Graphene oxide versus functionalized carbon nanotubes as a reinforcing agent in a PMMA/HA bone cement

Effect of surface modification of graphene oxide with a reactive silane coupling agent on the mechanical properties and biocompatibility of acrylic bone cements

Carbon allotrope materials (i.e. carbon nanotubes (CNTs), graphene, graphene oxide (GO)), have been used to reinforce acrylic bone cement. Nevertheless, the intrinsic incompatibility among the above materials produces a deficient interphase. Thus, in this work, the effect of the content of functionalized graphene oxide with a reactive silane on the mechanical properties and cell adhesion of acrylic bone cement was studied. GO was obtained by an oxidative process on natural graphite; subsequently, GO was functionalized with 3-methacryloxypropyltrimethoxysilane (MPS) to enhance the interphase between the graphenic material and acrylic polymeric matrix. Pristine GO and functionalized graphene oxide (GO-MPS) were characterized physicochemically (XPS, XRD, FTIR, and Raman) and morphologically (SEM and TEM). Silanized GO was added into the acrylic bone cement at different concentrations; the resulting materials were characterized mechanically, and their biocompatibility was also evaluated. The physicochemical characterization results showed that graphite was successfully oxidized, and the obtained GO was successfully functionalized with the silane coupling agent (MPS). SEM and TEM images showed that the GO is composed of few stacked layers. Compression testing results indicated a tendency of increasing stiffness and toughness of the acrylic bone cements at low concentration of functionalized GO. Additionally, the bending testing results showed a slightly increase in bone cement strain with the incorporation of GO-MPS. Finally, all samples exhibited cell viability higher than 70%, which means that materials are considered non-cytotoxic, according to the ISO 10993-5 standard.

Synergistic Remediation of Organic Dye by Titanium Dioxide/Reduced Graphene Oxide Nanocomposite

In this work, nanocomposites based on titanium dioxide and reduced graphene oxide (TiO2@rGO) with different weight percentages of rGO (4, 8, and 16 wt%) were prepared by the hydrothermal/solvothermal synthesis method and thermally treated at 300 °C. The prepared nanocomposites were explored for the removal of methylene blue dye (MB) in the presence of simulated solar illumination as well as natural sunlight. The structural, morphological, chemical, and optical properties of the as-synthesized TiO2@rGO nanocomposites were characterized. The obtained results of the graphene-based nanocomposite materials indicated the existence of interactions between TiO2 and rGO, i.e., the Ti-O-C bond, which confirmed the successful integration of both components to form the TiO2@rGO nanocomposites. The addition of rGO increased the specific surface area, decreased the band gap energy, and increased the photocatalytic degradation efficiency of MB from water compared to TiO2 nanoparticles. The results of photocatalytic activity indicated that the amount of rGO in the prepared TiO2@rGO nanocomposites played a significant role in the application of different photocatalytic parameters, including the initial dye concentration, catalyst concentration, water environment, and illumination source. Our studies show that the reinforcement of the nanocomposite with 8 wt% of rGO allowed us to obtain the maximum photocatalytic decomposition performance of MB (10 mg·L-1) with a removal percentage of 99.20 after 2 h. Additionally, the obtained results show that the prepared TiO2@rGO_8 wt% nanocomposite can be used in three consecutive cycles while maintaining photocatalytic activity over 90%.

Polymerization and Applications of Poly(methyl methacrylate)-Graphene Oxide Nanocomposites: A Review

Graphene oxide (GO)-incorporated poly(methyl methacrylate) (PMMA) nanocomposites (PMMA-GO) have demonstrated a wide range of outstanding mechanical, electrical, and physical characteristics. It is of interest to review the synthesis of PMMA-GO nanocomposites and their applications as multifunctional structural materials. The attention of this review is to focus on the radical polymerization techniques, mainly bulk and emulsion polymerization, to prepare PMMA-GO polymeric nanocomposite materials. This review also discusses the effect of solvent polarity on the polymerization process and the types of surfactants (anionic, cationic, nonionic) and initiator used in the polymerization. PMMA-GO nanocomposite synthesis using radical polymerization-based techniques is an active topic of study with several prospects for considerable future improvement and a variety of possible emerging applications. The concentration and dispersity of GO used in the polymerization play critical roles to ensure the functionality and performance of the PMMA-GO nanocomposites.

Analysis of the Effect of Component Ratio Imbalances on Selected Mechanical Properties of Seasoned, Medium Viscosity Bone Cements

The paper presents the results of experimental strength tests of specimens made of two commercially available bone cements subjected to compression, that is a typical variant of load of this material during use in the human body, after it has been used for implantation of prostheses or supplementation of bone defects. One of the factors analysed in detail was the duration of cement seasoning in Ringer's solution that simulates the aggressive environment of the human body and material degradation caused by it. The study also focused on the parameters of quantitative deviation from the recommended proportions of liquid (MMA monomer, accelerator and stabiliser) and powder (PMMA prepolymer and initiator) components, i.e., unintentional inaccuracy of component proportioning at the stage of cement mass preparation. Statistical analysis has shown the influence of these factors on the decrease in compressive strength of the cements studied, which may be of significant importance in operational practice.

