A review on the exploitation of biodegradable magnesium-based composites for medical applications

Magnesium-based alloys with adapted interfaces for bone implants and tissue engineering

Magnesium and its alloys are one of the most used materials for bone implants and tissue engineering. They are characterized by numerous advantages such as biodegradability, high biocompatibility and mechanical properties with values close to the human bone. Unfortunately, the implant surface must be adequately tuned, or Mg-based alloys must be alloyed with other chemical elements due to their increased corrosion effect in physiological media. This article reviews the clinical challenges related to bone repair and regeneration, classifying bone defects and presenting some of the most used and modern therapies for bone injuries, such as Ilizarov or Masquelet techniques or stem cell treatments. The implant interface challenges are related to new bone formation and fracture healing, implant degradation and hydrogen release. A detailed analysis of mechanical properties during implant degradation is extensively described based on different literature studies that included in vitro and in vivo tests correlated with material properties' characterization. Mg-based trauma implants such as plates and screws, intramedullary nails, Herbert screws, spine cages, rings for joint treatment and regenerative scaffolds are presented, taking into consideration their manufacturing technology, the implant geometrical dimensions and shape, the type of in vivo or in vitro studies and fracture localization. Modern technologies that modify or adapt the Mg-based implant interfaces are described by presenting the main surface microstructural modifications, physical deposition and chemical conversion coatings. The last part of the article provides some recommendations from a translational perspective, identifies the challenges associated with Mg-based implants and presents some future opportunities. This review outlines the available literature on trauma and regenerative bone implants and describes the main techniques used to control the alloy corrosion rate and the cellular environment of the implant.

The Influence of Manganese Addition on the Properties of Biodegradable Zinc-Manganese-Calcium Alloys

This study focuses on the preparation and characterization of zinc-based alloys containing magnesium, calcium, and manganese. The alloys were prepared by the melting of pure elements, casting them into graphite molds, and thermo-mechanically treating them via hot extrusion. The phase compositions of the samples were analyzed using X-ray diffraction technique and SEM/EDX analysis. The analysis confirmed that in addition to the Zn matrix, the materials are reinforced by the CaZn₁₃, MgZn_2, and Mn-based precipitates. The mechanical properties of the alloys were ascertained by tensile, compressive, and bending tests, measurement of the samples microhardness and elastic modulus. The results indicate that an increase in Mn content leads to an increase in the maximum stress experienced under both tension and compression. However, the plastic deformation of the alloys decreases with increasing Mn content. This study provides valuable insights into the microstructural changes and mechanical behavior of zinc-based alloys containing magnesium, calcium, and manganese, which can be used to design alloys for specific biomedical applications.

Controlled magnesium ion delivery system for in situ bone tissue engineering

Magnesium cation (Mg²⁺) has been an emerging therapeutic agent for inducing vascularized bone regeneration. However, the therapeutic effects of current magnesium (Mg) -containing biomaterials are controversial due to the concentration- and stage-dependent behavior of Mg²⁺. Here, we first provide an overview of biochemical mechanism of Mg²⁺ in various concentrations and suggest that 2-10 mM Mg²⁺in vitro may be optimized. This review systematically summarizes and discusses several types of controlled Mg²⁺ delivery systems based on polymer-Mg composite scaffolds and Mg-containing hydrogels, as well as their design philosophy and several parameters that regulate Mg²⁺ release. Given that the continuous supply of Mg²⁺ may prevent biomineral deposition in the later stage of bone regeneration and maturation, we highlight the controlled delivery of Mg²⁺ based dual- or multi-ions system, especially for the hierarchical therapeutic ion release system, which shows enhanced biomineralization. Finally, the remaining challenges and perspectives of Mg-containing biomaterials for future in situ bone tissue engineering are discussed as well.

The Flow-Induced Degradation and Vascular Cellular Response Study of Magnesium-Based Materials

Magnesium (Mg)-based materials are considered as potential materials for biodegradable vascular stents, and some Mg-based stents have obtained regulatory approval. However, the development and application of Mg-based stents are still restricted by the rapid degradation rate of Mg and its alloys. In order to screen out the desirable Mg-based materials for stents, the degradation behavior still needs further systematic study, especially the degradation behavior under the action of near-physiological fluid. Currently, the commonly used Mg-based vascular stent materials include pure Mg, AZ31, and WE43. In this study, we systematically evaluated their corrosion behaviors in a dynamic environment and studied the effect of their degradation products on the behavior of vascular cells. The results revealed that the corrosion rate of different Mg-based materials was related to the composition of the elements. The dynamic environment accelerated the corrosion of Mg-based materials. All the same, AZ31 still shows good corrosion resistance. The effect of corrosive products on vascular cells was beneficial to re-endothelialization and inhibition of smooth muscle cell proliferation at the implantation site of vascular stent materials.

