Biocompatibility of bioresorbable poly(L-lactic acid) composite scaffolds obtained by supercritical gas foaming with human fetal bone cells

A comprehensive review on nanocomposite biomaterials based on gelatin for bone tissue engineering

The creation of a suitable scaffold is a crucial step in the process of bone tissue engineering (BTE). The scaffold, acting as an artificial extracellular matrix, plays a significant role in determining the fate of cells by affecting their proliferation and differentiation in BTE. Therefore, careful consideration should be given to the fabrication approach and materials used for scaffold preparation. Natural polypeptides such as gelatin and collagen have been widely used for this purpose. The unique properties of nanoparticles, which vary depending on their size, charge, and physicochemical properties, have demonstrated potential in solving various challenges encountered in BTE. Therefore, nanocomposite biomaterials consisting of polymers and nanoparticles have been extensively used for BTE. Gelatin has also been utilized in combination with other nanomaterials to apply for this purpose. Composites of gelatin with various types of nanoparticles are particularly promising for creating scaffolds with superior biological and physicochemical properties. This review explores the use of nanocomposite biomaterials based on gelatin and various types of nanoparticles together for applications in bone tissue engineering.

Current Trend and New Opportunities for Multifunctional Bio-Scaffold Fabrication via High-Pressure Foaming

Biocompatible and biodegradable foams prepared using the high-pressure foaming technique have been widely investigated in recent decades as porous scaffolds for in vitro and in vivo tissue growth. In fact, the foaming process can operate at low temperatures to load bioactive molecules and cells within the pores of the scaffold, while the density and pore architecture, and, hence, properties of the scaffold, can be finely modulated by the proper selection of materials and processing conditions. Most importantly, the high-pressure foaming of polymers is an ideal choice to limit and/or avoid the use of cytotoxic and tissue-toxic compounds during scaffold preparation. The aim of this review is to provide the reader with the state of the art and current trend in the high-pressure foaming of biomedical polymers and composites towards the design and fabrication of multifunctional scaffolds for tissue engineering. This manuscript describes the application of the gas foaming process for bio-scaffold design and fabrication and highlights some of the most interesting results on: (1) the engineering of porous scaffolds featuring biomimetic porosity to guide cell behavior and to mimic the hierarchical architecture of complex tissues, such as bone; (2) the bioactivation of the scaffolds through the incorporation of inorganic fillers and drugs.

Polycaprolactone with multiscale porosity and patterned surface topography prepared using sacrificial 3D printed moulds: Towards tailor-made scaffolds

Biocompatible three-dimensional porous scaffolds are widely used in multiple biomedical applications. However, the fabrication of tailor-made 3D structures with controlled and combined multiscale macroscopic-microscopic, surface and inner porosities in a straightforward manner is still a current challenge. Herein, we use multimaterial fused deposition modeling (FDM) to generate poly (vinyl alcohol) (PVA) sacrificial moulds filled with poly (Ɛ-caprolactone) (PCL) to generate well defined PCL 3D objects. Further on, the supercritical CO₂ (SCCO₂) technique, as well as the breath figures mechanism (BFs), were additionally employed to fabricate specific porous structures at the core and surfaces of the 3D PCL object, respectively. The biocompatibility of the resulting multiporous 3D structures was tested in vitro and in vivo, and the versatility of the approach was assessed by generating a vertebra model fully tunable at multiple pore size levels. In sum, the combinatorial strategy to generate porous scaffolds offers unique possibilities to fabricate intricate structures by combining the advantages of additive manufacturing (AM), which provides flexibility and versatility to generate large sized 3D structures, with advantages of the SCCO₂ and BFs techniques, which allow to finely tune the macro and micro porosity at material surface and material core levels.

Additive Manufacturing of Biomaterials-Design Principles and Their Implementation

Additive manufacturing (AM, also known as 3D printing) is an advanced manufacturing technique that has enabled progress in the design and fabrication of customised or patient-specific (meta-)biomaterials and biomedical devices (e.g., implants, prosthetics, and orthotics) with complex internal microstructures and tuneable properties. In the past few decades, several design guidelines have been proposed for creating porous lattice structures, particularly for biomedical applications. Meanwhile, the capabilities of AM to fabricate a wide range of biomaterials, including metals and their alloys, polymers, and ceramics, have been exploited, offering unprecedented benefits to medical professionals and patients alike. In this review article, we provide an overview of the design principles that have been developed and used for the AM of biomaterials as well as those dealing with three major categories of biomaterials, i.e., metals (and their alloys), polymers, and ceramics. The design strategies can be categorised as: library-based design, topology optimisation, bio-inspired design, and meta-biomaterials. Recent developments related to the biomedical applications and fabrication methods of AM aimed at enhancing the quality of final 3D-printed biomaterials and improving their physical, mechanical, and biological characteristics are also highlighted. Finally, examples of 3D-printed biomaterials with tuned properties and functionalities are presented.

Additive manufacturing of PLA-based scaffolds intended for bone regeneration and strategies to improve their biological properties

Polylactic acid (PLA) is one of the most commonly used materials in the biomedical sector because of its processability, mechanical properties and biocompatibility. Among the different techniques that are feasible to process this biomaterial, additive manufacturing (AM) has gained attention recently, as it provides the possibility of tuning the design of the structures. This flexibility in the design stage allows the customization of the parts in order to optimize their use in the tissue engineering field. In the recent years, the application of PLA for the manufacture of bone scaffolds has been especially relevant, since numerous studies have proven the potential of this biomaterial for bone regeneration. This review contains a description of the specific requirements in the regeneration of bone and how the state of the art have tried to address them with different strategies to develop PLA-based scaffolds by AM techniques and with improved biofunctionality.

