Direct and indirect effects of P2O5 glass reinforced-hydroxyapatite composites on the growth and function of osteoblast-like cells

Regeneration of critical-sized defects, in a goat model, using a dextrin-based hydrogel associated with granular synthetic bone substitute

The development of injectable bone substitutes (IBS) have obtained great importance in the bone regeneration field, as a strategy to reach hardly accessible defects using minimally invasive techniques and able to fit to irregular topographies. In this scenario, the association of injectable hydrogels and bone graft granules is emerging as a well-established trend. Particularly, in situ forming hydrogels have arisen as a new IBS generation. An in situ forming and injectable dextrin-based hydrogel (HG) was developed, aiming to act as a carrier of granular bone substitutes and bioactive agents. In this work, the HG was associated to a granular bone substitute (Bonelike^®) and implanted in goat critical-sized calvarial defects (14 mm) for 3, 6 and 12 weeks. The results showed that HG improved the handling properties of the Bonelike^® granules and did not affect its osteoconductive features, neither impairing the bone regeneration process. Human multipotent mesenchymal stromal cells from the umbilical cord, extracellular matrix hydrolysates and the pro-angiogenic peptide LLKKK18 were also combined with the IBS. These bioactive agents did not enhance the new bone formation significantly under the conditions tested, according to micro-computed tomography and histological analysis.

In vivo systemic toxicity assessment of an oxidized dextrin-based hydrogel and its effectiveness as a carrier and stabilizer of granular synthetic bone substitutes

The worldwide incidence of bone disorders is raising, mainly due to aging population. The lack of effective treatments is pushing the development of synthetic bone substitutes (SBSs). Most ceramic-based SBSs commercially available display limited handling properties. Attempting to solve these issues and achieve wider acceptance by the clinicians, granular ceramics have been associated with hydrogels (HGs) to produce injectable/moldable SBSs. Dextrin, a low-molecular-weight carbohydrate, was used to develop a fully resorbable and injectable HG. It was first oxidized with sodium periodate and then cross-linked with adipic acid dihydrazide. The in vivo biocompatibility and safety of the dextrin-based HG was assessed by subacute systemic toxicity and skin sensitization tests, using rodent models. The results showed that the HG did not induce any systemic toxic effect, skin reaction, or genotoxicity, neither impaired the bone repair/regeneration process. Then, the HG was successfully combined with granular bone substitute, registered as Bonelike (250-500 μm) to obtain a moldable/injectable SBS, which was implanted in tibial fractures in goats for 3 and 6 weeks. The obtained results showed that HG allowed the stabilization of the granules into the defect, ensuring effective handling, and molding properties of the formulation, as well as an efficient cohesion of the granules. © 2019 Wiley Periodicals, Inc. J Biomed Mater Res Part A: 107A: 1678-1689, 2019.

Morphology effect of bioglass-reinforced hydroxyapatite (Bonelike(®) ) on osteoregeneration

In the last decades, the well-known disadvantages of autografts and allografts have driven to the development of synthetic bone grafts for bone regeneration. Bonelike(®) , a glass-reinforced hydroxyapatite (HA) composite was developed and registered for bone grafting. This biomaterial is composed by a modified HA matrix, with α- and β-tricalcium phosphate secondary phases. Aiming to improve the biological characteristics of Bonelike(®) , new spherical pelleted granules, of different shape and size, were developed with controlled micro and macrostructure. In the present study, it was compared the physicochemical properties and in vivo performance of different Bonelike(®) granule presentations-Bonelike(®) polygonal (500-1000 µm size) and Bonelike spherical (250-500 µm; 500-1000 µm size). For the in vivo study, Bonelike(®) was implanted on sheep femurs, with various implantation times (30 days, 60 days, 120 days, and 180 days). X-ray diffraction analysis revealed that the phase composition of different granules presentations was similar. Bonelike(®) spherical 500-1000 µm was the most porous material (global porosity and intraporosity) and Bonelike(®) polygonal 500-1000 µm the less porous. Considering the in vivo study, both polygonal and spherical granules presented osteoconductive proprieties. The spherical granules showed several advantages, including easier medical application through syringe and improved osteointegration, osteoconduction, and degradation, by the presence of larger pores, controlled micro- and macrosctructure and suitable particle format that adapts to bone growth. Bonelike(®) spherical 500-1000 µm showed improved new bone invasion throughout the material's structure and Bonelike(®) spherical 250-500 µm appeared to induce faster bone regeneration, presenting less unfilled areas and less lacunae in the histological analysis.

