PrP som en ny tilnærming for å hindre smitte: Forberedelse og<em> In vitro</em> Antimikrobielle egenskaper av PrP
Summary
Implant-associated infection is a significant clinical complication. This study describes an approach using platelet-rich plasma (PRP) to prevent implant-associated infections, presents the protocol for preparing PRP with constant platelet concentration, and reports the newly identified antimicrobial properties of PRP and related protocols for examining such antimicrobial properties in vitro.
Abstract
Implantat-assosiert infeksjon blir mer og mer utfordrende til helsevesenet over hele verden på grunn av økende antibiotikaresistens, overføring av antibiotikaresistente bakterier mellom dyr og mennesker, og de høye kostnadene ved behandling av infeksjoner.
I denne studien, utleverer vi en ny strategi som kan være effektive i å forebygge implantat-assosiert infeksjon basert på de potensielle antimikrobielle egenskapene blodplate-rik plasma (PRP). På grunn av sin veloverveide egenskaper for å fremme helbredelse, har PRP (et biologisk produkt) blitt stadig mer brukt for kliniske applikasjoner, inkludert ortopediske operasjoner, periodontal og muntlig operasjoner, maxillofacial operasjoner, plastisk kirurgi, idrettsmedisin, osv.
PRP kan være et avansert alternativ til konvensjonelle antibiotika behandlinger i å forebygge implantat-infeksjoner. Bruken av PRP kan være fordelaktig i forhold til konvensjonelle antibiotika behandlinger since PRP er mindre sannsynlig å indusere antibiotikaresistens og PRP er antimikrobiell og helbredende-fremme egenskaper kan ha en synergistisk effekt på infeksjon forebygging. Det er vel kjent at patogener og humane celler er racing for implantasjon overflater, og PRP egenskaper for å fremme helbredelse kan forbedre human cellefesting dermed redusere sjanser for infeksjon. I tillegg er PRP iboende biokompatibel, og sikker og fri fra risikoen av overførbare sykdommer.
For vår studie har vi valgt flere kliniske bakteriestammer som vanligvis finnes i ortopediske infeksjoner og undersøkt om PRP har in vitro antimikrobielle egenskaper mot disse bakteriene. Vi har utarbeidet PRP ved hjelp av en dobbelt sentrifugering tilnærming som tillater den samme blodplater konsentrasjonen som skal oppnås for alle prøver. Vi har oppnådd konsekvent antimikrobielle funn og fant ut at PRP har sterk in vitro antimikrobielle egenskaper mot bakterier som methicillin-sensitive og meticillinresistente Staphylococcus aureus, gruppe A streptokokker, og Neisseria gonorrhoeae. Derfor kan bruken av PRP har potensial for å hindre smitte og å redusere behovet for kostbare postoperativ behandling av implantat-assosierte infeksjoner.
Introduction
Implant-associated infection is a significant clinical complication. Staphylococcus aureus (S. aureus) is one of the most common microorganisms isolated from implant-associated infections. It is capable of producing a biofilm that covers the surfaces of implants and may lead to antibiotic-resistant infection 1,2. Treatment of implant-associated infection frequently requires long-term hospitalization for repeated debridements and prolonged parenteral antibiotic therapy. In antibiotic resistant cases, removal of the implant may be necessary. The rising resistance of bacteria to antibiotics has also been referred to by the Centers for Disease Control and Prevention (CDC) as “one of the world’s most pressing health problems.” In time, without the development of new and effective antimicrobial treatments, it is possible that multi-drug resistant pathogens will be untreatable with conventional antibiotics. Prevention of implant-associated infection is therefore important and novel prophylactic agents or approaches are needed for preventing such infections.
Platelet-rich plasma (PRP) is a concentration of autologous blood that contains over 30 growth factors which can help with bone and bone graft healing 3-5. The application of PRP to enhance bone regeneration and soft tissue maturation has been increasingly reported in clinics because of its high concentration of various growth factors released by platelets.
Several characteristics of PRP indicate that PRP may also have antimicrobial properties 6-9. PRP contains a large number of platelets, a high concentration of leukocytes (which may possess host-defense actions against bacteria and fungi), and multiple antimicrobial peptides 7,8,10. In a recent study of a large cohort of cardiac surgical patients, it was revealed that the intraoperative use of PRP-gel during wound closure significantly decreased the incidence of superficial and deep sternum infection 11. For these reasons and observations, we hypothesized that PRP, besides its well-studied healing-promoting properties, has antimicrobial properties. The potential advantages of using PRP to prevent infection may include: (i) PRP is less likely to induce resistance compared to conventional antibiotic treatments. (ii) PRP also has properties that promote healing which may have a synergistic effect on infection prevention; PRP’s healing-promoting properties could provide a seal to prevent bacterial attachment thereby reducing the odds for infection as pathogens and human cells are racing for implant surfaces 12,13. (iii) PRP is inherently biocompatible, and safe and free from the risk of transmissible diseases.
Our long-term goal is to use PRP as a new approach to prevent implant-associated infections. The aim of this study was to prepare PRP using a twice centrifugation approach, to examine PRP’s in vitro antimicrobial properties, and to describe the protocols for evaluating such antimicrobial properties.
Protocol
Representative Results
Discussion
Platelet-rich plasma has been increasingly used for clinical applications due to its healing-promoting properties 15-17. In the present study, PRP was presented as a new approach for infection prevention. PRP was found to have strong antimicrobial properties against MRSA, MSSA, Group A Streptococcus, and Neisseria gonorrhoeae. The major advantages of PRP, compared to conventional antibiotic treatments, for infection prevention include: (1) Current antibiotic therapies are facing challenges in…
Disclosures
The authors have nothing to disclose.
Acknowledgements
The authors thank Therwa Hamza, John E. Tidwell, Nina Clovis, and Suzanne Smith for experimental assistance and Suzanne Smith for proofreading. The authors also thank John Thomas, PhD for providing the bacterial clinical isolates and John B. Barnett, PhD for his support and the use of the biological safety lab at the Department of Microbiology, Immunology and Cell Biology at West Virginia University. The authors acknowledge financial support from the Osteosynthesis and Trauma Care Foundation and National Science Foundation (#1003907). Microscope experiments and image analysis were also performed in the West Virginia University Imaging Facility, which is supported in part by the Mary Babb Randolph Cancer Center and NIH grant P20 RR016440.
Animal use for blood draws were approved by the West Virginia University Institutional Animal Care and Use Committee. All experiments were executed in compliance with all relevant guidelines, regulations, and regulatory agencies.
Materials
| Name of Reagent/Material | Company | Catalog Number | Comments |
| Bovine thrombin | King Pharmaceuticals, Inc | 60793-215-05 | Thrombin (bovine origin) |
| Calcium chloride | King Pharmaceuticals, Inc | 60793-215-05 | 10% calcium chloride |
| Ethanol | Sigma-Aldrich | E7023 | |
| Isoflurane | Baxter | 1001936060 | |
| Mueller Hinton broth | Becton, Dickinson and Company | 275710 | |
| Phosphate-buffered saline | Sigma-Aldrich | D8662 | |
| Tri-sodium citrate | Sigma-Aldrich | W302600 | |
| Tryptic soy agar | Fisher Scientific | R01202 | |
| Centrifuge | Kendro Laboratory Products | 750043077 | |
| Syringe filter | Millipore | SLGP033RS |
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