Strontium-doped hydroxyapatite polysaccharide materials effect on ectopic bone formation

Probing the influence of strontium doping and annealing temperature on the structure and biocompatibility of hydroxyapatite nanorods

Among numerous biologically important metal cations, strontium (Sr2+) has received much attention in bone tissue regeneration because of its osteoinductive properties combined with its ability to inhibit osteoclast activity. In this study, strontium-doped hydroxyapatite (Sr-HAp) nanorods with varying molar ratios of Ca : Sr (10 : 0, 9 : 1, 5 : 5, 3 : 7 and 0 : 10) were synthesized using the chemical precipitation technique. The synthesized Sr-HAp nanostructures were characterized using powder X-ray diffraction (XRD), field emission scanning electron microscopy (FESEM), transmission electron microscopy, energy dispersive X-ray spectroscopy, and Raman and Fourier transform infrared (FTIR) spectroscopies to understand their structural and morphological features, and composition. XRD results revealed the formation of HAp nanostructures, whose unit cell volume increased as a function of the dopant level. The reaction process investigation showed the formation of hydroxyapatite (HAp), strontium apatite (SAp) and various Sr-HAp phases. FESEM micrographs displayed the morphological transformation of Sr-HAp from nanorods to nanosheets upon increasing the dopant level. In the FTIR spectra, the bands of the PO43- group shifted towards a lower wavenumber upon increasing the dopant concentration in Sr-HAp that signifies the structural distortion due to the presence of a large amount of strontium ions. The peaks of PO43- and OH- vibrations in the Raman spectra were further analysed to corroborate the structural distortion of Sr-HAp. Selected area electron diffraction patterns obtained using TEM reveal the reduced crystallinity of Sr-HAp due to Sr-doping, which is in line with the XRD results. Finally, the MTT (3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide) assay showed that the synthesized Sr-HAp has no toxic effect on the survival and growth of mesenchymal stem cells. In summary, the synthesized novel Sr-HAp nanorods exhibit great promise for bone tissue engineering applications.

Alginate templated synthesis, characterization and in vitro osteogenic evaluation of strontium-substituted hydroxyapatite

The objective of this study is to explore the potential role of alginate (Alg) in the crystallization of metal-substituted hydroxyapatite, with application in orthopaedic reconstruction. The alginate at different concentrations (0.5 and 1.0 wt%) facilitated in situ mineralization of hydroxyapatite (HA) and strontium-substituted HA (SHA, 10 and 30 mol%). The incorporation of the biopolymer and dopant induced notable changes in HA, including reduced crystal size from 31.0 to 16.4 nm and increased lattice volume from 577.3 to 598.0 Å3. The superior affinity of alginate for Sr2+ than for Ca2+ resulted in higher residual alginate in Alg/SHA (13.0 to 19.0 %) compared to Alg/HA (7.1 to 8.2 %). This residual alginate influenced composite properties: surface charge decreased from -26.5 to -45.7 mV, microhardness increased from 0.33 to 0.54 GPa, and dissolution increased from 0.17 to 0.39 %. The in vitro studies revealed that strontium substitution as well as the organization and crystallographic aspects of apatite regulated osteoblastic cell survival, proliferation, differentiation, and biomineralization. The findings suggest that an alginate concentration of 0.5 wt% is optimal for the crystallization of SHA with 10 mol% substitution, and its resulting composite possesses the ideal biomechanical properties to imitate native bone.

Dextrose, maltose and starch guide crystallization of strontium-substituted hydroxyapatite: A comparative study for bone tissue engineering application

The influence of carbohydrates on the crystallization of metal-substituted hydroxyapatite predicts its relevance to natural bone growth. This study demonstrates the role of carbohydrates in the crystallization of strontium-substituted hydroxyapatite (SHAP). The increasing order of hydroxyl groups, dextrose (monosaccharide) < maltose (disaccharide) < starch (polysaccharide), coordinated with Ca2+/Sr2+ and thus guided SHAP crystallization, with crystal size reduced from 35 to 19 nm, lattice volume increased from 518 to 537 Å3, and residual carbohydrates increased from 1.8 to 20.2 %. The variation in residual carbohydrates is due to their interaction with apatite and/or aqueous insolubility. Compared to pure SHAP, the starch-SHAP with higher residual starch showed increased water uptake from 1.23 ± 0.18 to 4.26 ± 0.21 % and degradation from 0.22 ± 0.06 to 1.53 ± 0.14 %, but decreased microhardness from 0.73 ± 0.12 to 0.38 ± 0.01 GPa and protein affinity from 4.82 ± 0.01 to 0.81 ± 0.01 μg/mg. However, its microhardness value was bone-like, and the reduced protein adsorption was masked by the rich osteogenic behaviour. In vitro cellular response demonstrated that the residual carbohydrate and strontium augmented osteocompatibility, proliferation, differentiation and biomineralization. The result concludes that carbohydrates drive SHAP crystallization, and starch-SHAP replicates natural bone.

