1
|
Che Z, Sun Q, Zhao Z, Wu Y, Xing H, Song K, Chen A, Wang B, Cai M. Growth factor-functionalized titanium implants for enhanced bone regeneration: A review. Int J Biol Macromol 2024; 274:133153. [PMID: 38897500 DOI: 10.1016/j.ijbiomac.2024.133153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Revised: 06/02/2024] [Accepted: 06/12/2024] [Indexed: 06/21/2024]
Abstract
Titanium and titanium alloys are widely favored materials for orthopedic implants due to their exceptional mechanical properties and biological inertness. The additional benefit of sustained local release of bioactive substances further promotes bone tissue formation, thereby augmenting the osseointegration capacity of titanium implants and attracting increasing attention in bone tissue engineering. Among these bioactive substances, growth factors have shown remarkable osteogenic and angiogenic induction capabilities. Consequently, researchers have developed various physical, chemical, and biological loading techniques to incorporate growth factors into titanium implants, ensuring controlled release kinetics. In contrast to conventional treatment modalities, the localized release of growth factors from functionalized titanium implants not only enhances osseointegration but also reduces the risk of complications. This review provides a comprehensive examination of the types and mechanisms of growth factors, along with a detailed exploration of the methodologies used to load growth factors onto the surface of titanium implants. Moreover, it highlights recent advancements in the application of growth factors to the surface of titanium implants (Scheme 1). Finally, the review discusses current limitations and future prospects for growth factor-functionalized titanium implants. In summary, this paper presents cutting-edge design strategies aimed at enhancing the bone regenerative capacity of growth factor-functionalized titanium implants-a significant advancement in the field of enhanced bone regeneration.
Collapse
Affiliation(s)
- Zhenjia Che
- Department of Orthopaedics, Shanghai Tenth People's Hospital, Tongji University School of Medicine, No. 301 Middle Yanchang Road, Shanghai 200072, People's Republic of China.
| | - Qi Sun
- Department of Orthopaedics, Shanghai Tenth People's Hospital, Tongji University School of Medicine, No. 301 Middle Yanchang Road, Shanghai 200072, People's Republic of China
| | - Zhenyu Zhao
- Department of Orthopaedics, Shanghai Tenth People's Hospital, Tongji University School of Medicine, No. 301 Middle Yanchang Road, Shanghai 200072, People's Republic of China
| | - Yanglin Wu
- Department of Orthopaedics, Shanghai Tenth People's Hospital, Tongji University School of Medicine, No. 301 Middle Yanchang Road, Shanghai 200072, People's Republic of China
| | - Hu Xing
- Department of Orthopaedics, Shanghai Tenth People's Hospital, Tongji University School of Medicine, No. 301 Middle Yanchang Road, Shanghai 200072, People's Republic of China
| | - Kaihang Song
- Department of Orthopaedics, Shanghai Tenth People's Hospital, Tongji University School of Medicine, No. 301 Middle Yanchang Road, Shanghai 200072, People's Republic of China
| | - Aopan Chen
- Department of Orthopaedics, Shanghai Tenth People's Hospital, Tongji University School of Medicine, No. 301 Middle Yanchang Road, Shanghai 200072, People's Republic of China
| | - Bo Wang
- Department of Orthopaedics, Shanghai Tenth People's Hospital, Tongji University School of Medicine, No. 301 Middle Yanchang Road, Shanghai 200072, People's Republic of China.
| | - Ming Cai
- Department of Orthopaedics, Shanghai Tenth People's Hospital, Tongji University School of Medicine, No. 301 Middle Yanchang Road, Shanghai 200072, People's Republic of China.
