Long-Term Maintenance of Projection of Nipples Reconstructed Using Three-Dimensionally Printed Poly-4-Hydroxybutyrate Bioabsorbable Scaffolds.

BACKGROUND: For patients who are unable to undergo nipple-sparing mastectomy, reconstruction of the nipple-areola complex has been shown to promote greater satisfaction in cosmetic outcome, body image, and sexual relationships. Although a variety of techniques have been developed to optimize the shape, size, and mechanical properties of the reconstructed nipple-areola complex, maintenance of sustained nipple projection over time remains a challenge for plastic surgeons. METHODS: Three-dimensionally printed poly-4-hydroxybutyrate (P4HB) scaffolds were designed and fabricated filled with either mechanically minced or zested patient-derived costal cartilage, designed with an internal P4HB lattice (rebar) to provide interior structure to foster tissue ingrowth, or left unfilled. All scaffolds were wrapped within a C-V flap on the dorsa of a nude rat. RESULTS: One year after implantation, neonipple projection and diameter were well preserved in all scaffolded groups compared with nonscaffolded neonipples ( P < 0.05). Histologic analysis showed significant vascularized connective tissue ingrowth at 12 months in both empty and rebar-scaffolded neonipples and fibrovascular cartilaginous tissue formation in mechanically processed costal cartilage-filled neonipples. The internal lattice promoted more rapid tissue infiltration and scaffold degradation and best mimicked the elastic modulus of the native human nipple after 1 year in vivo. No scaffolds extruded or caused any mechanical complications. CONCLUSIONS: Three-dimensionally printed biodegradable P4HB scaffolds maintain diameter and projection while approximating the histologic appearance and mechanical properties of native human nipples after 1 year with a minimal complication profile. These long-term preclinical data suggest that P4HB scaffolds may be readily translated for clinical application. CLINICAL RELEVANCE STATEMENT: The authors' unique, three-dimensionally printed P4HB scaffolds can be used to create custom nipple scaffolds that contour to any nipple shape and size, enabling the fabrication of tissue-engineered neonipples with significantly greater projection maintenance and closely approximating desired nipple biomechanical properties.

3D-printed poly-4-hydroxybutyrate bioabsorbable scaffolds for nipple reconstruction.

Nearly all autologous tissue techniques and engineered tissue substitutes utilized for nipple reconstruction are hindered by scar contracture and loss of projection of the reconstructed nipple. The use of unprocessed costal cartilage (CC) as an internal support for the reconstructed nipple has not been widely adopted because of the excessively firm resultant construct. Herein we use a 3D-printed Poly-4-Hydroxybutyrate (P4HB) bioabsorbable scaffold filled with mechanically processed patient-derived CC to foster ingrowth of tissue in vivo to protect the regenerated tissue from contractile forces as it matures. After 6 months in vivo, newly formed spongy fibrovascular cartilaginous tissue was noted in processed CC filled 3D-printed scaffolds, which maintained significantly greater projection than reconstructions without scaffolds. Interestingly, 3D-printed P4HB scaffolds designed with an internal 3D lattice of P4HB filaments (without CC) displayed the fastest material absorption and vascularized adipose-fibrous tissue as demonstrated by SEM and histological analysis, respectively. Using 3D-printed P4HB scaffolds filled with either processed CC, a 3D P4HB lattice or no fills, we have engineered neo-nipples that maintain projection over time, while approximating the biomechanical properties of the native human nipple. We believe that this innovative 3D-printed P4HB nipple reconstruction scaffold will be readily translatable to the clinic. STATEMENT OF SIGNIFICANCE: Nearly all autologous tissue techniques and engineered tissue substitutes utilized for nipple reconstruction are hindered by scar contracture and substantial loss of projection of the reconstructed nipple, leading to significant patient dissatisfaction. Using 3D-printed P4HB scaffolds filled with either processed costal cartilage or 3D P4HB lattices, we have engineered neo-nipples that resist the forces induced by scar contracture, resulting in maintenance of neo-nipple projection over time and biomechanically approximating human nipples after 6 months in vivo implantation. This novel 3D-printed bioabsorbable P4HB scaffold will be readily translatable to the clinic to reconstruct nipples with patient-specific dimensions and long-lasting projection.

Efficacy of treating segmental bone defects through endochondral ossification: 3D printed designs and bone metabolic activities.

