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Jiang C, Zhu G, Liu Q. Current application and future perspectives of antimicrobial degradable bone substitutes for chronic osteomyelitis. Front Bioeng Biotechnol 2024; 12:1375266. [PMID: 38600942 PMCID: PMC11004352 DOI: 10.3389/fbioe.2024.1375266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Accepted: 03/19/2024] [Indexed: 04/12/2024] Open
Abstract
Chronic osteomyelitis remains a persistent challenge for the surgeons due to its refractory nature. Generally, treatment involves extensive debridement of necrotic bone, filling of dead space, adequate antimicrobial therapy, bone reconstruction, and rehabilitation. However, the optimal choice of bone substitute to manage the bone defect remains debatable. This paper reviewed the clinical evidence for antimicrobial biodegradable bone substitutes in the treatment of osteomyelitis in recent years. Indeed, this combination was proved to eradicate infection and facilitate bone reconstruction, which might reduce the cost and hospital stay. Handling was associated with increased risk of unwanted side effect to affect bone healing. The study provides some valuable insights into the clinical evaluation of treatment outcomes in the aspects of infection eradication, bone reconstruction, and complications caused by materials. However, achieving complete infection eradication and subsequently perfect bone reconstruction remains challenging in compromised conditions, hence advanced innovative bone substitutes are imperative. In this review, we mainly focus on the desired functional effects of advanced bone substitutes on infection eradication and bone reconstruction from the future perspective. Handling property was optimized to simplify surgery process. It is expected that this review will provide an important opportunity to enhance the understanding of the design and application of innovative biomaterials to synergistically eradicate infection and restore integrity and function of bone.
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Affiliation(s)
- Chenxi Jiang
- Department of Stomatology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- School of Stomatology, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Hubei Province Key Laboratory of Oral and Maxillofacial Development and Regeneration, Wuhan, China
| | - Guangxun Zhu
- School of Stomatology, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Hubei Province Key Laboratory of Oral and Maxillofacial Development and Regeneration, Wuhan, China
- Department of Stomatology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Qian Liu
- Department of Stomatology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- School of Stomatology, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Hubei Province Key Laboratory of Oral and Maxillofacial Development and Regeneration, Wuhan, China
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2
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Tian Y, Sun R, Li Y, Liu P, Fan B, Xue Y. Research progress on the application of magnesium phosphate bone cement in bone defect repair: A review. Biomed Mater Eng 2024; 35:265-278. [PMID: 38728179 DOI: 10.3233/bme-230164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/12/2024]
Abstract
BACKGROUND Bone defects arising from diverse causes, such as traffic accidents, contemporary weapon usage, and bone-related disorders, present significant challenges in clinical treatment. Prolonged treatment cycles for bone defects can result in complications, impacting patients' overall quality of life. Efficient and timely repair of bone defects is thus a critical concern in clinical practice. OBJECTIVE This study aims to assess the scientific progress and achievements of magnesium phosphate bone cement (MPC) as an artificial bone substitute material. Additionally, the research seeks to explore the future development path and clinical potential of MPC bone cement in addressing challenges associated with bone defects. METHODS The study comprehensively reviews MPC's performance, encompassing e.g. mechanical properties, biocompatibility, porosity, adhesion and injectability. Various modifiers are also considered to broaden MPC's applications in bone tissue engineering, emphasizing drug-loading performance and antibacterial capabilities, which meet clinical diversification requirements. RESULTS In comparison to alternatives such as autogenous bone transplantation, allograft, polymethyl methacrylate (PMMA), and calcium phosphate cement (CPC), MPC emerges as a promising solution for bone defects. It addresses limitations associated with these alternatives, such as immunological rejection and long-term harm to patients. MPC can control heat release during the curing process, exhibits superior mechanical strength, and has the capacity to stimulate new bone growth. CONCLUSION MPC stands out as an artificial bone substitute with appropriate mechanical strength, rapid degradation, non-toxicity, and good biocompatibility, facilitating bone repair and regeneration. Modification agents can enhance its clinical versatility. Future research should delve into its mechanical properties and formulations, expanding clinical applications to create higher-performing and more medically valuable alternatives in bone defect repair.
