Multifunction Sr, Co and F co-doped microporous coating on titanium of antibacterial, angiogenic and osteogenic activities

Antimicrobial Potential of Strontium-Functionalized Titanium Against Bacteria Associated With Peri-Implantitis

OBJECTIVES

To explore the antimicrobial potential of strontium (Sr)-functionalized wafers against multiple bacteria associated with per-implant infections, in both mono- and multispecies biofilms.

MATERIALS AND METHODS

The bactericidal and bacteriostatic effect of silicon wafers functionalized with a strontium titanium oxygen coating (Sr-Ti-O) or covered only with Ti (controls) against several bacteria, either grown as a mono-species or multispecies biofilms, was assessed using a bacterial viability assay and a plate counting method. Mono-species biofilms were assessed after 2 and 24 h, while the antimicrobial effect on multispecies biofilms was assessed at Days 1, 3, and 6. The impact of Sr functionalization on the total percentage of Porphyromonas gingivalis in the multispecies biofilm, using qPCR, and gingipain activity was also assessed.

RESULTS

Sr-functionalized wafers, compared to controls, were associated with statistically significant less viable cells in both mono- and multispecies tests. The number of colony forming units (CFUs) within the biofilm was significantly less in Sr-functionalized wafers, compared to control wafers, for Staphylococcus aureus at all time points of evaluation and for Escherichia coli at Day 1. Gingipain activity was less in Sr-functionalized wafers, compared to control wafers, and the qPCR showed that P. gingivalis remained below detection levels at Sr-functionalized wafers, while it consisted of 15% of the total biofilm on control wafers at Day 6.

CONCLUSION

Sr functionalization displayed promising antimicrobial potential, possessing bactericidal and bacteriostatic ability against bacteria associated with peri-implantitis grown either as mono-species or mixed in a multispecies consortium with several common oral microorganisms.

Controlling the europium oxidation state in diopside through flux concentration

This paper explores the connection between the H3BO3 flux concentration and the co-existence of Eu2+ and Eu3+ dopants within CaMgSi2O6 crystals (diopside). The samples were synthesised using a solid-state synthesis method under varying atmospheric conditions, including oxidative (air), neutral (N2), and reductive (H2/N2 mixture) environments. Additionally, some materials underwent chemical modification by partially substituting Si4+ with Al3+ ions acting as charge compensation defects stabilizing Eu3+ luminescence. Depending on the specific synthesis conditions, the materials predominantly displayed either the orange-red luminescence of Eu3+ (under oxidising conditions) or the blue luminescence of Eu2+; however, the comprehensive results confirmed the co-existence of Eu3+/Eu2+ luminescence in both cases. This work shows that varying flux concentrations added during synthesis significantly affect the relative strength of Eu2+ and Eu3+ emissions in a manner dependent on the synthesis atmosphere. The emission of Eu2+ increases with a higher flux concentration in materials synthesised under oxidative and neutral atmospheres independent of the chemical modification. In contrast, for materials obtained under a reductive atmosphere, the changes in the Eu3+ emission intensity depended on the presence or absence of Al3+ ions namely the increase of flux increased the Eu3+ intensity in the case of unmodified materials and decreased in the Al-modified ones. All observed effects were qualitatively explained considering the double role of the flux in the studied system, which besides facilitating the diffusion of chemical species during synthesis acts as a charge compensating agent by creating B'Si centres stabilizing Eu3+ emission.

Advancements in incorporating metal ions onto the surface of biomedical titanium and its alloys via micro-arc oxidation: a research review

The incorporation of biologically active metallic elements into nano/micron-scale coatings through micro-arc oxidation (MAO) shows significant potential in enhancing the biological characteristics and functionality of titanium-based materials. By introducing diverse metal ions onto titanium implant surfaces, not only can their antibacterial, anti-inflammatory and corrosion resistance properties be heightened, but it also promotes vascular growth and facilitates the formation of new bone tissue. This review provides a thorough examination of recent advancements in this field, covering the characteristics of commonly used metal ions and their associated preparation parameters. It also highlights the diverse applications of specific metal ions in enhancing osteogenesis, angiogenesis, antibacterial efficacy, anti-inflammatory and corrosion resistance properties of titanium implants. Furthermore, the review discusses challenges faced and future prospects in this promising area of research. In conclusion, the synergistic approach of micro-arc oxidation and metal ion doping demonstrates substantial promise in advancing the effectiveness of biomedical titanium and its alloys, promising improved outcomes in medical implant applications.

[Progress in antibacterial/osteogenesis dual-functional surface modification strategy of titanium-based implants]

Objective

To review antibacterial/osteogenesis dual-functional surface modification strategy of titanium-based implants, so as to provide reference for subsequent research.

Methods

The related research literature on antibacterial/osteogenesis dual-functional surface modification strategy of titanium-based implants in recent years was reviewed, and the research progress was summarized based on different kinds of antibacterial substances and osteogenic active substances.

Results

At present, the antibacterial/osteogenesis dual-functional surface modification strategy of titanium-based implants includes: ① Combined coating strategy of antibiotics and osteogenic active substances. It is characterized in that antibiotics can be directly released around titanium-based implants, which can improve the bioavailability of drugs and reduce systemic toxicity. ② Combined coating strategy of antimicrobial peptides and osteogenic active substances. The antibacterial peptides have a wide antibacterial spectrum, and bacteria are not easy to produce drug resistance to them. ③ Combined coating strategy of inorganic antibacterial agent and osteogenic active substances. Metal ions or metal nanoparticles antibacterial agents have broad-spectrum antibacterial properties and various antibacterial mechanisms, but their high-dose application usually has cytotoxicity, so they are often combined with substances that osteogenic activity to reduce or eliminate cytotoxicity. In addition, inorganic coatings such as silicon nitride, calcium silicate, and graphene also have good antibacterial and osteogenic properties. ④ Combined coating strategy of metal organic frameworks/osteogenic active substances. The high specific surface area and porosity of metal organic frameworks can effectively package and transport antibacterial substances and bioactive molecules. ⑤ Combined coating strategy of organic substances/osteogenic active substancecs. Quaternary ammonium compounds, polyethylene glycol, N-haloamine, and other organic compounds have good antibacterial properties, and are often combined with hydroxyapatite and other substances that osteogenic activity.

