Role of hyaluronic acid and phospholipid in the lubrication of a cobalt-chromium head for total hip arthroplasty

Location of Polyelectrolytes in Swollen Lipid Oligobilayers

Osteoarthritis is caused by degeneration of the cartilage, which covers the bone ends of the joints and is decorated with an oligolamellar phospholipid (PL) bilayer. The gap between the bone ends is filled with synovial fluid mainly containing hyaluronic acid (HA). HA and PLs are supposed to reduce friction and protect the cartilage from wear in joint movement. However, a detailed understanding of the molecular mechanisms of joint lubrication is still missing. Previously, we found that aqueous solutions of HA and poly(allylamine hydrochloride) (PAH), the latter serving as a polymeric analogue to HA, adsorb onto the headgroups of surface-bound 1,2-dimyristoyl-sn-glycero-3-phosphocholine (DMPC) oligobilayers and significantly enhance their stability with respect to shear forces, typically occurring in joint movement. We now investigated the precise location of PAH chains across the lipid films in neutron reflectivity measurements, as bridging of the oligobilayers by polyelectrolytes (PEs) might be the cause for their improved mechanical stability. In a first set of experiments, we used hydrogenated PAH and chain-deuterated DMPC (DMPC-d54) to improve the contrast between the lipids and potentially intruding PAH. However, due to difficulties in distinguishing between incorporation of water and PAH, penetration into the lipid chain region could hardly be proven quantitatively. Therefore, we designed a more elaborate experiment based on mixed films of DMPC-d54 and hydrogenated DMPC, which is insensitive to water penetration into the films. Beside facilitating a detailed structural characterization of the oligolamellar system, this elaborate approach showed that PAH adsorbs to the DMPC heads and penetrates the lipid tail strata. No PAH was found in the lipid head strata, which excludes bridging of several lipid bilayers by the PE chains. The data are consistent with the assumption that PAH bridges are formed between the headgroups of two adjacent bilayers and contribute to the enhanced mechanical stability.

Intra-articular treatment of temporomandibular joint osteoarthritis by injecting actively-loaded meloxicam liposomes with dual-functions of anti-inflammation and lubrication

Temporomandibular joint (TMJ) osteoarthritis is a common osteochondral degenerative disease which can severely affect patient's mouth opening and mastication. Meloxicam (MLX), one of the most widely used non-steroidal anti-inflammatory drugs, is the main clinical therapy for the treatment of TMJ osteoarthritis. However, the clinical effect is greatly compromised because of its poor water solubility and high lipophilicity. In the present study, we developed an actively-loaded liposomal formulation, namely MLX-Ca(AC)₂Lipo, using meglumine to enhance aqueous solubility and divalent metal (Ca²⁺) solution to improve encapsulation efficiency. By the formation of the nano-bowl shaped MLX-Ca precipitates inside the liposomes, MLX-Ca(AC)₂Lipo successfully achieved an optimal encapsulation efficiency as high as 98.4% compared with previous passive loading method (60.6%). Additionally, MLX-Ca(AC)₂Lipo maintained stable, and the slow drug release not only prolonged the duration of drug efficacy but also improved bioavailability. It was shown in the in vitro and in vivo tests that MLX-Ca(AC)₂Lipo downregulated the synthesis of the inflammatory factors (such as prostaglandin-E2) and as a consequence reduced chondrocytes apoptosis and extracellular matrix degeneration. Furthermore, the intra-articular injection of MLX-Ca(AC)₂Lipo enhanced bioinspired lubrication of TMJ, protecting the cartilage from progressive wear. In summary, MLX-Ca(AC)₂Lipo with dual-functions of anti-inflammation and lubrication is a promising nanomedicine for the treatment of TMJ osteoarthritis by intra-articular injection.

