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Ahmed F, Minamizaki T, Aubin JE, Damayanti MA, Yoshiko Y. Large scale analysis of osteocyte lacunae in klotho hypomorphic mice using high-resolution micro-computed tomography. Ann Anat 2023; 250:152142. [PMID: 37572763 DOI: 10.1016/j.aanat.2023.152142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2023] [Revised: 07/14/2023] [Accepted: 07/26/2023] [Indexed: 08/14/2023]
Abstract
BACKGROUND Osteocytes are the most abundant cell type in adult bone, and the morphological characteristics of osteocytes and their lacunae appear to influence bone mass and fragility. Although conventional computed tomography (CT) has contributed greatly to advances in bone morphometry, capturing details of the entire hierarchical assembly, e.g., osteocyte lacuna parameters, has been limited by the analytical performance of CT (> 1 µm resolution). METHODS We used high-resolution (700 nm) micro-CT to evaluate and compare the osteocyte lacuna parameters over a large scale, i.e., in a maximum of about 45,700 lacunae (average), in tibial metaphyseal cortical bones of wild-type (WT) and αKlotho-hypomorphic (kl/kl) mice, the latter a model that exhibits osteopenia and aberrant osteocytes. RESULTS Of osteocyte lacuna parameters, lacunar surface per lacunar volume were significantly lower and lacuna diameter were significantly larger in kl/kl mice compared to WT mice. By analysis of individual osteocyte lacunae, we found that lacunar sphericity in kl/kl mice was higher than that in WT mice, and the diameters in the major and the minor axes were respectively lower and higher in kl/kl mice, especially at the proximal site of the region of interest. CONCLUSION We successfully assessed osteocyte lacuna parameters on the largest scale in mice reported to date and found that the shape of osteocyte lacunae of kl/kl mice are significantly different from those of WT mice. Although the mechanisms underlying the lacunar shape differences observed are not yet clear, changes in lacunar geometry are known to affect the transitions of strains to the osteocyte microenvironment and likely local osteocyte response(s). Thus, the fact that the differences are limited to the mesial region near the primary spongiosa suggests the likelihood of site-specific anomalies in mechanosensitive effects in kl/kl osteocytes with consequent site-specific effects bone metabolism and function.
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Affiliation(s)
- Faisal Ahmed
- Department of Calcified Tissue Biology, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - Tomoko Minamizaki
- Department of Calcified Tissue Biology, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - Jane E Aubin
- Department of Molecular Genetics, University of Toronto, Toronto, Canada
| | - Merry Annisa Damayanti
- Department of Calcified Tissue Biology, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan; Department of Dentomaxillofacial Radiology, Faculty of Dentistry, Padjadjaran University, Bandung, Indonesia
| | - Yuji Yoshiko
- Department of Calcified Tissue Biology, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan.
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Sato M, Shah FA. Contributions of Resin Cast Etching to Visualising the Osteocyte Lacuno-Canalicular Network Architecture in Bone Biology and Tissue Engineering. Calcif Tissue Int 2023; 112:525-542. [PMID: 36611094 PMCID: PMC10106349 DOI: 10.1007/s00223-022-01058-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Accepted: 12/21/2022] [Indexed: 01/09/2023]
Abstract
Recent years have witnessed an evolution of imaging technologies towards sophisticated approaches for visualising cells within their natural environment(s) and for investigating their interactions with other cells, with adjacent anatomical structures, and with implanted biomaterials. Resin cast etching (RCE) is an uncomplicated technique involving sequential acid etching and alkali digestion of resin embedded bone to observe the osteocyte lacuno-canalicular network using scanning electron microscopy. This review summarises the applicability of RCE to bone and the bone-implant interface. Quantitative parameters such as osteocyte size, osteocyte density, and number of canaliculi per osteocyte, and qualitative metrics including osteocyte shape, disturbances in the arrangement of osteocytes and canaliculi, and physical communication between osteocytes and implant surfaces can be investigated. Ageing, osteoporosis, long-term immobilisation, spinal cord injury, osteoarthritis, irradiation, and chronic kidney disease have been shown to impact osteocyte lacuno-canalicular network morphology. In addition to titanium, calcium phosphates, and bioactive glass, observation of direct connectivity between osteocytes and cobalt chromium provides new insights into the osseointegration potential of materials conventionally viewed as non-osseointegrating. Other applications include in vivo and in vitro testing of polymer-based tissue engineering scaffolds and tissue-engineered ossicles, validation of ectopic osteochondral defect models, ex vivo organ culture of whole bones, and observing the effects of gene dysfunction/deletion on the osteocyte lacuno-canalicular network. Without additional contrast staining, any resin embedded specimen (including clinical biopsies) can be used for RCE. The multitude of applications described here attest to the versatility of RCE for routine use within correlative analytical workflows, particularly in biomaterials science.
