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Bone regenerating effect of surface-functionalized titanium implants with sustained-release characteristics of strontium in ovariectomized rats

Identifieur interne : 000648 ( Pmc/Curation ); précédent : 000647; suivant : 000649

Bone regenerating effect of surface-functionalized titanium implants with sustained-release characteristics of strontium in ovariectomized rats

Auteurs : Vincent Offermanns [Autriche] ; Ole Zoffmann Andersen [Danemark] ; Gregor Riede [Autriche] ; Inge Hald Andersen [Danemark] ; Klaus Pagh Almtoft [Danemark] ; S Ren S Rensen [Danemark] ; Michael Sillassen [Danemark] ; Christian Sloth Jeppesen [Danemark] ; Michael Rasse [Autriche] ; Morten Foss [Danemark] ; Frank Kloss [Autriche]

Source :

RBID : PMC:4892864

Abstract

Since strontium (Sr) is known for its anabolic and anticatabolic effect on bone, research has been focused on its potential impact on osseointegration. The objective of this study was to investigate the performance of nanotopographic implants with a Sr-functionalized titanium (Ti) coating (Ti–Sr–O) with respect to osseointegration in osteoporotic bone. The trial was designed to examine the effect of sustained-release characteristics of Sr in poor-quality bone. Three Ti–Sr–O groups, which differed from each other in coating thickness, Sr contents, and Sr release, were examined. These were prepared by a magnetron sputtering process and compared to uncoated grade 4 Ti. Composition, morphology, and mechanical stability of the coatings were analyzed, and Sr release data were gained from in vitro washout experiments. In vivo investigation was carried out in an osteoporotic rat model and analyzed histologically, 6 weeks and 12 weeks after implantation. Median values of bone-to-implant contact and new bone formation after 6 weeks were found to be 84.7% and 54.9% (best performing Sr group) as compared to 65.2% and 23.8% (grade 4 Ti reference), respectively. The 12-week observation period revealed 84.3% and 56.5% (best performing Sr group) and 81.3% and 39.4% (grade 4 Ti reference), respectively, for the same measurements. The increase in new bone formation was found to correlate with the amount of Sr released in vitro. The results indicate that sputtered nanostructured Ti–Sr–O coatings showed sustained release of Sr and accelerate osseointegration even in poor-quality bone, and thus, may have impact on practical applications for medical implants.


Url:
DOI: 10.2147/IJN.S101673
PubMed: 27313456
PubMed Central: 4892864

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<p>Since strontium (Sr) is known for its anabolic and anticatabolic effect on bone, research has been focused on its potential impact on osseointegration. The objective of this study was to investigate the performance of nanotopographic implants with a Sr-functionalized titanium (Ti) coating (Ti–Sr–O) with respect to osseointegration in osteoporotic bone. The trial was designed to examine the effect of sustained-release characteristics of Sr in poor-quality bone. Three Ti–Sr–O groups, which differed from each other in coating thickness, Sr contents, and Sr release, were examined. These were prepared by a magnetron sputtering process and compared to uncoated grade 4 Ti. Composition, morphology, and mechanical stability of the coatings were analyzed, and Sr release data were gained from in vitro washout experiments. In vivo investigation was carried out in an osteoporotic rat model and analyzed histologically, 6 weeks and 12 weeks after implantation. Median values of bone-to-implant contact and new bone formation after 6 weeks