Controllable biodegradability, drug release behavior and hemocompatibility of PTX-eluting magnesium stents

Hierarchical Hybrid Coatings with Drug-Eluting Capacity for Mg Alloy Biomaterials

A hierarchical hybrid coating (HHC) comprising a ceramic oxide layer and two biodegradable polymeric (polycaprolactone, PCL) layers has been developed on Mg3Zn0.4Ca cast alloy in order to provide a controlled degradation rate and functionality by creating a favorable porous surface topography for cell adhesion. The inner, ceramic layer formed by plasma electrolytic oxidation (PEO) has been enriched in bioactive elements (Ca, P, Si). The intermediate PCL layer sealed the defect in the PEO layer and the outer microporous PCL layer loaded with the appropriate active molecule, thus providing drug-eluting capacity. Morphological, chemical, and biological characterizations of the manufactured coatings loaded with ciprofloxacin (CIP) and paracetamol (PAR) have been carried out. In vitro assays with cell lines relevant for cardiovascular implants and bone prosthesis (endothelial cells and premyoblasts) showed that the drug-loaded coating allows for cell proliferation and viability. The study of CIP and PAR cytotoxicity and release rate indicated that the porous PCL layer does not release concentrations detrimental to the cells. However, complete system assays revealed that corrosion behavior and increase of the pH negatively affects cell viability. H2 evolution during corrosion of Mg alloy substrate generates blisters in PCL layer that accelerate the corrosion locally in crevice microenvironment. A detailed mechanism of the system degradation is disclosed. The accelerated degradation of the developed system may present interest for its further adaptation to new cancer therapy strategies.

Heparin-Loaded Composite Coatings on Porous Stent from Pure Magnesium for Biomedical Applications

Challenges associated with drug-releasing stents used in percutaneous transluminal coronary angioplasty (PTCA) encompass allergic reactions, prolonged endothelial dysfunction, and delayed stent clotting. Although absorbable stents made from magnesium alloys seem promising, fast in vivo degradation and poor biocompatibility remain major challenges. In this study, zirconia (ZrO2) layers were used as the foundational coat, while calcium phosphate (CaP) served as the surface layer on unalloyed magnesium specimens. Consequently, the corrosion current density was decreased to 3.86, from 13.3 μA/cm2. Moreover, a heparin-controlled release mechanism was created by co-depositing CaP, gelatin (Gel), and heparin (Hep) on the specimens coated with CaP/ZrO2, thereby boosting magnesium's blood compatibility and prolonging the heparin-releasing time. Techniques like X-ray diffractometry (XRD), focused ion beam (FIB) system, toluidine blue testing, UV-visible spectrometry, field emission scanning electron microscopy (FESEM), and surrogate tests for endothelial cell viability were employed to examine the heparin-infused coatings. The drug content rose to 484.19 ± 19.26 μg/cm2 in multi-layered coatings (CaP-Gel-Hep/CaP-Hep/CaP/ZrO2) from 243.56 ± 55.18 μg/cm2 in a single layer (CaP-Hep), with the controlled release spanning beyond 28 days. Also, cellular viability assessments indicated enhanced biocompatibility of the coated samples relative to those without coatings. This suggests the potential of magnesium samples after coating ZrO2 and CaP with Gel as candidates for porous biodegradable stents or even scaffolds in biomedical applications.

Bioactive Synthetic Polymer-Based Polyelectrolyte LbL Coating Assembly on Surface Treated AZ31-Mg Alloys

Polyelectrolyte layer-by-layer (LbL) films on pretreated Mg containing 3 wt.% Al and 1 wt.% Zn (MgAZ31) alloy surfaces were prepared under physiological conditions offering improved bioresponse and corrosive protection. Pretreatments of the model MgAZ31 substrate surfaces were performed by alkaline and fluoride coating methods. The anti-corrosion and cytocompatibility behavior of pretreated substrates were evaluated. The LbL film assembly consisted of an initial layer of polyethyleneimine (PEI), followed by alternate layers of poly (lactic-co-glycolic acid) (PLGA) and poly (allylamine hydrochloride) (PAH), which self-arrange via electrostatic interactions on the pretreated MgAZ31 alloy substrate surface. The physicochemical characterization, surface morphologies, and microstructures of the LbL films were investigated using Fourier-transformed infrared spectroscopy (FTIR), atomic force microscopy (AFM), X-ray diffraction (XRD), and scanning electron microscopy (SEM). The in vitro stability studies related to the LbL coatings confirmed that the surface treatments are imperative to achieve the lasting stability of PLGA/PAH layers. Electrochemical impedance spectroscopy measurements demonstrated that pretreated and LbL multilayered coated substrates enhanced the corrosion resistance of the bare MgAZ31 alloy. Cytocompatibility studies using human mesenchymal stem cells seeded directly over the substrates showed that the pretreated and LbL-generated surfaces were more cytocompatible, displaying reduced cytotoxicity than the bare MgAZ31. The release of bovine serum albumin protein from the LbL films was also studied. The initial data presented cooperatively demonstrate the promise of creating LbL layers on Mg-related bioresorbable scaffolds to obtain improved surface bio-related activity.