Conclusion

The factors that affect the antibacterial and osteogenesis properties of titanium-based implants mainly include the structure and types of antibacterial substances, the structure and types of osteogenesis substances, and the coating process. At present, there is a lack of clinical verification of various strategies for antibacterial/osteogenesis dual-functional surface modification of titanium-based implants. The optimal combination, ratio, dose-effect mechanism, and corresponding coating preparation process of antibacterial substances and bone-active substances are needed to be constantly studied and improved.

Angiogenic and immunomodulation role of ions for initial stages of bone tissue regeneration

It is widely known that bone has intrinsic capacity to self-regenerate after injury. However, the physiological regeneration process can be impaired when there is an extensive damage. One of the main reasons is due to the inability to establish a new vascular network that ensures oxygen and nutrient diffusion, leading to a necrotic core and non-junction of bone. Initially, bone tissue engineering (BTE) emerged to use inert biomaterials to just fill bone defects, but it eventually evolved to mimic bone extracellular matrix and even stimulate bone physiological regeneration process. In this regard, the stimulation of osteogenesis has gained a lot of attention especially in the proper stimulation of angiogenesis, being critical to achieve a successful osteogenesis for bone regeneration. Besides, the immunomodulation of a pro-inflammatory environment towards an anti-inflammatory one upon scaffold implantation has been considered another key process for a proper tissue restoration. To stimulate these phases, growth factors and cytokines have been extensively used. Nonetheless, they present some drawbacks such as low stability and safety concerns. Alternatively, the use of inorganic ions has attracted higher attention due to their higher stability and therapeutic effects with low side effects. This review will first focus in giving fundamental aspects of initial bone regeneration phases, focusing mainly on inflammatory and angiogenic ones. Then, it will describe the role of different inorganic ions in modulating the immune response upon biomaterial implantation towards a restorative environment and their ability to stimulate angiogenic response for a proper scaffold vascularization and successful bone tissue restoration. STATEMENT OF SIGNIFICANCE: The impairment of bone tissue regeneration when there is excessive damage has led to different tissue engineered strategies to promote bone healing. Significant importance has been given in the immunomodulation towards an anti-inflammatory environment together with proper angiogenesis stimulation in order to achieve successful bone regeneration rather than stimulating only the osteogenic differentiation. Ions have been considered potential candidates to stimulate these events due to their high stability and therapeutic effects with low side effects compared to growth factors. However, up to now, no review has been published assembling all this information together, describing individual effects of ions on immunomodulation and angiogenic stimulation, as well as their multifunctionality or synergistic effects when combined together.

The effect of strontium content on physicochemical and osteogenic property of Sr/Ag-containing TiO2 microporous coatings

Strontium (Sr) is the most common element introduced into TiO₂ coatings to strengthen the osteogenic property of titanium implants. However, the optimal Sr content and its effect on osteogenic and physicochemical properties of the coatings need to be clarified. In the current study, TiO₂ microporous coatings with different contents of Sr (9.64-21.25 wt %) and silver (Ag) (0.38-0.75 wt %) were prepared via micro-arc oxidation technique. Sr contents did not change physicochemical properties of the coatings, including surface microstructure, micropore size and distribution, phase composition, roughness and hydrophilicity. Meanwhile, higher Sr contents (18.23-21.25 wt %) improved cytocompatibility, proliferation and alkaline phosphatase (ALP) activity of preosteoblasts, even the coatings underwent 30 days' PBS immersion. Furthermore, higher Sr contents facilitated preosteoblast growth and spreading, which are essential for their proliferation and osteogenic differentiation. Therefore, it is promising to incorporate higher Sr content (18.23-21.25 wt %) within TiO₂ microporous coatings to improve their osteogenic capability.

A Metal‐Ion‐Incorporated Mussel‐Inspired Poly(Vinyl Alcohol)‐Based Polymer Coating Offers Improved Antibacterial Activity and Cellular Mechanoresponse Manipulation

Cobalt (Co^II) ions have been an attractive candidate for the biomedical modification of orthopedic implants for decades. However, limited research has been performed into how immobilized Co^II ions affect the physical properties of implant devices and how these changes regulate cellular behavior. In this study we modified biocompatible poly(vinyl alcohol) with terpyridine and catechol groups (PVA‐TP‐CA) to create a stable surface coating in which bioactive metal ions could be anchored, endowing the coating with improved broad‐spectrum antibacterial activity against Escherichia coli and Staphylococcus aureus, as well as enhanced surface stiffness and cellular mechanoresponse manipulation. Strengthened by the addition of these metal ions, the coating elicited enhanced mechanosensing from adjacent cells, facilitating cell adhesion, spreading, proliferation, and osteogenic differentiation on the surface coating. This dual‐functional PVA‐TP‐CA/Co surface coating offers a promising approach for improving clinical implantation outcomes.

Modification of implant surfaces to stimulate mesenchymal cell activation

BACKGROUND

The process of osteointegration, as key point has the activation of mesenchymal cells at implant-bone interspace, their differentiation into osteoblasts and connection between the implant surface and the surrounding bone.

MAIN TEXT

Implant surfaces composed by biocompatible, organism-friendly materials require changes in content and surface morphology; changes that may further stimulate mesenchymal cell activation. The way the implant surfaces are affected with advantages and disadvantages, that typically bring each methodology, is also the purpose of this study. The study is of review type, based on finding articles about implant surface modification, with the aim of promoting the mesenchymal cell activation, utilizing keyword combination.

CONCLUSIONS

Implant success beyond the human element of the practicioner and the protocol element of implant treatment, also relies on the application of the right type of implant, at the right implant site, in accordance with oral and individual health status of the patient. Implant success does not depend on type of "coating" material of the implants. Based at this physiological process, the success or implant failure is not a process depending on the type of selected implant, because types of synthetic or natural materials that promote osteointegration are relatively in large number.

