In vitro properties of a chitosan-bonded bone-filling paste: studies on solubility of calcium phosphate compounds

Multi-element processed pyritum mixed to β-tricalcium phosphate to obtain a 3D-printed porous scaffold: An option for treatment of bone defects

Bone defects remain a challenging problem for doctors and patients in clinical practice. Processed pyritum is a traditional Chinese medicine that is often used to clinically treat bone fractures. It contains mainly Fe, Zn, Cu, Mn, and other elements. In this study, we added the extract of processed pyritum to β-tricalcium phosphate and produced a porous composite TPP (TCP/processed pyritum) scaffold using digital light processing (DLP) 3D printing technology. Scanning electron microscopy (SEM) analysis revealed that TPP scaffolds contained interconnected pore structures. When compared with TCP scaffolds (1.35 ± 0.15 MPa), TPP scaffolds (5.50 ± 0.24 MPa) have stronger mechanical strength and can effectively induce osteoblast proliferation, differentiation, and mineralization in vitro. Meanwhile, the in vivo study showed that the TPP scaffold had better osteogenic capacity than the TCP scaffold. Furthermore, the TPP scaffold had good biosafety after implantation. In summary, the TPP scaffold is a promising biomaterial for the clinical treatment of bone defects.

Polymeric additives to enhance the functional properties of calcium phosphate cements

The vast majority of materials used in bone tissue engineering and regenerative medicine are based on calcium phosphates due to their similarity with the mineral phase of natural bone. Among them, calcium phosphate cements, which are composed of a powder and a liquid that are mixed to obtain a moldable paste, are widely used. These calcium phosphate cement pastes can be injected using minimally invasive surgery and adapt to the shape of the defect, resulting in an entangled network of calcium phosphate crystals. Adding an organic phase to the calcium phosphate cement formulation is a very powerful strategy to enhance some of the properties of these materials. Adding some water-soluble biocompatible polymers in the calcium phosphate cement liquid or powder phase improves physicochemical and mechanical properties, such as injectability, cohesion, and toughness. Moreover, adding specific polymers can enhance the biological response and the resorption rate of the material. The goal of this study is to overview the most relevant advances in this field, focusing on the different types of polymers that have been used to enhance specific calcium phosphate cement properties.

Calcium phosphate-based composites as injectable bone substitute materials

A major weakness of current orthopedic implant materials, for instance sintered hydroxyapatite (HA), is that they exist as a hardened form, requiring the surgeon to fit the surgical site around an implant to the desired shape. This can cause an increase in bone loss, trauma to the surrounding tissue, and longer surgical time. A convenient alternative to harden bone filling materials are injectable bone substitutes (IBS). In this article, recent progress in the development and application of calcium phosphate (CP)-based composites use as IBS is reviewed. CP materials have been used widely for bone replacement because of their similarity to the mineral component of bone. The main limitation of bulk CP materials is their brittle nature and poor mechanical properties. There is significant effort to reinforce or improve the mechanical properties and injectability of calcium phosphate cement (CPC) and this review resumes different alternatives presented in this specialized literature.

Properties of anti-washout-type calcium silicate bone cements containing gelatin

Novel washout-resistant bone substitute materials consisting of gelatin-containing calcium silicate cements (CSCs) were developed. The washout resistance, setting time, diametral tensile strength (DTS), morphology, and phase composition of the hybrid cements were evaluated. The results indicated that the dominant phase of beta-Ca(2)SiO(4) for the SiO(2)-CaO powders increased with an increase in the CaO content of the sols. After mixing with water, the setting times of the CSCs ranged from 10 to 29 min, increasing with a decrease in the amount of CaO in the sols. Addition of gelatin into the CSC significantly prolonged (P < 0.05) the setting time by about 2 and 8 times, respectively, for 5% and 10% gelatin. However, the presence of gelatin appreciably improved the anti-washout and brittle properties of the cements without adversely affecting mechanical strength. It was concluded that 5% gelatin-containing CSC may be useful as bioactive bone repair materials.

