Stimulation of bone growth following zinc incorporation into biomaterials

Graphene Family Materials in Bone Tissue Regeneration: Perspectives and Challenges

We have witnessed abundant breakthroughs in research on the bio-applications of graphene family materials in current years. Owing to their nanoscale size, large specific surface area, photoluminescence properties, and antibacterial activity, graphene family materials possess huge potential for bone tissue engineering, drug/gene delivery, and biological sensing/imaging applications. In this review, we retrospect recent progress and achievements in graphene research, as well as critically analyze and discuss the bio-safety and feasibility of various biomedical applications of graphene family materials for bone tissue regeneration.

How cellular Zn2+ signaling drives physiological functions

Zinc is an essential micronutrient affecting many aspects of human health. Cellular Zn²⁺ homeostasis is critical for cell function and survival. Zn²⁺, acting as a first or second messenger, triggers signaling pathways that mediate the physiological roles of Zn²⁺. Transient changes in Zn²⁺ concentrations within the cell or in the extracellular region occur following its release from Zn²⁺ binding metallothioneins, its transport across membranes by the ZnT or ZIP transporters, or release of vesicular Zn²⁺. These transients activate a distinct Zn²⁺ sensing receptor, ZnR/GPR39, or modulate numerous proteins and signaling pathways. Importantly, Zn²⁺ signaling regulates cellular physiological functions such as: proliferation, differentiation, ion transport and secretion. Indeed, novel therapeutic approaches aimed to maintain Zn²⁺ homeostasis and signaling are evolving. This review focuses on recent findings describing roles of Zn²⁺ and its transporters in regulating physiological or pathological processes.

Enhanced cellular osteogenic differentiation on Zn-containing bioglass incorporated TiO2 nanorod films

Surface nanotopography and bioactive ions have been considered to play critical roles on the interactions of biomaterials with cells. In this study, a TiO₂ nanorod film incorporated with Zn-containing bioactive glass (TiO₂/Zn-BG) was prepared on tantalum substrate, trying to evaluate the synergistic effects of nanotopograpgy and bioactive ions to promote cellular osteogenic differentiation activity. The expression of osteogenic-related genes, ALP as well as the ECM mineralization on TiO₂/Zn-BG film were significantly upregulated compared to that of the film without TiO₂ nanorod nanostructure (Zn-BG) or without Zn (TiO₂/BG). Moreover, a much low Zn²⁺ release level on TiO₂/Zn-BG film was beneficial to promote the osteogenesis, which could be ascribed to that a semi-closed space established by TiO₂ nanorods with adhered cells provided an appropriate micro-environment that facilitated Zn²⁺ adsorption.

Synergistic effects of titania nanotubes and silicon to enhance the osteogenic activity

In this study, titania nanotubes (TNTs) incorporating silicon (Si) were formed on Ti disks using anodization and electron beam evaporation (EBE) technology to improve the osteogenic activity. The amount of Si was exquisitely adjusted by controlling the duration of EBE to optimize the biofunctionality. As the Si was incorporated, the samples exhibited hydrophilic surfaces. Long lasting and controllable Si release was observed from the EBE-modified samples without cytotoxicity. Moreover, initial cell adhesion, spreading, proliferation and osteogenic differentiation of MC3T3-E1 cells were evaluated. The results showed a notable enhancement of spreading, osteogenesis and differentiation of cells on silicon-coated TNTs (Si-TNTs). In particular, samples with highest amount of silicon (∼5.93% Si) displayed greatest augmentation of ALP activity, osteogenic-related gene expression and mineralization compared to the others in the present study. It was indicated that the modification with TNTs and appropriated Si content resulted in enhanced osteoblastic spreading, proliferation and differentiation, and therefore has the potential for future applications in the field of orthopedics.

Comparison Study of Bone Defect Healing Effect of Raw and Processed Pyritum in Rats

To evaluate and compare the effect of raw and processed pyritum on tibial defect healing, 32 male Sprague Dawley rats were randomly divided into four groups. After tibial defect, animals were produced and grouped: sham and control group were orally administrated with distilled water (1 mL/100 g), while treatment groups were given aqueous extracts of raw and processed pyritum (1.5 g/kg) for successive 42 days. Radiographic examination showed that bone defect healing effect of the treatment groups was obviously superior compared to that of the control group. Bone mineral density of whole tibia was increased significantly after treating with pyritum. Inductively coupled plasma-optical emission spectrometry showed that the contents of Ca, P, and Mg in callus significantly increased in the treatment groups comparing with the control. Moreover, serological analysis showed that the concentration of serum phosphorus of the treatment groups significantly increased compared with that of the control group. By in vitro study, we have evaluated the effects of drug-containing serum of raw and processed pyritum on osteoblasts. It was manifested that both the drug-containing sera of raw and processed pyritum significantly increased the mRNA levels of alkaline phosphatase and collagen type I. Protein levels of phosphorylated Smad2/3 also increased. The mRNA levels of osteocalcin and transforming growth factor β (TGF-β) type I and II receptors, as well as the protein levels of TGF-β1 in the processed groups, were higher than those in the control. In summary, both raw and processed pyritum-containing sera exhibited positive effects on osteoblasts, which maybe via the TGF-β1/Smad signaling pathway. Notably, the tibia defect healing effect of pyritum was significantly enhanced after processing.