Interaction of Mg Alloy with PLA Electrospun Nanofibers Coating in Understanding Changes of Corrosion, Wettability, and pH

A modified biodegradable magnesium alloy (AZ31, 96 wt% Mg, 3 wt% Al, and 1 wt% Zn) with polylactic acid (PLA) nanofibers was obtained by the electrospinning technique. The presence of PLA nanofibers was evidenced using Fourier transform infrared spectroscopy (FT-IR) and using an scanning electronic microscope (SEM) equipped with an energy dispersive X-ray spectroscopy (EDX) module. The degradation behavior of an uncoated Mg alloy and a Mg alloy coated with PLA was evaluated through hydrogen evolution, pH, and electrochemical measurements in simulated body fluid. Contact angle measurements showed a shift from hydrophilic towards the hydrophobic character of the alloy after its coating with PLA nanofibers. Furthermore, the electrochemical measurement results show that the Mg based alloy coated with PLA inhibits hydrogen evolution, thus being less prone to degradation. The aim of this research is not only to reduce the corrosion rate of Mg alloy and to improve its properties with the help of polylactic acid coating, but also to provide a study to understand the hydrophilic–hydrophobic balance of biodegradable magnesium based on surface energy investigations. Taking into account corrosion rate, wettability, and pH changes, an empiric model of the interaction of Mg alloy with PLA nanofibers is proposed.

Biodegradable Magnesium Biomaterials—Road to the Clinic

In recent decades, we have witnessed radical changes in the use of permanent biomaterials. The intrinsic ability of magnesium (Mg) and its alloys to degrade without releasing toxic degradation products has led to a vast range of applications in the biomedical field, including cardiovascular stents, musculoskeletal, and orthopedic applications. With the use of biodegradable Mg biomaterials, patients would not suffer second surgery and surgical pain anymore. Be that as it may, the main drawbacks of these biomaterials are the high corrosion rate and unexpected degradation in physiological environments. Since biodegradable Mg-based implants are expected to show controllable degradation and match the requirements of specific applications, various techniques, such as designing a magnesium alloy and modifying the surface characteristics, are employed to tailor the degradation rate. In this paper, some fundamentals and particular aspects of magnesium degradation in physiological environments are summarized, and approaches to control the degradation behavior of Mg-based biomaterials are presented.

Nutrient alloying elements in biodegradable metals: a review

As a new generation of biomedical metallic materials, biodegradable metals have become a hot research topic in recent years because they can completely degrade in the human body, thus preventing secondary surgery, and reducing the pain and economic burden for patients. Clinical applications require biodegradable metals with adequate mechanical properties, corrosion resistance, and biocompatibility. Alloying is an important method to create biodegradable metals with required and comprehensive performances. Since nutrient elements already have important effects on various physiological functions of the human body, the alloying of nutrient elements with biodegradable metals has attracted much attention. The present review summarizes and discusses the effects of nutrient alloying elements on the mechanical properties, biodegradation behavior, and biocompatibility of biodegradable metals. Moreover, future research directions of biodegradable metals with nutrient alloying elements are suggested.

Osteogenesis and degradation behavior of magnesium alloy plate in vivo

Introduction: The magnesium alloy was fabricated into orthopedic plates, and used to repair tibial fractures of New Zealand white rabbits. The osteogenesis and degradation behavior of magnesium alloy plates were investigated in vivo. Methods: 38 rabbits were randomly divided into an experimental group using the magnesium alloy plate and control group using a titanium alloy plate. Tibial fractures in the experimental group and control group were fixed with magnesium alloy plates and titanium alloy plates, respectively. An X-ray of the fracture site was taken at 1, 2, 4, 8, and 16 weeks after surgery. The formation of callus and expression of bone morphogenetic protein (BMP-2) in each group were examined at 4, 8, and 16 weeks postoperatively. The degradation behavior of the magnesium alloy plate was observed using a scanning electron microscope with an energy dispersive spectroscopy system. Results: The results of X-ray showed that the fracture healed gradually and there was significant callus around the plate in the magnesium alloy plate group than that in the titanium alloy plate groups. The formation of callus and the expression of BMP-2 in the magnesium alloy plate group were more significant than that in the titanium plate group. The degradation behavior of the magnesium alloy plates deepened in vivo with the implantation time. Conclusion: The results demonstrated that the magnesium alloy plate implanted into the rabbit tibia could promote the formation of callus and result in osteogenesis in vivo. Meanwhile, the magnesium alloy plate was absorbed gradually in vivo.

