A novel tissue-engineered bone graft composed of silicon-substituted calcium phosphate, autogenous fine particulate bone powder and BMSCs promotes posterolateral spinal fusion in rabbits

Osteogenesis Differentiation and Molecular Mechanism Study of a Si and Mg Dual-Ion System Based on mRNA Transcriptomic Sequencing Analysis

Both silicon (Si) and magnesium (Mg) ions play essential roles in bone health. However, the precise mechanisms by which these two ions enhance osteogenic differentiation remain to be fully elucidated. Herein, a Si-Mg dual-ion system was designed to investigate the effects of Si and Mg ions on the cytological behavior of mouse bone marrow mesenchymal stem cells (mBMSCs). The molecular mechanism of the Si-Mg dual-ion system regulating osteogenic differentiation of mBMSCs was investigated by transcriptome sequencing technology. In the single-ion system, the Si group with concentrations of 1.5 and 0.75 mM exhibited good combined effects (cell proliferation, alkaline phosphatase (ALP) activity, and osteogenic differentiation gene expression (Runx2, OPN, and Col-I)) of mBMSCs. The Mg group with concentrations of 5 and 2.5 mM showed better combined effects (cell proliferation, ALP activity, and osteogenic differentiation gene expression) of mBMSCs. In the dual-ion system, the silicon (0.75 mM)-magnesium (2.5 mM) experimental group significantly enhanced the proliferation, ALP activity, and osteogenesis-related gene expression (Runx2, OPN, and Col-I) of mBMSCs. The analysis of transcriptome sequencing results showed that Mg ions had a certain pro-stem cell osteogenic differentiation regulatory effect. Si ions had a stronger regulation on osteogenic differentiation than the Mg ions. The regulation of osteogenic differentiation by Si-Mg dual ions was synergistically enhanced compared to that of a single ion. In addition, the transforming growth factor beta (TGF-β) signaling pathway and mitogen-activated protein kinase (MAPK) signaling pathway were involved in mediating the pro-stem cell osteogenic differentiation by Si-Mg dual ions. This study sheds light on investigating the molecular mechanism of dual-ion regulation of the osteogenic differentiation of mBMSCs and enriches the theory of ion-regulating osteogenic differentiation.

Identification and function of periosteal skeletal stem cells in skeletal development, homeostasis, and disease

Background

Periosteum-resident skeletal stem cells (SSCs) are essential for the growth, maintenance, and repair of the skeletal system. These cells exhibit self-renewal ability and clonal pluripotency. Compared to the diverse bone marrow mesenchymal stem cells (BMSCs), periosteal skeletal stem cells (P-SSCs) represent a purified stem cell population and are preferable for bone tissue engineering.

Methods

This review covers the histological structure of the periosteum, process of isolating and characterising P-SSCs, and spatiotemporal distribution and characteristics of P-SSCs from different lineages. Additionally, the roles of P-SSCs in bone injury, disease, and periosteal niche regulation are discussed.

Results

Intramembrane and intraconal ossification of P-SSCs exhibits favourable therapeutic potential. Osteogenesis using P-SSCs is an ideal process for bone repair.

Conclusions

P-SSCs are vital for bone formation, maintenance, and repair. P-SSCs are essential components of the periosteal microenvironment. Therefore, it is essential to investigate their critical clinical applications and translational functions. By targeting and inducing endogenous stem cells, the in situ repair of bone defects can be facilitated, leading to the development of more effective novel therapies.

The translational potential of this article

To enhance our understanding of the function of P-SSCs in bone repair and skeleton-related diseases, it is imperative to elucidate the current research status of P-SSCs and ascertain the prospective trajectory for their advancement and refinement in bone tissue engineering. P-SSCs are expected to play an expanded role in treating bone abnormalities, leading to the optimisation of bone tissue treatment.

