Gadolinium accumulation in organs of Sprague-Dawley® rats after implantation of a biodegradable magnesium-gadolinium alloy

Degradation of WE43 Magnesium Alloy in Vivo and Its Degradation Products on Macrophages

Due to their biocompatibility, biodegradability, and suitable mechanical properties, magnesium-based biodegradable implants are emerging as a promising alternative to traditional metal implants. The Mg-4Y-3RE (WE43) biodegradable alloy is among the most extensively studied and widely utilized magnesium alloys in clinical applications. As an absorbable and degradable metallic material, magnesium alloys undergo gradual degradation, wear, and fracture within the body. These alloys reduce the long-term risks associated with permanent implants but generate insoluble byproducts that accumulate in surrounding tissues. Following the implantation of magnesium alloys, granulation tissue and fibrous encapsulation typically form around the material. However, limited research has addressed the interaction between insoluble byproducts of magnesium alloys and macrophages. This study focused on the biological effects of macrophages during the second stage of the host inflammatory response in the degradation process of magnesium alloy. Using subcutaneous implantation of WE43 magnesium alloy sheets, observations were made regarding the degradation components, morphological changes in surrounding tissues, and the biological effects of macrophages upon phagocytosis of insoluble byproducts. The primary degradation products of WE43 in vivo were identified as Ca3 (PO4)2, Mg3(PO4)2, Na3PO4, NaCa (PO4), MgSO4, MgCO3, NaCl, Mg24Y5, and Mg12YNd. Postimplantation, levels of IL-1β and IL-18 in adjacent tissues significantly increased (p < 0.05). By 8 weeks, compared to nitinol alloy, significant thickening of the fibrous capsule (p < 0.05) was observed, accompanied by substantial inflammatory cell infiltration, vascularization, and the presence of macrophages and multinucleated giant cells. Macrophages were observed extending pseudopodia to enclose and phagocytose particles, forming phagosomes and creating a relatively isolated microenvironment around the engulfed substances, where further particle degradation occurred. Following the phagocytosis of degradation products, macrophages exhibited increased lysosome numbers, mitochondrial swelling and damage, phagolysosome formation, and autophagosome development. Furthermore, the degradation products were observed to induce elevated reactive oxygen species (ROS) production in macrophages, activation of P2X7 receptors, enhanced IL-6 secretion, endoplasmic reticulum stress, autophagy, and activation of the NLRP3 inflammasome pathway. This study provides novel insights and contributes a theoretical foundation for a more comprehensive understanding of magnesium alloy degradation in vivo.

Biomedical Applications of Gadolinium-Containing Biomaterials: Not Only MRI Contrast Agent

The potential applications of rare earth elements (REEs) in biomedical fields have been intensively investigated. Numerous studies have shown that doping biomaterials with REEs can enhance their properties. Gadolinium (Gd) is a biocompatible REE that holds promise in biomedical applications. This review examines the use of Gd-doped biomaterials in osteogenic, antimicrobial, anticancer applications, and in bioimaging and bioprobes, as reported in the literature until December 2024. The included studies demonstrate that Gd-containing biomaterials promote osteogenesis, enhance antimicrobial properties, and perform well in anticancer applications and bioimaging. Taken together, they point to the considerable potential of Gd-doped biomaterials and thus to avenues for future research.

In vivo performance of lean bioabsorbable Mg-Ca alloy X0 and comparison to WE43: Influence of surface modification and alloying content

Magnesium alloys present a compelling prospect for absorbable implant materials in orthopedic and trauma surgery. This study evaluates an ultra-high purity, lean magnesium-calcium alloy (X0), both with and without plasma electrolytic oxidation (PEO) surface modification, in comparison to a clinically utilized WE43 magnesium alloy. It is shown that the mechanical properties of X0 can be tuned to yield a high-strength material suitable for bone screws (with an ultimate tensile strength of 336 MPa) or a ductile material appropriate for intraoperatively deformable plates (with an elongation at fracture of 24 %). Four plate-screw combinations were implanted onto the pelvic bones of six sheep without osteotomy for 8 weeks. Subsequent analysis utilized histology, micro-computed tomography, and light and electron microscopy. All implants exhibited signs of degradation and hydrogen-gas evolution, with PEO-coated X0 implants demonstrating the least volume loss and the most substantial new-bone formation on the implant surface and surrounding cancellous bone. Furthermore, the osteoconductive properties of the X0 implants, when uncoated, exceeded those of the uncoated WE43 implants, as evidenced by greater new-bone formation on the surface. This osteoconductivity was amplified with PEO surface modification, which mitigated gas evolution and enhanced osseointegration, encouraging bone apposition in the cancellous bone vicinity. These findings thus indicate that PEO-coated X0 implants hold substantial promise as a biocompatible and absorbable implant material.

Multi-modal investigation of the bone micro- and ultrastructure, and elemental distribution in the presence of Mg-xGd screws at mid-term healing stages

Magnesium (Mg) - based alloys are becoming attractive materials for medical applications as temporary bone implants for support of fracture healing, e.g. as a suture anchor. Due to their mechanical properties and biocompatibility, they may replace titanium or stainless-steel implants, commonly used in orthopedic field. Nevertheless, patient safety has to be assured by finding a long-term balance between metal degradation, osseointegration, bone ultrastructure adaptation and element distribution in organs. In order to determine the implant behavior and its influence on bone and tissues, we investigated two Mg alloys with gadolinium contents of 5 and 10 wt percent in comparison to permanent materials titanium and polyether ether ketone. The implants were present in rat tibia for 10, 20 and 32 weeks before sacrifice of the animal. Synchrotron radiation-based micro computed tomography enables the distinction of features like residual metal, degradation layer and bone structure. Additionally, X-ray diffraction and X-ray fluorescence yield information on parameters describing the bone ultrastructure and elemental composition at the bone-to-implant interface. Finally, with element specific mass spectrometry, the elements and their accumulation in the main organs and tissues are traced. The results show that Mg-xGd implants degrade in vivo under the formation of a stable degradation layer with bone remodeling similar to that of Ti after 10 weeks. No accumulation of Mg and Gd was observed in selected organs, except for the interfacial bone after 8 months of healing. Thus, we confirm that Mg-5Gd and Mg-10Gd are suitable material choices for bone implants.

A biodegradable Zn-5Gd alloy with biomechanical compatibility, cytocompatibility, antibacterial ability, and in vitro and in vivo osteogenesis for orthopedic applications

Zinc (Zn) and some of its alloys are recognized as promising biodegradable implant materials due to their acceptable biocompatibility, facile processability, and moderate degradation rate. Nevertheless, the limited mechanical properties and stability of as-cast Zn alloys hinder their clinical application. In this work, hot-rolled (HR) and hot-extruded (HE) Zn-5 wt.% gadolinium (Zn-5Gd) samples were prepared by casting and respectively combining with hot rolling and hot extrusion for bone-implant applications. Their microstructure evolution, mechanical properties, corrosion behavior, cytotoxicity, antibacterial ability, and in vitro and in vivo osteogenesis were systematically evaluated. The HR and HE Zn-5Gd exhibited significantly improved mechanical properties compared with those of their pure Zn counterparts and the HR Zn-5Gd showed a unique combination of tensile properties with an ultimate tensile strength of ∼311.6 MPa, yield strength of ∼236.5 MPa, and elongation of ∼40.6%, all of which are greater than the mechanical properties required for bone-implant materials. The HR and HE Zn-5Gd showed higher corrosion resistance than their pure Zn counterpart in Hanks' solution and the HE Zn-5Gd had the lowest corrosion rate of 155 µm/y measured by electrochemical corrosion and degradation rate of 26.9 µm/y measured by immersion testing. The HR and HE Zn-5Gd showed high cytocompatibility toward MC3T3-E1 and MG-63 cells, high antibacterial effects against S. aureus, and better in vitro osteogenic activity than their pure Zn counterparts. Furthermore, the HE Zn-5Gd exhibited better in vivo biocompatibility, osteogenesis, and osteointegration ability than pure Zn and pure Ti. STATEMENT OF SIGNIFICANCE: This work reports the mechanical properties, corrosion behaviors, cytocompatibility, antibacterial ability, in vitro and in vivo osteogenesis of biodegradable Zn-Gd alloy for bone-implant applications. Our findings demonstrate that the hot-rolled (HR) Zn-5Gd showed a unique combination of tensile properties with an ultimate tensile strength of ∼311.6 MPa, yield strength of ∼236.5 MPa, and elongation of ∼40.6%. The HR and HE Zn-5Gd showed higher corrosion resistance than their pure Zn counterpart in Hanks' solution. The HR and HE Zn-5Gd showed high cytocompatibility toward MC3T3-E1 and MG-63 cells, good antibacterial effects against S. aureus, and better in vitro osteogenic activity. Furthermore, the HE Zn-5Gd exhibited better in vivo biocompatibility, osteogenesis, and osteointegration ability than pure Zn and pure Ti.

