Manipulation of the degradation behavior of calcium sulfate by the addition of bioglass

Design and Manufacture of Bone Cements Based on Calcium Sulfate Hemihydrate and Mg, Sr-Doped Bioactive Glass

In the present study, a novel composite bone cement based on calcium sulfate hemihydrate (CSH) and Mg, Sr-containing bioactive glass (BG) as solid phase, and solution of chitosan as liquid phase were developed. The phase composition, morphology, setting time, injectability, viscosity, and cellular responses of the composites with various contents of BG (0, 10, 20, and 30 wt.%) were investigated. The pure calcium sulfate cement was set at approximately 180 min, whereas the setting time was drastically decreased to 6 min by replacing 30 wt.% glass powder for CSH in the cement solid phase. BG changed the microscopic morphology of the set cement and decreased the size and compaction of the precipitated gypsum phase. Replacing the CSH phase with BG increased injection force of the produced cement; however, all the cements were injected at a nearly constant force, lower than 20 N. The viscosity measurements in oscillatory mode determined the shear-thinning behavior of the pastes. Although the viscosity of the pastes increased with increasing BG content, it was influenced by the frequency extent. Pure calcium sulfate cement exhibited some transient cytotoxicity on human-derived bone mesenchymal stem cells and it was compensated by introducing BG phase. Moreover, BG improved the cell proliferation and mineralization of extracellular matrix as shown by calcein measurements. The results indicate the injectable composite cement comprising 70 wt.% CSH and 30 wt.% Mg, Sr-doped BG has better setting, mechanical and cellular behaviors and hence, is a potential candidate for bone repair, however more animal and human clinical evaluations are essential.

A simple method to improve the antibiotic elution profiles from polymethylmethacrylate bone cement spacers by using rapid absorbable sutures

OBJECTIVE

Antibiotic-loaded bone cement beads and spacers have been widely used for orthopaedic infection. Poor antibiotic elution is not capable of eradicating microbial pathogens and could lead to treatment failure. The elution profiles differ among different cement formulations. Although Simplex P cement has the least release amount, it is widely used due to its ready availability. Previous methods aiming to improve the elution profiles were not translated well to clinical practice. We sought to address this by using easily available materials to improve the elution profile of antibiotics from PMMA, which allows clinicians to implement the method intraoperatively.

METHODS

Vancomycin was mixed with Simplex P cement. We used Vicryl Rapide sutures to fabricate sustained-release cement beads by repetitively passing the sutures through the beads and/or mixing suture segments into the cement formulation. Vancomycin elution was measured for 49 days. The mechanism of antibiotic release was observed with gross appearance and scanning electron microscopic images. The antimicrobial activities against MRSA were tested using an agar disk diffusion bioassay.

RESULTS

Passing Vicryl Rapide sutures through cement beads significantly improved the elution profiles in the 7-week period. The increased ratios were 9.0% on the first day and 118.0% from the 2nd day to the 49th day. Addition of suture segments did not increase release amount. The Vicryl Rapide sutures completely degraded at the periphery and partially degraded at the center. The antibiotic particles were released around the suture, while antibiotic particles kept densely entrapped in the control group. The antimicrobial activities were stronger in passing suture groups.

CONCLUSION

Passing fast absorbable sutures through PMMA cement is a feasible method to fabricate sustained-release antibiotic bone cement. Intra-cement tunnels can be formed, and the effect can last for at least 7 weeks. It is suitable for a temporary spacer between two stages of a revision surgery.

A Composite of Cubic Calcium-Magnesium Sulfate and Bioglass for Bone Repair

Calcium sulfate (CS) bone cement has been shown to have good biocompatibility and can be used as a bone filler for repairing bone defects. However, its clinical application is limited due to its low compressive strength and weak bone repair activity. To this end, in this study, cubic crystalline magnesium-doped calcium sulfate (MgCS) was prepared and mixed with 45S5 bioglass (BG) to form a composite bone cement (MgCS/BG). The results show that cubic crystal calcium sulfate helps to increase the compressive strength of the composite bone cement to more than 60 MPa. More importantly, the obtained magnesium-doped composite bone cement can promote the adhesion and differentiation of mesenchymal stem cells and has good bioactivity. Through a skull defect model, it was found that MgCS/BG can significantly enhance bone defect repair and new bone formation. This new composite MgCS/BG is very promising for future translation into clinical applications.

