title: Ultrasound microbubbles enhance human β-defensin 3 against biofilms.
abstract: BACKGROUND
  The infection of orthopedic implantation devices with Staphylococcus has been a serious concern within the biomaterial community. Treatments are not always successful because of antibiotic-resistant bacteria biofilm infection. Recent studies have shown that combination of antibiotics with low-frequency ultrasound (US) can enhance the bactericidal activity effectively against the formation of biofilms in vitro pilot study. Meanwhile, microbubbles evolved as targeted drug-delivery agents can provide nuclei for inertial cavitation and lower the threshold for US-induced cavitation. Human β-defensin 3 (HBD-3) is a cationic antimicrobial peptide considered particularly promising for future bactericidal employment and has effect on antibiotic-resistant Staphylococcus biofilms. But the effect has not been reported when combined with US-targeted microbubble destruction (UTMD) in vivo.
  
  
  METHODS
  In this study, we evaluated the effect of HBD-3 combined with UTMD on two tested Staphylococcus by the spread plate method, crystal violet staining, confocal laser scanning microscopy, scanning electron microscopy, and real-time polymerase chain reaction.
  
  
  RESULTS
  In the study, we found that the biofilm densities, the percentage of live cells, and the viable counts of two tested Staphylococcus that recovered from the biofilm on the titanium surface in mice were significantly decreased in the group of the HBD-3 combined with UTMD, compared with those of other groups. Furthermore, in the experiment, we found out that UTMD could enhance HBD-3 activity, which inhibits the biofilm-associated genes expression of icaAD and the methicillin-resistance genes expression of MecA by promoting the icaR expression simultaneously.
  
  
  CONCLUSIONS
  The combination of HBD-3 with UTMD can play a significant role on the elimination of the antibiotic-resistant Staphylococcus biofilms in vivo.
authors.affiliation: Department of Orthopaedic Surgery, Anhui Provincial Hospital of Anhui Medical University, Hefei, China.
authors.forename: Shoumin
authors.initials: S
authors.lastname: Li
authors.affiliation: Department of Orthopaedic Surgery, Anhui Provincial Hospital of Anhui Medical University, Hefei, China.
authors.forename: Chen
authors.initials: C
authors.lastname: Zhu
authors.affiliation: Department of Orthopaedic Surgery, Anhui Provincial Hospital of Anhui Medical University, Hefei, China.
authors.forename: Shiyuan
authors.initials: S
authors.lastname: Fang
authors.affiliation: Department of Geriatrics, Anhui Provincial Hospital of Anhui Medical University, Hefei, China.
authors.forename: Weiwei
authors.initials: W
authors.lastname: Zhang
authors.affiliation: Department of Ultrasound, Anhui Provincial Hospital of Anhui Medical University, Hefei, China.
authors.forename: Nianan
authors.initials: N
authors.lastname: He
authors.affiliation: Department of Orthopaedic Surgery, Anhui Provincial Hospital of Anhui Medical University, Hefei, China.
authors.forename: Wei
authors.initials: W
authors.lastname: Xu
authors.affiliation: Department of Orthopaedic Surgery, Anhui Provincial Hospital of Anhui Medical University, Hefei, China. Electronic address: kongrongahslyy@163.com.
authors.forename: Rong
authors.initials: R
authors.lastname: Kong
authors.affiliation: Department of Orthopaedic Surgery, Anhui Provincial Hospital of Anhui Medical University, Hefei, China. Electronic address: shangxifuahslyy@163.com.
authors.forename: Xifu
authors.initials: X
authors.lastname: Shang
mesh_terms: D000818:Animals; D001426:Bacterial Proteins / Q000378:metabolism; D018441:Biofilms; D004353:Drug Evaluation, Preclinical; D008297:Male; D051379:Mice; D008807:Mice, Inbred BALB C; D008826:Microbial Sensitivity Tests; D045423:Microbubbles; D018613:Microscopy, Confocal; D008855:Microscopy, Electron, Scanning; D046915:Penicillin-Binding Proteins; D010641:Phenotype; D016459:Prosthesis-Related Infections / Q000188:drug therapy*; D013211:Staphylococcus aureus; D013212:Staphylococcus epidermidis; D014025:Titanium; D014464:Ultrasonic Therapy; D023083:beta-Defensins / Q000008:administration & dosage*
chemical_list: D001426:Bacterial Proteins; C422950:DEFB103A protein, human; C487495:MecA protein, Staphylococcus epidermidis; D046915:Penicillin-Binding Proteins; D023083:beta-Defensins; C487789:mecA protein, Staphylococcus aureus; D014025:Titanium
keywords: Biofilm; Microbubbles; Mouse; Staphylococcus; Ultrasound; β-defensin