[Biodegradable synthetic implant materials : clinical applications and immunological aspects]

A Visual Hydrogen Sensor Prototype for Monitoring Magnesium Implant Biodegradation

Alternative metals such as magnesium (Mg) and its alloys have been recently developed for clinical applications such as temporary implants for bone and tissue repair due to their desirable mechanical properties and ability to biodegrade harmlessly in vivo by releasing Mg²⁺, OH^-, and H₂ as biodegradation products. The current methods for monitoring in vivo Mg-alloy biodegradation are either invasive and/or costly, complex, or require large equipment and specially trained personnel, thus making real-time and point-of-care monitoring of Mg-alloy implants problematic. Therefore, innovative methods are critically needed. The objective of this research was to develop a novel, thin, and wearable visual H₂ sensor prototype for noninvasive monitoring of in vivo Mg-implant biodegradation in medical research and clinical settings with a fast response time. In this work, we successfully demonstrate such a prototype composed of resazurin and catalytic bimetallic gold-palladium nanoparticles (Au-Pd NPs) incorporated into a thin agarose/alginate hydrogel matrix that rapidly changes color from blue to pink upon exposure to various levels of H₂ at a constant flow rate. The irreversible redox reactions occurring in the sensor involve H₂, in the presence of Au-Pd NPs, converting resazurin to resorufin. To quantify the sensor color changes, ImageJ software was used to analyze photographs of the sensor taken with a smartphone during H₂ exposure. The sensor concentration range was from pure H₂ down to limits of detection of 6 and 8 μM H₂ (defined via two methods). This range is adequate for the intended application of noninvasively monitoring in vivo Mg-alloy implant biodegradation in animals for medical research and patients in clinical settings.

Local and systemic inflammation after implantation of a novel iron based porous degradable bone replacement material in sheep model

Despite the high potential of healthy bone to regenerate, the reconstruction of large bone defects remains a challenge. Due to the lack of mechanical stability of existing bone substitutes, recently developed degradable metallic alloys are an interesting alternative providing higher load-bearing capabilities. Degradable iron-based alloys therefore might be an attractive innovation. To test the suitability of a newly-designed iron-based alloy for such applications, an animal experiment was performed. Porous iron-based degradable implants with two different densities and a control group were tested. The implants were positioned in the proximal tibia of Merino sheep. Over a period of 6 and 12 months, blood and histological parameters were monitored for signs of inflammation and degradation. In the histological evaluation of the implants` environment we found degraded alloy particles, but no inflammatory reaction. Iron particles were also found within the popliteal lymph nodes on both sides. The serum blood levels of phosphorus, iron and ferritin in the long term groups were elevated. Other parameters did not show any changes. Iron-based degradable porous bone replacement implants showed a good biocompatibility in this experiment. For a clinical application, however, the rate of degradation would have to be significantly increased. Biocompatibility would then have to be re-evaluated.

Rheological characterization, compression, and injection molding of hydroxyapatite-silk fibroin composites

Traditional bone fixation devices made from inert metal alloys provide structural strength for bone repair but are limited in their ability to actively promote bone healing. Although several naturally derived bioactive materials have been developed to promote ossification in bone defects, it is difficult to translate small-scale benchtop fabrication of these materials to high-output manufacturing. Standard industrial molding processes, such as injection and compression molding, have typically been limited to use with synthetic polymers since most biopolymers cannot withstand the harsh processing conditions involved in these techniques. Here we demonstrate injection and compression molding of a bioceramic composite comprised of hydroxyapatite (HA) and silk fibroin (SF) from Bombyx mori silkworm cocoons. Both the molding behavior of the HA-SF slurry and final scaffold mechanics can be controlled by modulating SF protein molecular weight, SF content, and powder-to-liquid ratio. HA-SF composites with up to 20 weight percent SF were successfully molded into stable three-dimensional structures using high pressure molding techniques. The unique durability of silk fibroin enables application of common molding techniques to fabricate composite silk-ceramic scaffolds. This work demonstrates the potential to move bone tissue engineering one step closer to large-scale manufacturing of natural protein-based resorbable bone grafts and fixation devices.