Improved osseointegration of strontium-modified titanium implant by regulating angiogenesis and macrophage polarization

Strotium (Sr) has shown strong osteogenic potential and thereby been widely incorporated into dental and orthopedic implants. However, the improved osseointegration of strontium-modified titanium implant through regulation of angiogenesis and macrophage...

In Vivo Antibacterial Efficacy of Nanopatterns on Titanium Implant Surface: A Systematic Review of the Literature

Background: Bionic surface nanopatterns of titanium (Ti) materials have excellent antibacterial effects in vitro for infection prevention. To date, there is a lack of knowledge about the in vivo bactericidal outcomes of the nanostructures on the Ti implant surfaces. Methods: A systematic review was performed using the PubMed, Embase, and Cochrane databases to better understand surface nanoscale patterns’ in vivo antibacterial efficacy. The inclusion criteria were preclinical studies (in vivo) reporting the antibacterial activity of nanopatterns on Ti implant surface. Ex vivo studies, studies not evaluating the antibacterial activity of nanopatterns or surfaces not modified with nanopatterns were excluded. Results: A total of five peer-reviewed articles met the inclusion criteria. The included studies suggest that the in vivo antibacterial efficacy of the nanopatterns on Ti implants’ surfaces seems poor. Conclusions: Given the small number of literature results, the variability in experimental designs, and the lack of reporting across studies, concluding the in vivo antibacterial effectiveness of nanopatterns on Ti substrates’ surfaces remains a big challenge. Surface coatings using metallic or antibiotic elements are still practical approaches for this purpose. High-quality preclinical data are still needed to investigate the in vivo antibacterial effects of the nanopatterns on the implant surface.

iTRAQ-based proteomic analysis reveals potential osteogenesis-promoted role of ATM in strontium-incorporated titanium implant

The present study aims to reveal the osteogenic roles played by DNA damage response biomarkers through implementing isobaric tags for relative and absolute quantitation (iTRAQ) technique. First, sandblasted large-grit double acid-etched (SLA) titanium implant and strontium-incorporated (SLA-Sr) titanium implant were used for inserting in the tibiae of rats. iTRAQ technique was used to detect protein expression changes and identify differentially expressed proteins (DEPs). In total, 19,343 peptides and 4280 proteins were screened out. Among them, 91 and 138 DEPs were identified in the SLA-Sr group after implantation for 3 and 7 days, respectively. Ataxia-telangiectasia mutated (ATM) protein up-regulated on the 3rd day showed a trend of further up-regulation on the 7th day. Moreover, functional enrichment analyses were also conducted to explore the biological function of DEPs during the initial stage of osseointegration in vivo, which revealed that the biological functions of the DEPs on the 7th day were mainly related to "mismatch repair" and "mitotic G1 DNA damage checkpoint." Analysis of the Reactome signaling pathway showed that ATM was associated with TP53's regulation and activation. Finally, DNA damage repair related genes were selected for validation at mRNA and protein expression levels. Real-time reverse transcription-polymerase chain reaction and immunohistochemistry validation results demonstrated that mRNA expression level of ATM was higher in SLA-Sr group. In conclusion, SLA-Sr titanium implant could initiate DNA damage repair by activating expression levels of ATM. This study was striving to reveal new faces of better osseointegration and shedding light on the biological function and underlying mechanisms of this important procedure.

Antimicrobial Properties of Strontium Functionalized Titanium Surfaces for Oral Applications, A Systematic Review

The aim of this systematic review was to assess the current scientific evidence of the antimicrobial potential of strontium (Sr) when used to functionalize titanium (Ti) for oral applications. Out of an initial list of 1081 potentially relevant publications identified in three electronic databases (MEDLINE via PubMed, Scopus, and Cochrane) up to 1 February 2021, nine publications based on in vitro studies met the inclusion criteria. The antimicrobial potential of Sr was investigated on different types of functionalized Ti substrates, employing different application methods. Nine studies reported on the early, i.e., 6–24 h, and two studies on the late, i.e., 7–28 days, antimicrobial effect of Sr, primarily against Staphylococcus aureus (S. aureus) and/or Escherichia coli (E. coli). Sr-modified samples demonstrated relevant early antimicrobial potential against S. aureus in three studies; only one of which presented statistical significance values, while the other two presented only the percentage of antimicrobial rate and biofilm inhibition. A relevant late biofilm inhibition potential against S. aureus of 40% and 10%—after 7 and 14 days, respectively—was reported in one study. Combining Sr with other metal ions, i.e., silver (Ag), zinc (Zn), and fluorine (F), demonstrated a significant antimicrobial effect and biofilm inhibition against both S. aureus and E. coli. Sr ion release within the first 24 h was generally low, i.e., below 50 µg/L and 0.6 ppm; however, sustained Sr ion release for up to 30 days, while maintaining up to 90% of its original content, was also demonstrated. Thus, in most studies included herein, Sr-functionalized Ti showed a limited immediate (i.e., 24 h) antimicrobial effect, likely due to a low Sr ion release; however, with an adequate Sr ion release, a relevant antimicrobial effect, as well as a biofilm inhibition potential against S. aureus—but not E. coli—was observed at both early and late timepoints. Future studies should assess the antimicrobial potential of Ti functionalized with Sr against multispecies biofilms associated with peri-implantitis.

Zn- or Cu-Containing CaP-Based Coatings Formed by Micro-arc Oxidation on Titanium and Ti-40Nb Alloy: Part I-Microstructure, Composition and Properties

Zn- and Cu-containing CaP-based coatings, obtained by micro-arc oxidation process, were deposited on substrates made of pure titanium (Ti) and novel Ti-40Nb alloy. The microstructure, phase, and elemental composition, as well as physicochemical and mechanical properties, were examined for unmodified CaP and Zn- or Cu-containing CaP coatings, in relation to the applied voltage that was varied in the range from 200 to 350 V. The unmodified CaP coatings on both types of substrates had mainly an amorphous microstructure with a minimal content of the CaHPO₄ phase for all applied voltages. The CaP coatings modified with Zn or Cu had a range from amorphous to nano- and microcrystalline structure that contained micro-sized CaHPO₄ and Ca(H₂PO₄)₂·H₂O phases, as well as nano-sized β-Ca₂P₂O₇, CaHPO₄, TiO₂, and Nb₂O₅ phases. The crystallinity of the formed coatings increased in the following order: CaP/TiNb < Zn-CaP/TiNb < Cu-CaP/TiNb < CaP/Ti < Zn-CaP/Ti < Cu-CaP/Ti. The increase in the applied voltage led to a linear increase in thickness, roughness, and porosity of all types of coatings, unlike adhesive strength that was inversely proportional to an increase in the applied voltage. The increase in the applied voltage did not affect the Zn or Cu concentration (~0.4 at%), but led to an increase in the Ca/P atomic ratio from 0.3 to 0.7.

