Functionalized BaTiO3 enhances piezoelectric effect towards cell response of bone scaffold

3D-printed zinc oxide nanoparticles modified barium titanate/hydroxyapatite ultrasound-responsive piezoelectric ceramic composite scaffold for treating infected bone defects

Clinically, infectious bone defects represent a significant threat, leading to osteonecrosis, severely compromising patient prognosis, and prolonging hospital stays. Thus, there is an urgent need to develop a bone graft substitute that combines broad-spectrum antibacterial efficacy and bone-inductive properties, providing an effective treatment option for infectious bone defects. In this study, the precision of digital light processing (DLP) 3D printing technology was utilized to construct a scaffold, incorporating zinc oxide nanoparticles (ZnO-NPs) modified barium titanate (BT) with hydroxyapatite (HA), resulting in a piezoelectric ceramic scaffold designed for the repair of infected bone defects. The results indicated that the addition of ZnO-NPs significantly improved the piezoelectric properties of BT, facilitating a higher HA content within the ceramic scaffold system, which is essential for bone regeneration. In vitro antibacterial assessments highlighted the scaffold's potent antibacterial capabilities. Moreover, combining the synergistic effects of low-intensity pulsed ultrasound (LIPUS) and piezoelectricity, results demonstrated that the scaffold promoted notable osteogenic and angiogenic potential, enhancing bone growth and repair. Furthermore, transcriptomics analysis results suggested that the early growth response-1 (EGR1) gene might be crucial in this process. This study introduces a novel method for constructing piezoelectric ceramic scaffolds exhibiting outstanding osteogenic, angiogenic, and antibacterial properties under the combined influence of LIPUS, offering a promising treatment strategy for infectious bone defects.

Advanced Piezoelectric Materials, Devices, and Systems for Orthopedic Medicine

Harnessing the robust electromechanical couplings, piezoelectric materials not only enable efficient bio-energy harvesting, physiological sensing and actuating but also open enormous opportunities for therapeutic treatments through surface polarization directly interacting with electroactive cells, tissues, and organs. Known for its highly oriented and hierarchical structure, collagen in natural bones produces local electrical signals to stimulate osteoblasts and promote bone formation, inspiring the application of piezoelectric materials in orthopedic medicine. Recent studies showed that piezoelectricity can impact microenvironments by regulating molecular sensors including ion channels, cytoskeletal elements, cell adhesion proteins, and other signaling pathways. This review thus focuses on discussing the pioneering applications of piezoelectricity in the diagnosis and treatment of orthopedic diseases, aiming to offer valuable insights for advancing next-generation medical technologies. Beginning with an introduction to the principles of piezoelectricity and various piezoelectric materials, this review paper delves into the mechanisms through which piezoelectric materials accelerated osteogenesis. A comprehensive overview of piezoelectric materials, devices, and systems enhancing bone tissue repair, alleviating inflammation at infection sites, and monitoring bone health is then provided, respectively. Finally, the major challenges faced by applications of piezoelectricity in orthopedic conditions are thoroughly discussed, along with a critical outlook on future development trends.

Multifunctional scaffolds for bone repair following age-related biological decline: Promising prospects for smart biomaterial-driven technologies

The repair of large bone defects due to trauma, disease, and infection can be exceptionally challenging in the elderly. Despite best clinical practice, bone regeneration within contemporary, surgically implanted synthetic scaffolds is often problematic, inconsistent, and insufficient where additional osteobiological support is required to restore bone. Emergent smart multifunctional biomaterials may drive important and dynamic cellular crosstalk that directly targets, signals, stimulates, and promotes an innate bone repair response following age-related biological decline and when in the presence of disease or infection. However, their role remains largely undetermined. By highlighting their mechanism/s and mode/s of action, this review spotlights smart technologies that favorably align in their conceivable ability to directly target and enhance bone repair and thus are highly promising for future discovery for use in the elderly. The four degrees of interactive scaffold smartness are presented, with a focus on bioactive, bioresponsive, and the yet-to-be-developed autonomous scaffold activity. Further, cell- and biomolecular-assisted approaches were excluded, allowing for contemporary examination of the capabilities, demands, vision, and future requisites of next-generation biomaterial-induced technologies only. Data strongly supports that smart scaffolds hold significant promise in the promotion of bone repair in patients with a reduced osteobiological response. Importantly, many techniques have yet to be tested in preclinical models of aging. Thus, greater clarity on their proficiency to counteract the many unresolved challenges within the scope of aging bone is highly warranted and is arguably the next frontier in the field. This review demonstrates that the use of multifunctional smart synthetic scaffolds with an engineered strategy to circumvent the biological insufficiencies associated with aging bone is a viable route for achieving next-generation therapeutic success in the elderly population.

Combining external physical stimuli and nanostructured materials for upregulating pro-regenerative cellular pathways in peripheral nerve repair

Peripheral nerve repair remains a major clinical challenge, particularly in the pursuit of therapeutic approaches that ensure adequate recovery of patient's activity of daily living. Autografts are the gold standard in clinical practice for restoring lost sensorimotor functions nowadays. However, autografts have notable drawbacks, including dimensional mismatches and the need to sacrifice one function to restore another. Engineered nerve guidance conduits have therefore emerged as promising alternatives. While these conduits show surgical potential, their clinical use is currently limited to the repair of minor injuries, as their ability to reinnervate limiting gap lesions is still unsatisfactory. Therefore, improving patient functional recovery requires a deeper understanding of the cellular mechanisms involved in peripheral nerve regeneration and the development of therapeutic strategies that can precisely modulate these processes. Interest has grown in the use of external energy sources, such as light, ultrasound, electrical, and magnetic fields, to activate cellular pathways related to proliferation, differentiation, and migration. Recent research has explored combining these energy sources with tailored nanostructured materials as nanotransducers to enhance selectivity towards the target cells. This review aims to present the recent findings on this innovative strategy, discussing its potential to support nerve regeneration and its viability as an alternative to autologous transplantation.

Development and evaluation of 3D composite scaffolds with piezoelectricity and biofactor synergy for enhanced articular cartilage regeneration

The inability of articular cartilage to self-repair following injuries frequently precipitates osteoarthritis, profoundly affecting patients' quality of life. Given the limitations inherent in current clinical interventions, an urgent need exists for more effective cartilage regeneration methodologies. Previous studies have underscored the potential of electrical stimulation in cartilage repair, thus motivating the investigation of innovative strategies. The present study introduces a three-dimensional scaffold fabricated through a composite technique that leverages the synergy between piezoelectricity and biofactors to enhance cartilage repair. This scaffold is composed of polylactic acid (PLLA) and barium titanate (BT) for piezoelectric stimulation and at the bottom with a collagen-coated layer infused with fibroblast growth factor-18 (FGF-18) for biofactor delivery. Designed to emulate the properties of natural cartilage, the scaffold enables controlled generation of piezoelectric charges and the sustained release of biofactors. In vitro tests confirm that the scaffold promotes chondrocyte proliferation, matrix hyperplasia, cellular migration, and the expression of genes associated with cartilage formation. Moreover, in vivo studies on rabbits have illustrated its efficacy in catalyzing the in situ regeneration of articular cartilage defects and remodeling the extracellular matrix. This innovative approach offers significant potential for enhancing cartilage repair and holds profound implications for regenerative medicine.