In vitro and in vivo study on fine-grained Mg-Zn-RE-Zr alloy as a biodegradeable orthopedic implant produced by friction stir processing

Magnesium alloys containing biocompatible components show tremendous promise for applications as temporary biomedical devices. However, to ensure their safe use as biodegradeable implants, it is essential to control their corrosion rates. In concentrated Mg alloys, a microgalvanic coupling between the α-Mg matrix and secondary precipitates exists which results in increased corrosion rate. To address this challenge, we engineered the microstructure of a biodegradable Mg-Zn-RE-Zr alloy by friction stir processing (FSP), improving its corrosion resistance and mechanical properties simultaneously. The FS processed alloy with refined grains and broken and uniformly distributed secondary precipitates showed a relatively uniform corrosion morphology accompanied with the formation of a stable passive layer on the alloy surface. In vivo corrosion evaluation of the processed alloy in a small animal model showed that the material was well-tolerated with no signs of inflammation or harmful by-products. Remarkably, the processed alloy supported bone until it healed till eight weeks with a low in vivo corrosion rate of 0.7 mm/year. Moreover, we analyzed blood and histology of the critical organs such as liver and kidney, which showed normal functionality and consistent ion and enzyme levels, throughout the 12-week study period. These results demonstrate that the processed Mg-Zn-RE-Zr alloy offers promising potential for osseointegration in bone tissue healing while also exhibiting controlled biodegradability due to its engineered microstructure. The results from the present study will have profound benefit for bone fracture management, particularly in pediatric and elderly patients.

Nanomaterials: a promising multimodal theranostics platform for thyroid cancer

Thyroid cancer is the most prevalent malignant neoplasm of the cervical region and endocrine system, characterized by a discernible upward trend in incidence over recent years. Ultrasound-guided fine needle aspiration is the current standard for preoperative diagnosis of thyroid cancer, albeit with limitations and a certain degree of false-negative outcomes. Although differentiated thyroid carcinoma generally exhibits a favorable prognosis, dedifferentiation is associated with an unfavorable clinical course. Anaplastic thyroid cancer, characterized by high malignancy and aggressiveness, remains an unmet clinical need with no effective treatments available. The emergence of nanomedicine has opened new avenues for cancer theranostics. The unique features of nanomaterials, including multifunctionality, modifiability, and various detection modes, enable non-invasive and convenient thyroid cancer diagnosis through multimodal imaging. For thyroid cancer treatment, nanomaterial-based photothermal therapy or photodynamic therapy, combined with chemotherapy, radiotherapy, or gene therapy, holds promise in reducing invasiveness and prolonging patient survival or alleviating pain in individuals with anaplastic thyroid carcinoma. Furthermore, nanomaterials enable simultaneous diagnosis and treatment of thyroid cancer. This review aims to provide a comprehensive survey of the latest developments in nanomaterials for thyroid cancer diagnosis and treatment and encourage further research in developing innovative and effective theranostic approaches for thyroid cancer.

The combined effect of zinc and calcium on the biodegradation of ultrahigh-purity magnesium implants

Magnesium (Mg)-based implants are promising candidates for orthopedic interventions, because of their biocompatibility, good mechanical features, and ability to degrade completely in the body, eliminating the need for an additional removal surgery. In the present study, we synthesized and investigated two Mg-based materials, ultrahigh-purity ZX00 (Mg-Zn-Ca; <0.5 wt% Zn and <0.5 wt% Ca, in wt%; Fe-content <1 ppm) and ultrahigh-purity Mg (XHP-Mg, >99.999 wt% Mg; Fe-content <1 ppm), in vitro and in vivo in juvenile healthy rats to clarify the effect of the alloying elements Zn and Ca on mechanical properties, microstructure, cytocompatibility and degradation rate. Potential differences in bone formation and bone in-growth were also assessed and compared with state-of-the-art non-degradable titanium (Ti)-implanted, sham-operated, and control (non-intervention) groups, using micro-computed tomography, histology and scanning electron microscopy. At 6 and 24 weeks after implantation, serum alkaline phosphatase (ALP), calcium (Ca), and Mg level were measured and bone marrow stromal cells (BMSCs) were isolated for real-time PCR analysis. Results show that ZX00 implants have smaller grain size and superior mechanical properties than XHP-Mg, and that both reveal good biocompatibility in cytocompatibilty tests. ZX00 homogenously degraded with an increased gas accumulation 12 and 24 weeks after implantation, whereas XHP-Mg exhibited higher gas accumulation already at 2 weeks. Serum ALP, Ca, and Mg levels were comparable among all groups and both Mg-based implants led to similar relative expression levels of Alp, Runx2, and Bmp-2 genes at weeks 6 and 24. Histologically, Mg-based implants are superior for new bone tissue formation and bone in-growth compared to Ti implants. Furthermore, by tracking the sequence of multicolor fluorochrome labels, we observed higher mineral apposition rate at week 2 in both Mg-based implants compared to the control groups. Our findings suggest that (i) ZX00 and XHP-Mg support bone formation and remodeling, (ii) both Mg-based implants are superior to Ti implants in terms of new bone tissue formation and osseointegration, and (iii) ZX00 is more favorable due to its lower degradation rate and moderate gas accumulation.

Immune response differences in degradable and non-degradable alloy implants

Alloy based implants have made a great impact in the clinic and in preclinical research. Immune responses are one of the major causes of failure of these implants in the clinic. Although the immune responses toward non-degradable alloy implants are well documented, there is a poor understanding of the immune responses against degradable alloy implants. Recently, there have been several reports suggesting that degradable implants may develop substantial immune responses. This phenomenon needs to be further studied in detail to make the case for the degradable implants to be utilized in clinics. Herein, we review these new recent reports suggesting the role of innate and potentially adaptive immune cells in inducing immune responses against degradable implants. First, we discussed immune responses to allergen components of non-degradable implants to give a better overview on differences in the immune response between non-degradable and degradable implants. Furthermore, we also provide potential areas of research that can be undertaken that may shed light on the local and global immune responses that are generated in response to degradable implants.

Modified Biodegradation Behavior Induced Beneficial Microenvironments for Bone Regeneration by Low Addition of Gadolinium in Zinc

Zinc (Zn) shows a great potential as a biodegradable material for bone implants after a decade of systematic research and development. However, uncontrollable biodegradation behavior and biphasic dose-response prevent Zn from fulfilling its essential role in facilitating bone regeneration. In this study, the low addition of gadolinium (Gd) modifies the intrinsic microstructure of Zn in terms of grain size distribution, grain boundary misorientation, and texture. Adding Gd refines grain size distribution and creates a stronger basal plane texture in Zn, consequently, changing the current density distribution and reducing the anode dissolution rate during corrosion. As a result, uniform degradation is more predominant in Zn-0.4Gd alloy implant, in comparison to localized degradation in pure Zn implant in bone environments. The modified biodegradation behavior of the Zn-0.4Gd alloy implant induces significantly better new bone formation and osseointegration compared to the pure Zn implant. Therefore, Gd with trace amounts is able to tune the degradation behavior and improve the performance of Zn-based implants in promoting bone regeneration.

Degradation behavior and osseointegration of Mg-Zn-Ca screws in different bone regions of growing sheep: a pilot study

Magnesium (Mg)-based implants are highly attractive for the orthopedic field and may replace titanium (Ti) as support for fracture healing. To determine the implant-bone interaction in different bony regions, we implanted Mg-based alloy ZX00 (Mg < 0.5 Zn < 0.5 Ca, in wt%) and Ti-screws into the distal epiphysis and distal metaphysis of sheep tibiae. The implant degradation and osseointegration were assessed in vivo and ex vivo after 4, 6 and 12 weeks, using a combination of clinical computed tomography, medium-resolution micro computed tomography (µCT) and high-resolution synchrotron radiation µCT (SRµCT). Implant volume loss, gas formation and bone growth were evaluated for both implantation sites and each bone region independently. Additionally, histological analysis of bone growth was performed on embedded hard-tissue samples. We demonstrate that in all cases, the degradation rate of ZX00-implants ranges between 0.23 and 0.75 mm/year. The highest degradation rates were found in the epiphysis. Bone-to-implant contact varied between the time points and bone types for both materials. Mostly, bone-volume-to-total-volume was higher around Ti-implants. However, we found an increased cortical thickness around the ZX00-screws when compared with the Ti-screws. Our results showed the suitability of ZX00-screws for implantation into the distal meta- and epiphysis.

