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Dorozhkin SV. Calcium Orthophosphate (CaPO4)-Based Bioceramics: Preparation, Properties, and Applications. COATINGS 2022; 12:1380. [DOI: 10.3390/coatings12101380] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/02/2024]
Abstract
Various types of materials have been traditionally used to restore damaged bones. In the late 1960s, a strong interest was raised in studying ceramics as potential bone grafts due to their biomechanical properties. A short time later, such synthetic biomaterials were called bioceramics. Bioceramics can be prepared from diverse inorganic substances, but this review is limited to calcium orthophosphate (CaPO4)-based formulations only, due to its chemical similarity to mammalian bones and teeth. During the past 50 years, there have been a number of important achievements in this field. Namely, after the initial development of bioceramics that was just tolerated in the physiological environment, an emphasis was shifted towards the formulations able to form direct chemical bonds with the adjacent bones. Afterwards, by the structural and compositional controls, it became possible to choose whether the CaPO4-based implants would remain biologically stable once incorporated into the skeletal structure or whether they would be resorbed over time. At the turn of the millennium, a new concept of regenerative bioceramics was developed, and such formulations became an integrated part of the tissue engineering approach. Now, CaPO4-based scaffolds are designed to induce bone formation and vascularization. These scaffolds are usually porous and harbor various biomolecules and/or cells. Therefore, current biomedical applications of CaPO4-based bioceramics include artificial bone grafts, bone augmentations, maxillofacial reconstruction, spinal fusion, and periodontal disease repairs, as well as bone fillers after tumor surgery. Prospective future applications comprise drug delivery and tissue engineering purposes because CaPO4 appear to be promising carriers of growth factors, bioactive peptides, and various types of cells.
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Three-dimensional printing of clinical scale and personalized calcium phosphate scaffolds for alveolar bone reconstruction. Dent Mater 2022; 38:529-539. [PMID: 35074166 PMCID: PMC9016367 DOI: 10.1016/j.dental.2021.12.141] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 12/20/2021] [Indexed: 11/21/2022]
Abstract
OBJECTIVE Alveolar bone defects can be highly variable in their morphology and, as the defect size increases, they become more challenging to treat with currently available therapeutics and biomaterials. This investigation sought to devise a protocol for fabricating customized clinical scale and patient-specific, bioceramic scaffolds for reconstruction of large alveolar bone defects. METHODS Two types of calcium phosphate (CaP)-based bioceramic scaffolds (alginate/β-TCP and hydroxyapatite/α-TCP, hereafter referred to as hybrid CaP and Osteoink™, respectively) were designed, 3D printed, and their biocompatibility with alveolar bone marrow stem cells and mechanical properties were determined. Following scaffold optimization, a workflow was developed to use cone beam computed tomographic (CBCT) imaging to design and 3D print, defect-specific bioceramic scaffolds for clinical-scale bone defects. RESULTS Osteoink™ scaffolds had the highest compressive strength when compared to hybrid CaP with different infill orientation. In cell culture medium, hybrid CaP degradation resulted in decreased pH (6.3) and toxicity to stem cells; however, OsteoInk™ scaffolds maintained a stable pH (7.2) in culture and passed the ISO standard for cytotoxicity. Finally, a clinically feasible laboratory workflow was developed and evaluated using CBCT imaging to engineer customized and defect-specific CaP scaffolds using OsteoInk™. It was determined that printed scaffolds had a high degree of accuracy to fit the respective clinical defects for which they were designed (0.27 mm morphological deviation of printed scaffolds from digital design). SIGNIFICANCE From patient to patient, large alveolar bone defects are difficult to treat due to high variability in their complex morphologies and architecture. Our findings shows that Osteoink™ is a biocompatible material for 3D printing of clinically acceptable, patient-specific scaffolds with precision-fit for use in alveolar bone reconstructive procedures. Collectively, emerging digital technologies including CBCT imaging, 3D surgical planning, and (bio)printing can be integrated to address this unmet clinical challenge.
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Ryan DA, Cheng J, Masuda K, Cashman JR. Role of Curcuminoids and Tricalcium Phosphate Ceramic in Rat Spinal Fusion. Tissue Eng Part C Methods 2020; 26:577-589. [PMID: 33086948 DOI: 10.1089/ten.tec.2020.0217] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
Despite considerable research effort, there is a significant need for safe agents that stimulate bone formation. Treatment of large or complex bone defects remains a challenge. Implantation of small molecule-induced human bone marrow-derived mesenchymal stromal cells (hBMSCs) on an appropriate tricalcium phosphate (TCP) scaffold offers a robust system for noninvasive therapy for spinal fusion. To show the efficacy of this approach, we identified a small molecule curcuminoid that when combined with TCP ceramic in the presence of hBMSCs selectively induced growth of bone cells: after 8- or 25-day incubations, alkaline phosphatase was elevated. Treatment of hBMSCs with curcuminoid 1 and TCP ceramic increased osteogenic target gene expression (i.e., Runx2, BMP2, Osteopontin, and Osteocalcin) over time. In the presence of curcuminoid 1 and TCP ceramic, osteogenesis of hBMSCs, including proliferation, differentiation, and mineralization, was observed. No evidence of chondrogenic or adipogenic potential using this protocol was observed. Transplantation of curcuminoid 1-treated hBMSC/TCP mixtures into the spine of immunodeficient rats showed that it achieved spinal fusion and provided greater stability of the spinal column than untreated hBMSC-TCP implants or TCP alone implants. On the basis of histological analysis, greater bone formation was associated with curcuminoid 1-treated hBMSC implants manifested as contiguous growth plates with extensive hematopoietic territories. Stimulation of hBMSCs by administration of small molecule curcuminoid 1 in the presence of TCP ceramic afforded an effective noninvasive strategy that increased spinal fusion repair and provided greater stability of the spinal column after 8 weeks in immunodeficient rats. Impact statement Bone defects only slowly regenerate themselves in humans. Current procedures to restore spinal defects are not always effective. Some have side effects. In this article, a new method to produce bone growth within 8 weeks in rats is presented. In the presence of tricalcium phosphate ceramic, curcuminoid-1 small molecule-stimulated human bone marrow-derived mesenchymal stromal cells showed robust bone cell growth in vitro. Transplantation of this mixture into the spine showed efficient spinal fusion in rats. The approach presented herein provides an efficient biocompatible scaffold for delivery of a potentially clinically useful system that could be applicable in patients.
