The in vitro genotoxicity of orthopaedic ceramic (Al2O3) and metal (CoCr alloy) particles

Aluminum Nanoparticles Affect Human Platelet Function In Vitro

Endoprostheses are prone to tribological wear and biological processes that lead to the release of particles, including aluminum nanoparticles (Al NPs). Those particles can diffuse into circulation. However, the toxic effects of NPs on platelets have not been comprehensively analyzed. The aim of our work was to investigate the impact of Al NPs on human platelet function using a novel quartz crystal microbalance with dissipation (QCM-D) methodology. Moreover, a suite of assays, including light transmission aggregometry, flow cytometry, optical microscopy and transmission electron microscopy, were utilized. All Al NPs caused a significant increase in dissipation (D) and frequency (F), indicating platelet aggregation even at the lowest tested concentration (0.5 µg/mL), except for the largest (80 nm) Al NPs. A size-dependent effect on platelet aggregation was observed for the 5-20 nm NPs and the 30-50 nm NPs, with the larger Al NPs causing smaller increases in D and F; however, this was not observed for the 20-30 nm NPs. In conclusion, our study showed that small (5-50 nm) Al NPs caused platelet aggregation, and larger (80 nm) caused a bridging-penetrating effect in entering platelets, resulting in the formation of heterologous platelet-Al NPs structures. Therefore, physicians should consider monitoring NP serum levels and platelet activation indices in patients with orthopedic implants.

Critical Review on Toxicological Mechanisms Triggered by Inhalation of Alumina Nanoparticles on to the Lungs

Alumina nanoparticles (Al₂O₃ NPs) can be released in occupational environments in different contexts such as industry, defense, and aerospace. Workers can be exposed by inhalation to these NPs, for instance, through welding fumes or aerosolized propellant combustion residues. Several clinical and epidemiological studies have reported that inhalation of Al₂O₃ NPs could trigger aluminosis, inflammation in the lung parenchyma, respiratory symptoms such as cough or shortness of breath, and probably long-term pulmonary fibrosis. The present review is a critical update of the current knowledge on underlying toxicological, molecular, and cellular mechanisms induced by exposure to Al₂O₃ NPs in the lungs. A major part of animal studies also points out inflammatory cells and secreted biomarkers in broncho-alveolar lavage fluid (BALF) and blood serum, while in vitro studies on lung cells indicate contradictory results regarding the toxicity of these NPs.

Nanomaterial reinforced composite for biomedical implants applications: a mini-review

There is heavy demand for suitable implant materials with improved mechanical and biological properties. Classically, the demand was catered by conventional materials like metals, alloys, and polymer-based materials. Recently, nanomaterial reinforced composites have played a significant role in replacing conventional materials due to their excellent properties such as biocompatibility, bioactivity, high strength to weight ratio, long life, corrosion & wear resistance, and tailor-ability. Herein, we composed a systematic focus review on the role of nanoparticles in the form of composite materials for the advancements in orthopedic implants. Several nano materials-based reinforcements have been reviewed with various matrix materials, including metals, alloys, ceramics, composites, and polymers for biomedical implant applications. Moreover, the improved biological properties, mechanical properties, and other functionalities like infection resistance, drug delivery at the target, sensing, and detection of bone diseases, and corrosion & wear resistance are elaborated. At last, a particular focus has been given to the un-resolved challenges in orthopedic implant development.

Unveiling the Toxicity of Fine and Nano-Sized Airborne Particles Generated from Industrial Thermal Spraying Processes in Human Alveolar Epithelial Cells

High-energy industrial processes have been associated with particle release into workplace air that can adversely affect workers’ health. The present study assessed the toxicity of incidental fine (PGFP) and nanoparticles (PGNP) emitted from atmospheric plasma (APS) and high-velocity oxy-fuel (HVOF) thermal spraying. Lactate dehydrogenase (LDH) release, 2-(4-nitrophenyl)-2H-5-tetrazolio]-1,3-benzene disulfonate (WST-1) metabolisation, intracellular reactive oxygen species (ROS) levels, cell cycle changes, histone H2AX phosphorylation (γ-H2AX) and DNA damage were evaluated in human alveolar epithelial cells at 24 h after exposure. Overall, HVOF particles were the most cytotoxic to human alveolar cells, with cell viability half-maximal inhibitory concentration (IC₅₀) values of 20.18 µg/cm² and 1.79 µg/cm² for PGFP and PGNP, respectively. Only the highest tested concentration of APS-PGFP caused a slight decrease in cell viability. Particle uptake, cell cycle arrest at S + G₂/M and γ-H2AX augmentation were observed after exposure to all tested particles. However, higher levels of γ-H2AX were found in cells exposed to APS-derived particles (~16%), while cells exposed to HVOF particles exhibited increased levels of oxidative damage (~17% tail intensity) and ROS (~184%). Accordingly, APS and HVOF particles seem to exert their genotoxic effects by different mechanisms, highlighting that the health risks of these process-generated particles at industrial settings should not be underestimated.

Toxicological Impacts on Antioxidant Responses, Stress Protein, and Genotoxicity Parameters of Aluminum Oxide Nanoparticles in the Liver of Oreochromis niloticus

The aim of this study was to determine the toxic effects of aluminum oxide nanoparticles (Al₂O₃ NPs) on oxidative stress, stress protein, and genotoxicity parameters in Oreochromis niloticus. Ninety-six-hour LC₅₀ value of Al₂O₃ NPs was found as 52.4 ppm for O. niloticus. The fish were exposed to 2.6 ppm (5% of the 96-h LC₅₀) and 5.2 ppm (10% of the 96-h LC₅₀) for 3 days and 7 days. Various biochemical parameters, superoxide dismutase (SOD), catalase (CAT), glutathione peroxidase (GPx), glutathione-S-transferase (GST) activities, glutathione (GSH), thiobarbituric acid reactive substance (TBARS), heat shock protein 70 (HSP70; stress protein), and genotoxicity biomarker 8-hydroxy-2-deoxyguanosine (8-OHdG) levels, were determined. Results showed that antioxidant enzymes were significantly decreased in SOD, CAT, and GPx enzyme activity, but GST enzyme activity was significantly increased in 7 days. The oxidative stress parameters, GSH levels, were significantly decreased while 8-OHdG and TBARS levels were increased in 3 and 7 days. HSP70 levels were decreased in the concentrations of Al₂O₃ NPs and exposure times. Our results showed that as a result of changes in oxidative stress parameters, stress protein, and genotoxicity parameters, O. niloticus liver tissue is highly sensitive and toxic to aluminum oxide nanoparticle exposure.

Genotoxic impact of aluminum-containing nanomaterials in human intestinal and hepatic cells

Exposure of consumers to aluminum-containing nanomaterials (Al NMs) is an area of concern for public health agencies. As the available data on the genotoxicity of Al₂O₃ and Al⁰ NMs are inconclusive or rare, the present study investigated their in vitro genotoxic potential in intestinal and liver cell models, and compared with the ionic form AlCl₃. Intestinal Caco-2 and hepatic HepaRG cells were exposed to Al⁰ and Al₂O₃ NMs (0.03 to 80 μg/cm²). Cytotoxicity, oxidative stress and apoptosis were measured using High Content Analysis. Genotoxicity was investigated through γH2AX labelling, the alkaline comet and micronucleus assays. Moreover, oxidative DNA damage and carcinogenic properties were assessed using the Fpg-modified comet assay and the cell transforming assay in Bhas 42 cells respectively. The three forms of Al did not induce chromosomal damage. However, although no production of oxidative stress was detected, Al₂O₃ NMs induced oxidative DNA damage in Caco-2 cells but not likely related to ion release in the cell media. Considerable DNA damage was observed with Al⁰ NMs in both cell lines in the comet assay, likely due to interference with these NMs. No genotoxic effects were observed with AlCl₃. None of the Al compounds induced cytotoxicity, apoptosis, γH2AX or cell transformation.

