A multifaceted coating on titanium dictates osteoimmunomodulation and osteo/angio-genesis towards ameliorative osseointegration

Multifunctional Coating with Both Thermal Insulation and Antibacterial Properties Applied to Nickel-Titanium Alloy

BACKGROUND

With excellent shape memory and superelastic properties, shape memory alloy (SMA) is an ideal actuator, and it can form smart structure for different applications in medical field. However, SMA devices cause apparent thermal damage to the surrounding tissues when it works in vivo, making the application of smart structure that is composed of SMA actuator in vivo is greatly limited.

METHODS

In this paper, coating (APA) with PLA as the main body to limit the heat conduction, a multifunctional Ag nanoparticles (AgNPs)/polylactic acid (PLA)/Al2O3 was synthesized. The Al2O3 layer was formed by micro-arc oxidation (MAO) and AgNPs were synthesized by silver nitrate and ethylene glycol. Scanning electron microscopy, transmission electron microscope, and Fourier transform infrared spectra were applied to analyze the morphology and characterization of APA coating. The antimicrobial activity, thermal insulation activity, and biocompatibility of APA coating were furtherly explored and verified through animal experiments and immunohistochemistry.

RESULTS

With different particle sizes and concentrations of AgNPs, APA multi-functional films were successfully prepared. The Al2O3 layer was closely combined with SMA and formed a porous surface, so the PLA and AgNPs layers can firmly adhere to SMA, thus reducing the release of nickel ions in SMA. AgNPs gave APA coating excellent antibacterial activity and effectively inhibited the growth of Staphylococcus aureus. In addition, coupled with the low thermal conductivity of PLA and Al2O3, AgNPs were tightly anchored on the surface of PLA, which has high infrared reflectivity, making the APA coating obtain good thermal insulation performance.

CONCLUSION

We have successfully prepared the APA coating and obtained the optimum amount of AgNPs, which makes it have good thermal insulation performance, good antibacterial activity and good biocompatibility, which provides a new prospect for the application of SMA.

Endowing polyetheretherketone with anti-inflammatory ability and improved osteogenic ability

Both osteogenesis and anti-inflammatory bioactive materials play a vital role in the regeneration of skeletal defects. Bone inflammation is hard to cure and can lead to malformation or amputation. The purpose of this study is to use anti-inflammatory drugs to endow polyetheretherketone (PEEK) with the dual ability to achieve anti-inflammatory effects while maintaining favorable biocompatibility. In this experiment, the porous PEEK was immersed in an aspirin (ASP) solution after sulfonation, and the obtained porous PEEK had significantly improved the anti-inflammatory abilities. Additionally, grafting the bone forming peptide (BFP) onto the porous PEEK can distinctly enchance the osteogenesis capability. The effects of the BFP polypeptide on the proliferation of MC3T3-E1 cells and ALP activity, and the effects of aspirin on inflammation were systematically investigated. The modified material showed favorable biocompatibility and osteogenic ability. The results suggest that the combination of the BFP polypeptide with aspirin may lead to a synergetic effect on the stimulation of osteogenesis and on the reduction of inflammation.

The Anatase Phase of Nanotopography Titania with Higher Roughness Has Better Biocompatibility in Osteoblast Cell Morphology and Proliferation

Previous studies have concluded that surface-modified titanium oxide (titania, TiO2) surface properties promote osteoblast cell morphology and proliferation. To screen a suitable structured titania coating with the best biocompatibility to be used in dental implants, five titania films (two amorphous, one rutile, and two anatases) with different surfaces were successfully synthesized on polished titanium by radio frequency (RF) magnetron sputtering. We applied atomic force microscopy (AFM) and X-ray diffraction (XRD) to depict the formulations. Furthermore, MC3T3-E1, the mouse osteoblast precursor cell, was used to assess cell proliferation and observe morphologic changes at the film surface. The data indicated that the overall number of MC3T3-E1 cells on anatase films was significantly higher as compared with cells on rutile and amorphous films. Meanwhile, the actin filaments of the cells grown on the anatase phase films were well defined and fully spread. In addition, the film with higher roughness had enhanced biocompatibility than that with lower roughness. The results showed that the crystal phase and titania coated roughness had a greater influence on the biocompatibility of nanostructured titania film. The higher the roughness of the anatase phase was, the better bioactivity for the morphology and proliferation of osteoblast. This is a good surface-modified biological material and may have a good application prospect in dental implants.

Graphdiyne-modified TiO2 nanofibers with osteoinductive and enhanced photocatalytic antibacterial activities to prevent implant infection

Titanium implants have been widely used in bone tissue engineering for decades. However, orthopedic implant-associated infections increase the risk of implant failure and even lead to amputation in severe cases. Although TiO2 has photocatalytic activity to produce reactive oxygen species (ROS), the recombination of generated electrons and holes limits its antibacterial ability. Here, we describe a graphdiyne (GDY) composite TiO2 nanofiber that combats implant infections through enhanced photocatalysis and prolonged antibacterial ability. In addition, GDY-modified TiO2 nanofibers exert superior biocompatibility and osteoinductive abilities for cell adhesion and differentiation, thus contributing to the bone tissue regeneration process in drug-resistant bacteria-induced implant infection.

