Calcium Orthophosphate (CaPO4) Containing Composites for Biomedical Applications: Formulations, Properties, and Applications

The goal of this review is to present a wide range of hybrid formulations and composites containing calcium orthophosphates (abbreviated as CaPO4) that are suitable for use in biomedical applications and currently on the market. The bioactive, biocompatible, and osteoconductive properties of various CaPO4-based formulations make them valuable in the rapidly developing field of biomedical research, both in vitro and in vivo. Due to the brittleness of CaPO4, it is essential to combine the desired osteologic properties of ceramic CaPO4 with those of other compounds to create novel, multifunctional bone graft biomaterials. Consequently, this analysis offers a thorough overview of the hybrid formulations and CaPO4-based composites that are currently known. To do this, a comprehensive search of the literature on the subject was carried out in all significant databases to extract pertinent papers. There have been many formulations found with different material compositions, production methods, structural and bioactive features, and in vitro and in vivo properties. When these formulations contain additional biofunctional ingredients, such as drugs, proteins, enzymes, or antibacterial agents, they offer improved biomedical applications. Moreover, a lot of these formulations allow cell loading and promote the development of smart formulations based on CaPO4. This evaluation also discusses basic problems and scientific difficulties that call for more investigation and advancements. It also indicates perspectives for the future.

α-Tricalcium phosphate cement reinforced with silk fibroin: A high strength biomimetic bone cement with chloride-substituted hydroxyapatite

In the past decades, bone defects have become an increasing factor in the development of disability in patients, impacting their quality of life. Large bone defects have minor chances to self-repair, requiring surgical intervention. Therefore, α-TCP-based cements are rigorously studied for the development of bone filling and replacement applications due to the possibility of application in minimally invasive procedures. However, α-TCP-based cements do not present adequate mechanical properties for most orthopedic applications. The aim of this study is to develop a biomimetic α-TCP cement reinforced with 0.250-1.000 wt% of silk fibroin using non-dialyzed SF solutions. Samples with SF additions higher than 0.250 wt% presented complete transformation of the α-TCP to a biphasic CDHA/HAp-Cl material, which could enhance the osteoconductivity of the material. Samples reinforced with concentrations of 0.500 wt% SF showed an increase of 450% of the fracture toughness and 182% of the compressive strength of the control sample, even with 31.09% porosity, which demonstrates good coupling between the SF and the CPs. All samples reinforced with SF showed a microstructure with smaller needle-like crystals when compared to the control sample, which possibly contributed to the material's reinforcement. Moreover, the composition of reinforced samples did not affect the cytotoxicity of the CPCs and enhanced the cell viability presented by the CPC without SF addition. Hence, biomimetic CPCs with mechanical reinforcement through the addition of SF were successfully obtained through the developed methodology, with the potential to be further evaluated as a suitable material for bone regeneration.

The study of self-regulating α-TCP based composite by micro/nano scaled silk fibroin and α-CSH on physicochemical and biological properties of bone cement

A novel self-hardening α-tricalcium phosphate (α-TCP) bone cement complexed with different content of α-calcium sulfate hemihydrate (α-CSH) and micrometer hydroxyapatite mineralized silk fibroin (HA-SF) using micro/SF as curing liquid has been investigated in this work, which was capable of tunable setting time, degradation, mechanical property and ability to anti-washout. After addition 0 ∼ 25% α-CSH to the α-TCP cement with SFFs as curing liquid, it shortened the setting time of the modified composite to 10 ∼ 30 min. Furthermore, the addition of SFFs improved the compressive strength of the composite from 5.41 MPa to 9.44 MPa. The composites with both Na₂HPO₄ and SFFs as curing liquid showed good anti-collapse performance. The weight loss ratio of bone cement was -0.18 ∼ 12.08% in 4 weeks when the content of α-CSH in α-TCP/α-CSH was between 0 ∼ 25 wt%. During the degradation of α-CSH, the amorphous α-TCP were deposited as hydroxyapatite to formed a plate-like products on the surface of composite. Compared to the composite with Na₂HPO₄ solution as the curing liquid, alkaline phosphatase (ALP) activity of the composites using SFFs as curing liquid were maintained at high levels on the 14th day especially when the Ca/P ratio was 1.7. This study provides a theoretical basis for the regeneration of bone defects guided by bone cement materials.

α-TCP-based Calcium Phosphate Cements: a critical review

Calcium phosphates are promising materials for applications in bone repair and substitution, particularly for their bioactivity and ability to form self-setting cements. Among them, α-tricalcium phosphate (α-TCP) stands out due to its high solubility, its hydration reaction and bioresorbability. The synthesis of α-TCP is particularly complex and the interactions between some of the synthesis parameters are still not completely understood. The variety of methods available to synthesize α-TCP has provided a substantial variance in the properties of α-TCP-based cements and the decision about which method, parameters and starting reagents will be used for the powder's synthesis is determinant of the properties of the resulting material. Therefore, this review paper focuses on α-TCP's synthesis and properties, presenting the synthesis methods currently in use as well as a discussion of how the synthesis parameters and the cement preparation affect the reactivity and mechanical properties of the material, providing a guide for the selection of the most suitable process for each α-TCP application. STATEMENT OF SIGNIFICANCE: α-TCP is a calcium phosphate and it is currently one of the most investigated bioceramics for applications that explore its bioresorbability and the hydration reaction of α-TCP-based cements. Despite the increasing number of publications on the topic, there are still aspects not well understood. This review article aims at contributing to this fascinating subject by offering an update on the state of the art of α-TCP's synthesis methods, while also addressing topics that are not often discussed about this material, such as the preparation of α-TCP-based cements and how its parameters affect the properties of the resulting cements.

