Ion release from magnesium materials in physiological solutions under different oxygen tensions

An overview of magnesium-based implants in orthopaedics and a prospect of its application in spine fusion

Due to matching biomechanical properties and significant biological activity, Mg-based implants present great potential in orthopedic applications. In recent years, the biocompatibility and therapeutic effect of magnesium-based implants have been widely investigated in trauma repair. In contrast, the R&D work of Mg-based implants in spinal fusion is still limited. This review firstly introduced the general background for Mg-based implants. Secondly, the mechanical properties and degradation behaviors of Mg and its traditional and novel alloys were reviewed. Then, different surface modification techniques of Mg-based implants were described. Thirdly, this review comprehensively summarized the biological pathways of Mg degradation to promote bone formation in neuro-musculoskeletal circuit, angiogenesis with H-type vessel formation, osteogenesis with osteoblasts activation and chondrocyte ossification as an integrated system. Fourthly, this review followed the translation process of Mg-based implants via updating the preclinical studies in fracture fixation, sports trauma repair and reconstruction, and bone distraction for large bone defect. Furthermore, the pilot clinical studies were involved to demonstrate the reliable clinical safety and satisfactory bioactive effects of Mg-based implants in bone formation. Finally, this review introduced the background of spine fusion surgeryand the challenges of biological matching cage development. At last, this review prospected the translation potential of a hybrid Mg-PEEK spine fusion cage design.

Mg Biodegradation Mechanism Deduced from the Local Surface Environment under Simulated Physiological Conditions

Although certified magnesium-based implants are launched some years ago, the not well-defined Mg degradation mechanism under physiological conditions makes it difficult to standardize its use as a degradable biomaterial for a wide range of implant applications. Among other variables influencing the Mg degradation mechanism, monitoring the pH in the corrosive solution and, especially, at the corroding interface is important due to its direct relation with the formation and stability of the degradation products layer. The interface pH (pH at the Mg/solution interface) developed on Mg-2Ag and E11 alloys are studied in situ during immersion under dynamic conditions (1.5 mL min^-1 ) in HBSS with and without the physiological amount of Ca²⁺ cations (2.5 × 10^-3 m). The results show that the precipitation/dissolution of amorphous phosphate-containing phases, that can be associated with apatitic calcium-phosphates Ca_{10- x} (PO₄ )_{6- x} (HPO₄ or CO₃ )_x (OH or ½ CO₃ )_{2- x} with 0 ≤ x ≤ 2 (Ap-CaP), promoted in the presence of Ca²⁺ generates an effective local pH buffering system at the surface. Thus, high alkalinization is prevented, and the interface pH is stabilized in the range of 7.6 to 8.5.

The role of magnesium in biomaterials related infections

Magnesium is currently increasing interest in the field of biomaterials. An extensive bibliography on this material in the last two decades arises from its potential for the development of biodegradable implants. In addition, many researches, motivated by this progress, have analyzed the performance of magnesium in both in vitro and in vivo assays with gram-positive and gram-negative bacteria in a very broad range of conditions. This review explores the extensive literature in recent years on magnesium in biomaterials-related infections, and discusses the mechanisms of the Mg action on bacteria, as well as the competition of Mg²⁺ and/or synergy with other divalent cations in this subject.

Hypoxia influences the effects of magnesium degradation products on the interactions between endothelial and mesenchymal stem cells