Nanosized concave pit/convex dot microarray for immunomodulatory osteogenesis and angiogenesis

The immunomodulatory capability of biomaterials is of paramount importance for successful material-mediated bone regeneration. Particularly, the design of surface nano-topography can be leveraged to instruct immune reactions, yet the understanding of such "nano-morphology effect" is still very limited. Herein, highly ordered nano-concave pit (denoted as NCPit) and nano-convex dot (denoted as NCDot) microarrays with two different sizes were successfully constructed on a 316LSS surface via anodization and subsequently immersion-coating treatment, respectively. We, for the first time, comparatively investigated the interactions of NCPit and NCDot microarrays with RAW264.7 macrophages and their immunomodulatory impacts on osteogenesis and angiogenesis of human bone mesenchymal stem cells (hBMSCs) and human umbilical vein endothelial cells (HUVECs). NCDot microarrays induced macrophages towards M2 polarization with the higher expression level of anti-inflammatory markers (IL-10 and CD 206) and the lower level of pro-inflammatory markers (TNF-α, IL-1β, IL-6 and CD 86) than those of the corresponding NCPit microarrays. During the process, the expressions of osteogenesis-related genes (Runx2, OPN and OCN) of hBMSCs, and angiogenesis-related genes (eNOS, HIF-1α, KDR and VEGF) of HUVECs were significantly upregulated by the NCDot microarray-modulating immune microenvironment of macrophages, and finally stimulated osteogenesis and angiogenesis. Thus, the prepared NCDot arrays were able to significantly promote osteo-/angiogenic activity by generating a more suitable immune microenvironment than NCPit arrays, offering substantial evidence for designing immunomodulatory biomaterials with specific microstructures and optimal bioactivity.

Role of Hippo-YAP Signaling in Osseointegration by Regulating Osteogenesis, Angiogenesis, and Osteoimmunology

The social demand for dental implantation is growing at a rapid rate, while dentists are faced with the dilemma of implantation failures associated with unfavorable osseointegration. Clinical-friendly osteogenesis, angiogenesis and osteoimmunology around dental implants play a pivotal role in a desirable osseointegration and it's increasingly appreciated that Hippo-YAP signaling pathway is implicated in those biological processes both in vitro and in vivo in a variety of study. In this article we review the multiple effects of Hippo-YAP signaling in osseointegration of dental implants by regulating osteogenesis, angiogenesis and osteoimmunology in peri-implant tissue, as well as highlight prospective future directions of relevant investigation.

Near-Infrared Light Triggered Phototherapy and Immunotherapy for Elimination of Methicillin-Resistant Staphylococcus aureus Biofilm Infection on Bone Implant

Clinically, methicillin-resistant Staphylococcus aureus (MRSA) biofilm infection inevitably induces the failure of bone implants. Herein, a hydrophilic and viscous hydrogel of poly(vinyl alcohol) modified with chitosan, polydopamine, and NO release donor was formed on a red phosphorus nanofilm deposited on a titanium implant (Ti-RP/PCP/RSNO). Under the irradiation of near-infrared light (NIR), peroxynitrite (^•ONOO^-) was formed by the reaction between the released NO and superoxide (^•O₂^-) produced by the RP nanofilm. Specifically, we revealed the antibacterial mechanism of the ONOO^- against the MRSA biofilm. In addition, osteogenic differentiation was promoted and inflammatory polarization was regulated by the released NO without NIR irradiation through upregulating the expression of Opn and Ocn genes and TNF-α. The MRSA biofilm was synergistically eradicated by ^•ONOO^-, hyperthermia, and ^•O^2- under NIR irradiation as well as the immunoreaction of the M1 polarization. The in vivo results also confirmed the excellent osteogenesis and biofilm eradication by released NO from the RP/PCP/RSNO system under NIR irradiation, indicating the noninvasive tissue reconstruction of MRSA-infected tissues through phototherapy and immunotherapy.

Influence of silver speciation on the inflammatory regulation of AgNPs anchoring onto titania nanotubes

AgNPs were immobilized on titania nanotubes (TNT) by chelation of polydopamine (PD) to generate a TNT/PD/AgNPs (TPAS) via a simple dipping method. The inflammatory regulation of the TPAS coating were investigated. To gain a deep insight into the transformation of AgNPs in macrophages, a cation exchange reaction was introduced for speciation analysis of AgNPs and Ag⁺ by inductively coupled plasma-mass spectrometry. Owing to the magic signal amplification strategy, the trace AgNPs and Ag⁺ in release media and even in macrophages were easily detected. In simulated inflammatory microenvironment, M1 macrophages promoted the cell-responsive release of Ag⁺ from TPAS at 3 d, which dampened inflammation. Then, macrophages reduced Ag⁺ by intracellular metabolites, leading to the formation of new AgNPs in cells. This study give a new sight for discovering the inflammatory regulation mechanism of silver containing biomaterials.

