Increased bone remodelling around titanium implants coated with chondroitin sulfate in ovariectomized rats

Strontium-doping promotes bone bonding of titanium implants in osteoporotic microenvironment

Osteoporosis is a major challenge to oral implants, and this study focused on improving the osseointegration ability of titanium (Ti) implants in osteoporosis environment via surface modification, including doping of strontium ion and preparation of nanoscale surface feature. Our previous studies have shown that strontium (Sr) ions can enhance osteogenic activity. Therefore, we aimed to comprehensively evaluate the effect of hydrothermal treatment of Sr-doped titanium implant coating on bone-binding properties in the microenvironment of osteoporosis in this study. We fabricated Sr-doped nanocoating (AHT-Sr) onto the surface of titanium implants via hydrothermal reaction. The rough Sr-doping had good biological functions and could apparently promote osteogenic differentiation of osteoporotic bone marrow mesenchymal stem cells (OVX-BMSCs). Most importantly, AHT-Sr significantly promoted bone integration in the osteoporosis environment. This study provides an effective approach to implant surface modification for better osseointegration in an osteoporotic environment.

Men who stare at bone: multimodal monitoring of bone healing

Knowledge of the physiological and pathological processes, taking place in bone during fracture healing or defect regeneration, is essential in order to develop strategies to enhance bone healing under normal and critical conditions. Preclinical testing allows a wide range of imaging modalities that may be applied both simultaneously and longitudinally, which will in turn lower the number of animals needed to allow a comprehensive assessment of the healing process. This work provides an up-to-date review on morphological, functional, optical, biochemical, and biophysical imaging techniques including their advantages, disadvantages and potential for combining them in a multimodal and multiscale manner. The focus lies on preclinical testing of biomaterials modified with artificial extracellular matrices in various animal models to enhance bone remodeling and regeneration.

Multifunctional natural polymer-based metallic implant surface modifications

High energy traumas could cause critical damage to bone, which will require permanent implants to recover while functionally integrating with the host bone. Critical sized bone defects necessitate the use of bioactive metallic implants. Because of bioinertness, various methods involving surface modifications such as surface treatments, the development of novel alloys, bioceramic/bioglass coatings, and biofunctional molecule grafting have been utilized to effectively integrate metallic implants with a living bone. However, the applications of these methods demonstrated a need for an interphase layer improving bone-making to overcome two major risk factors: aseptic loosening and peri-implantitis. To accomplish a biologically functional bridge with the host to prevent loosening, regenerative cues, osteoimmunomodulatory modifications, and electrochemically resistant layers against corrosion appeared as imperative reinforcements. In addition, interphases carrying antibacterial cargo were proven to be successful against peri-implantitis. In the literature, metallic implant coatings employing natural polymers as the main matrix were presented as bioactive interphases, enabling rapid, robust, and functional osseointegration with the host bone. However, a comprehensive review of natural polymer coatings, bridging and grafting on metallic implants, and their activities has not been reported. In this review, state-of-the-art studies on multifunctional natural polymer-based implant coatings effectively utilized as a bone tissue engineering (BTE) modality are depicted. Protein-based, polysaccharide-based coatings and their combinations to achieve better osseointegration via the formation of an extracellular matrix-like (ECM-like) interphase with gap filling and corrosion resistance abilities are discussed in detail. The hypotheses and results of these studies are examined and criticized, and the potential future prospects of multifunctional coatings are also proposed as final remarks.

Effects of alginate/chondroitin sulfate-based hydrogels on bone defects healing

Repairing bone defects remains challenging in orthopedics. Here, strontium (Sr) alginate hydrogels containing chondroitin sulfate (CS) were fabricated for enhancing bone defects repair. The effects of CS incorporation ratio on the morphology, structure, thermal stability, water uptake and mechanical performance of Sr-CS/alginate hydrogels were also evaluated. Increasing CS incorporation ratio, Sr-CS/alginate hydrogels exhibit decreasing mechanical properties and lower water retention capacity. In vitro results suggest that Sr-CS/alginate hydrogels with higher CS ratio facilitate the proliferation of osteoblasts. Additionally, the osteogenic genes expressions were investigated by real-time quantitative polymerase chain reaction (RT-qPCR). The results reveal that Sr-CS/alginate hydrogels should have positive effects on modulating the osteogenic factors. Moreover, by employing repair femoral cylindrical defects rabbit model, the efficiency of as-fabricated Sr-CS/alginate hydrogels in bone regeneration was evaluated. The animal study suggests that Sr-CS/alginate hydrogel could significantly facilitate bone defects repair and therefore should potentially be useful for osteochondral tissue engineering.