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Affiliation(s)
- Daniel A Ryan
- Human BioMolecular Research Institute, San Diego, California, USA
| | - Jiongjia Cheng
- Human BioMolecular Research Institute, San Diego, California, USA
| | - Koichi Masuda
- Department of Orthopedic Surgery, University of California, San Diego, San Diego, California, USA
| | - John R Cashman
- Human BioMolecular Research Institute, San Diego, California, USA
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Korn P, Ahlfeld T, Lahmeyer F, Kilian D, Sembdner P, Stelzer R, Pradel W, Franke A, Rauner M, Range U, Stadlinger B, Lode A, Lauer G, Gelinsky M. 3D Printing of Bone Grafts for Cleft Alveolar Osteoplasty - In vivo Evaluation in a Preclinical Model. Front Bioeng Biotechnol 2020; 8:217. [PMID: 32269989 PMCID: PMC7109264 DOI: 10.3389/fbioe.2020.00217] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Accepted: 03/04/2020] [Indexed: 12/12/2022] Open
Abstract
One of the most common hereditary craniofacial anomalies in humans are cleft lip and cleft alveolar bone with or without cleft palate. Current clinical practice, the augmentation of the persisting alveolar bone defect by using autologous bone grafts, has considerable disadvantages motivating to an intensive search for alternatives. We developed a novel therapy concept based on 3D printing of biodegradable calcium phosphate-based materials and integration of osteogenic cells allowing fabrication of patient-specific, tissue-engineered bone grafts. Objective of the present study was the in vivo evaluation of implants in a rat alveolar cleft model. Scaffolds were designed according to the defect's geometry with two different pore designs (60° and 30° rotated layer orientation) and produced by extrusion-based 3D plotting of a pasty calcium phosphate cement. The scaffolds filled into the artificial bone defect in the palate of adult Lewis rats, showing a good support. Half of the scaffolds were colonized with rat mesenchymal stromal cells (rMSC) prior to implantation. After 6 and 12 weeks, remaining defect width and bone formation were quantified histologically and by microCT. The results revealed excellent osteoconductive properties of the scaffolds, a significant influence of the pore geometry (60° > 30°), but no enhanced defect healing by pre-colonization with rMSC.
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Affiliation(s)
- Paula Korn
- Department of Oral and Maxillofacial Surgery, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Tilman Ahlfeld
- Centre for Translational Bone, Joint and Soft Tissue Research, University Hospital “Carl Gustav Carus”, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
| | - Franziska Lahmeyer
- Department of Oral and Maxillofacial Surgery, Faculty of Medicine “Carl Gustav Carus”, Technische Universität Dresden, Dresden, Germany
| | - David Kilian
- Centre for Translational Bone, Joint and Soft Tissue Research, University Hospital “Carl Gustav Carus”, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
| | - Philipp Sembdner
- Institute of Machine Elements and Machine Design, Technische Universität Dresden, Dresden, Germany
| | - Ralph Stelzer
- Institute of Machine Elements and Machine Design, Technische Universität Dresden, Dresden, Germany
| | - Winnie Pradel
- Department of Oral and Maxillofacial Surgery, Faculty of Medicine “Carl Gustav Carus”, Technische Universität Dresden, Dresden, Germany
| | - Adrian Franke
- Department of Oral and Maxillofacial Surgery, Faculty of Medicine “Carl Gustav Carus”, Technische Universität Dresden, Dresden, Germany
| | - Martina Rauner
- Division of Endocrinology, Diabetes, and Bone Diseases, Department of Medicine III and Center for Healthy Aging, Faculty of Medicine “Carl Gustav Carus”, Technische Universität Dresden, Dresden, Germany
| | - Ursula Range
- Institute for Medical Informatics and Biometry, Faculty of Medicine “Carl Gustav Carus”, Technische Universität Dresden, Dresden, Germany
| | - Bernd Stadlinger
- Clinic of Cranio-Maxillofacial and Oral Surgery, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Anja Lode
- Centre for Translational Bone, Joint and Soft Tissue Research, University Hospital “Carl Gustav Carus”, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
| | - Günter Lauer
- Department of Oral and Maxillofacial Surgery, Faculty of Medicine “Carl Gustav Carus”, Technische Universität Dresden, Dresden, Germany
| | - Michael Gelinsky
- Centre for Translational Bone, Joint and Soft Tissue Research, University Hospital “Carl Gustav Carus”, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
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Wiedmer D, Cui C, Weber F, Petersen FC, Tiainen H. Antibacterial Surface Coating for Bone Scaffolds Based on the Dark Catalytic Effect of Titanium Dioxide. ACS APPLIED MATERIALS & INTERFACES 2018; 10:35784-35793. [PMID: 30273480 DOI: 10.1021/acsami.8b12623] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Biomaterials which promote tissue integration and resist microbial colonisation are required in bone tissue engineering to prevent biomaterial-associated infections. Surface modification of established materials for bone tissue engineering, such as TiO2, have emerged as promising anti-infective strategies. Interestingly, the antibacterial activity of TiO2 in the form of particles can be enhanced by combining it with H2O2, even in the absence of irradiation. However, it remains unknown whether TiO2 surfaces elicit a similar effect. In this study, the antibacterial effect of porous TiO2 scaffolds generated by the catalytic decomposition of H2O2 in the absence of light (dark catalysis) was investigated. Porous ceramic foams were fabricated and sol-gel coated for high catalytic activity. Degradation of methylene blue in the presence of 3% H2O2 increased by 80% for the sol-gel-coated surfaces. The degradation kinetics indicate that intermediate free radicals that form at the liquid-TiO2 interface are responsible for the oxidative behavior of the surface. TiO2 surfaces were further pretreated with 30% H2O2 for prolonged oxidative behavior. The biological response toward such surfaces was assessed in vitro. S. epidermidis biofilms formed on modified surfaces showed reduced viability compared to nonmodified surfaces. Further, the same surface modification showed no cytotoxic effects on MC3T3 preosteoblasts. However, the results from the conducted genotoxicity assay were inconclusive, and further studies are needed to exclude ROS-mediated DNA damage. To conclude, this study provides evidence that a simple surface modification based on the dark catalytic effect of TiO2 can be used to create antibacterial surface properties for ceramic bone scaffolds.