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Affiliation(s)
- Yongzheng Tian
- 940 Hospital of People's Liberation Army Joint Service Support Force, Lanzhou, China
- Gansu University of Traditional Chinese Medicine, Lanzhou, China
| | - Ruilong Sun
- 940 Hospital of People's Liberation Army Joint Service Support Force, Lanzhou, China
- Gansu University of Traditional Chinese Medicine, Lanzhou, China
| | - Yunfei Li
- 940 Hospital of People's Liberation Army Joint Service Support Force, Lanzhou, China
- Gansu University of Traditional Chinese Medicine, Lanzhou, China
| | - Peng Liu
- 940 Hospital of People's Liberation Army Joint Service Support Force, Lanzhou, China
- Gansu University of Traditional Chinese Medicine, Lanzhou, China
| | - Bo Fan
- 940 Hospital of People's Liberation Army Joint Service Support Force, Lanzhou, China
| | - Yun Xue
- 940 Hospital of People's Liberation Army Joint Service Support Force, Lanzhou, China
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3
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Ribeiro MEA, Huaman NRC, Folly MM, Gomez JGC, Sánchez Rodríguez RJ. A potential hybrid nanocomposite of poly(3-hydroxybutyrate-co-3-hydroxyvalerate) and fullerene for bone tissue regeneration and sustained drug release against bone infections. Int J Biol Macromol 2023; 251:126531. [PMID: 37634778 DOI: 10.1016/j.ijbiomac.2023.126531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2023] [Revised: 08/23/2023] [Accepted: 08/24/2023] [Indexed: 08/29/2023]
Abstract
Developing a multifunctional biomaterial for bone filling and local antibiotic therapy is a complex challenge for bone tissue engineering. Hybrid nanocomposites of poly(3-hydroxybutyrate-co-3-hydroxyvalerate) (PHBHV) with nanohydroxyapatite (nHA), fullerene (C60), and vancomycin (VC) were produced by injection. Fullerene was successfully impregnated with VC, as seen in FTIR. The crystallinity degree of PHBHV was slightly reduced in the presence of C60 and VC (64.3 versus 60.8 %), due to the plasticizing effect of these particles. It also resulted in a decrease in the glass transition temperature (Tg), observed by differential scanning calorimetry (DSC). Dense PHBHV/nHA/C60/VC had a flexural elastic modulus 29 % higher than PHBHV, as a result of the good interface between PHBHV, C60, and nHA - particles of high elastic modulus. Dense disks released 25.03 ± 4.27 % of VC for 14 days, which demonstrated its potential to be an alternative treatment to bone infections. Porous scaffolds of PHBHV/nHA/C60/VC were 3D printed with a porosity of 50 % and porous size of 467 ± 70 μm, and had compression elastic modulus of 0.022 GPa, being a promising material to trabecular bone replacement. The plasticizing effect of C60 improved the printability of the material. The hybrid nanocomposite was non-cytotoxic and showed good ability in adhering macrophage cells.
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Affiliation(s)
- Maria Eduarda Araújo Ribeiro
- Advanced Materials Laboratory - LAMAV, Universidade Estadual do Norte Fluminense Darcy Ribeiro, Avenida Alberto Lamego, 2000, Parque Califórnia, 28015-620 Campos dos Goytacazes, RJ, Brazil.
| | | | - Márcio Manhães Folly
- Animal Health Laboratory, Universidade Estadual do Norte Fluminense Darcy Ribeiro, Avenida Alberto Lamego, 2000, Parque Califórnia, Campos dos Goytacazes, RJ, Brazil
| | | | - Rubén J Sánchez Rodríguez
- Advanced Materials Laboratory - LAMAV, Universidade Estadual do Norte Fluminense Darcy Ribeiro, Avenida Alberto Lamego, 2000, Parque Califórnia, 28015-620 Campos dos Goytacazes, RJ, Brazil
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4
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Kaiser F, Schröter L, Wohlfahrt P, Geroneit I, Murek J, Stahlhut P, Weichhold J, Ignatius A, Gbureck U. Exploring the potential of magnesium oxychloride, an amorphous magnesium phosphate, and newberyite as possible bone cement candidates. J Biomater Appl 2023; 38:438-454. [PMID: 37525613 PMCID: PMC10494481 DOI: 10.1177/08853282231190908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/02/2023]
Abstract
Magnesium phosphate-based bone cements, particularly struvite (MgNH4PO4∙6H2O)-forming cements, have attracted increased scientific interest in recent years because they exhibit similar biocompatibility to hydroxyapatite while degrading much more rapidly in vivo. However, other magnesium-based minerals which might be promising are, to date, little studied. Therefore, in this study, we investigated three magnesium-based bone cements: a magnesium oxychloride cement (Mg3(OH)5Cl∙4H2O), an amorphous magnesium phosphate cement based on Mg3(PO4)2, MgO, and NaH2PO4, and a newberyite cement (MgHPO4·3H2O). Because it is not sufficiently clear from the literature to what extent these cements are suitable for clinical use, all of them were characterized and optimized regarding setting time, setting temperature, compressive strength and passive degradation in phosphate-buffered saline. Because the in vitro properties of the newberyite cement were most promising, it was orthotopically implanted into a partially weight-bearing tibial bone defect in sheep. The cement exhibited excellent biocompatibility and degraded more rapidly compared to a hydroxyapatite reference cement; after 4 months, 18% of the cement was degraded. We conclude that the newberyite cement was the most promising candidate of the investigated cements and has clear advantages over calcium phosphate cements, especially in terms of setting time and degradation behavior.
