Attachment and spreading of human gingival fibroblasts on potentially bioactive glasses in vitro

Bioactive Glass S53P4 in the Filling of Cavities in the Mastoid Cell Area in Surgery for Chronic Otitis Media

Objectives

Chronic infection of the middle ear and cholesteatoma can be treated surgically by exenteration of the mastoid air cells behind the ear. After a procedure with the canal wall–down technique, a cavity remains that is sometimes difficult to clean, collects crust, and becomes repeatedly infected. Such problematic mastoid cavities can be eliminated by filling the created cavity surgically after thorough removal of mucous membranes and cleaning of the bone.

Methods

We treated 7 patients with cavities after canal wall–down surgery for the treatment of chronic suppurative otitis media or cholesteatoma by filling the difficult-to-clean cavity in the mastoid cell area with granules of bioactive glass (BAG) S53P4 to avoid further retraction formation. The area with BAG was carefully closed with a musculoperiosteal flap.

Results

After the canal wall–down tympanomastoidectomy, the mastoid cavities were successfully filled in all 7 patients. No biomaterial-associated infection was seen, and no disadvantages for the patients due to the BAG were observed. The cavity in the mastoid cell area decreased in size in all patients treated.

Conclusions

This BAG seems to be a promising material for filling mastoid cavities after canal wall–down tympanomastoidectomy.

The use of anatomically drop-shaped bioactive glass S53P4 implants in the reconstruction of orbital floor fractures--A prospective long-term follow-up study

An isolated fracture of the orbital floor needs reconstruction if there is a clear herniation of adipose tissue or of the rectus inferior muscle into the maxillary sinus. A prospective study was carried out treating 20 patients with an isolated blow-out fracture of the orbital floor or with a combined zygomatico-orbito-maxillary complex fracture, using a newly designed anatomically drop-shaped implants made of bioactive glass (BAG) S53P4. Computed tomography (CT) was performed immediately postoperatively to confirm the correct position of the plate. The patients were followed up for an average of 32 months clinically and radiologically with magnetic resonance imaging (MRI) for an average of 31 months. None of the patients had any signs of complications related to the implant and the clinical outcome was very good. None of the patients had persisting diplopia. The level of the pupillas was normal in 15 of 20 patients. Minor hypo-ophthalmos ranging from 0.5 to 1.0 mm was observed in three patients, and moderate hypo-ophthalmos of 2.0 mm was seen in one patient. Hyperophthalmos of 1.0 mm was seen in one patient. Minor enophthalmos on the operated side ranging from 0.5 to 1.0 mm was seen in eight patients. Mild to moderate paraesthesia of the infraorbital nerve was observed in six patients. The immediate postoperative CT and the long term follow-up MRI revealed that the drop-shaped BAG implants retained their correct position in the orbital floor and did not show any evidence of losing their original shape or material resorption. No adverse tissue reaction was associated with the material. Due to the anatomical drop shape, the implants could successfully maintain the orbital volume and compensate for the retrobulbar adipose tissue atrophy.

Bone reconstruction: from bioceramics to tissue engineering

Over the past 30 years, an enormous array of biomaterials proposed as ideal scaffolds for cell growth have emerged, yet few have demonstrated clinical efficacy. Biomaterials, regardless of whether they are permanent or biodegradable, naturally occurring or synthetic, need to be biocompatible, ideally osteoinductive, osteoconductive, integrative, porous and mechanically compatible with native bone to fulfill their desired role in bone tissue engineering. These materials provide cell anchorage sites, mechanical stability and structural guidance and in vivo, provide the interface to respond to physiologic and biologic changes as well as to remodel the extracellular matrix in order to integrate with the surrounding native tissue. Calcium phosphate ceramics and bioactive glasses were introduced more than 30 years ago as bone substitutes. These materials are considered bioactive as they bond to bone and enhance bone tissue formation. The bioactivity property has been attributed to the similarity between the surface composition and structure of bioactive materials, and the mineral phase of bone. The drawback in using bioactive glasses and calcium phosphate ceramics is that close proximity to the host bone is necessary to achieve osteoconduction. Even when this is achieved, new bone growth is often strictly limited because these materials are not osteoinductive in nature. Bone has a vast capacity for regeneration from cells with stem cell characteristics. Moreover, a number of different growth factors including bone morphogenetic proteins, have been demonstrated to stimulate bone growth, collagen synthesis and fracture repair both in vitro and in vivo. Attempts to develop a tissue-engineering scaffold with both osteoconductivity and osteoinductivity have included loading osteoinductive proteins and/or osteogenic cells on the traditional bioactive materials. Yet issues that must be considered for the effective application of bioceramics in the field of tissue engineering are the degree of bioresorption and the poor mechanical strength. The synthesis of a new generation of biomaterials that can specifically serve as tissue engineering scaffolds for drug and cell delivery is needed. Nanotechnology can provide an alternative way of processing porous bioceramics with high mechanical strength and enhanced bioactivity and resorbability.

