Tailoring hierarchical meso-macroporous 3D scaffolds: from nano to macro

An overview of translational research in bone graft biomaterials

Natural bone healing is often inadequate to treat fractures with critical size bone defects and massive bone loss. Immediate surgical interventions through bone grafts have been found to be essential on such occasions. Naturally harvested bone grafts, although are the preferred choice of the surgeons; they suffer from serious clinical limitations, including disease transmission, donor site morbidity, limited supply of graft etc. Synthetic bone grafts, on the other hand, offer a more clinically appealing approach to decode the pathways of bone repair through use of tissue engineered biomaterials. This article critically retrospects the translational research on various engineered biomaterials towards bringing transformative changes in orthopaedic healthcare. The first section of the article discusses about composition and ultrastructure of bone along with the global perspectives on statistical escalation of bone fracture surgeries requiring use of bone grafts. The next section reviews the types, benefits and challenges of various natural and synthetic bone grafts. An overview of clinically relevant biomaterials from traditionally used metallic, bioceramic, and biopolymeric biomaterials to new generation composites have been summarised. Finally, this narrative review concludes with the discussion on the emerging trends and future perspectives of the promising bone grafts.

Surface Tailoring of 3D Scaffolds to Promote Osteogenic Differentiation

Customized bone scaffolds with osteogenic activities are desired for the regenerative repair of large-scale or irregularly shaped bone defects. This study developed a facile method to create osteogenic surfaces on three-dimensional (3D) printed scaffolds through coating-induced mineralization. The coating was synthesized using chemical vapor deposition of a polyelectrolyte containing oppositely charged groups. The opposite charges on the 3D scaffold played a crucial role in promoting the formation of nanoapatites without agglomeration, resulting in the retention of micro- and nanoscale pore openings needed for preosteoblasts to proliferate, differentiate, and migrate. The nanoapatite scaffold exhibited significant enhancement in osteoinductivity with a 107% increase in alkaline phosphatase expression and a 163% increase in osteocalcin activity compared to the pristine scaffold. The nanoapatite scaffold provided cues for preosteoblasts to grow along aligned features and migrate collectively. The findings of this study demonstrate the synergistic effect of oppositely charged polyelectrolytes and mineralized nanoapatites on promoting osteogenic activities on scaffold surfaces.

Antibacterial effect of 3D printed mesoporous bioactive glass scaffolds doped with metallic silver nanoparticles

The development of new biomaterials for bone tissue regeneration with high bioactivity abilities and antibacterial properties is being intensively investigated. We have synthesized nanocomposites formed by mesoporous bioactive glasses (MBGs) in the ternary SiO₂, CaO and P₂O₅ system doped with metallic silver nanoparticles (AgNPs) that were homogenously embedded in the MBG matrices. Ag/MBG nanocomposites have been directly synthesized and silver species were spontaneously reduced to metallic AgNPs by high temperatures (700 °C) obtained of last MBG synthesis step. Three-dimensional silver-containing mesoporous bioactive glass scaffolds were fabricated showing uniformly interconnected ultrapores, macropores and mesopores. The manufacture method consisted of a combination of a single-step sol-gel route in the mesostructure directing agent (P123) presence and a biomacromolecular polymer such as (hydroxypropyl)methyl cellulose (HPMC) as the macrostructure template, followed by rapid prototyping (RP) technique. Biological properties of Ag/MBG nanocomposites were evaluated by MC3T3-E1 preosteoblastic cells culture tests and bacterial (E. coli and S. aureus) assays. The results showed that the MC3T3-E1 cells morphology was not affected while preosteoblastic proliferation decreased when the presence of silver increased. Antimicrobial assays indicated that bacterial growth inhibition and biofilm destruction were directly proportional to the increased presence of AgNPs in the MBG matrices. Furthermore, in vitro co-culture of MC3T3-E1 cells and S. aureus bacteria confirmed that AgNPs presence was necessary for antibacterial activity, and AgNPs slightly affected cell proliferation parameters. Therefore, 3D printed scaffolds with hierarchical pore structure and high antimicrobial capacity have potential applications in bone tissue regeneration. STATEMENT OF SIGNIFICANCE: This study combines three key scientific aspects for bone tissue engineering: (i) materials with high bioactivity to repair and regenerate bone tissue that (ii) contain antibacterial agents to reduce the infection risk (iii) in the form of three-dimensional scaffolds with hierarchical porosity. Innovative methodology is described here: sol-gel method, which is employed to obtain mesoporous bioactive glass matrices doped with metallic silver nanoparticles where different polymer templates facilitate the different size scales presence, and rapid prototyping technique that provides ultra-large macroporosity according to computer-aided design. The dual scaffolds obtained are biocompatible and deliver active doses of silver capable of combating bone infections, which represent one of the most serious complications associated to surgical treatments of bone diseases and fractures.