Immunomodulation of surface biofunctionalized 3D printed porous titanium implants

Additive manufacturing (AM) techniques have provided many opportunities for the rational design of porous metallic biomaterials with complex and precisely controlled topologies that give rise to unprecedented combinations of mechanical, physical, and biological properties. These favorable properties can be enhanced by surface biofunctionalization to enable full tissue regeneration and minimize the risk of implant-associated infections (IAIs). There is, however, an increasing need to investigate the immune responses triggered by surface biofunctionalized AM porous metals. Here, we studied the immunomodulatory effects of AM porous titanium (Ti-6Al-4V) printed using selective laser melting, and of two additional groups consisting of AM implants surface biofunctionalized using plasma electrolytic oxidation (PEO) with/without silver nanoparticles. The responses of human primary macrophages and human mesenchymal stromal cells (hMSCs) were studied in terms of cell viability, cell morphology and biomarkers of macrophage polarization. Non-treated AM porous titanium triggered a strong pro-inflammatory response in macrophages, albeit combined with signs of anti-inflammatory effects. The PEO treatment of AM porous titanium implants showed a higher potential to induce polarization towards a pro-repair macrophage phenotype. We detected no cytotoxicity against hMSCs in any of the groups. However, the incorporation of silver nanoparticles resulted in strong cytotoxicity against attached macrophages. The results of this study indicate the potential immunomodulatory effects of the AM porous titanium enhanced with PEO treatment, and point towards caution and further research when using silver nanoparticles for preventing IAIs.

Graphene oxide coated Titanium Surfaces with Osteoimmunomodulatory Role to Enhance Osteogenesis

Graphene oxide (GO) and its derivatives are currently being explored for the modification of bone biomaterials. However, the effect of GO coatings on immunoregulation and subsequent impacts on osteogenesis are not known. In this study, GO was coated on pure titanium using dopamine. GO-coated titanium (Ti-GO) surfaces exhibited good biocompatibility, with the ability to stimulate the expression of osteogenic genes, and extracellular matrix mineralization in human mesenchymal stromal cells (hMSCs). Interestingly, it was found that GO-coated surfaces could manipulate the polarization of macrophages and expression of inflammatory cytokines via the Toll-like receptor pathway. Under physiological conditions, Ti-GO activated macrophages and induced mild inflammation and a pro-osteogenic environment, characterized by a slight increase in the levels of proinflammatory cytokines, as well as increased expression of the TGF-β1 and oncostatin M genes. In an environment mimicking acute inflammatory conditions, Ti-GO attenuated inflammatory responses, as shown by the downregulation of proinflammatory cytokines. Conditioned medium collected from macrophages stimulated by Ti-GO played a significant stimulatory role in the osteogenic differentiation of hMSCs. In summary, GO-coated surfaces displayed beneficial immunomodulatory effects in osteogenesis, indicating that GO could be a potential substance for the modification of bone scaffolds and implants.

Insights into the angiogenic effects of nanomaterials: mechanisms involved and potential applications

The vascular system, which transports oxygen and nutrients, plays an important role in wound healing, cardiovascular disease treatment and bone tissue engineering. Angiogenesis is a complex and delicate regulatory process. Vascular cells, the extracellular matrix (ECM) and angiogenic factors are indispensable in the promotion of lumen formation and vascular maturation to support blood flow. However, the addition of growth factors or proteins involved in proangiogenic effects is not effective for regulating angiogenesis in different microenvironments. The construction of biomaterial scaffolds to achieve optimal growth conditions and earlier vascularization is undoubtedly one of the most important considerations and major challenges among engineering strategies. Nanomaterials have attracted much attention in biomedical applications due to their structure and unique photoelectric and catalytic properties. Nanomaterials not only serve as carriers that effectively deliver factors such as angiogenesis-related proteins and mRNA but also simulate the nano-topological structure of the primary ECM of blood vessels and stimulate the gene expression of angiogenic effects facilitating angiogenesis. Therefore, the introduction of nanomaterials to promote angiogenesis is a great helpful to the success of tissue regeneration and some ischaemic diseases. This review focuses on the angiogenic effects of nanoscaffolds in different types of tissue regeneration and discusses the influencing factors as well as possible related mechanisms of nanomaterials in endothelial neovascularization. It contributes novel insights into the design and development of novel nanomaterials for vascularization and therapeutic applications.

A Novel Cytocompatibility Strengthening Strategy of Ultrafine-Grained Pure Titanium

Ultrafine-grained pure (UFG) titanium processed by equal channel angular pressing possesses mechanical properties comparable to those of Ti-6Al-4V and features more favorable friction resistance, biocompatibility, and corrosion resistance than does commercially pure (CP) titanium. Nevertheless, UFG titanium is still a bio-inert material with a lack of bone-inducing ability. Here, TiO₂-hydroxyapatite (TiO₂-HA) coatings were fabricated on CP titanium and UFG titanium through combining micro-arc oxidation and hydrothermal treatment together to improve their cytocompatibility. The results indicate that, compared with conventional coatings that use CP titanium as the substrate, such coatings formed on the UFG titanium possess additional hydrophilicity and in vitro cytocompatibility. The fantastic hierarchical structure of the UFG TiO₂-HA coating (UG-MH coating), including microscale and nanoscale pores and short column-shaped and sheet-shaped HA grains with varying geometric shapes, excellent hydrophilicity, and high polar force, enhances the mutual effects between the osteoblasts and titanium implant since it provides an adequate microenvironment for the ingrowth of osteoblasts, inducing osteoblast adhesion, proliferation, and differentiation. The UG-MH coating has a synergistic effect due to its fantastic hydrophilic hierarchical structure and high polar force on the up-regulated expression of cytoskeletal actin proteins as well as osteocalcin, protein kinase C (PKC), nuclear factor of activated T-cells (NFAT), and Wnt5, enabling osteoblasts to differentiate via the Wnt calcium-dependent signaling pathway. This study highlights the idea that the modified UFG titanium will be more suitable than CP titanium in dental and orthopedic applications.