N-halamine-based multilayers on titanium substrates for antibacterial application

Bacterial infection is one of the most severe postoperative complications leading to clinical orthopedic implants failure. To improve the antibacterial property of titanium (Ti) substrates, a bioactive coating composed of chitosan-1-(hydroxymethyl)- 5,5-dimethylhydantoin (Chi-HDH-Cl) and gelatin (Gel) was fabricated via layer-by-layer (LBL) assembly technique. The results of Fourier transform infrared spectroscopy (FTIR), nuclear magnetic resonance (¹HNMR) and X-ray photoelectron spectroscopy (XPS) showed that Chi-HHD-Cl conjugate was successfully synthesized. Scanning electron microscopy (SEM), atomic force microscope (AFM) and water contact angle measurements were employed to monitor the morphology, roughness changes and surface wettability of Ti substrates, which proved the multilayers coating formation. Antibacterial assay against Escherichia coli (E. coli) and Staphylococcus aureus (S. aureus) revealed that the Gel/Chi-HDH-Cl modified Ti substrates most efficiently inhibited the adhesion and growth of bacteria. Meanwhile, in vitro cellular tests confirmed that Gel/Chi-HDH-Cl multilayers had no obvious cytotoxicity to osteoblasts. The study thus provides a promising method to fabricate antibacterial Ti-based substrates for potential orthopedic application.

Potential anti-cancer and anti-Candida activity of Zn-derived foams

Zinc (Zn)-derived foams have been prepared from an alkaline electrolyte solution by galvanostatic electrodeposition under different conditions. A detailed physico-chemical characterization was performed by Raman spectroscopy, X-ray diffraction (XRD) and scanning electron microscopy (SEM). A pioneer application of these foams in medical implant-related applications was investigated. The in vitro behaviour of these Zn-derived foams in simulated physiological conditions was studied. The results revealed that the presence of zinc oxide was important enough to change the in vitro behaviour of these materials. The potential of these Zn-derived foams in inhibiting bone cancer cell proliferation - osteoscarcoma cells - and important pathogenic fungi responsible for implant-related infections -Candida albicans- was examined. Furthermore, the foams were evaluated for cytocompatibility with normal human osteoblasts. The results obtained allowed us to conclude that Zn-derived foams have an interesting potential for anti-cancer and anti-Candida activity, targeted for bone-related implant applications, suggesting that this novel material may have potential for further clinical studies.

Citrate chemistry and biology for biomaterials design

Leveraging the multifunctional nature of citrate in chemistry and inspired by its important role in biological tissues, a class of highly versatile and functional citrate-based materials (CBBs) has been developed via facile and cost-effective polycondensation. CBBs exhibiting tunable mechanical properties and degradation rates, together with excellent biocompatibility and processability, have been successfully applied in vitro and in vivo for applications ranging from soft to hard tissue regeneration, as well as for nanomedicine designs. We summarize in the review, chemistry considerations for CBBs design to tune polymer properties and to introduce functionality with a focus on the most recent advances, biological functions of citrate in native tissues with the new notion of degradation products as cell modulator highlighted, and the applications of CBBs in wound healing, nanomedicine, orthopedic, cardiovascular, nerve and bladder tissue engineering. Given the expansive evidence for citrate's potential in biology and biomaterial science outlined in this review, it is expected that citrate based materials will continue to play an important role in regenerative engineering.

Long-term in vivo evolution of high-purity Mg screw degradation - Local and systemic effects of Mg degradation products

Magnesium (Mg) based materials are the focus of research for use as degradable materials in orthopedics and cranio-maxillofacial surgery. However, corrosion rate control and biosecurity are still the key issues that need to be solved prior to their clinical applications. In the present study, as-rolled high-purity magnesium (HP Mg, 99.99 wt%) screws were implanted in rabbit tibiae for up to 52 weeks in order to investigate their long-term in vivo degradation and the local and systemic effects of their degradation products. A series of long-term monitoring were performed at various time points (4w, 12w, 26w and 52w) after implantation using numerous investigations such as micro-CT assay, histomorphometric analysis, local micro-environment testing and biochemical analysis of serum and urine. It was revealed that HP Mg screws had a uniform degradation morphology and a slow degradation rate in vivo during the period of 52 weeks. Their degradation products not only increased the local pH values but also changed the local Mg²⁺ ions concentration and gas cavity area in the peri-implant tissues in a dynamic manner. More importantly, both the new bone formation and bone-implant contact rate were increased at bone-implant interfaces at 26 weeks and 52 weeks post-implantation. Furthermore, neither abnormal elevation of serum magnesium and urine magnesium level, nor liver and kidney dysfunction were detected during the monitoring period of 26 weeks. All these results of long-term investigation suggest that HP Mg screws possess a slow degradation rate, desirable bone repair capacity and long-term local/systemic biosafety, and consequently may have good potential for application as bone fixation devices.

STATEMENT OF SIGNIFICANCE

The corrosion resistance control and biosecurity issues of Mg alloys limited their clinical applications in some extent. Mg purification is another effective way to improve corrosion resistance of Mg-based materials. However, the long-term in vivo degradation of high-purity magnesium (HP Mg) and the local and systemic effects of its degradation products have not been fully investigated yet, which are the key factors to determine the clinical application prospect of HP Mg. Especially the changes in peri-implant microenvironment may greatly influence the local physiological response and bone repair. In this study, the long-term evolution tendency of in vivo degradation behavior of HP Mg screws was discovered from the view of space-time. Furthermore, not only the dynamic changes of local microenvironment and the long-term evolution process of bone repair, but also the dynamic systemic responses were systematically revealed. Conclusions of this study may help us to further understand the long-term in vivo evolution of HP Mg degradation and the local/systemic effects of its degradation products and help to guide the design of biodegradable bone fixation material.

