Macrophage response to hydrophilic biomaterials regulates MSC recruitment and T-helper cell populations

Retrospective multicenter cohort analysis of 621 cases of BellaGel silicone breast implants with study of physicochemical properties and surface topography

This study aimed to assess the effectiveness and safety of BellaGel implants after implantation in Asian women and inform surgeons of another option for use in breast augmentation and reconstruction. This study was conducted in eight hospitals from November 27, 2015 to April 30, 2018. All patients underwent augmentation mammoplasty or implant-based breast reconstruction with BellaGel implants. Complication rates were compared between groups, and the cumulative hazard function was compared using the Kaplan-Meier survival analysis. Implants were grouped by surface type, and the cumulative hazard functions of total complication cases were compared. The biomechanical properties of the BellaGel implant and other company representative implants were tested using a mechanical testing machine, and surface topography was analyzed using a 3D laser scanning confocal microscope. There was a significant difference in the incidence of complications between the reconstruction (17.1%) and augmentation (4.7%) groups, but no significant difference in the complication rates of each group. There was no difference in the reoperation or revision rates between the groups. The log rank test showed a statistically significant difference in cumulative hazard function between the groups. Among the three types of implants (smooth, textured, and microtextured), the microtextured type had the lowest complication rate. The BellaGel microtexture implant had the highest maximal tensile load and displacement value. The BellaGel and Silksurface implants had the highest stored energy, although there was no significant difference. BellaGel implants can serve as a criterion for the selection of safe and effective implants among currently available implants.

Re-establishment of macrophage homeostasis by titanium surface modification in type II diabetes promotes osseous healing

Titanium surface mediated immunomodulation may address compromised post-implantation bone healing in diabetes mellitus. To assess in vitro phenotypic changes, M1 and M2 polarised Type 2 diabetic rat (Goto Kakizaki, GK) macrophages were cultured on micro-rough (SLA) or hydrophilic nanostructured SLA (modSLA) titanium. The in vivo effects of the SLA and modSLA surfaces on macrophage phenotype, wound-associated protein expression and bone formation were investigated using a critical-sized calvarial defect model. Compared to healthy macrophages, GK M2 macrophage function was compromised, secreting significantly lower levels of the anti-inflammatory cytokine IL-10. The modSLA surface attenuated the pro-inflammatory cellular environment, reducing pro-inflammatory cytokine production and promoting M2 macrophage phenotype differentiation. ModSLA also suppressed gene expression associated with macrophage multinucleation and giant cell formation and stimulated pro-osteogenic genes in co-cultured osteoblasts. In vivo, modSLA enhanced osteogenesis compared to SLA in GK rats. During early healing, proteomic analysis of both surface adherent and wound exudate material showed that modSLA promoted an immunomodulatory pro-reparative environment. The modSLA surface therefore successfully compensated for the compromised M2 macrophage function in Type 2 diabetes by attenuating the pro-inflammatory response and promoting M2 macrophage activity, thus restoring macrophage homeostasis and resulting in a cellular environment favourable for enhanced osseous healing.

Various Properties of Silicone Breast Implant Surfaces and Multimodal Techniques for the Functional Surface Modification

"Silicone breast implants are the most widely used medical devices for breast reconstruction and augmentation, and revision, but even after more than 60 years of use they are associated with multiple continued complications. Using advancement in current technologies, researchers are attempting to create an optimal implant surface for patients. Through these efforts, plastic surgeons and material researchers have made great progress in the field of implant research. Multimodal techniques for the functional modification of implant surfaces will contribute to further the development of ideal biomaterials useful in breast implants.

