Multi-Functional Bio-HJzyme Engineered Polyetheretherketone Implant with Cascade-Amplification Therapeutic Capabilities Toward Intractable Implant-Associated Infections.

Intractable implant-associated infections (IAIs) are the primary cause of prosthetic implant failure, particularly in the context of diabetes mellitus. There is an urgent need to design and construct versatile engineered implants integrated with cascade amplification therapeutic modality to significantly improve the treatment of diabetic IAIs. To address this issue, a multi-functional MXene/AgPO@glucose oxidase bio-heterojunction enzyme (M/A@GOx bio-HJzyme) coating is developed, which is decorated with an inert sulfonated polyetheretherketone implant (SP-M/A@G) via hydrothermal treatment and layered deposition. The decorated bio-HJzyme coating promoted cellular adhesion and proliferation of osteoblast cells on the implant. Simultaneously, upon 808 nm near-infrared (NIR) light irradiation, the decorated coating not only induces localized hyperthermia and reactive oxygen species (ROS) generation but also initiates Fenton-like and laccase-mimicking reactions and depletes glutathione (GSH) within the diabetes infection microenvironment. The cascade amplification therapeutic effects of phototherapy and biocatalytic therapy confer the engineered implants with robust cyclic antibacterial properties. Furthermore, in vivo, assessment demonstrated that the multi-functional bio-HJzyme can effectively eradicate infectious pathogens located on the implant and peri-implant tissues and promote the regeneration of diabetic infectious skin. Collectively, this study provides a revolutionary approach for constructing multi-functional implants with cascade amplification therapeutic capabilities for intractable diabetic IAIs.