Curcumin has immunomodulatory effects on RANKL-stimulated osteoclastogenesis in vitro and titanium nanoparticle-induced bone loss in vivo

Wear particle‐stimulated inflammatory bone destruction and the consequent aseptic loosening remain the primary causes of artificial prosthesis failure and revision. Previous studies have demonstrated that curcumin has a protective effect on bone disorders and inflammatory diseases and can ameliorate polymethylmethacrylate‐induced osteolysis in vivo. However, the effect on immunomodulation and the definitive mechanism by which curcumin reduces the receptor activators of nuclear factor‐kappa B ligand (RANKL)‐stimulated osteoclast formation and prevents the activation of osteoclastic signalling pathways are unclear. In this work, the immunomodulation effect and anti‐osteoclastogenesis capacities exerted by curcumin on titanium nanoparticle‐stimulated macrophage polarization and on RANKL‐mediated osteoclast activation and differentiation in osteoclastic precursor cells in vitro were investigated. As expected, curcumin inhibited RANKL‐stimulated osteoclast maturation and formation and had an immunomodulatory effect on macrophage polarization in vitro. Furthermore, studies aimed to identify the potential molecular and cellular mechanisms revealed that this protective effect of curcumin on osteoclastogenesis occurred through the amelioration of the activation of Akt/NF‐κB/NFATc1 pathways. Additionally, an in vivo mouse calvarial bone destruction model further confirmed that curcumin ameliorated the severity of titanium nanoparticle‐stimulated bone loss and destruction. Our results conclusively indicated that curcumin, a major biologic component of Curcuma longa with anti‐inflammatory and immunomodulatory properties, may serve as a potential therapeutic agent for osteoclastic diseases.

Enzyme responsive titanium substrates with antibacterial property and osteo/angio-genic differentiation potentials

After implantation into a host, titanium (Ti) orthopaedic materials are facing two major clinical challenges: bacterial infection and aseptic loosening, which directly determine the long-term survival of the implant. To endow Ti implant with self-defensive antibacterial properties and desirable osteo/angio-genic differentiation potentials, hyaluronic acid (HA)-gentamicin (Gen) conjugates (HA-Gen) and chitosan (Chi) polyelectrolyte multilayers were constructed on deferoxamine (DFO) loaded titania nanotubes (TNT) substrates via layer-by-layer (LBL) assembly technique, termed as TNT/DFO/HA-Gen. The HA-Gen conjugate was characterized by Fourier transform infrared spectroscopy (FTIR) and nuclear magnetic resonance (¹H NMR). The physicochemical properties of the substrates were characterized by field emission scanning electron microscopy (FE-SEM), atomic force microscopy (AFM), X-ray photoelectron spectroscopy (XPS) and contact angle measurements. The on-demand DFO release was associated with the degradation of multilayers triggered by exogenous hyaluronidase, which indicated enzymatic and bacterial responsiveness. The TNT/DFO/HA-Gen substrates displayed effective antifouling and antibacterial properties against Escherichia coli (E. coli) and Staphylococcus aureus (S. aureus), while were favourable for the adhesion, proliferation and osteo/angio-genic differentiation of mesenchymal stem cells (MSCs). The multifaceted drug-device combination (DDC) strategy showed potential applications in orthopaedic fields.

Stimulation of osteogenesis and angiogenesis by micro/nano hierarchical hydroxyapatite via macrophage immunomodulation

Biomaterial topography-based strategies are regarded as an effective way to regulate the osteoimmune environment which plays an indispensable role in the bone regeneration process. The rapid development of manufacture techniques makes it possible to investigate the cell-topography interactions by preparing various micro and nano-topographical surfaces on biomaterials. Still, it is a challenge to prepare well-defined micro/nano hierarchical structures of bioceramics due to the inherent brittleness of ceramic materials. Also, the correlation between osteoimmunomodulation initiated by micro/nano hierarchical topographies and the tissue regeneration outcomes is unclear. In this study, we prepared well-defined micro/nano hierarchical structures on hydroxyapatite (HA) bioceramics through the combination of the photolithography and hydrothermal techniques. Three different microscale circular patterns (4 μm, 12 μm and 36 μm) and nanotopographies (nanoneedle, nanosheet and nanorod) were fabricated by changing the size of the mask and the condition of the hydrothermal reaction. The macrophage responses on the nanoneedle structures with different micropatterns were investigated and the micro/nano hierarchical structures with appropriate pattern sizes could either promote or alleviate the macrophage polarization, which further affected the outcomes of the osteogenic differentiation of human bone marrow stromal cells (hBMSCs) and angiogenic activity of human umbilical vein endothelial cells (HUVECs). Our study demonstrated that osteoimmunomodulation could be manipulated via tuning the micro/nano hierarchical structures, which could lead to a new strategy for the development of bone biomaterials with favorable osteoimmunomodulatory properties.

