In vivo degradation performance of micro-arc-oxidized magnesium implants: a micro-CT study in rats

Osteointegration of Porous Poly-ε-Caprolactone-Coated and Previtalised Magnesium Implants in Critically Sized Calvarial Bone Defects in the Mouse Model

Metallic biomaterials are widely used in maxillofacial surgery. While titanium is presumed to be the gold standard, magnesium-based implants are a current topic of interest and investigation due to their biocompatible, osteoconductive and degradable properties. This study investigates the effects of poly-ε-caprolactone-coated and previtalised magnesium implants on osteointegration within murine calvarial bone defects: After setting a 3 mm × 3 mm defect into the calvaria of 40 BALB/c mice the animals were treated with poly-ε-caprolactone-coated porous magnesium implants (without previtalisation or previtalised with either osteoblasts or adipose derived mesenchymal stem cells), porous Ti6Al4V implants or without any implant. To evaluate bone formation and implant degradation, micro-computertomographic scans were performed at day 0, 28, 56 and 84 after surgery. Additionally, histological thin sections were prepared and evaluated histomorphometrically. The outcomes revealed no significant differences within the differently treated groups regarding bone formation and the amount of osteoid. While the implant degradation resulted in implant shifting, both implant geometry and previtalisation appeared to have positive effects on vascularisation. Although adjustments in degradation behaviour and implant fixation are indicated, this study still considers magnesium as a promising alternative to titanium-based implants in maxillofacial surgery in future.

Quantifying the degradation of degradable implants and bone formation in the femoral condyle using micro-CT 3D reconstruction

Degradation limits the application of magnesium alloys, and evaluation methods for non-traumatic in vivo quantification of implant degradation and bone formation are imperfect. In the present study, a micro-arc-oxidized AZ31 magnesium alloy was used to evaluate the degradation of implants and new bone formation in 60 male New Zealand white rabbits. Degradation was monitored by weighing the implants prior to and following implantation, and by performing micro-computed tomography (CT) scans and histological analysis after 1, 4, 12, 24, 36, and 48 weeks of implantation. The results indicated that the implants underwent slow degradation in the first 4 weeks, with negligible degradation in the first week, followed by significantly increased degradation during weeks 12–24 (P<0.05), and continued degradation until the end of the 48-week experimental period. The magnesium content decreased as the implant degraded (P<0.05); however, the density of the material exhibited almost no change. Micro-CT results also demonstrated that pin volume, pin mineral density, mean ‘pin thickness’, bone surface/bone volume and trabecular separation decreased over time (P<0.05), and that the pin surface area/pin volume, bone volume fraction, trabecular thickness, trabecular number and tissue mineral density increased over time (P<0.05), indicating that the number of bones and density of new bone increased as magnesium degraded. These results support the positive effect of magnesium on osteogenesis. However, from the maximum inner diameter of the new bone loop and diameter of the pin in the same position, the magnesium alloy was not capable of creating sufficient bridges between the bones and biomaterials when there were preexisting gaps. Histological analyses indicated that there were no inflammatory responses around the implants. The results of the present study indicate that a micro-arc-oxidized AZ31 magnesium alloy is safe in vivo and efficiently degraded. Furthermore, the novel bone formation increased as the implant degraded. The findings concluded that micro-CT, which is useful for providing non-traumatic, in vivo, quantitative and precise data, has great value for exploring the degradation of implants and novel bone formation.

Surface modification of valve metals using plasma electrolytic oxidation for antibacterial applications: A review

Plasma electrolytic oxidation (PEO) is an advance technique to develop porous oxidation layer on light metals, primarily to enhance corrosion and wear resistance. The oxidation layer can also offer a wide variety of mechanical, biomedical, tribological, and antibacterial properties through the incorporation of several ions and particles. Due to the increasing need of antimicrobial surfaces for biomedical implants, antibacterial PEO coatings have been developed through the incorporation of antibacterial agents. Metallic nanoparticles that have been employed most widely as antibacterial agents are reported to demonstrate serious health and environmental threats. To overcome the current limitations of these coatings, there is a significant need to develop antibacterial surfaces that are not harmful for patient's health and environment. Attention of the readers has been directed to utilize bioactive glasses as antibacterial agents for PEO coatings. Bioactive glasses are well known for their excellent bioactivity, biocompatibility, and antibacterial character. PEO coatings incorporated with bioactive glasses can provide environment-friendly antimicrobial surfaces with exceptional bioactivity, biocompatibility, and osseointegration. © 2017 Wiley Periodicals, Inc. J Biomed Mater Res Part A: 106A: 590-605, 2018.

Biocompatibility and Biocorrosion of Hydroxyapatite-Coated Magnesium Plate: Animal Experiment

Magnesium (Mg) has the advantage of being resorbed in vivo, but its resorption rate is difficult to control. With uncontrolled resorption, Magnesium as a bone fixation material has minimal clinical value. During resorption not only is the strength rapidly weakened, but rapid formation of metabolite also occurs. In order to overcome these disadvantages, hydroxyapatite (HA) surface coating of pure magnesium plate was attempted in this study. Magnesium plates were inserted above the frontal bone of Sprague-Dawley rats in both the control group (Bare-Mg group) and the experimental group (HA-Mg group). The presence of inflammation, infection, hydrogen gas formation, wound dehiscence, and/or plate exposure was observed, blood tests were performed, and the resorption rate and tensile strength of the retrieved metal plates were measured. The HA-Mg group showed no gas formation or plate exposure until week 12. However, the Bare-Mg group showed consistent gas formation and plate exposure beginning in week 2. WBC (White Blood Cell), BUN (Blood Urea Nitrogen), Creatinine, and serum magnesium concentration levels were within normal range in both groups. AST (Aspartate Aminotransferase) and ALT (Alanine Aminotransferase) values, however, were above normal range in some animals of both groups. The HA-Mg group showed statistically significant advantage in resistance to degradation compared to the Bare-Mg group in weeks 2, 4, 6, 8, and 12. Degradation of HA-Mg plates proceeded after week 12. Coating magnesium plates with hydroxyapatite may be a viable method to maintain their strength long enough to allow bony healing and to control the resorption rate during the initial period.