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 Vitro Degradation and Photoactivated Antibacterial Activity of a Hemin-CaP Microsphere-Loaded Coating on Pure Magnesium

Photoactivated sterilization has received more attention in dealing with implant-associated infections due to its advantages of rapid and effective bacteriostasis and broad-spectrum antibacterial activity. Herein, a micro-arc oxidation (MAO)/polymethyltrimethoxysilane (PMTMS)@hemin-induced calcium-bearing phosphate microsphere (Hemin-CaP) coating was prepared on pure magnesium (Mg) via MAO processing and dipping treatments. The morphology and composition of the coating were characterized via scanning electron microscopy, Fourier transform infrared spectrometer, X-ray diffractometer and X-ray photoelectron spectrometer. Corrosion behavior was evaluated through electrochemical and hydrogen evolution tests. The release of Fe³⁺ ions at different immersion times was measured with an atomic absorption spectrophotometer. Antibacterial performance and cytotoxicity were assessed using the spread plate method, MTT assay and live/dead staining experiment. The results showed that the corrosion current density of the MAO/PMTMS@(Hemin-CaP) coating (4.41 × 10^-8 A·cm^-2) was decreased by two orders of magnitude compared to that of pure Mg (3.12 × 10^-6 A·cm^-2). Photoactivated antibacterial efficiencies of the Hemin-CaP microspheres and MAO/PMTMS@(Hemin-CaP) coating reached about 99% and 92%, respectively, which we attributed to the photothermal and photodynamic properties of hemin with a porphyrin ring. Moreover, based on the release of Fe³⁺ ions, the MC3T3-E1 pre-osteoblasts' viability reached up to 125% after a 72 h culture, indicating a positive effect of the coating in promoting cell growth. Thus, this novel composite coating holds a promising application as bone implants.

Surface Heparinization of a Magnesium-Based Alloy: A Comparison Study of Aminopropyltriethoxysilane (APTES) and Polyamidoamine (PAMAM) Dendrimers

Magnesium (Mg)-based alloys are biodegradable metallic biomaterials that show promise in minimizing the risks of permanent metallic implants. However, their clinical applications are restricted due to their rapid in vivo degradation and low surface hemocompatibilities. Surface modifications are critically important for controlling the corrosion rates of Mg-based alloys and improving their hemocompatibilities. In the present study, two heparinization methods were developed to simultaneously increase the corrosion resistance and hemocompatibility of the AZ31 Mg alloy. In the first method, the surface of the AZ31 alloy was modified by alkali-heat treatment and then aminolyzed by 3-amino propyltriethoxy silane (APTES), a self-assembly molecule, and heparin was grafted onto the aminolyzed surface. In the second method, before heparinization, polyamidoamine dendrimers (PAMAM4-4) were grafted onto the aminolyzed surface with APTES to increase the number of surface functional groups, and heparinization was subsequently performed. The presence of a peak with a wavelength of about 1560 cm^-1 in the FTIR spectrum for the sample modified with APTES and dendrimers indicated aminolysis of the surface. The results indicated that the corrosion resistance of the Mg alloy was significantly improved as a result of the formation of a passive layer following the alkali-heat treatment. The results obtained from a potentiodynamic polarization (PDP) test showed that the corrosion current in the uncoated sample decreased from 25 µA to 3.7 µA in the alkali-heat-treated sample. The corrosion current density was reduced by 14 and 50 times in samples treated with the self-assembly molecules, APTES and dendrimers, respectively. After heparinization, the clotting time for pristine Mg was greatly improved. Clotting time increased from 480 s for the pristine Mg sample to 630 s for the APTES- and heparin-modified samples and to 715 s for the PAMAM- and heparin-modified samples. Cell culture data showed a slight improvement in the cell-supporting behavior of the modified samples.

Performance of PEO/Polymer Coatings on the Biodegradability, Antibacterial Effect and Biocompatibility of Mg-Based Materials

Magnesium (Mg) alloys have recently attracted attention in biomedicine as biodegradable materials with non-toxic degradable products. Such compounds have become a frontier in the study of biodegradable materials because of their remarkable biomechanical compatibility and superior biocompatibility. The use of Mg-based implants reduces the negative consequences of permanent biological implants by eliminating the necessity for biomaterial surgery following the healing process. However, the quick deterioration, formation of considerable gas of hydrogen volumes and a rise in the body environment pH are obstacles in the application of Mg as an implant material. Hence, compelling advances for erosion resistance and biocompatibility of magnesium and its alloys are noteworthy. Surface modification may be a practical approach because it improves the erosion resistance compared with extensive preparation of a treated surface for progressed bone recovery and cell attachment. Coating produced by plasma electrolytic oxidation (PEO) seems a compelling method in order to enhance magnesium and the properties of its alloys. PEO-formed coatings cannot provide long-term protection in the physiological environment due to their porous nature. Thus, a polymer coating is applied on the porous PEO-formed coating, which is steadily applied on the surface. Polymer coatings improve the biocompatibility properties of Mg and its alloys and increase corrosion resistance. In this article, the most recent advancements in PEO/polymer composite coatings are reviewed, and the biocompatibility of such coatings is examined.