Antibacterial, angiogenic, and osteogenic activities of Ca, P, Co, F, and Sr compound doped titania coatings with different Sr content

Titanium implants are often combined with microporous titania coatings simultaneously doped with various elements to enhance their antibacterial, angiogenic and osteogenic activities. To evaluate how Sr doping levels affect properties of titania coatings simultaneously doped with Ca, P, Co and F (TiCPCF coatings), we prepared coatings with Sr contents equal to 6, 11 and 18 wt% (TiCPCF-S6, TiCPCF-S11 and TiCPCF-S18, respectively) using micro-arc oxidation of titanium. Sr presence in TiCPCF coatings did not affect their phase compositions, microstructure, surface wettability, roughness, and adhesion to titanium. Antibacterial, angio- and osteo-genic activities of all the coatings were evaluated. Sr incorporation improved mesenchymal stem cell proliferation, osteogenic differentiation and implant osseointegration. TiCPCF-S11 showed the most optimum Sr content judging by its enhanced osteogenic activity. While Sr incorporation did not weaken angiogenic and antibacterial abilities of TiCPCF. Thus TiCPCF-S11 coating is a very strong candidate to be used as a next-generation bone implant material.

Bioinspired surface modification of orthopedic implants for bone tissue engineering

Biomedical implants have been widely used in various orthopedic treatments, including total hip arthroplasty, joint arthrodesis, fracture fixation, non-union, dental repair, etc. The modern research and development of orthopedic implants have gradually shifted from traditional mechanical support to a bioactive graft in order to endow them with better osteoinduction and osteoconduction. Inspired by structural and mechanical properties of natural bone, this review provides a panorama of current biological surface modifications for facilitating the interaction between medical implants and bone tissue and gives a future outlook for fabricating the next-generation multifunctional and smart implants by systematically biomimicking the physiological processes involved in formation and functioning of bones.

Synergistic Effects of Novel Superparamagnetic/Upconversion HA Material and Ti/Magnet Implant on Biological Performance and Long-Term In Vivo Tracking

To solve the clinical challenges presented by the long-term tracking of implanted hydroxyapatite (HA) bone repair material and to investigate the synergistic effects of superparamagnetic HA and a static magnetic field (SMF) on the promotion of osteogenesis, herein a new type of superparamagnetic/upconversion-generating HA material (HYH-Fe) is developed via a two-step doping method, as well as a specially-designed titanium implant with a built-in magnet to provide a local static magnetic field in vivo. The results show that the prepared HYH-Fe material maintains the crystal structure of HA and exhibits good cytocompatibility. The combined use of the superparamagnetic HYH-Fe material and SMF can effectively and synergistically promote osteogenesis/osteointegration surrounding the Ti implants. In addition, the HYH-Fe material exhibits distinct advantages in terms of both long-term fluorescence tracking and microcomputed tomography (micro-CT) tracking. The new material and tracking strategy in this study provide scientific feasibility and will have important clinical value for long-term tracking and evaluation of implanted materials and the bone repair effect.

Dual functional approaches for osteogenesis coupled angiogenesis in bone tissue engineering

Bone fracture healing is a multistep and overlapping process of inflammation, angiogenesis and osteogenesis. It is initiated by inflammation, causing the release of various cytokines and growth factors. It leads to the recruitment of stem cells and formation of vasculature resulting in the functional bone formation. This combined phenomenon is used by bone tissue engineers from past few years to address the problem of vasculature and osteogenic differentiation during bone regeneration. In this review, we have discussed all major studies reporting the dual functioning approach to promote osteogenesis coupled angiogenesis using various scaffolds. These scaffolds are broadly classified into four types based on the nature of their structural and functional components. The functionality of the scaffold is either due to the structural components or the loaded cargo which conducts or induces the coupled functionality. Dual delivery system for osteoinductive and angioinductive factors ensures the co-delivery of two different types of molecules to induce osteogenesis and angiogenesis. Single delivery scaffold for angioinductive and osteoinductive molecule releases single type of molecules which could induce both angiogenesis and osteogenesis. Osteoconductive scaffold consisted of bone constituents releases angioinductive factors. Osteoconductive and angioconductive scaffold composed of components which provide the native substrate features for osteogenesis and angiogenesis. This review article also discusses the studies highlighting the synergism of physico-chemical stimuli as dual functioning feature to enhance angiogenesis and osteogenesis simultaneously. In addition, this article covers one of the least discussed area of the bone regeneration i.e. 'cartilage formation as a median between angiogenesis and osteogenesis'.

Si, Sr, Ag co-doped hydroxyapatite/TiO2 coating: enhancement of its antibacterial activity and osteoinductivity

A multifaceted coating with favourable cytocompatibility, osteogenic activity and antibacterial properties would be of great significance and value due to its capability for improving osseointegration and alleviating prosthesis loosening. This study marks the first report on the coating of TiO2 nanotubular (TNT) arrays with Sr-and-Si-substituted hydroxyapatite (SSHA) endowed with antibacterial characteristics using silver ions. This TNT layer coated with Ag-substituted SSHA (SSAgHA) formed a composite coating with an interconnected microporous structure and a homogeneous distribution of Sr, Si and Ag; such a coating promoted cell adhesion and osteogenic potential. The anchoring effect of the TNT layer improved the adhesion strength of the SSAgHA/TNT coating to 16.9 ± 3.1 MPa, which was higher than the 15 MPa set in the ISO standard 13 779-4:2002. Moreover, the bio-corrosion resistance of the underlying Ti substrate was greatly enhanced by the composite coating. Hydroxyapatite (HA) and SSAgHA coatings provided a suitable environment for the adhesion, spreading and proliferation of mouse osteoblasts. The SSAgHA coating excellently inhibited bacterial activity and enhanced osteoinductivity with higher osteogenic differentiation compared with the HA coating. Sr and Si dopants increased the expression levels of the genes related to osteogenesis and successfully offset the potential cytotoxicity of Ag ions. Super-osteoinductivity was attributed to the rough and superhydrophilic surface of the composite coating. Therefore, the present study demonstrated the potential of the electrodeposited SSAgHA/TNT composite coating as a promising metallic implant with great intrinsic antibacterial activity and osteointegration ability.

