In vivo biocompatibility and degradation behavior of Mg alloy coated by calcium phosphate in a rabbit model

Ce-doped MgO films on AZ31 alloy substrate for biomedical applications: preparation, characterization and testing

Magnesium ions, MgO nanoparticles and thin films, magnesium alloys and cerium compounds are materials intensively studied due to their corrosion protection, antibacterial and pharmacological properties. In this work, we have designed, prepared and investigated, novel thin films of MgO doped with cerium, deposited on Mg alloy (AZ31) for temporary implants, in order to enhance their life time. More precisely, we report on microstructure and corrosion behavior of MgO pure and doped with 0.1 at % Ce films, fabricated by sol-gel route coupled with spin-coating technique, on AZ31 alloy substrate. A modified sol-gel method that start from magnesium acetylacetonate, cerium nitrate and 2-methoxyethanol (as a stabilizer for the sol) was been used successfully for cerium doped MgO sol precursor preparation. The structure and morphology of the surface of the coatings, before and after immersion for 7-30 d in Hank's solution at 37 °C, were characterized by x-ray diffraction (XRD), scanning electron microscopy, high-resolution transmission electron microscope, x-ray photoelectron spectroscopy and Fourier infrared transmittance spectrum (FT-IR). A comparison between the corrosion protection of undoped MgO and MgO doped with 0.1 at % Ce coatings on the AZ31 alloy substrate is performed by electrochemical tests and immersion tests using open circuit potential and electrochemical impedance spectroscopy in Hank's solution, at 37 °C. The electrochemical results showed that the protection of the AZ31 alloy substrate against corrosion was better with the doped with 0.1 at % Ce MgO film deposited than with pure MgO coting. The investigations of the films after immersion in Hank's solution, at 37 °C, for 7, 21 and 30 d indicated that the grown layer on the film is bone like apatite that suggests a good bioactivity of 0.1 at % Ce-doped MgO coating. Our work demonstrates that the performance corrosion protection of the biodegradable magnesium alloys used for orthopedic applications, in simulated physiological environments (Hank and Ringer) can be enhanced through coating with Ce3+doped MgO sol-gel thin film.

Plasma-Enabled Graphene Quantum Dot Hydrogel-Magnesium Composites as Bioactive Scaffolds for In Vivo Bone Defect Repair

Bioactive and mechanically stable metal-based scaffolds are commonly used for bone defect repair. However, conventional metal-based scaffolds induce nonuniform cell growth, limiting damaged tissue restoration. Here, we develop a plasma nanotechnology-enhanced graphene quantum dot (GQD) hydrogel-magnesium (Mg) composite scaffold for functional bone defect repair by integrating a bioresource-derived nitrogen-doped GQD (NGQD) hydrogel into the Mg ZK60 alloy. Each scaffold component brings major synergistic advantages over the current alloy-based state of the art, including (1) mechanical support of the cortical bone and calcium deposition by the released Mg2+ during degradation; (2) enhanced uptake, migration, and distribution of osteoblasts by the porous hydrogel; and (3) improved osteoblast adhesion and proliferation, osteogenesis, and mineralization by the NGQDs in the hydrogel. Through an in vivo study, the hybrid scaffold with the much enhanced osteogenic ability induced by the above synergy promotes a more rapid, uniform, and directional bone growth across the hydrogel channel, compared with the control Mg-based scaffold. This work provides insights into the design of multifunctional hybrid scaffolds, which can be applied in other areas well beyond the demonstrated bone defect repair.

In vivo degradation and bone reaction of long-term fixation with a magnesium alloy made by twin-roll casting in a rat femur model

BACKGROUND

The effect of casting parameters on the microstructure and corrosion resistance of Mg alloys is still limited, especially in clinical animal experiments.

OBJECTIVE

We prepared a new magnesium rare earth alloy (Mg-Re, where Re is Ce or La) by vertical two-roll casting and Mg-A by further rolling. The microstructure characteristics, degradation behavior, and bone reaction of the two alloys were studied.

METHOD

Ti, Mg-Re, and Mg-A alloy plates were implanted in a rat femur model, and their degradation behavior was observed 48 weeks later.

RESULTS

In vivo experiments showed no significant changes around the femur in the Ti group, excluding external factors that may cause bone remodeling and lead to new bone formation. Mg-A induces more new bone formation than Mg-Re, which meets the necessary conditions to prevent pathological fracture. The specimen staining and sectioning showed that the liver and heart of rats implanted with magnesium alloys had no pathological changes and the cell structure was normal, similar to that of rats without a magnesium alloy.

CONCLUSION

Mg-A alloy has good healing potential as a biodegradable implant material.

Improving hydroxyapatite coating ability on biodegradable metal through laser-induced hydrothermal coating in liquid precursor: Application in orthopedic implants

During the past decade, there has been extensive research toward the possibility of exploring magnesium and its alloys as biocompatible and biodegradable materials for implantable applications. Its practical medical application, however, has been limited to specific areas owing to rapid corrosion in the initial stage and the consequent complications. Surface coatings can significantly reduce the initial corrosion of Mg alloys, and several studies have been carried out to improve the adhesion strength of the coating to the surfaces of the alloys. The composition of hydroxyapatite (HAp) is very similar to that of bone tissue; it is one of the most commonly used coating materials for bone-related implants owing to favorable osseointegration post-implantation. In this study, HAp was coated on Mg using nanosecond laser coating, combining the advantages of chemical and physical treatments. Photothermal heat generated in the liquid precursor by the laser improved the adhesion of the coating through the precipitation and growth of HAp at the localized nanosecond laser focal area and increased the corrosion resistance and cell adhesion of Mg. The physical, crystallographic, and chemical bondings were analyzed to explore the mechanism through which the surface adhesion between Mg and the HAp coating layer increased. The applicability of the coating to Mg screws used for clinical devices and improvement in its corrosion property were confirmed. The liquid environment-based laser surface coating technique offers a simple and quick process that does not require any chemical ligands, and therefore, overcomes a potential obstacle in its clinical use.

