Metallic zinc exhibits optimal biocompatibility for bioabsorbable endovascular stents

A review on pancreatic duct stents: materials and emerging trends

Pancreatic duct strictures, which can arise from trauma, inflammation, or malignancy, often result in complications such as duct obstruction, pancreatic parenchymal hypertension, and ischemia. Endoscopic stenting is an effective therapeutic approach for managing these strictures. However, traditional plastic pancreatic duct stents fail to conform to the physiological curvature of the pancreas, while metal pancreatic duct stents with flared ends reduce migration but are associated with complications such as de novo strictures. Additionally, plastic and metal pancreatic duct stents require surgical removal. Whereas biodegradable pancreatic duct stents present a promising alternative due to their superior biocompatibility and ability to decompose into non-toxic materials, potentially eliminating the need for additional surgeries. Despite these advantages, biodegradable pancreatic duct stents remain in the experiment stage. This review assesses current materials of pancreatic duct stents, and emphasizes recent advancements in biodegradable options and emerging trends in clinical applications.

Innovations in Vascular Repair from Mechanical Intervention to Regenerative Therapies

BACKGROUND

Vascular diseases, including atherosclerosis and thrombosis, are leading causes of morbidity and mortality worldwide, often resulting in vessel stenosis that impairs blood flow and leads to severe clinical outcomes. Traditional mechanical interventions, such as balloon angioplasty and bare-metal stents, provided initial solutions but were limited by restenosis and thrombosis. The advent of drug-eluting stents improved short-term outcomes by inhibiting vascular smooth muscle cell proliferation, however, they faced challenges including delayed reendothelialization and late-stage thrombosis.

METHODS

This review highlights the progression from mechanical to biological interventions in treating vascular stenosis and underscores the need for integrated approaches that combine mechanical precision with regenerative therapies.

RESULTS

To address long-term complications, bioresorbable stents were developed to provide temporary scaffolding that gradually dissolves, yet they still encounter challenges with mechanical integrity and optimal degradation rates. Consequently, emerging therapies now focus on biological approaches, such as gene therapy, extracellular vesicle treatments, and cell therapies, that aim to promote vascular repair at the cellular level. These strategies offer the potential for true vascular regeneration by enhancing endothelialization, modulating immune responses, and stimulating angiogenesis.

CONCLUSION

Integrating mechanical precision with regenerative biological therapies offers a promising future for treating vascular stenosis. A comprehensive approach combining these modalities could achieve sustainable vascular health.

The biological effects of copper alloying in Zn-based biodegradable arterial implants

Biodegradable metals based on zinc are being developed to serve as temporary arterial scaffolding. Although the inclusion of copper is becoming more prevalent for grain refinement in zinc alloys, the biological activity of the copper component has not been well investigated. Here, two ZnCu alloys (0.8 and 1.5 wt% Cu) with and without thermal treatment were investigated for their hemocompatibility and biocompatibility. The microstructure was examined using scanning electron microscopy and X-ray diffraction. Zn-1.5Cu was found to contain nearly double the amount of second phase (CuZn5) precipitates as compared to Zn-0.8Cu. Thermal treatment dissolved a portion of the precipitates into the matrix. Since copper is a well-known catalyst for NO generation, the metals were tested both for their ability to generate NO release and for their thrombogenicity. Cellular responses and in vivo corrosion were characterized by a 6 months in vivo implantation of metal wires into rat arteries. The as-received Zn-1.5Cu displayed the least neointimal growth and smooth muscle cell presence, although inflammation was slightly increased. Thermal treatment was found to worsen the biological response, as determined by an increased neointimal size, increased smooth muscle cell presence and small regions of necrotic tissue. There were no trends in NO release between the alloys and thermal treatments. Corrosion progressed predominately through a pitting mechanism in vivo, which was more pronounced for the thermally treated alloys, with a more uniform corrosion seen for as-received Zn-1.5Cu. Differences in biological response are speculated to be due to changes in microstructure and pitting corrosion behavior.

Coronary bioresorbable metallic stents: Advancements and future perspectives

Percutaneous coronary intervention is a critical treatment for coronary artery disease, particularly myocardial infarction, and is highly recommended in clinical guidelines. Traditional metallic stents, although initially effective, remain permanently in the artery and can lead to complications such as in-stent restenosis, late thrombosis, and chronic inflammation. Given the temporary need for stenting and the potential for late complications, bioresorbable stents have emerged as a promising alternative. However, bioresorbable polymeric stents have encountered significant clinical challenges due to their low mechanical strength and ductility, which increase the risks of thrombosis and local inflammation. Consequently, bioresorbable metals are being considered as a superior option for coronary stents. This review examines the progress of bioresorbable metallic stents from both preclinical and clinical perspectives, aiming to provide a theoretical foundation for future research. Iron, zinc, and magnesium are the primary materials used for these stents. Zinc-based bioresorbable stents have shown promise in preclinical studies due to their biocompatibility and vascular protective properties, although human clinical studies are still limited. Magnesium-based stents have demonstrated positive clinical outcomes, being fully absorbed within 12 months and showing low rates of late lumen loss and target lesion failure at 6- and 12-months post-implantation. Initial trials of iron-based stents have indicated favorable mid-term safety and efficacy, with complete absorption by the body within three years and consistent luminal expansion beyond six months post-implantation. Despite these advancements, further trials are needed for comprehensive validation. In conclusion, while current materials do not fully meet the ideal requirements, ongoing research should focus on developing bioresorbable stents with enhanced performance characteristics to better meet clinical needs.

A Review of Additive Manufacturing of Biodegradable Fe and Zn Alloys for Medical Implants Using Laser Powder Bed Fusion (LPBF)

This review explores the advancements in additive manufacturing (AM) of biodegradable iron (Fe) and zinc (Zn) alloys, focusing on their potential for medical implants, particularly in vascular and bone applications. Fe alloys are noted for their superior mechanical properties and biocompatibility but exhibit a slow corrosion rate, limiting their biodegradability. Strategies such as alloying with manganese (Mn) and optimizing microstructure via laser powder bed fusion (LPBF) have been employed to increase Fe's corrosion rate and mechanical performance. Zn alloys, characterized by moderate biodegradation rates and biocompatible corrosion products, address the limitations of Fe, though their mechanical properties require improvement through alloying and microstructural refinement. LPBF has enabled the fabrication of dense and porous structures for both materials, with energy density optimization playing a critical role in achieving defect-free parts. Fe alloys exhibit higher strength and hardness, while Zn alloys offer better corrosion control and biocompatibility. In vitro and in vivo studies demonstrate promising outcomes for both materials, with Fe alloys excelling in load-bearing applications and Zn alloys in controlled degradation and vascular applications. Despite these advancements, challenges such as localized corrosion, cytotoxicity, and long-term performance require further investigation to fully harness the potential of AM-fabricated Fe and Zn biodegradable implants.

Hybrid additive manufacturing for Zn-Mg casting for biomedical application

Zinc (Zn) and its alloys have been the focus of recent materials and manufacturing research for orthopaedic implants due to their favorable characteristics including desirable mechanical strength, biodegradability, and biocompatibility. In this research, a novel process involving additive manufacturing (AM) augmented casting was employed to fabricate zinc-magnesium (Zn-0.8 Mg) artifacts with surface lattices composed of triply periodic minimal surfaces (TPMS), specifically gyroid. Scanning electron microscopy (SEM) and energy-dispersive X-ray spectroscopy (EDS) analysis confirmed that Zn-Mg intermetallic phases formed at the grain boundary. Micro indentation testing resulted in hardness value ranging from 83.772 to 99.112 HV and an elastic modulus varying from 92.601 to 94.625 GPa. Results from in vitro cell culture experiments showed that cells robustly survived on both TPMS and solid scaffolds, confirming the suitability of the material and structure as biomedical implants. This work suggests that this novel hybrid manufacturing process may be a viable approach to fabricating next generation biodegradable orthopaedic implants.

