Dual-action prevention of adherent and non-adherent biofouling <i>via</i> slippery, nitric oxide-releasing nanoemulsion-infused porous surfaces

Contemporary clinical problems, such as medical device failure due to onset infection and thrombosis, pose a significant threat to the care and treatment of critical patients. While infection is typically treated with broad-spectrum antibiotics, and thrombosis is treated with systemic administration of anticoagulants, these options are less favorable because of the escalation of antibiotic resistance and adverse anticoagulation effects such as excessive bleeding and platelet consumption. Alternative strategies must be considered to address these issues before the current strategies become ineffective and cause irreversible damage. One such strategy is the combination of a bioactive therapeutic, nitric oxide (NO), with a passive anti-fouling technique, slippery nanoemulsion-infused porous surfaces (SNIPS). Loading the NO donor <i>S</i>-nitrosoglutathione (GSNO) into the aqueous phase of an oil-based nanoemulsion (NE) and infusing the NE into the porous expanded polytetrafluoroethylene (ePTFE) fabricated a dual-action material as an alternative to current devices, such as indwelling silicone rubber catheters, that physically prevented and repelled fouling agents from adhering to the surface while also releasing a bioactive gaseous molecule to kill bacteria. The ePTFE infused with the GSNO-NE was able to maintain slippery behavior and physiological levels of NO for 24 h. The combination material remained cytocompatible with a relative cell viability >70% while significantly reducing gram-positive <i>Staphylococcus aureus</i> (<i>S. aureus</i>) and gram-negative <i>Escherichia coli</i> (<i>E. coli</i>) adhesion. The material also did not elicit any hemolytic effects when exposed to dilute whole blood. The ePTFE infused with the GSNO-NE demonstrated promising results with potential to be applied in biomedical applications.