title: Role of Electrochemically Activated Solution in Asepsis in Osteoblasts and Chondrocytes in vitro.
abstract: OBJECTIVE
  Implant infections are severe complications in orthopedic surgery. Treatment using antibiotics is often unsuccessful without removing the implant due to biofilm formation. In this context, antiseptics may be a potential option. These solutions have a wide antimicrobial spectrum but often cause damage to the local cell populations. In these cases, electrochemically activated solutions (ECAS) may be an alternative.
  
  
  METHODS
  Staphylococcus aureus was cultured overnight on polyethylene platelets under different growing conditions (standard-/-different biofilm inducing conditions). The samples were treated with an ECAS (0%-30%) and analyzed with regard to their antimicrobial efficacy and their effect on biofilm structures by determining the living bacterial count and scanning electron microscopy. Osteoblast and chondrocyte cell lines (MG-63, and CAL-78, respectively) were cultured to confluence and treated with an ECAS. Total cell count, metabolic activity using FDA staining, and proliferation using Ki67 staining were analyzed.
  
  
  RESULTS
  ECAS showed antimicrobial activity in concentrations <1%. In cases of biofilm formation, bacterial toxicity could be detected at concentrations from 3.75 -7.5%. At these same concentrations, a visible change in biofilm structure was observed. Regarding biocompatibility rates, up to 7.5% (of osteoblasts) and 3.75% (of chondrocytes) had little influence on metabolic activity and proliferation.
  
  
  CONCLUSIONS
  ECAS provide good antimicrobial efficacy while maintaining high biocompatibility. These results suggest that these solutions may provide promising alternatives in the treatment of implant-associated infections.
authors.affiliation: a Department of Orthopaedics and Rheumatology , University Hospital Marburg , Marburg , Germany.
authors.forename: Nathalie S D
authors.initials: NS
authors.lastname: Michel
authors.affiliation: a Department of Orthopaedics and Rheumatology , University Hospital Marburg , Marburg , Germany.
authors.forename: Jürgen R J
authors.initials: JR
authors.lastname: Paletta
authors.affiliation: b Institute of Medical Microbiology and Hygiene, Philipps-University Marburg , Marburg , Germany.
authors.forename: Martina
authors.initials: M
authors.lastname: Kerwart
authors.affiliation: a Department of Orthopaedics and Rheumatology , University Hospital Marburg , Marburg , Germany.
authors.forename: Adrian
authors.initials: A
authors.lastname: Skwara
mesh_terms: D000891:Anti-Infective Agents, Local / Q000737:chemistry / Q000627:therapeutic use*; D019643:Arthroplasty, Replacement / Q000009:adverse effects; D001207:Asepsis / Q000379:methods*; D058491:Bacterial Load / Q000187:drug effects; D018441:Biofilms / Q000187:drug effects; D002452:Cell Count; D002460:Cell Line; D049109:Cell Proliferation / Q000187:drug effects; D019902:Chondrocytes / Q000187:drug effects*; D055664:Electrochemical Techniques; D006801:Humans; D008855:Microscopy, Electron, Scanning; D010006:Osteoblasts / Q000187:drug effects*; D016459:Prosthesis-Related Infections / Q000188:drug therapy*; D012996:Solutions / Q000627:therapeutic use; D013203:Staphylococcal Infections / Q000188:drug therapy*; D013211:Staphylococcus aureus / Q000187:drug effects*
chemical_list: D000891:Anti-Infective Agents, Local; D012996:Solutions
keywords: antimicrobial effect; antiseptics; biofilm; cytotoxicity on musculoskeletal system; electrochemically activated solution; implant-associated infection