Biodegradable metals for cardiovascular stent application: interests and new opportunities

Study of the effect of magnetic fields on static degradation of Fe and Fe-12Mn-1.2C in balanced salts modified Hanks' solution

Iron and its alloys are attractive as biodegradable materials because of their low toxicity and suitable mechanical properties; however, they generally have a slow degradation rate. Given that corrosion is an electrochemical phenomenon where an exchange of electrons takes place, the application of magnetic fields from outside the body may accelerate the degradation of a ferrous temporary implant. In the present study, we have investigated the effect of alternating and direct low magnetic field (H = 6.5 kA/m) on the corrosion process of pure iron (Fe) and an iron-manganese alloy (FeMnC) in modified Hanks' solution. A 14-day static immersion test was performed on the materials. The corrosion rate was assessed by mass and cross-sectional loss measurements, scanning electron microscopy, X-ray diffractometry, Fourier-transform infrared spectroscopy and X-ray photoelectron spectroscopy before and after degradation. The results show that the presence of magnetic fields significantly accelerates the degradation rate of both materials, with the corrosion rate being twice as high in the case of Fe and almost three times as high for FeMnC. In addition, a homogenous degradation layer is formed over the entire surface and the chemical composition of the degradation products is the same regardless of the presence of a magnetic field.

Preparation, Mechanical Properties, and Degradation Behavior of Zn-1Fe-xSr Alloys for Biomedical Applications

As biodegradable materials, zinc (Zn) and zinc-based alloys have attracted wide attention owing to their great potential in biomedical applications. However, the poor strength of pure Zn and binary Zn alloys limits their wide application. In this work, a stir casting method was used to prepare the Zn-1Fe-xSr (x = 0.5, 1, 1.5, 2 wt.%) ternary alloys, and the phase composition, microstructure, tensile properties, hardness, and degradation behavior were studied. The results indicated that the SrZn13 phase was generated in the Zn matrix when the Sr element was added, and the grain size of Zn-1Fe-xSr alloy decreased with the increase in Sr content. The ultimate tensile strength (UTS) and Brinell hardness increased with the increase in Sr content. The UTS and hardness of Zn-1Fe-2Sr alloy were 141.65 MPa and 87.69 HBW, which were 55.7% and 58.4% higher than those of Zn-1Fe alloy, respectively. As the Sr content increased, the corrosion current density of Zn-1Fe-xSr alloy increased, and the charge transfer resistance decreased significantly. Zn-1Fe-2Sr alloy had a degradation rate of 0.157 mg·cm-2·d-1, which was 118.1% higher than the degradation rate of Zn-1Fe alloy. Moreover, the degradation rate of Zn-1Fe-xSr alloy decreased significantly with the increase in immersion time.

Manufacturing, Processing, and Characterization of Self-Expanding Metallic Stents: A Comprehensive Review

This paper aims to review the State of the Art in metal self-expanding stents made from nitinol (NiTi), showing shape memory and superelastic behaviors, to identify the challenges and the opportunities for improving patient outcomes. A significant contribution of this paper is its extensive coverage of multidisciplinary aspects, including design, simulation, materials development, manufacturing, bio/hemocompatibility, biomechanics, biomimicry, patency, and testing methodologies. Additionally, the paper offers in-depth insights into the latest practices and emerging trends, with a special emphasis on the transformative potential of additive manufacturing techniques in the development of metal stents. By consolidating existing knowledge and highlighting areas for future innovation, this review provides a valuable roadmap for advancing nitinol stents.

Exploring the biodegradability of candidate metallic intravascular stent materials using X-ray microfocus computed tomography: An in vitro study

In vitro testing for evaluating degradation mode and rate of candidate biodegradable metals to be used as intravascular stents is crucial before going to in vivo animal models. In this study, we show that X-ray microfocus computed tomography (microCT) presents a key added value to visualize degradation mode and to evaluate degradation rate and material surface properties in 3D and at high resolution of large regions of interest. The in vitro degradation behavior of three candidate biodegradable stent materials was evaluated: pure iron (Fe), pure zinc (Zn), and a quinary Zn alloy (ZnAgCuMnZr). These metals were compared to a reference biostable cobaltchromium (CoCr) alloy. To compare the degradation mode and degradation rate evaluated with microCT, scanning electron microscopy (SEM) and inductively-coupled plasma (ICP) were included. We confirmed that Fe degrades very slowly but with desirable uniform surface corrosion. Zn degrades faster but exhibits localized deep pitting corrosion. The Zn alloy degrades at a similar rate as the pure Zn, but more homogeneously. However, the formation of deep internal dendrites was observed. Our study provides a detailed microCT-based comparison of essential surface and corrosion properties, with a structural characterization of the corrosion behavior, of different candidate stent materials in 3D in a non-destructive way.

Characterization of Iron Oxide Nanotubes Obtained by Anodic Oxidation for Biomedical Applications-In Vitro Studies

To improve the biocompatibility and bioactivity of biodegradable iron-based materials, nanostructured surfaces formed by metal oxides offer a promising strategy for surface functionalization. To explore this potential, iron oxide nanotubes were synthesized on pure iron (Fe) using an anodic oxidation process (50 V-30 min, using an ethylene glycol solution containing 0.3% NH4F and 3% H2O, at a speed of 100 rpm). A nanotube layer composed mainly of α-Fe2O3 with diameters between 60 and 70 nm was obtained. The effect of the Fe-oxide nanotube layer on cell viability and morphology was evaluated by in vitro studies using a human osteosarcoma cell line (SaOs-2 cells). The results showed that the presence of this layer did not harm the viability or morphology of the cells. Furthermore, cells cultured on anodized surfaces showed higher metabolic activity than those on non-anodized surfaces. This research suggests that growing a layer of Fe oxide nanotubes on pure Fe is a promising method for functionalizing and improving the cytocompatibility of iron substrates. This opens up new opportunities for biomedical applications, including the development of cardiovascular stents or osteosynthesis implants.

Injectable Hydrogels in Cardiovascular Tissue Engineering

Heart problems are quite prevalent worldwide. Cardiomyocytes and stem cells are two examples of the cells and supporting matrix that are used in the integrated process of cardiac tissue regeneration. The objective is to create innovative materials that can effectively replace or repair damaged cardiac muscle. One of the most effective and appealing 3D/4D scaffolds for creating an appropriate milieu for damaged tissue growth and healing is hydrogel. In order to successfully regenerate heart tissue, bioactive and biocompatible hydrogels are required to preserve cells in the infarcted region and to bid support for the restoration of myocardial wall stress, cell survival and function. Heart tissue engineering uses a variety of hydrogels, such as natural or synthetic polymeric hydrogels. This article provides a quick overview of the various hydrogel types employed in cardiac tissue engineering. Their benefits and drawbacks are discussed. Hydrogel-based techniques for heart regeneration are also addressed, along with their clinical application and future in cardiac tissue engineering.

Biocorrosion and Cytotoxicity Studies on Biodegradable Mg-Based Multicomponent Alloys

Magnesium-based multicomponent alloys with different compositions, namely Mg60Al20Zn5Cu10Mn5 (Mg60 alloy), Mg70Al15Zn5Cu5Mn5 (Mg70 alloy), and Mg80Al5Cu5Mn5Zn5 (Mg 80) alloys, were prepared using the disintegrated melt deposition technique. The DMD technique is a distinctive method that merges the benefits from gravity die casting and spray forming. This approach facilitates high solidification rates, process yields, and reduced metal wastage, resulting in materials with a fine microstructure and minimal porosity. Their potential as biodegradable materials was assessed through corrosion in different simulated body fluids (SBFs), microstructure, and cytotoxicity tests. It was observed that the Mg60 alloy exhibited low corrosion rates (~× 10-5 mm/year) in all SBF solutions, with a minor amount of corrosive products, and cracks were observed. This can be attributed to the formation of the Mg32(AlZn)49 phase and to its stability due to Mg(OH)2 film, leading to excellent corrosion resistance when compared to the Mg70 and M80 alloys. Conversely, the Mg80 alloy exhibited high corrosion rates, along with more surface degradation and cracks, due to active intermetallic phases, such as Al6Mn, Al2CuMg, and Al2Cu phases. The order of corrosion resistance for the Mg alloy was found to be ASS > HBSS > ABP > PBS. Further, in vitro cytotoxicity studies were carried out using MDA-MB-231 tumor cells. By comparing all three alloys, in terms of proliferation and vitality, the Mg80 alloy emerged as a promising material for implants, with potential antitumor activity.

