The Osteogenic Role of Barium Titanate/Polylactic Acid Piezoelectric Composite Membranes as Guiding Membranes for Bone Tissue Regeneration

Synergistic effect of ultrasound and reinforced electrical environment by bioinspired periosteum for enhanced osteogenesis via immunomodulation of macrophage polarization through Piezo1

The periosteum plays a vital role in repairing bone defects. Researchers have demonstrated the existence of electrical potential in the periosteum and native bone, indicating that electrical signals are essential for functional bone regeneration. However, the clinical use of external electrical treatments has been limited due to their inconvenience and inefficacy. As an alternative, low-intensity pulsed ultrasound (LIPUS) is a noninvasive form of physical therapy that enhances bone regeneration. Furthermore, the wireless activation of piezoelectric biomaterials through ultrasound stimulation would generate electric charges precisely at the defect area, compensating for the insufficiency of external electrical stimulation and potentially promoting bone regeneration through the synergistic effect of mechanical and electrical stimulation. However, the optimal integration of LIPUS with an appropriate piezoelectric periosteum is yet to be explored. Herein, the BaTiO3/multiwalled-carbon nanotubes/collagen (BMC) membranes have been fabricated, possessing physicochemical properties including improved surface hydrophilicity, enhanced mechanical performance, ideal piezoelectricity, and outstanding biocompatibility, all of which are conducive to bone regeneration. When combined with LIPUS, the endogenous electrical microenvironment of native bone was recreated. After that, the wireless-generated electrical signals, along with the mechanical signals induced by LIPUS, were transferred to macrophages and activated Ca2+ influx through Piezo1. Ultimately, the regenerative effect of the BMC membrane with LIPUS stimulation (BMC + L) was confirmed in a mouse cranial defect model. Together, this research presents a co-engineering strategy that involves fabricating a novel biomimetic periosteum and utilizing the synergistic effect of ultrasound to enhance bone regeneration, which is achieved through the reinforcement of the electrical environment and the immunomodulation of macrophage polarization.

Bioelectret Materials and Their Bioelectric Effects for Tissue Repair: A Review

Biophysical and clinical medical studies have confirmed that biological tissue lesions and trauma are related to the damage of an intrinsic electret (i.e., endogenous electric field), such as wound healing, embryonic development, the occurrence of various diseases, immune regulation, tissue regeneration, and cancer metastasis. As exogenous electrical signals, such as conductivity, piezoelectricity, ferroelectricity, and pyroelectricity, bioelectroactives can regulate the endogenous electric field, thus controlling the function of cells and promoting the repair and regeneration of tissues. Materials, once polarized, can harness their inherent polarized static electric fields to generate an electric field through direct stimulation or indirect interactions facilitated by physical signals, such as friction, ultrasound, or mechanical stimulation. The interaction with the biological microenvironment allows for the regulation and compensation of polarized electric signals in damaged tissue microenvironments, leading to tissue regeneration and repair. The technique shows great promise for applications in the field of tissue regeneration. In this paper, the generation and change of the endogenous electric field and the regulation of exogenous electroactive substances are expounded, and the latest research progress of the electret and its biological effects in the field of tissue repair include bone repair, nerve repair, drug penetration promotion, wound healing, etc. Finally, the opportunities and challenges of electret materials in tissue repair were summarized. Exploring the research and development of new polarized materials and the mechanism of regulating endogenous electric field changes may provide new insights and innovative methods for tissue repair and disease treatment in biological applications.

Multifunctional scaffolds for bone repair following age-related biological decline: Promising prospects for smart biomaterial-driven technologies

The repair of large bone defects due to trauma, disease, and infection can be exceptionally challenging in the elderly. Despite best clinical practice, bone regeneration within contemporary, surgically implanted synthetic scaffolds is often problematic, inconsistent, and insufficient where additional osteobiological support is required to restore bone. Emergent smart multifunctional biomaterials may drive important and dynamic cellular crosstalk that directly targets, signals, stimulates, and promotes an innate bone repair response following age-related biological decline and when in the presence of disease or infection. However, their role remains largely undetermined. By highlighting their mechanism/s and mode/s of action, this review spotlights smart technologies that favorably align in their conceivable ability to directly target and enhance bone repair and thus are highly promising for future discovery for use in the elderly. The four degrees of interactive scaffold smartness are presented, with a focus on bioactive, bioresponsive, and the yet-to-be-developed autonomous scaffold activity. Further, cell- and biomolecular-assisted approaches were excluded, allowing for contemporary examination of the capabilities, demands, vision, and future requisites of next-generation biomaterial-induced technologies only. Data strongly supports that smart scaffolds hold significant promise in the promotion of bone repair in patients with a reduced osteobiological response. Importantly, many techniques have yet to be tested in preclinical models of aging. Thus, greater clarity on their proficiency to counteract the many unresolved challenges within the scope of aging bone is highly warranted and is arguably the next frontier in the field. This review demonstrates that the use of multifunctional smart synthetic scaffolds with an engineered strategy to circumvent the biological insufficiencies associated with aging bone is a viable route for achieving next-generation therapeutic success in the elderly population.

