Zinc-Doped Bioactive Glass/Polycaprolactone Hybrid Scaffolds Manufactured by Direct and Indirect 3D Printing Methods for Bone Regeneration.

A novel organic-inorganic hybrid, based on SiO2-CaO-ZnO bioactive glass (BG) and polycaprolactone (PCL), associating the highly bioactive and versatile bioactive glass with clinically established PCL was examined. The BG-PCL hybrid is obtained by acid-catalyzed silica sol-gel process inside PCL solution either by direct or indirect printing. Apatite-formation tests in simulated body fluid (SBF) confirm the ion release along with the hybrid's bone-like apatite forming. Kinetics differ significantly between directly and indirectly printed scaffolds, the former requiring longer periods to degrade, while the latter demonstrates faster calcium phosphate (CaP) formation. Remarkably, Zn diffusion and accumulation are observed at the surface within the newly formed active CaP layer. Zn release is found to be dependent on printing method and immersion medium. Investigation of BG at the atomic scale reveals the ambivalent role of Zn, capable of acting both as a network modifier and as a network former linking the BG silicate network. In addition, hMSCs viability assay proves no cytotoxicity of the Zn hybrid. LIVE/DEAD staining demonstrated excellent cell viability and proliferation for over seven weeks. Overall, this hybrid material either non-doped or doped with a metal trace element is a promising candidate to be translated to clinical applications for bone regeneration.

Bioactive glass-based organic/inorganic hybrids: an analysis of the current trends in polymer design and selection.

Bioactive glass-based organic/inorganic hybrids are a family of materials holding great promise in the biomedical field. Developed from bioactive glasses following recent advances in sol-gel and polymer chemistry, they can overcome many limitations of traditional composites typically used in bone repair and orthopedics. Thanks to their unique molecular structure, hybrids are often characterized by synergistic properties that go beyond a mere combination of their two components; it is possible to synthesize materials with a wide variety of mechanical and biological properties. The polymeric component, in particular, can be tailored to prepare tough, load-bearing materials, or rubber-like elastomers. It can also be a key factor in the determination of a wide range of interesting biological properties. In addition, polymers can also be used within hybrids as carriers for therapeutic ions (although this is normally the role of silica). This review offers a brief look into the history of hybrids, from the discovery of bioactive glasses to the latest developments, with a particular emphasis on polymer design and chemistry. First the benefits and limitations of hybrids will be discussed and compared with those of alternative approaches (for instance, nanocomposites). Then, key advances in the field will be presented focusing on the polymeric component: its chemistry, its physicochemical and biological advantages, its drawbacks, and selected applications. Comprehensive tables summarizing all the polymers used to date to fabricate sol-gel hybrids for biomedical applications are also provided, to offer a handbook of all the available candidates for hybrid synthesis. In addition to the current trends, open challenges and possible avenues of future development are proposed.

Osteogenic Effect of Fisetin Doping in Bioactive Glass/Poly(caprolactone) Hybrid Scaffolds.

Treating large bone defects or fragile patients may require enhancing the bone regeneration rate to overcome a weak contribution from the body. This work investigates the osteogenic potential of nutrient fisetin, a flavonoid found in fruits and vegetables, as a doping agent inside the structure of a SiO2-CaO bioactive glass-poly(caprolactone) (BG-PCL) hybrid scaffold. Embedded in the full mass of the BG-PCL hybrid during one-pot synthesis, we demonstrate fisetin to be delivered sustainably; the release follows a first-order kinetics with active fisetin concentration being delivered for more than 1 month (36 days). The biological effect of BG-PCL-fisetin-doped scaffolds (BG-PCL-Fis) has been highlighted by in vitro and in vivo studies. A positive impact is demonstrated on the adhesion and the differentiation of rat primary osteoblasts, without an adverse cytotoxic effect. Implantation in critical-size mouse calvaria defects shows bone remodeling characteristics and remarkable enhancement of bone regeneration for fisetin-doped scaffolds, with the regenerated bone volume being twofold that of nondoped scaffolds and fourfold that of a commercial trabecular bovine bone substitute. Such highly bioactive materials could stand as competitive alternative strategies involving biomaterials loaded with growth factors, the use of the latter being the subject of growing concerns.