Superior CKIP-1 sensitivity of orofacial bone-derived mesenchymal stem cells in proliferation and osteogenic differentiation compared to long bone-derived mesenchymal stem cells

Maxillofacial bone defects caused by multiple factors, including congenital deformations and tumors, have become a research focus in the field of oral medicine. Bone tissue engineering is increasingly regarded as a potential approach for maxillofacial bone repair. Mesenchymal stem cells (MSCs) with different origins display various biological characteristics. The aim of the present study was to investigate the effects of casein kinase‑2 interaction protein‑1 (CKIP‑1) on MSCs, including femoral bone marrow‑derived MSCs (BMMSCs) and orofacial bone‑derived MSCs (OMSCs), isolated from the femoral and orofacial bones of wild‑type (WT) and CKIP‑1 knockout (KO) mice. MSCs were isolated using collagenase II and the main biological characteristics, including proliferation, apoptosis and osteogenic differentiation, were investigated. Subcutaneous transplantation of MSCs in mice was also performed to assess ectopic bone formation. MTT and clone formation assay results indicated that cell proliferation in the KO group was increased compared with the WT group, and OMSCs exhibited significantly increased levels of proliferation compared with BMMSCs. However, the proportion of apoptotic cells was not significantly different between CKIP‑1 KO OMSCs and BMMSCs. Furthermore, it was revealed that osteogenic differentiation was increased in CKIP‑1 KO MSCs compared with WT MSCs, particularly in OMSCs. Consistent with the in vitro results, enhanced ectopic bone formation was observed in CKIP‑1 KO mice compared with WT mice, particularly in OMSCs compared with BMMSCs. In conclusion, the present results indicated that OMSCs may have a superior sensitivity to CKIP‑1 in promoting osteogenesis compared with BMMSCs; therefore, CKIP‑1 KO in OMSCs may serve as an efficient strategy for maxillofacial bone repair.

Role of biomechanics in vascularization of tissue-engineered bones

Biomaterial based reconstruction is still the most commonly employed method of small bone defect reconstruction. Bone tissue-engineered techniques are improving, and adjuncts such as vascularization technologies allow re-evaluation of traditional reconstructive methods for healingofcritical-sized bone defect. Slow infiltration rate of vasculogenesis after cell-seeded scaffold implantation limits the use of clinically relevant large-sized scaffolds. Hence, in vitro vascularization within the tissue-engineered bone before implantation is required to overcome the serious challenge of low cell survival rate after implantation which affects bone tissue regeneration and osseointegration. Mechanobiological interactions between cells and microvascular mechanics regulate biological processes regarding cell behavior. In addition, load-bearing scaffolds demand mechanical stability properties after vascularization to have adequate strength while implanted. With the advent of bioreactors, vascularization has been greatly improved by biomechanical regulation of stem cell differentiation through fluid-induced shear stress and synergizing osteogenic and angiogenic differentiation in multispecies coculture cells. The benefits of vascularization are clear: avoidance of mass transfer limitation and oxygen deprivation, a significant decrease in cell necrosis, and consequently bone development, regeneration and remodeling. Here, we discuss specific techniques to avoid pitfalls and optimize vascularization results of tissue-engineered bone. Cell source, scaffold modifications and bioreactor design, and technique specifics all play a critical role in this new, and rapidly growing method for bone defect reconstruction. Given the crucial importance of long-term survival of vascular network in physiological function of 3D engineered-bone constructs, greater knowledge of vascularization approaches may lead to the development of new strategies towards stabilization of formed vascular structure.

Magnetic mesoporous bioactive glass for synergetic use in bone regeneration, hyperthermia treatment, and controlled drug delivery

A combination of chemotherapy with hyperthermia can produce remarkable success in treating advanced cancers. For this purpose, magnetite (Fe₃O₄)-doped mesoporous bioactive glass nanoparticles (Fe₃O₄-MBG NPs) were synthesized by the sol–gel method. Fe₃O₄-MBG NPs were found to possess spherical morphology with a size of approximately 50 ± 10 nm and a uniform pore size of 9 nm. The surface area (309 m² g⁻¹) was sufficient for high drug loading capacity and mitomycin C (Mc), an anticancer drug, was entrapped in the Fe₃O₄-MBG NPs. A variable rate of drug release was observed at different pH values (6.4, 7.4 & 8.4) of the release media. No significant death of normal human fibroblast (NHFB) cells was observed during in vitro analysis and for Mc-Fe₃O₄-MBG NPs considerable inhibitory effects on the viability of cancer cells (MG-63) were observed. When Fe₃O₄-MBG NPs were immersed in simulated body fluid (SBF), hydroxycarbonate apatite (HCA) was formed, as confirmed by XRD and FTIR spectra. A negligible value of coercivity and zero remanence confirms that Fe₃O₄-MBG NPs are superparamagnetic. Fe₃O₄-MBG NPs showed a hyperthermia effect in an alternating magnetic field (AMF), and a rise of 11.5 °C in temperature during the first 6 min, making it suitable for hyperthermia applications. Fe₃O₄-MBG NPs expressed excellent biocompatibility and low cytotoxicity, therefore, they are a safe biomaterial for bone tissue regeneration, drug delivery, and hyperthermia treatment.

A combination of chemotherapy with hyperthermia can produce remarkable success in treating advanced cancers.

Silanized NaCa2HSi3O9 nanorods with a reduced pH increase on Ti for improving osteogenesis and angiogenesis in vitro

NaCa₂HSi₃O₉ nanorods with silane layers allow efficient Ca and Si release and controlled pH increase, and can enhance osteogenesis and angiogenesis on the Ti implant surface.

