Titanium metals form direct bonding to bone after alkali and heat treatments

The recent progress of bone regeneration materials containing EGCG

Epigallocatechin-3-gallate (EGCG) is the most effective active ingredient in tea polyphenols and belongs to the category of catechins. EGCG has excellent antioxidant activity, anti-inflammatory, osteogenesis-promoting, and antibacterial properties, and has been widely studied in orthopedic diseases such as osteoporosis. To reach the lesion site, achieve sustained release, promote osteogenesis, regulate macrophage polarization, and improve the physical properties of materials, EGCG needs to be cross-linked or incorporated in bone regeneration materials. This article reviews the application of bone regeneration materials combined with EGCG, including natural polymer bone regeneration materials, synthetic polymer bone regeneration materials, bioceramic bone regeneration materials, metal bone regeneration materials, hydrogel bone regeneration materials and metal-EGCG networks. In addition, the fabrication methods for the regenerated scaffolds are also elaborated in the text. To sum up, it reveals the excellent development potential of materials containing EGCG and the shortcomings of current research, which will provide important reference for the future exploration of bone regeneration materials containing EGCG.

Macrophage-to-osteocyte communication: Impact in a 3D in vitro implant-associated infection model

Macrophages and osteocytes are important regulators of inflammation, osteogenesis and osteoclastogenesis. However, their interactions under adverse conditions, such as biomaterial-associated infection (BAI) are not fully understood. We aimed to elucidate how factors released from macrophages modulate osteocyte responses in an in vitro indirect 3D co-culture model. Human monocyte-derived macrophages were cultured on etched titanium disks and activated with either IL-4 cytokine (anti-inflammatory M2 phenotype) or Staphylococcus aureus secreted virulence factors to simulate BAI (pro-inflammatory M1 phenotype). Primary osteocytes in collagen gels were then stimulated with conditioned media (CM) from these macrophages. The osteocyte response was analyzed by gene expression, protein secretion, and immunostaining. M1 phenotype macrophages were confirmed by IL-1β and TNF-α secretion, and M2 macrophages by ARG-1 and MRC-1.Osteocytes receiving M1 CM revealed bone inhibitory effects, denoted by reduced secretion of bone formation osteocalcin (BGLAP) and increased secretion of the bone inhibitory sclerostin (SOST). These osteocytes also downregulated the pro-mineralization gene PHEX and upregulated the anti-mineralization gene MEPE. Additionally, exhibited pro-osteoclastic potential by upregulating pro-osteoclastic gene RANKL expression. Nonetheless, M1-stimulated osteocytes expressed a higher level of the potent pro-osteogenic factor BMP-2 in parallel with the downregulation of the bone inhibitor genes DKK1 and SOST, suggesting a compensatory feedback mechanisms. Conversely, M2-stimulated osteocytes mainly upregulated anti-osteoclastic gene OPG expression, suggesting an anti-catabolic effect. Altogether, our findings demonstrate a strong communication between M1 macrophages and osteocytes under M1 (BAI)-simulated conditions, suggesting that the BAI adverse effects on osteoblastic and osteoclastic processes in vitro are partly mediated via this communication. STATEMENT OF SIGNIFICANCE: Biomaterial-associated infections are major challenges and the underlying mechanisms in the cellular interactions are missing, especially among the major cells from the inflammatory side (macrophages as the key cell in bacterial clearance) and the regenerative side (osteocyte as main regulator of bone). We evaluated the effect of macrophage polarization driven by the stimulation with bacterial virulence factors on the osteocyte function using an indirect co-culture model, hence mimicking the scenario of a biomaterial-associated infection. The results suggest that at least part of the adverse effects of biomaterial associated infection on osteoblastic and osteoclastic processes in vitro are mediated via macrophage-to-osteocyte communication.

DMP1 and IFITM5 Regulate Osteogenic Differentiation of MC3T3-E1 on PEO-Treated Ti-6Al-4V-Ca2+/Pi surface

Despite numerous studies on various surface modifications on titanium and its alloys, it remains unclear what kind of titanium-based surface modifications are capable of controlling cell activity. This study aimed to understand the mechanism at the cellular and molecular levels and investigate the in vitro response of osteoblastic MC3T3-E1 cultured on the Ti-6Al-4V surface modified by plasma electrolytic oxidation (PEO) treatment. A Ti-6Al-4V surface was prepared by PEO at 180, 280, and 380 V for 3 or 10 min in an electrolyte containing Ca²⁺/P_i ions. Our results showed that PEO-treated Ti-6Al-4V-Ca²⁺/P_i surfaces enhanced the cell attachment and differentiation of MC3T3-E1 compared to the untreated Ti-6Al-4V control but did not affect cytotoxicity as shown by cell proliferation and cell death. Interestingly, on the Ti-6Al-4V-Ca²⁺/P_i surface treated by PEO at 280 V for 3 or 10 min, MC3T3-E1 showed a higher initial adhesion and mineralization. In addition, the alkaline phosphatase (ALP) activity significantly increased in MC3T3-E1 on the PEO-treated Ti-6Al-4V-Ca²⁺/P_i (280 V for 3 or 10 min). In RNA-seq analysis, the expression of dentin matrix protein 1 (DMP1), sortilin 1 (Sort1), signal-induced proliferation-associated 1 like 2 (SIPA1L2), and interferon-induced transmembrane protein 5 (IFITM5) was induced during the osteogenic differentiation of MC3T3-E1 on the PEO-treated Ti-6Al-4V-Ca²⁺/P_i. DMP1 and IFITM5 silencing decreased the expression of bone differentiation-related mRNAs and proteins and ALP activity in MC3T3-E1. These results suggest that the PEO-treated Ti-6Al-4V-Ca²⁺/P_i surface induces osteoblast differentiation by regulating the expression of DMP1 and IFITM5. Therefore, surface microstructure modification through PEO coatings with Ca²⁺/P_i ions could be used as a valuable method to improve biocompatibility properties of titanium alloys.

