Short-term effect of magnesium implantation on the osteomyelitis modeled animals induced by Staphylococcus aureus

Challenges and Pitfalls of Research Designs Involving Magnesium-Based Biomaterials: An Overview

Magnesium-based biomaterials hold remarkable promise for various clinical applications, offering advantages such as reduced stress-shielding and enhanced bone strengthening and vascular remodeling compared to traditional materials. However, ensuring the quality of preclinical research is crucial for the development of these implants. To achieve implant success, an understanding of the cellular responses post-implantation, proper model selection, and good study design are crucial. There are several challenges to reaching a safe and effective translation of laboratory findings into clinical practice. The utilization of Mg-based biomedical devices eliminates the need for biomaterial removal surgery post-healing and mitigates adverse effects associated with permanent biomaterial implantation. However, the high corrosion rate of Mg-based implants poses challenges such as unexpected degradation, structural failure, hydrogen evolution, alkalization, and cytotoxicity. The biocompatibility and degradability of materials based on magnesium have been studied by many researchers in vitro; however, evaluations addressing the impact of the material in vivo still need to be improved. Several animal models, including rats, rabbits, dogs, and pigs, have been explored to assess the potential of magnesium-based materials. Moreover, strategies such as alloying and coating have been identified to enhance the degradation rate of magnesium-based materials in vivo to transform these challenges into opportunities. This review aims to explore the utilization of Mg implants across various biomedical applications within cellular (in vitro) and animal (in vivo) models.

Corrosion Behavior in Magnesium-Based Alloys for Biomedical Applications

Magnesium alloys exhibit superior biocompatibility and biodegradability, which makes them an excellent candidate for artificial implants. However, these materials also suffer from lower corrosion resistance, which limits their clinical applicability. The corrosion mechanism of Mg alloys is complicated since the spontaneous occurrence is determined by means of loss of aspects, e.g., the basic feature of materials and various corrosive environments. As such, this study provides a review of the general degradation/precipitation process multifactorial corrosion behavior and proposes a reasonable method for modeling and preventing corrosion in metals. In addition, the composition design, the structural treatment, and the surface processing technique are involved as potential methods to control the degradation rate and improve the biological properties of Mg alloys. This systematic representation of corrosive mechanisms and the comprehensive discussion of various technologies for applications could lead to improved designs for Mg-based biomedical devices in the future.

Effect of Magnesium Addition and High Energy Processing on the Degradation Behavior of Iron Powder in Modified Hanks’ Solution for Bioabsorbable Implant Applications

This paper shows the results of applying a combination of high energy processing and magnesium (Mg) as an alloying element in a strategy for enhancing the degradation rate of iron (Fe) for applications in the field of non-permanent medical implants. For this purpose, Fe powder was milled with 5 wt% of Mg (Fe5Mg) and its microstructure and characterized degradation behavior. As-received Fe powder was also milled in order to distinguish between the effects due to high energy processing from those due to the presence of Mg. The powders were prepared by high energy planetary ball milling for 16 h. The results show that the initial crystallite size diminishes from >150 nm to 16 nm for Fe and 46 nm for Fe5Mg. Static degradation tests of loose powder particles were performed in Hanks’ solution. Visual inspection of the immersed powders and the X-ray diffraction (XRD) phase quantification indicate that Fe5Mg exhibited the highest degradation rate followed by milled Fe and as received Fe, in this order. The analysis of degradation products of Fe5Mg showed that they consist on magnesium ferrite and pyroaurite, which are known to present good biocompatibility and low toxicity. Differences in structural features and degradation behaviors of milled Fe and milled Fe5Mg suggest the effective dissolution of Mg in the Fe lattice. Based on the obtained results, it can be said that Fe5Mg powder would be a suitable candidate for non-permanent medical implants with a higher degradation rate than Fe.