Reduced graphene oxide-incorporated calcium phosphate cements with pulsed electromagnetic fields for bone regeneration

Natural calcium phosphate cements (CPCs) derived from sintered animal bone have been investigated to treat bone defects, but their low mechanical strength remains a critical limitation. Graphene improves the mechanical properties of scaffolds and promotes higher osteoinduction. To this end, reduced graphene oxide-incorporated natural calcium phosphate cements (RGO-CPCs) are fabricated for reinforcement of CPCs' characteristics. Pulsed electromagnetic fields (PEMFs) were additionally applied to RGO-CPCs to promote osteogenic differentiation ability. The fabricated RGO-CPCs show distinct surface properties and chemical properties according to the RGO concentration. The RGO-CPCs’ mechanical properties are significantly increased compared to CPCs owing to chemical bonding between RGO and CPCs. In in vitro studies using a mouse osteoblast cell line and rat-derived adipose stem cells, RGO-CPCs are not severely toxic to either cell type. Cell migration study, western blotting, immunocytochemistry, and alizarin red staining assay reveal that osteoinductivity as well as osteoconductivity of RGO-CPCs was highly increased. In in vivo study, RGO-CPCs not only promoted bone ingrowth but also enhanced osteogenic differentiation of stem cells. Application of PEMFs enhanced the osteogenic differentiation of stem cells. RGO-CPCs with PEMFs can overcome the flaws of previously developed natural CPCs and are anticipated to open the gate to clinical application for bone repair and regeneration.

Natural calcium phosphate cements (CPCs) derived from sintered animal bone have been investigated to treat bone defects, but their low mechanical strength remains a critical limitation.

Silanized graphene oxide as a reinforcing agent for acrylic bone cements: physicochemical, mechanical and biological characterization

Recently, different carbon-based nanomaterials have been used as reinforcing agents in acrylic bone cement formulations. Among them, graphene oxide (GO) has attracted the attention of scientific community since it could improve not only the mechanical properties but also the biocompatibility characteristics of these materials. However, using GO presents some drawbacks, such as its poor dispersion and lack of interaction with polymeric matrices, which should be prior resolved to achieve its optimal performance in acrylic bone cement. Thus, in this work, GO was treated with 3-methacryloxy propyl trimethoxy silane at various concentrations (1, 3 and 5 wt.%) to improve the interaction between the nanofiller and the poly (methyl methacrylate) matrix. Modified GO was incorporated at different percentages (0.1, 0.5 and 0.75 wt.%) into acrylic bone cement formulations and some properties were evaluated. The silanization process of the GO was confirmed by FTIR, TGA and EDX. The improvement in the mechanical performance was monitored on the compression properties whereas those related with biological properties were evaluated by osteoblast cell viability and hemocompatibility tests. Results suggest that using a 1 wt.% of the silane coupling agent, during surface treatment of GO, yields the best mechanical performance in this type of materials. It was also found that the presence of neat GO or silanized GO does not compromise the cytocompatibility and hemocompatibility of acrylic bone cement formulations.

Optimization of Mechanical and Setting Properties in Acrylic Bone Cements Added with Graphene Oxide

The extended use of acrylic bone cements (ABC) in orthopedics presents some disadvantages related to the generation of high temperatures during methyl methacrylate polymerization, thermal tissue necrosis, and low mechanical properties. Both weaknesses cause an increase in costs for the health system and a decrease in the patient’s quality of life due to the prosthesis’s loosening. Materials such as graphene oxide (GO) have a reinforcing effect on ABC’s mechanical and setting properties. This article shows for the first time the interactions present between the factors sonication time and GO percentage in the liquid phase, together with the percentage of benzoyl peroxide (BPO) in the solid phase, on the mechanical and setting properties established for cements in the ISO 5833-02 standard. Optimization of the factors using a completely randomized experimental design with a factorial structure resulted in selecting nine combinations that presented an increase in compression, flexion, and the setting time and decreased the maximum temperature reached during the polymerization. All of these characteristics are desirable for improving the clinical performance of cement. Those containing 0.3 wt.% of GO were highlighted from the selected formulations because all the possible combinations of the studied factors generate desirable properties for the ABC.

Improved Mechanical Properties of Ultra-High Shear Force Mixed Reduced Graphene Oxide/Hydroxyapatite Nanocomposite Produced Using Spark Plasma Sintering

The addition of nanomaterials, such as graphene and graphene oxide, can improve the mechanical properties of hydroxyapatite (HA) nanocomposites (NCPs). However, both the dispersive state of the starting materials and the sintering process play central roles in improving the mechanical properties of the final HA NCPs. Herein, we studied the mechanical properties of a reduced graphene oxide (r-GO)/HA NCP, for which an ultra-high shear force was used to achieve a nano-sized mixture through the dispersion of r-GO. A low-temperature, short-duration spark plasma sintering (SPS) process was used to realize high-density, non-decomposing r-GO/HA NCPs with an improved fracture toughness of 97.8% via the addition of 0.5 wt.% r-GO. Greater quantities of r-GO improve the hardness and the fracture strength. The improved mechanical properties of r-GO/HA NCPs suggest their future applicability in biomedical engineering, including use as sintered bodies in dentistry, plasma spray-coatings for metal surfaces, and materials for 3D printing in orthopedics.

CNT and rGO reinforced PMMA based bone cement for fixation of load bearing implants: Mechanical property and biological response

Polymethyl methacrylate (PMMA) bone cements (BCs) have some drawbacks, including limited bioactivity and bone formation, as well as inferior mechanical properties, which may result in failure of the BC. To deal with the mentioned issues, novel bioactive polymethyl methacrylate-hardystonite (PMMA-HT) bone cement (BC) reinforced with 0.25 and 0.5 wt% of carbon nanotube (CNT) and reduced graphene oxide (rGO) was synthesized. In this context, the obtained bone cements were evaluated in terms of their mechanical and biological characteristics. The rGO reinforced bone cement exhibited better mechanical properties to the extent that the addition of 0.5 wt% of rGO where its compressive and tensile strength of bioactive PMMA-HT/rGO cement escalated from 92.07 ± 0.72 MPa, and 40.02 ± 0.71 MPa to 187.48 ± 5.79 MPa and 64.92 ± 0.75 MPa, respectively. Besides, the mechanisms of toughening, apatite formation, and cell interaction in CNT and rGO encapsulated PMMA have been studied. Results showed that the existence of CNT and rGO in BCs led to increase of MG63 osteoblast viability, and proliferation. However, rGO reinforced bone cement was more successful in supporting MG63 cell attachment compared to the CNT counterpart due to its wrinkled surface, which made a suitable substrate for cell adhesion. Based on the results, PMMA-HT/rGO can be a proper bone cement for the fixation of load-bearing implants.