Corrosion resistance and bioactivity enhancement of MAO coated Mg alloy depending on the time of hydrothermal treatment in Ca-EDTA solution

In this study, a two-step surface treatment was developed to restrain the rapid primary degradation of a biodegradable Mg alloy and to improve their biocompatibility. Micro arc oxidation (MAO) coating was performed in alkaline electrolytes such as 1.0 M NaOH with 0.1 M glycerol and 0.1 M Na3PO4. Hydrothermal treatment was performed in 0.1 M Ca-EDTA (C10H12CaN2Na2O8) and 0.5 M NaOH solution at 90 °C for different times (6, 12, 24, and 48 h). The film morphology and chemical properties were evaluated by XRD and FE-SEM. The electrochemical and corrosion behaviors were examined in the simulated body fluid, and cytotoxicity was assessed using MC3T3-E1 cells. After MAO coating, an oxide layer containing [Formula: see text] formed on the surface. During the hydrothermal treatment in Ca-EDTA solution, calcium phosphate and Mg(OH)2 were produced via a reaction between [Formula: see text] on the surface and Ca2+ in solution. The layer with ceramics and oxides was grown on the surface with increasing hydrothermal treatment time, and improved the surface corrosion resistance. The 24 h hydrothermal-treated group showed the lowest immersion corrosion rate and high cell viability. Therefore, this treatment was the most favorable surface modification for improving the initial corrosion resistance and bioactivity of the biodegradable Mg alloy.

The potential of isotopically enriched magnesium to study bone implant degradation in vivo

This pilot study highlights the substantial potential of using isotopically enriched (non-radioactive) metals to study the fate of biodegradable metal implants. It was possible to show that magnesium (Mg) release can be observed by combining isotopic mass spectrometry and isotopic pattern deconvolution for data reduction, even at low amounts of Mg released a from slowly degrading ²⁶Mg enriched (>99%) Mg metal. Following implantation into rats, structural in vivo changes were monitored by μCT. Results showed that the applied Mg had an average degradation rate of 16±5μmyear^-1, which corresponds with the degradation rate of pure Mg. Bone and tissue extraction was performed 4, 24, and 52weeks after implantation. Bone cross sections were analyzed by laser ablation inductively coupled plasma mass spectrometry (ICP-MS) to determine the lateral ²⁶Mg distribution. The ²⁶Mg/²⁴Mg ratios in digested tissue and excretion samples were analyzed by multi collector ICP-MS. Isotope pattern deconvolution in combination with ICP-MS enabled detection of Mg pin material in amounts as low as 200ppm in bone tissues and 20ppm in tissues up to two fold increased Mg levels with a contribution of pin-derived Mg of up to 75% (4weeks) and 30% (24weeks) were found adjacent to the implant. After complete degradation, no visual bone disturbance or residual pin-Mg could be detected in cortical bone. In organs, increased Δ²⁶Mg/²⁴Mg values up to 16‰ were determined compared to control samples. Increased Δ²⁶Mg/²⁴Mg values were detected in serum samples at a constant total Mg level. In contrast to urine, feces did not show a shift in the ²⁶Mg/²⁴Mg ratios. This investigation showed that the organism is capable of handling excess Mg well and that bones fully recover after degradation.

STATEMENT OF SIGNIFICANCE

Magnesium alloys as bone implants have faced increasing attention over the past years. In vivo degradation and metabolism studies of these implant materials have shown the promising application in orthopaedic trauma surgery. With advance in Mg research it has become increasingly important to monitor the fate of the implant material in the organism. For the first time, the indispensible potential of isotopically enriched materials is documented by applying ²⁶Mg enriched Mg implants in an animal model. Therefore, the spatial distribution of pin-Mg in bone and the pin-Mg migration and excretion in the organism could be monitored to better understand metal degradation as well as Mg turn over and excretion.

Simultaneous monitoring of the drug release and antitumor effect of a novel drug delivery system-MWCNTs/DOX/TC

Monitoring drug release and therapeutic efficacy is crucial for developing drug delivery systems. Our preliminary study demonstrated that, as compared with pristine multiwalled carbon nanotubes (MWCNTs), transactivator of transcription (TAT)-chitosan functionalized MWCNTs (MWCNTs-TC) were a more promising candidate for drug delivery in cancer therapy. In the present study, a MWCNTs/TC-based drug delivery system was developed for an anticancer drug, doxorubicin (DOX). The drug loading and in vitro release profiles, cellular uptake and cytotoxicity were assessed. More importantly, the in vivo drug release and antitumor effect of MWCNTs/DOX/TC were evaluated by noninvasive fluorescence and bioluminescence imaging. It was demonstrated that MWCNTs/DOX/TC can be efficiently taken up by BEL-7402 hepatoma cells. The release of DOX from MWCNTs/DOX/TC was faster under lower pH condition, which was beneficial for intrcellular drug release. The in vivo release process of DOX and antitumor effect in animal model were monitored simultaneously by noninvasive fluorescence and luminescence imaging, which demonstrated the application potential of MWCNTs/DOX/TC for cancer therapy.