Promotion effect of immobilized chondroitin sulfate on intrafibrillar mineralization of collagen

Chondroitin sulfate (CS) is widespread in mineralized tissues and is considered to play crucial roles during the mineralization process. However, its role in biomineralization remains controversial. In the present study, CS is immobilized to collagen fibrils to mimic its state in biomineralization. The results demonstrate that immobilized CS on collagen fibrils accelerates calcium phosphate nucleation and significantly promotes collagen mineralization by accumulating calcium ions in collagen fibrils. The stochastic optical reconstruction microscopy results confirm that CS gives the specific nucleation sites for calcium phosphate to preferentially form, the improved intrafibrillar heterogeneous nucleation of calcium phosphate facilitates intrafibrillar mineralization. It is found remarkably accelerated remineralization of CS immobilized demineralized dentin is achieved. This study offers insight on the understanding of the function of the biomacromolecule CS on the biomineralization front. In addition, CS effectively promotes intrafibrillar mineralization, which highlights fine prospect for CS to reconstruct collagen-mineralized tissues as a natural material.

Sulfated polysaccharide-based scaffolds for orthopaedic tissue engineering

Given their native-like biological properties, high growth factor retention capacity and porous nature, sulfated-polysaccharide-based scaffolds hold great promise for a number of tissue engineering applications. Specifically, as they mimic important properties of tissues such as bone and cartilage they are ideal for orthopaedic tissue engineering. Their biomimicry properties encompass important cell-binding motifs, native-like mechanical properties, designated sites for bone mineralisation and strong growth factor binding and signaling capacity. Even so, scientists in the field have just recently begun to utilise them as building blocks for tissue engineering scaffolds. Most of these efforts have so far been directed towards in vitro studies, and for these reasons the clinical gap is still substantial. With this review paper, we have tried to highlight some of the important chemical, physical and biological features of sulfated-polysaccharides in relation to their chondrogenic and osteogenic inducing capacity. Additionally, their usage in various in vivo model systems is discussed. The clinical studies reviewed herein paint a promising picture heralding a brave new world for orthopaedic tissue engineering.

Investigating the Mechanical Characteristics of Bone-Metal Implant Interface Using in situ Synchrotron Tomographic Imaging

Long-term stability of endosseous implants depends on successful bone formation, ingrowth and adaptation to the implant. Specifically, it will define the mechanical properties of the newly formed bone-implant interface. 3D imaging during mechanical loading tests (in situ loading) can improve the understanding of the local processes leading to bone damage and failure. In this study, titanium screws were implanted into rat tibiae and were allowed to integrate for 4 weeks with or without the addition of the growth factor Bone Morphogenetic Protein and the bisphosphonate Zoledronic Acid. Samples were subjected to in situ pullout using high-resolution synchrotron x-ray tomography at the Tomcat beamline (SLS, PSI, Switzerland) at 30 keV with 25 ms exposure time, resulting in a total acquisition time of 45 s per scan, with a 3.6 μm isotropic voxel size. Using a custom-made loading device positioned inside the beamline, screws were pulled out with 0.05 mm increment, acquiring multiple scans until rupture of the sample. The in situ loading protocol was adapted to ensure short imaging time, which enabled multiple samples to be tested with short loading steps, while keeping the total testing time low and reducing dose deposition. Higher trabecular bone content was quantified in the surrounding of the screw in the treated groups, which correlated with increased mechanical strength and stiffness. Differences in screw implantation, such as contact between threads and cortex as well as minor tilt of the screw were also correlated to the mechanical parameters. In situ loading enabled the investigation of crack propagation during the pullout, highlighting the mechanical behavior of the interface. Three typical crack types were observed: (1) rupture at the interface of trabecular and cortical bone tissues, close to the screw, (2) large crack inside the cortex connected to the implant, and (3) first failure away from the screw with cracks propagating toward the screw-bone interface. Mechanical properties of in vivo integrated bone-metal screws rely on a combination of multiple parameters that are difficult to identify and separate one from the other.