were found to be 84.7% and 54.9% (best performing Sr group) as compared to 65.2% and 23.8% (grade 4 Ti reference), respectively. The 12-week observation period revealed 84.3% and 56.5% (best performing Sr group) and 81.3% and 39.4% (grade 4 Ti reference), respectively, for the same measurements. The increase in new bone formation was found to correlate with the amount of Sr released in vitro. The results indicate that sputtered nanostructured Ti–Sr–O coatings showed sustained release of Sr and accelerate osseointegration even in poor-quality bone, and thus, may have impact on practical applications for medical implants.</p>
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<pmc article-type="research-article">
<pmc-dir>properties open_access</pmc-dir>
<front>
<journal-meta>
<journal-id journal-id-type="nlm-ta">Int J Nanomedicine</journal-id>
<journal-id journal-id-type="iso-abbrev">Int J Nanomedicine</journal-id>
<journal-id journal-id-type="publisher-id">International Journal of Nanomedicine</journal-id>
<journal-title-group>
<journal-title>International Journal of Nanomedicine</journal-title>
</journal-title-group>
<issn pub-type="ppub">1176-9114</issn>
<issn pub-type="epub">1178-2013</issn>
<publisher>
<publisher-name>Dove Medical Press</publisher-name>
</publisher>
</journal-meta>
<article-meta>
<article-id pub-id-type="pmid">27313456</article-id>
<article-id pub-id-type="pmc">4892864</article-id>
<article-id pub-id-type="doi">10.2147/IJN.S101673</article-id>
<article-id pub-id-type="publisher-id">ijn-11-2431</article-id>
<article-categories>
<subj-group subj-group-type="heading">
<subject>Original Research</subject>
</subj-group>
</article-categories>
<title-group>
<article-title>Bone regenerating effect of surface-functionalized titanium implants with sustained-release characteristics of strontium in ovariectomized rats</article-title>
</title-group>
<contrib-group>
<contrib contrib-type="author">
<name>
<surname>Offermanns</surname>
<given-names>Vincent</given-names>
</name>
<xref ref-type="aff" rid="af1-ijn-11-2431">1</xref>
<xref ref-type="corresp" rid="c1-ijn-11-2431"></xref>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Andersen</surname>
<given-names>Ole Zoffmann</given-names>
</name>
<xref ref-type="aff" rid="af2-ijn-11-2431">2</xref>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Riede</surname>
<given-names>Gregor</given-names>
</name>
<xref ref-type="aff" rid="af1-ijn-11-2431">1</xref>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Andersen</surname>
<given-names>Inge Hald</given-names>
</name>
<xref ref-type="aff" rid="af3-ijn-11-2431">3</xref>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Almtoft</surname>
<given-names>Klaus Pagh</given-names>
</name>
<xref ref-type="aff" rid="af3-ijn-11-2431">3</xref>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Sørensen</surname>
<given-names>Søren</given-names>
</name>
<xref ref-type="aff" rid="af3-ijn-11-2431">3</xref>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Sillassen</surname>
<given-names>Michael</given-names>
</name>
<xref ref-type="aff" rid="af2-ijn-11-2431">2</xref>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Jeppesen</surname>
<given-names>Christian Sloth</given-names>
</name>
<xref ref-type="aff" rid="af3-ijn-11-2431">3</xref>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Rasse</surname>
<given-names>Michael</given-names>
</name>
<xref ref-type="aff" rid="af1-ijn-11-2431">1</xref>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Foss</surname>
<given-names>Morten</given-names>
</name>
<xref ref-type="aff" rid="af2-ijn-11-2431">2</xref>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Kloss</surname>
