Hydroxyapatite reinforced poly(3-hydroxybutyrate) and poly(3-hydroxybutyrate-co-3-hydroxyvalerate) based degradable composite bone plate

Enabling Proregenerative Medical Devices via Citrate-Based Biomaterials: Transitioning from Inert to Regenerative Biomaterials

Regenerative medicine aims to restore tissue and organ function without the use of prosthetics and permanent implants. However, achieving this goal has been elusive, and the field remains mostly an academic discipline with few products widely used in clinical practice. From a materials science perspective, barriers include the lack of proregenerative biomaterials, a complex regulatory process to demonstrate safety and efficacy, and user adoption challenges. Although biomaterials, particularly biodegradable polymers, can play a major role in regenerative medicine, their suboptimal mechanical and degradation properties often limit their use, and they do not support inherent biological processes that facilitate tissue regeneration. As of 2020, nine synthetic biodegradable polymers used in medical devices are cleared or approved for use in the United States of America. Despite the limitations in the design, production, and marketing of these devices, this small number of biodegradable polymers has dominated the resorbable medical device market for the past 50 years. This perspective will review the history and applications of biodegradable polymers used in medical devices, highlight the need and requirements for regenerative biomaterials, and discuss the path behind the recent successful introduction of citrate-based biomaterials for manufacturing innovative medical products aimed at improving the outcome of musculoskeletal surgeries.

Polyhydroxyalkanoates: the natural biopolyester for future medical innovations

Polyhydroxyalkanoates (PHAs) are a family of natural microbial biopolyesters with the same basic chemical structure and diverse side chain groups. Based on their excellent biodegradability, biocompatibility, thermoplastic properties and diversity, PHAs are highly promising medical biomaterials and elements of medical devices for applications in tissue engineering and drug delivery. However, due to the high cost of biotechnological production, most PHAs have yet to be applied in the clinic and have only been studied at laboratory scale. This review focuses on the biosynthesis, diversity, physical properties, biodegradability and biosafety of PHAs. We also discuss optimization strategies for improved microbial production of commercial PHAs via novel synthetic biology tools. Moreover, we also systematically summarize various medical devices based on PHAs and related design approaches for medical applications, including tissue repair and drug delivery. The main degradation product of PHAs, 3-hydroxybutyrate (3HB), is recognized as a new functional molecule for cancer therapy and immune regulation. Although PHAs still account for only a small percentage of medical polymers, up-and-coming novel medical PHA devices will enter the clinical translation stage in the next few years.

Formulation and characterization of a novel PHBV nanocomposite for bone defect filling and infection treatment

Biodegradable materials that combine bioactivity with sustained drug release have been proved promising for the treatment and prophylaxis of bone infection. In this work, injection-molded nanocomposites were formulated from poly(3-hydroxybutyrate-co-3-6%hydroxyvalerate) (PHBV), nanodiamond (nD) and nanohydroxyapatite (nHA) loaded with vancomycin (VC). The components were compounded using a rotary evaporator (PHBV/nHA/VC/nD-R) or a spray-dryer (PHBV/nHA/VC/nD-SD). The nanoparticles acted as a nucleating agent, increasing PHBV crystallinity from 57.1% to up to 73.3% (PHBV/nHA/VC/nD-SD). The nHA particles were found to be well distributed on the formulations fracture surface observed by SEM-EDS micrographs. PHBV/nHA/VC/nD-SD presented higher glass transition temperature (18.1 vs 14.8 °C) and stronger interface than PHBV/nHA/VC/nD-R, as determined by dynamic mechanical analysis (DMA). Furthermore, the incorporation of nanoparticles increased PHBV flexural elastic modulus by 34% and match the reported for human bone. Both systems were able to present a sustained release of VC for 22 days, reaching 7.1 ± 1.3%(PHBV/nHA/VC/nD-R) and 4.8 ± 0.6% (PHBV/nHA/VC/nD-SD). VC presented antibacterial activity even after being processed at 178 °C in an injection molding machine. Moreover, in vitro assays showed a good adhesion and growth of cells on the specimens and suggested a non-cytotoxic and non-cytostatic behavior. These findings indicate that these systems can be further explored as bone defect filling material.

Effect of hydroxyapatite concentration on high-modulus composite for biodegradable bone-fixation devices

There are over 3 million bone fractures in the United States annually; over 30% of which require internal mechanical fixation devices to aid in the healing process. The current standard material used is a metal plate that is implanted onto the bone. However, metal fixation devices have many disadvantages, namely stress shielding and metal ion leaching. This study aims to fix these problems of metal implants by making a completely biodegradable material that will have a high modulus and exhibit great toughness. To accomplish this, long-fiber poly-l-lactic acid (PLLA) was utilized in combination with a matrix composed of polycaprolactone (PCL) and hydroxyapatite (HA) nano-rods. Through single fibril tensile tests, it was found that the PLLA fibers have a Young's modulus of 8.09 GPa. Synthesized HA nanorods have dimensions in the nanometer range with an aspect ratio over 6. By dip coating PLLA fibers in a suspension of PCL and HA and hot pressing the resulting coated fibers, dense fiber-reinforced samples were made having a flexural modulus up to 9.2 GPa and a flexural strength up to 187 MPa. The flexural modulus of cortical bone ranges from 7 to 25 GPa, so the modulus of the composite material falls into the range of bone. The typical flextural strength of bone is 130 MPa, and the samples here greatly exceed that with a strength of 187 MPa. After mechanical testing to failure the samples retained their shape, showing toughness with no catastrophic failure, indicating the possibility for use as a fixation material. © 2016 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater, 105B: 1963-1971, 2017.

