Engineering of Bioresorbable Polymers for Tissue Engineering and Drug Delivery Applications

Herein, the recent advances in the development of resorbable polymeric-based biomaterials, their geometrical forms, resorption mechanisms, and their capabilities in various biomedical applications are critically reviewed. A comprehensive discussion of the engineering approaches for the fabrication of polymeric resorbable scaffolds for tissue engineering, drug delivery, surgical, cardiological, aesthetical, dental and cardiovascular applications, are also explained. Furthermore, to understand the internal structures of resorbable scaffolds, representative studies of their evaluation by medical imaging techniques, e.g., cardiac computer tomography, are succinctly highlighted. This approach provides crucial clinical insights which help to improve the materials' suitable and viable characteristics for them to meet the highly restrictive medical requirements. Finally, the aspects of the legal regulations and the associated challenges in translating research into desirable clinical and marketable materials of polymeric-based formulations, are presented.

Hydroxyapatite/silver electrospun fibers for anti-infection and osteoinduction

Bone implant materials cause the most common complication of bone infections in orthopedic surgery, resulting in implant failure. Antibiotic treatment of bone infections leads to problems such as bacterial resistance and reduced osteogenic capacity. In this study, dopamine (DA) was self-polymerized on the surface of Polylactic acid (PLLA)/Hydroxyapatite (HA) nanowire composite fibers to form an adhesive polydopamine (PDA) membrane, and a stable silver-nanoparticles (Ag-NPs) coating layer was constructed on it by electrochemically driven Ag⁺ coordination and chelation through Polypyrrole (PPy) mediation, achieving steady and slow release of Ag-NPs. With optimized DA soaking time of 24 h and soaking concentration of 0.5 g·L^-1, nanoparticles were uniformly distributed on PLLA/HA/PDA/PPy/Ag composite fibers and the hydrophilicity of the composite fibers was well-behaved. Besides, the composite fibers possessed good physiological stability and 100% antibacterial rate against Escherichia coli (E. coli) as well as Staphylococcus aureus (S. aureus). In addition, the composite fibers had promoted apatite nucleation and growth on surface and good cytocompatibility with osteoblasts, indicating ability of inducing osteogenic differentiation. In summary, a multi-functional PLLA/HA/PDA/PPy/Ag composite fiber with long-term antibacterial property, bioactivity and osteoinductivity was successfully constructed by electrospinning and electrochemical deposition.

Biomineralization of poly-l-lactide spongy bone scaffolds obtained by freeze-extraction method

Implants in the form of polymer scaffolds are commonly used to regenerate bone tissue after traumas or tooth extractions. However, few implant formation methods enable building polymer scaffolds allowing to reconstruct larger bone losses without immune response. Spacious, porous poly-l-lactide implants with considerable volume were obtained using the phase inversion method with the freeze-extraction variant. The calcium phosphate (CaP) coating was deposited on implant surfaces with the biomimetic method to improve the implant's osteoconductivity. The substitues morphology was characterized-porosity, size and shape of pores; mechanical properties, mass absorbability of implants before and after mineralization. The characteristics were provided with scanning electron microscopy (SEM), static compression test and hydrostatic weighing, respectively. The presence of CaPs in the entire volume of the implant was confirmed with SEM and infrared spectroscopy with Fourier transform (FTIR). The biocompatibility of scaffolds was confirmed with in vitro quantitative test and microscopic observations. The obtained results show that the implants can be used in tissue engineering as a vehicle of platelet-rich plasma to regenerate critical spongy bone losses.

Optimization of Bone Scaffold Porosity Distributions

Additive manufacturing (AM) is a rapidly emerging technology that has the potential to produce personalized scaffolds for tissue engineering applications with unprecedented control of structural and functional design. Particularly for bone defect regeneration, the complex coupling of biological mechanisms to the scaffolds' properties has led to a predominantly trial-and-error approach. To mitigate this, shape or topology optimization can be a useful tool to design a scaffold architecture that matches the desired design targets, albeit at high computational cost. Here, we consider an efficient macroscopic optimization routine based on a simple one-dimensional time-dependent model for bone regeneration in the presence of a bioresorbable polymer scaffold. The result of the optimization procedure is a scaffold porosity distribution which maximizes the stiffness of the scaffold and regenerated bone system over the entire regeneration time, so that the propensity for mechanical failure is minimized.