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Affiliation(s)
- Friederike Kaiser
- Department for Functional Materials in Medicine and Dentistry, University Hospital Würzburg, Würzburg, Germany
| | - Lena Schröter
- Institute of Orthopedic Research and Biomechanics, Ulm University Medical Center, Ulm, Germany
| | - Philipp Wohlfahrt
- Department for Functional Materials in Medicine and Dentistry, University Hospital Würzburg, Würzburg, Germany
| | - Isabel Geroneit
- Department for Functional Materials in Medicine and Dentistry, University Hospital Würzburg, Würzburg, Germany
| | - Jérôme Murek
- Department for Functional Materials in Medicine and Dentistry, University Hospital Würzburg, Würzburg, Germany
| | - Philipp Stahlhut
- Department for Functional Materials in Medicine and Dentistry, University Hospital Würzburg, Würzburg, Germany
| | - Jan Weichhold
- Department for Functional Materials in Medicine and Dentistry, University Hospital Würzburg, Würzburg, Germany
| | - Anita Ignatius
- Institute of Orthopedic Research and Biomechanics, Ulm University Medical Center, Ulm, Germany
| | - Uwe Gbureck
- Department for Functional Materials in Medicine and Dentistry, University Hospital Würzburg, Würzburg, Germany
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Lukina Y, Safronova T, Smolentsev D, Toshev O. Calcium Phosphate Cements as Carriers of Functional Substances for the Treatment of Bone Tissue. MATERIALS (BASEL, SWITZERLAND) 2023; 16:4017. [PMID: 37297151 PMCID: PMC10254876 DOI: 10.3390/ma16114017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Revised: 05/14/2023] [Accepted: 05/23/2023] [Indexed: 06/12/2023]
Abstract
Interest in calcium phosphate cements as materials for the restoration and treatment of bone tissue defects is still high. Despite commercialization and use in the clinic, the calcium phosphate cements have great potential for development. Existing approaches to the production of calcium phosphate cements as drugs are analyzed. A description of the pathogenesis of the main diseases of bone tissue (trauma, osteomyelitis, osteoporosis and tumor) and effective common treatment strategies are presented in the review. An analysis of the modern understanding of the complex action of the cement matrix and the additives and drugs distributed in it in relation to the successful treatment of bone defects is given. The mechanisms of biological action of functional substances determine the effectiveness of use in certain clinical cases. An important direction of using calcium phosphate cements as a carrier of functional substances is the volumetric incorporation of anti-inflammatory, antitumor, antiresorptive and osteogenic functional substances. The main functionalization requirement for carrier materials is prolonged elution. Various release factors related to the matrix, functional substances and elution conditions are considered in the work. It is shown that cements are a complex system. Changing one of the many initial parameters in a wide range changes the final characteristics of the matrix and, accordingly, the kinetics. The main approaches to the effective functionalization of calcium phosphate cements are considered in the review.
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Affiliation(s)
- Yulia Lukina
- National Medical Research Center for Traumatology and Orthopedics Named after N.N. Priorov, Ministry of Health of the Russian Federation, Priorova 10, 127299 Moscow, Russia;
- Faculty of Digital Technologies and Chemical Engineering, Mendeleev University of Chemical Technology of Russia, Miusskaya pl. 9, 125047 Moscow, Russia
| | - Tatiana Safronova
- Department of Chemistry, Lomonosov Moscow State University, Building 3, Leninskie Gory 1, 119991 Moscow, Russia;
- Department of Materials Science, Lomonosov Moscow State University, Building 73, Leninskie Gory 1, 119991 Moscow, Russia;
| | - Dmitriiy Smolentsev
- National Medical Research Center for Traumatology and Orthopedics Named after N.N. Priorov, Ministry of Health of the Russian Federation, Priorova 10, 127299 Moscow, Russia;
| | - Otabek Toshev
- Department of Materials Science, Lomonosov Moscow State University, Building 73, Leninskie Gory 1, 119991 Moscow, Russia;
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Han Z, Wang B, Ren B, Liu Y, Zhang N, Wang Z, Liu J, Mao K. Characterization and Biomechanical Study of a Novel Magnesium Potassium Phosphate Cement. LIFE (BASEL, SWITZERLAND) 2022; 12:life12070997. [PMID: 35888086 PMCID: PMC9320010 DOI: 10.3390/life12070997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 06/28/2022] [Accepted: 06/30/2022] [Indexed: 11/26/2022]
Abstract
Magnesium potassium phosphate cement (MKPC) has attracted considerable attention as a bone regeneration material. However, there are only a few reports on its biomechanical properties. To evaluate the biomechanical properties of MKPC, we compared the mechanical parameters of pedicle screws enhanced with either MKPC or polymethyl methacrylate (PMMA) bone cement. The results show that the maximum pull-out force of the pedicle screws was 417.86 ± 55.57 and 444.43 ± 19.89 N after MKPC cement setting for 30 min and 12 h, respectively, which was better than that of the PMMA cement. In fatigue tests, the maximum pull-out force of the MKPC cement group was 435.20 ± 7.96 N, whereas that of the PMMA cement in the control group was 346.80 ± 7.66 N. Furthermore, the structural characterization analysis of the MKPC cement revealed that its microstructure after solidification was an irregular tightly packed crystal, which improved the mechanical strength of the cement. The maximum exothermic temperature of the MKPC reaction was 45.55 ± 1.35 °C, the coagulation time was 7.89 ± 0.37 min, and the compressive strength was 48.29 ± 4.76 MPa, all of which meet the requirements of clinical application. In addition, the MKPC cement did not significantly inhibit cell proliferation or increase apoptosis, thus indicating good biocompatibility. In summary, MKPC exhibited good biomechanical properties, high initial strength, good biocompatibility, and low exothermic reaction temperature, demonstrating an excellent application potential in the field of orthopedics.
