血管移植物感染(VGI)是一种令人恐惧的并发症。预防是最重要的,血管移植涂层(VGC)可以提供这样做的潜力,体外研究是至关重要的第一步。这项研究的目的是总结研究预防VGI的涂层策略的体外模型的关键特征,以便为未来转化研究的建立提供指导。
在MEDLINE中进行了全面搜索,Embase,和WebofScience。
根据系统评价和荟萃分析指南的首选报告项目进行系统评价。对于每个数据库,制定了具体的搜索策略。使用毒理学数据可靠性评估工具(ToxRTool)评估质量。包括使用VGC和用病原体接种移植物的体外模型。移植物的类型,涂层,和病原体进行了总结。评估每个研究中的结果评估。
总共,确定了4667项研究,其中45篇论文符合纳入标准。大多数使用聚酯接枝(68.2%)。31项研究(68.9%)包括抗生素,9项研究(20%)在其方案中使用了商业银移植物。新的抗菌策略(例如,蛋白水解酶)进行了研究。发现了多种测试方法,主要集中在细菌粘附上,涂层粘附和稀释,生物膜的形成,和细胞毒性。93%的研究(n=41)被认为是不可靠的。
聚酯是优选的接枝涂层类型。大多数涂层研究是基于抗生素;然而,新的涂层策略(例如,抗生物膜涂层)来了。许多体外设置是可用的。体外研究有很大的潜力,他们可以限制使用,但不能完全取代体内研究。本文可作为今后体外研究的指导性文件。
Vascular graft infection (VGI) is a feared complication. Prevention is of the utmost importance and vascular graft coatings (VGCs) could offer a potential to do this, with in vitro research a first crucial step. The aim of this study was to summarise key features of in vitro models investigating coating strategies to prevent VGI in order to provide guidance for the setup of future translational research.
A comprehensive search was performed in MEDLINE, Embase, and Web of Science.
A systematic
review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. For each database, a specific search strategy was developed. Quality was assessed with the Toxicological data Reliability Assessment Tool (ToxRTool). In vitro models using a VGC and inoculation of the graft with a pathogen were included. The type of graft, coating, and pathogen were summarised. The outcome assessment in each study was evaluated.
In total, 4 667 studies were identified, of which 45 papers met the inclusion criteria. The majority used polyester grafts (68.2%). Thirty-one studies (68.9%) included antibiotics, and nine studies (20%) used a commercial silver graft in their protocol. New antibacterial strategies (e.g., proteolytic enzymes) were investigated. A variety of testing methods was found and focused mainly on bacterial adherence, coating adherence and dilution, biofilm formation, and cytotoxicity. Ninety-three per cent of the studies (n = 41) were considered unreliable.
Polyester is the preferred type of graft to coat on. The majority of coating studies are based on antibiotics; however, new coating strategies (e.g., antibiofilm coating) are coming. Many in vitro setups are available. In vitro studies have great potential, they can limit the use, but cannot replace in vivo studies completely. This paper can be used as a guidance document for future in vitro research.