Low-modulus Mg/PCL hybrid bone substitute for osteoporotic fracture fixation

Mechanically robust and personalized silk fibroin-magnesium composite scaffolds with water-responsive shape-memory for irregular bone regeneration

The regeneration of critical-size bone defects, especially those with irregular shapes, remains a clinical challenge. Various biomaterials have been developed to enhance bone regeneration, but the limitations on the shape-adaptive capacity, the complexity of clinical operation, and the unsatisfied osteogenic bioactivity have greatly restricted their clinical application. In this work, we construct a mechanically robust, tailorable and water-responsive shape-memory silk fibroin/magnesium (SF/MgO) composite scaffold, which is able to quickly match irregular defects by simple trimming, thus leading to good interface integration. We demonstrate that the SF/MgO scaffold exhibits excellent mechanical stability and structure retention during the degradative process with the potential for supporting ability in defective areas. This scaffold further promotes the proliferation, adhesion and migration of osteoblasts and the osteogenic differentiation of bone marrow mesenchymal stem cells (BMSCs) in vitro. With suitable MgO content, the scaffold exhibits good histocompatibility, low foreign-body reactions (FBRs), significant ectopic mineralisation and angiogenesis. Skull defect experiments on male rats demonstrate that the cell-free SF/MgO scaffold markedly enhances bone regeneration of cranial defects. Taken together, the mechanically robust, personalised and bioactive scaffold with water-responsive shape-memory may be a promising biomaterial for clinical-size and irregular bone defect regeneration.

Neonatal GABAergic transmission primes vestibular gating of output for adult spatial navigation

GABAergic interneurons are poised with the capacity to shape circuit output via inhibitory gating. How early in the development of medial vestibular nucleus (MVN) are GABAergic neurons recruited for feedforward shaping of outputs to higher centers for spatial navigation? The role of early GABAergic transmission in assembling vestibular circuits for spatial navigation was explored by neonatal perturbation. Immunohistochemistry and confocal imaging were utilized to reveal the expression of parvalbumin (PV)-expressing MVN neurons and their perineuronal nets. Whole-cell patch-clamp recording, coupled with optogenetics, was conducted in vitro to examine the synaptic function of MVN circuitry. Chemogenetic targeting strategy was also employed in vivo to manipulate neuronal activity during navigational tests. We found in rats a neonatal critical period before postnatal day (P) 8 in which competitive antagonization of GABAergic transmission in the MVN retarded maturation of inhibitory neurotransmission, as evidenced by deranged developmental trajectory for excitation/inhibition ratio and an extended period of critical period-like plasticity in GABAergic transmission. Despite increased number of PV-expressing GABAergic interneurons in the MVN, optogenetic-coupled patch-clamp recording indicated null-recruitment of these neurons in tuning outputs along the ascending vestibular pathway. Such perturbation not only offset output dynamics of ascending MVN output neurons, but was further accompanied by impaired vestibular-dependent navigation in adulthood. The same perturbations were however non-consequential when applied after P8. Results highlight neonatal GABAergic transmission as key to establishing feedforward output dynamics to higher brain centers for spatial cognition and navigation.

3D-Printed Magnesium Peroxide-Incorporated Scaffolds with Sustained Oxygen Release and Enhanced Photothermal Performance for Osteosarcoma Multimodal Treatments

The hypoxic microenvironment in osteosarcoma inevitably compromises the antitumor effect and local bone defect repair, suggesting an urgent need for sustained oxygenation in the tumor. The currently reported oxygen-releasing materials have short oxygen-releasing cycles, harmful products, and limited antitumor effects simply by improving hypoxia. Therefore, the PCL/nHA/MgO2/PDA-integrated oxygen-releasing scaffold with a good photothermal therapy effect was innovatively constructed in this work to achieve tumor cell killing and bone regeneration functions simultaneously. The material distributes MgO2 powder evenly on the scaffold material through 3D printing technology and achieves the effect of continuous oxygen release (more than 3 weeks) through its slow reaction with water. The in vitro and in vivo results also indicate that the scaffold has good biocompatibility and sustained-release oxygen properties, which can effectively induce the proliferation and osteogenic differentiation of bone mesenchymal stem cells, achieving excellent bone defect repair. At the same time, in vitro cell experiments and subcutaneous tumorigenesis experiments also confirmed that local oxygen supply can promote osteosarcoma cell apoptosis, inhibit proliferation, and reduce the expression of heat shock protein 60, thereby enhancing the photothermal therapy effect of polydopamine and efficiently eliminating osteosarcoma. Taken together, this integrated functional scaffold provides a unique and efficient approach for antitumor and tumor-based bone defect repair for osteosarcoma treatment.

Ion incorporation into bone grafting materials

The use of biomaterials in regenerative medicine has expanded to treat various disorders caused by trauma or disease in orthopedics and dentistry. However, the treatment of large and complex bone defects presents a challenge, leading to a pressing need for optimized biomaterials for bone repair. Recent advances in chemical sciences have enabled the incorporation of therapeutic ions into bone grafts to enhance their performance. These ions, such as strontium (for bone regeneration/osteoporosis), copper (for angiogenesis), boron (for bone growth), iron (for chemotaxis), cobalt (for B12 synthesis), lithium (for osteogenesis/cementogenesis), silver (for antibacterial resistance), and magnesium (for bone and cartilage regeneration), among others (e.g., zinc, sodium, and silica), have been studied extensively. This review aims to provide a comprehensive overview of current knowledge and recent developments in ion incorporation into biomaterials for bone and periodontal tissue repair. It also discusses recently developed biomaterials from a basic design and clinical application perspective. Additionally, the review highlights the importance of precise ion introduction into biomaterials to address existing limitations and challenges in combination therapies. Future prospects and opportunities for the development and optimization of biomaterials for bone tissue engineering are emphasized.

Bioabsorbable Composites Based on Polymeric Matrix (PLA and PCL) Reinforced with Magnesium (Mg) for Use in Bone Regeneration Therapy: Physicochemical Properties and Biological Evaluation

Improvements in Tissue Engineering and Regenerative Medicine (TERM)-type technologies have allowed the development of specific materials that, together with a better understanding of bone tissue structure, have provided new pathways to obtain biomaterials for bone tissue regeneration. In this manuscript, bioabsorbable materials are presented as emerging materials in tissue engineering therapies related to bone lesions because of their ability to degrade in physiological environments while the regeneration process is completed. This comprehensive review aims to explore the studies, published since its inception (2010s) to the present, on bioabsorbable composite materials based on PLA and PCL polymeric matrix reinforced with Mg, which is also bioabsorbable and has recognized osteoinductive capacity. The research collected in the literature reveals studies based on different manufacturing and dispersion processes of the reinforcement as well as the physicochemical analysis and corresponding biological evaluation to know the osteoinductive capacity of the proposed PLA/Mg and PCL/Mg composites. In short, this review shows the potential of these composite materials and serves as a guide for those interested in bioabsorbable materials applied in bone tissue engineering.

