RESUMO
Osteomyelitis (OM) is a progressive, inflammatory infection of bone caused predominately by Staphylococcus aureus. Herein, we engineered an antibiotic-eluting collagen-hydroxyapatite scaffold capable of eliminating infection and facilitating bone healing. An iterative freeze-drying and chemical crosslinking approach was leveraged to modify antibiotic release kinetics, resulting in a layered dual-release system whereby an initial rapid release of antibiotic to clear infection was followed by a sustained controlled release to prevent reoccurrence of infection. We observed that the presence of microbial collagenase accelerated antibiotic release from the crosslinked layer of the scaffold, indicating that the material is responsive to microbial activity. As exemplar drugs, vancomycin and gentamicin-eluting scaffolds were demonstrated to be bactericidal, and supported osteogenesis in vitro. In a pilot murine model of OM, vancomycin-eluting scaffolds were observed to reduce S. aureus infection within the tibia. Finally, in a rabbit model of chronic OM, gentamicin-eluting scaffolds both facilitated radial bone defect healing and eliminated S. aureus infection. These results show that antibiotic-eluting collagen-hydroxyapatite scaffolds are a one-stage therapy for OM, which when implanted into infected bone defects simultaneously eradicate infection and facilitate bone tissue healing.
Assuntos
Antibacterianos , Gentamicinas , Osteomielite , Infecções Estafilocócicas , Staphylococcus aureus , Alicerces Teciduais , Animais , Alicerces Teciduais/química , Antibacterianos/farmacologia , Antibacterianos/química , Infecções Estafilocócicas/tratamento farmacológico , Osteomielite/tratamento farmacológico , Coelhos , Staphylococcus aureus/efeitos dos fármacos , Gentamicinas/farmacologia , Gentamicinas/administração & dosagem , Gentamicinas/química , Gentamicinas/uso terapêutico , Camundongos , Vancomicina/farmacologia , Vancomicina/química , Vancomicina/administração & dosagem , Durapatita/química , Cinética , Cicatrização/efeitos dos fármacos , Osteogênese/efeitos dos fármacos , Colágeno/química , FemininoRESUMO
Giant aneurysms have been treated with endovascular approaches like general, balloon-assisted and stent-assisted coiling, and flow diverter stent-assisted techniques. Few cases have been reported to be treated with both normal and large coils. Despite the mass effect, an adequate revascularization has been reported. An initial use of these coils is being reported in the current study. This is a case which has been successfully treated using a stent-assisted coiling with both small and large coils i.e., Penumbra Coil 400 (Penumbra, Inc., Alameda, California).