In Vitro Degradation and In Vivo Biocompatibility of Strontium-Doped Magnesium Phosphate-Reinforced Magnesium Composites

Magnesium is projected for use as a degradable orthopedic biomaterial. However, its fast degradation in physiological media is considered as a significant challenge for its successful clinical applications. Bioactive reinforcements containing Mg-based composites constitute one of the promising approaches for developing degradable metallic implants because of their adjustable mechanical behaviors, corrosion resistance, and biological response. Strontium is a trace element known for its role in enhancing osteoblast activity. In this study, bioactive SrO-doped magnesium phosphate (MgP)-reinforced Mg composites containing 1, 3, and 5 wt % MgP were developed through the casting route. The influence of the SrO-doped MgP reinforcement on degradation behaviors of the composites along with its cell-material interactions and in vivo biocompatibility was investigated. The wt % and distribution of MgP particles significantly improved the mechanical properties of the composite. HBSS immersion study indicated the least corrosion rate (0.56 ± 0.038 mmpy) for the Mg-3MgP composite. The higher corrosion resistance of Mg-3MgP leads to a controlled release of Sr-containing bioactive reinforcement, which eventually enhanced the cytotoxicity as measured using MG-63 cell-material interactions. The in vivo biocompatibility of the composite was evaluated using the rabbit femur defect model. Micro-computed tomography (μ-CT) and histological analysis supported the fact that Mg-3MgP maintained its structural integrity and enhanced osteogenesis (50.36 ± 2.03%) after 2 months of implantation. The results indicated that the Mg-MgP composite could be used as a degradable internal fracture fixation device material.

High-resolution ex vivo analysis of the degradation and osseointegration of Mg-xGd implant screws in 3D

Biodegradable magnesium (Mg) alloys can revolutionize osteosynthesis, because they have mechanical properties similar to those of the bone, and degrade over time, avoiding the need of removal surgery. However, they are not yet routinely applied because their degradation behavior is not fully understood.

In this study we have investigated and quantified the degradation and osseointegration behavior of two biodegradable Mg alloys based on gadolinium (Gd) at high resolution.

Mg-5Gd and Mg-10Gd screws were inserted in rat tibia for 4, 8 and 12 weeks. Afterward, the degradation rate and degradation homogeneity, as well as bone-to-implant interface, were studied with synchrotron radiation micro computed tomography and histology. Titanium (Ti) and polyether ether ketone (PEEK) were used as controls material to evaluate osseointegration.

Our results showed that Mg-5Gd degraded faster and less homogeneously than Mg-10Gd. Both alloys gradually form a stable degradation layer at the interface and were surrounded by new bone tissue. The results were correlated to in vitro data obtained from the same material and shape. The average bone-to-implant contact of the Mg-xGd implants was comparable to that of Ti and higher than for PEEK. The results suggest that both Mg-xGd alloys are suitable as materials for bone implants.

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High-resolution non-destructive synchrotron micro computed tomography of biodegradable Mg alloys ex vivo.

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Mg-xGd implants exhibit a high bone-to-implant contact, similar to titanium implants.

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Initially Mg-xGd implants are surrounded by a lesser bone volume fraction but reach similar levels as reference materials.

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Mg-xGd implants degrade at rates lower than 1 mm a⁻¹ in vivo, decreasing to less than 0.4 mm a⁻¹ after 12 weeks.

Implant degradation of low-alloyed Mg-Zn-Ca in osteoporotic, old and juvenile rats

Implant removal is unnecessary for biodegradable magnesium (Mg)-based implants and, therefore, the related risk for implant-induced fractures is limited. Aging, on the other hand, is associated with low bone-turnover and decreased bone mass and density, and thus increased fracture risk. Osteoporosis is accompanied by Mg deficiency, therefore, we hypothesized that Mg-based implants may support bone formation by Mg²⁺ ion release in an ovariectomy-induced osteoporotic rat model. Hence, we investigated osseointegration and implant degradation of a low-alloyed, degrading Mg-Zn-Ca implant (ZX00) in ovariectomy-induced osteoporotic (Osteo), old healthy (OH), and juvenile healthy (JH) groups of female Sprague Dawley rats via in vivo micro-computed tomography (µCT). For the Osteo rats, we demonstrate diminished trabecular bone already after 8 weeks upon ovariectomy and significantly enhanced implant volume loss, with correspondingly pronounced gas formation, compared to the OH and JH groups. Sclerotic rim development was observed in about half of the osteoporotic rats, suggesting a prevention from foreign-body and osteonecrosis development. Synchrotron radiation-based µCT confirmed lower bone volume fractions in the Osteo group compared to the OH and JH groups. Qualitative histological analysis additionally visualized the enhanced implant degradation in the Osteo group. To date, ZX00 provides an interesting implant material for young and older healthy patients, but it may not be of advantage in pharmacologically untreated osteoporotic conditions. STATEMENT OF SIGNIFICANCE: Magnesium-based implants are promising candidates for treatment of osteoporotic fractures because of their biodegradable, biomechanical, anti-bacterial and bone regenerative properties. Here we investigate magnesium‒zinc‒calcium implant materials in a rat model with ovariectomy-induced osteoporosis (Osteo group) and compare the related osseointegration and implant degradation with the results obtained for old healthy (OH) and juvenile healthy (JH) rats. The work applied an appropriate disease model for osteoporosis and focused in particular on long-term implant degradation for different bone conditions. Enhanced implant degradation and sclerotic rim formation was observed in osteoporotic rats, which illustrates that the setting of different bone models generates significantly modified clinical outcome. It further illustrated that these differences must be taken into account in future biodegradable implant development.

A review on properties of magnesium-based alloys for biomedical applications

With changing lifestyles, the demand for bone implantation has been increasing day by day. The deficiency of nutritious elements within the human body results in certain diseases like osteoporosis, rickets, and other skeletal disorders; lack of physical activities; and the increasing number of accidents are the primary reasons for bone damage/fracture. Metallic implants made up of chrome steel, cobalt-based alloys, and titanium-based alloys are being majorly used worldwide owing to their high strength and high corrosion resistance which makes them permanent orthopedic bioimplant materials, however, they display a stress-shielding effect and it also requires an implant removal surgery. Thus, these problems can be addressed through the employment of biodegradable materials. Among the available biodegradable metallic materials, Mg alloys have been identified as a prospective orthopedic implant material. These alloys are biodegradable as well as biocompatible, however, they experience a relatively higher rate of degradation limiting their usability as implant material. This study attempts to comprehensively assess the effects of various alloying elements such as Ca, Zn, Sn, Mn, Sr and Rare earth elements (REEs) on the mechanical and degradation behavior (bothin vivoandin vitro) of Mg alloys. Since the microstructure, mechanical properties and degradation response of the Mg alloys are dependent on the processing route, hence detailed processing- property database of different Mg alloys is provided in this paper.

Impact of gadolinium on mechanical properties, corrosion resistance, and biocompatibility of Zn-1Mg-xGd alloys for biodegradable bone-implant applications

Zinc (Zn) and its alloys are currently regarded as one of the promising families of biodegradable metals for implant applications owing to their suitable biodegradability and biofunctionality. However, the inadequate mechanical properties of as-cast (AC) pure Zn restricted the practical clinical bone-implant applications due to its coarse grain size and hexagon close-packed crystal structure. Here, the impact of gadolinium (Gd) on the mechanical properties, corrosion resistance, hemolysis percentage, anticoagulant activity, and cytotoxicity of AC and hot-rolled (HR) Zn-1Mg-xGd (x = 0.1, 0.2, and 0.3) (wt.%) alloys were investigated for biodegradable bone-implant applications. Tensile testing showed that the HR Zn-1Mg-0.3Gd alloy exhibited the highest tensile strength of 288.1 MPa, tensile yield strength of 250.9 MPa, and elongation of 13.2%. Electrochemical corrosion and immersion tests revealed that the corrosion rates of both AC and HR specimens increased with increasing Gd content in Hanks' solution, and the HR Zn-1Mg-xGd specimens exhibited higher corrosion rates compared to their AC counterparts. The HR Zn-1Mg-xGd specimens showed an increasing hemolysis percentages and decreasing activated partial thromboplastin time (APTT) values with increasing Gd addition. The alloy extracts of HR samples at ≤ 25% concentration exhibited no cytotoxicity toward MG-63 cells, and the HR Zn-1Mg-0.3Gd alloy displayed the highest cell viability among all three alloy extracts at 12.5% concentration. Overall, the HR Zn-1Mg-0.3Gd can be considered a promising biodegradable implant material for bone-implant materials owing to its high mechanical strength and ductility, suitable degradation rate, and satisfying biocompatibility. STATEMENT OF SIGNIFICANCE: In this work, Zn-1Mg-xGd (x = 0.1, 0.2, and 0.3 wt.%) alloys were developed by alloying with gadolinium (Gd) and hot-rolling, and their mechanical properties, corrosion behavior, hemolysis percentage, anticoagulant activity, and cytotoxicity were investigated for biodegradable implant application. Our findings demonstrated that the hot-rolled Zn-1Mg-0.3Gd alloy exhibit the highest ultimate tensile strength of 288.1 MPa, yield strength of 250.9 MPa, and elongation of 13.2%. Hot-rolled Zn-1Mg-xGd alloys show slowly increasing hemolysis percentages and decreasing activated partial thromboplastin time (APTT) values with increasing Gd addition. Extracts of hot-rolled Zn-1Mg-xGd alloys at a concentration of ≤ 25% show no cytotoxicity towards MG-63 cells, and Zn-1Mg-0.3Gd exhibit good cytocompatibility among all three alloys at a concentration of 12.5%.

