Porous poly(alpha-hydroxyacid)/Bioglass composite scaffolds for bone tissue engineering. I: Preparation and in vitro characterisation

Compressive Fracture Behavior of Zirconia/Resin Composites Prepared by Fused Deposition Modeling Combined with Vacuum Infiltration

Although bioceramic materials exhibit good biocompatibilities and bone conductivities, their high brittleness and low toughness properties limit their applications. Zirconia (ZrO2)/resin composites with idealized structures and properties were prepared by fused deposition modeling (FDM) combined with a vacuum infiltration process. The porous structure was prepared using the FDM three-dimensional printing technology, with granular zirconia as the raw material, and the relationship between the pore shape, pore size, and deformation was discussed. The results showed that square pores were more suitable than honeycomb pores for printing small pore sizes, and the resolution was high. Scanning electron microscopy observations showed that the superposition of multiple printing paths promoted the emergence of hole defects. The effects of the resin and the pore shape on the compressive strengths of the composites were studied. It was found that the compressive strengths of the honeycomb pore ZrO2/resin composites and porous ceramics were superior to those of the square pore samples. The introduction of the resin had a significant effect on the compressive strengths of the composites. The compressive strength increased in the direction perpendicular to the pores, while it decreased in the direction parallel to the pores.

Fundamentals and Applications of Raman-Based Techniques for the Design and Development of Active Biomedical Materials

Raman spectroscopy is an analytical method based on light-matter interactions that can interrogate the vibrational modes of matter and provide representative molecular fingerprints. Mediated by its label-free, non-invasive nature, and high molecular specificity, Raman-based techniques have become ubiquitous tools for in situ characterization of materials. This review comprehensively describes the theoretical and practical background of Raman spectroscopy and its advanced variants. The numerous facets of material characterization that Raman scattering can reveal, including biomolecular identification, solid-to-solid phase transitions, and spatial mapping of biomolecular species in bioactive materials, are highlighted. The review illustrates the potential of these techniques in the context of active biomedical material design and development by highlighting representative studies from the literature. These studies cover the use of Raman spectroscopy for the characterization of both natural and synthetic biomaterials, including engineered tissue constructs, biopolymer systems, ceramics, and nanoparticle formulations, among others. To increase the accessibility and adoption of these techniques, the present review also provides the reader with practical recommendations on the integration of Raman techniques into the experimental laboratory toolbox. Finally, perspectives on how recent developments in plasmon- and coherently-enhanced Raman spectroscopy can propel Raman from underutilized to critical for biomaterial development are provided.

Functionalized Collagen/Elastin-like Polypeptide Hydrogels for Craniofacial Bone Regeneration

Critical-sized cranial bone defects fail to re-ossify and require the surgical intervention of cranioplasty. To achieve superior bone healing in such cases, a hydrogel consisting of an interpenetrating network of collagen and elastin-like polypeptide to encapsulate bone morphogenetic protein-2 (BMP-2), doxycycline, and 45S5 Bioglass is developed. This hydrogel has an appropriate elastic modulus of 39 ± 2.2 kPa to allow proper handling during implantation. The hydrogel promotes human adipose-derived stem attachment, proliferation, and differentiation toward the osteogenic lineage, including the deposition of hydroxyapatite particles embedded within a collagenous fibrillar structure after 21 days of in vitro culture. After eight weeks of implantation of the acellular hydrogel in a critical-sized rat cranial defect model, only a small quantity of various pro-inflammatory (< 20 pg mg^-1 ) and anti-inflammatory (< 10 pg mg^-1 ) factors in the adjacent cranial tissue is noticed, indicating the overall biocompatibility of the hydrogel. Scanning electron microscopy evidenced the presence of new fibrous extracellular matrix and mineral aggregates at the defect site, with calcium/phosphorus ratio of 0.5 and 2.0 by eight and twelve weeks, respectively. Microcomputed tomography (Micro-CT) and histological analyses showed formation of mature mineralized tissue that bridged with the surrounding bone. Taken together, the acellular composite hydrogel shows great promise for superior bone healing after cranioplasty.

A Review on Manufacturing Processes of Biocomposites Based on Poly(α-Esters) and Bioactive Glass Fillers for Bone Regeneration

The incorporation of bioactive and biocompatible fillers improve the bone cell adhesion, proliferation and differentiation, thus facilitating new bone tissue formation upon implantation. During these last 20 years, those biocomposites have been explored for making complex geometry devices likes screws or 3D porous scaffolds for the repair of bone defects. This review provides an overview of the current development of manufacturing process with synthetic biodegradable poly(α-ester)s reinforced with bioactive fillers for bone tissue engineering applications. Firstly, the properties of poly(α-ester), bioactive fillers, as well as their composites will be defined. Then, the different works based on these biocomposites will be classified according to their manufacturing process. New processing techniques, particularly additive manufacturing processes, open up a new range of possibilities. These techniques have shown the possibility to customize bone implants for each patient and even create scaffolds with a complex structure similar to bone. At the end of this manuscript, a contextualization exercise will be performed to identify the main issues of process/resorbable biocomposites combination identified in the literature and especially for resorbable load-bearing applications.

