Osteoinduction with HA/TCP Ceramics of Different Composition and Porous Structure in Rabbits

Bone Regeneration in Load-Bearing Segmental Defects, Guided by Biomorphic, Hierarchically Structured Apatitic Scaffold

The regeneration of load-bearing segmental bone defects remains a significant clinical problem in orthopedics, mainly due to the lack of scaffolds with composition and 3D porous structure effective in guiding and sustaining new bone formation and vascularization in large bone defects. In the present study, biomorphic calcium phosphate bone scaffolds (GreenBone™) featuring osteon-mimicking, hierarchically organized, 3D porous structure and lamellar nano-architecture were implanted in a critical cortical defect in sheep and compared with allograft. Two different types of scaffolds were tested: one made of ion-doped hydroxyapatite/β-tricalcium-phosphate (GB-1) and other made of undoped hydroxyapatite only (GB-2). X-ray diffraction patterns of GB-1 and GB-2 confirmed that both scaffolds were made of hydroxyapatite, with a minor amount of β-TCP in GB-1. The chemical composition analysis, obtained by ICP-OES spectrometer, highlighted the carbonation extent and the presence of small amounts of Mg and Sr as doping ions in GB-1. SEM micrographs showed the channel-like wide open porosity of the biomorphic scaffolds and the typical architecture of internal channel walls, characterized by a cell structure mimicking the natural parenchyma of the rattan wood used as a template for the scaffold fabrication. Both GB-1 and GB-2 scaffolds show very similar porosity extent and 3D organization, as also revealed by mercury intrusion porosimetry. Comparing the two scaffolds, GB-1 showed slightly higher fracture strength, as well as improved stability at the stress plateau. In comparison to allograft, at the follow-up time of 6 months, both GB-1 and GB-2 scaffolds showed higher new bone formation and quality of regenerated bone (trabecular thickness, number, and separation). In addition, higher osteoid surface (OS/BS), osteoid thickness (OS.Th), osteoblast surface (Ob.S/BS), vessels/microvessels numbers, as well as substantial osteoclast-mediated implant resorption were observed. The highest values in OS.Th and Ob. S/BS parameters were found in GB-1 scaffold. Finally, Bone Mineralization Index of new bone within scaffolds, as determined by micro-indentation, showed a significantly higher microhardness for GB-1 scaffold in comparison to GB-2. These findings suggested that the biomorphic calcium phosphate scaffolds were able to promote regeneration of load-bearing segmental bone defects in a clinically relevant scenario, which still represents one of the greatest challenges in orthopedics nowadays.

Bone regeneration of a polymeric sponge technique-Alloplastic bone substitute materials compared with a commercial synthetic bone material (MBCP+TM technology): A histomorphometric study in porcine skull

Background

Polymeric sponge technique is recommended for developing the desired porosity of Biphasic calcium phosphate (BCP) which may favor bone regeneration.

Purpose

To investigate the healing of BCP with ratio of HA30/β‐TCP70 (HA30) and HA70/β‐TCP30 (HA70) polymeric sponge preparation, compare to commercial BCP (MBCP+TM).

Materials and Methods

Materials were tested X‐ray diffraction (XRD) pattern and scanning electron microscope (SEM) analysis. In eight male pigs, six calvarial defects were created in each subject. The defects were the filled with 1 cc of autogenous bone, MBCP+TM (MBCP), HA30, HA70, and left empty (negative group). The new bone formations, residual material particles and bone‐to‐graft contacts were analyzed at 4, 8, 12 and 16 weeks.

Results

Fabricated BCP showed well‐distributed porosity. At 16 weeks, new bone formations were 45.26% (autogenous), 33.52% (MBCP), 24.34% (HA30), 19.43% (HA70) and 3.37% (negative). Residual material particles were 1.88% (autogenous), 17.58% (MBCP), 26.74% (HA30) and 37.03% (HA70). These values were not significant differences (Bonferroni correction <0.005). Bone‐to‐graft contacts were 73.68% (MBCP), which was significantly higher than 41.68% (HA30) and 14.32% (HA70; Bonferroni correction <0.017).

Conclusions

Polymeric sponge technique offers well‐distributed porosity. The new bone formation and residual material particles were comparable to MBCP+TM, but the bone‐to‐graft contact was lower than MBCP+TM.

