Magnesium alloy AZ91 exhibits antimicrobial properties in vitro but not in vivo

Mg alloys with antitumor and anticorrosion properties for orthopedic oncology: A review from mechanisms to application strategies

As a primary malignant bone cancer, osteosarcoma (OS) poses a great threat to human health and is still a huge challenge for clinicians. At present, surgical resection is the main treatment strategy for OS. However, surgical intervention will result in a large bone defect, and some tumor cells remaining around the excised bone tissue often lead to the recurrence and metastasis of OS. Biomedical Mg-based materials have been widely employed as orthopedic implants in bone defect reconstruction, and, especially, they can eradicate the residual OS cells due to the antitumor activities of their degradation products. Nevertheless, the fast corrosion rate of Mg alloys has greatly limited their application scope in the biomedical field, and the improvement of the corrosion resistance will impair the antitumor effects, which mainly arise from their rapid corrosion. Hence, it is vital to balance the corrosion resistance and the antitumor activities of Mg alloys. The presented review systematically discussed the potential antitumor mechanisms of three corrosion products of Mg alloys. Moreover, several strategies to simultaneously enhance the anticorrosion properties and antitumor effects of Mg alloys were also proposed.

The development of magnesium-based biomaterials in bone tissue engineering: A review

Bone regeneration is a vital clinical challenge in massive or complicated bone defects. Recently, bone tissue engineering has come to the fore to meet the demand for bone repair with various innovative materials. However, the reported materials usually cannot satisfy the requirements, such as ideal mechanical and osteogenic properties, as well as biocompatibility at the same time. Mg-based biomaterials have considerable potential in bone tissue engineering owing to their excellent mechanical strength and biosafety. Moreover, the biocompatibility and osteogenic activity of Mg-based biomaterials have been the research focuses in recent years. The main limitation faced in the applications of Mg-based biomaterials is rapid degradation, which can produce excessive Mg2+ and hydrogen, affecting the healing of the bone defect. In order to overcome the limitations, researchers have explored several ways to improve the properties of Mg-based biomaterials, including alloying, surface modification with coatings, and synthesizing other composite materials to control the degradation rate upon implantation. This article reviewed the osteogenic mechanism and requirement for appropriate degradation rate and focused on current progress in the biomedical use of Mg-based biomaterials to inspire more clinical applications of Mg in bone regeneration in the future.

In vitro corrosion resistance and dual antibacterial ability of curcumin loaded composite coatings on AZ31 alloy: Effect of amorphous calcium carbonate

Rapid corrosion and bacterial infection are obstacles to put into use biodegradable magnesium (Mg) alloy as biomedical materials. In this research, an amorphous calcium carbonate (ACC)@curcumin (Cur) loaded poly-methyltrimethoxysilane (PMTMS) coating prepared by self-assembly method on micro-arc oxidation (MAO) coated Mg alloy has been proposed. Scanning electron microscopy, X-ray diffraction, X-ray photoelectron spectroscopy and Fourier transform infrared spectroscopy are adopted to analyze the morphology and composition of the obtained coatings. The corrosion behaviour of the coatings is estimated by hydrogen evolution and electrochemical tests. The spread plate method without or with 808 nm near-infrared irradiation is applied to evaluate the antimicrobial and photothermal antimicrobial ability of the coatings. Cytotoxicity of the samples is tested by 3-(4,5)-dimethylthiahiazo(-z-y1)-2,5-di- phenytetrazoliumromide (MTT) and live/dead assay culturing with MC3T3-E1 cells. Results show that the MAO/ACC@Cur-PMTMS coating exhibited favourable corrosion resistance, dual antibacterial ability, and good biocompatibility. Cur was employed as an antibacterial agent and photosensitizer for photothermal therapy. The core of ACC significantly improved the loading of Cur and the deposition of hydroxyapatite corrosion products during degradation, which greatly promoted the long-term corrosion resistance and antibacterial activity of Mg alloys as biomedical materials.

