Comparative review of piezoelectric biomaterials approach for bone tissue engineering

Synergistic interactions between physical exercise intervention, innovative materials, and neurovascular coupling in bone repair and injury recovery: a comprehensive review

Bone injury presents a prevalent challenge in clinical settings, with traditional treatment modalities exhibiting inherent limitations. Recent advancements have highlighted the potential of combining physical exercise intervention and innovative materials to enhance bone repair and recovery. This review explores the synergistic effects of physical exercise and novel materials in promoting bone regeneration, with a particular focus on the role of neurovascular coupling (NVC) mechanisms. Physical exercise not only stimulates bone cell function and blood circulation but also enhances the bioactivity of novel materials, such as nanofiber membranes and smart materials, which provide supportive scaffolds for bone cell attachment, proliferation, and differentiation. NVC, involving the interaction between neural activity and blood flow, is integral to the bone repair process, ensuring the supply of nutrients and oxygen to the injured site. Studies demonstrate that the combination of physical exercise and novel materials can accelerate bone tissue regeneration, with exercise potentially enhancing the bioactivity of materials and materials improving the effectiveness of exercise. However, challenges remain in clinical applications, including patient variability, material biocompatibility, and long-term stability. Optimizing the integration of physical exercise and novel materials for optimal therapeutic outcomes is a key focus for future research. This review examines the collaborative mechanisms between physical exercise, novel materials, and NVC, emphasizing their potential and the ongoing challenges in clinical settings. Further exploration is needed to refine their application and improve bone repair strategies.

Biophysical stimuli for promoting bone repair and regeneration

Bone injuries and diseases are associated with profound changes in the biophysical properties of living bone tissues, particularly their electrical and mechanical properties. The biophysical properties of healthy bone are attributed to the complex network of interactions between its various cell types (i.e., osteocytes, osteoclast, immune cells and vascular endothelial cells) with the surrounding extracellular matrix (ECM) against the backdrop of a myriad of biomechanical and bioelectrical stimuli arising from daily physical activities. Understanding the pathophysiological changes in bone biophysical properties is critical to developing new therapeutic strategies and novel scaffold biomaterials for orthopedic surgery and tissue engineering, as well as provides a basis for the application of various biophysical stimuli as therapeutic agents to restore the physiological microenvironment of injured/diseased bone tissue, to facilitate its repair and regeneration. These include mechanical, electrical, magnetic, thermal and ultrasound stimuli, which will be critically examined in this review. A significant advantage of utilizing such biophysical stimuli to facilitate bone healing is that these may be applied non-invasively with minimal damage to surrounding tissues, unlike conventional orthopedic surgical procedures. Furthermore, the effects of such biophysical stimuli can be localized specifically at the bone defect site, unlike drugs or growth factors that tend to diffuse away after delivery, which may result in detrimental side effects at ectopic sites.

Advanced Piezoelectric Materials, Devices, and Systems for Orthopedic Medicine

Harnessing the robust electromechanical couplings, piezoelectric materials not only enable efficient bio-energy harvesting, physiological sensing and actuating but also open enormous opportunities for therapeutic treatments through surface polarization directly interacting with electroactive cells, tissues, and organs. Known for its highly oriented and hierarchical structure, collagen in natural bones produces local electrical signals to stimulate osteoblasts and promote bone formation, inspiring the application of piezoelectric materials in orthopedic medicine. Recent studies showed that piezoelectricity can impact microenvironments by regulating molecular sensors including ion channels, cytoskeletal elements, cell adhesion proteins, and other signaling pathways. This review thus focuses on discussing the pioneering applications of piezoelectricity in the diagnosis and treatment of orthopedic diseases, aiming to offer valuable insights for advancing next-generation medical technologies. Beginning with an introduction to the principles of piezoelectricity and various piezoelectric materials, this review paper delves into the mechanisms through which piezoelectric materials accelerated osteogenesis. A comprehensive overview of piezoelectric materials, devices, and systems enhancing bone tissue repair, alleviating inflammation at infection sites, and monitoring bone health is then provided, respectively. Finally, the major challenges faced by applications of piezoelectricity in orthopedic conditions are thoroughly discussed, along with a critical outlook on future development trends.

Accelerated Bone Healing via Electrical Stimulation

Piezoelectric effect produces an electrical signal when stress is applied to the bone. When the integrity of the bone is destroyed, the biopotential within the defect site is reduced and several physiological responses are initiated to facilitate healing. During the healing of the bone defect, the bioelectric potential returns to normal levels. Treatment of fractures that exceed innate regenerative capacity or exhibit delayed healing requires surgical intervention for bone reconstruction. For bone defects that cannot heal on their own, exogenous electric fields are used to assist in treatment. This paper reviews the effects of exogenous electrical stimulation on bone healing, including osteogenesis, angiogenesis, reduction in inflammation and effects on the peripheral nervous system. This paper also reviews novel electrical stimulation methods, such as small power supplies and nanogenerators, that have emerged in recent years. Finally, the challenges and future trends of using electrical stimulation therapy for accelerating bone healing are discussed.