Nanoparticle Size Effect on Water Vapour Adsorption by Hydroxyapatite

Handling and properties of nanoparticles strongly depend on processes that take place on their surface. Specific surface area and adsorption capacity strongly increase as the nanoparticle size decreases. A crucial factor is adsorption of water from ambient atmosphere. Considering the ever-growing number of hydroxyapatite nanoparticles applications, we decided to investigate how the size of nanoparticles and the changes in relative air humidity affect adsorption of water on their surface. Hydroxyapatite nanoparticles of two sizes: 10 and 40 nm, were tested. It was found that the nanoparticle size has a strong effect on the kinetics and efficiency of water adsorption. For the same value of water activity, the quantity of water adsorbed on the surface of 10 nm nano-hydroxyapatite was five times greater than that adsorbed on the 40 nm. Based on the adsorption isotherm fitting method, it was found that a multilayer physical adsorption mechanism was active. The number of adsorbed water layers at constant humidity strongly depends on particles size and reaches even 23 layers for the 10 nm particles. The amount of water adsorbed on these particles was surprisingly high, comparable to the amount of water absorbed by the commonly used moisture-sorbent silica gel.

Regenerating bone with bioactive glass scaffolds: A review of in vivo studies in bone defect models

Large bone defects resulting from fractures and disease are a medical concern, being often unable to heal spontaneously by the body's repair mechanisms. Bone tissue engineering (BTE) is a promising approach for treating bone defects through providing a template to guide osseous regeneration. 3D scaffolds with microstructure mimicking host bone are necessary in common BTE strategies. Bioactive glasses (BGs) attract researchers' attention as BTE scaffolds as they are osteoconductive and osteoinductive in certain formulations. In vivo animal models allow understanding and evaluation of materials' performance in the complex physiological environment, being an inevitable step before clinical trials. The aim of this paper is to review for the first time published research investigating the in vivo osseous regenerative capacity of 3D BG scaffolds in bone defect animal models, to better understand and evaluate the progress and future outlook of the use of such scaffolds in BTE. The literature analysis reveals that the regenerative capacity of BG scaffolds depends on several factors; including BG composition, fabrication method, scaffold microstructure and pore characteristics, in addition to scaffold pretreatment and whether or not the scaffolds are loaded with growth factors. In addition, animal species selected, defect size and implantation time affect the scaffold in vivo behavior and outcomes. The review of the literature also makes clear the difficulty encountered to compare different types of bioactive glass scaffolds in their bone forming ability. Even considering such limitations of the current state-of-the-art, results generated from animal bone defect models provide an essential source of information to guide the design of BG scaffolds in future.

STATEMENT OF SIGNIFICANCE

Bioactive glasses are at the centre of increasing research efforts in bone tissue engineering as the number of research groups around the world carrying out research on this type of biomaterials continues to increase. However, there are no previous reviews in literature which specifically cover investigations of the performance of bioactive glass scaffolds in bone defect animal models. This is the topic of the present review, in which we have analysed comprehensively all available literature in the field. The review thus fills a gap in the biomaterials literature providing a broad platform of information for researchers interested in bioactive glasses in general and specifically in the outcomes of in vivo models. Bioactive glass scaffolds of different compositions tested in relevant bone defect models are covered.

Osteoinductive porous biphasic calcium phosphate ceramic as an alternative to autogenous bone grafting in the treatment of mandibular bone critical-size defects

The bone-induction capacity of a porous biphasic calcium phosphate (pBCP) using heterotopic implantation in mouse (mHI-model) and its efficacy as substitute for autograft in mandibular critical-size defect in rabbit (rabMCSD-model) was investigated. In mHI-model, pBCP was implanted into the thigh muscles and bone formation was histomorphometrically and immunohistochemically evaluated. In rabMCSD-model, 13 mm bone defects were treated with pBCP or autograft and bone repair comparatively evaluated by radiographic and histomorphometric methods. In mHI-model, formed bone and immunolabeling for bone morphogenetic protein-2 and osteopontin were observed in 90% of pBCP implanted samples after 12 weeks. In rabMCSD-model neither statistically significant difference was found in newly formed bone between pBCP and autograft groups at 4 weeks (18.8 ± 5.5% vs 27.1 ± 5.6%), 8 weeks (22.3 ± 2.7% vs 26.2 ± 5.1), and 12 weeks (19.6 ± 4.7% vs 19.6 ± 2.3%). At 12 weeks, the stability and contour of the mandible were restored in both treatments. Near tooth remaining, pBCP particles were covered by small amount of mineralized tissue exhibiting perpendicular attachments of collagen fiber bundles with histological characteristic of acellular cementum. Within the limitations of this study, it was concluded that pBCP is osteoinductive and able to stimulate the new formation of bone and cementum-like tissues in rabMCSD-model, suggesting that it may be an alternative to treatment of large bone defect and in periodontal regenerative therapy. © 2017 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater, 106B: 1546-1557, 2018.

