Cytotoxicity of Metal Ions Released from Nitinol Alloys on Endothelial Cells

Examining the role of nickel and NiTi nanoparticles promoting inflammation and angiogenesis

Nickel titanium (NiTi, or Nitinol) alloy is used in several biomedical applications, including cardiac, peripheral vascular, and fallopian tube stents. There are significant biocompatibility issues of metallic implants to nickel ions and nano-/micro-sized alloy particles. Our laboratories have recently shown that microscale CoCr wear particles from metal-on-metal hips crosslink with the innate immune signaling Toll-like receptor 4 (TLR4), prompting downstream signaling that results in interleukin (IL)-1β and IL-8 gene expression. In vivo, NiTi alloy can also generate wear particles on the nanoscale (NP) that have thus far not been studied for their potential to induce inflammation and angiogenesis that can, in turn, contribute to implant (e.g. stent) failure. Earlier studies by others demonstrated that nickel could induce contact hypersensitivity by crosslinking the human, but not the mouse, TLR4. In the present work, it is demonstrated that NiCl₂ ions and NiTi nanoparticles induce pro-inflammatory and pro-angiogenic cytokine/chemokine expression in human endothelial and monocyte cell lines in vitro. These observations prompt concerns about potential mechanisms for stent failure. The data here showed a direct correlation between intracellular uptake of Ni²⁺ and generation of reactive oxygen species. To determine a role for nickel and NiTi nanoparticles in inducing angiogenesis in vivo, 1-cm silicone angioreactors were implanted subcutaneously into athymic (T-cell-deficient) nude mice. The angioreactors contained Matrigel (a gelatinous protein mixture that resembles extracellular matrix) in addition to one of the following: PBS (negative control), VEGF/FGF-2 (positive control), NiCl_2, or NiTi NP. The implantation of angioreactors represents a potential tool for quantification of angiogenic potentials of medical device-derived particles and ions in vivo. By this approach, NiTi NP were found to be markedly angiogenic, while Ni²⁺ was less-so. The angioreactors may provide a powerful tool to examine if debris shed from medical devices may promote untoward biological effects.

Metallic Implants Used in Lumbar Interbody Fusion

Over the last decade, pedicle fixation systems have evolved and modifications in spinal fusion techniques have been developed to increase fusion rates and improve clinical outcomes after lumbar interbody fusion (LIF). Regarding materials used for screw and rod manufacturing, metals, especially titanium alloys, are the most popular resources. In the case of pedicle screws, that biomaterial can be also doped with hydroxyapatite, CaP, ECM, or tantalum. Other materials used for rod fabrication include cobalt-chromium alloys and nitinol (nickel-titanium alloy). In terms of mechanical properties, the ideal implant used in LIF should have high tensile and fatigue strength, Young's modulus similar to that of the bone, and should be 100% resistant to corrosion to avoid mechanical failures. On the other hand, a comprehensive understanding of cellular and molecular pathways is essential to identify preferable characteristics of implanted biomaterial to obtain fusion and avoid implant loosening. Implanted material elicits a biological response driven by immune cells at the site of insertion. These reactions are subdivided into innate (primary cellular response with no previous exposure) and adaptive (a specific type of reaction induced after earlier exposure to the antigen) and are responsible for wound healing, fusion, and also adverse reactions, i.e., hypersensitivity. The main purposes of this literature review are to summarize the physical and mechanical properties of metal alloys used for spinal instrumentation in LIF which include fatigue strength, Young's modulus, and corrosion resistance. Moreover, we also focused on describing biological response after their implantation into the human body. Our review paper is mainly focused on titanium, cobalt-chromium, nickel-titanium (nitinol), and stainless steel alloys.

Effect of hydroxyapatite/alumina composite coatings using HVOF on immersion behavior of NiTi alloys

Hydroxyapatite (HA) coatings have been widely used to improve biocompatibility of metal alloys. This paper discusses the effect of hydroxyapatite (HA) and HA/alumina coated NiTi on their corrosion and dissolution behavior in Phosphate Buffer Saline (PBS) and Ringer's lactate solutions. The HA was synthesized from biogenic method and used as initial powder in High-Velocity Oxygen Fuel (HVOF) spray technique for the deposition of two coating types, fully HA and HA + 15 wt.% alumina composite coating. The as-synthesized HA had irregular porous structure with relatively low Ca/P ratio of 1.52. Tafel polarization curves obtained from electrochemical test had showed that both coatings increased the corrosion resistance of the NiTi substrates significantly. The ICP-MS analysis results that indicated a low nickel dissolved in both solutions after immersion in 21 days had supported these findings. The nickel levels in the solutions from all samples, either bared substrate or coated samples, in fact below the maximum limit for allergies of the human body. Immersion testing showed the stability of HA and HA/alumina layers as a barrier which maintains its morphology in PBS solution but slightly changed in Ringers.

