title: Bacterial products primarily mediate fibroblast inhibition in biomaterial infection.
abstract: OBJECTIVE
  The stimulation of fibroblast growth is essential for the normal healing and tissue integration of biomaterials. The local elevation of proinflammatory mediators in infected perigraft fluid (PGF) may inhibit this growth. We sought to determine whether infected PGF inhibited fibroblast growth, and, if so, whether this was primarily dependent on the biomaterial, bacteria, or host.
  
  
  METHODS
  In vivo Dacron or expandable polytetra-fluoroethylene (ePTFE) grafts, sterile or colonized with slime-producing (RP-62A, viable or formalin-killed) or nonslime-producing (RP-62NA) Staphylococcus epidermidis (1 x 10(7) CFU/cm2), were implanted in Swiss Webster mice, and the PGF was harvested at 7 and 28 days. Antibodies to tumor necrosis factor alpha, interleukin 1 alpha, interferon gamma (7 micrograms/day), and indomethacin (50 micrograms/day) were administered by microinfusion pumps for 7 days and the PGF was harvested. Inhibition of the proinflammatory mediators was confirmed by enzyme-linked immunosorbant assay. The nontreated, heat-treated, or trypsin-digested in vivo PGF was incubated with an in vitro [3H]thymidine murine fibroblast (ATCC CCL-12) proliferation assay.
  
  
  RESULTS
  Fibroblast inhibition was significant at 7 and 28 days with infected PGF incubation compared with sterile and was not dependent on bacterial slime production or viability. Dacron sterile PGF did not significantly inhibit fibroblasts compared with control, whereas sterile ePTFE stimulated (P < 0.05) fibroblasts. Treatment of the PGF with proinflammatory cytokines, heat, and trypsin failed to reverse fibroblast inhibition in the infected state.
  
  
  CONCLUSIONS
  Biomaterial infection is associated with fibroblast inhibition that is dependent primarily on bacterial products and not the host or biomaterial. Conservative intervention strategies for graft infection need to address the problem of poor healing as well as bacterial clearance.
authors.affiliation: Department of Surgery, University of Louisville School of Medicine, Kentucky 40292, USA.
authors.forename: P K
authors.initials: PK
authors.lastname: Henke
authors.forename: T M
authors.initials: TM
authors.lastname: Bergamini
authors.forename: A L
authors.initials: AL
authors.lastname: Watson
authors.forename: K R
authors.initials: KR
authors.lastname: Brittian
authors.forename: D W
authors.initials: DW
authors.lastname: Powell
authors.forename: J C
authors.initials: JC
authors.lastname: Peyton
mesh_terms: D000818:Animals; D001672:Biocompatible Materials / Q000009:adverse effects*; D001807:Blood Vessel Prosthesis / Q000009:adverse effects*; D002455:Cell Division; D002460:Cell Line; D005347:Fibroblasts / Q000378:metabolism*; D018836:Inflammation Mediators / Q000037:antagonists & inhibitors / Q000378:metabolism; D008297:Male; D051379:Mice; D011093:Polyethylene Terephthalates / Q000009:adverse effects; D011138:Polytetrafluoroethylene / Q000009:adverse effects; D016459:Prosthesis-Related Infections / Q000209:etiology* / Q000473:pathology* / Q000517:prevention & control; D013203:Staphylococcal Infections / Q000209:etiology* / Q000473:pathology* / Q000517:prevention & control; D013212:Staphylococcus epidermidis / Q000472:pathogenicity
chemical_list: D001672:Biocompatible Materials; D018836:Inflammation Mediators; D011093:Polyethylene Terephthalates; D011138:Polytetrafluoroethylene