Review of the Effect of Surface Coating Modification on Magnesium Alloy Biocompatibility

Magnesium alloy, as an absorbable and implantable biomaterial, has been greatly developed in the application field of biomaterials in recent years due to its excellent biocompatibility and biomechanics. However, due to the poor corrosion resistance of magnesium alloy in the physiological environment, the degradation rate will be unbalanced, which seriously affects the clinical use. There are two main ways to improve the corrosion resistance of magnesium alloy: one is by adding alloying elements, the other is by surface modification technology. Compared with adding alloy elements, the surface coating modification has the following advantages: (1) The surface coating modification is carried out without changing the matrix elements of magnesium alloy, avoiding the introduction of other elements; (2) The corrosion resistance of magnesium alloy can be improved by relatively simple physical, chemical, or electrochemical improvement. From the perspective of corrosion resistance and biocompatibility of biomedical magnesium alloy materials, this paper summarizes the application and characteristics of six different surface coating modifications in the biomedical magnesium alloy field, including chemical conversion method, micro-arc oxidation method, sol-gel method, electrophoretic deposition, hydrothermal method, and thermal spraying method. In the last section, it looks forward to the development prospect of surface coating modification and points out that preparing modified coatings on the implant surface combined with various modification post-treatment technologies is the main direction to improve biocompatibility and realize clinical functionalization.

A Systematic Review and Network Meta-Analysis of Biomedical Mg Alloy and Surface Coatings in Orthopedic Application

Magnesium alloys have great application prospects as ideal bone implant materials. However, their poor corrosion resistance limits their clinical orthopedic application. Surface modification promotes the corrosion resistance of magnesium. Conversion coatings, such as calcium phosphate (Ca-P) coating, microarc oxidation (MAO) treatment, and fluoride (FLU) treatment, have been extensively investigated in in vivo studies. This systematic review and network meta-analysis compared the influence of different conversion coatings on bone repair, material properties, and systemic host response in orthopedic applications. Using the PICOS model, the inclusion criteria for biodegradable magnesium and its alloys were determined for in vivo studies. Four databases were used. The standard and weight mean differences with 95% confidence intervals were used to analyze new bone formation and degradation rate. Network structure and forest plots were created, and ranking probabilities were estimated. The risk of bias and quality of evidence were assessed using SYRCLE, CERQual, and GRADE tools. In the qualitative analysis, 43 studies were selected, and the evaluation of each outcome indicator was not entirely consistent from article to article. In the quantitative analysis, 21 articles were subjected to network meta-analysis, with 16 articles on implant degradation and 8 articles for new bone formation. Additionally, SUCRA indicated that Ca-P coating exhibited the highest corrosion resistance, followed by FLU treatment. MAO demonstrated the best capability for new bone formation, followed by Ca-P coating. Ca-P coating exhibited the highest overall performance. To conclude, coated Mg can promote better new bone formation than bare Mg and has considerable biocompatibility. Ca-P-coated Mg and MAO-coated Mg have the greatest potential to significantly promote corrosion resistance and bone regeneration, respectively. The findings of this study will provide a theoretical basis for the investigation of composite coatings and guidance for the orthopedic application of Mg bone implants.

Biodegradable shape memory alloys: Progress and prospects

Shape memory alloys (SMAs) have a wide range of potential novel medical applications due to their superelastic properties and ability to restore and retain a 'memorised' shape. However, most SMAs are permanent and do not degrade in the body when used in implantable devices. The use of non-degrading metals may lead to the requirement for secondary removal surgery and this in turn may introduce both short and long-term health risks, or additional waste disposal requirements. Biodegradable SMAs can effectively eliminate these issues by gradually degrading inside the human body while providing the necessary support for healing purposes, therefore significantly alleviating patient discomfort and improving healing efficiency. This paper reviews the current progress in biodegradable SMAs from the perspective of biodegradability, mechanical properties, and biocompatibility. By providing insights into the status of SMAs and biodegradation mechanisms, the prospects for Mg- and Fe-based biodegradable SMAs to advance biodegradable SMA-based medical devices are explored. Finally, the remaining challenges and potential solutions in the biodegradable SMAs area are discussed, providing suggestions and research frameworks for future studies on this topic.

