Controlled release of strontium ions from a bioactive Ti metal with a Ca-enriched surface layer

Antitumoral-Embedded Biopolymeric Spheres for Implantable Devices

The bioactive surface modification of implantable devices paves the way towards the personalized healthcare practice by providing a versatile and tunable approach that increase the patient outcome, facilitate the medical procedure, and reduce the indirect or secondary effects. The purpose of our study was to assess the performance of composite coatings based on biopolymeric spheres of poly(lactide-co-glycolide) embedded with hydroxyapatite (HA) and methotrexate (MTX). Bio-simulated tests performed for up to one week evidenced the gradual release of the antitumor drug and the biomineralization potential of PLGA/HA-MTX sphere coatings. The composite materials proved superior biocompatibility and promoted enhanced cell adhesion and proliferation with respect to human preosteoblast and osteosarcoma cell lines when compared to pristine titanium.

Mechanical, bioactive, and long-lasting antibacterial properties of a Ti scaffold with gradient pores releasing iodine ions

The ideal bone implant would effectively prevent aseptic as well as septic loosening by minimizing stress shielding, maximizing bone ingrowth, and preventing implant-associated infections. Here, a novel gradient-pore-size titanium scaffold was designed and manufactured to address these requirements. The scaffold features a larger pore size (900 μm) on the top surface, gradually decreasing to small sizes (600 μm to 300 μm) towards the center, creating a gradient structure. To enhance its functionality, the additively manufactured scaffolds were biofunctionalized using simple chemical and heat treatments so as to incorporate calcium and iodine ions throughout the surface. This unique combination of varying pore sizes with a biofunctional surface provides highly desirable mechanical properties, bioactivity, and notably, long-lasting antibacterial activity. The target mechanical aspects, including low elastic modulus, high compression, compression-shear, and fatigue strength, were effectively achieved. Furthermore, the biofunctional surface exhibits remarkable in vitro bioactivity and potent antibacterial activity, even under conditions specifically altered to be favorable for bacterial growth. More importantly, the integration of small pores alongside larger ones ensures a sustained high release of iodine, resulting in antimicrobial activity that persisted for over three months, with full eradication of the bacteria. Taken together, this gradient structure exhibits obvious superiority in combining most of the desired properties, making it an ideal candidate for orthopedic and dental implant applications.

Strontium-loaded 3D intramedullary nail titanium implant for critical-sized femoral defect in rabbits

The treatment of critical-sized bone defects has long been a major problem for surgeons. In this study, an intramedullary nail shaped three-dimensional (3D)-printed porous titanium implant that is capable of releasing strontium ions was developed through a simple and cost-effective surface modification technique. The feasibility of this implant as a stand-alone solution was evaluated using a rabbit's segmental diaphyseal as a defect model. The strontium-loaded implant exhibited a favorable environment for cell adhesion, and mechanical properties that were commensurate with those of a rabbit's cortical bone. Radiographic, biomechanical, and histological analyses revealed a significantly higher amount of bone ingrowth and superior bone-bonding strength in the strontium-loaded implant when compared to an untreated porous titanium implant. Furthermore, one-year histological observations revealed that the strontium-loaded implant preserved the native-like diaphyseal bone structure without failure. These findings suggest that strontium-releasing 3D-printed titanium implants have the clinical potential to induce the early and efficient repair of critical-sized, load-bearing bone defects.

Advanced surface engineering of titanium materials for biomedical applications: From static modification to dynamic responsive regulation

Titanium (Ti) and its alloys have been widely used as orthopedic implants, because of their favorable mechanical properties, corrosion resistance and biocompatibility. Despite their significant success in various clinical applications, the probability of failure, degradation and revision is undesirably high, especially for the patients with low bone density, insufficient quantity of bone or osteoporosis, which renders the studies on surface modification of Ti still active to further improve clinical results. It is discerned that surface physicochemical properties directly influence and even control the dynamic interaction that subsequently determines the success or rejection of orthopedic implants. Therefore, it is crucial to endow bulk materials with specific surface properties of high bioactivity that can be performed by surface modification to realize the osseointegration. This article first reviews surface characteristics of Ti materials and various conventional surface modification techniques involving mechanical, physical and chemical treatments based on the formation mechanism of the modified coatings. Such conventional methods are able to improve bioactivity of Ti implants, but the surfaces with static state cannot respond to the dynamic biological cascades from the living cells and tissues. Hence, beyond traditional static design, dynamic responsive avenues are then emerging. The dynamic stimuli sources for surface functionalization can originate from environmental triggers or physiological triggers. In short, this review surveys recent developments in the surface engineering of Ti materials, with a specific emphasis on advances in static to dynamic functionality, which provides perspectives for improving bioactivity and biocompatibility of Ti implants.

Immunomodulation and osseointegration activities of Na2TiO3 nanorods-arrayed coatings doped with different Sr content

To endow Ti-based orthopedic implants immunomodulatory capability and thus enhanced osseointegration, different amounts of Sr are doped in Na2TiO3 nanorods in the arrays with identical nanotopographic parameters (rod diameter, length and inter-rod spacing) by substitution of Na+ using hydrothermal treatment. The obtained arrays are denoted as STSr2, STSr4, and STSr7, where the arabic numbers indicate the incorporating amounts of Sr in Na2TiO3. The modulation effects of the Sr-doped nanorods arrays on macrophage polarization and osteogenetic functions of osteoblasts are investigated, together with the array without Sr (ST). Moreover, osseointegration of these arrays are also assayed in rat femoral condyles. Sr-doped nanorods arrays accelerate M1 (pro-inflammatory phenotype)-to-M2 (anti-inflammatory phenotype) transformation of the adhered macrophages, enhancing secretion of pro-osteogenetic cytokines and growth factors (TGF-β1 and BMP2), moreover, the Sr doped arrays directly enhance osteogenetic functions of osteoblasts. The enhancement of paracrine of M2 macrophages and osteogenetic function of osteoblasts is promoted with the increase of Sr incorporating amounts. Consequently, Sr doped arrays show significantly enhanced osseointegration in vivo compared to ST, and STSr7 exhibits the best performance. Our work sheds a new light on the design of surface chemical components and structures for orthopedic implants to enhance their osseointegration.