Application of a Strontium-Loaded, Phase-Transited Lysozyme Coating to a Titanium Surface to Enhance Osteogenesis and Osteoimmunomodulation

Background

To fabricate strontium (Sr)-incorporated titanium (Ti) surfaces by a novel 1-step phase-transited lysozyme (PTL) treatment, and investigate the effects of the prepared samples on osteogenesis and osteoimmunoregulation.

Material/Methods

Five groups of titanium specimens were prepared, including Ti, PTL, PTL@10Sr (PTL coating with 10 mg/mL Sr), PTL@20Sr PTL coating with 20 mg/mL Sr), and PTL@50Sr (PTL coating with 50 mg/mL Sr) groups. Behaviors of bone marrow mesenchymal stem cells (BMSCs) such as initial attachment, spread, proliferation, and migration, on different surfaces were examined by immunofluorescence, MTS assay, and Transwell system. Then the osteogenic differentiation of BMSCs was detected. When an immune response was factored in, the polarization of macrophages induced by the prepared surfaces was detected by real-time PCR, and the response of BMSCs to macrophage-conditioned medium was assessed in terms of cell migration and osteogenic differentiation. Finally, an in vivo study was performed, using the rat femora implant model, to evaluate the potential for osteogenic induction and osteoimmunoregulation of materials.

Results

Our in vitro experiments indicated that PTL coating could improve cell spread and adhesion, and the stable Sr release of PTL@Sr layers could promote cell migration and osteogenesis. Moreover, PTL@Sr surface could regulate the immune response of macrophages resulting in enhanced BMSCs recruitment and osteogenic differentiation. The in vivo evaluation showed less inflammatory infiltration and improved bone formation in the PTL@20Sr group.

Conclusions

The Sr-loaded PTL layers have greater potential for the induction of osteogenic differentiation of BMSCs, meanwhile Sr-loaded PTL layers could adjust the immune response and thus promote osteogenesis both in vitro and in vivo.

Micro/nano-hierarchical structured TiO2 coating on titanium by micro-arc oxidation enhances osteoblast adhesion and differentiation

Nano-structured and micro/nano-hierarchical structured TiO2 coatings were produced on polished titanium by the micro-arc oxidation (MAO) technique. This study was conducted to screen a suitable structured TiO2 coating for osteoblast adhesion and differentiation in dental implants. The formulation was characterized by scanning electron microscopy (SEM), X-ray diffraction (XRD) and wettability testing. Adhesion, proliferation and osteogenic differentiation of MG63 cells were analysed by SEM, Cell Counting Kit-8 (CCK-8) and quantitative real-time PCR. The micro/nano-hierarchical structured TiO2 coating with both slots and pores showed the best morphology and wettability. XRD analysis revealed that rutile predominated along with a minor amount of anatase in both TiO2 coatings. Adhesion and extension of MG63 cells on the micro/nano-hierarchical structured TiO2 coating were the most favourable. MG63 cells showed higher growth rates on the micro/nano-hierarchical structured TiO2 coating at 1 and 3 days. Osteogenic-related gene expression was markedly increased in the micro/nano-hierarchical structured TiO2 coating group compared with the polished titanium group at 7, 14 and 21 days. These results revealed the micro/nano-hierarchical structured TiO2 coating as a promising surface modification and suitable biomaterial for use with dental implants.

Role of p53 mediated miR-23a/CXCL12 pathway in osteogenic differentiation of bone mesenchymal stem cells on nanostructured titanium surfaces

Titanium surface modification is widely established and has been proven to improve the osseointegration, but the molecular mechanism remains to be fully elucidated. MicroRNAs serve vital roles in the process of regulating osteogenic differentiation of bone marrow-derived mesenchymal stem cells (BMSCs). In this study, we report that miR-23a was significantly down-regulated in the osteogenic differentiation process of BMSCs on nanostructured titanium surfaces. Elevated miR-23a inhibited osteogenic differentiation of BMSCs, and decreased miR-23a enhanced this process. In addition, we also observed that CXCL12 was a direct target of miR-23a. Knockdown of CXCL12 inhibited nanotube Ti induced-osteogenic differentiation of BMSCs, similar to the effect of upregulation of miR-23a. Finally, p53 was decreased and it regulated miR-23a/CXCL12 axis during nanotube Ti induced-osteogenic differentiation of BMSCs. Therefore, our findings suggest that by targeting CXCL12, miR-23a serves a vital role in osteogenic differentiation of BMSCs cultured on nanostructured titanium surfaces, which may provide novel clinical treatments for osseointegration.

Establishing an osteoimmunomodulatory coating loaded with aspirin on the surface of titanium primed with phase-transited lysozyme

BACKGROUND

To improve osseointegration and enhance the success rate of implanted biomaterials, the surface modification technology of bone implants has developed rapidly. Intensive research on osteoimmunomodulation has shown that the surfaces of implants should possess favorable osteoimmunomodulation to facilitate osteogenesis.