Intact surface of bioactive glass S53P4 is resistant to osteoclastic activity

Bioactive glass reacts with body fluids and is gradually dissolved in tissues and in cell cultures. We investigated whether osteoclasts contribute to this process, by culturing newborn rat bone-marrow cells containing osteoclasts on polished bioactive glass plates (glass S53P4). The cultures were inspected at days 1-5 and stained for alkaline phosphatase (ALP) to demonstrate osteoblasts and for tartrate resistant acid phosphatase (TRAP) to visualize osteoclasts. Nonosteoclastic cells proliferated several-fold both on bioactive glass and on plastic, whereas osteoclasts and their precursors matured into multicellular giant cells and degenerated. Most cells on bioactive glass became ALP-positive, whereas on plastic the majority of cells remained ALP-negative. Osteoclasts survived on bioactive glass for 4-5 days, whereas on plastic they degenerated and disappeared after 3 days. Condensed nuclei indicating apoptosis were detected both in degenerating osteoclasts and osteoblasts. The surface of the bioactive glass reacted rapidly forming rounded pits, erosions, and cracks within 24 h in areas occupied by osteoblasts. Light microscopy and scanning electron micrographs demonstrated, however, a smooth surface below the cytoplasm of osteoclasts. This indicates that when applied on an intact bioactive glass surface, osteoclasts were unable to dissolve the glass material within this culture period.

Assessment of polyglycolic acid mesh and bioactive glass for soft-tissue engineering scaffolds

Sufficient neovascularization of neotissue is currently a limiting factor for the engineering of large tissue constructs. 45S5 Bioglass has been investigated extensively in bone tissue engineering but there has been relatively little previous research on its application to soft-tissue engineering. The objectives of this study were to investigate the use of 45S5 Bioglass in soft-tissue engineering scaffolds using in vitro and in vivo models. A fibroblast cell line (208F) was used for in vitro evaluation of surfaces coated with 45S5 Bioglass. Increased proliferation of fibroblasts was observed after growth on polystyrene surfaces coated with low concentrations (0.01-0.2%wt/vol) of 45S5 Bioglass for 24 h in vitro, determined as a change in total cell number by measuring lactate dehydrogenase. At higher concentrations of 45S5 Bioglass and longer periods of incubation (48 and 72 h) on coated surfaces, cell proliferation was reduced. Light microscopy revealed that the morphology of fibroblasts grown on 45S5 Bioglass-coated surfaces was not altered at low concentrations, but at higher concentrations fibroblasts became vacuolated. Enzyme-linked immunosorbent assay of conditioned culture medium collected from fibroblasts grown for 24 h on surfaces coated with low concentrations of 45S5 Bioglass (0.01%wt/vol) was found to contain significantly higher concentrations of vascular endothelial growth factor. Histological examination of polyglycolic acid (PGA)/45S5 Bioglass composite scaffolds that had been implanted subcutaneously into rats revealed that 45S5 Bioglass-coated meshes were well tolerated. Light microscopy revealed that neovascularization into 45S5 Bioglass-coated meshes was significantly increased at 28 and 42 days. Electron microscopy revealed fibroblasts adhering closely to the PGA mesh but not to 45S5 Bioglass particles. The apparent ability of 45S5 Bioglass incorporated into scaffolds to increase neovascularization would be extremely beneficial during the engineering of larger soft-tissue constructs.