Fabrication and evaluation of a chitin whisker/poly(L-lactide) composite scaffold by the direct trisolvent-ink writing method for bone tissue engineering

Although poly(l-lactide) (PLLA) based porous scaffolds have been widely fabricated through 3D printing, their poor mechanical properties and osteogenic activity still do not meet the needs of bone tissue repair. Herein, chitin whiskers (CHWs), having outstanding mechanical properties, excellent cell affinity, osteogenic activity, etc. were designed to introduce into the PLLA matrix. Moreover, a trisolvent system, including dichloromethane (DCM), 2-butoxyethanlol (2-Bu) and dibutyl phthalate (DBP), instead of a single solvent system of DCM was chosen to prepare CHW/PLLA (CP) composite inks. Then, the CP porous composite scaffolds were further fabricated via the direct ink writing method. The as-printed CP composite scaffolds have good 3D porous structures with a pore size of 400 ± 14 μm and a porosity of 80 ± 5%. Compared with the pure PLLA scaffold, the CP composite scaffolds showed significantly superior hydrophilicity and compression performance, and also were more conducive to cell adhesion, proliferation, and up-regulating alkaline phosphate activity and calcium deposition due to the presence of CHWs. Moreover, these promoting effects of CHWs are positively related to the content of the whiskers in the range of 0-20 wt%. However, as the content of CHWs further increased to 40 wt%, the compression performance, cell affinity and osteogenic activity of the corresponding 40%CP composite scaffold decreased, which may be attributed to the different microstructure of the scaffold from other composite scaffolds. Interestingly, compared with these scaffolds containing a lower mass content of CHWs, only the 40%CP composite scaffold exhibited significant anti-inflammatory properties. These robust CP composite scaffolds offer a new route for bone tissue engineering application.

Exosomes from different cells: Characteristics, modifications, and therapeutic applications

Exosomes are cystic vesicles secreted by living cells with a phospholipid bilayer membrane. Importantly, these vesicles could serve to carry lipids, proteins, genetic materials, and transmit biological information in vivo. The cell-specific proteins and genetic materials in exosomes are capable of reflecting their cell origin and physiological status. Based on the different tissues and cells (macrophage, dendritic cells, tumor cells, mesenchymal stem cells, various body fluids, and so on), exosomes exhibit different characteristics and functions. Furthermore, owing to their high delivery efficiency, biocompatibility, and multifunctional properties, exosomes are expected to become a new means of drug delivery, disease diagnosis, immunotherapy, and precise treatment. At the same time, in order to supplement or enhance the therapeutic applicability of exosomes, chemical or biological modifications can be used to broaden, change or improve their therapeutic capabilities. This review focuses on three aspects: the characteristics and original functions of exosomes secreted by different cells, the modification and transformation of exosomes, and the application of exosomes in different diseases.

Hydrofluoric acid and nitric acid cotreatment for biofunctionalization of polyetheretherketone in M2 macrophage polarization and osteogenesis

Due to its excellent mechanical and low-friction properties, polyetheretherketone (PEEK) has been widely investigated for use in orthopedic applications over the past decade. However, the bioinertness and poor osteogenic properties of PEEK have hampered its clinical application. In this study, the surface of PEEK was modified by co-treatment with hydrofluoric acid and nitric acid (AFN). The microstructures of the modified PEEK surfaces were investigated using scanning electron microscopy. The water contact angles of the surfaces were also measured. To evaluate their cytocompatibility, PEEK samples were used as substrates to culture rat bone mesenchymal stem cells, and cell adhesion, viability, and expression of specific marker genes were measured. Treatment of PEEK with AFN (PEEK-AFN) was found to enable better osteoblast adhesion, spreading, and proliferation; the activity of alkaline phosphatase (an early osteogenic differentiation marker) was also found to be enhanced post-treatment. Furthermore, PEEK-AFN was able to modulate macrophage polarization and down regulated the expression of proinflammatory factors via inhibiting the NF-κB pathway. Thus, treatment of PEEK with AFN could promote M2 polarization of the macrophages and stimulate the differentiation of osteoblasts. These results provide valuable information that could facilitate the use of PEEK-based composites as bone implant materials.