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Affiliation(s)
- Zhenchuan Han
- Chinese PLA Medical School, Beijing 100853, China; (Z.H.); (B.R.)
- Senior Department of Orthopedics, The Fourth Medical Centre of Chinese PLA General Hospital, Beijing 100089, China; (Y.L.); (Z.W.)
- Department of Orthopedics, Chinese PLA Rocket Force Characteristic Medical Center, Beijing 100088, China;
| | - Bo Wang
- Department of Orthopedics, Beijing Jishuitan Hospital, Beijing 100035, China;
| | - Bowen Ren
- Chinese PLA Medical School, Beijing 100853, China; (Z.H.); (B.R.)
| | - Yihao Liu
- Senior Department of Orthopedics, The Fourth Medical Centre of Chinese PLA General Hospital, Beijing 100089, China; (Y.L.); (Z.W.)
| | - Nan Zhang
- Department of Orthopedics, Chinese PLA Rocket Force Characteristic Medical Center, Beijing 100088, China;
| | - Zheng Wang
- Senior Department of Orthopedics, The Fourth Medical Centre of Chinese PLA General Hospital, Beijing 100089, China; (Y.L.); (Z.W.)
| | - Jianheng Liu
- Senior Department of Orthopedics, The Fourth Medical Centre of Chinese PLA General Hospital, Beijing 100089, China; (Y.L.); (Z.W.)
- Correspondence: (J.L.); (K.M.)
| | - Keya Mao
- Senior Department of Orthopedics, The Fourth Medical Centre of Chinese PLA General Hospital, Beijing 100089, China; (Y.L.); (Z.W.)
- Correspondence: (J.L.); (K.M.)
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Fuchs A, Kreczy D, Brückner T, Gbureck U, Stahlhut P, Bengel M, Hoess A, Nies B, Bator J, Klammert U, Linz C, Ewald A. Bone regeneration capacity of newly developed spherical magnesium phosphate cement granules. Clin Oral Investig 2021; 26:2619-2633. [PMID: 34686919 PMCID: PMC8898248 DOI: 10.1007/s00784-021-04231-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Accepted: 10/13/2021] [Indexed: 01/27/2023]
Abstract
OBJECTIVES Magnesium phosphate-based cements begin to catch more attention as bone substitute materials and especially as alternatives for the more commonly used calcium phosphates. In bone substitutes for augmentation purposes, atraumatic materials with good biocompatibility and resorbability are favorable. In the current study, we describe the in vivo testing of novel bone augmentation materials in form of spherical granules based on a calcium-doped magnesium phosphate (CaMgP) cement. MATERIALS AND METHODS Granules with diameters between 500 and 710 μm were fabricated via the emulsification of CaMgP cement pastes in a lipophilic liquid. As basic material, two different CaMgP formulations were used. The obtained granules were implanted into drill hole defects at the distal femoral condyle of 27 New Zealand white rabbits for 6 and 12 weeks. After explantation, the femora were examined via X-ray diffraction analysis, histological staining, radiological examination, and EDX measurement. RESULTS Both granule types display excellent biocompatibility without any signs of inflammation and allow for proper bone healing without the interposition of connective tissue. CaMgP granules show a fast and continuous degradation and enable fully adequate bone regeneration. CONCLUSIONS Due to their biocompatibility, their degradation behavior, and their completely spherical morphology, these CaMgP granules present a promising bone substitute material for bone augmentation procedures, especially in sensitive areas. CLINICAL RELEVANCE The mostly insufficient local bone supply after tooth extractions complicates prosthetic dental restoration or makes it even impossible. Therefore, bone augmentation procedures are oftentimes inevitable. Spherical CaMgP granules may represent a valuable bone replacement material in many situations.