LSP/MAO composite bio-coating on AZ80 magnesium alloy for biomedical application

A composite bio-coating was fabricated on AZ80 magnesium (Mg) alloy by using micro-arc oxidation (MAO) under the pretreatment of laser shock peening (LSP) in order to improve the bio-corrosion resistance and the mechanical integrity. LSP treatment could induce grain refinement and compressive residual stress field on the surface of material. MAO bio-coating was grown in alkaline electrolyte with hydroxyapatite (HA, Ca₁₀(PO4)₆(OH)₂) to improve the biological properties of the material. The microstructure, element and phase composition for untreated based material (BM) and treated samples (LSP layer, MAO bio-coating and LSP/MAO composite bio-coating) were investigated by transmission electron microscopy (TEM), scanning electron microscope (SEM), energy dispersion spectroscopy (EDS) and X-ray diffraction (XRD). Electrochemical tests and slow strain rate tensile (SSRT) tests were used to evaluate the corrosion resistance and the stress corrosion susceptibility in simulated body fluid (SBF). The results indicated that LSP/MAO composite bio-coating can not only improve the corrosion resistance of Mg alloy substrate evidently but also increase the mechanical properties in SBF compared to LSP layer and MAO bio-coating. Mg alloy treated by LSP/MAO composite technique should be better suited as biodegradable orthopedic implants.

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

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

STATEMENT OF SIGNIFICANCE

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

Gadolinium accumulation in organs of Sprague-Dawley® rats after implantation of a biodegradable magnesium-gadolinium alloy

Biodegradable magnesium implants are under investigation because of their promising properties as medical devices. For enhancing the mechanical properties and the degradation resistance, rare earth elements are often used as alloying elements. In this study Mg10Gd pins were implanted into Sprague-Dawley® rats. The pin volume loss and a possible accumulation of magnesium and gadolinium in the rats' organs and blood were investigated in a long-term study over 36weeks. The results showed that Mg10Gd is a fast disintegrating material. Already 12weeks after implantation the alloy is fragmented to smaller particles, which can be found within the intramedullary cavity and the cortical bones. They disturbed the bone remodeling until the end of the study. The results concerning the elements' distribution in the animals' bodies were even more striking, since an accumulation of gadolinium could be observed in the investigated organs over the whole time span. The most affected tissue was the spleen, with up to 3240μgGd/kg wet mass, followed by the lung, liver and kidney (up to 1040, 685 and 207μgGd/kg). In the brain, muscle and heart, the gadolinium concentrations were much smaller (less than 20μg/kg), but an accumulation could still be detected. Interestingly, blood serum samples showed no accumulation of magnesium and gadolinium. This is the first time that an accumulation of gadolinium in animal organs was observed after the application of a gadolinium-containing degradable magnesium implant. These findings demonstrate the importance of future investigations concerning the distribution of the constituents of new biodegradable materials in the body, to ensure the patients' safety.

STATEMENT OF SIGNIFICANCE

In the last years, biodegradable Mg alloys are under investigation due to their promising properties as orthopaedic devices used for bone fracture stabilization. Gadolinium as Rare Earth Element enhances the mechanical properties of Mg-Gd alloys but its toxicity in humans is still questionable. Up to now, there is no study investigating the elements' metabolism of a REE-containing Magnesium alloy in an animal model. In this study, we examined the gadolinium distribution and accumulation in rat organs during the degradation of Mg10Gd. Our findings showed that Gd is accumulating in the animal organs, especially in spleen, liver and kidney. This study is of crucial benefit regarding a safe application of REE-containing Magnesium alloys in humans.

Magnesium alloys: A stony pathway from intensive research to clinical reality. Different test methods and approval-related considerations

The first degradable implant made of a magnesium alloy, a compression screw, was launched to the clinical market in March 2013. Many different complex considerations are required for the marketing authorization of degradable implant materials. This review gives an overview of existing and proposed standards for implant testing for marketing approval. Furthermore, different common in vitro and in vivo testing methods are discussed. In some cases, animal tests are inevitable to investigate the biological safety of a novel medical material. The choice of an appropriate animal model is as important as subsequent histological examination. Furthermore, this review focuses on the results of various mechanical tests to investigate the stability of implants for temporary use. All the above aspects are examined in the context of development and testing of magnesium-based biomaterials and their progress them from bench to bedside. A brief history of the first market launch of a magnesium-based degradable implant is given. © 2016 Wiley Periodicals, Inc. J Biomed Mater Res Part A: 105A: 329-347, 2017.

In vitro and in vivo evaluation of MgF2 coated AZ31 magnesium alloy porous scaffolds for bone regeneration

Porous magnesium scaffolds are attracting increasing attention because of their degradability and good mechanical property. In this work, a porous and degradable AZ31 magnesium alloy scaffold was fabricated using laser perforation technique. To enhance the corrosion resistance and cytocompatibility of the AZ31 scaffolds, a fluoride treatment was used to acquire the MgF₂ coating. Enhanced corrosion resistance was confirmed by immersion and electrochemical tests. Due to the protection provided by the MgF₂ coating, the magnesium release and pH increase resulting from the degradation of the FAZ31 scaffolds were controllable. Moreover, in vitro studies revealed that the MgF₂ coated AZ31 (FAZ31) scaffolds enhanced the proliferation and attachment of rat bone marrow stromal cells (rBMSCs) compared with the AZ31 scaffolds. In addition, our present data indicated that the extract of the FAZ31 scaffold could enhance the osteogenic differentiation of rBMSCs. To compare the in vivo bone regenerative capacity of the AZ31 and FAZ31 scaffolds, a rabbit femoral condyle defect model was used. Micro-computed tomography (micro-CT) and histological examination were performed to evaluate the degradation of the scaffolds and bone volume changes. In addition to the enhanced the corrosion resistance, the FAZ31 scaffolds were more biocompatible and induced significantly more new bone formation in vivo. Conversely, bone resorption was observed from the AZ31 scaffolds. These promising results suggest potential clinical applications of the fluoride pretreated AZ31 scaffold for bone tissue repair and regeneration.

