Combinatorial fluorapatite-based scaffolds substituted with strontium, magnesium and silicon ions for mending bone defects

Conjugation of PDLA onto MgO microspheres: comparison between solution grafting and melt grafting methods

Magnesium oxide (MgO) is known for its bioactivity and osteoconductivity when incorporated into biodegradable poly(lactic acid) (PLA), whereas the weak interfacial bonding between MgO microspheres (mMPs) and PLA often leads to suboptimal composite properties with uncontrollable functionality. Conjugation of mMPs with PLA may offer a good way to enhance their compatibility. In this study, we systematically investigated two grafting techniques, solution grafting (Sol) and melt grafting (Mel), to decorate poly (D-lactic acid) (PDLA) on mMPs pre-treated by prioritized hydration to obtain Sol MPs and Mel MPs, in order to optimize the grafting efficiency and improve their controllability in the properties including the crystal structure and surface morphology. Meanwhile, the Sol method showed an improved grafting ratio (2.9 times higher) compared to the Mel method. The conjugation of mMPs with PDLA effectively neutralized the rapid pH increase during the degradation of pure mMPs, which could be used for sustainable delivery of the Mg2+ ions. Moreover, the Sol MPs exhibited the lowest degradation rate constant, which could be well fitted by the first-order dynamic model, suggesting a transformation of the mMP degradation mode from bulk degradation to surface degradation. This change in the biodegradation mode was beneficial for decreasing the over-basic effect caused by the quick degradation of pure mMPs, thus extending their application in the development of PDLA/MgO composites towards tissue engineering or regenerative medicine.

Role of Ti3AlC2 MAX phase in regulating biodegradation and improving electrical properties of calcium silicate ceramic for bone repair applications

Calcium silicate ceramic is a promising bioceramic for various biomedical applications, but its high biodegradation rate and low strength restrict its clinical utility. As a result, the study devised an innovative solution to address these issues by utilizing the titanium aluminum carbide phase, potentially for the first time in biological applications, in conjugation with hydroxyapatite. Then, using powder metallurgy technology, they added these phases to calcium silicate to create nanocomposites. After soaking in simulated body fluid for ten days, the produced nanocomposites were assessed for bioactivity and biodegradability using scanning electron microscopy, inductively coupled plasma-atomic emission spectroscopy, and weight loss assays. Their electrical and dielectric properties were also measured before and after soaking in the simulated body fluid solution. Furthermore, the tribo-mechanical properties of all sintered samples were measured. Interestingly, adding 40% hydroxyapatite nanoparticles to calcium silicate reduced the porosity from 12 to 6%. However, adding five vol% of the titanium aluminum carbide phase to the same sample increased the porosity to 8%. Importantly, these recorded percentages of porosity were comparable to those of compact bone porosity, which range from 5 to 13%. The addition of hydroxyapatite and titanium aluminum carbide phase significantly improved the rapid biodegradation of calcium silicate, albeit with a slight decrease in its bioactive properties, as evidenced by the incomplete surface coverage of the samples with the hydroxyapatite layer in the scanning electron microscopy images. The electrical properties of the nanocomposites were better with the addition of hydroxyapatite and titanium aluminum carbide phase, which helped the bone heal faster. The addition of a titanium aluminum carbide phase significantly improved the mechanical properties of the resulting nanocomposites. For example, the calculated values for compressive strength of all examined samples were 131, 115, 105, 147, and 135 MPa. Based on the results, the prepared samples can be used in orthopaedic and dental applications.

