In vitro co-culture models for the assessment of orthopedic antibacterial biomaterials

B.I.M. Eijkel*, I. Apachitei, E.L. Fratila-Apachitei*, A.A. Zadpoor

*Corresponding author for this work

Research output: Contribution to journalReview articlepeer-review

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The antibacterial biofunctionality of bone implants is essential for the prevention and treatment of implant-associated infections (IAI). In vitro co-culture models are utilized to assess this and study bacteria-host cell interactions at the implant interface, aiding our understanding of biomaterial and the immune response against IAI without impeding the peri-implant bone tissue regeneration. This paper reviews existing co-culture models together with their characteristics, results, and clinical relevance. A total of 36 studies were found involving in vitro co-culture models between bacteria and osteogenic or immune cells at the interface with orthopedic antibacterial biomaterials. Most studies (∼67%) involved co-culture models of osteogenic cells and bacteria (osteo-bac), while 33% were co-culture models of immune cells and bacterial cells (im-bac). All models involve direct co-culture of two different cell types. The cell seeding sequence (simultaneous, bacteria-first, and cell-first) was used to mimic clinically relevant conditions and showed the greatest effect on the outcome for both types of co-culture models. The im-bac models are considered more relevant for early peri-implant infections, whereas the osteo-bac models suit late infections. The limitations of the current models and future directions to develop more relevant co-culture models to address specific research questions are also discussed.
Original languageEnglish
Article number1332771
Number of pages11
JournalFrontiers in Bioengineering and Biotechnology
Publication statusPublished - 2024


  • implant-associated infections
  • antibacterial biomaterials
  • in vitro co-culture models
  • osteogenic cells
  • immune cells


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