Effect of pectin on the crystallization of strontium substituted HA for bone reconstruction application

The biomacropolymers of bone extracellular matrix (ECM) guide the growth of hydroxyapatite (HA) with various ionic substitutions. Pectin, a plant polysaccharide with chemical similarities to ECM, was investigated for its potential to promote the crystallization of strontium-substituted HA (SH). The influence of pectin (0.5 and 1.0 wt%) on the in situ mineralization of SH (10 and 30 mol% calcium substitution with strontium) was studied. The preferential affinity of pectin to strontium over calcium favoured the incorporation of strontium in apatite, decreased crystal size (18.85-26.22 nm) and retained more pectin residues (8-16%). The residual pectin strongly interacted with small SH particles, resulting in high microhardness (0.43-0.85 GPa) and high surface charge (-32.1 to -30.3 mV), while weak interaction with large HA particles resulted in low microhardness (0.15-0.25 GPa) and low surface charge (-35.4 to -34.6 mV). The in vitro cellular study using human osteoblast-like MG-63 cells demonstrated that inorganic size and material crystallinity play a vital role in regulating osteogenesis. The study suggests that the synchronization of low pectin concentration (0.5 wt%) and high strontium substitution in HA (30 mol%) offers the desired microhardness and in vitro osteogenic properties to emulate natural bone.

Bone Regeneration in Small and Large Segmental Bone Defect Models after Radiotherapy Using Injectable Polymer-Based Biodegradable Materials Containing Strontium-Doped Hydroxyapatite Particles

The reconstruction of bones following tumor excision and radiotherapy remains a challenge. Our previous study, performed using polysaccharide-based microbeads that contain hydroxyapatite, found that these have osteoconductivity and osteoinductive properties. New formulations of composite microbeads containing HA particles doped with strontium (Sr) at 8 or 50% were developed to improve their biological performance and were evaluated in ectopic sites. In the current research, we characterized the materials by phase-contrast microscopy, laser dynamic scattering particle size-measurements and phosphorus content, before their implantation into two different preclinical bone defect models in rats: the femoral condyle and the segmental bone. Eight weeks after the implantation in the femoral condyle, the histology and immunohistochemistry analyses showed that Sr-doped matrices at both 8% and 50% stimulate bone formation and vascularization. A more complex preclinical model of the irradiation procedure was then developed in rats within a critical-size bone segmental defect. In the non-irradiated sites, no significant differences between the non-doped and Sr-doped microbeads were observed in the bone regeneration. Interestingly, the Sr-doped microbeads at the 8% level of substitution outperformed the vascularization process by increasing new vessel formation in the irradiated sites. These results showed that the inclusion of strontium in the matrix-stimulated vascularization in a critical-size model of bone tissue regeneration after irradiation.

Nanocomposite Based on HA/PVTMS/Cl2FeH8O4 as a Gas and Temperature Sensor

In this paper, a novel nanocrystalline composite material of hydroxyapatite (HA)/polyvinyltrimethoxysilane (PVTMS)/iron(II)chloride tetrahydrate (Cl₂FeH₈-O₄) with hexagonal structure is proposed for the fabrication of a gas/temperature sensor. Taking into account the sensitivity of HA to high temperatures, to prevent the collapse and breakdown of bonds and the leakage of volatiles without damaging the composite structure, a freeze-drying machine is designed and fabricated. X-ray diffraction, FTIR, SEM, EDAX, TEM, absorption and photoluminescence analyses of composite are studied. XRD is used to confirm the material structure and the crystallite size of the composite is calculated by the Monshi-Scherrer method, and a value of 81.60 ± 0.06 nm is obtained. The influence of the oxygen environment on the absorption and photoluminescence measurements of the composite and the influence of vaporized ethanol, N₂ and CO on the SiO₂/composite/Ag sensor device are investigated. The sensor with a 30 nm-thick layer of composite shows the highest response to vaporized ethanol, N₂ and ambient CO. Overall, the composite and sensor exhibit a good selectivity to oxygen, vaporized ethanol, N₂ and CO environments.

Barrier Membranes for Guided Bone Regeneration (GBR): A Focus on Recent Advances in Collagen Membranes

Guided bone regeneration (GBR) has become a clinically standard modality for the treatment of localized jawbone defects. Barrier membranes play an important role in this process by preventing soft tissue invasion outgoing from the mucosa and creating an underlying space to support bone growth. Different membrane types provide different biological mechanisms due to their different origins, preparation methods and structures. Among them, collagen membranes have attracted great interest due to their excellent biological properties and desired bone regeneration results to non-absorbable membranes even without a second surgery for removal. This work provides a comparative summary of common barrier membranes used in GBR, focusing on recent advances in collagen membranes and their biological mechanisms. In conclusion, the review article highlights the biological and regenerative properties of currently available barrier membranes with a particular focus on bioresorbable collagen-based materials. In addition, the advantages and disadvantages of these biomaterials are highlighted, and possible improvements for future material developments are summarized.