Processing strategies for smart electroconductive carbon nanotube-based bioceramic bone grafts

Electroconductive bone grafts have been designed to control bone regeneration. Contrary to polymeric matrices, the translation of the carbon nanotube (CNT) electroconductivity into oxide ceramics is challenging due to the CNT oxidation during sintering. Sintering strategies involving reactive-bed pressureless sintering (RB + P) and hot-pressing (HP) were optimized towards prevention of CNT oxidation in glass/hydroxyapatite (HA) matrices. Both showed CNT retentions up to 80%, even at 1300 °C, yielding an increase of the electroconductivity in ten orders of magnitude relative to the matrix. The RB + P CNT compacts showed higher electroconductivity by ∼170% than the HP ones due to the lower damage to CNTs of the former route. Even so, highly reproducible conductivities with statistical variation below 5% and dense compacts up to 96% were only obtained by HP. The hot-pressed CNT compacts possessed no acute toxicity in a human osteoblastic cell line. A normal cellular adhesion and a marked orientation of the cell growth were observed over the CNT composites, with a proliferation/differentiation relationship favouring osteoblastic functional activity. These sintering strategies offer new insights into the sintering of electroconductive CNT containing bioactive ceramics with unlimited geometries for electrotherapy of the bone tissue.

Biological evaluation of alginate-based hydrogels, with antimicrobial features by Ce(III) incorporation, as vehicles for a bone substitute

A novel hydrogel, based on an alginate/hyaluronate mixture and Ce(III) ions, with effective bioactive and antimicrobial ability was developed to be used as vehicle of a synthetic bone substitute producing an injectable substitute (IBS). Firstly, three different IBSs were prepared using three developed alginate-based hydrogels, the hydrogel Alg composed by alginate, the hydrogel Alg/Ch composed by an alginate/chitosan mixture and the hydrogel Alg/HA composed by an alginate/hyaluronate mixture. MG63 cells viability on the IBSs was evaluated, being observed a significantly higher cell viability on the Alg/HA_IBS at all time points, which indicates a better cell adaptation to the material, increasing their predisposition to produce extracellular matrix and thus allowing a better bone regeneration. Moreover, SEM analysis showed evident filopodia and a spreader shape of MG63 cells when seeded on Alg/HA_IBS. This way, based upon the in vitro results, the hydrogel Alg/HA was chosen to the in vivo study by subcutaneous implantation in an animal model, promoting a slight irritating tissue response and visible tissue repairing. The next step was to grant antimicrobial properties to the hydrogel that showed the best biological behavior by incorporation of Ce(III) ions into the Alg/HA, producing the hydrogel Alg/HA2. The antimicrobial activity of these hyaluronate-based hydrogels was evaluated against Staphylococcus aureus, Staphylococcus epidermidis, Pseudomonas aeruginosa and Candida albicans. Results showed that Ce(III) ions can significantly enhance the hydrogel antimicrobial ability without compromising the osteoconductivity improvement promoted by the vehicle association to the synthetic bone substitute.

Characterization and preliminary in vivo evaluation of a novel modified hydroxyapatite produced by extrusion and spheronization techniques

A glass-reinforced hydroxyapatite (HA) composite, recently registered as Bonelike®, was developed for bone grafting. This biomaterial is composed of a modified HA matrix with α- and β-tricalcium phosphate secondary phases and ionic species that mimic the chemical composition of human bone. Several in vitro and in vivo studies have confirmed the benefits of these properties. However, these studies were all executed with Bonelike® polygonal granules obtained by crushing. In this study, Bonelike® pellets were produced through a patented process, which required the use of techniques such as extrusion and spheronization. The final product presented a homogeneous size, a 55.1% global porosity and a spherical shape. This spherical shape permitted a better adaptation to the implantation site and improved injectability. Additionally, it also may contribute to formation of macropores as pellets packaging leaves open spaces. After implantation of Bonelike® polygonal granules and Bonelike® pellets in monocortical defects in sheep for 8 and 12 weeks, light microscopy and scanning electron microscopy showed extensive osteointegration simultaneously with bone regeneration for both presentations. Histomorphometric analysis did not reveal statistically significant differences between defects treated with Bonelike® polygonal granules and Bonelike® pellets, which suggests similar in vivo performances.