| |
Collapse
|
2
|
Cunningham BW, Brooks DM, Rolle NP, Weiner DA, Wang W. An investigational time course study of titanium plasma spray on osseointegration of PEEK and titanium implants: an in vivo ovine model. Spine J 2024; 24:721-729. [PMID: 37875243 DOI: 10.1016/j.spinee.2023.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 09/13/2023] [Accepted: 10/14/2023] [Indexed: 10/26/2023]
Abstract
BACKGROUND CONTEXT Methods to improve osseointegration of orthopedic spinal implants remains a clinical challenge. Materials composed of poly-ether-ether-ketone (PEEK) and titanium are commonly used in orthopedic applications due to their inherent properties of biocompatibility. Titanium has a clinical reputation for durability and osseous affinity, and PEEK offers advantages of a modulus that approximates osseous structures and is radiolucent. The hypothesis for the current investigation was that a titanium plasma spray (TPS) coating may increase the rate and magnitude of circumferential and appositional trabecular osseointegration of PEEK and titanium implants versus uncoated controls. PURPOSE Using an in vivo ovine model, the current investigation compared titanium plasma-sprayed PEEK and titanium dowels versus nonplasma-sprayed dowels. Using a time course study of 6 and 12 weeks postoperatively, experimental assays to quantify osseointegration included micro-computed tomography (microCT), biomechanical testing, and histomorphometry. STUDY DESIGN/SETTING In-vivo ovine model. METHODS Twelve skeletally mature crossbred sheep were equally randomized into postoperative periods of 6 and 12 weeks. Four types of dowel implants-PEEK, titanium plasma-sprayed PEEK (TPS PEEK), titanium, and titanium plasma-sprayed titanium (TPS titanium) were implanted into cylindrical metaphyseal defects in the distal femurs and proximal humeri (one defect per limb, n=48 sites). Sixteen nonoperative specimens (eight femurs and eight humeri) served as zero time-point controls. Half of the specimens underwent destructive biomechanical pullout testing and the remaining half quantitative microCT to quantify circumferential bone volume within 1 mm and 2 mm of the implant surface and histomorphometry to compute direct trabecular apposition. RESULTS There were no intra- or perioperative complications. The TPS-coated implants demonstrated significantly higher peak loads at dowel pullout at 6 and 12 weeks compared with uncoated controls (p<.05). No differences were observed across dowel treatments at the zero time-point (p>.05). MicroCT results exhibited no significant differences in circumferential osseointegration between implants within 1 mm or 2 mm of the dowel surface (p>.05). Direct appositional osseointegration of trabecular bone based on histomorphometry was higher for TPS-coated groups, regardless of base material, compared with uncoated treatments at both time intervals (p<.05). CONCLUSIONS The current in vivo study demonstrated the biological and mechanical advantages of plasma spray coatings. TPS improved histological incorporation and peak force required for implant extraction. CLINICAL SIGNIFICANCE Plasma spray coatings may offer clinical benefit by improving biological fixation and osseointegration within the first 6 to 12 weeks postoperatively- the critical healing period for implant-based arthrodesis procedures.
Collapse
Affiliation(s)
- Bryan W Cunningham
- Musculoskeletal Research Center, Department of Orthopaedic Surgery, MedStar Union Memorial Hospital, 201 E University Pkwy, Baltimore, MD 21218, USA
| | - Daina M Brooks
- Musculoskeletal Research Center, Department of Orthopaedic Surgery, MedStar Union Memorial Hospital, 201 E University Pkwy, Baltimore, MD 21218, USA.
| | - Nicholas P Rolle
- Department of Surgery, Inova Fairfax Medical Campus, 3300 Gallows Rd., Falls Church, VA 22042, USA
| | - David A Weiner
- Department of Orthopaedic Surgery, MedStar Southern Maryland Hospital Center, 7503 Surratts Rd, Clinton, MD 20735, USA
| | - Wenhai Wang
- Musculoskeletal Education and Research Center, A Division of Globus Medical, Inc. 2560 General Armistead Ave, Audubon, PA 19403, USA
| |
Collapse
|
3
|
Goh M, Min K, Kim YH, Tae G. Chemically heparinized PEEK via a green method to immobilize bone morphogenetic protein-2 (BMP-2) for enhanced osteogenic activity. RSC Adv 2024; 14:1866-1874. [PMID: 38192324 PMCID: PMC10772708 DOI: 10.1039/d3ra07660a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Accepted: 12/25/2023] [Indexed: 01/10/2024] Open
Abstract
Osseointegration remains one of the major challenges in the success of bone-related implants. Recently, polyetheretherketone (PEEK) has emerged as an alternative material in orthopedic and dental applications due to its bone-mimicking mechanical properties. However, its bioinertness resulting in poor osseointegration has limited its potential application. So, the surface modification of PEEK with bone morphogenetic protein-2 (BMP-2) can be a potential approach for improving osseointegration. In this study, we proposed the chemical modification of heparin onto PEEK through an environmentally benign method to exploit the BMP-2 binding affinity of heparin. The heparin was successfully functionalized on the PEEK surface via a combination of ozone and UV treatment without using organic solvents or chemicals. Furthermore, BMP-2 was efficiently immobilized on PEEK and exhibited a sustained release of BMP-2 compared to the pristine PEEK with enhancement of bioactivity in terms of proliferation as well as osteogenic differentiation of MG-63. The significant synergistic effect of BMP-2 and heparin grafting on osteogenic differentiation of MG-63 was observed. Overall, we demonstrated a relatively safe method where no harsh chemical reagent or organic solvent was involved in the process of heparin grafting onto PEEK. The BMP-2 loaded, heparin-grafted PEEK could serve as a potential platform for osseointegration improvement of PEEK-based bone implants.
