Graphene-modified CePO4 nanorods effectively treat breast cancer-induced bone metastases and regulate macrophage polarization to improve osteo-inductive ability.

BACKGROUND: Breast cancer bone metastasis has become one of the most common complications; however, it may cause cancer recurrence and bone nonunion, as well as local bone defects. METHODS: Herein, In vitro, we verified the effect of bioscaffold materials on cell proliferation and apoptosis through a CCK8 trial, staining of live/dead cells, and flow cytometry. We used immunofluorescence technology and flow cytometry to verify whether bioscaffold materials regulate macrophage polarization, and we used ALP staining, alizarin red staining and PCR to verify whether bioscaffold material promotes bone regeneration. In vivo, we once again studied the effect of bioscaffold materials on tumors by measuring tumor volume in mice, Tunel staining, and caspase-3 immunofluorescence. We also constructed a mouse skull ultimate defect model to verify the effect on bone regeneration. RESULTS: Graphene oxide (GO) nanoparticles, hydrated CePO4 nanorods and bioactive chitosan (CS) are combined to form a bioactive multifunctional CePO4/CS/GO scaffold, with characteristics such as photothermal therapy to kill tumors, macrophage polarization to promote blood vessel formation, and induction of bone formation. CePO4/CS/GO scaffold activates the caspase-3 proteasein local tumor cells, thereby lysing the DNA between nucleosomes and causing apoptosis. On the one hand, the as-released Ce3+ ions promote M2 polarization of macrophages, which secretes vascular endothelial growth factor (VEGF) and Arginase-1 (Arg-1), which promotes angiogenesis. On the other hand, the as-released Ce3+ ions also activated the BMP-2/Smad signaling pathway which facilitated bone tissue regeneration. CONCLUSION: The multifunctional CePO4/CS/GO scaffolds may become a promising platform for therapy of breast cancer bone metastases.

Fabrication, characterization, and biocompatibility of ethyl cellulose/carbonated hydroxyapatite composite coatings on Ti6Al4V.

In order to improve the biocompatibility of metallic implants, bioactive components are often used as coatings so that a real bond with the surrounding bone tissue can be formed. We prepared ethyl cellulose/carbonated hydroxyapatite composite coatings (ECHCs) on Ti6Al4V substrates with carbonated hydroxyapatite coatings (CHACs) without ethyl cellulose as controls. The inorganic constituent on the CHACs and ECHCs is calcium-deficient carbonated hydroxyapatite with a flaky texture and a low degree of crystallinity. The flaky carbonated hydroxyapatite plates aggregate to form macropores with an aperture size of around 0.5-2.0 µm. The presence of ethyl cellulose provides superior morphology, contact angle, and biocompatibility characteristics. In comparison to CHACs, ECHCs exhibit a smoother, crack-free surface because the cracks are filled by ethyl cellulose. Moreover, the contact angle of ECHCs is 37.3°, greater than that of CHACs (13.0°). Surface biocompatibility was investigated by using human bone mesenchymal stem cells (hBMSCs). The attachment, spreadability, viability and proliferation of hBMSCs on ECHCs are superior to those on CHACs. Thus, the crack-free ECHCs have excellent biocompatibility and are appropriate for use as biological implants.

Calcineurin/NFAT pathway mediates wear particle-induced TNF-α release and osteoclastogenesis from mice bone marrow macrophages in vitro.