Piezoelectric Biomaterials Inspired by Nature for Applications in Biomedicine and Nanotechnology

Bioelectricity provides electrostimulation to regulate cell/tissue behaviors and functions. In the human body, bioelectricity can be generated in electromechanically responsive tissues and organs, as well as biomolecular building blocks that exhibit piezoelectricity, with a phenomenon known as the piezoelectric effect. Inspired by natural bio-piezoelectric phenomenon, efforts have been devoted to exploiting high-performance synthetic piezoelectric biomaterials, including molecular materials, polymeric materials, ceramic materials, and composite materials. Notably, piezoelectric biomaterials polarize under mechanical strain and generate electrical potentials, which can be used to fabricate electronic devices. Herein, a review article is proposed to summarize the design and research progress of piezoelectric biomaterials and devices toward bionanotechnology. First, the functions of bioelectricity in regulating human electrophysiological activity from cellular to tissue level are introduced. Next, recent advances as well as structure-property relationship of various natural and synthetic piezoelectric biomaterials are provided in detail. In the following part, the applications of piezoelectric biomaterials in tissue engineering, drug delivery, biosensing, energy harvesting, and catalysis are systematically classified and discussed. Finally, the challenges and future prospects of piezoelectric biomaterials are presented. It is believed that this review will provide inspiration for the design and development of innovative piezoelectric biomaterials in the fields of biomedicine and nanotechnology.

Oxygen vacancy healing boosts the piezoelectricity of bone scaffolds

Although barium titanate (BaTiO3) presented tremendous potential in achieving self-powered stimulation to accelerate bone repair, pervasive oxygen vacancies restricted the full play of its piezoelectric performance. Herein, BaTiO3-GO nanoparticles were synthesized by the in situ growth of BaTiO3 on graphene oxide (GO), and subsequently introduced into poly-L-lactic acid (PLLA) powders to prepare PLLA/BaTiO3-GO scaffolds by laser additive manufacturing. During the synthesis process, CO and C-OH in GO would respectively undergo cleavage and dehydrogenation at high temperature to form negatively charged oxygen groups, which were expected to occupy positively charged oxygen vacancies in BaTiO3 and thereby inhibit the formation of oxygen vacancies. Moreover, GO could be partially reduced to reduced graphene oxide, which could act as a conductive phase to facilitate polarization charge transfer, thus further improving the piezoelectric performance. The results showed that the oxygen peak at the specific electron binding energy in O 1s declined from 54.4% to 14.6% and the Ti3+ peak that was positively correlated with oxygen vacancies apparently weakened for BaTiO3-GO, illustrating that the introduced GO significantly decreased the oxygen vacancy. As a consequence, the piezoelectric current of PLLA/BaTiO3-GO increased from 80 to 147.3 nA compared with that of PLLA/BaTiO3. The enhanced piezoelectric current effectively accelerated cell differentiation by upregulating alkaline phosphatase expression, calcium salt deposition and calcium influx. This work provides a novel insight for the design of self-powered stimulation scaffolds for bone regeneration.

3D-Printed Piezoelectric Scaffolds with Shape Memory Polymer for Bone Regeneration

The application of piezoelectric nanoparticles with shape memory polymer (SMP) to 3D-printed piezoelectric scaffolds for bone defect repair is an attractive research direction. However, there is a significant difference in dielectric constants between the piezoelectric phase and polymer phase, limiting the piezoelectric property. Therefore, novel piezoelectric acrylate epoxidized soybean oil (AESO) scaffolds doped with piezoelectric Ag-TMSPM-pBT (ATP) nanoparticles (AESO-ATP scaffolds) are prepared via digital light procession 3D-printing. The Ag-TMSPM-pBT nanoparticles improve the piezoelectric properties of the AESO scaffolds by TMSPM covalent functionalization and conductive Ag nanoparticles. The AESO scaffolds doped with 10 wt% Ag-TMSPM-pBT nanoparticles (AESO-10ATP scaffolds) exhibit promising piezoelectrical properties, with a piezoelectric coefficient (d33) of 0.9 pC N-1 and an output current of 146.4 nA, which are close to the piezoelectric constants of bone tissue. In addition, these scaffolds exhibit good shape memory function and can quickly recover their original shape under near-infrared (NIR) light irradiation. The results of osteogenesis capability evaluation indicate that the AESO-10ATP scaffolds can promote osteogenic differentiation of BMSCs in vitro and bone defect repair in vivo, indicating the 3D-printed AESO-10ATP piezoelectric scaffolds may have great application potential for bone regeneration.

