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Antibacterial Polymers: a Mechanistic Overview

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Antibacterial Polymers: a Mechanistic Overview Antibacterial Polymers: A Mechanistic Overview Ao Chen,1,3 Hui Peng,1,3Idriss Blakey,1,2 Andrew K. Whittaker1,2,3* 1Australian Institute for Bioengineering and Nanotechnology, The University of Queensland, Brisbane Qld 4072 2Centre for Advanced Imaging, The University of Queensland, Brisbane Qld 4072 3ARC Centre of Excellence in Convergent Bio-Nanoscience and Technology Bacterial fouling on surfaces is considered a major problem in modern society. Conventional methods to prevent biofilm formation often have little effect and may induce further contamination. In response to this challenge, antibacterial polymers have been designed and applied as an alternative approach to kill or inhibit bacteria and prevent the formation of biofilm. These polymers can be grouped into three broad classes, namely antibiotic-releasing polymers, polymeric antibiotics and antibiotic polymers. Antibiotic polymers are effective against bacteria both in solution and as coatings, through different mechanisms of action. In order to enhance their efficacy, antibacterial polymers have been designed with single or combined antibacterial and antibiofouling actions. The current review summarizes the mechanisms of action of antibacterial polymers, especially antibiotic polymers, both in solution and as coatings. It also discusses the antibacterial polymers with multiple functionalities. KEYWORDS: Antibacterial polymers, biofilms, mechanisms of action, testing 1. Introduction 1 Microbial fouling on the surface of materials is one of the major causes of poor hygiene. Such fouling appears in contaminated food storage, public facilities, household decorations, etc., and especially in hospitals and other medical environments. Nosocomial (hospital-based) contaminations have been considered as the major pathway of the spreads of bacterial and viral diseases1,2 and suggested to be historically responsible for several major disease outbreaks.3,4 The process of surface contamination leads to “biofilm formation”, during which a matrix of extracellular polymeric substances is excreted by the attached bacteria with the result that their colonies are protected from disinfectants. Biofilms can amplify the persistence of nosocomial pathogens,5 surpassing weeks or even months on inanimate surfaces.6 In brief, the steps in biofilm formation include initial attachment, permanent attachment and accumulation, film maturation and nourishment, and dispersion.7 It should be emphasized that the process of biofilm formation is irreversible after the initial attachment of microbes, during which large and continuous doses of disinfectants and/or antibiotics are required to eradicate the biofilm and prevent its repeated formation.8 Common disinfectants exploited include hypochlorite, reactive oxygen species (e.g. hydrogen peroxide), triclosan, silver salts, quaternary ammonium salts and alcohols.9 Advanced antibiotics have also been utilized.10 However, the presence of the biofilm significantly reduces the effects of disinfectants below lethal levels.7,11 On the other hand, continuous applications of small-molecule disinfectants or antibiotics at sub-lethal doses may induce enhanced biofilm formation12-14 and may potentially give rise to multi-resistant bacterial species.9,15,16 Hence, there is a pressing need to develop new antibacterial substances/materials to address this crucial problem. Recent advances in the field of polymer synthesis have greatly expanded the potential reach of polymers. The discovery of living/controlled polymerizations has enabled scientists to produce polymers with 2 controlled molecular weight, tailored properties and appropriate functionality for specific applications.17 Furthermore, with improvements in instrumental methods, such as NMR, fluorescence, AFM, X-ray and neutron diffraction, characterization of polymers has significantly advanced, providing clearer insight into their behavior under different situations. The combination of polymer science and the requirement for long-lasting sterilization has given rise to antibacterial polymers, which kill or inhibit the bacteria when they approach or are in contact. The advantages of antibacterial polymers are self-evident.12,13 Compared to small-molecule disinfectants, antibacterial polymers can usually exert long-lasting resistance against bacteria with a high concentration of active components and physical/chemical stability.18 Furthermore, antibacterial polymers also possess longer shelf- life, lower toxicity toward normal tissue and lower probability of inducing drug-resistant bacterial species.19 Compared to advanced antibiotics, such as antimicrobial peptides, the cost of antibacterial polymers is significantly lower