Chitosan scaffolds with BMP-6 loaded alginate microspheres for periodontal tissue engineering

Therapeutic functions of medical implants from various material categories with integrated biomacromolecular systems

Medical implants are designed to replace missing parts or improve body functions and must be capable of providing structural support or therapeutic intervention for a medical condition. Advances in materials science have enabled the development of devices made from metals, polymers, bioceramics, and composites, each with its specific advantages and limitations. This review analyzes the incorporation of biopolymers, proteins, and other biomacromolecules into implants, focusing on their role in biological integration and therapeutic functions. It synthesizes advancements in surface modification, discusses biomacromolecules as carriers for controlled drug release, and explores the application of nanoceramics and composites to improve osseointegration and tissue regeneration. Biomacromolecule systems are capable of interacting with device components and therapeutic agents - such as growth factors (GFs), antibiotics, and nanoceramics - allowing control over substance release. Incorporating therapeutic agents into these systems enables localized treatments for tissue regeneration, osseointegration, post-surgery infection control, and disease and pre-existing conditions. The review highlights these materials' therapeutic advantages and customization opportunities, by covering mechanical and biological perspectives. Developing composites and hybrid drug delivery systems align with recent efforts in interdisciplinary personalized medicine and implant innovations. For instance, a trend was observed for integrating inorganic (especially nanoceramics, e.g., hydroxyapatite) and organic phases in composites for better implant interaction with biological tissues and faster recovery. This article supports understanding how integrating these materials can create more personalized, functional, durable, and biocompatible implant devices.

Chitosan nanoparticle applications in dentistry: a sustainable biopolymer

The epoch of Nano-biomaterials and their application in the field of medicine and dentistry has been long-lived. The application of nanotechnology is extensively used in diagnosis and treatment aspects of oral diseases. The nanomaterials and its structures are being widely involved in the production of medicines and drugs used for the treatment of oral diseases like periodontitis, oral carcinoma, etc. and helps in maintaining the longevity of oral health. Chitosan is a naturally occurring biopolymer derived from chitin which is seen commonly in arthropods. Chitosan nanoparticles are the latest in the trend of nanoparticles used in dentistry and are becoming the most wanted biopolymer for use toward therapeutic interventions. Literature search has also shown that chitosan nanoparticles have anti-tumor effects. This review highlights the various aspects of chitosan nanoparticles and their implications in dentistry.

The Role of Microsphere Structures in Bottom-Up Bone Tissue Engineering

Bone defects have caused immense healthcare concerns and economic burdens throughout the world. Traditional autologous allogeneic bone grafts have many drawbacks, so the emergence of bone tissue engineering brings new hope. Bone tissue engineering is an interdisciplinary biomedical engineering method that involves scaffold materials, seed cells, and "growth factors". However, the traditional construction approach is not flexible and is unable to adapt to the specific shape of the defect, causing the cells inside the bone to be unable to receive adequate nourishment. Therefore, a simple but effective solution using the "bottom-up" method is proposed. Microspheres are structures with diameters ranging from 1 to 1000 µm that can be used as supports for cell growth, either in the form of a scaffold or in the form of a drug delivery system. Herein, we address a variety of strategies for the production of microspheres, the classification of raw materials, and drug loading, as well as analyze new strategies for the use of microspheres in bone tissue engineering. We also consider new perspectives and possible directions for future development.

Alginate-based Composites Microspheres: Preparations and Applications for Bone Tissue Engineering

Alginate-based biomaterials have been extensively studied for bone tissue engineering. Scaffolds, microspheres, and hydrogels can be developed using alginate, which is biocompatible, biodegradable, and able to deliver growth factors and drugs. Alginate microspheres can be produced using crosslinking, microfluidic, three-dimensional printing, extrusion, and emulsion methods. The sizes of the alginate microspheres range from 10 µm to 4 mm. This review describes the chemical characterization and mechanical assessment of alginate-based microspheres. Combinations of alginate with hydroxyapatite, chitosan, collagen, polylactic acid, polycaprolactone, and bioglass were discussed for bone tissue repair and regeneration. In addition, alginate combinations with bone morphogenetic proteins, vascular endothelial growth factor, transforming growth factor beta-3, other growth factors, cells, proteins, drugs, and osteoinductive drugs were analyzed for tissue engineering applications. Furthermore, the biocompatibility of developed alginate microspheres was discussed for different cell lines. Finally, alginate microsphere-based composites with stem cell interaction for bone tissue regeneration were presented. In the present review, we have assessed the preclinical research on in vivo models of alginate-based microspheres for bone tissue repair and regeneration. Overall, alginate-based microspheres are potential candidates for graft substitutes and the treatment of various bone-related diseases.

