Nanostructured calcium phosphate coatings on magnesium alloys: characterization and cytocompatibility with mesenchymal stem cells

A Systematic Review and Network Meta-Analysis of Biomedical Mg Alloy and Surface Coatings in Orthopedic Application

Magnesium alloys have great application prospects as ideal bone implant materials. However, their poor corrosion resistance limits their clinical orthopedic application. Surface modification promotes the corrosion resistance of magnesium. Conversion coatings, such as calcium phosphate (Ca-P) coating, microarc oxidation (MAO) treatment, and fluoride (FLU) treatment, have been extensively investigated in in vivo studies. This systematic review and network meta-analysis compared the influence of different conversion coatings on bone repair, material properties, and systemic host response in orthopedic applications. Using the PICOS model, the inclusion criteria for biodegradable magnesium and its alloys were determined for in vivo studies. Four databases were used. The standard and weight mean differences with 95% confidence intervals were used to analyze new bone formation and degradation rate. Network structure and forest plots were created, and ranking probabilities were estimated. The risk of bias and quality of evidence were assessed using SYRCLE, CERQual, and GRADE tools. In the qualitative analysis, 43 studies were selected, and the evaluation of each outcome indicator was not entirely consistent from article to article. In the quantitative analysis, 21 articles were subjected to network meta-analysis, with 16 articles on implant degradation and 8 articles for new bone formation. Additionally, SUCRA indicated that Ca-P coating exhibited the highest corrosion resistance, followed by FLU treatment. MAO demonstrated the best capability for new bone formation, followed by Ca-P coating. Ca-P coating exhibited the highest overall performance. To conclude, coated Mg can promote better new bone formation than bare Mg and has considerable biocompatibility. Ca-P-coated Mg and MAO-coated Mg have the greatest potential to significantly promote corrosion resistance and bone regeneration, respectively. The findings of this study will provide a theoretical basis for the investigation of composite coatings and guidance for the orthopedic application of Mg bone implants.

Nano-to-Submicron Hydroxyapatite Coatings for Magnesium-based Bioresorbable Implants - Deposition, Characterization, Degradation, Mechanical Properties, and Cytocompatibility

Magnesium (Mg) and its alloys have shown attractive biocompatibility and mechanical strength for medical applications, but low corrosion resistance of Mg in physiological environment limits its broad clinical translation. Hydroxyapatite (HA) nanoparticles (nHA) are promising coating materials for decreasing degradation rates and prolonging mechanical strength of Mg-based implants while enhancing bone healing due to their osteoconductivity and osteoinductivity. Conformal HA coatings with nano-to-submicron structures, namely nHA and mHA coatings, were deposited successfully on Mg plates and rods using a transonic particle acceleration (TPA) process under two different conditions, characterized, and investigated for their effects on Mg degradation in vitro. The nHA and mHA coatings enhanced corrosion resistance of Mg and retained 86-90% of ultimate compressive strength after in vitro immersion in rSBF for 6 weeks, much greater than non-coated Mg that only retained 66% of strength. Mg-based rods with or without coatings showed slower degradation than the respective Mg-based plates in rSBF after 6 weeks, likely because of the greater surface-to-volume ratio of Mg plates than Mg rods. This indicates that Mg-based plate and screw devices may undergo different degradation even when they have the same coatings and are implanted at the same or similar anatomical locations. Therefore, in addition to locations of implantation, the geometry, dimension, surface area, volume, and mass of Mg-based implants and devices should be carefully considered in their design and processing to ensure that they not only provide adequate structural and mechanical stability for bone fixation, but also support the functions of bone cells, as clinically required for craniomaxillofacial (CMF) and orthopedic implants. When the nHA and mHA coated Mg and non-coated Mg plates were cultured with bone marrow derived mesenchymal stem cells (BMSCs) using the in vitro direct culture method, greater cell adhesion densities were observed under indirect contact conditions than that under direct contact conditions for the nHA and mHA coated Mg. In comparison with non-coated Mg, the nHA and mHA coated Mg reduced BMSC adhesion densities directly on the surface, but increased the average BMSC adhesion densities under indirect contact. Further long-term studies in vitro and in vivo are necessary to elucidate the effects of nHA and mHA coatings on cell functions and tissue healing.

Responses of human urothelial cells to magnesium-zinc-strontium alloys and associated insoluble degradation products for urological stent applications

