Understanding the basis of medical use of poly-lactide-based resorbable polymers and composites – a review of the clinical and metabolic impact

Degradable biomedical elastomers: paving the future of tissue repair and regenerative medicine

Degradable biomedical elastomers (DBE), characterized by controlled biodegradability, excellent biocompatibility, tailored elasticity, and favorable network design and processability, have become indispensable in tissue repair. This review critically examines the recent advances of biodegradable elastomers for tissue repair, focusing mainly on degradation mechanisms and evaluation, synthesis and crosslinking methods, microstructure design, processing techniques, and tissue repair applications. The review explores the material composition and cross-linking methods of elastomers used in tissue repair, addressing chemistry-related challenges and structural design considerations. In addition, this review focuses on the processing methods of two- and three-dimensional structures of elastomers, and systematically discusses the contribution of processing methods such as solvent casting, electrostatic spinning, and three-/four-dimensional printing of DBE. Furthermore, we describe recent advances in tissue repair using DBE, and include advances achieved in regenerating different tissues, including nerves, tendons, muscle, cardiac, and bone, highlighting their efficacy and versatility. The review concludes by discussing the current challenges in material selection, biodegradation, bioactivation, and manufacturing in tissue repair, and suggests future research directions. This concise yet comprehensive analysis aims to provide valuable insights and technical guidance for advances in DBE for tissue engineering.

Medical-Grade Poly(Lactic Acid)/Hydroxyapatite Composite Films: Thermal and In Vitro Degradation Properties

Production of biocompatible composite scaffolds shifts towards additive manufacturing where thermoplastic biodegradable polymers such as poly(lactic acid) (PLA) are used as matrices. Differences between industrial- and medical-grade polymers are often overlooked although they may affect properties and degradation behaviour as significantly as the filler addition. In the present research, composite films based on medical-grade PLA and biogenic hydroxyapatite (HAp) with 0, 10, and 20 wt.% of HAp were prepared by solvent casting technique. The degradation of composites incubated in phosphate-buffered saline solution (PBS) at 37 °C after 10 weeks showed that the higher HAp content slowed down the hydrolytic PLA degradation and improved its thermal stability. Morphological nonuniformity after degradation was indicated by the different glass transition temperatures (T_g) throughout the film. The T_g of the inner part of the sample decreased significantly faster compared with the outer part. The decrease was observed prior to the weight loss of composite samples.

Biocompatibility and degradation comparisons of four biodegradable copolymeric osteosynthesis systems used in maxillofacial surgery: A goat model with four years follow-up

Applying biodegradable osteosyntheses avoids the disadvantages of titanium osteosyntheses. However, foreign-body reactions remain a major concern and evidence of complete resorption is lacking. This study compared the physico-chemical properties, histological response and radiographs of four copolymeric biodegradable osteosynthesis systems in a goat model with 48-months follow-up. The systems were implanted subperiosteally in both tibia and radius of 12 Dutch White goats. The BioSorb FX [poly(70LLA-co-30DLLA)], Inion CPS [poly([70–78.5]LLA-co-[16–24]DLLA-co-4TMC)], SonicWeld Rx [poly(DLLA)], LactoSorb [poly(82LLA-co-18GA)] systems and a negative control were randomly implanted in each extremity. Samples were assessed at 6-, 12-, 18-, 24-, 36-, and 48-month follow-up. Surface topography was performed using scanning electron microscopy (SEM). Differential scanning calorimetry and gel permeation chromatography were performed on initial and explanted samples. Histological sections were systematically assessed by two blinded researchers using (polarized) light microscopy, SEM and energy-dispersive X-ray analysis. The SonicWeld Rx system was amorphous while the others were semi-crystalline. Foreign-body reactions were not observed during the complete follow-up. The SonicWeld Rx and LactoSorb systems reached bone percentages of negative controls after 18 months while the BioSorb Fx and Inion CPS systems reached these levels after 36 months. The SonicWeld Rx system showed the most predictable degradation profile. All the biodegradable systems were safe to use and well-tolerated (i.e., complete implant replacement by bone, no clinical or histological foreign body reactions, no [sterile] abscess formation, no re-interventions needed), but nanoscale residual polymeric fragments were observed at every system's assessment.

