Eric Aguado

Macroporous biphasic calcium phosphate ceramics: influence of macropore diameter and macroporosity percentage on bone ingrowth

A total of 60 cylindrical 6 x 6 mm samples of a macroporous biphasic calcium phosphate (MBCP) ceramic were implanted into a distal femoral site in 30 rabbits. These samples represented six kinds of implants with two different macropore diameters and three different macroporosity percentages. Analysis of backscattered electron images of implant surfaces analysed by a factorial design method showed that implants with 565 microm pore size provided more abundant newly formed bone both in peripheral and deep pores than those with 300 microm pore size. No significant differences were found between implants with 40 and 50% macroporosity, suggesting that the influence of macropore size on bone ingrowth was greater than that of macroporosity percentage. MBCP implants with 565 microm pore diameter and 40% macroporosity represented the optimal association for homogeneous and abundant bone ingrowth.

Kinetic study of bone ingrowth and ceramic resorption associated with the implantation of different injectable calcium‐phosphate bone substitutes

This study investigated the in vivo performance of two composite injectable bone substitutes (IBS), each with different calcium-phosphate particles granulometries [40-80 (IBS 40-80) and 200-500 microm (IBS 200-500)]. These biomaterials were obtained by associating a biphasic calcium-phosphate (BCP) ceramic mineral phase with a 3% aqueous solution of a cellulosic polymer (hydroxy-propyl-methyl-cellulose). Both materials were injected for periods of 2, 3, 8, or 12 weeks into bone defects at the distal end of rabbit femurs. Quantitative results on new bone formation, BCP resorption, and staining for tartrate-resistant acid phosphatase (TRAP) activity were studied for statistical purposes. Measurements with scanning electron microscopy and image analysis showed that the final rates of newly formed bone were similar for both tested IBS after 12 weeks of implantation. Bone colonization occurred more extensively during early implantation times for IBS 40-80 than for IBS 200-500. For the latter, BCP degradation occurred regularly throughout the implantation period, whereas it was very intensive during the first 2 weeks for IBS 40-80. Positive TRAP-stained degradation cells were significantly more numerous for IBS 40-80 than for IBS 200-500 regardless of implantation time. With the granulometry of either mineral phase, both tested IBS supported extensive bone colonization, which was greater than that previously reported for an equivalent block of macroporous BCP. The resorption-bone substitution process seemed to occur earlier and faster for IBS 40-80 than for IBS 200-500. Both tested IBS expressed similar biological efficiency, with conserved in vivo bioactivity and bone-filling ability.

Biphasic Calcium Phosphate/Hydrosoluble Polymer Composites: A New Concept for Bone and Dental Substitution Biomaterials

Calcium phosphate materials have been increasingly employed in orthopedic and dental applications in recent years and are now being developed for use in noninvasive surgery or as carriers for drug delivery systems. We developed an injectable bone substitute (IBS) constituted of biphasic calcium phosphate and a hydrosoluble polymer as a carrier. In vivo biocompatibility and biofunctionality of IBS were tested in rabbits using implants in osseous and nonosseous areas. The results obtained demonstrated that the concept of IBS, a filler without initial mechanical properties but able to be rapidly resorbed and replaced by newly formed bone, can be applied to new surgical applications in orthopedic surgery, maxillofacial surgery, and dentistry for pulp capping and root filling.

Elaboration conditions influence physicochemical properties and in vivo bioactivity of macroporous biphasic calcium phosphate ceramics

Two different preparations of biphasic calcium phosphate (BCP) were characterized in vitro: BCP1 from a mechanical mixture of hydroxyapatite (HA) and β-tricalcium phosphate (β-TCP) powders, and BCP2 from calcination of a calcium-deficient apatite (CDA). The structural, physicochemical and mechanical parameters of these two preparations were investigated, and two different macroporous BCP1 (MBCP1) and BCP2 MBCP2) implants were manufactured and implanted in rabbit bone for in vivo bioactivity studies. Scanning electron microscopy observations showed that MBCP1 implants had a significantly higher degradation rate (P<0.0001) than MBCP2 implants. This was probably caused by the presence of calcium oxide impurities in BCP1 and the more intimate mixture and stable ultrastructure of BCP2. No significant difference about the newly formed bone rate in these two BCP preparations was observed. Very slight variations in sintering conditions appeared to influence the biodegradation behavior of the two MBCP implants despite their identical HA/β-TCP ratios and similar porosity. Precise and complete in vitro characterization enabled us to understand and predict in vivo degradation behavior.