In Vitro Study of Degradation and Cytocompatibility of Ceramics/PLA Composite Coating on Pure Zinc for Orthopedic Application

Zinc and its alloys are considered to be next-generation materials for fabricating absorbable biomedical devices. However, cytotoxicity has been reported to be associated with rapid degradation. To address these issues, a composite coating (PLA/Li-OCP) consisting of CaHPO4 conversion coating (Ca-P) and polylactic acid (PLA) decorated with Li-octacalcium phosphate particles was constructed on pure zinc. The immersion tests showed that the presence of Ca-P coating and PLA/Li-OCP coating on pure zinc could reduce the pH value. Compared with Ca-P coating, the introduction of the PLA/Li-OCP film on the Ca-P-coated samples could enhance the corrosion resistance, and there was one order of magnitude decrease in the corrosion current density. The cytocompatibility assay suggested that the PLA/Li-OCP coating favored the cell viability and upregulated the expression of related osteogenic-genes including RUNX2, OCN, and BMP. Therefore, the presence of the PLA/Li-OCP coating on pure zinc could effectively improve the degradation rate and cytocompatibility of pure zinc.

A surface-eroding poly(1,3-trimethylene carbonate) coating for magnesium based cardiovascular stents with stable drug release and improved corrosion resistance

Magnesium alloys with integration of degradability and good mechanical performance are desired for vascular stent application. Drug-eluting coatings may optimize the corrosion profiles of magnesium substrate and reduce the incidence of restenosis simultaneously. In this paper, poly (trimethylene carbonate) (PTMC) with different molecular weight (50,000 g/mol named as PTMC5 and 350,000 g/mol named as PTMC35) was applied as drug-eluting coatings on magnesium alloys. A conventional antiproliferative drug, paclitaxel (PTX), was incorporated in the PTMC coating. The adhesive strength, corrosion behavior, drug release and biocompatibility were investigated. Compared with the PLGA control group, PTMC coating was uniform and gradually degraded from surface to inside, which could provide long-term protection for the magnesium substrate. PTMC35 coated samples exhibited much slower corrosion rate 0.05 μA/cm2 in comparison with 0.11 μA/cm2 and 0.13 μA/cm2 for PLGA and PTMC5 coated counterparts. In addition, PTMC35 coating showed more stable and sustained drug release ability and effectively inhibited the proliferation of human umbilical vein vascular smooth muscle cells. Hemocompatibility test indicated that few platelets were adhered on PTMC5 and PTMC35 coatings. PTMC35 coating, exhibiting surface erosion behavior, stable drug release and good biocompatibility, could be a good candidate as a drug-eluting coating for magnesium-based stent.

Advances in coatings on magnesium alloys for cardiovascular stents - A review

Magnesium (Mg) and its alloys, as potential biodegradable materials, have drawn wide attention in the cardiovascular stent field because of their appropriate mechanical properties and biocompatibility. Nevertheless, the occurrence of thrombosis, inflammation, and restenosis of implanted Mg alloy stents caused by their poor corrosion resistance and insufficient endothelialization restrains their anticipated clinical applications. Numerous surface treatment tactics have mainly striven to modify the Mg alloy for inhibiting its degradation rate and enduing it with biological functionality. This review focuses on highlighting and summarizing the latest research progress in functionalized coatings on Mg alloys for cardiovascular stents over the last decade, regarding preparation strategies for metal oxide, metal hydroxide, inorganic nonmetallic, polymer, and their composite coatings; and the performance of these strategies in regulating degradation behavior and biofunction. Potential research direction is also concisely discussed to help guide biological functionalized strategies and inspire further innovations. It is hoped that this review can give assistance to the surface modification of cardiovascular Mg-based stents and promote future advancements in this emerging research field.

Sol-gel coating loaded with inhibitor on ZE21B Mg alloy for improving corrosion resistance and endothelialization aiming at potential cardiovascular application

To improve the service performance of vascular stents, we designed/selected a series of organic compounds from commercial drugs, natural plants, and marine life as the potential corrosion inhibitors for ZE21B alloy. Paeonol condensation tyrosine (PCTyr) Schiff base was found to be the most efficient inhibitor among them. The biocompatible, self-healing, anti-corrosive sol-gel coating loaded with corrosion inhibitor was fabricated on the Mg substrate through a convenient dip-coating tactic. The corrosion resistance, self-healing ability, cytotoxicity, and hemocompatibility of the coated sample were evaluated. These results suggested the potentiality of Schiff base inhibitor-loaded sol-gel coating for enhanced corrosion protection and desired biocompatibility of bioabsorbable cardiovascular implants.

Investigation on large elastoplastic deformation in expansion and springback for a composited bioresorbable stent

Mechanical performances for a composited bioresorbable stent were investigated by using the finite element method, which concerns the elastoplastic large deformation of expansion and springback during stent implantation. The introduced stent is composited by the outer layer of poly-L-lactic acid (PLLA) and the core of magnesium alloy (Mg alloy). As comparisons, meanwhile two single-material stents of PLLA and Mg alloy with the same geometric structures as the composited stent were considered. The numeric simulation results indicated that, the wrapping of PLLA can make the maximum Mises stress locate at the interior, it is beneficial to slow down the earlier surface degradation of stents caused by stress concentration. Also, the variation of residual deformation and stress distribution in Mg alloy core after PLLA outer layer degraded entirely are analyzed. The distributions of normal and total shear stresses on the interface of two materials were also calculated for the cases of expansion and springback. In addition, the analysis reveals the radius of implanted stent is in approximate linearly related to the expansion displacement load.

