Osteogenic capacity of alkali-free bioactive glasses. In vitro studies.

The high alkali content bioactive glasses commonly used to regenerate bone in dental, orthopedic, and maxillofacial surgeries induce some cytotoxicity in surrounding tissues. The present study aims the ability of some alkali-free bioactive glasses compositions, recently developed by our research group, to stimulate human mesenchymal stem cells (hMSCs) differentiation into osteoblasts in comparison to 45S5 Bioglass® . The obtained results demonstrated that alkali-free bioactive glasses possess higher stimulating towards differentiation of hMSCs in comparison to the control 45S5 Bioglass® . The von Kossa assay demonstrated that all bioactive glasses studied were able to induce the appearance of calcium deposits even when the cells were cultured in DMEM, proving that these biomaterials per se induce hMSCs cell differentiation. It was also observed that in both cell culture medium used (DMEM, and osteogenesis differentiation medium) alkali-free bioactive glasses clearly induced the appearance of more calcium deposits than the 45S5 Bioglass® , indicating their greater ability to induce cell differentiation. In summary, these results indicate that alkali-free bioactive glasses are a safe and valid alternative to 45S5 Bioglass® . © 2016 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater, 105B: 2360-2365, 2017.

Multifunctional chitosan/polyvinyl pyrrolidone/45S5 Bioglass® scaffolds for MC3T3-E1 cell stimulation and drug release.

Novel chitosan-polyvinyl pyrrolidone/45S5 Bioglass® (CS-PVP/BG) scaffolds were prepared via foam replication and chemical cross-linking techniques. The pristine BG, CS-PVP coated BG and genipin cross-linked CS-PVP/BG (G-CS-PVP/BG) scaffolds were synthesized and characterized in terms of chemical composition, physical structure and morphology respectively. Resistance to enzymatic degradation of the scaffold is improved significantly with the use of genipin cross-linked CS-PVP. The bio-effects of scaffolds on MC3T3-E1 osteoblast-like cells were evaluated by studying cell viability, adhesion and proliferation. The CCK-8 assay shows that cell viability on the resulting G-CS-PVP/BG scaffold is improved obviously after cross-linking of genipin. Cell skeleton images exhibit that well-stretched F-actin bundles are obtained on the G-CS-PVP/BG scaffold. SEM results present significant improvement on the cell adhesion and proliferation for cells cultured on the G-CS-PVP/BG scaffold. The drug release performance on the as-synthesized scaffold was studied in a phosphate buffered saline (PBS) solution. Vancomycin is found to be released in burst fashion within 24h from the pristine BG scaffold, however, the release period from the G-CS-PVP/BG scaffold is enhanced to 7days, indicating improved drug release properties of the G-CS-PVP/BG scaffold. Our results suggest that the G-CS-PVP/BG scaffolds possess promising physicochemical properties, sustained drug release capability and good biocompatibility for MC3T3-E1 cells' proliferation and adhesion, suggesting their potential applications in areas such as MC3T3-E1 cell stimulation and bone tissue engineering.

Molded polymer-coated composite bone void filler improves tobramycin controlled release kinetics.

Infection remains a significant problem associated with biomedical implants and orthopedic surgeries, especially in revision total joint replacements. Recent advances in antibiotic-releasing bone void fillers (BVF) provide new opportunities to address these types of device-related orthopedic infections that often lead to substantial economic burdens and reduced quality of life. We report improvements made in fabrication and scalability of an antibiotic-releasing polycaprolactone-calcium carbonate/phosphate ceramic composite BVF using a new solvent-free, molten-cast fabrication process. This strategy provides the ability to tailor drug release kinetics from the BVF composite based on modifications of the inorganic substrate and/or the polymeric component, allowing extended tobramycin release at bactericidal concentrations. The mechanical properties of the new BVF composite are comparable to many reported BVFs and validate the relative homogeneity of fabrication. Most importantly, fabrication quality controls are correlated with favorable drug release kinetics, providing bactericidal activity to 10 weeks in vitro when the polycaprolactone component exceeds 98% w/w of the total polymer fraction. Furthermore, in a time kill study, tobramycin-releasing composite fragments inhibited S. aureus growth over 48 h at inoculums as high as 10(9) CFU/mL. This customizable antibiotic-releasing BVF polymer-inorganic biomaterial should provide osseointegrative and osteoconductive properties while contributing antimicrobial protection to orthopedic sites requiring the use of bone void fillers.

Poly-cyclodextrin functionalized porous bioceramics for local chemotherapy and anticancer bone reconstruction.