Cubic multi-ions-doped Na2TiO3 nanorod-like coatings: Structure-stable, highly efficient platform for ions-exchanged release to immunomodulatory promotion on vascularized bone apposition

The dissolution-derived release of bioactive ions from ceramic coatings on metallic implants, despite improving osseointegration, renders a concern on the interfacial breakdown of the metal/coating/bone system during long-term service. Consequently, persistent efforts to seek alternative strategies instead of dissolution-derived activation are pressingly carrying out. Inspired by bone mineral containing ions as Ca²⁺, Mg²⁺, Sr²⁺ and Zn²⁺, here we hydrothermally grew the quadruple ions co-doped Na₂TiO₃ nanorod-like coatings. The co-doped ions partially substitute Na⁺ in Na₂TiO₃, and can be efficiently released from cubic lattice via exchange with Na⁺ in fluid rather than dissolution, endowing the coatings superior long-term stability of structure and bond strength. Regulated by the coatings-conditioned extracellular ions, TLR4-NFκB signalling is enhanced to act primarily in macrophages (MΦs) at 6 h while CaSR-PI3K-Akt1 signalling is potentiated to act predominately since 24 h, triggering MΦs in a M1 response early and then in a M2 response to sequentially secrete diverse cytokines. Acting on endothelial and mesenchymal stem cells with the released ions and cytokines, the immunomodulatory coatings greatly promote Type-H (CD31^hiEmcn^hi) angiogenesis and osteogenesis in vitro and in vivo, providing new insights into orchestrating insoluble ceramics-coated implants for early vascularized osseointegration in combination with long-term fixation to bone.

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Co-doped Ca²⁺, Mg²⁺, Sr²⁺ and Zn²⁺ in Na₂TiO₃ efficiently release via ion exchange.

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QID elevates extracellular concentrations of the ions and MΦ intracellular [Ca²⁺].

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Co-doped Na₂TiO₃ coatings promote immunomodulatory apposition of vascularized bone.

Influence of Composition and Preparation Conditions on the Structure and Properties of Composite Materials TiO2-SiO2/CaO with a Spherical Particle Shape Based on Tokem-200 Cationic Exchange Resins

Spherical biomaterials based on Tokem-200 cationic exchange resin were synthesized from solutions by the sol-gel method. The material framework is represented by TiO₂-SiO₂, and the inner part is filled with CaO (sample TiO₂-SiO₂/CaO). A stepwise heat treatment (drying at 60 °C) annealing at 150, 250, and 350 °C, each for 30 min, at 600 °C for 6 h, and 800 °C for 1 h is required to obtain a homogeneous material. In simulated body fluid solution, the sample exhibited bioactive properties, and gelatin could be used as a binding additive.

Double-edged sword: Therapeutic efficacy versus toxicity evaluations of doped titanium implants

Titanium-based orthopaedic/dental implants modified with various metal-doping strategies can enhance local therapy and bioactivity. Intentional or unintentional (because of loading and wear) release of metal ions/nanoparticles (NPs) from metal-doped implants can be therapeutic or cause adverse local tissue reactions, compromising long-term survival. Strategies to incorporate metals into implants, such as superficial or deep loading inside nano-engineered surfaces, including nanotubes, and the physiochemical characteristics of the released species significantly influence both their therapeutic and cytotoxic potential. In this review, we compare and contrast this 'double-edged sword' to arrive at an improved understanding of metal-doped implants to enable controlled therapy while minimising cytotoxicity concerns.

A trilogy antimicrobial strategy for multiple infections of orthopedic implants throughout their life cycle

Bacteria-associated infection represents one of the major threats for orthopedic implants failure during their life cycles. However, ordinary antimicrobial treatments usually failed to combat multiple waves of infections during arthroplasty and prosthesis revisions etc. As these incidents could easily introduce new microbial pathogens in/onto the implants. Herein, we demonstrate that an antimicrobial trilogy strategy incorporating a sophisticated multilayered coating system leveraging multiple ion exchange mechanisms and fine nanotopography tuning, could effectively eradicate bacterial infection at various stages of implantation. Early stage bacteriostatic effect was realized via nano-topological structure of top mineral coating. Antibacterial effect at intermediate stage was mediated by sustained release of zinc ions from doped CaP coating. Strong antibacterial potency was validated at 4 weeks post implantation via an implanted model in vivo. Finally, the underlying zinc titanate fiber network enabled a long-term contact and release effect of residual zinc, which maintained a strong antibacterial ability against both Staphylococcus aureus and Escherichia coli even after the removal of top layer coating. Moreover, sustained release of Sr2+ and Zn2+ during CaP coating degradation substantially promoted implant osseointegration even under an infectious environment by showing more peri-implant new bone formation and substantially improved bone-implant bonding strength.

TiO2 bioactive implant surfaces doped with specific amount of Sr modulate mineralization

One of the main problems that remain in the implant industry is poor osseointegration due to bioinertness of implants. In order to promote bioactivity, calcium (Ca), phosphorus (P) and strontium (Sr) were incorporated into a TiO₂ porous layer produced by micro-arc oxidation. Ca and P as bioactive elements are already well reported in the literature, however, the knowledge of the effect of Sr is still limited. In the present work, the effect of various amounts of Sr was evaluated and the morphology, chemical composition and crystal structure of the oxide layer were investigated. Furthermore, in vitro studies were carried out using human osteoblast-like cells. The oxide layer formed showed a triplex structure, where higher incorporation of Sr increased Ca/P ratio, amount of rutile and promoted the formation of SrTiO₃ compound. Biological tests revealed that lower concentrations of Sr did not compromise initial cell adhesion neither viability and interestingly improved mineralization. However, higher concentration of Sr (and consequent higher amount of rutile) showed to induce collagen secretion but with compromised mineralization, possibly due to a delayed mineralization process or induced precipitation of deficient hydroxyapatite. Ca-P-TiO₂ porous layer with less concentration of Sr seems to be an ideal candidate for bone implants.

The Use of Simulated Body Fluid (SBF) for Assessing Materials Bioactivity in the Context of Tissue Engineering: Review and Challenges

Some special implantable materials are defined as “bioactive” if they can bond to living bone, forming a tight and chemically-stable interface. This property, which is inherent to some glass compositions, or can be induced by applying appropriate surface treatments on otherwise bio-inert metals, can be evaluated in vitro by immersion studies in simulated body fluid (SBF), mimicking the composition of human plasma. As a result, apatite coating may form on the material surface, and the presence of this bone-like “biomimetic skin” is considered predictive of bone-bonding ability in vivo. This review article summarizes the story and evolution of in vitro bioactivity testing methods using SBF, highlighting the influence of testing parameters (e.g., formulation and circulation of the solution) and material-related parameters (e.g., composition, geometry, texture). Suggestions for future methodological refinements are also provided at the end of the paper.

