Recent development in multizonal scaffolds for osteochondral regeneration

Osteochondral Regeneration With Anatomical Scaffold 3D-Printing-Design Considerations for Interface Integration

There is a clinical need for osteochondral scaffolds with complex geometries for restoring articulating joint surfaces. To address that need, 3D-printing has enabled scaffolds to be created with anatomically shaped geometries and interconnected internal architectures, going beyond simple plug-shaped scaffolds that are limited to small, cylindrical, focal defects. A key challenge for restoring articulating joint surfaces with 3D-printed constructs is the mechanical loading environment, particularly to withstand delamination or mechanical failure. Although the mechanical performance of interfacial scaffolds is essential, interface strength testing has rarely been emphasized in prior studies with stratified scaffolds. In the pioneering studies where interface strength was assessed, varying methods were employed, which has made direct comparisons difficult. Therefore, the current review focused on 3D-printed scaffolds for osteochondral applications with an emphasis on interface integration and biomechanical evaluation. This 3D-printing focus included both multiphasic cylindrical scaffolds and anatomically shaped scaffolds. Combinations of different 3D-printing methods (e.g., fused deposition modeling, stereolithography, bioprinting with pneumatic extrusion of cell-laden hydrogels) have been employed in a handful of studies to integrate osteoinductive and chondroinductive regions into a single scaffold. Most 3D-printed multiphasic structures utilized either an interdigitating or a mechanical interlocking design to strengthen the construct interface and to prevent delamination during function. The most effective approach to combine phases may be to infill a robust 3D-printed osteal polymer with an interlocking chondral phase hydrogel. Mechanical interlocking is therefore recommended for scaling up multiphasic scaffold applications to larger anatomically shaped joint surface regeneration. For the evaluation of layer integration, the interface shear test is recommended to avoid artifacts or variability that may be associated with alternative approaches that require adhesives or mechanical grips. The 3D-printing literature with interfacial scaffolds provides a compelling foundation for continued work toward successful regeneration of injured or diseased osteochondral tissues in load-bearing joints such as the knee, hip, or temporomandibular joint.

A phosphate glass reinforced composite acrylamide gradient scaffold for osteochondral interface regeneration

The bone-cartilage interface is defined by a unique arrangement of cells and tissue matrix. Injury to the interface can contribute to the development of arthritic joint disease. Attempts to repair osteochondral damage through clinical trials have generated mixed outcomes. Tissue engineering offers the potential of integrated scaffold design with multiregional architecture to assist in tissue regeneration, such as the bone-cartilage interface. Challenges remain in joining distinct materials in a single scaffold mass while maintaining integrity and avoiding delamination. The aim of the current work is to examine the possibility of joining two closely related acrylamide derivatives such as, poly n-isopropyl acrylamide (pNIPAM) and poly n‑tert‑butyl acrylamide (pNTBAM). The target is to produce a single scaffold unit with distinct architectural regions in the favour of regenerating the osteochondral interface. Longitudinal phosphate glass fibres (PGFs) with the formula 50P2O5.30CaO.20Na2O were incorporated to provide additional bioactivity by degradation to release ions such as calcium and phosphate which are considered valuable to assist the mineralization process. Polymers were prepared via atom transfer radical polymerization (ATRP) and solutions cast to ensure the integration of polymers chains. Scaffold was characterized using scanning electron microscope (SEM) and Fourier transform infra-red (FTIR) techniques. The PGF mass degradation pattern was inspected using micro computed tomography (µCT). Biological assessment of primary human osteoblasts (hOBs) and primary human chondrocytes (hCHs) upon scaffolds was performed using alizarin red and colorimetric calcium assay for mineralization assessment; alcian blue staining and dimethyl-methylene blue (DMMB) assay for glycosaminoglycans (GAGs); immunostaining and enzyme-linked immunosorbent assay (ELISA) to detect functional proteins expression by cells such as collagen I, II, and annexin A2. FTIR analysis revealed an intact unit with gradual transformation from pNIPAM to pNTBAM. SEM images showed three distinct architectural regions with mean pore diameter of 54.5 µm (pNIPAM), 16.5 µm (pNTBAM) and 118 µm at the mixed interface. Osteogenic and mineralization potential by cells was observed upon the entire scaffold's regions. Chondrogenic activity was relevant on the pNTBAM side of the scaffold only with minimal evidence in the pNIPAM region. PGFs increased mineralization potential of both hOBs and hCHs, evidenced by elevated collagens I, X, and annexin A2 with reduction of collagen II in PGFs scaffolds. In conclusion, pNIPAM and pNTBAM integration created a multiregional scaffold with distinct architectural regions. Differential chondrogenic, osteogenic, and mineralized cell performance, in addition to the impact of PGF, suggests a potential role for phosphate glass-incorporated, acrylamide-derivative scaffolds in osteochondral interface regeneration.