In vitro and in vivo studies on zinc-hydroxyapatite composites as novel biodegradable metal matrix composite for orthopedic applications

Recent studies indicate that there is a great demand to optimize pure Zn with tunable degradation rates and more desirable biocompatibility as orthopedic implants. Metal matrix composite (MMC) can be a promising approach for this purpose. In this study, MMC with pure Zn as a matrix and hydroxyapatite (HA) as reinforcements were prepared by spark plasma sintering (SPS). Feasibility of novel Zn-HA composites to be used as orthopedic implant applications was systematically evaluated. After sintering, HA distributed in the Zn particle boundaries uniformly. Corrosion tests indicated that the degradation rates of Zn-HA composites were adjustable due to the biphasic effects of HA. Zn-HA composites showed significantly improved cell viability of osteoblastic MC3T3-E1 cells compared with pure Zn. Both pure Zn and composites exhibited a low thrombosis risk and hemolysis rates while a Zn ion concentration-dependent effect was found on coagulation time. An effective antibacterial property was observed as well. The volume loss of pure Zn and Zn-5HA composite was 1.7% and 3.2% after 8 weeks' implantation. Histological analysis found newly formed bone surrounding pure Zn and Zn-5HA composite at week 4 and increased bone mass over time. With prolonged implantation time, Zn-5HA composite was more effective on stimulating new bone formation than pure Zn. In summary, MMC is a feasible way to design Zn based materials with adjustable degradation rates and improved biocompatibility.

STATEMENT OF SIGNIFICANCE

Biodegradable zinc materials are promising candidates for the new generation of orthopedic implants. However, the slow degradation rates and unsatisfactory cytocompatibility of pure Zn in bone environments limit its future clinical applications. Generally, alloying is a common way to improve the performance of pure Zn. In this study, metal matrix composite was chosen as a novel strategy to solve the problems. Hydroxyapatite, as a bioactive component, was added into Zn matrix via spark plasma sintering. We find that Zn-HA composites exhibited adjustable degradation rates and improved biocompatibility both in vitro and in vivo. This study provides exhaustive and significant information including microstructure, mechanical performance, degradation behavior, biocompatibility, hemocompatibility and antibacterial property for the future Zn based implants design.

Runx2/Osterix and Zinc Uptake Synergize to Orchestrate Osteogenic Differentiation and Citrate Containing Bone Apatite Formation

Citrate is essential to biomineralization of the bone especially as an integral part of apatite nanocomposite. Citrate precipitate of apatite is hypothesized to be derived from mesenchymal stem/stromal cells (MSCs) upon differentiation into mature osteoblasts. Based on ¹³C-labeled signals identified by solid-state multinuclear magnetic resonance analysis, boosted mitochondrial activity and carbon-source replenishment of tricarboxylic acid cycle intermediates coordinate to feed forward mitochondrial anabolism and deposition of citrate. Moreover, zinc (Zn²⁺) is identified playing dual functions: (i) Zn²⁺ influx is influenced by ZIP1 which is regulated by Runx2 and Osterix to form a zinc-Runx2/Osterix-ZIP1 regulation axis promoting osteogenic differentiation; (ii) Zn²⁺ enhances citrate accumulation and deposition in bone apatite. Furthermore, age-related bone loss is associated with Zn²⁺ and citrate homeostasis; whereas, restoration of Zn²⁺ uptake alleviates age-associated declining osteogenic capacity and amount of citrate deposition. Together, these results indicate that citrate is not only a key metabolic intermediate meeting the emerging energy demand of differentiating MSCs but also participates in extracellular matrix mineralization, providing mechanistic insight into Zn²⁺ homeostasis and bone formation.

Microstructures, mechanical, and biological properties of a novel Ti-6V-4V/zinc surface nanocomposite prepared by friction stir processing

Background

The interaction between the material and the organism affects the survival rate of the orthopedic or dental implant in vivo. Friction stir processing (FSP) is considered a new solid-state processing technology for surface modification.

Purpose

This study aims to strengthen the surface mechanical properties and promote the osteogenic capacity of the biomaterial by constructing a Ti-6Al-4V (TC4)/zinc (Zn) surface nanocomposites through FSP.

Methods

FSP was used to modify the surface of TC4. The microstructures and mechanical properties were analyzed by scanning electron microscopy, transmission electron microscopy, nanoindentation and Vickers hardness. The biological properties of the modified surface were evaluated by the in vitro and in vivo study.

Results

The results showed that nanocrystalline and numerous β regions, grain boundary α phase, coarser acicular α phase and finer acicular martensite α′ appeared because of the severe plastic deformation caused by FSP, resulting in a decreased elastic modulus and an increased surface hardness. With the addition of Zn particles and the enhancement of hydrophilicity, the biocompatibility was greatly improved in terms of cell adhesion and proliferation. The in vitro osteogenic differentiation of rat bone marrow stromal cells and rapid in vivo osseointegration were enhanced on the novel TC4/Zn metal matrix nanocomposite surface.

Conclusion

These findings suggest that this novel TC4/Zn surface nanocomposite achieved by FSP has significantly improved mechanical properties and biocompatibility, in addition to promoting osseointegration and thus has potential for dental and orthopedic applications.

Immobilization of a carbon nanomaterial-based localized drug-release system using a bispecific material-binding peptide

Introduction

Inorganic materials are widely used in medical devices, such as artificial hearts, vessels, and joints, in stents, and as nanocarriers for drug-delivery systems. Carbon nanomaterials are of particular interest due to their biological inertness and their capability to accommodate molecules. Several attempts have been proposed, in which carbon nanomaterials are used as nanocarriers for the systemic delivery of drugs.

Materials and methods

We developed a drug-delivery system in which oxidized single-walled carbon nanohorns (oxSWNHs) were immobilized on a titanium (Ti) surface using material-binding peptides to enable localized drug delivery. For this purpose, we utilized a bispecific peptidic aptamer comprising a core sequence of a Ti-binding peptide and a SWNH-binding peptide to immobilize oxSWNHs on Ti.

