Biocompatibility studies on biodegradable polyester-based composites of human osteoblasts: a preliminary screening

Resorption and remodeling of hydroxyapatite-poly-L-lactic acid composite anterior cruciate ligament interference screws

PURPOSE

The purpose of this study was to evaluate the progression of hydroxyapatite-poly-L-lactic acid (HA-PLLA) interference screw resorption and remodeling in patients after anterior cruciate ligament (ACL) reconstruction.

METHODS

Sixty-five patients undergoing ACL reconstruction with patellar tendon autograft or allograft fixed at both the femur and tibia with HA-PLLA screws were evaluated. We evaluated 10 patients each at 2, 3, and 4 years postoperatively, whereas 35 patients were evaluated at 5 years postoperatively. In all patients a physical examination was performed and functional outcome scores and computed tomography (CT) analysis were obtained at follow-up.

RESULTS

Screw tract densities determined by CT at 5 years postoperatively were higher than muscle and were similar to the surrounding bone. At 4 years, 80% to 90% of screws were completely resorbed. At 5-year follow-up, 29% of patients showed complete ossification of the screw tract in the femur versus 34% in the tibia. There was no tunnel widening or sclerosis noted. Subjective and objective clinical results remained high throughout the study period.

CONCLUSIONS

The HA-PLLA interference screws are slowly resorbed over time, and the majority are completely resorbed between 3 and 4 years after ACL reconstruction with patellar tendon autograft or allograft. Osteoconductivity and remodeling were confirmed by CT scans, and no tunnel widening, sclerosis, cysts, or inflammatory changes were noted.

LEVEL OF EVIDENCE

Level IV, therapeutic case series.

Starch and its Derived Products: Biotechnological and Biomedical Applications

Starches are one of the most abundant renewable natural resources available to us, however their potential as a biomass feedstock for the production of a vast range of commercially viable chemicals/components for application in many areas of industrial, food and biomedical sciences is currently under-exploited. This review begins by presenting an overview of starch sources, composition and structure, and physicochemical characteristics. Specific topics discussed include amylose and amylopectin structure, their location in the amorphous and crystalline regions of starch granules, granule morphology, gelatinisation and pasting characteristics. The remainder of the review then focuses upon the biotechnological production of starch hydrolysis products, such as maltodextrins, glucose and fructose syrups, and cyclodextrins, and the chemical modification of starch, namely, oxidation, stabilisation (esterification and etherification), and cross-linking. Finally some specific examples of the development of starch-derived biomaterials for application in areas such as orthopaedics, bone cements, tissue engineering, and hydrogels are presented.

Isolation and Osteogenic Differentiation of Rat Periosteum-derived Cells

Selection of appropriate cultures having an osteogenic potential is a necessity if cell/biomaterial interactions are studied in long-term cultures. Osteoblastic cells derived from rat long bones or calvaria have the disadvantage of being in an advanced differentiation stage which results in terminal differentiation within 21 days. In this regard, less differentiated periosteum-derived osteoprogenitors could be more suitable.Periosteum-derived cells were isolated from the tibiae of adult Wistar rats (n = 12). The osteogenic potential with regard to alkaline phosphatase activity, morphology, nodule formation and mineralization was studied by culturing them in an osteogenic medium for up to 4 months.Seventy-five percent of the cultures (n = 9) did not show any increase in alkaline phosphatase activity nor nodule formation during long-term culture for up to 4 months. Nevertheless, in 25% of the cultures, alkaline phosphatase activity started from negligible (<5 mM pNP/mg protein) and increased towards approximately 50 mM pNP/mg protein. Three-dimensional nodule formation was observed at passages 3-5. In further passages (P5-P7), nodule formation capacity decreased and a diffuse mineralization pattern was observed.Suitable cultures with osteogenic capacity, can be selected at early passages based on the presence of cuboidal cells. These cells have the advantage of retaining their osteogenic potential even after prolonged cultivation (6-7 passages) before final differentiation occurs. Although periosteal cells are suitable for long term in vitro evaluation of biomaterials, the isolation and selection is time consuming. Hence, a more appropriate source to study cell/biomaterial interactions should be more convenient.

Biodegradable poly(alpha-hydroxy acid) polymer scaffolds for bone tissue engineering

Synthetic graft materials are emerging as a viable alternative to autogenous bone graft and bone allograft for the treatment of critical-sized bone defects. These materials can be osteoconductive but are rarely intrinsically osteogenic, although this can be greatly enhanced by the application of bone morphogenetic proteins (BMPs). This review will discuss the versatility of biodegradable poly(alpha-hydroxy acids) for the delivery of BMPs for bone tissue engineering. Poly(alpha-hydroxy acids) have a considerable potential for customization and adaptability via modification of design parameters, including scaffold architecture, composition, and biodegradability. Different fabrication techniques will also be discussed.

