2010 Panel on the biomaterials grand challenges

Engineering of an Osteoinductive and Growth Factor-Free Injectable Bone-Like Microgel for Bone Regeneration

Bone autografts remain the gold standard for bone grafting surgeries despite having increased donor site morbidity and limited availability. Bone morphogenetic protein-loaded grafts represent another successful commercial alternative. However, the therapeutic use of recombinant growth factors has been associated with significant adverse clinical outcomes. This highlights the need to develop biomaterials that closely approximate the structure and composition of bone autografts, which are inherently osteoinductive and biologically active with embedded living cells, without the need for added supplements. Here, injectable growth factor-free bone-like tissue constructs are developed, that closely approximate the cellular, structural, and chemical composition of bone autografts. It is demonstrated that these micro-constructs are inherently osteogenic, and demonstrate the ability to stimulate mineralized tissue formation and regenerate bone in critical-sized defects in-vivo. Furthermore, the mechanisms that allow human mesenchymal stem cells (hMSCs) to be highly osteogenic in these constructs, despite the lack of osteoinductive supplements, are assessed, whereby Yes activated protein (YAP) nuclear localization and adenosine signaling appear to regulate osteogenic cell differentiation. The findings represent a step toward a new class of minimally invasive, injectable, and inherently osteoinductive scaffolds, which are regenerative by virtue of their ability to mimic the tissue cellular and extracellular microenvironment, thus showing promise for clinical applications in regenerative engineering.

Albumin-Coated Polycaprolactone (PCL)-Decellularized Extracellular Matrix (dECM) Scaffold for Bone Regeneration

With the emphasis on collagen and hydroxyapatite, the main structural components of bone tissue, synthetic grafts fall short of matching the clinical efficacy of autologous bone grafts. Excluded non-collagenous protein (NCPs) and carbohydrates also participate in critical cell signaling cascades and guide mineral deposition during intermediate stages of bone healing. By mimicking the native fracture repair process, polymeric scaffolds that incorporate calcium-binding moieties present in fibrocartilage can potentially enhance their bioactivity, mineralization, and bone growth. Likewise, coating polymeric fibers with serum albumin is an additional strategy that can impart collagen-like biofunctionality and further increase mineral deposition on the fibrous surface. Here, a combination of electrospun polycaprolactone (PCL) fibers with chondrocyte-derived decellularized extracellular matrix (dECM) and albumin coating were investigated as a fibrocartilage-mimetic scaffold that can serve as a woven bone precursor for bone regeneration. PCL fibrous constructs coated with dECM and albumin are shown to synergistically increase calcium concentration and calcium phosphate (CaP) deposition in a simulated body fluid biomineralization assay. Albumin/dECM coating increased osteoblast proliferation and mineral deposition in culture. In contrast, CaP coating transformed osteoblast bone lining morphology into cuboidal phenotype and arrested their proliferation. Cell sheets of osteoblasts cultured on dECM/albumin/CaP-coated constructs exhibited an increase in calcium deposition and secretion of collagen, osteopontin, osteocalcin, and bone morphogenetic protein. These results highlight the potential of biomolecular coatings to enhance bone-mimetic properties of synthetic nanofibrous scaffolds, stimulate critical protein and mineral deposition, and augment the bone's capacity to heal. Thus, mimicking the intermediate stages of bone regeneration by incorporating calcium-binding moieties may prove to be a useful strategy for improving the clinical outcomes of synthetic bone grafts.

Biodegradable Polyphosphazenes for Regenerative Engineering

Regenerative engineering is a field that seeks to regenerate complex tissues and biological systems, rather than simply restore and repair individual tissues or organs. Since the first introduction of regenerative engineering in 2012, numerous research has been devoted to the development of this field. Biodegradable polymers such as polyphosphazenes in particular have drawn significant interest as regenerative engineering materials for their synthetic flexibility in designing into materials with a wide range of mechanical properties, degradation rates, and chemical functionality. These polyphosphazenes can go through complete hydrolytic degradation and provide harmlessly and pH neutral buffering degradation products such as phosphates and ammonia, which is crucial for reducing inflammation in vivo. Here, we discuss the current accomplishments of polyphosphazene, different methods for synthesizing them, and their applications in tissue regeneration such as bones, nerves, and elastic tissues.

