A Two-phase and Long-lasting Multi-antibacterial Coating Enables Titanium Biomaterials to Prevent Implants-related Infections

In clinical work, the main challenges for titanium (Ti) implantation are bacterial infection and aseptic loosening, which severely affect the survival rate of implants. The first 4 weeks post-operation is the infection peak phase of implants. Inhibiting implant infection caused by bacteria adhesion and proliferation during the early phase as well as promoting subsequent osteointegration is essential for implant success. Herein, we constructed a quaternary ammonium carboxymethyl chitosan (QCMC), collagen (COL Ⅰ) and hydroxyapatite (HAP) multilayers coating on Ti substrates via a modified layer-by-layer (LBL) technique and polymerization of dopamine. The QCMC/COL/HAP coating exhibited a multi-antibacterial property with a two-phase function: (1) At the first 4 weeks post-operation, the covalently bonded QCMC could be slowly degraded and demonstrated both contact-killing and release-killing properties during the infection peak phase; (2) At the second phase, osteogenesis and osseointegration-promotion capabilities were enhanced by HAP under the effective control of infection. The multifilm coating was degraded for more than 45 days under the action of collagenase Ⅰ, and displayed good biocompatibility and . Most importantly, the coating exhibited a long-lasting antibacterial activity for more than 3 months, against the main pathogenic bacteria of peri-implant infections. Both studies and animal models revealed a desirable osteogenic differentiation capacity of Ti-CCH. Therefore, our study reports a two-phase, long-lasting multi-antibacterial coating on Ti-CCH and indicates potential applications of the modified LBL strategy in orthopaedic fields, which is enlightening for developing practical implant and scaffold materials.