New biodegradable nanoparticles-in-nanofibers based membranes for guided periodontal tissue and bone regeneration with enhanced antibacterial activity

Introduction

Guided tissue regeneration (GTR) and guided bone regeneration (GBR) are commonly used surgical procedures for the repair of damaged periodontal tissues. These procedures include the use of a membrane as barrier to prevent soft tissue ingrowth and to create space for slowly regenerating periodontium and bone. Recent approaches involve the use of membranes/scaffolds based on resorbable materials. These materials provide the advantage of dissolving by time without the need of surgical intervention to remove the scaffolds.

Objectives

This study aimed at preparing a new series of nanofibrous scaffolds for GTR/GBR applications with enhanced mechanical properties, cell adhesion, biocompatibility and antibacterial properties.

Methods

Electrospun nanofibrous scaffolds based on polylactic acid/cellulose acetate (PLA/CA) or poly(caprolactone) (PCL) polymers were prepared and characterized. Different concentrations of green-synthesized silver nanoparticles, AgNPs (1-2% w/v) and hydroxyapatite nanoparticles, HANPs (10-20% w/v) were incorporated into the scaffolds to enhance the antibacterial and bone regeneration activity.

Results

In-vitro studies showed that addition of HANPs improved the cell viability by around 50% for both types of nanofibrous scaffolds. The tensile properties were also improved through addition of 10% HANPs but deteriorated upon increasing the concentration to 20%. AgNPs significantly improved the antibacterial activity with 40 mm inhibition zone after 32 days. Additionally, the nanofibrous scaffolds showed a desirable degradation profile with losing around 40-70% of its mass in 8 weeks.

Conclusions

The obtained results show that the developed nanofibrous membranes are promising scaffolds for both GTR and GBR applications.

Fabrication of 3D-Printed Biodegradable Porous Scaffolds Combining Multi-Material Fused Deposition Modeling and Supercritical CO2 Techniques

The fabrication of porous materials for tissue engineering applications in a straightforward manner is still a current challenge. Herein, by combining the advantages of two conventional methodologies with additive manufacturing, well-defined objects with internal and external porosity were produced. First of all, multi-material fused deposition modeling (FDM) allowed us to prepare structures combining poly (ε-caprolactone) (PCL) and poly (lactic acid) (PLA), thus enabling to finely tune the final mechanical properties of the printed part with modulus and strain at break varying from values observed for pure PCL (modulus 200 MPa, strain at break 1700%) and PLA (modulus 1.2 GPa and strain at break 5-7%). More interestingly, supercritical CO2 (SCCO2) as well as the breath figures mechanism (BFs) were additionally employed to produce internal (pore diameters 80-300 µm) and external pores (with sizes ranging between 2 and 12 μm) exclusively in those areas where PCL is present. This strategy will offer unique possibilities to fabricate intricate structures combining the advantages of additive manufacturing (AM) in terms of flexibility and versatility and those provided by the SCCO2 and BFs to finely tune the formation of porous structures.

Characterization of a composite polylactic acid-hydroxyapatite 3D-printing filament for bone-regeneration

Autologous cancellous-bone grafts are the current gold standard for therapeutic interventions in which bone-regeneration is desired. The main limitations of these implants are the need for a secondary surgical site, creating a wound on the patient, the limited availability of harvest-safe bone, and the lack of structural integrity of the grafts. Synthetic, resorbable, bone-regeneration materials could pose a viable treatment alternative, that could be implemented through 3D-printing. We present here the development of a polylactic acid-hydroxyapatite (PLA-HAp) composite that can be processed through a commercial-grade 3D-printer. We have shown that this material could be a viable option for the development of therapeutic implants for bone regeneration. Biocompatibility in vitro was demonstrated through cell viability studies using the osteoblastic MG63 cell-line, and we have also provided evidence that the presence of HAp in the polymer matrix enhances cell attachment and osteogenicity of the material. We have also provided guidelines for the optimal PLA-HAp ratio for this application, as well as further characterisation of the mechanical and thermal properties of the composite. This study encompasses the base for further research on the possibilities and safety of 3D-printable, polymer-based, resorbable composites for bone regeneration.

3D printed porous PLA/nHA composite scaffolds with enhanced osteogenesis and osteoconductivity in vivo for bone regeneration

Repair and regeneration of large bone defects is still a challenge, especially for defects which are the irregular and complex. Three-dimension (3D) printing, as an advanced fabrication technology, has been received considerable attentions due to its high precision, customized geometry and personalization. In this study, 3D porous polylactic acid/nano hydroxyapatite (PLA/nHA) composite scaffolds with enhanced osteogenesis and osteoconductivity were successfully fabricated by desktop fused deposition modeling technology. Morphological, composition and structural analysis revealed that nHA was successfully introduced into the PLA system and homogeneously dispersed in the printed PLA/nHA scaffolds. In vitro antibacterial experiment confirmed that the printed porous PLA/nHA scaffolds have good ability for loading and releasing vancomycin and levofloxacin. Meanwhile, MG-63 cells were used to evaluate the cytocompatibility of printed porous PLA/nHA scaffolds by proliferation and cellular morphological analysis. In addition, rabbit model was established to evaluate the osteogenesis and osteoconductivity of printed PLA/nHA scaffolds. All these results suggested that the 3D printed PLA/nHA scaffolds have great potential for repairing and regeneration of large bone defects.