Collapse
Affiliation(s)
- MeeiChyn Goh
- School of Materials Science and Engineering, Gwangju Institute of Science and Technology (GIST) Gwangju 61005 Republic of Korea
| | - Kiyoon Min
- School of Materials Science and Engineering, Gwangju Institute of Science and Technology (GIST) Gwangju 61005 Republic of Korea
| | - Young Ha Kim
- Korea Institute of Science and Technology Hwarang-ro 14-gil 5, Seongbuk-gu Seoul 02792 Republic of Korea
| | - Giyoong Tae
- School of Materials Science and Engineering, Gwangju Institute of Science and Technology (GIST) Gwangju 61005 Republic of Korea
| |
Collapse
|
4
|
Bontempi M, Capozza R, Visani A, Fini M, Giavaresi G, Gambardella A. Near-Surface Nanomechanics of Medical-Grade PEEK Measured by Atomic Force Microscopy. Polymers (Basel) 2023; 15:polym15030718. [PMID: 36772019 PMCID: PMC9920404 DOI: 10.3390/polym15030718] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Revised: 01/22/2023] [Accepted: 01/25/2023] [Indexed: 02/04/2023] Open
Abstract
Detecting subtle changes of surface stiffness at spatial scales and forces relevant to biological processes is crucial for the characterization of biopolymer systems in view of chemical and/or physical surface modification aimed at improving bioactivity and/or mechanical strength. Here, a standard atomic force microscopy setup is operated in nanoindentation mode to quantitatively mapping the near-surface elasticity of semicrystalline polyether ether ketone (PEEK) at room temperature. Remarkably, two localized distributions of moduli at about 0.6 and 0.9 GPa are observed below the plastic threshold of the polymer, at indentation loads in the range of 120-450 nN. This finding is ascribed to the localization of the amorphous and crystalline phases on the free surface of the polymer, detected at an unprecedented level of detail. Our study provides insights to quantitatively characterize complex biopolymer systems on the nanoscale and to guide the optimal design of micro- and nanostructures for advanced biomedical applications.
Collapse
Affiliation(s)
- Marco Bontempi
- Scienze e Tecnologie Chirurgiche, IRCCS Istituto Ortopedico Rizzoli, Via di Barbiano 1/10, 40136 Bologna, Italy
| | - Rosario Capozza
- School of Engineering, Institute for Infrastructure and Environment, The University of Edinburgh, Thomas Bayes Road, Edinburgh EH9 3JL, UK
| | - Andrea Visani
- Scienze e Tecnologie Chirurgiche, IRCCS Istituto Ortopedico Rizzoli, Via di Barbiano 1/10, 40136 Bologna, Italy
| | - Milena Fini
- Scientific Direction, IRCCS Istituto Ortopedico Rizzoli, Via di Barbiano 1/10, 40136 Bologna, Italy
| | - Gianluca Giavaresi
- Scienze e Tecnologie Chirurgiche, IRCCS Istituto Ortopedico Rizzoli, Via di Barbiano 1/10, 40136 Bologna, Italy
| | - Alessandro Gambardella
- Scienze e Tecnologie Chirurgiche, IRCCS Istituto Ortopedico Rizzoli, Via di Barbiano 1/10, 40136 Bologna, Italy
- Correspondence: ; Tel.: +39-051-636-6513
| |
Collapse
|
5
|
Erenay B, Sağlam ASY, Garipcan B, Jandt KD, Odabaş S. Bone surface mimicked PDMS membranes stimulate osteoblasts and calcification of bone matrix. BIOMATERIALS ADVANCES 2022; 142:213170. [PMID: 36341745 DOI: 10.1016/j.bioadv.2022.213170] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Revised: 10/06/2022] [Accepted: 10/20/2022] [Indexed: 06/16/2023]
Abstract
Cellular microenvironments play a crucial role in cell behavior. In addition to the biochemical cues present in the microenvironments, biophysical and biomechanical properties on surfaces have an impact on cellular functionality and eventually cellular fate. Effects of surface topography on cell behavior are being studied extensively in the literature. However, these studies often try to replicate topographical features of tissue surfaces by using techniques such as chemical etching, photolithography, and electrospinning, which may result in the loss of crucial micro- and nano- features on the tissue surfaces such as bone. This study investigates the topographical effects of bone surface by transferring its surface features onto polydimethylsiloxane (PDMS) membranes using soft lithography from a bovine femur. Our results have shown that major features on bone surfaces were successfully transferred onto PDMS using soft lithography. Osteoblast proliferation and calcification of bone matrix have significantly increased along with osteoblast-specific differentiation and maturation markers such as osteocalcin (OSC), osterix (OSX), collagen type I alpha 1 chain (COL1A1), and alkaline phosphatase (ALP) on bone surface mimicked (BSM) PDMS membranes in addition to a unidirectional alignment of osteoblast cells compared to plain PDMS surfaces. This presented bone surface mimicking method can provide a versatile native-like platform for further investigation of intracellular pathways regarding osteoblast growth and differentiation.
Collapse
Affiliation(s)
- Berkay Erenay
- Biomimetics and Bioinspired Biomaterials Research Laboratory, Institute of Biomedical Engineering, Boğaziçi University, 34684, Turkey
| | - Atiye Seda Yar Sağlam
- Department of Medical Biology and Genetics, Faculty of Medicine, Gazi University, Besevler, Ankara 06500, Turkey
| | - Bora Garipcan
- Biomimetics and Bioinspired Biomaterials Research Laboratory, Institute of Biomedical Engineering, Boğaziçi University, 34684, Turkey
| | - Klaus D Jandt
- Chair of Materials Science, Otto Schott Institute of Materials Research, Friedrich Schiller University, Jena 07743, Germany.
| | - Sedat Odabaş
- Biomaterials and Tissue Engineering Laboratory (BteLAB), Faculty of Science, Department of Chemistry, Ankara University, 06560, Turkey; Interdisciplinary Research Unit for Advanced Materials (INTRAM), Ankara University, Ankara 06560, Turkey.