Enzyme responsive titanium substrates with antibacterial property and osteo/angio-genic differentiation potentials

After implantation into a host, titanium (Ti) orthopaedic materials are facing two major clinical challenges: bacterial infection and aseptic loosening, which directly determine the long-term survival of the implant. To endow Ti implant with self-defensive antibacterial properties and desirable osteo/angio-genic differentiation potentials, hyaluronic acid (HA)-gentamicin (Gen) conjugates (HA-Gen) and chitosan (Chi) polyelectrolyte multilayers were constructed on deferoxamine (DFO) loaded titania nanotubes (TNT) substrates via layer-by-layer (LBL) assembly technique, termed as TNT/DFO/HA-Gen. The HA-Gen conjugate was characterized by Fourier transform infrared spectroscopy (FTIR) and nuclear magnetic resonance (¹H NMR). The physicochemical properties of the substrates were characterized by field emission scanning electron microscopy (FE-SEM), atomic force microscopy (AFM), X-ray photoelectron spectroscopy (XPS) and contact angle measurements. The on-demand DFO release was associated with the degradation of multilayers triggered by exogenous hyaluronidase, which indicated enzymatic and bacterial responsiveness. The TNT/DFO/HA-Gen substrates displayed effective antifouling and antibacterial properties against Escherichia coli (E. coli) and Staphylococcus aureus (S. aureus), while were favourable for the adhesion, proliferation and osteo/angio-genic differentiation of mesenchymal stem cells (MSCs). The multifaceted drug-device combination (DDC) strategy showed potential applications in orthopaedic fields.

Antibacterial, angiogenic, and osteogenic activities of Ca, P, Co, F, and Sr compound doped titania coatings with different Sr content

Titanium implants are often combined with microporous titania coatings simultaneously doped with various elements to enhance their antibacterial, angiogenic and osteogenic activities. To evaluate how Sr doping levels affect properties of titania coatings simultaneously doped with Ca, P, Co and F (TiCPCF coatings), we prepared coatings with Sr contents equal to 6, 11 and 18 wt% (TiCPCF-S6, TiCPCF-S11 and TiCPCF-S18, respectively) using micro-arc oxidation of titanium. Sr presence in TiCPCF coatings did not affect their phase compositions, microstructure, surface wettability, roughness, and adhesion to titanium. Antibacterial, angio- and osteo-genic activities of all the coatings were evaluated. Sr incorporation improved mesenchymal stem cell proliferation, osteogenic differentiation and implant osseointegration. TiCPCF-S11 showed the most optimum Sr content judging by its enhanced osteogenic activity. While Sr incorporation did not weaken angiogenic and antibacterial abilities of TiCPCF. Thus TiCPCF-S11 coating is a very strong candidate to be used as a next-generation bone implant material.

Verification of osteoblast differentiation on airborne-particle abrasion, large-grit, acid-etched surface of titanium implants regulated by yes-associated protein and transcriptional coactivator with PDZ-binding motif

Although airborne-particle abrasion, large-grit, acid-etched (SLA) surface technology can promote implant osseointegration; its mechanism remains unclear. By preparing the SLA titanium (Ti) plate (SLA Ti) and Polished Ti plate (Polished Ti), this experiment investigates the expression and distribution of the Yes-associated protein (YAP) and transcriptional coactivator with the PDZ-binding motif (TAZ) in MC3T3-E1 cells. In addition, gene YAP and TAZ silencing on the SLA Ti was conducted to observe changes in the osteoblast differentiation markers, runt-related transcription factor-2 (Runx2) and bone sialoprotein (BSP). The results demonstrated that SLA Ti surface microtopography could induce YAP/TAZ's transfer from the cytoplasm to the nuclei of MC3T3-E1 cells. The expression of YAP/TAZ increased in terms of mRNA and protein. After silencing the YAP/TAZ genes, Runx2 and BSP decreased, suggesting that YAP/TAZ plays an important regulatory role in this process. Meanwhile, the results also showed that SLA microtopography enhanced the expression of integrins α1, α2, and β1. After silencing the integrin α1, α2, and β1 genes, YAP and TAZ decreased in terms of mRNA and protein. Therefore, this experiment was the first to confirm that SLA surface microtopography facilitates osteoblast differentiation by regulating YAP/TAZ and confirms that the process can be related to integrins α1, α2, and β1.

Bioinspired surface modification of orthopedic implants for bone tissue engineering

Biomedical implants have been widely used in various orthopedic treatments, including total hip arthroplasty, joint arthrodesis, fracture fixation, non-union, dental repair, etc. The modern research and development of orthopedic implants have gradually shifted from traditional mechanical support to a bioactive graft in order to endow them with better osteoinduction and osteoconduction. Inspired by structural and mechanical properties of natural bone, this review provides a panorama of current biological surface modifications for facilitating the interaction between medical implants and bone tissue and gives a future outlook for fabricating the next-generation multifunctional and smart implants by systematically biomimicking the physiological processes involved in formation and functioning of bones.

Antiadipogenesis and Osseointegration of Strontium-Doped Implant Surfaces

The decreased bone density and increased marrow adiposity that occur with aging may influence the outcome of dental implants. Strontium (Sr), an anabolic agent for the treatment of osteoporosis, has an inhibitory effect on adipogenesis but favors osteogenesis of bone marrow–derived mesenchymal stem cells (BMSCs). However, little is known about the effects and mechanisms of local Sr release on adipogenesis during bone formation in aged bone. In this study, a potential dental implant material, Sr-doped titanium, was developed via a sandblasted, large-grit, and acid-etched (SLA) method combined with a hydrothermal process. The effects of Sr-SLA on initial adhesion, proliferation, intracellular redox state, and adipogenic differentiation of senescent BMSCs were investigated. The in vitro results showed that Sr-SLA promoted spreading of senescent BMSCs via upregulation of the gene and protein expression of integrin β1. In addition, it was revealed that Sr-SLA could reduce intracellular oxidative stress by decreasing the levels of reactive oxygen species and oxygen radicals and increasing the content of glutathione peroxidase. More important, Sr-SLA suppressed lipid droplet production and adipokines expression via downregulation of transcription peroxisome proliferator-activated receptor γ (PPARγ) and signal transducer and activator of transcription 1, thus inhibiting adipogenesis. Finally, the Sr-SLA implants were implanted in tibiae of aged (18-mo-old) Sprague-Dawley rats for 2 and 8 wk. Histomorphometric analysis demonstrated that Sr-SLA implants significantly enhanced osseointegration, and the inhibition effect on marrow adipose tissue formation was moderate. All these results suggest that due to the multiple functions produced by Sr, antiadipogenesis capability and rapid osseointegration were enhanced by the Sr-SLA coatings, which have potential application in dental implantation in the aged population.

