Abstract
An aging population leads to increasing demand for sustained quality of life with the aid of novel implants. Patients expect fast healing and few complications after surgery. Increased biofunctionality and antimicrobial behavior of implants, in combination with supportive stem cell therapy, can meet these expectations. Recent research in the field of bone implants and the implementation of autologous mesenchymal stem cells in the treatment of bone defects is outlined and evaluated in this review. The article highlights several advantages, limitations and advances for metal-, ceramic- and polymer-based implants and discusses the future need for high-throughput screening systems used in the evaluation of novel developed materials and stem cell therapies. Automated cell culture systems, microarray assays or microfluidic devices are required to efficiently analyze the increasing number of new materials and stem cell-assisted therapies. Approaches described in the literature to improve biocompatibility, biofunctionality and stem cell differentiation efficiencies of implants range from the design of drug-laden nanoparticles to chemical modification and the selection of materials that mimic the natural tissue. Combining suitable implants with mesenchymal stem cell treatment promises to shorten healing time and increase treatment success. Most research studies focus on creating antibacterial materials or modifying implants with antibacterial coatings in order to address the increasing number of complications after surgeries that are mostly caused by bacterial infections. Moreover, treatment of multiresistant pathogens will pose even bigger challenges in hospitals in the future, according to the World Health Organization (WHO). These antibacterial materials will help to reduce infections after surgery and the number of antibiotic treatments that contribute to the emergence of new multiresistant pathogens, whilst the antibacterial implants will help reduce the amount of antibiotics used in clinical treatment.
Highlights
Xie et al [57] studied the effect of strontium-doped calcium phosphate bone grafts in vitro on osteoblast-like ROS17/2.8 cells and in vivo on New Zealand white rabbits after implantation in bone defects
The results show improved biocompatibility and degradation properties for strontium-doped calcium phosphate grafts compared to calcium phosphate or hydroxyapatite grafts
Several novel materials have been developed for an optimal bone implant material that is mechanically stable, biodegradable, antimicrobial, biocompatible, osteoinductive and easy to manufacture
Summary
Research efforts are aimed at novel alloplastic materials that have the potential to reduce high complication rates while being available in large quantities They can be distinguished by their effects on the formation of new bone. Mesenchymal stem cells (MSCs) can differentiate into adipocytes [21], chondrocytes [22], neuron-like cells [23] or the osteoblastic lineage [7,24] Their potential to increase the number of osteoblasts at the implantation site and their anti-inflammatory effects [25,26] make them the ideal candidates for supporting the bone healing process. A further improvement and availability of these screening systems will help in identifying the ideal candidate as a bone graft substitute, and aid several other research areas such as stem cell differentiation, biomolecule- or cell-adhesion to surfaces or the effect of fluid dynamics on cell culture
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