Magnesium degradation under physiological conditions - Best practice

An overview of magnesium-based implants in orthopaedics and a prospect of its application in spine fusion

Due to matching biomechanical properties and significant biological activity, Mg-based implants present great potential in orthopedic applications. In recent years, the biocompatibility and therapeutic effect of magnesium-based implants have been widely investigated in trauma repair. In contrast, the R&D work of Mg-based implants in spinal fusion is still limited. This review firstly introduced the general background for Mg-based implants. Secondly, the mechanical properties and degradation behaviors of Mg and its traditional and novel alloys were reviewed. Then, different surface modification techniques of Mg-based implants were described. Thirdly, this review comprehensively summarized the biological pathways of Mg degradation to promote bone formation in neuro-musculoskeletal circuit, angiogenesis with H-type vessel formation, osteogenesis with osteoblasts activation and chondrocyte ossification as an integrated system. Fourthly, this review followed the translation process of Mg-based implants via updating the preclinical studies in fracture fixation, sports trauma repair and reconstruction, and bone distraction for large bone defect. Furthermore, the pilot clinical studies were involved to demonstrate the reliable clinical safety and satisfactory bioactive effects of Mg-based implants in bone formation. Finally, this review introduced the background of spine fusion surgeryand the challenges of biological matching cage development. At last, this review prospected the translation potential of a hybrid Mg-PEEK spine fusion cage design.

Effect of hematoma on early degradation behavior of magnesium after implantation

The corrosion of magnesium (Mg)-based bioabsorbable implanting devices is influenced by implantation environment which dynamically changes by biological response including wound healing. Understanding the corrosion mechanisms along the healing process is essential for the development of Mg-based devices. In this study, a hematoma model was created in a rat femur to analyze Mg corrosion with hematoma in the early stage of implantation. Pure Mg specimen (99.9%,ϕ1.2 × 6 mm) was implanted in rat femur under either hematoma or non-hematoma conditions. After a designated period of implantation, the specimens were collected and weighed. The insoluble salts formed on the specimen surfaces were analyzed using scanning electron microscopy, energy-dispersive x-ray spectroscopy, and Raman spectroscopy on days 1, 3, and 7. The results indicate that hematomas promote Mg corrosion and change the insoluble salt precipitation. The weight loss of the hematoma group (27.31 ± 5.91 µg mm-2) was significantly larger than that of the non-hematoma group (14.77 ± 3.28 µg mm-2) on day 7. In the non-hematoma group, carbonate and phosphate were detected even on day 1, but the only latter was detected on day 7. In the hematoma group, hydroxide was detected on day 1, followed by the formation of carbonate and phosphate on days 3 and 7. The obtained results suggest the hypoxic and acidic microenvironment in hematomas accelerates the Mg corrosion immediately after implantation, and the subsequent hematoma resorption process leads to the formation of phosphate and carbonate with organic molecules. This study revealed the risk of hematomas as an acceleration factor of the corrosion of Mg-based devices leading to the early implant failure. It is important to consider this risk in the design of Mg-based devices and to optimize surgical procedures controlling hemorrhage at implantation and reducing unexpected bleeding after surgery.

In Vitro Corrosion of Polyester-Coated Magnesium Alloy under pH-Static Conditions

The resorption rate of bioresorbable implants requires tuning to match the desired field of application. The use of Mg as implant material is highly advantageous, as it provides sufficient mechanical strength combined with its biodegradability. Consequently, the implant vanishes after it has served its intended purpose, allowing the complete restoration of natural tissue and organ function. However, a biodegradable Mg implant requires a biodegradable coating to slow the rate of Mg corrosion, as a permanent coating would negate the benefits of using Mg as an implant material. Therefore, degradable polymers are the materials of choice, especially polyester-based coatings, such as PLLA, as they have been proven in clinical practice over the long term. Within this work, the degradation retarding effect of a physical barrier in form of four clinically relevant polyester-based coatings, poly-l-lactide (PLLA), poly-l-lactide-co-glycolide (PLGA), poly(l-lactide-co-PEG) triblock copolymer (PLLA-co-PEG), and polydioxanone (PDO), is investigated in vitro under pH-static conditions using CO2 gas to compensate pH changes due to Mg corrosion. Coating thicknesses of 7.5 to 8.3 μm were comparable to commercially available stent systems. Quantitative analysis of magnesium concentration in buffered test medium by a photometric assay allows real-time monitoring. Shielding effect of different polyesters through polymer coating and formation of a protective passivation layer beneath the polymer coating was observed and characterized using SEM and EDX techniques. Our finding was that even imperfect polymer layers provide a considerable protective effect, and the used in vitro setup matches reported in vivo observations regarding elemental composition of corrosion products.

Research status and prospects of biodegradable magnesium-based metal guided bone regeneration membranes

Biodegradable magnesium-based metal guided bone regeneration (GBR) membranes possess excellent mechanical properties, biodegradability, and osteopromotive capabilities, making them ideal implants for the treatment of maxillofacial bone defects. This review summarizes the current status and future research trends related to magnesium-based GBR membranes. First, the research history and application fields of magnesium-based metals are introduced, and the advantages of the use of magnesium-based materials for GBR membranes, including their mechanical properties, biocompatibility, osteopromotive performance, and underlying mechanisms are discussed. Finally, this review addresses the current limitations of magnesium-based GBR membranes and their applications and prospects in the field of dentistry. In conclusion, considerable advancements have been in fundamental and translational research on magnesium-based GBR membranes, which lays a crucial foundation for the treatment of maxillofacial bone defects.

Advances in biodegradable materials: Degradation mechanisms, mechanical properties, and biocompatibility for orthopedic applications

Mg-based and Zn-based biodegradable materials have the potential to become the next-generation implant materials to treat bone diseases, because of their desired degradation and mechanical properties. This article reviews the status of these implant materials. The required properties of biodegradable materials such as biodegradability, mechanical properties, and biocompatibility for performance evaluation were briefly discussed. The influence of fabrication techniques, microstructure, alloying elements, and post-processing techniques on the properties of Mg and Zn-based materials was addressed. The degradation mechanism by dissolution, oxidation, and interaction with human body cells was discussed. The biocompatibility of Mg and Zn-based biodegradable materials was analyzed. The significance of in vitro and in vivo biocompatibility testing was highlighted, emphasizing the superiority of in vivo results over cell line studies. This article identifies the many Mg and Zn-based biodegradable materials and summarizes the key findings.

Synchrotron microtomography reveals insights into the degradation kinetics of bio-degradable coronary magnesium scaffolds

Bioresorbable magnesium scaffolds are a promising future treatment option for coronary artery stenosis, especially for young adults. Due to the degradation of these scaffolds (<1 year), long-term device-related clinical events could be reduced compared to treatments with conventional drug eluting stents. First clinical trials indicate a return of vasomotion after one year, which may be associated with improved long-term clinical outcomes. However, even after decades of development, the degradation process, ideal degradation time and biological response in vivo are still not fully understood. The present study investigates the in vivo degradation of magnesium scaffolds in the coronary arteries of pigs influenced by different strut thicknesses and the presence of antiproliferative drugs. Due to high 3D image contrast of synchrotron-based micro-CT with phase contrast (SR-μCT), a qualitative and quantitative evaluation of the degradation morphology of magnesium scaffolds was obtained. For the segmentation of the μCT images a convolutional network architecture (U-net) was exploited, demonstrating the huge potential of merging high resolution SR-μCT with deep learning (DL) supported data analysis. In total, 30 scaffolds, made of the rare earth alloy Resoloy®, with different strut designs were implanted into the coronary arteries of 10 domestic pigs for 28 days using drug-coated or uncoated angioplasty balloons for post-dilatation. The degradation morphology was analyzed using scanning electron microscopy, energy dispersive x-ray spectroscopy and SR-μCT. The data from these methods were then related to data from angiography, optical coherence tomography and histology. A thinner strut size (95 vs. 130 μm) and the presence of paclitaxel indicated a slower degradation rate at 28 d in vivo, which positively influences the late lumen loss (0.5 and 0.6 mm vs. 1.0 and 1.1 mm) and recoil values (0 and 1.7% vs. 6.1 and 22%).

