Khanda Milan, Seal Pallabi, Mohan Arya J, Arya Neha, Boda Sunil Kumar
Department of Bioscience and Biomedical Engineering, Indian Institute of Technology Indore, Khandwa Road, Simrol, Indore, Madhya Pradesh, 453552, India.
Department of Translational Medicine, All India Institute of Medical Sciences Bhopal, Bhopal, Madhya Pradesh, 462020, India.
Nanoscale. 2025 May 2;17(17):10462-10484. doi: 10.1039/d5nr00953g.
Despite minimally invasive surgeries and advancements in aseptic techniques, implant-associated infections are a significant complication in post-surgical implantation of medical devices. The standard practice of systemic antibiotic administration is often ineffective due to the development of bacterial antibiotic resistance, poor antibiotic penetration into biofilms, and low antibiotic bioavailability at the infected site. Infected implants are typically salvaged by tissue resection and antibacterial reinforcements during revision surgery. Towards this end, antimicrobial peptides (AMPs) have emerged as a promising alternative to traditional antibiotics to combat infections. Herein, a comprehensive overview of antimicrobial peptides, their structure and function, comparison with conventional antibiotics, antimicrobial properties, mechanisms of action of AMPs, and bacterial resistance to AMPs in relation to antibiotics are discussed. Furthermore, stimuli-responsive AMP delivery and contact killing AMP coatings on implant surfaces are deliberated. We discuss various methods of AMP immobilization and coatings on implant materials through physico-chemical coating strategies. The review also addresses the clinical status and current limitations of AMP coatings such as proteolytic instability and potential cytotoxicity. Finally, we conclude with future directions to develop small, effective AMP mimetics and encapsulation of AMPs within nanocarriers to improve antimicrobial properties and design-controlled release systems for sustained antimicrobial activity.
尽管微创手术和无菌技术有所进步，但植入相关感染仍是医疗器械术后植入的一个重大并发症。由于细菌产生抗生素耐药性、抗生素难以渗透到生物膜以及感染部位抗生素生物利用度低，全身使用抗生素的标准做法往往无效。在翻修手术中，感染的植入物通常通过组织切除和抗菌增强措施来挽救。为此，抗菌肽（AMPs）已成为对抗感染的一种有前途的传统抗生素替代品。本文讨论了抗菌肽的全面概述、其结构和功能、与传统抗生素的比较、抗菌特性、AMPs的作用机制以及细菌对AMPs与抗生素相关的耐药性。此外，还讨论了刺激响应性AMPs递送以及植入物表面的接触杀灭AMPs涂层。我们讨论了通过物理化学涂层策略将AMPs固定和涂覆在植入材料上的各种方法。该综述还讨论了AMPs涂层的临床现状和当前局限性，如蛋白水解不稳定性和潜在的细胞毒性。最后得出结论，未来的发展方向是开发小型、有效的AMPs模拟物，并将AMPs封装在纳米载体中以改善抗菌性能，并设计控释系统以实现持续的抗菌活性。