Strontium-doped bioactive glass-functionalized polyetheretherketone enhances osseointegration by facilitating cell adhesion

In the field of orthopedics, surgeons have long been facing the challenge of loosening of external fixation screws due to inherent material characteristics. Despite Polyetheretherketone (PEEK) being employed as an orthopedic implant material for many years, its bio-inert nature often hinders bone healing due to the limited bioactivity, which restricts its clinical applications. Herein, a new type of orthopedic implant (Sr-SPK) was developed by introducing strontium (Sr)-doped mesoporous bioactive glass (Sr-MBG) onto the surface of PEEK implants through a simple and feasible method. In vitro experiments revealed that Sr-SPK effectively promotes osteogenic differentiation while concurrently suppressing the formation of osteoclasts. The same results were validated in vivo with Sr-SPK significantly improving bone integration. Upon investigation, it was found that Sr-SPK promotes adhesion among bone marrow mesenchymal stem cells (BMSCs) thereby promoting osteogenesis by activating the regulation of actin cytoskeletal and focal adhesion pathways, as identified via transcriptome analysis. In essence, these findings suggest that the newly constructed Sr-doped biofunctionalized PEEK implant developed in this research can promote osteoblast differentiation and suppress osteoclast activity by enhancing cell adhesion processes. These results underline the immense potential of such an implant for wide-ranging clinical applications in orthopedics.

A multifunctional collagen-base bilayer membrane integrated with a bimetallic/polydopamine network for enhanced guided bone regeneration

The guided bone regeneration (GBR) technique is an effective treatment for small and medium-sized bone defects in the oral and maxillofacial region. However, currently available collagen membranes have limited functionality and are inadequate for clinical requirements. To address this challenge, this study pioneeringly developed a multifunctional bilayer membrane. Specifically, a bimetallic/polydopamine network (BPN), consisting of silver, magnesium, and dopamine, was successfully synthesized for the first time and integrated with collagen and hydroxyapatite. The resulting material was characterized, and its physicochemical properties, along with its barrier, osteogenic, angiogenic, antibacterial, hemostatic, and biosafety effects, were evaluated through both in vitro and in vivo studies. The results indicated that the BPN, composed of magnesium ions, silver nanoparticles (Ag NPs), and polydopamine (PDA), exhibited excellent thermal stability and slow release of silver and magnesium elements. The BPN/Col-HA membrane featured a bilayer structure with uniform distribution of silver and magnesium. It also demonstrated good hydrophilicity, suitable degradation and mechanical properties, as well as sustained release of silver and magnesium. In vitro experiments showed that the BPN/Col-HA membrane possessed desirable barrier, osteogenic, angiogenic, antibacterial, hemostatic, and biocompatible properties. In vivo results further confirmed its biosafety, hemostatic efficacy, and ability to effectively promote bone defect repair and angiogenesis. Thus, the BPN/Col-HA membrane emerges as a multifunctional GBR membrane with potential for clinical translation.

Morphology-Dependent Immunomodulatory Coating of Hydroxyapatite/PEO for Magnesium-Based Bone Implants

One of the most critical issues concerning orthopedic implants is the risk of chronic inflammation, which poses a threat to the bone healing process. Osteo-immunomodulation plays a pivotal role in implant technology by influencing proinflammatory and anti-inflammatory responses, ultimately promoting bone healing. This study aims to investigate the morphology-dependent osteo-immunomodulatory properties of a hydroxyapatite (HA)/plasma electrolytic oxidation (PEO)-coated WE43 alloy. In this context, following the PEO process with various operational parameters (duty cycles of 50-40, 50-20, 70-40%, and frequencies of 0.5, 0.8, and 1 kHz), a layer of HA was applied as the top coating using a straightforward hot-dip process. The results revealed the formation of the PEO layer with distinct morphologies and pore sizes, depending on the operational parameters. Specifically, a uniform PEO coating with small pore sizes (5.2-5.3 μm) led to the creation of plate-like HA particles, while a random-like HA structure formed on nonuniform surfaces with large pores (7.0-11.1 μm) of PEO. Moreover, it was observed that the plate-like HA coating exhibited higher adhesion strength than the random one (classified as class 2 vs class 3 based on cross-cut standards). Furthermore, electrochemical impedance spectroscopy (EIS) and polarization studies confirmed a substantial increase in the polarization resistance (680 kΩ) and total impedance (48 559.6 Ω) for the plate-like HA/PEO as compared to the substrate (an increase of 1511-fold and 311-fold, respectively) and the random HA/PEO samples (an increase of 85-fold and 18-fold, respectively). In addition, compared to random HA coatings, there was a significant enhancement in the viability (150% control vs 96% control), proliferation, and differentiation of MG63 cells when exposed to plate-like HA coatings. Moreover, surface morphology and chemistry pronouncedly impacted macrophages' viability, morphology, and phenotype. Notably, plate-like HA coatings resulted in a higher upregulation of BMP-2 and TGF-β than proinflammatory cytokines (IL-6 and M-CSF), indicating a polarization of macrophage type 1 (M1) toward type 2 (M2). In summary, the bilayer HA/PEO coating exhibited remarkable osteo-immunomodulatory activity, making it highly appealing for use in bone implant applications.