Engineered nanostructures within sol-gel bioactive glass for enhanced bioactivity and modulated drug delivery

The engineering of nanocrystalline phase in amorphous oxide materials such as bioactive glass is emerging as a new area of great technological and scientific interest in the field of biomaterials. This study reports for the first time the infusion of apatite nanocrystals in sol-gel-derived bioactive glass using P123 as the structure-directing agent. The synthesis of a multicomponent 80SiO₂-15CaO-5P₂O₅ bioactive glass material having a hierarchically ordered mesoporous structure with uniformly grown nanocrystals of apatite was achieved through a sono-assisted surfactant-templated sol-gel method. The bulk crystallographic analysis together with microstructural characterizations shows that the nanocrystalline apatite domains are uniformly dispersed as well as embedded along the mesopores. These nanocrystalline domains were found to influence the textural properties. In addition, macroscopic evidence for higher signs of bonelike matrix formation was observed by the biomineralization study in simulated body fluids. Osteostimulatory effects of these glass samples were evident by cultures in a osteogenic and non-osteogenic mediums with human osteosarcoma cells and a higher osteopromotive potential was authenticated by the alkaline phosphatase activity and alizarin red staining. Further, this study shows a new strategy to prolong the drug release period on account of the nanocrystalline phase and hierarchically positioned mesopores, thus making it a better drug delivery matrix as well.

Mesoporous Bioglasses Enriched with Bioactive Agents for Bone Repair, with a Special Highlight of María Vallet-Regí’s Contribution

Throughout her impressive scientific career, Prof. María Vallet-Regí opened various research lines aimed at designing new bioceramics, including mesoporous bioactive glasses for bone tissue engineering applications. These bioactive glasses can be considered a spin-off of silica mesoporous materials because they are designed with a similar technical approach. Mesoporous glasses in addition to SiO₂ contain significant amounts of other oxides, particularly CaO and P₂O₅ and therefore, they exhibit quite different properties and clinical applications than mesoporous silica compounds. Both materials exhibit ordered mesoporous structures with a very narrow pore size distribution that are achieved by using surfactants during their synthesis. The characteristics of mesoporous glasses made them suitable to be enriched with various osteogenic agents, namely inorganic ions and biopeptides as well as mesenchymal cells. In the present review, we summarize the evolution of mesoporous bioactive glasses research for bone repair, with a special highlight on the impact of Prof. María Vallet-Regí´s contribution to the field.

Design of 3D Scaffolds for Hard Tissue Engineering: From Apatites to Silicon Mesoporous Materials

Advanced bioceramics for bone regeneration constitutes one of the pivotal interests in the multidisciplinary and far-sighted scientific trajectory of Prof. Vallet Regí. The different pathologies that affect osseous tissue substitution are considered to be one of the most important challenges from the health, social and economic point of view. 3D scaffolds based on bioceramics that mimic the composition, environment, microstructure and pore architecture of hard tissues is a consolidated response to such concerns. This review describes not only the different types of materials utilized: from apatite-type to silicon mesoporous materials, but also the fabrication techniques employed to design and adequate microstructure, a hierarchical porosity (from nano to macro scale), a cell-friendly surface; the inclusion of different type of biomolecules, drugs or cells within these scaffolds and the influence on their successful performance is thoughtfully reviewed.