Biodegradable materials like well-documented Magnesium (Mg) are promising for their biocompatibility and tissue regeneration. Since Mg degradation is reported to be oxygen related, the effects of Mg were hypothesised to be influenced by oxygen. As two vital components of bone marrow, endothelial cells (EC) and mesenchymal stem cells (MSC), their interactions represent high scientific interest for tissue engineering and biodegradable Mg application. Human umbilical cord perivascular (HUCPV) and umbilical vein endothelial cell (HUVEC) were selected as sources of MSC and EC, respectively. Two types of coculture models were established to represent different phases of MSC-EC interaction: (i) where cells were physically separated thanks to a transwell and (ii) where cells were allowed to have heterotypic cellular contacts. Cell migration, gene, cytokines, and proliferation were investigated in HUCPV-HUVEC coculture using DNA, flow cytometry, wound healing assay, semi-quantitative real-time polymerase chain reaction (qRT-PCR), and enzyme-linked immunosorbent assay (ELISA). Mg degradation products increased HUCPV migration in transwell under hypoxia. Oxygen tension changed the gene regulation of migratory, angiogenetic or osteogenic regulators. Under contacting coculture and hypoxia, Mg degradation products remarkably increased cytokines (e.g., c-c motif chemokine ligand 2 and vascular endothelial growth factor) and MSC mineralisation. Mg degradation products decreased and increased the MSC proliferation in transwell and in heterotypic-contact coculture, respectively. In summary, this study indicates the roles of low oxygen and heterotypic contact to effects of Mg materials facilitating HUVEC and HUCPV. STATEMENT OF SIGNIFICANCE.

Different effects of single protein vs. protein mixtures on magnesium degradation under cell culture conditions

Bovine serum albumin (BSA) or fetal bovine serum (FBS), as the protein component, is usually added into solution to study the influence of proteins on Mg degradation. However, the specific character of proteins used and the interaction between organic molecules in FBS do not draw enough attention. This study investigated the influence of BSA, fibrinogen (Fib) and FBS on Mg degradation in Hanks' balanced salt solution without (HBSS) or with calcium (HBSSCa) and Dulbecco's modified eagle medium Glutamax-I (DMEM). The results reveal that the effect of BSA, Fib and FBS on the degradation rate of Mg is time- and media-dependent, as a result of the overlap of protein adsorption, binding/chelating to ions and interaction between organic molecules. The binding/chelating of proteins and/or the possible effect of proteins on the kinetics of products formation lead to the formation of different degradation precipitates on Mg surface in HBSS. The interaction between proteins and Ca²⁺/PO₄^3- accelerates the formation of Ca-P salts in HBSSCa and DMEM, thereby impeding the degradation of Mg. Moreover, the interplay between organic molecules and the specific character of proteins are highlighted by the cooperative (in media + FBS) or competitive (in DMEM + BSA + Fib) effect of proteins in the presence of more kinds of proteins and the different effect of BSA and Fib on the degradation of Mg. Therefore, the addition of proteins to testing medium is necessary for in vitro tests and DMEM + 10% FBS is recommended as the in vitro testing medium to present an in vivo-like degradation for Mg. STATEMENT OF SIGNIFICANCE: The present study emphasizes the difference between proteins, and the difference between single protein and protein mixture in view of the effect on Mg degradation. The results highlight the importance of the interaction between proteins in media, which can increase or decrease the degradation of Mg compared to the single protein. It can aid other researchers to understand the effect of proteins on Mg degradation and to pay more attention to the interaction of organic molecules on Mg degradation when more kinds of organic molecules are used in medium, especially for FBS. The submitted work could be of significant importance to other researchers working in the related fields, thus appealing to the readers of Acta Biomaterialia.

Mast Cell-Derived Histamine Regulates Liver Ketogenesis via Oleoylethanolamide Signaling

The conversion of lipolysis-derived fatty acids into ketone bodies (ketogenesis) is a crucial metabolic adaptation to prolonged periods of food scarcity. The process occurs primarily in liver mitochondria and is initiated by fatty-acid-mediated stimulation of the ligand-operated transcription factor, peroxisome proliferator-activated receptor-α (PPAR-α). Here, we present evidence that mast cells contribute to the control of fasting-induced ketogenesis via a paracrine mechanism that involves secretion of histamine into the hepatic portal circulation, stimulation of liver H₁ receptors, and local biosynthesis of the high-affinity PPAR-α agonist, oleoylethanolamide (OEA). Genetic or pharmacological interventions that disable any one of these events, including mast cell elimination, deletion of histamine- or OEA-synthesizing enzymes, and H₁ blockade, blunt ketogenesis without affecting lipolysis. The results reveal an unexpected role for mast cells in the regulation of systemic fatty-acid homeostasis, and suggest that OEA may act in concert with lipolysis-derived fatty acids to activate liver PPAR-α and promote ketogenesis.

