Biocompatible glass-ceramic materials for bone substitution

Association of environmental exposure to chromium with differential DNA methylation: An epigenome-wide study

Introduction: Previous studies have reported that chromium (Cr)-induced epigenetic alterations and DNA methylation play a vital role in the pathogenesis of diseases induced by chromium exposure. Epigenomic analyses have been limited and mainly focused on occupational chromium exposure; their findings are not generalizable to populations with environmental Cr exposure. Methods: We identified the differential methylation of genes and regions to elucidate the mechanisms of toxicity related to environmental chromium exposure. DNA methylation was measured in blood samples collected from individuals in Cr-contaminated (n = 10) and unexposed areas (n = 10) by using the Illumina Infinium HumanMethylation850K array. To evaluate the relationship between chromium levels in urine and CpG methylation at 850 thousand sites, we investigated differentially methylated positions (DMPs) and differentially methylated regions (DMRs) by using linear models and DMRcate method, respectively. The model was adjusted for biologically relevant variables and estimated cell-type compositions. Results: At the epigenome-wide level, we identified five CpGs [cg20690919 (p _{FDR =}0.006), cg00704664 (p _{FDR =}0.024), cg10809143 (p _{FDR =}0.043), cg27057652 (p _{FDR =}0.047), cg05390480 (p _{FDR =}0.024)] and one DMR (chr17: 19,648,718-19,648,972), annotated to ALDH3A1 genes (p < 0.05) as being significantly associated with log₂ transformed urinary chromium levels. Discussion: Environmental chromium exposure is associated with DNA methylation, and the significant DMPs and DMR being annotated to cause DNA damage and genomic instability were found in this work. Research involving larger samples is required to further explore the epigenetic effect of environmental chromium exposure on health outcomes through DNA methylation.

Adhesive Bioinspired Coating for Enhancing Glass-Ceramics Scaffolds Bioactivity

Bioceramic scaffolds, composed of a biphasic composite containing bioactive glass and hydroxyapatite, were prepared in this work to overcome the intrinsic limits of the two components taken separately (in particular, their specific reactivities and dissolution rates, which should be tunable as a function of the given clinical requirements). To mimic the biological environment and tune the different stages of cellular response, a coating with gelatin and chondroitin sulphate via Layer-by-Layer (LbL) assembly was presented and discussed. The resulting functionalized scaffolds were affected by the coating in terms of microstructure and porosity. In addition, the LbL coating significantly enhanced the seeded cell behaviour, with high adhesion, proliferation and osteogenic activity, as revealed by the alkaline phosphatase activity and overexpression of osteopontin and osteocalcin.

A Narrative Review of Bioactive Glass-Loaded Dental Resin Composites

This review aims to provide a comprehensive analysis of the characterizations of bioactive glass (BAG)-loaded dental resin-based composite materials. Online databases (Web of Science, PubMed, and Science Direct) were used to collect data published from January 2011 to January 2022. Only BAG-containing resin adhesive and resin restorative composites are discussed in this narrative review. BAG-loaded resin composites exhibit excellent mineralization ability reflecting enhanced ion release, pH elevation, and apatite formation, especially regarding high BAG loading. This aids the anti-demineralization and remineralization of teeth. Furthermore, BAG-loaded resin composites demonstrated in vitro biocompatibility and antibacterial performance. It has been suggested that BAG fillers with small particle sizes and no more than 20 wt% in terms of loading amount should be used to guarantee the appropriate mechanical properties of resin composites. However, most of these studies focused on one or some aspects using different resin systems, BAG types, and BAG amounts. As such, this makes the comparison difficult, and it is essential to find an optimal balance between different properties. BAG-loaded resin composites can be regarded as bioactive materials, which present major benefits in dentistry, especially their capability in the bacterial inhibition, cell biocompatibility, anti-demineralization, and remineralization of teeth.

Can 3D-Printed Bioactive Glasses Be the Future of Bone Tissue Engineering?

According to the Global Burden of Diseases, Injuries, and Risk Factors Study, cases of bone fracture or injury have increased to 33.4% in the past two decades. Bone-related injuries affect both physical and mental health and increase the morbidity rate. Biopolymers, metals, ceramics, and various biomaterials have been used to synthesize bone implants. Among these, bioactive glasses are one of the most biomimetic materials for human bones. They provide good mechanical properties, biocompatibility, and osteointegrative properties. Owing to these properties, various composites of bioactive glasses have been FDA-approved for diverse bone-related and other applications. However, bone defects and bone injuries require customized designs and replacements. Thus, the three-dimensional (3D) printing of bioactive glass composites has the potential to provide customized bone implants. This review highlights the bottlenecks in 3D printing bioactive glass and provides an overview of different types of 3D printing methods for bioactive glass. Furthermore, this review discusses synthetic and natural bioactive glass composites. This review aims to provide information on bioactive glass biomaterials and their potential in bone tissue engineering.

Osteogenic Potential of Magnesium (Mg)-Doped Multicomponent Bioactive Glass: In Vitro and In Vivo Animal Studies

The use of bioactive glasses (BGs) has been quite fruitful in hard tissue engineering due to the capability of these materials to bond to living bone. In this work, a melt-derived magnesium (Mg)-doped BG (composition: 45SiO₂–3P₂O₅–26CaO–15Na₂O–7MgO–4K₂O (mol.%)) was synthesized for being used in bone reconstruction. The prepared BGs were then manufactured as three-dimensional (3D) scaffolds by using the sponge replica approach. The microstructure of the samples was assessed by X-ray diffraction (XRD) and the surface morphology was observed by using scanning electron microscopy (SEM). The in vitro bioactivity and the release of osteo-stimulatory Mg²⁺ ions from the prepared samples were investigated over 7 days of incubation in simulated body fluids (SBF). In vitro cellular analyses revealed the compatibility of the Mg-doped BGs with human osteosarcoma cells (MG-63 cell line). Moreover, the Mg-doped BGs could induce bone nodule formation in vitro and improve the migratory ability of human umbilical vein endothelial cells (HUVECs). In vivo osteogenic capacity was further evaluated by implanting the BG-derived scaffolds into surgically-created critical-size bone defects in rats. Histological and immunohistological observations revealed an appropriate bone regeneration in the animals receiving the glass-based scaffolds after 12 weeks of surgery. In conclusion, our study indicates the effectiveness of the Mg-doped BGs in stimulating osteogenesis in both in vitro and in vivo conditions.