Micro/Nanostructured Topography on Titanium Orchestrates Dendritic Cell Adhesion and Activation via β2 Integrin-FAK Signals

Background and Purpose

In clinical application of dental implants, the functional state of dendritic cells (DCs) has been suggested to have a close relationship with the implant survival rate or speed of osseointegration. Although microscale surfaces have a stable osteogenesis property, they also incline to trigger unfavorable DCs activation and threaten the osseointegration process. Nanoscale structures have an advantage in regulating cell immune response through orchestrating cell adhesion, indicating the potential of hierarchical micro/nanostructured surface in regulation of DCs’ activation without sacrificing the advantage of microscale topography.

Materials and Methods

Two micro/nanostructures were fabricated based on microscale rough surfaces through anodization or alkali treatment, the sand-blasted and acid-etched (SA) surface served as control. The surface characteristics, in vitro and in vivo DC immune reactions and β2 integrin-FAK signal expression were systematically investigated. The DC responses to different surface topographies after FAK inhibition were also tested.

Results

Both micro/nano-modified surfaces exhibited unique composite structures, with higher hydrophilicity and lower roughness compared to the SA surface. The DCs showed relatively immature functional states with round morphologies and significantly downregulated β2 integrin-FAK levels on micro/nanostructures. Implant surfaces with micro/nano-topographies also triggered lower levels of DC inflammatory responses than SA surfaces in vivo. The inhibited FAK activation effectively reduced the differences in topography-caused DC activation and narrowed the differences in DC activation among the three groups.

Conclusion

Compared to the SA surface with solely micro-scale topography, titanium surfaces with hybrid micro/nano-topographies reduced DC inflammatory response by influencing their adhesion states. This regulatory effect was accompanied by the modulation of β2 integrin-FAK signal expression. The β2 integrin-FAK-mediated adhesion plays a critical role in topography-induced DC activation, which represents a potential target for material–cell interaction regulation.

Velvet antler polypeptide combined with calcium phosphate coating to protect peripheral nerve cells from oxidative stress

Functionalizing biomaterial substrates with biological signals shows promise in regulating cell behaviors through mimicking cellular microenvironment. Calcium phosphate (CaP) coating is an excellent carrier for immobilizing biological molecules due to its non-toxicity, good biocompatibility, biodegradability, and favorable affinity to plenty of molecules. In this study, we reported the adhesion, the viability and proliferation behaviors after oxidative stress injury of Schwann cells RSC96 on CaP immobilized with the Velvet Antler Peptide (VAP) isolated from velvet antler through coprecipitation process in modified Dulbecco's phosphate-buffered saline (DPBS) containing VAP. This approach provided well retention of functional molecules up to 28 days, and supported the adhesion and proliferation of RSC96 after oxidative stress injury without cytotoxicity. The simple and reproducible method of coprecipitation suggests that CaP is an ideal carrier to functionalize materials with biological molecules for peripheral nerve repair-related applications.

High Subsidence Rate After Primary Total Hip Arthroplasty Using a Zweymüller-type Noncemented Implant With a Matte Surface

Introduction:

The surface topography is one key factor that affects the initial fixation of prosthesis in total hip arthroplasty (THA). We aimed to evaluate the mid-term results of a Zweymüller-type noncemented femoral implant (Elance stem) that had a matte surface with a target average roughness of 1.0 to 2.5 μm. The prosthesis was subjected to alkali and heat treatments to enhance its bone-bonding property.

Methods:

In this retrospective study, 30 THAs (27 patients) done using an Elance stem from September 2012 to October 2014 were evaluated clinically and radiographically for a mean follow-up of 6.3 ± 1.7 years after the index THA.

Results:

Stem revision was indicated for six hips (20%). The survival rate with stem revision for any reason was 86.4% (95% confidence interval, 68.9%-94.8%) at 5 years. Stem subsidence >5 mm was noted in 17 hips (56.7%). The survival rate with stem subsidence >5 mm as the end point was 46.6% (95% confidence interval, 29.9%-64.2%) at 5 years.

Conclusion:

The Zweymüller-type noncemented stem with a low-roughness matte surface demonstrated a high subsidence rate, although the bone-bonding property was potentially enhanced by the alkali and heat treatments. Surgeons should be aware that an insufficient surface roughness could lead to poor mechanical fixation of the noncemented stem, even with an appropriate stem geometry and surface chemistry.

Selenomethionine-Modified Polyethylenimine-Based Nanoparticles Loaded with miR-132-3p Inhibitor-Biofunctionalized Titanium Implants for Improved Osteointegration