Biocompatibility of bioresorbable poly(L-lactic acid) composite scaffolds obtained by supercritical gas foaming with human fetal bone cells

The aim of this investigation was to test the biocompatibility of three-dimensional bioresorbable foams made of poly(L-lactic acid) (PLA), alone or filled with hydroxyapatite (HA) or beta-tricalcium phosphate (beta-TCP), with human primary osteoblasts, using a direct contact method. Porous constructs were processed by supercritical gas foaming, after a melt-extrusion of ceramic/polymer mixture. Three neat polymer foams, with pore sizes of 170, 310, and 600 microm, and two composite foams, PLA/5 wt% HA and PLA/5 wt% beta-TCP, were examined over a 4-week culture period. The targeted application is the bone tissue-engineering field. For this purpose, human fetal and adult bone cells were chosen because of their highly osteogenic potential. The association of fetal bone cells and composite scaffold should lead to in vitro bone formation. The polymer and composite foams supported adhesion and intense proliferation of seeded cells, as revealed by scanning electron microscopy. Cell differentiation toward osteoblasts was demonstrated by alkaline phosphatase (ALP) enzymatic activity, gamma-carboxylated Gla-osteocalcin production, and the onset of mineralization. The addition of HA or beta-TCP resulted in higher ALP enzymatic activity for fetal bone cells and a stronger production of Gla-osteocalcin for adult bone cells.

Reduced bone tunnel enlargement post hamstring ACL reconstruction with poly-L-lactic acid/hydroxyapatite bioabsorbable screws

Bone tunnel enlargement following anterior cruciate ligament (ACL) reconstruction can complicate revision surgery. This study compared postoperative tibial tunnel widening in patients who underwent arthroscopically assisted, single-incision, four-strand hamstring ACL reconstruction using a poly-L-lactic acid/hydroxyapatite blend (PLLA+HA) bioabsorbable interference screw for tibial fixation, with those in whom a plain poly-L-lactic acid (PLLA) screw was used. Thirty-four patients (13 with PLLA+HA tibial interference screw fixation and 21 with plain PLLA tibial interference screws) underwent a spiral CT scan to assess maximum tibial tunnel cross-sectional area at an average of 28.7 months follow-up. An assessment of tunnel wall sclerosis adjacent to the screw (cortication) was also made. The two groups were well matched for age, sex and graft diameters. Mean tibial tunnel enlargement in patients with PLLA+HA screws was 29.9% at average 30.9 months follow-up compared with 46% in patients with plain PLLA screw at an average 26.5 months follow-up (p=0.03). The tunnel wall adjacent to the screw appeared corticated in only 21% of patients with PLLA+HA screws (p=0.02) compared with 73% of patients with PLLA screws. The blending of HA with PLLA appears to reduce postoperative tunnel widening, and the reduced tunnel wall sclerosis seen postoperatively may indicate improved screw incorporation.

Human osteoblast cells: Isolation, characterization, and growth on polymers for musculoskeletal tissue engineering

We performed a detailed examination of the isolation, characterization, and growth of human osteoblast cells derived from trabecular bone. We further examined the morphology, phenotypic gene expression, mineralization,and growth of these human osteoblasts on polyester polymers used for musculoskeletal tissue engineering. Polylactic-co-glycolic acid [PLAGA (85:15, 50:50, 75:25)], and poly-lactic acid (L-PLA, D,L-PLA) were examined. The osteoblastic expression of key phenotypic markers osteocalcin, alkaline phosphatase, collagen, and bone sialoprotein at 4 and 8 weeks was examined. Reverse transcription-polymerase chain reaction studies revealed that trabecular-derived osteoblasts were positive for all markers evaluated with higher levels expressed over long-term culture. These cells also revealed mineralization and maturation as evidenced by energy dispersive X-ray analysis and scanning electron microscopy. Growth studies on PLAGA at 50:50,75:25, and 85:15 ratios and PLA in the L and DL isoforms revealed that human osteoblasts actively grew, with significantly higher cell numbers attached to scaffolds composed of PLAGA 50:50 in the short term and PLAGA 85:15 in the long term compared with PLA (p < 0.05). We believe human cell adhesion among these polymeric materials may be dependent on differences in cellular integrin expression and extracellular matrix protein elaboration.

Hydrothermal growth of hydroxyapatite scaffolds from aragonitic cuttlefish bones

Scaffolds of AB-type carbonated hydroxyapatite (HA) were successfully produced via hydrothermal transformation (HT) of aragonitic cuttlefish bones at 200 degrees C. The transformation was seemingly complete after 9 h of HT and no intermediate products were registered. Beyond low production cost, worldwide availability, and natural-biological origin of raw materials, the produced scaffolds preserved the initial structure of cuttlefish bone, featuring good biocompatibility in osteoblasts tests and ideal pore size ( approximately 80 microm in width and approximately 100 microm in height) and interconnectivity for supporting biological activities, such as bone tissue growth and vascularization. The highly channeled structure and the use of fresh cuttlefish bones favored the diffusion of the reaction solution towards the aragonite resulting in fast kinetics (after 1 h, hydroxyapatite was the dominant crystalline phase).