Drug-Eluting Stents and Balloons-Materials, Structure Designs, and Coating Techniques: A Review

Controlled drug delivery is a matter of interest to numerous scientists from various domains, as well as an essential issue for society as a whole. In the treatment of many diseases, it is crucial to control the dosing of a drug for a long time and thus maintain its optimal concentration in the tissue. Heart diseases are particularly important in this aspect. One such disease is an obstructive arterial disease affecting millions of people around the world. In recent years, stents and balloon catheters have reached a significant position in the treatment of this condition. Balloon catheters are also successfully used to manage tear ducts, paranasal sinuses, or salivary glands disorders. Modern technology is continually striving to improve the results of previous generations of stents and balloon catheters by refining their design, structure, and constituent materials. These advances result in the development of both successive models of drug-eluting stents (DES) and drug-eluting balloons (DEB). This paper presents milestones in the development of DES and DEB, which are a significant option in the treatment of coronary artery diseases. This report reviews the works related to achievements in construction designs and materials, as well as preparation technologies, of DES and DEB. Special attention was paid to the polymeric biodegradable materials used in the production of the above-mentioned devices. Information was also collected on the various methods of producing drug release coatings and their effectiveness in releasing the active substance.

Effect of GelMA Hydrogel Coatings on Corrosion Resistance and Biocompatibility of MAO-Coated Mg Alloys

Micro-arc oxidation (MAO) treatment is a simple and effective technique to improve the corrosion resistance for magnesium alloys. However, the presence of micro-pores and cracks on the coatings provides paths for corrosive ions to penetrate into and react with the substrate, limiting the long-term corrosion resistance. In this paper, we designed a composite coating with which GelMA hydrogel coatings with varying thicknesses were prepared on the surface of MAO-coated magnesium alloys via a dip-coating method, aiming to improve the biocorrosion resistance and biocompatibility. The surface morphology, the chemical composition of GelMA hydrogels, and the crystallographic structure of magnesium alloys were characterized by scanning electron microscope (SEM), Fourier-transform infrared spectroscopy (FTIR), and X-ray diffraction (XRD), respectively. The corrosion resistance and biocompatibility of all samples were evaluated through electrochemical and biological experiments. The results demonstrated that the addition of GelMA hydrogel could effectively seal the pores and improve the corrosion resistance and biocompatibility of MAO-coated magnesium alloys, especially for the sample with one layer of GelMA hydrogel, showing high cell proliferation rate, and its current density (Icorr) was two orders of magnitude lower than that of the MAO coating. Besides, the balance mechanism between corrosion and protection was proposed. As a result, the GelMA hydrogel coatings are beneficial to the application of MAO-coated magnesium alloys in bone tissue engineering and other fields.

Surface Morphology and Histopathological Aspects of Metallic Used Cardiovascular CoCr Stents

In this study, CoCr cardiovascular metallic stents with the same chemical composition as well as the adjacent tissues were analyzed. Recovered stents and adjacent tissues were characterized by surface morphology techniques like light microscopy (LM), scanning electron microscopy coupled with energy dispersive X-ray spectroscopy (SEM-EDS) and transmission electron microscopy (TEM). The presence of metals in the tissue from around explanted stent was also confirmed by TEM method. The released metal ions were measured using inductively coupled plasma mass spectrometry (ICP-MS). Histopathological analysis was used to highlight host tissue response to the implanted stents. EDX analysis revealed that 21 stents had the same composition. The quantities of Cr ions detected in the tissues were between 5 and 14 ppb and for Co ions were between 4 and 10 ppb. The tissue sections near the layers that generated large quantities of ions showed restenosis development and the deposits of surface calcifications were highlighted. The heavy metal levels observed in this study due to corrosion are too low to cause a systemic toxic response.

Binary Additives Enhance Micro Arc Oxidation Coating on 6061Al Alloy with Improved Anti-Corrosion Property

Given the corrosion tendency of the natural oxide film of aluminum alloys, micro arc oxidation (MAO) treatment is used as an efficient and economic method to enhance the corrosion resistance. However, irregular voids, pores, and micro cracks are easily formed during the MAO process, which are harmful to the anti-corrosion property of MAO coatings. In this paper, binary additives of electrolytes, including (NaPO3)6 and H3BO3, were used to obtain MAO coatings with improved thickness and compact microstructures on 6061 aluminum alloys. The as-prepared coatings were investigated using a thickness meter, scanning electron microscope (SEM), X-ray diffractometer (XRD), and electrochemical impedance spectroscope (EIS). The results showed that the coordinated influence of the binary additives could change the discharge behaviors and micro morphologies of the MAO coatings compared to the base silicate electrolyte. A thicker and stronger MAO coating could be achieved, which was mainly composed of Al2O3 phases. The EIS tests revealed that the corrosion current density of the obtained optimal MAO coating decreased by three orders of magnitude from 1.209 × 10−6 A·cm−2 to 2.981 × 10−9 A·cm−2. We believe that the binary additive-enhanced MAO coatings could provide a promising anti-corrosion solution in various applications.