Preparation of CaO@TiO2-SiO2 Biomaterial with a Sol-Gel Method for Bone Implantation

The calcium phosphate spherical material with a hierarchical structure has been used as a bone implantation material. To improve the properties of the implant material, the compositions of calcium phosphate, silicon, and titanium are crucial. The presence of silicon on the surface of the phosphate-calcium material accelerates the bonding of the implant with the bone (osseointegration). The aim of this work was to develop a sol-gel method to prepare spherical calcium-phosphate@TiO2-SiO2 biomaterials for bone implantation. The CaO@TiO2-SiO2 biomaterial with a core-shell structure was synthesized by the sol-gel method. The biological properties of the materials were studied with a simulated body fluid (SBF). The sample had a spherical shape. The sample exhibited bioactive properties because an increase in the content of calcium and phosphorus ions in the shell and the presence of precipitated ions from the solution were detected on the surface. The TiO2-SiO2 framework was uniformly fixed on the CaO core. Heat treatment of the hybrid mesostructure led to the formation of mesoporous materials with a specific regular structure in the nanometer size in the shell, which is necessary for the fixation of biological cells when the sample is introduced into the biological medium. The formation of a calcium-phosphate layer on the materials and the release of soluble silicon and calcium ions into the SBF are the key factors for the rapid connection of these materials with tissue. The results demonstrate that the CaO@TiO2-SiO2 biomaterial with a core-shell structure is a good candidate for bone implantation.

In vitro study of antibacterial and osteogenic activity of titanium metal releasing strontium and silver ions

Peri-prosthetic infection and loosening of implants are major problems in orthopaedic and dental surgery. To address these issues, surface treatment methods for titanium implants have been improved by modifying the alkali and heat treatment. We have previously fabricated calcium-treated Ti metal that releases Sr ions (CaSr-Ti), which resulted in a higher in vitro osteogenic response and early in vivo bone bonding.Further, we developed a Ti metal that released both Sr and Ag ions (CaSrAg-Ti). In this study, we evaluated the antibacterial ability and osteogenic cellular response of CaSrAg-Ti and CaSr-Ti in vitro using rat bone marrow stromal cells (BMSCs) cultured on implant samples and extract mediums (EMs) made by immersing the implant samples in the medium. CaSrAg-Ti did not show cytotoxicity and was associated with a slightly higher osteogenic response when compared to CaSr-Ti, without inhibiting the effect of Sr. The osteogenic response was also observed in the cells cultured with the CaSrAg-Ti EM; however, the response was not as high as that of the cells on the CaSrAg-Ti implant sample. Significantly higher antibacterial activity was observed along with an antibacterial efficacy of more than 95% against methicillin-susceptible Staphylococcus aureus and Escherichia coli. The main advantages of our surface treatment are its simplicity and low cost. Therefore, our treatment is promising for clinical applications in orthopaedic or dental Ti-based implants with antibacterial and early bone-bonding abilities.

Bioactivity and antibacterial activity of strontium and silver ion releasing titanium

To overcome problems associated with loosening of orthopedic implants and surgical site infections, we developed a novel, titanium (Ti)-based material that releases both strontium and silver ions (CaSrAg-Ti) based on alkali-and-heat treatment. The results of commercially pure Ti (cp-Ti), Ti that releases Sr ions only (CaSr-Ti), and the novel CaSrAg-Ti material were compared. Mechanical tests were performed to evaluate the in vivo bonding properties of CaSrAg-Ti and the bone-implant contact (BIC) ratio in histological specimens was determined at 4 and 8 weeks after implantation in a rat femur. Also, the in vitro antibacterial activities of this material against methicillin-susceptible Staphylococcus aureus (MSSA) were evaluated after a 24 h incubation period by assaying colony-forming units. In addition, antibacterial activities were evaluated in vivo at 7 days after implantation in a rat subcutaneous pocket model. There was direct contact between the bone and CaSrAg-Ti in histological specimens and no apparent signs of argyrosis in any rat. The bone-bonding strength and the BIC ratio were increased by 2.7- and 2.3-fold for CaSrAg-Ti vs. cp-Ti at 4 weeks and 2.2- and 2.0-fold at 8 weeks, respectively. As compared with cp-Ti, the number of viable MSSA remaining on CaSrAg-Ti was reduced by 100 ± 0% in vitro and 94.2 ± 6.9% in vivo. Ti that releases Sr and Ag ions is a promising material that exhibits both bone-bonding properties and anti-MSSA activities.

Bioactive effects of strontium loading on micro/nano surface Ti6Al4V components fabricated by selective laser melting

Selective laser melting (SLM) titanium alloys require surface modification to achieve early bone-bonding. This study investigated the effects of solution and heat treatment to induce the sustained release of strontium (Sr) ions from SLM Ti6Al4V implants (Sr-S64). The results were compared with a control group comprising an untreated surface [SLM pure titanium (STi) and SLM Ti6Al4V (S64)] and a treated surface to induce the release of calcium (Ca) ions from SLM Ti6Al4V (Ca-S64). The surface-treated materials showed homogenous nanoscale network formation on the original micro-topographical surface and formed bone-like apatite on the surface in a simulated body fluid within 3 days. In vitro evaluation using MC3T3-E1 cells showed that the cells were viable on Sr-S64 surface, and Sr-S64 enhanced cell adhesion-related and osteogenic differentiation-related genes expression. In vivo rabbit tibia model, Sr-S64 provided significantly greater bone-bonding strength and bone-implant contact area than those in controls (STi and S64) in the early phase (2-4 weeks) after implantation; however, there was no statistical difference between Ca-S64 and controls. In conclusion, Sr solution and heat treatment was a safe and effective method to enhance early bone-bonding ability of S-64 by improving the surface characteristics and sustained delivery for Sr.