Current status on clinical applications of magnesium-based orthopaedic implants: A review from clinical translational perspective

As a new generation of medical metallic material, magnesium (Mg) and its alloys with or without surface coating have attracted a great deal of attention due to its biodegradability and potential for avoiding a removal operation after the implant has fulfilled its function for surgical fixation of injured musculoskeletal tissues. Although a few clinical cases on Mg-based orthopaedic implants were reported more than a century ago, it was not until recently that clinical trials using these implants with improved physicochemical properties were carried out in Germany, China and Korea for bone fracture fixation. The promising results so far suggest a bright future for biodegradable Mg-based orthopaedic implants and would warrant large scale phase II/III studies. Given the increasing interest on this emerging biomaterials and intense effort to improve its properties for various clinical applications, this review covers the evolution, current strategies, and future perspectives in the development of Mg-based orthopaedic implants. We also highlight a few clinical cases performed in China that may be unfamiliar to the general orthopaedic community.

Effect of phosphate additives on the microstructure, bioactivity, and degradability of microarc oxidation coatings on Mg-Zn-Ca-Mn alloy

Calcium phosphate coatings were prepared on the surface of self-designed Mg-Zn-Ca-Mn alloy using microarc oxidization technology. To characterize the microstructures, cross-section morphologies, and compositions of the coatings, the authors used scanning electron microscopy equipped with an energy-disperse spectrometer, x-ray diffraction, and Fourier transform infrared spectroscopy. Potentiodynamic polarization in the simulated body fluid (SBF) was used to evaluate the corrosion behaviors of the samples. An SBF immersion test was used to evaluate the coating bioactivity and degradability. After the immersion tests, some bonelike apatite formed on the coating surfaces indicate that bioactivity of the coatings is excellent. The coating prepared in electrolyte containing (NaPO3)6 had slower degradation rate after immersion test for 21 days.

Long-term in vivo degradation behavior and near-implant distribution of resorbed elements for magnesium alloys WZ21 and ZX50

We report on the long-term effects of degrading magnesium implants on bone tissue in a growing rat skeleton using continuous in vivo micro-Computed Tomography, histological staining and Laser Ablation Inductively Coupled Plasma Mass Spectrometry (LA-ICP-MS). Two different magnesium alloys-one rapidly degrading (ZX50) and one slowly degrading (WZ21)-were used to evaluate the bone response and distribution of released Mg and Y ions in the femur of male Sprague-Dawley rats. Regardless of whether the alloy degrades rapidly or slowly, we found that bone recovers restitutio ad integrum after complete degradation of the magnesium implant. The degradation of the Mg alloys generates a significant increase in Mg concentration in the cortical bone near the remaining implant parts, but the Mg accumulation disappears after the implant degrades completely. The degradation of the Y-containing alloy WZ21 leads to Y enrichment in adjacent bone tissues and in newly formed bone inside the medullary space. Locally high Y concentrations suggest migration not only of Y ions but also of Y-containing intermetallic particles. However, after the full degradation of the implant the Y-enrichment disappears almost completely. Hydrogen gas formation and ion release during implant degradation did not harm bone regeneration in our samples.

STATEMENT OF SIGNIFICANCE

Magnesium is generally considered to be one of the most attractive base materials for biodegradable implants, and many magnesium alloys have been optimized to adjust implant degradation. Delayed degradation, however, generates prolonged presence in the organism with the risk of foreign body reactions. While most studies so far have only ranged from several weeks up to 12months, the present study provides data for complete implant degradation and bone regeneration until 24months, for two magnesium alloys (ZX50, WZ21) with different degradation characteristics. μCT monitoring, histological staining and LA-ICP-MS illustrate the distribution of the elements in the neighboring bony tissues during implant degradation, and reveal in particular high concentrations of the rare-earth element Yttrium.

In vivo assessment of a new multifunctional coating architecture for improved Mg alloy biocompatibility

Magnesium alloys are regarded as potential biodegradable load-bearing biomaterials for orthopedic applications due to their physico-chemical and biomechanical properties. However, their clinical applicability is restricted by their high degradation rate, which limits the physiological reconstruction of the neighbouring tissues. In this work, a multifunctional coating architecture was developed on an AZ31 alloy by conjoining an anodization process with the deposition of a polymeric-based layer consisting of polyether imine reinforced with hydroxyapatite nanoparticles, aiming at improved control of the corrosion activity and biological performance of the Mg substrate. Anodization and coating protocols were evaluated either independently or combined for corrosion resistance and biological behaviour, i.e. the irritation potential and angiogenic capability within a chicken chorioallantoic membrane assay, and bone tissue response following tibia implantation within a rabbit model. Electrochemical impedance spectroscopy (EIS) analysis showed that coated Mg constructs, particularly anodized plus coated with AZ31, exhibited excellent stability compared to the anodized alloy and, particularly, to the bare AZ31. Microtomographic evaluation of the implanted samples correlated with these degradation results. Mg constructs displayed a non-irritating behaviour, and were associated with high levels of vascular ingrowth. Bone ingrowth neighbouring the implanted constructs was observed for all samples, with coated and anodized plus coated samples presenting the highest bone formation. Gene expression analysis suggested that the enhanced bone tissue formation was associated with the boost in osteogenic activity through Runx2 upregulation, following the activation of PGC-1α/ERRα signaling. Overall, the developed multifunctional coatings appear to be a promising strategy to obtain safe and bioactive biodegradable Mg-based implants with potential applications within bone tissue.

