Estimation of anisotropic permeability in trabecular bone based on microCT imaging and pore-scale fluid dynamics simulations

Microfluidic device for enhancement and analysis of osteoblast differentiation in three-dimensional cell cultures

Three-dimensional (3D) cell cultures are to date the gold standard in biomedical research fields due to their enhanced biological functions compared to conventional two-dimensional (2D) cultures. 3D cell spheroids, as well as organoids, are better suited to replicate tissue functions, which enables their use both as in vitro models for basic research and toxicology, as well as building blocks used in tissue/organ biofabrication approaches. Culturing 3D spheroids from bone-derived cells is an emerging technology for both disease modelling and drug screening applications. Bone tissue models are mainly limited by the implementation of sophisticated devices and procedures that can foster a tissue-specific 3D cell microenvironment along with a dynamic cultivation regime. In this study, we consequently developed, optimized and characterized an advanced perfused microfluidic platform to improve the reliability of 3D bone cell cultivation and to enhance aspects of bone tissue maturation in vitro. Moreover, biomechanical stimulation generated by fluid flow inside the arrayed chamber, was used to mimic a more dynamic cell environment emulating a highly vascularized bone we expected to improve the osteogenic 3D microenvironment in the developed multifunctional spheroid-array platform. The optimized 3D cell culture protocols in our murine bone-on-a-chip spheroid model exhibited increased mineralization and viability compared to static conditions. As a proof-of-concept, we successfully confirmed on the beneficial effects of a dynamic culture environment on osteogenesis and used our platform for analysis of bone-derived spheroids produced from primary human pre-osteoblasts. To conclude, the newly developed system represents a powerful tool for studying human bone patho/physiology in vitro under more relevant and dynamic culture conditions converging the advantages of microfluidic platforms with multi-spheroid array technologies.

Accelerating cryoprotectant delivery using vacuum infiltration

The ability to cryopreserve bone marrow within the vertebral body (VB) would offer significant clinical and research benefits. However, cryopreservation of large structures, such as VBs, is challenging due to mass transport limitations that prevent the effective delivery of cryoprotectants into the tissue. To overcome this challenge, we examined the potential of vacuum infiltration, along with carbonation, to increase the penetration of cryoprotectants. In particular, we hypothesized that initial exposure to high-pressure carbon dioxide gas would introduce bubbles into the tissue and that subsequent vacuum cycling would cause expansion and contraction of the bubbles, thus enhancing the transport of cryoprotectant into the tissue. Experiments were carried out using colored dye and agarose gel as a model revealing that carbonation and vacuum cycling result in a 14% increase in dye penetration compared to the atmospheric controls. Experiments were also carried out by exposing VBs isolated from human vertebrae to 40% (v/v) DMSO solution. CT imaging showed the presence of gas bubbles within the tissue pores for carbonated VBs as well as control VBs. Vacuum cycling reduced the bubble volume by more than 50%, most likely resulting in replacement of this volume with DMSO solution. However, we were unable to detect a statistically significant increase in DMSO concentration within the VBs using CT imaging. This research suggests that there may be a modest benefit to carbonation and vacuum cycling for introduction of cryoprotectants into larger structures, like VBs.

A continuum mechanical porous media model for vertebroplasty: Numerical simulations and experimental validation

The outcome of vertebroplasty is hard to predict due to its dependence on complex factors like bone cement and marrow rheologies. Cement leakage could occur if the procedure is done incorrectly, potentially causing adverse complications. A reliable simulation could predict the patient-specific outcome preoperatively and avoid the risk of cement leakage. Therefore, the aim of this work was to introduce a computationally feasible and experimentally validated model for simulating vertebroplasty. The developed model is a multiphase continuum-mechanical macro-scale model based on the Theory of Porous Media. The related governing equations were discretized using a combined finite element-finite volume approach by the so-called Box discretization. Three different rheological upscaling methods were used to compare and determine the most suitable approach for this application. For validation, a benchmark experiment was set up and simulated using the model. The influence of bone marrow and parameters like permeability, porosity, etc., was investigated to study the effect of varying conditions on vertebroplasty. The presented model could realistically simulate the injection of bone cement in porous materials when used with the correct rheological upscaling models, of which the semi-analytical averaging of the viscosity gave the best results. The marrow viscosity is identified as the crucial reference to categorize bone cements as 'high- 'or 'low-' viscosity in the context of vertebroplasty. It is confirmed that a cement with higher viscosity than the marrow ensures stable development of the injection and a proper cement interdigitation inside the vertebra.