AIM: To investigate the roles of the calcineurin/nuclear factor of activated T cells (NFAT) pathway in regulation of wear particles-induced cytokine release and osteoclastogenesis from mouse bone marrow macrophages in vitro. METHODS: Osteoclasts were induced from mouse bone marrow macrophages (BMMs) in the presence of 100 ng/mL receptor activator of NF-κB ligand (RANKL). Acridine orange staining and MTT assay were used to detect the cell viability. Osteoclastogenesis was determined using TRAP staining and RT-PCR. Bone pit resorption assay was used to examine osteoclast phenotype. The expression and cellular localization of NFATc1 were examined using RT-PCR and immunofluorescent staining. The production of TNFα was analyzed with ELISA. RESULTS: Titanium (Ti) or polymethylmethacrylate (PMMA) particles (0.1 mg/mL) did not significantly change the viability of BMMs, but twice increased the differentiation of BMMs into mature osteoclasts, and markedly increased TNF-α production. The TNF-α level in the PMMA group was significantly higher than in the Ti group (96 h). The expression of NFATc1 was found in BMMs in the presence of the wear particles and RANKL. In bone pit resorption assay, the wear particles significantly increased the resorption area and total number of resorption pits in BMMs-seeded ivory slices. Addition of 11R-VIVIT peptide (a specific inhibitor of calcineurin-mediated NFAT activation, 2.0 µmol/L) did not significantly affect the viability of BMMs, but abolished almost all the wear particle-induced alterations in BMMs. Furthermore, VIVIT reduced TNF-α production much more efficiently in the PMMA group than in the Ti group (96 h). CONCLUSION: Calcineurin/NFAT pathway mediates wear particles-induced TNF-α release and osteoclastogenesis from BMMs. Blockade of this signaling pathway with VIVIT may provide a promising therapeutic modality for the treatment of periprosthetic osteolysis.

Berberine inhibits lipopolysaccharide- and polyethylene particle-induced mouse calvarial osteolysis in vivo.

BACKGROUND: Wear particle-induced osteolysis could lead to the aseptic loosening of implants. Studies have suggested that endotoxins, such as lipopolysaccharides (LPS), may be the primary causes of wear particle-mediated osteolysis, and that osteolysis may originate from subclinical levels of bacterial infection. However, effective therapies against wear particles and gram-negative bacterial or LPS-induced bone resorption are limited. MATERIALS AND METHODS: In the current study, the effect of berberine on LPS- and polyethylene (PE) particle-induced osteolysis in vivo was investigated using a mouse calvarial model. Osteoclast number per bone perimeter and eroded surface per bone surface were measured. RESULTS: Berberine (10 mg/kg), injected either simultaneously with LPS or 3 d after LPS (25 mg/kg) treatment, blocked LPS-induced osteoclast recruitment and bone resorption in the mouse calvarial model. A daily single-dose of berberine (10 mg/kg), injected either simultaneously with PE particles or 4 d after treatment with PE particles, blocked PE particle-induced osteoclast recruitment and bone resorption. Berberine treatment markedly decreased LPS and PE particle-induced osteoclast recruitment and bone resorption in the murine calvarial model. CONCLUSION: These results suggest that berberine may have therapeutic effect for osteolysis induced by wear particles and LPS in gram-negative bacteria.

Nickel-titanium shape-memory sawtooth-arm embracing fixator for periprosthetic femoral fractures.

PURPOSE: We reviewed data to determine outcomes for 21 consecutive Vancouver type B1 or type C periprosthetic fractures that we treated between 2001 and 2008 using a nickel-titanium shape-memory sawtooth-arm embracing fixator. METHODS: The study participants were 12 men and 9 women (mean age, 70.8 years; range, 42-85 years). The average duration of follow-up monitoring was 39.7 months (range, 1-78 months). In five cases, cables and screws were used for further stabilisation. No bone grafting was performed for any of the patients. RESULTS: Results were satisfactory, except for one patient who died one month after surgery from a cause unrelated to arthroplasty. Bone union was achieved in the remaining 20 cases within an average of 5.25 months. No implant failures or malunions occurred in any of the patients. The average Harris hip score at the final follow-up examination was 79.3 points. CONCLUSIONS: Our results show that the embracing fixator is a valid alternative treatment for Vancouver type B1 or type C periprosthetic femoral fractures.

[Clinical study of lumbar fusion by hybrid construct of stem cells technique and biodegradable material].