Evaluation of a Bioabsorbable Scaffold and Interlocked Nail System for Segmental Bone Defect

In the current study, we designed and manufactured a scaffold and fixation system for the reconstruction of long-bone segmental defects in a rabbit tibia model. We used biocompatible and biodegradable materials, polycaprolactone (PCL) and PCL soaked with sodium alginate (PCL-Alg) to manufacture the scaffold, interlocking nail and screws using a phase separation casing method. Degradation and mechanical tests on the PCL and PCL-Alg scaffolds indicated that both were suitable for faster degradation and early weight-bearing capacity. PCL scaffold surface porosity facilitated the infiltration of alginate hydrogel through the scaffold. Cell viability results showed that the number of cells increased on Day 7 and decreased marginally by Day 14. For accurate placement of the scaffold and fixation system, a surgical jig was designed and 3D-printed using biocompatible resin in a stereolithography (SLA) 3D printer, then cured with UV light for increased strength. Our cadaver tests using New Zealand White rabbit confirmed our novel jigs’ potential for accurate placement of the bone scaffold, intramedullary nail and the alignment of the fixation screws in future reconstructive surgeries on rabbit long-bone segmental defects. Additionally, the cadaver tests confirmed that our designed nails and screws were strong enough to carry the surgical insertion force. Therefore, our designed prototype has the potential for further clinical translational study using the rabbit tibia model.

Injectable magnesium oxychloride cement foam-derived scaffold for augmenting osteoporotic defect repair

HYPOTHESIS

Cement augmentation has been widely applied to promote osteoporotic fracture healing, whereas the existing calcium-based products suffer from the excessively slow degradation, which may impede bone regeneration. Magnesium oxychloride cement (MOC) shows promising biodegradation tendency and bioactivity, which is expected to be a potential alternative to the classic calcium-based cement for hard-tissue-engineering applications.

EXPERIMENTS

Here, a hierarchical porous MOC foam (MOCF)-derived scaffold with favorable bio-resorption kinetic and superior bioactivity is fabricated through Pickering foaming technique. Then, a systematic characterization in terms of material properties and in vitro biological performance have been conducted to evaluate the feasibility of the as-prepared MOCF scaffold to be a bone-augmenting material for treating osteoporotic defects.

FINDINGS

The developed MOCF shows excellent handling performance in the paste state, while exhibiting sufficient load-bearing capacity after solidification. In comparison with the traditional bone cement, calcium deficient hydroxyapatite (CDHA), our porous MOCF scaffold demonstrates a much higher biodegradation tendency and better cell recruitment ability. Additionally, the eluted bioactive ions by MOCF commits to a biologically inductive microenvironment, where the in vitro osteogenesis is significantly enhanced. It is anticipated that this advanced MOCF scaffold will be competitive for clinical therapies to augment osteoporotic bone regeneration.

PCL-nHAC/Mg-Ca alloy composite and preliminary study of its osteogenesis property

Owing to their excellent properties, magnesium alloys are widely used in bone tissue engineering. However, considerable work has been conducted to control the degradation rate and improve the cytocompatibility of magnesium alloys. In this study, low-cost production introduced a new bone repair composite (PCL-nHAC/Mg-Ca), which was composed of nano-hydroxylapatite-collagen (nHAC), polycaprolactone (PCL) and Mg-Ca alloy substrate treated by micro- arc oxidation (MAO). The experimental results showed that compared with the Mg-Ca alloy treated by MAO alone, the PCL-nHAC/Mg-Ca composite has a porous structure and a slower degradation rate. Cell experiments showed that the PCL-nHAC/Mg-Ca composite had good biocompatibility and significantly enhanced the proliferation of the MC3T3-E1 cells. The rabbit skull defect model further proved that the PCL-nHAC/Mg-Ca composite could regulate the degradation rate of the Mg-Ca alloy and promote the formation of bone tissue. Histological analyses showed that the PCL-nHAC/Mg-Ca composite had good stability in vivo and could better accelerate bone formation.

Applications of carbon dots and its modified carbon dots in bone defect repair

Bone defect repair is a continual and complicated process driven by a variety of variables. Because of its bright multicolor luminescence, superior biocompatibility, water dispersibility, and simplicity of synthesis from diverse carbon sources, carbon dots (CDs) have received a lot of interest. It has a broad variety of potential biological uses, including bone defect repair, spinal cord injury, and wound healing. Materials including CDs as the matrix or major component have shown considerable benefits in enabling bone defect healing in recent years. By altering the carbon dots or mixing them with other wound healing-promoting agents or materials, the repair effect may be boosted even further. The report also shows and discusses the use of CDs to heal bone abnormalities. The study first presents the fundamental features of CDs in bone defect healing, then provides CDs manufacturing techniques that should be employed in bone defect repair, and lastly examines their development in the area of bioengineering, particularly in bone defect repair. In this work, we look at how carbon dots and their alteration products may help with bone defect healing by being antibacterial, anti-infective, osteogenic differentiation-promoting, and gene-regulating.

Inhibition of Sympathetic Activation by Delivering Calcium Channel Blockers from a 3D Printed Scaffold to Promote Bone Defect Repair

Enhancing osteogenesis by promoting neural network reconstruction and neuropeptide release is considered to be an attractive strategy for repairing of critical size bone defects. However, traumatic bone defects often activate the damaged sympathetic nervous system (SNS) in the defect area and release excessive catecholamine to hinder bone defect repair. Herein, a 3D printed scaffold loaded with the calcium channel blocker-nifedipine is proposed to reduce the concentration of catecholamine present in the bone defect region and to accelerate bone healing. To this end, nifedipine-loaded ethosome and laponite are added into a mixed solution containing sodium alginate, methacrylated gelatin, and bone mesenchymal stem cells (BMSCs) to prepare a cell-laden scaffold using 3D bioprinting. The released nifedipine is able to close the calcium channels of nerve cells, thereby blocking sympathetic activation and ultimately inhibiting the release of catecholamine by sympathetic nerve cells, which further promotes the osteogenic differentiation and migration of BMSCs, inhibits osteoclastogenesis in vitro, and effectively improves bone regeneration in a rat critical-size calvarial defect model. Therefore, the results suggest that sustained release of nifedipine from the scaffold can effectively block SNS activation, providing promising strategies for future treatment of bone defects.

Exploring the Mystery of Osteoarthritis using Bioinformatics Analysis of Cartilage Tissue

BACKGROUND

Osteoarthritis (OA) is a kind of chronic disease relating to joints, which seriously affectsthe daily life activities of the elderly and can also lead to disability. However, the pathogenesis of OA is still unclear, which leads to limited treatment and the therapeutic effect far from people's expectations. This study aims to filter out key genes in the pathogenesis of OA and explore their potential role in the occurrence and development of OA.

METHODS

The dataset of GSE117999 was obtained and analyzed in order to identify the differentially expressed genes (DEGs), hub genes and key genes. We also identified potential miRNAs which may play a major role in the pathogenesis of OA, and verified their difference in OA by real-time quantitative PCR (RT-qPCR). DGldb was found to serve as an indicator to identify drugs with potential therapeutic effects on key genes and Receiver Operating Characteristic (ROC) analysis was used for identifying underlying biomarkers of OA.

RESULTS

We identified ten key genes, including MDM2, RB1, EGFR, ESR1, UBE2E3, WWP1, BCL2, OAS2, TYMS and MSH2. Then, we identified hsa-mir-3613-3p, hsa-mir-548e-5p and hsamir- 5692a to be potentially related to key genes. In addition, RT-qPCR confirmed the differential expression of identified genes in mouse cartilage with or without OA. We then identified Etoposide and Everolimus, which were potentially specific to the most key genes. Finally, we speculated that ESR1 might be a potential biomarker of OA.

CONCLUSION

In this study, potential key genes related to OA and their biological functions were identified, and their potential application value in the diagnosis and treatment of OA has been demonstrated, which will help us to improve the therapeutic effect of OA.