Recent advances in superlubricity of liposomes for biomedical applications

Achieving superlubricity, a state of lubrication where friction nearly vanishes, has become one of the most promising approaches to combat friction-induced energy dissipation and medical device failure. Phospholipids are amphiphilic molecules comprising highly hydrophilic phosphatidylcholine head groups as well as hydrophobic hydrocarbon chains, When solubilized, phospholipids can readily self-assemble to form different structures such as bilayers and vesicles (liposomes). Recently, liposomes have been identified as excellent lubricants, especially in the boundary lubrication regime the most common lubrication status in the field of biotribology. In this review, we summarize recent progress in employing liposomes as key players for employing superlubricity in biomedical applications. The relationship between lipids and liposomes, manufacturing approaches, lubrication regimes, and regulation mechanisms of liposomes are discussed. Finally, we indicate possible future directions for the use of liposome-mediated superlubricity in biomedical applications.

Wettability, Corrosion Resistance, and Osteoblast Response to Reduced Graphene Oxide on CoCr Functionalized with Hyaluronic Acid

The durability of metal-metal prostheses depends on achieving a higher degree of lubrication. The beneficial effect of hyaluronic acid (HA) on the friction and wear of both natural and artificial joints has been reported. For this purpose, graphene oxide layers have been electrochemically reduced on CoCr surfaces (CoCrErGO) and subsequently functionalized with HA (CoCrErGOHA). These layers have been evaluated from the point of view of wettability and corrosion resistance in a physiological medium containing HA. The wettability was analyzed by contact angle measurements in phosphate buffer saline-hyaluronic acid (PBS-HA) solution. The corrosion behavior of functionalized CoCr surfaces was studied with electrochemical measurements. Biocompatibility, cytotoxicity, and expression of proteins related to wound healing and repair were studied in osteoblast-like MC3T3-E1 cell cultures. All of the reported results suggest that HA-functionalized CoCr surfaces, through ErGO layers in HA-containing media, exhibit higher hydrophilicity and better corrosion resistance. Related to this increase in wettability was the increase in the expressions of vimentin and ICAM-1, which favored the growth and adhesion of osteoblasts. Therefore, it is a promising material for consideration in trauma applications, with improved properties in terms of wettability for promoting the adhesion and growth of osteoblasts, which is desirable in implanted materials used for bone repair.

Corrosion Behaviour and J774A.1 Macrophage Response to Hyaluronic Acid Functionalization of Electrochemically Reduced Graphene Oxide on Biomedical Grade CoCr

Improvements in the lubrication of metal–metal joint prostheses are of great clinical interest in order to minimize the particles released during wear–corrosion processes. In this work, electrochemically reduced graphene oxide (ErGO) on CoCr was functionalized with hyaluronic acid (ErGOHA). Functionalization was carried out by soaking for 24 h in phosphate buffer saline (PBS) solution containing 3 g/L hyaluronic acid (HA). The corrosion performance of CoCrErGO and CoCrErGOHA surfaces was studied by electrochemical impedance spectroscopy (EIS) for 7 days in PBS. Biocompatibility and cytotoxicity were studied in mouse macrophages J774A.1 cell line by the measurement of mitochondrial activity (WST-1 assay) and plasma membrane damage (LDH assay). The inflammatory response was examined through TNF-α and IL-10 cytokines in macrophages culture supernatants, used as indicators of pro-inflammatory and anti-inflammatory responses, respectively. EIS diagrams of CoCrErGOHA revealed two time constants: the first one, attributed to the hydration and diffusion processes of the HA layer adsorbed on ErGO, and the second one, the corrosion resistance of ErGOHA/CoCr interface. Macrophage assays showed better behavior on CoCrErGOHA than CoCr and CoCrErGO surfaces based on their biocompatible, cytotoxic, and inflammatory responses. Comparative analysis of IL-10 showed that functionalization with HA induces higher values of anti-inflammatory cytokine, suggesting an improvement in inflammatory behavior.

