N2 Biomedical LLC, One Patriots Park, Bedford, MA 01730, USA.
Adv Drug Deliv Rev. 2017 Mar;112:88-100. doi: 10.1016/j.addr.2017.01.007. Epub 2017 Feb 1.
Orthopedic and dental implants have been used successfully for decades to replace or repair missing or damaged bones, joints, and teeth, thereby restoring patient function subsequent to disease or injury. However, although device success rates are generally high, patient outcomes are sometimes compromised due to device-related problems such as insufficient integration, local tissue inflammation, and infection. Many different types of surface coatings have been developed to address these shortcomings, including those that incorporate therapeutic agents to provide localized delivery to the surgical site. While these coatings hold enormous potential for improving device function, the list of requirements that an ideal combination coating must fulfill is extensive, and no single coating system today simultaneously addresses all of the criteria. Some of the primary challenges related to current coatings are non-optimal release kinetics, which most often are too rapid, the potential for inducing antibiotic resistance in target organisms, high susceptibility to mechanical abrasion and delamination, toxicity, difficult and expensive regulatory approval pathways, and high manufacturing costs. This review provides a survey of the most recent developments in the field, i.e., those published in the last 2-3years, with a particular focus on technologies that have potential for overcoming the most significant challenges facing therapeutically-loaded coatings. It is concluded that the ideal coating remains an unrealized target, but that advances in the field and emerging technologies are bringing it closer to reality. The significant amount of research currently being conducted in the field provides a level of optimism that many functional combination coatings will ultimately transition into clinical practice, significantly improving patient outcomes.
几十年来，骨科和牙科植入物已成功用于替代或修复缺失或受损的骨骼、关节和牙齿，从而在疾病或损伤后恢复患者的功能。然而，尽管设备成功率通常很高，但由于与设备相关的问题，如整合不足、局部组织炎症和感染，患者的结果有时会受到影响。已经开发出许多不同类型的表面涂层来解决这些缺点，包括那些包含治疗剂以提供局部输送到手术部位的涂层。虽然这些涂层在改善设备功能方面具有巨大的潜力，但理想组合涂层必须满足的要求清单非常广泛，目前没有一种涂层系统能够同时满足所有标准。当前涂层面临的一些主要挑战是释放动力学不理想，最常见的是释放速度过快，可能会在目标生物中诱导抗生素耐药性，对机械磨损和分层的敏感性高，毒性，困难和昂贵的监管审批途径，以及高制造成本。本综述提供了该领域最近的发展情况，即过去 2-3 年发表的研究，特别关注具有克服治疗性涂层面临的最大挑战潜力的技术。结论是，理想的涂层仍然是一个未实现的目标，但该领域的进展和新兴技术正在使其更接近现实。目前在该领域进行的大量研究提供了一种乐观的看法，即许多功能性组合涂层最终将过渡到临床实践，从而显著改善患者的结果。
