Current status and outlook on the clinical translation of biodegradable metals

Han, Hyung‐Seop; Loffredo, Sergio; Jun, Indong; Edwards, James; Kim, Yu-Chan; Seok, Hyun‐Kwang; Witte, Frank; Mantovani, Diego; Glyn-Jones, S

doi:10.1016/j.mattod.2018.05.018

Cited by 310 publications

(207 citation statements)

References 106 publications

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“…Generally, low concentrations of Zn 2+ promoted the viability, proliferation, adhesion and migration of osteoblast cells, endothelial cells, and vascular smooth muscle cells, while high concentrations of Zn 2+ had opposite effects. Mg-based implants have been evaluated by extensive studies in bone environments with different animal models 6,41 . Most of the research reported enhanced new bone formation around the Mg-based implants including promoted local periosteal and endosteal bone formation.…”

Section: Discussionmentioning

confidence: 99%

Alloying design of biodegradable zinc as promising bone implants for load-bearing applications

et al. 2020

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Magnesium-based biodegradable metals (BMs) as bone implants have better mechanical properties than biodegradable polymers, yet their strength is roughly less than 350 MPa. In this work, binary Zn alloys with alloying elements Mg, Ca, Sr, Li, Mn, Fe, Cu, and Ag respectively, are screened systemically by in vitro and in vivo studies. Li exhibits the most effective strengthening role in Zn, followed by Mg. Alloying leads to accelerated degradation, but adequate mechanical integrity can be expected for Zn alloys when considering bone fracture healing. Adding elements Mg, Ca, Sr and Li into Zn can improve the cytocompatibility, osteogenesis, and osseointegration. Further optimization of the ternary Zn-Li alloy system results in Zn-0.8Li-0.4Mg alloy with the ultimate tensile strength 646.69 ± 12.79 MPa and Zn-0.8Li-0.8Mn alloy with elongation 103.27 ± 20%. In summary, biocompatible Znbased BMs with strength close to pure Ti are promising candidates in orthopedics for loadbearing applications.

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Section: Discussionmentioning

confidence: 99%

Alloying design of biodegradable zinc as promising bone implants for load-bearing applications

et al. 2020

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“…Although the traditional metallic and synthetic polymeric orthopedic implants have been predominantly applied in surgeries, they have shown increasing limitations in the treatment of some challenging bone diseases including osteoporotic fractures,12 nontraumatic osteonecrosis,13 atypical femoral fractures,14 and distraction osteogenesis15 due to impaired osteogenesis and angiogenesis of the host bone tissue 14,16. Recently, there have been enormous studies about the development of magnesium (Mg)‐based orthopedic implants dedicated by material engineers, preclinical scientists and clinicians,17–20 which may be able to address the flaws in current commercialized orthopedic implants. Mg is a biodegradable metal, with good biocompatibility and desirable Young's modulus close to that of natural cortical bone, and thus widely recognized as a potentially revolutionary orthopedic biomaterial 21.…”

Section: Introductionmentioning

confidence: 99%

“…Although there are numerus Reviews focusing on the design and degradation pattern of biodegradable metals,24,25 testing methods of corrosion mode of Mg‐based metals,21 current reported clinical trials,20 and interaction between biomaterials and cells,26 it still remains unclear with regards to the repair mechanism of Mg ions in bone fracture repair, extension of future clinical indications, and strategies for its application at high weight‐bearing skeletal sites. Therefore, we would like to address these questions in this Review and hope to broaden our understanding on its basic medical sciences and extend the use of Mg‐based implants in orthopedics.…”