Recent advances in research on magnesium alloys and magnesium–calcium phosphate composites as biodegradable implant materials

Magnesium alloys are modern biocompatible materials suitable for orthopaedic implants due to their biodegradability in biological environment. Many studies indicate that there is a high demand to design magnesium alloys with controllable in vivo corrosion rates and required mechanical properties. A solution to this challenge can be sought in the development of metal matrix composites based on magnesium alloys with addition of relevant alloying elements and bioceramic particles. In this study, the corrosion mechanisms along with corrosion protection methods in magnesium alloys are discussed. The recently developed magnesium alloys for biomedical applications are reviewed. Special attention is given to the newest research results in metal matrix composites composed of magnesium alloy matrix and calcium phosphates, especially hydroxyapatite or tricalcium phosphate, as the second phase with emphasis on the biodegradation behavior, microstructure and mechanical properties in view of potential application of these materials in bone implants.

Comparison study of different coatings on degradation performance and cell response of Mg-Sr alloy

To solve the problem of rapid degradation for magnesium-based implants, surface modification especially coating method is widely studied and showed the great potential for clinical application. However, as concerned to the further application and medical translation for biodegradable magnesium alloys, there are still lack of data and comparisons among different coatings on their degradation and biological properties. This work studied three commonly used coatings on Mg-Sr alloy, including micro-arc oxidation coating, electrodeposition coating and chemical conversion coating, and compared these coatings for requirements of favorable degradation and biological performances, how each of these coating systems has performed. Finally the mechanism for the discrepancy between these coatings is proposed. The results indicate that the micro-arc oxidation coating on Mg-Sr alloy exhibited the best corrosion resistance and cell response among these coatings, and is proved to be more suitable for the orthopedic application.

Biodegradable Mg-Cu alloys with enhanced osteogenesis, angiogenesis, and long-lasting antibacterial effects

A series of biodegradable Mg-Cu alloys is designed to induce osteogenesis, stimulate angiogenesis, and provide long-lasting antibacterial performance at the same time. The Mg-Cu alloys with precipitated Mg2Cu intermetallic phases exhibit accelerated degradation in the physiological environment due to galvanic corrosion and the alkaline environment combined with Cu release endows the Mg-Cu alloys with prolonged antibacterial effects. In addition to no cytotoxicity towards HUVECs and MC3T3-E1 cells, the Mg-Cu alloys, particularly Mg-0.03Cu, enhance the cell viability, alkaline phosphatase activity, matrix mineralization, collagen secretion, osteogenesis-related gene and protein expressions of MC3T3-E1 cells, cell proliferation, migration, endothelial tubule forming, angiogenesis-related gene, and protein expressions of HUVECs compared to pure Mg. The favorable osteogenesis and angiogenesis are believed to arise from the release of bioactive Mg and Cu ions into the biological environment and the biodegradable Mg-Cu alloys with osteogenesis, angiogenesis, and long-term antibacterial ability are very promising in orthopedic applications.

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

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

STATEMENT OF SIGNIFICANCE

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

In Vitro Corrosion and Cytocompatibility of a Microarc Oxidation Coating and Poly(L-lactic acid) Composite Coating on Mg-1Li-1Ca Alloy for Orthopedic Implants

Manipulating the degradation rate of biomedical magnesium alloys poses a challenge. The characteristics of a microarc oxidation (MAO), prepared in phytic acid, and poly(L-lactic acid) (PLLA) composite coating, fabricated on a novel Mg-1Li-1Ca alloy, were studied through field emission scanning electron microscopy (FE-SEM), electron probe X-ray microanalysis (EPMA), energy dispersive X-ray spectroscopy (EDS) and X-ray diffraction (XRD). The corrosion behaviors of the samples were evaluated via hydrogen evolution, potentiodynamic polarization and electrochemical impedance spectroscopy in Hanks' solution. The results indicated that the MAO/PLLA composite coatings significantly enhanced the corrosion resistance of the Mg-1Li-1Ca alloy. MTT and ALP assays using MC3T3 osteoblasts indicated that the MAO/PLLA coatings greatly improved the cytocompatibility, and the morphology of the cells cultured on different samples exhibited good adhesion. Hemolysis tests showed that the composite coatings endowed the Mg-1Li-1Ca alloys with a low hemolysis ratio. The increased solution pH resulting from the corrosion of magnesium could be tailored by the degradation of PLLA. The degradation mechanism of the composite coatings was discussed. The MAO/PLLA composite coating may be appropriate for applications on degradable Mg-based orthopedic implants.

In vivo degradation of binary magnesium alloys – a long-term study

Bioresorbable magnesium materials are widely investigated because of their promising properties as orthopedic devices. Pure magnesium (99.99%) and two binary magnesium alloys (Mg2Ag and Mg10Gd) were used to investigate the degradation behavior, the bone adherence and bone-implant interface mechanics of these materials in growing Sprague-Dawley

In vitro and in vivo comparison of binary Mg alloys and pure Mg

Biodegradable materials are under investigation due to their promising properties for biomedical applications as implant material. In the present study, two binary magnesium (Mg) alloys (Mg2Ag and Mg10Gd) and pure Mg (99.99%) were used in order to compare the degradation performance of the materials in in vitro to in vivo conditions. In vitro analysis of cell distribution and viability was performed on discs of pure Mg, Mg2Ag and Mg10Gd. The results verified viable pre-osteoblast cells on all three alloys and no obvious toxic effect within the first two weeks. The degradation rates in in vitro and in vivo conditions (Sprague-Dawley® rats) showed that the degradation rates differ especially in the 1st week of the experiments. While in vitro Mg2Ag displayed the fastest degradation rate, in vivo, Mg10Gd revealed the highest degradation rate. After four weeks of in vitro immersion tests, the degradation rate of Mg2Ag was significantly reduced and approached the values of pure Mg and Mg10Gd. Interestingly, after 4 weeks the estimated in vitro degradation rates approximate in vivo values. Our systematic experiment indicates that a correlation between in vitro and in vivo observations still has some limitations that have to be considered in order to perform representative in vitro experiments that display the in vivo situation.

