Newly developed Sr-substituted alpha-TCP bone cements

Injectable and high-strength PLGA/CPC loaded ALN/MgO bone cement for bone regeneration by facilitating osteogenesis and inhibiting osteoclastogenesis in osteoporotic bone defects

Osteoporosis (OP) can result in slower bone regeneration than the normal condition due to the imbalance between osteogenesis and osteoclastogenesis, making osteoporotic bone defects healing a significant clinical challenge. Calcium phosphate cement (CPC) is a promising bone substitute material due to its good osteoinductive activity, however, the drawbacks such as fragility, slow degradation rate and incapability to control bone loss restrict its application in osteoporotic bone defects treatment. Currently, we developed the PLGA electrospun nanofiber sheets to carry alendronate (ALN) and magnesium oxide nanoparticle (nMgO) into CPC, therefore, to obtain a high-strength bone cement (C/AM-PL/C). The C/AM-PL/C bone cement had high mechanical strength, anti-washout ability, good injection performance and drug sustained release capacity. More importantly, the C/AM-PL/C cement promoted the osteogenic differentiation of bone marrow mesenchymal stem cells and neovascularization via the release of Mg2+ (from nMgO) and Ca2+ (during the degradation of CPC), and inhibited osteoclastogenesis via the release of ALN in vitro. Moreover, the injection of C/AM-PL/C cement significantly improved bone healing in an OP model with femur condyle defects in vivo. Altogether, the injectable C/AM-PL/C cement could facilitate osteoporotic bone regeneration, demonstrating its capacity as a promising candidate for treatment of osteoporotic bone defects.

Enhancing Stability of High-Concentration β-Tricalcium Phosphate Suspension for Biomedical Application

We propose a novel process to efficiently prepare highly dispersed and stable Tricalcium Phosphate (β-TCP) suspensions. TCP is coupled with a polymer to enhance its brittleness to be used as an artificial hard tissue. A high solid fraction of β-TCP is mixed with the polymer in order to improve the mechanical strength of the prepared material. The high solid fractions led to fast particle aggregation due to Van der Waals forces, and sediments appeared quickly in the suspension. As a result, we used a dispersant, dispex AA4040 (A40), to boost the surface potential and steric hindrance of particles to make a stable suspension. However, the particle size of β-TCP is too large to form a suspension, as the gravity effect is much more dominant than Brownian motion. Hence, β-TCP was subjected to wet ball milling to break the aggregated particles, and particle size was reduced to ~300 nm. Further, to decrease sedimentation velocity, cellulose nanocrystals (CNCs) are added as a thickening agent to increase the overall viscosity of suspension. Besides the viscosity enhancement, CNCs were also wrapped with A40 micelles and increase the stability of the suspension. These CNC/A40 micelles further facilitated stable suspension of β-TCP particles with an average hydration radius of 244.5 nm. Finally, β-TCP bone cement was formulated with the suspension, and the related cytotoxicity was estimated to demonstrate its applicability for hard tissue applications.

Preparation and characterizations of an injectable and biodegradable high-strength iron-bearing brushite cement for bone repair and vertebral augmentation applications

Brushite cements have good osteoconductive and resorbable properties, but the low mechanical strength and poor injectability limit their clinical applications in load-bearing conditions and minimally invasive surgery. In this study, an injectable brushite cement that contains monocalcium phosphate monohydrate (MCPM) and β-tricalcium phosphate (β-TCP) as its solid phase and ammonium ferric citrate (AFC) solution as the aqueous medium was designed to have high mechanical strength. The optimized formulation achieved a compressive strength of 62.8 ± 7.2 MPa, which is above the previously reported values of hand-mixing brushite cements. The incorporation of AFC prolonged the setting times and greatly enhanced the injectability and degradation properties of the cements. In vitro and in vivo experiments demonstrated that the brushite cements exhibited good biocompatibility and bone regeneration capacity. The novel brushite cement is promising for bone healing in load-bearing applications.

A new injectable quick hardening anti-collapse bone cement allows for improving biodegradation and bone repair

The development of injectable cement-like biomaterials via a minimally invasive approach has always attracted considerable clinical interest for modern bone regeneration and repair. Although α-tricalcium phosphate (α-TCP) powders may readily react with water to form hydraulic calcium-deficient hydroxyapatite (CDHA) cement, its long setting time, poor anti-collapse properties, and low biodegradability are suboptimal for a variety of clinical applications. This study aimed to develop new injectable α-TCP-based bone cements via strontium doping, α-calcium sulfate hemihydrate (CSH) addition and liquid phase optimization. A combination of citric acid and chitosan was identified to facilitate the injectable and anti-washout properties, enabling higher resistance to structure collapse. Furthermore, CSH addition (5 %-15 %) was favorable for shortening the setting time (5-20 min) and maintaining the compressive strength (10-14 MPa) during incubation in an aqueous buffer medium. These α-TCP-based composites could also accelerate the biodegradation rate and new bone regeneration in rabbit lateral femoral bone defect models in vivo. Our studies demonstrate that foreign ion doping, secondary phase addition and liquid medium optimization could synergistically improve the physicochemical properties and biological performance of α-TCP-based bone cements, which will be promising biomaterials for repairing bone defects in situations of trauma and diseased bone.

Strontium Functionalization of Biomaterials for Bone Tissue Engineering Purposes: A Biological Point of View

Strontium (Sr) is a trace element taken with nutrition and found in bone in close connection to native hydroxyapatite. Sr is involved in a dual mechanism of coupling the stimulation of bone formation with the inhibition of bone resorption, as reported in the literature. Interest in studying Sr has increased in the last decades due to the development of strontium ranelate (SrRan), an orally active agent acting as an anti-osteoporosis drug. However, the use of SrRan was subjected to some limitations starting from 2014 due to its negative side effects on the cardiac safety of patients. In this scenario, an interesting perspective for the administration of Sr is the introduction of Sr ions in biomaterials for bone tissue engineering (BTE) applications. This strategy has attracted attention thanks to its positive effects on bone formation, alongside the reduction of osteoclast activity, proven by in vitro and in vivo studies. The purpose of this review is to go through the classes of biomaterials most commonly used in BTE and functionalized with Sr, i.e., calcium phosphate ceramics, bioactive glasses, metal-based materials, and polymers. The works discussed in this review were selected as representative for each type of the above-mentioned categories, and the biological evaluation in vitro and/or in vivo was the main criterion for selection. The encouraging results collected from the in vitro and in vivo biological evaluations are outlined to highlight the potential applications of materials’ functionalization with Sr as an osteopromoting dopant in BTE.