Surfactant-Stripped Micelles of Near Infrared Dye and Paclitaxel for Photoacoustic Imaging Guided Photothermal-Chemotherapy

Development of nanoagents with strong near-infrared (NIR) absorbance and high photothermal conversion capacity is highly desired for efficient photoacoustic (PA) imaging and photothermal therapy of cancers. Herein, surfactant-stripped micelles with photostable near-infrared dye, β-thiophene-fused BF₂ -azadipyrromethene (aza-BDTP), are prepared in the presence of paclitaxel (PTX) with Pluronic F127 as the surfactant. Distinct from hydrophobic aza-BDTP and PTX, the obtained surfactant-stripped micelles aza-BDTP/PTX show excellent solubility, physiological stability, and high loading efficiencies for corresponding aza-BDTP and PTX. Intriguingly, these aza-BDTP/PTX micelles exhibit high photothermal conversion efficiency at 33.9%, significantly higher than 16.9% for bare aza-BDTP molecules, owing to aggregation-induced quenching of aza-BDTP fluorescence. With excellent photostability, aza-BDTP/PTX micelles appear to be a highly stable photoacoustic imaging probe and show efficient tumor accumulation as visualized under photoacoustic imaging upon intravenous injection. After being irradiated with a 785 nm laser, 4T1 tumors on the mice with systemic administration of aza-BDTP/PTX micelles are fully eradiated without any recurrences within 60 d. This work presents a general method for efficient encapsulation of hydrophobic aza-BDTP and PTX, obtaining hybrid aza-BDTP/PTX micelles as promising nanotheranostics for imaging guided cancer combination therapy.

Comparison of endothelial cell attachment on surfaces of biodegradable polymer-coated magnesium alloys in a microfluidic environment

Polymeric coatings can provide temporary stability to bioresorbable metallic stents at the initial stage of deployment by alleviating rapid degradation and providing better interaction with surrounding vasculature. To understand this interfacing biocompatibility, this study explored the endothelial-cytocompatibility of polymer-coated magnesium (Mg) alloys under static and dynamic conditions compared to that of non-coated Mg alloy surfaces. Poly (carbonate urethane) urea (PCUU) and poly (lactic-co-glycolic acid) (PLGA) were coated on Mg alloys (WE43, AZ31, ZWEKL, ZWEKC) and 316L stainless steel (316L SS, control sample), which were embedded into a microfluidic device to simulate a vascular environment with dynamic flow. The results from attachment and viability tests showed that more cells were attached on the polymer-coated Mg alloys than on non-coated Mg alloys in both static and dynamic conditions. In particular, the attachment and viability on PCUU-coated surfaces were significantly higher than that of PLGA-coated surfaces of WE43 and ZWEKC in both static and dynamic conditions, and of AZ31 in dynamic conditions (P<0.05). The elementary distribution map showed that there were relatively higher Carbon weight percentages and lower Mg weight percentages on PCUU-coated alloys than PLGA-coated alloys. Various levels of pittings were observed underneath the polymer coatings, and the pittings were more severe on the surface of Mg alloys that corroded rapidly. Polymer coatings are recommended to be applied on Mg alloys with relatively low corrosion rates, or after pre-stabilizing the substrate. PCUU-coating has more selective potential to enhance the biocompatibility and mitigate the endothelium damage of Mg alloy stenting.

Advances in functionalized polymer coatings on biodegradable magnesium alloys - A review

Magnesium (Mg) and its alloys have become a research frontier in biodegradable materials owing to their superior biocompatibility and excellent biomechanical compatibility. However, their high degradation rate in the physiological environment should be well tackled prior to clinical applications. This review summarizes the latest progress in the development of polymeric coatings on biodegradable Mg alloys over the last decade, regarding preparation strategies for polylactic acid (PLA), poly (latic-co-glycolic) acid (PLGA), polycaprolactone (PCL), polydopamine (PDA), chitosan (CS), collagen (Col) and their composite, and their performance in terms of corrosion resistance and biocompatibility. Feasible perspectives and developing directions of next generation of polymeric coatings with respect to biomedical Mg alloys are briefly discussed.

STATEMENT OF SIGNIFICANCE

Magnesium (Mg) and its alloys have become a research frontier in biodegradable materials owing to their superior biocompatibility and suitable biomechanical compatibility. However, the principal drawback of Mg-based implants is their poor corrosion resistance in physiological environments. Hence, it is vital to mitigate the degradation/corrosion behavior of Mg alloys for safe biomedical deployments. This review summarizes the latest progress in development of polymeric coatings on biomedical Mg alloys regarding preparation strategy, corrosion resistance and biocompatibility, including polylactic acid (PLA), poly (latic-co-glycolic) acid (PLGA), polycaprolactone (PCL), chitosan (CS), polydopamine (PDA), collagen (Col) and their composite. In addition, functionalized polymer coatings with Mg alloys exhibits a promising prospect owing to their ability of degradation along with biocompatibility, self-healing, drug-delivery and osteoinduction.