Evaluation of biological performance of 3D printed trabecular porous tantalum spine fusion cage in large animal models

Background

The materials for artificial bone scaffolds have long been a focal point in biomaterials research. Tantalum, with its excellent bioactivity and tissue compatibility, has gradually become a promising alternative material. 3D printing technology shows unique advantages in designing complex structures, reducing costs, and providing personalized customization in the manufacture of porous tantalum fusion cages. Here we report the pre-clinical large animal (sheep) study on the newly developed 3D printed biomimetic trabecular porous tantalum fusion cage for assessing the long-term intervertebral fusion efficacy and safety.

Methods

Porous tantalum fusion cages were fabricated using laser powder bed fusion (LPBF) and chemical vapor deposition (CVD) methods. The fusion cages were characterized using scanning electron microscopy (SEM) and mechanical compression tests. Small-Tailed Han sheep served as the animal model, and the two types of fusion cages were implanted in the C3/4 cervical segments and followed for up to 12 months. Imaging techniques, including X-ray, CT scans, and Micro CT, were used to observe the bone integration of the fusion cages. Hard tissue sections were used to assess osteogenic effects and bone integration. The range of motion (ROM) of the motion segments was evaluated using a biomechanical testing machine. Serum biochemical indicators and pathological analysis of major organs were conducted to assess biocompatibility.

Results

X-ray imaging showed that both the 3D-printed and chemical vapor deposition porous tantalum fusion cages maintained comparable average intervertebral disc heights. Due to the presence of metal artifacts, CT and Micro CT imaging could not effectively analyze bone integration. Histomorphology data indicated that both the 3D-printed and chemical vapor deposition porous tantalum fusion cages exhibited similar levels of bone contact and integration at 3, 6, and 12 months, with bone bridging observed at 12 months. Both groups of fusion cages demonstrated consistent mechanical stability across all time points. Serum biochemistry showed no abnormalities, and no significant pathological changes were observed in the heart, liver, spleen, lungs, and kidneys.

Conclusion

This study confirms that 3D-printed and chemical vapor deposition porous tantalum fusion cages exhibit comparable, excellent osteogenic effects and long-term biocompatibility. Additionally, 3D-printed porous tantalum fusion cages offer unique advantages in achieving complex structural designs, low-cost manufacturing, and personalized customization, providing robust scientific support for future clinical applications.

The translational potential of this article

The translational potential of this paper is to use 3D printed biomimetic trabecular porous tantalum spine fusion cage with bone trabecular structure and validating its feasibility in large animal models (sheep). This study provides a basis for further research into the clinical application of the 3D printed biomimetic trabecular porous tantalum spine fusion cage.

Local drug delivery challenges and innovations in spinal neurosurgery

The development of novel therapeutics in the field of spinal neurosurgery faces a litany of translational challenges. Achieving precise drug targeting within the confined spaces associated with the spinal cord, canal and vertebra requires the development of next generation delivery systems and devices. These must be capable of overcoming inherent barriers related to drug diffusion, whilst concurrently ensuring optimal drug distribution and retention. In this review, we provide an overview of the most recent advances in the therapeutic management of diseases and disorders affecting the spine, including systems and devices capable of releasing small molecules and biopharmaceuticals that help eliminate pain and restore the mechanical function and stability of the spine. We highlight material-based approaches and minimally invasive techniques that can be employed to provide control over drug release kinetics and improve retention. We also seek to explore how the newest advancements in nanotechnology, biomaterials, additive manufacturing technologies and imaging modalities can be employed in this translational pursuit. Finally, we discuss the landscape of clinical trials and recently approved products aimed at overcoming the complexities associated with drug delivery to the spine.

Harvest of functional mesenchymal stem cells derived from in vivo osteo-organoids