Results

Scanning electron microscopy was used to confirm the presence of oxSWNHs adsorbed onto the Ti surface, and a quartz crystal microbalance was used to evaluate the binding process during oxSWNH adsorption. The oxSWNHs-ornamented Ti substrate was nontoxic to cells and released biologically active dexamethasone over a sustained period.

Conclusion

This oxSWNHs-immobilized system can be used to modify the surface of Ti in implants and be loaded with drugs that stimulate osteogenesis and bone regeneration.

In vitro and in vivo evaluation of polylactic acid-based composite with tricalcium phosphate microsphere for enhanced biodegradability and osseointegration

A biodegradable polylactic acid composite containing tricalcium phosphate microsphere was fabricated. The composite exhibited enhanced biocompatibility and a well-interconnected porous structure that enabled tissue ingrowth after degradation. The tricalcium phosphate microspheres had an average size of 106 ± 43 μm and were incorporated into the polylactic acid matrix using a high-shear mixer. The resulting bioactivity and hydrophilicity were enhanced to levels comparable to those of a polylactic acid composite containing tricalcium phosphate powder, which is a well-known material used in the medical field. An accelerated 30-day degradation test in HCl revealed successful generation of an open porous structure with ∼98% interconnectivity in the polylactic acid–tricalcium phosphate microsphere composite, demonstrating the potential of this material to induce enhanced osseointegration in the later stage of bone regeneration. The early stage osseointegration was also evaluated by implanting the composite in vivo using a rabbit femoral defect model. After 16 weeks of implantation, the bone-to-implant contact ratio of the polylactic acid–tricalcium phosphate microsphere composite was enhanced owing to tissue ingrowth through the generated pores near the surface.

Applications of Metals for Bone Regeneration

The regeneration of bone tissue is the main purpose of most therapies in dental medicine. For bone regeneration, calcium phosphate (CaP)-based substitute materials based on natural (allo- and xenografts) and synthetic origins (alloplastic materials) are applied for guiding the regeneration processes. The optimal bone substitute has to act as a substrate for bone ingrowth into a defect, as well as resorb in the time frame needed for complete regeneration up to the condition of restitution ad integrum. In this context, the modes of action of CaP-based substitute materials have been frequently investigated, where it has been shown that such materials strongly influence regenerative processes such as osteoblast growth or differentiation and also osteoclastic resorption due to different physicochemical properties of the materials. However, the material characteristics needed for the required ratio between new bone tissue formation and material degradation has not been found, until now. The addition of different substances such as collagen or growth factors and also of different cell types has already been tested but did not allow for sufficient or prompt application. Moreover, metals or metal ions are used differently as a basis or as supplement for different materials in the field of bone regeneration. Moreover, it has already been shown that different metal ions are integral components of bone tissue, playing functional roles in the physiological cellular environment as well as in the course of bone healing. The present review focuses on frequently used metals as integral parts of materials designed for bone regeneration, with the aim to provide an overview of currently existing knowledge about the effects of metals in the field of bone regeneration.

Perturbed bone composition and integrity with disorganized osteoblast function in zinc receptor/Gpr39-deficient mice

Changes in bone matrix composition are frequently found with bone diseases and may be associated with increased fracture risk. Bone is rich in the trace element zinc. Zinc was established to play a significant role in the growth, development, and maintenance of healthy bones; however, the mechanisms underlying zinc effects on the integrity of the skeleton are poorly understood. Here, we show that the zinc receptor (ZnR)/Gpr39 is required for normal bone matrix deposition by osteoblasts. Initial analysis showed that Gpr39-deficient ( Gpr39^-/-) mice had weaker bones as a result of altered bone composition. Fourier transform infrared spectroscopy analysis showed high mineral-to-matrix ratios in the bones of Gpr39^-/- mice. Histologic analysis showed abnormally high numbers of active osteoblasts but normal osteoclast numbers on the surfaces of bones from Gpr39^-/- mice. Furthermore, Gpr39^-/- osteoblasts had disorganized matrix deposition in vitro with cultures exhibiting abnormally low collagen and high mineral contents, findings that demonstrate a cell-intrinsic role for ZnR/Gpr39 in these cells. We show that both collagen synthesis and deposition by Gpr39^-/- osteoblasts are perturbed. Finally, the expression of the zinc transporter Zip13 and a disintegrin and metalloproteinase with thrombospondin motifs family of zinc-dependent metalloproteases that regulate collagen processing was downregulated in Gpr39^-/- osteoblasts. Altogether, our results suggest that zinc sensing by ZnR/Gpr39 affects the expression levels of zinc-dependent enzymes in osteoblasts and regulates collagen processing and deposition.-Jovanovic, M., Schmidt, F. N., Guterman-Ram, G., Khayyeri, H., Hiram-Bab, S., Orenbuch, A., Katchkovsky, S., Aflalo, A., Isaksson, H., Busse, B., Jähn, K., Levaot, N. Perturbed bone composition and integrity with disorganized osteoblast function in zinc receptor/Gpr39-deficient mice.

Graphene oxide as a dual Zn/Mg ion carrier and release platform: enhanced osteogenic activity and antibacterial properties

Graphene oxide as an ion carrier and release platform: enhanced osteogenic activity and antibacterial properties.