Development of Zn-2Cu-xMn/Mg Alloys for Orthopedic Applications: Mechanical Performance to In Vitro Degradation under Different Physiological Environments

Zinc (Zn) and its alloys are considered futuristic biodegradable materials for their acceptable mechanical properties, suitable corrosion rate, and good biocompatibility. In this study, we report newly developed biodegradable Zn-2Cu-xMn/Mg (x = 0, 0.1, and 0.5) alloys, aiming to achieve good mechanical strength with excellent elongation, desirable wear resistance, and suitable corrosion rate. The effect of Mn/Mg addition on the structural, mechanical, wear, and degradation behaviors of the Zn-2Cu-xMn/Mg alloys was thoroughly investigated. Degradation and tribological behaviors of the alloys were explored in the presence of simulated body fluid (SBF), Dulbecco's modified Eagle medium (DMEM), and DMEM with a 10% fetal bovine serum (FBS) solution. Alloy elements and hot rolling improve their mechanical properties significantly due to precipitation hardening, grain refinement, and solid solution strengthening owing to the formation of MnZn13 and Mg2Zn11 phases. Among all the alloys, the Zn-2Cu-0.5Mn alloy achieved the highest ultimate tensile strength (UTS) of ∼405 MPa and yield strength (YS) of ∼293 MPa with an excellent elongation of ∼51%. The corrosion behavior of the alloys as determined by a potentiodynamic polarization study under different solutions follows the sequence Zn-2Cu < Zn-2Cu-0.5Mn < Zn-2Cu-0.1Mn < Zn-2Cu-0.1Mg < Zn-2Cu-0.5Mg. The corrosion rate by immersion testing for 30 and 90 days also follows the same sequence. The corrosion rate in different solutions follows the order SBF > DMEM + 10%FBS > DMEM. The addition of Mn/Mg also improves the wear resistance and slows the wear rate under wet conditions. The bending test results also indicate the highest bending strength of ∼375 MPa for the Zn-2Cu-0.5Mn alloy, among all the alloys. The bending and tensile strengths deteriorate continuously after the immersion for 30 and 90 days in the solution of SBF, DMEM, and DMEM + 10%FBS. Therefore, the Zn-2Cu-xMn/Mg (x = 0.1 and 0.5) alloys can be considered potential biodegradable implant materials.

Enhanced Degradability of the Apatite-Based Calcium Phosphate Cement Incorporated with Amorphous MgZnCa Alloy

Degradability is vital for bone filling and plays an important role in bone regeneration. Evidence indicates that apatite-based calcium phosphate cement (ACPC) is a prospective biomaterial for bone repair with enhanced osteogenesis. However, poor degradability restricts their clinical application. In this study, MgZnCa-doped ACPC (MgZnCa/ACPC) composites were fabricated by adding 3 (wt) % amorphous MgZnCa powder in the solid phase of ACPC to enhance the biodegradation and bioactivity of the apatite ACPC. The chemical and the physical properties of the MgZnCa/ACPC composite were investigated and compared with the ACPC composite. The results showed that the incorporation of MgZnCa improved both the degradability and the compressive strength of the ACPC composite. X-ray diffraction and Fourier transform infrared spectrometry analysis suggested significant changes in the microstructures of the composites due to the incorporation and the anodic dissolution of MgZnCa alloy. These findings indicate that the MgZnCa/ACPC composite is capable of facilitating bone repair and regeneration by endowing favorable degradation property.

Biological response of degradation products of PEO-modified magnesium on vascular tissue cells, hemocompatibility and its influence on the inflammatory response

Cardiovascular stenting is the most widely used therapy to treat coronary artery disease caused by partial or total obstruction of the artery due to atherosclerotic plaque formation, with potentially fatal effects. There are different types of stents: bare metal stents, drug-eluting stents, bioabsorbable stents and dual therapy stents. However, they can lead to long-term complications, such as in-stent restenosis and late thrombosis. To reduce these adverse effects, research has focused on biodegradable metallic stents, since they retain the mechanical properties necessary to contain the injured artery while it is being repaired and, once their function has been fulfilled, the stent degrades without altering the system or compromising the patient's health. In this work we have evaluated the biological response of the degradation products of a bare Mg based biomaterial surface-modified by the plasma electrolytic oxidation (PEO) method on vascular tissue cells, hemocompatibility and inflammatory response. The results obtained are compatible with a biosafe material for future use as a cardiovascular implant, but it is necessary to continue with in vivo and mechanical properties tests to ensure and guarantee its use. SIGNIFICANCE STATEMENT: The development of fully bioresorbable stents is a promising alternative for the management of coronary artery disease without causing long-term problems at the implantation site. In this work, the hematological and immunological biocompatibility of bare Mg modified superficially by plasma electrolytic oxidation (PEO-Mg) was evaluated by in vitro and ex vivo assays. PEO-Mg was found to be compatible with blood and immune components surrounding the implantation site with no signs of toxicity to endothelial cells, macrophages, and arterial tissue. In addition, degradation products of PEO-Mg are eliminated by phagocytosis. However, an in-depth study of the physical and mechanical properties and in vivo biocompatibility must be carried out for its future use as a biomedical implant.

Advances in Bioresorbable Triboelectric Nanogenerators

With the growing demand for next-generation health care, the integration of electronic components into implantable medical devices (IMDs) has become a vital factor in achieving sophisticated healthcare functionalities such as electrophysiological monitoring and electroceuticals worldwide. However, these devices confront technological challenges concerning a noninvasive power supply and biosafe device removal. Addressing these challenges is crucial to ensure continuous operation and patient comfort and minimize the physical and economic burden on the patient and the healthcare system. This Review highlights the promising capabilities of bioresorbable triboelectric nanogenerators (B-TENGs) as temporary self-clearing power sources and self-powered IMDs. First, we present an overview of and progress in bioresorbable triboelectric energy harvesting devices, focusing on their working principles, materials development, and biodegradation mechanisms. Next, we examine the current state of on-demand transient implants and their biomedical applications. Finally, we address the current challenges and future perspectives of B-TENGs, aimed at expanding their technological scope and developing innovative solutions. This Review discusses advancements in materials science, chemistry, and microfabrication that can advance the scope of energy solutions available for IMDs. These innovations can potentially change the current health paradigm, contribute to enhanced longevity, and reshape the healthcare landscape soon.

In vitro and in vivo degradation behavior of Mg-0.45Zn-0.45Ca (ZX00) screws for orthopedic applications

Magnesium (Mg) alloys have become a potential material for orthopedic implants due to their unnecessary implant removal, biocompatibility, and mechanical integrity until fracture healing. This study examined the in vitro and in vivo degradation of an Mg fixation screw composed of Mg-0.45Zn-0.45Ca (ZX00, in wt.%). With ZX00 human-sized implants, in vitro immersion tests up to 28 days under physiological conditions, along with electrochemical measurements were performed for the first time. In addition, ZX00 screws were implanted in the diaphysis of sheep for 6, 12, and 24 weeks to assess the degradation and biocompatibility of the screws in vivo. Using scanning electron microscopy (SEM) coupled with energy dispersive X-ray spectroscopy (EDX), micro-computed tomography (μCT), X-ray photoelectron spectroscopy (XPS), and histology, the surface and cross-sectional morphologies of the corrosion layers formed, as well as the bone-corrosion-layer-implant interfaces, were analyzed. Our findings from in vivo testing demonstrated that ZX00 alloy promotes bone healing and the formation of new bone in direct contact with the corrosion products. In addition, the same elemental composition of corrosion products was observed for in vitro and in vivo experiments; however, their elemental distribution and thicknesses differ depending on the implant location. Our findings suggest that the corrosion resistance was microstructure-dependent. The head zone was the least corrosion-resistant, indicating that the production procedure could impact the corrosion performance of the implant. In spite of this, the formation of new bone and no adverse effects on the surrounding tissues demonstrated that the ZX00 is a suitable Mg-based alloy for temporary bone implants.

An Overview of Scaffolds and Biomaterials for Skin Expansion and Soft Tissue Regeneration: Insights on Zinc and Magnesium as New Potential Key Elements

The utilization of materials in medical implants, serving as substitutes for non-functional biological structures, supporting damaged tissues, or reinforcing active organs, holds significant importance in modern healthcare, positively impacting the quality of life for millions of individuals worldwide. However, certain implants may only be required temporarily to aid in the healing process of diseased or injured tissues and tissue expansion. Biodegradable metals, including zinc (Zn), magnesium (Mg), iron, and others, present a new paradigm in the realm of implant materials. Ongoing research focuses on developing optimized materials that meet medical standards, encompassing controllable corrosion rates, sustained mechanical stability, and favorable biocompatibility. Achieving these objectives involves refining alloy compositions and tailoring processing techniques to carefully control microstructures and mechanical properties. Among the materials under investigation, Mg- and Zn-based biodegradable materials and their alloys demonstrate the ability to provide necessary support during tissue regeneration while gradually degrading over time. Furthermore, as essential elements in the human body, Mg and Zn offer additional benefits, including promoting wound healing, facilitating cell growth, and participating in gene generation while interacting with various vital biological functions. This review provides an overview of the physiological function and significance for human health of Mg and Zn and their usage as implants in tissue regeneration using tissue scaffolds. The scaffold qualities, such as biodegradation, mechanical characteristics, and biocompatibility, are also discussed.