Graphical Abstract

Nanoparticle-Enabled Zn-0.1Mg Alloy with Long-Term Stability, Refined Degradation, and Favorable Biocompatibility for Biodegradable Implant Devices

Zinc-based alloys, specifically Zn-Mg, have garnered considerable attention as promising materials for biodegradable implants due to their favorable mechanical strength, appropriate corrosion rate, and biocompatibility. Nevertheless, the alloy's lack of mechanical stability and integrity, resulting from ductility loss induced by age hardening at room temperature, hampers its practical bioapplication. In this study, ceramic nanoparticles have been successfully incorporated into the Zn-Mg alloy system, leading to a significant improvement in long-term stability as well as mechanical strength and ductility. In addition, this study represents the first investigation of Zn-based nanocomposites both in vitro and in vivo to comprehend the influence of nanoparticles on the degradation behavior and biocompatibility of the Zn system. The findings indicate that the incorporation of WC nanoparticles effectively refines and stabilizes the degradation behavior of Zn-Mg without negatively impacting the cytocompatibility of the alloy. The subcutaneous implantation and femoral implantation further prove the benefits of nanoparticle incorporation and found no negative effects. Collectively, Zn-Mg-WC nanocomposites yield great potential for implant usage.

Insights into the biocompatibility of biodegradable metallic molybdenum for cardiovascular applications-a critical review

Atherosclerotic cardiovascular disease (ACD) is the leading cause of death worldwide. The gold standard of treatment is the implantation of a permanent stent implant that is often associated with complications such as thrombus formation, vascular neointimal response, and stent fracture, which altogether decrease the long-term safety and efficacy of the stent. Biodegradable metallic materials have become an attractive alternative because of the ability to facilitate a more physiological healing response while the metal degrades. Recently, Molybdenum (Mo) has been considered as a potential candidate due to its excellent mechanical and medical imaging properties. Moreover, the biomedical research studies performed to date have shown minimal adverse effects in vitro and in vivo. However, there are still concerns of toxicity at high doses, and the impact of the biochemical mechanisms of Mo on material performance especially in pathophysiological environments are yet to be explored. Mo is an essential co factor for enzymes such as xanthine oxidoreductase (XOR) that plays a critical role in vascular homeostasis and ACD progression. Herein, this review will focus on the biochemistry of Mo, its physiological and pathological effects with an emphasis on cardiovascular disease as well as the recent studies on Mo for cardiovascular applications and its advantages over other biodegradable metals. The limitations of Mo research studies will also be discussed and concluded with an outlook to move this revolutionary metallic biomaterial from the bench to the bedside.

A Critical Review of Biodegradable Zinc Alloys toward Clinical Applications

Biodegradable zinc (Zn) alloys stand out as promising contenders for biomedical applications due to their favorable mechanical properties and appropriate degradation rates, offering the potential to mitigate the risks and expenses associated with secondary surgeries. While current research predominantly centers on the in vitro examination of Zn alloys, notable disparities often emerge between in vivo and in vitro findings. Consequently, conducting in vivo investigations on Zn alloys holds paramount significance in advancing their clinical application. Different element compositions and processing methods decide the mechanical properties and biological performance of Zn alloys, thus affecting their suitability for specific medical applications. This paper presents a comprehensive overview of recent strides in the development of biodegradable Zn alloys, with a focus on key aspects such as mechanical properties, toxicity, animal experiments, biological properties, and molecular mechanisms. By summarizing these advancements, the paper aims to broaden the scope of research directions and enhance the understanding of the clinical applications of biodegradable Zn alloys.

Research Progress on Laser Powder Bed Fusion Additive Manufacturing of Zinc Alloys

Zinc, along with magnesium and iron, is considered one of the most promising biodegradable metals. Compared with magnesium and iron, pure Zn exhibits poor mechanical properties, despite its mild biological corrosion behavior and beneficial biocompatibility. Laser powder bed fusion (LPBF), unlike traditional manufacturing techniques, has the capability to rapidly manufacture near-net-shape components. At present, although the combination of LPBF and Zn has made great progress, it is still in its infancy. Element loss and porosity are common processing problems for LPBF Zn, mainly due to evaporation during melting under a high-energy beam. The formation quality and properties of the final material are closely related to the alloy composition, design and processing. This work reviews the state of research and future perspective on LPBF zinc from comprehensive assessments such as powder characteristics, alloy composition, processing, formation quality, microstructure, and properties. The effects of powder characteristics, process parameters and evaporation on formation quality are introduced. The mechanical, corrosion, and biocompatibility properties of LPBF Zn and their test methodologies are introduced. The effects of microstructure on mechanical properties and corrosion properties are analyzed in detail. The practical medical application of Zn is introduced. Finally, current research status is summarized together with suggested directions for advancing knowledge about LPBF Zn.

The influence of age on the biological response to biodegradable zinc arterial implants

Medical devices to treat arterial diseases of older humans are routinely designed and developed using young animals. This is the case despite the significant declines of tissue regeneration, cell proliferation, and inflammation in aged humans that are not reflected in young animals. The widespread use of age-mismatched animals is particularly a concern for the testing of interactive materials, such as biodegradable metals whose dynamic interfaces continuously impact local cell and tissue regenerative processes. In order to determine the importance and impact of age differences in biodegradable stent material biocompatibility, we implanted both inert (platinum) and biodegradable (zinc) metal wires into the arteries of 1 year old and 3-month-old rats for a period of 6 months and compared the biological responses. It was found that the older animals developed a significantly larger neointimal encapsulating tissue for zinc implants vs. a smaller tissue response for the platinum implants relative to the younger rats. The neointimas of older rats contained dramatically fewer macrophages for both implant metals. The presence of neointimal smooth muscle cells was also decreased in the older rats. Endothelial cell regeneration in the old arteries was not impacted by the different metal implants. These findings demonstrate that neointimal responses to metal implants in arterial tissue are strongly impacted by age-related changes. The findings also suggest that the reliance on young animal models to evaluate metal implants intended for the arteries of considerably older individuals may substantially over predict the biocompatibility.

Developing Zn-2Cu-xLi (x < 0.1 wt %) alloys with suitable mechanical properties, degradation behaviors and cytocompatibility for vascular stents

Biodegradable Zn alloys show great potential for vascular stents due to their moderate degradation rates and acceptable biocompatibility. However, the poor mechanical properties limit their applications. In this study, low alloyed Zn-2Cu-xLi (x = 0.004, 0.01, 0.07 wt %) alloys with favorable mechanical properties were developed. The microstructure consists of fine equiaxed η-Zn grains, micron, submicron-sized and coherent nano ε-CuZn4 phases. The introduced Li exists as a solute in the η-Zn matrix and ε-CuZn4 phase, and results in the increase of ε-CuZn4 volume fraction, the refinement of grains and more uniform distribution of grain sizes. As Li content increases, the strength of alloys is dramatically improved by grain boundary strengthening, precipitate strengthening of ε-CuZn4 and solid solution strengthening of Li. Zn-2Cu-0.07Li alloy has the optimal mechanical properties with a tensile yield strength of 321.8 MPa, ultimate tensile strength of 362.3 MPa and fracture elongation of 28.0 %, exceeding the benchmark of stents. It also has favorable mechanical property stability, weak tension compression yield asymmetry and strain rate sensitivity. It exhibits uniform degradation and a little improved degradation rate of 89.5 μm∙year-1, due to the improved electrochemical activity by increased ε-CuZn4 volume fraction, and generates Li2CO3 and LiOH. It shows favorable cytocompatibility without adverse influence on endothelial cell viability by trace Li+. The fabricated microtubes show favorable mechanical properties, and stents exhibit an average radial strength of 118 kPa. The present study indicates that Zn-2Cu-0.07Li alloy is a potential and promising candidate for vascular stent applications. STATEMENT OF SIGNIFICANCE: Zn alloys are promising candidates for biodegradable vascular stents. However, improving their mechanical properties is challenging. Combining the advantages of Cu and trace Li, Zn-2Cu-xLi (x < 0.1 wt %) alloys were developed for stents. As Li increases, the strength of alloys is dramatically improved by refined grains, increased volume fraction of ε-CuZn4 and solid solution of Li. Zn-2Cu-0.07Li alloy exhibits a TYS exceeding 320 MPa, UTS exceeding 360 MPa and fracture EL of nearly 30 %. It shows favorable mechanical stability, degradation behaviors and cytocompatibility. The alloy was fabricated into microtubes and stents for mechanical property tests to verify application feasibility for the first time. This indicates that Zn-2Cu-0.07Li alloy has great potential for vascular stent applications.