Therapeutic approaches to activate the canonical Wnt pathway for bone regeneration

Activation of the canonical Wingless-related integration site (Wnt) pathway has been shown to increase bone formation and therefore has therapeutic potential for use in orthopedic conditions. However, attempts at developing an effective strategy to achieve Wnt activation has been met with several challenges. The inherent hydrophobicity of Wnt ligands makes isolating and purifying the protein difficult. To circumvent these challenges, many have sought to target extracellular inhibitors of the Wnt pathway, such as Wnt signaling pathway inhibitors Sclerostin and Dickkopf-1, or to use small molecules, ions and proteins to increase target Wnt genes. Here, we review systemic and localized bioactive approaches to enhance bone formation or improve bone repair through antibody-based therapeutics, synthetic Wnt surrogates and scaffold doping to target canonical Wnt. We conclude with a brief review of emerging technologies, such as mRNA therapy and Clustered Regularly Interspaced Short Palindromic Repeats technology, which serve as promising approaches for future clinical translation.

Recent advances in biofunctional guided bone regeneration materials for repairing defective alveolar and maxillofacial bone: A review

The anatomy of the oral and maxillofacial sites is complex, and bone defects caused by trauma, tumors, and inflammation in these zones are extremely difficult to repair. Among the most effective and reliable methods to attain osteogenesis, the guided bone regeneration (GBR) technique is extensively applied in defective oral and maxillofacial GBR. Furthermore, endowing biofunctions is crucial for GBR materials applied in repairing defective alveolar and maxillofacial bones. In this review, recent advances in designing and fabricating GBR materials applied in oral and maxillofacial sites are classified and discussed according to their biofunctions, including maintaining space for bone growth; facilitating the adhesion, migration, and proliferation of osteoblasts; facilitating the migration and differentiation of progenitor cells; promoting vascularization; providing immunoregulation to induce osteogenesis; suppressing infection; and effectively mimicking natural tissues using graded biomimetic materials. In addition, new processing strategies (e.g., 3D printing) and new design concepts (e.g., developing bone mimetic extracellular matrix niches and preparing scaffolds to suppress connective tissue to actively acquire space for bone regeneration), are particularly worthy of further study. In the future, GBR materials with richer biological functions are expected to be developed based on an in-depth understanding of the mechanism of bone-GBR-material interactions.

Extraction of natural hydroxyapatite for biomedical applications—A review

Hydroxyapatite has recently played a crucial role in the sustainable development of biomedical applications. Publications related to hydroxyapatite as filler for biopolymers have exhibited an increasing trend due to the expanding research output. Based on the latest publications, the authors reviewed the research trends regarding hydroxyapatite use in biomedical applications. Analysis of the Scopus database using the keywords ‘hydroxyapatite” and “biomedical applications” determined that 1,714 papers were produced between 2012 and 2021. The number of publications related to these keywords more than doubled between 2012 (99) and 2021 (247). The hydrothermal method, solid-state reactions, the sol-gel process, emulsion, micro-emulsion, and mostly chemical precipitation were used to produce synthetic hydroxyapatite. Meanwhile, calcination, alkaline hydrolysis, precipitation, hydrothermal, and a combination of these techniques were used in producing natural hydroxyapatite. Studies in the current literature reveal that shell-based animal sources have been frequently used as hydroxyapatite resources during investigations concerning biomedical applications, while calcination was the extraction method most often applied. Essential trace elements of fish bone, oyster shell, and eggshell were also found in hydroxyapatite powder. Abalone mussel shell and eggshell showed Ca/P ratios closer to the stoichiometric ratio due to the use of effective extraction methods such as manipulating aging time or stirring process parameters. This review should greatly assist by offering scientific insights to support all the recommended future research works, not only that associated with biomedical applications.

Functional role of inorganic trace elements in dentin apatite tissue-Part 1: Mg, Sr, Zn, and Fe

Many essential elements exist in nature with significant influence on dentin and bone apatite tissue. Hydroxyapatite (HAp) is the major inorganic crystalline structure of dentin that provides a site for various physiological functions such as surface layer ion exchange. Decades of apatite research have shown that enamel is a high-substituted crystalline apatite, but recent findings suggest that dentin apatite may play a more important role in regulating ion exchange as well as mineral crystallinity. This article is the first part of a review series on the functional role of inorganic trace elements including magnesium, strontium, zinc, and iron in dentin hydroxyapatite. The morphology, physiology, crystallinity, and solubility of these elements as they get substituted into the HAp lattice are extensively discussed. An electronic search was performed on the role of these elements in dentin apatite from January 2007 to September 2021. The relationship between different elements and their role in the mineral upkeep of dentin apatite was evaluated. Several studies recognized the role of these elements in dentinal apatite composition and its subsequent effects on morphology, crystallinity, and solubility. These elements are of great importance in physiological processes and an essential part of living organisms. Magnesium and strontium stimulate osteoblast activity, while zinc can improve overall bone quality with its antibacterial properties. Iron nanoparticles are also vital in promoting bone tissue growth as they donate or accept electrons in redox reactions. Thus, understanding how these elements impact dentin apatite structure is of great clinical significance.

