Development and long-term in vivo evaluation of a biodegradable urethane-doped polyester elastomer

Citric Acid: A Nexus Between Cellular Mechanisms and Biomaterial Innovations

Citrate-based biodegradable polymers have emerged as a distinctive biomaterial platform with tremendous potential for diverse medical applications. By harnessing their versatile chemistry, these polymers exhibit a wide range of material and bioactive properties, enabling them to regulate cell metabolism and stem cell differentiation through energy metabolism, metabonegenesis, angiogenesis, and immunomodulation. Moreover, the recent US Food and Drug Administration (FDA) clearance of the biodegradable poly(octamethylene citrate) (POC)/hydroxyapatite-based orthopedic fixation devices represents a translational research milestone for biomaterial science. POC joins a short list of biodegradable synthetic polymers that have ever been authorized by the FDA for use in humans. The clinical success of POC has sparked enthusiasm and accelerated the development of next-generation citrate-based biomaterials. This review presents a comprehensive, forward-thinking discussion on the pivotal role of citrate chemistry and metabolism in various tissue regeneration and on the development of functional citrate-based metabotissugenic biomaterials for regenerative engineering applications.

Engineering multifunctional bioactive citrate-based biomaterials for tissue engineering

Developing bioactive biomaterials with highly controlled functions is crucial to enhancing their applications in regenerative medicine. Citrate-based polymers are the few bioactive polymer biomaterials used in biomedicine because of their facile synthesis, controllable structure, biocompatibility, biomimetic viscoelastic mechanical behavior, and functional groups available for modification. In recent years, various multifunctional designs and biomedical applications, including cardiovascular, orthopedic, muscle tissue, skin tissue, nerve and spinal cord, bioimaging, and drug or gene delivery based on citrate-based polymers, have been extensively studied, and many of them have good clinical application potential. In this review, we summarize recent progress in the multifunctional design and biomedical applications of citrate-based polymers. We also discuss the further development of multifunctional citrate-based polymers with tailored properties to meet the requirements of various biomedical applications.

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Multifunctional bioactive citrate-based biomaterials have broad applications in regenerative medicine.

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Recent advances in multifunctional design and biomedical applications of citate-based polymers are summarized.

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Future challenge of citrate-based polymers in various biomedical applications are discussed.

Development of Biodegradable Osteopromotive Citrate-Based Bone Putty

The burden of bone fractures demands development of effective biomaterial solutions, while additional acute events such as noncompressible bleeding further motivate the search for multi-functional implants to avoid complications including osseous hemorrhage, infection, and nonunion. Bone wax has been widely used in orthopedic bleeding control due to its simplicity of use and conformation to irregular defects; however, its nondegradability results in impaired bone healing, risk of infection, and significant inflammatory responses. Herein, a class of intrinsically fluorescent, osteopromotive citrate-based polymer/hydroxyapatite (HA) composites (BPLP-Ser/HA) as a highly malleable press-fit putty is designed. BPLP-Ser/HA putty displays mechanics replicating early nonmineralized bone (initial moduli from ≈2-500 kPa), hydration induced mechanical strengthening in physiological conditions, tunable degradation rates (over 2 months), low swelling ratios (<10%), clotting and hemostatic sealing potential (resistant to blood pressure for >24 h) and significant adhesion to bone (≈350-550 kPa). Simultaneously, citrate's bioactive properties result in antimicrobial (≈100% and 55% inhibition of S. aureus and E. coli) and osteopromotive effects. Finally, BPLP-Ser/HA putty demonstrates in vivo regeneration in a critical-sized rat calvaria model equivalent to gold standard autograft. BPLP-Ser/HA putty represents a simple, off-the-shelf solution to the combined challenges of acute wound management and subsequent bone regeneration.

The critical chemical and mechanical regulation of folic acid on neural engineering

The mandate of folic acid supplementation in grained products has reduced the occurrence of neural tube defects by one third in the U.S since its introduction by the Food and Drug Administration in 1998. However, the advantages and possible mechanisms of action of using folic acid for peripheral nerve engineering and neurological diseases still remain largely elusive. Herein, folic acid is described as an inexpensive and multifunctional niche component that modulates behaviors in different cells in the nervous system. The multiple benefits of modulation include: 1) generating chemotactic responses on glial cells, 2) inducing neurotrophin release, and 3) stimulating neuronal differentiation of a PC-12 cell system. For the first time, folic acid is also shown to enhance cellular force generation and global methylation in the PC-12 cells, thereby enabling both biomechanical and biochemical pathways to regulate neuron differentiation. These findings are evaluated in vivo for clinical translation. Our results suggest that folic acid-nerve guidance conduits may offer significant benefits as a low-cost, off-the-shelf product for reaching the functional recovery seen with autografts in large sciatic nerve defects. Consequently, folic acid holds great potential as a critical and convenient therapeutic intervention for neural engineering, regenerative medicine, medical prosthetics, and drug delivery.