| |
Collapse
|
6
|
Chraniuk M, Panasiuk M, Hovhannisyan L, Żołędowska S, Nidzworski D, Ciołek L, Woźniak A, Jaegermann Z, Biernat M, Gromadzka B. The Preliminary Assessment of New Biomaterials Necessitates a Comparison of Direct and Indirect Cytotoxicity Methodological Approaches. Polymers (Basel) 2022; 14:4522. [PMID: 36365516 PMCID: PMC9657594 DOI: 10.3390/polym14214522] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 10/07/2022] [Accepted: 10/19/2022] [Indexed: 09/05/2024] Open
Abstract
BACKGROUND Cytotoxicity testing is a primary method to establish the safety of biomaterials, e.g., biocomposites. Biomaterials involve a wide range of medical materials, which are usually solid materials and are used in bone regeneration, cardiology, or dermatology. Current advancements in science and technology provide several standard cytotoxicity testing methods that are sufficiently sensitive to detect various levels of cellular toxicity, i.e., from low to high. The aim was to compare the direct and indirect methodology described in the ISO guidelines UNE-EN ISO 10993-5:2009 Part 5. METHODS Cell proliferation was measured using WST-1 assay, and cytotoxicity was measured using LDH test kit. RESULTS The results indicate that the molecular surface of biomaterials have impact on the cytotoxicity and proliferation profile. Based on these results, we confirm that the indirect method does not provide a clear picture of the cell condition after the exposure to the surface, and moreover, cannot provide complete results about the effects of the material. CONCLUSIONS Comparison of both methods shows that it is pivotal to investigate biomaterials at the very early stages using both indirect and direct methods to access the influence of the released toxins and surface of the material on the cell condition.
Collapse
Affiliation(s)
- Milena Chraniuk
- Department of In Vitro Studies, Institute of Biotechnology and Molecular Medicine, Kampinoska 25, 80-180 Gdańsk, Poland
| | - Mirosława Panasiuk
- Department of In Vitro Studies, Institute of Biotechnology and Molecular Medicine, Kampinoska 25, 80-180 Gdańsk, Poland
| | - Lilit Hovhannisyan
- Department of In Vitro Studies, Institute of Biotechnology and Molecular Medicine, Kampinoska 25, 80-180 Gdańsk, Poland
| | - Sabina Żołędowska
- Department of In Vitro Studies, Institute of Biotechnology and Molecular Medicine, Kampinoska 25, 80-180 Gdańsk, Poland
| | - Dawid Nidzworski
- Department of In Vitro Studies, Institute of Biotechnology and Molecular Medicine, Kampinoska 25, 80-180 Gdańsk, Poland
| | - Lidia Ciołek
- Biomaterials Research Group, Ceramic and Concrete Division in Warsaw, Łukasiewicz Research Network-Institute of Ceramics and Building Materials, Cementowa 8, 31-983 Kraków, Poland
| | - Anna Woźniak
- Biomaterials Research Group, Ceramic and Concrete Division in Warsaw, Łukasiewicz Research Network-Institute of Ceramics and Building Materials, Cementowa 8, 31-983 Kraków, Poland
| | - Zbigniew Jaegermann
- Biomaterials Research Group, Ceramic and Concrete Division in Warsaw, Łukasiewicz Research Network-Institute of Ceramics and Building Materials, Cementowa 8, 31-983 Kraków, Poland
| | - Monika Biernat
- Biomaterials Research Group, Ceramic and Concrete Division in Warsaw, Łukasiewicz Research Network-Institute of Ceramics and Building Materials, Cementowa 8, 31-983 Kraków, Poland
| | - Beata Gromadzka
- Department of In Vitro Studies, Institute of Biotechnology and Molecular Medicine, Kampinoska 25, 80-180 Gdańsk, Poland
| |
Collapse
|
7
|
PEEK versus titanium-coated PEEK cervical cages: fusion rate. Acta Neurochir (Wien) 2022; 164:1501-1507. [PMID: 35471708 DOI: 10.1007/s00701-022-05217-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Accepted: 04/17/2022] [Indexed: 12/29/2022]
Abstract
BACKGROUND Anterior cervical discectomy and fusion (ACDF) is one of the most commonly performed procedures for degenerative cervical disease. The evaluation of fusion status is still not fully standardized, and a variety of measurement methods are used. This study presents our own evaluation of fusion by comparing two types of implants. METHODS A total of 170 disc spaces were operated on in 104 patients using PEEK (polyetheretherketone) cages and titanium-coated (TC) PEEK cages. Patients were assigned to a specific implant using a randomisation table. Fusion status was evaluated based on functional radiographs and CT scans obtained at 12 months post-surgery. Multivariate mixed-effects logistic regression models were performed to assess the association of type of implant with different fusion rates. RESULTS At 12 months post-surgery, CT scans were performed in 86 patients (a total of 144 disc spaces) and conventional radiographs were obtained in 102 (a total of 166 disc spaces). Complete fusion was demonstrated in 101 cases (71.1%), partial fusion in 43 cases (29.9%). There were no cases of absence of fusion. A total of 85 PEEK cages (59%) and 59 TC-PEEK cages (41%) were implanted. For PEEK cages, complete fusion was seen in 75 (88.2%) disc spaces, compared to 26 (44.1%) achieved with TC-PEEK cages. A significantly higher proportion of complete fusions (B = 15.58; P < 0.0001) after 12 months was observed with PEEK implants compared to TC-PEEK implants. CONCLUSION Complete fusion was noted at 12 months post-surgery significantly more frequently with PEEK implants compared to TC-PEEK implants.