Effects of Different Rare Earth Elements on the Degradation and Mechanical Properties of the ECAP Extruded Mg Alloys

Effects of different rare earth elements on the degradation and mechanical properties of the ECAP (equal channel angular pressing) extruded Mg alloys were investigated in this work. Microstructural characterization, thermodynamic calculation, a tensile test, an electrochemical test, an immersion test, a hydrogen evolution test and a cytotoxicity test were carried out. The results showed that yttrium addition was beneficial to the improvement of the alloy's strength, and the ultimate tensile strength (UTS) and yield strength (YS) values of the ECAPed Mg-2Zn-0.5Y-0.5Zr alloy reached 315 MPa and 295 MPa, respectively. In addition, Nd was beneficial to the corrosion resistance, for which, the corrosion rate of the ECAPed Mg-2Zn-0.5Nd-0.5Zr alloy was observed to be 0.42 ± 0.04 mm/year in Hank's solution after 14 days of immersion. Gd was moderate in improving both the corrosion resistance and mechanical properties. Moreover, after co-culturing with murine calvarial preosteoblasts (MC3T3-E1) cells, the ECAPed Mg-2Zn-0.5RE (Nd, Gd, Y)-0.5Zr alloys exhibited good cytocompatibility with a grade 1 cytotoxicity. Consequently, the ECAPed Mg-2Zn-0.5Nd-0.5Zr alloy showed the best application prospect in the field of orthopedics.

Multimodal ex vivo methods reveal that Gd-rich corrosion byproducts remain at the implant site of biodegradable Mg-Gd screws

Extensive research is being conducted on magnesium (Mg) alloys for bone implant manufacturing, due to their biocompatibility, biodegradability and mechanical properties. Gadolinium (Gd) is among the most promising alloying elements for property control in Mg alloy implants; however, its toxicity is controversial. Investigating Gd behavior during implant corrosion is thus of utmost importance. In this study, we analyzed the degradation byproducts at the implant site of biodegradable Mg-5Gd and Mg-10Gd implants after 12 weeks healing time, using a combination of different imaging techniques: histology, energy-dispersive x-ray spectroscopy (EDX), x-ray microcomputed tomography (µCT) and neutron µCT. The main finding has been that, at the healing time in exam, the corrosion appears to have involved only the Mg component, which has been substituted by calcium and phosphorus, while the Gd remains localized at the implant site. This was observed in 2D by means of EDX maps and extended to 3D with a novel application of neutron tomography. X-ray fluorescence analysis of the main excretory organs also did not reveal any measurable accumulation of Gd, further reinforcing the conclusion that very limited or no removal at all of Gd-alloy happened during degradation. STATEMENT OF SIGNIFICANCE: Gadolinium is among the most promising alloying elements for property control in biodegradable magnesium alloy implants, but its toxicity is controversial and its behavior during corrosion needs to be investigated. We combine 2D energy dispersive x-ray spectroscopy and 3D neutron and x-ray tomography to image the degradation of magnesium-gadolinium implants after 12 weeks of healing time. We find that, at the time in exam, the corrosion has involved only the magnesium component, while the gadolinium remains localized at the implant site. X-ray fluorescence analysis of the main excretory organs also does not reveal any measurable accumulation of Gd, further reinforcing the conclusion that very limited or no removal at all of Gd-alloy has happened during degradation.

A review of the physiological impact of rare earth elements and their uses in biomedical Mg alloys

Magnesium (Mg) is well-tolerated by the body, displaying exceedingly low toxicity, rapid excretion, and numerous bioactive effects, including improved bone formation and protection against oxidative stresses; further, Mg alloys can be degraded in vivo to allow complete removal of an implant without surgical intervention, avoiding revision surgery and thrombosis concerns seen with permanent implants. Rare earth elements (REEs) have been of particular interest in alloying Mg alloys for nearly a century due to their unique chemical and physical properties but have attracted increasing attention in recent decades. The REEs contribute greatly to the mechanical and biological properties of metal alloys, and so are common in Mg alloys in a wide variety of applications; in particular, they represent the dominant alloying additions in current, clinically applied Mg alloys. Notably, the use of these elements may assist in the development of advanced Mg alloys for use as biodegradable orthopedic implants and cardiovascular stents. To this end, current research progress in this area, highlighting the physiological impact of REEs in Mg alloys, is reviewed. Clinical work and preclinical data of REE-containing Mg alloys are analyzed. The biological roles of REEs in cellular responses in vivo require further research in the development of biofunctional Mg alloy medical devices. STATEMENT OF SIGNIFICANCE: The presented work is a review into the biological impact and current application of rare-earth elements (REEs) in biodegradable Mg-based biomaterials. Despite their efficacy in improving corrosion, mechanical, and manufacturability properties of Mg alloys, the physiological effects of REEs remain poorly understood. Therefore, the present work was undertaken to both provide guidance in the development of new biomedical alloys, and highlight areas of existing concerns and unclear knowledge. Key findings of this review include a summary of current clinical and preclinical work, and the identification of Sc as the most promising REE with regards to physiological impact. Y, Ce, Pr, Gd, Dy, Yb, Sm, and Eu should be considered carefully before their use as alloying elements, with other REEs intermediate or insufficiently studied.

Tissue responses after implantation of biodegradable Mg alloys evaluated by multimodality 3D micro-bioimaging in vivo

The local response of tissue triggered by implantation of degradable magnesium-based implant materials was investigated in vivo in a murine model. Pins (5.0 mm length by 0.5 mm diameter) made of Mg, Mg-10Gd, and Ti were implanted in the leg muscle tissue of C57Bl/6N mice (n = 6). Implantation was generally well tolerated as documented by only a mild short term increase in a multidimensional scoring index. Lack of difference between the groups indicated that the response was systemic and surgery related rather than material dependent. Longitudinal in vivo monitoring utilizing micro-computed tomography over 42 days demonstrated the highest and most heterogeneous degradation for Mg-10Gd. Elemental imaging of the explants by micro X-ray fluorescence spectrometry showed a dense calcium-phosphate-containing degradation layer. In order to monitor resulting surgery induced and/or implant material associated local cell stress, sphingomyelin based liposomes containing indocyanine green were administered. An initial increase in fluorescent signals (3-7 days after implantation) indicating cell stress at the site of the implantation was measured by in vivo fluorescent molecular tomography. The signal decreased until the 42nd day for all materials. These findings demonstrate that Mg based implants are well tolerated causing only mild and short term adverse reactions.

The role of rare earth elements in biodegradable metals: A review

Compared with non-degradable metals, biodegradable metals, as a new generation of medical metallic materials, do not require secondary, which reduces the pain and economic burden of patients. However, currently developed biodegradable metals, including iron-based alloys, magnesium-based alloys, and zinc-based alloys, have deficiencies in their corrosion rates and mechanical properties, which have severely restricted the clinical application of biodegradable metals. So there is an urgent need to improve their mechanical properties, degradation behaviors and biocompatibility. Alloying is an important way to modify biodegradable metal materials. Rare earth elements (REEs) as alloying elements in biodegradable metals have attracted a great deal of attention due to their unique atomic structure and properties. The present review summarizes the effects of rare earth elements on the mechanical properties, degradation behaviors, and biocompatibility of biodegradable metals. Moreover, future research directions of rare earth elements alloying biodegradable metals are also prospected. STATEMENT OF SIGNIFICANCE: As a new generation of biomedical metallic materials, biodegradable metals have become a hot research topic in recent years as they can degrade completely in human body and thus avoid further secondary surgery. However, these biodegradable metal systems have drawbacks in clinical applications. Alloying is an important method to improve the properties of biodegradable metals. Among the various alloying elements, Rare Earth alloying elements are usually considered due to their unique atomic structure and properties. The present review summarizes the recent research progress of Rare Earth alloying elements in biodegradable metals. The effects of the Rare Earth alloying elements on mechanical properties, biodegradation behavior and biocompatibility of biodegradable metals are presented and discussed in detail.

Surface Modification of Biomedical MgCa4.5 and MgCa4.5Gd0.5 Alloys by Micro-Arc Oxidation

The aim of this work was to characterize the structure and corrosion properties of the MgCa_4.5(Gd_0.5) alloys surface treated by the micro-arc oxidation (MAO) process. The MgCa_4.5 and MgCa_4.5Gd_0.5 alloy samples were processed by MAO in an electrolyte composed of NaOH (10 g/dm³), NaF (10 g/dm³), NaH₂PO₄ (5 g/dm³), Na₂SiO₂·5H₂O (10 g/dm³) and water. Two different voltages (120 V and 140 V) were used in the MAO process. The alloys protected by an oxide layer formed in the MAO were then the subject of corrosion resistance tests in an environment simulating the human body (Ringer’s solution). After the experiments, the resulting samples were investigated using SEM, XPS and EDS techniques. The addition of Gd affected the fragmentation of the coating structure, thereby increasing the specific surface; higher voltages during the MAO process increased the number and size of surface pores. Corrosion tests showed that the MgCa_4.5Gd_0.5 alloys were characterized by low polarization resistances and high corrosion current densities. The studies indicated the disadvantageous influence of gadolinium on the corrosion resistance of MgCa_4.5 alloys. The immersion tests confirmed lower corrosion resistance of MgCa_4.5Gd_0.5 alloys compared to the referenced MgCa_4.5 ones. The MgCa_4.5 alloy with the MAO coating established at voltage 140 V demonstrated the best anticorrosion properties.