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Foreign-body reactions are a major concern of biodegradable osteosyntheses.

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Amorphous poly(DLLA) showed the most predictable degradation profile.

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Nanoscale residual polymeric fragments could still be observed after 4 years.

PLA Renewable Bio Polymer Based Solid-State Gamma Radiation Detector-Dosimeter for Biomedical and Nuclear Industry Applications

Polylactic acid (PLA) as a "green," renewable corn-soy based polymer resin was assessed as a novel solid-state detector for rapid-turnaround gamma radiation dosimetry in the 1-100 kGy range-of significant interest in biomedical and general nuclear industry applications. Co-60 was used as the source of gamma photons. It was found that PLA resin responds well in terms of rheology and porosity metrics with an absorbed gamma dose (Dg). In this work, rheological changes were ascertained via measuring the differential mass loss ratio (MLR) of irradiated PLA placed within PTFE-framed (40 mm × 20 mm × 0.77 mm) cavities bearing ~0.9 g of PLA resin and pressed for 12-16 min in a controlled force hot press under ~6.6 kN loading and platens heated to 227 °C for the low Dg range: 0-11 kGy; and to 193 °C for the extended Dg range: 11-120 kGy. MLR varied quadratically from 0.05 to ~0.2 (1σ ~ 0.007) in the 0-11 kGy experiments, and from 0.05 to ~0.5 (1σ ~0.01) in the 0-120 kGy experiments. Rheological changes from gamma irradiation were modeled and simultaneously correlated with void-pocket formations, which increase with Dg. A single PLA resin bead (~0.04 g) was compressed 5 min at 216 °C in 0-16 kGy experiments, and compressed 2 min at 232 °C in the 16-110 kGy experiments, to form sturdy ~100 µm thick wafers in the same press. Aggregate coupon porosity was then readily measurable with conventional optical microscope imaging and analyzed with standard image processing; this provided complementary data to MLR. Average porosity vs. dose varied quadratically from ~0 to ~15% in the 0-16 kGy range and from ~0 to ~18% over the 16-114 kGy range. These results provide evidence for utilizing "green"/renewable (under $0.01) PLA resin beads for rapid and accurate (+/-5-10%) gamma dosimetry over a wide 0-120 kGy range, using simple to deploy mass and void measuring techniques using common laboratory equipment.

Titanium or Biodegradable Osteosynthesis in Maxillofacial Surgery? In Vitro and In Vivo Performances

Osteosynthesis systems are used to fixate bone segments in maxillofacial surgery. Titanium osteosynthesis systems are currently the gold standard. However, the disadvantages result in symptomatic removal in up to 40% of cases. Biodegradable osteosynthesis systems, composed of degradable polymers, could reduce the need for removal of osteosynthesis systems while avoiding the aforementioned disadvantages of titanium osteosyntheses. However, disadvantages of biodegradable systems include decreased mechanical properties and possible foreign body reactions. In this review, the literature that focused on the in vitro and in vivo performances of biodegradable and titanium osteosyntheses is discussed. The focus was on factors underlying the favorable clinical outcome of osteosyntheses, including the degradation characteristics of biodegradable osteosyntheses and the host response they elicit. Furthermore, recommendations for clinical usage and future research are given. Based on the available (clinical) evidence, biodegradable copolymeric osteosyntheses are a viable alternative to titanium osteosyntheses when applied to treat maxillofacial trauma, with similar efficacy and significantly lower symptomatic osteosynthesis removal. For orthognathic surgery, biodegradable copolymeric osteosyntheses are a valid alternative to titanium osteosyntheses, but a longer operation time is needed. An osteosynthesis system composed of an amorphous copolymer, preferably using ultrasound welding with well-contoured shapes and sufficient mechanical properties, has the greatest potential as a biocompatible biodegradable copolymeric osteosynthesis system. Future research should focus on surface modifications (e.g., nanogel coatings) and novel biodegradable materials (e.g., magnesium alloys and silk) to address the disadvantages of current osteosynthesis systems.

