Sustained Release of Functional Antibiotics from a Keratin Hydrogel Roy 1,2 D , Burmeister 2 D, Saul 3 J, Meng 3 H, Ellenburg 1 M, Burnett 1 L, Tomblyn 1 S, Christy 2 R 1KeraNetics, LLC, Winston-Salem, NC 27101 2United States Army Institute of Surgical Research, Fort Sam Houston, TX 78234 3Miami University, Oxford, OH 45056 Methods Results (cont’d) Abstract Wound infection resulting from battlefield injury can lead to impaired healing, increased hospitalization time, limb amputation, and psychological disorders. Current approaches to prevent burn infection include wound debridement and multiple applications of silvercontaining antibiotic dressings, which have been associated with delayed healing [1]. Therefore, the need exists for an aggressive, point-of-care antibiotic delivery system that prevents infection and infection recurrence while aiding in the regeneration process. Keratins are promising biomaterials for tissue engineering applications due to their ability to support cell attachment, proliferation, and migration [2,3]. Here we show that hydrogels composed of 15% (w/v) keratin supported the sustained release of several antibiotics including Ciprofloxacin, Cefazolin, Streptomycin and Neomycin. Specifically, Ciprofloxacin-loaded keratin hydrogels completely prevented both Gram-positive and Gram-negative bacteria growth for at least 2 weeks in vitro. The ability of Ciprofloxacin-loaded keratin hydrogels to restore healing of infected, full-thickness skin wounds is being investigated in a porcine model. These studies suggest antibiotic-loaded keratin hydrogels have the potential to prevent infection resulting from battlefield injury. . Group A B C D E Treatment Groups for Excision Study Tissue Wounds Test Material Harvest per Pig Day 3 3 Infected Day 7 3 Keratin Gel + 20 mg/ml Ciprofloxacin Day 11 3 Day 3 3 Infected Day 7 3 Keratin Gel + 10 mg/ml Ciprofloxacin Day 11 3 Day 3 3 Infected Day 7 3 Keratin Gel + 5 mg/ml Ciprofloxacin Day 11 3 Day 3 3 Infected Day 7 3 Saline Day 11 3 Day 3 3 Uninfected Day 7 3 Saline Day 11 3 Conclusions (A) (B) Figure 1. Keratin hydrogels support sustained release of several antibiotics. 100 l aliquots of the keratin hydrogels containing either Ciprofloxacin (2 mg/ml), Cefazolin (20 mg/ml), Streptomycin (20 mg/ml) or Neomycin (20 mg/ml) were placed in microcentrifuge tubes and overlaid with 100 l DPBS. DPBS was exchanged and analyzed at regular intervals. Antibiotics were quantified by fluorescence (Ciprofloxacin), light absorption (Cefazolin), size exclusion chromatography followed by UV absorption (Streptomycin), and ELISA (Neomycin, Europromixa, Netherlands). Data are presented as mean values +/- SEM of 3 separate gels. (A) Figure 5. Ciprofloxacin-loaded keratin hydrogels do not disrupt granulation tissue deposition. Full- Figure 3. Keratin hydrogels loaded with increasing Ciprofloxacin concentrations display increased antibiotic release and decreased gel degradation. 100 l aliquots of the keratin hydrogels containing either 20, 10, 5, 2, or 0 mg/ml Ciprofloxacin were placed in microcentrifuge tubes and overlaid with 100 l DPBS. DPBS was exchanged and analyzed at regular intervals. (A) Ciprofloxacin was quantified by fluorescence. (B) Total protein was quantified using a BCA assay. Data are presented as mean values +/- SEM of 3 separate gels. *, significant from all other treatments, p<0.05 (ANOVA). Methods Keratin Gel Preparation – Keratin was obtained by oxidative extraction of human hair and purified by KeraNetics using a patented process in a 21CFR820 validated facility. The lyophilized extract was weighed using a 95:5 a:g keratin ratio and hydrated with an aqueous solution containing antibiotics to achieve a 15% weight-to-volume ratio. Hydrogels formed overnight at 37 C. Porcine Excision Model – Full-thickness excision wounds were made on the dorsum of a pig using a 10 mm biopsy punch. Wounds were either infected with 