The Impact of Ultrashort Pulse Laser Structuring of Metals on In-Vitro Cell Adhesion of Keratinocytes

Besides the need for biomaterial surface modification to improve cellular attachment, laser-structuring is favorable for designing a new surface topography for external bone fixator pins or implants. The principle of this study was to observe how bioinspired (deer antler) laser-induced nano-microstructures influenced the adhesion and growth of skin cells. The goal was to create pins that allow the skin to attach to the biomaterial surface in a bacteria-proof manner. Therefore, typical fixator metals, steel, and titanium alloy were structured using ultrashort laser pulses, which resulted in periodical nano- and microstructures. Surface characteristics were investigated using a laser scanning microscope and static water contact angle measurements. In vitro studies with human HaCaT keratinocytes focused on cell adhesion, morphology, actin formation, and growth within 7 days. The study showed that surface functionalization influenced cell attachment, spreading, and proliferation. Micro-dimple clusters on polished bulk metals (DC20) will not hinder viability. Still, they will not promote the initial adhesion and spreading of HaCaTs. In contrast, additional nanostructuring with laser-induced periodic surface structures (LIPSS) promotes cell behavior. DC20 + LIPSS induced enhanced cell attachment with well-spread cell morphology. Thus, the bioinspired structures exhibited a benefit in initial cell adhesion. Laser surface functionalization opens up new possibilities for structuring, and is relevant to developing bioactive implants in regenerative medicine.

Functional chitosan gel coating enhances antimicrobial properties and osteogenesis of titanium alloy under persistent chronic inflammation

Titanium is widely used as surgical bone implants due to its excellent mechanical properties, corrosion resistance, and good biocompatibility. However, due to chronic inflammation and bacterial infections caused by titanium implants, they are still at risk of failure in interfacial integration of bone implants, severely limiting their broad clinical application. In this work, chitosan gels crosslinked with glutaraldehyde were prepared and successfully loaded with silver nanoparticles (nAg) and catalase nanocapsules (n (CAT)) to achieve functionalized coating on the surface of titanium alloy steel plates. Under chronic inflammatory conditions, n (CAT) significantly reduced the expression of macrophage tumor necrosis factor (TNF-α), increased the expression of osteoblast alkaline phosphatase (ALP) and osteopontin (OPN), and enhanced osteogenesis. At the same time, nAg inhibited the growth of S. aureus and E. coli. This work provides a general approach to functional coating of titanium alloy implants and other scaffolding materials.

Fabrication and evaluation of antimicrobial biomimetic nanofibre coating for improved dental implant bio-seal: An in vitro study

BACKGROUND

A weak implant-soft tissue interface may lead to bacterial ingression, breakdown of underlying tissues, and eventually implant failure. This study proposes a surface modification technique of titanium alloy (Ti), using a nano-biopolymer scaffold to enhance soft tissue attachment in dental implants.

METHODS

Gelatin (20% w/v) embedded with 10±2 nm silver nanoparticles (AgNPs) was electrospun to form a Gelatin Electrospun Mat (GEM) scaffold, bonded to Ti alloy surface using chemical surface functionalization. Antimicrobial activity of AgNPs was tested against representative Gram-positive (S. aureus) and Gram-negative bacteria (E. coli) at 4, 24, and 48 hours (h) and after embedding in scaffold at 48 h. Cytotoxicity analysis (MTT assay) was carried out using the 3T3 mouse fibroblast cell line at 24 and 72 h for two groups: Control (unmodified Ti disc) and Experimental (GEM embedded with AgNPs); and further validated by scanning electron microscopy (SEM).

RESULTS

The AgNPs-embedded GEM showed good antimicrobial activity at 48 h, with the AgNPs showing complete (99.99%) inhibition of bacterial colony counts at 24 h and 48 h. Cell viability and proliferation over the GEM modified Ti discs were seen to be significantly increased (p < 0.05) at 72 h as compared to control. SEM images revealed intimate spreading of fibroblasts, with differentiated cell morphology and pseudopodial processes, indicative of enhanced fibroblastic adhesion, growth, and differentiation over the scaffold.

CONCLUSION

Results show good antifouling properties and biocompatibility of the fabricated coating, making it a promising strategy to reduce post-operative infections and peri-implant diseases in Ti dental implants. This article is protected by copyright. All rights reserved.