Angio-osteogenic capacity of octacalcium phosphate co-precipitated with copper gluconate in rat calvaria critical-sized defect

The objective of this study is to investigate the effects of octacalcium phosphate (OCP)-induced bone regeneration on angiogenesis regulated by the inclusion of copper ions in OCP in vitro and in vivo. Calcium (Ca)-deficient Cu-OCPs, containing 0.01 wt% Cu (low-Cu-OCP) and 0.12 wt% Cu (high-Cu-OCP), were synthesized with co7pper gluconate salt. The lattice parameters of Cu-OCPs tended to decrease slightly with Cu inclusion, as estimated by Rietveld analysis. Cu ions were released in OCP when the materials were incubated in the medium for human umbilical vein endothelial cells (HUVECs). The solubility of Cu-OCPs, estimated by the degree of supersaturation, was slightly higher than that of the original OCP. Cu-OCP tended to hydrolyze to an apatite structure while maintaining the crystal plate-like morphology when incubated with mesenchymal stem D1 cells in osteogenic media for 14 days. The specimens were characterized by selected area electron diffraction, transmission electron microscopy, and Fourier transform infrared spectroscopy. Low-Cu-OCP significantly enhanced the HUVEC capillary cross-linking density. D1 cell differentiation was inhibited with the inclusion of Cu, even at low concentrations. The composite of low-Cu-OCP with a gelatin sponge (low-Cu-OCP/Gel) significantly enhanced angiogenesis coupled with bone regeneration when implanted in a rat calvarial critical-sized defect for 4 weeks, compared with the corresponding amount of Cu-containing Gel (Cu/Gel) or OCP/Gel materials through angiography and tissue histomorphometry. These results support the proposition that angiogenesis stimulated by low-Cu-OCP is closely related with enhanced bone regeneration.

Bioactive Calcium Phosphate-Based Composites for Bone Regeneration

Calcium phosphates (CaPs) are widely accepted biomaterials able to promote the regeneration of bone tissue. However, the regeneration of critical-sized bone defects has been considered challenging, and the development of bioceramics exhibiting enhanced bioactivity, bioresorbability and mechanical performance is highly demanded. In this respect, the tuning of their chemical composition, crystal size and morphology have been the matter of intense research in the last decades, including the preparation of composites. The development of effective bioceramic composite scaffolds relies on effective manufacturing techniques able to control the final multi-scale porosity of the devices, relevant to ensure osteointegration and bio-competent mechanical performance. In this context, the present work provides an overview about the reported strategies to develop and optimize bioceramics, while also highlighting future perspectives in the development of bioactive ceramic composites for bone tissue regeneration.

A Novel Fast-Setting Strontium-Containing Hydroxyapatite Bone Cement With a Simple Binary Powder System

In recent years, strontium-substituted calcium phosphate bone cement (Sr-CPC) has attracted more and more attentions in the field of bone tissue repair due to its comprehensive advantages of both traditional CPC and Sr ions. In this study, a crucial Sr-containing α-Ca_{3 - x} Sr _x (PO₄)₂ salt has been synthesized using a simplified one-step method at lower synthesis temperature. A novel Sr-CPC has been developed based on the simple binary Sr-containing α-Ca_{3 - x} Sr _x (PO₄)₂/Ca₄(PO₄)₂O cement powder. The physicochemical properties and hydration mechanism of this Sr-CPC at various Sr contents were intensively investigated. The setting product of this Sr-CPC after a set for 72 h is a single-phase Sr-containing hydroxyapatite, and its compressive strength slightly decreased and its setting time extended with the increase of Sr content. The hydration process included the initial formation of the medium product CaHPO₄⋅2H₂O (30 min∼1 h), the following complete hydration of Ca₄(PO₄)₂O and the initially formed CaHPO₄⋅2H₂O (2∼6 h), and the final self-setting of α-Ca_{3 - x} Sr _x (PO₄)₂ (6 h∼). The compressive strength of Sr-CPC, which was closely related to the transformation rate of Sr-containing hydroxyapatite, tended to increase with the extension of hydration time. In addition, Sr-CPC possessed favorable cytocompatibility and the effect of Sr ions on cytocompatibility of Sr-CPC was not obvious at low Sr contents. The present study suggests α-Ca_{3 - x} Sr _x (PO₄)₂ is a kind of vital Sr-containing salt source which is useful to develop some novel Sr-containing biomaterials. In addition, the new Sr-containing cement system based on this simple binary α-Ca_{3 - x} Sr _x (PO₄)₂/Ca₄(PO₄)₂O cement powder displayed an attractive clinical application potential in orthopedics.

Ion-doped Brushite Cements for Bone Regeneration

Decades of research in orthopaedics has culminated in the quest for formidable yet resorbable biomaterials using bioactive materials. Brushite cements most salient features embrace high biocompatibility, bioresorbability, osteoconductivity, self-setting characteristics, handling, and injectability properties. Such type of materials is also effectively applied as drug delivery systems. However, brushite cements possess limited mechanical strength and fast setting times. By means of incorporating bioactive ions, which are incredibly promising in directing cell fate when incorporated within biomaterials, it can yield biomaterials with superior mechanical properties. Therefore, it is a key to develop fine-tuned regenerative medicine therapeutics. A comprehensive overview of the current accomplishments of ion-doped brushite cements for bone tissue repair and regeneration is provided herein. The role of ionic substitution on the cements physicochemical properties, such as structural, setting time, hydration products, injectability, mechanical behaviour and ion release is discussed. Cell-material interactions, osteogenesis, angiogenesis, and antibacterial activity of the ion-doped cements, as well as its potential use as drug delivery carriers are also presented. STATEMENT OF SIGNIFICANCE: Ion-doped brushite cements have unbolted a new era in orthopaedics with high clinical interest to restore bone defects and facilitate the healing process, owing its outstanding bioresorbability and osteoconductive/osteoinductive features. Ion incorporation expands their application by increasing the osteogenic and neovascularization potential of the materials, as well as their mechanical performance. Recent accomplishments of brushite cements incorporating bioactive ions are overviewed. Focus was placed on the role of ions on the physicochemical and biological properties of the biomaterials, namely their structure, setting time, injectability and handling, mechanical behaviour, ion release and in vivo osteogenesis, angiogenesis and vascularization. Antibacterial activity of the cements and their potential use for delivery of drugs are also highlighted herein.