Design Strategies and Biomimetic Approaches for Calcium Phosphate Scaffolds in Bone Tissue Regeneration

Bone is a complex biologic tissue, which is extremely relevant for various physiological functions, in addition to movement, organ protection, and weight bearing. The repair of critical size bone defects is a still unmet clinical need, and over the past decades, material scientists have been expending efforts to find effective technological solutions, based on the use of scaffolds. In this context, biomimetics which is intended as the ability of a scaffold to reproduce compositional and structural features of the host tissues, is increasingly considered as a guide for this purpose. However, the achievement of implants that mimic the very complex bone composition, multi-scale structure, and mechanics is still an open challenge. Indeed, despite the fact that calcium phosphates are widely recognized as elective biomaterials to fabricate regenerative bone scaffolds, their processing into 3D devices with suitable cell-instructing features is still prevented by insurmountable drawbacks. With respect to biomaterials science, new approaches maybe conceived to gain ground and promise for a substantial leap forward in this field. The present review provides an overview of physicochemical and structural features of bone tissue that are responsible for its biologic behavior. Moreover, relevant and recent technological approaches, also inspired by natural processes and structures, are described, which can be considered as a leverage for future development of next generation bioactive medical devices.

Biodegradable interbody cages for lumbar spine fusion: Current concepts and future directions

Lumbar fusion often remains the last treatment option for various acute and chronic spinal conditions, including infectious and degenerative diseases. Placement of a cage in the intervertebral space has become a routine clinical treatment for spinal fusion surgery to provide sufficient biomechanical stability, which is required to achieve bony ingrowth of the implant. Routinely used cages for clinical application are made of titanium (Ti) or polyetheretherketone (PEEK). Ti has been used since the 1980s; however, its shortcomings, such as impaired radiographical opacity and higher elastic modulus compared to bone, have led to the development of PEEK cages, which are associated with reduced stress shielding as well as no radiographical artefacts. Since PEEK is bioinert, its osteointegration capacity is limited, which in turn enhances fibrotic tissue formation and peri-implant infections. To address shortcomings of both of these biomaterials, interdisciplinary teams have developed biodegradable cages. Rooted in promising preclinical large animal studies, a hollow cylindrical cage (Hydrosorb™) made of 70:30 poly-l-lactide-co-d, l-lactide acid (PLDLLA) was clinically studied. However, reduced bony integration and unfavourable long-term clinical outcomes prohibited its routine clinical application. More recently, scaffold-guided bone regeneration (SGBR) with application of highly porous biodegradable constructs is emerging. Advancements in additive manufacturing technology now allow the cage designs that match requirements, such as stiffness of surrounding tissues, while providing long-term biomechanical stability. A favourable clinical outcome has been observed in the treatment of various bone defects, particularly for 3D-printed composite scaffolds made of medical-grade polycaprolactone (mPCL) in combination with a ceramic filler material. Therefore, advanced cage design made of mPCL and ceramic may also carry initial high spinal forces up to the time of bony fusion and subsequently resorb without clinical side effects. Furthermore, surface modification of implants is an effective approach to simultaneously reduce microbial infection and improve tissue integration. We present a design concept for a scaffold surface which result in osteoconductive and antimicrobial properties that have the potential to achieve higher rates of fusion and less clinical complications. In this review, we explore the preclinical and clinical studies which used bioresorbable cages. Furthermore, we critically discuss the need for a cutting-edge research program that includes comprehensive preclinical in vitro and in vivo studies to enable successful translation from bench to bedside. We develop such a conceptual framework by examining the state-of-the-art literature and posing the questions that will guide this field in the coming years.

Growth and Regeneration of Osteochondral Cells in Bioactive Niche: A Promising Approach for Osteochondral Tissue Repair

Functional repair of osteochondral defects caused due to osteoarthritis still remains the greatest challenge in orthopedic therapy. A prospective clinical strategy would be exploring osteochondral tissue engineering possibilities that promote simultaneous regeneration of the articular cartilage layer as well as the underlying subchondral bone. Incorporating the appropriate cues onto the scaffolds for the regeneration of the two contrasting tissues is therefore a demanding function. In the present study, a polymer-ceramic composite scaffolding material consisting of ternary bioactive glass (67.12 SiO₂/28.5 CaO/4.38 P₂O₅ mol %) incorporated into a semi interpenetrating polymer network of hydrophilic-hydrophobic polymer (poly(vinyl alcohol)-polycaprolactone) matrix is prepared and physicochemically characterized. In vitro bioactivity, bone-bonding ability, and biocompatibility evaluation were performed in comparison with the pristine scaffold. The degree of chondrogenic and osteogenic potential of mesenchymal stem cells in both the scaffolds was evaluated by gene expression studies. Although both the scaffolds favored the differentiation to both cell lineages in their respective medium, a higher expression of bone specific genes found with the composite scaffold suggested that this composite scaffold would serve better for osteal layer and henceforth to promote the integration of the osteochondral construct at the defect site.

Biodegradable Poly(D-L-lactide-co-glycolide) (PLGA)-Infiltrated Bioactive Glass (CAR12N) Scaffolds Maintain Mesenchymal Stem Cell Chondrogenesis for Cartilage Tissue Engineering

Regeneration of articular cartilage remains challenging. The aim of this study was to increase the stability of pure bioactive glass (BG) scaffolds by means of solvent phase polymer infiltration and to maintain cell adherence on the glass struts. Therefore, BG scaffolds either pure or enhanced with three different amounts of poly(D-L-lactide-co-glycolide) (PLGA) were characterized in detail. Scaffolds were seeded with primary porcine articular chondrocytes (pACs) and human mesenchymal stem cells (hMSCs) in a dynamic long-term culture (35 days). Light microscopy evaluations showed that PLGA was detectable in every region of the scaffold. Porosity was greater than 70%. The biomechanical stability was increased by polymer infiltration. PLGA infiltration did not result in a decrease in viability of both cell types, but increased DNA and sulfated glycosaminoglycan (sGAG) contents of hMSCs-colonized scaffolds. Successful chondrogenesis of hMSC-colonized scaffolds was demonstrated by immunocytochemical staining of collagen type II, cartilage proteoglycans and the transcription factor SOX9. PLGA-infiltrated scaffolds showed a higher relative expression of cartilage related genes not only of pAC-, but also of hMSC-colonized scaffolds in comparison to the pure BG. Based on the novel data, our recommendation is BG scaffolds with single infiltrated PLGA for cartilage tissue engineering.

