Influence of Bone Substitutes on Mesenchymal Stromal Cells in an Inflammatory Microenvironment

Bone regeneration is driven by mesenchymal stromal cells (MSCs) via their interactions with immune cells, such as macrophages (MPs). Bone substitutes, e.g., bi-calcium phosphates (BCPs), are commonly used to treat bone defects. However, little research has focused on MSC responses to BCPs in the context of inflammation. The objective of this study was to investigate whether BCPs influence MSC responses and MSC-MP interactions, at the gene and protein levels, in an inflammatory microenvironment. In setup A, human bone marrow MSCs combined with two different BCP granules (BCP 60/40 or BCP 20/80) were cultured with or without cytokine stimulation (IL1β + TNFα) to mimic acute inflammation. In setup B, U937 cell-line-derived MPs were introduced via transwell cocultures to setup A. Monolayer MSCs with and without cytokine stimulation served as controls. After 72 h, the expressions of genes related to osteogenesis, healing, inflammation and remodeling were assessed in the MSCs via quantitative polymerase chain reactions. Additionally, MSC-secreted cytokines related to healing, inflammation and chemotaxis were assessed via multiplex immunoassays. Overall, the results indicate that, under both inflammatory and non-inflammatory conditions, the BCP granules significantly regulated the MSC gene expressions towards a pro-healing genotype but had relatively little effect on the MSC secretory profiles. In the presence of the MPs (coculture), the BCPs positively regulated both the gene expression and cytokine secretion of the MSCs. Overall, similar trends in MSC responses were observed with BCP 60/40 and BCP 20/80. In summary, within the limits of in vitro models, these findings suggest that the presence of BCP granules at a surgical site may not necessarily have a detrimental effect on MSC-mediated wound healing, even in the event of inflammation.

Spatio-temporal characterization of fracture healing patterns and assessment of biomaterials by time-lapsed in vivo micro-computed tomography

Thorough preclinical evaluation of functionalized biomaterials for treatment of large bone defects is essential prior to clinical application. Using in vivo micro-computed tomography (micro-CT) and mouse femoral defect models with different defect sizes, we were able to detect spatio-temporal healing patterns indicative of physiological and impaired healing in three defect sub-volumes and the adjacent cortex. The time-lapsed in vivo micro-CT-based approach was then applied to evaluate the bone regeneration potential of functionalized biomaterials using collagen and bone morphogenetic protein (BMP-2). Both collagen and BMP-2 treatment led to distinct changes in bone turnover in the different healing phases. Despite increased periosteal bone formation, 87.5% of the defects treated with collagen scaffolds resulted in non-unions. Additional BMP-2 application significantly accelerated the healing process and increased the union rate to 100%. This study further shows potential of time-lapsed in vivo micro-CT for capturing spatio-temporal deviations preceding non-union formation and how this can be prevented by application of functionalized biomaterials. This study therefore supports the application of longitudinal in vivo micro-CT for discrimination of normal and disturbed healing patterns and for the spatio-temporal characterization of the bone regeneration capacity of functionalized biomaterials.

Fatigue behavior of As-built selective laser melted titanium scaffolds with sheet-based gyroid microarchitecture for bone tissue engineering

Selective laser melting (SLM) has enabled the production of porous titanium structures with biological and mechanical properties that mimic bone for orthopedic applications. These porous structures have a reduced effective stiffness which leads to improved mechanotransduction between the implant and bone. Triply periodic minimal surfaces (TMPS), specifically the sheet-based gyroid structures, have improved compressive fatigue resistance due lack of stress concentrations. Sheet-based gyroid microarchitectures also have high surface area, permeability, and zero mean curvature. This study examines the effects of the gyroid microarchitectural design in parallel with SLM parameters on structure and function of as-built titanium alloy (Ti6Al4V ELI) scaffolds. Scaffold design was varied by varying unit cell size and wall thickness to produce scaffolds with porosity within the range of trabecular bone (50-90%). Manufacturer's default and refined laser parameters were used to examine the effect of input energy density on mechanical properties. Scaffolds exhibited a stretching-dominated deformation behavior under both compressive and tensile loading, and porosity dependent stiffness and strength. Internal void defects were observed within the walls of the gyroids structure, serving as sites for crack initiation leading to failure. Refinement of laser parameters resulted in increased compressive and tensile fatigue behavior, particularly for thicker walled gyroid microarchitectures, while thinner walls showed no significant change. The observed properties of as-built gyroid sheet microarchitectures indicates that these structures have potential for use in bone engineering applications. Furthermore, these results highlight the importance of parallel design and processing optimization for complex sheet-based porous structures produced via SLM. STATEMENT OF SIGNIFICANCE: Selective laser melting (SLM) is an additive manufacturing technology which produces complex porous scaffolds for orthopedic applications. Titanium alloy scaffolds with novel sheet-based gyroid microarchitectures were produced via SLM and evaluated for mechanical performance including fatigue behavior. Gyroid structures are function based topologies have been hypothesized to be promising for tissue engineering scaffolds due to the high surface area to volume ratio, zero mean curvature, and high permeability. This paper presents the effects of scaffold design and processing parameters in parallel, a novel study in the field on bone tissue scaffolds produced via additive manufacturing. Additionally, the comparison of compressive and tensile behavior of scaffolds presented is important in characterizing behavior and failure mechanisms of porous metals which undergo complex loading in orthopedic applications.

Extraordinary biological properties of a new calcium hydroxyapatite/poly(lactide-co-glycolide)-based scaffold confirmed by in vivo investigation

This study examined the potential of a new porous calcium hydroxyapatite scaffold covered with poly (lactide-co-glycolide) (PLGA) as a bone substitute, identifying its advantages over Geistlich Bio-Oss®, considered the gold standard, in in vivo biofunctionality investigations. Structural and morphological properties of the new scaffold were analyzed by scanning electron and atomic force microscopy. The biofunctionality assays were performed on New Zealand white rabbits using new scaffold for filling full-thickness defects of critical size. The evaluated parameters were: the presence of macrophages, giant cells, monoocytes, plasma cells, granulocytes, neoangiogenesis, fibroplasia, and the percentage of mineralization. Parallel biofunctionality assays were performed using Geistlich Bio-Oss®. The appearance of bone defects 12 weeks after the new scaffold implantation showed the presence of a small number of typical immune response cells. Furthermore, significantly reduced number of capillary buds, low intensity of fibroplasia and high degree of mineralization in a lamellar pattern indicated that the inflammation process has been almost completely overcome and that the new bone formed was in the final phase of remodeling. All biofunctionality assays proved the new scaffold's suitability as a bone substitute for applications in maxillofacial surgery. It showed numerous biological advantages over Geistlich Bio-Oss® which was reflected mainly as a lower number of giant cells surrounding implanted material and higher degree of mineralization in new formed bone.

Calcium orthophosphates (CaPO4): Occurrence and properties

The present overview is intended to point the readers' attention to the important subject of calcium orthophosphates (CaPO₄). This type of materials is of the special significance for the human beings because they represent the inorganic part of major normal (bones, teeth and antlers) and pathological (those appearing due to various diseases) calcified tissues of mammals. For example, atherosclerosis results in blood vessel blockage caused by a solid composite of cholesterol with CaPO₄, while dental caries (tooth decay) and osteoporosis (a low bone mass with microarchitectural changes) mean a partial decalcification of teeth and bones, respectively, that results in replacement of a less soluble and harder biological apatite by more soluble and softer calcium hydrogenorthophosphates. Due to the compositional similarities to the calcified tissues of mammals, CaPO₄ are widely used as biomaterials for bone grafting purposes. In addition, CaPO₄ have many other applications. Thus, there is a great significance of CaPO₄ for the humankind and, in this paper, an overview on the current knowledge on this subject is provided.