Skin adhesion to the percutaneous component of direct bone anchored systems: systematic review on preclinical approaches and biomaterials

Nowadays, direct bone anchored systems are an increasingly adopted approach in the therapeutic landscape for amputee patients. However, the percutaneous nature of these devices poses a major challenge to obtain a stable and lasting proper adhesion between the implant surface and the skin. A systematic review was carried out in three databases (PubMed, Scopus, Web of Science) to provide an overview of the innovative strategies tested with preclinical models (in vitro and in vivo) in the last ten years to improve the skin adhesion of direct bone anchored systems. Fifty five articles were selected after screening, also employing PECO question and inclusion criteria. A modified Cochrane RoB 2.0 tool for the in vitro studies and the SYRCLE tool for in in vivo studies were used to assess the risk of bias. The evidence collected suggests that the implementation of porous percutaneous structures could be one of the most favorable approach to improve proper skin adhesion, especially in association with bioactive coatings, as hydroxyapatite, and exploiting the field of nanostructure. Some issues still remain open as (a) the identification and characterization of the best material/coating association able to limit the shear stresses at the interface and (b) the role of keratinocyte turnover on the skin/biomaterial adhesion and integration processes.

Additive manufacturing of Ti6Al4V alloy via electron beam melting for the development of implants for the biomedical industry

Additive Manufacturing (AM) or rapid prototyping technologies are presented as one of the best options to produce customized prostheses and implants with high-level requirements in terms of complex geometries, mechanical properties, and short production times. The AM method that has been more investigated to obtain metallic implants for medical and biomedical use is Electron Beam Melting (EBM), which is based on the powder bed fusion technique. One of the most common metals employed to manufacture medical implants is titanium. Although discovered in 1790, titanium and its alloys only started to be used as engineering materials for biomedical prostheses after the 1950s. In the biomedical field, these materials have been mainly employed to facilitate bone adhesion and fixation, as well as for joint replacement surgeries, thanks to their good chemical, mechanical, and biocompatibility properties. Therefore, this study aims to collect relevant and up-to-date information from an exhaustive literature review on EBM and its applications in the medical and biomedical fields. This AM method has become increasingly popular in the manufacturing sector due to its great versatility and geometry control.

Osteogenic and antibacterial surfaces on additively manufactured porous Ti-6Al-4V implants: Combining silver nanoparticles with hydrothermally synthesized HA nanocrystals

The recently developed additively manufacturing techniques have enabled the fabrication of porous biomaterials that mimic the characteristics of the native bone, thereby avoiding stress shielding and facilitating bony ingrowth. However, aseptic loosening and bacterial infection, as the leading causes of implant failure, need to be further addressed through surface biofunctionalization. Here, we used a combination of (1) plasma electrolytic oxidation (PEO) using Ca-, P-, and silver nanoparticle-rich electrolytes and (2) post-PEO hydrothermal treatments (HT) to furnish additively manufactured Ti-6Al-4V porous implants with a multi-functional surface. The applied HT led to the formation of hydroxyapatite (HA) nanocrystals throughout the oxide layer. This process was controlled by the supersaturation of Ca²⁺ and PO₄^3- during the hydrothermal process. Initially, the high local supersaturation resulted in homogenous nucleation of spindle-like nanocrystals throughout the surface. As the process continued, the depletion of reactant ions in the outermost surface layer led to a remarkable decrease in the supersaturation degrees. High aspect-ratio nanorods and hexagonal nanopillars were, therefore, created. The unique hierarchical structure of the microporous PEO layer (pore size < 3 μm) and spindle-like HA nanocrystals (<150 nm) on the surface of macro-porous additively manufactured Ti-6Al-4V implants provided a favorable substrate for the anchorage of cytoplasmic extensions assisting cell attachment and migration on the surface. The results of our in vitro assays clearly showed the important benefits of the HT and the spindle-like HA nanocrystals including a significantly stronger and much more sustained antibacterial activity, significantly higher levels of pre-osteoblasts metabolic activity, and significantly higher levels of alkaline phosphatase activity as compared to similar PEO-treated implants lacking the HT.