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Affiliation(s)
- David Wiedmer
- Department of Biomaterials, Institute for Clinical Dentistry , University of Oslo , Oslo 0317 Norway
| | - Chen Cui
- Department of Biomaterials, Institute for Clinical Dentistry , University of Oslo , Oslo 0317 Norway
| | - Florian Weber
- Department of Biomaterials, Institute for Clinical Dentistry , University of Oslo , Oslo 0317 Norway
| | - Fernanda C Petersen
- Department of Oral Biology, Faculty of Dentistry , University of Oslo , Oslo 0316 Norway
| | - Hanna Tiainen
- Department of Biomaterials, Institute for Clinical Dentistry , University of Oslo , Oslo 0317 Norway
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Croes M, Kruyt MC, Groen WM, van Dorenmalen KMA, Dhert WJA, Öner FC, Alblas J. Interleukin 17 enhances bone morphogenetic protein-2-induced ectopic bone formation. Sci Rep 2018; 8:7269. [PMID: 29740080 PMCID: PMC5940874 DOI: 10.1038/s41598-018-25564-9] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Accepted: 04/24/2018] [Indexed: 02/06/2023] Open
Abstract
Interleukin 17 (IL-17) stimulates the osteogenic differentiation of progenitor cells in vitro through a synergy with bone morphogenetic protein (BMP)-2. This study investigates whether the diverse responses mediated by IL-17 in vivo also lead to enhanced BMP-2-induced bone formation. Since IL-17 is known to induce osteoclastogenesis, we studied the interactions between IL-17 and BMP-2 in ceramic scaffolds either or not carrying a coating with the bisphosphonate zoledronic acid (ZOL). Histological evaluation revealed that IL-17 alone did not induce any osteoclasts at day 10. On the other hand, BMP-2 clearly stimulated early tissue ingrowth and osteoclastogenesis. Both of these processes were blocked in presence of ZOL. IL-17 signaling restored early vascularized connective tissue formation and osteoclastogenesis induced by BMP-2 in ZOL-coated scaffolds. After 12 weeks, the bone volume induced by co-delivery of BMP-2 and IL-17 was doubled as compared to that induced by BMP-2 alone. We conclude that IL-17 has osteo-stimulatory effects through a synergy with bone-inductive BMP-2. Although local and single application of IL-17 does not mediate osteoclast formation, it could promote other processes involved in bone formation such as connective tissue ingrowth. The use of IL-17 may contribute to the development of improved bone graft substitutes.
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Affiliation(s)
- M Croes
- Department of Orthopaedics, University Medical Centre Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - M C Kruyt
- Department of Orthopaedics, University Medical Centre Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - W M Groen
- Department of Orthopaedics, University Medical Centre Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - K M A van Dorenmalen
- Department of Orthopaedics, University Medical Centre Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - W J A Dhert
- Department of Orthopaedics, University Medical Centre Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands.,Faculty of Veterinary Medicine, Utrecht University, Yalelaan 1, 3508 TD, Utrecht, The Netherlands
| | - F C Öner
- Department of Orthopaedics, University Medical Centre Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - J Alblas
- Department of Orthopaedics, University Medical Centre Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands.
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7
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Rh Owen G, Dard M, Larjava H. Hydoxyapatite/beta-tricalcium phosphate biphasic ceramics as regenerative material for the repair of complex bone defects. J Biomed Mater Res B Appl Biomater 2017; 106:2493-2512. [PMID: 29266701 DOI: 10.1002/jbm.b.34049] [Citation(s) in RCA: 81] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Revised: 10/27/2017] [Accepted: 10/31/2017] [Indexed: 01/07/2023]
Abstract
Bone is a composite material composed of collagen and calcium phosphate (CaP) mineral. The collagen gives bone its flexibility while the inorganic material gives bone its resilience. The CaP in bone is similar in composition and structure to the mineral hydroxyapatite (HA) and is bioactive, osteoinductive and osteoconductive. Therefore synthetic versions of bone apatite (BA) have been developed to address the demand for autologous bone graft substitutes. Synthetic HA (s-HA) are stiff and strong, but brittle. These lack of physical attributes limit the use of synthetic apatites in situations where no physical loading of the apatite occurs. s-HA chemical properties differ from BA and thus change the physical and mechanical properties of the material. Consequently, s-HA is more chemically stable than BA and thus its resorption rate is slower than the rate of bone regeneration. One solution to this problem is to introduce a faster resorbing CaP, such as β-tricalcium phosphate (β-TCP), when synthesizing the material creating a biphasic (s-HA and β-TCP) formulation of calcium phosphate (BCP). The focus of this review is to introduce the major differences between BCP and biological apatites and how material scientists have overcome the inadequacies of the synthetic counterparts. Examples of BCP performance in vitro and in vivo following structural and chemical modifications are provided as well as novel ultrastructural data. © 2017 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater, 106B: 2493-2512, 2018.