Advanced G-MPS-PMMA Bone Cements: Influence of Graphene Silanisation on Fatigue Performance, Thermal Properties and Biocompatibility

The incorporation of well-dispersed graphene (G) powder to polymethyl methacrylate (PMMA) bone cement has been demonstrated as a promising solution to improving its mechanical performance. However, two crucial aspects limit the effectiveness of G as a reinforcing agent: (1) the poor dispersion and (2) the lack of strong interfacial bonds between G and the matrix of the bone cement. This work reports a successful functionalisation route to promote the homogenous dispersion of G via silanisation using 3-methacryloxypropyltrimethoxy silane (MPS). Furthermore, the effects of the silanisation on the mechanical, thermal and biocompatibility properties of bone cements are presented. In comparison with unsilanised G, the incorporation of silanised G (G_MPS1 and G_MPS2) increased the bending strength by 17%, bending modulus by 15% and deflection at failure by 17%. The most impressive results were obtained for the mechanical properties under fatigue loading, where the incorporation of G_MPS doubled the Fatigue Performance Index (I) value of unsilanised G-bone cement-meaning a 900% increase over the I value of the cement without G. Additionally, to ensure that the silanisation did not have a negative influence on other fundamental properties of bone cement, it was demonstrated that the thermal properties and biocompatibility were not negatively impacted-allowing its potential clinical progression.

Effect of Hydrothermal Media on the in-situ Whisker Growth on Biphasic Calcium Phosphate Ceramics

BACKGROUND

There is still a big challenge to achieve a balance between mechanical characteristics and biological properties in biphasic calcium phosphate (BCP) ceramics.

PURPOSE

The present study focused on the in-situ whisker growth on BCP ceramics via different hydrothermal treatments and investigated the influences of these whiskers on the mechanical property and biological performance of the ceramics.

METHODS

Five kinds of BCP ceramics with in-situ whisker growth, ie, BCP-C, BCP-HNO3, BCP-Citric, BCP-NaOH, BCP-CaCl2 and BCP-Na3PO4 were fabricated by different hydrothermal treatments. The phase compositions, morphologies, crystal structures and mechanical strengths of the obtained BCP ceramics were firstly characterized. Then, the in vitro cell adhesion, proliferation and alkaline  phosphatase (ALP) activity of bone marrow stromal cells (BMSCs) on the BCP ceramics were evaluated. Lastly, the effects of in-situ whisker growth on the bone-like apatite formation abilities of BCP ceramics were also investigated by immersing them in simulated body fluid (SBF).

RESULTS

The results demonstrated that the hydrothermal conditions, especially the hydrothermal media, were crucial to determine the phase composition and morphology of the in-situ whisker. Especially among the five media used (HNO3, Citric, NaOH, CaCl2 and Na3PO4), the Na3PO4 treatment resulted in the shortest whisker with a unique hollow structure, and kept the original biphasic composition. All five kinds of whiskers increased the mechanical strength of BCP ceramics to some extent, and showed the good ability of bone-like apatite formation. The in vitro cell study demonstrated that the in-situ whisker growth had no adverse but even positive effect on the adhesion, proliferation and ALP activity of BMSCs.

CONCLUSION

Due to the growth of in-situ whiskers, the mechanical property and biological performance of the obtained BCP ceramics could increase simultaneously. Therefore, in-situ whiskers growth offers a promising strategy for the expanded application of BCP ceramics to meet the requirements of regenerative medicine.

Graphene-Based Biomaterials for Bone Regenerative Engineering: A Comprehensive Review of the Field and Considerations Regarding Biocompatibility and Biodegradation

Graphene and its derivatives have continued to garner worldwide interest due to their unique characteristics. Having expanded into biomedical applications, there have been efforts to employ their exceptional properties for the regeneration of different tissues, particularly bone. This article presents a comprehensive review on the usage of graphene-based materials for bone regenerative engineering. The graphene family of materials (GFMs) are used either alone or in combination with other biomaterials in the form of fillers in composites, coatings for both scaffolds and implants, or vehicles for the delivery of various signaling and therapeutic agents. The applications of the GFMs in each of these diverse areas are discussed and emphasis is placed on the characteristics of the GFMs that have implications in this regard. In tandem and of importance, this article evaluates the safety and biocompatibility of the GFMs and carefully elucidates how various factors influence the biocompatibility and biodegradability of this new class of nanomaterials. In conclusion, the challenges and opportunities regarding the use of the GFMs in regenerative engineering applications are discussed, and future perspectives for the developments in this field are proposed.

Bioactive, Ion-Releasing PMMA Bone Cement Filled with Functional Graphenic Materials

Graphene oxide and functionalized graphenic materials (FGMs) have promise as platforms for imparting programmable bioactivity to poly(methyl methacrylate) (PMMA)-based bone cement. To date, however, graphenic fillers have only been feasible in PMMA cements at extremely low loadings, limiting the bioactive effects. At higher loadings, graphenic fillers decrease cement strength by aggregating and interfering with curing process. Here, these challenges are addressed by combining bioactive FGM fillers with a custom cement formulation. These cements contain an order of magnitude more graphenic filler than previous reports. Even at 1 wt% FGM, these cements have compressive strengths of 78- 88 MPa, flexural strengths of 74-81 MPa, and flexural stiffnesses of 1.8-1.9 GPa, surpassing the ASTM requirements for bone cement and competing with traditional PMMA cement. Further, by utilizing designer FGMs with programmed bioactivity, these cements demonstrate controlled release of osteogenic calcium ions (releasing a total of 5 ± 2 µmol of Ca2+ per gram of cement over 28 d) and stimulate a 290% increase in expression of alkaline phosphatase in human mesenchymal stem cells in vitro. Also, design criteria are described to guide creation of future generations of bone cements that utilize FGMs as platforms to achieve dynamic biological activity.