Novel injectable calcium phosphate/chitosan composites for bone substitute materials

In this study, a novel injectable bone substitute material was developed which consists of chitosan, citric acid and glucose solution as the liquid phase, and tricalcium phosphate powder as the solid phase. This material was moldable because of its paste consistency after mixing. We used four groups of cement to investigate the mechanical properties and biocompatibility of the new biomaterial in vitro, which were named group A (10% citric acid), B (15% citric acid), C (20% citric acid) and D (25% citric acid). The setting times of the cements were 5-30 min. X-ray diffraction analysis showed that the products were hydroxyapatite (HA) and dicalcium phosphate anhydrous. When the concentration of citric acid was increased, the compressive strength of specimen increased. Through the simulated body fluid test, we observed the material was bioactive. Group D could induce Ca and P ions to deposit the surface group D quickly. These results indicated that the concentration of citric acid in the liquid component affected the mechanical properties and bioactivity of cements. The cell cultivation test showed that the cytocompatibility of the new biomaterial was good. The method for preparing the novel bone substitute material is simple. The starting material is more readily available and cheaper than HA, poly(methyl methacrylate), and so on. The cement could have good prospects for medical application.

Fast Setting Calcium Phosphate Cement-Chitosan Composite: Mechanical Properties and Dissolution Rates

Calcium phosphate cement (CPC) can self-harden in vivo to form hydroxyapatite (HA) with excellent osteoconductivity. In recent studies, CPC-chitosan composites are developed with high mechanical strength and washout resistance. The objectives of the present study are to optimize the setting time and mechanical properties of a CPC-chitosan composite by tailoring the chitosan content, and to evaluate the bioresorbability by using an in vitro dissolution model. Six chitosan mass fractions are tested: 0, 10, 15, 20, 25, and 30%. Specimens are immersed in solutions with pH ranging from 3.5 to 5 to simulate the acidic environments produced by osteoclasts in vivo. Dissolution is measured as the fraction of mass loss versus immersion time from 7d to 28d. The CPC-chitosan composite with 20% by mass chitosan has a setting time (mean±SD; n=4) of 13 1 min, significantly less than 87 7 min for CPC control without chitosan (p<0.05). The composite flexural strength (mean±SD; n 1/4 6) was 14 2 MPa, significantly higher than 4 1 MPa of CPC control (p<0.05). At an intermediate pH of 4.5, the fraction of mass loss for CPC with 20% chitosan and CPC control without chitosan are not significantly different (p>0.1). The dissolution rates (fraction of mass loss per day,%/d) were 1.05 for CPC control and 1.08 for CPC-chitosan. In summary, a CPC-chitosan composite is developed with fast-setting and a flexural strength three-fold of that of CPC control without chitosan. Both materials are soluble in acidic environments, indicating that adding chitosan did not compromise the bioresorbability of CPC. The strong and resorbable CPC–chitosan composite may be useful in moderate stress-bearing craniofacial and orthopedic repairs.

Extensive H+ release by bone substitutes affects biocompatibilityin vitro testing

Bone substitutes are widespread in orthopedic and trauma surgery to restore critical bony defects and/or promote local bone healing. Cell culture systems have been used for many years to screen biomaterials for their toxicity and biocompatibility. This study applies a human bone marrow cell culture system to evaluate the toxic in vitro effects of soluble components of different bone substitutes, which are already in clinical use. Different specimens of tricalcium phosphates (TCP) (Vitoss, Cerasorb), nondecalcified bovine bone (Lubboc), demineralized human bone matrices (DBM) (Grafton Flex/Putty), and collagen I/III matrix (ACI-Maix) were tested in Dulbecco's modified Eagle's medium (DMEM) and MesenCult culture solution and compared with a biomaterial-free cell culture. Biocompatibility parameters were cell viability evaluated by phase-contrast microscopy and laser flow cytometry, morphology, and the local H(+) release by bone substitutes. There were significant differences (p < 0.05) between the tested biomaterials and culture solutions. Collagen I/III, non-demineralized bovine bone, and TCP materials showed advantages for cell survival over other tested biomaterials (average values of vital cells/mL MesenCult/DMEM: Collagen I/III: 1090/1083; Vitoss: 893/483; Cerasorb: 471/523; Lubboc: 815/410; Grafton Putty: 61/44; Grafton Flex: 149/57). Especially the DBM materials lead to a significant decrease of pH, which is considered to be a major factor for cell death. DMEM culture solution supports cell survival for those bone substitutes that induce an alkaline reaction, whereas MesenCult media promotes cell vitality in biomaterials, which leads to an acidification of culture solution.

Properties of elastomeric calcium phosphate cement–chitosan composites

OBJECTIVE

Self-hardening calcium phosphate cements (CPC) have been shown to be efficacious in a number of clinical applications. For some applications it is desirable to have CPC in a non-rigid resorbable elastomeric matrix. In the present study, chitosan was evaluated as the matrix for preparing CPC-chitosan composites.