Nanotopography on titanium promotes osteogenesis via autophagy-mediated signaling between YAP and β-catenin

Nanostructured titanium implants are recognized for inducing osteogenesis, but the cell signal transductions related to topography are not fully understood. Implant topography is associated with the functionality of osteogenic transcription factors directed by β-catenin in the nucleus, and autophagic flux in the cytoplasm; YAP (Yes-associated protein) is implicated in the destruction of β-catenin in the cytoplasm and is susceptible to autophagic flux. This study investigated whether surface topography of the titanium implant modulates autophagy-lysosome degradation of cytoplasmic YAP. Titanium surfaces were modified with smooth, micro, or nanotopographies. Compared with the smooth and micro surfaces, nanotopography was associated with higher β-catenin nuclear translocation, osteogenic differentiation, and autophagy, and less cytoplasmic YAP. Blockade of the autophagy-lysosome pathway resulted in YAP retention in MC3T3-E1 cells. Cytoplasmic YAP restricted β-catenin nuclear translocation. In the nano surface group, β-catenin accumulation in the nucleus and expression of osteogenesis genes was improved. However, in the absence of cell-cell (confluent) contact, manipulation of YAP and β-catenin localization associated with topography-induced autophagy was lost. In summary, the osteogenesis observed in response to titanium implants with nanotopography involves a signaling link between YAP and β-catenin. STATEMENT OF SIGNIFICANCE: Titanium with rough topographical surfaces is extensively applied in orthopedic and dental clinics. However, the cellular response to topographies that promotes osteogenesis and underlying mechanisms are not fully understood. In this study, we modified titanium surfaces to produce smooth, micro, or nano topographies. Experiments indicated that the nanotopography induced a stronger autophagic response, leading to degraded cytoplasmic YAP. With the lower levels of YAP, β-catenin transported and accumulated in the nucleus to activate TCF/LEF transcription factors, resulting in stronger osteogenesis. Additionally, cell-cell contact was essential in the autophagy-mediated signaling link between YAP and β-catenin. Consequently, our investigation revealed a novel signal transduction in nanotopography-regulated osteogenesis, and supports the modification of biomaterial surfaces to maximize osseointegration.

Tri-Functional Calcium-Deficient Calcium Titanate Coating on Titanium Metal by Chemical and Heat Treatment

The main problem of orthopedic and dental titanium (Ti) implants has been poor bone-bonding to the metal. Various coatings to improve the bone-bonding, including the hydroxyapatite and titania, have been developed, and some of them have been to successfully applied clinical use. On the other hand, there are still challenges to provide antibacterial activity and promotion of bone growth on Ti. It was shown that a calcium-deficient calcium titanate coating on Ti and its alloys exhibits high bone-bonding owing to its apatite formation. In this study, Sr and Ag ions, known for their promotion of bone growth and antibacterial activity, were introduced into the calcium-deficient calcium titanate by a three-step aqueous solution treatment combined with heat. The treated metal formed apatite within 3 days in a simulated body fluid and exhibited antibacterial activity to Escherichia coli without showing any cytotoxicity in MC3T3-E1 preosteoblast cells. Furthermore, the metal slowly released 1.29 ppm of Sr ions. The Ti with calcium-deficient calcium titanate doped with Sr and Ag will be useful for orthopedic and dental implants, since it should bond to bone because of its apatite formation, promote bone growth due to Sr ion release, and prevent infection owing to its antibacterial activity.

Nanomagnetite-embedded PLGA Spheres for Multipurpose Medical Applications

We report on the synthesis and evaluation of biopolymeric spheres of poly(lactide-co-glycolide) containing different amounts of magnetite nanoparticles and Ibuprofen (PLGA-Fe₃O₄-IBUP), but also chitosan (PLGA-CS-Fe₃O₄-IBUP), to be considered as drug delivery systems. Besides morphological, structural, and compositional characterizations, the PLGA-Fe₃O₄-IBUP composite microspheres were subjected to drug release studies, performed both under biomimetically-simulated dynamic conditions and under external radiofrequency magnetic fields. The experimental data resulted by performing the drug release studies evidenced that PLGA-Fe₃O₄-IBUP microspheres with the lowest contents of Fe₃O₄ nanoparticles are optimal candidates for triggered drug release under external stimulation related to hyperthermia effect. The as-selected microspheres and their chitosan-containing counterparts were biologically assessed on macrophage cultures, being evaluated as biocompatible and bioactive materials that are able to promote cellular adhesion and proliferation. The composite biopolymeric spheres resulted in inhibited microbial growth and biofilm formation, as assessed against Staphylococcus aureus, Pseudomonas aeruginosa, and Candida albicans microbial strains. Significantly improved antimicrobial effects were reported in the case of chitosan-containing biomaterials, regardless of the microorganisms' type. The nanostructured composite biopolymeric spheres evidenced proper characteristics as prolonged and controlled drug release platforms for multipurpose biomedical applications.

Enhanced osteoconductivity on electrically charged titanium implants treated by physicochemical surface modifications methods

Biomimetic design is a key tenet of orthopedic device technology, and in particular the development of responsive surfaces that promote ion exchange with interfacing tissues, facilitating the ionic events that occur naturally during bone repair, hold promise in orthopedic fixation strategies. Non-bioactive nanostructured titanium implants treated by shot-blasting and acid-etching (AE) induced higher bone implant contact (BIC=52% and 65%) compared to shot-blasted treated (SB) implants (BIC=46% and 47%) at weeks 4 and 8, respectively. However, bioactive charged implants produced by plasma (PL) or thermochemical (BIO) processes exhibited enhanced osteoconductivity through specific ionic surface-tissue exchange (PL, BIC= 69% and 77% and BIO, BIC= 85% and 87% at weeks 4 and 8 respectively). Furthermore, bioactive surfaces (PL and BIO) showed functional mechanical stability (resonance frequency analyses) as early as 4 weeks post implantation via increased total bone area (BAT=56% and 59%) ingrowth compared to SB (BAT=35%) and AE (BAT=35%) surfaces.

Simulated body fluid and the novel bioactive materials derived from it

Professor Larry Hench first reported that certain glasses are able to spontaneously bond to living bone in 1970. This discovery stimulated research into new kinds of bone-bonding materials. However, there were no guiding principles for this purpose, and many animals were sacrificed in the effort to establish them. The present authors proposed in 1991 that the bone-bonding capacity of a material could be evaluated by examining apatite formation on its surface in an acellular simulated body fluid (SBF), without the need of performing any animal experiments. Various kinds of novel bone-bonding bioactive materials based on Ti metal and its alloys with a number of different functions have been developed using SBF. Some of these have entered clinical use as important bone-repairing materials. Without the method of SBF evaluation, these novel materials would not have been developed. © 2019 Wiley Periodicals, Inc. J Biomed Mater Res Part A: 107A: 968-977, 2019.