Regulation of bone homeostasis by traditional Chinese medicine active scaffolds and enhancement for the osteoporosis bone regeneration

ETHNOPHARMACOLOGICAL RELEVANCE

The active ingredients of traditional Chinese medicine (TCM), such as naringin (NG), Eucommiol, isopsoralen, icariin, Astragalus polysaccharides, and chondroitin sulfate, contained in Drynariae Rhizoma, Eucommiae Cortex, Psoralea corylifolia, Herba Epimedii, Astragalus radix and deer antler, are considered promising candidates for enhancing the healing of osteoporotic defects due to their outstanding bone homeostasis regulating properties. They are commonly used to activate bone repair scaffolds.

AIM OF THE REVIEW

Bone repair scaffolds are inadequate to meet the demands of osteoporotic defect healing due to the lack of regulation of bone homeostasis. Therefore, selecting bone scaffolds activated with TCM to improve the therapeutic effect of repairing osteoporotic bone defects.

MATERIALS AND METHODS

To gather information on bone scaffold activated by traditional Chinese medicine, we conducted a thorough search of several scientific databases, including Google Scholar, Web of Science, Scifinder, Baidu Scholar, PubMed, and China National Knowledge Infrastructure (CNKI).

RESULTS

This review discusses the mechanism of TCM active ingredients in regulating bone homeostasis, including stimulating bone formation and inhibiting bone resorption process and the healing mechanism of traditional bone repair scaffolds activated by them for osteoporotic defect healing.

CONCLUSION

In general, the introduction of TCM active ingredients provides a novel therapeutic approach for modulating bone homeostasis and facilitating osteoporotic defect healing, and also offers a new strategy for design of other unconventional bone defect healing materials.

Osteogenic differentiation of human mesenchymal stem cells on electroactive substrates

This study investigates the effect of electroactivity and electrical charge distribution on the biological response of human bone marrow stem cells (hBMSCs) cultured in monolayer on flat poly(vinylidene fluoride), PVDF, substrates. Differences in cell behaviour, including proliferation, expression of multipotency markers CD90, CD105 and CD73, and expression of genes characteristic of different mesenchymal lineages, were observed both during expansion in basal medium before reaching confluence and in confluent cultures in osteogenic induction medium. The crystallisation of PVDF in the electrically neutral α-phase or in the electroactive phase β, both unpoled and poled, has been found to have an important influence on the biological response. In addition, the presence of a permanent positive or negative surface electrical charge distribution in phase β substrates has also shown a significant effect on cell behaviour.

Progress of Piezoelectric Semiconductor Nanomaterials in Sonodynamic Cancer Therapy

Sonodynamic therapy is an emerging noninvasive tumor treatment method that utilizes ultrasound to stimulate sonosensitizers to produce a large amount of reactive oxygen species, inducing tumor cell death. Though sonodynamic therapy has very promising prospects in cancer treatment, the application of early organic sonosensitizers has been limited in efficacy due to the high blood clearance-rate, poor water solubility, and low stability. Inorganic sonosensitizers have thus been developed, among which piezoelectric semiconductor materials have received increasing attention in sonodynamic therapy due to their piezoelectric properties and strong stability. In this review, we summarized the designs, principles, modification strategies, and applications of several commonly used piezoelectric materials in sonodynamic therapy and prospected the future clinical applications for piezoelectric semiconductor materials in sonodynamic therapy.

Fabrication of poly (lactic-co-glycolic acid)/gelatin electro spun nanofiber patch containing CaCO3/SiO2 nanocomposite and quercetin for accelerated diabetic wound healing

An open wound or sore on the bottom of the foot caused by diabetes is known as a diabetic foot ulcer. Preventive measures are essential, including consistent foot care and glycemic management. The dangers associated with diabetic foot ulcers can be reduced via early identification and timely treatment. The risk of foot ulcers and limb amputation increases with age and duration of diabetes. Quercetin contains anti-inflammatory and antioxidant properties. Furthermore, the calcium carbonate/silica (CaCO3/SiO2) nanocomposite has a good anti-inflammatory property due to the presence of calcium, which will aid in wound healing. As a result, combining quercetin (plant based anti-inflammatory drug) and CaCO3/SiO2 nanocomposite will boost the wound healing rate. We have synthesized CaCO3/SiO2 nanocomposite in sol-gel method and characterized using XRD, FTIR and TEM. Cell line tests and the MTT assay revealed that the PLGA/gelatin/CaCO3/SiO2/quercetin patch enhanced the proliferation of cells. Its anti-bacterial efficacy against four major bacterial strains often found in wound locations, as well as its water retention, make it an ideal material for diabetic wound healing. In-vivo trials confirms the enhanced diabetic wound healing potential of the patch.

