The Biological Responses to Magnesium-Based Biodegradable Medical Devices

Long-Term Temporospatial Complementary Relationship between Degradation and Bone Regeneration of Mg-Al Alloy

The utilization of guided tissue regeneration membranes is a significant approach for enhancing bone tissue growth in areas with bone defects. Biodegradable magnesium alloys are increasingly being used as guided tissue regeneration membranes due to their outstanding osteogenic properties. However, the degradation rates of magnesium alloy bone implants documented in the literature tend to be rapid. Moreover, many studies focus only on the initial 3-month period post-implantation, limiting their applicability and impeding clinical adoption. Furthermore, scant attention has been given to the interplay between the degradation of magnesium alloy implants and the adjacent tissues. To address these gaps, this study employs a well-studied magnesium-aluminum (Mg-Al) alloy membrane with a slow degradation rate. This membrane is implanted into rat skull bone defects and monitored over an extended period of up to 48 weeks. Observations are conducted at various intervals (2, 4, 8, 12, 24, and 48 weeks) following the implantation. Assessment of degradation behavior and tissue regeneration response is carried out using histological sections, micro-CT scans, and scanning electron microscopy (SEM). The findings reveal that the magnesium alloy membranes demonstrate remarkable biocompatibility and osteogenic capability over the entire observation duration. Specifically, the Mg-Al alloy membranes sustain their structural integrity for 8 weeks. Notably, their osteogenic ability is further enhanced as a corrosion product layer forms during the later stages of implantation. Additionally, our in vitro experiments employing extracts from the magnesium alloy display a significant osteogenic effect, accompanied by a notable increase in the expression of osteogenic-related genes. Collectively, these results strongly indicate the substantial potential of Mg-Al alloy membranes in the context of guided tissue regeneration.

Nerve Regeneration with a Scaffold Incorporating an Absorbable Zinc-2% Iron Alloy Filament to Improve Axonal Guidance

Peripheral nerve damage that results in lost segments requires surgery, but currently available hollow scaffolds have limitations that could be overcome by adding internal guidance support. A novel solution is to use filaments of absorbable metals to supply physical support and guidance for nerve regeneration that then safely disappear from the body. Previously, we showed that thin filaments of magnesium metal (Mg) would support nerve regeneration. Here, we tested another absorbable metal, zinc (Zn), using a proprietary zinc alloy with 2% iron (Zn-2%Fe) that was designed to overcome the limitations of both Mg and pure Zn metal. Non-critical-sized gaps in adult rat sciatic nerves were repaired with silicone conduits plus single filaments of Zn-2%Fe, Mg, or no metal, with autografts as controls. After seventeen weeks, all groups showed equal recovery of function and axonal density at the distal end of the conduit. The Zn alloy group showed some improvements in early rat health and recovery of function. The alloy had a greater local accumulation of degradation products and inflammatory cells than Mg; however, both metals had an equally thin capsule (no difference in tissue irritation) and no toxicity or inflammation in neighboring nerve tissues. Therefore, Zn-2%Fe, like Mg, is biocompatible and has great potential for use in nervous tissue regeneration and repair.

Degradation of 3D-printed magnesium phosphate ceramics in vitro and a prognosis on their bone regeneration potential

Regenerative bone implants promote new bone formation and ideally degrade simultaneously to osteogenesis. Although clinically established calcium phosphate bone grafts provide excellent osseointegration and osteoconductive efficacy, they are limited in terms of bioresorption. Magnesium phosphate (MP) based ceramics are a promising alternative, because they are biocompatible, mechanically extremely stable, and degrade much faster than calcium phosphates under physiological conditions. Bioresorption of an implant material can include both chemical dissolution as well as cellular resorption. We investigated the bioresorption of 3D powder printed struvite and newberyite based MP ceramics in vitro by a direct human osteoclast culture approach. The osteoclast response and cellular resorption was evaluated by means of fluorescence and TRAP staining, determination of osteoclast activities (CA II and TRAP), SEM imaging as well as by quantification of the ion release during cell culture. Furthermore, the bioactivity of the materials was investigated via SBF immersion, whereas hydroxyapatite precipitates were analyzed by SEM and EDX measurements. This bioactive coating was resorbed by osteoclasts. In contrast, only chemical dissolution contributed to bioresorption of MP, while no cellular resorption of the materials was observed. Based on our results, we expect an increased bone regeneration effect of MP compared to calcium phosphate based bone grafts and complete chemical degradation within a maximum of 1.5-3.1 years.