Antifouling and antibacterial performance evaluation of polyethersulfone membranes modified with AZ63 alloy

Antibacterial membranes have attracted researchers' interest in recent years as a possible approach for dealing with biofouling on the membrane surface. This research aims to see if blending AZ63 Mg alloy into a polyethersulphone (PES) membrane can improve antifouling and separation properties. The composite membranes' pure water flux continued to increase from pristine PES to PES/AZ63 2.00 wt%. The results showed that PES/AZ63 2.00 wt% membrane supplied the highest permeate flux of E. coli. The steady-state fluxes of AZ63 composite membranes were 113.24, 104.38 and 44.79 L/m²h for PES/AZ63 2.00 wt%, 1.00 wt%, and 0.50 wt%, respectively. The enhanced biological activity of AZ63 was studied based on antioxidant activity, DNA cleavage, antimicrobial, anti-biofilm, bacterial viability inhibition and photodynamic antimicrobial therapy studies. The maximum DPPH scavenging activity was determined as 81.25% with AZ63. AZ63 indicated good chemical nuclease activity and also showed moderate antimicrobial activity against studied strains. The highest biofilm inhibition of AZ63 was 83.25% and 71.63% towards P. aeruginosa and S. aureus, respectively. The cell viability inhibition activity of AZ63 was found as 96.34% against E. coli. The photodynamic antimicrobial therapy results displayed that AZ63 demonstrated 100% bacterial inhibition when using E. coli.

In Vitro Degradation and Photoactivated Antibacterial Activity of a Hemin-CaP Microsphere-Loaded Coating on Pure Magnesium

Photoactivated sterilization has received more attention in dealing with implant-associated infections due to its advantages of rapid and effective bacteriostasis and broad-spectrum antibacterial activity. Herein, a micro-arc oxidation (MAO)/polymethyltrimethoxysilane (PMTMS)@hemin-induced calcium-bearing phosphate microsphere (Hemin-CaP) coating was prepared on pure magnesium (Mg) via MAO processing and dipping treatments. The morphology and composition of the coating were characterized via scanning electron microscopy, Fourier transform infrared spectrometer, X-ray diffractometer and X-ray photoelectron spectrometer. Corrosion behavior was evaluated through electrochemical and hydrogen evolution tests. The release of Fe³⁺ ions at different immersion times was measured with an atomic absorption spectrophotometer. Antibacterial performance and cytotoxicity were assessed using the spread plate method, MTT assay and live/dead staining experiment. The results showed that the corrosion current density of the MAO/PMTMS@(Hemin-CaP) coating (4.41 × 10^-8 A·cm^-2) was decreased by two orders of magnitude compared to that of pure Mg (3.12 × 10^-6 A·cm^-2). Photoactivated antibacterial efficiencies of the Hemin-CaP microspheres and MAO/PMTMS@(Hemin-CaP) coating reached about 99% and 92%, respectively, which we attributed to the photothermal and photodynamic properties of hemin with a porphyrin ring. Moreover, based on the release of Fe³⁺ ions, the MC3T3-E1 pre-osteoblasts' viability reached up to 125% after a 72 h culture, indicating a positive effect of the coating in promoting cell growth. Thus, this novel composite coating holds a promising application as bone implants.

Biodegradable Bone Implants as a New Hope to Reduce Device-Associated Infections-A Systematic Review

Bone fractures often require fixation devices that frequently need to be surgically removed. These temporary implants and procedures leave the patient more prone to developing medical device-associated infections, and osteomyelitis associated with trauma is a challenging complication for orthopedists. In recent years, biodegradable materials have gained great importance as temporary medical implant devices, avoiding removal surgery. The purpose of this systematic review was to revise the literature regarding the use of biodegradable bone implants in fracture healing and its impact on the reduction of implant-associated infections. The systematic review followed the PRISMA guidelines and was conducted by searching published studies regarding the in vivo use of biodegradable bone fixation implants and its antibacterial activity. From a total of 667 references, 23 studies were included based on inclusion and exclusion criteria. Biodegradable orthopedic implants of Mg-Cu, Mg-Zn, and Zn-Ag have shown antibacterial activity, especially in reducing infection burden by MRSA strains in vivo osteomyelitis models. Their ability to prevent and tackle implant-associated infections and to gradually degrade inside the body reduces the need for a second surgery for implant removal, with expectable gains regarding patients' comfort. Further in vivo studies are mandatory to evaluate the efficiency of these antibacterial biodegradable materials.