Sclerostin-Mediated Impaired Osteogenesis by Fibroblast-Like Synoviocytes in the Particle-Induced Osteolysis Model

Engineered biomaterials are envisioned to replace, augment, or interact with living tissues for improving the functional deformities associated with end-stage joint pathologies. Unfortunately, wear debris from implant interfaces is the major factor leading to periprosthetic osteolysis. Fibroblast-like synoviocytes (FLSs) populate the intimal lining of the synovium and are in direct contact with wear debris. This study aimed to elucidate the effect of Ti particles as wear debris on human FLSs and the mechanism by which they might participate in the bone remodeling process during periprosthetic osteolysis. FLSs were isolated from synovial tissue from patients, and the condition medium (CM) was collected after treating FLSs with sterilized Ti particles. The effect of CM was analyzed for the induction of osteoclastogenesis or any effect on osteogenesis and signaling pathways. The results demonstrated that Ti particles could induce activation of the NFκB signaling pathway and induction of COX-2 and inflammatory cytokines in FLSs. The amount of Rankl in the conditioned medium collected from Ti particle–stimulated FLSs (Ti CM) showed the ability to stimulate osteoclast formation. The Ti CM also suppressed the osteogenic initial and terminal differentiation markers for osteoprogenitors, such as alkaline phosphate activity, matrix mineralization, collagen synthesis, and expression levels of Osterix, Runx2, collagen 1α, and bone sialoprotein. Inhibition of the WNT and BMP signaling pathways was observed in osteoprogenitors after the treatment with the Ti CM. In the presence of the Ti CM, exogenous stimulation by WNT and BMP signaling pathways failed to stimulate osteogenic activity in osteoprogenitors. Induced expression of sclerostin (SOST: an antagonist of WNT and BMP signaling) in Ti particle–treated FLSs and secretion of SOST in the Ti CM were detected. Neutralization of SOST in the Ti CM partially restored the suppressed WNT and BMP signaling activity as well as the osteogenic activity in osteoprogenitors. Our results reveal that wear debris–stimulated FLSs might affect bone loss by not only stimulating osteoclastogenesis but also suppressing the bone-forming ability of osteoprogenitors. In the clinical setting, targeting FLSs for the secretion of antagonists like SOST might be a novel therapeutic approach for preventing bone loss during inflammatory osteolysis.

Analysis of Chemisorbed Tribo-Film for Ceramic-on-Ceramic Hip Joint Prostheses by Raman Spectroscopy

To understand the possible lubricant mechanism in ceramic-on-ceramic hip joint prostheses, biochemical reactions of the synovial fluid and the corresponding frictional coefficients were studied. The experiments were performed in a hip joint simulator using the ball-on-cup configuration with balls and cups made from two types of ceramics, BIOLOX^®forte and BIOLOX^®delta. Different lubricants, namely albumin, γ-globulin, hyaluronic acid and three model synovial fluids, were studied in the experiments and Raman spectroscopy was used to analyze the biochemical responses of these lubricants at the interface. BIOLOX^®delta surface was found less reactive to proteins and model fluid lubricants. In contrast, BIOLOX^®forte ball surface has shown chemisorption with both proteins, hyaluronic acid and model fluids imitating total joint replacement and osteoarthritic joint. There was no direct correlation between the measured frictional coefficient and the observed chemical reactions. In summary, the study reveals chemistry of lubricant film formation on ceramic hip implant surfaces with various model synovial fluids and their components.