The effect of nanoparticles of cobalt-chromium on human aortic endothelial cells in vitro

Despite advances in stent technology for vascular interventions, in-stent restenosis (ISR) remains a main complication. The corrosion of cobalt-chromium (CoCr) alloy coronary stents has been identified to be associated with ISR, whereas its role in ISR has not been elucidated. In the current work, CoCr nanoparticles, simulated corrosion products of CoCr alloy, were used to investigate their effect on the endothelial cells. It has been demonstrated that the cell viability declines and the cell membrane is damaged, indicating the cytotoxicity of CoCr nanoparticles. The expression of GRP78, CHOP, and cleaved-caspase12 proteins has increased when exposed to CoCr nanoparticles, suggesting that CoCr nanoparticles induced cell apoptosis through endoplasmic reticulum (ER) stress-mediated apoptotic pathway. An increased release of adhesion and inflammatory mediators was also induced by CoCr nanoparticles, including ICAM-1, VCAM-1, IL-1β, IL-6, and TNF-α. Our results demonstrated that CoCr nanoparticles could trigger apoptosis, adhesion, and inflammation. These findings indicated potential damaging effects of CoCr nanoparticles on the vascular endothelium, which suggested corrosion of CoCr alloy may promote the progression and development of ISR.

Genotoxic properties of materials used for endoprostheses: Experimental and human data

Approximately 2 million endoprostheses are implanted annually and metal ions as well as particles are released into the body from the materials which are used. This review describes the results of studies concerning genotoxic damage caused by artificial joints. DNA damage leads to various adverse long-term health effects in humans including cancer. Experiments with mammalian cells showed that metal ions and particles from orthopedic materials cause DNA damage. Induction of chromosomal aberrations (CA) was found in several in vitro experiments and in studies with rodents with metals from orthopedic materials. Human studies focused mainly on induction of CA (7 studies). Only few investigations (4) concerned sister chromatid exchanges, oxidative DNA damage (2) and micronucleus formation (1). CA are a reliable biomarker for increased cancer risks in humans) and were increased in all studies in patients with artificial joints. No firm conclusion can be drawn at present if the effects in humans are due to oxidative stress and if dissolved metal ions or release particles play a role. Our findings indicate that patients with artificial joints may have increased cancer risks due to damage of the genetic material. Future studies should be performed to identify safe materials and to study the molecular mechanisms in detail.

Genomic effects of a nanostructured alumina insecticide in human peripheral blood lymphocytes in vitro

Nanotechnology is providing new tools for precision agriculture, such as agrochemical agents and innovative delivery mechanisms to improve cropping efficiency. Powder nanoinsecticides, such as experimental nanostructured alumina (NSA), show great potential for sustainable agriculture as an alternative to conventional synthetic pesticides because their mechanism of insecticide action is based on physical rather than on biochemical phenomena. However, even in highly non-reactive and hardly soluble substances such as alumina, reduced particle size may lead to an increased toxicity of the material. In order to determine whether NSA induces DNA and chromosomal damage, its toxicity was assessed in human peripheral blood lymphocytes (PBL) and contrasted with commercial nanostructured alumina, natural insecticide powders and a conventional pesticide. PBL from healthy donors were exposed for 24 h to increasing concentrations (50, 100 and 200 μg/mL) of NSA particle agglomerates (<350 nm); positive and negative NSA-particles, respectively; bulk Al₂O₃ (4.5 μm) or Diatomaceous Earth (SiO₂, <4.5 μm). Alkaline comet assay and micronuclei (MNi) test were used to assess DNA damage and chromosomal breakage, respectively. Cell viability was tested with resazurin assay. Comet assay results revealed no significant increase in DNA damage by NSA compared to other natural substances. As expected, DNA breaks were significantly higher in cells exposed to an organophosphate [OPP] control (P < 0.05). No statistically significant differences were found in terms of cellular viability at 50 and 100 μg/mL of NSA but cell survival decreased at 200 μg/mL as well as in OPP group. Positively charged NSA particles significantly reduced cell viability and increased DNA migration and oxidative DNA damage (8-oxoG). NSA as well as the electrically charged NSA particles had no significant effect on MNi induction. Our results indicate that NSA particles are non-cytotoxic and non-genotoxic at the tested doses and do not cause obvious DNA damage in human PBL in vitro.

Assessing the cyto-genotoxic potential of model zinc oxide nanoparticles in the presence of humic-acid-like-polycondensate (HALP) and the leonardite HA (LHA)

The present study investigates the potential cyto-genotoxic effects of model zinc oxide nanoparticles (ZnO NPs) on human lymphocytes, with and/or without humic acids (HAs). Two types of HAs were studied, a natural well-characterized leonardite HA (LHA) and its synthetic-model, a humic-acid-like-polycondensate (HALP). The Cytokinesis Block Micronucleus (CBMN) assay was applied in cell cultures treated with different concentrations of ZnO NPs (0.5, 5, 10, 20 μg mL^-1) and under different concentrations of either HALP or LHA (ZnO NPs-HALP and ZnO NPs-LHA, at concentrations of 0.5-0.8, 5-8, 10-16, 20-32 and 0.5-2, 5-20, 10-40, 20-80 μg mL^-1, respectively). According to the results, ZnO NPs lacked genotoxicity but demonstrated cytotoxic potential. Binary mixtures of ZnO NPs-HAs (ZnO NPs-HALP or ZnO NPs-LHA) showed negligible alterations of micronuclei (MN) formation in challenged cells, with cytotoxic effects revealed only in case of cells treated with ZnO NPs-LHA at the concentration 5-20 μg mL^-1. Furthermore, no genotoxic phenomena were exerted neither by the ZnO NPs nor from their mixtures with HAs. These findings indicate [i] the cytotoxic activity of used ZnO NPs on human lymphocytes, and [ii] reveal the protective role of HAs against ZnO NPs mediated cytotoxicity.

Multigenerational Exposure to WCCo Nanomaterials-Epigenetics in the Soil Invertebrate Enchytraeus crypticus

It has become clear how important it is to assess longer term effects of (nano) materials in the environment given the current evidence showing how epigenetics drives response mechanisms. Here we studied global DNA methylation in standard soil invertebrate Enchytraeus crypticus over 224 days when exposed to nanostructured tungsten carbide cobalt (WCCo nanomaterials (NMs)) and to cobalt (CoCl₂) in a multigenerational experiment. In order to assess the transgenerational effect, we used a multigenerational (MG) test design consisting of four generations in spiked soil followed by two generations in clean soil. Results showed that MG exposure to WCCo NMs caused global DNA methylation to increase, which continued in unexposed generations and was associated with an increase in reproduction (phenotypic effect). In general, WCCo NMs caused more (and more consistent) methylation than CoCl₂.