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.

Alginate/chitosan modified immunomodulatory titanium implants for promoting osteogenesis in vitro and in vivo

The essentiality of macrophages for biomaterial-mediated osteogenesis has been increasingly recognized. However, it is still unclear what is the specific role and molecular mechanisms of macrophages and material properties in the regulation of osteogenesis. As an interdisciplinary field exploring the cross-talk between immune and skeletal systems, osteoimmunology has shifted the perspective of bone substitute materials from immunosuppressive materials to immunomodulatory materials. To fabricate an immunomodulatory Ti implant, alginate/chitosan multilayer films were fabricated on the surface of titania nanotubes (TNTs) to control the release of an anti-inflammatory cytokine interleukin (IL)-4 according to our previous work. The osteogenic effects and regulation mechanisms of the immunomodulatory Ti implants were investigated in vitro in different BMSCs culture modes. Alginate/chitosan multilayer-coated samples (with or without IL-4 loading) showed better direct osteogenic ability than TNTs by promoting biomineralization and up-regulating osteogenic gene expression (BMP1α, ALP, OPN, OCN) of BMSCs. Notably, material-induced macrophage polarization, M1 and M2, enhanced early and mid-stage osteogenesis of BMSCs via distinct pathways: M1 activated both BMP6/SMADs and Wnt10b/β-catenin pathways; while M2 activated TGF-β/SMADs pathway. Material surface properties dominated in regulating late osteogenesis probably due to the surface chemical composition (alginate, chitosan and Ca²⁺, etc.). Due to synergistic effects of material-induced inflammatory microenvironment and material surface properties, IL-4-loaded samples exhibited superior osteogenic capability through co-activation of three signaling pathways. The in vivo studies in rat bone defect model revealed that IL-4-loaded immunomodulatory implants successfully achieved macrophage phenotypic transition from pro-inflammatory M1 to anti-inflammatory M2 and subsequently improved new bone formation.

Biomimetic Aspects of Restorative Dentistry Biomaterials

Biomimetic has emerged as a multi-disciplinary science in several biomedical subjects in recent decades, including biomaterials and dentistry. In restorative dentistry, biomimetic approaches have been applied for a range of applications, such as restoring tooth defects using bioinspired peptides to achieve remineralization, bioactive and biomimetic biomaterials, and tissue engineering for regeneration. Advancements in the modern adhesive restorative materials, understanding of biomaterial-tissue interaction at the nano and microscale further enhanced the restorative materials' properties (such as color, morphology, and strength) to mimic natural teeth. In addition, the tissue-engineering approaches resulted in regeneration of lost or damaged dental tissues mimicking their natural counterpart. The aim of the present article is to review various biomimetic approaches used to replace lost or damaged dental tissues using restorative biomaterials and tissue-engineering techniques. In addition, tooth structure, and various biomimetic properties of dental restorative materials and tissue-engineering scaffold materials, are discussed.

Injectable Biomaterials for Dental Tissue Regeneration

Injectable biomaterials scaffolds play a pivotal role for dental tissue regeneration, as such materials are highly applicable in the dental field, particularly when compared to pre-formed scaffolds. The defects in the maxilla-oral area are normally small, confined and sometimes hard to access. This narrative review describes different types of biomaterials for dental tissue regeneration, and also discusses the potential use of nanofibers for dental tissues. Various studies suggest that tissue engineering approaches involving the use of injectable biomaterials have the potential of restoring not only dental tissue function but also their biological purposes.

Chitosan based bioactive materials in tissue engineering applications-A review

In recent years, there have been increasingly rapid advances of using bioactive materials in tissue engineering applications. Bioactive materials constitute many different structures based upon ceramic, metallic or polymeric materials, and can elicit specific tissue responses. However, most of them are relatively brittle, stiff, and difficult to form into complex shapes. Hence, there has been a growing demand for preparing materials with tailored physical, biological, and mechanical properties, as well as predictable degradation behavior. Chitosan-based materials have been shown to be ideal bioactive materials due to their outstanding properties such as formability into different structures, and fabricability with a wide range of bioactive materials, in addition to their biocompatibility and biodegradability. This review highlights scientific findings concerning the use of innovative chitosan-based bioactive materials in the fields of tissue engineering, with an outlook into their future applications. It also covers latest developments in terms of constituents, fabrication technologies, structural, and bioactive properties of these materials that may represent an effective solution for tissue engineering materials, making them a realistic clinical alternative in the near future.