Immobilization of type I collagen/hyaluronic acid multilayer coating on enoxacin loaded titania nanotubes for improved osteogenesis and osseointegration in ovariectomized rats

Titania nanotubes (Ti-NTs) have been proven to be good drug carriers and can release drugs efficiently around implants. Enoxacin (EN) is a broad-spectrum antibiotic that has the ability of anti-osteoclastogenesis. Immobilization of extracellular matrix components on the surface of the material can greatly enhance the biological activity of the implant and slow down the release rate of the drug in Ti-NTs. In the present study, a material system that provided uniform drug release, promoted osteogenesis, and inhibited osteoclast was designed and developed. Scanning electron microscopy, X-ray photoelectron spectroscopy, and water contact angle measurements were used for material surface characterization. Enoxacin release was detected by high performance liquid chromatography. Alkaline phosphatase and Alizarin Red staining were used to evaluate the osteogenic differentiation of rat bone marrow mesenchymal stem cells. Tartrate-resistant acid phosphatase staining and bone absorption assay were applied to osteoclastogenesis experiments. A drug delivery system based on Ti-NTs and type I collagen /hyaluronic acid multilayer coating (Ti-NT+EN+Col/HyA) with predominant biocompatibility, osteogenic property, and anti-osteoclastogenesis ability was successfully constructed. These excellent biological properties were further validated in an ovariectomized rat model. The results of the study indicate that Ti-NT+EN+Col/HyA is a potential material for future orthopedic implants.

Preparation and in vitro evaluation of novel cross-linked chondroitin sulphate nanoparticles by aluminium ions for encapsulation of green tea flavonoids

Chondroitin sulphate is a sulphated glycosaminoglycan biopolymer composed over 100 individual sugars. Chondroitin sulphate nanoparticles (NPs) loaded with catechin were prepared by an ionic gelation method using AlCl₃ and optimised for polymer and cross-linking agent concentration, curing time and stirring speed. Zeta potential, particle size, loading efficiency, and release efficiency over 24 h (RE₂₄%) were evaluated. The surface morphology of NPs was investigated by scanning electron microscopy and their thermal behaviour by differential scanning calorimetric. Antioxidant effect of NPs was determined by chelating activity of iron ions. The cell viability of mesenchymal stem cells was determined by 3-[4, 5-dimethylthiazol-2-yl]-2, 5-diphenyl tetrazolium bromide assay and the calcification of osteoblasts was studied by Alizarin red staining. The optimised NPs showed particle size of 176 nm, zeta potential of -20.8 mV, loading efficiency of 93.3% and RE₂₄% of 80.6%. The chatechin loaded chondroitin sulphate NPs showed 70-fold more antioxidant activity, 3-fold proliferation effect and higher calcium precipitation in osteoblasts than free catechin.

Does incorporating collagen and chondroitin sulfate matrix in implant surfaces enhance osseointegration? A systematic review and meta-analysis

Implant surface modification has been used to improve osseointegration. However, evidence regarding improved new bone formation (NBF) and osseointegration with the use of collagen-chondroitin sulfate (CS) matrix coated implants remains unclear. The aim of this study was to assess the efficacy of collagen-CS matrix coating on the osseointegration of implants. The focused question was "Does the incorporation of collagen-CS matrix in implant surfaces influence osseointegration?" To answer the question, indexed databases were searched up to July 2017 using various combinations of the key words "collagen", "chondroitin sulfate", "osseointegration", and "implants". The initial literature search identified 497 articles, of which 18 reporting experimental studies fulfilled the inclusion criteria. Thirteen of the studies included (72%) reported that implants coated with a collagen-CS matrix presented higher NBF, bone-to-implant contact, and/or bone volume density. The strength of this observation was supported by meta-analysis results. Nevertheless, the results should be interpreted with caution due to the lack of standardization regarding the dosage formulation of collagen-CS, short-term follow-up, and lack of assessment of confounders. On experimental grounds, the incorporation of collagen-CS matrix into implant surfaces appears to promote osseointegration. From a clinical perspective, the results from animal models support phase I studies in healthy humans.