A Comprehensive Review on Surface Modifications of Biodegradable Magnesium-Based Implant Alloy: Polymer Coatings Opportunities and Challenges

The development of biodegradable implants is certainly intriguing, and magnesium and its alloys are considered significant among the various biodegradable materials. Nevertheless, the fast degradation, the generation of a significant amount of hydrogen gas, and the escalation in the pH value of the body solution are significant barriers to their use as an implant material. The appropriate approach is able to solve this issue, resulting in a decrease the rate of Mg degradation, which can be accomplished by alloying, surface adjustment, and mechanical treatment. Surface modification is a practical option because it not only improves corrosion resistance but also prepares a treated surface to improve bone regeneration and cell attachment. Metal coatings, ceramic coatings, and permanent polymers were shown to minimize degradation rates, but inflammation and foreign body responses were also suggested. In contrast to permanent materials, the bioabsorbable polymers normally show the desired biocompatibility. In order to improve the performance of drugs, they are generally encapsulated in biodegradable polymers. This study summarized the most recent advancements in manufacturing polymeric coatings on Mg alloys. The related corrosion resistance enhancement strategies and future potentials are discussed. Ultimately, the major challenges and difficulties are presented with aim of the development of polymer-coated Mg-based implant materials.

Anticancer Effect of Biodegradable Magnesium on Hepatobiliary Carcinoma: An In Vitro and In Vivo Study

Biliary-stent implantation has become an effective treatment for patients with malignant obstructive jaundice caused by hepatobiliary carcinoma. Stent restenosis due to tumor ingrowth is a common problem. In this study, we assessed a biodegradable form of magnesium (Mg) for its anticancer effect on hepatobiliary carcinoma, compared to the conventional stent material of titanium (Ti). The results showed that a Mg extract inhibited proliferation and induced apoptosis in human cholangiocarcinoma cells, while a Mg plate inhibited cell adhesion and destroyed the cytoskeleton in the process of biodegradation. In animal experiments with H22 tumor-bearing mice, Mg wires implanted in tumors exhibited an inhibitory effect on their growth compared with Ti wires. Fifteen days after implantation of metal wires, the mean tumor volume and weight in the Mg group were significantly smaller than in the Ti group. We observed the dynamic-degradation process of Mg wires in tumors and generation of H₂ gas via soft X-ray photography and scanning electron microscopy. Histopathological analyses showed that apoptosis of tumor cells around Mg wires significantly increased, expression of carbonic anhydrase 9 significantly decreased, and the upstream protein hypoxia-inducible factor 1-alpha also decreased to some extent. Taken together, these results indicated that biodegradable Mg had antitumor properties both in vitro and in vivo, suggesting its potential application as a novel material for biodegradable biliary stents.

Recent research and progress of biodegradable zinc alloys and composites for biomedical applications: Biomechanical and biocorrosion perspectives

Biodegradable metals (BMs) gradually degrade in vivo by releasing corrosion products once exposed to the physiological environment in the body. Complete dissolution of biodegradable implants assists tissue healing, with no implant residues in the surrounding tissues. In recent years, three classes of BMs have been extensively investigated, including magnesium (Mg)-based, iron (Fe)-based, and zinc (Zn)-based BMs. Among these three BMs, Mg-based materials have undergone the most clinical trials. However, Mg-based BMs generally exhibit faster degradation rates, which may not match the healing periods for bone tissue, whereas Fe-based BMs exhibit slower and less complete in vivo degradation. Zn-based BMs are now considered a new class of BMs due to their intermediate degradation rates, which fall between those of Mg-based BMs and Fe-based BMs, thus requiring extensive research to validate their suitability for biomedical applications. In the present study, recent research and development on Zn-based BMs are reviewed in conjunction with discussion of their advantages and limitations in relation to existing BMs. The underlying roles of alloy composition, microstructure, and processing technique on the mechanical and corrosion properties of Zn-based BMs are also discussed.

Growth Factors, Carrier Materials, and Bone Repair

This chapter provides an overview of the growth factors active in bone regeneration and healing. Both normal and impaired bone healing are discussed, with a focus on the spatiotemporal activity of the various growth factors known to be involved in the healing response. The review highlights the activities of most important growth factors impacting bone regeneration, with a particular emphasis on those being pursued for clinical translation or which have already been marketed as components of bone regenerative materials. Current approaches the use of bone grafts in clinical settings of bone repair (including bone grafts) are summarized, and carrier systems (scaffolds) for bone tissue engineering via localized growth factor delivery are reviewed. The chapter concludes with a consideration of how bone repair might be improved in the future.