In Vivo Bone Formation Within Engineered Hydroxyapatite Scaffolds in a Sheep Model

Large bone defects still represent a major burden in orthopedics, requiring bone-graft implantation to promote the bone repair. Along with autografts that currently represent the gold standard for complicated fracture repair, the bone tissue engineering offers a promising alternative strategy combining bone-graft substitutes with osteoprogenitor cells able to support the bone tissue ingrowth within the implant. Hence, the optimization of cell loading and distribution within osteoconductive scaffolds is mandatory to support a successful bone formation within the scaffold pores. With this purpose, we engineered constructs by seeding and culturing autologous, osteodifferentiated bone marrow mesenchymal stem cells within hydroxyapatite (HA)-based grafts by means of a perfusion bioreactor to enhance the in vivo implant-bone osseointegration in an ovine model. Specifically, we compared the engineered constructs in two different anatomical bone sites, tibia, and femur, compared with cell-free or static cell-loaded scaffolds. After 2 and 4 months, the bone formation and the scaffold osseointegration were assessed by micro-CT and histological analyses. The results demonstrated the capability of the acellular HA-based grafts to determine an implant-bone osseointegration similar to that of statically or dynamically cultured grafts. Our study demonstrated that the tibia is characterized by a lower bone repair capability compared to femur, in which the contribution of transplanted cells is not crucial to enhance the bone-implant osseointegration. Indeed, only in tibia, the dynamic cell-loaded implants performed slightly better than the cell-free or static cell-loaded grafts, indicating that this is a valid approach to sustain the bone deposition and osseointegration in disadvantaged anatomical sites.

Competitive Adsorption of Plasma Proteins Using a Quartz Crystal Microbalance

Proteins that get adsorbed onto the surfaces of biomaterials immediately upon their implantation mediate the interactions between the material and the environment. This process, in which proteins in a complex mixture compete for adsorption sites on the surface, is determined by the physicochemical interactions at the interface. Competitive adsorption of bovine serum albumin (BSA), fibronectin (Fn), and collagen type I (Col I), sequentially and from mixtures, was investigated so as to understand the performances of different surfaces used in biomedical applications. A quartz crystal microbalance with dissipation was used to monitor the adsorption of these proteins onto two materials used in functional bone replacement, a titanium alloy (Ti6Al4V) and Ti6Al4V physisorbed with poly(sodium styrenesulfonate) [poly(NaSS)], and three controls, gold, poly(desaminotyrosyltyrosine ethyl ester carbonate) [poly(DTEc)], and polystyrene (PS). In experiments with individual proteins, the adsorption was the highest with Fn and Col I and the least with BSA. Also, protein adsorption was the highest on poly(NaSS) and Ti6Al4V and the least on poly(DTEc). In sequential adsorption experiments, protein exchange was observed in BSA + Fn, Fn + Col I, and BSA + Col I sequences but not in Fn + BSA and Col I + BSA because of the lower affinity of BSA to surfaces relative to Fn and Col I. Protein adsorption was the highest with Col I + Fn on hydrophobic surfaces. In experiments with protein mixtures, with BSA & Fn, Fn appears to be preferentially adsorbed; with Fn & Col I, both proteins were adsorbed, probably as multilayers; and with Col I & BSA, the total amount of protein was the highest, greater than that in sequential and individual adsorption of the two proteins, probably because of the formation of BSA and Col I complexes. Protein conformational changes induced by the adsorbing surfaces, protein-protein interactions, and affinities of proteins appear to be the important factors that govern competitive adsorption. The findings reported here will be useful in understanding the host response to surfaces used for implants.

Incorporation of RANKL promotes osteoclast formation and osteoclast activity on β-TCP ceramics

β-Tricalcium phosphate (β-TCP) ceramics are approved for the repair of osseous defects. In large defects, however, the substitution of the material by authentic bone is inadequate to provide sufficient long-term mechanical stability. We aimed to develop composites of β-TCP ceramics and receptor activator of nuclear factor κ-B ligand (RANKL) to enhance the formation of osteoclasts and promote cell mediated calcium phosphate resorption. RANKL was adsorbed superficially onto β-TCP ceramics or incorporated into a crystalline layer of calcium phosphate by the use of a co-precipitation technique. Murine osteoclast precursors were seeded onto the ceramics. After 15 days, the formation of osteoclasts was quantified cytologically and colorimetrically with tartrate-resistant acidic phosphatase (TRAP) staining and TRAP activity measurements, respectively. Additionally, the expression of transcripts encoding the osteoclast gene products cathepsin K, calcitonin receptor, and of the sodium/hydrogen exchanger NHA2 were quantified by real-time PCR. The activity of newly formed osteoclasts was evaluated by means of a calcium phosphate resorption assay. Superficially adsorbed RANKL did not induce the formation of osteoclasts on β-TCP ceramics. When co-precipitated onto β-TCP ceramics RANKL supported the formation of mature osteoclasts. The development of osteoclast lineage cells was further confirmed by the increased expression of cathepsin K, calcitonin receptor, and NHA2. Incorporated RANKL stimulated the cells to resorb crystalline calcium phosphate. Our in vitro study shows that RANKL incorporated into β-TCP ceramics induces the formation of active, resorbing osteoclasts on the material surface. Once formed, osteoclasts mediate the release of RANKL thereby perpetuating their differentiation and activation. In vivo, the stimulation of osteoclast-mediated resorption may contribute to a coordinated sequence of material resorption and bone formation. Further in vivo studies are needed to confirm the current in vitro findings.

Degradability of injectable calcium sulfate/mineralized collagen-based bone repair material and its effect on bone tissue regeneration

The nHAC/CSH composite is an injectable bone repair material with controllable injectability and self-setting properties prepared by introducing calcium sulfate hemihydrate (CSH) into mineralized collagen (nHAC). When mixed with water, the nHAC/CSH composites can be transformed into mineralized collagen/calcium sulfate dihydrate (nHAC/CSD) composites. The nHAC/CSD composites have good biocompatibility and osteogenic capability. Considering that the degradation behavior of bone repair material is another important factor for its clinical applications, the degradability of nHAC/CSD composites was studied. The results showed that the degradation ratio of the nHAC/CSD composites with lower nHAC content increased with the L/S ratio increase of injectable materials, but the variety of L/S ratio had no significant effect on the degradation ratio of the nHAC/CSD composites with higher nHAC content. Increasing nHAC content in the composites could slow down the degradation of nHAC/CSD composite. Setting accelerator had no significant effect on the degradability of nHAC/CSD composites. In vivo histological analysis suggests that the degradation rate of materials can match the growth rate of new mandibular bone tissues in the implanted site of rabbit. The regulable degradability of materials resulting from the special prescriptions of injectable nHAC/CSH composites will further improve the workability of nHAC/CSD composites.

Evolution of a mesoporous bioactive glass scaffold implanted in rat femur evaluated by (45)Ca labeling, tracing, and histological analysis

Mesoporous bioactive glass (MBG) as a biodegradable scaffold with a nanostructure has attracted significant attention. However, the in vivo evolution of MBG, which includes in situ degradation, the local effect induced by degradation, and the disposition of degradation products, remains unclear. In this study, we performed in situ labeling and synthesis of an MBG scaffold for the first time using (45)CaCl2. The obtained (45)Ca-MBG scaffolds possessed a mesoporous-macroporous cross-linked structure. These (45)Ca-MBG scaffolds were implanted in critical-sized rat femur defects (3 × 3 mm) for 1 day and for 1, 4, 8, and 12 weeks and analyzed by isotopic quantitative tracing. The results illustrated that the MBG scaffolds gradually degraded over time and persisted at a local level of approximately 9.63% at week 12. This finding suggests that only a very small amount of MBG-released calcium ions may have been transformed into calcium components of the new bone matrix. The research also confirmed that the active ingredients derived from the degradation of MBG scaffolds could actively regulate the mRNA expression levels of osteoblast-related genes in rat bone marrow-derived mesenchymal stem cells (rBMSCs) and promote bone regeneration in vivo. Moreover, through isotopic tracing of the entire body, (45)Ca, which disappeared in situ after implantation, could be detected in the heart, lungs, spleen, kidneys, intestines, and brain via the blood and was mainly accumulated in distal bone tissue, including the radius and cranium. However, (45)Ca radioactivity in the body tissues significantly decreased or disappeared after 12 weeks. Systemic toxicological studies on MBG scaffolds demonstrated the degradation products that spread to major organs did not cause abnormal histopathological changes. The above discoveries comprehensively address crucial issues regarding the application of MBG in vivo, and these findings provide a scientific basis for introducing a material with mesoporous structure into clinical applications.

