bacteria was compared to filling in the presence of bacterial biofilms of varying maturity to demonstrate proof-of-concept necessary prior to in vivo experiments. Antibiotic filling into biofilm-coated affinity polymers was comparable to drug filling seen in same affinity polymers without biofilm demonstrating that affinity polymers retain ability to fill with antibiotic even in the presence of biofilm. Additionally, post-implantation filled antibiotics showed sustained bactericidal activity in a zone of inhibition assay demonstrating post-implantation capacity to deliver filled antibiotics in a timeframe necessary to eradicate bacteria in biofilms. This work shows affinity polymers can fill high levels of antibiotics post-implantation independent of biofilm presence potentially enabling device rescue, rather than removal, in case of infection.

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“…One of the most frequently used antiseptics is chlorhexidine, with a broad spectrum of activity against Gram-positive and Gram-negative bacteria and yeasts, and with acceptable tolerability and a good safety record (McDonnell and Russell, 1999). Chlorhexidine has been approved by the American Food and Drug Administration (FDA) for application to intracorporally used medical devices, such as surgical meshes (Choe et al, 2000;Pérez-Köhler et al, 2015) and intravenous catheters (Maki, 1997) and has a history of successful clinical (Karpanen et al, 2016) and experimental use in preventing biomaterial-associated and other infections (Darouiche et al, 2008;Sjollema et al, 2014). Chlorhexidine combined with chloroxylenol in a dip-coating on rabbit tibia intramedullary nails prevented experimental S. aureus osteomyelitis (Darouiche et al, 1998a;Darouiche et al, 1998b).…”

Section: Discussionmentioning

confidence: 99%

A chlorhexidine-releasing epoxy-based coating on titanium implants prevents Staphylococcus aureus experimental biomaterial-associated infection

Riool,

Dirks,

Jaspers

et al. 2107

eCM

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Prevention of biomaterial-associated infections (BAI) remains a challenging problem, in particular due to the increased risk of resistance development with the current antibiotic-based strategies. Metallic orthopaedic devices, such as non-cemented implants, are often inserted under high mechanical stress. These non-cemented implants cannot be protected by e.g. antibiotic-releasing bone cement or other antimicrobial approaches, such as the use of bioactive glass. Therefore, in order to avoid abrasion during implantation procedures, we developed an antimicrobial coating with great mechanical stability for orthopaedic implants, to prevent Staphylococcus aureus BAI. We incorporated 5 and 10 wt % chlorhexidine in a novel mechanically stable epoxy-based coating, designated CHX 5 and CHX 10 , respectively. The coatings displayed potent bactericidal activity in vitro against S. aureus, with over 80 % of the release (19 µg/cm 2 for CHX 5 and 41 µg/ cm 2 for CHX 10 ) occurring within the first 24 h. In mice, the CHX 10 coating significantly reduced the number of CFU (colony forming units), both on the implants and in the peri-implant tissues, 1 d after S. aureus challenge. The CHX 10 -coated implants were well-tolerated by the animals, with no signs of toxicity observed by histological analysis. Moreover, the coating significantly reduced the frequency of culture-positive tissues 1 d, and of culturepositive implants 1 and 4 d after challenge. In summary, the chlorhexidine-releasing mechanically stable epoxybased CHX 10 coating prevented implant colonisation and S. aureus BAI in mice and has good prospects for clinical development.

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Preclinical Bioassay of a Polypropylene Mesh for Hernia Repair Pretreated with Antibacterial Solutions of Chlorhexidine and Allicin: An In Vivo Study

Cited by 37 publications

References 47 publications

Anti‐Adhesion Mesh for Hernia Repair Based on Modified Bacterial Cellulose

Anti‐Adhesion Mesh for Hernia Repair Based on Modified Bacterial Cellulose

Affinity interactions drive post-implantation drug filling, even in the presence of bacterial biofilm

A chlorhexidine-releasing epoxy-based coating on titanium implants prevents Staphylococcus aureus experimental biomaterial-associated infection

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