Potential antiosteoporosis effect of biodegradable magnesium implanted in STZ-induced diabetic rats

Icariin attenuates thioacetamide‑induced bone loss via the RANKL‑p38/ERK‑NFAT signaling pathway

There is an increasing incidence of destructive bone disease caused by osteoclast proliferation. This is characterized by reduced bone mass and imbalance of bone homeostasis. Icariin (ICA), a flavonoid compound isolated from Epimedium, has anti‑osteoporosis activity and inhibits the formation of osteoclasts and bone resorption. The purpose of the present study was to investigate the protective effect of ICA on osteoclastic differentiation induced by thioacetamide (TAA) and its possible mechanism in Sprague Dawley (SD) rats. In the present study, SD rats were intraperitoneally injected with TAA (300 mg/kg) for the bone loss model, treated with ICA (600 mg/kg, intragastric gavage) in the ICA group and TAA+ICA group for treatment of bone loss for 6 weeks. Indexes associated with bone metabolism, such as alkaline phosphatase, N‑terminal telopeptide of type‑I collagen (NTX‑I), calcium (Ca), phosphorus (P) and magnesium (Mg) in the serum, were detected. Osteoclast differentiation of femoral tissues was detected by hematoxylin and eosin and tartrate‑resistant acid phosphatase staining. The femoral bone mass was evaluated using a three‑point bending test and micro computed tomography. Western blotting was used to detect the expression levels of osteoclast‑related proteins in each group. In the rats treated with TAA, the serum concentrations of Ca, P and Mg were decreased, the serum concentration of NTX‑I was increased, osteoclast differentiation of the femur was increased, femur bone stress and bone mass were decreased and the bone loss and osteoclast formation were reduced after ICA treatment. In addition, ICA inhibited the protein expression of receptor activator of nuclear factor κ‑Β ligand (RANKL), receptor activator of nuclear factor κ‑B (RANK), p38, ERK, c‑Fos and nuclear factor of activated T cells 1 (NFATc1) in the femur of rats treated with TAA. The results suggested that ICA may inhibit osteoclast differentiation by downregulating the RANKL‑p38/ERK‑NFAT signaling pathway and prevent TAA‑induced bone loss. The results are helpful to understand the mechanism of osteoclast differentiation induced by TAA, as well as the antiresorptive activity and molecular mechanism of ICA, and to provide new ideas for the treatment of osteolytic diseases.

Effectiveness and safety of biodegradable Mg-Nd-Zn-Zr alloy screws for the treatment of medial malleolar fractures

Background

/Objective: This study aimed to evaluate the effectiveness and safety of treating medial malleolar fractures using our patented Mg-Nd-Zn-Zr alloy (abbr. JDBM) screws with Ca–P coating, in order to provide a solid basis for their further clinical translation.

Methods

Nine patients with medial malleolar fractures were treated using coated JDBM screws. All patients had closed injuries, and none had open fractures. Postoperative radiography was performed to evaluate fracture healing and degradation of the JDBM screws. The visual analogue scale (VAS) was used to evaluate the degree of postoperative pain perceived by the patients, and the American Orthopedic Foot and Ankle Society (AOFAS) ankle-hindfoot scoring system was used to evaluate their postoperative ankle function. Postoperative complications, including infection, failure of internal fixation, and malunion, were carefully recorded during follow-up.

Results

The mean follow-up time was 12.2 ​± ​4.9 months. After the operation, all patients achieved good medial malleolar fracture alignment, and none of them experienced breakage of the JDBM screws before fracture healing. Postoperative radiography indicated JDBM screws gradually degradated with implantation time, and obvious degradation could be observed 12 months, postoperatively. At the final follow-up, the patients’ mean VAS score was 2.3 ​± ​1.9. The mean AOFAS score was 90.4 ​± ​8.9, with excellent or good rates of 88.9%. None of the patients experienced infection, failure of internal fixation, malunion, or other complications.

Conclusion

Coated biodegradable JDBM screws are effective for the treatment of medial malleolar fractures, and have good prospects for further clinical translation in the future.

Translational potential statement

The results of this study indicates coated biodegradable JDBM screw is an alternative internal fixation instrument for fracture treatment and has excellent prospects for clinical translation.