<given-names>Frank</given-names>
</name>
<xref ref-type="aff" rid="af1-ijn-11-2431">1</xref>
</contrib>
</contrib-group>
<aff id="af1-ijn-11-2431">
<label>1</label>
Department of Cranio-, Maxillofacial and Oral Surgery, Medical University Innsbruck, Innsbruck, Austria</aff>
<aff id="af2-ijn-11-2431">
<label>2</label>
Interdisciplinary Nanoscience Center (iNANO), Faculty of Science and Technology, Aarhus University, Aarhus, Denmark</aff>
<aff id="af3-ijn-11-2431">
<label>3</label>
Tribology Centre, Danish Technological Institute, Aarhus, Denmark</aff>
<author-notes>
<corresp id="c1-ijn-11-2431">Correspondence: Vincent Offermanns, Department of Cranio-, Maxillofacial and Oral Surgery, Medical University Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria, Tel +43 512 504 24373, Email
<email>vincent.offermanns@i-med.ac.at</email>
</corresp>
</author-notes>
<pub-date pub-type="collection">
<year>2016</year>
</pub-date>
<pub-date pub-type="epub">
<day>30</day>
<month>5</month>
<year>2016</year>
</pub-date>
<volume>11</volume>
<fpage>2431</fpage>
<lpage>2442</lpage>
<permissions>
<copyright-statement>© 2016 Offermanns et al. This work is published and licensed by Dove Medical Press Limited</copyright-statement>
<copyright-year>2016</copyright-year>
<license>
<license-p>The full terms of this license are available at
<ext-link ext-link-type="uri" xlink:href="https://www.dovepress.com/terms.php">https://www.dovepress.com/terms.php</ext-link>
and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License (
<ext-link ext-link-type="uri" xlink:href="http://creativecommons.org/licenses/by-nc/3.0/">http://creativecommons.org/licenses/by-nc/3.0/</ext-link>
). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed.</license-p>
</license>
</permissions>
<abstract>
<p>Since strontium (Sr) is known for its anabolic and anticatabolic effect on bone, research has been focused on its potential impact on osseointegration. The objective of this study was to investigate the performance of nanotopographic implants with a Sr-functionalized titanium (Ti) coating (Ti–Sr–O) with respect to osseointegration in osteoporotic bone. The trial was designed to examine the effect of sustained-release characteristics of Sr in poor-quality bone. Three Ti–Sr–O groups, which differed from each other in coating thickness, Sr contents, and Sr release, were examined. These were prepared by a magnetron sputtering process and compared to uncoated grade 4 Ti. Composition, morphology, and mechanical stability of the coatings were analyzed, and Sr release data were gained from in vitro washout experiments. In vivo investigation was carried out in an osteoporotic rat model and analyzed histologically, 6 weeks and 12 weeks after implantation. Median values of bone-to-implant contact and new bone formation after 6 weeks were found to be 84.7% and 54.9% (best performing Sr group) as compared to 65.2% and 23.8% (grade 4 Ti reference), respectively. The 12-week observation period revealed 84.3% and 56.5% (best performing Sr group) and 81.3% and 39.4% (grade 4 Ti reference), respectively, for the same measurements. The increase in new bone formation was found to correlate with the amount of Sr released in vitro. The results indicate that sputtered nanostructured Ti–Sr–O coatings showed sustained release of Sr and accelerate osseointegration even in poor-quality bone, and thus, may have impact on practical applications for medical implants.</p>
</abstract>
<kwd-group>
<title>Keywords</title>
<kwd>nanotopography</kwd>
<kwd>osteoinduction</kwd>
<kwd>osseointegration</kwd>