Foam Replica Method in the Manufacturing of Bioactive Glass Scaffolds: Out-of-Date Technology or Still Underexploited Potential?

Since 2006, the foam replica method has been commonly recognized as a valuable technology for the production of highly porous bioactive glass scaffolds showing three-dimensional, open-cell structures closely mimicking that of natural trabecular bone. Despite this, there are important drawbacks making the usage of foam-replicated glass scaffolds a difficult achievement in clinical practice; among these, certainly the high operator-dependency of the overall manufacturing process is one of the most crucial, limiting the scalability to industrial production and, thus, the spread of foam-replicated synthetic bone substitutes for effective use in routine management of bone defect. The present review opens a window on the versatile world of the foam replica technique, focusing the dissertation on scaffold properties analyzed in relation to various processing parameters, in order to better understand which are the real issues behind the bottleneck that still puts this technology on the Olympus of the most used techniques in laboratory practice, without moving, unfortunately, to a more concrete application. Specifically, scaffold morphology, mechanical and mass transport properties will be reviewed in detail, considering the various templates proposed till now by several research groups all over the world. In the end, a comprehensive overview of in vivo studies on bioactive glass foams will be provided, in order to put an emphasis on scaffold performances in a complex three-dimensional environment.

Scaffold-Type Structure Dental Ceramics with Different Compositions Evaluated through Physicochemical Characteristics and Biosecurity Profiles

The design and development of ceramic structures based on 3D scaffolding as dental bone substitutes has become a topic of great interest in the regenerative dentistry research area. In this regard, the present study focuses on the development of two scaffold-type structures obtained from different commercial dental ceramics by employing the foam replication method. At the same time, the study underlines the physicochemical features and the biological profiles of the newly developed scaffolds, compared to two traditional Cerabone^® materials used for bone augmentation, by employing both the in vitro Alamar blue proliferation test at 24, 48 and 96 h poststimulation and the in ovo chick chorioallantoic membrane (CAM) assay. The data reveal that the newly developed scaffolds express comparable results with the traditional Cerabone^® augmentation masses. In terms of network porosity, the scaffolds show higher pore interconnectivity compared to Cerabone^® granules, whereas regarding the biosafety profile, all ceramic samples manifest good biocompatibility on primary human gingival fibroblasts (HGFs); however only the Cerabone^® samples induced proliferation of HGF cells following exposure to concentrations of 5 and 10 µg/mL. Additionally, none of the test samples induce irritative activity on the vascular developing plexus. Thus, based on the current results, the preliminary biosecurity profile of ceramic scaffolds supports the usefulness for further testing of high relevance for their possible clinical dental applications.

Bone-like ceramic scaffolds designed with bioinspired porosity induce a different stem cell response

Biomaterial science increasingly seeks more biomimetic scaffolds that functionally augment the native bone tissue. In this paper, a new concept of a structural scaffold design is presented where the physiological multi-scale architecture is fully incorporated in a single-scaffold solution. Hydroxyapatite (HA) and β-tricalcium phosphate (β-TCP) bioceramic scaffolds with different bioinspired porosity, mimicking the spongy and cortical bone tissue, were studied. In vitro experiments, looking at the mesenchymal stem cells behaviour, were conducted in a perfusion bioreactor that mimics the physiological conditions in terms of interstitial fluid flow and associated induced shear stress. All the biomaterials enhanced cell adhesion and cell viability. Cortical bone scaffolds, with an aligned architecture, induced an overexpression of several late stage genes involved in the process of osteogenic differentiation compared to the spongy bone scaffolds. This study reveals the exciting prospect of bioinspired porous designed ceramic scaffolds that combines both cortical and cancellous bone in a single ceramic bone graft. It is prospected that dual core shell scaffold could significantly modulate osteogenic processes, once implanted in patients, rapidly forming mature bone tissue at the tissue interface, followed by subsequent bone maturation in the inner spongy structure.

Surface Functionalization of a Silica-Based Bioactive Glass with Compounds from Rosa canina Bud Extracts

Bud extracts are a new category of vegetal products, which are used in gemmotherapy. These products are liquid preparation sources of bioactive molecules (phytochemicals) and are used in medicine as health-promoting agents. Rosa canina is a medicinal plant belonging to the family Rosaceae. The R. canina bud extracts, in particular, possess anti-inflammatory and antioxidant activities due to the presence of flavonoids and other phenolic compounds. The combination of R. canina bud extracts with biomaterials can be promising for obtaining multifunctional materials carrying both inorganic and biological properties. In this work, a protocol of functionalization has been properly designed, for the first time in the literature, in order to graft various bud extracts of R. canina to a silica-based bioactive glass (CEL2). The Folin-Ciocalteu method was used to determine the redox capacity of total polyphenols in the extracts and on functionalized solid samples. X-ray photoelectron spectroscopy analysis and fluorescence microscopy were employed to investigate the presence of phenol substances on the material surface. Bioactivity (in terms of ability of inducing hydroxyapatite precipitation) has been investigated by soaking the samples, with or without functionalization, in simulated body fluid. The presence of the polyphenols from bud extracts not only preserved glass bioactivity but even enhanced it. In particular, the solution obtained from the byproducts of primary extraction in glycerol macerate showed the best performances. Moreover, the presence and antioxidant activity of bud extract compounds on the material surface after grafting demonstrate the possibility of combining the glass inorganic bioactivity with the biomolecule-specific properties, making possible a local action at the implant site. The promising results reported in this work pave the way for the realization of new multifunctional materials with a green approach.