Recent Progress in the Auxiliary Phase Enhanced Flexible Piezocomposites

Piezocomposites with both flexibility and electromechanical conversion characteristics have been widely applied in various fields, including sensors, energy harvesting, catalysis, and biomedical treatment. In the composition of piezocomposites or their preparation process, a category of materials is commonly employed that do not possess piezoelectric properties themselves but play a crucial role in performance enhancement. In this review, the concept of auxiliary phase is first proposed to define these materials, aiming to provide a new perspective for designing high‐performance piezocomposites. Three different categories of modulation forms of auxiliary phase in piezocomposites are systematically summarized, including the modification of piezo‐matrix, the modification of piezo‐fillers, and the construction of special structures. Each category emphasizes the role of the auxiliary phase and systematically discusses the latest advancements and the physical mechanisms of the auxiliary phase enhanced flexible piezocomposites. Finally, a summary and future outlook of piezocomposites based on the auxiliary phase are provided.

Piezoelectric Scaffolds as Smart Materials for Bone Tissue Engineering

Bone repair and regeneration require physiological cues, including mechanical, electrical, and biochemical activity. Many biomaterials have been investigated as bioactive scaffolds with excellent electrical properties. Amongst biomaterials, piezoelectric materials (PMs) are gaining attention in biomedicine, power harvesting, biomedical devices, and structural health monitoring. PMs have unique properties, such as the ability to affect physiological movements and deliver electrical stimuli to damaged bone or cells without an external power source. The crucial bone property is its piezoelectricity. Bones can generate electrical charges and potential in response to mechanical stimuli, as they influence bone growth and regeneration. Piezoelectric materials respond to human microenvironment stimuli and are an important factor in bone regeneration and repair. This manuscript is an overview of the fundamentals of the materials generating the piezoelectric effect and their influence on bone repair and regeneration. This paper focuses on the state of the art of piezoelectric materials, such as polymers, ceramics, and composites, and their application in bone tissue engineering. We present important information from the point of view of bone tissue engineering. We highlight promising upcoming approaches and new generations of piezoelectric materials.

Recent Advances in 3D Printing of Smart Scaffolds for Bone Tissue Engineering and Regeneration

The repair and functional reconstruction of bone defects resulting from severe trauma, surgical resection, degenerative disease, and congenital malformation pose significant clinical challenges. Bone tissue engineering (BTE) holds immense potential in treating these severe bone defects, without incurring prevalent complications associated with conventional autologous or allogeneic bone grafts. 3D printing technology enables control over architectural structures at multiple length scales and has been extensively employed to process biomimetic scaffolds for BTE. In contrast to inert and functional bone grafts, next-generation smart scaffolds possess a remarkable ability to mimic the dynamic nature of native extracellular matrix (ECM), thereby facilitating bone repair and regeneration. Additionally, they can generate tailored and controllable therapeutic effects, such as antibacterial or antitumor properties, in response to exogenous and/or endogenous stimuli. This review provides a comprehensive assessment of the progress of 3D-printed smart scaffolds for BTE applications. It begins with an introduction to bone physiology, followed by an overview of 3D printing technologies utilized for smart scaffolds. Notable advances in various stimuli-responsive strategies, therapeutic efficacy, and applications of 3D-printed smart scaffolds are discussed. Finally, the review highlights the existing challenges in the development and clinical implementation of smart scaffolds, as well as emerging technologies in this field.

From electricity to vitality: the emerging use of piezoelectric materials in tissue regeneration

The unique ability of piezoelectric materials to generate electricity spontaneously has attracted widespread interest in the medical field. In addition to the ability to convert mechanical stress into electrical energy, piezoelectric materials offer the advantages of high sensitivity, stability, accuracy and low power consumption. Because of these characteristics, they are widely applied in devices such as sensors, controllers and actuators. However, piezoelectric materials also show great potential for the medical manufacturing of artificial organs and for tissue regeneration and repair applications. For example, the use of piezoelectric materials in cochlear implants, cardiac pacemakers and other equipment may help to restore body function. Moreover, recent studies have shown that electrical signals play key roles in promoting tissue regeneration. In this context, the application of electrical signals generated by piezoelectric materials in processes such as bone healing, nerve regeneration and skin repair has become a prospective strategy. By mimicking the natural bioelectrical environment, piezoelectric materials can stimulate cell proliferation, differentiation and connection, thereby accelerating the process of self-repair in the body. However, many challenges remain to be overcome before these concepts can be applied in clinical practice, including material selection, biocompatibility and equipment design. On the basis of the principle of electrical signal regulation, this article reviews the definition, mechanism of action, classification, preparation and current biomedical applications of piezoelectric materials and discusses opportunities and challenges for their future clinical translation.

Polyvinylidene Fluoride Based Piezoelectric Composites with Strong Interfacial Adhesion via Click Chemistry for Self-Powered Flexible Sensors

Achieving relatively uniform dispersion in organic-inorganic composites with overwhelming differences in surface energy is a perennial challenge. Herein, novel eliminated polyvinylidene fluoride (EPVDF)/EPVDF functionalized barium titanate nanoparticles (EPVDF@BT) flexible piezoelectric nanogenerators (PENGs) with strong interfacial adhesion are developed via thermal stretching following sequential click chemistry. Thanks to the strong interfacial adhesion, the optimal PENGs containing ultra-high β-phase content (97.2%) exhibit not only optimized mechanical and dielectric behaviors but also excellent piezoelectric properties with high piezoelectric output (V = 10.7 V, I = 216 nA), reliable durability (8000 cycles), ultrafast response time (20 ms), and good sensitivity (2.09 nA kPa-1), far outperforming most reported PVDF-based composites. Furthermore, COMSOL finite element simulations (FEM) confirm that the elevated stress transfer efficiency induced by the strong interfacial adhesion is the main driving force for enhanced piezoelectric performances. For practical applications, self-powered PENGs can simply but stably capture mechanical energy, drive tiny electronic devices, and serve as potential multifunctional and durable sensors for detecting human physiological motions. This work opens a pioneering avenue to break the trade-offs between piezoelectric and other properties, which is of great importance for developing self-powered flexible sensors.

Progress in the development of piezoelectric biomaterials for tissue remodeling

Piezoelectric biomaterials have demonstrated significant potential in the past few decades to heal damaged tissue and restore cellular functionalities. Herein, we discuss the role of bioelectricity in tissue remodeling and explore ways to mimic such tissue-like properties in synthetic biomaterials. In the past decade, biomedical engineers have adopted emerging functional biomaterials-based tissue engineering approaches using innovative bioelectronic stimulation protocols based on dynamic stimuli to direct cellular activation, proliferation, and differentiation on engineered biomaterial constructs. The primary focus of this review is to discuss the concepts of piezoelectric energy harvesting, piezoelectric materials, and their application in soft (skin and neural) and hard (dental and bone) tissue regeneration. While discussing the prospective applications as an engineered tissue, an important distinction has been made between piezoceramics, piezopolymers, and their composites. The superiority of piezopolymers over piezoceramics to circumvent issues such as stiffness mismatch, biocompatibility, and biodegradability are highlighted. We aim to provide a comprehensive review of the field and identify opportunities for the future to develop clinically relevant and state-of-the-art biomaterials for personalized and remote health care.

Scaffold-Based Poly(Vinylidene Fluoride) and Its Copolymers: Materials, Fabrication Methods, Applications, and Perspectives

Tissue engineering involves implanting grafts into damaged tissue sites to guide and stimulate the formation of new tissue, which is an important strategy in the field of tissue defect treatment. Scaffolds prepared in vitro meet this requirement and are able to provide a biochemical microenvironment for cell growth, adhesion, and tissue formation. Scaffolds made of piezoelectric materials can apply electrical stimulation to the tissue without an external power source, speeding up the tissue repair process. Among piezoelectric polymers, poly(vinylidene fluoride) (PVDF) and its copolymers have the largest piezoelectric coefficients and are widely used in biomedical fields, including implanted sensors, drug delivery, and tissue repair. This paper provides a comprehensive overview of PVDF and its copolymers and fillers for manufacturing scaffolds as well as the roles in improving piezoelectric output, bioactivity, and mechanical properties. Then, common fabrication methods are outlined such as 3D printing, electrospinning, solvent casting, and phase separation. In addition, the applications and mechanisms of scaffold-based PVDF in tissue engineering are introduced, such as bone, nerve, muscle, skin, and blood vessel. Finally, challenges, perspectives, and strategies of scaffold-based PVDF and its copolymers in the future are discussed.