A nanozyme-functionalized bilayer hydrogel scaffold for modulating the inflammatory microenvironment to promote osteochondral regeneration

BACKGROUND

The incidence of osteochondral defects caused by trauma, arthritis or tumours is increasing annually, but progress has not been made in terms of treatment methods. Due to the heterogeneous structure and biological characteristics of cartilage and subchondral bone, the integration of osteochondral repair is still a challenge.

RESULTS

In the present study, a novel bilayer hydrogel scaffold was designed based on anatomical characteristics to imitate superficial cartilage and subchondral bone. The scaffold showed favourable biocompatibility, and the addition of an antioxidant nanozyme (LiMn2O4) promoted reactive oxygen species (ROS) scavenging by upregulating antioxidant proteins. The cartilage layer effectively protects against chondrocyte degradation in the inflammatory microenvironment. Subchondral bionic hydrogel scaffolds promote osteogenic differentiation of rat bone marrow mesenchymal stem cells (BMSCs) by regulating the AMPK pathway in vitro. Finally, an in vivo rat preclinical osteochondral defect model confirmed that the bilayer hydrogel scaffold efficiently promoted cartilage and subchondral bone regeneration.

CONCLUSIONS

In general, our biomimetic hydrogel scaffold with the ability to regulate the inflammatory microenvironment can effectively repair osteochondral defects. This strategy provides a promising method for regenerating tissues with heterogeneous structures and biological characteristics.

Scaffold design considerations for peripheral nerve regeneration

Peripheral nerve injury (PNI) represents a serious clinical and public health problem due to its high incurrence and poor spontaneous recovery. Compared to autograft, which is still the best current practice for long-gap peripheral nerve defects in clinics, the use of polymer-based biodegradable nerve guidance conduits (NGCs) has been gaining momentum as an alternative to guide the repair of severe PNI without the need of secondary surgery and donor nerve tissue. However, simple hollow cylindrical tubes can barely outperform autograft in terms of the regenerative efficiency especially in critical sized PNI. With the rapid development of tissue engineering technology and materials science, various functionalized NGCs have emerged to enhance nerve regeneration over the past decades. From the aspect of scaffold design considerations, with a specific focus on biodegradable polymers, this review aims to summarize the recent advances in NGCs by addressing the onerous demands of biomaterial selections, structural designs, and manufacturing techniques that contributes to the biocompatibility, degradation rate, mechanical properties, drug encapsulation and release efficiency, immunomodulation, angiogenesis, and the overall nerve regeneration potential of NGCs. In addition, several commercially available NGCs along with their regulation pathways and clinical applications are compared and discussed. Lastly, we discuss the current challenges and future directions attempting to provide inspiration for the future design of ideal NGCs that can completely cure long-gap peripheral nerve defects.