Low-modulus Mg/PCL hybrid bone substitute for osteoporotic fracture fixation

In this paper, we describe a new biodegradable composite composed of polycaprolactone and magnesium. Incorporation of magnesium micro-particles into the polycaprolactone matrix yields mechanical properties close to those of human cancellous bone, and in vitro studies indicate that the silane-coated Mg/PCL composites have excellent cytocompatibility and osteoblastic differentiation properties. The bioactivity of the composites is manifested by the formation of calcium and phosphate after immersion in simulated body fluids. The bulk mechanical properties can be maintained for 2 months before obvious degradation takes place. The in vivo animal study reveals a larger amount of new bone formation on the silane-coated Mg/PCL composites compared to conventional PMMA and pure polycaprolactone and our results suggest potential clinical applications of the sliane-coated Mg/PCL composites.

β-Tricalcium phosphate induces apoptosis on dental follicle cells

Dental stem cells represent a good treatment option in regenerative dentistry. Regeneration of large bone defects can be achieved by a cell-based therapy consisting of osteogenic progenitor cells, such as dental follicle precursor cells (DFCs), in combination with bone substitute material used as a scaffold. A previous trial had shown that β-tricalcium phosphate (TCP) improves the osteogenic differentiation of DFCs. In the present trial, we investigated the attachment, survival, and proliferation of DFCs on TCP in more detail. A high initial cell number was required for the adhesion, attachment, and sufficient proliferation of DFCs on a TCP scaffold. The TCP scaffold released fine soluble particles enriched in TCP eluates that induced cell death and showed typical characteristics of programmed cell death (apoptosis) in DFCs. During cultivation on the TCP scaffold, DFCs showed a highly upregulated expression of antiapoptotic genes but a downregulated expression of proapoptotic markers. In conclusion, TCP supports osteogenic differentiation in DFCs but also induces programmed cell death. Our data suggest that surviving DFCs avoid programmed cell death by inducing antiapoptotic genes.

A novel cyclic RGD-containing peptide polymer improves serum-free adhesion of adipose tissue-derived mesenchymal stem cells to bone implant surfaces

Seeding of bone implants with mesenchymal stem cells (MSCs) may promote osseointegration and bone regeneration. However, implant material surfaces, such as titanium or bovine bone mineral, fail to support rapid and efficient attachment of MSCs, especially under serum-free conditions that may be desirable when human applications or tightly controlled experiments are envisioned. Here we demonstrate that a branched poly[Lys(Ser(i)-DL-Ala(m))] polymer functionalized with cyclic arginyl-glycyl-aspartate, when immobilized by simple adsorption to tissue culture plastic, surgical titanium alloy (Ti6Al4V), or Bio-Oss(®) bovine bone substitute, significantly accelerates serum-free adhesion and enhances seeding efficiency of human adipose tissue-derived MSCs. Moreover, when exposed to serum-containing osteogenic medium, MSCs survived and differentiated on the peptide-coated scaffolds. In summary, the presented novel polypeptide conjugate can be conveniently used for coating various surfaces, and may find applications whenever quick and efficient seeding of MSCs is required to various scaffolds in the absence of serum.

Influence of architecture of β-tricalcium phosphate scaffolds on biological performance in repairing segmental bone defects

BACKGROUND

Although three-dimensional (3D) β-tricalcium phosphate (β-TCP) scaffolds serve as promising bone graft substitutes for the segmental bone defect treatment, no consensus has been achieved regarding their optimal 3D architecture.

METHODS

In this study, we has systematically compared four types of β-TCP bone graft substitutes with different 3D architectures, including two types of porous scaffolds, one type of tubular scaffolds and one type of solid scaffolds, for their efficacy in treating segmental bone defect in a rabbit model.

RESULTS

Our study has demonstrated that when compared to the traditional porous and solid scaffolds, tubular scaffolds promoted significantly higher amount of new bone formation in the defect regions as shown by X-ray, micro CT examinations and histological analysis, restored much greater mechanical properties of the damaged bone evidenced by the biomechanical testing, and eventually achieved the complete union of segmental defect. Moreover, the implantation of tubular scaffolds enhanced the neo-vascularization at the defect region with higher bone metabolic activities than others, as indicated by the bone scintigraphy assay.

CONCLUSIONS

This study has further the current knowledge regarding the profound influence of overall 3D architecture of β-TCP scaffolds on their in vivo defect healing performance and illuminated the promising potential use of tubular scaffolds as effective bone graft substitute in treating large segmental bone defects.

[Progress of in vivo study on degradable magnesium alloys application as bone-implant materials]

OBJECTIVE

To review the progress of in vivo study on degradable magnesium alloys application as bone-implant materials.

METHODS

Recent literature was extensively reviewed and summarized, concerning the in vivo study on degradable magnesium alloys as orthopaedic implants.

RESULTS

Magnesium alloys possess a natural ability to degrade via corrosion in vivo, which is promising candidate material for orthopaedic medical device applications. A great progress has been made to improve in vivo performance and integration with bone tissue. However, the degradation mechanism of magnesium-based materials in the physiological environment and long-term effect on body are not available. The modulation of the corrosion rate of magnesium alloys must also be accomplished.

CONCLUSION

Magnesium alloys have the potential to serve as degradable implants for orthopaedic applications, but a great deal of further investigation is still necessary.

Divergent resorbability and effects on osteoclast formation of commonly used bone substitutes in a human in vitro-assay

Bioactive bone substitute materials are a valuable alternative to autologous bone transplantations in the repair of skeletal defects. However, clinical studies have reported varying success rates for many commonly used biomaterials. While osteoblasts have traditionally been regarded as key players mediating osseointegration, increasing evidence suggests that bone-resorbing osteoclasts are of crucial importance for the longevity of applied biomaterials. As no standardized data on the resorbability of biomaterials exists, we applied an in vitro-assay to compare ten commonly used bone substitutes. Human peripheral blood mononuclear cells (PBMCs) were differentiated into osteoclasts in the co-presence of dentin chips and biomaterials or dentin alone (control) for a period of 28 days. Osteoclast maturation was monitored on day 0 and 14 by light microscopy, and material-dependent changes in extracellular pH were assessed twice weekly. Mature osteoclasts were quantified using TRAP stainings on day 28 and their resorptive activity was determined on dentin (toluidin blue staining) and biomaterials (scanning electron microscopy, SEM). The analyzed biomaterials caused specific changes in the pH, which were correlated with osteoclast multinuclearity (r = 0.942; p = 0.034) and activity on biomaterials (r = 0.594; p = 0.041). Perossal led to a significant reduction of pH, nuclei per osteoclast and dentin resorption, whereas Tutogen bovine and Tutobone human strikingly increased all three parameters. Furthermore, natural biomaterials were resorbed more rapidly than synthetic biomaterials leading to differential relative resorption coefficients, which indicate whether bone substitutes lead to a balanced resorption or preferential resorption of either the biomaterial or the surrounding bone. Taken together, this study for the first time compares the effects of widely used biomaterials on osteoclast formation and resorbability in an unbiased approach that may now aid in improving the preclinical evaluation of bone substitute materials.

Computer-designed nano-fibrous scaffolds

Nano-fibrous scaffolding mimics aspects of the extracellular matrix to improve cell function and tissue formation. Although several methods exist to fabricate nano-fibrous scaffolds, the combination of phase separation with reverse solid freeform fabrication (SFF) allows for scaffolds with features at three different orders of magnitude to be formed, which is not easily achieved with other nano-fiber fabrication methods. This technique allows for the external shape and internal pore structure to be precisely controlled in an easily repeatable manner, while the nano-fibrous wall architecture facilitates cellular attachment, proliferation, and differentiation of the cells. In this chapter, we examine the fabrication of computer-designed nano-fibrous scaffolds utilizing thermally induced phase separation and reverse SFF, and the benefits of such scaffolds over more traditional tissue engineering scaffolds on cellular function and tissue regeneration.