Three-dimensional printing (3D printing) is a promising technique for producing scaffolds for bone tissue engineering applications. Porous scaffolds can be printed directly, and the design, shape and porosity can be controlled. 3D synthetic biodegradable polymeric scaffolds intended for in situ bone regeneration must meet stringent criteria, primarily appropriate mechanical properties, good 3D design, adequate biocompatibility and the ability to enhance bone formation. In this study, healing of critical-sized (5 â€‹mm) femur defects of rats was enhanced by implanting two different designs of 3D printed poly(l-lactide-co-ε-caprolactone) (poly(LA-co-CL)) scaffolds seeded with rat bone marrow mesenchymal stem cells (rBMSC), which had been pre-differentiated in vitro into cartilage-forming chondrocytes. Depending on the design, the scaffolds had an interconnected porous structure of 300-500 â€‹µm and porosity of 50-65%. According to a computational simulation, the internal force distribution was consistent with scaffold designs and comparable between the two designs. Moreover, the defects treated with 3D-printed scaffolds seeded with chondrocyte-like cells exhibited significantly increased bone formation up to 15 weeks compared with empty defects. In all experimental animals, bone metabolic activity was monitored by positron emission tomography 1, 3, 5, 7, 11 and 14 weeks after surgery. This demonstrated a time-dependent relationship between scaffold design and metabolic activity. This confirmed that successful regeneration was highly reproducible. The in vitro and in vivo data indicated that the experimental setups had promising outcomes and could facilitate new bone formation through endochondral ossification.

Controlled Release of Chemotherapeutic Platinum-Bisphosphonate Complexes from Injectable Calcium Phosphate Cements.

Herein, we present a method to release chemotherapeutic platinum-bisphosphonate (Pt-BP) complexes from apatitic calcium phosphate cements (CPCs). Pt-BP-loaded hydroxyapatite nanoparticles (HA NPs) were added at different ratios to the powder phase of the cements, which contained poly(D,L-lactic-co-glycolic acid) (PLGA) microspheres as porogens to accelerate their degradation. In vitro release kinetics of Pt-BP complexes revealed that the release rate of Pt species can be tuned by varying the amount of drug-loaded HA NPs as well as modifying the chemical structure of the Pt-BP complex to tailor its affinity with HA NPs. In addition, the incorporation of PLGA microspheres into the CPCs increased the degradation rate of the materials without affecting the release rate of Pt species. Finally, the antiproliferative activity of the free Pt-BP complexes and Pt-BP-loaded CPCs was evaluated using both human osteosarcoma cancer cells (MG-63) and human bone marrow-derived mesenchymal stromal cells (h-BMMSCs). This study demonstrated that both free Pt-BP complexes and the releasates from the CPCs were antiproliferative in a dose-dependent manner. Moreover, their antiproliferative activity was higher on MG-63 cells compared to h-BMMSC primary cells. In summary, it was shown that injectable CPCs can be rendered chemotherapeutically active by incorporation of HA NPs loaded with HA-binding Pt-BP complexes.

Development of porous polyurethane/strontium-substituted hydroxyapatite composites for bone regeneration.

Polyurethane (PU) has been widely used for the biomedical applications but its potential for bone regeneration is limited due to its lack of osteoconductive properties. Strontium substituted hydroxyapatite (SrHA) particles, on the other hand, are known to exhibit a positive effect on bone formation. Therefore, the aim of this study was to (i) develop porous polyurethane scaffolds containing strontium SrHA nanoparticles (PU/SrHA) and (ii) compare their in vitro biological performance for applications in bone regeneration to PU scaffolds. SrHA and HA was synthesized using a conventional wet-chemical neutralization reaction at temperatures of 25, 50, and 80°C. Chemical analysis was performed by inductively coupled plasma-optical emission spectrometry. Synthesizing temperatures at 25 and at 50°C were selected for the composite preparation (abbreviated as HA-25, SrHA-25, HA-50, and SrHA-50, respectively). PU was synthesized from isophorone diisocyanate, polytetramethylene ether glycol, and 1,4-butanediol. Composite scaffolds were prepared by addition of HA or SrHA nanoparticles into PU scaffolds during polymer preparation. The results showed that the Sr content in HA nanoparticles increased with increasing synthesis temperature. The addition of nanoparticles decreased the elongation-at-break and tensile strength, but significantly increased the surface wettability of the PU scaffolds. In vitro degradation tests demonstrated that release of cations was significantly higher from PU/SrHA-50 composite scaffolds. Cell culture tests indicated that PU composites containing either HA or SrHA nanoparticles increased proliferation of bone marrow stem cells as compared to plain PU scaffolds, whereas osteogenic differentiation was not affected by the incorporation of HA nanoparticles irrespective of the incorporation of Sr.