Magnesium implant degradation provides immunomodulatory and proangiogenic effects and attenuates peri-implant fibrosis in soft tissues

Implants made of magnesium (Mg) are increasingly employed in patients to achieve osteosynthesis while degrading in situ. Since Mg implants and Mg²⁺ have been suggested to possess anti-inflammatory properties, the clinically observed soft tissue inflammation around Mg implants is enigmatic. Here, using a rat soft tissue model and a 1-28 d observation period, we determined the temporo-spatial cell distribution and behavior in relation to sequential changes of pure Mg implant surface properties and Mg²⁺ release. Compared to nondegradable titanium (Ti) implants, Mg degradation exacerbated initial inflammation. Release of Mg degradation products at the tissue-implant interface, culminating at 3 d, actively initiated chemotaxis and upregulated mRNA and protein immunomodulatory markers, particularly inducible nitric oxide synthase and toll-like receptor-4 up to 6 d, yet without a cytotoxic effect. Increased vascularization was demonstrated morphologically, preceded by high expression of vascular endothelial growth factor. The transition to appropriate tissue repair coincided with implant surface enrichment of Ca and P and reduced peri-implant Mg²⁺ concentration. Mg implants revealed a thinner fibrous encapsulation compared with Ti. The detailed understanding of the relationship between Mg material properties and the spatial and time-resolved cellular processes provides a basis for the interpretation of clinical observations and future tailoring of Mg implants.

Development of a Bioreactor-Coupled Flow-Cell Setup for 3D In Situ Nanotomography of Mg Alloy Biodegradation

Functional materials feature hierarchical microstructures that define their unique set of properties. The prediction and tailoring of these require a multiscale knowledge of the mechanistic interaction of microstructure and property. An important material in this respect is biodegradable magnesium alloys used for implant applications. To correlate the relationship between the microstructure and the nonlinear degradation process, high-resolution in situ three-dimensional (3D) imaging experiments must be performed. For this purpose, a novel experimental flow cell is presented which allows for the in situ 3D-nano imaging of the biodegradation process of materials with nominal resolutions below 100 nm using nanofocused hard X-ray radiation from a synchrotron source. The flow cell setup can operate under adjustable physiological and hydrodynamic conditions. As a model material, the biodegradation of thin Mg-4Ag wires in simulated body fluid under physiological conditions and a flow rate of 1 mL/min is studied. The use of two full-field nanotomographic imaging techniques, namely transmission X-ray microscopy and near-field holotomography, is compared, revealing holotomography as the superior imaging technique for this purpose. Additionally, the importance of maintaining physiological conditions is highlighted by the preliminary results. Supporting measurements using electron microscopy to investigate the chemical composition of the samples after degradation are performed.

Effect of Fluoride Coatings on the Corrosion Behavior of Mg-Zn-Ca-Mn Alloys for Medical Application

The most critical shortcoming of magnesium alloys from the point of view of medical devices is the high corrosion rate, which is not well-correlated with clinical needs. It is well- known that rapid degradation occurs when an implant made of Mg-based alloys is placed inside the human body. Consequently, the implant loses its mechanical properties and failure can occur even if it is not completely degraded. The corrosion products that appear after Mg-based alloy degradation, such as H₂ and OH^- can have an essential role in decreasing biocompatibility due to the H₂ accumulation process in the tissues near the implant. In order to control the degradation process of the Mg-based alloys, different coatings could be applied. The aim of the current paper is to evaluate the effect of fluoride coatings on the corrosion behavior of magnesium alloys from the system Mg-Zn-Ca-Mn potentially used for orthopedic trauma implants. The main functional properties required for the magnesium alloys to be used as implant materials, such as surface properties and corrosion behavior, were studied before and after surface modifications by fluoride conversion, with and without preliminary sandblasting, of two magnesium alloys from the system Mg-Zn-Ca-Mn. The experimental results showed that chemical conversion treatment with hydrofluoric acid is useful as a method of increasing corrosion resistance for the experimental magnesium alloys from the Mg-Zn-Ca-Mn system. Also, high surface free energy values obtained for the alloys treated with hydrofluoric acid correlated with wettability lead to the conclusion that there is an increased chance for biological factor adsorption and cell proliferation. Chemical conversion treatment with hydrofluoric acid is useful as a method of increasing corrosion resistance for the experimental Mg-Zn-Ca-Mn alloys.

Biodegradable magnesium materials regulate ROS-RNS balance in pro-inflammatory macrophage environment

The relationship between reactive oxygen and nitrogen species (ROS-RNS) secretion and the concomitant biocorrosion of degradable magnesium (Mg) materials is poorly understood. We found that Mg foils implanted short term in vivo (24 h) displayed large amounts of proinflammatory F4/80+/iNOS + macrophages at the interface. We sought to investigate the interplay between biodegrading Mg materials (98.6% Mg, AZ31 & AZ61) and macrophages (RAW 264.7) stimulated with lipopolysaccharide (RAW 264.7^LPS) to induce ROS-RNS secretion. To test how these proinflammatory ROS-RNS secreting cells interact with Mg corrosion in vitro, Mg and AZ61 discs were suspended approximately 2 mm above a monolayer of RAW 264.7 cells, either with or without LPS. The surfaces of both materials showed acute (24 h) changes when incubated in the proinflammatory RAW 264.7^LPS environment. Mg discs incubated with RAW 264.7^LPS macrophages showed greater corrosion pitting, while AZ61 showed morphological and elemental bulk product changes via scanning electron microscopy-energy dispersive X-ray spectroscopy (SEM-EDX). X-ray photoelectron spectroscopy (XPS) analysis showed a reduction in the Ca/P ratio of the surface products for AZ61 disc incubated with RAW 264.7^LPS, but not the Mg discs. Moreover, RAW 264.7^LPS macrophages were found to be more viable in the acute biodegradative environment generated by Mg materials, as demonstrated by calcein-AM and cleaved (active) caspase-3 staining (CC3). LPS stimulation caused an increase in ROS-RNS, and a decrease in antioxidant peroxidase activity. Mg and AZ61 were found to change this ROS-RNS balance, independently of physiological antioxidant mechanisms. The findings highlight the complexity of the cellular driven acute inflammatory responses to different biodegradable Mg, and how it can potentially affect performance of these materials.

Phase-field modeling of pitting and mechanically-assisted corrosion of Mg alloys for biomedical applications

A phase-field model is developed to simulate the corrosion of Mg alloys in body fluids. The model incorporates both Mg dissolution and the transport of Mg ions in solution, naturally predicting the transition from activation-controlled to diffusion-controlled bio-corrosion. In addition to uniform corrosion, the presented framework captures pitting corrosion and accounts for the synergistic effect of aggressive environments and mechanical loading in accelerating corrosion kinetics. The model applies to arbitrary 2D and 3D geometries with no special treatment for the evolution of the corrosion front, which is described using a diffuse interface approach. Experiments are conducted to validate the model and a good agreement is attained against in vitro measurements on Mg wires. The potential of the model to capture mechano-chemical effects during corrosion is demonstrated in case studies considering Mg wires in tension and bioabsorbable coronary Mg stents subjected to mechanical loading. The proposed methodology can be used to assess the in vitro and in vivo service life of Mg-based biomedical devices and optimize the design taking into account the effect of mechanical deformation on the corrosion rate. The model has the potential to advocate further development of Mg alloys as a biodegradable implant material for biomedical applications. STATEMENT OF SIGNIFICANCE: A physically-based model is developed to simulate the corrosion of bioabsorbable metals in environments that resemble biological fluids. The model captures pitting corrosion and incorporates the role of mechanical fields in enhancing the corrosion of bioabsorbable metals. Model predictions are validated against dedicated in vitro corrosion experiments on Mg wires. The potential of the model to capture mechano-chemical effects is demonstrated in representative examples. The simulations show that the presence of mechanical fields leads to the formation of cracks accelerating the failure of Mg wires, whereas pitting severely compromises the structural integrity of coronary Mg stents. This work extends phase-field modeling to bioengineering and provides a mechanistic tool for assessing the service life of bioabsorbable metallic biomedical devices.

