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Functionalization of titanium surfaces with bioactive and antimicrobial peptide coatings - A systematic review and
Lívia Maiumi Uehara1, Giovanna Lara de Souza Reis1, João Marcos Carvalho-Silva1
1Department of Dental Materials and Prosthesis, Ribeirão Preto Dental School, University of São Paulo (USP), Ribeirão Preto, SP, Brazil.
Background:
This systematic aimed to answer: "How do peptide coatings functionalize titanium (Ti) surfaces?". The question was structured according to the PICOS strategy, PRISMA guidelines were followed and the review was registered in the Open Science Framework.
Methods:
A personalized search strategy was applied to Embase, Lilacs, PubMed/MEDLINE, Science Direct, Scopus, Web of Science Google Scholar and ProQuest databases. Included studies were in vitro, in vivo, or ex vivo experiments investigating the antimicrobial and osteogenic effects of peptide-functionalized Ti surfaces against Sthaphylococcus aureus and/or MC3T3-E1 cells. Excluded papers were clinical studies, reviews, studies lacking Ti surfaces or controls, those not using S. aureus or MC3T3-E1 cells, or involving non-murine models or peptide coatings combined with other agents. The risk of bias was assessed using RoBDEMAT for in vitro and Syrcle for in vivo studies. Meta-analysis was performed using inverse variance method under a random-effects model, 95 % confidence intervals (95 % CI), p-values, and heterogeneity index (I2).
Results:
A total of 1731 potential studies were identified, 728 were screened by title and abstract, 52 were selected for full reading, 43 were included in this systematic review and all studies showed high risk of bias. In vitro, peptide-functionalized Ti surfaces significantly reduced S. aureus adhesion and proliferation (effect size: -8.10, 95 % CI [-13.33 to -2.86], p = 0.002) and showed slightly higher cytotoxicity (0.67 [0.37-0.98], p < 0.001) for MC3T3-E1 cells, but enhanced bone mineralization (4.63 [2.44-6.81], p < 0.001) and expression of pro-osteogenic genes (2.30 [1.89-2.71], p < 0.001). In vivo, functionalized implants led to greater new bone formation (7.81 [5.44-10.18], p < 0.001), trabecular number (11.22 [3.78-18.66], p = 0.003), and thickness (6.38 [3.05-9.71], p = 0.0002).
Discussion:
Peptide coating of Ti surfaces for dental application can optimize implant performance, reduce infection and failure rates, and contribute to the development of safer and more effective therapies in oral rehabilitation. Therefore, this systematic review answered its question, as Ti coatings with peptides show antimicrobial and osteogenic activity as a surface functionalization mechanism.