Current state of fabrication technologies and materials for bone tissue engineering

A range of traditional and free-form fabrication technologies have been investigated and, in numerous occasions, commercialized for use in the field of regenerative tissue engineering (TE). The demand for technologies capable of treating bone defects inherently difficult to repair has been on the rise. This quest, accompanied by the advent of functionally tailored, biocompatible, and biodegradable materials, has garnered an enormous research interest in bone TE. As a result, different materials and fabrication methods have been investigated towards this end, leading to a deeper understanding of the geometrical, mechanical and biological requirements associated with bone scaffolds. As our understanding of the scaffold requirements expands, so do the capability requirements of the fabrication processes. The goal of this review is to provide a broad examination of existing scaffold fabrication processes and highlight future trends in their development. To appreciate the clinical requirements of bone scaffolds, a brief review of the biological process by which bone regenerates itself is presented first. This is followed by a summary and comparisons of commonly used implant techniques to highlight the advantages of TE-based approaches over traditional grafting methods. A detailed discussion on the clinical and mechanical requirements of bone scaffolds then follows. The remainder of the manuscript is dedicated to current scaffold fabrication methods, their unique capabilities and perceived shortcomings. The range of biomaterials employed in each fabrication method is summarized. Selected traditional and non-traditional fabrication methods are discussed with a highlight on their future potential from the authors' perspective. This study is motivated by the rapidly growing demand for effective scaffold fabrication processes capable of economically producing constructs with intricate and precisely controlled internal and external architectures. STATEMENT OF SIGNIFICANCE: The manuscript summarizes the current state of fabrication technologies and materials used for creating scaffolds in bone tissue engineering applications. A comprehensive analysis of different fabrication methods (traditional and free-form) were summarized in this review paper, with emphasis on recent developments in the field. The fabrication techniques suitable for creating scaffolds for tissue engineering was particularly targeted and their use in bone tissue engineering were articulated. Along with the fabrication techniques, we emphasized the choice of materials in these processes. Considering the limitations of each process, we highlighted the materials and the material properties critical in that particular process and provided a brief rational for the choice of the materials. The functional performance for bone tissue engineering are summarized for different fabrication processes and the choice of biomaterials. Finally, we provide a perspective on the future of the field, highlighting the knowledge gaps and promising avenues in pursuit of effective scaffolds for bone tissue engineering. This extensive review of the field will provide research community with a reference source for current approaches to scaffold preparation. We hope to encourage the researchers to generate next generation biomaterials to be used in these fabrication processes. By providing both advantages and disadvantage of each fabrication method in detail, new fabrication techniques might be devised that will overcome the limitations of the current approaches. These studies should facilitate the efforts of researchers interested in generating ideal scaffolds, and should have applications beyond the repair of bone tissue.

Comparative Study of Different Techniques for the Sterilization of Poly-L-lactide Electrospun Microfibers: Effectiveness vs. Material Degradation

Electrospinning of biopolymeric scaffolds is a new and effective approach for creating replacement tissues to repair defects and/or damaged tissues with direct clinical application. However, many hurdles and technical concerns regarding biological issues, such as cell retention and the ability to grow, still need to be overcome to gain full access to the clinical arena. Interaction with the host human tissues, immunogenicity, pathogen transmission as well as production costs, technical expertise, and good manufacturing and laboratory practice requirements call for careful consideration when aiming at the production of a material that is available off-the-shelf, to be used immediately in operative settings. The issue of sterilization is one of the most important steps for the clinical application of these scaffolds. Nevertheless, relatively few studies have been performed to systematically investigate how sterilization treatments may affect the properties of electrospun polymers for tissue engineering. This paper presents the results of a comparative study of different sterilization techniques applied to an electrospun poly-L-lactide scaffold: soaking in absolute ethanol, dry oven and autoclave treatments, UV irradiation, and hydrogen peroxide gas plasma treatment. Morphological and chemical characterization was coupled with microbiological sterility assay to validate the examined sterilization techniques in terms of effectiveness and modifications to the scaffold.

The results of this study reveal that UV irradiation and hydrogen peroxide gas plasma are the most effective sterilization techniques, as they ensure sterility of the electrospun scaffolds without affecting their chemical and morphological features.

Polymer-mineral scaffold augments in vivo equine multipotent stromal cell osteogenesis

Background

Use of bioscaffolds to direct osteogenic differentiation of adult multipotent stromal cells (MSCs) without exogenous proteins is a contemporary approach to bone regeneration. Identification of in vivo osteogenic contributions of exogenous MSCs on bioscaffolds after long-term implantation is vital to understanding cell persistence and effect duration.

Methods

This study was designed to quantify in vivo equine MSC osteogenesis on synthetic polymer scaffolds with distinct mineral combinations 9 weeks after implantation in a murine model. Cryopreserved, passage (P)1, equine bone marrow-derived MSCs (BMSC) and adipose tissue-derived MSCs (ASC) were culture expanded to P3 and immunophenotyped with flow cytometry. They were then loaded by spinner flask on to scaffolds composed of tricalcium phosphate (TCP)/hydroxyapatite (HA) (40:60; HT), polyethylene glycol (PEG)/poly-l-lactic acid (PLLA) (60:40; GA), or PEG/PLLA/TCP/HA (36:24:24:16; GT). Scaffolds with and without cells were maintained in static culture for up to 21 days or implanted subcutaneously in athymic mice that were radiographed every 3 weeks up to 9 weeks. In vitro cell viability and proliferation were determined. Explant composition (double-stranded (ds)DNA, collagen, sulfated glycosaminoglycan (sGAG), protein), equine and murine osteogenic target gene expression, microcomputed tomography (μCT) mineralization, and light microscopic structure were assessed.