Cardiovascular stents: overview, evolution, and next generation

Compared to bare-metal stents (BMSs), drug-eluting stents (DESs) have been regarded as a revolutionary change in coronary artery diseases (CADs). Releasing pharmaceutical agents from the stent surface was a promising progress in the realm of cardiovascular stents. Despite supreme advantages over BMSs, in-stent restenosis (ISR) and long-term safety of DESs are still deemed ongoing concerns over clinically application of DESs. The failure of DESs for long-term clinical use is associated with following factors including permanent polymeric coating materials, metallic stent platforms, non-optimal drug releasing condition, and factors that have recently been supposed as contributory factors such as degradation products of polymers, metal ions due to erosion and degradation of metals and their alloys utilizing in some stents as metal frameworks. Discovering the direct relation between stent materials and associating adverse effects is a complicated process, and yet it has not been resolved. For clinical success it is of significant importance to optimize DES design and explore novel strategies to overcome all problems including inflammatory response, delay endothelialization, and sub-acute stent thrombosis (ST) simultaneously. In this work, scientific reports are reviewed particularly focusing on recent advancements in DES design which covers both potential improvements of existing and recently novel prototype stent fabrications. Covering a wide range of information from the BMSs to recent advancement, this study mostly sheds light on DES's concepts, namely stent composition, drug release mechanism, and coating techniques. This review further reports different forms of DES including fully biodegradable DESs, shape-memory ones, and polymer-free DESs.

Biodegradability and platelets adhesion assessment of magnesium-based alloys using a microfluidic system

Magnesium (Mg)-based stents are extensively explored to alleviate atherosclerosis due to their biodegradability and relative hemocompatibility. To ensure the quality, safety and cost-efficacy of bioresorbable scaffolds and full utilization of the material tunability afforded by alloying, it is critical to access degradability and thrombosis potential of Mg-based alloys using improved in vitro models that mimic as closely as possible the in vivo microenvironment. In this study, we investigated biodegradation and initial thrombogenic behavior of Mg-based alloys at the interface between Mg alloys' surface and simulated physiological environment using a microfluidic system. The degradation properties of Mg-based alloys WE43, AZ31, ZWEK-L, and ZWEK-C were evaluated in complete culture medium and their thrombosis potentials in platelet rich plasma, respectively. The results show that 1) physiological shear stress increased the corrosion rate and decreased platelets adhesion rate as compared to static immersion; 2) secondary phases and impurities in material composition induced galvanic corrosion, resulting in higher corrosion resistance and platelet adhesion rate; 3) Mg-based alloys with higher corrosion rate showed higher platelets adhesion rate. We conclude that a microfluidic-based in vitro system allows evaluation of biodegradation behaviors and platelets responses of Mg-based alloys under specific shear stress, and degradability is related to platelets adhesion.

In situ incorporation of heparin/bivalirudin into a phytic acid coating on biodegradable magnesium with improved anticorrosion and biocompatible properties

Drugs were incorporated into a phytic acid coating on Mg by an in situ chemical route for corrosion control and biocompatibility.

Bio-Adaption between Magnesium Alloy Stent and the Blood Vessel: A Review

Biodegradable magnesium (Mg) alloy stents are the most promising next generation of bio-absorbable stents. In this article, we summarized the progresses on the in vitro studies, animal testing and clinical trials of biodegradable Mg alloy stents in the past decades. These exciting findings led us to propose the importance of the concept "bio-adaption" between the Mg alloy stent and the local tissue microenvironment after implantation. The healing responses of stented blood vessel can be generally described in three overlapping phases: inflammation, granulation and remodeling. The ideal bio-adaption of the Mg alloy stent, once implanted into the blood vessel, needs to be a reasonable function of the time and the space/dimension. First, a very slow degeneration of mechanical support is expected in the initial four months in order to provide sufficient mechanical support to the injured vessels. Although it is still arguable whether full mechanical support in stented lesions is mandatory during the first four months after implantation, it would certainly be a safety design parameter and a benchmark for regulatory evaluations based on the fact that there is insufficient human in vivo data available, especially the vessel wall mechanical properties during the healing/remodeling phase. Second, once the Mg alloy stent being degraded, the void space will be filled by the regenerated blood vessel tissues. The degradation of the Mg alloy stent should be 100% completed with no residues, and the degradation products (e.g., ions and hydrogen) will be helpful for the tissue reconstruction of the blood vessel. Toward this target, some future research perspectives are also discussed.

Fabrication of a Delaying Biodegradable Magnesium Alloy-Based Esophageal Stent via Coating Elastic Polymer