Synthesis and properties of Sr2+ doping α-tricalcium phosphate at low temperature

Strontium has been widely used in bone repair materials due to its roles in promoting osteoclast apoptosis and enhancing osteoblast proliferation. In this work, synthesis and the effects of Sr²⁺ doping α-tricalcium phosphate at low-temperature was studied. The setting time and the mechanical properties of α-tricalcium phosphate were controlled by varying the content of Sr²⁺. The synthesized compounds were evaluated by XRD, SEM, XPS, setting time, compressive strength, SBF immersion, and colorimetric CCK-8 assay. The results showed that Sr²⁺ can improve the compressive strength and cell activity of calcium phosphate bone cement.

Strontium-calcium phosphate hybrid cement with enhanced osteogenic and angiogenic properties for vascularised bone regeneration

Vascularized bone tissue engineering is regarded as one of the optimal treatment options for large bone defects. The lack of angiogenic properties and unsatisfactory physicochemical performance restricts calcium phosphate cement (CPC) from application in vascularized bone tissue engineering. Our previous studies have developed a starch and BaSO4 incorporated calcium phosphate hybrid cement (CPHC) with improved mechanical strength and handling properties. However, the bioactivity-especially the angiogenic ability-is still absent and requires further improvement. Herein, based on the reported CPHC and the osteogenic and angiogenic properties of strontium (Sr) ions, a strontium-enhanced calcium phosphate hybrid cement (Sr-CPHC) was developed to improve both biological and physicochemical properties of CPC. Compared to CPC, the initial setting time of Sr-CPHC was prolonged from 2.2 min to 20.7 min. The compressive strength of Sr-CPHC improved from 11.21 MPa to 45.52 MPa compared with CPC as well. Sr-CPHC was biocompatible and showed promotion of alkaline phosphatase (ALP) activity, calcium nodule formation and osteogenic relative gene expression, suggesting high osteogenic-inductivity. Sr-CPHC also facilitated the migration and tube formation of human umbilical vein endothelial cells (HUVECs) in vitro and up-regulated the expression of the vascular endothelial growth factor (VEGF) and Angiopoietin-1 (Ang-1). In vivo evaluation showed marked new bone formation in a rat calvarial defect model with Sr-CPHC implanted. Sr-CPHC also exhibited enhancement of neovascularization in subcutaneous connective tissue in a rat subcutaneous implantation model. Thus, the Sr-CPHC with the dual effects of osteogenesis and angiogenesis shows great potential for clinical applications such as the repair of ischemic osteonecrosis and critical-size bone defects.

Biological and mechanical performance and degradation characteristics of calcium phosphate cements in large animals and humans

Calcium phosphate cements (CPCs) have been used to treat bone defects and support bone regeneration because of their good biocompatibility and osteointegrative behavior. Since their introduction in the 1980s, remarkable clinical success has been achieved with these biomaterials, because they offer the unique feature of being moldable and even injectable into implant sites, where they harden through a low-temperature setting reaction. However, despite decades of research efforts, two major limitations concerning their biological and mechanical performance hamper a broader clinical use. Firstly, achieving a degradation rate that is well adjusted to the dynamics of bone formation remains a challenging issue. While apatite-forming CPCs frequently remain for years at the implant site without major signs of degradation, brushite-forming CPCs are considered to degrade to a greater extent. However, the latter tend to convert into lower soluble phases under physiological conditions, which makes their degradation behavior rather unpredictable. Secondly, CPCs exhibit insufficient mechanical properties for load bearing applications because of their inherent brittleness. This review places an emphasis on these limitations and provides an overview of studies that have investigated the biological and biomechanical performance as well as the degradation characteristics of different CPCs after implantation into trabecular bone. We reviewed studies performed in large animals, because they mimic human bone physiology more closely in terms of bone metabolism and mechanical loading conditions compared with small laboratory animals. We compared the results of these studies with clinical trials that have dealt with the degradation behavior of CPCs after vertebroplasty and kyphoplasty.

Strontium-Substituted Dicalcium Silicate Bone Cements with Enhanced Osteogenesis Potential for Orthopaedic Applications

Incorporating Sr element in biomaterials for bone implants is an effective way to improve their biological performance, as Sr element has been proved to enhance bone regeneration and depress bone resorption activity. In the present study, we developed a Sr-incorporated dicalcium silicate (C2S) bone cement as a potential candidate for bioactive self-setting bone cement in orthopaedics and stomatology. The Sr-C2S powders containing 0.3–6.8% Sr in molar ratio were prepared by means of chemical co-precipitation, and the results of XRD analysis indicated the incorporation of Sr element into the lattice of C2S. Sr-C2S bone cements, as prepared by mixing the powders with water, have a final setting time of 570 to 594 min, and compressive strength higher than that of C2S bone cement within certain incorporation range. The Sr-C2S bone cements possessed good in vitro bioactivity by inducing apatite formation in simulated body fluid (SBF) within 7 days. Moreover, the proliferation activity of human bone marrow mesenchymal stem cells (hBMSCs) with Sr-C2S bone cements was significantly higher than that with C2S bone cement, and the alkaline phosphatase (ALP) activity of hBMSCs was also enhanced with addition of Sr element in Sr-C2S groups. The Sr-C2S might therefore be a bioactive self-setting material with enhanced biological performance and holds the prospect for application in the bone regeneration area.