The Role of Chitosan and Graphene Oxide in Bioactive and Antibacterial Properties of Acrylic Bone Cements

Acrylic bone cements (ABC) are widely used in orthopedics for joint fixation, antibiotic release, and bone defect filling, among others. However, most commercially available ABCs exhibit a lack of bioactivity and are susceptible to infection after implantation. These disadvantages generate long-term loosening of the prosthesis, high morbidity, and prolonged and expensive treatments. Due to the great importance of acrylic bone cements in orthopedics, the scientific community has advanced several efforts to develop bioactive ABCs with antibacterial activity through several strategies, including the use of biodegradable materials such as chitosan (CS) and nanostructures such as graphene oxide (GO), with promising results. This paper reviews several studies reporting advantages in bioactivity and antibacterial properties after incorporating CS and GO in bone cements. Detailed information on the possible mechanisms by which these fillers confer bioactive and antibacterial properties to cements, resulting in formulations with great potential for use in orthopedics, are also a focus in the manuscript. To the best of our knowledge, this is the first systematic review that presents the improvement in biological properties with CS and GO addition in cements that we believe will contribute to the biomedical field.

Non-aqueous liquid crystals of hydroxyapatite nanorods

Hydroxyapatite (HA) nanorods in the collagen matrix of bone have a macroscopically ordered structure that has many similarities to the ordered structure of anisotropic nano-units in inorganic liquid crystals (LCs). Inspired by these similarities, we conducted the first (to our best knowledge) synthesis of HA LCs in non-polar solvents (such as cyclohexane and toluene), thus expanding the range of applicable monomers and polymers. We synthesized HA nanorods by a simple, effective, and oleic-acid-assisted hydrothermal route. The hydrothermal temperature directly modulates the aspect ratio of the HA nanorods, and indirectly modulates their LC behavior. The LC phase transition has no size limitation. Thus, our approach may be used to develop high solid content, macroscopically assembled, large-scale polymer-based bio(mimetic)-materials.

Applications of Graphene and Its Derivatives in Bone Repair: Advantages for Promoting Bone Formation and Providing Real-Time Detection, Challenges and Future Prospects

During continuous innovation in the preparation, characterization and application of various bone repair materials for several decades, nanomaterials have exhibited many unique advantages. As a kind of representative two-dimensional nanomaterials, graphene and its derivatives (GDs) such as graphene oxide and reduced graphene oxide have shown promising potential for the application in bone repair based on their excellent mechanical properties, electrical conductivity, large specific surface area (SSA) and atomic structure stability. Herein, we reviewed the updated application of them in bone repair in order to present, as comprehensively, as possible, their specific advantages, challenges and current solutions. Firstly, how their advantages have been utilized in bone repair materials with improved bone formation ability was discussed. Especially, the effects of further functionalization or modification were emphasized. Then, the signaling pathways involved in GDs-induced osteogenic differentiation of stem cells and immunomodulatory mechanism of GDs-induced bone regeneration were discussed. On the other hand, their applications as contrast agents in the field of bone repair were summarized. In addition, we also reviewed the progress and related principles of the effects of GDs parameters on cytotoxicity and residues. At last, the future research was prospected.

Osseointegration of Antimicrobial Acrylic Bone Cements Modified with Graphene Oxide and Chitosan

Acrylic bone cement (ABC) is one of the most used materials in orthopedic surgery, mainly for the fixation of orthopedic implants to the bone. However, ABCs usually present lack of biological activity and osseointegration capacity that leads to loosening of the prosthesis. This work reports the effect of introducing graphene oxide (GO) and chitosan (CS), separately or together, in the ABC formulation on setting performance, mechanical behavior, and biological properties. Introduction of both CS and GO to the ABC decreased the maximum temperature by 21% and increased the antibacterial activity against Escherichia coli by 87%, while introduction of only CS decreased bending strength by 32%. The results of cell viability and cell adhesion tests showed in vitro biocompatibility. The in vivo response was investigated using both subdermal and bone parietal implantations in Wistar rats. Modified ABCs showed absence of immune response, as confirmed by a normal inflammatory response in Wistar rat subdermal implantation. The results of the parietal bone implantation showed that the addition of CS and GO together allowed a near total healing bone–cement interface, as observed in the micrographic analysis. The overall results support the great potential of the modified ABCs for application in orthopedic surgery mainly in those cases where osseointegration is required.

Acrylic Bone Cements Modified with Graphene Oxide: Mechanical, Physical, and Antibacterial Properties

Bacterial infections are a common complication after total joint replacements (TJRs), the treatment of which is usually based on the application of antibiotic-loaded cements; however, owing to the increase in antibiotic-resistant microorganisms, the possibility of studying new antibacterial agents in acrylic bone cements (ABCs) is open. In this study, the antibacterial effect of formulations of ABCs loaded with graphene oxide (GO) between 0 and 0.5 wt.% was evaluated against Gram-positive bacteria: Bacillus cereus and Staphylococcus aureus, and Gram-negative ones: Salmonella enterica and Escherichia coli. It was found that the effect of GO was dependent on the concentration and type of bacteria: GO loadings ≥0.2 wt.% presented total inhibition of Gram-negative bacteria, while GO loadings ≥0.3 wt.% was necessary to achieve the same effect with Gram-positives bacteria. Additionally, the evaluation of some physical and mechanical properties showed that the presence of GO in cement formulations increased wettability by 17%, reduced maximum temperature during polymerization by 19%, increased setting time by 40%, and increased compressive and flexural mechanical properties by up to 17%, all of which are desirable behaviors in ABCs. The formulation of ABC loading with 0.3 wt.% GO showed great potential for use as a bone cement with antibacterial properties.

