Surface Modification of Cardiovascular Stent Material 316L SS with Estradiol-Loaded Poly (trimethylene carbonate) Film for Better Biocompatibility

Design and Validation of Additively Manufactured Metallic Cellular Scaffold Structures for Bone Tissue Engineering

Bone-related defects that cannot heal without significant surgical intervention represent a significant challenge in the orthopedic field. The use of implants for these critical-sized bone defects is being explored to address the limitations of autograft and allograft options. Three-dimensional cellular structures, or bone scaffolds, provide mechanical support and promote bone tissue formation by acting as a template for bone growth. Stress shielding in bones is the reduction in bone density caused by the difference in stiffness between the scaffold and the surrounding bone tissue. This study aimed to reduce the stress shielding and introduce a cellular metal structure to replace defected bone by designing and producing a numerically optimized bone scaffold with an elastic modulus of 15 GPa, which matches the human’s cortical bone modulus. Cubic cell and diagonal cell designs were explored. Strut and cell dimensions were numerically optimized to achieve the desired structural modulus. The resulting scaffold designs were produced from stainless steel using laser powder bed fusion (LPBF). Finite element analysis (FEA) models were validated through compression testing of the printed scaffold designs. The structural configuration of the scaffolds was characterized with scanning electron microscopy (SEM). Cellular struts were found to have minimal internal porosity and rough surfaces. Strut dimensions of the printed scaffolds were found to have variations with the optimized computer-aided design (CAD) models. The experimental results, as expected, were slightly less than FEA results due to structural relative density variations in the scaffolds. Failure of the structures was stretch-dominated for the cubic scaffold and bending-dominated for the diagonal scaffold. The torsional and bending stiffnesses were numerically evaluated and showed higher bending and torsional moduli for the diagonal scaffold. The study successfully contributed to minimizing stress shielding in bone tissue engineering. The study also produced an innovative metal cellular structure that can replace large bone segments anywhere in the human body.

A surface-eroding poly(1,3-trimethylene carbonate) coating for magnesium based cardiovascular stents with stable drug release and improved corrosion resistance

Magnesium alloys with integration of degradability and good mechanical performance are desired for vascular stent application. Drug-eluting coatings may optimize the corrosion profiles of magnesium substrate and reduce the incidence of restenosis simultaneously. In this paper, poly (trimethylene carbonate) (PTMC) with different molecular weight (50,000 g/mol named as PTMC5 and 350,000 g/mol named as PTMC35) was applied as drug-eluting coatings on magnesium alloys. A conventional antiproliferative drug, paclitaxel (PTX), was incorporated in the PTMC coating. The adhesive strength, corrosion behavior, drug release and biocompatibility were investigated. Compared with the PLGA control group, PTMC coating was uniform and gradually degraded from surface to inside, which could provide long-term protection for the magnesium substrate. PTMC35 coated samples exhibited much slower corrosion rate 0.05 μA/cm2 in comparison with 0.11 μA/cm2 and 0.13 μA/cm2 for PLGA and PTMC5 coated counterparts. In addition, PTMC35 coating showed more stable and sustained drug release ability and effectively inhibited the proliferation of human umbilical vein vascular smooth muscle cells. Hemocompatibility test indicated that few platelets were adhered on PTMC5 and PTMC35 coatings. PTMC35 coating, exhibiting surface erosion behavior, stable drug release and good biocompatibility, could be a good candidate as a drug-eluting coating for magnesium-based stent.

Applying extrusion-based 3D printing technique accelerates fabricating complex biphasic calcium phosphate-based scaffolds for bone tissue regeneration

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Biphasic calcium phosphates offer a chemically similar biomaterial to the natural bone, which can significantly accelerate bone formation and reconstruction.

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Robocasting is a suitable technique to produce porous scaffolds supporting cell viability, proliferation, and differentiation.

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This review discusses materials and methods utilized for BCP robocasting, considering recent advancements and existing challenges in using additives for bioink preparation.

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Commercialization and marketing approach, in-vitro and in-vivo evaluations, biologic responses, and post-processing steps are also investigated.

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Possible strategies and opportunities for the use of BCP toward injured bone regeneration along with clinical applications are discussed.