Multiple and Promising Applications of Strontium (Sr)-Containing Bioactive Glasses in Bone Tissue Engineering

Improving and accelerating bone repair still are partially unmet needs in bone regenerative therapies. In this regard, strontium (Sr)-containing bioactive glasses (BGs) are highly-promising materials to tackle this challenge. The positive impacts of Sr on the osteogenesis makes it routinely used in the form of strontium ranelate (SR) in the clinical setting, especially for patients suffering from osteoporosis. Therefore, a large number of silicate-, borate-, and phosphate-based BGs doped with Sr and produced in different shapes have been developed and characterized, in order to be used in the most advanced therapeutic strategies designed for the management of bone defects and injuries. Although the influence of Sr incorporation in the glass is debated regarding the obtained physicochemical and mechanical properties, the biological improvements have been found to be substantial both in vitro and in vivo. In the present study, we provide a comprehensive overview of Sr-containing glasses along with the current state of their clinical use. For this purpose, different types of Sr-doped BG systems are described, including composites, coatings and porous scaffolds, and their applications are discussed in the light of existing experimental data along with the significant challenges ahead.

Concentration-dependent osteogenic and angiogenic biological performances of calcium phosphate cement modified with copper ions

Development of multifunctional bone grafting biomaterials with both osteogenesis and angiogenesis properties have earned increasing interest in the field of regenerative medicine. In the present investigation, copper-doped β-tricalcium phosphate (Cu-TCP) powders were successfully synthesized. And Cu-containing calcium phosphate cement (Cu-CPC) was acquired through uniformly mixing CPC and Cu-TCP powders, with Cu-TCP serving as the donor of Cu²⁺. Cu-CPC exhibited suitable setting time, and the incorporation of Cu-TCP aggregating into CPC exhibited positive effect on the compressive strength while Cu²⁺ was in lower concentration. Investigation results showed that Cu-CPC had relatively low releasing amount of Cu²⁺, which was attributed to the re-bonding of Cu²⁺ into the newly formed HA crystals on surface. In vitro osteogenesis and angiogenesis properties of Cu-CPC were systematically evaluated through co-culture with mouse bone marrow stromal cells (mBMSCs) and human umbilical vein endothelial cells (HUVECs) respectively. The results indicated dose-dependent biological functions of Cu²⁺ in Cu-CPCs. The mBMSCs and HUVECs showed well activity and attachment morphology on TCP/CPC, 0.05 Cu-TCP/CPC, 0.1 Cu-TCP/CPC. The upregulated osteogenic-related genes expression and angiogenic-related genes expression were detected with lower Cu²⁺ content. Taken together, Cu-containing CPC is of great potential for the regeneration of vascularized new bone.

Applications of Metals for Bone Regeneration

The regeneration of bone tissue is the main purpose of most therapies in dental medicine. For bone regeneration, calcium phosphate (CaP)-based substitute materials based on natural (allo- and xenografts) and synthetic origins (alloplastic materials) are applied for guiding the regeneration processes. The optimal bone substitute has to act as a substrate for bone ingrowth into a defect, as well as resorb in the time frame needed for complete regeneration up to the condition of restitution ad integrum. In this context, the modes of action of CaP-based substitute materials have been frequently investigated, where it has been shown that such materials strongly influence regenerative processes such as osteoblast growth or differentiation and also osteoclastic resorption due to different physicochemical properties of the materials. However, the material characteristics needed for the required ratio between new bone tissue formation and material degradation has not been found, until now. The addition of different substances such as collagen or growth factors and also of different cell types has already been tested but did not allow for sufficient or prompt application. Moreover, metals or metal ions are used differently as a basis or as supplement for different materials in the field of bone regeneration. Moreover, it has already been shown that different metal ions are integral components of bone tissue, playing functional roles in the physiological cellular environment as well as in the course of bone healing. The present review focuses on frequently used metals as integral parts of materials designed for bone regeneration, with the aim to provide an overview of currently existing knowledge about the effects of metals in the field of bone regeneration.

Ionic Substitutions in Non-Apatitic Calcium Phosphates

Calcium phosphate materials (CaPs) are similar to inorganic part of human mineralized tissues (i.e., bone, enamel, and dentin). Owing to their high biocompatibility, CaPs, mainly hydroxyapatite (HA), have been investigated for their use in various medical applications. One of the most widely used ways to improve the biological and physicochemical properties of HA is ionic substitution with trace ions. Recent developments in bioceramics have already demonstrated that introducing foreign ions is also possible in other CaPs, such as tricalcium phosphates (amorphous as well as α and β crystalline forms) and brushite. The purpose of this paper is to review recent achievements in the field of non-apatitic CaPs substituted with various ions. Particular attention will be focused on tricalcium phosphates (TCP) and "additives" such as magnesium, zinc, strontium, and silicate ions, all of which have been widely investigated thanks to their important biological role. This review also highlights some of the potential biomedical applications of non-apatitic substituted CaPs.

Biofunctional Ionic-Doped Calcium Phosphates: Silk Fibroin Composites for Bone Tissue Engineering Scaffolding

The treatment and regeneration of bone defects caused by traumatism or diseases have not been completely addressed by current therapies. Lately, advanced tools and technologies have been successfully developed for bone tissue regeneration. Functional scaffolding materials such as biopolymers and bioresorbable fillers have gained particular attention, owing to their ability to promote cell adhesion, proliferation, and extracellular matrix production, which promote new bone growth. Here, we present novel biofunctional scaffolds for bone regeneration composed of silk fibroin (SF) and β-tricalcium phosphate (β-TCP) and incorporating Sr, Zn, and Mn, which were successfully developed using salt-leaching followed by a freeze-drying technique. The scaffolds presented a suitable pore size, porosity, and high interconnectivity, adequate for promoting cell attachment and proliferation. The degradation behavior and compressive mechanical strengths showed that SF/ionic-doped TCP scaffolds exhibit improved characteristics for bone tissue engineering when compared with SF scaffolds alone. The in vitro bioactivity assays using a simulated body fluid showed the growth of an apatite layer. Furthermore, in vitro assays using human adipose-derived stem cells presented different effects on cell proliferation/differentiation when varying the doping agents in the biofunctional scaffolds. The incorporation of Zn into the scaffolds led to improved proliferation, while the Sr- and Mn-doped scaffolds presented higher osteogenic potential as demonstrated by DNA quantification and alkaline phosphatase activity. The combination of Sr with Zn led to an influence on cell proliferation and osteogenesis when compared with single ions. Our results indicate that biofunctional ionic-doped composite scaffolds are good candidates for further in vivo studies on bone tissue regeneration.