Citrate chemistry and biology for biomaterials design

Leveraging the multifunctional nature of citrate in chemistry and inspired by its important role in biological tissues, a class of highly versatile and functional citrate-based materials (CBBs) has been developed via facile and cost-effective polycondensation. CBBs exhibiting tunable mechanical properties and degradation rates, together with excellent biocompatibility and processability, have been successfully applied in vitro and in vivo for applications ranging from soft to hard tissue regeneration, as well as for nanomedicine designs. We summarize in the review, chemistry considerations for CBBs design to tune polymer properties and to introduce functionality with a focus on the most recent advances, biological functions of citrate in native tissues with the new notion of degradation products as cell modulator highlighted, and the applications of CBBs in wound healing, nanomedicine, orthopedic, cardiovascular, nerve and bladder tissue engineering. Given the expansive evidence for citrate's potential in biology and biomaterial science outlined in this review, it is expected that citrate based materials will continue to play an important role in regenerative engineering.

Design Strategies and Applications of Biomaterials and Devices for Hernia Repair

Hernia repair is one of the most commonly performed surgical procedures worldwide, with a multi-billion dollar global market. Implant design remains a critical challenge for the successful repair and prevention of recurrent hernias, and despite significant progress, there is no ideal mesh for every surgery. This review summarizes the evolution of prostheses design toward successful hernia repair beginning with a description of the anatomy of the disease and the classifications of hernias. Next, the major milestones in implant design are discussed. Commonly encountered complications and strategies to minimize these adverse effects are described, followed by a thorough description of the implant characteristics necessary for successful repair. Finally, available implants are categorized and their advantages and limitations elucidated, including non-absorbable and absorbable (synthetic and biologically derived) prostheses, composite prostheses, and coated prostheses. This review not only summarizes the state of the art in hernia repair, but also suggests future research directions toward improved hernia repair utilizing novel materials and fabrication methods.

Citrate-Based Biomaterials and Their Applications in Regenerative Engineering

Advances in biomaterials science and engineering are crucial to translating regenerative engineering, an emerging field that aims to recreate complex tissues, into clinical practice. In this regard, citrate-based biomaterials have become an important tool owing to their versatile material and biological characteristics including unique antioxidant, antimicrobial, adhesive, and fluorescent properties. This review discusses fundamental design considerations, strategies to incorporate unique functionality, and examples of how citrate-based biomaterials can be an enabling technology for regenerative engineering.

In situ re-endothelialization via multifunctional nanoscaffolds

The endothelium monolayer lining in the luminal side of blood vessels provides critical antithrombotic functions. Damage to these cells will expose a highly thrombogenic subendothelium, which leads to pathological vascular changes. Using combined tissue engineering and ligand-receptor targeting strategy, we developed a biodegradable urethane-doped polyester (UPE) multifunctional targeting nanoparticle (MTN) scaffold system with dual ligands: (1) glycoprotein 1b (GP1b) to target the injured arterial endothelium and subendothelium and (2) anti-CD34 antibodies to capture endothelial progenitor cells for endothelium regeneration. The fabricated spherical MTNs of 400 nm were found to be cytocompatible and hemocompatible. Both the in vitro and ex vivo targeting of these nanoscaffolds not only showed binding specificity of MTNs onto the von Willebrand factor -coated surfaces that simulate the injured arterial walls but also competed with platelets for binding onto these injured sites. Further in vivo study has revealed that a single delivery of MTNs upon vascular injury reduced neointimal hyperplasia by 57% while increased endothelium regeneration by ∼ 60% in 21 days. These results support the promise of using MTN nanoscaffolds for treating vascular injury in situ.

Fabrication and characterization of biomimetic multichanneled crosslinked-urethane-doped polyester tissue engineered nerve guides

Biomimetic scaffolds that replicate the native architecture and mechanical properties of target tissues have been recently shown to be a very promising strategy to guide cellular growth and facilitate tissue regeneration. In this study, porous, soft, and elastic crosslinked urethane-doped polyester (CUPE) tissue engineered nerve guides were fabricated with multiple longitudinally oriented channels and an external non-porous sheath to mimic the native endoneurial microtubular and epineurium structure, respectively. The fabrication technique described herein is highly adaptable and allows for fine control over the resulting nerve guide architecture in terms of channel number, channel diameter, porosity, and mechanical properties. Biomimetic multichanneled CUPE guides were fabricated with various channel numbers and displayed an ultimate peak stress of 1.38 ± 0.22 MPa with a corresponding elongation at break of 122.76 ± 42.17%, which were comparable to that of native nerve tissue. The CUPE nerve guides were also evaluated in vivo for the repair of a 1 cm rat sciatic nerve defect. Although histological evaluations revealed collapse of the inner structure from CUPE TENGs, the CUPE nerve guides displayed fiber populations and densities comparable with nerve autograft controls after 8 weeks of implantation. These studies are the first report of a CUPE-based biomimetic multichanneled nerve guide and warrant future studies towards optimization of the channel geometry for use in neural tissue engineering.