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Affiliation(s)
- Andreas Fuchs
- Department of Oral & Maxillofacial Plastic Surgery, University Hospital Würzburg, Pleicherwall 2, 97070, Würzburg, Germany.
| | - Dorothea Kreczy
- Department for Functional Materials in Medicine and Dentistry, University Hospital Würzburg, Pleicherwall 2, 97070, Würzburg, Germany
| | - Theresa Brückner
- Department for Functional Materials in Medicine and Dentistry, University Hospital Würzburg, Pleicherwall 2, 97070, Würzburg, Germany
| | - Uwe Gbureck
- Department for Functional Materials in Medicine and Dentistry, University Hospital Würzburg, Pleicherwall 2, 97070, Würzburg, Germany
| | - Philipp Stahlhut
- Department for Functional Materials in Medicine and Dentistry, University Hospital Würzburg, Pleicherwall 2, 97070, Würzburg, Germany
| | - Melanie Bengel
- Department for Functional Materials in Medicine and Dentistry, University Hospital Würzburg, Pleicherwall 2, 97070, Würzburg, Germany
| | - Andreas Hoess
- INNOTERE GmbH, Meissner Strasse 191, 01445, Radebeul, Germany
| | - Berthold Nies
- INNOTERE GmbH, Meissner Strasse 191, 01445, Radebeul, Germany
| | - Julia Bator
- Department for Functional Materials in Medicine and Dentistry, University Hospital Würzburg, Pleicherwall 2, 97070, Würzburg, Germany
| | - Uwe Klammert
- Department of Oral & Maxillofacial Plastic Surgery, University Hospital Würzburg, Pleicherwall 2, 97070, Würzburg, Germany
| | - Christian Linz
- Department of Oral & Maxillofacial Plastic Surgery, University Hospital Würzburg, Pleicherwall 2, 97070, Würzburg, Germany
| | - Andrea Ewald
- Department for Functional Materials in Medicine and Dentistry, University Hospital Würzburg, Pleicherwall 2, 97070, Würzburg, Germany
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Radwan NH, Nasr M, Ishak RAH, Awad GAS. Moxifloxacin-loaded in situ synthesized Bioceramic/Poly(L-lactide-co-ε-caprolactone) composite scaffolds for treatment of osteomyelitis and orthopedic regeneration. Int J Pharm 2021; 602:120662. [PMID: 33933641 DOI: 10.1016/j.ijpharm.2021.120662] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 04/25/2021] [Accepted: 04/26/2021] [Indexed: 10/21/2022]
Abstract
High local intraosseous levels of antimicrobial agents are required for adequate long-term treatment of chronic osteomyelitis (OM). In this study, biodegradable composite scaffolds of poly-lactide-co-ε-caprolactone/calcium phosphate (CaP) were in-situ synthesized using two different polymer grades and synthesis pathways and compared to composites prepared by pre-formed (commercially available) CaP for delivery of the antibiotic moxifloxacin hydrochloride (MOX). Phase identification and characterization by Fourier transform infra-red (FTIR) spectroscopy, X-ray powder diffraction (XRPD) and scanning electron microscope (SEM) confirmed the successful formation of different CaP phases within the biodegradable polymer matrix. The selected in-situ formed CaP scaffold showed a sustained release for MOX for six weeks and adequate porosity. Cell viability study on MG-63 osteoblast-like cells revealed that the selected composite scaffold maintained the cellular proliferation and differentiation. Moreover, it was able to diminish the bacterial load, inflammation and sequestrum formation in the bones of OM-induced animals. The results of the present work deduce that the selected in-situ formed CaP composite scaffold is a propitious candidate for OM treatment, and further clinical experiments are recommended.
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Affiliation(s)
- Noha H Radwan
- Department of Pharmaceutics and Industrial Pharmacy, Faculty of Pharmacy, Ain Shams University, Cairo, Egypt
| | - Maha Nasr
- Department of Pharmaceutics and Industrial Pharmacy, Faculty of Pharmacy, Ain Shams University, Cairo, Egypt
| | - Rania A H Ishak
- Department of Pharmaceutics and Industrial Pharmacy, Faculty of Pharmacy, Ain Shams University, Cairo, Egypt.
| | - Gehanne A S Awad
- Department of Pharmaceutics and Industrial Pharmacy, Faculty of Pharmacy, Ain Shams University, Cairo, Egypt
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9
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Roux KM, Cobb LH, Seitz MA, Priddy LB. Innovations in osteomyelitis research: A review of animal models. Animal Model Exp Med 2021; 4:59-70. [PMID: 33738438 PMCID: PMC7954837 DOI: 10.1002/ame2.12149] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Accepted: 09/24/2020] [Indexed: 12/12/2022] Open
Abstract
Infection of bone tissue, or osteomyelitis, has become a growing concern in modern healthcare due in no small part to a rise in antibiotic resistance among bacteria, notably Staphylococcus aureus. The current standard of care involves aggressive, prolonged antibiotic therapy combined with surgical debridement of infected tissues. While this treatment may be sufficient for resolving a portion of cases, recurrences of the infection and associated risks including toxicity with long-term antibiotic usage have been reported. Therefore, there exists a need to produce safer, more efficacious options of treatment for osteomyelitis. In order to test treatment regimens, animal models that closely mimic the clinical condition and allow for accurate evaluation of therapeutics are necessary. Establishing a model that replicates features of osteomyelitis in humans continues to be a challenge to scientists, as there are many variables involved, including choosing an appropriate species and method to establish infection. This review addresses the refinement of animal models of osteomyelitis to reflect the clinical disease and test prospective therapeutics. The aim of this review is to explore studies regarding the use of animals for osteomyelitis therapeutics research and encourage further development of such animal models for the translation of results from the animal experiment to human medicine.