<kwd>osteoporosis</kwd>
<kwd>rodent</kwd>
</kwd-group>
</article-meta>
</front>
<floats-group>
<fig id="f1-ijn-11-2431" position="float">
<label>Figure 1</label>
<caption>
<p>Micro-computed tomography images.</p>
<p>
<bold>Notes:</bold>
(
<bold>A</bold>
) Tibia control and (
<bold>B</bold>
) tibia from ovariectomized rat (OVX) 14 weeks after bilateral OVX. The tibia from the OVX rat shows ~50% less bone volume compared to control; measurements were taken 2 mm away from the epiphyseal plate (indicated by red arrows and dotted lines). Scale bars are 1,000 μm.</p>
<p>
<bold>Abbreviation:</bold>
OVX, ovariectomy.</p>
</caption>
<graphic xlink:href="ijn-11-2431Fig1"></graphic>
</fig>
<fig id="f2-ijn-11-2431" position="float">
<label>Figure 2</label>
<caption>
<p>Surgical procedure shown in four steps.</p>
<p>
<bold>Notes:</bold>
(
<bold>A</bold>
) Exposed knee cap after incision; (
<bold>B</bold>
) drill between the medial collateral ligament and patella tendon; (
<bold>C</bold>
) inserted implant (marked with yellow arrow); and (
<bold>D</bold>
) skin suture.</p>
</caption>
<graphic xlink:href="ijn-11-2431Fig2"></graphic>
</fig>
<fig id="f3-ijn-11-2431" position="float">
<label>Figure 3</label>
<caption>
<p>Histological samples, stained with toluidine blue, including reference boxes and magnified images.</p>
<p>
<bold>Notes:</bold>
Reference box was 250×3,000 mm
<sup>2</sup>
and marks the standard area used to evaluate new bone formation: (
<bold>A</bold>
) 6 weeks, grade 4 Ti reference; (
<bold>B</bold>
) 6 weeks, unmodified 2,000 nm Ti–Sr–O coating; (
<bold>C</bold>
) 12 weeks, grade 4 Ti reference; and (
<bold>D</bold>
) 12 weeks, unmodified 2,000 nm Ti–Sr–O coating. The area of new bone formation inside the reference box was measured for all samples and used to calculate the percentage of de novo bone synthesis (marked with yellow arrows) with respect to the total reference area. In all cases, the edge of the reference area was at least 2 mm away from the growth plate. The side of the reference box facing the implant surface was also used to evaluate the percentage of direct BIC with respect to the total length of the reference. Scale bars are 1,000 μm.</p>
<p>
<bold>Abbreviation:</bold>
BIC, bone-to-implant contact.</p>
</caption>
<graphic xlink:href="ijn-11-2431Fig3"></graphic>
</fig>
<fig id="f4-ijn-11-2431" position="float">
<label>Figure 4</label>
<caption>
<p>SEM images of the two basis coatings deposited onto Si wafer substrates.</p>
<p>
<bold>Notes:</bold>
The intermediate Ti binding layer and Ti–Sr–O layer are indicated by the dotted lines: (
<bold>A</bold>
) 1,500 nm Ti–Sr–O coating. (
<bold>B</bold>
) 2,000 nm Ti–Sr–O coating. The morphology of the two coatings appears highly similar, having a column-like structure. Moreover, the structure appears granular and porous, and this has been found to be a key feature in relation to obtaining the desired Sr release characteristics.</p>
<p>
<bold>Abbreviation:</bold>
SEM, scanning electron microscopy.</p>
</caption>
<graphic xlink:href="ijn-11-2431Fig4"></graphic>
</fig>
<fig id="f5-ijn-11-2431" position="float">
<label>Figure 5</label>
<caption>
<p>Accumulated Sr release from the three Ti–Sr–O groups as determined by ICP-AES.</p>
<p>
<bold>Notes:</bold>
(
<bold>A</bold>
) The accumulated amount of Sr released over a period of 14 days. It is evident that the 2,000 nm (no wash) coating presents the highest release value, while the release of the 2,000 nm (industrial wash) and the 1,500 nm (22 minutes) is significantly lower. By presenting the accumulated release, the amount released within the first day greatly influences the graphical representation. (