Generation of scaffold incorporated with nanobioglass encapsulated in chitosan/chondroitin sulfate complex for bone tissue engineering

Over the past decade, various composite materials fabricated using natural or synthetic biopolymers incorporated with bioceramic have been widely investigated for the regeneration of segmental bone defect. In the present study, nano-bioglass incorporated osteoconductive composite scaffolds were fabricated through polyelectrolyte complexation/phase separation and resuspension of separated complex in gelatin matrix. Developed scaffold exhibits controlled bioreactivity, minimize abrupt pH rise (~7.8), optimal swelling behavior (2.6+-3.1) and enhances mechanical strength (0.62 ± 0.18 MPa) under wet condition. Moreover, in-vitro cell study shows that the fabricated scaffold provide suitable template for cellular attachment, spreading, biomineralization and collagen based matrix deposition. Also, the developed scaffold was evaluated for biocompatibility and bone tissue regeneration potential through implantation in non-union segmental bone defect created in rabbit animal model. The obtained histological analysis indicates strong potential of the composite scaffold for bone tissue regeneration, vascularization and reconstruction of defects. Thus, the developed composite scaffold might be a suitable biomaterial for bone tissue engineering applications.

Studies on Cell Compatibility, Antibacterial Behavior, and Zeta Potential of Ag-Containing Polydopamine-Coated Bioactive Glass-Ceramic

Dopamine is a small molecule that mimics the adhesive component (L-DOPA) of marine mussels with a catecholamine structure. Dopamine can spontaneously polymerize to form polydopamine (PDA) in a mild basic environment. PDA binds, in principle, to all types of surfaces and offers a platform for post-modification of surfaces. In this work, a novel Ag-containing polydopamine coating has been developed for the functionalization of bioactive glass-ceramics. In order to study the interactions between the surface of uncoated and coated samples and the environment, we have measured the surface zeta potential. Results confirmed that PDA can interact with the substrate through different chemical groups. A strongly negative surface zeta potential was measured, which is desirable for biocompatibility. The dual function of the material, namely the capability to exhibit bioactive behavior while being antibacterial and not harmful to mammalian cells, was assessed. The biocompatibility of the samples with MG-63 (osteoblast-like) cells was determined, as well as the antibacterial behavior against Gram-positive Staphylococcus carnosus and Gram-negative Escherichia coli bacteria. During cell biology tests, uncoated and PDA-coated samples showed biocompatibility, while cell viability on Ag-containing PDA-coated samples was reduced. On the other hand, antibacterial tests confirmed the strong antimicrobial properties of Ag-containing PDA-coated samples, although tailoring of the silver release will be necessary to modulate the dual effect of PDA and silver.

Tackling bioactive glass excessive in vitro bioreactivity: Preconditioning approaches for cell culture tests

Bioactive glasses (BGs) are being increasingly considered for biomedical applications in bone and soft tissue replacement approaches thanks to their ability to form strong bonding with tissues. However, due to their high reactivity once in contact with water-based solutions BGs rapidly exchange ions with the surrounding environment leading in most cases to an undesired increase of the pH under static in vitro conditions (due to alkaline ion "burst release"), making difficult or even impossible to perform cell culture studies. Several pre-conditioning treatments have been therefore proposed in laboratories worldwide to limit this problem. This paper presents an overview of the different strategies that have been put forward to pre-treat BG samples to tackle the pH raise issue in order to enable cell biology studies. The paper also discusses the relevant criteria that determine the selection of the optimal pre-treatment depending on the BG composition and morphology (e.g. particles, scaffolds).

STATEMENT OF SIGNIFICANCE

Bioactive glasses (BGs), since their discovery in 1971 by L.L Hench, have been widely used for bone replacement and repair, and, more recently, they are becoming highly attractive for bone and soft tissue engineering applications. BGs have in fact the ability to form a strong bond with both hard and soft tissues once in contact with biological fluid. The enhanced interaction of BGs with the biological environment is based on their significant surface bioreactivity. This surface effect of BGs is, on the other hand, problematic for cell biology studies by standard (static) cell culture methods: an excessive bioreactivity leads in most cases to a rapid and dramatic increase of the pH of the surrounding medium, which results in cell death and makes cell culture tests on BG samples impossible. The BG research community has been aware of this for many years and numerous pre-treatments have been proposed by different groups worldwide to limit this problem. For the first time, we have reviewed in this paper the variety of surface preconditioning treatments that have been put forward over the years, we provide a summary of such pre-treatments used in laboratory practice, discussing and offering criteria that can be used for the determination of the optimal pre-treatment depending on BG composition and morphology of the sample tested (bulk, particulate, scaffolds). The information and discussion provided in this review should support best research practice when testing bioactive glasses in cell culture.

Bioactive Glass-Ceramic Foam Scaffolds from 'Inorganic Gel Casting' and Sinter-Crystallization

Highly porous bioactive glass-ceramic scaffolds were effectively fabricated by an inorganic gel casting technique, based on alkali activation and gelification, followed by viscous flow sintering. Glass powders, already known to yield a bioactive sintered glass-ceramic (CEL2) were dispersed in an alkaline solution, with partial dissolution of glass powders. The obtained glass suspensions underwent progressive hardening, by curing at low temperature (40 °C), owing to the formation of a C–S–H (calcium silicate hydrate) gel. As successful direct foaming was achieved by vigorous mechanical stirring of gelified suspensions, comprising also a surfactant. The developed cellular structures were later heat-treated at 900–1000 °C, to form CEL2 glass-ceramic foams, featuring an abundant total porosity (from 60% to 80%) and well-interconnected macro- and micro-sized cells. The developed foams possessed a compressive strength from 2.5 to 5 MPa, which is in the range of human trabecular bone strength. Therefore, CEL2 glass-ceramics can be proposed for bone substitutions.