Setting behavior, apatite-forming ability, mechanical strength of polymethylmethacrylate bone cement through bioactivity modification of phosphate functional groups combined with Ca2+ ions

Bioactivity modification helps polymethylmethacrylate (PMMA) bone cement to reinforce its interfacial adhesion to bone tissues through the chemical bonding of apatite. Since Si-OH groups combined with Ca²⁺ ions have succeeded in inducing apatite formation, more combinations of functional groups and active ions are being explored. In this study, Bis[2-(methacryloyloxy)ethyl] phosphate (B2meP) containing phosphate (=PO₄H) groups and Ca(CH₃COO)₂ supplying Ca²⁺ ion were adopted to investigate the feasibility of equipping PMMA bone cement with apatite-forming ability in vitro, more effects under designed contents on setting behavior, injectability, contact angle, cytotoxicity and mechanical strength were also investigated. Results showed B2meP copolymerized with MMA and became one section of PMMA chains, surface = PO₄H groups and released Ca²⁺ ions pushed spherical apatite individuals nucleating and agglomerating into layer horizontally, Increasing B2meP content lowered the contact angle and the peak temperature, enhanced the cell viability of MC3T3-E1, but prolonged apatite forming period. Injectability rate performed a similar trend to setting time. Lower adding content and deposited apatite layer contributed to reduce the strength loss in soaking. Taking biological performance and other properties into balance, cement added with B2meP of 10 wt% in MMA and Ca(CH₃COO)₂ of 20 wt% in PMMA performed better.

Enhanced Osteogenic Differentiation of Human Primary Mesenchymal Stem and Progenitor Cultures on Graphene Oxide/Poly(methyl methacrylate) Composite Scaffolds

Due to its versatility, small size, large surface area, and ability to interact with biological cells and tissues, graphene oxide (GO) is an excellent filler for various polymeric composites and is frequently used to expand their functionality. Even though the major advantage of the incorporation of GO is the enhancement of mechanical properties of the composite material, GO is also known to improve bioactivity during biomineralization and promote osteoblast adhesion. In this study, we described the fabrication of a composite bone cement made of GO and poly(methyl methacrylate) (PMMA), and we investigated its potential to enhance osteogenic differentiation of human primary mesenchymal stem and progenitor cells. Through the analysis of three differentiation markers, namely alkaline phosphatase, secreted protein acidic and rich in cysteine, and bone morphogenetic protein-2 in the presence and in the absence of an osteogenic differentiation medium, we were able to indicate a composite produced manually with a thick GO paper as the most effective among all investigated samples. This effect was related to its developed surface, possessing a significant number of voids and pores. In this way, GO/PMMA composites were shown as promising materials for the applications in bone tissue engineering.

Polymethyl Methacrylate-Based Bone Cements Containing Carbon Nanotubes and Graphene Oxide: An Overview of Physical, Mechanical, and Biological Properties

Every year, millions of people in the world get bone diseases and need orthopedic surgery as one of the most important treatments. Owing to their superior properties, such as acceptable biocompatibility and providing great primary bone fixation with the implant, polymethyl methacrylate (PMMA)-based bone cements (BCs) are among the essential materials as fixation implants in different orthopedic and trauma surgeries. On the other hand, these BCs have some disadvantages, including Lack of bone formation and bioactivity, and low mechanical properties, which can lead to bone cement (BC) failure. Hence, plenty of studies have been concentrating on eliminating BC failures by using different kinds of ceramics and polymers for reinforcement and also by producing composite materials. This review article aims to evaluate mechanical properties, self-setting characteristics, biocompatibility, and bioactivity of the PMMA-based BCs composites containing carbon nanotubes (CNTs), graphene oxide (GO), and carbon-based compounds. In the present study, we compared the effects of CNTs and GO as reinforcement agents in the PMMA-based BCs. Upcoming study on the PMMA-based BCs should concentrate on trialing combinations of these carbon-based reinforcing agents as this might improve beneficial characteristics.

Viral Filtration Using Carbon-Based Materials

Viral infections alone are a significant cause of morbidity and mortality worldwide and have a detrimental impact on global healthcare and socio‐economic development. The discovery of novel antiviral treatments has gained tremendous attention and support with the rising number of viral outbreaks. In this work, carbonaceous materials, including graphene nanoplatelets and graphene oxide nanosheets, were investigated for antiviral properties. The materials were characterized using scanning electron microscopy and transmission electron microscopy. Analysis showed the materials to be two‐dimensional with lateral dimensions ranging between 1 and 4 µm for graphene oxide and 110 ± 0.11 nm for graphene nanoplatelets. Antiviral properties were assessed against a DNA virus model microorganism at concentrations of 0.5, 1.0 and 2.0 wt/v%. Both carbonaceous nanomaterials exhibited potent antiviral properties and gave rise to a viral reduction of 100% across all concentrations tested. Graphene oxide nanosheets were then incorporated into polymeric fibres, and their antiviral behaviour was examined after 3 and 24 hr. A viral reduction of 39% was observed after 24 hr of exposure. The research presented here showcases, for the first time, the antiviral potential of several carbonaceous nanomaterials, also included in a carrier polymer. These outcomes can be translated and implemented in many fields and devices to prevent viral spread and infection.