Exosomal miR-423-5p mediates the proangiogenic activity of human adipose-derived stem cells by targeting Sufu

BACKGROUND

Human adipose-derived stem cells (hADSCs) are an important source of cells for regenerative medicine. Evidence of extensive interactions with the surrounding microenvironment has led researchers to focus more on hADSCs as activating agents of regenerative pathways, rather than simply replacing damaged cells. Several studies have found that functional miRNAs can be packaged into exosomes and transferred from donor cells into recipient cells, indicating that transported miRNAs may be a new class of cell-to-cell regulatory species. The aim of the present study was to evaluate whether the exosome-derived miRNAs secreted by hADSCs are capable of influencing angiogenesis, a key step in tissue regeneration.

METHODS

Exosomes were purified from hADSCs followed by the characterization of their phenotype and angiogenic potential in vitro. RNA sequencing was performed to detect the miRNAs that were enriched in the hADSC-derived exosomes. A miRNA-mimic experiment was used to detect the key miRNAs in the proangiogenic activity of hADSC-derived exosomes.

RESULTS

Exosomes isolated from hADSCs were characterized as round membrane vesicles with a size of approximately 100 nm and were positive for CD9 and flotillin. The exosomes were internalized by primary human umbilical vein endothelial cells (HUVECs) and stimulated HUVEC proliferation and migration. Remarkably, the exosomes promoted vessel-like formation by HUVECs in a dose-dependent manner, and their maximum activity (10 μg/mL) was comparable with that of 5% FBS. The RNA-seq bioinformatics analysis predicted 1119 gene targets of the top 30 exosomal miRNAs in Gene Ontology (GO) analysis and Kyoto encyclopedia of genes and genomes (KEGG) pathway analysis, and the pathway involved in the angiogenesis was among the top KEGG pathways. Moreover, intact miR-423-5p was further demonstrated to be transferred into HUVECs via exosomes and to exert its angiogenic function by targeting Sufu.

CONCLUSIONS

Exosomal miR-423-5p mediated the proangiogenic activity of hADSCs by targeting Sufu, which may contribute to the exploitation of exosomes from hADSCs as a therapeutic tool for regenerative medicine.

Cobalt-mediated multi-functional dressings promote bacteria-infected wound healing

Wound dressings with multiple functions are required to meet the complexity of the wound healing process. The multifunctionality often leads to an increase in the complexity and difficulty in dressing preparation. To surmount this problem, we used a facile preparation and fabrication process to fabricate a multi-functional dressing by integrating four widely accessible materials: plain gauze, sodium alginate (SA), Ca²⁺ and Co²⁺. Firstly, mixed Ca²⁺/Co²⁺ ion solutions with different concentration were applied to gauzes. After drying, SA solution was added to ionized gauze and Co²⁺-Ca²⁺/Gauze/SA (Ion-GSA) composite dressings were formed easily. In vitro results showed that all Ion-GSA dressings exhibited strong mechanical properties, uniform dispersion and sustained release of Ca²⁺ and Co²⁺, and the ability to retain moisture and absorb wound exudate. Besides the above advantages, dressings prepared with 0.25 g/L Co²⁺ and 4 g/L Ca²⁺ (Co²⁺0.25-Ca²⁺4 GSA composite dressings) exhibited the best overall effect for inducing a hypoxia-like response, and favorable cytocompatibility, hemostatic property and antibacterial activity. In vivo wound healing assays revealed that Co²⁺0.25-Ca²⁺4 GSA composite dressings inhibited bacterial growth, increased local Hypoxia-inducible factor-1α (HIF-1α), vascular endothelial growth factor (VEGF), transforming growth factor-β1 (TGF-β1) protein expression, and accelerated full-thickness skin wound healing in mouse bacterial-infected wound model. The quick healing wounds had improved angiogenesis, macrophages regulation, re-epithelialization and dense collagen deposition. Collectively, our results indicated that Co²⁺0.25-Ca²⁺4 GSA composite dressings promote wound healing. STATEMENT OF SIGNIFICANCE: Wound dressings with integrated functionalities are required to meet complex clinical requirements. However, there is often a trade-off between reducing preparation complexity and increasing the multifunctionality of the dressing's properties. In this study, we prepared multifunctional composite dressings by a facile preparation process using widely accessible materials. The composite dressings possessed the mechanical strength of gauze, had the effective wound exudate absorption, moisture maintenance and hemostatic property capacity of calcium alginate hydrogels, and had the hypoxia-like induction and the antimicrobial effects of Co²⁺. These functions all together promote bacteria-infected wound healing. Thus, we believed that the composite dressings can be widely applied in skin wound repair duo to their facile preparation method and good therapeutic effect.

Antibacterial and osteogenic activity of a multifunctional microporous coating codoped with Mg, Cu and F on titanium

As preferred materials for bone tissue repair and replacement, titanium (Ti) and its alloys have been widely applied in clinical practice. However, since these materials are bioinert, synostosis cannot occur between these materials and natural bone. Therefore, modifying the surface of Ti with bioactive elements has been the subject of intense research. In the present study, a magnesium-copper-fluorine (Mg-Cu-F) codoped titanium dioxide microporous coating (MCFMT) was prepared on the surface of Ti by micro-arc oxidation (MAO). The coating had a micro/nanoporous structure and was uniformly doped with Mg, Cu and F. In vitro, the MCFMT could promote the adhesion, proliferation, differentiation, mineralization and apoptosis of MC3T3-E1 osteoblasts. In addition, MCFMT could inhibit the growth of Staphylococcus, providing a good antibacterial effect. Further studies showed that MCFMT promoted MAPK expression and might promote osteogenesis through ERK1/2 signaling. Therefore, establishing an MCFMT coating on the Ti surface is a feasible and effective way to improve the biological activity of Ti. This study provides a new concept and method for improving the biological activity of Ti and thus has important theoretical significance and potential applications.