Genotoxicity study of nano Al2O3, TiO2 and ZnO along with UV-B exposure: An Allium cepa root tip assay

The present effort aims to investigate the cytotoxic and genotoxic impact of three widely used nanoparticles (ZnO, TiO₂ and Al₂O₃) on root cells of Allium cepa as a test organism. The root tip of Allium cepa were treated with three different concentrations (0.1 10 and 100 mg/L) of the above-mentioned NPs and the observations were recorded after proper growth of root under both nanoparticle solutions and UV-B exposure in combined conditions and separately. The parameters such as mitotic index, various forms of chromosomal aberrations, various reactive oxygen species (ROS) generation such as superoxide radical (O^-_2·), hydrogen peroxide, hydroxyl radical (·OH), lipid peroxidation and bio-uptake of nanoparticles were assessed. The results revealed that for all the three nanoparticles, mitotic index (MI) was highly reduced in comparison to control. Among the three nanoparticles, the MI value of TiO₂ was 59.5% at 0.1 mg/L. Chromosomal aberration data suggest that nano Al₂O₃ exhibited disturbed metaphase at 0.1 mg/L, and abnormal anaphase and sticky metaphase at 10 and 100 mg/L, respectively. Similarly, lagged metaphase and anaphase with multiple chromatin bridges were recorded for both nano ZnO and nano TiO₂ at 0.1 mg/L. But, nonsignificant (p > 0.05) results were recorded between only nano metal oxide and UV-B along with nano metal oxide. ROS generation data revealed that ZnO is more active under UV-B than TiO₂ and Al₂O_3. The cellular deformation and the existence of metal in A. cepa under nano ZnO, TiO₂ and Al₂O₃ treatment were evaluated by Scanning Electron Micrograph (SEM) and X-ray fluorescence (XRF) study, respectively. It may safely be concluded that with respect to chromosomal aberration and mitotic index, out of the three nanoparticles, Al₂O₃ is the most severe at higher concentrations and nano ZnO shows lowest mitotic index under UV-B exposure.

Evaluation of human osteoblast metabolic activity in modified titanium-conditioned medium

To evaluate human osteoblast metabolic activity cultured in medium conditioned with commercially pure titanium after surface treatments with alumina or ceramic grit-blasting followed by acid etching. Commercially available, pure Grade 4 titanium disks were used and subjected to seven different surface modifications: (1) machined (MA)-used as the control group; (2) blasted with Al₂O₃ (Al₂O₃); (3) blasted with sintered ceramic (HAS); (4) blasted with non-sintered ceramics (HA); (5) blasted with Al₂O₃ and etched with HCl/H₂SO₄ (Al₂O₃ DE); (6) blasted with sintered ceramic and etched with HCl/H₂SO₄ (HAS DE), and (7) blasted with non-sintered ceramic and etched with HCl/H₂SO₄ (HA DE). A samples roughness evaluation test was carried out with an interference microscope, and energy-dispersive X-ray spectroscopy was performed to evaluate the presence of aluminum, phosphorus, and calcium deposited during the titanium surface treatment along with carbon contaminants acquired by the surface during processing. A culture medium conditioned with the respective samples was prepared in five dilutions, and its effect on human osteoblast cell viability was evaluated using the relative viability of cells. Human osteoblast metabolic activity was found to be the most intensive for the Al₂O₃ DE sample. The lowest activity was observed for the HAS DE. The material's cytocompatibility depended on both the surface roughness and its chemical composition. Etching had a dual effect on cell activity, depending on the chemical composition of the titanium surface after blasting.

Genotoxicity of Aluminum and Aluminum Oxide Nanomaterials in Rats Following Oral Exposure

Due to several gaps remaining in the toxicological evaluation of nanomaterials (NMs), consumers and public health agencies have shown increasing concern for human health protection. In addition to aluminum (Al) microparticles, Al-containing nanomaterials (Al NMs) have been applied by food industry as additives and contact materials. Due to the limited amount of literature on the toxicity of Al NMs, this study aimed to evaluate the in vivo genotoxic potential of Al0 and Al2O3 NMs after acute oral exposure. Male Sprague-Dawley rats were administered three successive gavages at 6, 12.5 and 25 mg/kg bw. A comparison with AlCl3 was done in order to assess the potential effect of dissolution into Al ions. Both DNA strand breaks and oxidative DNA damage were investigated in six organs/tissues (duodenum, liver, kidney, spleen, blood and bone marrow) with the alkaline and the Fpg-modified comet assays. Concomitantly, chromosomal damage was investigated in bone marrow and colon with the micronucleus assay. The comet assay only showed DNA damage with Al2O3 NMs in bone marrow (BM), while AlCl3 induced slight but non-significant oxidative DNA damage in blood. No increase of chromosomal mutations was observed after treatment with the two Al MNs either in the BM or in the colons of rats.

Favorable modulation of osteoblast cellular activity on Zr-modified Co-Cr-Mo alloy: The significant impact of zirconium on cell-substrate interactions

Cobalt-chromium-molybdenum alloys exhibit good mechanical properties (yield strength: ~530 MPa, ultimate tensile strength: ~1114 MPa, elongation-to-failure: ~47.3%, and modulus: ~227 GPa) and corrosion resistance. In recent years, from the perspective of osseointegration, they are considered to be lower in rank in comparison to the widely used titanium alloys. We elucidate here the significant and favorable modulation of cellular activity of Zr-modified Co-Cr-Mo alloys. The average grain size of Co-Cr-Mo alloy samples with and without Zr was 104 ± 27 and ~53 ± 11 μm, respectively. The determining role of small addition of Zr (0.04 wt. %) to the Co-Cr-Mo alloys in favorable modulation of cellular activity was accomplished by combining cellular biology and materials science and engineering. Experiments on the influence of Zr addition to Co-Cr-Mo alloys clearly demonstrated that the cell adhesion, spread and cell-substrate interactions were enhanced in the presence of Zr. The spread/growth rate of cells was ~120% on the Co-Cr-Mo alloy and 190% per day on the Co-Cr-Mo-Zr alloy. While the % area covered by the cells increased from ~5.1 to ~33.6% on Co-Cr-Mo alloy and ~19.2 to ~47.8% on Co-Cr-Mo-Zr alloy after 2 and 24 hr of incubation. Similarly, the cell density increased from ~1354 to ~3424 cells/cm² on Co-Cr-Mo alloy and ~3583 to ~7804 cells/cm² on Co-Cr-Mo-Zr alloy after 2 and 24 hr of incubation. Additionally, stronger vinculin focal adhesion contact and signals associated with actin stress fibers together with extracellular matrix protein, fibronectin, were noted.

Properties of silver contained coatings on CoCr alloys prepared by vacuum plasma spraying

The silver contained coatings on cast Cobalt Chrome (CoCr) alloys were prepared by vacuum plasma spraying technique. The Scanning Electron Microscopy (SEM), X-ray photoelectron spectroscopy (XPS), X-ray Diffraction (XRD), energy dispersive spectrometry (EDS), properties of corrosion resistance, wear resistance and effect of vitro antibacterial on the surface of silver contained coating were investigated. The cytotoxicity of the coatings was performed with L-929 fibroblasts by MTT assay. SEM showed that the surfaces of the coatings were dense, smooth, no obvious cracks except only a few pores. XRD analysis indicated that the contents of the surface were mainly Ag and Cr except a small amount of Ag₂O, Cr₂O₃. EDS analysis indicated that the distributions of Cr and Ag were uniform without any large-scale clustering. The wear resistance of silver coatings is similar to that of CoCr alloys, and the corrosion resistance is slightly better than that of CoCr alloys. The Ag coating had no significant effect on the proliferation of L929 cells. The antibacterial results indicated that the number of S. mutans and C. albicans were significantly reduced on the surface of silver contained coating than that of CoCr alloys. All the results indicated that the silver contained coatings can be achieved by vacuum plasma spraying technique with good surface characteristic and antibacterial properties and have promising applications in biomedical area.