Direct fabrication as a patient-targeted therapeutic in a clinical environment

A paradigm shift is taking place in orthopaedic and reconstructive surgery. This transition from using medical devices and tissue grafts towards the utilization of a tissue engineering approach combines biodegradable scaffolds with cells and/or biological molecules in order to repair and/or regenerate tissues. One of the potential benefits offered by solid freeform fabrication (SFF) technologies is the ability to create such biodegradable scaffolds with highly reproducible architecture and compositional variation across the entire scaffold due to their tightly controlled computer-driven fabrication. Many of these biologically activated materials can induce bone formation at ectopic and orthotopic sites, but they have not yet gained widespread use due to several continuing limitations, including poor mechanical properties, difficulties in intraoperative handling, lack of porosity suitable for cellular and vascular infiltration, and suboptimal degradation characteristics. In this chapter, we define scaffold properties and attempt to provide some broad criteria and constraints for scaffold design and fabrication in combination with growth factors for bone engineering applications. Lastly, we comment on the current and future developments in the field, such as the functionalization of novel composite scaffolds with combinations of growth factors designed to promote cell attachment, cell survival, vascular ingrowth, and osteoinduction.

Charge specific protein placement at submicrometer and nanometer scale by direct modification of surface potential by electron beam

The understanding and the precise control of protein adsorption is extremely important for the development and optimization of biomaterials. The challenge resides in controlling the different surface properties, such as surface chemistry, roughness, wettability, or surface charge, independently, as modification of one property generally affects the other. We demonstrate the creation of electrically modified patterns on hydroxyapatite by using scanning electron beam to tailor the spatial regulation of protein adsorption via electrostatic interactions without affecting other surface properties of the material. We show that domains, presenting modulated surface potential, can be created to precisely promote or reduce protein adsorption.

Generalized stern models of the electric double layer considering the spatial variation of permittvity and finite size of ions in saturation regime

The interaction between a charged metal implant surface and a surrounding body fluid (electrolyte solution) leads to ion redistribution and thus to formation of an electrical double layer (EDL). The physical properties of the EDL contribute essentially to the formation of the complex implant-biosystem interface. Study of the EDL began in 1879 by Hermann von Helmholtz and still today remains a scientific challenge. The present mini review is focused on introducing the generalized Stern theory of an EDL, which takes into account the orientational ordering of water molecules. To ascertain the plausibility of the generalized Stern models described, we follow the classical model of Stern and introduce two Langevin models for spatial variation of the relative permittivity for point-like and finite sized ions. We attempt to uncover the subtle interplay between water ordering and finite sized ions and their impact on the electric potential near the charged implant surface. Two complementary effects appear to account for the spatial dependency of the relative permittivity near the charged implant surface - the dipole moment vectors of water molecules are predominantly oriented towards the surface and water molecules are depleted due to the accumulation of counterions. At the end the expressions for relative permittivity in both Langevin models were generalized by also taking into account the cavity and reaction field.

Chitosan composites for bone tissue engineering--an overview

Bone contains considerable amounts of minerals and proteins. Hydroxyapatite [Ca₁₀(PO₄)₆(OH)₂] is one of the most stable forms of calcium phosphate and it occurs in bones as major component (60 to 65%), along with other materials including collagen, chondroitin sulfate, keratin sulfate and lipids. In recent years, significant progress has been made in organ transplantation, surgical reconstruction and the use of artificial protheses to treat the loss or failure of an organ or bone tissue. Chitosan has played a major role in bone tissue engineering over the last two decades, being a natural polymer obtained from chitin, which forms a major component of crustacean exoskeleton. In recent years, considerable attention has been given to chitosan composite materials and their applications in the field of bone tissue engineering due to its minimal foreign body reactions, an intrinsic antibacterial nature, biocompatibility, biodegradability, and the ability to be molded into various geometries and forms such as porous structures, suitable for cell ingrowth and osteoconduction. The composite of chitosan including hydroxyapatite is very popular because of the biodegradability and biocompatibility in nature. Recently, grafted chitosan natural polymer with carbon nanotubes has been incorporated to increase the mechanical strength of these composites. Chitosan composites are thus emerging as potential materials for artificial bone and bone regeneration in tissue engineering. Herein, the preparation, mechanical properties, chemical interactions and in vitro activity of chitosan composites for bone tissue engineering will be discussed.

Heparinized hydroxyapatite/collagen three-dimensional scaffolds for tissue engineering

Currently, in bone tissue engineering research, the development of appropriate biomaterials for the regeneration of bony tissues is a major concern. Bone tissue is composed of a structural protein, collagen type I, on which calcium phosphate crystals are enclosed. For tissue engineering, one of the most applied strategies consists on the development and application of three dimensional porous scaffolds with similar composition to the bone. In this way, they can provide a physical support for cell attachment, proliferation, nutrient transport and new bone tissue infiltration. Hydroxyapatite is a calcium phosphate with a similar composition of bone and widely applied in several medical/dentistry fields. Therefore, in this study, hydroxyapatite three dimensional porous scaffolds were produced using the polymer replication method. Next, the porous scaffolds were homogeneously coated with a film of collagen type I by applying vacuum force. Yet, due to collagen degradability properties, it was necessary to perform an adequate crosslinking method. As a result, N-(3-dimethylaminopropyl)-N'-ethylcarbodiimide hydrochloride (EDC) and N-hydroxysuccinimide (NHS) was employed as an efficient and non-toxic crosslinking method in this research. The composites were characterized by means of SEM, DSC and TNBS. Furthermore, heparin was incorporated in order to accomplish sustained delivery of a growth factor of interest namely, bone morphogenetic proteins (BMP-2). BMP-2 binding and release of non-heparinized and heparinized scaffolds was evaluated at specific time points. The incorporation of heparin leads to a reduced initial burst phase when compared to the non heparinized materials. The results show a beneficial effect with the incorporation of heparin and its potential as a localized drug delivery system for the sustained release of growth factors.

[Experimental research on osteogenic abilities of new bone tissue engineering scaffolds by recombinant bone morphogenetic protein]

This research sought to asses the efficacity of a new type of tissue engineering bone developed by PDLLA/ PLA-PEG-PLA and BMP as a kind of bone graft substitute in the rabbit model of mandibular defects; 15 mm x 6 mm bilateral mandibular periosteum bone defects were made surgically in 20 New Zealand adult rabbits. The porous scaffolds impregnated with rhBMP-2 were used for the purpose, and the scaffolds without rhBMP-2 were used as control. The methods adopted in this research were: macroscopy, histomorphologic exam, X-ray exam, SEM micrography, computer-aided analysis and graphics. The experimental group was shown to have an earlier inception of bone forming. New bone formation was seen along the border of the original mandibular bone and in the middle. At 12 weeks after surgery,the defects were almost filled with new bone. In the control group, the defects could not be repaired in its entirety, and there was no new bone in the middle. The porous scaffold is a promising carrier for BMP. This kind of bone graft substitute can serve as an osteoconductive and osteoinductive matrix.

Isolation of mesenchymal stem cells from bone marrow wastes of spinal fusion procedure (TLIF) for low back pain patients and preparation of bone dusts for transplantable autologous bone graft with a serum glue

Low back pain and subsequent disabilities are common. A lumbar spinal fusion procedure is an effective treatment with autologous bone grafts, but harvesting the bone from the iliac crest is associated with risks of complications. New treatments using stem cells together with osteoconductive and otesoinductive materials have made the procedure safer, but the inconsistency of the amount of stem cells harvested from bone marrow aspirate still remains to be solved. This study reports that the bone dusts, usually discarded as surgical wastes during transforaminal lumbar interbody fusion procedure (TLIF procedure), yielded cells which had the characteristics of mesenchymal stem cells (MSCs) in vitro. The cells were positive for the MSC markers and were able to differentiate in osteogenic and adipogenic directions. The cells grew robustly in an osteoconductive material, Bolheal (serum glue), and also proliferated well in culture medium supplemented with autologous serum. Therefore, the bone dust is a good candidate for the alternative source of stem cells other than bone marrow aspirate to increase the safety of the TLIF procedure.