Emerging zero-dimensional to four-dimensional biomaterials for bone regeneration

Bone is one of the most sophisticated and dynamic tissues in the human body, and is characterized by its remarkable potential for regeneration. In most cases, bone has the capacity to be restored to its original form with homeostatic functionality after injury without any remaining scarring. Throughout the fascinating processes of bone regeneration, a plethora of cell lineages and signaling molecules, together with the extracellular matrix, are precisely regulated at multiple length and time scales. However, conditions, such as delayed unions (or nonunion) and critical-sized bone defects, represent thorny challenges for orthopedic surgeons. During recent decades, a variety of novel biomaterials have been designed to mimic the organic and inorganic structure of the bone microenvironment, which have tremendously promoted and accelerated bone healing throughout different stages of bone regeneration. Advances in tissue engineering endowed bone scaffolds with phenomenal osteoconductivity, osteoinductivity, vascularization and neurotization effects as well as alluring properties, such as antibacterial effects. According to the dimensional structure and functional mechanism, these biomaterials are categorized as zero-dimensional, one-dimensional, two-dimensional, three-dimensional, and four-dimensional biomaterials. In this review, we comprehensively summarized the astounding advances in emerging biomaterials for bone regeneration by categorizing them as zero-dimensional to four-dimensional biomaterials, which were further elucidated by typical examples. Hopefully, this review will provide some inspiration for the future design of biomaterials for bone tissue engineering.

Raman spectroscopy in skeletal tissue disorders and tissue engineering: present and prospective

Musculoskeletal disorders are the most common reason of chronic pain and disability representing worldwide an enormous socio-economic burden. In this review, new biomedical application fields for Raman spectroscopy (RS) technique related to skeletal tissues are discussed showing that it can provide a comprehensive profile of tissue composition in situ, in a rapid, label-free, and non-destructive manner. RS can be used as a tool to study tissue alterations associated to aging, pathologies, and disease treatments. The main advantage with respect to currently applied methods in clinics is its ability to provide specific information on molecular composition, which goes beyond other diagnostic tools. Being compatible with water, RS can be performed without pre-treatment on unfixed, hydrated tissue samples, without any labelling and chemical fixation used in histochemical methods. This review provides first the description of basic principles of RS as a biotechnology tool and introduces into the field of currently available RS based techniques, developed to enhance Raman signal. The main spectral processing statistical tools, fingerprint identification and available databases are mentioned. The recent literature has been analysed for such applications of RS as tendon and ligaments, cartilage, bone, and tissue engineered constructs for regenerative medicine. Several cases of proof-of-concept preclinical studies have been described. Finally, advantages, limitations, future perspectives, and challenges for translation of RS into clinical practice have been also discussed.

Histological Evaluation of Porous Additive-Manufacturing Titanium Artificial Bone in Rat Calvarial Bone Defects

Jaw reconstruction using an additive-manufacturing titanium artificial bone (AMTAB) has recently attracted considerable attention. The synthesis of a titanium artificial bone is based on three-dimensional computed tomography images acquired before surgery. A histological evaluation of porous AMTAB (pAMTAB) embedded in rat calvarial bone defects was conducted. This study examined three groups: rats implanted with mixed-acid and heat-treated pAMTAB, rats implanted with untreated pAMTAB, and rats with no implant. In both pAMTAB groups, bone defects were created in rat calvarial bones using a 5-mm trephine bar, followed by pAMTAB implantation. The pAMTAB was fixed to the defect using the fitting force of the surrounding bones. The rats were sacrificed at 4, 8, and 16 weeks after implantation, and the skull was dissected. Undecalcified ground slides were prepared and stained with Villanueva Goldner. Compared with the no implant control group, both pAMTAB groups exhibited new bone formation inside the defect, with greater bone formation in the mixed-acid and heat-treated pAMTAB group than in the untreated pAMTAB group, but the difference was not significant. These data suggest that pAMTAB induces bone formation after implantation in bone defects. Bone formation appears to be enhanced by prior mixed-acid and heat-treated pAMTAB.

Recent applications of electrical, centrifugal, and pressurised emerging technologies for fibrous structure engineering in drug delivery, regenerative medicine and theranostics

Advancements in technology and material development in recent years has led to significant breakthroughs in the remit of fiber engineering. Conventional methods such as wet spinning, melt spinning, phase separation and template synthesis have been reported to develop fibrous structures for an array of applications. However, these methods have limitations with respect to processing conditions (e.g. high processing temperatures, shear stresses) and production (e.g. non-continuous fibers). The materials that can be processed using these methods are also limited, deterring their use in practical applications. Producing fibrous structures on a nanometer scale, in sync with the advancements in nanotechnology is another challenge met by these conventional methods. In this review we aim to present a brief overview of conventional methods of fiber fabrication and focus on the emerging fiber engineering techniques namely electrospinning, centrifugal spinning and pressurised gyration. This review will discuss the fundamental principles and factors governing each fabrication method and converge on the applications of the resulting spun fibers; specifically, in the drug delivery remit and in regenerative medicine.