Development of lightweight aggregates from stone cutting sludge, plastic wastes and sepiolite rejections for agricultural and environmental purposes

Three different wastes have been assessed for lightweight aggregate (LWA) manufacturing: granite and marble sludge (COR), sepiolite rejections (SEP) and polyethylene-hexene thermoplastics (P). A preliminary study of the physical and chemical properties of the raw materials was carried out to design proper batches. It was mixed 10% SEP with 90% COR to confer plasticity, and in turn, 0, 2.5, 5 and 10% (w/w) of P was added to check its suitability as a bloating agent. The mixtures were milled, kneaded with water, extruded, shaped into pellets, oven-dried and finally fired at 1100, 1125 and 1150 °C for 4, 8 and 16 min. The main technological properties of the aggregates related to bloating, density, porosity, loss on ignition, water absorption and compressive strength were measured. Scanning Electron Microscopy was used to study the microstructure of some LWAs. 23 out of 29 types of aggregate were lightweight, although neither bloating effect was observed, nor the typical cellular structure comprised of shell and core with relatively large pores was obtained, but a structure consisting of micropores and microchannels. The increase of temperature and time of firing involved a greater sintering, which in turn was translated into higher shrinkage, density and compressive strength values, but less porosity and water absorption. The addition of P did not involve any improvement, indeed it caused a significant decrease in compressive strength. The LWA sintered without P at the minimum time (4 min) and temperature of firing (1100 °C) was selected to assess its water suction capability. The results pointed out that this LWA could be suitable in hydroponics and/or water filtration systems, even better than the commercial LWA Arlita G3. A new and most environment-friendly perspective in LWA industry arises from here, promoting LWA production at relative low temperatures (prior to significant sintering occurs) and using non-plastic silty wastes instead of clays as major components.

Porous biomorphic silicon carbide ceramics coated with hydroxyapatite as prospective materials for bone implants

Porous and cytocompatible silicon carbide (SiC) ceramics derived from wood precursors and coated with bioactive hydroxyapatite (HA) and HA-zirconium dioxide (HA/ZrO2) composite are materials with promising application in engineering of bone implants due to their excellent mechanical and structural properties. Biomorphic SiC ceramics have been synthesized from wood (Hornbeam, Sapele, Tilia and Pear) using a forced impregnation method. The SiC ceramics have been coated with bioactive HA and HA/ZrO2 using effective gas detonation deposition approach (GDD). The surface morphology and cytotoxicity of SiC ceramics as well as phase composition and crystallinity of deposited coatings were analyzed. It has been shown that the porosity and pore size of SiC ceramics depend on initial wood source. The XRD and FTIR studies revealed the preservation of crystal structure and phase composition of in the HA coating, while addition of ZrO2 to the initial HA powder resulted in significant decomposition of the final HA/ZrO2 coating and formation of other calcium phosphate phases. In turn, NIH 3T3 cells cultured in medium exposed to coated and uncoated SiC ceramics showed high re-cultivation efficiency as well as metabolic activity. The recultivation efficiency of cells was the highest for HA-coated ceramics, whereas HA/ZrO2 coating improved the recultivation efficiency of cells as compared to uncoated SiC ceramics. The GDD method allowed generating homogeneous HA coatings with no change in calcium to phosphorus ratio. In summary, porous and cytocompatible bio-SiC ceramics with bioactive coatings show a great promise in construction of light, robust, inexpensive and patient-specific bone implants for clinical application.

Bioactive Glasses with Low Ca/P Ratio and Enhanced Bioactivity

Three new silica-based glass formulations with low molar Ca/P ratio (2–3) have been synthesized. The thermal properties, the crystalline phases induced by thermal treatments and the sintering ability of each glass formulation have been investigated by simultaneous differential scanning calorimetry-thermogravimetric analysis (DSC-TG), X-ray diffraction (XRD) and hot stage microscopy (HSM). The glasses exhibited a good sintering behavior, with two samples achieving shrinkage of 85%–95% prior to crystallization. The bioactivity of the glasses in simulated body fluid (SBF) has been investigated by performing XRD and Fourier transform infrared spectroscopy (FTIR) on the samples prior and after immersion. The glasses with lower MgO contents were able to form a fully crystallized apatite layer after three days of immersion in simulated body fluid (SBF), while for the glass exhibiting a higher MgO content in its composition, the crystallization of the Ca–P layer was achieved after seven days. The conjugation of these properties opens new insights on the synthesis of highly bioactive and mechanically strong prosthetic materials.

Composite bone cements loaded with a bioactive and ferrimagnetic glass-ceramic: Leaching, bioactivity and cytocompatibility

In this work, composite bone cements, based on a commercial polymethylmethacrylate matrix (Palamed®) loaded with ferrimagnetic bioactive glass-ceramic particles (SC45), were produced and characterized in vitro. The ferrimagnetic bioactive glass-ceramic belongs to the system SiO2-Na2O-CaO-P2O5-FeO-Fe2O3 and contains magnetite (Fe3O4) crystals into a residual amorphous bioactive phase. Three different formulations (containing 10, 15 and 20 wt.% of glass-ceramic particles respectively) have been investigated. These materials are intended to be applied as bone fillers for the hyperthermic treatment of bone tumors. The morphological, compositional, calorimetric and mechanical properties of each formulation have been already discussed in a previous paper. The in vitro properties of the composite bone cements described in the present paper are related to iron ion leaching test (by graphite furnace atomic absorption spectrometer), bioactivity (i.e. the ability to stimulate the formation of a hydroxyapatite - HAp - layer on their surface after soaking in simulated body fluid SBF) and cytocompatibility toward human osteosarcoma cells (ATCC CRL-1427, Mg63). Morphological and chemical characterizations by scanning electron microscopy and energy dispersion spectrometry have been performed on the composite samples after each test. The iron release was negligible and all the tested samples showed the growth of HAp on their surface after 28 days of immersion in a simulated body fluid (SBF). Cells showed good viability, morphology, adhesion, density and the ability to develop bridge-like structures on all investigated samples. A synergistic effect between bioactivity and cell mineralization was also evidenced.

Composite scaffolds for controlled drug release: role of the polyurethane nanoparticles on the physical properties and cell behaviour

Localised delivery of appropriate biomolecule/drug(s) can be suitable to prevent postoperative infections and inflammation after scaffold implantation in vivo. In this study composite shell scaffolds, based on an internally produced bioactive glass and a commercial hydroxyapatite, were surface coated with a uniform polymeric layer, embedded with thermo-stable polyesterurethane (PU)-based nanoparticles (NPs), containing an anti-inflammatory drug (indomethacin; IDCM). The obtained functionalised scaffolds were subjected to physico-mechanical and biological characterisations. The results indicated that NPs incorporation into the gelatin coating of the composite scaffolds: 1) not changed significantly the micro-architecture of the scaffolds in terms of mean pore diameter and pore size distribution; 2) increased the compressive modulus; and 3) allowed to a sustained IDMC release (65-70% of the loaded-drug) within the first week of incubation in physiological solution. On the other hand, the NPs incorporation did not affect the biocompatibility of composite scaffolds, as evidenced by viability and alkaline phosphatase (ALP) activity of MG63 human osteoblast-like cells.