The effect of biomimetic mineralization of 3D-printed mesoporous bioglass scaffolds on physical properties and in vitro osteogenicity

Three-dimensional Mesoporous bioactive glasses (MBGs) scaffolds has been widely considered for bone regeneration purposes and additive manufacturing enables the fabrication of highly bioactive patient-specific constructs for bone defects. Commonly, this process is performed with the addition of polymeric binders that facilitate the printability of scaffolds. However, these additives cover the MBG particles resulting in the reduction of their osteogenic potential. The present work investigates a simple yet effective phosphate-buffered saline immersion method for achieving polyvinyl alcohol binder removal while enables the maintenance of the mesoporous structure of MBG 3D-printed scaffolds. This resulted in significantly modifying the surface of the scaffold via the spontaneous formation of a biomimetic mineralized layer which positively affected the physical and biological properties of the scaffold. The extensive surface remodeling induced by the deposition of the apatite-like layer lead to a 3-fold increase in surface area, a 5-fold increase in the roughness, and 4-fold increase in the hardness of the PBS-immersed scaffolds when compared to the as-printed counterpart. The biomimetic mineralization also occurred throughout the bulk of the scaffold connecting the MBGs particles and was responsible for the maintenance of structural integrity. In vitro assays using MC3T3-E1 pre-osteoblast like cells demonstrated a significant upregulation of osteogenic-related genes for the scaffolds previously immersed in PBS when compared to the as-printed PVA-containing scaffolds. Although the pre-immersion scaffolds performed equally towards osteogenic cell differentiation, our data suggest that a short immersion in PBS of MBG scaffolds is beneficial for the osteogenic properties and might accelerate bone formation after implantation.

Mesoporous bioactive glasses for bone healing and biomolecules delivery

Impact of bone diseases and injury is increasing at an enormous rate during the past decades due to increase in road traffic accidents and other injuries. Bioactive glasses have excellent biocompatibility and osteoconductivity that makes it suitable for bone regeneration. Researches and studies conducted on several bioactive glasses gives an insight on the need of multi-disciplinary approaches involving various scientific fields to attain its full potential. Of late, a next generation bioactive glass called as mesoporous bioactive glass (MBG) has been developed with higher specific surface area and control over mesoporous structure that presents a new material for bone regeneration. A brief discussion and overview on the potential use of MBG as a suitable material for bone tissue regeneration and biomolecule delivery is included. Additionally, possible control of the structural and functional property based on composition and fabrication techniques are also covered. According to recent researches, MBG-implant interaction with bone forming cells for cellular growth and differentiation as well as its effect on delivery of growth factor, both in vitro and in vivo, are optimistic; yet, the complete efficacy of this material is still to be explored. Hence, in this article we will review the current development and its applications for bone tissue engineering (TE).

The Role of Zwitterionic Materials in the Fight against Proteins and Bacteria

Zwitterionization of biomaterials has been heightened to a potent tool to develop biocompatible materials that are able to inhibit bacterial and non-specific proteins adhesion. This constitutes a major progress in the biomedical field. This manuscript overviews the main functionalization strategies that have been reported up to date to design and develop these advanced biomaterials. On this regard, the recent research efforts that were dedicated to provide their surface of zwitterionic nature are summarized by classifying biomaterials in two main groups. First, we centre on biomaterials in clinical use, concretely bioceramics, and metallic implants. Finally, we revise emerging nanostructured biomaterials, which are receiving growing attention due to their multifunctionality and versatility mainly in the local drug delivery and bone tissue regeneration scenarios.

Multifunctional pH sensitive 3D scaffolds for treatment and prevention of bone infection

Multifunctional-therapeutic three-dimensional (3D) scaffolds have been prepared. These biomaterials are able to destroy the S. aureus bacterial biofilm and to allow bone regeneration at the same time. The present study is focused on the design of pH sensitive 3D hierarchical meso-macroporous 3D scaffolds based on MGHA nanocomposite formed by a mesostructured glassy network with embedded hydroxyapatite nanoparticles, whose mesopores have been loaded with levofloxacin (Levo) as antibacterial agent. These 3D platforms exhibit controlled and pH-dependent Levo release, sustained over time at physiological pH (7.4) and notably increased at infection pH (6.7 and 5.5), which is due to the different interaction rate between diverse Levo species and the silica matrix. These 3D systems are able to inhibit the S. aureus growth and to destroy the bacterial biofilm without cytotoxic effects on human osteoblasts and allowing an adequate colonization and differentiation of preosteoblastic cells on their surface. These findings suggest promising applications of these hierarchical MGHA nanocomposite 3D scaffolds for the treatment and prevention of bone infection.

