Immunomodulatory biomaterials against bacterial infections: Progress, challenges, and future perspectives

Shutao Zhang; Hongtao Yang; Minqi Wang; Diego Mantovani; Ke Yang; Frank Witte; Lili Tan; Bing Yue; Xinhua Qu

doi:10.1016/j.xinn.2023.100503

Immunomodulatory biomaterials against bacterial infections: Progress, challenges, and future perspectives

Innovation (Camb). 2023 Aug 28;4(6):100503. doi: 10.1016/j.xinn.2023.100503. eCollection 2023 Nov 13.

Authors

Shutao Zhang¹, Hongtao Yang², Minqi Wang¹, Diego Mantovani³, Ke Yang⁴, Frank Witte⁵, Lili Tan⁴, Bing Yue¹, Xinhua Qu¹

Affiliations

¹ Department of Bone and Joint Surgery, Department of Orthopedics, Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200001, China.
² School of Engineering Medicine, Beihang University, Beijing 100191, China.
³ Laboratory for Biomaterials and Bioengineering, Canada Research Chair I in Biomaterials and Bioengineering for the Innovation in Surgery, Department of Min-Met-Materials Engineering, Research Center of CHU de Quebec, Division of Regenerative Medicine, Laval University, Quebec City, QC G1V 0A6, Canada.
⁴ Institute of Metal Research, Chinese Academy of Sciences, Shenyang 110016, China.
⁵ Department of Prosthodontics, Geriatric Dentistry and Craniomandibular Disorders, Charite Medical University, Assmannshauser Strasse 4-6, 14197 Berlin, Germany.

Abstract

Bacterial infectious diseases are one of the leading causes of death worldwide. Even with the use of multiple antibiotic treatment strategies, 4.95 million people died from drug-resistant bacterial infections in 2019. By 2050, the number of deaths will reach 10 million annually. The increasing mortality may be partly due to bacterial heterogeneity in the infection microenvironment, such as drug-resistant bacteria, biofilms, persister cells, intracellular bacteria, and small colony variants. In addition, the complexity of the immune microenvironment at different stages of infection makes biomaterials with direct antimicrobial activity unsatisfactory for the long-term treatment of chronic bacterial infections. The increasing mortality may be partly attributed to the biomaterials failing to modulate the active antimicrobial action of immune cells. Therefore, there is an urgent need for effective alternatives to treat bacterial infections. Accordingly, the development of immunomodulatory antimicrobial biomaterials has recently received considerable interest; however, a comprehensive review of their research progress is lacking. In this review, we focus mainly on the research progress and future perspectives of immunomodulatory antimicrobial biomaterials used at different stages of infection. First, we describe the characteristics of the immune microenvironment in the acute and chronic phases of bacterial infections. Then, we highlight the immunomodulatory strategies for antimicrobial biomaterials at different stages of infection and their corresponding advantages and disadvantages. Moreover, we discuss biomaterial-mediated bacterial vaccines' potential applications and challenges for activating innate and adaptive immune memory. This review will serve as a reference for future studies to develop next-generation immunomodulatory biomaterials and accelerate their translation into clinical practice.

Publication types

Review