Enhanced efficiency in isolation and expansion of hAMSCs via dual enzyme digestion and micro-carrier

A two-stage method of obtaining viable human amniotic stem cells (hAMSCs) in large-scale is described. First, human amniotic stem cells are isolated via dual enzyme (collagenase II and DNAase I) digestion. Next, relying on a culture of the cells from porous chitosan-based microspheres in vitro, high purity hAMSCs are obtained in large-scale. Dual enzymatic (collagenase II and DNase I) digestion provides a primary cell culture and first subculture with a lower contamination rate, higher purity and a larger number of isolated cells. The obtained hAMSCs were seeded onto chitosan microspheres (CM), gelatin-chitosan microspheres (GCM) and collagen-chitosan microspheres (CCM) to produce large numbers of hAMSCs for clinical trials. Growth activity measurement and differentiation essays of hAMSCs were realized. Within 2 weeks of culturing, GCMs achieved over 1.28 ± 0.06 × 107 hAMSCs whereas CCMs and CMs achieved 7.86 ± 0.11 × 106 and 1.98 ± 0.86 × 106 respectively within this time. In conclusion, hAMSCs showed excellent attachment and viability on GCM-chitosan microspheres, matching the hAMSCs' normal culture medium. Therefore, dual enzyme (collagenase II and DNAase I) digestion may be a more useful isolation process and culture of hAMSCs on porous GCM in vitro as an ideal environment for the large-scale expansion of highly functional hAMSCs for eventual use in stem cell-based therapy.

Chitosan-based double-faced barrier membrane coated with functional nanostructures and loaded with BMP-6

In the present study, a chitosan-based, multifunctional and double-faced barrier membrane was developed for the periodontitis therapy. The porous surface of the membrane was coated with bone-like hydroxyapatite (HA) produced by microwave-assisted biomimetic method and enriched with bone morphogenetic factor 6 (BMP-6) to enhance the bioactivity of chitosan. This surface of the membrane was designed to be in contact with the hard tissue that was damaged due to periodontitis. Otherwise the nonporous surface of membrane, which is in contact with the inflammatory soft tissue, was coated with electrospun polycaprolactone (PCL) fibers to prevent the migration of epithelial cells to the defect area. PrestoBlue, Scanning Electron Microscope (SEM) and real-time PCR results demonstrated that while porous surface of the membrane was enhancing the proliferation and differentiation of MC3T3-E1 preosteoblasts, nonporous surface of membrane did not allow migration of epithelial Madine Darby Bovine Kidney (MDBK) cells. The barrier membrane developed here is biodegradable and can be easily manipulated, has osteogenic activity and inactivity for epithelial cells. Thus, by implanting this membrane to the damaged periodontal tissue, bone regeneration will take place and integrity of periodontal tissues will be preserved.

Tailored Biomaterials for Therapeutic Strategies Applied in Periodontal Tissue Engineering

Several therapeutic strategies are currently in development for severe periodontitis and other associated chronic inflammatory diseases. Guided tissue regeneration of the periodontium is based on surgical implantation of natural or synthetic polymers conditioned as membranes, injectable biomaterials (hydrogels), or three-dimensional (3D) matrices. Combinations of biomaterials with bioactive factors represent the next generation of regenerative strategy. Cell delivery strategy based on scaffold-cell constructs showed potential in periodontitis treatment. Bioengineering of periodontal tissues using cell sheets and genetically modified stem cells is currently proposed to complete existing (pre)clinical procedures for periodontal regeneration. 3D structures can be built using computer-assisted manufacturing technologies to improve the implant architecture effect on new tissue formation. The aim of this review was to summarize the advantages and drawbacks of biomimetic composite matrices used as biomaterials for periodontal tissue engineering. Their conditioning as two-dimensional or 3D scaffolds using conventional or emerging technologies was also discussed. Further biotechnologies are required for developing novel products tailored to stimulate periodontal regeneration. Additional preclinical studies will be useful to closely investigate the mechanisms and identify specific markers involved in cell-implant interactions, envisaging further clinical tests. Future therapeutic protocols will be developed based on these novel procedures and techniques.