Effect of strontium substitution on functional activity of phosphate-based glass

Phosphate-based glass (PBG) is a bioactive agent, composed of a glass network with phosphate as the primary component and can be substituted with various therapeutic ions for functional enhancement. Strontium (Sr) has been shown to stimulate osteogenic activity and inhibit pro-inflammatory responses. Despite this potential, there are limited studies that focus on the proportion of Sr substituted and its impact on the functional activity of resulting Sr-substituted PBG (PSr). In this study, focusing on the cellular biological response we synthesized and investigated the functional activity of PSr by characterizing its properties and comparing the effect of Sr substitution on cellular bioactivity. Moreover, we benchmarked the optimal composition against 45S5 bioactive glass (BG). Our results showed that PSr groups exhibited a glass structure and phosphate network like that of PBG. The release of Sr and P was most stable for PSr6, which showed favorable cell viability. Furthermore, PSr6 elicited excellent early osteogenic marker expression and inhibition of pro-inflammatory cytokine expression, which was significant compared to BG. In addition, compared to BG, PSr6 had markedly higher expression of osteopontin in immunocytochemistry, higher ALP expression in osteogenic media, and denser alizarin red staining in vitro. We also observed a comparable in vivo regenerative response in a 4-week rabbit calvaria defect model. Therefore, based on the results of this study, PSr6 could be identified as the functionally optimized composition with the potential to be applied as a valuable bioactive component of existing biomaterials used for bone regeneration.

Current surface modification strategies to improve the binding efficiency of emerging biomaterial polyetheretherketone (PEEK) with bone and soft tissue: A literature review

PURPOSE

The aim of this study was to review the literature on current surface modification strategies used to improve the binding efficiency of an emerging biological material, polyetheretherketone (PEEK), with bone and soft tissues.

STUDY SELECTION

This review was based on articles retrieved from PubMed, Google Scholar, Web of Science, and ScienceDirect databases. The main keywords used during the search were "polyetheretherketone (PEEK)," "implant," "surface modification," "biomaterials," "bone," "osseointegration," and "soft tissue."

RESULTS

The suitability of PEEK surface modification strategies has been critically analyzed and summarized here. Many cell and in vivo experiments in small animals have shown that the use of advanced modification technologies with appropriate surface modification strategies can effectively improve the surface inertness of PEEK, thereby improving its binding efficiency with bone and soft tissues.

CONCLUSIONS

Surface modifications of PEEK have revealed new possibilities for implant treatment; however, most results are based on in vitro or short-term in vivo evaluations in small animals. To achieve a broad application of PEEK in the field of oral implantology, more in vivo experiments and long-term clinical evaluations are needed to investigate the effects of various surface modifications on the tissue integration ability of PEEK to develop an ideal implant material.