Zn doped CaP coatings used for controlling the degradation rate of MgCa1 alloy: In vitro anticorrosive properties, sterilization and bacteria/cell-material interactions

The purpose of this study was to investigate the effect of Zn doped CaP coatings prepared by micro-arc oxidation method, as a possible approach to control MgCa1 alloy degradation. All the prepared coatings comprised a calcium deficient CaP phase. The control in this evaluation was performed with undoped CaP coating in SBF solution at body temperature (37 ± 0.5⁰C). The investigation involved determination of microchemical, mechanical, morphological, properties along with anticorrosive, cytocompatibility and antibacterial efficacy. The effect of sterilization process on the properties of the surfaces was also investigated. The results showed that the addition of Zn into CaP increased the corrosion resistance of MgCa1 alloy. Moreover, the adhesion strength of the coatings to MgCa1 alloy was enhanced by Zn addition. In cytotoxicity testing of the samples, extracts of the samples in MEM were incubated with L929 cells and malformation, degeneration and lysis of the cells were examined microscopically after 72 h. The results showed that all samples were cytocompatible. The degradation of MgCa1 alloy in the simulated body fluids (SBF) or DMEM was decreased by coating with CaP. Moreover, the degradation rate of CaP was further decreased by adding a small amount of Zn into the CaP matrix. The samples having CaP coatings and Zn doped CaP coating demonstrated antibacterial efficacy against E.coli. As a result, coating of magnesium alloy with Zn-doped CaP decreased the degradation rate, increased the corrosion resistance, cytocompatibility and the antibacterial effects of the alloys.

Mg-based materials diminish tumor spreading and cancer metastases

Cancer metastases are the most common causes of cancer-related deaths. The formation of secondary tumors at different sites in the human body can impair multiple organ function and dramatically decrease the survival of the patients. In this stage, it is difficulty to treat tumor growth and spreading due to arising therapy resistances. Therefore, it is important to prevent cancer metastases and to increase subsequent cancer therapy success. Cancer metastases are conventionally treated with radiation or chemotherapy. However, these treatments elicit lots of side effects, wherefore novel local treatment approaches are currently discussed. Recent studies already showed anticancer activity of specially designed degradable magnesium (Mg) alloys by reducing the cancer cell proliferation. In this work, we investigated the impact of these Mg-based materials on different steps of the metastatic cascade including cancer cell migration, invasion, and cancer-induced angiogenesis. Both, Mg and Mg–6Ag reduced cell migration and invasion of osteosarcoma cells in coculture with fibroblasts. Furthermore, the Mg-based materials used in this study diminished the cancer-induced angiogenesis. Endothelial cells incubated with conditioned media obtained from these Mg and Mg–6Ag showed a reduced cell layer permeability, a reduced proliferation and inhibited cell migration. The tube formation as a last step of angiogenesis was stimulated with the presence of Mg under normoxia and diminished under hypoxia.

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Magnesium (Mg)-based material degradation decrease cell migration and invasion of an osteosarcoma coculture.

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Mg-based material degradation products reduce cancer-induced angiogenesis at an early stage.

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These materials may reduce secondary tumor formation and metastases.

Toward understanding in vivo corrosion: Influence of interfacial hydrogen gas build-up on degradation of magnesium alloy implants

Limited material transport, causing gas cavities formation, is commonly observed during the degradation of magnesium implants, yet its effects on corrosion are not understood. Herein, a bespoke cell was designed, allowing for the incorporation of an additional agarose layer above the corroding magnesium sample. This design replicates the limited material transport in vitro and enables us to understand its influence on corrosion of magnesium alloys. This work investigated the influence of varying thickness of agarose (0-0.9 mm) on the corrosion of Mg-Zn-Zr magnesium alloy maintained at 37°C in phosphate-buffered saline (PBS). The introduction of agarose slowed transport of material away from the corroding magnesium surface, including the evolved hydrogen forming a gas cavity. It has been found that an initial increase in the agarose thickness (or the reduction in material transport) of 0.3 mm leads to an increase in the corrosion rate of the magnesium alloy by 62%. However, with a further increase in agarose thickness from 0.3 to 0.9 mm, the corrosion rate decreases by 37%. This observation has been attributed to the accumulation of, and competition between, chloride and hydroxide ions near the alloy's surface. In the presence of materials barrier, hydrogen measurement is no longer a reliable method for the measurement of corrosion rates. This study underscores the importance of the consideration of limited material transport during the in vitro corrosion tests of biomedical implants.

Progress in bioactive surface coatings on biodegradable Mg alloys: A critical review towards clinical translation

Mg and its alloys evince strong candidature for biodegradable bone implants, cardiovascular stents, and wound closing devices. However, their rapid degradation rate causes premature implant failure, constraining clinical applications. Bio-functional surface coatings have emerged as the most competent strategy to fulfill the diverse clinical requirements, besides yielding effective corrosion resistance. This article reviews the progress of biodegradable and advanced surface coatings on Mg alloys investigated in recent years, aiming to build up a comprehensive knowledge framework of coating techniques, processing parameters, performance measures in terms of corrosion resistance, adhesion strength, and biocompatibility. Recently developed conversion and deposition type surface coatings are thoroughly discussed by reporting their essential therapeutic responses like osteogenesis, angiogenesis, cytocompatibility, hemocompatibility, anti-bacterial, and controlled drug release towards in-vitro and in-vivo study models. The challenges associated with metallic, ceramic and polymeric coatings along with merits and demerits of various coatings have been illustrated. The use of multilayered hybrid coating comprising a unique combination of organic and inorganic components has been emphasized with future perspectives to obtain diverse bio-functionalities in a facile single coating system for orthopedic implant applications.

In-vivo bone remodeling potential of Sr-d-Ca-P /PLLA-HAp coated biodegradable ZK60 alloy bone plate

Magnesium and its alloys are widely applied biomaterials due to their biodegradability and biocompatibility. However, rapid degradation and hydrogen gas evolution hinder its applicability on a commercial scale. In this study, we developed an Mg alloy bone plate for bone remodeling and support after a fracture. We further coated the Mg alloy plate with Sr-D-Ca-P (Sr dopped Ca-P coating) and Sr-D-Ca-P/PLLA-HAp to evaluate and compare their biodegradability and biocompatibility in both in vitro and in vivo experiments. Chemical immersion and dip coating were employed for the formation of Sr-D-Ca-P and PLLA-HAp layers, respectively. In vitro evaluation depicted that both coatings delayed the degradation process and exhibited excellent biocompatibility. MC3T3-E1cells proliferation and osteogenic markers expression were also promoted. In vivo results showed that both Sr-D-Ca-P and Sr-D-Ca-P/PLLA-HAp coated bone plates had slower degradation rate as compared to Mg alloy. Remarkable bone remodeling was observed around the Sr-D-Ca-P/PLLA-HAp coated bone plate than bare Mg alloy and Sr-D-Ca-P coated bone plate. These results suggest that Sr-D-Ca-P/PLLA-HAp coated Mg alloy bone plate with lower degradation and enhanced biocompatibility can be applied as an orthopedic implant.

Bone Remodeling Interaction with Magnesium Alloy Implants Studied by SEM and EDX

The development direction of bioresorbable fixing structures is currently very relevant because it corresponds to the priority areas in worldwide biotechnology development. Magnesium (Mg)-based alloys are gaining high levels of attention due to their promising potential use as the basis for fixating structures. These alloys can be an alternative to non-degradable metal implants in orthopedics, maxillofacial surgery, neurosurgery, and veterinary medicine. In our study, we formulated a Mg-2Zn-2Ga alloy, prepared pins, and analyzed their biodegradation level based on SEM (scanning electron microscopy) and EDX (energy-dispersive X-ray analysis) after carrying out an experimental study on rats. We assessed the resorption parameters 1, 3, and 6 months after surgery. In general, the biodegradation process was characterized by the systematic development of newly formed bone tissue. Our results showed that Mg-2Zn-2Ga magnesium alloys are suitable for clinical applications.