Esophageal stent implantation can relieve esophageal stenosis and obstructions in benign esophageal strictures, and magnesium alloy stents are a good candidate because of biodegradation and biological safety. However, biodegradable esophageal stents show a poor corrosion resistance and a quick loss of mechanical support in vivo. In this study, we chose the elastic and biodegradable mixed polymer of Poly(ε-caprolactone) (PCL) and poly(trimethylene carbonate) (PTMC) as the coated membrane on magnesium alloy stents for fabricating a fully biodegradable esophageal stent, which showed an ability to delay the degradation time and maintain mechanical performance in the long term. After 48 repeated compressions, the mechanical testing demonstrated that the PCL-PTMC-coated magnesium stents possess good flexibility and elasticity, and could provide enough support against lesion compression when used in vivo. According to the in vitro degradation evaluation, the PCL-PTMC membrane coated on magnesium was a good material combination for biodegradable stents. During the in vivo evaluation, the proliferation of the smooth muscle cells showed no signs of cell toxicity. Histological examination revealed the inflammation scores at four weeks in the magnesium-(PCL-PTMC) stent group were similar to those in the control group (p > 0.05). The α-smooth muscle actin layer in the media was thinner in the magnesium-(PCL-PTMC) stent group than in the control group (p < 0.05). Both the epithelial and smooth muscle cell layers were significantly thinner in the magnesium-(PCL-PTMC) stent group than in the control group. The stent insertion was feasible and provided reliable support for at least four weeks, without causing severe injury or collagen deposition. Thus, this stent provides a new stent for the treatment of benign esophageal stricture and a novel research path in the development of temporary stents in other cases of benign stricture.

Controlled Slow-Release Drug-Eluting Stents for the Prevention of Coronary Restenosis: Recent Progress and Future Prospects

Drug-eluting stents (DES) have become more widely used by cardiologists than bare metal stents (BMS) because of their better ability to control restenosis. However, recognized negative events, particularly including delayed or incomplete endothelialization and late stent thrombosis, have caused concerns over the long-term safety of DES. Although stent-based drug delivery can facilitate a drug's release directly to the restenosis site, a burst of drug release can seriously affect the pharmacological action and is a major factor accounting for adverse effects. Therefore, the drug release rate has become an important criterion in evaluating DES. The factors affecting the drug release rate include the drug carrier, drug, coating methods, drug storage, elution direction, coating thickness, pore size in the coating, release conditions (release medium, pH value, temperature), and hemodynamics after the stent implantation. A better understanding of how these factors influence drug release is particularly important for the reasonable use of efficient control strategies for drug release. This review summarizes the factors influencing the drug release from DES and presents strategies for enhancing the control of the drug's release, including the stent design, the application of absorbable stents, the development of new polymers, and the application of nanocarriers and improvements in the coating technology. Therefore, this paper provides a reference for the preparation of novel controlled slow-release DES.

The development of carotid stent material

Endovascular angioplasty with stenting is a promising option for treating carotid artery stenosis. There exist a rapidly increasing number of different stent types with different materials. The bare-metal stent is the most commonly used stent with acceptable results, but it leaves us with the problems of thrombosis and restenosis. The drug-eluting stent is a breakthrough as it has the ability to reduce the restenosis rate, but the problem of late thrombosis still has to be addressed. The biodegradable stent disappears after having served its function. However, restenosis and degradation rates remain to be studied. In this article, we review every stent material with its characteristics, clinical results and complications and point out the standards of an ideal carotid stent.

Controlled release and corrosion protection by self-assembled colloidal particles electrodeposited onto magnesium alloys

Self-assembled nanoparticles loaded with bioactive agents were electrodeposited to provide the magnesium alloy with controlled release and corrosion resistance properties.

Functionalized Pluronic-b-poly(ε-caprolactone) based nanocarriers of paclitaxel: solubilization, antiproliferative efficacy and in vivo pharmaceutic kinetics

Novel paclitaxel (PTX) nanocarriers were developed based on the Pluronic-based pentablock copolymer and their pharmaceutical behaviours were thoroughly evaluated.

Microscopic bio-corrosion evaluations of magnesium surfaces in static and dynamic conditions

Biodegradable materials including biodegradable metals are continuously being investigated for the development of next generation cardiovascular stents. Predictive in vitro tests are needed that could evaluate potential materials while simulating in vivo conditions. In this manuscript we report the microscopic bio-corrosion evaluations of magnesium surfaces in static and dynamic conditions. A corrosion test bench was designed and fabricated and static and dynamic corrosion tests were carried out with samples of magnesium alloy. The fluid wall shear stress equation and the Churchill's friction factor equation were used to calculate the fluid velocity required to generate the desired shear stress on samples in the test bench. Static and dynamic corrosion tests at 24 and 72 h were carried out at 0.88 Pa shear stress mimicking the in vivo shear stress. Microscopic evaluations of the corroded surfaces were carried out by optical, scanning electron microscopy and energy dispersive X-ray spectroscopy to evaluate the corrosion behaviour and surface properties of the test samples. The surface and interface analysis of magnesium samples post test indicated that dynamic conditions prevented the build-up of corrosion by-products on the sample surface and the corrosion mechanism was uniform as compared to static conditions. The use of a masking element to restrict the exposed area of the sample didn't result in increased corrosion at the boundary. Thus, we have demonstrated the feasibility of the designed test bench as a viable method for bio-corrosion surface analysis under dynamic corrosion conditions for potential biodegradable cardiovascular stent materials.