Immune response differences in degradable and non-degradable alloy implants

Alloy based implants have made a great impact in the clinic and in preclinical research. Immune responses are one of the major causes of failure of these implants in the clinic. Although the immune responses toward non-degradable alloy implants are well documented, there is a poor understanding of the immune responses against degradable alloy implants. Recently, there have been several reports suggesting that degradable implants may develop substantial immune responses. This phenomenon needs to be further studied in detail to make the case for the degradable implants to be utilized in clinics. Herein, we review these new recent reports suggesting the role of innate and potentially adaptive immune cells in inducing immune responses against degradable implants. First, we discussed immune responses to allergen components of non-degradable implants to give a better overview on differences in the immune response between non-degradable and degradable implants. Furthermore, we also provide potential areas of research that can be undertaken that may shed light on the local and global immune responses that are generated in response to degradable implants.

A Superior High-Strength Dilute Mg-Bi-Ca Extrusion Alloy with a Bimodal Microstructure

Improving the mechanical properties of Mg alloys is of great significance for their wide application. A micro-alloyed Mg-1.45Bi-0.79Ca alloy (in wt.%) exhibiting a high tensile yield strength of 394 ± 5 MPa and a moderate elongation of 6.6 ± 0.6% was fabricated by single pass extrusion. The superior high strength is mainly attributed to the synergy effects of ultra-fine dynamic recrystallized grains; numerous Mg2Ca, Mg3Bi2, and Mg2Bi2Ca nano-precipitates; residual dislocations; sub-grain boundaries; as well as strong <10-10> fibre texture in the extrusion direction.

Immunological reaction to magnesium-based implants for orthopedic applications. What do we know so far? A systematic review on in vivo studies

Magnesium-based implants (Mg) became an attractive candidate in orthopedic surgery due to their valuable properties, such as osteoconductivity, biodegradability, elasticity and mechanical strength. However, previous studies on biodegradable and non-biodegradable metal implants showed that these materials are not inert when placed in vivo as they interact with host defensive mechanisms. The aim of this study was to systematically review available in vivo studies with Mg-based implants that investigated immunological reactions to these implants. The following questions were raised: Do different types of Mg-based implants in terms of shape, size and alloying system cause different extent of immune response? and; Are there missing links to properly understand immunological reactions upon implantation and degradation of Mg-based implants? The database used for the literature research was PubMed (U.S. National Library of Medicine) and it was undertaken in the end of 2021. The inclusion criteria comprised (i) in vivo studies with bony implantation of Mg-based implants and (ii) analysis of the presence of local immune cells or systemic inflammatory parameters. We further excluded any studies involving coated Mg-implants, in vitro studies, and studies in which the implants had no bone contact. The systematic search process was conducted according to PRISMA guidelines. Initially, the search yielded 225 original articles. After reading each article, and based on the inclusion and exclusion criteria, 16 articles were included in the systematic review. In the available studies, Mg-based implants were not found to cause any severe inflammatory reaction, and only a mild to moderate inflammatory potential was attributed to the material. The timeline of foreign body giant cell formation showed to be different between the reviewed studies. The variety of degradation kinetics of different tested implants and discrepancies in studies regarding the time points of immunological investigations impair the conclusion of immunological reactions. This may be induced by different physical properties of an implant such as size, shape and alloying system. Further research is essential to elucidate the underlying mechanisms by which implant degradation affects the immune system. Also, better understanding will facilitate the decision of patients whether to undergo surgery with new device implantation.

Biosafety and biodegradation studies of AZ31B magnesium alloy carotid artery stent in vitro and in vivo

Biosafety of AZ31B magnesium (Mg) alloy and the effect of its degradation products on tissues, organs, and whole systems are highly needed to be evaluated before clinical application. This study serves a wide variety of safety evaluations of biodegradable AZ31B alloy on nerve cells. As a result of this in vitro study, the maximum aluminum (Al) ion and Mg ion concentrations in the medium were estimated to be 22 μmol/L and 2.75 mmol/L, respectively, during degradation. In addition, the corresponding cell mortality was observed to be 36% and lower than 5% according to the resistance curves of the cell to Mg and Al ions. Furthermore, the maximum Al ion and Mg ion concentrations in serum and cerebrospinal fluid were detected to be 26.1 μmol/L and 1.2 mmol/L, respectively, for 5 months implantation. Combining the result of in vivo dialysis with the result of ion tolerance assay experiments, the actual death rate of nerve cells is estimated between 4 and 10% in vivo, which is lower than the result of in vitro cytotoxicity evaluation. Moreover, no psychomotor disability during clinical studies is observed. Consequently, stent made of AZ31B alloy with surface treatment is feasible for carotid artery stenosis, and it is safe in terms of cell viability on the nervous system.