Materials Suitable for Osteochondral Regeneration

Osteochondral defects affect articular cartilage, calcified cartilage, and subchondral bone. The main problem that they cause is a different behavior of cell tissue in the osteochondral and bone part. Articular cartilage is composed mainly of collagen II, glycosaminoglycan (GAG), and water, and has a low healing ability due to a lack of vascularization. However, bone tissue is composed of collagen I, proteoglycans, and inorganic composites such as hydroxyapatite. Due to the discrepancy between the characters of these two parts, it is difficult to find materials that will meet all the structural and other requirements for effective regeneration. When designing a scaffold for an osteochondral defect, a variety of materials are available, e.g., polymers (synthetic and natural), inorganic particles, and extracellular matrix (ECM) components. All of them require the accurate characterization of the prepared materials and a number of in vitro and in vivo tests before they are applied to patients. Taken in concert, the final material needs to mimic the structural, morphological, chemical, and cellular demands of the native tissue. In this review, we present an overview of the structure and composition of the osteochondral part, especially synthetic materials with additives appropriate for healing osteochondral defects. Finally, we summarize in vitro and in vivo methods suitable for evaluating materials for restoring osteochondral defects.

Integrating coaxial electrospinning and 3D printing technologies for the development of biphasic porous scaffolds enabling spatiotemporal control in tumor ablation and osteochondral regeneration

The osteochondral defects (OCDs) resulting from the treatment of giant cell tumors of bone (GCTB) often present two challenges for clinicians: tumor residue leading to local recurrence and non-healing of OCDs. Therefore, this study focuses on developing a double-layer PGPC-PGPH scaffold using shell-core structure nanofibers to achieve "spatiotemporal control" for treating OCDs caused by GCTB. It addresses two key challenges: eliminating tumor residue after local excision and stimulating osteochondral regeneration in non-healing OCD cases. With a shell layer of protoporphyrin IX (PpIX)/gelatin (GT) and inner cores containing chondroitin sulfate (CS)/poly(lactic-co-glycolic acid) (PLGA) or hydroxyapatite (HA)/PLGA, coaxial electrospinning technology was used to create shell-core structured PpIX/GT-CS/PLGA and PpIX/GT-HA/PLGA nanofibers. These nanofibers were shattered into nano-scaled short fibers, and then combined with polyethylene oxide and hyaluronan to formulate distinct 3D printing inks. The upper layer consists of PpIX/GT-CS/PLGA ink, and the lower layer is made from PpIX/GT-HA/PLGA ink, allowing for the creation of a double-layer PGPC-PGPH scaffold using 3D printing technique. After GCTB lesion removal, the PGPC-PGPH scaffold is surgically implanted into the OCDs. The sonosensitizer PpIX in the shell layer undergoes sonodynamic therapy to selectively damage GCTB tissue, effectively eradicating residual tumors. Subsequently, the thermal effect of sonodynamic therapy accelerates the shell degradation and release of CS and HA within the core layer, promoting stem cell differentiation into cartilage and bone tissues at the OCD site in the correct anatomical position. This innovative scaffold provides temporal control for anti-tumor treatment followed by tissue repair and spatial control for precise osteochondral regeneration.

High temperature oxidation treated 3D printed anatomical WE43 alloy scaffolds for repairing periarticular bone defects: In vitro and in vivo studies

