The future of bone healing

3D chitosan/hydroxyapatite scaffolds containing mesoporous SiO2-HA particles: A new step to healing bone defects

Biocompatible scaffolds with high mechanical strengths that contain biodegradable components could boost bone regeneration compared with nondegradable bone repair materials. In this study, porous chitosan (CS)/hydroxyapatite (HA) scaffolds containing mesoporous SiO2-HA particles were fabricated through the freeze-drying process. According to field emission scanning electron microscopy (FESEM) results, combining mesoporous SiO2-HA particles in CS/HA scaffolds led to a uniform porous structure. It decreased pore sizes from 320 ± 1.1 μm to 145 ± 1.4 μm. Moreover, the compressive strength value of this scaffold was 25 ± 1.2 MPa. The in-vitro approaches exhibited good sarcoma osteogenic cell line (SAOS-2) adhesion, spreading, and proliferation, indicating that the scaffolds provided a suitable environment for cell cultivation. Also, in-vivo analyses in implanted defect sites of rats proved that the CS/HA/mesoporous SiO2-HA scaffolds could promote bone regeneration via enhancing osteoconduction and meliorating the expression of osteogenesis gene to 19.31 (about 5-fold higher compared to the control group) by exposing them to the bone-like precursors. Further, this scaffold's new bone formation percentage was equal to 90 % after 21 days post-surgery. Therefore, incorporating mesoporous SiO2-HA particles into CS/HA scaffolds can suggest a new future tissue engineering and regeneration strategy.

A Review on Polymers for Biomedical Applications on Hard and Soft Tissues and Prosthetic Limbs

In the past decades, there has been a significant increase in the use of polymers for biomedical applications. The global medical polymer market size was valued at USD 19.92 billion in 2022 and is expected to grow at a CAGR of 8.0% from 2023 to 2030 despite some limitations, such as cost (financial limitation), strength compared to metal plates for bone fracture, design optimization and incorporation of reinforcement. Recently, this increase has been more pronounced due to important advances in synthesis and modification techniques for the design of novel biomaterials and their behavior in vitro and in vivo. Also, modern medicine allows the use of less invasive surgeries and faster surgical sutures. Besides their use in the human body, polymer biomedical materials must have desired physical, chemical, biological, biomechanical, and degradation properties. This review summarizes the use of polymers for biomedical applications, mainly focusing on hard and soft tissues, prosthetic limbs, dental applications, and bone fracture repair. The main properties, gaps, and trends are discussed.

Biocomponentes à base de hidroxiapatita: Influência da esterilização na resistência mecânica

Objetivo O objetivo deste estudo foi avaliar a influência da esterilização na resistência mecânica à compressão e flexão de biocomponentes à base de hidroxiapatita obtida a partir de osso bovino liofilizado e sua associação com quitosana.

Métodos O osso bovino liofilizado foi processado em partículas de 100 μm e misturado à quitosana em proporção de 50% de seu peso. A mistura foi acondicionada em moldes metálicos para preparo dos espécimes e esterilizada a 127°C em autoclave para posterior experimentação. Os espécimes foram submetidos a ensaios de compressão e flexão seguindo a norma 5833 da International Organization for Standardization (ISO); os espécimes eram blocos cilíndricos de 6 × 12 mm (para ensaios de compressão) e placas de 75 × 10 × 3,3 mm (para ensaios de flexão). As amostras foram divididas em quatro grupos de 20 espécimes cada, sendo 10 para ensaios de compressão e 10 para ensaios de flexão. Três grupos foram esterilizados (por autoclavagem, raios gama e óxido de etileno), enquanto o quarto grupo (controle) não foi. Os testes mecânicos obtidos nos diferentes processos de esterilização foram comparados por análise de variância (ANOVA, p < 0,05) seguido pelo teste de comparação múltipla de médias de Tukey, com intervalo de confiança de 95%.

Resultados Os espécimes apresentaram resistências médias à compressão de 10,25 MPa para o grupo de controle e 3,67 MPa, 9,65 MPa e 9,16 MPa após esterilização com óxido de etileno, raios gama e autoclavagem, respectivamente. Os resultados do teste de flexão mostraram uma resistência média de 0,40 MPa no grupo de controle, e 0,15 MPa, 0,17 MPa e 0,30 MPa após esterilização com óxido de etileno, raios gama e autoclavagem, respectivamente. A compressão máxima observada no grupo esterilizado com óxido de etileno foi estatisticamente diferente à obtida no grupo de controle (p = 0,0002), esterilizado com raios gama (p = 0,0003) e autoclavado (p = 0,0006). A flexão máxima dos espécimes esterilizados com raios gama foi estatisticamente diferente à observada no grupo de controle (p = 0,0245). No entanto, a resistência à flexão foi baixa em todos os espécimes.