Genotoxicity Assessment of Nanomaterials: Recommendations on Best Practices, Assays, and Methods

Nanomaterials (NMs) present unique challenges in safety evaluation. An international working group, the Genetic Toxicology Technical Committee of the International Life Sciences Institute's Health and Environmental Sciences Institute, has addressed issues related to the genotoxicity assessment of NMs. A critical review of published data has been followed by recommendations on methods alterations and best practices for the standard genotoxicity assays: bacterial reverse mutation (Ames); in vitro mammalian assays for mutations, chromosomal aberrations, micronucleus induction, or DNA strand breaks (comet); and in vivo assays for genetic damage (micronucleus, comet and transgenic mutation assays). The analysis found a great diversity of tests and systems used for in vitro assays; many did not meet criteria for a valid test, and/or did not use validated cells and methods in the Organization for Economic Co-operation and Development Test Guidelines, and so these results could not be interpreted. In vivo assays were less common but better performed. It was not possible to develop conclusions on test system agreement, NM activity, or mechanism of action. However, the limited responses observed for most NMs were consistent with indirect genotoxic effects, rather than direct interaction of NMs with DNA. We propose a revised genotoxicity test battery for NMs that includes in vitro mammalian cell mutagenicity and clastogenicity assessments; in vivo assessments would be added only if warranted by information on specific organ exposure or sequestration of NMs. The bacterial assays are generally uninformative for NMs due to limited particle uptake and possible lack of mechanistic relevance, and are thus omitted in our recommended test battery for NM assessment. Recommendations include NM characterization in the test medium, verification of uptake into target cells, and limited assay-specific methods alterations to avoid interference with uptake or endpoint analysis. These recommendations are summarized in a Roadmap guideline for testing.

Alumina nanoparticles size and crystalline phase impact on cytotoxic effect on alveolar epithelial cells after simple or HCl combined exposures

Applications using alumina nanoparticles (Al₂O₃ NPs) have incredibly increased in different fields of activity. In defense and aerospace fields, solid composite propellants use leads to complex combustion aerosols emissions containing high concentrations of Al₂O₃ NPs and hydrogen chloride gas (HCl). To better characterize potential hazard resulting from exposure to these aerosols, this study assesses cytotoxic effects of mixtures containing both compounds on human pulmonary alveolar epithelial cells (A549 cell line) after 24 h exposures. After all co-exposures cell viability was >80%. However co-exposures decrease normalized real-time cell index. Significant decreases of intracellular reduced glutathione pool were also observed after co-exposures to γ-10 nm or γ/δ-13 nm Al₂O₃ NPs and HCl. Co-incubations with γ/δ-13 nm or γ-500 nm Al₂O₃ particles and HCl induced significant DNA double-strand breaks increases. Moreover all co-exposures and HCl alone disrupted cell cycle (increased G1 phase cells). Transmission Electron Microscopy (TEM) observations revealed γ/δ-13 nm Al₂O₃NPs adsorption and internalization in cell cytoplasm only, suggesting indirect genotoxic effects. According to our results Al₂O₃ particles/HCl mixtures can induce cytotoxic effects and Al₂O₃ size and crystallinity are two main parameters influencing cytotoxic mechanisms.

Cobalt and its compounds: update on genotoxic and carcinogenic activities

This article summarizes recent experimental and epidemiological data on the genotoxic and carcinogenic activities of cobalt compounds. Emphasis is on the respiratory system, but endogenous exposure from Co-containing alloys used in endoprostheses, and limited data on nanomaterials and oral exposures are also considered. Two groups of cobalt compounds are differentiated on the basis of their mechanisms of toxicity: (1) those essentially involving the solubilization of Co(II) ions, and (2) metallic materials for which both surface corrosion and release of Co(II) ions act in concert. For both groups, identified genotoxic and carcinogenic mechanisms are non-stochastic and thus expected to exhibit a threshold. Cobalt compounds should, therefore, be considered as genotoxic carcinogens with a practical threshold. Accumulating evidence indicates that chronic inhalation of cobalt compounds can induce respiratory tumors locally. No evidence of systemic carcinogenicity upon inhalation, oral or endogenous exposure is available. The scarce data available for Co-based nanosized materials does not allow deriving a specific mode of action or assessment for these species.

Biological Impact of Silicon Nitride for Orthopaedic Applications: Role of Particle Size, Surface Composition and Donor Variation

The adverse biological impact of orthopaedic wear debris currently limits the long-term safety of human joint replacement devices. We investigated the role of particle size, surface composition and donor variation in influencing the biological impact of silicon nitride as a bioceramic for orthopaedic applications. Silicon nitride particles were compared to the other commonly used orthopaedic biomaterials (e.g. cobalt-chromium and Ti-6Al-4V alloys). A novel biological evaluation platform was developed to simultaneously evaluate cytotoxicity, inflammatory cytokine release, oxidative stress, and genotoxicity potential of particles using peripheral blood mononuclear cells (PBMNCs) from individual human donors. Irrespective of the particle size, silicon nitride did not cause any adverse responses whereas cobalt-chromium wear particles caused donor-dependent cytotoxicity, TNF-α cytokine release, oxidative stress, and DNA damage in PBMNCs after 24 h. Despite being similar in size and morphology, silicon dioxide nanoparticles caused the release of significantly higher levels of TNF-α compared to silicon nitride nanoparticles, suggesting that surface composition influences the inflammatory response in PBMNCs. Ti-6Al-4V wear particles also released significantly elevated levels of TNF-α cytokine in one of the donors. This study demonstrated that silicon nitride is an attractive orthopaedic biomaterial due to its minimal biological impact on human PBMNCs.

In vitro evaluation of the genotoxicity of CeO2 nanoparticles in human peripheral blood lymphocytes using cytokinesis-block micronucleus test, comet assay, and gamma H2AX

Engineered nanoparticles (ENPs) are used in a wide range of applications because of their unique properties. Cerium dioxide nanoparticles (CeO₂ NPs) are one of the important ENPs, and they can cause negative health effects, such as genotoxicity, in humans and other living organisms. The aim of this work was to analyze the genotoxic effects of short-term (3-24 h) CeO₂ NPs exposure to cultured human blood lymphocytes. Three genotoxicity systems "cytokinesis-block micronucleus test, comet assay, and gamma H2AX test" were used to show the genotoxic potential of CeO₂ NPs (particle size <25 nm, concentrations: 6, 12, and 18 µg/mL). Hydrogen peroxide was selected as the positive-control genotoxic agent. Our results indicate that CeO₂ NPs have genotoxic potential on human peripheral blood lymphocytes cells even at 3-24 h exposure under in vitro conditions.

Carbon-Fibre-Reinforced SiC Composite (C/SiSiC) as an Alternative Material for Endoprosthesis: Fabrication, Mechanical and In-Vitro Biological Properties

Particle-induced periprosthetic osteolysis and subsequent aseptic implant loosening are a major cause of compromising the long-term results of total joint replacements. To date, no implant has been able to mirror radically the tribological factors (friction/lubrication/wear) of in vivo tribological pairings. Carbon-Fibre Reinforced SiC-Composites (C/SiSiC), a material primarily developed for brake technology, has the opportunity to fulfil this requirement. Until now, the material itself has not been used in medicine. The aim of this investigation was to test the suitability of C/SiSiC ceramics as a new material for bearing couples in endoprosthetics. After the preparation of the composites flexural strength was determined as well as the Young’s-modulus and the coefficient of friction. To investigate in vitro biological properties, MG 63 and primary human osteoblasts were cultured on C/SiSiC composites. To review the proliferation, the cytotoxicity standardized tests were used. The cell morphology was observed by light microscopy, ESEM, confocal and 3D-laserscanning microscopy. C/SiSiC possesses a high resistance to wear. Cells exhibited no significant alterations in morphology. Vitality was not impaired by contact with the ceramic composite. There was no higher cytotoxicity to observe. Regarding these results, C/SiSiC ceramics seem to be biologically and mechanically appropriate for orthopaedic applications.