Role of calcium phosphate and bioactive glass coating on in vivo bone healing of new Mg-Zn-Ca implant

Present investigation focuses on development and detailed characterization of a new Mg alloy sample (BM) with and without coating of hydroxyapatite (BMH) and bioactive glass (BMG) by air plasma spray method. After detailed mechano-physico-chemical characterization of powders and coated samples, electrochemical corrosion and SBF immersion tests were carried out. Detailed in vitro characterizations for cell viability were undertaken using MG-63 cell line followed by in vivo tests in rabbit model for studying bone healing up to 60 days. Starting current density increases from BM to BMH to BMG indicating highest resistance towards corrosion in case of BMG samples, however BMH also showed highest i_corr value suggesting slowest rate of corrosion than BM and BMG samples. Dissolution of calcium ion in case of BMH and BMG control formation of apatite phases on surface. Ca²⁺ ions of coatings and from SBF solution underwent reduction reaction simultaneously with conversion of Mg to MgCl₂ releasing OH^- in the solution, which increases pH. Viability and propagation of human osteoblast-like cells was verified using confocal microscopy observations and from expression of bone specific genes. Alkaline phosphatase assay and ARS staining indicate cell proliferation and production of neo-osseous tissue matrix. In vivo, based on histology of heart, kidney and liver, and immune response of IL-2, IL-6 and TNFα, all the materials show no adverse effects in body system. The bone creation was observed to be more for BMH. Although both BMH and BMG show rays of possibilities in early new bone formation and tough bone-implant bonding at interface as compared to bare Mg alloy, however, BMG showed better well-sprayed coating covering on substrate and resistance against corrosion prior implanting in vivo. Also, better apatite formation on this sample makes it more favourable implant.

Exposure to high levels of magnesium disrupts bone mineralization in vitro and in vivo

Background

The removal of permanent internal fixation devices by secondary surgery could be avoided if these devices were made of degradable magnesium and magnesium alloys. Before such implants can be used clinically, however, the biological effect of magnesium exposure on surrounding bone must be evaluated. Previous studies have focused on bone formation; few have examined the effects of magnesium on the bone quality that affect many biomechanical properties.

Methods

Using bone quality parameters, we analyzed in vivo changes in bone properties and biomechanics after exposure to locally high levels of magnesium.

Results

Local bone mineralization was significantly disrupted following exposure to a porous rod of pure magnesium. Normal crystal formation and crystallinity were inhibited and the mineral-to-matrix ratio decreased. These results were consistent with those of in vitro experiments, in which high levels of magnesium inhibited mineral deposition by mesenchymal stem cells (MSCs) but increased alkaline phosphatase (ALP) expression. The same mineralization inhibition was observed around magnesium implants via micro-computerized tomography (micro-CT) and von Kossa staining. Such reduced bone quality around degrading magnesium rods could negatively impact bone biomechanics.

Conclusions

This study showed that exposure to the local high magnesium levels that arise from rapidly degrading magnesium devices may significantly disrupt bone mineralization and negatively impact bone biomechanics.

Bioabsorbable Osteofixation Materials for Maxillofacial Bone Surgery: A Review on Polymers and Magnesium-Based Materials

Clinical application of osteofixation materials is essential in performing maxillofacial surgeries requiring rigid fixation of bone such as trauma surgery, orthognathic surgery, and skeletal reconstruction. In addition to the use of titanium plates and screws, clinical applications and attempts using bioabsorbable materials for osteofixation surgery are increasing with demands to avoid secondary surgery for the removal of plates and screws. Synthetic polymeric plates and screws were developed, reaching satisfactory physical properties comparable to those made with titanium. Although these polymeric materials are actively used in clinical practice, there remain some limitations to be improved. Due to questionable physical strength and cumbersome molding procedures, interests in resorbable metal materials for osteofixation emerged. Magnesium (Mg) gained attention again in the last decade as a new metallic alternative, and numerous animal studies to evaluate the possibility of clinical application of Mg-based materials are being conducted. Thanks to these researches and studies, vascular application of Mg-based biomaterials was successful; however, further studies are required for the clinical application of Mg-based biomaterials for osteofixation, especially in the facial skeleton. The review provides an overview of bioabsorbable osteofixation materials in maxillofacial bone surgery from polymer to Mg.

Investigation of a cyanine dye assay for the evaluation of the biocompatibility of magnesium alloys by direct and indirect methods

Magnesium and its alloys are promising candidates for a new generation of biodegradable metals in orthopaedic applications due to their excellent biocompatibility, biodegradability, and mechanical properties that are similar to natural bone. However, direct in vitro assessment of these materials in the presence of cells is complicated by degradation products from the alloy that lead to a false positive for the most commonly used cell adhesion and cell proliferation assays. In this paper, a cyanine dye was used to quantitatively evaluate the in vitro biocompatibility of a Mg AZ31 alloy by both direct and indirect methods. The cytotoxicity of the corrosion products was evaluated via an indirect method; a 25% decrease in cell viability compared to control samples was observed. Moreover, direct assessment of cell adhesion and proliferation showed a statistically significant increase in cell number at the surface after 72 h. In addition, the degradation rate and surface characteristics of the Mg AZ31 alloy were evaluated for both direct and indirect tests. The degradation rate was unaffected by the presence of cells while evidence of an increase in calcium phosphate deposition on the magnesium alloy surface in the presence of cells was observed. This study demonstrates that a cyanine dye based assay provides a more accurate assessment of the overall in vitro biocompatibility of biodegradable metals than the more commonly used assays reported in the literature to date.

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Quantitative analysis of cell numbers on the surface of magnesium has been performed.

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No false positive was observed.

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Cyanine dye assays are an excellent alternative to tetrazolium salts for in vitro evaluation of bioabsorbable implants.