Results

The ASC and BMSC number increased significantly in HT constructs between 7 and 21 days of culture, and BMSCs increased similarly in GT constructs. Radiographic opacity increased with time in GT-BMSC constructs. Extracellular matrix (ECM) components and dsDNA increased significantly in GT compared to HT constructs. Equine and murine osteogenic gene expression was highest in BMSC constructs with mineral-containing scaffolds. The HT constructs with either cell type had the highest mineral deposition based on μCT. Regardless of composition, scaffolds with cells had more ECM than those without, and osteoid was apparent in all BMSC constructs.

Conclusions

In this study, both exogenous and host MSCs appear to contribute to in vivo osteogenesis. Addition of mineral to polymer scaffolds enhances equine MSC osteogenesis over polymer alone, but pure mineral scaffold provides superior osteogenic support. These results emphasize the need for bioscaffolds that provide customized osteogenic direction of both exo- and endogenous MSCs for the best regenerative potential.

Preparation of macroporous scaffolds with holes in pore walls and pressure driven flows through them

Controlling the pore architecture in macroporous scaffolds has important implications for their use as reactor packings and as catalyst supports.

Rapid prototyping technology and its application in bone tissue engineering

Bone defects arising from a variety of reasons cannot be treated effectively without bone tissue reconstruction. Autografts and allografts have been used in clinical application for some time, but they have disadvantages. With the inherent drawback in the precision and reproducibility of conventional scaffold fabrication techniques, the results of bone surgery may not be ideal. This is despite the introduction of bone tissue engineering which provides a powerful approach for bone repair. Rapid prototyping technologies have emerged as an alternative and have been widely used in bone tissue engineering, enhancing bone tissue regeneration in terms of mechanical strength, pore geometry, and bioactive factors, and overcoming some of the disadvantages of conventional technologies. This review focuses on the basic principles and characteristics of various fabrication technologies, such as stereolithography, selective laser sintering, and fused deposition modeling, and reviews the application of rapid prototyping techniques to scaffolds for bone tissue engineering. In the near future, the use of scaffolds for bone tissue engineering prepared by rapid prototyping technology might be an effective therapeutic strategy for bone defects.

Theoretical and practical aspects of using fetal fibroblasts for skin regeneration

Cutaneous wounding in late-gestational fetal or postnatal humans results in scar formation without any skin appendages. Early or mid- gestational skin healing in humans is characterized by the absence of scaring in a process resembling regeneration. Tremendous cellular and molecular mechanisms contribute to this distinction, and fibroblasts play critical roles in scar or scarless wound healing. This review discussed the different repair mechanisms involved in wound healing of fibroblasts at different developmental stages and further confirmed that fetal fibroblast transplantation resulted in reduced scar healing in vivo. We also discussed the possible problem in fetal fibroblast transplantation for wound repair. We proposed the use of small molecules to improve the regenerative potential of repairing cells in the wound given that remodeling of the wound microenvironment into a regenerative microenvironment in adults might improve skin regeneration.

Robust silk fibroin/bacterial cellulose nanoribbon composite scaffolds with radial lamellae and intercalation structure for bone regeneration

Biomimetic scaffolds with a gradient gap distance and robust mechanical properties were prepared using silk fibroin and bacterial cellulose.

Regionally-derived cell populations and skeletal stem cells from human foetal femora exhibit specific osteochondral and multi-lineage differentiation capacity in vitro and ex vivo

Background

Adult skeletal stem cells (SSCs) often exhibit limited in vitro expansion with undesirable phenotypic changes and loss of differentiation capacity. Foetal tissues offer an alternative cell source, providing SSCs which exhibit desirable differentiation capacity over prolonged periods, ideal for extensive in vitro and ex vivo investigation of fundamental bone biology and skeletal development.

Methods

We have examined the derivation of distinct cell populations from human foetal femora. Regionally isolated populations including epiphyseal and diaphyseal cells were carefully dissected. Expression of the SSC marker Stro-1 was also found in human foetal femora over a range of developmental stages and subsequently utilised for immuno-selection.

Results

Regional populations exhibited chondrogenic (epiphyseal) and osteogenic (diaphyseal) phenotypes following in vitro and ex vivo characterisation and molecular analysis, indicative of native SSC maturation during skeletal development. However, each population exhibited potential for induced multi-lineage differentiation towards bone (bone nodule formation), cartilage (proteoglycan and mucopolysaccharide deposition) and fat (lipid deposition), suggesting the presence of a shared stem cell sub-population. This shared sub-population may be comprised of Stro-1+ cells, which were later identified and immuno-selected from whole foetal femora exhibiting multi-lineage differentiation capacity in vitro and ex vivo.

Conclusions

Distinct populations were isolated from human foetal femora expressing osteochondral differentiation capacity. Stro-1 immuno-selected SSCs were isolated from whole femora expressing desirable multi-lineage differentiation capacity over prolonged in vitro expansion, superior to their adult-derived counterparts, providing a valuable cell source with which to study bone biology and skeletal development.

Electronic supplementary material

The online version of this article (doi:10.1186/s13287-015-0247-2) contains supplementary material, which is available to authorized users.