Review of titanium surface modification techniques and coatings for antibacterial applications

Implanted biomaterials play a key role in the current success of orthopedic and dental procedures. Pure titanium and its alloys are the most commonly used materials for permanent implants in contact with bone. However, implant-related infections remain among the leading reasons for failure. The most critical pathogenic event in the development of infection on biomaterials is biofilm formation, which starts immediately after bacterial adhesion. In the last decade, numerous studies reported the ability of titanium surface modifications and coatings to minimize bacterial adhesion, inhibit biofilm formation and provide effective bacterial killing to protect implanted biomaterials. In the present review, the different strategies to prevent infection onto titanium surfaces are reported: surface modification and coatings by antibiotics, antimicrobial peptides, inorganic antibacterial metal elements and antibacterial polymers. STATEMENT OF SIGNIFICANCE: Implanted biomaterials play a key role in the current success of orthopedic and dental procedures. Pure titanium and its alloys are the most commonly used materials for permanent implants in contact with bone. Microbial infection is one of the main causes of implant failure. Currently, the global infection risk is 2-5% in orthopedic surgery. Numerous solutions exist to render titanium surfaces antibacterial. The LBPS team is an expert on the functionalization of titanium surfaces by using bioactive polymers to improve the biologiocal response. In this review, the different strategies to prevent infection are reported onto titanium and titanium alloy surfaces such as surface modification by antibiotics, antimicrobial peptides, inorganic antibacterial metal elements and antibacterial polymers.

Chitosan-based sleeves loaded with silver and chlorhexidine in a percutaneous rabbit tibia model with a repeated bacterial challenge

Various strategies have been explored to prevent pin tract infections (PTI), including the use of antibacterial sleeves. However, an ideal animal model to evaluate the efficacy of antibacterial strategies is still lacking. This study aimed to construct an animal model with a consistent induction of infection after bacterial challenge. Further, the efficacy of silver and chlorhexidine loaded chitosan sleeves was evaluated to prevent PTI around a percutaneous implant. Titanium pins wrapped with sleeves were implanted in anterior lateral rabbit tibia. After 2 weeks, Staphylococcus aureus suspensions (1 × 10⁶ CFU) were injected weekly to the exit site, and the clinical infection status was recorded. After 6 weeks, all rabbits were euthanized to evaluate the bacterial colonization microbiologically and histomorphometrically. Results showed that the implant screw bilaterally penetrated the tibia and kept the implant stable. A rod length of twice the thickness of the soft-tissue layer was necessary to maintain the percutaneous penetration of the implants. A 100% infection rate was obtained by the bacterial inoculation. Silver loaded sleeves reduced significantly the bacterial density and reduced the inflammatory symptoms of the percutaneous pin tract. However, the addition of chlorhexidine to the sleeves had no added value in terms of further reduction of bacteria and inflammation. In conclusion, a consistent animal model was designed to evaluate strategies to prevent PTI. In addition, the use of silver loaded chitosan sleeves can be pursued for further (pre-)clinical exploration for the prevention of PTI. STATEMENT OF SIGNIFICANCE: This study constructed a bacterial challenged percutaneous rabbit tibia model to evaluate the potential of antibacterial strategies for the prevention of pin tract infections. The model was applied to evaluate a silver and chlorhexidine loaded membranes as an antibacterial sleeve. Our results demonstrate that the rabbit tibia model is suitable to evaluate antibacterial strategies for the prevention of pin tract infection as evidenced by the stable, bone fixed percutaneous implant and a 100% infection rate of the percutaneous pin tract. Silver loaded sleeves can lower the bacterial density of the percutaneous pin tract, but the addition of chlorhexidine to the silver-loaded sleeves does not contribute to an enhanced antibacterial effect. Such experiments are of considerable interest to those in the research community, industry, and clinicians involved the occurrence of infection of skin penetrating medical devices.

Nanoscience-Based Strategies to Engineer Antimicrobial Surfaces

Microbial contamination and biofilm formation of medical devices is a major issue associated with medical complications and increased costs. Consequently, there is a growing need for novel strategies and exploitation of nanoscience-based technologies to reduce the interaction of bacteria and microbes with synthetic surfaces. This article focuses on surfaces that are nanostructured, have functional coatings, and generate or release antimicrobial compounds, including "smart surfaces" producing antibiotics on demand. Key requirements for successful antimicrobial surfaces including biocompatibility, mechanical stability, durability, and efficiency are discussed and illustrated with examples of the recent literature. Various nanoscience-based technologies are described along with new concepts, their advantages, and remaining open questions. Although at an early stage of research, nanoscience-based strategies for creating antimicrobial surfaces have the advantage of acting at the molecular level, potentially making them more efficient under specific conditions. Moreover, the interface can be fine tuned and specific interactions that depend on the location of the device can be addressed. Finally, remaining important challenges are identified: improvement of the efficacy for long-term use, extension of the application range to a large spectrum of bacteria, standardized evaluation assays, and combination of passive and active approaches in a single surface to produce multifunctional surfaces.