Titanium and its alloys have been widely used as bone implants, but for reduced treatment span, improvements are urgently needed to achieve faster and better osteointegration. In this study, we found that miR-132-3p inhibited bone-marrow-derived stem cell (BMSC) osteogenic differentiation via targeting BMP2, and that inhibiting miR-132-3p could significantly improve the osteogenic capability of BMSCs. Moreover, we fabricated a biocompatible selenomethionine (SEMET)-modified polyethylene glycol (PEG)/polyethylenimine (PEI) nanoparticle (SeNP) cross-linked with 0.2% gelatin solutions and delivered miR-132-3p inhibitor to biofunctionalize alkali heat-treated titanium implants, resulting in the development of a novel coating for reverse transfection. The biological performances of PEG/PEI/miR-132-3p inhibitor and SeNP/miR-132-3p inhibitor-biofunctionalized titanium were compared. The biological effects, including cell viability, cytotoxicity, adhesion, cellular uptake, and osteogenic capacity of SeNP/miR-132-3p inhibitor-biofunctionalized titanium implants, were then assessed. Results showed that SeNPs presented appropriate morphology, diameter, and positive zeta potential for efficient gene delivery. The transfection efficiency of the SeNP/miR-132-3p inhibitor was comparable to that of the PEG/PEI/miR-132-3p inhibitor, but the former induced less reactive oxygen species (ROS) production and lower apoptosis rates. Confocal laser scanning microscopy (CLSM) demonstrated that SeNP/miR-132-3p inhibitor nanoparticles released from the titanium surfaces and were taken up by adherent BMSCs. In addition, the release profile showed that transfection could obtain a long-lasting silencing effect for more than 2 weeks. The cell viability, cytotoxicity, and cell spreading of SeNP/miRNA-132-3p inhibitor-biofunctionalized titanium were comparable with those of untreated titanium and the SeNP/miRNA-132-3p inhibitor negative control (NC)-biofunctionalized titanium but resulted in higher ALP activity and osteogenic gene expression levels. In vivo animal studies further certified that SeNP/miRNA-132-3p inhibitor nanoparticles from titanium surfaces promoted osteointegration, which was revealed by microcomputed tomography (micro-CT) and histological observations. Taken together, these findings suggested that selenomethionine-modified PEI-based nanoparticles could achieve better biocompatibility. Moreover, titanium implants biofunctionalized by SeNP/miRNA-132-3p inhibitor nanoparticles might have significant clinical potential for more effective osteointegration.

Different Cell and Tissue Behavior of Micro-/Nano-Tubes and Micro-/Nano-Nets Topographies on Selective Laser Melting Titanium to Enhance Osseointegration

Background and Purpose

Micro-/nano-tubes (TNTs) and micro-/nano-nets (TNNs) are the common and sensible choice in the first step of combined modifications of titanium surface for further functionalization in the purpose of extended indications and therapeutic effect. It is important to recognize the respective biologic reactions of these two substrates for guiding a biologically based first-step selection.

Materials and Methods

TNTs were produced by anodic oxidation and TNNs were formed by alkali-heat treatment. The original selective laser melting (SLM) titanium surface was set as control. Surface characterization was evaluated by scanning electron microscopy, surface roughness, and water contact angle measurements. Osteoclastogenesis and osteogenesis were measured. MC3T3-E1 cells and RAW 264.7 cells were used for in vitro assay in terms of adhesion, proliferation, and differentiation. In vivo assessments were taken on Beagle dogs with micro-CT and histological analysis.

Results

TNN and TNT groups performed decreased roughness and increased hydrophilicity compared with SLM group. For biological detections, the highest ALP activity and osteogenesis-related genes expression were observed in TNT group followed by TNN group (P <0.05). Interestingly, when it comes to the osteoclastogenesis, TNNs displayed lowest TRAP activity and osteoclastogenesis-related genes expression and TNTs were lower than SLM but higher than TNNs (P <0.05). BV/TV around implants was highest in TNT group after 4 weeks (P <0.05). HE, ALP and TRAP staining showed that osteogenic and osteoclastic activity around TNTs were both higher than TNNs (P <0.05).

Conclusion

TNNs and TNTs have dual advantages in promotion of osteogenesis and inhibition of osteoclastogenesis. Furthermore, TNNs showed better capability in inhibiting osteoclast activity while TNTs facilitated stronger osteogenesis. Our results implied that TNT substrates would take advantage in early application after implantation, while diseases with inappropriate osteoclast activity would prefer TNN substrates, which will guide a biologically based first-step selection on combined modification for different clinical purposes.

Osteoconductivity of bioactive Ti-6Al-4V implants with lattice-shaped interconnected large pores fabricated by electron beam melting

Additive manufacturing has facilitated the fabrication of orthopedic metal implants with interconnected pores. Recent reports have indicated that a pore size of 600 μm is beneficial for material-induced osteogenesis. However, the complete removal of the metal powder from such small pores of implants is extremely difficult especially in electron beam melting (EBM). We therefore developed a new type of Ti-6Al-4V implant with lattice-shaped interconnected pores measuring 880-1400 μm, which allowed for the easy removal of metal powder. This implant was fabricated by EBM and treated with NaOH, CaCl₂, heat, and water (ACaHW treatment) to render the metal surface bioactivity. In the present study, the mechanical and chemical property of the implants and the biocompatibility were evaluated. The SEM and micro-CT images demonstrated the 3D interconnectivity of the porous structures. The average porosity of the porous titanium implant was 57.5%. The implant showed maximum compressive load of 78.9 MPa and Young's modulus of 3.57 GPa which matches that of human cortical bone. ACaHW treatment of the porous Ti-6Al-4V implants induced apatite formation in simulated body fluid in vitro. The ACaHW-treated porous implants harvested from rabbit femoral bone showed direct bonding of bone to the metal surface without interposition of fibrous tissue. The porous ACaHW-treated implant had a higher affinity to the bone than the untreated one. The mechanical strength of implant fixation assessed using the push-out test was significantly higher in the ACaHW-treated implant than in untreated one. FE-SEM analysis and EDX mapping after push-out test of solid implants showed a lot of bone tissue patches on the surface of the ACaHW-treated implant. These results suggest that the new ACaHW-treated Ti-6Al-4V implant with lattice-shaped interconnected pores is a superior alternative to conventional materials for medical application.