Preparation of polylactide scaffolds for cancellous bone regeneration – preliminary investigation and optimization of the process

Polylactide scaffolds were prepared for the cancellous bone regeneration by the phase inversion method with freeze-extraction variant. A preliminary investigation and the optimization of the process were performed. For the obtained scaffolds, regression equations determining the effect: PLLA concentration by weight in 1,4-dioxane; volume ratio of the porophore/PLLA solution in 1,4-dioxane; and implant-forming solution pouring temperature, on the open porosity and mass absorbability were determined. The conditions in which the obtained implants were characterized by the maximal absorbability with the open porosity greater than 90 % were obtained.

* Engineering Membranes for Bone Regeneration

This review is focused on the use of membranes for the specific application of bone regeneration. The first section focuses on the relevance of membranes in this context and what are the specifications that they should possess to improve the regeneration of bone. Afterward, several techniques to engineer bone membranes by using "bulk"-like methods are discussed, where different parameters to induce bone formation are disclosed in a way to have desirable structural and functional properties. Subsequently, the production of nanostructured membranes using a bottom-up approach is discussed by highlighting the main advances in the field of bone regeneration. Primordial importance is given to the promotion of osteoconductive and osteoinductive capability during the membrane design. Whenever possible, the films prepared using different techniques are compared in terms of handability, bone guiding ability, osteoinductivity, adequate mechanical properties, or biodegradability. A last chapter contemplates membranes only composed by cells, disclosing their potential to regenerate bone.

Elastomeric enriched biodegradable polyurethane sponges for critical bone defects: a successful case study reducing donor site morbidity

Bone substitutes have been a critical issue as the natural source can seldom provide enough bone to support full healing. No bone substitute complies with all necessary functions and characteristics that an autograft does. Polyurethane sponges have been used as a surgical alternative to cancellous bone grafts for critical bone defect donor sites. Critical bone defects were created on the tibial tuberosity and iliac crest using an ovine model. In group I (control-untreated), no bone regeneration was observed in any animal. In group II (defects left empty but covered with a microporous polymeric membrane), the new bone bridged the top ends in all animals. In groups III and IV, bone defects were implanted with polyurethane scaffolds modified with biologically active compounds, and bone regeneration was more efficient than in group II. In groups III and IV there were higher values of bone regeneration specific parameters used for evaluation (P < 0.05) although the comparison between these groups was not possible. The results obtained in this study suggest that biodegradable polyurethane substitutes modified with biologically active substances may offer an alternative to bone graft, reducing donor site morbidity associated with autogenous cancellous bone harvesting.

A bioresorbable polylactide implant used in bone cyst filling

The aims in treating patients diagnosed with critical-sized bone defects resulting from bone cysts are to replace the lost bone mass after its removal and to restore function. The standard treatment is autologous or allogeneic bone transplantation, notwithstanding the known consequences and risks due to possible bone infection, donor site morbidity, bleeding and nerve injury and possible undesirable immune reactions. Additionally, allogeneic grafts are inhomogeneous, with a mosaic of components with difficult-to-predict regenerative potential, because they consist of cancellous bone obtained from different bones from various cadavers. In the present study, a 22-year-old patient with a history of right humerus fracture due to bone cysts was diagnosed with recurrent cystic lesions based on X-ray results. The patient qualified for an experimental program, in which he was treated with the application of a bioresorbable polylactide hybrid sponge filled with autologous platelet-rich plasma. Computed tomography and magnetic resonance imaging performed 3, 6, and 36 months after surgery showed progressive ossification and bone formation inside the defect cavity in the humerus. Three years after treatment with the bone substitute, the patient is pain free, and the cystic lesions have not reoccurred.

Biodegradable poly(ester urethane) urea scaffolds for tissue engineering: Interaction with osteoblast-like MG-63 cells

Porous three-dimensional scaffolds with potential for application as cancellous bone graft substitutes were prepared from aliphatic segmented poly(ester urethane) urea using the phase-inverse technique. Proton nuclear magnetic resonance, size-exclusion chromatography, electron spectroscopy for chemical analysis, secondary ion mass spectrometry, infrared spectroscopy, scanning electron microscopy, differential scanning calorimetry, computed tomography and mechanical tests were carried out, to characterize the scaffolds' physicochemical properties. Human osteosarcoma MG-63 cells were seeded into the scaffolds for 1, 2, 3 and 4weeks to evaluate their potential to support attachment, growth and proliferation of osteogenic cells. The scaffold-cell interaction was assessed by analysis of DNA content, total protein amount, alkaline phosphatase activity and WST-1 assay. The scaffolds supported cell attachment, growth and proliferation over the whole culture period of 4weeks (DNA, total protein amount). There was, however, a reduction in the WST-1 assay values at 4weeks, which might suggest a reduction in the rate of cell proliferation at this time.