STATEMENT OF SIGNIFICANCE

Multifunctional 3D nanocomposite scaffolds with the ability for loading and sustained delivery of an antimicrobial agent, to eliminate and prevent bone infection and at the same time to contribute to bone regeneration process without cytotoxic effects on the surrounding tissue has been proposed. These 3D scaffolds exhibit a sustained levofloxacin delivery at physiological pH (pH 7.4), which increasing notably when pH decreases to characteristic values of bone infection process (pH 6.7 and pH 5.5). In vitro competitive assays between preosteoblastic and bacteria onto the 3D scaffold surface demonstrated an adequate osteoblast colonization in entire scaffold surface together with the ability to eliminate bacteria contamination.

Prevention of bacterial adhesion to zwitterionic biocompatible mesoporous glasses

Novel materials, based on Mesoporous Bioactive Glasses (MBGs) in the ternary system SiO₂-CaO-P₂O₅, decorated with (3-aminopropyl)triethoxysilane (APTES) and subsequently with amino acid Lysine (Lys), by post-grafting method on the external surface of the glasses (named MBG-NH₂ and MBG-Lys), are reported. The surface functionalization with organic groups did not damage the mesoporous network and their structural and textural properties were also preserved despite the high solubility of MBG matrices. The incorporation of Lys confers a zwitterionic nature to these MBG materials due to the presence of adjacent amine and carboxylic groups in the external surface. At physiologic pH, this coexistence of basic amine and carboxilic acid groups from anchored Lys provided zero surface charge named zwitterionic effect. This behaviour could give rise to potential applications of antibacterial adhesion. Therefore, in order to assess the influence of zwitterionic nature in in vitro bacterial adhesion, studies were carried out with Staphylococcus aureus. It was demonstrated that the efficient interaction of these zwitterionic pairs onto the MBG surfaces reduced bacterial adhesion up to 99.9% compared to bare MBGs. In order to test the suitability of zwitterionic MBGs materials as bone grafts, their cytocompatibility was investigated in vitro with MC3T3-E1 preosteoblasts. These findings suggested that the proposed surface functionalization strategy provided MBG materials with notable antibacterial adhesion properties, hence making these materials promising candidates for local bone infection therapy.

STATEMENT OF SIGNIFICANCE

The present research work is focused in finding a preventive treatment of bone infection based on Mesoporous Bioactive Glasses (MBGs) with antibacterial adhesion properties obtained by zwitterionic surface modification. MBGs exhibit unique nanostructural, textural and bioactive characteristics. The novelty and originality of this manuscript is based on the design and optimization of a straightforward functionalization method capable of providing MBGs with zwitterionic surfaces that are able to inhibit bacterial adhesion without affecting their cytocompatibility. This new characteristic enhanced the MBG properties to avoid the bacterial adherence onto the implant surfaces for bone tissue engineering applications. Subsequently, it could help to decrease the infection rates after implantation surgery, which represents one of the most serious complications associated to surgical treatments of bone diseases and fractures.