Tailored therapeutic release from polycaprolactone-silica hybrids for the treatment of osteomyelitis: antibiotic rifampicin and osteogenic silicates.

The treatment of osteomyelitis, a destructive inflammatory process caused by bacterial infections to bone tissue, is one of the most critical challenges of orthopedics and bone regenerative medicine. The standard treatment consists of intense antibiotic therapies combined with tissue surgical debridement and the application of a bone defect filler material. Unfortunately, commercially available candidates, such as gentamicin-impregnated polymethylmethacrylate cements, possess very poor pharmacokinetics (i.e., 24 hours burst release) and little to no regenerative potential. Fostered by the intrinsic limitations associated with conventional treatments, alternative osteostimulative biomaterials with local drug delivery have recently started to emerge. In this study, we propose the use of a polycaprolactone-silica sol-gel hybrid material as carrier for the delivery of rifampicin, an RNA-polymerase blocker often used to treat bone infections, and of osteostimulative silicate ions. The release of therapeutic agents from the material is dual, offering two separate and simultaneous effects, and decoupled, meaning that the kinetics of rifampicin and silicate releases are independent from each other. A series of hybrid formulations with increasing amounts of rifampicin was prepared. The antibiotic loading efficacy, as well as the release profiles of rifampicin and silicates were measured. The characterization of cell viability and differentiation of rat primary osteoblasts and antibacterial performance were also performed. Gram-positive Staphylococcus aureus and Gram-negative Pseudomonas aeruginosa and Escherichia coli were selected due to their high occurrence in bone infections. Results confirmed that rifampicin can be successfully loaded within the hybrids without significant degradation and that it is possible to tailor the antibiotic release according to need. Once in a physiological environment, the rapid release of silicates was associated with optimal cell proliferation and the overexpression of osteoblastic differentiation. Simultaneously, rifampicin is delivered over the course of several weeks with significant inhibition of all tested strains. In particular, the materials caused a growth reduction of 7-10 orders of magnitude in Staphylococcus aureus, the major strain responsible for osteomyelitis worldwide. Our data strongly suggest that PCL/silica hybrids are a very promising candidate to develop bone fillers with superior biological performance compared to currently available options. Thanks to their unique synthesis route and their dual tailored release they can promote bone regeneration while reducing the risk of infection for several weeks upon implantation.

Optimized Bioactive Glass: the Quest for the Bony Graft.

Technological advances have provided surgeons with a wide range of biomaterials. Yet improvements are still to be made, especially for large bone defect treatment. Biomaterial scaffolds represent a promising alternative to autologous bone grafts but in spite of the numerous studies carried out on this subject, no biomaterial scaffold is yet completely satisfying. Bioactive glass (BAG) presents many qualifying characteristics but they are brittle and their combination with a plastic polymer appears essential to overcome this drawback. Recent advances have allowed the synthesis of organic-inorganic hybrid scaffolds combining the osteogenic properties of BAG and the plastic characteristics of polymers. Such biomaterials can now be obtained at room temperature allowing organic doping of the glass/polymer network for a homogeneous delivery of the doping agent. Despite these new avenues, further studies are required to highlight the biological properties of these materials and particularly their behavior once implanted in vivo. This review focuses on BAG with a particular interest in their combination with polymers to form organic-inorganic hybrids for the design of innovative graft strategies.

Bioactive Glass/Polycaprolactone Hybrid with a Dual Cortical/Trabecular Structure for Bone Regeneration.

Organic-inorganic hybrid biomaterials stand as a promise for combining bone bonding and bone mineral-forming ability, stimulation of osteogenic cells, and adequate mechanical properties. Bioactive glass (BG)-polycaprolactone (PCL) hybrids are of special interest as they gather the ability of BG to enhance osteoblast-mediated bone formation with the slow degradation rate and the toughness of PCL. In this study, BG-PCL hybrids were synthesized in the form of scaffold, owing to a dual cortical/trabecular structure mimicking the bone architecture. Their biological potential was evaluated both in vitro using rat primary osteoblasts (RPO) and in vivo in a mice model of critical-size calvarial defects. BG-PCL scaffolds were compared to Lubboc (BTB), a commercial purified bovine xenograft widely used in orthopedics and periodontal procedures and known for its efficiency. BG-PCL hybrids were found to facilitate RPO adhesion at their surface and to enhance RPO differentiation when compared to BTB. An in vivo micro-CT study demonstrates a higher bone ingrowth with BG-PCL scaffolds and a complete chemical conversion of the remaining BG-PCL after 3 months of implantation, while histological data show the vascularization of BG-PCL scaffolds and confirm the well-advanced bone regeneration with ongoing remodeling. Finally, we evidence the complete chemical conversion of the remaining BG-PCL into a bone-like mineral.