Micromorphological effect of calcium phosphate coating on compatibility of magnesium alloy with osteoblast

Octacalcium phosphate (OCP) and hydroxyapatite (HAp) coatings were developed to control the degradation speed and to improve the biocompatibility of biodegradable magnesium alloys. Osteoblast MG-63 was cultured directly on OCP- and HAp-coated Mg-3Al-1Zn (wt%, AZ31) alloy (OCP- and HAp-AZ31) to evaluate cell compatibility. Cell proliferation was remarkably improved with OCP and HAp coatings which reduced the corrosion and prevented the H2O2 generation on Mg alloy substrate. OCP-AZ31 showed sparse distribution of living cell colonies and dead cells. HAp-AZ31 showed dense and homogeneous distribution of living cells, with dead cells localized over and around corrosion pits, some of which were formed underneath the coating. These results demonstrated that cells were dead due to changes in the local environment, and it is necessary to evaluate the local biocompatibility of magnesium alloys. Cell density on HAp-AZ31 was higher than that on OCP-AZ31 although there was not a significant difference in the amount of Mg ions released in medium between OCP- and HAp-AZ31. The outer layer of OCP and HAp coatings consisted of plate-like crystal with a thickness of around 0.1 μm and rod-like crystals with a diameter of around 0.1 μm, respectively, which grew from a continuous inner layer. Osteoblasts formed focal contacts on the tips of plate-like OCP and rod-like HAp crystals, with heights of 2-5 μm. The spacing between OCP tips of 0.8-1.1 μm was wider than that between HAp tips of 0.2-0.3 μm. These results demonstrated that cell proliferation depended on the micromorphology of the coatings which governed spacing of focal contacts. Consequently, HAp coating is suitable for improving cell compatibility and bone-forming ability of the Mg alloy.

Comparison of Electrochemical Methods for the Evaluation of Cast AZ91 Magnesium Alloy

Linear polarization is a potentiodynamic method used for electrochemical characterization of materials. Obtained values of corrosion potential and corrosion current density offer information about material behavior in corrosion environments from the thermodynamic and kinetic points of view, respectively. The present study offers a comparison of applications of the linear polarization method (from -100 mV to +200 mV vs. E_OCP), the cathodic polarization of the specimen (-100 mV vs. E_OCP), and the anodic polarization of the specimen (+100 mV vs. E_OCP), and a discussion of the differences in the obtained values of the electrochemical characteristics of cast AZ91 magnesium alloy. The corrosion current density obtained by cathodic polarization was similar to the corrosion current density obtained by linear polarization, while a lower value was obtained by anodic polarization. Signs of corrosion attack were observed only in the case of linear polarization including cathodic and anodic polarization of the specimen.

A Case of Implant Failure in Partial Wrist Fusion Applying Magnesium-Based Headless Bone Screws

This article presents a case of implant failure resulting in mechanical instability of a scaphotrapezotrapezoideal arthrodesis using magnesium-based headless bone screws. During revision surgery osteolysis surrounding the screws was observed as well as degraded screw threads already in existence at 6 weeks after implantation. The supposed osseous integration attributed to magnesium-based screws could not be reproduced in this particular case. Thus, it can be reasoned that the use of magnesium-based screws for partial wrist arthrodesis cannot be encouraged, at least not in dual use.

Biomechanical Properties of a Novel Biodegradable Magnesium-Based Interference Screw

Magnesium-based interference screws may be an alternative in anterior/posterior cruciate ligament reconstruction. The well-known osteoconductive effects of biodegradable magnesium alloys may be useful. It was the purpose of this study to evaluate the biomechanical properties of a magnesium based interference screw and compare it to a standard implant. A MgYREZr-alloy interference screw and a standard implant (Milagro®; De Puy Mitek, Raynham, MA, USA) were used for graft fixation. Specimens were placed into a tensile loading fixation of a servohydraulic testing machine. Biomechanical analysis included pretensioning of the constructs at 20 N for 1 min following cyclic pretensioning of 20 cycles between 20 and 60 N. Biomechanical elongation was evaluated with cyclic loading of 1000 cycles between 50 and 200 N at 0.5 Hz. Maximum load to failure was 511.3±66.5 N for the Milagro® screw and 529.0±63.3 N for magnesium-based screw (ns, P=0.57). Elongations after preload, during cyclical loading and during failure load were not different between the groups (ns, P>0.05). Stiffness was 121.1±13.8 N/mm for the magnesium-based screw and 144.1±18.4 for the Milagro® screw (ns, P=0.32). MgYREZr alloy interference screws show comparable results in biomechanical testing to standard implants and may be an alternative for anterior cruciate reconstruction in the future.