<bold>B</bold>
) The accumulated amount of Sr release in the period between days 1 and 14. Here, the data from the initial 24 hours are omitted as indicated by the dashed line. Standard deviations for the measured values are included. However, for the majority of the measurements, these are smaller than the utilized markers. The legend applies to both graphs.</p>
<p>
<bold>Abbreviation:</bold>
ICP-AES, inductively coupled plasma atomic emission spectroscopy.</p>
</caption>
<graphic xlink:href="ijn-11-2431Fig5"></graphic>
</fig>
<fig id="f6-ijn-11-2431" position="float">
<label>Figure 6</label>
<caption>
<p>
<italic>R</italic>
<sub>a</sub>
measured on the surface of the four different implant groups.</p>
<p>
<bold>Note:</bold>
No statistical significant differences between the groups were found.</p>
<p>
<bold>Abbreviation:</bold>
<italic>R</italic>
<sub>a</sub>
, surface roughness.</p>
</caption>
<graphic xlink:href="ijn-11-2431Fig6"></graphic>
</fig>
<fig id="f7-ijn-11-2431" position="float">
<label>Figure 7</label>
<caption>
<p>In vivo data 6 weeks after implantation.</p>
<p>
<bold>Notes:</bold>
(
<bold>A</bold>
) Percentage of new bone formation (BA%). (
<bold>B</bold>
) Percentage of direct bone-to-implant contact (BIC%). Significant differences with respect to the grade 4 Ti reference are marked with **
<italic>P</italic>
<0.01 and ***
<italic>P</italic>
<0.001. Significant differences with respect to 2,000 nm with no wash are marked with
<sup></sup>
<italic>P</italic>
<0.05.</p>
<p>
<bold>Abbreviations:</bold>
BA%, bone area percentage; BIC%, bone-to-implant contact percentage.</p>
</caption>
<graphic xlink:href="ijn-11-2431Fig7"></graphic>
</fig>
<fig id="f8-ijn-11-2431" position="float">
<label>Figure 8</label>
<caption>
<p>In vivo data 12 weeks after implantation.</p>
<p>
<bold>Notes:</bold>
(
<bold>A</bold>
) Percentage of new bone formation (BA%). (
<bold>B</bold>
) Percentage of direct BIC. Significant differences with respect to grade 4 Ti reference are marked with *
<italic>P</italic>
<0.05, **
<italic>P</italic>
<0.01, and ***
<italic>P</italic>
<0.001.</p>
<p>
<bold>Abbreviations:</bold>
BA%, bone area percentage; BIC%, bone-to-implant contact percentage.</p>
</caption>
<graphic xlink:href="ijn-11-2431Fig8"></graphic>
</fig>
<fig id="f9-ijn-11-2431" position="float">
<label>Figure 9</label>
<caption>
<p>Comparison of (
<bold>A</bold>
) BA% and (
<bold>B</bold>
) BIC% after 6 weeks (white column) and 12 weeks (red squared column) postimplantation.</p>
<p>
<bold>Note:</bold>
Significant differences between the two time intervals are marked with *
<italic>P</italic>
<0.05.</p>
<p>
<bold>Abbreviations:</bold>
BA%, bone area percentage; BIC%, bone-to-implant contact percentage.</p>
</caption>
<graphic xlink:href="ijn-11-2431Fig9"></graphic>
</fig>
<table-wrap id="t1-ijn-11-2431" position="float">
<label>Table 1</label>
<caption>
<p>The three Ti–Sr–O coating groups used throughout this study</p>
</caption>
<table frame="hsides" rules="groups">
<thead>
<tr>
<th valign="top" align="left" rowspan="1" colspan="1">Group #</th>
<th valign="top" align="left" rowspan="1" colspan="1">Coating thickness</th>
<th valign="top" align="left" rowspan="1" colspan="1">Prewash parameters</th>
<th valign="top" align="left" rowspan="1" colspan="1">Final Sr surface content</th>
<th valign="top" align="left" rowspan="1" colspan="1">Samples description (prewash parameters)</th>
</tr>
</thead>
<tbody>
<tr>
<td valign="top" align="left" rowspan="1" colspan="1">1</td>
<td valign="top" align="left" rowspan="1" colspan="1">1,500 nm</td>