Challenges and Pitfalls of Research Designs Involving Magnesium-Based Biomaterials: An Overview

Magnesium-based biomaterials hold remarkable promise for various clinical applications, offering advantages such as reduced stress-shielding and enhanced bone strengthening and vascular remodeling compared to traditional materials. However, ensuring the quality of preclinical research is crucial for the development of these implants. To achieve implant success, an understanding of the cellular responses post-implantation, proper model selection, and good study design are crucial. There are several challenges to reaching a safe and effective translation of laboratory findings into clinical practice. The utilization of Mg-based biomedical devices eliminates the need for biomaterial removal surgery post-healing and mitigates adverse effects associated with permanent biomaterial implantation. However, the high corrosion rate of Mg-based implants poses challenges such as unexpected degradation, structural failure, hydrogen evolution, alkalization, and cytotoxicity. The biocompatibility and degradability of materials based on magnesium have been studied by many researchers in vitro; however, evaluations addressing the impact of the material in vivo still need to be improved. Several animal models, including rats, rabbits, dogs, and pigs, have been explored to assess the potential of magnesium-based materials. Moreover, strategies such as alloying and coating have been identified to enhance the degradation rate of magnesium-based materials in vivo to transform these challenges into opportunities. This review aims to explore the utilization of Mg implants across various biomedical applications within cellular (in vitro) and animal (in vivo) models.

Evaluating a targeted Palbociclib-Trastuzumab loaded smart niosome platform for treating HER2 positive breast cancer cells

In this study, we present a targeted and pH-sensitive niosomal (pHSN) formulation, incorporating quantum dot (QD)-labeled Trastuzumab (Trz) molecules for the specific delivery of Palbociclib (Pal) to cells overexpressing human epidermal growth factor receptor 2 (HER2). FTIR analyses confirmed the successful preparation of the pHSNs and their bioconjugation. The labeled Trz-conjugated Pal-pHSNs (Trz-Pal-pHSNs) exhibited a size of approximately 170 nm, displaying a spherical shape with a neutral surface charge of -1.2 mV. Pal encapsulation reached ∼86%, and the release pattern followed a two-phase pH-dependent mechanism. MTT assessments demonstrated enhanced apoptosis induction, particularly in HER2-positive cells, by Trz-Pal-pHSNs. Fluorescence imaging further validated the internalization of particles into cells. In conclusion, Trz-Pal-pHSNs emerge as a promising platform for personalized medicine in the treatment of HER2-positive breast cancer.

Structural and temporal dynamics analysis of zinc-based biomaterials: History, research hotspots and emerging trends

Objectives

To examine the 16-year developmental history, research hotspots, and emerging trends of zinc-based biodegradable metallic materials from the perspective of structural and temporal dynamics.

Methods

The literature on zinc-based biodegradable metallic materials in WoSCC was searched. Historical characteristics, the evolution of active topics and development trends in the field of zinc-based biodegradable metallic materials were analyzed using the bibliometric tools CiteSpace and HistCite.

Results

Over the past 16 years, the field of zinc-based biodegradable metal materials has remained in a hotspot stage, with extensive scientific collaboration. In addition, there are 45 subject categories and 51 keywords in different research periods, and 80 papers experience citation bursts. Keyword clustering anchored 3 emerging research subfields, namely, #1 plastic deformation #4 additive manufacturing #5 surface modification. The keyword alluvial map shows that the longest-lasting research concepts in the field are mechanical property, microstructure, corrosion behavior, etc., and emerging keywords are additive manufacturing, surface modification, dynamic recrystallization, etc. The most recent research on reference clustering has six subfields. Namely, #0 microstructure, #2 sem, #3 additive manufacturing, #4 laser powder bed fusion, #5 implant, and #7 Zn-1Mg.

Conclusion

The results of the bibliometric study provide the current status and trends of research on zinc-based biodegradable metallic materials, which can help researchers identify hot spots and explore new research directions in the field.

Surface (bio)-functionalization of metallic materials: How to cope with real interfaces?

Metallic materials are an important class of biomaterials used in various medical devices, owing to a suitable combination of their mechanical properties. The (bio)-functionalization of their surfaces is frequently performed for biocompatibility requirements, as it offers a powerful way to control their interaction with biological systems. This is particularly important when physicochemical processes and biological events, mainly involving proteins and cells, are initiated at the host-material interface. This review addresses the state of "real interfaces" in the context of (bio)-functionalization of metallic materials, and the necessity to cope with it to avoid frequent improper evaluation of the procedure used. This issue is, indeed, well-recognized but often neglected and emerges from three main issues: (i) ubiquity of surface contamination with organic compounds, (ii) reactivity of metallic surfaces in biological medium, and (iii) discrepancy in (bio)-functionalization procedures between expectations and reality. These disturb the assessment of the strategies adopted for surface modifications and limit the possibilities to provide guidelines for their improvements. For this purpose, X-ray photoelectrons spectroscopy (XPS) comes to the rescue. Based on significant progresses made in methodological developments, and through a large amount of data compiled to generate statistically meaningful information, and to insure selectivity, precision and accuracy, the state of "real interfaces" is explored in depth, while looking after the two main constituents: (i) the bio-organic adlayer, in which the discrimination between the compounds of interest (anchoring molecules, coupling agents, proteins, etc) and organic contaminants can be made, and (ii) the metallic surface, which undergoes dynamic processes due to their reactivity. Moreover, through one of the widespread (bio)-functionalization strategy, given as a case study, a particular attention is devoted to describe the state of the interface at different stages (composition, depth distribution of contaminants and (bio)compounds of interest) and the mode of protein retention. It is highlighted, in particular, that the occurrence or improvement of bioactivity does not demonstrate that the chemical schemes worked in reality. These aspects are particularly essential to make progress on the way to choose the suitable (bio)-functionalization strategy and to provide guidelines to improve its efficiency.

Investigations on the Degradation Behavior of Processed FeMnSi-xCu Shape Memory Alloys

A new functional Fe-30Mn-5Si-xCu (x = 1.5 and 2 wt%) biomaterial was obtained from the levitation induction melting process and evaluated as a biodegradable material. The degradation characteristics were assessed in vitro using immersion tests in simulated body fluid (SBF) at 37 ± 1 °C, evaluating mass loss, pH variation that occurred in the solution, open circuit potential (OCP), linear and cyclic potentiometry (LP and CP), scanning electron microscopy (SEM), energy dispersive spectroscopy (EDS) and nano-FTIR. To obtain plates as samples, the cast materials were thermo-mechanically processed by hot rolling. Dynamic mechanical analysis (DMA) was employed to evaluate the thermal properties of the smart material. Atomic force microscopy (AFM) was used to show the nanometric and microstructural changes during the hot rolling process and DMA solicitations. The type of corrosion identified was generalized corrosion, and over the first 3-5 days, an increase in mass was observed, caused by the compounds formed at the metal-solution interface. The formed compounds were identified mainly as oxides that passed into the immersion liquid. The degradation rate (DR) was obtained as a function of mass loss, sample surface area and immersion duration. The dynamic mechanical behavior and dimensions of the sample were evaluated after 14 days of immersion. The nanocompounds found on the surface after atmospheric corrosion and immersion in SBF were investigated with the Neaspec system using the nano-FTIR technique.