Effect of pore size on tissue ingrowth and osteoconductivity in biodegradable Mg alloy scaffolds

Magnesium has mechanical properties similar to those of bone and is being considered as a potential bone substitute. In the present study, two different pore sized scaffolds of the Mg alloy LAE442, coated with magnesium fluoride, were compared. The scaffolds had interconnecting pores of either 400 (p400) or 500 µm (p500). ß-TCP served as control. Ten scaffolds per time group (6, 12, 24, 36 weeks) were implanted in the trochanter major of rabbits. Histological analyses, µCT scans, and SEM/EDX were performed. The scaffolds showed slow volume decreases (week 36 p400: 9.9%; p500: 7.5%), which were accompanied by uncritical gas releases. In contrast, ß-TCP showed accelerated resorption (78.5%) and significantly more new bone inside (18.19 ± 1.47 mm³). Bone fragments grew into p400 (0.17 ± 0.19 mm³) and p500 (0.36 ± 0.26 mm³), reaching the centrally located pores within p500 more frequently. In particular, p400 displayed a more uneven and progressively larger surface area (week 36 p400: 253.22 ± 19.44; p500: 219.19 ± 4.76 mm²). A better osseointegration of p500 was indicated by significantly more trabecular contacts and a 200 µm wide bone matrix being in the process of mineralization and in permanent contact with the scaffold. The number of macrophages and foreign body giant cells were at an acceptable level concerning resorbable biomaterials. In terms of ingrown bone and integrative properties, LAE442 scaffolds could not achieve the results of ß-TCP. In this long-term study, p500 appears to be a biocompatible and more osteoconductive pore size for the Mg alloy LAE442.

Mg-6Zn alloys promote the healing of intestinal anastomosis via TGF-β/Smad signaling pathway in regulation of collagen metabolism as compared with titanium alloys

There is a great clinical need for biodegradable materials. This study aimed to investigate the effects of Mg-6Zn and titanium alloy stapler nails on intestinal anastomosis healing mediated via the TGF-β/Smad signaling pathway, as reflected in collagen metabolism in rabbits. Side-to-side ileo-ileostomy was performed with linear stapler loaded with the two nails. The results showed that no obvious postoperative complications such as abdominal infection and anastomotic leakage were observed. General observation and scanning electron microscope showed that Mg-6Zn alloy nails remained intact in the first week, degraded significantly in the second week, and were little left in the third week, while the titanium alloy nails showed intact substrate throughout the experimental period. Immunohistochemical analysis showed that the expression of TGF-β1 in Mg-6Zn alloy group was higher than that in titanium alloy group after 1 week, but it increased slowly, arrived at a lower level in the third week. Collagen I showed an increased expression in Mg-6Zn alloy group, but decreased with time in titanium alloy group. An enhanced expression of collagen III in Mg-6Zn alloy group in the first week but much lower in the third week as compared to the titanium alloy group. The expression of smad2 in Mg-6Zn alloy group maintained a steady level, while in titanium alloy group it showed a general upward trend. The expression of smad3 in both groups held steady after 2 weeks, then in the third week, it showed a strong uptrend in Mg-6Zn alloy group, while decreased immediately in titanium alloy group. Our findings suggest that Mg-6Zn alloy nails degraded significantly within 3 weeks and could provide stability of intestinal anastomosis in the reconstruction of intestinal tract. TGF-β/Smad signaling pathway may play a role in regulation of baseline collagen synthesis throughout the process.

Divalent metal cations stimulate skeleton interoception for new bone formation in mouse injury models

Bone formation induced by divalent metal cations has been widely reported; however, the underlying mechanism is unclear. Here we report that these cations stimulate skeleton interoception by promoting prostaglandin E2 secretion from macrophages. This immune response is accompanied by the sprouting and arborization of calcitonin gene-related polypeptide-α⁺ nerve fibers, which sense the inflammatory cue with PGE₂ receptor 4 and convey the interoceptive signals to the central nervous system. Activating skeleton interoception downregulates sympathetic tone for new bone formation. Moreover, either macrophage depletion or knockout of cyclooxygenase-2 in the macrophage abolishes divalent cation-induced skeleton interoception. Furthermore, sensory denervation or knockout of EP4 in the sensory nerves eliminates the osteogenic effects of divalent cations. Thus, our study reveals that divalent cations promote bone formation through the skeleton interoceptive circuit, a finding which could prompt the development of novel biomaterials to elicit the therapeutic power of these divalent cations.

Mechanisms underlying bone formation induced by divalent metal cations remain largely unknown. Here the authors show that these cations can activate the skeleton interoceptive circuit through the immune-neural axis to initiate new bone formation.

The Development of a Magnesium-Releasing and Long-Term Mechanically Stable Calcium Phosphate Bone Cement Possessing Osteogenic and Immunomodulation Effects for Promoting Bone Fracture Regeneration

Bone grafts are commonly used for the treatment of critical sized bone defects. Since the supply of autologous bone is insufficient, allogeneic bone grafts have been used most of the time. However, the poor osteogenic property of allogeneic bone grafts after pretreatment results in delayed union, non-union, or even occasional deformity. Calcium phosphate cement (CPC) is one of the most promising bone filling materials due to its good biocompatibility and similar chemical components as natural bone. However, clinical applications of CPC were hampered by limited osteogenic effects, undesired immune response which results in resorption, and poor mechanical stability in vivo. Magnesium (Mg) has been proven to trigger bone regeneration through modulating cell behaviors of mesenchymal stem cells and macrophages significantly. Unfortunately, the degradation raters of pure Mg and Mg oxide are extremely fast, resulting in early collapse of Mg contained CPC. In this study, we developed a novel magnesium contained calcium phosphate bone cement (Mg-CPC), possessing long-term mechanical stability and osteogenic effects through sustained release of Mg. Furthermore, in vitro studies showed that Mg-CPC had no cytotoxic effects on hBMMSCs and macrophage RAW 264.7, and could enhance the osteogenic differentiation as determined by alkaline phosphate (ALP) activity and calcium nodule staining, as well as suppress the inflammatory as determined by expression of anti-inflammatory cytokine IL-1RA. We also found that Mg-CPC promoted new bone formation and bone maturation in vivo. These results suggest that Mg-CPC should be a good substitute material for bone grafts in clinical use.

[Application progress of implantation in surgical treatment of cervical tuberculosis]

OBJECTIVE

To review the characteristics and applications of different implantation in cervical tuberculosis surgery and the research progress of the new implantation.

METHODS

By consulting relevant domestic and foreign research literature on cervical tuberculosis, the classification, advantages, disadvantages, and prospects of implantations were analyzed and summarized.

RESULTS

The incidence of cervical tuberculosis has increased recently and has a high disability rate. Currently, the implantation in the surgical treatment of cervical tuberculosis are mainly divided into bone materials, metal materials, and bioactive materials; the above materials have their own advantages and disadvantages, for example, the amount of autologous bone is limited, the complications of allogeneic bone are common, and the bone fusion effect of metal materials is poor. With the development of science and technology, the implantation are also more diverse.

CONCLUSION

The choice of the implantation affects the bone fusion directly, furthermore, it affects the effectiveness of cervical tuberculosis, the development of new implantation provides a variety of options for the treatment of cervical tuberculosis.