Collapse
|
8
|
Qin S, Lu Z, Gan K, Qiao C, Li B, Chen T, Gao Y, Jiang L, Liu H. Construction of a
BMP
‐2 gene delivery system for polyetheretherketone bone implant material and its effect on bone formation in vitro. J Biomed Mater Res B Appl Biomater 2022; 110:2075-2088. [PMID: 35398972 DOI: 10.1002/jbm.b.35062] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 03/15/2022] [Accepted: 03/19/2022] [Indexed: 11/11/2022]
Affiliation(s)
- Shuang Qin
- Department of Oral Comprehensive Therapy, Hospital of Stomatology Jilin University Changchun China
| | - Zhengkuan Lu
- Department of Oral Comprehensive Therapy, Hospital of Stomatology Jilin University Changchun China
| | - Kang Gan
- Department of Stomatology The First Affiliated Hospital of Zhengzhou University Zhengzhou China
| | - Chunyan Qiao
- Department of Oral Pathology, Hospital of Stomatology Jilin University Changchun China
| | - Baosheng Li
- Department of Dental Implantology, Hospital of Stomatology Jilin University Changchun China
| | - Tianjie Chen
- Department of Oral Comprehensive Therapy, Hospital of Stomatology Jilin University Changchun China
| | - Yunbo Gao
- Department of Oral Comprehensive Therapy, Hospital of Stomatology Jilin University Changchun China
| | - Lingling Jiang
- Department of Oral Comprehensive Therapy, Hospital of Stomatology Jilin University Changchun China
| | - Hong Liu
- Department of Oral Comprehensive Therapy, Hospital of Stomatology Jilin University Changchun China
| |
Collapse
|
9
|
Levin M, Spiro RC, Jain H, Falk MM. Effects of Titanium Implant Surface Topology on Bone Cell Attachment and Proliferation in vitro. MEDICAL DEVICES-EVIDENCE AND RESEARCH 2022; 15:103-119. [PMID: 35502265 PMCID: PMC9056099 DOI: 10.2147/mder.s360297] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Accepted: 04/07/2022] [Indexed: 01/05/2023] Open
Abstract
Purpose Titanium is commonly used for implants because of its corrosion resistance and osseointegration capability. It is well known that surface topology affects the response of bone tissue towards implants. In vivo studies have shown that in weeks or months, bone tissue bonds more efficiently to titanium implants with rough surfaces compared to smooth surfaces. In addition, stimulating early endosseous integration increases the long-term stability of bone-implants and hence their clinical outcome. Here, we evaluated the response of human MG-63 osteoblast-like cells to flat and solid, compared to rough and porous surface topologies in vitro 1–6 days post seeding. We compared the morphology, proliferation, and attachment of cells onto three smooth surfaces: tissue culture (TC) plastic or microscope cover glasses, machined polyether-ether-ketone (PEEK), and machined solid titanium, to cells on a highly porous (average Ra 22.94 μm) plasma-sprayed titanium surface (composite Ti-PEEK spine implants). Methods We used immuno-fluorescence (IF) and scanning electron microscopy (SEM), as well as Live/Dead and WST-1 cell proliferation assays. Results SEM analyses confirmed the rough topology of the titanium implant surface, compared to the smooth surface of PEEK, solid titanium, TC plastic and cover glasses. In addition, SEM analyses revealed that MG-63 cells seeded onto smooth surfaces (solid titanium, PEEK) adopted a flat, planar morphology, while cells on the rough titanium surface adopted an elongated morphology with numerous filopodial and lamellipodial extensions interacting with the substrate. Finally, IF analyses of focal adhesions (vinculin, focal adhesion kinase), as well as proliferation assays indicate that MG-63 cells adhere less and proliferate at a slower rate on the rough than on a smooth titanium surface. Conclusion These observations suggest that bone-forming osteoblasts adhere less strongly and proliferate slower on rough compared to smooth titanium surfaces, likely promoting cell differentiation, which is in agreement with other porous implant materials.