3D scaffold with effective multidrug sequential release against bacteria biofilm

Bone infection is a feared complication following surgery or trauma that remains as an extremely difficult disease to deal with. So far, the outcome of therapy could be improved with the design of 3D implants, which combine the merits of osseous regeneration and local multidrug therapy so as to avoid bacterial growth, drug resistance and the feared side effects. Herein, hierarchical 3D multidrug scaffolds based on nanocomposite bioceramic and polyvinyl alcohol (PVA) prepared by rapid prototyping with an external coating of gelatin-glutaraldehyde (Gel-Glu) have been fabricated. These 3D scaffolds contain three antimicrobial agents (rifampin, levofloxacin and vancomycin), which have been localized in different compartments of the scaffold to obtain different release kinetics and more effective combined therapy. Levofloxacin was loaded into the mesopores of nanocomposite bioceramic part, vancomycin was localized into PVA biopolymer part and rifampin was loaded in the external coating of Gel-Glu. The obtained results show an early and fast release of rifampin followed by sustained and prolonged release of vancomycin and levofloxacin, respectively, which are mainly governed by the progressive in vitro degradability rate of these scaffolds. This combined therapy is able to destroy Gram-positive and Gram-negative bacteria biofilms as well as inhibit the bacteria growth. In addition, these multifunctional scaffolds exhibit excellent bioactivity as well as good biocompatibility with complete cell colonization of preosteoblast in the entire surface, ensuring good bone regeneration. These findings suggest that these hierarchical 3D multidrug scaffolds are promising candidates as platforms for local bone infection therapy.

STATEMENT OF SIGNIFICANCE

The present study is focused in finding an adequate therapeutic solution for the treatment of bone infection based on 3D multifunctional scaffolds, which combines the merits of osseous regeneration and local multidrug delivery. These 3D multidrug scaffolds, containing rifampin, levofloxacin and vancomycin, localized in different compartments to achieve different release kinetics. These 3D multidrug scaffolds displays an early and fast release of rifampin followed by sustained and prolonged release of vancomycin and levofloxacin, which are able to destroy Staphylococcus and Escherichia biofilms as well as inhibit bacteria growth in very short time periods. This new combined therapy approach involving the sequential delivery of antibiofilms with antibiotics constitutes an excellent and promising alternative for bone infection treatment.

Fabrication and biocompatibility of poly(l-lactic acid) and chitosan composite scaffolds with hierarchical microstructures

The scaffold microstructure is crucial to reconstruct tissue normal functions. In this article, poly(l-lactic acid) and chitosan fiber (PLLA/CTSF) composite scaffolds with hierarchical microstructures both in fiber and pore sizes were successfully fabricated by combining thermal induced phase separation and salt leaching techniques. The composite scaffolds consisted of a nanofibrous PLLA matrix with diameter of 50-500nm, and chitosan fibers with diameter of about 20μm were homogenously distributed in the PLLA matrix as a microsized reinforcer. The composite scaffolds also had high porosity (>94%) and hierarchical pore size, which were consisted of both micropores (50nm-10μm) and macropores (50-300μm). By tailoring the microstructure and chemical composition, the mechanical property, pH buffer and protein adsorption capacity of the composite scaffold were improved significantly compared with those of PLLA scaffold. Cell culture results also revealed that the PLLA/CTSF composite scaffolds supported MG-63 osteoblast proliferation and penetration.

The effect of fiber size and pore size on cell proliferation and infiltration in PLLA scaffolds on bone tissue engineering

The scaffold microstructure has a great impact on cell functions in tissue engineering. Herein, the PLLA scaffolds with hierarchical fiber size and pore size were successfully fabricated by thermal-induced phase separation or combined thermal-induced phase separation and salt leaching methods. The PLLA scaffolds were fabricated as microfibrous scaffolds, microfibrous scaffolds with macropores (50–350 µm), nanofibrous scaffolds with micropores (100 nm to 10 µm), and nanofibrous scaffolds with both macropores and micropores by tailoring selective solvents for forming different fiber size and pre-sieved salts for creating controlled pore size. Among the four kinds of PLLA scaffolds, the nanofibrous scaffolds with both macropores and micropores provided a favorable microenvironment for protein adsorption, cell proliferation, and cell infiltration. The results further confirmed the significance of fiber size and pore size on the biological properties, and a scaffold with both micropores and macropores, and a nanofibrous matrix might have promising applications in bone tissue engineering.