Magnesium for Implants: A Review on the Effect of Alloying Elements on Biocompatibility and Properties

An attempt is made to cover the whole of the topic of biodegradable magnesium (Mg) alloys with a focus on the biocompatibility of the individual alloying elements, as well as shed light on the degradation characteristics, microstructure, and mechanical properties of most binary alloys. Some of the various work processes carried out by researchers to achieve the alloys and their surface modifications have been highlighted. Additionally, a brief look into the literature on magnesium composites as also been included towards the end, to provide a more complete picture of the topic. In most cases, the chronological order of events has not been particularly followed, and instead, this work is concentrated on compiling and presenting an update of the work carried out on the topic of biodegradable magnesium alloys from the recent literature available to us.

Effect and mechanism of a novel Mg-Nd-Gd-Sr alloy on osteogenic differentiation of bone marrow mesenchymal stem cells

We investigated the effect and mechanism of a novel Mg-3Nd-1Gd-0.3Sr-0.2Zn-0.4Zr (abbreviated to Mg-Nd-Gd-Sr) alloy on the osteogenic differentiation of bone marrow mesenchymal stem cells extracted from Sprague-Dawley rats. Cultured cells were divided into five groups: a control group cultured in osteogenic induction medium alone without Mg-Nd-Gd-Sr alloy extract, and four experimental groups cultured in the same medium with 25%, 50%, 75%, and 100% Mg-Nd-Gd-Sr alloy extracts, respectively. After 14 days of culture, ALP activity was determined and expressions of osteogenesis-related factors Runx2, OCN, and OPN at the mRNA level and Runx2, OCN, and OPN at the protein level were detected by RT-PCR and western blot, respectively. After 21 days of culture, mineralized nodules were detected by alizarin red staining. The results showed that bone marrow mesenchymal stem cells from Sprague-Dawley rats were successfully isolated in vitro using the whole bone marrow adherence method. Flow cytometry revealed that the cells expressed high levels of CD44 and CD90, but low levels of CD31 and CD45. Alizarin red staining indicated the formation of mineralized nodules in all five groups. Compared with the control group, the number of mineralized nodules was increased significantly in the four experimental groups (p < 0.05). The ALP activity in each group was significantly higher on day 14 than on day 7, and was significantly higher in the four experimental groups compared with the control group (p < 0.05). Moreover, the ALP activity was highest when the concentration of Mg-Nd-Gd-Sr alloy extract was 75% (p < 0.05). RT-PCR results showed that, compared with the control group, the mRNA expression of Runx2, OPN, and OCN was significantly higher in the four experimental groups (p < 0.05), and the highest mRNA expression of Runx2, OPN, and OCN was observed in the 75% experimental group (p < 0.05). Western blotting showed that Mg-Nd-Gd-Sr alloy extract significantly increased the protein expression of Runx2, OCN, and OPN compared with the control group (p < 0.05). Our data indicate that the novel Mg-Nd-Gd-Sr alloy can promotes the osteogenic differentiation of bone marrow mesenchymal stem cells isolated from Sprague-Dawley rats. During this process, there is an increase in the expressions of Runx2, OPN, and OCN mRNAs and Runx2, OCN, and OPN proteins.

Corrosion Behavior in Magnesium-Based Alloys for Biomedical Applications

Magnesium alloys exhibit superior biocompatibility and biodegradability, which makes them an excellent candidate for artificial implants. However, these materials also suffer from lower corrosion resistance, which limits their clinical applicability. The corrosion mechanism of Mg alloys is complicated since the spontaneous occurrence is determined by means of loss of aspects, e.g., the basic feature of materials and various corrosive environments. As such, this study provides a review of the general degradation/precipitation process multifactorial corrosion behavior and proposes a reasonable method for modeling and preventing corrosion in metals. In addition, the composition design, the structural treatment, and the surface processing technique are involved as potential methods to control the degradation rate and improve the biological properties of Mg alloys. This systematic representation of corrosive mechanisms and the comprehensive discussion of various technologies for applications could lead to improved designs for Mg-based biomedical devices in the future.