Magnesium degradation under physiological conditions - Best practice

This review focusses on the application of physiological conditions for the mechanistic understanding of magnesium degradation. Despite the undisputed relevance of simplified laboratory setups for alloy screening purposes, realistic and predictive in vitro setups are needed. Due to the complexity of these systems, the review gives an overview about technical measures, defines some caveats and can be used as a guideline for the establishment of harmonized laboratory approaches.

•

Physiological conditions are mandatory for mechanistic understanding of magnesium degradation.

•

Guidelines and caveats for experimental setups are reviewed.

•

Media composition is essential for reliable experiments.

Influence of the Microstructure and Silver Content on Degradation, Cytocompatibility, and Antibacterial Properties of Magnesium-Silver Alloys In Vitro

Implantation is a frequent procedure in orthopedic surgery, particularly in the aging population. However, it possesses the risk of infection and biofilm formation at the surgical site. This can cause unnecessary suffering to patients and burden on the healthcare system. Pure Mg, as a promising metal for biodegradable orthopedic implants, exhibits some antibacterial effects due to the alkaline pH produced during degradation. However, this antibacterial effect may not be sufficient in a dynamic environment, for example, the human body. The aim of this study was to increase the antibacterial properties under harsh and dynamic conditions by alloying silver metal with pure Mg as much as possible. Meanwhile, the Mg-Ag alloys should not show obvious cytotoxicity to human primary osteoblasts. Therefore, we studied the influence of the microstructure and the silver content on the degradation behavior, cytocompatibility, and antibacterial properties of Mg-Ag alloys in vitro. The results indicated that a higher silver content can increase the degradation rate of Mg-Ag alloys. However, the degradation rate could be reduced by eliminating the precipitates in the Mg-Ag alloys via T4 treatment. By controlling the microstructure and increasing the silver content, Mg-Ag alloys obtained good antibacterial properties in harsh and dynamic conditions but had almost equivalent cytocompatibility to human primary osteoblasts as pure Mg.

Fast corroding, thin magnesium coating displays antibacterial effects and low cytotoxicity

Bacterial colonisation and biofilm formation are characteristics of implant-associated infections. In search of candidates for improved prosthetic materials, fast corroding Mg-based coatings on titanium surfaces were examined for their cytotoxic and antimicrobial properties. Human osteoblasts and Staphylococcus epidermidis were each cultured on cylindrical Ti samples coated with a thin layer of Mg/Mg₄₅Zn₅Ca, applied via magnetron sputtering. Uncoated titanium samples served as controls. S. epidermidis was quantified by counting colony forming units. The biofilm-bound fraction was isolated via ultrasonic treatment, and the planktonic fraction via centrifugation. Biofilm-bound S. epidermidis was significantly decreased by approximately four to five orders of magnitude in both Mg- and Mg₄₅Zn₅Ca-coated samples after seven days compared to the control. The osteoblast viability was within the tolerance threshold of 70% stated in DIN EN ISO 10993-5:2009-10 for Mg (~80%) but not for Mg₄₅Zn₅Ca (~25%). Accordingly, Mg-coated titanium was identified as a promising candidate for an implant material with antibacterial properties and low cytotoxicity levels. The approach of exploiting fast corrosion contrasts with existing methods, which have generally focused on reducing corrosion.