Development of Sr-incorporated biphasic calcium phosphate bone cement

To follow the design strategy of traditional biphasic calcium phosphate (BCP) ceramic, in the present study, strontium-doped biphasic calcium phosphate bone cement (Sr-BCPC) composites comprising Sr-β-tricalcium phosphate (TCP)/Sr-hydroxyapatite (HAP) had been prepared for the first time using Sr _x -β-TCP/tetracalcium phosphate (TTCP) as a cement powder and diluted phosphoric acid as a cement liquid. The phase composition, setting time, compressive strength, washout resistance, in vitro degradation rate, microstructure evolutions, hydration dynamics and cytotoxicity of Sr-BCPC at various Sr contents were intensively investigated. It was found that the final cement product was composed of entangled Sr-HAP nano-needles and cobblestone-like Sr-β-TCP sub-micron particles, and the weight percentages in the final cement product after hydration in simulated body fluid for 24 h were in the ranges of 60 wt%-70 wt% Sr-HAP and 30 wt%-40 wt% Sr-β-TCP, respectively. Sr and the concentration of Sr exhibit significant effects on the phase compositions, compressive strength, setting time, in vitro degradation rate and cytotoxicity of the biphasic bone cement. In particular, the degradation rate increased considerably with the increase of the Sr-β-TCP phase. It is anticipated that the introduction of the 'biphasic' design into calcium phosphate bone cements is an effective strategy to improve their degradation properties.

Injectable MnSr-doped brushite bone cements with improved biological performance

Combining Mn and Sr co-doping β-TCP powder with sucrose addition in the setting liquid enhances injectability, mechanical and biological performance of brushite-forming cements, renders them promising for minimally invasive surgery applications.

Intrafibrillar mineralization of polyacrylic acid-bound collagen fibrils using a two-dimensional collagen model and Portland cement-based resins

The biomimetic remineralization of apatite-depleted dentin is a potential method for enhancing the durability of resin-dentin bonding. To advance this strategy from its initial proof-of-concept design, we sought to investigate the characteristics of polyacrylic acid (PAA) adsorption to desorption from type I collagen and to test the mineralization ability of PAA-bound collagen. Portland cement and β-tricalcium phosphate (β-TCP) were homogenized with a hydrophilic resin blend to produce experimental resins. The collagen fibrils reconstituted on nickel (Ni) grids were mineralized using different methods: (i) group I consisted of collagen treated with Portland cement-based resin in simulated body fluid (SBF); (ii) group II consisted of PAA-bound collagen treated with Portland cement-based resin in SBF; and (iii) group III consisted of PAA-bound collagen treated with β-TCP-doped Portland cement-based resin in deionized water. Intrafibrillar mineralization was evaluated using transmission electron microscopy. We found that a carbonyl-associated peak at pH 3.0 increased as adsorption time increased, whereas a hydrogen bond-associated peak increased as desorption time increased. The experimental resins maintained an alkaline pH and the continuous release of calcium ions. Apatite was detected within PAA-bound collagen in groups II and III. Our results suggest that PAA-bound type I collagen fibrils can be mineralized using Portland cement-based resins.

Novel Osteointegrative Sr-Substituted Apatitic Cements Enriched with Alginate

The present work describes the synthesis of novel injectable, self-setting bone cements made of strontium-substituted hydroxyapatite (Sr-HA), obtained by single-phase calcium phosphate precursors doped with different amounts of strontium and enriched with alginate. The addition of alginate improved the injectability, cohesion, and compression strength of the cements, without affecting the hardening process. A Sr-HA cement exhibiting adequate hardening times and mechanical strength for clinical applications was further tested in vivo in a rabbit model, in comparison with a commercial calcium phosphate cement, revealing the maintenance of biomimetic composition and porous microstructure even after one month in vivo, as well as enhanced ability to induce new bone formation and penetration.

Biodegradable Materials for Bone Repair and Tissue Engineering Applications

This review discusses and summarizes the recent developments and advances in the use of biodegradable materials for bone repair purposes. The choice between using degradable and non-degradable devices for orthopedic and maxillofacial applications must be carefully weighed. Traditional biodegradable devices for osteosynthesis have been successful in low or mild load bearing applications. However, continuing research and recent developments in the field of material science has resulted in development of biomaterials with improved strength and mechanical properties. For this purpose, biodegradable materials, including polymers, ceramics and magnesium alloys have attracted much attention for osteologic repair and applications. The next generation of biodegradable materials would benefit from recent knowledge gained regarding cell material interactions, with better control of interfacing between the material and the surrounding bone tissue. The next generations of biodegradable materials for bone repair and regeneration applications require better control of interfacing between the material and the surrounding bone tissue. Also, the mechanical properties and degradation/resorption profiles of these materials require further improvement to broaden their use and achieve better clinical results.

Injectability of calcium phosphate pastes: Effects of particle size and state of aggregation of β-tricalcium phosphate powders

The present study discloses a systematic study about the influence of some relevant experimental variables on injectability of calcium phosphate cements. Non-reactive and reactive pastes were prepared, based on tricalcium phosphate doped with 5 mol% (Sr-TCP) that was synthesised by co-precipitation. The varied experimental parameters included: (i) the heat treatment temperature within the range of 800-1100°C; (ii) different milling extents of calcined powders; (iii) the liquid-to-powder ratio (LPR); (iv) the use of powder blends with different particle sizes (PS) and particle size distributions (PSD); (v) the partial replacement of fine powders by large spherical dense granules prepared via freeze granulation method to simulate coarse individual particles. The aim was contributing to better understanding of the effects of PS, PSD, morphology and state of aggregation of the starting powders on injectability of pastes produced thereof. Powders heat treated at 800 and 1000°C with different morphologies but with similar apparent PSD curves obtained by milling/blending originated completely injectable reactive cement pastes at low LPR. This contrasted with non-reactive systems prepared thereof under the same conditions. Hypotheses were put forward to explain why the injectability results collected upon extruding non-reactive pastes cannot be directly transposed to reactive systems. The results obtained underline the interdependent roles of the different powder features and ionic strength in the liquid media on determining the flow and injectability behaviours.