Slow degrading Mg-based materials induce tumor cell dormancy on an osteosarcoma-fibroblast coculture model

Osteosarcoma is one of the most common cancers in young adults and is commonly treated using surgery and chemotherapy. During the past years, these therapy approaches improved but failed to ameliorate the outcomes. Therefore, novel, targeted therapeutic approaches should be established to enhance treatment success while preserving patient's quality of life. Recent studies suggest the application of degradable magnesium (Mg) alloys as orthopedic implants bearing a potential antitumor activity. Here, we examined the influence of Mg-based materials on an osteosarcoma-fibroblast coculture. Both, Mg and Mg-6Ag did not lead to tumor cell apoptosis at low degradation rates. Instead, the Mg-based materials induced cellular dormancy in the cancer cells indicated by a lower number of Ki-67 positive cancer cells and a higher p38 expression. This dormancy-like state could be reversed by reseeding on non-degrading glass slides but could not be provoked by inhibition of the protein kinase R-like endoplasmic reticulum kinase. By investigating the influence of the disjunct surface-near effects of the Mg degradation on cell proliferation, an increased pH was found to be a main initiator of Mg degradation-dependent tumor cell proliferation inhibition.

New dual-function in situ bone repair scaffolds promote osteogenesis and reduce infection

Background

The treatment of infectious bone defects is a difficult problem to be solved in the clinic. In situ bone defect repair scaffolds with anti-infection and osteogenic abilities can effectively deal with infectious bone defects. In this study, an in situ polycaprolactone (PCL) scaffold containing ampicillin (Amp) and Mg microspheres was prepared by 3D printing technology.

Results

Mg and Amp were evenly distributed in PCL scaffolds and could be released slowly to the surrounding defect sites with the degradation of scaffolds. In vitro experiments demonstrated that the PCL scaffold containing Mg and Amp (PCL@Mg/Amp) demonstrated good cell adhesion and proliferation. The osteogenic genes collagen I (COL-I) and Runx2 were upregulated in cells grown on the PCL@Mg/Amp scaffold. The PCL@Mg/Amp scaffold also demonstrated excellent antibacterial ability against E. coli and S. aureus. In vivo experiments showed that the PCL@Mg/Amp scaffold had the strongest ability to promote tibial defect repair in rats compared with the other groups of scaffolds.

Conclusions

This kind of dual-function in situ bone repair scaffold with anti-infection and osteogenic abilities has good application prospects in the field of treating infectious bone defects.

Biodegradable magnesium fixation screw for barrier membranes used in guided bone regeneration

An ideal fixation system for guided bone (GBR) regeneration in oral surgery must fulfil several criteria that includes the provision of adequate mechanical fixation, complete resorption when no longer needed, complete replacement by bone, as well as be biocompatible and have a good clinical manageability. For the first time, a biodegradable magnesium fixation screw made of the magnesium alloy WZM211 with a MgF₂ coating has been designed and tested to fulfill these criteria. Adequate mechanical fixation was shown for the magnesium fixation screw in several benchtop tests that directly compared the magnesium fixation screw with an equivalent polymeric resorbable device. Results demonstrated slightly superior mechanical properties of the magnesium device in comparison to the polymeric device even after 4 weeks of degradation. Biocompatibility of the magnesium fixation screw was demonstrated in several in vitro and in vivo tests. Degradation of the magnesium screw was investigated in in vitro and in vivo tests, where it was found that the screw is resorbed slowly and completely after 52 weeks, providing adequate fixation in the early critical healing phase. Overall, the magnesium fixation screw demonstrates all of the key properties required for an ideal fixation screw of membranes used in guided bone regeneration (GBR) surgeries.

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The first comprehensive report on experimental data for a biodegradable metallic fixation pin for use in oral surgery is presented.

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Results demonstrated superior mechanical properties of the Mg fixation pin in comparison to the polymeric pin even after 4 weeks of degradation.

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The MgF₂ coated Mg pin made of alloy WZM211 has a slow corrosion rate with a service time of 4 weeks and is fully resorped at 52 weeks after implantation.

Biodegradable magnesium barrier membrane used for guided bone regeneration in dental surgery

Barrier membranes are commonly used as part of the dental surgical technique guided bone regeneration (GBR) and are often made of resorbable collagen or non-resorbable materials such as PTFE. While collagen membranes do not provide sufficient mechanical protection of the covered bone defect, titanium reinforced membranes and non-resorbable membranes need to be removed in a second surgery. Thus, biodegradable GBR membranes made of pure magnesium might be an alternative. In this study a biodegradable pure magnesium (99.95%) membrane has been proven to have all of the necessary requirements for an optimal regenerative outcome from both a mechanical and biological perspective. After implantation, the magnesium membrane separates the regenerating bone from the overlying, faster proliferating soft tissue. During the initial healing period, the membrane maintained a barrier function and space provision, whilst retaining the positioning of the bone graft material within the defect space. As the magnesium metal corroded, it formed a salty corrosion layer and local gas cavities, both of which extended the functional lifespan of the membrane barrier capabilities. During the resorption of the magnesium metal and magnesium salts, it was observed that the membrane became surrounded and then replaced by new bone. After the membrane had completely resorbed, only healthy tissue remained. The in vivo performance study demonstrated that the magnesium membrane has a comparable healing response and tissue regeneration to that of a resorbable collagen membrane. Overall, the magnesium membrane demonstrated all of the ideal qualities for a barrier membrane used in GBR treatment.

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First report on a biodegradable metallic barrier membrane for use in oral surgery is presented.

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The mechanical stability of the metallic barrier membrane provides a careful shielding of the augmented bone defect.

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Full resorption of metallic barrier membrane and bone healing is completed long before current standards for second surgical patient treatment.

Biodegradable open-porous scaffolds made of sintered magnesium W4 and WZ21 short fibres show biocompatibility in vitro and in long-term in vivo evaluation

Open-porous scaffolds made of W4 and WZ21 fibres were evaluated to analyse their potential as an implant material. WZ21 scaffolds without any surface modification or coating, showed promising mechanical properties which were comparable to the W4 scaffolds tested in previous studies. Eudiometric testing results were dependent on the experimental setup, with corrosion rates differing by a factor of 3. Cytotoxicity testing of WZ21 showed sufficient cytocompatibility. The corrosion behavior of the WZ21 scaffolds in different cell culture media are indicating a selective dealloying of elements from the magnesium scaffold by different solutions. Long term in-vivo studies were using 24 W4 scaffolds and 12 WZ21 scaffolds, both implanted in rabbit femoral condyles. The condyles and important inner organs were explanted after 6, 12 and 24 weeks and analyzed. The in-vivo corrosion rate of the WZ21 scaffolds calculated by microCT-based volume loss was up to 49 times slower than the in-vitro corrosion rate based on weight loss. Intramembranous bone formation within the scaffolds of both alloys was revealed, however a low corrosion rate and formation of gas cavities at initial time points were also detected. No systemic or local toxicity could be observed. Investigations by μ-XRF did not reveal accumulation of yttrium in the neighboring tissue. In summary, the magnesium scaffold´s performance is biocompatible, but would benefit from a surface modification, such as a coating to obtain lower the initial corrosion rates, and hereby establish a promising open-porous implant material for load-bearing applications. STATEMENT OF SIGNIFICANCE: Magnesium is an ideal temporary implant material for non-load bearing applications like bigger bone defects, since it degrades in the body over time. Here we developed and tested in vitro and in a rabbit model in vivo degradable open porous scaffolds made of sintered magnesium W4 and WZ21 short fibres. These scaffolds allow the ingrowth of cells and blood vessels to promote bone healing and regeneration. Both fibre types showed in vitro sufficient cytocompatibility and proliferation rates and in vivo, no systemic toxicity could be detected. At the implantation site, intramembranous bone formation accompanied by ingrowth of supplying blood vessels within the scaffolds of both alloys could be detected.

Biodegradable Zn-Cu-Fe Alloy as a Promising Material for Craniomaxillofacial Implants: An in vitro Investigation into Degradation Behavior, Cytotoxicity, and Hemocompatibility

Zinc-based nanoparticles, nanoscale metal frameworks and metals have been considered as biocompatible materials for bone tissue engineering. Among them, zinc-based metals are recognized as promising biodegradable materials thanks to their moderate degradation rate ranging between magnesium and iron. Nonetheless, materials’ biodegradability and the related biological response depend on the specific implant site. The present study evaluated the biodegradability, cytocompatibility, and hemocompatibility of a hot-extruded zinc-copper-iron (Zn-Cu-Fe) alloy as a potential biomaterial for craniomaxillofacial implants. Firstly, the effect of fetal bovine serum (FBS) on in vitro degradation behavior was evaluated. Furthermore, an extract test was used to evaluate the cytotoxicity of the alloy. Also, the hemocompatibility evaluation was carried out by a modified Chandler-Loop model. The results showed decreased degradation rates of the Zn-Cu-Fe alloy after incorporating FBS into the medium. Also, the alloy exhibited acceptable toxicity towards RAW264.7, HUVEC, and MC3T3-E1 cells. Regarding hemocompatibility, the alloy did not significantly alter erythrocyte, platelet, and leukocyte counts, while the coagulation and complement systems were activated. This study demonstrated the predictable in vitro degradation behavior, acceptable cytotoxicity, and appropriate hemocompatibility of Zn-Cu-Fe alloy; therefore, it might be a candidate biomaterial for craniomaxillofacial implants.