due to the use of mature methods of synthesis and processing. Thus antibacterial polymers have become recognized as a very promising class of antibacterial materials. The past decade has witnessed rapid development of the field of antibacterial polymers, as summarized in a number of excellent reviews. In 2007, Kenawy et al. summarized the basic requirements of antibacterial polymers in a review focused on the factors that affect antibiotic activity of such materials (molecular weight, counter-ions and alkylation), the different methods of preparation, and the methods of application of antibacterial polymers.18 In the same year, Gabriel et al. surveyed the field of antibacterial polymers in which activity is determined by their amphiphilicity nature.20 Their review concentrated on host defense peptides and their synthetic mimics; finally this paper made a valuable contribution by discussing physicochemical 3 methods of analysis of interactions with cells. Munoz-Bonilla and Fernández-García provided in 2012 a systematic review on the different synthetic polymers with antibacterial properties, including design, synthesis and antimicrobial testing.21 More detailed discussions of the mechanism of action of antibacterial polymers were provided by Timofeeva and Kleshcheva, and Siedenbiedel and Tiller. Timofeeva and Kleshcheva summarized the mechanisms of action of antibacterial polymers and their coatings, and the factors that influence the behavior and toxicity of the materials, including molecular weight, alkylation and structure of the amine groups.22 The review by Siedenbiedel and Tiller categorized antibacterial polymers and “contact active” coatings based on the functional mechanisms and summarized research on antibacterial polymers with multiple properties.23 Jain et al. provided an overview of the different classes of antibacterial polymers, in which the effects of molecular weight and alkyl chain length, charge density, hydrophilicity, counter-ions, and pH were briefly discussed.24 Recently, Ganewatta and Tang comprehensively surveyed the design of different types of membrane-active antibacterial polymers (antibiotic polymers) through the adjustment of structural parameters, especially the amphiphilic balance, molecular weight and the selection of cationic groups to acquire optimal antibacterial activity and biocompatibility.25 Assemblies of antibacterial polymers were also discussed. However, according to our knowledge, previous reviews, especially in early reviews, the surveys on the mechanism of action of antibacterial polymers were often incomprehensive, sometimes with obscure classification in the concept of different antibacterial polymers. In the meantime, no survey has been conducted upon the mechanisms of antibiotic polymers immobilized as coatings since Timofeeva and Siedenbiedel, during which new results have provided deeper understanding in the mode of action of antibiotic polymer coatings. As a result, in this review, we focus on the discussion of the mechanism of action of antibacterial polymers 4 and how this is related to structure elaborately and concisely. We will first clearly give out the classification of antibacterial polymers to define and differentiate the concepts, with brief introduction to respective techniques of preparation based on recent developments. Focusing on antibiotic polymers, its current understanding of the mechanism of action in solution will be comprehensively discussed in relation to the effects of different structural parameters. The properties of antibiotic polymer coatings are then presented by refining latest and representative studies into three models. Finally, the design for antibacterial polymers with multiple functionalities will be elaborated. 2. Antibacterial Polymers in Solution: Mechanisms and Key Structural Factors 2.1 Classification of Antibacterial Polymers To date, three main concepts have been used in the design of effective antibacterial polymers: a) antibiotic- releasing polymers, b) polymeric antibiotics and c) antibiotic polymers.23 Antibiotic-releasing polymers carry antibiotics through physically- or chemically-reversible interactions, which can be released to a desired site to reach relatively high local concentrations in a controlled manner. Polymeric antibiotics are polymers that carry small-molecule antibiotics as pendant groups or repeat units which act in the same manner as their small-molecule antibacterial analogues. Antibiotic polymers usually possess the structure of a facially amphiphilic polycation and have antibacterial activities derived from the whole molecule (see Figure 1 for a schematic illustration of the three classes). However, since the mechanisms of action of antibiotic-releasing polymers and polymeric antibiotics are largely due to the properties of small molecule antibiotics, this review will
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