Effect of Magnesium on Dentinogenesis of Human Dental Pulp Cells

Introducing therapeutic ions into pulp capping materials has been considered a new approach for enhancing regeneration of dental tissues. However, no studies have been reported on its dentinogenic effects on human dental pulp cells (HDPCs). This study was designed to investigate the effects of magnesium (Mg2+) on cell attachment efficiency, proliferation, differentiation, and mineralization of HDPCs. HDPCs were cultured with 0.5 mM, 1 mM, 2 mM, 4 mM, and 8 mM concentrations of supplemental Mg2+ and 0 mM (control). Cell attachment was measured at 4, 8, 12, 16, and 20 hours. Cell proliferation rate was evaluated at 3, 7, 10, 14, and 21 days. Crystal violet staining was used to determine cell attachment and proliferation rate. Alkaline phosphatase (ALP) activity was assessed using the fluorometric assay at 7, 10, and 14 days. Mineralization of cultures was measured by Alizarin red staining. Statistical analysis was done using multiway analysis of variance (multiway ANOVA) with Wilks' lambda test. Higher cell attachment was shown with 0.5 mM and 1 mM at 16 hours compared to control (P < 0.0001). Cells with 0.5 mM and 1 mM supplemental Mg2+ showed significantly higher proliferation rates than control at 7, 10, 14, and 21 days (P < 0.0001). However, cell proliferation rates decreased significantly with 4 mM and 8 mM supplemental Mg2+ at 14 and 21 days (P < 0.0001). Significantly higher levels of ALP activity and mineralization were observed in 0.5 mM, 1 mM, and 2 mM supplemental Mg2+ at 10 and 14 days (P < 0.0001). However, 8 mM supplemental Mg2+ showed lower ALP activity compared to control at 14 days (P < 0.0001), while 4 mM and 8 mM supplemental Mg2+showed less mineralization compared to control (P < 0.0001). The study indicated that the optimal (0.5-2 mM) supplemental Mg2+ concentrations significantly upregulated HDPCs by enhancing cell attachment, proliferation rate, ALP activity, and mineralization. Magnesium-containing biomaterials could be considered for a future novel dental pulp-capping additive in regenerative endodontics.

Improvements of Corrosion Resistance and Antibacterial Properties of Hydroxyapatite/Cupric Oxide Doped Titania Composite Coatings on Degradable Magnesium Alloys

The excellent biocompatibility of calcium phosphate (CaP) coatings makes them widely used in magnesium (Mg) alloy orthopedic implant materials. However, the porous morphology of CaP coatings limits their corrosion resistance. A cupric oxide (CuO) doped titania (TiO₂) sol-gel coating is prepared on a porous hydroxyapatite (HA) coating. According to electrochemical test results, the HA/CuO-TiO₂ coating obtains a current density of 6 × 10^-4 mA/cm², lower than that of the Mg alloy (2.6 × 10^-2 mA/cm²). The hydrogen evaluation of the HA/CuO-TiO₂ coating is only 1/12 that of the Mg alloy after immersion for 7 days. In addition, the HA/CuO-TiO₂ coating has an antibacterial rate of 99.5 ± 0.4% against Staphylococcus aureus, significantly higher than that of the HA coating (19.8 ± 0.3%) and HTC0 coating (38.4 ± 0.5%). The CuO doped composite coating has no adverse effect or cytotoxicity on cell proliferation (cell viability ≥79.6%). Hence, the HA/CuO-TiO₂ composite coating is useful for enhancing the corrosion resistance and antibacterial properties of Mg alloys while ensuring cytocompatibility. The HA/CuO-TiO₂ coated AZ60 Mg alloy can meet the requirements of clinical application.

Biomimetic hydroxyapatite/collagen composite drives bone niche recapitulation in a rabbit orthotopic model

Synthetic osteoinductive materials that mimic the human osteogenic niche have emerged as ideal candidates to address this area of unmet clinical need. In this study, we evaluated the osteoinductive potential in a rabbit orthotopic model of a magnesium-doped hydroxyapatite/type I collagen ​(MHA/Coll) composite. The composite was fabricated to exhibit a highly fibrous structure of carbonated MHA with 70% (±2.1) porosity and a Ca/P ratio of 1.5 (±0.03) as well as a diverse range of elasticity separated to two distinct stiffness peaks of low (2.35 ​± ​1.16 ​MPa) and higher (9.52 ​± ​2.10 ​MPa) Young's Modulus. Data suggested that these specific compositional and nanomechanical material properties induced the deposition of de novo mineral phase, while modulating the expression of early and late osteogenic marker genes, in a 3D in vitro model using human bone marrow-derived mesenchymal stem cells (hBM-MSCs). When tested in the rabbit orthotopic model, MHA/Col1 scaffold induction of new trabecular bone mass was observed by DynaCT scan, only 2 weeks after implantation. Bone histomorphometry at 6 weeks revealed a significant amount of de novo bone matrix formation. qPCR demonstrated MHA/Coll scaffold full cellularization in vivo and the expression of both osteogenesis-associated genes (Spp1, Sparc, Col1a1, Runx2, Dlx5) as well as hematopoietic (Vcam1, Cd38, Sele, Kdr) and bone marrow stromal cell marker genes (Vim, Itgb1, Alcam). Altogether, these data provide ​evidence of the solid osteoinductive potential of MHA/Coll and its suitability for multiple approaches of bone regeneration.