Smart Orthopedic Biomaterials and Implants

Musculoskeletal injuries including bone defects continue to present a significant challenge in orthopedic surgery due to suboptimal healing. Bone reconstruction strategies focused on the use of biological grafts and bone graft substitutes in the form of biomaterials-based 3D structures in fracture repair. Recent advances in biomaterials science and engineering have resulted in the creation of intricate 3D bone-mimicking structures that are mechanically stable, biodegradable, and bioactive to support bone regeneration. Current efforts are focused on improving the biomaterial and implant physicochemical properties to promote interactions with the host tissue and osteogenesis. The "smart" biomaterials and their 3D structures are designed to actively interact with stem/progenitor cells and the extracellular matrix (ECM) to influence the local environment towards osteogenesis and de novo tissue formation. This article will summarize such smart biomaterials and the methodologies to apply either internal or external stimuli to control the tissue healing microenvironment. A particular emphasis is also made on the use of smart biomaterials and strategies to create functional bioactive implants for bone defect repair and regeneration.

Effects of Electrical Stimulation on Articular Cartilage Regeneration with a Focus on Piezoelectric Biomaterials for Articular Cartilage Tissue Repair and Engineering

There is increasing evidence that chondrocytes within articular cartilage are affected by endogenous force-related electrical potentials. Furthermore, electrical stimulation (ES) promotes the proliferation of chondrocytes and the synthesis of extracellular matrix (ECM) molecules, which accelerate the healing of cartilage defects. These findings suggest the potential application of ES in cartilage repair. In this review, we summarize the pathogenesis of articular cartilage injuries and the current clinical strategies for the treatment of articular cartilage injuries. We then focus on the application of ES in the repair of articular cartilage in vivo. The ES-induced chondrogenic differentiation of mesenchymal stem cells (MSCs) and its potential regulatory mechanism are discussed in detail. In addition, we discuss the potential of applying piezoelectric materials in the process of constructing engineering articular cartilage, highlighting the important advances in the unique field of tissue engineering.

Hybrid Systems of Nanofibers and Polymeric Nanoparticles for Biological Application and Delivery Systems

Nanomedicine is a new discipline resulting from the combination of nanotechnology and biomedicine. Nanomedicine has contributed to the development of new and improved treatments, diagnoses, and therapies. In this field, nanoparticles have notable importance due to their unique properties and characteristics, which are useful in different applications, including tissue engineering, biomarkers, and drug delivery systems. Electrospinning is a versatile technique used to produce fibrous mats. The high surface area of the electrospun mats makes them suitable for applications in fields using nanoparticles. Electrospun mats are used for tissue engineering, wound dressing, water-treatment filters, biosensors, nanocomposites, medical implants, protective clothing materials, cosmetics, and drug delivery systems. The combination of nanoparticles with nanofibers creates hybrid systems that acquire properties that differ from their components' characteristics. By utilizing nanoparticles and nanofibers composed of dissimilar polymers, the two synergize to improve the overall performance of electrospinning mats and nanoparticles. This review summarizes the hybrid systems of polymeric nanoparticles and polymeric nanofibers, critically analyzing how the combination improves the properties of the materials and contributes to the reduction of some disadvantages found in nanometric devices and systems.

Application of Piezoelectric Material and Devices in Bone Regeneration

Bone injuries are common in clinical practice. Given the clear disadvantages of autologous bone grafting, more efficient and safer bone grafts need to be developed. Bone is a multidirectional and anisotropic piezoelectric material that exhibits an electrical microenvironment; therefore, electrical signals play a very important role in the process of bone repair, which can effectively promote osteoblast differentiation, migration, and bone regeneration. Piezoelectric materials can generate electricity under mechanical stress without requiring an external power supply; therefore, using it as a bone implant capable of harnessing the body's kinetic energy to generate the electrical signals needed for bone growth is very promising for bone regeneration. At the same time, devices composed of piezoelectric material using electromechanical conversion technology can effectively monitor the structural health of bone, which facilitates the adjustment of the treatment plan at any time. In this paper, the mechanism and classification of piezoelectric materials and their applications in the cell, tissue, sensing, and repair indicator monitoring aspects in the process of bone regeneration are systematically reviewed.