Point-of-care bone cement based on natural peptide comonomer protects orthopaedic implants from bacterial challenge

Antibacterial polymethylmethacrylate (PMMA) bone cement plays an important role in the prevention of periprosthetic joint infection (PJI). PMMA cement based on the immobilization of antibacterial comonomers has expanded the horizon of the PJI prophylaxis, but creating clinically-convenient and accessible cement remains challenging. Here, we have developed a nisin based point-of-care (POC) technology. This technology relies on the synergistic engineering of the natural peptide nisin and can be applied in the operating room. Nisin can act as a comonomer and be immobilized via naturally occurring dehydroalanine (Dha), thereby endowing the cement with antibacterial activity (up to 98 %), mechanical strength (compliant with ASTM F451 standard, minimum 70 MPa), as well as biocompatibility both in vitro and in vivo. The utility is further exemplified by a periprosthetic infection model in rats, with compatibility studies confirming its seamless integration with commercially available cements. All the raw materials are commercially available and easily accessible, and the usage process is consistent with that of clinical cement, showing excellent operability, thus expanding the toolbox for PJI prophylaxis.