The in Vitro and in Vivo Degradation of Cross-Linked Poly(trimethylene carbonate)-Based Networks

The degradation of the poly(trimethylene carbonate) (PTMC) and poly(trimethylene carbonate-co-ε-caprolactone) (P(TMC-co-CL)) networks cross-linked by 0.01 and 0.02 mol % 2,2'-bis(trimethylene carbonate-5-yl)-butylether (BTB) was carried out in the conditions of hydrolysis and enzymes in vitro and subcutaneous implantation in vivo. The results showed that the cross-linked PTMC networks exhibited much faster degradation in enzymatic conditions in vitro and in vivo versus in a hydrolysis case due to the catalyst effect of enzymes; the weight loss and physical properties of the degraded networks were dependent on the BTB amount. The morphology observation in lipase and in vivo illustrated that enzymes played an important role in the surface erosion of cross-linked PTMC. The hydrolytic degradation rate of the cross-linked P(TMC-co-CL) networks increased with increasing ε-caprolactone (CL) content in composition due to the preferential cleavage of ester bonds. Cross-linking is an effective strategy to lower the degradation rate and enhance the form-stability of PTMC-based materials.

The biocompatibility of degradable magnesium interference screws: an experimental study with sheep

Screws for ligament reconstruction are nowadays mostly made of poly-L-lactide (PLLA). However, magnesium-based biomaterials are gathering increased interest in this research field because of their good mechanical property and osteoanabolic influence on bone metabolism. The aim of this pilot study was to evaluate the biocompatibility of an interference screw for ligament reconstruction made of magnesium alloy W4 by diecasting and milling and using different PEO-coatings with calcium phosphates. PLLA and titanium screws were used as control samples. The screws were implanted in the femur condyle of the hind leg of a merino sheep. The observation period was six and twelve weeks and one year. Histomorphometric, immunohistochemical, immunofluorescence, and molecular biological evaluation were conducted. Further TEM analysis was done. In all magnesium screws a clinically relevant gas formation in the vicinity of the biomaterial was observed. Except for the PLLA and titanium control samples, no screw was fully integrated in the surrounding bone tissue. Regarding the fabrication process, milling seems to produce less gas liberation and has a better influence on bone metabolism than diecasting. Coating by PEO with calcium phosphates could not reduce the initial gas liberation but rather reduced the bone metabolism in the vicinity of the biomaterial.

In vitro and in vivo biocompatibility and corrosion behaviour of a bioabsorbable magnesium alloy coated with octacalcium phosphate and hydroxyapatite

Octacalcium phosphate (OCP) and hydroxyapatite (HAp) coatings were formed on Mg-3 mass% Al-1 mass% Zn (AZ31) magnesium alloy by a single-step chemical solution deposition method. Chemically polished AZ31 (Cpol-AZ31) and HAp- and OCP-coated AZ31 (HAp- and OCP-AZ31) were immersed in a medium for 52 weeks or implanted in transgenic mice for 16 weeks to examine the long-term corrosion behaviour and in situ inflammation behaviour. In the medium, Mg-ion release was restricted for the initial several days and the corrosion rate thereafter was suppressed by approximately one-half with the HAp and OCP coatings. HAp-AZ31 showed a ∼20% lower corrosion rate than OCP-AZ31. Tissues of the transgenic mouse emit fluorescence in proportion to the degree of inflammation in situ. The luminescence intensity level was too low to be a problem regardless of the coatings. A thinner fibrous tissue layer was formed around OCP- and HAp-AZ31 than around Cpol-AZ31, indicating that the HAp and OCP coatings suppressed corrosion and foreign-body reaction in vivo. Visible pits were formed in filiform and round shapes in vitro and in vivo, respectively. Corrosion was observed underneath the coatings, and almost uniform corrosion took place in vitro, while local corrosion was predominant in vivo. These differences in corrosion morphology are attributed to the adhesion of tissues and the lower diffusivity on the surface in vivo than that in vitro. Dissolution behaviour of OCP crystals in vivo was different from that in vitro. It was demonstrated that the HAp and OCP coatings developed have great potential for a biocompatible and corrosion protection coating.