Does the incorporation of strontium into calcium phosphate improve bone repair? A meta-analysis

Background

The application of calcium phosphate (CaP)-based bone substitutes plays an important role in periodontal regeneration, implant dentistry and alveolar bone reconstruction. The incorporation of strontium (Sr) into CaP-based bone substitutes appears to improve their biological properties, but the reported in vivo bone repair performance is inconsistent among studies. Herein, we conducted a systematic review and meta-analysis to investigate the in vivo performance of Sr-doped materials.

Methods

We searched PubMed, EMBASE (via OVIDSP), and reference lists to identify relevant animal studies. The search, study selection, and data extraction were performed independently by two investigators. Meta-analyses and sub-group analyses were conducted using Revman version 5.4.1. The heterogeneity between studies were assessed by I². Publication bias was investigated through a funnel plot.

Results

Thirty-five studies were finally enrolled, of which 16 articles that reported on new bone formation (NBF) were included in the meta-analysis, covering 31 comparisons and 445 defects. The overall effect for NBF was 2.25 (95% CI 1.61–2.90, p < 0.00001, I² = 80%). Eight comparisons from 6 studies reported the outcomes of bone volume/tissue volume (BV/TV), with an overall effect of 1.42 (95% CI 0.65–2.18, p = 0.0003, I² = 75%). Fourteen comparisons reported on the material remaining (RM), with the overall effect being -2.26 (95% CI − 4.02 to − 0.50, p = 0.0009, I² = 86%).

Conclusions

Our study revealed that Sr-doped calcium phosphate bone substitutes improved in vivo performance of bone repair. However, more studies are also recommended to further verify this conclusion.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12903-022-02092-7.

Biomimetic PLGA/Strontium-Zinc Nano Hydroxyapatite Composite Scaffolds for Bone Regeneration

Synthetic bone graft substitutes have attracted increasing attention in tissue engineering. This study aimed to fabricate a novel, bioactive, porous scaffold that can be used as a bone substitute. Strontium and zinc doped nano-hydroxyapatite (Sr/Zn n-HAp) were synthesized by a water-based sol-gel technique. Sr/Zn n-HAp and poly (lactide-co-glycolide) (PLGA) were used to fabricate composite scaffolds by supercritical carbon dioxide technique. FTIR, XRD, TEM, SEM, and TGA were used to characterize Sr/Zn n-HAp and the composite scaffolds. The synthesized scaffolds were adequately porous with an average pore size range between 189 to 406 µm. The scaffolds demonstrated bioactive behavior by forming crystals when immersed in the simulated body fluid. The scaffolds after immersing in Tris/HCl buffer increased the pH value of the medium, establishing their favorable biodegradable behavior. ICP-MS study for the scaffolds detected the presence of Sr, Ca, and Zn ions in the SBF within the first week, which would augment osseointegration if implanted in the body. nHAp and their composites (PLGA-nHAp) showed ultimate compressive strength ranging between 0.4–19.8 MPa. A 2.5% Sr/Zn substituted nHAp-PLGA composite showed a compressive behavior resembling that of cancellous bone indicating it as a good candidate for cancellous bone substitute.

Finding the Perfect Membrane: Current Knowledge on Barrier Membranes in Regenerative Procedures: A Descriptive Review

Guided tissue regeneration (GTR) and guided bone regeneration (GBR) became common procedures in the corrective phase of periodontal treatment. In order to obtain good quality tissue neo-formation, most techniques require the use of a membrane that will act as a barrier, having as a main purpose the blocking of cell invasion from the gingival epithelium and connective tissue into the newly formed bone structure. Different techniques and materials have been developed, aiming to obtain the perfect barrier membrane. The membranes can be divided according to the biodegradability of the base material into absorbable membranes and non-absorbable membranes. The use of absorbable membranes is extremely widespread due to their advantages, but in clinical situations of significant tissue loss, the use of non-absorbable membranes is often still preferred. This descriptive review presents a synthesis of the types of barrier membranes available and their characteristics, as well as future trends in the development of barrier membranes along with some allergological aspects of membrane use.

Finding the Perfect Membrane: Current Knowledge on Barrier Membranes in Regenerative Procedures: A Descriptive Review

Guided tissue regeneration (GTR) and guided bone regeneration (GBR) became common procedures in the corrective phase of periodontal treatment. In order to obtain good quality tissue neo-formation, most techniques require the use of a membrane that will act as a barrier, having as a main purpose the blocking of cell invasion from the gingival epithelium and connective tissue into the newly formed bone structure. Different techniques and materials have been developed, aiming to obtain the perfect barrier membrane. The membranes can be divided according to the biodegradability of the base material into absorbable membranes and non-absorbable membranes. The use of absorbable membranes is extremely widespread due to their advantages, but in clinical situations of significant tissue loss, the use of non-absorbable membranes is often still preferred. This descriptive review presents a synthesis of the types of barrier membranes available and their characteristics, as well as future trends in the development of barrier membranes along with some allergological aspects of membrane use.