Design, synthesis and characterization of doped-titanium oxide nanomaterials with environmental and angiogenic applications

Since the last decade, the metal composite nanostructures have evolved as promising candidates in regard to their wide applications in the fields of science and engineering. Recently, several investigators identified the titanium based nanomaterials as excellent agents for multifunctional environmental and biomedical applications. In this perspective, we have developed a series of zinc-doped (2 and 5%) titanium oxide-based nanomaterials using various reaction conditions and calcination temperatures (TZ1-TZ3: calcined at 500°C, TZ4-TZ6: calcined at 600°C and TZ7-TZ9: calcined at 700°C). The calcined materials (TZ1 to TZ9) were thoroughly analyzed by several physico-chemical characterization methods. The increase of the calcination temperature results in significant changes of the textural properties of the nanostructured materials. In addition, the increase of the calcination temperature leads to the formation of anatase/rutile mixtures with higher quantity of rutile. Furthermore, incorporation of zinc changes the morphology of the obtained nanoparticles. The materials were studied in the photodegradation of methylene blue observing that materials calcined at lower temperatures (TZ1-TZ3) have higher photocatalytic activity than those of the materials calcined at 600°C (TZ4-TZ6), rutile-based systems TZ7-TZ9 are not active. Based on the background literature of titanium and zinc based nanostructures in therapeutic angiogenesis, we have explored the pro-angiogenic properties of these materials using various in vitro and in vivo assays. The zinc-doped titanium dioxide nanostructures (TZ5 and TZ6) exhibited increased cell viability, proliferation, enhanced S-phase cell population, increased pro-angiogenic messengers (ROS: reactive oxygen species and NO: nitric oxide) production and promoted in vivo blood vessel formation in a plausible mechanistic p38/STAT3 dependent signaling cascade. Altogether, the results of the present study showcase these zinc doped-titanium oxide nanoparticles as promising candidates for environmental (water-remediation) and therapeutic angiogenic applications.

Balancing Bacteria-Osteoblast Competition through Selective Physical Puncture and Biofunctionalization of ZnO/Polydopamine/Arginine-Glycine-Aspartic Acid-Cysteine Nanorods

Bacterial infection and lack of bone tissue integration are two major concerns of orthopedic implants. In addition, osteoinductivity often decreases and toxicity may arise when antibacterial agents are introduced to increase the antibacterial ability. Here hybrid ZnO/polydopamine (PDA)/arginine-glycine-aspartic acid-cysteine (RGDC) nanorod (NR) arrays are designed and prepared on titanium (Ti) implants to not only enhance the osteoinductivity but also effectively kill bacteria simultaneously, which are ascribed to the selective physical puncture and the biofunctionalization of ZnO/PDA/RGDC nanorods during the competition between bacteria and osteoblasts. That is, owing to the much larger size of osteoblasts than bacteria, the hybrid NRs can puncture bacteria but not damage osteoblasts. Meanwhile, the cytocompatibility can be enhanced through the suppression of both reactive oxygen species and higher Zn²⁺ concentration by the covering of PDA and RGDC. The in vitro results confirm the selective puncture of the bacterial membrane and the better osteoinductivity. In vivo tests also show much higher antibacterial efficacy of the hybrid NRs with far less amounts of lobulated neutrophils and adherent bacteria in the surrounding tissues. In addition, the hybrid NRs also accelerate formation of new bone tissues (20.1% higher than pure Ti) and osteointegration between implants and newly formed tissues (32.0% higher than pure Ti) even in the presence of injected bacteria. This work provides a surface strategy for designing implants with desirable ability of osseointegration and infection prevention simultaneously, which will exhibit tremendous clinical potential in orthopedic and dental applications.

Enhanced Anti-Infective Efficacy of ZnO Nanoreservoirs through a Combination of Intrinsic Anti-Biofilm Activity and Reinforced Innate Defense

The increasing prevalence of implant-associated infections (IAIs) imposes a heavy burden on patients and medical providers. Bacterial biofilms are recalcitrant to antiseptic drugs and local immune defense and can attenuate host proinflammatory response to interfere with bacterial clearance. Zinc oxide nanoparticles (ZnO NPs) play a dual role in antibacterial and immunomodulatory activities but compromise the cytocompatibility because of their intracellular uptake. Here, ZnO NPs were immobilized on titanium to form homogeneous nanofilms (from discontinuous to continuous) through magnetron sputtering, and the possible antimicrobial activity and immunomodulatory effect of nano-ZnO films were investigated. Nano-ZnO films were found to prohibit sessile bacteria more than planktonic bacteria in vitro, and the antibacterial effect occurred in a dose-dependent manner. Using a novel mouse soft tissue IAI model, the in vivo results revealed that nano-ZnO films possessed outstanding antimicrobial efficacy, which could not be ascribed solely to the intrinsic anti-infective activity of nano-ZnO films observed in vitro. Macrophages and polymorphonuclear leukocytes (PMNs), two important factors in innate immune response, were cocultured with nano-ZnO and bacteria/lipopolysaccharide in vitro, and the nano-ZnO films could enhance the antimicrobial efficacy of macrophages and PMNs through promoting phagocytosis and secretion of inflammatory cytokines. This study provides insights into the anti-infective activity and mechanism of ZnO and consolidates the theoretical basis for future clinical applications of ZnO.