3D-printed Mg-incorporated PCL-based scaffolds: A promising approach for bone healing

3D-printed scaffolds have been developed as potential therapeutic strategies in bone tissue engineering. Mg/PCL biomaterials have been attracted much attention owing to biocompatibility, biodegradability as well as tunable mechanical properties. In this work, we developed 3D-printed customized Mg/PCL composite scaffolds with enhanced osteogenesis and biomineralization. Mg microparticles embedded in PCL-based scaffolds took a positive role in the improvement of biocompatibility, biomineralization, and biodegradable abilities. When incorporated with 3 wt% Mg, PCL-based scaffolds exhibited the optimal bone repairing ability in vitro and in vivo. The in vitro experiments indicated that 3 Mg/PCL scaffolds had improved mechanical properties, good biocompatibility, enhanced osteogenic and angiogenic activities. Besides, the in vivo studies demonstrated that Mg/PCL scaffolds promoted tissue ingrowth and new bone formation. In sum, these findings indicated that 3D-printed cell-free Mg/PCL scaffolds are promising strategies for bone healing application.

Sequential activation of heterogeneous macrophage phenotypes is essential for biomaterials-induced bone regeneration

Macrophage has been gradually recognized as a central regulator in tissue regeneration, and the study of how macrophage mediates biomaterials-induced bone regeneration through immunomodulatory pathway becomes popular. However, the current understanding on the roles of different macrophage phenotypes in regulating bone tissue regeneration remains controversial. In this study, we demonstrate that sequential infiltration of heterogeneous phenotypes of macrophages triggered by bio-metal ions effectively facilitates bone healing in bone defect. Indeed, M1 macrophages promote the recruitment and early commitment of osteogenic and angiogenic progenitors, while M2 macrophages and osteoclasts support the deposition and mineralization of the bone matrix, as well as the maturation of blood vessels. Moreover, we have identified a group of bone biomaterial-related multinucleated cells that behave similarly to M2 macrophages with wound-healing features rather than participate in the bone resorption cascade similarly to osteoclasts. Our study shows how sequential activation of macrophage-osteoclast lineage contribute to a highly orchestrated immune response in the bone tissue microenvironment around biomaterials to regulate the complex biological process of bone healing. Therefore, we believe that the temporal activation pattern of heterogeneous macrophage phenotypes should be considered when the next generation of biomaterials for bone regeneration is engineered.

Injectable Cell- and Growth Factor-Free Poly(4-hydroxybutyrate) (P4HB) Microspheres with Open Porous Structures and Great Efficiency of Promoting Bone Regeneration

Delivering injectable microspheres in a minimally invasive way to repair complexly shaped tissue defects renders them attractive for clinical use. Especially, open porous microspheres that provide sufficient internal space for cell proliferation and nutrient diffusions can efficiently aid to completing reconstructions of tissue defects. In this work, chemically synthesized and biodegradable poly(4-hydroxybutyrate) (P4HB), which is the U.S. FDA-approved polyhydroxyalkanoate (PHA), was employed for fabricating open porous microspheres using a double-emulsion solvent evaporation method. The influences of fabrication parameters were discussed. It was found that the P4HB-based cell-free and growth factor-free open porous microspheres can enhance osteoblast differentiation of adipose-derived stem cells in vitro and accelerate rat calvarial bone-defect healing in vivo. These results demonstrated that the injectable open porous P4HB microspheres present a remarkable potential in bone tissue regeneration.

TRPM7 kinase-mediated immunomodulation in macrophage plays a central role in magnesium ion-induced bone regeneration

Despite the widespread observations on the osteogenic effects of magnesium ion (Mg2+), the diverse roles of Mg2+ during bone healing have not been systematically dissected. Here, we reveal a previously unknown, biphasic mode of action of Mg2+ in bone repair. During the early inflammation phase, Mg2+ contributes to an upregulated expression of transient receptor potential cation channel member 7 (TRPM7), and a TRPM7-dependent influx of Mg2+ in the monocyte-macrophage lineage, resulting in the cleavage and nuclear accumulation of TRPM7-cleaved kinase fragments (M7CKs). This then triggers the phosphorylation of Histone H3 at serine 10, in a TRPM7-dependent manner at the promoters of inflammatory cytokines, leading to the formation of a pro-osteogenic immune microenvironment. In the later remodeling phase, however, the continued exposure of Mg2+ not only lead to the over-activation of NF-κB signaling in macrophages and increased number of osteoclastic-like cells but also decelerates bone maturation through the suppression of hydroxyapatite precipitation. Thus, the negative effects of Mg2+ on osteogenesis can override the initial pro-osteogenic benefits of Mg2+. Taken together, this study establishes a paradigm shift in the understanding of the diverse and multifaceted roles of Mg2+ in bone healing.

Regulation of extracellular bioactive cations in bone tissue microenvironment induces favorable osteoimmune conditions to accelerate in situ bone regeneration

The design of orthopedic biomaterials has gradually shifted from “immune-friendly” to “immunomodulatory,” in which the biomaterials are able to modulate the inflammatory response via macrophage polarization in a local immune microenvironment that favors osteogenesis and implant-to-bone osseointegration. Despite the well-known effects of bioactive metallic ions on osteogenesis, how extracellular metallic ions manipulate immune cells in bone tissue microenvironments toward osteogenesis and subsequent bone formation has rarely been studied. Herein, we investigate the osteoimmunomodulatory effect of an extracellular bioactive cation (Mg²⁺) in the bone tissue microenvironment using custom-made poly lactic-co-glycolic acid (PLGA)/MgO-alendronate microspheres that endow controllable release of magnesium ions. The results suggest that the Mg²⁺-controlled tissue microenvironment can effectively induce macrophage polarization from the M0 to M2 phenotype via the enhancement of anti-inflammatory (IL-10) and pro-osteogenic (BMP-2 and TGF-β1) cytokines production. It also generates a favorable osteoimmune microenvironment that facilitates the proliferation and osteogenic differentiation of bone marrow mesenchymal stem cells. The in vivo results further verify that a large amount of bony tissue, with comparable bone mineral density and mechanical properties, has been generated at an early post-surgical stage in rat intramedullary bone defect models. This study demonstrates that the concept of in situ immunomodulated osteogenesis can be realized in a controlled magnesium tissue microenvironment.

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Controlled release of Mg²⁺ was achieved by the microfluidic electrosprayed PLGA/MgO-alendronate microspheres.

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PLGA/MgO-alendronate microspheres with satisfied osteoimmunomodulatory properties accelerated bone regeneration in vivo.

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Extracellular Mg²⁺ induced macrophage switch to M2 phenotype with enhanced expressions of IL-10, BMP-2 and TGF-β1.

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Osteoimmune microenvironment favourably upregulated the osteogenic expressions of BMSCs.