Optimization and Validation of a Custom-Designed Perfusion Bioreactor for Bone Tissue Engineering: Flow Assessment and Optimal Culture Environmental Conditions

Various perfusion bioreactor systems have been designed to improve cell culture with three-dimensional porous scaffolds, and there is some evidence that fluid force improves the osteogenic commitment of the progenitors. However, because of the unique design concept and operational configuration of each study, the experimental setups of perfusion bioreactor systems are not always compatible with other systems. To reconcile results from different systems, the thorough optimization and validation of experimental configuration are required in each system. In this study, optimal experimental conditions for a perfusion bioreactor were explored in three steps. First, an in silico modeling was performed using a scaffold geometry obtained by microCT and an expedient geometry parameterized with porosity and permeability to assess the accuracy of calculated fluid shear stress and computational time. Then, environmental factors for cell culture were optimized, including the volume of the medium, bubble suppression, and medium evaporation. Further, by combining the findings, it was possible to determine the optimal flow rate at which cell growth was supported while osteogenic differentiation was triggered. Here, we demonstrated that fluid shear stress up to 15 mPa was sufficient to induce osteogenesis, but cell growth was severely impacted by the volume of perfused medium, the presence of air bubbles, and medium evaporation, all of which are common concerns in perfusion bioreactor systems. This study emphasizes the necessity of optimization of experimental variables, which may often be underreported or overlooked, and indicates steps which can be taken to address issues common to perfusion bioreactors for bone tissue engineering.

Dental Implant Nano-Engineering: Advances, Limitations and Future Directions

Titanium (Ti) and its alloys offer favorable biocompatibility, mechanical properties and corrosion resistance, which makes them an ideal material choice for dental implants. However, the long-term success of Ti-based dental implants may be challenged due to implant-related infections and inadequate osseointegration. With the development of nanotechnology, nanoscale modifications and the application of nanomaterials have become key areas of focus for research on dental implants. Surface modifications and the use of various coatings, as well as the development of the controlled release of antibiotics or proteins, have improved the osseointegration and soft-tissue integration of dental implants, as well as their antibacterial and immunomodulatory functions. This review introduces recent nano-engineering technologies and materials used in topographical modifications and surface coatings of Ti-based dental implants. These advances are discussed and detailed, including an evaluation of the evidence of their biocompatibility, toxicity, antimicrobial activities and in-vivo performances. The comparison between these attempts at nano-engineering reveals that there are still research gaps that must be addressed towards their clinical translation. For instance, customized three-dimensional printing technology and stimuli-responsive, multi-functional and time-programmable implant surfaces holds great promise to advance this field. Furthermore, long-term in vivo studies under physiological conditions are required to ensure the clinical application of nanomaterial-modified dental implants.

The effect of pores and connections geometries on bone ingrowth into titanium scaffolds: an assessment based on 3D microCT images

In order to support bone tissue regeneration, porous biomaterial implants (scaffolds) must offer chemical and mechanical properties, besides favorable fluid transport. Titanium implants provide these requirements, and depending on their microstructural parameters, the osteointegration process can be stimulated. The pore structure of scaffolds plays an essential role in this process, guiding fluid transport for neo-bone regeneration. The objective of this work was to analyze geometric and morphologic parameters of the porous microstructure of implants and analyze their influences in the bone regeneration process, and then discuss which parameters are the most fundamental. Bone ingrowths into two different sorts of porous titanium implants were analyzed after 7, 14, 21, 28, and 35 incubation days in experimental animal models. Measurements were accomplished with x-ray microtomography image analysis from rabbit tibiae, applying a pore-network technique. Taking into account the most favorable pore sizes for neo-bone regeneration, a novel approach was employed to assess the influence of the pore structure on this process: the analyses were carried out considering minimum pore and connection sizes. With this technique, pores and connections were analyzed separately and the influence of connectivity was deeply evaluated. This investigation showed a considerable influence of the size of connections on the permeability parameter and consequently on the neo-bone regeneration. The results indicate that the processing of porous scaffolds must be focused on deliver pore connections that stimulate the transport of fluids throughout the implant to be applied as a bone replacer.