Optimization and evaluation of ciprofloxacin-loaded collagen/chitosan scaffolds for skin tissue engineering

A novel ciprofloxacin-loaded collagen-chitosan scaffold was developed for the treatment of wound using freeze drying method. The average pore size and porosity of developed scaffold was found to be around 125 µm and 91 ± 0.56%. Moreover, swelling, degradation and mechanical tests profile supported the suitability of scaffold for wound healing process. The scaffold has high degree of hemocompatibility towards the blood and promotes the growth, migration and proliferation of fibroblast. The developed scaffold exhibits antibacterial properties and was found to be efficient against the Gram-negative (E.coli) and Gram-positive (Staphylococcus aureus) bacteria hence can be used for wound healing applications. In vivo study demonstrated that the scaffold not only escalated the tissue regeneration time but also accelerated the wound healing process compared to control. The histological studies revealed better granulation, vascularization, and remodeling of extracellular matrix along with regeneration of epidermal and dermal layer of skin. Overall, the obtained results suggested that the developed skin tissue constructs possess the enormous potential for tissue regeneration and might be a suitable biomaterial for skin tissue engineering applications.

Design and evaluation of ciprofloxacin loaded collagen chitosan oxygenating scaffold for skin tissue engineering

Hypoxia and sepsis are key concerns towards modern regenerative medicine. Oxygen generating biomaterials having antibacterial property aims to answer these concerns. Hypoxia promotes reactive oxygen species at the implant site that delays wound healing. Sepsis in wound also contributes to delay in wound healing. Therefore, scaffold with antibacterial property and oxygen-producing capacities have shown ability to promote wound healing. In the present study oxygen releasing, ciprofloxacin loaded collagen chitosan scaffold was fabricated for sustained oxygen delivery. Calcium peroxide (CPO) acted as a chemical oxygen source. Oxygen release pattern exhibited a sustained release of oxygen with uniform deposition of CPO on the scaffold. The drug release study shows a prolonged, continuous, and sustained release of ciprofloxacin. Cell culture studies depict that scaffold has suitable cell attachment and migration properties for fibroblasts. In vivo studies performed in the skin flip model visually shows better wound healing and less necrosis. Histological studies show the maintenance of tissue architecture and the deposition of collagen. The results demonstrate that the proposed CPO coated ciprofloxacin loaded collagen-chitosan scaffold can be a promising candidate for skin tissue engineering.

Effect of Cu- and Zn-Doped Bioactive Glasses on the In Vitro Bioactivity, Mechanical and Degradation Behavior of Biodegradable PDLLA Scaffolds

Biodegradable polymer scaffolds filled with bioactive glass particles doped with therapeutic metal ions are a novel and promising strategy to repair critical-sized bone defects. In this study, scaffolds based on a poly (D, L-lactide acid) (PDLLA) matrix filled with un-doped and Cu-, Zn- and CuZn-doped bioactive glass particles were produced by freeze-drying and a salt-leaching method. The effects of the doping and content of the glass particles (10 and 30 wt.%) on the morphology, compression properties, apatite formation, and degradation behavior of the scaffolds were evaluated. The scaffolds presented high porosity (~93%) with pores ranged from 100 to 400 μm interconnected by smaller pores and this porosity was kept after the glass particles incorporation. The glass particles reinforced the polymer scaffolds with improvements as high as 130% in elastic moduli, and further promoted the apatite formation on the scaffold surface, both properties depending on the amount and type of filler. The bioactive glass particles boosted the scaffold degradation with the PDLLA/un-doped glass scaffold showing the highest rate, but still retaining structural and dimensional integrity. Our findings show that the incorporation of un-doped and metal-doped bioactive glasses increases the mechanical strength, promotes the bioactivity and modifies the degradation profile of the resulting polymer/glass scaffolds, making them better candidates for bone repair.

Multi-layer Scaffolds of Poly(caprolactone), Poly(glycerol sebacate) and Bioactive Glasses Manufactured by Combined 3D Printing and Electrospinning

Three-dimensional (3D) printing has been combined with electrospinning to manufacture multi-layered polymer/glass scaffolds that possess multi-scale porosity, are mechanically robust, release bioactive compounds, degrade at a controlled rate and are biocompatible. Fibrous mats of poly (caprolactone) (PCL) and poly (glycerol sebacate) (PGS) have been directly electrospun on one side of 3D-printed grids of PCL-PGS blends containing bioactive glasses (BGs). The excellent adhesion between layers has resulted in composite scaffolds with a Young's modulus of 240-310 MPa, higher than that of 3D-printed grids (125-280 MPa, without the electrospun layer). The scaffolds degraded in vitro by releasing PGS and BGs, reaching a weight loss of ~14% after 56 days of incubation. Although the hydrolysis of PGS resulted in the acidification of the buffer medium (to a pH of 5.3-5.4), the release of alkaline ions from the BGs balanced that out and brought the pH back to 6.0. Cytotoxicity tests performed on fibroblasts showed that the PCL-PGS-BGs constructs were biocompatible, with cell viability of above 125% at day 2. This study demonstrates the fabrication of systems with engineered properties by the synergy of diverse technologies and materials (organic and inorganic) for potential applications in tendon and ligament tissue engineering.

Recent advances and future perspectives of sol–gel derived porous bioactive glasses: a review

Sol–gel derived bioactive glasses have been extensively explored as a promising and highly porous scaffold materials for bone tissue regeneration applications owing to their exceptional osteoconductivity, osteostimulation and degradation rates.