Engineered stem cell niche matrices for rotator cuff tendon regenerative engineering

Rotator cuff (RC) tears represent a large proportion of musculoskeletal injuries attended to at the clinic and thereby make RC repair surgeries one of the most widely performed musculoskeletal procedures. Despite the high incidence rate of RC tears, operative treatments have provided minimal functional gains and suffer from high re-tear rates. The hypocellular nature of tendon tissue poses a limited capacity for regeneration. In recent years, great strides have been made in the area of tendonogenesis and differentiation towards tendon cells due to a greater understanding of the tendon stem cell niche, development of advanced materials, improved scaffold fabrication techniques, and delineation of the phenotype development process. Though in vitro models for tendonogenesis have shown promising results, in vivo models have been less successful. The present work investigates structured matrices mimicking the tendon microenvironment as cell delivery vehicles in a rat RC tear model. RC injuries augmented with a matrix delivering rat mesenchymal stem cells (rMSCs) showed enhanced regeneration over suture repair alone or repair with augmentation, at 6 and 12-weeks post-surgery. The local delivery of rMSCs led to increased mechanical properties and improved tissue morphology. We hypothesize that the mesenchymal stem cells function to modulate the local immune and bioactivity environment through autocrine/paracrine and/or cell homing mechanisms. This study provides evidence for improved tendon healing with biomimetic matrices and delivered MSCs with the potential for translation to larger, clinical animal models. The enhanced regenerative healing response with stem cell delivering biomimetic matrices may represent a new treatment paradigm for massive RC tendon tears.

Biodegradable Polyphosphazene-Based Blends for Regenerative Engineering

The occurrence of musculoskeletal tissue injury or disease and the subsequent functional impairment is at an alarming rate. It continues to be one of the most challenging problems in the human health care. Regenerative engineering offers a promising transdisciplinary strategy for tissues regeneration based on the convergence of tissue engineering, advanced materials science, stem cell science, developmental biology and clinical translation. Biomaterials are emerging as extracellular-mimicking matrices designed to provide instructive cues to control cell behavior and ultimately, be applied as therapies to regenerate damaged tissues. Biodegradable polymers constitute an attractive class of biomaterials for the development of scaffolds due to their flexibility in chemistry and the ability to be excreted or resorbed by the body. Herein, the focus will be on biodegradable polyphosphazene-based blend systems. The synthetic flexibility of polyphosphazene, combined with the unique inorganic backbone, has provided a springboard for more research and subsequent development of numerous novel materials that are capable of forming miscible blends with poly (lactide-co-glycolide) (PLAGA). Laurencin and co-workers has demonstrated the exploitation of the synthetic flexibility of Polyphosphazene that will allow the design of novel polymers, which can form miscible blends with PLAGA for biomedical applications. These novel blends, due to their well-tuned biodegradability, and mechanical and biological properties coupled with the buffering capacity of the degradation products, constitute ideal materials for regeneration of various musculoskeletal tissues.

LAY SUMMARY

Regenerative engineering aims to regenerate complex tissues to address the clinical challenge of organ damage. Tissue engineering has largely focused on the restoration and repair of individual tissues and organs, but over the past 25 years, scientific, engineering, and medical advances have led to the introduction of this new approach which involves the regeneration of complex tissues and biological systems such as a knee or a whole limb. While a number of excellent advanced biomaterials have been developed, the choice of biomaterials, however, has increased over the past years to include polymers that can be designed with a range of mechanical properties, degradation rates, and chemical functionality. The polyphosphazenes are one good example. Their chemical versatility and hydrogen bonding capability encourages blending with other biologically relevant polymers. The further development of Polyphosphazene-based blends will present a wide spectrum of advanced biomaterials that can be used as scaffolds for regenerative engineering and as well as other biomedical applications.

The Quest toward limb regeneration: a regenerative engineering approach

The Holy Grail to address the clinical grand challenge of human limb loss is to develop innovative strategies to regrow the amputated limb. The remarkable advances in the scientific understanding of regeneration, stem cell science, material science and engineering, physics and novel surgical approaches in the past few decades have provided a regenerative tool box to face this grand challenge and address the limitations of human wound healing. Here we discuss the convergence approach put forward by the field of Regenerative Engineering to use the regenerative tool box to design and develop novel translational strategies to limb regeneration.