Current urological devices such as ureteral stents and catheters still face serious problems, such as encrustation and biofilm formation. Magnesium (Mg) and its alloys showed great potentials as an alternative material for urological devices, due to their excellent biodegradability and antibacterial property. In this study, a serial of four promising Mg alloys which contain zinc (Zn) and strontium (Sr), i.e., Mg-4Zn-xSr (ZSr41) alloys, were investigated in vitro for potential ureteral stent application. Specifically, these four alloys have 4 wt% Zn in all and 0.15 wt% Sr in ZSr41_A, 0.5 wt% Sr in ZSr41_B, 1.0 wt% Sr in ZSr41_C and 1.5 wt% Sr in ZSr41_D. The cytocompatibility and degradation behaviors of Mg-4Zn-xSr alloys were studied by culturing with human urothelial cells (HUCs) for 24 h and 48 h using exposure culture method. ZSr41_B showed a better cytocompatibility with HUCs among all the Mg-4Zn-xSr alloys in both 24-hour and 48-hour cultures. Moreover, the cytocompatibility of insoluble degradation products of Mg, i.e., MgO and Mg(OH)₂, was also investigated by culturing different concentrations of MgO and Mg(OH)₂ nanoparticles with HUCs for 24 h and 48 h. The concentration of MgO and Mg(OH)₂ particles at 0.5 mg/mL and above, showed a significant decrease of cell density and cell size after 24-hour and 48-hour cultures. The concentration of MgO and Mg(OH)₂ at 1.0 mg/mL and above, showed no viable cells after 24-hour culture. Collectively, it is recommended to further reduce the degradation rates of Mg alloys in order to control possible side effects of the soluble and insoluble degradation products and to take the benefits of Mg-based biodegradable ureteral stents toward the future clinical translation.

In vitro and in vivo evaluation of novel biodegradable Mg-Ag-Y alloys for use as resorbable bone fixation implant

Magnesium (Mg) alloy is gaining more interest because of its degradability and osteogenic potential. Still, it has some deficiencies, such as its rapid degradation rate, insufficient mechanical property. This research aimed to design a novel biodegradable Mg-argentum (Ag)-yttrium (Y) alloy, and Y was added to improve degradable and mechanical property. Mg-Ag-Y alloys were characterized for mechanical features, practicabilities in vitro and in vivo. The mechanical features results shown that this novel component was similar to native bone tissue in elastic moduli, tensile, and compressive stress. Then mesenchymal stem cells (MSCs) were seeded in alloys to assess cell toxicity in vitro. The results showed that its aqueous extract was suitable for MSCs adhesion and proliferation. Then the alloy was evaluated for biomedical applications in nonfractured distal femora of Sprague Dawley rats for 6 weeks, compared with those of pure-Mg and stainless steel groups. All rats survived, and hematological and histological evaluation showed no abnormal physiology 6 weeks postimplantation, and measurements of serum Mg²⁺ concentration were within normal levels. X-ray scanning, microcomputed tomography, and histological examinations were performed to evaluate the degradability and osteogenic potential. The results indicated that the degradation rate of alloy was 0.91 mm per year, (range 0.77-1.22 mm), and pure-Mg 1.80 mm per year (1.43-2.26 mm). The new bone quantity was 3.18 mm³ (1.46-4.44 mm³ ) in Mg-Ag-Y alloys group, 1.39 mm³ (0.54-2.32 mm³ ) in pure-Mg group, and none in stainless steel group. These promising results suggest potential clinical application of Mg-Ag-Y alloys for use as resorbable bone fixation implant. © 2018 Wiley Periodicals, Inc. J Biomed Mater Res Part A: 106A: 2059-2069, 2018.

Development of a Novel Loading Device for Studying Magnesium Degradation under Compressive Load for Implant Applications

Medical implants play a key role in treating bone fractures. Permanent implants are currently used for immobilization of fractures and bearing physiological loads during bone healing. After bone has healed, these implants, if not removed, often cause complications in the long run; and secondary surgeries for removing them pose additional discomfort and expenses for patients. Magnesium (Mg)-based bioresorbable implants, can potentially eliminate the need for additional surgeries by degrading safely over time in the human body. When studying the degradation behaviors of Mg-based implants in vitro, it is important to simulate physiological conditions in vivo closely, including loading. Considering that implants often carry physiological loads in vivo and mechanical stresses affect the degradation rate of Mg, a novel loading device was designed and manufactured for studying Mg degradation under load over a long period of time in a simulated body fluid in vitro. Degradation of Mg rods were investigated by immersing in a revised simulated body fluid (rSBF) for two weeks while a consistent compressive load was applied using the loading device. The results showed that the loading device provided a consistent load of 500 ± 45 N during the two weeks of immersion. Mg rods showed a significant faster degradation rate under the applied load, as demonstrated by a higher mass loss of the sample, a higher pH increase and Mg²⁺ ion release in the rSBF.

The Degradation Interface of Magnesium Based Alloys in Direct Contact with Human Primary Osteoblast Cells

Magnesium alloys have been identified as a new generation material of orthopaedic implants. In vitro setups mimicking physiological conditions are promising for material / degradation analysis prior to in vivo studies however the direct influence of cell on the degradation mechanism has never been investigated. For the first time, the direct, active, influence of human primary osteoblasts on magnesium-based materials (pure magnesium, Mg-2Ag and Mg-10Gd alloys) is studied for up to 14 days. Several parameters such as composition of the degradation interface (directly beneath the cells) are analysed with a scanning electron microscope equipped with energy dispersive X-ray and focused ion beam. Furthermore, influence of the materials on cell metabolism is examined via different parameters like active mineralisation process. The results are highlighting the influences of the selected alloying element on the initial cells metabolic activity.