Bone marrow-derived mesenchymal stem cells (BM-MSCs) play a crucial role in stem cell therapy and are extensively used in regenerative medicine research. However, current methods for harvesting BM-MSCs present challenges, including a low yield of primary cells, long time of in vitro expansion, and diminished differentiation capability after passaging. Meanwhile mesenchymal stem cells (MSCs) recovered from cell banks also face issues like toxic effects of cryopreservation media. In this study, we provide a detailed protocol for the isolation and evaluation of MSCs derived from in vivo osteo-organoids, presenting an alternative to autologous MSCs. We used recombinant human bone morphogenetic protein 2-loaded gelatin sponge scaffolds to construct in vivo osteo-organoids, which were stable sources of MSCs with large quantity, high purity, and strong stemness. Compared with protocols using bone marrow, our protocol can obtain large numbers of high-purity MSCs in a shorter time (6 days vs. 12 days for obtaining passage 1 MSCs) while maintaining higher stemness. Notably, we found that the in vivo osteo-organoid-derived MSCs exhibited stronger anti-replicative senescence capacity during passage and amplification, compared to BM-MSCs. The use of osteo-organoid-derived MSCs addresses the conflict between the limitations of autologous cells and the risks associated with allogeneic sources in stem cell transplantation. Consequently, our protocol emerges as a superior alternative for both stem cell research and tissue engineering.

Biodegradable Cements for Bone Regeneration

Bone cements such as polymethyl methacrylate and calcium phosphates have been widely used for the reconstruction of bone. Despite their remarkable clinical success, the low degradation rate of these materials hampers a broader clinical use. Matching the degradation rate of the materials with neo bone formation remains a challenge for bone-repairing materials. Moreover, questions such as the mechanism of degradation and how the composition of the materials contribute to the degradation property remain unanswered. Therefore, the review provides an overview of currently used biodegradable bone cements such as calcium phosphates (CaP), calcium sulfates and organic-inorganic composites. The possible degradation mechanism and clinical performance of the biodegradable cements are summarized. This paper reviews up-to-date research and applications of biodegradable cements, hoping to provide researchers in the field with inspirations and references.

Preparation and characterizations of an injectable and biodegradable high-strength iron-bearing brushite cement for bone repair and vertebral augmentation applications

Brushite cements have good osteoconductive and resorbable properties, but the low mechanical strength and poor injectability limit their clinical applications in load-bearing conditions and minimally invasive surgery. In this study, an injectable brushite cement that contains monocalcium phosphate monohydrate (MCPM) and β-tricalcium phosphate (β-TCP) as its solid phase and ammonium ferric citrate (AFC) solution as the aqueous medium was designed to have high mechanical strength. The optimized formulation achieved a compressive strength of 62.8 ± 7.2 MPa, which is above the previously reported values of hand-mixing brushite cements. The incorporation of AFC prolonged the setting times and greatly enhanced the injectability and degradation properties of the cements. In vitro and in vivo experiments demonstrated that the brushite cements exhibited good biocompatibility and bone regeneration capacity. The novel brushite cement is promising for bone healing in load-bearing applications.

3D-plotted zinc silicate/β-tricalcium phosphate ceramic scaffolds enable fast osteogenesis by activating the p38 signaling pathway

Biomaterials in combination with multiple bioactive ions could create a favorable microenvironment for bone remolding. Herein, zinc silicate/β-tricalcium phosphate (ZS/β-TCP) composite ceramic scaffolds with different amounts of ZS (5, 10, and 15 wt%) were constructed using a three-dimensional fiber deposition (3DF) technique. The physicochemical, osteogenic and angiogenic properties of these interconnected macroporous scaffolds were investigated systematically. Simultaneously, GeneChip, alkaline phosphatase (ALP), western blot (WB) and polymerase chain reaction (PCR) were utilized to elucidate the underlying mechanism of the enhancement in osteogenic differentiation. The results showed that the incorporation of ZS significantly improved the mechanical performance by more than 5 fold in comparison with the β-TCP ceramic scaffold (4.79 ± 0.99 MPa). The ZS modified β-TCP scaffolds greatly supported the cytoactivity, adhesion, proliferation of mouse bone marrow mesenchymal stem cells (mBMSCs) and human umbilical vein endothelial cells (HUVECs). The expression levels of osteogenic genes and proteins as well as angiogenic genes were markedly upregulated by the sustained release of bioactive ions (mainly Si and Zn) from the composite scaffolds. The 10ZS/β-TCP demonstrated the best overall performance in vitro. Moreover, the 10ZS/β-TCP displayed a high bone volume fraction, bone maturity and angiogenesis after implantation in the rat skull defects for 6 weeks. It was further verified that ZS/β-TCP scaffolds stimulated the osteogenic differentiation of mBMSCs by activating the p38 signaling pathway directly. The 10ZS/β-TCP ceramic scaffold holds great potential for the fast repair of bone defects, and deep understanding of the mechanism will facilitate the formulation of new strategies for bone repair.

