Historic and current strategies in bone tissue engineering: do we have a hope in Hench?

Original implementation of low-temperature SPS for bioactive glass used as a bone biomaterial

Alkali borated bioactive glasses powders with compositions based on the SiO₂-Na₂O-CaO-P₂O₅-x B₂O₃ system (0 < x < 20 wt%); have been consolidated at low temperature using Spark Plasma Sintering (SPS). Through SPS technique under 50 MPa, it was possible to achieve fully dense and completely amorphous borated glasses at temperatures as low as 420 °C. By increasing the sintering temperature up to 430 °C, the dense samples crystallized which is mostly achieved at higher temperatures. This study reveals that the mechanical properties of these new borated biomaterials are suitable to be used as a promising candidate for repairing defects in non-load-bearing bones as well as for coating on the metallic surface implants to improve the bioactivity process bone/implant. The pressure had a weak effect on the crystallization and densification of the glass compared to the temperature during the powder consolidation by SPS. Moreover, by increasing the boron content, the compressive strength and the elastic modulus of the elaborated glasses decreased for being close to those of the natural.

Influence of low amounts of zinc or magnesium substitution on ion release and apatite formation of Bioglass 45S5

Magnesium and zinc ions play various key roles in the human body, being involved, among others, in skeletal development and wound healing. Zinc is also known to have antimicrobial properties. While low concentrations can stimulate cells in vitro, high concentrations of magnesium or zinc introduced into bioactive glasses significantly reduce glass degradation and ion release and inhibit apatite precipitation. On the other hand, magnesium and zinc ions improve the high temperature processing of bioactive glasses, even when present at low concentrations only. Results here show that by substituting small amounts of Mg or Zn for Ca, ion release remains high enough to allow for apatite precipitation. In addition, magnesium and zinc containing bioactive glasses are shown to be very susceptible to changes in particle size and relative surface area. For a given magnesium or zinc content in the glass, ion release and apatite formation can be enhanced dramatically by reducing the particle size, reaching comparable levels as Bioglass 45S5 of the same particle size range. Taken together, these findings suggest that when introducing these ions into bioactive glasses, ideally low Mg or Zn for Ca substitution as well as small particle sizes are used. This way, bioactive glasses combining good high temperature processing with fast ion release and apatite precipitation can be obtained, providing the potential additional benefit of releasing magnesium or zinc ions in therapeutic concentrations.

State of the art biofabrication technologies and materials for bone tissue engineering

Bone tissue engineering is a field whose relevance is paramount, especially for the treatment of musculoskeletal-related disabilities. Failure of conventional methods to create physiologically relevant bone materials has prompted exploring several 3D-printing and additive manufacturing processes, including bioprinting, selective laser sintering, electrospinning and stereolithography. These technologies emerged in conjunction with new materials such as Hyperelastic Bone™, graphene and thermoplastics coupled with cell-laden hydrogels. This work will review these current state-of-the-art materials and technologies, their impact on advancements in bone tissue engineering and will highlight future considerations for the field.

Synthesis, Characterization, and in Vitro Biological Evaluation of Copper-Containing Magnetic Bioactive Glasses for Hyperthermia in Bone Defect Treatment

Hyperthermia treatment induced by magnetic mesoporous glasses has been applied as a potential therapeutic approach for bone defects due to malignant tumors. The objective of this study was to synthesize and characterize the structural and biological properties of magnetic bioactive glasses (BGs) for producing multifunctional materials. The effect of the addition of copper (Cu) to the bioactive glass composition was also evaluated. Fe BG and FeCu BG as magnetic mesoporous BGs, and Cu BG as mesoporous BG were synthesized and dried by template sol-gel method. Then the synthesized bioglasses were characterized and analyzed using Fourier transform infrared spectroscopy (FTIR), X-ray diffraction (XRD), scanning electron microscopy (SEM), transmission electron microscopy (TEM), energy-dispersive electron disperse spectroscopy (EDS), Brunauer-Emmett-Teller (BET), and vibrating sample magnetometer (VSM). In addition, the antibacterial behavior, cytotoxicity assay (MTT test), proliferation assay of HUVEC cell assay, and bioactivity (ALP activity test) of the synthesized BGs were evaluated. The characterization results exhibited that the synthesized powders formed mesoporous glasses with nanoparticle morphology, good surface area, and magnetic properties. The synthesized BGs also demonstrated suitable biological behavior. The magnetic saturation of bioactive glasses was increased by the addition of copper oxide. A two-phase structure was observed for the magnetic glasses compared to the copper-containing glasses, thus making them suitable for drug delivery systems. The antibacterial behavior was found to be better for the Cu BG and Fe BG compared to the FeCu BG. However, the least amount of cytotoxicity was observed for the Fe BG and FeCu BG, compared to the Cu BG. In addition, the Fe-containing BGs compared with the control group showed a lack of HUVEC cell proliferation and angiogenesis motivation. From the ALP assay, higher bioactivity for the magnetic bioglasses in the presence of mesenchymal cells was found. From the results of this in vitro study, the Cu-containing magnetic bioglass (FeCu BG) could be considered as a new generation of magnetic glasses for inducing hyperthermia in treatment of bone defects due to malignant tumors. However, further in vitro and in vivo studies are required to confirm their applications in healing of bone defects and tissue engineering.