Antibacterial metals and alloys for potential biomedical implants

Metals and alloys, including stainless steel, titanium and its alloys, cobalt alloys, and other metals and alloys have been widely used clinically as implant materials, but implant-related infection or inflammation is still one of the main causes of implantation failure. The bacterial infection or inflammation that seriously threatens human health has already become a worldwide complaint. Antibacterial metals and alloys recently have attracted wide attention for their long-term stable antibacterial ability, good mechanical properties and good biocompatibility in vitro and in vivo. In this review, common antibacterial alloying elements, antibacterial standards and testing methods were introduced. Recent developments in the design and manufacturing of antibacterial metal alloys containing various antibacterial agents were described in detail, including antibacterial stainless steel, antibacterial titanium alloy, antibacterial zinc and alloy, antibacterial magnesium and alloy, antibacterial cobalt alloy, and other antibacterial metals and alloys. Researches on the antibacterial properties, mechanical properties, corrosion resistance and biocompatibility of antibacterial metals and alloys have been summarized in detail for the first time. It is hoped that this review could help researchers understand the development of antibacterial alloys in a timely manner, thereby could promote the development of antibacterial metal alloys and the clinical application.

Recent Advances in Research on Antibacterial Metals and Alloys as Implant Materials

Implants are widely used in orthopedic surgery and are gaining attention of late. However, their use is restricted by implant-associated infections (IAI), which represent one of the most serious and dangerous complications of implant surgeries. Various strategies have been developed to prevent and treat IAI, among which the closest to clinical translation is designing metal materials with antibacterial functions by alloying methods based on existing materials, including titanium, cobalt, tantalum, and biodegradable metals. This review first discusses the complex interaction between bacteria, host cells, and materials in IAI and the mechanisms underlying the antibacterial effects of biomedical metals and alloys. Then, their applications for the prevention and treatment of IAI are highlighted. Finally, new insights into their clinical translation are provided. This review also provides suggestions for further development of antibacterial metals and alloys.

Enhanced corrosion resistance and reduced cytotoxicity of the AZ91 Mg alloy by plasma nitriding and a hierarchical structure composed of ciprofloxacin-loaded polymeric multilayers and calcium phosphate coating

Much effort has made to lessen the cytotoxicity and enhance the corrosion resistance of biodegradable magnesium alloys, for example, by depositing multilayered polymeric coatings containing hydroxyapatite. In this work, a hierarchical structure composed of ciprofloxacin (Cip)-loaded on polyacrylic acid (PAA) and poly (ethyleneimine) (PEI) as biocompatible polymeric multilayers and calcium phosphate coating as the top layer is formed by the sol-gel method on the AZ91 Mg alloy with an intermediate layer formed by nitrogen plasma immersion ion implantation. The thicknesses of the multilayered coating and nitrided layer (Mg₃ N₂ ) are 10 μm and 140 nm, respectively. The corrosion current density decreases by 95.6% and the corrosion potential in the polarization curve shifts to the positive direction by 23%. The passivation process which occurs at defects by deposition of corrosion products mitigates both galvanic and localized corrosion. Slight increase in the contact angle and surface free energy, enhanced corrosion resistance, and reduced cytotoxicity are observed from the multilayered structure. The better corrosion resistance enables better control of release of Cip. Biological assessment indicates that the antibacterial activity against Escherichia coli is improved by 100% after culturing for 24 hr and the cell viability and noncytotoxic behavior of the coated AZ91 are enhanced as well. The corrosion behavior and biological results suggest that the strategy of using a hierarchical structure composed of Cip-loaded polymeric multilayers in conjunction with an intermediate plasma nitrided layer has large potential in the development of biodegradable orthopedic implants made of Mg alloys.