A glass-reinforced hydroxyapatite and surgical-grade calcium sulfate for bone regeneration: In vivo biological behavior in a sheep model

A glass-reinforced hydroxyapatite (HA) composite (Bonelike®) was developed for bone grafting. This biomaterial is composed of a modified HA matrix with α- and β-tricalcium phosphate secondary phases, resulting in higher solubility than single HA type of materials. Several in vitro and in vivo studies demonstrated that Bonelike® has a highly bioactive behavior, which was also confirmed by employing granular forms of this biomaterial in orthopedics and dental applications. However, a fast consolidation vehicle was needed to promote the fixation of Bonelike® granules if applied in larger defects or in unstable sites. Surgical-grade calcium sulfate (CS), which is widely recognized as a well-tolerated and inexpensive bone graft material, was the chosen vehicle to improve the handling characteristics of Bonelike® as it can be used in the form of a powder that is mixed with a liquid to form a paste that sets in situ. After application in non-critical monocortical defects in sheep, histological, and scanning electron microscopy evaluations demonstrated that Bonelike® associated to CS functioned as a very satisfactory scaffold for bone regeneration as it achieved synchronization of the ingrowing bone with biomaterial resorption and subsequent preservation of the bone graft initial volume. Therefore, our results indicate that CS is an effective vehicle for Bonelike® granules as it facilitates their application and does not interfere with their proven highly osteoconductive properties. In the opposite way, the incorporation of Bonelike® improves the bone regeneration capabilities of CS.

Application of Glass Reinforced Hydroxyapatite Composite in the Treatment of Human Intrabony Periodontal Angular Defects – Two Case Reports

Bony defects caused by periodontitis are often treated by regenerative therapy using autografts and/or allografts. Alloplasts such as hydroxyapatite or ceramics and bioactive glasses are used as osteoconductive materials that serve as scaffold for new bony ingrowth. The purpose of this study was to ascertain the possible regenerative capability of glass reinforced hydroxyapatite (Bonelike¬)¬¬¬ an osteoconductive synthetic graft in the treatment of human periodontal intrabony angular defects. The material was placed in 2 defects in 2 individual patients and clinical parameters such as probing depth (PD) and clinical attachment level (CAL) have been included. Bone fill was determined using an intra oral periapical radiograph (IOPA) and Autocad Software. After 3 months implantation period, there was an improvement in CAL and reduction in PD along with bone fill was observed.

Growth and phenotypic expression of human endothelial cells cultured on a glass-reinforced hydroxyapatite

Glass-reinforced hydroxyapatite composites (GR-HA) are bone regenerative materials that are characterized by their increased mechanical properties, when compared to synthetic hydroxyapatite. Bonelike is a GR-HA that is a result of the addition of a CaO-P(2)O(5) based glass to a HA matrix. This biomaterial has been successfully applied in clinical bone regenerative applications. This work aims to evaluate the ability of Bonelike to support the adhesion, proliferation and phenotypic expression of human endothelial cells, aiming to establish new bone tissue engineering pre-endothelialization strategies. Bonelike discs, regardless of being submitted to a pre-immersion treatment with culture medium, were seeded with first passage human umbilical vein endothelial cells, and characterized regarding proliferation and differentiation events. Pre-immersed Bonelike allowed the adhesion, proliferation and phenotype expression of endothelial cells. Seeded materials presented positive immunofluorescent staining for PECAM-1 and a tendency for the formation of cord-like arrangements under angiogenesis-stimulating conditions, although, compared to standard culture plates, a slight decreased cell growth was observed. In this way, Bonelike may be a suitable candidate for pre-endothelialization approaches in bone tissue engineering applications.

Cell-induced response by tetracyclines on human bone marrow colonized hydroxyapatite and Bonelike

Semi-synthetic tetracyclines are commonly used antibiotics that also seem to play an important role in the modulation of the immuno-inflammatory imbalance, verified in several bone diseases. The association of a therapeutic agent (that prevents bacterial infection and induces tissue formation) to a biomaterial aiming to repair/regenerate bone defects could contribute to a more predictable clinical outcome. The present study intends to evaluate the proliferation and functional activity of osteoblast-induced human bone marrow cells, cultured on the surface of hydroxyapatite (HA) and Bonelike, in the presence of therapeutic concentrations of doxycycline and minocycline. First passage bone marrow cells were cultured for 35 days on the surface of HA and Bonelike discs, in the absence or presence of 1 microg ml(-1) doxycycline and minocycline. Cultures performed in standard tissue culture plates were used as control. Doxycycline or minocycline induced cell proliferation and increased the extent of matrix mineralization in osteoblastic cell cultures established in the three substrates. Also, an improved biological behavior was verified in seeded Bonelike compared with HA. The results suggest that the local delivery of tetracyclines might associate the antimicrobial activity in implant-related bone infection with an eventual induction of osteoblastic proliferation and maintenance of the characteristic biological activity of these cells.