Bioceramics in ophthalmology

The benefits of ceramics in biomedical applications have been universally appreciated as they exhibit an extraordinarily broad set of physico-chemical, mechanical and biological properties which can be properly tailored by acting on their composition, porosity and surface texture to increase their versatility and suitability for targeted healthcare applications. Bioceramics have traditionally been used for the repair of hard tissues, such as bone and teeth, mainly due to their suitable strength for load-bearing applications, wear resistance (especially alumina, zirconia and composites thereof) and, in some cases, bone-bonding ability (calcium orthophosphates and bioactive glasses). Bioceramics have been also applied in other medical areas, like ophthalmic surgery; although their use in such a context has been scientifically documented since the late 1700s, the potential and importance of ceramic ocular implants still seem to be underestimated and an exhaustive, critical assessment is currently lacking in the relevant literature. The present review aims to fill this gap by giving a comprehensive picture of the ceramic-based materials and implants that are currently used in ophthalmology and pointing out the strengths and weaknesses of the existing devices. A prospect for future research is also provided, highlighting the potential of new, smart bioceramics able to carry specific added values which could have a significant impact on the treatment of ocular diseases.

Bone tissue engineering scaffolding: computer-aided scaffolding techniques

Tissue engineering is essentially a technique for imitating nature. Natural tissues consist of three components: cells, signalling systems (e.g. growth factors) and extracellular matrix (ECM). The ECM forms a scaffold for its cells. Hence, the engineered tissue construct is an artificial scaffold populated with living cells and signalling molecules. A huge effort has been invested in bone tissue engineering, in which a highly porous scaffold plays a critical role in guiding bone and vascular tissue growth and regeneration in three dimensions. In the last two decades, numerous scaffolding techniques have been developed to fabricate highly interconnective, porous scaffolds for bone tissue engineering applications. This review provides an update on the progress of foaming technology of biomaterials, with a special attention being focused on computer-aided manufacturing (Andrade et al. 2002) techniques. This article starts with a brief introduction of tissue engineering (Bone tissue engineering and scaffolds) and scaffolding materials (Biomaterials used in bone tissue engineering). After a brief reviews on conventional scaffolding techniques (Conventional scaffolding techniques), a number of CAM techniques are reviewed in great detail. For each technique, the structure and mechanical integrity of fabricated scaffolds are discussed in detail. Finally, the advantaged and disadvantage of these techniques are compared (Comparison of scaffolding techniques) and summarised (Summary).

Toward Strong and Tough Glass and Ceramic Scaffolds for Bone Repair

The need for implants to repair large bone defects is driving the development of porous synthetic scaffolds with the requisite mechanical strength and toughness in vivo. Recent developments in the use of design principles and novel fabrication technologies are paving the way to create synthetic scaffolds with promising potential for reconstituting bone in load-bearing sites. This article reviews the state of the art in the design and fabrication of bioactive glass and ceramic scaffolds that have improved mechanical properties for structural bone repair. Scaffolds with anisotropic and periodic structures can be prepared with compressive strengths comparable to human cortical bone (100-150 MPa), while scaffolds with an isotropic structure typically have strengths in the range of trabecular bone (2-12 MPa). However, the mechanical response of bioactive glass and ceramic scaffolds in multiple loading modes such as flexure and torsion - as well as their mechanical reliability, fracture toughness, and fatigue resistance - has received little attention. Inspired by the designs of natural materials such as cortical bone and nacre, glass-ceramic and inorganic/polymer composite scaffolds created with extrinsic toughening mechanisms are showing potential for both high strength and mechanical reliability. Future research should include improved designs that provide strong scaffolds with microstructures conducive to bone ingrowth, and evaluation of these scaffolds in large animal models for eventual translation into clinical applications.

Novel resorbable glass-ceramic scaffolds for hard tissue engineering: from the parent phosphate glass to its bone-like macroporous derivatives

One of the major challenges of hard tissue engineering research focuses on the development of scaffolds that can match the mechanical properties of the host bone and resorb at the same rate as the bone is repaired. The aim of this work was the synthesis and characterization of a resorbable phosphate glass, as well as its application for the fabrication of three dimensional (3-D) scaffolds for bone regeneration. The glass microstructure and behaviour upon heating were analysed by X-ray diffraction, differential scanning calorimetry and hot stage microscopy. The glass solubility was investigated according to relevant ISO standards using distilled water, simulated body fluid (SBF) and Tris-HCl as testing media. The glass underwent progressive dissolution over time in all three media but the formation of a hydroxyapatite-like layer was also observed on the samples soaked in SBF and Tris-HCl, which demonstrated the bioactivity of the material. The glass powder was used to fabricate 3-D macroporous bone-like glass-ceramic scaffolds by adopting polyethylene particles as pore formers: during thermal treatment, the polymer additive was removed and the sintering of glass particles was allowed. The obtained scaffolds exhibited high porosity (87 vol.%) and compressive strength around 1.5 MPa. After soaking for 4 months in SBF, the scaffolds mass loss was 76 wt.% and the pH of the solution did not exceed the 7.55 value, thereby remaining in a physiological range. The produced scaffolds, being resorbable, bioactive, architecturally similar to trabecular bone and exhibiting interesting mechanical properties, can be proposed as promising candidates for bone repair applications.

Antibiotic loading on bioactive glasses and glass-ceramics: An approach to surface modification

A bioactive glass and its corresponding glass-ceramic have been used to investigate the possibility to load a common antibiotic (carbenicillin) on their surface during the reactivity processes which occur by dipping these materials in a simulated body fluid. The materials bioactivity in the early stage of simulated body fluid treatment has been investigated by means of scanning electron microscopy (SEM-EDS) and X-ray diffraction. The uptake of carbenicillin has been performed by dipping the samples in simulated body fluid solution with a drug concentration of 500 mg/l for 6, 12 and 24 h. Some glass samples underwent a pre-treatment in simulated body fluid, for different time frames, in order to form a silica gel layer before the surface exposition to antibiotic. The carbenicillin release has been measured in water up to 36 h. The amount of incorporated and released antibiotic has been estimated by UV visible spectrophotometer. All samples were able to incorporate a significant amount of antibiotic and it was possible to tailor the drug release by modifying the simulated body fluid pre-treatment.