Fabrication and Osteogenesis of a Porous Nanohydroxyapatite/Polyamide Scaffold with an Anisotropic Architecture

Scaffolds are used in bone tissue engineering to provide a temporary structural template for cell seeding and extracellular matrix formation. However, tissue formation on scaffold outer edges after implantation due to insufficient interconnectivity may restrict cell infiltration and mass transfer to/from the scaffold center, leading to bone regeneration failure. To address this problem, we prepared nanohydroxyapatite/polyamide66 (n-HA/PA66) anisotropic scaffolds with axially aligned channels (300 μm) with the aim to enhance pore interconnectivity and subsequent cell and tissue infiltration throughout the scaffold. Anisotropic scaffolds with axially aligned channels had better mechanical properties and a higher porosity (86.37%) than isotropic scaffolds produced by thermally induced phase separation (TIPS). The channels in the anisotropic scaffolds provided cells with passageways to the scaffold center and thus facilitated cell attachment and proliferation inside the scaffolds. In vivo studies showed that the anisotropic scaffolds could better facilitate new bone ingrowth into the inner pores of the scaffold compared to the isotropic scaffolds. The anisotropic scaffolds also had improved vascular invasion into their inner parts, increasing the supply of oxygen and nutrients to the cells and thus facilitating revascularization and bone ingrowth. Enhanced cell and tissue penetration to the scaffold center was observed in the anisotropic scaffolds both in vitro and in vivo, indicating the axially aligned channels positively influenced cell and tissue infiltration. Thus, such scaffolds have great potential for applications in bone tissue engineering.

Enhanced interfacial adhesion and osteogenesis for rapid "bone-like" biomineralization by PECVD-based silicon oxynitride overlays

Structurally unstable fracture sites require metal fixative devices, which have long healing times due to their lack of osteoinductivity. Bioactive glass coatings lack in interfacial bonding, delaminate, and have reduced bioactivity due to the high temperatures used for their fabrication. Here, we test the hypothesis that low-temperature PECVD amorphous silica can enhance adhesion to the underlying metal surface and that N incorporation enhances osteogenesis and rapid biomineralization. A model Ti/TiO2-SiOx interface was formed by first depositing Ti onto Si wafers, followed by surface patterning, thermal annealing to form TiO2, and depositing SiOx/Si(ON)x overlays. TEM micrographs showed conformal SiOx layers on Ti/TiO2 overlays while XPS data revealed the formation of an elemental Ti-O-Si interface. Nanoscratch testing verified strong SiOx bonding with the underlying TiO2 layers. In vitro studies showed that the surface properties changed significantly to reveal the formation of hydroxycarbonate apatite within 6 h, and Si(ON)x surface chemistry induced osteogenic gene expression of human periosteal cells and led to a rapid "bone-like" biomineral formation within 4 weeks. XANES data revealed that the incorporation of N increased the surface HA bioactivity by increasing the carbonate to phosphate ratio. In conclusion, silicon oxynitride overlays on bone-implant systems enhance osteogenesis and biomineralization via surface nitrogen incorporation.

Human periosteum cell osteogenic differentiation enhanced by ionic silicon release from porous amorphous silica fibrous scaffolds

Current synthetic grafts for bone defect filling in the sinus can support new bone formation but lack the ability to stimulate or enhance osteogenic healing. To promote such healing, osteoblast progenitors such as human periosteum cells must undergo osteogenic differentiation. In this study, we tested the hypothesis that degradation of porous amorphous silica fibrous (PASF) scaffolds can enhance human periosteum cell osteogenic differentiation. Two types of PASF were prepared and evaluated according to their densities (PASF99, PASF98) with 99 and 98% porosity, respectively. Silicon (Si) ions were observed to rapidly release from both scaffolds within 24 h in vitro. PASF99 Si ion release rate was estimated to be nearly double that of PASF98 scaffolds. Mechanical tests revealed a lower compressive strength in PASF99 as compared with PASF98. Osteogenic expression analysis showed that PASF99 scaffolds enhanced the expression of activating transcription factor 4, alkaline phosphatase, and collagen (Col(I)α1, Col(I)α2). Scanning electron microscopy showed cellular and extracellular matrix (ECM) ingress into both scaffolds within 16 days and the formation of Ca-P precipitates within 85 days. In conclusion, this study demonstrated that PASF scaffolds enhance human periosteum cell osteogenic differentiation by releasing ionic Si, and structurally supporting cellular and ECM ingress.

Development of microspheres for biomedical applications: a review

An overview of microspheres manufactured for use in biomedical applications based on recent literature is presented in this review. Different types of glasses (i.e. silicate, borate, and phosphates), ceramics and polymer-based microspheres (both natural and synthetic) in the form of porous , non-porous and hollow structures that are either already in use or are currently being investigated within the biomedical area are discussed. The advantages of using microspheres in applications such as drug delivery, bone tissue engineering and regeneration, absorption and desorption of substances, kinetic release of the loaded drug components are also presented. This review also reports on the preparation and characterisation methodologies used for the manufacture of these microspheres. Finally, a brief summary of the existing challenges associated with processing these microspheres which requires further research and development are presented.