Bone ingrowth in macroporous Bonelike for orthopaedic applications

The aim of this study was to evaluate the biological behaviour of porous scaffold structures of Bonelike which is suitable for either direct clinical use or tissue engineering applications. Porous cylindrical specimens 8x10mm were implanted in the lateral aspect of the tibia of 13 patients (mean age 54 years), during osteotomy surgery for the treatment of medial compartment osteoarthritis of the knee. Implanted cylinders were retrieved at the same time as the removal of the blade plates at 3, 6, 9 and 12 months. Scanning electron microscopy and histological evaluations were performed to observe the biological responses of human bone tissue to porous Bonelike. The penetration depth was determined for all implantation periods, and after 6 months it was already possible to see new bone in the centre of the implanted cylinders, which gives 100% of penetration depth for all implantations periods except for 3 months when bone could only be seen in the peripherical region. Regarding the percentage of the area covered by new bone calculated from two-dimensional histological sections, values of 53+/-15, 76+/-12 and 88+/-9% were achieved for 6, 9 and 12 months, respectively. Due to its structural features porous Bonelike permitted effective vascularization and bone ingrowth, and therefore was fully osteointegrated as shown in the histological surveys. A slow biomaterial degradation with implantation time is envisaged since the material has displayed surface degradation. Bonelike scaffolds show potential for complete ingrowth of osseous tissue and restoration of vascularization throughout the defected site.

Histological and scanning electron microscopy analyses of bone/implant interface using the novel Bonelike synthetic bone graft

Synthetic bone grafts provide an alternative to autografts and allografts. Bonelike is a patented synthetic bone graft that mimics the mineral composition of bone. The aim of the present work was to assess the biological behavior of Bonelike graft in humans, before using the material in orthopedic applications of bone regeneration, for example, in opening wedge high tibial osteotomies for medial knee osteoarthritis. Bonelike granules were implanted in cortical bone of 11 patients undergoing osteotomies, and new bone formation, osteoconductive properties, and resorption characteristics of the granules were analyzed. The granules ranged from 500 to 1000 microm and were implanted in the lateral aspect of the tibia. The patients' mean age was 59 years (range 48 to 70 years); there were eight women and three men, all suffering from medial compartment osteoarthritis of the knee. At surgery, a 1 x 1 x 1-cm cortical defect was created 3 cm distal to the entry point of the screws, in line with the long axis of tibia. The implanted Bonelike graft sample was extracted for analysis during removal of the metallic prosthesis after implantation times of 6, 9, and 12 months. Radiological follow-up, scanning electron microscopy, histological analysis, and histomorphometric measurements were conducted on the retrieved samples to assess bone regeneration in the defect area. Osteoconductive capacity was demonstrated by extensive mature bone formation around the implanted granules and high levels of percentage bone-to-graft contact (from 67-84%). Bonelike acted as an excellent bioactive scaffold, allowing the migration, proliferation, and differentiation of bone cells on its surface, and therefore regeneration of the defects was achieved in a rapid, controlled manner. Our results suggest that Bonelike graft is an excellent candidate for orthopedic applications where rapid new bone formation is a fundamental requirement.

Effect of particulate bioactive glasses on human macrophages and monocytesin vitro

Bioactive glasses, originally developed to promote tissue adhesion, are finding an increasing array of biomedical applications. The aim of the current study was to assess the ability of silicate- and zinc phosphate-based bioactive glasses to modulate the secretion of cytokines from activated human macrophages and monocytes. Human macrophages and monocytes were isolated and cultured on surfaces coated with a range of quantities of the bioactive glasses. Nontoxic concentrations of the glasses were selected and assessed further for their ability to modulate the secretion of tumor necrosis factor (TNF)-alpha, interleukin (IL)-10 and -6, in the presence or absence of the stimulant lipopolysaccharide. 45S5 glass produced a significant reduction to the amount of TNF-alpha (p<0.05) and IL-6 (p<0.01) secreted by stimulated cells compared with cells stimulated in the absence of bioactive glass. A significant reduction in IL-6 secretion was also observed with the other silicate- and zinc phosphate-based glasses tested. IL-10 secretion was increased (but not significantly) in presence of all glasses tested. TNF-alpha and IL-6 secretion from stimulated cells was lower in presence of the silicate glasses compared with the zinc phosphate glasses, indicating that this system of bioactive glass might be of clinical use in conditions associated with inflammation.

