Enhanced antibiotic release and biocompatibility with simultaneous addition of N-acetylcysteine and vancomycin to bone cement: a potential replacement for high-dose antibiotic-loaded bone cement
Abstract Background Antibiotic-loaded bone cement (ALBC) is crucial for treating orthopedic infections, but its use is limited by suboptimal antibiotic release patterns and potential toxicity. This study explores the dual addition of N-acetylcysteine (NAC) and vancomycin to polymethylmethacrylate (P...
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| Format: | Article |
| Language: | English |
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BMC
2025-03-01
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| Series: | Journal of Orthopaedic Surgery and Research |
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| Online Access: | https://doi.org/10.1186/s13018-025-05637-y |
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| author | Tzu-Hao Tseng Chih-Hao Chang Chien-Lin Chen Hongsen Chiang Jyh-Horng Wang Tai-Horng Young |
| author_facet | Tzu-Hao Tseng Chih-Hao Chang Chien-Lin Chen Hongsen Chiang Jyh-Horng Wang Tai-Horng Young |
| author_sort | Tzu-Hao Tseng |
| collection | DOAJ |
| description | Abstract Background Antibiotic-loaded bone cement (ALBC) is crucial for treating orthopedic infections, but its use is limited by suboptimal antibiotic release patterns and potential toxicity. This study explores the dual addition of N-acetylcysteine (NAC) and vancomycin to polymethylmethacrylate (PMMA) as a strategy to enhance the antibacterial efficacy and reduce toxicity. Methods PMMA cement cylinders were loaded with varying combinations of NAC and vancomycin and tested for antibiotic release, cytotoxicity, and antibacterial activity over a 35-day period. Porosity of the cements was also evaluated as a measure of potential antibiotic release enhancement. Results The addition of NAC improved vancomycin release, particularly after the initial burst release phase, and reduced cytotoxicity compared to high-dose vancomycin alone. The optimal combination was found to be 2 gm vancomycin with either 2 gm or 4 gm of NAC, which maintained effective antibacterial activity over 35 days without the toxicity seen with higher doses of vancomycin alone. Moreover, NAC alone did not demonstrate antibacterial properties, indicating its role primarily as a bioenhancer in this context. Conclusion Simultaneous inclusion of NAC and vancomycin in PMMA bone cement provides a more favorable release profile and biocompatibility than high-dose vancomycin alone, suggesting a potential strategy for enhancing the therapeutic efficacy of ALBC in treating prosthetic joint infections. This approach allows for lower doses of antibiotics, reducing potential cytotoxicity, systemic toxicity and enhancing the duration of antibacterial activity. Level of evidence Laboratory study. |
| format | Article |
| id | doaj-art-db7d1f9a224a4fd28ade4e8b5eb5802c |
| institution | DOAJ |
| issn | 1749-799X |
| language | English |
| publishDate | 2025-03-01 |
| publisher | BMC |
| record_format | Article |
| series | Journal of Orthopaedic Surgery and Research |
| spelling | doaj-art-db7d1f9a224a4fd28ade4e8b5eb5802c2025-08-20T03:05:49ZengBMCJournal of Orthopaedic Surgery and Research1749-799X2025-03-012011910.1186/s13018-025-05637-yEnhanced antibiotic release and biocompatibility with simultaneous addition of N-acetylcysteine and vancomycin to bone cement: a potential replacement for high-dose antibiotic-loaded bone cementTzu-Hao Tseng0Chih-Hao Chang1Chien-Lin Chen2Hongsen Chiang3Jyh-Horng Wang4Tai-Horng Young5Department of Orthopaedic Surgery, National Taiwan University HospitalDepartment of Orthopaedic Surgery, National Taiwan University HospitalDepartment of Orthopaedic Surgery, National Taiwan University HospitalDepartment of Orthopaedic Surgery, National Taiwan University HospitalDepartment of Orthopaedic Surgery, National Taiwan University HospitalDepartment of Biomedical Engineering, College of Medicine, National Taiwan UniversityAbstract Background Antibiotic-loaded bone cement (ALBC) is crucial for treating orthopedic infections, but its use is limited by suboptimal antibiotic release patterns and potential toxicity. This study explores the dual addition of N-acetylcysteine (NAC) and vancomycin to polymethylmethacrylate (PMMA) as a strategy to enhance the antibacterial efficacy and reduce toxicity. Methods PMMA cement cylinders were loaded with varying combinations of NAC and vancomycin and tested for antibiotic release, cytotoxicity, and antibacterial activity over a 35-day period. Porosity of the cements was also evaluated as a measure of potential antibiotic release enhancement. Results The addition of NAC improved vancomycin release, particularly after the initial burst release phase, and reduced cytotoxicity compared to high-dose vancomycin alone. The optimal combination was found to be 2 gm vancomycin with either 2 gm or 4 gm of NAC, which maintained effective antibacterial activity over 35 days without the toxicity seen with higher doses of vancomycin alone. Moreover, NAC alone did not demonstrate antibacterial properties, indicating its role primarily as a bioenhancer in this context. Conclusion Simultaneous inclusion of NAC and vancomycin in PMMA bone cement provides a more favorable release profile and biocompatibility than high-dose vancomycin alone, suggesting a potential strategy for enhancing the therapeutic efficacy of ALBC in treating prosthetic joint infections. This approach allows for lower doses of antibiotics, reducing potential cytotoxicity, systemic toxicity and enhancing the duration of antibacterial activity. Level of evidence Laboratory study.https://doi.org/10.1186/s13018-025-05637-yAntibiotic-loaded bone cementVancomycinN-acetylcysteinePMMACytotoxicity |
| spellingShingle | Tzu-Hao Tseng Chih-Hao Chang Chien-Lin Chen Hongsen Chiang Jyh-Horng Wang Tai-Horng Young Enhanced antibiotic release and biocompatibility with simultaneous addition of N-acetylcysteine and vancomycin to bone cement: a potential replacement for high-dose antibiotic-loaded bone cement Journal of Orthopaedic Surgery and Research Antibiotic-loaded bone cement Vancomycin N-acetylcysteine PMMA Cytotoxicity |
| title | Enhanced antibiotic release and biocompatibility with simultaneous addition of N-acetylcysteine and vancomycin to bone cement: a potential replacement for high-dose antibiotic-loaded bone cement |
| title_full | Enhanced antibiotic release and biocompatibility with simultaneous addition of N-acetylcysteine and vancomycin to bone cement: a potential replacement for high-dose antibiotic-loaded bone cement |
| title_fullStr | Enhanced antibiotic release and biocompatibility with simultaneous addition of N-acetylcysteine and vancomycin to bone cement: a potential replacement for high-dose antibiotic-loaded bone cement |
| title_full_unstemmed | Enhanced antibiotic release and biocompatibility with simultaneous addition of N-acetylcysteine and vancomycin to bone cement: a potential replacement for high-dose antibiotic-loaded bone cement |
| title_short | Enhanced antibiotic release and biocompatibility with simultaneous addition of N-acetylcysteine and vancomycin to bone cement: a potential replacement for high-dose antibiotic-loaded bone cement |
| title_sort | enhanced antibiotic release and biocompatibility with simultaneous addition of n acetylcysteine and vancomycin to bone cement a potential replacement for high dose antibiotic loaded bone cement |
| topic | Antibiotic-loaded bone cement Vancomycin N-acetylcysteine PMMA Cytotoxicity |
| url | https://doi.org/10.1186/s13018-025-05637-y |
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