Intelligent and Bioactive Osseointegration of the Implanted Piezoelectric Bone Cement with the Host Bone Is Realized by Biomechanical Energy

Poly methyl methacrylate (PMMA) bone cement is widely used in orthopedic surgeries, including total hip/knee arthroplasty and vertebral compression fracture treatment. However, loosening due to bone resorption is a common mid-to-late complication. Therefore, developing bioactive bone cement that promotes bone growth and integration is key to reducing aseptic loosening. In this study, we developed a piezoelectric bone cement comprising PMMA and BaTiO3 with excellent electrobioactivity and further analyzed its ability to promote bone integration. Experiments demonstrate that the PMMA and 15 wt % BaTiO3 cement generated an open-circuit voltage of 37.109 V under biomimetic mechanical stress, which effectively promoted bone regeneration and interfacial bone integration. In vitro experiments showed that the protein expression levels of ALP and RUNX-2 in the 0.65 Hz and 20 min group increased by 1.74 times and 2.31 times. In vivo experiments confirmed the osteogenic ability of PMMA and 15 wt % BaTiO3, with the increment of bone growth in the non-movement and movement groups being 4.67 and 4.64 times, respectively, at the second month after surgery. Additionally, Fluo-4 AM fluorescence staining and protein blotting experiments verified that PMMA and 15 wt % BaTiO3 electrical stimulation promoted osteogenic differentiation of BMSCs by activating calcium-sensitive receptors and increasing calcium ion inflow by 1.41 times when the stimulation reached 30 min. Therefore, piezoelectric bioactive PMMA and 15 wt % BaTiO3 cement has excellent application value in orthopedic surgery systems where stress transmission is prevalent.

Injectable ultrasound-powered bone-adhesive nanocomposite hydrogel for electrically accelerated irregular bone defect healing

The treatment of critical-size bone defects with irregular shapes remains a major challenge in the field of orthopedics. Bone implants with adaptability to complex morphological bone defects, bone-adhesive properties, and potent osteogenic capacity are necessary. Here, a shape-adaptive, highly bone-adhesive, and ultrasound-powered injectable nanocomposite hydrogel is developed via dynamic covalent crosslinking of amine-modified piezoelectric nanoparticles and biopolymer hydrogel networks for electrically accelerated bone healing. Depending on the inorganic-organic interaction between the amino-modified piezoelectric nanoparticles and the bio-adhesive hydrogel network, the bone adhesive strength of the prepared hydrogel exhibited an approximately 3-fold increase. In response to ultrasound radiation, the nanocomposite hydrogel could generate a controllable electrical output (-41.16 to 61.82 mV) to enhance the osteogenic effect in vitro and in vivo significantly. Rat critical-size calvarial defect repair validates accelerated bone healing. In addition, bioinformatics analysis reveals that the ultrasound-responsive nanocomposite hydrogel enhanced the osteogenic differentiation of bone mesenchymal stem cells by increasing calcium ion influx and up-regulating the PI3K/AKT and MEK/ERK signaling pathways. Overall, the present work reveals a novel wireless ultrasound-powered bone-adhesive nanocomposite hydrogel that broadens the therapeutic horizons for irregular bone defects.

Ultrasound Stimulation of Piezoelectric Nanocomposite Hydrogels Boosts Chondrogenic Differentiation in Vitro, in Both a Normal and Inflammatory Milieu

The use of piezoelectric nanomaterials combined with ultrasound stimulation is emerging as a promising approach for wirelessly triggering the regeneration of different tissue types. However, it has never been explored for boosting chondrogenesis. Furthermore, the ultrasound stimulation parameters used are often not adequately controlled. In this study, we show that adipose-tissue-derived mesenchymal stromal cells embedded in a nanocomposite hydrogel containing piezoelectric barium titanate nanoparticles and graphene oxide nanoflakes and stimulated with ultrasound waves with precisely controlled parameters (1 MHz and 250 mW/cm2, for 5 min once every 2 days for 10 days) dramatically boost chondrogenic cell commitment in vitro. Moreover, fibrotic and catabolic factors are strongly down-modulated: proteomic analyses reveal that such stimulation influences biological processes involved in cytoskeleton and extracellular matrix organization, collagen fibril organization, and metabolic processes. The optimal stimulation regimen also has a considerable anti-inflammatory effect and keeps its ability to boost chondrogenesis in vitro, even in an inflammatory milieu. An analytical model to predict the voltage generated by piezoelectric nanoparticles invested by ultrasound waves is proposed, together with a computational tool that takes into consideration nanoparticle clustering within the cell vacuoles and predicts the electric field streamline distribution in the cell cytoplasm. The proposed nanocomposite hydrogel shows good injectability and adhesion to the cartilage tissue ex vivo, as well as excellent biocompatibility in vivo, according to ISO 10993. Future perspectives will involve preclinical testing of this paradigm for cartilage regeneration.

Piezoelectrically and Topographically Engineered Scaffolds for Accelerating Bone Regeneration

Bone regeneration remains a critical concern across diverse medical disciplines, because it is a complex process that requires a combinatorial approach involving the integration of mechanical, electrical, and biological stimuli to emulate the native cellular microenvironment. In this context, piezoelectric scaffolds have attracted considerable interest owing to their remarkable ability to generate electric fields in response to dynamic forces. Nonetheless, the application of such scaffolds in bone tissue engineering has been limited by the lack of a scaffold that can simultaneously provide both the intricate electromechanical environment and the biocompatibility of the native bone tissue. Here, we present a pioneering biomimetic scaffold that combines the unique properties of piezoelectric and topographical enhancement with the inherent osteogenic abilities of hydroxyapatite (HAp). Notably, the novelty of this work lies in the incorporation of HAp into polyvinylidene fluoride-co-trifluoro ethylene in a freestanding form, leveraging its natural osteogenic potential within a piezoelectric framework. Through comprehensive in vitro and in vivo investigations, we demonstrate the remarkable potential of these scaffolds to accelerate bone regeneration. Moreover, we demonstrate and propose three pivotal mechanisms─(i) electrical, (ii) topographical, and (iii) paracrine─that collectively contribute to the facilitated bone healing process. Our findings present a synergistically derived biomimetic scaffold design with wide-ranging prospects for bone regeneration as well as various regenerative medicine applications.