Collapse
Affiliation(s)
- Michael Levin
- Department of Bioengineering, P.C. Rossin College of Engineering & Applied Science, Lehigh University, Bethlehem, PA, 18015, USA
| | - Robert C Spiro
- Research and Development, Aesculap Implant Systems, LLC, Breinigsville, PA, 18031, USA
| | - Himanshu Jain
- Department of Materials Science & Engineering, P.C. Rossin College of Engineering & Applied Science, Lehigh University, Bethlehem, PA, 18015, USA
- Correspondence: Himanshu Jain; Matthias M Falk, Email ;
| | - Matthias M Falk
- Department of Biological Sciences, Lehigh University, Bethlehem, PA, 18015, USA
| |
Collapse
|
10
|
Enhancement of the bone-implant interface by applying a plasma-sprayed titanium coating on nanohydroxyapatite/polyamide66 implants in a rabbit model. Sci Rep 2021; 11:19971. [PMID: 34620967 PMCID: PMC8497622 DOI: 10.1038/s41598-021-99494-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Accepted: 09/27/2021] [Indexed: 12/05/2022] Open
Abstract
Solid fusion at the bone-implant interface (BII) is considered one of the indicators of a satisfactory clinical outcome for spine surgery. Although the mechanical and physical properties of nanohydroxyapatite/polyamide66 (n-HA/PA66) offers many advantages, the results of long-term follow-up for BIIs remain limited. This study aimed to improve the BII of n-HA/PA66 by applying plasma-sprayed titanium (PST) and assessing the mechanical and histological properties. After the PST coating was applied to n-HA/PA66 implants, the coating had uneven, porous surfaces. The compression results were not significantly different between the two groups. The micro-CT results demonstrated that at 6 weeks and 12 weeks, the bone volume (BV), BV/tissue volume (TV) and trabecular number (Tb.N) values of the n-HA/PA66-PST group were significantly higher than those of the n-HA/PA66 group. The results of undecalcified bone slicing showed that more new bone appeared to form around n-HA/PA66-PST implant than around n-HA/PA66 implant. The bone-implant contact (BIC) and push-out test results of the n-HA/PA66-PST group were better than those of the n-HA/PA66 group. In conclusion, after PST coating, direct and additional new bone-to-implant bonding could be achieved, improving the BII of n-HA/PA66 implants. The n-HA/PA66-PST implants could be promising for repair purposes.
Collapse
|
11
|
Harawaza K, Cousins B, Roach P, Fernandez A. Modification of the surface nanotopography of implant devices: A translational perspective. Mater Today Bio 2021; 12:100152. [PMID: 34746736 PMCID: PMC8554633 DOI: 10.1016/j.mtbio.2021.100152] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Revised: 10/16/2021] [Accepted: 10/19/2021] [Indexed: 01/24/2023] Open
Abstract
There is an increasing need for the development of superior, safe, and more sophisticated implants, especially as our society historically has been moving towards an increasingly aging population. Currently, most research is being focused on the next generation of advanced medical implants, that are not only biocompatible but have modified surfaces that direct specific immunomodulation at cellular level. While there is a plethora of information on cell-surface interaction and how surfaces can be nanofabricated at research level, less is known about how the academic knowledge has been translated into clinical trials and commercial technologies. In this review, we provide a clinical translational perspective on the use of controlled physical surface modification of medical implants, presenting an analysis of data acquired from clinical trials and commercial products. We also evaluate the state-of-the-art of nanofabrication techniques that are being applied for implant surface modification at a clinical level. Finally, we identify some current challenges in the field, including the need of more advanced nanopatterning techniques, the comparatively small number of clinical trials and comment on future avenues to be explored for a successful clinical translation.
Collapse
Affiliation(s)
- K. Harawaza
- Chemistry Department, School of Science, Loughborough University, Loughborough, LE11 3TU, UK
| | - B. Cousins
- Chemistry Department, School of Science, Loughborough University, Loughborough, LE11 3TU, UK
| | - P. Roach
- Chemistry Department, School of Science, Loughborough University, Loughborough, LE11 3TU, UK
| | - A. Fernandez
- Chemistry Department, School of Science, Loughborough University, Loughborough, LE11 3TU, UK
| |
Collapse
|
12
|
dos Santos FSF, Vieira M, da Silva HN, Tomás H, Fook MVL. Surface Bioactivation of Polyether Ether Ketone (PEEK) by Sulfuric Acid and Piranha Solution: Influence of the Modification Route in Capacity for Inducing Cell Growth. Biomolecules 2021; 11:biom11091260. [PMID: 34572473 PMCID: PMC8465912 DOI: 10.3390/biom11091260] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Revised: 12/26/2020] [Accepted: 12/27/2020] [Indexed: 11/16/2022] Open
Abstract
The aim of this study was to promote bioactivity of the PEEK surface using sulfuric acid and piranha solution. PEEK was functionalized by a sulfuric acid treatment for 90 s and by piranha solution for 60 and 90 s. Chemical modification of the PEEK surface was evaluated by infrared spectroscopy, contact angle analysis, cytotoxicity, cell adhesion and proliferation. The spectroscopy characteristic band associated with sulfonation was observed in all treated samples. PEEK with piranha solution 60 s showed an increase in the intensity of the bands, which was even more significant for the longer treatment (90 s). The introduction of the sulfonic acid functional group reduced the contact angle. In cytotoxicity assays, for all treatments, the number of viable cells was higher when compared to those of untreated PEEK. PEEK treated with sulfuric acid and piranha solution for 60 s were the treatments that showed the highest percentage of cell viability with no statistically significant differences between them. The modified surfaces had a greater capacity for inducing cell growth, indicative of effective cell adhesion and proliferation. The proposed chemical modifications are promising for the functionalization of PEEK-based implants, as they were effective in promoting bioactivation of the PEEK surface and in stimulating cell growth and proliferation.