Tuning the degradation rate of calcium phosphate cements by incorporating mixtures of polylactic-co-glycolic acid microspheres and glucono-delta-lactone microparticles.

Calcium phosphate cements (CPCs) are frequently used as synthetic bone graft materials in view of their excellent osteocompatibility and clinical handling behavior. Hydroxyapatite-forming CPCs, however, degrade at very low rates, thereby limiting complete bone regeneration. The current study has investigated whether degradation of apatite-forming cements can be tuned by incorporating acid-producing slow-resorbing poly(D,L-lactic-co-glycolic) acid (PLGA) porogens, fast-resorbing glucono-delta-lactone (GDL) porogens, or mixtures thereof. The physicochemical, mechanical, and degradation characteristics of these CPC formulations were systematically analyzed upon soaking in phosphate-buffered saline (PBS). In parallel, various CPC formulations were implanted intramuscularly and orthotopically on top of the transverse process of goats followed by analysis of the soft tissue response and bone ingrowth after 12 weeks. In vitro degradation of GDL was almost completed after 2 weeks, as evidenced by characterization of the release of gluconic acid, while PLGA-containing CPCs released glycolic acid throughout the entire study (12 weeks), resulting in a decrease in compression strength of CPC. Extensive in vitro degradation of the CPC matrix was observed upon simultaneous incorporation of 30% PLGA-10% GDL. Histomorphometrical evaluation of the intramuscularly implanted samples revealed that all CPCs exhibited degradation, accompanied by an increase in capsule thickness. In the in vivo goat transverse process model, incorporation of 43% PLGA, 30% PLGA-5% GDL, and 30% PLGA-10% GDL in CPC significantly increased bone formation and resulted in higher bone height compared with both 10% GDL and 20% GDL-containing CPC samples.

Accelerated calcium phosphate cement degradation due to incorporation of glucono-delta-lactone microparticles.

Injectable calcium phosphate cements (CPC) are frequently used for filling of bone defects due to their excellent osteocompatibility. Their poor degradability, however, limits complete regeneration of bone defects. Organic additives that produce acid by-products are particularly attractive to create macroporosity in situ since CPC degrade by acid dissolution. The aim of the current study was to investigate whether glucono-delta-lactone (GDL) can be used as acid-producing microparticles for incorporation into CPC without compromising its osteocompatibility. Characterization studies confirmed that CPCs containing either low or high amounts of GDL were injectable and self-setting, while a considerable amount of porosity was formed already within 1 day of incubation in phosphate buffered saline due to dissolution of GDL. Histomorphometrical evaluation after 2 weeks of implantation revealed that CPC containing 10% of GDL degraded faster and was replaced by more bone tissue than CPCs containing either Poly (lactic-co-glycolic acid) (PLGA) or gelatin microspheres. Summarizing, the current study showed that CPCs containing appropriate amounts of GDL display accelerated degradation and new bone formation compared with CPCs containing microparticles made of conventional polymers such as PLGA or gelatin.

Injectable biphasic calcium phosphate cements as a potential bone substitute.

Apatitic calcium phosphate cements (CPCs) have been widely used as bone grafts due to their excellent osteoconductive properties, but the degradation properties are insufficient to stimulate bone healing in large bone defects. A novel approach to overcome the lack of degradability of apatitic CPC involves the development of biphasic CPCs (BCPC) based on tricalcium phosphate (TCP) in both α- and ß-polymorphs. The aim of the current study was to prepare and analyze the physicochemical properties of BCPCs based on dual phase α/ß-TCP as obtained by heat treatment of pure α-TCP. The handling and mechanical characteristics of the samples as well as the degradation behavior under in vitro condition were investigated and compared with a standard monophasic α-TCP-based CPC. The results showed that different heat treatments of commercially available α-TCP allowed the formation of biphasic calcium phosphate powder with a variety of α/ß-TCP ratios. The use of biphasic powder particles as a reactant for CPCs resulted into increased setting and injectability times of the final BCPCs. During hardening of the cements, the amount of apatite formation decreased with increasing ß-TCP content in the biphasic precursor powders. The morphology of the monophasic CPC consisted of plate-like crystals, whereas needle-like crystals were observed for BCPCs. In vitro degradation tests demonstrated that dissolution rate and corresponding calcium release from the set cements increased considerably with increasing ß-TCP content, suggesting that apatitic CPCs can be rendered degradable by using biphasic α/ß-TCP as powder precursor phase.

Comparison of micro- vs. nanostructured colloidal gelatin gels for sustained delivery of osteogenic proteins: Bone morphogenetic protein-2 and alkaline phosphatase.