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Affiliation(s)
- Gethin Rh Owen
- Department of Oral, Biological & Medical Sciences, Faculty of Dentistry, University of British Columbia, Vancouver V6T 1Z3, Canada
| | - Michel Dard
- College of Dentistry, New York University, New York, New York
| | - Hannu Larjava
- Department of Oral, Biological & Medical Sciences, Faculty of Dentistry, University of British Columbia, Vancouver V6T 1Z3, Canada
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9
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Tethering of Epidermal Growth Factor (EGF) to Beta Tricalcium Phosphate (βTCP) via Fusion to a High Affinity, Multimeric βTCP-Binding Peptide: Effects on Human Multipotent Stromal Cells/Connective Tissue Progenitors. PLoS One 2015; 10:e0129600. [PMID: 26121597 PMCID: PMC4488278 DOI: 10.1371/journal.pone.0129600] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2014] [Accepted: 05/11/2015] [Indexed: 12/14/2022] Open
Abstract
Transplantation of freshly-aspirated autologous bone marrow, together with a scaffold, is a promising clinical alternative to harvest and transplantation of autologous bone for treatment of large defects. However, survival proliferation, and osteogenic differentiation of the marrow-resident stem and progenitor cells with osteogenic potential can be limited in large defects by the inflammatory microenvironment. Previous studies using EGF tethered to synthetic polymer substrates have demonstrated that surface-tethered EGF can protect human bone marrow-derived osteogenic stem and progenitor cells from pro-death inflammatory cues and enhance their proliferation without detriment to subsequent osteogenic differentiation. The objective of this study was to identify a facile means of tethering EGF to clinically-relevant βTCP scaffolds and to demonstrate the bioactivity of EGF tethered to βTCP using stimulation of the proliferative response of human bone-marrow derived mesenchymal stem cells (hBMSC) as a phenotypic metric. We used a phage display library and panned against βTCP and composites of βTCP with a degradable polyester biomaterial, together with orthogonal blocking schemes, to identify a 12-amino acid consensus binding peptide sequence, LLADTTHHRPWT, with high affinity for βTCP. When a single copy of this βTCP-binding peptide sequence was fused to EGF via a flexible peptide tether domain and expressed recombinantly in E. coli together with a maltose-binding domain to aid purification, the resulting fusion protein exhibited modest affinity for βTCP. However, a fusion protein containing a linear concatamer containing 10 repeats of the binding motif the resulting fusion protein showed high affinity stable binding to βTCP, with only 25% of the protein released after 7 days at 37oC. The fusion protein was bioactive, as assessed by its abilities to activate kinase signaling pathways downstream of the EGF receptor when presented in soluble form, and to enhance the proliferation of hBMSC when presented in tethered form on commercial βTCP bone regeneration scaffolds.
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10
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Sonnaert M, Kerckhofs G, Papantoniou I, Van Vlierberghe S, Boterberg V, Dubruel P, Luyten FP, Schrooten J, Geris L. Multifactorial Optimization of Contrast-Enhanced Nanofocus Computed Tomography for Quantitative Analysis of Neo-Tissue Formation in Tissue Engineering Constructs. PLoS One 2015; 10:e0130227. [PMID: 26076131 PMCID: PMC4467978 DOI: 10.1371/journal.pone.0130227] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2015] [Accepted: 05/17/2015] [Indexed: 11/26/2022] Open
Abstract
To progress the fields of tissue engineering (TE) and regenerative medicine, development of quantitative methods for non-invasive three dimensional characterization of engineered constructs (i.e. cells/tissue combined with scaffolds) becomes essential. In this study, we have defined the most optimal staining conditions for contrast-enhanced nanofocus computed tomography for three dimensional visualization and quantitative analysis of in vitro engineered neo-tissue (i.e. extracellular matrix containing cells) in perfusion bioreactor-developed Ti6Al4V constructs. A fractional factorial ‘design of experiments’ approach was used to elucidate the influence of the staining time and concentration of two contrast agents (Hexabrix and phosphotungstic acid) and the neo-tissue volume on the image contrast and dataset quality. Additionally, the neo-tissue shrinkage that was induced by phosphotungstic acid staining was quantified to determine the operating window within which this contrast agent can be accurately applied. For Hexabrix the staining concentration was the main parameter influencing image contrast and dataset quality. Using phosphotungstic acid the staining concentration had a significant influence on the image contrast while both staining concentration and neo-tissue volume had an influence on the dataset quality. The use of high concentrations of phosphotungstic acid did however introduce significant shrinkage of the neo-tissue indicating that, despite sub-optimal image contrast, low concentrations of this staining agent should be used to enable quantitative analysis. To conclude, design of experiments allowed us to define the most optimal staining conditions for contrast-enhanced nanofocus computed tomography to be used as a routine screening tool of neo-tissue formation in Ti6Al4V constructs, transforming it into a robust three dimensional quality control methodology.