Optimisation of lithium-substituted bioactive glasses to tailor cell response for hard tissue repair

Bioactive glasses (BG) are used clinically because they can both bond to hard tissue and release therapeutic ions that can stimulate nearby cells. Lithium has been shown to regulate the Wnt/β-catenin cell signalling pathway, which plays important roles in the formation and repair of bone and teeth. Lithium-releasing BG, therefore, have the potential to locally regulate hard tissue formation; however, their design must be tailored to induce an appropriate biological response. Here, we optimised the release of lithium from lithium-substituted BG by varying BG composition, particle size and concentration to minimise toxicity and maximise upregulation of the Wnt target gene Axin2 in in vitro cell cultures. Our results show that we can tailor lithium release from BG over a wide therapeutic and non-toxic range. Increasing the concentration of BG in cell culture medium can induce toxicity, likely due to modulations in pH. Nevertheless, at sub-toxic concentrations, lithium released from BG can upregulate the Wnt pathway in 17IA4 cells, similarly to treatment with LiCl. Taken together, these data demonstrate that ion release from lithium-substituted BG can be tailored to maximise biological response. These data may be important in the design of BG that can regulate the Wnt/β-catenin pathway to promote hard tissue repair or regeneration.

Biocompatibility evaluation of dicalcium phosphate/calcium sulfate/poly (amino acid) composite for orthopedic tissue engineering in vitro and in vivo

In vitro cytocompatibility of ternary biocomposite of dicalcium phosphate (DCP) and calcium sulfate (CS) containing 40 wt% poly (amino acid) (PAA) was evaluated using L929 fibroblasts and MG-63 osteoblast-like cells. Thereafter, the biocompatibility of biocomposite in vivo was investigated using an implantation in muscle and bone model. In vitro L929 and MG-63 cell culture experiments showed that the composite and PAA polymer were noncytotoxic and allowed cells to adhere and proliferate. The scanning electron microscope (SEM) confirmed that two kinds of cells maintained their phenotype on all of samples surfaces. Moreover, the DCP/CS/PAA composite showed higher cellular viability than that of PAA; meanwhile, the cell proliferation and ALP activity were much higher when DCP/CS had added into PAA. After implanted in muscle of rabbits for 12 weeks, the histological evaluation indicated that the composite exhibited excellent biocompatibility and no inflammatory responses were found. When implanted into bone defects of femoral condyle of rabbits, the composite was combined directly with the host bone tissue without fibrous capsule tissue, which shown good biocompatibility and osteoconductivity. Thus, this novel composite may have potential application in the clinical setting.

Dual mode antibacterial activity of ion substituted calcium phosphate nanocarriers for bone infections

Nanotechnology has tremendous potential for the management of infectious diseases caused by multi-drug resistant bacteria, through the development of newer antibacterial materials and efficient modes of antibiotic delivery. Calcium phosphate (CaP) bioceramics are commonly used as bone substitutes due to their similarity to bone mineral and are widely researched upon for the treatment of bone infections associated with bone loss. CaPs can be used as local antibiotic delivery agents for bone infections and can be substituted with antibacterial ions in their crystal structure to have a wide spectrum, sustained antibacterial activity even against drug resistant bacteria. In the present work, a dual mode antibiotic delivery system with antibacterial ion substituted calcium deficient hydroxyapatite (CDHA) nanoparticles has been developed. Antibacterial ions such as zinc, silver, and strontium have been incorporated into CDHA at concentrations of 6, 0.25–0.75, and 2.5–7.5 at. %, respectively. The samples were found to be phase pure, acicular nanoparticles of length 40–50 nm and width 5–6 nm approximately. The loading and release profile of doxycycline, a commonly used antibiotic, was studied from the nanocarriers. The drug release was studied for 5 days and the release profile was influenced by the ion concentrations. The release of antibacterial ions was studied over a period of 21 days. The ion substituted CDHA samples were tested for antibacterial efficacy on Staphylococcus aureus and Escherichia coli by MIC/MBC studies and time-kill assay. AgCDHA and ZnCDHA showed high antibacterial activity against both bacteria, while SrCDHA was weakly active against S. aureus. Present study shows that the antibiotic release can provide the initial high antibacterial activity, and the sustained ion release can provide a long-term antibacterial activity. Such dual mode antibiotic and antibacterial ion release offers an efficient and potent way to treat an incumbent drug resistant infection.