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The study proposes that BCP possesses an acceptable level of bone substituting, considering its challenges and struggles.

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Aim of review

Key scientific concepts of review

Programmed death-1 mediates venous neointimal hyperplasia in humans and rats

Venous neointimal hyperplasia can be a problem after vein interventions. We hypothesized that inhibiting programmed death-1 (PD-1) can decrease venous neointimal hyperplasia in a rat inferior vena cava (IVC) patch venoplasty model. The rats were divided into four groups: the control group was only decellularized without other special treatment; the PD-1 group was injected with a single dose of humanized PD-1 antibody (4 mg/kg); the PD-1 antibody coated patches group; the BMS-1 (a PD-1 small molecular inhibitor) coated patches group (PD-1 inhibitor-1). Patches were implanted to the rat IVC and harvested on day 14 and analyzed. Immunohistochemical analysis showed PD-1-positive cells in the neointima in the human samples. There was high protein expression of PD-1 in the neointima in the rat IVC venoplasty model. PD-1 antibody injection can significantly decrease neointimal thickness (p < 0.0001). PD-1 antibody or BMS-1 was successfully conjugated to the decellularized rat thoracic artery patch by hyaluronic acid with altered morphology and reduced the water contact angle (WCA). Patches coated with humanized PD-1 antibody or BMS-1 both can also decrease neointimal hyperplasia and inflammatory cells infiltration. PD-1-positive cells are present in venous neointima in both human and rat samples. Inhibition of the PD-1 pathway may be a promising therapeutic strategy to inhibit venous neointimal hyperplasia.

Investigation of Mg-xLi-Zn alloys for potential application of biodegradable bone implant materials

Implant therapy after osteosarcoma surgery is a major clinical challenge currently, especially the requirements for mechanical properties, degradability of the implants, and their inhibition of residual tumor cells. Biodegradable magnesium (Mg) alloy as medical bone implant material has full advantages and huge potential development space. Wherein, Mg-lithium (Li) based alloy, as an ultra-light alloy, has good properties for implants under certain conditions, and both Mg and Li have inhibitory effects on tumor cells. Therefore, Mg-Li alloy is expected to be applied in bone implant materials for mechanical supporting and inhibiting tumor cells simultaneously. In this contribution, the Mg-xLi-Zinc (Zn) series alloys (x = 3 wt%, 6 wt%, 9 wt%) were prepared to study the influence of different elements and contents on the structure and properties of the alloy, and the biosafety of the alloy was also evaluated. Our data showed that the yield strength, tensile strength, and elongation of as-cast Mg-xLi-Zn alloy were higher than those of as-cast Mg-Zn alloy; Mg-xLi-Zn alloy can kill osteosarcoma cells (MG-63) in a concentration-dependent manner, wherein Mg-3Li-Zn alloy (x = 3 wt%) and Mg-6Li-Zn alloy (x = 6 wt%) promoted the proliferation of osteoblasts (MC3T3) at a certain concentration of Li. In summary, our study demonstrated that the Mg-6Li-Zn alloy could be potentially applied as a material of orthopedic implant for its excellent multi-functions.

Hyaluronic acid/polyethyleneimine nanoparticles loaded with copper ion and disulfiram for esophageal cancer

In the clinical treatment of cancer, improving the effectiveness and targeting of drugs has always been a bottleneck problem that needs to be solved. In this contribution, inspired by the targeted inhibition on cancer from combination application of disulfiram and divalent copper ion (Cu²⁺), we optimized the concentration of disulfiram and Cu²⁺ ion for inhibiting esophageal cancer cells, and loaded them in hyaluronic acid (HA)/polyethyleneimine (PEI) nanoparticles with specific scales, in order to improve the effectiveness and targeting of drugs. The in vitro cell experiments demonstrated that more drug loaded HA/PEI nanoparticles accumulated to the esophageal squamous cell carcinoma (Eca109) and promoted higher apoptosis ratio of Eca109. Both in vitro and in vivo biological assessment verified that the disulfiram/Cu²⁺ loaded HA/PEI nanoparticles promoted the apoptosis of cancer cells and inhibited the tumor proliferation, but had no toxicity on other normal organs.