Initial biocompatibility and enhanced osteoblast response of Si doping in a porous BCP bone graft substitute

Granular shape biphasic calcium phosphate (BCP) bone grafts with and without doping of silicon cations were evaluated in regards to biocompatibility and MG-63 cellular response. To do this we studied Cellular cytotoxicity, cellular adhesion and spreading behavior and cellular differentiation with alizarin red S staining. Gene expression in MG-63 cells on the implanted bone substitutes was also examined at different time points using RT-PCR. In comparison, the Si-doped BCP granule showed more cellular viability than the BCP granule without doping in MTT assay. Moreover, cell proliferation was much higher when Si doping was employed. The cells grown on the silicon-doped BCP substitutes had more active filopodial growth with cytoplasmic webbing that proceeded to the flattening stage, which was indicative of well cellular adhesion. When these cells were exposed to Si-doped BCP granules for 14 days, well differentiated MG-63 cells were observed. Osteonectin and osteopontin genes were highly expressed in the late stage of differentiation (14 days), whereas collagen type I mRNA were found to be highly expressed during the early stage (day 3). These combined results of this study demonstrate that silicon-doped BCP enhanced osteoblast attachment/spreading, proliferation, differentiation and gene expression.

Next-generation biomedical implants using additive manufacturing of complex, cellular and functional mesh arrays

In this paper, we examine prospects for the manufacture of patient-specific biomedical implants replacing hard tissues (bone), particularly knee and hip stems and large bone (femoral) intramedullary rods, using additive manufacturing (AM) by electron beam melting (EBM). Of particular interest is the fabrication of complex functional (biocompatible) mesh arrays. Mesh elements or unit cells can be divided into different regions in order to use different cell designs in different areas of the component to produce various or continually varying (functionally graded) mesh densities. Numerous design elements have been used to fabricate prototypes by AM using EBM of Ti-6Al-4V powders, where the densities have been compared with the elastic (Young) moduli determined by resonant frequency and damping analysis. Density optimization at the bone-implant interface can allow for bone ingrowth and cementless implant components. Computerized tomography (CT) scans of metal (aluminium alloy) foam have also allowed for the building of Ti-6Al-4V foams by embedding the digital-layered scans in computer-aided design or software models for EBM. Variations in mesh complexity and especially strut (or truss) dimensions alter the cooling and solidification rate, which alters the alpha-phase (hexagonal close-packed) microstructure by creating mixtures of alpha/alpha' (martensite) observed by optical and electron metallography. Microindentation hardness measurements are characteristic of these microstructures and microstructure mixtures (alpha/alpha') and sizes.

Ultrastructural evaluation of in vitro mineralized calcium phosphate phase on surface phosphorylated poly(hydroxy ethyl methacrylate-co-methyl methacrylate)

The in vitro functionality of surface phosphorylated poly(hydroxy ethyl methacrylate-co-methyl methacrylate), poly(HEMA-co-MMA) to induce bioinspired mineralization of calcium phosphate phase is evaluated. The primary nucleation of calcium phosphate on the surface phosphorylated copolymer occurs within 3 days of immersion when immersed in 1.5x simulated body fluid and the degree of mineralization is proportional to the hydroxy ethyl methacrylate content in the copolymer. The calcium phosphate phase is identified as hydroxyapatite by X-Ray diffraction analysis. The transmission electron microscopic evaluation combined with selected area diffraction pattern and energy dispersive analysis exemplified that the primary nuclei of amorphous calcium phosphate transforms to crystalline needle like calcium rich apatite, within a period of 3 days immersion in simulated body fluid. The atomic force microscopic results corroborate the c-axis growth of the crystals within 3 days immersion in SBF.

[Prevention of osseous defaults in the craneosinostosis surgery using calvarian cranial particulate bone]

It is considered that up to 20% of the craniosinostosis patients require secondary surgeries. Different techniques have been used in craneofacial surgery for the reconstruction of great osseous defects in pediatric patients for many years. This paper is about a new technique to obtain osseous graft for covering osseous cranial defects, using particulate bone, harvested from the patient calvarian using a hand-driven brace and covered with a fibrin adhesive. This is a very simple technique, which provides a great amount of bone from the patient himself, therefore producing a small morbidity. Since 2007 the authors have been using autologous particulate bone harvested from de patient calvarian for the reconstruction of different size osseous defects found in craneofacial surgery, especially in pediatrics patients. Although alloplastic materials and bone substitutes have been used for cranial reconstruction, the best option is the autogenous bone. In contrast to synthetic materials autologous grafts have a faster osteointegration, due to their osteogenic, osteoinductive and osteconductive properties. Harvesting the bone from the calvarian patient produces a minimal morbidity compared to the extraction of grafts from other donor sites such as rips or hip. The use of autologous particulate bone in craniosinostosis surgery reduces the risk of second interventions due to secondary ossifications defects. On the other hand, the harvest is easy and the supply of bone it is enough in pediatric patients.

Dipeptide-based polyphosphazene and polyester blends for bone tissue engineering

Polyphosphazene-polyester blends are attractive materials for bone tissue engineering applications due to their controllable degradation pattern with non-toxic and neutral pH degradation products. In our ongoing quest for an ideal completely miscible polyphosphazene-polyester blend system, we report synthesis and characterization of a mixed-substituent biodegradable polyphosphazene poly[(glycine ethyl glycinato)(1)(phenyl phenoxy)(1)phosphazene] (PNGEG/PhPh) and its blends with a polyester. Two dipeptide-based blends namely 25:75 (Matrix1) and 50:50 (Matrix2) were produced at two different weight ratios of PNGEG/PhPh to poly(lactic acid-glycolic acid) (PLAGA). Blend miscibility was confirmed by differential scanning calorimetry, Fourier transform infrared spectroscopy, and scanning electron microscopy. Both blends resulted in higher tensile modulus and strength than the polyester. The blends showed a degradation rate in the order of Matrix2<Matrix1<PLAGA in phosphate buffered saline at 37 degrees C over 12 weeks. Significantly higher pH values of degradation media were observed for blends compared to PLAGA confirming the neutralization of PLAGA acidic degradation by polyphosphazene hydrolysis products. The blend components PLAGA and polyphosphazene exhibited a similar degradation pattern as characterized by the molecular weight loss. Furthermore, blends demonstrated significantly higher osteoblast growth rates compared to PLAGA while maintaining osteoblast phenotype over a 21-day culture. Both blends demonstrated improved biocompatibility in a rat subcutaneous implantation model compared to PLAGA over 12 weeks.

Loading of VEGF to the heparin cross-linked demineralized bone matrix improves vascularization of the scaffold

Deficient vascularization is one of the prominent shortcomings of porous tissue-engineering scaffolds, which results in insufficient oxygen and nutrients transportation. Here, heparin cross-linked demineralized bone matrices (HC-DBM) pre-loaded with vascular endothelial growth factor (VEGF) were designed to promote cells and new microvessels invasion into the matrices. After being chemical crosslinked with heparin by N-hydroxysuccinimide and N-(3-di-methylaminopropyl)-N'-ethylcarbodiimide, the scaffold could bind more VEGF than the non-crosslinked one and achieve localized and sustained delivery. The biological activity of VEGF binding on heparinized collagen was demonstrated by promoting endothelial cells proliferation. Evaluation of the angiogenic potential of heparinized DBM loaded with VEGF was further investigated by subcutaneous implantation. Improved angiogenesis of heparinized DBM loaded with VEGF was observed from haematoxylin-eosin staining and immunohistochemistry examination. The results demonstrated that heparin cross-linked DBM binding VEGF could be a useful strategy to stimulate cells and blood vessels invasion into the scaffolds.