Chitosan Biomaterials for Current and Potential Dental Applications

Chitosan (CHS) is a very versatile natural biomaterial that has been explored for a range of bio-dental applications. CHS has numerous favourable properties such as biocompatibility, hydrophilicity, biodegradability, and a broad antibacterial spectrum (covering gram-negative and gram-positive bacteria as well as fungi). In addition, the molecular structure boasts reactive functional groups that provide numerous reaction sites and opportunities for forging electrochemical relationships at the cellular and molecular levels. The unique properties of CHS have attracted materials scientists around the globe to explore it for bio-dental applications. This review aims to highlight and discuss the hype around the development of novel chitosan biomaterials. Utilizing chitosan as a critical additive for the modification and improvement of existing dental materials has also been discussed.

Prospects of chitosan-based scaffolds for growth factor release in tissue engineering

Tissue engineering is concerned about the rejuvenation and restoration of diseased and damages tissues/organs using man-made scaffolds that mimic the native environment of the cells. In recent years, a variety of biocompatible and biodegradable natural materials is employed for the fabrication of such scaffolds. Of these natural materials, chitosan is the most preferred one as it imitates the extracellular matrix (ECM) of the cells. Moreover, chitosan-based materials are pro-angiogenic and have antibacterial activity. These materials can be easily fabricated into the desired shape of the scaffolds that are suitable for tissue support and regeneration. Growth factors are small proteins/peptides that support and enhance the growth and differentiation of cells into a specific lineage. It has been observed that scaffolds capable of delivering growth factor promote tissue repair and regeneration at a faster rate when compared to scaffolds without growth factor. The present review focuses on the recent developments on chitosan-based scaffolds for the delivery of growth factors thereby improving and enhancing tissue regeneration.

Combined delivery of PDGF-BB and BMP-6 for enhanced osteoblastic differentiation

Natural microenvironment during bone tissue regeneration involves integration of multiple biological growth factors which regulate mitogenic activities and differentiation to induce bone repair. Among them platelet derived growth factor (PDGF-BB) and bone morphogenic protein-6 (BMP-6) are known to play a prominent role. The aim of this study was to investigate the benefits of combined delivery of PDGF-BB and BMP-6 on proliferation and osteoblastic differentiation of MC3T3-E1 preosteoblastic cells. PDGF-BB and BMP-6 were loaded in gelatin and poly (3-hydroxybutyric acid-co-3-hydroxyvaleric acid) particles, respectively. The carrier particles were then loaded into 3D chitosan matrix fabricated by freeze drying. The fast release of PDGF-BB during 7 days was accompanied by slower and prolonged release of BMP-6. The premising release of mitogenic factor PDGF-BB resulted in an increased MC3T3-E1 cell population seeded on chitosan scaffolds. Osteogenic markers of RunX2, Col 1, OPN were higher on chitosan scaffolds loaded with growth factors either individually or in combination. However, OCN expression and bone mineral formation were prominent on chitosan scaffolds incorporating PDGF-BB and BMP-6 as a combination.

Advanced biomatrix designs for regenerative therapy of periodontal tissues

Periodontitis is an inflammatory disease that causes loss of the tooth-supporting apparatus, including periodontal ligament, cementum, and alveolar bone. A broad range of treatment options is currently available to restore the structure and function of the periodontal tissues. A regenerative approach, among others, is now considered the most promising paradigm for this purpose, harnessing the unique properties of stem cells. How to make full use of the body's innate regenerative capacity is thus a key issue. While stem cells and bioactive factors are essential components in the regenerative processes, matrices play pivotal roles in recapitulating stem cell functions and potentiating therapeutic actions of bioactive molecules. Moreover, the positions of appropriate bioactive matrices relative to the injury site may stimulate the innate regenerative stem cell populations, removing the need to deliver cells that have been manipulated outside of the body. In this topical review, we update views on advanced designs of biomatrices-including mimicking of the native extracellular matrix, providing mechanical stimulation, activating cell-driven matrices, and delivering bioactive factors in a controllable manner-which are ultimately useful for the regenerative therapy of periodontal tissues.

Double-effective chitosan scaffold-PLGA nanoparticle system for brain tumour therapy: in vitro study

The chitosan scaffold, which has both of anticancer and antivascularization effects, was developed for using in local therapy of brain tumours. This is why, poly-lactic-co-glycolic acid (50:50) nanoparticles (~200 nm) including an anticancer drug, 5-fluorouracil (5-FU), were prepared by emulsion-solvent evaporation method. Then, these nanoparticles and antivascularization agent, bevacizumab, were loaded into the scaffold during manufacturing by freeze-drying and embedding after freeze-drying, respectively. The idea behind this system is to destroy tumour tissue by releasing 5-FU and to prevent the proliferation of tumour cells by releasing bevacizumab. In addition, 3D scaffold can support healthy tissue formation in the tumourigenic region. In vitro effectiveness of this system was investigated on T98G human glioblastoma cell line and human umbilical vein endothelial cells. The results show that the chitosan scaffold containing 100 µg 5-FU and 100 µg bevacizumab has a potential to prevent the tumour formation in vitro conditions.