Short-term effects of mineral particle sizes on cellular degradation activity after implantation of injectable calcium phosphate biomaterials and the consequences for bone substitution

This in vivo study investigated the influence of two calcium phosphate particle sizes (40-80 microm and 200-500 microm) on the cellular degradation activity associated with the bone substitution process of two injectable bone substitutes (IBS). The tested biomaterials were obtained by associating a biphasic calcium phosphate (BCP) ceramic mineral phase and a 3% aqueous solution of a cellulosic polymer (hydroxypropylmethylcellulose). Both were injected into osseous defects at the distal end of rabbit femurs for 2- and 3-week periods. Quantitative results for tartrate-resistant acid phosphatase (TRAP) cellular activity, new bone formation, and ceramic resorption were studied for statistical purposes. Positive TRAP-stained degradation cells were significantly more numerous for IBS 40-80 than IBS 200-500, regardless of implantation time. BCP degradation was quite marked during the first 2 weeks for IBS 40-80, and bone colonization occurred more extensively for IBS 40-80 than for IBS 200-500. The resorption-bone substitution process occurred earlier and faster for IBS 40-80 than IBS 200-500. Both tested IBS displayed similar biological efficiency, with conserved in vivo bioactivity and bone-filling ability. Differences in calcium phosphate particle sizes influenced cellular degradation activity and ceramic resorption but were compatible with efficient bone substitution.

Human Growth Hormone Locally Released in Bone Sites by Calcium-Phosphate Biomaterial Stimulates Ceramic Bone Substitution Without Systemic Effects: A Rabbit Study

Calcium‐phosphate bone replacement biomaterial has been used as a drug carrier for therapeutic agents. This study investigated the efficacy of local administration of human growth hormone (hGH) by macroporous biphasic calcium phosphate (MBCP) implants in improving the bone substitution qualities of ceramics. hGH release from MBCP implants loaded with 1 μg of hGH was rapid during the first 48 h and then sustained for a total of 9 days. Immunolocalization of hGH in vitro and in vivo by transmission electron microscopy showed its presence inside the material, indicating that it was able to penetrate within the porosity of the ceramic during the adsorption process. MBCP cylinders (6 × 6 mm) were loaded with 0.1, 1, and 10 μg of hGH and implanted into rabbit femurs (n = 40). The effects of locally released hGH on bone ingrowth and ceramic resorption were evaluated by scanning electron microscopy and image analysis. The results indicated that hGH increased bone ingrowth (+65%) and ceramic resorption (+140%) significantly in comparison with control implants and that the increase was dose dependent. Biochemical parameters monitored in rabbit plasma and urine, as well as the absence of any significant difference between contralateral implants and the control, indicated that hGH did not produce detectable systemic effects. Thus, the use of MBCP appears to be effective for local delivery of hGH, resulting in improved bone substitution.

Developments in injectable multiphasic biomaterials. The performance of microporous biphasic calcium phosphate granules and hydrogels

Calcium phosphate bioceramic granules associated with hydrosoluble polymers were developed as bone substitutes for various maxillofacial and orthopaedic applications. These injectable bone substitutes, support and regenerate bone tissue and resorb after implantation. The efficiency of these multiphasic materials is due to the osteogenic and osteoconductive properties of the microporous biphasic calcium phosphate. The associated hydrosoluble polymers are considered as carriers in order to achieve the rheological properties of injectable bone substitutes (IBS). In this study, we used 2 semi synthetic hydrosoluble polymers of polysaccharidic origin. The hydroxy propyl methyl cellulose (HPMC), with and without silane, was combined with microporous BCP granules. The presence of silane induced considerable gelation of the suspension. The 2 IBS used (without gelation, IBS1, with gelation, IBS2) were implanted in critical size femoral epiphysis defects in rabbits. No foreign body reactions were observed in either sample. However, because of the higher density from gelation, cell colonisation followed by bone tissue ingrowth was delayed over time with IBS2 compared to the IBS1 without gelation. The results showed resorption of the BCP granule and bone ingrowth at the expense of both IBS with different kinetics. This study demonstrates that the hydrogel cannot be considered merely as a carrier. The gelation process delayed cell and tissue colonisation by slow degradation of the HPMC Si, compared to the faster release of HPMC with IBS1, in turn inducing faster permeability and spaces for tissue ingrowth between the BCP granules.