3D printed polycaprolactone/beta-tricalcium phosphate/magnesium peroxide oxygen releasing scaffold enhances osteogenesis and implanted BMSCs survival in repairing the large bone defect

Ischemia and hypoxia in the bone defect area remain an intractable problem when treating large bone defects. Thus, oxygen-releasing biomaterials have been widely researched in recent years. Magnesium peroxide (MgO2) can release oxygen (O2), and magnesium ions (Mg2+), simultaneously, which is seen to have significant potential in bone substitutes. In this study, we used 3D printing technology to fabricate a MgO2-contained composite scaffold, which was composed of polycaprolactone (PCL), beta-tricalcium phosphate (β-TCP) and magnesium peroxide (MgO2). Physical properties and O2/Mg2+ releasing behavior of the scaffold were studied. Then, we evaluated the effects of the scaffold on cell survival, proliferation, migration, adhesion and osteogenic differentiation by the co-culture of bone marrow mesenchymal stem cells (BMSCs) and scaffold under normoxia and hypoxia in vitro. Finally, the osteogenic properties of the scaffold in vivo were evaluated via the rat femoral condylar bone defect model. The PCL/β-TCP/MgO2 scaffold showed good mechanical properties and sustained O2 and Mg2+ release for about three weeks. Meanwhile, the scaffold showed appreciable promotion on the survival, proliferation, migration and osteogenic differentiation of BMSCs under hypoxia compared with control groups. The results of imaging studies and histological analysis showed that implantation of PCL/β-TCP/MgO2 scaffold could promote seed cell survival and significantly increased new bone formation. In sum, the PCL/β-TCP/MgO2 scaffold is promising with great potential for treating large bone defects.

Facile preparation of nanostructured octacalcium phosphate coatings on micro-arc oxidized magnesium with different functionalities for bone repair application

Magnesium (Mg) has been considered as the next-generation orthopedic implant material due to its biodegradability, but high degradation rate and severe cytotoxicity hinder its clinical application. Preparing micro-arc oxidation (MAO)/octacalcium phosphate (OCP) composite coating is considered as an ideal approach to solve the problems. In this work, nanostructured OCP coatings with variable structures were prepared facilely on MAO coated Mg by chemical deposition (CD) in a simple trace PO₄^3- ion contained Ca(NO₃)₂ solution. The results show that nanostructured OCP grows and covers the MAO coating completely after CD. The morphology and thickness of OCP coating can be regulated by varying deposition time. The thinnest OCP coating with a fine structure is observed after 0.5 h of deposition, which shows the best cytocompatibility. Extending deposition time roughens the surface structure and thickens the coatings. The thickest OCP coating with a coarse structure can be obtained after 2 h of deposition, which shows the best corrosion resistance and mineralization. These results clearly indicate the functionality of the OCP coating can be easily tailored only by varying deposition time to meet different clinical requirements.

Stepwise 3D-spatio-temporal magnesium cationic niche: Nanocomposite scaffold mediated microenvironment for modulating intramembranous ossification

The fate of cells and subsequent bone regeneration is highly correlated with temporospatial coordination of chemical, biological, or physical cues within a local tissue microenvironment. Deeper understanding of how mammalian cells react to local tissue microenvironment is paramount important when designing next generation of biomaterials for tissue engineering. This study aims to investigate that the regulation of magnesium cationic (Mg²⁺) tissue microenvironment is able to convince early-stage bone regeneration and its mechanism undergoes intramembranous ossification. It was discovered that moderate Mg²⁺ content niche (~4.11 mM) led to superior bone regeneration, while Mg²⁺-free and strong Mg²⁺ content (~16.44 mM) discouraged cell adhesion, proliferation and osteogenic differentiation, thereby bone formation was rarely found. When magnesium ions diffused into free Mg zone from concentrated zone in late time point, new bone formation on free Mg zone became significant through intramembranous ossification. This study successfully demonstrates that magnesium cationic microenvironment serves as an effective biochemical cue and is able to modulate the process of bony tissue regeneration. The knowledge of how a Mg²⁺ cationic microenvironment intertwines with cells and subsequent bone formation gained from this study may provide a new insight to develop the next generation of tissue-repairing biomaterials.

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Regulation of Mg²⁺ concertation in tissue microenvironment can convince early-stage bone regeneration.

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Samples without and with strong Mg²⁺ microenvironments (16.44 mM) suppressed the osteogenic differentiation.

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When Mg²⁺ diffused into free Mg zone from concentrated zone over time, bone formation over free Mg zone becomes significant.

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Bone defect repair through intramembranous ossification was promoted by 3D-scaffold-created moderate Mg²⁺ microenvironment.

Bioabsorbable high-purity magnesium interbody cage: degradation, interbody fusion, and biocompatibility from a goat cervical spine model

Background

Bioabsorbable Mg-based implants have been a focus of orthopedic researches due to their intrinsic advantages in orthopedics surgeries. This study aimed to investigate the performance of bioabsorbable high-purity magnesium (HP Mg, 99.98 wt.%) interbody cages in anterior cervical discectomy and fusion (ACDF) and to evaluate the degradation of HP Mg cages under an interbody microenvironment.

Methods

ACDF was performed at C2–3 and C4–5, and a HP Mg cage or autologous iliac bone was randomly implanted. At 3, 6, 12 and 24 weeks after surgery, the cervical specimens were harvested to evaluate the fusion status, degradation and biocompatibility by CT, micro-CT, histological examinations and blood tests.

Results

There was no significant difference in the CT fusion score between cage group and autogenous ilium group at 3 and 6 weeks. At 12 and 24 weeks, the mean CT fusion score in the cage group was markedly lower than in the autogenous ilium group. CT and histological examinations showed bony junctions formed through the middle hole of the cage between upper and lower vertebral bodies in the cage group, but the total fusion area was less than 30%. The degradation rate of cages was relatively rapid within the first 3 weeks and thereafter became stable and slow gradually. The HP Mg cage had good biosecurity and biomechanical characteristics.

Conclusions

Implantation of Mg-based interbody cage achieves successful histological fusion, while the total fusion area needs to be improved. More studies are needed to improve the bone-cage interface.

Fabrication and Biological Activity of 3D-Printed Polycaprolactone/Magnesium Porous Scaffolds for Critical Size Bone Defect Repair

Polycaprolactone (PCL) is widely used in bone tissue engineering due to its biocompatibility and mechanical strength. However, PCL is not biologically active and shows poor hydrophilicity, making it difficult for new bones to bind tightly to its surface. Magnesium (Mg), an important component of natural bone, exhibits good osteo-inductivity and biological activity. Therefore, porous PCL/Mg scaffolds, including pure PCL, PCL/5%Mg, PCL/10%Mg, and PCL/15%Mg, were prepared to elucidate whether the porous structure of scaffolds and the bioactivity of PCL may be enhanced via 3D printing and incorporation of Mg powder. Compared with the control group (pure PCL only), the hydrophilicity of composite PCL/Mg scaffolds was greatly increased, resulting in the scaffolds having decreased water contact angles. Tests for adhesion and proliferation of rat bone marrow mesenchymal stem cells (rBMSCs) indicated that the PCL/10%Mg scaffold showed superior compatibility. Furthermore, as indicated by alkaline phosphatase (ALP) activity and semiquantitative analysis of alizarin red staining, PCL/10%Mg scaffolds exhibited significantly stronger osteogenic activity than the other scaffolds. Animal experiments demonstrated that PCL/10%Mg scaffolds displayed pro-osteogenic effects at an early stage (4 weeks) and produced more new bone mass 8-12 weeks following implantation, compared with the control group. Visceral and blood parameter analyses indicated that PCL/10%Mg scaffolds did not exert any noticeable toxic effects. PCL/10%Mg composite scaffolds were found to promote bone defect repair at an early stage with good cytocompatibility. This finding revealed a new concept in designing bone tissue materials, which showed potential as a clinical treatment for bone defects.