Bioactive poly (methyl methacrylate) bone cement for the treatment of osteoporotic vertebral compression fractures

Rationale: Poly (methyl methacrylate) (PMMA) bone cement is one of the most commonly used biomaterials for augmenting/stabilizing osteoporosis-induced vertebral compression fractures (OVCFs), such as percutaneous vertebroplasty (PVP) and balloon kyphoplasty (BKP). However, its clinical applications are limited by its poor performance in high compressive modulus and weak bonding to bone. To address these issues, a bioactive composite bone cement was developed for the treatment of osteoporotic vertebral compression fractures, in which mineralized collagen (MC) was incorporated into the PMMA bone cement (MC-PMMA). Methods: The in vitro properties of PMMA and MC-PMMA composite bone cement were determined, including setting time, compressive modulus, adherence, proliferation, and osteogenic differentiation of rat bone mesenchymal stem cells. The in vivo properties of both cements were evaluated in an animal study (36 osteoporotic New Zealand female rabbits divided equally between the two bone cement groups; PVP at L5) and a small-scale and short-term clinical study (12 patients in each of the two bone cement groups; follow-up: 2 years). Results: In terms of value for PMMA bone cement, the handling properties of MC-PMMA bone cement were not significantly different. However, both compressive strength and compressive modulus were found to be significantly lower. In the rabbit model study, at 8 and 12 weeks post-surgery, bone regeneration was more significant in MC-PMMA bone cement (cortical bone thickness, osteoblast area, new bone area, and bone ingrowth %; each significantly higher). In the clinical study, at a follow-up of 2 years, both the Visual Analogue Score and Oswestry Disability Index were significantly reduced when MC-PMMA cement was used. Conclusions: MC-PMMA bone cement demonstrated good adaptive mechanical properties and biocompatibility and may be a promising alternative to commercial PMMA bone cements for the treatment of osteoporotic vertebral fractures in clinical settings. While the present results for MC-PMMA bone cement are encouraging, further study of this cement is needed to explore its viability as an ideal alternative for use in PVP and BKP.

Incorporation of chitosan/graphene oxide nanocomposite in to the PMMA bone cement: Physical, mechanical and biological evaluation

One of the most popular types of bone cements is polymethylmethacrylate (PMMA). The properties of this bone cement have attracted many researchers effort to modify its properties. In this study, after preparation of chitosan (Cs) powder and Cs/graphene oxide (GO) nanocomposite powder, they were added homogeneously to the PMMA bone cement with different percentages. The results showed that the addition of 25 wt% of Cs/GO nanocomposite powder to the PMMA bone cement cause to increase the compressive strength by 16.2%, the compressive modulus by 69.1% and the bending strength by 24.0%. The obtained results showed that by adding Cs/GO nanocomposite powder to the PMMA bone cement, setting time and injectability were increased, maximum temperature was decreased and apatite-like deposition was increased after 4 weeks of incubation in SBF solution. The results of MG-63 cell culture confirmed the improvement of cell viability, growth and cell adhesion for 25 wt% PMMA-Cs/GO composite bone cement. Therefore, it can be concluded that 25 wt% PMMA-Cs/GO composite bone cement with improved mechanical, physical and biological properties can be a good replacement for common commercial bone cements in orthopedic applications.

Research into the thermal stability and mechanical properties of vitamin E diffusion modified irradiation cross-linked graphene oxide/ultra-high molecular weight polyethylene composites

Recently, there has been increasing interest in modifying ultra-high molecular weight polyethylene (UHMWPE) due to glaring needs in the artificial joint replacement field. It is generally reported in the literature that irradiation cross-linking and adding graphene oxide (GO)/vitamin E (VE) can enhance the mechanical properties of UHMWPE, but this can sacrifice the oxidation stability and gel content. This paper examines how VE diffusion can influence irradiation cross-linked GO/UHMWPE composites and whether mechanical performance and oxidation resistance can be maintained simultaneously, which will provide new guidance for prolonging the longevity of UHMWPE implants. The GO/UHMWPE composites were fabricated by means of liquid ultrasonic dispersion, hot pressing and irradiation cross-linking, followed by VE diffusion and homogenization treatment. The results indicated that limited VE diffusion decreased the water absorption and wettability. The crystallinity, melting temperature, thermal stability, hardness and scratch resistance of the composites basically remain essentially the same, except in the case of pure UHMWPE. In addition, the oxidation resistance was improved significantly after incorporating VE. Furthermore, the diffusion and enhancement mechanisms were also demonstrated, respectively.

Recently, there has been increasing interest in modifying ultra-high molecular weight polyethylene (UHMWPE) due to glaring needs in the artificial joint replacement field.

Graphene Oxide and Graphene Reinforced PMMA Bone Cements: Evaluation of Thermal Properties and Biocompatibility

The incorporation of well-dispersed graphene oxide (GO) and graphene (G) has been demonstrated as a promising solution to improve the mechanical performance of polymethyl methacrylate (PMMA) bone cements in an attempt to enhance the long-term survival of the cemented orthopaedic implants. However, to move forward with the clinical application of graphene-based PMMA bone cements, it is necessary to ensure the incorporation of graphene-based powders do not negatively affect other fundamental properties (e.g., thermal properties and biocompatibility), which may compromise the clinical success of the implant. In this study, the effect of incorporating GO and G on thermal properties, biocompatibility, and antimicrobial activity of PMMA bone cement was investigated. Differential scanning calorimetry studies demonstrated that the extent of the polymerisation reaction, heat generation, thermal conductivity, or glass transition temperature were not significantly (p > 0.05) affected by the addition of the GO or G powders. The cell viability showed no significant difference (p > 0.05) in viability when MC3-T3 cells were exposed to the surface of G- or GO-PMMA bone cements in comparison to the control. In conclusion, this study demonstrated the incorporation of GO or G powder did not significantly influence the thermal properties or biocompatibility of PMMA bone cements, potentially allowing its clinical progression.