Bone Repair and Regenerative Biomaterials: Towards Recapitulating the Microenvironment

Biomaterials and tissue engineering scaffolds play a central role to repair bone defects. Although ceramic derivatives have been historically used to repair bone, hybrid materials have emerged as viable alternatives. The rationale for hybrid bone biomaterials is to recapitulate the native bone composition to which these materials are intended to replace. In addition to the mechanical and dimensional stability, bone repair scaffolds are needed to provide suitable microenvironments for cells. Therefore, scaffolds serve more than a mere structural template suggesting a need for better and interactive biomaterials. In this review article, we aim to provide a summary of the current materials used in bone tissue engineering. Due to the ever-increasing scientific publications on this topic, this review cannot be exhaustive; however, we attempted to provide readers with the latest advance without being redundant. Furthermore, every attempt is made to ensure that seminal works and significant research findings are included, with minimal bias. After a concise review of crystalline calcium phosphates and non-crystalline bioactive glasses, the remaining sections of the manuscript are focused on organic-inorganic hybrid materials.

Chemical Modification and Foam Processing of Polylactide (PLA)

Polylactide (PLA) is known as one of the most promising biopolymers as it is derived from renewable feedstock and can be biodegraded. During the last two decades, it moved more and more into the focus of scientific research and industrial use. It is even considered as a suitable replacement for standard petroleum-based polymers, such as polystyrene (PS), which can be found in a wide range of applications-amongst others in foams for packaging and insulation applications-but cause strong environmental issues. PLA has comparable mechanical properties to PS. However, the lack of melt strength is often referred to as a drawback for most foaming processes. One way to overcome this issue is the incorporation of chemical modifiers which can induce chain extension, branching, or cross-linking. As such, a wide variety of substances were studied in the literature. This work should give an overview of the most commonly used chemical modifiers and their effects on rheological, thermal, and foaming behavior. Therefore, this review article summarizes the research conducted on neat and chemically modified PLA foamed with the conventional foaming methods (i.e., batch foaming, foam extrusion, foam injection molding, and bead foaming).

Electrospun Filaments Embedding Bioactive Glass Particles with Ion Release and Enhanced Mineralization

Efforts in tissue engineering aim at creating scaffolds that mimic the physiological environment with its structural, topographical and mechanical properties for restoring the function of damaged tissue. In this study we introduce composite fibres made by a biodegradable poly(lactic acid) (PLLA) matrix embedding bioactive silica-based glass particles (SBA2). Electrospinning is performed to achieve porous PLLA filaments with uniform dispersion of bioactive glass powder. The obtained composite fibres show in aligned arrays significantly increased elastic modulus compared with that of neat polymer fibres during uniaxial tensile stress. Additionally, the SBA2 bioactivity is preserved upon encapsulation as highlighted by the promoted deposition of hydroxycarbonate apatite (HCA) upon immersion in simulated body fluid solutions. HCA formation is sequential to earlier processes of polymer erosion and ion release leading to acidification of the surrounding solution environment. These findings suggest PLLA-SBA2 fibres as a composite, multifunctional system which might be appealing for both bone and soft tissue engineering applications.

A comprehensive review of biodegradable synthetic polymer-ceramic composites and their manufacture for biomedical applications

The application of various materials in biomedical procedures has recently experienced rapid growth. One area that is currently receiving significant attention from the scientific community is the treatment of a number of different types of bone-related diseases and disorders by using biodegradable polymer-ceramic composites. Biomaterials, the most common materials used to repair or replace damaged parts of the human body, can be categorized into three major groups: metals, ceramics, and polymers. Composites can be manufactured by combining two or more materials to achieve enhanced biocompatibility and biomechanical properties for specific applications. Biomaterials must display suitable properties for their applications, about strength, durability, and biological influence. Metals and their alloys such as titanium, stainless steel, and cobalt-based alloys have been widely investigated for implant-device applications because of their excellent mechanical properties. However, these materials may also manifest biological issues such as toxicity, poor tissue adhesion and stress shielding effect due to their high elastic modulus. To mitigate these issues, hydroxyapatite (HA) coatings have been used on metals because their chemical composition is similar to that of bone and teeth. Recently, a wide range of synthetic polymers such as poly (l-lactic acid) and poly (l-lactide-co-glycolide) have been studied for different biomedical applications, owing to their promising biocompatibility and biodegradability. This article gives an overview of synthetic polymer-ceramic composites with a particular emphasis on calcium phosphate group and their potential applications in tissue engineering. It is hoped that synthetic polymer-ceramic composites such as PLLA/HA and PCL/HA will provide advantages such as eliminating the stress shielding effect and the consequent need for revision surgery.

3D bioactive composite scaffolds for bone tissue engineering

Bone is the second most commonly transplanted tissue worldwide, with over four million operations using bone grafts or bone substitute materials annually to treat bone defects. However, significant limitations affect current treatment options and clinical demand for bone grafts continues to rise due to conditions such as trauma, cancer, infection and arthritis. Developing bioactive three-dimensional (3D) scaffolds to support bone regeneration has therefore become a key area of focus within bone tissue engineering (BTE). A variety of materials and manufacturing methods including 3D printing have been used to create novel alternatives to traditional bone grafts. However, individual groups of materials including polymers, ceramics and hydrogels have been unable to fully replicate the properties of bone when used alone. Favourable material properties can be combined and bioactivity improved when groups of materials are used together in composite 3D scaffolds. This review will therefore consider the ideal properties of bioactive composite 3D scaffolds and examine recent use of polymers, hydrogels, metals, ceramics and bio-glasses in BTE. Scaffold fabrication methodology, mechanical performance, biocompatibility, bioactivity, and potential clinical translations will be discussed.