Preparation and Characterization of Mg-RE Alloy Sheets and Formation of Amorphous/Crystalline Composites by Twin Roll Casting for Biomedical Implant Application

A new type of Mg-based metallic glass has attracted extensive attention due to its excellent corrosion resistance and favorable biocompatibility. In this study, an amorphous/crystalline composite Mg-RE alloy sheet was prepared by a vertical type twin roll caster (VTRC) method, and its microstructure was characterized by scanning electron microscopy (SEM), X-ray diffraction (XRD), and electron probe micro-analysis (EPMA) and transmission electron microscopy (TEM); furthermore, the corrosion behaviors of the Mg-RE alloy sheet were investigated in PBS solution using electrochemical techniques and immersion testing in a simulated physiological condition. Furthermore, it was implanted into the femur of rats to explore its prospect as biological transplantation material. Its microscopic characterization experiments show that the crystal structure is crystalline phase containing amorphous phase. Electrochemical experiments and immersion testing both showed that Mg-RE(La,Ce) sheet with VTRC has a better corrosion resistance than master alloy, and a uniform corrosion layer on the surface. In vivo, as an implant material, tests show that Mg-RE alloy sheets have better biocompatibility and induce new bone formation, and they can be expected to be utilized as implant materials in the future.

In vivo study of microarc oxidation coated Mg alloy as a substitute for bone defect repairing: Degradation behavior, mechanical properties, and bone response

Large segmental bone defect healing remains a great challenge in clinic. Limited by the source of autograft, bone graft substitute tends to be the research focus. In the present study, we propose a strategy by using microarc oxidation (MAO) coated magnesium scaffold as a large segmental bone graft substitute, utilizing its combination of strength, degradability, and controllable corrosion rate. Bare substrate, 10 μm and 20 μm thick MAO coated Mg scaffolds were implanted into ulna bone of New Zealand white rabbits, employing a 15 mm wide bone defect model. The biocompatibility and in vivo degradation of the implants, the bone defect healing response, and mechanical properties of the injured bone were investigated. The surface cytocompatibility evaluation results show that the MAO coated Mg are more suitable for cell proliferation. Micro-CT results show that abundant new bone formed and initially bridged the 15 mm gap at 8 weeks. Histological results indicate the newly formed bone was full of maturation at 12 weeks. Three point bending tests reveal that the injured bone possessed sufficient mechanical strength after 12 weeks. A 3-step in vivo degradation mechanism was proposed for the implants. In summary, we observed an actual trial of 15 mm wide bone defect healing where the newly formed bone bridged the bone gap at 8 weeks successfully. These data suggest a great potential of MAO coated magnesium to be a bone graft substitute.

Biocompatibility and Osteogenic Capacity of Mg-Zn-Ca Bulk Metallic Glass for Rabbit Tendon-Bone Interference Fixation

Mg-based alloys have great potential for development into fixation implants because of their highly biocompatible and biodegradable metallic properties. In this study, we sought to determine the biocompatibility of Mg₆₀Zn₃₅Ca₅ bulk metallic glass composite (BMGC) with fabricated implants in a rabbit tendon-bone interference fixation model. We investigated the cellular cytotoxicity of Mg₆₀Zn₃₅Ca₅ BMGC toward rabbit osteoblasts and compared it with conventional titanium alloy (Ti6Al4V) and polylactic acid (PLA). The results show that Mg₆₀Zn₃₅Ca₅ BMGC may be classed as slightly toxic on the basis of the standard ISO 10993-5. We further characterized the osteogenic effect of the Mg₆₀Zn₃₅Ca₅ BMGC extraction medium on rabbit osteoblasts by quantifying extracellular calcium and mineral deposition, as well as cellular alkaline phosphatase activity. The results of these tests were found to be promising. The chemotactic effect of the Mg₆₀Zn₃₅Ca₅ BMGC extraction medium on rabbit osteoblasts was demonstrated through a transwell migration assay. For the in vivo section of this study, a rabbit tendon-bone interference fixation model was established to determine the biocompatibility and osteogenic potential of Mg₆₀Zn₃₅Ca₅ BMGC in a created bony tunnel for a period of up to 24 weeks. The results show that Mg₆₀Zn₃₅Ca₅ BMGC induced considerable new bone formation at the implant site in comparison with conventional titanium alloy after 24 weeks of implantation. In conclusion, this study revealed that Mg₆₀Zn₃₅Ca₅ BMGC demonstrated adequate biocompatibility and exhibited significant osteogenic potential both in vitro and in vivo. These advantages may be clinically beneficial to the development of Mg₆₀Zn₃₅Ca₅ BMGC implants for future applications.

The Potential of Magnesium Based Materials in Mandibular Reconstruction

The future of biomaterial design will rely on development of bioresorbable implant materials that completely and safely degrade in vivo after the tissues grow, without generating harmful degradation products at the targeted anatomic site. Permanent biomaterials such as Ti6Al4V alloy, 316L stainless steel, and Co-based alloys currently used in mandibular reconstruction often result in stress shielding effects due to mismatch in the Young’s modulus values between the bone and the implant, resulting in implant loosening. Also, allergic responses due to metal ion releases necessitates revision surgery to prevent long term exposure of the body to toxic implant contents. Bioresorbable metals are perceived as revolutionary biomaterials that have transformed the nature of metallic biomaterials from bioinert to bioactive and multi-bio functional (anti-bacterial, anti-proliferation, and anti-cancer). In this aspect, magnesium (Mg)-based materials have recently been explored by the biomedical community as potential materials for mandibular reconstruction, as they exhibit favorable mechanical properties, adequate biocompatibility, and degradability. This article reviews the recent progress that has led to advances in developing Mg-based materials for mandibular reconstruction; correlating with the biomechanics of mandible and types of mandibular defects. Mg-based materials are discussed regarding their mechanical properties, corrosion characteristics, and in vivo performance. Finally, the paper summarizes findings from this review, together with a proposed scope for advancing the knowledge in Mg-based materials for mandibular reconstruction.