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Affiliation(s)
- Kylie M. Roux
- College of Veterinary MedicineMississippi State UniversityMississippi StateMSUSA
| | - Leah H. Cobb
- Department of Agricultural and Biological EngineeringMississippi State UniversityMississippi StateMSUSA
| | - Marc A. Seitz
- College of Veterinary MedicineMississippi State UniversityMississippi StateMSUSA
| | - Lauren B. Priddy
- Department of Agricultural and Biological EngineeringMississippi State UniversityMississippi StateMSUSA
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10
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Qiu G, Huang M, Liu J, Wang P, Schneider A, Ren K, Oates TW, Weir MD, Xu HHK, Zhao L. Antibacterial calcium phosphate cement with human periodontal ligament stem cell-microbeads to enhance bone regeneration and combat infection. J Tissue Eng Regen Med 2021; 15:232-243. [PMID: 33434402 DOI: 10.1002/term.3169] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Revised: 11/14/2020] [Accepted: 12/01/2020] [Indexed: 12/17/2022]
Abstract
Infectious bone defects remain a significant challenge in orthopedics and dentistry. Calcium phosphate cement (CPC) have attracted significant interest in use as local drug delivery system, which with great potential to control release of antibiotics for the treatment of infectious bone defects. Within the current study, a novel antibacterial scaffold of chitosan-reinforced calcium phosphate cement delivering doxycycline hyclate (CPCC + DOX) was developed. Furthermore, the capacity of CPCC + DOX scaffolds for bone regeneration was enhanced by the human periodontal ligament stem cells (hPDLSCs) encapsulated in alginate beads. CPCC + DOX scaffolds were fabricated to contain different concentrations of DOX. Flexural strength of CPCC + DOX ranged from 5.56 ± 0.70 to 6.2 ± 0.72 MPa, which exceeded the reported strength of cancellous bone. Scaffolds exhibited continual DOX release, reaching 80% at 21 days. Scaffold with 5 mg/ml DOX (CPCC + DOX5mg) had a strong antibacterial effect, with a 4-log colony forming unit reduction against S. aureus and P. gingivalis. The proliferation and osteogenic differentiation of hPDLSCs encapsulated in alginate hydrogel microbeads were investigated in culture with CPCC + DOX scaffolds. CPCC + DOX5mg had no negative effect on proliferation of hPDLSCs. Alkaline phosphatase activity, mineral synthesis, and osteogenic gene expressions for CPCC + DOX5mg group were much higher than control group. DOX did not compromise the osteogenic induction. In summary, the novel CPCC + DOX scaffold exhibited excellent mechanical properties and strong antibacterial activity, while supporting the proliferation and osteogenic differentiation of hPDLSCs. The CPCC + DOX + hPDLSCs construct is promising to enhance bone regeneration and combat bone infections in dental, craniofacial, and orthopedic applications.