The progress in bone cancer surgery and multimodal treatment concept achieve only modest improvement in the overall survival, due to failure in clearing out residual cancer cells at the surgical margin and extreme side-effects of adjuvant postoperative treatments. Our study aims to propose a new method based on cyclodextrin polymer (polyCD) functionalized hydroxyapatite (HA) for achieving a high local drug concentration with a sustained release profile and a better control of residual malignant cells via local drug delivery and promotion of the reconstruction of bone defects. PolyCD, a versatile carrier for therapeutic molecules, can be incorporated into HA (bone regeneration scaffold) through thermal treatment. The parameters of polyCD treatment on the macroporous HA (porosity 65%) were characterized via thermogravimetric analysis. Good cytocompatibility of polyCD functionalized bioceramics was demonstrated on osteoblast cells by cell vitality assay. An antibiotic (gentamicin) and an anticancer agent (cisplatin) were respectively loaded on polyCD functionalized bioceramics for drug release test. The results show that polyCD functionalization leads to significantly improved drug loading quantity (30% more concerning gentamicin and twice more for cisplatin) and drug release duration (7 days longer concerning gentamicin and 3 days longer for cisplatin). Conclusively, this study offers a safe and reliable drug delivery system for bioceramic matrices, which can load anticancer agents (or/and antibiotics) to reduce local recurrence (or/and infection).

Does bone marrow affect the radiological outcome when added to biphasic ceramic graft in treatment of benign bone lesions?

PURPOSE: The aim of this study is to describe the role of bone marrow aspirate in treatment of the benign bone lesions by comparing two groups of patients (16 patients in each group) with benign bone lesions treated with surgical curettage and filling the defect with either composite ceramic graft hydrated with bone marrow aspirate "group 1" or composite ceramic graft alone without a bone marrow aspirate "group 2". MATERIALS AND METHODS: The mean age was 19.7 years (group 1) and 18.5 years (group 2). The mean size of the cavitary bone lesions was 29.2 cm(2) (group 1) and 25.9 cm(2) (group 2). The mean follow-up period was 47 months. RESULTS: The percentage of ceraform resorption had increased from 31.3% at 6 months to 75.4% at 36 months for group 1 patients and from 20.9% at 6 months to 60.3% at 36 months for group 2 patients. The percentage of bone trabeculation through the cavitary defects had increased from 30.3% at 6 months to 85.5% at 36 months for group 1 patients and from 18.9% at 6 months to 72.0% at 36 months for group 2 patients. The mean of the percentage of ceraform persistence at 36 months after its implantation was 24.6% for group 1 patients and 39.7% for group 2 patients. CONCLUSION: Adding bone marrow aspirate to ceraform biphasic ceramic had hastened the rate of its resorption and had decreased the rate of its persistence.

Biodegradation of porous calcium phosphate scaffolds in an ectopic bone formation model studied by X-ray computed microtomograph.

Three types of ceramic scaffolds with different composition and structure [namely synthetic 100% hydroxyapatite (HA; Engipore), synthetic calcium phosphate multiphase biomaterial containing 67% silicon stabilized tricalcium phosphate (Si-TCP; Skelite) and natural bone mineral derived scaffolds (Bio-oss)] were seeded with mesenchymal stem cells (MSC) and ectopically implanted for 8 and 16 weeks in immunodeficient mice. X-ray synchrotron radiation microtomography was used to derive 3D structural information on the same scaffolds both before and after implantation. Meaningful images and morphometric parameters such as scaffold and bone volume fraction, mean thickness and thickness distribution of the different phases as a function of the implantation time, were obtained. The used imaging algorithms allowed a direct comparison and registration of the 3D structure before and after implantation of the same sub-volume of a given scaffold. In this way it was possible to directly monitor the tissue engineered bone growth and the complete or partial degradation of the scaffold. Further, the detailed kinetics studies on Skelite scaffolds implanted for different length of times from 3 days to 24 weeks, revealed in the X-ray absorption histograms two separate peaks associated to HA and TCP. It was therefore possible to observe that the progressive degradation of the Skelite scaffolds was mainly due to the resorption of TCP. The different saturation times in the tissue engineered bone growth and in the TCP resorption confirmed that the bone growth was not limited the scaffold regions that were resorbed but continued in the inward direction with respect to the pore surface.

Bone formation in a carbonate-substituted hydroxyapatite implant is inhibited by zoledronate: the importance of bioresorption to osteoconduction.