Reconstruction of subarticular bone defects is an intractable challenge in orthopedics. The simultaneous repair of cancellous defects, fractures, and cartilage damage is an ideal surgical outcome. 3D printed porous anatomical WE43 (magnesium with 4 wt% yttrium and 3 wt% rare earths) scaffolds have many advantages for repairing such bone defects, including good biocompatibility, appropriate mechanical strength, customizable shape and structure, and biodegradability. In a previous investigation, we successfully enhanced the corrosion resistance of WE43 samples via high temperature oxidation (HTO). In the present study, we explored the feasibility and effectiveness of HTO-treated 3D printed porous anatomical WE43 scaffolds for repairing the cancellous bone defects accompanied by split fractures via in vitro and in vivo experiments. After HTO treatment, a dense oxidation layer mainly composed of Y2O3 and Nd2O3 formed on the surface of scaffolds. In addition, the majority of the grains were equiaxed, with an average grain size of 7.4 μm. Cell and rabbit experiments confirmed the non-cytotoxicity and biocompatibility of the HTO-treated WE43 scaffolds. After the implantation of scaffolds inside bone defects, their porous structures could be maintained for more than 12 weeks without penetration and for more than 6 weeks with penetration. During the postoperative follow-up period for up to 48 weeks, radiographic examinations and histological analysis revealed that abundant bone gradually regenerated along with scaffold degradation, and stable osseointegration formed between new bone and scaffold residues. MRI images further demonstrated no evidence of any obvious damage to the cartilage, ligaments, or menisci, confirming the absence of traumatic osteoarthritis. Moreover, finite element analysis and biomechanical tests further verified that the scaffolds was conducive to a uniform mechanical distribution. In conclusion, applying the HTO-treated 3D printed porous anatomical WE43 scaffolds exhibited favorable repairing effects for subarticular cancellous bone defects, possessing great potential for clinical application.

A review of chitosan-based shape memory materials: Stimuli-responsiveness, multifunctionalities and applications

Shape memory polymers (SMPs), as a type of smart materials, possess the unique shape memory and deformation recovery abilities. Hence, SMPs have been attracted extensive attentions and widely used in fields of electric devices, aerospace structures and biomedical engineering. Chitosan (CS), as a renewable natural biomass material, exhibits the excellent biocompatibility, biodegradability and antibacterial activities. Using biomass CS as SMPs matrix materials could greatly enhance the environmental friendliness and adaptability, promoting the applications in fields of biomedical engineering and smart devices. This paper provides a detailed overview of current research progress about CS-based SMPs, including diverse stimuli responsiveness, multifunctionalities and various applications. Though, the research on CS-based SMPs is still in the early stage, which exhibits extensive prospect and potential, and could be of significance in advancing smart biomedical technologies.

Double-edged role of mechanical stimuli and underlying mechanisms in cartilage tissue engineering

Mechanical stimuli regulate the chondrogenic differentiation of mesenchymal stem cells and the homeostasis of chondrocytes, thus affecting implant success in cartilage tissue engineering. The mechanical microenvironment plays fundamental roles in the maturation and maintenance of natural articular cartilage, and the progression of osteoarthritis Hence, cartilage tissue engineering attempts to mimic this environment in vivo to obtain implants that enable a superior regeneration process. However, the specific type of mechanical loading, its optimal regime, and the underlying molecular mechanisms are still under investigation. First, this review delineates the composition and structure of articular cartilage, indicating that the morphology of chondrocytes and components of the extracellular matrix differ from each other to resist forces in three top-to-bottom overlapping zones. Moreover, results from research experiments and clinical trials focusing on the effect of compression, fluid shear stress, hydrostatic pressure, and osmotic pressure are presented and critically evaluated. As a key direction, the latest advances in mechanisms involved in the transduction of external mechanical signals into biological signals are discussed. These mechanical signals are sensed by receptors in the cell membrane, such as primary cilia, integrins, and ion channels, which next activate downstream pathways. Finally, biomaterials with various modifications to mimic the mechanical properties of natural cartilage and the self-designed bioreactors for experiment in vitro are outlined. An improved understanding of biomechanically driven cartilage tissue engineering and the underlying mechanisms is expected to lead to efficient articular cartilage repair for cartilage degeneration and disease.

Use of polyglycolic acid-hyaluronic acid/β-tricalcium phosphate scaffold with or without mesenchymal stem cells found ineffective in treating osteochondral lesions in rabbit knees

OBJECTIVE

In this experimental animal study, a novel bilayered scaffold used in the treatment of osteochondral defects in rabbit knees was evaluated. This novel scaffold's upper (cartilage) layer consists of polyglycolic acid and hyaluronic acid, and the lower (bone) layer consists of β-tricalcium phosphate. The purpose of this study was to evaluate the efficacy of this novel scaffold, combined with or without mesenchymal stem cells (MSCs), in the treatment of osteochondral defects in rabbit knees.