Translating textiles to tissue engineering: Creation and evaluation of microporous, biocompatible, degradable scaffolds using industry relevant manufacturing approaches and human adipose derived stem cells

Polymeric scaffolds have emerged as a means of generating three-dimensional tissues, such as for the treatment of bone injuries and nonunions. In this study, a fibrous scaffold was designed using the biocompatible, degradable polymer poly-lactic acid in combination with a water dispersible sacrificial polymer, EastONE. Fibers were generated via industry relevant, facile scale-up melt-spinning techniques with an islands-in-the-sea geometry. Following removal of EastONE, a highly porous fiber remained possessing 12 longitudinal channels and pores throughout all internal and external fiber walls. Weight loss and surface area characterization confirmed the generation of highly porous fibers as observed via focused ion beam/scanning electron microscopy. Porous fibers were then knit into a three-dimensional scaffold and seeded with human adipose-derived stem cells (hASC). Confocal microscopy images confirmed hASC attachment to the fiber walls and proliferation throughout the knit structure. Quantification of cell-mediated calcium accretion following culture in osteogenic differentiation medium confirmed hASC differentiation throughout the porous constructs. These results suggest incorporation of a sacrificial polymer within islands-in-the-sea fibers generates a highly porous scaffold capable of supporting stem cell viability and differentiation with the potential to generate large three-dimensional constructs for bone regeneration and/or other tissue engineering applications.

Characterization of fetal keratinocytes, showing enhanced stem cell-like properties: a potential source of cells for skin reconstruction

Epidermal stem cells have been in clinical application as a source of culture-generated grafts. Although applications for such cells are increasing due to aging populations and the greater incidence of diabetes, current keratinocyte grafting technology is limited by immunological barriers and the time needed for culture amplification. We studied the feasibility of using human fetal skin cells for allogeneic transplantation and showed that fetal keratinocytes have faster expansion times, longer telomeres, lower immunogenicity indicators, and greater clonogenicity with more stem cell indicators than adult keratinocytes. The fetal cells did not induce proliferation of T cells in coculture and were able to suppress the proliferation of stimulated T cells. Nevertheless, fetal keratinocytes could stratify normally in vitro. Experimental transplantation of fetal keratinocytes in vivo seeded on an engineered plasma scaffold yielded a well-stratified epidermal architecture and showed stable skin regeneration. These results support the possibility of using fetal skin cells for cell-based therapeutic grafting.

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Properties of fetal and adult keratinocytes are compared in tissue culture and grafts

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Fetal skin cells can be engrafted and show stable human-to-mouse skin regeneration

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Fetal keratinocytes are stem cell rich and need no differentiation before grafting

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Fetal keratinocytes are able to suppress proliferation of stimulated T cells in vitro

In vitro and in vivo bioactivity assessment of a polylactic acid/hydroxyapatite composite for bone regeneration

Synthetic bone graft substitutes based on composites consisting of a polymer and a calcium-phosphate (CaP) ceramic are developed with the aim to satisfy both mechanical and bioactivity requirements for successful bone regeneration. In the present study, we have employed extrusion to produce a composite consisting of 50 wt.% poly(D,L-lactic acid) (PLA) and 50 wt.% nano-sized hydroxyapatite (HA) powder, achieving homogeneous distribution of the ceramic within the polymeric phase. In vitro, in both a simulated physiological saline (SPS) and a simulated body fluid (SBF), a greater weight loss was observed for PLA/HA than for PLA particles upon 12-week immersion. Furthermore, in SPS, a continuous release of calcium and phosphate from the composite was measured, whereas in SBF, decrease of the amount of the two ions in the solution was observed both for PLA and PLA/HA accompanied with the formation of a CaP layer on the surface. In vitro characterization of the composite bioactivity was performed by culturing human mesenchymal stromal cells (hMSCs) and assessing proliferation and osteogenic differentiation, with PLA as a control. Both PLA/HA composite and PLA control were shown to support hMSCs proliferation over a period of two weeks. In addition, the composite significantly enhanced alkaline phosphatase (ALP) activity of hMSCs in osteogenic medium as compared with the polymer control. A novel implant design was employed to develop implants from dense, extruded materials, suitable for testing osteoinductivity in vivo. In a preliminary study in dogs, PLA/HA composite implants induced heterotopic bone formation upon 12-week intramuscular implantation in all animals, in contrast to PLA control, which was not osteoinductive. Unlike in vitro, a more pronounced degradation of PLA was observed in vivo as compared with PLA/HA composite.

A polycaprolactone/cuttlefish bone-derived hydroxyapatite composite porous scaffold for bone tissue engineering

Cuttlefish bone (CB) is an attractive natural biomaterial source to obtain hydroxyapatite (HAp). In this study, a porous polycaprolactone (PCL) scaffold incorporating CB-derived HAp (CB-HAp) powder was fabricated using the solvent casting and particulate leaching method. The presence of CB-HAp in PCL/CB-HAp scaffold was confirmed by X-ray diffraction (XRD). Scanning electron microscopy (SEM) and porosity analysis showed that the average pore dimension of the fabricated scaffold was approximately 200-300 μm, with ∼85% porosity, and that the compressive modulus increased after addition of CB-HAp powders. In vitro tests such as cell proliferation assay, cytotoxicity analysis, cell attachment observations, and alkaline phosphatase activity assays showed that the PCL/CB-HAp scaffold could improve the proliferation, viability, adherence, and osteoblast differentiation rate of MG-63 cells. When surgically implanted into rabbit calvarial bone defects, consistent with the in vitro results, PCL/CB-HAp scaffold implantation resulted in significantly higher new bone formation than did implantation of PCL alone. These findings suggest that addition of CB-HAp powder to the PCL scaffold can improve cellular response and that the PCL/CB-HAp composite scaffold has great potential for use in bone tissue engineering.

