Nitric Oxide-Based Antimicrobial Applications in Biomedical Devices
Summary
Nitric oxide (NO) serves as a versatile endogenous signalling molecule with broad-spectrum antimicrobial and antithrombotic activities. Its incorporation into biomedical devices aims to prevent bacterial adhesion, biofilm formation and device-associated infections while simultaneously reducing thrombogenicity in blood-contacting applications. Strategies for NO delivery span from surface coatings and liquid-infused interfaces to polymeric carriers and light-activated complexes. By fine-tuning NO release kinetics—through chemical donors, physical triggers or material design—these technologies seek to disrupt early stages of biofilm development, enhance antibiotic susceptibility and maintain biocompatibility. Practical implementations include catheters, vascular grafts and implantable sensors, in which active NO release complements passive non-fouling surfaces. The global significance of this approach lies in its potential to mitigate the burgeoning threat of antimicrobial resistance in both hospital and community settings, offering a platform for adjunctive therapies that synergise with existing antibiotics and reduce reliance on systemic treatments.
Research from Nature Portfolio
Recent foundational studies have demonstrated the power of combining active NO release with passive surface modification. One seminal work devised a liquid-infused silicone tubing by swelling medical-grade silicone with silicone oil and an S-nitrosothiol NO donor. This dual-action system maintained an ultra-low fouling interface while delivering sustained NO, achieving over 80 % reduction in platelet adhesion and up to 99 % inhibition of biofilm formation by both Staphylococcus aureus and Pseudomonas aeruginosa in bioreactor tests. Another key development introduced a ruthenium nitrosyl complex capable of light-triggered NO release. When applied against methicillin-resistant Staphylococcus epidermidis, submicromolar NO doses halved bacterial viability and, in combination with methicillin, increased bacterial sensitivity by two orders of magnitude. These studies underscore the feasibility of on-demand NO delivery to restore antibiotic efficacy and enhance device safety.
Nitric Oxide-Based Antimicrobial Applications in Biomedical Devices publication trend
The graph below shows the total number of articles in nitric oxide-based antimicrobial applications in biomedical devices across all publications each year (not limited to Nature Index journals).
Technical terms
Nitric oxide (NO): A gaseous signalling molecule with antimicrobial and antithrombotic properties employed to prevent biofilm formation on device surfaces.
Biofilm: A structured community of bacterial cells embedded in a self-produced polymeric matrix, exhibiting enhanced resistance to antibiotics.
NO donor: A chemical moiety such as an S-nitrosothiol or N-diazeniumdiolate that releases NO under physiological or triggered conditions.
Polymeric nanoparticles: Nano-sized carriers composed of polymers designed to encapsulate and co-deliver NO and conventional antibiotics for synergistic antimicrobial action.
Liquid-infused surface: A non-fouling interface achieved by infusing a lubricating fluid into a solid substrate to reduce protein adhesion, often combined with NO release for active antimicrobial defence.
References
- Co-delivery of nitric oxide and antibiotic using polymeric nanoparticles. Chemical Science (2016).
- Liquid-infused nitric oxide-releasing (LINORel) silicone for decreased fouling, thrombosis, and infection of medical devices. Scientific Reports (2017).
- Effect of trans(NO, OH)-[RuFT(Cl)(OH)NO](PF6) ruthenium nitrosyl complex on methicillin-resistant Staphylococcus epidermidis. Scientific Reports (2019).
- Recent Developments in Nitric Oxide Donors and Delivery for Antimicrobial and Anti-Biofilm Applications. Molecules (2022).
- Optimization of nitric oxide donors for investigating biofilm dispersal response in Pseudomonas aeruginosa clinical isolates. Applied Microbiology and Biotechnology (2020).
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