Bioactive glass and turbinate flaps in the repair of nasal septal perforations

Interpositional grafts between mucoperiosteal flaps are commonly used in the repair of septal perforations. We studied the use of bioactive glass (BAG) S53P4 as an interpositional graft and the use of turbinate flaps in 23 patients with septal perforations. Another 16 patients were treated with mucoperiosteal flaps only. The perforations were successfully closed in 38 of the 39 patients. One patient had a near-total septal perforation due to hypophysial surgery; it could not be closed. No extrusions of the BAG and no BAG-associated infections were seen; the average follow-up period was 28 months. BAG S53P4 seems to be a good interpositional graft in the repair of medium and large nasal septal perforations, and turbinate flaps are also reliable.

Biocompatibility of a physiological pressure sensor

A newly developed fiber optic micropressure sensor was evaluated for biocompatibility using the International Organization for Standardization (ISO) test standard 10993-6. The test material and an inert control (fused silica glass) were tested in New Zealand white rabbits. Four test specimens were implanted in the paravertebral muscles on one side of the spine about 2-5 cm from the mid-line and parallel to the spinal column. Similarly, four control specimens were implanted on the opposite side. The implantation periods were 1, 4, and 12 weeks to ensure a steady state biological tissue response. Four animals were tested at each time period. Macroscopic and microscopic observations were performed to compare the biological reactions between the test and control materials. There was an inflammatory reaction at 1 week which subsided at 4 weeks. There was fibrous tissue growth near the implant that also decreased over time. Most importantly, there was no significant difference in the biological response between the test and control materials. Therefore, we conclude that the pressure microsensor is biocompatible.

In vitro behavior of osteoblastic cells cultured in the presence of pseudowollastonite ceramic

Pseudowollastonite ceramic (psW) is a bioactive ceramic that binds to bone when implanted in vivo and may be useful for the treatment of skeletal defects. However, there have been no studies that examined the interaction between psW and osteoblastic cells in vitro. This study investigated the suitability of psW as a substratum for cell attachment and the ability of the material to effect osteoblasts at a distance from the material surface. Fetal rat calvarial cells were plated onto the ceramic and examined by scanning electron microscopy. The findings reported show that cells attached and proliferated on the surface to the ceramic. Attachment by cells to the material can be enhanced by preincubation of psW in serum or media containing fibronectin. The adhesion of cells can be inhibited by addition of GRGDS peptides suggesting that adhesion to psW is mediated by integrin binding to adsorbed proteins. To study the effects of psW at a distance, cells were cultured in the presence but not in direct contact with the material. Subsequent changes in proliferation, alkaline phosphatase expression, and bone nodule formation were assessed. Cells grown in wells containing psW demonstrated an increase in both the rate and total numbers of bone nodules formed, although there were no differences in proliferation or alkaline phosphatase expression. Overall, these results suggest that psW is biocompatible and osteoconductive.

Three-dimensional reconstruction of confocal laser microscopy images to study the behaviour of osteoblastic cells grown on biomaterials

The adhesion, spreading and cytoskeletal organization of osteoblastic cells seeded onto titanium and titania/hydroxyapatite composite coating (TiO2/HA) were studied using images acquired by confocal laser scanning microscopy. The fluorescence staining technique was employed to visualize actin cytoskeletal organization of cells, 2-D images were exhaustive when the cells were seeded at low density (in the first 24 h of incubation), but they were less clear when the cells proliferated and appeared stacked. Since the shareware software were not satisfactory, a new 3-D image reconstruction was developed using ordinary software and a model was obtained directly from the optical section set, in order to achieve a more realistic and faithful vision of morphological structures and to evaluate the behaviour of bone cells grown on materials. The results showed that the cells grown on titanium conform to the irregular substrate surfaces maximizing the contact between the cell membrane and the substrate and proliferate disposing close to each other. On the contrary, the osteoblasts seeded onto TiO2/HA coating develop clusters where the cells aggregated extending processes in order to establish intercellular connections. Cell aggregation is an early and critical event leading to cell differentiation and mineralization process and could be a first signal of the tendency of TiO2/HA coating to stimulate cell differentiation.

