Technological developments and future perspectives on graphene-based metamaterials: a primer for neurosurgeons

Neurodiagnostic and neurotherapeutic potential of graphene nanomaterials

Graphene has emerged as a highly promising nanomaterial for a variety of advanced technologies, including batteries, energy, electronics, and biotechnologies. Its recent contribution to neurotechnology is particularly noteworthy because its superior conductivity, chemical resilience, biocompatibility, thermal stability, and scalable nature make it well-suited for measuring brain activity and plasticity in health and disease. Graphene-mediated compounds are microfabricated in two central methods: chemical processes with natural graphite and chemical vapor deposition of graphene in a film form. They are widely used as biosensors and bioelectronics for neurodiagnostic and neurotherapeutic purposes in several brain disorders, such as Parkinson's disease, stroke, glioma, epilepsy, tinnitus, and Alzheimer's disease. This review provides an overview of studies that have demonstrated the technical advances of graphene nanomaterials in neuroscientific and clinical applications. We also discuss current limitations and future demands in relation to the clinical application of graphene, highlighting its potential technological and clinical significance for treating brain disorders. Our review underscores the potential of graphene nanomaterials as powerful tools for advancing the understanding of the brain and developing new therapeutic strategies.

The potential of graphene coatings as neural interfaces

Recent advances in nanotechnology design and fabrication have shaped the landscape for the development of ideal cell interfaces based on biomaterials. A holistic evaluation of the requirements for a cell interface is a highly complex task. Biocompatibility is a crucial requirement which is affected by the interface's properties, including elemental composition, morphology, and surface chemistry. This review explores the current state-of-the-art on graphene coatings produced by chemical vapor deposition (CVD) and applied as neural interfaces, detailing the key properties required to design an interface capable of physiologically interacting with neural cells. The interfaces are classified into substrates and scaffolds to differentiate the planar and three-dimensional environments where the cells can adhere and proliferate. The role of specific features such as mechanical properties, porosity and wettability are investigated. We further report on the specific brain-interface applications where CVD graphene paved the way to revolutionary advances in biomedicine. Future studies on the long-term effects of graphene-based materials in vivo will unlock even more potentially disruptive neuro-applications.

Organ distribution and biological compatibility of surface-functionalized reduced graphene oxide

Graphene is an sp² hybridized allotrope of carbon with a honeycomb lattice structure that has many applications in biomedicine owing to its unique physico-chemical properties. Graphene has attracted much interest from scientists for its biomedical potential, including in drug/gene delivery, fluorescent labeling of target analytes, tissue engineering, regenerative medicine and MRI contrast enhancement. However, there are very limited data available concerning the toxicity of graphene, and efforts have been made to study the bio-nano interactions of Pluronic functionalized reduced graphene oxide (rGO-P) in animal models. The present study aimed to evaluate the systemic toxicity of rGO-P and its ability to cross the blood-brain barrier in Swiss Albino mice subject to acute exposure to 10 mg kg^-1 body weight of rGO-P. Prolonged exposure was evaluated in female Wistar rats by analyzing feto-placental transmission and any associated developmental neurotoxicity after intravenous administration of 5 mg kg^-1 and 10 mg kg^-1 body weight of rGO-P. Biodistribution analysis using confocal Raman mapping indicated that tiny amounts of rGO-P accumulated in major organs of both dams and pups, with no evident toxic response. The accumulation of rGO-P in various tissues of rat pups born to treated dams is ample evidence of feto-placental transmission. The present study clearly suggests that rGO-P is not toxic under any of the experimental conditions. These findings can therefore be carried forward for application of rGO-P in drug/gene delivery, early diagnosis and treatment of various diseases in neonates and adults. The results of the study show that rGO-P is an auspicious and promising material for future healthcare applications.