Sulfur Contents in Sulfonated Hyaluronic Acid Direct the Cardiovascular Cells Fate

Hyaluronic acid (HA) is recognized as a functional carbohydrate polymer applied for the surface modification of cardiovascular implanted materials due to its molecular weight (MW) dependent cellular regulation. However, due to the enzyme digestion of hyaluronidase on HA in vivo, the stability of HA MW needs to be further improved. It has been reported that the stability of HA MW can be improved by sulfonation. In this study, sulfonated hyaluronic acids (S-HA) with sulfur content of 2.06, 3.69, 7.10, 8.98, and 9.71 were prepared through different sulfuric acid treatment procedures. Cell tests showed that S-HA with higher sulfur content played a significant role in promoting the proliferation and migration of endothelial cells and regulating smooth muscle cells to the physiological phenotype. In addition, it was also proved to inhibit the inflammatory macrophages adhesion/activation. Our data indicates that S-HA may be a better carbohydrate polymer for potential application of cardiovascular biomaterials.

A zwitterionic hydrogel coated titanium surface with high-efficiency endothelial cell selectivity for rapid re-endothelialization

Coronary stent implantation is an effective procedure for percutaneous coronary intervention treatment. However, its long-term safety and efficacy are still hindered by the in-stent restenosis and late thrombus formation. Herein, an anti-biofouling and endothelial cell selective zwitterionic hydrogel coating was developed to simultaneously enhance the nonspecific resistance and rapid re-endothelialization of the titanium surface. An endothelial cell selective peptide, REDV, could be simply conjugated on the zwitterionic carboxybetaine (CB) hydrogel to prepare the REDV/CB coating. It was found that the REDV/CB hydrogel layer maintained antifouling properties, which could inhibit the protein adsorption, bacterial adhesion, platelet activation and aggregation, and smooth muscle cell proliferation. More importantly, the co-culture study confirmed that the conjugated REVD peptide could specifically capture endothelial cells and promote their migration and proliferation, and simultaneously decrease the adhesion and proliferation of smooth muscle cells. Therefore, the antifouling and endothelial cell selective coating proposed in this work provides a promising strategy to develop an intravascular stent for promoted re-endothelialization and inhibited neointimal hyperplasia in clinical applications.

Conjugating heparin, Arg–Glu–Asp–Val peptide, and anti-CD34 to the silanic Mg–Zn–Y–Nd alloy for better endothelialization

Magnesium alloy is generally accepted as a potential cardiovascular stent material due to its good mechanical properties, biocompatibility, and biodegradability, and has become one of the research hotspots in this field. However, too fast degradation rate and delayed surface endothelialization have been the bottleneck of further application of magnesium alloy stent. In this study, we selected Mg–Zn–Y–Nd, a kind of biodegradable magnesium alloy for cardiovascular stent, and passivated its surface by alkali heat treatment and silane treatment to improve the corrosion resistance, subsequently conjugated Arg–Glu–Asp–Val (REDV) peptide and anti-CD34 to promote endothelial cells adhesion and capture endothelial progenitor cells respectively, further improving surface endothelialization. In addition, the heparin was also immobilized to the Mg–Zn–Y–Nd surface for the consideration of anti-coagulation and anti-inflammation. Systematic material characterization and biological evaluation show that we have successfully developed this composite surface on Mg–Zn–Y–Nd alloy, and achieved multiple functions such as corrosion resistance, promoting endothelialization, and inhibiting platelet/macrophage adhesion.

Development of a Highly Proliferated Bilayer Coating on 316L Stainless Steel Implants