IL-4 functionalized titanium dioxide nanotubes modulate the inflammatory response of macrophages

Inflammatory response is an essential part of optimal tissue-implant integration and the regeneration process. Due to their highly plastic properties, macrophages display phenotypic changes during inflammatory signaling. Investigating these changes on implant surfaces is essential for evaluating implant stability and longevity. In order to control macrophage polarization, IL-4 was conjugated to titanium dioxide nanotubes (TNTs) through polydopamine, and successful fabrication was checked by scanning electron microscopy (SEM), atomic force microscopy (AFM), X-ray photoelectron spectroscopy (XPS) and contact angle, respectively. In vitro experiments including immunofluorescence staining, cell proliferation, the expression of genes associated with pro-inflammatory M1 phenotype (tumor necrosis factor-alpha (TNF-α), Interleukin-18 (IL-18)) and cytokines related to the anti-inflammatory M2 phenotype (IL-4 and IL-10), and the production of nitric oxide (NO) and cytokines TNF-α, IL-10 were detected. Macrophage response showed that IL-4 functionalized TNTs favored macrophage polarization towards an anti-inflammatory M2-phenotype. This study provides a new strategy for use in medical devices and the development of advanced nano-biomaterials in immunotherapy applications.

Tremella-Like ZnO@Col-I-Decorated Titanium Surfaces with Dual-Light-Defined Broad-Spectrum Antibacterial and Triple Osteogenic Properties

The growing population of peri-implant diseases (PIDs) has become a public obsession, mainly due to the lack of antibacterial ability and osteogenic promotion of titanium (Ti) implants. Herein, inspired by tremella, we reported zinc oxide (ZnO)@collagen type I (Col-I)-decorated Ti for PIDs treatments. Compared with pure Ti implants, ZnO@Col-I-decorated Ti could be activated by a safe visible yellow light and showed excellent broad-spectrum antibacterial properties. The proliferation and osteogenic gene expression of bone marrow mesenchymal stem cells (BMSCs) indicated that the triple osseointegration of implants was realized through (I) the remarkedly improved surface hydrophilicity of ZnO@Col-I-decorated Ti, (II) the function of Col-I, and (III) the excellent near-infrared (NIR)-induced photothermal performance of ZnO. Collectively, the proposed dual-light-defined ZnO@Col-I coating was a promising implant surface modification system to provide customized treatments for each PID patient.

Hydrophilic titanium surfaces reduce neutrophil inflammatory response and NETosis

Neutrophils are sensitive to biomaterial surface properties, controlling activation and inflammatory microenvironment, revealing a novel target for enhancing biomaterial integration.

Cell-loaded injectable gelatin/alginate/LAPONITE® nanocomposite hydrogel promotes bone healing in a critical-size rat calvarial defect model

An injectable cell-laden nanocomposite hydrogel simulate natural ECM, promote cell proliferation, and accelerate bone healing of critical-size rat calvarial defects.

Improvement of rBMSCs Responses to Poly(propylene carbonate) Based Biomaterial through Incorporation of Nanolaponite and Surface Treatment Using Sodium Hydroxide

Poly(propylene carbonate) (PPC) has aroused extensive attention in the biomaterial field because of its excellent biocompatibility and appropriate degradability, but surface hydrophobicity and bioinertness limit its applications for bone repair and tissue engineering. In this study, a bioactive PPC/laponite (LAP) nanocomposite (PL) was prepared by a melt-blending method, and a microporous surface on PPC and PL (PT and PLT) was created by sodium hydroxide (NaOH) treatment. The results demonstrated that the surface roughness, hydrophilicity, surface energy, and degradability as well as protein adsorption of PLT were obviously improved compared with PPC. Moreover, the degradability of PLT was remarkably enhanced with a slight increase of pH values in Tris-HCl solution. Furthermore, adhesion and proliferation as well as osteogenic differentiation of rat bone marrow mesenchymal stem cells (rBMSCs) to PLT were significantly promoted compared with PPC. The results suggested that incorporating LAP into PPC obviously improved the surface performance of PL (with nanotopography), and surface treatment with NaOH further enhanced surface properties of PLT (with micronanotopography and hydrophilic groups), which significantly promoted responses of rBMSCs. In short, PLT displayed excellent cytocompatibility, which would have great potential for bone regeneration.