Bioactive glass S53P4 in repair of septal perforations and its interactions with the respiratory infection-associated microorganisms Haemophilus influenzae and Streptococcus pneumoniae

Interpositional grafts between mucoperiosteal flaps are commonly used in the repair of septal perforations. We studied the use of bioactive glass (BAG) S53P4 as an interpositional graft in 11 patients suffering from septal perforations. In aqueous environments, ions are released from the BAG and the pH rises in its vicinity, both of which may influence the growth and adhesion of microorganisms. Thus, we also studied the effects of the BAG S53P4 as granules or discs on the respiratory infection-associated microorganisms Haemophilus influenzae and Streptococcus pneumoniae. Growth inhibition was studied using an agar plate test and adhesion was analyzed both with and without serum precoating of the BAG S53P4. The perforations were successfully closed in 10 of 11 patients. One patient had a near total septum perforation, which could not be closed. No BAG-associated infections were seen during the follow-up. The BAG S53P4 did not show any clear growth inhibition of the microorganisms, which showed low adhesion to the material. Serum precoating increased the adsorption. Thus, uncoated BAG S53P4 seems to be a good graft in the repair of septal perforations.

Interactions between the bioactive glass S53P4 and the atrophic rhinitis-associated microorganism klebsiella ozaenae

In an aqueous environment, ions are released from a bioactive glass (BAG) and the pH rises in its vicinity. This may influence both growth and colonization of microorganisms. We studied the effects of the BAG S53P4 on the atrophic rhinitis-associated microorganism Klebsiella ozaenae. The glass was used in the form of granules or discs. Growth inhibition was studied using an agar plate test. Adhesion was studied by incubating bacterial suspension with the glass. The effect of the presence of the bacteria on the formation of the Si-rich layer on the bioactive glass was also analyzed. Furthermore, a follow up study of 19-74 months with ozena patients surgically treated with the BAG S53P4 was performed. The bioactive glass showed no clear growth inhibition of K. ozaenae in the agar plate test. K. ozaenae showed low adherence to the BAG S53P4. No growth of the microbe was seen on the glass during the 8 h incubations and the Si-rich layer was formed normally. The clinical follow-up study showed no infections of the implants and the symptoms of the patients were markedly reduced. Thus, the BAG S53P4 did not favor adhesion and colonization of K. ozaenae, in vitro, which is supported by the in vivo findings showing no BAG-associated infections or reinfections.

An image analysis method for the study of cell adhesion to biomaterials

This fluorescence image analysis method for the quantitative determination of cell adhesion on biomaterials allows bone cells labelled with propidium iodide to be counted automatically, directly on their support. The reliability of the estimation by fluorescence image analysis was validated by comparison with visual counting and with results obtained by an electronic particle counter. In this way it was possible to demonstrate that the adhesive properties of bone cells are dependent on the type of substrate--enstatite (MgO, SiO2, CaO-P2O5-Al2O3), Thermanox (modified polyethyleneterephthalate), or glass. In contrast, the spread of the cell cytoplasm, labelled with fluorescein isothiocyanate and measured by image analysis, does not vary significantly according to the substrate. The characterisation by SKIZ tessellation of the spatial cell arrangement shows that the bone cells have a random organisation on Thermanox and glass, whereas they form aggregates on enstatite.

Effect of serum proteins on osteoblast adhesion to surface-modified bioactive glass and hydroxyapatite

Previous studies indicate that modification of the surface of porous bioactive glass promotes osteoblast function. We hypothesize that bone formation on treated bioactive glass is due to the selective adsorption of serum attachment proteins. To test this hypothesis, we examined the profile of proteins adsorbed to treated bioactive glass and compared these proteins with those adsorbed to untreated bioactive glass and porous hydroxyapatite. Porous bioactive glass was treated with Tris-buffered electrolyte solution to generate a calcium phosphate-rich surface layer and then immersed in tissue-culture medium containing 10% serum. Proteins adsorbed to the ceramic surfaces were analyzed by sodium dodecyl sulfate-polyacrylamide gel electrophoresis and Western blot analysis. Porous hydroxyapatite bound a higher amount of total protein than did the other substrates. However, surface-modified porous bioactive glass adsorbed more fibronectin than did hydroxyapatite. The effect of serum-protein adsorption on osteoblast adhesion to bioactive glass and hydroxyapatite was also evaluated. Cell adhesion to porous bioactive glass that was surface-modified and serum-treated was significantly greater than to porous bioactive glass that was either surface-modified or serum-treated. Furthermore, cell adhesion to porous bioactive glass treated to form the dual layer of calcium phosphate and serum protein was significantly higher than adhesion to porous hydroxyapatite with adsorbed serum protein. Results of the study strongly suggest that adsorption of serum fibronectin to the surface of modified porous bioactive glass coated with calcium phosphate may be responsible for enhanced osteoblast adhesion.