The mTOR/ULK1 signaling pathway mediates the autophagy-promoting and osteogenic effects of dicalcium silicate nanoparticles

A novel bioactive inorganic material containing silicon, calcium and oxygen, calcium silicate (Ca₂SiO₄, C₂S) with a CaO-SiO₂ ingredient, has been identified as a potential candidate for artificial bone. Autophagy has an essential function in adult tissue homoeostasis and tumorigenesis. However, little is known about whether silicate nanoparticles (C₂S NPs) promote osteoblastic differentiation by inducing autophagy. Here we investigated the effects of C₂S NPs on bone marrow mesenchymal stem cell differentiation (BMSCs) in osteoblasts. Furthermore, we identified the osteogenic gene and protein expression in BMSCs treated with C₂S NPs. We found that autophagy is important for the ability of C₂S NPs to induce osteoblastic differentiation of BMSCs. Our results showed that treatment with C₂S NPs upregulated the expression of BMP2, UNX2, and OSX in BMSCs, and significantly promoted the expression of LC3 and Beclin, while P62 (an autophagy substrate) was downregulated. C₂S NP treatment could also enhance Alizarin red S dye (ARS), although alkaline phosphatase (ALP) activity was not significantly changed. However, all these effects could be partially reversed by 3-MA. We then detected potential signaling pathways involved in this biological effect and found that C₂S NPs could activate autophagy by suppressing mTOR and facilitating ULK1 expression. Autophagy further activated β-catenin expression and promoted osteogenic differentiation. In conclusion, C₂S NPs promote bone formation and osteogenic differentiation in BMSCs by activating autophagy. They achieve this effect by activating mTOR/ULK1, inducing autophagy, and subsequently triggering the WNT/β-catenin pathway to boost the differentiation and biomineralization of osteoblasts.

Properties of CaO-SiO2-P2O5 reinforced calcium phosphate cements and in vitro osteoblast response

Non-cytotoxic and bioactive tetracalcium phosphate/nanomonetite/calcium silicate-phosphate cements were prepared by simple mechanical mixing of starting powder precursors based on acid or basic tetracalcium phosphate/nanomonetite mixtures with 1 or 5 wt% addition of precititated amorphous or crystalline calcium silicate phosphate phases. The small additions (1-2 wt%) of crystalline CaSiP phase caused about a two-fold rise in the compressive strength of cements (up to 70 MPa) with simultaneous preservation of short setting time (around 5 min) and refinement of nanohydroxyapatite particles in microstructure. The results verified a close pH to body fluids and enhanced steady state concentrations of Ca²⁺, silicate and phosphate ions during the soaking of acid than the basic composite mixtures in physiological solution. No cytotoxicity or suppressing in proliferation activity of osteoblasts were revealed after the addition of CaSiP phases to cement powder mixtures. The ALP activity of osteoblasts during the first two days of culture on all composite systems was significantly higher than on pure tetracalcium phosphate/nanomonetite substrates. The superior enhancing in ALP osteoblast activity was found on cements with amorphous CaSiP glass component (even at low contents), which confirms excellent in vitro osteoblast activity on composites and their possible utilization as bone cements in reconstruction medicine.

Systematic investigation of β-dicalcium silicate-based bone cements in vitro and in vivo in comparison with clinically applied calcium phosphate cement and Bio-Oss®

Herein we systematically investigated the biological performance of a β-dicalcium silicate (β-C₂S)-based bone cement in comparison with the clinically used calcium phosphate cement (CPC) and Bio-Oss®.

Calcium Orthophosphate-Containing Biocomposites and Hybrid Biomaterials for Biomedical Applications

The state-of-the-art on calcium orthophosphate (CaPO4)-containing biocomposites and hybrid biomaterials suitable for biomedical applications is presented. Since these types of biomaterials offer many significant and exciting possibilities for hard tissue regeneration, this subject belongs to a rapidly expanding area of biomedical research. Through the successful combinations of the desired properties of matrix materials with those of fillers (in such systems, CaPO4 might play either role), innovative bone graft biomaterials can be designed. Various types of CaPO4-based biocomposites and hybrid biomaterials those are either already in use or being investigated for biomedical applications are extensively discussed. Many different formulations in terms of the material constituents, fabrication technologies, structural and bioactive properties, as well as both in vitro and in vivo characteristics have been already proposed. Among the others, the nano-structurally controlled biocomposites, those containing nanodimensional compounds, biomimetically fabricated formulations with collagen, chitin and/or gelatin, as well as various functionally graded structures seem to be the most promising candidates for clinical applications. The specific advantages of using CaPO4-based biocomposites and hybrid biomaterials in the selected applications are highlighted. As the way from a laboratory to a hospital is a long one and the prospective biomedical candidates have to meet many different necessities, the critical issues and scientific challenges that require further research and development are also examined.