Toughening robocast chitosan/biphasic calcium phosphate composite scaffolds with silk fibroin: Tuning printable inks and scaffold structure for bone regeneration.

The present work aims the production of composite bioceramic scaffolds by robocasting suppressing sintering as post printing process. To achieve this purpose, extrudable ink compositions containing a high concentration of bioceramic powders (hydroxyapatite and ß-tricalcium phosphate) embedded in aqueous polymeric solutions of chitosan and silk fibroin were fine-tuned. Polymeric solutions of chitosan/silk fibroin with different ratios were tested, maintaining the total amount of bioceramic solids at 30 vol%. The inks were characterized by rheological studies in viscometry and oscillatory modes, being the printable ones selected to produce scaffolds with different macropore sizes (300 µm and 500 µm). The scaffolds were characterized by mechanical properties (dry and wet conditions) and morphological features, as well as its degradability. In vitro studies were also evaluated in the scaffolds that presented the best structural performance. The addition of 2 wt% silk fibroin to a 5 wt% chitosan matrix allows to significantly improve the mechanical performance of the printed composite scaffolds, reflected in high values for Young's modulus and maximum compressive strength. This trend was continued in wet scaffolds with a concomitant reduction of mechanical properties. Regarding degradability, the scaffolds in general presented a weight loss in the range of 14-18% after 28 days incubation in HEPES solution at two different pH values at 37 °C, with an associated release of calcium and phosphorus ions. The scaffold with 300 µm porosity comprising the both polymers in its composition presented the less rate degradation when compared to the scaffolds with similar porosity and containing only chitosan as base matrix. Moreover, the combined natural polymers gave rise to a significant increase in the metabolic activity of human osteoblasts grown on the scaffolds with both macropore' size, being in line with the full cellular filling of their surfaces, demonstrated by SEM and confocal imaging. The advances presented in this work are a promising path in the ink's development for extrusion-based additive manufacturing techniques and subsequent biomaterials, encompassing suitable physical and chemical characteristics with high potential to be used as bone substitutes.

Effective production of multifunctional magnetic-sensitive biomaterial by an extrusion-based additive manufacturing technique.

A calcium phosphate (CaP)-based scaffold used as synthetic bone grafts, which smartly combines precise dimensions, controlled porosity and therapeutic functions, presents benefits beyond those offered by conventional practices, although its fabrication is still a challenge. The sintering step normally required to improve the strength of the ceramic scaffolds precludes the addition of any biomolecules or functional particles before this stage. This study presents a proof of concept of multifunctional CaP-based scaffolds, fabricated by additive manufacturing from an innovative ink composition, with potential for bone regeneration, cancer treatment by local magnetic hyperthermia and drug delivery platforms. Highly loaded inks comprising iron-doped hydroxyapatite and ß-tricalcium phosphate powders suspended in a chitosan-based solution, in the presence of levofloxacin (LEV) as model drug and magnetic nanoparticles (MNP), were developed. The sintering step was removed from the production process, and the integrity of the printed scaffolds was assured by the polymerization capacity of the ink composite, using genipin as a crosslinking agent. The effects of MNP and LEV on the inks' rheological properties, as well as on the mechanical and structural behaviour of non-doped and iron-doped scaffolds, were evaluated. Magnetic and magneto-thermal response, drug delivery and biological performance, such as cell proliferation in the absence and presence of an applied magnetic field, were also assessed. The addition of a constant amount of MNP in the iron-doped and non-doped CaP-based inks enhances their magnetic response and induction heating, with these effects more pronounced for the iron-doped CaP-based ink. These results suggest a synergistic effect between the iron-doped CaP-based powders and the MNP due to ferro/ferrimagnetic interactions. Furthermore, the iron presence enhances human mesenchymal stem cell metabolic activity and proliferation.

Injectable MnSr-doped brushite bone cements with improved biological performance.

Good mechanical properties and high injectability are the major requirements to ensure widespread application of calcium phosphate cements (CPCs) as bone substitutes in minimally invasive surgeries. However, obtaining CPCs that exhibit a good compromise between these two properties as well as good biological performance is still a great challenge. This study presents novel solutions to improve these properties, which include (i) co-doping ß-tricalcium phosphate (ß-TCP) powder with Sr and Mn, and (ii) adding small amounts of saccharides (sucrose or fructose) to the setting-liquid solution. The combination of these two strategies enabled full injectability and significantly increased the wet compressive strength of CPCs in comparison to undoped or solely Sr-doped CPCs. Furthermore, the proliferative response of human MG63 osteoblastic cells, their rate of collagen-I secretion, and particularly their growth behaviour on the cement surfaces were also enhanced. The overall improved relevant properties of Mn/Sr co-doped CPCs with added sucrose, including in vitro biological performance, renders them very promising materials for bone regeneration and tissue engineering.