Peri-implant tissue response and biodegradation performance of a Mg-1.0Ca-0.5Sr alloy in rat tibia

Biodegradable magnesium (Mg) alloys combine the advantages of traditional metallic implants and biodegradable polymers, having high strength, low density, and a stiffness ideal for bone fracture fixation. A recently developed Mg-Ca-Sr alloy potentially possesses advantageous characteristics over other Mg alloys, such as slower degradation rates and minimal toxicity. In this study, the biocompatibility of this Mg-Ca-Sr alloy was investigated in a rat pin-placement model. Cylindrical pins were inserted in the proximal tibial metaphyses in pre-drilled holes orthogonal to the tibial axis. Implant and bone morphologies were investigated using μCT at 1, 3, and 6 weeks after implant placement. At the same time points, the surrounding tissue was evaluated using H&E, TRAP and Goldner's trichrome staining. Although gas bubbles were observed around the degrading implant at early time points, the bone remained intact with no evidence of microfracture. Principle findings also include new bone formation in the area of the implant, suggesting that the alloy is a promising candidate for biodegradable orthopedic implants.

Examination of a biodegradable magnesium screw for the reconstruction of the anterior cruciate ligament: A pilot in vivo study in rabbits

The reconstruction of the anterior cruciate ligament is, for the most part, currently performed with interference screws made of titanium or degradable polymers. The aim of this study was to investigate the use of biodegradable magnesium interference screws for such a procedure because of their known biocompatibility and reported osteoconductive effects. The left tibiae of each of 18 rabbits were implanted with a magnesium-based (MgYREZr-alloy) screw, and another 18 with a titanium-based control. Each group was divided into observation periods of 4, 12 and 24weeks. After sacrifice, μCT scans were acquired to assess the amount of the gas liberated and the degradation rate of the implant. Histological evaluations were performed to investigate the local tissue response adjacent to the implant and to assess the status of the attachment between the tendon and the bone tissue. The μCT scans showed that liberation of gas was most prominent 4weeks after implantation and was significantly decreased by 24weeks. All screws remained in situ and formed a sufficient connection with the tendon and sufficient osseous integration at 24weeks. Histological evaluations showed neither inflammatory reactions nor necrosis of the tendon. The results of this pilot study in rabbits indicate that this magnesium-based interference screw should be considered as an alternative to conventional implant materials.

Optimized in vitro procedure for assessing the cytocompatibility of magnesium-based biomaterials

Magnesium (Mg) is a promising biomaterial for degradable implant applications that has been extensively studied in vitro and in vivo in recent years. In this study, we developed a procedure that allows an optimized and uniform in vitro assessment of the cytocompatibility of Mg-based materials while respecting the standard protocol DIN EN ISO 10993-5:2009. The mouse fibroblast line L-929 was chosen as the preferred assay cell line and MEM supplemented with 10% FCS, penicillin/streptomycin and 4mM l-glutamine as the favored assay medium. The procedure consists of (1) an indirect assessment of effects of soluble Mg corrosion products in material extracts and (2) a direct assessment of the surface compatibility in terms of cell attachment and cytotoxicity originating from active corrosion processes. The indirect assessment allows the quantification of cell-proliferation (BrdU-assay), viability (XTT-assay) as well as cytotoxicity (LDH-assay) of the mouse fibroblasts incubated with material extracts. Direct assessment visualizes cells attached to the test materials by means of live-dead staining. The colorimetric assays and the visual evaluation complement each other and the combination of both provides an optimized and simple procedure for assessing the cytocompatibility of Mg-based biomaterials in vitro.

Analysis of metallic traces from the biodegradation of endomedullary AZ31 alloy temporary implants in rat organs after long implantation times

AZ31 alloy has been tested as a biodegradable material in the form of endomedullary implants in female Wistar rat femurs. In order to evaluate the accumulation of potentially toxic elements from the biodegradation of the implant, magnesium (Mg), aluminium (Al), zinc (Zn), manganese (Mn) and fluorine (F) levels have been measured in different organs such as kidneys, liver, lungs, spleen and brain. Several factors that may influence accumulation have been taken into account: how long the implant has been in place, whether or not the bone is fractured, and the presence of an MgF2 protective coating on the implant. The main conclusions and the clinical relevance of the study have been that AZ31 endomedullary implants have a degradation rate of about 60% after 13 months, which is fully compatible with fracture consolidation. Neither bone fracture nor an MgF2 coating seems to influence the accumulation of trace elements in the studied organs. Aluminium is the only alloying element in this study that requires special attention. The increase in Al recovered from the sampled organs represents 3.95% of the amount contained in the AZ31 implant. Al accumulates in a statistically significant way in all the organs except the brain. All of this suggests that in long-term tests AZ31 may be a suitable material for osteosynthesis.