The effect of vanadium ferrite doping on the bioactivity of mesoporous bioactive glass-ceramics

Bioactive glasses are highly reactive surface materials synthesized by melting or sol–gel techniques. In this study, mesoporous bioactive glass-ceramics doped with different amounts of vanadium and iron ((60−(x + y)) SiO₂–36CaO–4P₂O₅–xV₂O₅–yFe₂O₃, x and y between 0, 5 and, 10 mole%) were synthesized using a sol–gel method. Then, their effects on particle morphology and the biomineralization process were examined in simulated body fluid (SBF). N2 adsorption isotherm analysis proved that the samples have a mesoporous structure. In addition, the Fourier-transform infrared spectroscopy (FTIR) spectra of the samples after soaking in SBF for various periods (7, 14, and 21 days) confirmed the presence of new chemical bonds related to the apatite phase, which is in accordance with scanning electron microscopy (SEM) observations. X-ray diffraction (XRD) patterns of the samples after SBF soaking showed that lower amounts of vanadium and iron were associated with the formation of a stable and more crystalline phase of hydroxyapatite. The MTT results showed that the cell viability of mesoporous bioactive glass containing 5% V₂O₅ remains more than 90% over 7 days, which indicates the biocompatibility of the samples. To conclude, further studies on these formulations are going to be carried out in future investigations for chemohyperthermia application.

Bioactive glasses are highly reactive surface materials synthesized by melting or sol–gel techniques.

Transformation from calcium sulfate to calcium phosphate in biological environment

The formation of a nano-apatite surface layer is frequently considered a measure of bioactivity, especially for non-phosphate bioceramics. In the present study, strontium-doped calcium sulfate, (Ca,Sr)SO₄, was used to verify the feasibility of this measure. The (Ca,Sr)SO₄ specimen was prepared by mixing 10% SrSO₄ by weight with 90% CaSO₄·½H₂O powder by weight. A solid solution of (Ca,7.6%Sr)SO₄ was then produced by heating the powder mixture at 1100 °C for 1 h. The resulting (Ca,Sr)SO₄ specimen was readily degradable in phosphate solution. A newly formed surface layer in the form of flakes was formed within one day of specimen immersion in phosphate solution. Structural and microstructure-compositional analyses indicated that the flakes were composed of octacalcium phosphate (OCP) crystals. An amorphous interface containing OCP nanocrystals was found between the newly formed surface layer and the remaining (Ca,Sr)SO₄ specimen. The specimen was also implanted into a rat distal femur bone defect. In addition to new bone, fibrous tissue and inflammatory cells were found to interlace the (Ca,Sr)SO₄ specimen. The present study indicated that a more comprehensive evaluation is needed to assess the bioactivity of non-phosphate bioceramics. The newly formed surface layer on the (Ca,Sr)SO₄ specimen after soaking in phosphate solution for 28 days.

High toughness resorbable brushite-gypsum fiber-reinforced cements

The ideal bone substitute material should be mechanically strong, biocompatible with a resorption rate matching the rate of new bone formation. Brushite (dicalcium phosphate dihydrate) cement is a promising bone substitute material but with limited resorbability and mechanical properties. To improve the resorbability and mechanical performance of brushite cements, we incorporated gypsum (calcium sulfate dihydrate) and diazonium-treated polyglactin fibers which are well-known for their biocompatibility and bioresorbability. Here we show that by combining brushite and gypsum, we were able to fabricate biocompatible composite cements with high fracture toughness (0.47 MPa·m^1/2) and a resorption rate that matched the rate of new bone formation. Adding functionalized polyglactin fibers to this composite cement further improved the fracture toughness up to 1.00 MPa·m^1/2. XPS and SEM revealed that the improvement in fracture toughness is due to the strong interfacial bonding between the functionalized fibers and the cement matrix. This study shows that adding gypsum and functionalized polyglactin fibers to brushite cements results in composite biomaterials that combine high fracture toughness, resorbability, and biocompatibility, and have great potential for bone regeneration.