Current strategies for enhancement of the bioactivity of artificial ligaments: A mini-review

Background and objective

Anterior cruciate ligament (ACL) reconstruction calls for artificial ligaments with better bioactivity, however systematic reviews regarding bioactivity enhancement strategies, technologies, and perspectives of artificial ligaments have been rarely found.

Methods

Research papers, reviews, and clinical reports related to artificial ligaments were searched and summarized the current status and research trends of artificial ligaments through a systematic analysis.

Results

Having experienced ups and downs since the very first record of clinical application, artificial ligaments differing in material, and fabrication methods have been reported with different clinical performances. Various manufacturing technologies have developed and realized scaffold- and cell-based strategies. Despite encouraging in-vivo and in-vitro test results, the clinical results of such new designs need further clinical examinations.

Conclusion

As the demand for ACL reconstruction dramatically increases, novel artificial ligaments with better osteoinductivity and mechanical performance are promising.

The translational potential of this article

To develop novel artificial ligaments simultaneously possessing excellent osteoinductivity and satisfactory mechanical performance, it is important to grab a glance at recent research advances. This systematic analysis provides researchers and clinicians with comprehensive and comparable information on artificial ligaments, thus being of clinical translational significance.

An injectable pH neutral bioactive glass-based bone cement with suitable bone regeneration ability

Background

As a class of promising bone augmentation materials, bone cements have attracted particular attention. Due to various limitations, the current bone cements are still imperfect. In this study, an injectable pH neutral bioactive bone cement (PSC/CSC) was developed by mixing phosphosilicate bioactive glass (PSC) and α-calcium sulfate hemihydrate (CSH), with the goal of optimizing bone defects repairs.

Methods

A range of compositions (PSC/CSC: 10P/90C, 30P/70C, 50P/50C) were developed and their physicochemical properties evaluated. Their bone regeneration ability was compared to those of two widely used bone cements as controls (calcium phosphate cement (CPC) and Genex®) in rabbit femoral condyle bone defect models for 4, 8 and 12 weeks. Based on physicochemical properties and in vivo bone regeneration ability, the PSC/CSC exhibited the best outcomes was selected. Then, in vitro, the effects of selected PSC/CSC, CPC and Genex® extracts on MC3T3-E1 cell proliferation, migration and osteogenesis as well as angiogenesis of HUVECs were examined.

Results

Based on physicochemical properties, the 30P/70C formula exhibited suitable operability and compressive strength (3.5 ± 0.3 MPa), which fulfilled the requirements for cancellous bone substitutes. In vivo, findings from micro-CT and histological analyses showed that the 30P/70C formula better promoted bone regeneration, compared to 10P/90C, 50P/50C, CPC and Genex®. Hence, 30P/70C was selected as the ideal PSC-based cement. In vitro, the 30P/70C extracts showed better promotion of cell viability, alkaline phosphatase (ALP) activity, calcium mineral deposition, mRNA and protein expression levels of osteogenesis in MC3T3-E1 cells, further supporting its superiority. Meanwhile, the 30P/70C extracts also showed better stimulation of HUVECs proliferation and angiogenesis.

Conclusion

The new composite cement, 30P/70C, is a favorable bioactive glass-based bone cement with suitable operability, compressive strength and bone regeneration ability.

The translational potential of this article

Clinically, treatment of large bone defects is still a major challenge for orthopaedic trauma. We showed that 30P/70C has the potential to be clinically used as an injectable cement for rapid bone repairs and reconstruction of critical sized bone defects.