Methods for improving the properties of zinc for the application of biodegradable vascular stents

Biodegradable stents can support vessels for an extended period, maintain vascular patency, and progressively degrade once vascular remodeling is completed, thereby reducing the constraints of traditional metal stents. An ideal degradable stent must have good mechanical properties, degradation behavior, and biocompatibility. Zinc has become a new type of biodegradable metal after magnesium and iron, owing to its suitable degradation rate and good biocompatibility. However, zinc's poor strength and ductility make it unsuitable as a vascular stent material. Therefore, this paper reviewed the primary methods for improving the overall properties of zinc. By discussing the mechanical properties, degradation behavior, and biocompatibility of various improvement strategies, we found that alloying is the most common, simple, and effective method to improve mechanical properties. Deformation processing can further improve the mechanical properties by changing the microstructures of zinc alloys. Surface modification is an important means to improve the biological activity, blood compatibility and corrosion resistance of zinc alloys. Meanwhile, structural design can not only improve the mechanical properties of the vascular stents, but also endow the stents with special properties such as negative Poisson 's ratio. Manufacturing zinc alloys with excellent degradation properties, improved mechanical properties and strong biocompatibility and exploring their mechanism of interaction with the human body remain areas for future research.

Development and Future Trends of Protective Strategies for Magnesium Alloy Vascular Stents

Magnesium alloy stents have been extensively studied in the field of biodegradable metal stents due to their exceptional biocompatibility, biodegradability and excellent biomechanical properties. Nevertheless, the specific in vivo service environment causes magnesium alloy stents to degrade rapidly and fail to provide sufficient support for a certain time. Compared to previous reviews, this paper focuses on presenting an overview of the development history, the key issues, mechanistic analysis, traditional protection strategies and new directions and protection strategies for magnesium alloy stents. Alloying, optimizing stent design and preparing coatings have improved the corrosion resistance of magnesium alloy stents. Based on the corrosion mechanism of magnesium alloy stents, as well as their deformation during use and environmental characteristics, we present some novel strategies aimed at reducing the degradation rate of magnesium alloys and enhancing the comprehensive performance of magnesium alloy stents. These strategies include adapting coatings for the deformation of the stents, preparing rapid endothelialization coatings to enhance the service environment of the stents, and constructing coatings with self-healing functions. It is hoped that this review can help readers understand the development of magnesium alloy cardiovascular stents and solve the problems related to magnesium alloy stents in clinical applications at the early implantation stage.

Comprehensive review of materials, applications, and future innovations in biodegradable esophageal stents

Esophageal stricture (ES) results from benign and malignant conditions, such as uncontrolled gastroesophageal reflux disease (GERD) and esophageal neoplasms. Upper gastrointestinal endoscopy is the preferred diagnostic approach for ES and its underlying causes. Stent insertion using an endoscope is a prevalent method for alleviating or treating ES. Nevertheless, the widely used self-expandable metal stents (SEMS) and self-expandable plastic stents (SEPS) can result in complications such as migration and restenosis. Furthermore, they necessitate secondary extraction in cases of benign esophageal stricture (BES), rendering them unsatisfactory for clinical requirements. Over the past 3 decades, significant attention has been devoted to biodegradable materials, including synthetic polyester polymers and magnesium-based alloys, owing to their exceptional biocompatibility and biodegradability while addressing the challenges associated with recurring procedures after BES resolves. Novel esophageal stents have been developed and are undergoing experimental and clinical trials. Drug-eluting stents (DES) with drug-loading and drug-releasing capabilities are currently a research focal point, offering more efficient and precise ES treatments. Functional innovations have been investigated to optimize stent performance, including unidirectional drug-release and anti-migration features. Emerging manufacturing technologies such as three-dimensional (3D) printing and new biodegradable materials such as hydrogels have also contributed to the innovation of esophageal stents. The ultimate objective of the research and development of these materials is their clinical application in the treatment of ES and other benign conditions and the palliative treatment of malignant esophageal stricture (MES). This review aimed to offer a comprehensive overview of current biodegradable esophageal stent materials and their applications, highlight current research limitations and innovations, and offer insights into future development priorities and directions.

In vitro and in vivo study on fine-grained Mg-Zn-RE-Zr alloy as a biodegradeable orthopedic implant produced by friction stir processing

Magnesium alloys containing biocompatible components show tremendous promise for applications as temporary biomedical devices. However, to ensure their safe use as biodegradeable implants, it is essential to control their corrosion rates. In concentrated Mg alloys, a microgalvanic coupling between the α-Mg matrix and secondary precipitates exists which results in increased corrosion rate. To address this challenge, we engineered the microstructure of a biodegradable Mg-Zn-RE-Zr alloy by friction stir processing (FSP), improving its corrosion resistance and mechanical properties simultaneously. The FS processed alloy with refined grains and broken and uniformly distributed secondary precipitates showed a relatively uniform corrosion morphology accompanied with the formation of a stable passive layer on the alloy surface. In vivo corrosion evaluation of the processed alloy in a small animal model showed that the material was well-tolerated with no signs of inflammation or harmful by-products. Remarkably, the processed alloy supported bone until it healed till eight weeks with a low in vivo corrosion rate of 0.7 mm/year. Moreover, we analyzed blood and histology of the critical organs such as liver and kidney, which showed normal functionality and consistent ion and enzyme levels, throughout the 12-week study period. These results demonstrate that the processed Mg-Zn-RE-Zr alloy offers promising potential for osseointegration in bone tissue healing while also exhibiting controlled biodegradability due to its engineered microstructure. The results from the present study will have profound benefit for bone fracture management, particularly in pediatric and elderly patients.

Impact of inverse unequal height strut structure on the functional performance of an additively manufactured cardiovascular stent

Recently, additive manufacturing (AM) has been investigated as an innovative method to manufacture stents due to its capability in producing complex and customized structures. In this paper, the cardiovascular stents of M-type and N-type with inverse unequal height strut structure and N-type with equal height strut structure were designed and manufactured by Selective Laser Melting (SLM). Following surface polishing, balloon expansion, plane compression and three-point bending experiments were carried out to evaluate the mechanical performance of the stent. The stents designed with inverse unequal height strut structure showed higher radial support performance and lower radial recoil when compared to the stents with uniform design. This study proved the feasibility of SLM in rapid manufacturing of cardiovascular stents that can be used for performance evaluation in design stage.

Porous metal implants: processing, properties, and challenges

Porous and functionally graded materials have seen extensive applications in modern biomedical devices-allowing for improved site-specific performance; their appreciable mechanical, corrosive, and biocompatible properties are highly sought after for lightweight and high-strength load-bearing orthopedic and dental implants. Examples of such porous materials are metals, ceramics, and polymers. Although, easy to manufacture and lightweight, porous polymers do not inherently exhibit the required mechanical strength for hard tissue repair or replacement. Alternatively, porous ceramics are brittle and do not possess the required fatigue resistance. On the other hand, porous biocompatible metals have shown tailorable strength, fatigue resistance, and toughness. Thereby, a significant interest in investigating the manufacturing challenges of porous metals has taken place in recent years. Past research has shown that once the advantages of porous metallic structures in the orthopedic implant industry have been realized, their biological and biomechanical compatibility-with the host bone-has been followed up with extensive methodical research. Various manufacturing methods for porous or functionally graded metals are discussed and compared in this review, specifically, how the manufacturing process influences microstructure, graded composition, porosity, biocompatibility, and mechanical properties. Most of the studies discussed in this review are related to porous structures for bone implant applications; however, the understanding of these investigations may also be extended to other devices beyond the biomedical field.