Carbonate-substituted hydroxyapatite (CHA) is more osteoconductive and more resorbable than hydroxyapatite (HA), but the underlying mode of its action is unclear. We hypothesised that increased resorption of the ceramic by osteoclasts might subsequently upregulate osteoblasts by a coupling mechanism, and sought to test this in a large animal model. Defects were created in both the lateral femoral condyles of 12 adult sheep. Six were implanted with CHA granules bilaterally, and six with HA. Six of the animals in each group received the bisphosphonate zoledronate (0.05 mg/kg), which inhibits the function of osteoclasts, intra-operatively. After six weeks bony ingrowth was greater in the CHA implants than in HA, but not in the animals given zoledronate. Functional osteoclasts are necessary for the enhanced osteoconduction seen in CHA compared with HA.

Synthetic vitreous fibers: a review of toxicology research and its impact on hazard classification.

Because the inhalation of asbestos, a naturally occurring, inorganic fibrous material, is associated with lung fibrosis and thoracic cancers, concerns have been raised about the possible health effects of synthetic vitreous fibers (SVFs). SVFs include a very broad variety of inorganic fibrous materials with an amorphous molecular structure. Traditionally, SVFs have been divided into three subcategories based on composition: fiberglass, mineral wool (rock, stone, and slag wools), and refractory ceramic fiber. For more than 50 years, the toxicologic potential of SVFs has been researched extensively using human epidemiology and a variety of laboratory studies. Here we review the research and its impact on hazard classification and regulation of SVFs. Large, ongoing epidemiology studies of SVF manufacturing workers have provided very little evidence of harmful effects in humans. Several decades of research using rodents exposed by inhalation have confirmed that SVF pulmonary effects are determined by the "Three D's", fiber dose (lung), dimension, and durability. Lung dose over time is determined by fiber deposition and biopersistence in the lung. Deposition is inversely related to fiber diameter. Biopersistence is directly related to fiber length and inversely related to fiber dissolution and fragmentation rates. Inhaled short fibers are cleared from the lung relatively quickly by mobile phagocytic cells, but long fibers persist until they dissolve or fragment. In contrast to asbestos, most of the SVFs tested in rodent inhalation studies cleared rapidly from the lung (were nonbiopersistent) and were innocuous. However, several relativley biopersistent SVFs induced chronic inflammation, lung scarring (fibrosis), and thoracic neoplasms. Thus, biopersistence of fibers is now generally recognized as a key determinant of the toxicologic potential of SVFs. In vitro dissolution of fibers in simulated extracellular fluid correlates fairly well with fiber biopersistence in the lung and pulmonary toxicity, but several exceptions suggest that biopersistence involves more than dissolution rate. Research demonstrating the relationship between biopersistence and SVF toxicity has provided a scientific basis for hazard classification and regulation of SVFs. For a nonhazardous classification, legislation recently passed by the European Union requires a respirable insulation wool to have a low lung-biopersistence or be noncarcinogenic in laboratory rats. U.S. fiberglass and mineral wool industries and the Occupational Health and Safety Administration (OSHA) have formed a voluntary Health and Safety Partnership Program (HSPP) that include: a voluntary permissible exposure level (PEL) in the workplace of 1 fiber/cc, a respiratory protection program for specified tasks, continued workplace air monitoring, and, where possible, the development of fiber formulations that do not persist in the lung. RCF manufacturers have implemented a Product Stewardship Program that includes: a recommended exposure guideline of 0.5 fibers/cc; a 5-year workplace air monitoring program; and research into the development of high-temperature-resistant, biosoluble fibers.

A science-based paradigm for the classification of synthetic vitreous fibers.

Synthetic vitreous fibers (SVFs) are a broad class of inorganic vitreous silicates used in a large number of applications including thermal and acoustical insulation and filtration. Historically, they have been grouped into somewhat artificial broad categories, e.g., glass, rock (stone), slag, or ceramic fibers based on the origin of the raw materials or the manufacturing process used to produce them. In turn, these broad categories have been used to classify SVFs according to their potential health effects, e.g., the International Agency for Research on Cancer and International Programme for Chemical Safety in 1988, based on the available health information at that time. During the past 10-15 years extensive new information has been developed on the health aspects of these fibers in humans, in experimental animals, and with in vitro test systems. Various chronic inhalation studies and intraperitoneal injection studies in rodents have clearly shown that within a given category of SVFs there can be a vast diversity of biological responses due to the different fiber compositions within that category. This information has been further buttressed by an in-depth knowledge of differences in the biopersistence of the various types of fibers in the lung after short-term exposure and their in vitro dissolution rates in fluids that mimic those found in the lung. This evolving body of information, which compliments and explains the results of chronic animal studies clearly show that these "broad" categories are somewhat archaic, oversimplistic, and do not represent current science. This new understanding of the relation between fiber composition, solubility, and biological activity requires a new classification system to more accurately reflect the potential health consequences of exposure to these materials. It is proposed that a new classification system be developed based on the results of short-term in vivo in combination with in vitro solubility studies. Indeed, the European Union has incorporated some of this knowledge, e.g., persistence in the lung into its recent Directive on fiber classification.