Conclusão A esterilização em autoclave não foi associada a diferenças estatisticamente significativas nos testes de compressão ou flexão. Assim, a autoclave foi a melhor opção de esterilização para os biocomponentes à base de hidroxiapatita neste estudo.

A Perfusion Culture System for Assessing Bone Marrow Stromal Cell Differentiation on PLGA Scaffolds for Bone Repair

Biomaterials development for bone repair is currently hindered by the lack of physiologically relevant in vitro testing systems. Here we describe the novel use of a bi-directional perfusion bioreactor to support the long term culture of human bone marrow stromal cells (BMSCs) differentiated on polylactic co-glycolic acid (PLGA). Primary human BMSCs were seeded onto porous PLGA scaffolds and cultured in static vs. perfusion culture conditions for 21 days in osteogenic vs. control media. PLGA scaffolds were osteoconductive, supporting a mature osteogenic phenotype as shown by the upregulation of Runx2 and the early osteocyte marker E11. Perfusion culture enhanced the expression of osteogenic genes Osteocalcin and Osteopontin. Extracellular matrix deposition and mineralisation were spatially regulated within PLGA scaffolds in a donor dependant manner. This, together with the observed upregulation of Collagen type X suggested an environment permissive for the study of differentiation pathways associated with both intramembranous and endochondral ossification routes of bone healing. This culture system offers a platform to assess BMSC behavior on candidate biomaterials under physiologically relevant conditions. Use of this system may improve our understanding of the environmental cues orchestrating BMSC differentiation and enable fine tuning of biomaterial design as we develop tissue-engineered strategies for bone regeneration.

In vitro response of macrophages to ceramic scaffolds used for bone regeneration

Macrophages, the primary cells of the inflammatory response, are major regulators of healing, and mediate both bone fracture healing and the inflammatory response to implanted biomaterials. However, their phenotypic contributions to biomaterial-mediated bone repair are incompletely understood. Therefore, we used gene expression and protein secretion analysis to investigate the interactions in vitro between primary human monocyte-derived macrophages and ceramic scaffolds that have been shown to have varying degrees of success in promoting bone regeneration in vivo Specifically, baghdadite (Ca3ZrSi2O9) and strontium-hardystonite-gahnite (Sr-Ca2ZnSi2O7-ZnAl2O4) scaffolds were chosen as two materials that enhanced bone regeneration in vivo in large defects under load compared with clinically used tricalcium phosphate-hydroxyapatite (TCP-HA). Principal component analysis revealed that the scaffolds differentially regulated macrophage phenotype. Temporal changes in gene expression included shifts in markers of pro-inflammatory M1, anti-inflammatory M2a and pro-remodelling M2c macrophage phenotypes. Of note, TCP-HA scaffolds promoted upregulation of many M1-related genes and downregulation of many M2a- and M2c-related genes. Effects of the scaffolds on macrophages were attributed primarily to direct cell-scaffold interactions because of only minor changes observed in transwell culture. Ultimately, elucidating macrophage-biomaterial interactions will facilitate the design of immunomodulatory biomaterials for bone repair.

Oleanolic Acid Enhances Mesenchymal Stromal Cell Osteogenic Potential by Inhibition of Notch Signaling

Oleanolic acid (OA), a pentacyclic triterpenoid, has been shown to modulate multiple signaling pathways in a variety of cell linages. But the mechanisms underlying OA-mediated mesenchymal stromal cell (MSC) osteogenic differentiation are not known. In this study, we examined effects of OA on cell viability, osteogenic differentiation in MSCs, and the involvement of Notch and BMP signaling. OA induced bone marrow derived MSC differentiation towards osteoprogenitor cells and inhibited Notch signaling in a dose dependent manner. Constitutive activation of Notch signaling fully blocked OA induced MSC osteogenic differentiation. The expression level of early osteogenic marker genes, ALP, Runx2, and type I collagen, which play a critical role in MSC to osteoblast transition and servers as a downstream target of BMP signaling, was significantly induced by OA. Furthermore, BMP2 mediated MSC osteogenic differentiation was significantly enhance by OA treatment, indicating a synergistic effect between BMP2 and OA. Our results suggest that OA is a promising bioactive agent for bone tissue regeneration, and inhibition of Notch signaling is required for its osteogenic effects on MSCs.