Melt spinning of poly(lactic acid) and hydroxyapatite composite fibers: influence of the filler content on the fiber properties

Composite fibers from poly(lactic acid) (PLA) and hydroxyapatite (HA) particles were prepared using melt spinning. Different loading concentrations of HA particles (i.e., 5, 10, 15, and 20 wt %) in the PLA fibers and solid-state draw ratios (SSDRs) were evaluated in order to investigate their influence on the fibers' morphology and thermal and mechanical properties. A scanning electron microscopy investigation indicated that the HA particles were homogeneously distributed in the PLA fibers. It was also revealed by atomic force microscopy and Fourier transform infrared spectroscopy that HA particles were located on the fiber surface, which is of importance for their intended application in biomedical textiles. Our results also suggest that the mechanical properties were independent of the loading concentration of the HA particles and that the SSDR played an important role in improving the mechanical properties of the composite fibers.

Monolithic and assembled polymer-ceramic composites for bone regeneration

The rationale for the use of polymer-ceramic composites for bone regeneration stems from the natural composition of bone, with collagen type I and biological apatite as the main organic and inorganic constituents, respectively. In the present study composite materials of PolyActive™ (PA), a poly(ethylene oxide terephthalate)/poly(butylene terephtalate) co-polymer, and hydroxyapatite (HA) at a weight ratio of 85:15 were prepared by rapid prototyping (RP) using two routes. In the first approach pre-extruded composite filaments of PA-HA were processed using three-dimensional fibre deposition (3DF) (conventional composite scaffolds). In the second approach PA scaffolds were fabricated using 3DF and combined with HA pillars produced inside stereolithographic moulds that fitted inside the pores of the PA three-dimensional structure (assembled composite scaffolds). Analysis of calcium and phosphate release in a simulated physiological solution, not containing calcium or phosphate, revealed significantly higher values for the HA pillars compared with other scaffolds. Release in simulated body fluid saturated with respect to HA did not show significant differences among the different scaffolds. Human mesenchymal stromal cells were cultured on polymer (3DF), conventional composite (3DF-HA) and assembled composite (HA assembled in 3DF) scaffolds and assessed for morphology, metabolic activity, DNA amount and gene expression of osteogenic markers using real time quantitative polymerase chain reaction (PCR). Scanning electron microscopy images showed that the cells attached to and infiltrated all the scaffolds. Assembled composites had a higher metabolic activity compared with 3DF-HA scaffolds while no significant differences were observed in DNA amounts. Gene expression of osteopontin in the assembled composite was significantly higher compared with the conventional composites. The strategy of composite fabrication by assembly appears to be a promising alternative to the conventional composite fabrication route for scaffolds for bone regeneration.

Functionalization of microstructured open-porous bioceramic scaffolds with human fetal bone cells

Bone substitute materials allowing trans-scaffold migration and in-scaffold survival of human bone-derived cells are mandatory for development of cell-engineered permanent implants to repair bone defects. In this study, we evaluated the influence on human bone-derived cells of the material composition and microstructure of foam scaffolds of calcium aluminate. The scaffolds were prepared using a direct foaming method allowing wide-range tailoring of the microstructure for pore size and pore openings. Human fetal osteoblasts (osteo-progenitors) attached to the scaffolds, migrated across the entire bioceramic depending on the scaffold pore size, colonized, and survived in the porous material for at least 6 weeks. The long-term biocompatibility of the scaffold material for human bone-derived cells was evidenced by in-scaffold determination of cell metabolic activity using a modified MTT assay, a repeated WST-1 assay, and scanning electron microscopy. Finally, we demonstrated that the osteo-progenitors can be covalently bound to the scaffolds using biocompatible click chemistry, thus enhancing the rapid adhesion of the cells to the scaffolds. Therefore, the different microstructures of the foams influenced the migratory potential of the cells, but not cell viability. Scaffolds allow covalent biocompatible chemical binding of the cells to the materials, either localized or widespread integration of the scaffolds for cell-engineered implants.

Adhesion and proliferation of human osteoblast-like cells on different biodegradable implant materials used for graft fixation in ACL-reconstruction

INTRODUCTION

This study investigates the adhesion and proliferation behaviour of human osteoblast-like cells over time when incubated on surfaces of biodegradable screws and pins used for graft fixation in ACL reconstruction.

MATERIALS AND METHODS

2 mm-sized-wedges of four bioresorbable implants [1. poly-L-lactide acid (PLLA) screw, 2. PLLA/β-tricalciumphosphate (PLLA/TCP) (70 %/30 %) screw, 3. poly-L-lactide-co-glycolic acid/β-tricalciumphosphate (PLGA/TCP) (70 %/30 %) screw and 4. PLLA pin] were incubated with human osteoblast-like cells. All probes were evaluated after 3,7,14 and 21 days by cell number count, determination of cell proliferation, observation of cell adhesion of human osteoblast-like cells under an environmental scanning electron microscope (ESEM), and by a live-dead assay.

RESULTS

Cell numbers were lower at all stages in both PLLA groups compared to the composite materials (PLLA/TCP and PLGA/TCP). A significant difference in cell proliferation was found after 21 days. The cells on both composite screws (PLLA/TCP and PLGA/TCP) maintained more contact points with the screw surface compared to the cells on PLLA screws under ESEM. No cytotoxicity could be observed in the live-dead assay.