Ca-Ag coexisting nano-structured titania layer on Ti metal surface with enhanced bioactivity, antibacterial and cell compatibility

A nano-structured titanate layer encapsulated with Ca²⁺ and Ag⁺ ions was successfully grown over commercially pure (CP) Ti metal by chemical treatment with H₂O₂ and subsequent treatment with Ca (NO₃)₂/AgNO₃ solutions. Heat treatment at 600 °C, further transformed this nano-structured titanate layer into titania containing Ca²⁺ and Ag⁺ ions. Thus modified Ti metal showed significant enhancement in apatite-forming ability when soaked in simulated body fluid (SBF). Presence of Ag⁺ ions showed good antimicrobial activity against pathogenic Staphylococcus aureus, and, Ca²⁺ ions being a major component of bone mineral accelerated the apatite-forming ability over Ti metal in SBF. Further, Ca²⁺and Ag⁺ ions proportion over Ti metal surface could be optimised in order to have minimum Ag concentration that can have not only antibacterial activity and also cell compatibility against MG 63 osteoblast-like cells. Therefore, the proposed surface modification approach presented here is expected to be useful in orthopaedic implants that necessitate enhanced bioactivity, antibacterial activity and cell compatibility.

Role of protein adsorption in the bio corrosion of metallic implants - A review

Implants are exposed to a complex physiological environment that contains various organic compounds, especially proteins. The adsorption of proteins has an immense influence on the corrosion, biocompatibility and wear properties of implantable metals. Proteins engage in multiple processes that could potentially inhibit or promote metal degradation, depending on the type of proteins, their concentration and the properties of the implant material. In the bio corrosion process, proteins are denatured and transform into a film on the metal surface, inhibiting corrosion. This film is found on many retrieved artificial joints, especially on worn areas, and can protect the passive film from scrapping due to its lubricating effect, thus decreasing tribocorroion. On the other hand, the interactions of metal ions with proteins (and amino acids) create colloidal organometallic complexes. Transport of the complex compounds away from the interface increases dissolution rates; thus, it accelerates the corrosion of metallic implants. The influence of protein adsorption on the corrosion behaviour of metallic biomaterials is presented in this review. Biocompatible metals that are favourably used as implants such as stainless steel, Co-Cr alloys, Ti alloys and biodegradable Mg and Fe alloys are specifically addressed. We have highlighted the adsorption phenomenon of protein on metallic implants, the interaction of proteins with metallic implants and the role of protein adsorption on implant biocorrosion behaviour as well as their wear resistance.

Multifunctional Coatings and Nanotopographies: Toward Cell Instructive and Antibacterial Implants

In biomaterials science, it is nowadays well accepted that improving the biointegration of dental and orthopedic implants with surrounding tissues is a major goal. However, implant surfaces that support osteointegration may also favor colonization of bacterial cells. Infection of biomaterials and subsequent biofilm formation can have devastating effects and reduce patient quality of life, representing an emerging concern in healthcare. Conversely, efforts toward inhibiting bacterial colonization may impair biomaterial-tissue integration. Therefore, to improve the long-term success of medical implants, biomaterial surfaces should ideally discourage the attachment of bacteria without affecting eukaryotic cell functions. However, most current strategies seldom investigate a combined goal. This work reviews recent strategies of surface modification to simultaneously address implant biointegration while mitigating bacterial infections. To this end, two emerging solutions are considered, multifunctional chemical coatings and nanotopographical features.

Role of calcium ions in defining the bioactivity of surface modified Ti metal

Nano-structured hydrogen titanate and sodium hydrogen titanate layers were formed when Ti metal was treated with H₂O₂ and NaOH solutions, respectively. The chemically treated Ti metals upon subsequent treatment with Ca(NO₃)₂ and CaCl₂ solutions, resulted in incorporation of Ca²⁺ ions into the nano-structured titanate layer. Thus formed nano-structured titanate layers containing Ca²⁺ ions when subjected to heat treatment, forms anatase and calcium titanate-rutile phases, respectively. In vitro apatite-forming ability in simulated body fluid (SBF) was positive for H₂O₂-Ca and heat-treated Ti metal in contrast to NaOH-Ca and heat treatment. Formation of anatase phase together with Ca²⁺ ion release into SBF was found to be the key driving force for such a high bioactivity of Ca²⁺ containing H₂O₂ treated Ti metal on contrary to NaOH and heat treatment. This study provides a new insight into the factors accelerating the bioactivity of Ti metals during various chemical and thermal treatments, which further aid and abet to design dental and orthopaedic implants with high bone-bonding ability.

Alkaline phosphatase levels of murine pre-osteoblastic cells on anodized and annealed titanium surfaces

Purpose

This study aimed to evaluate the initial adhesion morphology and alkaline phosphatase (ALP) activity of murine pre-osteoblastic MC3T3-E1 cells cultured on anatase/rutile mixed-phase TiO₂ thin films with photocatalytical activity with previously confirmed antibacterial properties.

Materials and methods

Anatase/rutile mixed-phase TiO₂ thin films fabricated by anodization and annealing of cpTi were used to culture MC3T3-E1 cells to evaluate the initial cellular adhesion morphology and ALP activity in vitro.

Results

Compared with MC3T3-E1 cells cultured on cpTi substrates and the control group, cells cultured on anatase/rutile mixed-phase TiO₂ thin films exhibited similar ALP levels after cell culture day 9.

Conclusion

Anodizing and annealing processes fabricate multifunctional surfaces on cpTi with improved osteogenic properties for implants.

Titanium Surfaces Functionalized with siMIR31HG Promote Osteogenic Differentiation of Bone Marrow Mesenchymal Stem Cells

Titanium (Ti) implants are widely used in the clinic as bone substitutes and dental implants, but further improvements are needed to obtain high osteogenic ability and consequent osseointegration. Knockdown of long noncoding RNA MIR31HG promotes osteogenic differentiation and bone formation. In this study, we fabricated a Ti surface functionalized with siRNA targeting MIR31HG (siMIR31HG) and accelerated osteogenesis of bone marrow mesenchymal stem cells (BMSCs). Chitosan/siRNA complex was loaded onto the thermal alkali-treated Ti surface to fabricate the siMIR31HG-functionalized Ti surface. The surface morphology, siRNA loading and release efficiency, and transfection efficacy were investigated, and the biological effects, such as cell proliferation, cell morphology, and osteogenic activity, were determined. The results showed that the siMIR31HG-functionalized Ti implant generated an ∼50% knockdown of MIR31HG, with no apparent cytotoxicity, which consequently enhanced osteogenic differentiation of BMSCs, as indicated by the increase of ALP production, extracellular matrix mineralization, osteogenic gene expression, and ectopic bone formation in vivo. The siMIR31HG biofunctionalization can be used to obtain better osseointegration of Ti implant in the clinic.