Evaluation of the in vitro biodegradation and biological behavior of poly(lactic-co-glycolic acid)/nano-fluorhydroxyapatite composite microsphere-sintered scaffold for bone tissue engineering

The objective of this research was to study the degradation and biological characteristics of the three-dimensional porous composite scaffold made of poly(lactic- co-glycolic acid)/nano-fluorhydroxyapatite microsphere using sintering method for potential bone tissue engineering. Our previous experimental results demonstrated that poly(lactic- co-glycolic acid)/nano-fluorhydroxyapatite composite scaffold with a ratio of 4:1 sintered at 90ºC for 2 h has the greatest mechanical properties and a proper pore structure for bone repair applications. The weight loss percentage of both poly(lactic- co-glycolic acid)/nano-fluorhydroxyapatite and poly(lactic- co-glycolic acid) scaffolds demonstrated a monotonic trend with increasing degradation time, that is, the incorporation of nano-fluorhydroxyapatite into polymeric scaffold could lead to weight loss in comparison with that of pure poly(lactic- co-glycolic acid). The pH change for composite scaffolds showed that there was a slight decrease until 2 weeks after immersion in simulated body fluid, followed by a significant increase in the pH of simulated body fluid without a scaffold at the end of immersion time. The mechanical properties of composite scaffold were higher than that of poly(lactic- co-glycolic acid) scaffold at total time of incubation in simulated body fluid; however, it should be noted that the incorporation of nano-fluorhydroxyapatite into composite scaffold leads to decline in the relatively significant mechanical strength and modulus during hydrolytic degradation. In addition, MTT assay and alkaline phosphatase activity results defined that a general trend of increasing cell viability was seen for poly(lactic- co-glycolic acid)/nano-fluorhydroxyapatite scaffold sintered by time when compared to control group. Eventually, experimental results exhibited poly(lactic- co-glycolic acid)/nano-fluorhydroxyapatite microsphere-sintered scaffold is a promising scaffold for bone repair.

A microstructural study of the degradation and calcium release from hydroxyapatite-calcium oxide ceramics made by infiltration

Hydroxyapatite pellets, partially densified in a low-temperature heat treatment, were infiltrated with calcium nitrate solution followed by in-situ precipitation of Ca(OH)₂ and CaCO₃. The infiltrated bodies were then densified to high relative density and the calcium carbonate transformed to calcium oxide during sintering and resulted in biphasic hydroxyapatite-CaO ceramics. This work investigated the influence of the infiltration on surface morphology, weight change, and microstructural-level degradation caused by exposure to saline at pH=7.4 and a temperature of 20°C. The CaO rendered the materials more susceptible to degradation, and released calcium into the saline faster than single phase, calcium deficient hydroxyapatite (HA) that were used as a control. In consequence, these ceramics could be used to release calcium into the culture microenvironments of bone tissue or bone marrow cells next to a scaffold surface.

Ornamenting 3D printed scaffolds with cell-laid extracellular matrix for bone tissue regeneration

3D printing technique is the most sophisticated technique to produce scaffolds with tailorable physical properties. But, these scaffolds often suffer from limited biological functionality as they are typically made from synthetic materials. Cell-laid mineralized ECM was shown to be potential for improving the cellular responses and drive osteogenesis of stem cells. Here, we intend to improve the biological functionality of 3D-printed synthetic scaffolds by ornamenting them with cell-laid mineralized extracellular matrix (ECM) that mimics a bony microenvironment. We developed bone graft substitutes by using 3D printed scaffolds made from a composite of polycaprolactone (PCL), poly(lactic-co-glycolic acid) (PLGA), and β-tricalcium phosphate (β-TCP) and mineralized ECM laid by human nasal inferior turbinate tissue-derived mesenchymal stromal cells (hTMSCs). A rotary flask bioreactor was used to culture hTMSCs on the scaffolds to foster formation of mineralized ECM. A freeze/thaw cycle in hypotonic buffer was used to efficiently decellularize (97% DNA reduction) the ECM-ornamented scaffolds while preserving its main organic and inorganic components. The ECM-ornamented 3D printed scaffolds supported osteoblastic differentiation of newly-seeded hTMSCs by upregulating four typical osteoblastic genes (4-fold higher RUNX2; 3-fold higher ALP; 4-fold higher osteocalcin; and 4-fold higher osteopontin) and increasing calcium deposition compared to bare 3D printed scaffolds. In vivo, in ectopic and orthotopic models in rats, ECM-ornamented scaffolds induced greater bone formation than that of bare scaffolds. These results suggest a valuable method to produce ECM-ornamented 3D printed scaffolds as off-the-shelf bone graft substitutes that combine tunable physical properties with physiological presentation of biological signals.