Physico-chemical characterization and biocompatibility of hydroxyapatite derived from fish waste

The aim of this study was to synthesize hydroxyapatite (HAP) powder from fish waste. The powder was characterized through X-ray diffraction, Fourier transform infrared spectroscopy, ion exchange chromatography, scanning electron microscopy and plasma emission spectrometry. The cyto- and genotoxicity was carried out to demonstrate biocompatibility in vivo by means of rat subcutaneous tissue test. The results showed that the visible crystalline nature of typical apatite crystal structure when they were calcined at 800 °C. Infrared spectroscopy analysis showed similar composition to HAP standard with the presence of carbonate ion demonstrated by wave number values of 871 cm^-1 and 1420 cm^-1 for calcinations at 800 °C. The scanning electronmicrographies depicted the crystal morphology and porous nature with average pore size of ~10 µm. Plasma emission spectrometry and ion exchange chromatography confirmed the presence of Ca and P in the samples. The mean of calcium content was 36.8; Mg was 0.8, Na was 0.7 and K was 0.5. Rat subcutaneous tissue test revealed that HAP presented biocompatibility. Furthermore, the lack of cyto- and genotoxicity in blood, liver, kidney and lung were noticed after 30 days of HAP implantation. Taken together, our results demonstrated that HAP from fish waste exhibits a great potential for using as biomaterial since is represents a simple, effective, low-cost process and satisfactory degree of biocompatibility.

Modularity in Total Hip Arthroplasty: Benefits, Risks, Mechanisms, Diagnosis, and Management

Modular implants are currently widely used in total hip arthroplasty because they give surgeons versatility during the operation, allow for easier revision surgery, and can be adjusted to better fit the anatomy of the specific patient. However, modular implants, specifically those that have metal-on-metal junctions, are susceptible to crevice and fretting corrosion. This can ultimately cause implant failure, inflammation, and adverse local tissue reaction, among other possible side effects. Surgeons should be aware of the possibility of implant corrosion and should follow a set of recommended guidelines to systematically diagnose and treat patients with corroded implants. Ultimately, surgeons will continue to use modular implants because of their widespread benefits. However, more research is needed to determine how to minimize corrosion and the negative side effects that have been associated with modular junctions in total hip arthroplasty. [Orthopedics. 2017; 40(6):355-366.].

Cobalt nanoparticles induce lung injury, DNA damage and mutations in mice

BACKGROUND

We and other groups have demonstrated that exposure to cobalt nanoparticles (Nano-Co) caused oxidative stress and inflammation, which have been shown to be strongly associated with genotoxic and carcinogenic effects. However, few studies have reported Nano-Co-induced genotoxic effects in vivo. Here, we propose that Nano-Co may have high genotoxic effects due to their small size and high surface area, which have high capacity for causing oxidative stress and inflammation.

METHODS

gpt delta transgenic mice were used as our in vivo study model. They were intratracheally instilled with 50 μg per mouse of Nano-Co. At day 1, 3, 7 and 28 after exposure, bronchoalveolar lavage (BAL) was performed and the number of neutrophils, CXCL1/KC level, LDH activity and concentration of total protein in the BAL fluid (BALF) were determined. Mouse lung tissues were collected for H&E staining, and Ki-67, PCNA and γ-H2AX immunohistochemical staining. 8-OHdG level in the genomic DNA of mouse lungs was determined by an OxiSelect™ Oxidative DNA Damage ELISA Kit, and mutant frequency and mutation spectrum in the gpt gene were also determined in mouse lungs at four months after Nano-Co exposure by 6-TG selection, colony PCR, and DNA sequencing.

RESULTS

Exposure of mice to Nano-Co (50 μg per mouse) resulted in extensive acute lung inflammation and lung injury which were reflected by increased number of neutrophils, CXCL1/KC level, LDH activity and concentration of total protein in the BALF, and infiltration of large amount of neutrophils and macrophages in the alveolar space and interstitial tissues. Increased immunostaining of cell proliferation markers, Ki-67 and PCNA, and the DNA damage marker, γ-H2AX, was also observed in bronchiolar epithelial cells and hyperplastic type II pneumocytes in mouse lungs at day 7 after Nano-Co exposure. At four months after exposure, extensive interstitial fibrosis and proliferation of interstitial cells with inflammatory cells infiltrating the alveolar septa were observed. Moreover, Nano-Co caused increased level of 8-OHdG in genomic DNA of mouse lung tissues. Nano-Co also induced a much higher mutant frequency as compared to controls, and the most common mutation was G:C to T:A transversion, which may be explained by Nano-Co-induced increased formation of 8-OHdG.

CONCLUSION

Our study demonstrated that exposure to Nano-Co caused oxidative stress, lung inflammation and injury, and cell proliferation, which further resulted in DNA damage and DNA mutation. These findings have important implications for understanding the potential health effects of nanoparticle exposure.

Diamond thin films: giving biomedical applications a new shine

Progress made in the last two decades in chemical vapour deposition technology has enabled the production of inexpensive, high-quality coatings made from diamond to become a scientific and commercial reality. Two properties of diamond make it a highly desirable candidate material for biomedical applications: first, it is bioinert, meaning that there is minimal immune response when diamond is implanted into the body, and second, its electrical conductivity can be altered in a controlled manner, from insulating to near-metallic. In vitro, diamond can be used as a substrate upon which a range of biological cells can be cultured. In vivo, diamond thin films have been proposed as coatings for implants and prostheses. Here, we review a large body of data regarding the use of diamond substrates for in vitro cell culture. We also detail more recent work exploring diamond-coated implants with the main targets being bone and neural tissue. We conclude that diamond emerges as one of the major new biomaterials of the twenty-first century that could shape the way medical treatment will be performed, especially when invasive procedures are required.

Melatonin counteracts cobalt nanoparticle‑induced cytotoxicity and genotoxicity by deactivating reactive oxygen species‑dependent mechanisms in the NRK cell line

Cobalt nanoparticles (CoNPs) released from metal-on-metal implants have caused considerable concern. Oxidative stress is associated with the mechanism underlying cobalt-induced cytotoxicity and genotoxicity. The indolamine melatonin exhibits protective effects against damage induced by metals. The present study investigated the in vitro effects of melatonin on the cytotoxicity and genotoxicity induced by CoNPs. CoNPs (20–50 nm in diameter) were employed in the present study. NRK rat kidney cells were exposed to various concentrations of CoNPs for different durations. The results of the current study demonstrated that CoNPs significantly increased reactive oxygen species (ROS) production and reduced cell viability, as determined by dichlorofluorescein diacetate, and Cell Counting Kit-8 and lactate dehydrogenase leakage assays, respectively. Furthermore, western blot analysis demonstrated that CoNPs led to an increase in the ratio of Bcl-2-associated X/Bcl-2, and the expression of cleaved caspase-3 was upregulated, which indicated increased apoptosis levels. Genotoxicity was detected by a comet assay, which revealed a significant induction in DNA damage, as determined by increases in the tail DNA % and olive tail moment. Phosphorylated-histone H2AX foci analyses by immunofluorescence also demonstrated that CoNPs induced DNA-double strand breaks. However, cellular treatment with melatonin reduced the effects of CoNPs on NRK cells by reducing the production of ROS. The results of the present study demonstrated that CoNPs induced cytotoxicity and genotoxicity by increasing oxidative stress, and melatonin may have pharmacological potential in protecting against the damaging effects of CoNPs following total hip arthroplasty.