Effect of TiC Nanoparticles on a Zn-Al-Cu System for Biodegradable Cardiovascular Stent Applications

Despite being a weaker metal, zinc has become an increasingly popular candidate for biodegradable implant applications due to its suitable corrosion rate and biocompatibility. Previous studies have experimented with various alloy elements to improve the overall mechanical performance of pure Zn without compromising the corrosion performance and biocompatibility; however, the thermal stability of biodegradable Zn alloys has not been widely studied. In this study, TiC nanoparticles were introduced for the first time to a Zn-Al-Cu system. After hot rolling, TiC nanoparticles were uniformly distributed in the Zn matrix and effectively enabled phase control during solidification. The Zn-Cu phase, which was elongated and sharp in the reference alloy, became globular in the nanocomposite. The strength of the alloy, after introducing TiC nanoparticles, increased by 31% from 259.7 to 340.3 MPa, while its ductility remained high at 49.2% elongation to failure. Fatigue performance also improved greatly by adding TiC nanoparticles, increasing the fatigue limit by 47.6% from 44.7 to 66 MPa. Furthermore, TiC nanoparticles displayed excellent phase control capability during body-temperature aging. Without TiC restriction, Zn-Cu phases evolved into dendritic morphologies, and the Al-rich eutectic grew thicker at grain boundaries. However, both Zn-Cu and Al-rich eutectic phases remained relatively unchanged in shape and size in the nanocomposite. A combination of exceptional tensile properties, improved fatigue performance, better long-term stability with a suitable corrosion rate, and excellent biocompatibility makes this new Zn-Al-Cu-TiC material a promising candidate for biodegradable stents and other biodegradable applications.

Structural and temporal dynamics analysis of zinc-based biomaterials: History, research hotspots and emerging trends

Objectives

To examine the 16-year developmental history, research hotspots, and emerging trends of zinc-based biodegradable metallic materials from the perspective of structural and temporal dynamics.

Methods

The literature on zinc-based biodegradable metallic materials in WoSCC was searched. Historical characteristics, the evolution of active topics and development trends in the field of zinc-based biodegradable metallic materials were analyzed using the bibliometric tools CiteSpace and HistCite.

Results

Over the past 16 years, the field of zinc-based biodegradable metal materials has remained in a hotspot stage, with extensive scientific collaboration. In addition, there are 45 subject categories and 51 keywords in different research periods, and 80 papers experience citation bursts. Keyword clustering anchored 3 emerging research subfields, namely, #1 plastic deformation #4 additive manufacturing #5 surface modification. The keyword alluvial map shows that the longest-lasting research concepts in the field are mechanical property, microstructure, corrosion behavior, etc., and emerging keywords are additive manufacturing, surface modification, dynamic recrystallization, etc. The most recent research on reference clustering has six subfields. Namely, #0 microstructure, #2 sem, #3 additive manufacturing, #4 laser powder bed fusion, #5 implant, and #7 Zn-1Mg.

Conclusion

The results of the bibliometric study provide the current status and trends of research on zinc-based biodegradable metallic materials, which can help researchers identify hot spots and explore new research directions in the field.

Remodelers of the vascular microenvironment: The effect of biopolymeric hydrogels on vascular diseases

Vascular disease is the leading health problem worldwide. Vascular microenvironment encompasses diverse cell types, including those within the vascular wall, blood cells, stromal cells, and immune cells. Initiation of the inflammatory state of the vascular microenvironment and changes in its mechanics can profoundly affect vascular homeostasis. Biomedical materials play a crucial role in modern medicine, hydrogels, characterized by their high-water content, have been increasingly utilized as a three-dimensional interaction network. In recent times, the remarkable progress in utilizing hydrogels and understanding vascular microenvironment have enabled the treatment of vascular diseases. In this review, we give an emphasis on the utilization of hydrogels and their advantages in the various vascular diseases including atherosclerosis, aneurysm, vascular ulcers of the lower limbs and myocardial infarction. Further, we highlight the importance and advantages of hydrogels as artificial microenvironments.

In vitro and in vivo studies on biodegradable Zn porous scaffolds with a drug-loaded coating for the treatment of infected bone defect

Additively manufactured biodegradable zinc (Zn) scaffolds have great potential to repair infected bone defects due to their osteogenic and antibacterial properties. However, the enhancement of antibacterial properties depends on a high concentration of dissolved Zn2+, which in return deteriorates osteogenic activity. In this study, a vancomycin (Van)-loaded polydopamine (PDA) coating was prepared on pure Zn porous scaffolds to solve the above dilemma. Compared with pure Zn scaffolds according to comprehensive in vitro tests, the PDA coating resulted in a slow degradation and inhibited the excessive release of Zn2+ at the early stage, thus improving cytocompatibility and osteogenic activity. Meanwhile, the addition of Van drug substantially suppressed the attachment and proliferation of S. aureus and E. coli bacterial. Furthermore, in vivo implantation confirmed the simultaneously improved osteogenic and antibacterial functions by using the pure Zn scaffolds with Van-loaded PDA coating. Therefore, it is promising to employ biodegradable Zn porous scaffolds with the proposed drug-loaded coating for the treatment of infected bone defects.

Biocompatibility and osteogenic potential of choline phosphate chitosan-coated biodegradable Zn1Mg

Zinc alloys have demonstrated considerable potentials as implant materials for biodegradable vascular and orthopedic applications. However, the high initial release of Zn2+ can trigger intense immune responses that impede tissue healing. To address this challenge and enhance the osteogenic capacity of zinc alloys, the surface of Zn1Mg was subjected to CO2 plasma modification (Zn1Mg-PP) followed by grafting with choline phosphate chitosan (Zn1Mg-PP-PCCs). This study aims to investigate the in vitro and in vivo biocompatibility of the surface-modified Zn1Mg. The effect of the surface modification on the inflammatory response and osteogenic repair process was investigated. Compared with unmodified Zn1Mg, the degradation rate of Zn1Mg-PP-PCCs was significantly decreased, avoiding the cytotoxicity triggered by the release of large amounts of Zn2+. Moreover, PCCs significantly enhanced the cell-material adhesion, promoted the proliferation of osteoblasts (MC3T3-E1) and upregulated the expression of key osteogenic factors in vitro. Notably, the in vivo experiments revealed that the surface modification of Zn1Mg suppressed inhibited the expression of inflammatory cytokines, promoting the secretion of anti-inflammatory factors, thereby reducing inflammation and promoting bone tissue repair. Furthermore, histological analysis of tissue sections exhibited strong integration between the material and the bone, along with well-defined new bone formation and reduced osteoclast aggregation on the surface. This was attributed to the improved immune microenvironment by PCCs, which promoted osteogenic differentiation of osteoblasts. These findings highlight that the preparation of PCCs coatings on zinc alloy surfaces effectively inhibited ion release and modulated the immune environment to promote bone tissue repair. STATEMENT OF SIGNIFICANCE: Surface modification of biodegradable Zn alloys facilitates the suppression of intense immune responses caused by excessive ion release concentrations from implants. We modified the surface of Zn1Mg with choline phosphate chitosan (PCCs) and investigated the effects of surface modification on the inflammatory response and osteogenic repair process. In vitro results showed that the PCCs coating effectively reduced the degradation rate of Zn1Mg to avoid cytotoxicity caused by high Zn2+ concentration, favoring the proliferation of osteoblasts. In addition, in vivo results indicated that Zn1Mg-PP-PCCs attenuated inflammation to promote bone repair by modulating the release of inflammation-related factors. The surface-modified Zn1Mg implants demonstrated strong osseointegration, indicating that the PCCs coating effectively modulated the immune microenvironment and promoted bone healing.

The Microstructural Evolution and Corrosion Behavior of Zn-Mg Alloys and Hybrids Processed Using High-Pressure Torsion

Zinc (Zn) alloys, particularly those incorporating magnesium (Mg), have been explored as potential bioabsorbable metals. However, there is a continued need to enhance the corrosion characteristics of Zn-Mg alloys to fulfill the requirements for biodegradable implants. This work involves a corrosion behavior comparison between severe-plastic-deformation (SPD) processed cast Zn-Mg alloys and their hybrid counterparts, having equivalent nominal compositions. The SPD processing technique used was high-pressure torsion (HPT), and the corrosion behavior was studied as a function of the number of turns (1, 5, 15) for the Zn-3Mg (wt.%) alloy and hybrid and as a function of composition (Mg contents of 3, 10, 30 wt.%) for the hybrid after 15 turns. The results indicated that HPT led to multimodal grain size distributions of ultrafine Mg-rich grains containing MgZn2 and Mg2Zn11 nanoscale intermetallics in a matrix of coarser dislocation-free Zn-rich grains. A greater number of turns resulted in greater corrosion resistance because of the formation of the intermetallic phases. The HPT hybrid was more corrosion resistant than its alloy counterpart because it tended to form the intermetallics more readily than the alloy due to the inhomogeneous conditions of the materials before the HPT processing as well as the non-equilibrium conditions imposed during the HPT processing. The HPT hybrids with greater Mg contents were less corrosion resistant because the addition of Mg led to less noble behavior.