Silica xerogel-chitosan nano-hybrids for use as drug eluting bone replacement

Silica xerogel-chitosan hybrids containing vancomycin were fabricated by the sol-gel process at room temperature and their potential as a drug eluting bone replacement was evaluated in terms of their mechanical properties and drug release behaviors. Regardless of the content of chitosan, all of the prepared hybrids had a uniform mesoporous structure, which would allow the effectual loading of vancomycin. As the content of chitosan was increased, the strength, strain to failure, and work of fracture of the hybrids were significantly enhanced, while the elastic modulus was decreased. These changes in the mechanical properties were mainly attributed to the mitigation of the brittleness of the silica xerogel through its hybridization with the flexible chitosan phase. In addition, the initial burst-effect was remarkably reduced by increasing the content of chitosan. The hybrids with more than 30% chitosan could release the vancomycin for an extended period of time in a controlled manner.

Preparation of porous 45S5 Bioglass-derived glass-ceramic scaffolds by using rice husk as a porogen additive

Bioactive glass is currently regarded as the most biocompatible material in the bone regeneration field because of its bioactivity, osteoconductivity and even osteoinductivity. In the present work porous glass-ceramic scaffolds, which were prepared from the 45S5 Bioglass by foaming with rice husks and sintering at 1050 degrees C for 1 h, have been developed. The produced scaffolds were characterized for their morphology, properties and bioactivity. Micrographs taken using a scanning electron microscope (SEM) were used for analysis of macropores, mesopores and micropores, respectively. The bioactivity of the porous glass-ceramic scaffolds was investigated using simulated body fluid (SBF) and characterized by SEM, energy dispersive spectroscopy (EDS) and X-ray diffraction (XRD). A great potential scaffold that provides sufficient mechanical support temporarily while maintaining bioactivity, and that can biodegrade at later stages is achievable with the developed 45S5 Bioglass-derived scaffolds.

[Research on bioactivity of magnesium and its alloys]

Magnesium is an essential microelement which is not harmful to human body. As a light-weight metal with properties similar to natural bone, magnesium material possesses the characteristics of its degradability, little biotoxicity, as well as its regulatory strength and controllable degradation-speed. After the tissue has healed sufficiently, the burden of a second surgical procedure can be avoided. Therefore, there is need of investigation on the possible use of magnesium and its alloys as medical biomaterials, and the study of its bioactivity is the foundation of further application. This article reviews the bioactivity of magnesium and its alloys.

[Development of biodegradable magnesium-based biomaterials]

Magnesium is a macroelement which is indispensable to human bodies. As a lightweight metal with high specific strength and favorable biocompatibility, magnesium and its alloys have been introduced in the field of biomedical materials research and have a broad application prospect. It is possible to develop new type of biodegradable medical magnesium alloys by use of the poor corrosion resistance of magnesium. Bioabsorbable magnesium stents implanted in vivo could mechanically support the vessel in a short term, effectly prevent the acute coronary occlusion and in-stent restenosis, and then be gradully biodegraded and completely absorbed in a long term. Osteoconductive bioactivity in magnesium-based alloys could promote the apposition growth of bone tissue. This paper reviews the progress of magnesium and its alloys applied in bone tissue and cardiovascular stents, and the prospect of the future research of magnesium-based biomaterials is discussed.

[Animal implantation with a new type of chitosan microspheres/calcium phosphate cement]

OBJECTIVE

To investigate bioactivity, biodegradation, bone conductive properties, and clinical maneuverability of a novel injectable chitosan microspheres/calcium phosphate cement (CPC).

METHODS

The bone defect of pi x 4 mmx4 mmx6 mm was made at both thigh bones of 12 rabbits, and experimental material (chitosan microspheres/CPC) or control material (alpha-tricalcium phosphate cement, alpha-TCP) was injected into the defect respectively. The filling situation was evaluated by X-ray 3 days after operation. The rabbits were divided into three groups, four for each group. The samples with chitosan microspheres and the control with alpha-TCP were collected at 8, 16, 24 weeks after operation. Histological examination and scanning electron microscope (SEM) evaluation were performed.

RESULTS

The absorption of implants with chitosan microspheres was observed at 8 weeks, and became more apparent at 16 weeks. Different size of cavities were observed in CPC after the degradation of chitosan microspheres. The chitosan microspheres/CPC was dramatically degraded after 24 weeks with a few chitosan microspheres, and new bone replaced the degraded materials. The implants with alpha-TCP were absorbed slowly compared with the chitosan microspheres/CPC. The cavities in alpha-TCP were small.

CONCLUSION

The chitosan microspheres/calcium phosphate cement has the characters of good biocompatible and osteocombinative ability. Compared with the control material, adding chitosan microspheres into CPC could enhance its degradability and facilitate the new bone formation.

Potential effects of a low-molecular-weight fucoidan extracted from brown algae on bone biomaterial osteoconductive properties

In this work, we first tested the influence of low-molecular-weight (LMW) fucoidan extracted from pheophicae cell wall on bidimensional cultured normal human osteoblasts' behaviors. Second, by impregnation procedure with LMW fucoidan of bone biomaterial (Lubboc), we explored in this bone extracellular matrix context its capabilities to support human osteoblastic behavior in 3D culture. In bidimensionnal cultures, we evidenced that LMW fucoidan promotes human osteoblast proliferation and collagen type I expression and favors precocious alkaline phosphatase activity. Furthermore, with LMW fucoidan, von Kossa's staining was positive at 30 days and positive only at 45 days in the absence of LMW fucoidan. In our three-dimensional culture models with the biomaterial pretreated with LMW fucoidan, osteoblasts promptly overgrew the pretreated biomaterial. We also evidenced that osteoblasts increased proliferation with pretreated biomaterial when compared with untreated biomaterial. Osteoblasts secreted osteocalcin and expressed BMP2 receptor on control material as well as with LMW fucoidan impregnated biomaterial. In conclusion, in our experimental conditions, LMW fucoidan stimulated expression of osteoblastic markers differentiation such as alkaline phosphatase activity, collagen type I expression, and mineral deposition; furthermore, cell proliferation was favored. These findings suggest that fucoidan could be clinically useful for bone regeneration and bone substitute design.

Spatial and temporal patterns of bone formation in ectopically pre-fabricated, autologous cell-based engineered bone flaps in rabbits

Biological substitutes for autologous bone flaps could be generated by combining flap pre-fabrication and bone tissue engineering concepts. Here, we investigated the pattern of neotissue formation within large pre-fabricated engineered bone flaps in rabbits. Bone marrow stromal cells from 12 New Zealand White rabbits were expanded and uniformly seeded in porous hydroxyapatite scaffolds (tapered cylinders, 10-20 mm diameter, 30 mm height) using a perfusion bioreactor. Autologous cell-scaffold constructs were wrapped in a panniculus carnosus flap, covered by a semipermeable membrane and ectopically implanted. Histological analysis, substantiated by magnetic resonance imaging (MRI) and micro-computerized tomography scans, indicated three distinct zones: an outer one, including bone tissue; a middle zone, formed by fibrous connective tissue; and a central zone, essentially necrotic. The depths of connective tissue and of bone ingrowth were consistent at different construct diameters and significantly increased from respectively 3.1+/-0.7 mm and 1.0+/-0.4 mm at 8 weeks to 3.7+/-0.6 mm and 1.4+/-0.6 mm at 12 weeks. Bone formation was found at a maximum depth of 1.8 mm after 12 weeks. Our findings indicate the feasibility of ectopic pre-fabrication of large cell-based engineered bone flaps and prompt for the implementation of strategies to improve construct vascularization, in order to possibly accelerate bone formation towards the core of the grafts.