Interfacing Graphene-Based Materials With Neural Cells

The scientific community has witnessed an exponential increase in the applications of graphene and graphene-based materials in a wide range of fields, from engineering to electronics to biotechnologies and biomedical applications. For what concerns neuroscience, the interest raised by these materials is two-fold. On one side, nanosheets made of graphene or graphene derivatives (graphene oxide, or its reduced form) can be used as carriers for drug delivery. Here, an important aspect is to evaluate their toxicity, which strongly depends on flake composition, chemical functionalization and dimensions. On the other side, graphene can be exploited as a substrate for tissue engineering. In this case, conductivity is probably the most relevant amongst the various properties of the different graphene materials, as it may allow to instruct and interrogate neural networks, as well as to drive neural growth and differentiation, which holds a great potential in regenerative medicine. In this review, we try to give a comprehensive view of the accomplishments and new challenges of the field, as well as which in our view are the most exciting directions to take in the immediate future. These include the need to engineer multifunctional nanoparticles (NPs) able to cross the blood-brain-barrier to reach neural cells, and to achieve on-demand delivery of specific drugs. We describe the state-of-the-art in the use of graphene materials to engineer three-dimensional scaffolds to drive neuronal growth and regeneration in vivo, and the possibility of using graphene as a component of hybrid composites/multi-layer organic electronics devices. Last but not least, we address the need of an accurate theoretical modeling of the interface between graphene and biological material, by modeling the interaction of graphene with proteins and cell membranes at the nanoscale, and describing the physical mechanism(s) of charge transfer by which the various graphene materials can influence the excitability and physiology of neural cells.

Inorganic Nanomaterials for Soft Tissue Repair and Regeneration

Inorganic nanomaterials have witnessed significant advances in areas of medicine including cancer therapy, imaging, and drug delivery, but their use in soft tissue repair and regeneration is in its infancy. Metallic, ceramic, and carbon allotrope nanoparticles have shown promise in facilitating tissue repair and regeneration. Inorganic nanomaterials have been employed to improve stem cell engraftment in cellular therapy, material mechanical stability in tissue repair, electrical conductivity in nerve and cardiac regeneration, adhesion strength in tissue approximation, and antibacterial capacity in wound dressings. These nanomaterials have also been used to improve or replace common surgical materials and restore functionality to damaged tissue. We provide a comprehensive overview of inorganic nanomaterials in tissue repair and regeneration, and discuss their promise and limitations for eventual translation to the clinic.

Nature's Electric Potential: A Systematic Review of the Role of Bioelectricity in Wound Healing and Regenerative Processes in Animals, Humans, and Plants

Natural endogenous voltage gradients not only predict and correlate with growth and development but also drive wound healing and regeneration processes. This review summarizes the existing literature for the nature, sources, and transmission of information-bearing bioelectric signals involved in controlling wound healing and regeneration in animals, humans, and plants. It emerges that some bioelectric characteristics occur ubiquitously in a range of animal and plant species. However, the limits of similarities are probed to give a realistic assessment of future areas to be explored. Major gaps remain in our knowledge of the mechanistic basis for these processes, on which regenerative therapies ultimately depend. In relation to this, it is concluded that the mapping of voltage patterns and the processes generating them is a promising future research focus, to probe three aspects: the role of wound/regeneration currents in relation to morphology; the role of endogenous flux changes in driving wound healing and regeneration; and the mapping of patterns in organisms of extreme longevity, in contrast with the aberrant voltage patterns underlying impaired healing, to inform interventions aimed at restoring them.

Physical principles of graphene cellular interactions: computational and theoretical accounts

Clarifying the physical principles of graphene cellular interactions is critical for the wider application of graphene-based nanomaterials in nanomedicine. This review highlights the advances in computational and theoretical accounts for this emerging field.

A DIFFERENTIAL EFFECT OF GRAPHENE OXIDE ON THE PRODUCTION OF PROINFLAMMATORY CYTOKINES BY MURINE MICROGLIA

Graphene oxide (GO) is a promising nanomaterial for application in a variety of biomedical fields, including neuro-oncology, neuroimaging, neuroregeneration and drug delivery. Microglia are the central macrophage-like cells critically involved in neuroimmunity. However, the interaction between GO and microglia remained mostly unknown. The present study investigated the influence of GO on the production of proinflammatory cytokines by microglia. Primary murine microglial cells were treated with GO (1–25 μg/mL) followed by stimulation with lipopolysaccharide (LPS) for 24 h. The cell viability was measured by spectrophotometry using AlamarBlueⓇ. The levels of interleukin (IL)-1β and tumor necrosis factor (TNF)-α in the supernatants were measured by enzyme-linked immunosorbent assay (ELISA). The IL-1β converting enzyme (ICE) activity was measured using a specific fluorescent substrate. The activity of cathepsin B and the lysosomal permeability and alkalinity were determined by flow cytometry. Treatment with GO did not affect cell viability, but significantly suppressed the production of IL-1β. In contrast, the production of TNF-α was unaltered. In addition, the lysosomal permeability and alkalinity in microglia treated with GO were increased, whereas the activity of cathepsin B and ICE was decreased. Collectively, these results demonstrated that exposure to GO differentially affected the production of proinflammatory cytokines, which is associated with the modulation of the lysosomal pathway of cytokines processing.