Optimization of Machining Parameters to Minimize Cutting Forces and Surface Roughness in Micro-Milling of Mg13Sn Alloy

This comprehensive study investigates the micro-milling of a Mg13Sn alloy, a material of considerable interest in various high-precision applications, such as biomedical implants. The main objective of the study was to explore the optimizations of variable feed per tooth (fz), cutting speed (Vc), and depth of cut (ap) parameters on the key outcomes of the micro-milling process. A unique experimental setup was employed, employing a spindle capable of achieving up to 60,000 revolutions per minute. Additionally, the study leveraged linear slides backed by micro-step motors to facilitate precise axis movements, thereby maintaining a resolution accuracy of 0.1 μm. Cutting forces were accurately captured by a mini dynamometer and subsequently evaluated based on the peak to valley values for Fx (tangential force) and Fy (feed force). The study results revealed a clear and complex interplay between the varied cutting parameters and their subsequent impacts on the cutting forces and surface roughness. An increase in feed rate and depth of cut significantly increased the cutting forces. However, the cutting forces were found to decrease noticeably with the elevation of cutting speed. Intriguingly, the tangential force (Fx) was consistently higher than the feed force (Fy). Simultaneously, the study determined that the surface roughness, denoted by Sa values, increased in direct proportion to the feed rate. It was also found that the Sa surface roughness values decreased with the increase in cutting speed. This study recommends a parameter combination of fz = 5 µm/tooth feed rate, Vc = 62.8 m/min cutting speed, and ap = 400 µm depth of cut to maintain a Sa surface roughness value of less than 1 µm while ensuring an optimal material removal rate and machining time. The results derived from this study offer vital insights into the micro-milling of Mg13Sn alloys and contribute to the current body of knowledge on the topic.

A new resorbable magnesium scaffold for de novo coronary lesions (DREAMS 3): one-year results of the BIOMAG-I first-in-human study

BACKGROUND

The third-generation coronary sirolimus-eluting magnesium scaffold, DREAMS 3G, is a further development of the DREAMS 2G (commercial name Magmaris), aiming to provide performance outcomes similar to drug-eluting stents (DES).

AIMS

The BIOMAG-I study aims to assess the safety and performance of this new-generation scaffold.

METHODS

This is a prospective, multicentre, first-in-human study with clinical and imaging follow-up scheduled at 6 and 12 months. The clinical follow-up will continue for 5 years.

RESULTS

A total of 116 patients with 117 lesions were enrolled. At 12 months, after completion of resorption, in-scaffold late lumen loss was 0.24±0.36 mm (median 0.19, interquartile range 0.06-0.36). The minimum lumen area was 4.95±2.24 mm² by intravascular ultrasound and 4.68±2.32 mm² by optical coherence tomography. Three target lesion failures were reported (2.6%, 95% confidence interval: 0.9-7.9), all clinically driven target lesion revascularisations. Cardiac death, target vessel myocardial infarction and definite or probable scaffold thrombosis were absent.

CONCLUSIONS

Data at the end of the resorption period of DREAMS 3G showed that the third-generation bioresorbable magnesium scaffold is clinically safe and effective, making it a possible alternative to DES.

CLINICALTRIALS

gov: NCT04157153.

Structural characterisation and degradation of Mg-Li thin films for biodegradable implants

Freestanding thin films of Mg-Li (magnesium-lithium) alloys with a Li mass fraction between 1.6% (m/m) and 9.5% (m/m) were prepared and studied with respect to their structure and degradation properties. With increasing Li content, the microstructure deviates from hexagonal Mg-Li with strict columnar growth and preferred orientation, and additional cubic Mg-Li and Li2CO3 occur. The corrosion rate was measured in Hanks' balanced salt solution by potentiodynamic polarisation and weight loss measurements to investigate biodegradation. Influences of the orientation, phase and protective layer formation lead to an increase in corrosion from 1.6 to 5.5% (m/m) from 0.13 ± 0.03 to 0.67 ± 0.29 mm/year when measured by potentiodynamic polarisation but a similar corrosion rate for 9.5% (m/m) and 3% (m/m) of Li of 0.27 ± 0.07 mm/year and 0.26 ± 0.05 mm/year.

Enhancing bone formation using absorbable AZ31B magnesium alloy membranes during distraction osteogenesis: A new material study

Purpose

To investigate whether the use of absorble AZ31B magnesium alloys over distraction gaps improves the quality and quantity of regenerated bone better than the use of Collagen membranes.

Methods

Fifteen mixed-breed dogs were randomly divided into the experimental (n = 10) and control (n = 5) groups. In the experimental group, two devices were implanted along the mandible; one side with absorble AZ31B and the other side with Collagen. The control animals did not undergo osteotomy or distraction. After a consolidation time of two months, 30 specimens were harvested, and newly created bone was identified using CBCT and micro-CT.

Results

The Collagen membranes were absorbed completely, and the AZ31B membranes became irregular and rough. Mandible length was successfully extended approximately 1 cm. More bone formation was found after using AZ31B than Collagen, and there was a significant difference in width reduction between experimental sites treated with AZ31B (0.11 ± 0.04 cm) and Collagen (0.42 ± 0.06 cm) (p < 0.05). Trabecular thickness was also significantly higher in AZ31B (0.338 ± 0.08 cm) and control (0.417 ± 0.05 cm) than Collagen (0.178 ± 0.04 cm) (p < 0.05).

Conclusion

An AZ31B membrane barrier is biocompatible and absorbable which can maintain the distraction gap and provide support to the attached osteoprogenitors by providing space for them to proliferate.

Investigation of Stent Prototypes for the Eustachian Tube in Human Donor Bodies

Chronic otitis media is often connected to Eustachian tube dysfunction. As successful treatment cannot be guaranteed with the currently available options, the aim is to develop a stent for the Eustachian tube (ET). Over the course of this development, different prototypes were generated and tested in ex vivo experiments. Four different prototypes of an ET stent and one commercially available coronary stent were implanted in the ET of seven human donor bodies. The position of the stents was verified by cone beam CT. The implanted ETs were harvested, embedded in resin and ground at 200 µm steps. Resulting images of the single steps were used to generate 3D models. The 3D models were then evaluated regarding position of the stent in the ET, its diameters, amount of squeezing, orientation of the axes and other parameters. Virtual reconstruction of the implanted ET was successful in all cases and revealed one incorrect stent placement. The cross-section increased for all metal stents in direction from the isthmus towards the pharyngeal orifice of the ET. Depending on the individual design of the metal stents (open or closed design), the shape varied also between different positions along a single stent. In contrast, the cross-section area and shape remained constant along the polymeric prototype. With the current investigation, insight into the behavior of different prototypes of ET stents was gained, which can help in defining the specifications for the intended ET stent.

Additive manufacturing of vascular stents

With the advancement of additive manufacturing (AM), customized vascular stents can now be fabricated to fit the curvatures and sizes of a narrowed or blocked blood vessel, thereby reducing the possibility of thrombosis and restenosis. More importantly, AM enables the design and fabrication of complex and functional stent unit cells that would otherwise be impossible to realize with conventional manufacturing techniques. Additionally, AM makes fast design iterations possible while also shortening the development time of vascular stents. This has led to the emergence of a new treatment paradigm in which custom and on-demand-fabricated stents will be used for just-in-time treatments. This review is focused on the recent advances in AM vascular stents aimed at meeting the mechanical and biological requirements. First, the biomaterials suitable for AM vascular stents are listed and briefly described. Second, we review the AM technologies that have been so far used to fabricate vascular stents as well as the performances they have achieved. Subsequently, the design criteria for the clinical application of AM vascular stents are discussed considering the currently encountered limitations in materials and AM techniques. Finally, the remaining challenges are highlighted and some future research directions are proposed to realize clinically-viable AM vascular stents. STATEMENT OF SIGNIFICANCE: Vascular stents have been widely used for the treatment of vascular disease. The recent progress in additive manufacturing (AM) has provided unprecedented opportunities for revolutionizing traditional vascular stents. In this manuscript, we review the applications of AM to the design and fabrication of vascular stents. This is an interdisciplinary subject area that has not been previously covered in the published review articles. Our objective is to not only present the state-of-the-art of AM biomaterials and technologies but to also critically assess the limitations and challenges that need to be overcome to speed up the clinical adoption of AM vascular stents with both anatomical superiority and mechanical and biological functionalities that exceed those of the currently available mass-produced devices.