Shear reversible cell/microsphere aggregate as an injectable for tissue regeneration

Injectable delivery systems have been widely used in tissue engineering as they can deliver cells into the body in a minimally invasive manner. In this study, it is hypothesized that microspheres with a similar size of cells could effectively form a shear reversible aggregate in the presence of cells and the aggregate could be useful to engineer tissues. Alginate microspheres are prepared by an emulsion method, followed by modification with a peptide containing the arginine-glycine-aspartic acid (RGD) sequence. RGD-modified alginate microspheres form an aggregate in the presence of chondrocytes, and the aggregation behavior is shear reversible. This cell/microsphere aggregate is useful to deliver chondrocytes into an animal model using a syringe, and effectively regenerates cartilage tissues in vivo.

Realizing the potential of gene-based molecular therapies in bone repair

A better understanding of osteogenesis at genetic and biochemical levels is yielding new molecular entities that can modulate bone regeneration and potentially act as novel therapies in a clinical setting. These new entities are motivating alternative approaches for bone repair by utilizing DNA-derived expression systems, as well as RNA-based regulatory molecules controlling the fate of cells involved in osteogenesis. These sophisticated mediators of osteogenesis, however, pose unique delivery challenges that are not obvious in deployment of conventional therapeutic agents. Viral and nonviral delivery systems are actively pursued in preclinical animal models to realize the potential of the gene-based medicines. This article will summarize promising bone-inducing molecular agents on the horizon as well as provide a critical review of delivery systems employed for their administration. Special attention was paid to synthetic (nonviral) delivery systems because they are more likely to be adopted for clinical testing because of safety considerations. We present a comparative analysis of dose-response relationships, as well as pharmacokinetic and pharmacodynamic features of various approaches, with the purpose of clearly defining the current frontier in the field. We conclude with the authors' perspective on the future of gene-based therapy of bone defects, articulating promising research avenues to advance the field of clinical bone repair.

Effects of hydroxyapatite nanostructure on channel surface of porcine acellular dermal matrix scaffold on cell viability and osteogenic differentiation of human periodontal ligament stem cells

A new nanostructured hydroxyapatite-coated porcine acellular dermal matrix (HAp-PADM) was fabricated by a biomimetic mineralization method. Human periodontal ligament stem cells were seeded on HAp-PADM and the effects of this scaffold on cell shape, cytoskeleton organization, cell viability, and osteogenic differentiation were examined. Periodontal ligament stem cells cultured on HAp-PADM exhibited different cell shape when compared with those on pure PADM. Moreover, HAp-PADM promoted cell viability and alkaline phosphatase activity significantly. Based on quantitative real-time polymerase chain reaction, the expression of bone-related markers runt-related transcription factor 2 (Runx2), osteopontin (OPN), and osteocalcin (OCN) upregulated in the HAp-PADM scaffold. The enhancement of osteogenic differentiation of periodontal ligament stem cells on the HAp-PADM scaffold was proposed based on the research results. The results of this study highlight the micro-nano, two-level, three-dimensional HAp-PADM composite as a promising scaffold for periodontal tissue engineering.

Alginate-Based Biomaterials for Regenerative Medicine Applications

Alginate is a natural polysaccharide exhibiting excellent biocompatibility and biodegradability, having many different applications in the field of biomedicine. Alginate is readily processable for applicable three-dimensional scaffolding materials such as hydrogels, microspheres, microcapsules, sponges, foams and fibers. Alginate-based biomaterials can be utilized as drug delivery systems and cell carriers for tissue engineering. Alginate can be easily modified via chemical and physical reactions to obtain derivatives having various structures, properties, functions and applications. Tuning the structure and properties such as biodegradability, mechanical strength, gelation property and cell affinity can be achieved through combination with other biomaterials, immobilization of specific ligands such as peptide and sugar molecules, and physical or chemical crosslinking. This review focuses on recent advances in the use of alginate and its derivatives in the field of biomedical applications, including wound healing, cartilage repair, bone regeneration and drug delivery, which have potential in tissue regeneration applications.