Influence of Surface Roughness on Biodegradability and Cytocompatibility of High-Purity Magnesium

High-purity magnesium (Mg) is a promising biodegradable metal for oral and maxillofacial implants. Appropriate surface roughness plays a critical role in the degradation behavior and the related cellular processes of biodegradable Mg-based metals. Nevertheless, the most optimized surface roughness has been questionable, especially for Mg-based oral and maxillofacial implants. Three representative scales of surface roughness were investigated in this study, including smooth (Sa < 0.5 µm), moderately rough (Sa between 1.0−2.0 µm), and rough (Sa > 2.0 µm). The results indicated that the degradation rate of the Mg specimen in the cell culture medium was significantly accelerated with increased surface roughness. Furthermore, an extract test revealed that Mg with different roughness did not induce an evident cytotoxic effect. Nonetheless, the smooth Mg surface had an adversely affected cell attachment. Therefore, the high-purity Mg with a moderately rough surface exhibited the most optimized balance between biodegradability and overall cytocompatibility.

A biodegradable 3D woven magnesium-based scaffold for orthopedic implants

Porous Magnesium (Mg) is a promising biodegradable scaffold for treating critical-size bone defects, and as an essential element for human metabolism, Mg has shown sufficient biocompatibility. Its elastic moduli and yield strengths are closer to those of cortical bone than common, inert metallic implants, effectively reducing stress concentrations around host tissue as well as stress shielding. More importantly, Mg can degrade and be absorbed in the human body in a safe and controlled manner, thereby reducing the need for second surgeries to remove implants. The development of porous Mg scaffolds via conventional selective laser melting (SLM) techniques has been limited due to Mg’s low boiling point, high vapor pressures, high reactivity, and non-ideal microstructures in additively manufactured parts. Here we present an exciting alternative to conventional additive techniques: 3D weaving with Mg wires that have controlled chemistries and microstructures. The weaving process offers high throughput manufacturing as well as porous architectures that can be optimized for stiffness and porosity with topology optimization. Once woven, we dip-coat the weaves with polylactic acid (PLA) to enhance their strength and corrosion resistance. Following fabrication, we characterize their mechanical properties, corrosion behavior, and cell compatibility in vitro, and we use an intramuscular implantation model to evaluate their in vivo corrosion behavior and tissue response.

A review on properties of magnesium-based alloys for biomedical applications

With changing lifestyles, the demand for bone implantation has been increasing day by day. The deficiency of nutritious elements within the human body results in certain diseases like osteoporosis, rickets, and other skeletal disorders; lack of physical activities; and the increasing number of accidents are the primary reasons for bone damage/fracture. Metallic implants made up of chrome steel, cobalt-based alloys, and titanium-based alloys are being majorly used worldwide owing to their high strength and high corrosion resistance which makes them permanent orthopedic bioimplant materials, however, they display a stress-shielding effect and it also requires an implant removal surgery. Thus, these problems can be addressed through the employment of biodegradable materials. Among the available biodegradable metallic materials, Mg alloys have been identified as a prospective orthopedic implant material. These alloys are biodegradable as well as biocompatible, however, they experience a relatively higher rate of degradation limiting their usability as implant material. This study attempts to comprehensively assess the effects of various alloying elements such as Ca, Zn, Sn, Mn, Sr and Rare earth elements (REEs) on the mechanical and degradation behavior (bothin vivoandin vitro) of Mg alloys. Since the microstructure, mechanical properties and degradation response of the Mg alloys are dependent on the processing route, hence detailed processing- property database of different Mg alloys is provided in this paper.

Analysis of a Pure Magnesium Membrane Degradation Process and Its Functionality When Used in a Guided Bone Regeneration Model in Beagle Dogs

For the surgical technique of guided bone regeneration (GBR), the choice of available barrier membranes has until recently not included an option that is mechanically strong, durable, synthetic and resorbable. The most commonly used resorbable membranes are made from collagen, which are restricted in their mechanical strength. The purpose of this study is to evaluate the degradation and regeneration potential of a magnesium membrane compared to a collagen membrane. In eighteen beagle dogs, experimental bone defects were filled with bovine xenograft and covered with either a magnesium membrane or collagen membrane. The health status of the animals was regularly monitored and recorded. Following sacrifice, the hemimandibles were prepared for micro-CT (μ-CT) analysis. Complications during healing were observed in both groups, but ultimately, the regenerative outcome was similar between groups. The μ-CT parameters showed comparable results in both groups in terms of new bone formation at all four time points. In addition, the μ-CT analysis showed that the greatest degradation of the magnesium membranes occurred between 1 and 8 weeks and continued until week 16. The proportion of new bone within the defect site was similar for both treatment groups, indicating the potential for the magnesium membrane to be used as a viable alternative to collagen membranes. Overall, the new magnesium membrane is a functional and safe membrane for the treatment of defects according to the principles of GBR.

Influences of Extrusion and Silver Content on the Degradation of Mg-Ag Alloys In Vitro and In Vivo

Binary magnesium-silver (Mg-Ag) alloys were designed as antibacterial materials for biomedical implant applications. In the present study, we focused on the effects of extrusion (extrusion ratio (ER): 1, 7.1, and 72.2) and Ag content (Ag = 0, 3, and 6 wt.%) on the degradation of Mg-Ag alloys in vitro and in vivo via microstructure characterization and corrosion/degradation measurements. The results showed that the Ag promoted a galvanic reaction with the Mg matrix to accelerate degradation or formed a protective oxide mesh texture to inhibit degradation, especially in vivo. Ag might also be beneficial for product crystallization, biomineralization, and organic matter deposition. For pure Mg, extrusion produced a more refined grain and decreased the degradation rate. For the Mg-Ag alloys, a low extrusion ratio (7.1) accelerated the degradation caused by the increase in the proportion of the precipitate. This promoted the release of Mg2+ and Ag+, which led to more deposition of organic matter and calcium phosphate, but also more H2 bubbles, which led to disturbance of product deposition in some local positions or even inflammatory reactions. Extrusion at a higher ratio (72.2) dissolved the precipitates. This resulted in moderate degradation rates and less gas production, which promoted osteogenesis without an obvious inflammation reaction.

Biodegradable Magnesium Biomaterials-Road to the Clinic

In recent decades, we have witnessed radical changes in the use of permanent biomaterials. The intrinsic ability of magnesium (Mg) and its alloys to degrade without releasing toxic degradation products has led to a vast range of applications in the biomedical field, including cardiovascular stents, musculoskeletal, and orthopedic applications. With the use of biodegradable Mg biomaterials, patients would not suffer second surgery and surgical pain anymore. Be that as it may, the main drawbacks of these biomaterials are the high corrosion rate and unexpected degradation in physiological environments. Since biodegradable Mg-based implants are expected to show controllable degradation and match the requirements of specific applications, various techniques, such as designing a magnesium alloy and modifying the surface characteristics, are employed to tailor the degradation rate. In this paper, some fundamentals and particular aspects of magnesium degradation in physiological environments are summarized, and approaches to control the degradation behavior of Mg-based biomaterials are presented.

Fabrication and evaluation of bioresorbable scaffolds for interventional cardiology application with sufficient drug release

Objectives

Bioresorbable scaffolds have been advocated as the new generation in interventional cardiology because they could provide temporary scaffolds and then disappear with resorption. Although, the available stents in clinical trials exhibited biosafety, efficacy, no death, and no apparent thrombosis, Mg-substrate degradation on drug release has not been investigated.

Materials and Methods

Therefore, more research has been needed to legitimize the replacement of current stents with Mg-based stents. UV-Vis spectrophotometer, scanning electron microscope (SEM), X-ray diffraction (XRD), pH measurement, H₂ evolution, and corrosion tests determined the change in hybrid properties and drug release rate.

Results

The effect of Mg degradation on drug release from poly-L-lactide (PLLA) specimen was much higher than that of the L605/PLLA sample. Hydrogen evolution caused by magnesium degradation compelled everolimus out without significant PLLA decomposition during the first 100 days, while formation of Mg(OH)₂ caused the PLLA to deform and crack.