In this research, a bilayer coating has been applied on the surface of 316 L stainless steel (316LSS) to provide highly proliferated metallic implants for bone regeneration. The first layer was prepared using electrophoretic deposition of graphene oxide (GO), while the top layer was coated utilizing electrospinning of poly (ε-caprolactone) (PCL)/gelatin (Ge)/forsterite solutions. The morphology, porosity, wettability, biodegradability, bioactivity, cell attachment and cell viability of the prepared coatings were evaluated. The Field Emission Scanning Electron Microscopy (FESEM) results revealed the formation of uniform, continuous, and bead-free nanofibers. The Energy Dispersive X-ray (EDS) results confirmed well-distributed forsterite nanoparticles in the structure of the top coating. The porosity of the electrospun nanofibers was found to be above 70%. The water contact angle measurements indicated an improvement in the wettability of the coating by increasing the amount of nanoparticles. Furthermore, the electrospun nanofibers containing 1 and 3 wt.% of forsterite nanoparticles showed significant bioactivity after soaking in the simulated body fluid (SBF) solution for 21 days. In addition, to investigate the in vitro analysis, the MG-63 cells were cultured on the PCL/Ge/forsterite and GO-PCL/Ge/forsterite coatings. The results confirmed an excellent cell adhesion along with considerable cell growth and proliferation. It should be also noted that the existence of the forsterite nanoparticles and the GO layer substantially enhanced the cell proliferation of the coatings.

Preparing a novel magnesium-doped hyaluronan/polyethyleneimine nanoparticle to improve endothelial functionalisation

Nowadays, tissue engineering vascularisation has become an important means of organ repair and treatment of major traumatic diseases. Vascular endothelial layer regeneration and endothelial functionalisation are prerequisites and important components of tissue engineering vascularisation. The present researches of endothelial functionalisation mainly focus on tissue engineering scaffold preparation and implant surface modification. Few studies have reported the interaction of endothelial functionalisation and scaled materials, especially the nanomaterials. Magnesium (Mg), as an essential cytotropic active element in the human body, should promote the growth of endothelial cells. However, the authors' previous work found that the Mg in the alloys had a defect of delayed endothelialisation, which may be attributed to the non-uniform scales of the degradation products from Mg alloys. To validate this hypothesis and fabricate a novel nanomaterial for tissue engineering vascularisation, the authors prepared Mg-doped hyaluronan (HA)/polyethyleneimine (PEI) nanoparticles for endothelial cells testing. Their data showed that the Mg-doped HA/PEI nanoparticle with small scales (diameter <150 nm) presented better ability on improving endothelial cells growth, functionalisation and nitric oxide release.

Effects of different polyaniline emeraldine compositions in electrodepositing ginsenoside encapsulated poly(lactic-co-glycolic acid) microcapsules coating: Physicochemical characterization and in vitro evaluation

Even though drug-eluting stent (DES) has prominently reduced restenosis, however, its complication of delayed endothelialization has caused chronic side effect. A coating of ginseng-based biodegradable polymer could address this issue due to its specific therapeutic values. However, deposition of this type of stable coating on metallic implant often scarce. Therefore, in this study, different polyaniline (PANI) emeraldine compositions were adopted to electrodeposit ginsenoside encapsulated poly(lactic-co-glycolic acid) microcapsules coating. The coating surfaces were analyzed using attenuated total reflectance-Fourier transform infrared spectroscopy, X-ray photoelectron spectroscopy, scanning electron microscopy, contact angle, and atomic force microscopy instruments. A month coating stability was then investigated with an evaluation of in vitro human umbilical vein endothelial cell analyses consisted of cytotoxicity and cells attachment assessments. The 1.5 mg PANI emeraldine has assisted the formation of stable, uniform, and rounded microcapsules coating with appropriate wettability and roughness. Less than 1.5 mg PANI emeraldine was not enough to drive the formation of microcapsules coating while greater than 1.5 mg caused the deposition of melted microcapsules. The similar coating also has promoted greater cells proliferation and attachment compared to other coating variation. Therefore, the utilization of electrodeposition to deposit a drug-based polymer coating could be implemented to develop DES, in accordance to stent implantation which ultimately aims for enrich endothelialization.

Enhancing biocompatibility and corrosion resistance of biodegradable Mg-Zn-Y-Nd alloy by preparing PDA/HA coating for potential application of cardiovascular biomaterials

In this paper the poly-dopamine (PDA)/hyaluronic acid (HA) coatings with different HA molecular weight (MW, 4 × 10³, 1 × 10⁵, 5 × 10⁵ and 1 × 10⁶ Da) were prepared onto the NaOH passivated Mg-Zn-Y-Nd alloy aiming at potential application of cardiovascular implants. The characterization of weight loss, polarization curves and surface morphology indicated that the coatings with HA MW of 1 × 10⁵ (PDA/HA-2) and 1 × 10⁶ Da (PDA/HA-4) significantly enhanced the corrosion resistance of Mg-Zn-Y-Nd. In vitro biological test also suggested better hemocompatibility, pro-endothelialization, anti-hyperplasia and anti-inflammation functions of the PDA/HA-2- and PDA/HA-4-coated Mg-Zn-Y-Nd alloy. Nevertheless, the in vivo implantation of SD rats' celiac artery demonstrated that the PDA/HA-2 had preferable corrosion resistance and biocompatibility.