Multi-leveled Nanosilicate Implants Can Facilitate Near-Perfect Bone Healing

Several studies have shown that nanosilicate-reinforced scaffolds are suitable for bone regeneration. However, hydrogels are inherently too soft for load-bearing bone defects of critical sizes, and hard scaffolds typically do not provide a suitable three-dimensional (3D) microenvironment for cells to thrive, grow, and differentiate naturally. In this study, we bypass these long-standing challenges by fabricating a cell-free multi-level implant consisting of a porous and hard bone-like framework capable of providing load-bearing support and a softer native-like phase that has been reinforced with nanosilicates. The system was tested with rat bone marrow mesenchymal stem cells in vitro and as a cell-free system in a critical-sized rat bone defect. Overall, our combinatorial and multi-level implant design displayed remarkable osteoconductivity in vitro without differentiation factors, expressing significant levels of osteogenic markers compared to unmodified groups. Moreover, after 8 weeks of implantation, histological and immunohistochemical assays indicated that the cell-free scaffolds enhanced bone repair up to approximately 84% following a near-complete defect healing. Overall, our results suggest that the proposed nanosilicate bioceramic implant could herald a new age in the field of orthopedics.

Effects of Zinc, Magnesium, and Iron Ions on Bone Tissue Engineering

Large-sized bone defects are a great challenge in clinics and considerably impair the quality of patients' daily life. Tissue engineering strategies using cells, scaffolds, and bioactive molecules to regulate the microenvironment in bone regeneration is a promising approach. Zinc, magnesium, and iron ions are natural elements in bone tissue and participate in many physiological processes of bone metabolism and therefore have great potential for bone tissue engineering and regeneration. In this review, we performed a systematic analysis on the effects of zinc, magnesium, and iron ions in bone tissue engineering. We focus on the role of these ions in properties of scaffolds (mechanical strength, degradation, osteogenesis, antibacterial properties, etc.). We hope that our summary of the current research achievements and our notifications of potential strategies to improve the effects of zinc, magnesium, and iron ions in scaffolds for bone repair and regeneration will find new inspiration and breakthroughs to inspire future research.

Hierarchical Therapeutic Ion‐Based Microspheres with Precise Ratio‐Controlled Delivery as Microscaffolds for In Situ Vascularized Bone Regeneration

Therapeutic ions, such as Si and Mg, play vital roles in regulating metabolism and promoting tissue repair, hence providing an efficient strategy in tissue engineering. The regenerative outcome is strongly dependent on the targeted delivery and controlled release of therapeutic ions. Nevertheless, it remains challenging to deliver multiple ions at controlled manners and ratios. Herein, hierarchical therapeutic ion‐based microspheres are fabricated. The coordinated release of Mg and Si ions at pre‐set ratios is achieved, based on which, Mg favors osteogenesis by inducing highly efficient cell recruitment and angiogenesis, and Si promotes massive collagen secretion and biomineralization to accelerate the bone maturation process. These therapeutic ion‐based microspheres (namely PNM2) can steadily release Mg and Si ions at an optimized ratio of 2:1, which shows the most significant synergistic effect on angiogenesis and osteogenesis. Furthermore, in a rat calvarial defects model, the volume and maturity of the vascularized neo‐bone tissue regenerated with PNM2 microspheres are comparable with or even surpassing those defects regenerated with growth factors and/or cell‐laden scaffolds. Overall, this platform provides a controllable strategy for the coordinated delivery of Mg/Si ions, opening a new avenue for developing therapeutic ion‐based microscaffold for tissue engineering.

The effects of a 3D-printed magnesium-/strontium-doped calcium silicate scaffold on regulation of bone regeneration via dual-stimulation of the AKT and WNT signaling pathways