Conclusion

A combined mechanism of lattice/hole diffusion-dissolution governed the release of everolimus with the activation energies of 5.409 kJ/mol and 4.936 kJ/mol for the first 24 hr and diffusion coefficients 6.06×10^-10 and 3.64×10^-11cm²/s for the 50^th to 100^th days. Prolonged suppression of hyperplasia within the smooth muscle cells by hybrid stent insertion could bring about the cessation of restenosis.

Corrosion Resistance and Cytocompatibility of Magnesium-Calcium Alloys Modified with Zinc- or Gallium-Doped Calcium Phosphate Coatings

In orthopedic surgery, metals are preferred to support or treat damaged bones due to their high mechanical strength. However, the necessity for a second surgery for implant removal after healing creates problems. Therefore, biodegradable metals, especially magnesium (Mg), gained importance, although their extreme susceptibility to galvanic corrosion limits their applications. The focus of this study was to control the corrosion of Mg and enhance its biocompatibility. For this purpose, surfaces of magnesium-calcium (MgCa1) alloys were modified with calcium phosphate (CaP) or CaP doped with zinc (Zn) or gallium (Ga) via microarc oxidation. The effects of surface modifications on physical, chemical, and mechanical properties and corrosion resistance of the alloys were studied using surface profilometry, goniometry, scanning electron microscopy (SEM), energy-dispersive X-ray spectroscopy (EDS), nanoindentation, and electrochemical impedance spectroscopy (EIS). The coating thickness was about 5-8 μm, with grain sizes of 43.1 nm for CaP coating and 28.2 and 58.1 nm for Zn- and Ga-doped coatings, respectively. According to EIS measurements, the capacitive response (Y_c) decreased from 11.29 to 8.72 and 0.15 Ω^-1 cm^-2 sⁿ upon doping with Zn and Ga, respectively. The E_corr value, which was -1933 mV for CaP-coated samples, was found significantly electropositive at -275 mV for Ga-doped ones. All samples were cytocompatible according to indirect tests. In vitro culture with Saos-2 cells led to changes in the surface compositions of the alloys. The numbers of cells attached to the Zn-doped (2.6 × 10⁴ cells/cm²) and Ga-doped (6.3 × 10⁴ cells/cm²) coatings were higher than that on the surface of the undoped coating (1.0 × 10³ cells/cm²). Decreased corrosivity and enhanced cell affinity of the modified MgCa alloys (CaP coated and Zn and Ga doped, with Ga-doped ones having the greatest positive effect) make them novel and promising candidates as biodegradable metallic implant materials for the treatment of bone damages and other orthopedic applications.

Harnessing superhydrophobic coatings for enhancing the surface corrosion resistance of magnesium alloys

Clinical applications of magnesium (Mg) alloys have been severely limited by their rapid corrosion in physiological environments. Superhydrophobic coatings can prevent water from contacting the Mg alloy surface, retarding alloy corrosion. In this study, a superhydrophobic Mg alloy was prepared by depositing fluorine-modified SiO₂ nanoparticles (SiO₂-F NPs) with polydopamine (PDA). The dip-coating strategy presented is simple, green, can be undertaken without any complex equipment, has reduced power consumption, and decreased threat to human health. The as-prepared superhydrophobic Mg alloy is resistant to corrosion in simulated body fluid (SBF). The superhydrophobicity was stable after the tape, water-impact and sand-impact tests over multiple cycles. In addition, cytotoxicity investigations demonstrated that the superhydrophobic Mg alloy exhibited excellent cytocompatibility. This work opens up a new avenue in the design of superhydrophobic Mg alloys for corrosion resistance.

Evaluating the morphology of the degradation layer of pure magnesium via 3D imaging at resolutions below 40 nm

Magnesium is attractive for the application as a temporary bone implant due to its inherent biodegradability, non-toxicity and suitable mechanical properties. The degradation process of magnesium in physiological environments is complex and is thought to be a diffusion-limited transport problem. We use a multi-scale imaging approach using micro computed tomography and transmission X-ray microscopy (TXM) at resolutions below 40 nm. Thus, we are able to evaluate the nanoporosity of the degradation layer and infer its impact on the degradation process of pure magnesium in two physiological solutions. Magnesium samples were degraded in simulated body fluid (SBF) or Dulbecco's modified Eagle's medium (DMEM) with 10% fetal bovine serum (FBS) for one to four weeks. TXM reveals the three-dimensional interconnected pore network within the degradation layer for both solutions. The pore network morphology and degradation layer composition are similar for all samples. By contrast, the degradation layer thickness in samples degraded in SBF was significantly higher and more inhomogeneous than in DMEM+10%FBS. Distinct features could be observed within the degradation layer of samples degraded in SBF, suggesting the formation of microgalvanic cells, which are not present in samples degraded in DMEM+10%FBS. The results suggest that the nanoporosity of the degradation layer and the resulting ion diffusion processes therein have a limited influence on the overall degradation process. This indicates that the influence of organic components on the dampening of the degradation rate by the suppression of microgalvanic degradation is much greater in the present study.

Clinical translation and challenges of biodegradable magnesium-based interference screws in ACL reconstruction

As one of the most promising fixators developed for anterior cruciate ligament (ACL) reconstruction, biodegradable magnesium (Mg)-based interference screws have gained increasing attention attributed to their appropriate modulus and favorable biological properties during degradation after surgical insertion. However, its fast degradation and insufficient mechanical strength have also been recognized as one of the major causes to limit their further application clinically. This review focused on the following four parts. Firstly, the advantages of Mg or its alloys over their counterparts as orthopaedic implants in the fixation of tendon grafts in ACL reconstruction were discussed. Subsequently, the underlying mechanisms behind the contributions of Mg ions to the tendon-bone healing were introduced. Thirdly, the technical challenges of Mg-based interference screws towards clinical trials were discussed, which was followed by the introduction of currently used modification methods for gaining improved corrosion resistance and mechanical properties. Finally, novel strategies including development of Mg/Titanium (Ti) hybrid fixators and Mg-based screws with innovative structure for achieving clinically customized therapies were proposed. Collectively, the advancements in the basic and translational research on the Mg-based interference screws may lay the foundation for exploring a new era in the treatment of the tendon-bone insertion (TBI) and related disorders.

3D-printed Mg-incorporated PCL-based scaffolds: A promising approach for bone healing

3D-printed scaffolds have been developed as potential therapeutic strategies in bone tissue engineering. Mg/PCL biomaterials have been attracted much attention owing to biocompatibility, biodegradability as well as tunable mechanical properties. In this work, we developed 3D-printed customized Mg/PCL composite scaffolds with enhanced osteogenesis and biomineralization. Mg microparticles embedded in PCL-based scaffolds took a positive role in the improvement of biocompatibility, biomineralization, and biodegradable abilities. When incorporated with 3 wt% Mg, PCL-based scaffolds exhibited the optimal bone repairing ability in vitro and in vivo. The in vitro experiments indicated that 3 Mg/PCL scaffolds had improved mechanical properties, good biocompatibility, enhanced osteogenic and angiogenic activities. Besides, the in vivo studies demonstrated that Mg/PCL scaffolds promoted tissue ingrowth and new bone formation. In sum, these findings indicated that 3D-printed cell-free Mg/PCL scaffolds are promising strategies for bone healing application.

Magnesium-based materials in orthopaedics: material properties and animal models

As a new generation of medical metal materials, degradable magnesium-based materials have excellent mechanical properties and osteogenic promoting ability, making them promising materials for the treatment of refractory bone diseases. Animal models can be used to understand and evaluate the performance of materials in complex physiological environments, providing relevant data for preclinical evaluation of implants and laying the foundation for subsequent clinical studies. To date, many researchers have studied the biocompatibility, degradability and osteogenesis of magnesium-based materials, but there is a lack of review regarding the effects of magnesium-based materials in vivo. In view of the growing interest in these materials, this review briefly describes the properties of magnesium-based materials and focuses on the safety and efficacy of magnesium-based materials in vivo. Various animal models including rats, rabbits, dogs and pigs are covered to better understand and evaluate the progress and future of magnesium-based materials. This literature analysis reveals that the magnesium-based materials have good biocompatibility and osteogenic activity, thus causing no adverse reaction around the implants in vivo, and that they exhibit a beneficial effect in the process of bone repair. In addition, the degradation rate in vivo can also be improved by means of alloying and coating. These encouraging results show a promising future for the use of magnesium-based materials in musculoskeletal disorders.