Section: Introductionmentioning

confidence: 99%

Biodegradable Magnesium‐Based Implants in Orthopedics—A General Review and Perspectives

et al. 2020

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Biodegradable Mg‐based metals may be promising orthopedic implants for treating challenging bone diseases, attributed to their desirable mechanical and osteopromotive properties. This Review summarizes the current status and future research trends for Mg‐based orthopedic implants. First, the properties between Mg‐based implants and traditional orthopedic implants are compared on the following aspects: in vitro and in vivo degradation mechanisms of Mg‐based implants, peri‐implant bone responses, the fate of the degradation products, and the cellular and molecular mechanisms underlying the beneficial effects of Mg ions on osteogenesis. Then, the preclinical studies conducted at the low weight bearing sites of animals are introduced. The innovative strategies (for example, via designing Mg‐containing hybrid systems) are discussed to address the limitations of Mg‐based metals prior to their clinical applications at weight‐bearing sites. Finally, the available clinical studies are summarized and the challenges and perspectives of Mg‐based orthopedic implants are discussed. Taken together, the progress made on the development of Mg‐based implants in basic, translational, and clinical research has laid down a foundation for developing a new era in the treatment of challenging and prevalent bone diseases.

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“…Stainless steel and titanium are current metals used as bioinert and permeant Class-III implants for orthopaedic applications. Recently, bioactive or biodegradable metals have attracted great attention in research and development (R&D) of biomaterials for clinical applications [1][2][3][4]. Our recent clinical work showed that the bone grafting fixation using biodegradable pure Mg screw was beneficial for successful fixation of bony flap used for treatment of osteonecrosis of the femoral head (ONFH) in patients with steroid-associated osteonecrosis https://doi.org/10.1016/j.biomaterials.2020.119828 Received 4 October 2019; Received in revised form 7 January 2020; Accepted 25 January 2020 (SAON) where bony flap displacement was avoided and local bone density was increased accompanied by Mg-screw degradation, partially explained by the biologic effects of degraded Mg ions, yet like many available related clinical studies the scientific or mechanistic evidence was lacking [5].…”

Section: Introductionmentioning

confidence: 99%

Magnesium and vitamin C supplementation attenuates steroid-associated osteonecrosis in a rat model

Wang

et al. 2020

Biomaterials

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A B S T R A C TMagnesium (Mg)-based biometal attracts clinical applications due to its biodegradability and beneficial biological effects on tissue regeneration, especially in orthopaedics, yet the underlying anabolic mechanisms in relevant clinical disorders are lacking. The present study investigated the effect of magnesium (Mg) and vitamin C (VC) supplementation for preventing steroid-associated osteonecrosis (SAON) in a rat experimental model. In SAON rats, 50 mg/kg Mg, or 100 mg/kg VC, or combination, or water control was orally supplemented daily for 2 or 6 weeks respectively. Osteonecrosis was evaluated by histology. Serum Mg, VC, and bone turnover markers were measured. Microfil-perfused samples prepared for angiography and trabecular architecture were evaluated by micro-CT. Primary bone marrow cells were isolated from each group to evaluate their potentials in osteoblastogenesis and osteoclastogenesis. The mechanisms were tested in vitro. Histological evaluation showed SAON lesions in steroid treated groups. Mg and VC supplementation synergistically reduced the apoptosis of osteocytes and osteoclast number, and increased osteoblast surface. VC supplementation significantly increased the bone formation marker PINP, and the combination significantly decreased the bone resorption marker CTX. TNFα expression and oxidative injury were decreased in bone marrow in Mg/VC/combination group. Mg significantly increased the blood perfusion in proximal tibia and decreased the leakage particles in distal tibia 2 weeks after SAON induction. VC significantly elevated the osteoblast differentiation potential of marrow cells and improved the trabecular architecture. The combination supplementation significantly inhibited osteoclast differentiation potential of marrow cells. In vitro study showed promoting osteoblast differentiation effect of VC, and antiinflammation and promoting angiogenesis effect of Mg with underlying mechanisms. Mg and VC supplementation could synergistically alleviate SAON in rats, indicating great translational potentials of metallic minerals for preventing SAON.

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Current status and outlook on the clinical translation of biodegradable metals

Cited by 310 publications

References 106 publications

Alloying design of biodegradable zinc as promising bone implants for load-bearing applications

Alloying design of biodegradable zinc as promising bone implants for load-bearing applications

Biodegradable Magnesium‐Based Implants in Orthopedics—A General Review and Perspectives

Magnesium and vitamin C supplementation attenuates steroid-associated osteonecrosis in a rat model

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