In vitro and in vivo analysis of the biodegradable behavior of a magnesium alloy for biomedical applications

The present study was designed to investigate the biodegradation behavior of Mg alloy plates in the maxillofacial region. For in vitro analysis, the plates were immersed in saline solution and simulated body fluid. For in vivo, the plates were implanted into the tibia, head, back, abdominal cavity, and femur and assessed at 1, 2, and 4 weeks after implantation. After implantation, the plate volumes and the formed insoluble salt were measured via micro-computed tomography. SEM/EDX analysis of the insoluble salt and histological analysis of the surrounding tissues were performed. The volume loss of plates in the in vitro groups was higher than that in the in vivo groups. The volume loss was fastest in the abdomen, followed by the head, back, tibia, and femur. There were no statistically significant differences in the insoluble salt volume of the all implanted sites. The corrosion of the Mg alloy will be affected to the surrounding tissue responses. The material for the plate should be selected based on the characteristic that Mg alloys are decomposed relatively easily in the maxillofacial region.

Evaluation of Magnesium-based Medical Devices in Preclinical Studies: Challenges and Points to Consider

Absorbable metallic implants have been under investigation for more than a century. Animal and human studies have shown that magnesium (Mg) alloys can be safely used in bioresorbable scaffolds. Several cardiovascular and orthopedic biodegradable metallic devices have recently been approved for use in humans. Bioresorbable Mg implants present many advantages when compared to bioabsorbable polymer or nonabsorbable metallic implants, including similar strength and mechanical properties as existing implant-grade metals without the drawbacks of permanence or need for implant removal. Imaging visibility is also improved compared to polymeric devices. Additionally, with Mg-based cardiovascular stents, the risk of late stent thrombosis and need for long-term anti-platelet therapy may be reduced as the host tissue absorbs the Mg degradation products and the morphology of the vessel returns to a near-normal state. Absorbable Mg implants present challenges in the conduct of preclinical animal studies and interpretation of pathology data due to their particular degradation process associated with gas production and release of by-products. This article will review the different uses of Mg implants, the Mg alloys, the distinctive degradation features of Mg, and the challenges confronting pathologists at tissue collection, fixation, imaging, slide preparation, evaluation, and interpretation of Mg implants.

The current trends of Mg alloys in biomedical applications-A review

Magnesium (Mg) has emerged as an ideal alternative to the permanent implant materials owing to its enhanced properties such as biodegradation, better mechanical strengths than polymeric biodegradable materials and biocompatibility. It has been under investigation as an implant material both in cardiovascular and orthopedic applications. The use of Mg as an implant material reduces the risk of long-term incompatible interaction of implant with tissues and eliminates the second surgical procedure to remove the implant, thus minimizes the complications. The hurdle in the extensive use of Mg implants is its fast degradation rate, which consequently reduces the mechanical strength to support the implant site. Alloy development, surface treatment, and design modification of implants are the routes that can lead to the improved corrosion resistance of Mg implants and extensive research is going on in all three directions. In this review, the recent trends in the alloying and surface treatment of Mg have been discussed in detail. Additionally, the recent progress in the use of computational models to analyze Mg bioimplants has been given special consideration. © 2018 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater 107B: 1970-1996, 2019.

A feasibility study of using biodegradable magnesium alloy in glaucoma drainage device

Technological advances in glaucoma have challenged the traditional treatment paradigm. Historically incisional surgery has been used in cases of advanced disease and/or uncontrolled intraocular pressures resistant to medical or laser interventions. More recently, perhaps due to advancements in imaging, surgery has been suggested to be beneficial earlier in the treatment paradigm. Despite these trends, surgical manipulation of the tissues and unpredictability of wound healing continue to result in surgical failure. Magnesium is an essential element for human body and plays a critically important role in maintaining the functional and structural integrity of several tissues, including the eye. Due to several of its advantageous properties such as non-toxicity, biodegradability, and high biological compatibility, magnesium alloy has attracted great attention as a novel biomaterial. Biodegradable cardiovascular stents made of magnesium alloy have already been introduced into clinical practice. The purpose of this review is to determine if bioabsorbable magnesium alloys can be utilized as a promising candidate for the development of a new generation of glaucoma surgical assistive devices.