Degradation testing of Mg alloys in Dulbecco's modified eagle medium: Influence of medium sterilization

This work studies the in vitro degradation of Mg alloys for bioabsorbable implant applications under near physiological conditions. For this purpose, the degradation behaviour of Mg alloys in Dulbecco's modified eagle medium (DMEM) which is a commonly used cell culture medium is analysed. Unfortunately, DMEM can be contaminated by microorganisms, acidifying the medium and accelerating the Mg degradation process by dissolution of protective degradation layers, such as (Mgx,Cay)(PO4)z. In this paper the influence of sterilization by applying UV-C radiation and antibiotics (penicillin/streptomycin) is analysed with two implant material candidates: Mg-Gd and Mg-Ag alloys; and pure magnesium as well as Mg-4Y-3RE as a reference.

Degradation rates and products of pure magnesium exposed to different aqueous media under physiological conditions

As magnesium and many of its alloys are a promising class of degradable implant materials, a thorough understanding of their degradation under physiological conditions is a key challenge in the field of biomaterial science. In order to increase the predictive power of in vitro studies, it is necessary to imitate the in vivo conditions, track the decomposition process and identify the products that form during the degradation pathway. In this in vitro study, slices of pure magnesium were exposed to Hank’s Balanced Salt Solution (HBSS), Dulbecco’s Modified Eagle Medium (DMEM) and simulated body fluid (SBF), respectively, under cell culture conditions, which included CO

Behavior of bone cells in contact with magnesium implant material

Magnesium-based implants exhibit several advantages, such as biodegradability and possible osteoinductive properties. Whether the degradation may induce cell type-specific changes in metabolism still remains unclear. To examine the osteoinductivity mechanisms, the reaction of bone-derived cells (MG63, U2OS, SaoS2, and primary human osteoblasts (OB)) to magnesium (Mg) was determined. Mg-based extracts were used to mimic more realistic Mg degradation conditions. Moreover, the influence of cells having direct contact with the degrading Mg metal was investigated. In exposure to extracts and in direct contact, the cells decreased pH and osmolality due to metabolic activity. Proliferating cells showed no significant reaction to extracts, whereas differentiating cells were negatively influenced. In contrast to extract exposure, where cell size increased, in direct contact to magnesium, cell size was stable or even decreased. The amount of focal adhesions decreased over time on all materials. Genes involved in bone formation were significantly upregulated, especially for primary human osteoblasts. Some osteoinductive indicators were observed for OB: (i) an increased cell count after extract addition indicated a higher proliferation potential; (ii) increased cell sizes after extract supplementation in combination with augmented adhesion behavior of these cells suggest an early switch to differentiation; and (iii) bone-inducing gene expression patterns were determined for all analyzed conditions. The results from the cell lines were inhomogeneous and showed no specific stimulus of Mg. The comparison of the different cell types showed that primary cells of the investigated tissue should be used as an in vitro model if Mg is analyzed. © 2015 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater, 105B: 165-179, 2017.

Synthesis of Magnesium Oxide Hierarchical Microspheres: A Dual-Functional Material for Water Remediation

High concentration of heavy metals and microbes present in water can reduce the quality of water and bring serious side effects to human beings. Their removal from water is of great importance. In this study, MgO microspheres with hierarchical morphology have been synthesized by a facile and low-cost precipitation-aging-calcination method and their dual functionality for effective arsenic removal and microbial inhibition has been investigated for the first time. By systematical investigation on the synthesis, structure and performance relationship, optimized MgO microspheres are prepared with both high arsenic removal capacity and prominent antibacterial activity. Hierarchical MgO microspheres calcined at 500 °C exhibit the best trade-off between As(III) adsorption (502 mg g(-1)) and antibacterial performance (complete elimination at 700 μg mL(-1)). It is also demonstrated that our materials can be used for the simultaneous removal of arsenic and microbes in a model water system. This study offers a convenient and low cost dual-function agent with efficient performance for water treatment.