The role of new zinc incorporated monetite cements on osteogenic differentiation of human mesenchymal stem cells

β-Tricalcium phosphate particles were sintered in the presence of different amounts (0-0.72mol) of zinc oxide (ZnO) to prepare zinc doped β-TCP (Znβ-TCP) particles for further use in novel monetite (DCPA: CaHPO₄) zinc incorporated bone cements with osteogenic differentiation potential towards human mesenchymal stem cells (hMSCs). XRD analysis of zinc incorporated cements prepared with β-TCP reagent particles doped with different amount of ZnO (i.e. 0.03, 0.09 and 0.18mol ZnO) revealed the presence of unreacted Znβ-TCP and monetite. Furthermore, it was shown that zinc ions preferentially occupied the β-TCP crystal lattice rather than the monetite one. Release experiments indicated a burst release of ions from the different fabricated cements during the first 24h of immersion with zinc concentrations ranging between 85 and 100% of the total concentration released over a period of 21days. Cell proliferation significantly increased (P<0.05) on zinc incorporated monetite respect to control samples (Zinc-free cement) at 7 and 14days post seeding. The expression of Runx-2 was significantly up regulated (P<0.05) in the case of cells seeded on monetite prepared with β-TCP doped with 0.03 moles of ZnO. On the other hand, the cell mineralization as well as the expression of osteogenic marker genes ALP and OSC decreased significantly (P<0.05) at 14days post cell seeding. In conclusion, these results suggest that the zinc ions released from the cements during the first 24h of culture played a critical role in regulating the osteogenic differentiation of hMSCs.

Synthesis and biological properties of Zn-incorporated micro/nano-textured surface on Ti by high current anodization

It is acknowledged that ideal implant coatings should possess micro/nano-textured surface, have good interfacial bonding, and can release bioactive elements. In this study, we fabricated a Zn-incorporated micro/nano-textured surface by one-step high current anodization (HCA) in an aqueous solution with 10g/L of NaOH and different concentrations of Zn(NO₃)₂ (4, 7, and 12g/L). The control group of Zn-free was fabricated in the electrolyte of 7g/L Zn(NO₃)₂. Scanning electron microscopy (SEM), high-resolution transmission electron microscopy (HR-TEM), X-ray photoelectron spectroscopy (XPS), X-ray diffraction (XRD), and inductively coupled plasma mass spectroscopy (ICP-MS) were used to analyze the morphology, composition, microstructure, and Zn⁺ release kinetics of the micro/nano-textured coatings. The biological properties of the surface structure were evaluated by cytotoxicity assay, cell viability, cytoskeletal assembly and alkaline phosphatase activity. Our results show the micro/nano-textured surface is composed of TiO₂ mesoporous arrays, into which the Zn is demonstrated to be incorporated in the form of ZnO. The Zn content in the surface and release level of Zn²⁺ can be tailored through varying Zn(NO₃)₂ concentration in the electrolyte. In addition, the surface oxide layers show good interfacial bonding strength to the substrate. Compared with pure Ti and anodized Zn-free samples, the Zn-incorporated surface can upregulate osteoblast functions such as proliferation and alkaline phosphatase activity, which are assayed by MTT and ALP staining experiments, respectively. Collectively, this micro/nano-textured structure combined with high interfacial bonding strength and release of Zn²⁺ render the material surface promising as orthopedic implant coatings.

Evaluation of zinc-doped mesoporous hydroxyapatite microspheres for the construction of a novel biomimetic scaffold optimized for bone augmentation

Biomaterials with high osteogenic activity are desirable for sufficient healing of bone defects resulting from trauma, tumor, infection, and congenital abnormalities. Synthetic materials mimicking the structure and composition of human trabecular bone are of considerable potential in bone augmentation. In the present study, a zinc (Zn)-doped mesoporous hydroxyapatite microspheres (Zn-MHMs)/collagen scaffold (Zn-MHMs/Coll) was developed through a lyophilization fabrication process and designed to mimic the trabecular bone. The Zn-MHMs were synthesized through a microwave-hydrothermal method by using creatine phosphate as an organic phosphorus source. Zn-MHMs that consist of hydroxyapatite nanosheets showed relatively uniform spherical morphology, mesoporous hollow structure, high specific surface area, and homogeneous Zn distribution. They were additionally investigated as a drug nanocarrier, which was efficient in drug delivery and presented a pH-responsive drug release behavior. Furthermore, they were incorporated into the collagen matrix to construct a biomimetic scaffold optimized for bone tissue regeneration. The Zn-MHMs/Coll scaffolds showed an interconnected pore structure in the range of 100-300 μm and a sustained release of Zn ions. More importantly, the Zn-MHMs/Coll scaffolds could enhance the osteogenic differentiation of rat bone marrow-derived mesenchymal stem cells. Finally, the bone defect repair results of critical-sized femoral condyle defect rat model demonstrated that the Zn-MHMs/Coll scaffolds could enhance bone regeneration compared with the Coll or MHMs/Coll scaffolds. The results suggest that the biomimetic Zn-MHMs/Coll scaffolds may be of enormous potential in bone repair and regeneration.

Analysis of Blood Concentrations of Zinc, Germanium, and Lead and Relevant Environmental Factors in a Population Sample from Shandong Province, China

Trace elements, including zinc (Zn) and germanium (Ge), are essential for health; deficiency or excess levels of trace elements results is harmful. As a result of industrial and agricultural production, Pb widely exists in people’s living environment. It is absorbed mainly through the respiratory and digestive tracts, producing systemic harm. Reference values for a normal, healthy population are necessary for health assessment, prevention and treatment of related diseases, and evaluation of occupational exposures. Reference ranges for the Chinese population have not been established. From March 2009 to February 2010; we collected data and blood samples (n = 1302) from residents aged 6–60 years living in Shandong Province, China. We measured blood concentrations of Zn, Ge, and Pb using inductively coupled plasma mass spectrometry to determine reference ranges. Results were stratified by factors likely to affect the concentrations of these trace elements: sex, use of cosmetics or hair dye, age, alcohol intake, smoking habits, and consumption of fried food. The overall geometric mean (GM) concentrations (95% confidence interval) were 3.14 (3.08–3.20) mg/L for Zn, 19.9 (19.3–20.6) μg/L for Ge, and 24.1 (23.2–25.1) μg/L for Pb. Blood Zn concentrations were higher in women than in men (p < 0.001), while the opposite was found for Pb (p < 0.001) and sex did not influence Ge (p = 0.095). Alcohol use was associated with higher blood concentrations of Zn (p = 0.002), Ge (p = 0.002), and Pb (p = 0.001). The GM concentration of Zn was highest in 20–30-year-olds (p < 0.001), while Pb concentrations were highest in 12–16-year-olds (p < 0.001). Use of hair dye was associated with lower blood concentrations of Ge (p < 0.05). GM blood concentrations of Pb differed significantly between those who consumed fried foods 1–2 times/month (18.7 μg/L), 1–2 times/week (20.9 μg/L), and every day (28.5 μg/L; p < 0.001). Blood Pb concentrations were higher in subjects who used cosmetics (p < 0.05), hair dye (p < 0.05), and who smoked cigarettes (p < 0.001) than in those who did not.