Mineralized Collagen Modified Polymethyl Methacrylate Bone Cement for Osteoporotic Compression Vertebral Fracture at 1-Year Follow-up

STUDY DESIGN

Retrospective comparative study.

OBJECTIVE

This study aimed to compare the clinical effects and imaging features of polymethyl methacrylate (PMMA) bone cement with and without mineralized collagen (MC) in percutaneous kyphoplasty (PKP) for osteoporotic vertebral compression fractures (OVCFs).

SUMMARY OF BACKGROUND DATA

PKP with PMMA is widely performed for OVCF. However, numerous complications have also been reported about the PMMA bone cement. Moreover, PMMA bone cement with and without MC have not been compared with respect to their postoperative efficacy and long-term follow-up.

METHODS

From July 2016 to July 2017, 105 OVCF patients were randomly divided into two groups based on their PKP treatment: MC-PMMA group and PMMA group. Clinical operation, cement leakage, Oswestry Disability Index, visual analog scale, height of the fractured vertebrae, Cobb angle, refracture of the adjacent vertebra, recompression, and computed tomography values of the injured vertebra were compared between the two groups postoperatively and after 1-year follow-up.

RESULTS

Clinical operation showed no differences between the two groups. Visual analog scale scores, Oswestry Disability Index scores, and Cobb angles showed statistically significant differences between the two groups after 1-year follow-up. The height of the vertebral body showed significant difference at 3 days postoperatively and preoperatively in each group and significant difference after 1 year between the two groups. The rate of refracture and leakage of the MC-PMMA group was lower than that of the PMMA group. The computed tomography value of the MC-PMMA group was obviously higher than that of the PMMA group after 1-year follow-up.

CONCLUSION

MC-modified PMMA did not change the beneficial properties of PMMA. This new bone cement has better biocompatibility, can form a stable structure in the vertebral body, and improve the prognosis of patients by reducing pain and reoperation.

LEVEL OF EVIDENCE

3.

Novel Bioactive and Antibacterial Acrylic Bone Cement Nanocomposites Modified with Graphene Oxide and Chitosan

Acrylic bone cements (ABCs) have played a key role in orthopedic surgery mainly in arthroplasties, but their use is increasingly extending to other applications, such as remodeling of cancerous bones, cranioplasties, and vertebroplasties. However, these materials present some limitations related to their inert behavior and the risk of infection after implantation, which leads to a lack of attachment and makes necessary new surgical interventions. In this research, the physicochemical, thermal, mechanical, and biological properties of ABCs modified with chitosan (CS) and graphene oxide (GO) were studied. Fourier transform infrared (FTIR) spectroscopy, proton nuclear magnetic resonance (¹H-NMR) scanning electron microscopy (SEM), Raman mapping, thermogravimetric analysis (TGA), differential scanning calorimetry (DSC), compression resistance, mechanical dynamic analysis (DMA), hydrolytic degradation, cell viability, alkaline phosphatase (ALP) activity with human osteoblasts (HOb), and antibacterial activity against Gram-negative bacteria Escherichia coli were used to characterize the ABCs. The results revealed good dispersion of GO nanosheets in the ABCs. GO provided an increase in antibacterial activity, roughness, and flexural behavior, while CS generated porosity, increased the rate of degradation, and decreased compression properties. All ABCs were not cytotoxic and support good cell viability of HOb. The novel formulation of ABCs containing GO and CS simultaneously, increased the thermal stability, flexural modulus, antibacterial behavior, and osteogenic activity, which gives it a high potential for its uses in orthopedic applications.

Poly (Methyl Methacrylate)/Biphasic Calcium Phosphate/Nano Graphene Bone Cement for Orthopedic Application

Background:

The aim of this study was to make a bioactive bone cement based on poly (methyl methacrylate) (PMMA) with suitable mechanical properties.

Methods:

PMMA has been modified by fabricating a composite consisting of biphasic calcium phosphate (BCP) 68 wt%, PMMA 31 wt% and graphene (Gr) 1 wt% (PMMA/BCP/Gr), 32 wt% of PMMA, and 68 wt% of BCP (PMMA/BCP) and pure PMMA by milling, mixing with monomer liquid, and casting. The modified cements were evaluated regarding mechanical properties, bioactivity, degradation rate, and biocompatibility.

Results:

The scanning electron microscopy (SEM) images of hydroxyapatite (HA) formed on samples surface after 28 days of immersion in simulated body fluid (SBF) demonstrated that bioactivity was obtained due to the addition of BCP, and the degradation rate of the cement was enhanced as well. Investigations of mechanical properties revealed that BCP increased the elastic modulus of PMMA more than 1.5 times, but predictably decreased elongation. The addition of 1 wt% Gr increased elongation and yield strength from 16.39% ± 1.02% and 61.67 ± 1.52 Mpa for PMMA/BCP to 35.18% ± 2.42% and 78.40 ± 2.06 Mpa for PMMA/BCP/Gr, respectively. MG63 cells survival and proliferation improved from 127.55% ± 7.03% for PMMA to 201.41% ± 10.7% for PMMA/BCP/Gr on Day 4 of culture.

Conclusion:

According to the obtained results of mechanical and biological tests, it seems that new PMMA/BCP/Gr bone cement has a potentiality for usage in orthopedic applications.

Tricalcium silicate/graphene oxide bone cement with photothermal properties for tumor ablation

Illustration of the Tricalcium silicate/graphene oxide bone cement for bone tumor ablation.

Silver-doped graphene oxide nanocomposite triggers cytotoxicity and apoptosis in human hepatic normal and carcinoma cells

Introduction

Graphene oxide nanoparticles have been widely used in industry and biomedical fields due to their unique physicochemical properties. However, comparative cytotoxicity of silver-doped reduced graphene oxide (rGO–Ag) nanoparticles on normal and cancerous liver cells has not been well studied yet.