F-doped TiO2 microporous coating on titanium with enhanced antibacterial and osteogenic activities

To enhance bacterial resistance and osteogenesis of titanium (Ti) -based implants, TiO2/calcium-phosphate coatings (TiCP) doped with various amounts of fluorine (F) (designated as TiCP-F1, TiCP-F6, and TiCP-F9) were prepared on Ti by micro-arc oxidation. The F doped TiCP coatings possess a microporous structure (pore size of 3-4 μm in average diameter) which is evenly covered by nano-grains of 30-60 nm in size. Successful F incorporation into TiCP was determined by X-ray photoelectron spectroscopy, and it shows weak influence on the microstructure, phase compositions, surface roughness and wettability of TiCP. All the coatings bonded firmly to the Ti substrates and showed enduring high adhesion strength in biological circumstances. The bacterial resistance and osteogenesis of the coatings were evaluated by implanting testing materials in vitro and in an infected rabbit model caused by bacteria. Both the in vitro and in vivo results indicated that TiCP and TiCP-F1 were of much higher osteogenic activity compared with Ti but lacking of bacterial resistance, whereas TiCP with high F addition (TiCP-F6 and TiCP-F9) exhibited both dramatically improved bacterial resistance and osteogenesis. In summary, TiCP-F6 possessed the best antibacterial and osteogenic activities, especially exhibited excellent osseointegration efficacy in the infected rabbit model.

Cationic Substitutions in Hydroxyapatite: Current Status of the Derived Biofunctional Effects and Their In Vitro Interrogation Methods

High-performance bioceramics are required for preventing failure and prolonging the life-time of bone grafting scaffolds and osseous implants. The proper identification and development of materials with extended functionalities addressing socio-economic needs and health problems constitute important and critical steps at the heart of clinical research. Recent findings in the realm of ion-substituted hydroxyapatite (HA) could pave the road towards significant developments in biomedicine, with an emphasis on a new generation of orthopaedic and dentistry applications, since such bioceramics are able to mimic the structural, compositional and mechanical properties of the bone mineral phase. In fact, the fascinating ability of the HA crystalline lattice to allow for the substitution of calcium ions with a plethora of cationic species has been widely explored in the recent period, with consequent modifications of its physical and chemical features, as well as its functional mechanical and in vitro and in vivo biological performance. A comprehensive inventory of the progresses achieved so far is both opportune and of paramount importance, in order to not only gather and summarize information, but to also allow fellow researchers to compare with ease and filter the best solutions for the cation substitution of HA-based materials and enable the development of multi-functional biomedical designs. The review surveys preparation and synthesis methods, pinpoints all the explored cation dopants, and discloses the full application range of substituted HA. Special attention is dedicated to the antimicrobial efficiency spectrum and cytotoxic trade-off concentration values for various cell lines, highlighting new prophylactic routes for the prevention of implant failure. Importantly, the current in vitro biological tests (widely employed to unveil the biological performance of HA-based materials), and their ability to mimic the in vivo biological interactions, are also critically assessed. Future perspectives are discussed, and a series of recommendations are underlined.

Environment-Friendly Synthesis of Trace Element Zn, Sr, and F Codoping Hydroxyapatite with Non-cytotoxicity and Improved Osteoblast Proliferation and Differentiation

Hydroxyapatite (HAp, Ca₁₀[PO₄]₆[OH]₂) doped with numerous trace elements possesses sensational biochemical effects in natural bones. To study the biochemical function of Zn, Sr, and F elements, a series of neoteric HAp biomaterials with Zn, Sr, and F concentrations close to natural bones are firstly synthesized by one-pot hydrothermal method. These materials are characterized through powder X-ray diffraction (XRD), Fourier transform infrared spectroscopy (FTIR), and scanning electron microscope (SEM). All the synthesized materials are HAp phase. The morphology of these materials is nanorods. The phenomenon that L929 cells can live even at 400 μg/mL powder concentration indicates that these materials are non-cytotoxic. The active effects of samples on proliferation and differentiation of osteoblast cells (MC3T3-E1) are certified by MTT and alkaline phosphatase (ALP) activity assays. The adhesion and proliferation of osteoblast measurement manifest that amounts of MC3T3-E1 advances about 1.86 times for ZnSrF/HAp compared with undoped HAp. This achievement may inspire us on the artificial design of new-style bionic bone grafts using trace bioactive elements and also suggest its latent applications in orthopedic surgery and bone osseointegration.

In vitro corrosion behavior and biocompatibility of nanostructured Ti6Al4V

Ti6Al4V (TC4) alloy has long been used as a bone interfacing implant material in dentistry and orthopedics due to its excellent biocompatibility and mechanical properties. The performance of TC4 can be further tailored by altering its grain structures. In this study, by means of sliding friction treatment (SFT), a nano-grained (NG) surface layer with an average grain size of ≤100 nm on the topmost surface was successfully generated on coarse-grained (CG) TC4 alloy sheet. It was shown that the NG surface possessed notably enhanced corrosion resistance in physiological solution compared to the CG surface, due to the formation of thicker and denser passive film facilitated by surface nanocrystallization. Additionally, the NG surface with stronger hydrophilicity favorably altered the absorption of anchoring proteins such as fibronectin (Fn) and vitronectin (Vn) that can mediate subsequent osteoblast functions. The in vitro results indicated that the NG surface exhibited remarkable enhancement in osteoblast adherence, spreading and proliferation, and obviously accelerated the osteoblast differentiation as compared to CG surface. Moreover, the NG surface also demonstrated good hemocompatibility. These findings suggest that SFT can endure bio-metals with advanced multifunctional properties for biomedical applications.