In vivo study of microarc oxidation coated biodegradable magnesium plate to heal bone fracture defect of 3mm width

Microarc oxidation (MAO) coated magnesium (Mg) with improved corrosion resistance appeal increasing interests as a revolutionary biodegradable metal for fractured bone fixing implants application. However, the in vivo corrosion degradation of the implants and bone healing response are not well understood, which is highly required in clinic. In the present work, 10μm and 20μm thick biocompatible MAO coatings mainly composed of MgO, Mg₂SiO₄, CaSiO₃ and Mg₃(PO₄)₂ phases were fabricated on AZ31 magnesium alloy. The electrochemical tests indicated an improved corrosion resistance of magnesium by the MAO coatings. The 10μm and 20μm coated and uncoated magnesium plates were separately implanted into the radius bone fracture site of adult New Zealand white rabbits using a 3mm width bone fracture defect model to investigate the magnesium implants degradation and uninhibited bone healing. Taking advantage of the good biocompatibility of the MAO coatings, no adverse effects were detected through the blood test and histological examination. The implantation groups of coated and uncoated magnesium plates were both observed the promoting effect of bone fracture healing compared with the simple fracture group without implant. The releasing Mg²⁺ by the degradation of implants into the fracture site improved the bone fracture healing, which is attributed to the magnesium promoting CGRP-mediated osteogenic differentiation. Mg degradation and bone fracture healing promoting must be tailored by microarc oxidation coating with different thickness for potential clinic application.

In vivo characterization of magnesium alloy biodegradation using electrochemical H2 monitoring, ICP-MS, and XPS

The effect of widely different corrosion rates of Mg alloys on four parameters of interest for in vivo characterization was evaluated: (1) the effectiveness of transdermal H₂ measurements with an electrochemical sensor for noninvasively monitoring biodegradation compared to the standard techniques of in vivo X-ray imaging and weight loss measurement of explanted samples, (2) the chemical compositions of the corrosion layers of the explanted samples by XPS, (3) the effect on animal organs by histology, and (4) the accumulation of corrosion by-products in multiple organs by ICP-MS. The in vivo biodegradation of three magnesium alloys chosen for their widely varying corrosion rates - ZJ41 (fast), WKX41 (intermediate) and AZ31 (slow) - were evaluated in a subcutaneous implant mouse model. Measuring H₂ with an electrochemical H₂ sensor is a simple and effective method to monitor the biodegradation process in vivo by sensing H₂ transdermally above magnesium alloys implanted subcutaneously in mice. The correlation of H₂ levels and biodegradation rate measured by weight loss shows that this non-invasive method is fast, reliable and accurate. Analysis of the insoluble biodegradation products on the explanted alloys by XPS showed all of them to consist primarily of Mg(OH)₂, MgO, MgCO₃ and Mg₃(PO₄)₂ with ZJ41 also having ZnO. The accumulation of magnesium and zinc were measured in 9 different organs by ICP-MS. Histological and ICP-MS studies reveal that there is no significant accumulation of magnesium in these organs for all three alloys; however, zinc accumulation in intestine, kidney and lung for the faster biodegrading alloy ZJ41 was observed. Although zinc accumulates in these three organs, no toxicity response was observed in the histological study. ICP-MS also shows higher levels of magnesium and zinc in the skull than in the other organs.

STATEMENT OF SIGNIFICANCE

Biodegradable devices based on magnesium and its alloys are promising because they gradually dissolve and thereby avoid the need for subsequent removal by surgery if complications arise. In vivo biodegradation rate is one of the crucial parameters for the development of these alloys. Promising alloys are first evaluated in vivo by being implanted subcutaneously in mice for 1month. Here, we evaluated several magnesium alloys with widely varying corrosion rates in vivo using multiple characterization techniques. Since the alloys biodegrade by reacting with water forming H₂ gas, we used a recently demonstrated, simple, fast and noninvasive method to monitor the biodegradation process by just pressing the tip of a H₂ sensor against the skin above the implant. The analysis of 9 organs (intestine, kidney, spleen, lung, heart, liver, skin, brain and skull) for accumulation of Mg and Zn revealed no significant accumulation of magnesium in these organs. Zinc accumulation in intestine, kidney and lung was observed for the faster corroding implant ZJ41. The surfaces of explanted alloys were analyzed to determine the composition of the insoluble biodegradation products. The results suggest that these tested alloys are potential candidates for biodegradable implant applications.

Radiological, histological, and hematological evaluation of hydroxyapatite-coated resorbable magnesium alloy screws placed in rabbit tibia

Titanium (Ti) screw has excellent mechanical property, and osseointegration capacity. However, they require surgery for removal. In contrast, polymer screws are resorbable, but they have poor mechanical properties. In this research, magnesium alloy screws (WE43: Mg-Y-Nd-Zr) that have advantages of titanium and polymer were manufactured. In addition, to increase biocompatibility and control degradation rate, the Mg alloy was coated with hydroxyapatite (HA). Torsion test and corrosion test were performed in vitro. For clinical, radiological and histological evaluation, on the eight rabbits, two HA-coated screws were installed in left tibia, and two noncoated screws were installed in right tibia. Each four rabbits were sacrificed 6 and 12 weeks postoperatively. For hematological evaluation, the same type of screws were installed on both legs. Complete blood count (CBC), Mg²⁺ concentrate were sampled from the ear central artery on the operation day for a control point, and at 1, 2, 4, 6, 8, and 12 weeks. Mg alloy screws have no differences of biocompatibility according to the HA coating. However, resorption of screw was slower in case of the HA coating. The hematological problem related releasing of Mg was not found. The results suggest that Mg alloy screws have feasibility for clinical application. © 2016 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater, 105B: 1636-1644, 2017.