Facile fabrication of phospholipid-functionalized nanofiber-based barriers with enhanced anti-adhesion efficiency

Electrospun nanofibrous membranes (NFMs) have attracted considerable attention as a potential physical barrier for reducing postoperative adhesion. However, no anti-adhesion barrier can completely prevent adhesion formation. In this study, phospholipid-functionalized NFMs were readily fabricated by one-step electrospinning to obtain nanofiber-based barriers with enhanced wettability and anti-adhesion efficiency. The optimized phospholipid NFMs were shown to have a fiber diameter of 831 nm ± 135 nm that is drastically decreasing, high porosity of 87.6 % ± 1.1 %, and superior hydrophilicity. Moreover, the phospholipid NFMs with excellent cytocompatibility exhibited fibroblasts being significantly reduced (≈ 51 %) after incubation of 3 days compared to that of the NFMs (≈ 96 %), confirming long-lasting anti-adhesion capability against fibroblasts. Meanwhile, less cell adhesion and proliferation of Raw 264.7 macrophages on NFM-10Lec indicated its superior anti-inflammatory effects. Thus, the facile phospholipid-functionalized nanofibers provided a promising strategy for anti-adhesion applications.

Fibroblast-Like-Synoviocytes Mediate Secretion of Pro-Inflammatory Cytokines via ERK and JNK MAPKs in Ti-Particle-Induced Osteolysis

Biomaterials are designed to replace and augment living tissues in order to provide functional support to skeletal deformities. However, wear debris produced from the interfaces of metal implants initiates inflammatory bone loss, causing periprosthetic osteolysis. Lately, fibroblast-like synoviocytes (FLS) have been shown to play a role in wear-debris-induced osteolysis. Thus, here we have tried to understand the underlying mechanism of FLS involvement in wear-debris-induced osteolysis. Our results demonstrate that the effects of Ti particle (1:100 cell-to-Ti particle ratio) on FLS can induce Cox-2 expression and activate NFkB signaling. Moreover, the mRNA expression of pro-inflammatory cytokines such as IL-6, IL-8, IL-11, IL-1β, and TNFα was found to be elevated. However, among these pro-inflammatory cytokines, the mRNA and protein levels of only IL-6, IL-1β, and TNFα were found to be significantly higher. Ti particles activated extracellular signal-regulated kinase (ERK) and c-Jun N-terminal kinase (JNK) mitogen-activated protein kinases (MAPKs) as an early response in FLS. Co-inhibition of ERK and JNK signaling pathways by their specific inhibitors (PD9805 and SP600125, respectively) resulted in the suppression of mRNA and protein levels of IL-6, IL-1β, and TNFα in FLS. Taken together, targeting ERK and JNK MAPKs in FLS might provide a therapeutic option for reducing the secretion of bone-resorbing pro-inflammatory cytokines, thus preventing periprosthetic osteolysis.

Synthetic periprosthetic synovial fluid development for in vitro cell-tribocorrosion testing using the Taguchi array approach

Synovial fluid is dynamic in vivo with biological components changing in ratio and size depending on the health of the joint space, making it difficult to model in vitro. Previous efforts to develop synthetic synovial fluid have typically focused on single organic-tribological interactions with implant surfaces, thus ignoring interplay between multiple solution components. Using a Taguchi orthogonal array, we were able to isolate the individual effects of five independent synovial fluid composition variables: ratios of (1) hyaluronic acid to phospholipids (HA:PL) and (2) albumin to globulin (A:G), and concentrations of (3) hydrogen peroxide (H₂ O₂ ), (4) cobalt (Co²⁺ ) and (5) chromium (Cr³⁺ ) ions on macrophage viability and reduced glutathione production, local solution pH and the comprehensive CoCrMo alloy electrochemical response. While no single synovial fluid variable significantly affected the collective response, HA:PL ratio resulted in the largest impact factor (Δ) on 12 of the 13 measured responses with significant effects (p < .05) on the average macrophage survival rate and electrochemical capacitive state of the CoCrMo surface. Cluster analysis separated significant responses from all trials into three groups, corresponding to healthy, mild, or severely inflamed fluids, respectively; with the healthy synovial fluid composition having mid-range HA:PL ratios with no Co²⁺ ions, and the severely inflamed fluids consisting of low and high HA:PL ratios with H₂ O₂ and Co²⁺ ions. By utilizing the Taguchi approach in combination with cluster analysis, we were able to advance our knowledge of complex multivariate synthetic synovial fluids influence on macrophage and electrochemical behavior at the cell-solution-metal interface.