Porous membranes of quaternized chitosan composited with strontium-based nanobioceramic for periodontal tissue regeneration

This report demonstrates the development of a degradable quaternary ammonium derivative of chitosan (QC) composited with strontium-containing nanoapatite (SA) for bioactivity. The material was made as porous membrane by solution casting and freeze drying, for guided tissue regeneration (GTR) applications. The micromorphology, tensile strength, suture pull-out strength, degradation (in vitro, in phosphate buffered saline), and cytocompatibility (using human periodontal ligament cells) were tested to investigate the effect of derivatization and SA addition. The porosity of the membranes increased with increasing SA content and so did the tensile strength and the degradation. The suture pull-out strength, however, showed a decrease. The cell culture evaluation endorsed biocompatibility. The composite with 1.5 mg SA per 1 mL QC was found to have optimal qualities for GTR applications.

Evaluation of fluorohydroxyapatite/strontium coating on titanium implants fabricated by hydrothermal treatment

Titanium and its alloys are considered as appropriate replacements for the irreparable bone. Calcium phosphate coatings are widely used to improve the osteoinduction and osseointegration ability of titanium alloys. To further improve the performance of the calcium phosphate-coated implants, strontium (Sr) was introduced to partially replace the calcium ions. In this study, the effect of Sr ion addition on the fluorohydroxyapatite (FHA)-coated Ti6Al4V alloy was investigated and all the coatings were treated under hydrothermal condition. X-ray diffraction (XRD) and scanning electron microscopy (SEM) were used to investigate the phases and microstructures, respectively. Shear tests were done to evaluate the bond strength of the coating layer. MTT, adhesion, and alkaline phosphatase tests were performed to evaluate the biocompatibility and osteogenic behavior of the samples. Results showed that the average crystallite size for the strontium-doped FHA samples was 48 nm and the bond strength had increased 13.15% in comparison with FHA-coated samples. Analysis of variance showed p value for all MTT tests at more than 0.322 and there was not any evidence of cell death after 7 days. The results of the ALP test showed that the increase of the cell activity in Sr samples from day 7 to 14 is three times higher than the FHA ones.

Biomimetic Strontium Substituted Calcium Phosphate Coating for Bone Regeneration

Cellulose acetate (CA)/strontium phosphate (SrP) hybrid coating has been proposed as an effective strategy to build up novel bone-like structures for bone healing since CA is soluble in most organic solvents. Strontium (Sr2+) has been reported as a potential agent to treat degenerative bone diseases due to its osteopromotive and antibacterial effects. Herein, bioactive hybrid composite SrP-based coatings (CASrP) were successfully produced for the first time. CASrP was synthesized via a modified biomimetic method (for 7—CA7dSrP, and 14 days—CA14dSrP), in which the metal ion Sr2+ was used in place of Ca2+ in the simulated body fluid. Energy-dispersive X-ray (EDX) and Fourier transform infrared spectroscopy (FTIR) analysis confirmed the SrP incorporation chemically in the CASrP samples. Atomic absorption spectroscopy (AAS) supported EDX data, showing Sr2+ adsorption into CA, and its significant increase with the augmentation of time of treatment (ca. 92%—CA7dSrP and 96%—CA14dSrP). An increment in coating porosity and the formation of SrP crystals were evidenced by scanning electron microscopy (SEM) images. X-ray diffraction (XRD) evidenced a greater crystallinity than CA membranes and a destabilization of CA14dSrP structure compared to CA7dSrP. The composites were extremely biocompatible for fibroblast and osteoblast cells. Cell viability (%) was higher either for CA7dSrP (48 h: ca. 92% and 115%) and CA14dSrP (48 h: ca. 88% and 107%) compared to CA (48 h: ca. 70% and 51%) due to SrP formation and Sr2+ presence in its optimal dose in the culture media (4.6–9 mg·L−1). In conclusion, the findings elucidated here evidence the remarkable potential of CA7dSrP and CA14dSrP as bioactive coatings on the development of implant devices for inducing bone regeneration.

Zn0.8Li0.1Sr-a biodegradable metal with high mechanical strength comparable to pure Ti for the treatment of osteoporotic bone fractures: In vitro and in vivo studies

