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Updated: Jun 19, 2025
Author Spotlight: Advancing Research on Candida albicans Biofilm-Associated Prosthetic Joint Infections
Published on: February 2, 2024
Cutibacterium acnes invades submicron osteocyte lacuno-canalicular networks following implant-associated
Mina Botros1,2, Karen L de Mesy Bentley1,2,3, Derek T Schloemann1,2
1Center for Musculoskeletal Research, University of Rochester Medical Center, Rochester, New York, USA.
Abstract:
Cutibacterium acnes, part of normal skin flora, is increasingly recognized as an opportunistic pathogen capable of causing chronic prosthetic joint infections (PJI) associated with total hip and knee arthroplasty. However, there is a paucity of literature examining the pathogenesis of C. acnes during PJI. To study this, we developed an implant-associated osteomyelitis murine model in which 8-10-week-old C57BL6 mice were subjected to transtibial implantation of titanium or stainless-steel L-shaped pins contaminated with C. acnes. Postsurgery, mice were killed on Days 14 and 28 for terminal assessments of (1) bacterial load in bone, implant, and internal organs (heart, spleen, kidney, and liver), (2) bone osteolysis (micro-CT), (3) abscess formation (histology), and (4) systematic electron microscopy (EM). In vitro scanning EM (SEM) confirmed that C. acnes can form biofilms on stainless-steel and titanium implants. In mice, C. acnes could persist for 28 days in the tibia. Also, we observed C. acnes dissemination to internal organs. C. acnes chronic osteomyelitis revealed markedly reduced bone osteolysis and abscess formation compared to Staphylococcus aureus infections. Importantly, transmission EM (TEM) investigation revealed the presence of C. acnes within canaliculi, demonstrating that C. acnes can invade the osteocyte lacuno-canalicular networks (OLCN) within bone. Our preliminary pilot study, for the first time, revealed that the OLCN in bone can be a reservoir for C. acnes and potentially provides a novel mechanism of why C. acnes chronic implant-associated bone infections are difficult to treat.
Insights
Cutibacterium acnes can persist in bone for 28 days and invade the osteocyte lacuno-canalicular networks (OLCN), potentially explaining why chronic prosthetic joint infections are challenging to treat.
Area of Science:
- Orthopedics
- Infectious Diseases
- Microbiology
Background:
- Cutibacterium acnes (C. acnes) is a normal skin bacterium increasingly implicated in prosthetic joint infections (PJI).
- The pathogenesis of C. acnes in PJI remains poorly understood, with limited research available.
- Chronic PJI caused by C. acnes are notoriously difficult to eradicate.
Purpose of the Study:
- To investigate the pathogenesis of C. acnes in an implant-associated osteomyelitis murine model.
- To explore C. acnes persistence, dissemination, and interaction with bone tissue.
- To identify potential mechanisms contributing to treatment resistance in C. acnes PJI.
Main Methods:
- Development of a murine model involving transtibial implantation of contaminated titanium or stainless-steel pins.
- Assessment of bacterial load, bone osteolysis (micro-CT), abscess formation (histology), and biofilm formation (SEM) at 14 and 28 days post-surgery.
- Transmission electron microscopy (TEM) to visualize C. acnes within bone microstructures.
Main Results:
- C. acnes successfully formed biofilms on implants in vitro and persisted in murine tibias for 28 days.
- Dissemination of C. acnes to internal organs was observed.
- C. acnes infections showed reduced osteolysis and abscess formation compared to Staphylococcus aureus.
- TEM revealed C. acnes invasion into the osteocyte lacuno-canalicular networks (OLCN).
Conclusions:
- The osteocyte lacuno-canalicular network (OLCN) serves as a potential reservoir for C. acnes.
- Invasion of the OLCN may represent a novel mechanism contributing to the recalcitrance of C. acnes chronic bone infections.
- This study provides crucial insights into C. acnes pathogenesis in PJI, paving the way for improved therapeutic strategies.
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