Heterostructured piezocatalytic nanoparticles with enhanced ultrasound response for efficient repair of infectious bone defects

Infection of bone defects remains a challenging issue in clinical practice, resulting in various complications. The current clinical treatments include antibiotic therapy and surgical debridement, which can cause drug-resistance and potential postoperative complications. Therefore, there is an urgent need for an efficient treatment to sterilize and promote bone repair in situ. In this work, an ultrasound responsive selenium modified barium titanate nanoparticle (Se@BTO NP) was fabricated, which exhibited significant antibacterial and bone regeneration effects. Selenium nanoparticle (Se NP) was modified on the surface of barium titanate nanoparticle (BTO NP) to form heterostructure, which facilitated the second distribution of piezo-induced carriers under ultrasound (US) irradiation and improved the separation of electron-hole pairs. The Se@BTO NPs exhibited remarkable antibacterial efficiency with an antibacterial rate of 99.23 % against Staphylococcus aureus (S.aureus) and significantly promoted the osteogenic differentiation under ultrasound irradiation. The in vivo experiments exhibited that Se@BTO NPs successfully repaired the femoral condylar bone defects of rats infected by S.aureus, resulting in significant promotion of bone regeneration. Overall, this work provided an innovative strategy for the utilization of US responsive nanomaterials in efficient bacteria elimination and bone regeneration. STATEMENT OF SIGNIFICANCE: Infectious bone defects remain a challenging issue in clinical practice. Current antibiotic therapy and surgical debridement has numerous limitations such as drug-resistance and potential complications. Herein, we designed an innovative ultrasound responsive selenium modified barium titanate nanoparticle (Se@BTO NP) to achieve efficient non-invasive bacteria elimination and bone regeneration. In this work, Se@BTO nanoparticles can enhance the separation of electrons and holes, facilitate the transfer of free carriers due to the cooperative effect of ultrasound induced piezoelectric field and heterojunction construction, and thus exhibit remarkable antibacterial and osteogenesis effect. Overall, our study provided a promising strategy for the utilization of piezocatalytic nanomaterials in efficient antibacterial and bone regeneration.

Reactive oxygen species for therapeutic application: Role of piezoelectric materials

This perspective article emphasizes the significant role of reactive oxygen species (ROS) in in vivo remedial therapy of various diseases and complications, capitalizing on their potential reactivity. Among the various influencers, herein, piezoelectric materials driven ROS generation activity is primarily considered. Intrinsic non-centrosymmetry of piezoelectric materials makes them suitable for distinct dipole formation in the presence of external mechanical stimuli. Such characteristics prompt the positioning of opposite charged carriers to execute associated redox transformations that effectively participate to generate ROS in the aqueous media of the cell cytoplasm, organelles and nucleus. The immense reactivity of piezoelectric material driven ROS is fostered to terminate cellular toxicity or curtail tumor cell growth, due to their higher specificity. This perspective considers the conjugated performance of piezoelectric materials and ultrasound which can remotely generate electrical charges that promote ROS production for therapeutic application. In particular, a substantial synopsis is provided for the remedial activity of numerous piezocatalytic materials in tumor cell apoptosis, antibacterial treatment, dental care and neurological disorders. Subsequently, the report precisely demonstrates the methods involving various spectrophotometric approaches for the analysis of the ROS. Finally, the key challenges of piezoelectric material-based therapy are discussed and systematic future progress is outlined.

Piezoelectric Nanomaterials Activated by Ultrasound in Disease Treatment

Electric stimulation has been used in changing the morphology, status, membrane permeability, and life cycle of cells to treat certain diseases such as trauma, degenerative disease, tumor, and infection. To minimize the side effects of invasive electric stimulation, recent studies attempt to apply ultrasound to control the piezoelectric effect of nano piezoelectric material. This method not only generates an electric field but also utilizes the benefits of ultrasound such as non-invasive and mechanical effects. In this review, important elements in the system, piezoelectricity nanomaterial and ultrasound, are first analyzed. Then, we summarize recent studies categorized into five kinds, nervous system diseases treatment, musculoskeletal tissues treatment, cancer treatment, anti-bacteria therapy, and others, to prove two main mechanics under activated piezoelectricity: one is biological change on a cellular level, the other is a piezo-chemical reaction. However, there are still technical problems to be solved and regulation processes to be completed before widespread use. The core problems include how to accurately measure piezoelectricity properties, how to concisely control electricity release through complex energy transfer processes, and a deeper understanding of related bioeffects. If these problems are conquered in the future, piezoelectric nanomaterials activated by ultrasound will provide a new pathway and realize application in disease treatment.

Sonopiezoelectric Nanomedicine and Materdicine

Endogenous electric field is ubiquitous in a multitude of important living activities such as bone repair, cell signal transduction, and nerve regeneration, signifying that regulating the electric field in organisms is highly beneficial to maintain organism health. As an emerging and promising research direction, piezoelectric nanomedicine and materdicine precisely activated by ultrasound with synergetic advantages of deep tissue penetration, remote spatiotemporal selectivity, and mechanical-electrical energy interconversion, have been progressively utilized for disease treatment and tissue repair by participating in the modulation of endogenous electric field. This specific nanomedicine utilizing piezoelectric effect activated by ultrasound is typically regarded as "sonopiezoelectric nanomedicine". This comprehensive review summarizes and discusses the substantially employed sonopiezoelectric nanomaterials and nanotherapies to provide an insight into the internal mechanism of the corresponding biological behavior/effect of sonopiezoelectric biomaterials in versatile disease treatments. This review primarily focuses on the sonopiezoelectric biomaterials for biosensing, drug delivery, tumor therapy, tissue regeneration, antimicrobia, and further illuminates the underlying sonopiezoelectric mechanism. In addition, the challenges and developments/prospects of sonopiezoelectric nanomedicine are analyzed for promoting the further clinical translation. It is earnestly expected that this kind of nanomedicine/biomaterials-enabled sonopiezoelectric technology will provoke the comprehensive investigation and promote the clinical development of the next-generation multifunctional materdicine.

Smart Orthopedic Biomaterials and Implants

Musculoskeletal injuries including bone defects continue to present a significant challenge in orthopedic surgery due to suboptimal healing. Bone reconstruction strategies focused on the use of biological grafts and bone graft substitutes in the form of biomaterials-based 3D structures in fracture repair. Recent advances in biomaterials science and engineering have resulted in the creation of intricate 3D bone-mimicking structures that are mechanically stable, biodegradable, and bioactive to support bone regeneration. Current efforts are focused on improving the biomaterial and implant physicochemical properties to promote interactions with the host tissue and osteogenesis. The "smart" biomaterials and their 3D structures are designed to actively interact with stem/progenitor cells and the extracellular matrix (ECM) to influence the local environment towards osteogenesis and de novo tissue formation. This article will summarize such smart biomaterials and the methodologies to apply either internal or external stimuli to control the tissue healing microenvironment. A particular emphasis is also made on the use of smart biomaterials and strategies to create functional bioactive implants for bone defect repair and regeneration.

A Comprehensive Review on Barium Titanate Nanoparticles as a Persuasive Piezoelectric Material for Biomedical Applications: Prospects and Challenges

Stimulation of cells with electrical cues is an imperative approach to interact with biological systems and has been exploited in clinical practices over a wide range of pathological ailments. This bioelectric interface has been extensively explored with the help of piezoelectric materials, leading to remarkable advancement in the past two decades. Among other members of this fraternity, colloidal perovskite barium titanate (BaTiO₃ ) has gained substantial interest due to its noteworthy properties which includes high dielectric constant and excellent ferroelectric properties along with acceptable biocompatibility. Significant progression is witnessed for BaTiO₃ nanoparticles (BaTiO₃ NPs) as potent candidates for biomedical applications and in wearable bioelectronics, making them a promising personal healthcare platform. The current review highlights the nanostructured piezoelectric bio interface of BaTiO₃ NPs in applications comprising drug delivery, tissue engineering, bioimaging, bioelectronics, and wearable devices. Particular attention has been dedicated toward the fabrication routes of BaTiO₃ NPs along with different approaches for its surface modifications. This review offers a comprehensive discussion on the utility of BaTiO₃ NPs as active devices rather than passive structural unit behaving as carriers for biomolecules. The employment of BaTiO₃ NPs presents new scenarios and opportunity in the vast field of nanomedicines for biomedical applications.