The in vivo effect of a porous titanium alloy flange with hydroxyapatite, silver and fibronectin coatings on soft-tissue integration of intraosseous transcutaneous amputation prostheses

Aims

The Intraosseous Transcutaneous Amputation Prosthesis (ITAP) may improve quality of life for amputees by avoiding soft-tissue complications associated with socket prostheses and by improving sensory feedback and function. It relies on the formation of a seal between the soft tissues and the implant and currently has a flange with drilled holes to promote dermal attachment. Despite this, infection remains a significant risk. This study explored alternative strategies to enhance soft-tissue integration.

Materials and Methods

The effect of ITAP pins with a fully porous titanium alloy flange with interconnected pores on soft-tissue integration was investigated. The flanges were coated with fibronectin-functionalised hydroxyapatite and silver coatings, which have been shown to have an antibacterial effect, while also promoting viable fibroblast growth in vitro. The ITAP pins were implanted along the length of ovine tibias, and histological assessment was undertaken four weeks post-operatively.

Results

The porous titanium alloy flange reduced epithelial downgrowth and increased soft-tissue integration compared with the current drilled flange. The addition of coatings did not enhance these effects.

Conclusion

These results indicate that a fully porous titanium alloy flange has the potential to increase the soft-tissue seal around ITAP and reduce susceptibility to infection compared with the current design.

Cite this article: Bone Joint J 2017;99-B:393–400.

Calcium Phosphate Bioceramics: A Review of Their History, Structure, Properties, Coating Technologies and Biomedical Applications

Calcium phosphate (CaP) bioceramics are widely used in the field of bone regeneration, both in orthopedics and in dentistry, due to their good biocompatibility, osseointegration and osteoconduction. The aim of this article is to review the history, structure, properties and clinical applications of these materials, whether they are in the form of bone cements, paste, scaffolds, or coatings. Major analytical techniques for characterization of CaPs, in vitro and in vivo tests, and the requirements of the US Food and Drug Administration (FDA) and international standards from CaP coatings on orthopedic and dental endosseous implants, are also summarized, along with the possible effect of sterilization on these materials. CaP coating technologies are summarized, with a focus on electrochemical processes. Theories on the formation of transient precursor phases in biomineralization, the dissolution and reprecipitation as bone of CaPs are discussed. A wide variety of CaPs are presented, from the individual phases to nano-CaP, biphasic and triphasic CaP formulations, composite CaP coatings and cements, functionally graded materials (FGMs), and antibacterial CaPs. We conclude by foreseeing the future of CaPs.

Biocatalytic synthesis, antimicrobial properties and toxicity studies of arginine derivative surfactants

Two novel arginine-based cationic surfactants were synthesized using as biocatalyst papain, an endopeptidase from Carica papaya latex, adsorbed onto polyamide. The classical substrate N (α)-benzoyl-arginine ethyl ester hydrochloride for the determination of cysteine and serine proteases activity was used as the arginine donor, whereas decyl- and dodecylamine were used as nucleophiles for the condensation reaction. Yields higher than 90 and 80 % were achieved for the synthesis of N (α)-benzoyl-arginine decyl amide (Bz-Arg-NHC10) and N (α)-benzoyl-arginine dodecyl amide (Bz-Arg-NHC12), respectively. The purification process was developed in order to make it more sustainable, by using water and ethanol as the main separation solvents in a single cationic exchange chromatographic separation step. Bz-Arg-NHC10 and Bz-Arg-NHC12 proved antimicrobial activity against both Gram-positive and Gram-negative bacteria, revealing their potential use as effective disinfectants as they reduced 99 % the initial bacterial population after only 1 h of contact. The cytotoxic effect towards different cell types of both arginine derivatives was also measured. Bz-Arg-NHCn demonstrated lower haemolytic activity and were less eye-irritating than the commercial cationic surfactant cetrimide. A similar trend could also be observed when cytotoxicity was tested on hepatocytes and fibroblast cell lines: both arginine derivatives were less toxic than cetrimide. All these properties would make the two novel arginine compounds a promising alternative to commercial cationic surfactants, especially for their use as additives in topical formulations.