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Background    Staphylococcus aureus  in its biofilm form has been associated with recalcitrant chronic rhinosinusitis with significant resistance to conventional therapies. This study aims to determine if liposomal-encapsulation of a precursor of the naturally occurring antimicrobial nitric oxide (NO) enhances its desired anti-biofilm effects against  S. aureus , in the hope that improving its efficacy can provide an effective topical agent for future clinical use.    Methodology    S. aureus  ATCC 25923 biofilms were grown  in-vitro  using the Minimum Biofilm Eradication Concentration (MBEC) device and exposed to 3 and 60 mg/mL of the NO donor isosorbide mononitrate (ISMN) encapsulated into different anionic liposomal formulations based on particle size (unilamellar ULV, multilamellar MLV) and lipid content (5 and 25 mM) at 24 h and 5 min exposure times. Biofilms were viewed using  Live-Dead  Baclight stain and confocal scanning laser microscopy and quantified using the software COMSTAT2.    Results  At 3 and 60 mg/mL, ISMN-ULV liposomes had comparable and significant anti-biofilm effects compared to untreated control at 24 h exposure (p = 0.012 and 0.02 respectively). ULV blanks also had significant anti-biofilm effects at both 24 h and 5 min exposure (p = 0.02 and 0.047 respectively). At 5 min exposure, 60 mg/mL ISMN-MLV liposomes appeared to have greater anti-biofilm effects compared to pure ISMN or ULV particles. Increasing liposomal lipid content improved the anti-biofilm efficacy of both MLV and ULVs at 5 min exposure.    Conclusion  Liposome-encapsulated “nitric oxide” is highly effective in eradicating  S. aureus  biofilms  in-vitro , giving great promise for use in the clinical setting to treat this burdensome infection. Further studies however are needed to assess its safety and efficacy  in-vivo  before clinical translation is attempted.

Liposome-Encapsulated ISMN: A Novel Nitric Oxide-Based Therapeutic Agent against Staphylococcus aureus Biofilms