Determinants of the pathogenicity of man-made vitreous fibers (MMVF).

INTRODUCTION AND OBJECTIVES: A number of man-made vitreous fibers (MMVF) have been developed over the years to replace asbestos fibres in its uses as insulating material. Concerns have been raised that these man-made fibers may also pose a significant health hazard when inhaled during their manufacture and application. As will be discussed in this brief overview, dose, dimension and durability of fibrous particles are key parameters with respect to the induction of adverse pulmonary effects, including carcinogenicity as well as non-cancer effects. In particular, fiber biopersistence plays a most important role for pulmonary pathogenicities, and consequently biopersistence receives greatest attention in the search of new fibrous materials. METHODS AND RESULTS: Tests to evaluate fiber biopersistence include the administration of fibers by a short-term inhalation (5 days) or intratracheal instillation into rats. Advantages of the inhalation methodology include the even distribution throughout the lung administered by a physiological process. A disadvantage of this method is the limited respirability of long fibers in the rat whereas they are well respirable by humans. Such long fibers ( > 20 microm) have the greatest potential for tumorigenicity and need special consideration in connection with the evaluation of fiber biopersistence. Enrichment of the inhaled aerosol by these long fibers needs to be considered in order to deposit enough of them in the lower respiratory tract of the rat. In contrast, the advantage of the instillation technique is that these long fibers can be delivered to the lung. However, the major disadvantages of intratracheal instillations are the potential of the administered fibers to form clumps and aggregates in the airways and the induction of a major inflammatory response when high-bolus doses are administered. This could influence fiber dissolution in the lungs significantly. CONCLUSIONS: At the same delivered lung dose, a fiber of low biopersistency has the least effect and is, therefore, less likely to induce lung or pleural tumors even under chronic exposure conditions. Respective animal studies with more fibers of different biopersistence have confirmed this general principle. It is very important that, when evaluating and interpreting fiber effects observed in experimental animals, species differences with respect to respirability, lung retention and mechanisms of responses are considered.

Lung cancer risk associated with exposure to man-made fibers.

We show that available experimental data from long-term experiments are consistent with the hypothesis that the oncogenic potential of man-made fibers is determined completely by their biopersistence. We present an analysis of these data within the initiation-promotion-progression paradigm of carcinogenesis. Our method of analysis takes explicit account of the temporal pattern of fiber burden in the rat lung, and suggests that fibers act as initiators in the lung. We estimate a dose-dependent initiation parameter and show how it can be transported to human populations for assessment of the risk of lung cancer following exposure to man-made fibers.

Degradation of calcium phosphate ceramics.

Degradation of three types of sintered calcium phosphate ceramic spheres was investigated in vitro at low pH conditions (LPC) and in an in vivo model, that is, injection into a mouse peritoneal cavity. Degradation was observed under both conditions. The rate of degradation depended on the type of ceramic, with beta-TCP degrading faster than HA and HA degrading faster than FA. Degradation was characterized by dissolution of the necks and the formation of cracks and irregularities in the grains. Intraperitoneal injection of the spheres into a mouse peritoneal cavity led to the formation of foreign body granulomas in which degradation could be observed. The in vivo degradation pattern was similar to that observed in vitro, but longer implantation times resulted in a further degradation. Small fragments rich in Ca and P were present in inclusion bodies. Calcium phosphate crystals sometimes also were observed in mitochondria, many of which were subject to lysis. We observed that ceramic type and implantation period also were related to the number of dead cells in the granulomas. Furthermore, extracellular deposits were seen between cells and ceramic spheres. Ca and P and also Fe were detected in these deposits. The presence of Fe is indicative of a lysosomal origin and thus of exocytotic activity.

Bone formation and implant degradation of coralline porous ceramics placed in bone and ectopic sites.