Effect of surface reaction stage on fibronectin-mediated adhesion of osteoblast-like cells to bioactive glass

Bioactive glasses and ceramics enhance bone formation and bond directly to bone, and have emerged as promising substrates for bone tissue engineering applications. Bone bioactivity involves physicochemical surface reactions and cellular events, including cell attachment to adsorbed extracellular matrix proteins. The effects of fibronectin (Fn) adsorption and glass surface reaction stage on the attachment of osteoblast-like cells (ROS 17/2.8) to bioactive glass were analyzed. Bioactive glass disks were pretreated in a simulated physiologic solution to produce three reaction layers: unreacted glass (BG0), amorphous calcium phosphate (BG1d), and carbonated hydroxyapatite (BG7d). Synthetic hydroxyapatite (sHA) and nonreactive borosilicate glass (CG) were used as controls. A spinning disk device which applied a linear range of forces to attached cells while maintaining uniform chemical conditions at the interface was used to quantify cell adhesion. The number of adherent cells decreased in a sigmoidal fashion with applied force, and the resulting detachment profile provided measurements of adhesion strength. For the same amount of adsorbed Fn, cell adhesion was higher on surface-reacted bioactive glasses (BG1d and BG7d) than on BG0, CG, and sHA. For all substrates, cell attachment was primarily mediated by the RGD binding site of Fn, as demonstrated by blocking experiments with antibodies and RGD peptides. Cell adhesion strength increased linearly with adsorbed Fn surface density. Analysis of this fundamental relationship revealed that improved adhesion to reacted bioactive glasses resulted from enhanced cell receptor-Fn interactions, suggesting substrate-dependent conformational changes in the adsorbed Fn.

Osteogenic cell cytotoxicity and biomechanical strength of the new ceramic Diopside

Diopside was prepared by sintering a powder compact composed of CaMgSi2O6 at 1573K for 2 h. In order to clarify the biocompatibility of Diopside, the cytotoxicity of Diopside against the osteogenic cell line MC3T3-E1 and the bone-Diopside interface strength were examined. On both the 14th and 21st days of incubation of MC3T3-E1 cells with Diopside, ALP activities were not significantly lower than those of the CTRL. TEM photographs of MC3T3-E1 on Diopside after 14 days of incubation showed active secretion of crystals from osteoblast-like cells. Scanning electron microscopic analysis showed that the cells on Diopside formed multiple cell layers similar to those on the CTRL both 14 and 21 days after incubation. These results showed that Diopside had no cytotoxic effect on MC3T3-E1. The pulling test showed that failure loads of Diopside were significantly lower than those of AWGC. Histologically, there was no fibrous tissue or foreign body reaction at the bone interface. SEM-EPMA showed that Diopside had attached to the bone via a calcium-phosphorus layer. SEM back-scattered electron imaging showed that the Diopside plate had degraded to a porous state 12 weeks after implantation. These findings indicate that Diopside is a biodegradable ceramic.

Protein adsorption to a bioactive glass with special reference to precorrosion

The protein adsorption properties of the bioactive glass S53P4 were studied using albumin, IgG, and fibrinogen solutions (1 mg/mL) as well as diluted plasma, serum, and 1:1:1 mixtures of albumin, IgG, and fibrinogen. The bioactive glass granules (315-500 microns) were used in the experiments without pretreatments or as precorroded with an Si-rich or a Ca,P-rich layer. The protein adsorption properties of S53P4 were compared to a commercial bioactive glass (Bioglass), an inert glass, an experimental glass ceramic, titanium (Ti), and hydroxyapatite (HA). The untreated S53P4 bound in Trisbuffered saline mainly albumin from diluted plasma and serum and the 1:1:1 (1 mg of each) mixture of albumin, IgG, and fibrinogen. No binding of fibrinogen was observed. The omission of NaCl from the buffer used in the experiments increased the number of proteins bound by the S53P4. Most of the albumin bound by the glass could be detached with 0.5-1M NaCl speaking for electrostatic protein bonding. The protein adsorption properties of Bioglass resembled those of S53P4. The Ca,P-rich layer glass, the inert glass, the glass ceramic, HA, and Ti all bound several plasma and serum proteins, including fibrinogen. The Si-rich layer glass showed protein binding properties resembling the untreated glass more than the Ca,P-rich layer glass. The protein adsorption test used in the present study revealed differences in the protein adsorption properties of the studied materials, which may reflect differences in their surface potentials. It also functioned in registration of corrosion-induced changes in the surface properties of the S53P4. As judged by the protein adsorption properties, the untreated S53P4 could have a higher biocompatibility than the two precorroded glasses. Precorrosion, especially the formation of the Ca,P-rich layer, increased the number of proteins bound by the S53P4. Thus, a precorroded glass as compared to the untreated glass could be a better carrier of specific proteins that may be used to improve the biocompatibility of the bioactive glass.