Graphene-based nanomaterials: biological and medical applications and toxicity

Graphene and its derivatives, due to a wide range of unique properties that they possess, can be used as starting material for the synthesis of useful nanocomplexes for innovative therapeutic strategies and biodiagnostics. Here, we summarize the latest progress in graphene and its derivatives and their potential applications for drug delivery, gene delivery, biosensor and tissue engineering. A simple comparison with carbon nanotubes uses in biomedicine is also presented. We also discuss their in vitro and in vivo toxicity and biocompatibility in three different life kingdoms (bacterial, mammalian and plant cells). All aspects of how graphene is internalized after in vivo administration or in vitro cell exposure were brought about, and explain how blood-brain barrier can be overlapped by graphene nanomaterials.

Carbon nanotubes and graphene as emerging candidates in neuroregeneration and neurodrug delivery

Neuroregeneration is the regrowth or repair of nervous tissues, cells, or cell products involved in neurodegeneration and inflammatory diseases of the nervous system like Alzheimer’s disease and Parkinson’s disease. Nowadays, application of nanotechnology is commonly used in developing nanomedicines to advance pharmacokinetics and drug delivery exclusively for central nervous system pathologies. In addition, nanomedical advances are leading to therapies that disrupt disarranged protein aggregation in the central nervous system, deliver functional neuroprotective growth factors, and change the oxidative stress and excitotoxicity of affected neural tissues to regenerate the damaged neurons. Carbon nanotubes and graphene are allotropes of carbon that have been exploited by researchers because of their excellent physical properties and their ability to interface with neurons and neuronal circuits. This review describes the role of carbon nanotubes and graphene in neuroregeneration. In the future, it is hoped that the benefits of nanotechnologies will outweigh their risks, and that the next decade will present huge scope for developing and delivering technologies in the field of neuroscience.

Graphene in neurosurgery: the beginning of a new era

Nanotechnology has revolutionized the approach to different fields of industry and medicine. Among the new nanomaterial used, one of the most promising appears to be graphene. Its versatility, due to a particular chemical configuration, confers to it enormous potential of application. Graphene has recently been tested also in biomedical research with excellent results. Neurosurgery can benefit of this material for therapeutic purposes such as targeting controlled drug/gene delivery in brain tumor treatment, as well as photothermal and photodynamic cancer therapy, improving biosensing and bioimaging, and lastly as biocompatible material for intracranial and/or spinal devices. However, it still remains an experimental material whose in vitro and in vivo toxicity is tested with controversial results for the human health. Noteworthy is the fact that it is not possible so far to know its long-term toxicity.

"Extremely minimally invasive": recent advances in nanotechnology research and future applications in neurosurgery

The term "nanotechnology" refers to the development of materials and devices that have been designed with specific properties at the nanometer scale (10(-9) m), usually being less than 100 nm in size. Recent advances in nanotechnology have promised to enable visualization and intervention at the subcellular level, and its incorporation to future medical therapeutics is expected to bring new avenues for molecular imaging, targeted drug delivery, and personalized interventions. Although the central nervous system presents unique challenges to the implementation of new therapeutic strategies involving nanotechnology (such as the heterogeneous molecular environment of different CNS regions, the existence of multiple processing centers with different cytoarchitecture, and the presence of the blood-brain barrier), numerous studies have demonstrated that the incorporation of nanotechnology resources into the armamentarium of neurosurgery may lead to breakthrough advances in the near future. In this article, the authors present a critical review on the current 'state-of-the-art' of basic research in nanotechnology with special attention to those issues which present the greatest potential to generate major therapeutic progresses in the neurosurgical field, including nanoelectromechanical systems, nano-scaffolds for neural regeneration, sutureless anastomosis, molecular imaging, targeted drug delivery, and theranostic strategies.

How graphene is expected to impact neurotherapeutics in the near future

The scientific research on graphene, a monolayer honeycomb lattice made of carbon atoms which was initially isolated in 2004, has grown exponentially in the last decade. The increasing amount of research funding directed to basic science studies on such revolutionary material promises to boost the scientific discoveries and technological developments in such field in an unprecedented way. Because its unique mechanical, optical, thermal, electronic and magnetic properties, graphene research is expected to foster new technological developments with significant applications to neurotherapeutics in several different fields in the near future. However, before the advances on graphene research may reach the clinical practice, future studies on the biocompatibility, neurotoxicity as well as long-term effects of distinct graphene forms (as well as graphene's derivatives) upon different biological tissues are still required.