PURPOSE: This study was undertaken to determine the resorption rate of porous ceramic implants. The hypothesis was that implants placed in soft tissues would degrade more rapidly than implants placed in bone. MATERIALS AND METHODS: To test this hypothesis, implants were manufactured by applying a thin coating of hydroxylapatite onto an interconnected, porous calcium carbonate substrate. Control implants were made entirely of hydroxylapatite with identical microstructure. Two adult dogs received a total of 56 implants placed in the femur, skeletal muscle, and subcutaneous tissues. After killing the animals at 4 months, the specimens were removed, embedded in plastic, sectioned, and either stained for light microscopic examination or subjected to quantitative image analysis using a scanning electron microscope. RESULTS: Contrary to the hypothesis, the rate of degradation was faster for implants placed in bone than in soft tissue. Within the 4 months, degradation was 24% to 63% in bone, depending on the composition. However, it was not statistically significant in either intramuscular or subcutaneous tissue. A surprising observation was that bone ingrowth occurred in 67% of the implants placed in soft tissues. On average, it was 4.3% in intramuscular sites and 6.6% in subcutaneous sites. This bone was histologically normal in 71% of the implants containing bone. CONCLUSION: This study demonstrates that porous ceramic implants composed of hydroxylapatite on calcium carbonate will degrade more rapidly in bone defects than in soft tissue sites. In addition, implants with interconnected porosity and surfaces of hydroxylapatite will become ingrown with bone even after placement in soft tissues. The exact mechanisms for both of these phenomena are not understood.

Chronic inhalation and biopersistence of refractory ceramic fiber in rats and hamsters.

Lifetime "nose-only" inhalation studies were conducted in rats using four types of refractory ceramic fibers (FCF), 1 micron in diameter x 22 to 26 microns length: High Purity, Kaolin, Zirconia, and After-Service; and on hamsters using Kaolin RCF. For comparison, animals also were exposed to chrysotile fibers. Rats were exposed 6 hr/day, 5 days/week for 24 months to concentrations ranging between 3 and 30 mg/m3. Time- and dose-dependent lesions in the rat included the development of interstitial fibrosis, pleural fibrosis, pulmonary tumors, and mesothelioma. Exposure to 3, 9 or 16 mg/m3 produced no excess lung tumors; no fibrosis was seen at 3 mg/m3. A significant increase in lung tumors and interstitial fibrosis was observed at 30 mg/m3. A single mesothelioma was observed in rats exposed to 9 mg/m3, while two occurred at 30 mg/m3. Hamsters were similarly exposed to 30 mg/m3 Kaolin RCF for 18 months; no lung tumors were induced, but pulmonary and pleural fibrosis were observed and there was a 42% incidence of mesothelioma. Multiple interim sacrifices together with recovery animals allowed detailed assessment of the lung burden of RCF, which was found to be dose related and, at the high doses, exceeded 10(5) fibers/mg of dry lung. During the various recovery periods there was a clear reduction in fiber burden. Mathematical modeling of these data for deposition, clearance, and retention and for species is currently underway.

Biological activity of respirable industrial fibres treated to mimic residence in the lung.

The durability of fibres in the lung environment after deposition could be a key factor in determining whether they accumulate to a sufficient tissue dose to cause pathological change. There is a shortage of information on the relative durabilities of respirable industrial fibres of various types. We describe a strategy for assessing the ability of different fibre types to persist in the lung milieu and to retain their biological activity. This is particularly important for the development of mesothelioma, where the long latent time that characterises this disease would be expected to exclude, from culpability, fibres that are not durable. We have combined a pre-treatment step in pH 5.0 or 7.0 with an assay that relies on the ability of fibres to damage the mesothelium. The long-term aim is to assess the impact that treatment in various pH solutions has on (a) fibre size/number, (b) loss of key elements, (c) the ability to damage the mesothelium. Such information should enable us to better predict the potential of fibres to cause mesothelioma.

The metabolism of ceramic and non-ceramic forms of uranium dioxide after deposition in the rat lung.

Ceramic and non-ceramic forms of uranium dioxide, produced industrially, were administered to rats either by inhalation or as an aqueous suspension which was injected directly into the pulmonary region of the lungs. The results showed that: 1 both materials should be assigned to inhalation class Y as defined by the International Commission on Radiological Protection; 2 whilst the translocation of uranium to the blood for the non-ceramic UO2 was about twice that obtained for the ceramic form, the two dioxides were unlikely to be differentiated on the basis of their lung retention kinetics; 3 the distribution of uranium amongst body tissues and the relationship between systemic content and cumulative urinary excretion indicated that it was transported in the hexavalent form; 4 in addition to air sampling procedures, lung radioactivity counting measurements could be used to advantage for assessing occupational exposures; 5 the exposure limits should be based on radiation dose rather than chemical toxicity.