Bioeffects of micron-size magnesium particles on inflammatory cells and bone turnover in vivo and in vitro

Magnesium (Mg) is a promising biodegradable metal offering many potential advantages over current scaffold technologies. Many studies have reported on the corrosion characteristics the Mg and its bioeffects in vitro and in vivo, but there are few studies on the biological effects of the corrosive products of Mg - the micron-size Mg particles (MgMPs). In this study, the effects of size-selected commercial MgMPs on bone turnover and macrophages were investigated in vivo and in vitro. We found that MgMPs were susceptible to engulfment by macrophages, leading to cell lysis, likely resulting from H2 gas production. We also found that the inflammatory cytokines IL-1, IL-6, and TNF-α were induced more strongly by titanium particles (TiMPs) group than by either MgMPs or control. Examination of the expression of bone remodeling markers revealed that MgMPs are beneficial for bone regeneration. Micro-CT scanning indicated that, 30 days postimplantation, unlike TiMPs, MgMPs had no adverse effect on either bone quality or quantity. We have investigated the bioeffects of micron-size MgMPs in vivo and in vitro, and our results indicate that MgMPs may promote bone regeneration without inducing inflammation. © 2015 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater, 104B: 923-931, 2016.

Fracture bone healing and biodegradation of AZ31 implant in rats

The ideal temporary implant should offer enough mechanical support to allow healing of the fracture and then biodegrade and be resorbed by metabolic mechanisms without causing any toxic effect. The aim of this research has been to simultaneously study in situ bone healing and the biodegradation of AZ31 Mg alloy as an osteosynthesis material. The in vivo study was carried out in AZ31 implants with and without Mg-fluoride coating inserted in un-fractured and fractured femurs of Wistar rats for long experimentation time, from 1 to 13 months, by means of computed tomography, histological and histomorphometric analysis. Tomography analysis showed the bone healing and biodegradation of AZ31 implants. The fracture is healed in 100% of the animals, and AZ31 maintains its mechanical integrity throughout the healing process. Biodegradation was monitored, quantifying the evolution of gas over time by 3D composition of tomography images. In all the studied groups, gas pockets disappear with time as a result of the diffusion process through soft tissues. Histomorphometric studies reveal that after 13 months the 46.32% of AZ31 alloy has been resorbed. The resorption of the coated and uncoated AZ31 implants inserted in fractured femurs after 1, 9 and 13 months does not have statistically significant differences. There is a balance between the biodegradation of AZ31 and bone healing which allows the use of AZ31 to be proposed as an osteosynthesis material.

In vitro degradation behavior and cytocompatibility of biodegradable AZ31 alloy with PEO/HT composite coating

Biodegradable magnesium-based implants have attracted much attention recently in orthopedic applications because of their good mechanical properties and biocompatibility. However, their rapid degradation in vivo will not only reduce their mechanical strength, but also induce some side effects, such as local alkalization and gas cavity, which may lead to a failure of the implant. In this work, a hydroxyapatite (HA) layer was prepared on plasma electrolytic oxidization (PEO) coating by hydrothermal treatment (HT) to fabricate a PEO/HT composite coating on biodegradable AZ31 alloy. The in vitro degradation behaviors of all samples were evaluated in simulated body fluid (SBF) and their surface cytocompatibility was also investigated by evaluating the adhesion and proliferation of osteoblast cells (MC3T3-E1). The results showed that the HA layer consisted of a dense inner layer and a needle-like outer layer, which successfully sealed the PEO coating. The in vitro degradation tests showed that the PEO/HT composite coating improved the corrosion resistance of AZ31 alloy in SBF, presenting nearly no severe local alkalization and hydrogen evolution. The lasting corrosion resistance of the PEO/HT composite coating may attribute to the new hydroxyapatite formation during the degradation process. Moreover, compared with AZ31 alloy and PEO coating, PEO/HT composite coating was more suitable for cells adhesion and proliferation, indicating improved surface cytocompatibility. The results show that the PEO/HT composite coating is promising as protective coating on biodegradable magnesium-based implants to enhance their corrosion resistance as well as improve their surface cytocompatibility for orthopedic applications.

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

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

The biocompatibility of degradable magnesium interference screws: an experimental study with sheep

Screws for ligament reconstruction are nowadays mostly made of poly-L-lactide (PLLA). However, magnesium-based biomaterials are gathering increased interest in this research field because of their good mechanical property and osteoanabolic influence on bone metabolism. The aim of this pilot study was to evaluate the biocompatibility of an interference screw for ligament reconstruction made of magnesium alloy W4 by diecasting and milling and using different PEO-coatings with calcium phosphates. PLLA and titanium screws were used as control samples. The screws were implanted in the femur condyle of the hind leg of a merino sheep. The observation period was six and twelve weeks and one year. Histomorphometric, immunohistochemical, immunofluorescence, and molecular biological evaluation were conducted. Further TEM analysis was done. In all magnesium screws a clinically relevant gas formation in the vicinity of the biomaterial was observed. Except for the PLLA and titanium control samples, no screw was fully integrated in the surrounding bone tissue. Regarding the fabrication process, milling seems to produce less gas liberation and has a better influence on bone metabolism than diecasting. Coating by PEO with calcium phosphates could not reduce the initial gas liberation but rather reduced the bone metabolism in the vicinity of the biomaterial.