Methods for improving the properties of zinc for the application of biodegradable vascular stents

Biodegradable stents can support vessels for an extended period, maintain vascular patency, and progressively degrade once vascular remodeling is completed, thereby reducing the constraints of traditional metal stents. An ideal degradable stent must have good mechanical properties, degradation behavior, and biocompatibility. Zinc has become a new type of biodegradable metal after magnesium and iron, owing to its suitable degradation rate and good biocompatibility. However, zinc's poor strength and ductility make it unsuitable as a vascular stent material. Therefore, this paper reviewed the primary methods for improving the overall properties of zinc. By discussing the mechanical properties, degradation behavior, and biocompatibility of various improvement strategies, we found that alloying is the most common, simple, and effective method to improve mechanical properties. Deformation processing can further improve the mechanical properties by changing the microstructures of zinc alloys. Surface modification is an important means to improve the biological activity, blood compatibility and corrosion resistance of zinc alloys. Meanwhile, structural design can not only improve the mechanical properties of the vascular stents, but also endow the stents with special properties such as negative Poisson 's ratio. Manufacturing zinc alloys with excellent degradation properties, improved mechanical properties and strong biocompatibility and exploring their mechanism of interaction with the human body remain areas for future research.

Nerve Regeneration with a Scaffold Incorporating an Absorbable Zinc-2% Iron Alloy Filament to Improve Axonal Guidance

Peripheral nerve damage that results in lost segments requires surgery, but currently available hollow scaffolds have limitations that could be overcome by adding internal guidance support. A novel solution is to use filaments of absorbable metals to supply physical support and guidance for nerve regeneration that then safely disappear from the body. Previously, we showed that thin filaments of magnesium metal (Mg) would support nerve regeneration. Here, we tested another absorbable metal, zinc (Zn), using a proprietary zinc alloy with 2% iron (Zn-2%Fe) that was designed to overcome the limitations of both Mg and pure Zn metal. Non-critical-sized gaps in adult rat sciatic nerves were repaired with silicone conduits plus single filaments of Zn-2%Fe, Mg, or no metal, with autografts as controls. After seventeen weeks, all groups showed equal recovery of function and axonal density at the distal end of the conduit. The Zn alloy group showed some improvements in early rat health and recovery of function. The alloy had a greater local accumulation of degradation products and inflammatory cells than Mg; however, both metals had an equally thin capsule (no difference in tissue irritation) and no toxicity or inflammation in neighboring nerve tissues. Therefore, Zn-2%Fe, like Mg, is biocompatible and has great potential for use in nervous tissue regeneration and repair.

Polydopamine (PDA) coatings with endothelial vascular growth factor (VEGF) immobilization inhibiting neointimal formation post zinc (zn) wire implantation in rat aortas

BACKGROUND

Bioresorbable stents are designed to provide temporary mechanical support to the coronary arteries and then slowly degrade in vivo to avoid chronic inflammation. Zinc (Zn) is a promising material for bioresorbable stents; However, it can cause inflammation and neointimal formation after being implanted into blood vessels.

METHODS

To improve biocompatibility of Zn, we first coated it with polydopamine (PDA), followed by immobilization of endothelial vascular growth factor (VEGF) onto the PDA coatings. Adhesion, proliferation, and phenotype maintenance of endothelial cells (ECs) on the coated Zn were evaluated in vitro. Then, a wire aortic implantation model in rats mimicking endovascular stent implantation in humans was used to assess vascular responses to the coated Zn wires in vivo. Thrombosis in aortas post Zn wire implantation, degradation of Zn wires in vivo, neointimal formation surrounding Zn wires, and macrophage infiltration and extracellular matrix (ECM) remodeling in the neointimas were examined.

RESULTS

In vitro data showed that the PDA-coated Zn encouraged EC adhesion, spreading, proliferation, and phenotype maintenance on its surfaces. VEGF functionalization on PDA coatings further enhanced the biocompatibility of Zn to ECs. Implantation of PDA-coated Zn wires into rat aortas didn't cause thrombosis and showed a faster blood flow than pure Zn or the Zn wires coated with VEGF alone. In addition, the PDA coating didn't affect the degradation of Zn wires in vivo. Besides, the PDA-coated Zn wires reduced neointimal formation, increased EC coverage, decreased macrophage infiltration, and declined aggrecan accumulation in ECM. VEGF immobilization onto PDA coatings didn't cause thrombosis and affect Zn degradation in vivo as well, and further increased the endothelization percentage as compared to PDA coating alone, thus resulting in thinner neointimas.

CONCLUSION

These results indicate that PDA coatings with VEGF immobilization would be a promising approach to functionalize Zn surfaces to increase biocompatibility, reduce inflammation, and inhibit neointimal formation after Zn implantation in vivo.

Adaptation of Vascular Smooth Muscle Cell to Degradable Metal Stent Implantation

Iron-, magnesium-, or zinc-based metal vessel stents support vessel expansion at the period early after implantation and degrade away after vascular reconstruction, eliminating the side effects due to the long stay of stent implants in the body and the risks of restenosis and neoatherosclerosis. However, emerging evidence has indicated that their degradation alters the vascular microenvironment and induces adaptive responses of surrounding vessel cells, especially vascular smooth muscle cells (VSMCs). VSMCs are highly flexible cells that actively alter their phenotype in response to the stenting, similarly to what they do during all stages of atherosclerosis pathology, which significantly influences stent performance. This Review discusses how biodegradable metal stents modify vascular conditions and how VSMCs respond to various chemical, biological, and physical signals attributable to stent implantation. The focus is placed on the phenotypic adaptation of VSMCs and the clinical complications, which highlight the importance of VSMC transformation in future stent design.

[Research status and development of biodegradable zinc alloy as orthopedics implant]

Znic (Zn) alloys with good cytocompatibility and suitable degradation rate have been a kind of biodegradable metal with great potential for clinical applications. This paper summarizes the biological role of degradable Zn alloy as bone implant materials, discusses the mechanical properties of different Zn alloys and their advantages and disadvantages as bone implant materials, and analyzes the influence of different processing strategies (such as alloying and additive manufacturing) on the mechanical properties of Zn alloys. This paper provides systematic design approaches for biodegradable Zn alloys as bone implant materials in terms of the material selection, product processing, structural topology optimization, and assesses their application prospects with a view to better serve the clinic.

Lithium-Induced Optimization Mechanism for an Ultrathin-Strut Biodegradable Zn-Based Vascular Scaffold

To reduce incidences of in-stent restenosis and thrombosis, the use of a thinner-strut stent has been clinically proven to be effective. Therefore, the contemporary trend is toward the use of ultrathin-strut (≤70 µm) designs for durable stents. However, stents made from biodegradable platforms have failed to achieve intergenerational breakthroughs due to their excessively thick struts. Here, microalloying is used to create an ultrathin-strut (65 µm) zinc (Zn) scaffold with modified biodegradation behavior and improved biofunction, by adding lithium (Li). The scaffold backbone consists of an ultrafine-grained Zn matrix (average grain diameter 2.28 µm) with uniformly distributed nanoscale Li-containing phases. Grain refinement and precipitation strengthening enable it to achieve twice the radial strength with only 40% of the strut thickness of the pure Zn scaffold. Adding Li alters the thermodynamic formation pathways of products during scaffold biodegradation, creating an alkaline microenvironment. Li₂ CO₃  may actively stabilize this microenvironment due to its higher solubility and better buffering capability than Zn products. The co-release of ionic zinc and lithium enhances the beneficial differential effects on activities of endothelial cells and smooth muscle cells, resulting in good endothelialization and limited intimal hyperplasia in porcine coronary arteries. The findings here may break the predicament of the next-generation biodegradable scaffolds.

