Titanium addition influences antibacterial activity of bioactive glass coatings on metallic implants

The unexplored role of alkali and alkaline earth elements (ALAEs) on the structure, processing, and biological effects of bioactive glasses

Bioactive glass has been employed in several medical applications since its inception in 1969. The compositions of these materials have been investigated extensively with emphasis on glass network formers, therapeutic transition metals, and glass network modifiers. Through these experiments, several commercial and experimental compositions have been developed with varying chemical durability, induced physiological responses, and hydroxyapatite forming abilities. In many of these studies, the concentrations of each alkali and alkaline earth element have been altered to monitor changes in structure and biological response. This review aims to discuss the impact of each alkali and alkaline earth element on the structure, processing, and biological effects of bioactive glass. We explore critical questions regarding these elements from both a glass science and biological perspective. Should elements with little biological impact be included? Are alkali free bioactive glasses more promising for greater biological responses? Does this mixed alkali effect show increased degradation rates and should it be employed for optimized dissolution? Each of these questions along with others are evaluated comprehensively and discussed in the final section where guidance for compositional design is provided.

Biomaterials for Tissue Engineering Applications and Current Updates in the Field: A Comprehensive Review

Tissue engineering has emerged as an interesting field nowadays; it focuses on accelerating the auto-healing mechanism of tissues rather than organ transplantation. It involves implanting an In Vitro cultured initiative tissue or a scaffold loaded with tissue regenerating ingredients at the damaged area. Both techniques are based on the use of biodegradable, biocompatible polymers as scaffolding materials which are either derived from natural (e.g. alginates, celluloses, and zein) or synthetic sources (e.g. PLGA, PCL, and PLA). This review discusses in detail the recent applications of different biomaterials in tissue engineering highlighting the targeted tissues besides the in vitro and in vivo key findings. As well, smart biomaterials (e.g. chitosan) are fascinating candidates in the field as they are capable of elucidating a chemical or physical transformation as response to external stimuli (e.g. temperature, pH, magnetic or electric fields). Recent trends in tissue engineering are summarized in this review highlighting the use of stem cells, 3D printing techniques, and the most recent 4D printing approach which relies on the use of smart biomaterials to produce a dynamic scaffold resembling the natural tissue. Furthermore, the application of advanced tissue engineering techniques provides hope for the researchers to recognize COVID-19/host interaction, also, it presents a promising solution to rejuvenate the destroyed lung tissues.

Dual-Drug Delivery via Zein In Situ Forming Implants Augmented with Titanium-Doped Bioactive Glass for Bone Regeneration: Preparation, In Vitro Characterization, and In Vivo Evaluation

In situ forming implants (IFIs) are non-surgical approach using biodegradable polymers to treat bone fractures. The study aimed at preparing dual-drug-loaded IFIs to deliver pitavastatin (osteogenic drug) and tedizolid (antibiotic) using zein as the implant matrix via solvent-induced phase inversion method. At first, several investigations were done on pitavastatin-loaded zein IFIs, where three concentrations of zein were used (10, 20, and 30% w/v). IFIs were evaluated for their solidification time, rheological properties, injectability, and in vitro release. IFIs containing bioactive glass nanoparticles were prepared by the addition of non-doped bioactive glass nanoparticles (BGT₀; 1, 3, 5, and 10% w/v) or titanium-doped bioactive glass nanoparticles (BGT₅; 1% w/v) to the selected concentration of zein (30% w/v) and then evaluated. The optimized dual-medicated implant (D-ZIFI 1) containing pitavastatin, tedizolid, sodium hyaluronate (3% w/v), and BGT₅ (1% w/v) was prepared and compared to IFI lacking both sodium hyaluronate and BGT₅ (D-ZIFI 2). D-ZIFI 1 and 2 sustained the release profiles of both drugs for 28 days. SEM images proved the interconnected porous structure of D-ZIFI 1 due to sodium hyaluronate. In vivo studies on surgically induced bone defects in Sprague–Dawley rats signified the proper accelerated bone healing ability of D-ZIFI 1 over D-ZIFI 2. Results presented D-ZIFI 1 as a promising, effective, non-surgical approach for bone healing.

Titanium-Containing Silicate-Based Sol-Gel Bioactive Glass: Development, Characterization, and Applications

Bioactive glasses are surface-reactive glasses that, when placed in physiological fluid, undergo a transformation from glass to hydroxyapatite. Doping the bioactive glass with metallic ions can impart desirable and unique properties that are not inherent to natural hydroxyapatite. Once such ion is titanium. Titanium exists in trace amounts in native dental enamel, and its presence has been correlated with increased tooth hardness and brightness, both desirable clinical properties. Synthetic titanium-substituted hydroxyapatite exhibits better mechanical and antibacterial properties and demonstrates potential for an improved cellular response when compared to unmodified hydroxyapatite with applications in the broader field of bone tissue engineering. In this work, we use the sol-gel method to synthesize a titanium-containing silicate-based bioactive glass aimed at generating titanium-substituted hydroxyapatite on the glass surface upon immersion in body fluid. Titanium is homogeneously distributed throughout our glass, which keeps its amorphous nature. After 14 days of immersion in simulated body fluid, the glass forms a titanium-substituted hydroxyapatite on its surface. Enamel surfaces treated with the titanium-containing glass show significantly increased microhardness compared to enamel surfaces treated with a control glass, confirming the potential for the proposed glass in enamel remineralization. We also show that the presence of titanium in the glass promotes cell differentiation toward bone formation, suggesting further applications for this material in the broader field of bone tissue engineering.