OBJECTIVE: To explorer the effectiveness of enriched bone marrow stem cells technique for lumbar fusion. METHODS: With the randomization and control principles, 2 graft materials [Enrichment bone marrow mesenchymal stem cells hybridized with beta-tri calcium phosphate (composite graft group), autologous iliac crest bone graft (autograft group)] were compared in posterior lumbar fusion procedures. 56 patients with degenerative disc disease, lumbar instability or spinal stenosis, were included. The volume of cells suspension in pre- and post-enrichment and the number of nucleated cells (NCs) were identified. The number of osteoprogenitor cells was estimated by counting the colony-forming units which express alkaline phosphatase (CFUs/ALP+). Then the efficiency of the enrichment was evaluated. Clinical follow-up with roentgenogram and Oswestry scale scores was performed for outcome evaluation. RESULTS: (249 +/- 31) ml bone marrow per patient from bilateral iliac crests was aspirated peri-operatively. About (43 +/- 11) ml enriched bone marrow was collected. The number of NCs was concentrated from (15.9 +/- 3.3) x 10(6)/ml to (44.1 +/- 10.8) x 10(6)/ml, CFUs/ALP+ was significantly increased from (118 +/- 86)/ml to(486 +/- 305)/ml. The follow-up was about (26.3 +/- 7.5) months. There was no significant differences in age, gender, disease and fusion segments between the two groups. The fusion rate was 93.3% and 96.2% for composite graft group and autograft group, respectively (chi2 = 0.2146, P = 0.6432). There was no difference in operation time between the two group (t = 0.5243, P = 0.6022), but blood loss in composite graft group was more than that in autograft group (t = 6.4664, P < 0.01). Cell salvage for auto-transfusion could transfuse back half of the blood loss during operation. No hematoma or chronic soreness in the bone marrow donor sites of composite graft group occurred, but a little exudation or moderate swelling in the wound happened in 4 cases which disappeared under medical treatment. Meanwhile, 15.4% patients had hematoma in the iliac bone donor site and 26.9% patients had chronic soreness, but no case had wound problem in autograft group. As for Oswestry scale scores, there was no significant difference between the two groups. CONCLUSIONS: The enrichment technique of autologous bone marrow stem cells can greatly increase the concentration of MSCs. It is a rapid and safe method used peri-operatively. The composite material of enriched MSCs and porous beta-TCP is a good bone substitute in posterior spinal fusion.

[The effect of ultra high molecular weight polyethylene particles on macrophage].

OBJECTIVE: To study the effect of ultra high molecular weight polyethylene (UHMWPE) particles on macrophages and evaluate the expression of NFAT2, a key transcriptional factor for osteoclast differentiation. METHODS: From November 2004 to February 2005, macrophages were co-cultured with UHMWPE particles. When observed at different times, the proliferation activity of macrophages was analyzed by MTT and the expression of calcineurin (CaN) and NFAT2 by immunohistochemical and RT-PCR method respectively. RESULTS: The macrophages phagocytosed UHMWPE particles in an early time, the expression of CaN and NFAT2 was increased, while the proliferation activity was not enhanced. CONCLUSIONS: UHMWPE particles can stimulate macrophages to phagocytose significantly, and enhance the expression of the transcriptional factor NFAT2.

[VASCULARITY STUDY ON PERIPROSTHETIC TISSUES AROUND ASEPTIC LOOSENING AFTER TOTAL HIP ARTHROPLASTY].