Understanding the Future Prospects of Synergizing Minimally Invasive Transforaminal Lumbar Interbody Fusion Surgery with Ceramics and Regenerative Cellular Therapies

Transforaminal lumber interbody fusion (TLIF) is the last resort to address the lumber degenerative disorders such as spondylolisthesis, causing lower back pain. The current surgical intervention for these abnormalities includes open TLIF. However, in recent years, minimally invasive TLIF (MIS-TLIF) has gained a high momentum, as it could minimize the risk of infection, blood loss, and post-operative complications pertaining to fusion surgery. Further advancement in visualizing and guiding techniques along with grafting cage and materials are continuously improving the safety and efficacy of MIS-TLIF. These assistive techniques are also playing a crucial role to increase and improve the learning curve of surgeons. However, achieving an appropriate output through TLIF still remains a challenge, which might be synergized through 3D-printing and tissue engineering-based regenerative therapy. Owing to their differentiation potential, biomaterials such as stem/progenitor cells may contribute to restructuring lost or damaged tissues during MIS-TLIF, and this therapeutic efficacy could be further supplemented by platelet-derived biomaterials, leading to improved clinical outcomes. Thus, based on the above-mentioned strategies, we have comprehensively summarized recent developments in MIS-TLIF and its possible combinatorial regenerative therapies for rapid and long-term relief.

Enhanced mechanical and biological performances of CaO-MgO-SiO2 glass-ceramics via the modulation of glass and ceramic phases

This work reports a new CaO-MgO-SiO₂ (CMS) bioactive glass-ceramic, using ZrO₂ as a nucleus to modulate the ratios of glass and ceramic phases as a function of sintering temperature. Mg-rich bioactive CMS glass-ceramics exhibit advantages regarding mechanical strength (flexural strength ~190 MPa and compressive strength ~555 MPa), in-vitro and in-vivo biocompatibilities, and bone ingrowth. The high mechanical strengths could be attributed to the CaMgSi₂O₆ glass-ceramic and lower porosity. X-ray absorption spectra indicate an increased SiO covalent bond via the development of CaMgSi₂O₆ glass-ceramics. From the in-vitro cytotoxicity and BMSC differentiation assays, the CMS samples sintered above 800 °C exhibited better cell attachment and differentiation, possibly due to structural stability, appropriate pore, and ion release to boost osteogenesis. Compared to hydroxyapatite (HA) ceramics, the CMS glass-ceramics display higher mechanical strengths, biocompatibility, and osteoconductivity. An in-vivo experiment demonstrated a fine bone-ingrowth profile around the CMS implant. This study may further the application of CMS glass-ceramics in bone implants.

Biological analysis of an innovative biodegradable antibiotic eluting bioactive glass/gypsum composite bone cement for treating experimental chronic MRSA osteomyelitis

A multi-barrier antibiotics loaded biodegradable composite bone cement for resolving chronic osteomyelitis has been studied to understand the physico-mechanical properties, drug loading/eluting efficiency, and different merits and demerits prior to clinical application. After successful induction of bone infection in 28 rabbits using methicillin-resistant Staphylococcus aureus (MRSA) strains, calcium sulfate/bioactive glass based composite cement was implanted in 12 defects to assess its performance over parenteral therapy with microscopic and radiological examination for 90 days. The composite cement revealed acceptable physico-mechanical properties and controlled drug elution kinetics. Furthermore, the antibiotics concentrations in bone up to 42 days were sufficient to kill MRSA without eliciting adverse drug reactions. The striking feature of platelets aggregation by composite cement could assist bone healing. The controlled degradation with simultaneous entrapment of composite cement within the osteoid tissues and complete repair of infected cortical defects (holes) in rabbit tibia at 6 weeks indicated the excellent anti-infective and osteoconductive properties of composite cement. Thus, the animal study demonstrated the superiority of composite over injectable antibiotic therapy based on infection resolution and bone regeneration. We thereby conclude that the composite cement can be effectively applied in the treatment of resistant cases of chronic osteomyelitis.

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Described the preparation method of multi-barrier CS/BG composite bone cement.

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Made by coating the antibiotics loaded porous BG granules with PLGA and α-CSH.

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Introduced antibiotics elution study in ideal immersion medium.

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Beneficial role of PLGA on drug release and activation of platelets by cement was explored.

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New cement showed great potential to repair bone infection and to hasten osteosynthesis.

Bioactive, degradable and multi-functional three-dimensional membranous scaffolds of bioglass and alginate composites for tissue regenerative applications

Multifunctional bioactive hydrogel ECM like membrane for 3D dynamic tissue/disease modelling.