# LubriShieldTM—A permanent urinary catheter coating that prevents uropathogen biofilm formation in vitro independent of host protein conditioning

## TL;DR

LubriShieldTM is a new coating for urinary catheters that prevents biofilm formation by pathogens in the lab, even after exposure to host proteins.

## Contribution

LubriShieldTM is a novel permanent coating that prevents uropathogen biofilm formation without releasing active substances or killing microbes.

## Key findings

- LubriShieldTM reduced biofilm formation by up to 99% in artificial urine for 14 days.
- The coating maintained antibiofilm efficacy after conditioning with fibrinogen (83% reduction in biofilm).
- Microbes on LubriShieldTM showed 78% increased antibiotic susceptibility compared to uncoated surfaces.

## Abstract

Catheter-associated urinary tract infection is one of the most common healthcare-associated infections, with biofilm formation playing a key role in its pathogenesis. Indwelling medical devices introduce ideal pathways inside the body for pathogens and feature surfaces conducive to biofilm development, often leading to severe clinical infections recalcitrant to antimicrobials. When bacteria and fungi switch to biofilm mode of growth, they produce a matrix in the form of extracellular polymeric substances (EPS). This creates a unique environment for growing virulent colonisers and persisting cells while forming a shielding barrier against immune system attacks, antimicrobial agents and mechanical removal by fluid shear forces. To address this challenge, LubriShieldTM – a novel permanent coating – was invented and evenly applied to both internal and external surfaces of indwelling urinary Foley catheters. Without releasing active substances, it effectively prevented pathogens from producing biofilm. The superhydrophilic coating, incorporating a proprietary anti-fouling ligand, significantly inhibited colonising uropathogens from forming biofilm for up to 14 days in artificial urine medium without microbial killing (up to 99% reduction, P < 0.001). In a glass bladder flow model, LubriShieldTM still significantly reduced biofilm formation by 83% (P < 0.0001). Importantly, LubriShield™ maintained its antibiofilm efficacy even after conditioning with fibrinogen, a host-derived protein known to promote bacterial attachment (P = 0.007). RNA-seq analysis revealed significant downregulation of genes associated with microbial EPS formation on the coated surfaces. Additionally, microorganisms adhering to LubriShieldTM coated catheters showed a 78% increased susceptibility to antibiotics compared to those on uncoated catheters (P = 0.004).