Co-existence effect of tricalcium phosphate and bioactive glass on biological and biodegradation characteristic of Poly L-Lactic Acid (PLLA) in trinary composite scaffold form

The purpose of this study is to analyze the co-existence effect of 30 wt.% TCP-BG phases on degradation and precipitation behaviors of PLLA based composite scaffold in biological media. First, phase separation method was used to synthesize of the pure PLLA and the trinary composite scaffolds, and second they were immersed in SBF solution for 45 days. Subsequently, the degradation and precipitation characteristic were investigated by analyzing of pH value and weight changes of the immersed samples, the ability of biological products formation and the change of relative molecular weight of PLLA matrix as function of the degradation time. Finally, the experimental data of relative molecular weight change were verified by Han and Pan model and comparisons were made between them. Results have represented precipitation of huge amount of carbonate apatite on surface of the composite scaffold, and also the acidity of SBF media changes moderately which is prove better bioactivity properties compare to the pure PLLA scaffold. The results of comparison with the model point to quiet good agreement between them in early stage of degradation. So, the consequences suggest that the TCP-BG/PLLA composite scaffold have great potential to be applied in bone replacements or repairs.

Natural and Synthetic Biodegradable Polymers: Different Scaffolds for Cell Expansion and Tissue Formation

The formation of tissue produced by implanted cells is influenced greatly by the scaffold onto which they are seeded. In the long term it is often preferable to use a biodegradable material scaffold so that all the implanted materials will disappear, leaving behind only the generated tissue. Research in this area has identified several natural biodegradable materials. Among them, hydrogels are receiving increasing attention due to their ability to retain a great quantity of water, their good biocompatibility, their low interfacial tension, and the minimal mechanical and frictional irritation that they cause. Biocompatibility is not an intrinsic property of materials; rather it depends on the biological environment and the tolerability that exists with respect to specific polymer-tissue interactions. The most often utilized biodegradable synthetic polymers for 3D scaffolds in tissue engineering are saturated poly-a-hydroxy esters, including poly(lactic acid) (PLA) and poly(glycolic acid) (PGA), as well as poly(lactic-co-lycolide) (PLGA) copolymers. Hard materials provide compressive and torsional strength; hydrogels and other soft composites more effectively promote cell expansion and tissue formation. This review focuses on the future potential for understanding the characteristics of the biomaterials considered evaluated for clinical use in order to repair or to replace a sizable defect by only harvesting a small tissue sample.

Characterization and osteogenic evaluation of mesoporous magnesium–calcium silicate/polycaprolactone/polybutylene succinate composite scaffolds fabricated by rapid prototyping

The properties of scaffolds for bone tissue engineering, including their biocompatibility, highly interconnected porosity, and mechanical integrity, are critical for promoting cell adhesion, proliferation, and osteoinduction. We used various physical and biological assays to obtain in vitro confirmation that the proposed composite scaffolds are potentially suitable for applications to bone tissue engineering. The proposed new composite scaffolds, which we fabricated by a rapid prototyping technique, were composed of mesoporous magnesium–calcium silicate (m_MCS), polycaprolactone (PCL), and polybutylene succinate (PBSu). We systematically evaluated the characteristics of the composite scaffolds, such as the hydrophilicity and bioactivity. We also investigated the proliferation and osteogenic differentiation of human mesenchymal stem cells (MSCs) scaffolded on the m_MCS/PCL/PBSu composite. Our results showed that, compared to the m_MCS/PCL scaffold, the m_MCS/PCL/PBSu scaffold has improved water absorption, in vitro degradability, biocompatibility, and bioactivity in simulated body fluid, while its mechanical strength is reduced. Moreover, the results of the cytotoxicity tests specified in ISO 10993-12 and ISO 10993-5 clearly indicate that the m_MCS/PCL scaffold is not toxic to cells. In addition, we obtained significant increases in initial cell attachment and improvements to the osteogenic MSC differentiation by replacing the m_MCS/PCL scaffold with the m_MCS/PCL/PBSu scaffold. Our results indicate that the m_MCS/PCL/PBSu scaffold achieves enhanced bioactivity, degradability, cytocompatibility, and osteogenesis. As such, this scaffold is a potentially promising candidate for use in stem cell-based bone tissue engineering.

A new composite scaffold consisting of mesoporous magnesium–calcium silicate (m_MCS), polycaprolactone (PCL), and polybutylene succinate (PBSu) was manufactured by a rapid prototyping technique, for stem cell-based bone tissue engineering.

Treatment of a burn animal model with functionalized tridimensional electrospun biomaterials

Laminin-functionalized poly-d,l-lactic acid scaffolds were produced. Following this, mesenchymal stem cells and keratinocytes were seeded on biomaterials for the in vivo experiments, where the biomaterials with or without cells were implanted. The analysis is comprised of the visual aspect and mean size of the lesion plus the histology and gene expression. The results showed that the cells occupied all the structure of the scaffolds in all the groups. After nine days of in vivo experiments, the defect size did not show statistical difference among the groups, although the groups with the poly-d,l-lactic acid/Lam biomaterial had the lowest lesion size and presented the best visual aspect of the wound. Gene expression analysis showed considerable increase of tumor growth factor beta 1 expression, increased vascular endothelial growth factor and balance of the BAX/Bcl-2 ratio when compared to the lesion group. Histological analysis showed well-formed tissue in the groups where the biomaterials and biomaterials plus cells were used. In some animals, in which biomaterials and cells were used, the epidermis was formed throughout the length of the wound. In conclusion, these biomaterials were found to be capable of providing support for the growth of cells and stimulated the healing of the skin, which was improved by the use of cells.