Preparing Sodium Alginate/Polyethyleneimine Spheres for Potential Application of Killing Tumor Cells by Reducing the Concentration of Copper Ions in the Lesions of Colon Cancer

Inhibition of residual malignant tumors in patients with colon cancer after operation is one of the difficulties in rehabilitation treatment. At present, using biocompatible materials to remove the copper ion which is the growth dependence of malignant tumors in the lesion site is considered to be the frontier means to solve this problem. In this work, we developed a sodium alginate (SA)/polyethyleneimine (PEI) hydrogel sphere via cross-linking method (SA/SP/SA; SP = SA/PEI) as an oral biomaterial for adsorbing and removing copper ions from colon cancer lesions. The evaluated results showed that the SA/PEI/SA (SPS) hydrogel sphere obtained the largest swelling rate at pH 8.3 which was the acid-base value of colon microenvironment and absorbed more copper ions compared with the SA control. The cell experiment presented that the SPS hydrogel sphere owned better compatibility on normal fibroblasts and promoted higher death of colon cancer cells compared with SA/PEI (SP) and SA control. Our data suggested that the SA/PEI hydrogel sphere had the potentiality as an oral biomaterial for inhibiting colon cancer cells.

Surface evaluation of titanium oxynitride coatings used for developing layered cardiovascular stents

Stents are important medical devices used to increase the quality and life expectancy of patients with heart diseases and stroke, leading causes of death, worldwide. In order to minimize the risk of restenosis, different coating on bare metal stents (BMS) such as polymer coatings; titanium dioxide, titanium nitride or titanium oxynitride coatings; carbon coatings and others are used. The aim of this work was to develop novel stents coated with titanium oxynitride (TiO_xN_y) with optimal chemical, mechanical and biological properties having possibly good coverage rate of inner and outer stent surfaces. The improvement should be achieved by optimization and development of a magnetron sputtering deposition technology. The goal of the study is understanding of the existing potential for improvement of the deposition technology and the coating quality itself. For this study, different O₂/N₂ ratios, meaning 1/2, 1/5 and 1/10 (the ratios of reagent gasses are given for the values of mass flows into the chamber) has been selected. Stability in simulated body fluids, surface morphology and protein adsorption as well as preliminary cytotoxic behaviour of the samples on HUVEC cells has been analysed. SEM experiments have shown the potential in the improvement of coating-stent adhesion by all samples. TiO_xN_y 1:5 samples were found to have the lowest adsorption, the smoothest surface morphology and the smallest rate of salt deposition from simulated body fluids (SBFs). This kind of surface has been recommended for further optimization and application.

Nature-inspired extracellular matrix coating produced by micro-patterned smooth muscle and endothelial cells endows cardiovascular materials with better biocompatibility

Functionalizing cardiovascular biomaterials with an extracellular matrix (ECM) via in vitro decellularization has been applied as an effective method to improve the biocompatibility of implants.

The Surface Modification Methods for Constructing Polymer-Coated Stents

Implanting a metal stent plays a key role in treating cardiovascular diseases. However, the high corrosion rate of metal-based devices severely limits their practical applications. Therefore, how to control the corrosion rate is vital to take full advantages of metal-based materials in the treatment of cardiovascular diseases. This review details various methods to design and construct polymer-coated stents. The techniques are described and discussed including plasma deposition, electrospinning, dip coating, layer-by-layer self-assembly, and direct-write inkjet. Key point is provided to highlight current methods and recent advances in hindering corrosion rate and improving biocompatibility of stents, which greatly drives the rising of some promising techniques involved in the ongoing challenges and potential new trends of polymer-coated stents.