Comparative Study of Porous Iron Foams for Biodegradable Implants: Structural Analysis and In Vitro Assessment

Biodegradable metal systems are the future of modern implantology. This publication describes the preparation of porous iron-based materials using a simple, affordable replica method on a polymeric template. We obtained two iron-based materials with different pore sizes for potential application in cardiac surgery implants. The materials were compared in terms of their corrosion rate (using immersion and electrochemical methods) and their cytotoxic activity (indirect test on three cell lines: mouse L929 fibroblasts, human aortic smooth muscle cells (HAMSC), and human umbilical vein endothelial cells (HUVEC)). Our research proved that the material being too porous might have a toxic effect on cell lines due to rapid corrosion.

In vitro hemocompatibility studies on small-caliber stents for cardiovascular applications

The doping of biologically meaningful ions into biphasic calcium phosphate (BCP) bioceramics, which exhibit biocompatibility with human body parts, has led to their effective use in biomedical applications in recent years. Doping with metal ions while changing the characteristics of the dopant ions, an arrangement of various ions in the Ca/P crystal structure. In our work, small-diameter vascular stents based on BCP and biologically appropriate ion substitute-BCP bioceramic materials were developed for cardiovascular applications. The small-diameter vascular stents were created using an extrusion process. FTIR, XRD, and FESEM were used to identify the functional groups, crystallinity, and morphology of the synthesized bioceramic materials. In addition, investigation of the blood compatibility of the 3D porous vascular stents was carried out via hemolysis. The outcomes indicate that the prepared grafts are appropriate for clinical requirements.

A "built-up" composite film with synergistic functionalities on Mg-2Zn-1Mn bioresorbable stents improves corrosion control effects and biocompatibility

Control of premature corrosion of magnesium (Mg) alloy bioresorbable stents (BRS) is frequently achieved by the addition of rare earth elements. However, limited long-term experience with these elements causes concerns for clinical application and alternative methods of corrosion control are sought after. Herein, we report a "built-up" composite film consisting of a bottom layer of MgF₂ conversion coating, a sandwich layer of a poly (1, 3-trimethylene carbonate) (PTMC) and 3-aminopropyl triethoxysilane (APTES) co-spray coating (PA) and on top a layer of poly (lactic-co-glycolic acid) (PLGA) ultrasonic spray coating to decorate the rare earth element-free Mg-2Zn-1Mn (ZM21) BRS for tailoring both corrosion resistance and biological functions. The developed "built-up" composite film shows synergistic functionalities, allowing the compression and expansion of the coated ZM21 BRS on an angioplasty balloon without cracking or peeling. Of special importance is that the synergistic corrosion control effects of the "built-up" composite film allow for maintaining the mechanical integrity of stents for up to 3 months, where complete biodegradation and no foreign matter residue were observed about half a year after implantation in rabbit iliac arteries. Moreover, the functionalized ZM21 BRS accomplished re-endothelialization within one month.

Anticoagulant Properties of Coated Fe-Pd Ferromagnetic Shape Memory Ribbons

Shape memory alloys, especially ferromagnetic shape memory alloys, are interesting new materials for the manufacturing of stents. Iron-palladium alloys in particular can be used to manufacture self-expanding temporary stents due to their optimum rate of degradation, which is between that of magnesium and pure iron, two metals commonly used in temporary stent research. In order to avoid blood clotting upon the introduction of the stent, they are often coated with anticoagulants. In this study, sulfated pectin, a heparin mimetic, was synthesized in different ways and used as coating on multiple iron-palladium alloys. The static and dynamic prothrombin time (PT) and activated partial thromboplastin time (APTT) of the prepared materials were compared to samples uncoated or coated with polyethylene glycol. While no large differences were observed in the prothrombin time measurements, the activated partial thromboplastin time increased significantly with all alloys coated with sulfated pectin. Aside from that, sulfated pectin synthesized by different methods also caused slight changes in the activated partial thromboplastin time. These findings show that iron-palladium alloys can be coated with anticoagulants to improve their utility as material for temporary stents. Sulfated pectin was characterized by nuclear magnetic resonance (NMR) and Fourier-transform infrared (FTIR) spectroscopy, and the coated alloys by scanning electron microscopy (SEM) and energy dispersive X-ray analysis (EDX).

Preliminary results of absorbable magnesium stent for treating eustachian tube dysfunction in a porcine model

Absorbable magnesium (Mg) stents have an attractive biocompatibility and rapid degradation rate, but their degradable behavior and efficacy in the Eustachian tube (ET) have not yet been investigated. In this study, the degradable behavior of the Mg stent in artificial nasal mucus was evaluated. The Mg stents in the porcine ET model were also investigated to evaluate their safety and efficacy. Four Mg stents were placed into the four ETs of two pigs. The mass loss rate of the Mg stents gradually decreased over time. The decrease rates were 30.96% at one week, 49.00% at two weeks, and 71.80% at four weeks. On the basis of histological findings, the thickness of submucosal tissue hyperplasia and the degree of inflammatory cell infiltration significantly decreased at four weeks compared with two weeks. Biodegradation of the Mg stent occurred before tissue proliferative reactions, and the ET patency was successfully maintained without stent-induced tissue hyperplasia at four weeks. The Mg stent that biodegrades rapidly seems to be effective and safe in porcine ET. Further investigation is required to verify the optimal stent shape and indwell period in the ET.

Advances in Biodegradable Electronic Skin: Material Progress and Recent Applications in Sensing, Robotics, and Human-Machine Interfaces

The rapid growth of the electronics industry and proliferation of electronic materials and telecommunications technologies has led to the release of a massive amount of untreated electronic waste (e-waste) into the environment. Consequently, catastrophic environmental damage at the microbiome level and serious human health diseases threaten the natural fate of the planet. Currently, the demand for wearable electronics for applications in personalized medicine, electronic skins (e-skins), and health monitoring is substantial and growing. Therefore, "green" characteristics such as biodegradability, self-healing, and biocompatibility ensure the future application of wearable electronics and e-skins in biomedical engineering and bioanalytical sciences. Leveraging the biodegradability, sustainability, and biocompatibility of natural materials will dramatically influence the fabrication of environmentally friendly e-skins and wearable electronics. Here, the molecular and structural characteristics of biological skins and artificial e-skins are discussed. The focus then turns to the biodegradable materials, including natural and synthetic-polymer-based materials, and their recent applications in the development of biodegradable e-skin in wearable sensors, robotics, and human-machine interfaces (HMIs). Finally, the main challenges and outlook regarding the preparation and application of biodegradable e-skins are critically discussed in a near-future scenario, which is expected to lead to the next generation of biodegradable e-skins.

Metals Biotribology and Oral Microbiota Biocorrosion Mechanisms

During the last decades, metal-based biomaterials have been extensively explored to be used as biocompatible metals for biomedical applications, owing to their superior mechanical properties and corrosion resistance. Consequently, for long-term implanted medical devices, to assure the biomaterials' reliability, functionality, and biocompatibility, studying the various bio-tribological damage mechanisms to obtain the optimum properties is one of the most important goals. In this review, we consider the most important metal-based biomaterials such as stainless steel, alloys of titanium (Ti), cobalt-chromium (Co-Cr), and Nichel-Titatium (Ni-Ti), as well Magnesium (Mg) alloys and with Tantalum (Ta), emphasizing their characteristics, clinical applications, and deterioration over time. The influence of metal elements on biological safety, including significant effects of metal-based biomaterials in dentistry were discussed, considering the perspectives of surface, mechanical properties, corrosion behaviors, including interactions, bio-mechanisms with tissues, and oral environments. In addition, the role of the oral microbiota was explored due to its role in this erosion condition, in order to further understand the mechanism of metal-based biomaterials implanted on the microflora balance of aerobic and anaerobic bacteria in an oral environment.