Mechanism of Calcium Incorporation Inside Sol-Gel Silicate Bioactive Glass and the Advantage of Using Ca(OH)2 over Other Calcium Sources.

Calcium is an essential component of osteogenesis and is often required for imparting significant bioactivity to synthetic bone substitutes and, in particular, silicate-based materials. However, the mechanism of calcium incorporation inside sol-gel silicates is poorly understood. In this work, we shed light on the determinant parameters for incorporation of calcium into acid-base-catalyzed sol-gel silicates at ambient temperature: increasing the pH above the isoelectric point of silicic acid and the nature of the calcium counterion in the calcium precursor are found to be the key. Based on our proposed reaction sequence, we were able to compare calcium precursors and select an ideal candidate compound for the synthesis of bioactive glasses (BG) and organic-inorganic hybrids at ambient temperature. Reproducible syntheses and gel times of SiO2-CaO BG were obtained using calcium hydroxide (CH), and we demonstrate its usability in the synthesis of promising BG-polycaprolactone hybrid scaffolds. BG and hybrids prepared with CH were able to form nanocrystalline nonstoichiometric apatite in simulated body fluid. The increased reliability of low-temperature syntheses associated with the use of a stable and inexpensive alkaline-earth precursor are major steps toward the translation of calcium silicate hybrids or other alkaline-earth silicates from bench to clinic.

Physicochemical regulation of TGF and VEGF delivery from mesoporous calcium phosphate bone substitutes.

AIM: Determination of the physicochemical parameters governing growth factors (GFs) adsorption and release from mesoporous calcium phosphate ceramics. MATERIALS & METHODS: Six mesoporous calcium phosphate ceramics prepared by soft and hard templating were loaded with two different physiological concentrations of TGF-ß1 or VEGF165 and their in vitro kinetics of adsorption/release were studied. RESULTS: This low GF loading promotes adsorption on the highest binding sites. The usually encountered detrimental burst release is thus considerably reduced for samples prepared by hard-templating method. CONCLUSION: Our findings highlight that the strong affinity of GFs with the ceramic surfaces, demonstrated by a slow GFs release, is enhanced by the large surface area, confinement into mesopores of ceramics and high difference of surface charge between ceramic surfaces and GFs.

Bioactive glass-gelatin hybrids: building scaffolds with enhanced calcium incorporation and controlled porosity for bone regeneration.

Thanks to their active promotion of bone formation, bioactive glasses (BG) offer unique properties for bone regeneration, but their brittleness prevents them from being used in a wide range of applications. Combining BG with polymers into a true hybrid system is therefore an ideal solution to associate toughness from the polymer and stimulation of bone mineralization from the glass. In this work, we report the synthesis and characterization of hybrid scaffolds based on SiO2-CaO bioactive glass and gelatin, a hydrolyzed form of bone type-I collagen. Incorporation of calcium ions, known to trigger bone formation and cellular activity, into the hybrid structure was achieved at ambient temperature through careful control of chemistry of the sol-gel process. Thorough characterization of the materials highlights the effect of grafting an organoalkoxysilane coupling molecule to covalently link networks of BG and gelatin, and proves it a successful means to take control over the degradation and bioactive properties of hybrids. Importantly, BG-gelatin hybrids are synthesized in a process fully conducted at ambient temperature that allows obtaining open-porous scaffolding structures, with well-controlled and tuneable porosity with regards to both pore and interconnection sizes. Mechanical properties of the scaffolds under compression are similar to that of trabecular bone and their apatite-forming ability is even higher than that of pure BG scaffold foams.