A comparative study of simulated body fluids in the presence of proteins

Simulated body fluid (SBF) is widely used as part of an in vitro method to evaluate implant materials such as their apatite forming ability (AFA), a typical indication of potential bone-bonding ability in vivo. We report the use of carbonate-buffered SBFs as potential solutions for implant evaluation and the effect of proteins, represented by bovine serum albumin (BSA) in SBFs on the formation of hydroxyapatite (HA). These solutions are buffered by the thermodynamic equilibrium with 5% CO₂ in an incubator, and result in a deposition of carbonated HA. Using several titanium-based surfaces, these solutions were studied in comparison with the widely-used SBF (ISO 23317). The presence of BSA strongly inhibited the formation of HA in traditional SBF, while HA can still be observed in carbonate-buffered SBFs. A kinetic study reveals that the inhibitory effect is concentration dependent with 0.1g/L and 1g/L of BSA having little effect on HA growth but a complete inhibition of HA formation at 5g/L of BSA, as tested using NaOH treated titanium with a known positive AFA. The decrease in solution pH and free calcium concentrations in SBFs due to the addition of BSA is not significant, suggesting other causes for the strong inhibitory effect.

STATEMENT OF SIGNIFICANCE

The successful use of simulated body fluids (SBFs) to evaluate potential bioactive implants relies on the better understanding of the heterogeneous nucleation and growth of hydroxyapatite in solution. Although a standardized recipe for SBF was developed over a decade ago, a few key issues remain to be understood, i.e. the behavior of carbonate-buffered SBFs having similar buffering mechanism as human blood, and the effect of proteins on hydroxyapatite formation on bioactive materials. This paper addresses these two issues and would help the reader better understand the subtleties in this domain and better interpret the results generated using SBFs.

Novel bioactive materials developed by simulated body fluid evaluation: Surface-modified Ti metal and its alloys

Until the discovery of the bone-bonding activity of Bioglass by Hench et al. in the early 1970s, it had not been demonstrated that a synthetic material could bond to living bone without eliciting a foreign body reaction. Since then, various kinds of materials based on calcium phosphate, such as sintered hydroxyapatite and β-tricalcium phosphate have also been shown to bond to living bone. Until the discovery of the bone-bonding activity of Ti metal formed with a sodium titanate surface layer by the present authors in 1996, it had not been shown that a metallic material could bond to living bone. Since then, various kinds of surface-modified Ti metal and its alloys have been found to bond to living bone. Until the discovery of the osteoinduction of porous hydroxyapatite by Yamasaki in 1990, it was unknown whether a synthetic material could induce bone formation even in muscle tissue. Since then, various kinds of porous calcium phosphate ceramics have been shown to induce osteoinduction. Until the discovery of osteoinduction induced by a porous Ti metal formed with a titanium oxide surface layer by Fujibayashi et al. in 2004, it had been unclear whether porous metals would be able to induce osteoinduction. These novel bioactive materials have been developed by systematic research into the apatite formation that occurs on surface-modified Ti metal and its related materials in an acellular simulated body fluid (SBF) having ion concentrations almost equal to those of human blood plasma. Some of the novel bioactive materials based on Ti metal are already in clinical use or clinical trials, such as artificial hip joints and spinal fusion devices. In the present paper, we review how these novel bioactive materials based on Ti metal have been developed based on an evaluation of apatite formation in SBF. Without the SBF evaluation, these novel bioactive materials would most likely never have been developed.

STATEMENT OF SIGNIFICANCE

On the basis of systematic study of apatite formation on a material in a simulated body fluid, various kinds of novel bioactive materials possessing not only bone-bonding activity and but also various other functions such as bone growth promotion, antibacterial activity and osteoinduction have been developed. Some of them are already successfully applied to clinical applications or trials for artificial hip joints and spinal fusion devices. It is shown in the present paper how these novel bioactive materials have been developed.

Topography and nanostructural evaluation of chemically and thermally modified titanium substrates

In this research, the effects of chemical and thermal treatment on the morphological and compositional aspects of titanium substrates and so, potentially, on development of biomimetic bone like layers formation during simulated body fluid (SBF) soaking was investigated. The HF, HF/HNO3 and NaOH solutions were used for chemical treatment and some of alkali-treated samples followed a heat treatment at 600°C. The treated samples before and after soaking were subjected to material characterization tests using scanning electron microscopy (SEM), X-ray diffraction (XRD) and atomic force microscopy (AFM). White light interferometry (WLI) was used to determine the roughness parameters such as Ra, Rq, RKu and Rsk. The significance of the obtained data was assessed using ANOVA variance analysis between all samples. It was observed that the reaction at grain boundaries and sodium titanate intermediate layers play a great role in the nucleation of calcium phosphate layers. Based on the obtained results in this work, the calcium phosphate microstructure deposited on titanium substrates was more affected by chemical modification than surface topography.