Scaffolds for bone restoration from cuttlefish

Scaffolds of pure hydroxyapatite suitable for either direct clinical use or tissue-engineering applications were successfully produced via hydrothermal transformation of aragonite, obtained from fresh cuttlefish bones, at 200 degrees C followed by sintering. Beyond low production cost, worldwide availability and natural-biological origin of raw materials, the produced scaffolds have ideal pore size and interconnectivity features suitable for supporting biological activities, such as bone tissue growth and vascularization. Bioactivity in vitro tests were excellent: (a) rapid and pronounced formation of hydroxyapatite occurred when the scaffolds were immersed in simulated body fluid (SBF), and (b) outstanding proliferation of osteoblasts was registered. The produced scaffolds can be machined and shaped very easily at any stage of processing. Therefore, these ceramic scaffolds can satisfy both bioactivity demands and the requirements for shaping of tailor-made individualized implants, especially for randomly damaged bones.

Bioresorbable composites prepared by supercritical fluid foaming

Bone is a natural composite construct, with a gradient structure going from a loose interconnected cellular core to an outer dense wall, thus minimizing bone weight while keeping a high mechanical resistance. Due to this unique and complex structure, bone defects are difficult to replace or repair. Tissue engineering aims at providing artificial bone grafts. Several techniques have been proposed to produce porous structures or scaffolds, but, as yet, with no optimal solutions. This article focuses on bioresorbable ceramic-polymer composite foams obtained by supercritical fluid foaming. This flexible technique enables an adequate morphology and suitable properties for bone tissue engineering to be obtained. Composite scaffolds are biocompatible, allowing cell proliferation and differentiation.

Development of hybrid materials based on hydroxyethylmethacrylate as supports for improving cell adhesion and proliferation

A novel hydrogel based on 2-hydroxyethylmethacrylate and fumed silica nanoparticles is presented. The filler was mixed at increasing amount (3-40% w/w) to the organic monomer, before accomplish thermal polymerization. The hybrid composite materials obtained were characterized as far as concern the physical-chemical stability and sorption behaviour in water and water solutions. The novel hybrid hydrogels were compared to poly(hydroxyethylmethacrylate) (pHEMA) on cytocompatibility and ability to elicit cell adhesion and proliferation. These in vitro assays showed that the first ones were supporting cell growth better then pHEMA, moreover experiments on murine fibroblasts showed improved adhesion and proliferation with the increase of the nanomeric filler content. For a more physiological response, the in vitro tests should match biomaterials with cell populations typical of the implant site. Therefore, in view of future applications of these composites as scaffolds for bone engineering, in a successive step of our research we selected primary cultures of human osteoblasts (OB) as the most appropriate models to study the in vitro performance of these materials. The preliminary results obtained confirmed the remarkable improvement of OB adhesion properties of the new hybrids with respect to pure pHEMA.

IGF-I and TGF-beta 1 incorporated in a poly(D,L-lactide) implant coating stimulates osteoblast differentiation and collagen-1 production but reduces osteoblast proliferation in cell culture

Previous in vivo studies revealed a stimulating effect of locally applied IGF-I and TGF-beta1 released from poly(D,L-lactide)-coated titanium implants on rat and porcine fracture healing. The purpose of the present study was to evaluate the effect of IGF-I (5% w/w) and TGF-beta1 (1% w/w) and the carrier PDLLA on osteoblasts in cell culture to improve the understanding of these growth factors. The well-characterized human osteoblast cell line hFOB 1.19 was used in the study. The implants and cells were cocultured in a noncontact manner. The cells were incubated for 10 days in total, and the implants (n = 6 each group and time point) were added for 1 h, 12 h, 24 h, 2 d, 4 d, or 10 d. To analyze a possible effect of the growth factors or the coating, cell proliferation, metabolism, and differentiation were investigated. As an indicator for differentiation the production of collagen I was chosen. All experimental groups showed comparable cell vitality. No change in the pH of the medium was detectable between the analyzed groups. When the effect of the titanium implant and the PDLLA coating were compared with the control culture, no differences in proliferation, metabolic activity, and collagen I production were detectable. The osteoblasts treated with IGF-I and TGF-beta1 released from PDLLA revealed a significantly enhanced collagen I production with a decrease in proliferation and metabolic activity compared to the other groups. No significant differences in collagen I production were seen due to the incubation time points. None of the experimental groups evoked an immunological response on mouse macrophages. In conclusion, the PDLLA-carrier showed no negative effect on osteoblasts, whereas the incorporated growth factors stimulated osteoblast differentiation.