Development and characterization of an injectable cement of nano calcium-deficient hydroxyapatite/multi(amino acid) copolymer/calcium sulfate hemihydrate for bone repair

A novel injectable bone cement was developed by integration of nano calcium-deficient hydroxyapatite/multi(amino acid) copolymer (n-CDHA/MAC) and calcium sulfate hemihydrate (CSH; CaSO4 · 1/2H2O). The structure, setting time, and compressive strength of the cement were investigated. The results showed that the cement with a liquid to powder ratio of 0.8 mL/g exhibited good injectability and appropriate setting time and mechanical properties. In vitro cell studies indicated that MC3T3-E1 cells cultured on the n-CDHA/MAC/CSH composite spread well and showed a good proliferation state. The alkaline phosphatase activity of the MC3T3-E1 cells cultured on the n-CDHA/MAC/CSH composite was significantly higher than that of the cells on pure CSH at 4 and 7 days of culture. The n-CDHA/MAC/CSH cement was implanted into critical size defects of the femoral condyle in rabbits to evaluate its biocompatibility and osteogenesis in vivo. Radiological and histological results indicated that introduction of the n-CDHA/MAC into CSH enhanced new bone formation, and the n-CDHA/MAC/CSH cement exhibited good biocompatibility and degradability. In conclusion, the injectable n-CDHA/MAC/CSH composite cement has a significant clinical advantage over pure CSH cement, and may be a promising bone graft substitute for the treatment of bone defects.

Biocompatibility and strength retention of biodegradable Mg-Ca-Zn alloy bone implants

The biocompatibility and strength retention of a Mg-Ca-Zn alloy were studied to evaluate its efficacy for osteosynthesis applications. Mg-Ca-Zn alloy and self-reinforced poly l-lactide (SR-PLLA) bone screws were implanted into New Zealand rabbits for radiography analysis, micro computed tomography analysis, histomorphometry, hematology, serum biochemistry, histopathology, and inductively coupled plasma mass spectrometry analysis. Bending and torsion tests were performed on intact specimens to find the initial mechanical strength of these Mg-Ca-Zn alloy bone screws. Strength retention of the Mg-Ca-Zn alloy implants were calculated from in vivo degradation rates and initial mechanical strength. Based on the animal study, Mg-Ca-Zn alloy bone screw showed absence of subcutaneous gas pockets, characteristic surface erosion properties, faster degradation rate than SR-PLLA bone screw, normal reference range of hematology and serum biochemistry, better histopathological response than SR-PLLA bone screw, and stable concentrations of each constituent element in soft tissues surrounding the implants. The initial strength and strength retention of Mg-Ca-Zn alloy were compared with those of various biomaterials. The initial strength of Mg-Ca-Zn alloy was higher than those of biostable and biodegradable polymers. The strength retention of Mg-Ca-Zn alloy bone screws was similar to those of biodegradable polymer. Therefore, this Mg-Ca-Zn alloy represents an excellent biodegradable biomaterial candidate for osteosynthesis applications.

Drug Release Profile from Calcium-Induced Alginate-Phosphate Composite Gel Beads

Calcium-induced alginate-phosphate composite gel beads were prepared, and model drug release profiles were investigated in vitro. The formation of calcium phosphate in the alginate gel matrix was observed and did not affect the rheological properties of the hydrogel beads. X-ray diffraction patterns showed that the calcium phosphate does not exist in crystalline form in the matrix. The initial release amount and release rate of a water-soluble drug, diclofenac, from the alginate gel beads could be controlled by modifying the composition of the matrix with calcium phosphate. In contrast, the release profile was not affected by the modification for hydrocortisone, a drug only slightly soluble in water.