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Affiliation(s)
- Gengtao Qiu
- Department of Trauma and Joint Surgery, Shunde Hospital, Southern Medical University, Foshan, Guangdong, China.,Department of Orthopaedic Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China.,Department of Advanced Oral Sciences and Therapeutics, University of Maryland Dental School, Baltimore, Maryland, USA
| | - Mingguang Huang
- Department of Orthopaedic Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China
| | - Jin Liu
- Department of Advanced Oral Sciences and Therapeutics, University of Maryland Dental School, Baltimore, Maryland, USA.,Key Laboratory of Shannxi Province for Craniofacial Precision Medicine Research, College of Stomatology, Xi'an Jiaotong University, Xi'an, Shannxi, China
| | - Ping Wang
- Kornberg School of Dentistry, Temple University, Philadelphia, Pennsylvania, USA
| | - Abraham Schneider
- Department of Oncology and Diagnostic Sciences, University of Maryland School of Dentistry, Baltimore, Maryland, USA.,Marlene and Stewart Greenebaum Cancer Center, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Ke Ren
- Department of Neural and Pain Sciences, School of Dentistry, Program in Neuroscience, University of Maryland, Baltimore, Maryland, USA
| | - Thomas W Oates
- Department of Advanced Oral Sciences and Therapeutics, University of Maryland Dental School, Baltimore, Maryland, USA
| | - Michael D Weir
- Department of Advanced Oral Sciences and Therapeutics, University of Maryland Dental School, Baltimore, Maryland, USA
| | - Hockin H K Xu
- Department of Advanced Oral Sciences and Therapeutics, University of Maryland Dental School, Baltimore, Maryland, USA.,Marlene and Stewart Greenebaum Cancer Center, University of Maryland School of Medicine, Baltimore, Maryland, USA.,Center for Stem Cell Biology and Regenerative Medicine, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Liang Zhao
- Department of Trauma and Joint Surgery, Shunde Hospital, Southern Medical University, Foshan, Guangdong, China.,Department of Orthopaedic Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China
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11
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Cobb LH, McCabe EM, Priddy LB. Therapeutics and delivery vehicles for local treatment of osteomyelitis. J Orthop Res 2020; 38:2091-2103. [PMID: 32285973 PMCID: PMC8117475 DOI: 10.1002/jor.24689] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Revised: 04/07/2020] [Accepted: 04/11/2020] [Indexed: 02/04/2023]
Abstract
Osteomyelitis, or the infection of the bone, presents a major complication in orthopedics and may lead to prolonged hospital visits, implant failure, and in more extreme cases, amputation of affected limbs. Typical treatment for this disease involves surgical debridement followed by long-term, systemic antibiotic administration, which contributes to the development of antibiotic-resistant bacteria and has limited ability to eradicate challenging biofilm-forming pathogens including Staphylococcus aureus-the most common cause of osteomyelitis. Local delivery of high doses of antibiotics via traditional bone cement can reduce systemic side effects of an antibiotic. Nonetheless, growing concerns over burst release (then subtherapeutic dose) of antibiotics, along with microbial colonization of the nondegradable cement biomaterial, further exacerbate antibiotic resistance and highlight the need to engineer alternative antimicrobial therapeutics and local delivery vehicles with increased efficacy against, in particular, biofilm-forming, antibiotic-resistant bacteria. Furthermore, limited guidance exists regarding both standardized formulation protocols and validated assays to predict efficacy of a therapeutic against multiple strains of bacteria. Ideally, antimicrobial strategies would be highly specific while exhibiting a broad spectrum of bactericidal activity. With a focus on S. aureus infection, this review addresses the efficacy of novel therapeutics and local delivery vehicles, as alternatives to the traditional antibiotic regimens. The aim of this review is to discuss these components with regards to long bone osteomyelitis and to encourage positive directions for future research efforts.
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Affiliation(s)
- Leah H. Cobb
- Department of Agricultural and Biological Engineering, Mississippi State University, Mississippi State, MS, USA
| | - Emily M. McCabe
- Department of Agricultural and Biological Engineering, Mississippi State University, Mississippi State, MS, USA,Department of Mechanical Engineering, Mississippi State University, Mississippi State, MS, USA
| | - Lauren B. Priddy
- Department of Agricultural and Biological Engineering, Mississippi State University, Mississippi State, MS, USA,corresponding author: Contact: , (662) 325-5988, Department of Agricultural and Biological Engineering, Mississippi State University, 130 Creelman Street, Mississippi State, MS, USA 39762
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12
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Roller BL, Stoker AM, Cook JL. Elution properties of a resorbable magnesium phosphate cement. J Clin Orthop Trauma 2020; 11:S729-S734. [PMID: 32999547 PMCID: PMC7503075 DOI: 10.1016/j.jcot.2020.06.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2020] [Revised: 05/14/2020] [Accepted: 06/07/2020] [Indexed: 10/24/2022] Open
Abstract
OBJECTIVE This study tests the elution capabilities of a magnesium phosphate cement (MPC). Study objectives were to quantify the passive release of magnesium ions from MPC and to assess the effects of antibiotic-loaded MPC on bacterial growth and osteoblast viability. METHODS MPC constructs were created and incubated in fetal bovine serum (FBS). At 2, 4, and 17 weeks, a sample was collected for magnesium ion concentration analysis. Control and vancomycin-loaded (vanc) MPC beads were also created. Zone of inhibition was measured after incubating beads on Staphylococcus aureus agar plates for 24 h. Osteoblasts were seeded onto control and vanc beads and cultured for 9 days. Metabolic activity was measured via a resazurin assay. ANOVA with Tukey HSD post-hoc tests and t-tests were performed. RESULTS Magnesium ions were eluted at 2 and 4-week time points without significant difference, but demonstrated a significant spike at the 17-week time point. Zones of inhibition for the bacterial species was observed for Vanc-MPC beads, but not control beads. No cytotoxic effects on osteoblasts were noted. CONCLUSION MPC has potential to improve bone regeneration based on its ability to passively elute magnesium. Additionally, antibiotic-loaded MPC inhibits bacterial growth while avoiding osteoblast cytotoxicity.