<td valign="top" align="left" rowspan="1" colspan="1">22 minutes PBS</td>
<td valign="top" align="left" rowspan="1" colspan="1">5.8±0.2 at%</td>
<td valign="top" align="left" rowspan="1" colspan="1">1,500 nm (22 minutes)</td>
</tr>
<tr>
<td valign="top" align="left" rowspan="1" colspan="1">2</td>
<td valign="top" align="left" rowspan="1" colspan="1">2,000 nm</td>
<td valign="top" align="left" rowspan="1" colspan="1">No wash</td>
<td valign="top" align="left" rowspan="1" colspan="1">9.1±0.03 at%</td>
<td valign="top" align="left" rowspan="1" colspan="1">2,000 nm (no wash)</td>
</tr>
<tr>
<td valign="top" align="left" rowspan="1" colspan="1">3</td>
<td valign="top" align="left" rowspan="1" colspan="1">2,000 nm</td>
<td valign="top" align="left" rowspan="1" colspan="1">Industrial wash</td>
<td valign="top" align="left" rowspan="1" colspan="1">5.2±0.1 at%</td>
<td valign="top" align="left" rowspan="1" colspan="1">2,000 nm (industrial wash)</td>
</tr>
</tbody>
</table>
<table-wrap-foot>
<fn id="tfn1-ijn-11-2431">
<p>
<bold>Notes:</bold>
The sample name indicates the thickness of the coating and the postdeposition treatment used to modify the sample. Both the 1,500 nm and 2,000 nm coatings were deposited using the same conditions but with a reduced process time in the case of the 1,500 nm coating. The Sr surface content was determined by XPS.</p>
</fn>
<fn id="tfn2-ijn-11-2431">
<p>
<bold>Abbreviations:</bold>
at%, atomic percentage; PBS, phosphate buffered saline; XPS, X-ray photoelectron spectroscopy.</p>
</fn>
</table-wrap-foot>
</table-wrap>
<table-wrap id="t2-ijn-11-2431" position="float">
<label>Table 2</label>
<caption>
<p>Elemental composition of the surfaces of the tested coatings expressed as at%</p>
</caption>
<table frame="hsides" rules="groups">
<thead>
<tr>
<th valign="top" align="left" rowspan="1" colspan="1">Group #</th>
<th valign="top" align="left" rowspan="1" colspan="1">Samples description (washing parameters)</th>
<th valign="top" align="left" rowspan="1" colspan="1">Ti (at%)</th>
<th valign="top" align="left" rowspan="1" colspan="1">Sr (at%)</th>
<th valign="top" align="left" rowspan="1" colspan="1">O (at%)</th>
</tr>
</thead>
<tbody>
<tr>
<td valign="top" align="left" rowspan="1" colspan="1">1</td>
<td valign="top" align="left" rowspan="1" colspan="1">1,500 nm (22 minutes)</td>
<td valign="top" align="left" rowspan="1" colspan="1">24.3±0.3</td>
<td valign="top" align="left" rowspan="1" colspan="1">5.8±0.2</td>
<td valign="top" align="left" rowspan="1" colspan="1">69.9±0.5</td>
</tr>
<tr>
<td valign="top" align="left" rowspan="1" colspan="1">2</td>
<td valign="top" align="left" rowspan="1" colspan="1">2,000 nm (no wash)</td>
<td valign="top" align="left" rowspan="1" colspan="1">22.2±0.5</td>
<td valign="top" align="left" rowspan="1" colspan="1">9.1±0.03</td>
<td valign="top" align="left" rowspan="1" colspan="1">68.6±0.5</td>
</tr>
<tr>
<td valign="top" align="left" rowspan="1" colspan="1">3</td>
<td valign="top" align="left" rowspan="1" colspan="1">2,000 nm (industrial wash)</td>
<td valign="top" align="left" rowspan="1" colspan="1">24.8±0.5</td>
<td valign="top" align="left" rowspan="1" colspan="1">5.2±0.1</td>
<td valign="top" align="left" rowspan="1" colspan="1">70.0±0.3</td>
</tr>
</tbody>
</table>
<table-wrap-foot>
<fn id="tfn3-ijn-11-2431">
<p>
<bold>Note:</bold>
It is evident that the washing procedures reduce the surface Sr content of the two untreated coatings.</p>
</fn>
<fn id="tfn4-ijn-11-2431">
<p>
<bold>Abbreviation:</bold>
at%, atomic percentage.</p>
</fn>
</table-wrap-foot>
</table-wrap>
</floats-group>
</pmc>
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