The first in vivo investigation of Zn-based biodegradable metal aiming to treat osteoporotic bone fractures, a soaring threat to human health, is reported in this paper. Among the newly developed biodegradable metal system (ZnLiSr), Zn0.8Li0.1Sr exhibits excellent comprehensive mechanical properties, with an ultimate tensile strength (524.33 ± 18.01 MPa) comparable to pure Ti (the gold standard for orthopaedic implants), and a strength-ductility balance over 10 GPa%. The in vitro degradation tests using simulated body fluid (SBF) shows that Zn0.8Li0.1Sr manifests a uniform degradation morphology and smaller corrosion pits, with a degradation rate of 10.13 ± 1.52 μm year^-1. Real-time PCR and western blotting illustrated that Zn0.8Li0.1Sr successfully stimulated the expression of critical osteogenesis-related genes (ALP, COL-1, OCN and Runx-2) and proteins. Twenty-four weeks' in vivo implantations within ovariectomized (OVX) rats were conducted to evaluate the osteoporotic-bone-fracture-treating effects of Zn0.8Li0.1Sr, with pure Ti as control group. Micro-CT, histological and immunohistochemical evaluations all revealed that Zn0.8Li0.1Sr possesses a similar biosafety level to, while significantly superior osteogenesis-inducing and osteoporotic-bone-fracture-treating effects than pure Ti. ZnLiSr biodegradable alloys manifest excellent comprehensive mechanical properties, good biosafety and osteoporotic-bone-fracture-treating effects, which would provide preferable choices for future medical applications, especially in load-bearing positions.

Membranes for Guided Bone Regeneration: A Road from Bench to Bedside

Bone resorption can negatively influence the osseointegration of dental implants. Barrier membranes for guided bone regeneration (GBR) are used to exclude nonosteogenic tissues from influencing the bone healing process. In addition to the existing barrier membranes available on the market, a growing variety of membranes for GBR with tailorable physicochemical properties are under preclinical evaluation. Hence, the aim of this review is to provide a comprehensive description of materials used for GBR and to report the main industrial and regulatory aspects allowing the commercialization of these medical devices (MDs). In particular, a summary of the main attributes defining a GBR membrane is reported along with a description of commercially available and under development membranes. Finally, strategies for the scaling-up of the manufacturing process and the regulatory framework of the main MD producers (USA, EU, Japan, China, and India) are presented. The description of the regulatory approval process of GBR membranes is representative of the typical path that medium- to high-risk MDs have to follow for an effective medical translation, which is of fundamental importance to increase the impact of biomedical research on public health.

Hydrogel-Colloid Composite Bioinks for Targeted Tissue-Printing

The development of extrusion-based bioprinting for tissue engineering is conditioned by the design of bioinks displaying adequate printability, shape stability, and postprinting bioactivity. In this context, simple bioink formulations, made of cells supported by a polymer matrix, often lack the necessary versatility. To address this issue, intense research work has been focused on introducing colloidal particles into the ink formulation. By creating weak cross-links between polymer chains, added particles modify the rheology and mechanical behavior of bioinks to improve their printability and structural integrity. Additionally, nano- and microscopic particles display composition- and structure-specific properties that can affect the cellular behavior and enhance the formation of tissue within the printed material. This Review offers a comprehensive picture of the role of colloids in bioprinting from a physicochemical and biological perspective. As such, it provides guidance on devising adaptable bioinks for the fabrication of biomimetic tissues.

Comprehensive In Vitro Testing of Calcium Phosphate-Based Bioceramics with Orthopedic and Dentistry Applications

Recently, a large spectrum of biomaterials emerged, with emphasis on various pure, blended, or doped calcium phosphates (CaPs). Although basic cytocompatibility testing protocols are referred by International Organization for Standardization (ISO) 10993 (parts 1-22), rigorous in vitro testing using cutting-edge technologies should be carried out in order to fully understand the behavior of various biomaterials (whether in bulk or low-dimensional object form) and to better gauge their outcome when implanted. In this review, current molecular techniques are assessed for the in-depth characterization of angiogenic potential, osteogenic capability, and the modulation of oxidative stress and inflammation properties of CaPs and their cation- and/or anion-substituted derivatives. Using such techniques, mechanisms of action of these compounds can be deciphered, highlighting the signaling pathway activation, cross-talk, and modulation by microRNA expression, which in turn can safely pave the road toward a better filtering of the truly functional, application-ready innovative therapeutic bioceramic-based solutions.

Enhanced osteogenesis and angiogenesis by PCL/chitosan/Sr-doped calcium phosphate electrospun nanocomposite membrane for guided bone regeneration

Membranes play pivotal role in guided bone regeneration (GBR) technique for reconstruction alveolar bone. GBR membrane that is able to stimulate both osteogenic and angiogenic differentiation of cells may be more effective in clinic practice. Herein, we fabricated the Sr-doped calcium phosphate/polycaprolactone/chitosan (Sr-CaP/PCL/CS) nanohybrid fibrous membrane by incorporating 20 wt% bioactive Sr-CaP nanoparticles into PCL/CS matrix via one-step electrospinning method, in order to endow the membrane with stimulation of osteogenesis and angiogenesis. The physicochemical properties, mechanical properties, Sr²⁺ release behavior, and the membrane stimulate bone mesenchymal stem cell (BMSCs) differentiation were evaluated in comparison with PCL/CS and CaP/PCL/CS membranes. The SEM images revealed that the nanocomposite membrane mimicked the extracellular matrix structure. The release curve presented a 28-day long continuous release of Sr²⁺ and concentration which was certified in an optimal range for positive biological effects at each timepoint. The in vitro cell culture experiments certified that the Sr-CaP/PCL/CS membrane enjoyed excellent biocompatibility and remarkably promoted rat bone mesenchymal stem cell (BMSCs) adhesion and proliferation. In terms of osteogenic differentiation, BMSCs seeded on the Sr-CaP/PCL/CS membrane showed a higher ALP activity level and a better matrix mineralization. What's more, the synergism of the Sr²⁺ and CaP from the Sr-CaP/PCL/CS membrane enhanced BMSCs angiogenic differentiation, herein resulting in the largest VEGF secretion amount. Consequently, the Sr-CaP/PCL/CS nanohybrid electrospun membrane has promising applications in GBR.