Bio-functionalization of biomedical metals

Bio-functionalization means to endow biomaterials with bio-functions so as to make the materials or devices more suitable for biomedical applications. Traditionally, because of the excellent mechanical properties, the biomedical metals have been widely used in clinic. However, the utilized functions are basically supporting or fixation especially for the implantable devices. Nowadays, some new functions, including bioactivity, anti-tumor, anti-microbial, and so on, are introduced to biomedical metals. To realize those bio-functions on the metallic biomedical materials, surface modification is the most commonly used method. Surface modification, including physical and chemical methods, is an effective way to alter the surface morphology and composition of biomaterials. It can endow the biomedical metals with new surface properties while still retain the good mechanical properties of the bulk material. Having analyzed the ways of realizing the bio-functionalization, this article briefly summarized the bio-functionalization concepts of six hot spots in this field. They are bioactivity, bony tissue inducing, anti-microbial, anti-tumor, anticoagulation, and drug loading functions.

In Vivo Response of Laser Processed Porous Titanium Implants for Load-Bearing Implants

Applications of porous metallic implants to enhance osseointegration of load-bearing implants are increasing. In this work, porous titanium implants, with 25 vol.% porosity, were manufactured using Laser Engineered Net Shaping (LENS™) to measure the influence of porosity towards bone tissue integration in vivo. Surfaces of the LENS™ processed porous Ti implants were further modified with TiO₂ nanotubes to improve cytocompatibility of these implants. We hypothesized that interconnected porosity created via additive manufacturing will enhance bone tissue integration in vivo. To test our hypothesis, in vivo experiments using a distal femur model of male Sprague-Dawley rats were performed for a period of 4 and 10 weeks. In vivo samples were characterized via micro-computed tomography (CT), histological imaging, scanning electron microscopy, and mechanical push-out tests. Our results indicate that porosity played an important role to establish early stage osseointegration forming strong interfacial bonding between the porous implants and the surrounding tissue, with or without surface modification, compared to dense Ti implants used as a control.

Regulating the osteogenic function of rhBMP 2 by different titanium surface properties

Bone morphogenetic protein 2 (BMP-2) is important for regulating the osteogenic differentiation of mesenchymal stem cells and the response of bone tissue. It adsorbs on the surface of biomedical implants immediately and plays a role of mediator between the materials surfaces and the host cells. Studies usually connect the material surface properties and the new bone formation directly. However, interaction between the adsorbed BMP-2 on the implant surface and the cells in the tissue is the key to explaining the osteogenic properties of the material. So, in this article, we investigated the conformational and functional changes induced by the surface modified titanium metals. We found that the α-helix and β-sheet structure of rhBMP-2 can be well maintained on the anodic oxidation treated titanium surface. The osteogenic function of rhBMP-2 can sustain for a relatively long time even though there is less amount adhere to the surface compared with that on the acid alkali treated titanium. Surface properties, especially the morphology enable a larger amount of rhBMP-2 to adsorb to the surface of the acid alkali treated titanium, but the conformation of the protein is severely influenced. The percentage of α-helix structure is also significantly decreased so that the efficacy of rhBMP-2 is only maintained in the early time. This study indicated that different surface modification of the surface could regulate the structure of rhBMP-2 and then further influence its osteogenic function. © 2016 Wiley Periodicals, Inc. J Biomed Mater Res Part A: 104A: 1882-1893, 2016.

Apatite Formation and Biocompatibility of a Low Young's Modulus Ti-Nb-Sn Alloy Treated with Anodic Oxidation and Hot Water

Ti-6Al-4V alloy is widely prevalent as a material for orthopaedic implants because of its good corrosion resistance and biocompatibility. However, the discrepancy in Young’s modulus between metal prosthesis and human cortical bone sometimes induces clinical problems, thigh pain and bone atrophy due to stress shielding. We designed a Ti-Nb-Sn alloy with a low Young’s modulus to address problems of stress disproportion. In this study, we assessed effects of anodic oxidation with or without hot water treatment on the bone-bonding characteristics of a Ti-Nb-Sn alloy. We examined surface analyses and apatite formation by SEM micrographs, XPS and XRD analyses. We also evaluated biocompatibility in experimental animal models by measuring failure loads with a pull-out test and by quantitative histomorphometric analyses. By SEM, abundant apatite formation was observed on the surface of Ti-Nb-Sn alloy discs treated with anodic oxidation and hot water after incubation in Hank’s solution. A strong peak of apatite formation was detected on the surface using XRD analyses. XPS analysis revealed an increase of the H₂O fraction in O 1s XPS. Results of the pull-out test showed that the failure loads of Ti-Nb-Sn alloy rods treated with anodic oxidation and hot water was greater than those of untreated rods. Quantitative histomorphometric analyses indicated that anodic oxidation and hot water treatment induced higher new bone formation around the rods. Our findings indicate that Ti-Nb-Sn alloy treated with anodic oxidation and hot water showed greater capacity for apatite formation, stronger bone bonding and higher biocompatibility for osteosynthesis. Ti-Nb-Sn alloy treated with anodic oxidation and hot water treatment is a promising material for orthopaedic implants enabling higher osteosynthesis and lower stress disproportion.

Influence of strontium ions incorporated into nanosheet-pore topographical titanium substrates on osteogenic differentiation of mesenchymal stem cells in vitro and on osseointegration in vivo

Strontium ions incorporation and nanosheet-pore topography of titanium substrates synergistically improve the osteogensis of MSCs and osseointegration in vivo.

Growth of Novel Ceramic Layers on Metals via Chemical and Heat Treatments for Inducing Various Biological Functions

The present authors' systematic studies on growth of novel ceramic layers on Ti metal and its alloys by chemical and heat treatments for inducing bone-bonding bioactivity and some other biological functions are reviewed. Ti metal formed an apatite on its surface in a simulated body fluid, when heat-treated after exposure to strong acid solutions to form rutile surface layer, or to strong alkali solutions to form sodium titanate surface layer. Both types of Ti metal tightly bonded to the living bone. The alkali and heat treatment was applied to the surface Ti metal of an artificial hip joint and successfully used in the clinic since 2007. The acid and heat treatments was applied to porous Ti metal to induce osteoconductivity as well as osteoinductivity. The resulting product was successfully used in clinical trials for spinal fusion devices. For the Ti-based alloys, the alkali and heat treatment was little modified to form calcium titanate surface layer. Bone-growth promoting Mg, Sr, and Zn ions as well as the antibacterial Ag ion were successfully incorporated into the calcium titanate layer.