REGENERATIVE ENGINEERING: APPROACHES TO LIMB REGENERATION AND OTHER GRAND CHALLENGES

The clinical grand challenge to regenerate complex tissue and organ systems call for a paradigm shift that requires a transdisciplinary approach. The field of regenerative engineering puts forward a Convergence approach to create a regenerative toolbox to move beyond individual tissue repair to the regeneration of complex tissues and organ systems. Here we discuss the regenerative tool box currently under development to address grand opportunities in complex tissue/organ regeneration.

Rapid and extensive collapse from electrically responsive macroporous hydrogels

Electrically responsive hydrogels are created with interconnected macropores, which greatly enhance their ability to rapidly undergo volumetric collapse when subjected to moderate electric fields. When optimized, these electrogels are easily integrated into arrays capable of rapid configurational and chromatic optical modulations, and when loaded with drugs, are able to coordinate the delivery profile of multiple drugs.

Medical and biological engineering in the next 20 years: the promise and the challenges

In 2011, the American Institute for Medical and Biological Engineering (AIMBE) (www.aimbe.org) celebrated its 20th anniversary by undertaking to identify major societal challenges to which medical and biological engineers can contribute solutions in the next 20 years. This report is a summary of the six major challenges that were identified. The report also discusses some specific areas within these high-level challenges that can form the basis for policy action, provides a brief rationale for pursuing those areas, and discusses roadblocks to progress. The six overarching challenges are: 1) engineering safe and sustainable water and food supply, 2) engineering personalized health care, 3) engineering solutions to injury and chronic diseases, 4) engineering global health through infectious disease prevention and therapy, 5) engineering sustainable bioenergy production, and 6) engineering the 21st century US economy. While arrived at independently by AIMBE, many of the elements overlap with similar challenges identified by other bodies. The similarities highlight the central mission of medical and biological engineers, working with other experts, which is to solve important problems central to human health and welfare.

Short-term and long-term effects of orthopedic biodegradable implants

Presently, orthopedic and oral/maxillofacial implants represent a combined $2.8 billion market, a figure expected to experience significant and continued growth. Although traditional permanent implants have been proved clinically efficacious, they are also associated with several drawbacks, including secondary revision and removal surgeries. Non-permanent, biodegradable implants offer a promising alternative for patients, as they provide temporary support and degrade at a rate matching tissue formation, and thus, eliminate the need for secondary surgeries. These implants have been in clinical use for nearly 25 years, competing directly with, or maybe even exceeding, the performance of permanent implants. The initial implantation of biodegradable materials, as with permanent materials, mounts an acute host inflammatory response. Over time, the implant degradation profile and possible degradation product toxicity mediate long-term biodegradable implant-induced inflammation. However, unlike permanent implants, this inflammation is likely to cease once the material disappears. Implant-mediated inflammation is a critical determinant for implant success. Thus, for the development of a proactive biodegradable implant that has the ability to promote optimal bone regeneration and minimal detrimental inflammation, a thorough understanding of short- and long-term inflammatory events is required. Here, we discuss an array of biodegradable orthopedic implants, their associated short- and long- term inflammatory effects, and methods to mediate these inflammatory events.

Poly(lactide-co-glycolide)-Hydroxyapatite Composites: The Development of Osteoinductive Scaffolds for Bone Regenerative Engineering