Synthesis and antimicrobial properties of Zn-mineralized alginate nanocomposites

New bioactive and antimicrobial biomaterials were produced by alginate-mediated biomineralization with Zn-mineral phase. The synthesis procedure is simple, cost-effective and resulted in two different Zn-mineralized alginate nanocomposites, Zn-carbonate/Zn-alginate and Zn-phosphate/Zn-alginate. The presence of Zn-mineral phase and its type, have significantly affected nanocomposite morphology, stability, total metallic loading and potential to release Zn(II) in physiological environment. Antimicrobial experiments showed that both types of Zn-mineralized nanocomposites exhibit strong antimicrobial effect against Escherichia coli, Staphylococcus aureus and Candida albicans. These results suggest that alginate biomineralization, where minerals are salts of essential metallic ions like Zn(II), represents a good strategy for designing multifunctional biomaterials for potential biomedical applications.

Multifunctions of dual Zn/Mg ion co-implanted titanium on osteogenesis, angiogenesis and bacteria inhibition for dental implants

In order to improve the osseointegration and long-term survival of dental implants, it is urgent to develop a multifunctional titanium surface which would simultaneously have osteogeneic, angiogeneic and antibacterial properties. In this study, a potential dental implant material-dual Zn/Mg ion co-implanted titanium (Zn/Mg-PIII) was developed via plasma immersion ion implantation (PIII). The Zn/Mg-PIII surfaces were found to promote initial adhesion and spreading of rat bone marrow mesenchymal stem cells (rBMSCs) via the upregulation of the gene expression of integrin α1 and integrin β1. More importantly, it was revealed that Zn/Mg-PIII could increase Zn²⁺ and Mg²⁺ concentrations in rBMSCs by promoting the influx of Zn²⁺ and Mg²⁺ and inhibiting the outflow of Zn²⁺, and then could enhance the transcription of Runx2 and the expression of ALP and OCN. Meanwhile, Mg²⁺ ions from Zn/Mg-PIII increased Mg²⁺ influx by upregulating the expression of MagT1 transporter in human umbilical vein endothelial cells (HUVECs), and then stimulated the transcription of VEGF and KDR via activation of hypoxia inducing factor (HIF)-1α, thus inducing angiogenesis. In addition to this, it was discovered that zinc in Zn/Mg-PIII had certain inhibitory effects on oral anaerobic bacteria (Pg, Fn and Sm). Finally, the Zn/Mg-PIII implants were implanted in rabbit femurs for 4 and 12weeks with Zn-PIII, Mg-PIII and pure titanium as controls. Micro-CT evaluation, sequential fluorescent labeling, histological analysis and push-out test consistently demonstrated that Zn/Mg-PIII implants exhibit superior capacities for enhancing bone formation, angiogenesis and osseointegration, while consequently increasing the bonding strength at bone-implant interfaces. All these results suggest that due to the multiple functions co-produced by zinc and magnesium, rapid osseointegration and sustained biomechanical stability are enhanced by the novel Zn/Mg-PIII implants, which have the potential application in dental implantation in the future.

STATEMENT OF SIGNIFICANCE

In order to enhance the rapid osseointegration and long-term survival of dental implants, various works on titanium surface modification have been carried out. However, only improving osteogenic activity of implants is not enough, because angiogenesis and bacteria inhibition are also very important for dental implants. In the present study, a novel dental implant material-dual Zn/Mg ion co-implanted titanium (Zn/Mg-PIII) was developed, which was found to have superior osteoinductivity, pro-angiogenic effects and inhibitory effects against oral anaerobes. Furthermore, synergistic effects of Zn/Mg ions on osteogenic differentiation of rBMSCs and the possible mechanism were discovered. In addition, rapid osseointegration and sustained biomechanical stability are greatly enhanced by Zn/Mg-PIII implants, which may have the potential application in dental implantation in the future. We believe this paper may be of particular interest to the readers.

Mn-containing titanium surface with favorable osteogenic and antimicrobial functions synthesized by PIII&D

Reasonable incorporation of manganese into titanium is believed to be able to enhance the osteogenic and antibacterial activities of orthopedic implants. However, it is still a challenge to compromise Mn-induced cytotoxicity and better develop its biocompatibility and antimicrobial ability. To pinpoint this issue, a stable Mn ion release platform was created on Ti using plasma immersion ion implantation and deposition (PIII&D) technique. Compared with as-etched titanium, as a result, promoted antibacterial abilities against gram-negative bacteria species and enhanced osteogenic-related gene expressions on rBMMSC were observed on Mn-containing sample. Meanwhile, the Mn-containing samples showed no obvious cytotoxicity. Our results here provide insight to be better understanding the relationships between additives-induced biological performance and the dose, state, and stability of the doped element.

Small organic molecule-mediated hydrothermal synthesis of hierarchical porous hydroxyapatite microspheres by the incorporation of copper ions

Hierarchical porous hydroxyapatite microspheres with a pit in the center were prepared under the synergistic effect of inositol hexakisphosphate and copper ions.