Effects on growth and osteogenic differentiation of mesenchymal stem cells by the strontium-added sol-gel hydroxyapatite gel materials

In the present study, strontium-modified hydroxyapatite gels (Sr-HA) at different concentrations were prepared using sol-gel approach and their effect on human-bone-marrow-derived mesenchymal stem cells, were evaluated. The effect of Strontium on physico-chemical and morphological properties of hydroxyapatite gel were evaluated. Morphological analyses (SEM and TEM) demonstrate that an increasing in the amount of Sr ions doped into HA made the agglomerated particles smaller. The substitution of large Sr2+ for small Ca2+ lead to denser atomic packing of the system causing retardation of crystals growth. The biological results demonstrated that hydroxyapatite gel containing from 0 to 20 mol% of Sr presented no cytotoxicity and promote the expression of osteogenesis related genes including an early marker for osteogenic differentiation ALP; a non-collagen protein OPN and a late marker for osteogenic differentiation OCN. Finally, the Sr-HA gels could have a great potential application as filler in bone repair and regeneration and used in especially in the osteoporotic disease.

Fast setting and anti-washout injectable calcium–magnesium phosphate cement for minimally invasive treatment of bone defects

The fa-ICMPC exhibited potent anti-washout properties, fast setting, improved injectability, good biodegradability and osteoconductivity.

Strontium modified calcium phosphate cements – approaches towards targeted stimulation of bone turnover

Strontium modified calcium phosphate cements can target local bone turnover by stimulating osteoblast proliferation and differentiation (1) as well as bone mineralisation (2), reducing osteoclastogenesis (3) and resorption activity, increase osteoclast apoptosis (4) and affect osteoblast/osteoclast paracrine signalling (5).

Investigation on corrosion protection and mechanical performance of minerals substituted hydroxyapatite coating on HELCDEB-treated titanium using pulsed electrodeposition method

The present work aims to investigate the effects of mineral (strontium, magnesium and zinc) substituted hydroxyapatite (M-HAP) coating on high-energy low-current DC electron beam (HELCDEB)-treated titanium (Ti).

β-Dicalcium silicate-based cement: synthesis, characterization and in vitro bioactivity and biocompatibility studies

β-dicalcium silicate (β-Ca₂ SiO₄, β-C₂ S) is one of the main constituents in Portland cement clinker and many refractory materials, itself is a hydraulic cement that reacts with water or aqueous solution at room/body temperature to form a hydrated phase (C-S-H), which provides mechanical strength to the end product. In the present investigation, β-C₂ S was synthesized by sol-gel process and it was used as powder to cement preparation, named CSiC. In vitro bioactivity and biocompatibility studies were assessed by soaking the cement samples in simulated body fluid solutions and human osteoblast cell cultures for various time periods, respectively. The results showed that the sol-gel process is an available synthesis method in order to obtain a pure powder of β-C₂ S at relatively low temperatures without chemical stabilizers. A bone-like apatite layer covered the material surface after soaking in SBF and its compressive strength (CSiC cement) was comparable with that of the human trabecular bone. The extracts of this cement were not cytotoxic and the cell growth and relative cell viability were comparable to negative control.

A novel strontium(II)-modified calcium phosphate bone cement stimulates human-bone-marrow-derived mesenchymal stem cell proliferation and osteogenic differentiation in vitro

In the present study, the in vitro effects of novel strontium-modified calcium phosphate bone cements (SrCPCs), prepared using two different approaches on human-bone-marrow-derived mesenchymal stem cells (hMSCs), were evaluated. Strontium ions, known to stimulate bone formation and therefore already used in systemic osteoporosis therapy, were incorporated into a hydroxyapatite-forming calcium phosphate bone cement via two simple approaches: incorporation of strontium carbonate crystals and substitution of Ca(2+) by Sr(2+) ions during cement setting. All modified cements released 0.03-0.07 mM Sr(2+) under in vitro conditions, concentrations that were shown not to impair the proliferation or osteogenic differentiation of hMSCs. Furthermore, strontium modification led to a reduced medium acidification and Ca(2+) depletion in comparison to the standard calcium phosphate cement. In indirect and direct cell culture experiments with the novel SrCPCs significantly enhanced cell proliferation and differentiation were observed. In conclusion, the SrCPCs described here could be beneficial for the local treatment of defects, especially in the osteoporotic bone.

Self-setting calcium orthophosphate formulations

In early 1980s, researchers discovered self-setting calcium orthophosphate cements, which are bioactive and biodegradable grafting bioceramics in the form of a powder and a liquid. After mixing, both phases form pastes, which set and harden forming either a non-stoichiometric calcium deficient hydroxyapatite or brushite. Since both of them are remarkably biocompartible, bioresorbable and osteoconductive, self-setting calcium orthophosphate formulations appear to be promising bioceramics for bone grafting. Furthermore, such formulations possess excellent molding capabilities, easy manipulation and nearly perfect adaptation to the complex shapes of bone defects, followed by gradual bioresorption and new bone formation. In addition, reinforced formulations have been introduced, which might be described as calcium orthophosphate concretes. The discovery of self-setting properties opened up a new era in the medical application of calcium orthophosphates and many commercial trademarks have been introduced as a result. Currently such formulations are widely used as synthetic bone grafts, with several advantages, such as pourability and injectability. Moreover, their low-temperature setting reactions and intrinsic porosity allow loading by drugs, biomolecules and even cells for tissue engineering purposes. In this review, an insight into the self-setting calcium orthophosphate formulations, as excellent bioceramics suitable for both dental and bone grafting applications, has been provided.

A novel and easy-to-prepare strontium(II) modified calcium phosphate bone cement with enhanced mechanical properties

The aim of this study was to evaluate two different approaches to obtaining strontium-modified calcium phosphate bone cements (SrCPCs) without elaborate synthesis of Sr-containing calcium phosphate species as cement precursors that could release biologically effective doses of Sr(2+) and thus could improve the healing of osteoporotic bone defects. Using strontium carbonate as a strontium(II) source, it was introduced into a hydroxyapatite-forming cement either by the addition of SrCO3 to an α-tricalcium phosphate-based cement precursor mixture (A-type) or by substitution of CaCO3 by SrCO3 during precursor composition (S-type). The cements, obtained after setting in a water-saturated atmosphere, contained up to 2.2at.% strontium in different distribution patterns as determined by time-of-flight secondary ion mass spectrometry and energy-dispersive X-ray spectroscopy. The setting time of CPC and A-type cements was in the range of 6.5-7.5min and increased for substitution-type cements (12.5-13.0min). Set cements had an open porosity between 26 and 42%. Compressive strength was found to increase from 29MPa up to 90% in substituted S-type cements (58MPa). SrCPC samples released between 0.45 and 1.53mgg(-1) Sr(2+) within 21days and showed increased radiopacity. Based on these findings, the SrCPC developed in this study could be beneficial for the treatment of defects of systemically impaired (e.g. osteoporotic) bone.