Engineered macroporous hydrogel scaffolds via pickering emulsions stabilized by MgO nanoparticles promote bone regeneration

Hydrogels are appealing biomaterials for regenerative medicine since biomimetic modifications of their polymeric network can provide unique physical properties and emulate the native extracellular matrix (ECM). Meanwhile, therapeutic metal ions, such as magnesium ions (Mg²⁺), not only regulate cellular behaviours but also stimulate local bone formation and healing. However, the absence of a meaningful macroporous structure and the uncompromising mechanical strength are still challenges. Herein, we designed a macroporous composite hydrogel based on mild and fast thiol-ene click reactions. The Pickering emulsion method was adopted to form a macroporous structure and introduce MgO nanoparticles (NPs). The results show that the composite hydrogel possesses good mechanical strength and an evenly distributed macroporous structure. MgO NPs stabilized at the oil/water interface not only function as effective emulsion stabilizers, but also enhance the mechanical properties of hydrogels and mediate the sustained release of Mg²⁺. In vitro cell experiments demonstrated that the composite hydrogel displays good biocompatibility. More importantly, the release of Mg²⁺ ions from hydrogels can effectively promote the osteogenic differentiation of BMSCs. Furthermore, an in vivo study showed that macroporous hydrogels can provide a good extracellular matrix microenvironment for in situ osteogenesis and accelerate bone tissue regeneration.

Magnesium Alloys With Tunable Interfaces as Bone Implant Materials

Magnesium (Mg) based biodegradable materials are a new generation orthopedic implant materials that are intended to possess same mechanical properties as that of bone. Mg alloys are considered as promising substitutes to permanent implants due to their biodegradability in the physiological environment. However, rapid corrosion rate is one of the major constraints of using Mg alloys in clinical applications in spite of their excellent biocompatibility. Approaches to overcome the limitations include the selection of adequate alloying elements, proper surface treatment, surface modification with coating to control the degradation rate. This review focuses on current advances on surface engineering of Mg based biomaterials for biomedical applications. The review begins with a description of corrosion mechanism of Mg alloy, the requirement for appropriate surface functionalization/coatings, their structure-property-performance relationship, and suitability for biomedical applications. The control of physico-chemical properties such as wettability, surface morphology, surface chemistry, and surface functional groups of the coating tailored by various approaches forms the pivotal part of the review. Chemical surface treatment offers initial protection from corrosion and inorganic coating like hydroxyapatite (HA) improves the biocompatibility of the substrate. Considering the demand of ideal implant materials, multilayer hybrid coatings on Mg alloy in combination with chemical pretreatment or inorganic HA coating, and protein-based polymer coating could be a promising technique to improve corrosion resistance and promote biocompatibility of Mg-based alloys.

A biodegradable multifunctional nanofibrous membrane for periodontal tissue regeneration

Biomaterial-based membranes represent a promising therapeutic option for periodontal diseases. Although conventional periodontal membranes function greatly in preventing the ingrowth of both fibroblasts and epithelial cells as well as connective tissues, they are not capable of promoting periodontal tissue regeneration. Here, we report a multifunctional periodontal membrane prepared by electrospinning biodegradable polymers with magnesium oxide nanoparticles (nMgO). nMgO is a light metal-based nanoparticle with high antibacterial capacity and can be fully resorbed in the body. Our results showed that incorporating nMgO into poly(L-lactic acid) (PLA)/gelatin significantly improved the overall properties of membranes, including elevated tensile strength to maintain structural stability and adjusted degradation rate to fit the time window of periodontal regeneration. Acidic degradation products of PLA were neutralized by alkaline ions from nMgO hydrolysis, ameliorating pH microenvironment beneficial for cell proliferation. In vitro studies demonstrated considerable antibacterial and osteogenic properties of nMgO-incorporated membranes that are highly valuable for periodontal regeneration. Further investigations in a rat periodontal defect model revealed that nMgO-incorporated membranes effectively guided periodontal tissue regeneration. Taken together, our data indicate that nMgO-incorporated membranes might be a promising therapeutic option for periodontal regeneration. STATEMENT OF SIGNIFICANCE: Traditional clinical treatments of periodontal diseases largely focus on the management of the pathologic processes, which cannot effectively regenerate the lost periodontal tissue. GTR, a classic method for periodontal regeneration, has shown promise in clinical practice. However, the current membranes might not fully fulfill the criteria of ideal membranes. Here, we report bioabsorbable nMgO-incorporated nanofibrous membranes prepared by electrospinning to provide an alternative for the clinical practice of GTR. The membranes not only function greatly as physical barriers but also exhibit high antibacterial and osteoinductive properties. We therefore believe that this study will inspire more practice work on the development of effective GTR membranes for periodontal regeneration.

Enhanced osteoinductivity and corrosion resistance of dopamine/gelatin/rhBMP-2-coated β-TCP/Mg-Zn orthopedic implants: An in vitro and in vivo study

Magnesium-based biomaterials are attracting increasingly more attention for orthopedic applications based on their appropriate mechanical properties, biodegradability, and favorable biocompatibility. However, the high corrosion rate of these materials remains to be addressed. In this study, porous β-Ca3(PO4)2/Mg-Zn (β-TCP/Mg-Zn) composites were fabricated via a powder metallurgy method. The β-TCP/Mg-Zn composites with 6% porosity exhibited optimal mechanical properties, and thus, they were selected for surface modification. A novel dopamine/gelatin/recombinant human bone morphogenetic protein-2 (rhBMP-2) coating with demonstrated stability was prepared to further improve the corrosion resistance of the composite and enhance early osteoinductivity. The homogeneously coated β-TCP/Mg-Zn composite showed significantly improved corrosion resistance according to electrochemical and immersion tests. In addition, extracts from the dopamine/gelatin/rhBMP-2-coated β-TCP/Mg-Zn composite not only facilitated cell proliferation but also significantly enhanced the osteogenic differentiation of Sprague-Dawley rat bone marrow-derived mesenchymal stem cells in vitro. Furthermore, in vivo experiments were performed to evaluate the biodegradation, histocompatibility, and osteoinductive potential of the coated composite. No obvious pathological changes in the vital visceral organs were observed after implantation, and radiography and hematoxylin-eosin staining showed strong promotion of new bone formation, matched composite degradation and bone regeneration rates, and complete absorption of the released hydrogen gas. Collectively, these results indicate that the dopamine/gelatin/rhBMP-2-coated β-TCP/Mg-Zn composite offers improved corrosion resistance, favorable biocompatibility, and enhanced osteoinductive potential for use in the fabrication of orthopedic implants.

Solvent-based Extrusion 3D Printing for the Fabrication of Tissue Engineering Scaffolds

Three-dimensional (3D) printing has been emerging as a new technology for scaffold fabrication to overcome the problems associated with the undesirable microstructure associated with the use of traditional methods. Solvent-based extrusion (SBE) 3D printing is a popular 3D printing method, which enables incorporation of cells during the scaffold printing process. The scaffold can be customized by optimizing the scaffold structure, biomaterial, and cells to mimic the properties of natural tissue. However, several technical challenges prevent SBE 3D printing from translation to clinical use, such as the properties of current biomaterials, the difficulties associated with simultaneous control of multiple biomaterials and cells, and the scaffold-to-scaffold variability of current 3D printed scaffolds. In this review paper, a summary of SBE 3D printing for tissue engineering (TE) is provided. The influences of parameters such as ink biomaterials, ink rheological behavior, cross-linking mechanisms, and printing parameters on scaffold fabrication are considered. The printed scaffold structure, mechanical properties, degradation, and biocompatibility of the scaffolds are summarized. It is believed that a better understanding of the scaffold fabrication process and assessment methods can improve the functionality of SBE-manufactured 3D printed scaffolds.