Cytotoxic effect of galvanically coupled magnesium-titanium particles on Escherichia coli

Orthopedic device-related infections (ODRIs) are difficult to control due to microbial biofilm formation and associated with high-level resistance to conventional antibiotics. In many cases, the only treatment option for ODRI is explantation. Previous studies have shown that application of cathodic potentials at the metal surface can eradicate biofilms, and Mg and Mg-Ti particles have the same effect as cathodic potentials. This study investigated the effects of Mg and Mg-Ti particles on established biofilms and planktonic cells E. coli. Bacterial cultures with developed biofilms or planktonic cells were treated with Mg or Mg-Ti particles, and the viability were assessed using flow cytometry or visual assessment methods (i.e., observation from SEM images and opacity of the solution). It was found that viability of biofilms treated with 16.67 mg/ml of Mg was 2.8 ± 0.96% at the end of 6-hr killing compared to untreated controls. This extent of killing was more significant compared to 24-hr grown biofilms treated with ofloxacin, an antibiotic known to be effective against these bacteria. Biofilms treated with 50 and 100 μg/ml of ofloxacin had 62 ± 4.6% and 52 ± 19.3% survival, respectively, where ofloxacin at these concentrations is known to kill planktonic counterparts very effectively. Inhibition zone tests revealed that biofilms within 2 mm of Mg or Mg-Ti particle clusters were effectively killed. These results demonstrated the potential of Mg or Mg-Ti particles in killing microbial biofilms and potential for controlling ODRI.

In vitro and in vivo antibacterial performance of Zr & O PIII magnesium alloys with high concentration of oxygen vacancies

The effects of dual Zr and O plasma immersion ion implantation (Zr & O PIII) on antibacterial properties of ZK60 Mg alloys are systematically investigated. The results show that a hydrophobic, smooth, and ZrO₂-containing graded film is formed. Electrochemical assessment shows that the corrosion rate of the plasma-treated Mg alloy decreases and the decreased degradation rate is attributed to the protection rendered by the surface oxide. In vitro and in vivo antibacterial tests reveal Zr & O PIII ZK60 presents higher antibacterial rate compared to Zr PIII ZK60 and untreated control. The hydrophobic and smooth surface suppresses bacterial adhesion. High concentration of oxygen vacancies in the surface films are determined by X-ray photoelectron spectroscopy (XPS), UV–vis diffuse reflectance spectra (UV–vis DRS) and electron paramagnetic resonance (EPR) and involved in the production of reactive oxygen species (ROS). The higher level of ROS expression inhibits biofilm formation by down-regulating the expression of icaADBC genes but up-regulating the expression of icaR gene. In addition, Zr & O PIII improves cell viability and initial cell adhesion confirming good cytocompatibility. Dual Zr & O PIII is a simple and practical means to expedite clinical acceptance of biodegradable magnesium alloys.

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A ZrO₂-containing graded film with high concentration of oxygen vacancies was formed via PIII.

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S. aureus adhesion was suppressed due to enhanced hydrophobicity and decreased roughness.

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High concentration of oxygen vacancies lead to the upregulation of ROS expression.

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ROS mediates biofilm-associated genes expression to inhibit biofilm formation in vitro and in vivo.

Microstructural, mechanical, in vitro corrosion and biological characterization of an extruded Zn-0.8Mg-0.2Sr (wt%) as an absorbable material

Zinc (Zn) alloys seem to be promising candidates for application in orthopaedic or cardiovascular medical implants. In this area, high standards are required regarding the biocompatibility as well as excellent mechanical and tailored degradation properties. In the presented study, a novel Zn-0.8Mg-0.2Sr (wt%) alloy has been fabricated by the combination of casting, homogenization annealing and extrusion at 200 °C. As a consequence of its fine-grained homogenous microstructure, the prepared material is characterized by an excellent combination of tensile yield strength, ultimate tensile strength and elongation corresponding to 244 MPa, 324 MPa and 20% respectively. The in vitro corrosion rates of the Zn-0.8Mg-0.2Sr alloy in the physiological solution and the simulated body fluid were 244 μm/a and 69.8 μm/a, respectively. Furthermore, an extract test revealed that Zn-0.8Mg-0.2Sr extracts diluted to 25% had no adverse effects towards L929 fibroblasts, TAg periosteal cells and Saos-2 osteoblasts. Moreover, the Zn-0.8Mg-0.2Sr surface showed effective inhibition of initial Streptococcus gordonii adhesion and biofilm formation. These results indicated the Zn-0.8Mg-0.2Sr alloy, which has superior mechanical properties, might be a promising candidate for materials used for load-bearing applications.