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Affiliation(s)
- Maarten Sonnaert
- Prometheus, Division of Skeletal Tissue Engineering, KU Leuven, Leuven, Belgium
- Department of Materials Engineering, KU Leuven, Heverlee, Belgium
| | - Greet Kerckhofs
- Prometheus, Division of Skeletal Tissue Engineering, KU Leuven, Leuven, Belgium
- Department of Development and Regeneration, Skeletal Biology and Engineering Research Center, KU Leuven, Leuven, Belgium
- Biomechanics Research Unit, Université de Liege, Liège, Belgium
- * E-mail:
| | - Ioannis Papantoniou
- Prometheus, Division of Skeletal Tissue Engineering, KU Leuven, Leuven, Belgium
- Department of Development and Regeneration, Skeletal Biology and Engineering Research Center, KU Leuven, Leuven, Belgium
| | | | - Veerle Boterberg
- Polymer Chemistry and Biomaterials Group, University of Ghent, Ghent, Belgium
| | - Peter Dubruel
- Polymer Chemistry and Biomaterials Group, University of Ghent, Ghent, Belgium
| | - Frank P. Luyten
- Prometheus, Division of Skeletal Tissue Engineering, KU Leuven, Leuven, Belgium
- Department of Development and Regeneration, Skeletal Biology and Engineering Research Center, KU Leuven, Leuven, Belgium
| | - Jan Schrooten
- Prometheus, Division of Skeletal Tissue Engineering, KU Leuven, Leuven, Belgium
- Department of Materials Engineering, KU Leuven, Heverlee, Belgium
| | - Liesbet Geris
- Prometheus, Division of Skeletal Tissue Engineering, KU Leuven, Leuven, Belgium
- Biomechanics Research Unit, Université de Liege, Liège, Belgium
- Department of Mechanical Engineering, Biomechanics Section, KU Leuven, Heverlee, Belgium
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11
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Boix M, Eslava S, Costa Machado G, Gosselin E, Ni N, Saiz E, De Coninck J. ATR-FTIR measurements of albumin and fibrinogen adsorption: Inert versus calcium phosphate ceramics. J Biomed Mater Res A 2015; 103:3493-502. [PMID: 25940865 DOI: 10.1002/jbm.a.35496] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2015] [Revised: 04/27/2015] [Accepted: 04/29/2015] [Indexed: 11/06/2022]
Abstract
Arthritis, bone fracture, bone tumors and other musculoskeletal diseases affect millions of people across the world. Nowadays, inert and bioactive ceramics are used as bone substitutes or for bone regeneration. Their bioactivity is very much dictated by the way proteins adsorb on their surface. In this work, we compared the adsorption of albumin and fibrinogen on inert and calcium phosphates ceramics (CaPs) using attenuated total reflection Fourier transform infrared spectroscopy (ATR-FTIR) to follow in situ protein adsorption on these materials. To this effect, we developed a sol-gel technique to control the surface chemistry of an ATR-FTIR detector. Hydroxyapatite adsorbed more albumin and β-tricalcium phosphate adsorbed more fibrinogen. Biphasic calcium phosphate presented the lowest adsorption among CaP for both proteins, illustrating the effect of surface heterogeneities. Inert ceramics adsorbed a lower amount of both proteins compared with bioactive ceramics. A significant change was observed in the conformation of the adsorbed protein versus the surface chemistry. Hydroxyapatite produced a larger loss of α-helix structure on albumin and biphasic calcium phosphate reduced β-sheet percentage on fibrinogen. Inert ceramics produced large α-helix loss on albumin and presented weak interaction with fibrinogen. Zirconia did not adsorb albumin and titanium dioxide promoted huge denaturalization of fibrinogen.
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Affiliation(s)
- Marcel Boix
- Université De Mons-UMONS, Laboratoire De Physique Des Surfaces Et Des Interfaces, Avenue Maistriau 19, Mons, 7000, Belgium
| | - Salvador Eslava
- Department of Chemical Engineering, University of Bath, United Kingdom.,Department of Materials, Imperial College London, Center for Advanced Structural Ceramics, United Kingdom
| | - Gil Costa Machado
- Department of Materials, Imperial College London, Center for Advanced Structural Ceramics, United Kingdom
| | - Emmanuel Gosselin
- Université De Mons-UMONS, Laboratoire De Physique Des Surfaces Et Des Interfaces, Avenue Maistriau 19, Mons, 7000, Belgium
| | - Na Ni
- Department of Materials, Imperial College London, Center for Advanced Structural Ceramics, United Kingdom
| | - Eduardo Saiz
- Department of Materials, Imperial College London, Center for Advanced Structural Ceramics, United Kingdom
| | - Joël De Coninck
- Université De Mons-UMONS, Laboratoire De Physique Des Surfaces Et Des Interfaces, Avenue Maistriau 19, Mons, 7000, Belgium
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12
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Li JJ, Kaplan DL, Zreiqat H. Scaffold-based regeneration of skeletal tissues to meet clinical challenges. J Mater Chem B 2014; 2:7272-7306. [PMID: 32261954 DOI: 10.1039/c4tb01073f] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
The management and reconstruction of damaged or diseased skeletal tissues have remained a significant global healthcare challenge. The limited efficacy of conventional treatment strategies for large bone, cartilage and osteochondral defects has inspired the development of scaffold-based tissue engineering solutions, with the aim of achieving complete biological and functional restoration of the affected tissue in the presence of a supporting matrix. Nevertheless, significant regulatory hurdles have rendered the clinical translation of novel scaffold designs to be an inefficient process, mainly due to the difficulties of arriving at a simple, reproducible and effective solution that does not rely on the incorporation of cells and/or bioactive molecules. In the context of the current clinical situation and recent research advances, this review will discuss scaffold-based strategies for the regeneration of skeletal tissues, with focus on the contribution of bioactive ceramic scaffolds and silk fibroin, and combinations thereof, towards the development of clinically viable solutions.