Structure Optimization of a Fe-Mn-Pd Alloy by Equal-Channel Angular Pressing for Biomedical Use

In this work, a Fe-Mn-Pd alloy was produced by methods of equal channel angular pressing (ECAP) in order to obtain an alloy with a high rate of degradation for the development of biodegradable devices. Special efforts were made to the obtaining of an ultrafine-grained structure of alloys in a fully austenitic state at temperatures of 300 °C and 450 °C. Further investigation of its effect on the corrosion rate and mechanical properties was carried out. The formation of an austenitic structure with structural element sizes of 100-250 nm after deformation was confirmed by X-ray diffraction analysis. ECAP proved to be the reason for a significant increase in strength with maximum σUTS = 1669 MPa and σYS = 1577 MPa while maintaining satisfactory plasticity. The alloy degradation rate was investigated using the potentiodynamic polarization analysis. The corrosion rate of the alloy after ECAP (~1 mm/y) is higher than that of the coarse-grained state and significantly higher than that of annealed iron (~0.2 mm/y). ECAP in both modes did not impair the biocompatibility of the Fe-Mn-Pd alloy and the colonization of the sample surface by cells.

Experimental study on novel biodegradable Zn-Fe-Si alloys

Bioabsorbable metals are increasingly attracting attention for their potential use as materials for degradable implant devices. Zinc (Zn) alloys have shown great promises due to their good biocompatibility and favorable degradation rate. However, it has been difficult to maintain an appropriate balance among strength, ductility, biocompatibility, and corrosion rate for Zn alloys historically. In this study, the microstructure, chemical composition, mechanical properties, biocompatibility, and corrosion rate of a new ternary zinc-iron-silicon (Zn-Fe-Si) alloy system was studied as a novel material for potential biodegradable implant applications. The results demonstrated that the in situ formed Fe-Si intermetallic phases enhanced the mechanical strength of the material while maintaining a favorable ductility. With Fe-Si reinforcements, the microhardness of the Zn alloys was enhanced by up to 43%. The tensile strength was increased by up to 76% while elongation to failure remained above 30%. Indirect cytotoxicity testing showed the Zn-Fe-Si system had good biocompatibility. Immersion testing revealed the corrosion rate of Zn-Fe-Si system was not statistically different from pure Zn. To understand the underlying phase formation mechanism, the reaction process in this ternary system during the processing was also studied via phase evolution and Gibbs free energy analysis. The results suggest the Zn-Fe-Si ternary system is a promising new material for bioabsorbable metallic medical devices.

A novel chitosan and polydopamine interlinked bioactive coating for metallic biomaterials

Chitosan coatings have shown good bioactive properties such as antibacterial and antiplatelet properties, especially on blood-contacted biomedical materials. However, as blood-contacted biomedical device, the intravascular metal stent has a burden with adverse effects on the structural integrity, such as mechanical load during implantation and substrate degradation if a biodegradable metal is used as the substrate. It is unquestionably true that the structural integrity of the coated stent is essential. The adhesion strength between the coating and the substrate positively affects it. Silane and polydopamine (PDA) interstitial layers have been investigated to improve the corrosion resistance, biosafety and adhesion strength. This work addressed this challenge by using PDA as an intermediate and glutaraldehyde as a linking agent to establish a strong link between the polymer coating and the intermediate coating. Compared with PDA-only and glutaraldehyde-linked silane layer, the novel coating displayed a notable increase in adhesion. When compared with the bare Ni-free stainless steel, the performance of the novel coating was not significantly different. This novel chitosan film on the glutaraldehyde linked-PDA interface can be applied to various metallic substrates where synergic bioactive and anticorrosive effects of PDA interstitial coating and chitosan are needed. Graphical abstract.

Biodegradable interbody cages for lumbar spine fusion: Current concepts and future directions

Lumbar fusion often remains the last treatment option for various acute and chronic spinal conditions, including infectious and degenerative diseases. Placement of a cage in the intervertebral space has become a routine clinical treatment for spinal fusion surgery to provide sufficient biomechanical stability, which is required to achieve bony ingrowth of the implant. Routinely used cages for clinical application are made of titanium (Ti) or polyetheretherketone (PEEK). Ti has been used since the 1980s; however, its shortcomings, such as impaired radiographical opacity and higher elastic modulus compared to bone, have led to the development of PEEK cages, which are associated with reduced stress shielding as well as no radiographical artefacts. Since PEEK is bioinert, its osteointegration capacity is limited, which in turn enhances fibrotic tissue formation and peri-implant infections. To address shortcomings of both of these biomaterials, interdisciplinary teams have developed biodegradable cages. Rooted in promising preclinical large animal studies, a hollow cylindrical cage (Hydrosorb™) made of 70:30 poly-l-lactide-co-d, l-lactide acid (PLDLLA) was clinically studied. However, reduced bony integration and unfavourable long-term clinical outcomes prohibited its routine clinical application. More recently, scaffold-guided bone regeneration (SGBR) with application of highly porous biodegradable constructs is emerging. Advancements in additive manufacturing technology now allow the cage designs that match requirements, such as stiffness of surrounding tissues, while providing long-term biomechanical stability. A favourable clinical outcome has been observed in the treatment of various bone defects, particularly for 3D-printed composite scaffolds made of medical-grade polycaprolactone (mPCL) in combination with a ceramic filler material. Therefore, advanced cage design made of mPCL and ceramic may also carry initial high spinal forces up to the time of bony fusion and subsequently resorb without clinical side effects. Furthermore, surface modification of implants is an effective approach to simultaneously reduce microbial infection and improve tissue integration. We present a design concept for a scaffold surface which result in osteoconductive and antimicrobial properties that have the potential to achieve higher rates of fusion and less clinical complications. In this review, we explore the preclinical and clinical studies which used bioresorbable cages. Furthermore, we critically discuss the need for a cutting-edge research program that includes comprehensive preclinical in vitro and in vivo studies to enable successful translation from bench to bedside. We develop such a conceptual framework by examining the state-of-the-art literature and posing the questions that will guide this field in the coming years.

Additive Manufacturing of Biomaterials-Design Principles and Their Implementation

Additive manufacturing (AM, also known as 3D printing) is an advanced manufacturing technique that has enabled progress in the design and fabrication of customised or patient-specific (meta-)biomaterials and biomedical devices (e.g., implants, prosthetics, and orthotics) with complex internal microstructures and tuneable properties. In the past few decades, several design guidelines have been proposed for creating porous lattice structures, particularly for biomedical applications. Meanwhile, the capabilities of AM to fabricate a wide range of biomaterials, including metals and their alloys, polymers, and ceramics, have been exploited, offering unprecedented benefits to medical professionals and patients alike. In this review article, we provide an overview of the design principles that have been developed and used for the AM of biomaterials as well as those dealing with three major categories of biomaterials, i.e., metals (and their alloys), polymers, and ceramics. The design strategies can be categorised as: library-based design, topology optimisation, bio-inspired design, and meta-biomaterials. Recent developments related to the biomedical applications and fabrication methods of AM aimed at enhancing the quality of final 3D-printed biomaterials and improving their physical, mechanical, and biological characteristics are also highlighted. Finally, examples of 3D-printed biomaterials with tuned properties and functionalities are presented.

Initial status and 3-month results relating to the use of biodegradable nitride iron stents in children and the evaluation of right ventricular function

Background

Pulmonary artery stenosis is often associated with congenital heart disease. The aim of the study was to evaluate the efficacy and safety of stenting for branch pulmonary artery stenosis using a biodegradable nitride iron stent (IBS^® Angel™) and right ventricular systolic and diastolic function.