Effects of FGF-2 release from a hydrogel polymer on bone mass and microarchitecture

Bone substitutes are widely used for filling and restoring bone defects. Among them, methacrylic polymers are employed in load-bearing bones to seal hip prostheses. Incorporation of growth factors into a polymer device could be a way to enhance bone growth. In the present study, we evaluated the capacity of poly(2-hydroxyethyl methacrylate) - pHEMA - copolymerized with 2-vinyl pyrrolidone - VP - to release proteins. Fibroblast growth factor-2 (FGF-2) was incorporated into cylinders of p(HEMA-co-VP). FGF-2 release was studied by ELISA in vitro and cylinders were implanted in the femoral condyle of white New Zealand rabbits. After 2 months post-surgery, FGF-2 was able to enhance bone formation by increasing bone volume; this effect was evidenced by an increase in trabecular number and bone gain was mainly in the form of woven bone. At 3 months post-surgery, no difference could be evidenced between animals receiving vehicle or FGF-2. Animals receiving vehicle exhibited bone mass higher than at 2 months and woven bone was replaced by mature bone with a lamellar matrix. The hydrogel polymer allowed the release of FGF-2, which in return enhanced bone regeneration soon after surgery but the effect vanished rapidly.

In Vivo Retrovirus-Mediated Gene Transfer to the Liver of Dogs Results in Transient Expression and Induction of a Cytotoxic Immune Response

Gene transfer in regenerating dog liver using high-titer recombinant retroviral vectors carrying the E. coli beta-galactosidase gene was studied. Supernatants containing amphotropic or gibbon ape pseudotyped recombinant retroviruses were infused into a peripheral vein in beagle dogs after partial hepatectomy. The kinetics of liver regeneration were determined in the animals and daily infusions were carried out for 4 or 5 days during the regeneration period. Up to 2.8% of hepatocytes were beta-galactosidase positive at the end of the procedure. However, the number of positive cells declined rapidly and few positive hepatocytes were detected after 3 weeks. PCR demonstrated the disappearance of the provirus. Histologically, inflammatory lesions were observed in the transduced livers. Finally, we demonstrated the presence of a cytotoxic T lymphocyte immune response directed against beta-galactosidase-expressing cells, which could explain the disappearance of the transgene. This work suggests that the efficiency of in vivo gene delivery using high-titer retroviral vectors directly infused into the circulation may be hampered by a cytotoxic immune response against the infected cells.

Growth hormone‐loaded macroporous calcium phosphate ceramic: In vitro biopharmaceutical characterization and preliminary in vivo study

Calcium phosphate ceramics recently have been used for administering therapeutic agents in bone. The present work investigated the efficacy of macroporous biphasic calcium phosphate (MBCP) implants as a matrix for local delivery of human growth hormone (hGH). An initial study showed that the release of 5 microg of hGH loaded onto MBCP cylinders was rapid during the first 48 h and sustained for a total of 11 days. The biological integrity of hGH (88.2%) was checked using a specific bioassay (cellular proliferation of hGH-sensitive Nb2 cells) in comparison with a radioimmunoassay to calculate the proportion of bioactive hGH released. MBCP cylinders then were loaded with 1, 10, and 100 microg of hGH and implanted into rabbit femurs (n = 16) to determine hGH effects on bone ingrowth and ceramic resorption, as evaluated by scanning electron microscopy and image analysis. Results indicated that hGH increased bone ingrowth and ceramic resorption significantly in comparison with contralateral and control implants. Biochemical parameters monitored in rabbit plasma showed that hGH did not produce detectable systemic effects. Thus the use of MBCP appears to be effective for local delivery of hGH and for increasing bone ingrowth.