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Affiliation(s)
- Jiao Jiao Li
- Biomaterials and Tissue Engineering Research Unit, School of AMME, University of Sydney, Sydney, NSW 2006, Australia.
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13
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Papantoniou I, Sonnaert M, Geris L, Luyten FP, Schrooten J, Kerckhofs G. Three-dimensional characterization of tissue-engineered constructs by contrast-enhanced nanofocus computed tomography. Tissue Eng Part C Methods 2013; 20:177-87. [PMID: 23800097 DOI: 10.1089/ten.tec.2013.0041] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
To successfully implement tissue-engineered (TE) constructs as part of a clinical therapy, it is necessary to develop quality control tools that will ensure accurate and consistent TE construct release specifications. Hence, advanced methods to monitor TE construct properties need to be further developed. In this study, we showed proof of concept for contrast-enhanced nanofocus computed tomography (CE-nano-CT) as a whole-construct imaging technique with a noninvasive potential that enables three-dimensional (3D) visualization and quantification of in vitro engineered extracellular matrix (ECM) in TE constructs. In particular, we performed a 3D qualitative and quantitative structural and spatial assessment of the in vitro engineered ECM, formed during static and perfusion bioreactor cell culture in 3D TE scaffolds, using two contrast agents, namely, Hexabrix® and phosphotungstic acid (PTA). To evaluate the potential of CE-nano-CT, a comparison was made to standardly used techniques such as Live/Dead viability/cytotoxicity, Picrosirius Red staining, and to net dry weight measurements of the TE constructs. When using Hexabrix as the contrast agent, the ECM volume fitted linearly with the net dry ECM weight independent from the flow rate used, thus suggesting that it stains most of the ECM. When using PTA as the contrast agent, comparing to net weight measurements showed that PTA only stains a part of the ECM. This was attributed to the binding specificity of this contrast agent. In addition, the PTA-stained CE-nano-CT data showed pronounced distinction between flow conditions when compared to Hexabrix, indicating culture-specific structural ECM differences. This novel type of information can contribute to optimize bioreactor culture conditions and potentially critical quality characteristics of TE constructs such as ECM quantity and homogeneity, facilitating the gradual transformation of TE constructs in well-characterized TE products.
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Affiliation(s)
- Ioannis Papantoniou
- 1 Prometheus, Division of Skeletal Tissue Engineering , KU Leuven, Leuven, Belgium
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Dorozhkin SV. Calcium Orthophosphate-Based Bioceramics. MATERIALS (BASEL, SWITZERLAND) 2013; 6:3840-3942. [PMID: 28788309 PMCID: PMC5452669 DOI: 10.3390/ma6093840] [Citation(s) in RCA: 103] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/20/2013] [Revised: 08/07/2013] [Accepted: 08/19/2013] [Indexed: 02/07/2023]
Abstract
Various types of grafts have been traditionally used to restore damaged bones. In the late 1960s, a strong interest was raised in studying ceramics as potential bone grafts due to their biomechanical properties. A bit later, such synthetic biomaterials were called bioceramics. In principle, bioceramics can be prepared from diverse materials but this review is limited to calcium orthophosphate-based formulations only, which possess the specific advantages due to the chemical similarity to mammalian bones and teeth. During the past 40 years, there have been a number of important achievements in this field. Namely, after the initial development of bioceramics that was just tolerated in the physiological environment, an emphasis was shifted towards the formulations able to form direct chemical bonds with the adjacent bones. Afterwards, by the structural and compositional controls, it became possible to choose whether the calcium orthophosphate-based implants remain biologically stable once incorporated into the skeletal structure or whether they were resorbed over time. At the turn of the millennium, a new concept of regenerative bioceramics was developed and such formulations became an integrated part of the tissue engineering approach. Now calcium orthophosphate scaffolds are designed to induce bone formation and vascularization. These scaffolds are often porous and harbor different biomolecules and/or cells. Therefore, current biomedical applications of calcium orthophosphate bioceramics include bone augmentations, artificial bone grafts, maxillofacial reconstruction, spinal fusion, periodontal disease repairs and bone fillers after tumor surgery. Perspective future applications comprise drug delivery and tissue engineering purposes because calcium orthophosphates appear to be promising carriers of growth factors, bioactive peptides and various types of cells.
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Jin F, Xie Y, Wang N, Qu X, Lu J, Hao Y, Dai K. Poor osteoinductive potential of subcutaneous bone cement-induced membranes for tissue engineered bone. Connect Tissue Res 2013; 54:283-9. [PMID: 23758267 DOI: 10.3109/03008207.2013.811499] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Large segmental bone defects remain a challenge for reconstructive surgeons. A two-stage repair strategy may offer a potential solution. Here, we sought to evaluate the osteoinductive potential of bone cement-induced membranes in an ectopic site. METHODS First, bone cements were inserted into the subcutaneous tissues of 16 rabbits to induce membrane formation. After 2, 4, 6 and 8 weeks, the induced membranes were harvested to assess their vascularization and osteoinductive potential. Next, bone cements were subcutaneously inserted into 12 rabbits for 4 weeks. These bone cements were then harvested from the newly formed membranes and replaced with granular porous β-TCP, with or without bone mesenchymal stem cells. New bone formation was then evaluated after 3, 6 and 9 weeks. RESULTS The highest level of blood vessel formation and bone morphogenetic protein-2 expression in the membranes were found at 4 weeks (p < 0.05). In addition, vascular endothelial growth factor concentration was highest after 2 weeks (p < 0.001), persisting until 8 weeks. However, the results showed little ectopic bone formation at these time points. CONCLUSION While bone cement-induced membranes appear to provide a suitable environment for bone formation, they fail to drive osteoinduction in non-osseous sites for the purposes of bone tissue engineering.
