PROJECT SUMMARY/ABSTRACT: Open fractures are frequently (more than 150,000 cases in the U.S. every
year) seen and have high (~10%) infection rates. Open fracture-associated infections are clinically devastating,
and have led to reduced limb function, secondary operations, delayed union/nonunion, and death. Infection has
led to significantly high costs in healthcare, resulting in approximately $500 million of additional costs in managing
open fractures each year in the U.S. Further complicating the problem, alarmingly high percentages (e.g., 32.2%
for tibial fractures) of open fracture infections are associated with antibiotic resistant bacteria, which have led to
a two-fold increase in morbidity and mortality, and have made the drug choices for infection management
increasingly limited. The long-term goal of this application is to develop translational strategies to prevent or
treat bone infections in clinical settings. The objective of this project is to develop safe antimicrobial nanohybrid
methods to reduce antibiotic resistant infections in open fractures. The central hypothesis is that nanohybriding
two unique antimicrobial materials with different dimensions at the nanometer scale will synergistically enhance
antimicrobial properties and significantly reduce host toxicity. There are three specific aims: (i) To test the
hypothesis that innovative silver nanoparticle-carbon nanotube (AgNP-CNT) nanohybrids present high
antimicrobial properties against various bacteria seen in open fractures and low toxicity toward cells important
to bone. (ii) To test the hypothesis that AgNP-CNT nanohybrids present high antimicrobial properties and low
host toxicity in preventing antibiotic resistant infections in an animal model. (iii) To test the hypothesis that
bioengineering AgNP-CNT nanohybrids on implant surfaces enhances preclinical outcomes. Specifically, the in
vitro antimicrobial properties of AgNP-CNT nanohybrids will be tested against a variety of bacteria and their
cytotoxicity properties toward multiple human cells will be determined. The nanohybrids will be tested in an open
femur fracture rat model to assess their effects on infection, healing, and host toxicity. Moreover, the nanohybrids
will be bioengineered on orthopaedic implants and their coatings will be tested both in vitro and in vivo; delivering
antimicrobials at the implant surface is expected to achieve high antimicrobial levels at the right place to minimize
systemic toxicity. This project will contribute new knowledge on how hybriding two materials with different
dimensions at the nanometer scale may synergistically increase antimicrobial properties and reduce host toxicity.
The expected outcome is a biologically safe, nanotechnology-based strategy that will drive and broaden the
safe use of silver and carbon nanotubes for local biomedical applications (e.g., open fracture fixation). The
nanohybrids may be engineered on various medical products – ranging from bone grafts, dental implants, and
catheters, to bandages and needles – to reduce infections while improving recovery.