Microstructural, Electrochemical and In Vitro Analysis of Mg-0.5Ca-xGd Biodegradable Alloys

The subject of Mg-based biodegradable materials, used for medical applications, has been extensively studied throughout the years. It is a known fact that alloying Mg with biocompatible and non-toxic elements improves the biodegradability of the alloys that are being used in the field of surgical applications. The aim of this research is to investigate the aspects concerning the microstructure, electrochemical response (corrosion resistance) and in vitro cytocompatibility of a new experimental Mg-based biodegradable alloy—Mg–0.5%Ca with controlled addition of Gd as follows: 0.5, 1.0, 1.5, 2.0 and 3.0 wt.%—in order to establish improved biocompatibility with the human hard and soft tissues at a stable biodegradable rate. For this purpose, scanning electron microscopy (SEM), energy-dispersive spectroscopy (EDS), light microscopy (LM) and X-ray diffraction (XRD) were used for determining the microstructure and chemical composition of the studied alloy and the linear polarization resistance (LPR) method was used to calculate the corrosion rate for the biodegradability rate assessment. The cellular response was evaluated using the 3-(4,5-dimethyltiazol-2-yl)-2,5-diphenyl tetrazolium bromide (MTT) test followed by fluorescence microscopy observation. The research led to the discovery of a dendritic α-Mg solid solution, as well as a lamellar Mg2Ca and a Mg5Gd intermetallic compound. The in vivo tests revealed 73–80% viability of the cells registered at 3 days and between 77 and 100% for 5 days, a fact that leads us to believe that the experimental studied alloys do not have a cytotoxic character and are suitable for medical applications.

A lean magnesium-zinc-calcium alloy ZX00 used for bone fracture stabilization in a large growing-animal model

Over the last decade, demand has increased for developing new, alternative materials in pediatric trauma care to overcome the disadvantages associated with conventional implant materials. Magnesium (Mg)-based alloys seem to adequately fulfill the vision of a homogeneously resorbable, biocompatible, load-bearing and functionally supportive implant. The aim of the present study is to introduce the high-strength, lean alloy Mg‒0.45Zn‒0.45Ca, in wt% (ZX00), and for the first time investigate the clinical applicability of screw osteosynthesis using this alloy that contains no rare-earth elements. The alloy was applied in a growing sheep model with osteotomized bone (simulating a fracture) and compared to a non-osteotomy control group regarding degradation behavior and fracture healing. The alloy exhibits an ultimate tensile strength of 285.7 ± 3.1 MPa, an elongation at fracture of 18.2 ± 2.1%, and a reduced in vitro degradation rate compared to alloys containing higher amounts of Zn. In vivo, no significant difference between the osteotomized bone and the control group was found regarding the change in screw volume over implantation time. Therefore, it can be concluded that the fracture healing process, including its effects on the surrounding area, has no significant influence on degradation behavior. There was also no negative influence from hydrogen-gas formation on fracture healing. Despite the proximal and distal screws showing chronologically different gas release, the osteotomy showed complete consolidation. STATEMENT OF SIGNIFICANCE: Conventional implants involve several disadvantages in pediatric trauma care. Magnesium-based alloys seem to overcome these issues as discussed in the recent literature. This study evaluates the clinical applicability of high-strength lean Mg‒0.45Zn‒0.45Ca (ZX00) screws in a growing-sheep model. Two groups, one including a simulated fracture and one group without fracture, underwent implantation of the alloy and were compared to each other. No significant difference regarding screw volume was observed between the groups. There was no negative influence of hydrogen-gas formation on fracture healing and a complete fracture consolidation was found after 12 weeks for all animals investigated.

A lean bioabsorbable magnesium-zinc-calcium alloy ZX00 used for operative treatment of medial malleolus fractures: early clinical results of a prospective non-randomized first in man study

Aims

This study is a prospective, non-randomized trial for the treatment of fractures of the medial malleolus using lean, bioabsorbable, rare-earth element (REE)-free, magnesium (Mg)-based biodegradable screws in the adult skeleton.

Methods

A total of 20 patients with isolated, bimalleolar, or trimalleolar ankle fractures were recruited between July 2018 and October 2019. Fracture reduction was achieved through bioabsorbable Mg-based screws composed of pure Mg alloyed with zinc (Zn) and calcium (Ca) ( Mg-Zn0.45-Ca0.45, in wt.%; ZX00). Visual analogue scale (VAS) and the presence of complications (adverse events) during follow-up (12 weeks) were used to evaluate the clinical outcomes. The functional outcomes were analyzed through the range of motion (ROM) of the ankle joint and the American Orthopaedic Foot and Ankle Society (AOFAS) score. Fracture reduction and gas formation were assessed using several plane radiographs.

Results

The follow-up was performed after at least 12 weeks. The mean difference in ROM of the talocrural joint between the treated and the non-treated sites decreased from 39° (SD 12°) after two weeks to 8° (SD 11°) after 12 weeks (p ≤ 0.05). After 12 weeks, the mean AOFAS score was 92.5 points (SD 4.1). Blood analysis revealed that Mg and Ca were within a physiologically normal range. All ankle fractures were reduced and stabilized sufficiently by two Mg screws. A complete consolidation of all fractures was achieved. No loosening or breakage of screws was observed.

Conclusion

This first prospective clinical investigation of fracture reduction and fixation using lean, bioabsorbable, REE-free ZX00 screws showed excellent clinical and functional outcomes.

Cite this article: Bone Joint Res 2020;9(8):477–483.

Recent Developments in Magnesium Metal-Matrix Composites for Biomedical Applications: A Review

Recently, there is a growing interest in developing magnesium (Mg) based degradable biomaterial. Although corrosion is a concern for Mg, other physical properties, such as low density and Young's modulus, combined with good biocompatibility, lead to significant research and development in this area. To address the issues of corrosion and low yield strength of pure Mg, several approaches have been adopted, such as, composite preparation with suitable bioactive reinforcements, alloying, or surface modifications. This review specifically focuses on recent developments in Mg-based metal matrix composites (MMCs) for biomedical applications. Much effort has gone into finding suitable bioactive, bioresorbable reinforcements and processing techniques that can improve upon existing materials. In summary, this review provides a comprehensive overview of existing Mg-based composite preparation and their mechanical and corrosion properties and biological responses and future perspectives on the development of Mg-based composite biomaterials.

Mechanical properties and cytocompatibility of dense and porous Zn produced by laser powder bed fusion for biodegradable implant applications

In this work, the macrotexture of dense Zn produced by laser powder bed fusion (LPBF) was studied and the mechanical properties for different tensile bar orientations were measured. The compressive strength of LPBF Zn scaffolds with five different unit cells was measured for a relative density of 20-51%. In addition, the response of mesenchymal stem cells to the LPBF Zn scaffolds was studied. The elastic modulus and yield strength of dense LPBF Zn were 110.0 ± 0.2 GPa and 78.0 ± 0.4 MPa, respectively in the vertical and 81.0 ± 0.4 GPa and 55.0 ± 0.7 MPa in the horizontal direction. This could be explained by the preferential orientation of the 〈0001〉 direction in the building plane. For LPBF Zn scaffolds, the plateau stress for the different unit cells varied between 8 and 33 MPa for a 30% relative density. Calcein staining, lactate production and DNA measurements over a 13-day period showed that mesenchymal stem cell viability was low for Zn scaffolds. This work forms a basis for further research into the LPBF texture formation of metals with hexagonal crystal structure, guides implant designers in scaffold unit cell and relative density selection and motivates further research into the cytocompatibility of LPBF Zn. STATEMENT OF SIGNIFICANCE: Laser powder bed fusion (LPBF) is a manufacturing technology which allows the seamless combination of porous and non-porous volumes in a metallic implant and is used in the orthopedic manufacturing industry today. The production of highly dense Zn with LPBF has been described earlier, but the mechanical properties of the resulting material have not been studied in detail yet. This study is the first to report on (i) the influence of different scanning strategies on the macrotexture of dense LPBF Zn and the resulting anisotropy of its mechanical properties, (ii) the relationship between the relative density and strength for LPBF Zn scaffolds with five different unit cells and (iii) the in vitro response of mesenchymal stem cells to these scaffolds.