Methods

From July 2021 to February 2022, a total of 11 cases (ages ranged from 36 to 86 months old) were included in this pre and post-intervention, prospective, cohort and preclinical study. All cases underwent transthoracic echocardiographic (TTE), chest radiography, along with computed tomography (256-slice scanner, multiple-detector) and right heart catheterization. Different types of biodegradable nitride iron stents were implanted. TTE was performed serially 1 day, 1 month and 3 months after the procedure to evaluate the rate of restenosis and right ventricular function.

Results

Stenting was successful in 11 patients. There were no major adverse cardiovascular events related to the device or to the procedure. Blood perfusion in the branch pulmonary artery was improved immediately. At follow-up, there was no significant restenosis that required re-intervention. None of the patients suffered from in-stent thrombosis, vascular embolism, stent displacement or heart failure. Compared with normal values, there were statistical with regards to FAC, E/A and E′/A′. Furthermore, we found that TAPSE correlated significantly with pulsed Doppler S wave (p = 0.008) and left ventricular ejection fraction (p < 0.01). The early trans-tricuspid inflow velocities E/E′ (tissue doppler at the lateral tricuspid annulus) correlated significantly with E′/A′ (p = 0.009). FAC and E′/A′ were statistically different from those prior to stenting (p = 0.041 and p = 0.035) when tested one month postoperatively. At three months postoperatively, only E/A showed a statistical difference (p = 0.015).

Conclusion

Our analysis suggests that biodegradable nitride iron stents are feasible, safe, and effective in children. Some small improvements were observed in right ventricular systolic and diastolic function after successful transcatheter intervention, although change was not statistically significant due to the small sample number. (A clinical Trial to Evaluate the Safety and Efficacy of IBS Angel in Patients With Pulmonary Artery Stenosis (IRIS); NCT04973540).

The Effect of Mn on the Mechanical Properties and In Vitro Behavior of Biodegradable Zn-2%Fe Alloy

The attractiveness of Zn-based alloys as structural materials for biodegradable implants mainly relates to their excellent biocompatibility, critical physiological roles in the human body and excellent antibacterial properties. Furthermore, in in vivo conditions, they do not tend to produce hydrogen gas (as occurs in the case of Mg-based alloys) or voluminous oxide (as occurs in Fe-based alloys). However, the main disadvantages of Zn-based alloys are their reduced mechanical properties and their tendency to provoke undesirable fibrous encapsulation due to their relatively high standard reduction potential. The issue of fibrous encapsulation was previously addressed by the authors via the development of the Zn-2%Fe alloy that was selected as the base alloy for this study. This development assumed that the addition of Fe to pure Zn can create a microgalvanic effect between the Delta phase (Zn11Fe) and the Zn-matrix that significantly increases the biodegradation rate of the alloy. The aim of the present study is to examine the effect of up to 0.8% Mn on the mechanical properties of biodegradable Zn-2%Fe alloy and to evaluate the corrosion behavior and cytotoxicity performance in in vitro conditions. The selection of Mn as an alloying element is related to its vital role in the synthesis of proteins and the activation of enzyme systems, as well as the fact that Mn is not considered to be a toxic element. Microstructure characterization was carried out by optical microscopy and scanning electron microscopy (SEM), while phase analysis was obtained by X-ray diffraction (XRD). Mechanical properties were examined in terms of hardness and tensile strength, while corrosion performance and electrochemical behavior were assessed by immersion tests, open circuit potential examination, potentiodynamic polarization analysis and impedance spectroscopy. All the in vitro corrosion testing was performed in a simulated physiological environment in the form of a phosphate-buffered saline (PBS) solution. The cytotoxicity performance was evaluated by indirect cell viability analysis, carried out according to the ISO 10993-5/12 standard using Mus musculus 4T1 cells. The obtained results clearly demonstrate the strengthening effect of the biodegradable Zn-2%Fe alloy due to Mn addition. The effect of Mn on in vitro corrosion degradation was insignificant, while in parallel Mn had a favorable effect on indirect cell viability.

Effect of Pulse Frequency on the Microstructure and the Degradation of Pulse Electroformed Zinc for Fabricating the Shell of Biodegradable Dosing Pump

In this work, we applied single-pulse electrodeposition method to prepare biodegradable zinc coating for the shell of an implantable dosing pump, and explored the effect of pulse frequency on microstructures and degradation behavior of electroformed zinc. Samples were produced by single-pulse electro-deposition technique with different pulse frequencies (50 Hz, 100 Hz, and 1000 Hz). By controlling the pulse frequency, the thickness of the zinc coating can be adjusted. The 50 Hz produced zinc film possesses strong (11.0) grain orientation, 100 Hz produced zinc film possesses clear ((11.0) and (10.0)) grain orientations, yet 1000 Hz produced zinc film shows more random grain orientations of (10.0), (10.1), and (11.0), which provides a possible way to design a controllable nanometer surface microtopography. Although thermodynamic degradation tendency implied from open current corrosion voltage were similar, the kinetic corrosion rate showed a clear increasing trend as pulse frequency increased from 50 Hz to 1000 Hz, which corresponded with the electrochemical impedance spectroscopy and long-term soaking test in hanks solution. According to ISO 10993-5:2009 and ISO 10993-4:2002, electrodeposited zinc materials produced in this study showed a benign hemolysis ratio and no toxicity for cell growth. Zinc prepared under 50 Hz shows the best blood compatibility. Electrodeposited zinc materials are expected to be used for the shell of a degradable dosing pump.

Progress in manufacturing and processing of degradable Fe-based implants: a review

Biodegradable metals have gained vast attention as befitting candidates for developing degradable metallic implants. Such implants are primarily employed for temporary applications and are expected to degrade or resorbed after the tissue is healed. Fe-based materials have generated considerable interest as one of the possible biodegradable metals. Like other biometals such as Mg and Zn, Fe exhibits good biocompatibility and biodegradability. The versatility in the mechanical behaviour of Fe-based materials makes them a better choice for load-bearing applications. However, the very low degradation rate of Fe in the physiological environment needs to be improved to make it compatible with tissue growth. Several studies on tailoring the degradation behaviour of Fe in the human body are already reported. Majority of these works include studies on the effect of manufacturing and processing techniques on biocompatibility and biodegradability. This article focuses on a comprehensive review and analysis of the various manufacturing and processing techniques so far reported for developing biodegradable iron-based orthopaedic implants. The current status of research in the field is neatly presented, and a summary of the works is included in the article for the benefit of researchers in the field to contextualise their research and effectively find the lacunae in the existing scholarship.

In Vitro Degradability, Microstructural Evaluation, and Biocompatibility of Zn-Ti-Cu-Ca-P Alloy

According to the modern era, zinc is one of the best replacements for human bio-implants due to its acceptable degradation, nominal degradable rate, and biocompatibility. However, alloying zinc with other nutrient metals is mandatory to improve the mechanical properties. In this research, Zn-4Ti-4Cu was alloyed with calcium and phosphorous through a powder metallurgical process to make guided bone regeneration (GBR). First, the sintering temperature of the alloy was found with the usage of thermogravimetric analysis (TGA). Tensile and compression tests showed the suitability of the alloy in strength. The microstructural characteristics were provided with EDS and SEM. The different phases of the alloy were detected with X-ray diffraction (XRD). We can clearly depict the precipitates formed and the strengthening mechanism due to titanium addition. An electrochemical corrosion (ECM) test was carried out with simulated body fluid (Hank’s solution) as the electrolyte. Cytotoxicity, biocompatibility, mechanical properties, and corrosion resistance properties were studied and discussed.