Borate and Silicate Bioactive Glass Coatings Prepared by Nanosecond Pulsed Laser Deposition

Silicate (13-93) and borate (13-93-B3) bioactive glass coatings were successfully deposited on titanium using the nanosecond Pulsed Laser Deposition technique. The coatings’ microstructural characteristics, compositions and morphologies were examined by a number of physico-chemical techniques. The deposited coatings retain the same functional groups of the targets, are a few microns thick, amorphous, compact and crack free. Their surface is characterized by the presence of micrometric and nanometric particles. The surface topography, investigated by Atomic Force Microscopy, is characterized by spherical or ellipsoidal particles of the 0.2–3 μm size range for the 13-93 silicate bioactive glass film and of the 0.1–1 µm range for the 13-93-B3 borate bioactive glass coating. Equine adipose tissue-derived mesenchymal stem cells (ADMSCs) were applied for biological tests and the osteogenic differentiation activity of cells on the deposited coatings was studied after ADMSCs growth in osteogenic medium and staining with Alizarin Red. Cytocompatibility and osteogenic differentiation tests have shown that thin films retain the biocompatibility properties of the target silicate and borate glass, respectively. On the other hand, no antibacterial activity of the borate glass films was observed, suggesting that ion doping is advisable to inhibit bacterial growth on the surface of borate glass thin films.

Sol-Gel-Derived Bioactive and Antibacterial Multi-Component Thin Films by the Spin-Coating Technique

Although metallic alloys commonly used as prosthetics are durable and mechanically strong, they are often bioinert and lack antibacterial properties. Implementing a bioactive glass material with antibacterial properties as a coating on a metallic substrate provides mechanical strength and bioactivity, as well as antibacterial properties. Many coating methods have been extensively investigated; however, most of them can be expensive, are difficult to scale up, or do not form thin films, which could prevent their translation to clinical practice. The formation of thin films by spin-coating multi-component solution-gelation (sol-gel)-derived glass with antibacterial and bioactive properties has not been achieved previously. For this study, stainless steel 316L substrates were spin-coated with a sol-gel-derived bioactive and antibacterial glass coating in SiO₂ 58.3-P₂O₅ 7.1-CaO 25.6-Al₂O₅ 5.4-Ag₂O 2.1-Na₂O 1.5 wt% system (Ag-BG). A sol-gel processing condition that avoids elemental separation upon spin-coating when sintering happens at below the calcination temperature (500 °C) has been developed. This work demonstrates that silver reduction occurs when the concentrations of other cations such as Ca²⁺ and Na⁺ in the solution increase. Increasing the stirring duration time prior to the increase of cations, Ag⁺ ions are stabilized by aluminum tetrahedra, and their reduction to metallic silver does not occur. This study also shows that large dilution ratios (water:tetraethyl orthosilicate) greater than 25:1, accompanied by long stirring durations, produce morphologically homogeneous coatings. Using this strategy, thin films were formed with antibacterial properties against methicillin-resistant Staphylococcus aureus (MRSA) biofilm and biological responses that promote eukaryotic cell adhesion and proliferation. In total, the improved synthesis strategy opens new avenues for the development of novel bioactive and antibacterial thin-film coatings, as it reveals the processing characteristics that control the physicochemical and morphological properties of the formed films.

In vitro evaluation of novel titania-containing borate bioactive glass scaffolds

Titanium-containing borate bioactive glass scaffolds (0, 5, 15, and 20 mol %, identified as BRT0, BRT1, BRT3, and BRT4) with a microstructure similar to that of human trabecular bone were prepared and evaluated in vitro for potential bone loss applications in revision total knee arthroplasty (rTKA). Methyl thiazolyl tetrazolium (MTT) cell viability assays of scaffold ion release extracts revealed that BRT0 scaffolds (0 mol % titanium) inhibited cell proliferation and activity at day 14. At day 30, all scaffold extracts decreased cell proliferation and activity significantly. However, live/dead cell assay results demonstrated that degradation products from all the scaffolds had no inhibitory effect on cell viability. Significant bactericidal efficacies of BRT3 extracts against Escherishia coli (Gram-negative) and BRT1 extracts against Staphylococcus aureus and Staphylococcus epidermidis (both Gram-positive bacteria) were demonstrated. Finally, evaluation of the cell/bioactive glass surface interactions showed well-spread cells on the surface of the BRT3 glass discs and BRT1 and BRT3 scaffolds, when compared to BRT0 and BRT4 scaffolds. The results indicate that by changing the Ti⁴⁺ :B³⁺ ratio, the ion release and consequently cell proliferation could be improved. in vitro results in this study demonstrate that BRT3 scaffolds could be a promising candidate for addressing bone loss in rTKAs; however, in vivo studies would be required to evaluate the effect of a dynamic environment on the cell and tissue response to the fabricated scaffolds.