A surface-engineered multifunctional TiO2 based nano-layer simultaneously elevates the corrosion resistance, osteoconductivity and antimicrobial property of a magnesium alloy

Magnesium biometals exhibit great potentials for orthopeadic applications owing to their biodegradability, bioactive effects and satisfactory mechanical properties. However, rapid corrosion of Mg implants in vivo combined with large amount of hydrogen gas evolution is harmful to bone healing process which seriously confines their clinical applications. Enlightened by the superior biocompatibility and corrosion resistance of passive titanium oxide layer automatically formed on titanium alloy, we employ the Ti and O dual plasma ion immersion implantation (PIII) technique to construct a multifunctional TiO₂ based nano-layer on ZK60 magnesium substrates for enhanced corrosion resistance, osteoconductivity and antimicrobial activity. The constructed nano-layer (TiO₂/MgO) can effectively suppress degradation rate of ZK60 substrates in vitro and still maintain 94% implant volume after post-surgery eight weeks. In animal study, a large amount of bony tissue with increased bone mineral density and trabecular thickness is formed around the PIII treated group in post-operation eight weeks. Moreover, the newly formed bone in the PIII treated group is well mineralized and its mechanical property almost restores to the level of that of surrounding mature bone. Surprisingly, a remarkable killing ratio of 99.31% against S. aureus can be found on the PIII treated sample under ultra-violet (UV) irradiation which mainly attributes to the oxidative stress induced by the reactive oxygen species (ROS). We believe that this multifunctional TiO₂ based nano-layer not only controls the degradation of magnesium implant, but also regulates its implant-to-bone integration effectively. STATEMENT OF SIGNIFICANCE: Rapid corrosion of magnesium implants is the major issue for orthopaedic applications. Inspired by the biocompatibility and corrosion resistance of passive titanium oxide layer automatically formed on titanium alloy, we construct a multifunctional TiO₂/MgO nanolayer on magnesium substrates to simultaneously achieve superior corrosion resistance, satisfactory osteoconductivity in rat intramedullary bone defect model and excellent antimicrobial activity against S. aureus under UV irradiation. The current findings suggest that the specific TiO₂/MgO nano-layer on magnesium surface can achieve the three objectives aforementioned and we believe this study can demonstrate the potential of biodegradable metals for future clinical applications.

Embedding magnesium metallic particles in polycaprolactone nanofiber mesh improves applicability for biomedical applications

Magnesium (Mg) metal is of great interest in biomedical applications, especially in tissue engineering. Mg exhibits excellent in vivo biocompatibility, biodegradability and, during degradation, releases Mg ions (Mg²⁺) with the potential to improve tissue repair. We used electrospinning technology to incorporate Mg particles into nanofibers. Various ratios of Mg metal microparticles (<44 µm diameter) were incorporated into nanofiber polycaprolactone (PCL) meshes. Physicochemical properties of the meshes were analyzed by scanning electron microscopy (SEM), Fourier-transform infrared spectroscopy (FTIR), mechanical tensile testing, X-ray diffractometry and UV-VIS spectrophotometry. Biological properties of meshes were evaluated in vitro and in vivo. Under mammalian cell culture conditions, Mg-containing meshes released hydrogen gas and relative amounts of free Mg²⁺ that reflected the Mg/PCL ratios. All meshes were non-cytotoxic for 3T3 fibroblasts and PC-12 pheochromocytoma cells. In vivo implantation under the skin of mice for 3, 8 and 28 days showed that Mg-containing meshes were well vascularized, with improved measures of inflammation and healing compared to meshes without Mg. Evidence included an earlier appearance and infiltration of tissue repairing macrophages and, after 28 days, evidence of more mature tissue remodeling. Thus, these new composite nanofiber meshes have promising material properties that mitigated inflammatory tissue responses to PCL alone and improved tissue healing, thus providing a suitable matrix for use in clinically relevant tissue engineering applications. STATEMENT OF SIGNIFICANCE: The biodegradable metal, magnesium, safely biodegrades in the body, releasing beneficial byproducts. To improve tissue delivery, magnesium metal particles were incorporated into electrospun nanofiber meshes composed of a biodegradable, biocompatible polymer, polycaprolactone (PCL). Magnesium addition, at several concentrations, did not alter PCL chemistry, but did alter physical properties. Under cell culture conditions, meshes released magnesium ions and hydrogen gas and were not cytotoxic for two cell types. After implantation in mice, the mesh with magnesium resulted in earlier appearance of M2-like, reparative macrophages and improved tissue healing versus mesh alone. This is in agreement with other studies showing beneficial effects of magnesium metal and provides a new type of scaffold material that will be useful in clinically relevant tissue engineering applications.

Three-dimensional Printed Mg-Doped β-TCP Bone Tissue Engineering Scaffolds: Effects of Magnesium Ion Concentration on Osteogenesis and Angiogenesis In Vitro

Background

Three-dimensional (3D) printed bone tissue engineering scaffolds have been widely used in research and clinical applications. β-TCP is a biomaterial commonly used in bone tissue engineering to treat bone defects, and its multifunctionality can be achieved by co-doping different metal ions. Magnesium doping in biomaterials has been shown to alter physicochemical properties of cells and enhance osteogenesis.

Methods

A series of Mg-doped TCP scaffolds were manufactured by using cryogenic 3D printing technology and sintering. The characteristics of the porous scaffolds, such as microstructure, chemical composition, mechanical properties, apparent porosity, etc., were examined. To further study the role of magnesium ions in simultaneously inducing osteogenesis and angiogenesis, human bone marrow mesenchymal stem cells (hBMSCs) and human umblical vein endothelial cells (HUVECs) were cultured in scaffold extracts to investigate cell proliferation, viability, and expression of osteogenic and angiogenic genes.

Results

The results showed that Mg-doped TCP scaffolds have the advantages of precise design, interconnected porous structure, and similar compressive strength to natural cancellous bone. hBMSCs and HUVECs exhibit high proliferation rate, cell morphology and viability in a certain amount of Mg²⁺. In addition, this concentration of magnesium can also increase the expression levels of osteogenic and angiogenic biomarkers.

Conclusion

A certain concentration of magnesium ions plays an important role in new bone regeneration and reconstruction. It can be used as a simple and effective method to enhance the osteogenesis and angiogenesis of bioceramic scaffolds, and support the development of biomaterials and bone tissue engineering scaffolds.

Surface degradation-enabled osseointegrative, angiogenic and antiinfective properties of magnesium-modified acrylic bone cement

Objective

This work focuses on tackling the inadequate bone/implant interface strength of acrylic bone cements, which is a formidable problem diminishing their clinical performance, especially in percutaneous kyphoplasty surgery.

Methods

A new strategy of incorporating magnesium particles into clinically used poly(methylmethacrylate) (PMMA) bone cement to prepare a surface-degradable bone cement (SdBC) is proposed and validated both in vitro and in vivo.