Appropriately adapted properties of hot-extruded Zn-0.5Cu-xFe alloys aimed for biodegradable guided bone regeneration membrane application

Appropriately adapted comprehensive mechanical properties, degradation behavior and biocompatibility are prerequisites for the application of Zn-based biodegradable implants. In this study, hot-extruded Zn-0.5Cu-xFe (x = 0.1, 0.2 and 0.4 wt%) alloys were fabricated as candidates for biodegradable materials for guided bone regeneration (GBR) membranes. The hot-extrusion process and Cu alloying were expected mostly to enhance the mechanical properties, and the Fe alloying was added mainly for regulating the degradation. The microstructure, mechanical properties and in vitro degradation behavior were systematically investigated. The ZnCuFe alloys were composed of a Zn matrix and FeZn₁₃ phase. With increasing Fe content, a higher FeZn₁₃ phase precipitation with larger particles was observed. Since elongation declined significantly until fracture with increasing Fe content up to 0.4 wt%, the ZnCuFe (0.2 wt%) alloy achieved a good balance between mechanical strength and ductility, with an ultimate tensile strength of 202.3 MPa and elongation at fracture of 41.2%. Moreover, the addition of Fe successfully accelerated the degradation of ZnCuFe alloys. The ZnCuFe (0.2 wt%) alloy showed relatively uniform corrosion in the long-term degradation test. Furthermore, extracts of the ZnCuFe (0.2 wt%) alloy showed no apparent cytotoxic effects against L929 fibroblasts, Saos-2 osteoblasts or TAg periosteal cells. The ZnCuFe (0.2 wt%) alloy exhibited the potential to inhibit bacterial adhesion of Streptococcus gordonii and mixed oral bacteria. Our study provides evidence that the ZnCuFe (0.2 wt%) alloy can represent a promising material for the application as a suitable GBR membrane.

The role of magnesium in biomaterials related infections

Magnesium is currently increasing interest in the field of biomaterials. An extensive bibliography on this material in the last two decades arises from its potential for the development of biodegradable implants. In addition, many researches, motivated by this progress, have analyzed the performance of magnesium in both in vitro and in vivo assays with gram-positive and gram-negative bacteria in a very broad range of conditions. This review explores the extensive literature in recent years on magnesium in biomaterials-related infections, and discusses the mechanisms of the Mg action on bacteria, as well as the competition of Mg²⁺ and/or synergy with other divalent cations in this subject.

Evaluation of a Zn-2Ag-1.8Au-0.2V Alloy for Absorbable Biocompatible Materials

Zinc (Zn) and Zn-based alloys have been proposed as a new generation of absorbable metals mainly owing to the moderate degradation behavior of zinc between magnesium and iron. Nonetheless, mechanical strength of pure Zn is relatively poor, making it insufficient for the majority of clinical applications. In this study, a novel Zn–2Ag–1.8Au–0.2V (wt.%) alloy (Zn–Ag–Au–V) was fabricated and investigated for use as a potential absorbable biocompatible material. Microstructural characterization indicated an effective grain-refining effect on the Zn alloy after a thermomechanical treatment. Compared to pure Zn, the Zn–Ag–Au–V alloy showed significantly enhanced mechanical properties, with a yield strength of 168 MPa, an ultimate tensile strength of 233 MPa, and an elongation of 17%. Immersion test indicated that the degradation rate of the Zn–Ag–Au–V alloy in Dulbecco’s phosphate buffered saline was approximately 7.34 ± 0.64 μm/year, thus being slightly lower than that of pure Zn. Biocompatibility tests with L929 and Saos-2 cells showed a moderate cytotoxicity, alloy extracts at 16.7%, and 10% concentration did not affect metabolic activity and cell proliferation. Plaque formation in vitro was reduced, the Zn–Ag–Au–V surface inhibited adhesion and biofilm formation by the early oral colonizer Streptococcus gordonii, indicating antibacterial properties of the alloy.