Biological properties of polycaprolactone and barium titanate composite in biomedical applications

The ceramic-polymer composite materials are widely known for their exceptional mechanical and biological properties. Polycaprolactone (PCL) is a biodegradable polymer material extensively used in various biomedical applications. At the same time, barium titanate (BT), a ceramic material, exhibits piezoelectric properties similar to bone, which is essential for osseointegration. Furthermore, a composite material that combines the benefits of PCL and BT results in an innovative composite material with enhanced properties for biomedical applications. Thus, this review is organised into three sections. Firstly, it aims to provide an overview of the current research on evaluating biological properties, including antibacterial activity, cytotoxicity and osseointegration, of PCL polymeric matrices in its pure form and reinforced structures with ceramics, polymers and natural extracts. The second section investigates the biological properties of BT, both in its pure form and in combination with other supporting materials. Finally, the third section provides a summary of the biological properties of the PCLBT composite material. Furthermore, the existing challenges of PCL, BT and their composites, along with future research directions, have been presented. Therefore, this review will provide a state-of-the-art understanding of the biological properties of PCL and BT composites as potential futuristic materials in biomedical applications.

Physical stimuli-emitting scaffolds: The role of piezoelectricity in tissue regeneration

The imbalance between life expectancy and quality of life is increasing due to the raising prevalence of chronic diseases. Musculoskeletal disorders and chronic wounds affect a growing percentage of people and demand more efficient tools for regenerative medicine. Scaffolds that can better mimic the natural physical stimuli that tissues receive under healthy conditions and during healing may significantly aid the regeneration process. Shape, mechanical properties, pore size and interconnectivity have already been demonstrated to be relevant scaffold features that can determine cell adhesion and differentiation. Much less attention has been paid to scaffolds that can deliver more dynamic physical stimuli, such as electrical signals. Recent developments in the precise measurement of electrical fields in vivo have revealed their key role in cell movement (galvanotaxis), growth, activation of secondary cascades, and differentiation to different lineages in a variety of tissues, not just neural. Piezoelectric scaffolds can mimic the natural bioelectric potentials and gradients in an autonomous way by generating the electric stimuli themselves when subjected to mechanical loads or, if the patient or the tissue lacks mobility, ultrasound irradiation. This review provides an analysis on endogenous bioelectrical signals, recent developments on piezoelectric scaffolds for bone, cartilage, tendon and nerve regeneration, and their main outcomes in vivo. Wound healing with piezoelectric dressings is addressed in the last section with relevant examples of performance in animal models. Results evidence that a fine adjustment of material composition and processing (electrospinning, corona poling, 3D printing, annealing) provides scaffolds that act as true emitters of electrical stimuli that activate endogenous signaling pathways for more efficient and long-term tissue repair.

Global trends and hot topics in clinical applications of perovskite materials: a bibliometric analysis

In recent years, perovskite has received increasing attention in the medical field. However, there has been a lack of related bibliometric analysis in this research field. This study aims to analyse the research status and hot topics of perovskite in the medical field from a bibliometric perspective and explore the research direction of perovskite. This study collected 1852 records of perovskite research in the medical field from 1983 to 2022 in the Web of Science (WOS) database. The country, institution, journal, cited references, and keywords were analysed using CiteSpace, VOS viewer, and Bibliometrix software. The number of articles related to perovskite research in the medical field has been increasing every year. China and USA have published the most papers and are the main forces in this research field. The University of London Imperial College of Science, Technology, and Medicine is the most active institution and has contributed the most publications. ACS Applied Materials & Interfaces is the most prolific journal in this field. "Medical electronic devices", "X-rays", and "piezoelectric materials" are the most researched directions of perovskite in the medical field. "Performance", "perovskite", and "solar cells" are the most frequently used keywords in this field. Advanced Materials is the most relevant and academically influential journal for perovskite research. Halide perovskites have been a hot topic in this field in recent years and will be a future research trend. X-ray, electronic medical equipment, and medical stents are the main research directions.

