In Vitro Evaluation of a Fibrin Gel Antibiotic Delivery System Containing Mesenchymal Stem Cells and Vancomycin Alginate Beads for Treating Bone Infections and Facilitating Bone Formation

Abstract

Bone infection and defects are two major problems that occur in the course of treating posttraumatic open bone fractures and osteomyelitis for which local antibiotic delivery is efficacious. Further, hemostasis is an essential treatment after removal of infected bones. Herein we report a new antibiotics delivery system made of vancomycin alginate beads embedded in a fibrin gel (Vanco-AB-FG) to treat bone infections, with the addition of bone marrow–derived mesenchymal stem cells (BMMSCs) seeded in the fibrin gel to promote bone formation. The proliferation of BMMSCs was measured under different conditions of three-dimensional (3D) gel or monolayer, with or without Vanco-AB; cells were labeled by enhanced green fluorescence protein, and their morphology and distribution were observed. The alkaline phosphatase (ALP) activity, real-time RT-PCR, and von Kossa staining were used for determining the osteogenic differentiation of BMMSCs. The concentrations of vancomycin resulting from the antibiotic delivery were determined; the antibiotic activity was evaluated by an assay with standard Staphylococcus aureus (ATCC 25923) as a biological target. The results showed that for Vanco-AB-FG, vancomycin concentrations remained above the breakpoint sensitivity for 22 days. The 3D culture within the gel and the addition of Vanco-AB affected the cell behavior. The morphology of BMMSCs within the 3D gel was different from that in monolayer. The proliferation of the cells within the 3D gel was lower than that in monolayer in early stage, but in later stage the number of BMMSCs in Vanco-AB-FG was similar to that in monolayer. The ALP activity was higher in the 3D gel, and the addition of Vanco-AB slightly increased ALP activity. The osteogenic gene expression levels of ALP, osteopontin, and α1 chain of collagen I were higher in the 3D gel than those in monolayer, and additional Vanco-AB could also increase their expression. The von Kossa staining showed that the deposition of mineralization was observed in both the 3D gel and monolayer cultures, but the mineralization nodule size in monolayer was bigger and the number of them in 3D gel was greater. In conclusion, this system could be an alternative treatment for bone infections and defects.