Dual Ion Releasing Nanoparticles for Modulating Osteogenic Cellular Microenvironment of Human Mesenchymal Stem Cells

In this study we developed a dual therapeutic metal ion-releasing nanoparticle for advanced osteogenic differentiation of stem cells. In order to enhance the osteogenic differentiation of human mesenchymal stem cells (hMSCs) and induce angiogenesis, zinc (Zn) and iron (Fe) were synthesized together into a nanoparticle with a pH-sensitive degradation property. Zn and Fe were loaded within the nanoparticles to promote early osteogenic gene expression and to induce angiogenic paracrine factor secretion for hMSCs. In vitro studies revealed that treating an optimized concentration of our zinc-based iron oxide nanoparticles to hMSCs delivered Zn and Fe ion in a controlled release manner and supported osteogenic gene expression (RUNX2 and alkaline phosphatase) with improved vascular endothelial growth factor secretion. Simultaneous intracellular release of Zn and Fe ions through the endocytosis of the nanoparticles further modulated the mild reactive oxygen species generation level in hMSCs without cytotoxicity and thus improved the osteogenic capacity of the stem cells. Current results suggest that our dual ion releasing nanoparticles might provide a promising platform for future biomedical applications.

Effect of Ni ion release on the cells in contact with NiTi alloys

Nickel-titanium alloys have been used in medical applications for several years; however, biocompatibility of the material remains controversial. In the present study, the human umbilical vein endothelial cells (HUVEC) were cultured in contact with the nitinol used in two different heat treatment  surface modifications-helium and hydrogen. The amount of Ni ions released from these alloys in contact with HUVEC was measured in media and in the cells by ICP-MS. An increased release of Ni ions was detected in He alloy compared with H₂ alloy modification with an elevation with the metal exposition duration (24 h vs. 72 h). The cells contained the Ni ions in both selected alloy modifications with the lower levels in H₂ alloys. To evaluate the potential of multiple metal applications, similar values were observed in media and in cell suspension for all surface modification combinations. The model analysis of effect of metal ion release on distant cells in the body showed that the concentration is interestingly similar to concentrations in cells in direct contact with the metal alloy. The cells are able to regulate the concentration of Ni ions within the cell. According to our best knowledge, the study for the first time describes the presence of Ni ions released from nitinol directly in the cells. In the case of the H₂ modification, the lowest levels of Ni ions were detected both in medium and in the cells, which likely increases the biocompatibility of the nitinol alloy.

Interaction of primary human trabecular meshwork cells with metal alloy candidates for microinvasive glaucoma surgery

BACKGROUND

Microinvasive glaucoma surgery (MIGS) is a relatively new addition to the glaucoma treatment paradigm. Small metallic stents are inserted into the trabecular meshwork in order to increase aqueous humour drainage. MIGS procedures are rapidly being adopted owing to a more favourable side effect profile when compared with traditional surgery. Remarkably, this rapid rate of utilization has occurred without any published studies on the effect of metal alloys used in these stents on human trabecular meshwork cells (HTMCs). Therefore, this study aimed to determine the effect of candidate metal alloys for MIGS on HTMC morphology, viability and function.

METHODS

Human trabecular meshwork cells were cultured on the surfaces of titanium (polished and sandblasted), a titanium-nickel (nitinol) alloy and glass (as control substratum). Fluorescence imaging was used to assess cell morphology and spreading. A lactate dehydrogenase cytotoxicity assay, cell death detection ELISA, MTT cell viability assay, BrdU cell proliferation assay and fibronectin ELISA were also conducted.

RESULTS

Cells cultured on sandblasted titanium exhibited significantly greater spreading than cells cultured on other substrata. In comparison, HTMCs cultured on nitinol displayed poor spreading. Significantly more cell death, by both necrosis and apoptosis, occurred on nitinol than on titanium and glass. Also, cell viability and proliferation were suppressed on nitinol compared with titanium or glass. Finally, HTMCs on both titanium and nitinol produced greater amounts of fibronectin than cells grown on glass.

CONCLUSIONS

Substratum topography and metal alloy composition were found to impact morphology, viability and function of primary HTMC cultures.

Evaluation of biocompatibility using in vitro methods: interpretation and limitations

The in vitro biocompatibility of novel materials has to be proven before a material can be used as component of a medical device. This must be done in cell culture tests according to internationally recognized standard protocols. Subsequently, preclinical and clinical tests must be performed to verify the safety of the new material and device. The present chapter focuses on the first step, the in vitro testing according to ISO 10993-5, and critically discusses its limited significance. Alternative strategies and a brief overview of activities to improve the current in vitro tests are presented in the concluding section.

Assessment of Corrosion Resistance and Metal Ion Leaching of Nitinol Alloys

Nitinol usage for biomedical implant devices has received significant attention due to its high corrosion resistance and biocompatibility. However, surface treatments are known to affect surface charge, surface chemistry, morphology, wettability, and corrosion resistance. In this investigation, the corrosion resistance of a binary and various ternary Nitinol alloys was determined after being subjected to electropolishing, magnetoelectropolishing, and water boiling and passivation. Cyclic polarization in vitro corrosion tests were conducted in Phosphate Buffer Saline (PBS) in compliance with ASTM F 2129-08 before and after surface treatments. The concentrations of dissolved metal ions in the electrolyte were also determined by ICPMS.