Characterization and Properties of Mg-xGd-1.5Nd-0.5Zn-0.5Zr Alloys for Biodegradation Applications

The differences in microstructural characteristics, mechanical properties, and corrosion behavior of the as-cast and solution-treated Mg-xGd-1.5Nd-0.5Zn-0.5Zr alloys (Mg-xGd, x = 1, 3, and 5) were studied and discussed. The as-cast Mg-xGd alloys mainly consisted of an α-Mg and island-like eutectic (Mg,Zn)₃RE phase, a few cuboidal phases (REH₂), and a ZnZr phase. With the increase of Gd content, the grain sizes of the as-cast Mg-xGd alloys decreased. Compared to the microstructure of the as-cast Mg-xGd alloys, the eutectic (Mg,Zn)₃RE phase disappeared and the cuboidal REH₂ phases existed in the solution-treated Mg-xGd alloys. A large amount of ZnZr_x phase was precipitated from α-Mg in the Mg-3Gd alloy and demonstrates a flower-like distribution. The ultimate tensile strength (UTS) and yield strength (YS) of the solution-treated Mg-xGd alloys increased with an increasing Gd content, with the UTS and YS of the Mg-5Gd alloys reaching 217.5 and 125.2 MPa, respectively. Immersion and electrochemical tests showed that the as-cast Mg-3Gd alloy presented the best corrosion resistance with a corrosion rate of 0.285 mm/yr. The corrosion resistance of the solution-treated Mg-3Gd alloy attained the lowest value (0.973 mm/yr), due to the large quantities of ZnZr_x with a flower-like phase distribution, forming series of galvanic couple groups with the α-Mg.

Comparative in vitro study on binary Mg-RE (Sc, Y, La, Ce, Pr, Nd, Sm, Eu, Gd, Tb, Dy, Ho, Er, Tm, Yb and Lu) alloy systems

Correct selection of alloying elements is important for developing novel biodegradable magnesium alloys with superior mechanical and biological performances. In contrast to various reports on nutrient elements (Ca, Zn, Sr, etc.) as alloying elements of biomedical magnesium alloys, there is limited information about how to choose the right rare earth elements (REEs) as alloying elements of magnesium. In this work, 16 kinds of REEs were individually added into Mg, including Sc, Y, La, Ce, Pr, Nd, Sm, Eu, Gd, Tb, Du, Ho, Er, Tm, Yb and Lu, to fabricate binary Mg-RE model alloys with different composition points. Under the same working history, comparative studies were undertaken and the impact of each kind of rare earth element on the microstructure, mechanical property, corrosion behavior and biocompatibility of Mg were investigated. The corresponding influence level for the 16 kinds of REEs were ranked. The results showed that the second phases were detected in some Mg-RE alloys, which were mainly composed of Mg₁₂RE. By adding different REEs into Mg with proper contents, the mechanical properties of resulting Mg-RE binary alloys could be adjusted in wide range. The corrosion resistance of Mg-light REE alloys was generally better than Mg-heavy REE alloys. As for biocompatibility, Mg-RE model alloys showed no cytotoxic effect on MC3T3-E1 cells. The hemolysis rates of all experimental Mg-RE model alloys were lower than 5% except for Mg-Lu alloy model. In general, the addition of different REEs into Mg could improve its performance from different aspects. This work provides a better understanding on suitable REEs as alloying elements for magnesium, and the future R&D direction on biomedical Mg-RE alloys was proposed. STATEMENT OF SIGNIFICANCE: In contrast to various reports on nutrient elements (Ca, Zn, Sr, etc.) as alloying elements of biomedical magnesium alloys, until now there is limited information about how to choose the right rare earth elements (REEs) as alloying elements of magnesium. In this work, comparative studies were undertaken by individually adding 16 kinds of REEs, including Sc, Y, La, Ce, Pr, Nd, Sm, Eu, Gd, Tb, Du, Ho, Er, Tm, Yb and Lu, into Mg to fabricate binary Mg-RE model alloys, with different composition points, then the impact of each kind of rare earth element on the microstructure, mechanical property, corrosion behavior and biocompatibility of Mg under the same working history were investigated, and the corresponding influence level for the 16 kinds of REEs were ranked. This work provides a better understanding on suitable REEs as alloying elements for magnesium, and the future R&D direction on biomedical Mg-RE alloys was proposed.

Analysis of the bone ultrastructure around biodegradable Mg-xGd implants using small angle X-ray scattering and X-ray diffraction

Magnesium alloys are increasingly researched as temporary biodegradable metal implants in bone applications due to their mechanical properties which are more similar to bone than conventional implant metals and the fact that Magnesium occurs naturally within the body. However, the degradation processes in vivo and in particular the interaction of the bone with the degrading material need to be further investigated. In this study we are presenting the first quantitative comparison of the bone ultrastructure formed at the interface of biodegradable Mg-5Gd and Mg-10Gd implants and titanium and PEEK implants after 4, 8 and 12 weeks healing time using two-dimensional small angle X-ray scattering and X-ray diffraction. Differences in mineralization, orientation and thickness of the hydroxyapatite are assessed. We find statistically significant (p < 0.05) differences for the lattice spacing of the (310)-reflex of hydroxyapatite between titanium and Mg-xGd materials, as well as for the (310) crystal size between titanium and Mg-5Gd, indicating a possible deposition of Mg within the bone matrix. The (310) lattice spacing and crystallite size further differ significantly between implant degradation layer and surrounding bone (p < 0.001 for Mg-10Gd), suggesting apatite formation with significant amounts of Gd and Mg within the degradation layer. STATEMENT OF SIGNIFICANCE: Biodegradable Magnesium-based alloys are emerging as a viable alternative for temporary bone implant applications. However, in order to understand if the degradation of the implant material influences the bone ultrastructure, it is necessary to study the bone structure using high-resolution techniques. We have therefore employed 2D small angle X-ray scattering and X-ray diffraction to study the bone ultrastructure surrounding Magnesium-Gadolinium alloys as well as Titanium and PEEK alloys at three different healing times. This is the first time, that the bone ultrastructure around these materials is directly compared and that a statistical evaluation is performed. We found differences indicating a possible deposition of Mg within the bone matrix as well as a local deposition of Mg and/or Gd at the implant site. DATA AVAILABILITY STATEMENT: The raw/processed data required to reproduce these findings cannot be shared at this time as the data also forms part of an ongoing study.

The role of zinc in the biocorrosion behavior of resorbable Mg‒Zn‒Ca alloys

Zinc- and calcium-containing magnesium alloys, denominated ZX alloys, excel as temporary implant materials because of their composition made of physiologically essential minerals and lack of commonly used rare-earth alloying elements. This study documents the specific role of nanometric intermetallic particles (IMPs) on the in vitro and in vivo biocorrosion behavior of two ZX-lean alloys, Mg‒Zn1.0‒Ca0.3 (ZX10) and Mg‒Zn1.5‒Ca0.25 (ZX20) (in wt.%). These alloys were designed according to thermodynamic considerations by finely adjusting the nominal Zn content towards microstructures that differ solely in the type of phase composing the IMPs: ZX10, with 1.0 wt.% Zn, hosts binary Mg₂Ca-phase IMPs, while ZX20, with 1.5 wt.% Zn, hosts ternary IM1-phase IMPs. Electrochemical methods and the hydrogen-gas evolution method were deployed and complemented by transmission electron microscopy analyses. These techniques used in concert reveal that the Mg₂Ca-type IMPs anodically dissolve preferentially and completely, while the IM1-type IMPs act as nano-cathodes, facilitating a faster dissolution of ZX20 compared to ZX10. Additionally, a dynamically increasing cathodic reactivity with progressing dissolution was observed for both alloys. This effect is explained by redeposits of Zn on the corroding surface, which act as additional nano-cathodes and facilitate enhanced cathodic reaction kinetics. The higher degradation rate of ZX20 was verified in vivo via micro-computed tomography upon implantation of both materials into femurs of Sprague Dawley^Ⓡ rats. Both alloys were well integrated with direct bone‒implant contact observable 4 weeks post operationem, and an appropriately slow and homogeneous degradation could be observed with no adverse effects on the surrounding tissue. The results suggest that both alloys qualify as new temporary implant materials, and that a minor adjustment of the Zn content may function as a lever for tuning the degradation rate towards desired applications. STATEMENT OF SIGNIFICANCE: In Mg‒Zn‒Ca (ZX)-lean alloys Zn is the most electropositive element, and thus requires special attention in the investigation of biocorrosion mechanisms acting on these alloys. Even a small increase of only 0.5 wt.% Zn is shown to accelerate the biodegradation rate in both simulated body conditions and in vivo. This is possible due to Zn's role in influencing the type of intermetallic particles (IMPs) in these alloys. These IMPs in turn, even though minute in size, are shown to govern the biocorrosion behavior on the macroscopic scale. The deep understanding gained in this study on the role of Zn and of the IMP type it governs is crucial to ensuring a safe and controllable implant degradation.