Evidence for inoculum size and gas interfaces as critical factors in bacterial biofilm formation on magnesium implants in an animal model

Infections of medical implants caused by bacterial biofilms are a major clinical problem. Bacterial colonization is predicted to be prevented by alkaline magnesium surfaces. However, in experimental animal studies, magnesium implants prolonged infections. The reason for this peculiarity likely lies within the ‒still largely hypothetical‒ mechanism by which infection arises. Investigating subcutaneous magnesium implants infected with bioluminescent Pseudomonas aeruginosa via in vivo imaging, we found that the rate of implant infections was critically dependent on a surprisingly high quantity of injected bacteria. At high inocula, bacteria were antibiotic-refractory immediately after infection. High cell densities are known to limit nutrient availability, restricting proliferation and trigger quorum sensing which could both contribute to the rapid initial resistance. We propose that gas bubbles such as those formed during magnesium corrosion, can then act as interfaces that support biofilm formation and permit long-term survival. This model could provide an explanation for the apparent ineffectiveness of innovative contact-dependent bactericidal implant surfaces in patients. In addition, the model points toward air bubbles in tissue, either by inclusion during surgery or by spontaneous gas bubble formation later on, could constitute a key risk factor for clinical implant infections.

Investigation of zinc‑copper alloys as potential materials for craniomaxillofacial osteosynthesis implants

In this study, zinc‑copper (ZnCu) alloys were investigated regarding their feasibility as absorbable metals for osteosynthesis implants, especially in the craniomaxillofacial area. Mechanical properties and in vitro corrosion behavior of as-rolled Zn-xCu (x = 1, 2 and 4 wt%) alloys were systematically evaluated and screened. The as-rolled Zn4Cu alloy had mechanical properties that were superior to the most absorbable craniomaxillofacial osteosynthesis materials recently reported. The addition of Cu to Zn showed to have no apparent effect on the corrosion rates of the samples. The rolling process on Zn and Zn1Cu resulted in more uniform corrosion than on as-cast counterparts after 28 days immersion. Furthermore, the Zn4Cu alloys exhibited no apparent cytotoxic effect towards L929, TAg or Saos-2 cells. Proliferation rates of TAg and Saos-2 cells were shown to be activated by specific Zn ion concentrations in the as-rolled Zn4Cu alloy extracts. Analysis of in vitro antibacterial properties revealed that the as-rolled Zn4Cu alloy possessed the potential to inhibit biofilm formation of mixed oral bacteria. We conclude that the as-rolled Zn4Cu alloy might be a promising material for fabrication of craniomaxillofacial osteosynthesis implants.

Advanced antibacterial activity of biocompatible tantalum nanofilm via enhanced local innate immunity

Tantalum (Ta) has been shown to enhance osseointegration in clinical practice, yet little is known about whether Ta nanofilms can be used as antimicrobial coatings in vivo. A highly biocompatible Ta nanofilm was developed using magnetron sputtering technology to further study the mechanism of its antibacterial effects in vivo and elucidate its potential for clinical translation. The Ta nanofilms exhibited effective antimicrobial activity against soft tissue infections but did not show an intrinsic antimicrobial effect in vitro. This inconsistency between the in vivo and in vitro antimicrobial effects was further investigated using ex vivo models. The Ta nanofilms could enhance the phagocytosis of bacteria by polymorphonuclear neutrophils (PMNs, neutrophils), reduce the lysis of neutrophils and enhance the proinflammatory cytokine release of macrophages. This accumulative enhancement of the local host defenses contributed to the favorable antibacterial effect in vivo. The alleviated osteolysis observed in the presence of the Ta nanofilms in the osteomyelitis model further proved the practicality of this antibacterial strategy in the orthopedic field. In summary, Ta nanofilms show excellent biocompatibility and in vivo antimicrobial activity mediated by the enhancement of local innate immunity and are promising for clinical application. STATEMENT OF SIGNIFICANCE: In this study, Ta nanofilms were deposited on titanium substrate by magnetron sputtering. Ta nanofilms exhibited excellent in vivo and in vitro biocompatibility. In vivo antimicrobial effects of Ta nanofilms were revealed by soft tissue infection and osteomyelitis models, while no direct antibacterial activity was observed in vitro. Comprehensive ex vivo models revealed that Ta nanofilms could enhance the phagocytosis of bacteria by neutrophils, reduce the lysis of neutrophils and promote the release of proinflammatory cytokines from macrophages. This immunomodulatory effect helps host to eliminate bacteria. In contrast to traditional antimicrobial nanocoatings which apply toxic materials to kill bacteria, this work proposes a safe, practical and effective Ta nanofilm immunomodulatory antimicrobial strategy with clinical translational prospect.