Mechanisms of pore formation in hydrogel scaffolds textured by freeze-drying

Whereas freeze-drying is a widely used method to produce porous hydrogel scaffolds, the mechanisms of pore formation involved in this process remained poorly characterized. To explore this, we focused on a cross-linked polysaccharide-based hydrogel developed for bone tissue engineering. Scaffolds were first swollen in 0.025% NaCl then freeze-dried at low cooling rate, i.e. -0.1 °C min^-1, and finally swollen in aqueous solvents of increasing ionic strength. We found that scaffold's porous structure is strongly conditioned by the nucleation of ice. Electron cryo-microscopy of frozen scaffolds demonstrates that each pore results from the growth of one to a few ice grains. Most crystals were formed by secondary nucleation since very few nucleating sites were initially present in each scaffold (0.1 nuclei cm^-3 °C^-1). The polymer chains are rejected in the intergranular space and form a macro-network. Its characteristic length scale coincides with the ice grain size (160 μm) and is several orders of magnitude greater than the mesh size (90 nm) of the cross-linked network. After sublimation, the ice grains are replaced by macro-pores of 280 μm mean size and the resulting dry structure is highly porous, i.e. 93%, as measured by high-resolution X-ray tomography. In the swollen state, the scaffold mean pore size decreases in aqueous solvent of increasing ionic strength (120 µm in 0.025% NaCl and 54 µm in DBPS) but the porosity remains the same, i.e. 29% regardless of the solvent. Finally, cell seeding of dried scaffolds demonstrates that the pores are adequately interconnected to allow homogenous cell distribution. STATEMENT OF SIGNIFICANCE: The fabrication of hydrogel scaffolds is an important research area in tissue engineering. Hydrogels are textured to provide a 3D-framework that is favorable for cell proliferation and/or differentiation. Optimum hydrogel pore size depends on its biological application. Producing porous hydrogels is commonly achieved through freeze-drying. However, the mechanisms of pore formation remain to be fully understood. We carefully analyzed scaffolds of a cross-linked polysaccharide-based hydrogel developed for bone tissue engineering, using state-of-the-art microscopic techniques. Our experimental results evidenced the shaping of hydrogel during the freezing step, through a specific ice-templating mechanism. These findings will guide the strategies for controlling the porous structure of hydrogel scaffolds.

Bibliographic review on the state of the art of strontium and zinc based regenerative therapies. Recent developments and clinical applications

This review brings up to date the state of the art of strontium and zinc based regenerative therapies, both having a promoting effect on tissue formation and a role inhibiting resorption in musculoskeletal disorders.

Cationic Substitutions in Hydroxyapatite: Current Status of the Derived Biofunctional Effects and Their In Vitro Interrogation Methods

High-performance bioceramics are required for preventing failure and prolonging the life-time of bone grafting scaffolds and osseous implants. The proper identification and development of materials with extended functionalities addressing socio-economic needs and health problems constitute important and critical steps at the heart of clinical research. Recent findings in the realm of ion-substituted hydroxyapatite (HA) could pave the road towards significant developments in biomedicine, with an emphasis on a new generation of orthopaedic and dentistry applications, since such bioceramics are able to mimic the structural, compositional and mechanical properties of the bone mineral phase. In fact, the fascinating ability of the HA crystalline lattice to allow for the substitution of calcium ions with a plethora of cationic species has been widely explored in the recent period, with consequent modifications of its physical and chemical features, as well as its functional mechanical and in vitro and in vivo biological performance. A comprehensive inventory of the progresses achieved so far is both opportune and of paramount importance, in order to not only gather and summarize information, but to also allow fellow researchers to compare with ease and filter the best solutions for the cation substitution of HA-based materials and enable the development of multi-functional biomedical designs. The review surveys preparation and synthesis methods, pinpoints all the explored cation dopants, and discloses the full application range of substituted HA. Special attention is dedicated to the antimicrobial efficiency spectrum and cytotoxic trade-off concentration values for various cell lines, highlighting new prophylactic routes for the prevention of implant failure. Importantly, the current in vitro biological tests (widely employed to unveil the biological performance of HA-based materials), and their ability to mimic the in vivo biological interactions, are also critically assessed. Future perspectives are discussed, and a series of recommendations are underlined.