Ca-Ag coexisting nano-structured titania layer on Ti metal surface with enhanced bioactivity, antibacterial and cell compatibility

A nano-structured titanate layer encapsulated with Ca²⁺ and Ag⁺ ions was successfully grown over commercially pure (CP) Ti metal by chemical treatment with H₂O₂ and subsequent treatment with Ca (NO₃)₂/AgNO₃ solutions. Heat treatment at 600 °C, further transformed this nano-structured titanate layer into titania containing Ca²⁺ and Ag⁺ ions. Thus modified Ti metal showed significant enhancement in apatite-forming ability when soaked in simulated body fluid (SBF). Presence of Ag⁺ ions showed good antimicrobial activity against pathogenic Staphylococcus aureus, and, Ca²⁺ ions being a major component of bone mineral accelerated the apatite-forming ability over Ti metal in SBF. Further, Ca²⁺and Ag⁺ ions proportion over Ti metal surface could be optimised in order to have minimum Ag concentration that can have not only antibacterial activity and also cell compatibility against MG 63 osteoblast-like cells. Therefore, the proposed surface modification approach presented here is expected to be useful in orthopaedic implants that necessitate enhanced bioactivity, antibacterial activity and cell compatibility.

Strontium/adiponectin co-decoration modulates the osteogenic activity of nano-morphologic polyetheretherketone implant

Polyetheretherketone (PEEK)-based implants have become popular in hard tissue orthopedic and dental field. However, its inherent bio-inertness limited its applications for bone repair/substitution of osteoporosis patients, with poor osteogenesis capability. In order to ameliorate their bioactivity, the 3D porous PEEK substrate was created by sulfonate processing, and the substrate was subsequently incorporated with strontium (Sr) through a hydrothermal reaction in Sr(OH)₂ solutions. The adiponectin (APN) protein membrane was deposited on the substrate via polydopamine-assisted deposition. Surface characterization results disclosed that the nanostructures had been formed on sPEEK-Sr-APN surafces, and APN coatings on the substrates could adjust Sr release rate and further mediate cell-material interactions. in vitro experiments indicated that the cellular effects (proliferation and differentiation) of MC3T3-E1 were significantly increased with Sr/APN coordinated regulation. This study provides bioactive Sr and APN as promising active components for bio-functional bone regeneration/substitution, and optimizes the osteointegration of PEEK implants in clinic.

A critical review of multifunctional titanium surfaces: New frontiers for improving osseointegration and host response, avoiding bacteria contamination

Evolution of metal implants progressively shifted the focus from adequate mechanical strength to improved biocompatibility and absence of toxicity and, finally, to fast osseointegration. Recently, new frontiers and challenges of Ti implants have been addressed to improvement of bioactivity, fighting of bacterial infection and biofilm formation, as well as modulation of inflammation. This is closely related to the clinical demand of multifunctional implants able to simultaneously have a number of specific responses with respect to body fluids, cells (osteoblasts, fibroblasts, macrophages) and pathogenic agents (bacteria, viruses). This complex system of multiple biological stimuli and surface responses is a major arena of the current research on biomaterials and biosurfaces. This review covers the strategies explored to this purpose since 2010 in the case of Ti and Ti alloys, considering that the number of related papers doubled about in the last seven years and no review has comprehensively covered this engaging research area yet. The different approaches followed for producing multifunctional Ti-based surfaces involve the use of thick and thin inorganic coatings, chemical surface treatments, and functionalization strategies coupled with organic coatings.

STATEMENT OF SIGNIFICANCE

According to the clinical demand of multifunctional implants able to simultaneously have a number of specific responses with respect to body fluids, cells and pathogenic agents, new frontiers of Ti implants have been addressed to improvement of bioactivity, fighting of bacterial infection and biofilm formation, as well as modulation of inflammation. Literature since 2010 is here reviewed. Several strategies for getting bioactive and antibacterial actions on Ti surfaces have been suggested, but they still need to be optimized with respect to several concerns. A further step will be to combine on the same surface a proven ability of modulation of inflammatory response. The achievement of multifunctional surfaces able to modulate inflammation and to promote osteogenesis is a grand challenge.

Strontium and magnesium ions released from bioactive titanium metal promote early bone bonding in a rabbit implant model

We have previously developed the "alkali and heat treatment" method to confer bioactivity (bone-bonding ability) to titanium metal (Ti). As strontium (Sr) and magnesium (Mg) ions reportedly promote osteoblastic cell proliferation and differentiation and accelerate bone formation, we improved this method to induce the release of Sr (Sr-Ti) or Mg (Mg-Ti) ions from Ti in a previous study. Here, we evaluated the bioactivity of these novel surface treatments, Sr-Ti and Mg-Ti. In vitro evaluation of cell viability, expression of integrin β1, β catenin, and cyclin D1, osteogenic gene expression, alkaline phosphatase activity, and extracellular mineralization using MC3T3-E1 cells revealed that Sr-Ti and Mg-Ti enhanced proliferation and osteogenic differentiation. In rabbit in vivo studies, Sr-Ti and Mg-Ti also provided greater biomechanical strength and bone-implant contact than the positive control Ti (Ca-Ti), especially at the early stage (4-8weeks), and maintained these properties for a longer period (16-24weeks). Advantages of the improved method include process simplicity, applicability for any implant shape, and lack of adverse effects on implant composition and structure. Therefore, our treatment is promising for clinical applications to achieve early bone bonding.

STATEMENT OF SIGNIFICANCE

Implantation into osteoporotic bone constitutes a challenging problem because of early migration or loosening of the implant, which is primarily due to insufficient initial fixation in porotic bone. Therefore, it is desirable to provide implants with a capacity for early bone bonding. We have achieved conferring early bone bonding ability to titanium metal by releasing strontium ions or magnesium ions. Our treatment is promising for clinical applications to achieve early bone bonding of orthopedic or dental Ti-based implants.