Cytotoxicity of biodegradable magnesium alloy WE43 to tumor cells in vitro: Bioresorbable implants with antitumor activity?

In this study, a degradable magnesium alloy WE43 (Mg-3.56%Y-2.20%Nd-0.47%Zr) was used as a research object. To refine its microstructure from the initial homogenized one, the alloy was subjected to severe plastic deformation (SPD) by equal channel angular pressing (ECAP). The data presented show that coincubation of tumor LNCaP and MDA-MB-231 cells with the WE43 alloy in the homogenized and the ECAP-processed states led to a decrease in their viability and proliferation. An increase in the concentration of Annexin V(+) cells during coincubation with samples in both microstructural states investigated was also observed. This is associated with the induction of apoptosis in the cell culture through contact with the samples. Concurrently, a significant drop in the concentration of Bcl-2(+) cells occurred. It was established that ECAP led to an enhancement of the cytotoxic activity of the alloy against tumor cells. This study demonstrated that alloy WE43 can be considered as a promising candidate for application in orthopedic implants in clinical oncology, where it could play a double role of a mechanically stable, yet bioresorbable, scaffold with local antitumor activity. © 2019 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater 108B:167-173, 2020.

In vitro and in vivo evaluation of novel biodegradable Mg-Ag-Y alloys for use as resorbable bone fixation implant

Magnesium (Mg) alloy is gaining more interest because of its degradability and osteogenic potential. Still, it has some deficiencies, such as its rapid degradation rate, insufficient mechanical property. This research aimed to design a novel biodegradable Mg-argentum (Ag)-yttrium (Y) alloy, and Y was added to improve degradable and mechanical property. Mg-Ag-Y alloys were characterized for mechanical features, practicabilities in vitro and in vivo. The mechanical features results shown that this novel component was similar to native bone tissue in elastic moduli, tensile, and compressive stress. Then mesenchymal stem cells (MSCs) were seeded in alloys to assess cell toxicity in vitro. The results showed that its aqueous extract was suitable for MSCs adhesion and proliferation. Then the alloy was evaluated for biomedical applications in nonfractured distal femora of Sprague Dawley rats for 6 weeks, compared with those of pure-Mg and stainless steel groups. All rats survived, and hematological and histological evaluation showed no abnormal physiology 6 weeks postimplantation, and measurements of serum Mg²⁺ concentration were within normal levels. X-ray scanning, microcomputed tomography, and histological examinations were performed to evaluate the degradability and osteogenic potential. The results indicated that the degradation rate of alloy was 0.91 mm per year, (range 0.77-1.22 mm), and pure-Mg 1.80 mm per year (1.43-2.26 mm). The new bone quantity was 3.18 mm³ (1.46-4.44 mm³ ) in Mg-Ag-Y alloys group, 1.39 mm³ (0.54-2.32 mm³ ) in pure-Mg group, and none in stainless steel group. These promising results suggest potential clinical application of Mg-Ag-Y alloys for use as resorbable bone fixation implant. © 2018 Wiley Periodicals, Inc. J Biomed Mater Res Part A: 106A: 2059-2069, 2018.

Bio-Corrosion of Magnesium Alloys for Orthopaedic Applications

Three Mg alloys, Mg–1.34% Ca–3% Zn (MCZ), Mg–1.34% Ca–3% Zn–0.2% Sr (MCZS), and Mg–2% Sr (MS), were examined to understand their bio-corrosion behavior. Electrochemical impedance spectroscopy and polarization scans were performed after 6 days of immersion in cell culture medium, and ion release and changes in media pH were tracked over a 28 day time period. Scanning electron microscopy (SEM) of alloy microstructure was performed to help interpret the results of the electrochemical testing. Results indicate that corrosion resistance of the alloys is as follows: MCZ > MCZS > MS.