Processing and characterization of innovative scaffolds for bone tissue engineering

A new protocol, based on a modified replication method, is proposed to obtain bioactive glass scaffolds. The main feature of these samples, named "shell scaffolds", is their external surface that, like a compact and porous shell, provides both high permeability to fluids and mechanical support. In this work, two different scaffolds were prepared using the following slurry components: 59 % water, 29 % 45S5 Bioglass(®) and 12 % polyvinylic binder and 51 % water, 34 % 45S5 Bioglass(®), 10 % polyvinylic binder and 5 % polyethylene. All the proposed samples were characterized by a widespread microporosity and an interconnected macroporosity, with a total porosity of 80 % vol. After immersion in a simulated body fluid (SBF), the scaffolds showed strong ability to develop hydroxyapatite, enhanced by the high specific surface of the porous systems. Moreover preliminary biological evaluations suggested a promising role of the shell scaffolds for applications in bone tissue regeneration. As regards the mechanical behaviour, the shell scaffolds could be easily handled without damages, due to their resistant external surface. More specifically, they possessed suitable mechanical properties for bone regeneration, as proved by compression tests performed before and after immersion in SBF.

Aldehyde dehydrogenases and cell proliferation

Aldehyde dehydrogenases (ALDHs) oxidize aldehydes to the corresponding carboxylic acids using either NAD or NADP as a coenzyme. Aldehydes are highly reactive aliphatic or aromatic molecules that play an important role in numerous physiological, pathological, and pharmacological processes. ALDHs have been discovered in practically all organisms and there are multiple isoforms, with multiple subcellular localizations. More than 160 ALDH cDNAs or genes have been isolated and sequenced to date from various sources, including bacteria, yeast, fungi, plants, and animals. The eukaryote ALDH genes can be subdivided into several families; the human genome contains 19 known ALDH genes, as well as many pseudogenes. Noteworthy is the fact that elevated activity of various ALDHs, namely ALDH1A2, ALDH1A3, ALDH1A7, ALDH2*2, ALDH3A1, ALDH4A1, ALDH5A1, ALDH6, and ALDH9A1, has been observed in normal and cancer stem cells. Consequently, ALDHs not only may be considered markers of these cells, but also may well play a functional role in terms of self-protection, differentiation, and/or expansion of stem cell populations. The ALDH3 family includes enzymes able to oxidize medium-chain aliphatic and aromatic aldehydes, such as peroxidic and fatty aldehydes. Moreover, these enzymes also have noncatalytic functions, including antioxidant functions and some structural roles. The gene of the cytosolic form, ALDH3A1, is localized on chromosome 17 in human beings and on the 11th and 10th chromosome in the mouse and rat, respectively. ALDH3A1 belongs to the phase II group of drug-metabolizing enzymes and is highly expressed in the stomach, lung, keratinocytes, and cornea, but poorly, if at all, in normal liver. Cytosolic ALDH3 is induced by polycyclic aromatic hydrocarbons or chlorinated compounds, such as 2,3,7,8-tetrachlorodibenzo-p-dioxin, in rat liver cells and increases during carcinogenesis. It has been observed that this increased activity is directly correlated with the degree of deviation in hepatoma and lung cancer cell lines, as is the case in chemically induced hepatoma in rats. High ALDH3A1 expression and activity have been correlated with cell proliferation, resistance against aldehydes derived from lipid peroxidation, and resistance against drug toxicity, such as oxazaphosphorines. Indeed, cells with a high ALDH3A1 content are more resistant to the cytostatic and cytotoxic effects of lipidic aldehydes than are those with a low content. A reduction in cell proliferation can be observed when the enzyme is directly inhibited by the administration of synthetic specific inhibitors, antisense oligonucleotides, or siRNA or indirectly inhibited by the induction of peroxisome proliferator-activated receptor γ (PPARγ) with polyunsaturated fatty acids or PPARγ transfection. Conversely, cell proliferation is stimulated by the activation of ALDH3A1, whether by inhibiting PPARγ with a specific antagonist, antisense oligonucleotides, siRNA, or a medical device (i.e., composite polypropylene prosthesis for hernia repair) used to induce cell proliferation. To date, the mechanisms underlying the effects of ALDHs on cell proliferation are not yet fully clear. A likely hypothesis is that the regulatory effect is mediated by the catabolism of some endogenous substrates deriving from normal cell metabolism, such as 4-hydroxynonenal, which have the capacity to either stimulate or inhibit the expression of genes involved in regulating proliferation.

Optimization of composition, structure and mechanical strength of bioactive 3-D glass-ceramic scaffolds for bone substitution

Fabrication of 3-D highly porous, bioactive, and mechanically competent scaffolds represents a significant challenge of bone tissue engineering. In this work, Bioglass®-derived glass-ceramic scaffolds actually fulfilling this complex set of requirements were successfully produced through the sponge replication method. Scaffold processing parameters and sintering treatment were carefully designed in order to obtain final porous bodies with pore content (porosity above 70 %vol), trabecular architecture and mechanical properties (compressive strength up to 3 MPa) analogous to those of the cancellous bone. Influence of the Bioglass® particles size on the structural and mechanical features of the sintered scaffolds was considered and discussed. Relationship between porosity and mechanical strength was investigated and modeled. Three-dimensional architecture, porosity, mechanical strength and in vitro bioactivity of the optimized Bioglass®-derived scaffolds were also compared to those of CEL2-based glass-ceramic scaffolds (CEL2 is an experimental bioactive glass originally developed by the authors at Politecnico di Torino) fabricated by the same processing technique, in an attempt at understanding the role of different bioactive glass composition on the major features of scaffolds prepared by the same method.