In vitro and in vivo studies of Mg-30Sc alloys with different phase structure for potential usage within bone

Proper alloying magnesium with element scandium (Sc) could transform its microstructure from α phase with hexagonal closed-packed (hcp) structure into β phase with body-cubic centered (bcc) structure. In the present work, the Mg-30 wt% Sc alloy with single α phase, dual phases (α + β) or β phase microstructure were developed by altering the heat-treatment routines and their suitability for usage within bone was comprehensively investigated. The β phased Mg-30 wt% Sc alloy showed the best mechanical performance with ultimate compressive strength of 603 ± 39 MPa and compressive strain of 31 ± 3%. In vitro degradation test showed that element scandium could effectively incorporate into the surface corrosion product layer, form a double-layered structure, and further protect the alloy matrix. No cytotoxic effect was observed for both single α phased and β phased Mg-30 wt% Sc alloys on MC3T3 cell line. Moreover, the β phased Mg-30 wt%Sc alloy displayed acceptable corrosion resistance in vivo (0.06 mm y^-1) and maintained mechanical integrity up to 24 weeks. The degradation process did not significantly influence the hematology indexes of inflammation, hepatic or renal functions. The bone-implant contact ratio of 75 ± 10% after 24 weeks implied satisfactory integration between β phased Mg-30 wt%Sc alloy and the surrounding bone. These findings indicate a potential usage of the bcc-structured Mg-Sc alloy within bone and might provide a new strategy for future biomedical magnesium alloy design. STATEMENT OF SIGNIFICANCE: Scandium is the only rare earth element that can transform the matrix of magnesium alloy into bcc structure, and Mg-30 wt%Sc alloy had been recently reported to exhibit shape memory effect. The aim of the present work is to study the feasibility of Mg-30 wt%Sc alloy with different constitutional phases (single α phase, single β phase or dual phases (α + β)) as biodegradable orthopedic implant by in vitro and in vivo testings. Our findings showed that β phased Mg-30 wt%Sc alloy which is of bcc structure exhibited improved strength and superior in vivo degradation performance (0.06 mm y^-1). No cytotoxicity and systematic toxicity were shown for β phased Mg-30 wt%Sc alloy on MC3T3 cell model and rat organisms. Moreover, good osseointegration, limited hydrogen gas release and maintained mechanical integrity were observed after 24 weeks' implantation into the rat femur bone.

The gadolinium hypothesis for fibromyalgia and unexplained widespread chronic pain

Fibromyalgia (FM) is a chronic, painful, heterogeneous, and common disorder carrying a substantial socio-economical burden. It lacks effective cures and its aetiology is still unknown. There exists evidence for central and peripheral neurological contribution to the symptoms but grasping the real source of abnormal nervous system sensitization remains an ongoing challenge. There exists an association between an injury/trauma and the onset of the symptoms, but a causal relationship has not been yet sufficiently supported by scientific evidence. I postulate a role for gadolinium-based contrast agents and retention of gadolinium in the body. This conjecture breaks the hypothesis of a direct role for a physical injury/trauma per se in favour of an indirect one by the subsequent diagnostic procedures. It creates a new link between retention of gadolinium in the body and painful conditions as FM and unexplained chronic widespread pain reported after a trauma, surgery, or medical illness. Experimental evidence demonstrates possible retention of gadolinium species in human body, still lacking conclusive answers on their pathological consequences. Notwithstanding, there exist some initial data that report unexplained chronic widespread pain and symptoms of FM in those patients: they are suggestive for pathological consequences associated with gadolinium retention. Besides clear compelling symptoms overlapping, biochemical findings are provided to sustain the hypothesis of a role for gadolinium in the disease process focusing on neurotransmitters, endogenous metal cations, cytokines, and muscle tissue. Experimental findings strongly support the hypothesis of impairment at the cellular, intracellular, and systemic levels in FM. And these data are highly compatible with collateral effects associated with the interference of the gadolinium ion and its pharmaceutical chelates into biochemical pathways in vivo. The hypothesis presented in this article, along with the support of scientific evidence, links FM and unexplained chronic widespread pain reported after a trauma, surgery, or medical illness to retention of gadolinium in the body. If the hypothesis is confirmed, it could improve diagnosis and prevention, while providing a ground for development of new treatments.

The current trends of Mg alloys in biomedical applications-A review

Magnesium (Mg) has emerged as an ideal alternative to the permanent implant materials owing to its enhanced properties such as biodegradation, better mechanical strengths than polymeric biodegradable materials and biocompatibility. It has been under investigation as an implant material both in cardiovascular and orthopedic applications. The use of Mg as an implant material reduces the risk of long-term incompatible interaction of implant with tissues and eliminates the second surgical procedure to remove the implant, thus minimizes the complications. The hurdle in the extensive use of Mg implants is its fast degradation rate, which consequently reduces the mechanical strength to support the implant site. Alloy development, surface treatment, and design modification of implants are the routes that can lead to the improved corrosion resistance of Mg implants and extensive research is going on in all three directions. In this review, the recent trends in the alloying and surface treatment of Mg have been discussed in detail. Additionally, the recent progress in the use of computational models to analyze Mg bioimplants has been given special consideration. © 2018 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater 107B: 1970-1996, 2019.

Short-term exposure to titanium, aluminum and niobium (Ti-6Al-4Nb) alloy powder can disturb the serum low-density lipoprotein concentrations and antioxidant profile in vital organs but not the behavior of male albino mice

A group of seven-week-old albino mice of both genders were orally administered with a suspension of 25 mg Ti-6Al-4Nb/ml of saline/kg body weight and evaluated in comparison with a control group of animals treated with saline. Evaluation of both the groups was conducted through behavioral tests (Rota rod, open field, novel object and light dark box test), blood biochemical tests [complete blood count and selected serum parameters ([cholesterol, high-density lipoproteins, low-density lipoproteins, creatinine and triglycerides)] and on the basis of measured concentration of antioxidant metabolites (superoxide dismutase, catalase and lipid peroxidation) in vital organs (brain, heart, liver, kidney and lungs). Based upon the results of these tests, it has been found that the applied dose of Ti-6Al-4Nb alloy powder has not effect on physical and neurological outcome of these animals. However, it can increase low-density lipoprotein concentrations as well as disturb the H₂O₂ and lipid peroxidation associated metabolic pathways, especially in male albino mice. Whereas all other hematological indices and antioxidative stress parameters were unaffected.

Comparison of a resorbable magnesium implant in small and large growing-animal models

Fracture treatment in children needs new implant materials to overcome disadvantages associated with removal surgery. Magnesium-based implants constitute a biocompatible and bioresorbable alternative. In adults and especially in children, implant safety needs to be evaluated. In children the bone turnover rate is higher and implant material might influence growth capacity, and the long-term effect of accumulated particles or ions is more critical due to the host's prolonged post-surgery lifespan. In this study we aimed to investigate the degradation behavior of ZX00 (Mg-0.45Zn-0.45Ca; in wt.%) in a small and a large animal model to find out whether there is a difference between the two models (i) in degradation rate and (ii) in bone formation and in-growth. Our results 6, 12 and 24 weeks after ZX00 implantation showed no negative effects on bone formation and in-growth, and no adverse effects such as fibrotic or sclerotic encapsulation. The degradation rate did not significantly differ between the two growing-animal models, and both showed slow and homogeneous degradation performance. Our conclusion is that small animal models may be sufficient to investigate degradation rates and provide preliminary evidence on bone formation and in-growth of implant materials in a growing-animal model.

STATEMENT OF SIGNIFICANCE

The safety of implant material is of the utmost importance, especially in children, who have enhanced bone turnover, more growth capacity and longer postoperative lifespans. Magnesium (Mg)-based implants have long been of great interest in pediatric orthopedic and trauma surgery, due to their good biocompatibility, biodegradability and biomechanics. In the study documented in this manuscript we investigated Mg-Zn-Ca implant material without rare-earth elements, and compared its outcome in a small and a large growing-animal model. In both models we observed bone formation and in-growth which featured no adverse effects such as fibrotic or sclerotic encapsulation, and slow homogeneous degradation performance of the Mg-based implant material.

Resorbable implants in pediatric fracture treatment

Pediatric osteosynthesis has developed over the last 20 years, thereby reducing medical and economic burden, including long and expensive hospitalization. Currently, conventional and rigid alloying systems such as titanium are used for stabilization of bone fractures in children. In many cases, implants must be removed, as otherwise growth would be impeded. Biodegradable implant materials exhibit beneficial properties and would make a second removal surgery unnecessary. In the following article, we will give an overview of implant materials that are currently used in pediatric traumatology with a focus on Mg-based implants. Furthermore, we will discuss current scientific knowledge on resorbable implants, including results from pre-clinics and clinics.