The "Magnesium Sacrifice" Strategy Enables PMMA Bone Cement Partial Biodegradability and Osseointegration Potential

Poly (methyl methacrylate) (PMMA)-based bone cements are the most commonly used injectable orthopedic materials due to their excellent injectability and mechanical properties. However, their poor biocompatibility and excessive stiffness may cause complications such as aseptic implant loosening and stress shielding. In this study, we aimed to develop a new type of partially biodegradable composite bone cement by incorporating magnesium (Mg) microspheres, known as "Mg sacrifices" (MgSs), in the PMMA matrix. Being sensitive to the physiological environment, the MgSs in PMMA could gradually degrade to produce bioactive Mg ions and, meanwhile, result in an interconnected macroporous structure within the cement matrix. The mechanical properties, solidification, and biocompatibility, both in vitro and in vivo, of PMMA⁻Mg bone cement were characterized. Interestingly, the incorporation of Mg microspheres did not markedly affect the mechanical strength of bone cement. However, the maximum temperature upon setting of bone cement decreased. This partially biodegradable composite bone cement showed good biocompatibility in vitro. In the in vivo study, considerable bony ingrowth occurred in the pores upon MgS degradation. Together, the findings from this study indicate that such partially biodegradable PMMA⁻Mg composite may be ideal bone cement for minimally invasive orthopedic surgeries such as vertebroplasty and kyphoplasty.

Magnesium-based biodegradable alloys: Degradation, application, and alloying elements

In recent years, the paradigm about the metal with improved corrosion resistance for application in surgery and orthopedy was broken. The new class of biodegradable metal emerges as an alternative for biomedical implants. These metals corrode gradually with an appropriate host response and release of corrosion products. And it is absolutely necessary to use essential metals metabolized by hosting organism with local and general nontoxic effect. Magnesium serves this aim best; it plays the essential role in body metabolism and should be completely excreted within a few days after degradation. This review summarizes data from Mg discovery and its first experimental and clinical application of modern concept of Mg alloy development. We focused on biodegradable metal application in general surgery and orthopedic practice and showed the advantages and disadvantages Mg alloys offer. We focused on methods of in vitro and in vivo investigation of degradable Mg alloys and correlation between these methods. Based on the observed data, a better way for new alloy pre-clinical investigation is suggested. This review analyzes possible alloying elements that improve corrosion rate, mechanical properties, and gives the appropriate host response.

Mg and Mg alloys: how comparable are in vitro and in vivo corrosion rates? A review

Due to their biodegradability, magnesium and magnesium-based alloys could represent the third generation of biomaterials. However, their mechanical properties and time of degradation have to match the needs of applications. Several approaches, such as choice of alloying elements or tailored microstructure, are employed to tailor corrosion behaviour. Due to the high electrochemical activity of Mg, numerous environmental factors (e.g. temperature and surrounding ion composition) influence its corrosion behaviour, making it unpredictable. Nevertheless, the need of reliable in vitro model(s) to predict in vivo implant degradation is increasing. In an attempt to find a correlation between in vitro and vivo corrosion rates, this review presents a systematic literature survey, as well as an attempt to correlate the different results.

Effect of implantation of biodegradable magnesium alloy on BMP-2 expression in bone of ovariectomized osteoporosis rats

The study was focused on the implantation of a biodegradable AZ31 magnesium alloy into the femoral periosteal of the osteoporosis modeled rats. The experimental results showed that after 4weeks implantation of AZ31 alloy in the osteoporosis modeled rats, the expression of BMP-2 in bone tissues of the rats was much enhanced, even higher than the control group, which should promote the bone formation and be beneficial for reducing the harmful effect of osteoporosis. Results of HE stains showed that the implantation of AZ31 alloy did not have obvious pathological changes on both the liver and kidney of the animal.

Magnesium incorporation into β-TCP reduced its in vivo resorption by decreasing parathormone production

Beta-tricalcium phosphate (β-TCP), one of the most widely used bioresorbable materials for bone therapy, can be doped with magnesium ions, generating β-TCMP. The objectives of this work were to evaluate, on a murine dental alveolus grafting model, the biocompatibility of β-TCP and β-TMCP granules by histomorphometric analysis, as well as the impact on plasmatic levels of receptor activator of nuclear factor κB ligand (RANK-L), osteoprotegerin (OPG), osteocalcin, osteopontin, and parathormone (PTH) during bone repair, using Luminex multiplexing technology. After grafting for 42 days, β-TCP grafted group presented higher bioresorption and induced more newly formed bone than β-TCMP (p < 0.05). β-TCP grafting also induced higher plasmatic levels of RANK-L, compared to β-TCMP and control (blood clot) groups at 21st day (p < 0.05). PTH, which remained at low levels in control group, presented a time-dependent increase in grafted groups, attaining significantly higher levels with β-TCP by the 42nd day (p < 0.05). RANK-L/OPG ratio increased on β-TCP group and attained a peak on the 21st day. In conclusion, β-TCP granules were more bioresorbable and osteogenic than β-TCMP granules, and the resorption of both materials might have been affected by osteoclastogenesis modulated by changes in the plasmatic levels of PTH and RANK-L.