Biomimetic Approaches for Bone Tissue Engineering

Although autologous bone grafts are considered a gold standard for the treatment of bone defects, they are limited by donor site morbidities and geometric requirements. We propose that tissue engineering technology can overcome such limitations by recreating fully viable and biological bone grafts. Specifically, we will discuss the use of bone scaffolds and autologous cells with bioreactor culture systems as a tissue engineering paradigm to grow bone in vitro. We will also discuss emergent vascularization strategies to promote graft survival in vivo, as well as the role of inflammation during bone repair. Finally, we will highlight some recent advances and discuss new solutions to bone repair inspired by endochondral ossification.

A simple critical-sized femoral defect model in mice

While bone has a remarkable capacity for regeneration, serious bone trauma often results in damage that does not properly heal. In fact, one tenth of all limb bone fractures fail to heal completely due to the extent of the trauma, disease, or age of the patient. Our ability to improve bone regenerative strategies is critically dependent on the ability to mimic serious bone trauma in test animals, but the generation and stabilization of large bone lesions is technically challenging. In most cases, serious long bone trauma is mimicked experimentally by establishing a defect that will not naturally heal. This is achieved by complete removal of a bone segment that is larger than 1.5 times the diameter of the bone cross-section. The bone is then stabilized with a metal implant to maintain proper orientation of the fracture edges and allow for mobility. Due to their small size and the fragility of their long bones, establishment of such lesions in mice are beyond the capabilities of most research groups. As such, long bone defect models are confined to rats and larger animals. Nevertheless, mice afford significant research advantages in that they can be genetically modified and bred as immune-compromised strains that do not reject human cells and tissue. Herein, we demonstrate a technique that facilitates the generation of a segmental defect in mouse femora using standard laboratory and veterinary equipment. With practice, fabrication of the fixation device and surgical implantation is feasible for the majority of trained veterinarians and animal research personnel. Using example data, we also provide methodologies for the quantitative analysis of bone healing for the model.

Effect of different hydroxyapatite incorporation methods on the structural and biological properties of porous collagen scaffolds for bone repair

Scaffolds which aim to provide an optimised environment to regenerate bone tissue require a balance between mechanical properties and architecture known to be conducive to enable tissue regeneration, such as a high porosity and a suitable pore size. Using freeze-dried collagen-based scaffolds as an analogue of native ECM, we sought to improve the mechanical properties by incorporating hydroxyapatite (HA) in different ways while maintaining a pore architecture sufficient to allow cell infiltration, vascularisation and effective bone regeneration. Specifically we sought to elucidate the effect of different hydroxyapatite incorporation methods on the mechanical, morphological, and cellular response of the resultant collagen-HA scaffolds. The results demonstrated that incorporating either micron-sized (CHA scaffolds) or nano-sized HA particles (CnHA scaffolds) prior to freeze-drying resulted in moderate increases in stiffness (2.2-fold and 6.2-fold, respectively, vs. collagen-glycosaminoglycan scaffolds, P < 0.05, a scaffold known to support osteogenesis), while enabling good cell attachment, and moderate mesenchymal stem cell (MSC)-mediated calcium production after 28 days' culture (2.1-fold, P < 0.05, and 1.3-fold, respectively, vs. CG scaffolds). However, coating of collagen scaffolds with a hydroxyapatite precipitate after freeze-drying (CpHA scaffolds) has been shown to be a highly effective method to increase the compressive modulus (26-fold vs. CG controls, P < 0.001) of scaffolds while maintaining a high porosity (~ 98%). The coating of the ligand-dense collagen structure results in a lower cell attachment level (P < 0.05), although it supported greater cell-mediated calcium production (P < 0.0001) compared with other scaffold variants after 28 days' culture. The comparatively good mechanical properties of these high porosity scaffolds is obtained partially through highly crosslinking the scaffolds with both a physical (DHT) and chemical (EDAC) crosslinking treatment. Control of scaffold microstructure was examined via alterations in freezing temperature. It was found that the addition of HA prior to freeze-drying generally reduced the pore size and so the CpHA scaffold fabrication method offered increased control over the resulting scaffolds microstructure. These findings will help guide future design considerations for composite biomaterials and demonstrate that the method of HA incorporation can have profound effects on the resulting scaffold structural and biological response.