Mechanical properties of fibre/ filler based poly(Lactic Acid) (Pla) composites : A brief review

Being a biodegradable polymer, poly(lactic acid) (PLA) based composites receive greater preference over non-biodegradable plastics. Poly(lactic acid) has to find its place in various applications such as polymer composites, agriculture, biomedical, etc. Polymer composites based on PLA possess comparable mechanical strength, endurance, flexibility and endures future opportunities. Several combinations of natural fibers and filler-based PLA composites have been fabricated and investigated for physical and mechanical changes. Moreover, several biopolymers and compatibilizers are added to PLA to provide rigidity. The paper presents a tabulated review of the various natural fiber/filter-based PLA composites and the preparation and outcomes. In addition, enhancement made by the reinforcement of nano filler in the PLA are also discussed in brief. The significance of PLA in the biomedical application has been discussed in brief. The paper also shed lights in the social and economic aspects of PLA.

The multifaceted roles of macrophages in bone regeneration: A story of polarization, activation and time

To present knowledge, macrophages are found in all tissues of the human body. They are a cell population with high plasticity which come with a multitude of functions which appear to be adapted to the respective tissue niche and micro-environment in which they reside. Bone harbors multiple macrophage subpopulations, with the osteoclasts as classical representative of a bone resorbing cells and osteomacs as a bone tissue resident macrophage first described by the expression of F4/80. Both subtypes are found throughout all phases in bone healing. In vivo data on bone regeneration have demonstrated their essential role in initiating the healing cascade (inflammatory phase) but also of the later phases of healing (e.g. endochondral and intramembranous bone formation). To participate in such diverse processes macrophages have to be highly plastic in their functionality. Thus, the widely used M1/M2 paradigm to distinguish macrophage subpopulations may not mirror the comprehensive role of the dynamics of macrophage plasticity. From a clinical perspective it is especially relevant to distinguish what drives macrophages in impaired healing scenarios, implant loosening or infections, where their specific role of a misbalanced inflammatory setting is so far only partially known. With this review we aim at illustrating current knowledge and gaps of knowledge on macrophage plasticity and function during the cascades of regeneration and reconstitution of bone tissue. We propose aspects of the known biological mechanisms of macrophages and their specific subsets that might serve as targets to control their function in impaired healing and eventually support a scar-free regeneration. STATEMENT OF SIGNIFICANCE: Macrophages are essential for successful regeneration. In scar-free healing such as in bone, a complete failure of healing was shown if macrophages were depleted; the M1/M2 switch appears to be key to the progression from pro-inflammation to regeneration. However, experimental data illustrate that the classical M1/M2 paradigm does not completely mirror the complexity of observed macrophage functions during bone healing and thus demands a broader perspective. Within this review we discuss the high degree of plasticity of macrophages and the relevant contribution of the different and more specific M2 subtypes (M2a-M2f) during (bone) regeneration. It summarizes the versatile roles of macrophages in skeletal regeneration and thereby highlights potential target points for immunomodulatory approaches to enable or even foster bone repair.

Crosslinking of Polylactide by High Energy Irradiation and Photo-Curing

Polylactide (PLA) is presently the most studied bioderived polymer because, in addition to its established position as a material for biomedical applications, it can replace mass production plastics from petroleum. However, some drawbacks of polylactide such as insufficient mechanical properties at a higher temperature and poor shape stability have to be overcome. One of the methods of mechanical and thermal properties modification is crosslinking which can be achieved by different approaches, both at the stage of PLA-based materials synthesis and by physical modification of neat polylactide. This review covers PLA crosslinking by applying different types of irradiation, i.e., high energy electron beam or gamma irradiation and UV light which enables curing at mild conditions. In the last section, selected examples of biomedical applications as well as applications for packaging and daily-use items are presented in order to visualize how a variety of materials can be obtained using specific methods.