Heat treatment of Na2O-CaO-P2O5-SiO2 bioactive glasses: densification processes and postsintering bioactivity

Because of their excellent bioactivity, bioactive glasses are increasingly diffused to produce biomedical devices for bone prostheses, to face the dysfunctions that may be caused by traumatic events, diseases, or even natural aging. However, several processing routes, such as the production of scaffolds or the deposition of coatings, include a thermal treatment to apply or sinter the glass. The exposure to high temperature may induce a devetrification phenomenon, altering the properties and, in particular, the bioactivity of the glass. The present contribution offers an overview of the thermal behavior and properties of two glasses belonging to the Na2O-CaO-P2O5-SiO2 system, to be compared to the standard 45S5 Bioglass(®). The basic goal is to understand the effect of both the original composition and the thermal treatment on the performance of the sintered glasses. The new glasses, the one (BG_Na) with a high content of Na2O, the other (BG_Ca) with a high content of CaO, were fully characterized and sintering tests were performed to define the most interesting firing cycles. The sintered samples, treated at 880°C and 800°C respectively, were investigated from a microstructural point of view and their mechanical properties were compared to those of the bulk (not sintered) glass counterparts. The effect of sintering was especially striking on the BG_Ca material, whose Vickers hardness increased from 598.9 ± 46.7 HV to 1053.4 ± 35.0 HV. The in vitro tests confirmed the ability of the glasses, both in bulk and sintered form, of generating a hydroxyapatite surface layer when immersed in a simulated body fluid. More accurate biological tests performed on the sintered glasses proved the high bioactivity of the CaO-rich composition even after a heat treatment.

Bioactive glass scaffolds for bone tissue engineering: state of the art and future perspectives

The repair and regeneration of large bone defects resulting from disease or trauma remains a significant clinical challenge. Bioactive glass has appealing characteristics as a scaffold material for bone tissue engineering, but the application of glass scaffolds for the repair of load-bearing bone defects is often limited by their low mechanical strength and fracture toughness. This paper provides an overview of recent developments in the fabrication and mechanical properties of bioactive glass scaffolds. The review reveals the fact that mechanical strength is not a real limiting factor in the use of bioactive glass scaffolds for bone repair, an observation not often recognized by most researchers and clinicians. Scaffolds with compressive strengths comparable to those of trabecular and cortical bones have been produced by a variety of methods. The current limitations of bioactive glass scaffolds include their low fracture toughness (low resistance to fracture) and limited mechanical reliability, which have so far received little attention. Future research directions should include the development of strong and tough bioactive glass scaffolds, and their evaluation in unloaded and load-bearing bone defects in animal models.

Bone tissue response to porous and functionalized titanium and silica based coatings

Background

Topography and presence of bio-mimetic coatings are known to improve osseointegration. The objective of this study was to evaluate the bone regeneration potential of porous and osteogenic coatings.

Methodology

Six-implants [Control (CTR); porous titanium coatings (T1, T2); thickened titanium (Ti) dioxide layer (TiO₂); Amorphous Microporous Silica (AMS) and Bio-active Glass (BAG)] were implanted randomly in tibiae of 20-New Zealand white rabbits. The animals were sacrificed after 2 or 4 weeks. The samples were analyzed histologically and histomorphometrically. In the initial bone-free areas (bone regeneration areas (BRAs)), the bone area fraction (BAF) was evaluated in the whole cavity (500 µm, BAF-500), in the implant vicinity (100 µm, BAF-100) and further away (100–500 µm, BAF-400) from the implant. Bone-to-implant contact (BIC-BAA) was measured in the areas where the implants were installed in contact to the host bone (bone adaptation areas (BAAs)) to understand and compare the bone adaptation. Mixed models were used for statistical analysis.

Principal Findings

After 2 weeks, the differences in BAF-500 for different surfaces were not significant (p>0.05). After 4 weeks, a higher BAF-500 was observed for BAG than CTR. BAF-100 for AMS was higher than BAG and BAF-400 for BAG was higher than CTR and AMS. For T1 and AMS, the bone regeneration was faster in the 100-µm compared to the 400-µm zone. BIC-BAA for AMS and BAG was lower after 4 than 2 weeks. After 4 weeks, BIC-BAA for BAG was lower than AMS and CTR.

Conclusions

BAG is highly osteogenic at a distance from the implant. The porous titanium coatings didn't stimulate bone regeneration but allowed bone growth into the pores. Although AMS didn't stimulate higher bone response, it has a potential of faster bone growth in the vicinity compared to further away from the surface. BIC-BAA data were inconclusive to understand the bone adaptation.

Bioactive Glass and Glass-Ceramic Scaffolds for Bone Tissue Engineering

Traditionally, bioactive glasses have been used to fill and restore bone defects. More recently, this category of biomaterials has become an emerging research field for bone tissue engineering applications. Here, we review and discuss current knowledge on porous bone tissue engineering scaffolds on the basis of melt-derived bioactive silicate glass compositions and relevant composite structures. Starting with an excerpt on the history of bioactive glasses, as well as on fundamental requirements for bone tissue engineering scaffolds, a detailed overview on recent developments of bioactive glass and glass-ceramic scaffolds will be given, including a summary of common fabrication methods and a discussion on the microstructural-mechanical properties of scaffolds in relation to human bone (structure-property and structure-function relationship). In addition, ion release effects of bioactive glasses concerning osteogenic and angiogenic responses are addressed. Finally, areas of future research are highlighted in this review.

Resorbable glass-ceramic phosphate-based scaffolds for bone tissue engineering: synthesis, properties, and in vitro effects on human marrow stromal cells

Highly porous bioresorbable glass-ceramic scaffolds were prepared via sponge replication method by using an open-cell polyurethane foam as a template and phosphate-based glass powders. The glass, belonging to the P2O5-SiO2-CaO-MgO-Na2O-K2O system, was synthesized by a melting-quenching route, ground, and sieved to obtain powders with a grain size of less than 30 μm. A slurry containing glass powders, polyvinyl alcohol, and water was prepared to coat the polymeric template. The removal of the polymer and the sintering of the glass powders were performed by a thermal treatment, in order to obtain an inorganic replica of the template structure. The structure and properties of the scaffold were investigated from structural, morphological, and mechanical viewpoints by means of X-ray diffraction, scanning electron microscopy, density measurements, image analysis, and compressive tests. The scaffolds exhibited a trabecular architecture that closely mimics the structure of a natural spongy bone. The solubility of the porous structures was assessed by soaking the samples in acellular simulated body fluid (SBF) and Tris-HCl for different time frames and then by assessing the scaffold weight loss. As far as the test in SBF is concerned, the nucleation of hydroxyapatite on the scaffold trabeculae demonstrates the bioactivity of the material. Biological tests were carried out using human bone marrow stromal cells to test the osteoconductivity of the material. The cells adhered to the scaffold struts and were metabolically active; it was found that cell differentiation over proliferation occurred. Therefore, the produced scaffolds, being biocompatible, bioactive, resorbable, and structurally similar to a spongy bone, can be proposed as interesting candidates for bone grafting.