Design and properties of biomimetic irregular scaffolds for bone tissue engineering

The treatment of sizeable segmental bone defects remains a challenge encountered by surgeons. In addition to bone transplantation, porous scaffolds have become a common option. Although the mechanical and biological properties of porous scaffold have recently been the subject of intense research, pore irregularity as a critical characteristic has been poorly explored. Therefore, this study aimed to design an irregular biomimetic scaffold for use in bone tissue engineering applications. The irregular scaffold was based on the Voronoi tessellation method for similarity with the primary histomorphological indexes of bone (porosity, trabecular thickness, cortical bone thickness, and surface to volume ratio). Moreover, a new gradient method was adopted, in which porosity was maintained constant, and the strut diameter was changed to generate a gradient in the irregular scaffold. The permeability and stress concentration characteristics of the irregular scaffold were compared against three conventional scaffolds (the octet, body-centered cubic, pillar body-centered cubic). The results illustrated that the microstructure of the irregular scaffold could be controlled similarly to that of the cortical/cancellous bone unit. Simultaneously, a broad range of permeability was identified for the irregular scaffold, and gradient irregular scaffolds performed better in terms of both permeability and stress distribution than regular scaffolds. This study describes a novel method for the design of irregular scaffolds, which have good controllability and excellent permeability.

Porous polylactic acid scaffolds for bone regeneration: A study of additively manufactured triply periodic minimal surfaces and their osteogenic potential

Three different triply periodic minimal surfaces (TPMS) with three levels of porosity within those of cancellous bone were investigated as potential bone scaffolds. TPMS have emerged as potential designs to resemble the complex mechanical and mass transport properties of bone. Diamond, Schwarz, and Gyroid structures were 3D printed in polylactic acid, a resorbable medical grade material. The 3D printed structures were investigated for printing feasibility, and assessed by morphometric studies. Mechanical properties and permeability investigations resulted in similar values to cancellous bone. The morphometric analyses showed three different patterns of pore distribution: mono-, bi-, and multimodal pores. Subsequently, biological activity investigated with pre-osteoblastic cell lines showed no signs of cytotoxicity, and the scaffolds supported cell proliferation up to 3 weeks. Cell differentiation investigated by alkaline phosphatase showed an improvement for higher porosities and multimodal pore distributions, suggesting a higher dependency on pore distribution and size than the level of interconnectivity.

Synthetic open cell foams versus a healthy human vertebra: Anisotropy, fluid flow and μ-CT structural studies

Commercial synthetic open-cell foams are an alternative to human cadaveric bone to simulate in vitro different scenarios of bone infiltration properties. Unfortunately, these artificial foams do not reproduce the anisotropic microstructure of natural bone and, consequently, their suitability in these studies is highly questionable. In order to achieve scaffolds that successfully mimic human bone, microstructural studies of both natural porous media and current synthetic approaches are necessary at different length scales. In this line, the present research was conducted to improve the understanding of local anisotropy in natural vertebral bone and synthetic bone-like porous foams. To attain this objective, small volumes of interest within these materials were reconstructed via micro-computed tomography. The anisotropy of the microstructures was analysed by means of both their main local histomorphometric features and the behaviour of an internal flow computed via computational fluid dynamics. The results showed that the information obtained from each of the micro-volumes of interest could be scaled up to understand not only the macroscopic averaged isotropic and/or anisotropic behaviour of the samples studied, but also to improve the design of macroscopic porous implants better fitting specific local histomorphometric scenarios. The results also clarify the discrepancies in the permeability obtained in the different micro-volumes of interest analysed. STATEMENT OF SIGNIFICANCE: A deep insight comparative study between the porous microstructure of healthy vertebral bone and that of synthetic bone-like open-cell rigid foams used in in vitro permeability studies of bone cement has been performed. The results obtained are of fundamental relevance to computational studies because, in order to achieve convergence values, the computation process should be limited to small computation domains or micro-volumes of interest. This makes the results specific spatial dependent and for this reason computation studies cannot directly capture the macroscopic average behaviour of an anisotropic porous structure such as the one observed in natural bones. The results derived from this study are also important because we have been able to show that the specific spatial information contained in only one healthy vertebra is enough to capture, from a geometric point of view, the same information of "specific surface area vs. porosity" - in other words, the same basic law - that can also be found in other human bones for different patients, even at different biological ages. This is an important finding that, despite the efforts made and the controversies formulated by other authors, should be studied more thoroughly with other bone species and tissues (healthy and/or diseased). Moreover, our results should help to understand that, with the extensive capabilities of current 3D printing technologies, there is an enormous potential in the design of biomimetic porous bone-like scaffolds for bone tissue engineering applications.

