University of Groningen, University Medical Center Groningen, Department of BioMedical Engineering, Antonius Deusinglaan 1, 9713 AV, Groningen, The Netherlands.
Department of Medical Microbiology, CINIMA (Center for Infection and Immunity Amsterdam), Academic Medical Center, University of Amsterdam, Meibergdreef 15, 1105 AZ Amsterdam, The Netherlands.
Acta Biomater. 2018 Apr 1;70:12-24. doi: 10.1016/j.actbio.2018.02.001. Epub 2018 Feb 10.
Bacterial adhesion and subsequent biofilm formation on biomedical implants and devices are a major cause of their failure. As systemic antibiotic treatment is often ineffective, there is an urgent need for antimicrobial biomaterials and coatings. The term "antimicrobial" can encompass different mechanisms of action (here termed "antimicrobial surface designs"), such as antimicrobial-releasing, contact-killing or non-adhesivity. Biomaterials equipped with antimicrobial surface designs based on different mechanisms of action require different in vitro evaluation methods. Available industrial standard evaluation tests do not address the specific mechanisms of different antimicrobial surface designs and have therefore been modified over the past years, adding to the myriad of methods available in the literature to evaluate antimicrobial surface designs. The aim of this review is to categorize fourteen presently available methods including industrial standard tests for the in vitro evaluation of antimicrobial surface designs according to their suitability with respect to their antimicrobial mechanism of action. There is no single method or industrial test that allows to distinguish antimicrobial designs according to all three mechanisms identified here. However, critical consideration of each method clearly relates the different methods to a specific mechanism of antimicrobial action. It is anticipated that use of the provided table with the fourteen methods will avoid the use of wrong methods for evaluating new antimicrobial designs and therewith facilitate translation of novel antimicrobial biomaterials and coatings to clinical use. The need for more and better updated industrial standard tests is emphasized.
European COST-action TD1305, IPROMEDAI aims to provide better understanding of mechanisms of antimicrobial surface designs of biomaterial implants and devices. Current industrial evaluation standard tests do not sufficiently account for different, advanced antimicrobial surface designs, yet are urgently needed to obtain convincing in vitro data for approval of animal experiments and clinical trials. This review aims to provide an innovative and clear guide to choose appropriate evaluation methods for three distinctly different mechanisms of antimicrobial design: (1) antimicrobial-releasing, (2) contact-killing and (3) non-adhesivity. Use of antimicrobial evaluation methods and definition of industrial standard tests, tailored toward the antimicrobial mechanism of the design, as identified here, fulfill a missing link in the translation of novel antimicrobial surface designs to clinical use.
生物医学植入物和设备上细菌的黏附和随后的生物膜形成是它们失效的主要原因。由于全身抗生素治疗通常无效，因此迫切需要抗菌生物材料和涂层。“抗菌”一词可以包含不同的作用机制（这里称为“抗菌表面设计”），例如抗菌释放、接触杀灭或非黏附性。基于不同作用机制的具有抗菌表面设计的生物材料需要不同的体外评估方法。现有的工业标准评估测试并未解决不同抗菌表面设计的具体作用机制，因此在过去几年中进行了修改，增加了文献中可用于评估抗菌表面设计的无数方法。本综述的目的是根据其作用机制的适宜性，将目前现有的 14 种方法（包括工业标准测试）分为用于体外评估抗菌表面设计的方法。没有一种单一的方法或工业测试可以根据这里确定的三种机制来区分抗菌设计。然而，对每种方法的批判性考虑清楚地将不同的方法与抗菌作用的特定机制联系起来。预计使用提供的包含 14 种方法的表格将避免使用错误的方法来评估新的抗菌设计，并促进将新型抗菌生物材料和涂层转化为临床应用。强调了需要更多和更好的更新的工业标准测试。
欧洲 COST 行动 TD1305，IPROMEDAI 的目的是更好地了解生物材料植入物和设备的抗菌表面设计的机制。当前的工业评估标准测试不能充分考虑不同的、先进的抗菌表面设计，但迫切需要获得令人信服的体外数据，以批准动物实验和临床试验。本综述旨在为三种截然不同的抗菌设计机制（1）抗菌释放、（2）接触杀灭和（3）非黏附性提供创新且清晰的指导，以选择合适的评估方法。抗菌评估方法和定义的工业标准测试，针对这里确定的设计的抗菌机制进行定制，是将新型抗菌表面设计转化为临床应用的缺失环节。