In silico modelling of the corrosion of biodegradable magnesium-based biomaterials: modelling approaches, validation and future perspectives

Metallic biomedical implants based on magnesium, zinc and iron alloys have emerged as bioresorbable alternatives to permanent orthopaedic implants over the last two decades. The corrosion rate of biodegradable metals plays a critical role in controlling the compatibility and functionality of the device in vivo. The broader adoption of biodegradable metals in orthopaedic applications depends on developing in vitro methods that accurately predict the biodegradation behaviour in vivo. However, the physiological environment is a highly complex corrosion environment to replicate in the laboratory, making the in vitro-to-in vivo translation of results very challenging. Accordingly, the results from in vitro corrosion tests fail to provide a complete schema of the biodegradation behaviour of the metal in vivo. In silico approach based on computer simulations aim to bridge the observed differences between experiments performed in vitro and vivo. A critical review of the state-of-the-art of computational modelling techniques for predicting the corrosion behaviour of magnesium alloy as a biodegradable metal is presented.

Degradation Analysis of Thin Mg-xAg Wires Using X-ray Near-Field Holotomography

Magnesium–silver alloys are of high interest for the use as temporary bone implants due to their antibacterial properties in addition to biocompatibility and biodegradability. Thin wires in particular can be used for scaffolding, but the determination of their degradation rate and homogeneity using traditional methods is difficult. Therefore, we have employed 3D imaging using X-ray near-field holotomography with sub-micrometer resolution to study the degradation of thin (250 μm diameter) Mg-2Ag and Mg-6Ag wires. The wires were studied in two states, recrystallized and solution annealed to assess the influence of Ag content and precipitates on the degradation. Imaging was employed after degradation in Dulbecco’s modified Eagle’s medium and 10% fetal bovine serum after 1 to 7 days. At 3 days of immersion the degradation rates of both alloys in both states were similar, but at 7 days higher silver content and solution annealing lead to decreased degradation rates. The opposite was observed for the pitting factor. Overall, the standard deviation of the determined parameters was high, owing to the relatively small field of view during imaging and high degradation inhomogeneity of the samples. Nevertheless, Mg-6Ag in the solution annealed state emerges as a potential material for thin wire manufacturing for implants.

Exploring the degradation behavior of MgXAg alloys by in vitro electrochemical methods

Magnesium as biodegradable biomaterial could serve as bone augmentation material in implant dentistry. The knowledge about the predictability of the biodegradation process is essential as this process needs to go hand in hand with the formation of new bone to gradually replace the augmentation material. Therefore, this work aimed to assess if the electrochemistry (EC) measurements of the corrosion process correlate with the surface features at various time points during the surface degradation, in order to describe the degradation process of Mg and Mg alloys more reliably, under the assumption that differences in EC behavior can be detected and related to specific patterns on the surface.

In this test setup, a special optical chamber was used for electrochemical measurements on Mg and Mg-alloys (Mg2Ag, Mg4Ag, and Mg6Ag). Specimens were investigated using different circulating cell culture solutions as electrolytes, these were minimum essential medium (MEM), Hank's Balanced Salt Solution (HBSS), and MEM+ (MEM with added sodium hydrogen carbonate) at 37 °C. Open circuit potential measurements (OCP) over 30 min followed by cyclic polarization were performed. The electrochemistry data, including OCP, exchange current density and corrosion potential, were compared with visible changes at the surface during these treatments over time. The results show that the addition of silver (Ag) leads to a “standardization” of the degradation regardless of the selected test medium. It is currently difficult to correlate the visible microscopic changes with the data taken from the measurements. Therefore, further investigations are necessary.

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MgXAg alloys were investigated electrochemically in MEM, HBSS and MEM+ at 37℃ in circulated electrolyte.

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A correlation between optical appearance and electrochemical data was performed.

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Visible high activity on the surface corresponded with high electrochemical activity.

Investigation of the impact of magnesium versus titanium implants on protein composition in osteoblast by label free quantification

Metallic implant biomaterials predominate in orthopaedic surgery. Compared to titanium-based permanent implants, magnesium-based ones offer new possibilities as they possess mechanical properties closer to the ones of bones and they are biodegradable. Furthermore, magnesium is more and more considered to be "bioactive" i.e., able to elicit a specific tissue response or to strengthen the intimate contact between the implant and the osseous tissue. Indeed, several studies demonstrated the overall beneficial effect of magnesium-based materials on bone tissue (in vivo and in vitro). Here, the direct effects of titanium and magnesium on osteoblasts were measured on proteomes levels in order to highlight metal-specific and relevant proteins. Out of 2100 identified proteins, only 10 and 81 differentially regulated proteins, compare to the control, were isolated for titanium and magnesium samples, respectively. Selected ones according to their relationship to bone tissue were further discussed. Most of them were involved in extracellular matrix maturation and remodelling (two having a negative effect on mineralisation). A fine-tuned balanced between osteoblast maturation, differentiation and viability was observed.

Biomimetic Strontium Substituted Calcium Phosphate Coating for Bone Regeneration

Cellulose acetate (CA)/strontium phosphate (SrP) hybrid coating has been proposed as an effective strategy to build up novel bone-like structures for bone healing since CA is soluble in most organic solvents. Strontium (Sr2+) has been reported as a potential agent to treat degenerative bone diseases due to its osteopromotive and antibacterial effects. Herein, bioactive hybrid composite SrP-based coatings (CASrP) were successfully produced for the first time. CASrP was synthesized via a modified biomimetic method (for 7—CA7dSrP, and 14 days—CA14dSrP), in which the metal ion Sr2+ was used in place of Ca2+ in the simulated body fluid. Energy-dispersive X-ray (EDX) and Fourier transform infrared spectroscopy (FTIR) analysis confirmed the SrP incorporation chemically in the CASrP samples. Atomic absorption spectroscopy (AAS) supported EDX data, showing Sr2+ adsorption into CA, and its significant increase with the augmentation of time of treatment (ca. 92%—CA7dSrP and 96%—CA14dSrP). An increment in coating porosity and the formation of SrP crystals were evidenced by scanning electron microscopy (SEM) images. X-ray diffraction (XRD) evidenced a greater crystallinity than CA membranes and a destabilization of CA14dSrP structure compared to CA7dSrP. The composites were extremely biocompatible for fibroblast and osteoblast cells. Cell viability (%) was higher either for CA7dSrP (48 h: ca. 92% and 115%) and CA14dSrP (48 h: ca. 88% and 107%) compared to CA (48 h: ca. 70% and 51%) due to SrP formation and Sr2+ presence in its optimal dose in the culture media (4.6–9 mg·L−1). In conclusion, the findings elucidated here evidence the remarkable potential of CA7dSrP and CA14dSrP as bioactive coatings on the development of implant devices for inducing bone regeneration.

Engineering a Bioactive Hybrid Coating for In Vitro Corrosion Control of Magnesium and Its Alloy

Magnesium (Mg) and its alloys are promising biodegradable metallic implant materials. However, their clinical applications are limited by their fast corrosion rate in the biological environment. In this work, with an outlook to improve the in vitro corrosion resistance of Mg and WE43 Mg alloy, a layer-by-layer interfacially engineered anticorrosive and bioactive coating consisting of a natural oxide lower layer, hydroxyapatite (HA) middle layer, and silk fibroin (SF) top layer was fabricated and investigated. Anodization was used to create natural oxide layer induced microroughness on substrates. The electrochemically deposited HA layer improved the surface microroughness and microhardness but significantly decreased Mg ion release, hydrogen gas evolution, and weight loss in simulated body fluid. The spin-coated SF layer further decreased hydrophilicity, in vitro degradation, and corrosion rate. The nonspecific and specific intermolecular interactions between fabricated layers along with their mechanical interlocking interface contributed to improved adhesion strength and integrity of the coating. The SF+HA-coated samples showed enhanced degradation and corrosion resistance due to a synergistic effect of the underlying HA layer, hindering the ingress of aggressive ions and the top hydrophobic SF layer, preventing the ingress of corrosive solution. The SF+HA-coated Mg and WE43 Mg alloy samples exhibited 50 and 26 times decreased corrosion rate, respectively, compared to uncoated samples. Moreover, in vitro cytotoxicity and cell culture studies using a mouse fibroblast cell showed that the SF+HA hybrid coating improved the cell viability, attachment, and proliferation, with cells exhibiting elongated morphology on coated samples as compared to a round shape on uncoated samples.