Osteogenesis, hemocompatibility, and foreign body response of polyvinylidene difluoride-based composite reinforced with carbonaceous filler and higher volume of piezoelectric ceramic phase

Hybrid polymer-ceramic composites have been widely investigated for bone tissue engineering applications. The incorporation of a large amount of inorganic phase, like barium titanate (BaTiO₃) with good dispersion, in a polymeric matrix using a conventional processing approach has always been challenging. Also, the comprehensive study encompassing the interactions of key components of living organisms (cell, blood, tissue) with such hybrid composites is not well explored in many published studies. Built on our earlier studies and recognizing the importance of poly(vinylidene fluoride) (PVDF) as a widely used polymer for a wide spectrum of biomedical applications, the present study reports the qualitative and quantitative analysis of the biocompatibility of PVDF composite (PVDF/30BT/3MWCNT) reinforced with large amounts of BaTiO₃ (30 wt %) and tailored addition of multiwalled carbon nanotubes (MWCNT; 3 wt %). The melt mixing-extrusion-compression moulding-based processing approach resulted in an enhancement of β-phase content, thermal stability, and wettability in the semi-crystalline PVDF composite. The enhanced hemocompatibility of PVDF/30BT/3MWCNT has been established conclusively by a series of in vitro blood-material interaction assays, including haemolysi, analysis of platelets attachment and activation, dynamic blood coagulation, and plasma recalcification time. The cytocompatibility study confirms an improved adhesion, proliferation, and migration of osteoprogenitor cells (preosteoblasts; MC3T3-E1) on PVDF/30BT/3MWCNT, in a manner better than neat PVDF, in vitro. When these cells were cultured in osteogenic differentiating media, the modulated osteogenesis, in terms of alkaline phosphatase activity, intracellular Ca²⁺ concentration, and calcium deposition on the PVDF/30BT/3MWCNT, was recorded. Following subcutaneous implantation of PVDF/30BT/3MWCNT in rat model, no apparent variation was recorded in the complete hemogram (blood hematology analysis) or serum biochemistry, post 30-, 60-, and 90-days surgery. Importantly, 90-days post-implantation, the fibrous capsule thickness was significantly reduced in the composites w.r.t PVDF alone, together with better blood vessel formation, indicating improved neovascularization around the composite. This study establishes the efficacy of inorganic fillers in enhancing the biocompatibility of PVDF, which could open up a wide range of biomedical applications.

Surface modification of polyether ether ketone implant with a novel nanocomposite coating containing poly (vinylidene fluoride) toward improving piezoelectric and bioactivity performance

Polyether ether ketone (PEEK) is an appropriate biomaterial for orthopedic implant applications due to its superior mechanical properties, chemical resistance, nontoxicity, and Magnetic resonance imaging (MRI) compatibility. Unfortunately, the inherent bio-inertness of PEEK restricted its application and required some modification to provide better bioactivity. Besides it, the generated electrical signals in the bone due to its piezoelectricity features have a vital role in regulating bone repair and regeneration. We aimed to modify the surface of PEEK with a dual-functionality nanocomposite that provides surface bioactivity and simulates the piezoelectricity of bone. So, we introduced a novel piezoelectric-bioactive nanocomposite of dispersed poly (vinylidene fluoride) (PVDF) in a sulfonated PEEK (SPEEK) matrix containing Nanohydroxyapatite (nHA) and Carbon nanofiber (CNF) fillers for coating on PEEK substrate to improve its biological activity and simulate the electrical microenvironment for bone tissue. Furthermore, sulfonation of the PEEK surface was conducted as an intermediate layer to prepare better adhesion between the coating nanocomposite and the PEEK sublayer. Surface and cross-section morphology, apatite formation, and cell attachment were investigated on the different treated PEEK surfaces using field-emission scanning electron microscopy (FESEM) and energy dispersive X-ray analysis (EDX). Also, piezoelectric performance, electrical conductivity, contact angle, and mechanical properties were examined on the prepared samples. Moreover, cell viability and cell morphology were investigated for biological evaluation with human osteoblast-like MG-63 cells. Collectively, the hydrophilicity of modified PEEK (mPEEK) coated with nanocomposite was improved due to the synergistic effects of SPEEK functional groups and nHA. Also, comprehensive investigation on the mPEEK treated with nanocomposite indicated a noticeably better bone-like apatite formation, cell proliferation, and cell attachments in the presence of nHA. The transfer of induced piezoelectric charges from dispersed PVDF in the matrix to the surface of nanocomposite containing 2 wt% of CNF increased output voltage to 1893 mV. On the other hand, the presence of CNF in nanocomposites enhanced tensile strength and Young's modulus by 92% and 117%, respectively.

Application of Piezoelectric Material and Devices in Bone Regeneration

Bone injuries are common in clinical practice. Given the clear disadvantages of autologous bone grafting, more efficient and safer bone grafts need to be developed. Bone is a multidirectional and anisotropic piezoelectric material that exhibits an electrical microenvironment; therefore, electrical signals play a very important role in the process of bone repair, which can effectively promote osteoblast differentiation, migration, and bone regeneration. Piezoelectric materials can generate electricity under mechanical stress without requiring an external power supply; therefore, using it as a bone implant capable of harnessing the body's kinetic energy to generate the electrical signals needed for bone growth is very promising for bone regeneration. At the same time, devices composed of piezoelectric material using electromechanical conversion technology can effectively monitor the structural health of bone, which facilitates the adjustment of the treatment plan at any time. In this paper, the mechanism and classification of piezoelectric materials and their applications in the cell, tissue, sensing, and repair indicator monitoring aspects in the process of bone regeneration are systematically reviewed.

Boost piezocatalytic activity of BaSO4 by coupling it with BaTiO3, Cu:BaTiO3, Fe:BaTiO3, S:BaTiO3 and modify them by sucrose for water purification

The purpose of this study is to improve the efficiency of decontamination using BaSO₄ as a piezocatalyst. Three techniques are employed in this study to enhance the piezocatalytic activity of BaSO₄. The first method involves coupling BaSO₄ with BaTiO₃. The acid red 151 and acid blue 113 decontamination rates improved from 56.7% and 60.9% to 61.3% and 64.4%, respectively, as a result of this strategy. Additionally, the composite of BaSO₄ and BaTiO₃ was doped with copper, iron, sulfur, and nitrogen. By doping BaTiO₃, acid red 151 and acid blue 113 achieved 86.7% and 89.2% efficiency, respectively. Finally, the nanostructures were modified with sucrose. These strategies improved degradation efficiency for acid red 151 and acid blue 113 to 92.9% and 93.3%, respectively. The reusability results showed that the piezo-catalytic activity of the m-S-BaSO₄-BaTiO₃ catalyst did not show a significant loss after five recycles for the degradation of AB113.

3D-Printed Piezoelectric Porous Bioactive Scaffolds and Clinical Ultrasonic Stimulation Can Help in Enhanced Bone Regeneration

This paper presents a comprehensive effort to develop and analyze first-of-its-kind design-specific and bioactive piezoelectric scaffolds for treating orthopedic defects. The study has three major highlights. First, this is one of the first studies that utilize extrusion-based 3D printing to develop design-specific macroporous piezoelectric scaffolds for treating bone defects. The scaffolds with controlled pore size and architecture were synthesized based on unique composite formulations containing polycaprolactone (PCL) and micron-sized barium titanate (BaTiO3) particles. Second, the bioactive PCL-BaTiO3 piezoelectric composite formulations were explicitly developed in the form of uniform diameter filaments, which served as feedstock material for the fused filament fabrication (FFF)-based 3D printing. A combined method comprising solvent casting and extrusion (melt-blending) was designed and deemed suitable to develop the high-quality PCL-BaTiO3 bioactive composite filaments for 3D printing. Third, clinical ultrasonic stimulation (US) was used to stimulate the piezoelectric effect, i.e., create stress on the PCL-BaTiO3 scaffolds to generate electrical fields. Subsequently, we analyzed the impact of scaffold-generated piezoelectric stimulation on MC3T3 pre-osteoblast behavior. Our results confirmed that FFF could form high-resolution, macroporous piezoelectric scaffolds, and the poled PCL-BaTiO3 composites resulted in the d33 coefficient in the range of 1.2-2.6 pC/N, which is proven suitable for osteogenesis. In vitro results revealed that the scaffolds with a mean pore size of 320 µm resulted in the highest pre-osteoblast growth kinetics. While 1 Hz US resulted in enhanced pre-osteoblast adhesion, proliferation, and spreading, 3 Hz US benefited osteoblast differentiation by upregulating important osteogenic markers. This study proves that 3D-printed bioactive piezoelectric scaffolds coupled with US are promising to expedite bone regeneration in orthopedic defects.