Biphasic Calcium Phosphate (BCP)-Immobilized Porous Poly (d,l-Lactic-co-Glycolic Acid) Microspheres Enhance Osteogenic Activities of Osteoblasts

The purpose of this study was to evaluate the potential of porous poly (d,l-lactic-co-glycolic acid) (PLGA) microspheres (PMSs) immobilized on biphasic calcium phosphate nanoparticles (BCP NPs) (BCP-IM-PMSs) to enhance osteogenic activity. PMSs were fabricated using a fluidic device, and their surfaces were modified with l-lysine (aminated-PMSs), whereas the BCP NPs were modified with heparin⁻dopamine (Hep-DOPA) to obtain heparinized⁻BCP (Hep-BCP) NPs. BCP-IM-PMSs were fabricated via electrostatic interactions between the Hep-BCP NPs and aminated-PMSs. The fabricated BCP-IM-PMSs showed an interconnected pore structure. In vitro studies showed that MG-63 cells cultured on BCP-IM-PMSs had increased alkaline phosphatase activity, calcium content, and mRNA expression of osteocalcin (OCN) and osteopontin (OPN) compared with cells cultured on PMSs. These data suggest that BCP NP-immobilized PMSs have the potential to enhance osteogenic activity.

Immunohistochemistry evaluation of BMP-2 with β-tricalcium phosphate matrix, polylactic and polyglycolic acid gel, and calcium phosphate cement in rats

PURPOSE

The installation of implants has become a routine procedure in the clinic. However, it takes time and adequate bone thickness, and for that, tissue engineering has made efforts to develop substitutes for autografts, in view of certain disadvantages of this material. The decision to choose the most suitable graft material for each case is an important step in the success of bone reconstruction. This study was to verify, by means of immunohistochemical study, that the addition of bone morphogenetic protein had some influence on biomaterials commercially available, taking into account the formation of mineralized tissue, bone replacement, and the amount of degradation of biomaterials.

METHODS

The sample consisted of 72 rats that were divided into eight treatment groups, in which two defects of 5 mm were made in each animal calvaria. Euthanasia was performed at 5, 15, and 30 days postop.

RESULTS

A histologic and histometric analysis was performed to quantitate the area of mineralized tissue formed, the area of newly formed bone, and the area of degradation of the biomaterials. Data were analyzed with multiple comparisons of means by Tukey contrasts, and significant difference was assigned at the level of P < 0.05. The proteins used for immunohistochemical analysis accounted for the process of formation, mineralization, and bone resorption and was performed using ordinal qualitative analysis, where from assigning scores.

CONCLUSIONS

Bone morphogenetic protein 2 was shown to be effective as an inducer of bone formation process independent biomaterial used mainly for accelerating the resorption process of the framework.

Tissue Engineering of the Intervertebral Disc's Annulus Fibrosus: A Scaffold-Based Review Study

Tissue engineering as a high technology solution for treating disc's problem has been the focus of some researches recently; however, the upcoming successful results in this area depends on understanding the complexities of biology and engineering interface. Whereas the major responsibility of the nucleus pulposus is to provide a sustainable hydrated environment within the disc, the function of the annulus fibrosus (AF) is more mechanical, facilitating joint mobility and preventing radial bulging by confining of the central part, which makes the AF reconstruction important. Although the body of knowledge regarding the AF tissue engineering has grown rapidly, the opportunities to improve current understanding of how artificial scaffolds are able to mimic the AF concentric structure-including inter-lamellar matrix and cross-bridges-addressed unresolved research questions. The aim of this literature review was to collect and discuss, from the international scientific literature, information about tissue engineering of the AF based on scaffold fabrication and material properties, useful for developing new strategies in disc tissue engineering. The key parameter of this research was understanding if role of cross-bridges and inter-lamellar matrix has been considered on tissue engineering of the AF.

Poly (lactic acid)-based biomaterials for orthopaedic regenerative engineering

Regenerative engineering converges tissue engineering, advanced materials science, stem cell science, and developmental biology to regenerate complex tissues such as whole limbs. Regenerative engineering scaffolds provide mechanical support and nanoscale control over architecture, topography, and biochemical cues to influence cellular outcome. In this regard, poly (lactic acid) (PLA)-based biomaterials may be considered as a gold standard for many orthopaedic regenerative engineering applications because of their versatility in fabrication, biodegradability, and compatibility with biomolecules and cells. Here we discuss recent developments in PLA-based biomaterials with respect to processability and current applications in the clinical and research settings for bone, ligament, meniscus, and cartilage regeneration.

PDLLA scaffolds with Cu- and Zn-doped bioactive glasses having multifunctional properties for bone regeneration