Fossils as candidate material for orthopedic applications

Ceramic powders from fossil deposits were thoroughly characterized from the material point of view and sintered to produce massive components. The raw material, a mixture of apatite minerals, feldspars, and quartz, seems ideally suitable to obtain a biologically compatible glass ceramic. Preliminary in vitro tests of proliferation and adhesion of MG63 human osteoblast-like cell line on a selected sample are encouraging. Results are correlated with sintering conditions and phase composition: the fossil can be sintered to almost full density at temperatures as low as 900 °C and seems to quickly promote cell activation with respect to hydroxylapatite.

Alkaline phosphatase grafting on bioactive glasses and glass ceramics

Bone integration of orthopaedic or dental implants and regeneration of damaged bone at the surgical site are still unresolved problems in prosthetic surgery. For this reason, biomimetic surfaces (i.e. both inorganic and biological bioactive surfaces) represent a challenge for bone implantation. In this research work a hydrolase enzyme (alkaline phosphatase) was covalently grafted to inorganic bioactive glass and glass ceramic surfaces, in order to impart biological bioactivity. The functionalized samples were analysed by means of X-ray photoelectron spectroscopy in order to verify enzyme presence on the surface. Enzyme activity was measured by means of UV-visual spectroscopy after reaction with the natural substrate. Scanning electron microscopy-energy-dispersive spectroscopy observations allowed monitoring of the morphological and chemical modification of the materials during the different steps of functionalization. In vitro inorganic bioactivity was investigated by soaking samples in simulated body fluid. Enzymatic activity of the samples was tested and compared before and after soaking. Enzymatic activity of the solution was monitored at different experimental times. This study demonstrates that alkaline phosphatase could be successfully grafted onto different bioactive surfaces while maintaining its activity. Presence of the enzyme in vitro enhances the inorganic bioactivity of the materials tested.

Feasibility and Tailoring of Bioactive Glass-ceramic Scaffolds with Gradient of Porosity for Bone Grafting

The aim of this research study is the preparation and characterization of graded glass—ceramic scaffolds that are able to mimic the structure of the natural bone tissue, formed by cortical and cancellous bone. The material chosen for the scaffolds preparation is a glass belonging to the system SiO 2—P2O5—CaO—MgO—Na 2O—K2O (CEL2). The glass was synthesized by a conventional melting—quenching route, ground, and sieved to obtain powders of specific size. The scaffolds were fabricated using different methods: polyethylene burn-off, sponge replication, a glazing-like technique, and combinations of these methods. The scaffolds were characterized through morphological observations, density measurements, volumetric shrinkage, mechanical tests, and in vitro bioactivity tests. The features of the scaffolds prepared using the different methods were compared in terms of morphological structure, pores content, and mechanical strength. The proposed scaffolds effectively mimic the cancellous/cortical bone system in terms of structure, porosity, and mechanical strength, and they exhibit a highly bioactive behavior. Therefore, these graded grafts have a great potential for biomedical applications and can be successfully proposed for the substitution of load-bearing bone portions.

Micro-CT studies on 3-D bioactive glass-ceramic scaffolds for bone regeneration

The aim of this study was the preparation and characterization of bioactive glass-ceramic scaffolds for bone tissue engineering. For this purpose, a glass belonging to the system SiO2-P2O5-CaO-MgO-Na2O-K2O (CEL2) was used. The sponge-replication method was adopted to prepare the scaffolds; specifically, a polymeric skeleton was impregnated with a slurry containing CEL2 powder, polyvinyl alcohol (PVA) as a binding agent and distilled water. The impregnated sponge was then thermally treated to remove the polymeric phase and to sinter the inorganic one. The obtained scaffolds possessed an open and interconnected porosity, analogous to cancellous bone texture, and with a mechanical strength above 2 MPa. Moreover, the scaffolds underwent partial bioresorption due to ion-leaching phenomena. This feature was investigated by X-ray computed microcomputed tomography (micro-CT). Micro-CT is a three-dimensional (3-D) radiographic imaging technique, able to achieve a spatial resolution close to 1 microm(3). The use of synchrotron radiation allows the selected photon energy to be tuned to optimize the contrast among the different phases in the investigated samples. The 3-D scaffolds were soaked in a simulated body fluid (SBF) to study the formation of hydroxyapatite microcrystals on the scaffold struts and on the internal pore walls. The 3-D scaffolds were also soaked in a buffer solution (Tris-HCl) for different times to assess the scaffold bioresorption according to the ISO standard. A gradual resorption of the pores walls was observed during the soakings both in SBF and in Tris-HCl.

High strength bioactive glass-ceramic scaffolds for bone regeneration

This research work is focused on the preparation of macroporous glass-ceramic scaffolds with high mechanical strength, equivalent with cancellous bone. The scaffolds were prepared using an open-cells polyurethane sponge as a template and glass powders belonging to the system SiO(2)-P(2)O(5)-CaO-MgO-Na(2)O-K(2)O. The glass, named as CEL2, was synthesized by a conventional melting-quenching route, ground and sieved to obtain powders of specific size. A slurry of CEL2 powders, polyvinyl alcohol (PVA) as a binder and water was prepared in order to coat, by a process of impregnation, the polymeric template. A thermal treatment was then used to remove the sponge and to sinter the glass powders, in order to obtain a replica of the template structure. The scaffolds were characterized by means of X-ray diffraction analysis, morphological observations, density measurements, volumetric shrinkage, image analysis, capillarity tests, mechanical tests and in vitro bioactivity evaluation.