Evaluation of a biodegradable graft substitute in rabbit bone defect model

OBJECTIVE

To evaluate a new biodegradable copolymer calcium sulfate/poly amino acid (CS/PAA) as a graft substitute for the repair of the surgically created cancellous bone defects in rabbits and its biological properties in vivo.

MATERIALS AND METHODS

Cancellous bone defects were created by drilling holes in the unilateral lateral aspect of the femoral condyle of New Zealand white rabbits. Three groups were assigned: Group A rabbits were grafted with 80% CS/PAA and group B rabbits were grafted with 95% CS/PAA as two treatment groups; group C was sham-operation control group. To study the osteogenic capability in vivo, specimens were harvested at 4, 8, 12, and 16 weeks after implantation and were evaluated by gross assessment, X-ray, histological examination, and histomorphometry. In order to identify the molecular mechanism of bone defect repair, the expression of bone morphogenetic protein-2 (BMP-2) and vascular endothelial growth factor (VEGF) was detected using Western blot at 4 weeks.

RESULTS

Group A and group B showed more vigorous and rapid repair leading to regeneration of cancellous bone than sham-operation control group on gross observation, radiology, and histomorphometry. There was no significant difference between groups A and B. Morphological observation and histological examination showed that the copolymers degraded in sync with the new bone formation process. The expression of BMP-2 and VEGF in implantation groups was higher than that in control group by western blot.

CONCLUSION

These findings demonstrated that the novel biodegradable copolymers can repair large areas of cancellous bone defects. With its controllable degradation rate, it suggests that CS/PAA may be a series of useful therapeutic substitute for bone defects.

Tissue response to chitosan/γ-PGA polyelectrolyte complex using a rat model

In this study, the in vivo soft tissue response of chitosan/γ-poly(glutamic acid) (γ-PGA) polyelectrolyte complex (PEC) using a rat model was assessed using chitosan as a cationic polyelectrolyte and γ-PGA as an anionic polyelectrolyte; four groups of chitosan/γ-PGA PECs were synthesized according to the molar ratio of amine groups of chitosan to the carboxylic acid groups of γ-PGA. Different soft tissue responses to chitosan/γ-PGA PEC were observed between the epithelium and the muscle. In the epithelium, the wound dressed with chitosan/γ-PGA PEC healed faster than the control, with chitosan attracting polymorphonuclear (PMN) cells and γ-PGA creating a hydrophilic environment. In the muscle, a quantitative evaluation of the tissue response revealed that different degradation phenomena were evoked by different compositions of chitosan/γ-PGA PEC. After implantation for 28 days, the chitosan/γ-PGA PEC with chitosan dominating showed extensive surface erosion and superficial fragmentation surrounded by inflammatory cells, while chitosan/γ-PGA PECs with γ-PGA dominating elicited minimal degradation. These results confirm that the degradation of PECs can be controlled by tailoring the chitosan/γ-PGA PECs for different purposes. It appears that different local tissue conditions in muscle and epithelium may be involved in this difference.

Chitosan Membrane with Surface-bonded Growth Factor in Guided Tissue Regeneration Applications

The potential of surface covalently bonded rhBMP-2 biodegradable chitosan membrane was examined for guided tissue regeneration (GTR) applications. A chitosan surface-bonded rhBMP-2 membrane was produced via amide bond formation between chitosan and rhBMP-2 using EDC/NHS as the catalyst. The chitosan surface-bonded rhBMP-2 membrane retained more than 70% of the initial rhBMP-2 after 4 weeks of incubation, whereas the chitosan surface-adsorbed rhBMP-2 membrane retained only 30%. The surface-bonded rhBMP-2 did not denature, but expressed sustained biological activity, such as osteoblast cell adhesion, proliferation, and differentiation. X-ray images and histology of an in vivo segmental bone defect rabbit model showed that the chitosan surface-bonded rhBMP-2 membrane induced new bone formation. The chitosan surface-bonded rhBMP-2 membrane has the potential as a bioactive material for GTR.

Clinical use of resorbable polymeric membranes in the treatment of bone defects

The reconstruction of large bone defects remains a clinically challenging condition. Although many treatment approaches exist, they all have limitations. Recently, bioresorbable polylactide membranes have become commercially available. These membranes, when applied to bone defects, enhance bone healing by direct osteoconduction, exclusion of nonosseous tissues, and enhancing the osteogenic environment for autologous grafts. When combined with appropriate internal fixation and autologous bone graft, bioresorbable polylactide membranes allow for single-step reconstruction of large bone defects.