Immunological Responses to Total Hip Arthroplasty

The use of total hip arthroplasties (THA) has been continuously rising to meet the demands of the increasingly ageing population. To date, this procedure has been highly successful in relieving pain and restoring the functionality of patients’ joints, and has significantly improved their quality of life. However, these implants are expected to eventually fail after 15–25 years in situ due to slow progressive inflammatory responses at the bone-implant interface. Such inflammatory responses are primarily mediated by immune cells such as macrophages, triggered by implant wear particles. As a result, aseptic loosening is the main cause for revision surgery over the mid and long-term and is responsible for more than 70% of hip revisions. In some patients with a metal-on-metal (MoM) implant, metallic implant wear particles can give rise to metal sensitivity. Therefore, engineering biomaterials, which are immunologically inert or support the healing process, require an in-depth understanding of the host inflammatory and wound-healing response to implanted materials. This review discusses the immunological response initiated by biomaterials extensively used in THA, ultra-high-molecular-weight polyethylene (UHMWPE), cobalt chromium (CoCr), and alumina ceramics. The biological responses of these biomaterials in bulk and particulate forms are also discussed. In conclusion, the immunological responses to bulk and particulate biomaterials vary greatly depending on the implant material types, the size of particulate and its volume, and where the response to bulk forms of differing biomaterials are relatively acute and similar, while wear particles can initiate a variety of responses such as osteolysis, metal sensitivity, and so on.

Biocompatibility of four common orthopedic biomaterials following neuroelectromyostimulation: An in-vivo study

Despite the worldwide high prevalence of total joint arthroplasty (TJA), life expectancy of prosthesis remains limited by mechanical and chemical constraint which promote wear debris production, surrounding tissues damage and finally prosthesis loosening. Such results could be amplified by neuro-myoelectrostimulation (NMES; widely used to reduce neuromuscular deficits observed following TJA surgery). It was previously described in an in vivo experiment that interactions between NMES and Ti6Al4V implant are deleterious for both implant and surrounding muscles. The purpose of the present study was to compare the biocompatibility of four common orthopedic biomaterials, two metallic (Ti6Al4V, CrCo) and two nonmetallic (PEEK, Al₂ O₃ ) alloys, fixed on rat tibial crest in which the surrounding muscles were electrostimulated. Muscle cell death rate was not found significantly increased, with or without electrical stimulation for nonmetallic implants. Contrary to Ti6Al4V alloy, the CrCo implant did not induce destruction of the surrounding muscle. However, cell viability decreased for both metallic alloys when NMES was applied but within a greater significant extent for Ti6Al4V implant. Otherwise, when NMES was applied, implant-to-bone adhesion significantly decreased for Ti6Al4V while no significant difference was found for PEEK, Al₂ O₃ , and CrCo. Statistical analyses reveal also a lesser adhesion strength for Ti6Al4V compared with CrCo when NMES was applied. Selecting the most suitable material in term of biocompatibility remains a major concern and non-metallic materials seems to be more appropriated in regard to electrical currents used for post TJA care. © 2017 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater, 106B: 1156-1164, 2018.

Toxicity and oxidative stress responses induced by nano- and micro-CoCrMo particles

Particles on the nano- and micro-meter scales present unique cell-specific cellular effects (i.e.cytotoxicity and oxidative stress).

Particle Disease: A Current Review of the Biological Mechanisms in Periprosthetic Osteolysis After Hip Arthroplasty

Background:

Inflammatory responses to wear debris cause osteolysis that leads to aseptic prosthesis loosening and hip arthroplasty failure. Although osteolysis is usually associated with aseptic loosening, it is rarely seen around stable implants. Aseptic implant loosening is a simple radiologic phenomenon, but a complex immunological process. Particulate debris produced by implants most commonly causes osteolysis, and this is called particle-associated periprosthetic osteolysis (PPO).

Objective:

The objective of this review is to outline the features of particle-associated periprosthetic osteolysis to allow the physician to recognise this condition and commence early treatment, thereby optimizing patient outcome.

Methods:

A thorough literature search was performed using available databases, including Pubmed, to cover important research published covering particle-associated PPO.

Results:

Although osteolysis causes bone resorption, clinical, animal, and in vitro studies of particle bioreactivity suggest that particle-associated PPO represents the culmination of several biological reactions of many cell types, rather than being caused solely by the osteoclasts. The biological activity is highly dependent on the characteristics and quantity of the wear particles.

Conclusion:

Despite advances in total hip arthroplasty (THA), particle-associated PPO and aseptic loosening continue to be major factors that affect prosthetic joint longevity. Biomarkers could be exploited as easy and objective diagnostic and prognostic targets that would enable testing for osteolysis after THA. Further research is needed to identify new biomarkers in PPO. A comprehensive understanding of the underlying biological mechanisms is crucial for developing new therapeutic interventions to reverse or suppress biological responses to wear particles.

The biological response to orthopedic implants for joint replacement. II: Polyethylene, ceramics, PMMA, and the foreign body reaction

Novel evidence-based prosthetic designs and biomaterials facilitate the performance of highly successful joint replacement (JR) procedures. To achieve this goal, constructs must be durable, biomechanically sound, and avoid adverse local tissue reactions. Different biomaterials such as metals and their alloys, polymers, ceramics, and composites are currently used for JR implants. This review focuses on (1) the biological response to the different biomaterials used for TJR and (2) the chronic inflammatory and foreign-body response induced by byproducts of these biomaterials. A homeostatic state of bone and surrounding soft tissue with current biomaterials for JR can be achieved with mechanically stable, infection free and intact (as opposed to the release of particulate or ionic byproducts) implants. Adverse local tissue reactions (an acute/chronic inflammatory reaction, periprosthetic osteolysis, loosening and subsequent mechanical failure) may evolve when the latter conditions are not met. This article (Part 2 of 2) summarizes the biological response to the non-metallic materials commonly used for joint replacement including polyethylene, ceramics, and polymethylmethacrylate (PMMA), as well as the foreign body reaction to byproducts of these materials. © 2016 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater, 105B: 1685-1691, 2017.

The Protective Effect of Bafilomycin A1 Against Cobalt Nanoparticle-Induced Cytotoxicity and Aseptic Inflammation in Macrophages In Vitro

Co ions released due to corrosion of Co nanoparticles (CoNPs) in the lysosomes of macrophages may be a factor in the particle-induced cytotoxicity and aseptic inflammation accompanying metal-on-metal (MOM) hip prosthesis failure. Here, we show that CoNPs are easily dissolved under a low pH, simulating the acidic lysosomal environment. We then used bafilomycin A1 to change the pH inside the lysosome to inhibit intracellular corrosion of CoNPs and then investigated its protective effects against CoNP-induced cytotoxicity and aseptic inflammation on murine macrophage RAW264.7 cells. XTT {2,3-bis (2-methoxy-4-nitro-5-sulfophenyl)-5-[(phenylamino) carbonyl]-2H-tetrazolium hydroxide} assays revealed that bafilomycin A1 can significantly decrease CoNP-induced cytotoxicity in RAW264.7 cells. Enzyme-linked immunosorbent assays showed that bafilomycin A1 can significantly decrease the subtoxic concentration of CoNP-induced levels of pro-inflammatory cytokines (tumor necrosis factor-α, interleukin-1β, and interleukin-6), but has no effect on anti-inflammatory cytokines (transforming growth factor-β and interleukin-10) in RAW264.7 cells. We studied the protective mechanism of bafilomycin A1 against CoNP-induced effects in RAW264.7 cells by measuring glutathione/oxidized glutathione (GSH/GSSG), superoxide dismutase, catalase, and glutathione peroxidase levels and employed scanning electron microscopy, transmission electron microscopy, and energy dispersive spectrometer assays to observe the ultrastructural cellular changes. The changes associated with apoptosis were assessed by examining the pAKT and cleaved caspase-3 levels using Western blotting. These data strongly suggested that bafilomycin A1 can potentially suppress CoNP-induced cytotoxicity and aseptic inflammation by inhibiting intracellular corrosion of CoNPs and that the reduction in Co ions released from CoNPs may play an important role in downregulating oxidative stress in RAW264.7 cells.