METHODS

Osteochondral defects were created in the left femoral trochlea of 30 rabbits. In group A, defects were treated with scaffold combined with MSCs; in group B, defects were treated with cell-free scaffolds; and group C was a control group with defects left untreated. In the 12th week, animals were sacrificed for macroscopic evaluation.

RESULTS

The mean International Cartilage Repair Society (ICRS) macroscopic scores were 4.95 for group A, 6.16 for group B, and 8.25 for group C. The mean Oswestry Arthroscopic Scores (OAS) were 1.65 for group A, 3.39 for group B, and 6.05 for group C. The macroscopic scores were significantly higher in group C than group A for ICRS scores and group A and group B for OAS (P < .001, P < .000, P < .022).

CONCLUSION

In essence, our findings indicate that the newly developed osteochondral scaffold, when tested in a rabbit model, is not as effective as expected in repairing full-thickness osteochondral defects, with or without the supplementation of MSCs. Further investigation is required to enhance the effectiveness of this novel combination.

Effect of glycosaminoglycans with different degrees of sulfation on chondrogenesis

OBJECTIVES

This study aims to investigate the effects and mechanisms of chondroitin sulfate (CS), dermatan sulfate (DS), and heparin (HEP) on chondrogenesis of murine chondrogenic cell line (ATDC5) cells and the maintenance of murine articular cartilage in vitro.

METHODS

ATDC5 and articular cartilage tissue explant were cultured in the medium containing different sulfated glycosaminoglycans. Cell proliferation, differentiation, cartilage formation, and mechanism were observed using cell proliferation assay, Alcian blue staining, real-time quantitative polymerase chain reaction (RT-qPCR), and Western blot, respectively.

RESULTS

Results showed that HEP and DS primarily activated the bone morphogenetic protein (BMP) signal pathway, while CS primarily activated the protein kinase B (AKT) signal pathway, further promoted ATDC5 cell proliferation and matrix production, and increased Sox9, Col2a1, and Aggrecan expression.

CONCLUSIONS

This study investigated the differences and mechanisms of different sulfated glycosaminoglycans in chondrogenesis and cartilage homeostasis maintenance. HEP promotes cartilage formation and maintains the normal state of cartilage tissue in vitro, while CS plays a more effective role in the regeneration of damaged cartilage tissue.

New Photocrosslinked 3D Foamed Scaffolds Based on GelMA Copolymers: Potential Application in Bone Tissue Engineering

The production of customized polymeric hydrogels in the form of 3D scaffolds with application in bone tissue engineering is currently a topic of great interest. Based on gelatin methacryloyl (GelMa) as one of the most popular used biomaterials, GelMa with two different methacryloylation degrees (DM) was obtained, to achieve crosslinked polymer networks by photoinitiated radical polymerization. In this work, we present the obtention of new 3D foamed scaffolds based on ternary copolymers of GelMa with vinylpyrrolidone (VP) and 2-hydroxyethylmethacrylate (HEMA). All biopolymers obtained in this work were characterized by infrared spectroscopy (FTIR) and thermogravimetric analysis (TGA), whose results confirm the presence of all copolymers in the crosslinked biomaterial. In addition, scanning electron microscopy (SEM) pictures were obtained verifying the presence of the porosity created by freeze-drying process. In addition, the variation in its swelling degree and its enzymatic degradation in vitro was analyzed as a function of the different copolymers obtained. This has allowed us to observe good control of the variation in these properties described above in a simple way by varying the composition of the different comonomers used. Finally, with these concepts in mind, biopolymers obtained were tested through assessment of several biological parameters such as cell viability and differentiation with MC3T3-E1 pre-osteoblastic cell line. Results obtained show that these biopolymers maintain good results in terms of cell viability and differentiation, along with tunable properties in terms of hydrophilic character, mechanical properties and enzymatic degradation.