Similarities and differences in coatings for magnesium-based stents and orthopaedic implants

Magnesium (Mg)-based biodegradable materials are promising candidates for the new generation of implantable medical devices, particularly cardiovascular stents and orthopaedic implants. Mg-based cardiovascular stents represent the most innovative stent technology to date. However, these products still do not fully meet clinical requirements with regards to fast degradation rates, late restenosis, and thrombosis. Thus various surface coatings have been introduced to protect Mg-based stents from rapid corrosion and to improve biocompatibility. Similarly, different coatings have been used for orthopaedic implants, e.g., plates and pins for bone fracture fixation or as an interference screw for tendon-bone or ligament-bone insertion, to improve biocompatibility and corrosion resistance. Metal coatings, nanoporous inorganic coatings and permanent polymers have been proved to enhance corrosion resistance; however, inflammation and foreign body reactions have also been reported. By contrast, biodegradable polymers are more biocompatible in general and are favoured over permanent materials. Drugs are also loaded with biodegradable polymers to improve their performance. The key similarities and differences in coatings for Mg-based stents and orthopaedic implants are summarized.

Direct writing of bio-functional coatings for cardiovascular applications

The surface modification of metallic biomaterials is of critical importance to enhance the biocompatibility of surgical implant materials and devices. This article investigates the use of a direct-write inkjet technique for multilayer coatings of a biodegradable polymer (polyester urethane urea (PEUU)) embedded with an anti-proliferation drug paclitaxel (Taxol). The direct-write inkjet technique provides selective patterning capability for depositing multimaterial coatings on three-dimensional implant devices such as pins, screws, and stents for orthopedic and vascular applications. Drug release profiles were studied to observe the influence of drug loading and coating thickness for obtaining tunable release kinetics. Platelet deposition studies were conducted following ovine blood contact and significant reduction in platelet deposition was observed on the Taxol loaded PEUU substrate compared with the unloaded control. Rat smooth muscle cells were used for cell proliferation studies. Significant reduction in cell growth was observed following the release of anti-proliferative drug from the biopolymer thin film. This research provides a basis for developing anti-proliferative biocompatible coatings for different biomedical device applications.

Biodegradable poly(lactide-co-glycolide) coatings on magnesium alloys for orthopedic applications

Polymeric film coatings were applied by dip coating on two magnesium alloy systems, AZ31 and Mg4Y, in an attempt to slow the degradation of these alloys under in vitro conditions. Poly(lactic-co-glycolic acid) polymer in solution was explored at various concentrations, yielding coatings of varying thicknesses on the alloy substrates. Electrochemical corrosion studies indicate that the coatings initially provide some corrosion protection. Degradation studies showed reduced degradation over 3 days, but beyond this time point however, do not maintain a reduction in corrosion rate. Scanning electron microscopy indicates inhomogeneous coating durability, with gas pocket formation in the polymer coating, resulting in eventual detachment from the alloy surface. In vitro studies of cell viability utilizing mouse osteoblast cells showed improved biocompatibility of polymer coated substrates over the bare AZ31 and Mg4Y substrates. Results demonstrate that while challenges remain for long term degradation control, the developed polymeric coatings nevertheless provide short term corrosion protection and improved biocompatibility of magnesium alloys for possible use in orthopedic applications.

Magnesium used in bioabsorbable stents controls smooth muscle cell proliferation and stimulates endothelial cells in vitro

Magnesium-based bioabsorbable cardiovascular stents have been developed to overcome limitations of permanent metallic stents, such as late stent thrombosis. During stent degradation, endothelial and smooth muscle cells will be exposed to locally high magnesium concentrations with yet unknown physiological consequences. Here, we investigated the effects of elevated magnesium concentrations on human coronary artery endothelial and smooth muscle cell (HCAEC, HCASMC) growth and gene expression. In the course of 24 h after incubation with magnesium chloride solutions (1 or 10 mM) intracellular magnesium level in HCASMC raised from 0.55 ± 0.25 mM (1 mM) to 1.38 ± 0.95 mM (10 mM), while no increase was detected in HCAEC. Accordingly, a DNA microarray-based study identified 69 magnesium regulated transcripts in HCAEC, but 2172 magnesium regulated transcripts in HCASMC. Notably, a significant regulation of various growth factors and extracellular matrix components was observed. In contrast, viability and proliferation of HCAEC were increased at concentrations of up to 25 mM magnesium chloride, while in HCASMC viability and proliferation appeared to be unaffected. Taken together, our data indicate that magnesium halts smooth muscle cell proliferation and stimulates endothelial cell proliferation, which might translate into a beneficial effect in the setting of stent associated vascular injury.

Biodegradable metals for cardiovascular stent application: interests and new opportunities

During the last decade, biodegradable metallic stents have been developed and investigated as alternatives for the currently-used permanent cardiovascular stents. Degradable metallic materials could potentially replace corrosion-resistant metals currently used for stent application as it has been shown that the role of stenting is temporary and limited to a period of 6-12 months after implantation during which arterial remodeling and healing occur. Although corrosion is generally considered as a failure in metallurgy, the corrodibility of certain metals can be an advantage for their application as degradable implants. The candidate materials for such application should have mechanical properties ideally close to those of 316L stainless steel which is the gold standard material for stent application in order to provide mechanical support to diseased arteries. Non-toxicity of the metal itself and its degradation products is another requirement as the material is absorbed by blood and cells. Based on the mentioned requirements, iron-based and magnesium-based alloys have been the investigated candidates for biodegradable stents. This article reviews the recent developments in the design and evaluation of metallic materials for biodegradable stents. It also introduces the new metallurgical processes which could be applied for the production of metallic biodegradable stents and their effect on the properties of the produced metals.