In vivo monitoring the biodegradation of magnesium alloys with an electrochemical H2 sensor

Monitoring the biodegradation process of magnesium and its alloys in vivo is challenging. Currently, this process is monitored by micro-CT and X-ray imaging in vivo, which require large and costly instrumentation. Here we report a simple and effective methodology to monitor the biodegradation process in vivo by sensing H2 transdermally above a magnesium sample implanted subcutaneously in a mouse. An electrochemical H2 microsensor was used to measure the biodegradation product H2 at the surface of the skin for two magnesium alloys (ZK40 and AZ31) and one high purity magnesium single crystal (Mg8H). The sensor was able to easily detect low levels of H2 (30-400μM) permeating through the skin with a response time of about 30s. H2 levels were correlated with the biodegradation rate as determined from weight loss measurements of the implants. This new method is noninvasive, fast and requires no major equipment.

STATEMENT OF SIGNIFICANCE

Biomedical devices such as plates and screws used for broken bone repair are being developed out of biodegradable magnesium alloys that gradually dissolve when no longer needed. This avoids subsequent removal by surgery, which may be necessary if complications arise. A rapid, non-invasive means for monitoring the biodegradation process in vivo is needed for animal testing and point of care (POC) evaluation of patients. Here we report a novel, simple, fast, and noninvasive method to monitor the biodegradation of magnesium in vivo by measuring the biodegradation product H2 with an electrochemical H2 sensor. Since H2 rapidly permeates through biological tissue, measurements are made by simply pressing the sensor tip against the skin above the implant; the response is within 30s.

Sirolimus-loaded CaP coating on Co-Cr alloy for drug-eluting stent

To achieve polymer-free and controllable drug-eluting system, there have been many efforts to modify the surface composition and topography of metal stent. Recently, calcium phosphate is commonly applied to metallic implants as a coating material for fast fixation and firm-implant bone attachment on the account of its demonstrated bioactive and osteoconductive properties. In the present study, the release of sirolimus could be controllable because of immobilization of sirolimus during the process of biomimetic CaP coating forming. A completely new concept is the drug carrier of biomimetic CaP coating with sirolimus for an absorbable drug eluting system, which in turn can serve as a drug reservoir. We here describe the characteristic, mechanisms and drug release in vitro of new drug-eluting system in comparison to conventional system equivalent. Nano-structured calcium phosphate (CaP) coating was formed on the cobalt–chromium (Co-Cr) alloy substrate. By immersing coated sample in solution with sirolimus (rapamycin), the sirolimus could be immobilized in the newly formed CaP layer. The morphology, composition and formation process of the coating were studied with scanning electron microscopy, energy dispersive spectrometer, X-ray diffraction and X-ray photoelectron spectroscopy. The results showed that a uniform CaP coating incorporated with sirolimus was observed on Co-Cr alloy.

In vivo study of magnesium plate and screw degradation and bone fracture healing

Each year, millions of Americans suffer bone fractures, often requiring internal fixation. Current devices, like plates and screws, are made with permanent metals or resorbable polymers. Permanent metals provide strength and biocompatibility, but cause long-term complications and may require removal. Resorbable polymers reduce long-term complications, but are unsuitable for many load-bearing applications. To mitigate complications, degradable magnesium (Mg) alloys are being developed for craniofacial and orthopedic applications. Their combination of strength and degradation make them ideal for bone fixation. Previously, we conducted a pilot study comparing Mg and titanium devices with a rabbit ulna fracture model. We observed Mg device degradation, with uninhibited healing. Interestingly, we observed bone formation around degrading Mg, but not titanium, devices. These results highlighted the potential for these fixation devices. To better assess their efficacy, we conducted a more thorough study assessing 99.9% Mg devices in a similar rabbit ulna fracture model. Device degradation, fracture healing, and bone formation were evaluated using microcomputed tomography, histology and biomechanical tests. We observed device degradation throughout, and calculated a corrosion rate of 0.40±0.04mm/year after 8 weeks. In addition, we observed fracture healing by 8 weeks, and maturation after 16 weeks. In accordance with our pilot study, we observed bone formation surrounding Mg devices, with complete overgrowth by 16 weeks. Bend tests revealed no difference in flexural load of healed ulnae with Mg devices compared to intact ulnae. These data suggest that Mg devices provide stabilization to facilitate healing, while degrading and stimulating new bone formation.

Mg and Mg alloys: how comparable are in vitro and in vivo corrosion rates? A review

Due to their biodegradability, magnesium and magnesium-based alloys could represent the third generation of biomaterials. However, their mechanical properties and time of degradation have to match the needs of applications. Several approaches, such as choice of alloying elements or tailored microstructure, are employed to tailor corrosion behaviour. Due to the high electrochemical activity of Mg, numerous environmental factors (e.g. temperature and surrounding ion composition) influence its corrosion behaviour, making it unpredictable. Nevertheless, the need of reliable in vitro model(s) to predict in vivo implant degradation is increasing. In an attempt to find a correlation between in vitro and vivo corrosion rates, this review presents a systematic literature survey, as well as an attempt to correlate the different results.

A novel pseudo-protein-based biodegradable coating for magnesium substrates: in vitro corrosion phenomena and cytocompatibility

The goal of this study is to examine whether a member of the newly developed biodegradable pseudo-protein biomaterial family could provide a far better protection and performance than the popular hydrolytically degradable poly(glycolide-co-lactide) (PLGA) biomaterial on an experimental magnesium substrate as a model.