Synovial Fluid Viscosity Test is Promising for the Diagnosis of Periprosthetic Joint Infection

BACKGROUND

So far there is no "gold standard" test for the diagnosis of periprosthetic joint infection (PJI), compelling clinicians to rely on several serological and synovial fluid tests with no 100% accuracy. Synovial fluid viscosity is one of the parameters defining the rheology properties of synovial fluid. We hypothesized that patients with PJI may have a different level of synovial fluid viscosity and aimed to investigate the sensitivity and specificity of synovial fluid viscosity in detecting PJI.

METHODS

This prospective study was initiated to enroll patients undergoing primary and revision arthroplasty. Our cohort consisted of 45 patients undergoing revision for PJI (n = 15), revision for aseptic failure (n = 15), and primary arthroplasty (n = 15). PJI was defined using the Musculoskeletal Infection Society criteria. In all patients, synovial fluid viscosity, C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), and plasma d-dimer levels were measured preoperatively.

RESULTS

The synovial fluid viscosity level was significantly lower (P = .0011) in patients with PJI (7.93 mPa·s, range 3.0-15.0) than in patients with aseptic failure (13.11 mPa·s, range 6.3-20.4). Using Youden's index, 11.80 mPa·s was determined as the optimal threshold value for synovial fluid viscosity for the diagnosis of PJI. Synovial fluid viscosity outperformed CRP, ESR, and plasma d-dimer, with a sensitivity of 93.33% and a specificity of 66.67%.

CONCLUSION

Synovial fluid viscosity seems to be on the same level of accuracy with CRP, ESR, and d-dimer regarding PJI detection and to be a promising marker for the diagnosis of PJI.

AFM Study on Superlubricity between Ti6Al4V/Polymer Surfaces Achieved with Liposomes

Liposomes have been considered as the boundary lubricant in natural joints. They are also the main component of bionic lubricant. In this study, the tribological properties of liposomes on Ti6Al4V/polymer surface were studied by atomic force microscope (AFM) at the nanoscale. The superlubricity with a friction coefficient of 0.007 was achieved under the maximal pressure of 15 MPa, consisting with the lubrication condition of natural joints. Especially, when the AFM probe was hydrophilically modified and preadsorbed, the friction coefficient and load bearing capacity could be further improved. In addition, the probe with a large radius could maintain the stable lubrication of liposomes in the contact zone. Finally, an optimal lubrication model of liposomes was established and the critical force for superlubricity was also proposed. It was the boundary between elastic deformation and plastic deformation for vesicles. It was also the indicator of the plough effect appearing on the adsorbed layer. This work reveals the interfacial behavior of liposomes and realizes the controllable superlubricity system, providing more guidance for clinical application.

Albumin Protein Cleavage Affects the Wear and Friction of Ultra-High Molecular Weight Polyethylene