Collapse
Affiliation(s)
- Flavia Suzany Ferreira dos Santos
- Departament of Materials Engineering, Federal University of Campina Grande, Campina Grande 58429-900, PB, Brazil; (F.S.F.d.S.); (H.N.d.S.)
| | - Mariana Vieira
- CQM—Centro de Química da Madeira, Universidade da Madeira, Campus da Penteada, 9020-105 Funchal, Portugal; (M.V.); (H.T.)
| | - Henrique Nunes da Silva
- Departament of Materials Engineering, Federal University of Campina Grande, Campina Grande 58429-900, PB, Brazil; (F.S.F.d.S.); (H.N.d.S.)
| | - Helena Tomás
- CQM—Centro de Química da Madeira, Universidade da Madeira, Campus da Penteada, 9020-105 Funchal, Portugal; (M.V.); (H.T.)
| | - Marcus Vinícius Lia Fook
- Departament of Materials Engineering, Federal University of Campina Grande, Campina Grande 58429-900, PB, Brazil; (F.S.F.d.S.); (H.N.d.S.)
- Correspondence: ; Tel.: +55-8321011841
| |
Collapse
|
13
|
Frankenberger T, Graw CL, Engel N, Gerber T, Frerich B, Dau M. Sustainable Surface Modification of Polyetheretherketone (PEEK) Implants by Hydroxyapatite/Silica Coating-An In Vivo Animal Study. MATERIALS 2021; 14:ma14164589. [PMID: 34443112 PMCID: PMC8398357 DOI: 10.3390/ma14164589] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Revised: 08/06/2021] [Accepted: 08/12/2021] [Indexed: 12/27/2022]
Abstract
Polyetheretherketone (PEEK) has the potential to overcome some of the disadvantages of titanium interbody implants in anterior cervical and discectomy and fusion (ACDF). However, PEEK shows an inferior biological behavior regarding osseointegration and bioactivity. Therefore, the aim of the study was to create a bioactive surface coating on PEEK implants with a unique nanopore structure enabling the generation of a long-lasting interfacial composite layer between coating material and implant. Seventy-two PEEK implants-each thirty-six pure PEEK implants (PI) and thirty-six PEEK implants with a sprayed coating consisting of nanocrystalline hydroxyapatite (ncHA) embedded in a silica matrix and interfacial composite layer (SPI)-were inserted in the femoral condyles of adult rats using a split-side model. After 2, 4 and 8 weeks, the femur bones were harvested. Half of the femur bones were used in histological and histomorphometrical analyses. Additionally, pull-out tests were performed in the second half. Postoperative healing was uneventful for all animals, and no postoperative complications were observed. Considerable crestal and medullary bone remodeling could be found around all implants, with faster bone formation around the SPI and fewer regions with fibrous tissue barriers between implant and bone. Histomorphometrical analyses showed a higher bone to implant contact (BIC) in SPI after 4 and 8 weeks (p < 0.05). Pull-out tests revealed higher pull-out forces in SPI at all time points (p < 0.01). The presented findings demonstrate that a combination of a bioactive coating and the permanent chemical and structural modified interfacial composite layer can improve bone formation at the implant surface by creating a sustainable bone-implant interface. This might be a promising way to overcome the bioinert surface property of PEEK-based implants.
Collapse
Affiliation(s)
- Thomas Frankenberger
- Institute of Physics, Rostock University, 18057 Rostock, Germany; (T.F.); (T.G.)
| | - Constantin Leon Graw
- Department of Oral, Maxillofacial and Plastic Surgery, Rostock University Medical Center, 18057 Rostock, Germany; (C.L.G.); (N.E.); (B.F.)
| | - Nadja Engel
- Department of Oral, Maxillofacial and Plastic Surgery, Rostock University Medical Center, 18057 Rostock, Germany; (C.L.G.); (N.E.); (B.F.)
| | - Thomas Gerber
- Institute of Physics, Rostock University, 18057 Rostock, Germany; (T.F.); (T.G.)
| | - Bernhard Frerich
- Department of Oral, Maxillofacial and Plastic Surgery, Rostock University Medical Center, 18057 Rostock, Germany; (C.L.G.); (N.E.); (B.F.)
| | - Michael Dau
- Department of Oral, Maxillofacial and Plastic Surgery, Rostock University Medical Center, 18057 Rostock, Germany; (C.L.G.); (N.E.); (B.F.)