Blending with transition metals improves bioresorbable zinc as better medical implants

Zinc (Zn) is a new class of bioresorbable metal that has potential for cardiovascular stent material, orthopedic implants, wound closure devices, etc. However, pure Zn is not ideal for these applications due to its low mechanical strength and localized degradation behavior. Alloying is the most common/effective way to overcome this limitation. Still, the choice of alloying element is crucial to ensure the resulting alloy possesses sufficient mechanical strength, suitable degradation rate, and acceptable biocompatibility. Hereby, we proposed to blend selective transition metals (i.e., vanadium-V, chromium-Cr, and zirconium-Zr) to improve Zn's properties. These selected transition metals have similar properties to Zn and thus are beneficial for the metallurgy process and mechanical property. Furthermore, the biosafety of these elements is of less concern as they all have been used as regulatory approved medical implants or a component of an implant such as Ti6Al4V, CoCr, or Zr-based dental implants. Our study showed the first evidence that blending with transition metals V, Cr, or Zr can improve Zn's properties as bioresorbable medical implants. In addition, three in vivo implantation models were explored in rats: subcutaneous, aorta, and femoral implantations, to target the potential clinical applications of bioresorbable Zn implants.

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Tensile strength and elongation of Zn alloys can reach over 220 MPa and 30%, respectively.

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Three in vivo implantation models to investigate and compare biodegradations behavior at different locations of the body.

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Zn–Zr and Zn–V alloys can induce pro-regenerative inflammation responses in aortas.

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All Zn alloys can promote osteointegration in femur.

Bioresorbable PPDO sliding-lock stents with optimized FDM parameters for congenital heart disease treatment

Stent implantation has been a promising therapy for congenital heart disease (CHD) due to better efficacy. Compared to permanent metal stents, bioresorbable polymer stents have shown a great advantage in accommodating the vascular growth of pediatric patients, but the application is still limited due to inferior radial strength. Here, bioresorbable poly(p-dioxanone) (PPDO) sliding-lock stents for CHD treatment were fabricated by fused deposition modeling (FDM). The effects of FDM processing parameters, including nozzle temperature, bed temperature, layer thickness, and printing speed, on the mechanical properties of PPDO parts were investigated to optimize the processing condition to enhance the radial strength of stents. Finite element analysis (FEA) was also used to evaluate the mechanical properties of stents. PPDO sliding-lock stents fabricated under optimized FDM parameters showed radial strength of 3.315 ± 0.590 N/mm, superior to benchmark commercial metal stents. Radial strength curve and compression behavior of PPDO sliding-lock stents were investigated. Results of FEA exhibited that strut width, shape of the mesh cell and surface coverage ratio had an impact on the compression force of PPDO sliding-lock stents. PPDO sliding-lock stents fabricated with optimized FDM parameters show favorable mechanical performance and meet the requirement of CHD treatment.

Microstructures, mechanical and corrosion properties of graphene nanoplatelet-reinforced zinc matrix composites for implant applications

Zinc (Zn)-based alloys and composites are gaining increasing interest as promising biodegradable implant materials due to their appropriate biodegradation rates and biological functionalities. However, the inadequate mechanical strength and ductility of pure Zn have restricted its application. In this study, Zn matrix composites (ZMCs) reinforced with 0.1-0.4 wt.% graphene nanoplatelets (GNP) fabricated via powder metallurgy were investigated as potential biodegradable implant materials. The microstructures, mechanical properties, and corrosion behaviors of the GNP-reinforced ZMCs were characterized using optical microscopy, scanning electron microscopy combined with energy-dispersive X-ray spectroscopy, Raman spectroscopy, compression testing, and electrochemical and immersion testing in Hanks' balanced salt solution (HBSS). The microstructural study revealed that the GNP was uniformly dispersed in the ZMCs after ball milling and sintering at 420°C for 6 h. The microhardness, compressive yield strength, ultimate compressive strength, and compressive strain of the ZMC-0.2GNP were 69 HV, 123 MPa, 247 MPa, and 23 %, respectively, improvements of ∼ 18 %, 50%, ∼ 28%, and ∼ 15% compared to pure Zn. The corrosion rate of the ZMCs were lower than that of the pure Zn in HBSS, and the ZMC-0.2GNP composite exhibited the lowest corrosion rate of 0.09 mm/y as measured by electrochemical testing. Biocompatibility assessment indicated that the diluted extracts of pure Zn and GNP-reinforced ZMCs with concentrations of 12.5% and 6.25% exhibited no cytotoxicity after cell culturing for up to 5 days, and the diluted extracts of ZMC-0.2 GNP composite revealed more than 90% cell viability after cell culturing of 3 days, showing the satisfying cytocompatibility. STATEMENT OF SIGNIFICANCE: Biodegradable Zn is a promising candidate material for orthopedic implant applications. Nonetheless, the inadequate mechanical strength and ductility of pure Zn limited its clinical application. In this study, Zn matrix composites (ZMCs) reinforced with 0.1-0.4 wt.% graphene nanoplatelets (GNP) were developed via powder metallurgy, and the reinforcing efficacy of GNP on their mechanical properties was investigated. The addition of GNP significantly improved the compressive properties of ZMCs, with the Zn-0.2GNP composite exhibiting the best compressive properties, including 123 MPa compressive yield strength, 247 MPa ultimate compressive strength, and 22.9% compressive strain. Further, the 12.5% concentration extract of the ZMCs exhibited no cytotoxicity after cell culturing for 5 d toward SaOS2 cells.

Structure, Biodegradation, and In Vitro Bioactivity of Zn-1%Mg Alloy Strengthened by High-Pressure Torsion

The effect of high-pressure torsion (HPT) on the microstructure, phase composition, mechanical characteristics, degradation rate, and bioactive properties of the Zn-1%Mg alloy is studied. An ultrafine-grained (UFG) structure with an average grain size of α-Zn equal to 890 ± 26 nm and grains and subgrains of the Mg₂Zn₁₁ and MgZn₂ phases with a size of 50-100 nm are formed after HPT. This UFG structure leads to an increase in the ultimate tensile strength of the alloy by ~3 times with an increase in elongation to 6.3 ± 3.3% due to the formation of a basal texture. The study of corrosion resistance did not show a significant effect of HPT on the degradation rate of the alloy. In addition, no significant changes in the bioactivity of the alloy after HPT: hemolysis, cellular colonization and Escherichia coli growth inhibition.

Bioresorbable vascular metallic scaffolds: Current status and research trends

To combat the long-term side effects associated with present-generation drug-eluting stents and provide opportunities for repeat scaffolding of plaqued arteries and treatment of coarctation of the aorta in infants and children, a new generation of bioresorbable stents has been introduced. Stents made of bioresorbable materials are corroded and absorbed by the body after completing their task as vascular scaffolding, allowing the stented arteries to restore their normal function. The concept is achieved by engineering stents that retain mechanical properties and integrity for at least 6-12 months before being broken down, metabolized, and harmlessly excreted by the body, leaving the treated vessel with a healthy endothelium, normal vasomotion, and free of the implant. In this article, the authors briefly review the development status of bioresorbable materials for stenting applications, their mechanical properties, and behavior in the vascular environment. Emphasis is given to new materials and under-explored research directions including long-term biocompatibility and emerging designs of bioactive stents. The goal for next-generation bioresorbable metals is the controlled release of therapeutic metal ions that could eliminate the need for anti-inflammatory drug-eluting coatings, characteristic of current-generation biostable stent metal scaffolds.

Effects of Different Concentrations of BSA on In Vitro Corrosion Behavior of Pure Zinc in Artificial Plasma

When medical metallic materials are implanted in the body and come into contact with the body fluid environment, proteins will be rapidly adsorbed on the surface and affect the corrosion process of the material. Currently, there is no uniform understanding of the effect of protein adsorption on the corrosion behavior of materials due to the limitations of the nature of metal materials, protein concentrations, and different media environments. The effect of various bovine serum albumin (BSA) concentrations in artificial plasma (AP) on the corrosion behavior of pure Zn during 14 days of immersion was investigated in this research. The corrosion rate of pure Zn was slowed down by the addition of BSA, and the decelerating effect of lower protein concentration on the corrosion rate of Zn was more significant in the initial stage of immersion. With prolonging the immersion time, the corrosion rate of pure Zn in different media slowed down and stabilized, and the corrosion rates of pure Zn showed a decreasing trend with an increase of BSA concentration. Furthermore, the Langmuir adsorption isotherm model was utilized to study the relationship between the BSA concentration and corrosion behavior of pure Zn and to analyze the role of proteins in the degradation mechanism of pure Zn. This work could be useful for further exploration of potential clinical applications of zinc alloys.