Intracellular co-delivery of Sr ion and phenamil drug through mesoporous bioglass nanocarriers synergizes BMP signaling and tissue mineralization

Inducing differentiation and maturation of resident multipotent stem cells (MSCs) is an important strategy to regenerate hard tissues in mal-calcification conditions. Here we explore a co-delivery approach of therapeutic molecules comprised of ion and drug through a mesoporous bioglass nanoparticle (MBN) for this purpose. Recently, MBN has offered unique potential as a nanocarrier for hard tissues, in terms of high mesoporosity, bone bioactivity (and possibly degradability), tunable delivery of biomolecules, and ionic modification. Herein Sr ion is structurally doped to MBN while drug Phenamil is externally loaded as a small molecule activator of BMP signaling, for the stimulation of osteo/odontogenesis and mineralization of human MSCs derived from dental pulp. The Sr-doped MBN (85Si:10Ca:5Sr) sol-gel processed presents a high mesoporosity with a pore size of ∼6nm. In particular, Sr ion is released slowly at a daily rate of ∼3ppm per mg nanoparticles for up to 7days, a level therapeutically effective for cellular stimulation. The Sr-MBN is internalized to most MSCs via an ATP dependent macropinocytosis within hours, increasing the intracellular levels of Sr, Ca and Si ions. Phenamil is loaded maximally ∼30% into Sr-MBN and then released slowly for up to 7days. The co-delivered molecules (Sr ion and Phenamil drug) have profound effects on the differentiation and maturation of cells, i.e., significantly enhancing expression of osteo/odontogenic genes, alkaline phosphatase activity, and mineralization of cells. Of note, the stimulation is a result of a synergism of Sr and Phenamil, through a Trb3-dependent BMP signaling pathway. This biological synergism is further evidenced in vivo in a mal-calcification condition involving an extracted tooth implantation in dorsal subcutaneous tissues of rats. Six weeks post operation evidences the osseous-dentinal hard tissue formation, which is significantly stimulated by the Sr/Phenamil delivery, based on histomorphometric and micro-computed tomographic analyses. The bioactive nanoparticles releasing both Sr ion and Phenamil drug are considered to be a promising therapeutic nanocarrier platform for hard tissue regeneration. Furthermore, this novel ion/drug co-delivery concept through nanoparticles can be extensively used for other tissues that require different therapeutic treatment.

STATEMENT OF SIGNIFICANCE

This study reports a novel design concept in inorganic nanoparticle delivery system for hard tissues - the co-delivery of therapeutic molecules comprised of ion (Sr) and drug (Phenamil) through a unique nanoparticle of mesoporous bioactive glass (MBN). The physico-chemical and biological properties of MBN enabled an effective loading of both therapeutic molecules and a subsequently sustained/controlled release. The co-delivered Sr and Phenamil demonstrated significant stimulation of adult stem cell differentiation in vitro and osseous/dentinal regeneration in vivo, through BMP signaling pathways. We consider the current combination of Sr ion with Phenamil is suited for the osteo/odontogenesis of stem cells for hard tissue regeneration, and further, this ion/drug co-delivery concept can extend the applications to other areas that require specific cellular and tissue functions.

Two-in-One Biointerfaces-Antimicrobial and Bioactive Nanoporous Gallium Titanate Layers for Titanium Implants

The inhibitory effect of gallium (Ga) ions on bone resorption and their superior microbial activity are attractive and sought-after features for the vast majority of implantable devices, in particular for implants used for hard tissue. In our work, for the first time, Ga ions were successfully incorporated into the surface of titanium metal (Ti) by simple and cost-effective chemical and heat treatments. Ti samples were initially treated in NaOH solution to produce a nanostructured sodium hydrogen titanate layer approximately 1 μm thick. When the metal was subsequently soaked in a mixed solution of CaCl₂ and GaCl₃, its Na ions were replaced with Ca and Ga ions in a Ga/Ca ratio range of 0.09 to 2.33. 8.0% of the Ga ions were incorporated into the metal surface when the metal was soaked in a single solution of GaCl₃ after the NaOH treatment. The metal was then heat-treated at 600 °C to form Ga-containing calcium titanate (Ga–CT) or gallium titanate (GT), anatase and rutile on its surface. The metal with Ga–CT formed bone-like apatite in a simulated body fluid (SBF) within 3 days, but released only 0.23 ppm of the Ga ions in a phosphate-buffered saline (PBS) over a period of 14 days. In contrast, Ti with GT did not form apatite in SBF, but released 2.96 ppm of Ga ions in PBS. Subsequent soaking in hot water at 80 °C dramatically enhanced apatite formation of the metal by increasing the release of Ga ions up to 3.75 ppm. The treated metal exhibited very high antibacterial activity against multidrug resistant Acinetobacter baumannii (MRAB12). Unlike other antimicrobial coating on titanium implants, Ga–CT and GT interfaces were shown to have a unique combination of antimicrobial and bioactive properties. Such dual activity is essential for the next generation of orthopaedic and dental implants. The goal of combining both functions without inducing cytotoxicity is a major advance and has far reaching translational perspectives. This unique dual-function biointerfaces will inhibit bone resorption and show antimicrobial activity through the release of Ga ions, while tight bonding to the bone will be achieved through the apatite formed on the surface.

Strontium folic acid derivative functionalized titanium surfaces for enhanced osteogenic differentiation of mesenchymal stem cells in vitro and bone formation in vivo

The introduction of the bioactive strontium (Sr) element has become an attractive method in the design of bio-functional layers on titanium surfaces. However, there are still no effective solutions to some of the associated problems including the toxicity of free Sr²⁺ ions and the rapid and irreversible loss of the strontium element from the bio-functional layers. In this study, we successfully fabricated a bioactive layer on Ti substrates with a strontium folic acid derivative (FASr). About 3.11 at% Sr was incorporated into the Ti surface. The characterization results showed that FASr was stable over a long period of time and minimal free Sr²⁺ ions were detected in simulated body fluid (SBF). In the in vitro experiment, the FASr could significantly promote the cell adhesion, proliferation and osteogenic differentiation of mesenchymal stem cells (MSCs) over a short period. Furthermore, it could dramatically accelerate the bone formation around the implant. In vivo, a total of 30 7-week old male Sprague Dawley (SD) rats were applied for implantation tests. The results showed that this positive stimulatory effect became more evident in the later stages of the in vivo observation. This study provides an effective strategy for designing and optimizing Ti-based implants.