- Correspondence: ; Tel.: +49-381-494-6688
| |
Collapse
|
14
|
|
15
|
Verma S, Sharma N, Kango S, Sharma S. Developments of PEEK (Polyetheretherketone) as a biomedical material: A focused review. Eur Polym J 2021. [DOI: 10.1016/j.eurpolymj.2021.110295] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
|
16
|
Gu X, Sun X, Sun Y, Wang J, Liu Y, Yu K, Wang Y, Zhou Y. Bioinspired Modifications of PEEK Implants for Bone Tissue Engineering. Front Bioeng Biotechnol 2021; 8:631616. [PMID: 33511108 PMCID: PMC7835420 DOI: 10.3389/fbioe.2020.631616] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Accepted: 12/10/2020] [Indexed: 12/15/2022] Open
Abstract
In recent years, polyetheretherketone (PEEK) has been increasingly employed as an implant material in clinical applications. Although PEEK is biocompatible, chemically stable, and radiolucent and has an elastic modulus similar to that of natural bone, it suffers from poor integration with surrounding bone tissue after implantation. To improve the bioactivity of PEEK, numerous strategies for functionalizing the PEEK surface and changing the PEEK structure have been proposed. Inspired by the components, structure, and function of bone tissue, this review discusses strategies to enhance the biocompatibility of PEEK implants and provides direction for fabricating multifunctional implants in the future.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | - Yanmin Zhou
- Department of Oral Implantology, Hospital of Stomatology, Jilin University, Changchun, China
| |
Collapse
|
17
|
Osteoconductive and Osteoinductive Surface Modifications of Biomaterials for Bone Regeneration: A Concise Review. COATINGS 2020. [DOI: 10.3390/coatings10100971] [Citation(s) in RCA: 55] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
The main aim of bone tissue engineering is to fabricate highly biocompatible, osteoconductive and/or osteoinductive biomaterials for tissue regeneration. Bone implants should support bone growth at the implantation site via promotion of osteoblast adhesion, proliferation, and formation of bone extracellular matrix. Moreover, a very desired feature of biomaterials for clinical applications is their osteoinductivity, which means the ability of the material to induce osteogenic differentiation of mesenchymal stem cells toward bone-building cells (osteoblasts). Nevertheless, the development of completely biocompatible biomaterials with appropriate physicochemical and mechanical properties poses a great challenge for the researchers. Thus, the current trend in the engineering of biomaterials focuses on the surface modifications to improve biological properties of bone implants. This review presents the most recent findings concerning surface modifications of biomaterials to improve their osteoconductivity and osteoinductivity. The article describes two types of surface modifications: (1) Additive and (2) subtractive, indicating biological effects of the resultant surfaces in vitro and/or in vivo. The review article summarizes known additive modifications, such as plasma treatment, magnetron sputtering, and preparation of inorganic, organic, and composite coatings on the implants. It also presents some common subtractive processes applied for surface modifications of the biomaterials (i.e., acid etching, sand blasting, grit blasting, sand-blasted large-grit acid etched (SLA), anodizing, and laser methods). In summary, the article is an excellent compendium on the surface modifications and development of advanced osteoconductive and/or osteoinductive coatings on biomaterials for bone regeneration.
Collapse
|
18
|
Surface Modification of Biomedical Titanium Alloy: Micromorphology, Microstructure Evolution and Biomedical Applications. COATINGS 2019. [DOI: 10.3390/coatings9040249] [Citation(s) in RCA: 81] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
With the increasing demand for bone implant therapy, titanium alloy has been widely used in the biomedical field. However, various potential applications of titanium alloy implants are easily hampered by their biological inertia. In fact, the interaction of the implant with tissue is critical to the success of the implant. Thus, the implant surface is modified before implantation frequently, which can not only improve the mechanical properties of the implant, but also polish up bioactivity and osseoconductivity on a cellular level. This paper aims at reviewing titanium surface modification techniques for biomedical applications. Additionally, several other significant aspects are described in detail in this article, for example, micromorphology, microstructure evolution that determines mechanical properties, as well as a number of issues concerning about practical application of biomedical implants.
Collapse
|
19
|
Wei T, Wang J, Yu X, Wang Y, Wu Q, Chen C. Mechanical and thermal properties and cytotoxicity of Al2O3 nano particle-reinforced poly(ether-ether-ketone) for bone implants. RSC Adv 2019; 9:34642-34651. [PMID: 35529981 PMCID: PMC9074165 DOI: 10.1039/c9ra05258e] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Accepted: 10/08/2019] [Indexed: 11/21/2022] Open
Abstract
A novel preparation method for a PEEK/Al2O3 composite biomaterial for human bone implantation was proposed.
Collapse
Affiliation(s)
- Tianyue Wei
- State Key Laboratory of Advanced Technology for Materials Synthesis and Processing
- Wuhan University of Technology
- Wuhan 430070
- China
| | - Jin Wang
- State Key Laboratory of Advanced Technology for Materials Synthesis and Processing
- Wuhan University of Technology
- Wuhan 430070
- China
| | - Xunzhi Yu
- State Key Laboratory of Advanced Technology for Materials Synthesis and Processing
- Wuhan University of Technology
- Wuhan 430070
- China
| | - Youfa Wang
- State Key Laboratory of Advanced Technology for Materials Synthesis and Processing
- Wuhan University of Technology
- Wuhan 430070
- China
- Biomedical Materials and Engineering Research Center of Hubei Province
| | - Qingzhi Wu
- State Key Laboratory of Advanced Technology for Materials Synthesis and Processing
- Wuhan University of Technology
- Wuhan 430070
- China
- Biomedical Materials and Engineering Research Center of Hubei Province
| | - Chang Chen
- State Key Laboratory of Advanced Technology for Materials Synthesis and Processing
- Wuhan University of Technology
- Wuhan 430070
- China
| |
Collapse
|