Influence of Copper on the Microstructural, Mechanical, and Biological Properties of Commercially Pure Zn-Based Alloys for a Potential Biodegradable Implant

Three Zn-based alloys (Zn1Cu, Zn2Cu, and Zn3Cu) were developed by the addition of Cu (1, 2, and 3 wt %) into commercially pure Zn. This report systematically investigates the potential for these newly developed Zn-based alloys as biodegradable materials. Microstructural studies reveal the presence of spherical-shaped nanosized precipitates of ε-CuZn₄ in the Zn1Cu alloy, whereas Zn2Cu and Zn3Cu alloys exhibit the presence of both micron- and nanosized precipitates of ε-CuZn₄. The mechanical properties such as hardness, tensile and compressive strengths improve significantly with an increase in the amount of Cu in the alloy. The Zn3Cu alloy exhibits the highest yield strength (225 ± 9 MPa) and ultimate tensile strength (330 ± 12 MPa) among all of the alloys, which are ∼2.7 and 2 times higher than those of pure Zn. In vitro degradation behavior is evaluated by the potentiodynamic polarization study and immersion testing in Hank's solution for 20 and 75 days. The corrosion rate after both polarization and immersion testing follows the order of pure Zn < Zn1Cu < Zn3Cu < Zn2Cu. An electrochemical impedance spectroscopy (EIS) study also concludes that Zn2Cu shows the lowest corrosion resistance. The % cell viability values of 3T3 fibroblasts cells after 5 days of culture in a 50% diluted extract of pure Zn, Zn2Cu, and Zn3Cu alloys are 76 ± 0.024, 86.18 ± 0.033, and 92.9 ± 0.026%, respectively, establishing the improved cytocompatibility of the alloys as compared to pure Zn. Furthermore, an antibacterial study also reveals that the Zn3Cu alloy exhibits 80, 67, and 100% increases in the zone of inhibition (ZOI) for Escherichia coli, Bacillus subtilis, and Pseudomonas aeruginosa bacteria, respectively, as compared to that of pure Zn.

Biodegradable iron-silicon implants produced by additive manufacturing

Due to many negative and undesirable side effects from the use of permanent implants, the development of temporary implants based on biocompatible and biodegradable materials is a promising area of modern medicine. In the presented study, we have investigated complex-shaped iron-silicon (Fe-Si) scaffolds that can be used as potential biodegradable framework structures for creating solid implants for bone grafting. Since iron and silicon are biocompatible materials, and their alloy should also have biocompatibility. It has been demonstrated that cells UC-MSC and 3T3 were attached to, spread, and proliferated on the Fe-Si scaffolds' surface. Most of UC-MSC and 3T3 remained viable, only single dead cells were observed. According to the results of biological testing, the scaffolds have shown that deposition of calcium phosphate particles occurs on day one in the scaffold at the defect site that can be used as a primary marker of osteodifferentiation. These results demonstrate that the 3D-printed porous iron-silicon (Fe-Si) alloy scaffolds are promising structures for bone grafting and regeneration.

Yes-associated Protein Contributes to Magnesium Alloy-derived Inflammation in Endothelial Cells

Magnesium alloy (Mg alloy) has attracted massive attention in the potential applications of cardiovascular stents because of its good biocompatibility and degradability. However, whether and how the Mg alloy induces inflammation in endothelial cells remains unclear. In the present work, we investigated the activation of Yes-associated protein (YAP) upon Mg alloy stimuli and unveiled the transcriptional function in Mg alloy-induced inflammation. Quantitative RT–PCR, western blotting and immunofluorescence staining showed that Mg alloy inhibited the Hippo pathway to facilitate nuclear shuttling and activation of YAP in human coronary artery endothelial cells (HCAECs). Chromatin immunoprecipitation followed sequencing was carried out to explore the transcriptional function of YAP in Mg alloy-derived inflammation. This led to the observation that nuclear YAP further bonded to the promoter region of inflammation transcription factors and co-transcription factors. This binding event activated their transcription and modified mRNA methylation of inflammation-related genes through regulating the expression of N6-methyladenosine modulators (METTL3, METTL14, FTO and WTAP). This then promoted inflammation-related gene expression and aggravated inflammation in HCAECs. In YAP deficiency cells, Mg alloy-induced inflammation was reduced. Collectively, our data suggest that YAP contributes to the Mg alloy-derived inflammation in HCAECs and may provide a potential therapeutic target that alleviates inflammation after Mg alloy stent implantation.

Effect of Magnesium Addition and High Energy Processing on the Degradation Behavior of Iron Powder in Modified Hanks’ Solution for Bioabsorbable Implant Applications

This paper shows the results of applying a combination of high energy processing and magnesium (Mg) as an alloying element in a strategy for enhancing the degradation rate of iron (Fe) for applications in the field of non-permanent medical implants. For this purpose, Fe powder was milled with 5 wt% of Mg (Fe5Mg) and its microstructure and characterized degradation behavior. As-received Fe powder was also milled in order to distinguish between the effects due to high energy processing from those due to the presence of Mg. The powders were prepared by high energy planetary ball milling for 16 h. The results show that the initial crystallite size diminishes from >150 nm to 16 nm for Fe and 46 nm for Fe5Mg. Static degradation tests of loose powder particles were performed in Hanks’ solution. Visual inspection of the immersed powders and the X-ray diffraction (XRD) phase quantification indicate that Fe5Mg exhibited the highest degradation rate followed by milled Fe and as received Fe, in this order. The analysis of degradation products of Fe5Mg showed that they consist on magnesium ferrite and pyroaurite, which are known to present good biocompatibility and low toxicity. Differences in structural features and degradation behaviors of milled Fe and milled Fe5Mg suggest the effective dissolution of Mg in the Fe lattice. Based on the obtained results, it can be said that Fe5Mg powder would be a suitable candidate for non-permanent medical implants with a higher degradation rate than Fe.

Current status and outlook of biodegradable metals in neuroscience and their potential applications as cerebral vascular stent materials

Over the past two decades, biodegradable metals (BMs) have emerged as promising materials to fabricate temporary biomedical devices, with the purpose of avoiding potential side effects of permanent implants. In this review, we first surveyed the current status of BMs in neuroscience, and briefly summarized the representative stents for treating vascular stenosis. Then, inspired by the convincing clinical evidence on the in vivo safety of Mg alloys as cardiovascular stents, we analyzed the possibility of producing biodegradable cerebrovascular Mg alloy stents for treating ischemic stroke. For these novel applications, some key factors should also be considered in designing BM brain stents, including the anatomic features of the cerebral vasculature, hemodynamic influences, neuro-cytocompatibility and selection of alloying elements. This work may provide insights into the future design and fabrication of BM neurological devices, especially for brain stents.

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The current status of the application of biodegradable metals (BM) in neuroscience was presented.

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We analyzed the possibility of producing biodegradable cerebrovascular Mg alloy stents for ischemic stroke treatment.

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Key factors in designing BM brain stents were discussed.

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This work may provide insights into the future design and fabrication of BM neurological devices, especially for brain stents.

Mechanical properties, in vitro and in vivo biocompatibility analysis of pure iron porous implant produced by metal injection molding: A new eco-friendly feedstock from natural rubber (Hevea brasiliensis)

Metal injection molding (MIM) has become an important manufacturing technology for biodegradable medical devices. As a biodegradable metal, pure iron is a promising biomaterial due to its mechanical properties and biocompatibility. In light of this, we performed the first study that manufactured and evaluated the in vitro and in vivo biocompatibility of samples of iron porous implants produced by MIM with a new eco-friendly feedstock from natural rubber (Hevea brasiliensis), a promisor binder that provides elastic property in the green parts. The iron samples were submitted to tests to determine density, microhardness, hardness, yield strength, and stretching. The biocompatibility of the samples was studied in vitro with adipose-derived mesenchymal stromal cells (ADSCs) and erythrocytes, and in vivo on a preclinical model with Wistar rats, testing the iron samples after subcutaneous implant. Results showed that the manufactured samples have adequate physical, and mechanical characteristics to biomedical devices and they are cytocompatible with ADSCs, hemocompatible and biocompatible with Wistars rats. Therefore, pure iron produced by MIM can be considered a promising material for biomedical applications.