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REVIEW ARTICLE

Preventing bacterial adhesion on scaffolds for bone

tissue engineering

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1,2
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Sandra Sánchez-Salcedo , Montserrat Colilla , Isabel Izquierdo-Barba and María
Vallet-Regí 1,2*
1 Department of Inorganic and Bioinorganic Chemistry, Faculty of Pharmacy, Complutense University of Madrid, Sani-
tary Research Institute “Hospital 12 de Octubre i+12”. Plaza Ramón y Cajal S/N, E-28040 Madrid, Spain
2 Center on Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), Spain

Abstract: Bone implant infection constitutes a major sanitary concern which is associated to high morbidity and health
costs. This manuscript focused on overviewing the main research efforts committed up to date to develop innovative
alternatives to conventional treatments, such as those with antibiotics. These strategies mainly rely on chemical modifi-
cations of the surface of biomaterials, such as providing it of zwitterionic nature, and tailoring the nanostructure surface
of metal implants. These surface modifications have successfully allowed inhibition of bacterial adhesion, which is the
first step to implant infection, and preventing long-term biofilm formation compared to pristine materials. These strate-
gies could be easily applied to provide three-dimensional (3D) scaffolds based on bioceramics and metals, of which its
manufacture using rapid prototyping techniques was reviewed. This opens the gates for the design and development of
advanced 3D scaffolds for bone tissue engineering to prevent bone implant infections.
Keywords: Antibacterial adhesion, biofilm formation, zwitterionic surfaces, nanostructured surfaces, rapid prototyping
3D scaffolds, bone tissue engineering.

*Correspondence to: María Vallet-Regí, Department of Inorganic and Bioinorganic Chemistry, Faculty of Pharmacy, Complutense Univer-
sity of Madrid, Institute of Investigation Sanitaria Hospital 12 de Octubre i+12. Ramón and Cajal Plaza s/n, E-28040 Madrid, Spain; Email:
vallet@ucm.es
Received: October 27, 2015; Accepted: December 8, 2015; Published Online: December 28, 2015
Citation: Sánchez-Salcedo S, Colilla M, Izquierdo-Barba I, et al., 2016, Preventing bacterial adhesion on scaffolds for bone tissue
engineering. International Journal of Bioprinting, vol.2(1): 20–34. http://dx.doi.org/10.18063/IJB.2016.01.008.

1. Introduction the developed world are caused by organisms growing
T community consisting of prokaryotic cells perma-
[4]
on biofilms . A biofilm is a microbial-derived sessile
he infection risk of bone implants is a major
clinical concern that could lead to implant fail-
nently attached to a substratum one to each other, em-
ure and subsequent serious postoperative com-
plications of surgical procedures with high morbidity bedded in a matrix of extracellular polymeric sub-
[2]
stances that it had produced . Bacteria forming bio-
and costs to the national healthcare systems. Bone films are resistant to host defenses and conventional
implant infections are usually caused by bacterial at- antibacterial therapies such as vaccines and antibiotics
[1]
tachment and colonization on the implant surface . that are effective to eliminate infections caused by
[5]
Bacterial adhesion and subsequent growth usually planktonic bacteria . Therefore, the initial bacterial
results in slime enclosed biofilm formation on the im- adhesion to the biomaterial surface becomes critical in
plant surface [2,3] . In fact, it has been estimated that infection pathogenesis.
65–80% of bacterial infections treated by clinicians in Of late, new approaches have been proposed to

Preventing bacterial adhesion on scaffolds for bone tissue engineering. © 2016 Sandra Sánchez-Salcedo, et al. This is an Open Access article distri-
buted under the terms of the Creative Commons Attribution-NonCommercial 4.0 International License (http://creativecommons.org/licenses/by-nc/4.0/),
permitting all non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
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