Colloidal gels have recently emerged as a promising new class of materials for regenerative medicine by employing micro- and nanospheres as building blocks to assemble into integral scaffolds. To this end, physically crosslinked particulate networks are formed that are injectable yet cohesive. By varying the physicochemical properties of different particle populations, the suitability of colloidal gels for programmed delivery of multiple therapeutic proteins is superior over conventional monolithic gels that lack this strong capacity for controlled drug release. Colloidal gels made of biodegradable polymer micro- or nanospheres have been widely investigated over the past few years, but a direct comparison between micro- vs. nanostructured colloidal gels has not been made yet. Therefore, the current study has compared the viscoelastic properties and capacity for drug release of colloidal gels made of oppositely charged gelatin microspheres vs. nanospheres. Viscoelastic properties of the colloidal gelatin gels were characterized by rheology and simple injectability tests, and in vitro release of two selected osteogenic proteins (i.e. bone morphogenetic protein-2 (BMP-2) and alkaline phosphatase (ALP)) from the colloidal gelatin gels was evaluated using radiolabeled BMP-2 and ALP. Nanostructured colloidal gelatin gels displayed superior viscoelastic properties over microsphere-based gels in terms of elasticity, injectability, structural integrity, and self-healing behavior upon severe network destruction. In contrast, microstructured colloidal gelatin gels exhibited poor gel strength and integrity, unfavorable injectability, and did not recover after shearing, resulting from the poor gel cohesion due to insufficiently strong interparticle forces. Regarding the capacity for drug delivery, sustained growth factor (BMP-2) release was obtained for both micro- and nanosphere-based gels, the kinetics of which were mainly depending on the particle size of gelatin spheres with the same crosslinking density. Therefore, the optimal gelatin carrier for drug delivery in terms of particle size and crosslinking density still needs to be established for specific clinical indications that require either short-term or long-term release. It can be concluded that nanostructured colloidal gelatin gels show great potential for sustained delivery of therapeutic proteins, whereas microstructured colloidal gelatin gels are not sufficiently cohesive as injectables for biomedical applications.

Effect of calcium carbonate on hardening, physicochemical properties, and in vitro degradation of injectable calcium phosphate cements.

The main disadvantage of apatitic calcium phosphate cements (CPCs) is their slow degradation rate, which limits complete bone regeneration. Carbonate (CO3²â») is the common constituent of bone and it can be used to improve the degradability of the apatitic calcium phosphate ceramics. This study aimed to examine the effect of calcite (CaCO3) incorporation into CPCs. To this end, the CaCO3 amount (0-4-8-12 wt %) and its particle size (12.0-µm-coarse or 2.5-µm-fine) were systematically investigated. In comparison to calcite-free CPC, the setting time of the bone substitute was delayed with increasing CaCO3 incorporation. Reduction of the CaCO3 particle size in the initial powder increased the injectability time of the paste. During hardening of the cements, the increase in calcium release was inversely proportional to the extent of CO3²â» incorporation into apatites. The morphology of the carbonate-free product consisted of large needle-like crystals, whereas small plate-like crystals were observed for carbonated apatites. Compressive strength decreased with increasing CaCO3 content. In vitro accelerated degradation tests demonstrated that calcium release and dissolution rate from the set cements increased with increasing the incorporation of CO3²â», whereas differences in CaCO3 particle size did not affect the in vitro degradation rate under accelerated conditions.

Influence of the pore generator on the evolution of the mechanical properties and the porosity and interconnectivity of a calcium phosphate cement.

Porosity and interconnectivity are important properties of calcium phosphate cements (CPCs) and bone-replacement materials. Porosity of CPCs can be achieved by adding polymeric biodegradable pore-generating particles (porogens), which can add porosity to the CPC and can also be used as a drug-delivery system. Porosity affects the mechanical properties of CPCs, and hence is of relevance for clinical application of these cements. The current study focused on the effect of combinations of polymeric mesoporous porogens on the properties of a CPC, such as specific surface area, porosity and interconnectivity and the development of mechanical properties. CPC powder was mixed with different amounts of PLGA porogens of various molecular weights and porogen sizes. The major factors affecting the properties of the CPC were related to the amount of porogen loaded and the porogen size; the molecular weight did not show a significant effect per se. A minimal porogen size of 40 µm in 30 wt.% seems to produce a CPC with mechanical properties, porosity and interconnectivity suitable for clinical applications. The properties studied here, and induced by the porogen and CPC, can be used as a guide to evoke a specific host-response to maintain CPC integrity and to generate an explicit bone ingrowth.