Biomaterial-induced alterations of human neutrophils under fluid shear stress: scanning electron microscopical study in vitro

Morphological changes of human polymorphonuclear neutrophils (PMN) adhering to hydrophilic (glass) and hydrophobic (FEP-Teflon, polyethylene, polypropylene) surfaces were studied in a parallel-plate flow chamber at the light and scanning electron microscopical levels. The PMN were exposed to a shear stress of 0.19 Pa (1.9 dynes cm-2) or were allowed to adhere without the stress component (static control) during 30 min for all four biomaterials. Observation by light microscopy was performed in situ in the flow chamber at 1, 5, 10, 15, 20, 25 and 30 min. The total number of adherent cells as a function of time and the activation status of the population on the basis of morphological criteria were determined. On the hydrophilic material adhesion of activated PMN was significantly higher (P < 0.05) than on the more hydrophobic surfaces. This effect was most pronounced for the adhesion of neutrophils to glass and polypropylene (PP). Polyethylene (PE) showed only minor adhesion rates. Scanning electron microscopy revealed details of cell shape changes and permitted a more precise classification of populations of neutrophils based on distinctive shapes. As PMN were exposed to shear stress on glass, the majority of cells exhibited surface veils, ridges and ruffles, suggesting a high level of cell migration. In this case, on polymeric surfaces the presence of filopodial networks (FEP-Teflon) and ameoboid cell shapes (PP and PE) was noted. The results suggest that a low shear stress, as well as various chemical and physical properties of biomaterial surfaces, are together responsible for differentiation of PMN populations on solid substrata.

Evaluation of biocompatibility of various ceramic powders with human fibroblasts in vitro

Cell reaction to powders of ceramics was studied in vitro. Cultured human fibroblasts were exposed to different types of ceramic powders: zirconia (ZP), alumina (A), tricalcium phosphate (TCP) and hydroxyapatite (HA), at various concentrations. The cell viability at the different exposure times was measured by the colony formation (expressed as colony forming efficiency, CFE), neutral red uptake (NR) and colorimetric tetrazolium (MTT) reduction. Alumina and hydroxyapatite showed no cytotoxic effects at studied doses (1-500 mug/ml) while zirconia and tricalcium phosphate inhibited cell viability, with 50% of CFE reduction at the concentration of about 50 mug/ml. In order to study the cytotoxic mechanism of zirconia powder, two further experiments were included, viz. the cellular response to the sintered zirconia ceramic powders (CZP) which were obtained by crushing the sintered ceramic material; and the measurement of the degradation of zirconia ceramic plate in the different solutions, i.e., either in saline or in 0.02 M lactic acid (pH 2.72). Similar cell reactions were obtained for the CZP and ZP by using MTT and NR assays. Slow releases of ions from zirconia ceramic plate, yttrium in both solutions and zirconium and yttrium in lactic acid, were detected.

Osteoblast responses to orthopedic implant materials in vitro

Responses of neonatal rat calvarial osteoblasts to a variety of orthopedic implant materials were examined in vitro. Attachment, proliferation, and collagen synthesis of a well-characterized line of osteoblasts with 316L stainless steel, Ti-6Al-4V, Co-Cr-Mo, PMMA, hydroxyapatite, borosilicate glass, and tissue culture polystyrene were studied. Cell adhesion and growth were similar on nonapatitic materials. In contrast, attachment and growth of osteoblasts were significantly lower and slower, respectively, on hydroxyapatite. Collagen synthesis per cell and relative collagen synthesis, however, were comparable on all the materials tested.