Results

This surface degradation characteristic enables osseointegrative, angiogenic and antiinfective properties. SdBC showed fast surface degradation and formed porous surfaces as designed, while the desirable high compressive strengths (≥70 MPa) of the cement were preserved. Besides, the SdBC with proper Mg content promoted osteoblast adhesion, spreading, proliferation and endothelial cell angiogenesis capacity compared with PMMA. Also, SdBC demonstrated clear inhibitory effect on Staphylococcus aureus and Escherichia coli. In vivo evaluation on SdBC by the rat femur defect model showed that the bone/implant interface strength was significantly enhanced in SdBC (push-out force of 11.8 ± 1.5 N for SdBC vs 7.0 ± 2.3N for PMMA), suggesting significantly improved osseointegration and bone growth induced by the surface degradation of the cement. The injectability, setting times and compressive strengths of SdBC with proper content of Mg particles (2.8 wt% and 5.4 wt%) were comparable with those of the clinical acrylic bone cement, while the heat release during polymerization was reduced (maximum temperature 78 ± 1 °C for PMMA vs 73.3 ± 1.5 °C for SdBC).

Conclusions

This work validates a new concept of designing bioactive bone/implant interface in PMMA bone cement. And this surface-degradable bone cement possesses great potential for minimally invasive orthopaedic surgeries such as percutaneous kyphoplasty.

The translational potential of this article

This work reports PMMA/Mg surface-degradable acrylic bone cements that possess enhanced osseointegrative, angiogenic and antiinfective properties that are lacking in the clinically used acrylic bone cements. This new kind of bone cements could improve the treatment outcome of many orthopaedic surgeries such as percutaneous kyphoplasty and arthroplasty.

Characterizations and interfacial reinforcement mechanisms of multicomponent biopolymer based scaffold

It is difficult for a single component biopolymer to meet the requirements of scaffold at present. The development of multicomponent biopolymer based scaffold provides an effective method to solve the issue based on the advantages of each kind of the biomaterials. However, the compatibility between different components might be very poor due to the difficulties in forming strong interfacial bonding, and thereby significantly degrading the integrated mechanical properties of the scaffold. In recent years, interface phase introduction, surface modification and in situ growth have been the major strategies for enhancing interfacial bonding. This article presents a comprehensive overview on the research in the area of constructing multicomponent biopolymer based scaffold and reinforcing their interfacial properties, and more importantly, the interfacial bonding mechanisms are systematically summarized. Detailly, interface phase introduction can build a bridge between biopolymer and other components to form strong interface bonding with the two phases under the action of interface phase. Surface modification can graft organic molecules or polymers containing functional groups onto other components to crosslink with biopolymer. In situ growth can directly in situ synthesize other components with the action of nucleating agent serving as an adherent platform for the nucleation and growth of other components to biopolymer surface by chemical bonding. In addition, the mechanical properties (including strength and modulus) and biological properties (including bioactivity, cytocompatibility and biosensing in vitro, and tissue compatibility, bone regeneration capacity in vivo) of multicomponent biopolymer based scaffold after interfacial reinforcing are also reviewed and discussed. Finally, suggestions for further research are given with highlighting the need for specific investigations to assess the interface formation, structure, properties, and more in vivo studies of scaffold before applications.

Influence of magnesium particles and Pluronic F127 on compressive strength and cytocompatibility of nanocomposite injectable and moldable beads for bone regeneration

A novel one-step preparation of magnesium particles and Pluronic F127 incorporated with calcium sulfate hemihydrate (CSH) and nano-hydroxyapatite (nHA) ready to use injectable or moldable beads was developed for bone tissue regeneration applications. The nanocomposite showed setting time less than 15 min, very good injectability (75-85%) and good mechanical strength (52-80 MPa). Samples immersed in SBF showed controlled degradation (40-45% reduction in weight) in 28 days. The nanocomposite bone graft was cytocompatible against MG63 osteosarcoma cells and increased the osteogenic gene expression by 2-3 folds. These results indicate that it can be a potential defect filling biomaterial for bone tissue regeneration at the fracture site.

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

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

3D-Bioprinted Osteoblast-Laden Nanocomposite Hydrogel Constructs with Induced Microenvironments Promote Cell Viability, Differentiation, and Osteogenesis both In Vitro and In Vivo

An osteoblast-laden nanocomposite hydrogel construct, based on polyethylene glycol diacrylate (PEGDA)/laponite XLG nanoclay ([Mg5.34Li0.66Si8O20(OH)4]Na0.66, clay)/hyaluronic acid sodium salt (HA) bio-inks, is developed by a two-channel 3D bioprinting method. The novel biodegradable bio-ink A, comprised of a poly(ethylene glycol) (PEG)-clay nanocomposite crosslinked hydrogel, is used to facilitate 3D-bioprinting and enables the efficient delivery of oxygen and nutrients to growing cells. HA with encapsulated primary rat osteoblasts (ROBs) is applied as bio-ink B with a view to improving cell viability, distribution uniformity, and deposition efficiency. The cell-laden PEG-clay constructs not only encapsulated osteoblasts with more than 95% viability in the short term but also exhibited excellent osteogenic ability in the long term, due to the release of bioactive ions (magnesium ions, Mg2+ and silicon ions, Si4+), which induces the suitable microenvironment to promote the differentiation of the loaded exogenous ROBs, both in vitro and in vivo. This 3D-bioprinting method holds much promise for bone tissue regeneration in terms of cell engraftment, survival, and ultimately long-term function.

Bone grafts and biomaterials substitutes for bone defect repair: A review

Bone grafts have been predominated used to treat bone defects, delayed union or non-union, and spinal fusion in orthopaedic clinically for a period of time, despite the emergency of synthetic bone graft substitutes. Nevertheless, the integration of allogeneic grafts and synthetic substitutes with host bone was found jeopardized in long-term follow-up studies. Hence, the enhancement of osteointegration of these grafts and substitutes with host bone is considerably important. To address this problem, addition of various growth factors, such as bone morphogenetic proteins (BMPs), parathyroid hormone (PTH) and platelet rich plasma (PRP), into structural allografts and synthetic substitutes have been considered. Although clinical applications of these factors have exhibited good bone formation, their further application was limited due to high cost and potential adverse side effects. Alternatively, bioinorganic ions such as magnesium, strontium and zinc are considered as alternative of osteogenic biological factors. Hence, this paper aims to review the currently available bone grafts and bone substitutes as well as the biological and bio-inorganic factors for the treatments of bone defect.

Atomic layer deposited ZrO2 nanofilm on Mg-Sr alloy for enhanced corrosion resistance and biocompatibility

The biodegradability and good mechanical property of magnesium alloys make them potential biomedical materials. However, their rapid corrosion rate in the human body's environment impairs these advantages and limits their clinical use. In this work, a compact zirconia (ZrO₂) nanofilm was fabricated on the surface of a magnesium-strontium (Mg-Sr) alloy by the atomic layer deposition (ALD) method, which can regulate the thickness of the film precisely and thus also control the corrosion rate. Corrosion tests reveal that the ZrO₂ film can effectively reduce the corrosion rate of Mg-Sr alloys that is closely related to the thickness of the film. The cell culture test shows that this kind of ZrO₂ film can also enhance the activity and adhesion of osteoblasts on the surfaces of Mg-Sr alloys.

STATEMENT OF SIGNIFICANCE

The significance of the current work is to develop a zirconia nanofilm on biomedical MgSr alloy with controllable thickness precisely through atomic layer deposition technique. By adjusting the thickness of nanofilm, the corrosion rate of Mg-Sr alloy can be modulated, thereafter, the degradation rate of Mg-based alloys can be controlled precisely according to actual clinical requirement. In addition, this zirconia nanofilm modified Mg-Sr alloys show excellent biocompatibility than the bare samples. Hence, this work provides a new surface strategy to control the degradation rate while improving the biocompatibility of substrates.