Robust Osteoconductive β-Tricalcium Phosphate/L-poly(lactic acid) Membrane via Orientation-Strengthening Technology

L-poly(lactic acid) (PLLA) is a biodegradable material with multiple biomedical application potentials, especially as a membrane for guided bone regeneration. In terms of its low strength and poor osteogenic activity, improving these two properties is the key to resolve the limitations of PLLA for bone-associated applications. Herein, an orientation-strengthening technology (OST) was developed to reinforce PLLA's mechanical strength by introducing biocompatible β-tricalcium phosphate (β-TCP) to improve the crystallinity of PLLA, allowing for the formation of a highly oriented architecture to acquire an advanced membrane with high mechanical property. Furthermore, the addition of β-TCP nanoparticles significantly promotes the osteogenic activity of the composites. The tensile strength of the membrane containing 5 wt % β-TCP was 220 MPa, which was 4-folds that of the native polylactic acid fabricated via the conventional method. The oriented microstructure enhanced both the mechanical strength and the osteogenic activity of the material. The parallel grooves on the material surface are similar to the mineralized collagen fibers on the bone surface, which promoted the growth and differentiation of osteoblasts, with β-TCP further contributing to the osteoconductive effect. The combination of β-TCP and orientation-strengthening effect endows the material with higher mechanical properties and bioactivities, which provides an advanced manufacturing strategy for the preparation of PLLA-based materials for bone repair.

Filler-Enhanced Piezoelectricity of Poly-L-Lactide and Its Use as a Functional Ultrasound-Activated Biomaterial

Poly-L-lactide (PLLA) offers a unique possibility for processing into biocompatible, biodegradable, and implantable piezoelectric structures. With such properties, PLLA has potential to be used as an advanced tool for mimicking biophysical processes that naturally occur during the self-repair of wounds and damaged tissues, including electrostimulated regeneration. The piezoelectricity of PLLA strongly depends on the possibility of controlling its crystallinity and molecular orientation. Here, it is shown that modifying PLLA with a small amount (1 wt%) of crystalline filler particles with a high aspect ratio, which act as nucleating agents during drawing-induced crystallization, promotes the formation of highly crystalline and oriented PLLA structures. This increases their piezoelectricity, and the filler-modified PLLA films provide a 20-fold larger voltage output than nonmodified PLLA during ultrasound (US)-assisted activation. With 99% PLLA content, the ability of the films to produce reactive oxygen species (ROS) and increase the local temperature during interactions with US is shown to be very low. US-assisted piezostimulation of adherent cells directly attach to their surface (such as skin keratinocytes), stimulate cytoskeleton formation, and as a result cells elongate and orient themselves in a specific direction that align with the direction of PLLA film drawing and PLLA dipole orientation.

Recent advances in modified poly (lactic acid) as tissue engineering materials

As an emerging science, tissue engineering and regenerative medicine focus on developing materials to replace, restore or improve organs or tissues and enhancing the cellular capacity to proliferate, migrate and differentiate into different cell types and specific tissues. Renewable resources have been used to develop new materials, resulting in attempts to produce various environmentally friendly biomaterials. Poly (lactic acid) (PLA) is a biopolymer known to be biodegradable and it is produced from the fermentation of carbohydrates. PLA can be combined with other polymers to produce new biomaterials with suitable physicochemical properties for tissue engineering applications. Here, the advances in modified PLA as tissue engineering materials are discussed in light of its drawbacks, such as biological inertness, low cell adhesion, and low degradation rate, and the efforts conducted to address these challenges toward the design of new enhanced alternative biomaterials.

The bioelectrical properties of bone tissue

Understanding the bioelectrical properties of bone tissue is key to developing new treatment strategies for bone diseases and injuries, as well as improving the design and fabrication of scaffold implants for bone tissue engineering. The bioelectrical properties of bone tissue can be attributed to the interaction of its various cell lineages (osteocyte, osteoblast and osteoclast) with the surrounding extracellular matrix, in the presence of various biomechanical stimuli arising from routine physical activities; and is best described as a combination and overlap of dielectric, piezoelectric, pyroelectric and ferroelectric properties, together with streaming potential and electro-osmosis. There is close interdependence and interaction of the various electroactive and electrosensitive components of bone tissue, including cell membrane potential, voltage-gated ion channels, intracellular signaling pathways, and cell surface receptors, together with various matrix components such as collagen, hydroxyapatite, proteoglycans and glycosaminoglycans. It is the remarkably complex web of interactive cross-talk between the organic and non-organic components of bone that define its electrophysiological properties, which in turn exerts a profound influence on its metabolism, homeostasis and regeneration in health and disease. This has spurred increasing interest in application of electroactive scaffolds in bone tissue engineering, to recapitulate the natural electrophysiological microenvironment of healthy bone tissue to facilitate bone defect repair.