Biomaterials for Regenerative Cranioplasty: Current State of Clinical Application and Future Challenges
Abstract
:1. Introduction
2. Regeneration Capacity of Cranium
2.1. Biological Basis of Cranium Regeneration
2.2. Clinical Observation of Cranium Regeneration
Age (Years) | Gender | Indications of Craniectomy | Highlights of the Surgical Process | Post-Operative Outcome | Ref. |
---|---|---|---|---|---|
6 | Male | TBI |
|
| [50] |
7 | Female | TBI |
|
| [48] |
8 | Female | Brain abscess |
|
| [51] |
12 | Female | Tumour |
|
| [52] |
15 | Male | TBI |
|
| |
18 | Male | TBI |
|
| [53] |
20 | Female | TBI |
|
| [47] |
29 | Female | TBI |
|
| [54] |
64 | Male | TBI |
|
| [49] |
3. Three types of Regenerative Cranioplasty Implants and Progress of Clinical Translation
3.1. CaP/Ti Composites
3.2. Mineralised Collagen
3.3. Three-dimensional-Printed PCL and Its Composites
4. Perspectives on Enhancing the Regenerative Cranioplasty Implants
4.1. Enhancing the Osteogenic Potential on the Scalp Side
Factors | Type of Factors | Carrier of the Factors | Animal Species And Size of Cranial Defects | Impact on Cell Recruitment | Ref. |
---|---|---|---|---|---|
IL-4 | Biological | Electrospun PLGA/HA scaffolds loaded with IL-4 and coated with carboxymethyl chitosan–collagen–hydrogel | SD rats D = 5 mm | The hydrogel coating impeded the IL-4 release in an early stage (Day 1–3) to maintain a moderate pro-inflammatory response that recruits BMSC. Afterwards, the hydrogel degraded and released trapped IL-4 to induce an anti-inflammatory response to upregulate cranium regeneration | [155] |
BML-284, carboxymethyl chitosan | Biological | β-TCP with PDA coating | Rats D = 5 mm | Surface functionalisation with BML-284 and carboxymethyl chitosan promoted the M2 (anti-inflammatory) polarisation of macrophages and facilitated endogenous MSC recruitment to support cranium regeneration | [156] |
HyA-DA | Biological | Collagen I/HA composite hydrogel | NZ rabbits D = 10 mm | The presence of HyA-DA at the Collagen I/HA interface activated the M2 polarisation of macrophages to induce the endogenous MSC recruitment and subsequent cranial defect repair | [157] |
LepR-a | Biological | PLA with PDA coating and BMP-2 loaded hollow MnO2 nanoparticles | C57BL/6 mice D = 4 mm | Surface functionalisation with LepR, a surface marker for >90% of Prx1+ SSC, recruited SSC (in vitro and in vivo) through antibody-antigen reaction and contributed to enhanced cranium regeneration | [158] |
SDF-1 | Biological | CSO/H NPs | Nude mice subcutaneous | SDF-1 released from nanoparticles induced in vitro and in vivo MSC recruitment, while BMP-2 (released subsequently) enhanced osteogenic differentiation of stem cells. | [148] |
BMP-2 | Biological | Phosphate buffered saline (for injection) or collagen scaffold | C57BL/6 mice D = 5 mm | In vitro administration of BMP-2 enhanced the chemotactic migration of osteoblasts by 170–300%; Sequential release of SDF-1 (from scaffold) followed by BMP-2 (injection) dramatically enhanced the recruitment and osteogenic differentiation of BMSCs, leading to enhanced calvaria defect healing | [146,147] |
FGF-2 | Biological | BMP-2 loaded HA/collagen scaffold with polyelectrolyte multilayer coating | Mice D = 3.5 mm | Sequential release of FGF-2 (from coating) followed by BMP-2 (from scaffold) greatly enhanced the recruitment of Sca-1+ progenitor cells and subsequent osteogenesis at the calvaria defects of mice | [159] |
PDGF-B | Biological | Recombinant adenoviruses loaded in mesoporous glass–silk scaffolds | BALB/c mice 5 × 5 mm2 | Release of adenoviruses from the scaffold was able to infect MSC, PDLSC, and DPSC, leading to enhanced production of PDGF-B that subsequently improved the migration of these (undifferentiated) cells to support calvaria defect healing. | [160] |