OBJECTIVE: To observe the vascularity in periprosthetic tissues of aseptic loosening after total hip arthroplasty (THA) and to explore the relationship between expression of vascularity and osteolysis. METHODS: Between October 2009 and June 2012, interface tissues were obtained from 22 patients (22 hips) who underwent revision of THA because of prosthetic aseptic loosening, including 12 males and 10 females with the age range of 53-81 years and prosthesis survival range of 6-14 years. The interface tissues were divided into osteolysis group and non-osteolysis group based on preoperative X-ray findings and intraoperative observation. The synovial tissues were harvested from another 8 patients (3 males and 5 females, aged 58-72 years) with osteoarthritis undergoing THA as control group. HE stainging was used to observe the histological character, and low-wear or high-wear was identified according to metal or polyethylene particles amount in osteolysis group. The CD34 immunohistochemical staining was used to mark the blood vessels. Microvessel density and microvessel index were calculated with the use of image analysis software. RESULTS :Histological observation showed that wear particles and numerous macrophages/multinucleated giant cells accumulated in the membrane of osteolysis group, while many fibroblasts and synovial cells existed in non-osteolysis group. The microvessels density and microvessel index were significantly lower in non-osteolysis group than those in osteolysis group and control group (P < 0.05), and there was no significant difference in microvessel density and microvessel index between osteolysis group and control group (P > 0.05). There were less microvessel density and microvessel index in heavy-loaded metal or polyethylene wear particles areas than those in low-loaded metal or polyethylene wear particles areas (P < 0.05), and there for either polyethylene or metal particles (P > 0.05). CONCLUSION: The phagocytosis of macrophage in periprosthetic tissues need vicinal microvessels formation and blood supply to some extent. Vascular injury and decreased blood supply at the implant-bone interface seem to be one of the reasons for insufficient implant osseointegration and aseptic loosening.

Hydroxyapatite coatings with oriented nanoplate and nanorod arrays: Fabrication, morphology, cytocompatibility and osteogenic differentiation.

Hydroxyapatite (HA) crystals exhibit rod-like shape with c-axis orientation and plate-like shape with a(b)-axis orientation in vertebrate bones and tooth enamel surfaces, respectively. Herein, we report the synthesis of HA coatings with the oriented nanorod arrays (RHACs) and HA coatings with oriented nanoplate arrays (PHACs) by using bioglass coatings as sacrificial templates. After soaking in simulated body fluid (SBF) at 120°C, the bioglass coatings are hydrothermally converted into the HA coatings via a dissolution-precipitation reaction. If the Ca/P ratios in SBF are 2.50 and 1.25, the HA crystals on the coatings are oriented nanorod arrays and oriented nanoplate arrays, respectively. Moreover, the bioglass coatings are treated with SBF at 37°C, plate-like HA coatings with a low crystallinity (SHACs) are prepared. As compared with the Ti6Al4V and SHACs, the human bone marrow stromal cells (hBMSCs) on the RHACs and PHACs have better cell adhesion, spreading, proliferation and osteogenic differentiation because of their moderately hydrophilic surfaces and similar chemical composition, morphology and crystal orientation to human hard tissues. Notably, the morphologies of HA crystals have no obvious effects on cytocompatibility and osteogenic differentiation. Hence, the HA coatings with oriented nanoplate arrays or oriented nanorod arrays have a great potential for orthopedic applications.

Fabrication of three-dimensional porous scaffold based on collagen fiber and bioglass for bone tissue engineering.

An ideal scaffold for bone tissue engineering should have interconnected porous structure, good biocompatibility, and mechanical properties well-matched with natural bones. Collagen is the key component in the extracellular matrix (ECM) of natural bones, and plays an important role in bone regeneration. The biological activity of collagen has promoted it to be an advantageous biomaterial for bone tissue engineering; however, the mechanical properties of these scaffolds are insufficient and the porous structures are not stable in the wet state. An effective strategy to solve this problem is to fabricate a hybrid scaffold of biologically derived and synthetic material, which have the necessary bioactivity and mechanical stability needed for bone synthesis. In this work, a three-dimensional macroporous bone scaffold based on collagen (CO) fiber and bioglass (BG) is fabricated by a slurry-dipping technique, and its relevant mechanical and biological properties are evaluated. The CO/BG scaffold is interconnected with a porosity of 81 ± 4.6% and pore size of 40-200 µm. Compared with CO scaffold, water absorption value of CO/BG scaffold decreases greatly from 889% to 52%, which significantly alleviates the swelling behavior of collagen and improves the stability of scaffold structure. The CO/BG scaffold has a compression strength of 5.8 ± 1.6 MPa and an elastic modulus of 0.35 ± 0.01 Gpa, which are well-matched with the mechanical properties of trabecular bones. In vitro cell assays demonstrate that the CO/BG scaffold has good biocompatibility to facilitate the spreading and proliferation of human bone marrow stromal cells. Hence, the CO/BG scaffold is promising for bone tissue engineering application.