Strontium-Substituted Bioceramics Particles: A New Way to Modulate MCP-1 and Gro-α Production by Human Primary Osteoblastic Cells.

BACKGROUND: To avoid morbidity and limited availability associated with autografts, synthetic calcium phosphate (CaP) ceramics were extensively developed and used as bone filling materials. Controlling their induced-inflammatory response nevertheless remained a major concern. Strontium-containing CaP ceramics were recently demonstrated for impacting cytokines' secretion pattern of human primary monocytes. The present study focuses on the ability of strontium-containing CaP to control the human primary bone cell production of two major inflammatory and pro-osteoclastogenic mediators, namely MCP-1 and Gro-α, in response to ceramics particles. METHODS: This in vitro study was performed using human primary osteoblasts in which their response to ceramics was evaluated by PCR arrays, antibody arrays were used for screening and real-time PCR and ELISA for more focused analyses. RESULTS: Study of mRNA and protein expression highlights that human primary bone cells are able to produce these inflammatory mediators and reveal that the adjunction of CaP in the culture medium leads to their enhanced production. Importantly, the current work determines the down-regulating effect of strontium-substituted CaP on MCP-1 and Gro-α production. CONCLUSION: Our findings point out a new capability of strontium to modulate human primary bone cells' communication with the immune system.

In vitro and in vivo evaluation of the inflammatory potential of various nanoporous hydroxyapatite biomaterials.

AIM: To discriminate the most important physicochemical parameters for bone reconstruction, the inflammatory potential of seven nanoporous hydroxyapatite powders synthesized by hard or soft templating was evaluated both in vitro and in vivo. MATERIALS & METHODS: After physical and chemical characterization of the powders, we studied the production of inflammatory mediators by human primary monocytes after 4 and 24 h in contact with powders, and the host response after 2 weeks implantation in a mouse critical size defect model. RESULTS: In vitro results highlighted increases in the secretion of TNF-α, IL-1, -8, -10 and proMMP-2 and -9 and decreases in the secretion of IL-6 only for powders prepared by hard templating. In vivo observations confirmed an extensive inflammatory tissue reaction and a strong resorption for the most inflammatory powder in vitro. CONCLUSION: These findings highlight that the most critical physicochemical parameters for these nanoporous hydroxyapatite are, the crystallinity that controls dissolution potential, the specific surface area and the size and shape of crystallites.

Bioactive glass hybrids: a simple route towards the gelatin-SiO2-CaO system.

Bioactive glass hybrids are among the most promising materials for bone regeneration, but the incorporation of calcium, a key element for mineralization properties of the implant, into the inorganic part of the hybrid network is challenging. We present here a synthesis route towards both class I and II gelatin-bioactive glass hybrids allowing the efficient incorporation of calcium ions at low temperature.

Cobalt-releasing 1393 bioactive glass-derived scaffolds for bone tissue engineering applications.

Loading biomaterials with angiogenic therapeutics has emerged as a promising approach for developing superior biomaterials for engineering bone constructs. In this context, cobalt-releasing materials are of interest as Co is a known angiogenic agent. In this study, we report on cobalt-releasing three-dimensional (3D) scaffolds based on a silicate bioactive glass. Novel melt-derived "1393" glass (53 wt % SiO2, 6 wt % Na2O, 12 wt % K2O, 5 wt % MgO, 20 wt % CaO, and 4 wt % P2O5) with CoO substituted for CaO was fabricated and was used to produce a 3D porous scaffold by the foam replica technique. Glass structural and thermal properties as well as scaffold macrostructure, compressive strength, acellular bioactivity, and Co release in simulated body fluid (SBF) were investigated. In particular, detailed insights into the physicochemical reactions occurring at the scaffold-fluid interface were derived from advanced micro-particle-induced X-ray emission/Rutherford backscattering spectrometry analysis. CoO is shown to act in a concentration-dependent manner as both a network former and a network modifier. At a concentration of 5 wt % CoO, the glass transition point (Tg) of the glass was reduced because of the replacement of stronger Si-O bonds with Co-O bonds in the glass network. Compressive strengths of >2 MPa were measured for Co-containing 1393-derived scaffolds, which are comparable to values of human spongy bone. SBF studies showed that all glass scaffolds form a calcium phosphate (CaP) layer, and for 1393-1Co and 1393-5Co, CaP layers with incorporated traces of Co were observed. The highest Co concentrations of ∼12 ppm were released in SBF after reaction for 21 days, which are known to be within therapeutic ranges reported for Co(2+) ions.