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Affiliation(s)
- Fangchun Jin
- Shanghai Key Laboratory of Orthopaedic Implants, Department of Orthopaedics, Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine , Shanghai , P.R. China and
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Viateau V, Manassero M, Sensébé L, Langonné A, Marchat D, Logeart-Avramoglou D, Petite H, Bensidhoum M. Comparative study of the osteogenic ability of four different ceramic constructs in an ectopic large animal model. J Tissue Eng Regen Med 2013; 10:E177-87. [DOI: 10.1002/term.1782] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2012] [Revised: 01/24/2013] [Accepted: 04/24/2013] [Indexed: 11/10/2022]
Affiliation(s)
- Véronique Viateau
- Laboratory of Bioengineering and Biomechanics for Bone Articulation (B2OA - UMR CNRS 7052); University of Paris 7; PRES Paris Cité Paris France
- Ecole Nationale Vétérinaire d'Alfort; Maisons Alfort France
| | - Mathieu Manassero
- Laboratory of Bioengineering and Biomechanics for Bone Articulation (B2OA - UMR CNRS 7052); University of Paris 7; PRES Paris Cité Paris France
- Ecole Nationale Vétérinaire d'Alfort; Maisons Alfort France
| | - Luc Sensébé
- Etablissement Français du Sang Centre-atlantique; UMR5273 CNRS/UPS/EFS; Tours France
| | - Alain Langonné
- Etablissement Français du Sang Centre-atlantique; UMR5273 CNRS/UPS/EFS; Tours France
| | - David Marchat
- CIS; Ecole Nationale Supérieure des Mines de Saint-Etienne; Saint-Etienne France
| | - Delphine Logeart-Avramoglou
- Laboratory of Bioengineering and Biomechanics for Bone Articulation (B2OA - UMR CNRS 7052); University of Paris 7; PRES Paris Cité Paris France
| | - Hervé Petite
- Laboratory of Bioengineering and Biomechanics for Bone Articulation (B2OA - UMR CNRS 7052); University of Paris 7; PRES Paris Cité Paris France
| | - Morad Bensidhoum
- Laboratory of Bioengineering and Biomechanics for Bone Articulation (B2OA - UMR CNRS 7052); University of Paris 7; PRES Paris Cité Paris France
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Tanase CE, Sartoris A, Popa MI, Verestiuc L, Unger RE, Kirkpatrick CJ. In vitro
evaluation of biomimetic chitosan–calcium phosphate scaffolds with potential application in bone tissue engineering. Biomed Mater 2013; 8:025002. [DOI: 10.1088/1748-6041/8/2/025002] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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Bose S, Roy M, Bandyopadhyay A. Recent advances in bone tissue engineering scaffolds. Trends Biotechnol 2012; 30:546-54. [PMID: 22939815 DOI: 10.1016/j.tibtech.2012.07.005] [Citation(s) in RCA: 1194] [Impact Index Per Article: 99.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2012] [Revised: 07/23/2012] [Accepted: 07/23/2012] [Indexed: 12/12/2022]
Abstract
Bone disorders are of significant concern due to increase in the median age of our population. Traditionally, bone grafts have been used to restore damaged bone. Synthetic biomaterials are now being used as bone graft substitutes. These biomaterials were initially selected for structural restoration based on their biomechanical properties. Later scaffolds were engineered to be bioactive or bioresorbable to enhance tissue growth. Now scaffolds are designed to induce bone formation and vascularization. These scaffolds are often porous, made of biodegradable materials that harbor different growth factors, drugs, genes, or stem cells. In this review, we highlight recent advances in bone scaffolds and discuss aspects that still need to be improved.
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Affiliation(s)
- Susmita Bose
- W.M. Keck Biomedical Materials Research Lab, School of Mechanical and Materials Engineering, Washington State University, Pullman, WA 99164-2920, USA.
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Demirkiran H. Bioceramics for Osteogenesis, Molecular and Cellular Advances. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2012; 760:134-47. [DOI: 10.1007/978-1-4614-4090-1_9] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
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20
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Dorozhkin SV. Calcium orthophosphates as bioceramics: state of the art. J Funct Biomater 2010; 1:22-107. [PMID: 24955932 PMCID: PMC4030894 DOI: 10.3390/jfb1010022] [Citation(s) in RCA: 94] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2010] [Revised: 11/16/2010] [Accepted: 11/25/2010] [Indexed: 12/18/2022] Open
Abstract
In the late 1960s, much interest was raised in regard to biomedical applications of various ceramic materials. A little bit later, such materials were named bioceramics. This review is limited to bioceramics prepared from calcium orthophosphates only, which belong to the categories of bioactive and bioresorbable compounds. There have been a number of important advances in this field during the past 30-40 years. Namely, by structural and compositional control, it became possible to choose whether calcium orthophosphate bioceramics were biologically stable once incorporated within the skeletal structure or whether they were resorbed over time. At the turn of the millennium, a new concept of calcium orthophosphate bioceramics-which is able to promote regeneration of bones-was developed. Presently, calcium orthophosphate bioceramics are available in the form of particulates, blocks, cements, coatings, customized designs for specific applications and as injectable composites in a polymer carrier. Current biomedical applications include artificial replacements for hips, knees, teeth, tendons and ligaments, as well as repair for periodontal disease, maxillofacial reconstruction, augmentation and stabilization of the jawbone, spinal fusion and bone fillers after tumor surgery. Exploratory studies demonstrate potential applications of calcium orthophosphate bioceramics as scaffolds, drug delivery systems, as well as carriers of growth factors, bioactive peptides and/or various types of cells for tissue engineering purposes.