Hydroxyapatite coatings with oriented nanoplate arrays: synthesis, formation mechanism and cytocompatibility.

Hydroxyapatite (HA) is the main inorganic constituent of natural bones and teeth with c-axis orientation and a(b)-axis orientation, respectively. Designing HA coatings (HACs) with specific orientation and morphology is an important strategy to improve their biological properties. Herein, we report, for the first time, the hydrothermal synthesis of HACs with oriented nanoplate arrays according to the following steps: (i) deposition of brushite/chitosan coatings (BCCs) on Ti6Al4V substrates; and (ii) transformation of HACs with oriented nanoplate arrays from BCCs after hydrothermal treatment with alkaline solutions. After soaking the BCCs in a NaOH solution under hydrothermal conditions, the Ca2+ and PO4 3- ions are released from the coatings because of the dissolution reaction of brushite, and they react with OH- ions to form HA nanoplates. Interestingly, these HA nanoplates with a preferential c-plane orientation are perpendicular to the coating surfaces. Hydrothermal reaction time and Ca/P ratio of BCCs have great effects on the morphologies of HA nanoplates. On increasing the reaction time from 3 h to 3 days or decreasing the Ca/P ratio from 2.0 to 1.0, the widths (or lengths) of HA nanoplates increase gradually. Simulated body fluid immersion (SBF) tests reveal that the HACs with oriented nanoplate arrays can promote the formation of apatite on the surfaces, suggesting their good in vitro bioactivity. Moreover, human bone marrow stromal cells (hBMSCs) have been used as cell models to investigate cytocompatibility of the HACs. The hBMSCs on the HACs have better cell adhesion, spreading, proliferation and osteogenic differentiation than those on Ti6Al4V substrates because the HACs are similar to the minerals of human hard tissues in chemical composition, morphology and crystallographic orientation. Therefore, HACs with oriented nanoplate arrays have great potential for use as implants of human hard tissues.

Hydrothermal fabrication of ZSM-5 zeolites: biocompatibility, drug delivery property, and bactericidal property.

The bone graft-associated infection is widely considered in orthopedic surgery, which may lead to implant failure, extensive bone debridement, and increased patient morbidity. In this study, we fabricated ZSM-5 zeolites for drug delivery systems by hydrothermal method. The structure, morphology, biocompatibility, drug delivery property, and bactericidal property of the ZSM-5 zeolites were investigated. The ZSM-5 zeolites have mordenite framework inverted-type structure and exhibit the disk-like shape with the diameter of ∼350 nm and thickness of ∼165 nm. The biocompatibility tests indicate that human bone marrow stromal cells spread out well on the surfaces of the ZSM-5 zeolites and proliferate significantly with increasing culture time. As compared with the conventional hydroxyapatite particles, the ZSM-5 zeolites possess greater drug loading efficiency and drug sustained release property because of the ordered micropores, large Brunauer-Emmett-Teller (BET) surface areas, and functional groups. For the gentamicin-loaded ZSM-5 zeolites, the sustained release of gentamicin minimizes significantly bacterial adhesion and prevents biofilm formation against Staphylococcus epidermidis. The excellent biocompatibility, drug delivery property, and bactericidal property of the ZSM-5 zeolites suggest that they have great application potentials for treating implant-associated infections.

Hydrothermal fabrication of hydroxyapatite/chitosan/carbon porous scaffolds for bone tissue engineering.