Integrated Design Approaches for 3D Printed Tissue Scaffolds: Review and Outlook

Emerging 3D printing technologies are enabling the fabrication of complex scaffold structures for diverse medical applications. 3D printing allows controlled material placement for configuring porous tissue scaffolds with tailored properties for desired mechanical stiffness, nutrient transport, and biological growth. However, tuning tissue scaffold functionality requires navigation of a complex design space with numerous trade-offs that require multidisciplinary assessment. Integrated design approaches that encourage iteration and consideration of diverse processes including design configuration, material selection, and simulation models provide a basis for improving design performance. In this review, recent advances in design, fabrication, and assessment of 3D printed tissue scaffolds are investigated with a focus on bone tissue engineering. Bone healing and fusion are examples that demonstrate the needs of integrated design approaches in leveraging new materials and 3D printing processes for specified clinical applications. Current challenges for integrated design are outlined and emphasize directions where new research may lead to significant improvements in personalized medicine and emerging areas in healthcare.

The effect of charge density on the velocity and attenuation of ultrasound waves in human cancellous bone

Cancellous bone is a highly porous material, and two types of waves, fast and slow, are observed when ultrasound is used for detecting bone diseases. There are several possible stimuli for bone remodelling processes, including bone fluid flow, streaming potential, and piezoelectricity. Poroelasticity has been widely used for elucidating the bone fluid flow phenomenon, but the combination of poroelasticity with charge density has not been introduced. Theoretically, general poroelasticity with a varying charge density is employed for determining the relationship between wave velocity and attenuation with charge density. Fast wave velocity and attenuation are affected by porosity as well as charge density; however, for a slow wave, both slow wave velocity and attenuation are not as sensitive to the effect of charge density as they are for a fast wave. Thus, employing human femoral data, we conclude that charged ions gather on trabecular struts, and the fast wave, which moves along the trabecular struts, is significantly affected by charge density.

An ECM-Mimicking, Mesenchymal Stem Cell-Embedded Hybrid Scaffold for Bone Regeneration

While biologically feasible, bone repair is often inadequate, particularly in cases of large defects. The search for effective bone regeneration strategies has led to the emergence of bone tissue engineering (TE) techniques. When integrating electrospinning techniques, scaffolds featuring randomly oriented or aligned fibers, characteristic of the extracellular matrix (ECM), can be fabricated. In parallel, mesenchymal stem cells (MSCs), which are capable of both self-renewing and differentiating into numerous tissue types, have been suggested to be a suitable option for cell-based tissue engineering therapies. This work aimed to create a novel biocompatible hybrid scaffold composed of electrospun polymeric nanofibers combined with osteoconductive ceramics, loaded with human MSCs, to yield a tissue-like construct to promote in vivo bone formation. Characterization of the cell-embedded scaffolds demonstrated their resemblance to bone tissue extracellular matrix, on both micro- and nanoscales and MSC viability and integration within the electrospun nanofibers. Subcutaneous implantation of the cell-embedded scaffolds in the dorsal side of mice led to new bone, muscle, adipose, and connective tissue formation within 8 weeks. This hybrid scaffold may represent a step forward in the pursuit of advanced bone tissue engineering scaffolds.