METHODS

Cement specimens were prepared by mixing CPC powder (an equimolar mixture of tetracalcium phosphate and dicalcium phosphate anhydrous) with a chitosan solution at a powder/liquid ratio of 2-2.5. The setting time was measured by a Gilmore needle method. A standard three-point flexural test was used to fracture the specimens at a crosshead speed of 0.5 mm/min. Powder X-ray diffraction analysis was used to determine the conversion of the CPC to hydroxyapatite.

RESULTS

The CPC-chitosan composites were more stable in water than conventional CPC. They did not disintegrate even when placed in water immediately after mixing. The CPC-chitosan paste hardened within 10 min in all cases. The 1d mean flexural modulus (GPa) for the control CPC was 5.3 (0.3) (mean (standard deviation); n=5), and that for CPC-chitosan composites were between 2.7 (0.3) and 4.7 (0.3). The 1d mean flexural strength (MPa) for the control was 16.6 (1.9), and that for the CPC-chitosan ranged from 4.5 (0.5) and 12.0 (1.0) (n=5). Chitosan did not interfere the conversion of CPC components to hydroxyapatite.

SIGNIFICANCE

This study demonstrates that CPC-chitosan composites are stable in a wet environment and have acceptable mechanical strengths for clinical applications.

An animal evaluation of a paste of chitosan glutamate and hydroxyapatite as a synthetic bone graft material

The objective of this study was to develop a synthetic bone graft in a paste form. Reported here are the results of the evaluation of a paste of chitosan glutamate (Protosan) and hydroxyapatite (referred to as a paste) used in a critical size defect model in rats. Eight-millimeter--diameter cranial defects were made in rat calvaria following a protocol approved by the animal review committee. Five groups were studied: (1) empty control, (2) defect filled with paste only, (3) defect filled with the paste containing bone-marrow aspirate, (4) defect filled with paste containing BMP-2, and (5) defect filled with paste containing osteoblasts cultured from bone-marrow aspirate. The sacrifice intervals were 9 and 18 weeks. Calvaria containing the defect were harvested, and the bone mineral density (BMD) was determined by dual energy X-ray absorptiometry. Push-out strength measurements were also performed. The BMD values of empty control were significantly lower than those of other groups at both 9 and 18 weeks. The mechanical properties, that is, push-out strengths and area under the push-out load and displacement were not significantly different between the samples. Histological examination of Goldner-trichromestained undecalcified sections showed the presence of mineralized bone spicules in the defect areas that were more prominent in those filled with paste and osteoblasts cultured from bone-marrow aspirate. Hence, this study demonstrated that the paste of chitosan glutamate and hydroxyapatite-containing osteoblasts cultured from bone-marrow aspirate would be an effective material to repair bone defects.

Crystal polymer interaction with new injectable bone substitute; SEM and Hr TEM study

A composite constituted of calcium phosphate (CaP) granules and a hydrophilic polymer as a carrier (hydroxy-propyl-methyl cellulose, HPMC) was developed to be an injectable bone substitute (IBS, CNRS patent). IBS is a composite and not an ionic cement. The composite obtained is ready to use and sterile. Chemical interactions between organic and inorganic components appeared during the association of the two. The interactions of the CaP and the polymer have been studied using scanning electron microscopy (SEM), electron microprobe (EDX), and high-resolution transmission electron microscopy (HrTEM) SEM revealed a degradation of the granules into smaller particles while EDX was unable to show significant changes in the Ca/P ratio during aging of the composite. With Hr TEM, however, we observed hydrolysis (process of dissolution and precipitation) from the surface to about 13 nm into the HA crystals and occasional dissolution with precipitation of beta-TCP crystals. In HA, the first zone of interaction consisted of a single layer of small globular crystals of 2 to 3 nm in diameter. Numerous lattice patterns in all three axes could be observed. Under the globular crystals zone, the inter-reticular distances of the single crystals appeared enlarged by 1.2% (from 0.817 to 0.827 nm). The enlargement seems to correspond to diffusion of HPO(4) into the crystal lattice. In beta-TCP crystals, dissolution was observed to be several nanometers deep, but globular surface precipitation rarely was observed. With time or after steam sterilization, no changes were observed. These data demonstrate the strong interactions of the hydrophylic polymer with calcium phosphate, but only in the first several nanometers of thickness.