It is well established that the total protein concentration and albumin-to-globulin ratio influence the wear of ultra-high molecular polyethylene (UHMWPE, “polyethylene”) in joint prostheses. A factor on wear not yet studied, but of possible clinical relevance, is protein cleavage. Such cleavage is expected in the presence of an inflammatory response and as a result of wear processes at the articular interface. The aim of this study was to compare the tribological behavior of polyethylene articulated against an orthopedic wrought CoCrMo alloy for three lubricants: cleaved albumin, uncleaved albumin, and newborn calf serum (control). We hypothesized that the cleavage of albumin will increase the friction and wear rate of polyethylene, with a concomitant roughening of the polymer surface and the generation of larger wear debris particles. Cleavage of the bovine albumin into five fragments was performed by digestion with cyanogen bromide. In pin-on-flat (POF) wear tests of polyethylene pins made of Ticona GUR^® 1020/1050 against CoCrMo alloy discs, the cleaved albumin led to the lowest polyethylene wear and highest friction coefficients, whereas albumin led to the highest wear rates. In knee simulator tests, the albumin lubricant also led to a 2.7-fold increase in the tibial insert wear rate compared to the regular bovine serum lubricant (a wear rate for the cleaved albumin could not be obtained). The generated polyethylene wear particles were of increasing size and fibrillar shape in going from serum to albumin to cleaved albumin, although only the shape achieved statistical significance. Unlike bovine serum, cleaved albumin led to wear scars for both the POF and simulator wear tests that closely emulated the morphological features observed on explanted polyethylene tibial inserts from total knee replacements. We posit that the smaller protein fragments can more efficiently adsorb on the surfaces of both the polyethylene and the metal, thus offering protection against wear, while at the same time leading to an increase in friction, particle size, and particle elongation, as the protein fragment films interact adhesively during sliding. The results of this study have implications for pre-clinical wear testing methodology as they suggest that albumin concentration may be more pertinent than total protein concentration for wear testing polyethylene.

Synergies in lubrication

In living organisms the aqueous medium is used for providing low friction forces. This is achieved by synergistic actions of different biomolecules that together accomplish a high load bearing capacity and sustain an easily sheared water layer.

Insight into the Tribological Behavior of Liposomes in Artificial Joints

Liposomes are widely used in drug delivery and gene therapy, and their new role as boundary lubricant in natural/artificial joints has been found in recent years. In this study, the tribological properties of liposomes on titanium alloy (Ti6Al4 V)/UHMWPE interface were studied by a ball-on-disc tribometer. The efficient reduction of friction coefficient and wear on both surfaces under various velocities and loads is found. A multilayer structure of physically adsorbed liposomes on Ti6Al4 V surface was also observed by atomic force microscope (AFM). Except for the hydration mechanism by phosphatidylcholine (PC) groups, the well-performed tribological properties by liposomes is also attributed to the existence of adsorbed liposome layers on both surfaces, which could reduce asperities contact and show great bearing capacity. This work enriches the research on liposomes for lubrication improvement on artificial surface and shows their value in clinical application.

Surface-Active Lipid Linings under Shear Load--A Combined in-Situ Neutron Reflectivity and ATR-FTIR Study

We study shear effects in solid-supported lipid membrane stacks by simultaneous combined in-situ neutron reflectivity (NR) and attenuated total reflection Fourier transform infrared spectroscopy (ATR-FTIR). The stacks mimic the terminal surface-active phospholipid (SAPL) coatings on cartilage in mammalian joints. Piles of 11 bilayer membranes of 1,2-dimyristoyl-sn-glycero-3-phosphocholine (DMPC) are immobilized at the interface of the solid silicon support and the liquid D2O backing phase. We replace the natural hyaluronic acid (HA) component of synovial fluid by a synthetic substitute, namely, poly(allylamine hydrochloride) (PAH), at identical concentration. We find the oligolamellar DMPC bilayer films strongly interacting with PAH resulting in a drastic increase of the membranes d spacing (by a factor of ∼5). Onset of shear causes a buckling-like deformation of the DMPC bilayers perpendicular to the applied shear field. With increasing shear rate we observe substantially enhanced water fractions in the membrane slabs which we attribute to increasing fragmentation caused by Kelvin-Helmholtz-like instabilities parallel to the applied shear field. Both effects are in line with recent theoretical predictions on shear-induced instabilities of lipid bilayer membranes in water (Hanasaki, I.; Walther, J. H.; Kawano, S.; Koumoutsakos, P. Phys. Rev. E 2010, 82, 051602). With the applied shear the interfacial lipid linings transform from their gel state Pβ' to their fluid state Lα. Although in chain-molten state with reduced bending rigidity the lipid layers do not detach from their solid support. We hold steric bridging of the fragmented lipid bilayer membranes by PAH molecules responsible for the unexpected mechanical stability of the DMPC linings.