Conjugation of amino-bioactive glasses with 5-aminofluorescein as probe molecule for the development of pH sensitive stimuli-responsive biomaterials

Bioceramics, such as silica-based glasses, are widely used in bone and teeth restoration. Nowadays, the association between nanotechnology and pharmacology is one of the most promising research fields in cancer therapy. The advanced processing methods and new chemical strategies allow the incorporation of drugs within them or on their functionalized surfaces. Bioceramics can act as local drug delivery systems to treat bone and teeth diseases. The present paper reports data related to the development of a pH-stimuli responsive bioactive glass. The glass conjugation with 5-aminofluorescein (5-AF), through a pH-sensitive organic spacer, allows to produce a pH-responsive bioactive biomaterial: when it is exposed to specific pH changes, it can favour the release of 5-AF directly at the target site. 5-AF has been chosen as a simple, low cost, non toxic model to simulate doxorubicin, an anticancer drug. As doxorubicin, 5-AF contains an amino group in its structure in order to form an amide bond with the carboxylic functionalities of the glass. Raman spectroscopy and thermal analysis confirm the glass conjugation of 5-AF by means of an amide bond; the amount of 5-AF loaded was very high (≈ 65 and 44 wt%). The release tests at two different pH (4.2 and 7.4) show that the amount of released 5-AF is higher at acid pH with respect to physiological one. This preliminary datum evidenced that a pH-sensitive drug delivery system has been developed. The low amount of 5-AF released (<1 wt% of the total 5-AF) is due to the very low solubility of 5-AF in aqueous medium. This disadvantage, may be overcome in a dynamic environment (physiological conditions), where it is possible to obtain a drug release system ensuring an effective therapeutic dose for long times and, at the same time, avoiding the drug toxicity.

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.

Sol-gel silica-based biomaterials and bone tissue regeneration

The impact of bone diseases and trauma in developed and developing countries has increased significantly in the last decades. Bioactive glasses, especially silica-based materials, are called to play a fundamental role in this field due to their osteoconductive, osteoproductive and osteoinductive properties. In the last years, sol-gel processes and supramolecular chemistry of surfactants have been incorporated to the bioceramics field, allowing the porosity of bioglasses to be controlled at the nanometric scale. This advance has promoted a new generation of sol-gel bioactive glasses with applications such as drug delivery systems, as well as regenerative grafts with improved bioactive behaviour. Besides, the combination of silica-based glasses with organic components led to new organic-inorganic hybrid materials with improved mechanical properties. Finally, an effort has been made to organize at the macroscopic level the sol-gel glass preparation. This effort has resulted in new three-dimensional macroporous scaffolds, suitable to be used in tissue engineering techniques or as porous pieces to be implanted in situ. This review collects the most important advances in the field of silica glasses occurring in the last decade, which are called to play a lead role in the future of bone regenerative therapies.

Preparation and characterization of biodegradable poly(D,L-lactide) and surface-modified bioactive glass composites as bone repair materials

In order to improve filler dispersion and phase compatibility between poly(D,L-lactide) (PDLLA) and inorganic bioactive glass (BG) particles, and to enhance the mechanical properties of PDLLA/BG composites, the silane coupling agent 3-glycidoxypropyltrimethoxysilane (KH570) was used to modify the surface of BG particles (represented by KBG). The structure and properties of PDLLA/BG and PDLLA/KBG composites were investigated by mechanical property testing and scanning electron microscopy (SEM). This study demonstrated that the Guth and Gold models can be combined to predict the Young's modulus of the composites. The Pukanszky modulus showed that the interaction parameter B of PDLLA/KBG composites was higher than that of the PDLLA/BG, which indicates that there is a higher interfacial interaction between the PDLLA and KBG. The composites were incubated in simulated body fluid (SBF) at 37 degrees C to study the in vitro degradation and bioactivity of the composites and to detect bone-like apatite formation on their surfaces.