Bioactivity in SBF versus trace element effects: The isolated role of Mg2+ and Zn2+ in osteoblast behavior

The bioactivity assay originally proposed by Kokubo is one of the most commonly used tests to indirectly evaluate the biocompatibility of bioactive glasses. However, extensive evidence has shown that trace elements present in biomaterials may stimulate cellular behavior in different ways even when no apatite formation is observed, i.e., in biomaterials with low or no bioactivity. To further elucidate this topic, we designed three different SiO₂-rich bioglass compositions in which CaO was partially replaced by ZnO and MgO, two oxides known to affect bioactivity as well as osteoblastic behavior. The physicochemical changes induced by the presence of oxides and their effects on biological behavior, as well as the adhesion, proliferation and differentiation of human osteoblast-like osteosarcoma cells (MG-63), were followed by a bioactivity assay in simulated body fluid (SBF). The insertion of ZnO or MgO decreased the glass transition (T_g) and crystallization (T_c) temperatures as a function of the increase in nonbonding oxygens, which was directly reflected in the higher solubility. The release of Mg²⁺ ions from the MgO-containing samples inhibited the bioactivity in SBF, inducing high cell adhesion and proliferation and moderate ALP activity. The release of Zn²⁺ also inhibited the bioactivity in SBF but, in contrast to the release of Mg²⁺, induced low cell adhesion and proliferation and high ALP activity compared to the control.

Synergistic effect of deep ball burnishing and HA coating on surface integrity, corrosion and immune response of biodegradable AZ31B Mg alloys

The fast degradation and consequent loss of mechanical integrity is a major problem of biodegradable Mg alloy, which limits its clinical viability. This paper presents the influence of a synergistic approach combining deep ball burnishing and hydroxyapatite (HA) coating on biomechanical integrity, degradation and immune response of Mg alloy (AZ31B). The burnishing resulted in smooth surface topography, increased hardness from 0.87 to 1.45 GPa and induced microstructural disturbances with deformation twins/twin bands, which enabled formation of a dense and compact platelet-like crystals HA coating of 110 μm thickness. Compared to the untreated and burnished specimens, the burnished + HA coated surface provided remarkably higher corrosion resistance as indicated by lower corrosion current density and smaller mass loss. HA coating and surface integrity enhancement by burnishing were predominantly responsible for improved corrosion resistance. HA coating on the burnished surface exhibited hydrophilic properties and adequate bonding strength. While the modified surfaces promoted cell growth, the burnished + HA surface outperformed in exhibiting less pro-inflammatory and high anti-inflammatory cytokines, demonstrating that the treated surfaces were not posing any threat to immune cells. The findings indicate that the synergistic surface treatment can be a viable means to enhance corrosion resistance and immune response of Mg alloys implants.

Graphene Family Nanomaterial Reinforced Magnesium-Based Matrix Composites for Biomedical Application: A Comprehensive Review

Together with the enhancement of the load-bearing implant process for bone substitution and reproduction, an increasing requirement was observed concerning biodegradable magnesium and its alloys with lighter density and outstanding characteristics. Regardless of the current great potential of Mg utilization currently, the broader use of Mg alloys continues to be constrained by several natural causes, such as low resistance of corrosion, inadequate mechanical integrity during the healing process, and poor antibacterial performance. In this perspective, Mg-based composite encapsulated within graphene family nanomaterials (GFNs) such as graphene (Gr), graphene oxide (GO), graphene nanoplatelets (GNPs), and reduced graphene oxide (rGO) as reinforcement agents present great antibacterial activity, as well as cellular response and depicted numerous benefits for biomedical use. Magnesium matrix nanocomposites reinforced with GFNs possess enhanced mechanical properties and high corrosion resistance (low concentration graphene). It is worth noting that numerous elements including the production technique of the Mg-based composite containing GFNs and the size, distribution, and amounts of GFNs in the Mg-based matrix have a crucial role in their properties and applications. Then, the antibacterial mechanisms of GFN-based composite are briefly described. Subsequently, the antibacterial and strengthening mechanisms of GFN-embedded Mg-based composites are briefly described. This review article is designed to wrap up and explore the most pertinent research performed in the direction of Mg-based composites encapsulated within GFNs. Feasible upcoming investigation directions in the field of GFN-embedded Mg-based composites are discussed in detail.