Bonelike/PLGA hybrid materials for bone regeneration: preparation route and physicochemical characterisation

Bonelike/PLGA hybrid materials have been developed using gamma-MPS as silane-coupling agent between the inorganic and organic phases for controlled drug delivery applications. Silanization showed to be more effective when cyclohexane was used as a non-polar solvent (nP method) due to a chemical interaction between Bonelike, and the silane film, while by using a 95/5 (V/V) methanol/water as a polar solvent (P method), a much thinner film was achieved. Functional groups of PLGA, such as the carbonyl group (C=O), were identified using Raman and FTIR-ATR analysis and therefore these groups may be used to link therapeutic molecules. These novel hybrid materials prepared by combining silanization and post-hybridisation processes are expected to find use in medical applications of bone regeneration and as drug delivery carrier for therapeutic molecules.

Mechanical performance and osteoblast-like cell responses of fluorine-substituted hydroxyapatite and zirconia dense composite

A fluorine-substituted hydroxyapatite (FHA) and zirconia (ZrO(2)) dense composite (50:50 by volume) was fabricated, and its feasibility for hard tissue applications was investigated in terms of its mechanical properties and osteoblast-like cell (MG63) responses in vitro. The incorporation of fluorine into the hydroxyapatite (HA) structure was highly effective in producing a completely dense apatite-ZrO(2) composite through a pressureless sintering route, by preventing the thermal degradation of the apatite and ZrO(2). The resultant FHA-ZrO(2) dense composite had excellent mechanical properties, such as flexural strength (310 MPa), fracture toughness (3.4 MPam(1/2)), hardness (10 GPa), and elastic modulus (160 GPa). The flexural strength and fracture toughness of the composite showed a noticeable improvement by a factor of approximately 4 with respect to the pure apatites (HA and FHA). The MG63 cellular responses to the composite were assessed in terms of the cell proliferation (cell number and [(3)H]-thymidine incorporation) and differentiation (alkaline phosphatase activity, osteocalcin, and collagen production). The cells on the FHA-ZrO(2) composite spread and grew well, and proliferated actively during the culture period. The expression of alkaline phosphatase, osteocalcin, and collagen by the cells on the composite showed a similar trend to that on the pure apatites, although slight down-regulations were observed, implying that the FHA-ZrO(2) 50:50 composite retains the osteoblastic functionality and traits of the pure HA ceramics to a high degree. This finding, in conjunction with the considerable improvements in mechanical properties, supports the extended use of this composite for hard tissue applications.

Si(3)N(4)-bioglass composites stimulate the proliferation of MG63 osteoblast-like cells and support the osteogenic differentiation of human bone marrow cells

The in vitro osteocompatibility of a novel Si(3)N(4)-bioglass composite (70-30% weight proportion) with improved mechanical properties (fracture toughness = 4.4 M Pa m(1/2); bending strength = 383 +/- 47 MPa) is reported. Immersion of the composite samples in culture medium (30 min to 7 days) resulted in rapid protein adsorption to the surface and, also, dissolution of the intergranular phase of bioglass (time-dependent process) with the formation of different size cavities. "As-received" and pre-treated material samples presented a similar behaviour concerning the proliferation of MG63 osteoblast-like cells, evaluated during a 5-day culture period. Seeded materials showed a higher cell growth rate as compared to cultures performed on the standard plastic culture plates. To assess the osteogenic potential of the composite, "as-received" material samples were seeded with human bone marrow cells and cultured for 35 days in experimental conditions that favour the development of the osteoblastic phenotype. The cell adhesion process was similar to that observed in control cultures. Cells successfully adapted to the irregularities of the surface and were able to grow towards inside the cavities; in addition, osteogenic differentiation occurred with the formation of abundant cell-mediated mineralised deposits. Results suggest that this Si(3)N(4)-bioglass composite seems to be a promising candidate for high-stress medical applications.

Novel approach to fabricate porous gelatin-siloxane hybrids for bone tissue engineering

Porous and bioactive gelatin-siloxane hybrids were successfully synthesized by using a combined sol-gel processing, post-gelation soaking, and freeze-drying process to provide a novel kind of materials in the developments and optimization of bone tissue engineering. The pore sizes of the hybrids can be well controlled by varying the freezing temperature. The scaffolds were soaked in a simulated body fluid (SBF) up to 14 days to evaluate the in vitro bioactivity. The Ca(2+)-containing scaffolds showed in vitro bioactivity as they biomimetically deposited apatite, but the Ca(2+)-free scaffolds failed. Cytotoxicity and cytocompatibility of those scaffolds and their extracts were monitored by the MC3T3-E1 cell responses, including the cell proliferation and the alkaline phosphatase activity. It was demonstrated that appropriate incorporation of Ca(2+) ions stimulated osteoblast proliferation and differentiation in vitro.