Calcium orthophosphate coatings on magnesium and its biodegradable alloys

Biodegradable metals have been suggested as revolutionary biomaterials for bone-grafting therapies. Of these metals, magnesium (Mg) and its biodegradable alloys appear to be particularly attractive candidates due to their non-toxicity and as their mechanical properties match those of bones better than other metals do. Being light, biocompatible and biodegradable, Mg-based metallic implants have several advantages over other implantable metals currently in use, such as eliminating both the effects of stress shielding and the requirement of a second surgery for implant removal. Unfortunately, the fast degradation rates of Mg and its biodegradable alloys in the aggressive physiological environment impose limitations on their clinical applications. This necessitates development of implants with controlled degradation rates to match the kinetics of bone healing. Application of protective but biocompatible and biodegradable coatings able to delay the onset of Mg corrosion appears to be a reasonable solution. Since calcium orthophosphates are well tolerated by living organisms, they appear to be the excellent candidates for such coatings. Nevertheless, both the high chemical reactivity and the low melting point of Mg require specific parameters for successful deposition of calcium orthophosphate coatings. This review provides an overview of current coating techniques used for deposition of calcium orthophosphates on Mg and its biodegradable alloys. The literature analysis revealed that in all cases the calcium orthophosphate protective coatings both increased the corrosion resistance of Mg-based metallic biomaterials and improved their surface biocompatibility.

Magnesium alloys as a biomaterial for degradable craniofacial screws

Recently, magnesium (Mg) alloys have received significant attention as potential biomaterials for degradable implants, and this study was directed at evaluating the suitability of Mg for craniofacial bone screws. The objective was to implant screws fabricated from commercially available pure Mg and alloy AZ31 in vivo in a rabbit mandible. First, Mg and AZ31 screws were compared to stainless steel screws in an in vitro pull-out test and determined to have a similar holding strength (∼40N). A finite-element model of the screw was created using the pull-out test data, and this model can be used for future Mg alloy screw design. Then, Mg and AZ31 screws were implanted for 4, 8 and 12weeks, with two controls of an osteotomy site (hole) with no implant and a stainless steel screw implanted for 12weeks. Microcomputed tomography was used to assess bone remodeling and Mg/AZ31 degradation, both visually and qualitatively through volume fraction measurements for all time points. Histological analysis was also completed for the Mg and AZ31 at 12weeks. The results showed that craniofacial bone remodeling occurred around both Mg and AZ31 screws. Pure Mg had a different degradation profile than AZ31; however, bone growth occurred around both screw types. The degradation rate of both Mg and AZ31 screws in the bone marrow space and the muscle were faster than in the cortical bone space at 12weeks. Furthermore, it was shown that by alloying Mg, the degradation profile could be changed. These results indicate the promise of using Mg alloys for craniofacial applications.

Monetite and brushite coated magnesium: in vivo and in vitro models for degradation analysis

The use of magnesium (Mg) as a biodegradable metallic replacement of permanent orthopaedic materials is a current topic of interest and investigation. The appropriate biocompatibility, elastic modulus and mechanical properties of Mg recommend its suitability for bone fracture fixation. However, the degradation rates of Mg can be rapid and unpredictable resulting in mass hydrogen production and potential loss of mechanical integrity. Thus the application of calcium phosphate coatings has been considered as a means of improving the degradation properties of Mg. Brushite and monetite are utilized and their degradation properties (alongside uncoated Mg controls) are assessed in an in vivo subcutaneous environment and the findings compared to their in vitro degradation behaviour in immersion tests. The current findings suggest monetite coatings have significant degradation protective effects compared to brushite coatings in vivo. Furthermore, it is postulated that an in vitro immersion test may be used as a tentative predictor of in vivo subcutaneous degradation behavior of calcium phosphate coated and uncoated Mg.

Biocompatibility of rapidly solidified magnesium alloy RS66 as a temporary biodegradable metal

Biodegradable magnesium-based alloys are very promising materials for temporary implants. However, the clinical use of magnesium-based alloys is often limited by rapid corrosion and by insufficient mechanical stability. Here we investigated RS66, a magnesium-based alloy with extraordinary physicochemical properties of high tensile strength combined with a high ductility and a homogeneous grain size of ~1 μm which was obtained by rapid solidification processing and reciprocal extrusion. Using a series of in vitro and in vivo experiments, we analyzed the biodegradation behavior and the biocompatibility of this alloy. In vitro, RS66 had no cytotoxic effects in physiological concentrations on the viability and the proliferation of primary human osteoblasts. In vivo, RS66 cylinders were implanted into femur condyles, under the skin and in the muscle of adult rabbits and were monitored for 1, 2, 3, 4 and 8 weeks. After explantation, the RS66 cylinders were first analyzed by microtomography to determine the remaining RS66 alloy and calculate the corrosion rates. Then, the implantation sites were examined histologically for healing processes and foreign body reactions. We found that RS66 was corroded fastest subcutaneously followed by intramuscular and bony implantation of the samples. No clinical harm with transient gas cavities during the first 6 weeks in subcutaneous and intramuscular implantation sites was observed. No gas cavities were formed around the implantation site in bone. The corrosion rates in the different anatomical locations correlated well with the local blood flow prior to implantation. A normal foreign body reaction occurred in all tissues. Interestingly, no enhanced bone formation could be observed around the corroding samples in the condyles. These data show that RS66 is biocompatible, and due to its interesting physicochemical properties, this magnesium alloy is a promising material for biodegradable implants.