METHODS

A novel, green and efficient phase-transited lysozyme (PTL) technique was used to prime titanium discs with a positive charge. In addition, sodium hyaluronate (HA) and self-assembled type I collagen containing aspirin (ASA) nanoparticles were decorated on PTL-primed Ti discs via electrostatic interaction.

RESULTS

The behaviors of bone marrow stromal cells (BMSCs) on the Ti disc surfaces containing ASA were analyzed in different conditioned media (CM) generated by macrophages. Additionally, the secretion of inflammation-related cytokines of macrophages on the surfaces of different Ti discs was investigated in in vitro experiments, which showed that the Ti surface containing ASA not only supported the migration, proliferation and differentiation of BMSCs but also reduced the inflammatory response of macrophages compared with Ti discs without surface modification. After implantation in vivo, the ASA-modified implant can significantly contribute to bone formation around the implant, which mirrors the evaluation in vitro.

CONCLUSION

This study highlights the significant effects of appropriate surface characteristics on the regulation of osteogenesis and osteoimmunomodulation around an implant. Implant modification with ASA potentially provides superior strategies for the surface modification of biomaterials.

Carbon nanotube reinforced polyvinyl alcohol/biphasic calcium phosphate scaffold for bone tissue engineering

In this paper, a well-developed porous carbon nanotube (CNT) reinforced polyvinyl alcohol/biphasic calcium phosphate (PVA/BCP) scaffold was fabricated by a freeze-thawing and freeze-drying method. The microstructure, mechanical properties and the composition of the scaffolds were characterized by field emission scanning electron microscopy (FE-SEM), X-ray diffraction (XRD) and Fourier-transform infrared spectroscopy (FTIR). The results illustrate that after the incorporation of CNTs, the compressive strength of the hydrogels (moisture state) reached 81 ± 6 kPa, presenting a significantly higher value than that of pure PVA/BCP hydrogels (48 ± 2 kPa). Meanwhile, CNT reinforced PVA/BCP scaffolds exhibited a porous structure and high interconnectivity (80 ± 0.6%). The degradation analysis indicated that the degradation ratio of scaffolds can be varied by changing the concentrations of BCP powders and CNTs. Cell culture results show that PVA/BCP/CNT porous scaffolds have no negative effects on the survival and proliferation of cells. These results strongly show that the composite scaffolds may possess a potential application in the field of bone tissue engineering and regeneration.

In this paper, a well-developed porous carbon nanotube (CNT) reinforced polyvinyl alcohol/biphasic calcium phosphate (PVA/BCP) scaffold was fabricated by a freeze-thawing and freeze-drying method.

A cancellous bone matrix system with specific mineralisation degrees for mesenchymal stem cell differentiation and bone regeneration

Bone regenerative therapies have been explored using various biomaterial systems.

Inflammatory responses to micro/nano-structured titanium surfaces with silver nanoparticles in vitro

The fabricated AgPD-MNT exhibited potent antibacterial activity and mediated the inflammatory response.

Additively manufactured porous metallic biomaterials

Additively manufactured (AM, =3D printed) porous metallic biomaterials with topologically ordered unit cells have created a lot of excitement and are currently receiving a lot of attention given their great potential for improving bone tissue regeneration and preventing implant-associated infections.

Peptide LL-37 coating on micro-structured titanium implants to facilitate bone formation in vivo via mesenchymal stem cell recruitment

Titanium (Ti) and Ti-alloys were widely used in clinic orthopedics, however, the insufficient bone formation surrounding Ti-based implants still limited their biological performances. Surface modification of Ti substrates is essential to improve their interactions with bone-forming cells and bone tissue. In this study, we modified Ti substrates by coating peptide LL-37 onto micro-structured Ti substrates and aimed to (i) induce mesenchymal stem cells (MSCs) migration both in vitro and in vivo, (ii) facilitate osteogenic differentiation of MSCs and new bone formation. The surface micro-structured Ti substrates with hydroxyapatite deposition were fabricated by a two-step method including micro-arc oxidation (MAO) and hydrothermal treatment. LL-37 was loaded on micro-structured Ti substrates with the assistance of polydopamine coating. We confirmed that surface-modified Ti substrates benefited viability, adhesion, migration and osteogenic differentiation of MSCs in vitro. In a femur-defect rat model, the surface-modified Ti implants effectively induced CD29⁺/CD90⁺ positive cells migration in one week after implantation. According to the results of H&E, Masson's trichrome staining and immunohistochemical staining of OCN, OPN and collagen I, the targeted Ti implants exhibited significant new bone formation after implantation for 4 weeks. These results indicate that the surface modification of Ti samples facilitated bone formation through MSCs recruitment. STATEMENT OF SIGNIFICANCE: The inherent surface bioinertness of titanium (Ti) and Ti-alloys still limits their biological performances in clinical applications. Recently, the strategy of mesenchymal stem cells (MSCs) recruitment has been proposed to improve the osteointegration of bone implants. Herein, we reports the surface modification of Ti implants from the point of MSCs recruitment. Peptide LL-37 was coated on micro-structured Ti substrates to (i) recruit MSCs, (ii) regulate bio-physiological performance of MSCs, and (iii) facilitate bone formation in vivo. Our results improve the understanding of the interaction between Ti implants and MSCs, and provide a promising strategy of MSCs recruitment in the design of bone repair related biomaterials.