Immunohistochemical evaluation after Sr-enriched biphasic ceramic implantation in rabbits femoral neck: comparison of seven different bone conditions

Strontium (Sr) has shown effectiveness for stimulating bone remodeling. Nevertheless, the exact therapeutic values are not established yet. Authors hypothesized that local application of Sr-enriched ceramics would enhance bone remodeling in constant osteoporosis of rabbits' femoral neck bone. Seven different bone conditions were analyzed: ten healthy rabbits composed a control group, while other twenty underwent ovariectomy and were divided into three groups. Bone defect was filled with hydroxyapatite 30% (HAP) and tricalcium phosphate 70% (TCP) granules in 7 rabbits, 5% of Sr-enriched HAP/TCP granules in 7, but sham defect was left unfilled in 6 rabbits. Bone samples were obtained from operated and non-operated legs 12 weeks after surgery and analyzed by histomorphometry and immunohistochemistry (IMH). Mean trabecular bone area in control group was 0.393 mm2, in HAP/TCP - 0.226 mm2, in HAP/TCP/Sr - 0.234 mm2 and after sham surgery - 0.242 mm2. IMH revealed that HAP/TCP/Sr induced most noticeable increase of nuclear factor kappa beta 105 (NFkB 105), osteoprotegerin (OPG), osteocalcin (OC), bone morphogenetic protein 2/4 (BMP 2/4), collagen type 1α (COL-1α), interleukin 1 (IL-1) with comparison to intact leg; NFkB 105 and OPG rather than pure HAP/TCP or sham bone. We concluded that Sr-enriched biomaterials induce higher potential to improve bone regeneration than pure bioceramics in constant osteoporosis of femoral neck bone. Further studies on bigger osteoporotic animals using Sr-substituted orthopedic implants for femoral neck fixation should be performed to confirm valuable role in local treatment of osteoporotic femoral neck fractures in humans.

Strontium-Substituted Hydroxyapatite-Gelatin Biomimetic Scaffolds Modulate Bone Cell Response

Strontium has a beneficial role on bone remodeling and is proposed for the treatment of pathologies associated to excessive bone resorption, such as osteoporosis. Herein, the possibility to utilize a biomimetic scaffold as strontium delivery system is explored. Porous 3D gelatin scaffolds containing about 30% of strontium substituted hydroxyapatite (SrHA) or pure hydroxyapatite (HA) are prepared by freeze-drying. The scaffolds display a very high open porosity, with an interconnectivity of 100%. Reinforcement with further amount of gelatin provokes a modest decrease of the average pore size, without reducing interconnectivity. Moreover, reinforced scaffolds display reduced water uptake ability and increased values of mechanical parameters when compared to as-prepared scaffolds. Strontium displays a sustained release in phosphate buffered saline: the quantities released after 14 d from as-prepared and reinforced scaffolds are just 14 and 18% of the initial content, respectively. Coculture of osteoblasts and osteoclasts shows that SrHA-containing scaffolds promote osteoblast viability and activity when compared to HA-containing scaffolds. On the other hand, osteoclastogenesis and osteoclast differentiation are significantly inhibited on SrHA-containing scaffolds, suggesting that these systems could be usefully applied for local delivery of strontium in loci characterized by excessive bone resorption.

Synergistic effect of strontium, bioactive glass and nano-hydroxyapatite promotes bone regeneration of critical-sized radial bone defects

Critical-sized bone defects constitute a major health issue in orthopedics and usually cause mal-unions due to an inadequate number of migrated progenitor cells into the defect site or their incomplete differentiation into osteogenic precursor cells. The current study aimed to develop an optimized osteoinductive and angiogenic scaffold by incorporation of strontium (Sr) and bioglass (BG) into gelatin/nano-hydroxyapatite (G/nHAp) seeded with bone marrow mesenchymal stem cells to enhance bone regeneration. The scaffolds were fabricated by a freeze-drying technique and characterized in terms of morphology, structure, porosity and degradation rate. The effect of fabricated scaffolds on cell viability, attachment and differentiation into osteoblastic lineages was evaluated under in vitro condition. Micro computed tomography scan, histological and histomorphometric analysis were performed after implantation of scaffolds into the radial bone defects in rat. RT-PCR analysis showed that G/nHAp/BG/Sr scaffold significantly increased the expression level of osteogenic and angiogenic markers in comparison to other groups (P < 0.05). Moreover, the defects treated with the BMSCs-seeded scaffolds showed superior bone formation and mechanical properties compared to the cell-free scaffolds 4 and 12 weeks post-implantation. Finally, the BMSCs-seeded G/nHAp/BG/Sr scaffold showed the greatest bone regenerative capacity which was more similar to autograft. It is concluded that combination of Sr, BG, and nHAp can synergistically enhance the bone regeneration process. In addition, our results demonstrated that the BMSCs have the potential to considerably increase the bone regeneration ability of osteoinductive scaffolds. © 2018 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater, 107B: 50-64, 2019.