Novel multifunctional scaffolds for bone regeneration can be developed by incorporation of bioactive glasses (BG) doped with therapeutic and antibacterial metal ions, such as copper (Cu) and zinc (Zn), into a biodegradable polymer. In this context, porous composite materials of biodegradable poly(d, l-lactide) (PDLLA) mixed with sol-gel BG of chemical composition 60SiO₂ ; 25CaO; 11Na₂ O; and 4P₂ O₅ (mol %) doped with either 1 mol % of CuO or ZnO, and with both metals, were prepared. The cytocompatibility of the scaffolds on bone marrow stromal cells (ST-2) depended on both, the amount of glass filler and the concentration of metal ion, as evaluated by lactate dehydrogenase (LDH) activity, cell viability (water-soluble tetrazolium salt [WST-8]), and by cell morphology (scanning electron microscopy [SEM]) tests. In particular, scaffolds having a filler content of 10 wt % showed the highest cytocompatibility. In addition, compared to the neat polymer, the scaffolds containing Cu promoted the angiogenesis marker (Vascular endothelial growth factor concentration) to a larger extent while scaffolds containing Zn increased the osteogenesis marker (specific alkaline phosphatase-activity). Noteworthy, the scaffolds with both metal ions showed a combined effect on both properties. Cu- and Zn-doped glasses also provided higher antibacterial capacity to PDLLA-based scaffolds against methicillin-resistant S. aureus bacteria than undoped glass. In combination, our results showed that by a proper addition of Cu- and Zn-doped BG to a PDLLA matrix, multifunctional composite scaffolds with enhanced biological activity can be designed for bone tissue regeneration. © 2016 Wiley Periodicals, Inc. J Biomed Mater Res Part A: 105A: 746-756, 2017.

Biodegradable ceramic-polymer composites for biomedical applications: A review

The present work focuses on the state-of-the-art of biodegradable ceramic-polymer composites with particular emphasis on influence of various types of ceramic fillers on properties of the composites. First, the general needs to create composite materials for medical applications are briefly introduced. Second, various types of polymeric materials used as matrices of ceramic-containing composites and their properties are reviewed. Third, silica nanocomposites and their material as well as biological characteristics are presented. Fourth, different types of glass fillers including silicate, borate and phosphate glasses and their effect on a number of properties of the composites are described. Fifth, wollastonite as a composite modifier and its effect on composite characteristics are discussed. Sixth, composites containing calcium phosphate ceramics, namely hydroxyapatite, tricalcium phosphate and biphasic calcium phosphate are presented. Finally, general possibilities for control of properties of composite materials are highlighted.

Minocycline Loaded Hybrid Composites Nanoparticles for Mesenchymal Stem Cells Differentiation into Osteogenesis

Bone transplants are used to treat fractures and increase new tissue development in bone tissue engineering. Grafting of massive implantations showing slow curing rate and results in cell death for poor vascularization. The potentials of biocomposite scaffolds to mimic extracellular matrix (ECM) and including new biomaterials could produce a better substitute for new bone tissue formation. A purpose of this study is to analyze polycaprolactone/silk fibroin/hyaluronic acid/minocycline hydrochloride (PCL/SF/HA/MH) nanoparticles initiate human mesenchymal stem cells (MSCs) proliferation and differentiation into osteogenesis. Electrospraying technique was used to develop PCL, PCL/SF, PCL/SF/HA and PCL/SF/HA/MH hybrid biocomposite nanoparticles and characterization was analyzed by field emission scanning electron microscope (FESEM), contact angle and Fourier transform infrared spectroscopy (FT-IR). The obtained results proved that the particle diameter and water contact angle obtained around 0.54 ± 0.12 to 3.2 ± 0.18 µm and 43.93 ± 10.8° to 133.1 ± 12.4° respectively. The cell proliferation and cell-nanoparticle interactions analyzed using (3-(4,5-dimethyl thiazol-2-yl)-5-(3-carboxymethoxyphenyl)-2-(4-sulfophenyl)-2H-tetrazolium inner salt) MTS assay (Promega, Madison, WI, USA), FESEM for cell morphology and 5-Chloromethylfluorescein diacetate (CMFDA) dye for imaging live cells. Osteogenic differentiation was proved by expression of osteocalcin, alkaline phosphatase activity (ALP) and mineralization was confirmed by using alizarin red (ARS). The quantity of cells was considerably increased in PCL/SF/HA/MH nanoparticles when compare to all other biocomposite nanoparticles and the cell interaction was observed more on PCL/SF/HA/MH nanoparticles. The electrosprayed PCL/SF/HA/MH biocomposite nanoparticle significantly initiated increased cell proliferation, osteogenic differentiation and mineralization, which provide huge potential for bone tissue engineering.

Morphological effects of porous poly-d,l-lactic acid/hydroxyapatite scaffolds produced by supercritical CO2 foaming on their mechanical performance

A novel supercritical CO2 foaming technique was used to fabricate scaffolds of controllable morphology and mechanical properties, with the potential to tailor the scaffolds to specific tissue engineering applications. Biodegradable scaffolds are widely used as temporary supportive structures for bone regeneration. The scaffolds must provide a sufficient mechanical support while allowing cell attachment and growth as well as metabolic activities. In this study, supercritical CO2 foaming was used to prepare fully interconnected porous scaffolds of poly-d,l-lactic acid and poly-d,l-lactic acid/hydroxyapatite. The morphological, mechanical and cell behaviours of the scaffolds were measured to examine the effect of hydroxyapatite on these properties. These scaffolds showed an average porosity in the range of 86%–95%, an average pore diameter of 229–347 µm and an average pore interconnection of 103–207 µm. The measured porosity, pore diameter, and interconnection size are suitable for cancellous bone regeneration. Compressive strength and modulus of up to 36.03 ± 5.90 and 37.97 ± 6.84 MPa were measured for the produced porous scaffolds of various compositions. The mechanical properties presented an improvement with the addition of hydroxyapatite to the structure. The relationship between morphological and mechanical properties was investigated. The matrices with different compositions were seeded with bone cells, and all the matrices showed a high cell viability and biocompatibility. The number of cells attached on the matrices slightly increased with the addition of hydroxyapatite indicating that hydroxyapatite improves the biocompatibility and proliferation of the scaffolds. The produced poly-d,l-lactic acid/hydroxyapatite scaffolds in this study showed a potential to be used as bone graft substitutes.