Bacterial biofilms are a pervasive issue in orthopaedic surgery causing up to 80% of infections. Antimicrobial photodynamic therapy (aPDT) is a proposed technique for eradication of biofilms, clinical translation requires optimization of treatment parameters. This study assessed the effectiveness of three light spectra in activating photosensitizing porphyrins to kill a dual species biofilm of E. Coli and E. faecalis grown in a microfluidic device. Blue-red, amber, or blue-amber-red light sources were compared at either 30J/cm2 or 60J/cm2 doses given to activate endogenously produced porphyrins after one hour incubation with 10 or 20% 5-ALA in a saline solution. Changes in biomass 24 hours after treatment were measured using confocal microscopy and OCT to determine treatment effectiveness.
The issue of radiation damage to skin in conventional radiotherapy (RT) has motivated pre-clinical studies to demonstrate reduced skin toxicity and overall improved normal tissue sparing in high-dose rate FLASH RT. We address the critical need for diagnostic tools to evaluate radiobiological response mechanisms produced with FLASH RT by using low-coherence light scattering to quantify skin and tumor tissue response to FLASH versus conventional radiotherapy. A study of melanoma growth in dorsal skin window chambers on rodents in vivo following separate regiments of RT treatment was conducted with optical coherence tomography (OCT), followed by parametric texture analysis of volumetric OCT images to delineate viable and dead cell clusters in tissue. Longitudinal quantification of viable and dead cell proportion demonstrates the severity of conventional RT damage to skin in comparison with higher epidermal structural integrity preserved by FLASH radiotherapy, highlighting potential of OCT for microstructural imaging in this first-of-its-kind study.
Well-organized ecosystems of bacteria colonize orthopaedic devices causing biofilm infections that are notoriously difficult to manage. Biofilms typically exhibit increased resistance to antibiotics leading to treatment failure, and tools for eradicating biofilms that do not increase antibiotic resistance are greatly needed. Antimicrobial photodynamic therapy (aPDT) is a promising form of treatment to combat clinically relevant biofilms. Exogenous provision of 5-aminolevulinic acid (5-ALA) to biofilm-forming clinical strains of E. coli, E. faecalis and S. aureus was recently shown by several research groups to result in the accumulation of sufficient quantities of endogenous photosensitizers porphyrins (protoporphyrin IX, coproporphyrin III and others), via the heme biosynthetic pathway, to produce a significant phototoxic effect when exposed to activating light. For clinical translation of this extremely promising approach, here we develop a portable light source for 5-ALA-based aPDT of orthopaedic implant biofilms, spectrally shaped for optimal porphyrin light absorption at wavelengths range approved by FDA for clinical use. After phantom calibration, we tested it on E.coli-E.faecalis biofilms grown in soft lithography-fabricated microfluidic chips and on methicillin-resistant S. aureus (MRSA) biofilms grown on titanium and stainless steel orthopaedic hardware in custom-designed macrofluidic devices. Successful in-vitro experiments allowed us to conduct a proof-of-concept validation study in a preclinical rat model of MRSA-contaminated open fracture. Following tibia fracture and two hours of wound infection development, a one hour incubation with 20% 5-ALA and treatment with either 90J/cm2 or three fractions of 30J/cm2 light doses demonstrated 94% and 99% overall reduction of MRSA, respectively, while the temperature of the tissue remained <39°C, below the threshold for thermal damage. The encouraging results suggest further preclinical testing of the developed light source for optimization of aPDT regimen and 5-ALA concentration to reduce the risk of long-term side effects in animal models of contaminated trauma surgery.
Methicillin-resistant S. aureus (MRSA) bacteria commonly found on orthopaedic implants, form treatment resistant biofilms that are difficult to manage. Creating new imaging modalities that allow us to understand biofilm development and accurately indicate the efficacy of treatments will greatly aid research in biofilm infection treatment methods. In this in vitro study, we determined the correlation between the number of MRSA CFUs and the radiance of MRSA aliquots with bioluminescent plasmids in the resolution volume of the Perkin Elmer’s IVIS Spectrum imaging system at specific imaging depths. We standardized MRSA bioluminescence curves for planktonic and biofilm-associated MRSA grown on titanium and stainless-steel orthopaedic hardware. The ability to relate measured radiance to the biofilm bioburden on a metal surface provides a critical tool for our ongoing pre-clinical studies identifying and treating biofilm-forming infections in contaminated high-energy fracture (rats) and contaminated osseointegration after amputation (rabbits).
Orthopaedic implant-associated infections cause serious complications primarily attributed to bacterial biofilm formation and often characterized by increased antibiotic resistance and diminished treatment response. There is currently a lack of imaging modalities that can directly visualize biofilms to determine the location and extent of contamination. Optical coherence tomography (OCT) is a portable, non-invasive, high-resolution imaging modality with the potential to fulfill this unmet need. In this study, we aim to evaluate the efficacy of OCT in detecting biofilms formed by life- and limb-threatening bacteria on orthopaedic implants. Bioluminescent strain SAP231 of methicillin-resistant S. aureus (MRSA) was used to grow biofilms on the surfaces of titanium and stainless-steel orthopaedic hardware situated inside custom-designed macrofluidic devices, allowing continuous nutrient broth supply and waste removal. Three-dimensional OCT images of each piece of hardware were obtained every 24 hours with subsequent bioluminescence imaging using the PerkinElmer IVIS Spectrum. OCT texture analysis based on multi-parametric fitting approach was developed and validated against IVIS quantification for accurate identification of live MRSA signatures. The monitoring of biofilm formation and measurement of film thicknesses starting at 12 micrometers and reaching 180 micrometers in 72 hours on metal hardware is demonstrated. This proof-of-concept study highlights the ability of OCT to detect and quantify the formation of MRSA bacterial biofilms in a high fidelity orthopaedic implant biofilm model in vitro, opening avenues for translation of this technique to preclinical models of contaminated orthopaedic trauma surgery and further clinical translation.
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