Regenerative engineering represents a new multidisciplinary paradigm to engineer complex tissues, organs, or organ systems through the integration of tissue engineering with advanced materials science, stem cell science and developmental biology. While possessing elements of tissue engineering, regenerative medicine, and morphogenesis, regenerative engineering is distinct from these individual disciplines since it specifically focuses on the integration and subsequent response of stem cells to biomaterials. One goal of regenerative engineering is the design of materials capable of inducing associated cells toward highly specialized functions. For example, the interaction of cells with calcium phosphate surfaces has proven to be an important signaling modality in promoting osteogenic differentiation. A biodegradable polymer-ceramic composite system has been developed from poly(lactide-co-glycolide) and in situ synthesized hydroxyapatite based on the three-dimensional sintered microsphere matrix platform. We have systematically optimized scaffold physico-chemical, mechanical, and structural properties for bone tissue regeneration applications by varying several parameters such as solution pH, polymer:ceramic ratio, sintering time and sintering temperature. The bioactivity of composite scaffolds is attributed to their ability to deliver calcium ions to surrounding medium and allow for reprecipitation of calcium phosphate on the scaffold surface. Furthermore, the composite scaffolds have demonstrated increased loading capacity of osteoinductive growth factor (BMP-2) and a more sustained release profile due to a greater number of adsorption sites provided by the ionic calcium and phosphate groups as well as a larger matrix surface area. In vitro cell studies were performed to investigate the efficacy of this composite system to induce osteogenic differentiation of human adipose-derived stem cells. Cells cultured on the ceramic containing scaffolds exhibited significantly higher expression of osteoblastic markers and greater extracellular matrix mineralization than non-ceramic containing scaffolds, indicating the potential for the ceramic phase to promote osteogenic differentiation. In addition, loaded BMP-2 retained its bioactivity as a mitogen and osteoinductive agent during the differentiation of adipose-derived stem cells into mature osteoblasts. In vivo evaluation using a critical-sized ulnar defect model in New Zealand white rabbits demonstrated the ability of composite scaffolds to support cellular infiltration throughout the scaffold pore structure and vascularization of new tissue, as well as facilitate formation of newly mineralized bone tissue. The work described herein provides strong evidence for the potential of polymer-ceramic composite scaffolds to function as osteoinductive bone graft substitutes, and paves the way for future development of advanced tissue-inducing materials.

Nanostructured polymeric scaffolds for orthopaedic regenerative engineering

Successful regeneration necessitates the development of three-dimensional (3-D) tissue-inducing scaffolds that mimic the hierarchical architecture of native tissue extracellular matrix (ECM). Cells in nature recognize and interact with the surface topography they are exposed to via ECM proteins. The interaction of cells with nanotopographical features such as pores, ridges, groves, fibers, nodes, and their combinations has proven to be an important signaling modality in controlling cellular processes. Integrating nanotopographical cues is especially important in engineering complex tissues that have multiple cell types and require precisely defined cell-cell and cell-matrix interactions on the nanoscale. Thus, in a regenerative engineering approach, nanoscale materials/scaffolds play a paramount role in controlling cell fate and the consequent regenerative capacity. Advances in nanotechnology have generated a new toolbox for the fabrication of tissue-specific nanostructured scaffolds. For example, biodegradable polymers such as polyesters, polyphosphazenes, polymer blends and composites can be electrospun into ECM-mimicking matrices composed of nanofibers, which provide high surface area for cell attachment, growth, and differentiation. This review provides the fundamental guidelines for the design and development of nanostructured scaffolds for the regeneration of various tissue types in human upper and lower extremities such as skin, ligament, tendon, and bone. Examples focusing on the collective work of our laboratory in those areas are discussed to demonstrate the regenerative efficacy of this approach. Furthermore, preliminary strategies and significant challenges to integrate these individual tissues into one complex organ through regenerative engineering-based integrated graft systems are also discussed.

Biomechanics of the sensor-tissue interface-effects of motion, pressure, and design on sensor performance and the foreign body response-part I: theoretical framework

The importance of biomechanics in glucose sensor function has been largely overlooked. This article is the first part of a two-part review in which we look beyond commonly recognized chemical biocompatibility to explore the biomechanics of the sensor-tissue interface as an important aspect of continuous glucose sensor biocompatibility. Part I provides a theoretical framework to describe how biomechanical factors such as motion and pressure (typically micromotion and micropressure) give rise to interfacial stresses, which affect tissue physiology around a sensor and, in turn, impact sensor performance. Three main contributors to sensor motion and pressure are explored: applied forces, sensor design, and subject/patient considerations. We describe how acute forces can temporarily impact sensor signal and how chronic forces can alter the foreign body response and inflammation around an implanted sensor, and thus impact sensor performance. The importance of sensor design (e.g., size, shape, modulus, texture) and specific implant location on the tissue response are also explored. In Part II: Examples and Application (a sister publication), examples from the literature are reviewed, and the application of biomechanical concepts to sensor design are described. We believe that adding biomechanical strategies to the arsenal of material compositions, surface modifications, drug elution, and other chemical strategies will lead to improvements in sensor biocompatibility and performance.