Detection and analysis of nanoparticles in patients: A critical review of the status quo of clinical nanotoxicology

On the cusp of massive commercialization of nanotechnology-enhanced products and services, the physical and chemical analysis of nanoparticles in human specimens merits immediate attention from the research community as a prerequisite for a confident clinical interpretation of their occurrence in the human organism. In this review, we describe the caveats in current practices of extracting and isolating nanoparticles from clinical samples and show that they do not help truly define the clinical significance of detected exogenous nano-sized objects. Finally, we suggest a systematic way of tackling these demanding scientific tasks. More specifically, a precise and true qualitative evaluation of nanoparticles in human biological samples is still hindered by various technical reasons. Such a procedure is more refined when the nature of the pollutants is known, like in the case of nano-sized wear debris originating from biomedical prostheses. Nevertheless, nearly all available analytical methods provide unknown quantitative accuracy and qualitative precision due to the challenging physical and chemical nature of nanoparticles. Without trustworthy information to describe the nanoparticulate load of clinical samples, it is impossible to accurately assess its pathological impact on isolated cases or allow for relevant epidemiological surveys on large populations. Therefore, we suggest that the many and various specimens stored in hospitals be used for the refinement of methods of exhaustive quantitative and qualitative characterization of prominent nanoparticles in complex human milieu.

Genetic alterations in periprosthetic soft-tissue masses from patients with metal-on-metal hip replacement

Adverse soft tissue reactions in patients with metal-on-metal (MoM) hip replacement are associated with cobalt (Co) and chromium (Cr) particles released from the implant. Exposing the patients to long periods of increased metal ions concentrations resulting from the wear of these implants poses an increased risk of genotoxicity/mutagenicity. A variable proportion of patients develop periprosthetic soft-tissue masses or pseudotumors at the site of the implant. There is a concern that exposure to increased metal ions could increase the risk of cancer. In order to investigate whether the periprosthetic soft-tissue mass harbours any cancer- related genetic alterations, we studied DNA isolated from periprosthetic tissues of 20 patients with MoM hip replacement, for copy number alterations and mutations in hotspot regions of 50 cancer genes using aCGH and amplicon-based next generation sequencing. Our results showed copy number gains at 12q14.3 and 21q21.1in tumour from patient diagnosed with liposarcoma. Copy number alterations in periprosthetic tissues were seen in three other patients, one had a region of gain at 9q24.1 affecting JAK2 and INSL6, and two patients had region of gain at 6p21.1, affecting RUNX2. Mutation analysis showed V1578del mutation in NOTCH1 in two patients. The copy number alterations and mutations seen in periprosthetic soft-tissue masses are earlier reported in either haematological malignancies or in osteoblast related bone dysplasia. The presence of genetic anomalies was associated with longer in-situ time of the implant. Our findings warrant the need of similar studies in larger patient cohorts to evaluate the risk of development of neoplastic alterations in periprosthetic tissues of patients with MoM hip replacement.

Cytotoxicity of aluminum oxide nanoparticles on Allium cepa root tip--effects of oxidative stress generation and biouptake

The commercial usage of Al2O3 nanoparticles (Al2O3 NPs) has gone up significantly in the recent times, enhancing the risk of environmental contamination with these agents and their consequent adverse effects on living systems. The current study has been designed to evaluate the cytogenetic potential of Al2O3 NPs in Allium cepa (root tip cells) at a range of exposure concentrations (0.01, 0.1, 1, 10, and 100 μg/mL), their uptake/internalization profile, and the oxidative stress generated. We noted a dose-dependent decrease in the mitotic index (42 to 28 %) and an increase in the number of chromosomal aberrations. Various chromosomal aberrations, e.g. sticky, multipolar and laggard chromosomes, chromosomal breaks, and the formation of binucleate cells, were observed by optical, fluorescence, and confocal laser scanning microscopy. FT-IR analysis demonstrated the surface chemical interaction between the nanoparticles and root tip cells. The biouptake of Al2O3 in particulate form led to reactive oxygen species generation, which in turn probably contributed to the induction of chromosomal aberrations.

Cytotoxic and genotoxic characterization of aluminum and silicon oxide nanoparticles in macrophages

OBJECTIVE

Although aluminum oxide and silicon oxide nanoparticles are currently available as dental materials, there is a lack of basic information concerning their biocompatibility. This study evaluates the biological responses of cultured macrophages (RAW264) to aluminum oxide (Al2O3NPs) and silicon oxide nanoparticles (SiO2NPs) by analyzing cytotoxicity and genotoxicity.

METHODS

The nanoparticles are amorphous and spherical, with diameters of 13 nm for the Al2O3NPs and 12 nm for the SiO2NPs. The cultured RAW264 are exposed to the nanoparticles (NPs) and examined for cytotoxicity using the WST-8 cell viability and Hoechst/PI apoptosis assay, for genotoxicity by micronucleus analysis, for changes in nuclear shape (deformed nuclei) and for comet assay using confocal microscopy, and micromorphological analysis is done using scanning and transmission electron microscopes.

RESULTS

Nuclei and DNA damage because of exposure to both types of NPs is observed by inmunostaining genotoxicity testing. The cytotoxicity and genotoxicity are well correlated in this study. Numerous NPs are observed as large aggregates in vesicles, but less or nonexistent NP internalization is seen in the nucleus or cytoplasm. These morphological results suggest that a primary cause of cell disruption is the chemical changes of the NPs in the low pH of vesicles (i.e., ionization of Al2O3 or SiO2) for both types of oxide NPs.

SIGNIFICANCE

Although further research on the elution of NP concentrations on cell or tissue activity under simulated clinical conditions is required, NP concentrations over 200 μg/mL are large enough to induce cytotoxic and genotoxic effects to cells.

A randomized controlled trial: preoperative home-based combined Tai Chi and Strength Training (TCST) to improve balance and aerobic capacity in patients with total hip arthroplasty (THA)

OBJECTIVES

To investigate the effect of a 12-week balance training program, combined TCST, on balance activity and aerobic capacity in patients with hip osteoarthritis.

METHODS

Single-blind randomized grouping cohort study was conducted at our hospital from December 2008 to December 2011. A total of 81 patients aged from 60 to 69 years old diagnosed with end-stage hip osteoarthritis were recruited. They were randomly divided into two groups: training group (TG) and control group (CG). Participants in TG should do the TCST program under family's supervision for 12 weeks. Parameters including WOMAC score, 6 min walk test, stand up, walk test, situation of the hip mobility were compared between TG and CG by one-way ANOVA.

RESULTS

There was no significant difference of baseline characteristics between these two groups (P>0.05). Participants in TG could complete 87.1% of movements of TCST. After training, the distance of 6-min walk was obviously increased from 409.59±51.31 m to 478.10±52.46 m (P<0.01), and the time for up and go was significantly shorten from 18.53±3.90 s to 14.61±2.60 s (P<0.01), and self-reported functional status scores evaluated by WOMAC was improved from 40.97±5.65 to 36.28±5.11 (P<0.01). However, there were no significant changes in pain WOMAC and side hip motion.