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Affiliation(s)
- Brandon L. Roller
- Wake Forest School of Medicine, Department of Radiology, Winston-Salem, NC, USA,Corresponding author. Wake Forest School of Medicine, Medical Center Blvd, Winston-Salem, NC, 27157-1088, USA.
| | - Aaron M. Stoker
- University of Missouri, Department of Orthopaedic Surgery, Columbia, MO, USA,Thompson Laboratory for Regenerative Orthopaedics, University of Missouri, Columbia, MO, USA
| | - James L. Cook
- University of Missouri, Department of Orthopaedic Surgery, Columbia, MO, USA,Thompson Laboratory for Regenerative Orthopaedics, University of Missouri, Columbia, MO, USA
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13
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Developments in Antibiotic-Eluting Scaffolds for the Treatment of Osteomyelitis. APPLIED SCIENCES-BASEL 2020. [DOI: 10.3390/app10072244] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Osteomyelitis is a devastating disease caused by the infection of bone tissue and is associated with significant morbidity and mortality. It is treated with antibiotic therapy and surgical debridement. A high dose of systemic antibiotics is often required due to poor bone penetration and this is often associated with unacceptable side-effects. To overcome this, local, implantable antibiotic carriers such as polymethyl methacrylate have been developed. However, this is a non-biodegradable material that requires a second surgery to be removed. Attention has therefore shifted to new antibiotic-eluting scaffolds which can be created with a range of unique properties. The purpose of this review is to assess the level of evidence that exists for these novel local treatments. Although this field is still developing, these strategies seem promising and provide hope for the future treatment of chronic osteomyelitis.
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14
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Ewald A, Kreczy D, Brückner T, Gbureck U, Bengel M, Hoess A, Nies B, Bator J, Klammert U, Fuchs A. Development and Bone Regeneration Capacity of Premixed Magnesium Phosphate Cement Pastes. MATERIALS (BASEL, SWITZERLAND) 2019; 12:E2119. [PMID: 31266228 PMCID: PMC6651064 DOI: 10.3390/ma12132119] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Revised: 06/26/2019] [Accepted: 06/28/2019] [Indexed: 02/06/2023]
Abstract
Magnesium phosphate cements (MPC) have been demonstrated to have a superior bone regeneration capacity due to their good solubility under in vivo conditions. While in the past only aqueous MPC pastes have been applied, the current study describes the fabrication and in vitro/in vivo testing of an oil-based calcium doped magnesium phosphate (CaMgP) cement paste. Premixed oil-based pastes with CaMgP chemistry combine the advantages of conventional MPC such as high mechanical strength and good resorbability with a prolonged shelf-life and an easier clinical handling. The pastes set in an aqueous environment and predominantly form struvite and achieve a compressive strength of ~8-10 MPa after setting. The implantation into a drill-hole defect at the distal femoral condyle of New Zealand white rabbits over a course of 6 and 12 weeks demonstrated good biocompatibility of the materials without the formation of soft connective tissue or any signs of inflammation. In contrast to a hydroxyapatite forming reference paste, the premixed CaMgP pastes showed subsequent degradation and bony regeneration. The CaMgP cement pastes presented herein are promising bone replacement materials with excellent material properties for an improved and facilitated clinical application.
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Affiliation(s)
- Andrea Ewald
- Department for Functional Materials in Medicine and Dentistry, University Hospital Würzburg, Pleicherwall 2, 97070 Würzburg, Germany.
| | - Dorothea Kreczy
- Department for Functional Materials in Medicine and Dentistry, University Hospital Würzburg, Pleicherwall 2, 97070 Würzburg, Germany
| | - Theresa Brückner
- Department for Functional Materials in Medicine and Dentistry, University Hospital Würzburg, Pleicherwall 2, 97070 Würzburg, Germany
| | - Uwe Gbureck
- Department for Functional Materials in Medicine and Dentistry, University Hospital Würzburg, Pleicherwall 2, 97070 Würzburg, Germany
| | - Melanie Bengel
- Department for Functional Materials in Medicine and Dentistry, University Hospital Würzburg, Pleicherwall 2, 97070 Würzburg, Germany
| | - Andreas Hoess
- INNOTERE GmbH, Meissner Strasse 191, 01445 Radebeul, Germany
| | - Berthold Nies
- INNOTERE GmbH, Meissner Strasse 191, 01445 Radebeul, Germany
| | - Julia Bator
- Department for Functional Materials in Medicine and Dentistry, University Hospital Würzburg, Pleicherwall 2, 97070 Würzburg, Germany
| | - Uwe Klammert
- Department of Oral & Maxillofacial Plastic Surgery, University Hospital Würzburg, Pleicherwall 2, 97070 Würzburg, Germany
| | - Andreas Fuchs
- Department of Oral & Maxillofacial Plastic Surgery, University Hospital Würzburg, Pleicherwall 2, 97070 Würzburg, Germany
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