Comparative review of piezoelectric biomaterials approach for bone tissue engineering

Bone as a minerals' reservoir and rigid tissue of the body generating red and white blood cells supports various organs. Although the self-regeneration property of bone, it cannot regenerate spontaneously in severe damages and still remains as a challenging issue. Tissue engineering offers several techniques for regenerating damaged bones, where various biomaterials are examined to fabricate scaffolds for bone repair. Piezoelectric characteristic plays a crucial role in repairing and regenerating damaged bone by mimicking the bone niche behavior. Piezoelectric biomaterials show significant potential for bone tissue engineering. Herein we try to have a comparative review on piezoelectric and non-piezoelectric biomaterials used in bone tissue engineering, classified them, and discussed their effects on implanted cells and manufacturing techniques. Especially, Polyvinylidene fluoride (PVDF) and its composites are the most practically used piezoelectric biomaterials for bone regeneration. PVDF and its composites have been summarized and discussed to repair damaged bone tissues.

Biocompatible and Electroconductive Nanocomposite Scaffolds with Improved Piezoelectric Response for Bone Tissue Engineering

Electroactive scaffolds are relatively new tools in tissue engineering that open new avenue in repairing damaged soft and hard tissues. These scaffolds can induce electrical signaling while providing an ECM-like microenvironment. However, low biocompatibility and lack of biodegradability of piezoelectric and conductive polymers limits their clinical translation. In the current study, we have developed highly biocompatible, electroconductive nanofibrous scaffolds based on poly-L-lactic acid/polyaniline/carbon nanotube (PLLA/polyaniline/CNT). Physical and chemical properties of fabricated scaffolds were tested using various techniques. Biological characteristics of the scaffolds are also examined to check cellular attachment as well as differentiation of cultured (progenitor) cells. Scaffolds were optimized to direct osteogenic differentiation of mesenchymal stem cells. Such scaffolds can offer new strategies for the regeneration of damaged/lost bone.

Improved activity of MC3T3-E1 cells by the exciting piezoelectric BaTiO3/TC4 using low-intensity pulsed ultrasound

Developing bioactive materials for bone implants to enhance bone healing and bone growth has for years been the focus of clinical research. Barium titanate (BT) is an electroactive material that can generate electrical signals in response to applied mechanical forces. In this study, a BT piezoelectric ceramic coating was synthesized on the surface of a TC4 titanium alloy, forming a BT/TC4 material, and low-intensity pulsed ultrasound (LIPUS) was then applied as a mechanical stimulus. The combined effects on the biological responses of MC3T3-E1 cells were investigated. Results of scanning electron microscopy, energy-dispersive X-ray spectroscopy, and X-ray diffraction showed that an uniform nanospheres -shaped BT coating was formed on TC4 substrate. Piezoelectric behaviors were observed using piezoelectric force microscopy with the piezoelectric coefficient d33 of 0.42 pC/N. Electrochemical measures indicated that LIPUS-stimulated BT/TC4 materials could produce a microcurrent of approximately 10 μA/cm2. In vitro, the greatest osteogenesis (cell adhesion, proliferation, and osteogenic differentiation) was found in MC3T3-E1 cells when BT/TC4 was stimulated using LIPUS. Furthermore, the intracellular calcium ion concentration increased in these cells, possibly because opening of the L-type calcium ion channels was promoted and expression of the CaV1.2 protein was increased. Therefore, the piezoelectric BT/TC4 material with LIPUS loading synergistically promoted osteogenesis, rending it a potential treatment for early stage formation of reliable bone-implant contact.

In Vitro Study on the Piezodynamic Therapy with a BaTiO3-Coating Titanium Scaffold under Low-Intensity Pulsed Ultrasound Stimulation

To solve the poor sustainability of electroactive stimulation in clinical therapy, a strategy of combining a piezoelectric BaTiO3-coated Ti6Al4V scaffold and low-intensity pulsed ultrasound (LIPUS) was unveiled and named here as piezodynamic therapy. Thus, cell behavior could be regulated phenomenally by force and electricity simultaneously. First, BaTiO3 was deposited uniformly on the surface of the three-dimensional (3D) printed porous Ti6Al4V scaffold, which endowed the scaffold with excellent force-electricity responsiveness under pulsed ultrasound exposure. The results of live/dead staining, cell scanning electron microscopy, and F-actin staining showed that cells had better viability, better pseudo-foot adhesion, and more muscular actin bundles when they underwent the piezodynamic effect of ultrasound and piezoelectric coating. This piezodynamic therapy activated more mitochondria at the initial stage that intervened in the cell cycle by promoting cells' proliferation and weakened the apoptotic damage. The quantitative real-time polymerase chain reaction data further confirmed that the costimulation of the ultrasound and the piezoelectric scaffolds could trigger adequate current to upregulated the expression of osteogenic-related genes. The continuous electric cues could be generated by the BaTiO3-coated scaffold and intermittent LIPUS stimulation; thereon, more efficient bone healing would be promoted by piezodynamic therapy in future treatment.

Fabrication of PVDF/BaTiO3/CNT Piezoelectric Energy Harvesters with Bionic Balsa Wood Structures through 3D Printing and Supercritical Carbon Dioxide Foaming

Piezoelectric energy harvesters have received widespread attention in recent decades due to their inimitable electrical energy conversion methods. However, traditional polymer/piezoceramic materials and 2D thin-film structures have limited output performance, making them difficult to be efficiently applied in the collection of discrete mechanical energy. Here, new ternary composite powders were successfully developed by the ultrasonic coating method, and array structural devices with the construction of micropores were prepared using selective laser sintering (SLS) and supercritical carbon dioxide foaming (Sc-CO₂) technologies. Coating carbon nanotubes improved the polarization efficiency of poly(vinylidene fluoride)/barium titanate (PVDF/BaTiO₃) composites, which made it easy to perfectly combine the BaTiO₃ piezoelectric constant and the flexibility of PVDF, promoting d₃₃ from 0.7 to 2.6 pc/N. In addition, simulations and experiments simultaneously proved that SLS parts with high array densities amplified piezoelectric outputs because of a greater compression deformation in the vertical direction. Meanwhile, under the synergistic effect of SLS and Sc-CO₂, 3D bionic balsa wood structure foams were successfully fabricated, which took advantage of the normal space, expanded the stress-strain effect, and improved the piezoelectric output capability. Excitingly, the prepared foam could directly produce 19.3 V and 415 nA piezoelectric output to charge a 1 μF commercial capacitor to 5.03 V within 180 s, which surpassed most of the PVDF piezoelectric energy harvesters reported thus far. This work has an excellent innovative and practical value in enriching the types of piezoelectric materials for SLS 3D printing and the design of 3D piezoelectric structures.