Bisphosphonate binding affinity as assessed by inhibition of carbonated apatite dissolution in vitro

Bisphosphonates (BPs), which display a high affinity for calcium phosphate surfaces, are able to selectively target bone mineral, where they are potent inhibitors of osteoclast-mediated bone resorption. The dissolution of synthetic hydroxyapatite (HAP) has been used previously as a model for BP effects on natural bone mineral. The present work examines the influence of BPs on carbonated apatite (CAP), which mimics natural bone more closely than does HAP. Constant composition dissolution experiments were performed at pH 5.50, physiological ionic strength (0.15M) and temperature (37 degrees C). Selected BPs were added at (0.5 x 10(-6)) to (50.0 x 10(-6))M, and adsorption affinity constants, K(L), were calculated from the kinetics data. The BPs showed concentration-dependent inhibition of CAP dissolution, with significant differences in rank order zoledronate > alendronate > risedronate. In contrast, for HAP dissolution at pH 5.50, the differences between the individual BPs were considerably smaller. The extent of CAP dissolution was also dependent on the relative undersaturation, sigma, and CAP dissolution rates increased with increasing carbonate content. These results demonstrate the importance of the presence of carbonate in mediating the dissolution of CAP, and the possible involvement of bone mineral carbonate in observed differences in bone affinities of BPs in clinical use.

[Biocompatibility of combined deproteinized bone coated with hepatocyte growth factor as scaffold for osteoblasts in vitro in fetal rabbits]

OBJECTIVE

To determine the cellular compatibility of combined deproteinized bone(DPB) coated with hepatocyte growth factor (HGF), and to observe the adherent effect of osteoblasts in response to HGF.

METHODS

Osteoblasts were isolated from fetal rabbits. Osteoblasts were cultured with DPB coated with HGF and deproteinized bone as experimental group and contral group, respectively. The proliferation and alkalinephosphatase activity were tested. Their growth was examined by inverted phase contrast microscope and scanning electronmicroscope.

RESULTS

The osteoblasts were attached to the outside and inside surfaces and grew well. HGF/DPB could stimulate the alkalinephosphatase activity of the osteoblasts and improve the proliferation of the osteoblasts.

CONCLUSION

HGF/DPB has good biocompatibility and bone induction. HGF could improve the adherent effect of DPB on osteoblasts, and it could be used as scaffold material for the bone tissue engineering.

The effect of simvastatin on bone formation and ceramic resorption in a peri-implant defect model

Experimental use of statins as stimulators of bone formation suggests they may have widespread applicability in the field of orthopaedics. With their combined effects on osteoblasts and osteoclasts, statins have the potential to enhance resorption of synthetic materials and improve bone ingrowth. In this study, the effect of oral and local administration of simvastatin to a beta tricalcium phosphate (betaTCP)-filled defect around an implant was compared with recombinant human bone morphogenetic protein 2 (rhBMP2). On hundred and sixty-two Sprague-Dawley rats were assigned to treatment groups: local application of 0.1, 0.9 or 1.7 mg of simvastatin, oral simvastatin at 5, 10 or 50 mg kg(-1) day(-1) for 20 days, local delivery of 1 or 10 microg of rhBMP2, or control. At 6 weeks rhBMP2 increased serum tartrate-resistant acid phosphatase 5b levels and reduced betaTCP area fraction, particle size and number compared with control, suggesting increased osteoclast activity. There was reduced stiffness and increased mechanical strength with this treatment. Local simvastatin resulted in a decreased mineral apposition rate at 6 weeks and increased fibrous area fraction, betaTCP area fraction, particle size and number at 26 weeks. Oral simvastatin had no effect compared with control. Local application of rhBMP2 increased resorption and improved mechanical strength whereas simvastatin was detrimental to healing. Oral simvastatin was ineffective at promoting either ceramic resorption or bone formation. The effect of statins on the repair of bone defects with graft substitute materials is influenced by its bioavailability. Thus, further studies on the optimal delivery system are needed.

Histological and histomorphometric investigations on bone integration of rapidly resorbable calcium phosphate ceramics

Resorbable ceramics can promote the bony integration of implants. Their rate of degradation should ideally be synchronized with bone regeneration. We report here the results of a histological study of implants with two resorbable calcium phosphate ceramic coatings: Ca(2)KNa(PO(4))(2)-(GB14) and Ca(10)[K/Na](PO(4))(7)-(602020). The results attained with these ceramic-coated implants show the benefits of these materials with regard to bioactive bone-healing stimulation, compared with uncoated implants. The GB14 ceramic coating exhibited greater bone regeneration and differentiation on its surface than the conventional hydroxyapatite coating and helped bone tissue achieve more extensive contact free of connective tissue. Not until the coating disintegrated did the histological features of GB14- and 602020-coated implants converge-both implant types were integrated into bone. Rapid disintegration of the coating material, as with 602020, supports osteoblast proliferation but has negative effects on bone mineralization. Both resorbable ceramics tested, GB14 and 602020, demonstrated bioactivity; even metal surfaces coated with these materials were populated by mature bone tissue without connective tissue after disintegration of their ceramic coating. The less rapidly degrading material, GB14, achieved better results. Degradable calcium phosphate coatings have the potential to stimulate bone regeneration. From the histological viewpoint, the resorbable ceramics examined here can be recommended as coating materials for clinical use.

[Morphological study of biocompatibility of the material on the bases of bone collagen saturated by sulphated glycosaminoglycans]

Results of the experimental study of material on the bases of bone undemineralized collagen saturated by sulphated glycosaminoglycans are described in the article. It was done in the experiment evaluation of its biocompatibility with surrounding tissues of the experimental animals. On the grounds of the received data it can be concluded that such material implantation into the bone defects would favour quick cell migration into the defect and implant's vascularization, that in its turn would create preconditions for new bone tissue development.

Formation of osteoclast-like cells on HA and TCP ceramics

An essential property of bone substitute materials is that they are integrated into the natural bone remodelling process, which involves the resorption by osteoclast cells and the formation by osteoblast cells. If monocyte cells adhere to a calcium phosphate surface (bone or bone substitute material), they can fuse together and form multinucleated osteoclast cells. In this study we show that osteoclast-like cells derived from a human leukoma monocytic lineage responded in a different way to tricalciumphosphate (TCP) than to hydroxyapatite (HA) ceramics. Both ceramics were degraded by resorbing cells; however, HA enhanced the formation of giant cells. The osteoclast-like cells on HA formed a more pronounced actin ring, and larger lacunas could be observed. TCP ceramics are medically used as bone substitute materials because of their high dissolution rate. On the other hand, highly soluble calcium phosphate ceramics like TCP seem to be inappropriate for osteoclast resorption because they produce a high calcium concentration in the osteoclast interface and in the environment.

Immunohistochemical in situ characterization of orthopedic implants on polymethyl metacrylate embedded cutting and grinding sections

When investigating the tissue reaction on orthopedic implants, the cellular activity at the bone-implant interface is of special interest. Preparation of undecalcified bone sections with methylmetacrylate (MMA)-based resins allows evaluation of the host tissue reactions with the implant in situ. However, the technical workup is demanding and few reports exist on the immunohistochemical characterization of these sections. Rat (R), sheep (S), and human (H) samples were investigated. R specimens contained intramedullary rods in the rat tibia. S specimens were sheep tibiae with an external fixator. H specimens were obtained from deceased patients. Specimens were embedded in MMA-based Technovit 9100N using cold polymerization. Sections of 10-15 microm thickness were obtained and prepared for immunohistochemical staining. Good morphological detail was preserved in all specimens providing information about mineralization, recent bone formation, and bone-implant contact. The following antibodies could reproducibly be detected specifically: Osteopontin (R, S, H), Osteonectin, Cathepsin D (R, S), von Willebrand factor (R, H), Osteocalcin, ED 1 (R), CD 3, CD 68, Keratin (H). Control procedures without adding primary antibodies showed no unspecific staining. Reliable detection of immunohistochemical markers of bone resorption, bone formation, inflammation, and angiogenesis at undecalcified sections with the implant in situ appears promising in enhancing our understanding of the cellular activity and cell-matrix interactions at the bone-implant interface.