Materials and methods

This study aimed at determining the toxic potential of rGO–Ag nanocomposite on human liver normal (CHANG) and cancer (HepG2) cells. The rGO–Ag nanocomposite was characterized by using different advanced instruments, namely, dynamic light scattering, scanning electron microscope, and transmission electron microscope.

Results

The rGO–Ag nanocomposite reduced cell viability and impaired cell membrane integrity of CHANG and HepG2 cells in a dose-dependent manner. Additionally, it induced reactive oxygen species generation and reduced mitochondrial membrane potential in both cells in a dose-dependent manner. Moreover, the activity of oxidative enzymes such as lipid peroxide, superoxide dismutase, and catalase were increased and glutathione was reduced in both cells exposed to rGO–Ag nanocomposite. Pretreatment with N-acetylcysteine inhibited cytotoxicity and reactive oxygen species generation in CHANG and HepG2 cells exposed to rGO–Ag nanocomposite (50 µg/mL). DNA damage was determined by Comet assay and maximum DNA damage occurred at rGO–Ag nanocomposite (25 µg/mL) for 24 h. It is also valuable to inform that HepG2 cells appear to be slightly more susceptible to rGO–Ag nanocomposite exposure than CHANG cells.

Conclusion

This result provides a basic comparative toxic effect of rGO–Ag nanocomposite on hepatic normal and cancerous liver cells.

Nanocements produced from mesoporous bioactive glass nanoparticles

Biomedical cements are considered promising injectable materials for bone repair and regeneration. Calcium phosphate composition sized with tens of micrometers is currently one of the major powder forms. Here we report a unique cement form made from mesoporous bioactive glass nanoparticles (BGn). The nanopowder could harden in reaction with aqueous solution at powder-to-liquid ratios as low as 0.4-0.5 (vs. 2.0-3.0 for conventional calcium phosphate cement CPC). The cementation mechanism investigated from TEM, XRD, FT-IR, XPS, and NMR analyses was demonstrated to be the ionic (Si and Ca) dissolution and then reprecipitation to form Si-Ca-(P) based amorphous nano-islands that could network the particles. The nanopowder-derived nanocement exhibited high surface area (78.7 m²/g); approximately 9 times higher than conventional CPC. The immersion of nanocement in simulated body fluid produced apatite nanocrystallites with ultrafine size of 10 nm (vs. 55 nm in CPC). The ultrafine nanocement adsorbed protein molecules (particularly positive charged proteins) at substantial levels; approximately 160 times higher than CPC. The nanocement released Si and Ca ions continuously over the test period of 2 weeks; the Si release was unique in nanocement whereas the Ca release was in a similar range to that observed in CPC. The release of ions significantly stimulated the responses of cells studied (rMSCs and HUVECs). The viability and osteogenesis of rMSCs were significantly enhanced by the nanocement ionic extracts. Furthermore, the in vitro tubular networking of HUVECs was improved by the nanocement ionic extracts. The in vivo neo-blood vessel formation in CAM model was significantly higher by the nanocement implant when compared with the CPC counterpart, implying the Si ion release might play a significant role in pro-angiogenesis. Furthermore, the early bone forming response of the nanocement, based on the implantation in a rat calvarial bone defect, demonstrated a sign of osteoinductivity along with excellent osteocondution and bone matrix formation. Although more studies remain to confirm the potential of nanocement, some of the intriguing physico-chemical properties and the biological responses reported herein support the promise of the new 'nanopowder-based nanocement' for hard tissue repair and regeneration.

Graphene-Based Nanocomposites as Promising Options for Hard Tissue Regeneration

Tissues are often damaged by physical trauma, infection or tumors. A slight injury heals naturally through the normal healing process, while severe injury causes serious health implications. Therefore, many efforts have been devoted to treat and repair various tissue defects. Recently, tissue engineering approaches have attracted a rapidly growing interest in biomedical fields to promote and enhance healing and regeneration of large-scale tissue defects. On the other hand, with the recent advances in nanoscience and nanotechnology, various nanomaterials have been suggested as novel biomaterials. Graphene, a two-dimensional atomic layer of graphite, and its derivatives have recently been found to possess promoting effects on various types of cells. In addition, their unique properties, such as outstanding mechanical and biological properties, allow them to be a promising option for hard tissue regeneration. Herein, we summarized recent research advances in graphene-based nanocomposites for hard tissue regeneration, and highlighted their promising potentials in biomedical and tissue engineering.

Functional Graphene Nanomaterials Based Architectures: Biointeractions, Fabrications, and Emerging Biological Applications

Functional graphene nanomaterials (FGNs) are fast emerging materials with extremely unique physical and chemical properties and physiological ability to interfere and/or interact with bioorganisms; as a result, FGNs present manifold possibilities for diverse biological applications. Beyond their use in drug/gene delivery, phototherapy, and bioimaging, recent studies have revealed that FGNs can significantly promote interfacial biointeractions, in particular, with proteins, mammalian cells/stem cells, and microbials. FGNs can adsorb and concentrate nutrition factors including proteins from physiological media. This accelerates the formation of extracellular matrix, which eventually promotes cell colonization by providing a more beneficial microenvironment for cell adhesion and growth. Furthermore, FGNs can also interact with cocultured cells by physical or chemical stimulation, which significantly mediate their cellular signaling and biological performance. In this review, we elucidate FGNs-bioorganism interactions and summarize recent advancements on designing FGN-based two-dimensional and three-dimensional architectures as multifunctional biological platforms. We have also discussed the representative biological applications regarding these FGN-based bioactive architectures. Furthermore, the future perspectives and emerging challenges will also be highlighted. Due to the lack of comprehensive reviews in this emerging field, this review may catch great interest and inspire many new opportunities across a broad range of disciplines.