Porous carbon fiber felts (PCFFs) have great applications in orthopedic surgery because of the strong mechanical strength, low density, high stability, and porous structure, but they are biologically inert. To improve their biological properties, we developed, for the first time, the hydroxyapatite (HA)/chitosan/carbon porous scaffolds (HCCPs). HA/chitosan nanohybrid coatings have been fabricated on PCFFs according to the following stages: (i) deposition of chitosan/calcium phosphate precursors on PCFFs; and (ii) hydrothermal transformation of the calcium phosphate precursors in chitosan matrix into HA nanocrystals. The scanning electron microscopy images indicate that PCFFs are uniformly covered with elongated HA nanoplates and chitosan, and the macropores in PCFFs still remain. Interestingly, the calcium-deficient HA crystals exist as plate-like shapes with thickness of 10-18 nm, width of 30-40 nm, and length of 80-120 nm, which are similar to the biological apatite. The HA in HCCPs is similar to the mineral of natural bone in chemical composition, crystallinity, and morphology. As compared with PCFFs, HCCPs exhibit higher in vitro bioactivity and biocompatibility because of the presence of the HA/chitosan nanohybrid coatings. HCCPs not only promote the formation of bone-like apatite in simulated body fluid, but also improve the adhesion, spreading, and proliferation of human bone marrow stromal cells. Hence, HCCPs have great potentials as scaffold materials for bone tissue engineering and implantation.

Bactericidal properties and biocompatibility of a gentamicin-loaded Fe3O4/carbonated hydroxyapatite coating.

Postoperative implant-associated infection remains a serious complication in total joint arthroplasty (TJA) surgery. The addition of antibiotics to bone cement is used as an antimicrobial prophylaxis in cemented joint arthroplasty; however, in cementless arthroplasty, there are no comparable measures for the local delivery of antibiotics. In this study, a gentamicin-loaded Fe3O4/carbonated hydroxyapatite coating (Gent-MCHC) was fabricated according to the following steps: (i) deposition of Fe3O4/CaCO3 particles on Ti6Al4V substrates by electrophoretic deposition; (ii) conversions of MCHC from Fe3O4/CaCO3 coatings by chemical treatment; and (iii) formation of Gent-MCHC by loading gentamicin into MCHC. MCHC possessed mesoporous structure with a pore size of about 3.8 nm and magnetic property with the saturation magnetization strength of about 4.03 emu/g. Gent-MCHC had higher drug loading efficiency and drug release capacity, and superior biocompatibility and mitogenic activity than Ti6Al4V. Moreover, Gent-MCHC deterred bacterial adhesion and prevented biofilm formation. These results demonstrate that Gent-MCHC can be used as a local drug delivery system to prevent implant-associated infection in TJA surgery.

Drug delivery property, bactericidal property and cytocompatibility of magnetic mesoporous bioactive glass.

A multifunctional magnetic mesoporous bioactive glass (MMBG) has been widely used for a drug delivery system, but its biological properties have been rarely reported. Herein, the effects of mesopores and Fe3O4 nanoparticles on drug loading-release property, bactericidal property and biocompatibility have been investigated by using mesoporous bioactive glass (MBG) and non-mesoporous bioactive glass (NBG) as control samples. Both MMBG and MBG have better drug loading efficiency than NBG because they possess ordered mesoporous channels, big specific surface areas and high pore volumes. As compared with MBG, the Fe3O4 nanoparticles in MMBG not only provide magnetic property, but also improve sustained drug release property. For gentamicin-loaded MMBG (Gent-MMBG), the sustained release of gentamicin and the Fe3O4 nanoparticles minimize bacterial adhesion significantly and prevent biofilm formation against Staphylococcus aureus (S. aureus) and Staphylococcus epidermidis (S. epidermidis). Moreover, the magnetic Fe3O4 nanoparticles in MMBG can promote crucial cell functions such as cell adhesion, spreading and proliferation. The excellent biocompatibility and drug delivery property of MMBG suggest that Gent-MMBG has great potentials for treatment of implant-associated infections.