Nanostructured Ti6Al4V alloy fabricated using modified alkali-heat treatment: Characterization and cell adhesion

In order to optimize the creation of a nanostructured surface on Ti6Al4V titanium alloy, an alkali treatment was performed using a 10-M NaOH solution at various temperatures (30, 40, 50, and 60°C) so as to determine the optimal temperature. This was combined with subsequent heat treatments (200, 400, 600, and 800°C) in air. The effects of different temperatures for the latter treatments on the nanostructure surface and the initial cell adhesion were evaluated, and the optimal temperature of the alkali solution was found to be 30°C. Further, the nanotopography, surface chemistry, and surface roughness of the nanoporous structure were retained after heat treatments performed at 200, 400, and 600°C, and only the phase structure was altered. The amorphous sodium titanate phase, the content of which increased with increased heat-treatment temperature, may have played a role in promoting cell adhesion on the nanoporous surface. However, heat treatment at 800°C did not enhance the cell-surface attachment. Rather, the nanostructure degraded significantly with the reappearance of Al and V.

Effect of Tricalcium Magnesium Silicate Coating on the Electrochemical and Biological Behavior of Ti-6Al-4V Alloys

In the current study, a sol-gel-synthesized tricalcium magnesium silicate powder was coated on Ti-6Al-4V alloys using plasma spray method. Composition of feed powder was evaluated by X-ray diffraction technique before and after the coating process. Scanning electron microscopy and atomic force microscopy were used to study the morphology of coated substrates. The corrosion behaviors of bare and coated Ti-6Al-4V alloys were examined using potentiodynamic polarization test and electrochemical impedance spectroscopy in stimulated body fluids. Moreover, bare and coated Ti-6Al-4V alloys were characterized in vitro by culturing osteoblast and mesenchymal stem cells for several days. Results demonstrated a meaningful improvement in the corrosion resistance of Ti-6Al-4V alloys coated with tricalcium magnesium silicate compared with the bare counterparts, by showing a decrease in corrosion current density from 1.84 μA/cm² to 0.31 μA/cm². Furthermore, the coating substantially improved the bioactivity of Ti-6Al-4Valloys. Our study on corrosion behavior and biological response of Ti-6Al-4V alloy coated by tricalcium magnesium silicate proved that the coating has considerably enhanced safety and applicability of Ti-6Al-4V alloys, suggesting its potential use in permanent implants and artificial joints.

Effect of surface treatments on the surface morphology, corrosion property, and antibacterial property of Ti-10Cu sintered alloy

Ti-10Cu sintered alloy has shown strong antibacterial properties against S. aureus and E. coli and good cell biocompatibility in vitro and in vivo, displaying potential application as an implant material. Surface treatments are always applied to implants to improve the surface biocompatibility. In this paper, several typically used surface treatments, including sandblasting (SB), sandblasted and large-grits acid etching (SLA), and alkaline heat treatment (AH) were chosen to modify the Ti-10Cu. A cp-Ti (commercially pure titanium) sample was used as control sample. The effect of surface treatments on the corrosion properties and antibacterial properties of the Ti-10Cu sintered alloy was investigated. After SB and SLA treatments, a rough surface with a TiO2 layer was formed on the surface, which reduced the corrosion resistance and enhanced the Ti and Cu ion release. After AH treatment, a smooth but microporous surface with a TiO2/titanate layer was formed, which improved slightly the corrosion resistance. However, the Cu ion and Ti ion release from the Ti-10Cu sample was promoted by AH treatment due to the fact that more Ti2Cu phases were exposed on the AH-treated Ti-10Cu sample. It was demonstrated that the Ti-10Cu samples after surface treatments still exhibited good antibacterial properties against S. aureus, which indicated that the surface treatment did not reduce the antibacterial activity. The control mechanism was thought to be related to the high Cu ion release even after surface treatments. It was expected that the surface treatments provided Ti-10Cu sintered alloy with good surface bioactivity without reduction in antibacterial activity.

Chitosan/siCkip-1 biofunctionalized titanium implant for improved osseointegration in the osteoporotic condition

Biofunctionalization with siRNA targeting the key negative modulators of bone turnover involved in the molecular mechanism of osteoporosis, such as casein kinase-2 interacting protein-1 (Ckip-1), may lead to enhanced Ti osseointegration in the osteoporotic condition. In this study, even siRNA loading was accomplished by the thermal alkali (TA) treatment to make the Ti ultrahydrophilic and negatively charged to facilitate the physical adsorption of the positively charged CS/siR complex, designated as TA-CS/siR. The intracellular uptake of the CS/siR complex and the gene knockdown efficiency were assessed with bone marrow mesenchymal stem cells (MSCs) as well as the green fluorescent protein (GFP) expressing H1299 cells. In vitro osteogenic activity of TA-CS/siCkip-1 targeting Ckip-1 was assessed with MSCs. In vivo osseointegration of TA-CS/siCkip-1 was assessed in the osteoporotic rat model. TA-CS/siR showed excellent siRNA delivery efficiency and gene silencing effect. TA-CS/siCkip-1 significantly improved the in vitro osteogenic differentiation of MSCs in terms of the enhanced alkaline phosphatase and collagen product and extracellular matrix mineralization, and led to dramatically enhanced in vivo osseointegration in the osteoporostic rat model, showing promising clinical potential for the osteoporotic condition application. TA-CS/siR may constitute a general approach for developing the advanced Ti implants targeting specific molecular mechanism.