A computational model of fibroblast and macrophage spatial/temporal dynamics in foreign body reactions

The implantation of medical devices often triggers several immune responses, one kind of which is categorized as foreign body reactions. It is well established that macrophages and many other cells participate in the complex processes of foreign body reactions, and cause severe inflammations and fibrotic capsule formation in surrounding tissues. However, the detailed mechanisms of macrophage responses, recruitment and activation, in foreign body reactions are not totally understood. In the meantime, mathematical models have been proposed to systematically decipher the behavior of this complex system of multiple cells, proteins and biochemical processes in wound healing responses. Based on these early works, this study introduces a mathematical model in two spatial dimensions to investigate the transient behavior of macrophages, fibroblasts and their interactions during the formation of fibrotic tissue. We find that the simulation results are consistent with the experimental observations. These findings support that the model can reveal quantitative insights for studying foreign body reaction processes.

Synthesis and characterization of biomimetic citrate-based biodegradable composites

Natural bone apatite crystals, which mediate the development and regulate the load-bearing function of bone, have recently been associated with strongly bound citrate molecules. However, such understanding has not been translated into bone biomaterial design and osteoblast cell culture. In this work, we have developed a new class of biodegradable, mechanically strong, and biocompatible citrate-based polymer blends (CBPBs), which offer enhanced hydroxyapatite binding to produce more biomimetic composites (CBPBHAs) for orthopedic applications. CBPBHAs consist of the newly developed osteoconductive citrate-presenting biodegradable polymers, crosslinked urethane-doped polyester and poly (octanediol citrate), which can be composited with up to 65 wt % hydroxyapatite. CBPBHA networks produced materials with a compressive strength of 116.23 ± 5.37 MPa comparable to human cortical bone (100-230 MPa), and increased C2C12 osterix gene and alkaline phosphatase gene expression in vitro. The promising results above prompted an investigation on the role of citrate supplementation in culture medium for osteoblast culture, which showed that exogenous citrate supplemented into media accelerated the in vitro phenotype progression of MG-63 osteoblasts. After 6 weeks of implantation in a rabbit lateral femoral condyle defect model, CBPBHA composites elicited minimal fibrous tissue encapsulation and were well integrated with the surrounding bone tissues. The development of citrate-presenting CBPBHA biomaterials and preliminary studies revealing the effects of free exogenous citrate on osteoblast culture shows the potential of citrate biomaterials to bridge the gap in orthopedic biomaterial design and osteoblast cell culture in that the role of citrate molecules has previously been overlooked.

Fluorescence imaging enabled urethane-doped citrate-based biodegradable elastomers

The field of tissue engineering and drug delivery calls for new measurement tools, non-invasive real-time assays, and design methods for the next wave of innovations. Based on our recent progress in developing intrinsically biodegradable photoluminescent polymers (BPLPs) without conjugating organic dyes or quantum dots, in this paper, we developed a new type urethane-doped biodegradable photoluminescent polymers (UBPLPs) that could potentially serve as a new tool to respond the above call for innovations. Inherited from BPLPs, UBPLPs demonstrated strong inherent photoluminescence and excellent cytocompatibility in vitro. Crosslinked UBPLPs (CUBPLPs) showed soft, elastic, but strong mechanical properties with a tensile strength as high as 49.41 ± 6.17 MPa and a corresponding elongation at break of 334.87 ± 26.31%. Porous triphasic CUBPLP vascular scaffolds showed a burst pressure of 769.33 ± 70.88 mmHg and a suture retention strength of 1.79 ± 0.11 N. Stable but photoluminescent nanoparticles with average size of 103 nm were also obtained by nanoprecipitation. High loading efficiency (91.84%) and sustained release of 5-fluorouracil (up to 120 h) were achieved from UBPLP nanoparticles. With a quantum yield as high as 38.65%, both triphasic scaffold and nanoparticle solutions could be non-invasively detected in vivo. UBPLPs represent an innovation in fluorescent biomaterial design and may offer great potential in advancing the field of tissue engineering and drug delivery where bioimaging has gained increasing interest.

Citrate-based Biodegradable Injectable hydrogel Composites for Orthopedic Applications

Previous studies have confirmed that natural bone apatite crystals are bound with citrate-rich molecules. Citrates on apatite crystals impact bone development and its load-bearing function. However, such understanding has never been translated into bone biomaterials design. Herein, a first citrate-based injectable composite material for orthopedic applications is developed based on our recently developed biodegradable poly(ethylene glycol) maleate citrate (PEGMC) and hydroxyapatite (HA). PEGMC contains rich carboxylic groups that could chelate with calcium-containing HA thus facilitating polymer/HA interactions, similar to natural citrate-bound apatite crystal. The crosslinking of poly(ethylene glycol) diacrylate (PEGDA) with PEGMC/HA composites allows an addition control over degradation and mechanical properties of the crosslinked PEGMC/HA (CPEGMC/HA) composites. CPEGMC/HA composite can serve as an ideal injectable cell carrier as confirmed by the enhanced DNA content, ALP activity, and calcium production through a human fetal osteoblast encapsulation study. Ex vivo study on porcine femoral head demonstrated that PEGMC/HA is a potentially promising injectable biodegradable bone material for the treatment of osteonecrosis of the femoral head. Development of biodegradable citrate-based injectable PEGMC/HA composite is an initial step for the development of the next generation of bone tissue engineering and orthopedic biomaterials.