Numerous studies have demonstrated that calcium silicate (CS) can be doped with various trace metal elements such as strontium (Sr) or magnesium (Mg). These studies have confirmed that such modifications promote bone regeneration. However, the development and emergence of 3D printing have further made it possible to fabricate bone grafts with precise structural designs using multi-bioceramics so as to better suit specific clinical requirements. We fabricated scaffolds using Mg-doped CS as the outer layer with Sr-doped CS in the center. In addition, PCL was used to improve printability of the scaffolds. This enhanced Mg and Sr architecture prevented premature degradation of the scaffolds during immersion while enabling the release of ions in a sustained manner in order to achieve the desired therapeutic goals. Even the capabilities of stem cells were shown to be enhanced when cultured on these scaffolds. Furthermore, the hybrid scaffolds were found to up-regulate the expression of bone-related proteins such as factors leading to differentiation-inducing pathways, including PI3K/Akt, Wnt, and TRPM7. The in vivo performance of the proposed scaffolds was assessed using micro-CT. The histological results revealed that the hybrid scaffolds were able to further enhance bone regeneration as compared to uni-bioceramics. By combining 3D printing, multi-ceramics, and trace metal elements, a novel hybrid scaffold could be fabricated with ease and specifically suited to future bone tissue engineering applications.

Effectiveness of treating segmental bone defects with a synergistic co-delivery approach with platelet-rich fibrin and tricalcium phosphate

Several studies have applied tricalcium phosphate (TCP) or autografts in bone tissue engineering to enhance the clinical regeneration of bone. Unfortunately, there are several drawbacks related to the use of autografts, including a risk of infection, blood loss, limited quantities, and donor-site morbidities. Platelet-rich fibrin (PRF) is a natural extracellular matrix (ECM) biomaterial that possesses bioactive factors, which can generally be used in regenerative medicine. The goal of the present investigation was to develop osteoconductive TCP incorporated with bioactive PRF for bio-synergistic bone regeneration and examine the potential biological mechanisms and applications. Our in vitro results showed that PRF plus TCP had excellent biosafety and was favorable for initiating osteoblast cell attachment, slow release of bioactive factors, cell proliferation, cell migration, and ECM formation that potentially impacted bone repair. In a rabbit femoral segmental bone defect model, regeneration of bone was considerably augmented in defects locally implanted by PRF plus TCP according to radiographic and histologic examinations. Notably, the outcomes of this investigation suggest that the combination of PRF and TCP possesses novel synergistic and bio-inspired functions that facilitate bone regeneration.

Influence of Pr3+ and CO32− Ions Coupled Substitution on Structural, Optical and Antibacterial Properties of Fluorapatite Nanopowders Obtained by Precipitation

Coupled substitution of fluorapatite (FAP) crystal lattice plays an important role in the engineering of optically active nanomaterials. Uniform fluorapatite nanopowders doped with praseodymium (Pr3+) and carbonate (CO32−) ions have been successfully synthesized by precipitation method under room temperature (25 °C). The structural, morphological, chemical and optical properties of monophase material were characterized by X-ray diffraction (XRD), Fourier Transform Infrared and Far Infrared Spectroscopy (FTIR and FIR, respectively), Scanning Electron Microscopy with Energy Dispersive Spectroscopy (SEM/EDS), Transmission Electron Microscopy (TEM) and Photoluminescence Spectroscopy (PL). Coupled substitution of FAP crystal lattice with Pr3+ and CO32− reduces the crystallite size with a constant c/a ratio of 1.72. FTIR study showed that synthesized nanopowders were AB-type CO32− substitution, and FIR study revealed new Pr–O vibrations. TEM analysis was found that synthesized nanopowders were composed of irregular spheres in the nanometer range. The fluorescence of FAP nanoparticles was in the violet-blue region of the visible part of the spectrum. When Pr3+ was doped in a lattice, the violet-blue emission becomes sharper due to reabsorption. MCR–ALS analyses of fluorescence spectra indicated the shift of the maximum to the blue color with the increase in the concentration of Pr3+ ions. Additionally, luminescent nanopowders demonstrated significant antibacterial activity against Escherichia coli. As the obtained nanoparticles showed a good absorption of ultraviolet A light and reabsorption of blue-green luminescence, they are suitable for further development of optically active nanomaterials for light filtering. Optically active PrCFAP nanopowders with antibacterial properties may be promising additives for the development of multifunctional cosmetic and health care products.