Superhydrophobic Microporous Substrates via Photocuring: Coupling Optical Pattern Formation to Phase Separation for Process-Tunable Pore Architectures

We present a new approach to synthesize microporous surfaces through the combination of photopolymerization-induced phase separation and light pattern formation in photopolymer-solvent mixtures. The mixtures are irradiated with a wide-area light pattern consisting of high and low intensity regions. This light pattern undergoes self-focusing and filamentation, thereby preserving its spatial profile through the mixture. Over the course of irradiation, the mixture undergoes phase separation, with the polymer and solvent located in the bright and dark regions of the light profile, respectively, to produce a binary phase morphology with a congruent arrangement as the optical pattern. A congruently arranged microporous structure is attained upon solvent removal. The microporous surface structure can be varied by changing the irradiating light profile via photomask design. The porous architecture can be further tuned through the relative weight fractions of photopolymer and solvent in the mixture, resulting in porosities ranging from those with discrete and uniform pore sizes to hierarchical pore distributions. All surfaces become superhydrophobic (water contact angles >150°) when spray-coated with a thin layer of polytetrafluoroethylene nanoparticles. The water contact angles can be enhanced by changing the surface porosity via the processing conditions. This is a scalable and tunable approach to precisely control microporous surface structure in thin films to create functional surfaces and antiwetting coatings.

The effects of Sr-incorporated micro/nano rough titanium surface on rBMSC migration and osteogenic differentiation for rapid osteointegration

MNT-Sr can promote rBMSC osteogenic differentiation and significantly enhance rBMSC migration and homing via activation of SDF-1α/CXCR4 signaling.

Strontium-loaded titania nanotube arrays repress osteoclast differentiation through multiple signalling pathways: In vitro and in vivo studies

The loosening of implants is an important clinical issue, particularly for patients with osteoporosis. In these patients, an implant should preferably both promote osteoblast differentiation and repress osteoclastic resorption. In the present study, we fabricated coatings containing TiO2 nanotubes (NTs) incorporated with strontium (Sr) on titanium (Ti) surfaces through hydrothermal treatment. The amount of loaded Sr was controlled by hydrothermally treating the samples in a Sr(OH)2 solution for 1 and 3 h (samples NT-Sr1h and NT-Sr3h, respectively) and found that both types of NT-Sr samples inhibited osteoclast differentiation by reducing the expression of osteoclast marker genes. Additionally, this inhibitory effect was mainly attributed to suppression of RANKL-induced activation of nuclear factor-κB (NF-κB). Moreover, NT-Sr also inhibited the Akt and nuclear factor of activated T-cell cytoplasmic 1 (NFATc1) signalling pathways. Interestingly, we also found that NT-Sr promoted RANKL-induced extracellular signal-regulated kinase (ERK) phosphorylation. Using ovariectomised rats as a model, we observed that NT-Sr prevented bone loss in vivo. In conclusion, our findings demonstrate that NT-Sr might effectively inhibit osteoclast differentiation by repressing the NF-κB and Akt/NFATc1 pathways and by negatively regulating the ERK pathway in vitro and in vivo.

Synergetic Cues of Bioactive Nanoparticles and Nanofibrous Structure in Bone Scaffolds to Stimulate Osteogenesis and Angiogenesis

Providing a nanotopological physical cue in concert with a bioactive chemical signal within 3D scaffolds, while it being considered a promising approach for bone regeneration, has yet to be explored. Here, we develop 3D porous scaffolds that are networked to be a nanofibrous structure and incorporated with bioactive glass nanoparticles (BGn) to tackle this issue. The presence of BGn and nanofibrous structure (BGn + nanofibrous) substantially increased the surface area, hydro-affinity and protein loading capacity of scaffolds. In particular, the BGn released Si and Ca ions to the levels known to be biologically effective, offering the bone scaffold an ability to deliver therapeutic ions. The mesenchymal stem cells (MSCs) from rats exhibited significantly accelerated adhesion events including cell anchorage, cytoskeletal extensions, and the expression of adhesion signaling molecules on the BGn/nanofibrous scaffolds. The cells gained a more rapid proliferation and migration (penetration) ability over 2 weeks within the BGn + nanofibrous scaffolds than within either nanofibrous or BGn scaffolds. The osteogenesis of MSCs, as confirmed by the expressions of bone-associated genes and proteins, as well as the cellular mineralization was significantly stimulated by the BGn and nanofibrous topology in a synergistic manner. The behaviors of endothelial cells (HUVECs) including cell migration and tubule networking were also enhanced when influenced by the BGn and nanofibrous scaffolds (but more by BGn than by nanofiber). A subcutaneous tissue implantation of the scaffolds further evidenced the in vivo stimulation of neo-blood vessel formation by the BGn + nanofibrous cues, suggesting the possible promising role in bone regeneration. Taken together, the therapeutic ions and nanofibrous topology implemented within 3D scaffolds are considered to play synergistic actions in osteogenesis and angiogenesis, implying the potential usefulness of the BGn + nanofibrous scaffolds for bone tissue engineering.

Significantly enhanced osteoblast response to nano-grained pure tantalum

Tantalum (Ta) metal is receiving increasing interest as biomaterial for load-bearing orthopedic applications and the synthetic properties of Ta can be tailored by altering its grain structures. This study evaluates the capability of sliding friction treatment (SFT) technique to modulate the comprehensive performances of pure Ta. Specifically, novel nanocrystalline (NC) surface with extremely small grains (average grain size of ≤20 nm) was fabricated on conventional coarse-grained (CG) Ta by SFT. It shows that NC surface possessed higher surface hydrophilicity and enhanced corrosion resistance than CG surface. Additionally, the NC surface adsorbed a notably higher percentage of protein as compared to CG surface. The in vitro results indicated that in the initial culture stages (up to 24 h), the NC surface exhibited considerably enhanced osteoblast adherence and spreading, consistent with demonstrated superior hydrophilicity on NC surface. Furthermore, within the 14 days culture period, NC Ta surface exhibited a remarkable enhancement in osteoblast cell proliferation, maturation and mineralization as compared to CG surface. Ultimately, the improved osteoblast functions together with the good mechanical and anti-corrosion properties render the SFT-processed Ta a promising alternative for the load-bearing bone implant applications.