Influence of glass scaffolds macroporosity on the bioactive process.

Little is known about the ideal morphology for three-dimensional (3D) porous scaffolds to be used in bone tissue engineering. The present study will supply useful data about the dependence of the mineralization process upon macroporous features of bioactive glass scaffolds. It also points out the difficulty in distinguishing between the bioactive properties of scaffolds if using common characterization techniques often considered as standard techniques to assess in vitro bioactivity. Here, two bioactive glass foams with different porosities (porous diameters and interconnection sizes) were successfully synthesized by varying the surfactant quantity in the sol-gel foaming process. The two foams had porosities apparently sufficient to serve as a bone tissue engineering scaffold and exhibited no significant difference when studied for the releasing or the taking up of ionic species when immersed in simulated body fluid (SBF). However, thanks to microion beam analysis, it was possible to highlight key differences in the mineralization reaction taking place at the surface of the pores. It is clearly evident that the homogeneity of reaction inside the 3D-scaffolds is particularly dependent upon porosity. In particular, it is demonstrated that inadequate porous features can result in limited circulation of the fluid inside the pores. Careful attention must be paid to the pore size distribution and interconnection sizes when designing scaffolds for bone tissue engineering, in order to induce homogeneous mineralization inside the porous material and for the scaffold to be efficiently alimented with nutrients or growth factors while allowing a free circulation of the bone cells.

Green and safe in situ templating of bioactive glass scaffolds for bone tissue engineering.

This communication reports a new process for the synthesis of bioactive glass foams. This process is based on the use of gelatin as a template during the foaming of a sol, and the gelled gelatin template formed in situ maintains the foam structure during further condensation of the glass network.

In vitro reactivity of Cu doped 45S5 Bioglass® derived scaffolds for bone tissue engineering.

Cu-doped 45S5 bioactive glasses with varying Cu contents were fabricated and used to process 3D porous scaffolds via the foam replica technique. Cu-doping results in the weakening of the glass network and a decrease in its glass transition temperature. Acellular in vitro studies revealed very high bioactivity independent of Cu doping as indicated by the fast formation of a carbonated hydroxyapatite layer (CHA) on scaffold surfaces after immersion in simulated body fluid (SBF). The kinetics of the glass-ceramic scaffold's transition to an amorphous calcium phosphate layer (ACP) and the crystallisation of CHA were explored by FT-IR and SEM analyses. The elemental distribution in the scaffold/fluid interface region was monitored by the advanced micro-PIXE-RBS (particle induced X-ray emission/Rutherford backscattering spectrometry) method. Cu-containing glasses showed slower release of Si, Ca and P from the scaffold periphery, whereas traces of Cu were found incorporated in the CaP layer on the scaffold surface. Cu release kinetics from the scaffolds in SBF were found to depend on culturing conditions while highest Cu concentrations of ∼3.1 ppm and ∼4.6 ppm under static and quasi-dynamic conditions, respectively, were observed. Since Cu exhibits potential angiogenic and osteogenic properties, the Cu-containing scaffolds are suggested as promising materials for bone tissue engineering applications.

87Sr solid-state NMR as a structurally sensitive tool for the investigation of materials: antiosteoporotic pharmaceuticals and bioactive glasses.