Sr-containing hydroxyapatite: morphologies of HA crystals and bioactivity on osteoblast cells

A series of Sr-substituted hydroxyapatites (HA), of general formula Ca(10-x)Srx(PO4)6(OH)2, where x=2 and 4, were synthesized by solid state methods and characterized extensively. The reactivity of these materials in cell culture medium was evaluated, and the behavior towards MG-63 osteoblast cells (in terms of cytotoxicity and proliferation assays) was studied. Future in vivo studies will give further insights into the behavior of the materials. A paper by Lagergren et al. (1975), concerning Sr-substituted HA prepared by a solid state method, reports that the presence of Sr in the apatite composition strongly influences the apatite diffraction patterns. Zeglinsky et al. (2012) investigated Sr-substituted HA by ab initio methods and Rietveld analyses and reported changes in the HA unit cell volume and shape due to the Sr addition. To further clarify the role played by the addition of Sr on the physico-chemical properties of these materials we prepared Sr-substituted HA compositions by a solid state method, using different reagents, thermal treatments and a multi-technique approach. Our results indicated that the introduction of Sr at the levels considered here does influence the structure of HA. There is also evidence of a decrease in the crystallinity degree of the materials upon Sr addition. The introduction of increasing amounts of Sr into the HA composition causes a decrease in the specific surface area and an enrichment of Sr-apatite phase at the surface of the samples. Bioactivity tests show that the presence of Sr causes changes in particle size and/or morphology during soaking in MEM solution; on the contrary the morphology of pure HA does not change after 14 days of reaction. The presence of Sr, as Sr-substituted HA and SrCl2, in cultures of human MG-63 osteoblasts did not produce any cytotoxic effect. In fact, Sr-substituted HA increased the proliferation of osteoblast cells and enhanced cell differentiation: Sr in HA has a positive effect on MG-63 cells. In contrast, Sr ions alone, at the concentrations released by Sr-HA (1.21-3.24 ppm), influenced neither cell proliferation nor differentiation. Thus the positive effects of Sr in Sr-HA materials are probably due to the co-action of other ions such as Ca and P.

Controlling the biological function of calcium phosphate bone substitutes with drugs

There is a growing interest in bone tissue engineering for bone repair after traumatic, surgical or pathological injury, such as osteolytic tumor or osteoporosis. In this regard, calcium phosphate (CaP) bone substitutes have been used extensively as bone-targeting drug-delivery systems. This localized approach improves the osteogenic potential of bone substitutes by delivering bone growth factors, thus extending their biofunctionality to any pathological context, including infection, irradiation, tumor and osteoporosis. This review briefly describes the physical and chemical processes implicated in the preparation of drug-delivering CaPs. It also describes the impact of these processes on the intrinsic properties of CaPs, especially in terms of the drug-release profile. In addition, this review focuses on the potential influence of drugs on the resorption rate of CaPs. Interestingly, by modulating the resorption parameters of CaP biomaterials, it should be possible to control the release of bone-stimulating ions, such as inorganic phosphate, in the vicinity of bone cells. Finally, recent in vitro and in vivo evaluations are extensively reported.

Calcium phosphate cements as drug delivery materials

Calcium phosphate cements are used as synthetic bone grafts, with several advantages, such as their osteoconductivity and injectability. Moreover, their low-temperature setting reaction and intrinsic porosity allow for the incorporation of drugs and active principles in the material. It is the aim of the present work to: a) provide an overview of the different approaches taken in the application of calcium phosphate cements for drug delivery in the skeletal system, and b) identify the most significant achievements. The drugs or active principles associated to calcium phosphate cements are classified in three groups, i) low molecular weight drugs; ii) high molecular weight biomolecules; and iii) ions.

Strontium- and magnesium-enriched biomimetic β-TCP macrospheres with potential for bone tissue morphogenesis

During the last two decades, biogenic mineral ions have become important additives in treatments for bone regeneration and repair. Prominent among these is strontium, which is a potent suppressor of osteoclast bone resorption. Another is magnesium, which has a key influence in mineralization processes. The shells of benthic foraminiferans, hydrothermally converted into β-TCP, have been shown to effectively release a number of bone-promoting drugs at clinically relevant levels. In this study we characterized the effects of converted foraminiferan calcium dissolution and the concomitant release profile of intrinsic strontium and magnesium. We tested the effects of strontium- and magnesium-enriched macrospheres on human osteoblast (SaOS-2) and monocytoid (U937) cell lines, which can be induced to express equivalent phagocytic activities to osteoclasts. On dissolution in a biomimetic physiological solution, the macrospheres released biologically significant quantities of calcium and phosphate ions in the first 18 days. At 3 days, during which biogenic mineral ions are released, the number of U937 osteoclast-like monocyte cells decreased, while 4 days later the osteoblast cell number increased. These results show that strontium and magnesium naturally enriched macrospheres are capable of altering the metabolic activities of the cells regulating bone homeostasis. These unique macrospheres are natural origin bone void filler particles that resorb, and release physiologically significant levels of incorporated strontium, magnesium and calcium, which together make a uniquely multifunctional in situ remedy for bone regeneration and repair and the treatment of bone-wasting diseases.

Experimental resin cements containing bioactive fillers reduce matrix metalloproteinase-mediated dentin collagen degradation

INTRODUCTION

Collagen dentin matrix may represent a suitable scaffold to be remineralized in the presence of bioactive materials. The purpose of this study was to determine if experimental resin cements containing bioactive fillers may modulate matrix metalloproteinase-mediated collagen degradation of etched dentin.

METHODS

Human dentin beams demineralized using 10% phosphoric acid or 0.5 mol/L EDTA were infiltrated with the following experimental resins: (1) unfilled resin, (2) resin with Bioglass 45S5 particles (Sylc; OSspray Ltd, London, UK), and (3) resin with β-tricalcium phosphate-modified calcium silicate cement (HCAT-β) particles. The filler/resin ratio was 40/60 wt%. The specimens were stored in artificial saliva, and the determination of C-terminal telopeptide (ICTP) was performed by radioimmunoassay after 24 hours, 1 week, and 4 weeks. Scanning electron microscopic analysis of dentin surfaces after 4 weeks of storage was also executed.