2.5 x 104 colony-forming units (cfu) of Pseudomonas aeruginosa or uninfected (saline-treated) and allowed to heal. On days 1 and 3 post-surgery, infected wounds were treated with 200 l of antibiotic-loaded keratin hydrogels or saline. Biopsies were collected on days 3, 7, and 11 post-surgery for bacteria quantification and histological analysis. Results Results (B) (A) thickness wounds were infected with P. aeruginosa and treated with Ciprofloxacin (Cipro)-loaded keratin hydrogels as described in ‘Methods’. Wound tissue was biopsied on day 11 post-surgery, formalin-fixed, embedded in paraffin and sectioned. Sections through the center of the wound were stained using Masson’s Trichrome. Images represent 1 of 3 separate wounds. Arrows indicate wound edge. Bar = 1 mm. Conclusions • Keratin hydrogels support the sustained release of several antibiotics. • Ciprofloxacin-loaded keratin hydrogels inhibit Grampositive and Gram-negative bacteria growth for 2 weeks in vitro. • Ciprofloxacin-loaded keratin hydrogels decrease bacteria growth in a porcine excision wound model without interfering with healing. • Antibiotic-loaded keratin hydrogels make promising candidates to prevent infection resulting from battlefield injury. Acknowledgements (B) The authors would like to thank Sandra Becerra, Chris Bell, Sean Christy, and Nicole Wrice for their excellent technical assistance and Dr. Shanmugasundaram Natesan for helpful scientific discussion. This work was possible due to generous funding from the US Army, contracts # W81XWH-12-C-0004 and # W81XWH-10-C-0165. References Figure 2. Antibiotic-loaded keratin hydrogels inhibit bacteria growth. (A) Mueller-Hinton broth was inoculated with a single colony of P. aeruginosa and diluted to a concentration of 105 cfu/ml. The 105 cfu/ml broth was added to 1 ml of keratin hydrogels with or without the antibiotics, sampled daily, and serially diluted to determine the number of cfu/ml present in the broth. Data are presented as mean +/SEM of 3 separate gels. *, significant from ‘Keratin Only’, p<0.05 (ANOVA). (B) Similar studies to that described in (A) were carried out with Staphylococcus aureus and Fascioloides magna. After day 7, the bacterial culture was continued, and samples were diluted to 104 cfu/ml. Data represents the day in which colonies were observed at this dilution, indicating the failure of the antibiotic to control the bacteria growth. Data are presented as mean values +/- SEM of 3 separate gels. Figure 4. Ciprofloxacin-loaded keratin hydrogels decrease bacteria growth in vivo. Full-thickness wounds were infected with P. aeruginosa and treated with Ciprofloxacin (Cipro)-loaded keratin hydrogels as described in ‘Methods’. Wound tissue was biopsied on days 7 and 11, homogenized, serially diluted and plated onto either (A) Mueller-Hinton agar or (B) Pseudomonas-selective agar to determine viable cfu. Data are presented as mean values +/SEM of 3 separate wounds. *, significant from ‘Saline’, p<0.05 (ANOVA). 1.Wasiak J et al. Dressings for superficial and partial thickness burns. Cochrane Database Syst Rev. 2010. 2.Verma V et al. Preparation of scaffolds from human hair proteins for tissue-engineering applications. Biomed Mater. 2008; 3(2). 3.Sando L et al. Photochemical crosslinking of soluble wool keratins produces a mechanically stable biomaterial that supports cell adhesion and proliferation. J Biomed Mater Res A. 2010; 95(3). Animal Statement This study has been conducted in compliance with the Animal Welfare Act, the implementing Animal Welfare Regulations, and the principles of the Guide for the Care and Use of Laboratory Animals. Department of Defense Disclaimer The opinions or assertions contained herein are the private views of the author and are not to be construed as official or as reflecting the views of the Department of the Army or the Department of Defense.
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