DISCUSSION

Mainly, β-TCP as part of a composite implant seems to offer good ultrastructural properties for cell adhesion according to our in vitro study. Cell numbers seem to be influenced by the degradation behaviour with higher cell numbers in the composite groups.

Biomaterial selection for tooth regeneration

Biomaterials are native or synthetic polymers that act as carriers for drug delivery or scaffolds for tissue regeneration. When implanted in vivo, biomaterials should be nontoxic and exert intended functions. For tooth regeneration, biomaterials have primarily served as a scaffold for (1) transplanted stem cells and/or (2) recruitment of endogenous stem cells. This article critically synthesizes our knowledge of biomaterial use in tooth regeneration, including the selection of native and/or synthetic polymers, three-dimensional scaffold fabrication, stem cell transplantation, and stem cell homing. A tooth is a complex biological organ. Tooth loss represents the most common organ failure. Tooth regeneration encompasses not only regrowth of an entire tooth as an organ, but also biological restoration of individual components of the tooth including enamel, dentin, cementum, or dental pulp. Regeneration of tooth root represents perhaps more near-term opportunities than the regeneration of the whole tooth. In the adult, a tooth owes its biological vitality, arguably more, to the root than the crown. Biomaterials are indispensible for the regeneration of tooth root, tooth crown, dental pulp, or an entire tooth.

Endothelialization and in-stent restenosis on the surface of glycoprotein IIIa monoclonal antibody eluting stent

Since the percutaneous transtuminal coronary angioplasty was introduced into China in 1984, this procedure has become widely accepted as an important step in coronary revascularization. This study shows the effect of the monoclonal antibody (mAb) on the platelet glycoprotein IIIa receptor during endothelialization and in-stent restenosis by implanting the mAb-eluting stents into iliac arteries of rabbits. The hard tissue cross sections of the stent-implanted arterial segments were made by polymethylmethacrylate embedding. Arterial intima proliferation was observed and analyzed. The endothelialization of the stent surface was observed using scanning electron microscope, whereas the ultrastructure of the neointima was observed using transmission electron microscope. After one month of stent implantation, the surfaces of both groups were covered by intact endothelial layers, but the neointimal areas and the ratio of stenosis were significantly lesser in the mAb-eluting stent group (p < 0.01). After 3 months, the ratio of stenosis in the mAb-eluting stent group was 14.67 ± 0.79, whereas that of the bare stent group was 21.58 ± 1.76 (p < 0.01). Therefore, the mAb eluting from the stent surface has the potential to accelerate endothelialization, prevent thrombosis formation due to the interaction of stent with blood, and decrease the stenosis ratio by inhibiting neointima proliferation.

The effect of processing variables on morphological and mechanical properties of supercritical CO2 foamed scaffolds for tissue engineering

The porous structure of a scaffold determines the ability of bone to regenerate within this environment. In situations where the scaffold is required to provide mechanical function, balance must be achieved between optimizing porosity and maximizing mechanical strength. Supercritical CO(2) foaming can produce open-cell, interconnected structures in a low-temperature, solvent-free process. In this work, we report on foams of varying structural and mechanical properties fabricated from different molecular weights of poly(DL-lactic acid) P(DL)LA (57, 25 and 15 kDa) and by varying the depressurization rate. Rapid depressurization rates produced scaffolds with homogeneous pore distributions and some closed pores. Decreasing the depressurization rate produced scaffolds with wider pore size distributions and larger, more interconnected pores. In compressive testing, scaffolds produced from 57 kDa P(DL)LA exhibited typical stress-strain curves for elastomeric open-cell foams whereas scaffolds fabricated from 25 and 15 kDa P(DL)LA behaved as brittle foams. The structural and mechanical properties of scaffolds produced from 57 kDa P(DL)LA by scCO(2) ensure that these scaffolds are suitable for potential applications in bone tissue engineering.

Bone regeneration and stem cells

This invited review covers research areas of central importance for orthopaedic and maxillofacial bone tissue repair, including normal fracture healing and healing problems, biomaterial scaffolds for tissue engineering, mesenchymal and foetal stem cells, effects of sex steroids on mesenchymal stem cells, use of platelet-rich plasma for tissue repair, osteogenesis and its molecular markers. A variety of cells in addition to stem cells, as well as advances in materials science to meet specific requirements for bone and soft tissue regeneration by addition of bioactive molecules, are discussed.

Human fetal bone cells in delivery systems for bone engineering

The aim of this study was to culture human fetal bone cells (dedicated cell banks of fetal bone derived from 14 week gestation femurs) within both hyaluronic acid gel and collagen foam, to compare the biocompatibility of both matrices as potential delivery systems for bone engineering and particularly for oral application. Fetal bone cell banks were prepared from one organ donation and cells were cultured for up to 4 weeks within hyaluronic acid (Mesolis®) and collagen foams (TissueFleece®). Cell survival and differentiation were assessed by cell proliferation assays and histology of frozen sections stained with Giemsa, von Kossa and ALP at 1, 2 and 4 weeks of culture. Within both materials, fetal bone cells could proliferate in three-dimensional structure at ∼70% capacity compared to monolayer culture. In addition, these cells were positive for ALP and von Kossa staining, indicating cellular differentiation and matrix production. Collagen foam provides a better structure for fetal bone cell delivery if cavity filling is necessary and hydrogels would permit an injectable technique for difficult to treat areas. In all, there was high biocompatibility, cellular differentiation and matrix deposition seen in both matrices by fetal bone cells, allowing for easy cell delivery for bone stimulation in vivo.