Mechanical and in vitro degradation behavior of magnesium-bioactive glass composites prepared by SPS for biomedical applications

In order to make magnesium (Mg) a successful candidate for fracture fixation devices, it is imperative to control the corrosion rate and enhance its elastic modulus. In the present work, we have prepared bioactive glass (BG) reinforced magnesium composite using spark plasma sintering (SPS). Simultaneous application of heat and pressure during SPS decreased the softening point of BG (600°C), allowing it to coat the Mg particles partially. As a result, BG was found along the Mg particle boundaries, which was confirmed by elemental mapping. Addition of BG improved microhardness and elastic modulus of Mg-BG composites. Corrosion behavior was studied by hydrogen evolution and immersion corrosion in phosphate buffered saline (PBS). After 64 h of immersion, Mg-10 wt % BG composite showed highest corrosion resistance. Quantitative micro-computed tomography (micro-CT) results indicated porosity increase in Mg-BG composites during immersion. The maximum increase in porosity (1.66%) was noticed for pure Mg while the minimum for Mg-10 wt % BG composite. MG63 cell-material interactions, using extract method, showed good cytocompatibility for Mg-10 wt % BG composite. The concentration of Mg ion in cell culture media was measured using atomic absorption spectroscopy after 24 h immersion of Mg/BG composites. The results indicated that using BG as reinforcement and SPS as sintering method; we can prepare corrosion resistant and high modulus Mg-BG composites that can be used for fabricating bone fracture fixation plates. © 2018 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater, 107B: 352-365, 2019.

Investigation on the in vitro cytocompatibility of Mg-Zn-Y-Nd-Zr alloys as degradable orthopaedic implant materials

Mg-Zn-Y-Nd-Zr alloy has been developed as a new type of biodegradable orthopaedic implant material by the authors' research group with its excellent mechanical properties and controllable degradation rate. In this study, the cytocompatibility of Mg-Zn-Y-Nd-Zr alloy was systematically evaluated through in vitro cell culture method. MTT assay was applied to evaluate the cytotoxicity of Mg-Zn-Y-Nd-Zr alloy and no toxic effect was observed on L929 and MC3T3-E1 cells followed the protocol of ISO 10993 standard. Considering the potential ion accumulation in the bony environment, this study further investigated the cytotoxic effect of accumulated metallic ions during the alloy degradation by extending the extract preparation time. When the extract preparation time was prolonged to 1440 h, the accumulated metallic ions leaded to severe cell apoptosis, of which the combined ion concentration was determined as 39.5-65.8 µM of Mg²⁺, 3.5-5.9 µM of Zn²⁺, 0.44-0.74 µM of Y³⁺, 0.3-0.52 µM of Nd³⁺ and 0.11-0.18 µM of Zr⁴⁺ for L929, and 65.8-92.2 µM of Mg²⁺, 5.9-8.3 µM of Zn²⁺, 0.74-1.04 µM of Y³⁺, 0.52-0.73 µM of Nd³⁺ and 0.18-0.25 µM of Zr⁴⁺ for MC3T3-E1 cells. Besides the cell viability assessment, high expression of ALP activity and calcified nodules implied that metal elements in Mg-Zn-Y-Nd-Zr alloys can promote the osteogenic differentiation. Hence, excellent cytocompatibility has equipped Mg-Zn-Y-Nd-Zr alloy as a promising candidate for orthopaedic implant application, which can remarkably guide the magnesium-based alloy design and provide scientific evidence for clinical practice in future.

The degradation and transport mechanism of a Mg-Nd-Zn-Zr stent in rabbit common carotid artery: A 20-month study

Mg-based stent is a promising candidate of the next generation fully degradable vascular stents. The latest progress includes the CE approval of the Magmaris ® WE43 based drug eluting stent. However, so far, the long term (more than 1 year implantation) in vivo degradation and the physiological effects caused by the degradation products were still unclear. In this study, a 20 month observation was carried out after the bare Mg-Nd-Zn-Zr (abbr. JDBM) stent prototype was implanted into the common carotid artery of New Zealand white rabbit in order to evaluate its safety, efficacy and especially degradation behavior. The degradation of the main second phase Mg₁₂Nd was also studied. Results showed that the bare JDBM stent had good safety and efficacy with a complete re-endothelialization within 28 days. The JDBM stent struts were mostly replaced in situ by degradation products in 4 month. The important finding was that the volume and Ca concentration of the degradation products decreased in the long term, eliminating the clinicians' concern of possible vessel calcification. In addition, the alloying elements Mg and Zn in the stent could be safely metabolized as continuous enrichment in any of the main organs were not detected although Nd and Zr showed an abrupt increase in spleen and liver after 1 month implantation. Collectively, the long term in vivo results showed the rapid re-endothelialization of JDBM stent and the long term safety of the degradation products, indicating its great potential as the backbone of the fully degradable vascular stent.

STATEMENT OF SIGNIFICANCE

Mg-based stent is a promising candidate of the next generation fully degradable stents, especially after the recent market launch of one of its kind (Magmaris). However the fundamental question about the long term degradation and metabolic mechanism of Mg-based stent and its degradation products remain unanswered. We implanted our patented Mg-Nd-Zn-Zr bare stent into the common carotid artery of rabbits and conducted a 20 months observation. We found that the Ca containing degradation products could be further degraded in vivo. All the alloying elements showed no continuous enrichment in the main organs of rabbits. These findings eliminate the clinicians' concern of possible vessel calcification and element enrichment after the implantation of Mg alloy based stents to some extent.

In Vitro and in Vivo Studies on Biomedical Magnesium Low-Alloying with Elements Gadolinium and Zinc for Orthopedic Implant Applications

Ternary magnesium alloys with low combined addition of elements gadolinium and zinc were developed in the present work, with their microstructures, mechanical properties, in vitro degradation behaviors, and cytotoxicity being systematically studied. Furthermore, the Mg-1.8Zn-0.2Gd alloy, with the best in vitro performance, was implanted into Sprague Dawley rats to examine its in vivo degradation performance for up to 6 months. It was found that Mg-1.8Zn-0.2Gd, composed of a single α-Mg phase, owned excellent strength and toughness that were comparable to the CE marked MAGNEZIX, the mischmetal added Mg alloy. Owing to the uniform single-phased microstructure, the degradation rate of this alloy was around 0.12 mm/y measured by electrochemical testing, which was comparable to high purity magnesium. Moreover, the Mg-1.8Zn-0.2Gd alloy exhibited no cytotoxicity to L929, MG63, and VSMC cells. In vivo degradation characterized by micro-computed tomography revealed that the Mg-1.8Zn-0.2Gd implant could maintain structural integrity in the first 2 months, and serious degradation could be observed after 6 months. A remarkable 100% survival rate of experimental animals was observed with no negative effects on bone tissues. The implant and the surrounding bone were well integrated within 2 months, implying good biocompatibility and osteoconductivity of the experimental alloy. On the basis of the above findings, the feasibility of Mg-Zn-Gd alloys for use as orthopedic implants was systematically discussed. This study provides a new strategy for development of high-performance Mg-rare earth (RE)-based alloys with superior mechanical properties and corrosion resistance while effectively avoiding the possible standing toxic effect of RE elements.

Nano-confinement-driven enhanced magnetic relaxivity of SPIONs for targeted tumor bioimaging

Superparamagnetic iron oxide nanoparticles (SPIONs) are highly biocompatible and have a versatile synthetic technique based on coprecipitation, reduction-precipitation, and hydrothermal methods, where Fe³⁺ and Fe²⁺ react in aqueous solutions; both these ions are present in our body and have clear metabolic pathways; therefore, they have attracted extensive research interest and development in the field of diagnostic imaging and therapy. However, most SPION-based clinical diagnostic contrast agents are discontinued due to severe pain, low transverse magnetic relaxivity range of 80-180 mM^-1 s^-1, shorter circulation half-life, and lack of disease specificity. Therefore, in this study, we engineered a bone cancer-targeted hybrid nanoconstruct (HNC) with a high transverse magnetic relaxivity of 625 mM^-1 s^-1, which was significantly higher than that of clinical contrast agents. The engineered HNC is peripherally decorated with a bone-seeking agent, alendronic acid-conjugated phospholipid, exhibiting a hydrodynamic size of 80 nm with a negative surface potential, -35 mV. The interior skeleton of the HNC is composed of biodegradable and biocompatible poly(l-lactic-co-glycolic acid) (PLGA), in which 5 nm SPIONs are confined. We have successfully tuned the distance between the confined SPIONs from 0.5 to 4 nm, as revealed by transmission electron microscopy (TEM) images and magnetic resonance image (MRI) phantoms. This cluster confinement dramatically enhances magnetic relaxivity possibly due to the increase in net local magnetization due to proximal field inhomogeneity. In an in vitro examination, 80% of HNC is found to bind with hydroxyapatite (HAp), which when characterized by TEM shows a painting of SPIONs over a HAp crystal. HNC is found to accumulate in mouse osteosarcoma tumor (K7M2 tumor model); both MRI and histological examination of the tumor show the potential of HNC as targeting agents for diagnosis of tumor in the bone.