Absorbable magnesium-based stent: physiological factors to consider for in vitro degradation assessments

Absorbable metals have been widely tested in various in vitro settings using cells to evaluate their possible suitability as an implant material. However, there exists a gap between in vivo and in vitro test results for absorbable materials. A lot of traditional in vitro assessments for permanent materials are no longer applicable to absorbable metallic implants. A key step is to identify and test the relevant microenvironment and parameters in test systems, which should be adapted according to the specific application. New test methods are necessary to reduce the difference between in vivo and in vitro test results and provide more accurate information to better understand absorbable metallic implants. In this investigative review, we strive to summarize the latest test methods for characterizing absorbable magnesium-based stent for bioabsorption/biodegradation behavior in the mimicking vascular environments. Also, this article comprehensively discusses the direction of test standardization for absorbable stents to paint a more accurate picture of the in vivo condition around implants to determine the most important parameters and their dynamic interactions.

Engineering and functionalization of biomaterials via surface modification

Recent progress pertaining to the surface treatment of implantable macro-scale biomaterials and using micro- and nano-biomaterials for disease diagnosis and drug/gene delivery is reviewed.

Protoporphyrin incorporated alginate hydrogel: preparation, characterization and fluorescence imaging in vivo

A protoporphyrin incorporated alginate hydrogel exhibits the fluorescence ability to locate a drug and carrier with multispectral fluorescence imaging in vivo.

Testing the in vitro performance of hydroxyapatite coated magnesium (AZ91D) and titanium concerning cell adhesion and osteogenic differentiation

In the current study the in vitro outcome of a degradable magnesium alloy (AZ91D) and standard titanium modified by nanostructured-hydroxyapatite (n-HA) coatings concerning cell adhesion and osteogenic differentiation was investigated by direct cell culture. The n-HA modification was prepared via radio-frequency magnetron sputtering deposition and proven by field emission scanning electron microscopy and X-ray powder diffraction patterns revealing a homogenous surface coating. Human mesenchymal stem cell (hMSCs) adhesion was examined after one and 14 days displaying an enhanced initial cell adhesion on the n-HA modified samples. The osteogenic lineage commitment of the cells was determined by alkaline phosphatase (ALP) quantification. On day one n-HA coated AZ91D exhibited a comparable ALP expression to standard tissue culture polystyrene samples. However, after 14 days solely little DNA and ALP amounts were measurable on n-HA coated AZ91D due to the lack of adherent cells. Titanium displayed excellent cell adhesion properties and ALP was detectable after 14 days. An increased pH of the culture was measured for AZ91D as well as for n-HA coated AZ91D. We conclude that n-HA modification improves initial cell attachment on AZ91D within the first 24 h. However, the effect does not persist for 14 days in in vitro conditions.

Formation mechanism, degradation behavior, and cytocompatibility of a nanorod-shaped HA and pore-sealed MgO bilayer coating on magnesium

A novel bilayer coating (HT24h) was fabricated on magnesium using microarc oxidation (MAO) and hydrothermal treatment (HT). The coating comprises an outer layer of narrow interrod spaced hydroxyapatite (HA) nanorods and an inner layer of MgO containing Mg(OH)2/HA-sealing-pores. The hydrothermal formation mechanism of HA nanorods on MAO-formed MgO was explored. Also, evolution of structure and bonding integrity of HT24h coating with immersion in physiological saline (PS) for 0-90 days, corrosion resistance and cytocompatibility of the coating were investigated, together with MgO containing Mg(OH)2-sealing-pores (HT2h) and porous MgO (MAO) coatings. Corrosion resistance was identified by three-point bending and electrochemical tests in PS, while cytocompatibility was determined by MTT, live/dead staining, and vinculin-actin-nucleus tricolor staining assays of hFOB1.19 cells. Immersion tests indicate that cracking rather than delamination is a common feature in most areas of the coatings up to day 90 and degradation is the reason for thinning in thickness of the coatings. MAO and HT2h coatings exhibit a significant thinning due to fast degradation of MgO. However, HT24h coating shows a quite small thinning, owing to the fact that the HA nanorods underwent quite slow degradation while the underlying MgO only underwent conversion to Mg(OH)2 without dissolution of the Mg(OH)2. Scratch tests reveal that HT24h coating still retains relatively high bonding integrity, although the failure position changes from the MgO interior to a point between the HA and MgO layers after 90 days of immersion. HT24h coating appears far more effective than MAO and HT2h coatings in reducing degradation and maintaining the mechanical integrity of Mg, as well as enhancing the mitochondrial activity, adhesion, and proliferation of osteoblasts.

Loss of mechanical properties in vivo and bone-implant interface strength of AZ31B magnesium alloy screws with Si-containing coating

In this study the loss of mechanical properties and the interface strength of coated AZ31B magnesium alloy (a magnesium-aluminum alloy) screws with surrounding host tissues were investigated and compared with non-coated AZ31B, degradable polymer and biostable titanium alloy screws in a rabbit animal model after 1, 4, 12 and 21weeks of implantation. The interface strength was evaluated in terms of the extraction torque required to back out the screws. The loss of mechanical properties over time was indicated by one-point bending load loss of the screws after these were extracted at different times. AZ31B samples with a silicon-containing coating had a decreased degradation rate and improved biological properties. The extraction torque of Ti6Al4V, poly-l-lactide (PLLA) and coated AZ31B increased significantly from 1week to 4weeks post-implantation, indicating a rapid osteosynthesis process over 3weeks. The extraction torque of coated AZ31B increased with implantation time, and was higher than that of PLLA after 4weeks of implantation, equalling that of Ti6Al4V at 12weeks and was higher at 21weeks. The bending loads of non-coated AZ31B and PLLA screws degraded sharply after implantation, and that of coated AZ31B degraded more slowly. The biodegradation mechanism, the coating to control the degradation rate and the bioactivity of magnesium alloys influencing the mechanical properties loss over time and bone-implant interface strength are discussed in this study and it is concluded that a suitable degradation rate will result in an improvement in the mechanical performance of magnesium alloys, making them more suitable for clinical application.