CONCLUSION

The 12-week TCST program have good adherence, and can effectively improve balance and aerobic capacity status in patients with end-stage osteoarthritis, while this training can not effectively alleviate the pain and improve hip motion of patients. Hence, further THA is necessary to solve the problems.

PRACTICE

Patients with osteoarthritis can do this training program under family's supervision.

IMPLICATIONS

Providing a good advice on rehabilitation for patients preparing to do THA.

Toxicology of wear particles of cobalt-chromium alloy metal-on-metal hip implants Part II: Importance of physicochemical properties and dose in animal and in vitro studies as a basis for risk assessment

The objective of the Part II analysis was to evaluate animal and in vitro toxicology studies of CoCr particles with respect to their physicochemistry and dose relevance to metal-on-metal (MoM) implant patients as derived from Part I. In the various toxicology studies, physicochemical characteristics were infrequently considered and administered doses were orders of magnitude higher than what occurs in patients. Co was consistently shown to rapidly release from CoCr particles for distribution and elimination from the body. CoCr micron sized particles appear more biopersistent in vivo resulting in inflammatory responses that are not seen with similar mass concentrations of nanoparticles. We conclude, that in an attempt to obtain data for a complete risk assessment, future studies need to focus on physicochemical characteristics of nano and micron sized particles and on doses and dose metrics relevant to those generated in patients or in properly conducted hip simulator studies.

How has the introduction of new bearing surfaces altered the biological reactions to byproducts of wear and modularity?

BACKGROUND

Biological responses to wear debris were largely elucidated in studies focused on conventional ultrahigh-molecular-weight polyethylene (UHMWPE) and some investigations of polymethymethacrylate cement and orthopaedic metals. However, newer bearing couples, in particular metal-on-metal but also ceramic-on-ceramic bearings, may induce different biological reactions.

QUESTIONS/PURPOSES

Does wear debris from the newer bearing surfaces result in different biological responses compared with the known responses observed with conventional metal-on-UHMWPE bearings?

METHODS

A Medline search of articles published after 1996 supplemented by a hand search of reference lists of included studies and relevant conference proceedings was conducted to identify the biological responses to orthopaedic wear debris with a focus on biological responses to wear generated from metal-on-highly crosslinked polyethylene, metal-on-metal, ceramic-on-ceramic, and ceramic-on-polyethylene bearings. Articles were selected using criteria designed to identify reports of wear debris particles and biological responses contributing to prosthesis failure. Case reports and articles focused on either clinical outcomes or tribology were excluded. A total of 83 papers met the criteria and were reviewed in detail.

RESULTS

Biological response to conventional UHMWPE is regulated by the innate immune response. It is clear that the physical properties of debris (size, shape, surface topography) influence biological responses in addition to the chemical composition of the biomaterials. Highly crosslinked UHMWPE particles have the potential to alter, rather than eliminate, the biological response to conventional UHMWPE. Metal wear debris can generate elevated plasma levels of cobalt and chromium ions. These entities can provoke responses that extend to the elicitation of an acquired immune response. Wear generated from ceramic devices is significantly reduced in volume and may provide the impression of an "inert" response, but clinically relevant biological reactions do occur, including granulomatous responses in periprosthetic tissues.

CONCLUSIONS

The material composition of the device, the physical form of the debris, and disease pathophysiology contribute to complex interactions that determine the outcome to all wear debris. Metal debris does appear to increase the complexity of the biological response with the addition of immunological responses (and possibly direct cellular cytotoxicity) to the inflammatory reaction provoked by wear debris in some patients. However, the introduction of highly crosslinked polyethylene and ceramic bearing surfaces shows promising signs of reducing key biological mechanisms in osteolysis.

Whole blood metal ion measurement reproducibility between different laboratories

Monitoring patients' metal ion blood concentrations can be useful in cases of problematic metal on metal hip implants. Our objective was to evaluate the reproducibility of metal ion level values measured by two different laboratories. Whole blood samples were collected in 46 patients with metal on metal hip arthroplasty. For each patients, two whole blood samples were collected and analyzed by two laboratories. Laboratory 1 had higher results than laboratory 2. There was a clinically significant absolute difference between the two laboratories, above the predetermined threshold, 35% of Cr samples and 38% of Co samples. All laboratories do not use the same technologies for their measurements. Therefore, decision to revise a metal on metal hip arthroplasty should rely on metal ion trends and have to be done in the same laboratory.

Systematic review of potential health risks posed by pharmaceutical, occupational and consumer exposures to metallic and nanoscale aluminum, aluminum oxides, aluminum hydroxide and its soluble salts

Abstract Aluminum (Al) is a ubiquitous substance encountered both naturally (as the third most abundant element) and intentionally (used in water, foods, pharmaceuticals, and vaccines); it is also present in ambient and occupational airborne particulates. Existing data underscore the importance of Al physical and chemical forms in relation to its uptake, accumulation, and systemic bioavailability. The present review represents a systematic examination of the peer-reviewed literature on the adverse health effects of Al materials published since a previous critical evaluation compiled by Krewski et al. (2007) . Challenges encountered in carrying out the present review reflected the experimental use of different physical and chemical Al forms, different routes of administration, and different target organs in relation to the magnitude, frequency, and duration of exposure. Wide variations in diet can result in Al intakes that are often higher than the World Health Organization provisional tolerable weekly intake (PTWI), which is based on studies with Al citrate. Comparing daily dietary Al exposures on the basis of "total Al"assumes that gastrointestinal bioavailability for all dietary Al forms is equivalent to that for Al citrate, an approach that requires validation. Current occupational exposure limits (OELs) for identical Al substances vary as much as 15-fold. The toxicity of different Al forms depends in large measure on their physical behavior and relative solubility in water. The toxicity of soluble Al forms depends upon the delivered dose of Al(+3) to target tissues. Trivalent Al reacts with water to produce bidentate superoxide coordination spheres [Al(O2)(H2O4)(+2) and Al(H2O)6 (+3)] that after complexation with O2(•-), generate Al superoxides [Al(O2(•))](H2O5)](+2). Semireduced AlO2(•) radicals deplete mitochondrial Fe and promote generation of H2O2, O2 (•-) and OH(•). Thus, it is the Al(+3)-induced formation of oxygen radicals that accounts for the oxidative damage that leads to intrinsic apoptosis. In contrast, the toxicity of the insoluble Al oxides depends primarily on their behavior as particulates. Aluminum has been held responsible for human morbidity and mortality, but there is no consistent and convincing evidence to associate the Al found in food and drinking water at the doses and chemical forms presently consumed by people living in North America and Western Europe with increased risk for Alzheimer's disease (AD). Neither is there clear evidence to show use of Al-containing underarm antiperspirants or cosmetics increases the risk of AD or breast cancer. Metallic Al, its oxides, and common Al salts have not been shown to be either genotoxic or carcinogenic. Aluminum exposures during neonatal and pediatric parenteral nutrition (PN) can impair bone mineralization and delay neurological development. Adverse effects to vaccines with Al adjuvants have occurred; however, recent controlled trials found that the immunologic response to certain vaccines with Al adjuvants was no greater, and in some cases less than, that after identical vaccination without Al adjuvants. The scientific literature on the adverse health effects of Al is extensive. Health risk assessments for Al must take into account individual co-factors (e.g., age, renal function, diet, gastric pH). Conclusions from the current review point to the need for refinement of the PTWI, reduction of Al contamination in PN solutions, justification for routine addition of Al to vaccines, and harmonization of OELs for Al substances.