Biocompatibility of Zinc Matrix Biodegradable Composites Reinforced by Graphene Nanosheets

As a new type of biodegradable implant material, zinc matrix composites have excellent potential in the application of biodegradable implants because of their better corrosion resistance than magnesium matrix materials. Our previous studies have shown that graphene nanosheet reinforced zinc matrix composites (Zn-GNS) prepared by spark plasma sintering (SPS) have good mechanical properties and suitable degradation rate. However, the biocompatibility of zinc matrix composites is still a problem of concern. The cytocompatibility and blood compatibility of pure zinc and Zn-GNS composites in vitro were studied. The results showed that Zn-GNS composites had acceptable toxicity to MG-63 human osteosarcoma cells. In addition, the hemolysis rate of pure zinc and its composites were less than 3%, which has no adverse effect on adhered platelets, and has good antithrombotic and antiadhesion platelets properties. In conclusion, the addition of GNS did not adversely affect the biocompatibility of Zn-GNS composites, which indicated that Zn-GNS composites are a promising candidate for bone implantation.

Improved biocompatibility of Zn-Ag-based stent materials by microstructure refinement

The metallurgical engineering of bioresorbable zinc (Zn)-based medical alloys would greatly benefit from clarification of the relationships between material properties and biological responses. Here we investigate the biocompatibility of three Zn-based silver (Ag)-containing alloys, ranging from binary to quinary alloy systems. Selected binary and quinary Zn-Ag-based alloys underwent solution treatment (ST) to increase the solubility of Ag-rich phases within the Zn bulk matrix, yielding two different microstructures (one without ST and a different one with ST) with the same elemental composition. This experimental design was intended to clarify the relationship between elemental profile/microstructure and biocompatibility for the Zn-Ag system. We found that the quinary alloy system (Zn-4Ag-0.8Cu-0.6Mn-0.15Zr) performed significantly better, in terms of histomorphometry, than any alloy system we have evaluated to date. Furthermore, when solution treated to increase strength and ductility and reduce the fraction of Ag-rich phases, the quinary alloy's biocompatibility further improved. In vitro corrosion testing and metallographic analysis of in vivo implants demonstrated a more uniform mode of corrosion for the solution treated alloy. We conclude that Zn-Ag alloys can be engineered through alloying to substantially reduce neointimal growth. The positive effect on neointimal growth can be further enhanced by dissolving the AgZn₃ precipitates in the Zn matrix to improve the corrosion uniformity. These findings demonstrate that neointimal-forming cells can be regulated by elemental additions and microstructural changes in degradable Zn-based implant materials. STATEMENT OF SIGNIFICANCE: The metallurgical engineering of bioresorbable zinc (Zn)-based medical alloys would greatly benefit from clarification of the relationships between material properties and biological responses. Here, selected binary and quinary Zn-Ag-based alloys underwent solution treatment (ST) to increase the solubility of Ag-rich phases within the Zn bulk matrix, yielding two different microstructures (one without ST and a different one with ST) with the same elemental composition. We found that applying a thermal treatment restores mechanical strength and mitigates the strain rate sensitivity of Zn-Ag alloys by dissolving AgZn₃ precipitates. Ag-rich nano-precipitates in Zn decrease biocompatibility, a phenomenon that can be counteracted by dissolving the AgZn₃ precipitates in the bulk Zn matrix.

Flow stress stabilization of Zn-Cu-Mn-Mg alloys using thermomechanical processing

Zinc-based alloys are potential candidates for bioabsorbable metallic devices due to their application-appropriate corrosion rates and biocompatibility. However, strain softening and rate sensitivity in tensile testing remain as challenges for their use in load bearing applications. In this study, three different Zn-xCu-yMn-0.05Mg (x = 0.5, 1.0 wt%, y = 0.4, 0.6 wt%) alloys were formulated and their microstructure and tensile properties in the room-temperature rolled condition were characterized. Additionally, the effect of short-time annealing at 320 °C on the strain softening and strain rate sensitivity of alloys was studied. The results indicate that dissolution of secondary phases and grain coarsening lead to the suppression of strain softening and strain rate sensitivity. The evolution of microstructure during the room-temperature tensile testing indicates that dynamic recrystallization is responsible for strain softening and can be eliminated by tuning the fraction of secondary phases and underlying grain size. The formulated alloys are not susceptible to natural aging and show good thermal stability during aging up to 200 °C for 60 h due to the pinning effect of MnZn13 precipitates on the grain boundaries.

Effects of Extrusion and Rolling Processes on the Microstructure and Mechanical Properties of Zn-Li-Ag Alloys

In this work, a novel Zn-0.5%Li-0.1%Ag alloy was cast and extruded into rods, which were rolled into a plate, and the effects of extrusion and rolling on the microstructure and mechanical properties of the Zn-0.5%Li-0.1%Ag alloy were evaluated. The results show that grain strengthening occurs in all of the alloys because of the presence of nano-LiZn4 precipitates. The extrusion and rolling processes promote grain size refinement and orientation order, and the microstructure and mechanical properties of the Zn-0.5%Li-0.1%Ag alloy can be significantly improved by secondary processing. The elastic modulus and tensile strength of the processed alloy increased to 83.1 GPa and 251.6 MPa, respectively, compared to 75.6 GPa and 185.8 MPa, respectively, for the as-cast Zn-0.5%Li-0.1%Ag alloy. More importantly, elongation was greatly improved, from 16.9% to 92.6%, which is an increase of up to 448%, and there were transgranular cleavage planes and intergranular cleavage planes in the fracture surfaces. The intergranular cleavage planes were dominant, and they showed ductile fracture characteristics.

Synthesis of Star 6-Arm Polyethylene Glycol-Heparin Copolymer to Construct Anticorrosive and Biocompatible Coating on Magnesium Alloy Surface

Magnesium alloy has become a research hotspot of the degradable vascular stent materials due to its biodegradability and excellent mechanical properties. However, its rapid degradation rate after implantation and the limited biocompatibility restrict its application in clinic. Constructing a multifunctional bioactive polymer coating on the magnesium alloys represents one of the popular and effective approaches to simultaneously improve the corrosion resistance and biocompatibility. In the present study, the copolymer of 6-arm polyethylene glycol and heparin (PEG-Hep) was successfully synthesized and then immobilized on the surface of chitosan (Chi)-modified magnesium alloy surface through electrostatic interaction to improve the corrosion resistance and biocompatibility. The results of attenuated total reflection Fourier transform infrared spectroscopy (ATR-FTIR), X-ray photoelectron spectroscopy (XPS) and scanning electron microscopy showed that a dense and compact coating was created on the magnesium alloy surface. The coating displayed excellent hydrophilicity. At the same time, the as-prepared coating can significantly not only improve the corrosion potential, reduce the corrosion current and the pH changes of the immersion solution, but also keep a relatively intact surface morphology after immersing in simulated body fluid solution for 14 days, demonstrating that the coating can significantly improve the corrosion resistance of the magnesium alloy. Moreover, the magnesium alloy with PEG-Hep coating exhibited excellent hemocompatibility according to the results of the hemolysis rate and platelet adhesion and activation. In addition, the modified magnesium alloy had a good ability to promote the endothelial cell adhesion and proliferation. Therefore, the PEG-Hep multifunctional coating can be applied in the surface modification of the biodegradable magnesium alloy stent to simultaneously improve the corrosion resistance and biocompatibility.

Influences of Stent Design on In-Stent Restenosis and Major Cardiac Outcomes: A Scoping Review and Meta-Analysis

Thanks to the developments in implantable biomaterial technologies, invasive operating procedures, and widespread applications especially in vascular disease treatment, a milestone for interventional surgery was achieved with the introduction of vascular stents. Despite vascular stents providing a solution for embolisms, this technology includes various challenges, such as mechanical, electro-chemical complications, or in-stent restenosis (ISR) risks with long-term usage. Therefore, further development of biomaterial technologies is vital to overcome such risks and problems. For this purpose, recent research has focused mainly on the applications of surface modification techniques on biomaterials and vascular stents to increase their hemocompatibility. ISR risk has been reduced with the development and prevalent usage of the art technology stent designs of drug-eluting and biodegradable stents. Nevertheless, their problems have not been overcome completely. Furthermore, patients using drug-eluting stents are faced with further clinical challenges. Therefore, the bare metal stent, which is the first form of the vascular stent technology and includes the highest ISR risk, is still in common usage for vascular treatment applications. For this reason, further research is necessary to solve the remaining vital problems. In this scoping review, stent-based major cardiac events including ISR are analyzed depending on different designs and material selection in stent manufacturing. Recent and novel approaches to overcome such challenges are stated in detail.