Biocompatible β-SrHPO4 clusters with dandelion-like structure as an alternative drug carrier

Recent researches about calcium phosphate (CaP) biomaterials used as drug delivery systems are focusing on the better understanding of the microenvironment around the implant-host tissue interface, with the aim to provide a bone response in pathological ones. Towards the improvement of the osteogenic potential of CaP drug carriers, dandelion-like β-SrHPO₄ clusters (Φ10-20μm) has been prepared by a homogeneous precipitation method under the hydrolysis of carbamide. Adhesion, spreading, proliferation, osteogenic differentiation and mRNA expression of bone mesenchymal stem cells (BMSCs) mediated by β-SrHPO₄ clusters were investigated. Highly osteoconductive and biodegradable octacalcium phosphate with similar structure was employed as the control. By contrast, β-SrHPO₄ clusters exhibited remarkably better affinity, enhanced proliferation and osteogenic differentiation of BMSCs, providing a promising alternative bioactive bone substitute and drug carrier for tissue repair. With the unique dandelion-like microstructure, we believe that our as-prepared material will open up new avenues for applicability of CaP drug delivery systems in the near future.

Controlled release of strontium through neutralization reaction within a methoxy(polyethylene glycol)-polyester hydrogel

BACKGROUND

The aim of this study was to develop a minimally invasive hydrogel system that can release strontium ions, an element that has been shown to increase osteoblast proliferation and prohibit bone resorption, in a controlled manner.

METHODS

SrCO3 was selected as the salt of choice due to potential acid neutralization reaction between SrCO3 and degradation by-products of methoxy(polyethylene glycol)-co-poly(lactic-co-glycolic acid) (mPEG-PLGA): namely, lactic acid and glycolic acid. SrCO3 was incorporated into mPEG-PLGA hydrogel, and the system was assessed for gelation properties, drug release and biocompatibility.

RESULTS

SrCO3 incorporation at hydrogel to SrCO3 ratios of 5:1, 3:1 and 1:1 (wt%) did not compromise the thermosensitivity of mPEG-PLGA hydrogels. Furthermore, incorporation of SrCO3 at 1:1 ratio prevented copolymer self-catalysis and decreased hydrogel weight loss from 85% to 61% in vitro after 30 days. During the 30-day time frame, zero-order strontium release was observed and was correlated to hydrogel degradation and acidity. The addition of SrCO3 also improved in vivo hydrogel biocompatibility, due to moderation of acidic microenvironment and amelioration of inflammatory response.

CONCLUSIONS

These results showed that the described system is suitable for the extended release of strontium and exhibits potential for localized treatment for osteoporosis or as a bone void filler.

Osteogenic activity and angiogenesis of a SrTiO3 nano-gridding structure on titanium surface

Dual effect of alveolate double-layered SrTiO₃ nano-gridding based on Ti substrate: osteogenic activity and angiogenesis.

Novel bioactive materials developed by simulated body fluid evaluation: Surface-modified Ti metal and its alloys

Until the discovery of the bone-bonding activity of Bioglass by Hench et al. in the early 1970s, it had not been demonstrated that a synthetic material could bond to living bone without eliciting a foreign body reaction. Since then, various kinds of materials based on calcium phosphate, such as sintered hydroxyapatite and β-tricalcium phosphate have also been shown to bond to living bone. Until the discovery of the bone-bonding activity of Ti metal formed with a sodium titanate surface layer by the present authors in 1996, it had not been shown that a metallic material could bond to living bone. Since then, various kinds of surface-modified Ti metal and its alloys have been found to bond to living bone. Until the discovery of the osteoinduction of porous hydroxyapatite by Yamasaki in 1990, it was unknown whether a synthetic material could induce bone formation even in muscle tissue. Since then, various kinds of porous calcium phosphate ceramics have been shown to induce osteoinduction. Until the discovery of osteoinduction induced by a porous Ti metal formed with a titanium oxide surface layer by Fujibayashi et al. in 2004, it had been unclear whether porous metals would be able to induce osteoinduction. These novel bioactive materials have been developed by systematic research into the apatite formation that occurs on surface-modified Ti metal and its related materials in an acellular simulated body fluid (SBF) having ion concentrations almost equal to those of human blood plasma. Some of the novel bioactive materials based on Ti metal are already in clinical use or clinical trials, such as artificial hip joints and spinal fusion devices. In the present paper, we review how these novel bioactive materials based on Ti metal have been developed based on an evaluation of apatite formation in SBF. Without the SBF evaluation, these novel bioactive materials would most likely never have been developed.

STATEMENT OF SIGNIFICANCE

On the basis of systematic study of apatite formation on a material in a simulated body fluid, various kinds of novel bioactive materials possessing not only bone-bonding activity and but also various other functions such as bone growth promotion, antibacterial activity and osteoinduction have been developed. Some of them are already successfully applied to clinical applications or trials for artificial hip joints and spinal fusion devices. It is shown in the present paper how these novel bioactive materials have been developed.

Nanosheet-pore topographical titanium substrates: a biophysical regulator of the fate of mesenchymal stem cells

Sub-micrometer nanosheet-pore topographic titanium substrates are fabricated with a distinct effect on the adhesion and osteogenic differentiation of MSCs in vitro.

Influence of strontium ions incorporated into nanosheet-pore topographical titanium substrates on osteogenic differentiation of mesenchymal stem cells in vitro and on osseointegration in vivo

Strontium ions incorporation and nanosheet-pore topography of titanium substrates synergistically improve the osteogensis of MSCs and osseointegration in vivo.

A Strontium-Modified Titanium Surface Produced by a New Method and Its Biocompatibility In Vitro

OBJECTIVE

To present a new and effective method of producing titanium surfaces modified with strontium and to investigate the surface characteristics and in vitro biocompatibility of titanium (Ti) surfaces modified with strontium (Sr) for bone implant applications.

MATERIALS AND METHODS

Sr-modified Ti surfaces were produced by sequential treatments with NaOH, strontium acetate, heat and water. The surface characteristics and the concentration of the Sr ions released from the samples were examined. Cell adhesion, morphology and growth were investigated using osteoblasts isolated from the calvaria of neonatal Sprague-Dawley rats. Expression of osteogenesis-related genes and proteins was examined to assess the effect of the Sr-modified Ti surfaces on osteoblasts.