Zinc-Modified Sulfonated Polyetheretherketone Surface with Immunomodulatory Function for Guiding Cell Fate and Bone Regeneration

The cytokines released by immune cells are considered important factors to induce bone tissue regeneration. However, the pathway of those bone-targeting macrophage cytokines induced by biomaterial surface under tissue microenvironment is rarely reported. In this study, the immunomodulatory capability of zinc ions on macrophage polarization and its effects on osteogenic differentiation are investigated. Hence, a layer of zinc ions are incorporated on sulfonated polyetheretherketone (SPEEK) biomaterials by using a customized magnetron sputtering technique. The results reveal that the microenvironment on Zn-coated SPEEK can modulate nonactivated macrophage polarization to an anti-inflammatory phenotype and induce the secretion of anti-inflammatory and osteogenic cytokines. The osteogenic differentiation capability of bone marrow stromal cells (BMSCs) is therefore enhanced, leading to improved osteointegration between the zinc-coated SPEEK and bone tissue. This study verifies that zinc ion is a promising additive in the osteoimmunomodulation process and provides knowledge that may pave the way to develop the next generation of immunomodulatory biomaterials.

Differential effect of hydroxyapatite nano-particle versus nano-rod decorated titanium micro-surface on osseointegration

Coating materials applied for intraosseous implants must be optimized to stimulate osseointegration. Osseointegration is a temporal and spatial physiological process that not only requires interactions between osteogenesis and angiogenesis but also necessitates a favorable immune microenvironment. It is now well-documented that hierarchical nano-micro surface structures promote the long-term stability of implants, the interactions between nano-micro structure and the immune response are largely unknown. Here, we report the effects of microporous titanium (Ti) surfaces coated with nano-hydroxyapatite (HA) produced by micro-arc oxidation and steam-hydrothermal treatment (SHT) on multiple cell behavior and osseointegration. By altering the processing time of SHT it was possible to shift HA structures from nano-particles to nano-rods on the microporous Ti surfaces. Ti surfaces coated with HA nano-particles were found to modulate the inflammatory response resulting in an osteoimmune microenvironment more favorable for osteo-/angio-genesis, most likely via the activation of certain key signaling pathways (TGF-β, OPG/RANKL, and VEGF). By contrast, Ti surfaces coated with nano-rod shaped HA particles had a negative impact on osteo-/angio-genesis and osteoimmunomodulation. In vivo results further demonstrated that Ti implant surfaces decorated with HA nano-particles can stimulate new bone formation and osseointegration with enhanced interaction between osteocytes and implant surfaces. This study demonstrated that Ti implants with micro-surfaces coated with nano-particle shaped HA have a positive impact on osseointegration.

STATEMENT OF SIGNIFICANCE

Osteo-/angio-genesis are of importance during osteointegration of the implants. Recent advances unravel that immune response of macrophages and its manipulated osteoimmunomodulation also exerts a pivotal role to determine the fate of the implant. Surface nano-micro modification has evidenced to be efficient to influence osteogenesis, however, little is known links nano-microstructured surface to immune response, as well the osteoimmunomodulation. This study demonstrates that the nano-particles decorated micro-surface, compared with the nano-rods decorated micro-surface enables osteogenesis and angiogenesis concurrently that has not been investigated previously. This study also unravels that the immune response of macrophages can be manipulated by the nano-micro surface, especially the nano-dimension matters, leading to a differential effect on osteointegration. The additional knowledge obtained from this study may provide foundation and reference for future design of the coating materials for implantable materials.

Titanium-based implant comprising a porous microstructure assembled with nanoleaves and controllable silicon-ion release for enhanced osseointegration

Osseointegration is crucial for early fixation as well as for long-term implantation success, hence numerous efforts have been made to tune the surface topography or chemical composition of biomedical implants to improve osseointegration. In this work, various nanostructures, including nanoflocs, nanobundles, nanorods, and nanoleaves, were introduced to the surface of silicon (Si)-incorporated microporous structure to form Si-incorporated micro-nano hierarchical structures on titanium (Ti)-based implants. The osseointegration of the implants were systemically assessed in vivo and in vitro. The in vitro evaluations showed that the nanostructures promoted the protein adsorption, thus modulating the early cellular responses, including the attachment and spreading of osteoblasts and human endothelial cells (HUVECs), and subsequent cell proliferation and differentiation. Furthermore, compared with the single microporous structure, the nanostructures located over the microporous structure protected the Si ions from quick release and allowed the long-term sustained Si-ions release, which further contributed to the proliferation and differentiation of osteoblasts and vascular endothelial growth factor (VEGF) secretion as well as the tube formation of HUVECs. Collectively, the favorable nano-surface structures, especially the nanoleaves structure, and the constant Si-ion release together led to robust osteogenic and angiogenic activities. More importantly, in vivo micro-CT evaluation and histological observations further verified that the Si-incorporated micro-nano hierarchical implant with nanoleaves structure could efficiently promote new bone formation, thus indicating it was an attractive candidate as a next-generation bone-implant material.

The synergistic effect of strontium-substituted hydroxyapatite and microRNA-21 on improving bone remodeling and osseointegration

Surgical failure, mainly caused by loosening implants, causes great mental and physical trauma to patients.

The effects of TiO2 nanotube arrays with different diameters on macrophage/endothelial cell response and ex vivo hemocompatibility

Percutaneous coronary intervention with stenting is the most widely adopted surgical technique for the treatment of coronary disease.