Injectability of calcium phosphate pastes: Effects of particle size and state of aggregation of ß-tricalcium phosphate powders.

The present study discloses a systematic study about the influence of some relevant experimental variables on injectability of calcium phosphate cements. Non-reactive and reactive pastes were prepared, based on tricalcium phosphate doped with 5 mol% (Sr-TCP) that was synthesised by co-precipitation. The varied experimental parameters included: (i) the heat treatment temperature within the range of 800-1100°C; (ii) different milling extents of calcined powders; (iii) the liquid-to-powder ratio (LPR); (iv) the use of powder blends with different particle sizes (PS) and particle size distributions (PSD); (v) the partial replacement of fine powders by large spherical dense granules prepared via freeze granulation method to simulate coarse individual particles. The aim was contributing to better understanding of the effects of PS, PSD, morphology and state of aggregation of the starting powders on injectability of pastes produced thereof. Powders heat treated at 800 and 1000°C with different morphologies but with similar apparent PSD curves obtained by milling/blending originated completely injectable reactive cement pastes at low LPR. This contrasted with non-reactive systems prepared thereof under the same conditions. Hypotheses were put forward to explain why the injectability results collected upon extruding non-reactive pastes cannot be directly transposed to reactive systems. The results obtained underline the interdependent roles of the different powder features and ionic strength in the liquid media on determining the flow and injectability behaviours.

Effects of Mn-doping on the structure and biological properties of ß-tricalcium phosphate.

Doping calcium phosphates with trace elements that exist in bone tissues is beneficial in terms of cell-material interactions and in vivo performance of the bone grafts made thereof. Manganese (Mn) is an essential element for normal growth and metabolism of bone tissues, but studies reporting the effects of Mn-doping calcium phosphates are scarce. The present study investigated the influence of Mn-doping on the structure, morphology and biological properties of ß-tricalcium phosphate [ß-Ca3(PO4)2] (ß-TCP). Mn-doped (MnTCP) powders, with Mn contents varying from 0 to 10 mol%, were obtained through an aqueous precipitation method followed by heat treatment at 800 °C. The successful incorporation of Mn into ß-TCP structure was proved through quantitative X-ray diffraction (XRD) phase analysis coupled with structural Rietveld refinement. Increasing Mn concentrations led to decreasing trends of a- and c-axis lattice parameters, and Mn-doping also significantly affected the morphology of ß-TCP powders. In vitro proliferation and differentiation assays of MC3T3-E1 osteoblastic-like cells, grown in the presence of the powders, revealed that the biological benefits of Mn-doped ß-TCP are limited to lower Mn incorporation levels and potentially related to their surface microstructure. The Mn1-ßTCP composition revealed the best set of bioactivity properties, potentially a good candidate for future applications of ß-TCP materials in osteoregeneration.

Synthesis, mechanical and biological characterization of ionic doped carbonated hydroxyapatite/ß-tricalcium phosphate mixtures.

The influence of ionic substituents in calcium phosphates intended for bone and tooth replacement biomedical applications is an important research topic, owing to the essential roles played by trace elements in biological processes. The present study investigates the mechanical and biological evaluation of ionic doped hydroxyapatite/ß-tricalcium phosphate mixtures which have been prepared by a simple aqueous precipitation method. Heat treating the resultant calcium phosphates in a carbonated atmosphere led to the formation of ionic doped carbonated hydroxyapatite/ß-tricalcium phosphate mixtures containing the essential ions of biological apatite. The structural analysis determined by Rietveld refinement confirmed the presence of hydroxyapatite as the main phase, together with a considerable amount of ß-tricalcium phosphate. Such phase assemblage is essentially due to the influence of substituted ions during synthesis. The results from mechanical tests proved that carbonate substitutions are detrimental for the mechanical properties of apatite-based ceramics. In vitro proliferation assays of osteoblastic-like cells (MC3T3-E1 cell line) to powders revealed that carbonate incorporation can either delay or accelerate MC3T3 proliferation, although reaching the same proliferation levels as control cells after 2 weeks in culture. Further, the powders enable pre-osteoblastic differentiation in a similar manner to control cells, as indirectly measured by ALP activity and Type-I collagen medium secretion.

Biological responses of brushite-forming Zn- and ZnSr- substituted beta-tricalcium phosphate bone cements.