RESULTS

The modified titanium surface had a mesh structure with significantly greater porosity, and approximately5.37±0.35at.% of Sr was incorporated into the surface. The hydrophilicity was enhanced by the incorporation of Sr ions and water treatment. The average amounts of Sr released from the Sr-modified plates subjected to water treatment were slight higher than the plates without water treatment. Sr promoted cellular adhesion, spreading and growth compared with untreated Ti surfaces. The Sr-modified Ti plates also promoted expression of osteogenesis-related genes,and expression of OPN and COL-І by osteoblasts. Ti plates heat treated at 700°C showed increased bioactivity in comparison with those treated at 600°C. Water treatment upregulated the expression of osteogenesis-related genes.

CONCLUSIONS

These results show that Sr-modification of Ti surfaces may improve bioactivity in vitro. Water treatment has enhanced the response of osteoblasts. The Sr-modified Ti heat-treated at 700°C exhibited better bioactivity compared with that heated at 600°C.

Growth of Novel Ceramic Layers on Metals via Chemical and Heat Treatments for Inducing Various Biological Functions

The present authors' systematic studies on growth of novel ceramic layers on Ti metal and its alloys by chemical and heat treatments for inducing bone-bonding bioactivity and some other biological functions are reviewed. Ti metal formed an apatite on its surface in a simulated body fluid, when heat-treated after exposure to strong acid solutions to form rutile surface layer, or to strong alkali solutions to form sodium titanate surface layer. Both types of Ti metal tightly bonded to the living bone. The alkali and heat treatment was applied to the surface Ti metal of an artificial hip joint and successfully used in the clinic since 2007. The acid and heat treatments was applied to porous Ti metal to induce osteoconductivity as well as osteoinductivity. The resulting product was successfully used in clinical trials for spinal fusion devices. For the Ti-based alloys, the alkali and heat treatment was little modified to form calcium titanate surface layer. Bone-growth promoting Mg, Sr, and Zn ions as well as the antibacterial Ag ion were successfully incorporated into the calcium titanate layer.

Nanostructured Ti6Al4V alloy fabricated using modified alkali-heat treatment: Characterization and cell adhesion

In order to optimize the creation of a nanostructured surface on Ti6Al4V titanium alloy, an alkali treatment was performed using a 10-M NaOH solution at various temperatures (30, 40, 50, and 60°C) so as to determine the optimal temperature. This was combined with subsequent heat treatments (200, 400, 600, and 800°C) in air. The effects of different temperatures for the latter treatments on the nanostructure surface and the initial cell adhesion were evaluated, and the optimal temperature of the alkali solution was found to be 30°C. Further, the nanotopography, surface chemistry, and surface roughness of the nanoporous structure were retained after heat treatments performed at 200, 400, and 600°C, and only the phase structure was altered. The amorphous sodium titanate phase, the content of which increased with increased heat-treatment temperature, may have played a role in promoting cell adhesion on the nanoporous surface. However, heat treatment at 800°C did not enhance the cell-surface attachment. Rather, the nanostructure degraded significantly with the reappearance of Al and V.

The in vitro and in vivo performance of a strontium-containing coating on the low-modulus Ti35Nb2Ta3Zr alloy formed by micro-arc oxidation

The β-titanium alloy is thought to be a promising alloy using as orthopedic or dental implants owing to its characteristics, which contains low elastic modulus, high corrosion resistance and well biocompatibility. Our previous study has reported that a new β-titanium alloy Ti35Nb2Ta3Zr showed low modulus close to human bone, equal tissue compatibility to a traditional implant alloy Ti6Al4V. In this study, micro-arc oxidation (MAO) was applied on the Ti35Nb2Ta3Zr alloy to enhance its surface characteristics and biocompatibility and osseointegration ability. Two different coatings were formed, TiO2 doped with calcium-phosphate coating (Ca-P) and calcium-phosphate-strontium coating (Ca-P-Sr). Then we evaluated the effects of the MAO coatings on the Ti35Nb2Ta3Zr alloy through in vitro and in vivo tests. As to the characteristics of the coatings, the morphology, chemical composition, surface roughness and contact angle of MAO coatings were tested by scanning electron microscopy, energy dispersive spectroscopy, atomic force microscopy, and video contact-angle measurement system respectively. Besides, we performed MTT assay, ALP test and cell morphology-adhesion test on materials to evaluate the MAOed coating materials' biocompatibility in vitro. The in vivo experiment was performed through rabbit model. Alloys were implanted into rabbits' femur shafts, then we performed micro-CT, histological and sequential fluorescent labeling analysis to evaluate implants' osseointegration ability in vivo. Finally, the Ca-P specimens and Ca-P-Sr specimens exhibited a significant enhancement in surface roughness, hydrophilicity, cell proliferation, cell adhesion. More new bone was found around the Ca-P-Sr coated alloy than Ca-P coated alloy and Ti35Nb2Ta3Zr alloy. In conclusion, the MAO treatment improved in vitro and in vivo performance of Ti35Nb2Ta3Zr alloy. The Ca-P-Sr coating may be a promising modified surface formed by MAO for the novel β-titanium alloy Ti35Nb2Ta3Zr.

Bioactive titanate layers formed on titanium and its alloys by simple chemical and heat treatments

To reveal general principles for obtaining bone-bonding bioactive metallic titanium, Ti metal was heat-treated after exposure to a solution with different pH. The material formed an apatite layer at its surface in simulated body fluid when heat-treated after exposure to a strong acid or alkali solution, because it formed a positively charged titanium oxide and negatively charged sodium titanate film on its surface, respectively. Such treated these Ti metals tightly bonded to living bone. Porous Ti metal heat-treated after exposure to an acidic solution exhibited not only osteoconductive, but also osteoinductive behavior. Porous Ti metal exposed to an alkaline solution also exhibits osteoconductivity as well as osteoinductivity, if it was subsequently subjected to acid and heat treatments. These acid and heat treatments were not effective for most Ti-based alloys. However, even those alloys exhibited apatite formation when they were subjected to acid and heat treatment after a NaOH treatment, since the alloying elements were removed from the surface by the latter. The NaOH and heat treatments were also not effective for Ti-Zr-Nb-Ta alloys. These alloys displayed apatite formation when subjected to CaCl₂ treatment after NaOH treatment, forming Ca-deficient calcium titanate at their surfaces after subsequent heat and hot water treatments. The bioactive Ti metal subjected to NaOH and heat treatments has been clinically used as an artificial hip joint material in Japan since 2007. A porous Ti metal subjected to NaOH, HCl and heat treatments has successfully undergone clinical trials as a spinal fusion device.