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Affiliation(s)
- Mari Sato
- Oral Biochemistry and Molecular Biology, Graduate School of Dental Medicine, Hokkaido University, Sapporo, Japan
| | - Furqan A Shah
- Department of Biomaterials, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
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Titanium nanotopography induces osteocyte lacunar-canalicular networks to strengthen osseointegration. Acta Biomater 2022; 151:613-627. [PMID: 35995407 DOI: 10.1016/j.actbio.2022.08.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Revised: 08/09/2022] [Accepted: 08/12/2022] [Indexed: 11/20/2022]
Abstract
Osteocyte network architecture is closely associated with bone turnover. The cellular mechanosensing system regulates osteocyte dendrite formation by enhancing focal adhesion. Therefore, titanium surface nanotopography might affect osteocyte network architecture and improve the peri-implant bone tissue quality, leading to strengthened osseointegration of bone-anchored implants. We aimed to investigate the effects of titanium nanosurfaces on the development of osteocyte lacunar-canalicular networks and osseointegration of dental implants. Alkaline etching created titanium nanosurfaces with anisotropically patterned dense nanospikes, superhydrophilicity, and hydroxyl groups. MLO-Y4 mouse osteocyte-like cells cultured on titanium nanosurfaces developed neuron-like dendrites with increased focal adhesion assembly and gap junctions. Maturation was promoted in osteocytes cultured on titanium nanosurfaces compared to cells cultured on machined or acid-etched micro-roughened titanium surfaces. Osteocytes cultured in type I three-dimensional collagen gels for seven days on nano-roughened titanium surfaces displayed well-developed interconnectivity with highly developed dendrites and gap junctions compared to the poor interconnectivity observed on the other titanium surfaces. Even if superhydrophilicity and hydroxyl groups were maintained, the loss of anisotropy-patterned nanospikes reduced expression of gap junction in osteocytes cultured on alkaline-etched titanium nanosurfaces. Four weeks after placing the titanium nanosurface implants in the upper jawbone of wild-type rats, osteocytes with numerous dendrites were found directly attached to the implant surface, forming well-developed lacunar-canalicular networks around the nano-roughened titanium implants. The osseointegration strength of the nano-roughened titanium implants was significantly higher than that of the micro-roughened titanium implants. These data indicate that titanium nanosurfaces promote osteocyte lacunar-canalicular network development via nanotopographical cues and strengthen osseointegration. STATEMENT OF SIGNIFICANCE: The clinical stability of bone-anchoring implant devices is influenced by the bone quality. The osteocyte network potentially affects bone quality and is established by the three-dimensional (3D) connection of neuron-like dendrites of well-matured osteocytes within the bone matrix. No biomaterials are known to regulate formation of the osteocyte network. The present study provides the first demonstration that titanium nanosurfaces with nanospikes created by alkali-etching treatment enhance the 3D formation of osteocyte networks by promoting osteocyte dendrite formation and maturation by nanotopographic cues, leading to strengthened osseointegration of titanium implants. Osteocytes attached to the titanium nanosurfaces via numerous cellular projections. The success of osteocyte regulation by nanotechnology paves the way for development of epoch-making technologies to control bone quality.
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Zima A, Czechowska J, Szponder T, Ślósarczyk A. In vivo behavior of biomicroconcretes based on α-tricalcium phosphate and hybrid hydroxyapatite/chitosan granules and sodium alginate. J Biomed Mater Res A 2020; 108:1243-1255. [PMID: 32056372 DOI: 10.1002/jbm.a.36898] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Revised: 01/31/2020] [Accepted: 02/04/2020] [Indexed: 11/08/2022]
Abstract
The current studies provide insights into how predictions based on results of physicochemical and in vitro tests are consistent with the results of in vivo studies. The new biomicroconcrete type materials were obtained by mixing the solid phase, composed of hybrid hydroxyapatite/chitosan granules and highly reactive α-tricalcium phosphate powder, used as the setting agent. This approach guaranteed a good adhesion of the continuous cement phase to the surface of granules. It has been demonstrated that developed biomicroconcretes are surgically handy, possessed favorable physicochemical and biological properties and can be considered as effective bone implant material. The hierarchical porosity and compressive strength (2-6 MPa) similar to cancellous bone made them suitable for low-load bearing applications. Despite the fact that final setting times of biomicroconcretes were longer than recommended in the literature (i.e., exceeded 15 min), their short cohesion time allows for a successful implantation in a rabbit femoral defect model. Histological analysis and Raman studies revealed newly formed bone tissues around the sides of implanted materials. Furthermore, the process of neovascularization and reconstruction of the bone tissue, as well as a reverse scaffolding process, was visible. No signs of inflammation or adverse tissue reactions were observed during the experiment.