RESULTS

Collagen degradation was prominent both in phosphoric acid and EDTA-treated dentin. Resin infiltration strongly reduced the MMP activity in demineralized dentin. Resin-containing Bioglass 45S5 particles exerted higher and more stable protection of collagen at all tested dentin states and time points. HCAT-β induced collagen protection from MMPs only in EDTA-treated specimens. Dentin remineralization was achieved when dentin was infiltrated with the resin cements containing bioactive fillers.

CONCLUSIONS

MMP degradation of dentin collagen is strongly reduced in resin-infiltrated dentin. The inclusion of Bioglass 45S5 particles exerted an additional protection of collagen during dentin remineralization.

In vitro degradation and cytocompatibility of dicalcium phosphate dihydrate cements prepared using the monocalcium phosphate monohydrate/hydroxyapatite system reveals rapid conversion to HA as a key mechanism

We previously showed that dicalcium phosphate dihydrate (DCPD) cements can be prepared using monocalcium phosphate monohydrate (MCPM) and hydroxyapatite (HA). In this study, we have characterized the degradation properties and biocompatibility of these novel cements. To study the degradation properties, cements were prepared using MCPM:HA molar ratios of 4:1, 2:1, 2:3, and 2:5. Degradation was evaluated in vitro by static soaking in PBS, and changes in pH, mass, compressive strength, and composition were monitored. Conversion of DCPD to HA was noted in the 4:1 group, which initially consisted of pure DCPD. However, the 2:1 group, which initially consisted of DCPD and an intermediate amount of unreacted HA, underwent rapid conversion to HA associated with significantly greater pH drop and mass loss as well as a complete loss of mechanical integrity. On the basis of these results, we directly compared the cytocompatibility of 2:1 MCPM:HA cements to DCPD cements prepared with an equivalent percent molar excess of β-tricalcium phosphate (β-TCP) using an in vitro cell viability assay. Viability of cells co-cultured with 2:1 MCPM:HA cements was significantly reduced after just 48 h, while viability of cells cultured with the β-TCP-based cements was no different from control cells. In conclusion, this study demonstrates that conversion to HA plays an important role in the degradation of DCPD cements prepared with the MCPM/HA system, affecting both physical properties and cytocompatibility. These results could have important clinical implications for MCPM/HA cements.

Dicalcium phosphate cements: brushite and monetite

Dicalcium phosphate cements were developed two decades ago and ever since there has been a substantial growth in research into improving their properties in order to satisfy the requirements needed for several clinical applications. The present paper presents an overview of the rapidly expanding research field of the two main dicalcium phosphate bioceramics: brushite and monetite. This review begins with a summary of all the different formulae developed to prepare dicalcium phosphate cements, and their setting reaction, in order to set the scene for the key cement physical and chemical properties, such as compressive and tensile strength, cohesion, injectability and shelf-life. We address the issue of brushite conversion into either monetite or apatite. Moreover, we discuss the in vivo behavior of the cements, including their ability to promote bone formation, biodegradation and potential clinical applications in drug delivery, orthopedics, craniofacial surgery, cancer therapy and biosensors.

Alpha-tricalcium phosphate (α-TCP): solid state synthesis from different calcium precursors and the hydraulic reactivity

The effects of solid state synthesis process parameters and primary calcium precursor on the cement-type hydration efficiency (at 37 °C) of α-tricalcium phosphate (Ca(3)(PO(4))(2) or α-TCP) into hydroxyapatite (Ca(10-x)HPO(4)(PO(4))(6-x)(OH)(2-x) x = 0-1, or HAp) have been investigated. α-TCP was synthesized by firing of stoichiometric amount of calcium carbonate (CaCO(3)) and monetite (CaHPO(4)) at 1150-1350 °C for 2 h. Three commercial grade CaCO(3) powders of different purity were used as the starting material and the resultant α-TCP products for all synthesis routes were compared in terms of the material properties and the reactivity. The reactant CaHPO(4) was also custom synthesized from the respective CaCO(3) source. A low firing temperature in the range of 1150-1350°C promoted formation of β-polymorph as a second phase in the resultant TCP. Meanwhile, higher firing temperatures resulted in phase pure α-TCP with poor hydraulic reactivity. The extension of firing operation also led to a decrease in the reactivity. It was found that identical synthesis history, morphology, particle size and crystallinity match between the α-TCPs produced from different CaCO(3) sources do not essentially culminate in products exhibiting similar hydraulic reactivity. The changes in reactivity are arising from differences in the trace amount of impurities found in the CaCO(3) precursors. In this regard, a correlation between the observed hydraulic reactivities and the impurity content of the CaCO(3) powders--as determined by inductively coupled plasma mass spectrometry--has been established. A high level of magnesium impurity in the CaCO(3) almost completely hampers the hydration of α-TCP. This impurity also favors formation of β- instead of α-polymorph in the product of TCP upon firing.

Interfacial pH: a critical factor for osteoporotic bone regeneration

Osteoporosis is a disease attributed to an imbalance in communication between osteoblasts and osteoclasts, possibly arising from a locally acidic microenvironment which hinders normal cell function. However, to date, little or no attention has been paid to these cells' milieu in respect of implant materials. Although it has been claimed for a few biomaterials that they stimulate bone formation, seldom has their surface behavior been invoked to explain behavior. With degradation, ion concentrations and pH at the material's surface must vary and thus may affect osteoblast response directly. On degradation of a recently developed biomaterial, Sr-containing CaSiO3, the interfacial pH was found to be appreciably higher than that of the bulk medium and the "standard" physiological value of 7.4. At these high values (pH > 8), both the proliferation and alkaline phosphatase (ALP) activity of osteoblasts was significantly enhanced, with a maximum response at 10% Sr substitution for Ca. This shows that the chemistry of the solid-liquid interface is a critical factor in bone regeneration, although this has generally been overlooked. Thus, the interfacial pH in particular is to be considered, rather than the bulk value, and this may be of importance in many related contexts in bone-tissue engineering.