In vitro degradation of pure Mg in response to glucose

Magnesium and its alloys are promising biodegradable biomaterials but are still challenging to be used in person with high levels of blood glucose or diabetes. To date, the influence of glucose on magnesium degradation has not yet been elucidated, this issue requires more attention. Herein, we present pure Mg exhibiting different corrosion responses to saline and Hank’s solutions with different glucose contents, and the degradation mechanism of pure Mg in the saline solution with glucose in comparison with mannitol as a control. On one hand, the corrosion rate of pure Mg increases with the glucose concentration in saline solutions. Glucose rapidly transforms into gluconic acid, which attacks the oxides of the metal and decreases the pH of the solution; it also promotes the absorption of chloride ions on the Mg surface and consequently accelerates corrosion. On the other hand, better corrosion resistance is obtained with increasing glucose content in Hank’s solution due to the fact that glucose coordinates Ca²⁺ ions in Hank’s solution and thus improves the formation of Ca-P compounds on the pure Mg surface. This finding will open up new avenues for research on the biodegradation of bio-Mg materials in general, which could yield many new and interesting results.

Biocompatibility of magnesium implants in primary human reaming debris-derived cells stem cells in vitro

BACKGROUND

Use of magnesium for resorbable metal implants is a new concept in orthopaedic and dental medicine. The majority of studies on magnesium's biocompatibility in vitro have assessed the short-term effect of magnesium extract on cells. The aim of this study was to evaluate the influence of direct exposure to magnesium alloys on the bioactivity of primary human reaming debris-derived (HRD) cells.

MATERIALS AND METHODS

Pure Mg, Mg2Ag, WE43 and Mg10Gd were tested for biocompatibility. The study consisted of assessment of cell viability by 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) test, evaluation of alkaline phosphatase (ALP) content, and study of cell morphology under light microscopy, scanning electron microscopy (SEM) and transmission electron microscopy (TEM), along with determination of calcification and pH changes induced by magnesium.

RESULTS

The number of viable cells in the presence of Mg2Ag was high over the entire observation period. Inhibition of ALP content in osteogenic differentiating HRD was caused by pure Mg at day 14 and 28. All other magnesium alloys did not affect the ALP content. Exposure of HRD to magnesium increased the amount of lysosomes and endocytotic vesicles. Cellular attachment was generally the best for those crystals that formed on the surface of all materials. A decrease was observed in Ca(2+) in the medium from day 1 to day 14.

CONCLUSIONS

In terms of cell morphology, cell viability and differentiation, cell density and the effect on the surrounding pH, Mg2Ag showed the most promising results. All magnesium materials induced calcification, which is beneficial for orthopaedic and dental applications.

Influence of various sterilization methods on hardness, grain size and corrosion rate of a Mg6Ag-alloy

Sterilization is a necessary step for all implant materials. Different methods can influence the materials properties. Especially important for magnesium as degradable materials is the determination of the corrosion properties. In this study the influence of 70% ethanol, glutaraldehyde, autoclaving, dry heat, UV-, gamma- and electron beam-irradiation on mechanical and corrosion parameters were analyzed. As mechanical parameters hardness and grain size were determined. The corrosion rate under physiological conditions, weight of the corrosion layer and corrosion morphology was determined. It could be demonstrated that irradiation treatments and 70% ethanol are suitable methods, as they decrease the corrosion rate. Heat-introducing methods (autoclaving and dry heat) acted as incomplete ageing treatments on this alloy and therefore increased the corrosion rate. Furthermore, osmolality showed a better correlation to the actual corrosion rate than the pH. Therefore an optimum ratio between alloying system, implant and sterilization method has to be established, depending on the intended application.

Optimization of cell adhesion on mg based implant materials by pre-incubation under cell culture conditions

Magnesium based implants could revolutionize applications where orthopedic implants such as nails, screws or bone plates are used because they are load bearing and degrade over time. This prevents a second surgery to remove conventional implants. To improve the biocompatibility we studied here if and for how long a pre-incubation of the material under cell culture conditions is favorable for cell attachment and proliferation. For two materials, Mg and Mg10Gd1Nd, we could show that 6 h pre-incubation are already enough to form a natural protective layer suitable for cell culture.