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Affiliation(s)
- Aneta Zima
- Faculty of Materials Science and Ceramics, AGH-UST University of Science and Technology, Krakow, Poland
| | - Joanna Czechowska
- Faculty of Materials Science and Ceramics, AGH-UST University of Science and Technology, Krakow, Poland
| | - Tomasz Szponder
- Faculty of Veterinary Medicine, University of Life Sciences, Lublin, Poland
| | - Anna Ślósarczyk
- Faculty of Materials Science and Ceramics, AGH-UST University of Science and Technology, Krakow, Poland
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Shah FA, Ruscsák K, Palmquist A. 50 years of scanning electron microscopy of bone-a comprehensive overview of the important discoveries made and insights gained into bone material properties in health, disease, and taphonomy. Bone Res 2019; 7:15. [PMID: 31123620 PMCID: PMC6531483 DOI: 10.1038/s41413-019-0053-z] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2019] [Revised: 04/09/2019] [Accepted: 04/11/2019] [Indexed: 02/06/2023] Open
Abstract
Bone is an architecturally complex system that constantly undergoes structural and functional optimisation through renewal and repair. The scanning electron microscope (SEM) is among the most frequently used instruments for examining bone. It offers the key advantage of very high spatial resolution coupled with a large depth of field and wide field of view. Interactions between incident electrons and atoms on the sample surface generate backscattered electrons, secondary electrons, and various other signals including X-rays that relay compositional and topographical information. Through selective removal or preservation of specific tissue components (organic, inorganic, cellular, vascular), their individual contribution(s) to the overall functional competence can be elucidated. With few restrictions on sample geometry and a variety of applicable sample-processing routes, a given sample may be conveniently adapted for multiple analytical methods. While a conventional SEM operates at high vacuum conditions that demand clean, dry, and electrically conductive samples, non-conductive materials (e.g., bone) can be imaged without significant modification from the natural state using an environmental scanning electron microscope. This review highlights important insights gained into bone microstructure and pathophysiology, bone response to implanted biomaterials, elemental analysis, SEM in paleoarchaeology, 3D imaging using focused ion beam techniques, correlative microscopy and in situ experiments. The capacity to image seamlessly across multiple length scales within the meso-micro-nano-continuum, the SEM lends itself to many unique and diverse applications, which attest to the versatility and user-friendly nature of this instrument for studying bone. Significant technological developments are anticipated for analysing bone using the SEM.
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Affiliation(s)
- Furqan A. Shah
- Department of Biomaterials, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Krisztina Ruscsák
- Department of Biomaterials, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Anders Palmquist
- Department of Biomaterials, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Abstract
In lamellar bone, a network of highly oriented interconnected osteocytes is organized in concentric layers. Through their cellular processes contained within canaliculi, osteocytes are highly mechanosensitive and locally modulate bone remodeling. We review the recent developments demonstrating the significance of the osteocyte lacuno-canalicular network in bone maintenance around implant biomaterials. Drilling during implant site preparation triggers osteocyte apoptosis, the magnitude of which correlates with drilling speed and heat generation, resulting in extensive remodeling and delayed healing. In peri-implant bone, osteocytes physically communicate with implant surfaces via canaliculi and are responsive to mechanical loading, leading to changes in osteocyte numbers and morphology. Certain implant design features allow peri-implant osteocytes to retain a less aged phenotype, despite highly advanced extracellular matrix maturation. Physicochemical properties of anodically oxidized surfaces stimulate bone formation and remodeling by regulating the expression of RANKL (receptor activator of nuclear factor-κB ligand), RANK, and OPG (osteoprotegerin) from implant-adherent cells. Modulation of certain osteocyte-related molecular signaling mechanisms (e.g., sclerostin blockade) may enhance the biomechanical anchorage of implants. Evaluation of the peri-implant osteocyte lacuno-canalicular network should therefore be a necessary component in future investigations of osseointegration to more completely characterize the biological response to materials for load-bearing applications in dentistry and orthopedics.