Sustained raloxifene release from hyaluronan-alendronate-functionalized titanium nanotube arrays capable of enhancing osseointegration in osteoporotic rabbits

To enhance the localized bone remodeling at titanium-based implants under osteoporotic conditions, TiO₂ nanotube arrays (TNT) were used as nanoreserviors for raloxifene (Ral) and then covered with the hybrid multilayered coating of chitosan and alendronate grafted hyaluronic acid (HA-Aln) via a spin-assisted layer-by-layer technique. The fabrication of this system (TNT/Ral/LBL-Aln) was characterized by field emission scanning electron microscopy (SEM), atomic force microscope (AFM) and X-ray photoelectron spectroscopy (XPS), respectively. The release test showed that the composited multilayers onto Ral-loaded TiO₂ nanotube substrate (TNT/Ral) could prevent the burst release of Ral from TiO₂ nanotube arrays and maintain stable Ral concentration at the implant site even after 192h. The TNT/Ral/LBL-Aln system demonstrated higher alkaline phosphatase (ALP) activity, mineralization capability in osteoblasts as well as lower tartrate-resistant acid phosphatase (TRAP) activity in osteoclasts compared to both bare TiO₂ nanotube and TNT/Ral substrate, respectively. Moreover, the in vivo tests of micro-CT, histological staining and push-out testing showed that TNT/Ral/LBL-Aln implant could efficiently enhance the formation of new bone around the implant and promote bone binding in osteoporotic rabbits. The study indicated the potential application of TNT/Ral/LBL-Aln system for bone remodeling under osteoporotic condition.

The effects of implant topography on osseointegration under estrogen deficiency induced osteoporotic conditions: Histomorphometric, transcriptional and ultrastructural analysis

Compromised bone quality and/or healing in osteoporosis are recognised risk factors for impaired dental implant osseointegration. This study examined the effects of (1) experimentally induced osteoporosis on titanium implant osseointegration and (2) the effect of modified implant surface topography on osseointegration under osteoporosis-like conditions. Machined and micro-roughened surface implants were placed into the maxillary first molar root socket of 64 ovariectomised and sham-operated Sprague-Dawley rats. Subsequent histological and SEM observations showed tissue maturation on the micro-rough surfaced implants in ovariectomised animals as early as 3days post-implantation. The degree of osseointegration was also significantly higher around the micro-rough implants in ovariectomised animals after 14days of healing although by day 28, similar levels of osseointegration were found for all test groups. The micro-rough implants significantly increased the early (day 3) gene expression of alkaline phosphatase, osteocalcin, receptor activator of nuclear factor kappa-B ligand and dentin matrix protein 1 in implant adherent cells. By day 7, the expression of inflammatory genes decreased while the expression of the osteogenic markers increased further although there were few statistically significant differences between the micro-rough and machined surfaces. Osteocyte morphology was also affected by estrogen deficiency with the size of the cells being reduced in trabecular bone. In conclusion, estrogen deficiency induced osteoporotic conditions negatively influenced the early osseointegration of machined implants while micro-rough implants compensated for these deleterious effects by enhancing osteogenic cell differentiation on the implant surface.

STATEMENT OF SIGNIFICANCE

Lower bone density, poor bone quality and osseous microstructural changes are all features characteristic of osteoporosis that may impair the osseointegration of dental implants. Using a clinically relevant trabecular bone model in the rat maxilla, we demonstrated histologically that the negative effects of surgically-induced osteoporosis on osseointegration could be ameliorated by the biomaterial's surface topography. Furthermore, gene expression analysis suggests this may be a result of enhanced osteogenic cell differentiation on the implant surface.