The improvement of corrosion resistance, biocompatibility and osteogenesis of the novel porous Mg–Nd–Zn alloy

A magnesium scaffold is a promising biodegradable bone repair material.

TiO2nanotubes enriched with calcium, phosphorous and zinc: promising bio-selective functional surfaces for osseointegrated titanium implants

TiO₂nanotubes enriched with Ca, P, and Zn by reverse polarization anodization, are promising bio-selective functional structures for osseointegrated titanium implants.

Osteogenic activity and angiogenesis of a SrTiO3 nano-gridding structure on titanium surface

Dual effect of alveolate double-layered SrTiO₃ nano-gridding based on Ti substrate: osteogenic activity and angiogenesis.

Study of a new bone-targeting titanium implant-bone interface

New strategies involving bone-targeting titanium (Ti) implant-bone interface are required to enhance bone regeneration and osseointegration for orthopedic and dental implants, especially in osteoporotic subjects. In this study, a new dual-controlled, local, bone-targeting delivery system was successfully constructed by loading tetracycline-grafted simvastatin (SV)-loaded polymeric micelles in titania nanotube (TNT) arrays, and a bone-targeting Ti implant-bone interface was also successfully constructed by implanting the delivery system in vivo. The biological effects were evaluated both in vitro and in vivo. The results showed that Ti surfaces with TNT-bone-targeting micelles could promote cytoskeletal spreading, early adhesion, alkaline phosphatase activity, and extracellular osteocalcin concentrations of rat osteoblasts, with concomitant enhanced protein expression of bone morphogenetic protein (BMP)-2. A single-wall bone-defect implant model was established in normal and ovariectomized rats as postmenopausal osteoporosis models. Microcomputed tomography imaging and BMP-2 expression in vivo demonstrated that the implant with a TNT-targeting micelle surface was able to promote bone regeneration and osseointegration in both animal models. Therefore, beneficial biological effects were demonstrated both in vitro and in vivo, which indicated that the bone-targeting effects of micelles greatly enhance the bioavailability of SV on the implant-bone interface, and the provision of SV-loaded targeting micelles alone exhibits the potential for extensive application in improving local bone regeneration and osseointegration, especially in osteoporotic subjects.

Characterization of mesoporous calcium phosphates from calcareous marine sediments containing Si, Sr and Zn for bone tissue engineering

Calcium phosphates (CAPs) can be produced from either biologically sourced materials or mineral deposits. The raw materials impart unique properties to the CAPs due to innate trace amounts of elements that affect the crystal structure, morphology and stoichiometry. Using calcium carbonate (CaCO₃) precursors derived from fossilized calcareous marine sediments (FCMSs), we have synthesized a novel class of CAP biomaterials, termed fm-CaPs, with defined Ca/P molar ratios of 1.4 and 1.7 using a wet synthesis method. Compared with commercially available CAP biomaterials, such as hydroxyapatite (HA) and beta-tricalcium phosphate (β-TCP), fm-CaP1.7 had a biphasic composition consisting of an HA phase (in a hexagonal system) and a β-TCP phase (in a rhombohedral crystalline system), which is desirable for the current design of bone substitutes, whereas fm-CaP1.4 consisted of an HA phase and a beta-dicalcium pyrophosphate phase (in a tetragonal system). These bioceramics exhibited a fringe structure of regular crystallographic orientation with well-ordered mesoporous channels. The FCMS raw material imparted trace amounts of silicon (Si), strontium (Sr) and zinc (Zn) to fm-CaPs; these are elements that are important for bone formation. The cyto-compatibility of these biomaterials and their effects on cellular activity were evaluated using osteoblast cells. Cell proliferation assays revealed no signs of cytotoxicity, whereas cells growth was equal to or better than HA and β-TCP controls. The SEM analysis of the cell and material interactions showed good cell spreading on the fm-CaP materials that was comparable to β-TCP and in vitro assays suggested robust osteogenic differentiation, as seen by increased mineralization (alizarin red) and upregulation of osteogenic gene expression. Our results indicate that fm-CaP1.7, in particular, has chemical, physical and morphological properties that make this material suitable for applications that promote bone tissue regeneration.

Does incorporating zinc in titanium implant surfaces influence osseointegration? A systematic review

STATEMENT OF PROBLEM

Titanium implant surfaces have been modified to improve osseointegration; however, the evidence for incorporating zinc into titanium implants to improve new bone formation and osseointegration is not clear.

PURPOSE

The purpose of this systematic review was to assess the efficacy of treating titanium surfaces with zinc on the osseointegration of implants.

MATERIAL AND METHODS

The focused question addressed was, "Does incorporating zinc in titanium implant surfaces influence osseointegration?" Indexed databases were searched up to January 2016 using the key words "Bone to implant contact"; "implant"; "zinc"; "osseointegration." Letters to the editor, case reports/case series, historic reviews, and commentaries were excluded. The pattern of the review was customized to summarize the pertinent data.

RESULTS

Ten experimental studies were included, all of which were performed in animals (5 in rabbits, 4 in rodents, and 1 in goats). The number of titanium implants placed ranged from 10 to 78. The results from all studies showed that incorporating zinc into titanium implants enhanced new bone formation and/or bone-to-implant contact around implants. One study reported that zinc enhanced the removal torque on implants.

CONCLUSIONS

The current available evidence on adding zinc to titanium implants surfaces to enhance osseointegration remains unclear. Further investigation is necessary to assess its effectiveness and safety in humans and to establish a standard methodology and ideal compound for incorporating zinc ion into titanium implant surfaces in a clinical setting.