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Affiliation(s)
- F A Shah
- 1 Department of Biomaterials, Sahlgrenska Academy, University of Gothenburg, Göteborg, Sweden
| | - P Thomsen
- 1 Department of Biomaterials, Sahlgrenska Academy, University of Gothenburg, Göteborg, Sweden
| | - A Palmquist
- 1 Department of Biomaterials, Sahlgrenska Academy, University of Gothenburg, Göteborg, Sweden
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Iordachescu A, Amin HD, Rankin SM, Williams RL, Yapp C, Bannerman A, Pacureanu A, Addison O, Hulley PA, Grover LM. An In Vitro Model for the Development of Mature Bone Containing an Osteocyte Network. ACTA ACUST UNITED AC 2017. [DOI: 10.1002/adbi.201700156] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Affiliation(s)
- Alexandra Iordachescu
- School of Chemical Engineering; University of Birmingham; Edgbaston Birmingham B15 2TT UK
- Botnar Research Centre (NDORMS); University of Oxford; Old Road Headington Oxford OX3 7LD UK
| | - Harsh D. Amin
- Inflammation, Development and Repair; National Heart & Lung Institute; Faculty of Medicine; Imperial College London; London SW7 2AZ UK
- Centre for Blast Injury Studies; Department of Bioengineering; Imperial College London; London SW7 2AZ UK
| | - Sara M. Rankin
- Inflammation, Development and Repair; National Heart & Lung Institute; Faculty of Medicine; Imperial College London; London SW7 2AZ UK
- Centre for Blast Injury Studies; Department of Bioengineering; Imperial College London; London SW7 2AZ UK
| | - Richard L. Williams
- School of Chemical Engineering; University of Birmingham; Edgbaston Birmingham B15 2TT UK
| | - Clarence Yapp
- Botnar Research Centre (NDORMS); University of Oxford; Old Road Headington Oxford OX3 7LD UK
- Department of Cell Biology; Harvard Medical School; 240 Longwood Ave Boston MA 02115 USA
| | - Alistair Bannerman
- School of Chemical Engineering; University of Birmingham; Edgbaston Birmingham B15 2TT UK
| | - Alexandra Pacureanu
- European Synchrotron Radiation Facility; Beamline Groups Unit; 71 avenue des Martyrs 38000 Grenoble France
| | - Owen Addison
- School of Dentistry; University of Birmingham; 5 Mill Pool Way Edgbaston Birmingham B5 7EG UK
| | - Philippa A. Hulley
- Botnar Research Centre (NDORMS); University of Oxford; Old Road Headington Oxford OX3 7LD UK
| | - Liam M. Grover
- School of Chemical Engineering; University of Birmingham; Edgbaston Birmingham B15 2TT UK
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Pazzaglia UE, Congiu T. The cast imaging of the osteon lacunar-canalicular system and the implications with functional models of intracanalicular flow. J Anat 2012; 222:193-202. [PMID: 23082756 DOI: 10.1111/joa.12004] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/26/2012] [Indexed: 11/30/2022] Open
Abstract
A casting technique with methyl-methacrylate (MMA) was applied to the study of the osteon lacunar-canalicular network of human and rabbit cortical bone. The MMA monomer infiltration inside the vascular canals and from these into the lacunar-canalicular system was driven by capillarity, helped by evaporation and the resulting negative pressure in a system of small pipes. There was uniform, centrifugal penetration of the resin inside some osteons, but this was limited to a depth of four to five layers of lacunae. Moreover, not all of the osteon population was infiltrated. This failure can be the result of one of two factors: the incomplete removal of organic debris from the canal and canalicular systems, and lack of drainage at the osteon external border. These data suggest that each secondary osteon is a closed system with a peripheral barrier (represented by the reversal line). As the resin advances into the osteon, the air contained inside the canalicula is compressed and its pressure increases until infiltration is stopped. The casts gave a reliable visualization of the lacunar shape, position and connections between the lacunae without the need for manipulations such as cutting or sawing. Two systems of canalicula could be distinguished, the equatorial, which connected the lacunae (therefore the osteocytes) lying on the same concentric level, and the radial, which established connections between different levels. The equatorial canalicula radiated from the lacunar border forming ramifications on a planar surface around the lacuna, whereas the radial canalicula had a predominantly straight direction perpendicular to the equatorial plane. The mean length of the radial canalicula was 40.12 ± 10.26 μm in rabbits and 38.4 ± 7.35 μm in human osteons; their mean diameter was 174.4 ± 71.12 nm and 195.7 ± 79.58 nm, respectively. The mean equatorial canalicula diameter was 237 ± 66.04 nm in rabbit and 249.7 ± 73.78 nm in human bones, both significantly larger (P < 0.001) than the radial. There were no significant differences between the two species. The lacunar surface measured on the equatorial plane was higher in rabbit than in man, but the difference was not statistically significant. The cast of the lacunar-canalicular network obtained with the reported technique allows a direct, 3-D representation of the system architecture and illustrates how the connections between osteocytes are organized. The comparison with models derived by the assumption of the role of hydraulic conductance and other mechanistic functions provides descriptive, morphological data to the ongoing discussion on the Haversian system biology.