Mechanical Analysis and Corrosion Analysis of Zinc Alloys for Bioabsorbable Implants for Osteosynthesis

Zinc alloys have recently been researched intensely for their great properties as bioabsorbable implants for osteosynthesis. Pure zinc (Zn) itself has relatively poor strength, which makes it insufficient for most clinical use. Research has already proven that the mechanical strength of zinc can be enhanced significantly by alloying it with silver. This study evaluated zinc silver alloys (ZnAg) as well as novel zinc silver titanium alloys (ZnAgTi) regarding their mechanical properties for the use as bioabsorbable implants. Compared to pure zinc the mechanical strength was enhanced significantly for all tested zinc alloys. The elastic properties were only enhanced significantly for the zinc silver alloys ZnAg6 and ZnAg9. Regarding target values for orthopedic implants proposed in literature, the best mechanical properties were measured for the ZnAg3Ti1 alloy with an ultimate tensile strength of 262 MPa and an elongation at fracture of 16%. Besides the mechanical properties, the corrosion rates are important for bioabsorbable implants. This study tested the corrosion rates of zinc alloys in PBS solution (phosphate buffered solution) with electrochemical corrosion measurement. Zinc and its alloys showed favorable corrosion rates, especially in comparison to magnesium, which has a much lower degradation rate and no buildup of hydrogen gas pockets during the process. Altogether, this makes zinc alloys highly favorable for use as material for bioabsorbable implants for osteosynthesis.

Preparation of medical Mg-Zn alloys and the effect of different zinc contents on the alloy

In recent years, along with the development and application of magnesium alloys, magnesium alloys have been widely used in automotive, aerospace, medicine, sports, and other fields. In the field of medical materials, magnesium not only has the advantage of light weight, high strength, and a density similar to that of human bone, but also has good biocompatibility and promotes the growth of human bone. However, the mechanical properties and corrosion resistance of magnesium alloys need to be further improved to meet the requirements for human biodegradable implants. In this study, three alloys (mass fractions: Mg-10Zn, Mg-20Zn, and Mg-30Zn (wt.%)) were prepared using powder metallurgy by homogeneously mixing powders of the above materials in a certain amount with magnesium as the substrate through the addition of zinc elements, which also have good biocompatibility. The effect of zinc on the microstructure, mechanical properties, wear performance, and corrosion resistance of magnesium-zinc alloys was studied when the zinc content was different. The results show that compared with the traditional magnesium alloy using powder metallurgy, prepared magnesium alloy has good resistance to compression and bending, its maximum compressive stress can reach up to 318.96 MPa, the maximum bending strength reached 189.41 MPa, and can meet the mechanical properties of the alloy as a human bone-plate requirements. On the polarization curve, the maximum positive shift of corrosion potential of the specimens was 73 mv and the maximum decrease of corrosion-current density was 53.2%. From the comparison of the above properties, it was concluded that the three prepared alloys of which Mg-20% Zn had the best overall performance. Its maximum compressive stress, maximum bending strength, and corrosion-current density reached 318.96 MPa, 189.41 MPa and 2.08 × 10^-5 A·cm^-2 respectively, which are more suitable for use as human implant bone splints in human-body fluid environment. The mechanical properties of the sintered Mg-Zn alloys were analyzed using powder-metallurgy techniques, and their microstructure, micromotion wear properties, electrochemical corrosion properties and composition of the physical phases were analyzed and discussed.

A review on current research status of the surface modification of Zn-based biodegradable metals

Recently, zinc and its alloys have been proposed as promising candidates for biodegradable metals (BMs), owning to their preferable corrosion behavior and acceptable biocompatibility in cardiovascular, bone and gastrointestinal environments, together with Mg-based and Fe-based BMs. However, there is the desire for surface treatment for Zn-based BMs to better control their biodegradation behavior. Firstly, the implantation of some Zn-based BMs in cardiovascular environment exhibited intimal activation with mild inflammation. Secondly, for orthopedic applications, the biodegradation rates of Zn-based BMs are relatively slow, resulting in a long-term retention after fulfilling their mission. Meanwhile, excessive Zn2+ release during degradation will cause in vitro cytotoxicity and in vivo delayed osseointegration. In this review, we firstly summarized the current surface modification methods of Zn-based alloys for the industrial applications. Then we comprehensively summarized the recent progress of biomedical bulk Zn-based BMs as well as the corresponding surface modification strategies. Last but not least, the future perspectives towards the design of surface bio-functionalized coatings on Zn-based BMs for orthopedic and cardiovascular applications were also briefly proposed.

Zinc-nutrient element based alloys for absorbable wound closure devices fabrication: Current status, challenges, and future prospects

The need for the development of load-bearing, absorbable wound closure devices is driving the research for novel materials that possess both good biodegradability and superior mechanical characteristics. Biodegradable metals (BMs), namely: magnesium (Mg), zinc (Zn) and iron (Fe), which are currently being investigated for absorbable vascular stent and orthopaedic implant applications, are slowly gaining research interest for the fabrication of wound closure devices. The current review presents an overview of the traditional and novel BM-based intracutaneous and transcutaneous wound closure devices, and identifies Zn as a promising substitute for the traditional materials used in the fabrication of absorbable load-bearing sutures, internal staples, and subcuticular staples. In order to further strengthen Zn to be used in highly stressed situations, nutrient elements (NEs), including calcium (Ca), Mg, Fe, and copper (Cu), are identified as promising alloying elements for the strengthening of Zn-based wound closure device material that simultaneously provide potential therapeutic benefit to the wound healing process during implant biodegradation process. The influence of NEs on the fundamental characteristics of biodegradable Zn are reviewed and critically assessed with regard to the mechanical properties and biodegradability requirements of different wound closure devices. The opportunities and challenges in the development of Zn-based wound closure device materials are presented to inspire future research on this rapidly growing field.

Advances in coatings on magnesium alloys for cardiovascular stents - A review

Magnesium (Mg) and its alloys, as potential biodegradable materials, have drawn wide attention in the cardiovascular stent field because of their appropriate mechanical properties and biocompatibility. Nevertheless, the occurrence of thrombosis, inflammation, and restenosis of implanted Mg alloy stents caused by their poor corrosion resistance and insufficient endothelialization restrains their anticipated clinical applications. Numerous surface treatment tactics have mainly striven to modify the Mg alloy for inhibiting its degradation rate and enduing it with biological functionality. This review focuses on highlighting and summarizing the latest research progress in functionalized coatings on Mg alloys for cardiovascular stents over the last decade, regarding preparation strategies for metal oxide, metal hydroxide, inorganic nonmetallic, polymer, and their composite coatings; and the performance of these strategies in regulating degradation behavior and biofunction. Potential research direction is also concisely discussed to help guide biological functionalized strategies and inspire further innovations. It is hoped that this review can give assistance to the surface modification of cardiovascular Mg-based stents and promote future advancements in this emerging research field.

Bioabsorbable metal zinc differentially affects mitochondria in vascular endothelial and smooth muscle cells

Zinc is an essential trace element having various structural, catalytic and regulatory interactions with an estimated 3000 proteins. Zinc has drawn recent attention for its use, both as pure metal and alloyed, in arterial stents due to its biodegradability, biocompatibility, and low corrosion rates. Previous studies have demonstrated that zinc metal implants prevent the development of neointimal hyperplasia, which is a common cause of restenosis following coronary intervention. This suppression appears to be smooth muscle cell-specific, as reendothelization of the neointima is not inhibited. To better understand the basis of zinc's differential effects on rat aortic smooth muscle (RASMC) versus endothelial (RAENDO) cells, we conducted a transcriptomic analysis of both cell types following one-week continuous treatment with 5 µM or 50 µM zinc. This analysis indicated that genes whose protein products regulate mitochondrial functions, including oxidative phosphorylation and fusion/fission, are differentially affected by zinc in the two cell types. To better understand this, we performed Seahorse metabolic flux assays and quantitative imaging of mitochondrial networks in both cell types. Zinc treatment differently affected energy metabolism and mitochondrial structure/function in the two cell types. For example, both basal and maximal oxygen consumption rates were increased by zinc in RASMC but not in RAENDO. Zinc treatment increased apparent mitochondrial fusion in RASMC cells but increased mitochondrial fission in RAENDO cells. These results provide some insight into the mechanisms by which zinc treatment differently affects the two cell types and this information is important for understanding the role of zinc treatment in vascular cells and improving its use in biodegradable metal implants.