Injectable nanoclay gels for angiogenesis

The retention and sustained activity of therapeutic proteins at delivery sites are goals of regenerative medicine. Vascular endothelial growth factor (VEGF) has significant potential in promoting the growth and regeneration of blood vessels but is intrinsically labile. This is exacerbated by the inflammatory microenvironments at sites requiring regeneration. For VEGF to be efficacious, it may require a carrier that stabilises it, protects it from degradation and retains it at the site of interest. In this study, we tested the hypothesis that injectable nanoclay gels comprising Laponite™ XLG (a synthetic hectorite clay) can stabilise VEGF and retain it in the active form for therapeutic delivery. To achieve this, VEGF was incorporated in Laponite gels and its activity tested at a range of concentrations using in vitro cell culture tubulogenesis assays and in vivo angiogenesis assays. We found that VEGF-Laponite gels enhanced tubulogenesis in a dose-dependent manner in vitro. When administered subcutaneously in vivo, Laponite was retained at the injection site for up to a period of three weeks and promoted a 4-fold increase in blood vessel formation compared with that of alginate or vehicle controls as confirmed by CD31 staining. Notably, as compared to alginate, Laponite gels did not release VEGF, indicating a strong interaction between the growth factor and the nanoclay and suggesting that Laponite enhancement of VEGF efficacy is due to its retention at the implantation site for a prolonged period. Our approach provides a robust method for the delivery of bioactive recombinant VEGF without the necessity for complex hydrogel or protein engineering. STATEMENT OF SIGNIFICANCE: In medicine, it is important to deliver drugs to a particular location in the body. Often, however, the drugs are quickly broken down and carried away in the blood before they can exert their effect. In this study, we used a type of synthetic clay, called Laponite™, to preserve a molecule, named VEGF, that stimulates the growth of blood vessels. Previously, we have been able to bind VEGF to the surface of clays, but the clay is not effective when injected or applied as a gel. Herein, we show that we can mix VEGF with the clay and that it strongly stimulates blood vessel growth. We speculate that this would be a useful material for skin wound healing.

Osteoblast/bone-tissue responses to porous surface of polyetheretherketone-nanoporous lithium-doped magnesium silicate blends' integration with polyetheretherketone

The porous surface of a polyetheretherketone (PK)-nanoporous lithium-doped magnesium silicate (NLS) blend (PKNLS) was fabricated on a PK surface by layer-by-layer pressuring, sintering, and salt-leaching. As controls, porous surfaces of a PK/lithium-doped magnesium silicate blend (PKLS) and PK were fabricated using the same method. The results revealed that porosity, water absorption, and protein absorption of the porous surface of PKNLS containing macropores and nanopores were obviously enhanced compared to PKLS and PK containing macropores without nanopores. In addition, PKNLS, with both macroporostiy and nanoporosity, displayed the highest ability of apatite mineralization in simulated body liquid, indicating excellent bioactivity. In vitro responses (including adhesion, proliferation, and differentiation) of MC3T3E1 cells to PKNLS were significantly enhanced compared to PKLS and PK. In vivo implantation results showed that new bone grew into the macroporous surface of PKNLS, and the amount of new bone for PKNLS was the highest. In short, PKNLS integration with PK significantly promoted cells/bone-tissue responses and exhibited excellent osteogenesis in vivo, which might have great potential for bone repair.

The summary of the most important cell-biomaterial interactions that need to be considered during in vitro biocompatibility testing of bone scaffolds for tissue engineering applications

Tissue engineered products (TEPs), which mean biomaterials containing either cells or growth factors or both cells and growth factors, may be used as an alternative to the autografts taken directly from the bone of the patients. Nevertheless, the use of TEPs needs much more understanding of biointeractions between biomaterials and eukaryotic cells. Despite the possibility of the use of in vitro cellular models for initial evaluation of the host response to the implanted biomaterial, it is observed that most researchers use cell cultures only for the evaluation of cytotoxicity and cell proliferation on the biomaterial surface, and then they proceed to animal models and in vivo testing of bone implants without fully utilizing the scientific potential of in vitro models. In this review, the most important biointeractions between eukaryotic cells and biomaterials were discussed, indicating molecular mechanisms of cell adhesion, proliferation, and biomaterial-induced activation of immune cells. The article also describes types of cellular models which are commonly used for biomaterial testing and highlights the possibilities and drawbacks of in vitro tests for biocompatibility evaluation of novel scaffolds. Finally, the review summarizes recent findings concerning the use of adult mesenchymal stem cells for TEP generation and compares the potential of bone marrow- and adipose tissue-derived stem cells in regenerative medicine applications.