Animal models of orthopaedic infections. A review of rabbit models used to induce long bone bacterial infections

The development of infections is one of the main complications in orthopaedics, especially in the presence of implants for the osteosynthesis of compound fractures and joint prosthesis. Indeed, foreign materials and implants act as substrates for the adhesion and proliferation of bacterial strains able to produce biofilm, causing peri-implant osteomyelitis. The eradication of biofilm remains a great challenge for the host immune system, as well as for medical and surgical approaches, thus imposing the need for new prophylactic and/or therapeutic strategies in which animal models have an essential role. In vivo orthopaedic models have mainly been used to study the pathogenesis of infections, biofilm behaviour and the efficacy of antimicrobial strategies, to select diagnostic techniques and test the efficacy of novel materials or surface modifications to impede both the establishment of bone infections and the associated septic loosening of implants. Among several models of osteomyelitis and implant-related infections described in small rodents and large animals, the rabbit has been widely used as a reliable and reproducible model of orthopaedic infections. This review examines the relevance of rabbits for the development of clinically representative models by analysing the pros and cons of the different approaches published in the literature. This analysis will aid in increasing our knowledge concerning orthopaedic infections by using this species. This review will be a tool for researchers who need to approach pre-clinical studies in the field of bone infection and have to identify the most appropriate animal model to verify their scientific hypothesis.

Biofunctional Mg coating on PEEK for improving bioactivity

High purity Mg was successfully coated on polyetheretherketone (PEEK) by vapor deposition method in order to improve the bioactivity including antibacterial property of PEEK implant. The morphology and elemental composition of the coating were characterized by scanning electron microscopy (SEM) and energy-dispersive spectroscopy (EDS), showing that the coating was mainly composed of Mg at deposition temperature of 175 °C, 185 °C, 200 °C and 230 °C. The higher the substrate temperature was, the larger the Mg particle size was. The coating degraded and gradually peeled off from the surface of PEEK after up to 21 days' immersion. It was found that the degradation of Mg coating could strongly kill Staphylococcus aureus with antibacterial rate reaching to 99%. Mg can be expected to be coated on those bio-inert biomaterials to offer specific bioactivities.

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High purity Mg was coated on PEEK by vapor deposition method.

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The Mg coating degraded and gradually peeled off from the surface of PEEK after up to 21 days immersion.

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The degradation of Mg coating could strongly kill Staphylococcus aureus with antibacterial rate reaching to 99%.

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.

Reduced antibacterial property of metallic magnesium in vivo

Magnesium and its alloys have drawn interest as antibacterial biomaterials, owing to their ability to alkalize the surrounding medium during degradation. The antibacterial effect of pure Mg and Mg alloys in vitro has previously been reported. However, the antibacterial property of Mg in vivo might be different because of the apparently dissimilar corrosion characteristics. In this study, pure Mg rods were implanted and bacterial suspension were injected into rat femurs to investigate the antibacterial property of Mg in vivo. The results showed that contrary to the high antibacterial rate in vitro, Mg exhibited a dramatic drop in antibacterial effect in vivo. Bacteria proliferated on the surface of the Mg rods as well as in the femur. Inflammatory cells filled cavities in the cortical bone of the femur, which was demonstrated by histological and micro-CT examination after 2 and 4 weeks of implantation. It is suggested that a reduced corrosion rate in vivo would result in insufficient pH value. In addition, the deposition layer would prevent further corrosion of Mg and provide a favorite site for bacteria adhesion. Hence, the dramatically reduced antibacterial property of Mg needs to be noticed when it is used as a biomaterial.

Early results using a biodegradable magnesium screw for modified chevron osteotomies

This is the first larger study analyzing the use of magnesium-based screws for fixation of modified Chevron osteotomies in hallux valgus surgery. Forty-four patients (45 feet) were included in this prospective study. A modified Chevron osteotomy was performed on every patient and a magnesium screw used for fixation. The mean clinical follow up was 21.4 weeks. The mean age of the patients was 45.5 years. Forty patients could be provided with the implant, in four patients the surgeon decided to change to a standard metallic implant. The AOFAS, FAAM and pain NRS-scale improved markedly. The hallux valgus angle, intermetatarsal angle and sesamoid position improved significantly. Seven patients showed dorsal subluxation, rotation or medial shifting of the metatarsal heads within the first 3 months. One of these patients was revised, in all others the findings were considered clinically not significant or the patients refused revision. This study shows the feasibility of using magnesium screws in hallux valgus-surgery. Surgeons starting with the use of these implants should be aware of the proper handling of these implants and should know about corrosion effects during healing and its radiographic appearance. © 2016 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 34:2207-2214, 2016.