An in vivo study of osteoplastic properties of resorbable poly-3-hydroxybutyrate in models of segmental osteotomy and chronic osteomyelitis

A series of 3D implants and filling materials prepared from powdered biodegradable polymers, polyhydroxyalkanoates (PHAs), have been designed for the purposes of reparative osteogenesis. The 3D implants are made of resorbable polymer of hydroxybutyric acid (poly-3-hydroxybutyrate, P3HB) and a composite of this polymer with hydroxyapatite (HA) (P3HB/HA). The properties of the implants were studied in vivo in a model of segmental osteotomy and compared with commercial material Bio-Oss(®). All implants containing P3HB as the main component facilitate reconstructive osteogenesis. P3HB and P3HB/HA show pronounced osteoplastic properties; their in vivo degradation is slow and corresponds to the growth of a new bone tissue, facilitating normal reparative osteogenesis. Also, powdered P3HB and P3HB/tienam can be used as filling materials for osteoplasty of bone cavities infected by Staphylococcus aureus. Biodegradable 3D implants and P3HB-based filling materials show pronounced osteoplastic properties and degrade in vivo at a slow rate, enabling normal reparative osteogenesis.

Improvement of the cytocompatibility of electrospun poly[(R)-3-hydroxybutyrate-co-(R)-3-hydroxyvalerate] mats by Ecoflex

Poly[(R)-3-hydroxybutyrate-co-(R)-3-hydroxyvalerate] (PHBV) is a nature-derived polyester with potential application in tissue engineering scaffolds. However, PHBV is associated with disadvantages including high brittleness, slow degradation, high hydrophobicity, and unsatisfactory biocompatibility. In this study, we sought to improve the properties of PHBV by blending it with Ecoflex, a synthetic biopolyester with a high flexibility, fast degradation, and comparatively higher hydrophilicity. PHBV was codissolved with Ecoflex in dichloromethane at different mass ratios (PHBV/Ecoflex: 100/0, 70/30, 50/50, and 30/70) and electrospun into mats. Compared with the pure PHBV mat, the Ecoflex-containing mats showed decreased contact angles with phosphate-buffered saline (PBS), accelerated weight loss in PBS, and increased strain at break with increasing Ecoflex mass ratios. In vitro cell culture also showed significantly improved adhesion and proliferation of human bone marrow stroma cells with the introduction of Ecoflex. Blending PHBV with Ecoflex is a simple and effective method to improve the chemical, mechanical, and biological properties of PHBV simultaneously and thereby to expedite its application in tissue engineering. To our knowledge, this is the first report showing the biocompatibility of Ecoflex-containing materials with human cells.

Bioactive ceramic-reinforced composites for bone augmentation

Biomaterials have been used to repair the human body for millennia, but it is only since the 1970s that man-made composites have been used. Hydroxyapatite (HA)-reinforced polyethylene (PE) is the first of the 'second-generation' biomaterials that have been developed to be bioactive rather than bioinert. The mechanical properties have been characterized using quasi-static, fatigue, creep and fracture toughness testing, and these studies have allowed optimization of the production method. The in vitro and in vivo biological properties have been investigated with a range of filler content and have shown that the presence of sufficient bioactive filler leads to a bioactive composite. Finally, the material has been applied clinically, initially in the orbital floor and later in the middle ear. From this initial combination of HA in PE other bioactive ceramic polymer composites have been developed.

The fabrication and characterization of biodegradable HA/PHBV nanoparticle-polymer composite scaffolds

This study reports the fabrication and characterization of nano-sized hydroxyapatite (HA)/poly(hydroxyabutyrate-co-hydroxyvalerate) (PHBV) polymer composite scaffolds with high porosity and controlled pore architectures. These scaffolds were prepared using a modified thermally induced phase-separation technique. This investigation focuses on the effect of fabrication conditions on the overall pore architecture of the scaffolds and the dispersion of HA nanocrystals within the composite scaffolds. The morphologies, mechanical properties and in vitro bioactivity of the composite scaffolds were investigated. It was noted that the pore architectures could be manipulated by varying phase-separation parameters. The HA particles were dispersed in the pore walls of the scaffolds and were well bonded to the polymer. The introduction of HA greatly increased the stiffness and strength, and improved the in vitro bioactivity of the scaffolds. The results suggest these newly developed nano-HA/PHBV composite scaffolds may serve as an effective three-dimensional substrate in bone tissue engineering.

Chemical and topographical modification of PHBV surface to promote osteoblast alignment and confinement

Proper cell attachment and distribution, and thus stronger association in vivo between a bone implant and native tissue will improve the success of the implant. In this study, the aim was to achieve promotion of attachment and uniform distribution of rat mesenchymal stem cell-derived osteoblasts by introducing chemical and topographical cues on poly(3-hydroxybutyrate-co-3-hydroxyvalerate) (PHBV) film surfaces. As the chemical cues, either alkaline phosphatase was covalently immobilized on the film surface to induce deposition of calcium phosphate minerals or fibrinogen was adsorbed to improve cell adhesion. Microgrooves and micropits were introduced on the film surface by negative replication of micropatterned Si wafers. Both chemical cues improved cell attachment and even distribution on the PHBV films, but Fb was more effective especially when combined with the micropatterns. Cell alignment (<10 degrees deviation angle) parallel to chemically modified microgrooves (1, 3, or 8 microm groove width) and on 10 microm-thick Fb lines printed on the unpatterned films was achieved. The cells on unpatterned and 5 microm-deep micropitted films were distributed and oriented randomly. Results of this study proved that microtopographies on PHBV can improve osseointegration when combined with chemical cues, and that microgrooves and cell adhesive protein lines on PHBV can guide selective osteoblast adhesion and alignment.