Investigations on the Mechanical Properties of Glass Fiber/Sisal Fiber/Chitosan Reinforced Hybrid Polymer Sandwich Composite Scaffolds for Bone Fracture Fixation Applications

This study aims to explore the mechanical properties of hybrid glass fiber (GF)/sisal fiber (SF)/chitosan (CTS) composite material for orthopedic long bone plate applications. The GF/SF/CTS hybrid composite possesses a unique sandwich structure and comprises GF/CTS/epoxy as the external layers and SF/CTS/epoxy as the inner layers. The composite plate resembles the human bone structure (spongy internal cancellous matrix and rigid external cortical). The mechanical properties of the prepared hybrid sandwich composites samples were evaluated using tensile, flexural, micro hardness, and compression tests. The scanning electron microscopic (SEM) images were studied to analyze the failure mechanism of these composite samples. Besides, contact angle (CA) and water absorption tests were conducted using the sessile drop method to examine the wettability properties of the SF/CTS/epoxy and GF/SF/CTS/epoxy composites. Additionally, the porosity of the GF/SF/CTS composite scaffold samples were determined by using the ethanol infiltration method. The mechanical test results show that the GF/SF/CTS hybrid composites exhibit the bending strength of 343 MPa, ultimate tensile strength of 146 MPa, and compressive strength of 380 MPa with higher Young’s modulus in the bending tests (21.56 GPa) compared to the tensile (6646 MPa) and compressive modulus (2046 MPa). Wettability study results reveal that the GF/SF/CTS composite scaffolds were hydrophobic (CA = 92.41° ± 1.71°) with less water absorption of 3.436% compared to the SF/CTS composites (6.953%). The SF/CTS composites show a hydrophilic character (CA = 54.28° ± 3.06°). The experimental tests prove that the GF/SF/CTS hybrid composite can be used for orthopedic bone fracture plate applications in future.

Translational status of biomedical Mg devices in China

Magnesium (Mg) and its alloys as temporary medical implants with biodegradable and properly mechanical properties have been investigated for a long time. There are already three kinds of biodegradable Mg implants which are approved by Conformite Europeene (CE) or Korea Food and Drug Administration (KFDA), but not China Food and Drug Administration (CFDA, now it is National Medical Products Administration, NMPA). As we know, Chinese researchers, surgeons, and entrepreneurs have tried a lot to research and develop biodegradable Mg implants which might become other new approved implants for clinical applications. So in this review, we present the representative Mg implants of three categories, orthopedic implants, surgical implants, and intervention implants and provide an overview of current achievement in China from academic publications and Chinese patents. We would like to provide a systematic way to translate Mg and its alloy implants from experiment designs to clinical products.

Degradable magnesium-based alloys for biomedical applications: The role of critical alloying elements

Magnesium-based alloys exhibit biodegradable, biocompatible and excellent mechanical properties which enable them to serve as ideal candidate biomedical materials. In particular, their biodegradable ability helps patients to avoid a second surgery. The corrosion rate, however, is too rapid to sustain the healing process. Alloying is an effective method to slow down the corrosion rate. However, currently magnesium alloys used as biomaterials are mostly commercial alloys without considering cytotoxicity from the perspective of biosafety. This article comprehensively reviews the status of various existing and newly developed degradable magnesium-based alloys specially designed for biomedical application. The effects of critical alloying elements, compositions, heat treatment and processing technology on the microstructure, mechanical properties and corrosion resistance of magnesium alloys are discussed in detail. This article covers Mg-Ca based, Mg-Zn based, Mg-Sr based, Mg-RE based and Mg-Cu-based alloy systems. The novel methods of fabricating Mg-based biomaterials and surface treatment on Mg based alloys for potential biomedical applications are summarized.

Applications of Metals for Bone Regeneration

The regeneration of bone tissue is the main purpose of most therapies in dental medicine. For bone regeneration, calcium phosphate (CaP)-based substitute materials based on natural (allo- and xenografts) and synthetic origins (alloplastic materials) are applied for guiding the regeneration processes. The optimal bone substitute has to act as a substrate for bone ingrowth into a defect, as well as resorb in the time frame needed for complete regeneration up to the condition of restitution ad integrum. In this context, the modes of action of CaP-based substitute materials have been frequently investigated, where it has been shown that such materials strongly influence regenerative processes such as osteoblast growth or differentiation and also osteoclastic resorption due to different physicochemical properties of the materials. However, the material characteristics needed for the required ratio between new bone tissue formation and material degradation has not been found, until now. The addition of different substances such as collagen or growth factors and also of different cell types has already been tested but did not allow for sufficient or prompt application. Moreover, metals or metal ions are used differently as a basis or as supplement for different materials in the field of bone regeneration. Moreover, it has already been shown that different metal ions are integral components of bone tissue, playing functional roles in the physiological cellular environment as well as in the course of bone healing. The present review focuses on frequently used metals as integral parts of materials designed for bone regeneration, with the aim to provide an overview of currently existing knowledge about the effects of metals in the field of bone regeneration.