Bio-inspired biomaterial Mg-Zn-Ca: a review of the main mechanical and biological properties of Mg-based alloys

The toxicity of alloying elements in magnesium alloys used for biomedical purposes is an interesting and innovative subject, due to the great technological advances that would result from their application in medical devices (MDs) in traumatology. Recently promising results have been published regarding the rates of degradation and mechanical integrity that can support Mg alloys; this has led to an interest in understanding the toxicological features of these emerging biomaterials. The growing interest of different segments of the MD market has increased the determination of different research groups to clarify the behavior of alloying elements in vivo. This review covers the influence of the alloying elements on the body, the toxicity of the elements in Mg-Zn-Ca, as well as the mechanical properties, degradation, processes of obtaining the alloy, medical approaches and future perspectives on the use of the Mg in the manufacture of MDs for various medical applications.

In vitro evaluation of the ZX11 magnesium alloy as potential bone plate: Degradability and mechanical integrity

Considering the excellent biocompatibility of magnesium (Mg) alloys and their better mechanical properties compared to polymer materials, a wrought MgZnCa alloy with low contents of Zn (0.7 wt%) and Ca (0.6 wt%) (ZX11) was developed by twin roll casting (TRC) technology as potential biodegradable bone plates. The degradability and cell response of the ZX11 alloy were evaluated in vitro, as well as the mechanical integrity according to tensile tests after immersion. The results revealed a slightly higher degradation rate for the rolled ZX11, in comparison to that of the annealed one. It was mainly caused by the deformation twins and residual strain stored in the rolled alloy, which also seemed to promote localized degradation, thereby leading to a relatively fast deterioration in mechanical properties, especially the fracture strain/elongation. In contrast, after the annealing treatment, the alloy showed relatively lower strength, yet a lower degradation rate and quite stable elongation during the initial weeks of immersion were observed. More importantly, the ZX11 alloy, regardless of the annealing treatment, showed good in vitro cytocomopatibility regarding human primary osteoblasts. The assessment indicates the rolled alloy as a good choice for implantation sites where relatively high mechanical strength is needed during the early implantation, while the annealed alloy is a potential candidate for the sites which demand stable mechanical integrity during service. STATEMENT OF SIGNIFICANCE: The development of magnesium alloys as bone implants demands low degradation rate to gain not only a slow hydrogen evolution, but also a stable mechanical integrity during service. The present study develops a micro-alloyed MgZnCa alloy via twin roll casting (TRC) technology. It exhibited limited cytotoxicity, fairly low degradation rate and comparable strength to the reported Mg-1Zn-5Ca alloy which has been used as bone screws in clinical trials, indicating the great potential application as biodegradable bone implants. Furthermore, it showed good mechanical integrity during immersion to support the defect healing. Our results can aid other researchers to evaluate the mechanical integrity of biodegradable materials and to pay more attention to the effect of degradation behaviour on mechanical integrity of materials.

Comparison of endothelial cell attachment on surfaces of biodegradable polymer-coated magnesium alloys in a microfluidic environment

Polymeric coatings can provide temporary stability to bioresorbable metallic stents at the initial stage of deployment by alleviating rapid degradation and providing better interaction with surrounding vasculature. To understand this interfacing biocompatibility, this study explored the endothelial-cytocompatibility of polymer-coated magnesium (Mg) alloys under static and dynamic conditions compared to that of non-coated Mg alloy surfaces. Poly (carbonate urethane) urea (PCUU) and poly (lactic-co-glycolic acid) (PLGA) were coated on Mg alloys (WE43, AZ31, ZWEKL, ZWEKC) and 316L stainless steel (316L SS, control sample), which were embedded into a microfluidic device to simulate a vascular environment with dynamic flow. The results from attachment and viability tests showed that more cells were attached on the polymer-coated Mg alloys than on non-coated Mg alloys in both static and dynamic conditions. In particular, the attachment and viability on PCUU-coated surfaces were significantly higher than that of PLGA-coated surfaces of WE43 and ZWEKC in both static and dynamic conditions, and of AZ31 in dynamic conditions (P<0.05). The elementary distribution map showed that there were relatively higher Carbon weight percentages and lower Mg weight percentages on PCUU-coated alloys than PLGA-coated alloys. Various levels of pittings were observed underneath the polymer coatings, and the pittings were more severe on the surface of Mg alloys that corroded rapidly. Polymer coatings are recommended to be applied on Mg alloys with relatively low corrosion rates, or after pre-stabilizing the substrate. PCUU-coating has more selective potential to enhance the biocompatibility and mitigate the endothelium damage of Mg alloy stenting.

Biodegradable Metals

Over the last two decades, significant scientific efforts have been devoted to developingbiodegradable metal implants for orthopedic and cardiovascular applications, mainly due to theirimproved mechanical properties compared to those of biodegradable polymers [...]