Synergistic effects of surface chemistry and topologic structure from modified microarc oxidation coatings on Ti implants for improving osseointegration

Microarc oxidation (MAO) coating containing Ca, P, Si, and Na elements on a titanium (Ti) implant has been steam-hydrothermally treated and further mediated by post-heat treatment to overcome the compromised bone-implant integration. The bone regeneration, bone-implant contact, and biomechanical push-out force of the modified Ti implants are discussed thoroughly in this work. The best in vivo performances for the steam-hydrothermally treated one is attributed to the synergistic effects of surface chemistry and topologic structure. Through post-heat treatment, we can decouple the effects of surface chemistry and the nanoscale topologic structure easily. Attributed to the excellent in vivo performance of the surface-modified Ti implant, the steam-hydrothermal treatment could be a promising strategy to improve the osseointegration of the MAO coating covered Ti implant.

Electrochemical behavior and effect of heat treatment on morphology, crystalline structure of self-organized TiO2 nanotube arrays on Ti-6Al-7Nb for biomedical applications

In the present work, we investigate the formation of self-organized titanium oxide nanotube layers by anodic oxidation on titanium alloy Ti-6Al-7Nb in electrolyte solution containing sulfuric acid and hydrofluoric acid. The anodized surface was characterized by micro-Raman, X-ray diffraction (XRD), field emission scanning electron microscopy (FESEM) and energy-dispersive X-ray spectroscopy (EDS). The corrosion behavior of the treated and untreated samples was investigated through electrochemical impedance spectroscopy (EIS) and potentiodynamic polarization studies in simulated body fluid (Hanks' solution). The investigations show that the native oxide on the sample is replaced by self-assembled nanoarray by anodization. FESEM of samples annealed at 450 to 800 °C show tubular morphology whereas those annealed at 850 °C show collapse of nanotubes. Electrochemical impedance data of the substrate and 10 V anodized samples were fitted with a two-time constant equivalent circuit and that of anodized samples (20, 30 V) with a three-time constant equivalent circuit.

The construction of hierarchical structure on Ti substrate with superior osteogenic activity and intrinsic antibacterial capability

The deficient osseointegration and implant-associated infections are pivotal issues for the long-term clinical success of endosteal Ti implants, while development of functional surfaces that can simultaneously overcome these problems remains highly challenging. This study aimed to fabricate sophisticated Ti implant surface with both osteogenic inducing activity and inherent antibacterial ability simply via tailoring surface topographical features. Micro/submciro/nano-scale structure was constructed on Ti by three cumulative subtractive methods, including sequentially conducted sandblasting as well as primary and secondary acid etching treatment. Topographical features of this hierarchical structure can be well tuned by the time of the secondary acid treatment. Ti substrate with mere micro/submicro-scale structure (MS0-Ti) served as a control to examine the influence of hierarchical structures on surface properties and biological activities. Surface analysis indicated that all hierarchically structured surfaces possessed exactly the same surface chemistry as that of MS0-Ti, and all of them showed super-amphiphilicity, high surface free energy, and high protein adsorption capability. Biological evaluations revealed surprisingly antibacterial ability and excellent osteogenic activity for samples with optimized hierarchical structure (MS30-Ti) when compared with MS0-Ti. Consequently, for the first time, a hierarchically structured Ti surface with topography-induced inherent antibacterial capability and excellent osteogenic activity was constructed.

Alternative technique for calcium phosphate coating on titanium alloy implants

As an alternative technique for calcium phosphate coating on titanium alloys, we propose to functionalize the metal surface with anionic bath containing chlorides of palladium or silver as activators. This new deposition route has several advantages such as controlled conditions, applicability to complex shapes, no adverse effect of heating, and cost effectiveness. A mixture of hydroxyapatite and calcium phosphate hydrate is deposited on the surface of Ti–6Al–4V. Calcium phosphate coating is built faster compared with the one by Simulated Body Fluid. Cell morphology and density are comparable to the control one; and the results prove no toxic compound is released into the medium during the previous seven days of immersion. Moreover, the cell viability is comparable with cells cultivated with the virgin medium. These experimental treatments allowed producing cytocompatible materials potentially applicable to manufacture implantable devices for orthopedic and oral surgeries.

Is the bone-bonding ability of a cementless total hip prosthesis enhanced by alkaline and heat treatments?

BACKGROUND

Cementless total hip arthroplasty (THA) implants using alkaline and heat treatments were developed to enhance bone bonding. Although bone-bonding ability of the alkali- and heat-treated titanium surface has been demonstrated in animal studies, it remains unknown whether it enhances or provides durable bone bonding in humans.

QUESTIONS/PURPOSES

We therefore (1) determined long-term survivorship, function, and radiographic signs of failure of fixation of alkali- and heat-treated THA implants; and (2) histologically examined their bone-bonding ability in two human retrievals.

METHODS

We retrospectively reviewed 58 patients who underwent 70 primary THAs, of whom 67 were available for minimum followup of 8 years (average, 10 years; range, 8-12 years). Survival rate was calculated. Hip function was evaluated using the Japan Orthopaedic Association (JOA) hip scores, and radiographic signs of implant failure were determined from anteroposterior radiographs. Two retrieved implants were investigated histologically.

RESULTS

Using revision for any reason as the end point, the overall survival rate was 98% (95% confidence interval, 96%-100%) at 10 years. The patients' average JOA hip scores improved from 47 points preoperatively to 91 points at the time of the last followup. No implant had radiographic signs of loosening. Histologically we observed bone in the pores 2 weeks after implantation in one specimen and apparently direct bonding between bone and the titanium surface in its deep pores 8 years after implantation.

CONCLUSIONS

Cementless THA implants with alkaline and heat treatments showed a high survival rate. Further study is required to determine whether the treatment enhances direct bone bonding.