Pickering high internal phase emulsion-based hydroxyapatite-poly(ε-caprolactone) nanocomposite scaffolds

Biocompatible, biodegradable and bioactive nanocomposite (NC) scaffolds with well-defined interconnected porous structures have attracted increasing attention in bone tissue engineering. In this work, we develop a facile method to fabricate poly(l-lactic acid)-modified hydroxyapatite (g-HAp)-poly(ε-caprolactone) (PCL) NC porous scaffolds by solvent evaporation based on water-in-dichloromethane (W/O) Pickering high internal phase emulsion (HIPE) templates, which are stabilized using g-HAp nanoparticles. The resultant porous scaffolds demonstrate interconnected and rough pore structures, which can be adjusted readily by varying g-HAp nanoparticle concentration, PCL concentration and the internal phase volume fraction. Moreover, the investigation of mechanical properties and in vitro biomineralization activity shows that the Young's modulus, compressive stress and bioactivity of the fabricated porous scaffolds are significantly enhanced upon increasing the g-HAp nanoparticle concentration. In addition, in vitro drug release studies of the porous scaffolds using ibuprofen (IBU) as a model drug show that the loaded IBU displays a sustained release profile. In vitro cell culture assays confirm that mouse bone mesenchymal stem cells can adhere, spread, and proliferate on the porous scaffolds, indicating that the porous scaffolds are biocompatible. All these results suggest that the fabricated g-HAp-PCL NC scaffolds have a promising potential for bone tissue engineering application.

Mesoporous bioactive glasses: Relevance of their porous structure compared to that of classical bioglasses

In the last decade, the development of third generation bioceramics for Bone Tissue Regeneration has experienced significant progress with the emergence of a new generation of nanostructured materials named mesoporous bioactive glasses (MBG). This new generation of materials, also known as “templated glasses”, presents chemical compositions similar to those of conventional bioactive sol–gel glasses and the added value of an ordered mesopore arrangement. This article shows an indepth comparative study of the ordered porous structures of MBGs compared to conventional glasses (melt and solgel) andhowthese properties influence the bioactivity process. Moreover, the possibility to tailor the textural and structural properties of these nanostructured materials by an exhaustive control of the different synthesis parameters is also discussed. A brief overview regarding the possibility of using these materials as controlled drug delivery systems and as starting materials for the fabrication of 3D scaffolds for bone tissue regeneration is also given.

Physical and biological activities of newly designed, macro-pore-structure-controlled 3D fibrous poly(ε-caprolactone)/hydroxyapatite composite scaffolds

A 3D fibrous scaffold using an electrohydrodynamic jet process supplemented with in vitro mineralization to obtain a hydroxyapatite layer in simulated body fluid was fabricated.

Effects of 3D nanocomposite bioceramic scaffolds on the immune response

The interaction of new nanocomposite mesoporous glass/hydroxyapatite (MGHA) scaffolds with immune cells involved in both innate and acquired immunity has been studied in vitro as an essential aspect of their biocompatibility assessment. Since the immune response can be affected by the degradation products of bioresorbable scaffolds and scaffold surface changes, both processes have been evaluated. No alterations in proliferation and viability of RAW-264.7 macrophage-like cells were detected after culture on MGHA scaffolds which did not induce cell apoptosis. However, a slight cell size decrease and an intracellular calcium content increase were observed after contact of this cell line with MGHA scaffolds or their extracts. Although no changes in the percentages of RAW cells with low and high contents of reactive oxygen species (ROS) are observed by the treatment with 7 day extracts, this study has revealed modifications of these percentages after direct contact with scaffolds and by the treatment with 24 h extracts, related to the high reactivity/bioactivity of this MGHA nanocomposite at initial times. Furthermore, when normal fresh murine spleen cells were used as an experimental model closer to physiological conditions, no significant alterations in the activation of different immune cell subpopulations were detected in the presence of 24 h MGHA extract. MGHA scaffolds did not affect either the spontaneous apoptosis or intracellular cytokine expression (IL-2, IL-10, IFN-γ, and TNF-α) after 24 h treatment. The results obtained in the present study with murine immune cell subpopulations (macrophages, lymphocytes B, lymphocytes T and natural killer cells) support the biocompatibility of the MGHA material and suggest an adequate host tissue response to their scaffolds upon their implantation.

Enhancing in vitro bioactivity and in vivo osteogenesis of organic–inorganic nanofibrous biocomposites with novel bioceramics

MGHA-introduced, an electrospun SF-based composite can exhibit improved physicochemical and biological properties to stimulate bone tissue regeneration and repair.