Electrodeposited dopamine/strontium-doped hydroxyapatite composite coating on pure zinc for anti-corrosion, antimicrobial and osteogenesis

Zinc-based biometal is expected to become a new generation of biodegradable implants. Due to its antibacterial and biocompatibility in vivo, zinc metals is recently considered to be the most promising biodegradable metal, However, cytotoxicity is the thorny problem that currently restrict its application, due to the excessive Zn ions released during degradation. In order to solve these problems, dopamine modified strontium-doped hydroxyapatite coating (SrHA/PDA) was fabricated on alkali-treated pure zinc to improve its corrosion rate and cytocompatibility by electrodeposition for the first time. The obtained coating showed a dense structure and high crystallinity, which was attributed to the attraction of Ca²⁺ ions by polydopamine. The results showed that the SrHA/PDA coating delayedthe degradation rate of zinc metal, which reduced the release of Zn²⁺, thereby reducing its cytotoxicity. Additionally, electrochemical tests showed that SrHA/PDA coating can reduce the corrosion rate of pure zinc. In vitro cell viability showed that even at high Zn²⁺ concentrations (3.11 mg/L), preosteoblasts (MC3T3-E1) cells proliferated at a high rate on SrHA/PDA, thus confirming that Sr²⁺ counteracted the cytotoxic effects of Zn²⁺ and promoted cell differentiation. Moreover, the SrHA/PDA coating still maintained excellent antibacterial effects against pathogenic bacterial strains (Escherichia coli and Staphylococcus aureus). Mild pH changes had no significant effect on the viability of cells and bacterias. Collectively, the present study elucidated that by coating SrHA/PDA/Zn(OH)₂ on Zn, a controllable corrosion rate, original antibacterial properties and better cell compatibility can be achieved. This provided a new strategy for the surface modification of biodegradable Zn.

Antibacterial metals and alloys for potential biomedical implants

Metals and alloys, including stainless steel, titanium and its alloys, cobalt alloys, and other metals and alloys have been widely used clinically as implant materials, but implant-related infection or inflammation is still one of the main causes of implantation failure. The bacterial infection or inflammation that seriously threatens human health has already become a worldwide complaint. Antibacterial metals and alloys recently have attracted wide attention for their long-term stable antibacterial ability, good mechanical properties and good biocompatibility in vitro and in vivo. In this review, common antibacterial alloying elements, antibacterial standards and testing methods were introduced. Recent developments in the design and manufacturing of antibacterial metal alloys containing various antibacterial agents were described in detail, including antibacterial stainless steel, antibacterial titanium alloy, antibacterial zinc and alloy, antibacterial magnesium and alloy, antibacterial cobalt alloy, and other antibacterial metals and alloys. Researches on the antibacterial properties, mechanical properties, corrosion resistance and biocompatibility of antibacterial metals and alloys have been summarized in detail for the first time. It is hoped that this review could help researchers understand the development of antibacterial alloys in a timely manner, thereby could promote the development of antibacterial metal alloys and the clinical application.

Recent advances and directions in the development of bioresorbable metallic cardiovascular stents: Insights from recent human and in vivo studies

Over the past two decades, significant advancements have been made regarding the material formulation, iterative design, and clinical translation of metallic bioresorbable stents. Currently, magnesium-based (Mg) stent devices have remained at the forefront of bioresorbable stent material development and use. Despite substantial advances, the process of developing novel absorbable stents and their clinical translation is time-consuming, expensive, and challenging. These challenges, coupled with the continuous refinement of alternative bioresorbable metallic bulk materials such as iron (Fe) and zinc (Zn), have intensified the search for an ideal absorbable metallic stent material. Here, we discuss the most recent pre-clinical and clinical evidence for the efficacy of bioresorbable metallic stents and material candidates. From this perspective, strategies to improve the clinical performance of bioresorbable metallic stents are considered and critically discussed, spanning material alloy development, surface manipulations, material processing techniques, and preclinical/biological testing considerations. STATEMENT OF SIGNIFICANCE: Recent efforts in using Mg, Fe, and Zn based materials for bioresorbable stents include elemental profile changes as well as surface modifications to improve each of the three classes of materials.  Although a variety of alloys for absorbable metallic stents have been developed, the ideal absorbable stent material has not yet been discovered. This review focuses on the state of the art for bioresorbable metallic stent development. It covers the three bulk materials used for degradable stents (Mg, Fe, and Zn), and discusses their advances from a translational perspective. Strategies to improve the clinical performance of bioresorbable metallic stents are considered and critically discussed, spanning material alloy development, surface manipulations, material processing techniques, and preclinical/biological testing considerations.

Cardiovascular Stents: A Review of Past, Current, and Emerging Devices

One of the leading causes of morbidity and mortality worldwide is coronary artery disease, a condition characterized by the narrowing of the artery due to plaque deposits. The standard of care for treating this disease is the introduction of a stent at the lesion site. This life-saving tubular device ensures vessel support, keeping the blood-flow path open so that the cardiac muscle receives its vital nutrients and oxygen supply. Several generations of stents have been iteratively developed towards improving patient outcomes and diminishing adverse side effects following the implanting procedure. Moving from bare-metal stents to drug-eluting stents, and recently reaching bioresorbable stents, this research field is under continuous development. To keep up with how stent technology has advanced in the past few decades, this paper reviews the evolution of these devices, focusing on how they can be further optimized towards creating an ideal vascular scaffold.

Biodegradable ZnLiCa ternary alloys for critical-sized bone defect regeneration at load-bearing sites: In vitro and in vivo studies

A novel biodegradable metal system, ZnLiCa ternary alloys, were systematically investigated both in vitro and in vivo. The ultimate tensile strength (UTS) of Zn0.8Li0.1Ca alloy reached 567.60 ± 9.56 MPa, which is comparable to pure Ti, one of the most common material used in orthopedics. The elongation of Zn0.8Li0.1Ca is 27.82 ± 18.35%, which is the highest among the ZnLiCa alloys. The in vitro degradation rate of Zn0.8Li0.1Ca alloy in simulated body fluid (SBF) showed significant acceleration than that of pure Zn. CCK-8 tests and hemocompatibility tests manifested that ZnLiCa alloys exhibit good biocompatibility. Real-time PCR showed that Zn0.8Li0.1Ca alloy successfully stimulated the expressions of osteogenesis-related genes (ALP, COL-1, OCN and Runx-2), especially the OCN. An in vivo implantation was conducted in the radius of New Zealand rabbits for 24 weeks, aiming to treat the bone defects. The Micro-CT and histological evaluations proved that the regeneration of bone defect was faster within the Zn0.8Li0.1Ca alloy scaffold than the pure Ti scaffold. Zn0.8Li0.1Ca alloy showed great potential to be applied in orthopedics, especially in the load-bearing sites.

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The first research work of ZnLiCa alloys to be used as biodegradable metals.

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The ultimate tensile strength (UTS) of Zn0.8Li0.1Ca alloy reached 567.60 ± 9.56 MPa, which is comparable to pure Ti, one of the most common material used in orthopedics.

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Porous scaffolds made of Zn0.8Li0.1Ca showed superior bone-defect-treating effects to pure Ti scaffolds in New Zealand rabbits.

In vitro and in vivo studies to evaluate the feasibility of Zn-0.1Li and Zn-0.8Mg application in the uterine cavity microenvironment compared to pure zinc

Significant advances have been achieved in the research evaluating Zn and its alloys as degradable metallic biomaterials mainly for application in bone and blood vessels. In the present study, the degradation behaviors of Zn-0.1Li and Zn-0.8Mg alloys in simulated uterine fluid (SUF) were systematically investigated for 300 days. In vitro viability assays were conducted in different uterine cells (HUSMCs, HEECs, and HESCs), and histological examination after the in vivo implantation into the uterine cavity was performed using pure Zn as control. The immersion test results indicated that both Zn-0.1Li and Zn-0.8Mg alloys exhibited better corrosion resistance than pure Zn, with Zn₃(PO₄)₂⋅4H₂O and CaZn₂(PO₄)₂⋅2H₂O being the main corrosion products detected in the SUF in addition to ZnO. The cell cytotoxicity assays revealed that Zn-0.1Li and Zn-0.8Mg exhibited better cytocompatibility than Zn. Moreover, the in vivo experiments demonstrated that the Zn-0.1Li and Zn-0.8Mg alloys induced less inflammation in the uterine tissue than pure Zn, with CaCO₃ and Zn(HPO₄)⋅3H₂O being the major biocorrosion products in addition to ZnO. According to these results, zinc alloys appear to be suitable potential candidate materials for future intrauterine biomedical devices.