Fabrication And In Vitro Evaluation Of 3D Printed Porous Silicate Substituted Calcium Phosphate Scaffolds For Bone Tissue Engineering

Silicate-substituted calcium phosphate (Si-CaP) ceramics, alternative materials for autogenous bone grafting, exhibit excellent osteoinductivity, osteoconductivity, biocompatibility and biodegradability; thus, they have been widely used for treating bone defects. However, the limited control over the spatial structure and weak mechanical properties of conventional Si-CaP ceramics hinder their wide application. Here, we used digital light processing (DLP) printing technology to fabricate a novel porous 3D printed Si-CaP scaffold to enhance the scaffold properties. Scanning electron microscopy, compression tests, and computational fluid dynamics simulations of the 3D printed Si-CaP scaffolds revealed a uniform spatial structure, appropriate mechanical properties, and effective interior permeability. Furthermore, compared to Si-CaP groups, 3D printed Si-CaP groups exhibited sustained release of silicon (Si), calcium (Ca) and phosphorus (P) ions. Furthermore, 3D printed Si-CaP groups had more comprehensive and persistent osteogenic effects due to increased osteogenic factor expression and calcium deposition. Our results show that the 3D printed Si-CaP scaffold successfully improved bone marrow mesenchymal stem cell (BMSCs) adhesion, proliferation and osteogenic differentiation and possessed a distinct apatite mineralization ability. Overall, with the help of DLP printing technology, Si-CaP ceramic materials facilitate the fabrication of ideal bone tissue engineering scaffolds with essential elements, providing a promising approach for bone regeneration. This article is protected by copyright. All rights reserved.

Periosteum and development of the tissue-engineered periosteum for guided bone regeneration

Background

Periosteum plays a significant role in bone formation and regeneration by storing progenitor cells, and also acts as a source of local growth factors and a scaffold for recruiting cells and other growth factors. Recently, tissue-engineered periosteum has been studied extensively and shown to be important for osteogenesis and chondrogenesis. Using biomimetic methods for artificial periosteum synthesis, membranous tissues with similar function and structure to native periosteum are produced that significantly improve the efficacy of bone grafting and scaffold engineering, and can serve as direct replacements for native periosteum. Many problems involving bone defects can be solved by preparation of idealized periosteum from materials with different properties using various techniques.

Methods

This review summarizes the significance of periosteum for osteogenesis and chondrogenesis from the aspects of periosteum tissue structure, osteogenesis performance, clinical application, and development of periosteum tissue engineering. The advantages and disadvantages of different tissue engineering methods are also summarized.

Results

The fast-developing field of periosteum tissue engineering is aimed toward synthesis of bionic periosteum that can ensure or accelerate the repair of bone defects. Artificial periosteum materials can be similar to natural periosteum in both structure and function, and have good therapeutic potential. Induction of periosteum tissue regeneration and bone regeneration by biomimetic periosteum is the ideal process for bone repair.

Conclusions

Periosteum is essential for bone formation and regeneration, and it is indispensable in bone repair. Achieving personalized structure and composition in the construction of tissue engineering periosteum is in accordance with the design concept of both universality and emphasis on individual differences and ensures the combination of commonness and individuality, which are expected to meet the clinical needs of bone repair more effectively.

The translational potential of this article

To better understand the role of periosteum in bone repair, clarify the present research situation of periosteum and tissue engineering periosteum, and determine the development and optimization direction of tissue engineering periosteum in the future. It is hoped that periosteum tissue engineering will play a greater role in meeting the clinical needs of bone repair in the future, and makes it possible to achieve optimization of bone tissue therapy.

The "Three in One" Bone Repair Strategy for Osteoporotic Fractures

In aging society, osteoporotic fractures have become one major social problem threatening the health of the elderly population in China. Compared with conventional fractures, low bone mass, bone defect and retarded healing issues of osteoporotic fractures lead to great difficulties in treatment and rehabilitation. Addressing major concerns in clinical settings, we proposed the "three in one" bone repair strategy focusing on anti-osteoporosis therapies, appropriate bone grafting and fracture healing accelerating. We summarize misconceptions and repair strategies for osteoporotic fracture management, expecting improvement of prognosis and clinical outcomes for osteoporotic fractures, to further improve therapeutic effect and living quality of patients.