The core aim of this study was to investigate zinc (Zn)- and zinc and strontium (ZnSr)-containing brushite-forming beta-tricalcium phosphate (TCP) cements for their effects on proliferation and differentiation of osteoblastic-like cells (MC3T3-E1 cell line) as well as for their in vivo behaviour in trabecular bone cylindrical defects in a pilot study. In vitro proliferation and maturation responses of MC3T3-E1 osteoblastic-like cells to bone cements were studied at the cellular and molecular levels. The Zn- and Sr-containing brushite cements were found to stimulate pre-osteoblastic proliferation and osteoblastic maturation. Indeed, MC3T3-E1 cells exposed to the powdered cements had increased proliferative rates and higher adhesiveness capacity, in comparison to control cells. Furthermore, they exhibited higher alkaline phosphatase (ALP) activity and increased Type-I collagen secretion and fibre deposition into the extracellular matrix. Proliferative and collagen deposition properties were more evident for cells grown in cements doped with Sr. The in vivo osteoconductive propertiesof the ZnCPC and ZnSrCPC cements were also pursued. Histological and histomorphometric analyses were performed at 1 and 2 months after implantation, using carbonated apatite cement (Norian SRS) as control. There was no evidence of cement-induced adverse foreign body reactions, and furthermore ZnCPC and ZnSrCPC cements revealed better in vivo performance in comparison to the control apatite cement. Additionally, the presence of both zinc and strontium resulted in the highest rate of new bone formation. These novel results indicate that the investigated ZnCPC and ZnSrCPC cements are both biocompatible and osteoconductive, being good candidate materials to use as bone substitutes.

In vitro performance assessment of new brushite-forming Zn- and ZnSr-substituted beta-TCP bone cements.

The present study investigated the in vitro performance of brushite-forming Zn- and ZnSr-substituted beta-TCP bone cements in terms of wet mechanical strength and biological response. Quantitative phase analysis and structural refinement of the powdered samples were performed by X-ray powder diffraction and Rietveld refinement technique. Initial and final setting times of the cement pastes, measured using Gilmore needles technique, showed that ZnSrCPC sets faster than ZnCPC. The measured values of the wet strength after 48 h of immersion in PBS solution at 37 degrees C showed that ZnSrCPC cements are stronger than ZnCPC cements. Human osteosarcoma-derived MG63 cell line proved the nontoxicity of the cement powders, using the resazurin metabolic assay.

Synthesis and structural characterization of strontium- and magnesium-co-substituted beta-tricalcium phosphate.

The synthesis of five different Sr(2+)- and Mg(2+)-co-substituted beta-tricalcium phosphate (beta-TCP) has been obtained by heating the calcium-deficient apatites above 800 degrees C. With the investigated concentrations of Sr(2+) and Mg(2+) from the present study, no additional phases other than beta-TCP have been detected. The synthesized powders have been characterized by X-ray diffraction, Fourier transform infrared spectrometry, elemental analysis and Rietveld refinement studies. The co-substitution of Sr(2+) and Mg(2+) in the beta-TCP has resulted in the formation of crystalline beta-TCP at hexagonal setting (space group R3c). The reduction of lattice a- and c-axis parameters with the combined substitution of Sr(2+) and Mg(2+) in the beta-TCP has been found evident from the present results. Sr(2+) has been found occupying the Ca(1,2,3,4) sites and Mg(2+) was found at the sixfold coordinated Ca(5) site of beta-TCP structure.

Injectability of brushite-forming Mg-substituted and Sr-substituted alpha-TCP bone cements.

The influence of magnesium- and strontium-substitutions on injectability and mechanical performance of brushite-forming alpha-TCP cements has been evaluated in the present work. The effects of Mg- and Sr-substitutions on crystalline phase composition and lattice parameters were determined through quantitative X-ray phase analysis and structural Rietveld refinement of the starting calcium phosphate powders and of the hardened cements. A noticeable dependence of injectability on the liquid-to-powder ratio (LPR), smooth plots of extrusion force versus syringe plunger displacement and the absence of filter pressing effects were observed. For LPR values up to 0.36 ml g(-1), the percentage of injectability was always higher and lower for Mg-containing cements and for Sr-containing cements, respectively, while all the pastes could be fully injected for LPR > 0.36 ml g(-1). The hardened cements exhibited relatively high wet compressive strength values (~17-25 MPa) being the Sr- and Mg-containing cements the strongest and the weakest, respectively, holding an interesting promise for uses in trauma surgery such as for filling bone defects and in minimally invasive techniques such as percutaneous vertebroplasty to fill lesions and strengthen the osteoporotic bone.