Bactericidal property and biocompatibility of gentamicin-loaded mesoporous carbonated hydroxyapatite microspheres.

Implant-associated infection is a serious problem in orthopaedic surgery. One of the most effective ways is to introduce a controlled antibiotics delivery system into the bone filling materials, achieving sustained release of antibiotics in the local sites of bone defects. In the present work, mesoporous carbonated hydroxyapatite microspheres (MCHMs) loaded with gentamicin have been fabricated according to the following stages: (i) the preparation of the MCHMs by hydrothermal method using calcium carbonate microspheres as sacrificial templates, and (ii) loading gentamicin into the MCHMs. The MCHMs exhibit the 3D hierarchical nanostructures constructed by nanoplates as building blocks with mesopores and macropores, which make them have the higher drug loading efficiency of 70-75% than the conventional hydroxyapatite particles (HAPs) of 20-25%. The gentamicin-loaded MCHMs display the sustained drug release property, and the controlled release of gentamicin can minimize significantly bacterial adhesion and prevent biofilm formation against S. epidermidis. The biocompatibility tests by using human bone marrow stromal cells (hBMSCs) as cell models indicate that the gentamicin-loaded MCHMs have as excellent biocompatibility as the HAPs, and the dose of the released gentamicin from the MCHMs has no toxic effects on the hBMSCs. Hence, the gentamicin-loaded MCHMs can be served as a simple, non-toxic and controlled drug delivery system to treat bone infections.

Promotion of bone formation by naringin in a titanium particle-induced diabetic murine calvarial osteolysis model.

Diabetic patients have an increased risk of prosthesis failure requiring revision surgery. Furthermore, skeletal defects are observed in conjunction with type 1 diabetes. Using a titanium particle-induced calvarial osteolysis model in diabetic mice, we investigated the effect of diabetes on the osteolytic process and the role of naringin in its prevention. Three groups each of nondiabetic or diabetic mice were treated with vehicle only, with particles only, or with particles then naringin for 10 days. Alteration of bone indices near the midline suture were then analyzed by microcomputed tomography scanning and histology. Serum levels of osteocalcin (OCN) and cross-linked N-telopeptide of type I collagen (NTx) were measured by enzyme-linked immunosorbent assay. The decreases in new bone formation (p < 0.05), calvaria thickness (p < 0.05), bone volume (p < 0.05), midline suture area (p < 0.05), and OCN concentration (p < 0.05) found in diabetic mice were normalized with naringin treatment. Diabetic state promoted particle-induced osteolysis. Naringin, an osteoanabolic agent, improved bone indices apparently by stimulating bone formation. Therefore, naringin may be beneficial in preventing and treating debris-mediated periprosthetic osteolysis after total joint replacement, especially in diabetics.

Berberine inhibits Staphylococcus epidermidis adhesion and biofilm formation on the surface of titanium alloy.

Biofilm formed by Staphylococcus epidermidis (S. epidermidis) is a common cause of periprosthetic infection. Recently, we have discovered that berberine is bacteriostatic for S. epidermidis. The purpose of the present study was to examine the effect of berberine on S. epidermidis adhesion and biofilm formation on the surface of titanium alloy, which is a popular material for orthopedic joint prostheses. Three strains of S. epidermidis (ATCC 35984, ATCC 12228, and SE 243) were used for in vitro experiment. Direct colony counting showed that berberine significantly inhibited S. epidermidis adhesion on the titanium alloy disk in 2 h at the concentration of 45 microg/mL. When examined with crystal violet staining, confocal laser scanning microscopy, and scanning electron microscopy, we found that higher concentrations (>30 microg/mL) of berberine effectively prevented the formation of S. epidermidis biofilm on the surface of the titanium disk in 24 h. These findings suggest that berberine is a potential agent for the treatment of periprosthetic infection.