Nanotubular TiO2 regulates macrophage M2 polarization and increases macrophage secretion of VEGF to accelerate endothelialization via the ERK1/2 and PI3K/AKT pathways

Background

Macrophages play important roles in the immune response to, and successful implantation of, biomaterials. Titanium nanotubes are considered promising heart valve stent materials owing to their effects on modulation of macrophage behavior. However, the effects of nanotube-regulated macrophages on endothelial cells, which are essential for stent endothelialization, are unknown. Therefore, in this study we evaluated the inflammatory responses of endothelial cells to titanium nanotubes prepared at different voltages.

Methods and results

In this study we used three different voltages (20, 40, and 60 V) to produce titania nanotubes with three different diameters by anodic oxidation. The state of macrophages on the samples was assessed, and the supernatants were collected as conditioned media (CM) to stimulate human umbilical vein endothelial cells (HUVECs), with pure titanium as a control group. The results indicated that titanium dioxide (TiO2) nanotubes induced macrophage polarization toward the anti-inflammatory M2 state and increased the expression of arginase-1, mannose receptor, and interleukin 10. Further mechanistic analysis revealed that M2 macrophage polarization controlled by the TiO2 nanotube surface activated the phosphatidylinositol 3-kinase/AKT and extracellular signal-regulated kinase 1/2 pathways through release of vascular endothelial growth factor to influence endothelialization.

Conclusion

Our findings expanded our understanding of the complex influence of nanotubes in implants and the macrophage inflammatory response. Furthermore, CM generated from culture on the TiO2 nanotube surface may represent an integrated research model for studying the interactions of two different cell types and may be a promising approach for accelerating stent endothelialization through immunoregulation.

Novel in vitro comparative model of osteogenic and inflammatory cell response to dental implants

OBJECTIVES

Roughened dental implants promote mesenchymal stem cell (MSCs) osteoblastic differentiation, and hydrophilic modifications induce anti-inflammatory macrophages activation. While the effect of different surface modifications on osseointegration of commercial dental implants have been compared in vivo and clinically, the initial cellular response to these modifications often overlooked. We aimed to characterize the macrophage inflammatory response and MSC osteogenesis across different commercially available implants in vitro.

METHODS

Six commercially available rough implants [OsseoSpeed™ (Astra-Tech™, Implant A); Osseotite^® (Biomet 3i™, Implant B); TiUnite™ (Nobel-Biocare^®, Implant C); Ti-SLA^®, (Implant D), Roxolid^® (RXD-SLA, Implant E), RXD-SLActive^® (Implant F) (Straumann^®)] were examined. Macrophages and MSCs were seeded directly on implants and cultured in custom vials. mRNA and protein levels of pro- (IL1B, IL6, IL17A, CXCL10, TNFa) and anti- (IL4, IL10, TGFB1) inflammatory markers were measured after 24 and 48h in macrophages. Osteoblastic differentiation of MSCs was assessed after seven days by alkaline phosphatase activity, osteocalcin, and angiogenic, osteogenic, and inflammatory markers by ELISA and qPCR (n=6/variable, ANOVA, post hoc Tukey HSD with α=0.05).

RESULTS

Hydrophilic implant F induced the highest level of osteogenic factor released from MSCs and anti-inflammatory factors from macrophages with the lowest level of pro-inflammatory factors. Alternatively, implants A and C supported lower levels of osteogenesis and increased secretion of pro-inflammatory factors.

SIGNIFICANCE

In this study, we successfully evaluated differences in cell response to commercially available clinical implants using an in vitro model. Data from this model suggest that not all surface modification procedures generate the same cell response.