Therapeutics for enhancement of spinal fusion: A mini review

Objective

With the advances in biological technologies over the past 20 years, a number of new therapies to promote bone healing have been introduced. Particularly in the spinal surgery field, more unprecedented biological therapeutics become available to enhance spinal fusion success rate along with advanced instrumentation approaches. Yet surgeons may not have been well informed about their safety and efficacy profiles in order to improve clinical practices. Therefore there is a need to summarize the evidence and bring the latest progress to surgeons for better clinical services for patients.

Methods

We comprehensively reviewed the literatures in regard to the biological therapeutics for enhancement of spinal fusion published in the last two decades.

Results

Autograft bone is still the gold standard for bone grafting in spinal fusion surgery due to its good osteoconductive, osteoinductive, and osteogenic abilities. Accumulating evidence suggests that adding rhBMPs in combination with autograft effectively promotes the fusion rate and improves surgical outcomes. However, the stimulating effect on spinal fusion of other growth factors, including PDGF, VEGF, TGF-beta, and FGF, is not convincing, while Nell-1 and activin A exhibited preliminary efficacy. In terms of systemic therapeutic approaches, the osteoporosis drug Teriparatide has played a positive role in promoting bone healing after spinal surgery, while new medications such as denosumab and sclerostin antibodies still need further validation. Currently, other treatment, such as controlled-release formulations and carriers, are being studied for better releasing profile and the administration convenience of the active ingredients.

Conclusion

As the world's population continues to grow older, the number of spinal fusion cases grows substantially due to increased surgical needs for spinal degenerative disease (SDD). Critical advancements in biological therapeutics that promote spinal fusion have brought better clinical outcomes to patients lately. With the accumulation of higher-level evidence, the safety and efficacy of present and emerging products are becoming more evident. These emerging therapeutics will shift the landscape of perioperative therapy for the enhancement of spinal fusion.

A novel rat model of interbody fusion based on anterior lumbar corpectomy and fusion (ALCF)

BACKGROUND

Rats have been widely used as experimental animals when performing fundamental research because they are economical, rapidly reproducing, and heal quickly. While the rat interbody fusion model has been applied in basic studies, existing rat models generally have shortcomings, such as insufficiently simulating clinical surgery. The purpose of this study was to develop a novel rat model of interbody fusion which more closely represents clinical surgery.

METHODS

The internal fixation was designed based on physical measurements of the rats' lumbar spine. Then, ten rats divided into two groups (A and B) underwent anterior lumbar corpectomy and fusion of the L5 vertebrae. Groups A and B were sacrificed four and 8 weeks post-surgery, respectively. Micro-CT and histological examination were used to evaluate the model. Fusion rate, bone volume fraction (BV/TV), trabecular bone number (Tb.N), trabecular bone thickness (Tb.Th), and the area ratio of newly formed bone (NB) were calculated for quantitative analysis.

RESULTS

Based on the L5 body dimensions of individual rats, 3D-printed titanium cage of the appropriate size were printed. The operations were successfully completed in all ten rats, and X-ray confirmed that internal fixation was good without migration. Micro-CT suggested that fusion rates in group B (100%) were greater than group A (40%, P < 0.05). The BV/TV (B: 42.20 ± 10.50 vs. A: 29.02 ± 3.25, P < 0.05) and Tb.N (B: 4.66 ± 1.23 vs. A: 1.97 ± 0.40, P < 0.05) were greater in group B than A, and the Tb.Th in group B was lower than group A (B: 0.10 ± 0.04 vs. A: 0.15 ± 0.02, P < 0.05). Histomorphometry results demonstrated that the area ratio of NB in group B were greater than group A (B: 35.72 ± 12.80 vs. A: 12.36 ± 16.93, P < 0.05).

CONCLUSION

A rat interbody fusion model based on anterior lumbar corpectomy and fusion has successfully been constructed and verified. It could provide a new choice for fundamental research using animal models of spinal fusion.