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Bone formation and degradation of a highly porous biphasic calcium phosphate ceramic in presence of BMP-7, VEGF and mesenchymal stem cells in an ectopic mouse model. J Craniomaxillofac Surg 2010; 38:423-30. [DOI: 10.1016/j.jcms.2010.01.003] [Citation(s) in RCA: 71] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2009] [Revised: 01/18/2010] [Accepted: 01/19/2010] [Indexed: 11/23/2022] Open
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Gindraux F, Obert L, Laganier L, Barnouin L. Industrial approach in developing an advanced therapy product for bone repair. J Tissue Eng Regen Med 2010; 4:194-204. [PMID: 19967743 DOI: 10.1002/term.227] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Mesenchymal stem cells (MSCs) are multipotent cells with therapeutic applications. The aim of our work was to develop an advanced therapy product for bone repair, associating autologous human adipose-derived MSCs (ASCs) with human bone allograft (TBF; Phoenix). We drew up specifications that studied: (a) the influence of tissue collection procedures (elective liposuction or non-invasive resection) and patient age on cell number and function; (b) monolayer cell culture conditions and osteodifferentiation and particularly the possibility of reducing stages of culture; and (c) the bone construct preparation and especially the comparison between two types of cells seeded on bone allograft (number of cultured processed lipoaspirate (PLA) cells and monolayer-expanded ASCs) and cultured for 1, 2 and 3 weeks. The results showed that tissue harvesting techniques and patient age did not affect PLA cell number and ASC cloning efficiency. PLA cells can be directly osteodifferentiated (instead of culturing them in expansion medium first and then differentiating them) and these cells were able to mineralize when they were cultured in an osteogenic medium containing calcium chloride. PLA cells directly seeded on bone allograft for a minimum of 3 weeks of culture in this osteogenic medium expressed osteocalcin and colonized the matrix better than monolayer-expanded ASCs. This work detailed the specifications of a pharmaceutical laboratory to develop an advanced therapy product and this current approach is promising for bone repair.
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Affiliation(s)
- Florelle Gindraux
- Intervention, Innovation, Imagery, Engineering in Health (EA4268), University of Franche-Comté, Besançon, France.
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Porter JR, Ruckh TT, Popat KC. Bone tissue engineering: a review in bone biomimetics and drug delivery strategies. Biotechnol Prog 2010; 25:1539-60. [PMID: 19824042 DOI: 10.1002/btpr.246] [Citation(s) in RCA: 203] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Critical-sized defects in bone, whether induced by primary tumor resection, trauma, or selective surgery have in many cases presented insurmountable challenges to the current gold standard treatment for bone repair. The primary purpose of a tissue-engineered scaffold is to use engineering principles to incite and promote the natural healing process of bone which does not occur in critical-sized defects. A synthetic bone scaffold must be biocompatible, biodegradable to allow native tissue integration, and mimic the multidimensional hierarchical structure of native bone. In addition to being physically and chemically biomimetic, an ideal scaffold is capable of eluting bioactive molecules (e.g., BMPs, TGF-betas, etc., to accelerate extracellular matrix production and tissue integration) or drugs (e.g., antibiotics, cisplatin, etc., to prevent undesired biological response such as sepsis or cancer recurrence) in a temporally and spatially controlled manner. Various biomaterials including ceramics, metals, polymers, and composites have been investigated for their potential as bone scaffold materials. However, due to their tunable physiochemical properties, biocompatibility, and controllable biodegradability, polymers have emerged as the principal material in bone tissue engineering. This article briefly reviews the physiological and anatomical characteristics of native bone, describes key technologies in mimicking the physical and chemical environment of bone using synthetic materials, and provides an overview of local drug delivery as it pertains to bone tissue engineering is included.
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Affiliation(s)
- Joshua R Porter
- Department of Mechanical Engineering, School of Biomedical Engineering, Colorado State University, Fort Collins, CO 80523, USA
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Biphasic Calcium Phosphate Ceramics for Bone Regeneration and Tissue Engineering Applications. MATERIALS 2010. [PMCID: PMC5513510 DOI: 10.3390/ma3020815] [Citation(s) in RCA: 145] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Biphasic calcium phosphates (BCP) have been sought after as biomaterials for the reconstruction of bone defects in maxillofacial, dental and orthopaedic applications. They have demonstrated proven biocompatibility, osteoconductivity, safety and predictability in in vitro, in vivo and clinical models. More recently, in vitro and in vivo studies have shown that BCP can be osteoinductive. In the field of tissue engineering, they represent promising scaffolds capable of carrying and modulating the behavior of stem cells. This review article will highlight the latest advancements in the use of BCP and the characteristics that create a unique microenvironment that favors bone regeneration.
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Bongio M, van den Beucken JJJP, Leeuwenburgh SCG, Jansen JA. Development of bone substitute materials: from ‘biocompatible’ to ‘instructive’. ACTA ACUST UNITED AC 2010. [DOI: 10.1039/c0jm00795a] [Citation(s) in RCA: 96] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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