Probing the osteoinductive effect of calcium phosphate by using an in vitro biomimetic model

The use of calcium phosphate (CaP)-based carriers in bone engineering is a promising approach to induce in vivo bone formation. However, the exact mechanism of osteoinduction by CaP is not known. Here, by mimicking the in vivo Ca(2+) and P(i)-enriched environment in an in vitro model, we assessed the effects of these ions on human periosteum-derived cells. We observed a significant Ca(2+) and P(i)-induced cell proliferation, which was found to be through the modulation of cell cycle progression, in a dose- and time-dependent manner. In addition, Ca(2+), P(i), and combined Ca-P upregulated osteogenic gene expression in a dose- and time-dependent manner. Encouragingly, both ions administered individually or in combination persistently and dose dependently upregulated bone morphogenetic protein-2 gene expression. This suggested a potential osteoinductive effect through an autonomous activation of the bone morphogenetic protein signaling pathway by released Ca(2+) and P(i), which may serve as an autocrine/paracrine osteoinduction loop that drives the cellularized CaP constructs toward effective bone formation in vivo. In conclusion, through an in vitro biomimetic model, we have partially probed the roles of the released Ca(2+) and P(i) on the osteoinductivity of CaP-based biomaterials.

Solvent-dependent properties of electrospun fibrous composites for bone tissue regeneration

Biodegradable polymer-ceramic composite scaffolds have gained importance in recent years in the field of orthopedic biomaterials and tissue engineering scaffolds for improving the rate of degradation and limited mechanical properties of bioactive ceramics. This study sought to create composites using the electrospinning process to achieve fibrous scaffolds with uniform fiber morphologies and uniform ceramic dispersions. Composites consisting of 20% hydroxyapatite/80% beta-tricalcium phosphate (20/80 HA/TCP) and poly (epsilon-caprolactone) (PCL) were fabricated. The 20/80 HA/TCP composition was chosen as the ceramic component because of previous reports of greater bone tissue formation in comparison with HA or TCP alone. For electrospinning, PCL was dissolved in either methylene chloride (Composite-MC) or a combination of methylene chloride (80%) and dimethylformamide (20%) (Composite-MC + DMF). Composite-MC mats contained a bimodal distribution of fiber diameters with nanofibers between larger, micron-sized fibers with an average pore size of 79.6 + or - 67 microm, whereas Composite-MC + DMF fibers had uniform fiber diameters with an average pore size of 7.0 + or - 4.2 microm. Elemental mapping determined that the ceramic was distributed throughout the mat and inside the fiber for both composites. However, physical characterization using differential scanning calorimetry (DSC) and mechanical testing revealed that the ceramic in the mats produced with MC + DMF were more uniformly dispersed than the ceramic in the mats produced with MC alone. Maximum tensile stress and strain were significantly higher for Composite-MC + DMF mats compared with Composite-MC mats and were comparable with the mechanical properties of mats of PCL alone. For both composites, there was molecular interaction between the PCL and the ceramic, as demonstrated by a maximum increase of approximately 10 degrees C in the glass transition values with the addition of the ceramic, as confirmed by Fourier transform infrared analysis. In addition, the crystallization behavior of the composites suggested that the ceramic was acting as a nucleating agent. Cell viability studies using human mesenchymal stem cells (MSC) showed that both composite scaffolds supported cell growth. However, cell numbers at early time points in culture were significantly higher on mats produced from MC + DMF compared with mats prepared with MC alone. Further examination revealed that cells were able to infiltrate the pores of the Composite-MC mats, but remained on the outer surface of the Composite-MC + DMF and unfilled PCL mats during the culture period. The results of this study demonstrate that the solvent or solvent combination used in preparing the electrospun composite mats plays a critical role in determining its properties, which may, in turn, affect cell behavior.