"To Be Microbiocidal and Not to Be Cytotoxic at the Same Time…"-Silver Nanoparticles and Their Main Role on the Surface of Titanium Alloy Implants

The chemical vapor deposition (CVD) method has been used to produce dispersed silver nanoparticles (AgNPs) on the surface of titanium alloy (Ti6Al4V) and nanotubular modified titanium alloys (Ti6Al4V/TNT5), leading to the formation of Ti6Al4V/AgNPs and Ti6Al4V/TNT5/AgNPs systems with different contents of metallic silver particles. Their surface morphology and silver particles arrangement were characterized by scanning electron microscopy (SEM), energy dispersive X-ray spectrometry (EDS), and atomic force microscopy (AFM). The wettability and surface free energy of these materials were investigated on the basis of contact angle measurements. The degree of silver ion release from the surface of the studied systems immersed in phosphate buffered saline solution (PBS) was estimated using inductively coupled plasma ionization mass spectrometry (ICP-MS). The biocompatibility of the analyzed materials was estimated based on the fibroblasts and osteoblasts adhesion and proliferation, while their microbiocidal properties were determined against Gram-positive and Gram-negative bacteria, and yeasts. The results of our works proved the high antimicrobial activity and biocompatibility of all the studied systems. Among them, Ti6Al4V/TNT5/0.6AgNPs contained the lowest amount of AgNPs, but still revealed optimal biointegration properties and high biocidal properties. This is the biomaterial that possesses the desired biological properties, in which the potential toxicity is minimized by minimizing the number of silver nanoparticles.

Recent advances in the use of carbon nanotubes as smart biomaterials

Carbon nanotubes (CNTs) have remarkable mechanical, thermal, electronic, and biological properties due to their particular atomic structure made of graphene sheets that are rolled into cylindrical tubes. Due to their outstanding properties, CNTs have been used in several technological fields. Currently, the most prominent research area of CNTs focuses on biomedical applications, using these materials to produce hybrid biosensors, drug delivery systems, and high performance composites for implants. Although a great number of research studies have already shown the advantages of CNT-based biomedical devices, their clinical use for in vivo application has not been consummated. Concerns related to their toxicity, biosafety, and biodegradation still remain. The effect of CNTs on the human body and the ecosystem is not well established, especially due to the lack of standardization of toxicological tests, which generate contradictions in the results. CNTs' toxicity must be clarified to enable the medical use of these exceptional materials in the near future. In this review, we summarize recent advances in developing biosensors, drug delivery systems, and implants using CNTs as smart biomaterials to identify pathogens, load/deliver drugs and enhance the mechanical and antimicrobial performance of implants.

Bioactive Glasses and Glass-Ceramics for Healthcare Applications in Bone Regeneration and Tissue Engineering

The discovery of bioactive glasses (BGs) in the late 1960s by Larry Hench et al. was driven by the need for implant materials with an ability to bond to living tissues, which were intended to replace inert metal and plastic implants that were not well tolerated by the body. Among a number of tested compositions, the one that later became designated by the well-known trademark of 45S5 Bioglass® excelled in its ability to bond to bone and soft tissues. Bonding to living tissues was mediated through the formation of an interfacial bone-like hydroxyapatite layer when the bioglass was put in contact with biological fluids in vivo. This feature represented a remarkable milestone, and has inspired many other investigations aiming at further exploring the in vitro and in vivo performances of this and other related BG compositions. This paradigmatic example of a target-oriented research is certainly one of the most valuable contributions that one can learn from Larry Hench. Such a goal-oriented approach needs to be continuously stimulated, aiming at finding out better performing materials to overcome the limitations of the existing ones, including the 45S5 Bioglass®. Its well-known that its main limitations include: (i) the high pH environment that is created by its high sodium content could turn it cytotoxic; (ii) and the poor sintering ability makes the fabrication of porous three-dimensional (3D) scaffolds difficult. All of these relevant features strongly depend on a number of interrelated factors that need to be well compromised. The selected chemical composition strongly determines the glass structure, the biocompatibility, the degradation rate, and the ease of processing (scaffolds fabrication and sintering). This manuscript presents a first general appraisal of the scientific output in the interrelated areas of bioactive glasses and glass-ceramics, scaffolds, implant coatings, and tissue engineering. Then, it gives an overview of the critical issues that need to be considered when developing bioactive glasses for healthcare applications. The aim is to provide knowledge-based tools towards guiding young researchers in the design of new bioactive glass compositions, taking into account the desired functional properties.