Strontium is an element of fundamental importance in biomedical science. Indeed, it has been demonstrated that Sr(2+) ions can promote bone growth and inhibit bone resorption. Thus, the oral administration of Sr-containing medications has been used clinically to prevent osteoporosis, and Sr-containing biomaterials have been developed for implant and tissue engineering applications. The bioavailability of strontium metal cations in the body and their kinetics of release from materials will depend on their local environment. It is thus crucial to be able to characterize, in detail, strontium environments in disordered phases such as bioactive glasses, to understand their structure and rationalize their properties. In this paper, we demonstrate that (87)Sr NMR spectroscopy can serve as a valuable tool of investigation. First, the implementation of high-sensitivity (87)Sr solid-state NMR experiments is presented using (87)Sr-labeled strontium malonate (with DFS (double field sweep), QCPMG (quadrupolar Carr-Purcell-Meiboom-Gill), and WURST (wideband, uniform rate, and smooth truncation) excitation). Then, it is shown that GIPAW DFT (gauge including projector augmented wave density functional theory) calculations can accurately compute (87)Sr NMR parameters. Last and most importantly, (87)Sr NMR is used for the study of a (Ca,Sr)-silicate bioactive glass of limited Sr content (only ~9 wt %). The spectrum is interpreted using structural models of the glass, which are generated through molecular dynamics (MD) simulations and relaxed by DFT, before performing GIPAW calculations of (87)Sr NMR parameters. Finally, changes in the (87)Sr NMR spectrum after immersion of the glass in simulated body fluid (SBF) are reported and discussed.

A new insight into the dissociating effect of strontium on bone resorption and formation.

Calcium phosphates are widely used as biomaterials and strontium (Sr) is known to have the ability to modify the bone balance towards osteosynthesis. In the present study we investigated the capacity of Sr-substituted sol-gel calcium phosphate to modify the expression of genes and proteins involved in extracellular matrix synthesis by primary bone cells. We first determined the most effective concentration of strontium using human primary bone cells. Sol-gel biphasic calcium phosphate (BCP) powders were then synthesised to obtain release of the optimal concentration of strontium. Finally, human osteoblasts obtained from explant cultures were cultured in the presence of sol-gel BCP, Sr-substituted BCP (5% Sr-substituted BCP, corresponding to a release of 5×10(-5)M [Sr(2+)] under the culture conditions (BCP(5%))) and medium containing strontium chloride (SrCl(2)). Viability, proliferation, cell morphology, protein production and protein activity were studied. We demonstrated that 5×10(-5)M SrCl(2) and BCP(5%) increased the expression of type I collagen and SERPINH1 mRNA and reduced the production of matrix metalloproteinases (MMP-1 and MMP-2) without modifying the levels of the tissue inhibitors of MMPs (TIMPs). Thus strontium has a positive effect on bone formation.

The effect of zinc on hydroxyapatite-mediated activation of human polymorphonuclear neutrophils and bone implant-associated acute inflammation.

Hydroxyapatite (HA) is widely used as coating biomaterial for prosthesis metal parts and as bone substitute. The release of HA particles induces an inflammatory response and, if uncontrolled, could result in implant loss. At the inflamed site, the polymorphonuclear cells (PMNs) represent the earliest phagocytic cells that predominate the cellular infiltrate. We have recently proposed that HA wear debris activate polymorphonuclear cells (PMNs) initiating and/or amplifying thereby the acute inflammatory response. Previous studies have shown that activation of monocytes by HA could be modulated by supplementing this latter with the divalent cation, Zinc. The purpose of this work was to investigate the modulation of PMNs activation following exposure to zinc-substituted HA. Our study demonstrate that addition of zinc to HA particles resulted in decreased levels of the pro-inflammatory mediator interleukin-8 (IL-8) and the matrix metallo-proteinase-9. We also show that these changes involve IL-8 receptors (CXCR-1 and CXCR-2).

Polymorphonuclear neutrophil response to hydroxyapatite particles, implication in acute inflammatory reaction.

Hydroxyapatite (HA) is widely used as a bone substitute or coating biomaterial in bone diseases or prosthesis metal parts. The release of HA particles induces an inflammatory response and, if uncontrolled, could result in implant loss. Among the hallmarks of such inflammatory response is early recruitment of the polymorphonuclear cells (PMNs). The purpose of this work is to investigate the response of PMNs following exposure to HA in terms of secreted mediators. Our study shows that HA particles increase the release of pro-inflammatory mediators such as interleukin-1alpha, as well as chemotactic factors such as interleukin-8, macrophage inflammatory protein-1alpha and macrophage inflammatory protein-1beta. HA also induces an increase in matrix metalloproteinase 9 expression. Taken together, our data demonstrate for the first time that HA is capable of activating PMNs, a phenomenon that could potentially contribute to the onset of implant-associated inflammation.