PFS (CPFSSTKT-NH2) peptide | Biological | SCP/SF scaffold | SD rats D = 5 mm | Functionalisation of SCP/SF with PFS peptide, a peptide with stem cell-homing ability, enhanced both in vitro and in vivo recruitment of MSC to promote cranium regeneration | [141] |
Ground autologous bone | Biological | Bioprinted alginate–gelatin hydrogel scaffold | Beagle dogs 20 × 20 mm2 | Implantation of scaffolds containing ground autologous bone and transplanted BMSC into cranium defects of rats upregulated the expression of SDF-1 and consequently enhanced in situ recruitment of CD90+/CD105+ BMSC to support cranium regeneration | [143] |
Lithium-doped BG | Chemical | PLGA | C57BL/6 mice D = 4 mm | Incorporation of Li in BG enhanced in vitro migration of BMSC under low/high glucose environment and contributed to superior regeneration of calvaria defect in mice with diabetes | [161] |
Lanthanum-doped BG | Chemical | Chitosan | SD rats D = 5 mm | Increased loading of La-BG improved in vitro recruitment and subsequent expression of angiogenesis-related genes of HUVEC to improve cranium regeneration | [162] |
Calcium ion (from CaSO4) | Chemical | Agarose/chitosan scaffold | BALB/c mice D = 5 mm | Calcium ions released from the scaffold enhanced in situ recruitment of Osx+ osteoprogenitor cells at the mice calvaria defect and subsequently resulted in more pronounced bone regeneration | [163] |
Piezoelectric stimulus | Physical | PHA and PBT in CG | Rats Unknown size | PHA/CG/5%PBT hydrogel most effectively induced migration and M2 polarisation of RAW 264.7 cells (murine macrophages), which subsequently enhanced the in vitro recruitment of MC3T3-E1 (murine pre-osteoblasts) and HUVEC, and facilitated cranium regeneration | [164] |
SrFe12O19 nanoparticles | Physical | Lanthanum-doped HA/CS scaffold | SD rats D = 5 mm | The incorporation of magnetic SrFe12O19 nanoparticles induced an incorporated magnetic field and promoted the recruitment of MSC to enhance cranium regeneration | [144] |
4.2. Proper Management of Surrounding Soft Tissue
4.3. Endochondral Ossification as an Alternative Ossification Mode
4.4. Consideration of the Local Mechanical Environment
5. Conclusions
Funding
Acknowledgments
Conflicts of Interest
References
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Category | Biodegradability | Mechanical Properties of Major Components | Bone-Bonding and Bone Regeneration | Highlights of Reviewed Clinical Studies |
---|---|---|---|---|
CaP/Ti | Partly biodegradable | Ti: ~900 MPa (UTS) [111] 105–125 GPa (YM)[111] CaP (Monetite *, dense): ~445 MPa (UTS) [112] ~377.5 GPa (YM) [112] | Yes |
|
Mineralised collagen | Fully biodegradable | Collagen (bulk): 2–90 MPa (UTS) [92,113] <2 GPa (YM) [114] HA: 308–509 MPa (CS) [115] 42.2–81.4 GPa (CM) [115] | Yes |
|
Three-dimensional-printed PCL and β-TCP/PCL composites | Fully biodegradable | PCL: ~28.7 MPa (UTS) [109] 0.25 GPa (YM-Tension)[109] β-TCP: 1–10 GPa (UTS-Theoretical) [116] ~110 GPa (YM) [116] | No (PCL) Yes (β-TCP/PCL) |
|
Human calvaria | - | 43–79 MPa (UTS) [117] 11.7–15.0 GPa (YM) [117] | - | - |
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He, L. Biomaterials for Regenerative Cranioplasty: Current State of Clinical Application and Future Challenges. J. Funct. Biomater. 2024, 15, 84. https://doi.org/10.3390/jfb15040084
He L. Biomaterials for Regenerative Cranioplasty: Current State of Clinical Application and Future Challenges. Journal of Functional Biomaterials. 2024; 15(4):84. https://doi.org/10.3390/jfb15040084
Chicago/Turabian StyleHe, Lizhe. 2024. "Biomaterials for Regenerative Cranioplasty: Current State of Clinical Application and Future Challenges" Journal of Functional Biomaterials 15, no. 4: 84. https://doi.org/10.3390/jfb15040084