Biomedical Implants with Charge-Transfer Monitoring and Regulating Abilities

Transmembrane charge (ion/electron) transfer is essential for maintaining cellular homeostasis and is involved in many biological processes, from protein synthesis to embryonic development in organisms. Designing implant devices that can detect or regulate cellular transmembrane charge transfer is expected to sense and modulate the behaviors of host cells and tissues. Thus, charge transfer can be regarded as a bridge connecting living systems and human-made implantable devices. This review describes the mode and mechanism of charge transfer between organisms and nonliving materials, and summarizes the strategies to endow implants with charge-transfer regulating or monitoring abilities. Furthermore, three major charge-transfer controlling systems, including wired, self-activated, and stimuli-responsive biomedical implants, as well as the design principles and pivotal materials are systematically elaborated. The clinical challenges and the prospects for future development of these implant devices are also discussed.

Piezoelectric Nanomaterials Activated by Ultrasound: The Pathway from Discovery to Future Clinical Adoption

Electrical stimulation has shown great promise in biomedical applications, such as regenerative medicine, neuromodulation, and cancer treatment. Yet, the use of electrical end effectors such as electrodes requires connectors and batteries, which dramatically hamper the translation of electrical stimulation technologies in several scenarios. Piezoelectric nanomaterials can overcome the limitations of current electrical stimulation procedures as they can be wirelessly activated by external energy sources such as ultrasound. Wireless electrical stimulation mediated by piezoelectric nanoarchitectures constitutes an innovative paradigm enabling the induction of electrical cues within the body in a localized, wireless, and minimally invasive fashion. In this review, we highlight the fundamental mechanisms of acoustically mediated piezoelectric stimulation and its applications in the biomedical area. Yet, the adoption of this technology in a clinical practice is in its infancy, as several open issues, such as piezoelectric properties measurement, control of the ultrasound dose in vitro, modeling and measurement of the piezo effects, knowledge on the triggered bioeffects, therapy targeting, biocompatibility studies, and control of the ultrasound dose delivered in vivo, must be addressed. This article explores the current open challenges in piezoelectric stimulation and proposes strategies that may guide future research efforts in this field toward the translation of this technology to the clinical scene.

Bone Piezoelectricity-Mimicking Nanocomposite Membranes Enhance Osteogenic Differentiation of Bone Marrow Mesenchymal Stem Cells by Amplifying Cell Adhesion and Actin Cytoskeleton

Ferroelectric biomaterials have been widely investigated and demonstrated to enhance osteogenesis by simulating the inherent electrical properties of bone tissues. Nevertheless, the underlying biological processes are still not wellunderstood. Hence, this study investigated the underlying biological processes by which bone piezoelectricity-mimicking barium titanate/poly(vinylidene fluoride-trifluoroethylene) nanocomposite membranes (BTO nanocomposite membranes) promote osteogenesis of Bone Marrow Mesenchymal Stem Cells (BMSCs). Ourresults revealed that the piezoelectric coefficient (d₃₃) of nanocomposite membranes aftercontrolled corona poling was similar to that of native bone, and exhibited highly-stable piezoelectrical properties and concentrated surface electrical potential. These nanocomposite membranes significantly enhanced the adhesion and spreading of BMSCs, which was manifested as increased number and area of mature focal adhesions. Furthermore, the nanocomposite membranes significantly promoted the expression of integrin receptors genes (α1, α5 andβ3), which in turn enhanced osteogenesis of BMSCs, as manifested by upregulated Alkaline Phosphatase (ALP) and Bone Morphogenetic Protein 2 (BMP2) expression levels. Further investigations found that the Focal Adhesion Kinase (FAK)-Extracellular Signal-Regulated Kinase1/2 (ERK 1/2) signaling axis may be involved in the biological process of polarized nanocomposite membrane-induced osteogenesis. This study thus provides useful insights for betterunderstanding of the biological processes by which piezoelectric or ferroelectric biomaterials promote osteogenesis.

Research and application of hydrostatic high pressure in tumor vaccines (Review)

It is well known that hydrostatic pressure (HP) is a physical parameter that is now regarded as an important variable for life. High hydrostatic pressure (HHP) technology has influenced biological systems for more than 100 years. Food and bioscience researchers have shown great interest in HHP technology over the past few decades. The development of knowledge related to this area can better facilitate the application of HHP in the life sciences. Furthermore, new applications for HHP may come from these current studies, particularly in tumor vaccines. Currently, cancer recurrence and metastasis continue to pose a serious threat to human health. The limited efficacy of conventional treatments has led to the need for breakthroughs in immunotherapy and other related areas. Research into tumor vaccines is providing new insights for cancer treatment. The purpose of this review is to present the main findings reported thus far in the relevant scientific literature, focusing on knowledge related to HHP technology and tumor vaccines, and to demonstrate the potential of applying HHP technology to tumor vaccine development.

Enhanced compressive strengths and induced cell growth of 1-3-type BaTiO3/PMMA bio-piezoelectric composites

Barium titanate (BaTiO₃) has been used as a bone implant material because of its piezoelectric properties and the ability to promote cell growth when combined with hydroxyapatite. However, the brittleness of BaTiO₃ inhibits its use as a bone replacement material at load-bearing sites, and the reduction of BaTiO₃ content in the composite reduces its piezoelectric effect on bone growth. In this study, we explored a preparation method, which included directional freeze casting and self-solidification of bone cement, to obtain 1-3-type BaTiO₃/PMMA bio-piezoelectric composites with a lamellar structure. The lamellar BaTiO₃ layer through the composite from the bottom to the top significantly improved the piezoelectric properties of the composite. In addition, the dendritic ceramic bridges on the BaTiO₃ pore walls can improve the compressive strength and elastic modulus of BaTiO₃/PMMA bio-piezoelectric composites with a lamellar structure. More importantly, it was found that polarized lamellar BaTiO₃ could induce osteoblasts to grow in the direction of the BaTiO₃ layers. When the width of the BaTiO₃ layer was in the range of 8-21 μm, osteoblasts along the BaTiO₃ layer showed well growth, which can be of great value for the production of biomimetic bone units.

Piezoelectric and Magnetoelectric Scaffolds for Tissue Regeneration and Biomedicine: A Review

Electric fields are ubiquitous throughout the body, playing important role in a multitude of biological processes including osteo-regeneration, cell signaling, nerve regeneration, cardiac function, and DNA replication. An increased understanding of the role of electric fields in the body has led to the development of devices for biomedical applications that incorporate electromagnetic fields as an intrinsically novel functionality (e.g., bioactuators, biosensors, cardiac/neural electrodes, and tissues scaffolds). However, in the majority of the aforementioned devices, an implanted power supply is necessary for operation, and therefore requires highly invasive procedures. Thus, the ability to apply electric fields in a minimally invasive manner to remote areas of the body remains a critical and unmet need. Here, we report on the potential of magnetoelectric (ME)-based composites to overcome this challenge. ME materials are capable of producing localized electric fields in response to an applied magnetic field, which the body is permeable to. Yet, the use of ME materials for biomedical applications is just beginning to be explored. Here, we present on the potential of ME materials to be utilized in biomedical applications. This will be presented alongside current state-of-the-art for in vitro and in vivo electrical stimulation of cells and tissues. We will discuss key findings in the field, while also identifying challenges, such as the synthesis and characterization of biocompatible ME materials, challenges in experimental design, and opportunities for future research that would lead to the increased development of ME biomaterials and their applications.