Magnesium degradation as determined by artificial neural networks

Magnesium degradation under physiological conditions is a highly complex process in which temperature, the use of cell culture growth medium and the presence of CO2, O2 and proteins can influence the corrosion rate and the composition of the resulting corrosion layer. Due to the complexity of this process it is almost impossible to predict the parameters that are most important and whether some parameters have a synergistic effect on the corrosion rate. Artificial neural networks are a mathematical tool that can be used to approximate and analyse non-linear problems with multiple inputs. In this work we present the first analysis of corrosion data obtained using this method, which reveals that CO2 and the composition of the buffer system play a crucial role in the corrosion of magnesium, whereas O2, proteins and temperature play a less prominent role.

Effect of biologically relevant ions on the corrosion products formed on alloy AZ31B: an improved understanding of magnesium corrosion

Simulated physiological solutions mimicking human plasma have been utilized to study the in vitro corrosion of biodegradable metals. However, corrosion and corrosion product formation are different for different solutions with varied responses and, hence, the prediction of in vivo degradation behavior is not feasible based on these studies alone. This paper reports the role of physiologically relevant salts and their concentrations on the corrosion behavior of a magnesium alloy (AZ31B) and subsequent corrosion production formation. Immersion tests were performed for three different concentrations of Ca(2+), HPO4(2-), HCO3(-) to identify the effect of each ion on the corrosion of AZ31B assessed at 1, 3 and 10 days. Time-lapse morphological characterization of the samples was performed using X-ray computed tomography and scanning electron microscopy. The chemical composition of the surface corrosion products was determined by electron dispersive X-ray spectroscopy and X-ray diffraction. The results show that: (1) calcium is not present in the corrosion product layer when only Cl(-) and OH(-) anions are available; (2) the presence of phosphate induces formation of a densely packed amorphous magnesium phosphate corrosion product layer when HPO4(2-) and Cl(-) are present in solution; (3) octacalcium phosphate and hydroxyapatite (HAp) are deposited on the surface of the magnesium alloy when HPO4(2-) and Ca(2+) are present together in NaCl solution (this coating limits localized corrosion and increases general corrosion resistance); (4) addition of HCO3(-) accelerates the overall corrosion rate, which increases with increasing bicarbonate concentration; (5) the corrosion rate decreases due to the formation of insoluble HAp on the surface when HCO3(-), Ca(2+), and HPO4(2-) are present together.

A system for characterizing Mg corrosion in aqueous solutions using electrochemical sensors and impedance spectroscopy

Understanding Mg corrosion is important to the development of biomedical implants made from Mg alloys. Mg corrodes readily in aqueous environments, producing H2, OH- and Mg2+. The rate of formation of these corrosion products is especially important in biomedical applications where they can affect cells and tissue near the implant. We have developed a corrosion characterization system (CCS) that allows realtime monitoring of the solution soluble corrosion products OH-, Mg2+, and H2 during immersion tests commonly used to study the corrosion of Mg materials. Instrumentation was developed to allow the system to also record electrochemical impedance spectra simultaneously in the same solution to monitor changes in the Mg samples. We demonstrated application of the CCS by observing the corrosion of Mg (99.9%) in three different corrosion solutions: NaCl, HEPES buffer, and HEPES buffer with NaCl at 37°C for 48 h. The solution concentrations of the corrosion products measured by sensors correlated with the results using standard weight loss measurements to obtain corrosion rates. This novel approach gives a better understanding of the dynamics of the corrosion process in realtime during immersion tests, rather than just providing a corrosion rate at the end of the test, and goes well beyond the immersion tests that are commonly used to study the corrosion of Mg materials. The system has the potential to be useful in systematically testing and comparing the corrosion behavior of different Mg alloys, as well as protective coatings.