Efficacy of prevascularization for segmental bone defect repair using β-tricalcium phosphate scaffold in rhesus monkey

Although small animal model (rabbit) showed successful bone defect repair using prevascularized tissue-engineered bone grafts (TEBG), large animal (rhesus monkey) studies are still needed to extrapolate the findings from animal data to humans. In current study, we investigated the efficacy of prevascularized TEBG for segmental bone defect repair in rhesus monkey. The segmental diaphyseal defects were created in both tibias. In group A, the defect was filled with prevascularized MSCs/scaffold prepared by inserting saphenous vascular bundle into the side groove and a fascia flap coverage; In group B, the defect was filled with MSCs/scaffold with a fascia flap coverage; In group C, the defect was filled with MSCs/scaffold; In group D, the defect was filled with only scaffold. The angiogenesis and new bone formation were compared among groups at 4, 8, and 12 weeks postoperatively. The results showed the prevascularized TEBG in group A could augment new bone formation and capillary vessel in-growth. It had significantly higher values of vascularization and radiographic grading score compared with other groups. In conclusion, the in vivo experiment data of prevascularized TEBG was further enriched from small to large animal model. It implies that prevascularized TEBG has great potentials in clinical applications.

Nano-ceramic composite scaffolds for bioreactor-based bone engineering

BACKGROUND

Composites of biodegradable polymers and bioactive ceramics are candidates for tissue-engineered scaffolds that closely match the properties of bone. We previously developed a porous, three-dimensional poly (D,L-lactide-co-glycolide) (PLAGA)/nanohydroxyapatite (n-HA) scaffold as a potential bone tissue engineering matrix suitable for high-aspect ratio vessel (HARV) bioreactor applications. However, the physical and cellular properties of this scaffold are unknown. The present study aims to evaluate the effect of n-HA in modulating PLAGA scaffold properties and human mesenchymal stem cell (HMSC) responses in a HARV bioreactor.

QUESTIONS/PURPOSES

By comparing PLAGA/n-HA and PLAGA scaffolds, we asked whether incorporation of n-HA (1) accelerates scaffold degradation and compromises mechanical integrity; (2) promotes HMSC proliferation and differentiation; and (3) enhances HMSC mineralization when cultured in HARV bioreactors.

METHODS

PLAGA/n-HA scaffolds (total number = 48) were loaded into HARV bioreactors for 6 weeks and monitored for mass, molecular weight, mechanical, and morphological changes. HMSCs were seeded on PLAGA/n-HA scaffolds (total number = 38) and cultured in HARV bioreactors for 28 days. Cell migration, proliferation, osteogenic differentiation, and mineralization were characterized at four selected time points. The same amount of PLAGA scaffolds were used as controls.

RESULTS

The incorporation of n-HA did not alter the scaffold degradation pattern. PLAGA/n-HA scaffolds maintained their mechanical integrity throughout the 6 weeks in the dynamic culture environment. HMSCs seeded on PLAGA/n-HA scaffolds showed elevated proliferation, expression of osteogenic phenotypic markers, and mineral deposition as compared with cells seeded on PLAGA scaffolds. HMSCs migrated into the scaffold center with nearly uniform cell and extracellular matrix distribution in the scaffold interior.

CONCLUSIONS

The combination of PLAGA/n-HA scaffolds with HMSCs in HARV bioreactors may allow for the generation of engineered bone tissue.

CLINICAL RELEVANCE

In cases of large bone voids (such as bone cancer), tissue-engineered constructs may provide alternatives to traditional bone grafts by culturing patients' own MSCs with PLAGA/n-HA scaffolds in a HARV culture system.

Minimally invasive soft-tissue and osseous stabilization (MISOS) technique for midfoot and hindfoot deformities

The surgical repair of unstable midfoot and hindfoot deformities in the high-risk patient remains a challenge with little guidance available in the literature. The author presents a proposed surgical intervention for midfoot and hindfoot deformities utilizing a minimally invasive soft-tissue and osseous stabilization (MISOS) approach. The article presents a detailed, step-by-step description of the procedure used for these difficult limb salvage cases.