Mimicking the electrophysiological microenvironment of bone tissue using electroactive materials to promote its regeneration

The process of bone tissue repair and regeneration is complex and requires a variety of physiological signals, including biochemical, electrical and mechanical signals, which collaborate to ensure functional recovery. The inherent piezoelectric properties of bone tissues can convert mechanical stimulation into electrical effects, which play significant roles in bone maturation, remodeling and reconstruction. Electroactive materials, including conductive materials, piezoelectric materials and electret materials, can simulate the physiological and electrical microenvironment of bone tissue, thereby promoting bone regeneration and reconstruction. In this paper, the structures and performances of different types of electroactive materials and their applications in the field of bone repair and regeneration are reviewed, particularly by providing the results from in vivo evaluations using various animal models. Their advantages and disadvantages as bone repair materials are discussed, and the methods for tuning their performances are also described, with the aim of providing an up-to-date account of the proposed topics.

Challenges on optimization of 3D-printed bone scaffolds

Advances in biomaterials and the need for patient-specific bone scaffolds require modern manufacturing approaches in addition to a design strategy. Hybrid materials such as those with functionally graded properties are highly needed in tissue replacement and repair. However, their constituents, proportions, sizes, configurations and their connection to each other are a challenge to manufacturing. On the other hand, various bone defect sizes and sites require a cost-effective readily adaptive manufacturing technique to provide components (scaffolds) matching with the anatomical shape of the bone defect. Additive manufacturing or three-dimensional (3D) printing is capable of fabricating functional physical components with or without porosity by depositing the materials layer-by-layer using 3D computer models. Therefore, it facilitates the production of advanced bone scaffolds with the feasibility of making changes to the model. This review paper first discusses the development of a computer-aided-design (CAD) approach for the manufacture of bone scaffolds, from the anatomical data acquisition to the final model. It also provides information on the optimization of scaffold's internal architecture, advanced materials, and process parameters to achieve the best biomimetic performance. Furthermore, the review paper describes the advantages and limitations of 3D printing technologies applied to the production of bone tissue scaffolds.

Induction of osteogenic differentiation by demineralized and decellularized bovine extracellular matrix derived hydrogels associated with barium titanate

Bone tissue-derive biomaterials have become of great interest to treat diseases of the skeletal system. Biological scaffolds of demineralized and decellularized extracellular matrices (ECM) have been developed and one of these options are ECM hydrogels derived from bovine bone. Nanomaterials may be able to regulate stem cell differentiation due to their unique physical-chemical properties. The present work aimed to evaluate the osteoinductive effects of ECM hydrogels associated with barium titanate nanoparticles (BTNP) on dental pulp cells derived from exfoliated teeth. The addition of BTNP in the ECM derived hydrogel did not affect cell proliferation and the formation of bone nodules. Furthermore, it increased the expression of bone alkaline phosphatase. The results demonstrated that the nanobiocomposites were able to promote the osteogenic differentiation, even in the absence of chemical inducing factors for osteogenic differentiation. In conclusion, bovine bone ECM hydrogel combined with BTNP presented and increased expression of markers of osteogenic differentiation in the absence of chemical inducing factors.

Hybridization of graphene oxide and mesoporous bioactive glass: Micro-space network structure enhance polymer scaffold

Graphene oxide (GO) and mesoporous bioactive glass (MBG) are commonly used to improve the mechanical and biological properties of polymer scaffolds, respectively. Nevertheless, their single introduction to polymers may encounter problems with uneven dispersion due to nano-aggregation effects. In this work, a GO and MBG hybrid with micro-space network structure were prepared by a chemical reduction-coagulation method to solve these problems. GO and MBG were first uniformly mixed in an alkaline aqueous dispersion. Subsequently, GO was partially reduced by introducing dopamine and co-coagulated with MBG, and then assembled into a GO@PDA@MBG hybrid structure under electrostatic effect. Specifically, the ring opening and deoxygenation reaction between the oxygen-containing functional group of GO and the amine group of dopamine achieves functionalization and partial reduction of GO. In addition, the hydrogen bond between the amine group of dopamine and the silanol hydroxyl group of MBG promotes the coagulation of MBG on GO@PDA. The hybrid structure was then mixed into polymer matrix to prepare a composite scaffold by a laser additive manufacturing process. The results showed that GO @ PDA @ MBG hybrid structure increased the tensile strength and modulus of polymer scaffold from 5.8 MPa and 312.2 MPa to 14.1 MPa and 539.7 MPa, respectively. The enhanced mechanical properties can be attributed to the "pinning" and "crack strengthening" effect of GO@PDA@MBG hybrid structure in polymer matrix. Besides, the scaffold also significantly promotes adhesion and proliferation of osteoblasts, demonstrating good biological properties.

Graphene-assisted barium titanate improves piezoelectric performance of biopolymer scaffold

Biopolymer scaffold is expected to generate electrical stimulation, aiming to mimic an electrical microenvironment to promote cell growth. In this work, graphene and barium titanate (BT) was introduced into selective laser sintered poly-l-lactic acid (PLLA) scaffold. BT as one piezoelectric ceramic was used as the piezoelectric source, whereas graphene served as superior conductive filler. Significantly, the incorporated graphene enhanced the electrical conductivity and thereby increased the electric field strength applied on BT nanoparticles during poling. In this case, more electric domain within BT rearranged along the poling field direction, thus promoting the piezoelectric response of the composites. Results showed that the PLLA/BT/graphene scaffold exhibited relatively high output voltage of 1.4 V and current of 10 nA. Cells tests proved that these electrical signals considerably promoted cell proliferation and differentiation. Moreover, the scaffold exhibited improved mechanical properties due to the rigid particle enhancement effect and increased crystallinity.

Bioactive Tetracalcium Phosphate Scaffolds Fabricated by Selective Laser Sintering for Bone Regeneration Applications

Tetracalcium phosphate (TTCP), a potential biological scaffold material, has attracted increasing interest for bone regeneration applications due to its good biodegradability and biocompatibility. In this research, three-dimensional porous TTCP scaffolds were manufactured via selective laser sintering (SLS), and an in-depth and meticulous study on the influence of laser power on the microstructure and mechanical properties of TTCP scaffolds was performed. The results showed that the TTCP particles fused together and formed a solid object due to the decrease in the number of micro-pores in the scaffold as the laser power increased from 6 W to 9 W. The maximum compressive strength that the scaffold could withstand and the strength of the fracture toughness were 11.87 ± 0.64 MPa and 1.12 ± 0.1 MPa·m^1/2, respectively. When the laser power increased from 9 W to 10 W, the TTCP grains grew abnormally, resulting in diminished mechanical properties. The bioactivity tests showed that the surfaces of the scaffolds were entirely covered by bone-like apatite layers after soaking in simulated body fluid (SBF) for three days, indicating that the scaffolds exhibit excellent bioactivity. Moreover, cell experiments showed that the TTCP scaffolds had good biocompatibility. This study indicated that SLS-fabricated TTCP scaffolds may be a promising candidate for bone regeneration applications.

Electrospun Fibre Webs Templated Synthesis of Mineral Scaffolds Based on Calcium Phosphates and Barium Titanate

The current work focuses on the development of mineral scaffolds with complex composition and controlled morphology by using a polymeric template in the form of nonwoven fibre webs fabricated through electrospinning. By a cross-linking process, gelatine fibres stable in aqueous solutions were achieved, these being further subjected to a loading step with two types of mineral phases: calcium phosphates deposited by chemical reaction and barium titanate nanoparticles as decoration on the previously achieved structures. Thus, hybrid materials were obtained and subsequently processed in terms of freeze-drying and heat treating with the purpose of burning the template and consolidating the mineral part as potential bone implants with improved biological response by external stimulation. The results confirmed the tunable morphology, as well as the considerable applicability of both as-prepared and final samples for the development of medical devices, which encourages the continuation of research in the direction of assessing the synergistic contribution of barium titanate domains polarisation/magnetisation by external applied fields.