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Affiliation(s)
- Ugo E Pazzaglia
- Department of Specialità Chirurgiche, Scienze Radiologiche, Mediche e Sanità Pubblica, Orthopaedic Clinic of the University of Brescia, Italy.
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Wang L, Shao J, Ye T, Deng L, Qiu S. Three-dimensional morphology of microdamage in peri-screw bone: a scanning electron microscopy of methylmethacrylate cast replica. MICROSCOPY AND MICROANALYSIS : THE OFFICIAL JOURNAL OF MICROSCOPY SOCIETY OF AMERICA, MICROBEAM ANALYSIS SOCIETY, MICROSCOPICAL SOCIETY OF CANADA 2012; 18:1106-1111. [PMID: 23046724 DOI: 10.1017/s1431927612001286] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Screw implantation inevitably causes microdamage in surrounding bone. However, little is known about the detailed characteristics of microdamage in peri-screw bone. In this study, we developed a method to construct microdamage cast with methylmethacrylate (MMA) and observed the cast using scanning electron microscopy (SEM). In basic fuchsin stained bone sections observed by bright-field and fluorescence microscopy, diffuse damage, cross-hatched damage, and linear cracks were all presented in peri-screw bone. Using MMA casting/SEM method, we found numerous densely packed microcracks in the areas with diffuse damage. The osteocyte canaliculi and the microcracks consisting of diffuse damage had a similar diameter (or width), usually <0.5 μm, but their morphology was largely different. In the area with cross-hatched damage, the orientation of microcracks was similar to that in diffuse damage, but the number was significantly decreased. Many microcracks were thicker than 1 μm and associated with a rough surface. Large linear cracks (∼10 μm in diameter) occurred in different areas. Plenty of microcracks were present on the surface of some linear cracks. In conclusion, the MMA casting/SEM method can demonstrate the three-dimensional morphology of different types of microdamage, particularly the microcracks in diffuse damage, which are unable to be shown by light microscopy.
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Affiliation(s)
- Lei Wang
- Shanghai Key Laboratory for Prevention and Treatment of Bone and Joint Diseases with Integrated Chinese-Western Medicine, Department of Orthopedics, Shanghai Institute of Traumatology and Orthopedics, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, PR China
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Hoppe A, Güldal NS, Boccaccini AR. A review of the biological response to ionic dissolution products from bioactive glasses and glass-ceramics. Biomaterials 2011; 32:2757-74. [PMID: 21292319 DOI: 10.1016/j.biomaterials.2011.01.004] [Citation(s) in RCA: 1271] [Impact Index Per Article: 97.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2010] [Accepted: 01/04/2011] [Indexed: 01/08/2023]
Abstract
Several inorganic materials such as special compositions of silicate glasses, glass-ceramics and calcium phosphates have been shown to be bioactive and resorbable and to exhibit appropriate mechanical properties which make them suitable for bone tissue engineering applications. However, the exact mechanism of interaction between the ionic dissolution products of such inorganic materials and human cells are not fully understood, which has prompted considerable research work in the biomaterials community during the last decade. This review comprehensively covers literature reports which have investigated specifically the effect of dissolution products of silicate bioactive glasses and glass-ceramics in relation to osteogenesis and angiogenesis. Particularly, recent advances made in fabricating dense biomaterials and scaffolds doped with trace elements (e.g. Zn, Sr, Mg, and Cu) and investigations on the effect of these elements on the scaffold biological performance are summarized and discussed in detail. Clearly, the biological response to artificial materials depends on many parameters such as chemical composition, topography, porosity and grain size. This review, however, focuses only on the ion release kinetics of the materials and the specific effect of the released ionic dissolution products on human cell behaviour, providing also a scope for future investigations and identifying specific research needs to advance the field. The biological performance of pure and doped silicate glasses, phosphate based glasses with novel specific compositions as well as several other silicate based compounds are discussed in detail. Cells investigated in the reviewed articles include human osteoblastic and osteoclastic cells as well as endothelial cells and stem cells.
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Affiliation(s)
- Alexander Hoppe
- Institute of Biomaterials, Department of Materials Science and Engineering, University of Erlangen-Nuremberg, Cauerstrasse 6, 91058 Erlangen, Germany
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