Molded vascularized neo-ossicle formation in silicone chambers

Vascularized bone grafts generally achieve their aims but are not used frequently owing to donor site morbidity and limited supply. To bioengineer an alternate vascularized bone graft, we developed a novel silicone bone reactor capable of producing vascularized neo-ossicles when appropriate osteoprecursor elements are included in the implanted chambers. Requirements for ossicle production were assessed in the model, including osteoprogenitor cells (donor bone marrow), osteoinductive signals (rhBMP2 or demineralized bone matrix), and osteoconductive matrix (Collagraft). Ossicle production required patency of the vascular pedicle, and for samples not containing cancellous isograft, donor marrow viability and an osteoinductive signal. Ossicles were produced without the need for an implanted osteoinductive matrix. Bone production and maturation time course were similar in chambers containing cancellous isograft, marrow/rhBMP2, and marrow/demineralized bone matrix. The demineralized bone matrix group had delayed early bone production, and the rhBMP2 group had lower final bone area. All groups had central osteolysis in the vascularized neo-ossicles. We believe the approach is promising for selected applications.

Lateral alveolar ridge augmentation using a synthetic nano-crystalline hydroxyapatite bone substitution material (Ostim®). Preliminary clinical and histological results

OBJECTIVES

The purpose of this preliminary two-center clinical prospective study was to evaluate the tissue composition of augmented sites after the use of a nano-crystalline hydroxyapatite (ncHA) bone substitution material by clinical and histological examinations.

MATERIAL AND METHODS

A synthetic ncHA augmentation material was used without any additives in 14 patients requiring lateral ridge augmentation 6-7 months before (10 patients) or at implant placement (four patients). The ncHA material was covered by a titanium mesh for space maintenance. Clinical and radiographic parameters were evaluated and bone biopsy cores, obtained 6-7 months following augmentation, were assessed histologically and histomorphometrically.

RESULTS

One patient showed gingival swelling, redness and pain at the augmentation site requiring removal of the titanium mesh 6 weeks postoperatively. In seven patients, a premature exposure of the titanium mesh without any inflammatory symptoms was noted. The width of the fixed gingival and the alveolar ridge height did not change significantly at least 6 months following augmentation (P>0.5), whereas a significant gain in alveolar ridge width (P=0.01) was noted. After a median period of prosthetic loading of 24 months, no implant was considered to be a failure. Histology revealed ncHA remnants in peripheral and central parts of biopsy cores obtained from seven patients after at least 6 months without histological symptoms of inflammation, whereas histomorphometry of bone cores revealed no significant differences of the mean percentage area of ncHA in peripheral (23.4%) and central (15.1%) parts of biopsy cores (P=0.262). The mean percentage area of bone colonizing the defect was 52.3%.

CONCLUSIONS

Small amounts of ncHA were found after at least 6 months in bone biopsies. The former defect space was filled with bone. The alveolar ridge width gain was found to be significant after lateral augmentation utilizing ncHA, providing a quantitatively and qualitatively sufficient site for primary stable implant placement.

Repair of critical size defects in the rat cranium using ceramic-reinforced PLA scaffolds obtained by supercritical gas foaming

Bioresorbable scaffolds made of poly(L-lactic acid) (PLA) obtained by supercritical gas foaming were recently described as suitable for tissue engineering, portraying biocompatibility with primary osteoblasts in vitro and interesting mechanical properties when reinforced with ceramics. The behavior of such constructs remained to be evaluated in vivo and therefore the present study was undertaken to compare different PLA/ceramic composite scaffolds obtained by supercritical gas foaming in a critical size defect craniotomy model in Sprague-Dawley rats. The host-tissue reaction to the implants was evaluated semiquantitatively and similar tendencies were noted for all graft substitutes: initially highly reactive but decreasing with time implanted. Complete bone-bridging was observed 18 weeks after implantation with PLA/ 5 wt % beta-TCP (PLA/TCP) and PLA/5 wt % HA (PLA/HA) scaffolds as assessed by histology and radiography. We show here for the first time that this solvent-free technique provides a promising approach in tissue engineering demonstrating both the biocompatibility and osteoconductivity of the processed structures in vivo.

Cell morphology, markers, spreading, and proliferation on orthopaedic biomaterials. An innovative cellular model for the "in vitro" study

The aims of tissue engineering are the in vitro reconstruction of functionally active tissues, and the in vivo induction of their appropriate development. The great progresses in the fields of biology and biomaterials represent key events, which allowed the recent improvement of tissue engineering. In the orthopaedic perspective, tissue engineering is focused on the development of innovative materials, whose action consists in recruiting bone progenitor cells and in stimulating their proliferation. In this context, it should remind that these materials should not only allow cells adhesion and proliferation, but also ensure that attached cells maintain the cellular properties of the original tissue. In this study, a new cellular model, suitable for the rapid in vitro determination of the above parameters, is presented. The cell model derives from a human osteosarcoma cell line, Saos-2, which maintained the cytological features of the osteoblast cells. The cell line was genetically modified to express constitutively the enhanced green fluorescent protein. The engineered cell line Saos-eGFP represents a suitable in vitro mode for studying the biocompatibility, the cell adhesion, spreading, and proliferation on biomaterials developed for clinical applications.

In vitro degradation characteristics of photocrosslinked anhydride systems for bone augmentation applications

In the past decade, injectable biomaterials that are capable of in situ formation have garnered increased interest for use in restorative orthopedic procedures. In this study, the in vitro degradation of photocrosslinked polyanhydride matrices, derived from methacrylic anhydrides of 1,6-bis(p-carboxyphenoxy)hexane (MCPH) and sebacic acid (MSA) were evaluated over a 6-week period under physiological conditions. These matrices were augmented with two additives--the reactive diluent poly(ethylene glycol) diacrylate (PEGDA) and the buffering agent calcium carbonate (CaCO3). Disk shaped specimens were produced by crosslinking the components using both chemical and photoinitiators and exposure to visible light. The experimental variables studied included: MCPH:MSA ratio, PEGDA molecular weight and weight fraction, and incorporation of CaCO3. The effects of these variables on local pH, water uptake, mass loss, and mechanical properties were explored. Increasing the MCPH:MSA ratio decreased the mass loss and water uptake at predetermined endpoints, and decreased buffer acidity during degradation. Both PEGDA and CaCO3 were found to decrease acidity and to reduce water uptake during degradation. Incorporation of CaCO3 enabled maintenance of compressive modulus during degradation. These results demonstrate that incorporation of reactive diluents and nonreactive additives into networks of photocrosslinked anhydrides can improve system properties as a material for bone replacement.

Interaction of a blood coagulation factor on electrically polarized hydroxyapatite surfaces

Although the polarization treatment of hydroxyapatite (HA) remarkably enhances the osteoconductivity, the mechanisms have not yet been completely understood. The interaction of proteins in blood and tissue fluids with biomaterials are reportedly triggers for later cellular responses and played a major role in osteoconductive processes. Considering this, we disclosed the interaction of polarized HA surface with a coagulation factor, fibrin stabilizing factor XIII (FXIII). The HA activated FXIII even in Ca2+ free buffer, based on the SDS-PAGE detections of alpha-polymer and gamma-dimer bands assigned to stabilized fibrin. The Ca2+ ions, possibly released from the HA surfaces, were examined whether they initiate the activation of the FXIII. It was experimentally proved by ICP analysis that the induced large negative charges on the electrically polarized HA significantly increased the released Ca2+ concentration for the short pre-incubation time of 3 min. The more Ca2+ ions released from the negatively charged HA (N-HA) surfaces were more effective in the activation of the FXIII, resulting in the rapider disappearance of the gamma-chain bands in fibrin. The slightly lower Ca2+ concentration in the positively charged HA, compared to the nonpolarized HA activated the FXIII at an almost equal rate. The accelerated activation contributed to the stabilization of fibrin scaffold. Therefore, the polarity difference of the induced charges of the polarized HA surface altered the rate of the FXIII activation. The early stage interaction of the HA surfaces with blood proteins was considered to be an essential process of the accelerated new bone formation near implanted N-HA surface.